Bright Class Settlement Portal

To submit a Claim for a payment from the Settlement Fund on behalf of yourself, please fill out the Claim Form below (note: if you are completing a claim as the Authorized Representative of a claimant, you must select “Authorized Representative” as your Claim Form Type and complete the Authorized Representative Claim Form instead). The deadline to file your claim is 11:59 p.m. ET on January 24, 2027.

First Name

Middle

Last Name

Street/P.O.Box

City

State

Zip Code

Telephone Number

Email Address

Approximate Date You Moved Into a Brookdale Community

What Brookdale Community did you move into (provide facility name below)

If You Moved into a Brookdale Community in Florida, Did You Pay a Community Fee?

Yes

I Don’t Know

One of the following must apply for you to qualify for payment. Please check the box(s) that apply:

My Arbitration Provision was crossed out or declined in writing.

I did not sign my Residency Agreement. My Residency Agreement was signed by a third party and the document that authorized the third party to sign the residency agreement excluded the power to consent to arbitration or to waive the right to a jury trial.

I attest to the best of my knowledge that the information provided in this Claim Form is accurate.

Signature

Date

A. Representative / Claimant Information

To submit a Claim for a payment from the Settlement Fund on behalf of a Claimant, please fill out the Claim Form below (note: if you are completing a claim on your own behalf, you must select “Self” as your Claim Form Type and complete the Individual Claim Form instead). The deadline to file a claim is 11:59 p.m. ET on January 24, 2027.

First Name

Middle

Last Name

Street/P.O.Box

City

State

Zip Code

Telephone Number

Your Email Address

Name of Settlement Class Member on whose behalf you are acting:

First Name

Middle

Last Name

Approximate Date the Claimant Moved into a Brookdale Community

What Brookdale Community did the Claimant move into (provide facility name below)

If the Claimant Moved into a Brookdale Community in Florida, Did the Claimant Pay a Community Fee?

Yes

I Don’t Know

One of the following must apply for you to qualify for payment. Please check the box(s) that apply:

The Arbitration Provision in the Claimant's Residency Agreement was crossed out or declined in writing.

The Claimant did not sign the Residency Agreement. The Claimant's Residency Agreement was signed by a third party and the document that authorized the third party to sign the residency agreement excluded the power to consent to arbitration or to waive the right to a jury trial.

B. Documents & Signature

If you are submitting this claim form as an Authorized Representative of a Claimant, you must also provide the following:

(a) If the Claimant is deceased, the Authorized Representative’s Claim Form must be accompanied by an order appointing the Authorized Representative on behalf of the Claimant’s estate or a notarized statement that you are the Claimant’s Authorized Representative and are legally authorized to act on their behalf.

(b) If the Claimant is not deceased, the Authorized Representative must submit a copy of the operative authorizing document (such as a Power of Attorney) or a notarized statement that the representative is legally authorized to act on behalf of the Claimant.

Upload your supporting documents here:

I attest to the best of my knowledge that the information provided in this Claim Form is accurate.

Signature

Date

Settlement Claim Form

A. Representative / Claimant Information

Name of Settlement Class Member on whose behalf you are acting:

B. Documents & Signature

ENTER YOUR EMAIL ADDRESS AND YOUR LAST NAME

Settlement Claim Form

A. Representative / Claimant Information

Name of Settlement Class Member on whose behalf you are acting:

B. Documents & Signature

Log In Options

ENTER YOUR EMAIL ADDRESS AND YOUR LAST NAME