List the name, title, SSN, and business address of all managing employees below as defined in 42 CFR 455.101.

Existing records cannot be deleted; they must be End Dated, with the exception of new records.

Managing Employee – indicates a general manager, business manager, administrator, director or other individual who exercises operational or managerial control over, or who directly or indirectly conducts the day-to-day operation of an institution, organization or agency.

Name

• Enter the First and Last Name.  Middle Initials are optional in this field.

• Upon First and Last Names (Middle Name if entered, as well) being added to the grid as a record, the first, middle, and last names will display in the grid as Name in following format:  Last Name, First Name  Middle Name (if entered), ex  Kennedy, John Fitzgerald

SSN

• Enter the Social Security Number

Title

• Select the appropriate title from the drop-down box.  See Table 1

DOB

• Enter the Date of Birth

• Age cannot be greater than 100 years of age

Effective Date

• Enter the date this individual became a managing employee

Expiration Date

In KY MPPA, some records cannot be deleted. To add a new record, the previous record must have an Expiration Date added in order to keep the history on file. To add an Expiration Date to a record, click the "Edit" button and add an Expiration Date. If a new record is added to the grid, the active dates of the new record cannot overlap existing record dates.

Address

• Enter the address information in this field

City

• Enter the city for the applicable address

State

• State defaults to Kentucky but is editable

• Select the state from the drop down box

Zip Code

• Enter the appropriate zip code for the applicable address entered

Zip+4

• If known, enter the appropriate +4 Zip code

County

• Enter the corresponding county for the applicable address entered

• If  state is not Kentucky, the default county should be “Out of State”

Once all information has been added to the fields, click Validate Address to confirm the address

Select the address match, and click Choose and Continue to add the address to the grid

If fields are entered then N/A is checked, the data entered will be cleared

Special Characters:

• The following Special Characters cannot be used in the situations below. Field properties will not allow the following characters in the box:

 For First Name, Business Name, Other name (if any):    | + \ '

 For Last Name field:    | + \ ', and numbers are not allowed

 For Comment Boxes:     <  >  ^  ~ ` + | \ / ¬ £

 For Address fields:    | + ! @ # $ ^ * ( ) ? / \ " < > & : ; _

• If you copy and paste an excluded special character, an error message will display after clicking Save & Next

• Remove excluded characters from pasted information or uploaded text in the document

Save & Next:

• When finished, click Save & Next to save the information and proceed to the next page

• Click Back to go to the previous screen without saving

• Click Exit to return to the dashboard without saving

• Note that if the information is not saved, you will lose the data on the current page