198603723-2-3-2026-28-AS-FFIS-DQZPZ6-20260205104501

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603723
Report Date: 02/03/2026
Date Signed: 02/03/2026 10:18:03 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/11/2025 and conducted by Evaluator Luis DeLeon

COMPLAINT CONTROL NUMBER: 28-AS-20250611135715

FACILITY NAME:	BEVERLY HILLS SENIOR CARE		FACILITY NUMBER:	198603723
ADMINISTRATOR:	ORDONEZ, DANA		FACILITY TYPE:	740
ADDRESS:	1015 S ORANGE GROVE AVE		TELEPHONE:	(323) 933-8271
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90019
CAPACITY:	45	CENSUS: 44	DATE:	02/03/2026
		UNANNOUNCED	TIME BEGAN:	08:07 AM
MET WITH:	Administrator Dana Ordonez		TIME COMPLETED:	10:30 AM

ALLEGATION(S):

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Facility staff are not providing agreed upon items per the admission agreement.
Facility staff are not meeting residents’ nutritional needs
Staff is not safeguarding residents’ personal belongings
Staff are not ensuring the facility is free of pests
Staff are harassing a resident in care
Facility is not allowing resident payment options for monthly rent
Facility is in disrepair

INVESTIGATION FINDINGS:

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*** This report supersedes the LIC-9099 dated 7/18/2025 to clarify findings. The findings remain the same. ***
Licensing Program Analyst (LPA) Luis De Leon conducted an unannounced subsequent complaint visit to re-deliver findings on the above allegations. LPA met with Administrator Dana Ordonez and explained the purpose of today's visit.

During the initial visit on 6/13/25, LPA conducted a physical plant tour, obtained copies of the staff roster, client roster, Admission Agreements for residents R1-R4 including R1’s agency placement notes, Physicians Report for residents R1-R4, Resident Personal Property and Valuables, Facility weekly food menus, invoices of food orders, and pest control invoices.

Report continues on page 9099C...

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Luis DeLeon
LICENSING EVALUATOR SIGNATURE:	DATE: 02/03/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/03/2026

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 1 of 8

Control Number 28-AS-20250611135715

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: BEVERLY HILLS SENIOR CARE	FACILITY NUMBER: 198603723
	VISIT DATE: 02/03/2026

NARRATIVE

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*** This report supersedes the LIC-9099C dated 07/18/2025 to clarify findings. The findings remain the same. ***
During subsequent visit on 7/17/2025, LPA conducted interviews and conducted physical plant tour of common areas. LPA conducted five (5) staff interviews, five (5) resident interviews, and an interview with R1's placement agency program associate. LPA obtained the following documents: R1’s monthly invoice, facility maintenance logs, pest control invoices, and R1’s admission agreement dated 04/05/2025.
During today’s visit, LPA re-delivered licensing report and findings.

Regarding allegation: Facility staff are not providing agreed upon items per the admission agreement.
It is alleged that upon residents’ admission to the facility, an agreement was made between the resident, the facility administrator and the resident’s placement agency. The agreement was that resident’s placement agency would provide monies to Administrator in order for the resident to have a television and a refrigerator for R1 to store R1’s purchased food. The refrigerator was agreed upon in order for the facility to be able to meet the residents’ dietary needs. The investigation consisted of LPA’s interviews five (5) residents, five (5) staff, and one witness #1 (W1). LPA reviewed resident #1 (R1’s) admission agreement and pertinent documents in R1s file. Tour of the physical plant including R1s room which contained a television set and a mini refrigerator. The investigation revealed the following: The administrator denied agreeing to provide a television and/or a refrigerator. The Administrator stated that she did not make any offers to provide R1 with a television and/or a refrigerator as part of the admissions agreement upon R1s initial placement at the facility. The administrator stated that a mini refrigerator was provided in R1’s room; however, R1 was not satisfied with the size of the refrigerator. LPA reviewed R1’s admission agreement dated 04/05/2025 which did not indicate that a television and/or refrigerator along with monies for food or clothes would be provided to R1. Four (4) out of five (5) staff stated that they are not aware of an agreement and/or a conversation with prospective residents and had no knowledge of an agreement to provide a resident with a television and/or refrigerator. Interviews with R1 revealed that the facility had agreed to provide R1 with a Television and a refrigerator as part of the admission agreement. R1 stated that facility was not able to accommodate R1’s dietary needs and R1 needed a refrigerator to store R1's own purchased food to meet R1's dietary needs. Interviews with three (3) of five (5) residents revealed that items such as televisions and/or refrigerators are not provided by the facility. Residents stated that televisions and/or refrigerators in residents' rooms had been provided to residents by the previous facility owner, or items were already in residents room when residents moved into the facility, or the items were donated by residents’ family. (Report continues on page 9099C...)

SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Luis DeLeon
LICENSING EVALUATOR SIGNATURE:	DATE: 02/03/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/03/2026

LIC9099 (FAS) - (06/04)

Page: 7 of 8

Control Number 28-AS-20250611135715

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: BEVERLY HILLS SENIOR CARE	FACILITY NUMBER: 198603723
	VISIT DATE: 02/03/2026

NARRATIVE

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*** This report supersedes the LIC-9099C dated 07/18/2025 to clarify findings. The findings remain the same. ***
LPA’s interview with witness #1 (W1) revealed that R1’s placement agency does not provide or offer items such as a television and/or refrigerator. W1 does not believe R1’s placement agency staff would make such an offer; otherwise, W1 would have heard about it. W1 stated that R1’s placement agency requests clothing from facilities, if facility has any available; otherwise, residents can buy clothing using their Personal and Incidental Allowance (P&I money). Based upon the investigation, residents, witness, and staff interviews, document review, and LPA observations, facility and/or placement agency did not make any offer during initial resident placement for items such as a television or a refrigerator.

Regarding allegation: Facility staff are not meeting residents’ nutritional needs.
It is alleged that the facility would not be able to meet R1’s dietary needs due to R1 restricted health condition and that the facility’s food alternatives were not going to meet R1's needs. Therefore, the Administrator, resident #1 (R1) and R1's placement agency, agreed to provide R1 with a refrigerator, so that R1 could be provided with meals delivered by meals on wheels and meal would be kept in R1’s room. The investigation consisted of LPA interviews with five (5) residents, five (5) staff, and one (1) witness (W1). LPA reviewed the R1’s facility file, including the admission agreement, physician’s report, the facility’s weekly food menu, and alternative food menu. LPA obtained a copy of the kitchen modified diet menu, which lists residents’ modified diets and observed R1 has a modified diet in place. Interviews with residents revealed that four (4) out of five (5) residents had no issues with food service at the facility. One (1) of five (5) residents interviewed reported that staff accommodate residents when requesting meal changes to manage the resident’s weight. LPA interviews with staff revealed that Administrator received a specific food request from R1 for R1’s food diet which included salmon, steak, chicken, tuna, turkey, lentils, vegetables, and fruits. Excluded food listed were pasta, pork, and bread. LPA reviewed R1’s physician report dated 02/11/2025 which did not indicate that R1 was on a modified diet. LPA interviewed five (5) staff, three (3) out of five (5) staff indicated that as part of facility protocol, staff reaches out to each resident two hours prior to each meal. The resident has the opportunity to request an alternative meal from the published food menu. The staff communicates residents’ choice for kitchen staff to prepare the residents’ meals. Interview with Staff #4 (S4) revealed that R1 requested S4 to not offer R1 breakfast, because R1 doesn’t eat breakfast. However, later on, S4 observed R1 requesting breakfast from another staff member. In addition, S4 has not received any requests from R1 regarding R1 choosing meals from the alternative food menu. (Report continues on page 9099C...)

SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Luis DeLeon
LICENSING EVALUATOR SIGNATURE:	DATE: 02/03/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/03/2026

LIC9099 (FAS) - (06/04)

Page: 6 of 8

Control Number 28-AS-20250611135715

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: BEVERLY HILLS SENIOR CARE	FACILITY NUMBER: 198603723
	VISIT DATE: 02/03/2026

NARRATIVE

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*** This report supersedes the LIC-9099C dated 07/18/2025 to clarify findings. The findings remain the same. ***
LPA observed that in R1's room, the refrigerator contained R1's own meals that R1 prepares using the dining room’s microwave. LPA interviewed W1, which revealed that R1’s placement agency did not offer R1 with assistance in obtaining food for delivery from meals on wheels or from another food delivery service. Based upon the investigation, residents, witness, and staff interviews, document review, and LPA observations, facility is meeting residents’ dietary needs as documented on resident’s physicians’ orders and following food menu planning.

Regarding allegation: Staff is not safeguarding residents’ personal belongings.
It is alleged that the facility staff is not safeguarding residents #1 (R1) personal belongings, and as a result, R1 has had items damaged in R1’s room such as cigarettes burns on dining table and bed mattress. Investigation consisted of LPA interviews with five (5) residents and five (5) staff and reviewed documents, including R1’s Resident Personal Property and Valuables (LIC-621). LPA observed R1’s cell phone and phone charger. LPA observed clothing on hangers by R1’s room entrance door. LPA interviews with four (4) out of five (5) residents indicated that residents denied having any personal property lost or damaged at facility. One (1) of five (5) residents stated that when attending the day program, the residents left their room door open and none of the residents’ items were lost or damaged. One (1) out of five (5) staff mentioned that there have been some instances where resident’s laundry has been mixed up, but staff sorted out the laundry. Five (5) out of five (5) staff denied knowledge of hearing any residents complain about residents’ personal items lost or damaged. One (1) of Five (5) staff member stated that upon R1's admission to the facility, R1 requested staff to not enter R1s room and staff was informed of R1’s request. LPA gained access to R1’s room for R1 interview via back-room door leading to dining area and observed that R1 barricaded R1s room main door leading to hallway to prevents anyone from entering R1's room. LPA observed a chair and/or table blocking entrance to R1’s room from the hallway door thus preventing anyone from accessing R1’s room. LPA observed that during previous facility visits, R1 had prevented LPA and Administrator from entering R1 room when R1 was not at the facility. Based upon the investigation, residents, staff interviews, document review, and LPA observations, there is insufficient evidence to support the allegation that staff are not safeguarding residents’ personal belongings.

(Report continues on page 9099C...)

SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Luis DeLeon
LICENSING EVALUATOR SIGNATURE:	DATE: 02/03/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/03/2026

LIC9099 (FAS) - (06/04)

Page: 4 of 8

Control Number 28-AS-20250611135715

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: BEVERLY HILLS SENIOR CARE	FACILITY NUMBER: 198603723
	VISIT DATE: 02/03/2026

NARRATIVE

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*** This report supersedes the LIC-9099C dated 07/18/2025 to clarify findings. The findings remain the same. ***
Regarding allegation: Staff are not ensuring the facility is free of pests.
It is alleged that the facility is infested with roaches and spiders in all common areas of the facility, including residents’ rooms and that the facility staff are failing to ensure that facility is free of pests. Investigation consisted of LPA interviews with five (5) residents, five (5) staff and reviewed documents. Administrator explained that the facility has a service agreement with a pest control company for monthly treatments. In addition, the administrator may call for pest control services on an as needed basis. Administrator stated that during the Pest Control company’s monthly visit, the administrator provides the pest control technician with the various rooms to be fumigated. The Pest Control service agreement includes services to control pests such as roaches, ants, and spiders. Interview with residents revealed that four (4) out of five (5) residents have observed roaches. Three (3) out of five (5) residents have observed roaches in their rooms and one (1) out of five (5) residents observed roaches coming out from the elevator shaft. However, three (3) residents stated that the facility staff took care of pests by fumigating the affected area. Residents have observed exterminators frequently spraying around facility rooms and common areas. Interviews with three (3) out of five (5) staff revealed that staff have seen roaches in the resident rooms or in the kitchen area. Staff stated that in all instances involving observed pest, a fumigation treatment was performed, and staff have not seen any pest or roaches since the treatment. During LPAs physical plant tour, LPA observed roaches only in R1's room and LPA did not observe any roaches or pest in any other part of the facility, including other resident’s room, the kitchen or common area of the facility. Administrator provided LPA with facility notes dated 04/23/28 and 05/28/25, which indicated that R1 denied access to the pest control exterminator to treat R1’s room for pests. Based upon the investigation, residents, staff interviews, document review, and LPA observations, the facility is making effort to maintain the facility free of pest and provided documentation of pest control monthly visits since 10/23/24.

Regarding allegation: Staff are harassing a resident in care.
It is alleged that the facility staff is damaging resident's table and mattress with cigarette burns, removing items from resident's room. It is alleged that the staff harassment is due to the residents age, the resident and other resident’s skin color, and resident's damaging facility property. Investigation consisted of LPA interviewed with five (5) residents, five (5) staff, and witness #1 (W1). Interview with residents revealed that four (4) out of five (5) residents denied being physically or verbally harassed by staff. (Report continues on page 9099C...)

SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Luis DeLeon
LICENSING EVALUATOR SIGNATURE:	DATE: 02/03/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/03/2026

LIC9099 (FAS) - (06/04)

Page: 8 of 8

Control Number 28-AS-20250611135715

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: BEVERLY HILLS SENIOR CARE	FACILITY NUMBER: 198603723
	VISIT DATE: 02/03/2026

NARRATIVE

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*** This report supersedes the LIC-9099C dated 07/18/2025 to clarify findings. The findings remain the same. ***
Two (2) out of four (4) residents denied being harassed by staff because of their skin color and all stated that they were happy to be at the facility. LPA observed during R1's interview that R1 had behavioral issues. In addition, interviews with W1 described a similar experience when R1's placement agency staff attempted to meet with R1 to discuss R1’s services. As of 07/18/25, R1’s placement agency staff have not been able to speak with R1 due to R1’s refusal to speak with placement agency staff. Interviews with staff revealed that five (5) out of five (5) staff denied the allegation above. Staff reported that during staff meetings, staff were given reminders from administration to always be nice and respectful to facility residents. Three (3) out of five (5) staff denied harassing residents and stated that staff speak respectfully to residents. Based upon the investigation, interviews with staff and residents, witness interview, and LPA observations, the facility staff were not found to be harassing residents in care.

Regarding allegation: Facility is not allowing resident payment options for monthly rent.
It is alleged that the facility does not allow resident payment options for monthly rent. The administrator has refused to accept rent for the last two months and refuses payments in the form of a money order. It is also alleged that the administrator requests that residents’ payments are in cash. The investigation consisted of LPAs interviews with five (5) residents, five (5) staff, and document review. LPA review of R1's admission agreement revealed that agreement states that rent payment can be made in the form of checks and/or money orders under the section of “Payment Provisions.” Administrator stated that residents have payment options for monthly rent and even though the admission agreement does not state that cash is accepted, the cash option is also available for private-pay residents. Interviews with staff revealed that four (4) out of five (5) staff are not aware of how payments are made to the facility administration. Interview with four (4) out of five (5) residents revealed that none of the residents have had any issues with making the monthly rent payments. All four (4) residents stated that they are not aware of how payments are made since rent payments are directly made by the Social Security Administration (SSI) or other social services agencies. Based upon the investigation, residents and staff interviews, witness interviews, and document review, the facility does offer payment options in the form of personal check, money order and/or cash.
(Report continues on page 9099C...)

SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Luis DeLeon
LICENSING EVALUATOR SIGNATURE:	DATE: 02/03/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/03/2026

LIC9099 (FAS) - (06/04)

Page: 3 of 8

Control Number 28-AS-20250611135715

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: BEVERLY HILLS SENIOR CARE	FACILITY NUMBER: 198603723
	VISIT DATE: 02/03/2026

NARRATIVE

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*** This report supersedes the LIC-9099C dated 07/18/2025 to clarify findings. The findings remain the same. ***
Regarding allegation: Facility is in disrepair
It is alleged that the facility and a resident’s room are in disrepair. Per the details of the allegation, the lock to resident’s room is broken, there are holes in the walls from nails in the resident’s room that are not patched, the resident’s mattress cover is torn and burned, and the floor molding is loose. The investigation consisted of LPA interviews with five (5) residents, five (5) staff, LPA tour of the physical plant, and document review. During the physical plant inspection conducted on 06/13/25, LPA toured residents’ rooms and common areas of the facility. LPA did not observe any health and safety concerns and/or risks to residents. LPA observed a water leak under the sink of a resident’s room that was reported to the administrator. Administrator sent repair requests to in-house maintenance staff to address water leak issue. LPA toured R1’s room and observed that R1’s room had various holes from nails on walls, unpainted wall patch, a mattress cover that was torn and had cigarette burns, and floor molding that was dirty. Interviews with four (4) of out five (5) residents revealed that none of the residents have observed any issues with their rooms or common areas of the facility. All residents stated that staff maintenance quickly responds when issues are reported for repairs to their rooms. A resident stated that administration and staff keep up the facility in good repair. Interviews with staff revealed that five (5) out of five (5) staff denied the allegation above. Five (5) out of five (5) staff stated that requests for repairs are reported to administration. Normally, repairs are completed within one day, unless an outside vendor is needed to repair an issue. Staff described that repairs are completed as soon as possible and staff stated that the administration responds quickly to residents’ requests for repairs. LPA reviewed maintenance logs for facility and observed repair request since November 2023. An interview with maintenance staff (S3) revealed that S3 is responsible for repairing minor jobs throughout the facility. However, if a job requires a professional service, administration places call for repair services. Administrator provided LPA with invoices for recent repairs made by commercial contractors. Administrator shared with LPA facility notes dated 04/23/2025, the notes indicate that R1 refused to allow an electrician into R1’s room to inspect R1's bathroom socket, due to an adjacent dining room socket not having power. On 04/07/25, R1 indicated verbally to staff that no one, including staff, are allowed in R1's room and R1 would do R1's own cleaning and changing of the bed linen and sheets. Interview with one of five staff revealed that since R1's first day of admission, R1 requested that staff #2 (S2) not enter R1’s room.

(Report continues on page 9099C...)

SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Luis DeLeon
LICENSING EVALUATOR SIGNATURE:	DATE: 02/03/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/03/2026

LIC9099 (FAS) - (06/04)

Page: 5 of 8

Control Number 28-AS-20250611135715

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: BEVERLY HILLS SENIOR CARE	FACILITY NUMBER: 198603723
	VISIT DATE: 02/03/2026

NARRATIVE

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*** This report supersedes the LIC-9099C dated 07/18/2025 to clarify findings. The findings remain the same. ***

During the 07/18/2025 visit, R1 allowed maintenance staff (S3) to come to R1’s room with LPA to take note of repairs needed to be done in R1’s room. R1 accused S3 of harassing R1; however, LPA did not observe staff harassing R1. S3 took steps back against wall, face down, and S3 took notes of repairs to be done in R1's room. Administrator stated that R1 has not allowed staff entry into R1's room to inspect the room for repairs and staff have made prior attempts to perform repairs to R1's room. Based upon investigation, residents and staff interviews, document review and LPAs observations, the facility is not in disrepair, with the exception of R1’s room due to R1 denying staff entry to R1's room. Staff continue to work with R1 to make any necessary repairs to R1's room.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is UNSUBSTANTIATED.

Exit interview held with Administrator Dana Ordonez. A copy of the report was provided.

SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Luis DeLeon
LICENSING EVALUATOR SIGNATURE:	DATE: 02/03/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/03/2026

LIC9099 (FAS) - (06/04)

Page: 2 of 8