MIA Management, Inc. Making Assisted Living Affordable

1. MIA Management, Inc. Making Assisted Living Affordable 2003

2. The Aging Demographics of America One out of every eight Americans is 65 years or older. A projected increase of 50% is expected in nine years. In the year 2030, the baby boomers will add 70 million to the 65+ generation in the US, more than double in 1999. This is a first time historical phenomenon that has profound implications. In 1999, the median income of older persons was $19,079 for males and $10,943 for females. It is estimated that in 1999, 3.2 million elders lived below the poverty line. Older women were at the lowest levels of poverty.This population has been neglected by the Assisted Living Facility (ALF) industry. Most of these elders have moved from other states and have no anchors or friends and need someone to coordinate their needed services. Public housing administrators want their older tenants to age in place, but they claim to not have the money, time, or know-how to translate their desires into a reality. MIA Management, Inc. can change this.

3. Investments in Senior Housing and Long Term Care…. • Not-for-profit senior living capital markets remains active in 2001. Lending expected to reach $3 billion at the end of 2002. • Second quarter of 2001, assisted living properties hit a two year low in new construction. • With little increase in supply of new properties, the demand can once again catch up with existing supply. • 89% of the investments in senior housing and long term care were performing satisfactorily with only 0.6% foreclosure. • Occupancy rates in assisted living remain high 85% with 90% of congregate 93% for CCRC. • Source: National Investment Center November 2001 Insider

4. Affordable Assisted Living Can Benefit the Elderly & Taxpayer • In Florida more than half of the elders have incomes of less than $25,000 a year and do not have access to assisted living. They forgo needed services, move away from communities or enter a nursing home. • Over 35% of housing resident elders go into nursing homes because they are no longer able to live by themselves. Nursing homes cost the taxpayer four times more than an Assisted Living Facility (ALF). • Medicaid primarily funds long term care services for low income. The majority of Medicaid funds go to pay the nursing homes. Florida Medicaid budget is about to burst reaching$3 Billion. • Diverting residents from nursing homes into affordable ALF will save the government money. • Source: Business Journal of South Florida

5. The Real Story Private ALFs fail because: • Poor management • Cater only to one market segment in the middle upper Income (a market that is saturated) • Endure law suits trying to cut expenses to make a profit • Expenses are high because they have debt services and receive no tax breaks or subsidies from the government Affordable ALFs succeed because: • They are debt-free, receive subsidies from the federal government and or tax-free financing • Cater to low-income elders that are fastest growing population in the US and are largely neglected • Conversions of existing buildings allows elders to age in place and no vacancy issues • New construction and or acquisition of a building meets the needs of this largely neglected population • Generates new revenue and jobs for residents of public housing • Government is already in the business of catering to this population With no profit incentive, the government can deliver higher quality of services at lower costs….. MIA Management, Inc. has proven results as a exceptional ALF management company

6. The ALF Process MIA Management, Inc. can perform all functions for the client

7. MIA Management, Inc. Solutions Consulting Services - market research, - site identification development, - demand and supply studies, - marketability / feasibility studies, - competition research, - acquisitions and development plans, - workplans, - resident and staff focus groups, - pro forma and financial projections, - costs of conversion, - licensing, - implementation of all systems, - financial procedures, Consulting Services, continued - operation procedures, - outreach plans, - maintenance, - pharmacy and pharmaceutical services, - food services and catering, - activities and services for elders, - aging network consultation, - evaluation and monitoring of projects, - care management for private sector, - hiring and training of all staff, - implementation and management workshops, - aging issues, and lobbying.

8. MIA Management, Inc. Solutions, continued Procedures and ManualsMIA Management, Inc. produces several publications, including all procedure manuals, emergency and safety plans, safety manuals and risk management. Easy and ready to use by any client in the nation. ManagementMIA Management, Inc. management staff FundingIdentification and access to funding streams and Medicaid waiver specialists MIA Management, Inc.SubsidiaryEating Well caters food, including special diets, to Adult Day Care, senior centers, ALF, schools with design of menus and cost benefit analysis.

9. Reasons for our Success - Critical Success Factors Deliver Commitments Manage Risks Minimize Disruptions Support Growth

10. Reason for our Success - Critical Success Factors Deliver Commitments Only consulting company with this expertise, group of associates with wide range of extensive experience in financial brokering investment, lobbying, management, design, evaluation, market research, property and site development, USHUD funding mechanisms and procedures, aging network contacts, experience with Medicaid waivers. Manage Risks MIA Management, Inc. experience in this area means that the clients will minimize risks of being cost effective. Experience also allows for expeditious response to problems and less costly implementation and management costs. Minimize Disruptions Best practices in the business allows MIA Management, Inc. to avoid common problems arising out of the implementation. Contacts with both USHUD, the state governments and aging networks permits MIA Management, Inc. to be more effective and expeditious. Support Growth Extensive market research allows MIA Management, Inc. to predict and guarantee success in a given market. Aware of change preferences and taste of market.

11. MIA Management, Inc. Credentials 50 Staff Members and a cadre of experts in all areas of the elderly marketWrote and lobbied for first project-based Medicaid Waiver in public housingSuccessful writers of First HOPE VI grant of 4.5 Million to Miami Dade Housing AgencyUSHUD Consultants and HOPE VI expeditersDesigned first state-of-the-art assisted living in public housingInnovative management styleProven track record of no staff turnover and lowest client attrition rateRetention of all clients - every project undertaken has been successful in meeting goalsMIA Management, Inc. has never been sued or experienced any lossesSuccessful replication of award-winning modelConsistently creates profitability, full occupancy and jobs for projects once bankrupted

12. MIA Management, Inc. Successful Clients Miami Dade Housing Agency-Helen Sawyer PlazaHousing Authority of Pinellas CountyOrlando Housing AuthorityHousing Authority of TampaHousing Authority of TitusvilleHousing Authority of the City of Fort PierceHousing Authority of Miami BeachHousing Authority of Moundsville, West VirginiaHousing Authority of Williamson West Virginia Wheeling Housing Authority, West Virginia Russell House of Virginia Beach, VirginiaClallam County Housing Authority, Washington State, Clark County, North Las Vegas and City of Las Vegas, Ispheming Housing Authority, Michigan Mayfield Housing Authority, Kentucky. Private Investors Rouse Corporation, TriadDelant Corporation Lobbied dedicated Medicaid waiver funds to all housing authorities in Florida

13. MIA Management, Inc. Client Case Study MIA Management, Inc. was awarded a contract to convert a 1976 unit public housing building into an assisted living facility. The building, the Helen Sawyer Plaza, had 80% vacancy for the last four years and had become an eye soar and a drain on county revenues. Converting public housing into assisted living had never been done before and there were many hurdles that included lack of funding to pay for services and the standardization of the building based on state licensing requirements Challenge MIA Management, Inc. wrote a bill and lobbied the legislature for $1.3 million of Medicaid funding to pay for the services. It was a one time allocation set for five years. MIA Management, Inc. created a conversion model which they called Total Housing Enterprise Model (T.H.E.M) based on vertical integration of all services, innovative management style and multiple steam financing. To license and open the facility, some start-up costs were required and MIA Management, Inc. found the funding and made the facility profitable within three months of opening. Today, Helen Sawyer is the pride and joy of Miami-Dade Housing Authority. It has won five national awards, become the national model and subject of excellent press. Approach • MIA Management, Inc. created the first case of converting public housing into assisted living (Helen Sawyer Plaza) • Helen Sawyer is the national model on public housing to assisted living facility • Profitable assisted living facility within three months of opening • Helen Sawyer has won five national awards Results

14. MIA Management, Inc. Client Case Study Heatherwood Apartments were three cement block buildings built in1969 with 96 units and no sprinklers, air conditioning or alarm systems. Given the bad state of repair, the buildings were mostly vacant. The average age of the authority’s elderly residents was 75 years old and the attrition rate among this population was 55%. Pinellas County has the highest number of elderly in the state of Florida. Most of these elders are poor. There was no private assisted living catering to the poor in the entire county. Challenge MIA Management, Inc. was hired to determine the best use of these buildings and the demand and supply for affordable assisted living units. Funding was needed to provide services. MIA Management, Inc recommended that two of the Heatherwood Apartment buildings be demolished and a new structure be built given the cost involved in converting the two old buildings. The market analysis revealed an acute need for affordable ALF services within the authority and the larger community. Both residents and staff supported the idea. Approach • Apartments were demolished and tax-free bond financing was obtained to build a new state-of-the art ALF due to open in November 2002. • MIA Management, Inc. obtained Medicaid priority funding for services to eligible residents of the new facility. • The ALF is expected to be profitable and at full capacity within three months. Results

15. What Our Clients Have To Say…… "I am very impressed with the facility and the residents that I met.  It is great to see first hand how HUD is working in a positive way to improve people's lives."  Mel Martinez, Secretary U.S. Department of Housing and Urban Development, Washington D.C. “I want to commend you for helping us understand the concept of Assisted Living Facilities which is truly an optimal answer to the needs of a large number of elderly persons. Thanks for everything you do!” Jose Cintron, USHUD Florida State Coordinator “We are fortunate indeed to have hired this firm ad are very satisfied with the level of professionalism, commitment and dedication to results. MIA Management, Inc. has successfully implemented a revolutionary idea of providing high quality services to the frailest, most needy and often forgotten segment of our community – the elderly poor.” Rene Rodriquez, Director Miami-Dade Housing Agency “Miami’s Helen Sawyer Plaza offers low-Income seniors a revolutionary option: The chance to keep their dignity and independence. The secret to Sawyer’s success lies with the energetic duo, Bretos and Ramirez.” The Miami Herald, July 31, 1999

16. What Our Clients Have To Say…… “I strongly believe that MIA Consulting has changed the way poor elders in this country can be served in assisted living. It deserves recognition for taking a bold step and for the tenacity in making sure it was successful.” Max Rothman, Director Florida International University Center on Aging “Public housing authorities in Florida will be able to successfully sidestep the hurdles associated with securing Medicaid waivers. The driving force behind this opening was Coral Gables-based MIA Management, Inc. which has seen the dilemma first-hand. The Housing Research Foundation “Congratulations on receiving two prestigious national awards. These honors clearly indicate the level of overall excellence achieved by you and your staff through your tireless dedication and commitment to a job well done.” Dennis C. Moss, Commissioner Miami-Dade County During the past two years I have felt at peace knowing that my dad was receiving from all of you the service he needed and I was unable to provide. From the bottom of my heart, you have all my blessings and my sincere wish that this program continues to bring tranquility to all seniors and family members like me. Heliana Hernandez, daughter of Sergio Bermudez a Helen Sawyer Plaza resident