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Disclosure Schedule

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What is a Disclosure Schedule?

A disclosure schedule is often attached to a merger or acquisition purchase agreement to fulfill the seller’s obligation to inform the buyer of the acquired company’s assets, obligations, and other key information. It contains supplemental explanations of statements alluded to in the M&A contract.

Disclosure statements typically list the names and affiliations of board members, major stockholders, key accounts and contracts, and intellectual property and other strategic assets the company owns, as well as known and potential liabilities such as commitments to contribute to employee health and retirement plans, lawsuits, or pending investigations by regulatory, environmental, or law enforcement officials.

Disclosure Schedule Sample

EXHIBIT 10.50

 

HEALTHMONT, INC.

 

COMPANY DISCLOSURE SCHEDULE

 

This Company Disclosure Schedule has been prepared and delivered in accordance with that certain Agreement and Plan of Merger, dated as of October 15, 2002 (the “Agreement”), by and among SunLink Health Systems, Inc., an Ohio corporation (“SunLink” or “Parent”), HM Acquisition Corp., a Delaware corporation (“Merger Sub”), on the one hand, and HealthMont, Inc., a Tennessee corporation (the “Company”), on the other hand. Unless the context otherwise requires, terms that are not defined in this Company Disclosure Schedule shall have the meanings set forth in the Agreement.

 

The Company Disclosure Schedule is qualified in its entirety by reference to specific provisions of the Agreement. Inclusion of the information herein shall not be construed as an admission that such information is material to the business, financial condition or results of operations of the Company except to the extent that the Agreement requires that such information for a particular Section is material.

 

Matters reflected in these schedules are not necessarily limited to matters required by the Agreement to be reflected herein. Such additional matters are set forth for informational purposes only and do not necessarily include other matters of a similar nature.

 

Headings have been inserted for each schedule for convenience of reference only and shall to no extent have the effect of amending or changing the express description of such schedules as set forth in the Purchase Agreement. A disclosure made in one schedule need not be made in another schedule if such disclosure on its face would reasonably put the party to whom such disclosure is made on notice of the applicability of such disclosure to other schedules, and would not make the disclosure in the other schedule materially misleading, and would not result in the omission of any material fact necessary in light of the circumstances to make the disclosure in such other schedule or schedules (or the absence of any such disclosure) not misleading. The disclosure of an item by a party in one schedule shall not result in any duty on the part of the party to whom such disclosure is made to inquire as to the application of such matter to any other section of the Company Disclosure Schedule.

 

1


Section 1.6

 

Director Consulting Agreements

 

The Company has entered into a Consulting Agreement with each of the following directors of the Company (collectively, the “Director Consulting Agreements”):

 

Richard E. Ragsdale

E. Thomas Chaney

Joel S. Kanter

Gene E. Burleson

Kay L. Brown

Jay M. Haft

Arlen B. Reynolds

 

2


Section 3.2

 

Subsidiaries and Affiliates

 

Section 3.2(a)

 

A.

   Name of Company Subsidiaries Jurisdiction    Qualification
     1. HealthMont of Georgia, Inc. Tennessee    Tennessee, Georgia
     2. HealthMont of Texas, Inc. Tennessee    Tennessee, Texas
     3. HealthMont of Texas I, LLC Tennessee    Tennessee, Texas
     4. HealthMont of Missouri, Inc. Tennessee    Tennessee, Missouri
     5. HealthMont of West Virginia, Inc. Tennessee    Tennessee

B.

   Other Securities Owned by Company     
     None     

 

Section 3.2(b)

 

Liens held on Capital Stock of Company Subsidiaries

 

The Company and each of the Company Subsidiaries is a party to (i) that certain Mortgage Loan Agreement (the “Mortgage Loan Agreement”), dated as of August 31, 2000, with Heller Healthcare Finance, Inc. (“Heller”), and (ii) that certain Revolving Loan and Security Agreement (the “Revolving Loan Agreement” and together with the Mortgage Loan Agreement, the “Heller Loan Documents”)), dated as of August 31, 2000, with Heller.

 

The collateral for the loan evidenced by the Revolving Loan Agreement includes those items listed in Section 3.1 of the Revolving Loan Agreement. The Company and the Parent acknowledge that the collateral for such loan does not include the capital stock of the Company Subsidiaries because the stock certificates evidencing the capital stock of the Company Subsidiaries are currently held by and are under the control of the Company and have not been pledged to Heller or a bailee or affiliate of Heller. In the event that the definition of “general intangibles” in Section 3.1(f) of the Revolving Loan Agreement is

 

3


held to include the capital stock of the Company Subsidiaries as collateral under the Revolving Loan Agreement, the Company and the Parent acknowledge that such interpretation will not be considered a breach of the Company’s representations and warranties under this Agreement.

 

4


Section 3.3

 

Capitalization

 

Section 3.3(b)

 

Under the Shareholders’ Agreement, dated as of August     , 2000, among the Company and the shareholders of the Company (the “Shareholders’ Agreement”):

 

  1.   The shareholders are obligated to vote such that five (5) directors consist of persons nominated by the Sovereign Shareholders (as defined in the Shareholders’ Agreement”) and three (3) directors consist of persons nominated by the Founders (as defined in the Shareholders’ Agreement).

 

  2.   Certain types of significant transactions (including the Merger) must be approved by a majority of the directors, plus at least one director nominated by the Founders.

 

Section 3.3(d)

 

In addition to the Heller Warrants, the Company has outstanding the following Company Derivative Securities:

 

NAME OF STOCKHOLDER


   Options @
1.82


   Options @
2.75


   Total Options

   Options to
be
Forgiven


    Remaining
Options


   Warrants
@ 1.25


Arlen B. Reynolds

   10,000    5,000    15,000    0     15,000     

Kay L. Brown

   10,000    5,000    15,000    0     15,000     

Joel S. Kanter

   10,000    5,000    15,000    0     15,000    200,000

Gene E. Burleson & M. Jan Burleson

   10,000    5,000    15,000    0     15,000    80,000

Jay Haft and Clayre Haft

   10,000    5,000    15,000    0     15,000     

Richard E. Ragsdale

   10,000    5,000    15,000    0     15,000    200,000

Chaney Family Partnership LTD

   10,000    5,000    15,000    0     15,000    160,000

Timothy S. Hill

        40,000    40,000    (40,000 )   0    20,000

Greg Griffith

   14,000    4,000    18,000    (18,000 )   0     

Lori Petrie

   7,000    3,000    10,000    (10,000 )   0     

Janet Meders

   7,000    3,000    10,000    (10,000 )   0     

 

5


Cheryl Cheney

   5,000    3,000    8,000    (8,000 )   0

Leslie Bingham

   14,000    8,000    22,000    (22,000 )   0

Jerry Torba

   -    10,000    10,000    (10,000 )   0

Cherrie Klamer

   -    4,000    4,000    (4,000 )   0

Tom Butler

   -    60,000    60,000    (60,000 )   0

Tom Scott

   8,000    5,000    13,000    (13,000 )   0

Steve Love

   4,000    2,000    6,000    (6,000 )   0

 

 

6


Section 3.6

 

Vote Required

 

The Shareholder Approval requirement is now seventy-five percent (75%).

 

7


Section 3.7

 

Consents and Approvals

 

Section 3.7(a)

 

Pursuant to the Heller Loan Documents, the consent of Heller is necessary for the Company to complete the transactions contemplated by this Agreement.

 

Section 3.7(b)

 

None.

 

8


Section 3.8

 

Financial Statements

 

Section 3.8(b)

 

None.

 

Section 3.8(d)

 

None.

 

9


Section 3.9

 

Undisclosed Liabilities

 

A.   The Company is a party to a certain Master Lease Agreement, dated as of January 15, 2001, with Comdisco Healthcare Group, Inc. (“Comdisco”) related to the lease of certain equipment described in the schedules attached thereto (the “Comdisco Lease Agreement”). Certain equipment leased pursuant to the Comdisco Lease Agreement is used at the Eastmoreland Hospital, which hospital is no longer owned by the Company. GKPS, Inc. (“GKPS”), the current owner of the hospital, assumed the Company’s obligations under Comdisco Lease Agreement when it purchased the hospital from the Company, but the Company remains liable to Comdisco under the agreement.

 

The equipment leased pursuant to the Comdisco Lease Agreement that is used at Eastmoreland Hospital consists of the following:

 

  1.   Acuson X-10 ART Ultrasound (60-month lease; $1,548/month)
  2.   Siemens Mobile 1.0 Impact Expert MRI (60-month lease; $12,248/month)
  3.   GE High Speed Advantage RP CT (60-month lease; $6,686/month)

 

Attached is a schedule showing the total amount for which HealthMont may be liable under each of the above as of the date of the Agreement.

 

B.   Symphony Healthcare V, LLC (f/k/a HealthMont of Oregon V, LLC) leases certain real property located in Multnomah County, Oregon (the lease agreement, as amended. being referred to herein as the “Woodland Park Lease Agreement”). The Company is guarantor under the Woodland Park Lease Agreement in an amount up to $500,000. GKPS, current owner of the Woodland Park Hospital, assumed the Company’s obligations as guarantor when it purchased the hospital from the Company, but the Company remains liable to the lessor under the lease agreement to the extent of its guaranty.

 

C.   The Company is a party to certain capital leases (the “LinvaTec Leases”) with LinvaTec Financial Services (“LinvaTec”) related to equipment located at Woodland Park Hospital, which is no longer owned by the Company. GKPS, the current owner of the hospital, assumed the Company’s obligations under the LinvaTec Leases, but the Company remains liable to LinvaTec under the lease agreements.

 

The equipment leased pursuant to the LinvaTec leases consists of the following:

 

  1.   2 Apex 3 chip camera controller
  2.   2 Sony Medical Monitor 20”
  3.   2 Sony UP5/MD printer

 

10


  4.   3 Autoclav 300D Eyecap camera head
  5.   2 Xenon light source
  6.   1 Laparoflator console 252

 

Attached is a schedule showing the total amount for which HealthMont may be liable under each of the above as of the date of the Agreement.

 

D.   The agreements described in subparagraphs A.9., 14., and 15. of Section 3.20 of this Company Disclosure Schedule may relate in part to equipment used at Eastmoreland Hospital and/or Woodland Park Hospital. GKPS, the current owner of the hospitals, assumed the Company’s obligations under these agreements, but the Company remains liable to the lessors under the agreements.

 

Attached is a schedule showing the total amount for which HealthMont may be liable under each of the above as of the date of the Agreement.

 

E.   When the Company sold the subsidiaries that own Eastmoreland Hospital and Woodland Park Hospital to GKPS, it retained the following liabilities:

 

  1.   Douglas Grimm

 

  i.   Incident Occurrence Date: 5/99-10/00

 

  ii.   Incident Report Date: 6/1/01

 

  iii.   Description: Former employee requesting severance pay from New American Healthcare

 

  iv.   Plaintiff Atty: Linda L. Marshall, 3 Monroe Pike, Suite P, Lake Oswego, OR 97035

 

  v.   Status: Demand made on HealthMont through summons (jury trial requested)

 

  vi.   Claim: $38,423.07 plus legal fees

 

  vii.   HealthMont Attorney: Caroline R. Guest, Davis, Wright Tremaine, 1300 SW Fifth Ave., Portland, OR 97201

 

  2.   Pat Rice

 

  i.   Incident Occurrence Date: 8/3/01

 

  ii.   Incident Report Date: 8/31/01

 

  iii.   Description: Employee (night shift charge nurse) defied physician orders for a patient admitted and when reprimanded became very upset. Employee was diagnosed with manic, paranoid behavior by staff psychiatrist. Employee was subsequently terminated.

 

  iv.   Plaintiff Atty: Oregon Bureau Labor & Ind., 800 NE Oregon Street #32, Portland, OR 97232

 

  v.   Status: Precautionary file established

 

  vi.   Claim: None to date

 

11


     Sep-02

   Oct-02

   Nov-02

   Dec-02

   Jan-03

   Feb-03

   Mar-03

   Apr-03

   May-03

   Jun-03

   Jul-03

   Aug-03

   Sep-03

   Oct-03

HealthMont Payment Guarantees:

                                                                     

Dolly

                                                                     

RJ Young (copiers)

   1,447    1,447    1,447    1,447    1,447    1,447    1,447    1,447    1,447    1,447    1,447    1,447    1,447    1,447

Comdisco

                                                                     

CT

   7,446    7,446    7,446    7,446    7,446    7,446    7,446    7,446    7,446    7,446    7,446    7,446    7,446    7,446

R&F

   3,788    3,788    3,788    3,788    3,788    3,788    3,788    3,788    3,788    3,788    3,788    3,788    3,788    3,788

IBM AS400 lease

   1,693    1,693    1,693    1,693    1,693    1,693    1,693    1,693    1,693    1,693    1,693    1,693    1,693    1,693

Woodland Park Hospital (Portland)

                                                                     

RJ Young (copiers)

   3,348    3,348    3,348    3,348    3,348    3,348    3,348    3,348    3,348    3,348    3,348    3,348    3,348    3,348

IBM AS400 lease

   3,032    3,032    3,032    3,032    3,032    3,032    3,032    3,032    3,032    3,032    3,032    3,032    3,032    3,032

Linvatec

   2,411    2,411    2,411    2,411    2,411    2,411    2,411    2,411    2,411    2,411    2,411    2,411    2,411    2,411

Eastmoreland Hospital (Portland)

                                                                     

RJ Young (copiers)

   1,767    1,767    1,767    1,767    1,767    1,767    1,767    1,767    1,767    1,767    1,767    1,767    1,767    1,767

Comdisco

                                                                     

Ultrasound

   1,548    1,548    1,548    1,548    1,548    1,548    1,548    1,548    1,548    1,548    1,548    1,548    1,548    1,548

MRI

   12,248    12,248    12,248    12,248    12,248    12,248    12,248    12,248    12,248    12,248    12,248    12,248    12,248    12,248

CT

   20,482    20,482    20,482    20,482    20,482    20,482    20,482    20,482    20,482    20,482    20,482    20,482    20,482    20,482

Monthly Total

   59,210    59,210    59,210    59,210    59,210    59,210    59,210    59,210    59,210    59,210    59,210    59,210    59,210    59,210

Cumulative Total

   2,549,813    2,490,603    2,431,393    2,372,183    2,312,973    2,253,763    2,194,553    2,135,343    2,076,133    2,016,923    1,957,712    1,898,502    1,839,292    1,780,082

Woodland Park Hospital (Portland)

                                                                     

Hospital Lease (flat $500,000 guarantee for lease default on 20 plus year lease)

     500,000    500,000    500,000    500,000    500,000    500,000    500,000    500,000    500,000    500,000    500,000    500,000    500,000    500,000

Total

   3,049,813    2,990,603    2,931,393    2,872,183    2,812,973    2,753,763    2,694,553    2,635,343    2,576,133    2,516,923    2,457,712    2,398,502    2,339,292    2,280,082

 

12


 

     Nov-03

   Dec-03

   Jan-04

   Feb-04

   Mar-04

   Apr-04

   May-04

   Jun-04

   Jul-04

   Aug-04

   Sep-04

   Oct-04

   Nov-04

   Dec-04

   Jan-05

   Feb-05

   Mar-05

   Apr-05

HealthMont Payment Guarantees:

                                                                                         

Dolly

                                                                                         

RJ Young (copiers)

   1,447    1,447    1,447    1,447    1,447    1,447    1,447    1,447    1,447    1,447                                        

Comdisco

                                                                                         

CT

   7,446    7,446    7,446    7,446    7,446    7,446    7,446    7,446    7,446    7,446    7,446    7,446    7,446    7,446    7,446    7,446    7,446    7,446

R&F

   3,788    3,788    3,788    3,788    3,788    3,788    3,788    3,788    3,788    3,788    3,788    3,788    3,788    3,788    3,788    3,788    3,788    3,788

IBM AS400 lease

   1,693    1,693    1,693    1,693    1,693    1,693    1,693    1,693    1,693    1,693    1,693    1,693    1,693    1,693    1,693    1,693    1,693    1,693

Woodland Park Hospital (Portland)

                                                                                         

RJ Young (copiers)

   3,348    3,348    3,348    3,348    3,348    3,348    3,348    3,348    3,348    3,348                                        

IBM AS400 lease

                                                                                         

Linvatec

   2,411                                                                                     

Eastmoreland Hospital (Portland)

                                                                                         

RJ Young (copiers)

   1,767    1,767    1,767    1,767    1,767    1,767    1,767    1,767    1,767    1,767                                        

Comdisco

                                                                                         

Ultrasound

   1,548    1,548    1,548    1,548    1,548    1,548    1,548    1,548    1,548    1,548    1,548    1,548    1,548    1,548    1,548    1,548    1,548    1,548

MRI

   12,248    12,248    12,248    12,248    12,248    12,248    12,248    12,248    12,248    12,248    12,248    12,248    12,248    12,248    12,248    12,248    12,248    12,248

CT

   20,482    20,482    20,482    20,482    20,482    20,482    20,482    20,482    20,482    20,482    20,482    20,482    20,482    20,482    20,482    20,482    20,482    20,482

Monthly Total

   56,178    53,767    53,767    53,767    53,767    53,767    53,767    53,767    53,767    53,767    47,205    47,205    47,205    47,205    47,205    47,205    47,205    47,205

Cumulative Total

   1,720,872    1,664,694    1,610,927    1,557,160    1,503,393    1,449,626    1,395,859    1,342,092    1,288,325    1,234,558    1,180,791    1,133,586    1,086,381    1,039,176    991,971    944,766    897,560    850,355

Woodland Park Hospital (Portland)

                                                                                         

Hospital Lease (flat $500,000 guarantee for lease default on 20 plus year lease)

                   
     500,000    500,000    500,000    500,000    500,000    500,000    500,000    500,000    500,000    500,000    500,000    500,000    500,000    500,000    500,000    500,000    500,000    500,000

Total

   2,220,872    2,164,694    2,110,927    2,057,160    2,003,393    1,949,626    1,895,859    1,842,092    1,788,325    1,734,558    1,680,791    1,633,586    1,586,381    1,539,176    1,491,971    1,444,766    1,397,560    1,350,355

 

13


    May-05

  Jun-05

  Jul-05

  Aug-05

  Sep-05

  Oct-05

  Nov-05

  Dec-05

  Jan-06

  Feb-06

  Mar-06

  Apr-06

  May-06

  Jun-06

  Jul-06

  Aug-06

  Sep-06

  Oct-06

HealthMont Payment Guarantees:

                                                                       

Dolly

                                                                       

RJ Young (copiers)

                                                                       

Comdisco

                                                                       

CT

  7,446   7,446   7,446   7,446   7,446   7,446   7,446   7,446   7,446   7,446   7,446   7,446   7,446   7,446                

R&F

  3,788   3,788   3,788   3,788   3,788   3,788   3,788   3,788   3,788   3,788   3,788   3,788   3,788   3,788                

IBM AS400 lease

  1,693   1,693   1,693   1,693                                                        

Woodland Park Hospital (Portland)

                                                                       

RJ Young (copiers)

                                                                       

IBM AS400 lease

                                                                       

Linvatec

                                                                       

Eastmoreland Hospital (Portland)

                                                                       

RJ Young (copiers)

                                                                       

Comdisco

                                                                       

Ultrasound

  1,548   1,548   1,548   1,548   1,548   1,548   1,548   1,548   1,548   1,548   1,548                            

MRI

  12,248   12,248   12,248   12,248   12,248   12,248   12,248   12,248   12,248   12,248   12,248   12,248   12,248   12,248                

CT

  20,482   20,482   20,482   20,482   20,482   20,482   20,482   20,482   20,482   20,482   20,482   20,482   20,482   20,482   20,482   20,482   20,482   20,482

Monthly Total

  47,205   47,205   47,205   47,205   45,512   45,512   45,512   45,512   45,512   45,512   45,512   43,964   43,964   43,964   20,482   20,482   20,482   20,482

Cumulative Total

  803,150   755,945   708,740   661,535   614,330   568,818   523,306   477,794   432,282   386,770   341,258   295,746   251,782   207,819   163,855   143,373   122,891   102,409

Woodland Park Hospital (Portland)

                                                                       

Hospital Lease (flat $500,000 guarantee for lease default on 20 plus year lease)

               
    500,000   500,000   500,000   500,000   500,000   500,000   500,000   500,000   500,000   500,000   500,000   500,000   500,000   500,000   500,000   500,000   500,000   500,000

Total

  1,303,150   1,255,945   1,208,740   1,161,535   1,114,330   1,068,818   1,023,306   977,794   932,282   886,770   841,258   795,746   751,782   707,819   663,855   643,373   622,891   602,409

 

14


    Nov-06

  Dec-06

  Jan-07

  Feb-07

  Total

 

Will

Remain


 

Working

To
remove


      

HealthMont Payment
Guarantees:

                                  

Dolly

                  0               

RJ Young (copiers)

                  34,728   34,728           

Comdisco

                  0   0           

CT

                  342,522   342,522           

R&F

                  174,248   174,248           

IBM AS400 lease

                  60,948   60,948           

Woodland Park
Hospital (Portland)

                                  

RJ Young (copiers)

                  80,352       80,352      Credit app being completed

IBM AS400 lease

                  42,448   42,448           

Linvatec

                  36,166               

Eastmoreland
Hospital (Portland)

                                  

RJ Young (copiers)

                  42,408       42,408      Credit app being completed

Comdisco

                  0               

Ultrasound

                  66,582       66,582      Working with GE-should hear back next week

MRI

                  563,390       563,390       

CT

  20,482   20,482   20,482   20,482   1,106,022       1,106,022       

Monthly Total

 

20,482

  20,482   20,482   20,482                   

Cumulative Total

 

81,928

  61,446   40,964   20,482   2,549,813   654,894   1,858,754       

Woodland Park
Hospital (Portland)

                                  

Hospital Lease (flat $500,000 guarantee for lease default on 20 plus year lease)

          
    500,000       500,000   500,000   500,000          110,000  To get removed. Six weeks to get finalized.

Total

 

581,928

  561,446   540,964   520,482                   

 

 

15


Section 3.10

 

Absence of Certain Changes

 

A.   Arrangements relating to the Divestco Disposition. (Sections 3.10(b)(i) and (ii))

 

B.   Draws under the Revolving Loan Agreement. (Section 3.10(b)(iv))

 

C.   The Company intends to take the actions disclosed in Section 5.1 of the Company Disclosure Schedule.

 

D.   The Company has entered into a Settlement Agreement with GKPS, dated as of August 20, 2002, and certain related agreements (the “GKPS Settlement Agreements”) settling certain disputes related to the acquisition by GKPS of the stock of certain of the Company’s subsidiaries. As part of that settlement, the Company released certain claims against GKPS, relinquished its rights to certain property tax refunds and cancelled a promissory note from GKPS in the original principal amount of $600,000, all as described more particularly in the GKPS Settlement Agreements. (Sections 3.10(b)(iv) and (vii))

 

E.   The Company has entered into a Lease Termination Agreement (the “Lease Termination Agreement”) with The Dover Centre LLC (the “Lessor”), dated as of August 27, 2002, terminating the lease of the Company’s corporate offices located at 113 Seaboard Lane, Franklin, Williamson County, Tennessee, Suite C-200 in Building C of Phase I of the Dover Centre. Pursuant to the Lease Termination Agreement, the Company must pay Lessor $275,000. In connection with the Lease Termination Agreement, the Company has closed its corporate offices and sold certain office furniture and other equipment. (Section 3.10(b)(x))

 

F.   The Company has entered into Separation and Settlement Agreements (the “Separation and Settlement Agreements”) with the former employees listed below, which agreements require the payment of severance in the amounts set forth opposite their names (Section 3.10(b)(iii)):

 

Name        


   Title

   Severance

Corporate Severance

           

Ingram, David

   VP    $ 28,739

Price, Ann

   M    $ 14,312

Hunt, Jeanette

   AA    $ 1,594

McCarthy, Jane

   AA    $ 2,160

Reed, Shari

   AA    $ 9,000

 

16


G.   The Company entered into a letter agreement (the “NAHC Settlement Agreement”) with New American Healthcare Corporation (“NAHC”) settling certain claims of the Company against NAHC stemming from the Company’s acquisition of certain hospitals from NAHC in August 2000. (Section 3.10(b)(xv))

 

H.   The Company amended that certain letter agreement (the “Overline Loan Agreement”), dated as of January 17, 2002, between the Company and certain subsidiaries, on the one hand, and Heller, on the other hand, generally extending the maturity date of the overline loan referenced therein (the “Overline Loan”) from August 31, 2002 to August 31, 2003. Any reference in this Company Disclosure Schedule to the Heller Loan Documents shall be deemed to include the Overline Loan Agreement. (Section 3.10(b)(x))

 

I.   The Company has entered into a Letter of Credit Reimbursement Agreement (the “Letter of Credit Reimbursement Agreement”), dated as of August             , 2002, with Timothy S. Hill, E. Thomas Chaney, Chicago Private Investments, Inc., Gene E. Burleson and Richard E. Ragsdale (collectively, the “Lending Directors”), on the other hand, relating to the reimbursement of the Lending Directors in the event the letters of credit maintained by the Lending Directors that secure the Overline Loan are drawn upon. Such reimbursement is to be in the form of Shares, as more fully described in the agreement. (Section 3.10(b)(xiii))

 

J.   The Company has entered into a Separation Agreement and General Release, dated as of             , 2001, with Gene Wright (the “Wright Separation Agreement”) pursuant to which the Company redeemed from Mr. Wright a total of 450,670 Shares in consideration for, among other things, the forgiveness of certain loans from the Company. (Sections 3.10(b)(vii) and (xiii))

 

K.   The Company has entered into a Separation Agreement and General Release, dated as of June 24, 2002, with Gary Tharpe (the “Tharpe Separation Agreement”) pursuant to which the Company redeemed from Mr. Tharpe a total of 42,016 Shares. (Sections 3.10(b)(vii) and (xiii))

 

L.   The Company has entered into a Separation Agreement and General Release, dated as of July 15, 2002, with Jerry Christine (the “Christine Separation Agreement”). (Sections 3.10(b)(vii) and (xiii))

 

M.   The Company entered into that certain Amendment No. 4 to Mortgage Loan Agreement (the “Mortgage Loan Agreement”), dated as of March 31, 2002, between the Company and certain subsidiaries, on the one hand, and Heller, on the other hand, generally making certain modifications to certain financial covenant provisions in the Mortgage Loan Agreement. Any reference herein to the Heller Loan Documents is deemed to include this amendment. (Section 3.10(b)(x))

 

17


N.   The Company has entered into that certain Founders Stock Redemption Agreement (the “Founders Stock Redemption Agreement”), dated as of             , 2002, between the Company, on the one hand, and certain founding shareholders of the Company, on the other hand, pursuant to which the Company will redeem certain shares held by such shareholders prior to the Closing. (Sections 3.10(b)(i) and (ii))

 

O.   The Company intends to make an election under Section 338(h)(10) of the Internal Revenue Code of 1986, as amended, with respect to the transactions effected pursuant to the GKPS Agreements. (Sections 3.10(b)(xvii))

 

18


Section 3.11

 

Litigation

 

A.   Adel

 

  1.   The Georgia Department of Community Health has alleged Medicaid overpayments of approximately $106,000 relating to periods during which the hospital was owned by New American Healthcare Corporation. The Company is no longer challenging this claim and has been reimbursed the amount of the overpayments pursuant to the NAHC Settlement Agreement.

 

  2.   See attached.

 

B.   Callaway

 

See attached.

 

C.   Dolly Vinsant

 

See attached.

 

D.   Other

 

See Section 3.9.E. of this Company Disclosure Schedule.

 

19


HEALTHMONT, INC.

 

Month End: 10/08/2002

 

ACTIVE/THREATENED/POTENTIAL LIGITATION-MASTER LIST

 

Hospital


 

Case
Name


 

Incident

Occurred


 

Incident

Reported


 

Description


 

Legal Action By

Potential Plaintiff


 

HealthMont

Attorney


 

Potential

Plaintiff Request


 

Current Status


Dolly

      3/14/01   5/21/01   25 y/o female admitted for chronic cholecystitis. Patient subsequently underwent laparascopic surgery & open choledochoduodenostmy with anastomosis. Patient had transsection of common bile duct.  

Kent Buckingham

Buckingham Law Firm

1707 West Wall Street

Midland, TX 79701

915-570-1919

  St. Paul notified   None to date   Precautionary file established

Adel

      03/26/01   06/07.01   Patient admitted to ER due to auto accident. Patient received a chest Tube before being life-flighted to another facility. He complained that His wallet was missing with $4,300. Sheriff’s office said the wife had The wallet. Later the family said there was the money missing along with A necklace and two rings. Two months later hospital received letter From atty stating the patient’s chest tube was installed incorrectly.  

Faye Edmondson

Harrison & Edmondson, LLC

125 W. Columbus Street

Dadeville, AL 36853

  St. Paul notified   $4,300 and jewelry   Precautionary file established
        09/29/01   02/05/02   Patient born in hospital 9/29/01 then transferred to Phoebe? Patient was seen again on 10/31/01 and again on 11/22/01. Dr. Rubio Stated that patient is deceased but does not have any information. Patient was not brought to Adel. Hospital has received a request For medical records.  

Langdale, Vallotton,

Linahan & Wetherington

1007 N. Patterson St.

Valdosta, GA 31603-1571

  St. Paul notified   No request to date   Precautionary file established
        03/17/02   03/19/02   Two year old treated in ER on morning of 3/17/02 for fever, Nausea, vomiting & loss of appetite and discharged home. Evening 3/17/02 ambulance brought child in code with Diagnosis of cardiorespiratory arrest, etiology unclear, child Deceased. Child also seen in ER 4 days prior with diagnosis Of influenza. Autopsy being performed. Medical records requested.  

Fulp &Holt

207 E. Gordon Street

P.O. Box 1571

Valdosta, GA 31603-1571

  St. Paul notified   No request to date   Precautionary file established
        01/30/01   08/28/02   Patient brought to ER via EMS with diagnosis of Retroperitoneal hematoma, acute blood loss anemia. Patient transferred to South GA Med Ctr then expired.  

Gregory, Christy & Maniklal

708 16th Ave E

Cordelle, GA 31015

229-273-7150

  St. Paul notified   Copy of Medical Records   Precautionary file established
        11/07/00   08/03/02   Patient to emergency room via EMS in full arrest. Entire record sent to Potential Plaintiff.  

Robins, Laplan, Milder & Ciresi, L.L.P.

One Atlanta Plaza

950 East Paces Ferry Road N.E.

Atlanta, GA

 

St. Paul notified

08/30/2002

  Copy of Medical Records   Precautionary file established
        02/07/02   10/04/02   Patient seen in ER on 2/07/02 and claims she stumbled on steps in MRI unit Three days ago complaining of swollen right foot with redness to big toe.  

M. Stan Ballew

PO Drawer 1188

Tifton, GA 31793

 

St. Paul notified

10/04/02

  Copy of Medical Records   Precautionary file established

Callaway

      03/29/01   04/04/01   Patient reesented to ER with abdominal pain and subsequently died as a Result of a ruptured ectopic pregnancy.  

Padberg Law Firm

1010 Market Street

Suite 650

St. Louis, MO 63101

314-621-2900

  St. Paul notified   Husband of deceased stated that he would be suing the hospital regarding the hospital care.   Notification of suit served on 4/3/02
        06/05/01   07/11/02   Patient admitted for a bowel obstruction, experienced complications Following surgery and was transferred to another hospital. On 6/27/01 she expired.  

Robert E. Keaney

Jerome J. Duff & Assoc. Inc.

1015 Locust Street, Suite 605

St. Louis, MO 63101-1322

314-621-3833

  St. Paul notified   No request to date   Precautionary file established.

 

20


Section 3.12

 

Employee Benefit Plans

 

A.   Employees at Adel, Georgia may purchase certain types of supplemental medical policies, and upon separation from service have the right to retain those policies. (Section 3.12(f))

 

B.   Each of the hospitals provides medical and dental coverage to its employees through welfare plans that are self-funded. The plans are administered by Employee Benefits Services. They maintain reinsurance generally for claims in excess of $50,000 through American National Insurance Company/CCH. (Section 3.12(g))

 

Section 3.12(l)

 

None

 

21


Section 3.14

 

Environmental Laws

 

None, other than as stated in the following Phase I and Phase II reports previously furnished to Parent:

 

A.   Phase I Environmental Site Assessment for Dolly Vinsant Memorial Hospital dated June 26, 2000.

 

B.   Phase I Environmental Site Assessment for Memorial Hospital of Adel dated June 26, 2000.

 

C.   Report of Phase I Environmental Site Assessment for Callaway Community Hospital dated December 5, 2000.

 

D.   Report of Limited Phase II Environmental Site Assessment for Callaway Community Hospital dated December 5, 2000.

 

22


Section 3.17

 

Employees

 

23


GENERAL LIST

 

24


HealthMont, Inc. Corporate Office Employees as of 04/01/02

 

“Confidential portion of material has been omitted and filed separately with the SEC”

 

25


HealthMont, Inc.

Board of Directors

Annual Consulting Compensation Amounts

 

Board Member


   Annual Compensation

Kay L. Brown

   $ 15,000.00

Gene E. Burleson

   $ 15,000.00

E. Thomas Chaney

   $ 49,000.00

Jay M. Haft

   $ 15,000.00

Joel S. Kanter

   $ 15,000.00

Richard E. Ragsdale

   $ 44,000.00

Arlen B. Reynolds

   $ 15,000.00
    

Total

   $ 168,000.00
    

 

26


“Confidential portion of material has been omitted and filed separately with the SEC”

 

27


Section 3.19

 

Interested Party Transactions

 

Section 3.19(a)

 

A.   On August 31, 2000, the Company made a loan to Tim Hill in the original principal amount of $ 89,000. Loan will be repaid at or prior to Closing, in the form of the Company shares as set forth in that certain Non-Competition Agreement and General Release, dated October             , 2002, between Tim Hill and the Company.

 

B.   The Company has entered into the Director Consulting Agreements.

 

C.   The Company intends to effect the Divestco Disposition.

 

D.   The Company has entered into the Letter of Credit Reimbursement Agreement.

 

Section 3.19(b)

 

None

 

Section 3.19(c)

 

None

 

28


Section 3.20

 

Contracts

 

Section 3.20(a)

 

A.   General Agreements

 

  1.   Amended and Restated Employment Agreement, dated as of February 1, 2002, between the Company and Timothy S. Hill.

 

  2.   Wright Separation Agreement.

 

  3.   Tharpe Separation Agreement.

 

  4.   Shareholders’ Agreement.

 

  5.   Heller Loan Documents.

 

  6.   Asset Purchase Agreement, dated as of August 31, 2000, among the Company, on the one hand, and NAHC and certain of its subsidiaries, on the other hand, and certain agreements related thereto (the “NAHC Agreements”).

 

  7.   Stock Purchase Agreement, dated as of February 28, 2002, between the Company and GKPS, and certain agreements related thereto (the “GKPS Agreements”).

 

  8.   Agreement between the Company and Healthcare Management Systems, Inc. (software license)

 

  9.   End of Lease Supplement, dated September 6, 2001, between the Company and IBM Credit Corporation, amending that certain Term Lease Master Agreement, dated April 27, 1998, and Quicklease Agreement, dated October 20, 1998, between New American Healthcare Corporation (computer hardware lease)

 

    Recurring Amounts Due: See End of Lease Supplement for schedule of monthly payments.

 

29


  10.   Agreement between the Company and Hospital Resource Management, L.C. (chargemaster maintenance)

 

    Dated: November 7, 2001
    Amended: May 3, 2002
    Recurring Amounts Due: $4,500 per month

 

  11.   Agreement between the Company and LBMC Healthcare Group (reimbursement services)

 

  12.   Agreement between the Company and MSLI, GP (license for Microsoft software)

 

  13.   Lease Agreement between the Company and The Dover Centre, LLC (office lease). This Lease Agreement was terminated, generally effective as of September 15, 2002, pursuant to the Lease Termination Agreement.

 

  14.   Agreement between the Company and Minnesota Mining and Manufacturing Company (coding software license)

 

  15.   Agreement between the Company and R.J. Young Leasing (copiers at the Company facilities, including the Hospitals)

 

  16.   Agreement between the Company and SSI Group Inc. (software license)

 

  17.   Property Tax Consulting Agreement with the Company:

 

    Dated: October 26, 2001
    Name: Easley, McCaleb & Associates, Inc.
    Services: Property Tax Consultants
    Rate of Compensation: $1,250 flat fee per hospital/$10 per bed

 

  18.   Comdisco Lease Agreement

 

  19.   Agreement between the Company and MCI WorldCom Communications, Inc. (telecommunications/internet services)

 

  20.   Agreement between the Company and Broadline (group purchasing agreement)

 

  21.   LinvaTec Leases

 

  22.   GKPS Settlement Agreements

 

  23.   Lease Termination Agreement

 

30


  24.   Separation and Settlement Agreements

 

  25.   NAHC Settlement Agreement

 

  26.   Letter of Credit Reimbursement Agreement

 

  27.   Christine Separation Agreement

 

  28.   Service Agreement between the Company and Cambridge Integrated Services Group, Incorporated (claims management)

 

    Dated: October 1, 2002
    Termination Date: September 30, 2003

 

  29.   Services Agreement between the Company and David B. Ingram (information services)

 

    Dated: September 23, 2002
    Termination Date: December 31, 2002

 

  30.   Founders Stock Redemption Agreement.

 

B.   Agreements Related to Adel

 

  1.   Lease Agreement between the Company and Lucy Acree (lease of annex on North Hutchinson)

 

    Commencement Date: October 30, 1998
    Termination Date: October 31, 2005
    Recurring Amounts Due: $1,800 per month as of November 1, 2000 (subject to annual increases)

 

  2.   Following month-to-month lease agreements related to leases of the real property described in subparagraphs 3 through 7 of Section 3.24A of the Company Disclosure Schedule:

 

  (a)   Home Health Building located at 1905 South Hutchinson, Adel, Georgia
    Commencement Date: November 1, 1998
    Recurring Amount Due: $1,250 per month

 

  (b)   Medical Record Storage Building located at 100 Memorial Drive
    Commencement Date: June 7, 1999
    Recurring Amount Due: $600 per month

 

  (c)   Surgeon’s Office located at 901 N. Parrish, Adel Georgia

 

31


    Commencement Date: July 1, 2000
    Recurring Amount Due: $500 per month

 

  (d)   Memorial Hospital Annex located at 8098 N. Hutchinson, Adel, Georgia
    Commencement Date: June 15, 2000
    Recurring Amount Due: $500 per month

 

  3.   Equipment Lease between HealthMont of Georgia, Inc. and Acuson Corporation

 

    Signing Date: October 17, 2000, by Company; May 16, 2001, by Acuson
    Termination Date: 60 months commencing on Term Commencement Date (undefined)
    Recurring Amounts Due: $4,266.97 per month

 

  4.   Magnetic Resonance Imaging Shared Service Agreement between HealthMont of Georgia, Inc. and Diversified Imaging Services, Inc. (MRI Services)

 

    Commencement Date: November 1, 2000
    Termination Date: November 1, 2002, renewable for one successive one-year period
    Recurring Amounts Due: See Fee Schedule, Section 15

 

  5.   Agreement between HealthMont of Georgia, Inc. and Dowling Enterprises (preventive maintenance for hospital systems)

 

    Commencement Date: October 1, 2000
    Termination Date: September 30, 2001
    Recurring Amounts Due: $900 per month
    Addendum I: October 19, 2000
    Addendum II: October 19, 2000

 

  6.   Agreement between HealthMont of Georgia, Inc. and Morrison Management Specialists, Inc. (food services)

 

    Commencement Date: September 1, 2000
    Termination Date: Renewable for one-year periods
    Recurring Amounts Due: Regular Monthly Billing, including management fee, pursuant to Article 2
    Amendment: August 1, 2002

 

32


    7.   Master Rental and License Agreement between HealthMont of Georgia, Inc. and Pyxis Corporation

 

    Dated: May 1, 2001
    Termination Date: 60 months from April 1, 2001
    Recurring Amounts Due: $2,844 per month

 

    8.   Physician Recruitment Agreement

 

    Dated: July 26, 2001
    Name: Kent Biehler, DPM
    Position: Podiatrist
    Rate of Compensation: Income guarantee based on gross receipts of [****] per year, which amount is split with hospital in Nashville, Georgia
    Termination Date: September 30, 2004
    Addendum: July 26, 2001

 

    9.   Managed Care Contract between Memorial Hospital of Adel, Inc. and Blue Cross and Blue Shield of Georgia, Inc.

 

    Dated: May 15, 1997
    Termination Date: Renewable one-year terms
    Amendment: April 5, 2002

 

  10.   Professional Services Agreement

 

    Dated: March 19, 1997
    Name: Thomas Fausett, M.D.
    Position: Family Practice
    Rate of Compensation: Provides for payments based on physician’s net revenue
    Termination Date: June 30, 2001 (loan forgiveness period extends for as long as physician working at hospital)

 

  11.   Physician Assistance Agreement

 

    Dated: October 11, 1999
    Name: Fred H. Fritzsche, Jr., M.D.
    Position: Family Practice
    Rate of Compensation: Income guarantee based on net receipts of [****] per year
    Termination Date: August 1, 2003 (by letter dated 12/13/01, it looks like he may have wanted to repudiate the contract)

 

[****] Confidential portion of material has been omitted and filed separately with the SEC.

 

33


  12.   Lease Agreement between the Company and GE Capital Healthcare Financial Services (lease of GEGS Millennium MPS)

 

    Commencement Date: March 19, 2002
    Termination Date: 60 months from Commencement Date
    Recurring Amount Due: $3,713.50 per month plus tax

 

  13.   Lease Agreement between the Company and GE Healthcare Financial Services (lease of GE Sanographic 800T)

 

    Commencement Date: March 19, 2002
    Termination Date: 60 months from Commencement Date
    Recurring Amount Due: $1,216.08 per month plus tax

 

  14.   Exclusive Professional Services Agreement

 

    Dated: October 1, 2001
    Name: General Anesthesia Services, LLC
    Services: Anesthesia Services
    Rate of Compensation: [****] per year
    Termination Date: September 30, 2004

 

  15.   Physician Recruitment Agreement

 

    Dated: July 25, 2001
    Name: Mary R. Howell, M.D.
    Position: Obstetrician and Gynecologist
    Rate of Compensation: Income guarantee based on gross receipts of [****] per year to be split with hospital in Nashville, Georgia (60% to be paid by Adel)
    Termination Date: September 30, 2002 (provides for two-year forgiveness of loan period up to September 30, 2004)

 

  16.   Mobile MRI Services Agreement

 

    Dated: August 14, 2002
    Name: Shared Imaging
    Commencement Date: November 2002
    Termination Date: 12 months following Commencement Date
    Recurring Amounts Due: See Exhibit A, page 1

 

  17.   Cooperating Provider Network Hospital Cooperating Provider Agreement between Memorial Hospital of Adel and America’s Health Plan, Inc., dated July 1, 1997.

 

[****] Confidential portion of material has been omitted and filed separately with the SEC.

 

34


  18.   Health Care Provider Network Agreement Hospital – National between BCE Emergis Corporation and Memorial Hospital of Adel, dated August 1, 2002.

 

  19.   Master Preferred Provider Network Hospital Agreement between Beech Street Corporation and Memorial Hospital of Adel, Inc., dated January 27, 1997.

 

  20.   Facility Contract between Community Care Network, Inc. and Memorial Hospital of Adel, Inc., dated December 10, 1997.

 

  21.   Hospital Participation Agreement between the State of Georgia, Department of Community Health, Division of Public Employee Health Benefits and Memorial Hospital of Adel, dated January 1, 2000.

 

  22.   Agreement between CompFirst, Inc. and Memorial Hospital of Adel, Inc., dated August 21, 1997.

 

  23.   Hospital Contract between First Health Group Corp., acting in its capacity as owner and operator of The First Health® Network and Memorial Hospital of Adel, dated March 2, 1999, and amended on March 2, 1999, March 10, 1999, and June 12, 2000.

 

  24.   Hospital Participation Agreement, State of Georgia, between FOCUS Healthcare Management, Inc. and Memorial Hospital of Adel, Inc., dated January 16, 1998.

 

  25.   Hospital Participation Agreement for the State of Georgia Department of Community Health (DCH) between Memorial Hospital of Adel, Inc. and Georgia 1st, Inc., dated April 4, 2000.

 

  26.   Hospital Agreement between Memorial Hospital of Adel and Humana Military Healthcare Services, Inc., dated September 29, 1998.

 

  27.   PPO Participating Facility Agreement between MultiPlan, Inc. and Memorial Hospital of Adel, dated May 2, 1995.

 

  28.   Network Facility Agreement between National Provider Network, Incorporated and Memorial Hospital, dated July 13, 1999.

 

  29.   PPO Hospital Participation Agreement between Principal Health Care of Georgia, Inc. and Memorial Hospital of Adel, dated March 1, 1998.

 

  30.   Provider Agreement between Memorial Hospital of Adel and Provider Networks of America, Inc., dated April 4, 1997.

 

35


  31.   Affiliate Hospital Participation Agreement between South Georgia Health Partners, L.L.C. and Memorial Hospital of Adel, dated September 17, 2001.

 

  32.   Hospital Agreement between SpecialNet, Inc. and Memorial Hospital of Adel, dated March 1, 1998.

 

  33.   Participating Hospital Agreement between UNICARE Life & Health Insurance Company and Memorial Hospital of Adel, dated September 25, 1998.

 

  34.   Health Care Service Facility Agreement between Memorial Hospital of Adel and USA Managed Care Organization, Inc., dated August 26, 1997.

 

C.   Agreements Related to Callaway

 

  1.   Managed Care Contract between HealthMont of Missouri, Inc. and Dana Corporation d/b/a American Health Group, dated October 1, 2001.

 

  2.   Managed Care Contract between Callaway Community Hospital and Right Choice Managed Care, Inc. (Blue Cross/Blue Shield), dated February 10, 2000.

 

  3.   Managed Care Contract between HealthMont of Missouri, Inc. and Beech Street Corporation, dated February 1, 2001.

 

  4.   Agreement between HealthMont of Missouri, Inc. and Chem/Aqua (water quality assurance program)

 

    Commencement Date: January 4, 2002
    Termination Date: January 3, 2003
    Recurring Amount Due: $716.45 per month plus taxes and freight

 

  5.   Managed Care Agreement between HealthMont of Missouri, Inc. and Health Value Management, Inc.

 

  6.   Managed Care Contract between HealthMont of Missouri, Inc. and Cigna HealthCare of St. Louis, Inc., dated October 1, 2001.

 

  7.   Managed Care Contract between HealthMont of Missouri, Inc. and CorVel Corporation, dated May 31, 2001.

 

36


  8.   Physical Therapy Agreement

 

    Dated: March 1, 2002
    Termination Date: March 1, 2005
    Name: Critchfield Physical Therapy, P.C.
    Services: Physical Therapy
    Rate of Compensation: [****] per outpatient and [****] per inpatient

 

  9.   Agreement between HealthMont of Missouri, Inc. and Specialized Imaging Services, Inc. (nuclear medicine equipment rental)

 

    Dated: February 1, 2002
    Termination Date: February 1, 2005
    Recurring Amount Due: $2,700 per month

 

  10.   Emergency Services Agreement

 

    Dated: September 26, 2001
    Termination Date: One-year renewable terms
    Name: ECS of Missouri, Inc.
    Services: Emergency Services
    Rate of Compensation: Approximately [****] annually

 

  11.   Physician Employment Agreement

 

    Dated: January 24, 2002
    Name: Ghassan H. Elkadi, M.D.
    Position: Internal Medicine Physician
    Rate of Compensation: Base rate of [****], plus bonus award
    Termination Date: (three years from commencement date which was based on the approval of, or entry into U.S. in, H-1B status and receipt of J-1 visa waiver)

 

  12.   Agreement between HealthMont of Missouri, Inc. and George D. Groce, M.D. and Jane L. Groce (lease for hospital space)

 

    Commencement Date: January 1, 2001
    Termination Date: January 1, 2002
    Recurring Amount Due: [****] per month

 

[****] Confidential portion of material has been omitted and filed separately with the SEC.

 

37


  13.   Managed Care Agreement between HealthMont of Missouri, Inc. and HealthCare and USA of Missouri, LLC

 

    Dated: April 1, 1996
    Amendment Number 1: March 5, 1996
    Amendment Number 2: December 1, 2001

 

  14.   Managed Care Agreement between HealthMont of Missouri, Inc. and HealthLink HMO, Inc., dated August 1, 2001.

 

  15.   Managed Care Contract between HealthMont of Missouri, Inc. and HealthLink, Inc., dated August 1, 2001.

 

  16.   Managed Care Contract between HealthMont of Missouri, Inc. and Humana Kansas City, Inc. and Humana Insurance Company, dated September 12, 2001.

 

  17.   Childbirth Instruction Agreement

 

    Dated: March 20, 2002
    Name: Lori Johnson
    Services: Pre-Natal Classes
    Rate of Compensation: [****] per 6-week session
    Termination Date: Term is for six 6-week sessions

 

  18.   Physical Therapy Agreement

 

    Dated: January 1, 2001
    Name: Daniel L. Kuebler
    Services: Home Health Physical Therapy
    Rate of Compensation: [****] per visit and $0.30 per mile
    Termination Date: Originally January 1, 2002 with renewable one-year terms

 

  19.   Agreement for Biological Specimen Collection

 

    Dated: February 26, 2002
    Termination Date: None; can be terminated by either party with 30 days’ notice
    Name: LabOne
    Services: Biological specimen Collection

 

[****] Confidential portion of material has been omitted and filed separately with the SEC.

 

38


  20.   Professional Services Agreement

 

    Dated: January 1, 2001
    Name: Professional Associates, LLC
    Services: Home Health Medical Social Services
    Rate of Compensation: [****] per visit and $0.31 per mile
    Expiration Date: Originally January 1, 2002 with one-year renewable terms

 

  21.   Consulting Agreement

 

    Dated: April 9, 2001
    Name: Midwest Radiation Safety Consultants
    Services: Nuclear Medicine Consulting
    Rate of Compensation: [****] per quarter
    Termination Date: April 9, 2002 with renewable one-year terms

 

  22.   Managed Care Contract between HealthMont of Missouri, Inc. and Missouri Care Health Plan, dated April 1, 2002.

 

  23.   Managed Care Agreement between HealthMont of Missouri, Inc. and Multiplan, Inc.

 

  24.   Managed Care Agreement between HealthMont of Missouri, Inc. and One Health Plan of Kansas Missouri, Inc., dated December 5, 2001.

 

  25.   Pharmacy Services Agreement

 

    Dated: May 16, 2002
    Name: PharmaSource Healthcare, Inc.
    Services: Operation and Management of Hospital Pharmacy Department
    Rate of Compensation: [****] per month and 127% of actual salary costs
    Termination Date: May 7, 2004 with renewable two-year terms

 

  26.   Managed Care Contract between HealthMont of Missouri, Inc. and ppoNEXT, Inc., dated December 1, 2001.

 

  27.   Managed Care Contract between HealthMont of Missouri, Inc. and Private Healthcare Systems, Inc., dated April 26, 2001.

 

  28.   Rapid Response Testing and Specimen Collection Agreement

 

    Dated: May 30, 2001

 

  2.   Managed Care agreement between HealthMont of Texas I, LLC and AmCare Health Plans of Texas, Inc., dated April 1, 2002.

 

  3.   Agreement between HealthMont of Texas I, LLC and AES NewEnergy, Inc. (retail electric services)

 

    Dated: January 3, 2002
    Termination Date: February 2003
    Recurring Amounts Due: Based on monthly utility usage

 

  4.   Professional Services Agreement

 

    Dated: April 17, 2001
    Name: A.S.A.P. Nursing Agency, LLC
    Services: Nursing Services

 

[****] Confidential portion of material has been omitted and filed separately with the SEC.

 

39


    Name: Quest Diagnostics Inc.
    Services: Rapid response testing and specimen collection
    Rate of Compensation: Attachment 1 lists payment terms for various testing
    Termination Date: May 30, 2002

 

  29.   Sleep Disorder Testing Agreement

 

    Dated: April 1, 2002
    Name: WH Somnography Sleep Disorder Labs
    Services: Provide in-hospital sleep disorder testing
    Rate of Compensation: Dependent on healthcare plan of patient
    Termination Date: April 30, 2004

 

  30.   Managed Care Contract between HealthMont of Missouri, Inc. and UnitedHealthcare of the Midwest, Inc., dated September 15, 2001.

 

  31.   Managed Care Contract between HealthMont of Missouri, Inc. and USA Managed Care Organization, Inc.

 

    Dated: September 2, 1997
    Termination Date: Renewable one-year terms

 

  32.   Agreement for Medical and Related Services between HealthMont of Missouri, Inc. doing business as Callaway Community Hospital and Fulton State Hospital, dated March 27, 2001.

 

  33.   Hospital Participation Agreement between Group Health Plan, Inc. and Callaway Community Hospital, dated June 19, 1997, and amended April 8, 1998.

 

  34.   Hospital Contract between Affordable Health Care Concepts and Callaway Community Hospital, dated July 22, 1993.

 

  35.   Nurse Practitioner Recruitment Agreement, dated September 16, 2002, between HealthMont of Missouri, Inc. and Barbara Lynne Sanchez.

 

D.   Agreements Related to Dolly Vinsant

 

  1.   Agreement between HealthMont of Texas I, LLC and Alcon Laboratories (equipment lease for Phaco Machine)

 

    Commencement Date: February 2002
    Termination Date: February 2005
    Recurring Amounts Due: $394.06 per month

 

40


    Rate of Compensation: Rate solicited under Section 3 of Agreement
    Termination Date: April 17, 2003

 

  5.   Agreement between HealthMont of Texas I, LLC and Beckman Coulter (lease of laboratory equipment)

 

    Dated: February 28, 2002
    Termination Date: February 28, 2007
    Recurring Amounts Due: Approximately $10,800 per month

 

  6.   Physician Recruitment Agreement

 

    Date: January 14, 2002
    Name: Alejandro Biglione
    Position: Internal Medicine Physician
    Rate of Compensation: Income guarantee based on gross receipts of [****] per month
    Termination Date: December 2, 2003 but loan forgiveness period continues until December 2, 2005

 

  7.   Managed Care Agreement between NAHC II of Texas, Inc. and USA Managed Care Organization, Inc. (children’s health insurance program—“CHIP”)

 

  8.   Emergency Services Agreement

 

    Commencement Date: November 1, 1998
    Name: Emergency Care Specialists of Texas, P.A.
    Services: Emergency medical services
    Rate of Compensation: [****] per month
    Termination Date: Original termination date October 31, 2001

 

[****] Confidential portion of material has been omitted and filed separately with the SEC.

 

41


    Amended: September 1, 2000

 

    9.   Managed Care Agreement between HealthMont of Texas I, LLC and Health Value Management, Inc.

 

  10.   Nursing Services Agreement

 

    Dated: February 15, 2001
    Name: Intensivo Nursing Service, Inc.
    Services: Nursing staff coverage
    Rate of Compensation: Rate schedule on Exhibit A of Agreement
    Termination Date: Originally February 15, 2002

 

  11.   Physician Recruitment Agreement

 

    Dated: June 6, 2001
    Name: Arnulfo Izquierdo, D.O.
    Position: Family Medicine Practitioner
    Rate of Compensation: Income guarantee based on gross receipts of [****] per month
    Termination Date: Original term ends August 12, 2002 and forgiveness of loan period ends August 12, 2005

 

  12.   Medical Staffing Agreement

 

    Commencement Date: May 17, 2001
    Name: Medical Staffing Network, Inc.
    Services: Nurse staffing services
    Rate of Compensation: Rates on last page of agreement
    Termination Date: Original term ends May 16, 2002 unless renewed

 

  13.   Managed Care Agreement between HealthMont of Texas I, LLC and Private Healthcare Systems, Inc., dated November 5, 2001.

 

  14.   Administrative Services Agreement

 

    Dated: November 17, 1999
    Name: Special Care Hospital Management Corporation
    Services: Inpatient emergency medical/surgical detoxification services and chemical dependency education
    Rate of Compensation: [****] per month
    Termination Date: Original termination date September 1, 2002 with renewable one-year terms

 

[****]  Confidential portion of material has been omitted and filed separately with the SEC.

 

42


  15.   Managed Care Contract between HealthMont of Texas I, LLC and Texas Department of Health

 

  16.   Managed Care Contract between HealthMont of Texas I, LLC and Texas Rehabilitation Commission,  dated October 20, 1996.

 

  17.   Managed Care Contract between HealthMont of Texas I, LLC and Texas True Choice, Inc./Ethix Southwest, Inc.,  dated August 7, 2001.

 

  18.   Managed Care Contract between HealthMont of Texas I, LLC and UnitedHealthcare of Texas, Inc., UnitedHealthcare Insurance Company, United Healthcare Services, Inc. and United Health Networks, Inc.

 

  19.   Managed Care Contract between HealthMont of Texas I, LLC and UP & UP Health Services, dated May 1, 1996.

 

  20.   Agreement between HealthMont of Texas I, LLC and The Scope Exchange, Inc. (lease of GI equipment)

 

    Commencement Date: January 24, 2002
    Termination Date: January 24, 2005
    Recurring Amount Due: $2,400 per month

 

  21.   Agreement between HealthMont of Texas I, LLC and Regions Financial Corporation (master equipment lease for telephone system)

 

  22.   Purchase/Service Agreement between HealthMont of Texas I, LLC and AVAYA Communication (purchase of telephone system)

 

  23.   Term promissory note from Petros Chapanos, M.D. in the original principal amount of $55,000, maturity date:  January 1, 2007

 

  24.   Term promissory note from Prasad Movva, M.D. in the original principal amount of $25,000, maturity date:  February 1, 2005

 

  25.   Term promissory note from Jody M. Griswold, D.O. in the original principal amount of $50,000; maturity date:  March 1, 2005

 

  26.   Managed Care Agreement with South Texas Veterans Health Care System.

 

  27.   Managed Care Agreement with USC Health Services, dated May 1, 1998.

 

  28.   Managed Care Agreement with Unicare Life and Health Insurance Company, dated July 28, 1998.

 

43


  29.   Managed Care Agreement with Texas Municipal League Group Benefits Risk Pool/TML Intergovernmental Employee Benefits Pool, dated July 28, 1998.

 

  30.   Managed Care Agreement with ProAmerica Managed Care Inc., dated July 1, 1994 and amended July 17, 1999.

 

  31.   Managed Care Agreement with Preferred Health Network Inc., dated June 1, 1993 and amended April 12, 1993.

 

  32.   Managed Care Agreement with PHP Healthcare corporation dated October 15, 1997.

 

  33.   Managed Care Agreement with Newton Healthcare Network LLC.

 

  34.   Managed Care Agreement with MultiPlan Inc., dated March 1, 1993.

 

  35.   Managed Care Agreement with National Healthcare Alliance Inc., dated June 1, 1994.

 

  36.   Managed Care Agreement with MedicalControl Network Solutions, Inc., dated June 1, 1999.

 

  37.   Managed Care Agreement with MedCorp. Southwest, Inc., dated May 1, 1993.

 

  38.   Managed Care Agreement with Med-Care Advantage Corp., dated December 15, 1995.

 

  39.   Managed Care Agreement with HealthSmart Preferred Care, Inc., dated April 10, 2000.

 

  40.   Managed Care Agreement with Health Strategies, Inc., dated January 1, 1994.

 

  41.   Managed Care Agreement with Guardian Resources, Inc., dated August 1, 1998.

 

  42.   Managed Care Agreement with BCBSTX, dated July 15, 1996 and amended April 3, 2000.

 

  43.   Managed Care Agreement with Teachers Retirement System of Texas, Inc.

 

44


Section 3.20(a)(i)

 

None

 

Section 3.2(a)(vii)

 

None

 

Section 3.20(b)

 

None

 

Section 3.20(c)

 

None

 

45


Section 3.21

 

Licenses and Accreditations

 

A.   Adel Licenses and Accreditations

 

  1.   Hospital Permit granted November 1, 1998 by the Georgia Department of Human Resources, Effective Date 9/1/2000, #037-597

 

  2.   Nursing Home or Intermediate Care Home Permit issued November 1, 1998 by the Georgia Department of Human Resources, 1-037-1561

 

  3.   Home Health Agency License granted to Memorial Hospital of Adel to operate Memorial Home Health, license granted by the Georgia Department of Human Resources, effective 10/1/01 – 9/30/02, #037-101

 

  4.   Occupation Tax Certification No. 375 issued by the City of Adel, Georgia, expiration date December 31, 2002. Boiler and Pressure Vessel Operating Permit, expiration date April 30, 1992. Certificate of Inspection of Boiler Room issued April 8, 1999 by Georgia Department of Labor, expiration date April 1, 2000 (inspection has been delayed; new certificate cannot be issued until inspection is performed); Certificate of Inspection of new wing and fire tube issued May 6, 1999 by Georgia Department of Labor, expiration date May 1, 2002 (new inspection to be scheduled by Zurich, the company that insures the boilers, as soon as possible).

 

  5.   Control Substance Registration Certificate, DEA registration no. BM6194841 and DEA registration no. BM6194839, issued by the United States Department of Justice Drug Enforcement Administration, expiration date January 31, 2002, #BM6194839, expires 1/31/05 and #BH6990914, expires 10/31/03.

 

  6.   Georgia State Board of Pharmacy, Pharmacy and License No. 005557 issued by the State of Georgia, expiration date June 30, 2001, #005557, expires 6/30/03.

 

  7.   CLIA Laboratory Certificate of Accreditation issued by the Department of Health and Human Services Healthcare Financing Administration, CLI ID No. 11D0265621, expiration date November 17, 2001, expires 11/17/03.

 

  8.   Certified Mammography Facility, as certified by the U.S. Department of Health and Human Services Public Health Service Food and Drug Administration, expiration date February 28, 2003.

 

  9.   Georgia Radioactive Materials License issued by the Georgia Department of Natural Resources, license no. GA.571-1, expiration date 8/31/05.

 

  10.   Accreditation by the Joint Commission on Accreditation of Healthcare Organizations, 2000-2003.

 

B.   Dolly Vinsant Licenses and Accreditations

 

46


  1.   Hospital License No. 000245 from the Texas Department of Health, expiration August 31, 2002.

 

  2.   Texas Sales and Use Tax Permit for Tax Payer No. 3-00029-3302-3, effective October 21, 1976.

 

  3.   Pharmacy License issued by the Texas Board of Pharmacy to Dolly Vinsant Memorial Hospital, #20672, expiration 11/02.

 

  4.   Controlled Substance Registration Certificate issued by the United States Department of Justice Drug Enforcement Administration, DEA registration no. BN5632547, expiration October 31, 2000, #BD7001542, expiration 6/30/03.

 

  5.   CLIA Laboratory Certificate of Accreditation issued by the Department of Health and Human Services Health Care Financing Administration, #45D0660557, expiration 11/30/03.

 

  6.   Radioactive Material License No. L04567, issued by the Texas Department of Health Bureau of Radiation Control, expiration date April 30, 2002.

 

  7.   Accreditation issued by the Joint Commission on Accreditation of Health Care Organizations dated July 1, 1998 effective for three years from April 18, 1998.

 

  8.   Petroleum Storage Tank registered to New American Healthcare Corp. by the Texas Natural Resource Conservation Commission (“TNRCC”), Facility ID No. 69803, Owner Account ID No. 53650, registration does not expire but TNRCC requires notification of transfer of ownership.

 

  9.   Boiler Certificate of Operation, #C-99L07993, expiration date 10/27/03.

 

C.   Callaway Licenses and Accreditations

 

  1.   Missouri Department of Health & Senior Services – CCH License, Expiration Date: 12/31/2002, License #463-1

 

  2.   Missouri Department of Health Home Health License, Expiration Date: 11/30/2002, License #709

 

  3.   City of Fulton Business License, Expiration Date: 02/28/2003, License #20010600

 

47


  4.   DEA, Expiration Date: 08/31/2003, License #BC7153858

 

  5.   BNDD, Expiration Date: 12/31/2004, License #19605

 

  6.   Missouri Board of Pharmacy, Expiration Date: 10/31/2003, License #2001000394

 

  7.   HCFA, CLIA Certificate, Expiration Date: 11/30/2002, CLIA ID: 26D0446483

 

  8.   Missouri Department of Health Certified Mammography Facility, Expiration Date: 12/31/2002

 

  9.   JCAHO, 2003

 

48


Section 3.22

 

Insurance

 

HEALTHMONT, INC.

Full List of Lines of Coverage

 

Covered Hospitals

 

Dolly Vinsant Memorial Hospital—Retro Date: September 1, 2000

Memorial Hospital of Adel, Inc.—Retro Date: September 1, 2000

Calloway Community Hospital—Retro Date: January 1, 2001

 

Coverage Line


 

Carrier


 

Policy #


     

Limits


Property

  Zurich  

[****]

8/31/00—8/31/02

  $ 147,508,654   Blanket
            $ 53,496,414   Business Interruption
            $ 15,000   Deductible
            $ 50,000   Flood Limit
            $ 50,000   Earth Movement Limit
            $ 15,000   Deductible except for Woodland Park & Eastmoreland
            5% of PD and BI value or $100,000 whichever is greater
            $ 25,000   Windstorm deductible applies to Dolly Memorial Hospital

Hospital Professional Liability Hospital General Liability

(GL & HPL)l

  St. Paul Fire & Marine  

[****]

8/31/01—8/31/02

 

$

$

1,000,000

300,000

 

Each Occurrence

Fire Damage—Each Event

Pollution Liability Hazard—Ea.

                  Event
                  Pollution Liability Hazard
            $ 2,000,000   Aggregate—All Events
            $ 50   Damage Deductible/Per claim
            $ 250,000   Deductible/Annual/Aggregate

Umbrella Liability

  St. Paul Insurance Co.  

[****]

8/31/01—8/31/02

 

$

$

10,000,000

10,000,000

 

Occurrence Limit

Aggregate Limit

                   

Automobile Liability

  St. Paul Mercury Insurance Co.  

[****]

8/31/01—8/31/02

 

$

$

1,000,000

1,000,000

 

Limit of Liability

Uninsured Motorists

            $ 2,000   Medical Payments
            $ 2,500   Personal Injury Protection
            $ 500   Collision Deductible
            $ 250   Comprehensive Deductible

Texas Automobiles

  St. Paul Mercury Insurance Co.  

[****]

8/31/01—8/31/02

 

$

$

1,000,000

1,000,000

 

Limit of Liability

Uninsured Motorists

            $ 2,500   Medical payments
            $ 2,500   Personal Injury Protection
            $ 500   Collision Deductible
            $ 250   Comprehensive Deductible

Workers Compensation

  American Home Assurance  

[****]

8/31/01—8/31/02

  State Statutory Limits

Workers Compensation—Georgia

     

[****]

8/31/01—8/31/02

         

    Employers Liability

          $ 1,000,000   Each Accident
            $ 1,000,000   Policy Limit
            $ 1,000,000   Each Employee

    Calloway Community Hospital

(Covered by Separate State policy)

  Missouri Hospital Association  

[****]

1/01/02—1/01/03

         

Heliport

(Coverage for Calloway Community Hospital)

  National Union  

[****]

1/1/02—1/1/03

 

$

$

3,000,000

1,000

 

Per Occurrence

Medical Payments Per Person

                   

Sensitive Risk

  Gulf Insurance Company  

[****]

8/31/01—8/31/02

 

$

$

3,000,000

250,000

 

Limit of Liability—Each Loss

Maximum Benefit applicable to any one

                  person
            $ 1,250,000   Aggregate Limit for any one accident

Crime

  National Union Fire Insurance co.   [****]   $ 1,000,000   Fiduciary Limit
        8/31/01—8/31/02   $ 25,000   Deductible

Fiduciary

  National Union Fire Insurance Co.   [****]   $ 3,000,000   Fiduciary Limit
        4/31/00—4/31/01   $ 0   Deductible

Directors and Officers

  National Union Fire Insurance Co.   [****]   $ 5,000,000   Limit of Liability

Executive Directors & Officers

      8/31/01—8/31/02   $ 100,000   Retention Limit
            $ 100,000   Employment Practices

[****]  Confidential portion of material has been omitted and filed separately with the SEC.

 

 

49


SCHEDULE OF YOUR CURRENT INSURANCE

As of September 30, 2002

Prepared for: HealthMont, Inc.

 

Type of Coverage


  

Policy Limits


   Policy Period

  

Company & Policy Number


   Annual Premium

Property

   Limit         08/31/02 to
08/31/03
   Zurich
[****]
   $115,233
     $36,062,431    Blanket Occurrence Limit as follows:               
     Included    Building               
     Included    Contents               
     Included    Improvements and Betterments               
     Included    EDP               
     Included    Business Interruption               
     Sublimits                    
     $36,062,431    Flood per occurrence at Premises Outside a 500 Year Flood Plain               
     $10,000,000    Flood per occurrence at Premises Outside a 100 Year Flood Plain but Within a 500 Year Flood Plain               
     $  5,000,000    Flood per occurrence at Locations Within a 100 Year Flood Plain               
     Excluded    Earthquake (Zone 1)               
     $25,000,000    Earthquake (Zone 2)               
     $36,062,431    Earthquake Annual Aggregate (Zone 3 & 4)               
     $         1,000    Per Patient Property with $500,000 Annual Aggregate               
     $     250,000    Transit (Aggregate Liability in any single occurrence)               
     $  5,000,000    Valuable Paper               
     $  2,500,000    Accounts Receivable               
     $     250,000    Exhibition Floater               
     $  1,000,000    Service Interruption               
     $  2,000,000    Building Ordinance/Demolition/Increased Cost of Construction               
     $  5,000,000    Extra Expense—Schedule Premises               

 

[****] Confidential portion of material has been omitted and filed separately with the SEC.

 

Note: This Policy Schedule is only an outline of coverage that has been prepared for your convenience. Actual Policy Language must be consulted for any definitive evaluation of coverage terms and conditions.

 

50


SCHEDULE OF YOUR CURRENT INSURANCE

As of September 30, 2002

Prepared for: HealthMont, Inc.

 

Type of Coverage


  

Policy Limits


   Policy Period

  

Company & Policy Number


   Annual Premium

Deductibles

   $       25,000    Except               
          1X Daily Average Value for Business Income               
     $     100,000    Flood at Premises Outside a 500 Year Flood Plain               
     $     250,000    Flood at Premises Outside a 100 Year Flood Plain but Within a 500 Year Flood Plain               
     $     500,000    Flood each Building Within a 100 Year Flood Plain               
     $     500,000    Flood each Building Contents Within a 100 Year Flood Plain               
     $     500,000    Flood Business Income at Premises Within a 100 Year Flood Plain               
     $     100,000    Earthquake (Zone 3, 4 and 5) (Zone 1 excluded)               
     $     100,000    Wind except               
     $     250,000    For Dolly Vinsant Memorial Hospital, San Benito, TX               
     $       25,000    Service Interruption Property Damage with 24 hour waiting period followed by a $25,000 deductible except 72 hour Waiting Period followed by a $25,000 deductible for Dolly Vinsant Memorial Hospital               
Boiler and Machinery Sublimits    $36,062,431    Combined Property Damage/Business Interruption    08/31/02 to
08/31/03
   Zurich
[****]
   Included
     $  1,000,000    Spoilage               
     $       25,000    Hazardous Substance               
     $       25,000    Ammonia Contamination               
     $       25,000    Water Damage               
     Deductible:    $25,000 Property Damage               
          1 Times Average Daily Value for Business Interruption               

 

[****] Confidential portion of material has been omitted and filed separately with the SEC.

 

Note: This Policy Schedule is only an outline of coverage that has been prepared for your convenience. Actual Policy Language must be consulted for any definitive evaluation of coverage terms and conditions.

 

51


SCHEDULE OF YOUR CURRENT INSURANCE

As of September 30, 2002

Prepared for: HealthMont, Inc.

 

Type of Coverage


  Policy Limits

  Policy Period

 

Company & Policy Number


  Annual Premium

General Liability/

  $ 3,000,000   General Aggregate   08/31/02 to   Lexington Insurance   $ 1,350,000 +
(occurrence form)
Health Care
  $ 3,000,000   Products and Completed Operations Aggregate   08/31/03  

Company

[****]

 

 

 

Taxes and

Surcharges

Professional

(claims made)

 

$

$

$

$

$

1,000,000

1,000,000

50,000

5,000

500,000

 

Personal and Advertising Injury

Each Occurrence Limit

Fire Damage Limit (any one fire)

Medical Expenses Limit (any one person)

Deductible

             
         
         
         
         
         

Employee Benefits

 

$

$

1,000,000

1,000

 

Aggregate Limit (claims made)

Deductible

      Lexington Insurance Co.     Included
                   

Crime

 

$

$

1,000,000

25,000

 

Limit of Liability

Deductible

  08/31/02 to
08/31/03
 

National Union Fire Ins. Company

[****]

  $ 6,984
         

Automobile

 

$

$

$

$

$

$

1,000,000

1,000,000

2,000

35,000

250

500

 

Combined Single Limit

Uninsured Motorist (Owned Autos)

Medical Payments

Hired Car Physical Damage

Deductible—Comprehensive

Deductible—Collision

  08/31/02 to
08/31/03
 

St. Paul Fire & Marine

[****]

  $ 9,379
                 
                 
                 
                 
                 
Automobile
(Texas)
 

$

$

$

$

$

$

1,000,000

1,000,000

2,500

35,000

250

500

 

Combined Single Limit

Uninsured Motorist (Owned Autos)

Medical Payments

Hired Car Physical Damage

Deductible—Comprehensive

Deductible—Collision

  08/31/02 to
08/31/03
 

St. Paul Fire & Marine

[****]

  $ 1,146
                 
                 
                 
                 
                 

Aviation

 

$

$

5,000,000

1,000

 

Each Occurrence

Medical Expenses

  01/01/01 to
01/01/02
 

National Union

[****]

  $ 3,545
                     

 

[****] Confidential portion of material has been omitted and filed separately with the SEC.

 

*   This policy is on a “Claims Made” basis, which means that the policy in force at the time of the loss is the responding party. Late reporting could result in declination of coverage by the carrier.

 

Note: This Policy Schedule is only an outline of coverage that has been prepared for your convenience. Actual Policy Language must be consulted for any definitive evaluation of coverage terms and conditions.

 

52


SCHEDULE OF YOUR CURRENT INSURANCE

As of September 30, 2002

Prepared for: HealthMont, Inc.

 

Type of Coverage


   Policy Limits

   Policy Period

  

Company & Policy Number


   Annual Premium

Workers Compensation

   Statutory               

Employers Liability

  

$1,000,000

$1,000,000

$1,000,000

  

Each Accident

Policy Limit

Each Employee

   08/31/02 to
08/31/03
  

American Home Assurance

[****]

   $348,650
              
              

Special Coverage

   $3,000,000    Limit of Liability    08/31/02 to
08/31/03
  

Gulf Insurance Company

[****]

   $    2,800
Directors & Officers Liability   

$5,000,000

$100,000

  

Limit of Liability

Retention

   08/31/02 to
08/31/03
  

National Union Fire Ins. Co.

[****]

   $  97,500

Fiduciary

  

$3,000,000

$3,000,000

  

Each Loss

Aggregate

   08/31/02 to
08/31/03
  

National Union Fire Ins. Co.

[****]

   $    7,300

 

[****] Confidential portion of material has been omitted and filed separately with the SEC.

 

Note: This Policy Schedule is only an outline of coverage that has been prepared for your convenience. Actual Policy Language must be consulted for any definitive evaluation of coverage terms and conditions.

 

 

53


Section 3.23

 

Books and Records

 

None.

 

54


Section 3.24

 

Real Property

 

Section 3.24(a)

 

A.   Adel Real Property

 

  1.   Memorial Hospital/Convalescent Center (owned)

 

  2.   OB/GYN Clinic located at 308 N. Parrish, Adel, Georgia (owned)

 

  3.   Home Health Building located at 1905 South Hutchinson, Adel, Georgia (leased)

 

  4.   Medical Record Storage Building located at 206 E. Memorial Dr., Adel, Georgia (leased)

 

  6.   Surgeon’s Office located at 901 N. Parrish, Adel, Georgia (leased)

 

  7.   Memorial Hospital Annex located at 808 N. Hutchinson, Adel, Georgia (leased)

 

B.   Dolly Vinsant

 

  1.   Real property consists of 7.498 acres of land on the southeast quarter of block #81 of San Benito Land and Water Company Subdivision, City of San Benito, Texas, and the structures (hospital and maintenance building) that lie on the property.

 

  2.   Leases for the purpose of medical office practice are active for three parcels of the hospital building totaling approximately 4000 square feet. The Company is the lessor.

 

C.   Callaway

 

  See   attached description of owned real property.

 

  Under   the Heller Loan Documents, Heller possesses a Lien with respect to real property of the Company and the Subsidiaries.

 

Section 3.24(c)

 

None.

 

55


Section 3.24(e)

 

None.

 

Section 3.24(f)

 

None.

 

56


Exhibit “A”

 

Legal Description

 

Part of Section 18, Township 47 North, Range 9 West, Callaway County, Missouri, described as follows:

 

Commencing at an Aluminum State Monument at the Southeast corner of said Section 18; thence N 81° 44’ 27” W, 1041.05 feet to a ½” iron pin at the Southwest corner of Lot 1, of the Corrected Plat of Westminster College Subdivision, Recorded in Plat Book 8, page 12, said point being the True Point of Beginning, thence N 89° 18’ 24” E along the north right of way line of South Hospital Drive, 165.00’ to a ½” iron pin at a point of curve; thence continuing along said North right of way line on a curve to the left having a central angle of 25° 05’ 08”, a radius of 795.00’, an arc distance of 348.07’, and a chord bearing and distance of N 76° 45’ 50” E, 345.30’ to a point of compound curve; thence continuing along said right of way line in a Northeasterly to Northwesterly direction, on a curve to the left having a central angle of 88° 50’ 00”, a radius of 625.00’, an arc distance of 969.02’, and a chord bearing and distance of N 19° 48’ 19” E, 874.84’ to a point of reverse curve; thence continue along the Westerly right of way line of said South Hospital Drive in a Northwesterly direction on a curve to the right having a central angle of 16° 15’ 00”, a radius of 1065.00’, an arc distance of 302.05’, and a chord bearing and distance of N 16° 29’ 13” W, 301.04’ to a concrete monument on the South right of way line of Missouri State Route “F”; thence S 81° 38’ 16” W along said right of way line, 135.00’ to a ½” iron pin at a point of curve; thence continue along said right of way line on a curve to the right having a central angle of 17° 07’ 09”, a radius of 1562.69’, an arc distance of 466.91’, and a chord bearing and distance of N 81° 18’ 24” W, 465.17’ to a ½” iron pin; thence leaving said right of way line S 20° 28’ 53” W, 152.75’ to a ½” iron pin; thence N 89° 58’ 07” W, 57.31’ to a ½” iron pin at the Northwest corner of said Lot 1; thence S 0° 15’ 35” W, along the West line of said Lot 1, 1076.28’ to the True Point of Beginning,

 

EXCEPT THEREFROM, a tract of land being a part of Lot 1 of the corrected Plat of Westminster College Subdivision #1, a subdivision filed for public record in Plat Book 8, Page 12, of Callaway County Land Records, located in Section 18, Township 47 North, Range 9 West, Callaway County, Missouri, described as follows: Commencing at a point on the Northern right of way line of South Hospital Drive, 50’ wide, said point being on the South boundary line of said Lot 1, said point bears N 89° 18’ 24” E, 39.17’ from the Southwest corner of said Lot 1; thence leaving said right of way line along the projection of the Southeast wall of the existing Hospital N 49° 45’ 02” E, 582.58’ to the corner of the existing wall; thence S 12° 32’ 32” E, 32.76’ to the True Point of Beginning, thence S 40° 14’ 58” E, 32.87’ to a point; thence S 49°45’ 02” W, 39.33’ to a point; thence N 40° 14’ 58” W, 32.87 feet to a point; thence N 49° 45’ 02” E, 39.33’ to the True Point of Beginning.

 

G230788.1

 

 

57


Section 3.25

 

Tangible Personal Property; Investment Assets

 

Section 3.25(a)

 

A.   Each lessor of equipment leased to the Company or any of its Subsidiaries possesses a Lien with respect to the equipment so leased. Such leases include those listed in Section 3.20(a)A.9, A.15, A.18, A.21, B.3, D.1, D.5, D.20, D.21.
B.   Under the Heller Loan Documents, Heller possesses a Lien with respect to personal property of the Company and the Subsidiaries, including machinery, equipment, furniture and fixtures.

 

Section 3.25(b)

 

None.

 

58


Section 3.26

 

Bank and Brokerage Accounts

 

HealthMont, Inc.

 

Bank Account Numbers

 

     Account
Number


 

Intended Use


  

Signatory


HealthMont, Inc. — Corporate

             

Regions Bank

500 Corporate Centre Drive

   [****]   CONCENTRATION    Timothy S. Hill, Gerald S. Christine

Franklin, TN 37067

   [****]   Co-wide A/P    Timothy S. Hill, Gerald S. Christine
     [****]   Corp. Manual A/P    Timothy S. Hill, Gerald S. Christine
               
     [****]   Co-wide Payroll    Timothy S. Hill, Gerald S. Christine
     [****]   Management Payroll    Timothy S. Hill, Gerald S. Christine
               
     [****]  

Employee Benefits Medical

Claims

   Timothy S. Hill, Gerald S. Christine,
Bradley P. Ray, Larry R. Dust
     [****]   Customer Debit Account    Timothy S. Hill, Gerald S. Christine
               

BankOne, Texas

1717 Main Street

Dallas, TX 75201

   [****]   Lockbox Account    Timothy S. Hill

Dolly Vinsant Memorial Hospital

             

BankOne, TX

1717 Main Street

Dallas, TX 75201

  

[****]

P.O. Box 972400

 

Lockbox Account Number

Lockbox P.O. Number

   Timothy S. Hill

Coastal Bank

198 South Sam Houston

San Benito, TX 78586

  

[****]

[****]

 

Depository

Tax Deposit & Impress Account

  

Timothy S. Hill, Ann R. Price

Leslie Bingham, Harvey Torres, Timothy S. Hill, Ann R. Price

Memorial Hospital of Adel

BankOne, TX

1717 Main Street

Dallas, TX 75201

  

[****]

P.O. Box 972398

 

 

 

Lockbox Account Number

Lockbox P.O. Number

  

Timothy S. Hill

Adel Banking Company

101 N. Hutchinson Ave.

P.O. Box 191

Adel, GA 31620

   [****]   Depository    Timothy S. Hill, Ann R. Price

First State Bank & Trust

Company of Valdosta

527 N. Patterson Street

Valdosta, GA 31601

   [****]   MasterCard/Visa    Timothy S. Hill, Gerald S. Christine

Farmers & Merchants Bank

301 West Fourth Street

P.O. Box 560

Adel, GA 31620

  

[****]

[****]

[****]

 

Tax Deposit

Impress

Resident Trust Account

  

Timothy S. Hill, Greg Griffith, Lori
Petrie, Janet Meders

Timothy S. Hill, Greg Griffith, Lori
Petrie, Janet Meders

Timothy S. Hill, Greg Griffith, Lori
Petrie, Janet Meders

Callaway Community Hospital

BankOne, TX

1717 Main Street

Dallas, TX 75201

  


[****]

P.O. Box 972508

 


Lockbox Account Number

Lockbox P.O. Number

  
Timothy S. Hill

Central Bank

P.O. Box 779

Jefferson City, MO 65102

  

[****]

[****]

[****]

 

Depository

Payroll Tax & Impress Account

Checking Account

  

Timothy S. Hill, Ann R. Price

Timothy S. Hill, Gerald M. Torba,

Deborah I. Horne

Timothy S. Hill, Ann R. Price

07/10/2002

             

 

[****] Confidential portion of material has been omitted and filed separately with the SEC.

 

59


Section 3.27

 

Powers of Attorney

 

Easley, McCaleb & Associates, Inc. has a power of attorney related to the Property Tax Consulting Agreement listed in Section 3.20(a)A.17.

 

60


Section 3.28

 

Accounts Receivable

 

None.

 

61


Section 3.30

 

Healthcare Licenses

 

A.   See Section 3.21 of this Company Disclosure Schedule.

 

B.   The Company owns rights to the servicemark “HealthMont, Inc.,” which is currently pending approval from the United States Patent and Trademark Office.

 

C.   HealthMont of Georgia, Inc. owns the right to the names: (i) Memorial Hospital of Adel; (ii) Memorial Home Health; and (iii) Memorial Convalescent Center.

 

D.   HealthMont of Texas, Inc. owns the right to use the names: (i) Dolly Vinsant Memorial Hospital; (ii) The Dolly V L.C.; (iii) The Dolly, Inc.; (iv) The Dolly Home Healthcare; (v) Dolly Home Oxygen Service; and (vi) San Benito Medical Associates After Hours Clinic.

 

62


Section 3.31

 

Medicare Participation/Accreditation

 

None.

 

63


Section 3.33

 

Medical Staff Matters

 

None.

 

64


Section 3.34

 

Sensitive Payments

 

None.

 

65


Section 3.35

 

Healthcare Reports and Documents

 

The only extension the Company has requested outside of the normal guidelines for filing a healthcare report was for the Callaway Medicaid Cost Report for period ending 3/31/01.

 

66


Section 5.1

 

Conduct of the Business of the Company

 

Section 5.1(b)(vi)

 

A.   In consideration of a general release in form reasonably acceptable to Parent and in consideration of all rights to receive shares of the Company or any successor thereto, whether under any Company Benefit Plan, Company Derivative Security, employment agreement, consulting agreement or otherwise, the Company may pay the following amounts as severance (which amounts shall be in lieu of, and not in addition to, any severance benefits otherwise payable) to the persons set forth below prior to the Effective Date.

 

Name        


   Title

   Severance

Corporate Severance

         

Hill, Tim

   CEO    $175,000

Butler, Tom

   AVP    50,000

Scott, Tom

   AVP    50,000

Love, Steve

   M    20,000

 

B.   The Company will acquire a tail for its directors and officers insurance.

 

C.   The Company may take such other actions as agreed upon from time to time by the Company and the Parent.

 

Section 5.1(b)(x)

 

None

 

Section 5.1(b)(xi)

 

None

 

Section 5.1(b)(xiv)

 

None

 

Section 5.1(b)(xvi)

 

None

 

Section 5.1(c)

 

67


None.

 

Section 5.1(e)

 

None

 

68


Section 5.7

 

Company Stock Options

 

Options granted to the following directors/entities will be outstanding as of the Effective Time:

 

Arlen B. Reynolds

   15,000

Kay L. Brown

   15,000

Joel S. Kanter

   15,000

Gene E. and M. Jan Burleson

   15,000

Jay and Clayre Haft

   15,000

Richard E. Ragsdale

   15,000

Chaney Family Partnership

   15,000

 

69


Section 5.8

 

Company Warrants

 

All Company Warrants other than the Heller Warrants will be cancelled on or before the Effective Time.

 

70


Section 5.14(a)

 

Healthcare Approvals

 

The Company may be required: (i) to file notice with the State of Georgia at least thirty (30) days prior to consummation of the Merger; (ii) to file notice with the State of Missouri within fifteen (15) days after consummation of the Merger; and (iii) to file notice with the State of Texas within fifteen (15) days after consummation of the Divestco Disposition.

 

71


Section 5.24(a)

 

Closing Net Working Capital

 

HealthMont, Inc.

Working Capital Computation

 

     March 31, 2002

   August 31, 2002

 
     Total

   Dolly

   Total W/O Dolly

   Total

   Dolly

   Total W/O Dolly

 

Current Assets:

                               

Cash

   $567    $205    $362    $235    $147    $88  

Total accounts receivable

   4,397    945    3,452    4,834    1,546    3,288  

Investory

   714    209    505    804    214    590  

Prepaid expense

   567    58    509    160    29    131  
    
  
  
  
  
  

Total current assets

   $6,245    $1,417    $4,828    $6,033    $1,936    $4,097  

Current liabilities:

                               

Accounts payable

   $2,870    $496    $2,374    $3,332    $833    $2,499  

Accrued expenses

   1,915    163    1,752    1,787    219    1,568  

Current portion capital leases

   368    161    207    388    166    222  

Change in Revolver

   0         0    190         190  
    
  
  
  
  
  

Total current liabilities

   $5,153    $820    $4,333    $5,697    $1,218    $4,479  

Net working capital

             $495              ($382 )

Net working capital at testing date cannot be less than             ($150,000)


   Fail

 

Computation of change in revolver:

                               

Current portion LTD (revolver)

                               

Base

   $3,889    $3,889    $3,889              $3,889  

Current balance

   3,889    3,889    4,079              4,079  
    
  
  
            

Change

   $0    $0    $190              $190  
    
  
  
            

 

72


Section 5.24(b)

 

Closing Hospital-Level EBITDA

 

HealthMont, Inc.

EBITDA Test

 

     August-02

 

Prior twelve month EBITDA:

                

Adel

           $ 1,368,935  

Callaway

             1,683,483  
            


Subtotal

           $ 3,052,418  

Less Prior year contractuals:

                

Adel

   $ (231,597 )        

Medicare PY

     92,452          

Medicaid PY

                

Callaway

                

Medicare PY

     (128,071 )        

Medicaid PY

     (28,243 )        
    


       

Total prior year amounts

           $ (295,459 )

Add back cost related to Surgeon:

                

Jun-02

     23,414          

Jul-02

     23,458          

Aug-02

     23,778          

Sep-02

     23,872          
    


       

Total cost add back

             94,522  
            


             $ 2,851,481  

EBITDA test:

                

Base EBITDA

   $ 3,000,000          

Collar %

     90.83 %        

Collar amount

             2,725,000  
Test    Pass

 

 

73


Section 6.1(p)

 

Indebtedness Described in Section 6.1(p)(iv)

 

A.   Any Indebtedness identified in Section 3.9 of this Company Disclosure Schedule.

 

B.   Liabilities incurred pursuant to any action permitted under Section 5.1 of this Company Disclosure Schedule.

 

C.   Contingent liabilities associated with HealthMont of Texas, Inc. (“HealthMont of Texas”) as to which HealthMont of Texas has agreed to indemnify the Company pursuant to the Indemnification Agreement.

 

74


Section 8.1

 

Divestco Liabilities

 

A.   Pursuant to the Divestco Disposition Agreement, the Company, as part of the Company Debt Restructuring, will cause Divestco to be released from any further liability to Heller and will cause any liens held by Heller on the stock and assets of Divestco to be released.

 

B.   After completion of the Divestment, the Company will retain liability under the Comdisco Lease Agreement, the LinvaTec Leases and the agreements listed in subparagraphs A.9., 14., and 15. of Section 3.20. See also the attachment to Section 3.9. Divestco has agreed to indemnify the Company for these contingent liabilities.

 

75


Executed as of this 15th day of October, 2002.

 

HEALTHMONT, INC.

By:

 

/s/    TIMOTHY S. HILL        


Its:   President

 

76


Reference:
Security Exchange Commission - Edgar Database, EX-10.50 8 dex1050.htm HEALTHMONT, INC. DISCLOSURE SCHEDULE, Viewed October 4, 2021, View Source on SEC.

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