RFI_Attachment_IV_-_SAMPLE_BUSINESS_ORGANIZATIONAL_CHART.pdf
PDF 242 KB Posted
- Attached to
- RFI DCA OIS 24-24-006
- Solicitation number
- 0000034110
- Issued by
- California
About this file
This document is a sample organizational chart for Y Pharmacy LLC demonstrating the ownership structure and required documentation for what appears to be a state pharmacy licensing or contracting application. The chart illustrates a complex ownership hierarchy starting with Y Pharmacy LLC as the applicant business, owned 100% by X HOLDING Inc., which is in turn owned by XYZ Pharmacy LLC, followed by Y Pharmacy LP, with ownership distributed among multiple entities including AAA Pharmacy Inc (50%), Bob Parker Irrevocable Trust (25%), and Parker LP (25%).
The chart details specific documentation requirements throughout the ownership structure, including Ownership Information forms (17A-33), corporation supporting documents, partnership agreements, trust documents, and various state filings. Each entity level requires specific documentation such as Articles of Incorporation, Statements of Information, Partnership Agreements, Stock Ledgers, and Bylaws. The ownership structure includes multiple types of business entities including LLCs, corporations, limited partnerships, and a trust, with Rachel Parker identified as having a 25% indirect beneficial ownership in the applicant business through the Bob Parker Irrevocable Trust.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| RFI___DCA_OIS_24-25-006_-_Attachment_I_Requirements.xlsx | XLSX spreadsheet | |
| RFI_Attachment_III_Proposed_Solution_ROM_Estimate.pdf | ||
| RFI_Questions_and_Answers.pdf | ||
| RFI___DCA_OIS_24-25-006.pdf | ||
| RFI_Attachment_II_-_Vendor_Questionnaire.pdf |
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Text version
SAMPLE ORGANIZATIONAL CHART
Y Pharmacy LLC – Applicant Business
Applicant Business
Y Pharmacy LLC
X HOLDING Inc.
100% Beneficial Interest in Y Pharmacy LLC
• Ownership Information (17A-33)
• Corporation Supporting Documents o Articles of Incorporation (Initial and all amendments) o Current Statement of Information o Stock Ledger and Stock Certificates (Issued and Cancelled) o Bylaws (Initial and all amendments)
Bob Parker Irrevocable Trust 1/1/2000
25% Beneficial Interest in Y Pharmacy LP
• Ownership Information (17A-33)
• Copy of Unredacted Trust
Y Pharmacy LP
100% Beneficial Interest in XYZ Pharmacy LLC
• Ownership Information (17A-33)
• Partnership Supporting Documents o Certificate of Limited Partnership or Application for Registration as a Foreign LP o Partnership Agreement
Bob Parker
(Trustee & Settlor)
0%
Rachel Parker (Beneficiary)
100% (25% indirect owner of Applicant Business)
RAP GP
LLC
General Partner
1%
45 Limited Partners all holding less than 9% Beneficial Interest
XYZ Pharmacy LLC
100% Beneficial Interest in X HOLDING Inc.
• Ownership Information (17A-33)
• Limited Liability Company Supporting Documents o Articles of Organization (Initial and all amendments) o Current Statement of Information or Foreign LLC.
o Operating/Limited Liability Agreement (Initial and all amendments)
AAA Pharmacy Inc (10K)
50% Beneficial Interest in Y Pharmacy LP
• Ownership Information (17A-33)
• Corporation Supporting
Documents o Articles of Incorporation
(Initial and all amendments) o Current Statement of
Information o A Copy of Page 1 of 10K, the page(s) identifying the executive officers and directors, and the page(s) listing the subsidiaries.
Parker LP 25% Beneficial Interest in Y
Pharmacy LP
• Ownership
Information (17A- 33)
• Partnership Supporting Documents o Certificate of
Limited Partnership or Application for Registration as a Foreign LP o Partnership Agreement
Bob Parker General Partner
0%
RFI # DCA OIS 24-25-006 Attachment IV
File details come from the government source that posted it. Updated .