(a) The incorporators shall file with the commissioner an application for a certificate of authority to do business upon a form to be furnished by the department, which shall include or have attached the following:
(1) The names, and for the preceding 10 years, all addresses and all occupations of all incorporators and proposed directors and officers;
(2) A certified copy of the corporate articles and bylaws and all amendments thereto, a list of the names, addresses, and occupations of all directors and principal officers and, if previously incorporated, for the three most recent years, the corporation annual statements and reports;
(3) All agreements relating to the corporation to which any incorporator or proposed director or officer is a party;
(4) A statement of the amount and sources of the funds available for organization expenses and the proposed arrangements for reimbursement and compensation of incorporators or other persons;
(5) A statement of compensation of the directors and officers;
(6) The forms to be used for any proposed contracts between the corporation and providers of dental services and any corporations which perform administration, marketing or management services, concerning the provision of services to subscribers;
(7) The operating plan for conducting the dental service plan corporation, including all of the following:
a. The geographical area in which business is intended to do business in the first five years;
b. The types of dental service plan coverage intended to be provided in the first five years, including specification whether and to what extent services are to be provided;
c. The proposed marketing methods and management procedures, together with projected subscriber participation;
d. Actuarial data or other similar statistical data, documented and verified in such manner as the department may reasonably require, affirmatively demonstrating the anticipated income and expenses in the first five years, including, without limitation, the projected expenditure for dental services; and projected source of funds to make up any anticipated deficits.
(8) A current statement of the assets and liabilities of the applicant;
(9) Forms of all prepaid dental service contracts the applicant proposes to offer showing the rates to be charged for each form of contract;
(10) Such other documents or information as the department may reasonably require or deem necessary.
Last modified: May 3, 2021