Each application for a certificate of authority must be filed with the Commissioner
on a form prescribed by the Commissioner, must be verified by an officer or authorized
representative of the organization for dental care and must include:
1. A copy of any organizational document for the organization and all amendments to
2. A copy of any bylaws, rules or regulations governing the internal affairs of the
3. A list of the names, addresses and official positions of the persons responsible
for operating the organization, including the members of the board of directors, board
of trustees, executive committee, principal officers or partners.
4. A copy of the contracts made or proposed to be made between the applicant and those
persons listed in subsection 3 and the dentists.
5. A statement describing the applicant's plan for dental care, its facilities and
6. A copy of the policy to be issued to its members.
7. A copy of any contract for groups to be issued to employers, unions, trustees or
8. Certified financial statements showing the applicant's assets, liabilities and
sources of support. A copy of the applicant's most recent certified financial statement satisfies this
requirement unless the Commissioner requests additional information from the applicant.
9. A description of the method to be used to market the plan for dental care, including
a financial statement, a projection for the initial 5 years of operation of the plan
and a statement of the sources of capital for the organization.
10. A power of attorney executed by the applicant or its officers, which appoints
the Commissioner as the attorney for the applicant upon whom service of process may
be made in this State.
11. A statement describing the geographic area or areas to be served by the applicant.
12. A statement indicating that all the dentists for the plan are licensed pursuant
to chapter 631 of NRS.
13. Any other information requested by the Commissioner.
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