Illinois Administrative Code
Title 50 - INSURANCE
Part 2051 - PREFERRED PROVIDER PROGRAMS
Section 2051.270 - Organizational Requirements

a) An organizational chart describing the relationship between the administrator, its parent organization and any affiliates, including the state of domicile and the primary business of each entity;

b) Proof of registration with the Illinois Secretary of State and the company's FEIN;

c) Names, addresses, official positions and biographical affidavits of the person or persons responsible for the conduct of the affairs of the administrator. The biographical affidavits shall include, but not be limited to, the following information: identifying information of the administrator; affiant's identifying and contact information; affiant's educational, residential and employment history; affiant's professional, business and technical licenses and memberships; a complete history of affiant's fidelity bonding; criminal charges and convictions; civil, regulatory, administrative and disciplinary actions in an individual or corporate capacity; a complete history of affiant's bankruptcy, insolvency, liens and foreclosures in an individual or corporate capacity; affiant's consent to release background reports to the Department and consent for third parties to cooperate in the gathering of background information; and affiant's and his or her immediate family's equity holdings in any entity subject to insurance regulation. The Department will accept the biographical affidavit, and any supplement thereto, obtained from the website of the NAIC or the Department. A copy of the NAIC Biographical Affidavit form is available under "Managed Care License/Registration Information" on the Department's website at http://insurance.illinois.gov/company/companyMain.html; and

d) Location of all administrative offices of the administrator located in this State and regular business hours during which offices are open.