J.H. FLOYD SUNSHINE MANOR, INC.

Contacts

Phone	+1 941-906-9217

Authorized person

Name	MR. WAYNE F RICHARDSON
Role	CFO
Phone	9419554915

Taxonomy

Taxonomy Code	310400000X - Assisted Living Facility
License Number	AL9060
State	FL
Is Primary	Yes

Other Provider Identifiers

Issuer	MEDICAID
Number	140833000
State	FL
Issuer	MEDICAID
Number	675814200
State	FL

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	1986-01-01
Business code	623000
Sponsor’s telephone number	9419554915
Plan sponsor’s address	1755 18TH STREET, SARASOTA, FL, 34234

Plan administrator’s name and address

Administrator’s EIN	590995138
Plan administrator’s name	J.H. FLOYD SUNSHINE MANOR, INC.
Plan administrator’s address	1755 18TH STREET, SARASOTA, FL, 34234
Administrator’s telephone number	9419554915

Signature of

Role	Plan administrator
Date	2011-02-17
Name of individual signing	GEORGE BUMBRAY
Valid signature	Filed with authorized/valid electronic signature
Role	Employer/plan sponsor
Date	2011-02-17
Name of individual signing	GEORGE BUMBRAY
Valid signature	Filed with authorized/valid electronic signature

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	1986-01-01
Business code	623000
Sponsor’s telephone number	9419554915
Plan sponsor’s address	1755 18TH STREET, SARASOTA, FL, 34234

Plan administrator’s name and address

Administrator’s EIN	590995138
Plan administrator’s name	J.H. FLOYD SUNSHINE MANOR, INC.
Plan administrator’s address	1755 18TH STREET, SARASOTA, FL, 34234
Administrator’s telephone number	9419554915

Signature of

Role	Plan administrator
Date	2010-10-04
Name of individual signing	GEORGE BUMBRAY
Valid signature	Filed with authorized/valid electronic signature
Role	Employer/plan sponsor
Date	2010-10-04
Name of individual signing	GEORGE BUMBRAY
Valid signature	Filed with authorized/valid electronic signature