Date Business Commenced. 19. Other members of a Controlled Group or Affiliated Service Group: (Only participating members should sign the Adoption Agreement. May check both controlled group and affiliated service group.) Controlled Group: (List Participating Members) Affiliated Service Group: (List Participating Members)
Appears in 3 contracts
Samples: Adoption Agreement, Volume Submitter Adoption Agreement, Adoption Agreement
Date Business Commenced. 19. Other members Members of a Controlled Group or Affiliated Service Group: (Only participating members should sign the Adoption Agreement. May check both controlled group and affiliated service group.) ☐ Controlled Group: (List Participating Members) ☐ Affiliated Service Group: (List Participating Members) ☐ Multiple Employer Plan: (List participating Employers)
Appears in 2 contracts
Samples: Volume Submitter Adoption Agreement, Volume Submitter Adoption Agreement
Date Business Commenced. 19. Other members Members of a Controlled Group or Affiliated Service Group: (Only participating members should sign the Adoption Agreement. May check both controlled group and affiliated service group.) ☐ Controlled Group: (List Participating Members) ☐ Affiliated Service Group: (List Participating Members)
Appears in 1 contract
Samples: Adoption Agreement
Date Business Commenced. 1917. Other members Members of a Controlled Group or Affiliated Service Group: (Only participating members should sign the Adoption Agreement. May check both controlled group and affiliated service group.) Controlled Group: (List Participating Membersparticipating members) Affiliated Service Group: (List Participating Membersparticipating members)
Appears in 1 contract
Samples: Adoption Agreement
Date Business Commenced. 1917. Other members Members of a Controlled Group or Affiliated Service Group: (Only participating members should sign the Adoption Agreement. May check both controlled group and affiliated service group.) SAMPLE Controlled Group: (List Participating Membersparticipating members) Affiliated Service Group: (List Participating Membersparticipating members)
Appears in 1 contract
Samples: Volume Submitter Adoption Agreement
Date Business Commenced. 19. Other members Members of a Controlled Group or Affiliated Service Group: (Only participating members should sign the Adoption Agreement. May check both controlled group and affiliated service group.) Controlled Group: (List Participating Members) Affiliated Service Group: (List Participating Members)
Appears in 1 contract
Samples: Volume Submitter Adoption Agreement
Date Business Commenced. 19. Other members Members of a Controlled Group or Affiliated Service Group: (Only participating members should sign the Adoption Agreement. May check both controlled group and affiliated service group.) o Controlled Group: (List Participating Members) o Affiliated Service Group: (List Participating Members) o Multiple Employer Plan: (List participating Employers)
Appears in 1 contract
Samples: Volume Submitter Adoption Agreement
