Disclosure Report Requirements. This disclosure must include for each person: • The name and address of the person, including the primary business address, every business location, and P.O. Box address, as applicable; • Date of birth and Social Security Number (SSN) (in the case of an individual); • Tax identification number for a corporation with an ownership or control interest in the MCO or for a Subcontractor in which the MCO has a five percent (5%) or more interest; • Whether the person (individual or corporation) with ownership or control interest in the disclosing entity and/or Subcontractor is related to any other person with ownership or control interest such as a spouse, parent, child, or sibling; • The name of any other organization in which a person with ownership or control interest in the MCO also has an ownership or control interest; and • The name, address, date of birth, and SSN of an agent or a managing employee of the disclosing entity.
Appears in 6 contracts
Samples: Purchase of Service Provider Agreement, Purchase of Service Provider Agreement, Purchase of Service Provider Agreement
Disclosure Report Requirements. This disclosure must include for each person: • The name and address of the person, including the primary business address, every business location, and P.O. Box address, as applicable; • Date of birth and Social Security Number (SSN) (in the case of an individual); • Tax identification number for a corporation with an ownership or control interest in the MCO or for a Subcontractor in which the MCO has a five percent (5%) or more interest; • Whether the person (individual or corporation) with ownership or control interest in the disclosing entity and/or Subcontractor is related to any other person with ownership or control interest such as a spouse, parent, child, or sibling; • The name of any other organization in which a person with ownership or control interest in the MCO also has an ownership or control interest; and • The name, address, date of birth, and SSN of an agent or a managing employee of the disclosing entity.
Appears in 4 contracts
Samples: Purchase of Service Provider Agreement, Purchase of Service Provider Agreement, Purchase of Service Provider Agreement
Disclosure Report Requirements. This disclosure must include for each person: • The name and address of the person, including the primary business address, every business location, and P.O. Box address, as applicable; • Date of birth and Social Security Number (SSN) (in the case of an individual); • Tax identification number for a corporation with an ownership or control interest in the MCO or for a Subcontractor in which the MCO has a five percent (5%) percent or more interest; • Whether the person (individual or corporation) with ownership or control interest in the disclosing entity and/or Subcontractor is related to any other person with ownership or control interest such as a spouse, parent, child, or sibling; • The name of any other organization in which a person with ownership or control interest in the MCO also has an ownership or control interest; and • The name, address, date of birth, and SSN Social Security Number of an agent or a managing employee of the disclosing entity.
Appears in 1 contract
Disclosure Report Requirements. This disclosure must include for each person: • The name and address of the person, including the primary business address, every business location, and P.O. Box address, as applicable; • Date of birth and Social Security Number (SSN) (in the case of an individual); • Tax identification number for a corporation with an ownership or control interest in the MCO or for a Subcontractor in which the MCO has a five percent (5%) percent or more interest; • Whether the person (individual or corporation) with ownership or control interest in the disclosing entity and/or Subcontractor is related to any other person with ownership or control interest such as a spouse, parent, child, or sibling; • The name of any other organization in which a person with ownership or control interest in the MCO also has an ownership or control interest; and • The name, address, date of birth, and SSN Social Security Number of an agent or a managing employee of the disclosing entity.
Appears in 1 contract