PARRIS N. GLENDENING, Governor                             Ch. 346

(I)      THE ADDRESS OF THE PROVIDER AND THE OFFICE TO WHICH
COMMENTS MAY BE SENT;

(II)    THE NAME AND ADDRESS OF THE AFFECTED FACILITY AND
THE NAME AND ADDRESS OF THE PROVIDER;

(III) THE ORGANIZATIONAL STRUCTURE AND MANAGEMENT OF
THE PROVIDER AND THE FACILITY AFTER THE PROPOSED SALE OR OTHER
TRANSFER IS COMPLETED, INCLUDING:

A. 1. IF THE PROVIDER IS TO BE A CORPORATION OR
LIMITED LIABILITY COMPANY, THE NAME OF THE CORPORATION OR LIMITED
LIABILITY COMPANY, THE STATE IN WHICH THE CORPORATION IS INCORPORATED
OR THE LIMITED LIABILITY COMPANY IS FORMED, AND THE NAME OF THE CHIEF
EXECUTIVE OFFICER;

B. 2. IF THE PROVIDER IS TO BE A PARTNERSHIP, THE
NAMES OF THE GENERAL PARTNERS, THE STATE GOVERNING THE FORMATION OF
THE PARTNERSHIP, AND THE NAME OF THE PRIMARY INDIVIDUAL RESPONSIBLE
FOR MANAGING THE PARTNERSHIP;

C. 3. IF THE PROVIDER IS TO BE AN UNINCORPORATED
ASSOCIATION, THE NAMES OF THE MEMBERS, THE STATE GOVERNING THE
UNINCORPORATED ASSOCIATION'S ACTIVITIES, AND THE NAME OF THE PRIMARY
INDIVIDUAL RESPONSIBLE FOR MANAGING THE ASSOCIATION;

D. 4. IF THE PROVIDER IS TO BE A TRUST, THE NAME OF
THE TRUSTEE, THE NAMES OF THE OWNERS OF THE BENEFICIAL INTERESTS IN THE
TRUST, THE STATE GOVERNING THE TRUST, AND THE NAME OF THE PRIMARY
INDIVIDUAL RESPONSIBLE FOR OVERSEEING THE TRUSTS ACTIVITIES;

E. 5. IF THE PROVIDER IS TO BE A PARTNERSHIP HAVING
A CORPORATION OR LIMITED LIABILITY COMPANY AS ONE OR MORE OF ITS
GENERAL PARTNERS, THE NAME OF THE CORPORATION OR LIMITED LIABILITY
COMPANY, THE STATE IN WHICH THE CORPORATION IS INCORPORATED OR THE
LIMITED LIABILITY COMPANY IS FORMED, AND THE NAME OF THE CHIEF
EXECUTIVE OFFICER; AND

F. 6. THE NAMES AND OCCUPATIONS OF THE OFFICERS,
DIRECTORS, TRUSTEES, GENERAL PARTNERS, PRINCIPALS, AND ANY PERSON OR
ENTITY WHO WILL HAVE A 10% OR GREATER EQUITY OR BENEFICIAL INTEREST IN
THE PROVIDER OR IN THE ENTITY OWNING OR CONTROLLING THE PROVIDER;

(IV)   A COPY OF THE CORPORATE CHARTER, PARTNERSHIP
AGREEMENT, ARTICLES OF ASSOCIATION, MEMBERSHIP AGREEMENT, OR TRUST
AGREEMENT AS IT WILL PERTAIN TO THE LEGAL ORGANIZATION OF THE PROVIDER
AFTER THE SALE OR OTHER TRANSFER;

(V)     A STATEMENT AS TO ANY AFFILIATION WITH A RELIGIOUS,
CHARITABLE, OR OTHER NONPROFIT ORGANIZATION THAT WILL EXIST AFTER THE
PROPOSED SALE OR OTHER TRANSFER AND THE EXTENT, IF ANY, TO WHICH THE

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