Section 5.04 - Application(1) Application for a Chiropractic Facility License may be made by a sole proprietorship, partnership, corporation, limited liability company, or limited liability partnership.(2) An applicant for a Chiropractic Facility License shall:(a) submit to the Board an application as prescribed by the Board;(b) In support of the application, each applicant shall submit the following information: 1. If owned by an individual, partnership or trust, the names and ownership percentages of such individual, partners or trustees, except that, in the case of a limited partnership, such information shall be provided only for those limited partners owning 10% or more of the partnership interest and the general partner;2. If owned by a for profit corporation, the names of all stockholders who hold 10% or more of any class of the outstanding stock, specifying the percentage owned;3. If owned by a not for profit corporation, the names of the members and directors of the corporation; and4. The name and ownership percentage of each individual who directly or indirectly has any ownership interest of 10% or more.(c) pay the required non-refundable fees; and(d) arrange for the premises to be inspected and approved by the Board.(3) The application must be attested to by the owner, if a sole proprietorship, or by an authorized agent of record, if a partnership, corporation, limited liability company or limited liability partnership.(4) Unless a waiver is granted by the Board, the Chiropractor of Record must have a minimum of four years of verifiable experience as a Chiropractor licensed in the Commonwealth or another jurisdiction, where the person's responsibilities included but were not limited to patient care, record keeping, and billing.(5) To determine eligibility for a Chiropractic Facility license, the Board will require and consider evidence of good moral character as outlined in 233 CMR 2.04: Good Moral Character Requirement, and current suitability to operate a chiropractic facility. Factors relevant to this consideration include, but are not limited to, sufficiency of present resources, financial background and licensing history (including previous or current participation in the operation of any licensed facility or licensed practice) of the following individuals: (a) the Chiropractor of Record;(c) any person who has authority to direct and control the billing operations of the practice;(d) all licensed professionals (in any licensed profession) who practice at the Chiropractic Facility;(g) owners, shareholders or other entities having a 10% or greater pecuniary interest in the Chiropractic Facility; and(h) any other relevant employees as determined by the Board.(6) The Board also requires identification of any previous Chiropractic Facility that existed at that location and may require and consider supplemental application information and materials reasonably necessary to prevent insurance fraud, protect the health, safety, or welfare of the public, or for other regulatory purposes.(7) The Board will not issue a facility license based on an incomplete submission.(8) The Board will not issue a facility license if required local permit and certificates have not been obtained or if the Board's inspection reveals that the premises is in violation of 233 CMR.Amended by Mass Register Issue 1333, eff. 2/24/2017.