Get Ks Disclosure Of Ownership And Control Interest Statement 2016-2025
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How to fill out the KS Disclosure of Ownership and Control Interest Statement online
Completing the KS Disclosure of Ownership and Control Interest Statement is essential for participation in the Kansas Medical Assistance Program. This guide provides a straightforward approach to filling out the form online, ensuring you understand each section and requirement.
Follow the steps to accurately complete the form online.
- Click ‘Get Form’ button to access the form and open it in the appropriate environment.
- Begin with the identity of the provider entity or individual by entering the name, date of birth, EIN/SSN, and NPI. Ensure all fields are complete and accurate.
- Provide the ownership information. List all individuals or organizations with a direct or indirect ownership of 5% or more. Include primary addresses and correct percentage of ownership.
- Complete the section on familial relationships by indicating if any individuals listed in the previous question are related. Specify their relationships as required.
- Record any business transactions with subcontractors exceeding $25,000 in the last 12 months. Provide subcontractor names, addresses, and any applicable identification numbers.
- Identify significant business transactions with wholly owned suppliers or subcontractors within the past five years, if applicable.
- List all managing employees who control operations, including their names and positions.
- Disclose any outstanding debt involving household members of the individuals listed in previous sections, if applicable.
- Complete the criminal convictions, adverse legal actions, and other information requested in questions 9 through 11, ensuring to attach relevant documentation.
- Finalize by providing contact details for audit purposes and the physical address for record location. Ensure all information is clear and correctly formatted.
- Once all sections are complete, review the form to ensure all fields are filled accurately. Options to save changes, download, print, or share the form will be available.
Don't wait—complete your KS Disclosure of Ownership and Control Interest Statement online today.
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Disclosure of ownership is the process of revealing who owns and controls a business, particularly in regulated industries like healthcare. This disclosure ensures that stakeholders understand who makes key decisions and holds financial interests. The KS Disclosure of Ownership and Control Interest Statement plays a vital role in this process, helping organizations comply with regulations and fostering trust among clients and partners.
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