EX-25.1 74 ex25-1.htm EXHIBIT 25.1 ex25-1.htm
Exhibit 25.1
 
  
securities and exchange commission
Washington, D.C. 20549
 

FORM T-1

STATEMENT OF ELIGIBILITY UNDER
THE TRUST INDENTURE ACT OF 1939 OF A
CORPORATION DESIGNATED TO ACT AS TRUSTEE
Check if an Application to Determine Eligibility of
a Trustee Pursuant to Section 305(b)(2)
 

U.S. BANK NATIONAL ASSOCIATION
(Exact name of Trustee as specified in its charter)

31-0841368
I.R.S. Employer Identification No.

800 Nicollet Mall
Minneapolis, Minnesota
 
55402
(Address of principal executive offices)
(Zip Code)
 
Raymond S. Haverstock
U.S. Bank National Association
60 Livingston Avenue
St. Paul, MN 55107
(651) 495-3909
(Name, address and telephone number of agent for service)
 
ExamWorks Group, Inc.(1)
(Exact name of obligor as specified in its charter)
 
(1) SEE TABLE OF ADDITIONAL OBLIGORS

Delaware
27-2909425
(State or other jurisdiction of incorporation or organization)
(I.R.S. Employer Identification No.)
   

3280 Peachtree Road N.E. Suite 2625
Atlanta, GA
 
30305
(Address of Principal Executive Offices)
(Zip Code)

9% Senior Unsecured Notes Due 2019
Guarantees of 9% Senior Unsecured Notes Due 2019
(Title of the Indenture Securities)

 
 
 
 
TABLE OF ADDITIONAL OBLIGORS
 
Exact name of Obligor as specified in its Charter*
  
State or other
Jurisdiction of
Incorporation or
Organization
  
I.R.S.
Employee
Identification
Number
ExamWorks, Inc.
Delaware
  
26-1114252
Southwest Medical Examination Services, Inc.
Texas
  
75-2437666
Diagnostic Imaging Institute, Inc.
Texas
  
75-2576931
Pacific Billing Services, Inc.
Texas
  
87-0792602
Marquis Medical Administrators, Inc.
New York
  
01-0654414
Florida Medical Specialists, Inc.
New Jersey
  
65-0149635
CFO Medical Services, LLC
New Jersey
  
26-1114252
IME Software Solutions, LLC
Michigan
  
35-2162737
ExamWorks Review Services, LLC
Delaware
  
26-1114252
Ricwel of West Virginia, LLC
West Virginia
  
20-2905113
ExamWorks Evaluations of New York, LLC
New York
  
26-1114252
Network Medical Review Company, Ltd.
Illinois
  
76-0711128
Network Medical Management Company, Ltd.
Illinois
  
32-0012239
Elite Physicians, Ltd.
Illinois
  
36-4041877
Insurance Appeals, Ltd.
Illinois
  
32-0012246
WorkersFirst, Inc.
Illinois
  
20-4362500
MES Group, Inc.
Michigan
  
38-2286375
Medical Evaluation Specialists, Inc.
Michigan
  
38-2193020
Medical Evaluation Specialists
California
  
94-2837383
Medical Evaluation Specialists – Massachusetts, Inc.
Massachusetts
  
04-2881880
Medical Evaluation Specialists, Inc.
Pennsylvania
  
38-3132995
MES Management Services, Inc.
New York
  
01-0565230
Lone Star Consulting Services, Inc.
Texas
  
76-0609620
DDA Management Services, LLC
New York
  
26-2733528
MLS Group of Companies, Inc.
Michigan
  
38-3341904
Medicolegal Services, LLC
Delaware
  
45-3416919
IME Resources, LLC
Delaware
  
61-1665175
CredentialMed, LLC
Delaware
  
38-3857370
iSalus, LLC
Delaware
  
37-1659699
ExamWorks Canada, Inc.
Delaware
  
27-2914150
ExamWorks Europe, Inc.
Delaware
  
27-3351533
 
  *
The address of the principal executive offices of all of the obligors is 3280 Peachtree Road, N.E., Atlanta, Georgia 30305.
 
 
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FORM T-1

Item 1.      GENERAL INFORMATION.  Furnish the following information as to the Trustee.

 
a)
Name and address of each examining or supervising authority to which it is subject.
Comptroller of the Currency
Washington, D.C.

 
b)
Whether it is authorized to exercise corporate trust powers.
Yes

Item 2.     AFFILIATIONS WITH OBLIGOR.  If the obligor is an affiliate of the Trustee, describe each such affiliation.
None

Items 3-15
Items 3-15 are not applicable because to the best of the Trustee's knowledge, the obligor is not in default under any Indenture for which the Trustee acts as Trustee.

Item 16.     LIST OF EXHIBITS: List below all exhibits filed as a part of this statement of eligibility and qualification.

 
1. 
A copy of the Articles of Association of the Trustee.*

 
2. 
A copy of the certificate of authority of the Trustee to commence business, attached as Exhibit 2.

 
3.
A copy of the certificate of authority of the Trustee to exercise corporate trust powers, attached as Exhibit 3.

 
4.
A copy of the existing bylaws of the Trustee.**
 
 
 
5.
A copy of each Indenture referred to in Item 4.  Not applicable.

 
6.
The consent of the Trustee required by Section 321(b) of the Trust Indenture Act of 1939, attached as Exhibit 6.

 
7.
Report of Condition of the Trustee as of December 31, 2011 published pursuant to law or the requirements of its supervising or examining authority, attached as Exhibit 7.



 
* Incorporated by reference to Exhibit 25.1 to Amendment No. 2 to registration statement on S-4, Registration Number 333-128217 filed on November 15, 2005.
 
** Incorporated by reference to Exhibit 25.1 to registration statement on S-4, Registration Number 333-166527 filed on May 5, 2010.

 
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SIGNATURE

Pursuant to the requirements of the Trust Indenture Act of 1939, as amended, the Trustee, U.S. BANK NATIONAL ASSOCIATION, a national banking association organized and existing under the laws of the United States of America, has duly caused this statement of eligibility and qualification to be signed on its behalf by the undersigned, thereunto duly authorized, all in the City of St. Paul, State of Minnesota on the 3rd day of April, 2012.
 
 
By:
/s/ Raymond S. Haverstock  
    Raymond S. Haverstock  
   
Vice President
  
 
 
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Exhibit 2
 
 
5
 
 
Exhibit 3
 
 
6
 
 
Exhibit 6

CONSENT


In accordance with Section 321(b) of the Trust Indenture Act of 1939, the undersigned, U.S. BANK NATIONAL ASSOCIATION hereby consents that reports of examination of the undersigned by Federal, State, Territorial or District authorities may be furnished by such authorities to the Securities and Exchange Commission upon its request therefor.


Dated: April 3rd, 2012

 
By:
/s/ Raymond S. Haverstock  
    Raymond S. Haverstock  
   
Vice President
  

 
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Exhibit 7
U.S. Bank National Association
Statement of Financial Condition
As of 12/31/2011

($000’s)

   
12/31/2011
  
Assets
      
Cash and Balances Due From
   $ 13,960,499  
Depository Institutions
        
Securities
     69,485,200  
Federal Funds
     11,887  
Loans & Lease Financing Receivables
     204,182,862  
Fixed Assets
     5,472,961  
Intangible Assets
     12,446,662  
Other Assets
     24,910,739  
Total Assets
   $ 330,470,810  
         
Liabilities
        
Deposits
   $ 236,091,541  
Fed Funds
     7,936,151  
Treasury Demand Notes
     0  
Trading Liabilities
     377,634  
Other Borrowed Money
     34,507,710  
Acceptances
     0  
Subordinated Notes and Debentures
     5,945,617  
Other Liabilities
     10,944,902  
Total Liabilities
   $ 295,803,555  
         
Equity
        
Minority Interest in Subsidiaries
   $ 1,926,211  
Common and Preferred Stock
     18,200  
Surplus
     14,133,323  
Undivided Profits
     18,589,521  
Total Equity Capital
   $ 34,667,255  
         
Total Liabilities and Equity Capital
   $ 330,470,810  
 
 
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