Get Shpda Change Of Ownership Application Form

Filling out the Shpda Change Of Ownership Application Form online can streamline the transfer of ownership for healthcare organizations. This guide provides clear and detailed instructions to help users successfully complete the form, ensuring all necessary information is captured accurately.

Follow the steps to fill out the Shpda Change Of Ownership Application Form online.

1. Click the ‘Get Form’ button to obtain the Shpda Change Of Ownership Application Form and open it in your preferred editor.
2. Enter the purchasing organization information in Part I. Include the name, address, city, state, zip code, county, number/type of licensed beds, owner(s), and operator(s) of the organization.
3. Proceed to Part II to provide the selling organization information. Fill in the name, address, city, state, zip code, county, number/type of licensed beds, owner(s), and operator(s) for the selling organization.
4. In Part III, specify the monetary value of purchase and the number/type of beds involved. Describe the terms of purchase, adding more pages if necessary.
5. Part IV requires information about the certificate of need authority. Fill in the number of beds, types of institutional health services, and the service area by county for home health agencies.
6. Attach a supplementary sheet addressing the financial scope of the project, details of services offered, potential new beds, conversion of beds, and acquisition of assets.
7. Complete Part V with the certification of information. Ensure all signatures, titles, and dates are included for both the purchaser and seller. Confirm agreement with the terms regarding record retention.
8. Finally, review the completed form for accuracy. Save any changes, download a copy, and print or share the document as needed.

Start completing your forms online today to ensure a smooth change of ownership process.