CERTIFICATE OF NEED APPLICATION

St. Anthony's - A Catholic Retirement Community

Add 19 Assisted Living Facility beds

Project #5796 RS

submitted to

Missouri Health Facilities Review Committee

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DIVIDER I: Application Summary

Application Summary shall include the completed forms in the following order:

1. Applicant Identification and Certification (Form MO 580-1861)

(see Attachment 2, preceded by amended Letter of Intent, see Attachment 1)

2. Representative Registration (Form MO 580-1869)

(see Attachments 3a-b)

3. Proposed Project Budget (Form MO 580-1863) and detail sheet

(see Attachments 4a-b)

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DIVIDER I: Attachments

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Attachment 1

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Attachment 2a

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Attachment 3a

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Attachment 3b

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Attachment 4a

Proposed Project Budget Detail Sheet

1. New Construction Costs

(not applicable)

2. Renovation Costs

(not applicable)

4. Architectural/Engineering Fees

(not applicable)

5. Other Equipment (not in construction contract)

(not applicable)

6. Major Medical Equipment

(not applicable)

7. Land Acquisition Costs

(not applicable)

8. Consultant’s Fees/Legal Fees

$10,000 for development fees.

9. Interest During Construction

(not applicable)

10. Other Costs

$40,000 has been estimated for additional furniture.

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Attachment 4b

DIVIDER II: Proposal Description

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DIVIDER II: Proposal Description

Proposal description shall include documents which:

1. Provide a complete detailed project description.

The applicant is proposing to add 19 assisted living facility beds to their existing 81-bed ALF by converting 19 private rooms to semi-private use in existing space of approximately 8,000 sq. ft.

St. Anthony's is designed to be a 100-bed assisted living facility (ALF). The facility is located in an urban area, and will offer a modern, yet warm and welcoming design. St. Anthony’s will aim to provide a living environment that will address not only the physical needs of the residents, but also the social and emotional needs. The advisory board, administration and staff will promote services that manage and provide a continuum of care, as well as provide comfort and security to residents. Today’s modern seniors will have the ability to take advantage of various services and accommodations such as:

• Beautiful pick-up/drop-off area with porte cochere • Covered parking for visitors and family of residents • A spacious lobby and visiting area with TV’s and lounging areas • A Salon for haircuts, manicures and pedicures • Secured outdoor gathering areas for residents • Dog park with walking trail for resident exercise • Numerous social and recreational activities coordinated daily • Housekeeping and laundry taken care of for residents • Physical therapy will be offered on-site • Library, lounge room, theater and chapel open to all residents • Three meals (if desired) per day in our spacious dining area • Assistance with activities of daily living (dressing, bathing, and medications) • Emergency Alert Services with a 24 hour communication system to alert staff in the case of medical emergencies • Certified staff on duty 24 hours a day, 7 days a week

This senior-friendly facility will address the immediate needs of seniors in the area, as well as the long-term demands of future generations still to come. The facility will offer moderately-priced assisted living to consumers living in the area with services aimed towards accommodating patients of all levels of care. Certified staff will be attentive and convey a professional demeanor to ensure that residents feel at home and cared for. The facility will emit a sense of community, and empower residents to feel independent, yet secure, in their living arrangement.

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2. Provide a timeline of events for the project, from CON issuance through project competition.

(see Attachment 5a)

3. Provide a legible city or county map showing the exact location of the proposed facility.

(see Attachment 5b)

4. Provide site plan for the proposed project.

(see Attachment 5c <site plan>)

5. Provide preliminary schematic drawings for the proposed project including the location of each bed.

(see Attachment 5c-d <facility schematic>

6. Provide evidence that architectural plans have been submitted to the Department of Health and Senior Services.

(see Attachment 6)

7. Provide the proposed gross square footage.

The proposed square footage of the additional beds will be 8,000 square feet.

8. Document ownership of the project site, or provide an option to purchase.

Attached please find the 6-page copy of the General Warranty Deed, which documents the ownership of the real estate by St. Anthony's, LLC (see Attachments 7a-f).

9. Define the community to be served (service area: 2025 population, area, rationale).

The community to be served is primarily defined as the people aged 65 and over who reside within the 15-mile radius (see Attachment 5a) from this location who are in need of assisting living services.

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10. Provide 2025 population projections for the 15-mile radius service area.

The applicant has adjusted the population data based on the applicable Rules process using the 2025 projections acquired from the Department of Health and Senior Services. The following tables and maps illustrate this information (see Attachments 8a <DHSS 15-mile zip code and cities maps>, 8b <DHSS 15-mile zip code populations>, and 8c - 8d <2020 Population Projections & Bed Need>).

11. Identify specific community problems or unmet needs the proposal would address.

When the community need methodology of 25 beds per one thousand population 65+ is applied to the 131,418 population of 65+ in the 15-mile radius, it results in a total RCF/ALF need of 3,285 beds. There are 2,569 licensed and 453 approved RCF/ALF beds in the same radius according to the CON published inventory. Thus, there is a need for 263 more RCF/ALF beds in this area.

12. Provide historical utilization for each of the past three (3) years and utilization projections through the first three (3) FULL years of operation of the new LTC beds.

Since this is a new assisted living facility for which there is no historical data. Projected utilization for the first three years:

Year Patient Days 2021 12,141 2022 29,814 2023 35,846

13. Provide the methods and assumptions used to project utilization.

Utilization projections are based on extensive experience of the Consultant in numerous other assisted living facilities currently in operation in Missouri, and localized for this specific area.

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14. Document that consumers needs and preferences have been included in planning this project and describe how consumers had an opportunity to provide input.

The Applicant met with numerous residents and officials in the Kansas City area in order to determine their perceptions of long-term care needs in this area. All were very supportive and encouraging.

Consumer needs in the community will be met by this 100-bed assisted living facility because the care model will focus on the basic care needs of the residents. These services are currently of limited availability in the area.

Interested persons were notified of this application via a newspaper Public Notice posted in the June 14, 2020, Kansas City Star (see Attachment 11h).

15. Provide copies of any petitions, letters of support or opposition received.

The following letters of support (see Attachments 9a-f):

• Representative Gail McCann Beatty, District 26 • Mayor Sylvester “Sly” James, Jr., Kansas City • Representative Emmanuel Cleaver, II, Member of Congress, 5th District • City Councilman Kevin McManus, 6th District in District, Kansas City • City Councilman Scott Taylor, 6th District at Large, Kansas City • Executive Frank White, Jr., Jackson County

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DIVIDER II: Attachments

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Attachment 5a

Timeline of EventsCON approval September 14, 2020...................

Room reassignment September 21, 2020..........

Licensure September 28, 2020...........................

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Attachment 5b

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Attachment 5bSite Plan

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Attachment 5c

Schematic

SP

SP

SP

SP

SP

SP

SP

SP

SP

SP

SP

SP SP SP

SPSP

SP

SP

SP

SP: semi-private conversion

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Attachment 6

From: Tom Piper <macquest@mac.com>Subject: Schematics for St. Anthony's additionDate: June 9, 2020 at 2:25:18 PM CDTTo: David East <david.east@dhss.mo.gov>Cc: Matt Ledom <matt@damcoinc.com>

David:

Please find attached a PDF version of the site plan and schematic for the proposed 19-bed assisted living facility addition to St. Anthony’s - A Catholic Retirement Community, an existing 81-bed ALF in Kansas City.

This information is provided to you as part of the Certificate of Need application process. The actual working drawings had previously been sent to you for examination and approval.

Best Wishes,

Tom

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Attachment 7a

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Attachment 7b

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Attachment 7c

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Attachment 7d

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Attachment 7e

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Attachment 7f

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Attachment 7g

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Attachment 7h

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Attachment 8a

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Attachment 8b

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Attachment 8c

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Attachment 8dBed Need Calculations

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Attachment 9a

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Attachment 9b

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Attachment 9c

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Attachment 9d

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Attachment 9e

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Attachment 9f

DIVIDER III: Community Need Criteria and Standards

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DIVIDER III: Community Need Criteria and Standards

Document the following, if applicable:

1. For ICF/SNF beds, address the population-based bed need methodology of fifty-three (53) beds per one thousand (1,000) population age sixty-five (65) and older.

(not applicable)

2. For RCF/ALF beds, address the population-based bed need methodology of twenty-five (25) beds per one thousand (1,000) population age sixty-five (65) and older.

The population data provided by the Department of Health and Senior Services was included in Divider II. The percentage adjustments by the applicant to accommodate zip code population inside the 15-mile radius were also included in Divider II.

An inventory of existing and approved RCF and ALF facilities inside the 15-mile radius is provided (see Attachment 10a), as well as a map showing the location of these facilities (see Attachment 10b). Based on this data, there will be a need for at least 263 additional RCF/ALF beds in the 15-mile radius for the year 2025 as follows:

Unmet Need = (25 x P) - U Where: 25 = RCF/ALF need rate per 1,000 population age 65+ P = Year 2025 population in the 15-mile radius U = Number of existing and approved beds in 15-mile radius Unmet Need = (0.025 x 131,418) - 3,022 = 263 RCF/ALF bed need

3. Document any alternate need methodology used to determine the need for additional beds such as LTCH, Alzheimer’s, mental health or other specialty beds.

(not applicable)

4. Document any alternate need methodology used to determine the need for additional beds such asAlzheimer’s, mental health or other specialty beds.

(not applicable)

5. For any proposed facility which is designed and operated exclusively for persons with acquired human immunodeficiency syndrome (AIDS), provide information to justify the need for the type of beds being proposed.

(not applicable)

6. If the project is to add beds to an existing facility, has the facility received a Notice of Noncompliance within the last 18 months as a result of a survey, inspection or complaint investigation? If the answer is yes, explain.

No, the ALF had just opened at the time of this application.

DIVIDER III: Attachments

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Attachment 10a

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Attachment 10b

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Attachment 10c

DIVIDER IV: Financial Feasibility Criteria and Standards

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DIVIDER IV: Financial Feasibility Criteria and Standards

Document the following, if applicable:

1. Document that the proposed costs per square foot are reasonable when compared to the latest “RS Means Construction Cost data”.

(not applicable) RS Means for the Missouri-Other area (see Attachment 11a).

2. Document that sufficient financing is available by providing a letter from a financial institution or an auditors statement indicating that sufficient funds are available.

A detailed letter of interest from the First National Bank of Omaha demonstrates substantial interest pending certificate of need approval (see Attachments 11b-e).

3. Provide Service-Specific Revenues and Expenses (Form MO 580-1865) for the latest three (3) years, and projected through three (3) years beyond project completion. Since this is a new facility, there is no historical information. This form attached for

projections of 2021 to 2023 (see Attachment 11g).

4. Document how patient charges were derived.

Charges are based on extensive experience of the Consultants in numerous other facilities currently in operation in Missouri, and localized for this specific area.

5. Document responsiveness to the needs of the medically indigent.

Because this is a full-function assisted living facility which will not be eligible for public reimbursement such as Medicare or Medicaid, there are other provisions for discounted services. Provisions will be made to allow residents to relocate to more affordable apartments, including the option to share an apartment, and assistance will be provided in securing veteran benefits, Mason benefits, and use of medical tax deduction to offset rising costs. Third party providers will be utilized when Medicare services are available per physician order. Residents with limited resources will also be referred to other services who provide indigent care. Interested persons were notified of this application via newspaper Public Notice in the June 14, 2020, Kansas City Star (see Attachment 11g).

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6. For a proposed new skilled nursing or intermediate care facility, what percent of your admissions would Medicaid eligible on the first day of admission or become Medicaid eligible within 90 days of admission?

(not applicable)

7. For an existing skilled nursing or intermediate care facility proposing to add beds, what percent of your admissions is Medicaid eligible on the first day of admission or becomes Medicaid eligible within 90 days of admission?

(not applicable)

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DIVIDER IV: Attachments

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Attachment 11a

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Attachment 11b

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Attachment 11c

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Attachment 11d

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Attachment 11e

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Attachment 11f

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Attachment 11g

(printed both online and in the local paper version)

THE KANSAS

CITY STAR

St. Anthony's - A Catholic Retirement Community plans to add 19 assisted living facility beds at 1010 E. 68th Street, Kansas City, MO 64131 pending certificate of need approval of their $50,000 application from the Missouri Health Facilities Review Committee. This application (Proj. No. 5796 RS) will be filed on or before July 2, 2020.

END of

CERTIFICATE OF NEED APPLICATION

St. Anthony's - A Catholic Retirement Community

Add 19 Assisted Living Facility beds

Project #5796 RS

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