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.
Appears in 2 contracts
Sources: Health Care Services Agreement, Speech and Hearing Services Provider Agreement