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American Healthcare Capital Brochure

American HealthCare Capital ∙ Executive Offices   4333 Admiralty Way, Marina del Rey, CA 90292 ∙ Ph 800‐424‐1338 ∙ Fax 310‐437‐4448  www.americanhealthcarecapital.com ∙ info@americanhealthcarecapital.com  ©2008 American HealthCare Capital, All Rights Reserved    VALUATION QUESTIONNAIRE       American HealthCare Capital CORPORATE FINANCE  ●  MERGERS & ACQUISITIONS    Background Data ___________________________________________________________________________________________________________ Company Name Ownership Type (S Corp, C Corp, LLC, etc.) Years In Business __________________________________________________________________________________________________________________ Address Suite # City State Zip Code __________________________________________________________________________________________________________________ Name of Contact Title Email Address __________________________________________________________________________________________________________________ Office Phone Cell Phone Home Phone Which number is best to reach you at? □ Office Phone □ Cell Phone □ Home Phone __________________________________________________________________________________________________________________ Is there anything special about the company and its location? Operational Data ___________________________________________________________________________________________________________ What service area do you cover? (List of counties or cities, number of miles from office, etc.) __________________________________________________________________________________________________________________ What is the core business? Are there any other lines of business? (Home Health, Hospice, Pharmacy, DME, Behavioral Health, PT, LTC, etc.) __________________________________________________________________________________________________________________ Please provide a breakdown of payor sources as a percentage of revenue. __________________________________________________________________________________________________________________ How many employees vs. independent contractors? Please provide an organizational chart or number of employees with list of positions. Financial Data __________________________________________________________________________________________________________________ Total Annual Revenue Gross Profit Margin Adjusted Pre-tax Profit __________________________________________________________________________________________________________________ Is your business increasing, declining, or flat? __________________________________________________________________________________________________________________ Are there any outstanding liabilities such as law suits, tax liens, or judgments? Exit Strategy __________________________________________________________________________________________________________________ Why are you selling? __________________________________________________________________________________________________________________ Is there any interest in staying with the company?


American Healthcare Capital Brochure
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