SHJ25-009 fully executed document

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Docusign Envelope lD: CEBCOB3C-DFA1 -4BOC-AFE8-6A4A63440086 51.1 .5 If Facility has a five percent (5%) ownership interest in any of its subcontractors, the tax identification number of the subcontractor(s); 51.1.6 Whether any person with an ownership or control interest in Facility is related by marriage or blood as a spouse, parent, child, or sibling to any other person with an ownership or control interest in Facility; 51.1.7 If Facility has a five percent (5%) ownership interest in any of its subcontractors, whether any person with an ownership or control interest in such subcontractor is related by marriage or blood as a spouse, parent, child, or sibling to any other person with an ownership or control interest in Facility; and 51 .1.8 Whether any person with an ownership or control interest in Facility also has an ownership or control interest in any other Medicaid provider, in the State's fiscal provider or in any Managed Care entity. 51.2 Upon the request of CHPW or HCA, Facility shall fumish to HCA, within thirty- five (35) calendar days of a request, full and complete business transaction information as follows: 51.2.I The ownership of any subcontractor with whom Facility has had business transactions totaling more than twenty-five thousand dollars ($25,000.00) during the previous twelve (12) month period ending on the date of the request; and 51.2.2 Any significant business transaction between Facility and any wholly owned supplier or any subcontractor during the previous five (5) year period ending on the date of the request. Facility shall provide any further information needed or reasonably requested by CHPW for the purpose of satisfuing CHPW's HCA reporting requirements under the State Contract, or for the purpose of veriffing or screening for exclusion from federal or state health care programs, or for conviction of various criminal or civil offences, among the individuals or entities who have an ownership or control interest in, or who are a managing employee of, Facility. 51.3 Upon request, Facility shall furnish to the Washington Secretary of State, the Secretary of the US Department of Health and Human Services, the Inspector General of the US Department of Health and Human Services, the Washington State Auditor, the Comptroller of the Currency, and HCA a description of the transaction between Facility and a party in interest (as defined in Section 1318(b) of the Public Health Service Act) within thirty-five (35) calendar days of the request, including the following transactions: 5 I .3. 1 Any sale or exchange, or leasing of any property between Facility and such a party; 5I.3.2 Any furnishing for consideration of goods, services (including management services), or facilities between Facility and such apafiy but not including salaries paid to employees for services provided in the normal course of their employment; and 2020 Facility Exh BIB - McaidProv Page 40 ofSl Contract #5908-662684