ACHA Information

AHCA – Proof of Financial Ability to Operate

Our firm provides expert preparation of the Agency for Health Care Administration’s (AHCA) Proof of Financial Ability to Operate. A part of the application process to acquire new or change of ownership licensure of various healthcare facilities and/or providers includes the Form 3100-0009. The Form 3100-0009 is the Proof of Financial Ability to Operate (PFOA). AHCA requires a Certified Public Accountant to compile, examine, or apply agreed-upon procedures to prospective financial statements, including summaries of significant assumptions and accounting policies.


These forms must accompany any initial or change of ownership (CHOW) application for the following health care provider types:

Adult Day Care Centers (ADCC)
Assisted Living Facilities (ALF)
Immediate Care Facilities for the Developmentally Disabled (ICFDD)
Prescribed Pediatric Extended Care Center (PPEC)
Health Care Clinics
Home Health Agencies
Home Medical Equipment
Skilled Nursing Facilities
Hospice

Form 3100-0009 is a two year prospective financial statement of the business. AHCA needs to verify the business will have the following:

  • Financial viability,

  • Proper Staffing requirements (as mandated by law),

  • Documents revenue & expenses properly (based on industry standards),

  • and has funding to cover shortfalls.

There are two main monetary requirements for an initial license application: Working Capital & Contingency Funding. Working Capital are the funds required to pay operating costs until the business maintains positive cash flow, it includes the pre-opening costs. Contingency Funding is one month’s of operating expenses (from year one of the projection) which is required should there be any extraordinary circumstances. Certain healthcare providers need to have three months’ of Contingency Funding. Those submitting a change of ownership (CHOW) application have a third requirement, the purchase price.


In order to complete the PFOA we need the following information

Initial Application

  • Main Application Form completed (draft acceptable)

  • Entity information (incorporation documents)

  • List of costs associated with opening the business (if already paid please bring receipt)

  • Estimated Revenues

  • Staffing Salaries & Wages

  • Estimated Expenses

  • Copy of Lease Agreement

  • Insurance Costs

  • Any other loan/leasing agreements

  • Any other estimated purchases of equipment

Change of Ownership (CHOW)

  • Main Application Form completed (draft acceptable)

  • Entity information (incorporation documents)

  • Purchase & Sale Contract of Business

  • Last two year tax returns and/or financial statements from current owner

  • Current Revenues & estimated changes upon CHOW

  • Current Staffing Salaries/ Wages & estimated changes upon CHOW

  • Current Expenses & estimated changes upon CHOW

  • Copy of Lease Agreement & assignment to applicant

  • Insurance Costs

  • Any other loan/leasing agreements

  • Any other estimated purchases of equipment


Contact our office today to schedule an appointment.


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