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*Prism DHA Lahore Phase 9 Development Update July 2016*
*Prism DHA Lahore Phase 9 Development Update July 2016*
<<< Standing in Prism A Block While Taking Picture *Prism DHA Lahore Phase 9 Development Update* More Pictures Can Be Seen At Lahore Rral Estate Facebook Page Here http://www.lahorerealestate.com/plots-for-sale/prism-dha-lahore-phase-9/ or here https://www.facebook.com/permalink.php?story_fbid=1173455266031331&id=119021218141413 Time to make long term investment again in Prism plots taking advantage of this current taxes confusion buying opportunity. Please dont look for short term. Prism is going to return you most in 3 year from even todays prices that have out performed all other Lahore housing projects in DHA Lahore and all Lahore property market. To buy sell plots here or to get free assessment of your plot you are buying or selling anywhere or stay fully updated on daily bases on development prices trends please leave SMS or a free WhatsApp text message at +16308024186 or +92322492992 . Choudry Mujahid Yasin ( CMY ) +16308024186
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Mazel Tov Furniture Sofas Reviews
- Other Living Room Furnitures:
- Average: 3.9
- High: 5.0
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- Mazel Tov Furniture
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Comments about Mazel Tov Furniture Sofas:
I'm pretty sure thepictured sofa is the North Shore one which happens to be the living room set I purchased. It was a pleasure to do business from start to finish! I find it very stylish and comfortable. The store in my area had it much more expensive. I save a bundle by buying it online!
Comments about Mazel Tov Furniture Sofas:
I dunno if you guys ever heard of this set or this site, but I'm thrilled with it. I'm a secretary for a very well off dermatologist who asked me to pick up some new furniture for the waiting room. The office is pretty modern so this fits in nicely. It's so sleek, and yet so comfortable. Real top notch, being a 100% leather set. I would suggest you look over the color options as there are 5 or 6 of them. For anyone looking for higher end, yet greatly priced set, go with this one(my boss is thrilled with it and me .... ;) )
Comments about Mazel Tov Furniture Sofas:
we put in a big order of furniture from this company. It took over than a month to deliver with a very inflexible delivery schedule. If you miss them, then you will need to wait few more weeks "when the truck is in town again" to get your furniture. So, figure out how much you are saving from this company VS how much you are making per hour, because you will need to take time off from work to sit and wait for the delivery. (not to mention they changed my delivery time frame couple times already) Some of the furniture were damaged (and all of them have scratches). We had to send part of order back and it took another month to get them back.
Comments about Mazel Tov Furniture Sofas:
I have received my order and I am fully satisfied with my purchase. Not only does it look great, my back feels great too. This is due to the fact that I didn't need to work on moving my sofa or setting it up as that all came included FREE with my order!!! Beware of other online furniture companies that'll tell you it's free shipping, as this means free CURBSIDE shipping! I've made that mistake before and after setting up my dining set from that other company, I was sorely disappointed. I almost got a hernia, and I didn't set it up perfectly! On the other hand the sofa was in perfect condition as it was supposed to be, because the pros set it up. Oh, and the delivery time was even shorter than I anticipated. I will not hesitate to recommend Mazel tov furniture to friends and colleagues from here on out.
Comments about Mazel Tov Furniture Sofas:
I've had my fair share of ugly consumer transactions, both over the web and in person, and I think they all should go to mazel tov furniture for a lesson on how to conduct buisiness. Although the name of the website was a bit hard for me to pronounce, that is where the difficulty stopped. Really a pleasure to deal with, great prices, and good quality pieces. Setup guys were proffesional and quick. **A+ **
Comments about Mazel Tov Furniture Sofas:
I was a little anxious to buy furniture through the internet with a company, but I was amazed by service, Mazel tov furniture's professionality, their speed and the promises that they kept. I had my Sofa, brand-new and genuine, within a week after placing the order, so I'm very satisfied and I surely will buy again through this shop.


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|Half Baths
|Property type
|Minimum Stay
|7 nights
Beautiful Villa Mango was built in 2000 and newly furnished in 2013. Villa Mango is located at the desirable Northwest side of Bradenton, Florida, a 10 minute drive to Anna Maria Island!
Step into an open floor plan with plenty of room for the entire family to spread out and enjoy their vacation in their own space. Warm and inviting, the high end finishes, top of the line decor, and cathedral ceilings will make this vacation home experience an unforgettable one, for sure!
While the dining options in Bradenton and Anna Maria Island are superb, the modern kitchen, equip with all the comforts of home may just make you second guess not wanting to cook while on vacation! Enjoy breakfast seated at the breakfast bar, lunch at the pool side table, and share some memories at the gorgeous dining room table.
Villa Mango is set up for all of your entertainment needs with cable and wifi internet throughout. Perfect for posting beautiful vacation photos for everyone to see!
There are three seriously comfortable bedrooms, each with king beds. Sleep deeply after a day in the Florida sun and wake up refreshed and ready for a new day of adventure! Adding to the luxury experience, there is a full master ensuite, another large bathroom off the two guest bedrooms, and another half bathroom perfectly placed right by the pool!
Mango's pool is the heart of the property! Screened in to protect our guests from Florida's smallest little pests, the pool area has sun loungers, a gas grill, and a dining table to make this the perfect spot to spend so much of your vacation outdoors!
A utility room provides a washing machine and a dryer.
Villa Mango is in a PRIME, very upscale neighborhood where location is EVERYTHING. Close to the beach, yes... but a short bike ride or hike to Robinson's Preserve is a MUST DO while staying at Villa Mango! Bring your camera for some of the most breathtaking scenes nature has ever acted out at this well preserved wildlife area. Plan dinner at Pier 22, directly on the Manatee River and get a glimpse of some of the most spectacular boats you'll ever see!Take in a show at the brand new performing arts building, and take the kids to experience the Bradenton Riverwalk!
Plan the vacation that has a little something for everyone!
Wir haben 16 wundervolle Tage in dieser tollen Villa verbracht! Es fehlte an nichts, alles ist vorhanden! Zum zweiten Mal haben wir bei Island Dreams gebucht, alles hat perfekt geklappt, sehr zu empfehlen! Die Gegend finden wir persönlich sehr schön, typisch amerikanische Villensiedlung, in der man sich sofort wohlfühlt, zum Strand und zum Shoppen ist es nicht weit. Die Rahmenbedingungen für einen tollen Urlaub sind zu 100% gegeben!
Beautiful home, great location. Would definitely stay here again.
Villa Mango is a very nice place, located in a dead-end street with no traffic. The house was very clean and the kitchen was amazing - huge and very well equipped. The location was perfect, less than 20 minutes to Anna Maria Island. The patio with the pool size is fairly good, but less impressive as the house itself.
Villa Mango is a very nice place, located in a dead-end street with no traffic. The house was very clean and the kitchen was amazing - huge and very well equipped. The location was perfect, less than 20 minutes to Anna Maria Island. The patio with the pool size is fairly good, but less impressive as the house itself.
Beautiful home, great location. Would definitely stay here again.
We love the house there was lots of room for everyone. The screened in pool was a lot of fun. Everything in the house was top quality. We would have rented for next year if not already booked.
Welcome to beautiful northwest Bradenton! Be sure to check out Robinson Preserve, downtown Bradenton, and of course Anna Maria Island!
|Rate Period
|Weekend Night
|Monthly *
Sep 5 2016 - Dec 14 2016
7 night minimum stay
My Standard Rate
7 night minimum stay
|Damage Waiver
|$50 + Tax
|Professional Cleaning
|$160 + Tax
|Booking Fee
|$48 + Tax
|Tax Rate
$500 Down Payment at time of reservation. Balance due 30 days prior to arrival.
$500 Anzahlung mit Buchung. Restbetrag fällig 30 Tage vor Anreise.
* Approximate monthly rate. Actual rate will depend on the days of the month you stay.


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Having undesirable fat in numerous areas of your body can have a substantial effect on your health and self-confidence. While traditional weight reduction through workout and diet is an excellent way to drop weight in general, even the very best workouts cannot target problem areas like the tummy, inner thighs, arms, and buttocks. Liposuction is a time evaluated treatment that is utilized to remove excess fat from particular locations of the body, permitting an individual to shape and contour their body to their preference. Is liposuction right for you? Find out now.
Pros of Liposuction
There are many benefits to this cosmetic procedure, including:
• Right away obvious changes. Unlike conventional weight-loss, liposuction produces modifications that are right away noticeable in the body. Some distinction is visible right away, and the preferred outcomes are usually achieved in just a couple of days.
• Proven and safe. This cosmetic treatment has actually been performed by seasoned cosmetic surgeons all over the world for many years and the technique has been refined over and again to be safe and reliable.
• Recovery time is usually fast. The downtime needed after having this kind of treatment is generally much less than what is needed for other kinds of cosmetic treatments, consisting of abdominoplasty, breast reduction, and more. Individuals who have had the procedure can frequently go back to work far more rapidly than they prepared for and can return to living a healthy, active lifestyle.
• Weight reduction can be irreversible. With the ideal maintenance techniques, the fat that was gotten rid of throughout the liposuction procedure will not return.
• Complete control over your physique. With liposuction, an individual can have complete control over how they want to look, beyond what conventional diet and exercise can provide. Providing people this power over their bodies increases self-confidence and assistance individuals feel their best.
While there are numerous advantages to liposuction, there are naturally a couple of cautions that should be taken into account before making the final decision to move forward with the treatment.
Cons of Liposuction
Before having actually liposuction done, it is necessary to analyze the potential disadvantages of the treatment and identify if the advantages surpass the threats in your particular case. Your specialist can assist you learn more about the dangers related to the procedure and can assist you decide if moving on is the right thing for you.
• Problems with basic anesthesia. Since liposuction is performed under basic anesthesia, the procedure brings the exact same threats as any other kind of surgical treatment where general anesthesia is utilized. Underlying medical conditions may enhance these threats.
• Unfavorable reactions. Bruising, bleeding, and pain are all to be anticipated, nevertheless, in unusual cases can cause more substantial issues.
• The potential to acquire the weight back. After having liposuction done, it is crucial to maintain a healthy diet plan and workout appropriately as advised by your doctor. Failure to do so might cause acquiring back the weight that was lost or potentially much more.
There are dangers associated with liposuction, for many people, the benefits far surpass them. Inform yourself about the procedure by having extensive conversations with your surgeon and consider how liposuction has the potential to impact you as a special person. Just you and your cosmetic surgeon can figure out if liposuction will offer you with the results you are looking for within your expectations.
Laser Liposuction procedure is a new non invasive procedure to loose unwanted bodyfat in Artesia New Mexico
Laser liposuction is a more recent, minimally intrusive procedure that involves heating the fat cells to melting point and getting rid of the melted fat through a small cannula. The treatment is generally done right in your doctor's workplace and is an outstanding choice for individuals who have less than 500 ml of fat to get rid of from any one location. Laser liposuction can be a safe, complementary treatment to weight-loss in order to shape the body you have actually constantly wanted.
Contact a Surgeon in your Artesia New Mexico today.
If you're thinking about liposuction as a weight loss solution, it is essential that you discuss your desires with a certified cosmetic surgeon in your area. Your specialist will perform a total exam and health history questionnaire to figure out if liposuction can benefit you and help you reach your physical and emotional objectives. Call today for a consultation and find out more about how liposuction can help you achieve the body of your dreams.


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To show you the most accurate prices, TTPM only displays our pricing tool on products which we've reviewed in the past three years.
With the Barbie Puppy Play Park, a clap of Barbie's hands sends her two dogs in motion, sliding down the slide and pushing around a ball in the play park. Just press the button on Barbie's back, and the doll's hands move together in a clap. When the button is pushed, it also activates a "clapping" sound, and the sound is what activates the dogs. As you might expect, kids can also clap their hands to activate the dogs.
Press the button on the front of the big dog to turn it on. (Press it again to turn it off.) When they register a clapping sound, the dogs will move around for about five seconds. The sound activates the big dog, but the small dog cannot move on its own. To have both dogs moving, you can attach the two dogs via clips underneath them either side by side or with the big dog in front and the small dog in back.
Barbie fans will like the "magic" of making the dogs move. Whether or not girls have dogs in their home, this cute playset lets girls pretend to take care of and play with dogs along with Barbie.
The play park itself is kind of small, so the dogs don't have far to go until they hit an obstacle. The dogs do not have the ability to bounce off an obstacle and turn around, so kids will frequently be picking up the dogs and turning them around. It might be more fun to play with the dogs outside of the play park.
The Barbie Puppy Play Park is for ages 3 and up.
Assembly is required. It takes about 10 minutes to put together.
Two AAA batteries are required but not included.
This product is not for use on loose dirt or wet surfaces.
2 AAA batteries required
SpacePOP Luna
from Madame Alexander
SpacePOP Athena
from Madame Alexander
SpacePOP Juno
from Madame Alexander
SpacePOP Hera
from Madame Alexander
SpacePOP Rhea
from Madame Alexander
Barbie Made to Move Soccer Player
from Mattel
Shibajuku Girls Suki
from Hunter Products
Shibajuku Girls Namika
from Hunter Products
Barbie Made to Move
from Mattel
from Lammily LLC


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June 27, 2005
MILTON HOSPITAL TRANSITIONAL CARE UNIT, PLAINTIFF,v.TOMMY THOMPSON, DEFENDANT.
The plaintiff, Milton Hospital Transitional Care Unit ("Milton"), a skilled nursing facility located on the campus of Milton Hospital in Milton, Massachusetts, brings this action pursuant to the Administrative Procedure Act ("APA"), 5 U.S.C. § 701 et seq., to overturn a decision by the Secretary of the Department of Health and Human Services ("Secretary"), denying Milton a "new provider exemption" under Medicare regulation 42 C.F.R. § 413.30(e) (1997). Complaint ("Compl.") ¶¶ 1, 5. Currently before the Court are the Plaintiff's Motion for Summary Judgment ("Pl.'s Mot."), the Defendant's Motion for Summary Judgment ("Def.'s Mot."), and the parties' oppositions thereto.*fn1 For the reasons that follow, this Court will grant the plaintiff's motion, and deny the defendant's motion.
I. Background
A. Regulatory Background
To better understand the dispute in this case, it is helpful first to set forth the regulatory scheme which is at issue here.*fn2
(1) Federal Regulatory Scheme
Title XVIII of the Social Security Act established a system of health insurance for the aged and disabled, which is commonly referred to as the Medicare Program. See 42 U.S.C. § 1395 et seq. The Medicare Program is administered by the Secretary through the Centers for Medicare and Medicaid Services ("CMS"), formerly known as the Health Care Financing Administration ("HCFA"). St. Elizabeth's Med. Ctr. of Boston v. Thompson, 396 F.3d 1228, 1230 (D.C. Cir. 2005). Under the Medicare Program, a facility meeting the requirements of a skilled nursing facility ("SNF") can receive reimbursement for the "reasonable costs" it incurres for certain inpatient hospital and post-hospital extended care services provided to Medicare beneficiaries, subject to certain cost limits under 42 U.S.C. §§ 1395c, 1395d, 1395i, 1395x(b), (i), 1395yy(a) and 42 C.F.R. § 413.30 (1997).*fn3 "Seeking to encourage Medicare-certified provides to operate efficiently, Congress has instructed the Secretary . . . to cap payments under these programs at what he determines to be reasonable cost limits . . . and apply statutory norms in the determination." St. Elizabeth's, 396 F.3d at 1230 (internal citations omitted). A "reasonable cost," as applied to routine service and ancillary service costs at a freestanding SNF,*fn4 is 112% of the adjusted average amount of per diem routine service costs incurred by similar SNFs nationwide, adjusted to the prevailing wage rates of SNFs in the area. 42 U.S.C. § 1395yy(a). Any amount above a reasonable cost is deemed to be "unnecessary in the efficient delivery of needed health services" and is therefore disallowed. 42 U.S.C. § 1395x(v)(1)(A).*fn5 Thus, costs exceeding the reasonable costs cap are deemed unreasonable and are not reimburseable. Id. However, the Secretary can provide exemptions from that cap, 42 U.S.C. § 1395yy(c), and this has been done by establishing a "new provider exemption," which "allow[s] a provider to recoup the higher costs normally resulting from low occupancy rates and start-up costs during the time it takes to build its patient population," Paragon Health Network, Inc. v. Thompson, 251 F.3d 1141, 1149 (7th Cir. 2001) (internal quotation marks omitted). This exemption lasts until "the end of the provider's first cost reporting period beginning at least two years after the provider accepts its first patient." 42 C.F.R. § 413.30(e) (1997). Specifically, the new provider exemption in effect at the time Milton sought the exemption provided:
Exemptions from the limits imposed under this section may be granted to a new provider. A new provider is a provider of inpatient services that has operated as the type of provider (or the equivalent) for which it is certified under Medicare, under present and previous ownership, for less than three full years.
Id. Thus, to qualify for the new provider exemption, a facility must show that it is either (1) new, or (2) operating for the first time as a SNF or equivalent. It follows logically that facilities that (1) have operated before under "present or previous ownership," and (2) have operated as a SNF or equivalent, cannot qualify as "new providers."
St. Elizabeth's, 396 F.3d at 1231 (emphasis in original).*fn6 As the District of Columbia Circuit has recognized, "[t]here is no definitive court precedent as to what it means to operate as a SNF or its equivalent," and there is a split in the various United States Court of Appeals "over whether it is reasonable for CMS to attribute operation under previous ownership to a newly opened SNF solely because it acquired such rights" from another facility as required under state law. Id.
(2) Massachusetts' Regulatory Scheme
The Commonwealth of Massachusetts regulates health care facilities in its jurisdiction, in part, by issuing a Determination of Need ("DON"). A DON functions to ensure that "adequate health care services are made reasonably available to every person in the [Commonwealth] at the lowest reasonable aggregate costs," and does so by regulating the construction, relocation, and expansion of health care facilities. See Mass. Regs. Code tit. 105, § 100.532. Prior to beginning construction on a health care facility, the owner of that facility must first obtain a DON from the Massachusetts Department of Public Health, indicating that there has been a determination that there is a need for such a facility. Mass. Gen Laws. ch. 111, § 25C. Since 1992, Massachusetts has imposed a moratorium on DON applications for new nursing facility beds; thus, to obtain such a right, a facility must first acquire an existing nursing facility or transfer ownership of an unimplemented project, and then request that a DON be transferred to the new facility or location. Def.'s Mem. at 8-9. In addition, any nursing facility must be licensed as either a level I, II, III, or IV facility in order to operate in the Commonwealth. Pl.'s Mem. at 7-8.
B. Factual Background
Milton is a 20-bed hospital-based SNF located on the campus of Milton Hospital in Milton, Massachusetts. Administrative Record ("A.R.") at 2. In 1994, Neponset Hall, Inc. ("Neponset") owned and operated two licensed nursing homes-Neponset Hall Nursing Home and Ashmont Manor Nursing Home-with a total of 175 beds in Dorchester, Massachusetts. Id. at 675, 698. The Neponset nursing homes were Medicaid-certified as "nursing facilities." Id. at 3. On July 20, 1994, Neponset received a DON from the Massachusetts Department of Public Health "for new construction to replace and relocate" Neponset's two nursing homes into a single facility with 187 beds to be located in Milton, Massachusetts. Id. at 675. In order to open its own facility on the campus of Milton Hospital, Milton agreed on September 23, 1994, to purchase a 20-bed portion of Neponset's DON authorization for the new construction for $400,000 in order to transfer the beds to Milton's new facility. Id. at 698. In a letter to Neponset dated October 28, 1994, the Massachusetts Department of Public Health indicated that Milton's transfer request would be granted. Id. at 709-10. Subsequently, in December 1995, the Massachusetts Department of Public Health informed Neponset that because the "transfer will occur before the replacement facility is constructed, . . . [the transfer] must be associated with an actual decrease in the number of originally licensed beds, rather than a decrease in not yet licensed beds." Id. at 1232 (emphasis in original). The final plans for Neponset's replacement facility-Marian Bay Skilled Nursing and Rehabilitation Center ("Marina Bay")-were not approved until June 3, 1999. Id. at 114. However, on January 9, 1995, the Massachusetts Department of Public Health had notified Milton that its architectural plans had been approved, id. at 1235-36, and that Milton's licensure would be contingent upon the "prior or simultaneous delicensure of beds" at Ashmont Manor and/or Neponset Hall, or the "prior or simultaneous delicensure of 20 beds at the facility resulting from the completed consolidation" of Ashmont Manor and Neponset Hall. Id. at 1237. On May 1, 1995, Milton's received a license to operate a 20-bed nursing facility. Id. at 2795. On that same date, the Massachusetts Department of Health "permanently eliminated 20 level III beds" at the Neponset Hall facility. Id. at 3209. Milton also admitted its first patient on that same day. Id. at 2, 74, 2799.
On May 12, 1996, Milton was certified to receive Medicare payments, id. at 2, 74, 2797-98, and on June 2, 1995, submitted a request for an exemption from the SNF routine service cost limits as a new provider, id. at 2797-2801. On November 20, 1995, the CMS denied Milton's request for a new provider exemption. Id. at 623-27. Milton appealed this decision to the Provider Reimbursement Review Board ("PRRB"), id. at 631-32, which reversed CMS's denial of Milton's request, id. at 73-128. However, on December 3, 2002, the Administrator of the CMS ("Administrator"), on behalf of the Secretary, reversed the PRRB's decision, concluding that the "CMS correctly determined that the Provider in this case did not meet the criteria . . . for the new provider exemption." Id. at 12.
The gravamen of the Administrator's decision was that the "transfer of operation rights [from Neponset to Milton of the 20-beds] constitutes a change of ownership transaction for purposes of determining whether the Provider qualified for an exemption as a new provider." Id. at 11. Thus, the Administrator determined that because Milton acquired the rights to the beds from Neponset, it had effectively operated previously under different ownership. Moreover, the Administrator concluded that the record shows that the prior owner of the beds [Neponset], as a [nursing facility], was a Medicaid certified Nursing Facility, and had provided skilled nursing and related services for more than three years prior to the transfer of ownership. Thus, the prior owner was clearly an equivalent provider of skilled nursing and/or rehabilitative services for more than three years.
Id. In addition to being a Medicaid-certified nursing facility, which the Administrator posits mandates a conclusion that Neponset was a nursing-facility, the Administrator found that Neponset was "clearly an equivalent provider of skilled nursing and/or rehabilitative services for more than three years." Id. In support of this conclusion, the Administrator noted that there is "evidence in the record from a CMS database maintained to track the kinds of services provided by health care facilities," which indicates that Neponset was providing skilled nursing services. Id. at 11-12. Accordingly, the Administrator concluded, based upon the change of ownership of the rights to the beds, that Milton had operated under "present or previous ownership," as a SNF or its equivalent. Id. at 12.
Milton now appeals the Administrator's final agency action, alleging that it was not supported by substantial evidence in the record and that it was arbitrary and capricious, an abuse of discretion, and otherwise not in accordance with the law in violation of the APA. Compl. ¶¶ 31, 37.
C. St. Elizabeth's Med. Ctr. v. Thompson Opinion
Before this Court had the opportunity to resolve the dispositive motions in this case, the District of Columbia Circuit was presented with a case with nearly identical issues. Accordingly, this Court, with the consent of the parties, stayed the proceedings in this case until the District of Columbia Circuit resolved the case before it, which it has now done. In that case, St. Elizabeth's, in 1996, purchased operating rights from an existing nursing home-Friel Nursing Home-in order to open a transactional care unit. St. Elizabeth's, 396 F.3d at 1231. The "sole purpose" of the purchase was to obtain a DON from the Massachusetts Department of Public Health, which was required at that time under state law, to open a new nursing facility. Id. St. Elizabeth's transactional care unit qualified as a SNF under the Medicare statute, and in January 1997, St. Elizabeth's applied to the CMS for a new provider exemption for its new facility. Id. at 1231-32. The CMS denied St. Elizabeth's request "on the basis that (1) the [transactional care unit] 'was established due to the purchase and relocation of 29 long term care beds . . .' which, (2) as a Medicaid-certified nursing facility ("NF"), provided the same 'type of services' as the [transaction care unit]." Id. at 1232. In essence, the "CMS determined that because the [transactional care unit] acquired operating rights from Friel, it in effect operated previously under other ownership. Further, the CMS determined that Friel's status as a [Medicaid-certified] nursing facility qualified it as a SNF or its equivalent." Id. This decision was later reversed by the PRRB. Id. However, in December 2002, the Secretary, acting through the CMS Administrator, reversed the PRRB's decision concluding that St. Elizabeth's "did not qualify for the new provider exemption because (1) the fact that it was opened using operating rights acquired from Friel meant it had already been in operation under prior ownership, and (2) Friel 'was an equivalent provider of skilled nursing and/or rehabilitative services.'" Id. at 1233. St. Elizabeth's filed suit in the district court, which affirmed the Secretary's decision. Id. at 1232.
On appeal, the District of Columbia Circuit reversed "on the basis that the Administrator lacked substantial evidence to conclude that Friel operated as a SNF or its equivalent." Id. at 1232-33. Thus, St. Elizabeth's was entitled to a new provider exemption. Id. at 1233. In reaching its decision, the Circuit Court noted that "[u]nder the terms of the governing regulation, both [of the Secretary's conclusions] had to be made to disqualify the [transactional care unit] from the exception," and that the Administrator addressed only the second conclusion-the equivalency of the providers. Id. at 1233. Moreover, the Circuit Court rejected the Secretary's position that St. Elizabeth's and Friel were equivalent because "Friel was a Medicaid-certified NF and operated as such." Id. at 1233. First, the Court compared the statutory definitions of a nursing facility under the Medicaid statute*fn7 with a skilled nursing facility under the Medicare statute,*fn8 and concluded that while "the range of services provided by a NF can encompass skilled nursing or rehabilitative care" and that some facilities may be qualified as both NFs and SNFs, "a facility must be primarily engaged in providing skilled nursing or rehabilitative care to qualify as a SNF, whereas a facility need not even offer such services at all to qualify as a NF." Id. at 1234 (emphasis in original). Thus, the Court concluded that "the bare fact [that] an institution has gained NF status or is operating as a NF, without more, is not sufficient to qualify the NF as a SNF or its equivalent." Id. Moreover, the Court noted in St. Elizabeth's that "[t]he record evidence is all to the effect that Friel was primarily engaged in providing custodial care to its residents . . . not . . . that Friel was primarily engaged in providing skilled nursing and/or rehabilitative services." Id. Accordingly, the Court concluded that the Secretary's equivalency determination lacked substantial evidence in the record and had to be overturned. Id.
II. Standard of Review
Judicial review of a decision rendered by the Secretary is governed by the standards established by the Administrative Procedure Act ("APA"), 5 U.S.C. § 701 et seq. Thomas Jefferson Univ. v. Shalala, 512 U.S. 504, 512 (1994). Under the APA, a court can set aside an agency action if the court finds the action to be "arbitrary, capricious, an abuse of discretion, or otherwise not in accordance with the law." 5 U.S.C. § 706(2)(A). Similarly, a Court should set aside any agency decision issued on the basis of an evidentiary hearing record if the agency decision is "unsupported by substantial evidence" in the record. 5 U.S.C. § 706(2)(E).
A court must give substantial deference to an agency's interpretation of its own regulations, Bowles v. Seminole Rock & Sand Co., 325 U.S. 410, 414 (1945), and that interpretation "must be given 'controlling weight unless it is plainly erroneous or inconsistent with the regulation'" itself, Thomas Jefferson, 512 U.S. at 512 (quoting Bowles, 325 U.S. at 414). Under this test, a court must defer to an agency's interpretation of a regulation unless an alternative reading is "compelled by the regulation's plain language" or, if the language is ambiguous, by "other indications of the Secretary's intent at the time of the regulation's promulgation." Id. Accordingly, if the language of a regulation does not "speak[] clearly 'to the precise question at issue'" in a case, "say[ing] nothing explicitly about" the specific matter in dispute, the court must give substantial deference to the agency's resolution of the resulting ambiguity. Barnhart v. Walton, 535 U.S. 212, 217-19 (2002). The court's task then is "not to decide which among several competing interpretations best serves the regulatory purpose;" rather, the court's limited role is to set aside only those agency interpretations that affirmatively are plainly "inconsistent" with the regulation itself. Thomas Jefferson, 512 U.S. at 512. The Supreme Court has recognized that this heightened deference is particularly warranted in the Medicare context because of the complex and highly technical nature of the program, where "the identification and classification of relevant 'criteria necessarily require significant expertise and entail the exercise of judgment grounded in policy concerns.'" Thomas Jefferson, 512 U.S. at 512.
III. Legal Analysis
In this case, this Court is asked to review the decision of the Administrator, made on behalf of the Secretary, denying Milton's request for a new provider exemption following an administrative hearing. A.R. at 1-13, 232-458. As already discussed, to uphold this decision, this Court must conclude that there was substantial evidence in the record to support both (1) that Milton operated previously under "present or previous ownership," and (2) that the Neponset facilities operated as a SNF or its equivalent. St. Elizabeth's, 396 F.3d at 1231. Adhering to the guidance provided by the Circuit Court, this Court will also begin its analysis by addressing the Administrator's second argument.*fn9
(A) Did the Neponset Facilities Operate as a SNF or its Equivalent?
In deciding the equivalency issue, the Administrator found that the record shows that the prior owner of the beds, as a NF, was a Medicaid certified Nursing Facility, and had provided skilled nursing and related services for more than three years prior to the transfer of ownership. Thus, the prior owner was clearly an equivalent provider of skilled nursing and/or rehabilitative services for more than three years.
A.R. at 11. To support this conclusion, the Administrator relied on (1) his interpretation of the statutory and regulatory definitions of a Medicaid-certified NF and a Medicare-certified SNF, and (2) the evidentiary record. A.R. at 11-12. First, the Administrator noted that the nursing home reform provisions of the Omnibus Budget Reconciliation Act of 1987 established a uniform certification standard for both Medicare-certified SNFs and Medicaid-certified NFs. Id. at 11. Thus, the Administrator concluded that under this uniform standard, both SNFs and NFs "are required to provide directly or indirectly, the same basic range of services." Id. Thus, the Administrator found that "the fact that the prior owner of the DON rights was a NF supports the conclusion that it was clearly an equivalent provider of skilled nursing and/or rehabilitative services for more than three years." Id. In addition, the Administrator noted that a report from a CMS database makes clear that the following services were provided at the Neponset facilities: "indwelling and external catheters, bowl and bladder training, care of pressure ulcers, respirator care, trach care, special rehab services, injections and tube feeds," which he seems to conclude are skilled nursing or rehabilitative services. Id. at 11-12 & n.12.
Now, the defendant advances three arguments to support the Administrator's decision. In addition to the aforementioned mentioned legal argument and the alleged evidentiary support in the CMS database report, A.R. at 774-77, the defendant relies heavily on the Management Minutes Questionnaires and Management Minutes Questionnaire Turnaround Documents (collectively "MMQ"), which are included in the administrative record. Def.'s Supp. Mem. at 4; A.R. at 1317-2706. The MMQ is used on a quarterly basis by the Massachusetts Medicaid program to catagorize patients based on the care provided to them in order to determine a reimbursement rate for each patient in a facility. A.R. at 1273-74. The MMQ documents the services provided to each Medicaid-eligible patient, and looks at, among other services, certain "skilled" services. A.R. at 1276, 1278, 1283-84. Contrary to the defendant's argument, however, for the following reasons, the record lacks substantial evidence to support the conclusion that Neponset operated as a SNF or its equivalent.
(1) The Administrator's Legal Argument
First, the Circuit Court in St. Elizabeth's clearly rejected the Administrator's legal conclusion that because SNFs and NFs are established under uniform certification standards, NFs are the equivalent to SNFs. In fact, the Administrator's legal conclusion in this case is identical, word-for-word, to the legal conclusion reached by the Administrator in St. Elizabeth's and rejected by the Circuit Court. Compare A.R. at 11, with St. Elizabeth's, 396 F.3d at 1233. The Circuit Court, when comparing the statutory definitions of both a Medicaid-certified NF and a Medicare-certified SNF, noted that "a facility must be primarily engaged in providing skilled nursing or rehabilitative care to qualify as a SNF, whereas a facility need not even offer such services at all to qualify as a NF." St. Elizabeth's, 396 F.3d at 1234 (emphasis in original). Thus, as the Circuit Court held, "the bare fact that an institution has gained NF status or is operating as a NF, without more, is not sufficient to qualify the NF as a SNF or its equivalent." Id. Accordingly, the defendant's equivalency argument, without more, does not support the Administrator's decision.*fn10
(2) The Administrative Record
The Circuit Court in St. Elizabeth's made clear that courts must look beyond the label carried by a facility, but instead must assess the services actually provided by that facility. Thus, to be qualified as an SNF or its equivalent, the institution must be "primarily engaged in providing to residents" skilled nursing care and rehabilitative services. 42 U.S.C. § 1395i-3(a). While an NF can provide such services, it does not need to do so in order to qualify as a NF, so long as on a regular basis it primarily provides "[h]ealth-related care and services to individuals who because of their mental or physical condition require care and services (above the level of room and board) which can be made available to them only through institutional facilities . . . ."
42 U.S.C. § 1396r(a). Therefore, while a NF can be the equivalent of an SNF if it provides skilled nursing and rehabilitative care, it is not the equivalent if it only provides, for lack of a better phrase, "custodial care." See St. Elizabeth's, 396 F.3d at 1234. Accordingly, the Court must turn to the administrative record to determine if there is substantial evidence in the record to support the Administrator's decision. As previously discussed, the defendant alleges that the information from the CMS database and the MMQs supports the conclusion that Neponset was operated as a SNF or its equivalent. Def.'s Mem. at 35; Def.'s Supp. Mem. at 4-7. The defendant's argument, however, simply misses the mark.
(a) The CMS Database Report
The CMS database report, A.R. at 774-77, identifies four dates during which a survey was completed at Ashmont Manor documenting the number of times particular services were provided to patients. Id. This survey represent particular points in time when the survey was conducted, and does not represent data from an ongoing reporting system. A.R. at 308 (Julie Stankiivic deposition). After reviewing the report, the Administrator concluded that the Neponset facilities were providing the following services: "indwelling and external catheters, bowl and bladder training, care of pressure ulcers, respirator care, trach care, special rehab services, injections and tube feeds." Id. at 11-12 & n.12. However, after reviewing the CMS database report, this Court cannot conclude that the report supports the Administrator's conclusion that the Neponset facilities operated as the equivalent of a SNF.
The data contained in the CMS database report relied on by the Administrator is limited to Ashmont Manor, which constitutes roughly one-half of the total beds at the two Neponset facilities, and captures the services provided at those facilities only at limited, distinct periods of time.*fn11 A.R. 308, 774-76. This report fails to support the Administrator's ruling for a number of reasons. First, the beds that were transferred from the Neponsent facilities to Milton came from Neponset Hall, not Ashmont Manor. A.R. at 3209 (letter from department of Health and Human Services notifying Neponset that it has eliminated 20 beds at Neponset Hall on the same date that Milton became licensed for 20 beds). Thus, because this report's data is limited to a different facility, it provides no support whatsoever for the Administrator's ruling. Nevertheless, even if this Court were to conclude that the same type of services were provided to patients in Neponset Hall in the same numbers, this report simply represents the type of services that were performed at these discrete, annual points in time. A.R. at 308. There is no evidence that these services were being provided on an ongoing or regular basis. Thus, the CMS database report simply does not support the conclusion that the Neponset facilities were primarily engaged in skilled nursing or rehabilitative services. Rather, at most, the report demonstrates that Ashmont Manor was engaged in some skilled nursing services on the days the survey data was collected.
In any event, even if this Court were to assume that the CMS database report represents the types of services performed at Neponset Hall, or the Neponset facilities collectively, and that the services reflect the type and number of services conducted on a regular basis during the three year "look back period"*fn12 when the data was collected, the information in that report does not support the conclusion that the facility was primarily engaged in providing skilled nursing or rehabilitative services, or anything more than the delivery of health-care related services. First, even assuming that each entry of a health-care services on the CMS database represents a skilled-nursing service, and each entry represented such a service to a different patient (as opposed to one patient receiving multiple services), only 45% of the residents at Ashmont Manor received such services in 1993 and 31% in 1994.*fn13 Pl.'s Supp. Mem. at 12. Because the data shows that such services were provided to less than half of the residents, it fails to demonstrate that Ashmont Manor was primarily engaged in providing skilled nursing or rehabilitative services. Accord, Chao v. Rocky's Auto, Inc., 2003 WL 1958020 (10th Cir. April 25, 2003) (noting that by regulation "primarily engaged" means devoting "over 50 percent of the salesman's . . . time" to "selling or servicing the enumerated vehicles."); Donovan v. Bereuter's Inc., 704 F.2d 1034, 1038 (10th Cir. 1983); Lindenberg v. Dep't of Justice, 657 F. Supp. 154, 159 (D.D.C. 1987).
In addition, based upon the paucity of information contained in the CMS database report, this Court cannot even assess whether the services provided to patients were skilled nursing and rehabilitative services, or were merely health-related care services provided in an institutional setting. In fact, according to Medicare regulations, many of the services listed in the CMS database report can be provided as either skilled or unskilled services. For example, the CMS database report lists as a service, services provided to residents related to catheters. And the column, labeled "Cont. Cath." includes both indwelling catheters, as well as an external catheter, and requires the individual completing the form to count the number patients that maintain continence with some type of catheter. A.R. at 308, 771. First, the descriptions of catheters in the CMS instructions does not define a service provided by a nursing facility, rather it defines and classifies patients, those with catheters. Id. Second, even if this designation constitutes a service provided to a patient, there is simply no way to know whether that service is skilled or unskilled. Specifically, "[r]outine services to maintain satisfactory functioning of indwelling bladder catheters" is an unskilled services, 42 C.F.R. § 409.33(d)(3), while "[i]nsertion and sterile irrigation and replacement of suprapubic catheters" is a skilled nursing service, 42 C.F.R. § 409.33(b)(4). In fact, Julie Stankivic, testifying on behalf of the intermediary for the plaintiff's application to the defendant,*fn14 acknowledged that it was not possible to determine whether the CMS database report was identifying skilled or unskilled services when it referenced the use of catheters. A.R. at 318. This witness made a similar concession regarding the respiratory treatment category services, noting that the patients could have been receiving either skilled or unskilled services. Id. at 320. Another example further illustrates this point. The CMS database report lists as a category "Skin Pres Sore," or skin pressure sores. A.R. at 774. While "[t]reatment of extensive decubitus ulcers" is a skilled nursing service, 42 C.F.R § 409.33(b)(6), "[p]rophylactic and palliative skin care, including bathing and application of creams, or treatment of minor skin problems" is not a skilled nursing service. 42 C.F.R. § 409(d)(5). On this record, it is clear that the CMS database report provides no support for the Administrator's conclusion that the Neponset facilities operated as a SNF or its equivalent, as the record evidence does not support a finding that Neponset was primarily engaged in providing skilled nursing and/or rehabilitative services.
(b) MMQ Documentation
The Secretary, in his supplemental briefs that have been filed with this Court, also relies heavily on the MMQs*fn15 to support his conclusion that Neponset operated as a SNF or its equivalent. Def.'s Supp. Mem. at 4-7. MMQs are "required for all new Medicaid . . . residents at the time of admission to the facility . . . [and] is used on a quarterly basis by each facility for updating the Management Minutes Category for all Medicaid eligible residents." A.R. at 1273.
Each MMQ must be completed by a licensed nurse. Id. at 1273. Specifically, the MMQ documents the nursing services patients have received during the month immediately preceding the month of the survey. Id. at 1274. In this case, the record contains MMQs for both Neponset facilities from January 1991 until March 1995, a total of eighteen quarterly MMQs, comprising over thirteen hundred pages. Id. at 1317-2706.
Despite the large number of documents, the MMQs, just as the CMS database report, do not support the Administrator's conclusion.*fn16 The MMQs have twenty-four separate categories. A.R. at 1292. For each category, the licensed nurse completing the form must assign both a numerical code which designates the reason for selection of that category, A.R. at 1276-78, and a score which identifies the type of service performed for an individual resident, id. at 1277-90. Based upon the completed MMQs, the defendant asserts that the Neponset facilities were engaged in nursing services that were the same as or equivalent to a SNF. As support for this argument, the defendant has provided the Court with a compendium of patients and the type of skilled service they received. See Def.'s Supp. Mem., Ex. 1. When reviewing this index of services, it is apparent that the defendant relies on a number of different categories, which he classifies as skilled nursing or rehabilitation services. However, while both this Court and the plaintiff concede that some of the services offered by the Neponset facilities might rise to the level of skilled nursing or rehabilitative services, it is clear that many also do not.*fn17 Pl.'s Supp.
Reply at 13.
First, the vast majority of patients listed in the defendant's index are described as receiving the "skilled service" of "medication administration." Pl.'s Supp. Mem., Ex. 1-108. While the defendant does not direct this Court to which part of the MMQs' "medication administration" category he is referencing, it appears that the defendant is referring to the dispensing and charting of medication entries. A.R. at 1277-78. However, there is simply no merit to the defendant's contention that this is a skilled service. For one thing, the instructions of the MMQ require that every completed form contain the code for dispensing and charting medication. Id. Specifically, the instructions state that "[a]ll residents receive 30 points since it reflects the necessary presence of a licensed nurse on duty at the nursing unit." Id. at 1278. And, the MMQs are preprinted with the appropriate boxes already completed. Id. Thus, the nurse completing this form has no discretion to assess whether a patient is in fact receiving this service or to determine whether the receipt of this service constitutes a skilled nursing or rehabilitative service. Moreover, in the instructions for completing the MMQ, dispensing and charting medication is defined as "[p]ouring, delivering and charting medications; including routine injections, prn medication, eye drops, eye ointments, and suppositories . . . ." Id. at 1277. Some of these services are clearly, by regulation, not skilled services. 42 C.F.R. § 409.33(d)(1) (stating that "[a]dministration of routine oral medications, eye drops, and ointments" are not skilled services). Accordingly, the administration of medication at the Neponset facilities does not support the conclusion that Neponset provides skilled nursing or rehabilitative services.
The defendant also identifies a number of patients who have received "Other Skilled Procedures." Pl.'s Supp. Mem., Ex. 1 at 1-108. Here, the defendant refers to line item 12 of the MMQ-"Skilled Procedure Daily -- Other." A.R. at 1284. Within this category, the MMQ instructions require that the nurse completing the form enter an appropriate procedure code, 1 through 14, which represent different types of services. Code 14 designates "other" skilled procedures. The instructions provide no guidance on what "other skilled procedures" entail. However, Sharon Aker, a Neponset employee, stated that "'Other' was the code that we could capture the application of topical ointments." A.R. at 259. As already discussed, the application of ointments is not a skilled service. 42 C.F.R. § 409.33(d)(1). Thus, again, providing services that fall within this category does not support the Administrator's conclusion, as these services are not skilled nursing or rehabilitative services.
A third example is further proof that the MMQs do not support the Administrator's ruling. Under line 13 of the MMQ, the nurse completing the form is required to indicate that a resident has Behavioral Problems if "[t]he resident displays, at least three times per week, selected types of behavior that are generally considered dependent or disruptive, and require staff intervention such as: disrobing or exposing oneself; screaming; being physically abusive to oneself or others; stealing; getting lost or wandering into inappropriate places; inability to avoid simple dangers." A.R. at 1285. There is simply no evidence in the record, and the defendant points to none, that even hints that addressing these types of problems rises to the level of a skilled nursing service. In fact, the only evidence in the record is to the contrary. Namely, Ms. Aker testified that handling these types of behavioral problems does not implicate skilled nursing services. A.R. at 263.
Admittedly, some of the services listed on the MMQs appear on their face to be skilled services. However, for many other services, it is simply impossible to determine whether those services qualify as skilled nursing services.*fn18 Accordingly, this Court must conclude that the decision by the Administrator regarding the equivalency finding simply lacks substantial support in the record. Therefore, his decision must be vacated.*fn19
(B) Remedy
Having concluded that the Administrator's decision was not based on substantial evidence in the record, the next question the Court must address is what is the proper remedy? The defendant posits that the case should be remanded to the agency for further proceedings, Def.'s Supp. Reply at 10-11, while the plaintiff posits that the case should not be remanded because the Secretary has already had an opportunity to put evidence into the record and the record is now closed, Pl.'s Supp. Reply at 1. "The language of the APA . . . allows courts only to 'hold unlawful and set aside' illegal agency action." Heartland Hosp. v. Thompson, 328 F. Supp. 2d 8, 14 (D.D.C. 2004). The Supreme Court has made clear that "[i]f the record before the agency does not support the agency action, if the agency has not considered all relevant factors, or if the reviewing court simply cannot evaluate the challenged action on the basis of the record before it, the proper course, except in rare circumstances, is to remand to the agency for additional investigation or explanation." Florida Power & Light Co. v. Lorion, 470 U.S. 729, 744 (1985); see also Tourus Records, Inc. v. DEA, 259 F.3d 731, 737 (D.C. Cir. 2001) (citing Lorin, 470 U.S. at 744). Accordingly, because this is not one of those rare situations where contrary action should be taken, the Court must conclude that this case should be remanded to the agency for further consideration of the plaintiff's new provider exemption request for its skilled nursing facility.
VI. Conclusion
For the aforementioned reasons, this Court must vacate the Administrator's ruling because it is not supported by substantial evidence. Accordingly, this Court must deny the defendant's motion for summary judgment, and grant the plaintiff's motion for summary judgment.
SO ORDERED this 27th day of June, 2005.
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Need assistance to guide as the qwerty pad, navigation and other keys are not working. when conncting the phone to laptop, the alarm confirmation appears and cannot cancel or open other file.
already restart the phone and removed the memory card but still problem occurs.
Solved! Go to Solution.
Perfom a back up from your device information , the make an update if your device dont have any update make a force detection or just a reset of factory settings if the error continues you need a warranty replacement.
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I have done below information and updated the phone. the contacts and memo pad lists was gone. anyways it would be restore? informations in the memo pad are very important.


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No Bake Chocolate Cookies
Total Time
Prep 10 mins
Cook 0 mins
These have been in my family since the early 1920's when my Gramma Alice made up the recipe. They have been a family favorite forever.
Ingredients Nutrition
- 1⁄2 cup cocoa
- 4 cups sugar
- 1 cup milk
- 1 cup margarine
- 1 cup peanut butter
- 2 1⁄2 teaspoons vanilla
- 1⁄4 teaspoon salt
- 6 cups quick-cooking oatmeal
- Bring first 7 ingredients to a rolling boil.
- Cook for 3 minutes.
- Remove from heat.
- Add quick cooking Oatmeal.
- Mix well and drop by teaspoon onto wax paper or parchment paper.
- Let cool.
- Note: After I have let them cool, I put them in an AIR TIGHT container.
- Regarding Chef #219653's review all I can say is NO KIDDING Back then she used Butter; then when it was said butter wasn't good for a person she changed it to margarine. She used to have to moisten the oats first (patting out the excess water) and then add them to the boiled ingredients. I believe it took about 40 – 45 minutes to do the recipe back then ( I can't remember for sure) and I cannot ask her as she died in September 1979.
- Thank for you review as it made me clarify original recipe.
Most Helpful
These are great and I thank your Gramma Alice for coming up with her recipe
This is truely a Five Star recipe,no matter who made it up they were one smart cook-ie....and I have been making this recipe for many many years myself,and make them for every bake sale our church has,and sell out each and every time. They are so rich and taste like hot fudge. I LOVE THEM!!! Darlene


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"We had a lovely 32 hours at Tangalooma. Swimming, relaxing, eating, drinking, sleeping - everything you want for mini holiday (only wish it was a bit longer). The bar is perfectly placed for people watching and also for the light show that was an afternoon storm coming across the bay from Redcl..."
S, Nov 2016, AU
Hotels within 15 miles of Moreton Island
6 people looked at this hotel in the last hour
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"So very very kid friendly and the facilities are amazing for fishing, dolphins are easy to find along with turtles and plenty of fish to catch, the pool is beautiful and gardens and cubby house were very cool. We will definitely be returning"
A Traveller, Aug 2015, AU
Hotels within 16 miles of Moreton Island
11 people looked at this hotel in the last hour
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"Nice place with great facilities close to the beach and golf course, "
A Traveller, Nov 2016, AU
7 people looked at this hotel in the last hour
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"From the first moment when we walked through the door and took in the amazing view over the water, we were delighted and the rest of our stay was equally so. The location is tops; pub across the road as well as newsagent, chemist, local supermarket and takeaways. The furnishings and appliances ..."
A Traveller, Apr 2016, AU
Hotels within 18 miles of Moreton Island
13 people looked at this hotel in the last hour
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"This hotel has comparable rates to other hotels on the island, but with far nicer and modern facilities. We loved the bungalow, it's very comfortable and suitable for couples. I would definitely stay at this hotel again and recommend it to friends."
A Traveller, Oct 2015, AU
9 people looked at this hotel in the last hour
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"Fantastic family stay. We stayed on the third level in a two bedroom apartment. Comfortable open plan with sunlight and a breeze. Wi-fi available outside in the grounds but not from the room . Friendly helpful management that gave us an early check in and a late check out at no additional charge...."
A Traveller, Oct 2016, AU
- Manta Lodge YHA & Scuba Centre - HostelNo Guest Reviews yet
5 people looked at this hotel in the last hour
4 people looked at this hotel in the last hour
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"A relaxed hotel, with a great view! Food at the whales way was fantastic. Rooms are neat but dated, however it didn't impact on stay. There was no washing machine detergent and they were very stingy with t towels and dish washer detergent, considering that you need to have the place clean allo..."
A Traveller, Oct 2016, AU
- Stradbroke Island Beach Hotel & SpaNo Guest Reviews yet
3 people looked at this hotel in the last hour
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"I was literally blown away by how beautiful and enchanting a place straddie is but not only that, the people are so warm and welcoming! I doubt there's anywhere better on the planet to stay than the straddie beach hotel, much love xx"
A Traveller, Jul 2015, AU
Hotels within 19 miles of Moreton Island
11 people looked at this hotel in the last hour
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"Only stayed one night but it was a pleasant one - room looked out on to the canal."
A Traveller, Nov 2016, AU
Map of hotels in Moreton Island
- Brisbane Entertainment Centre
- Brisbane Convention and Exhibition Centre
- South Bank Parklands
- Queen Street Mall
- Sirromet Wines
- The Gabba
- Portside Wharf
- Suncorp Stadium
- Treasury Casino
- Princess Alexandra Hospital
- Greenslopes Private Hospital
- Westfield Chermside
- Queensland Performing Arts Centre
- Brisbane City Hall
- RNA Showgrounds
- University of Queensland
- The Wesley Hospital
- Queensland University of Technology
- Mater Private Hospital Brisbane
- Emporium
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Oyuna Indigo Daya Cashmere Travel Blanket
Oyuna Indigo Daya Cashmere Travel Blanket
Elegant and luxurious, the Daya Travel Blanket by UK-based label Oyuna is handmade from 100% cashmere. Versatile and lightweight, this cozy throw is perfect for both home and travel. Throw it on your lap, around your shoulders or belt it as a shawl. Shown here in an indigo grey/blue with brown and grey trim. The belt/strap is a deep eggplant. • 100% cashmere • Handmade in Mongolia • Dry clean only Dimensions: 70" x 47"
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text:
Beef Curry
|Chopped onion
|1⁄2 Cup (8 tbs)
|Curry powder
|2 Teaspoon
|Cooking oil
|1 Tablespoon
|Cubed cooked beef
|2 Cup (32 tbs)
|2 Small, peeled and sliced or chopped
|3⁄4 Cup (12 tbs)
|1⁄2 Cup (8 tbs)
|Instant beef bouillon granules
|1 Teaspoon
|1⁄2 Teaspoon
|Cold water
|1⁄4 Cup (4 tbs)
|All purpose flour
|1 Tablespoon
|Hot cooked rice
|1 Cup (16 tbs)
In 10-inch skillet cook onion and curry powder in hot oil till onion is tender.
Stir in cubed beef, sliced or chopped apples, the 3/4 cup water, raisins, instant beef bouillon granules, and salt.
Cover and simmer for 10 minutes.
Blend the 1/4 cup cold water with flour; stir into skillet mixture.
Cook and stir till thickened and bubbly.
Season to taste with additional salt and pepper.
Rate It
Nutrition Rank
Nutrition Facts
Serving size: Complete recipe
Calories 1890 Calories from Fat 431
% Daily Value*
Total Fat 48 g74.2%
Saturated Fat 13.5 g67.7%
Trans Fat 0 g
Cholesterol 432.2 mg144.1%
Sodium 2408 mg100.3%
Total Carbohydrates 180 g60.1%
Dietary Fiber 13.8 g55.2%
Sugars 78.5 g
Protein 183 g366.9%
Vitamin A 4.2% Vitamin C 30.5%
Calcium 15.6% Iron 136%
*Based on a 2000 Calorie diet


text: Home Gallery Print (Slideshow) Coca-Cola Mad Men Tribute The 'Mad Men' Cast Is Now Appearing on Coke Bottles in Times Square Beverage Brand Returns the Favor to Its Fellow Cast Members Published on May 19, 2015 Editor's Pick Coca-Cola didn't spend a dime on the key role that it played in the Mad Men series finale. So the least it could do was pay tribute to its fellow cast members with this outdoor effort in New York's Times Square. The digital billboard running now features a series of "Share a Coke" bottles bearing the names of the show's lead players, Don, Betty, Peggy, Pete, Joan, Roger, as well as individual signs for each character that will change at regular intervals throughout the hour. The effort follows yesterday's tweet from Coca-Cola's VP-Global Design James Sommerville, featuring a Coke bottle named Don. Rate this Ad You must be registered to rate the ad. Please Login or Register Now About CreditsDateMay 19, 2015Client:Coca-Cola CategoryOOHPackage Latest Creativity News on Ad Age Romance, Bromance Ruined by a Cheeky Skywriter in Slim Jim's New Spot Creative Thinkers Join Hulsbosch, Maxus, BBH Just What Is the 'Agency of the Future' and Has Omnicom Built It? Advertisement Ad Age Events Nov 02 Los Angeles, CA SummitAd Age Brand Summit The Ad Age Brand Summit in Los Angeles peels apart the layers of brand building with a carefully crafted roster of top marketing, technology, and creative leaders. Learn more Related work Coca-Cola: Magician David Coca-Cola: As One Coca-Cola: That's Gold - Gold Actions David Miami Want to see your work in our gallery? Submit now


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£105,000 Offers Around
Seldom available spacious semi-detached villa close to Kames Bay Beach. Lounge, kitchen, rear porch, shower room; upstairs 3 dble beds. Oil CH. Gardens. EER Band E. Ideal family home/buy to let and viewing is highly recommended.
This house description is based upon information supplied by the owner, or on behalf of the owner. These property particulars are produced in good faith and do not constitute or form part of any contract. s1homes do not take any responsibility for the accuracy of the information contained in this document.
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text:
ShelXle: a Qt graphical user interface for SHELXL
© Christian B. Hübschle et al. 2011
Journal of Applied Crystallography
Volume 44, Issue 6, pages 1281–1284, December 2011
Additional Information
How to Cite
Hübschle, C. B., Sheldrick, G. M. and Dittrich, B. (2011), ShelXle: a Qt graphical user interface for SHELXL. Jnl Applied Crystallography, 44: 1281–1284. doi: 10.1107/S0021889811043202
- molecule viewers;
- electron density maps;
- syntax highlighting;
- isosurfaces;
- graphical user interfaces
ShelXle is a graphical user interface for SHELXL [Sheldrick, G. M. (2008). Acta Cryst. A64, 112–122], currently the most widely used program for small-molecule structure refinement. It combines an editor with syntax highlighting for the SHELXL-associated .ins (input) and .res (output) files with an interactive graphical display for visualization of a three-dimensional structure including the electron density (Fo) and difference density (Fo–Fc) maps. Special features of ShelXle include intuitive atom (re-)naming, a strongly coupled editor, structure visualization in various mono and stereo modes, and a novel way of displaying disorder extending over special positions. ShelXle is completely compatible with all features of SHELXL and is written entirely in C++ using the Qt4 and FFTW libraries. It is available at no cost for Windows, Linux and Mac-OS X and as source code.


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Veterinary Practice/Animal Hospital focused on small animals established for 50 years. This small animal veterinary hospital provides compassionate professional veterinary medical services for client's pets. The practice includes a full-service veterinary hospital, and offers total health care from preventative care, diet and nutrition, surgery, in house laboratory work, boarding, and dental care. Room in clinic to add groomer either on staff or as an outside contractor. A pharmacy is also available on location for most medications, shampoos and flea and heartworm preventatives. This acquisition is a tremendous opportunity for a Veterinarian that wants to work full-time in the small animal veterinary practice and grow the business. Real Estate is available and encouraged for consistent location for clientele.
Financials (USD)
Asking Price $65,000
Sales $212,726
Profit $37,929
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United States District Court, N.D. Illinois, Eastern Division
July 23, 2014
SYLVESTER JAMISON, ROBERT DOMINICK, REGINALD BREWER, and JERMAINE JOHNSON, Plaintiffs,v.COOK COUNTY, ILLINOIS; THOMAS DART, individually and in his official capacity as the Sheriff of Cook County; TONI PRECKWINKLE individually and in her official capacity as the Cook County Board President; MICHAEL MILLER, individually and in his official capacity as Director of the Cook County Jail; and MICHAEL BRYANT, individually and in his official capacity as Assistant Superintendent of Cook County Jail, Defendants.
JAMES F. HOLDERMAN, District Judge.
On November 9, 2011, plaintiffs Sylvester Jamison, Robert Dominick, Reginald Brewer, and Jermaine Johnson (collectively, "Plaintiffs") brought a pro se civil rights complaint (Dkt. No. 1) against defendants Cook County, Illinois, Cook County Sheriff Thomas Dart, Cook County Board President Toni Preckwinkle, Cook County Jail Director Michael Miller, and Cook County Jail Assistant Superintendent Michael Bryant (collectively, "Defendants"). On March 4, 2014, Plaintiffs-who are now represented by court-appointed counsel-filed an amended complaint ("Amended Complaint") (Dkt. No. 62 ("Am. Compl.")) against the same Defendants. Plaintiffs' Amended Complaint, filed under 42 U.S.C. § 1983, alleges that Defendants failed to provide safe drinking at Cook County Jail ("CCJ") in violation of Plaintiffs' rights under the Eighth and Fourteenth Amendments to the Constitution. Defendants have moved to dismiss Plaintiffs' Amended Complaint pursuant to Federal Rule of Civil Procedure 12(b)(5). (Dkt. No. 67.) For the reasons explained below, that motion is denied.
In November 2011, when Plaintiffs first brought this suit, they were all incarcerated at CCJ. (Am. Compl. ¶ 1.) Plaintiffs allege CCJ's drinking water at the time contained unacceptably high levels of lead. (Am. Compl. ¶¶ 6-8, 17-19.) Although Plaintiffs originally couched their complaint as a class action on behalf of all inmates forced to drink the unhealthy water, Plaintiffs' Amended Complaint no longer seeks class-wide relief. (Am. Compl. ¶ 40.) Because of the nature of Plaintiffs' allegations and the complexity of dealing with multi-plaintiff litigation, the court appointed Steven Danekas ("Danekas") of Swanson, Martin & Bell to represent Plaintiffs in accordance with Danekas's trial bar obligations under Local Rule 83.37. (Dkt. No. 6.) The court further ordered that summonses would not issue until Danekas, within 60 days, notified the court whether he intended to proceed with the complaint on file or file an amended complaint. ( Id. )
On January 24, 2012, after receiving no communication from Danekas, Plaintiffs filed a motion to compel his appearance. (Dkt. No. 8.) Plaintiffs' motion apparently jolted Danekas into action and he filed a motion to withdraw one week later. (Dkt. No. 11.) Danekas sought permission to withdraw on the basis of his firm's past representation of Cook County, Illinois and because his "firm is so identified with the defense of Section 1983 actions, it is believed that accepting the present assignment might be injurious to the firm's relationships with present clients." (Dkt. No. 11 ¶¶ 4-5.) Danekas's motion did not, however, state why he failed to discover his firm's "reputational conflict" until nearly three months after his appointment. The court nevertheless granted Danekas's motion to withdraw (Dkt. No. 15) and appointed Howard Adelman ("Adelman") of Adelman, Gettleman, Merens, Berish & Carter. (Dkt. No. 16).
On March 1, 2012, the court granted Adelman's motion to withdraw because he purportedly did not possess the expertise necessary to represent Plaintiffs. (Dkt. Nos. 17, 19.) The court appointed James Harman ("Harman") of Cirignni, Heller, & Harman to replace Adelman. (Dkt. No. 22.) Harman, unfortunately, orally moved to withdraw at the first status hearing and the court granted his request. (Dkt. No. 24.) On April 19, 2012, the court appointed Edward Manzke ("Manzke") of the Collins Law Firm to serve as Plaintiffs' new counsel. ( Id. )
Manzke, unlike Plaintiffs' previously appointed counsel, accepted the representation and spent four months working on the case. Manzke purportedly conducted research concerning City of Chicago water quality reports, but not enough research to prepare an amended complaint and serve Defendants. (Dkt. No. 38.) On October 29, 2012, Manzke filed a motion to withdraw because it became clear to him that he had an ethical obligation not to pursue the case. ( Id. ) The court granted Manzke's motion (Dkt. No. 39) and appointed Brenda Feis ("Feis") of Stowell & Friedman to represent Plaintiffs (Dkt. No. 40). Feis promptly moved to withdraw on the basis of incompetency. (Dkt. No. 42.) On February 5, 2013, the court granted Feis's motion and appointed Plaintiffs' current counsel, Andrew Jacobson ("Jacobson") of Brown, Udell, Pomerantz, & Delrahim. (Dkt. No. 44.)
Jacobson or a member of his firm have represented Plaintiffs for the past 17 months and have appeared (or failed to appear) on a number of occasions in connection with the case. On May 9, 2013, counsel stated that they were in the process of contacting all of the Plaintiffs and had served FOIA requests to investigate the water quality issues at CCJ.[1] (Dkt. No. 49.) On June 13, 2013, counsel acknowledged that they had not served Defendants but requested another month to prepare an amended complaint. The delay apparently stemmed from counsel's difficulty in obtaining Plaintiffs' administrative records from CCJ. The court granted counsel's request, but counsel failed to appear at the next status hearing on July 25, 2013. (Dkt. No. 51.) On August 1, 2013, counsel told the court that their information on Plaintiffs' administrative records was "as good as it's going to get" and that they would proceed to file an amended complaint. (Dkt. No. 53.) The court again accommodated counsel's request and set September 6, 2013 as the deadline to file an amended complaint. ( Id ). Consistent with past experience, September 6th came and went without any filing. On September 24, 2013, counsel appeared and stated that they were in the process of finalizing the amended complaint and would be ready to file it within two to three weeks. (Dkt. No. 54.) Two weeks later, on October 10, 2013, counsel returned to court and requested an additional 30-45 days because they lacked certain of Plaintiffs' administrative records. The court again granted counsel's request but declined set a specific deadline for the filing of an amended complaint. (Dkt. No. 56.)
On December 3, 2013, counsel failed to appear for a second time and the court dismissed the case for want of prosecution. (Dkt. No. 57.) On January 30, 2014, the court granted Plaintiffs' motion to vacate the order of dismissal and reinstated the case. (Dkt. No. 61.) On March 4, 2014, Plaintiffs finally filed their Amended Complaint (Dkt. No. 62) and sent waivers of service to Defendants one week later on March 11, 2014 (Dkt. No. 67 Ex. 1). Defendants have moved to dismiss Plaintiffs' Amended Complaint for insufficient service of process pursuant to Federal Rule of Civil Procedure 12(b)(5).
Defendants argue that the case should be dismissed because Plaintiffs failed to serve the original complaint in accordance with Rule 4(m). Under Rule 4(m), if a plaintiff fails to serve a summons and complaint on a defendant "within 120 days after the filing of the complaint, " a district court "shall dismiss the action without prejudice... or direct that service be effected within a specified time...." Fed.R.Civ.P. 4(m). But before dismissing an action, "a district court must first inquire whether a plaintiff has established good cause for failing to effect timely service." Panaras v. Liquid Carbonic Indus. Corp., 94 F.3d 338, 340 (7th Cir. 1996). If a plaintiff meets the burden of showing good cause for the failure to serve, the court "has no choice but to extend the time for service, and the inquiry is ended." Id. Moreover, even "absent a showing of good cause, a district court must still consider whether a permissive extension of time is warranted." Id. at 341.
When making this determination, the court considers a number of factors in order to balance of hardships to both parties. Panaras, 94 F.3d at 341; Coleman v. Milwaukee Bd. of Sch. Dirs., 290 F.3d 932, 934 (7th Cir. 2002). These factors include: (1) whether the statute of limitations would bar the plaintiff's re-filing of the complaint; (2) if the defendant has been attempting to evade service or has concealed a defect in the service made; (3) whether an extension of time would harm the defendant's ability to defend the lawsuit; (4) whether the defendant received actual notice of the lawsuit; and (5) whether the defendant was eventually actually served. Fed.R.Civ.P. 4(m), Advisory Committee Note, 1993 Amendments; United States v. McLaughlin, 470 F.3d 698, 700 (7th Cir. 2006); Coleman, 290 F.3d at 934; Troxell v. Fedders of N.A., Inc., 160 F.3d at 381, 383 (7th Cir. 1998); Panaras, 94 F.3d at 341. The court may exercise its discretion in considering these factors and determining whether to grant an extension of time within which the plaintiff may serve the defendant. Coleman, 290 F.3d at 934.
Although Plaintiffs proceed straight to a good cause defense, the court must first determine whether service was untimely. The 120-day period normally begins to run when the complaint is filed. Geiger v. Allen, 850 F.2d 330, 333 (7th Cir. 1988) (citing Fed.R.Civ.P. 4(m)). In this case, however, the court ordered that no summonses would issue until Danekas, Plaintiffs' original counsel, notified the court whether he intended to proceed with the original complaint or file an amended complaint. (Dkt. No. 6.) In other words, the court extended the time for service until Plaintiffs' counsel could review and revise the original complaint. Delaying service in a case like this makes sense for obvious reasons. Pro se plaintiffs are not trained lawyers and often name incorrect or immune defendants in their complaints. By suspending service until counsel can revise a potentially deficient complaint, the court helps incorrectly named or immune defendants avoid having to hire counsel and appear in court. The delay is usually a minor one as long as counsel embrace their pro bono obligations as members of this district's trial bar. That unfortunately did not happen here. Four appointed attorneys withdrew without conducting any work on the matter and another did not remain long enough to file an amended complaint.
Current counsel, by contrast, have represented Plaintiffs continuously for roughly 17 months. Although the court appreciates counsel continuing where a number of predecessors have withdrawn, counsel have twice failed to appear and have taken far too long-13 months-to file an amended complaint. At least part of the delay, however, has been caused by the difficulty of obtaining basic records from CCJ. For this reason, and because counsel were undertaking a pro bono representation at the court's request, the court repeatedly extended the deadline to prepare an amended complaint. As recently as October 10, 2013, the court stated that "leave remains, " and declined to set a deadline for the amended complaint, the filing of which would terminate the court's leave to delay service. Although the court dismissed the case on December 3, 2013, the time period for service is tolled between the date of dismissal and the date the court reinstates the action. See Geiger, 850 F.2d at 333. Accordingly, even assuming that the time to serve was no longer suspended upon reinstatement, the 120-day period started to run no earlier than January 30, 2014, when the court reinstated the case. Plaintiffs filed their Amended Complaint on March 4, 2013; Plaintiffs sent waivers of service to Defendants on March 11, 2014; and Defendants filed the instant motion on May 21, 2014-all before the 120-day period expired on May 30, 2014. The court therefore determines that service was not untimely.
Even if the time for service had expired, good cause exists for extending the time period for service. As Plaintiffs assert in their response, the applicable statute of limitations would bar Plaintiffs from re-filing their complaint, a factor that favors extension. Moreover, once the court granted Plaintiffs' request for counsel, Plaintiffs were entitled to rely on appointed counsel's actual and competent representation. The court, in its discretion, will not forever foreclose Plaintiffs' claims because of delays that were entirely outside of their control.
For the reasons set forth above, Defendants "motion to dismiss Plaintiffs' complaint" [67] is denied because service was not untimely. Defendants' responsive pleading to Plaintiffs' Amended Complaint is due on or before 8/22/14. Status hearing set for 9/2/14 at 9:00 a.m. The parties are encouraged to discuss settlement.
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Weekend TV watch
CBS re-airs one of the best episodes of "Undercover Boss" (tonight at 8 on WBZ, Ch. 4), in which Mitchell B. Modell of Modell's Sporting Goods works alongside some of his incredible employees. This is a real tear-jerker of an hour, and you might have missed it when it originally aired — the night Superstorm Sandy struck.
In the season finale of IFC's "Portlandia" (tonight at 10), the weirdly, warmly eccentric residents suffer through an electrical blackout.
"Red Widow," ABC's newest drama (debuting Sunday at 9 p.m. on ABC, Ch. 5), follows a woman (Radha Mitchell, "Pitch Black") who gets involved in organized crime to protect her family. That's the kind of logic that flies on Sunday nights.
"The Bible" comes to life, thanks to "Survivor" producer Mark Burnett and his wife, Roma Downey, in this History miniseries (Sunday at 9 p.m.). The premiere dramatizes key parts of the Old Testament, including Noah's building of his ark and Moses leading the Israelites out of Egypt.
On the premiere of NBC's "All-Star Celebrity Apprentice" (Sunday at 9 p.m.), Donald Trump gathers some of the most notorious players of seasons past — including Gary Busey, LaToya Jackson, Bret Michaels, Dennis Rodman and Omarosa — for another round of charity fundraising and tantrums. All I can say is, Marilu Henner, you have a perfect memory, so there's no excuse, you know these people are bonkers.
On AMC's "The Walking Dead" (Sunday at 9 p.m.), Rick goes hunting for more weapons to take on the Governor. Anyone else feel like this story is being dragged out longer than the epic season two search for Sophia?