| Category / Item | Cost / Other Basis | Accumulated Depreciation | Book Value | End of Year Fair Market Value |
|---|---|---|---|---|
| Machinery and Equipment | 139,272 | 53,563 | 85,709 | 85,709 |
| Item No. | 1 |
|---|---|
| Lender's Name | Elizabeth Cassin |
| Lender's Title | CEO |
| Original Amount of Loan | 85000 |
| Balance Due | 47988 |
| Date of Note | 2010-12 |
| Maturity Date | 2012-08 |
| Repayment Terms | payments begin 8/1/2011 |
| Interest Rate | 10.0000 |
| Security Provided by Borrower | None |
| Purpose of Loan | sustain interim operations |
| Description of Lender Consideration | |
| Consideration FMV |
| Item No. | 1 |
|---|---|
| Lender's Name | catholic healthcare west |
| Lender's Title | |
| Relationship to Insider | |
| Original Amount of Loan | 900000 |
| Balance Due | 903750 |
| Date of Note | 2012-03 |
| Maturity Date | 2016-03 |
| Repayment Terms | due and payable on March 2016 |
| Interest Rate | 5.0000 |
| Security Provided by Borrower | |
| Purpose of Loan | operations |
| Description of Lender Consideration | |
| Consideration FMV |
| Item No. | 2 |
|---|---|
| Lender's Name | Wichita Financial Services |
| Lender's Title | |
| Relationship to Insider | owned by CEO |
| Original Amount of Loan | 556061 |
| Balance Due | 556061 |
| Date of Note | 2010-01 |
| Maturity Date | 2017-01 |
| Repayment Terms | 2yrs interest only, 9.5% after |
| Interest Rate | 4.0000 |
| Security Provided by Borrower | Asset purchase agreement |
| Purpose of Loan | Asset Purchase Agreement |
| Description of Lender Consideration | |
| Consideration FMV |
| Description | Beginning of Year - Book Value | End of Year - Book Value | End of Year - Fair Market Value |
|---|---|---|---|
| Net Intangible Assets | 404,662 | 393,662 | 393,662 |
| FQHC Contract | 292,639 | 243,866 | 243,866 |
| Description | Revenue and Expenses per Books | Net Investment Income | Adjusted Net Income | Disbursements for Charitable Purposes |
|---|---|---|---|---|
| taxes and licenses | 3,695 | 3,695 | ||
| storage | 2,814 | 2,814 | ||
| repairs and maintenance | 18,277 | 18,277 | ||
| payroll taxes | 51,324 | 51,324 | ||
| Patient Assistance | 8,010 | 8,010 | ||
| miscellaneous | 1,843 | 1,843 | ||
| medical supplies | 58,733 | 58,733 | ||
| insurance | 62,461 | 62,461 | ||
| disposal | 8,400 | 8,400 | ||
| cost of services | 252,605 | 252,605 | ||
| contract services | 223,172 | 223,172 | ||
| computer supplies | 90,967 | 90,967 | ||
| bank charges | 488 | 488 | ||
| Amortization | 59,773 | |||
| advertising | 19,338 | 19,338 | ||
| administrative | 7,728 | 7,728 |
| Description | Revenue And Expenses Per Books | Net Investment Income | Adjusted Net Income |
|---|---|---|---|
| patient fees | 1,441,198 | ||
| Other Income | 43,559 |
| Category | Amount | Net Investment Income | Adjusted Net Income | Disbursements for Charitable Purposes |
|---|---|---|---|---|
| professional services | 221,939 | 0 | 0 | 176,559 |
| Name | Address |
|---|---|
| Blue Shield of CA |
50 Beal Street San Francisco,CA94105 |
| Catholic Healthcare West |
3033 North Third Ave Phoenix,AZ85013 |