Document:

Exhibit 10.40  

First
Amendment to Lease Agreement 

Change
of Commencement Date 

This
First Amendment to Lease Agreement (the "Amendment") is made and entered into to be effective as of January 15, 2004, by and between MISSION RIDGE ASSOCIATES LLC, a Delaware limited
liability company ("Landlord"), and ENSIGN FACILITY SERVICES, INC. a Nevada corporation ("Tenant"), with reference to the following facts: 

Recitals

        A.    Landlord
and Tenant have entered into that certain Lease Agreement dated August 28, 2003 (the "Lease"), for the leasing of certain premises containing
approximately 15,920 rentable square feet of space located at 27101 Puerta Real, Suite 450, Mission Viejo, California (the "Premises") as such Premises are more fully described in the Lease. 

        B.    Landlord
and Tenant wish to amend the Commencement Date of the Lease. 

NOW,
THEREFORE, in consideration of the foregoing and for other good and valuable consideration, the receipt and adequacy of which are hereby acknowledged, Landlord and Tenant hereby agree as follows: 

	1.
	Recitals:
Landlord and Tenant agree that the above recitals are true and correct.

	2.
	The
Commencement Date of the Lease shall be February 1, 2004.

	3.
	The
last day of the Term of the Lease (the "Expiration Date") shall be September 30, 2009.

	4.
	The
dates on which the Base Rent will be adjusted are: 

for
the period 2/01/04 to 1/31/05 the monthly Base Rent shall be $34,228.00;

for the period 2/01/05 to 8/31/05 the monthly Base Rent shall be $35,183.20;

for the period 9/01/05 to 8/31/06 the monthly Base Rent shall be $35,979.20;

for the period 9/01/06 to 8/31/07 the monthly Base Rent shall be $36,775.20;

for the period 9/01/07 to 8/31/08 the monthly Base Rent shall be $37,571.20; and

for the period 9/01/08 to 9/30/09 the monthly Base Rent shall be $38,367.20. 

Provided
Tenant faithfully performs all of the terms and conditions of this Lease, landlord hereby agrees to (i) abate Tenant's obligation to pay Tenant's monthly Base Rent for the first (1st),
second (2nd), third (3rd), fourth (4th), fifth (5th), sixth (6th) full months of the initial Lease Term for the entire Premises and (ii) abate Tenant's obligation to pay Tenant's monthly Base
Rent as to four thousand (4,000) rentable square feet of the Premises for the seventh (7th), eighth (8th), ninth (9th), tenth (10th), eleventh (11th) and twelfth (12th) full calendar months of the
initial Lease Term. 

	5.
	Effect
of Amendment: Except as modified herein, the terms and conditions of the Lease shall remain unmodified and continue in full force and effect. In the event of any conflict
between the terms and conditions of the Lease and this Amendment, the terms and conditions of this Amendment shall prevail.

	6.
	Definitions:
Unless otherwise defined in this Amendment, all terms not defined in this Amendment shall have the meaning set forth in the Lease.

	7.
	Authority:
Subject to the provisions of the Lease, this Amendment shall be binding upon and inure to the benefit of the parties hereto, their respective heirs, legal representatives,
successors and 

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assigns.
Each party hereto and the persons signing below warrant that the person signing below on such party's behalf is authorized to do so and to bind such party to the terms of this Amendment. 

	8.
	The
terms and provisions of the Lease are hereby incorporated in this Amendment. 

IN
WITNESS WHEREOF, the parties have executed this Amendment as of the date and year first above written. 

Tenant:

ENSIGN FACILITY SERVICES, INC. a Nevada corporation 

	By:	/s/ CHRISTOPHER R. CHRISTENSEN
	Its:	President
	Date:	6/07/04
	
 By:	

/s/ J. RICHARD TOOLE
	Its:	Secy
	Date:	6/09/04
	
 Landlord:	

 
	 MISSION RIDGE ASSOCIATES LLC,

a Delaware limited liability company,

Owner
	
 By:	

LEGACY PARTNERS COMMERCIAL, L.P.,

a California limited partnership,

as property manager and agent for Owner
	
 By:	

LEGACY PARTNERS COMMERCIAL, INC.,

a Texas corporation
	
 By:	

/s/ DEBRA SMITH

Senior Vice President
	Date:	6/17/04

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Exhibit 10.41  

 
 

FORM OF INDEPENDENT CONSULTING AND
  CENTRALIZED SERVICES AGREEMENT
  (Non-Clinical)
  Ensign Facility Services, Inc.    
    

	Effective Date:	 	 
	

CONSULTANT:	
 	

ENSIGN FACILITY SERVICES, INC., a Nevada corporation
	

Address:	
 	

32232 Paseo Adelanto, Suite 100

San Juan Capistrano, CA 92675
	

Phone:	
 	

(949) 487-9500
	

Fax:	
 	

(949) 487-9300
	

FACILITY:	
 	

[EACH FACILITY OPERATED BY THE ENSIGN GROUP, INC. OR ITS SUBSIDIARIES IS SEPARATELY A PARTY TO THIS FORM OF AGREEMENT]
	

Address:	
 	

 
	

Phone:	
 	

 
	

Fax:	
 	

 
	

FEIN:	
 	

 

        THIS
INDEPENDENT CONSULTING AND CENTRALIZED SERVICES AGREEMENT ("Agreement") is made and entered into by and between the above-named Consultant and Facility as of the Effective Date,
with respect to the following facts and intentions: 

 
 

R E C I T A L S    
    

        A.    Facility
is an independent long-term care facility with its own administrative and clinical leadership and staff operating in and from premises located at the
address set forth above (the "Facility Premises"), providing inpatient skilled nursing, rehabilitation and therapy services, and other goods and services to the community associated with the
long-term care industry; and 

        B.    Consultant
is a provider of centralized accounting, payroll, legal, human resources, benefits, risk management, purchasing, technology, training, motivation, compliance,
credit enhancement, billing and collection services, as well as other goods and services frequently provided by the corporate or regional service centers of multi facility long-term care
chains and other businesses, to aid the efficient, competitive and sound operation of individual businesses and facilities like Facility; and 

        C.    Facility
desires to engage the services of Consultant to assist Facility personnel with the non-care and non-clinical aspects of Facility's
operations and activities, in order to permit Facility personnel to more effectively focus on Facility's primary mission of rendering superior long-term care services to the Facility's
patients and residents; 

        IN
CONSIDERATION OF THE PREMISES and for other good and valuable consideration, the receipt and sufficiency of which the parties hereby mutually acknowledge, the parties agree: 

 
 

TERMS AND CONDITIONS    
    

        1.    Incorporation of Exhibits and Recitals    The Recitals set forth above, as well as the exhibits attached hereto,
are incorporated herein by this reference as if fully set forth herein. 

 

        2.    Consultant's Duties    The Consultant agrees to provide such of the following services as Facility, at
Facility's option and request from time to time, desires to obtain from Consultant during the term of this Agreement, and to perform its duties hereunder in a good, professional and workmanlike
manner. Such duties shall include, without limitation (herein the "Services"): 

        2.1.  Consultant's
Duties, Generally. 

        2.1.1. Consultant
will provide Services in substantial conformance to applicable federal and state laws and the established policies of Consultant and Facility in effect
from time to time, and Consultant will conduct periodic self-audit/compliance reviews in order to ensure that Consultant substantially complies with federal, state and local statutes and
regulations applicable to the provision of the Services. Facility hereby grants to Consultant a limited power of attorney to act in Facility's name and stead for the convenience of Facility and/or
Consultant, provided that this power shall not be used except in conjunction with Services under this Agreement. 

        2.1.2. Consultant
shall make clear to all parties with whom it deals in the course of rendering the Services that it is an independent contractor and not an employer,
employee, partner, co-venturer or other affiliate of Facility. At all times while in the Facility, Consultant's employees and representatives shall wear uniforms and/or badges clearly
indicating their affiliation with Consultant. 

        2.2.    Specific Duties of Consultant.    During the term of this Agreement, Consultant shall provide to Facility and
its staff, residents and patients, the specific Services listed on Exhibit A. In the event of any conflict between the terms of Exhibit A and the terms contained in the main body of this
Agreement, the terms of Exhibit A shall control. Consultant's duties shall specifically not include (i) the rendition of any direct care to patients or residents, (ii) the
rendition of clinical advice for the care or treatment of any particular patient or resident, (iii) maintenance or handling of patient trust property, or (iv) any other service not
specifically enumerated herein as a part of the Services and requested by Facility, all of which shall be the sole duty and domain of Facility, its administrators, caregivers and other staff. 

        3.    Facility's Duties.    Facility shall: 

        3.1.  Operate
its business in and from the Facility Premises in substantial compliance with applicable laws and regulations, and maintain all federal and state licenses and
certifications required to operate the Facility and provide Services to patients and residents (collectively the "Licenses"). Facility shall perform all duties required of a licensee and provider
under applicable local, state and federal laws, codes, regulations and provider agreements affecting the operation of the Facility. Within five (5) days of receipt, Facility shall deliver to
Consultant notification of any actual revocation or suspension of its Licenses. 

        3.2.  Not
unreasonably restrict or limit the Consultant's right to exercise its independent professional judgment, including its right to recommend Services to be rendered
and to render such Services using such methods, technologies and procedures as Consultant deems appropriate. 

        3.3.  Timely
furnish Consultant with such information and materials as might ordinarily be expected for Consultant to perform its duties hereunder. Facility shall be solely
responsible to assure the accuracy and completeness of all information provided by Facility and its personnel to Consultant, and Consultant shall be entitled to rely thereon without inquiry or
diligence of any kind. 

        3.4.  As
and to the extent that Consultant's employees and agents require access to the Facility Premises to perform the Services, Facility shall provide adequate working
space, equipment and access to Facility's staff for the provision of Services. Equipment and materials placed at the 

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Facility
by Consultant shall be used exclusively for the purposes of this Agreement. Upon termination or at Consultant's request, Facility shall return equipment and materials, in the same condition
as when delivered to Facility, reasonable wear and tear excepted. 

        3.5.  In
addition to the foregoing, during the term of this Agreement, Facility shall cooperate with Consultant and Consultant's other client facilities and businesses as
more fully set forth in Exhibit A. 

        4.    Compensation.    

        4.1.  For
and in consideration of the services to be provided under this Agreement, the Facility shall pay to the Consultant as the "Consultant Compensation" a monthly
consulting fee equal to five percent (5.0%) of Facility's gross revenue from all sources. A reasonable estimate of anticipated monthly Consultant Compensation shall be paid on or before the first
(1st) day of each month during the Term hereof, and shall be "trued up" at the beginning of the next following month with such following month's estimated payment. Payment for any partial month of the
Term shall be prorated based on the number of days during the month that Consultant served under this Agreement. In the event Facility closes or its census is or drops below 60% of licensed capacity
during any month during the Term, the Consultant Compensation for any such month or partial month shall be calculated, at Consultant's option, based on historical revenues and patient mix, as if the
occupancy were at 60%. At Consultant's option Consultant shall be entitled to deduct the Consultant Compensation from sums collected for Facility by Consultant, and shall provide Facility with
invoices (or if paid by deduction accountings) for the monthly fee by the last day of the month following the month of service. 

        4.2.  In
addition to and not as part of the Consultant Compensation, Facility shall reimburse Consultant for all costs and expenses advanced, incurred or paid by Consultant
in the rendition Services. 

        5.    Insurance.    

        5.1.  Consultant
agrees to maintain general liability insurance during the term of this agreement in an amount not less than One Million Dollars ($1,000,000) per claim and
Three Million Dollars ($3,000,000) in the aggregate. 

        5.2.  Facility
agrees to maintain general and professional liability insurance in an amount not less than One Million Dollars ($1,000,000) per occurrence and Three Million
Dollars ($3,000,000) in the aggregate. 

        5.3.  Both
parties agree to maintain such other and further insurance as may be required by law or the terms of any agreement to which they are parties, including without
limitation worker's compensation insurance (where required by law), directors and officers coverage, automobile and similar liability, and property and casualty insurance. 

        5.4.  All
insurance policies shall (i) be issued by insurance companies with a policyholder rating of at least "B+" in the most recent version of Best's Key Rating
Guide, and (ii) for Facility's coverage, be written by companies authorized to do so in the State where the Facility Premises are located. Facility's policies shall additionally
(iii) name Ensign Facility Services, Inc. and The Ensign Group, Inc. as "additional
insureds," and (iv) provide that they will not be cancelled on less than ten (10) days' prior written notice to Consultant. A current certificate or other acceptable evidence of
Facility's insurance shall be timely deposited and kept on file with Consultant during the Term. 

        6.    Term and Termination.    The Term of this Agreement shall commence on the Effective Date and continue thereafter
for a period of one (1) year. This Agreement shall automatically extend for additional periods of one (1) year each unless written notice of termination is given not less than sixty 

3

 

(60) days
prior to the end of the then-current term. Notwithstanding anything contained herein to the contrary, either party may terminate this Agreement and the Term hereof at any
time during the Term upon sixty (60) days written notice; further, in the event of (i) abandonment by a party of its duties hereunder, or (ii) nonpayment of any Consultant
Compensation within five (5) days after delivery of invoice or other written demand therefor; or (iii) any breach or violation of this Agreement (other than non-payment of
Consultant Compensation) which is not cured within thirty (30) days following delivery of written notice of such breach or violation, (iv) any material violation of law or regulations,
or loss or failure of license or licensure, or and violation of the eligibility requirements for reimbursement under any government program by a party, or (v) the occurrence or existence of any
condition, practice, procedure, action, inaction or omission of, by or involving a party which, in the reasonable opinion of the other party constitutes either a threat to the health, safety and
welfare of any patient or a violation of any law, regulation, requirement, Licenses, eligibility or material agreement governing Facility's or Consultant's operation, then the other party shall have
the right to summarily and immediately terminate this Agreement upon written notice to the first party. 

        7.     Regulatory
Changes. Facility and Consultant mutually agree that in the event local, state or federal government agencies promulgate regulations which materially affect
the terms of this Agreement, including but not limited to changes affecting the cost of providing Services hereunder, this Agreement shall be immediately subject to renegotiation upon the initiative
of either party. 

        8.    Warranties.    

        8.1.    Facilities Warranties.    Facility hereby makes the following warranties and representations to Consultant in
connection with Consultant's entry into this Agreement, which warranties shall survive the termination of this Agreement: 

        8.1.1. Facility
is properly licensed by the State in which the Facility's operation(s) is located by the proper licensing and certification authorities for such State, and
all permits and licenses required for the operation of Facility's business(es) have been received and are now currently effective. 

        8.1.2. As
of the Effective Date, except as specifically disclosed on Schedule 7 attached hereto and incorporated herein, there is no litigation, administrative
proceedings, event or hold or similar lien on State or Federal payments to Facility, either underway or threatened, nor are their arbitration proceedings or governmental investigations relating to the
Facility, or the business conducted thereon underway or threatened against Facility or the Facility 

        8.1.3. To
the best of Facility's knowledge, the business operations of the Facility at the Commencement Date comply with all local, State and Federal zoning, labor and other
applicable laws, ordinances, rules and regulations applicable to the Facility. 

        8.1.4. Facility
has been duly formed in the state of its domicile and remains in good standing in such state, and (if operating in a state other than its domicile) has been
duly registered and authorized to do business in the state where its business operation(s) is located and is in good standing in that state as well. 

        8.1.5. Facility
is authorized to consummate the transactions covered by this Agreement. 

        8.2.    Consultant's Warranties.    Consultant hereby makes the following warranties and representations to Facility
in connection with Facility's entry into this Agreement, which warranties shall survive the termination of this Agreement: 

        8.2.1. Consultant
is a Nevada corporation in good standing, and is registered to do business in, and is in good standing with, the State of California. 

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        8.2.2. Consultant
is authorized to consummate the transactions covered by this Consulting Agreement. 

        9.    Licensure, Eligibility and Compliance.    

        9.1.  Consultant
acknowledges that its activities under this Agreement may be governed by, inter alia, the United States Department of Health and Human Services' Office of
the Inspector General's Compliance Program Guidelines for Skilled Nursing Facilities. Consultant represents and warrants that neither Consultant nor any individual or entity with a direct or indirect
ownership or control interest of
five percent (5%) or more in Consultant, nor any director, officer, agent or employee of such party, is debarred, suspended or excluded under any state or federal healthcare program it is currently
eligible to participate in Medicare, Medicaid, and all other federally funded health care programs and is not subject to any sanction or exclusion by any of those programs. Consultant agrees to
immediately disclose any actual or threatened federal, state or local investigations or imposed sanctions of any kind, in progress or initiated subsequent to the date of entering into this Agreement.
Consultant further represents and warrants that it is not currently sanctioned under any applicable state or federal fraud and abuse statutes, including exclusion from any state or federal health care
program. If, during the term of this Agreement, Consultant, its parent, or any officer, director or owner receives such a sanction, or notice of proposed sanction, Consultant shall provide notice of
and a full explanation of such sanction or proposed sanction and the period of its duration within ten (10) days of receipt. Facility reserves the right to terminate the Agreement immediately
upon receipt of notice that Consultant has been sanctioned under fraud and abuse statutes and/or any other federal, state or local regulation. 

        9.2.  If
the Facility Premises are located in the state of Texas, Consultant agrees to complete, execute and deliver to Facility upon request a Certification Regarding
Debarment, Suspension, Ineligibility and Voluntary Exclusion for Covered Contracts on Form 2046 as promulgated by the Texas Department of Protective & Regulatory Services. 

        9.3.  Consultant
acknowledges that it has received a copy of Facility's Corporate Compliance Program, and agrees to abide by the provisions thereof governing Vendors and
Vendor services. 

        10.    Consultant's Schedule and Availability.    

        10.1. Consultant
shall be reasonably available to the Facility on an on-call basis, and shall spend sufficient time at the Facility Premises each month to
fulfill Consultant's duties hereunder. 

        10.2. Nothing
in this Agreement shall be construed as limiting or restricting in any manner Consultant's right to render the same or similar services to other individuals or
entities, including but not limited to, other nursing homes and acute care facilities during or subsequent to the Term of this Agreement; similarly, nothing in this Agreement shall require Facility to
exclusively use all of Consultant's services in the Facility during the Term of this Agreement. 

        10.3. Consultant's
employees and representatives are entitled to be reasonably absent for annual vacations, sick leave, continuing education, and personal reasons; provided
that in the event of any absence Consultant shall consult with the Facility concerning the impending absence and cooperate with the Facility in providing alternate resources to Facility to temporarily
fulfill Consultant's duties during the period of absence. 

        11.    Contractual Relationship.    

        11.1.    Independent Contractor.    It is expressly acknowledged by both parties that Consultant is an independent
contractor. Nothing herein is intended to be construed to create an employer-employee, partnership, joint venturer or other relationship between Consultant and the Facility. Facility has and shall
retain all statutory liability and responsibility for the continued operation of the Facility as the licensee under Facility's Licenses. No provision of this Agreement shall create 

5

 

any
right in the Facility to exercise control or direction over the manner or method by which Consultant performs its duties or renders Services hereunder, nor shall Consultant exercise control or
direction over the manner or method by which Facility operates or serves its patients and residents; provided always, that services shall be provided in a manner consistent with all applicable laws,
rules and regulations of all governmental authorities, and Facility's Corporate Compliance Program. Facility will not withhold from compensation payable to Consultant hereunder, or be in any way
responsible for, any sums for income tax, employment insurance, Social Security, or any other agency and Consultant agrees that the payment of all such amounts as may be required by law are and shall
be the sole responsibility of Consultant. 

        11.2.    Fair Market Value.    The amounts to be paid to Consultant hereunder have been determined by the parties
through good faith and arms-length bargaining to be the fair market value of the services to be rendered hereunder. No amount paid or to be paid hereunder is intended to be, nor will it be
construed as, an offer, inducement or payment, whether directly or indirectly, overtly or covertly, for the referral of patients by Consultant to Facility, or by Facility to Consultant, or for the
recommending or arranging of the purchase, lease or order of any item or service. For purposes of this section, Consultant and Facility will include each such entity and any affiliate thereof. No
referrals are required under this Agreement. 

        11.3.    Work Product.    The work product created in the course of Consultant's services under this agreement shall
be the exclusive property of Consultant, and all manuals, forms, and documents (including without limitation, all writings, drawings, blueprints, pictures, recordings, computer or machine readable
data, and all copies or reproductions thereof) which result from, describe or relate to the services performed or to be performed pursuant to this agreement or the results thereof, including without
limitation all notes, data, reports or other information received or generated in the performance of this Agreement (excepting data incorporated in medical records required to be kept and maintained
by Facility), shall be the exclusive property of Consultant and shall be delivered to Consultant upon request. 

        11.4.    Consultant's Employees, Non-Solicitation.    During the term of this Agreement, Facility shall
not solicit the services of or hire, as an employee or independent contractor at the Facility, of (i) any Consultant employee, agent or representative who provided, managed or otherwise was
involved in the provision of Services to Facility within the previous twelve (12) months (a "Restricted Employee"), or (ii) any business enterprise or other entity in which such
Restricted Employee owns a
twenty percent (20%) or greater interest. Nothing herein shall preclude Facility from advertising available positions or opportunities by posting in the Facility or through newspaper ads or other
generally accepted recruiting mediums. The parties acknowledge that the restrictions set forth in this Article are reasonable in scope and important to Consultant's business interests, and that the
enforcement of this Article does not restrict Facility from engaging in Services for its own account. In the event that Facility hires a Restricted Employee, facility shall pay a recruiting fee to
Consultant in the amount of Seven Thousand Five Hundred and No/100 Dollars ($7,500.00) per Restricted Employee hired. 

        11.5.    HUD Identity-of-Interest Provisions.    In the event that there is any
"identity-of-interest" between Facility and Consultant as defined under regulations promulgated by the United States Department of Housing and Urban Development ("HUD"), then
upon request of HUD or Facility, Consultant will make available to HUD, at a reasonable time and place, its records and records of identity-of-interest companies which relate
to the goods and services charged to the Facility. Records and information will be sufficient to permit HUD to determine the services performed, the dates the services were performed, the location at
which the services were performed, the time consumed in providing the services, the charges made for the materials, and the per-unit and total charges levied for said services. 

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        12.    Indemnification.    

        12.1. Facility
agrees to defend, indemnify, and hold Consultant, its parent, subsidiaries, affiliated and related companies, directors, officers, employees, and agents,
wholly harmless from and against any and all costs (including reasonable attorney's fees) liabilities, claims, losses, lawsuits, settlements, demands, causes, judgments and expenses arising from the
performance of this Agreement to the extent that such costs and liabilities result from the negligence or willful misconduct of Facility. 

        12.2. Consultant
agrees to defend, indemnify, and hold Facility, its parent, subsidiaries, affiliated and related companies, directors, officers, employees, and agents,
wholly harmless for, from and against any and all costs (including reasonable attorney's fees), liabilities, claims, losses, lawsuits, settlements, demands, causes, judgments and expenses arising from
or connected with Consultant's acts or omissions or the performance of this Agreement, to the extent that such costs and liabilities are alleged to result from the negligence or willful misconduct of
Consultant. 

        12.3. A
party receiving notice of a claim or potential claim shall send written notice to the other within ten (10) business days, and shall fully cooperate in the
defense thereof by counsel mutually acceptable to the parties. The parties' rights to indemnification set forth in this Article are non exclusive and are
not intended to affect in any way any other rights of the parties to indemnification under applicable federal, state or local laws and regulations. 

        13.    Access to Books and Records.    Pursuant to 42 U.S.C. §1395x(V)(1)(I), during the six
(6) year period after completion of services hereunder, the Facility will, upon written request, make available to the Secretary of Health and Human Services or to the Comptroller General, or
their duly authorized representatives, this Agreement, books, documents, and records that are necessary to certify the nature and extent of costs incurred by the Facility under the provisions of this
Agreement. This provision shall be in force for any twelve (12) month period during which the total value of services provided or goods delivered hereunder is Ten Thousand Dollars ($10,000) or
more. This section shall have no effect unless Consultant is deemed a "subcontractor" under any regulation adopted under the provision of the United States Code cited above. 

        14.    Privacy.    

        14.1.    HIPAA Applicability and Compliance.    Facility may be a "Covered Entity" under, and required to comply with,
the applicable provisions of the Health Insurance Portability and Accountability Act of 1996 as amended ("HIPAA") and the regulations and guidelines pertaining thereto (collectively with HIPAA the
"HIPAA Rules"), and to obtain sufficient assurances that its contracting parties will appropriately safeguard patients' "Protected Health Information" ("PHI") as defined in the HIPAA Rules. In the
course of performing Consultant's services, duties and obligations herein, Consultant may receive, create or obtain access to PHI. Consultant agrees to maintain the security and confidentiality of
PHI, as required of Facility by applicable laws and regulations, including without limitation the HIPAA Rules, and to execute and deliver such additional documentation and assurances as Facility may
reasonably request to comply with HIPAA and any amendments thereto and related laws and regulations. 

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        14.2.    Correlation of Record Handling Requirements.    In the event of any conflict between the requirements of this
Article 13 and/or between the various laws, statutes, ordinances and regulations relating to or otherwise affecting the subject matter thereof, the requirement or applicable law that that
presents the most stringent standard for compliance, as reasonably determined by Facility, shall be followed, such that compliance is achieved or maximized in all cases. 

        14.3.    Confidential Information.    Consultant shall preserve the confidentiality of all private, confidential
and/or proprietary information disclosed to or discovered by Consultant in connection with this Agreement, including, without limitation, nonpublic financial information, manuals, protocols, policies,
procedures, marketing, and strategic information, Facility lists, computer software, training materials, resident/patient health information, resident/patient records, and resident/patient care and
outcomes data ("Confidential Information") as and to the extent required by law. Consultant shall not use for its own benefit or disclose or otherwise disseminate to third parties, directly or
indirectly, any Confidential Information without prior written consent from Facility, provided however that if Consultant grants Facility access to, and Facility uses, Consultant's UItraCars or
similar databases or information sharing mechanisms, Facility's information may be provided to similar facilities and Facility hereby grants Facility's consent to such information sharing as a
condition to Facility's receipt of access to such mechanisms and the data they contain form time to time. Upon termination of this Agreement, all Confidential Information and copies thereof shall be
returned to Facility. Consultant and Facility shall comply with applicable federal, state and local laws and regulations with respect to all Confidential Information, including, but not limited to,
any disclosures thereof pursuant to this section. 

        15.    Notices.    All notices which are required or which may be given pursuant to the terms of this Agreement shall
be in writing and shall be sufficient in all respects if given in writing and delivered personally or by registered or certified mail, return receipt requested, or by a comparable commercial delivery
system, and notice shall be deemed to be given on the date hand-delivered or on the date which is three (3) business days after the date deposited in United States mail, or with a
comparable commercial delivery system, with postage or other delivery charges thereon prepaid, at the addresses first set forth above or such other addresses as Facility and Consultant may designate
by written notice to the other from time to time. For a notice from Consultant to Facility to be effective, a true and complete copy of such shall be simultaneously delivered by Consultant to notice
sent by Consultant to Ensign Facility Services, Inc., Attn: General Counsel, 32232 Paseo Adelanto, Suite 100, San Juan Capistrano, CA 92675, or such other address as Consultant
may from time to time specify. 

        16.    Arbitration.    

        16.1. Any
controversy, dispute or claim arising in connection with the interpretation, performance or breach of this Lease, including any claim based on contract, tort or
statute, shall be determined by final and binding, confidential arbitration with Judicial Mediation and Arbitration Service ("JAMS/Endispute") in Orange County, California, provided that if
JAMS/Endispute (or any successor organization thereto) no longer exists, then such arbitration shall be administered by the American Arbitration Association ("AAA") in accordance with its
then-existing Commercial Arbitration Rules, and the sole arbitrator shall be selected in accordance with such AAA rules. Any arbitration hereunder shall be governed by the United States
Arbitration Act, 9 U.S.C. 1-16 (or any successor legislation thereto), and judgment upon the award rendered by the arbitrator may be entered by any state or federal court having
jurisdiction thereof. Neither Landlord, Tenant nor the arbitrator shall disclose the existence, content or results of any arbitration hereunder without the prior written consent of all parties;
provided, however, that either party may disclose the existence, content or results of any such arbitration to its partners, officers, directors, employees, agents, attorneys and accountants and to
any other Person to whom disclosure is required by applicable Legal Requirements, including pursuant to an order of a court 

8

 

of
competent jurisdiction. Unless otherwise agreed by the parties, any arbitration hereunder shall be held at a neutral location selected by the arbitrator in the major metropolitan area in the State
closest in proximity to the Leased Property. The cost of the arbitrator and the expenses relating to the arbitration (exclusive of legal fees) shall be borne equally by Landlord and Tenant unless
otherwise specified in the award of the arbitrator, in which case such fees and costs paid or payable to the arbitrator shall be included in "reasonable costs and attorneys' fees" for purposes of
Section 17.2, and the arbitrator shall specifically have the power to award to the prevailing party pursuant to such Section 17.2 such party's costs and expenses, including fees and
costs paid to the arbitrator. 

        16.2. NOTICE:
BY INITIALING IN THE SPACE BELOW YOU ARE AGREEING TO HAVE ANY DISPUTES ARISING IN THIS "ARBITRATION OF DISPUTES" PROVISION DECIDED BY NEUTRAL ARBITRATION AS
PROVIDED HEREIN AND BY CALIFORNIA LAW AND YOU ARE GIVING UP ANY RIGHTS YOU MIGHT POSSESS TO HAVE SUCH DISPUTE LITIGATED IN A COURT OR JURY TRIAL. BY INITIALING IN THE SPACE BELOW, YOU ARE GIVING UP
YOUR JUDICIAL RIGHTS TO DISCOVERY AND APPEAL, UNLESS THOSE RIGHTS ARE SPECIFICALLY INCLUDED IN THIS "ARBITRATION OF DISPUTES" PROVISION. IF YOU REFUSE TO SUBMIT TO ARBITRATION AFTER AGREEING TO THIS
PROVISION, YOU MAY BE COMPELLED TO ARBITRATE UNDER THE AUTHORITY OF THE CALIFORNIA CODE OF CIVIL PROCEDURE. YOUR AGREEMENT OF THE PARTIES TO THIS ARBITRATION PROVISION 1S VOLUNTARY. 

        BY
INITIALING BELOW YOU AFFIRM THAT YOU HAVE READ AND UNDERSTAND THE FOREGOING AND AGREE TO SUBMIT DISPUTES ARISING OUT OF THE MATTERS INCLUDED IN THIS "ARBITRATION OF DISPUTES"
PROVISION TO NEUTRAL ARBITRATION. 

	

	
 	

	CONSULTANT	 	FACILITY

        17.    Miscellaneous.    

        17.1. This
Agreement has been negotiated by and between Consultant and Facility in arms-length negotiations, and both parties are responsible for its drafting.
Both parties have reviewed this Agreement with appropriate counsel, or have waived their right to do so, and the parties hereby mutually and irrevocably agree that this Agreement shall be construed
neither for nor against either party, but in accordance with the plain language and intent hereof. The invalidity or unenforceability of any provision of this Agreement shall not affect the other
provision hereto, and this Agreement shall be construed in all respects as if such invalid or unenforceable provisions were omitted. Headings are used herein for convenience only, and shall play no
part in the construction of any provision of this Agreement 

        17.2. In
the event of any dispute between the parties arising under or in relation to this Agreement, the prevailing party in such dispute or litigation shall have the right
to receive from the nonprevailing party all of the prevailing party's reasonable costs and attorneys' fees incurred in connection with any such dispute and/or litigation. As used herein, the term
"prevailing party" shall refer to that party to this Agreement for whom the result ultimately obtained most closely approximates such party's position in such dispute or litigation. 

        17.3. This
Agreement shall be governed by the laws of the state in which the Facility Premises are located. Notwithstanding anything contained herein to the contrary, venue
for any action involving this Agreement shall lie solely in Orange County, California. 

        17.4. Time
is of the essence of this Agreement and every term and condition hereof. 

9

 

        17.5. The
waiver by any party hereto of breach of any provision of this Agreement shall not operate as or be construed to be a waiver of any subsequent breach by any party. 

        17.6. This
Agreement shall binding upon the parties hereto, their heirs, successors and assigns. Notwithstanding the foregoing, the parties mutually acknowledge that a
material and substantial consideration in the parties' mutual execution of this Agreement is the identity and reputation of the other party, and each party's subjective perception of the other's value
to and compatibility with such party and its officers, employees, facilities and patients. As such, notwithstanding anything contained herein to the contrary, this Agreement and the rights of the
parties hereunder are personal to the parties and may not be assigned or subcontracted to, nor shall the duties and responsibilities of either hereunder be delegated to or rendered by, any other
person or entity without the express prior written consent of the other party, which consent may be granted or denied, conditionally or unconditionally, by a party in its sole, absolute and unfettered
discretion. 

        17.7. Notwithstanding
the expiration or earlier termination of this Agreement, the obligations and/or liabilities of the parties hereunder, relating to events, occurring
during the Term, to which the parties' indemnification obligations under Section 12 apply, shall continue in full force and effect after the Agreement terminates, subject to applicable
California statutes of limitation. Additionally, the covenants of the parties under Sections 11.4, 13, 14 and 16 shall survive the termination of this Agreement. 

        17.8. This
Agreement is solely between the parties hereto, and shall not create any right or benefit in any third party, including without limitation any creditor, agent,
partner, employee or affiliate of Current Operator, or any entity or agency having jurisdiction of any of the Licenses, the Facility or the operation of the business therein. 

        17.9. This
Agreement represents the entire agreement and understanding of the parties with respect to the subject matter hereof, and supersedes and negates any previous
contracts between Facility and Consultant. Facility and Consultant mutually agree that this Agreement may not be modified unless such modification is in writing and signed by both parties. 

        IN
WITNESS WHEREOF, the parties have affixed their signatures hereto as of the dates set forth below. 

	CONSULTANT:	 	FACILITY:
	

ENSIGN FACILITY SERVICES, INC.,

a Nevada corporation	
 	

[EACH FACILITY OPERATED BY THE ENSIGN GROUP, INC. OR ITS SUBSIDIARIES IS SEPARATELY A PARTY TO THIS FORM OF AGREEMENT]
	

By:	
 	

	
 	

 	
 	

 
	Gregory K. Stapley

Authorized Agent

Date	 	 	 	 
	 	 	 	 	By:	 	The Ensign Group, Inc.
	 	 	 	 	A Delaware corporation, its sole member
	

 	
 	

 	
 	

By:	
 	

	 	 	 	 	President

Authorized Agent

Date:

10

 
 
 

EXHIBIT A
  to
  INDEPENDENT CONSULTING AND
  CENTRALIZED SERVICES AGREEMENT
  (Non-Clinical)    
    

        THIS
EXHIBIT A supplements the foregoing INDEPENDENT CONSULTING AND CENTRALIZED SERVICES AGREEMENT (the "Agreement") made and entered into by and between the therein-named Consultant and
Facility and forms a part thereof. The specific duties and obligations described herein may or may not be performed by either party, depending upon the needs, preferences and requests of the other
from time to time. The lists of duties and activities are not exhaustive, but where certain duties or activities are expressly limited, excluded or proscribed hereby, such activities shall not be
requested or performed. Consultant's services shall be rendered on a non-exclusive basis, and Consultant shall have no duty to limit its services solely to Facility. Any service to be
rendered by Consultant hereunder may be, at Consultant's sole option, rendered on a joint or "pooled" basis with or to Facility and other clients of Consultant. Consultant
may provide any of its services hereunder through the use or assistance of subcontractors, but such subcontractors shall be subject to all of the terms and conditions of this Agreement. Although
Consultant shall have discretion to make certain decisions regarding its services for Facility in the day-to-day rendition of such services, Facility shall remain solely
responsible for all decisions and actions made by, at, for or involving Facility and the operation of Facility's business. 

SPECIFIC SERVICES TO BE RENDERED BY CONSULTANT:  

        1.     Accounting.

        A.    Provides
regular financial statements, analysis and reports to Facility management and Facility's lenders and customers. 

        B.    Provides
billing and collections oversight and assistance, including without limitation general compliance counseling, provided however that Facility shall be solely
responsible for assessment, billing and collection compliance. 

        C.    Tracks
lockbox and other revenues, as well as all expenses submitted to Consultant, including without limitation capital projects expenses, and consults on the
advisability of major capital expenditures. 

        D.    Provides
accounts payable processing based on Facility-supplied payables data. 

        E.    Provides
payroll services based upon Facility-generated payroll data; including without limitation providing separate payrolls for key employee groups as deemed prudent
by Consultant or requested by Facility, 

        F.     Assists
in the preparation and filing of cost reports and other required financial filings and reports. 

        G.    Oversees
borrowing and other financial relationships and acts as liaison for lenders and outside accounting and financial consultants, and assists in procuring,
maintaining and complying with the terms of financing and credit relationships, which may, with Facility's acquiescence AND at
Consultant's sole option, be created on a standalone basis for Facility or jointly in concert with some or all of Consultant's other clients. 

        2.     Human
Resources. 

11

 

        A.    Procures
and assists Facility in administering employee benefits plans as requested by Facility for its employees, such as health, dental, defined benefit, defined
contribution, life insurance, disability, employee assistance programs and other benefits which may, with Facility's acquiescence AND at Consultant's sole option, be created on a standalone basis for
Facility or jointly or in concert with some or all of Consultant's other clients. 

        B.    Provides
sample form policy and procedure manuals, employee handbooks and hiring, performance evaluation and disciplinary forms and the like, to facilitate the efficient
establishment and conduct of employer-employee relations; provided that all manuals, materials and forms provided in connection therewith shall be and remain the property of Consultant and may not be
copied, reproduced, distributed or used other than with the express written permission of Consultant. 

        C.    Provides
general assistance with human resources, labor and employment questions and issues, including questions related to hiring, disciplining and separation of
employees; provided that Consultant shall have no responsibility for hiring, discipline or separation of Facility employees, which responsibility shall be an remain the sole province of Facility. 

        D.    Provides
periodic inservices and other trainings as requested by Facility, including an annual training meeting or convention for Facility's Administrator and Director of
Nursing (which may be offered simultaneously and in conjunction with the annual trainings for other of Consultant's clients), to assist managers and staff in the lawful and efficient conduct of their
business affairs; provided that all trainings and materials provided in connection therewith shall be and remain the property of Consultant and may not be copied, reproduced, distributed or used other
than with the express written permission of Consultant. 

        E.    Provides,
as requested by Facility, independent third-party investigation of employment-related allegations of managerial and/or staff misconduct and recommendations (but
not directives) with respect thereto. 

        F.     Assists
Facility in establishing employee sharing arrangements with other facilities or employers, and also in facilitating and implementing Facility employee transfer
policies, as requested on a case-by-case basis by Facility. 

        3.     Technical &
Compliance Resource. 

        A.    Provides
a delegate to serve as a resource to and advisory member of the Facility's Quality Assurance Committee, who attends and participates in both monthly and special
Quality Assurance Committee meetings; provided that such delegate shall be subject to the same obligations of confidentiality as any other member of the Committee, but shall not be allowed to vote or
direct the work of the Committee or the Facility. 

        B.    Assists
Facility management in preparing for, reviewing and responding to the various official surveys and inspections of Facility's premises and clinical practices. 

        C.    Participates,
solely as an advisory resource and not as a director, manager or decisionmaker, in staff and Facility committee meetings, including without limitation
Infection Control, Pharmacy Services, Patient Care Policy Reviews and other meetings, when reasonably requested to do so by the Executive Director, and assists the Executive Director and other
Facility management in evaluating the implementation of the recommendations of the Facility's committees. 

        D.    Participates,
solely as a resource and not as a director, in the development of patient care policies and systems for the Facility. 

12

 

        E.    Assists
in the identification and, where requested by Facility the evaluation, of prospective candidates and contractors to serve in clinical service, nursing, therapy
service and other leadership and line staff roles in the Facility. In addition, and at Facility's request and at Facility's sole cost and expense, facilitates the sharing of clinical resource
personnel, including specialists, among Facility and other clients of Consultant who wish to obtain such additional personnel and share the cost of hiring, training, and compensating such personnel. 

        F.     Assists
in designing policies and procedures to periodically review the health status of employees to ascertain freedom from infection, compliance with local and state
health regulations for the various specific categories of employees, and proper documentation of compliance. 

        G.    Participates,
in an advisory capacity, with the utilization review committee to develop norms, standards and criteria for the design and conduct of the committee's
medical care evaluation studies. However, Consultant shall not direct in any way the functions of the utilization review committee such as individual patient reviews. 

        H.    Participates
in the design and periodic evaluation of the Facility's staff development and clinical inservice programs, provided that all manuals, materials and forms
provided in connection therewith shall be and remain the property of Consultant and may not be copied, reproduced, distributed or used other than with the express written permission of Consultant 

        I.     Provides
periodic clinical inservices and other formal and informal trainings as requested by Facility, which may be offered simultaneously and in conjunction with the
trainings for other of Consultant's clients. Such trainings shall include no nursing, therapy or direct care services by Consultant's representatives, but may or may not include, without limitation,
assistance with resident assessment, charting and similar activities when performed in connection with inservices, survey readiness reviews, mock surveys and other similar clinical consulting and
training, in order to assist clinical leadership and staff in the lawful and efficient conduct of caregiving and therapy operations; provided that all trainings and materials provided in connection
therewith shall be and remain the property of Consultant and may not be copied, reproduced, distributed or used other than with the express written permission of Consultant. 

        J.     Assists
in the development, implementation and periodic valuation of certified nursing assistant training programs and other experience-based clinical training
activities, whether conducted by Facility or by a third-party educator at Facility's site under a clinical affiliation agreement. 

        K.    Provides
sample form clinical and therapy policy and procedure manuals, handbooks and forms; provided that all manuals, materials and forms provided in connection
therewith shall be and remain the property of Consultant and may not be copied, reproduced, distributed or used other than with the express written permission of Consultant. 

        4.     Legal
Services. 

        A.    Provides
general legal counsel consisting of limited legal services and assistance, including litigation management, corporate filings and governance assistance, legal
compliance tools, licensing assistance and similar services; provided however that Consultant shall render no legal advice or court representation in any jurisdiction where an employee of Consultant
is not licensed to do so unless otherwise permitted by law. 

        B.    Provides
contract review, processing and general assistance with vendor, customer and other contracts; and Facility hereby authorizes Consultant to negotiate and enter
into contracts on Facility's behalf as Facility's agent solely for such limited purpose, but Consultant shall not be bound to perform such contracts for Facility. Consultant is also authorized to
include Facility in "pooled" or joint contracts with other of Consultant's clients, provided that in no event shall 

13

 

Facility
ever be jointly, severally or in any other way authorized, bound or liable for the acts or omissions of Consultant or any other client of Consultant for or under any such contract or
arrangement, and the scope of Consultant's authority shall not include obligating Facility in any way for the obligations of Consultant or any other person or entity. 

        C.    Provides
a designated Corporate Compliance Officer, compliance hotline, compliance manuals and training; provided that all manuals, materials and forms provided in
connection therewith shall be and remain the property of Consultant and may not be copied, reproduced, distributed or used other than with the express written permission of Consultant. 

        D.    If
applicable, provides or arranges for statutory agent services in those states where Facility has a presence but is not domiciled. 

        E.    Provides
investigation services where complaints or allegations prevent onsite Facility leadership from conducting such investigations. 

        F.     Provides
periodic legal, compliance, regulatory and similar inservices and other formal and informal trainings as requested by Facility, which may be offered
simultaneously and in conjunction with the trainings for other of Consultant's clients. Such trainings shall include no nursing or direct care services by Consultant's representatives, but may or may
not include, without limitation, assistance with proper patient charting and similar activities when performed in connection with inservices, medical records, survey readiness reviews, mock surveys
and other similar consulting and training, in order to assist clinical leadership and staff in the lawful, prudent and efficient conduct of caregiving operations; provided that all trainings and
materials provided in connection therewith shall be and remain the property of Consultant and may not be copied, reproduced, distributed or used other than with the express written permission of
Consultant. 

        G.    Provides
assistance in labor and employment matters, including collective bargaining and other labor relations activities, and processing of state and federal employment
(e.g., EEOC, DFEH, OCR, NLRB and similar agencies and programs) claims. 

        5.     Risk
Management. 

        A.    Interfaces
with insurance brokers and carriers to procure and maintain necessary and desirable insurance coverages. Consultant may, at Consultant's option and unless
Facility objects, provide coverages under "pooled risk arrangements or "blanket" policies that cover other clients of Consultant, and Facility shall pay its allocated share of the premiums for such
coverages based on the rating and risk profile of Facility as determined by Consultant, the broker and/or the insurance underwriters setting the premium. In addition, Consultant may provide such
services, at Consultant's option, through captives or pooled insurance arrangements with other clients of Consultant or other insureds. 

        B.    Provides,
itself or through brokers or outside consultants, limited loss prevention evaluations and services. 

        C.    Provides
worker's compensation coverages, training, resources and systems, which may or may not include, at Consultant's option, assisting Facility, either for Facility's
own account with third-party carriers, or under self-insurance certificates issued to Consultant or Facility, to selfinsure for worker's compensation and other risks. 

        6.     Information
Technology. 

        A.    Provides
basic technology services, including assistance with computer, peripheral and network installations and troubleshooting where Facility uses hardware and software
supported by Consultant. 

14

 

        B.    Provides
centralized Internet, Intranet, and other technology programs and services to promote the efficient, accurate and timely collection and collation of operating
and other business data. 

        C.    Provides
assistance in designing and maintaining web addresses, email services and informational websites for the Facility. 

        D.    Provides
centralized purchasing and procurement services and counseling for Facility's planning, acquisition and use of technology products and services. 

        7.     Miscellaneous
Services. 

        A.    Provides
periodic Administrator-in-Training ("AIT") and Leadership programs, as well as other formal and informal trainings as requested by
Facility, which may be offered simultaneously and in conjunction with the trainings for other of Consultant's clients. Such trainings shall include no nursing or direct care services by Consultant's
representatives, but may or may not include, without limitation, assistance with filing of nursing home administrator and similar certification and licensing applications, and other similar
assistance, consulting and training, in order to assist Facility leadership and staff in obtaining and maintaining necessary and appropriate certifications and licenses; provided that all trainings
and materials provided in connection therewith shall be and remain the property of Consultant and may not be copied, reproduced, distributed or used other than with the express written permission of
Consultant 

        B.    Provides
centralized purchasing opportunities from vendors, and service providers; provided that (i) Facility shall not be required to participate on any such
purchasing cooperative or arrangement, (ii) Facility shall never be liable for the expenses, acts or omissions of Consultant or other clients of Consultant under such arrangements, but shall be
responsible solely for its own purchases thereunder, (iii) catalogs, materials and forms provided in connection therewith shall be and remain the property of Consultant and may not be copied,
reproduced, distributed or used other than with the express written permission of Consultant, and (iv) Consultant shall be authorized to act as Facility's agent for the limited purpose of
negotiating and entering into such arrangements, but not for actually committing to the ordering of any product or service or the incurrence of any obligation thereunder, which shall be the sole
province of Facility. 

ADDITIONAL DUTIES TO BE PERFORMED BY FACILITY:  

        Without limiting any other duty or obligation of Facility at law or under the Agreement, Facility shall do all of the following: 

        8.     Facility
shall be solely responsible for (i) naming, managing and documenting the activities of its own Governing Body as required by applicable laws and
regulations, (ii) hiring, supervising and evaluating its administrator and other employees, and (iii) overseeing the day-to-day conduct of its business and
related activities. 

        9.     Facility
shall be solely responsible for providing a safe and sanitary environment for patients and personnel. 

        10.   Facility
shall be solely responsible for (i) operating its business in and from the Facility Premises in substantial compliance with applicable laws and
regulations, (ii) maintaining all federal and state licenses and certifications required to operate the Facility and provide Services to patients and residents (iii) performing all
duties required of a licensee and provider under applicable local, state and federal laws, codes, regulations and provider agreements affecting the operation of the Facility, and (iv) notifying
Consultant of any threatened, pending or actual revocation or suspension of its Licenses. 

        11.   Timely
furnish Consultant with such information and materials as might ordinarily be expected for Consultant to perform its duties hereunder. Facility shall be solely
responsible to assure the 

15

 

accuracy
and completeness of all information provided by Facility and its personnel to Consultant, and Consultant shall be entitled to rely thereon without inquiry or diligence of any kind. 

        12.   Facility
shall not unreasonably restrict or limit Consultant's access to necessary information, and acknowledges Consultant's right to exercise its independent
professional judgment, including recommending Services and rendering such Services using such methods, technologies and procedures as Consultant deems appropriate. 

        13.   As
and to the extent that Consultant's employees and agents require access to the Facility Premises to perform the Services, Facility shall provide adequate working
space, equipment and access to Facility's staff for the provision of Services. Equipment and materials placed at the Facility by Consultant shall be used exclusively for the purposes of this
Agreement. Upon termination or at Consultant's request, Facility shall return equipment and materials, in the same condition as when delivered to Facility, reasonable wear and tear excepted. 

        14.   If
requested by Consultant, Facility shall send delegates to Consultant's customer service teams, operator forums, evaluation and other service teams, trainings, and
other committees and events as reasonably requested and available. In addition, to the extent available Facility delegates shall from time to time participate, both as trainees and trainers, in
training and leadership conferences and events for the benefit of Consultant and others. 

        15.   With
Facility's acquiescence, and at Consultant's expense to the extent the trainee does not provide value to Facility, Facility agrees to periodically serve as a
training site for Consultant's employees, providing (where available) preceptorship and organized training for AITs and other trainees of Consultant. In the event that a compensated trainee does not
provide full value to Facility during his/her training program, Consultant shall pay directly, or reimburse Facility for, the portion of the trainee's compensation and training expenses that exceed
the reasonable value provided. 

16

QuickLinks

FORM OF INDEPENDENT CONSULTING AND CENTRALIZED SERVICES AGREEMENT (Non-Clinical) Ensign Facility Services, Inc.

R E C I T A L S

TERMS AND CONDITIONS

EXHIBIT A to INDEPENDENT CONSULTING AND CENTRALIZED SERVICES AGREEMENT (Non-Clinical)

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