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reporting.mmcc@maryland.gov

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Organization, Ownership, and Control Disclosure

Effective May 18, 2020 COMAR 10.62.08.12, 10.62.19.10, and 10.62.25.11 require each licensee to submit information regarding ownership and control by July 1 each year. Failure to submit this report may result in a fine, suspension/revocation, or both. 

Please direct any questions regarding this report to reporting.mmcc@maryland.gov.

Licensee Information

License Type

Licensee Name

Corporate Structure

Please upload a chart or table demonstrating the corporate structure of the licensee. The chart or table must identify:

  1. The names of any parent, holding, affiliate, or subsidiary companies; and 
  2. The relationship between the parent, holding, affiliate, or subsidiary companies and the licensee. 

Important: this includes any third-party "management company" that operates the licensee's business. The licensee must upload a chart or table demonstrating the relationship between the management company and any parent, holding, affiliate, or subsidiary of the management company. 

If NONE, upload a signed attestation that the licensee has no parent, holding, affiliate, or subsidiary companies and no management company. 

Upload Corporate Structure Chart/Table or Signed Attestation

Organizational Chart

Please provide a hierarchical organizational chart of the licensee, which identifies the name and office/title of any of the below members of the organization: 

  1. Members of the Board of Directors;
  2. Principal and/or corporate officers (e.g. Chief Executive Officer, Chief Operating Officer, Senior Vice President, etc.); and
  3. Members of management (including anyone who has a role in the day-to-day management of the licensee).

Upload Organizational Chart

Capitalization Table

Please complete and submit a capitalization table using the Excel template provided on our website

Attestation

I attest that the information reported on this form is accurate and complete as of this date: (Click on the box to select a date from the calendar)

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