ASSISTED LIVING ESTABLISHMENT CONTRACT

THIS ASSISTED LIVING ESTABLISHMENT CONTRACT (hereinafter referred to as the “Contract”) made this _____ day of ______, 20____, between ______(herein called the “Tenant”), and COURTYARD ESTATES OF FARMINGTON, (herein called “FCE”) located at 1000 East Fort Street, Farmington, Il61531. FCE is an assisted living housing establishment licensed by the State of Illinois Department of Public Health. In consideration of the agreements set forth in this Contract to be kept and performed by the Tenant and FCE, FCE hereby leases to the Tenant a living unit (herein called “the Unit”) described as follows:

Unit No. ____ located at COURTYARD ESTATES OF FARMINGTON,

1000 East Fort Street, Farmington, Il 61531.

All upon the terms and conditions of this Contract.

1.Terms of Lease. This is a month-to-month tenancy for calendar month periods. The tenancy shall begin, and the Tenant shall have the right to occupy the Unit, on ______. This tenancy shall terminate upon the earliest to occur of the following events:

A.Written notice by either party to the other, delivered not less than thirty (30) days prior to the end of the month upon which the tenancy is to terminate; or

B.Within five (5) days after a determination by FCE that the Tenant no longer meets the health eligibility requirements as set forth in Paragraph 10 of this Contract; or

C.Within thirty (30) days after receipt by the Tenant of written notice from FCE to Tenant of a failure by Tenant to pay the rent or otherwise perform all the terms and conditions set forth in this Contract.

2.Tenancy Fee.

A.Tenant shall pay to FCE an initial monthly rental in the amount of $ per day, payable in advance on the first day of each month. The monthly rental includes the services described in Section 6, which services may be revised by FCE from time to time. If, at the beginning of the tenancy there is a partial month, the Tenant shall pay in advance a prorated rent for the number of days of occupancy to the end of the month. FCE shall have the right, during the term of tenancy, to make a change in the amount of monthly rental. FCE will provide a written notice to the Tenant of the change in the monthly rental at least thirty (30) days before the effective date of the change.

B.Independent Rates: The following is a breakdown of the Monthly Tenancy Fees:

Basic Tenancy Charge(studio)...... $2,300.00/month

Basic Tenancy Charge (1 Bdrm)...... $2,700.00/month

Extra Person Charge ...... $1000/month

Pendant: Call light equipment……………$200.00

C.Assisted Rates: The following is a breakdown of the Monthly Tenancy Fees:

Basic Tenancy Charge (studio)...... $2,700.00/month

Basic Tenancy Charge (1 Bdrm)...... $3,100.00/month

Extra Person Charge ...... $1200/month

Pendant: Call light equipment…………..$200.00

D.Memory Care Rates: The following is a breakdown of the Monthly Tenancy Fees:

Basic Tenancy Charge (studio)...... $3,800.00/month

E. Pendant: Call light equipment...... $200.00

F.Cable TV ……………………………………$20.00 / month

G.Processing Fee: The facility charges a non-refundable processing fee that is used to prepare the room for occupancy, initial assessments and general expenses of preparing the apartment for occupancy upon termination of residency. ………………….$500.00

Total Monthly Tenancy Fees...... $

Billing and Payment Procedures. Each tenant will be billed in advance and will receive a monthly statement on or around the 20th of each month. Payment is expected for the full amount shown on the statement and is due on the first of each month. Payments can be paid in person to the Business Office Manager or the Director of the facility. If payment is mailed, it should be mailed to the address shown in the first paragraph of this document.

Apartment Hold Policy: It is the policy of FCE that there will continue to be a rental charge for each day regardless if tenant is not present in the facility. This includes vacations, illness requiring hospitalization, rehab or other absence.

3.Changes in Rates. The Tenant, Responsible Party, and any other person signing this Contract on behalf of the Tenant shall be given thirty (30) days advanced written notice of any changes in the rates for Tenancy Fees during the term of the Contract. The Tenant, Responsible Party or Tenant’s Representative may assent to the rate change or choose to terminate this Contract within thirty (30) days of the receipt of the written notice.

4.Costs. The Tenant agrees to pay and discharge all reasonable costs, attorney fees, and expenses that shall be incurred by FCE in enforcing the provisions of this Contract including the nonpayment of rent and/or pursuing any forcible entry and detainer actions. Medical Assistance under Article V or VI of the Illinois Public Aid Code is not available for payment for services provided at FCE.

5.Use of Premises. Tenant shall use the Premises for residential purposes only. The Premises shall be occupied by the following person or persons, ______, all of whom are considered Tenant hereunder. Except for occasional overnight guests (as hereinafter defined in the attached Rules and Regulations), no other person or persons shall be permitted to occupy the Premises without FCE’s prior written consent. Tenant acknowledges that FCE is housing intended for persons 55 years of age or older and that FCE would not lease the Premises to Tenant if one of the persons described in this Section is not at least 55 years of age. Tenant agrees not to use the Premises or FCE in an unsafe manner or in a manner that would injure, destroy or destruct all or any portion of the Premises FCEor any person. In the event of any use of the Premises or FCE by Tenant causes an injury to the Premises, FCEor to any person, Tenant shall be liable for all such injuries, damages and claims and agrees to indemnify and hold harmless FCE for any and all such injuries, damages and claims.

6.Services.

A. Utilities. FCE shall provide, at its expense, water, sewer, gas, electricity and garbage removal services. Tenant shall pay for its telephone services and any other utility services that he or she utilizes.

B.Meals. The Tenancy Fees entitle the Tenant three(3) meals every day. Guests may be invited to any meal on an “as-available” basis. Guest meals will be billed to the Tenant as an additional charge. FCE requests that each Tenant give as much prior notice as possible if Tenant intends to bring guests to any meal so that the proper accommodations can be made to serve the guests. In addition, upon request, room service will be provided to the Tenant at the Premises during designated hours for an additional charge determined by FCE.

C.Housekeeping/Laundry. FCE will provide light cleaning services for the Premises including vacuuming, light dusting, cleaning bathroom fixtures, entry floor and kitchen counters, appliances and the sink. Personal Laundry and linen service will be provided by FCE

D.Security. Security provided 24 hours each day by means of alarmed entrances to the premises.

E. Assistance. Assistance with activities of daily living as required by each Tenant.These include: Eating, dressing, bathing, toileting, transferring and personal hygiene.

F.Emergency Response. A procedure in place 24 hours a day by which the Tenantcan obtain emergency assistance when needed. Call buttons are maintained in each unit that will notify FCE personnel of the Tenant’s need for assistance.

G. Policy of Notification. It is the policy of the FCE to notify a relative or other individual in case of emergency, significant change in tenants condition or termination of residency as soon as possible.

7.Personal Physician and other providers. The Tenant shall be entitled to retain the services of his or her own personal physician or provider of other services at his or her sole expense or under the terms of an individual or group plan of health insurance, or under the terms of any public or private assistance program providing such coverage. FCE is not responsible for the negligence of any such personal physician or other provider. FCE does not provide physician provided medical care.

8.Maintenance. FCE may modify, change or redecorate the Premises at its expense at any time in order to meet any requirements of federal, state or local laws, rules, regulations or ordinances, or for any other reason. FCEshall be responsible for all structural maintenance and repairs, and for the maintenance and repair of heating, ventilating, and air conditioning equipment, plumbing, and electrical service, except that FCE shall not be responsible to the Tenant under this Section 8for conditions caused or created by the negligent or wrongful act or omission of the Tenant, Tenant’s guests, as defined in Section 24 below, another Tenant or any other person on the Premises without FCE’s consent. All appliances, carpeting, window treatments, lighting fixtures, and television reception systems will be maintained in the same condition as they are furnished by FCE at the beginning of the Term, less normal wear and tear.

9.Access and Inspection. FCEshall have the right to enter the Premises from time to time in order to inspect the Premises, make necessary or agreed repairs, decorations, alterations or improvements to the Premises, supply the services set forth in this Contract to the Premises or to exhibit the Premises to prospective or actual purchasers, mortgagees, prospective Tenants, workmen and contractors; provided, however, that this right shall be exercised in such manner as will not unreasonably interfere with Tenant’s use and enjoyment of the premises. Notwithstanding any provision to the contrary, FCE may enter the Premises at any time or times for the protection or preservation of the Premises and without Tenant’s consent in case of abandonment (as hereinafter defined), emergency, or when Tenant unreasonably withholds its consent to such entry. Tenant shall not place or cause to be placed any locks on the doors not supplied by FCE. Any cost incurred by FCE in removing any unauthorized locks shall be borne by Tenant. Tenant shall deposit with FCE duplicates of any keys or combinations necessary to gain entry into Premises.

10.Assignment and Subletting. Tenant shall not assign this Contract or sublet the Premises without FCE’s prior written consent, which consent may be withheld in FCE’s sole and absolute discretion. No such assignment or subletting shall relieve Tenant from its duties to perform all of the agreements, covenants and conditions of this Contract.

11.Appointment of Tenant’s Representative (Optional): The Tenant hereby identifies (name a person): ______

12.Rights of Termination.

A.Rescission by FCE Prior to the Actual Occupancy Date. If, prior to the Actual Occupancy Date, FCE determines in its sole and absolute discretion that any Tenant is ineligible for entrance into FCE for any reason including, but not limited to, the death of a Tenant or failure of a Tenant to comply with Paragraph 10 (d)(1)herein below, then upon written notice from FCE to Tenant, this Contract shall be automatically cancelled and the Tenant or his legal representative shall receive within sixty (60) days thereafter a refund of all monies paid to FCE less those special costs incurred by FCE due to modifications in the structure or furnishings of the Premises that the Tenant specifically requested.

B.Rescission by Tenant. The Tenant has the right to rescind this Contract for any reason and at any time, provided that Tenant has given FCE thirty (30) days prior written notice of his intent to rescind this Contract. Subject to the terms of this Contract, upon termination, Tenant or his legal representative shall receive within thirty (30) days thereafter a refund of the pro-rata portion of the Tenancy Fees (based on the number of days left in the month of termination). Under the following circumstances, Tenant or Tenant’s representative may terminate residency immediately after notice to the facility: 1) if Tenant has suffered any neglect, abuse or financial exploitation, or 2) if the facility has caused the Tenant imminent danger of life, health or safety.

C.Termination by Death. In the event all of the Tenants of the Premises are deceased, this Contract shall automatically terminate on the date Tenant’s property is removed from FCE and possession of the unit is returned to FCE. The death of one Tenant of the Premises jointly occupied by two parties to this Contract shall not cause this Contract to be terminated.

D.Termination Due to Failure to Meet Residency Requirements.

1.Attached hereto and incorporated herein by reference are the Residency Requirements of FCE. In the event Tenant does not meet all Residency Requirements, FCEmay terminate this Contract and pursue discharge of the Tenant.

E.Termination Due to Material Change in Health

The Tenant’s health, physical and mental capabilities at the time of execution of this Contract, and at all times during the Term of this Contract must be such that Tenant shall be able to maintain himself/herself in the Premises without additional assistance not otherwise afforded to Tenant under the terms of this Contract. In addition to the foregoing, the Tenant shall be subject to the following terms and conditions:

  1. Within thirty (30) days prior to the Actual Occupancy Date and annually thereafter, the Tenant shall obtain a comprehensive assessment that includes an evaluation of the prospective Tenant's physical, cognitive, and psychosocial condition which shall be completed by a licensed physician who shall forward the medical report for such examination and the medical history of the Tenant to FCE and the Tenant must, in the opinion of FCE’s appointed licensed physician (“FCE’s Physician”), qualify as a person capable of Assisted Living;
  1. Based on the assessment, a written service plan shall be developed and mutually agreed upon by the provider and the Tenant. The service plan, which shall be reviewed annually, or more often as the Tenant's condition, preferences, or service needs change, shall serve as a basis for the service delivery contract between the provider and the Tenant. Based on the assessment, the service plan may provide for the disconnection or removal of any appliance;
  1. Tenant agrees to obtain from time to time, such additional physical examinations and reports as required by FCE to document theTenant’s continued goal to maintain his or her qualification for Assisted Living;
  1. All medical examinations and services mentioned hereunder, whether requested by the Tenant or FCE, shall be at the sole cost and expense of the Tenant;
  1. FCE may rely upon the medical history and medical examinations of the Tenant which are submitted to it, and all determinations made by FCE based on such information and such other medical information as FCE may request or obtain, shall be conclusively binding upon the Tenant. FCE shall have no responsibility or liability for any decisions or judgments which are made in reliance upon such medical information; and
  1. Any person who is determined by his or her personal physician, or by FCE, to be suffering from a contagious illness or disease, an emotional or mental illness or impairment, or other incapacity which might jeopardize the health, well being, or peaceful enjoyment of the other Tenants, shall be subject to the termination of their tenancy by FCE, which determination shall be made solely by FCE.

13.Quiet Enjoyment. If Tenant shall timely pay the Tenancy Fees and perform all of the Tenant’s covenants and conditions required by this Contract on its part to be performed, then Tenant may freely, peaceably and quietly occupy and enjoy the Premises. FCE agrees to make reasonable efforts to protect the Tenant from interference or disturbance by third persons; however, FCE shall not be liable for any such interference or disturbance caused by other Tenants or other persons, nor shall the Tenant be released from any of the obligations of this Contract because of such interference or disturbance.

14.Surrender. Upon the termination of this Contract in accordance with the terms hereof, Tenant shall quietly and peaceably deliver possession of the Premises to FCE without notice or demand, except as may be specifically required by any provision of this Contract. Tenant shall deliver possession of the Premises in as good order, repair and condition as they existed at the commencement of the term of this Contract.

15.Damage to or Destruction of Premises.

A.If, during the term of this Contract, the Premises are damaged by fire, windstorm or other casualty so that the Premises are rendered wholly unfit for occupancy, and if said Premises cannot be repaired within one hundred twenty (120) days from the date of such damage, then this Contract, at the option of either FCE or Tenant, may be terminated as of the date of such damage by giving written notice to the other party within one hundred fifty (150) days from the date of such damage; otherwise, the parties will be deemed to have waived their rights to terminate this Contract by virtue of the damage to the Premises. In the event either FCE or Tenant elects to terminate this Contract, Tenant shall pay the Tenancy fees apportioned to the time of damage and shall immediately surrender the Premises to FCE, who may then enter upon and repossess the same, the Tenant shall thereupon be relieved from any further liability hereunder for the Tenancy Fees that were not yet due and payable. If neither FCE nor Tenant elects to terminate this Contract or if the damage by any of the above casualties rendering the Premises wholly uninhabitable can be repaired within one hundred twenty (120) days thereafter, FCE agrees to repair such damage promptly and this Contract shall not be affected in any manner, except that the Tenancy Fees shall be suspended and shall not accrue from the date of such damage until such repairs have been completed or Tenant occupies the Premises, whichever occurs first.