On June 28, 2023 a
Exhibit,Appendix
was filed
involving a dispute between
People Of The State Of New York, By Letitia James, Attorney General Of The State Of New York,
and
Abraham Operations Associates Llc Dba Beth Abraham Center For Rehabilitation And Nursing,
Aharon Lantzitsky,
Amir Abramchik,
Aron Gittleson,
Beth Rozenberg,
Bis Funding Capital Llc,
Centers For Care Llc Dba Centers Health Care,
Cfsc Downstate Llc,
Daryl Hagler,
David Greenberg,
Delaware Operations Associates Llc Dba Buffalo Center For Rehabilitation And Nursing,
Delaware Real Property Associates Llc,
Elliot Kahan,
Hollis Operating Co Llc Dba Holliswood Center For Rehabilitation And Healthcare,
Hollis Real Estate Co Llc,
Jeffrey Sicklick,
Jonathan Hagler,
Kenneth Rozenberg,
Leo Lerner,
Light Property Holdings Ii Associates Llc,
Mordechai Moti Hellman,
Reuven Kaufman,
Schnur Operations Associates Llc Dba Martine Center For Rehabilitation And Nursing,
Skilled Staffing Llc,
Sol Blumenfeld,
for Commercial - Other - Commercial Division
in the District Court of New York County.
Preview
FILED: NEW YORK COUNTY CLERK 06/28/2023 04:17 PM INDEX NO. 451549/2023
NYSCEF DOC. NO. 355 RECEIVED NYSCEF: 06/28/2023
WINSLOW EXHIBIT 38
FILED: NEW YORK COUNTY CLERK 06/28/2023 04:17 PM INDEX NO. 451549/2023
12:54 PM
8/24/22, DOC. Nursing Home Certification Submission System
NYSCEF NO. 355 RECEIVED NYSCEF: 06/28/2023
New York State Department of Health
Bureau of Long Term Care Reimbursement
Division of Finance and Rate Setting
Aug 24, 2022 12 54 PM
BackJ Nursina Home Cost Report » Nursing Home Certification Submission System
Nursing Home Certification Submission System
NEW YORK STATE DEPARTMENT OF HEALTH
OFFICE OF HEALTH SYSTEMS MANAGEMENT
RHCF-4 (4/06) DOH-490
FACILITY: Martine Center for Rehabilitation and Nursing
OPERATING CERTIFICATE NUMBER: 5902317N
REPORT FOR THE PERIOD ENDED: 12/31/2021
DECLARATION CONTROL NUMBER (DCN): 22161318
Operators Certification
The following statement must be read and a certification of such be signed pursuant to Part 86-2.6(a). This subpart states "The Financial
and statistical reports shall be certified by the operator of a proprietary medical facility, an officer of a voluntary facility or the public
official responsible for the operation of a public medical facility". Please enter only one signature.
Certification Statement
Misrepresentation or falsification of any information contained on this form may be punishable by fine and / or imprisonment under New
York State Law and Federal Law.
Certification of Operator
I hereby certify that I am the Operator and have read the above statement and I have examined and compared the information contained
in the RHCF -4 report file with the information provided in my electronically transmitted Department of Health file, DCN identified above,
and that to the best of my knowledge and belief, they are true and complete and that these files are identical.
I also certify that Parts I and II were completed in accordance with the RHCF - 4 instructions and that Part IV was completed in
accordance with the residential Health Care Facility Accounting and Reporting Manual (RHCFARM). I also certify, the Part(s) 111,if
required to be filed as part of this report, was (were) completed in accordance with RHCFARM and the information called for in Part Ill
has been reported for each lender or organization related to the provider as defined in Schedule 16 of Part II.
I also certify that all salary and non-salary expenses presented in the RHCF - 4 (with the exception of those expenses attributable to
Research, Physicians Offices and other Rentals, Gift Shop, Public Restaurant, Fund Raising and Sold Services) considering the
adjustments contained in the Part II and the recoveries of expense detailed in Exhibit I of the Part IV were incurred to provide patient
care in the facility.
AUG 04 2022 05 48 54 PM kr305547
Date Signature
Kenneth Rozenberg
Ope_[iggt
DOH 490 (4/06)
' ' ' ' ' ' ' '
En d of Certification
DCN 22161318 was previously certified by HCS ID kr305547,
https://commerce.health.state.ny.us/hpn/cgi-bin/applinks/rhcfr/cert4.cgi 1/2
FILED: NEW YORK COUNTY CLERK 06/28/2023 04:17 PM INDEX NO. 451549/2023
12:54 PM
8/24/22, DOC. Nursing Home Certification Submission System
NYSCEF NO. 355 RECEIVED NYSCEF: 06/28/2023
Kenneth Rozenberg , ODerator for Martine Center for Rehabilitation and Nursing.
Continue
Nursing Home Cost Report Main Page
https://commerce.health.state.ny.us/hpn/cgi-bin/applinks/rhcfr/cert4.cgi 2/2
Document Filed Date
June 28, 2023
Case Filing Date
June 28, 2023
Category
Commercial - Other - Commercial Division
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FILED: NEW YORK COUNTY CLERK 06/28/2023 04:17 PM INDEX NO. 451549/2023 NYSCEF DOC. NO. 355 RECEIVED NYSCEF: 06/28/2023 WINSLOW EXHIBIT 38 FILED: NEW YORK COUNTY CLERK 06/28/2023 04:17 PM INDEX NO. 451549/2023 12:54 PM 8/24/22, DOC. Nursing Home Certification Submission System NYSCEF NO. 355 RECEIVED NYSCEF: 06/28/2023 New York State Department of Health Bureau of Long Term Care Reimbursement Division of Finance and Rate Setting Aug 24, 2022 12 54 PM BackJ Nursina Home Cost Report » Nursing Home Certification Submission System Nursing Home Certification Submission System NEW YORK STATE DEPARTMENT OF HEALTH OFFICE OF HEALTH SYSTEMS MANAGEMENT RHCF-4 (4/06) DOH-490 FACILITY: Martine Center for Rehabilitation and Nursing OPERATING CERTIFICATE NUMBER: 5902317N REPORT FOR THE PERIOD ENDED: 12/31/2021 DECLARATION CONTROL NUMBER (DCN): 22161318 Operators Certification The following statement must be read and a certification of such be signed pursuant to Part 86-2.6(a). This subpart states "The Financial and statistical reports shall be certified by the operator of a proprietary medical facility, an officer of a voluntary facility or the public official responsible for the operation of a public medical facility". Please enter only one signature. Certification Statement Misrepresentation or falsification of any information contained on this form may be punishable by fine and / or imprisonment under New York State Law and Federal Law. Certification of Operator I hereby certify that I am the Operator and have read the above statement and I have examined and compared the information contained in the RHCF -4 report file with the information provided in my electronically transmitted Department of Health file, DCN identified above, and that to the best of my knowledge and belief, they are true and complete and that these files are identical. I also certify that Parts I and II were completed in accordance with the RHCF - 4 instructions and that Part IV was completed in accordance with the residential Health Care Facility Accounting and Reporting Manual (RHCFARM). I also certify, the Part(s) 111,if required to be filed as part of this report, was (were) completed in accordance with RHCFARM and the information called for in Part Ill has been reported for each lender or organization related to the provider as defined in Schedule 16 of Part II. I also certify that all salary and non-salary expenses presented in the RHCF - 4 (with the exception of those expenses attributable to Research, Physicians Offices and other Rentals, Gift Shop, Public Restaurant, Fund Raising and Sold Services) considering the adjustments contained in the Part II and the recoveries of expense detailed in Exhibit I of the Part IV were incurred to provide patient care in the facility. AUG 04 2022 05 48 54 PM kr305547 Date Signature Kenneth Rozenberg Ope_[iggt DOH 490 (4/06) ' ' ' ' ' ' ' ' En d of Certification DCN 22161318 was previously certified by HCS ID kr305547, https://commerce.health.state.ny.us/hpn/cgi-bin/applinks/rhcfr/cert4.cgi 1/2 FILED: NEW YORK COUNTY CLERK 06/28/2023 04:17 PM INDEX NO. 451549/2023 12:54 PM 8/24/22, DOC. Nursing Home Certification Submission System NYSCEF NO. 355 RECEIVED NYSCEF: 06/28/2023 Kenneth Rozenberg , ODerator for Martine Center for Rehabilitation and Nursing. Continue Nursing Home Cost Report Main Page https://commerce.health.state.ny.us/hpn/cgi-bin/applinks/rhcfr/cert4.cgi 2/2