Application for License — Form — Accompanying Documents — Filing Fee — Unpaid Contributions Reported as Separate Item

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Application for the license shall be made on forms approved by the commissioner, containing the information the commissioner deems necessary. Each application for the license shall be accompanied by copies of the following documents:

  1. Certificate of incorporation;
  2. Bylaws;
  3. Proposed contracts between the corporation and participating hospital or hospitals showing terms under which hospital service is to be furnished to subscribers;
  4. Contracts to be issued to subscribers showing a table of the rates to be charged and the benefits to which they are entitled, showing benefits expressed in service rather than in dollars; however, with equitable arrangements to protect the interests of subscribers when it becomes impossible for the service to be provided. The contracts should make clear that the ultimate responsibility for service to subscribers rests with the member hospital or hospitals; and
  5. A statement of its financial condition and business in such form and detail as the commissioner may require, including the amounts of contribution paid for working capital, and the name or names of each contributor and the terms of the contribution, signed and sworn to by the president and secretary or other proper officers, and shall pay for the filing of the statement the sum of thirty dollars ($30.00). Contributions not paid, but agreed to be paid, may be reported as a separate item, but shall not be admitted as assets of the corporation.


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