Preview
Exhibit 8
Re: Simple Business Model for Vascular Setup
Subject: Re: Simple Business Model for Vascular Setup
From: "Andrew E. Gomes, MD"
Date: 3/10/2015, 10:14 PM
To: Sam Alam
BCC: Donna Looser
Sam,
See Ajay's response below. He is a very sharp guy, no bullshit, and trustworthy. Let's do a call with
him about this this week - ?
| like the idea of a box within a box.
RE: UCC
You can lead-line a room for cheap. What you need however is holding area for pre-post patients and
also a waiting room/exam. I'm not sure the UCC provides any synergy to adding patients. You would
need a fair amount of space during the 8-5 hours. Most MD's (no matter what Specialty - endovasc)
only want to work M-F 8-5. The flip-side is possibly offer vascular testing and screening to all those
who roll through the UCC (that I can see would benefit the vascular care center)
I'm not in favor of compressing the technical margin by sharing
for little gain, when finding space is
not that difficult. The model does allow for risk-sharing. If you did the procedures in an ASC, the ASC
would bill for the procedure because you are doing the procedure on their real estate under their
certificate. As soon as they bill, the revenue goes to their "shared profit" scheme.
As you pointed out. The deciding factor is going to be referrals. Doing a doc-in-a-doc-in-a-box means
choosing the right synergistic partner. That is going to be inside or next toa dialysis center. That
model is already being rolled out by Lifeline and Fresenius.
If you can get one center cash flow positive in a short time, the next two are easier. - rinse and repeat.
The whole thing is predicated on patients. patients. patients.
You have patients, you win.... that is it. Syndicates / Cartels / "Arrangements" / Patient Sources are
the key to your success, everything else is easy!!!
Ajay
On Tue, Mar 10, 2015 at 2:48 PM, Andrew E. Gomes, MD wrote:
Interesting. | believe a fixed C-arm would be required in order to do this, a mobile one would be a
jerry-rig at best, it would take 3 times longer to do procedures, and many (e.g. arteries, some of the
highest paying), you couldn't do at all b/c of the inability to do timed run-offs. We need to bring
Ajay into this conversation Sam, he is super smart, desi too! And he'll sign the NDA and we can
trust him
AG000365
Lof8 12/20/2019, 5:49 PM
Re: Name
Subject: Re: Name
From: "Andrew E. Gomes, MD"
Date: 3/17/2015, 12:19 PM
To: Sam Alam
Hi Sam,
| appreciate and am humbled by the kind words. I'm just a simple guy who happens to be a doctor,
there is so much wrong with healthcare and | cannot simply stand by and make SOOK and play golf like
all the other guys | know are doing. If I'm not part of the solution then | am part of the problem. And
hopefully if capitalism works the way it is supposed to, in disrupting things for the better, I'll be able to
earn some money to keep the lights on and keep food on the table. | have no doubt that you are a
large part of Monzer's success; does he acknowledge this? There is no substitute for front lines, in the
trenches experience -- not degree, or |Q, or salesmanship, or money -- and you definitely have that,
lots and lots of experience in this arena. So | have no doubt that you are the right person for me to
team up with. There are a lot of voids in my knowledge of healthcare right now, but fortunately you
fill them.
Regarding the "Casper Radiology, LLC" name, this would be a brand new Texas company, nothing at all
to do with "Casper Teleradiology, PLLC" which is a New York entity which | own 100% of. Donna has
been with me for a long time and worked for relatively low pay yet always done what | asked her,
learned new things, and always put up with my oftentimes demanding and exacting and perfectionist
nature. She trusts me, if we don't give her equity she would be okay with that, but | would like to
offer her more pay. Becky -- well | don't know her that well yet, it does seem that her political and
sales sawviness are slightly lacking, but we do need a "workhorse" marketing and referral generation
person, and she seems to fit that bill. | have no problem not offering her equity either, but if that were
the case then we'd definitely have to pay her more, and we'd have to figure out another way to
incentivize her to grow the pie (e.g. bonus based on % of collections). As long as she somehow got
paid more with our growth, I think she'd be ok with it. Tuan alone brings nothing to the table, if we
need his brother DT's investment and Tuan can make that happen, then he can get a small equity
piece for that e.g. DT - 28%, Tuan 2%. Ajay is super smart and motivated, | know you'd like him, when
he comes down we'll all meet. | do think he should have a small equity stake e.g. 5%, and I'm pretty
sure he'd be willing to put in money for that too.
On Tue, Mar 17, 2015 at 10:25 AM, Sam Alam wrote:
Andrew:
[have no problem. While | don’t know the ownership structure of Casper Radiology — | will give you “advice” as an
older man.
| find you to be one of the best MD | have seen in a long-long time. You have the potential to become — no
exaggeration - a very-very wealthy man. The traits | see in you — I wish my son had a few. You have success written
all over you and honestly speaking that is why | am driven to help you become successful.
AG000488
Lof3 12/20/2019, 5:44 PM
RE: FW: IR Centers
Subject: RE: FW: IR Centers
From: "Andrew E. Gomes, MD"
Date: 4/14/2015, 1:56 PM
To: Sam Alam
CC: Ajay Choudhri
No just tell me the amount I'll bring it
-
Andrew E. Gomes, MD
CEO - Casper Radiology
agomes casperradiolo; {COM
www.CasperRadiology.com
914-623-8156 - office
646-596-4926 - cell
917-591-7836 - efax
On Apr 14, 2015 1:53 PM, "Sam Been? wrote:
Andrew: do you want me to cut a check to Jon? Let me know.
Ajay: Please make yourself available to meet Jon Spiers over the phone on Monday
— just 10 minutes of your time is
\ fine
Sam
tia Senienentegtencere sis psc ee ~ ae si
From: Andrew E. Gomes, MD [mailto:aqomes@casperradiology.com]
Sent: Tuesday, April 14, 2015 12:35 PM
: To: Sam Alam
Ce: Ajay Choudhri This email negates Gome's affidavit that they told
Subject: Re: FW: IR Centers Sam did not provide the plan they requested from
him
Great. Things are moving forward. | think it's time to jump in and start swimming.
On Tue, Apr 14, 2015 at 12:33 PM, Sam Alam wrote:
' Andrew/Ajay: See below
From: Dr Jon Spiers [maitto:jps@jpspiers.com]
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Re: confidential info
Subject: Re: confidential info
From: "Andrew E. Gomes, MD"
Date: 3/10/2015, 10:16 PM
To: Ajay Choudhri @
Good shit. | forwarded to Sam. Let's do a call with him, and maybe Becky, later this week and have a
meeting of the minds on this. When are good days and times for you?
Thing is, Sam has the local connections to make something like this happen if we want
On Tue, Mar 10, 2015 at 8:13 PM, Ajay Choudhri wrote:
Andrew, ©
Next week was wide open until | booked it solid 2 weeks ago. | can't make it next week. | have time
on monday the week of 3/30. | can take that monday off and fly in on sunday night. I'd have to lock
that down pretty quick before someone grabs that day
| like the idea of a box within a box.
RE: UCC
You can lead-line a room for cheap. What you need however is holding area for pre-post patients
and also a waiting room/exam. I'm not sure the UCC provides any synergy to adding patients. You
would need a fair amount of space during the 8-5 hours. Most MD's (no matter what specialty -
endovasc) only want to work M-F 8-5. The flip-side is possibly offer vascular testing and screening
to all those who roll through the UCC (that | can see would benefit the vascular care center)
I'm not in favor of compressing the technical margin by sharing for little gain, when finding space is
not that difficult. The model does allow for risk-sharing. If you did the procedures in an ASC, the
ASC would bill for the procedure because you are doing the procedure on their real estate under
their certificate. As soon as they bill, the revenue goes to their "shared profit" scheme.
As you pointed out. The deciding factor is going to be referrals. Doing a doc-in-a-doc-in-a-box
means choosing the right synergistic partner. That is going to be inside or next to a dialysis center.
That model is already being rolled out by Lifeline and Fresenius.
If you can get one center cash flow positive in a short time, the next two are easier. - rinse and
repeat. The whole thing is predicated on patients. patients. patients.
You have patients (like Indian Reservations!!!!!!), you win.... that is it. Syndicates / Cartels /
"Arrangements" / Patient Sources are the key to your success, everything else is easy!!!
y
Ajay
AG002185
lofS 12/20/2019, 7:56
Preview
Exhibit 8 Re: Simple Business Model for Vascular Setup Subject: Re: Simple Business Model for Vascular Setup From: "Andrew E. Gomes, MD" Date: 3/10/2015, 10:14 PM To: Sam Alam BCC: Donna Looser Sam, See Ajay's response below. He is a very sharp guy, no bullshit, and trustworthy. Let's do a call with him about this this week - ? | like the idea of a box within a box. RE: UCC You can lead-line a room for cheap. What you need however is holding area for pre-post patients and also a waiting room/exam. I'm not sure the UCC provides any synergy to adding patients. You would need a fair amount of space during the 8-5 hours. Most MD's (no matter what Specialty - endovasc) only want to work M-F 8-5. The flip-side is possibly offer vascular testing and screening to all those who roll through the UCC (that I can see would benefit the vascular care center) I'm not in favor of compressing the technical margin by sharing for little gain, when finding space is not that difficult. The model does allow for risk-sharing. If you did the procedures in an ASC, the ASC would bill for the procedure because you are doing the procedure on their real estate under their certificate. As soon as they bill, the revenue goes to their "shared profit" scheme. As you pointed out. The deciding factor is going to be referrals. Doing a doc-in-a-doc-in-a-box means choosing the right synergistic partner. That is going to be inside or next toa dialysis center. That model is already being rolled out by Lifeline and Fresenius. If you can get one center cash flow positive in a short time, the next two are easier. - rinse and repeat. The whole thing is predicated on patients. patients. patients. You have patients, you win.... that is it. Syndicates / Cartels / "Arrangements" / Patient Sources are the key to your success, everything else is easy!!! Ajay On Tue, Mar 10, 2015 at 2:48 PM, Andrew E. Gomes, MD wrote: Interesting. | believe a fixed C-arm would be required in order to do this, a mobile one would be a jerry-rig at best, it would take 3 times longer to do procedures, and many (e.g. arteries, some of the highest paying), you couldn't do at all b/c of the inability to do timed run-offs. We need to bring Ajay into this conversation Sam, he is super smart, desi too! And he'll sign the NDA and we can trust him AG000365 Lof8 12/20/2019, 5:49 PM Re: Name Subject: Re: Name From: "Andrew E. Gomes, MD" Date: 3/17/2015, 12:19 PM To: Sam Alam Hi Sam, | appreciate and am humbled by the kind words. I'm just a simple guy who happens to be a doctor, there is so much wrong with healthcare and | cannot simply stand by and make SOOK and play golf like all the other guys | know are doing. If I'm not part of the solution then | am part of the problem. And hopefully if capitalism works the way it is supposed to, in disrupting things for the better, I'll be able to earn some money to keep the lights on and keep food on the table. | have no doubt that you are a large part of Monzer's success; does he acknowledge this? There is no substitute for front lines, in the trenches experience -- not degree, or |Q, or salesmanship, or money -- and you definitely have that, lots and lots of experience in this arena. So | have no doubt that you are the right person for me to team up with. There are a lot of voids in my knowledge of healthcare right now, but fortunately you fill them. Regarding the "Casper Radiology, LLC" name, this would be a brand new Texas company, nothing at all to do with "Casper Teleradiology, PLLC" which is a New York entity which | own 100% of. Donna has been with me for a long time and worked for relatively low pay yet always done what | asked her, learned new things, and always put up with my oftentimes demanding and exacting and perfectionist nature. She trusts me, if we don't give her equity she would be okay with that, but | would like to offer her more pay. Becky -- well | don't know her that well yet, it does seem that her political and sales sawviness are slightly lacking, but we do need a "workhorse" marketing and referral generation person, and she seems to fit that bill. | have no problem not offering her equity either, but if that were the case then we'd definitely have to pay her more, and we'd have to figure out another way to incentivize her to grow the pie (e.g. bonus based on % of collections). As long as she somehow got paid more with our growth, I think she'd be ok with it. Tuan alone brings nothing to the table, if we need his brother DT's investment and Tuan can make that happen, then he can get a small equity piece for that e.g. DT - 28%, Tuan 2%. Ajay is super smart and motivated, | know you'd like him, when he comes down we'll all meet. | do think he should have a small equity stake e.g. 5%, and I'm pretty sure he'd be willing to put in money for that too. On Tue, Mar 17, 2015 at 10:25 AM, Sam Alam wrote: Andrew: [have no problem. While | don’t know the ownership structure of Casper Radiology — | will give you “advice” as an older man. | find you to be one of the best MD | have seen in a long-long time. You have the potential to become — no exaggeration - a very-very wealthy man. The traits | see in you — I wish my son had a few. You have success written all over you and honestly speaking that is why | am driven to help you become successful. AG000488 Lof3 12/20/2019, 5:44 PM RE: FW: IR Centers Subject: RE: FW: IR Centers From: "Andrew E. Gomes, MD" Date: 4/14/2015, 1:56 PM To: Sam Alam CC: Ajay Choudhri No just tell me the amount I'll bring it - Andrew E. Gomes, MD CEO - Casper Radiology agomes casperradiolo; {COM www.CasperRadiology.com 914-623-8156 - office 646-596-4926 - cell 917-591-7836 - efax On Apr 14, 2015 1:53 PM, "Sam Been? wrote: Andrew: do you want me to cut a check to Jon? Let me know. Ajay: Please make yourself available to meet Jon Spiers over the phone on Monday — just 10 minutes of your time is \ fine Sam tia Senienentegtencere sis psc ee ~ ae si From: Andrew E. Gomes, MD [mailto:aqomes@casperradiology.com] Sent: Tuesday, April 14, 2015 12:35 PM : To: Sam Alam Ce: Ajay Choudhri This email negates Gome's affidavit that they told Subject: Re: FW: IR Centers Sam did not provide the plan they requested from him Great. Things are moving forward. | think it's time to jump in and start swimming. On Tue, Apr 14, 2015 at 12:33 PM, Sam Alam wrote: ' Andrew/Ajay: See below From: Dr Jon Spiers [maitto:jps@jpspiers.com] AG000986 lofS 12/20/2019, 5:21 & = = >a aS oD oz De® Pc = 2 2 = & of e @ < ot sa ots ws a x G50 ano £ 65 QNDE as as Re: confidential info Subject: Re: confidential info From: "Andrew E. Gomes, MD" Date: 3/10/2015, 10:16 PM To: Ajay Choudhri @ Good shit. | forwarded to Sam. Let's do a call with him, and maybe Becky, later this week and have a meeting of the minds on this. When are good days and times for you? Thing is, Sam has the local connections to make something like this happen if we want On Tue, Mar 10, 2015 at 8:13 PM, Ajay Choudhri wrote: Andrew, © Next week was wide open until | booked it solid 2 weeks ago. | can't make it next week. | have time on monday the week of 3/30. | can take that monday off and fly in on sunday night. I'd have to lock that down pretty quick before someone grabs that day | like the idea of a box within a box. RE: UCC You can lead-line a room for cheap. What you need however is holding area for pre-post patients and also a waiting room/exam. I'm not sure the UCC provides any synergy to adding patients. You would need a fair amount of space during the 8-5 hours. Most MD's (no matter what specialty - endovasc) only want to work M-F 8-5. The flip-side is possibly offer vascular testing and screening to all those who roll through the UCC (that | can see would benefit the vascular care center) I'm not in favor of compressing the technical margin by sharing for little gain, when finding space is not that difficult. The model does allow for risk-sharing. If you did the procedures in an ASC, the ASC would bill for the procedure because you are doing the procedure on their real estate under their certificate. As soon as they bill, the revenue goes to their "shared profit" scheme. As you pointed out. The deciding factor is going to be referrals. Doing a doc-in-a-doc-in-a-box means choosing the right synergistic partner. That is going to be inside or next to a dialysis center. That model is already being rolled out by Lifeline and Fresenius. If you can get one center cash flow positive in a short time, the next two are easier. - rinse and repeat. The whole thing is predicated on patients. patients. patients. You have patients (like Indian Reservations!!!!!!), you win.... that is it. Syndicates / Cartels / "Arrangements" / Patient Sources are the key to your success, everything else is easy!!! y Ajay AG002185 lofS 12/20/2019, 7:56