Section 690.40  Contents of Licensure Application

An application to operate a nurse agency shall be made on a form provided by the Department.  Upon receipt of an application, the Department may request additional information as necessary to determine whether to issue the license. The application shall contain but is not limited to the following:

a)         Business leadership

1)         The name, address, federal employer identification number, telephone number, and email address of the person seeking the license, including the trade or assumed name under which the person does business. If doing business under a trade or assumed name, the applicant shall include proof of compliance with the Assumed Business Name Act [805 ILCS 405].

2)         The name, address, federal employer identification number, telephone number, and email address of the registered agent for the place of business, including the position held by that person or entity with the person. Applications for registration renewal shall contain the name, address, federal employer identification number, email address, and telephone number of any new registered agent for the place of business, including the position held by that person or entity with the nurse agency;

b)         Business structure

1)         If the person seeking a license 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 the names and addresses of shareholders owning more than 5% of the corporation's stock or membership units shall be provided for an initial license.  Applications for license renewal shall contain any amendments to the articles of incorporation and bylaws.

2)         If the person seeking a license is a partnership: the names, business or personal addresses, and telephone numbers of all partners. Applications for registration renewal shall contain the names, business or personal addresses, and telephone numbers of all new partners.

3)         If the person seeking a license is a limited liability company: a copy of the articles of organization, the operating agreement, and the names and addresses of all organizers and members owning more than 5% of the membership;

c)         The names and addresses of all premises from which the nurse agency will provide services, including information on whether the location is a residential address;

d)         The name and address of the person under whose management or supervision the nurse agency will be operated;

e)         Description of business activity;

f)         A statement of whether the owner or operator has ever been convicted of a felony;

g)         The name of the supervising nurse or supervising nurses, if not the same person identified under (d), who is responsible for management or supervision of the nurse agency;

h)         A statement of financial solvency declaring:

1)         That the nurse agency or its owners have not been adjudged insolvent or bankrupt in a State or federal court;

2)         That a court proceeding to make a judgment of bankruptcy or insolvency with respect to the nurse agency or its owners is not pending in a State or federal court; and

3)         That the nurse agency agrees to inform the Director before any court proceeding that could make a judgment of insolvency or bankruptcy with respect to the nurse agency or its owners;

i)          A statement detailing the experience and qualifications of the owner or operator to operate a nurse agency;

j)          An attestation that the nurse agency is in compliance with State and federal laws 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;

k)         A certificate of insurance showing the nurse agency has professional liability insurance in the amounts of at least $1,000,000 per incident and $3,000,000 in aggregate;

l)          A certificate of insurance showing the nurse agency has workers' compensation insurance coverage for all nurses and certified nurse aides employed, assigned, or referred by the nurse agency to a health care facility;

m)        Copies of all currently effective contracts with health care facilities employing, assigning, or referring nurses or certified nurse aides to those health care facilities, including any effective material amendments or modifications, all of which are exempt from disclosure under Section 7.5(fff) of the Freedom of Information Act [5 ILCS 140]; [225 ILCS 510/5]

n)         Payment of an application fee made using the State Treasurer's E-Pay program or any successor program; and

o)         For a licensed nurse agency seeking a license renewal, a completed Shift Fulfillment Attestation Form detailing the total number of shifts contracted for, missed, and fulfilled in the 3 quarters preceding the application date in a format prescribed by the Department. [225 ILCS 510/7] This form can be found at https://labor.illinois.gov/laws-rules/fls/nurse-agency-licensing-act.html.

(Source:  Amended at 49 Ill. Reg. 6180, effective April 25, 2025)