Public Disclosure

UniHealth Home Care, Inc. is a for profit home health agency. Our MISSION is to enable patients and their families to acquire updated knowledge and skills necessary to live and manage independently at home and to facilitate smooth recovery process after an illness or surgery.

UniHealth Home Care, Inc. will annually complete a written public disclosure statement signed by the CEO/President. UniHealth Home Care, Inc. will comply with the reporting requirements of Part 420, Subpart C of Title 42 in the Code of Federal Regulations as they apply to the agency.

Upon request, the following information will be made available to the patients of UniHealth Home Care, Inc., or to the public:

1. Names and addresses of individuals, corporations, or subcontractors having a combined direct or indirect ownership or 5% or more in the organization
2. Names and addresses of those persons directly related (spouse, sibling, parent, child) to individuals named in “A”
3. Names and addresses of individuals in “A” or “B” with an ownership or controlling interest in a Medicare or Medicaid facility
4. When the organization is a corporation, the names and addresses of officers, directors, or partners
5. Description of any criminal offense conviction involving titles XVIII, XIX, or XX brought against any persons listed in “A,” “B,” or “C”
6. Names and addresses of any individual currently employed in a managerial, accounting, auditing, or similar capacity who were employed by the organization’s fiscal intermediary within the previous 12 months
7. Changes in the Administrator, Program Director, or Medical Director during the previous 12 months
8. The dates of any of the following:
   1. Actual or anticipated change in ownership or control in the previous or next 12 months
   2. Anticipated bankruptcy filings
   3. Operational changes by a management company
   4. Leasing agreements by another organization
   5. Address changes for the parent, or branches
9. Agency mission statement
10. Proof of license/accreditation status
11. Policies and procedures regarding patient rights

Public Disclosure Statement will be made available to the public upon request and/or as required (i.e.: Medicaid/Medicare regulations). Such circumstances include but are not limited to:

• To regulatory agency (including state, accrediting agency, CMS etc.) at the time of initial request for certification and for each subsequent survey by the given regulatory agency thereafter.
• Disclosure will also be made within 35 days of any change in ownership or management to regulatory agencies as required.

Ian S. Quiambao, RN
CEO/President/Clinical Director