Application for Certification as a Public-Private Health - Maryland - mdinsurance state md 2025

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering the name of your Nonprofit Corporation in the designated field. Ensure accuracy as this is crucial for identification.
3. Fill in your street address, including city, state, and zip code. This information is essential for correspondence with the Maryland Insurance Administration.
4. Provide your telephone and fax numbers to facilitate communication. Make sure these numbers are current.
5. Enter your Federal Employer Identification Number (FEIN) accurately, as it is required for processing your application.
6. Attach the Articles of Incorporation and Bylaws certified by at least two executive officers. This documentation verifies your corporate mission and governance structure.
7. Complete the Biographical Affidavit for each Board member on an attached sheet, ensuring all required details are included.
8. Confirm understanding of obligations regarding written agreements with counties and provide necessary documentation as specified in the form.
9. Lastly, ensure you include proof of sufficient funds through a Statutory Deposit, Irrevocable Letter of Credit, or Surety Bond as outlined in the instructions.

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