(a)

1. (1) Applicants for license shall:

   1. (A) File a notarized application with the Division of Provider Services and Quality Assurance upon forms prescribed by the division; and
   2. (B) Pay an annual license fee of ten cents (10¢) per patient bed or ten dollars ($10.00), whichever is greater.
2. (2) This fee shall be paid to the State Treasury.
3. (3) If the license is denied, the fee will be returned to the applicant.
4. (4) Facilities operated by any unit or division of state or local government shall be exempted from payment of a licensing fee.

5. (5) The application shall be signed by:

   1. (A) The owner if individually owned;
   2. (B) One (1) partner if owned under partnership;
   3. (C) Two (2) officers of the board if operated under corporation, church, or nonprofit association; and
   4. (D) In case of a governmental unit, by the head of the governmental entity having jurisdiction over it.

6. (6) Applicants shall set forth:

   1. (A) The full name and address of the institutions for which license is sought;
   2. (B) The names of the persons in control;
   3. (C) A signed statement by a registered nurse indicating responsibility for nursing services of the home; and
   4. (D) Such other information as the division may require.

(b) In these instances where a distinct part of a facility is to be licensed as a skilled nursing facility and the remainder of the facility is to be licensed under some other category:

1. (1) Separate applications must be filed for each license; and
2. (2) Separate licensure fees shall be required with each application.

(c) Each home applying for and receiving a license must furnish the following information to the Department of Human Services:

1. (1) The identity of each person directly or indirectly having an ownership interest of five percent (5%) or more in such nursing home;
2. (2) In case such nursing home is organized as a corporation, the identify of each officer and director of the corporation;
3. (3) In case such nursing home is organized as a partnership, the identity of each partner;
4. (4) Identity of owners of building and equipment leased, including ownership breakdown of the leasing entity;

5. (5) Information on the:

   1. (A) Administrator;
   2. (B) Directors;
   3. (C) Management company;
   4. (D) Owner;
   5. (E) Operator; or
   6. (F) Other management agent that the applicant or applicants will use to manage the facility;
6. (6) Information on the owner or owners of the building or other structures that will be used in the operation of the facility;
7. (7) Information on all other facilities owned, operated, or managed by the applicant or applicants;

8. (8) Information on all other facilities owned, operated, or managed by the:

   1. (A) Administrators;
   2. (B) Directors;
   3. (C) Management company;
   4. (D) Owner;
   5. (E) Operator; or
   6. (F) Other management agent that the applicant or applicants will use to manage the facility; and
9. (9) Affirmative evidence of ability to comply with standards, rules, and regulations as may be lawfully prescribed.

(d) The department may deny a license if:

1. (1) The administrator, officers, directors, or management company, operator, or other management agent that the applicant will use to manage the facility has ever been convicted of a felony;
2. (2) A facility or facilities owned or operated by the applicant or applicants have been found, after final administrative decision, to have committed a Class A violation;
3. (3) A facility or facilities owned or operated by the administrator, directors, management company, operator, or other management agent (that the applicant or applicants will use to manage the facility) has been found, after final administrative decision, to have committed a Class A violation;
4. (4) The applicant or applicants have had a license revoked or suspended;
5. (5) The administrator, directors, management company, operator, or other management agent that the applicant or applicants will use to manage the facility have had a license revoked;
6. (6) The applicant or applicants have not demonstrated to the satisfaction of the department that any other facility owned, operated, or administered by the applicant or applicants, administrator, directors, management company, operator, or other management agent that the applicant or applicants will use to manage the facility, is and has been in substantial compliance with the standards as set by applicable state and federal law; or
7. (7) The applicant or applicants have not demonstrated to the satisfaction of the department that any other facility (owned, operated, or administered by the administrator, directors, management company, operator, or other management agent that the applicant or applicants will use to manage the facility) is and has been in substantial compliance with the standards as set by applicable state and federal law.