APPLICATION FOR INSTITUTION CHANGE IN OWNERSHIP OR CONTROL
Institution: / ABHES ID Code:Street: / City: / State: / Zip Code:
On-Site Administrator:
In accordance with ABHES policies, accreditation is not transferable with a change in ownership or control; therefore, upon consummation of the change, accreditation ceases. Thus, notification of a potential change in ownership or control is to be submitted to ABHES immediately, and if deemed a substantive change by ABHES, a completed application for the change MUST be submitted to ABHES within 10 days after the purchase (or sale) of an institution. To ensure the least amount of interruption in institutional operation, the ABHES Substantive Change Committee will consider the application in a timely manner.
Please provide the following information:
1. / The exact date of the purchase (or sale):2. Form of ownership:
Sole Proprietorship BusinessPrivately Held Business Corporation
Publicly Held Business Corporation
Non-Profit Organization
Limited Liability Partnership Company
Limited Partnership Company
Other
3. Complete applicable sections below for new owner:
Sole Proprietorship Business
If sole proprietorship business, provide legal name and address:
Name of Ownership / AddressList name, title, and address of individual responsible for operations of the sole proprietorship business that owns the institution.
Name / Title / Address
Privately Held Business Corporation
If Privately Held Business Corporation, list the exact ownership structure, including all levels of subsidiaries under the parent corporation and any subsidiary corporations operating as non-main campuses:
· Provide the ownership percentage breakdown of each entity in the chain of ownership, up to and including the individual(s) who control the ultimate ownership entity in the chain of ownership.
· Provide descriptions for each level that include all individuals, partnerships, LLCs, corporations, trusts, or other forms of ownership stock.)
Ownership Name and Description Percentage of Ownership
List all corporate officers:
Name / TitlePublicly Held Business Corporation
If Publicly Held Business Corporation, list the exact ownership structure, including all levels of subsidiaries under the parent corporation and any subsidiary corporations operating as non-main campuses:
· Provide the ownership percentage breakdown of each entity in the chain of ownership, up to and including the individual(s) who control the ultimate ownership entity in the chain of ownership.
· Provide descriptions for each level that include all individuals, partnerships, LLCs, corporations, trusts, or other forms of ownership (for publicly traded corporations, this includes shareholders that directly own 10% of the stock.)
Ownership Name and Description Percentage of Ownership
List all corporate officers:
Name / Title / Voting Member (Yes/No)If publicly held business corporation, the stock is traded on the (specify):
NASDAQ; NYSE; ASE; OTC; Regional Exchange: Non-Profit Organization
If Non-Profit Organization, list the all members and officers of the board of directors/trustees:
(Continue on additional sheet if necessary.)
Name / Title / Voting MemberYes No
Provide the name, title and contact information for the individual whom ABHES should contact regarding the Non-Profit Organization:
Name and Title Email Address Telephone Number
If non-profit organization, has this organization been officially recognized by the Internal Revenue Service as an exempt organization under Section 501 © (3), 501 © (4), 501© (5) or 501© (6) of the IRS Code?
Yes / NoLimited Liability Company
If Limited Liability Company, list all members:
(Continue on additional sheet if necessary.)
Names of Members / Percentage of Membership (Ownership Interest)Provide the name, title and contact information for the individual whom ABHES should contact regarding the Limited Liability Company:
Name and Title Email Address Telephone Number
Limited Liability Partnership Company; Limited Partnership Company
If Limited Liability Partnership Company, Limited Partnership Company, list all partners:
(Continue on additional sheet if necessary.)
Names of General Partners / Percentage of Partnership (Ownership Interest)Names of Limited Partners / Percentage of Partnership (Ownership Interest)
Provide the name, title and contact information for the individual whom ABHES should contact regarding the Limited Liability Partnership Company; Limited Partnership Company:
Name and Title Email Address Telephone Number
4. Contact information for new owner(s):
Street Address:City: / State: / Zip Code:
Telephone Number: / Facsimile Number:
E-mail Address: / Website:
5. / Does the new owner(s) own other ABHES-accredited institutions? / Yes / No
If yes, please identify the name, address and ID code of other institutions:
Name / Address / ABHES ID #6. List key personnel (e.g., managers, department heads, and program directors):
Name / Title / Position / Years in Position / Years at the Institution
Answer the following questions:
1. Has any new owner or manager been directly or indirectly employed or affiliated with any school which has lost or been denied accreditation by any accrediting organization during that individual’s period of employment or affiliation? If the answer is yes, please attach a statement to this application which details the facts and circumstances surrounding that school’s loss or denial of accreditation.
2. Has any new owner or manager been directly or indirectly employed or affiliated with any school that has closed without appropriately completing the education or training program for all enrolled students (e.g., an orderly teach-out plan/agreement) or entered into bankruptcy during that individual’s period of employment or affiliation? If the answer is yes, please attach a statement to this application which details the facts and circumstances surrounding that school’s closure, bankruptcy or both as applicable.
3. Has any new owner or manager been directly or indirectly employed or affiliated with any school that has lost or been denied eligibility to participate in Federal Student Financial Aid programs, including those under Title IV of the Higher Education Act? If the answer is yes, please attach a statement to this application which details the facts and circumstances surrounding the loss or denial of Title IV eligibility.
4. Is any action pending (e.g. court action, audit, inquiry, review, administrative action), or has action been taken, by any court or administrative body (e.g. federal or state court, grand jury, special investigator, U.S. Department of Education, or any state agency), as to any new owner or manager? If the answer is yes, please attach a statement to this application which gives full disclosure of the person(s) and the matters involved. Include a statement of the facts and circumstances surrounding the action identifying the matter (i.e., still under investigation, preliminary decision under appeal, etc.) and the position taken by the new owner or manager involved. If the matter is final, provide a copy of the final action documentation.
5. Has any new owner or manger served in a similar capacity in any other school where either that individual or the school has been charged or indicted in a civil or criminal forum or proceeding alleging fraud, misappropriation, or any criminal act? If the answer is yes, please attach a statement to this application which gives full disclosure of the person(s) and the matters involved. Include a statement of the facts and circumstances surrounding the action identifying the owner or manager and the school which is involved. If the matter is not yet final, please describe the procedural status of the matter (i.e., still under investigation, preliminary decision under appeal, etc.) and the position taken by the new owner or manager involved. If the matter is final, provide a copy of the final action documentation.
The following documents must be included in the application. Please enclose:
1. A true and complete copy of the contract of sale or purchase agreement.
2. Curriculum vitae of new owner(s) including information on post-secondary institutional affiliations during the past ten (10) years.
3. A detailed description of the proposed ownership structure that includes:
a. The current form of ownership (e.g., sole proprietorship, partnership, corporation, etc.) and
b. An ownership diagram that sets forth a precise breakdown of the proposed new ownership structure including a percentage ownership breakdown/delineation of each entity in the chain of ownership, up to and including the individual(s) who own the ultimate ownership entity in the chain of ownership. The ownership descriptions must include all individuals, partnerships, LLCs, corporations, trusts, or other forms of ownership (for publically traded corporations, this includes shareholders that directly own 10% of the stock as of the date of the application). Please submit with this form the ownership disclosure submitted in your application to participate in federal student aid programs.
4. A list of all board members, managers, and/or partners affiliated with each entity disclosed in the organization structure that is proposed to acquire the school that includes a description as to how each individual’s experience and background prepares them to oversee the operation of an accredited school and assures the likelihood that the school will remain in compliance with accreditation standards after the ownership changes
5. An internally prepared Opening Day Balance Sheet for the new ownership for the period after the date of the change, and the most recent audited financial statements for the new owner, prepared by an outside and independent accounting firm in accordance with ABHES standards on financial reporting.
6. Current program enrollments (identify program name and number of students enrolled).
7. A properly executed, notarized statement of buyer and seller assuring ABHES that appropriate provisions have been made for all tuition refunds now due, or which may become due, to all students to whom the institution has an obligation (see Attachment A- Statement of Responsibility for Refund Liability).
8. Documentation of state approval to operate the institution under the new ownership.
9. Pertinent information resulting in this change, including changes in program(s), refund policy, tuition, facility and staff.
10. The name and curriculum vitae of the new on-site administrator, if applicable, including information on post-secondary institutional affiliations during the past ten (10) years.
11. A properly executed, notarized statement of purchaser assuring ABHES that it will guarantee student training should the institution cease operation (See Attachment B - Guarantee of Student Training).
12. The application fee. See Fees Appendix in the Accreditation Manual.
ATTACHMENT A
Statement of Responsibility for Refund Liability
as purchaser andas seller of
Name of institution:
City: / State:
HEREBY assure the Accrediting Bureau of Health Education Schools (ABHES) and any interested parties such as students, financial institutions, and government agencies that appropriate provisions have been made for the payment of all tuition refunds now due or which may become due for all students to whom the institution has an obligation. If a previous owner is contractually liable for a refund but fails to fulfill the obligation, the new owner must satisfy the claim of the student or government agency and look to relief from the former owner in a separate action.
FURTHER, I (we) understand that copies of this statement are available to students, financial institutions, federal and state agencies, and other interested persons, and hereby authorize such distribution and release of information.
Seller(s) Signatures:Buyer(s)
Signatures:
State of
County of
Subscribed and sworn to before me, a notary public, this
day of (month) (year).
Notary Public
My commission expires: (date)
ATTACHMENT B
GUARANTEE OF STUDENT TRAINING
as purchaser ofName of institution:
certify that the aforementioned institution is owned by me (us) and is subject to my (our) leadership, guidance, control, and responsibility. As an assurance of performance, I (we) guarantee that the training for which students enroll at the above named facility will be made available to them, by me (us), or by the transfer of the students to a facility offering a similar curriculum, without additional payment by the student other than that agreed upon in the original contract. If this arrangement is not acceptable to the student, the student shall have the option of a refund within 30 days of any interruption of service in accordance with the Statement of Responsibility for Refund Liability.
Signature(s):
State of
County of
Subscribed and sworn to before me, a notary public, this
day of (month) (year).
Notary Public
My commission expires: (date)
Signature of new owner: / Date:
Visit www.abhes.org for additional information on ABHES policies, procedures or standards, and to view the Accreditation Manual.
APPLICATION SUBMISSION
Submit the completed application* on a USB drive or on a compact disk CD and the application fee (See the fees appendix in the Accreditation Manual. Application fee is not refundable.) to:
ABHES
7777 Leesburg Pike, Suite314 North
Falls Church, VA 22043
*The application must be submitted as one* seamless Portable Document Format (.pdf) file. The application may not be submitted to the Commission via e-mail. It is imperative that the USB or CD is correctly labeled with the (1) institution’s name, (2) city/state, (3) ABHES ID #, (4) “Institution Change in Ownership.”
If you have any questions regarding the application, please call us at 703-917-9503.
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