Form Submission

Step 1 of 4

25%
  • Due Diligence Items (Schedule A)

  • Could we please get the following items for the Practice if possible:

    Tax returns;

    Profit & Loss statements

    • For 2015, 2016, 2017;
    • For the most recent year-to-date (“YTD”) 2018 period and the same corresponding YTD 2017 period (IE YTD September 2017 and YTD September 2018);

    Production/Collections report(s):

    • For 2015, 2016, 2017, YTD 2017 and YTD 2018 by Provider;
    • For 2015, 2016, 2017, YTD 2017 and YTD 2018 by ADA code or specialty;
    • For 2015, 2016, 2017, YTD 2017 and YTD 2018 by Provider by ADA code or specialty;
    • For 2015, 2016, 2017, YTD 2017 and YTD 2018 by Payor (or high-level payor breakdown);

    A copy of the current lease agreement(s) on the premise(s);

    Terms of any debt associated with the Practice

    Non-surgeon employee roster which includes the following details:

    • Part-time or Full-time status
    • Hourly Compensation (with and without anticipated bonus)
    • Estimated annual hours worked
    • Benefits, Health, retirement plans
    • Roles and general tasks associated with such roles

  • Drop files here or