Ictdl Jiiu /R^ GENERAL INFORMATION SHEET (GIS) M & \W BT , for the YEAR 2021 RECEIVCDSOB ------—— STOCK CORPORATION GENERAL INSTRUCTIONS: [ ------^7 1
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* ■ «=f S On,j A r>9«=» ICTDl jiiu /r^ GENERAL INFORMATION SHEET (GIS) m & \W BT , FOR THE YEAR 2021 RECEIVCDSOB -------—— STOCK CORPORATION GENERAL INSTRUCTIONS: [ --------------- ^7 1. FOR USER CORPORATION: THIS GIS SHOULD BE SUBMITTED WITHIN THIRTY (30) CALENDAR DAYS FROM THE DATE Or THE ANNUAL STOCKHOLDERS' MEETING. DO NOT LEAVE ANY ITEM BLANK. WRITE "N.A." IF THE INFORMATION REQUIRED IS NOT APPLICABLE TO THE CORPORATION OR "NONE" IF THE INFORMATION IS NON-EXISTENT. IF THE ANNUAL STOCKHOLDERS' MEETING IS HELD ON A DATE OTHER THAN THAT STATED IN THE BY-LAWS, THE GIS SHALL BE SUBMITTED WITHIN THIRTY (30) CALENDAR DAYS AFTER THE ELECTION OF THE DIRECTORS, TRUSTEES AND OFFICERS OF THE CORPORATION AT THE ANNUAL MEMBERS' MEETING. 2. IF NO MEETING IS HELD, THE CORPORATION SHALL SUBMIT THE GIS NOT LATER THAN JANUARY 30 OF THE FOLLOWING YEAR. HOWEVER, SHOULD AN ANNUAL STOCKHOLDERS' MEETING BE HELD THEREAFTER, A NEW GIS SHALL BE SUBMITTED/FILED. 3. THIS GIS SHALL BE ACCOMPLISHED IN ENGLISH AND CERTIFIED AND SWORN TO BY THE CORPORATE SECRETARY OF THE CORPORATION. 4. THE SEC SHOULD BE TIMELY APPRISED OF RELEVANT CHANGES IN THE SUBMITTED INFORMATION AS THEY ARISE. FOR CHANGES RESULTING FROM ACTIONS THAT AROSE BETWEEN THE ANNUAL MEETINGS, THE CORPORATION SMALL SUBMIT AMENDED GIS CONTAINING THE NEW INFORMATION TOGETHER WITH A COVER LETTER SIGNED THE CORPORATE SECRETARY OF THE CORPORATION. THE AMENDED GIS AND COVER LETTER SHALL BE SUBMITTED WITHIN SEVEN (7) DAYS AFTER SUCH CHANGE OCCURED OR BECAME EFFECTIVE. 5. SUBMIT FOUR (4) COPIES OF THE GIS TO THE RECEIVING SECTION AT THE SEC MAIN OFFICE, OR TO SEC SATELLITE OFFICES OR EXTENSION OFFICES. ALL COPIES SHALL UNIFORMLY BE ON A4 OR LETTER-SIZED PAPER. THE PAGES OF ALL COPIES SHALL USE ONLY ONE SIDE 6. ONLY THE GIS ACCOMPLISHED IN ACCORDANCE WITH THESE INSTRUCTIONS SHALL BE CONSIDERED AS HAVING BEEN FILED. 7. THIS GIS MAY BE USED AS EVIDENCE AGAINST THE CORPORATION AND ITS RESPONSIBLE DIRECTORS/OFFICERS FOR ANY VIOLATION OF EXISTING LAWS, RULES AND REGULATIONS ===== PLEASE PRINT LEGIBLY =========== CORPORATE NAME: DATE REGISTERED: VALUE CARE HEALTH SYSTEMS, INC. 04/18/1997 BUSINESS/TRADENAME: FISCAL YEAR END: VALUE CARE HEALTH SYSTEMS, INC. SEC REGISTRATION NUMBER: A1997-04963 December 31 DATE OF ANNUAL MEETING PER BY-LAWS: CORPORATE TAX IDENTIFICATION NUMBER mm Every Third Friday of May 004-986-965-000 ACTUAL DATE OF ANNUAL MEETING: WEBSITE/URL ADDRESS: 6-May-21 www.vaUiecareheaIth.com COMPLETE PRINCIPAL OFFICE ADDRESS: E-MAIL ADDRESS: NO. 33 MERALCO AVENUE, BARANGAY SAN ANTONIO, PASIG CITY [email protected] COMPLETE BUSINESS ADDRESS: FAX NUMBER: NO. 33 MERALCO AVENUE, BARANGAY SAN ANTONIO, PASIG CITY 8637-9456 OFFICIAL E-MAIL ADDRESS ALTERNATE E-MAIL ADDRESS OFFICIAL MOBILE NUMBER ALTERNATE MOBILE [email protected] [email protected] 0917-863-5290 0905-133-4831 NAME OF EXTERNAL AUDITOR & ITS SIGNING PARTNER: SEC ACCREDITATION NUMBER (if TELEPHONE NUMBER(S): applicable): MACEDA VALENCIA & CO/ARACEL1 F. CASELES 1779-A 8702-3388 PRIMARY PURPOSE/ACTIVITY/INDUSTRY PRESENTLY ENGAGED IN: INDUSTRY CLASSIFICATION: GEOGRAPHICAL CODE: HEALTH MAINTENANCE ORGANIZATION ("HMO") HMO N/A ======================= INTERCOMPANY AFFILIATIONS : = = = = = = = = = = = = = : PARENT COMPANY SEC REGISTRATION NO. ADDRESS N/A N/A N/A SUBSIDIARY/AFFILIATE SEC REGISTRATION NO. ADDRESS MEDISCAN DIAGNOSTIC CENTER A1996-07024 1332-1336 WEST EAST CENTER, TAFT AVENUE, MANILA MRI DIAGNOSTIC CENTER, INC. A2002-05489 1334 WEST EAST CENTER, TAFT AVENUE, ERMITA, MANILA CARDINAL SANTOS MEDICAL CENTER COMPOUND, WILSON CARDINAL MRI CENTER INC. A199610242 ST. GREENHILLS, SAN |UAN CITY NOTE: USE ADDITIONAL SHEET IF NECESSARY GIS_STOCK(v.2020) Page 1 I GENERAL INFORMATION SHEET STOCK CORPORATION :===; ======== == PLEASE PRINT LEGIBLY ======== : = : : = = = = Corporate Name: VALUE CARE HEALTH SYSTEMS, INC. A. Is the Corporation a covered person under the Anti Money Laundering Act ♦ Yes r no (AMLA), as amended? (Rep. Acts. 9160/9164/10167/10365) Please check the appropriate box: 1. G a. Banks Jewelry dealers in precious metals, who, as a O b. Offshore Banking Units 4.n business, trade in precious metals □ c. Quasi-Banks □ d. Trust Entities FI e. Non-Stock Savings and Loan Associations □ f. Pawnshops Q g. Foreign Exchage Dealers s.D Jewelry dealers in precious stones, who, as a □ h. Moneychangers business, trade in precious stone I I i. Remittance Agents O j. Electronic Money Issuers I I k. Financial Institutions which Under Special Laws are subject to Bangko Sentral ng Pilipinas' (BSP] supervision and/or regulation, Company service providers which, as a business, including their subsidiaries and affiliates. 6. provide any of the following services to third 2. parties: Q a. Insurance Companies □ b. Insurance Agents □ a. acting as a formation agent of juridical persons I I c. Insurance Brokers I I b. acting as (or arranging for another person to act as] Q d. Professional Reinsurers a director or corporate secretary of a company, a □ e. Reinsurance Brokers partner of a partnership, or a similar position in Q f Holding Companies relation to other juridical persons Q g. Holding Company Systems Q h. Pre-need Companies □ c. providing a registered office, business address or □ i. Mutual Benefit Association accommodation, correspondence or administrative [2] j. All Other Persons and entities supervised and/or regulated by the address for a company, a partnership or any other Insurance Commission (IC) legal person or arrangement 3. [J a. Securities Dealers I | d. acting as (or arranging for another person to act as] □ b. Securities Brokers a nominee shareholder for another person CH c. Securities Salesman 7. Persons who provide any of the following services: ] d. Investment Houses | | a. managing of client money, securities or other assets D e. Investment Agents and Consultants □ f. Trading Advisors EH b. management ofbank, savings or securities accounts □ g. Other entities managing Securities or rendering similar services □ h. Mutual Funds or Open-end Investment Companies EH c. organization of contributions for the creation, EH i. Close-end Investment Companies operation or management of companies I I j. Common Trust Funds or Issuers and other similar entities I I k. Transfer Companies and other similar entities EH d. creation, operation or management of juridical □ 1. Other entities administering or otherwise dealing in currency, persons or arrangements, and buying and selling commodities or financial derivatives based there on business entities EH m. Entities administering of otherwise dealing in valuable objects «- 1 1 None of the above EH n. Entities administering or otherwise dealing in cash Substitutes and Describe Health Maintenance Organization other similar monetary instruments or property supervised and/or nature of regulated by the Securities and Exchange Commission (SEC] business: B. Has the Corporation complied with the requirements on Customer Due Diligence (CDD] or Know Your Customer (KYC], record-keeping, and submission of reports - Yes No under the AMLA, as amended, since the last filing of its CIS?__________________ GIS_STOCK(v.2020] Page 2 GENERAL INFORMATION SHEET STOCK CORPORATION === PLEASE PRINT LEGIBLY = CORPORATE NAME: VALUE CARE HEALTH SYSTEMS, INC CAPITAL STRUCTURE AUTHORIZED CAPITAL STOCK NUMBER OF AMOUNT (PhP) TYPE OF SHARES* PAR/STATED VALUE SHARES (No. of shares X Par/Stated Value) COMMON 250,000,000 1.00 250,000,000.00 TOTAL 250,000,000 TOTAL P 250,000,000.00 SUBSCRIBED CAPITAL NUMBER OF NO. OF NUMBER OF SHARES IN THE PAR/STATED % OF FILIPINO STOCK TYPE OF SHARES* AMOUNT (PhP) SHARES HANDS OF THE VALUE OWNERSHIP HOLDERS PUBLIC** 17 COMMON 250,000,000 1.00 _2sg,pgo,ggo.qo_ 100.00 17 TOTAL 250,000,000 TOTAL TOTAL P 250,000,000.00 NUMBER OF FOREIGN NO. OF NUMBER OF SHARES IN THE PAR/STATED % OF (INDICATE BY STOCK TYPE OF SHARES* AMOUNT (PhP) SHARES HANDS OF THE VALUE OWNERSHIP NATIONALITY) HOLDERS PUBLIC** N/A Percentage of Foreign Equity : TOTAL TOTAL TOTAL P TOTAL SUBSCRIBED P 250,000,000.00 PAID-UP CAPITAL NO. OF NUMBER OF % OF FILIPINO STOCK TYPE OF SHARES* PAR/STATED VALUE AMOUNT (PhP) SHARES OWNERSHIP HOLDERS 17 COMMON 250,000,000 1.00 _2_5g,ogq,gqo_.go_ 100.00 17 TOTAL 250,000,000 TOTAL P 250,000,000.00 100.00 FOREIGN NO. OF NUMBER OF % OF (INDICATE BY STOCK TYPE OF SHARES* PAR/STATED VALUE AMOUNT (PhP) SHARES OWNERSHIP NATIONALITY) HOLDERS N/A 0.00 % TOTAL TOTAL P TOTAL PAID-UP P 250,000,000.00 * This includes Value Care Health Systems, Inc, which purchased eight (8) common shares. ** Other than Directors, Officers, Shareholders owning 10% of outstanding shares. G1S.STOCK (v.2020) Page 3 GENERAL INFORMATION SHEET STOCK CORPORATION == PLEASE PRINT LEGIBLY === CORPORATE NAME: VALUE CARE HEALTH SYSTEMS, INC. DIRECTORS / OFFICERS STOCK EXEC. NAME/CURRENT RESIDENTIAL ADDRESS NATIONALITY (NCR BOARD GENDER OFFICER TAX IDENTIFICATION HOLDER COMM. NUMBER 1. DR. SAMUEL D.ANG 19 Bunker Hill, New Manila, Quezon Filipino Y C M Y N/A A/M 161-577-019 City 2. DR. PATRICIA L. TAN President/ C/C& 36 Apo Street, Sta. Mesa Heights, Filipino Y M F Y 113-933-071 CEO A/C Quezon City 3. DR. JOSE Y. GARCIA ]R. 28 Padre Burgos, Ayala Heights Filipino YM MY N/A 129-344-903 Village, Matandang Balara, Quezon 4. DR. LAWRENCE 0. GOTAMCO Filipino Y M M Y N/A N/C 6 Obudan Street, Manresa, Quezon 119-451-633 5. DR. JOSEFINA C. CHUA 112 Apo Street, Barangay Lourdes, Filipino N M F Y Treasurer C/M 132-459-396 Quezon City 6. DR. CESAR S. CO 5 Dinalupihan Street, Damar Village, Filipino Y MM Y N/A N/M 111-221-707 Quezon City 7. ROBERTSON K. LAUREL 95 Xavier Street, Unit 4C Avalon Filipino N 1 M Y N/A N/M 134-021-309 Condominium, Greenhills, San Juan 8. JOHNLU G. KOA 2nd Floor, Unit 6,108 E.