Banking for the Dental Professional

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1 1 Items include checks paid (including electronified checks), checks deposited, deposit tickets, ACH debits, and ACH credits. An electronified check is a check that has been used as a source of information to enable a one-time payment from your account in the form of an ACH debit. An excess item fee of $0.50 per item over MasterCard. MasterCard, Debit MasterCard, and the MasterCard brand marks are trademarks of MasterCard International Incorporated. Certain terms, conditions, and exclusions apply. See and for complete benefit terms and conditions. 3 Premier Banking is for personal use only. 4 If you use an ATM that is not owned by Sandy Spring Bank to withdraw funds from your Premier Banking account and are assessed an ATM surcharge fee by the owner of the machine, we will credit your Premier Banking account for the surcharge fee, up to 4 ($12 maximum) per monthly statement cycle. Surcharge refund does not apply to interchange fees on international transactions. *Not FDIC Insured No Bank Guarantee Not a Bank Deposit Not Insured by Any Government Agency May Lose Value Banking for the Dental Professional Georgia Avenue, Olney, Maryland sandyspringbank.com Member FDIC

2 Products and services that can help you meet your business and financial goals. Whatever the life-stage of your dental practice whether you are just starting out, expanding, or maintaining your practice Sandy Spring Bank offers an array of products that can meet your financial services needs. We understand the specialized needs of Dental Professionals and will work with you as a true financial partner. The products and services we recommend will offer you a full range of solutions designed to help you achieve your business objectives. With everything from loans, lines of credit, checking accounts and treasury management services to wealth management, insurance and employee benefit programs Sandy Spring Bank has all the services you need today and in the future. Financing Solutions At Sandy Spring Bank, we can provide the financing you need for working capital as well as practice acquisition and startup, mortgages, leasehold improvements/expansion, and more. Commercial Loans and Lines of Credit Regardless of whether you re just starting out, buying into an established practice, or growing your individual practice, we have the right financing option for you. Checking Solutions Our checking account products are designed with your needs in mind. We ll help you select the one that is right for you. Flex Business Checking The business checking account to meet the needs of your practice now and as your practice grows. Flex Business Checking also provides you additional valuable and money saving benefits. Monthly Statement Transaction Tiers Number of Transaction Items 1 Monthly Maintenance Fee Minimum Monthly Average Balance to Avoid the Fee None No Minimum Required $10 $5, and above $20 $15,000 Remote deposit capture for a fixed monthly fee of $50 which includes a free single document scanner and up to 100 checks scanned per month at no charge. Free Business Debit MasterCard with Easy Savings Rebate Program 2 and access to over 55,000 ATMs surcharge-free. Commercial Checking As your business grows, our Commercial Checking Account offers expanded and comprehensive services. Offset fees with an earnings credit on checking balances. Specialized lockbox services for patient remittances with image capability. Remote deposit capture to facilitate check collections. Wire Transfer and ACH access through ebiz. Free Business Debit MasterCard with Easy Savings Rebate Program 2 and access to over 55,000 ATMs surcharge-free. Premier Banking personal checking accounts with no monthly maintenance fees (for account signers). 3 Workplace Banking At Sandy Spring Bank, we don t forget about your employees. Our Workplace Banking offers your employees special rewards and benefits including free checking. Personal Banking Products and Services Sandy Spring Bank can offer both you and your employees a complete package of banking services. Personal Checking and Savings We offer a variety of checking accounts including: My Free Banking Checking with no minimum balance requirement and unlimited check writing, plus BankXpress Online Banking with Bill Pay, Mobile Banking with Mobile Deposit, access to more than 55,000 ATMs and a Debit MasterCard all free. Premier Banking A comprehensive package of banking services including: 4 ATM surcharge refunds per monthly statement cycle, 4 access to over 55,000 ATMs surcharge-free, unlimited check writing, BankXpress Online Banking with Bill Pay, free Premier Checks, World Debit MasterCard, discounts on other Bank products and it even pays interest. Other Banking Services Money Market Accounts Certificates of Deposit Personal loans and lines of credit Mortgage loans Insurance Services* Sandy Spring Bank offers a variety of insurance products through its subsidiaries Sandy Spring Insurance and Neff & Associates. At Sandy Spring Insurance, we can help you prepare for the unexpected. Sound planning and the proper insurance could help keep your practice running and guarantee future financial security for your family. Sandy Spring Insurance offers a full range of business insurance policies including: Worker s Compensation Commercial Umbrella Life and Health Property & Casualty Medical Malpractice The insurance professionals at Neff & Associates can review your existing Professional Liability Insurance and make recommendations to ensure that your practice is properly covered. Wealth Management* We provide access to a full range of services for both your practice and your personal investment needs. Certified Financial Planners (CFPs) with West Financial Services, Inc., a subsidiary of Sandy Spring Bank specializing in financial planning for medical professionals, can work with you to develop a comprehensive personal plan in such ares as tuition planning, cash flow management, estate planning, and more. Additional Services Health Savings Accounts (HSAs) Merchant Services (competitive rates for your Credit Card Processing) Employee Benefits Payroll and Human Resources Management Solutions Contact us at to discuss the many ways Sandy Spring Bank can help your practice.

3 Dental Professional Financing Application Thank you for applying to Sandy Spring Bank. Please fill out this form in as much detail as possible, attach it to any applicable supporting information, and return everything to your Relationship Manager or to Sandy Spring Bank, Small Business Loan Center, 6831 Benjamin Franklin Drive, Columbia, Maryland, Each guarantor must complete and sign a separate application. If you have any questions, please contact your Relationship Manager, or contact the Commercial Business Center at (866) Important Information about Procedures for Opening a New Account To help the government fight the funding of terrorism and money laundering activities, Federal law requires all financial institutions to obtain, verify, and record information that identifies each person who opens an account. What this means for you: When you open an account, we will ask you for your name, address, date of birth, and other information that allows us to identify you. We may also ask to see your driver s license or other identifying documents. Application Checklist All requests should include the basic information and the following: A. (for equipment or leasehold improvements) B. (for real estate) C. (for practice purchase) Basic information (needed for all requests) o Completed and signed application o Three years of personal and business tax returns with all schedules (two years if total request below $500,000) o Year-to-date practice financial statements A. Financing equipment or leasehold improvements o Invoice(s) and/or construction contract(s) B. Financing real estate o Draft purchase agreement / letter of intent o Existing leases (if applicable) C. Financing practice purchase o Draft purchase and sales agreement(s) / letter of intent o Practice Valuation o Draft lease o Draft employment agreements o Production Reports o Curriculum vitae Additional Information Need Prior to Closing o Sandy Spring Bank listed as beneficiary on life insurance policy o Sandy Spring Bank listed as loss payee on business personal property insurance policy o Sandy Spring Bank listed as loss payee on hazard insurance policy (if financing real estate) o Verification of disability insurance policy o Verification of malpractice insurance policy o State dental license o Articles of Incorporation and By-laws or Operating Agreement o Signed IRS form 4506-T SSB-Dental Application (Rev. 2/27/2017) 1 of 7

4 Financial Team Contact List Accountant Name: Phone: Attorney Name: Phone: Insurance Agent Name: Phone: Practice Broker Name: Phone: Real Estate Broker Name: Phone: Other: Name: Phone: Borrower Information Practice Name: Practice Address: Practice Phone: Tax ID#: City, State, Zip: Ownership: % Entity Status: o C-Corp o S-Corp o LLC/LLP % o Partnership o Sole Proprietorship Membership: o Maryland State Dental Association o Northern Virginia Dental Society o Other: Financing Request Application Date: / / Requested Closing Date: / / Amount: Practice Acquisition $ Leasehold Improvements $ Practice Refinance $ Real Estate $ New Equipment $ Other: $ Equipment Refinance $ Total $ Seller financing amount, if any: $ Term (months): o 24 o 36 o 48 o 60 o 72 o 84 o 96 o 120 o 180 o Other Collateral: Please list collateral available to secure loan request(s) along with descriptions and values. Type Description Value Existing Liens $ $ SSB-Dental Application (Rev. 2/27/2017) 2 of 7

5 Acquisition Practice Information (tell us about the practice you are buying) Type of acquisition: o Entity purchase o Asset purchase o Practice merger o Client list purchase In-process Complete N/A Additional Information Visited practice o o o Met with staff o o o Negotiated purchase/sales agreement(s) o o o Negotiated employment agreement(s) o o o Negotiated lease o o o Insurance credentialing o o o Relocate primary residence o o o Create new legal entity for purchase o o o Obtain life and disability insurance o o o Will the current dentist stay? Will you hire an associate? Do you own another practice? Do you have a non-compete contract? If yes, what will be the compensation? If yes, what will be the compensation? If yes, miles between the two practices If yes, miles and years Dentists #: Hygienists #: Office staff #: Active patients #: Specialties: o General/Family o Periodontics o Endodontics o Orthodontics o Surgery o Other Days worked per week: # Patients per day: # Full Schedule Average charge per visit $ Services breakdown: Dentistry % Hygiene % Other % Collections breakdown: Fee for service % PPO % HMO % Planned expansion or expenditures SSB-Dental Application (Rev. 2/27/2017) 3 of 7

6 Current Practice Information (tell us about the practice you have) Date of formation: / / Dentists #: Hygienists #: Office staff #: Specialties: o General/Family o Periodontics o Endodontics o Orthodontics o Surgery o Other Days worked per week: # Patients per day: # Full Schedule Average charge per visit $ Services breakdown: Dentistry % Hygiene % Other % Collections breakdown: Fee for service % PPO % HMO % Production % paid to Associate(s) % Production % paid to Hygienist(s) % Planned expansion or expenditures Accept Credit Cards Primary Bank Existing debt: Please list any existing debt that is not being consolidated with this request, including student debt or student loan debt. Name of creditor Line or loan Secured Balance Rate Payment Maturity date $ % $ / / $ % $ / / If yes, please attach a written explanation: Has the practice ever filed bankruptcy? Is the practice involved in any litigation, at this time? Are any taxes or debts currently past due? Is the practice liable for any debt not shown above? Has the practice incurred a loss in any of the last 3 years? Doctor Information (please complete for each guarantor) Name: Social Security #: Date of Birth: / / Home address: City: State: Zip: Phone number: Time at current address: Dental license #: State: Have you ever had an action against your license? Years practicing #: School and Degree(s): Are you, or will you continue, working as an associate in another practice? ---Complete only if applying jointly--- Name: Social Security #: Date of Birth: / / Home address: City: State: Zip: Phone number: Time at current address: Occupation: Title: Time in business: SSB-Dental Application (Rev. 2/27/2017) 4 of 7

7 Doctor Information Continued Statement of personal financial condition as of: / / The assets, liabilities, income and expenses described in this financial statement are (check the appropriate box): o Individual If you are applying for credit individually, list all your own individual income, expenses, assets, and liabilities. o Joint If you are applying for credit jointly, list all of the income, expenses, assets, and liabilities for both parties. o We intend to apply for Joint credit. Assets Liabilities Cash In This Bank Credit Card Balances (Schedule 1) In Other Banks Accounts Payable Securities Marketable Securities Notes Payable To This Bank (Schedule 2) Non-Marketable Securities (Schedule 4) Other Notes Payable Loans Receivable Mortgages Primary Residence Real Estate Primary Residence Payable Home Equity Loans (Schedule 5) Wholly-Owned Real Estate (Schedule 5) Wholly-Owned Real Estate Partially-Owned Real Estate Partially-Owned Real Estate Other Partnership Interests Income Taxes Outstanding Automobiles and Vehicles Other Taxes Outstanding Cash Value Life Insurance (Schedule 3) Other Liabilities Retirement Funds and Deferred Compensation Other Assets Total Assets Total Liabilities Net Worth (Assets less Liabilities) Sources of Income Annual Expenditures Salary & Wages Income Taxes Interest Income Estimated Living Expenses Dividend Income Real Estate Expenses Business Income Alimony, Child Support, Other Real Estate Income Education or Child Care Expenses Other* Other Subtotal Subtotal Non-recurring Residence Mortgage Payment Sales of Assets Rent Payments Commissions Car and/or Vehicle Payments Home Equity Line/Loan Payments Credit Card Payments Other Real Estate Payments Other Total Total *You do not have to include information about income from alimony, child support or separate maintenance payments unless you want us to consider this income in connection with this application for credit. Statement of Contingent Liabilities: Contingent liabilities are financial obligations of other individuals, partnerships, or companies which you have endorsed, guaranteed, or otherwise agreed to or have a statutory obligation to honor in the event of certain contingencies. They may also be any direct obligations that are not reflected in the balance sheet above that you will be required to honor in the event of certain contingencies. These include obligations to Sandy Spring Bank as well as to other banks or creditors of any kind. You must disclose all such guarantees, endorsements, etc. below. o I have no contingent liabilities. Type of Obligation Name of Creditor Amount Maturity date Explanation of Purpose SSB-Dental Application (Rev. 2/27/2017) 5 of 7

8 Supporting Schedules Please state all of the owners for each account listed. Schedule 1 Depository Accounts Names on Account Depository Institution Balance Type of Account Pledged Total Balances in Accounts Schedule 2 Marketable Securities Security or Fund Title in Name(s) Of Shares # Share Value Total Market Value Pledged Restricted Total Market Value Schedule 3 Life Insurance Carried Name of Insurer Policy in Name(s) Of Beneficiary Amount Loans Cash Value Total Face Amount and Policy Loans Schedule 4 Notes Payable (Exclude Mortgage Listed in Schedule 5) Name of Creditor Type of Loan Original Current Rate Maturity Payment Collateral Total Current Balance and Monthly Payments Schedule 5 Wholly-Owned Real Estate Address State Title Type Value Balance Lender Rate Payment Residence Total Value and Mortgage Balances Schedule 6 Partially-Owned Real Estate Address State Title Type Value Balance Lender Rate Payment Residence Total Value and Mortgage Balances Citizenship/Residency U.S. Citizen Permanent Resident Alien* Applicant Co-Applicant SSB-Dental Application (Rev. 2/27/2017) 6 of 7

9 * Proof of Permanent Resident Alien status must be presented at time of application. The card number and expiration date must be recorded for the loan file. If yes, please attach a written explanation: Are any of the assets previously listed held under a trust agreement, in an estate, or any other name or capacity? Do any of your assets secure any debts that have not been reported in the proceeding schedules? Have you ever filed for personal bankruptcy, had property owned foreclosed, or made a settlement or an assignment for the benefit of creditors? Are there any unsatisfied judgments against you or has any corporation or partnership in which you are (were) an owner or general partner ever filed for bankruptcy or legal action? Are you, or any corporation or partnership in which you are an owner or general partner, a party to any suit or legal action, or are there any unsatisfied judgments against you? Are any income tax returns, whether personal or that of any corporation or partnership in which you are an owner or a general partner, currently being audited or contested? Authorization: The information contained in this application and statement is provided for the purpose of obtaining, or maintaining credit with you on behalf of the undersigned, or persons, firms, or corporations in whose behalf the undersigned may either severally or jointly with others, execute a guaranty in your favor. Each undersigned understands that you are relying on the information provided herein (including the designation made as to ownership of property) in deciding to grant or continue credit. Each undersigned represents and warrants that the information provided is true and complete and that you may consider this statement as continuing to be true and correct until a written notice of a change is given to you by the undersigned. You are authorized to make all inquiries you deem necessary to verify the accuracy of the statements made herein, and to determine my/our creditworthiness. You are authorized to answer questions about your credit experience with me/us. You authorize and instruct any person to complete and furnish to us any information that we may request and agree that such information, along with this application, shall remain our property. You authorize us to disclose any information in or relating to this application and/or account if approved (including information received from third persons) to any applicant for or guarantor of, this credit and to any of our existing or future subsidiaries, affiliates, and assigns, and to any potential assignee, transferee, or participant in the credit to which this application relates. For Personal Information Only: Only your personal consumer information is subject to the following disclosure. Commercial entities may not opt out of affiliate sharing. The Fair Credit Reporting Act permits us to share, among the Sandy Spring family of companies, information about you from consumer reporting agencies and other outside sources. If you do not wish us to provide this externally derived information to our affiliated companies, you may advise us by writing us at Sandy Spring Bank, ATTN: Quality Control-Operations, Georgia Ave., Olney, MD To help us identify this application/account, please include your name, address, telephone number, social security number, and indicate that your request relates to your application/account. By notifying us as specified, the information that we may share among the Sandy Spring family of companies and others having the right to receive such information will be limited to that relating to our experience information about you (e.g., the existence, history and status of your account), but will not include other, externally derived information. FOR JOINT CREDIT APPLICANTS WE REQUIRE THAT THIS FINANCIAL STATEMENT BE SIGNED BY ALL APPLICANTS Signature (Individual): Date Signature (Other Party): Date SSB-Dental Application (Rev. 2/27/2017) 7 of 7