Colorado Code § 10-16-503

Application for certificate of authority
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(1) An application for a certificate
of authority to operate as a prepaid dental care plan organization formed under part 1 of this
article 16 and this part 5 shall be filed with the commissioner on a form prescribed by the
commissioner. Such application shall be verified by an officer or authorized representative of the
applicant and shall set forth, or be accompanied by, the following:
(a) A copy of any basic organizational document of the applicant such as the articles of
incorporation, articles of association, partnership agreement, trust agreement, or other applicable
documents and all amendments to such documents;
(b) A copy of all bylaws, rules and regulations, or similar documents regulating the
conduct of the internal affairs of the applicant;
(c) A list of the names, addresses, and official positions of the persons who are
responsible for the conduct of the affairs of the applicant, including, but not limited to, all
members of the board of directors, board of trustees, executive committee, or other governing
board or committee, the principal officers in the case of a corporation, and the partners or
members in the case of a partnership or association;
(d) If the prepaid dental care plan organization is a corporation, evidence that the board
of directors of such corporation includes:
(I) Dentists, duly licensed pursuant to article 220 of title 12, who have contracted with
the corporation to render dental care services to enrollees;
(II) Enrollees of the prepaid dental care plan, who shall comprise at least one-third of the
members of the board;
(e) A copy of any contract made or to be made between any providers or persons listed
in paragraph (c) of this subsection (1) and the applicant;
(f) A statement generally describing the prepaid dental care plan organization and its
dental plan or plans, facilities, and personnel;
(g) A copy of the form of enrollee coverage to be issued to the enrollees;
(h) A copy of the form of any group contract which is to be issued to employers, unions,
trustees, or other applicants;
(i) Financial statements showing the applicant's assets, liabilities, and sources of
financial support. If the applicant's financial affairs are audited by independent certified public
accountants, a copy of the applicant's most recent regular certified financial statement shall
satisfy this requirement unless the commissioner determines that additional or more recent
financial information is required for the proper administration of part 1 of this article and this
part 5.
(j) A description of the proposed method of marketing the prepaid dental care plan, a
financial plan which includes a three-year projection of the initial operating results anticipated,
and a statement as to the sources of working capital as well as any other sources of funding;
(k) A power of attorney duly executed by such applicant, if not domiciled in this state,
appointing the commissioner as the true and lawful attorney of such applicant in and for this
state, upon whom all lawful process in any legal action or proceeding against the prepaid dental
care plan organization on a cause of action arising in this state may be served;
(l) Repealed.
(m) Such other information as the commissioner may require.
(2) Any existing domestic prepaid dental care plan organization with fifteen hundred or
more dental plan enrollees on January 1, 1980, shall have three years to meet the requirements of
sections 10-16-505 and 10-16-506. However, such organization shall submit with its application
or certificate of authority, a plan approved by the commissioner to meet the requirements of
sections 10-16-505 and 10-16-506 at ten percent the first year of operation, fifty percent the
second year of operation, and one hundred percent the third year of operation. In addition to
exemptions provided elsewhere in this subsection (2), the commissioner may grant a one-year
waiver from the provisions of this subsection (2).
(3) Within ten days following any significant modification of any matter furnished
pursuant to subsection (1) of this section, a prepaid dental care plan organization shall file notice
of such modification together with such supporting documents as are necessary to fully explain
the modification with the commissioner.

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