An application shall contain all of the following:
(a)CA 健康与安全 Code § 1779.4(a) 申请人签署的、在伪证罪处罚下的声明,证明据申请人所知和所信,申请中提交的项目是正确的。如果申请人是公司,首席执行官应签署该声明。如果有多名申请人,这些要求应适用于每位申请人。
(b)CA 健康与安全 Code § 1779.4(b) 申请人的姓名和营业地址。
(c)CA 健康与安全 Code § 1779.4(c) 总费用计算的明细,包括所用数字的来源,以及一张金额为总申请费80%的支票。
(d)CA 健康与安全 Code § 1779.4(d) 持续照护退休社区的名称、地址和不动产描述。
(e)CA 健康与安全 Code § 1779.4(e) 持续照护退休社区的持续照护居民人数估算。
(f)CA 健康与安全 Code § 1779.4(f) 拟议持续照护退休社区的描述,包括将提供给居民或可供居民使用的服务和照护。
(g)CA 健康与安全 Code § 1779.4(g) 一份声明,说明申请是用于签订持续照护或终身照护合同的授权证书。
(h)CA 健康与安全 Code § 1779.4(h) 拟议持续照护退休社区作为老年人居住照护设施的运营许可证,或证明申请人已从部门的社区照护许可部门获得初步许可批准的文件。
(i)CA 健康与安全 Code § 1779.4(i) 拟议专业护理设施的运营许可证,或证明已向州卫生服务部许可和认证部门提交申请的证据(如适用)。
(j)CA 健康与安全 Code § 1779.4(j) 一份声明,披露对申请人持有或曾持有的执照、许可证或证书采取或正在采取的任何撤销或其他纪律处分。
(k)CA 健康与安全 Code § 1779.4(k) 任何与拟议持续照护退休社区相关的利益方被判犯有重罪或对重罪指控不抗辩,或在民事诉讼中被最终判决认定有责任或被禁止的任何事项的描述,如果该重罪或民事诉讼涉及欺诈、贪污、欺诈性挪用或侵占财产。就本款而言,“利益方”包括拟议持续照护退休社区的开发商或申请人的任何代表,包括所有普通合伙人、公司的高级管理人员或首席运营官和董事会成员;以及每个实体的有限责任公司的管理成员和经理;这些人在拟议持续照护退休社区方面拥有重要的决策权。
(l)CA 健康与安全 Code § 1779.4(l) 如果申请人是除个人以外的实体,还应提交以下信息:
(1)CA 健康与安全 Code § 1779.4(l)(1) 一份声明,说明法律实体的类型,并列出每个主要负责人在该法律实体中的权益及其程度。就本段而言,“主要负责人”指在法律实体中拥有10%或以上财务权益的任何个人或实体。当申请以公司名义提交时,控制持续照护退休社区运营的母公司、唯一公司股东或唯一公司成员应列为申请人。当存在多个公司申请人时,应在申请中以公司名称共同列出,并且授权证书应以这些公司的联合名称颁发。当申请由合伙企业提交时,所有普通合伙人应被列为共同申请人,并且部门应在其颁发的任何授权证书中将他们列为共同提供者。
(2)CA 健康与安全 Code § 1779.4(l)(2) 提供者管理机构成员的姓名。
(3)CA 健康与安全 Code § 1779.4(l)(3) 一份声明,说明申请人是否曾或正在与宗教、慈善、非营利或营利性组织有附属关系,以及任何附属关系的程度。该声明还应包括附属组织在何种程度上(如有)将对申请人的财务和合同义务负责,并应由附属组织的负责官员签署。
(4)CA 健康与安全 Code § 1779.4(l)(4) 一份声明,说明任何母实体或其他附属实体,所识别的每个实体的主要活动,每个实体与申请人的关系,以及每个实体在申请人中持有的权益。
(5)CA 健康与安全 Code § 1779.4(l)(5) 所有合同、管理协议或其他文件副本,阐明与每个其他实体的关系。
(A)CA 健康与安全 Code § 1779.4(l)(5)(A) A description of all debt to be incurred by the applicant for the continuing care retirement community, including the anticipated terms and costs of the financing. The applicant’s outstanding
indebtedness related to the continuing care retirement community may not, at any time, exceed the appraised value of the continuing care retirement community.
(B)CA 健康与安全 Code § 1779.4(l)(5)(B) A description of the source and amount of the equity to be contributed by the applicant.
(C)CA 健康与安全 Code § 1779.4(l)(5)(C) A description of the source and amount of all other funds, including entrance fees, that will be necessary to complete and operate the continuing care retirement community.
(D)CA 健康与安全 Code § 1779.4(l)(5)(D) A statement itemizing all estimated project costs, including the real property costs and the cost of acquiring or designing and constructing the continuing care retirement community, and all other similar costs that the provider expects to incur prior to the commencement of operation. This itemization shall identify all costs related to the continuing care retirement community or
project, including financing expenses, legal expenses, occupancy development costs, marketing costs, and furniture and equipment.
(E)CA 健康与安全 Code § 1779.4(l)(5)(E) A description of the interest expense, insurance premiums, and property taxes that will be incurred prior to opening.
(F)CA 健康与安全 Code § 1779.4(l)(5)(F) An estimate of any proposed continuing care retirement community reserves required for items such as debt service, insurance premiums, and operations.
(G)CA 健康与安全 Code § 1779.4(l)(5)(G) An estimate of the amount of funds, if any, that will be necessary to fund startup losses, fund statutory and refundable contract reserves, and to otherwise provide additional financial resources in an amount sufficient to ensure full performance by the provider of its continuing care contract obligations.
(3)CA 健康与安全 Code § 1779.4(l)(3) An analysis of the potential
market for the applicant’s continuing care retirement community, addressing such items as:
(A)CA 健康与安全 Code § 1779.4(l)(3)(A) A description of the service area, including its demographic, economic, and growth characteristics.
(B)CA 健康与安全 Code § 1779.4(l)(3)(B) A forecast of the market penetration the continuing care retirement community will achieve based on the proposed fee structure.
(C)CA 健康与安全 Code § 1779.4(l)(3)(C) Existing and planned competition in and about the primary service area.
(4)CA 健康与安全 Code § 1779.4(l)(4) A detailed description of the sales and marketing plan, including all of the following:
(A)CA 健康与安全 Code § 1779.4(l)(4)(A) Marketing projections, anticipated sales, and cancellation rates.
(B)CA 健康与安全 Code § 1779.4(l)(4)(B) Month-by-month forecast of unit sales through
sellout.
(C)CA 健康与安全 Code § 1779.4(l)(4)(C) A description of the marketing methods, staffing, and advertising media to be used by the applicant.
(D)CA 健康与安全 Code § 1779.4(l)(4)(D) An estimate of the total entrance fees to be received from residents prior to opening the continuing care retirement community.
(5)CA 健康与安全 Code § 1779.4(l)(5) Projected move-in rates, deposit collections, and resident profiles, including couple mix by unit type, age distribution, care and nursing unit utilization, and unit turnover or resale rates.
(6)CA 健康与安全 Code § 1779.4(l)(6) A description or analysis of development-period costs and revenues throughout the development of the proposed continuing care retirement community.
(z)CA 健康与安全 Code § 1779.4(z) Projected annual financial statements for the period commencing on the first day of the
applicant’s current fiscal year through at least the fifth year of operation.
(1)CA 健康与安全 Code § 1779.4(z)(1) Projected annual financial statements shall be prepared on an accrual basis using the same accounting principles and procedures as the audited financial statements furnished pursuant to subdivision (x).
(2)CA 健康与安全 Code § 1779.4(z)(2) Separate projected annual cash-flow statements shall be provided. These statements shall show projected annual cash-flows for the duration of any debt associated with the continuing care retirement community. If the continuing care retirement community property is leased, the cash-flow statement shall demonstrate the feasibility of closing the continuing care retirement community at the end of the lease period.
(A)CA 健康与安全 Code § 1779.4(z)(2)(A) The projected annual cash-flow statements shall be submitted using prevailing rates of interest, and assume no
increase of revenues and expenses due to inflation.
(B)CA 健康与安全 Code § 1779.4(z)(2)(B) The projected annual cash-flow statements shall include all of the following:
(i)CA 健康与安全 Code § 1779.4(z)(2)(B)(i) A detailed description and a full explanation of all assumptions used in preparing the projections, accompanied by supporting supplementary schedules and calculations, all to be consistent with the financial study and marketing study furnished pursuant to subdivision (y). The department may require such other supplementary schedules, calculations, or projections as it determines necessary for an adequate application.
(ii)CA 健康与安全 Code § 1779.4(z)(2)(B)(ii) 每月运营现金流,显示持续照护合同收取的月费、如适用则为医疗单位费用、其他定期费用、用于运营的捐赠和遗赠,以及任何其他预计的运营收入来源减去运营开支后的预计收入。
(iii)CA 健康与安全 Code § 1779.4(z)(2)(B)(iii) 活动产生的合同现金流,显示预售、押金收入、入住费以及所有其他预计的活动收入来源减去合同获取、营销和广告支出后的预计收入。
(iv)CA 健康与安全 Code § 1779.4(z)(2)(B)(iv) 融资活动现金流,包括但不限于债券或贷款收益减去债券发行或贷款成本和费用、偿债(包括CAL抵押贷款保险费)、受托人费用、本金和利息支付、租赁、合同、租赁协议或其他长期融资。
(v)CA 健康与安全 Code § 1779.4(z)(2)(B)(v) 投资活动现金流,包括但不限于施工进度款、建筑师和工程服务、未包含在施工合同中的家具和设备、项目开发、检查和测试、有价证券、投资收益以及基金间转账。
(vi)CA 健康与安全 Code § 1779.4(z)(2)(B)(vi) 预测期内现金的增加或减少。
(vii)CA 健康与安全 Code § 1779.4(z)(2)(B)(vii) 期初现金余额,指现有、可用并承诺用于拟议持续照护退休社区的现金、有价证券、准备金和其他资金。
(viii)CA 健康与安全 Code § 1779.4(z)(2)(B)(viii) 期末现金余额。
(ix)CA 健康与安全 Code § 1779.4(z)(2)(B)(ix) 应提供每个列报期间期末现金余额组成部分的详细信息,包括但不限于债券准备金、其他准备金、存款资金和建设资金的期末现金余额。
(3)CA 健康与安全 Code § 1779.4(z)(3) 如果第 (2) 款要求的现金流量表显示提供者将拥有超过持续照护退休社区两个月预计运营开支的现金余额,则申请应附带一份关于现金余额投资方式以及做出投资决策人员的说明。
(4)CA 健康与安全 Code § 1779.4(z)(4) 部门可以要求申请人提供关于其运营预算、重大维修和改进所需现金预测或与其预测相关的任何其他事项的额外数据,包括关于入住率预测、单位类型、夫妻组合、居民构成中的性别和年龄估计、周转率、退款义务和销售额的额外信息、时间表和计算。
(aa)
(1)Copy CA 健康与安全 Code § 1779.4(aa)(1) 申请人声明确认其需签署并记录一份关于持续照护退休社区财产的“转让法定限制通知”。
(2)CA 健康与安全 Code § 1779.4(aa)(2) 本款要求的通知应经确认并适合备案,描述财产,声明申请人根据本章将所述财产的全部或部分用于持续照护退休社区的意图,并应基本采用以下形式:
特此通知,下述财产已获许可或拟获许可用于持续照护退休社区,因此,该财产的使用和转让受《健康与安全法典》第1773条和第1789.4条规定的使用和转让条件和限制的约束。本通知根据《健康与安全法典》第1779.4条 (aa) 款记录。
该不动产,其法定所有者为(插入法定所有者姓名),且是本通知所指的法定限制的标的,具体描述如下:(插入本通知所适用的不动产的法定描述和评估员地块编号。)”
(3)CA 健康与安全 Code § 1779.4(3) 转让法定限制通知应保持有效,直至部门发出解除通知。部门应在收到已完全履行对居民的所有义务的证明后,签署并记录该通知的解除。