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N is is -...J is ....... .t::>. N CD '" m . . "'" c: ('\ z ~E~ ~::J: ~ U\ '~j ;:;J ()\~: r"1 s:t ~~ ...,., ~s nx ~ r.....:> C~ =:> ~ -.-, rr"l CD r0 en :; FINANCING STATEMENT ow INSTRUCTIONS front and back CAREFULLY \ME & PHONE OF CONTACT AT FILER [optional] r20 ,NO ACKNOWLEDGMENT TO: (Name and Address) f;;rst St~ PO Box 79 Gothenburg, NE 69138 ti- t' o rr1 rT! C> en ::D ::3 I--' 1-" -, c:> C) L ~ ('") (f) o ---1 C 1> z---1 -jrrl -<0 0"" """z :J:: f"ll 1> U! r- "Xl 11>- (J) ;>::: 1> .................. en en THE ABOVE SPACE IS FOR FILING OFFICE USE ONLY 1 . DEBTOR'S EXACT FULL LEGAL NAME - ins.rtonIY2!lll debtor nome (1 a or1 b) -do nolabbrevialeorcombine names 1.. ORGANIZATION'S NAME Mid-Plains Center for Behavioral Healthcare Services Inc. OR 1 b. INDIVIDUAL'S lAST NAME FIRST NAME MIDDLE NAME k MAILING ADDRESS CITY STATE POSTAL CODE PO Box 1763 1d. SEE INSTRUCTIONS Grand Island 1 f. JURISDICTION OF ORGANIZATION NE 68802 19. ORGANIZATIONAL ID #, ifany Nebraska 2. ADDITIONAL DEBTOR'S EXACT FULL LEGAL NAME - insert only 2!lll debtor name (2a or 2b) _ do not abbreviate or combine names 2a. ORGANIZATION'S NAME OR 2b. INDIVIDUAL'S lAST NAME FIRST NAME MIDDLE NAME 2c. MAILING ADDRESS CITY STATE POSTAL CODe 2d. SEE INSTRUCTIONS 2g. ORGANIZATIONAL 10 #, if any 2e. TYPE OF ORGANIZATION 21. JURISDICTION OF ORGANIZATION 3. SECURED PARTY'S NAME (orNAMEofTOTAlASSIGNEEofASSIGNOR SlP)-insertonIYlllll!secu,ed party name (3a or3b) oi ~i c:>ar ~i ~i <D~ /O.'s"""o SUFFIX COUNTRY USA NONE SUFFIX COUNTRY NONE 30. ORGANIZATION'S NAME OR First State Bank 3b. INDIVIDUAL'S lAST NAME FIRST NAME MIDDLE NAME SUFFIX 3c. MAILING ADDRESS CITY STATE IPOSTAlCODE COUNTRY PO Box 79 Gothenbure: NE 69138 USA 4. This FINANCING STATEMENT covers the following collateral: All inventory, equipment, accounts (including but not limited to all health-care~insurance receivables), chattel paper, instruments (including but not limited to all promissory notes), letter~of-credit rights, letters of credit, documents, deposit accounts, investment property, money, other rights to payment and performance, and general intangibles (including but not limited to all software and all payment intangibles); all fixtures; all timber to be cut; all attachments, accessions, accessories, fittings, increases, tools, parts, repairs, supplies, and commingled goods relating to the foregoing property, and all additions, replacements of and substitutions for all or any part of the foregoing property; all insurance refunds relating to the foregoing property; all good will relating to the foregoing property; all records and data and embedded software relating to the foregoing property, and all equipment, inventory and software to utilize, create, maintain and process any such records and data on electronic media; and all supporting obligations relating to the foregoing property; all whether now existing'or hereafter arising, whether now owned or hereafter acquired or whether now or hereafter subject to any rights in the foregoing property; and all products and proceeds (including but not limited to all insurance payments) of or relating to the foregoing property Deblor 2 International Association of Commercial Administrators (IACA) FILING OFFICE COPY - UCC FINANCING STATEMENT (FORM UCC1) (REV. OS/22/02)