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Alabama Department of Labor

Professional Employer Organization Registration Form

Has PEO been verified?
YES
By whom? RP
When? 11/07/2019
 

To the ALABAMA DEPARTMENT OF LABOR :

     The undersigned, a professional employer organization subject to the provisions of the Alabama Professional Employer Organization Registration Act, as last amended, hereby registers for the privilege of operating as a limited professional employer organization in the State of Alabama, and submits the following facts under oath to the Alabama Department of Labor:
 
 

Professional Employer Organization Information:

 
Type of Registration:
  Initial Registration  
Name of PEO:
 Innoworks Employment Services Inc  
Date of Organization:
 04/05/2019  
Unemployment Compensation Account #
 9999999999  
Federal ID #
834352322  
Business Address:
 3405 Milton Ave., Ste 209  
City, State, Zip:
 Dallas, TX 75205  
Telephone:
 (469)907-4309  
Fax:
 (469)575-3944  
Web site:
 www.innoworksemployment.com  
 

Primary Contact Person:


 
Name
 Jenny  Hood  
Business Address:
 146 North Street, Ste. 3  
City, State, Zip:
 Lehighton, PA  18235  
Telephone:
 610- 377-3807  
Fax:
 610 -377-5052  
E-Mail Address:
 jhood@innovemp.com  
 

Organizational Structure Information:

 
Organizational Structure Type:  Corporation  
If registrant is a corporation, provide the corporate name, if different than name of PEO, and the State in which the Articles of Incorporation are filed.  TX  
Please provide a list, by jurisdiction, of each name under which the registrant/PEO has operated in the preceding five years, including any alternative names, names of predecessors and, if known, successor business entities.  Innoworks Employment Services Inc is a newly formed company that has no predecessors, successors, or alternative names during the past five years  
   

Consolidated Registration :

 
Is the registrant company a part of a group / multiple organizations?  No  
Note: A separate registration fee for each PEO is still required.  
   

Current Alabama Agent For Service of Process:


 
Name :
 John A Hollansworth  
Business Address:
 212 W. Troy St., Ste B  
City, State, Zip:
 Dothan, AL 36303  
Telephone:
 (205)383-1667  
Fax:
 (205)383-1667  
E-Mail Address:
 admin@incsmart.com  
 

Controlling Persons, Officers, and Directors :

 

Controlling Persons Based on Ownership:

 
Full Name Full Address Date of Birth Percent Ownership Social Security Number / Federal Employer ID Number  
   

Officers, Directors, Partners, and Controlling Persons Based on Position:

 
Full Name Title/Position Date of Birth Social Security Number  
   

Registrant Business History:

 
1.) Have any of the Registrant's proposed controlling persons been convicted of or entered a guilty plea or a plea of nolo contendere to:  
  a.) a crime in any jurisdiction which relates to the operation of a professional employer organization or the ability to engage in business as a professional employer organization? No
  b.)Fraud, deceit, or misconduct in the classification of employees or reporting of employee wages under the workers' compensation laws in any jurisdiction or territory in the United States?  No
  c.)Fraud, deceit, or misconduct in the establishment of or maintence of workers' compensation coverage?  No
  d.)Fraud, deceit, or misconduct in the operation of a professional employer organization?  No
  e.)Found guilty by a court of competent jurisdiction of conduct or practices which show that registrant is incompetent, negligent, dishonest, or so untruthful that money, property, or investments may not safely be entrusted to them?  No
If yes, to any of the above questions please enter brief description here:  
2.) Has either the Registrant or any of its proposed controlling persons been refused a license, registration, or certification as a PEO, PEO Group, or controlling person, or renewal thereof, in any jurisdiction or territory in the United States?  No
3.) Has either the Registrant or any of its proposed controlling persons been involved in or owned an interest in a PEO or PEO Group that has been adjudicated bankrupt, filed proceedings under the Bankruptcy Act, or has otherwise closed due to insolvency?  No
4.) Are any of the licenses, registrations, or certifications of the Registrant or any of its proposed controlling persons currently under investigation or currently pending disciplinary action in any jurisdiction or territory in the United States? No
5.) Has the Registrant or any of its proposed controlling persons ever failed to satisfy any tax liabilities?  No
6.) Has the Registrant or any of its proposed controlling persons ever been cited, fined, convicted, or had actions taken against it/them for failure to maintain evidence of workers' compensation insurance coverage?  No
7.) Has the Registrant or any of its proposed controlling persons ever been found liable for civil fraud, deceit, or misconduct by any court in any jurisdiction or territory in the United States?  No
8.) Is the Registrant delinquent, as of the date of registration, with respect to any of its obligations of payroll, payroll related taxes, workers' compensation insurance or employee benefits in any jurisdiction or territory in the United States?  No
 

Alabama Operations - Office Information
Address of Office: Contact Person's Full Name: Telephone Number: E-Mail Address:
 

Alabama Client Companies
 

Prior Operation in Alabama
Has the applicant commenced operations in Alabama prior to this registration?   No
 

Insurance Benefits
Will you provide workers' compensation insurance coverage to any leased employee in the State of Alabama?   Yes
Are the premiums on the policy as of the date of this registration paid in full?   Yes
If the answer to the previous question is NO, are the unpaid amounts in dispute with your insurance carrier?  
 

Financial Statements
Is this registrant requesting a waiver of this financial statement requirement?  Yes 04/05/2019
Are there any quartly or interim financial statements in existence?  Yes