411-067-0050 Disclosure Statement (1) All providers must file a disclosure statement with the Division upon initial application and annually thereafter. The disclosure statement must be on forms prescribed by the Division. (2) DISCLOSURE STATEMENT: The disclosure statement must include: (a) The rights and requirements of the residents described in OAR 411-067-0086; (b) The names of the individuals who constitute the provider or, if the provider is a partnership, limited liability company, corporation, or other legal entity, whether for profit or not for profit, the name of the legal entity and each of the officers, directors, trustees, or managing general partners of the legal entity and a description of each individual's duties on behalf of the legal entity; (c) The business address of the provider and a statement of whether the provider is an individual, partnership, limited liability company, corporation, or other affiliated organization; (d) The names and business addresses of any individual having any more than a 10 percent direct or indirect ownership or beneficial interest in the provider, the percentage of the direct or indirect ownership or beneficial interest, and a description of each individual’s interest in or occupation with the provider; (e) A statement as to whether the provider is or is not affiliated with any other organization of any kind, the extent of the affiliation, if any, and the extent to which the organization is responsible for the financial and contractual obligations of the provider; (f) The provision of the Internal Revenue Code, if any, under which the provider or any affiliated organization is exempt from the payment of federal income taxes; (g) The location and general description of the CCRC including the location and number of living units and licensed long term care beds considered part of the CCRC, and any other care facilities owned or operated by the provider. The provider must disclose the following about any proposed CCRC or other care facilities: (A) The estimated completion date; (B) A statement as to whether or not construction has begun; and (C) Any contingencies subject to which construction may be deferred; (h) The number of open bed long term care facility beds operated by the CCRC; (i) A description of services provided or proposed to be furnished by the provider under its residency agreements including without limitation: (A) The extent to which medical care, long term care, or health related services are furnished, and the locations where the services shall be furnished. If the services are furnished at a facility that is not registered as part of the CCRC’s campus, the provider must state the location where the services are furnished and any additional fees associated with the services; and (B) The services made available by the CCRC at an extra charge over and above the entrance fee; (j) A description of all fees required of each resident including the entrance fee, regular periodic charges, and the manner in which any additional fees or regular periodic charges shall be determined. The description must include: (A) The circumstances under which the resident shall be permitted to remain in the CCRC in the event the resident is unable to pay regular periodic charges or other fees; (B) The terms and conditions under which the residency agreement may be canceled by the provider or the resident or in the event of the death of the resident prior to or following occupancy of the living unit; (C) In boldfaced type, the percentage of the entrance fee refund required by ORS 101.080 and the manner in which this percentage is calculated; (D) The conditions under which a living unit occupied by a resident may be made available by the provider to another resident other than on the death of the resident executing the residency agreement; (E) The manner by which the provider may adjust regular periodic charges or other recurring fees; (F) A statement of the fees to be charged if the resident marries or divorces while at the designated CCRC, the terms concerning a resident’s spouse’s entry to or departure from a CCRC, and the consequences if a new spouse does not meet the requirements for entry; and (G) The terms and conditions for the transfer of a resident out of the CCRC; (k) The provider’s most recent audited financial statement. The audited financial statement may not have been prepared more than 16 months prior to the date of the initial application for registration; (l) A copy of the residency agreement offered to the prospective resident by the provider; (m) A statement on the cover page in a prominent location and typeface that registration of the CCRC does not constitute approval, recommendation, or endorsement of the CCRC by the Department, and that such registration does not evidence the accuracy or completeness of the information set forth in the disclosure statement; (n) Copies of the primary written brochures and written promotional materials furnished to prospective residents; (o) A full description of all contracts that the provider has entered into with affiliated organizations and an explanation of the financial impact that the contracts may have on residents; (p) An affidavit signed by an authorized representative of the CCRC confirming that the disclosure statement is complete and accurate; (q) If required, a copy of the escrow agreement as described in OAR 411-067-0070. (r) Any person or legal entity named in subsection (b) or (d) of this section and any proposed or existing manager must disclose: (A) Business experience in operation or management of CCRCs or other licensed long term care facilities; (B) Whether the person or legal entity has been convicted of a crime; (C) Whether the person has been a party to any civil action in which a judgment for damages was obtained or in which an injunction was issued against the person for fraud, embezzlement, fraudulent conversion, or misappropriation of property; (D) Whether the person or legal entity has been a party to any civil action in which a judgment for damages was obtained or in which an injunction was issued against the person or legal entity for fraud, embezzlement, fraudulent conversion, or misappropriation of property; (E) Whether the person or legal entity has had any state, federal permits, or licenses, suspended or revoked, or if a state or federal authority has disqualified the person or legal entity from providing services in the Medicare or Medicaid program in connection with the person or legal entity's business activities; (F) The identity of any business or professional service entity in which the person or legal entity has a 10 percent or greater ownership interest and which the provider intends to employ to provide goods, services, or any other things of value; and (G) The anticipated costs to the provider or a statement that such costs cannot presently be estimated. (3) INITIAL DISCLOSURE STATEMENT: In addition to complying with all the provisions of section (2) of this rule, the provider must submit on behalf of a new CCRC a statement of the anticipated source and application of funds used or to be used in the purchase or construction of the CCRC including: (a) An estimate of the cost of purchasing or constructing and equipping the CCRC that the provider expects to incur or become obligated for prior to the commencement of the operation of the CCRC; (b) A description of any mortgage loan or other long term financing intended to be used for the financing of the CCRC; (c) An estimate of the total entrance fees to be received from the residents at or prior to the commencement of operation of the CCRC based on projected occupancy at the time the CCRC commences operation; and (d) An estimate of the funds, if any, anticipated to be necessary to pay for start-up losses. (4) ANNUAL DISCLOSURE STATEMENT: (a) In addition to the information required in section (2) of this rule, the annual disclosure statement must include: (A) A copy of the certificate of registration. The certificate of registration must be used as the cover page for the annual disclosure statement; (B) A disclosure of any change in ownership or manager; (C) The frequency and the dates of the residents' council meetings or meetings with all residents of the CCRC as described in OAR 411-067-0083; and (D) Copies of all notices of changes in regular periodic charges or notices of proposed changes in fees or services that were given to residents during the provider's most recently completed fiscal year. (b) To amend an annual disclosure statement, a provider must file all amended documents and new materials with the Division. (5) RIGHT OF REVIEW: (a) The provider must notify prospective residents of their right to review the initial disclosure statement after entry of an order registering the provider and before the provider enters into any residency agreement with or on behalf of the prospective resident. (b) The provider must make the current annual disclosure statement available to each resident and prospective resident. (c) The provider must make copies of the initial disclosure statement available upon request. The initial disclosure statement must be available during regular business hours in the business office of the CCRC. (6) DUE DATE FOR ANNUAL DISCLOSURE STATEMENT: (a) If a certificate of registration is issued six months or more prior to the provider's fiscal year end, then the next annual disclosure statement and registration fee is due by the fourth month following the first fiscal year end, after the issuance date of the certificate of registration and annually thereafter. (b) If a certificate of registration is issued less than six months prior to the provider's fiscal year end, then the next annual disclosure statement and registration fee is due by the fourth month following the second fiscal year end, after the issuance date of the certificate of registration and annually thereafter. Statutory/Other Authority: ORS 101.150 & 410.090 Statutes/Other Implemented: ORS 101.050, 101.052 & 101.080 History: SPD 8-2011, f. 3-31-11, cert. ef. 4-1-11 SDSD 5-1999, f. 4-30-99, cert. ef. 5-1-99 SSD 9-1990, f. & cert. ef. 3-26-90