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200314134
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Last modified
10/16/2011 8:20:05 AM
Creation date
10/28/2005 4:02:38 PM
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200314134
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°h TC1 <br />M i <br />UCC FINANCING STATEMENT Z <br />FOLLOW INSTRUCTIONS front and back CAREFULLY <br />A. NAME & PHONE OF CONTACT AT FILER [optional] <br />B. SEND ACKNOWLEDGMENT TO: (Name and Address) <br />CT Corporation Systems <br />UCC Services - McClafferty Team 3 <br />111 Eighth Avenue, 13th Floor <br />New York, NY 10011 <br />File in: Hall County, NE <br />1a. ORGANIZATION'S NAME <br />Lehman Commercial Paper Inc., as Administrative Agent <br />OR <br />M <br />3c. MAILINGADDRESS <br />+gyp <br />—n <br />1 b. INDIVIDUAL'S LAST NAME <br />FIRST NAME <br />C <br />—, <br />D <br />z <br />STATE <br />v <br />M <br />Q <br />AR <br />n <br />C/) <br />C <br />°h TC1 <br />M i <br />UCC FINANCING STATEMENT Z <br />FOLLOW INSTRUCTIONS front and back CAREFULLY <br />A. NAME & PHONE OF CONTACT AT FILER [optional] <br />B. SEND ACKNOWLEDGMENT TO: (Name and Address) <br />CT Corporation Systems <br />UCC Services - McClafferty Team 3 <br />111 Eighth Avenue, 13th Floor <br />New York, NY 10011 <br />File in: Hall County, NE <br />IY/ S7 SSG SD 133 Lit JI THE ABOVE SPACE IS FOR FILING OFFICE USE ONLY <br />1. DEBTOR'S EXACT FULL LEGAL NAME - insertonivone debtorname (1 a or 1 b) -do notabbreviate orcombine names <br />1a. ORGANIZATION'S NAME <br />Lehman Commercial Paper Inc., as Administrative Agent <br />OR <br />Beverly Enterprises-Nebraska, Inc. <br />3c. MAILINGADDRESS <br />+gyp <br />OR <br />1 b. INDIVIDUAL'S LAST NAME <br />FIRST NAME <br />MIDDLE NAME <br />—, <br />D <br />CITY <br />STATE <br />COUNTRY <br />c/o Beverly Enterprises, Inc., 1000 Beverly Way <br />Q <br />AR <br />IPOSTALCODE <br />72919 — " <br />O <br />C <br />ADDTINFORE Ile. TYPE OF ORGANIZATION <br />1f. JURISDICTION OF ORGANIZATION <br />� — <br />CD <br />r <br />.T� (rt <br />W <br />rrl <br />M <br />C1117900 FiNONE <br />(All <br />vt <br />(i1 <br />cv <br />cn <br />-r Z <br />O <br />20-0314134 <br />IY/ S7 SSG SD 133 Lit JI THE ABOVE SPACE IS FOR FILING OFFICE USE ONLY <br />1. DEBTOR'S EXACT FULL LEGAL NAME - insertonivone debtorname (1 a or 1 b) -do notabbreviate orcombine names <br />2. ADDITIONAL DEBTOR'S EXACT FULL LEGAL NAME - insert only = debtor name (2a or 2b) - do not abbreviate or combine names <br />i <br />3. SECURED PARTY'S NAME (or NAME ofTOTAL ASSIGNEE of ASSIGNOR S/ Pl- insertnnlvnno— umd nartvname law nr3hl <br />1a. ORGANIZATION'S NAME <br />Lehman Commercial Paper Inc., as Administrative Agent <br />OR <br />Beverly Enterprises-Nebraska, Inc. <br />3c. MAILINGADDRESS <br />CITY <br />OR <br />1 b. INDIVIDUAL'S LAST NAME <br />FIRST NAME <br />MIDDLE NAME <br />SUFFIX <br />1c.MAILINGADDRESS <br />CITY <br />STATE <br />COUNTRY <br />c/o Beverly Enterprises, Inc., 1000 Beverly Way <br />Fort Smith <br />AR <br />IPOSTALCODE <br />72919 — " <br />US <br />1 d. SEE INSTRUCTIONS <br />ADDTINFORE Ile. TYPE OF ORGANIZATION <br />1f. JURISDICTION OF ORGANIZATION <br />1g. ORGANIZATIONAL ID #,if any <br />ORGANIZATION <br />DEBTOR I Corporation <br />California <br />C1117900 FiNONE <br />2. ADDITIONAL DEBTOR'S EXACT FULL LEGAL NAME - insert only = debtor name (2a or 2b) - do not abbreviate or combine names <br />i <br />3. SECURED PARTY'S NAME (or NAME ofTOTAL ASSIGNEE of ASSIGNOR S/ Pl- insertnnlvnno— umd nartvname law nr3hl <br />4. 1 his FINANCING STATEMENT covers the following collateral: <br />See Exhibit I and Schedule A attached hereto and made a part hereof. <br />FILING <br />ebtor 2 <br />$, OPTIONAL FILER <br />053114/1025 <br />FILING OFFICE COPY — UCC FINANCING STATEMENT (FORM UCC1) (REV. 05/22/02) <br />DEUCCIPNAT - 12/17/2002 C T System Online <br />3a. ORGANIZATION'S NAME <br />Lehman Commercial Paper Inc., as Administrative Agent <br />OR <br />3b. INDIVIDUAL'S LAST NAME FIRST NAME MIDDLE NAME SUFFIX <br />3c. MAILINGADDRESS <br />CITY <br />STATE <br />COUNTRY <br />745 7th Avenue <br />New York <br />NY <br />IPOSTALCODE <br />10019 <br />USA <br />4. 1 his FINANCING STATEMENT covers the following collateral: <br />See Exhibit I and Schedule A attached hereto and made a part hereof. <br />FILING <br />ebtor 2 <br />$, OPTIONAL FILER <br />053114/1025 <br />FILING OFFICE COPY — UCC FINANCING STATEMENT (FORM UCC1) (REV. 05/22/02) <br />DEUCCIPNAT - 12/17/2002 C T System Online <br />
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