IAMG4100-R002 IOWA DEPARTMENT OF HUMAN SERVICES PAGE 1 AS OF 03/31/25 MEDICAID MANAGEMENT INFORMATION SYSTEM RUN DATE 03/29/25 BILLING DOCUMENTS REPORT SNF PAYMENT SUMMARY BY VENDOR PROVIDER TYPE: 18 SKILLED NURSING FACILITY VENDOR BED OTHER CLIENT TOTAL NUMBER VENDOR NAME PAYMENT HOLD DAYS DAYS PARTICIPATION RECIPIENTS --------- ----------------------------------- --------------- ---------- ---------- --------------- ----------- 065000100 CENTER FOR COMPREHENSIVE SVCS D/B/A 16,800.00 0 28 0.00 1 065163800 ON WITH LIFE 125,530.12 10 97 0.00 2 065509200 HANCOCK CO MEMORIAL HOSP 7,419.60 0 3 0.00 1 065518300 FRANKLIN GENERAL HOSPITAL 0.00 0 40 0.00 1 065533200 FLOYD COUNTY MEMORIAL HOSP 0.00 0 10 0.00 1 065573800 VIRGINIA GAY HOSPITAL 340.00 0 17 0.00 1 065587800 HANSEN FAMILY HOSPITAL 0.00 0 0 0.00 1 065993800 CHILDSERVE HABILITATION CENTER 211,997.54 0 166 1,065.12 7 TOTAL: 362,087.26 10 361 1,065.12 15 IAMG4100-R002 IOWA DEPARTMENT OF HUMAN SERVICES PAGE 2 AS OF 03/31/25 MEDICAID MANAGEMENT INFORMATION SYSTEM RUN DATE 03/29/25 BILLING DOCUMENTS REPORT ICF PAYMENT SUMMARY BY VENDOR PROVIDER TYPE: 20 INTERMEDIATE CARE FACILITY VENDOR BED OTHER CLIENT TOTAL NUMBER VENDOR NAME PAYMENT HOLD DAYS DAYS PARTICIPATION RECIPIENTS --------- ----------------------------------- --------------- ---------- ---------- --------------- ----------- 080006300 CAREAGE HILLS REHAB & HEALTHCARE 11,240.20 0 52 1,531.00 1 080006500 CLARION WELLNESS & REHAB CENTER 17,970.12 1 90 4,560.48 1 080006900 GREATER SOUTHSIDE HEALTH AND REHABI 9,557.40 0 30 0.00 1 080008900 BETTENDORF HEALTH CARE CENTER 14,790.62 0 50 377.38 1 080009300 THE ALVERNO HEALTH CARE FACILITY 3,292.20 0 19 2,390.51 1 080010000 THE COTTAGES 6,953.63 0 30 1,662.37 1 080015100 ELM CREST RETIREMENT COMMUNITY 18,933.18 0 61 0.00 1 080017600 CASA DE PAZ HEALTH CARE CENTER 9,720.20 0 78 696.00 2 080018100 GRUNDY CARE CENTER 245.88 0 30 0.00 1 080018200 PLEASANT ACRES CARE CENTER 2,384.45 0 12 1,291.75 1 080018700 PIONEER VALLEY LIVING & REHAB 35,412.96 0 137 2,410.00 2 080021800 IVY AT DAVENPORT 7,341.50 0 29 1,100.09 1 080021900 BETHANY HOME 18,186.54 0 61 0.00 1 080023000 ACCURA HEALTHCARE OF MARSHALLTOWN 23,119.52 0 120 7,953.28 1 080023100 ACCURA HEALTHCARE OF SPIRIT LAKE 166.70 0 5 1,241.90 1 080023300 ACCURA HEALTHCARE OF CRESCO 0.00 0 52 0.00 1 080023500 BETHANY LIFE 10,925.72 0 46 2,038.00 1 080024000 WINDMILL MANOR 262.40 0 0 262.40- 1 080025900 PILLAR OF CEDAR VALLEY 4,777.92 0 28 0.00 1 080027900 AZRIA HEALTH PRAIRIE RIDGE 8,620.79 0 30 1,320.01 1 080028300 AZRIA HEALTH CLARINDA 8,113.31 0 31 1,872.10 1 080029100 GRANGER NURSING & REHAB CENTER 29,855.84 0 92 0.00 1 080029400 UNIVERSITY PARK NURSING & REHAB CEN 15,592.68 0 56 649.00 2 080034600 ARBOR COURT 12,081.89 0 82 2,591.06 2 080065700 PINE ACRES REHAB AND CARE CENTER 302.08 0 34 0.00 1 080066500 AZRIA HEALTH LONGVIEW 8,848.34 0 55 0.00 1 080066600 AZRIA HEALTH ROSE VISTA 0.00 0 70 0.00 1 080068400 NEWTON HEALTH CARE CENTER 1,427.49 0 14 2,127.25 1 080068500 URBANDALE HEALTH CARE CENTER 2,148.37 0 7 0.00 1 080071500 HARMONY WATERLOO 15,267.86 0 78 1,334.00 2 080073200 THE VISTAS AT BETTENDORF 36,139.08 0 127 4,691.42 4 080079700 CROWN POINTE ESTATES CARE CENTER 17,181.83 0 92 9,679.41 1 080117500 ENGLISH VALLEY CARE CENTER 20,812.22 0 92 628.38 1 080130800 FRIENDSHIP HAVEN 7,084.76 0 30 1,671.34 1 080142300 GOOD SAMARITAN SOCIETY-DAVENPORT 14,735.03 2 52 2,541.45 2 080154800 GOOD SAMARITAN SOCIETY RED OAK 0.00 0 32 0.00 1 080158900 GOOD SAMARITAN SOCIETY-WAUKON 0.00 0 2 0.00 1 080159700 GOOD SAMARITAN SOCIETY-WEST UNION 4,518.10 0 18 1,016.00 1 080232200 THE VINTON LUTHERAN HOME 6,650.90 0 0 6,650.90- 1 080234800 LUTHERAN LIVING SENIOR CAMPUS 20,545.72 0 110 5,988.00 2 080237100 MADRID HOME FOR THE AGING 8,033.66 0 31 2,413.96 1 080309800 PARKVIEW CARE CENTER 11,032.84 7 52 0.00 1 080325400 PLEASANT VIEW INC 16,041.06 0 63 0.00 1 080378300 STACYVILLE COMMMUNITY NURSING HOME 0.00 0 30 0.00 1 080399900 TIMELY MISSION NURSING HM 18,985.64 0 92 3,639.00 1 080402100 TRIPOLI NURSING & REHAB 18,271.80 0 60 0.00 1 080424500 MARTIN HEALTH CENTER 7,746.96 0 24 0.00 1 080466600 NEW LONDON SPECIALTY CARE 8,843.06- 0 31 0.00 1 IAMG4100-R002 IOWA DEPARTMENT OF HUMAN SERVICES PAGE 3 AS OF 03/31/25 MEDICAID MANAGEMENT INFORMATION SYSTEM RUN DATE 03/29/25 BILLING DOCUMENTS REPORT ICF PAYMENT SUMMARY BY VENDOR PROVIDER TYPE: 20 INTERMEDIATE CARE FACILITY VENDOR BED OTHER CLIENT TOTAL NUMBER VENDOR NAME PAYMENT HOLD DAYS DAYS PARTICIPATION RECIPIENTS --------- ----------------------------------- --------------- ---------- ---------- --------------- ----------- 080496300 ACCURA HEALTHCARE OF PLEASANTVILLE 22,239.76 0 92 1,223.00 1 080514300 ACCURA HEALTHCARE OF CHEROKEE 215.69 0 38 0.00 1 080515000 ACCURA HEALTHCARE OF SIOUX CITY 27,708.75 0 136 3,097.90 4 080531700 STATE CENTER SPECIALTY CARE 21,420.49 0 91 0.00 1 080604200 IOWA VETERANS HOME 2,067,387.82 40 5,257 513,068.22 185 080758600 WELLINGTON PLACE 7,198.10 0 30 991.00 1 080797400 CENTERVILLE SPECIALTY CARE 15,434.64 0 62 792.00 2 080800600 AVOCA SPECIALTY CARE 708.67 0 6 877.79 1 080802200 CORNING SPECIALTY CARE 0.00 0 42 0.00 1 080805500 LAPORTE CITY SPECIALTY CARE 1,919.04 0 8 0.00 1 080810500 CRESTON SPECIALTY CARE 0.00 0 8 0.00 1 080811300 CRESTVIEW SPECIALTY CARE 0.00 0 24 0.00 1 080812100 DUBUQUE SPECIALTY CARE 0.00 0 18 0.00 1 080815400 HERITAGE SPECIALTY CARE 0.00 0 18 0.00 1 080816200 LAMONI SPECIALTY CARE 12,626.08 0 47 0.00 1 080818800 LYON SPECIALTY CARE 5,291.28 0 28 764.00 1 080819600 MANLY SPECIALTY CARE 34.60- 0 0 34.60 1 080820400 SOUTHRIDGE SPECIALTY CARE 758.73 0 12 0.00 1 080825300 PARKRIDGE SPECIALTY CARE 399.59 0 35 0.00 2 080826100 NORTHCREST SPECIALTY CARE 0.00 0 9 0.00 1 080827900 RAVENWOOD SPECIALTY CARE 46,756.88 0 209 10,502.85 4 080831100 WEST RIDGE SPECIALTY CARE 23,238.46 0 122 7,497.00 2 080832900 WESTWOOD SPECIALTY CARE 17,894.27 0 53 13,406.87- 3 080916000 ANAMOSA CARE CENTER 4,360.26 0 31 4,099.64 1 080962400 MISSISSIPPI VALLEY HEALTHCARE&REHAB 0.00 0 39 4,570.82 1 080964000 THE AMBASSADOR SIDNEY INC 2,260.00 0 0 2,260.00- 1 080980600 HAWKEYE CARE CENTER-DUBUQUE 2,471.00 0 10 506.60 1 TOTAL: 2,776,731.24 50 8,780 594,860.39 280 IAMG4100-R002 IOWA DEPARTMENT OF HUMAN SERVICES PAGE 4 AS OF 03/31/25 MEDICAID MANAGEMENT INFORMATION SYSTEM RUN DATE 03/29/25 BILLING DOCUMENTS REPORT RCF PAYMENT SUMMARY BY VENDOR PROVIDER TYPE: 23 RESIDENTIAL CARE FACILITY VENDOR BED OTHER CLIENT TOTAL NUMBER VENDOR NAME PAYMENT HOLD DAYS DAYS PARTICIPATION RECIPIENTS --------- ----------------------------------- --------------- ---------- ---------- --------------- ----------- 010506400 SCENIC ACRES 403.60 0 56 1,702.00 2 011170800 PARK PLACE 472.51 0 84 2,685.89 3 011515400 CEDAR VALLEY RANCH 403.60 0 84 2,754.80 3 011623600 ANDREW JACKSON CARE 1,032.40 0 167 5,246.80 6 014759500 RINGGOLD CO GROUP HOME 211.80 0 28 841.00 1 030019700 HOPE HAVEN ADMIN 191.80 0 28 861.00 1 030025100 SCENIC ACRES 675.20 0 112 3,536.00 4 030030700 SUSAN HESPEN 218.12 0 28 834.68 1 030032800 RISE LTD 211.80 3 25 841.00 1 030039200 COMPREHENSIVE SYSTEMS 561.20 2 110 3,650.00 4 030053000 CEDAR VALLEY RANCH 3,282.40 14 350 10,404.00 13 030056100 PRIDE GROUP 1,309.78 0 233 7,428.40 9 030056600 PRAIRIE VIEW 84.80 0 28 968.00 1 030061600 MEDIAPOLIS CARE FACILITY 4,699.48 0 508 14,211.00 5 030061800 PENN CENTER INC 5,738.42 0 579 15,565.00 1 030067300 PARK PLACE 383.60 0 56 1,722.00 2 030070700 AREA RESIDENTIAL CARE 2,344.84 6 355 11,133.60 5 030084800 COUNTRY CARE CENTER CORP 117.92 0 28 934.88 1 030085500 CEDAR VALLEY RANCH 612.40 3 109 3,598.80 4 030086900 HILLCREST FAMILY SERVICES 9,598.39 24 809 21,514.93 13 030091900 PRIDE GROUP 613.40 0 84 2,545.00 3 030093900 ANDREW JACKSON CARE 660.20 0 183 6,220.60 7 030123700 MICHAEL GIVANS 870.62 0 101 2,879.40 1 030125900 NISHNA PRODUCTIONS RES COOR 1,908.84- 9 116 2,696.00- 1 030136600 RINGGOLD CO GROUP HOME 464.00 2 113 3,860.00 4 030149100 PATHWAYS 191.80 0 28 861.00 1 030170800 EYERLY BALL CMHS 3,021.90 0 333 9,261.00 1 030172900 WILLIAM DORRELL 7,851.86 0 212 0.00 1 030190300 PENN CENTER INC 1,380.40 0 300 9,884.00 10 030235000 PRIDE GROUP 211.80 19 28 1,555.40 2 030252000 HOWARD COLE 161.80 0 28 891.00 1 030263200 HORIZONS UNLIMITED 211.80 0 28 841.00 1 030284600 STEVEN CAREY 139.01 0 28 913.79 1 030294900 DAVID GIOVANNONI 0.00 0 28 1,052.80 1 030310900 BRIAN STEINFORD % CEDAR VALLEY RANC 54.54 1 27 998.26 1 030339500 HILLCREST FAMILY SERVICES 182.40 0 59 2,036.00 1 030353600 JUSTIN OLIPHANT 176.20 0 27 839.00 1 030381200 TRAVIS BROWN 191.80 0 28 861.00 1 030382600 HANDICAPPED DEV CENTER 191.80 0 28 861.00 1 030406000 STEVEN STRAIGHT 2,720.48 0 302 8,421.00 1 030413800 ALAN CHAMBERS % COUNTRY CARE CTR 248.80 0 28 804.00 1 030425100 THOMAS FAULKNER 0.00 0 28 1,052.80 1 030456600 JACK SCOTT 226.22 0 59 1,968.00 1 030459500 PRIDE GROUP 656.40 0 84 2,502.00 3 030463300 FRANCISCO GALVEZ % COMP SYSTEMS 162.63 0 28 890.17 1 030464300 ABBE CENTER FOR COMMUNITY MENTAL 4,126.94 55 618 21,155.24 24 030475000 THE PRIDE GROUP 42.80 1 27 1,010.00 1 030476500 HILLCREST 14,784.19 54 1,908 57,958.22 16 IAMG4100-R002 IOWA DEPARTMENT OF HUMAN SERVICES PAGE 5 AS OF 03/31/25 MEDICAID MANAGEMENT INFORMATION SYSTEM RUN DATE 03/29/25 BILLING DOCUMENTS REPORT RCF PAYMENT SUMMARY BY VENDOR PROVIDER TYPE: 23 RESIDENTIAL CARE FACILITY VENDOR BED OTHER CLIENT TOTAL NUMBER VENDOR NAME PAYMENT HOLD DAYS DAYS PARTICIPATION RECIPIENTS --------- ----------------------------------- --------------- ---------- ---------- --------------- ----------- 030481800 HILLCREST 536.40 0 59 1,682.00 1 030487400 THE PRIDE GROUP 1,067.78 0 41 451.20 1 030491800 JESSY ADKISSON 1,858.90 0 184 4,962.00 1 030493500 PRIDE GROUP 444.60 0 56 1,661.00 2 030522100 GREGORY CASSI 199.92 0 28 852.88 1 030524800 HDC 403.60 0 56 1,702.00 2 030526100 JARED SCHAER 2,675.88 0 273 7,422.00 1 030536000 ABBE 65.80 0 28 987.00 1 030550500 JULIA LINNANE 191.80 0 28 861.00 1 030552100 VF SHERIDAN SPRINGS 782.74 0 112 3,428.46 4 030552700 SHERIDAN SPRINGS 804.73 7 152 5,173.67 6 030557100 VERA FRENCH SHERIDAN SPRING 249.60 0 56 1,856.00 2 030558200 SHELLEY FIEDLER 496.40 0 59 1,722.00 1 030576800 MARY J PARKIN 496.40 2 57 1,722.00 1 030578800 COUNTRY CARE 205.08 0 56 1,900.52 2 030587200 CEDAR VALLEY RANCH INC 225.60 0 56 1,880.00 2 030587400 ARCBEACON HILL RCF 256.40 0 59 1,962.00 1 030606900 ABBE CENTER BUS OFFICE 905.94 0 152 4,780.40 4 030612900 HORIZONS UNLIMITED OF PAC INC 521.12 0 56 1,584.48 2 030613600 ADELINE COMM. LIVING HOME 496.40 4 55 1,722.00 1 030614300 IMAGINE THE POSSIBILITIES INC 536.40 0 59 1,682.00 1 030614900 VERA FRENCH COMM MENTAL 575.40 3 109 3,635.80 4 030615200 HILLCREST FAMILY SERVICES 1,433.46 0 167 4,715.48 1 030615300 BUNKER HILL COMMUNITY LIVING HOME 262.40 0 59 1,956.00 1 030623200 OPTIMAE LIFE SERVICES 2,945.48 0 327 9,160.18 4 030645300 OPTIMAE CALHOUN 456.40 0 58 1,701.00 1 030646400 HORIZONS UNLIMITED 1,064.71 0 140 4,199.29 5 030679100 ABBE CENTER FOR COMMUNITY MENTAL 1,455.46 0 155 4,339.00 4 030679200 THUNDERBIRD 417.80 0 28 635.00 1 030679300 HANDICAPPED DEV GRP HM #8 191.80 0 28 861.00 1 030679400 THE PRIDE GROUP 0.00 0 9 331.38 1 030680100 PRIDE IV 659.60 0 82 2,423.60 3 030680600 ABBE CENTER FOR CMH 191.80 0 28 861.00 1 030685400 PRIDE GROUP @ PRIMGHAR 512.40 2 82 2,646.00 3 030690000 KEYWAY COMMUNITY LIVING HOME 1,402.72 4 114 3,034.08 2 030690100 IMAGINE THE POSSIBILITIES INC 442.93 0 56 1,662.67 2 030690900 ABBE CENTER FOR CMH 2,986.82 2 290 7,898.00 5 030693100 ABBE CENTER FOR COMMUNITY MENTAL 23.80 0 23 841.00 1 030745400 NISHNA PRODUCTIONS 423.60 14 70 2,734.80 3 034463000 TERRACE VIEW RESIDENTIAL 90.80 0 28 962.00 1 035515600 COMP SYSTEMS 300.63 0 56 1,804.97 2 035565100 NITC 350.80 0 28 702.00 1 036348100 PARK PLACE FOR 324.60 0 56 1,781.00 2 036376200 HILLCREST 5,252.50 17 453 12,169.12 4 036377000 COUNTRY CARE CENTER 726.26 0 112 3,484.94 4 036800100 MAINSTREAM LIVING 403.60 0 56 1,702.00 2 037594900 MOSAIC 258.80 0 28 794.00 1 037611100 PARTNERSHIP FOR PROGRESS 211.80 5 23 841.00 1 IAMG4100-R002 IOWA DEPARTMENT OF HUMAN SERVICES PAGE 6 AS OF 03/31/25 MEDICAID MANAGEMENT INFORMATION SYSTEM RUN DATE 03/29/25 BILLING DOCUMENTS REPORT RCF PAYMENT SUMMARY BY VENDOR PROVIDER TYPE: 23 RESIDENTIAL CARE FACILITY VENDOR BED OTHER CLIENT TOTAL NUMBER VENDOR NAME PAYMENT HOLD DAYS DAYS PARTICIPATION RECIPIENTS --------- ----------------------------------- --------------- ---------- ---------- --------------- ----------- 038186300 KAIN RINEHART 211.80 0 28 841.00 1 038614400 RISE GROUP HOME 1,001.00 0 168 5,315.80 6 038736500 INDIANOLA RESIDENTIAL 121.78 0 29 946.00 1 039090600 JENNIFER NEUZIL % HILLCRES RCF 8.60 0 31 1,157.00 1 039409800 PRIDE GROUP 247.78 0 29 820.00 1 040847600 PRIDE I 0.00 0 28 1,052.80 1 040965600 JOAN ROUTH 93.80 0 28 959.00 1 089006300 THUNDERBIRD 2,264.08 0 244 6,720.00 1 089479000 NISHNA PROD. GRP.HOME #2 1,968.50 9 144 3,689.14 1 TOTAL: 112,894.21 244 13,482 399,231.12 282 IAMG4100-R002 IOWA DEPARTMENT OF HUMAN SERVICES PAGE 7 AS OF 03/31/25 MEDICAID MANAGEMENT INFORMATION SYSTEM RUN DATE 03/29/25 BILLING DOCUMENTS REPORT ICF PAYMENT SUMMARY BY VENDOR PROVIDER TYPE: 25 ICF ID STATE VENDOR BED OTHER CLIENT TOTAL NUMBER VENDOR NAME PAYMENT HOLD DAYS DAYS PARTICIPATION RECIPIENTS --------- ----------------------------------- --------------- ---------- ---------- --------------- ----------- 088008800 WOODWARD RESOURCE CENTER 41,057.24 0 28 0.00 1 TOTAL: 41,057.24 0 28 0.00 1 IAMG4100-R002 IOWA DEPARTMENT OF HUMAN SERVICES PAGE 8 AS OF 03/31/25 MEDICAID MANAGEMENT INFORMATION SYSTEM RUN DATE 03/29/25 BILLING DOCUMENTS REPORT ICF PAYMENT SUMMARY BY VENDOR PROVIDER TYPE: 27 COMMUNITY BASED ICF/ID VENDOR BED OTHER CLIENT TOTAL NUMBER VENDOR NAME PAYMENT HOLD DAYS DAYS PARTICIPATION RECIPIENTS --------- ----------------------------------- --------------- ---------- ---------- --------------- ----------- 088003900 VILLAGE NORTHWEST UNLIMITED 13,518.12 0 28 0.00 1 088026000 HILLS AND DALES 36,384.91 0 79 1,806.06 2 088068200 PROGRESS INDUSTRIES WEST 13,373.19 1 27 0.00 1 088081500 HACIENDA COMMUNITY LIVING HOME 56,698.21 7 111 0.00 2 088107800 WOODRIDGE HOUSE 20,037.85 0 28 0.00 1 088127600 BALANCE AUTISM 14,864.50 0 31 0.00 1 088142500 CHILDSERVE HOMES BEAVERDALE HOUSE 20,969.48 0 28 0.00 1 088148200 CHILDSERVE JOHNSTON DUPLEX SOUTH 13,534.64 0 28 0.00 1 088176300 BALANCE AUTISM YOUTH HOME 27,402.14 0 62 0.00 2 088203500 CHILDSERVE HOMES ANKENY TOWNHOME 12,541.48 0 28 993.16 1 088212600 CHILDSERVE HOMES ANKENY DUPLEX 13,534.64 0 28 0.00 1 088214200 CHILDSERVE HOMES MORNINGSIDE HOME 86,551.00 20 160 0.00 2 TOTAL: 329,410.16 28 638 2,799.22 16 ** END OF REPORT **