DISCLOSURE OF OWNERSHIP AND CONTROL INTEREST STATEMENT Clause Samples

DISCLOSURE OF OWNERSHIP AND CONTROL INTEREST STATEMENT. I. Identifying Information
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DISCLOSURE OF OWNERSHIP AND CONTROL INTEREST STATEMENT. Disclosing entity is defined as a Medicaid provider (other than an individual practitioner or group of practitioners), or a fiscal agent. Indirect ownership interest is defined as ownership interest in an entity that has direct or indirect ownership interest in the disclosing entity. The amount of indirect ownership in the disclosing entity that is held by any other entity is determined by multiplying the percentage of ownership interest at each level. For example, if A owns 10 percent of the stock in a corporation that owns 80 percent of the stock of the disclosing entity, A’s interest equates to an 8 percent indirect ownership and must be reported. Conversely, if B owns 80 percent of the stock of a corporation that owns 5 percent of the stock of the disclosing entity, B’s interest equates to a 4 percent indirect ownership interest in the disclosing entity and need not be reported. Controlling interest is defined as the operational direction or management of a disclosing entity which may be maintained by any or all of the following devices; the ability or authority, expressed or reserved to amend or change the corporate identity (i.e., joint venture agreement, unincorporated business status) of the disclosing entity; the ability or authority to nominate or name members of the Board of Directors or Trustees of the disclosing entity; the ability or authority, expressed or reserved to amend or change the by-laws, constitution or other operating or management direction of the disclosing entity; the right to control any or all of the assets or other property of the disclosing entity upon the sale or dissolution of that entity; the ability or authority, expressed or reserved to control the sale of any or all of the assets to encumber such assets by way of mortgage or other indebtedness, to dissolve the entity or to arrange for the sale or transfer of the disclosing entity to new ownership or control. In order to determine percentage of ownership, mortgage, deed of trust, note, or other obligation, the percentage of interest owned in the obligation is multiplied by the percentage of the disclosing entity’s assets used to secure the obligation. For example, if A owns 10 percent of a note secured by 60 percent of the provider’s assets, A’s interest in the provider’s assets equates to 6 percent and must be reported. Conversely, if B owns 40 percent of a note secured by 10 percent of the provider’s assets, B’s interest in the provider’s assets equates to 4 percent a...
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DISCLOSURE OF OWNERSHIP AND CONTROL INTEREST STATEMENT. ITEM III (a) List the name, title, address and SSN (TIN if an organization) of all individuals or organizations having a direct or indirect ownership or control interest of five (5) percent or more that was convicted of a criminal offense related to the involvement of such persons or organizations in any of the programs established under Medicare, Medicaid or the Title XX services program since the inception of those programs.
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DISCLOSURE OF OWNERSHIP AND CONTROL INTEREST STATEMENT. Contractor shall comply with the requirements pertaining to the Disclosure of Ownership and Control Interest Statement contained in Exhibit G, “Program Integrity Requirements,” and submit to County the “Disclosure of Ownership and Control Interest Statement,” included herein as Exhibit H.
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DISCLOSURE OF OWNERSHIP AND CONTROL INTEREST STATEMENT. Return the original and a copy to the Department of Elder Affairs retain a copy for your files. This form is to be completed annually. Any substantial delay in completing the form should be reported to the Department of Elder Affairs.
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DISCLOSURE OF OWNERSHIP AND CONTROL INTEREST STATEMENT. A full and accurate disclosure of ownership and financial interest is required. Failure to submit requested information may result in a refusal by the Merced County Department of Mental Health and Alcohol and Drug Services (MHP) to enter into an agreement or contract with any such institution or in termination of existing agreements.
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DISCLOSURE OF OWNERSHIP AND CONTROL INTEREST STATEMENT. Disclosing entity is defined as a Medicaid provider (other than an individual practitioner or group of practitioners), or a fiscal agent.
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DISCLOSURE OF OWNERSHIP AND CONTROL INTEREST STATEMENT. A. Contractor agrees to furnish Behavioral Health with the names of its officers, owners, stockholders owning more than ten percent (10%) of its stock, and major creditors holding more than five percent (5%) of the debt of Contractor. This information shall become public record on file with the Department of Health and Human Services. B. Contractor agrees to comply with the requirements set forth in the Federal Regulations 42 CFR 455.104-455.106 in reference to the Medicare, Medicaid, or Title 22 service programs. C. Contractor certifies that neither it nor its principals nor any of its subcontractors are presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participating in any of such programs by any federal agency or by any department, agency, or political subdivision of the State. For purposes of this paragraph, “principal” means an officer, director, owner, partner, key employee, or other person with primary management or supervisory responsibilities, or a person who has a critical influence or substantive control over Contractor’s operations. Contractor shall be required to submit a Disclosure of Ownership and Control Interest Statement during the initial contracting, recontracting and/or recredentialing process, or upon request by Behavioral D. Contractor agrees to submit to Behavioral Health the completed form attached herein as Exhibit F, “Conflict of Interest and Ownership/Control Attestation for Contractors”.” E. Contractor agrees to notify Behavioral Health and update the Disclosure of Ownership and Control Interest Statement if a change in ownership occurs. Contractor shall notify Behavioral Health within thirty-five (35) days.
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Related to DISCLOSURE OF OWNERSHIP AND CONTROL INTEREST STATEMENT

  • Disclosure of Beneficial Ownership (a) Without prejudice to the requirements of applicable law concerning disclosure of beneficial ownership of Shares, any Beneficial Owner (as defined below) of American Depositary Shares who becomes, or ceases to be, directly or indirectly the Beneficial Owner of more than five percent (5%) of all outstanding Shares (whether such interest is held in whole or in part through Receipts) shall, within five (5) days (excluding Saturdays, Sundays and legal holidays in any part of Japan) following such event, send written notice to the Issuer at its head office in Japan as specified in Section 7.5 containing the following information: (i) the name, address and nationality of such Beneficial Owner and all other persons by whom or on whose behalf such Shares have been acquired or are held; the number of American Depositary Shares and total Shares (including American Depositary Shares) beneficially owned directly or indirectly by such Beneficial Owner immediately before and immediately after the event requiring notification; the names and addresses of any persons other than the Depositary, the Custodian, or either of their nominees, through whom such beneficially owned Shares are held, or in whose name such Shares are registered in the Issuer’s transfer book, and the respective numbers of Shares beneficially held through each such person; the date or dates of acquisition of the beneficial interest in such Shares; and the number of any Shares; and the number of any Shares in which such Beneficial Owner has the right to acquire directly or indirectly beneficial ownership and material information as to such right(s) of acquisition; and (ii) the names, addresses and nationalities of any persons with whom such Beneficial Owner is acting as a partnership, limited partnership, syndicate or other group for the purpose of acquiring, holding, voting or disposing of a beneficial interest in Shares; and the number of Shares being acquired, held, voted or disposed of as a result of such association (being the total number held by such group). Any Beneficial Owner of more than five percent (5%) of all outstanding Shares shall promptly notify the Issuer as provided above of any material change in the information previously notified, including, without limitation, a change of more than one (1%) in the percentage of total Shares to which the beneficial ownership relates. As used herein, the term "Beneficial Owners" of Shares means a person who, directly or indirectly, through any contract, trust arrangement, understanding, relationship, or otherwise, has an interest in any Shares (other than the Depositary, Custodian or any of their nominees) which underlie any American Depositary Shares issued hereunder (including having the right to exercise or control the exercise of any right conferred by the holding of such Shares or the power to vote or to direct voting or the power to dispose or to direct disposition) and includes any owner of an American Depositary Share hereunder. (b) Without prejudice to the requirements of applicable law and the provisions of the Issuer’s Articles of Incorporation, any Beneficial Owner of Shares shall, if so requested in writing by the Issuer, provide such information with respect to the beneficial ownership of Shares (including not only Shares underlying American Depositary Shares, but also any other Shares in which such Beneficial Owner has an interest) by such Beneficial Owner as is requested by the Issuer. Such Beneficial Owner shall provide such information to the Issuer in writing the time specified by the Issuer.

  • Certificate of Beneficial Ownership and Other Additional Information Borrowers shall provide to Agent and the Lenders: (i) confirmation of the accuracy of the information set forth in the most recent Certificate of Beneficial Ownership provided to the Agent and Lenders; (ii) a new Certificate of Beneficial Ownership, in form and substance acceptable to Agent and each Lender, when the individual(s) to be identified as a Beneficial Owner have changed; and (iii) such other information and documentation as may reasonably be requested by Agent or any Lender from time to time for purposes of compliance by Agent or such Lender with applicable laws (including without limitation the USA Patriot Act and other “know your customer” and anti-money laundering rules and regulations), and any policy or procedure implemented by Agent or such Lender to comply therewith.

  • Notice Regarding Predatory Offender Information Information regarding the predatory offender registry and persons registered with the predatory offender registry under MN Statute 243.166 may be obtained by contacting the local law enforcement offices in the community where the property is located, or the Minnesota Department of Corrections at (▇▇▇) ▇▇▇-▇▇▇▇, or from the Department of Corrections Web site at ▇▇▇.▇▇▇▇.▇▇▇▇▇.▇▇.▇▇.

  • Beneficial Ownership Information We commit to provide to the procuring entity the Beneficial Ownership Information in conformity with the Beneficial Ownership Disclosure Form upon receipt of notification of intention to enter into a contract in the event we are the successful tenderer in this subject procurement proceeding.

  • Buyer Information True and complete copies of all documents listed in the Buyer Disclosure Schedule have been made available or provided to Seller. The books of account, stock record books and other financial and corporate records of Buyer and the Buyer Subsidiaries, all of which have been made available to Seller, are complete and correct in all material respects.