Disclosure Statement
Disclosure Statement
May 30, 2016
The Cardinal at North Hills
4030 The Cardinal at North Hills Street
Raleigh, North Carolina 27609
Phone: 919-781-2021
www.thecardinalatnorthhills.com
www.lifeatthecardinal.com
NCDOI No. ________________________
The Cardinal at North Hills, like all other continuing care retirement communities in the
state of North Carolina, is subject to an article concerning licensure and disclosure. In
accordance with Chapter 58, Article 64 of the North Carolina General Statutes of the State
of North Carolina:
 The Cardinal at North Hills must deliver a Disclosure Statement to a prospective
member prior to or at the time a prospective resident executes a residency
agreement or at the time a prospective resident transfers any money or other
property to the Cardinal at North Hills, whichever occurs first;
 Licensure under the Article does not constitute approval, recommendation, or
endorsement of the Cardinal at North Hills by the Department of Insurance or the
state of North Carolina, nor does such licensure ensure accuracy or completeness of
the information in this Disclosure Statement;
Unless earlier revised, The Cardinal of North Hills intends for this Disclosure statement to
remain effective for one (1) year and one hundred fifty (150) days after the date hereof
through October 27, 2017.
Table of Contents
Page
1.
Introduction to the Cardinal at North Hills.............................................................. 3
2.
Community Ownership………………………………………………………..…. 4
3.
Management Company……………………………………………………..……. 5
4.
Affiliations………………………………………………………………………… 9
5.
Description of The Community…………………………………………………… 10
6.
Resident Information……………………………………………………………… 12
7.
Resident Services…………………………………………………………………. 14
8.
Healthcare Services………………………………………………………………. 19
9.
Relocation Information…………………………………………………………… 21
10.
Termination and Refunds…………………………………………………………. 28
11.
Fees and Other Charges…………………………………………………………… 31
12.
Residency Criteria………………………………………………………………… 34
13.
Financial Disclosure and Information……………………………………………… 35
Exhibits
A. Actuarial Population Projection Report …………………………………………… 36
B. Internally prepared Forward-Looking Financial Statements ……………………….61
C. Forecasted Financials ……………………………………………………………… 70
D. Binding Reservation Agreement ………………………………………………….. 101
E. Independent Living Residence Agreement ……………………………………….. 102
F. Resident Handbook ……………………………………………………………….. 140
G. Application for Residency ………………………………………………………… 173
H. Physicians Report …………………………………………………………………. 179
I. Independent Living Appendix A…………………………………………………... 183
J. Assisted Living Residence and Care Agreement ………………………………..... 186
K. Skilled Nursing Care Resident and Care Agreement …………………………….. 252
1.
Introduction to the Cardinal at North Hills
Welcome to The Cardinal at North Hills, a full-service rental Continuing Care Retirement
Community (CCRC) offering multiple lifestyle choices designed to promote independence,
dignity and an engaged way of life. More than just a place to live, The Cardinal is ideally
located in the midst of Raleigh’s vibrant North Hills Midtown neighborhood. Residents will find
The Cardinal to be the perfect place to live, play and grow. Its location will combine the
convenience of North Hills’ walkable lifestyle with the best of dining, shopping and
entertainment for every aspect of community life. Residents enjoy a variety of quality activities,
lifelong learning and volunteer opportunities.
At The Cardinal, you will have the opportunity to experience Kisco Senior Living’s award
winning whole person approach to wellness called The Art of Living WellSM. This is a
personalized approach to creating the lifestyle choices you aspire to. There are a wide range of
options such as participating in a regular Tai Chi or yoga class in the fitness center, water
aerobics in the heated indoor swimming pool, honing your skills in the woodshop, painting in
the art studio, or just relaxing with a good book on the covered veranda. And if dining is your
pleasure, you’ll appreciate a range of onsite dining venues from casual to elegant in addition to
the numerous restaurants and sidewalk cafes right outside your door in North Hills. The choices
are almost endless and totally up to you.
Independent Living Residences at The Cardinal will range from one bedroom to three bedroom
floor plans with upscale finishes and full kitchens. An adjacent building will provide assisted
living, memory care and nursing care in a warm residential setting.
Community Address:
The Cardinal at North Hills
4030 Cardinal at North Hills Street
Raleigh, North Carolina 27609
Owner’s Business Address:
The Cardinal at North Hills, LLC
5790 Fleet Street, Suite 300
Carlsbad, CA 92008
2.
Community Ownership
KSL Toledo Tenant, LLC is the sole member and manager (100%) of The Cardinal at North
Hills, LLC. KSL Toledo Tenant, LLC is a manager-member limited liability company
managed by KSL Toledo Manager, LLC, a North Carolina limited liability company.
The membership percentages of KSL Toledo Tenant, LLC are:
KSL Toledo Manager, LLC having 0.1% membership
5790 Fleet Street, Suite 300
Carlsbad, CA 92008
KSL Toledo Member, LLC having 99.9% membership
5790 Fleet Street, Suite 300
Carlsbad, CA 92008
The officers of KSL Toledo Tenant, LLC include:
Andrew S. Kohlberg, President*
c/o Kisco Senior Living
5790 Fleet Street, Suite 300
Carlsbad, CA 92008
Mitchell Brown, Vice President
c/o Kisco Senior Living
5790 Fleet Street, Suite 300
Carlsbad, CA 92008
Terri Novak, Vice President
c/o Kisco Senior Living
5790 Fleet Street, Suite 300
Carlsbad, CA 92008
Mark Dressel, Vice President/ Treasurer
c/o Kisco Senior Living
5790 Fleet Street, Suite 300
Carlsbad, CA 92008
Gillian Freeman, Secretary
c/o Kisco Senior Living
5790 Fleet Street, Suite 300
Carlsbad, CA 92008
The Cardinal at North Hills will be managed by Kisco Senior Living, LLC (KSL). KSL will
provide services to operate and maintain the Cardinal on Owner's behalf. Kisco Senior Living is
indirectly owned by Andrew S. Kohlberg who also owns more than 10% of the Cardinal
operations. The cost of the services provided by KSL to the Cardinal will equal approximately
five percent (5%) of the annual revenue collected by the Cardinal.
* = Majority Owner
3.
Management Company
The Cardinal at North Hills will be managed by Kisco Senior Living (KSL). Family-owned
Kisco Senior Living, based in Carlsbad California, owns and operates 21 full service senior
living communities in six states offering both independent and assisted living. Six of these
communities are located in North Carolina, three of which are in the Raleigh area not including
The Cardinal. With an award-winning approach to senior living and wellness, Kisco creates
communities where residents and associates share passions, live and work in balance and build a
legacy. Since 1990, Kisco's guiding principles of integrity, dignity and compassion have
balanced the interests of residents, associates and business partners. For more information, log on
to www.KiscoSeniorLiving.com.
KSL began acquiring properties in 1990 and established its operating capability in 1995. KSL’s
competencies encompass development, acquisition and the successful turnaround or optimization
of operations and ongoing management of senior communities.
KSL is structured around a team-based model at both its Home Office and at each community.
Home Office service teams directly support the on-site Executive Directors and their
community management teams. The multi-disciplinary service teams work closely with the
Executive Directors and their department heads to achieve KSL’s goals of resident satisfaction,
associate satisfaction and optimal financial performance. The teams are charged with meeting
the performance goals established for each community and are provided with a variety of
resources and tools to meet those goals.
KSL promotes a culture focused on delivering exemplary customer service, innovative wellness
programs and continuous improvement. The overriding strategic objectives for the company are
to enrich the lives of our resident’s, provide a rewarding work environment for our associates
and to achieve responsible and profitable growth for our financial partners. KSL strategically
plans and reviews all new and existing service and operating programs and seeks to provide
residents with best-in-class services and facilities while carefully controlling associated costs.
This approach enables KSL to manage its operations to a much higher standard and to achieve
revenues and profit margins that exceed top quartile industry metrics for combined independent
and assisted living communities.
KSL and its leadership have been recognized by numerous business and senior living industry
groups. The California Council of Excellence (the state level Malcolm Baldrige National
Quality Award program) named KSL as a distinguished silver-level Eureka award winner of
the 2008 California Awards for Performance Excellence (“CAPE”). The annual CAPE program
honors California companies who achieve superior results through innovation, customer service
and performance excellence. In 2008, KSL’s largest community, The Fountains in Melbourne,
FL, was awarded the 2008 Best of the Best award by The Assisted Living Federation of
America. Mr. Kohlberg was awarded the SAGE Person of the Year Award by the Building
Industry of Southern California’s Seniors Housing Council in 2002. In 2003, he received the
ICON Award in the Service Enriched Builder/Developer category from the National
Association of Home Builders (“NAHB”). KSL’s development projects have received
numerous design awards from the American Institute of Architects, NAHB Seniors Housing
Council and Pacific Coast Builders Council.
The officers of Kisco Senior Living, LLC are:
Andrew S. Kohlberg, President/Chief Executive Officer
c/o Kisco Senior Living 5790 Fleet Street, Suite 300 Carlsbad, CA 92008
Andrew S. Kohlberg is the Founder, President and CEO of Kisco Senior Living, LLC. Mr.
Kohlberg’s primary responsibilities are providing strategic planning and direction for property
operations and management as well as sourcing and executing acquisitions including the
placement of equity and debt financing. Through his timely purchase of well-located
retirement properties, he built Kisco’s core portfolio of assets. The portfolio includes 20
communities in six states with over $140 million in annual revenue and approximately 1600
associates. He is now carefully expanding the company through new development and
acquisitions.
Mr. Kohlberg attended the University of Tennessee and has completed advanced studies at the
University of California San Diego in real estate economics and feasibility analysis,
commercial real estate development, fundamentals of construction and legal aspects of real
estate investment.
He is an active member of the American Senior Housing Association (ASHA), California
Assisted Living Facilities Association (CALFA), and the San Diego Chapter of Young
Presidents’ Organization (YPO). In November 2002, the Seniors Housing Council awarded
him the SAGE Person of the Year Award for his commitment to the seniors housing industry.
In April 2003, he accepted the Icon Award in the Service Enriched Builder/Developer category
from the National Association of Home Builders.
Mitchell Brown, Vice President/Chief Development Officer
c/o Kisco Senior Living 5790 Fleet Street, Suite 300 Carlsbad, CA 92008
Mr. Brown manages Kisco Development LLC, the development arm for Kisco Senior Living,
LLC. He also serves on Kisco Senior Living’s senior leadership team with a focus on strategic
planning and asset management. Over the past 15 years, Kisco Development has completed
over $400 million in new additions to Kisco Senior Living’s portfolio. These projects include
new senior living campuses with independent, congregate and assisted living ranging from 160
to over 300 units as well as age qualified apartment communities up to 265 units. Mr. Brown
also oversees major renovations and capital improvement to Kisco’s existing portfolio.
Mr. Brown is member and past Chair of the Urban Land Institute’s Senior Housing Council as
well as a member of the NAHB 50+ Housing Council. He has contributed articles to Seniors
Housing News, Multi Housing News and has been a speaker at several national conferences.
He also served on the City of Newport Beach Planning Commission.
Mr. Brown received a Master of Arts degree in Urban Planning from the UCLA School of
Architecture and Urban Planning and a Bachelor of Arts degree from the Evergreen State
College in Olympia, Washington.
Terri Novak, Vice President, Chief Operating Officer
c/o Kisco Senior Living 5790 Fleet Street, Suite 300 Carlsbad, CA 92008
As Chief Operating Officer for Kisco Senior Living, LLC, Terri Novak is responsible for
providing support, guidance and direction in the management of the company’s seniors’
communities including continuum of care campuses (CCRC), assisted living and specialized
memory care dementia. She is responsible for the day-to-day operations of 20 communities in
six states with over $140 million in annual revenue and approximately 1600 associates. She is
also responsible for developing and refining programs to monitor and improve all aspects of
customer satisfaction for residents and their families.
Ms. Novak has more than 25 years of management experience and with more than 18 of those
years focused in leadership positions in the senior housing and healthcare industries. She has
fulfilled operations, management and marketing duties for programs that include independent
living, skilled nursing, dementia care, assisted living, home health and home and community
based services.
Ms. Novak has an associate’s degree in Health Care Administration and earned her Bachelor of
Science degree in Human Resource management and a Master of Business Administration
degree from Friends University in Wichita, Kansas. She is the past president of the Kansas
Adult Care Executives (KACE) and has served as a board member of Kansas Association of
Homes and Services for the Aging (KAHSA). Ms. Novak is a certified California Awards for
Performance Excellence (CAPE) Examiner to lead expertise in achieving world-class results
through the criteria of the Baldrige National Quality Program.
Mark Dressel, Vice President, Chief Financial Officer
c/o Kisco Senior Living 5790 Fleet Street, Suite 300 Carlsbad, CA 92008
As CFO for Kisco Senior Living, LLC, Mr. Dressel is responsible for relationships with lenders
and investors, assisting with development of capital investors, analysis and pro forma modeling
of acquisition and development opportunities, oversight of finance and risk and serves as a
member of the senior leadership team. He is responsible for the financial management of 21
communities in seven states with over $170 million in annual revenue.
Mr. Dressel holdsaBachelorofScienceinBusinessAdministrationandHotelRestaurant
ManagementfromJamesMadisonUniversity.His25yearcareerinfinanceandoperations
includesseniorlevelroleswithTheRitz‐CarltonHotelCompanyandMandarinOriental
HotelGroup.PriortojoiningKiscoinJanuary2016,DresselservedasCFOandCOOfor
NovareGroup,aprivatelyheldrealestatedevelopmentandoperatingcompany
specializinginupscaleresidentialandhotelproperties.
If you have additional information you’d like to request about the people of The Cardinal,
please feel free to write to:
The Cardinal at North Hills
Disclosure Statement Information
5790 Fleet Street, Suite 300
Carlsbad, CA 92008
Community Management Team (CMT)
The Cardinal will be led by Mr. Tom Ford. Mr. Ford has been with Kisco Senior Living for 14
years during which time he was Executive Director at Woodland Terrace in Cary and Magnolia
Glen in Raleigh. Tom earned a BS in Business Administration/Health Care Management and a
Master’s Degree in Public Administration. Additional CMT members supporting Mr. Ford are:
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Assisted Living Director
Dining Services Director
Environmental Services Director
Hospitality Director
Nursing Care Director
Resident Relations Director
Wellness Director
Sales Director
Business Office/Finance Director
Neither the managers nor any principals of The Cardinal (i) have been convicted of a felony or
pleaded nolo contendere to a felony charge or been held liable or enjoined in a civil action by
final judgment for a felony or civil action involved fraud, embezzlement, fraudulent
conversion, or misappropriation of property; or (ii) is subject to a currently effective injunctive
or restrictive court order, or within the past five years, had any state or federal license or permit
suspended or revoked as a result of an action brought by any governmental agency or
department, arising out of or related to business activity of health care, including actions
affecting a license to operate a foster care facility, nursing home, retirement home, home for the
aged, or facility subject to N.C.G.S. §58-64 or similar law in another state.
4.
Affiliations
The Cardinal is a private, independent, for profit limited liability company, which is not
affiliated with any religious, charitable or other affinity group.
5.
Description of The Community
The Cardinal at North Hills (CNH) will be a rental Continuing Care Retirement Community
(CCRC) located in the master planned, mixed use neighborhood of North Hills. The new
community is under construction on a 5.9 acre site located between Six Forks Road and St.
Albans Drive at the eastern end of the North Hills Park District. The community will include a
mix of independent living residences connected to a clubhouse commons as well as assisted
living, specialized assisted living for memory care and nursing care. The main entrance will be at
the east end of Midtown Park with a covered drop off and visitor parking in a motor court
flanked by the clubhouse commons and two, 5 story independent living (IL) buildings. The two
IL buildings will contain a total of 165 residences (for an estimated 300 residents) including one,
two and three bedroom floor plans. Parking for the IL residences will be in a garage located
below the buildings with direct elevator access. There will be one assigned, reserved parking
space per residence as well as additional spaces in the garage. IL residences will include walk-in
closets, washers and dryers, full kitchens, a 24 hour emergency call system and a choice of
upgrades.
The clubhouse commons will be a three level building connected to the IL buildings at the lobby
level by enclosed walkways. The lobby level will included multiple dining venues with a full
commercial kitchen, administrative offices, library, bar, and a living room/lounge area connected
to a large outdoor terrace overlooking the gardens below. The garden level will include the
beauty salon, fitness center, spa and wellness areas, indoor pool and various back of house
support areas and mechanical spaces. Outdoor amenities at this level will include a terraced
garden with walking paths, sitting areas, planting areas for resident and outdoor entertainment
venues. The mezzanine level will include a “family room” that can be reserved for parties and
gatherings, art studio, media center/chapel, card and billiard room with a pub, and a multipurpose
space which can be combined and expanded into larger spaces for specific functions such as
large receptions, lectures and meetings.
Assisted living, memory care and nursing care will be located in an adjacent building with a
separate entry and drop off to the south of the clubhouse. This building will be connected to the
clubhouse for ease of shared services and access. Parking for this building will be in a
contiguous parking deck. Specialized memory care for Alzheimer’s and related dementias will
be located in a “household” format on the garden level with a secure outdoor garden. The lobby
level will include a clinic, OT/PT/Rehab spaces as well as nursing care and assisted living.
Assisted living will also be located on the mezzanine level and will include a dining room, living
room and other support spaces.
As a CCRC, The Cardinal will offer multiple lifestyle choices designed to promote
independence, dignity and an engaged lifestyle. Independent living residences are available for
older adults who live in their own private residence. In this community, they will enjoy life just
as they did in their own home, but will now have access to various services such as
housekeeping, maintenance, and scheduled transportation, several dining venues with flexible
meal plans, fitness classes, social activities and “life-long” learning. It is anticipated that IL
residents will have a variety of choices in service options customized to their needs and
presented in concert with the many adjacent amenities and services in North Hills.
The Independent Living lifestyle will be offered in a fee format with an initial contractual
reservation fee (or entrance fee) equal to two months of the Fees for the Residence type selected.
Some examples of services and features covered by the fees include:
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A flexible meal plan
Regular housekeeping (every other week)
All utilities except telephone and premium cable
24 hour emergency call system
Scheduled transportation
A full range of social programs
Wellness and fitness center with Kisco’s signature Art of Living Well program
For residents who require additional physical or cognitive support, there will be a range of
services provided in the licensed health care building which will include assisted living, memory
care and nursing care. Independent living Residents will have priority access to any of these
areas which may be on a short term basis, if able to return to their IL residence, or a permanent
change in residence based on need. In the memory care and nursing households, all living spaces
are anticipated to be private alcove or studio apartments organized around communal dining,
living, activity and outdoor spaces. All meals, housekeeping and other services will be provided
as well as a full daily calendar of engagement activities and individualized supportive care. Fees
will be based on Residence type with additional charges related to care services provided.
Current fees are detailed in Section 11 below.
6.
Resident Information
Effective communication between residents and management is essential to the operational
success of The Cardinal. In addition to the more formal lines of communication, The Cardinal
has established a number of informal communications vehicles for the ease and convenience of
Residents.
Front Desk
Concierge services are available and when a Front Desk associate is not on duty, the main line
telephone will be answered by the Receptionist on duty.
Resident Notices
Bulletin boards, which are located in the postal and message center, are maintained as a means of
conveying information to Residents. One board is for "official" The Cardinal notices, schedules
and announcements and is kept current by The Cardinal Associates.
The other board is for items of Resident interest, Resident notices, and other unofficial items.
This board is maintained by The Cardinal, in conjunction with the Resident Advisory Council.
The common areas will also have several monitors which will access a community channel. This
system will display all community events and activities and will also be available on resident
televisions and computers in each residence.
U.S. Postal Service
The U.S. Postal Service will pick up and deliver mail to the postal and message center.
Individual mailboxes are located in the postal and message center and a mail pick up schedule will
be posted. Residents of nursing care and memory care will have mail delivered to their apartment.
Newspaper Delivery Service
The Cardinal will provide a limited number of newspapers and periodicals in a central location for
resident use. Arrangements for receiving and paying for newspapers and magazines must be made
directly by the Resident.
Cable Television
"Basic" cable television is included in the Monthly Fee. "Premium" channels may be contracted for
by the Resident, and will be billed directly to the Resident by the authorized cable provider.
An "in-house" community information channel is provided for items such as daily dining specials,
scheduled events, community updates, and emergency announcements.
Clerical Services
Residents may desire certain business services from time to time. Examples of these services are
listed below. Facilities to handle these services may be available in the Business Center. If you
require assistance, please contact a Resident Relations representative.
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Facsimile (Fax) Services
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Copier Services
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Notary Services
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Parcel service such as FedEx, UPS
(An additional fee may apply to above services)
Salon
A beauty and barber salon and spa will be located within The Cardinal. Operating hours and rates
will be set by the salon proprietor, and are subject to change without notice.
7.
Resident Services
Maintenance
Supervision of the maintenance function is the direct responsibility of the management of The
Cardinal.
The primary functions of Maintenance are:
 To keep the Residences and public areas clean and in good repair
 To maintain The Cardinal grounds and landscaping
 To develop and implement a program of preventive maintenance
 To provide trash removal services.
Maintenance after Move-In
After a Resident moves into a Residence, the Maintenance associates may assist in hanging pictures,
mirrors and shelves, without charge for the first two hours of labor. This work must be requested
within 30 days after move-in and should be scheduled as a four hour block of time. Associates may
inspect Resident-owned lamps and other appliances, and reserves the right to disable these items, if
unsafe, until the Resident can make arrangements for repairs.
Replacement of Light Bulbs
Maintenance will replace light bulbs in the common areas and in the Residence’s light fixtures,
which are installed as part of the building's original equipment. Residents are expected to furnish
bulbs for their own lamp fixtures and Maintenance will assist in changing them as necessary.
Maintenance of a Residence during a Resident's Absence
In the event of a maintenance emergency, as determined by The Cardinal, a Maintenance associate
may enter the Residence.
Grounds Maintenance
All landscaping at The Cardinal was installed in accordance with an approved plan including
watering systems and sprinklers. Residents may not install trees, bushes or other plantings without
prior written approval of the Executive Director.
Swimming Pool/Spa Maintenance
Care of the swimming pool, including establishing and maintaining proper chemical levels, is the
responsibility of The Cardinal. Water temperatures will be maintained at a comfortable to comply
with state regulatory requirements.
Pest Control
Pest control service will be provided on a scheduled basis.
Recycling and Waste Disposal
Trash and recycling rooms will be provided on each floor with trash and recycle bins. Only
disposable trash in sealed plastic bags, not loose garbage, should be placed in the trash and recycle
bins in these rooms. Items to be recycled will be collected in accordance with the current
community recycling program. Feline/pet excrement (not including litter) shall be disposed of in
Residence toilet. Litter must be placed in a tightly sealed plastic bag and placed in the trash bins.
Dogs need to be relieved outside the building in the designated pet area.
With the exception of bones, all cooking oils, fat, banana peels, onion skins, celery, coffee grounds
and similar coarse items which should be disposed of properly in the trash, all other food waste
should be put down the garbage disposal in the kitchen sink.
A Resident with a large or bulky trash item, including moving boxes, may call the maintenance to
make arrangements for it to be picked up.
For safety and to maintain a neat, clean environment, no trash of any kind should be put out in the
residence building hallways.
Storage Facilities
Each Residence is assigned a storage cubicle in a storage area separate from the residence.
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Locking of the assigned cubicle is the responsibility of the Resident. The storage areas
themselves will remain locked with Resident access provided by use of his or her entrance
key.
Assistance in moving items into or out of the storage cubicle can be obtained by contacting a
Customer Service associate.
The Cardinal is not responsible for items stored in a Resident's assigned storage cubicle.
Storage room aisles are designed for easy access to each storage space. Items may not
protrude into, or be put on, the floors of the aisle. Flammable liquids, chemicals,
pyrotechnics or ammunition may not be stored in any storage area or cubicle. Valuable
items such as jewelry, china, paintings, etc., should not be stored in storage areas.
Housekeeping
The supervision of the Housekeeping function is the direct responsibility of The Cardinal
management.
The primary functions of Housekeeping are:
 Basic housekeeping and cleaning services in the Residences
 Cleaning of all public spaces
 Laundering of The Cardinal washable goods.
Housekeeping Service
Housekeeping service is provided once every other week to each Residence, with certain exceptions
during holidays to the degree scheduling permits, housekeeping services will be provided in the
Residences at the same day and time every other week.
Residents will be provided a schedule of housekeeping visits, and notified of any anticipated
changes. In an effort to provide maximum utilization, management is not able to guarantee that the
same housekeeper will service your Residence each time. Individual housekeepers may be rotated
from time to time.
The Cardinal reserves the right to enter a Residence to perform routine housekeeping services in a
Resident's absence, unless the Resident has signed an Access Limitation Form allowing entry only
if the Resident is present. If this form is on file, and the Resident is not present at the scheduled
housekeeping time, then The Cardinal will not be obligated to re-schedule housekeeping services.
Services Included in Routine Cleaning
 Cleaning top of refrigerator, stove, countertops and sink; sweeping and wet mopping the
floor.
 Cleaning bathtub and showers, sink, countertops, toilet bowl, tank and tank cover, and
mirror; sweeping and wet mopping the floor.
 Light, top surface dusting; vacuuming carpet.
 Light dusting, vacuuming carpet and linen change (clean linens must be provided by
resident).
 Cleaning window sills, spot-cleaning carpet, trash removal; sweeping patio.
 Certain cleaning tasks will be accomplished by The Cardinal on a periodic basis, including
window washing inside and out and carpet shampooing, if needed.
Services Not Included in Routine or Expanded Cleaning
 Washing dishes, preparing food, waxing floors.
 Housekeeping associates will not dust or clean flat surfaces where there might be a chance
of breakage.
 Moving heavy furniture.
 Cleaning inside the refrigerator.
 Polishing silver or brass, etc.
 Personal laundry.
Extra Housekeeping Services
Extra housekeeping services may be requested from The Cardinal.
These extra services would include, but are not limited to, those services not included in routine
cleaning (as described above), or other services requested by the Resident and approved by The
Cardinal. Charges for extra housekeeping services are outlined in Appendix A and will be added to
the monthly statement.
Carpet Cleaning
Carpets will be cleaned depending on normal "wear and tear" and routine expanded cleaning
schedules, as determined by The Cardinal. Should, in the opinion of The Cardinal, special carpet
cleaning is required in a Residence or in a public area due to a pet, unusual wear and tear, or general
abuse, the Resident will be charged for that service.
Safety
The Cardinal will be staffed 24 hours a day, 7 days per week by Customer Service Associates.
These associates do not carry firearms, but does carry two-way communication equipment capable
of receiving and acknowledging emergency calls and routing communication with other
Community Associates and Residents. The Emergency Call System will include a daily check-in
system which sends a notification to the Customer Service desk each morning that the Resident is
up and about.
Firearms
Firearms are not allowed at The Cardinal.
Vehicle Identification
All Resident-owned vehicles will be required to display a small decal on the vehicle. Such decals
will be individually numbered for proper vehicle identification. Decals will be issued by The
Cardinal at the time of vehicle registration. In the event that a vehicle is added or disposed of, the
Resident is responsible for notifying The Cardinal of the change. Residents who own vehicles are
required to maintain current registration and appropriate insurance.
In Case of Fire or Other Disasters
 At The Cardinal, the Residence buildings and other common spaces are fully sprinkled.
 Emergency Fire Evacuation procedures are provided to Residents for strategic placement in
the Residence for quick reference in the event of an emergency.
 In case of fire in a Residence building or the common areas of the main building, Residents
should not use the elevators, but should proceed with caution to the nearest building exit.
 A Community Disaster Plan is available. This plan includes a specific section on Fire and
Evacuation. Residents are urged to read and to become familiar with the contents of the
Disaster Plan.
Smoke Detectors, Residence
Every Residence will have a smoke detectors installed. Smoke detectors report directly to either
the emergency call system or the main fire panel.
Smoke Detectors, Public Areas
Public area smoke detectors are connected directly to the main fire panel and are monitored by an
external alarm service.
If a public area smoke detector is activated, an audible alarm will sound in the immediate vicinity;
alarms will automatically sound at the control desk in the Administrative area and the Fire
Department automatically will be called by the external alarm service. A strobe light and horn will
also be activated in each Residence wing of the involved building.
Cardinal associates will be dispatched to the location of an activated public area smoke detector.
Residents should take action per the Emergency Fire Evacuation procedures.
Emergency Call System
Residences are equipped with an emergency call system in each bedroom and bathroom. If the call
system is activated, a Cardinal associate will check on you. If necessary, 911 will be called.
This call system is for emergency use only. It is not intended to be used for any other purpose. In
the event of a medical emergency or life threatening event for which calling 911 is appropriate, the
Resident should call 911 if possible, prior to using the emergency call system.
8.
Health Center Services
The Cardinal offers healthcare options for Residents that include assisted living, memory support
and nursing care, should you require assistance due to a change in your health status. Fees for these
services are outlined in the service offerings.
Priority Access to Health Center Services
Priority for admission to the Health Center services among residents will be established on a firstcome, first-served basis. If no space is available in the Community’s assisted living, memory
support or nursing care apartments you may choose to receive services, as appropriate, at a nearby
outside facility. A resident will be allowed to move directly in to the Health Care Center, without
the 30 day independent living requirement, if their spouse is a resident in the independent living.
Level of Living Determinations
The Community Care Management Team will determine, in consultation with you, your physician,
other health care providers, and your representative, whether you need assisted living, memory
support or nursing care, the extent of the care to be provided, whether such care will be provided at
the Community or away from the Community, and whether any relocation from your residence for
care is temporary or permanent.
No Obligation to Prepay for Health Center Services
The Cardinal is a rental CCRC with a full continuum of care and does not require you to prepay for
Health Center services, nor does it accept any liability to pay for your future health care services.
Assisted Living
Assisted Living cares for Residents who need assistance with the activities of daily living. Assisted
living offers three meals per day; a variety of social and therapeutic activities and is staffed 24 hours
a day. These services are provided within the scope of state licensure.
Memory Support
The Memory Support household is for Residents who have Dementia or require memory
enhancement services. The memory support center was designed to help Residents feel as
comfortable as possible and features spaces for recreational activities and programs. Associates in
memory support receive special training in order to provide the necessary programming and
assistance with activities of daily living to the Residents. Dining service includes three meals per
day served in a family style dining area, as well as delicious snacks served in the kitchen. These
services are provided within the scope of state licensure.
Nursing Care
Nursing Care is for Residents who require a more intensive nursing or rehabilitative services.
Associates in nursing care are specially trained to provide supportive care and assistance. Dining
service includes three meals per day, as well as delicious snacks and a variety of social and
therapeutic activities. Nursing Care is staffed 24 hours a day with Registered Nurses and certified
nursing assistants. These services are provided within the scope of state licensure.
Home Care Service
You may arrange for limited Home Care Services in your apartment. You and all providers of
Home Care Services or other Personal Services agree in writing to adhere to and comply with the
Community Policies for Home Care Services or Personal Services providers. If you arrange for
Home Care Services or Personal Services, you accept full responsibility for the cost of such
services. You understand and agree that The Cardinal shall not be liable for any loss, damage, or
injury to you, another Resident, or any other person caused by such providers.
Subject to the approval of The Cardinal, you may utilize Home Care Services in the apartment so
long as you are able to satisfy the Conditions of Occupancy. Such services must be approved in
advance and in writing by The Cardinal. The Cardinal reserves the right to review credentials of all
Home Care Assistants, to approve or prohibit the use of or to require the discontinuation of Home
Care Services. You are responsible to pay for all such services. As a condition of its approval, all
Personal Service providers and/or Home Care providers must provide the Community with an
appropriate release and indemnification agreement, proof of workers’ compensation and liability
insurance, as well as proof that such Personal Service providers are free of tuberculosis and/or any
other contagious or communicable disease, and are subject to a criminal background check. To the
extent required, you shall confirm that any approved Personal Service providers has workers’
compensation insurance coverage. In the absence of such coverage, you are required to provide
workers’ compensation insurance to the extent required by law. The Cardinal reserves the right to
terminate your authorization to utilize Home Care Services in the event that you do not comply with
the requirements, or require transfer to another level of care.
9.
Relocation Information
Relocations from Residence
Substitution of Residence by The Cardinal
The Cardinal reserves the right to substitute your Residence with another comparable Residence if it
is necessary to do so to meet any requirement of law or the lawful order or direction of the Fire
Marshal or another authorized public official, or for any other reasonable purpose, as determined to
be appropriate by The Cardinal.
Voluntary Relocation of Single Resident or Both Joint Residents
If you wish, you may move to another Residence at The Cardinal, subject to Residence availability
and The Cardinal’s approval. You must notify the Community in writing of the Residence desired.
You shall be responsible for all moving and cleaning costs associated with leaving your Residence
in acceptable condition or (“Unit Ready”) which is defined as restoring your original Residence to
its original condition, excluding ordinary wear and tear. In addition, you shall pay the Monthly Fee
on both Residences until such time that you make the vacated Residence available to the Cardinal in
acceptable condition Unit Ready after which you will then only pay the Monthly Fee on your new
or different Residence. The parties shall sign an amendment to their Agreement that identifies your
new or different Residence and the applicable Monthly Fee.
Subsequent Joint Occupancy by Residents of Different Residences
 If you and another Resident, residing in two separate Residences, decide to live together,
you may release one of your residences and live together in the other residence, subject to
availability and The Cardinal’s approval. You shall be responsible for all moving and
cleaning costs and the cost of restoring the vacated residence to its original condition,
excluding ordinary wear and tear. The vacated residence Monthly Fee will cease upon it
being Unit Ready. You will sign an amendment to your Agreement that identifies your
different accommodation, states that you have elected to live in such accommodation, and
identifies the double occupancy Monthly Fee.

If you and another Resident, residing in two separate residences, decide to live together in a
new or different residence, you may release both of your current residences and move into a
new or different residence, subject to availability and The Cardinal’s approval. You shall be
responsible for all moving and cleaning costs and the cost of restoring your former
residences to their original condition, excluding ordinary wear and tear. The vacated
residence or residences Monthly Fee will cease upon it being Unit Ready. You and your
joint occupant will sign a new Agreement that identifies your new or different
accommodation and identifies the Monthly Fee for your new or different accommodation.
Subsequent Joint Occupancy by Resident and Non-Resident
If you wish to live in your Residence with someone who is not a Resident of The Cardinal, the nonResident must follow the standard application procedures for move-in to the Community. Both of
you shall be __ years of age or older. If the non-Resident’s application is rejected, (s) he/she shall
not qualify to be a Resident of The Cardinal. The rejection of the non-Resident’s application will
have no effect on your existing agreements with the Cardinal, and you may choose to continue
living in your Residence alone or terminate your Residence Agreement in accordance with its terms.
If the application is approved, the new Resident shall pay, on the same terms that apply to all
Residents, the Second Person Monthly Fee. Both of you shall sign an amendment to the Agreement
that identifies the Monthly Fee for your Residence. Both Residents together and each Resident
separately will be liable for all fees described in the Agreement.
Dissolution, Divorce or Separation of Residents
If you jointly occupy your Residence, and you divorce, separate, or otherwise wish to live
separately while at The Cardinal, either of you shall be entitled to relocate from your Residence to a
different residence, subject to residence availability and the Community’s approval. The
transferring Resident shall then pay the Monthly Fees for single occupancy of his or her new or
different residence and will sign a new Residence Agreement.
Relocation within The Cardinal for Health Center Services
The Community Care Management Team, in consultation with you, your physician, and your
representative, shall determine whether your relocation from your Residence is temporary or
permanent.
Temporary Relocation Within The Cardinal.
 Single Occupancy.
o If you require temporary Health Center services, you shall (a) continue to pay your
regular Monthly Fee for your Residence; (b) pay the Monthly Health Center Fee;
and (c) pay for any charges for ancillary items and services you receive that are not
covered by the Monthly Health Center Fee.

Double Occupancy.
o If you occupy your Residence with another Resident and one of you is temporarily
transferred outside your Residence for Health Center services, the remaining
Resident may continue to occupy your Residence. In that case, the remaining
Resident will be obligated to pay the Monthly Fee for single occupancy and charges
for optional items and services. The transferred Resident will pay the applicable
Monthly Health Center Fee and any charges for ancillary items and services (s)he
receives that are not covered by the Monthly Health Center Fee. If both of you
simultaneously receive Health Center services, you will be responsible for
continuing to pay only the single occupancy Monthly Fee for your Residence and
each of you shall pay (a) the applicable Monthly Health Center Fee for care
received; and (b) any charges for ancillary items and services that each of you
receive that are not covered by the Monthly Health Center Fee. Both Residents
together and each Resident separately will be liable for all fees described in the
Agreement.
Permanent Relocation for Health Center Services Within The Cardinal

Single Occupancy.
o If you occupy your Residence by yourself and you require permanent Health Center
services you shall vacate your Residence and relocate to a Health Center apartment
as appropriate. You will continue to pay The Cardinal the Monthly Fee until you
make your Residence Unit Ready to The Cardinal. You shall be responsible for all
moving and cleaning costs and the cost of restoring your former residence to its
original condition, excluding ordinary wear and tear. Once your Residence is Unit
Ready, the Unit will be deemed available to The Cardinal for sales and marketing
purposes, and the Resident will be released of any further responsibility regarding
the former residence, notwithstanding any additional costs required as determined by
the Community following a thorough inspection of the Residence after you have
moved. In addition, you shall pay the applicable Monthly Health Center Fee and any
charges for ancillary items and services you receive. After you have made your
Residence Unit Ready to The Cardinal, you shall be responsible for paying only the
Monthly Health Center Fee and any charges for ancillary items and services you
receive.

Double Occupancy.
o If you occupy your Residence with another Resident and one of you requires
permanent Health Center services, the remaining Resident may continue to occupy
your Residence. In that case, the remaining Resident will be obligated to pay the
Monthly Fee for single occupancy and any charges for optional items and services.
The transferred Resident will pay the applicable Monthly Health Center Fee and any
charges for ancillary items and services he/she receives. If both of you
simultaneously require permanent Health Center services, you shall vacate your
Residence and relocate to one of The Cardinal’s Health Center apartments. You
shall continue to pay only the single occupancy Monthly Fee until your Residence is
Unit Ready. In addition, each of you shall pay the applicable Monthly Health Center
Fee for the care received and any charges for ancillary items and services you
receive. Once your Residence is Unit Ready, each of you shall be responsible for
paying only the applicable Monthly Health Center Fee and any charges for ancillary
items and services you receive.
Health Center Services Agreements
If you require permanent or temporary health care services within The Cardinal, prior to or upon
moving to an assisted living or skilled nursing apartment at The Cardinal Health Center, you must
sign an Assisted Living Residence and Care Agreement or Nursing Care Residence and Care
Agreement, as applicable, in the form then required by The Cardinal (the “Health Center
Agreements”). The current forms of the Health Center Agreements are attached to this Disclosure
Statement.
Summary of Health Center Agreements.
The Assisted Living Residence and Care Agreement is a month to month agreement, and you will
pay Monthly Health Center Fees during your occupancy of an assisted living apartment. The
Nursing Care Residence and Care Agreement provides for a Daily Health Center Fee, which will be
billed to you on a monthly basis based on the days of your occupancy in a nursing care apartment.
The Monthly Health Center Fees and the Daily Health Center Fees may be referenced herein as the
“Health Center Fees”. The Health Center Agreements will be binding contracts between you and
The Cardinal at North Hills Healthcare, LLC, which operates the Health Center pursuant to
contracts with The Cardinal. Under the Health Center Agreements, both assisted living apartments
and skilled nursing apartments (both referenced herein as “Health Center Apartments”) are provided
with all utilities except for telephone and premium cable television service. Assisted living
apartments are provided with floor and window coverings, and you must furnish the assisted living
apartment with furnishings that comply with North Carolina adult care home regulations (The
Cardinal’s Healthcare staff will inform you of these requirements). Skilled Nursing apartments and
Memory Care Assisted Living Apartments are provided with all required furnishings, and you may
not add furnishings to these Apartments except as approved by The Cardinal Health Center staff,
and all added furnishings must comply with North Carolina nursing care and assisted living
regulations.
Alterations to assisted living apartments may be made, at your expense, with the prior written
consent of the Executive Director. When you vacate the apartment, you will be responsible for
restoring the apartment to its original state. Skilled Nursing apartments may not be altered.
The Health Center Fee includes basic laundering and housekeeping services as described in the
Health Center Agreements. Additional housekeeping and laundry services can be provided for an
additional charge. You are responsible for personal dry cleaning.
Assisted living and nursing care residents generally provide their own supplies for personal care and
hygiene. However, if you are unable to provide such supplies or choose not to provide them, The
Cardinal Health Center will provide you with personal items for an additional charge.
All Health Center Agreements provide three (3) nutritious meals a day plus snacks, in accordance
with regulatory requirements. Tray service is available for no additional charge. Guests may dine
with you at an additional cost. Guests who are residents of the independent living component of
The Cardinal may use their monthly dining allowance to purchase guest meals in the Health Center.
Under the Assisted Living Residence and Care Agreement, the Monthly Health Center Fee includes
assistance with activities of daily living such as medication management, bathing, dressing,
ambulating and incontinence care. Different personal care service packages will be offered to
assisted living residents depending on their specific needs. The scope and pricing of these levels of
assisted living services may be changed at the discretion of The Cardinal Health Center upon thirty
(30) days written notice to you. When you are transferred to an assisted living apartment in
accordance with your Residence Agreement, the professional staff in consultation with your
physician and family will perform an assessment of your needs to determine the appropriate level of
service for you. The Cardinal Health Center staff will periodically reassess as needed to maintain
your appropriate level of care service. The current fees for the various levels of assisted living care
at The Cardinal Health Center and the description of these levels are set forth in appendices attached
to the Assisted Living Residence and Care Agreement. These fees are subject to change.
Under the Skilled Nursing Residence and Care Agreement, the Daily Health Center Fee includes a
program of nursing care determined in consultation with your physician to determine the
appropriate level of care. When you are transferred to a skilled nursing apartment in accordance
with your Residence Agreement, the professional staff will perform an assessment of your needs,
consult with your physician and family, and determine with you the appropriate program of nursing
care for you. The Cardinal Health Center will periodically review your care needs as appropriate.
The current fees for nursing care at The Cardinal Health Center are set forth in appendices attached
to the Nursing Care Residence and Care Agreement. These fees are subject to change.
In addition to the services provided as part of the Health Center Fee, additional option services will
be available to you at an extra charge. Some of the optional services offered by The Cardinal
Health Center include:
1.
2.
3.
4.
5.
7.
8.
Guest meals and services;
Tray service;
Personal transportation and supervision;
Beauty/barber shop services (if such services are provided by an outside
vendor, the vendor will bill you directly for beauty and barber services);
Additional laundry and housekeeping services beyond those described
above;
Repairs and maintenance of personal items; and
Any other services that we elect to offer in the future.
The current fees for optional services at The Cardinal Health Center are set forth in appendices to
the Health Center Agreements, and are subject to change.
The Cardinal Health Center is not responsible for furnishing or paying for any health care items or
services not expressly included in the Health Center Agreements, including but not limited to
physicians' services, surgery, hospital care, private duty care or other specialized care. Examples of
such specialized care include but are not limited to, treatment or examination of eyes or teeth,
medications, vitamins, eyeglasses, contact lenses, hearing aids, orthopedic appliances, prosthetic
devices, laboratory tests, x-ray services, toiletries and personal supplies not required to be provided
under the applicable Health Center Agreement.
The Health Center Fees and all other payments due to The Cardinal Health Center under the Health
Center Agreements are due by the 5th day of the month. If you fail to pay fees when due, The
Cardinal Health Center may charge you a late payment of up to five percent (5%) on your thencurrent Health Center Fees for each delinquent payment. Returned checks shall be subject to a
Fifty Dollar ($50.00) penalty.
You may terminate the Assisted Living Residence and Care Agreement upon thirty (30) days’
notice, or immediately in the case of your death. You may terminate the Nursing Care Residence
and Care Agreement with two (2) day notice, or immediately in the case of your death. In either
case, you or your estate will be responsible for paying the applicable Health Center Fee until such
time as your belongings are removed from your health center apartment. The Cardinal Health
Center may terminate your Health Center Agreement upon thirty (30) days’ notice if certain
conditions are met, including changes in your condition requiring services that The Cardinal Health
Center cannot provide. The Cardinal Health Center may also terminate your Health Center
Agreement upon less than thirty (30) days’ notice if we determine that (a) a delay in discharge or
transfer would jeopardize your health or safety or the health or safety of other residents at The
Cardinal Health Center; or (b) your condition has improved sufficiently to allow for a more
immediate discharge or transfer, as documented by a physician. Terminations are discussed in
more detail in the Health Center Agreements.
If you vacate your health center apartment for any reason, but fail to remove your belongings
from the health center apartment, we may remove your belongings and store them at the expense
of you or your estate, and if you or your estate abandon your belongings we may dispose of them
in accordance with North Carolina law.
In the event of a termination of your Health Center Agreement, your estate will receive a refund
of any unused pro rata portion of your Health Center Fee within thirty (30) days of the date your
belongings are removed from your health center apartment. Any such refund will be reduced by
the amount of any unpaid amount you owe to The Cardinal Health Center, the costs of repairing
your health center apartment or any other property of the Cardinal Health Center damaged by
you or your visitors outside of normal wear and tear, and any expense we incur to remove and
store your belongings.
Smoking is not allowed in the Health Center. Pets are not allowed in assisted living apartments..
. Pets are not allowed in the Health Center apartments except as part of an approved therapy
program sponsored by The Cardinal or service dogs.
The Health Center Agreements contain other important terms and conditions that you should review
prior to execution.
Relocation to an Outside Health Care Facility
 Temporary Relocation.
o If you relocate to an outside facility for Health Care services because no space is
available at The Cardinal Health Center, you shall continue to pay your regular Monthly
Fee for your Residence until you return. In addition, you shall be responsible for paying
the outside facility’s charges for the housing, services and items you receive at that
facility. The Cardinal in not responsible to pay such charges to the outside facility.
When space becomes available at The Cardinal Health Center, and as medical
circumstances allow, as determined by the Community care management team, you,
your physician, and/or your representative, The Cardinal will notify you to return. All
obligations regarding the provision and quality of care at the outside facility shall be the
responsibility of that facility and not The Cardinal, and you agree to hold The Cardinal
harmless for any injury or damage you incur at an outside care center.

Single Occupancy.
 If you require temporary Health Care services at an outside facility, you shall
continue to pay your regular Monthly Fee for your Residence as well as the
applicable rate including any charges for ancillary items and services you
receive that are not covered by the Monthly Fee.

Double Occupancy.
 If you occupy your Residence with another Resident and one of you is
temporarily transferred to an outside facility for Health Care services, the
remaining Resident may continue to occupy your Residence. In that case,
the remaining Resident will be obligated to pay the Monthly Fee for single
occupancy and charges for optional items and services. The transferred
Resident will pay any charges for ancillary items and services he/she
receives that are not covered by the Monthly Fee. If both of you
simultaneously receive Health Care services at an outside facility, you will
be responsible for continuing to pay only the single occupancy Monthly Fee
for your Residence and each of you shall pay any charges for ancillary items
and services that each of you receive that are not covered by the Monthly
Health Center Fee. Both Residents together and each Resident separately
will be liable for all fees described in the Agreement.

Permanent Relocation.
o If you occupy your Residence by yourself and you permanently relocate to an outside
Health Care facility, your Agreement will terminate. In the event of double occupancy,
if one Resident requires permanent assisted living, memory care or nursing care at an
outside facility, your Agreement will terminate with respect to the transferring Resident
and will continue only with respect to the remaining Resident.
Conditions Pertaining to Change of Residence
If you choose to move to a different Residence at The Cardinal, transfer to The Cardinal Health
Center, or move out of The Cardinal, the cost of refurbishment of your former Residence that is
over and above normal wear and tear may be assessed to you. This determination will be made by
the Community following a thorough inspection of the Residence after you have moved. The
moving costs associated with any move will be your sole responsibility.
Required Relocation
 You may be required to relocate to The Cardinal Health Center or an outside facility, as
appropriate, if any of the following exists as determined by the Community Care Management
Team, in consultation with you, your physician, and/or your representative:
o You fail to meet the Conditions of Occupancy for Residential living;
o Your continued occupancy of your Residence endangers your health, safety, or wellbeing or that of another person and your needs require that you be relocated to protect
your own health or safety or that of other Residents;
o You require care that cannot lawfully be provided in your Residence, The Cardinal
Health Center or care that The Cardinal is unable to or does not routinely provide;
o Your needs cannot be met at The Cardinal for reasons such as design or staffing or the
program of services offered at the Community;
o You exhibit behavior that endangers you or threatens the safety or well-being of other
Residents, violates the Community's rules, regulations, policies and procedures for
living in a retirement communal setting and creates an unreasonable and continuing
disturbance of the peaceful enjoyment of The Cardinal by other Residents, or you are
generally unable to benefit from the program of services available at The Cardinal; or
o Your personal physician has determined that you require services and care not available
at The Cardinal.
10.
Terminations and Refunds
Termination Due to Death or Change in Status Prior to Occupancy
If you die before occupying your Residence, or if, on account of an illness, injury, or incapacity that
occurs prior to occupying your Residence, you would be precluded from occupying your Residence
under the terms of this Agreement, this Agreement will be automatically canceled. You may be
eligible for residence in The Cardinal Health Center depending on the criteria for admissions
established by The Cardinal and the State of North Carolina. In either case, The Cardinal will pay
you or your estate a refund of your Deposit and any pre-paid fees; less any costs specifically
incurred by The Cardinal at your request as set forth in writing and signed by both parties. Your
estate will receive the refund within thirty (30) days from the date notice of death is received by the
Community or the date The Cardinal sends you notice of termination due to changed circumstances.
If you executed your Agreement with another Resident, your Agreement will remain in effect with
respect to the surviving Resident regarding payment of any refund.
Cancellation Period/Refund
 Cancellation by You.
o There will be a Cancellation Period of thirty (30) days during which you may cancel
your Agreement, with or without cause. The Cancellation Period begins on the later of
(a) the date that you sign your Residence Agreement and pay the applicable Deposit, or
(b) the date The Cardinal provides this Disclosure Statement to you. You must provide
written notice of such cancellation decision within the thirty (30) day period. You may
move in to your Residence during the Cancellation Period, but you are not required to
move in during the Cancellation Period if you do not wish to do so. In the event of
such cancellation, you shall be entitled to a refund of monies paid to The Cardinal
except that The Cardinal shall deduct from your refund (a) the reasonable value of any
services and accommodations rendered to you by The Cardinal; (b) any other costs
specifically incurred by The Cardinal at your request as set forth in writing and signed
by both parties; and (c) a cancellation fee in the amount of one thousand dollars
($1,000.00). In addition, you will lose any earnings credit accrued on monies paid to
The Cardinal. You will receive the refund within thirty (30) days after the date of your
written notice of cancellation, except that if you moved into your Residence you shall
receive the refund within thirty (30) days after you have vacated the Residence, removed
all your belongings from it, and restored it to its original clean condition, excluding
ordinary wear and tear. You must make your Residence available to The Cardinal as
described above within twenty (20) days after the date of the written notice of
cancellation.

Cancellation by The Cardinal.
o There will be a Cancellation Period of thirty (30) days after the date that you sign your
Residence Agreement and paid the applicable Deposit during which The Cardinal may
cancel your Agreement, with or without cause, upon written notice within the thirty (30)
day period. In the event of such cancellation, you shall be entitled to a refund of monies
paid to the Cardinal except that the Community shall deduct from your refund (a) the
reasonable value of any services and accommodations rendered to you by the
Community; and (b) any other costs specifically incurred by the Community at your
request as set forth in writing and signed by both parties. In addition, you will lose any
interest accrued on monies paid to the Community. You will receive the refund within
thirty (30) days after the date of The Cardinal’s written notice of cancellation, except
that if you moved into your Residence you shall receive the refund within thirty (30)
days after you make your Residence available to The Cardinal. You must make your
Residence available to The Cardinal within twenty (20) days after the date of the written
notice of cancellation.
Death of Resident During or After Cancellation Period Following Move In
Your Agreement will automatically terminate if you die during or after the thirty (30) day
Cancellation Period following your move into your Residence. In that case, The Cardinal will pay a
refund to your estate in accordance with the provisions of the Residence Agreement. Your payment
obligations will continue until your Residence is Unit Ready. If you executed your Residence
Agreement with another Resident, your Agreement will remain in effect with respect to the
surviving Resident regarding payment of any refund.
Termination by Resident After Cancellation Period
You may terminate your Agreement at any time after the thirty (30) day Cancellation Period by
giving The Cardinal thirty (30) days written notice, unless a shorter notice period is mutually agreed
to in writing. Until the effective termination date or the date you make your Residence Unit Ready,
whichever is later, you will pay the established Monthly Fee and other charges for accommodations,
and services performed by The Cardinal, together with such amounts as will cover other expenses
incurred by you, and any repairs to or replacement of The Cardinal property for damage caused by
you, excluding ordinary wear and tear.
Termination by The Cardinal After Cancellation Period
 The Cardinal may terminate your Agreement at any time after the Cancellation Period for
good cause, upon giving you thirty (30) days written notice. Good cause shall include, but
not be limited to, the following:
 Your failure to perform any of your obligations under your Agreement, including your
obligation to pay your Monthly Fee and other charges;
 You, your guests, or Home Care assistants failure to abide by the rules, regulations, policies
and procedures of The Cardinal, described in the Resident Handbook or in such other
documents or publications as may be provided from time-to-time, as they now exist or as
they may later be amended by the Cardinal in its sole discretion;
 Any material omission or misstatement in your Application For Residency, your
Reservation Agreement and any and all other documents filed with The Cardinal by you or
on your behalf;
 Your behavior creates an unreasonable and continuing disturbance within the Community
that is detrimental to the health, safety or peaceful enjoyment of others;
 You have needs that cannot be met at The Cardinal for reasons such as licensing, design or
staffing, or a condition that cannot be accommodated at The Cardinal as determined by the
Community or as defined by licensing regulations;
 You refuse to relocate for appropriate care or accept services and care required in order for
the Community to meet your needs;
 Your permanent relocation (or the permanent relocation of both of you, if you are a couple)
from The Cardinal premises.
Continued Monthly Fee Payment Obligation
You are required to pay the Monthly Fee throughout any and all notice periods until your Residence
is returned to The Cardinal in the described condition. The Cardinal will deduct from any refund
owed to you: (a) all unpaid Monthly Fee and other charges, including any applicable late charges
and interest; and (b) the cost (if any) of restoring your Residence to its original clean condition
(excluding normal wear and tear).
Deposit Refund After Cancellation Period.
At the end of the cancellation period, 50% of your deposit will be applied to the first month’s
Monthly Fee and the remainder of the deposit will become the property of The Cardinal, and not
refundable for any reason. You will not receive a refund of your deposit if your Agreement is
terminated after the Cancellation Period for any reason, except in the event of your death or change
in financial or health condition prior to taking occupancy at The Cardinal, as outlined in the first
paragraph of this Section 11.
11.
Fees and Other Charges
Deposit
A non-refundable deposit for your residence at The Cardinal equal to months of your Fees for the
residence you select is due upon execution of the Residence Agreement unless you have already
made such a deposit under a Binding Reservation Agreement. For those that made a deposit under
the Binding Reservation Agreement prior to opening, 50% of your deposit will be applied to the
first month’s Monthly Fee and the remainder of the deposit will be nonrefundable except as set forth
in the Residence Agreement. After opening, 100% of the deposit equal to two months of the
monthly service fee with be non-refundable. Monthly and Community fees vary according to the
size of independent living residence.
Your deposit is payable by check, money order, or wire transfer, and is due upon signing your
Residence Agreement.
Fee Amount
Fees vary according to the size of independent living residence and the number of occupants
residing in the independent living residence. The Fees will be due regardless of whether or not the
resident actually occupies the independent living residence. The following tables detail the monthly
service fees by type of residence.
The Cardinal at North Hills
INDEPENDENT LIVING FEE SCHEDULE
Independent Living Residences – Fees shown are subject to change.
PLAN
NAME
TYPE
SQUARE FT.
OPENING
MONTHLY FEES
Plan A
The Salisbury
1 Bedroom/1 Bath
Approx. 800
$4,475
Plan B
The Glenwood
1 Bedroom/1 Bath
Approx. 950
$5,052
Plan C
The Dawson
1 Bedroom/Den/1.5 Bath
Approx. 1,110
$5,125
Plan D
The Cameron
1 Bedroom/Den/1.5 Bath
Approx. 1,140
$5,369
Plan E
The Morgan
2 Bedroom/2 Bath
Approx. 1,200
$5,439
Plan F
The Marlowe
2 Bedroom/2 Bath
Approx. 1,265
$5,670
Plan F+
The Marlowe Plus
2 Bedroom/2 Bath
Approx. 1,330
$5,820
Plan J
The Hillsborough
2 Bedroom/2 Bath
Approx. 1,375
$5,560
Plan G
The Oxford
2 Bedroom/2 Bath
Approx. 1,555
$5,900
Plan K
The Granville
2 Bedroom/Den/2 Bath
Approx. 1,610
$6,900
Plan H
The Churchill
2 Bedroom/Den/2 Bath
Approx. 1,720
$7,137
Plan I
The Edenton
3 Bedroom/3 Bath
Approx. 2,080
$9,077
*Amounts shown are average Monthly Fees. Actual Monthly Fee will vary depending on the
location of the Residence within the community. Fees do not include Second Person Fees or any
optional or ancillary services. The Second Person Fee for Independent Living is $780.00.
Construction of the independent living portion of The Cardinal at North Hills is anticipated to be
complete in November 2016.
The Cardinal at North Hills Heath Center
HEALTH CENTER FEE SCHEDULE
Health Center – Fees shown are subject to change.
TYPE
CARE LEVEL
SQUARE FT.
OPENING MONTHLY
FEES*
Studio
Assisted Living
Approx. 325
$ 4,700
1 Bedroom
Assisted Living
Approx. 555
$ 5,200
1 Bedroom
Assisted Living
Approx. 655
$ 5,700
Studio
Memory Care
Approx. 325
$ 6,000
Studio
Nursing Care
Approx. 325
$ 9,000
*Amounts shown are Base Monthly Fees. Fees for additional Levels of Care will be established
at the time of residency based on need in accordance with published rates. Second Person Fee
for Assisted Living is $.940
Payment Procedures
You will commence paying your Fees and any other applicable service fees 30 days prior to
occupying your independent living residence. Thereafter, your Fees shall be payable in advance on
the first (1st) day of each month. You will be billed by the Community for the Fees for the next
month’s services and accommodations. Payment must be made by check, money order, electronic
payment, or other means prescribed by the Community.
Late Payment Charge and Interest
The Cardinal reserves the right to impose a late payment charge and interest at the maximum legal
rate not to exceed one and one-half percent (1.5%) per month, which is equal to eighteen percent
(18%) per annum, if you do not pay your Fees and other fees due under this Agreement by the due
date. You will be responsible for paying all attorneys’ fees and costs incurred by The Cardinal
related to the recovery of delinquent amounts due under this Agreement.
Obligations to Make Payment/Default/Financial Assistance
You are required to make all payments due to the Community in a timely manner and otherwise
satisfy your personal financial obligations. If you fail to pay the Fees or other charges in a timely
fashion, The Cardinal may, in its discretion, terminate your Agreement upon thirty (30) days written
notice. In the event of such termination, all unpaid fees and charges (including late payment
charges and interest) will be deducted from any refund payment that is due. The Cardinal has no
obligation to give you any financial assistance.
Adjustments
The Cardinal may increase or decrease the Fees or the scope or frequency of services upon thirty
(30) days advance notice. No notice will be required if a fee change results from a change in your
level of care or in the optional services you request.
Absences
You are responsible for continuing to pay your Fees whenever you are absent from the Community.
Charges for Optional Services
You will be billed for optional services selected either at the time they are rendered or with the next
billing cycle (see Appendix A). The payment procedures for optional service charges, including the
imposition of late fees and interest, are the same as for the Fees. The current charges for optional
services are set forth in the schedule of fees for optional services. The Cardinal may, in its sole
discretion, adjust the fees for optional services for any reason upon providing thirty (30) days
advance notice to Residents.
Joint Liability for Fees
If two Residents are signing the Agreement, both Residents together, and each Resident separately
will be liable for all fees described in their Residence Agreement. If you share your residence with
another resident who has executed another Residence Agreement, both of you are liable for all fees
due under both your and the other Resident’s Residence Agreement, including late payment charges
and interest.
12.
Residency Criteria
Age Criteria
Prospective residents must be at least 55 years of age at the time occupancy begins. If a resident is
married to a person who will be less than 55 years of age at the time of occupancy of the
independent living residence, the underage spouse may be approved for residency in the residence,
in The Cardinal's sole discretion, provided the spouse is at least 55 years of age and meets the other
admission requirements applicable to new residents. The Cardinal reserves the right to limit the
number of residents under the age of 62 that will live in the Community.
Health Criteria
Prospective residents must meet the health criteria established by The Cardinal for independent
living and be independently mobile, able to manage all activities of daily living, able to selfadminister medications with a reminder, if necessary, oriented as to person, place and time and be
able to plan and organize daily activities. A preliminary health screen completed by the prospective
resident's primary physician certifying as to certain independent living criteria is due 60 days after
the execution of the Residence Agreement by the prospective resident followed by a complete
medical history and physical examination, which is due at least 30 days prior to the prospects
proposed residency at the Community.
Financial Criteria
The prospective resident must have sufficient financial resources to allow payments to The Cardinal
to cover the costs of living in the Community including the deposit, monthly service fees or other
fees for all levels of care and to pay normal living expenses beyond the services to be provided by
The Cardinal. The prospective resident shall provide such financial information as The Cardinal
reasonably requires in such form as is acceptable to The Cardinal, to determine the prospective
resident's ability to pay.
Additional Occupants
If a current Resident wishes to have another person who is not a current resident of The Cardinal
move into the Residents Residence (for example, if the current Resident marries a non-Resident),
the new occupant must apply and meet the same admission requirements applicable to new
residents. If the prospective resident’s application is rejected, the prospective resident may not take
up co-occupancy with the existing Resident, but such rejection will have no effect on the existing
Resident’s Residence Agreement.
13.
Financial Disclosure
North Carolina law requires continuing care retirement communities such as The Cardinal to
maintain operating reserves equal to fifty percent (50%) of the total operating costs in a given
year, or twenty-five percent (25%) of such total operating costs if occupancy as of a certain date
exceeds ninety percent (90%) of the community's capacity. This law provides security to
residents that the community will be able to meet its contractual obligations to provide
continuing care. Once the Community is open, its projected occupancy rates and financial
statements will demonstrate its ability to meet the reserve levels required by law.
During the pre-construction phase, all deposits received from prospective residents will be held
in escrow with a state-chartered bank. The escrow funds are invested in the bank's interestbearing money market account. The escrowed funds may not be released to The Cardinal until
statutorily mandated levels of reserves are received and long-term financing is secured. If The
Cardinal fails to meet these pre-opening financing obligations, the bank shall return the escrowed
monies to the prospective residents, including any interest earned thereon. These statutorily
mandated financing levels are detailed in the North Carolina General Statutes at §58-64-20(a)(9).
The Cardinal has secured the state-required number of reservation agreements to open. The
Cardinal will be financed and owned by a joint venture partnership between HCRI North
Carolina Properties III, LP, an affiliate of Welltower (formerly Health Care REIT, Inc. (HCN)
and KSL Toledo Member, LLC, an affiliate of Kisco Senior Living, LLC (KSL). The Cardinal
at North Hills will be one of three senior living communities in Raleigh, North Carolina owned
by this HCN and KSL partnership under a Master Lease Agreement.
Upon completion of construction, the HCN/KSL partnership will lease the completed community
to another affiliate of Kisco Senior Living, LLC (The Cardinal at North Hills, LLC) for 15 years
with two extension options. The Cardinal at North Hills, LLC is the entity responsible to fund the
operating costs including the start-up losses. The initial Lease payment will be based on the total
cost of the completed project. The Initial Lease payment is projected to be approximately
$625,000 per month beginning in early 2017. The actual total cost of the project and the actual
Initial Lease Rate will determine the Lease payment at the point the community is ready for
occupancy. Upon reaching stabilization, the lease payments escalate over the term in fixed
increments of 0.25% annually. KSL has the option to purchase the community at the end of the
lease.
Exhibit A
The Cardinal at North Hills
Actuarial Population Projection Report
Providing actuarial, financial and planning services to managers
of the continuum of care for senior populations
December 2, 2015
Mr. Mitchell K. Brown
Chief Development Officer
Kisco Senior Living
5790 Fleet Street, Suite 300
Carlsbad, CA 92008
Dear Mr. Brown:
Kisco Senior Living engaged the consulting firm, A.V. Powell & Associates, LLC to conduct an
actuarial population projection report for The Cardinal at North Hills. The final report was
submitted to Kisco Senior Living management on September 6, 2012. This population projection
report shows that contractholders are expected to annually utilize 64 health care beds by the end
of the 20-year projection period (see Table 2.1). Variation in expected health care utilization is
not likely to exceed plus-or-minus 20% (see Table 2.15). The split of total health care utilization
between assisted living, memory support, and nursing care can be influenced by the
community’s transfer policies and configuration.
Please note that the actuarial population projections in the report were originally prepared in
2012, assuming the CCRC would be opening in May 2015. Since the actual CCRC opening is
expected to occur in Fall 2016, the actuarial population projectons should be shifted out by at
least one year.
Our population projections indicate that there is sufficient health center capacity for The
Cardinal at North Hills to meet its contractual obligation to provide health care to its
contractholders.
Please let me know if you need anything further.
Sincerely,
Molly J. Shaw
Senior Consultant
Providing actuarial and financial projections to organizations serving senior populations
300 West 4th Street, Suite A  Eureka, MO 63025-1839  636.549.3502 phone  [email protected]
OTHER OFFICES: Atlanta, GA  Kansas City, MO  Virginia Beach, VA
Providing actuarial, financial and planning services to managers
of the continuum of care for senior populations
September 6, 2012
Ms. Kimberly Hynek
Chief Financial Officer
Kisco Retirement Communities
5790 Fleet Street, Suite 300
Carlsbad, CA 92008
Dear Ms. Hynek:
This report describes the procedures and results of the actuarial population flow projections for The
Cardinal at North Hills. These actuarial population flows show projected independent living
turnover and projected health care utilization over a 20-year period.
Based on the contract and occupancy assumptions provided by you, A.V. Powell & Associates LLC
believes that these projections are reasonable and can be relied on for financial feasibility analysis.
Any reference to A.V. Powell & Associates in the feasibility study must be approved in advance, in
writing, by A.V. Powell & Associates. This report can not be included in any registration statement
or offering material associated with the public offering or private placement of any security.
Thank you for providing us the opportunity to conduct this review on your behalf. Please call us if
you have any questions or need additional projections.
Sincerely,
A.V. Powell & Associates LLC
A.V. POWELL & ASSOCIATES LLC
6255 Barfield Road NE ♦ Suite102
Atlanta, GA 30328-4332
404.845.0360 phone ♦ 404.845.0366 fax
Page 40 of 335
300 West 4th Street ♦ Suite A
Eureka, MO 63025-1839
636.549.3502 phone
8 East 125th Terrace
Kansas City, MO 64145-1604
816.943.6430 phone ♦ 816.943.6453 fax
OVERVIEW
We have developed actuarial projections of future population flows for The Cardinal at North Hills.
The population projection models are based on the pro forma income statement and occupancy
schedule provided by you. The assumed opening date is May 2015. Fill-up of the independent
living units is assumed over the next 30 months. New entrants are projected in order to maintain the
assumed 93.75% (150 out of 160 independent living units) occupancy level after fill-up.
Table 2.1 shows a summary of the projection results. The annual independent living turnover after
2020 is expected to average 18 units. Contractholders who were direct entrants to independent
living are expected to annually utilize 32 assisted living/memory support beds and 32 nursing care
beds by the end of the 20-year projection period. Variation in expected health care utilization is not
likely to exceed plus-or-minus 20%. The split of total health care utilization between assisted
living, memory support, and nursing care can be influenced by the community’s transfer policies
and configuration.
ASSUMPTIONS
Table 0.3.1 shows the number of units by level of care. Beginning-of-year and average occupancy
assumptions by unit type are shown on Tables 0.3.2 and 0.3.3.
Our projections are based on assumptions regarding rates of death (mortality), rates of assisted
living and nursing care utilization (morbidity), and probabilities of move-out. Assuming that
residents will leave The Cardinal at North Hills at these rates, we added new entrants to achieve
occupancy levels defined by the community’s management.
The selection of the mortality, morbidity, and move-out assumptions was based on the experience
of communities in the A.V. Powell & Associates database of CCRC residents, adjusted with a 5year age set forward to reflect a rental contract mix rather than the lifecare / modified lifecare mix
that is predominately in the AVP database.
We developed life expectancies for individuals and couples (Table 1.3) based on the mortality and
morbidity rate assumptions for The Cardinal at North Hills. The individual life expectancies are
provided in five-year intervals in total and in each level of care. For couples, the last survivor life
expectancy is the number of years that at least one member of a couple is expected to live in the
community.
Page 41 of 335
To project new entrants into the community, we made assumptions concerning the gender, age, and
double occupancy rate of future residents. These assumptions, based on recent entrants to CCRCs
in A.V. Powell & Associates’ database, are shown in Table 1.4. We assumed that the average age at
entry increases by one year for every five years of operation to correspond to the “aging in place” of
the existing population and the difficulty in attracting younger entrants that most CCRCs
experience.
METHODOLOGY
To simulate the future population flow, we performed the following steps 100 times for each year
of the 20 -year projection period:
1.
The assumptions described above were applied to the resident census at the beginning of
the projection year to generate the number of deaths, withdrawals, and permanent and
temporary transfers to health care. In determining turnover, only deaths or permanent
transfers from single residents in independent living cause a unit turnover.
2.
New entrants were generated to fill the appropriate number of double or single units.
This process produces expected values as well as a range of possible values for certain statistics.
Our methodology is defined in Continuing Care Retirement Communities: An Empirical,
Financial, and Legal Analysis by H.E. Winklevoss and A.V. Powell and the Society of Actuaries'
Textbook on Life Contingencies by C.W. Jordan.
Page 42 of 335
DETAILED RESULTS
Detailed results of the projections are presented in Tables 2.1 through 2.16.
Table 2.1 contains a summary of the projection results. The table shows the independent living
turnover, including sales of units that were not previously occupied the annual number of new
entrants, and total deaths or move-outs. The table also shows the average number of contractholders
and the assisted living and nursing care usage by permanent and temporary residents, for each year
in the projection period.
Table 2.2 shows the demographic statistics at the beginning of each year in the projection
period, including resident counts, average age, and years in the community.
Table 2.3 shows projected resident movement statistics by level of care.
Table 2.4 contains independent living turnover statistics and new entrant characteristics.
Columns three and four reflect the number of new entrants and the total turnover associated with
units that were previously occupied and new sales of units that were not previously occupied. This
table also shows the number of deaths, move-outs, and permanent transfers that caused unit
turnover. New sales represent the difference between the beginning of year occupancy from one
year to the next.
Table 2.5 shows the projected average number of contractholder days by level of care.
Permanent and temporary nursing care usage is shown separately, since temporary residents are
expected to return to their permanent care level. The sum of total contractholder days will exceed
the total number of residents given in Table 2.2 since residents on temporary transfer are counted in
both their permanent status and their temporary status.
Table 2.13 contains the projected independent living turnover by unit type. Unit types are
assigned to one of six groupings, as shown at the bottom of the table.
Table 2.14 contains the number of direct admissions to assisted living and transfers from
apartments to assisted living. We did not calculate projected refunds in this report because The
Cardinal at North Hills will only be offering rental contracts.
Page 43 of 335
Table 2.15 contains the range in independent living turnover and health care
utilization. Health care utilization is the sum of the projected assisted living and nursing care
usage. The likely minimum, average, and likely maximum values are provided for turnover and
health care utilization. The minimum and maximum values are also expressed as a percentage of
the average.
Table 2.16 shows the number of assisted living and nursing care contractholders per
100 independent living residents. The likely minimum and likely maximum values are also
given. We did not calculate projected refunds in this report because The Cardinal at North Hills
will only be offering rental contracts.
CERTIFICATION
A.V. Powell & Associates LLC believes that these projections form a reasonable basis for financial
projections of The Cardinal at North Hills. It should be noted that our projections of health care
usage and apartment turnover due to resident moves are based on assumptions that residents will
move to different levels of care as their “needs” dictate. Also, future health care usage can be
influenced by several factors that may change in the future or cannot be effectively modeled such
as:
•
contract provisions or health screening criteria at admission
•
management philosophy in regard to aging-in-place
•
number and acuity mix of health care beds
•
availability of home care services and private duty nurses
Therefore, based on the preceding issues and “actuarially small” census size, it is unlikely that
actual experience will match these projections exactly. The projections should be re-evaluated
from time to time to reflect updated community experience.
Page 44 of 335
List of Tables
(NOTE: THE TABLE LABELING PURPOSELY SKIPS CERTAIN NUMBERS)
TABLE 0.3.1............................................................................. Unit Capacity
TABLE 0.3.2.......................................................... Beginning of Year Unit Occupancy
TABLE 0.3.3................................................................... Average Unit Occupancy
TABLE 1.3........................................................................... Life Expectancies
TABLE 1.4..................................................................... New Entrant Assumptions
TABLE 2.1................................................. Summary of Population Projection Statistics
TABLE 2.2............................................. Beginning of Fiscal Year Demographic Statistics
TABLE 2.3................................................................ Resident Movement Statistics
TABLE 2.4............................................................... Apartment Turnover Statistics
TABLE 2.5.............................................................. Resident Days by Level of Care
TABLE 2.13.................................................. Projected Apartment Turnover by Unit Type
TABLE 2.14........................... Admission and Transfers to Assisted Living and Refund Statistics
TABLE 2.15...................... Projected Variation in Apartment Turnover and Health Care Utilization
TABLE 2.16.................................................. Projected Variation in Health Care Ratios
Page 45 of 335
Table 0.3.1
Cardinal at North Hills
Facility Unit Configuration
Unit Capacity
Square
Feet
----
Unit Type
---------
2015
----
2016
----
2017
----
2018
----
2019
----
2020
----
2021
----
2022
----
2023
----
2024+
-----
INDEPENDENT LIVING:
Studio A .
One BR B .
One BR C .
One BR/Den
Two BR E .
Two BR F .
Two BR G .
Two BR/Den
Two BR/Den
Two BR/Den
.
.
.
D
.
.
.
H
I
J
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
600
715
775
1,025
1,180
1,250
1,295
1,540
1,670
1,735
8
16
50
22
16
16
8
12
4
8
---160
----
8
16
50
22
16
16
8
12
4
8
---160
----
8
16
50
22
16
16
8
12
4
8
---160
----
8
16
50
22
16
16
8
12
4
8
---160
----
8
16
50
22
16
16
8
12
4
8
---160
----
8
16
50
22
16
16
8
12
4
8
---160
----
8
16
50
22
16
16
8
12
4
8
---160
----
8
16
50
22
16
16
8
12
4
8
---160
----
8
16
50
22
16
16
8
12
4
8
---160
----
8
16
50
22
16
16
8
12
4
8
----160
-----
. . .
small
med .
. . .
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
325
555
655
325
13
1
13
18
---45
----
13
1
13
18
---45
----
13
1
13
18
---45
----
13
1
13
18
---45
----
13
1
13
18
---45
----
13
1
13
18
---45
----
13
1
13
18
---45
----
13
1
13
18
---45
----
13
1
13
18
---45
----
13
1
13
18
----45
-----
NC Studio . . . . . . .
325
15
---15
----
15
---15
----
15
---15
----
15
---15
----
15
---15
----
15
---15
----
15
---15
----
15
---15
----
15
---15
----
15
----15
-----
ASSISTED LIVING:
AL
AL
AL
MC
Studio
One BR
One BR
Studio
NURSING CARE:
Page 46 of 335
Table 0.3.2
Cardinal at North Hills
Facility Unit Configuration
Beginning of Year Unit Occupancy
Unit Type
---------
2015
----
2016
----
2017
----
2018
----
2019
----
2020
----
2021
----
2022
----
2023
----
2024+
-----
INDEPENDENT LIVING:
Studio A . .
One BR B . .
One BR C . .
One BR/Den D
Two BR E . .
Two BR F . .
Two BR G . .
Two BR/Den H
Two BR/Den I
Two BR/Den J
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
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.
.
.
.
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.
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.
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.
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.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
0
0
0
0
0
0
0
0
0
0
---0
----
2
5
15
6
5
5
2
3
1
2
---46
----
5
11
33
14
11
11
5
8
3
5
---106
----
7
15
47
21
16
15
7
11
4
7
---150
----
7
15
47
21
16
15
7
11
4
7
---150
----
7
15
47
21
16
15
7
11
4
7
---150
----
7
15
47
21
16
15
7
11
4
7
---150
----
7
15
47
21
16
15
7
11
4
7
---150
----
7
15
47
21
16
15
7
11
4
7
---150
----
7
15
47
21
16
15
7
11
4
7
----150
-----
. . .
small
med .
. . .
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
0
0
0
0
---0
----
12
1
12
14
---39
----
12
1
12
17
---42
----
12
1
12
17
---42
----
12
1
12
17
---42
----
12
1
12
17
---42
----
12
1
12
17
---42
----
12
1
12
17
---42
----
12
1
12
17
---42
----
12
1
12
17
----42
-----
NC Studio . . . . . . . . . .
0
---0
----
10
---10
----
14
---14
----
14
---14
----
14
---14
----
14
---14
----
14
---14
----
14
---14
----
14
---14
----
14
----14
-----
ASSISTED LIVING:
AL
AL
AL
MC
Studio
One BR
One BR
Studio
NURSING CARE:
Page 47 of 335
Table 0.3.3
Cardinal at North Hills
Facility Unit Configuration
Average Number of Unit/Beds Occupied
Unit Type
---------
2015
----
2016
----
2017
----
2018
----
2019
----
2020
----
2021
----
2022
----
2023
----
2024+
-----
INDEPENDENT LIVING:
Studio A . .
One BR B . .
One BR C . .
One BR/Den D
Two BR E . .
Two BR F . .
Two BR G . .
Two BR/Den H
Two BR/Den I
Two BR/Den J
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
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.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
1
2
6
2
2
2
1
1
0
1
---18
----
4
8
24
11
8
8
4
6
2
4
---79
----
7
14
42
18
14
14
7
10
3
6
---135
----
7
15
47
21
16
15
7
11
4
7
---150
----
7
15
47
21
16
15
7
11
4
7
---150
----
7
15
47
21
16
15
7
11
4
7
---150
----
7
15
47
21
16
15
7
11
4
7
---150
----
7
15
47
21
16
15
7
11
4
7
---150
----
7
15
47
21
16
15
7
11
4
7
---150
----
7
15
47
21
16
15
7
11
4
7
----150
-----
. . .
small
med .
. . .
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
5
0
5
6
---16
----
12
1
12
17
---42
----
12
1
12
17
---42
----
12
1
12
17
---42
----
12
1
12
17
---42
----
12
1
12
17
---42
----
12
1
12
17
---42
----
12
1
12
17
---42
----
12
1
12
17
---42
----
12
1
12
17
----42
-----
NC Studio . . . . . . . . . .
4
---4
----
13
---13
----
14
---14
----
14
---14
----
14
---14
----
14
---14
----
14
---14
----
14
---14
----
14
---14
----
14
----14
-----
ASSISTED LIVING:
AL
AL
AL
MC
Studio
One BR
One BR
Studio
NURSING CARE:
Page 48 of 335
Table 1.3
Individual Life Expectancies for 2015 Residents in
INDEPENDENT LIVING in Cardinal at North Hills
(Based on Baseline Decrements)
Current Age
-----------
Life Expectancy
for
Residents in
INDEPENDENT LIVING
---------------
Portion of
Lifetime in
INDEPENDENT LIVING
-----------
Portion of
Lifetime in
ASSISTED
LIVING
-----------
Portion of
Lifetime in
NURSING
CARE
-----------
FEMALE
60
20.1 years
16.1 years
2.3 years
1.7 years
65
17.4
13.6
2.1
1.7
70
14.6
10.9
2.0
1.7
75
11.8
8.2
1.9
1.7
80
9.4
6.2
1.7
1.5
81 *
8.9
5.8
1.6
1.5
85
7.4
4.8
1.3
1.3
90
6.1
4.5
0.7
0.9
95
5.2
4.4
0.1
0.7
100
3.8
3.4
0.0
0.4
MALE
60
16.2 years
14.6 years
1.0 years
0.6 years
65
13.1
11.7
0.9
0.5
70
10.4
9.1
0.8
0.5
75
8.6
7.2
0.9
0.5
80
7.0
5.6
0.9
0.5
81 *
6.8
5.4
0.9
0.5
85
6.0
4.7
0.8
0.5
90
5.3
4.7
0.4
0.2
95
4.2
3.9
0.2
0.1
100
2.8
2.6
0.1
0.1
* Average age at entry for residents of INDEPENDENT LIVING.
Page 49 of 335
Table 1.3
Individual Life Expectancies for 2015 Residents in
ASSISTED LIVING in Cardinal at North Hills
(Based on Baseline Decrements)
Current Age
-----------
Life Expectancy
for
Residents in
ASSISTED
LIVING
---------------
Portion of
Lifetime in
INDEPENDENT LIVING
-----------
Portion of
Lifetime in
ASSISTED
LIVING
-----------
Portion of
Lifetime in
NURSING
CARE
-----------
FEMALE
60
12.5 years
0.0 years
10.3 years
2.2 years
65
11.4
0.0
9.1
2.3
70
9.9
0.0
7.5
2.4
75
8.3
0.0
6.1
2.2
80 *
7.0
0.0
5.0
2.0
85
5.9
0.0
4.0
1.9
90
4.6
0.0
3.3
1.3
95
3.3
0.0
2.5
0.8
100
2.2
0.0
1.8
0.4
MALE
60
11.0 years
0.0 years
10.0 years
1.0 years
65
9.0
0.0
8.0
1.0
70
7.4
0.0
6.4
1.0
75
5.9
0.0
5.0
0.9
80 *
4.5
0.0
3.7
0.8
85
3.8
0.0
3.0
0.8
90
3.1
0.0
2.4
0.7
95
2.2
0.0
1.8
0.4
100
1.8
0.0
1.6
0.2
* Average age for residents of ASSISTED LIVING.
Page 50 of 335
Table 1.3
Individual Life Expectancies for 2015 Residents in
NURSING CARE in Cardinal at North Hills
(Based on Baseline Decrements)
Current Age
-----------
Life Expectancy
for
Residents in
NURSING
CARE
---------------
Portion of
Lifetime in
INDEPENDENT LIVING
-----------
Portion of
Lifetime in
ASSISTED
LIVING
-----------
Portion of
Lifetime in
NURSING
CARE
-----------
FEMALE
60
6.5 years
0.0 years
0.0 years
6.5 years
65
6.4
0.0
0.0
6.4
70
6.1
0.0
0.0
6.1
75
5.6
0.0
0.0
5.6
80 *
4.7
0.0
0.0
4.7
85
4.1
0.0
0.0
4.1
90
3.6
0.0
0.0
3.6
95
2.9
0.0
0.0
2.9
100
2.4
0.0
0.0
2.4
MALE
60
3.6 years
0.0 years
0.0 years
3.6 years
65
3.1
0.0
0.0
3.1
70
2.8
0.0
0.0
2.8
75
2.6
0.0
0.0
2.6
80 *
2.5
0.0
0.0
2.5
85
2.3
0.0
0.0
2.3
90
2.0
0.0
0.0
2.0
95
1.7
0.0
0.0
1.7
100
1.4
0.0
0.0
1.4
* Average age for residents of NURSING CARE.
Page 51 of 335
TABLE 1.3 Continued
Last Survivor Life Expectancies for 2015 Residents in
INDEPENDENT LIVING in Cardinal at North Hills
(Based on Baseline Decrements)
¦ M 60
M 65
M 70
M 75
M 80
M 85
M 90
M 95
M100
_____________________________________________________________________________________
F 60 ¦ 23.7
22.6
21.7
21.2
20.8
20.6
20.5
20.3
20.2
¦
F 62 ¦ 22.9
21.7
20.7
20.2
19.8
19.6
19.4
19.3
19.1
¦
F 64 ¦ 22.2
20.8
19.8
19.2
18.8
18.5
18.4
18.2
18.0
¦
F 66 ¦ 21.4
20.0
18.9
18.2
17.7
17.5
17.3
17.1
17.0
¦
F 68 ¦ 20.7
19.1
17.9
17.2
16.7
16.4
16.2
16.0
15.9
¦
F 70 ¦ 20.0
18.3
17.0
16.2
15.6
15.3
15.1
14.9
14.7
¦
F 72 ¦ 19.4
17.6
16.1
15.2
14.6
14.2
14.0
13.8
13.6
¦
F 74 ¦ 18.9
16.9
15.3
14.3
13.6
13.2
13.0
12.7
12.5
¦
F 76 ¦ 18.4
16.3
14.6
13.5
12.7
12.3
12.0
11.7
11.4
¦
F 78 ¦ 18.0
15.7
13.9
12.8
11.9
11.4
11.1
10.8
10.5
¦
F 80 ¦ 17.6
15.3
13.4
12.1
11.2
10.7
10.3
9.9
9.6
¦
F 82 ¦ 17.4
14.9
12.9
11.6
10.6
10.0
9.6
9.1
8.8
¦
F 84 ¦ 17.2
14.6
12.5
11.1
10.0
9.4
9.0
8.5
8.0
¦
F 86 ¦ 17.0
14.4
12.2
10.7
9.6
8.9
8.5
7.9
7.4
¦
F 88 ¦ 16.9
14.2
11.9
10.4
9.2
8.5
8.0
7.4
6.9
¦
F 90 ¦ 16.8
14.0
11.7
10.2
9.0
8.3
7.8
7.1
6.5
¦
F 92 ¦ 16.7
13.9
11.6
10.1
8.8
8.1
7.5
6.9
6.2
¦
F 94 ¦ 16.6
13.8
11.4
9.9
8.6
7.8
7.3
6.6
5.9
¦
F 96 ¦ 16.5
13.7
11.3
9.6
8.3
7.5
6.9
6.2
5.5
¦
F 98 ¦ 16.4
13.6
11.1
9.4
8.0
7.2
6.6
5.8
5.0
¦
F100 ¦ 16.4
13.4
10.9
9.2
7.8
6.9
6.3
5.4
4.5
Page 52 of 335
Table 1.4
New Entrant Assumptions for Cardinal at North Hills
Entrants to INDEPENDENT LIVING
Entry Age
--------55- 59
60- 64
65- 69
70- 74
75- 79
80- 84
85- 89
90 and over
Female
-----0.0 %
0.0
5.0
10.0
25.0
40.0
20.0
0.0
------100.0 %
Male
---0.0 %
0.0
5.0
5.0
15.0
60.0
15.0
0.0
------100.0 %
Average age at entry
80.5
81.3
Unit
----
Probability that New
Entrants will be a Couple
-------------------------
Studio A........................................................................0.0 %
One BR B.......................................................................10.0
One BR C.......................................................................10.0
One BR/Den D...................................................................25.0
Two BR E.......................................................................75.0
Two BR F.......................................................................75.0
Two BR G.......................................................................75.0
Two BR/Den H...................................................................90.0
Two BR/Den I...................................................................90.0
Two BR/Den J...................................................................90.0
Probability that:
-----------------
Gender Distribution
-------------------
Single Entrant is Female.......................................................75.0 %
Coupled Entrants Same Sex.......................................................0.0
Contract Selection Distribution
-------------------------------
Probability the New
Contract will be Selected
-------------------------
CURRENT RENTAL CONTRACT.......................................................100.0 %
Page 53 of 335
Table 2.1 Baseline
Cardinal at North Hills
Summary of Population Projection Statistics
Fiscal
Year
------
Total
Independent Living
Turnover
----------
Number
of New
Entrants
--------
Number
of Deaths
or Move-outs
------------
Average
Number
Total
Residents
---------
- - - - Excludes Direct Entrants - - - Total
Total
Total
ASSISTED
NURSING
Health
LIVING *
CARE
*
Care
*
----------------------------
2015
2016
2017
2018
2019
47
63
52
11
15
65
87
72
15
21
1
4
10
14
17
69
150
199
211
214
0
1
4
8
14
0
2
4
7
11
1
3
8
16
25
2020
2021
2022
2023
2024
17
18
18
18
18
23
25
25
25
25
18
20
21
22
23
218
224
229
232
235
20
24
28
30
31
14
18
22
24
26
34
43
49
54
57
2025
2026
2027
2028
2029
18
18
19
18
18
26
25
26
25
24
23
24
25
24
25
237
239
240
241
241
32
32
32
33
33
28
29
30
30
31
59
61
62
63
64
2030
2031
2032
2033
2034
19
18
18
18
18
26
25
25
25
25
25
25
26
25
25
242
242
242
242
242
32
32
32
32
32
32
33
32
32
32
64
65
65
64
64
* The values in columns six, seven, and eight reflect the average during the year.
SOME COLUMNS OR ROWS MAY NOT ADD DUE TO ROUNDING.
Page 54 of 335
Table 2.2 Baseline
Cardinal at North Hills
Beginning of Fiscal Year Demographic Statistics
Fiscal
Year
------
Units
Occupied
INDEPENDENT LIVING
----------
- - - - - - Number of Permanent Residents - - - - - INDEPENDASSISTED
NURSING
ENT LIVING
LIVING
CARE
Total
------------------------------------
Average
Age
-------
Yrs In
Comm.
-------
2015
2016
2017
2018
2019
0
46
106
150
150
26
111
185
201
194
0
0
2
6
11
0
0
1
3
6
26
111
188
210
211
80.6
80.6
81.0
81.7
82.4
0.5
0.7
1.2
1.9
2.7
2020
2021
2022
2023
2024
150
150
150
150
150
189
186
184
183
182
17
22
27
29
31
9
13
16
19
21
216
221
226
231
234
82.9
83.5
83.9
84.3
84.6
3.4
4.0
4.4
4.8
5.2
2025
2026
2027
2028
2029
150
150
150
150
150
182
182
182
182
182
31
32
32
32
33
23
24
25
26
26
236
238
240
240
241
84.9
85.2
85.5
85.7
86.0
5.5
5.7
5.9
6.1
6.3
2030
2031
2032
2033
2034
150
150
150
150
150
182
182
182
182
182
32
32
32
32
32
27
28
28
28
27
241
242
242
242
242
86.2
86.5
86.7
86.9
87.1
6.4
6.5
6.6
6.6
6.7
SOME COLUMNS OR ROWS MAY NOT ADD DUE TO ROUNDING.
Page 55 of 335
Table 2.3 Baseline
Cardinal at North Hills
Resident Movement Statistics
Fiscal
Year
-----2015
2016
2017
2018
2019
- - - - - - - - Deaths - - - - - - - INDEPENDASSISTED
NURSING
ENT LIVING
LIVING
CARE
---------------------------1
0
0
3
0
0
8
0
0
10
1
1
11
2
2
- - - - - Permanent Transfers - - - - INDEPENDINDEPENDASSISTED
ENT LIVING
ENT LIVING
LIVING
to
to
to
ASSISTED
NURSING
NURSING
LIVING
CARE
CARE
---------------------------0
0
0
2
1
0
4
2
0
7
3
0
9
4
1
2020
2021
2022
2023
2024
11
12
11
11
11
3
3
4
4
5
3
4
5
6
7
10
10
10
10
9
4
5
4
4
4
2
3
4
4
4
2025
2026
2027
2028
2029
11
11
12
12
11
5
5
5
4
5
7
7
8
7
8
9
9
9
9
9
4
4
4
4
4
4
4
4
4
5
2030
2031
2032
2033
2034
12
12
12
12
12
4
4
5
5
4
7
8
8
8
8
9
8
9
8
8
4
4
4
4
4
4
4
4
4
4
Page 56 of 335
Table 2.4 Baseline
Cardinal at North Hills
INDEPENDENT LIVING Turnover Statistics
Fiscal
Year
-----2015
2016
2017
2018
2019
Average
Age of
New
Entrants
---------80.3
80.3
80.2
80.3
80.4
Number
of New
Entrants
---------65
87
72
15
21
INDEPENDENT LIVING
Turnover
---------47
63
52
11
15
- - - - - Cause of INDEPENDENT LIVING Turnover - - - Move
Permanent
Out
Death
Transfer
New Sales*
------------------------------------0
0
1
46
1
1
1
60
1
4
3
44
1
5
5
0
1
6
8
0
2020
2021
2022
2023
2024
81.3
81.0
81.5
81.4
81.3
23
25
25
25
25
17
18
18
18
18
1
1
1
1
0
7
7
8
7
7
9
10
9
10
11
0
0
0
0
0
2025
2026
2027
2028
2029
82.1
82.3
82.3
82.3
82.2
26
25
26
25
24
18
18
19
18
18
1
1
1
1
0
7
8
8
8
8
10
9
10
9
10
0
0
0
0
0
2030
2031
2032
2033
2034
83.3
83.3
83.5
83.1
83.4
26
25
25
25
25
19
18
18
18
18
1
1
1
0
1
9
8
8
9
9
9
9
9
9
8
0
0
0
0
0
* This column reflects the annual change in the beginning of year INDEPENDENT LIVING occupancy (see Table 2.2, column 2).
Page 57 of 335
Table 2.5 Baseline
Cardinal at North Hills
Projected Resident Days by Level of Care
(All Contractholder Days)
Fiscal
Year
-----2015
2016
2017
2018
2019
INDEPENDENT LIVING
---------24,975
54,082
70,606
72,248
70,036
Permanent
ASSISTED
LIVING
---------55
438
1,400
3,028
5,183
Temporary
ASSISTED
LIVING
---------0
0
0
0
0
Total
ASSISTED
LIVING
---------55
438
1,400
3,028
5,183
Permanent
NURSING
CARE
---------27
173
661
1,577
2,725
Temporary
NURSING
CARE
---------122
540
944
1,108
1,185
Total
NURSING
CARE
---------149
713
1,605
2,685
3,910
2020
2021
2022
2023
2024
68,401
67,355
66,839
66,563
66,392
7,262
8,932
10,061
10,809
11,304
0
0
0
0
0
7,262
8,932
10,061
10,809
11,304
3,964
5,296
6,504
7,355
7,953
1,274
1,349
1,413
1,463
1,505
5,238
6,645
7,917
8,818
9,458
2025
2026
2027
2028
2029
66,375
66,481
66,581
66,510
66,412
11,508
11,696
11,799
11,895
11,886
0
0
0
0
0
11,508
11,696
11,799
11,895
11,886
8,537
9,032
9,273
9,486
9,698
1,528
1,555
1,580
1,603
1,626
10,065
10,587
10,853
11,089
11,324
2030
2031
2032
2033
2034
66,423
66,452
66,377
66,372
66,507
11,751
11,718
11,757
11,819
11,793
0
0
0
0
0
11,751
11,718
11,757
11,819
11,793
9,979
10,225
10,160
9,994
9,933
1,626
1,642
1,653
1,677
1,697
11,605
11,867
11,813
11,671
11,630
SOME COLUMNS OR ROWS MAY NOT ADD DUE TO ROUNDING.
Page 58 of 335
Table 2.13 Baseline
Cardinal at North Hills
Projected INDEPENDENT LIVING Turnover by Unit Type
Fiscal
Year
-----2015
2016
2017
2018
2019
- - - - - - - - - - - - - - - - Turnover by Unit Type - - - - - - - - - - - - - - - Group I
Group II
Group III
Group IV
Group V
Group VI
------------------------------------------------------2
21
6
12
6
0
3
27
8
15
10
0
3
23
8
12
6
0
1
5
2
2
1
0
1
7
2
3
2
0
INDEPENDENT LIVING
Turnover
---------47
63
52
11
15
INDEPENDENT LIVING
Turnover
Percentage
---------261.1 %
79.7
38.5
7.3
10.0
2020
2021
2022
2023
2024
1
1
1
1
1
7
8
8
8
8
3
3
3
3
3
4
4
4
4
4
2
2
2
2
2
0
0
0
0
0
17
18
18
18
18
11.3
12.0
12.0
12.0
12.0
2025
2026
2027
2028
2029
1
1
1
1
1
8
8
9
8
8
3
3
3
3
3
4
4
4
4
4
2
2
2
2
2
0
0
0
0
0
18
18
19
18
18
12.0
12.0
12.7
12.0
12.0
2030
2031
2032
2033
2034
1
1
1
1
1
9
7
8
9
8
3
3
3
2
3
4
4
4
4
4
2
3
2
2
2
0
0
0
0
0
19
18
18
18
18
12.7
12.0
12.0
12.0
12.0
Unit Type Groupings
------------------Group I
= Studio A
Group IV = Two BR E
Two BR F
Two BR G
Page 59 of 335
Group II = One BR B
One BR C
Group III = One BR/Den D
Group V
Group VI = None included
= Two BR/Den H
Two BR/Den I
Two BR/Den J
Table 2.14 Baseline
Cardinal at North Hills
Move-out and Refund Statistics
Fiscal
Year
-----2015
2016
2017
2018
2019
Direct
Entry to
ALU
---------0
0
0
0
0
Transfers
to
ALU
---------0
2
4
7
9
Number of
Refunds
---------0
0
0
0
0
- - - - - - - - Refund Amounts Due to - - - - - - - Permanent
Death
Move-out
Transfer
Total
------------------------------------$ 0
$ 0
$ 0
$ 0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
2020
2021
2022
2023
2024
0
0
0
0
0
10
10
10
10
9
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
2025
2026
2027
2028
2029
0
0
0
0
0
9
9
9
9
9
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
2030
2031
2032
2033
2034
0
0
0
0
0
9
8
9
8
8
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
SOME COLUMNS OR ROWS MAY NOT ADD DUE TO ROUNDING.
Page 60 of 335
Table 2.15 Baseline
Cardinal at North Hills
Projected Variation in INDEPENDENT LIVING Turnover* and Health Care Utilization
(Based on 100 Iterations)
Fiscal
Year
-----2015
2016
2017
2018
2019
- - - INDEPENDENT LIVING Turnover* - - Likely
Likely
Minimum
Average
Maximum
---------------------------0( 0%)
1
2(200%)
0( 0 )
3
5(167 )
4( 50 )
8
11(138 )
6( 55 )
11
17(155 )
10( 67 )
15
22(147 )
- - - - Health Care Utilization - - - Likely
Likely
Minimum
Average
Maximum
---------------------------1(100%)
1
2(200%)
2( 50 )
4
6(150 )
5( 63 )
8
13(163 )
10( 63 )
16
22(138 )
18( 72 )
25
32(128 )
2020
2021
2022
2023
2024
10(
12(
11(
12(
12(
59
67
61
67
67
)
)
)
)
)
17
18
18
18
18
22(129
25(139
24(133
24(133
25(139
)
)
)
)
)
26(
33(
38(
43(
45(
76
77
78
80
79
)
)
)
)
)
34
43
49
54
57
42(124
52(121
60(122
64(119
67(118
)
)
)
)
)
2025
2026
2027
2028
2029
11(
12(
11(
11(
11(
61
67
58
61
61
)
)
)
)
)
18
18
19
18
18
25(139
25(139
25(132
24(133
24(133
)
)
)
)
)
47(
50(
51(
51(
50(
80
82
82
81
78
)
)
)
)
)
59
61
62
63
64
70(119
71(116
73(118
76(121
76(119
)
)
)
)
)
2030
2031
2032
2033
2034
12(
13(
12(
11(
12(
63
72
67
61
67
)
)
)
)
)
19
18
18
18
18
26(137
24(133
25(139
25(139
26(144
)
)
)
)
)
50(
51(
52(
52(
51(
78
78
80
81
80
)
)
)
)
)
64
65
65
64
64
76(119
77(118
77(118
78(122
79(123
)
)
)
)
)
* Apartment turnover does not include sales of units that were not occupied at beginning of year.
Page 61 of 335
Table 2.16 Baseline
Cardinal at North Hills
Projected Variation in Refunds and Health Care Ratios
(Based on 100 Iterations)
Fiscal
Year
-----2015
2016
2017
2018
2019
- - - - - - - - Refunds - - - - - - - Likely
Likely
Minimum
Average
Maximum
---------------------------$ 0
$ 0
$ 0
0
0
0
0
0
0
0
0
0
0
0
0
Health Care Ratio per 100 ILU Residents
Likely
Likely
Minimum
Average
Maximum
---------------------------1.2
2.2
5.2
1.4
2.8
4.9
2.6
4.4
6.4
5.5
7.9
10.1
9.5
13.0
16.3
2020
2021
2022
2023
2024
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
13.7
17.5
21.1
23.1
25.2
18.3
23.1
26.9
29.5
31.2
23.0
27.9
32.6
34.8
36.9
2025
2026
2027
2028
2029
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
26.1
27.6
27.9
27.5
27.5
32.5
33.5
34.0
34.5
34.9
37.9
38.2
39.8
42.6
42.4
2030
2031
2032
2033
2034
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
28.0
28.0
28.6
28.4
28.4
35.1
35.5
35.5
35.3
35.2
42.4
41.1
41.6
42.3
42.4
Page 62 of 335
Exhibit B
The Cardinal at North Hills
Internally Prepared Forward-Looking Financial Statements
Internally prepared Forward-Looking Financial Statements
for
The Cardinal at North Hills, LLC
and
The Cardinal at North Hills Healthcare, LLC
As of and for the Years Ending
December 2014 through December 2021
This report, prepared internally by the Cardinal, provides further updated projections from those
contained in the approved Step 3 application from March 2014 and the October 15, 2012 compilation
report prepared by Clifton Larson Allen (CLA).
The changes are described in this update.
Forward-Looking Statements
This document contains “forward-looking” statements. When the company uses words such as “may,”
“will,” “intend,” “should,” “believe,” “expect,” “anticipate,” “project,” “estimate” or similar expressions,
it is making forward-looking statements. Forward-looking statements are not guarantees of future
performance and involve risks and uncertainties. The company’s expected results may not be achieved,
and actual results may differ materially from expectations. This may be a result of various factors,
including, but not limited to, the satisfaction of closing conditions to the definitive agreement, including,
the receipt of regulatory approvals; the respective parties’ performance of their obligations under the
definitive agreement; and unanticipated difficulties and/or expenditures relating to the transaction. No
obligation exists to update or revise any forward-looking statements, whether because of new
information, future events or otherwise, or to update the reasons why actual results could differ from
those projected in any forward-looking statements.
Even if able to:







Have beginning of year balance sheet account consistent with the estimates
Achieve the timeline for the project development
Achieve its presales levels
Achieve the proposed pricing for independent living units, assisted units, and nursing beds
Achieve its independent living occupancy fill up rates and occupancy levels
Achieve assisted living and nursing occupancy levels from transfers from independent living
units
Receive equity contributions to fund development and working capital for the company
There will usually be differences between the projected and actual results because events and
circumstances frequently do not occur as expected; and those difference may be material.
Summary of Changes to the Project Financial Model
The buildings and number of units have not changed since the approval of the Step 3 Disclosure
Statement. A minor adjustment in the larger 2 and 3 bedroom independent living unit mix is documented
in Exhibit I. Pre-leasing has been very successful with 126 (76%) of the 165 independent living units
committed with Step 3 deposits and an additional 150 priority waitlist ($1,000) deposits on hand. The
project started construction later than anticipated in the Step 3 projections and also experienced
construction related weather related delays due to two very wet winters in 2015 and 2016. With the
buildings now “dried in”, it is projected that Certificates of Occupancy for the independent living
buildings will be achieved in late October 2016.
The updated financial projections herein assume moving in residents starting in November 2016 whereas
the Step 3 projections assumed this to begin in September 2015. The assumptions related to the number
of move-ins per month during fill up to stabilized occupancy are similar to Step 3. This updated financial
information runs from 2014 through 2021 whereas the Step 3 report ran from 2014 to 2020. Stabilized
occupancy is projected to occur in December 2018 in this report whereas it was assumed to occur in April
2018 in the Step 3 projections.
This updated financial information includes the latest projections for monthly service fees at opening as
well as operating revenues and expenses. Total project costs increased by approximately 10% between
Steps 3 and 4. The key components of the increase were construction market dynamics, change orders
related to unsuitable soils and other typical construction issues, additional FF&E items as well as
increases in soft cost categories for design, marketing and start-up operations. Projected net operating
income also increased resulting in financial performance and investor returns slightly better than that
assumed in the Step 3 projections.
Attached hereto are updated projections of operational performance, cash flows, balance sheet, move -in
schedule and total project costs.
Unless noted otherwise, the assumptions described in the Step 3 application and the base CLA report
remain valid.
CONFIDENTIAL ‐ For Kisco Internal Use Only
The Cardinal at North Hills LLC and The Cardinal at North Hills Healthcare LLC
Projected Combined Statements of Operations
For the Years Ending December 31
(In Thousands of Dollars)
Prepared by: kh/mkb/gf
YE Dec-14
YE Dec-15
YE Dec-16
YE Dec-17
YE Dec-18
YE Dec-19
YE Dec-20
Version: TCNH-3
YE Dec-21
REVENUE
Monthly Fee Rent Revenue
Health Care Charges Revenue
Amortization of Entrance Fees
Other Revenue
Investment/Interest Income
Contributions/Gifts
Total Revenue
-
-
284
-
7,019
263
13,504
642
16,394
785
17,052
810
17,789
836
-
-
252
1,123
1,077
750
774
800
-
-
536
8,404
15,223
17,928
18,636
19,424
-
-
36
-
282
388
332
794
358
570
479
1,145
391
632
541
1,276
403
654
559
1,319
411
674
576
1,360
-
-
62
3
39
79
170
391
24
311
556
1,381
425
33
400
663
1,897
446
36
439
718
2,123
461
37
453
742
2,196
475
38
461
766
2,283
-
-
140
19
152
125
10
1,265
847
129
1,119
542
60
7,588
876
146
1,500
503
62
7,591
904
154
1,666
372
64
7,630
934
159
1,726
384
66
7,630
964
164
1,790
396
68
7,670
-
-
2,100
0
14,743
3
16,652
15
17,408
24
17,746
32
18,128
-
-
(1,564)
(6,339)
(1,429)
520
890
1,296
Other Changes in Members' Equity
Equity Contributions - KSL - Working Capital
Equity Contributions - KSL - ORR
KSL Distributions - ORR refunds
-
-
4,950
7,746
-
4,503
780
-
613
167
(4,315)
83
74
-
24
135
-
162
Change in Members' Equity
-
-
11,132
(1,055)
(4,964)
677
1,049
1,458
EXPENSES
Health Care Expenses:
Wellness
Assisted Living
Memory
Skilled Nursing Facility
Operations Expenses:
Maintenance/Environmental
Laundry
Housekeeping
Utilities
Dietary
Administrative Expenses:
Property Taxes & Insurance
Associate Services
General & Administrative
Sales
Marketing
Lease Expense to Affiliate
Interest Expense
Depreciation
Total Expense
Operating Income (Loss)
1
C:\Users\pardue\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\VZZS7BIT\CNH Porforma Step 4 DOI submittal (2).xlsx
DOI.Operations
1
CONFIDENTIAL ‐ For Kisco Internal Use Only
The Cardinal at North Hills LLC and The Cardinal at North Hills Healthcare LLC
Projected Combined Balance Sheets
For the Years Ending December 31
(In Thousands of Dollars)
Prepared by: kh/mkb/gf
YE Dec-14
YE Dec-15
YE Dec-16
YE Dec-17
YE Dec-18
YE Dec-19
YE Dec-20
Version: TCNH-3
YE Dec-21
ASSETS
CURRENT ASSETS
Cash and Cash Equivalents
Investments
Resident Accounts Receivable, Net
Inventory
Prepaid Expenses and Other Current Assets
Total Current Assets
RESTRICTED ASSETS
Resident Escrow Deposits
Statutory Operating Reserve
Total Restricted Assets
FIXED ASSETS
Property, Plant and Equipment
Construction in Progress
Less Accumulated Depreciation
Net Property, Plant and Equipment
Total Assets
-
-
3,393
1,485
472
870
1,630
2,944
-
-
14
6
6
3,419
227
50
50
1,812
411
63
63
1,010
484
68
68
1,491
503
71
71
2,275
411
63
63
3,481
789
789
975
975
194
7,746
7,940
154
8,526
8,680
154
4,378
4,532
154
4,451
4,605
154
4,586
4,740
154
4,748
4,902
-
-
5
61
136
305
473
548
-
-
5
(0)
61
(3)
133
(19)
286
(42)
431
(74)
474
789
975
11,363
10,552
5,674
6,383
7,447
8,858
789
789
975
975
19
19
194
232
161
161
154
476
204
204
154
562
220
220
154
593
227
227
154
608
204
204
154
562
789
975
232
476
562
593
608
562
-
-
789
975
LIABILITIES AND MEMBERS' EQUITY
CURRENT LIABILITIES
Accounts Payable
Accrued Expenses and Other Current Liabilities
Resident Escrow Deposits
Total Current Liabilities
1
LONG-TERM DEBT
DEFERRED REVENUE
Refundable
Non-Refundable
Total Liabilities
MEMBERS' EQUITY
Restricted
Unrestricted
Equity - HCN
Equity - KSL
Net Income/(Loss)
Total Members' Equity
Total Liabilities and Members' Equity
12,696
(1,564)
11,132
17,980
(7,903)
10,076
14,444
(9,332)
5,112
14,601
(8,811)
5,789
14,759
(7,921)
6,839
14,921
(6,625)
8,296
11,363
10,552
5,674
6,383
7,447
8,858
Y:\My Documents\COMMUNITIES\CNH‐ KSL Toledo Tenant, LLC\State Licensing\DOI\Step 4\05.17.16 Step 4 docs\05.17.16 CNH Porforma Step 4 DOI submittal (2).xlsx
DOI.BalSheet
1
CONFIDENTIAL ‐ For Kisco Internal Use Only
The Cardinal at North Hills LLC and The Cardinal at North Hills Healthcare LLC
Projected Combined Statements of Cash Flows
For the Years Ending December 31
(In Thousands of Dollars)
Prepared by: kh/mkb/gf
YE Dec-14
Cash Flows From Operating Activities
Change in Members' Equity
Adjustments to Reconcile Change in Members' Equity to
Net Cash Provided by (Used in) Operating Activities:
Depreciation
Remove Equity contributions
Increase in Current Assets
Increase (Decrease) in Resident Deposits Payable
Increase in Current Liabilities
Net Cash Used in Operating Activities
YE Dec-15
YE Dec-16
YE Dec-20
Version: TCNH-3
YE Dec-21
(4,964)
677
186
186
(12,696)
(26)
(781)
38
(2,334)
0
(5,284)
(301)
(40)
284
(6,395)
3
(780)
(211)
86
(5,866)
15
(157)
(83)
32
484
24
(159)
(24)
15
905
32
(162)
107
(47)
1,388
(789)
(789)
(186)
(186)
(5)
(6,965)
(6,969)
(56)
(740)
(796)
(75)
4,148
4,073
(169)
(74)
(243)
(169)
(135)
(304)
(75)
(162)
(237)
-
-
12,696
12,696
5,284
5,284
780
780
157
157
159
159
162
162
Net Increase (Decrease) in Cash
-
-
3,393
(1,908)
(1,013)
399
760
1,313
Cash - Beginning of Year
-
-
-
3,393
1,485
472
870
1,630
Cash End of Year
-
-
3,393
1,485
472
870
1,630
2,944
Cash Flows From Financing Activities
Equity Contributions
Net Cash Provided By Financing Activities
789
789
YE Dec-19
(1,055)
Cash Flows From Investing Activities
(Increase) Decrease in Investments
Project Construction
Capital Expenditures
(Increase) Decrease in Assets Limited As To Use
Net Cash Provided By (Used In) Investing Activities
-
YE Dec-18
11,132
1
-
YE Dec-17
Y:\My Documents\COMMUNITIES\CNH‐ KSL Toledo Tenant, LLC\State Licensing\DOI\Step 4\05.17.16 Step 4 docs\05.17.16 CNH Po
DOI.CashFlow
forma Step 4 DOI submittal (2).xlsx
1,049
1,458
1
Table 4
The Cardinal
Projected Independent Living Move-in Schedule
8/31/2015
9/30/2015
10/31/2015
11/30/2015
12/31/2015
1/31/2016
2/29/2016
3/31/2016
4/30/2016
5/31/2016
6/30/2016
7/31/2016
8/31/2016
9/30/2016
10/31/2016
11/30/2016
12/31/2016
1/31/2017
2/28/2017
3/31/2017
4/30/2017
5/31/2017
6/30/2017
7/31/2017
8/31/2017
9/30/2017
10/31/2017
11/30/2017
12/31/2017
1/31/2018
2/28/2018
3/31/2018
4/30/2018
5/31/2018
6/30/2018
7/31/2018
8/31/2018
9/30/2018
10/31/2018
11/30/2018
12/31/2018
August 2015
September 2015
October 2015
November 2015
December 2015
January 2016
February 2016
March 2016
April 2016
May 2016
June 2016
July 2016
August 2016
September 2016
October 2016
November 2016
December 2016
January 2017
February 2017
March 2017
April 2017
May 2017
June 2017
July 2017
August 2017
September 2017
October 2017
November 2017
December 2017
January 2018
February 2018
March 2018
April 2018
May 2018
June 2018
July 2018
August 2018
September 2018
October 2018
November 2018
December 2018
Move-ins
Cumulative
Occupancy
Occupancy
Percent
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
17
17
11
8
8
8
8
5
5
5
5
5
4
4
4
4
4
4
4
4
4
4
4
4
4
3
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
17
34
45
53
61
69
77
82
87
92
97
102
106
110
114
118
122
126
130
134
138
142
146
150
154
157
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
10%
21%
27%
32%
37%
42%
47%
50%
53%
56%
59%
62%
64%
67%
69%
72%
74%
76%
79%
81%
84%
86%
88%
91%
93%
95%
Cardinal at North Hills
Step 3 to Step 4 Budget Comparison
05/20/16
Item Description
Notes
Step 3
Step 4
Variance
10,100,000
10,640,954
540,954
Site costs prior to HCN JV
Site Work
3,400,000
3,049,281
(350,719)
shifted scope to shell
Shell Costs
47,876,472
60,687,320
12,810,849
Structural Parking
5,700,000
0
200,000
0
(200,000)
in shell cost line
FF & E*
1,800,000
2,549,999
749,999
added scope and amenities
Contingency - Hard Costs
2,000,000
738,205
2,075,000
2,940,241
865,241
added construction administration
Permits & Fees
350,000
416,552
66,552
City impact fee schedule increases
Surveys & Reports
170,000
225,295
55,295
additional testing and inspection costs
Property Taxes
300,000
769,769
469,769
duration of project
Insurance
275,000
0
(275,000)
in property taxes cost line
Title & Other
25,000
0
(25,000)
in surveys and reports cost line
Legal(Professional Services)
220,000
680,679
460,679
Appraisal Fee
10,000
0
(10,000)
in sruveys and reports cost line
Marketing/Pre-Opening Operations*
2,750,000
3,495,000
745,000
extended construction period
Developer Fee*
1,750,000
1,750,000
0
Land Costs
Land Purchase Price
Hard Costs
Pre-Construction Management
construction inflation and scope shift
(5,700,000) in shell cost line
(1,261,795) draw down for change orders
Soft Costs
Architect & Engineer
0
Financing Costs
Financing Costs
Construction Rent Payments
Total Development Budget
765,000
765,000
0
6,383,872
6,663,892
280,021
86,150,343
95,372,187
9,221,844
additional interest period
Y:\My Documents\COMMUNITIES\CNH- KSL Toledo Tenant, LLC\State Licensing\DOI\Step 4\05.17.16 Step 4 docs\Exhibit II Disclosure Statement\05.18.16 CNH Step 3 to Step 4 Development Budget
5/18/2016 6:21 PM
Confidential--For Internal Use Only
Comparison.xlsx
Exhibit C
The Cardinal at North Hills
Forecasted Financials
COMPILATION OF A COMBINED FINANCIAL PROJECTION
OF
THE CARDINAL AT NORTH HILLS, LLC
AND
THE CARDINAL AT NORTH HILLS HEALTHCARE, LLC
AS OF AND FOR THE YEARS ENDING
DECEMBER 31, 2012 THROUGH DECEMBER 31, 2016
Page 72 of 335
TABLE OF CONTENTS
Independent Accountants’ Compilation Report ............................................................................................ 1
Projected Consolidated Statements of Operations
For the Years Ending December 31, 2012 through 2016 ................................................................. 3
Projected Consolidated Statements of Cash Flows
For the Years Ending December 31, 2012 through 2016 ................................................................. 4
Projected Consolidated Balance Sheets
At December 31, 2012 through 2016 ............................................................................................... 5
Projected Consolidated Statements of Changes in Members’ Equity
At December 31, 2012 through 2016 ............................................................................................... 6
Summary of Significant Projection Assumptions and Accounting Policies
Introduction ...................................................................................................................................... 7
Background Information .................................................................................................................. 8
Development of Community .......................................................................................................... 14
Summary of Significant Accounting Policies ................................................................................ 15
Management’s Basis for Projection of Revenue ............................................................................ 17
Management’s Basis for Projection of Expenses ........................................................................... 24
Management’s Basis for Other Items ............................................................................................. 25
Management’s Sensitivity Analysis ............................................................................................... 27
Page 73 of 335
Members
The Cardinal at North Hills, LLC
Furthermore, even if the Organization is able to:







Have beginning of year balance sheet accounts consistent with Management’s estimates
Achieve the timeline for project development
Achieve its presale levels
Achieve the proposed pricing for independent units, assisted units and nursing beds
Achieve its independent living occupancy fill up rates and occupancy levels
Achieve assisted living and nursing occupancy levels from transfers from independent living units
Receive equity contributions to fund development and working capital for the Organization
there will usually be differences between the projected and actual results because events and circumstances
frequently do not occur as expected, and those differences may be material.
We have no responsibility to update this report for events and circumstances occurring after the date of this report.
CliftonLarsonAllen LLP
Charlotte, North Carolina
October 15, 2012
2
Page 75 of 335
THE CARDINAL AT NORTH HILLS, LLC AND THE CARDINAL AT NORTH HILLS
HEALTHCARE, LLC
PROJECTED COMBINED STATEMENTS OF OPERATIONS
ASSUMING THE HYPOTHETICAL ASSUMPTIONS NOTED ON PAGE 7
FOR THE YEARS ENDING DECEMBER 31,
(IN THOUSANDS OF DOLLARS)
2012
REVENUES
Monthly Fee Rent Revenue
Health Care Charges Revenue
Amortization of Entrance Fees
Other Revenue
Investment/Interest Income
Contributions/Gifts
Total Revenues
$
2013
2014
2015
2,389 $
256
611
38
3,294
2016
- $
-
- $
-
- $
-
8,863
690
682
80
10,315
-
-
-
184
254
269
459
341
445
515
754
EXPENSES
Health Care Expenses:
Wellness
Assisted Living
Memory
Skilled Nursing Facility
Operations Expenses:
Maintenance/Environmental
Laundry
Housekeeping
Utilities
Dietary
Administrative Expenses:
Property Taxes & Insurance
Associate Services
General & Administrative
Sales
Marketing
Lease Expense to Affiliate
Interest Expense
Depreciation
Total Expenses
-
-
-
269
30
168
276
787
464
51
368
477
1,603
-
-
-
474
104
762
439
235
4,085
1
8,796
733
181
1,417
558
243
6,128
4
14,282
Operating Income (Loss)
-
-
-
(5,502)
(3,967)
-
-
-
11,605
1,290
4,270
475
- $
- $
- $
OTHER CHANGES IN MEMBERS' EQUITY
Equity Contributions - Healthcare REIT
Equity Contributions - Kisco
Change in Members' Equity
$
7,393 $
See Summary of Significant Projection Assumptions and Accounting Policies and
Independent Accountants’ Compilation Report
3
Page 76 of 335
778
THE CARDINAL AT NORTH HILLS, LLC AND THE CARDINAL AT NORTH HILLS
HEALTHCARE, LLC
PROJECTED COMBINED STATEMENTS OF CASH FLOWS
ASSUMING THE HYPOTHETICAL ASSUMPTIONS NOTED ON PAGE 7
FOR THE YEARS ENDING DECEMBER 31,
(IN THOUSANDS OF DOLLARS)
2012
CASH FLOWS FROM OPERATING ACTIVITIES
Change in Members' Equity
Adjustments to Reconcile Change in Members'
Equity to Net Cash Provided by (Used in)
Operating Activites:
Depreciation
Remove Equity Contributions
Increase in Current Assets
Increase (Decrease) in Resident Deposits Payable
Increase in Current Liabilities
Net Cash Used In Operating Activities
$
2013
- $
CASH FLOWS FROM INVESTING ACTIVITIES
(Increase) Decrease in Investments
Project Construction
Capital Expenditures
Increase in Assets Limited As To Use
Net Cash Provided By (Used In) Investing Activities
CASH FLOWS FROM FINANCING ACTIVITIES
Equity Contributions
Net Cash Provided By Financing Activities
2014
- $
2015
- $
2016
7,393 $
778
125
125
664
664
186
186
1
(12,895)
(218)
(781)
387
(6,113)
4
(4,745)
(285)
(40)
282
(4,006)
(125)
(125)
(664)
(664)
(186)
(186)
(37)
(6,358)
(6,395)
(55)
(402)
(457)
-
-
-
12,895
12,895
4,745
4,745
Net Increase (Decrease) in Cash
-
-
-
387
282
Cash - Beginning of Year
-
-
-
-
387
- $
- $
- $
387 $
669
Cash - End of Year
$
See Summary of Significant Projection Assumptions and Accounting Policies and
Independent Accountants’ Compilation Report
4
Page 77 of 335
THE CARDINAL AT NORTH HILLS, LLC AND THE CARDINAL AT NORTH HILLS
HEALTHCARE, LLC
PROJECTED COMBINED BALANCE SHEETS
ASSUMING THE HYPOTHETICAL ASSUMPTIONS NOTED ON PAGE 7
AT DECEMBER 31,
(IN THOUSANDS OF DOLLARS)
2012
2013
2014
2015
2016
ASSETS
CURRENT ASSETS
Cash and Cash Equivalents
Investments
Resident Accounts Receivable, Net
Inventory
Prepaid Expenses and Other Current Assets
Total Current Assets
$
-
$
-
$
-
$
387 $
89
65
65
606
669
280
112
112
1,173
RESTRICTED ASSETS
Resident Escrow Deposits
Statutory Operating Reserve
Total Restricted Assets
125
125
789
789
975
975
FIXED ASSETS
Property, Plant and Equipment
Construction in Progress
Less Accumulated Depreciation
Net Property, Plant and Equipment
-
-
-
37
(1)
36
125 $
789 $
975 $
7,975 $
CURRENT LIABILITIES
Accounts Payable
Accrued Expenses and Other Current Liabilities
Resident Escrow Deposits
Total Current Liabilities
125
125
789
789
975
975
194
194
194
582
335
335
154
824
LONG-TERM DEBT
-
-
-
-
-
DEFERRED REVENUE
Refundable
Nonrefundable
-
-
-
-
-
125
789
975
582
824
-
-
-
-
-
-
-
-
6,653
740
7,393
7,353
818
8,171
7,975 $
8,995
Total Assets
$
194
7,139
7,333
154
7,581
7,735
92
(5)
87
8,995
LIABILITIES AND NET ASSETS
Total Liabilities
MEMBERS' EQUITY
Restricted
Unrestricted
Equity - Healthcare REIT
Equity - Kisco
Total Members' Equity
Total Liabilities and Members' Equity
$
-
-
-
125 $
789 $
975 $
See Summary of Significant Projection Assumptions and Accounting Policies and
Independent Accountants’ Compilation Report
5
Page 78 of 335
THE CARDINAL AT NORTH HILLS, LLC
PROJECTED COMBINED STATEMENTS OF CHANGES IN MEMBERS’ EQUITY
ASSUMING THE HYPOTHETICAL ASSUMPTIONS NOTED ON PAGE 7
FOR THE YEARS ENDING DECEMBER 31,
(IN THOUSANDS OF DOLLARS)
2012
2013
2014
2015
2016
MEMBERS' EQUITY
Beginning Balance
Member Contributions
Member Distributions
Net Income (Loss)
Ending Balance
$
-
$
$
$
-
$
$
-
$
$
$
12,895
(5,502)
7,393 $
7,393
4,745
(3,967)
8,171
See Summary of Significant Projection Assumptions and Accounting Policies and
Independent Accountants’ Compilation Report
6
Page 79 of 335
Summary of Significant Projection Assumptions and Accounting Policies
Introduction
Basis of Presentation
The financial projection presents, to the best of the knowledge and belief of management of the Cardinal at North
Hills, LLC and the Cardinal at North Hills Healthcare, LLC (collectively hereafter, the “Organization”), its
contracted management firm, Kisco Senior Living, LLC, and its developer, Kisco Development, LLC
(collectively, “Management”) the expected financial position, results of activities and cash flows of the
Organization for the five-year period ending December 31, 2016 assuming the “Hypothetical Assumptions”, as
described hereinafter.
Accordingly, the financial projection reflects Management’s judgment as of October 15, 2012, the date of this
projection, of the expected conditions and its expected course of action assuming the Hypothetical Assumptions.
The assumptions disclosed herein are the assumptions which Management believes are significant to the financial
projection. However, even if the Hypothetical Assumptions were to occur, there will usually be differences
between the projected and actual results, because events and circumstances frequently do not occur as expected,
and those differences may be material.
This financial projection is limited to inclusion in the Organization’s disclosure statement filing with the North
Carolina Department of Insurance and cannot be used for any other purpose.
Hypothetical Assumptions
A hypothetical assumption is an assumption used in a financial projection to present a condition or course of
action that is not necessarily expected to occur (since there are factors present that are likely to change) but is
consistent with the purpose of the presentation. Management does not need to have a reasonably objective basis
for the hypothetical assumption, although the hypothetical assumption should be consistent with the purpose of
the projection. Management’s hypothetical assumptions (the “Hypothetical Assumptions”) are described below:
Management has compiled its financial projection assuming that the Organization:







Has beginning of year balance sheet accounts consistent with Management’s estimates
Achieves the timeline for project development
Achieves its presale levels
Achieves the proposed pricing for independent units, assisted units and nursing beds
Achieves its independent living occupancy fill up rates and occupancy levels
Achieves assisted living and nursing occupancy levels from transfers from independent living units
Receives equity contributions to fund development and working capital for the Organization
consistent with the plans presented in this Summary of Significant Projection Assumptions.
7
Page 80 of 335
Summary of Significant Projection Assumptions and Accounting Policies
Background Information
Background
The Cardinal at North Hills, LLC is a limited liability corporation organized under the laws of the State of North
Carolina that will provide independent living. The Cardinal at North Hills, LLC is anticipated to obtain nursing
services from The Cardinal at North Hills Healthcare, LLC, related through common ownership. Collectively, the
Cardinal at North Hills, LLC and The Cardinal at North Hills Healthcare, LLC are referred to as the
“Community” or the “Organization” throughout this document. The physical independent living facility will be
leased by The Cardinal at North Hills, LLC from KSL Toledo Tenant, LLC pursuant to a subtenant agreement.
The assisted living and nursing facility will be leased by The Cardinal at North Hills Healthcare, LLC from KSL
Toledo Tenant, LLC pursuant to a subtenant agreement. The master tenant, KSL Toledo Tenant, LLC, will enter
into construction and development agreements for property and building that will be leased to both The Cardinal
at North Hills, LLC and The Cardinal at North Hills Healthcare, LLC.
The following organizational chart describes the ownership structure of the Community.
The sole managing member of The Cardinal at North Hills, LLC and The Cardinal at North Hills Healthcare, LLC
is KSL Toledo Tenant, LLC. The Cardinal at North Hills, LLC (“The Organization”), a North Carolina limited
liability company, was organized to provide senior housing and long-term care services to the elderly.
8
Page 81 of 335
Summary of Significant Projection Assumptions and Accounting Policies
Background Information, Continued
The site where the Community will be built is currently owned by HCRI North Carolina Properties III, Limited
Partnership ("HCRI"), an affiliate of HC REIT, the majority provider of equity capital for the development of the
Community. HCRI will sell the site to 300 St. Albans Drive, LLC. The buildings and improvements for the
Community will also be owned by 300 St. Albans Drive, LLC subsequent to being constructed and developed.
300 St. Albans Drive, LLC will be the landlord for the Community.
KSL Landlord, LLC will own 100% of 300 St. Albans Drive, LLC. This landlord entity will thus be wholly
controlled by KSL Landlord, LLC. KSL Landlord, LLC will be owned 90% by HCRI and 10% by KSL Toledo
Member, Limited Liability Company ("KSL"), an affiliate of Kisco Senior Living, LLC.
HC REIT is a publicly-held real estate investment trust based in Toledo, Ohio that has been in existence for nearly
40 years. HC REIT's primary focus is to own real estate assets with medical or health care components. HC REIT
has created a lending and capital relationship with developers to create opportunities to purchase and own such
assets. HC REIT typically does not participate in the operations of the facilities that it owns. In most cases, HC
REIT simply acts as a landlord to medical providers, CCRC's, and other senior living projects.
HC REIT will serve as the Administrative Member of KSL Landlord, LLC and deal with most ordinary decisions
for KSL Landlord, LLC and 300 St. Albans Drive, LLC. Major decisions of KSL Landlord, LLC and 300 St.
Albans Drive, LLC will be directed by a Board of Members.
KSL, holding ten percent (10%) of the interest in KSL Landlord, LLC, is a newly formed single-purpose entity
formed exclusively to partner with HCRI to act as landlord for the project. The landlord will lease the property to
KSL Toledo Tenant, LLC (“Tenant”). The majority owner of Tenant is the Andrew S. Kohlberg Trust dated
4/4/1989. The LLC manager of Tenant is KSL Toledo Manager, LLC, which is controlled by Andrew S.
Kohlberg.
The Community will be managed by Kisco Senior Living, LLC. As the Founder and Chief Executive Officer of
Kisco Senior Living, LLC and of Kisco Development Company, Mr. Kohlberg has been developing, owning, and
acquiring senior living communities since 1990. Through his timely purchase of well-located retirement
properties, he continues to build Kisco's core portfolio of assets including 20 communities in six states with over
$140 million in annual revenue and over 1400 associates.
As outlined above, because the Cardinal is being developed in concert with the acquisition of two existing rental
properties (not part of Management’s forecast), a master lease structure has been created. The master tenant is
“KSL Toledo Tenant, LLC” which is owned 100% by KSL Toledo Member, LLC. The master tenant owns 100%
of the membership interests in the subtenant entities for each of the three properties, with the subtenant entity for
the Cardinal being The Cardinal at North Hills, LLC and The Cardinal at North Hills Healthcare, LLC,
(collectively, “The Cardinal”). The Cardinal will hold all licenses necessary to operate the community.
The Organization proposes to operate a new start-up community located on an approximate six-acre site within a
100-acre mixed use development in the North Hills area of Raleigh, North Carolina, to be known as The Cardinal
at North Hills. The Cardinal at North Hills is expected to consist of (i) 160 independent living residences, (ii) 27
assisted living units, (iii) 18 specialized assisted living units for memory care, (iv) 15 nursing beds, and (v)
common spaces (collectively the “Project” or the “The Cardinal” or the “Community”).
The Community’s independent living units are designed for adults age 62 and older. Construction is projected to
begin in the fourth quarter of 2013 and be open for occupancy in the second quarter of 2015.
In North Carolina, there is a certificate of need requirement for assisted living units and nursing beds. Pursuant to
Policy LTC-1 of the North Carolina State Medical Facilities Plan, the Organization can apply for an exemption
9
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Summary of Significant Projection Assumptions and Accounting Policies
Background Information, Continued
under this policy (“sheltered beds”). Under such policy, the Organization has already obtained a certificate of
need for both the nursing beds and assisted living units. Upon completion of the Project the Organization will
have a total of 27 assisted living, 18 memory care and 15 nursing beds.
The following table reflects the proposed unit configuration at The Cardinal after completion of the Project, as
well as anticipated rental pricing in 2015 dollars.
10
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Summary of Significant Projection Assumptions and Accounting Policies
Background Information, Continued
Table 1
The Cardinal
Unit Configuration
Type, Number, and Pricing
Number of Monthly Service
Units
Fees (2015)
Unit Type
Independent Living Units
A
Studio
8
$
3,485
B
1 Bedroom/1 Bath
16
$
4,006
C
1 Bedroom/1 Bath
50
$
4,214
D
1 Bedroom/1 Bath w/ Den
22
$
4,786
E
2 Bedroom/2 Bath
16
$
5,046
F
2 Bedroom/2 Bath
16
$
5,150
G
2 Bedroom/2 Bath
8
$
5,254
H
2 Bedroom/2 Bath w/ Den
12
$
6,034
I
2 Bedroom/2 Bath w/ Den
4
$
6,555
J
2 Bedroom/2 Bath w/ Den
8
$
6,763
$
780
160
$
4,787
AL Studio
3
$
3,902
AL Plus Studio
10
$
3,902
AL 1 Bedroom
1
$
4,682
AL 1 Bedroom
13
$
5,046
MC Studio
18
$
4,994
$
988
45
$
4,687
15
$
8,063
15
$
8,063
Second Person Fees
Total Independent Living Units and Weighted Averages
Assisted Living Units
Second Person Fees
Total Assisted Living Units and Weighted Averages
Nursing Beds
NC Studio
Total Nursing Beds and Weighted Averages
Total Units
220
Source: Management
Independent Living Residences
The Project will feature 160 independent living residences in two mid-rise buildings. Twelve different floor plan
options offer one- two- and three-bedroom configurations ranging from 670 square feet to 1,815 square feet.
Standard features for each residence will include luxury vinyl plank flooring in the entryway and kitchen,
carpeting throughout the living areas, ample closets and storage areas, a fully-equipped kitchen
(refrigerator/freezer with icemaker, disposal, microwave, dishwasher, and oven/range), washer and dryer,
11
Page 84 of 335
Summary of Significant Projection Assumptions and Accounting Policies
Background Information, Continued
bathroom(s) with tub and/or shower and vanity, an emergency response system with 24-hour security and
emergency assistance, fire and smoke detectors, reserved underground parking, an individualized heating and air–
conditioning system, lever door handles, pre-wired cable, telephone and computer service, and a terrace or
balcony.
Independent Living Services
Independent living residents will have access to special services such as housekeeping, home maintenance,
scheduled transportation, several dining venues with flexible meal plans, fitness classes, social activities and "lifelong" learning.
Health Care Services
The health care center provides for a full continuum of on-site services with 45 assisted living units (of which 18
are memory care units) and 15 nursing beds, all of which are private. Assisted living units will provide both
studio and one-bedroom options, all with full bath and kitchenette. Nursing services include 24-hour supervision,
assistance in activities of daily living, and health-related care.
Common Areas
The Cardinal’s central feature is a 35,000 square foot clubhouse offering multiple dining venues, marketplace café
and lounge area, parlor, game rooms, art studio, auditorium, fitness area, indoor pool and spa, beauty and barber
shop and administrative areas.
The healthcare center has its own common and support areas including rehab therapy and a primary care clinic,
living, activity and dining areas for each level and other health related and administrative support spaced.
A proposed timeline for the Project, as provided by Management, is summarized in the following table:
12
Page 85 of 335
Summary of Significant Projection Assumptions and Accounting Policies
Background Information, Continued
Table 2
The Cardinal
Project Timeline
Date
November 2013
April 2015
January 2016
March 2016
May 2016
October 2017
Item
Construction for the Project begins
Buildings Completed and Fill-up Begins
Assisted living units achieve stabilized occupancy (95%)
Memory Care units achieve stabilized occupancy (95%)
Nursing Units achieve stabilized occupancy (95%)
Independent living units achieve stabilized occupancy (95%)
Source: Management
For a copy of the Residence and Care Agreement, please refer to The Cardinal’s Disclosure Statement filed
with the North Carolina Department of Insurance.
13
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Summary of Significant Projection Assumptions and Accounting Policies
Development of the Community
The development and construction of the Community will be conducted by entities other than the Organization.
Upon completion of the Community, the Organization will lease, pursuant to a subtenant lease agreement, the
Community from the master tenant, KSL Toledo Tenant, LLC.
HC REIT is a publicly-held real estate investment trust based in Toledo, Ohio that has been in existence for nearly
40 years. HC REIT's primary focus is to own real estate assets with medical or health care components. HC REIT
has created a lending relationship with developers to create opportunities to purchase and own such assets. HC
REIT typically does not participate in the operations of the facilities that it owns. In most cases, HC REIT simply
acts as a landlord to medical providers, CCRC's, and other senior living projects.
For selected new developments, such as The Cardinal, HC REIT offers financing for 100% of the development
costs. Incorporated in these costs are funds for all aspects of construction as well as funding for operating deficits
until the property is stabilized. In this case, HC REIT will sell The Cardinal property to the landlord entity, and
will provide the cash investment in the landlord entity needed to construct the Community, thus providing a level
of stability for retirement and health care projects that exceeds that of conventional bank loan financing. The
landlord entity will be owned by affiliates of HC REIT and KSL, as discussed previously.
A master lease will be executed that governs the ongoing relationship between the landlord, 300 St. Albans Drive,
LLC and the master tenant KSL Toledo Tenant, LLC ("Master Lease") who will sublease the property to The
Cardinal. The Master Lease sets forth the terms and conditions for the landlord to lease the land and building back
to The Cardinal for a predetermined amount. This lease has an initial term that will be at least 15 years with two,
5-year extension options. Management has projected that this lease should not be reflected as a capital lease, and
therefore, the Organization will only reflect lease expense and will not reflect property assets or depreciation in its
projection.
In summary, The Cardinal is anticipated to be a stabilized project whose physical assets are owned by affiliates of
HC REIT and KSL, but subleased to The Cardinal to operate as a fully licensed CCRC. The Cardinal will
generate revenue primarily from the ongoing operations of the retirement community. The revenue from
operations will be comprised predominately of monthly service fees for the independent living units and charges
to the health care residents. The primary expenses are operating expenses associated with the monthly services
provided to the residents and rental expenses paid to the landlord entity.
14
Page 87 of 335
Summary of Significant Projection Assumptions and Accounting Policies
Summary of Significant Accounting Policies
(a)
Basis of Accounting
The Organization maintains its accounting and financial records according to the accrual basis of
accounting and in accordance with GAAP.
(b)
Cash and Cash Equivalents
Cash and cash equivalents include certain investments in highly liquid instruments with original
maturities of three months or less from the date of acquisition, which are not included in restricted
assets or investments.
(c)
Investments
Investments in debt and equity trading securities are carried at fair value. Investment earnings are also
recorded as non-operating gains. Management does not assume any changes in the underlying values
of investments during the projection period that would result in unrealized gains or losses.
(d)
Resident Deposits
Represents the amounts paid by depositors (two-months monthly service fees for a selected unit) and
held in escrow.
(f)
Restricted Assets
Restricted assets include assets set aside to meet the North Carolina statutory operating reserve
requirements and assets set aside to fund a repair and replacement fund, as required by the Proposed
Loans.
Statutory Operating Reserve - Section 58-64-33 of the General Statutes of North Carolina, as
amended, establishes an operating reserve requirement that must be satisfied on an annual basis.
Specifically, in years where the overall occupancy of the facility exceeds 90%, the operating reserve
amount required equals 25% of operating expenses. In years where overall occupancy is under 90%, a
reserve equal to 50% of operating expenses must be established. To the extent that construction of the
facility is within five years or the funds have been set aside for the payment of interest and principal on
debt, interest expense and mandated principal payments would be excluded from the statutory
operating reserve requirements.
Resident Deposits - The Organization has established this fund to set aside any deposits received by
future residents.
(g)
Property and Equipment
Property and equipment is stated at cost less accumulated depreciation. Contributed property is
recorded at its estimated fair value at the date of receipt. Depreciation is computed on a straight-line
basis for all depreciable assets over the estimated useful lives of respective assets (3 to 39 years).
15
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Summary of Significant Projection Assumptions and Accounting Policies
Summary of Significant Accounting Policies
(h)
Resident Fees
Resident fees represent the estimated net realizable amounts from residents and others for services
rendered. Resident fees are recorded as revenue when earned.
(i)
Income Taxes
The Organization does not provide for income taxes since all taxable income is allocated to the
Organization’s Members for the inclusion in their respective income tax returns.
(j)
Allocation of Profit and Loss
In accordance with the limited liability company operating agreement, profits and losses are allocated
to each member of the Organization in accordance with their respective membership interests.
16
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Summary of Significant Projection Assumptions and Accounting Policies
Management’s Basis for Projection of Revenue
Revenues for the Project are primarily generated from monthly service fees for the independent living units and
monthly service fees and per diem charges from the Health Center residents.
Revenues for the independent living units are based on the monthly service fees assumed by Management to be
charged to the residents and the assumed utilization of the independent living units. Health care revenues consist
of revenue generated from services provided to residents in assisted living, memory care, and nursing care units.
For residents under the Resident Agreement, transfers to the Health Center are classified as either a temporary
transfer or a permanent transfer. Residents under the Resident Agreement who transfer to the Health Center pay
the following depending on the transfer classification:

Temporary Transfer - Residents continue to pay the normal monthly fee that is in effect for their
independent living unit, plus the then published Health Center per diem charge for their Health Center
unit and the cost of additional meals, and any other additional fees (including upgrades to larger units, if
applicable) for services provided to the resident, that are not included in the Health Center per diem
charge.

Permanent Transfer - Upon permanent transfer to the Health Center, the resident must pay the then
published Health Center per diem charge plus charges for other services not included in the Health Center
per diem charge, and must also give up his/her independent living unit. Thereafter, the resident shall no
longer be responsible for the monthly service fee that was in effect for their independent living unit;
provided however, the independent living unit is jointly occupied, and one resident transfers to the Health
Center, the remaining resident would continue to occupy the residence and would be charged the normal
monthly fee that is applicable to a single occupant in effect for their independent living unit.
Projected Occupancy Levels
The following tables reflect the projected utilization and the anticipated move-in schedule of the Project’s
independent living units.
17
Page 90 of 335
Summary of Significant Projection Assumptions and Accounting Policies
Management’s Basis for Projection of Revenue
Table 3
The Cardinal
Projected Utilization of Independent Living Units
For the Years Ending
December 31,
Projected:
2012
2013
2014
2015
2016
Average Number of Available
Independent Living Units
Average Number of
Occupied Units
120
160
Average Percent
Occupancy
18
79
N/A
N/A
N/A
15.0%
49.4%
Source: Management
5/31/2015
6/30/2015
7/31/2015
8/31/2015
9/30/2015
10/31/2015
11/30/2015
12/31/2015
1/31/2016
2/29/2016
3/31/2016
4/30/2016
5/31/2016
6/30/2016
7/31/2016
8/31/2016
9/30/2016
10/31/2016
11/30/2016
12/31/2016
Table 4
The Cardinal
Projected Project Independent Living Move-in Schedule
Cumulative
Move-ins
Occupancy
May 2015
6.0
6.0
June 2015
6.0
12.0
July 2015
6.0
18.0
August 2015
6.0
24.0
September 2015
6.0
30.0
October 2015
6.0
36.0
November 2015
5.0
41.0
December 2015
5.0
46.0
January 2016
5.0
51.0
February 2016
5.0
56.0
March 2016
5.0
61.0
April 2016
5.0
66.0
May 2016
5.0
71.0
June 2016
5.0
76.0
July 2016
5.0
81.0
August 2016
5.0
86.0
September 2016
5.0
91.0
October 2016
5.0
96.0
November 2016
5.0
101.0
December 2016
5.0
106.0
Occupancy
Percent
4%
8%
11%
15%
19%
23%
26%
29%
32%
35%
38%
41%
44%
48%
51%
54%
57%
60%
63%
66%
Source: Management
The schedule noted above extends through the last year of Management’s projection. Management has presented a
proforma of its statement of operations as if the Project were operating at its full occupancy, which Management
has indicated occurs beyond the projection period.
18
Page 91 of 335
Summary of Significant Projection Assumptions and Accounting Policies
Management’s Basis for Projection of Revenue
The projected double occupancy percentages in the independent living units are based upon assumptions provided
by Management and are as follows:
Table 5
The Cardinal
Double Occupancy Percentage Independent Living Units
Double Occupancy Percentage
2012
2013
2014
N/A
N/A
N/A
Source: Management
19
Page 92 of 335
2015
40%
2016
40%
Summary of Significant Projection Assumptions and Accounting Policies
Management’s Basis for Projection of Revenue
Assisted living and nursing occupancy is based on internal transfers from independent living units. Projected
resident transfers from independent living to assisted living and nursing, as well as from assisted living to nursing,
have been provided by Management. In North Carolina, unless a certificate of need is obtained for assisted living
or nursing that allows admissions from the community, occupancy is restricted to residents of the independent
living units. As a result, occupancy of the assisted living units and nursing could vary based on Management’s
ability to attract a number of minimally frail independent living residents during the initial fill-up. In addition,
there are certain exceptions that allow for direct admissions into assisted living or nursing (for example,
individuals who have signed residency agreement for independent living units, and who become ill prior to
moving into independent living).
The following tables show projected assisted living and nursing utilization assumptions provided by Management
for the Project:
Table 6
The Cardinal
Projected Utilization of Assisted Living Units
Assisted Living Standard
For the Years Ending
December 31,
Projected:
2012
2013
2014
2015
2016
Average Number
of Available
Average Number
of Occupied Units
20
27
10
25
Assisted Living Special Care
Average Percent
Occupancy
Average Number
of Available
N/A
N/A
N/A
50%
93%
Average Number
of Occupied Units
14
18
Average Percent
Occupancy
-
N/A
N/A
N/A
43%
94%
6
17
Source: Management
The projected double occupancy percentages in the assisted living units are based upon assumptions provided by
Management and are as follows:
Table 7
The Cardinal
Double Occupancy Percentage Assisted Living Units
Double Occupancy Percentage
2012
2013
2014
N/A
N/A
N/A
Source: Management
20
Page 93 of 335
2015
2016
5%
4%
Summary of Significant Projection Assumptions and Accounting Policies
Management’s Basis for Projection of Revenue
Table 8
The Cardinal
Projected Utilization of Nursing Beds
For the Years Ending
December 31,
Projected:
2012
2013
2014
2015
2016
Average Number of Nursing
Beds
Average Number of
Occupied Nursing Beds
Average Percent
Occupancy
11
15
-
4
13
N/A
N/A
N/A
36.4%
86.7%
Source: Management
Prior to commencement of construction for the Project, the Organization must achieve a 50% presale level as
evidenced by signed reservation agreements and collection of a deposit equal to 2 months rent. During the “Step
2” deposit phase that for a rental community represents two months rent as the deposit, prospective residents will
complete a qualifying health screening which certifies the prospect or, in the case of a couple, at least one
prospective resident is currently appropriate for independent living. If there is a health status change after this
benchmark, then this prospective resident can be admitted directly into healthcare. Per Management, 70% of the
prospective residents are projected to have a spouse, and of these prospective residents, it is anticipated that at
least 7% will require admission to healthcare when the community opens.
Management anticipates that residents will be able to access healthcare via home health services while residing in
the independent living units.
Consistent with The Cardinal’s Certificate of Need application, occupancy levels for assisted living need to reach
85 percent during the second year of operation.
Projected Monthly Service Fees
The following table summarizes the monthly service fees and daily rates for the various types of Residence and
Care Agreements for the Project. The monthly fees are shown in 2015 fiscal year dollars and are projected to
increase 4.0 percent annually thereafter.
21
Page 94 of 335
Summary of Significant Projection Assumptions and Accounting Policies
Management’s Basis for Projection of Revenue
Table 9
The Cardinal
Monthly Service Fees
Number of Monthly Service
Units
Fees (2015)
Unit Type
Independent Living Units
A
Studio
8
$
3,485
B
1 Bedroom/1 Bath
16
$
4,006
C
1 Bedroom/1 Bath
50
$
4,214
D
1 Bedroom/1 Bath w/ Den
22
$
4,786
E
2 Bedroom/2 Bath
16
$
5,046
F
2 Bedroom/2 Bath
16
$
5,150
G
2 Bedroom/2 Bath
8
$
5,254
H
2 Bedroom/2 Bath w/ Den
12
$
6,034
I
2 Bedroom/2 Bath w/ Den
4
$
6,555
J
2 Bedroom/2 Bath w/ Den
8
$
6,763
$
780
160
$
4,787
AL Studio
3
$
3,902
AL Plus Studio
10
$
3,902
AL 1 Bedroom
1
$
4,682
AL 1 Bedroom
13
$
5,046
MC Studio
18
$
4,994
$
988
45
$
4,687
15
$
8,063
15
$
8,063
Second Person Fees
Total Independent Living Units and Weighted Averages
Assisted Living Units
Second Person Fees
Total Assisted Living Units and Weighted Averages
Nursing Beds
NC Studio
Total Nursing Beds and Weighted Averages
Total Units
220
Source: Management
22
Page 95 of 335
Summary of Significant Projection Assumptions and Accounting Policies
Management’s Basis for Projection of Revenue
The following table reflects projected rate increases. Increases in fees are generally anticipated to equal or exceed
increases in operating expenses during the projection period.
Table 10
The Cardinal
Projected Rate Increases
Unit Type
Independent Living Monthly Fee Increases
Health Center Rate Increase
2012
(1)
(1)
2013
(1)
(1)
2014
(1)
(1)
2015
(1)
(1)
2016
4.0%
4.0%
Source: Management
Note (1): Pricing is shown in year 2015 dollars above
Investment Income
Interest income consists of interest earned on available cash, investments and restricted assets. The following
table reflects Management’s assumed realized investment earning rates during the projection period.
Table 11
The Cardinal
Projected Investment Earning Rates
Cash and Cash Equivalents
Investments
Restricted Assets Operating Reserve Fund
2012
1.0%
2.0%
1.0%
2013
1.0%
2.0%
1.0%
2014
1.0%
2.0%
1.0%
2015
1.0%
2.0%
1.0%
2016
1.0%
2.0%
1.0%
Restricted Assets - Resident Deposits
1.0%
1.0%
1.0%
1.0%
1.0%
Source: Management
Management does not project any unrealized gains/losses from the valuation or sale of investments during the
projection period.
23
Page 96 of 335
Summary of Significant Projection Assumptions and Accounting Policies
Management’s Basis for Projection of Expenses
Operating Expenses
Operating expenses have been projected to be recognized during the month incurred. Management has projected
operating expenses based upon Management’s operating plans for the Project. In general, operating expenses are
projected to increase at 3.5 percent annually throughout the projection period for inflation.
The specific basis for major expense items were formulated by Management and are discussed below.
Salaries and Benefits
Most departments include labor-related costs. A full time equivalent employee (“FTE”) represents 2,080 hours of
time paid annually. Average hourly rates and related benefit costs are projected to increase at a rate of 3.5 percent
annually throughout the projection period for inflation. Benefit costs include payroll taxes and employee benefits
including FICA, workers’ compensation, health insurance, and other miscellaneous benefits for the entire campus.
Health Care Expenses
Health Care Expenses consist of wellness, assisted living, memory care and nursing related costs that include
various costs for supplies, contract services, and other necessary costs of operating the various components of the
health care center. These costs are anticipated to increase as occupancy increases, and annually at 3.5 percent
annually throughout the projection period for inflation.
Operations Expenses
Operations expenses include maintenance/environmental, laundry, housekeeping and utility costs. Management
assumes that these costs would vary with changes in occupancy levels. In addition, these costs include the nonlabor costs of maintaining the community. The costs are anticipated to increase during the Project’s fill-up
correlating with increases in resident census, and underlying costs are assumed to increase 3.5 percent annually
throughout the projection period for inflation.
Dietary
Non- salary related costs of the food service include costs for raw food and dietary supplies and other such costs
and are based on the historical operating experience of Management. Management projects that these costs would
increase at approximately 3.5 percent annually throughout the projection period for inflation.
Administrative Expenses
Administrative expenses include property taxes and insurance, associate services, general and administrative
costs, sales, and marketing expenses, as projected by Management. These costs are anticipated to increase
annually at 3.5 percent annually throughout the projection period, for inflation.
Lease Expense
Management has projected lease expense pursuant to the subtenant lease agreement with the property owner.
Income Taxes
The Organization does not provide for income taxes since all taxable income is allocated to the Organization’s
Members for the inclusion in their respective income tax returns.
24
Page 97 of 335
Summary of Significant Projection Assumptions and Accounting Policies
Management’s Basis for Other Items
Restricted Assets
A narrative description of the restricted assets follows.
Resident Deposits – The Organization has established this fund to restrict all deposits received for future
residents.
North Carolina Statutory Operating Reserve Requirement – Section 58-64-33(a) of the General Statutes of North
Carolina, as amended, requires that all continuing care facilities maintain operating reserves equal to 50 percent of
the total operating costs (as defined in Section 58-64-33) (or 25 percent of the total operating costs if such
facilities maintain an occupancy level in excess of 90 percent and the North Carolina Commissioner of Insurance
so approves) projected for the twelve-month period following the period covered by the most recent annual
statement filed with the North Carolina Department of Insurance. Such operating reserves may only be released
upon approval of the North Carolina Commissioner of Insurance.
Property and Equipment
The Organization leases the property for the Community pursuant to a lease agreement. Management’s projection
reflects property and equipment related to routine capital expenditures.
Master Lease Agreement
The Cardinal is required under the Master Lease to develop a fully operational CCRC on the land, and may not
begin construction until at least 50 percent of the independent living units are pre-sold. In addition, construction
of all improvements must be completed within 24 months of the commencement of construction, as provided for
in the Master Lease Agreement.
25
Page 98 of 335
Summary of Significant Projection Assumptions and Accounting Policies
Management’s Basis for Other Items
Current Assets and Current Liabilities
Cash
Cash balances are projected at 30 days of operating expenses for the Project.
Investments
Investment balances for the projection period are based on the results of the Projected Statements of Cash Flows.
Accounts Receivable
Accounts receivable, net of allowance for non-collectible accounts, are projected at 10 days of total resident
revenue for the Project.
Inventory
Inventory items have been projected based on approximately 5 days of operating expenses for the Project.
Prepaid Expenses
Prepaid expenses consisting of prepaid insurance, inventory and other prepaid items have been projected based on
approximately 5 days of operating expenses for the Project.
Accounts Payable
Accounts payable has been projected based on 15 days payable of annual operating expenses for the Project,
excluding wages and benefits and interest expense.
Accrued Expenses
Accrued salaries have been projected based on 15 days payable of annual salaries and benefits for the Project.
26
Page 99 of 335
Summary of Significant Projection Assumptions and Accounting Policies
Management’s Sensitivity Analysis
As noted in Table 4, Management’s assumed fill of its independent living units do not achieve its intended
stabilized occupancy during the last year of the projection, which is for the five year period ending December 31,
2016. As a result, Management has prepared the following sensitivity analysis to reflect its financial performance
assuming that stabilized occupancy of 95 percentage in its independent living units had been achieved by 2016.
The purpose of this proforma presentation of projected year 2016 is to present Management’s projected financial
performance for a stabilized year of operations.
As Projected
2016
OCCUPANCY ASSUMPTIONS
Independent Living
Assisted Living - Standard
Assisted Living - Special Care
Skilled Nursing
49.4%
93.0%
94.0%
86.7%
27
Page 100 of 335
Pro-forma
2016
95.0%
95.0%
95.0%
95.0%
Summary of Significant Projection Assumptions and Accounting Policies
Management’s Sensitivity Analysis
Table 12
The Cardinal
Proforma Presentation of Year 2016 Assuming Stabilized Project Occupancy
(In Thousands of Dollars)
As Projected
2016
REVENUES
Monthly Fee Rent Revenue
Health Care Charges Revenue
Amortization of Entrance Fees
Other Revenue
Investment/Interest Income
Contributions/Gifts
Total Revenues
$
EXPENSES
Health Care Expenses:
Wellness
Assisted Living
Memory
Skilled Nursing Facility
Operations Expenses:
Maintenance/Environmental
Laundry
Housekeeping
Utilities
Dietary
Administrative Expenses:
Property Taxes & Insurance
Associate Services
General & Administrative
Sales
Marketing
Lease Expense to Affiliate
Interest Expense
Depreciation
Total Expenses
Operating Income (Loss)
$
28
Page 101 of 335
8,863
690
682
80
10,315
Pro-forma
2016
$
13,360
679
452
81
14,572
341
445
515
754
389
443
516
756
464
51
368
477
1,603
504
56
465
522
1,903
733
181
1,417
558
243
6,128
4
14,282
731
198
1,651
393
137
6,170
4
14,838
(3,967)
$
(266)
Exhibit D
The Cardinal at North Hills
Binding Reservation Agreement
The Cardinal at North Hills
Binding Reservation Agreement
THIS Agreement made this
day of
,
,
by and between The Cardinal at North Hills (hereinafter referred to as The Cardinal), a
North Carolina corporation authorized to transact business in the State of North Carolina,
and (hereinafter referred to as Prospective Resident, whether one or two persons).
Prospective Resident desires to make a reservation for residency within The Cardinal at
North Hills and hereby requests acceptance of this Reservation Agreement for a
Residence, #
(hereinafter referred to as Residence) for
as well as a Monthly Fee which is
which the Reservation Deposit is $
currently $_
. The Monthly Fee is subject to change according to the terms of
The Cardinal’s Resident Agreement.
A. Amount of Reservation Deposit
The amount of the Reservation Deposit equals two times the Monthly Fee applicable for
the Residence selected. The Reservation Deposit may be refunded under the
circumstances set forth in Section F of this Reservation Agreement prior to the time you
sign the Resident Agreement. When you take occupancy at The Cardinal at North Hills,
one half of the Reservation Deposit will be applied to pay the Monthly Fee for your first
month of residency, and the remaining half of the Reservation Deposit will be applied to
a community fee that will be nonrefundable except as set forth in the Resident
Agreement.
B. Escrow
The Reservation Deposit will be escrowed by The Cardinal at North Hills in the
NewBridge Bank. Prospective Resident’s Reservation Deposit remains the property of
the Prospective Resident, subject to the terms of this Reservation Agreement, until
released to The Cardinal at North Hills upon execution of the Resident Agreement.
C. Interest
Interest will accrue on the Reservation Deposit based on the Money Market Deposit
Account interest rate of the Escrow Bank named in Section B. above. Interest will begin
to accrue on the first day of the month following execution of this Reservation
Agreement. Accrued interest will be paid to the Prospective Resident within 30 days
following the execution of the Resident Agreement. Accountings of interest accrued will
be made to Prospective Resident semi-annually, as of June 30 or December 31 of each
calendar year.
D. Residency Requirements
Concurrent with the execution of this Reservation Agreement, the Prospective Resident
has completed an Application for Residency including Confidential Financial Information
and Health History and has met the preliminary financial and medical criteria for
residency at The Cardinal. An additional updated Confidential Financial Statement and
Physical Examination Form completed by the Prospective Resident’s physician stating
that Prospective Resident is capable of living independently at The Cardinal at North
Hills will be required within 90 days prior to executing the Resident Agreement and
taking up occupancy within The Cardinal.
E. Independent Living Resident Agreement. Prospective Resident and The Cardinal at
North Hills agree that this Agreement contains the complete understanding between them
with respect to the Reservation Deposit and both parties understand that within 90 days
prior to the date of occupancy, an Independent Resident Agreement will be executed by
both parties and that a copy of the Independent Living Resident Agreement has been
provided to Prospective Resident for review.
F. Refund of Deposit Payment Prior to Execution of Residency Agreement
The Prospective Resident has the right to rescind this Agreement without penalty within
thirty (30) days of signing. If the Prospective Resident rescinds this Reservation
Agreement by giving written notice to The Cardinal at North Hills within the thirty (30)
day period, the Reservation Deposit amount shall be returned to the Resident within thirty
(30) days and in accordance with the Escrow Agreement. No interest will be paid if
Prospective Resident rescinds this Reservation Agreement in the thirty (30) day period.
Following the expiration of the thirty (30) day period, the Reservation Deposit amount
shall be refunded within thirty (30) days under the following conditions:
1. Death of Prospective Resident. If Prospective Resident dies before taking
occupancy, the Reservation Deposit, plus any accrued interest, will be refunded to
the Prospective Resident’s estate. If Prospective Resident in this Agreement is
two (2) persons, no refund will be made under the provisions of this paragraph
unless requested by the survivor, and the survivor is entitled to all rights under
this Agreement as if the survivor had been the only Prospective Resident.
2. Inability to Live Independently. If Prospective Resident is precluded from
independent living for health reasons as certified in the Confidential Physical
Examination and wishes to withdraw his/her reservation, The Cardinal at North
Hills shall refund the Reservation Deposit plus any accrued interest. If
Prospective Resident in this Agreement is two (2) persons and one CoProspective Resident is able to live independently, no refund will be made under
the provisions of this paragraph unless requested by the eligible Co-Prospective
Resident.
3. Change in Financial Status. If Prospective Resident’s financial status changes
prior to occupancy to the degree that Prospective Resident is no longer financially
qualified for residency, The Cardinal at North Hills shall refund the Reservation
Deposit, plus any accrued interest.
4. Failure of the Project to be Developed. Should the management of The Cardinal
at North Hills determine that there is not sufficient interest to support the proposed
The Cardinal at North Hills project, The Cardinal at North Hills shall refund the
entire Reservation Deposit, plus any accrued interest, within thirty (30) days of
notice to Prospective Resident that the project will not be developed.
5. Desire of Prospective Resident to Terminate. If Prospective Resident desires to
terminate this Agreement more than thirty (30) days after the date of execution by
The Cardinal at North Hills and if this Agreement is not terminated under Section
F.1, F.2, F.3, or F.4 of this Agreement, The Cardinal at North Hills shall refund
the Reservation Deposit, plus any accrued interest, within thirty (30) days, less a
Processing Fee equal to fifty percent of the Reservation Deposit for the selected
residence, and less any costs specifically incurred by The Cardinal at North Hills
at the written request of Prospective Resident for upgrades or design changes to
the selected residence. Such refund shall be made within thirty (30) days of the
date this Agreement becomes null and void.
Prospective Resident cannot transfer or assign this Agreement. This Agreement shall be
considered to be in effect only when executed by an authorized representative of The
Cardinal at North Hills
Prospective Resident
Date
Prospective Resident
Date
The Cardinal at North Hills hereby acknowledges
the receipt of the Reservation Deposit in the
amount of:
$ __________________________
__________________________
Date
__________________________
By
Exhibit E
The Cardinal at North Hills
Independent Living Residence Agreement
Independent Living
Residence Agreement
TABLE OF CONTENTS
1.
LIVING ACCOMMODATIONS .........................................................................................
1.1
Residence ..................................................................................................................
1.2
Furnishings ...............................................................................................................
1.3
Utilities .....................................................................................................................
1.4
Customized Changes to Your Residence ..................................................................
1.5
Maintenance and Repairs ..........................................................................................
2.
COMMUNITY AREAS .......................................................................................................
3.
INDEPENDENT LIVING SERVICES ................................................................................
3.1 Dining .............................................................................................................................
3.2 Laundry ...........................................................................................................................
3.3 Housekeeping .................................................................................................................
3.4
Gardening and Maintenance .....................................................................................
3.5
Storage Space............................................................................................................
3.6
Social-Recreational Activities ..................................................................................
3.7
Guests .......................................................................................................................
3.8
Pets ............................................................................................................................
3.9 Transportation .................................................................................................................
3.10 Parking ..........................................................................................................................
3.11 Safety and Emergencies ................................................................................................
3.12 Administration ..............................................................................................................
3.13 Assessments ..................................................................................................................
3.14 Wellness Services .........................................................................................................
3.15 Interruption of Services ................................................................................................
IndependentLivingResidenceAgreement4.21.2016
Page2
TABLE OF CONTENTS (CONT.)
4.
5.
6.
ASSISTED LIVING AND NURSING CARE SERVICES .................................................
4.1
Assisted Living Services...........................................................................................
4.2
Memory Support Services ........................................................................................
4.3
Nursing Care Services ..............................................................................................
4.4
Priority Access to Health Center ..............................................................................
4.5
Level of Living Determinations................................................................................
4.6
No Obligation to Prepay for Health Center Services................................................
4.7
Home Care Service ...................................................................................................
FEES .....................................................................................................................................
5.1
Deposit ......................................................................................................................
5.2
Monthly Fees ............................................................................................................
5.3
Charges for Optional Services ..................................................................................
5.4
Joint Liability for Fees ..............................................................................................
RELOCATIONS FROM RESIDENCE ...............................................................................
6.1
Substitution of Residence by The Cardinal
6.2
Voluntary Relocation of Single Resident or Both Joint Residents ...........................
6.3
Subsequent Joint Occupancy by Residents of Different Residence .........................
6.4
Subsequent Joint Occupancy by Resident and Non-Resident ..................................
6.5
Dissolution, Divorce or Separation of Residents ......................................................
6.6
Relocation Within The Cardinal ...............................................................................
6.7
Relocation to an Outside Health Care Facility .........................................................
6.8
Conditions Pertaining to Change of Residence ........................................................
6.9
Required Relocation .................................................................................................
IndependentLivingResidenceAgreement4.21.2016
Page3
TABLE OF CONTENTS (CONT.)
7.
8.
TERMINATION AND REFUNDS ......................................................................................
7.1
Termination Due to Resident’s Death Prior to Occupancy ......................................
7.2
Cancellation Period/Refund ......................................................................................
7.3
Death of Resident During or After Cancellation Period Following Move In...........
7.4
Termination by Resident After Cancellation Period/Refund....................................
7.5
Termination by The Cardinal After Cancellation Period .........................................
7.6
Continued Monthly Fee Payment Obligation ...........................................................
RIGHTS OF RESIDENTS ...................................................................................................
8.1
No Real Property Interest .........................................................................................
8.2
Subordination of Rights ............................................................................................
9.
RESIDENT RECORDS........................................................................................................
10.
MISCELLANEOUS .............................................................................................................
10.1 Resident Advisory Council ...........................................................................................
10.2 Rules, Regulations, Policies and Procedures/Resident Handbook ...............................
10.3 Power of Attorney.........................................................................................................
10.4 Resident’s Financial Condition.....................................................................................
10.5 Residency Documents ..................................................................................................
10.6 Other Residents or Non-Residents................................................................................
10.7 No Assignment .............................................................................................................
10.8 Liability and Property Matters .....................................................................................
10.9 Right of Entry ...............................................................................................................
10.10 Relationships Between Residents and Associates ......................................................
10.11 Waiver.........................................................................................................................
10.12 Notices ........................................................................................................................
IndependentLivingResidenceAgreement4.21.2016
Page4
TABLE OF CONTENTS (CONT.)
10.13 Entire Agreement ......................................................................................................
10.14 Governing Law .........................................................................................................
10.15 Severability ...............................................................................................................
10.16 Consent to Assignment .............................................................................................
10.17 Smoking ....................................................................................................................
10.18 Obligations Concerning Firearms .............................................................................
10.19 Motor Vehicle Operating Privileges .........................................................................
10.20 Guarantor ..................................................................................................................
10.21 Voluntary Arbitration................................................................................................
IndependentLivingResidenceAgreement4.21.2016
Page5
INDEPENDENT LIVING RESIDENCE AGREEMENT
This Independent Living Residence Agreement (this “Agreement”) is entered into on____________, 20___,
by The Cardinal at North Hills, LLC, a North Carolina limited liability company, and its agent, Kisco Senior
Living,
LLC,
(“The
Cardinal
and/or
The
Community”)
and
___________________________________________________ (“you”). (If more than one person signs this
Agreement, the term “you” refers to each of you individually, and to both of you together.) This Agreement
shall be in effect for 13 months from the above date and shall automatically renew each year thereafter
unless cancelled or terminated in accordance with the relevant sections of this Agreement.
RECITALS
The Cardinal at North Hills, LLC, a Continuing Care Retirement Community (hereinafter “The Cardinal or
the “Community”) offers residency, care and services to qualified persons aged 62 and older. The
Community is operated on a nondiscriminatory basis and affords equal treatment and access to services to
all eligible persons.
You have applied for and have been accepted for residency at The Cardinal. You desire to take up
residence at The Cardinal, and agree to pay the fees and other amounts required under this Agreement in
consideration for the accommodations and services provided by The Cardinal.
AGREEMENT
1. LIVING ACCOMMODATIONS
The Cardinal will provide you with the following accommodations and services, subject to the
terms and conditions of this Agreement.
1.1
Residence
You have chosen to live in Residence No. _________________ (“your Residence”).
1.2
Furnishings
You are responsible for furnishing your Residence with those items not provided by the
Community. Your Residence will be equipped with window and floor coverings, washer/dryer,
microwave oven, electric oven and range, dishwasher, refrigerator, in-sink disposal and air
conditioning. Your minor appliances, special equipment and furnishings must meet the safety
standards of The Cardinal and are subject to the prior approval by the Management.
1.3
Utilities.
Utilities included in the Monthly Fee for the Residence are electricity, water and sewer, trash
removal, basic internet/data services, and basic cable TV service. You are responsible for paying
for all other utilities and service charges including local and long distance telephone charges,
premium internet/data services and premium TV service fees. The Cardinal reserves the right to
establish maximum usage levels, and to charge you for any excessive or unreasonable usage due to
waste or abuse.
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1.4
Customized Changes to Your Residence
You may decorate your Residence with items that are not permanent fixtures to the Residence and
can be easily removed without changing or damaging the aesthetic or structural integrity of the
Residence. Other modifications to your Residence must be approved, in writing, by the Executive
Director and must be in compliance with the rules, regulations, policies and procedures relating to
modifications to Residence contained in the Resident Handbook. The selection and approval of a
contractor for structural changes shall be made by the Community. You may be supplied with the
estimated cost of changes but are required to pay the entire amount, even if it exceeds the estimate.
Any structural changes or improvements to the Residence will become the Community’s property.
The Cardinal will not be required to refund the cost of any approved structural changes or
improvements. If you have made approved modifications or changes to your Residence and you
move out of The Cardinal, you or your estate must restore your Residence to its original condition,
excluding ordinary wear and tear, unless otherwise agreed to in writing by the Executive Director.
You or your estate will be responsible for restoration costs relating to the removal of any
modifications, and all costs associated with the restoration of the Residence to its original clean
condition. You or your estate must consult with The Cardinal prior to initiating any restoration and
the Community may, at its sole discretion, elect to retain any approved modifications. This excludes
required ADA modifications.
1.5 Maintenance and Repairs
Your Monthly Fee includes repair and maintenance of your Residence and repair and replacement
of those furnishings that are provided by The Cardinal. Maintenance, repair and replacement related
to ordinary wear and tear are covered under your Monthly Fee. Maintenance and repairs of your
Residence and furnishings made necessary by causes other than ordinary wear and tear, and those
costs, will be charged to you separately. You are responsible for maintaining or arranging for the
maintenance and repair of your personal property.
1.6 Term of Agreement.
This Agreement has an initial term of thirteen (13) months, and at the end of the initial term of
thirteen (13) months and each succeeding term, this Agreement shall automatically renew for an
additional successive term of twelve (12) months, unless terminated by either party in accordance
with the provisions of Article 7 of this Agreement.
2. COMMUNITY AREAS
You may share with other Residents the use of the grounds and common areas at The Cardinal
subject to the rules, regulations, policies and procedures contained in the Resident Handbook, which
is subject to change from time to time. Common areas currently anticipated to be available to
Residents include space for dining, lounges, meeting rooms, a library, exercise facility, and any
other common areas provided at The Cardinal. These common areas may change during your time
of residency. The Community may modify, change or expand common areas at The Cardinal in its
sole discretion.
3. INDEPENDENT LIVING SERVICES
The following services will be available at The Cardinal. Unless otherwise indicated, these services
are included in your Monthly Fee (see Appendix A for a schedule of fees for additional
items/services not included in your Monthly Fee).
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3.1
Dining
3.1.1 Dining Service. Meals will be served throughout the day in the Community dining
venues, with various menus, services, and options, as described in the Resident Handbook.
Your Monthly Fee includes a Monthly Dining Account, in the amount set forth on Appendix
A. The amount of your Monthly Fee allocated to your Monthly Dining Account is subject to
change with a 30-day notice by The Cardinal. You may use your Monthly Dining Account
throughout the month to purchase meals, snacks, food items, tray service, and beverages at
the prices established by the Community and as revised from time to time. Should you
exhaust your Monthly Dining Account in any particular month, then any additional meals,
snacks, and/or other food items may be provided at an additional charge above your
Monthly Fee. Unused portions of the Monthly Dining Account will be deemed expended
and will not be carried over to any subsequent month.
3.1.2 Guest Dining. You may use your Monthly Dining Account to pay for your guests’
meals (see Appendix A).
3.1.3 Tray Service. Meal delivery to your Residence shall be provided on request for an
additional fee as described in Appendix A.
3.2 Laundry
Your Residence includes a washer and dryer. Personal laundry assistance is available for an
additional fee (see Appendix A).
3.3 Housekeeping
You agree to maintain your Residence in a clean, sanitary, safe and orderly condition as determined
by The Cardinal management. Your Monthly Fee includes scheduled standard housekeeping
services for your Residence as described in the Resident Handbook. Additional housekeeping
services beyond those scheduled are available for an additional fee as described in Appendix A.
3.4
Gardening and Maintenance.
The Cardinal will perform gardening, maintenance and landscaping services for common areas at the
Community.
3.5
Storage Space
In addition to the storage space in your Residence, storage space is also available at The Cardinal in
accordance with the Resident Handbook. The State Fire Marshal, other governmental authorities, and
Management may restrict what can be stored and the manner in which it is stored. Additional storage
lockers are available as described in Appendix A.
3.6
Social and Recreational Activities
The six dimensions of wellness – emotional, intellectual, physical, social, spiritual and vocational are part of promoting a healthy lifestyle. The Cardinal will provide programs and services designed to
encourage a healthy lifestyle in accordance with the schedule and established at its discretion. There
may be an additional charge for some activities, programs and special excursions.
3.7
Guests
Guests must abide by all applicable rules contained in the Resident Handbook, including any
limitations on the length of stay or frequency of visits. If your guest exceeds the limitations on the
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length of stay, he or she must apply and qualify for residency at The Cardinal. You will be
responsible for assuring that your guests abide by these rules and are not disruptive. Your guests may
be denied access to The Cardinal if they fail to observe the Resident Handbook rules. Home Care or
Personal Service Providers are not considered guests and are not entitled to the same privileges as
guests. Home Care or Personal Service Providers must meet the criteria for access to The Cardinal.
(See Section 4.7 regarding Home Care Service/Personal Service Provider).
3.8
Pets
Subject to The Cardinal’s pet policy, pets are welcome provided they meet the criteria set forth in the
Resident Handbook. You shall assume financial responsibility and any obligations for any damage, to
persons, property, or otherwise, caused by the pet. The Community reserves the right to rescind
approval of the pet if it determines that the pet constitutes a nuisance or danger to the Community, or
threatens the quiet enjoyment of other Residents. If you wish to bring a pet to The Cardinal, you must
pay a monthly pet fee, in the amount set forth on Appendix A, as long as your pet resides at The
Cardinal.
3.9
Transportation
Transportation service is provided to Residents on a scheduled basis in Community vehicles, at no
charge. A list of destinations, as well as departure and return times, will be established by the
Community and posted in suitable locations in the community.. Scheduled transportation times and
destinations are set from time to time by the Community with input from the Resident Advisory
Council. Other transportation services (such as to medical appointments or outside the radius
designated on Appendix A) may be available according to fee-for-service rates. Scheduled trips
depart from the main entrance of The Cardinal unless otherwise indicated. The Cardinal reserves the
right to re-schedule planned trips in the event of an emergency or in the event of, an equipment
failure or based on minimum resident participation for such trips. .As a Resident of The Cardinal, you
will also have access to any transportation services that are made available The Cardinal by North
Hills.
3.10 Parking
Each Residence at The Cardinal will be assigned one (1) underground parking space. Your parking
space at the Community is personal and you may not transfer, lease, or assign your parking space..
Vehicles must be registered as set forth in the Resident Handbook. Additional parking spaces may be
available for a fee as set forth in Appendix A.
3.11 Safety and Emergencies
Each Residence will be equipped with a response call system, smoke detector and sprinkler system.
The response call system is monitored twenty-four (24) hours per day to alert staff to emergencies
and illnesses. When a Community associate determines that, in his or her judgment, an emergency
exists, an associate will call 911.
3.12 Assessments
Payment of the Monthly Fee shall include assessments for real estate taxes and North Hills
community association fees. Payment of an allocated portion of any real estate tax assessment or
other real estate related fee or assessment does not give you any interest in the land, improvements, or
real estate of The Cardinal.
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3.13 Wellness Services
Your Monthly Fee includes access to a well-being assessment provided by The Cardinal. In addition,
subject to reasonable utilization, some preventive health services are available, including blood
pressure, temperature and pulse checks, wellness counseling, wellness education and minor first aid.
Additional services may be available at an extra charge as set forth in Appendix A.
3.14 Interruption of Services
Temporary interruption of services or failure to maintain services provided for in this Agreement
shall not constitute a breach of this Agreement if it results from causes beyond the reasonable control
of The Cardinal, such as fire, weather related, earthquake, damage, labor disturbances, government
regulations, or acts of terrorism. In such circumstances, the Community may use commercially
reasonable efforts to sustain or restore service or provide a substitute service.
4
ASSISTED LIVING, MEMORY SUPPORT AND NURSING CARE SERVICES
The Cardinal community will include an attached Health Center which will offer Health Care
service options, herein referred to as “Health Center Services”, for Residents that include assisted
living, memory support and nursing care should you require assistance due to a change in your
health status. These services, including ancillary services such as supplies, medications and therapy
services, are not included in the Monthly Fee and are provided at an additional charge above the
Monthly Fee (the “Health Center Fee”), as outlined in Appendix A. The Health Center Fee is paid
pursuant to the terms of an Assisted Living Residence and Care Agreement or a Skilled Nursing
Residence and Care Agreement, as applicable. Generally, Assisted Living Health Center Fees are
determined and billed on a monthly basis, while Skilled Nursing Health Center Fees are determined
on a daily basis but billed on a monthly basis. The current forms of the Assisted Living Residence
and Care Agreement and the Skilled Nursing Residence and Care Agreement are attached to the
Disclosure Statement you received when you applied for residency at the Cardinal. Some, but not
all, of the services provided and obligations set forth in these agreements are described in this
Section 4. You should review these agreements in full. Your responsibility to pay both the Monthly
Fee and the Health Center Fee is described in Section 6 of this Agreement.
4.1 Assisted Living Services
The Health Center includes assisted living apartments and services. If you need assistance with such
daily activities as bathing, grooming, dressing, or medication supervision, The Community will
make available these services to you in an assisted living apartment. The cost of assisted living is at
an additional charge and is not included in the Monthly Fee. Part of the move-in process to assisted
living involves signing a separate Assisted Living Residence and Care Agreement in its then current
form. The services you receive and certain additional rights and obligations will be set forth in the
Assisted Living Residence and Care Agreement. The terms of this Agreement will continue to apply
until you permanently vacate your Residence and terminate this Agreement in accordance with
Article 7.. If there are no assisted living apartments available or your needs exceed the level of care
that can be provided in an assisted living apartment, you may be transferred to the memory support
or nursing care apartments or to an outside care center as appropriate.
4.2 Memory Support Services
The Health Center includes memory support apartments and services. If you need assistance with
such daily activities as bathing, grooming, dressing, or medication supervision and have Dementia
or require memory enhancement services, the Community will make available these services to you
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in a memory support apartment. The cost of memory support is at an additional charge and is not
included in the Monthly Fee. Part of the move-in process to memory support involves signing a
separate Assisted Living Residence and Care Agreement in its then current form. The services you
receive and certain additional rights and obligations will be set forth in the Assisted Living
Residence and Care Agreement. The terms of this Agreement will continue to apply until you
permanently vacate your Residence and terminate this Agreement in accordance with Article 7. If
there are no apartments available or your needs exceed the level of care that can be provided in the
memory support apartment, you may be transferred to the nursing care apartments or to an outside
care center as appropriate.
4.3
Nursing Care Services
The Health Center includes nursing care apartments and services. If you need assistance with daily
activities such as bathing, grooming, dressing, or medication supervision and require nursing
services, the Community may make available these services to you in a nursing care apartment. The
cost of nursing care is at an additional charge and is not included in the Monthly Fee. Part of the
move-in process to nursing care involves signing a separate Nursing Care Agreement in its then
current form. The services you receive and certain additional rights and obligations will be set forth
in the Agreement. The terms of this Agreement will continue to apply until you permanently vacate
your Residence and terminate this Agreement in accordance with Article 7. If there are no apartments
available or your needs exceed the level of care that can be provided in the nursing care apartment,
you may be transferred to an outside care center as appropriate.
4.4
Level of Living Determinations
The Community care management team will determine, in consultation with you, your physician,
other Health Care providers, and your representative, whether you need assisted living, memory
support or nursing care, the extent of the care to be provided, whether such care will be provided at
the Community or away from the Community, and whether any relocation from your apartment for
care is temporary or permanent (see Section 6.9).
4.5 No Obligation to Prepay for Health Center Services
You are not obligated to prepay for any future Health Center services. The Cardinal is a fee-forservice continuing care provider and does not require you to prepay for Health Center services, nor
does it accept any liability to pay for your future Health Center services. In the event any other
Health Care provider seeks payment from you for services offered under this Agreement, The
Cardinal shall not assume any liability for or make any payment for any such Health Center services
because you were not required to prepay for any Health Center services.
4.6 Home Care/Personal Service Providers
All outside caregivers, companions, personal service providers and other personnel employed or
retained by you to render services at The Cardinal shall be subject to our policies and rules. All such
personnel must obtain the security clearances required under North Carolina law and must be
employed by a licensed agency with insurance coverage, including liability and worker’s
compensation, satisfactory to us in our sole discretion. Our policies and rules for personal service
providers were provided to you in the move-in packet, and may be updated or revised from time to
time. Current policies are available at the front desk of The Cardinal. Generally speaking, these
policies provide that you may utilize home health or home care agencies, or other providers of your
choice provided that such agencies or providers abide by our rules and regulations and that we may
exclude providers that do not comply. The services we provide as outlined in this Agreement do not
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include monitoring the services of outside providers, and we are not responsible for their actions or
omissions.
5
FEES
5.1 Deposit
The Deposit for your Residence at The Cardinal is _____________dollars ($______________),
which is equal to two months' Monthly Fee. Your Deposit is payable by check, money order, or wire
transfer, and is due upon signing this Agreement. Any refund of your Deposit will be governed by
Section 7 below. If there are two of you, the allocation of any such refund will be as described in
Section 7 below.
5.2
Monthly Fee
5.2.1 Amount. The initial Monthly Fee for your Residence for single occupancy is
______________________ dollars ($__________). If your Residence is jointly occupied,
there will be an additional Second Person Monthly Fee of ($___________).
5.2.2 Payment Procedures. You will commence paying your Monthly Fee on __________.
Thereafter, your Monthly Fee shall be payable in advance on the first (1st) day of each month.
You will be billed by the Community for the Monthly Fee for the next month’s services and
accommodations. Payment must be made by check, money order, electronic payment, or other
means prescribed by the Community. Any check, money order, or other paper remittance
must be mailed to The Cardinal or personally delivered to The Cardinal Administrative
Office.
5.2.3 Late Payment Charge and Interest. The Cardinal reserves the right to impose a late
payment charge and interest at the rate described in Appendix A, if you do not pay your
Monthly Fee and other fees due under this Agreement by the due date. You will be
responsible for paying all attorneys’ fees and costs incurred by The Cardinal related to the
recovery of delinquent amounts due under this Agreement.
5.2.4 Obligations to Make Payment/Default/Financial Assistance. You are required to
make all payments due to the Community in a timely manner and otherwise satisfy your
personal financial obligations. If you fail to pay the Monthly Fee or other charges in a timely
fashion, The Cardinal may, in its discretion, terminate this Agreement under Section 7.5
upon thirty (30) days written notice. In the event of such termination, all unpaid fees and
charges (including late payment charges and interest) will be deducted from any amounts
owed to you by The Cardinal.
5.2.5 Adjustments. The Cardinal reserves the right to increase or decrease the Monthly
Fee or the scope or frequency of services upon thirty (30) days advance notice.
5.2.6 Absences. You are responsible for continuing to pay your full Monthly
Fee whenever you are absent from the Community.
5.3
Charges for Optional Services
You will be billed for optional services selected either at the time they are rendered or with the next
billing cycle (see Appendix A). The payment procedures for optional service charges, including the
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imposition of late fees and interest, are the same as for the Monthly Fee. The current charges for
optional services are set forth in the schedule of fees for optional services. By signing this
Agreement, you hereby acknowledge receipt of a copy of The Cardinal schedule of current fees for
optional services. The Cardinal may, in its sole discretion, adjust the fees for optional services for
any reason upon providing thirty (30) days advance notice to Residents.
5.4
Joint Liability for Fees
If two Residents are signing this Agreement, both Residents together and each Resident separately
will be liable for all fees described in this Agreement. If you share your Residence with another
Resident who has executed another Residence Agreement, both of you are liable for all fees due
under each of your Residence Agreements, including late payment charges and interest.
6
RELOCATIONS FROM RESIDENCE
6.1
Substitution of Residence by The Cardinal
The Cardinal reserves the right to substitute your Residence with another comparable Residence if it
is necessary to do so to meet any requirement of law or the lawful order or direction of the Fire
Marshal or another authorized public official, or for any other reasonable purpose, as determined to
be appropriate by The Cardinal.
6.2
Voluntary Relocation of Single Resident or Both Joint Residents
If you wish, you may move to another Residence at The Cardinal, subject to Residence availability
and The Cardinal’s approval. You must notify the Community in writing of the Residence desired.
You shall be responsible for all moving and cleaning costs and the cost of restoring your original
Residence to its original condition, excluding ordinary wear and tear. In addition, you shall pay the
Monthly Fee on both Residences until such time that you make the vacated Residence available to
the Cardinal in acceptable condition (“Unit Ready”) after which you will then only pay the Monthly
Fee on your new or different Residence. The parties shall sign an amendment to this Agreement that
identifies your new or different Residence and the applicable Monthly Fee.
6.3
Subsequent Joint Occupancy by Residents of Different Residences
6.3.1 Existing Residence of a Resident. If you and another Resident, residing in two
separate Residences, decide to live together, you may release one of your residences and live
together in the other residence, subject to availability and The Cardinal’s approval. You
shall be responsible for all moving and cleaning costs and the cost of restoring the vacated
residence to its original condition, excluding ordinary wear and tear. The vacated residence
Monthly Fee will cease upon it being Unit Ready. You will sign a new agreement.
6.3.2 New or Different Residence. If you and another Resident, residing in two separate
residences, decide to live together in a new or different residence, you may release both of
your current residences and move into a new or different residence, subject to availability and
The Cardinal’s approval. You shall be responsible for all moving and cleaning costs and the
cost of restoring your former residences to their original condition, excluding ordinary wear
and tear. The vacated residence or residences Monthly Fee will cease upon it being Unit
Ready. You and your joint occupant will sign a new Residence Agreement that identifies your
new or different accommodation and identifies the Monthly Fee for your new or different
accommodation.
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6.4
Subsequent Joint Occupancy by Resident and Non-Resident
If you wish to live in your Residence with someone who is not a Resident of The Cardinal, the nonResident must follow the standard application procedures for move-in to the Community. Both of you
shall be 62 years of age or older. If the non-Resident’s application is rejected, (s) he shall not qualify
to be a Resident of The Cardinal. Such rejection will have no effect on your obligations or rights
hereunder and you may remain in your Residence or terminate this Agreement in accordance with
Section 7.4. If the application is approved, the new Resident shall pay, on the same terms that apply
to all Residents, the Second Person Monthly Fee. Both of you shall sign an amendment to this
Agreement that identifies the Monthly Fee for your Residence. Both Residents together and each
Resident separately will be liable for all fees described in this Agreement.
6.5
Dissolution, Divorce or Separation of Residents
If you jointly occupy your Residence, and you divorce, separate, or otherwise wish to live separately
while at The Cardinal, either of you shall be entitled to relocate from your Residence to a different
residence, subject to residence availability and the Community’s approval. The transferring Resident
shall then pay the Monthly Fees for single occupancy of his or her new or different residence and will
sign a new Residence Agreement. The non-transferring Resident will continue to pay the single
occupancy Monthly Fee for your Residence. If either of you wishes to terminate your Agreement, see
Section 7.4.
6.6
Relocation Within The Cardinal for Health Center Services
The Community care management team, in consultation with you, your physician, and your
representative, shall determine whether your relocation from your Residence is temporary or
permanent.
6.6.1 Temporary Relocation Within The Cardinal.
6.6.1.1 Single Occupancy. If you require temporary Health Center services, you shall
continue to pay your regular Monthly Fee for your Residence as well as the Health Center
Fee, as well as any charges for ancillary items and services you receive that are not covered
by the Health Center Fee.
6.6.1.2 Double Occupancy. If you occupy your Residence with another Resident and one of
you is temporarily transferred outside your Residence for Health Center services, the
remaining Resident may continue to occupy your Residence. In that case, the remaining
Resident will be obligated to pay the Monthly Fee for single occupancy and charges for
optional items and services. The transferred Resident will pay the applicable Health Center
Fee and any charges for ancillary items and services (s) he receives that are not covered by the
Health Center Fee. If both of you simultaneously receive Health Center services, you will be
responsible for continuing to pay the full double occupancy Monthly Fee for your Residence
and each of you shall pay (a) the applicable Health Center Fee for care received; and (b) any
charges for ancillary items and services that each of you receive that are not covered by the
Health Center Fee.
6.6.2 Permanent Relocation to The Cardinal Health Center
6.6.2.1 Single Occupancy. If you occupy your Residence by yourself and you require
permanent Health Center services you shall vacate your Residence and relocate to a Health
Center apartment as appropriate. You will continue to pay The Cardinal the Monthly Fee
until you make your Residence Unit Ready (see Section 7.2.1) to The Cardinal. You shall be
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responsible for all moving and cleaning costs and the cost of restoring your former residence
to its original condition, excluding ordinary wear and tear. In addition, you shall pay the
applicable Health Center Fee and any charges for ancillary items and services you receive.
Once your Residence is Unit Ready, the Unit will be deemed available to The Cardinal for
sales and marketing purposes, and the Resident will be released of any further responsibility
regarding the former residence. After you have made your Residence Unit Ready to The
Cardinal, you shall be responsible for paying only the Health Center Fee and any charges for
ancillary items and services you receive.
6.6.2.2 Double Occupancy. If you occupy your Residence with another Resident and one of
you requires permanent Health Center services, the remaining Resident may continue to
occupy your Residence. In that case, the remaining Resident will be obligated to pay the
Monthly Fee for single occupancy and any charges for optional items and services. The
transferred Resident will pay the applicable Health Center Fee and any charges for ancillary
items and services (s)he receives. If both of you simultaneously require permanent Health
Center services, you shall vacate your Residence and relocate to one of The Cardinal Health
Center apartments. You shall continue to pay the double occupancy Monthly Fee until your
Residence is Unit Ready (see Section 7.2.1). You shall be responsible for all moving and
cleaning costs and the cost of restoring your former residence to its original condition,
excluding ordinary wear and tear. In addition, each of you shall pay the applicable Health
Center Fee for the care received and any charges for ancillary items and services you receive.
Once your Residence is Unit Ready, each of you shall be responsible for paying only the
applicable Health Center Fee and any charges for ancillary items and services you receive.
6.7
Relocation to an Outside Health Care Facility
6.7.1 Temporary Relocation. If you relocate to an outside facility for health care services because
no space is available at The Cardinal Health Center, you shall continue to pay your regular Monthly
Fee for your Residence until you return. In addition, you shall be responsible for paying the outside
facility’s charges for the housing, services and items you receive at that facility. The Cardinal is not
responsible to pay such charges to the outside facility. When space becomes available at The
Cardinal Health Center, and as medical circumstances allow, as determined by the Community care
management team, you, your physician, and/or your representative, The Cardinal will notify you to
return. All obligations regarding the provision and quality of care at the outside facility shall be the
responsibility of that facility and not The Cardinal, and you agree to hold The Cardinal harmless for
any injury or damage you incur at an outside care center.
6.7.1.1 Single Occupancy. If you require temporary health care services outside The
Cardinal, you shall continue to pay your regular Monthly Fee for your Residence as well as
any charges for ancillary items and services you receive that are not covered by the Monthly
Fee.
6.7.1.2 Double Occupancy. If you occupy your Residence with another Resident and one of
you is temporarily transferred outside The Cardinal for health care services, the remaining
Resident may continue to occupy your Residence. In that case, the remaining Resident will be
obligated to pay the Monthly Fee for single occupancy and charges for ancillary items and
services received that are not covered by the Monthly Fee. If both of you
simultaneously receive health care services outside The Cardinal, you will be responsible for
continuing to pay the single occupancy Monthly Fee for your Residence and any charges for
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ancillary items and services that each of you receive that are not covered by the Monthly Fee.
6.7.2 Permanent Relocation. If you occupy your Residence by yourself and you permanently
relocate to an outside health care facility, this Agreement will terminate in accordance with Section 7.
In the event of double occupancy, if one Resident requires permanent assisted living, memory care or
nursing care at an outside facility, this Agreement will terminate with respect to the transferring
Resident and will continue only with respect to the remaining Resident in accordance with Section 7.
In such event, the remaining Resident will continue to pay the single occupancy Monthly Fee as well
as any charges for ancillary items and services received that are not covered by the Monthly Fee.
6.8
Conditions Pertaining to Change of Residence
If you choose to move to a different Residence at The Cardinal, transfer to The Cardinal Health Center, or
move out of The Cardinal, the cost of refurbishment of your former Residence that is over and above normal
wear and tear may be assessed to you. This determination will be made by the Community following a
thorough inspection of the Residence after you have moved. The moving costs associated with any move will
be your sole responsibility.
6.9
Required Relocation
You may be required to relocate to a Health Center apartment at The Cardinal or an outside facility, as
appropriate, if any of the following exists as determined by the Community Care Management Team, in
consultation with you, your physician, and/or your representative:
1.
2.
3.
5.
6.
7
Your continued occupancy of your Residence endangers your health, safety, or well-being or
that of another person and your needs require that you be relocated to protect your own health
or safety or that of other Residents;
You require care that cannot lawfully be provided in your Residence, an available Health
Center apartment, or that The Cardinal is unable to or does not routinely provide;
Your needs cannot be met at The Cardinal for reasons such as design or staffing or the
program of services offered at the Community;
You exhibit behavior that endangers you or threatens the safety or well-being of other
Residents, violates the Community's rules, regulations, policies and procedures for living in a
retirement communal setting and creates an unreasonable and continuing disturbance of the
peaceful enjoyment of The Cardinal by other Residents, or you are generally unable to
benefit from the program of services available at The Cardinal; Your mental or physical
condition is such that your continued occupancy of your Residence or Health Center
apartment would be unlawful, or The Cardinal determines that your continued occupancy
would present an unreasonable risk of injury to yourself or to The Cardinal; or
Your personal physician has determined that you require services and care not available at
The Cardinal.
TERMINATION AND REFUNDS
7.1 Termination Due to Death or Other Cause Prior to Occupancy
If you die before occupying your Residence, or if, on account of an illness, injury, or incapacity that
occurs prior to occupying your Residence, you would be precluded from occupying your Residence
under the terms of this Agreement, this Agreement will be automatically canceled. In that case, The
Cardinal will pay you or your estate a refund of your Deposit and any pre-paid fees; less any costs
IndependentLivingResidenceAgreement4.21.2016
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specifically incurred by The Cardinal at your request as set forth in writing and signed by you. In
addition, you will not be entitled to receive any interest earned on monies paid to The Cardinal.
Your estate will receive the refund within thirty (30) days from the date notice of death is received
by the Community. If you executed this Agreement with another Resident, this Agreement will
remain in effect with respect to the surviving Resident regarding payment of any refund.
7.2
Cancellation Period/Refund Before or After Occupancy
7.2.1 Cancellation by You. You many cancel this Agreement with or without cause during
the Cancellation (or Rescission) Period. The Rescission Period is thirty (30) days following
the later of the execution of the Agreement or the receipt of a Disclosure Statement that
meets the requirements of this section, and the resident to whom the contract pertains is not
required to move into the facility before the expiration of the 30 day period. You must
provide written notice of such cancellation decision within the Cancellation Period. In the
event of such cancellation, you shall be entitled to a refund of monies paid to The Cardinal
except that The Cardinal shall deduct from your refund (a) the portion of the Monthly Fee
applicable to the period in which you actually occupied your Residence, if any, (b) the
reasonable value of any ancillary services and accommodations rendered to you by The
Cardinal applicable to the period in which you actually occupied your Residence; (c) any
other costs specifically incurred by The Cardinal at your request as set forth in writing and
signed by you; and (c) a service charge in the amount of one thousand dollars ($1,000.00) to
cover the costs of processing your application, the lost business opportunity, marketing
costs, carrying costs for a vacant Residence, and other damages suffered by The Cardinal
resulting from your cancellation. In addition, you will not be entitled to receive any interest
earned on monies paid to The Cardinal. You will receive the refund within thirty (30) days
after the date of your written notice of cancellation, except that if you moved into your
Residence you shall receive the refund within thirty (30) days after you have made the
Residence Unit Ready. You must make your Residence Unit Ready to The Cardinal as
described above within twenty (20) days after the date of the written notice of cancellation.
7.2.2 Cancellation by The Cardinal. The Cardinal may cancel this Agreement, with or
without cause, upon written notice within the Cancellation Period. In the event of such
cancellation, you shall be entitled to a refund of monies paid to The Cardinal except that The
Cardinal shall deduct from your refund (a) the portion of the Monthly Fee applicable to the
period in which you actually occupied your Residence, if any, and (b) the reasonable value of
any ancillary services and accommodations rendered to you by The Cardinal applicable to the
period in which you actually occupied your Residence; (c) any other costs specifically
incurred by The Cardinal at your request as set forth in writing and signed by you. In addition,
you will not be entitled to receive any interest earned on monies paid to The Cardinal. You
will receive the refund within thirty (30) days after the date of The Cardinal’s written notice
of cancellation, except that if you moved into your Residence you shall receive the refund
within thirty (30) days after you make your Residence Unit Ready to The Cardinal. You must
make your Residence Unit Ready to The Cardinal within twenty (20) days after the date of the
written notice of cancellation.
7.3
Death of Resident After Cancellation Period
This Agreement will terminate if you die after the thirty (30) day Cancellation Period. In that case,
subject to Section 7.6, The Cardinal will pay a refund to your estate only if The Cardinal has already
received Monthly Fees with respect to the period after the date your Residence is Unit Ready, and in
IndependentLivingResidenceAgreement4.21.2016
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such case the refund will be equal to the pro rata portion of any such Monthly Fees applicable to
periods following the date your Residence is made Unit Ready. No portion of your Deposit will be
refunded. Your payment obligations will continue until your Residence is Unit Ready. If you
executed this Agreement with another Resident, this Agreement will remain in effect with respect to
the surviving Resident, and the Monthly Fee will adjust to the then current single-occupancy rate for
the Residence.
7.4
Termination by Resident After Cancellation Period/Refund. You may terminate this
Agreement at any time after the Cancellation Period by giving The Cardinal thirty (30) days written
notice, unless a shorter notice period is mutually agreed to in writing. If you terminate this
Agreement during the initial thirteen (13) month term (except by reason of your death or permanent
transfer to the Health Center), you will be responsible for all Monthly Fees for the entire initial
thirteen (13) month term. If you terminate this Agreement after the initial thirteen (13) month term,
then until the effective termination date or the date you make your Residence Unit Ready, whichever
is later, you will pay the established Monthly Fee and other charges for accommodations and services
performed by The Cardinal. You will also be responsible for the charges described in Section 7.6.
After the Cancellation Period, one half of the Deposit will be applied to the Monthly Fee for your
first month, and the remaining half of the Deposit will become the property of The Cardinal and will
not be refundable for any reason.
7.5
Termination by The Cardinal After Cancellation Period
7.5.1 The Cardinal may terminate this Agreement at any time after the Cancellation Period for
good cause, upon giving you thirty (30) days written notice. You must vacate the Residence
by the end of such thirty day notice period. During the period from the date of notice to the
date you make your Residence Unit Ready, you will pay the established Monthly Fee and
other charges for accommodations and services performed by The Cardinal. You will also be
responsible for the charges described in Section 7.6. In case of a termination after the
Cancellation Period, one half of the Deposit will be applied to the Monthly Fee for your first
month, and the remaining half of the Deposit will become the property of The Cardinal and
will not be refundable for any reason. Good cause shall include, but not be limited to, the
following:
a.
Your failure to perform any of your obligations under this Agreement, including your
obligation to pay your Monthly Fee and other charges;
b.
You, your guest’s, or Home Care/Personal Service Provider failure to abide by the
rules, regulations, policies and procedures of The Cardinal, described in the Resident
Handbook or in such other documents or publications as may be provided from timeto-time, as they now exist or as they may later be amended by the Cardinal in its sole
discretion;
c.
Any material omission or misstatement in your Application For Residency, your
Reservation Agreement and any and all other documents filed with The Cardinal by
you or on your behalf;
d.
Your behavior creates an unreasonable and continuing disturbance within the
Community that is detrimental to the health, safety or peaceful enjoyment of others;
e.
You have needs that cannot be met at The Cardinal for reasons such as licensing,
design or staffing, or a condition that cannot be accommodated at The Cardinal as
determined by the Community or as defined by licensing regulations;
f.
You refuse to relocate for appropriate care in accordance with Section 6.9 or accept
services and care required in order for the Community to meet your needs;
IndependentLivingResidenceAgreement4.21.2016
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g.
h.
Your mental or physical condition is such that your continued occupancy of your
Residence or Health Center apartment would be unlawful, or The Cardinal determines
that your continued occupancy would present an unreasonable risk of injury to
yourself or to The Cardinal; or
Your permanent relocation (or the permanent relocation of both of you, if you are a
couple) from The Cardinal premises.
7.6 Payment Obligations Upon Termination
You will not be entitled to any refund of your Deposit upon termination of this Agreement. The
Cardinal will pay a refund to you or your estate only if The Cardinal has already received Monthly
Fees with respect to the period after the date your Residence is Unit Ready, and in such case the
refund will be equal to the pro rata portion of any such Monthly Fees applicable to periods
following the date your Residence is made Unit Ready. You must pay, and The Cardinal will deduct
from any refund owed to you under this Section 7: (a) all unpaid Monthly Fees and charges you
incurred for ancillary goods and services, including any applicable late charges and interest; (b) the
cost (if any) of restoring your Residence to its original clean condition (excluding normal wear and
tear); (c) any other costs specifically incurred by The Cardinal at your request as set forth in writing
and signed by you; and (d) any costs incurred by The Cardinal in preparing your Residence for
residency or for any other purpose Your indemnification obligation reflected in Section 10.8
survives the termination of this Agreement.
8
RIGHTS OF RESIDENTS
8.1
No Real Property Interest
Your rights under this Agreement do not include any proprietary interests in the properties or assets
of The Cardinal or in any fees once paid to The Cardinal. You shall have no estate, leasehold, or
other real property interest in your Residence or in The Cardinal, and you shall have no ownership
or management interest in The Cardinal or in any third-party contractor. You may not lease your
Residence to any other person or allow any person to occupy it in your place. All fees paid by you
to The Cardinal, including the Deposit, shall become the sole property of The Cardinal. These fees
are not held in trust for your benefit. All fees paid by you to The Cardinal, including Deposit, may
be used by The Cardinal for any purpose.
8.2
Subordination of Rights
You understand and agree that your rights under this Agreement are and will be subordinate to the
rights of a secured lender under any mortgage, deed of trust, or other senior security interest that is
placed on The Cardinal property, now or in the future.
9
RESIDENT RECORDS
You consent to the release of your personal and medical records maintained by The Cardinal for
treatment, payment and operations as determined reasonably necessary by The Cardinal. Any such
release may be to its employees, agents and to other health care providers from whom you receive
services, to third-party payers of health care services, to any Managed Care Organization in which
you may be enrolled, or to others deemed reasonably necessary by The Cardinal for purposes of
treatment, payment and operations. Release of records for other purposes shall be done in
accordance with applicable law, with a specific authorization from you, where required. Authorized
agents of the state or federal government, including the Long Term Care Ombudsman, may obtain
IndependentLivingResidenceAgreement4.21.2016
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your records without your written consent or authorization.
10
MISCELLANEOUS
10.1 Resident Advisory Council
You are encouraged to participate in the Resident Advisory Council at The Cardinal to discuss and
make suggestions regarding any program at The Cardinal. However, you understand and agree that
the Resident Advisory Council is advisory only and that neither it nor you shall have any right to
manage or determine policy at The Cardinal.
10.2 Rules, Regulations, Policies and Procedures/Resident Handbook
You agree to be bound by the general rules, regulations, policies and procedures of The Cardinal
contained within the Resident Handbook or in such other documents or publications, as they now
exist or as it may later be amended by The Cardinal in its sole discretion. The Resident Handbook
should not be construed as a contract. It does not grant any contractual rights to Residents. The
Cardinal may, in its sole discretion, amend the Resident Handbook from time to time. By signing
this Agreement, you hereby acknowledge receipt of a copy of the current Resident Handbook. You
agree to use and occupy your Residence solely as your residence and to maintain it in a clean and
orderly manner and in compliance with all applicable governmental requirements, including all
public and health and police regulations, to the full extent permitted by law. You understand that
failure to abide by such rules and regulations may result in termination of this Agreement. You
agree not to: permit another person to reside in your Residence without our prior approval; use or
operate any equipment or machinery or engage in any conduct that is harmful to your Residence,
other property of The Cardinal or residents or associates of The Cardinal, or is disturbing to other
residents; engage in any commercial activity at The Cardinal; employ any person in or about your
Residence whose employment may create a liability on our part; or hire any of our associates to
perform any services at The Cardinal without our consent.
10.3 Power of Attorney
You agree to make reasonable advance arrangements in the event of your death or incompetence.
You may want to assign a Durable Power of Attorney (POA) for Health Care and financial
decision-making and we encourage you to seek appropriate professional or legal advice regarding
your options. If you have assigned Power of Attorney, the individual(s) agree to sign this
Agreement along with any Guarantor as set forth in Section 10.20. Copies of documents regarding
assignment of a Durable Power of Attorney will be provided to The Cardinal.
10.4 Resident’s Financial Condition
You have completed Confidential Financial and Health Information contained in the Application for
Residency, and demonstrated therein to the satisfaction of The Cardinal that you have the financial
ability to pay the Deposit, Monthly Fee, other expenses associated with your residency and receipt
of services at the Community, and expenses as may be incurred by you in The Cardinal Health
Center. You agree that your financial condition is substantially the same on the date this Agreement
is executed, as it was on the date of the most recent financial statement provided to The Cardinal.
10.5 Residency Documents
You have submitted your Application for Residency and your Reservation Agreement which are
incorporated by reference into this Agreement and made an express part of it. You warrant that all
information contained in these documents is true and correct, and you understand that The Cardinal
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has relied on this information in accepting you for residency at The Cardinal. You further understand
that the submission of false information shall constitute grounds for the termination of this
Agreement.
10.6.1 Other Residents or Non-Residents
The Cardinal may enter into agreements with other Residents or non-Residents that may contain
terms different from those contained in this Agreement. Despite such differences, this Agreement
alone sets forth your rights and obligations with respect to your care and residence at The Cardinal.
10.6.2 No Assignment
Your rights and privileges to use and enjoy your Residence and services of the Community are
personal, and may not be transferred or assigned by you, by any proceeding at law or otherwise.
10.8 Liability and Property Matters
10.8.1 Liability in General. You accept full responsibility for any injury or damage caused to
others, or suffered by you, as a result of your own acts or omissions, and those of your guests
or invitees, and you shall indemnify and hold harmless The Cardinal and its respective
directors, agents, and employees (also referred to as associates) from any and all liability for
such injury or damage, including attorneys’ fees. We recommend that you maintain general
liability insurance in an amount and form sufficient to cover such liability. You may be
required to maintain additional insurance for Home Care/ Personal Service Providers hired by
you, including worker’s compensation insurance, if and to the extent set forth in The
Cardinal’s policies and procedures.
10.8.2 Third Party Liability. If you are injured as the result of an act or omission of a third
party, you hereby grant the Community a lien on any judgment, settlement, or recovery in the
amount of any expense incurred by The Cardinal in caring for you as the result of such injury
that is not reimbursed directly to the Community by you or by another source. You agree to
cooperate in the diligent prosecution of any claim or action against the third party.
10.8.3 Property Damage. The Cardinal shall not be responsible for the loss of any property
belonging to you due to theft, fire, water damage, or any cause beyond the control of The
Cardinal, including property placed in your storage area, if any, Residence, or on the
Community property. The Community strongly encourages you to obtain insurance protection
to cover the full replacement value of your personal property. You shall also be responsible for
any loss or damage that you or your guests cause to property at The Cardinal, excluding
ordinary wear and tear. You hereby agree to indemnify and reimburse the Community for any
loss or damage suffered by the Community as a result of your or your guests’ or invitees’
carelessness or negligence.
10.8.4 Removal and Storage. The Cardinal shall have the right, to remove promptly and store
property from your Residence, at your expense or at the expense of your estate, when you have
vacated your Residence on a permanent basis (for example, upon termination of this
Agreement, permanent relocation, or death). The Cardinal shall not be liable for any damages
to your property while the property is in storage. If your property is not removed from storage
within sixty (60) days, The Cardinal shall dispose of your property. You or your estate shall be
obligated to pay all costs for the removal or disposal of your property.
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10.8.5 Keys and Locks. The Cardinal shall provide you with a set of keys or electronic key
fobs or cards to access your Residence and the common areas within The Cardinal. If you
wish to make a duplicate of a key, the key must be duplicated through services provided by
the Community. You are prohibited from distributing a key or a duplicate of a key to anyone
without first obtaining the Community’s approval. Upon its approval, the key to be distributed
to an individual identified by you must be registered with the Community. The Cardinal shall
not be responsible for any loss, damage or theft of any personal property belonging to you,
your estate or your guests as a result of the duplication of your key(s). You agree not to install
additional locks or gates on any doors or windows of the Residence without The Cardinal’s
express written consent. If the Community approves your request to install such locks, you
shall provide Community management with a key to each lock. Upon termination, you agree
to return all keys, key fobs, access cards, and other access devices for the Residence and the
common areas within The Cardinal.
10.9 Right of Entry
Except in the case of emergencies, The Cardinal will attempt to contact you before entering your
Residence. You agree that the Community associates and agents shall have the right to enter your
Residence at reasonable times to perform the services described in this Agreement, for management
purposes, any other reasonable purpose, and at any time for enforcement of applicable laws and
regulations and emergency purposes.
10.10 Relationships Between Residents and Associates
The Cardinal instructs the Community associates to be cordial and helpful to Residents. The
relationship between Residents and associates should at all times remain professional. Associates
must not be delayed or deterred by Residents in the performance of their duties. The supervision of
associates comes from the Community supervisors and not from Residents. Any complaints about
associates or requests for special assistance must be made to the appropriate supervisor or to the
Executive Director. Giving gratuities or bequests to associates or associate’s families is not permitted
under any circumstances. You agree not to hire The Cardinal associates or solicit such associates to
resign to work for you without the prior written consent of the Community to such arrangement. You
agree not to hire any former Community associate without the written consent of The Cardinal.
10.11 Waiver
The failure of The Cardinal in any instance or instances to insist upon your strict performance or
observation of, or compliance with, any of the terms or provisions of this Agreement, shall not be
construed to be a waiver or relinquishment of its right to insist upon your strict compliance with all of
the terms and provisions of this Agreement.
In addition, acceptance by the Community of any payment from you after your breach of any term of
this Agreement or after providing you with a notice of termination shall not constitute a waiver of the
right of The Cardinal to insist upon full performance of all terms of this Agreement, nor shall it waive
the Community’s right to terminate this Agreement for any cause, including any breach previously
committed.
10.12 Notices
All notices given under this Agreement shall be in writing and shall be addressed to the management.
Such notices shall be effective when personally delivered to the management or when deposited in
the United States first class mail, provided that they are properly addressed with postage prepaid. The
address for notices follows:
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Executive Director
c/o The Cardinal at North Hills, LLC
4030 Cardinal at North Hills Street
Raleigh, North Carolina 27609
10.13 Entire Agreement
This Agreement, its attachments, documents incorporated by reference, and all of your Application
for Residency documents constitute the entire agreement between you and The Cardinal and may be
amended only by a written instrument signed by you or your legal representative and by an
authorized representative of The Cardinal. If you relocate to Health Center, you will sign an Assisted
Living Residence and Care Agreement or Skilled Nursing Residence and Care Agreement, as
applicable, which will contain additional terms relating to your occupancy of a Health Center
apartment, and such agreements do not constitute amendments to this Agreement. The invalidity of
any part of this Agreement shall not affect in any way the validity of the remainder of this
Agreement. Oral representations and agreements are not binding on The Cardinal and you
acknowledge that you are not relying on any oral representations or agreements made by any person
representing or purporting to represent The Cardinal.
10.14 Governing Law
This agreement shall be governed by the laws of the State of North Carolina.
10.15 Severability
If any provision of this Agreement is determined by a judicial or administrative tribunal of proper
jurisdiction to be invalid or unenforceable, such provision shall be severed from the Agreement and
the balance of this Agreement shall remain in full force and effect.
10.16 Consent to Assignment
You consent to the collateral or other assignment by The Cardinal of its right, title and interest in this
Agreement.
10.17 Smoking
The Cardinal is a smoke-free Community. Accordingly, smoking is not permitted in any indoor
public space or outdoor common areas at any time. Smoking is not permitted in your individual
Residence or on the patio.
10.18 Obligations Concerning Firearms
The Cardinal does not permit firearms or weapons on its premises.
10.19 Motor Vehicle Operating Privileges
You shall operate a motor vehicle in accordance with The Cardinal’s rules, regulations, policies and
procedures which are reflected in the Resident Handbook and which include, but are not limited to,
legal speed limits and safe driving procedures and practices. The Cardinal reserves the right to revoke
your driving and parking privileges on its property if you do not abide by the applicable rules,
regulations, policies and procedures.
10.20 Legal Representative, Responsible Parties and Guarantors
10.20.1 Legal Representative. A Legal Representative is an individual who has authority to
act on the Resident's behalf, under independent legal authority. Examples of a Legal
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Representative include a guardian, a conservator, or the holder of a Durable Power of
Attorney executed by the Resident. Documents evidencing a person's Legal Representative
status must be provided to us. If a Resident has a court appointed guardian or conservator, the
guardian or conservator is required to sign this Agreement.
10.20.2 Responsible Party. A Responsible Party is an individual who voluntarily agrees to
honor certain specified obligations of the Resident under this Agreement without incurring
any personal financial liability. Examples of a Responsible Party include a relative or a friend
of the Resident. We will require a person to sign this Agreement as a Responsible Party if the
person has legal access to or physical control of the Resident's income or resources to pay for
the care and services we provide and others that you request. We may decline to admit any
Resident who has no source of payment for all or part of the Resident's stay.
10.20.3 Guarantor. A Guarantor is an individual who has agreed to be personally liable to
pay for all amounts you owe to The Cardinal. A Responsible Party or Legal Representative is
not a Guarantor unless the person serving as Responsible Party or Legal Representative also
executes this Agreement as a Guarantor. If there is a Guarantor, you agree immediately to
give The Cardinal Health Center written notice of any change in the Guarantor's financial
condition, address, or telephone number. By signing below, Guarantor agrees promptly to pay
all fees and charges incurred by you or on your behalf under this Agreement. The foregoing
is a guaranty of payment and not of collection, and The Cardinal shall have no obligation to
file suit or obtain a judgment against you prior to enforcing its rights against the Guarantor.
10.20.4 Rights and Obligations of a Legal Representative and Responsible Party under
this Agreement:
a) If you sign this Agreement as a Legal Representative or Responsible Party, you incur no
personal financial liability by doing so.
b) If you sign this Agreement as a Legal Representative or Responsible Party, you agree to
use the Resident's available income and resources to pay for the Resident's care and
services.
c) By signing this Agreement as a Legal Representative or Responsible Party, you also agree
to apply for benefits to which the Resident may be entitled and to furnish third party
payers with information and documentation concerning the Resident which reasonably is
available to you and which is necessary to the processing of the Resident's application for
third party payor benefits.
10.21 Voluntary Arbitration
BOTH PARTIES UNDERSTAND THAT AGREEING TO ARBITRATION IS NOT A
CONDITION OF YOUR MOVE-IN TO THE CARDINAL. By initialing the line at the end of this
Section, however, you agree that any and all claims and disputes arising from or related to this
Agreement or to your residency, care or services at The Cardinal, whether made against us or any
other individual or entity, shall be resolved by submission to neutral, binding arbitration; except that
any claim or dispute involving summary ejectment proceedings (eviction) or any claims that are
brought in small claims court shall not be subject to arbitration unless all parties involved agree to
arbitrate such proceedings. Both parties give up their constitutional rights to have any such dispute
decided in a court of law before a jury, and instead accept the use of arbitration. You may withdraw
your agreement to arbitrate within thirty (30) days after signing this agreement by giving us your
notice of withdrawal. Arbitrations shall be administered by the National Arbitration Forum under the
IndependentLivingResidenceAgreement4.21.2016
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Code of Procedure then in effect. Arbitrations shall be conducted by a single arbitrator selected in
accordance with the Federal Arbitration Act unless otherwise mutually agreed. Arbitrations will be
held at an agreed upon location, or in the absence of such agreement, at the Community. The
arbitrator’s fee shall be shared equally by the Parties. Any award by the arbitrator may be entered as a
judgment in any court having jurisdiction. In reaching a decision, the arbitrator shall prepare findings
of fact and conclusions of law. Each party shall bear its own costs and fees in connection with the
arbitration. You have the right to be represented by legal counsel in any proceedings initiated under
this arbitration provision. Because this arbitration provision addresses important legal rights, the
Cardinal encourages and recommends that you obtain the advice and assistance of legal counsel to
review the legal significance of this voluntary arbitration provision prior to signing this Agreement.
This arbitration clause binds all parties to this Agreement and their spouse, heirs, representatives,
executors, administrators, successors, and assigns, as applicable. After termination of this Agreement,
this arbitration clause shall remain in effect for the resolution of all claims and disputes that are
unresolved as of that date. If any part of this Arbitration clause is determined to be unenforceable, the
remaining portions of the clause shall remain valid and shall be enforced by the Parties. I have read
and understand the effect of this agreement to arbitrate and understand I have relinquished certain
legal rights, including the right to a jury trial, by agreeing to arbitrate.
Resident’s initials _________
Resident’s initials __________
POA/ Guarantors initials _____
By initialing the line at the end of this paragraph, you understand that you have the right to rescind
your agreement to arbitration within thirty (30) days from the date you sign this Agreement by
making such rescission in a writing signed by you and delivered to The Cardinal within thirty (30)
days from the date you sign this Agreement.
Resident’s initials __________
Resident’s initials __________
POA/Guarantors initials _________
11
Reading and Signing of Agreement
By signing this Agreement, below I the Resident represent that I have read and agree to all of the terms of
this agreement.
RESIDENT(S)
______________________________
Date
_____________________________
Resident
______________________________
Date
_____________________________
Resident
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THE CARDINAL AT NORTH HILLS, LLC
By: _________________________________
Its: _________________________________
Date: _______________________________
By signing below, the undersigned Guarantor hereby agrees to be fully and personally
liable for, and agrees to pay promptly upon request, all amounts owed to The Cardinal by
the Resident. The undersigned agrees that The Cardinal shall not be obligated to pursue
any legal action or obtain any judgment against the Resident or the Resident’s assets as a
condition to requiring payment by Guarantor.
GUARANTOR:
____________________________________
Signature
_______________________________
Printed Name
_________________________________________________________________________
Address
____________________________________
Phone Number
_______________________________
Date
POWER OF ATTORNEY:
____________________________________
Signature
_______________________________
Printed Name
_________________________________________________________________________
Address
____________________________________
Phone Number
IndependentLivingResidenceAgreement4.21.2016
_______________________________
Date
Page26
Appendix A Acknowledgement
The undersigned acknowledge receipt of the schedule of Fees for Optional Services:
______________________________________
Resident Signature
____________________________
Date
______________________________________
Resident/Responsible Party Signature
____________________________
Date
______________________________________
Community Representative Signature
____________________________
Date
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Exhibit F
The Cardinal at North Hills
Resident Handbook
Resident Handbook
Resident Handbook May 2016
Page 1 of 31
VISION, MISSION, AND PRINCIPLES,
VALUES AND BELIEFS
Vision Statement
We create communities where we share passions, live in
balance, and build a legacy.
Mission Statement
Making a Difference Every DaySM
Statement of Principles, Values and Beliefs
We are committed to exemplary service delivered with integrity, dignity, and
compassion. Our communities for seniors are distinguished by warm, secure and
friendly environments.
We will enhance each Resident's lifestyle by:
 Responding immediately to Residents' needs and concerns
 Offering high quality, creatively designed programs
 Encouraging independence
 Promoting a sense of community and friendship
We the staff are committed to:
 Teamwork
 Being professional
 Open communication
 Fostering a learning environment
 Continuous improvement
 Profitability
We live by a standard of conduct which encompasses honesty, accountability,
personal development and a passion for excellence.
Resident Handbook May 2016
Page 2 of 31
TABLE OF CONTENTS
1
INTRODUCTION
2
RESIDENT ASSOCIATION
3 THE COMMUNITY MANAGEMENT TEAM
4 GENERAL INFORMATION
Additional Resident Convenience Services
4.4
Resident Guests
4.5
Amenities and Furnishings
4.6
Wellness / Fitness Center
4.7
Pool and Spa Services
4.8
Locks and Keys
4.9
Absences
4.10
Personal Service Provider or Home Care Services
6.1
Maintenance
6.2
Housekeeping
6.3
Safety
6.4
Community Services
Dining Services
8 HEALTH CARE SERVICES
4.3
7.1
Resident Information Services
7 DINING SERVICES
4.2
6 RESIDENT SERVICES
General Policies
5 PAYMENT OF MONTHLY FEES
4.1
8.1
Medical Assistance
8.2
Services
8.3
Move-in to Assisted Living / Memory Care
9 COMMUNITY SERVICE
10 CONCLUSION
Resident Handbook May 2016
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Section 1
Introduction
KISCO SENIOR LIVING
For over 25 years, we have specialized in developing and managing full service senior living communities
that provide an enriched lifestyle. In 1996, we created our guiding principles, values and beliefs, which are
based on the concepts of integrity, dignity and compassion. These principles balance the interests of our
Residents, associates and business partners. To this day, they form the basis for how we operate as a
company.
We cherish the uniqueness of each of our Kisco communities and the contributions they make to create a
great place to live for Residents and a great place to work for associates. We continually share best practices,
successes, and learning so we can refine and bring innovation to our ongoing operations and future
communities. We are an enduring, sustainable company that provides opportunities and services to meet the
changing needs of our customers and their families.
THE ART OF LIVING WELLSM
Kisco Senior Living embraces the Art of Living WellSM philosophy as part of every aspect of
community life. Wellness is truly a combination of all six dimensions (emotional, intellectual, physical,
social, spiritual and vocational). We focus on the six dimensions of wellness as the driving force behind
our comprehensive wellness program. The Community is a place for you to celebrate your individuality
and enhance your sense of belonging. We hope you will build new relationships, share your passions and
create your legacy at The Cardinal.
COMMUNITY LIFESTYLE & AMENITIES
The Cardinal Clubhouse - Residents gather to socialize, learn, entertain others and be
entertained, dine or just relax.
Wellness Center - Fitness Center, pool, spa, yoga and other classes massage and showers. State of the art
instructors, equipment and professional fitness/wellness team.
Gardens & Fitness Paths – A number of walking/fitness paths and gardens for outdoor living and activities.
Resident Library – The library features computer stations, wifi and a range of resident selected news,
reference and reading materials.
Multi-Purpose – Indoor, outdoor area for events, presentations, lectures and spiritual services. This area
will be equipped with multimedia projection and surround sound capabilities.
Resident Handbook May 2016
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Section 2
Resident Association
All Residents of The Cardinal will be members of the Resident Association. The Association will be run by
the Residents.
Meetings will be held on a frequent basis as a forum for comments, concerns,
compliments, community updates and to promote activities of interest. The Resident Association input to
the management is advisory in nature. The Resident Association will elect its own officers, to form a
Resident Advisory Committee. The Executive Director of The Cardinal may assist the Residents in
developing and organizing the Resident Council.
RESIDENT COMMITTEES
The Resident Association is anticipated to have active Resident committees. Examples include;
 Building & Grounds
 Dining Services
 Events/ Programs
 Associate Appreciation
 Library
We believe that effective communication between Residents and the Community Management Team is an
important contributor to a community’s success. The Community Management Team has an open door
policy and will provide to Residents the scheduled meetings and forums as an opportunity to express their
opinions and suggestions.
Examples may include:
 Resident Forums with Executive Director
 Food Forum with Dining Services
 New Resident Orientation
Resident Handbook May 2016
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Section 3
The Community Management Team
The Management Company shall be responsible for all duties and responsibilities relating to the
management and day-to-day operations of The Cardinal. These duties and responsibilities include the
following employment of the Executive Director and a Community Management Team (Department Heads)
essential to the start-up and ongoing operation of The Cardinal.
Resident Input and Communications
We are committed to open communication and being responsive to Resident’s needs and concerns. We
encourage our Residents to convey their ideas, concerns and compliments to the Community Management
Team. The channels are:

Residents may direct specific questions regarding any services to the Community
Management Team.

Residents may contact the Executive Director on any matter concerning any aspect of life at
The Cardinal.

Residents may contact an officer of the Resident Association Advisory Committee concerning any
aspect of inter- Resident relations, or The Cardinal policies governing Resident activities.

Residents may make suggestions or ask questions, through Comment and Concern program.
Forms may be obtained from the Customer Service representative or on-line. The Comment and
Concern program provides for a written response by the Executive Director, appropriate team
resident, or, at the discretion of the Executive Director, the Resident Association.
Resident Handbook May 2016
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Section 4
General Information
4.1
GENERAL POLICIES
The following policies have been adopted by The Cardinal:
4.1.1
Insurance
The Cardinal will maintain insurance on all property owned by The Cardinal against
reasonable losses and liabilities. Residents are encouraged to purchase personal liability and
personal property insurance similar to a "renter's" policy.
4.1.2
Electric Scooters
Any Resident needing an electric scooter inside the buildings of The Cardinal must submit a
written request to the Executive Director with a statement from a physician to confirm that the
scooter is required.
For safety reasons, Residents will be required to demonstrate their ability to operate the
scooter in accordance with procedures established by the Community. Maximum speed
control governors are required and will be set by The Cardinal. Residents shall pay for
installation of the governor if scooter isn’t already equipped. Scooters should be driven at a
speed which does not exceed a normal walking pace for most Residents. Please contact the
Resident Relations Director before operating a scooter on campus.
In the Dining Venues, a Resident using a scooter is encouraged to transfer from the
scooter into a dining room chair.
To prevent blocking hallways and other common areas, scooters may not be parked in the
corridors or near any emergency exits or in heavily traveled areas of the buildings.
The recharging of scooters is the responsibility of the Resident, and the Resident is
responsible for any damage due to battery leaks or other malfunctions.
Scooters may not exceed a maximum size of 46 inches in length and 24 inches in width. In
addition a governor to control speed and an audible back up device are required for your
safety and the safety of others.
4.1.3
Wheelchairs
In order to achieve independence, some Residents may require the use of wheelchairs. In
the Dining Venues, a Resident is encouraged to transfer from a wheelchair into a
comfortable dining room chair.
Resident Handbook May 2016
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For those Residents or guests who occasionally need a wheelchair for use while in The
Cardinal buildings, if available, one may be obtained by contacting a Customer Service
associate.
4.1.4
Tipping
The Cardinal is committed to providing high quality, consistent and equal service to all
Residents. Because of its potential for compromising this goal, tipping any associate of the
Community is prohibited. Tipping is broadly defined to include not only monetary gifts
but also any gifts of personal items such as clothing, jewelry, furniture, appliances, etc.
An Associate Appreciation Fund may be established and managed by the Resident
Association to provide recognition of all associates. This fund is an annual voluntary
contribution given to show appreciation for the services that associates provide. We also
have other recognition programs that acknowledge associates who have provided exemplary
services. Please share your appreciation of respective associates with the Executive Director
and the associate will be rewarded in accordance with The Cardinal’s Associate Rewards and
Recognition programs.
4.1.5
Hiring Outside Services by Residents
Residents are not permitted to directly hire current associates of The Cardinal to perform
work during the associates' off-duty hours. Former associates of The Cardinal are not
permitted to return to The Cardinal to perform work directly for The Cardinal Residents as
independent contractors for at least six months following their departure from The Cardinal
and must have approval from the Executive Director.
It is the responsibility of the Resident to satisfy the following conditions prior to hiring any
individual or contractor to perform a service:





Receive prior written approval from The Cardinal.
Provide proof of acceptable workers' compensation and liability insurance.
Establish that the person to be hired has current local and state licenses, as
appropriate.
Criminal background screening.
Negative tuberculosis test or chest x-ray indicating free of communicable disease.
4.1.6
Appropriate Dress
Residents are requested to be appropriately dressed while using the public areas of The
Cardinal. The Executive Director, with input from the Resident Association, will
determine the dress code for Residents in all Public areas, dining venues or other public
activity spaces.
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4.1.7
Smoking
To promote the health, safety and wellbeing of all Residents, The Cardinal is committed to
maintaining a smoke-free environment. Accordingly, smoking is not permitted in any
indoor or outdoor public space at any time. Smoking is not permitted in your individual
Residence or on the patio.
4.1.8
Barbecues
Outdoor barbecue equipment will be provided by The Cardinal in designated areas.
Cooking is not allowed on your patio or balcony.
4.1.9
Pets
We understand that having pets is an important part of your life. We welcome pets in our
independent living residences, but are unable to accommodate pets in our memory care
apartments, assisted living apartments, and nursing care apartments. Residents may have a
maximum of two dogs and/or cats in their Residence. Pets are not to exceed 35 pounds
without written permission by the Executive Director subject to the following conditions:
 The pet must be leashed at all times in common areas of the campus.
 Pet excrement must be immediately cleaned up by the Resident and placed in an
appropriate receptacle.
 All dogs must be licensed by and registered as required by the City and Wake
County of North Carolina and a copy of the license provided to The Cardinal.
 Residents must keep pet noise to a minimum.
 Pets are not allowed in public areas within The Cardinal with the exception of corridors
and elevators which must be utilized by the pet to go outdoors.
 All dogs must be registered with The Cardinal. At the time of pet registration,
owners must provide the name and telephone number of a designated person
who has agreed to take care of the pet during times when the owner may be
unavailable.
 All pet owners must sign an indemnification form relieving The Cardinal of liability
for damage to property or for an injury caused by a pet.
 All pet owners must agree to reimburse The Cardinal for damage and odor
elimination beyond reasonable wear and tear to The Cardinal property,
including Residence fixtures and carpeting, caused by the pet. A pet fee may be
collected for this purpose.
 All Resident pet owners agree to adjudication of complaints from other Residents by
The Cardinal management. All Resident pet owners agree that if their current pet
permanently departs The Cardinal, any replacement pet will have a size limitation not to
exceed 35 lbs. and subject to Manager approval.
 Residents wishing to bring a pet to The Cardinal other than those types listed above
must contact The Cardinal in advance for written approval.
 Residents wishing to take pets to the Health Center for a "visit" are encouraged to do
so, but only after making prior arrangements with the Executive Director or
designee.
Resident Handbook May 2016
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4.1.10
Parking
In order to maintain a safe environment for The Cardinal, please review and maintain the
guidelines outlined below:
A parking space is specifically assigned to a Residence and resident vehicle(s)
should be parked in the assigned space.
Guests should park in designated visitor spaces.
In the event of a violation of parking restrictions, a Cardinal associate will notify the violator
to correct the situation. If unable to make contact, and it is determined that a hazard exists,
the vehicle may be towed at the expense of the owner.
4.1.11
Guest Parking
Designated parking spaces are available for visitors and Residents should encourage their
guests to use them. Long term visitors should check in with the customer service
associate to receive a parking pass that should be displayed on the vehicle at all times.
Visitors are not allowed to park in spaces assigned for Residents only.
Residents, associates and visitors are responsible for the condition of their vehicle. If a
vehicle damages The Cardinal, repairs and clean-up shall be at the vehicle owner’s expense.
The Cardinal is not responsible for damages to vehicles parked on the property.
4.1.12
Operation of Motor Vehicles
All vehicles must be operated in a safe manner when on The Cardinal property. Maximum
speed of any vehicle will be designated and posted signs should be obeyed. It is the vehicle
owner's responsibility to be properly insured for any risks associated with vehicle operation
or ownership.
4.2
RESIDENT INFORMATION SERVICES
Effective communication between The Cardinal Residents and management is essential to the
operational success of The Cardinal. In addition to the more formal lines of communication
outlined above, The Cardinal has established a number of informal communications vehicles for the
ease and convenience of Residents.
4.2.1
Customer Service Associate
Customer Service associates will be the primary point of contact for Independent Living
Resident concerns or information. There is a customer service representative on duty 24
hours a day 365 days a year. Health Care Residents should contact their nursing care
associate as primary point of contact for assistance.
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4.2.2
Resident Information Form
All Residents must have an up-to-date "Resident Information Form" on file with the main
office. All information will be kept confidential. The purpose of this form is to
provide basic information to be used in the event of an emergency. The Cardinal will
request that Resident Information Forms be updated periodically. Residents are urged to
contact the administration office to initiate a change whenever appropriate.
4.2.3
Resident Directory
A Resident Directory containing the telephone numbers, email addresses, and Residence
numbers of each Resident are published periodically by The Cardinal. To protect the
privacy of all Residents, this directory should be treated as confidential. All changes
necessary to this directory should be reported to The Cardinal.
Residents’ telephone numbers and email addresses will be listed in the directory unless a
Resident specifically requests in writing that this information be omitted. Residents may
also have their names and Residence numbers omitted if they prefer not to be listed in
the directory.
4.2.4
U.S. Postal Service
The U.S. Postal Service will pick up and deliver mail to the postal and message center. A
separate postal and message center is located in the Health Care Center for residents of
assisted living, memory care, and nursing care apartments.
Individual mailboxes are located in the postal and message center and a mail pick up
schedule will be posted.
The Customer Service associate will not accept items from the U.S. Postal Service and
commercial carriers, or parcels and letters that require signatures on behalf of the Resident
addressee unless the Resident has specifically requested in writing that this be done. The
Customer Service associate is not able to accept any C.O.D. packages, but will attempt to
notify a Resident at the time of delivery.
The Customer Service associate will notify a Resident of the presence of a letter or
package at the reception desk by placing a note in the Resident's internal communications
box, by email, or by telephone.
A Cardinal associate will assist a Resident in moving large or heavy packages to the
Residence when available. Arrangements for this service can be made through the
Customer Service representative.
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4.2.5
Non-U.S. Postal Distribution
The Executive Director or Designee must give prior approval for any distribution of notices
or flyers made by a Resident, group of Residents, or non-Resident.
4.2.6
Newspaper Delivery Service
Arrangements for receiving and paying for newspapers and magazines must be made
directly by the Resident.
4.2.7
Cable Television
"Basic" cable television is included in the Monthly Fee. "Premium" channels may be
contracted for by the Resident, and will be billed directly to the Resident by the authorized
cable provider. If you experience difficulty with your initial activation, please contact the
Resident Relations associate.
An "in-house" community information channel is provided for items such as daily dining
specials, scheduled events, Community updates, and emergency announcements.
4.2.8
Telephone Service
Residents are responsible for obtaining their individual telephone service. Residents can use
either their cell phone or can obtain local and long distance service from our preferred
carrier. This service will be added to your monthly statement as outlined in Appendix A of
your service agreement.
4.3
ADDITIONAL RESIDENT CONVENIENCE SERVICES
Please contact a Customer Service Representative if you have any questions or need assistance.
4.3.1
Clerical Services
Residents may desire certain business services from time to time. Examples of these services
are listed below. Facilities to handle these services may be available in the Business Center.
If you require assistance, please contact the Customer Service representative.
 Facsimile (Fax) Services
 Copier Services
 Notary Services
 Parcel service such as FedEx, UPS
An additional fee may apply to above services
Resident Handbook May 2016
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4.3.2
Salon
A beauty and barber salon will be located within The Cardinal. The salon is operated by an
independent business owner, not by The Cardinal. Operating hours and rates will be set
by the salon proprietor, and are subject to change without notice.
4.3.3
Lost and Found
The Cardinal will maintain all "found" property until either the owner is identified or
90 days have passed, after which time The Cardinal may dispose of the "found" property.
For "found" items deemed to have material value, The Cardinal may post a "found" notice
on the official bulletin board. For "lost" items, the Resident may prepare a "lost" notice
and present it to The Cardinal management for posting.
4.4
RESIDENT GUESTS
4.4.1
Overnight Guests in the Residence
Residents may have overnight guests in their Residence. When Residents have overnight
guests, they must notify the Customer Service desk for administrative and security purposes.
Special limitations may be placed on overnight guests in nursing care, assisted living, and
memory care apartments based on the Resident’s plan of care.
4.4.2
Length of Visit
A practical limitation must be placed on the length of a guest's stay in order that the facilities
rightfully belonging to all Residents are not abused. For this reason, guests should be
limited to a stay of no more than fourteen (14) days per year without the Resident obtaining
the prior approval of the Executive Director. Such approval will not be unreasonably
withheld if there are valid reasons for a stay. The impact to other residents will be
considered, and there may be special limitations for nursing care apartments.
4.4.3
Responsibility for Guests
The Resident should take special care to insure that guests follow the policies at The
Cardinal. Guests may participate in activities that are available to Residents. Guests may be
required to sign a waiver for certain activities.
4.4.4
Dining Privileges
Residents are welcome to have guests for meals offered in the Community dining venues.
The dining charges for guests may be deducted from Independent Living Resident’s dining
account or added to their monthly statement. Health Center residents can have guests meals
charged to their account.
Resident Handbook May 2016
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4.4.5
Guests under the Age of 16
Children are welcome as guests of a Resident. To respect the rights of all Residents, guests
under the age of sixteen (16) must be accompanied by the sponsoring Resident at all times
when using any of the public facilities at The Cardinal.
4.5
RESIDENCE AMENITIES AND FURNISHINGS
4.5.1
Modifications to a Residence
Modifications to the interior of a Residence requested by a Resident may be approved as
long as the modification complies with all applicable laws and building codes, including any
applicable health care laws and regulations, is structurally feasible, is consistent with the
Community architecture, and does not unduly inconvenience other Residents. The
requesting Resident must agree to pay for all installation costs of the modification prior to
work commencing, and may be responsible for any cost associated with returning the
Residence to its original condition upon vacancy.
All modifications must be approved in advance in writing by the Executive Director, at
which time a determination will be made as to whether the Resident is responsible for the
costs associated with returning the Residence to its original condition upon vacancy. If an
independent contractor is used by the Resident to perform the modifications, the
independent contractor must show that they are appropriately licensed and insured with both
liability and workers compensation insurance. A Modification Request Form is available
from the Customer Service representative for this purpose.
Nursing care apartments may not be modified.
4.5.2
Draperies/Curtains/Window Coverings
All Residences are furnished with building standard window blinds in accordance with the
interior design plan. Additional draperies or curtains for windows and doors may be
hung at the Resident's expense.
Draperies or curtains hung at a Resident's expense should comply with The Cardinal
guidelines and building codes, and, if applicable, health care laws and regulations.
4.5.3
Appliances and Fixtures - Substitutions
Substitutions of appliances and fixtures for those furnished by The Cardinal must be
requested in writing and approved in writing by the Executive Director prior to installation.
All substitutions of appliances and fixtures will be at the Resident's expense. Appliances
and fixtures provided by Residents must comply with all applicable laws and regulations.
Resident Handbook May 2016
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4.5.4
Floor Covering
The policy for substituting floor covering for materials provided by The Cardinal is the same
as that for substituting appliances or fixtures. The Cardinal must approve any non-standard
flooring specifications or substitutions.
All substituted floor coverings will remain the property of The Cardinal.
4.5.5
Painting of Residences - Routine
Painting of the interior of Residences will be done on a periodic basis as required using
standard colors. Priority for repainting of Residences will be determined by The Cardinal
and labor and material will be provided by The Cardinal.
Residents may choose a color or type of paint other than that provided by The Cardinal with
the written permission of the Executive Director, and will be required to pay for any
incremental increased cost of material or labor.
4.5.6
Replacement of Carpeting - Routine
Re-carpeting of Residences will be done as required based on normal wear and tear.
Residents may request a carpet change prior to this time at their expense.
Residents will have a choice of standard carpet colors from those offered by The Cardinal.
The cost of any upgraded or non-standard carpets will be borne by the Resident.
4.5.7
Repair of Appliances – Routine
Each time an appliance requires repair, the Executive Director, through past service records,
will determine (at The Cardinal’s discretion) the cost-effectiveness of repair versus
replacement and act accordingly.
4.5.8
Patio and Residence Exterior
Most independent living Residences have a patio for the use and enjoyment of the resident.
The patio is visible to other Residents, guests and prospective Residents of The Cardinal.
In order to maintain an appealing appearance, the following guidelines apply to each patio:
1. Appropriate furniture and small plants may be placed on the patio. Any unsightly
items such as signs, laundry, boxes, etc. should not be placed on the patio.
2. In order to comply with local fire safety requirements, no cooking (including any grills,
hibachis and/or barbecues) is permitted on the patio.
3. Be considerate of your neighbors below when watering plants or cleaning the patio. All
plants must have drain plates. Any bird feeders must be enclosed to capture bird seed. Bird
seed must not become a nuisance for your neighbors or attract pests.
4. Any additions of rails, enclosures, shades, awnings or nettings require written permission
from the Executive Director.
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4.6
WELLNESS / FITNESS CENTER
At The Cardinal we practice The Art of Living WellSM philosophy as part of everything we
do, from the programs we offer, to the services we provide. Wellness is truly the
combination of many factors that both strengthen and enhance the mind, body and spirit.
The Cardinal Clubhouse is the center for community connectivity including health and
wellness programs, socializing, neighborhood events, cultural and educational opportunities.
The Wellness/Fitness Center includes a heated swimming pool and spa area and includes
cardiovascular and strength training equipment. Classes, opportunities for life-long learning,
social outings, spiritual growth, community involvement, day and overnight trips are offered.
A calendar will be provided monthly and special events will be distributed / announced
through our in-house Community channel and notices distributed to Residents.
4.6.1
Classes and Events
Examples may include:
 Regularly scheduled fitness programs including aqua exercise, yoga, tai chi, meditation
and personal training
 Learning Center offering computer classes, second career and volunteer
opportunities, card games such as bridge, poker, mahjong and cribbage
 Art appreciation and painting classes
 Seminars – Current event forums, book reviews, cooking and guest speakers
 Excursions – Theater, overnight trips and special attractions
4.6.2
Fees
In addition to the events and programs provided, there are programs for which an additional
charge may apply. Such charges include, but are not limited to, off-site meals, theater
events, overnight trips and their relevant transportation costs of other special services.
Residents will be notified of the cost in advance.
4.6.3
Waivers
Some activities that involve strenuous activity or present special risks may require
participants to sign waivers of legal liability as a condition of participation.
4.7
POOL AND SPA SERVICES
The Cardinal’s pool is available for the use of residents and their invited guests. Various
classes are held year round. It is required that individuals shower before entering the
water and wear suitable swimming attire. Residents and guests use the pool “at their own
risk” as there is no lifeguard on duty.
Resident Handbook May 2016
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Consumption of food and drink is restricted to the pool deck area and is not allowed while
in the water. Glass containers are not allowed on the pool deck area. Residents are
cautioned that the pool depth is not appropriate for diving. Therefore, diving is prohibited.
Pool deck furniture is provided for the relaxation and enjoyment of residents and guests who
use the pool area.
Spa services will be available by appointment only. Call the Customer Service associate
for reservations and fee schedule.
4.8
LOCKS AND KEYS
You will be provided with one (1) set of keys and/or electronic fobs or cards per resident on
the day of your move-in at The Cardinal. This set consists of one (1) each of the
following: Residence key, mailbox key, storage key and exterior door key. You may pick
up your keys from a Customer Service associate on the day you are scheduled to move in.
You will also receive a purchasing card for dining and optional services. In the event
that your keys and/or card are lost, you may purchase another set at the Customer
Service desk for a charge as outlined in the Appendix A of your Resident Agreement.
4.9
ABSENCES
For your safety, please notify the Customer Service desk if you plan to leave the
Community. Residents in Health Care Center should contact their nursing care associate.
Indicate how long you will be gone, anticipated return and where you may be reached in
case of an emergency. This also applies to when a resident is going to be gone overnight
or longer, such as vacations.
4.10
Personal Service or Companion HOME SERVICES Providers
The Cardinal may provide on-site companion or personal service providers which would be
available at your discretion or the discretion of the community if you are a safety risk to
yourself or others. The cost will be borne by you. You may also choose to hire home
health aides or other domestic assistance at your own cost. All personal service providers of
in-home assistance are subject to The Cardinal’s policies, must register with The Cardinal,
sign agreements and meet requirements established by The Cardinal from time to time.
Before engaging an in-home assistant of any type, you must notify the Customer Service
desk and review and agree to abide by, and cause your in-home assistant to abide by, the
policies of The Cardinal. You will be responsible for seeing that any in-home assistant
hired by you complies with all policies of The Cardinal, and you will be responsible for any
damage to persons or property caused by your in-home assistants.
Resident Handbook May 2016
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Section 5
PAYMENT OF MONTHLY FEES
PAYMENT OF MONTHLY FEES AND ANCILLARY CHARGES
On or about the first (1st) day of each month, each Resident will receive a written statement for that month's
Fees, plus an itemized listing of all ancillary charges incurred during the previous month.
For the convenience of the Resident and efficiency of operations, payments made through the use of
electronic funds transfer are preferred. If electronic funds transfer is not utilized by the Resident, a check
payable to "The Cardinal at North Hills" should be remitted to the administration office.
Should a Resident wish to question any item on the statement, the Resident Relations Director will be
available to discuss any unresolved questions or items. Any sums not in good faith dispute and not paid by
the Fifth ( 5th) day of the month shall be subject to a late charge of 5 % per month until paid.
Resident Handbook May 2016
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Section 6
Resident Services
The Cardinal is responsible for the upkeep and repair of the building and its amenities. We provide
Maintenance, Housekeeping, Security, and Community Services. The primary functions of these areas are
described in the sections below.
6.1
MAINTENANCE
Supervision of the maintenance function is the direct responsibility of the management of
The Cardinal. The primary functions of Maintenance are:
 To keep the Residence and public areas clean and in good repair
 To maintain The Cardinal grounds and landscaping
 To develop and implement a program of preventive maintenance
 To provide trash removal services.
6.1.1
Work Orders/Maintenance Requests
Maintenance of The Cardinal property or of a Residence is controlled by a work order
system that will ensure tracking and follow up on maintenance requests. In order to process
maintenance requests, a priority system is in place designating maintenance requests as:
Emergency, Priority, or Routine. Top priority is given to emergencies and any items that
constitute a safety hazard to Residents or associates. Maintenance requests should be reported
based upon the system outlined below.
6.1.2
Reporting Procedures
Emergencies - Emergency problems that may involve structural or major equipment problems
throughout the facility, or pose a threat to the safety of Residents or associates, or emergency
problems noted in a Residence, should be reported immediately, regardless of the time of day.
Priority - Priority maintenance problems are those that create an immediate inconvenience to
Residents or those that could result in further damage to The Cardinal property or a Residence
if left uncorrected (examples include: air- conditioning failure, toilet stopped up, and water
leaks.)
Routine - Routine maintenance problems are those that occur through the course of daily
living in The Cardinal and do not pose any safety risk or immediate inconvenience to the
Resident. Examples include: Doors/windows not closing properly, faucet leaks, etc.
6.1.3
Maintenance after Move-In
After a Resident moves into a Residence, Maintenance associates will assist in hanging
pictures, mirrors and shelves on a limited basis. This work must be requested within 30 days
after move-in. Associates may inspect Resident-owned lamps and other appliances, and
reserves the right to disable these items, if unsafe, until the Resident can make arrangements
for repairs.
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6.1.4
Preventive Maintenance
The Cardinal will follow a written preventive maintenance plan to keep the buildings,
equipment, furniture and furnishings in good repair and free of safety hazards.
6.1.5
Replacement of Light Bulbs
Maintenance associates will replace light bulbs in the common areas and in the Residence’s
light fixtures, which are installed as part of the building's original equipment. Residents are
expected to furnish bulbs for their own lamp fixtures.
6.1.6
Maintenance of a Residence during a Resident's Absence
In the event of a maintenance emergency, as determined by The Cardinal, a
Maintenance associate may enter the Residence.
A Maintenance associate will provide advance notice of scheduled preventive maintenance
activities requiring access to individual Residences. After such notice, unless a Resident has
provided reason (e.g., illness) not to do so, the associate is deemed to have permission to enter
the Residence according to that schedule regardless of the Resident's presence.
Corrective maintenance items are initiated by "Requests for Maintenance" from Residents or
the Community staff when necessary. The Maintenance department schedules corrective
maintenance on a routine basis. The Maintenance associate will assume access to a
Residence is acceptable, even if the Resident is absent, unless the Resident has an "Access
Limitation Form" on file with The Cardinal. In that event, the Maintenance associate will not
enter the Residence and maintenance will be rescheduled in accordance with maintenance
priorities.
Corrective maintenance is generally scheduled between the hours of 8:30 A.M. and
4:30 P.M., Monday-Friday. Residents will be notified in advance if corrective maintenance is
to begin during standard hours. If a Maintenance associate plans to visit a Residence at other
times, the Resident affected will be notified in advance. All maintenance on The Cardinal
property and equipment must be performed by The Cardinal or authorized by The Cardinal.
6.1.7
Grounds Maintenance
The Cardinal management is responsible for maintaining the grounds. This includes,
but is not limited to: mowing grass; fertilizing lawns, trees and bushes; cleaning up
debris; pruning trees and bushes; cleaning up dead vegetation; and watering as
appropriate.
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6.1.8
Landscaping by Residents
All landscaping at The Cardinal was installed in accordance with an approved plan including
watering systems and sprinklers. Residents may not install trees, bushes or other plantings
without prior written approval of the Executive Director.
Residents who enjoy gardening may volunteer to care for specific plantings or plant
beds or designated Resident gardening plots. Requests to do so may be made to
Maintenance.
6.1.9
Care of Plants
Watering and care of plants in public areas is the responsibility of The Cardinal. Residents are
asked not to tend these plants without specific agreement with The Cardinal.
6.1.10 Tools and Supplies - Resident Use
The Cardinal tools, equipment and supplies may be used only by maintenance personnel in
the performance of their duties. Residents, guests, or associates may not borrow tools,
supplies, or equipment of The Cardinal.
6.1.11 Swimming Pool/Spa Maintenance
Care of the swimming pool, including establishing and maintaining proper chemical levels, is
the responsibility of The Cardinal. Water temperatures will be maintained at a comfortable to
comply with state regulatory requirements.
6.1.12 Pest Control
Pest control service will be provided on a scheduled basis. Should a Resident experience
difficulties with pests, the Resident should complete a "request for maintenance" form.
Arrangements will be made to re-treat the area.
Should, in the opinion of The Cardinal, special pest control be required in a Residence or in a
public area due to unhygienic conditions created by the Resident or by a Resident’s pet, the
Resident may be charged for that service.
6.1.13 Recycling and Waste Disposal
Trash and recycling rooms will be provided on each floor with trash and recycle bins.
Only disposable trash in sealed plastic bags, not loose garbage, should be placed in the trash
and recycle bins in these rooms. Items to be recycled will be collected in accordance with
the current community recycling program. Feline/pet excrement (not including litter) shall
be disposed of in the Residence toilet. Litter must be placed in a tightly sealed plastic bag
and placed in the trash bins. Dogs need to be relieved outside the building.
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A Resident with a large or bulky trash item, including moving boxes, may call the
maintenance to make arrangements for it to be picked up.
Food waste, with the exception of bones, all cooking oils, fat, banana peels, onion skins,
celery, coffee grounds and similar items, should be put down the garbage disposal in the
kitchen sink.
For safety and to maintain a neat, clean environment, no trash of any kind should be put out in
the building hallways.
6.1.14 Storage Facilities
Each independent living residence is assigned a storage cubicle in a storage area separate
from the residence. Assisted living and nursing care apartments are not automatically
assigned a storage cubicle.




Locking of the assigned cubicle is the responsibility of the Resident. The storage areas
themselves will remain locked with Resident access provided by use of his or her entrance
key.
Assistance in moving items into or out of the storage cubicle can be obtained by
contacting a Customer Service associate.
The Cardinal is not responsible for items stored in a Resident's assigned storage cubicle.
Storage room aisles are designed for easy access to each storage space. Items may not
protrude into, or be put on, the floors of the aisle. Flammable liquids,
chemicals, pyrotechnics or ammunition may not be stored in any storage area or cubicle.
Valuable or fragile items such as jewelry, china, paintings, etc., should not be stored in
storage areas.
6.2
HOUSEKEEPING
The supervision of the Housekeeping function is the direct responsibility of The Cardinal
management.
The primary functions of Housekeeping are:



Basic housekeeping and cleaning services in the Residences
Cleaning of all public spaces
Laundering of The Cardinal washable goods.
6.2.1
Housekeeping Service
Housekeeping service is provided once every other week to each Independent Living Residence
and weekly to each Health Center apartment. With certain exceptions during holidays to the degree
scheduling permits, housekeeping services will be provided in the Residences at the same day and
time.
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Residents will be provided a schedule of housekeeping visits, and notified of any anticipated changes.
In an effort to provide maximum utilization, management is not able to guarantee that the same
housekeeper will service your Residence each time. Individual housekeepers may be rotated from
time to time.
The Cardinal reserves the right to enter a Residence to perform routine housekeeping services in a
Resident's absence, unless the Resident has signed an Access Limitation Form allowing entry
only if the Resident is present. If this form is on file, and the Resident is not present at the
scheduled housekeeping time, then The Cardinal will do its best to re-schedule housekeeping services.
6.2.2
Services Included in Routine Cleaning






6.2.3
Cleaning top of refrigerator, stove, countertops and sink; sweeping and wet
mopping the floor.
Cleaning bathtub and showers, sink, countertops, toilet bowl, tank and tank cover,
and mirror; sweeping and wet mopping the floor.
Light, top surface dusting; vacuuming carpet.
Light dusting, vacuuming carpet and linen change (clean linens must be
provided by resident).
Cleaning window sills, spot-cleaning carpet, trash removal; sweeping patio.
Certain cleaning tasks will be accomplished by The Cardinal on a periodic basis,
including:
o Window washing, inside and out.
o Carpet shampooing, if needed.
Services Not Included in Routine or Expanded Cleaning





Housekeeping associates will not dust or clean flat surfaces where there might be a chance
of breakage.
Moving heavy furniture.
Cleaning inside the refrigerator.
Polishing silver or brass, etc.
Personal laundry.
6.2.4
Extra Housekeeping Services
Extra housekeeping services may be requested from The Cardinal. These extra services
would include, but are not limited to, those services not included in routine cleaning (as
described above), or other services requested by the Resident and approved by The Cardinal.
Under no circumstances will personal services be provided by the housekeeping such as
bathing, hair styling, dressing, assistance with dining or administering or assisting with
medication.
Charges for extra housekeeping services are outlined in Appendix A and will be added to the
monthly statement.
For insurance reasons, Residents may not have housekeeping service performed by
housekeepers who are not associates of The Cardinal without prior written approval from the
Executive Director.
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6.2.5
Housekeeping Services in the Health Center
Housekeeping and laundry services in Health Center apartments are more comprehensive
than those provided in independent living residences. For more information on the
housekeeping and laundry services that are provided in the Health Center, please refer to
the current form of the Residence and Care Agreements for Nursing Care and Assisted
Living.
6.2.6
Carpet Cleaning
Carpets will be cleaned depending on normal "wear and tear" and routine expanded cleaning
schedules, as determined by The Cardinal.
Should, in the opinion of The Cardinal, special carpet cleaning is required in a Residence or
in a public area due to a pet, unusual wear and tear, or general abuse, the responsible
Resident will be charged for that service.
6.3
SAFETY
6.3.1
Firearms
Firearms are not allowed at The Cardinal.
6.3.2
Vehicle Identification
All Resident-owned vehicles will be required to display a small decal on the vehicle. Such
decals will be individually numbered for proper vehicle identification. Decals will be issued
by The Cardinal at the time of vehicle registration. In the event that a vehicle is added or
disposed of, the Resident is responsible for notifying The Cardinal of the change.
Residents who own vehicles are required to maintain current registration and appropriate
insurance.
6.3.3
In Case of Fire or Other Disasters
All buildings are fully sprinkled. Emergency Fire Evacuation procedures are provided to
Residents for strategic placement in the Residence for quick reference in the event of an
emergency. In case of fire in a Residence building or the common areas of the main building,
Residents should not use the elevators, but should proceed with caution to the nearest
building exit. If instructed to remain in your Residence prepare yourself for evacuation and
remain in your Residence until given further instructions.
A Community Disaster Plan is available. This plan includes a specific section on Fire and
Evacuation. Residents are urged to read and to become familiar with the contents of the
Disaster Plan.
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6.3.4 Smoke Detectors, Residences
Every Residence will have a smoke detector installed. Smoke detectors report directly
through the emergency call system and to communication devices.
6.3.5 Smoke Detectors, Public Areas
Public area smoke detectors are connected directly to the general fire alarm system and are
monitored by an external alarm service.
If a public area smoke detector is activated, an audible alarm will sound in the immediate
vicinity; alarms will automatically sound at the control desk in the Administrative area and the
Fire Department automatically will be called by the external alarm service. A strobe light and
horn will also be activated in each Residence wing of the involved building.
Cardinal associates will be dispatched to the location of an activated public area smoke
detector. Residents should take action per the Emergency Fire Evacuation procedures.
6.3.6 Fire Drills
To promote safety and awareness, periodic fire drills will be held at The Cardinal. All fire
drills scheduled by The Cardinal involving the Residents will be pre-announced. It is
possible, however, that the local Fire Department may conduct fire drills from time to time
without an advance warning to either associates or Residents.
6.3.7 Emergency Call System
Residences are equipped with an emergency call system in each bedroom and bathroom. If
an emergency medical issue arises, assistance can be summoned by activating the
emergency call system in the Residence. Life-threatening or critical medical emergencies
will be referred to the appropriate off-site emergency medical authorities by calling 911. In
Independent Living, the Emergency Call System will include a daily check-in system which
sends a notification to the Resident relations associate desk each morning that the Resident is
up and about. If the Independent Living Resident is unable to respond, a safety check will be
performed by Cardinal staff
6.4 COMMUNITY SERVICES
6.4.1 Scheduled Transportation
Transportation service is provided to residents on a scheduled basis in community vehicles. As
a resident of The Cardinal you will also have access to the North Hills transportation program.
* Note the Cardinal does not control the transport services of the North Hills Home Owners
Association. A list of destinations, as well as departure and return times, will be established
by The Cardinal and posted on the bulletin board in the postal and message center and the
in-house television station. Scheduled transportation times and destinations are set from time
to time by The Cardinal with input from the Resident’s. An appropriately licensed associate
will drive the vehicle and assist Residents with packages. All scheduled trips depart from the
Resident Handbook May 2016
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main entrance of The Cardinal unless otherwise indicated. The Cardinal reserves the right to
re-schedule planned trips in the event of an emergency or in the event of an equipment failure.
6.4.2 Individual Transportation
Subject to availability, The Cardinal vehicles, with driver, will be available for local and area
trips when requested by an individual Resident or Resident groups. Individual use is
accommodated on a first come, first served basis, and may be reserved up to 30 days in
advance. A minimum of two days advance notice is required. Estimated costs will be
established in advance.
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Section 7
Dining Services
The Dining program offers Residents and guests a variety of dining venues. The Bistro offers casual all
day dining featuring an “open kitchen” for demonstrations and cooking classes as well as breakfast, lunch and
dinner featuring healthy dining choices, seasonal selections and Chef’s daily specials. The Veranda Dining
Room and pub will be available for cocktails, dinner and other events such as Sunday Brunch.
The Cardinal management is responsible for the operation of all food and beverage areas in The
Cardinal including the Clubhouse and Health Center.
The primary functions of Dining Services are:
 Planning menus for all food and beverages served in The Cardinal dining venues, and ordering
food and supplies accordingly
 Preparing and serving the at The Cardinal
 Providing catered services for the Residents of The Cardinal at an additional fee
7.1
DINING SERVICES
7.1.1 Dining Atmosphere
The overall dining program is designed to provide a variety of eating experiences. In order
for the program to meet the expectations of all Residents, different dining venues have been
established.
7.1.2 Menus
Menus are prepared with sound nutritional considerations in mind. Menu selections which
are low fat, low cholesterol in accordance with American Dietary Association "Heartsaver"
guidelines are clearly indicated.
Standard menu items will be provided along with daily "specials." Standard menus are
changed periodically in order to ensure "seasonal" variety.
7.1.3 Service Hours
The hours for dining service will be established by The Cardinal, and may be changed
periodically, based on input from Residents.
During holidays and special occasions, meal times may be modified based on input from
Residents. Schedules for these meal times will be communicated well in advance.
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7.1.4 Guest Meals
Guests are welcome at any meal. Charges for the guest meal will be included on the
Resident's monthly bill or may be deducted from the Independent Living Resident dining
account.
7.1.5 Special Diets
The menu is structured to provide the Resident with options that satisfy most diets.
Less common diets prescribed by a Resident's physician may be prepared by Dining Services,
if the capabilities exist to do so. Residents having special dietary restrictions should meet
with the Community Nutritionist. An additional cost may be associated with special diets.
7.1.6 Nutrition/Diet Counseling
A Registered Dietitian will review all menus on a continuing basis. The Dietitian may be
available to counsel individual Residents on such issues as nutrition, diets, and special diets.
Appointments for counseling may be scheduled.
7.1.7 Dining Account
In Independent Living, each Resident will have a declining balance dining account based on a
predetermined value included in the Fees. The menu offerings will include a wide range of
options and flexibility in using your dining account. Your account can be used in any dining
venue at The Cardinal, including meals eaten as a guest in the Health Center, and may also be
utilized for guest dining and beverages. A dining account balance not utilized within the current
month will be forfeited.
Residents in assisted living and nursing care apartments receive three meals a day and
appropriate snacks as part of the Monthly Health Center Fee (for Assisted Living) or Daily
Health Center Fee (for Nursing Care).
7.1.8 Catering Service
Dining Services will cater special events for a Resident in his or her Residence or in one of
The Cardinal public areas at an additional fee. These services range from "party trays" that
can be taken to the Residence, to full dinner parties. Since the primary function of Dining
Services is preparing meals for Residents, reservations for catering services should be made as
far in advance as possible. Arrangements for catering and parties may include food, beverages,
room set-ups, decorations, wait staff and clean up. A Resident desiring catering service will be
required to approve a written cost estimate prior to the event. Actual charges will appear on
the Resident's monthly statement. A brochure will be available from Resident relations.
7.1.9 Tray Service
Meal delivery to the Residence can be arranged by contacting Dining Services the day of
delivery, at least one hour prior to the start of that meal service. Additional fees may apply as
described in Appendix A.
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Section 8
Health Care Services
The Cardinal offers health care options for Residents that include assisted living, memory support and
nursing care, should you require assistance due to a change in your health status. Fees for these services are
outlined in the service offerings. Entry into the Health Center is subject to certain additional requirements,
including the execution of an Assisted Living Residence and Care Agreement or Skilled Nursing Care
Residence and Care Agreement, as applicable. Cardinal Residents will have access to the following
healthcare services:
8.1
Assisted Living
Assisted Living cares for Residents who need assistance with the activities of daily living. Assisted
Living offers three meals per day and appropriate snacks, a variety of social and therapeutic
activities, and is staffed 24 hours a day. These services are provided within the scope of state
licensure.
8.2
Memory Support
The Memory Support household is for Residents who have dementia or require memory
enhancement services. The memory support center is designed to help Residents feel as
comfortable as possible and features indoor and outdoor spaces for recreational activities and
programs. Associates in memory support receive special training in order to provide the necessary
programming and assistance with activities of daily living to the Residents. Dining service includes
three meals per day served in a family style dining area, as well as appropriate snacks served in the
kitchen. These services are provided within the scope of state licensure.
8.3
Nursing Care
Nursing Care is for Residents who require a more intensive nursing or rehabilitative services
pursuant to plan of care developed with the Resident’s physician. Associates in nursing care are
specially trained to provide supportive care and assistance. Dining service includes three meals
per day, as well as appropriate snacks and a variety of social and therapeutic activities. Nursing
Care is staffed 24 hours a day with Registered Nurses and certified nursing assistants. These
services are provided within the scope of state licensure.
Resident Handbook May 2016
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Section 9
Community Service
The Cardinal fosters a culture of service and desires to make a meaningful impact in our community. There
are opportunities for volunteer service at The Cardinal. Opportunities may involve serving as a host to a
special event, welcoming a new resident, joining one of the many Resident committees and/or leading a
specialty class where you can share your expertise with others. External community opportunities are
available at churches, hospitals, service organizations and schools. If you would like to know what
volunteer opportunities are available, please see the Wellness Director.
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Section 10
Conclusion
The guidelines set forth in this Handbook are for the benefit of the entire Community and are subject to
amendment or revision by the Community as circumstances warrant. Any Resident seeking clarification of a
stated policy or who otherwise has a comment or question is encouraged to contact the Executive Director or
complete a Resident Suggestion form.
Resident Handbook May 2016
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Exhibit G
The Cardinal at North Hills
Application for Residency
APPLICATION FOR RESIDENCY
This Application for Residency at The Cardinal will become a part of the Resident Agreement and must be
completed in its entirety. The application includes General, Health and Financial information. The
Community affords equal treatment and access to its services for all persons without unlawful discrimination
due to race, color, religion, sex, age, marital status, national origin, sexual orientation, ancestry, or disability.
All information will be held in confidence.
Name:
DOB (mm/dd/yyyy):
Address :
City:
County:
Phone Number:
State:
(
Zip:
)
E-mail:
Cell Number
(
)
Family or Persons to Contact for Assistance / Emergencies
Name:
Relationship to Applicant:
Address:
E-Mail:
City:
Phone Number:
State:
(
)
Cell Number
Name:
(
)
Relationship to Applicant:
Address:
E-Mail:
City:
Phone Number:
Zip Code:
State:
(
)
Zip Code:
Cell Number
(
)
Power of Attorney:
Name:
Relationship to Applicant:
Address:
E-Mail:
City:
Phone Number:
Sta e:
(
)
Zip Code :
Cell Number
(
)
CONFIDENTIAL HEALTH HISTORY
Please complete this section with your current health status.
1. Describe your current living situation below:
Living with Spouse
Living Alone
Living with Family
Other
2. Please describe your overall health status including physical and emotional well-being:
Good
Fair
Poor
3. Have you had any major health concerns over the past 5 years?
Yes
No
If yes, please describe:
4. Have you had any medical conditions that required hospitalization in the past 12 months?
Yes
No
If yes, please describe:
5. Physician(s): i.e. Primary Care, Cardiologist, Ophthalmologist, Dentist, etc.
Name:
Name:
Address:
Address:
Email:
Email:
Phone:
Phone:
Specialty:
Specialty:
5. How often do you see your Primary Care Physician / Specialist?
Weekly
Monthly
Other
6. Do you use any devices to assist in your mobility? If yes, please check all that apply
Cane
Walker
Wheelchair
Electric Scooter
7. Have you had any injuries or falls within the past 12 months?
Yes
No
If yes, please describe:
8. Do you require assistance with grooming, bathing or dressing?
Yes
No
If yes, please describe:
9. Please list the medications you are currently taking below:
Medication:
11.
Dosage:
Frequency:
Do you need any assistance in managing your medications?
Yes
No
If yes, please describe:
12.
Do you have any known allergies?
Yes
No
If yes, please describe:
13.
Do you have any of the following:
Diabetes
14.
Parkinson’s
Pacemaker
Other
Do you exercise regularly?
Yes
No
If so, how often?
Daily
Weekly
Monthly
What types of exercises do you enjoy:
15.
Do you participate in Community Activities (social events, outings, golf, etc.)?
Yes
No
If yes, please describe:
CONFIDENTIAL FINANCIAL INFORMATION
Applicant Information (Type or Print)
Name:
FINANCIAL INFORMATION
Assets:
Total
Cash
$
Liabilities:
Total
Notes
$
Mortgages
Accounts:
Other (Describe):
Checking
Savings
Money Market
Investments:
Certificates of Deposit
$
TOTAL LIABILITIES:
Stocks and Bonds
Mutual Funds
Monthly Income:
IRA/401K
Social Security
Other
Pensions & Retirement
Real Estate
Annuities
Home Market Value
Investment & Savings Interest
Other RE Market Value
Current Employment
Other:
Other (Describe):
TOTAL ASSETS:
$
TOTAL MONTHLY
INCOME:
$
BANK/FINANCIAL ADVISOR:
Name
Branch Location
Person to Contact
THIRD PARTY INFORMATION:
If a third party will be paying for all, or a portion of your monthly rent, please list below the name and address of
that individual:
Name:
Address:
Telephone Number:
Relationship to Resident:
E-mail:
Note: A letter and financial statement from the guarantor, if any, may be required.
I declare the answers to the foregoing questions to be true, full and complete to the best of my knowledge. Any
material misstatement in the information or subsequent transfer of assets empowers the Community to void the
application approval and/or resident agreement. I understand that the Community may verify statements given in
this application.
Date:
Print Name:
Signature:
Exhibit H
The Cardinal at North Hills
Physician’s Report
Exhibit I
The Cardinal at North Hills
Appendix A
Appendix A Acknowledgement
The undersigned acknowledge receipt of the schedule of Fees for Optional Services:
______________________________________
Resident Signature
____________________________
Date
______________________________________
Resident/Responsible Party Signature
____________________________
Date
______________________________________
Community Representative Signature
____________________________
Date
Exhibit J
The Cardinal at North Hills
Assisted Living Residence and Care Agreement
THE CARDINAL AT NORTH HILLS
HEALTH CENTER
ASSISTED LIVING AND MEMORY CARE
RESIDENCE AND CARE AGREEMENT
May 2016
TABLE OF CONTENTS
Page
I.
CORE SERVICES ............................................................................................................ 4
II.
PERSONAL ASSISTANCE AND CARE ....................................................................... 7
III.
OPTIONAL SERVICES .................................................................................................. 8
IV.
EXCLUDED HEALTH-RELATED SERVICES ............................................................ 8
V.
TERM OF AGREEMENT ............................................................................................... 9
VI.
FEES ................................................................................................................................. 9
VII.
TRANSFERS FROM APARTMENT ............................................................................ 12
VIII.
TERMINATION............................................................................................................. 13
IX.
YOUR PROPERTY RIGHTS AND OBLIGATIONS................................................... 16
X.
OTHER PERSONAL OBLIGATIONS ......................................................................... 17
XI.
LEGAL REPRESENTATIVES, RESPONSIBLE PARTIES, GUARANTORS........... 18
XII.
MISCELLANEOUS …………………………………………………………………...20
APPENDIX A
FEES FOR OPTIONAL SERVICES AND LEVELS
OF CARE
APPENDIX B
FINANCIAL STATUS
APPENDIX C
STATEMENT OF RESIDENTS' PERSONAL RIGHTS
THE CARDINAL AT NORTH HILLS
HEALTH CENTER
ASSISTED LIVING
RESIDENCE AND CARE AGREEMENT
This Residence and Care Agreement (“Agreement”) is made by and among The Cardinal at
North Hills Healthcare, LLC, (“Cardinal Healthcare”) doing business as “The Cardinal Health Center”
located at [address], and its agent Kisco Senior Living, LLC, a Delaware limited liability company
(“Kisco Senior Living”), on the one hand, and ____________________________ ("you") on the other.
Where appropriate, Cardinal Healthcare and Kisco Senior Living are collectively referred to in this
Agreement as ““we,” us, or "our". (If more than one person is signing this Agreement, "you" refers to
each of you individually and to both of you together.)
Cardinal Healthcare operates The Cardinal Health Center, which is the assisted living, memory
care and skilled nursing component of The Cardinal, a licensed Continuing Care Retirement
Community located in Raleigh, North Carolina, which provides residences, care and services to
persons 62 years of age and older (“The Cardinal”). Kisco Senior Living manages The Cardinal Health
Center on behalf of Cardinal Healthcare. The Cardinal is operated on a non-discriminatory basis and
affords equal treatment and access to services to eligible persons regardless of race, color, religion,
creed, gender, national origin, ancestry, or sexual orientation.
You have applied for accommodations at The Cardinal Health Center for Assisted Living or
Memory Care and your application has been accepted. The purpose of this Agreement is to provide a
statement of the services that we will furnish to you at The Cardinal Health Center, and the other legal
obligations that The Cardinal Health Center will assume. This Agreement also sets forth your legal
obligations to The Cardinal Health Center, both financial and non-financial. If your move to The
Cardinal Health Center is temporary in nature then this Agreement supplements, but does not replace
or amend, the Independent Living Residence Agreement you signed when you became a resident of the
independent living portion of The Cardinal. If your move to The Cardinal Health Center is permanent
then the Independent Living Residence Agreement will terminate in accordance with the provisions
therein.
I.
CORE SERVICES
You will be provided with the following Core Services at The Cardinal Health Center, subject to
the terms of this Agreement. These services are included in your Monthly Health Center Fee unless
otherwise indicated. If you (singly or jointly with another person) currently occupy a Residence in the
independent living component of The Cardinal, the Monthly Health Center Fee is in addition to any fees
that may be owed to The Cardinal with respect to that Residence, in accordance with your Independent
Living Residence Agreement.
A. Living Accommodations.
1.
Residence. You have chosen to live in Apartment #______ ("the Apartment") at
The Cardinal Health Center. You may live in the Apartment on a month-to-month basis, subject to the
terms of this Agreement and to the general policies of The Cardinal Health Center, contained in the
Resident Handbook as it now exists and as it may later be amended, and to the other written rules and
policies of The Cardinal Health Center.
2.
Utilities. Utilities included in the Monthly Fee for the Residence are electricity,
water and sewer, trash removal, basic internet/data services, and basic cable TV service. You are
responsible for paying for all other utilities and service charges including local and long distance
telephone charges, premium internet/data services and premium TV service fees. The Cardinal reserves
the right to establish maximum usage levels, and to charge you for any excessive or unreasonable usage
due to waste or abuse.
3.
Furnishings. Your Apartment comes equipped with basic furnishings, appliances
and floor and window coverings. You are also free to use your own small electric appliances and special
equipment, provided that The Cardinal Health Center's safety standards are met. For your safety and the
safety of all other residents of The Cardinal Health Center, cooking in your Apartment is not allowed.
You may furnish the Apartment with your own furniture, if appropriate for your health condition and
provided that The Cardinal Health Center's safety standards are met. You may decorate your Apartment
with items that are not permanent fixtures to the Apartment and can be easily removed without changing
or damaging the aesthetic or structural integrity of the Apartment. You or your estate will be responsible
for removing your furnishings and other items when your Apartment is vacated.
4.
Maintenance. We will perform all necessary maintenance and repairs of the
Apartment and the furnishings and equipment provided by The Cardinal at our expense. You will be
responsible for any necessary maintenance and repairs of equipment and furnishings you provide. You
will be responsible for reimbursing the Community for any damage to the Apartment or the furnishings
and equipment provided by The Cardinal other than normal wear and tear.
5.
Alterations. Any physical change to the Apartment requires the prior written
approval of the Executive Director of The Cardinal, and shall be made at your own expense. If you
obtain such approval, you will be responsible for restoring the original decor when the Apartment is
vacated, unless we specifically exempt you from this requirement in writing. No structural changes
to your Apartment are allowed.
6.
Common Facilities. You will be entitled to share with all other residents of The
Cardinal Health Center the use of the common areas, including the dining areas, lounge areas,
beauty/barber shop, multi-purpose rooms and recreation rooms. We may change or reconfigure common
spaces in the future at our discretion.
B.
Laundry.
Basic personal laundry and linen services are provided as described in the Resident
Handbook. Additional or more frequent laundry services are available and will be charged as set forth in
Appendix A. You shall be responsible for your personal dry cleaning.
C.
Housekeeping.
The Cardinal Health Center will provide housekeeping services in your Apartment as
described in the Resident Handbook. Additional housekeeping services as needed or requested will be
available for an additional charge (see Appendix A).
D.
Personal Supplies.
We assume that residents wish to provide their own supplies for personal care and
hygiene. However, if you are unable to provide such supplies or choose not to provide them, we will
provide you with personal items for an additional charge (see Appendix A).
E.
Meals.
Three meals will be served daily to residents at The Cardinal Health Center and snacks
will likewise be made available. These meals and snacks are included in your Monthly Health Center
Fee. We will also accommodate some special diets, if prescribed by your physician as a medical
necessity, for an additional charge. You will also be charged a fee for any special diets or supplements
not prescribed by your physician that you request and that we agree to provide.
1.
Room Service. We will provide room service to your Apartment, as set forth in
the Resident Handbook. There may be an additional charge for room service as set forth in Appendix A.
2.
Guests. Guests are welcome to any meal as set forth in the Resident Handbook.
There will be a fee for guest meals (see Appendix A). If your guest is a resident in the independent
living component of The Cardinal, your guest may use his or her dining account to pay for guest meals
in the Health Center.
F.
Planned Activities.
The Community has a program of social, emotional, intellectual, physical, spiritual, and
vocational activities, both at and away from The Cardinal Health Center. You are welcome to participate
in such activities as desired. There may be an extra charge for some of the activities offered by the
Community which require additional supplies or services provided by an outside vendor or outings which
are away from The Cardinal Health Center as set forth in Appendix A.
G.
Transportation.
We will make available to residents or otherwise assure the provision of scheduled
transportation to the nearest appropriate health facilities for medical and dental appointments, social
services agencies, shopping and recreational facilities, and religious activities as outlined in the
Resident Handbook. We will provide or arrange for additional personal transportation for a charge
(see Appendix A).
H.
Emergency Response and Fire Protection.
Your Apartment will be equipped with an emergency call system, smoke detector and
sprinkler system. The call system is monitored 24 hours per day to alert staff to emergencies and
illnesses. When the staff at The Cardinal Health Center determines that, in its judgment, an emergency
exists, staff will call 911.
II. PERSONAL ASSISTANCE AND CARE.
Staff of The Cardinal Health Center will regularly observe your medical condition and
help identify health, dietary and social needs or needs for special services. In accordance with your plan
of care and applicable North Carolina law, The Cardinal Health Center will provide you with the care
and services necessary to enable you to attain and maintain the highest practical level of physical,
emotional, and social well-being within the appropriate setting.
A.
Assisted Living Services.
Assisted living care and services will be provided in a designated apartment or specific
common areas related to assisted living. Services include, but are not limited to: assistance with
activities of daily living, such as bathing, dressing, ambulating, and assistance with medications;
scheduling of medical and dental appointments; accessing community resources and transferring to
outside facilities as needed and prescribed by your primary care physician.
B.
Memory Support Services
Memory care and services will be provided for residents with Alzheimer’s disease and
other forms of dementia. These services will be provided in a designated, secured memory support area
within The Cardinal Health Center. Services will include, but are not limited to, assistance with
activities of daily living, such as bathing, dressing, grooming, ambulating, and assistance with
medications; scheduling of medical and business appointments; providing incidental medical care, as
appropriate; and intervening on your behalf in the event of an emergency.
C.
Establishing Levels of Care
Different personal care service packages are offered to residents of The Cardinal Health
Center depending on their specific needs. The scope and pricing of these levels of care and services may
be changed at The Cardinal Health Center’s discretion upon thirty (30) days’ written notice to you.
When you applied for move-in to The Cardinal Health Center, the professional staff performed an
appraisal of your needs and determined with you and your physician the appropriate level of service for
you, as set forth in Section VI.A. We will periodically reappraise you as needed in light of your
changing needs to determine the appropriate level of service that you require. The current fees for the
various Levels of Care at The Cardinal Health Center and the description of these Levels are set forth in
attached Appendix A. These fees are subject to change as provided in Section VI.D below. Please note
that The Cardinal Health Center is not permitted to use restraints on its residents, and the use of
restraints is also inconsistent with our philosophy. We encourage our residents to participate in physical
activities to the extent of their capabilities. Thus, falls and other personal injuries may occur from time
to time.
III. OPTIONAL SERVICES
The Cardinal Health Center will make available to you several optional services at an extra
charge, to be billed on a monthly basis. Some of the optional services offered by The Cardinal Health
Center include:
1.
Guest meals and services;
2.
Room service;
3.
Personal transportation and supervision;
4.
Beauty/barber shop services
5.
Provision of certain personal supplies described in Section I.D above;
6.
Additional laundry and housekeeping services beyond those referenced in Sections I.B
and I.C above;
7.
Repairs and maintenance of personal items; and
8.
Any other optional services that we elect to offer in the future. The current fees for
optional services at The Cardinal Health Center are set forth in attached Appendix A, and are
subject to change as provided in Section VI.D below.
IV. EXCLUDED HEALTH-RELATED SERVICES
The Cardinal Health Center shall not be responsible for furnishing or paying for any health care
items or services not expressly included in this Agreement, including but not limited to home health,
hospice, physicians' services, nursing services, surgery, hospital care, home care, private duty care,
treatment or examination of eyes or teeth, medications, medical supplies, vitamins, eyeglasses, contact
lenses, hearing aids, orthopedic appliances, prosthetic devices, laboratory tests, x-ray services, toiletries
and personal supplies not required to be provided under Section I.D above, or other care or equipment
beyond The Cardinal Health Center 's routine levels of staffing and equipment.
V.
TERM OF AGREEMENT
This Agreement shall be in effect from month to month, unless and until it is terminated as set
forth in Section VIII below.
VI.
FEES
A. Monthly Health Center Fee.
A.
Monthly Health Care Fee.
Monthly Health Care Fee for Resident One:
Fee for Level
Care (if applicable):
Total Monthly Health Care Fee for Resident One:
If applicable, the initial Monthly Health Care Fee for a second resident residing in your Apartment is:
Fee for Level
Care (if applicable):
Total Monthly Health Care Fee for Second Resident:
Total for Both Residents (if applicable):
Prior to occupancy of your Apartment, you will be responsible to pay your entire
Monthly Health Center Fee for the first month of occupancy. If you begin occupying your Apartment
on a day after the first day of the calendar month, your Monthly Health Center Fee will be prorated
accordingly and appear on your first monthly statement. If your Apartment is occupied by two
Residents and it reverts to single occupancy, the remaining Resident shall pay the fee for "Core Services
for Resident One" and the fee for the appropriate level of care for that resident. The Monthly Health
Center Fee is payable in advance by the first (1st) day of each calendar month, and is considered
delinquent if not received by the tenth (10th) day of the month. Your right to occupy and use the
Apartment and to receive services at The Cardinal Health Center is contingent upon timely payment of
the Monthly Health Center Fee and all other applicable charges and fees under this Agreement.
B.
Fees for Levels of Care and Optional Services.
The charges for all Levels of Care and for all optional services at The Cardinal Health
Center shall be as set forth in Appendix A, which is attached to this Agreement. Appendix A is subject
to change from time to time. You will be given notice of any planned change in the fees set forth in
Appendix A, as described in subsection D below. Charges for optional services will be billed on your
monthly statement, and are payable by the first (1st) day of each calendar month and are considered
delinquent if not received by the fifth () (5th)day of the month.
C.
Adjustments to Fees or Services.
1.
Fees. The Community shall give thirty (30) days’ prior written notice to you of
any change in the Monthly Health Center Fee, as set forth in Appendix A, fees for levels of care, or in
the charges for optional services. However, as described in Section VI.G, if you begin receiving a
different level of care, including beginning to receive Memory Care services, the rate for the new level
of care shall be charged immediately. In the event of a rate increase, The Cardinal Health Center will
include with the notice of the increase the reasons for the increase and a general summary of the
additional costs that led to the increase.
2.
Services. The Community may modify the services provided under this
Agreement upon thirty (30) days’ prior written notice, provided that the services do not fall below the
standards established by applicable North Carolina regulatory authorities.
E.
Payment and Failure to Make Payments.
You will be required to make all payments due to The Cardinal Health Center in a timely
manner and otherwise fulfill your financial obligations to The Cardinal Health Center. We do not accept
SSI/SSP eligible residents for move-in to The Cardinal Health Center. Payment shall be made to The
Cardinal Health Center by check or money order and either mailed to
_______________________________or delivered to the business office at The Cardinal Health Center,
or you may arrange for automatic payments from a financial institution. If you fail to pay your Monthly
Health Center Fee or other charges by the Fifth (5th) day of each calendar month, The Cardinal Health
Center may charge you a late payment as described in Appendix A on your then-current Monthly Health
Center Fee for each delinquent payment. You will receive a monthly statement that itemizes any fees or
charges you have incurred. Returned checks shall be subject to a penalty as described in Appendix A..
F.
Guarantor
Your care and services at The Cardinal Health Center shall be guaranteed by ___
_______________________________("Guarantor"). You agree to provide The Cardinal Health Center
with timely written notice of any change in Guarantor's financial condition, address, or telephone
number. By signing below, Guarantor agrees promptly to pay all fees and charges incurred by you or
on your behalf under this Agreement. The foregoing is a guaranty of payment and not of collection,
and The Cardinal shall have no obligation to file suit or obtain a judgment against you prior to
enforcing its rights against the Guarantor.
G.
Change of Level of Care
The staff of The Cardinal Health Center will perform a periodic reappraisal of your
needs. If we determine that you need a different level of care than that which you are currently
receiving, The Cardinal Health Center will provide you and your responsible person, if applicable,
with written notice of the change. You agree to change to a level of care appropriate to your needs.
The rate for the new level of care, as set forth in Appendix A, shall apply immediately.
VII. TRANSFERS
A.
Transfer for More Appropriate Care.
The portion of The Cardinal Health Center in which you will reside is licensed by the state
of North Carolina for assisted living, however it is not designed to provide higher levels of care such as
nursing or care for serious mental or emotional disorders. You may remain in the assisted living or
memory care portion of The Cardinal Health Center as long as doing so is permitted by applicable
licensure laws and fire safety standards, and, in the judgment of the staff of The Cardinal Health Center,
your care needs and levels of functioning are consistent with those of other residents and with the level
of staffing and facilities offered at The Cardinal Health Center, and your presence does not create a
danger to yourself or others. If the staff of The Cardinal Health Center determines that it is inappropriate
for you to remain in your Apartment, you may be asked to move to the nursing care portion of The
Cardinal Health Center or to an outside facility, and this Agreement will terminate in accordance with
Section VIII. During your transition to another setting that can meet your needs, you may be required to
obtain temporary one-on-one care from an outside provider as determined at the sole discretion of the
Executive Director. You will be financially responsible for this service which will be billed directly to
you by the responsible company or The Cardinal Health Center in accordance with Appendix A.
B.
Substitution of Apartment.
We may need to substitute your Apartment with another to comply with any law or
lawful order of any authorized public official, or for any other reasonable purpose, as determined by
The Cardinal Health Center. You agree to such substitution and agree to pay the Monthly Health
Center Fee applicable to the new Apartment.
C.
Voluntary Apartment Change
Your request for a change of apartment may be granted at The Cardinal Health Center’s
discretion. You will pay the then-applicable Monthly Health Center Fee for the new Apartment
beginning on your first day of occupancy. If you move on a day other than the first day of the month,
any difference in rates between your current Apartment and the new Apartment will be credited or
debited to your account, as the case may be, on a pro rata basis. You will be responsible for all costs
associated with the move, including an apartment transfer fee as noted in Appendix A.
VIII. TERMINATION
A.
Termination by You.
You may terminate this Agreement at any time, with or without cause, by giving The
Cardinal Health Center thirty (30) days’ prior written notice of termination, with the exception of your
death wherein this agreement terminates automatically. After termination, you will continue to be
responsible for your full Monthly Health Center Fee until the thirty (30) day period has expired and all
your property is removed.
B.
Termination by Community.
1.
Upon Thirty (30) Days’ Notice. The Cardinal Health Center may terminate this
Agreement upon thirty (30) days’ written and verbal notice to you and your Legal Representative
and/or Responsible Person, if applicable, if any of the following events occur:
a. Nonpayment of the Monthly Health Center Fee within ten (10) days of the due
date;
b. Your failure to comply with State or local law after receiving written notice of
the alleged violation;
c. Your failure to comply with general policies of The Cardinal Health Center as
described in this Agreement, in the Resident Handbook, or as determined by the Executive Director; or
d. If after move-in, it is determined that discharge is necessary for your welfare
because your needs can no longer be met at The Cardinal Health Center.
2.
Upon Three (3) Days Notice. In addition, The Cardinal Health Center may
terminate this agreement upon three (3) days written notice for good cause. Good cause exists if we
determine that your continued presence at The Cardinal Health Center poses a threat to the mental and/or
physical health or safety of yourself or to the mental and/or physical health or safety of others in the
Community.
3.
Notice. If the Community terminates this Agreement under Section VIII.B., you
and your personal representative (if any) shall receive a notice describing the reasons for such
termination.
4.
Appeal. If you wish to appeal a termination, you may do so by requesting a
review in writing to the Chief Operating Officer of Kisco Senior Living within ten (10) days following
the termination notice. The Chief Operating Officer or designee will schedule a meeting with you and
your representatives during which you can present reasons why the termination should not occur. The
Chief Operating Officer will then make a final determination which will be provided to you in writing.
5.
Conditions That May Lead To Reassessment. Please note that the following
conditions, among others, may lead to a reassessment and a termination of your residency in
accordance with paragraph VIII.B.1.d above. Termination may occur if:
a. You do not meet the requirements for residency established by state law and
regulations.
b. You present an immediate physical threat or danger to yourself or others.
c. You have active communicable tuberculosis or another communicable disease.
d. You require 24-hour skilled nursing or intermediate care or have an unstable
medical condition which requires more than routine care by a licensed professional.
e. You have needs in conflict with other residents or the programs of services
offered, or require more care and supervision than other residents.
f. You have a primary need for care and supervision that results from dementia or
a mental disorder resulting in ongoing behavior which would upset the general resident group, or which
would require us to provide to you a greater amount of care and supervision than other residents at The
Cardinal Health Center or if you cannot generally benefit from the program of services available at The
Cardinal Health Center.
g. You are bedridden as defined by state licensing regulations or are unable to
independently transfer or require multi-person transfers.
h. You refuse to accept services required in order for The Cardinal Health Center
to meet your needs.
i. You have health care needs that cannot be met at The Cardinal Health Center
for reasons such as licensure, design or staffing, including, but not limited to, conditions that require
physical or chemical restraints, unstable mental health diagnosis, swallowing difficulties or other
conditions that create a choking risk, complex special diets that cannot be self-managed, the inability to
self-manage insulin or other injections ordered by a physician, inability to self-manage the
administration of supplemental oxygen, severe circulatory disorders, unmanageable incontinence, stage
III or IV skin ulcers, any unstable medical condition or conditions that cannot be accommodated by The
Cardinal Health Center as defined by state licensing regulations.
j.
Your personal physician has determined that you require services
not available at The Cardinal Health Center.
k.
If your condition changes so that you are considered a wandering or
significant fall risk or if you are unable to respond to verbal instructions in an emergency and your
needs cannot be met through the Memory Care program.
l.
You have fluctuating or high levels of medication administration
including, but not limited to, frequent changes or readjustment of medications, multiple physicians
prescribing resident medications, or combinations of medications or medical regimens prescribed by
the physician beyond The Cardinal Health Center’s scope of services or the staffs’ training and skill or
do not comply with state licensing regulations.
C.
Your Death.
This Agreement shall terminate automatically upon your death. Your estate will receive
a refund of any unused pro rata portion of your Monthly Health Center Fee within thirty (30) days
following removal of all property from your Apartment.
D.
Move Out and Refund.
1.
Vacating Apartment. If this Agreement is terminated for any reason, you or
your estate must vacate the Apartment and remove all of your property from it. You or your estate
shall remain liable for the Monthly Health Center Fee, calculated at the lowest level of care, until all
property is removed from your apartment and it is restored to a clean condition (except for normal
wear and tear), whichever occurs later. The Cardinal Health Center may also remove your property
from the Apartment and charge you or your estate a property storage fee if either you or your estate
fails to vacate the Apartment and remove your personal belongings from it in a timely manner. If you
or your estate abandons your personal property following termination of this Agreement, The Cardinal
Health Center shall have the right to dispose of such abandoned property in accordance with state law.
The Cardinal Health Center has the right to enforce the provisions of this section by appropriate legal
proceedings.
2.
Refund of Unused Portion of Monthly Health Center Fee. Following termination
of this Agreement, The Cardinal Health Center will pay you or your estate a refund equal to any
Monthly Health Center Fees received by The Cardinal in excess of those required by VIII.D.1. above,
or other amounts that The Cardinal Health Center owes to you, minus the following: (i) the amount of
any unpaid Monthly Health Center Fees or other charges that you owe to The Cardinal Health Center
under this Agreement; (ii) the costs of repairing any damage to the Apartment that is not caused by
normal wear and tear; (iii) the costs of repairing any of The Cardinal Health Center’s property that was
damaged by you or your visitors; and (iv) any expense incurred by The Cardinal Health Center to
remove and/or store any of your property that was not removed when you vacated the Apartment. You
or your estate will receive any refund that is due within thirty (30) days following the effective
termination date.
3.
Survival. Section VIII. D. shall survive the termination of this Agreement.
E. Couples.
If there are two residents under this Agreement, and one dies or permanently vacates the
Apartment, this Agreement shall continue in full force and effect and the then-current Monthly Health
Center Fee applicable to single occupancy of the Apartment at the level of care for the remaining
resident shall apply.
IX. YOUR PROPERTY RIGHTS AND OBLIGATIONS
A.
No Management or Property Interest.
This Agreement shall give you no property right or management interest in The Cardinal
Health Center, The Cardinal, or any of their assets. In addition, you shall have no right to any of The
Cardinal Health Center's personal property, including furnishings and fixtures in the Apartment or in
the common areas at The Cardinal Health Center.
B.
Property Loss and Damage.
The Cardinal shall not be responsible for the loss of any property belonging to you due
to theft, fire, water damage, or any cause beyond the control of The Cardinal, whether in your
Apartment or elsewhere on the Community property. The Community strongly encourages you to
obtain insurance protection to cover the full replacement value of your personal property. You shall
also be responsible for any loss or damage that you or your guests cause to property at The Cardinal,
excluding ordinary wear and tear. You hereby agree to indemnify and reimburse the Community for
any loss or damage suffered by the Community as a result of your or your guests’ or invitees’
carelessness or negligence.
C.
Right of Entry
For your safety and comfort, the staff of The Cardinal Health Center must be permitted
to enter the Apartment to perform basic housekeeping services, respond to emergencies, make repairs
and improvements, and perform other management functions as we deem necessary or advisable. In
addition, because components of The Cardinal Health Center are licensed under the North Carolina
nursing home laws, any duly authorized agent of the North Carolina Department of Health and Human
Services (the “Department”) may, upon stating the purpose of the visit, enter and inspect any licensed
portion of The Cardinal Health Center, which may include your Apartment, without advance notice.
We shall also have the right to show the Apartment to prospective residents at any reasonable time
during the thirty (30)-day period prior to the termination date for this Agreement. Whenever feasible,
our staff will attempt to give you reasonable notice before entering the Apartment.
D.
Keys and Locks.
The Cardinal shall provide you with a set of keys or electronic key fobs or cards to
access your Apartment and the common areas within The Cardinal. If you wish to make a duplicate of
a key, the key must be duplicated through services provided by the Community. You are prohibited
from distributing a key or a duplicate of a key to anyone without first obtaining the Community’s
approval. Upon its approval, the key to be distributed to an individual identified by you must be
registered with the Community. The Cardinal shall not be responsible for any loss, damage or theft of
any personal property belonging to you, your estate or your guests as a result of the duplication of your
key(s). You agree not to install additional locks or gates on any doors or windows of the Apartment
without The Cardinal’s express written consent. If the Community approves your request to install
such locks, you shall provide Community management with a key to each lock. Upon termination, you
agree to return all keys, key fobs, access cards, and other access devices for the Apartment and the
common areas within The Cardinal.
X. OTHER PERSONAL OBLIGATIONS
A.
Your Liability to Others.
You accept full responsibility for any injury or damage caused to others, or suffered by
you, as a result of your own acts or omissions, and those of your guests or invitees, and you shall
indemnify and hold harmless The Cardinal and its respective directors, agents, and employees (also
referred to as associates) from any and all liability for such injury or damage, including attorneys’ fees.
We recommend that you maintain general liability insurance in an amount and form sufficient to cover
such liability. You may be required to maintain additional insurance for personal service providers
hired by you, including worker’s compensation insurance, if and to the extent set forth in The
Cardinal’s policies and procedures.
B.
Third Party Liability.
If you are injured as the result of an act or omission of a third party, you hereby grant the
Community a lien on any judgment, settlement, or recovery in the amount of any expense incurred by
The Cardinal in caring for you as the result of such injury that is not reimbursed directly to the
Community by you or by another source. You agree to cooperate in the diligent prosecution of any
claim or action against the third party.
C.
Personal Affairs.
You agree to make reasonable advance arrangements in the event of your death or
incompetence. You may want to assign a Durable Power of Attorney (POA) for health care and
financial decision-making and we encourage you to seek appropriate professional or legal advice
regarding your options.
D.
Home Care/Personal Service Providers
Subject to applicable North Carolina assisted living laws and regulations, you may
arrange for home care or other personal services in your apartment. You and all providers of home care
or other personal services agree in writing to adhere to and comply with the Community Policies for
Personal Service Providers. If you arrange for such services, you accept full responsibility for the cost
of such services. You understand and agree that The Cardinal shall not be liable for any loss, damage,
or injury to you, another Resident, or any other person caused by providers of home care or other
personal services. The Cardinal reserves the right to review credentials of all personal service
providers and to approve or prohibit the use of particular personal service providers. As a condition of
its approval, all personal service providers must provide the Community with an appropriate release
and indemnification agreement, proof of workers’ compensation and liability insurance, as well as
proof that such personal service providers are free of tuberculosis and/or any other contagious or
communicable disease, and are subject to a criminal background check, as well as compliance with any
other requirements or policies put in place by The Cardinal from time to time. To the extent required,
you shall confirm that any approved personal service provider has workers’ compensation insurance
coverage. In the absence of such coverage, you are required to provide workers’ compensation
insurance to the extent required by law. The Cardinal reserves the right to terminate your authorization
to utilize personal service providers in the event that you or they do not comply with the requirements,
or you require transfer to another level of care under Article VII. The Cardinal does not monitor the
services of personal service providers and is not responsible for their actions or inactions or any harm
or liability they may cause.
E.
Relationships Between Residents and Associates.
You agree to cooperate with the staff of The Cardinal Health Center in performing their
duties to maintain your Apartment and provide the care and other services described in this Agreement
and in your care plan. The Cardinal instructs the Community associates to be cordial and helpful to
Residents. The relationship between Residents and associates should at all times remain professional.
Associates must not be delayed or deterred by Residents in the performance of their duties. The
supervision of associates comes from the Community supervisors and not from Residents. Any
complaints about associates or requests for special assistance must be made to the appropriate
supervisor or to the Executive Director. Giving gratuities or bequests to associates or associate’s
families is not permitted under any circumstances. You agree not to hire The Cardinal associates or
solicit such associates to resign to work for you without the prior written consent of the Community to
such arrangement. You agree not to hire any former Community associate without the written consent
of The Cardinal.
XI. LEGAL REPRESENTATIVES, RESPONSIBLE PARTIES, AND GUARANTORS.
A.
Legal Representative. A Legal Representative is an individual who has authority
to act on the Resident's behalf, under independent legal authority. Examples of a Legal Representative
include a guardian, a conservator, or the holder of a Durable Power of Attorney executed by the
Resident. Documents evidencing a person's Legal Representative status must be provided to us. If a
Resident has a court appointed guardian or conservator, the guardian or conservator is required to sign
this Agreement.
B.
Responsible Party. A Responsible Party is an individual who voluntarily agrees
to honor certain specified obligations of the Resident under this Agreement without incurring any
personal financial liability. Examples of a Responsible Party include a relative or a friend of the
Resident. We will require a person to sign this Agreement as a Responsible Party if the person has
legal access to or physical control of the Resident's income or resources to pay for the care and services
we provide and others that you request. We may decline to admit any Resident who has no source of
payment for all or part of the Resident's stay.
Guarantor. A Guarantor is an individual who has agreed to be personally liable
C.
to pay for all amounts you owe to The Cardinal Health Center for the care and services provided
hereunder. A Responsible Party or Legal Representative is not a Guarantor unless the person serving as
Responsible Party or Legal Representative also executes this Agreement as a Guarantor. If there is a
Guarantor, you agree immediately to give The Cardinal Health Center written notice of any change in
the Guarantor's financial condition, address, or telephone number. By signing this Agreement, the
Guarantor agrees promptly to pay all fees and charges incurred by you or on your behalf under this
Agreement. This is a guaranty of payment and not of collection, and The Cardinal shall be entitled to
proceed directly and immediately against the Guarantor for any overdue fees or charges without any
requirement to exhaust its remedies against you.
D.
Rights and Obligations of a Legal Representative and Responsible Party
under this Agreement:
1.
If you sign this Agreement as a Legal Representative or Responsible Party, you
incur no personal financial liability by doing so.
2.
If you sign this Agreement as a Legal Representative or Responsible Party, you
agree to use the Resident's available income and resources to pay for the Resident's care and services.
3.
By signing this Agreement as a Legal Representative or Responsible Party, you
also agree to apply for benefits to which the Resident may be entitled and to furnish third party payers
with information and documentation concerning the Resident which reasonably is available to you and
which is necessary to the processing of the Resident's application for third party payor benefits.
4.
By signing this Agreement as a Legal Representative or Responsible Party, you
have the right to participate in the care planning process for the Resident, and we will use reasonable
efforts to notify you where there is:
a. An accident or incident involving the Resident that results in injury and has the potential for
requiring physical intervention;
b. A significant change in the Resident's physical, mental, or psychosocial status; or
c. A need to alter the Resident's treatment significantly.
You are also entitled to receive all notices required to be sent to the Resident by current law or by this
Agreement.
XII. MISCELLANEOUS
A.
Accuracy of Application Documents.
As part of your application to The Cardinal Health Center, you have filed application
forms. You warrant that all information contained in these documents is true and correct, and you
understand that we have relied on this information in accepting you for residency at The Cardinal
Health Center.
B.
Examination of Records.
You acknowledge that the Department of Health and Human Services or any other State
licensing agency may inspect your residency and care records as part of an evaluation of The Cardinal
Health Center.
C.
Resident Handbook.
You agree to abide by the general policies of The Cardinal Health Center contained
below and in the Resident Handbook, as it now exists or as it may later be amended at the discretion of
The Cardinal Health Center. You received a copy of the current Resident Handbook when you signed
this Agreement. We reserve the right to amend the Resident Handbook at any time. We will provide
you a new Resident Handbook if we amend it in the future. You understand that your failure to abide
by The Cardinal Health Center’s general policies may result in termination of the Agreement by The
Cardinal Health Center. In accordance with state law, these policies must be reasonable. By signing
this Agreement you acknowledge that you have reviewed the Resident Handbook and the general
policies of The Cardinal Health Center and agree that they are reasonable. The following additional
general policies apply:
1.
Residents of The Cardinal Health Center must pay all fees and charges that are
owing to The Cardinal Health Center in accordance with their Residence and Care Agreement when
due.
2.
Residents may not breach any representation, covenant, agreement or obligation
of the resident under their Residence and Care Agreements, including but not limited to any
representation regarding financial status set forth in Appendix B, which is made part of this
Agreement.
3.
Residents must not engage in conduct that poses a danger to themselves or
others at The Cardinal Health Center, must not be disruptive, must not create unsafe conditions, and
must not be physically or verbally abusive to other residents or staff.
4.
Residents must ensure that their family members, guardians, personal
representatives or guests are not disruptive, do not create unsafe conditions, and are not physically or
verbally abusive to the detriment of the resident, other residents or staff.
5.
Residents must not engage in conduct that violates federal, state, or local laws or
ordinances.
If you wish to suggest changes to the general policies of The Cardinal Health Center
you may do so at any time by notifying the Executive Director.
D. Guest Visits and Communications.
We encourage family visits and communication. Your guests are welcome to visit and
participate in appropriate activities at The Cardinal Health Center, if you so desire, provided they
respect the rights of other residents and staff and abide by our visitor and guest policies, including
reasonable limitations on the length of stay and frequency of visits. You will be responsible for
assuring that your guests abide by these rules and are not disruptive. All visitors must register at the
front desk when entering The Cardinal Health Center. We reserve the right to remove or deny entry
to The Cardinal Health Center to any visitor whom we determine is disruptive or dangerous.
E.
Smoking Policy.
The Cardinal is a smoke free community and smoking is not permitted in your
Apartment or any of the common areas of The Cardinal.
F.
Pet Policy.
Pets are not allowed in The Cardinal Health Center, except for service animals
providing assistance to residents with disabilities.
G.
Motorized Cart
If you at any time you intend to utilize a motorized cart, you must abide by The
Cardinal Health Center's rules set forth in the Resident Handbook and a separate Motorized Cart
Policy.
H.
Assignment.
The Cardinal Health Center reserves the right to assign this Agreement to any
successor-in-interest selected by it. You may not transfer or assign your right to use the services and
accommodations at The Cardinal Health Center to any other individual or entity.
I.
Personal Rights.
Consistent with North Carolina law, you shall have the rights set forth in the Statement
of Residents’ Personal Rights, which is attached to this Agreement as Appendix C.
J.
Notices.
All notices given under this Agreement shall be in writing and shall be addressed to The Cardinal
Health Center at its administrative office at The Cardinal Health Center or to you at your Apartment. Such
notices shall be effective when personally delivered or two (2) days after being deposited in the United
States mail, properly addressed and first class postage prepaid.
K.
Grievances.
If you have a grievance or complaint regarding The Cardinal Health Center you may
contact the Executive Director or the home office of Kisco Senior Living at 1-866-KISCO SL (866547-2675). A copy of the community’s grievance procedure for resolution of resident complaints is
available upon request.
L.
Entire Agreement.
This Agreement (together with the documents and appendices referenced herein)
constitutes the entire agreement between you and The Cardinal Health Center and may be amended
only by a written instrument signed by you and by an authorized representative of The Cardinal Health
Center. If any part of this Agreement is held to be invalid or unenforceable, the remainder of the
Agreement shall remain valid and enforceable, unless the context requires otherwise.
M.
Waiver.
The failure of The Cardinal Health Center in any instance or instances to insist upon
your strict performance or observation of or compliance with, any of the terms or provisions of this
Agreement, shall not be construed to be a waiver or relinquishment of its right to insist upon your strict
compliance with all of the terms and provisions of this Agreement. In addition, acceptance by The
Cardinal Health Center of any payment from you after your breach of any term of this Agreement or
after providing you with a notice of termination based on a reappraisal as described in Section
VIII.B.1.d, above, shall not constitute a waiver of the right of The Cardinal Health Center to insist
upon full performance of all terms of this Agreement, nor shall it waive The Cardinal Health Center’s
right to terminate this Agreement for any breach previously committed or to terminate in accordance
with Section VIII.B.1.d.
N. ARBITRATION.
BY INITIALING BELOW, YOU AGREE THAT ANY AND ALL CLAIMS AND DISPUTES
ARISING FROM OR RELATED TO THIS AGREEMENT OR TO YOUR RESIDENCY, CARE OR
SERVICES AT THE CARDINAL HEALTH CENTER, WHETHER MADE AGAINST US OR ANY
OTHER INDIVIDUAL OR ENTITY, INCLUDING, WITHOUT LIMITATION, PERSONAL
INJURY CLAIMS, SHALL BE RESOLVED BY SUBMISSION TO NEUTRAL, BINDING
ARBITRATION IN ACCORDANCE WITH THE FEDERAL ARBITRATION ACT; EXCEPT
THAT ANY CLAIM OR DISPUTE INVOLVING SUMMARY EJECTMENT PROCEEDINGS
(EVICTION) OR ANY CLAIMS THAT CAN BE BROUGHT IN SMALL CLAIMS COURT SHALL
NOT BE SUBJECT TO ARBITRATION UNLESS BOTH PARTIES AGREE TO ARBITRATE
SUCH PROCEEDINGS. BOTH PARTIES GIVE UP THEIR CONSTITUTIONAL RIGHTS TO
HAVE ANY SUCH DISPUTE DECIDED IN A COURT OF LAW BEFORE A JURY, AND
INSTEAD ACCEPT THE USE OF ARBITRATION. THE ARBITRATION SHALL BE
CONDUCTED IN WAKE COUNTY, NORTH CAROLINA BY A SINGLE NEUTRAL
ARBITRATOR SELECTED BY THE CARDINAL HEALTH CENTER, UNLESS OTHERWISE
MUTUALLY AGREED. IN REACHING A DECISION, THE ARBITRATOR SHALL PREPARE A
WRITTEN DECISION THAT INCLUDES FINDINGS OF FACT, THE REASONS UNDERLYING
THE DECISION, AND CONCLUSIONS OF LAW. EACH PARTY SHALL BEAR ITS OWN
COSTS AND FEES IN CONNECTION WITH THE ARBITRATION. THIS ARBITRATION
CLAUSE BINDS ALL PARTIES TO THIS AGREEMENT AND THEIR SPOUSES, HEIRS,
REPRESENTATIVES, EXECUTORS, EXECUTIVE DIRECTORS, SUCCESSORS, ASSIGNS,
MANAGERS, AND AGENTS AS APPLICABLE. AFTER TERMINATION OF THIS
AGREEMENT, THIS ARBITRATION CLAUSE SHALL REMAIN IN EFFECT FOR THE
RESOLUTION OF ALL CLAIMS AND DISPUTES THAT ARE UNRESOLVED AS OF THAT
DATE. IN THE EVENT THAT ANY PART OF THIS ARBITRATION CLAUSE IS DETERMINED
TO BE UNENFORCEABLE, THE REMAINING PORTIONS OF THE CLAUSE SHALL REMAIN
VALID AND SHALL BE ENFORCED BY THE PARTIES. IF THE FEDERAL ARBITRATION
ACT DOES NOT PERMIT ARBITRATION IN ACCORDANCE WITH THIS CLAUSE, THEN THE
MATTER SHALL BE ARBITRATED IN ACCORDANCE WITH STATE LAW.
BY INITIALING BELOW, YOU WARRANT THAT THIS PARAGRAPH HAS BEEN
EXPLAINED TO YOU, THAT YOU UNDERSTAND ITS SIGNIFICANCE, THAT YOU
VOLUNTARILY AGREE TO BE BOUND BY IT.
INITIALS: __________ / _________
POA/Guarantor Initials
A. Resident Acknowledgment. –
By signing below, you acknowledge all of the following:
1.
You have received a signed copy of this Residence and Care Agreement, which
specifies the services and accommodations that you will receive at The Cardinal Health Center and the
charges for such services;
2.
You have received a written copy of the Resident Handbook, which contains the
rules and regulations and grievance policies for The Cardinal Health Center residents;
3.
You have received a copy of the Statement of Residents’ Personal Rights, which
is attached to this Agreement as Appendix C;
4.
The Cardinal staff has indicated to you whether the Cardinal has signed Form
DSS-1464 concerning compliance with Title VI of the Civil Rights Act;
5.
You or your family members, as appropriate, have received the information that
must be disclosed under Section 131D-8 of the North Carolina Statutes and Rule 1906 of the
Administrative Code for specialized memory support.
B. Governing Law.
This Agreement shall be governed by North Carolina law.
This Agreement shall be effective as of _____________ , _____.
RESIDENT:
________________________________
Signature
________________________________
Printed Name
________________________________
Date of Birth
________________________________
Date of Move-In
________________________________
Date
RESIDENT:
Signature
________________________________
Printed
Name
________________________________
Date of Birth
________________________________
Date of Move-In
________________________________
Date
COMMUNITY:
___________________________________
________________________________
By
________________________________
Title
________________________________
Community
________________________________
Address
________________________________
Date
LEGAL REPRESENTATIVE:
(Power of Attorney, Guardian, etc.)
RESPONSIBLE PERSON:
________________________________
Signature
________________________________
Printed Name
________________________________
Address
________________________________
Phone Number
________________________________
Date
________________________________
Signature
________________________________
Printed Name
________________________________
Address
________________________________
Phone Number
________________________________
Date
By signing below, the undersigned Guarantor hereby agrees to be fully and personally liable for,
and agrees to pay promptly upon request, all amounts owed to The Cardinal by the Resident.
The undersigned agrees that The Cardinal shall not be obligated to pursue any legal action or
obtain any judgment against the Resident or the Resident’s assets as a condition to requiring
payment by Guarantor.
GUARANTOR:
________________________________
Signature
________________________________
Printed Name
________________________________
Address
________________________________
Phone Number
_______________________________
Date
Appendix B
FINANCIAL STATUS
The Cardinal Health Center is a component of a continuing care retirement community that
depends on a predictable level of private pay fees in order to operate on a sound financial basis
and provide an appropriate level of care and services to our residents. This means that we are
not able to accept residents who receive or who are eligible to receive Social Security
Supplemental Security Income benefits (“SSI”). By signing below, you represent and warrant
that you are not an SSI recipient, that you have sufficient assets and income so that you do not
currently qualify for SSI and will not so qualify for the foreseeable future, and you warrant that
you will not apply for SSI benefits nor allow anyone to apply for SSI benefits on your behalf
while you are a resident of The Cardinal Health Center.
Signed: Resident ___________________ __________________________
Responsible Party ____________________________________________
Appendix C
THE CARDINAL HEALTH CENTER
STATEMENT OF RESIDENTS' PERSONAL RIGHTS
Pursuant to North Carolina General Statutes Section 131D-21, every resident shall have
the following rights:
(1)
To be treated with respect, consideration, dignity, and full recognition of his or
her individuality and right to privacy.
(2)
To receive care and services which are adequate, appropriate, and in compliance
with relevant federal and State laws and rules and regulations.
(3)
To receive upon admission and during his or her stay a written statement of the
services provided by the facility and the charges for these services.
(4)
To be free of mental and physical abuse, neglect, and exploitation.
(5)
Except in emergencies, to be free from chemical and physical restraint unless
authorized for a specified period of time by a physician according to clear and
indicated medical need.
(6)
To have his or her personal and medical records kept confidential and not
disclosed except as permitted or required by applicable State or federal law.
(7)
To receive a reasonable response to his or her requests from the facility
administrator and staff.
(8)
To associate and communicate privately and without restriction with people and
groups of his or her own choice on his or her own or their initiative at any
reasonable hour.
(9)
To have access at any reasonable hour to a telephone where he or she may speak
privately.
(10)
To send and receive mail promptly and unopened, unless the resident requests that
someone open and read mail, and to have access at his or her expense to writing
instruments, stationery, and postage.
(11)
To be encouraged to exercise his or her rights as a resident and citizen, and to
be permitted to make complaints and suggestions without fear of coercion or
retaliation.
(12)
To have and use his or her own possessions where reasonable and have an
accessible, lockable space provided for security of personal valuables. This space
shall be accessible only to the resident, the administrator, or supervisor-in-charge.
(13)
To manage his or her personal needs funds unless such authority has been
delegated to another. If authority to manage personal needs funds has been
delegated to the facility, the resident has the right to examine the account at
any time.
(14)
To be notified when the facility is issued a provisional license or notice of
revocation of license by the North Carolina Department of Health and Human
Services and the basis on which the provisional license or notice of revocation of
license was issued. The resident's responsible family member or guardian shall
also be notified.
(15)
To have freedom to participate by choice in accessible community activities and
in social, political, medical, and religious resources and to have freedom to refuse
such participation.
(16)
To receive upon admission to the facility a copy of this section.
(17)
To not be transferred or discharged from a facility except for medical reasons, the
residents' own or other residents' welfare, nonpayment for the stay, or when the
transfer is mandated under State or federal law. The resident shall be given at
least 30 days' advance notice to ensure orderly transfer or discharge, except in the
case of jeopardy to the health or safety of the resident or others in the home. The
resident has the right to appeal a facility's attempt to transfer or discharge the
resident pursuant to rules adopted by the Medical Care Commission, and the
resident shall be allowed to remain in the facility until resolution of the appeal
unless otherwise provided by law. The Medical Care Commission shall adopt
rules pertaining to the transfer and discharge of residents that offer protections to
residents for safe and orderly transfer and discharge.
By signing below, you acknowledge that you have received a copy of the personal rights
delineated above and outlined in North Carolina General Statutes Section 131D-21at the time of
your move-in:
Resident: ___________________________________
Date: _____________
Resident: ___________________________________
Date: ___________
Exhibit K
The Cardinal at North Hills
Skilled Nursing Care Residence and Care Agreement
THE CARDINAL AT NORTH HILLS
HEALTH CENTER
SKILLED NURSING RESIDENCE AND CARE
AGREEMENT
May 2016
TABLE OF CONTENTS
Page
I.
CORE SERVICES .................................................................................................. 3
II.
PERSONAL ASSISTANCE AND CARE ........................................................... 5
III.
OPTIONAL SERVICES ...................................................................................... 6
IV.
EXCLUDED HEALTH-RELATED SERVICES ................................................... 7
V.
TERM OF AGREEMENT ...................................................................................... 7
VI.
FEES ....................................................................................................................... 8
VII. TRANSFERS FROM APARTMENT .................................................................. 11
VIII. TERMINATION ................................................................................................... 12
IX. YOUR PROPERTY RIGHTS AND OBLIGATIONS ........................................... 15
X.
OTHER PERSONAL OBLIGATIONS ................................................................ 16
XI. LEGAL REPRESENTATIVES, RESPONSIBLE PARTIES, AND
GUARANTORS ............................................................................................................. 17
XII. MEDICAL TREATMENT ……………………………………………………..19
XIII. MISCELLANEOUS ………………………………………………………..…..20
APPENDIX A
FEES FOR OPTIONAL SERVICES AND LEVELS
OF CARE
APPENDIX B
FINANCIAL STATUS
APPENDIX C
STATEMENT OF RESIDENTS' PERSONAL RIGHTS
APPENDIX D
HOLDING BED SPACE
APPENDIX E
PAYMENTS BY THIRD PARTY PAYORS
THE CARDINAL AT NORTH HILLS
HEALTH CENTER
SKILLED NURSING
RESIDENCE AND CARE AGREEMENT
This Residence and Care Agreement (“Agreement”) is made by and among The Cardinal at
North Hills Healthcare, LLC, (“Cardinal Healthcare”) doing business as “The Cardinal Health Center”
located at [address], and its agent Kisco Senior Living, LLC, a Delaware limited liability company
(“Kisco Senior Living”), on the one hand, and ____________________________ ("you") on the other.
Where appropriate, Cardinal Healthcare and Kisco Senior Living are collectively referred to in this
Agreement as “we,” us, or "our". (If more than one person is signing this Agreement, "you" refers to
each of you individually and to both of you together.)
Cardinal Healthcare operates The Cardinal Health Center, which is the assisted living, memory
care and skilled nursing component of The Cardinal, a licensed Continuing Care Retirement
Community located in Raleigh, North Carolina, which provides residences, care and services to
persons 62 years of age and older (“The Cardinal”). Kisco Senior Living manages The Cardinal Health
Center on behalf of Cardinal Healthcare. The Cardinal is operated on a non-discriminatory basis and
affords equal treatment and access to services to eligible persons regardless of race, color, religion,
creed, gender, national origin, ancestry, or sexual orientation.
You have applied for accommodations at The Cardinal Health Center for Nursing Care and
your application has been accepted. The purpose of this Agreement is to provide a statement of the
services that we will furnish to you at The Cardinal Health Center, and the other legal obligations that
The Cardinal Health Center will assume. This Agreement also sets forth your legal obligations to The
Cardinal Health Center, both financial and non-financial. If your move to The Cardinal Health Center
is temporary in nature then this Agreement supplements, but does not replace or amend, the
Independent Living Residence Agreement you signed when you became a resident of the independent
living portion of The Cardinal. If your move to The Cardinal Health Center is permanent then the
Independent Living Residence Agreement will terminate in accordance with the provisions therein.
I.
CORE SERVICES
You will be provided with the following Core Services at The Cardinal Health Center, subject to
the terms of this Agreement. These services are included in your Daily Health Center Fee unless
otherwise indicated. If you (singly or jointly with another person) currently occupy a Residence in the
independent living component of The Cardinal, the Daily Health Center Fee is in addition to any fees
that may be owed to The Cardinal with respect to that Residence, in accordance with your Independent
Living Residence Agreement.
A. Living Accommodations.
1.
Residence. You have chosen to live in Apartment #______ ("the Apartment") at
The Cardinal Health Center. You may live in the Apartment on a daily basis, subject to the terms of this
Agreement and to the general policies of The Cardinal Health Center, contained in the Resident
Handbook as it now exists and as it may later be amended, and to the other written rules and policies of
The Cardinal Health Center.
2.
Utilities. Utilities included in the Daily Health Center Fee for the Residence are
electricity, water and sewer, trash removal, basic internet/data services, and basic cable TV service. You
are responsible for paying for all other utilities and service charges including local and long distance
telephone charges, premium internet/data services and premium TV service fees. The Cardinal reserves
the right to establish maximum usage levels, and to charge you for any excessive or unreasonable usage
due to waste or abuse.
3.
Furnishings. Your Apartment comes equipped with basic furnishings, and floor
and window coverings. You are also free to use your own small electric appliances and special
equipment, provided that The Cardinal Health Center's safety standards are met. For your safety and the
safety of all other residents of The Cardinal Health Center, cooking in your Apartment is not allowed.
You may furnish the Apartment with your own furniture, if appropriate for your health condition and
provided that The Cardinal Health Center's safety standards are met. You may decorate your Apartment
with items that are not permanent fixtures to the Apartment and can be easily removed without changing
or damaging the aesthetic or structural integrity of the Apartment. You or your estate will be responsible
for removing your furnishings and other items when your Apartment is vacated.
4.
Maintenance. We will perform all necessary maintenance and repairs of the
Apartment and the furnishings and equipment provided by The Cardinal at our expense. You will be
responsible for any necessary maintenance and repairs of equipment and furnishings you provide. You
will be responsible for reimbursing the Community for any damage to the Apartment or the furnishings
and equipment provided by The Cardinal other than normal wear and tear.
5.
Alterations. Any physical change to the Apartment requires the prior written
approval of the Executive Director of The Cardinal, and shall be made at your own expense. If you
obtain such approval, you will be responsible for restoring the original decor when the Apartment is
vacated, unless we specifically exempt you from this requirement in writing. Note- No structural
changes to your Apartment are allowed.
6.
Common Facilities. You will be entitled to share with all other residents of The
Cardinal Health Center the use of the common areas, including the dining areas, lounge areas, library,
beauty/barber shop, multi-purpose rooms and recreation rooms. We may change or reconfigure common
spaces in the future at our discretion.
B.
Laundry.
Basic personal laundry and linen services are provided as described in the Resident
Handbook. Additional or more frequent laundry services are available and will be charged as set forth in
Appendix A. You shall be responsible for your personal dry cleaning.
C.
Housekeeping.
The Cardinal Health Center will provide housekeeping services in your Apartment as
described in the Resident Handbook. Additional housekeeping services as needed or requested will be
available for an additional charge (see Appendix A).
D.
Personal Supplies.
We assume that residents wish to provide their own supplies for personal care and
hygiene. However, if you are unable to provide such supplies or choose not to provide them, we will
provide you with personal items for an additional charge (see Appendix A).
B.
Medical Supplies.
If your physician orders medical supplies, you may provide those supplies yourself or
you may ask that we provide them for an additional charge (see Appendix A)
E.
Meals.
Three meals will be served daily to residents at The Cardinal Health Center and snacks
will likewise be made available. These meals and snacks are included in your Daily Health Center Fee.
We will also accommodate some special diets, if prescribed by your physician as a medical necessity
which may require an additional charge,. . If your physician prescribes supplements, you may provide
them yourself or you may ask that we provide them for an additional charge (see Appendix A). You
will also be charged a fee for any special diets or supplements not prescribed by your physician that you
request and that we agree to provide.
1.
Room Service. We will provide room service to your Apartment, as set forth in
the Resident Handbook. There may be an additional charge for room service outside of regularly
scheduled meals and snacks, as set forth in Appendix A.
2.
Guests. Guests are welcome to any meal as set forth in the Resident Handbook.
There will be a fee for guest meals (see Appendix A). If your guest is a resident in the independent
living component of The Cardinal, your guest may use his or her dining account to pay for guest meals
in the Health Center.
F.
Planned Activities.
The Community has a program of social, emotional, intellectual, physical, spiritual, and
vocational activities, both at and away from The Cardinal Health Center. You are welcome to participate
in such activities as desired. There may be an extra charge for some of the activities offered by the
Community which require additional supplies or services provided by an outside vendor or outings which
are away from The Cardinal Health Center as set forth in Appendix A.
G.
Transportation.
We will make available to residents or otherwise assure the provision of scheduled
transportation to the nearest appropriate health facilities for medical and dental appointments, social
services agencies, shopping and recreational facilities, and religious activities as outlined in the
Resident Handbook. We will provide or arrange for additional personal transportation for a charge
(see Appendix A).
H.
Emergency Response and Fire Protection.
Your Apartment will be equipped with an emergency call system, smoke detector and
sprinkler system. The call system is monitored 24 hours per day to alert staff to emergencies and
illnesses. When the staff at The Cardinal Health Center determines that, in its judgment, an emergency
exists, staff may call 911 based on the nature of the emergency.
II. PERSONAL ASSISTANCE AND CARE.
Staff of The Cardinal Health Center will regularly observe your medical condition and
help identify health, medical, dietary and social needs or needs for special services. In accordance with
your plan of care and applicable North Carolina law, The Cardinal Health Center will provide you with
the care and services necessary to enable you to attain and maintain the highest practical level of
physical, emotional, and social well-being within the appropriate setting.
When you applied for move-in to The Cardinal Health Center, your attending physician
and professional staff performed an assessment of your needs. Within twenty (24) hours of your movein, a nursing assessment will be completed by a registered nurse to determine the appropriate level of
service for you. We will reassess you within fourteen (14) days and then periodically as needed in light
of your changing needs. The Daily Health Center Fee will be determined by the level of care required to
meet your needs, as determined by the initial assessment and periodic reassessments. The Daily Health
Center Fee is discussed in more detail in Section VI of this Agreement.
Please note that The Cardinal Health Center does not permit use of restraints on its
residents, and the use of restraints is also inconsistent with our philosophy. We encourage our residents
to participate in physical activities to the extent of their capabilities. Thus, falls and other personal
injuries may occur from time to time.
III. OPTIONAL SERVICES
The Cardinal Health Center will make available to you several optional services at an extra
charge, to be billed on a monthly basis. Some of the optional services offered by The Cardinal Health
Center include:
1. Guest meals and services; 2. Room service outside of regularly scheduled meals and snacks; 3. Personal transportation and supervision; 4. Beauty/barber shop services ; 5. Provision of certain personal supplies described in Section I.D above; 6. Provision of certain medical supplies described in Section I.E above; 7. Additional laundry and housekeeping services beyond those referenced in Sections I.B and
I.C above; 8. Repairs and maintenance of personal items; and 9. Any other optional services that we elect to offer in the future. The current fees for
optional services at The Cardinal Health Center are set forth in attached Appendix A,
and are subject to change as provided in Section VI.D below. IV. EXCLUDED HEALTH-RELATED SERVICES
The Cardinal Health Center shall not be responsible for furnishing or paying for any health care
items or services not expressly included in this Agreement, including but not limited to home health,
hospice, physicians' services, surgery, hospital care, home care, private duty care, treatment or
examination of eyes or teeth, medications, medical supplies, vitamins, eyeglasses, contact lenses,
hearing aids, orthopedic appliances, prosthetic devices, laboratory tests, x-ray services, toiletries and
personal supplies not required to be provided under Section I.D above, or other care or equipment
beyond The Cardinal Health Center 's routine levels of staffing and equipment.
V.
TERM OF AGREEMENT
This Agreement shall be in effect from month to month, unless and until it is terminated as set
forth in Section VIII below.
VI.
FEES
Daily Health Center Fee.
Prior to occupancy of your Apartment, you must pay an amount equal to thirty (30)
days of Daily Health Center Fees at the level of care determined by your initial assessment. This
amount will be credited to the Daily Health Center Fees incurred by you after you occupy your
Apartment. At the beginning of each month thereafter, you must pay an amount equal to (i) thirty (30)
days of the Daily Health Center Fee for the level of care in effect as of the day of payment, to be
credited to the Daily Health Center Fees incurred by you during such month, plus or minus (ii) any
excess amount owed by you to The Cardinal on account of an increase in your Daily Health Center
Fees during the prior month(s) or any amount owed by The Cardinal to you on account of a decrease in
your Daily Health Center Fees during the prior month(s). You will receive a statement setting forth the
amount due prior to the first (1st) day of each month. Daily Health Center Fees described in this
Section are payable by the first (1st) day of each calendar month, and are considered delinquent if not
received by thefifth (5th) day of the month. Your right to occupy and use the Apartment and to receive
services at The Cardinal Health Center is contingent upon timely payment of Daily Health Center Fees
and all other applicable charges and fees under this Agreement.
B.
Fees for Optional Services.
The charges for all optional services at The Cardinal Health Center shall be as set forth in
Appendix A, which is attached to this Agreement. Appendix A is subject to change from time to time.
You will be given notice of any planned change in the fees set forth in Appendix A, as described in
subsection D below. Charges for optional services will be billed on your monthly statement, and are
payable by the first (1st) day of each calendar month and are considered delinquent if not received by
the fifth (5th) day of the month.
C.
Adjustments to Fees or Services.
1.
Fees. The Community shall give thirty (30) days’ prior written notice to you of
any change in the schedule of Daily Health Center Fees associated with each level of care, and any
change in the schedule of fees for optional services, as set forth in Appendix A. In the event of a rate
increase, The Cardinal Health Center will include with the notice of the increase the reasons for the
increase and a general summary of the additional costs that led to the increase. When your level of care
changes so that your Daily Health Center Fee increases or decreases in accordance with the schedule of
fees then in effect, you will begin paying the Daily Health Center Fee associated with the new level of
care immediately.
2.
Services. The Community may modify the services provided under this
Agreement upon thirty (30) days’ prior written notice, provided that the services do not fall below the
standards established by applicable North Carolina regulatory authorities.
E.
Payment and Failure to Make Payments.
You will be required to make all payments due to The Cardinal Health Center in a timely
manner and otherwise fulfill your financial obligations to The Cardinal Health Center. The Cardinal
Health Center does not participate in the Medicaid program. We do not accept SSI/SSP eligible residents
for move-in to The Cardinal Health Center. Payment shall be made to The Cardinal Health Center by
check or money order and either mailed to _______________________________or delivered to the
business office at The Cardinal Health Center, or you may arrange for automatic payments from a
financial institution. If you fail to pay your Daily Health Center Fee or other charges by the fifth (5th)
day of each calendar month, The Cardinal Health Center may charge you a late payment fee (as
described in Appendix A) for each delinquent payment. You will receive a monthly statement that
itemizes any fees or charges you have incurred. Returned checks shall be subject to a penalty as
described in Appendix A.
F.
Guarantor
Your care and services at The Cardinal Health Center shall be guaranteed by ___
_______________________________("Guarantor"). You agree to provide The Cardinal Health Center
with timely written notice of any change in Guarantor's financial condition, address, or telephone
number. By signing below, Guarantor agrees promptly to pay all fees and charges incurred by you or
on your behalf under this Agreement. The foregoing is a guaranty of payment and not of collection,
and The Cardinal shall have no obligation to file suit or obtain a judgment against you prior to
enforcing its rights against the Guarantor.
G.
Change of Level of Care
The staff of The Cardinal Health Center will perform a periodic reappraisal of your
needs. If we determine that you need a different level of care than that which you are currently
receiving, The Cardinal Health Center will provide you and your responsible person, if applicable,
with written notice of the change. You agree to change to a level of care appropriate to your needs.
The rate for the new level of care, as set forth in Appendix A, shall apply immediately.
VII. TRANSFERS
A.
Transfer for More Appropriate Care.
The portion of The Cardinal Health Center in which you will reside is licensed by the state
of North Carolina as a Nursing Home. You may remain in the portion of The Cardinal Health Center as
long as doing so is permitted by applicable licensure laws and fire safety standards, and, in the judgment
of the staff of The Cardinal Health Center, your care needs and levels of functioning are consistent with
those of other residents and with the level of staffing and services offered at The Cardinal Health Center,
and your presence does not create a danger to yourself or others. If the staff of The Cardinal Health
Center determines that it is inappropriate for you to remain in your Apartment, you may be asked to
move from The Cardinal Health Center or to an outside facility, and this Agreement will terminate in
accordance with Section VIII. During your transition to another setting that can meet your needs, you
may be required to obtain temporary one-on-one care from an outside provider as determined at the sole
discretion of the Executive Director. You will be financially responsible for this service which will be
billed directly to you by the responsible company or The Cardinal Health Center in accordance with
Appendix A.
B.
Substitution of Apartment.
We may need to substitute your Apartment with another to comply with any law or
lawful order of any authorized public official, or for any other reasonable purpose, as determined by
The Cardinal Health Center. You agree to such substitution and agree to pay the Daily Health Center
Fee applicable to the new Apartment.
C.
Voluntary Apartment Change
Your request for a change of apartment may be granted at The Cardinal Health Center’s
discretion. You will pay the then-applicable Daily Health Center Fee for the new Apartment beginning
on your first day of occupancy. If you move on a day other than the first day of the month, any
difference in rates between your current Apartment and the new Apartment will be credited or debited to
your account, as the case may be, on a pro rata basis. You will be responsible for all costs associated
with the move, including an apartment transfer fee as noted in Appendix A.
VIII. TERMINATION
A.
Termination by You.
You may terminate this Agreement and discharge yourself from receiving nursing care at
The Cardinal Health Center and return to your independent living Residence or assisted living
Apartment at The Cardinal by giving us two days advance notice, provided that your health condition is
such that The Cardinal Health Center can accept your return as an assisted living resident within the
assisted living laws and regulations of the state of North Carolina. If you are discharging from nursing
care and departing The Cardinal (for any reason other than your death), you must also give us two days
advance notice. You may depart your Apartment at any time, subject to our right to charge you for two
(2) days of the Daily Health Center Fee if you leave without providing the required two (2) day advance
notice. Your estate will not be charged for the two (2) days stay if the inability to give the required two
(2) day advance notice is caused by your death. We will provide assistance and consult with your
physician, Legal Representative and/or Responsible Person in arranging for your voluntary transfer or
discharge.
B.
Termination by Community.
1.
Internal Transfer. After consultation with your physician, Legal Representative,
and/or Responsible Person, The Cardinal Health Center may transfer you back to your independent
living Residence or assisted living Apartment at The Cardinal upon thirty (30) days advance notice of
such transfer if we determine that the transfer or discharge is appropriate because your health has
improved sufficiently so that you no longer need nursing care services.
2.
Upon Thirty (30) Days’ Notice. The Cardinal Health Center may terminate this
Agreement upon thirty (30) days’ written and verbal notice to you and your Legal Representative and/or
Responsible Person, if applicable, if any of the following events occur:
a. Nonpayment of any amounts owed by you, including the Daily Health Center
Fees, within ten (10) days of the due date;
b. Your failure to comply with State or local law after receiving written notice of
the alleged violation;
c. Your failure to comply with general policies of The Cardinal Health Center as
described in this Agreement, in the Resident Handbook, or as determined by the Executive Director; or
d. If after move-in, it is determined that discharge is necessary for your welfare
because your needs can no longer be met at The Cardinal Health Center.
3.
Upon Three (3) Days Notice. In addition, The Cardinal Health Center may
terminate this agreement upon three (3) days written notice for good cause. Good cause exists if we
determine that your continued presence at The Cardinal Health Center poses a threat to the mental
and/or physical health or safety of yourself or to the mental and/or physical health or safety of others in
the Community.
4.
Notice. If the Community terminates this Agreement under Section VIII.B., you
and your personal representative (if any) shall receive a notice describing the reasons for such
termination.
5.
Discharge Planning. The community will work with you, your physician, and
your responsible party to create a discharge plan. This plan will be designed according to each
resident’s needs.
6.
Appeal. If you wish to appeal a termination, you may do so by requesting a
review in writing to the Chief Operating Officer of Kisco Senior Living within ten (10) days following
the termination notice. The Chief Operating Officer or designee will schedule a meeting with you and
your representatives during which you can present reasons why the termination should not occur. The
Chief Operating Officer will then make a final determination which will be provided to you in writing.
7.
Conditions That May Lead To Reassessment. Please note that the following
conditions, among others, may lead to a reassessment and a termination of your residency in accordance
with paragraph VIII.B.1.d above. Termination may occur if:
a. You do not meet the requirements for residency established by state law and
regulations.
b. You present an immediate physical threat or danger to yourself or others.
c. You have active communicable tuberculosis or another communicable disease.
d. You have an unstable medical condition which requires services above
those provided in care setting
e. You have needs in conflict with other residents or the programs of services
offered.
f. You have a primary need for care and supervision that results from a mental
disorder causing ongoing behavior which would upset the general resident group, or which would
require us to provide to you a greater amount of care and supervision than other residents at The
Cardinal Health Center or if you cannot generally benefit from the program of services available at The
Cardinal Health Center.
g. You refuse to accept services required in order for The Cardinal Health Center
to meet your needs.
h. You have health care needs that cannot be met at The Cardinal Health Center
for reasons such as licensure, design or staffing, including, but not limited to, conditions that require
physical or chemical restraints, unstable mental health diagnosis, swallowing difficulties or other
conditions that create a choking risk, complex special diets, any unstable medical condition or
conditions that cannot be accommodated by The Cardinal Health Center as defined by state licensing
regulations.
j.
Your personal physician has determined that you require services
not available at The Cardinal Health Center.
k.
If your condition changes so that you are considered a wandering or
significant fall risk.
C.
Your Death.
This Agreement shall terminate automatically upon your death.
D.
Move Out and Refund.
1.
Vacating Apartment. If this Agreement is terminated for any reason, you or
your estate must vacate the Apartment and remove all of your property from it. You or your estate
shall remain liable for the Daily Health Center Fee, calculated at the lowest level of care, until all
property is removed from your apartment and it is restored to a clean condition (except for normal
wear and tear), whichever occurs later. The Cardinal Health Center may also remove your property
from the Apartment and charge you or your estate a property storage fee if either you or your estate
fails to vacate the Apartment and remove your personal belongings from it in a timely manner. If you
or your estate abandons your personal property following termination of this Agreement, The Cardinal
Health Center shall have the right to dispose of such abandoned property in accordance with state law.
The Cardinal Health Center has the right to enforce the provisions of this section by appropriate legal
proceedings.
2.
Refund of Unused Portion of Daily Health Center Fee. Following termination of
this Agreement, The Cardinal Health Center will pay you or your estate a refund equal to any Daily
Health Center Fees received by The Cardinal in excess of those required by VIII.D.1. above, or other
amounts that The Cardinal Health Center owes to you, minus the following: (i) the amount of any
unpaid Daily Health Center Fees or other charges that you owe to The Cardinal Health Center under
this Agreement; (ii) the costs of repairing any damage to the Apartment that is not caused by normal
wear and tear; (iii) the costs of repairing any of The Cardinal Health Center’s property that was
damaged by you or your visitors; and (iv) any expense incurred by The Cardinal Health Center to
remove and/or store any of your property that was not removed when you vacated the Apartment. You
or your estate will receive any refund that is due within thirty (30) days following the effective
termination date.
3.
Survival. Section VIII. D. shall survive the termination of this Agreement.
IX. YOUR PROPERTY RIGHTS AND OBLIGATIONS
A.
No Management or Property Interest.
This Agreement shall give you no property right or management interest in The Cardinal
Health Center, The Cardinal, or any of their assets. In addition, you shall have no right to any of The
Cardinal Health Center's personal property, including furnishings and fixtures in the Apartment or in
the common areas at The Cardinal Health Center.
B.
Property Loss and Damage.
The Cardinal shall not be responsible for the loss of any property belonging to you due
to theft, fire, water damage, or any cause beyond the control of The Cardinal, whether in your
Apartment or elsewhere on the Community property. The Community strongly encourages you to
obtain insurance protection to cover the full replacement value of your personal property. You shall
also be responsible for any loss or damage that you or your guests cause to property at The Cardinal,
excluding ordinary wear and tear. You hereby agree to indemnify and reimburse the Community for
any loss or damage suffered by the Community as a result of your or your guests’ or invitees’
carelessness or negligence.
C.
Right of Entry
For your safety and comfort, the staff of The Cardinal Health Center must be permitted
to enter the Apartment to perform basic housekeeping services, respond to emergencies, make repairs
and improvements, and perform other management functions as we deem necessary or advisable. In
addition, because components of The Cardinal Health Center are licensed under the North Carolina
nursing home laws, any duly authorized agent of the North Carolina Department of Health and Human
Services (the “Department”) may, upon stating the purpose of the visit, enter and inspect any licensed
portion of The Cardinal Health Center, which may include your Apartment, without advance notice.
We shall also have the right to show the Apartment to prospective residents at any reasonable time
during the thirty (30)-day period prior to the termination date for this Agreement. Whenever feasible,
our staff will attempt to give you reasonable notice before entering the Apartment.
D.
Keys and Locks.
The Cardinal shall provide you with a set of keys or electronic key fobs or cards to
access your Apartment and the common areas within The Cardinal. If you wish to make a duplicate of
a key, the key must be duplicated through services provided by the Community. You are prohibited
from distributing a key or a duplicate of a key to anyone without first obtaining the Community’s
approval. Upon its approval, the key to be distributed to an individual identified by you must be
registered with the Community. The Cardinal shall not be responsible for any loss, damage or theft of
any personal property belonging to you, your estate or your guests as a result of the duplication of your
key(s). You agree not to install additional locks or gates on any doors or windows of the Apartment
without The Cardinal’s express written consent. If the Community approves your request to install
such locks, you shall provide Community management with a key to each lock. Upon termination, you
agree to return all keys, key fobs, access cards, and other access devices for the Apartment and the
common areas within The Cardinal.
X. OTHER PERSONAL OBLIGATIONS
A.
Your Liability to Others.
You accept full responsibility for any injury or damage caused to others, or suffered by
you, as a result of your own acts or omissions, and those of your guests or invitees, and you shall
indemnify and hold harmless The Cardinal and its respective directors, agents, and employees (also
referred to as associates) from any and all liability for such injury or damage, including attorneys’ fees.
We recommend that you maintain general liability insurance in an amount and form sufficient to cover
such liability. You may be required to maintain additional insurance for personal service providers
hired by you, including worker’s compensation insurance, if and to the extent set forth in The
Cardinal’s policies and procedures.
B.
Third Party Liability.
If you are injured as the result of an act or omission of a third party, you hereby grant the
Community a lien on any judgment, settlement, or recovery in the amount of any expense incurred by
The Cardinal in caring for you as the result of such injury that is not reimbursed directly to the
Community by you or by another source. You agree to cooperate in the diligent prosecution of any
claim or action against the third party.
C.
Personal Affairs.
You agree to make reasonable advance arrangements in the event of your death or
incompetence. You may want to assign a Durable Power of Attorney (POA) for health care and
financial decision-making and we encourage you to seek appropriate professional or legal advice
regarding your options.
D.
Home Care/Personal Service Providers
Subject to applicable North Carolina laws and regulations pertaining to skilled nursing
facilities, you may arrange for home care or other personal services in your apartment. You and all
providers of home care or other personal services agree in writing to adhere to and comply with the
Community Policies for Personal Service Providers. If you arrange for such services, you accept full
responsibility for the cost of such services. You understand and agree that The Cardinal shall not be
liable for any loss, damage, or injury to you, another Resident, or any other person caused by providers
of home care or other personal services. The Cardinal reserves the right to review credentials of all
personal service providers and to approve or prohibit the use of particular personal service providers.
As a condition of its approval, all personal service providers must provide the Community with an
appropriate release and indemnification agreement, proof of workers’ compensation and liability
insurance, as well as proof that such personal service providers are free of tuberculosis and/or any other
contagious or communicable disease, and are subject to a criminal background check, as well as
compliance with any other requirements or policies put in place by The Cardinal from time to time. To
the extent required, you shall confirm that any approved personal service provider has workers’
compensation insurance coverage. In the absence of such coverage, you are required to provide
workers’ compensation insurance to the extent required by law. The Cardinal reserves the right to
terminate your authorization to utilize personal service providers in the event that you or they do not
comply with the requirements, or you require transfer to another level of care under Article VII. The
Cardinal does not monitor the services of personal service providers and is not responsible for their
actions or inactions or any harm or liability they may cause.
E.
Relationships Between Residents and Associates.
You agree to cooperate with the staff of The Cardinal Health Center in performing their
duties to maintain your Apartment and provide the care and other services described in this Agreement
and in your care plan. The Cardinal instructs the Community associates to be cordial and helpful to
Residents. The relationship between Residents and associates should at all times remain professional.
Associates must not be delayed or deterred by Residents in the performance of their duties. The
supervision of associates comes from the Community supervisors and not from Residents. Any
complaints about associates or requests for special assistance must be made to the appropriate
supervisor or to the Executive Director. Giving gratuities or bequests to associates or associate’s
families is not permitted under any circumstances. You agree not to hire The Cardinal associates or
solicit such associates to resign to work for you without the prior written consent of the Community to
such arrangement. You agree not to hire any former Community associate without the written consent
of The Cardinal.
XI. LEGAL REPRESENTATIVES, RESPONSIBLE PARTIES, AND GUARANTORS.
A.
Legal Representative. A Legal Representative is an individual who has authority
to act on the Resident's behalf, under independent legal authority. Examples of a Legal Representative
include a guardian, a conservator, or the holder of a Durable Power of Attorney executed by the
Resident. Documents evidencing a person's Legal Representative status must be provided to us. If a
Resident has a court appointed guardian or conservator, the guardian or conservator is required to sign
this Agreement.
B.
Responsible Party. A Responsible Party is an individual who voluntarily agrees
to honor certain specified obligations of the Resident under this Agreement without incurring any
personal financial liability. Examples of a Responsible Party include a relative or a friend of the
Resident. We will require a person to sign this Agreement as a Responsible Party if the person has
legal access to or physical control of the Resident's income or resources to pay for the care and services
we provide and others that you request. We may decline to admit any Resident who has no source of
payment for all or part of the Resident's stay.
Guarantor. A Guarantor is an individual who has agreed to be personally liable
C.
to pay for all amounts you owe to The Cardinal Health Center for the care and services provided
hereunder. A Responsible Party or Legal Representative is not a Guarantor unless the person serving as
Responsible Party or Legal Representative also executes this Agreement as a Guarantor. If there is a
Guarantor, you agree immediately to give The Cardinal Health Center written notice of any change in
the Guarantor's financial condition, address, or telephone number. By signing this Agreement, the
Guarantor agrees promptly to pay all fees and charges incurred by you or on your behalf under this
Agreement. This is a guaranty of payment and not of collection, and The Cardinal shall be entitled to
proceed directly and immediately against the Guarantor for any overdue fees or charges without any
requirement to exhaust its remedies against you.
D.
Rights and Obligations of a Legal Representative and Responsible Party
under this Agreement:
1.
If you sign this Agreement as a Legal Representative or Responsible Party, you
incur no personal financial liability by doing so.
2.
If you sign this Agreement as a Legal Representative or Responsible Party, you
agree to use the Resident's available income and resources to pay for the Resident's care and services.
3.
By signing this Agreement as a Legal Representative or Responsible Party, you
also agree to apply for benefits to which the Resident may be entitled and to furnish third party payers
with information and documentation concerning the Resident which reasonably is available to you and
which is necessary to the processing of the Resident's application for third party payor benefits.
4.
By signing this Agreement as a Legal Representative or Responsible Party, you
have the right to participate in the care planning process for the Resident, and we will use reasonable
efforts to notify you where there is:
a. An accident or incident involving the Resident that results in injury and has the potential for
requiring physical intervention;
b. A significant change in the Resident's physical, mental, or psychosocial status; or
c. A need to alter the Resident's treatment significantly.
You are also entitled to receive all notices required to be sent to the Resident by current law or by this
Agreement.
XII. MEDICAL TREATMENT
A.
Consent to Treatment and Right to Refuse Medical Treatment
By signing this Agreement, you consent to receive the nursing facility care and services
we have agreed to provide to you. You consent to routine nursing care and medical care, as
recommended or ordered by your attending physician.
You have the right to refuse any nursing care or medical treatment. If you are incapable
of making your own medical decisions, or become so in the future, we will follow the direction of your
Legal Representative.
You have the right to be fully informed about the nursing and medical care we provide
to you. Your inquiries will be handled promptly by our administrative and nursing care staff.
B.
Appointing a Personal Physician:
All Residents receiving nursing care at The Cardinal Health Center must have a
designated attending physician. You have the right to receive care from an attending physician of your
choice. You must provide us with your attending physician's name and telephone number.
If you have no attending physician, or do not provide us with the information concerning
your attending physician, we will consult with you and/or your Legal Representative and assist you in
selecting an attending physician of your choice. If, after consultation, you do not select a physician, we
will select an attending physician for you. If we select an attending physician for you, we will make
reasonable efforts to ensure that the services of the physician are covered by your health insurance, if
any, and we will provide you with the physician's name, telephone number and specialty.
In the event of a life-threatening emergency, we will make reasonable efforts to contact
your attending physician, and if we are unable to do so, we may obtain the services of our Medical
Director or the services of another physician. You are responsible for payment of physician services
not covered by your insurance programs.
C.
Selecting a Pharmacy:
While residing at The Cardinal Health Center, you have the right to utilize the services
of a pharmacy of your choice; however, you acknowledge that your choice of pharmacy must meet
certain requirements established by The Cardinal Health Center as well as limitations imposed by your
health insurance provider. You agree not to bring medications or drugs into The Cardinal Health
Center. All medications you consume at The Cardinal Health Center must be administered by our
staff.
D.
Advance Directives.
You may provide us with advance directives specifying your wishes as to the care and
services you desire to receive in certain situations. Such an advance directive may be a separate form
or contained within a Durable Power of Attorney, or Health Care Power of Attorney. While it is not
a condition of admission, you may provide us with a Health Care Power of Attorney designating an
individual to make health care decisions for you in the event you become incapable of doing so or in
the event you are unable to communicate your health care decisions to us. If you have an advance
directive, you must provide a copy of the directive to us so that we may inform our staff to ensure
that your wishes are respected.
XIII. MISCELLANEOUS
A.
Accuracy of Application Documents.
As part of your application to The Cardinal Health Center, you have filed application
forms. You warrant that all information contained in these documents is true and correct, and you
understand that we have relied on this information in accepting you for residency at The Cardinal
Health Center.
B.
Examination of Records.
You acknowledge that the Department of Health and Human Services or any other State
licensing agency may inspect your residency and care records as part of an evaluation of The Cardinal
Health Center.
C.
Resident Handbook.
You agree to abide by the general policies of The Cardinal Health Center contained
below and in the Resident Handbook, as it now exists or as it may later be amended at the discretion of
The Cardinal Health Center. You received a copy of the current Resident Handbook when you signed
this Agreement. We reserve the right to amend the Resident Handbook at any time. We will provide
you any updates to the Resident Handbook if we amend it in the future. . You understand that your
failure to abide by The Cardinal Health Center’s general policies may result in termination of the
Agreement by The Cardinal Health Center. In accordance with state law, these policies must be
reasonable. By signing this Agreement you acknowledge that you have reviewed the Resident
Handbook and the general policies of The Cardinal Health Center and agree that they are reasonable.
The following additional general policies apply:
1.
Residents of The Cardinal Health Center must pay all fees and charges that are
owing to The Cardinal Health Center in accordance with their Residence and Care Agreement when
due.
2.
Residents may not breach any representation, covenant, agreement or obligation
of the resident under their Residence and Care Agreements, including but not limited to any
representation regarding financial status set forth in Appendix B, which is made part of this
Agreement.
3.
Residents must not engage in conduct that poses a danger to themselves or
others at The Cardinal Health Center, must not be disruptive, must not create unsafe conditions, and
must not be physically or verbally abusive to other residents or staff.
4.
Residents must ensure that their family members, guardians, personal
representatives or guests are not disruptive, do not create unsafe conditions, and are not physically or
verbally abusive to the detriment of the resident, other residents or staff.
5.
Residents must not engage in conduct that violates federal, state, or local laws or
ordinances.
If you wish to suggest changes to the general policies of The Cardinal Health Center
you may do so at any time by notifying the Executive Director.
D. Guest Visits and Communications.
We encourage family visits and communication. You have the right to have visits
from family members, friends, physicians, or representatives of the State Health Department or
Ombudsman Program at any time; however, you may need to inform staff of after-hours visitation in
order for your visitors to gain access when the building is secured. Your guests are welcome to visit
and participate in appropriate activities at The Cardinal Health Center, if you so desire, provided
they respect the rights of other residents and staff and abide by our visitor and guest policies,
including reasonable limitations on the length of stay and frequency of visits. You will be
responsible for assuring that your guests abide by these rules and are not disruptive. All visitors must
register at the front desk when entering The Cardinal Health Center. We reserve the right to remove
or deny entry to The Cardinal Health Center to any visitor whom we determine is disruptive or
dangerous.
E.
Smoking Policy.
The Cardinal is a smoke free community and smoking is not permitted in your
Apartment or any of the common areas of The Cardinal.
F.
Pet Policy.
Pets are not allowed at The Cardinal Health Center, except for service animals
providing assistance to residents with disabilities.
G.
Motorized Cart
If you at any time you intend to utilize a motorized cart, you must abide by The
Cardinal Health Center's rules set forth in the Resident Handbook and a separate Motorized Cart
Policy.
H.
Assignment.
The Cardinal Health Center reserves the right to assign this Agreement to any
successor-in-interest selected by it. You may not transfer or assign your right to use the services and
accommodations at The Cardinal Health Center to any other individual or entity.
I.
Personal Rights.
Consistent with North Carolina law, you shall have the rights set forth in the Statement
of Residents’ Personal Rights, which is attached to this Agreement as Appendix C.
J.
Notices.
All notices given under this Agreement shall be in writing and shall be addressed to The Cardinal
Health Center at its administrative office at The Cardinal Health Center or to you at your Apartment. Such
notices shall be effective when personally delivered or two (2) days after being deposited in the United
States mail, properly addressed and first class postage prepaid.
K.
Grievances.
If you have a grievance or complaint regarding The Cardinal Health Center you may
contact the Executive Director or the home office of Kisco Senior Living at 1-866-KISCO SL (866547-2675). A copy of the community’s grievance procedure for resolution of resident complaints is
available upon request.
L.
Entire Agreement.
This Agreement (together with the documents and appendices referenced herein)
constitutes the entire agreement between you and The Cardinal Health Center and may be amended
only by a written instrument signed by you and by an authorized representative of The Cardinal Health
Center. If any part of this Agreement is held to be invalid or unenforceable, the remainder of the
Agreement shall remain valid and enforceable, unless the context requires otherwise.
M.
Waiver.
The failure of The Cardinal Health Center in any instance or instances to insist upon
your strict performance or observation of or compliance with, any of the terms or provisions of this
Agreement, shall not be construed to be a waiver or relinquishment of its right to insist upon your strict
compliance with all of the terms and provisions of this Agreement. In addition, acceptance by The
Cardinal Health Center of any payment from you after your breach of any term of this Agreement or
after providing you with a notice of termination based on a reappraisal as described in Section
VIII.B.1.d, above, shall not constitute a waiver of the right of The Cardinal Health Center to insist
upon full performance of all terms of this Agreement, nor shall it waive The Cardinal Health Center’s
right to terminate this Agreement for any breach previously committed or to terminate in accordance
with Section VIII.B.1.d.
N. ARBITRATION.
BY INITIALING BELOW, YOU AGREE THAT ANY AND ALL CLAIMS AND DISPUTES
ARISING FROM OR RELATED TO THIS AGREEMENT OR TO YOUR RESIDENCY, CARE OR
SERVICES AT THE CARDINAL HEALTH CENTER, WHETHER MADE AGAINST US OR ANY
OTHER INDIVIDUAL OR ENTITY, INCLUDING, WITHOUT LIMITATION, PERSONAL
INJURY CLAIMS, SHALL BE RESOLVED BY SUBMISSION TO NEUTRAL, BINDING
ARBITRATION IN ACCORDANCE WITH THE FEDERAL ARBITRATION ACT; EXCEPT
THAT ANY CLAIM OR DISPUTE INVOLVING SUMMARY EJECTMENT PROCEEDINGS
(EVICTION) OR ANY CLAIMS THAT CAN BE BROUGHT IN SMALL CLAIMS COURT SHALL
NOT BE SUBJECT TO ARBITRATION UNLESS BOTH PARTIES AGREE TO ARBITRATE
SUCH PROCEEDINGS. BOTH PARTIES GIVE UP THEIR CONSTITUTIONAL RIGHTS TO
HAVE ANY SUCH DISPUTE DECIDED IN A COURT OF LAW BEFORE A JURY, AND
INSTEAD ACCEPT THE USE OF ARBITRATION. THE ARBITRATION SHALL BE
CONDUCTED IN WAKE COUNTY, NORTH CAROLINA BY A SINGLE NEUTRAL
ARBITRATOR SELECTED BY THE CARDINAL HEALTH CENTER, UNLESS OTHERWISE
MUTUALLY AGREED. IN REACHING A DECISION, THE ARBITRATOR SHALL PREPARE A
WRITTEN DECISION THAT INCLUDES FINDINGS OF FACT, THE REASONS UNDERLYING
THE DECISION, AND CONCLUSIONS OF LAW. EACH PARTY SHALL BEAR ITS OWN
COSTS AND FEES IN CONNECTION WITH THE ARBITRATION. THIS ARBITRATION
CLAUSE BINDS ALL PARTIES TO THIS AGREEMENT AND THEIR SPOUSES, HEIRS,
REPRESENTATIVES, EXECUTORS, EXECUTIVE DIRECTORS, SUCCESSORS, ASSIGNS,
MANAGERS, AND AGENTS AS APPLICABLE. AFTER TERMINATION OF THIS
AGREEMENT, THIS ARBITRATION CLAUSE SHALL REMAIN IN EFFECT FOR THE
RESOLUTION OF ALL CLAIMS AND DISPUTES THAT ARE UNRESOLVED AS OF THAT
DATE. IN THE EVENT THAT ANY PART OF THIS ARBITRATION CLAUSE IS DETERMINED
TO BE UNENFORCEABLE, THE REMAINING PORTIONS OF THE CLAUSE SHALL REMAIN
VALID AND SHALL BE ENFORCED BY THE PARTIES. IF THE FEDERAL ARBITRATION
ACT DOES NOT PERMIT ARBITRATION IN ACCORDANCE WITH THIS CLAUSE, THEN THE
MATTER SHALL BE ARBITRATED IN ACCORDANCE WITH STATE LAW.
BY INITIALING BELOW, YOU WARRANT THAT THIS PARAGRAPH HAS BEEN
EXPLAINED TO YOU, THAT YOU UNDERSTAND ITS SIGNIFICANCE, THAT YOU
VOLUNTARILY AGREE TO BE BOUND BY IT.
RESIDENT INITIALS: __________
/ _________
POA/GUARANTOR INITIALS: _____________________
A. Resident Acknowledgment. –
By signing below, you acknowledge all of the following:
1.
You have received a signed copy of this Residence and Care Agreement, which
specifies the services and accommodations that you will receive at The Cardinal Health Center and the
charges for such services;
2.
You have received a written copy of the Resident Handbook, which contains the
rules and regulations and grievance policies for The Cardinal Health Center residents;
3.
You have received a copy of the Statement of Residents’ Personal Rights, which
is attached to this Agreement as Appendix C;
4.
The Cardinal staff has indicated to you whether the Cardinal has signed Form
DSS-1464 concerning compliance with Title VI of the Civil Rights Act;
5.
You or your family members, as appropriate, have received the information that
must be disclosed under Section 131D-8 of the North Carolina Statutes and Rule 1906 of the
Administrative Code for specialized memory support.
B. Governing Law.
This Agreement shall be governed by North Carolina law.
This Agreement shall be effective as of _____________ , _____.
RESIDENT:
________________________________
Signature
________________________________
Printed Name
________________________________
Date of Birth
________________________________
Date of Move-In
________________________________
Date
COMMUNITY:
________________________________
By
________________________________
Title
________________________________
Community
________________________________
Address
________________________________
Date
LEGAL REPRESENTATIVE:
(Power of Attorney, Guardian, etc.)
RESPONSIBLE PERSON:
________________________________
Signature
________________________________
Printed Name
________________________________
Address
________________________________
Phone Number
________________________________
Date
________________________________
Signature
________________________________
Printed Name
________________________________
Address
________________________________
Phone Number
________________________________
Date
By signing below, the undersigned Guarantor hereby agrees to be fully and personally liable for,
and agrees to pay promptly upon request, all amounts owed to The Cardinal by the Resident.
The undersigned agrees that The Cardinal shall not be obligated to pursue any legal action or
obtain any judgment against the Resident or the Resident’s assets as a condition to requiring
payment by Guarantor.
GUARANTOR:
________________________________
Signature
________________________________
Printed Name
________________________________
Address
________________________________
Phone Number
_______________________________
Date
Appendix A
The undersigned acknowledge receipt of the schedule of Fees for Optional Services:
_____________________________________
___________________________
Resident Signature
Date
_____________________________________
___________________________
Resident/Responsible Party Signature
Date
_____________________________________
Appendix A
The undersigned acknowledge receipt of the schedule of Fees for Optional Services:
_____________________________________
Resident Signature
___________________________
Date
_____________________________________
Resident/Responsible Party Signature
___________________________
Date
_____________________________________
Community Representative Signature
___________________________
Date
Appendix B
FINANCIAL STATUS
The Cardinal Health Center is a component of a continuing care retirement community that
depends on a predictable level of private pay fees in order to operate on a sound financial basis and
provide an appropriate level of care and services to our residents. This means that we are not able
to accept residents who receive or who are eligible to receive Social Security Supplemental
Security Income benefits (“SSI”). The Cardinal Health Center does not participate in the Medicaid
program. By signing below, you represent and warrant that you are not an SSI recipient, that you
have sufficient assets and income so that you do not currently qualify for SSI and will not so
qualify for the foreseeable future, and you warrant that you will not apply for SSI benefits nor
allow anyone to apply for SSI benefits on your behalf while you are a resident of The Cardinal
Health Center.
Signed: Resident _____________________________________________
Responsible Party ____________________________________________
Appendix C
THE CARDINAL HEALTH CENTER
STATEMENT OF RESIDENTS' PERSONAL RIGHTS
Pursuant to North Carolina General Statutes Section 131D-21, every resident shall have
the following rights:
(1)
To be treated with respect, consideration, dignity, and full recognition of his or
her individuality and right to privacy.
(2)
To receive care and services which are adequate, appropriate, and in compliance
with relevant federal and State laws and rules and regulations.
(3)
To receive upon admission and during his or her stay a written statement of the
services provided by the facility and the charges for these services.
(4)
To be free of mental and physical abuse, neglect, and exploitation.
(5)
Except in emergencies, to be free from chemical and physical restraint unless
authorized for a specified period of time by a physician according to clear and
indicated medical need.
(6)
To have his or her personal and medical records kept confidential and not
disclosed except as permitted or required by applicable State or federal law.
(7)
To receive a reasonable response to his or her requests from the facility
administrator and staff.
(8)
To associate and communicate privately and without restriction with people and
groups of his or her own choice on his or her own or their initiative at any
reasonable hour.
(9)
To have access at any reasonable hour to a telephone where he or she may speak
privately.
(10)
To send and receive mail promptly and unopened, unless the resident requests that
someone open and read mail, and to have access at his or her expense to writing
instruments, stationery, and postage.
(11)
To be encouraged to exercise his or her rights as a resident and citizen, and to
be permitted to make complaints and suggestions without fear of coercion or
retaliation.
(12)
To have and use his or her own possessions where reasonable and have an
accessible, lockable space provided for security of personal valuables. This space
shall be accessible only to the resident, the administrator, or supervisor-in-charge.
(13)
To manage his or her personal needs funds unless such authority has been
delegated to another. If authority to manage personal needs funds has been
delegated to the facility, the resident has the right to examine the account at
any time.
(14)
To be notified when the facility is issued a provisional license or notice of
revocation of license by the North Carolina Department of Health and Human
Services and the basis on which the provisional license or notice of revocation of
license was issued. The resident's responsible family member or guardian shall
also be notified.
(15)
To have freedom to participate by choice in accessible community activities and
in social, political, medical, and religious resources and to have freedom to refuse
such participation.
(16)
To receive upon admission to the facility a copy of this section.
(17)
To not be transferred or discharged from a facility except for medical reasons, the
residents' own or other residents' welfare, nonpayment for the stay, or when the
transfer is mandated under State or federal law. The resident shall be given at
least 30 days' advance notice to ensure orderly transfer or discharge, except in the
case of jeopardy to the health or safety of the resident or others in the home. The
resident has the right to appeal a facility's attempt to transfer or discharge the
resident pursuant to rules adopted by the Medical Care Commission, and the
resident shall be allowed to remain in the facility until resolution of the appeal
unless otherwise provided by law. The Medical Care Commission shall adopt
rules pertaining to the transfer and discharge of residents that offer protections to
residents for safe and orderly transfer and discharge.
By signing below, you acknowledge that you have received a copy of the personal rights
delineated above and outlined in North Carolina General Statutes Section 131D-21at the time of
your move-in:
Resident: ___________________________________
Date: _____________
Resident: ___________________________________
Date: _____________
Appendix D
Holding Bed Space
Policy Statement
The Cardinal Health Center informs Residents upon admission and prior to a transfer for
hospitalization or therapeutic leave of our bed-hold policy.
Policy Interpretation and Implementation
1.
Upon admission and at the time a Resident is transferred for hospitalization or for
therapeutic leave, a representative of the business office will provide the Resident with
information concerning our bed-hold policy.
2.
When emergency transfers are necessary, The Cardinal Health Center will use best
efforts to provide the Resident or the Resident’s Legal Representative with information
concerning our bed-hold policy within twenty-four hours of such transfer.
3.
Residents must provide The Cardinal Health Center with written authorization to either
reserve or release the bed space within twenty- four hours of the Resident's transfer from The
Cardinal Health Center.
4.
A copy of the resident's bed-hold or release record will be filed in the Resident's medical
record.
5.
Inquiries concerning bed-hold policies should be referred to the business office.
Bed Hold Reservation Form
I, __________________ , a resident of The Cardinal Health Center skilled nursing
facility, hereby request that The Cardinal Health Center hold my bed space during my absence
from The Cardinal Health Center. I understand that by making this request I am responsible for
payment of the basic Health Center Daily Fee for each day that the bed space is held.
I, _____________________ , the Legal Representative of _____________________ , a
resident of The Cardinal Health Center skilled nursing facility, hereby request that The Cardinal
Health Center hold his/her bed space while he/ she is absent from the facility. I understand that I
will be responsible for payment of the basic Health Center Daily Fee.
I understand that the basic Health Center Daily Fee is $ ___________ per day.
Signature: ____________________________
Print Name:
Signature/Title of Community Representative
A copy of this document must be filed in the Resident's medical record.
Release of Bed Space
I,_________________ , a resident of The Cardinal Health Center skilled nursing facility,
have been informed of The Cardinal Health Center’s bed-holding policy and hereby request that
my bed not be held during my absence. I understand that by releasing my bed space I will be
eligible for readmission to the first available semi- private room if I continue to meet the
admission policies of The Cardinal Health Center skilled nursing facility.
I,________________ , the Legal Representative of ____________________ , a resident
of The Cardinal Health Center skilled nursing facility, have been informed of The Cardinal
Health Center’s bed-holding policy and hereby request that the Resident’s bed not be held during
his/her absence. I understand that by releasing the Resident’s bed space the Resident will be
eligible for readmission to the first available semi- private room if he/she continues to meet the
admission policies of The Cardinal Health Center skilled nursing facility.
Signature:
Print Name:
Signature/Title of Community Representative
A copy of this document must be filed in the Resident's medical record.
Appendix E
Payments by Third Party Payors
1. Payment by the Medicare Program:
a. Medicare Payment Eligibility
The Medicare Program will pay for your nursing facility care and services at The Cardinal Health
Center if and only if:
1) We are able to accept payment from the Medicare Program;
2) You are eligible for nursing facility benefits provided under the current Medicare Program;
3) You have been admitted to The Cardinal Health Center within 30 days after a hospital stay or
at least three (3) nights; AND
4) You require nursing services that must be performed or supervised by professional or
technical personnel, based on current Medicare regulations.
The current Medicare Program will pay for your nursing facility care and services at The Cardinal Health
Center only if a bill is submitted to the Medicare Program for that care. Based on the four factors listed
above, we will make the initial decision on whether or not to submit a bill to the Medicare Program for
any portion of your first 100 days in nursing care at The Cardinal Health Center. We will give you or (if
applicable) your Legal Representative or Responsible Party written notification when we first decide that
we will not submit a bill to the Medicare Program. This notification is sometimes referred to as a Denial
Letter or Notice of Non-Coverage. If, at that point, you or your Legal Representative or Responsible Party
disagrees with our decision, you or your Legal Representative or Responsible Party can require us to bill
the Medicare Program for up to 100 days of care. Your direction to us is sometimes referred to as a
direction to submit a Demand Bill. If the reason for the Denial Letter or Notice of Non-Coverage involves
clinical reasons and you direct us to submit a Demand Bill, we will not bill you for any applicable copayment or deductible. If the reason for the Denial Letter or Notice of Non-Coverage involves technical
reasons (for example, you were not admitted to The Cardinal Health Center within 30 days after a hospital
stay or at least three nights), then we may bill you while the Medicare Program considers the Demand
Bill, and we will furnish you with an appropriate refund if the Medicare Program approves the Demand
Bill, subject to your obligation to pay any applicable co-payment or deductible.
b. Daily Co-payment
Currently the Medicare Program will pay for at most 100 days of your stay in nursing care at The
Cardinal Health Center per spell of illness. During the 21st through 100th days, however, you will be
responsible for paying a daily Medicare co-payment to us. The Medicare Program sets the amount of this
daily co-payment.
c. Covered Items and Services
Payment by the Medicare Program currently includes payment for nursing services, certain therapies, use
of a bed and the room in which the bed is located, linens, bedding, diapers and other incontinence
supplies, routine laundry service, regular meals and snacks, certain equipment, social services, activities,
and routine personal hygiene items which are required to meet your needs. Certain items and services are
not covered in the Medicare daily rate. Extra charges for those non-covered items and services are set
forth in Appendix A of this Agreement. Certain other services are not included in our daily Medicare rate
(such as dental care and optometry services) and are billed directly by the provider.
Future change in federal law may change the items and services that are included in payment by the
Medicare Program to us. You will be notified of such changes as they may occur.
d. Medicare Managed Care Plans
We do not participate as a provider of nursing facility care and services under any Medicare managed care
plan.
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