(a)

1. (1) Applicants for license shall file a notarized application with the Division of Provider Services and Quality Assurance upon forms prescribed by the division and shall 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) Applications shall be signed by the owner if individually owned, by one (1) partner if owned under partnership, by two (2) officers of the board if operated as a corporation, church, or nonprofit association and in case of a governmental unit, by the head of the governmental entity having jurisdiction over it.
6. (6) Applicants shall set forth the full name and address of the facilities for which license is sought, the names of the persons in control, and such other information as the division may require.

(b) Each facility applying for and receiving a license must furnish the following information:

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