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UCC FINANCING STATEMENT ADDENDUM 9. NAME OF FIRST DEBTOR'(1a or 1b) ON RELATED FINANCING STATEMENT 200314134 1 9a. ORGANIZATION'S NAME OR I Beverly Enterprises- Nebraska, Inc. 9b. INDIVIDUAL'S LAST NAME IFIRSTNAME 10. MISCELLANEOUS: THE ABOVE SPACE IS FOR FILING OFFICE USE ONLY 11. ADDITIONAL DEBTORS EXACT FULL LEGAL NAME - insert only = name (11a or 11 b) - do not abbreviate or combine names ORGANIZATION'S NAME _' 11 b. INDIVIDUAL'S LAST NAME FIRST NAME MIDDLE NAME SUFFIX 11 c. MAILING ADDRESS CITY STATE POSTAL CODE COUNTRY 11d. SEEINSTRUCTIONS ADD'L INFO RE 11e. TYPE OF ORGANIZATION 11f. JURISDICTION OF ORGANIZATION 11 g. ORGANIZATIONAL ID #, if any ORGANIZATION DEBTOR I I ri NONE 12. ADDITIONAL SECURED PARTY'S ASSIGNOR S /P'S NAME - insert only 40S name (12a or 12b) 12a. ORGANIZATION'S NAME OR 12b. INDIVIDUAL'S LAST NAME FIRST NAME MIDDLE NAME SUFFIX 12c. MAILING ADDRESS CITY STATE IPOSTALCODE COUNTRY 13. This FINANCING STATEMENT covers timber to be cut or as- extracted 16. Additional collateral description: collateral, or is filed as a ® fixture filing. 14. Description of real estate: See Exhibit I and Schedule A attached hereto and made a part hereof. 15. Name and address of a RECORD OWNER of above - described real estate (if Debtor does not have a record interest): Beverly Enterprises- Nebraska, Inc. c/o Beverly Enterprises, Inc. 17. Check 2& if applicable and check gnly one box. 1000 Beverly Way Debtor is a Trust or 11 Trustee acting with respect to property held in trust or Decedent's Estate Fort Smith, AR 72919 18. Check 20(y if applicable and check gn)y one box. Debtor is a TRANSMITTING UTILITY Filed in connection with a Manufactured -Home Transaction — effective 30 years Filed in connection with a Public - Finance Transaction — effective 30 years FILING OFFICE COPY — UCC FINANCING STATEMENT ADDENDUM (FORM UCC1Ad) (REV. 05 /22/02) TXUCCIAD - 10/07/02 C T System Online