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<subtitle num="05" heading="Acquisition and Conversion of Nonprofit Hospitals" title_num="02" title_heading="Office of the Attorney General">
  <chapter num="01" heading="Applications for and Hearings on the Acquisition and Conversion of Nonprofit Hospitals">
    <regulation prefix="Regulation" num=".01" heading="Scope.">
      <text>This chapter applies to the conversion and acquisition of a nonprofit hospital and is intended to effectuate the provisions of State Government Article, Title 6.5, Annotated Code of Maryland, and is not intended to modify or conflict with the provisions of that title.</text>
    </regulation>
    <regulation prefix="Regulation" num=".02" heading="Definitions.">
      <paragraph num="A.">
        <text>In this chapter, the following terms have the meanings indicated.</text>
      </paragraph>
      <paragraph num="B.">
        <text>Terms Defined.</text>
        <paragraph num="(1)">
          <text>“Acquisition” has the meaning stated in State Government Article, §6.5-101(b), Annotated Code of Maryland.</text>
        </paragraph>
        <paragraph num="(2)">
          <text>“Application” means any documents or other materials filed with the Attorney General in accordance with State Government Article, §6.5-201, Annotated Code of Maryland, and Regulation .03 of this chapter.</text>
        </paragraph>
        <paragraph num="(3)">
          <text>“Attorney General” means the Attorney General or a designee of the Attorney General.</text>
        </paragraph>
        <paragraph num="(4)">
          <text>“Board” means the board of directors, board of trustees, or other managing board of a corporation or institution.</text>
        </paragraph>
        <paragraph num="(5)">
          <text>“Certificate of need” has the meaning stated in Health-General Article, §19-114, Annotated Code of Maryland.</text>
        </paragraph>
        <paragraph num="(6)">
          <text>“Consideration” means any cash, stocks, or things of value promised by the transferee to the transferor for completion of the acquisition.</text>
        </paragraph>
        <paragraph num="(7)">
          <text>“Department” means the Secretary of Health or a designee of the Secretary of Health.</text>
        </paragraph>
        <paragraph num="(8)">
          <text>“Fair value” means the value of the transferor considering all relevant factors, including those set forth in State Government Article, §6.5-301(d), Annotated Code of Maryland.</text>
        </paragraph>
        <paragraph num="(9)">
          <text>“Hospital” has the meaning stated in Health-General Article, §19-301(g), Annotated Code of Maryland.</text>
        </paragraph>
        <paragraph num="(10)">
          <text>“Material” means an original or any copy of any information or document, including a card, computerized record, correspondence, disc or diskette, drawing, electronic record, film or microfilm, form, map, photograph, photostat, recording, or tape.</text>
        </paragraph>
        <paragraph num="(11)">
          <text>“Modification” means a temporary or permanent condition that shall be satisfied or executed by the transferee or transferor, or both.</text>
        </paragraph>
        <paragraph num="(12)">
          <text>“Transferee” means the person in an acquisition that received the ownership or control of the nonprofit health entity that is the subject of the acquisition.</text>
        </paragraph>
        <paragraph num="(13)">
          <text>Transferor.</text>
          <paragraph num="(a)">
            <text>“Transferor” has the meaning stated in State Government Article, §6.5-101(b), Annotated Code of Maryland.</text>
          </paragraph>
          <paragraph num="(b)">
            <text>“Transferor” includes, for purposes of information sought during the application process, predecessor or merged entities.</text>
          </paragraph>
        </paragraph>
      </paragraph>
    </regulation>
    <regulation prefix="Regulation" num=".03" heading="Application.">
      <paragraph num="A.">
        <text>A person that seeks to engage in an acquisition of a nonprofit health entity shall mail or deliver 30 complete copies of an application to the Office of the Attorney General, 200 St. Paul Place, Baltimore, Maryland 21202.</text>
      </paragraph>
      <paragraph num="B.">
        <text>The application shall include:</text>
        <paragraph num="(1)">
          <text>The name, address, and designated representative of:</text>
          <paragraph num="(a)">
            <text>The transferor;</text>
          </paragraph>
          <paragraph num="(b)">
            <text>The transferee; and</text>
          </paragraph>
          <paragraph num="(c)">
            <text>Any other parties to the acquisition;</text>
          </paragraph>
        </paragraph>
        <paragraph num="(2)">
          <text>All of the terms of the proposed acquisition, including consideration to be paid by the transferee;</text>
        </paragraph>
        <paragraph num="(3)">
          <text>A copy of the acquisition agreement or agreements, including any exhibits or attachments;</text>
        </paragraph>
        <paragraph num="(4)">
          <text>A financial and community impact analysis report from an independent expert or consultant that addresses the criteria in State Government Article, §6.5-301, Annotated Code of Maryland;</text>
        </paragraph>
        <paragraph num="(5)">
          <text>Minutes of all board meetings of the transferor and the transferee for the 60 months preceding the filing;</text>
        </paragraph>
        <paragraph num="(6)">
          <text>All reports, analyses, memoranda, correspondence, or other documents submitted to or considered by the board of the transferor in approving the proposed acquisition;</text>
        </paragraph>
        <paragraph num="(7)">
          <text>All requests by the transferor for purchase bids made to any entity during the 60 months preceding the filing;</text>
        </paragraph>
        <paragraph num="(8)">
          <text>All documents comprising, analyzing, or responding to offers of purchase of the transferor from entities other than the transferee for the 60 months preceding the filing;</text>
        </paragraph>
        <paragraph num="(9)">
          <text>All documents describing, proposing, or summarizing compensation to be paid by the transferee or transferor to officers, directors, or employees of the transferor as a result of the proposed acquisition, including any contracts or other documents reflecting continued employment of such officers, directors, or employees after completion of the acquisition;</text>
        </paragraph>
        <paragraph num="(10)">
          <text>All transaction documents that are necessary to be executed in order to effect the proposed acquisition;</text>
        </paragraph>
        <paragraph num="(11)">
          <text>All articles of incorporation and bylaws of the transferor, and any wholly owned subsidiaries of the transferor, adopted since the creation of the transferor;</text>
        </paragraph>
        <paragraph num="(12)">
          <text>All documents describing restrictions on the use of gifts of $5,000 or more that were made to the transferor or its wholly owned subsidiaries;</text>
        </paragraph>
        <paragraph num="(13)">
          <text>All annual reports and audited financial statements of the transferor for the 60 months preceding the application and any audited or unaudited current financial statements of the transferor;</text>
        </paragraph>
        <paragraph num="(14)">
          <text>All documents relating to any certificate of need and any license to operate held by the transferor for the 60 months preceding the application;</text>
        </paragraph>
        <paragraph num="(15)">
          <text>All documents relating to any proposed maintenance of effort after acquisition or any proposed change after acquisition in the provision of health care services in the community in which the transferor-hospital is located; and</text>
        </paragraph>
        <paragraph num="(16)">
          <text>All other documents related to the acquisition.</text>
        </paragraph>
      </paragraph>
      <paragraph num="C.">
        <text>An application is complete only if all documents and information required to be provided by §B of this regulation and all expert reports, including those the Attorney General requests as authorized in State Government Article, §6.5-203(e), Annotated Code of Maryland and Regulation .04 of this chapter, are filed. The Attorney General may ask questions of the transferor, transferee, or both, to determine if an application is complete.</text>
      </paragraph>
    </regulation>
    <regulation prefix="Regulation" num=".04" heading="Financial and Community Impact Report and Other Expert Assistance.">
      <paragraph num="A.">
        <text>The transferee shall file a financial and community impact report prepared by an independent expert that analyzes whether:</text>
        <paragraph num="(1)">
          <text>The purchase price represents the fair value of the transferor;</text>
        </paragraph>
        <paragraph num="(2)">
          <text>The fair value of the transferor will be paid in accordance with State Government Article, §6.5-301(b)(2), Annotated Code of Maryland;</text>
        </paragraph>
        <paragraph num="(3)">
          <text>Any part of the public or charitable assets that are subject to the acquisition will inure directly or indirectly to an officer, director, or trustee of the transferor;</text>
        </paragraph>
        <paragraph num="(4)">
          <text>Any conflicts of interest exist for any officer, director, or trustee of the transferor; and</text>
        </paragraph>
        <paragraph num="(5)">
          <text>The transaction is in the public interest, analyzing each factor set forth in State Government Article, §6.5-301(e), Annotated Code of Maryland, including if and to what extent the cost of health care in the community will be affected, and reaching a conclusion on each factor.</text>
        </paragraph>
      </paragraph>
      <paragraph num="B.">
        <text>After consultation with the Department, the Attorney General may hire an independent expert, at the expense of the transferee, to prepare a financial and community impact report analyzing one or more of the factors in §A of this regulation or in State Government Article, §6.5-301, Annotated Code of Maryland.</text>
      </paragraph>
      <paragraph num="C.">
        <text>After consultation with the Department, the Attorney General may hire experts, at the expense of the transferee, to assist in executing the responsibilities set forth in State Government Article, Title 6.5, Annotated Code of Maryland.</text>
      </paragraph>
    </regulation>
    <regulation prefix="Regulation" num=".05" heading="Public Access to Documents.">
      <paragraph num="A.">
        <text>Any person may request to inspect or copy all or part of an application or documents generated upon review of an application.</text>
      </paragraph>
      <paragraph num="B.">
        <text>Unless it conflicts with this chapter or State Government Article, Title 6.5, Annotated Code of Maryland, the Maryland Public Information Act, State Government Article, Title 10, Subtitle 6, Annotated Code of Maryland applies to public access to the application or documents generated upon review of an application, including provisions concerning judicial review of a denial of access.</text>
      </paragraph>
      <paragraph num="C.">
        <text>General Rule of Confidentiality and Nondisclosure. Except as provided in §D or E of this regulation or otherwise by law, all information and documents gathered by or filed with the Attorney General pursuant to an application, investigation, or examination under this chapter are:</text>
        <paragraph num="(1)">
          <text>Confidential;</text>
        </paragraph>
        <paragraph num="(2)">
          <text>Not subject to subpoena; and</text>
        </paragraph>
        <paragraph num="(3)">
          <text>Not to be made public by the Attorney General or any other party.</text>
        </paragraph>
      </paragraph>
      <paragraph num="D.">
        <text>Waiver by Written Consent of Person to Which the Material Relates. If the person to whom the material relates gives prior written consent by delivery in a form considered acceptable by the Attorney General, the material may be made public.</text>
      </paragraph>
      <paragraph num="E.">
        <text>Attorney General's Discretion to Disclose. After giving the applicant notice and an opportunity to be heard, if the Attorney General determines that disclosure is in the interest of the stockholders of the transferor or the public, the Attorney General may disclose all or part of material otherwise confidential under §C of this regulation.</text>
      </paragraph>
      <paragraph num="F.">
        <text>Process for Requesting Access.</text>
        <paragraph num="(1)">
          <text>A request to inspect or copy materials shall be in writing.</text>
        </paragraph>
        <paragraph num="(2)">
          <text>The request shall be directed to the Attorney General.</text>
        </paragraph>
        <paragraph num="(3)">
          <text>The request shall:</text>
          <paragraph num="(a)">
            <text>Contain the requestor's name and address;</text>
          </paragraph>
          <paragraph num="(b)">
            <text>Be signed by the requestor; and</text>
          </paragraph>
          <paragraph num="(c)">
            <text>Contain a brief description of the information sought.</text>
          </paragraph>
        </paragraph>
        <paragraph num="(4)">
          <text>If the Attorney General grants a request for inspection or copying, the materials shall be produced within a reasonable period not to exceed 30 days from the date of the receipt of the request.</text>
        </paragraph>
        <paragraph num="(5)">
          <text>If the Attorney General denies the request in whole or in part, the denial shall:</text>
          <paragraph num="(a)">
            <text>Be mailed within 30 days from the date of the receipt of the request; and</text>
          </paragraph>
          <paragraph num="(b)">
            <text>State the reasons for the denial.</text>
          </paragraph>
        </paragraph>
        <paragraph num="(6)">
          <text>With the consent of the requestor, any time limit imposed in this process may be extended for an additional period.</text>
        </paragraph>
      </paragraph>
      <paragraph num="G.">
        <text>Fee for Copying Materials. The Attorney General may:</text>
        <paragraph num="(1)">
          <text>Charge a reasonable fee per page of material copied comparable to fees currently charged by other agencies for copies provided under the State Government Article, §10-621, Annotated Code of Maryland; or</text>
        </paragraph>
        <paragraph num="(2)">
          <text>Waive the fee if the Attorney General decides that waiver of the fee is in the public interest.</text>
        </paragraph>
      </paragraph>
      <paragraph num="H.">
        <text>Judicial Review. The requestor may seek judicial review of a decision by the Attorney General to deny access to materials, but, unless otherwise ordered by a court, the appeal may not delay action upon the application for conversion.</text>
      </paragraph>
    </regulation>
    <regulation prefix="Regulation" num=".06" heading="Public Hearing.">
      <paragraph num="A.">
        <text>Within 90 days of receiving a complete application, including all expert reports required or requested by the Attorney General, the Attorney General shall hold a public hearing in the jurisdiction in which the hospital to be acquired by the transferee is located. If the acquisition involves hospitals in more than one jurisdiction, the Attorney General shall hold at least one public hearing in each jurisdiction in which a hospital to be acquired by the transferee is located.</text>
      </paragraph>
      <paragraph num="B.">
        <text>The hearing shall be quasi-legislative and not a contested case hearing.</text>
      </paragraph>
      <paragraph num="C.">
        <text>Notice of all hearings shall be published in accordance with State Government Article, §6.5-202, Annotated Code of Maryland.</text>
      </paragraph>
      <paragraph num="D.">
        <text>The transferee is responsible for all reasonable costs related to the public hearings.</text>
      </paragraph>
      <paragraph num="E.">
        <text>The Attorney General shall determine the conduct of the hearing, including:</text>
        <paragraph num="(1)">
          <text>The order of presentation; and</text>
        </paragraph>
        <paragraph num="(2)">
          <text>Time limits for questions and testimony.</text>
        </paragraph>
      </paragraph>
      <paragraph num="F.">
        <text>The Attorney General may:</text>
        <paragraph num="(1)">
          <text>Request the attendance of persons to testify or the production of documents;</text>
        </paragraph>
        <paragraph num="(2)">
          <text>Issue a subpoena requiring the:</text>
          <paragraph num="(a)">
            <text>Attendance of persons to testify; or</text>
          </paragraph>
          <paragraph num="(b)">
            <text>Production of documents;</text>
          </paragraph>
        </paragraph>
        <paragraph num="(3)">
          <text>Employ related discovery procedures;</text>
        </paragraph>
        <paragraph num="(4)">
          <text>Request that the Department join the Attorney General in presiding at the hearing;</text>
        </paragraph>
        <paragraph num="(5)">
          <text>Require testimony to be given under oath;</text>
        </paragraph>
        <paragraph num="(6)">
          <text>Ask questions of anyone present at the hearing;</text>
        </paragraph>
        <paragraph num="(7)">
          <text>Take questions from the audience and redirect the questions to others present at the hearing; and</text>
        </paragraph>
        <paragraph num="(8)">
          <text>Record the hearing by audiotape or stenographic means.</text>
        </paragraph>
      </paragraph>
      <paragraph num="G.">
        <text>Recorded Hearings.</text>
        <paragraph num="(1)">
          <text>If the hearing is recorded, the Office of the Attorney General or the Attorney General's designee shall maintain the original audiotape or stenographic record.</text>
        </paragraph>
        <paragraph num="(2)">
          <text>The transferee shall be responsible for the cost of transcribing the record and providing a copy of the record to the:</text>
          <paragraph num="(a)">
            <text>Transferee;</text>
          </paragraph>
          <paragraph num="(b)">
            <text>Transferor; and</text>
          </paragraph>
          <paragraph num="(c)">
            <text>Attorney General.</text>
          </paragraph>
        </paragraph>
      </paragraph>
      <paragraph num="H.">
        <text>The rules of evidence do not apply to a hearing held under this chapter.</text>
      </paragraph>
      <paragraph num="I.">
        <text>The Attorney General shall receive and mark all exhibits offered at the hearing if they are relevant to the hearing.</text>
      </paragraph>
      <paragraph num="J.">
        <text>The Attorney General shall control and maintain custody of the hearing record, which shall consist of:</text>
        <paragraph num="(1)">
          <text>The complete application;</text>
        </paragraph>
        <paragraph num="(2)">
          <text>Notice of all hearings;</text>
        </paragraph>
        <paragraph num="(3)">
          <text>Exhibits and other documents entered into the record as approved by the Attorney General;</text>
        </paragraph>
        <paragraph num="(4)">
          <text>The register of all persons who participated in the hearing;</text>
        </paragraph>
        <paragraph num="(5)">
          <text>Any audiotape of the hearing;</text>
        </paragraph>
        <paragraph num="(6)">
          <text>Any transcript of the hearing; and</text>
        </paragraph>
        <paragraph num="(7)">
          <text>The final decision of the Attorney General.</text>
        </paragraph>
      </paragraph>
    </regulation>
    <regulation prefix="Regulation" num=".07" heading="Decision.">
      <paragraph num="A.">
        <text>Within 60 days after the record is closed, including the conclusion of any public hearings, submission of any expert reports, and consultation with the Department, the Attorney General shall issue a decision:</text>
        <paragraph num="(1)">
          <text>Approving the application without modification;</text>
        </paragraph>
        <paragraph num="(2)">
          <text>Approving the application with modification; or</text>
        </paragraph>
        <paragraph num="(3)">
          <text>Disapproving the application.</text>
        </paragraph>
      </paragraph>
      <paragraph num="B.">
        <text>For good cause, the Attorney General may extend the time for a decision for a 60-day period. Only two time extensions may be granted.</text>
      </paragraph>
      <paragraph num="C.">
        <text>The decision of the Attorney General becomes effective 90 days after the date the decision is issued.</text>
      </paragraph>
      <paragraph num="D.">
        <text>Unless otherwise required by law, a person aggrieved by a final decision of the Attorney General may file a petition for review in the circuit court for the county in which the hospital to be acquired by the transferee is located. If the acquisition involves hospitals in more than one county, the appeal may be filed in the circuit court for any of the jurisdictions in which a hospital to be acquired by the transferee is located. A petition for review shall be filed not later than 30 days after the date the Attorney General's final decision becomes effective.</text>
      </paragraph>
    </regulation>
    <annotations>
      <annotation type="Authority">State Government Article, §6.5-103, Annotated Code of Maryland</annotation>
      <annotation type="History" subtype="Administrative History">Effective date: December 12, 2002 (29:24 Md. R. 1918)</annotation>
    </annotations>
  </chapter>
</subtitle>