(b) The department shall issue a disclosure statement form that shall generally require disclosure, at a minimum, of the following information:

1. (1) General information regarding the provider and the continuing care retirement community, including at a minimum all of the following:

   1. (A) The continuing care retirement community’s name, address, and telephone number.
   2. (B) The type of ownership, names of the continuing care retirement community’s owner and operator, the names of any affiliated facilities, and any direct religious affiliation.
   3. (C) Whether accredited and by what organization.
   4. (D) The year the continuing care retirement community opened and the distance to the nearest shopping center and hospital.
   5. (E) Whether the continuing care retirement community offers life care contracts or continuing care contracts, and whether the continuing care retirement community is single story or multistory.
   6. (F) The number of the continuing care retirement community’s studio units, one bedroom units, two bedroom units, cottages or houses, assisted living beds, and skilled nursing beds.
   7. (G) The continuing care retirement community’s percentage occupancy at the provider’s most recent fiscal yearend.
   8. (H) The form of contracts offered, the range of entrance fees, the percentages of a resident’s entrance fees that may be refunded, and the health care benefits included in contract.
   9. (I) Any age and insurance requirements for admission.
   10. (J) A listing of common area amenities and other services included with the monthly service fee, and a listing of those amenities and services that are available for an additional charge.
   11. (K) The number of meals each day included in the monthly service fee, the number of meals available for an extra charge, the frequency of housekeeping services, and additional cost, if any , for housekeeping services.

2. (2) Income from operations during the most recent five years for which audited financial statements have been completed, including all of the following:

   1. (A) Operating income (excluding amortization of entrance fee income).
   2. (B) Operating expense (excluding depreciation, amortization, and interest).
   3. (C) Net income from operations.
   4. (D) Interest expense.
   5. (E) Unrestricted contributions.
   6. (F) Nonoperating income or expense, excluding extraordinary items.
   7. (G) Net income or loss before entrance fees.
   8. (H) Net cash-flow from entrance fees, that is the total deposits less refunds.
3. (3) The name of the lender, outstanding balance, interest rate, date of origination, date of maturity, and amortization period for all secured debt.
4. (4) Financial ratios for each of the three most recent years for which audited financial statements have been prepared, including all of the following: debt-to-asset ratio, operating ratio, debt service coverage ratio, and days cash-on-hand. The formulas for each ratio shall be determined by the department after consultation with the Continuing Care Advisory Committee.
5. (5) The average monthly service fees charged during the most recent five years, and the percentage changes in the average from year to year, for each of the following: studio units, one bedroom units, two bedroom units, cottages and houses, assisted living units, and skilled nursing units.
6. (6) Comments from the provider explaining any of the information included in the disclosure form.