A report filed under section 1 of this chapter must be on a form prescribed by the commissioner and must include the following:

1. (1) If the information is different from the initial application for a registration or from the last annual report, a:

   1. (A) list of the name and residence address of each individual responsible for conducting the discount medical card program organization's affairs, including:

      1. (i) each member of the board of directors, board of trustees, executive committee, or other governing board or committee; and
      2. (ii) each officer; and
   2. (B) disclosure of the extent and nature of any contract or arrangement between each individual listed under clause (A) and the discount medical card program organization, including possible conflicts of interest.
2. (2) The number of cardholders in Indiana of the discount medical card program organization's discount medical card program.

As added by P.L.73-2006, SEC.3.