Landmark Holdings of Missouri, LLC. owns and operates Long Term Acute Care Hospitals with four facilities currently in operation. The first Landmark Hospital opened in February 2006, and is located in Cape Girardeau, Missouri. Landmark Hospital of Cape Girardeau is a joint venture between Landmark Holdings of Missouri, LLC and Saint Francis Health Development Services, Inc It is a freestanding 30-bed, single-story, facility with all private rooms, and is designed to be easily expanded to 42 private rooms. Landmark Hospital of Cape Girardeau received Medicare certification on March 16, 2006.Landmark Holdings opened its second facility in Joplin, Missouri on May 21, 2007 and received Medicare certification on May 30, 2007. Landmark Hospital of Joplin is a joint venture with Freeman Health System, St. John s Regional Medical Center and four local Joplin physicians. The Joplin facility is licensed for 30 beds, and designed to expand to 42 beds as the need for long term acute care services grows.Construction was completed in Athens, Georgia on the 42-bed Landmark Hospital of Athens, LLC in June 2008. The facility passed state inspection on July 14th, admitted its first patient on July 15th, and passed its Medicare survey on July 21, 2008.The fourth Landmark Hospital was opened in Columbia, Missouri in September 2009. The facility passed state inspection on September 17 and admitted its first patient on September 22. After successfully completing its 6-month Medicare length-of-stay demonstration period on March 31, 2010, the facility received notification on May 25, 2010 from The Centers for Medicare and Medicaid Services that it had been certified as a Long-Term Acute Care Hospital effective April 1, 2010.Landmark Hospitals leases hospital buildings from White Oaks Real Estate Development, LLC, at fair market value rent per hospital bed, as determined by Marshall Stevens, a St. Louis-based healthcare facilities valuation company.Landmark Holdings is owned by Dr. Bill Kapp and Mr. Mike Norman. Dr. Kapp is a practicing orthopedic surgeon in Cape Girardeau, MO. Mr. Norman is a hospital administrator with over twenty-five years experience, the last ten years in the LTAC hospital industry.LTAC hospitals meet a specific need in the healthcare continuum. They are defined in federal regulations at 42 CFR 412.33 ( e ). To be a Medicare-certified LTAC hospital, Landmark Hospital is required to establish a Medicare average length of stay ( ALOS ) of 25 days or longer and meet CMS Hospital Conditions of Participation. LTAC hospitals open as general acute care hospitals and are reimbursed under IPPS for the first six months. These first six months are known as the length-of-stay demonstration period. After maintaining a Medicare ALOS of 25 days for six months, Landmark Hospital applies to CMS for a change in provider status and receives a LTAC-hospital Medicare provider number. Landmark Hospital must continue to maintain a Medicare ALOS of 25 days or longer to keep its LTAC-hospital provider status.LTAC hospitals provide diagnostic and medical treatment to patients with chronic diseases and medically complex conditions. LTAC hospital patients are too ill for placement in skilled nursing facilities.Landmark Hospital follows InterQual criteria to determine the appropriateness of patient admission and continued hospital stay. Daily physician rounds are required. Registered nurses and respiratory therapists with certification in Advanced Cardiac Life Support ( ACLS ) are on duty twenty-four hours every day. Physical, occupational, and speech therapies are available. The emphasis landmark Hospital is on multi-disciplinary treatment planning.The six major InterQual subsets treated Landmark Hospital are: ventilator weaning, respiratory complex, other medically complex, infectious diseases, wound/skin, and cardiovascular/peripheral vascular.Patients admitted to Landmark Hospital are referred by short-term, general acute care hospit