An application to operate a nurse agency shall be made to the Department on forms provided by the Department. A separate application shall be submitted for each additional location from which a nurse agency is operated. All applications must be under oath and must be accompanied by an equitable application fee which will be set by the Department by rule. A separate license must be obtained for each location from which a nurse agency is operated unless the nurse agency is owned and managed by the same applicant. The Department may impose a fine of up to $500 for the submission of false or misleading information. The application shall contain the following information: (1) name and address of the person, partnership, corporation or other entity that is the applicant; (2) if the applicant is a corporation or limited liability company, a copy of its articles of incorporation or organization, a copy of its current bylaws, and the names and addresses of its officers and directors and shareholders owning more than 5% of the corporation's stock or membership units; (3) the name and location of premises from which the applicant will provide services; (4) the names and addresses of the person or persons under whose management or supervision the nurse agency will be operated; (5) a statement of financial solvency; (6) a statement detailing the experience and qualifications of the applicant to operate a nurse agency, however, the failure of a nurse agency to demonstrate previous experience to operate an agency does not in and of itself constitute grounds for the denial of a license; (7) evidence of compliance or intent to comply with State or federal law relating to employee compensation, including but not limited to, social security taxes, State and federal income taxes, workers' compensation, unemployment taxes, and State and federal overtime compensation laws; (8) evidence of general and professional liability insurance in the amounts of at least $1,000,000 per incident and $3,000,000 in aggregate and workers' compensation coverage for all nurses or certified nursing aides employed, assigned, or referred by the nurse agency to a health care facility; (8.5) copies of all currently effective contracts with health care facilities; and (9) any other relevant information which the Department determines is necessary to properly evaluate the applicant and application as required by the Department by rule. corporation or other entity that is the applicant; liability company, a copy of its articles of incorporation or organization, a copy of its current bylaws, and the names and addresses of its officers and directors and shareholders owning more than 5% of the corporation's stock or membership units; applicant will provide services; under whose management or supervision the nurse agency will be operated; qualifications of the applicant to operate a nurse agency, however, the failure of a nurse agency to demonstrate previous experience to operate an agency does not in and of itself constitute grounds for the denial of a license; State or federal law relating to employee compensation, including but not limited to, social security taxes, State and federal income taxes, workers' compensation, unemployment taxes, and State and federal overtime compensation laws; insurance in the amounts of at least $1,000,000 per incident and $3,000,000 in aggregate and workers' compensation coverage for all nurses or certified nursing aides employed, assigned, or referred by the nurse agency to a health care facility; with health care facilities; and Department determines is necessary to properly evaluate the applicant and application as required by the Department by rule.
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