Form 3698, 2010, Resident Fund Surety Bond (Page 2 of 3) in pdf

Form 3698, 2010, Resident Fund Surety Bond Page 2

Form 3698

Page 2 / 09-2010

PROVIDED FURTHER, that this bond shall be executed by the Principal and Surety and filed together with the aforesaid

Schedule A at the Texas Department of Aging and Disability Services, Regulatory Services Division, ICF/Nursing Facility

Contract Unit (W-535), P.O. Box 149030, Austin, Texas 78714-9030.

PROVIDED FURTHER, that the term "resident" as employed in the bond shall include all persons presently and hereafter

residing in the above referenced facility and all persons who after a term of residence in the above referenced facility are

voluntarily or involuntarily discharged. The term "resident" as employed in this bond shall be limited to residents receiving

Medicaid payments unless the personal funds of Medicaid recipients are commingled with or deposited in a pooled account

with the personal funds of private pay residents, in which case the term "resident" applies also to private pay residents

whose funds are so situated.

PROVIDED FURTHER, that the term "other responsible parties representing such residents" as employed in this bond

shall include the resident's guardian, the parent of a minor resident, the resident's responsible party, a member of the

resident's immediate family, the administrator or executor of the resident's estate, any person or agency serving as a

source of financial support for the resident or any other person rightly entitled to resident funds held by the Principal.

PROVIDED FURTHER, that no recovery or enforcement action on this bond shall be maintained unless the Texas

Department of Aging and Disability Services consents in writing to such recovery or action.

10. PROVIDED FURTHER, that this bond shall be continuous in for and may be terminated by the Surety upon its giving thirty

(30) days written notice to the Principal of such termination, and the Surety shall simultaneously file a copy of such notice

with the Texas Department of Aging and Disability Services at the address provided in paragraph 6 above. However,

claims may be filed for a period of three years and ninety (90) days after the effective termination date in connection with

any resident trust fund transactions occurring during the effective period of the bond.

11. IN WITNESS WHEREOF, we have duly executed the foregoing obligation this

day of

, 20

Name of Surety

Attorney in Fact

Address of Surety

Name of Principal

by Agent of Principal

Address of Principal

Form 3698, 2010, Resident Fund Surety Bond Page 2