376.920. Annual statement, form, contents.
Annual statement, form, contents.
376.920. The annual statement shall be in such form as thedepartment shall elect. The proposed provider shall include as anexhibit a copy of the proposed form of life care contract to beentered into with residents at each facility. The annualstatement shall contain the following information:
(1) The name and business address of applicant;
(2) The name, address and a description of the physicalproperty of the facility;
(3) The terms and conditions of the life care contracts tobe used by the applicant, including the services to be providedto residents pursuant to the contract and the fees or charges tobe paid by residents, including the method of payment of suchfees or charges. The description of terms and conditions shallinclude:
(a) A statement of the fees that will be charged if theresident marries while at the facility, and a statement of theterms concerning the entry of a spouse to the facility and theconsequences if the spouse does not meet the requirements forentry;
(b) The circumstances under which the resident will bepermitted to remain in the facility in the event of possiblefinancial difficulties of the resident;
(c) The terms and conditions under which a contract forcontinuing care at the facility may be canceled by the provideror by the resident; and the conditions, if any, under which allor any portion of the entrance fee will be refunded in the eventof cancellation of the contract by the provider or by theresident or in the event of the death of the resident prior to orfollowing occupancy of a living unit;
(d) The conditions under which a living unit occupied by aresident may be made available by the facility to a different ornew resident other than on the death of the original resident;
(4) If the applicant is other than an individual, such as acorporation, partnership, or trust, a statement naming the typeof legal entity and listing the interest and extent of suchinterest of each principal in the entity. For the purposes ofthis section, "principal" means any person or entity having a tenpercent or more financial interest or, if the legal entity is atrust, each beneficiary of the trust holding a ten percent ormore beneficial interest;
(5) If the applicant is other than an individual, the namesof the members of the board of directors, the trustees, or themanaging partners;
(6) The estimated number of residents of the facility to beprovided services by the applicant pursuant to the life carecontracts;
(7) A statement of the provisions that have been made orwill be made to provide reserve funding or security by theprovider to enable the provider to fully perform his obligationspursuant to life care contracts, including, but not limited to,the establishment of escrow accounts, accounts in financialinstitutions, trusts, or reserve funds;
(8) A statement as to whether the applicant was or isaffiliated with a religious, charitable, or other nonprofitorganization, the extent of any affiliation and the extent towhich the affiliate organization will be responsible for thefinancial and contract obligations of the applicant;
(9) If the applicant is a subsidiary corporation or theaffiliate of another corporation, a statement identifying theparent corporation or the other affiliate corporation and theprimary activities of such parent or other affiliate corporation;
(10) A description of the business experience of theapplicant in the operation of similar facilities and, if thefacility will be managed on a day-to-day basis by a corporationor organization other than the applicant, a description of thebusiness experience of the manager in the operation or managementof similar facilities. The description shall include the nameand address of any professional service, firm, association,trust, partnership, or corporation in which such manager has, orwhich has in such manager, a ten percent or greater interest andwhich it is presently intended will or may provide goods, leases,or services to the facility of a value of five hundred dollarswithin any year, including a description of the goods, leases orservices and the probable or anticipated cost thereof to thefacility or provider or a statement that such cost cannotpresently be estimated;
(11) A statement as to whether the applicant, a principal, aparent or subsidiary corporation, or an affiliate has had anyinjunctive or restrictive order of a court of record, or anysuspension or revocation of any state or federal license orpermit, arising out of or relating to business activity or healthcare applied against it, including without limitation actionsaffecting a license to operate a foster care facility, a healthcare institution, retirement home, or a home for the aged;
(12) A statement of any periodic rates to be initially paidby residents, the method by which such rates are determined andthe manner by which the provider may adjust such rates in thefuture. If the facility is already in operation, or if theprovider operates one or more similar facilities within thisstate, the statement shall include tables showing the frequencyand average dollar amount of each increase in periodic rates ateach such facility for the previous five years or such shorterperiod as the facility may have been operated by the provider;
(13) A statement of the terms and conditions under which alife care contract may be canceled by the provider or resident,including any health and financial conditions required for aperson to continue as a resident and any conditions under whichall or any portion of the entrance fee will be refunded by theprovider;
(14) If construction or purchase of the facility has not yetbeen completed, a statement of the anticipated source andapplication of the funds to be used in such purchase orconstruction, including all of the following:
(a) An estimate of the cost of purchasing or constructingand equipping the facility including such related costs asfinancing expense, legal expense, land costs, occupancydevelopment costs, and all other similar costs which the providerexpects to incur or become obligated for prior to thecommencement of operations;
(b) An estimate of the total entrance fees to be receivedfrom residents upon completion of occupancy;
(c) A description of any mortgage loan or other long-termfinancing intended to be used for the financing of the facility,including the anticipated terms and costs of such financing;
(d) An estimate of any funds which are anticipated to benecessary to fund start-up losses and to assure full performanceof the obligations of the provider pursuant to life carecontracts including, but not limited to, any reserve fund escrowrequired by the division pursuant to section 376.940*;
(15) Financial statements of the applicant as of a date notmore than ninety days prior to the date the annual statement isfiled, which shall include a balance sheet and income statementsfor the three most recent fiscal years of the applicant or suchshorter period of time as the applicant shall have been inexistence. If applicant's fiscal year ended more than ninetydays prior to the date of filing there shall also be included anincome statement, which need not be certified, covering theperiod between the date such fiscal year ended and a date notmore than ninety days prior to the date the application is filed.
(L. 1981 S.B. 84 § 4, subsec. 4)*Original rolls refer to "section 8". Section 8, now § 376.950, has nothing to do with escrow accounts. However, section 6 of the bill, now § 376.940, does. Apparently intersectional reference should have referred to section 6, and accordingly § 376.940 has been inserted here.