(a) The disclosure statement must include the name and business address of the provider and a statement of whether the provider is a partnership, corporation, or other type of legal entity. If the provider is not an individual, the statement must include:
(1) the name and business address of each officer, director, trustee, and managing or general partner; and
(2) the name and business address of each person who has at least a 10 percent interest in the provider and a description of the person's interest in or occupation with the provider.
(b) The provider may include in the disclosure statement any other material information concerning the facility or the provider.