10. Fire/Extended Coverage:

(a) Does Named Insured lease premises from others (where estimated value of leased portion exceeds $25,000 give schedule and whether liability assumed)?
   Yes - Information not available. Primary coverage providing CCC except for owned property or net lease agreements.

(b) Indicate locations where estimated value of personal property of others in Named Insured's Care, Custody or Control may exceed $25,000 (e.g., data processing equipment, leased machinery, material on consignment, storage). List of locations not available. Exposure is covered under the primary general liability policy.

11. State loss record during the past five years specifying:
   (a) All bodily injury or property damage claims (whether insured or not), in excess of $25,000 (enter full amount from first dollar in each case):
      see attachment #3
   (b) In respect of Products Liability, the Aggregate amount of losses (from first dollar) by year:
      See attachment #4

12. Is the Named Insured a Self-Insured for W.C.A.? yes

If 'yes' specify:
   (a) States where Self-Insured:
      Ohio
   (b) Excess protection carried, including E.L. and E.L.O.D. limits:
      $1,500,000 policy aggregate for occupational disease
      $500,000 Bodily Injury by accident
      $500,000 each employee for occupational disease

13. Has the Named Insured any known exposure under the following legislation? No. If 'yes' specify which and give separate payrolls:
   (i) Jones Act:
   (ii) Federal Railroad Employees Act:
   (iii) Federal Longshoremen's & Harbor Workers' Act.

14. If Malpractice cover required, state:
   (a) Number of Doctors employed: Full Time Part Time
      50        45
   (b) Number of Nurses employed: 198       44