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Confidential Registration
Paragon Ventures - Confidential Registration
Your Interests
We are interested in SELLING our business.
We are interested in learning more about strategic EXIT PLANNING
We are interested in current MARKET VALUATION for our business .
We are interested in recent mergers and acquisition transactions.
We are interested in receiving the Paragon Ventures M&A Minute and InSight Email Newsletters
We are interested registering as a BUYER of healthcare businesses
Which of the following best describes your interest?
Business Owner / Seller
Individual Buyer
Strategic Buyer
Private Equity Investor/Sponsor
Broker
Real Estate Agent
Contact information:
Name
*
Title
*
Organization
*
Address
Address
Address
Address
City
City
State/Province
Alabama
Alaska
Arkansas
Arizona
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State/Province
Zip/Postal
Zip/Postal
Phone Number (including area code)
*
Fax
Email Address
*
Website/URL
Preferred method of contact:
Business Phone
Mobile Phone
E-mail
We are primarily interested in the following categories:
Ancillary Support Services
Behavioral Health Services
Healthcare Financial Services
Healthcare Provider
Home Health / Hospice
Medical Device
Medical Supply
Other
Pharmacy
Select a category to see more options
We are primarily interested in the following Ancillary Support Service areas:
Consulting Services
Group Purchasing Organization (GPO)
Healthcare IT
Outsourced Services
Population Health
TeleHealth
Select any that apply
We are primarily interested in the following Behavioral Health Service areas:
Addiction Treatment
Adult Mental Health
Child Pediatric Health
Intensive Out Patient
Traumatic Brain Injury
Select any that apply
We are primarily interested in the following Healthcare Financial Service areas:
Billing / Collections
Electronic Medical Records
Medical Insurance Services
Medical Lien Funding
Revenue Cycle Management
Select any that apply
We are primarily interested in the following Healthcare Provider areas:
Dental Practices
Hospital / Facility
Nursing Home / Assisted Living
Outpatient Rehabilitation Facilities
Physical / Occupational/Speech
Physician Practice Groups
Sleep Labs
Surgery Centers
Urgent Care Centers
Women's Health
Select any that apply
We are primarily interested in the following Home Health / Hospice areas:
Ambulatory Care
Assisted Living
Home Nursing
Hospice
Long Term Care
Medicare Certified
Pediatric Homecare
Private Duty
Skilled Nursing
Staffing
Select any that apply
We are primarily interested in the following Medical Device areas:
Biomedical Repair / Maintenance
Medical / Dental Product Manufacturers
Medical Asset Management
Medical Equipment Rental (B2B)
Select any that apply
We are primarily interested in the following Medical Supply areas:
Diabetic Supplies
DME/HME Products & Services
Long Term Care Equipment Services
Mail Order / Internet Medical Supply
Mobility Aids
Respiratory Services
Sleep Equipment & Supplies
Wound Care Specialty Beds
Hospital Supplies - Distribution
Select any that apply
We are primarily interested in the following Pharmacy areas:
Alternate Site Infusion
Compouning Pharmacy
Institutional / LTC Pharmacy
Mail Order Pharmacy
Pharmaceutical Distributors
Pharmacy Benefit Manager (PBM)
Retail Pharmacy
Specialty Pharmacy
Select any that apply
Please specify the Other areas you are primarily interested in:
Geographic Location:
East Coast
West Coast
South
Mid-West
Anywhere
Please briefly describe your business and market focus:
Business Profile
Entity Type
C Corporation
S Corporation
LLC
Partnership
Public Company
Other
Other
Number of Stakeholders
Year Established
Gross Sales
Net Earnings
Describe your main product/service
DUNS #/Financial Reference
Product Mix As a percentage of collected revenue:
Product / Service: #1
#1 - % of collected revenue
Product / Service: #2
#2 - % of collected revenue
Product / Service: #3
#3 - % of collected revenue
Product / Service: #4
#4 - % of collected revenue
Product / Service: #5
#5 - % of collected revenue
Product / Service: other
other - % of collected revenue
Number of Employees
Number of Branch Locations
Does the owner have an active role in management?
Yes
No
How did you find Paragon Ventures?
Internet Search (Google)
Internet Search (Yahoo or Other)
Healthcare Industry Trade Show
Referral from Paragon client
Referral (other)
Direct Mail
Other
Other
Comments
Prospective Client Profile Confidentiality Agreement
I have read and agree with the terms of the
Seller Confidentiality Agreement
.
*
Yes / Agree
I would like to receive further communications from Paragon Ventures and/or Highway Capital LLC
Yes
By typing your FULL NAME in the field below, you are signing this document as it relates to the information in the above Seller Registration Profile and Confidentiality Agreement:
(required) Signature (FULL NAME):
*
If you are human, leave this field blank.
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