Disclosure of Ownership Interest. 8.17.1 The Developer, at the filing of its initial application, completed a Disclosure of Ownership Interest form with the City. The Developer hereby states, certifies and confirms to the City that the information on that form is still true and correct as of the Effective Date, if not then the form shall be revised if necessary. The Disclosure of Ownership Interest form shall be attached as Exhibit “C” to this Agreement and is incorporated herein by reference and made a part hereof.
Disclosure of Ownership Interest. Pursuant to Chapter 2-000-000, 2-000-000, 2-000-000 and 2-000-000 of the Municipal Code of the City of Chicago, all grantees/ proposers shall provide the following information with their proposal. Notwithstanding, the Corporation Counsel may require an additional information which is reasonably intended to achieve full disclosure of ownership interests from grantee or proposer. Every question must be answered. If the question is not applicable, answer with “NA.” If the answer is none, please answer “None.” Note: The person preparing Section I, II, III, IV or V of this statement must sign the bottom of Page 4 before a Notary Public. Grantee/ Proposer Name: Unicom Enterprises, Inc. Grantee/ Proposer Address: 10 Xxxxx Xxxxxxxx Xxxxxxx, Xxxxxxxx 00000-0000 Grantee/ Proposer is a: (x)Corporation; ( )Sole Proprietor; ( )Partnership; (Check One) ( ) Not-for Profit Corporation ( )Joint Venturer*; ( )Other; *Each Joint Venture Partner must submit a completed Disclosure of Ownership Interest.
Disclosure of Ownership Interest. $2,500 per provider disclosure/attestation for each disclosure/attestation that is not received or is received and signed by a provider that does not request or contain complete and satisfactory disclosure of the requirements outlined in 42 C.F.R. part 455, subpart B.
Disclosure of Ownership Interest. The corporation is owned partially or completely by one or more other corporations: YES ( ) NO ( ) If “yes,” submit a Disclosure of Ownership Interests form for each of said corporations.
Disclosure of Ownership Interest subcontracts to allow it to terminate such contracts as required by this certification.
Disclosure of Ownership Interest. $625 per contractor/subcontractor disclosure/attestation for each disclosure/attestation that is not received or is received and signed by a contractor/subcontractor that does not request or contain complete and satisfactory disclosure of the requirements outlined in 42 C.F.R. part 455, subpart B.
Disclosure of Ownership Interest. In accordance with 42 C.F.R. § 438.608(c)(2), the Contractor shall provide to the Department written disclosures of Ownership and Control Interests as required under 42 C.F.R. § 455.104, including:
a. The name, address, date of birth, and Social Security Number or Tax Identification Number as applicable for any individual or corporation with a direct or indirect or combined Ownership or Control Interest in the Contractor, of five percent (5%) or more of the Contractor’s equity, owns five percent (5%) or more of any mortgage, deed of trust, note, or other obligation secured by the Contractor if that interest equals at least five percent (5%) of the value of the Contractor’s assets;
b. The name, address, date of birth, and Social Security Number of the Executive Director and the CEO of the Contractor;
c. Whether the person with an Ownership or Control Interest in the Contractor is related to another person with Ownership or Control Interest in the Contractor or a Subcontractor as a spouse, parent, child, or sibling;
d. The Name, Address, Date of Birth, and Social Security Number of the managing employees of the Contractor
i. Upon effective date of the Contract;
ii. Upon renewal or extension of the Contract; and
iii. Within thirty-five (35) days after any change in the Contractor’s ownership.
Disclosure of Ownership Interest. Such Existing Unitholder (and each Owner, if applicable) who is a physician represents and warrants that he or she has complied, and each Existing Unitholder (and each Owner, if applicable) who is an immediate family member (as such term is defined in 42 C.F.R. §411.351) of a physician and each Existing Unitholder (and each Owner, if applicable) that is not a natural person and is owned, directly or indirectly, by a physician or an immediate family member of a physician, represents and warrants that such Existing Unitholder’s (and each Owner’s, if applicable) immediate family member who is a physician or direct or indirect physician owners have complied, with the disclosure requirements set forth in 42 C.F.R. §489.20(u)(2).
Disclosure of Ownership Interest. SOLE PROPRIETORSHIPS
