(ii) Any expenditure that is made to lease or, by comparable
arrangement, obtain any plant or equipment for the health care facility, if:

1. The expenditure is made as part of an acquisition,
improvement, or expansion, and, after adjustment for inflation as provided in the
rules and regulations of the Commission, the total expenditure, including the cost of
each study, survey, design, plan, working drawing, specification, and other essential
activity, is more than $1,250,000;

2. The expenditure is made as part of a replacement of any
plant and equipment and is more than $1,250,000 after adjustment for inflation as
provided in the regulations of the Commission;

3. The expenditure results in a substantial change in the bed
capacity of the health care facility; or

4. The expenditure results in the establishment of a new
medical service in a health care facility that would require a certificate of need under
subsection (i) of this section.

(2) A certificate of need is required before any equipment or plant is
donated to a health care facility, if a certificate of need would be required under
paragraph (1) of this subsection for an expenditure by the health care facility to
acquire the equipment or plant directly.

(3) A certificate of need is required before any equipment or plant is
transferred to a health care facility at less than fair market value if a certificate of
need would be required under paragraph (1) of this subsection for the transfer at fair
market value.

(4) A certificate of need is required before a person acquires a health care
facility if a certificate of need would be required under paragraph (1) of this
subsection for the acquisition by or on behalf of the health care facility.

(5) This subsection does not apply to:

(i) Site acquisition;

(ii) Acquisition of a health care facility if, at least 30 days before
making the contractual arrangement to acquire the facility, written notice of the
intent to make the arrangement is filed with the Commission and the Commission
does not find, within 30 days after the Commission receives notice, that the health
services or bed capacity of the facility will be changed;

(iii) Acquisition of business or office equipment that is not directly
related to patient care;

(iv) Capital expenditures to the extent that they are directly related
to the acquisition and installation of major medical equipment;

(v) A capital expenditure made as part of a consolidation or merger
of 2 or more health care facilities, or conversion of a health care facility or part of a
facility to a nonhealth-related use if: