Requirements for Changes to a Registered Agency

PURPOSE: This rule outlines requirements for changes to an issued registration of a supplemental health care services agency in Missouri. (1) A registered agency shall notify the department of any change in ownership or operator within thirty (30) days of the change. This includes the addition or removal of any owners, operators, or controlling persons. The registration shall be void and the new owner and/or operator shall apply for a new registration and pay the required fee. The date issued on the new registration shall be the effective date when the change of ownership or operator occurred. (A) A registered agency which is a partnership, limited partnership, limited liability company, or corporation that undergoes any of the following changes, or a new corporation, partnership, limited partnership, limited liability company, or other entity assumes operation of an agency whether by one (1) or by more than one (1) action shall apply for a new registration: 1. With respect to a partnership, a change in the majority interest of general partners; 2. With respect to a limited partnership, a change in the general partner or in the majority interest of limited partners; 3. With respect to a limited liability company, a change in any manager or in the majority interest of members or parent company; and 4. With respect to a corporation, a change in the persons who own, hold, or have the power to vote the majority of any class of securities issued by the corporation. (2) An agency shall notify the department of any change in agency name, address, phone number, fax number, email address, and/or responsible contact person information by completing and submitting a Changes to a Registered Agency form, included herein, to the department. Any change of owner or operator will require a new initial application and payment of the required fee. SENIOR SERVICES MISSOURI DEPARTMENT OF HEALTH AND SENIOR SERVICES DIVISION OF REGULATION AND LICENSURE SUPPLEMENTAL HEALTH CARE SERVICES AGENCY CHANGES TO A REGISTERED AGENCY FORM Only fill out sections related to the necessary agency changes. AGENCY REGISTRATION NUMBER CURRENT REGISTERED AGENCY NAME NEW REGISTERED AGENCY NAME (if changing name) CURRENT REGISTERED BUSINESS PHYSICAL ADDRESS CITY STATE ZIP CODE NEW BUSINESS PHYSICAL ADDRESS (if changing address) *Additional documentation and information may be required CITY STATE ZIP CODE CURRENT REGISTERED BUSINESS MAILING ADDRESS Same as physical address CITY STATE ZIP CODE NEW BUSINESS MAILING ADDRESS (if changing address) Same as physical address CITY STATE ZIP CODE NEW AGENCY TELEPHONE NUMBER (if changing number) NEW AGENCY FAX NUMBER (if changing fax number) NEW OR ADDITIONAL AGENCY EMAIL ADDRESS (if changing or adding an email address. Also, indicate if a current email address should be removed) NEW RESPONSIBLE CONTACT PERSON (if changing contact person) NEW RESPONSIBLE CONTACT PERSON EMAIL AND PHONE NUMBER (if different from registered Agency) REASON FOR CHANGES LISTED ABOVE: RESPONSIBLE CONTACT PERSON NAME SIGNATURE DATE MO 580-3425 (08/23) AUTHORITY: section 198.648, RSMo Supp. 2022.* Original rule filed Feb. 8, 2023, effective Sept. 30, 2023. *Original authority: 198.648, RSMo 2022.