PARRIS N. GLENDENING, Governor

Ch. 346

(VII) THE NAME AND ADDRESS OF ANY PROFESSIONAL SERVICE
FIRM, ASSOCIATION, TRUST, PARTNERSHIP, COMPANY, OR CORPORATION IN WHICH
A PERSON IDENTIFIED IN ITEM (VI) OF THIS PARAGRAPH HAS A 10% OR GREATER
FINANCIAL INTEREST AND WHICH IS ANTICIPATED TO PROVIDE GOODS, PREMISES,
OR SERVICES TO THE FACILITY OR PROVIDER OF A VALUE OF $10,000 OR MORE
WITHIN ANY FISCAL YEAR, INCLUDING AND A DESCRIPTION OF THE GOODS,
PREMISES, OR SERVICES AND THEIR ANTICIPATED COST TO THE FACILITY OR
PROVIDER; HOWEVER, DISCLOSURE OF SALARY, WAGE, OR BENEFIT INFORMATION
OF EMPLOYEES OF THE PROVIDER IS NOT REQUIRED; AND

(VIII)A STATEMENT REGARDING WHETHER THE PROVIDER IS
QUALIFIED, OR INTENDS TO QUALIFY, AS A TAX EXEMPT ORGANIZATION UNDER
THE INTERNAL REVENUE CODE;

(3)     A copy of the corporate charter, partnership agreement, articles of
association, membership agreement, [ or] trust [ agreement] AGREEMENT, OR SIMILAR
INSTRUMENT OR AGREEMENT [ as it pertains] PERTAINING to the legal organization
of the [applicant] PROVIDER;

(4)     A certified FINANCIAL statement of the [applicant's] PROVIDER
[financial condition, including balance sheet and income statements for the 3 most recent
fiscal years, or all years of operation if fewer than 3 years] FOR AS MANY OF THE MOST
RECENT FISCAL YEARS, NOT EXCEEDING 3 YEARS, FOR WHICH CERTIFIED
FINANCIAL STATEMENTS ARE OBTAINABLE UNDER GENERALLY ACCEPTED
ACCOUNTING PRINCIPLES. If the [applicant's] PROVIDER'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 any affiliation with a religious, charitable, or other
nonprofit organization; the extent of any [affiliation;] AFFILIATION, and the extent, if
any, to which the affiliate organization will be responsible for the financial and
contractual obligations of the [applicant] PROVIDER;

(6)     A copy of the agreement to be entered into between the provider and
subscriber for continuing [care] CARE, AND ANY PRIORITY ADMISSION AGREEMENTS
BETWEEN THE PROVIDER AND ANY HEALTH CARE PROVIDER TO PROVIDE
HEALTH-RELATED BENEFITS;

(7)     A statement of the MOST CURRENT 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)] (8) A statement of the role of any publicly funded benefit or insurance
program in the financing of care;

[(10)] (9) [A sample] THE FORM AND SUBSTANCE of ANY ADVERTISING
CAMPAIGN, [ each planned or previously published advertisement] ADVERTISEMENT,

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