Accredited Investor Questionnaire

Step 1: Please read the agreement

I have read and understood the document.

Step 2: Please provide the following personal information:

Full Name *

Email *

Age *

Date of Birth *

Phone *

Social Security Number or Employee Identification Number *

Date and Place Executed *

Residence Address (including zip code) *

Residence/Business (optional)

Step 3: Please indicate by check mark which of the following categories best describes your prior experience:

Substantial Experience Limited Experience No Experience Marketable Securities Equity Securities for which no market exists Limited Partnerships Initial Public Offerings

Step 4: I am an accredited investor (as defined in Rule 501(a) of Reg. D) because (check each appropriately:)

I am a natural person whose individual net worth, or joint net worth with my spouse, exceeds $1,000,000. I am a natural person who had individual income exceeding $200,000 in each of the two most recent years or joint income with my spouse exceeding $300,000 in each of those years and I have a reasonable expectation of reaching the same income level in the current year. I am a broker-dealer registered pursuant to Section 15 of the Securities Exchange Act of 1934. I am an organization described in Section 501(c)(3) of the Internal Revenue Code, not formed for the specific purpose of acquiring the Units, with total assets exceeding $5,000,000. I am a corporation, limited liability company or similar business trust or partnership, not formed for the specific purpose of acquiring the Units, with total assets exceeding $5,000,000. I am a trust, not formed for the specific purpose of acquiring the Units, with total assets exceeding $5,000,000 and whose purchase is directed by a 'sophisticated person', as defined in Rule 506(b)(2)(ii) of Reg. D. (For the purposes of this questionnaire, a 'sophisticated person' means any person who has such knowledge and experience in financial and business matters that he or she is capable of evaluating the merits and risks of the prospective investment.) I am an employee benet plan within the meaning of the Employee Retirement Income Security Act of 1974 and (i) investment decisions for such plan are made by a plan fiduciary, as defined in Section 3(21) of such Act, which is a bank, savings and loan association, insurance company or registered investment advisor or (ii) such plan has total assets exceeding $5,000,000 or (iii) if a self directed plan, investment decisions are made solely by accredited investors. I am an entity in which all of the equity owners are accredited investors. I am an accredited investor for the following reasons:

Step 5: Please select your professional designation (choose one):

Current Place of Employment *

Current Title/Role *

Years of Experience in the Healthcare *

Step 6: Signature

I have carefully read and fully understand all the documents presented in this application, including the:

Prospectus
Accredited Investor Questionnaire
Non-Disclosure Agreement
Participation Agreement

I acknowledge and accept all the terms, rights, and limitations described therein.
I declare that all information I have provided is true, accurate, and complete to the best of my knowledge and belief.
I understand that the Company may rely on this information in evaluating my eligibility and participation in the Fund, and that any misrepresentation may result in termination of my application or participation.
I understand that this acknowledgment constitutes a binding electronic affirmation under applicable laws and is the legal equivalent of my signature.