IAMG4100-R002 IOWA DEPARTMENT OF HUMAN SERVICES PAGE 1 AS OF 06/30/25 MEDICAID MANAGEMENT INFORMATION SYSTEM RUN DATE 06/28/25 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 0.00 0 0 0.00 1 065509200 HANCOCK CO MEMORIAL HOSP 0.00 0 54 0.00 1 065562100 GREATER COMMUNITY HOSPITAL 0.00 0 7 0.00 1 065589400 CASS COUNTY MEM HOSP 0.00 0 28 0.00 1 065993800 CHILDSERVE HABILITATION CENTER 235,486.57 2 186 1,166.49 6 TOTAL: 235,486.57 2 275 1,166.49 10 IAMG4100-R002 IOWA DEPARTMENT OF HUMAN SERVICES PAGE 2 AS OF 06/30/25 MEDICAID MANAGEMENT INFORMATION SYSTEM RUN DATE 06/28/25 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 --------- ----------------------------------- --------------- ---------- ---------- --------------- ----------- 080001400 OSKALOOSA CARE CENTER 0.00 0 5 42.00 1 080004200 OAKLAND MANOR 3,151.86 0 18 2,611.02 1 080006300 CAREAGE HILLS REHAB & HEALTHCARE 6,550.05 0 32 1,064.00 2 080007700 LINN HAVEN REHAB & HEALTHCARE 0.00 0 3 0.00 1 080008100 LAURENS CARE CENTER 245.54 0 30 0.00 1 080008300 CRESTVIEW NURSING & REHABILITATION 21,370.32 0 72 0.00 2 080009300 THE ALVERNO HEALTH CARE FACILITY 0.00 0 6 0.00 1 080017600 CASA DE PAZ HEALTH CARE CENTER 9,277.37 0 62 696.00 3 080017800 CEDAR FALLS HEALTH CARE CENTER 2,220.53 0 5 658.03- 2 080018900 ACCURA HEALTHCARE OF POMEROY 8,955.90 0 31 0.00 1 080021800 IVY AT DAVENPORT 16,483.40 0 74 2,200.10 1 080023000 ACCURA HEALTHCARE OF MARSHALLTOWN 8,027.14 0 31 0.00 1 080023100 ACCURA HEALTHCARE OF SPIRIT LAKE 26,878.42 0 91 1,241.90- 2 080024000 WINDMILL MANOR 0.00 0 10 0.00 1 080025900 PILLAR OF CEDAR VALLEY 10,409.04 0 61 0.00 1 080027900 AZRIA HEALTH PRAIRIE RIDGE 16,960.14 0 62 3,584.18 1 080028300 AZRIA HEALTH CLARINDA 0.00 0 1 0.00 1 080029400 UNIVERSITY PARK NURSING & REHAB CEN 17,663.86 0 94 898.06 4 080034600 ARBOR COURT 8,082.01 0 31 0.00 1 080066500 AZRIA HEALTH LONGVIEW 8,952.16 0 57 0.00 1 080068300 KEOSAUQUA HEALTH CARE CENTER 33,236.82 0 142 6,362.72 3 080068400 NEWTON HEALTH CARE CENTER 6,169.15 0 38 3,479.43 2 080070300 JACKSON RIDGE HEALTH CARE CENTER 10,876.54 0 42 1,934.30 2 080070800 ENNOBLE NURSING AND REHAB 9,190.26 0 31 0.00 1 080071300 NORTHBROOK HEALTHCARE AND REHABILIT 81,059.87 0 502 33,077.81 6 080072000 HARMONY UTICA RIDGE 0.00 0 1 0.00 1 080074100 THE BRIDGES AT ANKENY 0.00 0 9 0.00 1 080075100 GRANDVIEW CARE CENTER 1,985.20 0 0 0.00 1 080075400 SPENCER POST ACUTE REHABILITATION 7,762.08 0 28 1,299.00 1 080078700 LAKE MILLS CARE CENTER 4,150.96 0 30 2,726.54 1 080079100 GREATER SOUTHSIDE HEALTH AND REHABI 110.20 0 15 0.00 1 080079400 MANOR HOUSE CARE CENTER 14,299.50 0 59 2,679.52 1 080082100 CLARKSVILLE NURSING & REHAB CENTER 4,914.06 0 0 4,914.06- 1 080117500 ENGLISH VALLEY CARE CENTER 8,877.84 0 62 5,914.12 1 080130800 FRIENDSHIP HAVEN 4,862.11 0 28 3,310.25 2 080143100 GOOD SAMARITAN SOCIETY-ESTHERVILLE 14,159.06 0 59 2,617.00 1 080148000 GOOD SAMARITAN SOCIETY-INDIANOLA 4,566.84 0 0 4,566.84- 1 080159700 GOOD SAMARITAN SOCIETY-WEST UNION 7,686.25 0 25 0.00 1 080194400 HOLY SPIRIT RETIREMENT HOME 27,633.04 0 120 4,784.96 1 080204100 IOOF HOME & COMMUNITY THERAPY CENTE 17,307.54 0 62 2,047.00 1 080210800 KAHL HOME FOR THE AGED 3,382.73 0 29 6,457.55 1 080211600 KANAWHA COMMUNITY HOME 0.00 0 22 0.00 1 080260300 MAYFLOWER HOME 13,591.68 0 46 1,638.00 1 080314800 PARKVIEW MANOR CARE CENTER 4,897.36 0 19 824.30 1 080340300 RIDGECREST VILLAGE 7,070.66 0 23 0.00 1 080353600 ROTARY SENIOR LIVING 0.00 0 7 0.00 1 080370000 SOLON NURSING CARE CENTER 7,810.03 0 31 1,141.84 1 080381700 STONEHILL CARE CENTER 141.02 0 0 0.00 1 IAMG4100-R002 IOWA DEPARTMENT OF HUMAN SERVICES PAGE 3 AS OF 06/30/25 MEDICAID MANAGEMENT INFORMATION SYSTEM RUN DATE 06/28/25 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 --------- ----------------------------------- --------------- ---------- ---------- --------------- ----------- 080453400 SIBLEY SPECIALTY CARE 64.48 0 8 0.00 1 080466600 NEW LONDON SPECIALTY CARE 1,932.08- 0 8 0.00 1 080469000 WILLOW DALE WELLNESS VILLAGE 26,046.73 0 97 5,196.00 1 080473200 OAKWOOD CARE CENTER 9,618.18 0 43 1,935.06 1 080481500 HERITAGE CARE & REHABILITATION CTR 33.48 0 27 0.00 1 080515000 ACCURA HEALTHCARE OF SIOUX CITY 23,323.17 0 96 2,170.88 3 080524200 PERRY LUTHERAN HOME 8,752.85 0 31 0.00 1 080554900 LINN MANOR CARE CENTER 8,830.04 0 31 0.00 1 080604200 IOWA VETERANS HOME 2,598,416.73 64 5,955 527,656.06 188 080732100 FLEUR HEIGHTS CENTER FOR WELLNESS & 33,218.85 0 137 4,600.00 1 080758600 WELLINGTON PLACE 0.00 0 2 0.00 1 080791700 OAKWOOD SPECIALTY CARE 15,391.70 0 60 2,356.26 1 080810500 CRESTON SPECIALTY CARE 0.00 0 3 0.00 1 080813900 DUNLAP SPECIALTY CARE 7,107.86 0 32 3,425.72 1 080818800 LYON SPECIALTY CARE 5,940.06 0 31 764.00 1 080819600 MANLY SPECIALTY CARE 1,304.00 0 0 1,304.00- 1 080820400 SOUTHRIDGE SPECIALTY CARE 8,568.00 0 32 0.00 2 080821200 MECHANICSVILLE SPECIALTY CARE 0.00 0 11 0.00 1 080822000 NORTHERN MAHASKA SPECIALTY CARE 23,815.33 0 89 4,128.00 1 080824600 SOUTHERN HILLS SPECIALTY CARE 11,519.43 0 59 4,367.50 1 080827900 RAVENWOOD SPECIALTY CARE 6,994.73 0 62 4,077.49 2 080962400 MISSISSIPPI VALLEY HEALTHCARE&REHAB 13,856.01 10 51 4,570.82 1 080980600 HAWKEYE CARE CENTER-DUBUQUE 2,328.56 0 0 2,328.56- 1 TOTAL: 3,264,166.65 74 9,055 641,624.10 281 IAMG4100-R002 IOWA DEPARTMENT OF HUMAN SERVICES PAGE 4 AS OF 06/30/25 MEDICAID MANAGEMENT INFORMATION SYSTEM RUN DATE 06/28/25 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 629.20 0 62 1,702.00 2 011170800 PARK PLACE 51.53- 0 29 1,038.87- 3 011515400 CEDAR VALLEY RANCH 671.80 1 92 2,825.00 3 011623600 ANDREW JACKSON CARE 1,016.40 0 124 3,646.00 4 014759500 RINGGOLD CO GROUP HOME 324.60 0 31 841.00 1 030019700 HOPE HAVEN ADMIN 304.60 0 48 1,500.20 2 030025100 SCENIC ACRES 609.20 0 62 1,722.00 2 030030700 SUSAN HESPEN 341.35 6 25 824.25 1 030039200 COMPREHENSIVE SYSTEMS 1,034.40 0 124 3,628.00 4 030053000 CEDAR VALLEY RANCH 7,883.40 13 451 9,563.00 13 030056100 PRIDE GROUP 1,694.60 20 166 5,299.00 6 030056600 PRAIRIE VIEW 522.20 0 62 1,809.00 2 030061600 MEDIAPOLIS CARE FACILITY 1,471.70 0 134 3,566.70 2 030061800 PENN CENTER INC 3,864.12 6 511 15,359.80 2 030064600 NORTH IOWA TRANSITIONAL CENTER 1,569.20 0 87 1,702.00 3 030067300 PARK PLACE 1,030.50 0 93 2,466.30 3 030070700 AREA RESIDENTIAL CARE 1,045.90 1 153 4,744.50 5 030084800 COUNTRY CARE CENTER CORP 227.10 0 31 938.50 1 030085500 CEDAR VALLEY RANCH 785.40 0 124 3,877.00 4 030086900 HILLCREST FAMILY SERVICES 10,083.20 24 1,102 32,254.40 14 030091900 PRIDE GROUP 1,362.40 0 154 4,428.00 5 030093900 ANDREW JACKSON CARE 1,121.00 0 155 4,707.00 5 030125900 NISHNA PRODUCTIONS RES COOR 320.70 0 31 844.90 1 030136600 RINGGOLD CO GROUP HOME 802.40 2 122 3,860.00 4 030149100 PATHWAYS 304.60 0 31 861.00 1 030170800 EYERLY BALL CMHS 304.60 0 31 861.00 1 030190300 PENN CENTER INC 1,848.80 9 239 7,476.00 8 030212600 MICHAEL HENNINGFIELD 155.60 0 31 1,010.00 1 030235000 PRIDE GROUP 324.60 2 29 841.00 1 030252000 HOWARD COLE 274.60 0 31 891.00 1 030263200 HORIZONS UNLIMITED 324.60 0 31 841.00 1 030284600 STEVEN CAREY 128.31 0 31 1,037.29 1 030294900 DAVID GIOVANNONI 59.60 0 31 1,106.00 1 030310900 BRIAN STEINFORD % CEDAR VALLEY RANC 167.34 1 30 998.26 1 030339500 HILLCREST FAMILY SERVICES 405.20 0 92 3,054.00 1 030381200 TRAVIS BROWN 304.60 0 31 861.00 1 030382600 HANDICAPPED DEV CENTER 304.60 0 31 861.00 1 030401800 ASHLIE RAGON 324.60 0 31 841.00 1 030406000 STEVEN STRAIGHT 304.60 0 31 861.00 1 030409400 NEW HAMPTON GROUP HOME 304.60 0 31 861.00 1 030413800 ALAN CHAMBERS % COUNTRY CARE CTR 314.60 0 31 851.00 1 030425100 THOMAS FAULKNER 43.60 0 31 1,122.00 1 030436600 RODERICK SEYMOUR 1,372.60 5 146 4,305.00 1 030456600 JACK SCOTT 169.60 0 31 996.00 1 030459500 PRIDE GROUP 973.80 0 93 2,523.00 3 030463300 FRANCISCO GALVEZ % COMP SYSTEMS 275.43 0 31 890.17 1 030464300 ABBE CENTER FOR COMMUNITY MENTAL 6,062.42 34 617 18,391.00 20 030475000 THE PRIDE GROUP 155.60 2 29 1,010.00 1 IAMG4100-R002 IOWA DEPARTMENT OF HUMAN SERVICES PAGE 5 AS OF 06/30/25 MEDICAID MANAGEMENT INFORMATION SYSTEM RUN DATE 06/28/25 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 --------- ----------------------------------- --------------- ---------- ---------- --------------- ----------- 030476500 HILLCREST 13,722.26 21 1,996 61,827.56 19 030481800 HILLCREST 2,408.80 0 243 6,728.00 2 030487400 THE PRIDE GROUP 137.42 0 31 1,004.00 1 030488400 HILLCREST 611.60 0 61 1,682.00 1 030492000 COMP SYSTEMS 509.60 5 26 656.00 1 030492900 NORTH IA TRANSITION CENT 1,262.40 8 116 3,400.00 4 030493500 PRIDE GROUP 797.44- 0 122 3,646.24- 3 030522100 GREGORY CASSI 2,958.67 6 237 6,106.37 1 030524800 HDC 629.20 0 62 1,702.00 2 030526100 JARED SCHAER 3,000.48 0 304 8,263.00 1 030536000 ABBE 2,387.20 6 214 5,884.80 7 030550500 JULIA LINNANE 609.20 10 52 1,722.00 1 030552100 VF SHERIDAN SPRINGS 1,245.52 1 123 3,416.88 4 030552700 SHERIDAN SPRINGS 1,050.13 4 120 3,612.27 4 030557100 VERA FRENCH SHERIDAN SPRING 475.20 0 62 1,856.00 2 030558200 SHELLEY FIEDLER 1,473.46 0 154 4,221.00 1 030568200 NANCY NAILL 304.60 0 31 861.00 1 030574200 PAUL OBE 55.80 1 150 5,621.80 1 030576800 MARY J PARKIN 2,267.26 17 227 6,741.00 1 030578800 COUNTRY CARE 430.68 0 62 1,900.52 2 030587200 CEDAR VALLEY RANCH INC 451.20 0 62 1,880.00 2 030587400 ARCBEACON HILL RCF 184.60 0 31 981.00 1 030606900 ABBE CENTER BUS OFFICE 617.80 0 93 2,879.00 3 030612900 HORIZONS UNLIMITED OF PAC INC 1,380.48 5 119 3,281.92 4 030614900 VERA FRENCH COMM MENTAL 974.17 0 124 3,688.23 4 030615200 HILLCREST FAMILY SERVICES 2,464.82 1 260 7,309.00 2 030615300 BUNKER HILL COMMUNITY LIVING HOME 187.60 0 31 978.00 1 030615600 OPTIMAE LIFE SERVICES 324.60 0 31 841.00 1 030623200 OPTIMAE LIFE SERVICES 649.20 0 62 1,682.00 2 030646400 HORIZONS UNLIMITED 962.27 0 93 2,534.53 3 030678600 NINTH STREET GROUP HOME 339.20 7 55 1,992.00 2 030679100 ABBE CENTER FOR COMMUNITY MENTAL 818.80 0 93 2,678.00 3 030679200 THUNDERBIRD 346.40 0 49 1,496.00 2 030679300 HANDICAPPED DEV GRP HM #8 304.60 0 31 861.00 1 030680100 PRIDE IV 283.60 0 31 882.00 1 030680600 ABBE CENTER FOR CMH 304.60 17 14 861.00 1 030685400 PRIDE GROUP @ PRIMGHAR 829.80 4 89 2,667.00 3 030690000 KEYWAY COMMUNITY LIVING HOME 812.70 3 59 1,518.50 2 030690100 IMAGINE THE POSSIBILITIES INC 2,043.53 0 212 5,927.67 4 030690900 ABBE CENTER FOR CMH 508.20 0 62 1,823.00 2 030693100 ABBE CENTER FOR COMMUNITY MENTAL 174.20 0 27 841.00 1 030745400 NISHNA PRODUCTIONS 738.80 0 93 2,758.00 3 034463000 TERRACE VIEW RESIDENTIAL 203.60 0 31 962.00 1 035515600 COMP SYSTEMS 2,118.06 10 238 7,206.74 8 036348100 PARK PLACE FOR 550.20 0 62 1,781.00 2 036376200 HILLCREST 3,302.60 18 318 9,331.00 5 036377000 COUNTRY CARE CENTER 1,177.46 0 124 3,484.94 4 036800100 MAINSTREAM LIVING 953.80 0 93 2,543.00 3 IAMG4100-R002 IOWA DEPARTMENT OF HUMAN SERVICES PAGE 6 AS OF 06/30/25 MEDICAID MANAGEMENT INFORMATION SYSTEM RUN DATE 06/28/25 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 646.02 0 62 1,661.00 1 038258000 BREESE REST HOME 1,302.60 0 151 4,375.00 1 038614400 RISE GROUP HOME 1,572.60 1 185 5,421.00 6 038810800 PRIDE GROUP 611.60 0 61 1,682.00 1 038899100 COMP SYSTEMS MARY A 304.60 0 31 861.00 1 039090600 JENNIFER NEUZIL % HILLCRES RCF 8.60 0 61 2,285.00 1 039460100 PRIDE GROUP 405.02 0 11 0.00 1 040526600 ROBERT HEFFLEFINGER % ARC 79.60 6 25 1,086.00 1 040847600 PRIDE I 94.60 0 31 1,071.00 1 040965600 JOAN ROUTH 206.60 0 31 959.00 1 089003100 PRIDE GROUP @ 6TH AVENUE 2,308.24 0 184 4,466.64 1 089522700 PARK PLACE 689.48 0 122 3,897.72 2 TOTAL: 120,850.83 277 13,377 391,413.25 292 IAMG4100-R002 IOWA DEPARTMENT OF HUMAN SERVICES PAGE 7 AS OF 06/30/25 MEDICAID MANAGEMENT INFORMATION SYSTEM RUN DATE 06/28/25 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 --------- ----------------------------------- --------------- ---------- ---------- --------------- ----------- 088025200 COURAGE HOMES 14,920.30 0 31 0.00 1 088026000 HILLS AND DALES 29,972.66 0 62 0.00 2 088036900 PARK VIEW HOMES 38,214.97 0 93 686.00 3 088063300 BLUFF VIEW HOMES 14,249.02 2 29 0.00 1 088081500 HACIENDA COMMUNITY LIVING HOME 29,715.22 4 58 68.00 3 088107800 WOODRIDGE HOUSE 14,961.53 0 31 0.00 1 088127600 BALANCE AUTISM 29,249.50 0 61 0.00 1 088142500 CHILDSERVE HOMES BEAVERDALE HOUSE 5,530.77 0 7 0.00 1 088148200 CHILDSERVE JOHNSTON DUPLEX SOUTH 14,984.78 0 31 0.00 1 088176300 BALANCE AUTISM YOUTH HOME 26,687.95 13 48 0.00 1 088203500 CHILDSERVE HOMES ANKENY TOWNHOME 13,818.29 0 31 1,166.49 1 088212600 CHILDSERVE HOMES ANKENY DUPLEX 14,939.04 2 29 0.00 1 088214200 CHILDSERVE HOMES MORNINGSIDE HOME 29,484.47 7 55 325.00 2 TOTAL: 276,728.50 28 566 2,245.49 19 ** END OF REPORT **