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Get UHC Employer Information Form 2020-2024

Dress: Physical Address: Website (If applicable): SECTION B Type of Business Organization for Sole Proprietor C-Corporation S-Corporation Federal Tax Purposes (check one): Partnership/LLP Non-Profit Farm LLC SECTION C 1. Is the group maintaining the minimum contribution requirement defined in your Group Policy? 2. Does the business have any owners or employees not listed on the quarterly wage and tax statement? Yes No Yes* No** *If yes, please see list within Section E for addition.

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