Preview
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COMMONWEALTH OF MASSACHUSETTS
MIDDLESEX, SS. SUPERIOR COURT
CIVIL ACTION NO.
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* ZUCVIO78
BENCHMARK SENIOR LIVING, LLC *
D/B/A THE ATRIUM AT CARDINAL *
DRIVE,
PLAINTIFF
Vv. COMPLAINT
KATHLEEN COWLES (F/K/A RECEIVED AI24124 te
KATHLEEN ADAMS),
DEFENDANT
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COMPLAINT
Plaintiff complains against the Defendant as follows:
1 Plaintiff, Benchmark Senior Living, LLC d/b/a The Atrium at Cardinal Drive
(“Benchmark”), is a Massachusetts limited liability corporation duly registered with the
Secretary of the Commonwealth of Massachusetts which has a usual place of business at
201 Jones Road Third Floor West, Waltham, MA 02451.
2. Defendant Kathleen Cowles (f/k/a Kathleen Adams) is a resident of Hillcrest
Commons Nursing & Rehabilitation Facility with an address of 169 Valentine Road,
Pittsfield, MA 01201.
3 Defendant’s daughter, Sarah Cowles-Gentile, is acting on Defendant’s behalf
as her power of attorney.
4 This court has general personal jurisdiction over Defendant as Defendant is
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domiciled in Massachusetts. G.L. c. 223A, § 2.
5 Venue is proper as this is a transitory action brought in the county where one
of the parties lives or has its usual place of business. G.L. c. 223, § 1.
6 In July 2022, Defendant submitted an Application for Residency
(“Application”) to Benchmark to live at The Atrium at Cardinal Drive in Agawam, MA. A
copy of said Application is appended hereto as Exhibit A.
7
In said Application, Defendant listed her estimated home value as
$900,000.00.
8 At that time, the Defendant’s home was 161 Covell Road, Tolland, MA
01034,
1 On July 28; 2022, Ms. .Cowles-Gentile signed a Residency Agreement
(“Agreement”) between Benchmark and Defendant on behalf of Defendant. A copy of said
Agreement is appended hereto as Exhibit B.
9 A Fee Schedule was attached
‘to the Agreement which outlined the costs for
Defendant’s housing as well as food and supportive and personal care services (“residential
services”).
10. Defendant moved into Benchmark’s facility at The Atrium at Cardinal Drive
(“Facility”) on July 29, 2022.
11. Defendant moved out of the Facility on or about March 7, 2024.
12. Defendant has a significant outstanding balance owed to Benchmark for
housing and residential services.
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COUNT I (Breach of Contract)
13. Plaintiff hereby incorporates the above paragraphs herein.
14. Defendant executed a valid contract with Plaintiff in the form of the
Residency Agreement.
15. Defendant breached that contract and thereby caused damages to the Plaintiff
by virtue of failing to pay the amounts due to Plaintiff under the Residency Agreement.
COUNT II antum Meruit
16. Plaintiff hereby incorporates the above paragraphs herein.
17. Plaintiff provided substantial housing and residential services to Defendant.
18. There was an agreement and understanding between Plaintiff and Defendant
Kathleen Cowles as well as her power of attorney, Sarah Cowles-Gentile, that Defendant
Kathleen Cowles would be responsible for the payment of the housing and residential
services provided by Plaintiff.
19. Plaintiff is entitled to the fair value of the housing and its residential services
provided to Defendant and the costs which accrued for her care.
COUNT II (Unjust Enrichment)
20. Plaintiff hereby incorporates the above paragraphs herein.
21. Defendant accepted and received a benefit from the housing and residential
services provided and costs incurred by Plaintiff for her care and lodging.
22. Defendant will be unjustly enriched if she is allowed to enjoy the benefits
conferred on her without paying for the housing and residential services provided by, and
3
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costs incurred by, Plaintiff.
23. Defendant has in fact been unjustly enriched by receiving the benefits of
Plaintiff's services for her housing and care without paying Plaintiff for the same as well
as the Plaintiff incurred to provide care and lodging to her.
24. Defendant is liable to Plaintiff for the benefits she received from Plaintiff
without paying compensation to Plaintiff.
WHEREFORE, Plaintiff respectfully requests that this Honorable Court enter
judgment in its favor and against the Defendant for such sums as this Court shall determine,
including interest, costs, attorneys’ fees, as provided under the Agreement, the laws of the
Commonwealth, the rules of Court, and order any other relief this Court may deem
appropriate.
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Respectfully submitted,
BENCHMARK SENIOR LIVING, LLC
By its attorneys,
WADLEIGH, STARR & PETERS, P.L.L.C
Date: April 19, 2024 4s/ Craig Donais
Craig S. Donais, Esq., BBO# 634112
95 Market Street
Manchester, NH 03101
603-669-4140
cdonais@wadleighlaw.com
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EXHIBIT A
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The completion of the enclosed document is necessary to begin the process
for residency. It includes basic information about your current situation,
financial information and medical information. We realize that many of the
questions are of a personal nature, we will protect the confidentiality of your
responses. When you have completed the application, please return it to us.
Thank you for your interest. We look forward to having you join our family.
BENCHMARK
ail SENTOR LIVING
LIVING
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Financial/Insurance Information:
INCOME SOURCES:
The following worksheet is necessary to determine if your financial resources are adequate
to cover the monthly
Living costs at this Benchmark Community (this information is kept confidential)
Spouse's Income
Employment Income: $ per month $ per month
Social Security Income: $1,026.00 per month $ 1,389.00 per month
Employer Pension: $ per month g 4,941.29 per month
Interest & Dividend Income: $ per month $ per month
Annuity Income: $ per month $ per month
Life Insurance Benefits: $ per month $ per month
Support from Family: $ per month $ per month
Rental Income: $ per month $ per month
Other: $ per month $ per month
Total Monthly Income $ 1,026.00 $ 5,330.29
ls there any additional information we should be aware of when reviewing your financial
resources?
Assets: nn oe
Please list your assets, including Bank Accounts, Savings Accounts, Life Insurance (cash
value), Stocks & Bonds, Home, Real Estate and other major assets. Please attach additional
information, if necessary.
Resident Type/Description Institution $ Amount/Value
SAVINGS PEOPLE'S 69,000
Estimated Home Value 900K
O
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BENCHMARK
Benchmark Senior Living New Resident Contact Form
Reston CLE A
CIBWLES
Representatives and Emergency Contact Preferences
If there is someone designated to manage your affairs, please describe type of
power given (i.e., financial, durable, medical, springing, general, limited,
conservator, guardian) and list name, address, and phone number of person who
holds such power. Please furnish a complete copy of the authorizing document, as
well as any trust documents, which may pertain to these Powers.
Representative 1:
a Gentile
Name: hn ~ Geahl PRel lationship: daualater son-tn-law
Address: BO Hoven De.
City: Granox State: Cr Zip: OW’OSS
Phone: ( Biad ) WN
ty -_ 9118
Work: ( \Sarmx os cell ext.
Cell: (Bbo_) SYS SoZ -_ AYO
E-mail: Sarahscowles@ aol.com
Type of Power Given:
[7 Responsible Party
[A Power of Attorney (Type(s): )
CA Healthcare Proxy
uM Emergency Contact —Primary } Secondary / Tertiary (Circle One)
(] Other (Guardian, Conservator, etc.)
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Representative 2:
Heid + Cowles
Name: Aaron Cowles oF Relationship: —son | deugake~in - law
Address: Q Yovearn Bd
City: Tolland State: HA Zip: DIOS
Phone: ( ) -
Work: ( ) - ext.
Cell: (413 ) Z2\e
—_s ~_UYS
E-mail: les lint il. co
Type of Power Given:
[U1 Responsible Party
(1 Power of Attorney (Type(s): )
CI Healthcare Proxy
[7 Emergency Contact — Primary Tertiary (Circle One)
0 Other (Guardian, Conservator, etc.)
Representative 3:
Name: Relationship:
Address:
City: State: Zip
Phone: ( ) -
Work: ( ) - ext.
Cell: ( ) -
E-mail:
Type of Power Given:
L Responsible Party
(C Power of Attorney (Type(s): )
C1 Healthcare Proxy
O Emergency Contact — Primary/ Secondary / Tertiary (Circle One)
2
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C] Other (Guardian, Conservator, etc.)
OQ
Representative 4:
Name: Relationship:
Address:
City: State: Zip
Phone: ( ) -
Work: ( ) - ext.
Cell: ( ) -
E-mail:
Type of Power Given:
oO Responsible Party
(1 Power of Attorney (Type(s): )
C1 Healthcare Proxy
O Emergency Contact — Primary/ Secondary / Tertiary (Circle One)
(J Other (Guardian, Conservator, etc.)
Insurance Information
Please list all of your medical insurance coverage, including supplemental and
long-term care:
United Healtheare Policy#_ FIS iol 449
Policy #
Policy #
Long-Term Care Insurance Company # Policy #
Health Information
Primary Care Physician’s Name: Saseph Maglio
Address: iS E. Granloy ed
City: Granby State: CT Zip: 0035
Phone: (@uD_)_ 53 - 724
Fax: ( ) _—__——
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Physician’s Specialty:
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Pharmacy: CVS - Southwick. MA
Phone: (413 _)_ 5U9__ - YT
Dentist: Or. Steve Farley
Phone: (@00_)_ G88
Ys -_4325
Other Health Care Providers seen by resident:
1) Physician’s Name:
Phone: ( ) -
Physician’s Specialty:
2) Physician’s Name:
Phone: ( ) -
Physician’s Specialty:
Other Information
Hospital Preference:
St. cancis - €d state _- renebld , MA
Religious Preference (optional):
House of Worship:
Clergy Name: Phone: ( )
Do you have a Funeral Home preference?
Carmon Funeral tome
Address: 304 Salen Brak St. Phone: (800_)_ 53 -_le37
Do you intend to maintain acar? Yes ®o")
If yes, Make, Model, Year and license plate #:
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Lease Recommendation
Report Information
Transaction No. 0064184310
Property
MS437 - The Atrium at Cardinal Drive - AGAWAM MA 01001
Performed by ALLISONBAKER:
Performed on Wednesday July. 27,2022. 411:01:08 EST
LEASE RECOMMENDATION - 386
Messages (4)
+ This applicant has been screened through the MSSO Search. Sex Offender registrant information is derived from the same state hosted Sex Offender database
registries accessible through the department of justice ORU SJODIN website, Results associated with this, will reflect on CrimSAFE report.
* Prior to making leasing decisian, always check criminal results.
+ Scanned by AppALERT,
‘+ This transaction was Scored using the Affardable model,
a a aon
f
| SCORE RECOMMENDATION
(386 ACCEPT WITH CONDITIONS
800
wore pa Decision Message - Contact Duane Heron at Home Office for further investigation on the financial
Accep — 400 - 800 | wherewithal of this applicant and acceptance conditions.
Accept with Condition: 350-399 | - oe
Decline with Referral: | 300-349 |
200-289|
‘CRIMSAFE RECOMMENDATION
ACCEPT
Based upon your community CrimSAFE settings and the results of this search, no disqualifying
records were found.
aed
httos://www.residentscreening.net/rsn/default.aspx?allrenorts=64| 8431 N&crenarts=64 1843 HAVIN.
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July 27, 2022
SAFERENT® SCORE REPORT
4:500M
REPORT INFORMATION
Transaction No: 0064184310 Performed By: ALLISONBAKER
Performed On: Wednesday July 27, 2022 / 11:00:52 EDT Property: MS437- The Atrium at Cardinal Drive
Request 1D: MSI6M3S3
APPLICANT INFORMATION
Name: KATHLEEN A COWLES. ‘SSN: sik
+k BB50,
Monthly Income: $1026 Dos: 06/26/1943
Phone: acoonseaco Email:
Current Address: 161 COVELL RD, TOLLAND MA 01034 Previous Address:
YOUR COMMUNITY'S DECISION
Applicant Decision: ACCEPT WITH CONDITIONS - 386
‘Contact Ouane Heron at Home Office for further investigation on the financial wherewithal of this applicant and
acceptance conditions,
YOUR MANAGEMENT COMPANY ESTABLISHES CRITERIA (DECISION POINTS) APPROPRIATE FOR APPROVAL OF APPLICANTS TO YOUR COMMUNITY.
QUESTIONS REGARDING THESE CRITERIA SHOULD BE DIRECTED TO YOUR MANAGEMENT COMPANY.
‘SCORE ATTRIBUTE
if improved, the following items could positively impact this applicant's score.
»* Credit
** Application Data
‘LEASE INFORMATION
Monthly Rent: $10350 Security Deposit: $0
Total Income: $1026 Lease Term: Month to Month
Bedrooms: STU Marketing Source:
Client Reference: Rent/Income:
SafeRent® Score is designed as a useful predictor tool, but és not a guarantee of the future performance of an applicant, WARNING: A person must have permissible
pose under the Fair Credit Reporting ACKFCRA: 15 U.S.C. 1681-1681} to obtain a consumer report. The FCRA provides that any person who knowingly and wilfully
obtains a cansumer report under false pretenses may face criminal prosecution, including fines and possible imprisonment. A consumer reporting agency may not prohibit
users from disctosing the contents of the repart directly to the consumer, however the FCRA under most instances does not require users to do so, It is recommended that
users refer all consumer inquiries regarding the information contained in this report directly to SafeRent Soutlons, LLC. The Federat Trade Commission has said that
consumer report users must consult the relevant provisions of the FCRA for detaits about their obligations under the FCRA, More information about cansumer report user's
obligationsis avaiable at www ftc.govicredit.
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SUNITED BANK $-16 $100,000-0 CLOSED CURR ACCT
xxxxx62 BB BEI 15 4 4-03-20 4-20 (71) Beceeeccecece
xa 188 3-20 ceececeeeece,
SOLD 70: PEOPLES UNITED BANK
** PURCHASED BY ANOTHER LENDER **
MeT BANK 7-08 $15,015-0 PAID CORR ACCT
wend BB AUT 72 1 ‘7-31-14 Tg (23) Beececccecece
xxxxx197254400002 Wd eceeecececee,
‘*SYNCB/AMAZON 12-12 $210-L $340-8 PAID DEL WAS 90
muon BY CHG REV 1 3-18-20 3-20 (67) 11¢¢3211¢cccc
3-20 eccoodo000c1
‘** ACCOUNT CLOSED AT CREDIT GRANTOR'S REQUEST **
‘*JEMCB CARD 7-08 $9,300-L $9,851-8 OPEN CURWAS150-2+
mauoml0 BC FSC REV 1 7-10-22 $2,773 1-21 (99) cecececeeeece
6-22 $219 19/5 ccccccic2iic
‘** PAYING ONDER A PARTIAL PAYMENT AGREEMENT +
*CAPITAL ONE 3-00 $800-1 $1,035-8 OPEN COR WAS 60
yooondé BC BCC REV 1 6-27-22 $776 10-21 (89) coggoocccaice
22 $15 eceeciceeece,
*SYNCB/TIX COS 10-16 $190-L $364-8 OFEN CUR WAS 30
youx30 CG CHG REV 1 1-20-22 $96 2-20 (71) cceceececeeco
7-22 $38 1-20/1 090000000000
‘THD/CBNA ~95 $6,100-L $5,072-8 ‘OPEN CURR ACCT
so0u62 ZR CHG REV 3 "22-22 $3,936 7-22 (99) ececececceece
7-22 sais ceeccececece,
PEOPLES UNITED BANK 5-14 $72,378-L $31, 069-2 OPEN CURR ACCT
2xxxx90 BB B/E LOC 6-30-22 $29,513 6-22 (28) ecececececece
6-22 $107 eeeeceeeccce:
PEOPLES UNITED BANK “14 $100, 000-0 OPEN CORR ACCT
xxxxx90 BB HET 160 2 6-30-22 $42,731 6-22 (25) ecececceecece
xxexx416200017 6-22 $803 ceececeeeece:
KEYBANK NA e-19 $26,578-0 OFEN CURR ACCT
xxtxxx20 BB RUT 75, 2 30-22 $13,835 6-22 (35) eceeceececeee,
00280233307 6-22 $431 ceeeecececce:
END ~~ EXPERIAN
ceo End of Experian Roport --~
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July 27, 2022
CRIMSAFE REPORT
4:50PM
REPORT INFORMATION
Property ID: M5437 Phone: 413-821-9911
Property Name: The Atrium at Cardinal Orive Fax: 413-821-9912
Request Date: 07/27/2022, Request Type: ‘CrimSAFE
Request ID: MSI6M3S3 Permissible Purpose: Resident Screening
Process Date: 07/27/2022 08:00:52
APPLICANT INFORMATION,
Name: KATHLEEN A COWLES Suffix:
SSN: KKXK-BB50 Dos: 06/26/1943
Address: 161 COVELL RD
TOLLAND, MA 01034
TRANSACTION(s) USED
Request# Type State County
MSIGM3S3 MSSO- *
MSI6M3S4 MULTI-STATE PLUS a
CRIMSAFE RESULT
BASED UPON YOUR COMMUNITY CRIMSAFE SETTINGS AND THE RESULTS OF THIS SEARCH, NO DISQUALIFYING RECORDS WERE FOUND.
NOTE: THE ACCURATE INPUT OF NAME, SSN, DATE OF BIRTH AND ADDRESS IS REQUIRED TO IMPROVE THE RETRIEVAL OF INFORMATION
RELATING TO THE APPLICANT. A public record has been found with elements matching the information presented by your applicant. However, it
is your sole responsibility to compare these elements and/or to obtain additional verification of the information provided. THOUGH THE
INFORMATION AS TO THE SUBJECT OF THE INVESTIGATION CONTAINED IN THIS REPORT IS ACCURATELY COPIED FROM PUBLIC RECORDS, THIS.
REPORT DOES NOT GUARANTEE THE ACCURACY, TRUTHFULNESS OR COMPLETENESS OF THE INFORMATION AS TO THE SUBJECT OF THE
INVESTIGATION, ANO {NFORMATION GENERATED AS A RESULT OF IDENTITY THEFT, INCLUDING EVIDENCE OF CRIMINAL ACTIVITY, MAY BE
INACCURATELY ASSOCIATED WITH THE CONSUMER WHO IS THE SUBJECT OF THE REPORT. Remember, you must comply with your obligations
under the federal Fair Credit Reporting Act. your Service Agreement, and the other applicable federal, state and local laws.
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Kathleen Cowles
ADVERSE ACTION
Dear Kathleen Cowles, xxx-1%-8850
‘Thank you for your recent application ta: The
CordAtrium atinsl
Brive
At this time your application has been Approved C nally with
This adverse action has been taken in eccordance with the requirements of the federal Fuir Credit Reporting Act, 1S U.S.C. 1631m(a).
This decision was based on:
1X [Information contained in consumer report(s} obtained from or through SafeRent Solutions LLC, which may include credit or consumer Information from one.or
more credit bureaus or consumer reporting agencies.
SafeRent Solutions LLC can be reached at: Consumer Relations P.O, Box 3890 Coppell, TX 75019, By phone: +1 (888) 333-2413,
{ 1 {aformation obtained from a source other than a consumer reporting agency, (You have the right to disclosure of the nature of this information, apon your
furnishing proper identification, if you make a written request to us within 60 days of receiving this letter.)
{ ] Other:
In evaluating your application, information obtained from or through SafeRent Solutions LLC, which may include credit information or consumer information from
‘one or more of the credit bureaus or consumer reporting agencies, may havc influenced our decision in whole or in part. These consumer-reporting agencies
and /or credit bureaus did not make the decision to take adverse action and are unable to provide specific reasons why adverse action was taken.
YOU HAVE CERTAIN RIGHTS UNDER FEDERAL AND STATE LAW WITH RESPECT TO YOUR CONSUMER REPORT. IF ANY PERSON TAKES ADVERSE ACTION
BASED IN WHOLE OR IN PART ON ANY INFORMATION CONTAINED IN A CONSUMER REPORT OR CREDIT REPORT, YOU HAVE THE RIGHT TO A DISCLOSURE.
OF THE INFORMATION [N YOUR CONSUMER FILE FROM THE AGENCY THAT PROVIDED SUCH INFORMATION, IF YOU MAKE A WRITTEN REQUEST TO THEM
AND UPON YOUR PROPER IDENTIFICATION WITHIN 60 DAYS OF RECEIVING THIS DENIAL. THE FEDERAL FAIR CREDIT REPORTING ACT ALSO PROVIDES
THAT YOU ARE ENTITLED TO OBTAIN FROM ANY NATIONWIDE CREDIT REPORTING AGENCY OR CREDIT BUREAU A FREE COPY OF YOUR REPORT IN ANY
‘TWELVE MONTH PERIOD. YOU HAVE THE RIGHT TO DIRECTLY DISPUTE WITH THE CONSUMER REPORTING AGENCY AND/OR CREDIT BUREAU THE
ACCURACY AND COMPLETENESS OF ANY INFORMATION FURNISHED BY THAT AGENCY OR BUREAU AND TO PROVIDE A CONSUMER STATEMENT
DESCRIBING YOUR POSITION [F YOU DISPUTE THE INFORMATION IN YOUR CONSUMER FILE, IF YOU BELIEVE THE INFORMATION IN YOUR CONSUMER
FILE IS INACCURATE OR INCOMPLETE, YOU MAY CALL SAFERENT SOLUTIONS LLC CONSUMER RELATIONS DEPARTMENT AT (888) 333-2413. SAFERENT
SOLUTIONS LLC WILL INITIATE THE REINVESTIGATION OF ANY DISPUTED INFORMATION OBTAINED THROUGH THEM AND WILL REINVESTIGATE ANY
DISPUTED INFORMATION OBTAINED FROM THEIR DATABASE.
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EXHIBIT B
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RESIDENCY AGREEMENT
Q 1 YOUR APPLICATION AND ELIGIBILITY
You have provided information on our application forms, a health history and
medical report, an emergency contact and other information in connection with.your
application. You. have given us the results of a health evaluation by a physician (or
another licensed practitioner, if permitted by law). You agree that all of the
information provided by you, or on your behalf, is true, complete and current as of
the date it was provided. You acknowledge that’ we are relying on this information
in entering into this Agreement.
Upon.our request, you agtée to provide the results of a PPD or chest x-ray performed:
within thirty (30) days of the date you begin to reside at the Community. You also
agree:that, if your health evaluation is dated more thai ninety. (90) days priot to'your
move-in date, you will provide:an updated health evaluation before moving in.
Upon our request, you agree that you will have your-health evaluation information
updated by a physician (or another licensed practitioner): annually, after you are
hospitalized or when we request updated information because.of a change in your
health of functional abilities.
You agree‘to-designate a local personal physician within thirty (30) days after move-
© in.and to provide us with his or hername, address and telephone number. By signing
this Agreément, you agree that your physician and other professionals/caregivers
may consult with our staff as-needed with respect to matters affecting your wellness
and caré
I OURSERVICES TO-:YOU!
We offer'to provide.a broad array of services to you. See the Description of Personal
Service Plans.and Packages found as Attachment A to this: Agreement.
A. Individual_Assessmént. A compréhensive assessment must be
performed prior to move-in, focusing on your health, physical, social,
functional, activity and cognitive néeds and preferences. This
assessment will identify if your needs anid. preferences can. be met by
the Community, We also use this. customized, point-based assessment
process to determine your appropriate Personal Service Plan. See the
Attachment A-Description of Basic and Personal Service Plans and
Packages, for services that are available. We conduct a reassessment if
1 Executive Directors have the discretion to change staffing levels based on the individual care
Oy needs of the residents.
Residency Agreement Page |
Core Residency Agreement — November 2021
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a significant change in your condition warrants, as well as on a regular
periodic basis, as required by law. A reassessment may result in
Q changes in your individual service plan, which, in turn, may require a
change in your fees.
Individual Service Plan. You agree to work with us, your Legal
Representative and/or your authorized practitionér in developing and
carrying out'an individual service plan that meets your needs and
preferences. Your individual service plan lists specific services you
will receive, their duration and frequency:
I. OUR COMMUNITY
We-will provide the following accommodations and services to you:
A Your Suite.
1 Private Room. Your Suite may: be private: or semi-private. It
shall include a bathroom equipped with: one toilet and one
bathtub/shower. You are encouraged to. bring your own
furniture; however, we can assist you in obtaining rental
furniture. We provide carpeting and/or floor coverings, draperies
and/or window. coverings and paint.and/or wall-covering:on all
O interior walls and ceilings. We have the exclusive right to
determine and select. the‘ype style, design and. color of these
items.
2. Shared Suites. If two persons, whether or not related, share. a
Suite (Shared Occupancy"), each person will sign a separate
Residency Agreement. specifying the Shared. Rate in the Fee
Summary attached, along with a Shared Suite Addendum. By
signing this Agreement at the Shared Rate, you consent to
sharitig your Suite. (Please note that:some of our niarketing or:
other materials may refer to "companion-style-occupancy."). If
a married:couple is sharing a Suite, you are hereby agreeing to
be jointly and severally responsible for all fees due under this
Agreement and under the Agreement of your spouse for such
shared suite, just as if you were a signatory: to such other
Agreement.
Live-in Caregiver. If you employ a live-in caregiver, you will
be charged a Live-In Caregiver Fee (as specified in Attachment
D-Fee Schedule), commencing on the 30th day (whether or not
©)
Residency Agreement Page 2
Core Residency Agreement — November 2021
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consecutive) after the caregiver moves in. From and after the date
on which the Live-In Caregiver Fee is first applicable, the
caregiver shall be entitled to three meals per day. In addition,
your caregiver must at all times abide by all of the rules and
regulations with respect to behavior that is applicable to our
residents. You (or your Legal Representative). are responsible
for the conduct of your live-in caregiver. Our Rules/Guidelines
for Private Duty. Caregivers, which can be obtained from the
Community’s Executive Director, must be: signed by you (or
your Legal Representative).
Relocation. If, at your’ request, ‘you choosé to change Suites
within the Community, you will be responsible for paying the
actual ‘cost of labor and materials rieeded for cleaning and
redecorating the new Suite and for moving you to the new Suite.
Fees are outlined in Attachment:D-Fee Schedule. If you relocate
at our request, ‘you will not be responsible for such costs. In the
event.of any Suite change, you:will also be required, to execute a
new Residency Agreement, if relocating between neighborhoods
(arbor ‘or Traditional) and/or a Fee Summary Amendment,
outlining your fees for the new Suite:
Common Areas and: Grounds. You are entitled:to use the common
areas, facilities and grourids. of the Commiunity together with other
residents. We provide basic landscaping. and grounds-keeping care,
including lawn:service and snow removal.
Utilities. We provide heat, air conditioning, water, electricity, pre-
wiring: for cable and telephone access, sewage and disposal and trash
removal from designated collection points. Temporary interruption of
utility: services due to factots outside of our control or due’to repairs,
Preview
Ipenior Gourt - Middlesex scket Number COMMONWEALTH OF MASSACHUSETTS MIDDLESEX, SS. SUPERIOR COURT CIVIL ACTION NO. ROR OK oR oR oR oR oR Roe ok oR ROR ok oR oR ROR oR OK * ZUCVIO78 BENCHMARK SENIOR LIVING, LLC * D/B/A THE ATRIUM AT CARDINAL * DRIVE, PLAINTIFF Vv. COMPLAINT KATHLEEN COWLES (F/K/A RECEIVED AI24124 te KATHLEEN ADAMS), DEFENDANT ok Ok oR OR OR OR OR GR OR OR OR RRR KR ROR KR ROR OK COMPLAINT Plaintiff complains against the Defendant as follows: 1 Plaintiff, Benchmark Senior Living, LLC d/b/a The Atrium at Cardinal Drive (“Benchmark”), is a Massachusetts limited liability corporation duly registered with the Secretary of the Commonwealth of Massachusetts which has a usual place of business at 201 Jones Road Third Floor West, Waltham, MA 02451. 2. Defendant Kathleen Cowles (f/k/a Kathleen Adams) is a resident of Hillcrest Commons Nursing & Rehabilitation Facility with an address of 169 Valentine Road, Pittsfield, MA 01201. 3 Defendant’s daughter, Sarah Cowles-Gentile, is acting on Defendant’s behalf as her power of attorney. 4 This court has general personal jurisdiction over Defendant as Defendant is jperior Court - Middlesex ycket Number domiciled in Massachusetts. G.L. c. 223A, § 2. 5 Venue is proper as this is a transitory action brought in the county where one of the parties lives or has its usual place of business. G.L. c. 223, § 1. 6 In July 2022, Defendant submitted an Application for Residency (“Application”) to Benchmark to live at The Atrium at Cardinal Drive in Agawam, MA. A copy of said Application is appended hereto as Exhibit A. 7 In said Application, Defendant listed her estimated home value as $900,000.00. 8 At that time, the Defendant’s home was 161 Covell Road, Tolland, MA 01034, 1 On July 28; 2022, Ms. .Cowles-Gentile signed a Residency Agreement (“Agreement”) between Benchmark and Defendant on behalf of Defendant. A copy of said Agreement is appended hereto as Exhibit B. 9 A Fee Schedule was attached ‘to the Agreement which outlined the costs for Defendant’s housing as well as food and supportive and personal care services (“residential services”). 10. Defendant moved into Benchmark’s facility at The Atrium at Cardinal Drive (“Facility”) on July 29, 2022. 11. Defendant moved out of the Facility on or about March 7, 2024. 12. Defendant has a significant outstanding balance owed to Benchmark for housing and residential services. iperior Court - Middlesex scket Number COUNT I (Breach of Contract) 13. Plaintiff hereby incorporates the above paragraphs herein. 14. Defendant executed a valid contract with Plaintiff in the form of the Residency Agreement. 15. Defendant breached that contract and thereby caused damages to the Plaintiff by virtue of failing to pay the amounts due to Plaintiff under the Residency Agreement. COUNT II antum Meruit 16. Plaintiff hereby incorporates the above paragraphs herein. 17. Plaintiff provided substantial housing and residential services to Defendant. 18. There was an agreement and understanding between Plaintiff and Defendant Kathleen Cowles as well as her power of attorney, Sarah Cowles-Gentile, that Defendant Kathleen Cowles would be responsible for the payment of the housing and residential services provided by Plaintiff. 19. Plaintiff is entitled to the fair value of the housing and its residential services provided to Defendant and the costs which accrued for her care. COUNT II (Unjust Enrichment) 20. Plaintiff hereby incorporates the above paragraphs herein. 21. Defendant accepted and received a benefit from the housing and residential services provided and costs incurred by Plaintiff for her care and lodging. 22. Defendant will be unjustly enriched if she is allowed to enjoy the benefits conferred on her without paying for the housing and residential services provided by, and 3 Iperior Court - Middlesex icket Number costs incurred by, Plaintiff. 23. Defendant has in fact been unjustly enriched by receiving the benefits of Plaintiff's services for her housing and care without paying Plaintiff for the same as well as the Plaintiff incurred to provide care and lodging to her. 24. Defendant is liable to Plaintiff for the benefits she received from Plaintiff without paying compensation to Plaintiff. WHEREFORE, Plaintiff respectfully requests that this Honorable Court enter judgment in its favor and against the Defendant for such sums as this Court shall determine, including interest, costs, attorneys’ fees, as provided under the Agreement, the laws of the Commonwealth, the rules of Court, and order any other relief this Court may deem appropriate. Ipenor Court - Middiesex icket Number Respectfully submitted, BENCHMARK SENIOR LIVING, LLC By its attorneys, WADLEIGH, STARR & PETERS, P.L.L.C Date: April 19, 2024 4s/ Craig Donais Craig S. Donais, Esq., BBO# 634112 95 Market Street Manchester, NH 03101 603-669-4140 cdonais@wadleighlaw.com Ipenor Court - Middlesex icket Number EXHIBIT A Iperior Court - Middlesex scket Number of i ‘ ty © rs Fy: su ae 3 & iA h i ab i Pa a mo yy Lae, OR an. G=0sn DE =a RONG A Ot The completion of the enclosed document is necessary to begin the process for residency. It includes basic information about your current situation, financial information and medical information. We realize that many of the questions are of a personal nature, we will protect the confidentiality of your responses. When you have completed the application, please return it to us. Thank you for your interest. We look forward to having you join our family. BENCHMARK ail SENTOR LIVING LIVING Ipenor Gourt - Middlesex yeket Number O Financial/Insurance Information: INCOME SOURCES: The following worksheet is necessary to determine if your financial resources are adequate to cover the monthly Living costs at this Benchmark Community (this information is kept confidential) Spouse's Income Employment Income: $ per month $ per month Social Security Income: $1,026.00 per month $ 1,389.00 per month Employer Pension: $ per month g 4,941.29 per month Interest & Dividend Income: $ per month $ per month Annuity Income: $ per month $ per month Life Insurance Benefits: $ per month $ per month Support from Family: $ per month $ per month Rental Income: $ per month $ per month Other: $ per month $ per month Total Monthly Income $ 1,026.00 $ 5,330.29 ls there any additional information we should be aware of when reviewing your financial resources? Assets: nn oe Please list your assets, including Bank Accounts, Savings Accounts, Life Insurance (cash value), Stocks & Bonds, Home, Real Estate and other major assets. Please attach additional information, if necessary. Resident Type/Description Institution $ Amount/Value SAVINGS PEOPLE'S 69,000 Estimated Home Value 900K O Iperior Gourt - Middlesex icket Number BENCHMARK Benchmark Senior Living New Resident Contact Form Reston CLE A CIBWLES Representatives and Emergency Contact Preferences If there is someone designated to manage your affairs, please describe type of power given (i.e., financial, durable, medical, springing, general, limited, conservator, guardian) and list name, address, and phone number of person who holds such power. Please furnish a complete copy of the authorizing document, as well as any trust documents, which may pertain to these Powers. Representative 1: a Gentile Name: hn ~ Geahl PRel lationship: daualater son-tn-law Address: BO Hoven De. City: Granox State: Cr Zip: OW’OSS Phone: ( Biad ) WN ty -_ 9118 Work: ( \Sarmx os cell ext. Cell: (Bbo_) SYS SoZ -_ AYO E-mail: Sarahscowles@ aol.com Type of Power Given: [7 Responsible Party [A Power of Attorney (Type(s): ) CA Healthcare Proxy uM Emergency Contact —Primary } Secondary / Tertiary (Circle One) (] Other (Guardian, Conservator, etc.) sperior Court - Middlesex ycket Number O O Representative 2: Heid + Cowles Name: Aaron Cowles oF Relationship: —son | deugake~in - law Address: Q Yovearn Bd City: Tolland State: HA Zip: DIOS Phone: ( ) - Work: ( ) - ext. Cell: (413 ) Z2\e —_s ~_UYS E-mail: les lint il. co Type of Power Given: [U1 Responsible Party (1 Power of Attorney (Type(s): ) CI Healthcare Proxy [7 Emergency Contact — Primary Tertiary (Circle One) 0 Other (Guardian, Conservator, etc.) Representative 3: Name: Relationship: Address: City: State: Zip Phone: ( ) - Work: ( ) - ext. Cell: ( ) - E-mail: Type of Power Given: L Responsible Party (C Power of Attorney (Type(s): ) C1 Healthcare Proxy O Emergency Contact — Primary/ Secondary / Tertiary (Circle One) 2 perior Court - Middlesex acket Number C] Other (Guardian, Conservator, etc.) OQ Representative 4: Name: Relationship: Address: City: State: Zip Phone: ( ) - Work: ( ) - ext. Cell: ( ) - E-mail: Type of Power Given: oO Responsible Party (1 Power of Attorney (Type(s): ) C1 Healthcare Proxy O Emergency Contact — Primary/ Secondary / Tertiary (Circle One) (J Other (Guardian, Conservator, etc.) Insurance Information Please list all of your medical insurance coverage, including supplemental and long-term care: United Healtheare Policy#_ FIS iol 449 Policy # Policy # Long-Term Care Insurance Company # Policy # Health Information Primary Care Physician’s Name: Saseph Maglio Address: iS E. Granloy ed City: Granby State: CT Zip: 0035 Phone: (@uD_)_ 53 - 724 Fax: ( ) _—__—— - perior Court - Middlesex acket Number Physician’s Specialty: O Pharmacy: CVS - Southwick. MA Phone: (413 _)_ 5U9__ - YT Dentist: Or. Steve Farley Phone: (@00_)_ G88 Ys -_4325 Other Health Care Providers seen by resident: 1) Physician’s Name: Phone: ( ) - Physician’s Specialty: 2) Physician’s Name: Phone: ( ) - Physician’s Specialty: Other Information Hospital Preference: St. cancis - €d state _- renebld , MA Religious Preference (optional): House of Worship: Clergy Name: Phone: ( ) Do you have a Funeral Home preference? Carmon Funeral tome Address: 304 Salen Brak St. Phone: (800_)_ 53 -_le37 Do you intend to maintain acar? Yes ®o") If yes, Make, Model, Year and license plate #: Ipenor Got icket Nuim pSatelent Solutions O Page | of 11 Lease Recommendation Report Information Transaction No. 0064184310 Property MS437 - The Atrium at Cardinal Drive - AGAWAM MA 01001 Performed by ALLISONBAKER: Performed on Wednesday July. 27,2022. 411:01:08 EST LEASE RECOMMENDATION - 386 Messages (4) + This applicant has been screened through the MSSO Search. Sex Offender registrant information is derived from the same state hosted Sex Offender database registries accessible through the department of justice ORU SJODIN website, Results associated with this, will reflect on CrimSAFE report. * Prior to making leasing decisian, always check criminal results. + Scanned by AppALERT, ‘+ This transaction was Scored using the Affardable model, a a aon f | SCORE RECOMMENDATION (386 ACCEPT WITH CONDITIONS 800 wore pa Decision Message - Contact Duane Heron at Home Office for further investigation on the financial Accep — 400 - 800 | wherewithal of this applicant and acceptance conditions. Accept with Condition: 350-399 | - oe Decline with Referral: | 300-349 | 200-289| ‘CRIMSAFE RECOMMENDATION ACCEPT Based upon your community CrimSAFE settings and the results of this search, no disqualifying records were found. aed httos://www.residentscreening.net/rsn/default.aspx?allrenorts=64| 8431 N&crenarts=64 1843 HAVIN. - ipenor Gout i a i eRent acket Numbt Solutions © © Page 3 of 11 July 27, 2022 SAFERENT® SCORE REPORT 4:500M REPORT INFORMATION Transaction No: 0064184310 Performed By: ALLISONBAKER Performed On: Wednesday July 27, 2022 / 11:00:52 EDT Property: MS437- The Atrium at Cardinal Drive Request 1D: MSI6M3S3 APPLICANT INFORMATION Name: KATHLEEN A COWLES. ‘SSN: sik +k BB50, Monthly Income: $1026 Dos: 06/26/1943 Phone: acoonseaco Email: Current Address: 161 COVELL RD, TOLLAND MA 01034 Previous Address: YOUR COMMUNITY'S DECISION Applicant Decision: ACCEPT WITH CONDITIONS - 386 ‘Contact Ouane Heron at Home Office for further investigation on the financial wherewithal of this applicant and acceptance conditions, YOUR MANAGEMENT COMPANY ESTABLISHES CRITERIA (DECISION POINTS) APPROPRIATE FOR APPROVAL OF APPLICANTS TO YOUR COMMUNITY. QUESTIONS REGARDING THESE CRITERIA SHOULD BE DIRECTED TO YOUR MANAGEMENT COMPANY. ‘SCORE ATTRIBUTE if improved, the following items could positively impact this applicant's score. »* Credit ** Application Data ‘LEASE INFORMATION Monthly Rent: $10350 Security Deposit: $0 Total Income: $1026 Lease Term: Month to Month Bedrooms: STU Marketing Source: Client Reference: Rent/Income: SafeRent® Score is designed as a useful predictor tool, but és not a guarantee of the future performance of an applicant, WARNING: A person must have permissible pose under the Fair Credit Reporting ACKFCRA: 15 U.S.C. 1681-1681} to obtain a consumer report. The FCRA provides that any person who knowingly and wilfully obtains a cansumer report under false pretenses may face criminal prosecution, including fines and possible imprisonment. A consumer reporting agency may not prohibit users from disctosing the contents of the repart directly to the consumer, however the FCRA under most instances does not require users to do so, It is recommended that users refer all consumer inquiries regarding the information contained in this report directly to SafeRent Soutlons, LLC. The Federat Trade Commission has said that consumer report users must consult the relevant provisions of the FCRA for detaits about their obligations under the FCRA, More information about cansumer report user's obligationsis avaiable at www ftc.govicredit. httos://www.residentscreening.net/rsn/default.aspxallrevorts=64 1843 1 0&renorts=641 843... T/2712022 ipenor Cour icket NumbeshateRent Solutions O O Page 5 of 11 SUNITED BANK $-16 $100,000-0 CLOSED CURR ACCT xxxxx62 BB BEI 15 4 4-03-20 4-20 (71) Beceeeccecece xa 188 3-20 ceececeeeece, SOLD 70: PEOPLES UNITED BANK ** PURCHASED BY ANOTHER LENDER ** MeT BANK 7-08 $15,015-0 PAID CORR ACCT wend BB AUT 72 1 ‘7-31-14 Tg (23) Beececccecece xxxxx197254400002 Wd eceeecececee, ‘*SYNCB/AMAZON 12-12 $210-L $340-8 PAID DEL WAS 90 muon BY CHG REV 1 3-18-20 3-20 (67) 11¢¢3211¢cccc 3-20 eccoodo000c1 ‘** ACCOUNT CLOSED AT CREDIT GRANTOR'S REQUEST ** ‘*JEMCB CARD 7-08 $9,300-L $9,851-8 OPEN CURWAS150-2+ mauoml0 BC FSC REV 1 7-10-22 $2,773 1-21 (99) cecececeeeece 6-22 $219 19/5 ccccccic2iic ‘** PAYING ONDER A PARTIAL PAYMENT AGREEMENT + *CAPITAL ONE 3-00 $800-1 $1,035-8 OPEN COR WAS 60 yooondé BC BCC REV 1 6-27-22 $776 10-21 (89) coggoocccaice 22 $15 eceeciceeece, *SYNCB/TIX COS 10-16 $190-L $364-8 OFEN CUR WAS 30 youx30 CG CHG REV 1 1-20-22 $96 2-20 (71) cceceececeeco 7-22 $38 1-20/1 090000000000 ‘THD/CBNA ~95 $6,100-L $5,072-8 ‘OPEN CURR ACCT so0u62 ZR CHG REV 3 "22-22 $3,936 7-22 (99) ececececceece 7-22 sais ceeccececece, PEOPLES UNITED BANK 5-14 $72,378-L $31, 069-2 OPEN CURR ACCT 2xxxx90 BB B/E LOC 6-30-22 $29,513 6-22 (28) ecececececece 6-22 $107 eeeeceeeccce: PEOPLES UNITED BANK “14 $100, 000-0 OPEN CORR ACCT xxxxx90 BB HET 160 2 6-30-22 $42,731 6-22 (25) ecececceecece xxexx416200017 6-22 $803 ceececeeeece: KEYBANK NA e-19 $26,578-0 OFEN CURR ACCT xxtxxx20 BB RUT 75, 2 30-22 $13,835 6-22 (35) eceeceececeee, 00280233307 6-22 $431 ceeeecececce: END ~~ EXPERIAN ceo End of Experian Roport --~ https://www.residentscreening.net/rsn/default.aspx?allreports=64 1843 1 0&revorts=641843... 12712022 Iperior Cour acket Numb wSateRent Solutions Page 7 of 11 July 27, 2022 CRIMSAFE REPORT 4:50PM REPORT INFORMATION Property ID: M5437 Phone: 413-821-9911 Property Name: The Atrium at Cardinal Orive Fax: 413-821-9912 Request Date: 07/27/2022, Request Type: ‘CrimSAFE Request ID: MSI6M3S3 Permissible Purpose: Resident Screening Process Date: 07/27/2022 08:00:52 APPLICANT INFORMATION, Name: KATHLEEN A COWLES Suffix: SSN: KKXK-BB50 Dos: 06/26/1943 Address: 161 COVELL RD TOLLAND, MA 01034 TRANSACTION(s) USED Request# Type State County MSIGM3S3 MSSO- * MSI6M3S4 MULTI-STATE PLUS a CRIMSAFE RESULT BASED UPON YOUR COMMUNITY CRIMSAFE SETTINGS AND THE RESULTS OF THIS SEARCH, NO DISQUALIFYING RECORDS WERE FOUND. NOTE: THE ACCURATE INPUT OF NAME, SSN, DATE OF BIRTH AND ADDRESS IS REQUIRED TO IMPROVE THE RETRIEVAL OF INFORMATION RELATING TO THE APPLICANT. A public record has been found with elements matching the information presented by your applicant. However, it is your sole responsibility to compare these elements and/or to obtain additional verification of the information provided. THOUGH THE INFORMATION AS TO THE SUBJECT OF THE INVESTIGATION CONTAINED IN THIS REPORT IS ACCURATELY COPIED FROM PUBLIC RECORDS, THIS. REPORT DOES NOT GUARANTEE THE ACCURACY, TRUTHFULNESS OR COMPLETENESS OF THE INFORMATION AS TO THE SUBJECT OF THE INVESTIGATION, ANO {NFORMATION GENERATED AS A RESULT OF IDENTITY THEFT, INCLUDING EVIDENCE OF CRIMINAL ACTIVITY, MAY BE INACCURATELY ASSOCIATED WITH THE CONSUMER WHO IS THE SUBJECT OF THE REPORT. Remember, you must comply with your obligations under the federal Fair Credit Reporting Act. your Service Agreement, and the other applicable federal, state and local laws. https://www.residentscreening.net/rsn/defauit.aspx?allrevorts=64 1843 | O&renorts=64 1843... T2T222 !penior Cour icket Numb: SaleRent Solutions O Page 9 of 11 Kathleen Cowles ADVERSE ACTION Dear Kathleen Cowles, xxx-1%-8850 ‘Thank you for your recent application ta: The CordAtrium atinsl Brive At this time your application has been Approved C nally with This adverse action has been taken in eccordance with the requirements of the federal Fuir Credit Reporting Act, 1S U.S.C. 1631m(a). This decision was based on: 1X [Information contained in consumer report(s} obtained from or through SafeRent Solutions LLC, which may include credit or consumer Information from one.or more credit bureaus or consumer reporting agencies. SafeRent Solutions LLC can be reached at: Consumer Relations P.O, Box 3890 Coppell, TX 75019, By phone: +1 (888) 333-2413, { 1 {aformation obtained from a source other than a consumer reporting agency, (You have the right to disclosure of the nature of this information, apon your furnishing proper identification, if you make a written request to us within 60 days of receiving this letter.) { ] Other: In evaluating your application, information obtained from or through SafeRent Solutions LLC, which may include credit information or consumer information from ‘one or more of the credit bureaus or consumer reporting agencies, may havc influenced our decision in whole or in part. These consumer-reporting agencies and /or credit bureaus did not make the decision to take adverse action and are unable to provide specific reasons why adverse action was taken. YOU HAVE CERTAIN RIGHTS UNDER FEDERAL AND STATE LAW WITH RESPECT TO YOUR CONSUMER REPORT. IF ANY PERSON TAKES ADVERSE ACTION BASED IN WHOLE OR IN PART ON ANY INFORMATION CONTAINED IN A CONSUMER REPORT OR CREDIT REPORT, YOU HAVE THE RIGHT TO A DISCLOSURE. OF THE INFORMATION [N YOUR CONSUMER FILE FROM THE AGENCY THAT PROVIDED SUCH INFORMATION, IF YOU MAKE A WRITTEN REQUEST TO THEM AND UPON YOUR PROPER IDENTIFICATION WITHIN 60 DAYS OF RECEIVING THIS DENIAL. THE FEDERAL FAIR CREDIT REPORTING ACT ALSO PROVIDES THAT YOU ARE ENTITLED TO OBTAIN FROM ANY NATIONWIDE CREDIT REPORTING AGENCY OR CREDIT BUREAU A FREE COPY OF YOUR REPORT IN ANY ‘TWELVE MONTH PERIOD. YOU HAVE THE RIGHT TO DIRECTLY DISPUTE WITH THE CONSUMER REPORTING AGENCY AND/OR CREDIT BUREAU THE ACCURACY AND COMPLETENESS OF ANY INFORMATION FURNISHED BY THAT AGENCY OR BUREAU AND TO PROVIDE A CONSUMER STATEMENT DESCRIBING YOUR POSITION [F YOU DISPUTE THE INFORMATION IN YOUR CONSUMER FILE, IF YOU BELIEVE THE INFORMATION IN YOUR CONSUMER FILE IS INACCURATE OR INCOMPLETE, YOU MAY CALL SAFERENT SOLUTIONS LLC CONSUMER RELATIONS DEPARTMENT AT (888) 333-2413. SAFERENT SOLUTIONS LLC WILL INITIATE THE REINVESTIGATION OF ANY DISPUTED INFORMATION OBTAINED THROUGH THEM AND WILL REINVESTIGATE ANY DISPUTED INFORMATION OBTAINED FROM THEIR DATABASE. https://www.residentscreening.net/rsn/default.aspx?allrenorts=64| 843 1 N&-renorts=641243 TITIIOI enor Gourt - Middlesex reket Number EXHIBIT B {penior Court - Middlesex icket Number RESIDENCY AGREEMENT Q 1 YOUR APPLICATION AND ELIGIBILITY You have provided information on our application forms, a health history and medical report, an emergency contact and other information in connection with.your application. You. have given us the results of a health evaluation by a physician (or another licensed practitioner, if permitted by law). You agree that all of the information provided by you, or on your behalf, is true, complete and current as of the date it was provided. You acknowledge that’ we are relying on this information in entering into this Agreement. Upon.our request, you agtée to provide the results of a PPD or chest x-ray performed: within thirty (30) days of the date you begin to reside at the Community. You also agree:that, if your health evaluation is dated more thai ninety. (90) days priot to'your move-in date, you will provide:an updated health evaluation before moving in. Upon our request, you agree that you will have your-health evaluation information updated by a physician (or another licensed practitioner): annually, after you are hospitalized or when we request updated information because.of a change in your health of functional abilities. You agree‘to-designate a local personal physician within thirty (30) days after move- © in.and to provide us with his or hername, address and telephone number. By signing this Agreément, you agree that your physician and other professionals/caregivers may consult with our staff as-needed with respect to matters affecting your wellness and caré I OURSERVICES TO-:YOU! We offer'to provide.a broad array of services to you. See the Description of Personal Service Plans.and Packages found as Attachment A to this: Agreement. A. Individual_Assessmént. A compréhensive assessment must be performed prior to move-in, focusing on your health, physical, social, functional, activity and cognitive néeds and preferences. This assessment will identify if your needs anid. preferences can. be met by the Community, We also use this. customized, point-based assessment process to determine your appropriate Personal Service Plan. See the Attachment A-Description of Basic and Personal Service Plans and Packages, for services that are available. We conduct a reassessment if 1 Executive Directors have the discretion to change staffing levels based on the individual care Oy needs of the residents. Residency Agreement Page | Core Residency Agreement — November 2021 Ipenior Gourt - Midatesex scket Number a significant change in your condition warrants, as well as on a regular periodic basis, as required by law. A reassessment may result in Q changes in your individual service plan, which, in turn, may require a change in your fees. Individual Service Plan. You agree to work with us, your Legal Representative and/or your authorized practitionér in developing and carrying out'an individual service plan that meets your needs and preferences. Your individual service plan lists specific services you will receive, their duration and frequency: I. OUR COMMUNITY We-will provide the following accommodations and services to you: A Your Suite. 1 Private Room. Your Suite may: be private: or semi-private. It shall include a bathroom equipped with: one toilet and one bathtub/shower. You are encouraged to. bring your own furniture; however, we can assist you in obtaining rental furniture. We provide carpeting and/or floor coverings, draperies and/or window. coverings and paint.and/or wall-covering:on all O interior walls and ceilings. We have the exclusive right to determine and select. the‘ype style, design and. color of these items. 2. Shared Suites. If two persons, whether or not related, share. a Suite (Shared Occupancy"), each person will sign a separate Residency Agreement. specifying the Shared. Rate in the Fee Summary attached, along with a Shared Suite Addendum. By signing this Agreement at the Shared Rate, you consent to sharitig your Suite. (Please note that:some of our niarketing or: other materials may refer to "companion-style-occupancy."). If a married:couple is sharing a Suite, you are hereby agreeing to be jointly and severally responsible for all fees due under this Agreement and under the Agreement of your spouse for such shared suite, just as if you were a signatory: to such other Agreement. Live-in Caregiver. If you employ a live-in caregiver, you will be charged a Live-In Caregiver Fee (as specified in Attachment D-Fee Schedule), commencing on the 30th day (whether or not ©) Residency Agreement Page 2 Core Residency Agreement — November 2021 es —— ~ ~ ~ _ \perior Court - Middlesex acket Number consecutive) after the caregiver moves in. From and after the date on which the Live-In Caregiver Fee is first applicable, the caregiver shall be entitled to three meals per day. In addition, your caregiver must at all times abide by all of the rules and regulations with respect to behavior that is applicable to our residents. You (or your Legal Representative). are responsible for the conduct of your live-in caregiver. Our Rules/Guidelines for Private Duty. Caregivers, which can be obtained from the Community’s Executive Director, must be: signed by you (or your Legal Representative). Relocation. If, at your’ request, ‘you choosé to change Suites within the Community, you will be responsible for paying the actual ‘cost of labor and materials rieeded for cleaning and redecorating the new Suite and for moving you to the new Suite. Fees are outlined in Attachment:D-Fee Schedule. If you relocate at our request, ‘you will not be responsible for such costs. In the event.of any Suite change, you:will also be required, to execute a new Residency Agreement, if relocating between neighborhoods (arbor ‘or Traditional) and/or a Fee Summary Amendment, outlining your fees for the new Suite: Common Areas and: Grounds. You are entitled:to use the common areas, facilities and grourids. of the Commiunity together with other residents. We provide basic landscaping. and grounds-keeping care, including lawn:service and snow removal. Utilities. We provide heat, air conditioning, water, electricity, pre- wiring: for cable and telephone access, sewage and disposal and trash removal from designated collection points. Temporary interruption of utility: services due to factots outside of our control or due’to repairs,