Disclosure statement — Contents

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  1. (a) No later than sixty (60) days prior to the first solicitation of a contract to provide continuing care, the provider shall deliver an initial disclosure statement to the State Insurance Department. This statement shall contain all of the following information:

    1. (1) The name and business address of the provider and a statement as to whether the provider is a partnership, corporation, or other type of legal entity;

    2. (2) The names and business addresses of the officers, directors, trustees, managing or general partners, and any person having a ten percent (10%) or greater equity or beneficial interest in or of the provider, and a description of that person's interest in or occupation with the provider;

    3. (3) A statement as to whether the provider or any of its officers, directors, trustees, partners, managers, or affiliates, within ten (10) years prior to the date of application:

      1. (A) Was convicted of a felony, a crime that if committed in Arkansas would be a felony, or any crime having to do with the provision of continuing care or providing of licensed nursing home care;

      2. (B) Has been held liable or enjoined in a civil action by final judgment if the civil action involved fraud, embezzlement, fraudulent conversion, or misappropriation of property;

      3. (C) Had a prior discharge in bankruptcy or was found insolvent in any court action; or

      4. (D) Had any state or federal licenses or permits suspended or revoked or had any state, federal, or industry self-regulatory agency commence an action against him or her and the result of the action;

    4. (4) A statement as to:

      1. (A) Whether the provider is or ever has been affiliated with a religious, charitable, or other nonprofit organization;

      2. (B) The nature of the affiliation, if any;

      3. (C) The extent to which the affiliate organization will be responsible for the financial and contract obligations of the provider; and

      4. (D) The provision of the Internal Revenue Code, if any, under which the provider or affiliate is exempt from the payment of income tax;

    5. (5) The location and description of the physical property or properties of the facility, existing or proposed, and to the extent proposed, the estimated completion date or dates whether or not construction has begun, and the contingencies subject to which construction may be deferred;

    6. (6) The services provided or proposed to be provided under contracts for continuing care at the facility, including the extent to which medical care is furnished. The disclosure statement shall clearly state which services are included in basic contracts for continuing care and which services are made available at or by the facility at extra charge;

    7. (7) A description of all fees required of residents, including the entrance fee and periodic charges, if any. The description shall include the manner by which the provider may adjust periodic charges or other recurring fees and the limitations on the adjustments, if any;

    8. (8) A balance sheet of the provider, audited by a certified public accountant, and certifed to by the provider, as of the end of the two (2) most recent fiscal years;

    9. (9) A calculation of the actuarially required refund reserve showing the alternative bases upon which the calculation is made; and

    10. (10) A copy of the standard form or forms of contract used by the provider which contain the minimum requirements of this subchapter for continuing care contracts to be attached as an exhibit to each disclosure statement.

  2. (b) The provider shall file with the department annually, within four (4) months following the end of the provider's fiscal year, an annual disclosure statement. This statement shall contain the information required by this subchapter for the initial disclosure statement, in addition to a financial statement as of the end of the provider's fiscal year, audited and certified by a certified public accountant.


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