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					                         CCRC/Nursing Home Salary & Benefits Questionnaire

       Before entering any data, save this spreadsheet to your hard drive.
      Data will be lost if the spreadsheet is not saved prior to entering data.

Email the Excel questionnaire to:

                                 rzabka@hhcsinc.com
We will email a confirmation of receipt for your file.
If you do not receive an email confirmation within 24 hours, please contact our office.

Questions? Call Rosanne Zabka, (201) 405-0075, ext. 11.
Dear CCRC/Nursing Home Executive:


HCS and The American Association of Homes and Services for the Aging invite you to participate in our annual
2009-2010 CCRC Salary & Benefits Report.


The Report is the only one of its kind to exclusively cover CCRC compensation. Publication is scheduled for June 2009. Over
480 CCRC’s participated in last year’s Report and provided data on more than 72,000 employees.


HCS will also be publishing the Nursing Home Salary and Benefits Report in July 2009. The Nursing Home Report is published
in cooperation with AAHSA and supported by the American Health Care Association (AHCA). Last year’s Nursing Home Report
contained data from 414 not-for-profit and 1,721 for-profit facilities. This questionnaire is designed for both CCRCs and Nursing
Homes.

As a survey participant, you will save 50% off the purchase price. Participants pay $135, nonparticipants pay $295. There is
also a discounted rate for purchasing both Reports.

Please submit survey data effective as of March 2009. If you anticipate increases between now and March, provide the
anticipated rates. If no increases are planned, submit data using the current date.


As always, all data received from participants will remain confidential. We look forward to receiving your completed
questionnaire.



Sincerely,
Rosanne Zabka
Director of Reports
                               Report Data Effective March 1. Use current data, unless your company enters a new fiscal year on March 1.

    Save spreadsheet to you computer, before entering any data.
    Data will be lost if the spreadsheet is not saved prior to entering data.

    Email your completed questionnaire to:

                                                                            rzabka@hhcsinc.com
    An email confirmation will be sent to you within 24 hours.
    If you do not receive a confirmation, call HCS immediately at 201-405-0075.

Corporate Facility Information

    Complete the Multi-Facility Data section.

    To place an order for the published Report, please complete the Order Form.

Multi Facility Information


                                                                                    Nursing                 No. of      No.
                                                                      CCRC                      No. of                                                    No.
                  Facility                                                           Home                  Nursing   Licensed    No. AL      No. IL
                                                                                                CCRC                                                  Alzheimer’s
                  Name                                              Operating      Operating                Home      Nursing     Beds       Units
        Id                       City       State        Zip                                    FTE’s                                                    Beds
                                                                    Revenue        Revenue                  FTE’s      Beds
       215      Countryside   Bowling        OH         43076      $11,800,000    $1,600,000      245        120        248        101        101          41
                               Green
       216       The Arbor    Sikeston       MO         63801      $4,900,000     $1,100,000      119           87      216         0          0           50


             ID               Unique facility Id number or code                  CCRC Operating Revenue              CCRC Annual Operating Revenue for the last 12 months
             Facility Name    Facility Name                                      NH Operating Revenue                Nursing Home Annual Operating Revenue for the last 12 months
             City             City                                               No. of CCRC FTEs                    Number of CCRC FTEs
             State            Two letter state abbreviation                      No. of Nursing Home FTEs            Number of Nursing Home FTEs
             Zip              Zip code at this facility                          No. of Licensed Nursing Beds        Number of Licensed Nursing Beds
                                                                                 No. of AL Beds                      Number of Assisted Living Beds
                                                                                 No. of IL Units                     Number of Independent Living Units
                                                                                 No. of Alzheimer’s Beds             Number of Alzheimer’s Beds

Salary and Hourly Data

    Report data for each position per facility. Do not Report total per state.

    Please report full-time salaries or hourly rates on the appropriate spreadsheet, using the HCS job number for each position. Jobs 1-42 are salaried employees, jobs 50-90
    are hourly employees.
    Any annual salaries submitted where an employee is not full-time will skew data results. Example: Job 11, receives $25,000 but works only 27.5 hours per week. Either
    submit the salary annualized at $37,364 or the hourly rate of $17.48.
                                 Jobs 1 - 42 Salaried Employees                                                            Jobs 50 - 90 Hourly Employee
                                                      Annual
                                No. of    Average                                                                              No. of                           Hourly
                                                      Salary  Annual Salary                                         HCS Job               Hourly     Hourly
         Id      HCS Job #     Salaried    Annual                                  Bonus                      Id               Hourly                           Range
                                                      Range     Range Max.                                            #                    Rate    Range Min.
                                FTE’s      Salary                                                                              FTE’s                             Max.
                                                       Min.
        215           1           1        98,000     94,000     157,000           12,500                     215     51         15        14.35      12.43     18.03
        215           3           4        63,000     52,000      87,000           5,750                      215     54         52         8.68      8.00      11.60


Services & Policies, Shift Differentials, and Fringe Benefits

    Complete one time only for all your facilities.


E-mail the data to: rzabka@hhcsinc.com.

If you do not receive a confirmation within 24 hours, please call Rosanne Zabka at (201) 405-0075, ext. 11.
3f9dcb17-7b63-4666-a7b2-33fa4a905077.xls - UPLOAD                                                                                                      Facility Order Form

       HCS Use Only                               Nursing Home & CCRC Salary & Benefits Questionnaire
        M      D       U                                          Conducted in cooperation with
       INC SD          FB                          The American Association of Homes and Services for the Aging
                                                                            Supported by
                                                              The American Health Care Association
                                                      Published by: Hospital & Healthcare Compensation Service
                                            PO Box 376 Oakland NJ 07436-0376 (Tel) 201-405-0075 (Fax) 201-405-2110
                                                                          www.hhcsinc.com

                                                                               ORDER FORM
       Please reserve                  copies of 2009-2010 Continuing Care Retirement Comm. Salary & Benefits Report (published late June)

       Please reserve                  copies of 2009-2010 Nursing Home Salary & Benefits Report (published late July)

                                                                        CCRC                                               Nursing Home

                                                     Hardcopy                    Hardcopy &                   Hardcopy                     Hardcopy &
        Standard Pricing+                              Only                      Excel CD ^                     Only                       Excel CD ^

                Pre-Paid Participant *                   $135.00                    $435.00                      $135.00                      $435.00

                Billed Participant *                     $155.00                    $455.00                      $155.00                      $455.00

                Non-Participant *                        $295.00                    $595.00                      $295.00                      $595.00
        AHCA MEMBERS+
                Non-Participant *                        $295.00                    $595.00                      $225.00                      $525.00
        AAHSA MEMBERS+

                Pre-Paid Participant *                   $125.00                    $425.00                      $125.00                      $425.00

                Billed Participant *                     $135.00                    $435.00                      $135.00                      $435.00
                Non-Participant *                        $225.00                    $525.00                      $225.00                      $525.00

                   + Please Add $15.00 Shipping per Report. We ship UPS Ground to the continental United States. Additional charges will be ap plied
                   for AK, HI, APO, etc. UPS will not deliver to a PO box.

                   *Payment must be received by May 31 to qualify for the Pre-Paid Rate. Send check with survey or copy of order form to ensure
                   proper credit to your account.

                   ^ The Excel CD contains only the salary/hourly data tables from the published Report (does not contain fringe benefits.) Mu st be
                   purchased in conjunction with the hard copy.

                   Due to the sensitve nature of the data no returns will be accepted.

                   Please make checks payable to:
                      HOSPITAL & HEALTHCARE COMPENSATION SERVICE
                      PO Box 376
                      Oakland, NJ 07436

        Name, Title:


        Company


        Street Shipping Address:


        City, State, Zip Code:



            American Express                MasterCard             Visa


                                                   Credit Card Number                                                Expiration Date


        Card Holder's Name:


        Credit Card Billing Address:




2009-2010 CCRC/NH Survey
                                                                                                                                                       Facility Order Form
HCS Use Only                             Nursing Home & CCRC Salary & Benefits Questionnaire
 M   D    U                                              Conducted in cooperation with
INC SD     FB                             The American Association of Homes and Services for the Aging
                                                                   Supported by
                                                      The American Health Care Association
                                            Published by: Hospital & Healthcare Compensation Service
                                  PO Box 376 Oakland NJ 07436-0376 (Tel) 201-405-0075 (Fax) 201-405-2110
                                                                www.hhcsinc.com




Company Name:                                                                                                            Number of Sites:


Contact Name, Title:


Facility Address:


City, State, Zip Code:


Telephone:                    Fax:                           Email:


May we publish the name of your organization as a participant in this survey?                Yes          No
All data received from participants will remain confidential. No data which will identify a specific facility will be released. A blank
response shall be considered “Yes”.

Would you like to receive updates/information on this HCS Report?                 Yes       No
A blank response shall be considered a “Yes”.




2009-2010 CCRC/NH Survey                                                                                                           Corp Contact Info
                                                                                                                                                    No. of
                                                                                                                             No. of     No. of
                                                                                                                No. FTE's                          Assisted      No. of         No. of
                                                                             Annual CCRC       Annual Nursing               FTE's at   Licensed
   Your Co. ID          Facility Name         City      State   Zip Code                                         at the                             Living/   Independent    Alzheimer's
                                                                           Operating Revenue   Home Revenue                 Nursing    Nursing
                                                                                                                 CCRC                             Personal    Living Units      Beds
                                                                                                                             Home        Beds
                                                                                                                                                  Care Beds


215 EXAMPLE        Countryside          Bowling Green   OH      43076        $11,800,000        $1,600,000        245        120         248        101          101              41
216 EXAMPLE        The Arbor            Sikeston        MO      63801        $4,900,000         $1,100,000        119         87         216         0             0              50




                                                                                                                                                                    Multi-Facility Data

   2009-2010 CCRC NH Survey (Multi)
                                        Please Check All Services That Apply to your Facility

1. Type of Facility

         CCRC                       Long-term Care                Nursing Home                 Skilled Nursing

         Assisted Living            Independent Living            Extended Care                Int. Care/Developmentally Disabled

2. Services Offered

         Adult Day Care             Home Care                    Pastoral Care                 Social Services
         Alzheimer's Pgm.           Hospice                      Pharmacy                      Speech Pathology
         Bariatric Care             Medicare Cert.               Physical Therapy              Transportation
                                    Nursing (RN, LPN)            Physician Care                Volunteer
         Dental                     Occ. Therapy                 Private Duty
         Dietitian Svcs.            Parkinson’s Care             Respiratory


3. During the last year, what was the average number of hours per month where agency/registry staff was used for:
                      LPNs                       RNs


4. What was your average position vacancy rate during the last year?
   (Vacancy rate = Total number of unfilled budgeted positions divided by the number of actual positions, multiplied by 100.)
                                     Average Vacancy                                            Average Vacancy
                                         Rate (%)                                                   Rate (%)
    Department Heads                                            RNs
    Therapy                                                     LPNs
    Dietary                                                     CNAs
    Environmental Services                                      Resident Assistants


5. What was the average length of time it took to fill a position/hire during the last year?
                                     Average Days to                                             Average Days to
                                      Fill a Position                                             Fill a Position
    Department Heads                                    Days    RNs                                                 Days
    Therapy                                             Days    LPNs                                                Days
    Dietary                                             Days    CNAs                                                Days
    Environmental Services                              Days    Resident Assistants                                 Days


6. What is the average number of Nursing Staff on duty for each shift?
                                                     Day         Evening         Night
     Licensed Nursing Staff
     (RNs, LPNs, & Nurse Assistants)

     Unlicensed Nursing Staff




                                                                                                                                Services & Policies
    2009-2010 CCRC/NH Survey
7. What are the Actual and Planned Percent Increases for the following?
   (Management Employees are defined as those who are exempt from receiving overtime pay. Nonmanagement
   employees are those who are eligible to receive overtime pay.)

                                                      Management                 Nonmanagement               RNs         LPNs         CNAs
      Actual % Increase
      GRANTED
      between 4/2008 and 3/2009

      Actual % Increase
      PLANNED
      between 4/2009 and 3/2010


8. What CRITERIA are used for granting increases:
                                  Management               Nonmanagement         RNs          LPNs       CNAs

   1. Cost of Living (COLA)
   2. Merit
   3. Step
   4. Other


9. What is your estimated annual turnover rate in percents for the following jobs?
   [Turnover rate is the number of times, on average an facility replaced a position in one year (12 months). Turnover does not include
   hiring for new or increased positions. Turnover rate = Total number of resignations, terminations, and vacancies divided by the number
   of actual positions, multiplied by 100.]

                                      % Turnover                                                % Turnover
    Department Heads                                           Therapy

    Dining Services                                            RNs

    Environmental Services                                     LPNs

    Marketing                                                  CNAs


10. Does your facility outsource the following services?       If Yes, who is your service provider?
    Dining Services                   Yes            No

    Environmental Services            Yes            No

    Therapy                           Yes            No




                                                                                                                            Services & Policies
    2009-2010 CCRC/NH Survey
PLEASE SHOW ADDITIONAL PAY ($) FOR: SHIFT, WEEKEND, DIFFERENTIAL RATES, AND PER DIEM PAY FOR THE
JOBS LISTED.
                                    (Show additional hourly rate.)

                 50            51           52         53         55          56           57          59         64             65
             Staff Nurse     Charge      Practical   Charge    Certified     Non-        Certified   Activity   PT Asst.       PT Aide
For                        Staff Nurse    Nurse      Nurse    Nurse Aide    Certified   Medication    Aide
Working:                      (RN)        (LPN)      (LPN)                 Nurse Aide   Technician


Weekends



2nd Shift
(Evenings)


3rd Shift
(Nights)


Per Diem
Rate



Pool Rate




                                                                                                                 Shift Differentials
       2009-2010 CCRC/NH Survey
                                   Jobs 1 - 42 Annual Salaried Employees
                                        Average Annual     Annual Salary     Annual Salary
Your Co. ID Job No. No. of FTE's                                                              Annual Bonus
                                            Salary        Range Minimum     Range Maximum
215                 3               1           $87,800           $78,000           $97,000           $9,000
216                 3               1           $61,250           $58,000           $70,000           $6,500




                                                                                                     Jobs 1-42

2009-2010 CCRC NH Survey (Multi)
                                         Jobs 50 - 90 Hourly Employees
                                        No. of                     Hourly Rate      Hourly Rate
                Your Co. ID Job No.               Hourly Rate
                                        FTE's                       Minimum          Maximum
                215                51         3           $22.50           $16.00           $23.00
                216                51         2           $17.65           $13.75           $20.00




                                                                                                     Jobs 50-90

2009-2010 CCRC NH Survey (Multi)
                                     Complete only Once for Entire Company.
 Please answer the following questions pertaining to the Fringe Benefits provided to your Full-Time Employees.
  I.      CAFETERIAN PLAN
          Does the Facility offer a Cafeteria Plan for funding employee benefits?               Yes               No

  II.     VACATION TIME or PAID TIME OFF (PTO) BANK SYSTEM
          (Paid Time Off is the combined compensated time for all Paid Holidays, Excused Paid Absences, Personal Days, Vacation Time and Sick
          Leave.)

          1. Which of the following does the Facility offer?             PTO        Vacation Time


          2. How many days off are given after the number of years shown are worked?


           MANAGEMENT EMPLOYEES                        NONMANAGEMENT EMPLOYEES                         RNS & PROFESSIONALS


         After       Number of Days Off                After       Number of Days Off               After      Number of Days Off

         1 Year                        Days           1 Year                        Days            1 Year                     Days
         5 Years                       Days           5 Years                       Days            5 Years                    Days
         10 Years                      Days           10 Years                      Days            10 Years                   Days
         15 Years                      Days           15 Years                      Days            15 Years                   Days
         20 Years                      Days           20 Years                      Days            20 Years                   Days


          3. When are employees eligible to take Vacation Time or PTO?

                 Upon Employment                    After 90 Days

                 After 30 Days                      After 6 Months

                 After 60 Days                      After 1 Year


  III.    PAID HOLIDAYS (If PTO, skip to question IV.)

          1. How many holidays (including Christmas and excluding other religious holidays) are paid though not worked?

                 MANAGEMENT                            NONMANAGEMENT                                  RNs & PROFESSIONALS


          2. How many religious holidays (excluding Christmas) are paid though not worked?


          3. What is the rate of pay for holidays worked?
                                              MANAGEMENT              NONMANAGEMENT                  RNs & PROFESSIONALS
          A. No additional pay
          B. 1 1/2 x base pay
          C. 2 x base pay
          D. 2 1/2 x base pay
          E. 3 x base pay
          F. Equal time off (no additional pay)


          4. When are employees eligible for Paid Holidays?

                 Upon Employment                    After 60 Days

                 After 30 Days                      After 90 Days




                                                                                                                                          Fringe Benefits
2009-2010 CCRC/NH Survey (Multi)
  IV.     EXCUSED PAID ABSENCES (If included in PTO, skip to question V.)
          1. How many days with pay are granted annually for personal leave? (Exclude death in family)                                      Days
          2. How many days with pay are granted annually for sick leave?                                                                    Days
          3. How many days with pay are granted per occurrence for death-in-family leave?                                                   Days
          4. What is the maximum number of days of excused paid absences which can be used or banked?                                       Days
          5. After what period of employment may an employee use Paid Days off?
              Upon Employment                        After 90 Days
              After 30 Days                          After 6 Months
              After 60 Days                          After 1 Years

  V.      BREAKS (Not including lunch.)

          1. How many breaks are permitted for each shift (not including lunch)?            None         1                 2            3
          2. What is the time allowed for each break? (Answer in minutes.)                  10 min.          15 min.              20 min.


  VI.     JURY DUTY PAY
          What salary payments do employees on jury duty receive?
              Full pay.
              Difference between regular salary and juror's fees.
              No salary paid.


  VII.    EDUCATIONAL ASSISTANCE                                                             MANAGEMENT                        NONMANAGEMENT

          1. Does your Facility have an Educational Assistance Program for
             COLLEGE LEVEL courses for its employees?                                           Yes          No                   Yes         No
             If YES, then answer question 2.
          2. What reimbursements to employees are made for COLLEGE LEVEL courses?
                 A. Full amount of tuition. (100%)
                 B. Part of tuition. (Indicate Percent.)                                                          %                                %
                 C. Up to a fixed dollar amount. (Indicate amount.)                   $                                $


          3. Does your Facility have an Educational Assistance Program for
             NONCOLLEGE LEVEL courses for its employees?                                        Yes          No                   Yes         No
              If YES, then answer question 4.
          4. What reimbursements to employees are made for NONCOLLEGE LEVEL
             courses such as nursing personnel training and education, technical
             training, business, and secretarial school?
                 A. Full amount of tuition. (100%)
                 B. Part of tuition. (Indicate Percent.)                                                          %                                %
                 C. Up to a fixed dollar amount. (Indicate amount.)                   $                                $


  VIII.   GROUP LIFE INSURANCE                                                               MANAGEMENT                        NONMANAGEMENT


          1. Does the Facility carry Life Insurance for its employees?                          Yes          No                   Yes         No

             If YES, then answer next question.

             Average Annual Premium per Employee            $                or $               /$1000


          2. How much insurance is provided for:
              A. Fixed amount (Indicate $ amount.)                                    $                                $
              B. 1 x salary
              C. 1.5 x salary
              D. 2 x salary
              E. 3 x salary
              F. 4 x salary
              G. Other (Indicate.)




                                                                                                                                                   Fringe Benefits
2009-2010 CCRC/NH Survey (Multi)
VIII.   GROUP LIFE INSURANCE (continued)
                                                                                                   MANAGEMENT                  NONMANAGEMENT
         3. Facility pays entire cost.
         4. Employee pays entire cost.
         5. Facility and employee share cost.
            If facility & employee share cost:                                 Facility Pays               %                                   %
         6. What is the waiting period for enrollment?
              Upon Employment                      After 90 Days
              After 30 Days                        After 6 Months
              After 60 Days                        After 1 Years


  IX.    ACCIDENTAL DEATH AND DISMEMBERMENT INSURANCE
                                                                                                   MANAGEMENT                  NONMANAGEMENT
         1. Does the Facility carry AD&D coverage for its employees?                                 Yes        No                Yes      No
            If YES, then answer next question.
            Average Annual Premium per Employee           $                    or $                  /$1000

         2. How much AD&D is provided for:
             A. Fixed amount (Indicate $ amount.)                                              $                           $
             B. 1 x salary
             C. 1.5 x salary
             D. 2 x salary

             E. Other (Indicate.)
         3. Facility pays entire cost.
         4. Employee pays entire cost.
         5. Facility and employee share cost.
            If facility & employee share cost:                                 Facility Pays               %                                    %


  X.     SHORT-TERM NONOCCUPATIONAL SICKNESS AND ACCIDENT DISABILITY INSURANCE)

         1. Does the Facility have a Short-Term Nonoccupational Sickness and
            Accident Disability Insurance Program?                                                   Yes        No

            If YES, then answer next question.

         2. Are Short-Term Disability benefits provided in addition to State
                                                                                                     Yes        No
            Disability benefits payments?

         3. Facility pays entire cost.
         4. Employee pays entire cost.
         5. Facility and employee share cost.                       If facility & employee share cost:     Facility Pays                % of premium


  XI.    LONG-TERM NONOCCUPATIONAL SICKNESS AND ACCIDENT DISABILITY INSURANCE
                                                                                                   MANAGEMENT                  NONMANAGEMENT
        1. Does the Facility have a Long-Term Nonoccupational Sickness                               Yes       No                 Yes     No
           and Accident Disability Insurance Program?
            If YES, then answer next question.

        2. Facility pays entire cost.
        3. Employee pays entire cost.
        4. Facility and employee share cost.
            If facility & employee share cost:                                 Facility Pays               %                                   %
        5. What is the waiting period for enrollment?
              Upon Employment                      After 90 days
              After 30 days                        After 6 months
              After 60 days                        After 1 year




                                                                                                                                                Fringe Benefits
2009-2010 CCRC/NH Survey (Multi)
  XII.    HEALTH INSURANCE
          1. Does the Facility have a Health Insurance Program?                       Yes       No
              If YES, then answer next question.
              Average Annual Premium per Employee $                        (single)     Self Funded
          2. Employee Coverage
              A. Facility pays entire cost.
              B. Employee pays entire cost
              C. Facility and employee share cost.                                            Facility Pays         % of premium
          3. Dependent Coverage
              A. Are dependents covered under the Health Insurance Plan?              Yes       No
                If YES, then answer next question.
              B. Facility pays entire cost of dependent coverage.
              C. Employee pays entire cost of dependent coverage.
              D. Facility and employee share cost of dependent coverage.                      Facility Pays         % of premium
          4. What is the waiting period for enrollment?
               Upon Employment                       After 90 days
               After 30 days                         After 6 months
               After 60 days                         After 1 year


  XIII.   DENTAL INSURANCE PLAN
          1. Does the Facility have a Dental Insurance Plan?                          Yes       No
              If YES, then answer next question.
              Average Annual Premium per Employee $                        (single)         Self Funded
          2. Employee Coverage
              A. Facility pays entire cost.
              B. Employee pays entire cost.
              C. Facility and employee share cost.                                            Facility Pays         % of premium
          3. Dependent Coverage
              A. Are dependents covered under the Dental Insurance Plan?              Yes       No
                If YES, then answer next question.
              B. Facility pays entire cost of dependent coverage.
              C. Employee pays entire cost of dependent coverage.
              D. Facility and employee share cost of dependent coverage.                      Facility Pays         % of premium
          4. What is the waiting period for enrollment?
               Upon Employment                       After 90 days
               After 30 days                         After 6 months
               After 60 days                         After 1 year


  XIV.    VISION INSURANCE PLAN
          1. Does the Facility have a Vision Insurance Plan?                          Yes       No

              If YES, then answer next question.
              Average Annual Premium per Employee $                        (single)         Self Funded
          2. Employee Coverage
             A. Facility pays entire cost.
              B. Employee pays entire cost.
              C. Facility and employee share cost.                                    Facility Pays           % of premium
          3. Dependent Coverage
              A. Are dependents covered under the Vision Insurance Plan?
                If YES, then answer next question.
              B. Facility pays entire cost of dependent coverage.
              C. Employee pays entire cost of dependent coverage.                     Facility Pays           % of premium




                                                                                                                             Fringe Benefits
2009-2010 CCRC/NH Survey (Multi)
              C. Employee pays entire cost of dependent coverage.


  XIV.     VISION INSURANCE PLAN (continued)
          4. What is the waiting period for enrollment?
               Upon Employment                        After 90 days
               After 30 days                          After 6 months
               After 60 days                          After 1 year


  XV.      LONG TERM CARE INSURANCE
          1. Does the Facility have a Long Term Care Insurance program?                              Yes          No
          2. Employee Coverage
              A. Facility pays entire cost.
              B. Employee pays entire cost.
              C. Facility and employee share cost.                                                            Facility Pays             % of premium


  XVI.     CHILD CARE PLAN
          1. Does the Facility sponsor a program for employee childcare?                             Yes          No
              If YES, then answer next question.
          2. Which of the following does the Facility offer?                 On-site facility           Off-site support
              A. Facility pays entire cost.
              B. Employee pays entire cost.
              C. Facility and employee share cost.                              Facility Pays                 %


  XVII.    PENSION PLAN
          1. Does the Facility have a Pension Plan?                                                  Yes          No
              If YES, then answer next question.
          2. Is it a Defined Benefit Plan?                                                           Yes          No
          3. Facility pays entire cost.                       Facility Contributes What Average % of Salary                       %
          4. Employee pays entire cost.                       Employee Contributes What Average % of Salary                       %
          5. Facility and employee share cost.                Facility Contributes What Average % of Salary                       %


  XVIII. 401(k)/403(b) PLAN
          1. Does the Facility have a 401(k) or 403(b) Plan?                                         Yes          No
          2. Employee contributes what average percent of salary?                                             %
          3. Does the Facility match employees’ contributions?                                       Yes          No
              If yes, the employer matches, what is the amount?
                                 % of salary.
                                 cents per $1.00 of employee contribution, up to                     % of salary or $
          4. What is the eligibility period for enrollment?                    Upon employment         or                     months/                    hours
          5. Vesting - number of months until fully (100%) vested.             Immediate Vested        or                     months


  XIX.     SEVERANCE
          1. Does the Facility provide Severance Pay?                                                Yes          No
          2. Indicate Number of Weeks Pay Given for Years in Service.
                  Number of Weeks                                    Number of Years                        Maximum Number of Weeks Allowed
          3. Is Pay Contingent Upon Years in Service?                                                Yes          No


  XX.      MILEAGE
          1. Does the Facility provide mileage expense reimbursement?                                Yes          No
          2. What is the rate per mile allowed?                $                  per mile or        2009 Federal Rate $0.55 per mile (eff. Jan. 2009)


  XXI.     PROFESSIONAL ASSOCIATION FEES
          1. Does the Facility pay the cost of professional association membership fees?                      Yes       No


  XXII.    EDUCATIONAL AND PROFESSIONAL MEETINGS
          1. Does the Facility pay for time off for educational and professional meetings?                    Yes       No



                                                                                                                                                 Fringe Benefits
2009-2010 CCRC/NH Survey (Multi)
                                                 EXEMPT POSITION DESCRIPTIONS
                                                MANAGEMENT AND ADMINISTRATIVE
            1 EXECUTIVE DIRECTOR--Responsible for all operations of the community. Hired by the Board of Directors;
              reports to board regarding strategic planning and policy making activities.

            2 ASSOCIATE DIRECTOR--Responsible for various divisions/departments of the community. Reports to the
              Executive Director. Responsible for decision making in the absence of the Executive Director.
            3 NURSING HOME ADMINISTRATOR (Health Services)--Responsible for planning and is accountable for all
              activities and departments of the Nursing Home subject to rules and regulations promulgated by government
              agencies to ensure proper health care services to residents. Administers, directs, and coordinates all activities
              of Nursing Home to carry out its objectives in providing resident care.

            4 NURSING HOME ASSISTANT ADMINISTRATOR (Health Services)--Reports to the Administrator. Assists in
              the administrative functions of the operations.
            5 DIRECTOR OF ASSISTED LIVING--Responsible for the daily operations of assisted living. Directs and
              supervises the work of staff in providing for the care and needs of the residents. Includes scheduling of staff
              work.
            6 RESIDENTIAL ADMINISTRATOR--Responsible for all operations of the community’s apartment units.
              Includes financial management and staffing.
            7 DIRECTOR OF HOSPICE--Responsible for all operations of the hospice unit or hospice program.
            8 CHIEF FINANCIAL OFFICER--Reports to Executive Director and is responsible for preparing and reporting
              financial accounting of facility to board, bond holders or other debt holders. Participates in strategic planning
              activities. Coordinates and prepares the annual budget.
            9 CONTROLLER--Manages the financial operation of the facility, including keeping of fiscal records and control
              of funds. Provides guidance to management on financial affairs. (The Controller function also includes
              responsibility for Business Office Manager functions, # 82).
          10 COMPLIANCE OFFICER--Responsible for developing, implementing, and overseeing compliance activities to
             ensure the facility is in compliance with federal, state, and/or local regulations and accreditation standards.


          11 DIRECTOR OF HUMAN RESOURCES--Plans, develops, and administers the Personnel and Labor Relations
             Program within the basic policies of the facility. Formulates, implements, and supervises policies and
             programs relative to selection, orientation, training, promotion, and welfare of all personnel and all employer-
             employee relationships.

          12 DIRECTOR OF DEVELOPMENT--Responsible for the design, development, and implementation of fund
             raising and innovative marketing programs, special events, capital campaigns, deferred giving programs, and
             other facility relations activities essential to business development.
          13 DIRECTOR OF MARKETING--Responsible for marketing/selling to viable markets. Fulfills marketing goals by
             generating new business and maintaining existing business. Explores new business opportunities through
             referral sources as well as promoting existing business. Responsible for preparation and implementation of an
             annual marketing plan.
                                                       THERAPY AND NURSING
          14 DIRECTOR OF THERAPY/REHABILITATION--Directs department(s) of Occupational, Physical, Recreational
             and Speech Therapies, in treatment and rehabilitation of patients. Assigns patients to staff therapists for
             treatment and reviews patients’ progress. Communicates results of patient care to other services/departments.


          15 DIRECTOR OF NURSES--Responsible for administration of nursing services. Directs, plans, and coordinates
             service activities of professional nursing and auxiliary nursing personnel in rendering resident care. Interprets
             policy and regulations to all nursing personnel and ensures compliance. Analyzes and evaluates nursing and
             related services rendered to ensure quality of resident care.

          16 ASSISTANT DIRECTOR OF NURSES--Second highest level position in the Nursing Department. Reports to
             the Director of Nurses. This position takes in some of the responsibilities of the Nursing Department as may be
             delegated. Provides assistance in the functioning of the Nursing Department
          17 NURSING SUPERVISOR (RN)--Supervises and coordinates activities of personnel assigned to a specific shift.
             Communicates and applies policies, practices, procedures, objectives, and goals necessary for attainment of
             satisfactory resident care. Demonstrates clinical expertise of Standards of Practice accorded by license as a
             Registered Nurse




                                                                                                                                  Job Descriptions
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          18 HEAD NURSE (RN)--Directs nursing service activities including the preparation of nursing care plans, and
             instructs nurses in an organized patient care unit. Assigns duties to professional and ancillary nursing
             personnel based on patients' needs, available staff, and unit needs. Supervises and evaluates work
             performance in terms of patient care, staff relations, and efficiency of service. (This position normally reports to
             the Nursing Supervisor (RN), above).

          19 NURSING SUPERVISOR (LPN)--Supervises and coordinates activities of personnel assigned to a specific
             shift. Communicates and applies policies, practices, procedures, objectives, and goals necessary for
             attainment of satisfactory resident care.

          20 DIRECTOR OF STAFF DEVELOPMENT--Develops and manages the orientation in-service program and
             development of staff in accordance with the facility's educational goals.
          21 MDS COORDINATOR--Responsibilities include oversight of the generation of a Minimum Data Set (MDS) for
             each Medicare patient and electronic transmission of required data by timeframe mandated by the State.


          22 ACTIVITY DIRECTOR--Responsible for planning, implementation, scope, and emphasis of activity programs to
             encourage and stimulate residents to fuller and richer lives. Plans and assists in research projects.
             Supervises activity aides.
                                                           FOOD SERVICES
          23 DIRECTOR OF DINING/FOOD SERVICES (Graduate Dietitian)--Plans, organizes, and directs the Dining
             Services Department in providing the residents’ facility with a high quality dining program. Develops, maintains
             and implements policies and procedures for service of food; supervises food service staff.


          24 ASST. DIRECTOR OF DINING/FOOD SERVICES (Graduate Dietitian)--Assists in planning and supervising
             activities of the Department to provide service to residents, employees, and visitors. Assists in providing
             technical guidance and administrative direction over dietary planning, menu formulation, and preparation and
             serving of regular therapeutic diets. Orders food and kitchen supplies.

          25 DIRECTOR OF DINING/FOOD SERVICES (Not a Dietitian)--Plans, organizes, and directs the Dining Services
             Department in providing the residents’ facility with a high quality dining program. Develops, maintains and
             implements policies and procedures for service of food; supervises food service staff.
          26 ASST. DIRECTOR OF DINING/FOOD SERVICES (Not a Dietitian)--Assists in planning and supervising
             activities of the Department to provide service to residents, employees, and visitors. Assists in providing
             technical guidance and administrative direction over dietary planning, menu formulation, and preparation and
             serving of regular therapeutic diets. Orders food and kitchen supplies.

                                                    ENVIRONMENTAL SERVICES
          27 DIRECTOR OF ENVIRONMENTAL SERVICES--Performs administrative and supervisory work directing the
             operation, maintenance, and security of the facility. Responsible for planning, scheduling, supervising,
             participating in, and inspecting the work of departmental employees engaged in the operations, maintenance,
             repair, and safeguarding of facility. Can also be called Director of Physical Plant.


          28 SECURITY SUPERVISOR--Responsible for the safety and security of residents, facility and service programs,
             staff and property. Oversees the work of the Security Guards on assigned shifts.
          29 HOUSEKEEPING AND LAUNDRY SUPERVISOR*--Supervises a variety of activities in housekeeping and
             laundry in maintaining the facility in an orderly, clean, and sanitary condition and in processing linens,
             garments, and other washables through washing and drying cycles. *See Laundry Supervisor and
             Housekeeping Supervisor if covered by two positions.
          30 LAUNDRY SUPERVISOR--Supervises laundry personnel in such service activities as washing, cleaning,
             ironing, processing, and delivery of uniforms and linens. Regulates work flow and sets up production
             standards for the department.

          31 HOUSEKEEPING SUPERVISOR--Supervises and administers housekeeping program to maintain facility in
             sanitary and orderly condition. Establishes standards, work methods, and schedules.
          32 MAINTENANCE SUPERVISOR--Supervises a variety of activities in maintenance of physical plant and
             grounds of the facility. Plans maintenance schedule and work requirements in conformance with current and
             projected needs. Functionally responsible for proper provision of all light, heat, and service facilities for all
             buildings and physical plant.

                                                 ADMINISTRATIVE AND PASTORAL
          33 DIRECTOR OF PURCHASING--Responsible for purchasing of supplies, equipment, service, inventory control,
             capital equipment accountability, and distribution services including: linens, sterile supplies and central stores.


                                                                                                                                 Job Descriptions
2009-2010 CCRC/NH Survey                                                                                                                19 of 22
          34 DIRECTOR OF INFORMATION SYSTEMS--Top level position in Information Systems Department. Directs
             and coordinates systems, programming, and operational activities of Information Systems Center. Consults
             with management to define boundaries and priorities for projects and discusses equipment acquisition.


          35 DIRECTOR OF PASTORAL SERVICES--Provides religious counseling and guidance to patients, family
             members, and employees. Coordinates pastoral activity with clergy of all faiths. Functions in
             conformance with facility goals and philosophy. Coordinates and plans religious services for the
             facility.
                                                        MARKETING
          36 MARKETING REPRESENTATIVE--Performs sales functions for the retirement facility, finding and following up
             on leads, interviewing potential residents, providing information and selling vacant units.


          37 MARKETING COORDINATOR--Coordinates and oversees the admission process for independent living.
             Includes tours, applications, wait list, etc. Facilitates the transition of future residents to (residential) living
             units.
          38 ADMISSIONS COORDINATOR--Coordinates all aspects of resident care including admissions, discharges,
             resident assessments, care plans, etc. with residents, residents’ families, staff, and administration.


          39 DIRECTOR OF RESIDENT AND FACILITY SERVICE--Directs, supervises, coordinates, and evaluates the
             staff and services for the residents and all facility service programs. Oversees and supervises residents’
             moves and transfers within the retirement facility. Maintains department compliance with OSHA.


                                                            SOCIAL SERVICES
          40 MEDICAL SOCIAL WORKER, M.S.W.--Identifies and understands the social and emotional factors underlying
             patients' illness and communicates these factors to the health team. Assists patients and their families in
             understanding and accepting treatment necessary to maximize medical benefits and their adjustment to
             permanent and temporary effects of illness.
          41 SOCIAL SERVICE AND ACTIVITY DIRECTOR*--Responsible for planning, implementation, scope and
             emphasis of facility’s activity and social service program to encourage and stimulate residents to fuller and
             richer lives. Assists in the development of policies regarding participation in facility planning for health and
             welfare services. Responsible for supervision of activities of social workers and aides. *See Social Service
             Director and Activity Director if covered by two positions.
          42 SOCIAL SERVICE DIRECTOR--Responsible for planning and administering social service programs.
             Supervises facility social workers. Assists in development of policies regarding participation in facility planning
             for health and welfare services.
                                                NONEXEMPT POSITION DESCRIPTIONS
                                                     NURSING AND THERAPY
          50 STAFF NURSE (RN)--Renders professional nursing care to patients within an assigned unit. Performs
             nursing techniques for the comfort and well-being of the patient. Administers prescribed medications.
             Maintains patients' medical records on nursing observations. May assist physician during treatment and
             examination of patient.

          51 CHARGE STAFF NURSE (RN)--Serves as a Nurse (RN) in charge of a nursing unit. All other job functions are
             the same as the Staff Nurse (RN).
          52 PRACTICAL NURSE (LPN)--Performs assigned nursing procedures for the comfort and well-being of patients
             such as assisting in admission of new patients, bathing and feeding, making beds, helping patients into and out
             of bed, and collecting specimens. Administers specified medication. Provides a wide variety of patient care
             activities as accorded by licensure

          53 CHARGE NURSE (LPN)--Serves as a Nurse (LPN) in charge of a nursing unit. All other job functions are the
             same as the Practical Nurse (LPN).
          54 NURSE PRACTITIONER-- Serves as liaison between the clinical staff and the administrative operational staff.
             Plans and evaluates the clinical management of residents. Evaluates treatment plans, medications, and other
             necessary care. Provides clinical recommendations to nursing staff to address the medical needs of the
             residents.

          55 CERTIFIED NURSE AIDE--Performs various resident care activities and related nonprofessional services
             essential to caring for personal needs and comfort of residents. Function may not exceed Standards of
             Practice as accorded by Certification.




                                                                                                                                    Job Descriptions
2009-2010 CCRC/NH Survey                                                                                                                   20 of 22
          56 NON-CERTIFIED NURSE AIDE--Performs various resident care activities and related nonprofessional services
             essential to caring for personal needs and comfort of residents. Function does not include activities accorded
             a Certified Nurse Aide.
          57 CERTIFIED MEDICATION TECHNICIAN--Dispenses medication to residents under the direction of the Nursing
             Staff. Function may not exceed Standard of Practice as accorded by Certification
          58 NUTRITION AND HYDRATION ASSISTANT (FEEDING ASSISTANT)--Part-time or existing non-nursing facility
             employee who performs the single task of assisting those residents with eating and drinking who do not have a
             clinical condition that requires the training of a nurse or nurse aide. Must successfully complete a State-
             approved training program and work under the supervision of an RN or LPN.


          59 ACTIVITY AIDE--Assists in the planning, organization, and directing of activity programs for patients. Prepares
             reports on patients' progress as may be required. Activities may include sports, dramatics, nature study, social
             activities, games, and arts and crafts in accordance with patients' needs.
                                                               THERAPY
          60 OCCUPATIONAL THERAPIST--Plans occupational therapy programs for patients involving such activities as
             manual arts and crafts, practice in prevocational and vocational skills, and activities of daily living. Studies
             patients' reactions and assesses patients' progress.
          61 OCCUPATIONAL THERAPY AIDE--Provides support services to occupational therapist in the delivery of
             therapy services.
          62 OCCUPATIONAL THERAPY ASSISTANT (COTA)--Assists OT in administering occupational therapy program
             in hospital, related facility, or facility setting for physically, developmentally, mentally or emotionally disabled
             clients. Assists in evaluation of clients daily living skills and capacities to determine extent of abilities and
             limitations.

          63 PHYSICAL THERAPIST--Organizes and conducts prescribed therapy programs for patients involving exercise,
             heat, water, light, and electricity. Applies diagnostic and prognostic muscle, nerve, joint, and functional ability
             tests. Directs and aids patients in active and passive exercises. Evaluates, records, and reports patients'
             progress.
          64 PHYSICAL THERAPY ASSISTANT (LPTA)--Administers physical therapy treatments to patients, working
             under direction of and as assistant to PT. Assists in active and passive manual therapeutic exercises,
             therapeutic massage, and heat, light, sound, water, and electrical modality treatments such as ultrasound,
             electrical stimulation, ultraviolet, infrared, and hot and cold packs.

          65 PHYSICAL THERAPY AIDE--Assists the physical therapist by assembling equipment, carrying out specified
             treatment programs, and helping with complex treatment procedures. Other duties may include the personal
             care of patients, safety precautions, and related duties.

          66 RESPIRATORY THERAPIST--Performs respiratory modalities such as pressure breathing, mechanical
             ventilation, positive pressure breathing, humidity/medicated aerosol therapy, medical gas administration,
             pulmonary drainage procedures, and cardiopulmonary resuscitation. Sets up and operates various types of
             oxygen and other therapeutic gas and mist equipment.

          67 SPEECH THERAPIST/LANGUAGE PATHOLOGIST--Diagnoses and treats speech and language disorders by
             evaluating causes and test results. Interprets findings to all concerned with the patient. Plans, directs, or
             conducts remedial program designed to improve or restore communicative efficiency. Determines need for
             referral to specialist

                                                    ENVIRONMENTAL SERVICES
          68 HOUSEKEEPING AND LAUNDRY AIDE--Provides a variety of housekeeping and/or laundry duties in
             maintaining the facility in an orderly, sanitary condition and in the collection and laundering of linens, garments
             and washables.
          69 MAINTENANCE HELPER--Provides a variety of routine and unskilled tasks in the maintenance and repair of
             facility grounds and facility.
          70 MAINTENANCE MECHANIC I--Performs a variety of non-routine and semiskilled duties in maintaining
             equipment and the physical plant of the facility.
          71 MAINTENANCE MECHANIC II--Performs a variety of non-routine and skilled maintenance and repair activities
             on the facility buildings and equipment.
          72 SECURITY GUARD--Polices buildings and grounds in the prevention of fire, theft, vandalism, and illegal entry.


                                                            FOOD SERVICE



                                                                                                                               Job Descriptions
2009-2010 CCRC/NH Survey                                                                                                              21 of 22
          73 REGISTERED CLINICAL DIETITIAN--Responsible for the assessment and achievement of defined nutritional
             goals and residents’ nutritional needs. Must have current state licensure requirements to practice.


          74 DINING ROOM SUPERVISOR--Responsible for supervision of waitpersons and dining room staff in the setting
             up of tables, serving food, cleaning and maintenance of the dining room and customer service, etc. Ensures
             that food is handled in accordance with sanitary standards and recognized food serving standards.


          75 CHEF/KITCHEN MANAGER--Oversees the work of the kitchen staff. Assures that all foods are prepared and
             cooked in accordance with specified recipes and procedures. Assures that foods served to residents and
             guests are of a high quality, meeting standards of portion, doneness, freshness, and presentation. Can also be
             called Maitre’d.
          76 CHEF--Supervises and assists cooking staff in the production of all menu items, in accordance with production
             schedules in a timely manner. Conducts quality assurance tests for all items. Supervises safe food handling
             procedures.
          77 SOUS COOK--Responsible for preparing and cooking a wide variety of food for residents, employees, and
             visitors. May oversee the work of other food service personnel involved in cooking.
          78 COOK--Prepares and cooks a limited variety of food for residents, employees, and visitors. May oversee the
             work of other food service personnel involved in cooking.
          79 DIETARY AIDE--Performs a variety of food service functions in maintaining clean and sanitary conditions of
             food service areas, facilities, and equipment. May assist in some aspects of food preparation.

          80 WAITPERSON--Serves residents’ meals in a timely manner and resets tables for the next meal.
          81 HOSTESS--Responsible for setting and opening of the dining room. Checks in residents for meals. Handles
             food in accordance with recognized food serving standards.
                                                ADMINISTRATIVE AND CLERICAL
          82 BUSINESS OFFICE MANAGER*--Prepares budgets, financial statements, and various reports. Responsible
             for general accounting function, including accounts payable, receivable, payroll, and bank reconciliations.
             Handles and records cash transactions. (*This position may be called Bookkeeper in small facilities.)


          83 ACCOUNTS PAYABLE CLERK--Performs various functions in the verification and payment of invoices.
             Verifies receipt of goods against packing slip, invoice, and purchase order preparatory to payment. May
             perform a variety of complicated, non-routine tasks at the CLERK II level.
          84 ACCOUNTS RECEIVABLE CLERK--Performs various functions in the billings to a variety of payers. May
             perform a variety of complicated, non- routine tasks at the CLERK II level.
          85 CLERK I--Performs simple, routine, clerical tasks and computer entry in the processing of various
             transactions. Functions may include some typing of reports, memoranda, etc. and filing of various documents.


          86 CLERK II--Performs a variety of clerical tasks in the processing of complicated, non-routine transactions.
             Function may include word processing, memoranda, and the processing of various documents and operating
             copying machine.

          87 PAYROLL CLERK--Performs various calculations of payrolls including withholding and deductions and other
             payroll functions. Job duties may be coordinated with automated payroll computer service. Job requires
             coding payroll data for computer processing.

          88 EXECUTIVE ASSISTANT--Performs secretarial duties for president and/or other key executives requiring
             extensive knowledge of organization, policies, and procedures. Types a variety of correspondence and
             documents of a confidential and sensitive nature. Screens and places phone calls, arranges meetings, and
             analyzes reports and correspondence as assigned.

          89 ADMINISTRATIVE ASSISTANT--Performs secretarial duties which are routine in nature. Types
             correspondence. Maintains personal files, arranges meetings, and screens calls.
          90 RECEPTIONIST--Greets and directs visitors entering the facility. Operates console to take and relay incoming
             calls. May perform simple, routine, clerical and typing tasks.




                                                                                                                          Job Descriptions
2009-2010 CCRC/NH Survey                                                                                                         22 of 22

				
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