United healthcare disclosure of ownership control interest and management statement form 2026

1. Click ‘Get Form’ to open the united healthcare disclosure of ownership control interest and management statement form in the editor.
2. Begin by filling out the 'Contracted Provider Entity Information' section. Ensure every field is complete, including the type of disclosing entity, legal name, and complete address.
3. Proceed to Section I: Provider Entity Ownership Information. Indicate if there are individuals or organizations with a Direct or Indirect Ownership or Controlling Interest of 5% or more. If yes, provide their details as required.
4. Continue to Section II: Ownership in Other Providers & Entities. If applicable, list any other providers where owners have a controlling interest.
5. In Section III: Subcontractor Ownership, indicate if your entity has a Direct or Indirect Ownership Interest in any subcontractors and provide necessary details.
6. Complete Sections IV through VII by providing information on familial relationships, criminal convictions, business transactions, and management/control details as prompted.
7. Review all entries for accuracy before submitting. Attach any additional sheets if necessary and ensure that all required fields are filled out correctly.

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