Envision - Class 5 (Second-Out Term Loan) Common Stock Registration Form

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IN THE UNITED STATES BANKRUPTCY COURT
FOR THE SOUTHERN DISTRICT OF TEXAS
HOUSTON DIVISION

	)
In re:	)	Chapter 11
	)
ENVISION HEALTHCARE CORPORATION, et al.,^{^[1]}	)	Case No. 23-90342 (CML)
	)
Debtors.	)	(Jointly Administered)
	)

REORGANIZED ENVISION PARENT NEW COMMON STOCK REGISTRATION FORM (this “Registration Form”)

FOR DISTRIBUTIONS PURSUANT TO THE PLAN

To: Holders of Class 5 – EVPS Second-Out Term Loan Claims (“Holders”) entitled to receive their pro rata share of 98.25% of the Reorganized Envision Parent New Common Stock, subject to dilution by the Reorganized Envision Parent Management Incentive Plan and the New Warrants, in accordance with the Plan of Envision Healthcare Corporation et al. – Case No. 23-90342 (CML)). Defined terms used herein but not defined shall have the meanings ascribed to such terms in the Plan.

In order to receive your distribution of Reorganized Envision Parent New Common Stock, you must submit a separate Registration Form for each Holder (at the fund level) as reflected on the lender register as of the Distribution Record Date.

Equity Registration Information Form Deadline (to receive Reorganized Envision Parent New Common Stock on or about the Effective Date): October 24, 2023 at 5:00 pm New York City Time (the “New Common Stock Registration Form Deadline”).

HOLDERS WHO DO NOT RETURN THIS REGISTRATION FORM AND SIGNATURE PAGE TO THE STOCKHOLDERS’ AGREEMENT BY THE NEW COMMON STOCK REGISTRATION FORM DEADLINE SHOULD EXPECT TO RECEIVE THEIR REORGANIZED ENVISION PARENT NEW COMMON STOCK ALLOCATION AFTER THE EFFECTIVE DATE, WHICH IS ANTICIPATED TO BE ON OR ABOUT OCTOBER 31, 2023.

If you do not complete and submit this Registration Form and the signature page to the Stockholders’ Agreement so that such documents are actually received by the Distribution Agent by the New Common Stock Registration Form Deadline, or if the information you have sent is incomplete or illegible, your distributions of Reorganized Envision Parent New Common Stock may be delayed to a subsequent round of distributions made after the Effective Date. If you fail to submit this Registration Form and the signature page to the Stockholders’ Agreement pursuant to the terms of this Registration Form by the one-year anniversary of the Effective Date, your Reorganized Envision Parent New Common Stock shall be deemed unclaimed property under section 347(b) of the Bankruptcy Code, and such distribution shall revert to the Reorganized EVPS Debtors automatically and without need for a further order by the Bankruptcy Court(notwithstanding any applicable federal, provincial, or state escheat, abandoned, or unclaimed property laws to the contrary), and your claim to your Reorganized Envision Parent New Common Stock shall be discharged and forever barred.

Each Holder of an EVPS Second-Out Term Loan Claim as of the Distribution Record Date may designate an Affiliate of such Holder (a “Designee”) to receive its pro rata share of the Reorganized Envision Parent New Common Stock.

[1] A complete list of each of the Debtors in these chapter 11 cases and the last four digits of their federal tax identification numbers may be obtained on the website of the Debtors’ Claims and Noticing Agent at https://restructuring.ra.kroll.com/Envision. The Debtors’ service address is 1A Burton Hills Boulevard, Nashville, Tennessee 37215.

Please list the name of the Holder exactly as it will appear on the lender register as of the Distribution Record Date:

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Download Signature Page to Stockholders' Agreement

Envision- Class 5 Signature Page.pdf 79 KB

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Upload Signature Page to Stockholders' Agreement

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Please deliver your completed Registration Form (with an accompanying IRS Form W-9 or appropriate IRS Form W-8, as applicable) to the Distribution Agent, via the Distribution Agent’s E-Portal. To access the Electronic Portal, visit https://restructuring.ra.kroll.com/envision/, click on the “Submit EVPS Class 5 Registration Information Form” section of the website and follow the instructions to submit your documentation.

THE E-PORTAL IS THE ONLY VALID METHOD OF SUBMISSION AND NO OTHER METHODS WILL BE ACCEPTED. Delivery of this Registration Form in any way other than as set out above will not constitute a valid submission of information. Delivery of this Registration Form to any person other than the Distribution Agent does not constitute delivery to the Distribution Agent.

Questions relating to this Registration Form should be directed to the Distribution Agent via email to EnvisionIssuerServices@is.kroll.com (please reference “AmSurg Registration Form” in the subject line) or at the following phone number: 833-477-3499 (Toll-free) and +1 646-440-4804 (International). To obtain copies of the documents, please visit https://restructuring.ra.kroll.com/Envision/.

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Envision - Class 5 (Second-Out Term Loan) Common Stock Registration Form

Introduction

Item 1. Holder Information

Item 2. Registration Delivery Information