APPLICATION FOR CHANGE IN



APPLICATION FOR CHANGE IN LEGAL STATUS, OWNERSHIP OR CONTROL PART iIInstitutionalThis application must be submitted to ABHES within 5 days following the change in legal status, ownership or control, which ABHES consented via approval of the Application for Change in Legal Status, Ownership or Control – Part I.1. GENERAL INFORMATION:NAME OF INSTITUTION:Click or tap here to enter text.ABHES ID #: Click or tap here to enter text.STREET ADDRESS:Click or tap here to enter text.CITY, STATE, ZIP:Click or tap here to enter text.NAME OF CEO:(SPECIFY DR., MR., MS., MRS.)Click or tap here to enter text.TITLE:Click or tap here to enter text.EMAIL ADDRESS:Click or tap here to enter text.DIRECT PHONE #: Click or tap here to enter text.NAME OF ON-SITE ADMINISTRATOR:(SPECIFY DR., MR., MS., MRS.)Click or tap here to enter text.TITLE:Click or tap here to enter text.EMAIL ADDRESS:Click or tap here to enter text.DIRECT PHONE #:Click or tap here to enter text.2. Change of Ownership InformationPlease provide the following information:Date of Change: Click or tap to enter a date.Click or tap here to enter text.CURRENT Form of NEW ownership:? There is no change to the Form of ownership as presented in Application for a Change in Ownership or Control - Part I? There is a change in the Form of ownership as presented in Application for a Change in Ownership or Control - Part I as indicated below:?Sole Proprietorship Business?Non-Profit Organization?Privately Held Business Corporation?Limited Liability Partnership Company ?Publicly Held Business Corporation?Limited Partnership Company?Other, explain: Click or tap here to enter text.3. New Owner Information? There is no change to the ownership information that was presented in Application for a Change in Legal Status, Ownership or Control - Part I? There is a change in the ownership information from that which was presented in Application for a Change in Legal Status, Ownership or Control - Part I as indicated below:Sole Proprietorship BusinessIf sole proprietorship business, provide legal name and address:Name of OwnershipAddressClick or tap here to enter text.Click or tap here to enter text.List name, title, and address of individual responsible for operations of the sole proprietorship business that owns the institution. NameTitleAddressClick or tap here to enter text.Click or tap here to enter text.Click or tap here to enter text.Privately Held Business CorporationIf 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 DescriptionPercentage of OwnershipClick or tap here to enter text.Click or tap here to enter text.Click or tap here to enter text.Click or tap here to enter text.Click or tap here to enter text.Click or tap here to enter text.Click or tap here to enter text.Click or tap here to enter text.Click or tap here to enter text.Click or tap here to enter text.Click or tap here to enter text.Click or tap here to enter text.List all corporate officers:NameTitleClick or tap here to enter text.Click or tap here to enter text.Click or tap here to enter text.Click or tap here to enter text.Click or tap here to enter text.Click or tap here to enter text.Click or tap here to enter text.Click or tap here to enter text.Publicly Held Business CorporationIf 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 DescriptionPercentage of OwnershipClick or tap here to enter text.Click or tap here to enter text.Click or tap here to enter text.Click or tap here to enter text.Click or tap here to enter text.Click or tap here to enter text.Click or tap here to enter text.Click or tap here to enter text.Click or tap here to enter text.Click or tap here to enter text.Click or tap here to enter text.Click or tap here to enter text.List all corporate officers:NameTitleClick or tap here to enter text.Click or tap here to enter text.Click or tap here to enter text.Click or tap here to enter text.Click or tap here to enter text.Click or tap here to enter text.Click or tap here to enter text.Click or tap here to enter text.If publicly held business corporation, the stock is traded on the (specify):NASDAQ; NYSE; ASE; OTC; Regional Exchange: ?Click or tap here to enter text.Non-Profit OrganizationIf Non-Profit Organization, list the all members and officers of the board of directors/trustees:NameTitleTerm of OfficeVoting Member?End Date YesNoClick or tap here to enter text.Click or tap here to enter text.Click or tap to enter a date.??Click or tap here to enter text.Click or tap here to enter text.Click or tap to enter a date.??Click or tap here to enter text.Click or tap here to enter text.Click or tap to enter a date.??Click or tap here to enter text.Click or tap here to enter text.Click or tap to enter a date.??Click or tap here to enter text.Click or tap here to enter text.Click or tap to enter a date.??Click or tap here to enter text.Click or tap here to enter text.Click or tap to enter a date. ??If non-profit organization, attach a copy of the Governance Policy (Exhibit 12).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?No?Provide the name, title and contact information for the individual whom ABHES should contact regarding the Non-Profit Organization:Name and TitleEmail AddressTelephone NumberClick or tap here to enter text.Click or tap here to enter text.Click or tap here to enter text.Limited Liability CompanyIf Limited Liability Company, list all members:Member NamePercentage of Membership (Ownership Interest)Click or tap here to enter text.Click or tap here to enter text.Click or tap here to enter text.Click or tap here to enter text.Click or tap here to enter text.Click or tap here to enter text.Click or tap here to enter text.Click or tap here to enter text.Click or tap here to enter text.Click or tap here to enter text.Click or tap here to enter text.Click or tap here to enter text.Provide the name, title and contact information for the individual whom ABHES should contact regarding the Limited Liability Company: Name and TitleEmail AddressTelephone NumberClick or tap here to enter text.Click or tap here to enter text.Click or tap here to enter text.Limited Liability Partnership Company; Limited Partnership CompanyIf Limited Liability Partnership Company, Limited Partnership Company, list all partners:Names of General PartnersPercentage of Partnership (Ownership Interest)Click or tap here to enter text.Click or tap here to enter text.Click or tap here to enter text.Click or tap here to enter text.Click or tap here to enter text.Click or tap here to enter text.Click or tap here to enter text.Click or tap here to enter text.Click or tap here to enter text.Click or tap here to enter text.Click or tap here to enter text.Click or tap here to enter text.Names of Limited PartnersPercentage of Partnership (Ownership Interest)Click or tap here to enter text.Click or tap here to enter text.Click or tap here to enter text.Click or tap here to enter text.Click or tap here to enter text.Click or tap here to enter text.Click or tap here to enter text.Click or tap here to enter text.Click or tap here to enter text.Click or tap here to enter text.Click or tap here to enter text.Click or tap here to enter text.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 TitleEmail AddressTelephone NumberClick or tap here to enter text.Click or tap here to enter text.Click or tap here to enter text.4. Contact information for new owner:NAME:(SPECIFY DR., MR., MS.)Click or tap here to enter text.TITLE :Click or tap here to enter text.Address:Click or tap here to enter text.EMAIL ADDRESS:Click or tap here to enter text.DIRECT PHONE #: Click or tap here to enter text.5. key personnel:? There is no change to Key Personnel at the institution as were listed in the Application for a Change in Legal Status, Ownership or Control - Part I. ? There is a change in the Key Personnel than that which was listed in the Application for a Change in Legal Status, Ownership or Control - Part I as indicated below:NameTitlePositionYears in PositionYears at the InstitutionClick or tap here to enter text.Click or tap here to enter text.Click or tap here to enter text.Click or tap here to enter text.Click or tap here to enter text.Click or tap here to enter text.Click or tap here to enter text.Click or tap here to enter text.Click or tap here to enter text.Click or tap here to enter text.Click or tap here to enter text.Click or tap here to enter text.Click or tap here to enter text.Click or tap here to enter text.Click or tap here to enter text.Click or tap here to enter text.Click or tap here to enter text.Click or tap here to enter text.Click or tap here to enter text.Click or tap here to enter text.6. Required EXHIBITSThe following documents must be included in the application submission. Exhibit 1A true and complete copy of the final signed and executed contract of sale or purchase agreement.Exhibit 2An internally prepared Opening Day Balance Sheet for the new ownership as of the date of the change.IMPORTANT NOTE:Exhibits 3, 4, and 5 are only to be submitted if the information is different than that presented in the Application for a Change in Legal Status, Ownership or Control - Part I.Exhibit 3The current form of ownership (e.g., sole proprietorship, partnership, corporation, etc.) andAn ownership diagram that sets forth a precise breakdown of the 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 will 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 publicly traded corporations, this includes shareholders that will directly own 10% of the stock as of the date of the change). Please submit with this form the ownership disclosure submitted in your application to participate in federal student aid programs.Exhibit 4A 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 change. Exhibit 5The name and curriculum vitae of the designated new on-site administrator, including information on post-secondary institutional affiliations during the past ten (10) years.SIGNATURE OF NEW OWNER:Name:Click or tap here to enter text.Title:Click or tap here to enter text.Signature:Click or tap here to enter text.Date:Click or tap to enter a date.APPLICATION SUBMISSION INSTRUCTIONSThe completed application must be submitted as one seamless Portable Document Format (.pdf) file to ABHES online via DropBox Applications. The application may not be submitted to the Commission via e-mail.? It is imperative that the pdf is correctly named with ABHES ID#, Change in Ownership Part 2, and date of submission (ex: I‐100_ Change_in_Ownership-Part 2 _72020).The application will not be processed until the fee is received. See the fees appendix in the Accreditation Manual. Payment of any fees can be remitted electronically via bank transfer in lieu of a hardcopy check, or by credit card where a 2.9% convenience fee is to be applied. Please contact the Accounting Department at accounting@ or (571) 282-0076 to obtain your invoice.If you have any questions regarding the application, please contact ABHES at 703-917-9503. ................
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