CONTINUING CARE PROVIDER
PRE-OPERATIONAL ADDENDUM
Pursuant to K.S.A. 40-2232(f) the following information is required for Continuing Care Providers who have received contract considerations but has not yet commenced operation of a home or facility.
Name of Continue Care Provider:
1) A statement of the anticipated source and application of the funds used or to be used in the purchase or construction of the facility:
2) An estimate of such costs as financing expense, legal expense, land costs, marketing costs and other similar costs which the provider expects to incur or become obligated for prior to the commencement of operations:
3) A description of any mortage loan or any other financing intended to be used for the financing of the facility, including the anticipated terms and costs of such financing:
4) An estimate of the total entrance fee to be received from or on behalf of resident at or prior to commencement of operation; and
5) An estimate of the funds, if any, which are anticipated to be necessary to fund start-up loses and provide reserve funds to assure full performance of the obligations of the provider under continuing care contracts.
Acknowledged by:
Name:
Title:
Phone:
Email:
