HARRY HUGHES, Governor

1091

(4)  A CERTIFIED STATEMENT OF THE APPLICANT'S
FINANCIAL SITUATION, INCLUDING A BALANCE SHEET AND INCOME
STATEMENTS, FOR THE 3 MOST RECENT FISCAL YEARS. IF THE
APPLICANT'S FISCAL YEAR ENDED MORE THAN 90 DAYS PRIOR TO THE
DATE OF FILING, THERE SHALL ALSO BE INCLUDED AN INCOME
STATEMENT, WHICH NEED NOT BE CERTIFIED, COVERING THE PERIOD
BETWEEN THE DATE THE FISCAL YEAR ENDED AND A DATE NOT MORE
THAN 90 DAYS PRIOR TO THE DATE THE APPLICATION IS FILED.

(5)  A STATEMENT AS TO WHETHER THE PROVIDER WAS
OR IS AFFILIATED WITH A RELIGIOUS, CHARITABLE, OR OTHER
NONPROFIT ORGANIZATION, THE EXTENT OF ANY AFFILIATION AND
THE EXTENT, IF ANY, TO WHICH THE AFFILIATE ORGANIZATION WILL
BE RESPONSIBLE FOR THE FINANCIAL AND CONTRACTUAL OBLIGATIONS
OF THE APPLICANT.

(6)  A COPY OF THE AGREEMENT TO BE ENTERED INTO
BETWEEN THE PROVIDER AND SUBSCRIBERS FOR CONTINUING CARE.

(7)  A STATEMENT OF THE FEE STRUCTURE, INCLUDING
ESCALATOR OR OTHER AUTOMATIC ADJUSTMENT PROVISIONS.

(8)  A DESCRIPTION OF THE FACILITY WHICH IS
PROPOSED TO BE USED OR IS BEING USED TO FURNISH CONTINUING
CARE.

(9)  A STATEMENT OF THE ROLE OF ANY PUBLICLY
FUNDED BENEFIT OR INSURANCE PROGRAM IN THE FINANCING OF THE
CARE.

(10)  A SAMPLE OF EACH PREVIOUSLY PUBLISHED OR
PLANNED ADVERTISEMENT OR CIRCULAR FOR THE FACILITY DURING
THE PAST 5 YEARS.

(11)  OTHER REASONABLE AND PERTINENT DATA AS THE
OFFICE SHALL REQUIRE.

(B)  ANNUALLY THEREAFTER, WITHIN 120 DAYS AFTER THE END
OF ITS FISCAL YEAR, THE PROVIDER SHALL FILE AN APPLICATION
FOR A RENEWAL CERTIFICATE ON A FORM PRESCRIBED BY THE
OFFICE. THE APPLICATION SHALL INDICATE ANY ADDITIONS OR
CHANGES TO THE INFORMATION REQUIRED BY SUBSECTION (A) OF
THIS SECTION, AND SHALL BE ACCOMPANIED BY A CERTIFIED
FINANCIAL STATEMENT FOR THE PRECEDING FISCAL YEAR. IF THE
APPLICATION AND ACCOMPANYING INFORMATION IS NOT RECEIVED BY
THE OFFICE WITHIN THE 120-DAY PERIOD, A LATE FEE MAY BE
CHARGED. FAILURE TO FILE THE REQUIRED INFORMATION WITHIN 90
DAYS OF THE DUE DATE SHALL BE A VIOLATION OF THIS ACT.

(C)  WHEN AN APPLICANT HAS MORE THAN ONE FACILITY
OFFERING CONTINUING CARE, SEPARATE APPLICATIONS FOR
REGISTRATION AND RENEWAL CERTIFICATES SHALL BE MADE FOR EACH
FACILITY.

(D)  UPON RECEIPT OF AN APPLICATION, THE OFFICE SHALL
REVIEW THE APPLICATION AND DETERMINE IF: