Fla. Stat. § 651.022
(2) The application for a provisional certificate of authority shall be on a form prescribed by the department and shall contain the following information:
(b) The full names, residences, and business addresses of:
1. The proprietor, if the applicant or provider is an individual.
2. Every partner or member, if the applicant or provider is a partnership or other unincorporated association, however organized, having fewer than 50 partners or members, together with the business name and address of the partnership or other organization.
3. The principal partners or members, if the applicant or provider is a partnership or other unincorporated association, however organized, having 50 or more partners or members, together with the business name and business address of the partnership or other organization. If such unincorporated organization has officers and a board of directors, the full name and business address of each officer and director may be set forth in lieu of the full name and business address of its principal members.
4. The corporation and each officer and director thereof, if the applicant or provider is a corporation.
5. Every trustee and officer, if the applicant or provider is a trust.
6. The manager, whether an individual, corporation, partnership, or association.
7. Any stockholder holding at least a 10-percent interest in the operations of the facility in which the care is to be offered.
8. Any person whose name is required to be provided in the application under the provisions of this paragraph and who owns any interest in or receives any remuneration from, either directly or indirectly, any professional service firm, association, trust, partnership, or corporation providing goods, leases, or services to the facility for which the application is made, with a real or anticipated value of $500 or more, and the name and address of the professional service firm, association, trust, partnership, or corporation in which such interest is held. The applicant shall describe such goods, leases, or services and the probable cost to the facility or provider and shall describe why such goods, leases, or services should not be purchased from an independent entity.
9. Any person, corporation, partnership, association, or trust owning land or property leased to the facility, along with a copy of the lease agreement.
10. Any affiliated parent or subsidiary corporation or partnership.
(c) 1. Evidence that the applicant is reputable and of responsible character. If the applicant is a firm, association, organization, partnership, business trust, corporation, or company, the form shall require evidence that the members or shareholders are reputable and of responsible character, and the person in charge of providing care under a certificate of authority shall likewise be required to produce evidence of being reputable and of responsible character.
2. Evidence satisfactory to the department of the ability of the applicant to comply with the provisions of this chapter and with rules adopted by the department pursuant to this chapter.
3. A statement of whether a person identified in the application for a provisional certificate of authority or the administrator or manager of the facility, if such person has been designated, or any such person living in the same location:
a. Has been convicted of a felony or has pleaded nolo contendere to a felony charge, or has been held liable or has been enjoined in a civil action by final judgment, if the felony or civil action involved fraud, embezzlement, fraudulent conversion, or misappropriation of property.
b. Is subject to a currently effective injunctive or restrictive order or federal or state administrative order relating to business activity or health care as a result of an action brought by a public agency or department, including, without limitation, an action affecting a license under chapter 400. The statement shall set forth the court or agency, the date of conviction or judgment, and the penalty imposed or damages assessed, or the date, nature, and issuer of the order. Before determining whether a provisional certificate of authority is to be issued, the department may make an inquiry to determine the accuracy of the information submitted pursuant to subparagraphs 1. and 2.
(3) In addition to the information required in subsection (2), an applicant for a provisional certificate of authority shall submit a market feasibility study. The market feasibility study shall include at least the following information:
History.--ss. 4, 33, ch. 83-328; s. 35, ch. 85-62; s. 42, ch. 85-321; s. 2, ch. 87-136; s. 2, ch. 89-363; s. 2, ch. 92-56; s. 12, ch. 93-22; s. 4, ch. 97-229.