EX-25.1 7 d18466exv25w1.htm STATEMENT OF ELIGIBILITY OF THE TRUSTEE ON FORM T-1 exv25w1
 

Exhibit 25.1

FORM T-1

SECURITIES AND EXCHANGE COMMISSION

Washington, D.C. 20549

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) |     |

BNY MIDWEST TRUST COMPANY

(formerly known as CTC Illinois Trust Company)
(Exact name of trustee as specified in its charter)
     
Illinois
(State of incorporation
if not a U.S. national bank) 		  36-3800435
(I.R.S. employer
identification no.)
     
2 North LaSalle Street
Suite 1020
Chicago, Illinois
(Address of principal executive offices) 		   
 
60602
(Zip code)

Beverly Enterprises, Inc.

     
Delaware
(State or other jurisdiction of
incorporation or organization) 		  62-1691861
(I.R.S. employer
identification no.)

 

 

         
    (State or other jurisdiction of   (I.R.S. Employer
(Exact names of registrants as   incorporation or   Identification
specified in its charter)
   organization)
   No.)
4F Funding, Inc.
  California   95-3849624
 
        
AEDON HomeCare – Houston, LLC
  Delaware   20-0149281
 
        
AEDON HomeCare – Minnesota, LLC
  Delaware   20-0889272
 
        
AEDON HomeCare, LLC
  Delaware   43-1974984
 
        
AEDON Staffing, LLC
  Delaware   43-1974983
 
        
AEGIS Therapies – Oregon, Inc.
  Delaware   20-0353804
 
        
AEGIS Therapies – Wisconsin, Inc.
  Delaware   20-0043503
 
        
AEGIS Therapies, Inc.
  Delaware   71-0811574
 
        
AEGIS Therapies – Florida, Inc.
  Delaware   71-0859178
 
        
Affirmacare, LLC
  Delaware   20-1193397
 
        
AGI-Camelot, Inc.
  Maryland   43-1253376
 
        
AseraCare Hospice – Birmingham, LLC
  Delaware   20-1187019

-2-

 

         
    (State or other jurisdiction of   (I.R.S. Employer
(Exact names of registrants as   incorporation or   Identification
specified in its charter)
   organization)
   No.)
AseraCare Hospice – Corinth, LLC
  Delaware   20-1187926
 
        
AseraCare Hospice – Demopolis, LLC
  Delaware   20-1187474
 
        
AseraCare Hospice – Hamilton, LLC
  Delaware   20-1187948
 
        
AseraCare Hospice – Jackson, LLC
  Delaware   20-1187986
 
        
AseraCare Hospice – Marshall County, LLC
  Delaware   20-1187937
 
        
AseraCare Hospice – Memphis, LLC
  Delaware   20-1188108
 
        
AseraCare Hospice – Meridian, LLC
  Delaware   20-1187872
 
        
AseraCare Hospice – Monroeville, LLC
  Delaware   20-1188030
 
        
AseraCare Hospice – New Albany, LLC
  Delaware   20-1187862
 
        
AseraCare Hospice – New Horizons, LLC
  Delaware   20-1188150
 
        
AseraCare Hospice – Philadelphia, LLC
  Delaware   20-1187566
 
        
AseraCare Hospice – Russellville, LLC
  Delaware   20-1188073

-3-

 

         
    (State or other jurisdiction of   (I.R.S. Employer
(Exact names of registrants as   incorporation or   Identification
specified in its charter)
   organization)
   No.)
AseraCare Hospice – Senatobia, LLC
  Delaware   20-1187538
 
        
AseraCare Hospice – Tennessee, LLC
  Delaware   20-1188156
 
        
Beverly – Bella Vista Holding, Inc.
  Delaware   71-0797481
 
        
Beverly – Missouri Valley Holding, Inc.
  Delaware   71-0797485
 
        
Beverly – Rapid City Holding, Inc.
  Delaware   71-0797483
 
        
Beverly Enterprises – Alabama, Inc.
  California   95-3742145
 
        
Beverly Enterprises – Arizona, Inc.
  California   95-3750871
 
        
Beverly Enterprises – Arkansas, Inc.
  California   95-3751272
 
        
Beverly Enterprises – California, Inc.
  California   95-2499218
 
        
Beverly Enterprises – Delaware, Inc.
  California   95-3849628
 
        
Beverly Enterprises – District of Columbia, Inc.
  California   95-3750889
 
        
Beverly Enterprises – Florida, Inc.
  California   95-3742251

-4-

 

         
    (State or other jurisdiction of   (I.R.S. Employer
(Exact names of registrants as   incorporation or   Identification
specified in its charter)
   organization)
   No.)
Beverly Enterprises – Garden Terrace, Inc.
  California   95-3849648
 
        
Beverly Enterprises – Georgia, Inc.
  California   95-3750880
 
        
Beverly Enterprises – Hawaii, Inc.
  California   95-3750890
 
        
Beverly Enterprises – Illinois, Inc.
  California   95-3750883
 
        
Beverly Enterprises – Indiana, Inc.
  California   95-3744258
 
        
Beverly Enterprises – Kansas, LLC
  California   27-0019977
 
        
Beverly Enterprises – Kentucky, Inc.
  California   95-3750894
 
        
Beverly Enterprises – Maryland, Inc.
  California   95-3750892
 
        
Beverly Enterprises – Massachusetts, Inc.
  California   95-3750893
 
        
Beverly Enterprises – Minnesota, LLC
  California   27-0019982
 
        
Beverly Enterprises – Mississippi, Inc.
  California   95-3742144
 
        
Beverly Enterprises – Missouri, Inc.
  California   95-3750895

-5-

 

         
    (State or other jurisdiction of   (I.R.S. Employer
(Exact names of registrants as   incorporation or   Identification
specified in its charter)
   organization)
   No.)
Beverly Enterprises – Nebraska, Inc.
  California   95-3750873
 
        
Beverly Enterprises – New Jersey, Inc.
  California   95-3750884
 
        
Beverly Enterprises – North Carolina, Inc.
  California   95-3742257
 
        
Beverly Enterprises – Ohio, Inc.
  California   95-3750867
 
        
Beverly Enterprises – Oregon, Inc.
  California   95-3750881
 
        
Beverly Enterprises – Pennsylvania, Inc.
  California   95-3750870
 
        
Beverly Enterprises – South Carolina, Inc.
  California   95-3750866
 
        
Beverly Enterprises – Tennessee, Inc.
  California   95-3742261
 
        
Beverly Enterprises – Texas, Inc.
  California   95-3744256
 
        
Beverly Enterprises – Virginia, Inc.
  California   95-3742694
 
        
Beverly Enterprises – Washington, Inc.
  California   95-3750868
 
        
Beverly Enterprises – West Virginia, Inc.
  California   95-3750888

-6-

 

         
    (State or other jurisdiction of   (I.R.S. Employer
(Exact names of registrants as   incorporation or   Identification
specified in its charter)
   organization)
   No.)
Beverly Enterprises – Wisconsin, Inc.
  California   95-3742696
 
        
Beverly Enterprises International Limited
  California   95-3982125
 
        
Beverly Health and Rehabilitation Services, Inc.
  California   95-2301514
 
        
Beverly Healthcare – California, Inc.
  California   95-3750879
 
        
Beverly Healthcare – Rochester MN, LLC
  Delaware   20-0151678
 
        
Beverly Healthcare Management – MN, LLC
  Delaware   20-0169053
 
        
Beverly Healthcare, LLC
  Indiana   71-0817438
 
        
Beverly Manor Inc. of Hawaii
  California   99-0144750
 
        
Beverly Savana Cay Manor, Inc.
  California   95-4217381
 
        
Beverly-Indianapolis, LLC
  Indiana   71-0824184
 
        
BEVRD, LLC
  Delaware   11-3651454
 
        
CERES Select, LLC
  Delaware   83-0358301

-7-

 

         
    (State or other jurisdiction of   (I.R.S. Employer
(Exact names of registrants as   incorporation or   Identification
specified in its charter)
   organization)
   No.)
CERES Strategies Medical Services, LLC
  Delaware   83-0346146
 
        
CERES Strategies, Inc.
  Delaware   71-0812407
 
        
Commercial Management, Inc.
  Iowa   42-0891358
 
        
Community Care, Inc.
  North Carolina   56-1487367
 
        
Compassion and Personal Care Services, Inc.
  North Carolina   56-1904822
 
        
Eastern Home Health Supply & Equipment Co., Inc.
  North Carolina   56-1581980
 
        
Hale Nani, Inc.
  California   95-3849636
 
        
Hallmark Convalescent Homes, Inc.
  Michigan   41-1413478
 
        
HomeCare Preferred Choice, Inc.
  Delaware   62-1702864
 
        
Hospice of Eastern Carolina, Inc.
  North Carolina   56-1951841
 
        
Hospice Preferred Choice, Inc.
  Delaware   71-0761314
 
        

-8-

 

         
    (State or other jurisdiction of   (I.R.S. Employer
(Exact names of registrants as   incorporation or   Identification
specified in its charter)
   organization)
   No.)
Liberty Nursing Homes, Incorporated
  Virginia   54-0784334
 
        
MATRIX Occupational Health, Inc.
  Delaware   58-2380955
 
        
MATRIX Wellness, LLC
  Delaware   27-0019980
 
        
Medical Arts Health Facility of Lawrenceville, Inc.
  Georgia   58-1329700
 
        
Moderncare of Lumberton, Inc.
  North Carolina   56-1217025
 
        
Nebraska City S-C-H, Inc.
  Nebraska   41-1413481
 
        
Nursing Home Operators, Inc.
  Ohio   34-0949279
 
        
Petersen Health Care, Inc.
  Alabama   59-2043392
 
        
South Alabama Nursing Home, Inc.
  California   95-3809397
 
        
South Dakota – Beverly Enterprises, Inc.
  Delaware   95-3750887
 
        
Southeastern Home Medical Equipment –
Alabama, LLC
  Delaware   20-1198867
 
        
Southeastern Home Medical Equipment –
Mississippi, LLC
  Delaware   20-1198933

-9-

 

         
    (State or other jurisdiction of   (I.R.S. Employer
(Exact names of registrants as   incorporation or   Identification
specified in its charter)
   organization)
   No.)
Southeastern Home Medical Equipment –
Tennessee, LLC
  Delaware   20-1198957
 
        
Spectra Healthcare Alliance, Inc.
  Delaware   71-0759298
 
        
Tar Heel Infusion Company, Inc.
  North Carolina   56-1767308
 
        
TMD Disposition Company
  Florida   59-3151568
 
        
Vantage Healthcare Corporation
  Delaware   35-1572998
 
        
VIZIA Healthcare Design Group, LLC
  Delaware   20-0337901
     
One Thousand Beverly Way
Fort Smith, Arkansas
(Address of principal executive offices) 		   
72919
(Zip code)

7⅞% Senior Subordinated Notes due 2014
(Title of the indenture securities)

-10-

 

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.

     
Name
   Address
Office of Banks & Trust Companies of the
State of Illinois
  500 E. Monroe Street
Springfield, Illinois 62701-1532
 
    
Federal Reserve Bank of Chicago
  230 S. LaSalle Street
Chicago, Illinois 60603

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

       Yes.

2.   Affiliations with Obligor.

       If the obligor is an affiliate of the trustee, describe each such affiliation.

       None.

16.   List of Exhibits.

Exhibits identified in parentheses below, on file with the Commission, are incorporated herein by reference as an exhibit hereto, pursuant to Rule 7a-29 under the Trust Indenture Act of 1939 (the “Act”) and 17 C.F.R. 229.10(d).

     
1.
  A copy of Articles of Incorporation of BNY Midwest Trust Company (formerly CTC Illinois Trust Company, formerly Continental Trust Company) as now in effect. (Exhibit 1 to Form T-1 filed with the Registration Statement No. 333-47688.)
   
2,3.
  A copy of the Certificate of Authority of the Trustee as now in effect, which contains the authority to commence business and a grant of powers to exercise corporate trust powers. (Exhibit 2 to Form T-1 filed with the Registration Statement No. 333-47688.)
   
4.
  A copy of the existing By-laws of the Trustee. (Exhibit 4 to Form T-1 filed with the Registration Statement No. 333-47688.)
   
6.
  The consent of the Trustee required by Section 321(b) of the Act. (Exhibit 6 to Form T-1 filed with the Registration Statement No. 333-47688.)
   
7.
  A copy of the latest report of condition of the Trustee published pursuant to law or to the requirements of its supervising or examining authority.

-11-

 

SIGNATURE

     Pursuant to the requirements of the Act, the Trustee, BNY Midwest Trust Company, a corporation organized and existing under the laws of the State of Illinois, has duly caused this statement of eligibility to be signed on its behalf by the undersigned, thereunto duly authorized, all in The City of Chicago, and State of Illinois, on the 22nd day of September, 2004.
         
  BNY Midwest Trust Company
 		  
  By:   C. Potter    
    Name:   C. Potter
    Title:   Assistant Vice President   
 

-12-

 

OFFICE OF BANKS AND REAL ESTATE
Bureau of Banks and Trust Companies

CONSOLIDATED REPORT OF CONDITION
OF

BNY Midwest Trust Company
2 North LaSalle Street
Suite 1020
Chicago, Illinois 60602

Including the institution’s domestic and foreign subsidiaries completed as of the close of business on March 31, 2004, submitted in response to the call of the Office of Banks and Real Estate of the State of Illinois.

         
ASSETS
   Thousands of Dollars
    (000)
1. Cash and Due from Depository Institutions
     45,800  
2. U.S. Treasury Securities
     -0-  
3. Obligations of States and Political Subdivisions
     -0-  
4. Other Bonds, Notes and Debentures
     -0-  
5. Corporate Stock
     -0-  
6. Trust Company Premises, Furniture, Fixtures and Other Assets Representing Trust Company Premises
     694  
7. Accounts Receivable
     4,398  
8. Goodwill
     86,813  
9. Intangibles
     -0-  
10. Other Assets
     133  
(Itemize amounts greater than 15% of Line 10)
        
Prepaid Expenses
     71  
Computer Software
     36  
11. TOTAL ASSETS
     137,838  

Page 1 of 3

 

OFFICE OF BANKS AND REAL ESTATE
Bureau of Banks and Trust Companies

CONSOLIDATED REPORT OF CONDITION
OF

BNY Midwest Trust Company
2 North LaSalle Street
Suite 1020
Chicago, Illinois 60602

         
LIABILITIES
   Thousands of Dollars
12. Accounts Payable
     42  
13. Taxes Payable
     4,678  
14. Other Liabilities for Borrowed Money
     25,425  
15. Other Liabilities
        
(Itemize amounts greater than 15% of Line 14)
        
Reserve for Taxes
     8,770  
 
     9,251  
16. TOTAL LIABILITIES
     39,396  
EQUITY CAPITAL
        
17. Preferred Stock
     -0-  
18. Common Stock
     2,000  
19. Surplus
     67,130  
20. Reserve for Operating Expenses
     -0-  
21. Retained Earnings (Loss)
     29,312  
22. TOTAL EQUITY CAPITAL
     98,442  
23. TOTAL LIABILITIES AND EQUITY CAPITAL
     137,838  

Page 2 of 3

 

     
I,
  Robert L. DePaola, Vice President
 
 
  (Name and Title of Officer Authorized to Sign Report)

of BNY Midwest Trust Company certify that the information contained in this statement is accurate to the best of my knowledge and belief. I understand that submission of false information with the intention to deceive the Commissioner or his Administrative officers is a felony.

/s/ Robert L. DePaola

(Signature of Officer Authorized to Sign Report)

Sworn to and subscribed before me this 23rd day of     January    , 2004.

My Commission expires May 15, 2007.

/s/ Joseph A. Giacobino, Notary Public

(Notary Seal)

Person to whom Supervisory Staff should direct questions concerning this report.

     
Emmie Chan
  Assistant Treasurer
 
 
 
Name
  Title
 
    
(212) 437-5639
    
 
Telephone Number (Extension)
    
 
    
eychan@bankofny.com
    
 
 
  
E-mail
    

Page 3 of 3