Fill and Sign the Agreement Share Form

Agreement between Physicians to Share Offices without Forming PartnershipAgreement made on the ______________ (date), between ____________________ (Name of Dr. One) of __________________________________________________________ ___________________ (street address, city, state, zip code) , referred to herein as Dr. One, and ___________________ (Name of Dr. Two), of ___________________________________ ___________________________________________ (street address, city, state, zip code), referred to herein as Dr. Two. Whereas, each of the parties is a doctor of medicine, and each is licensed by the State of ________________ (name of state) to practice medicine in that state; and Whereas, Dr. One is a tenant under a lease of a certain suite of offices located at ____________________________________________________________________________ (street address, city, state, zip code) , hereinafter called the Premises, which Dr. Two desires to share only for the practice of medicine; Now, therefore, for and in consideration of the mutual covenants contained in this agreement, and other good and valuable consideration, the receipt and sufficiency of which is hereby acknowledged, the parties agree as follows: 1. Sharing of Offices The parties shall share the Premises, and the equipment, furniture and fixtures used in connection with the Premises, for their respective practices of medicine. 2. Duration This agreement shall continue in force for an indefinite time, provided that it shall terminate: A. On termination of Dr. One's lease of the Premises; B. On _____ (number) days' written notice by either party to the other; or C. At any time on mutual agreement by the parties in writing. 3. Relationship of the Parties The parties are not partners, and the clientele and income of each are separate and distinct. As a matter of convenience or accommodation, one or the other of the parties may from time to time furnish medicines or render other services to a patient of the other, but in that event the party rendering service shall collect the applicable fee and charges from the patient, and the other party shall be in no way liable for those fees and charges. 4. Consideration A. The parties will prorate the monthly overhead of the above-described office according to the gross earnings from professional fees of each during the month. B. Gross earnings means the total business done by a party, including both cash and fees charged, but carried as credit items, less discounts given patients on accounts incurred after _______________ (date), fees paid to other physicians, laboratory fees and similar such expenses that have been paid. C. The following items shall not be included in gross earnings or considered in prorating office overhead:1. Accounts receivable that were contracted prior to the effective date of this Agreement; and 2. Redeemed accounts of patients that are later paid by the patient. D. In arriving at the total overhead for the month, the following items shall be included: 1. Rent, which for the purposes of this Agreement shall be considered to be $__________ per month, regardless of fluctuation of the rent payable under Dr. One's lease; 2. Employees' salaries, and any Social Security, unemployment or other taxes; 3. Office supplies, drugs, dressings and all other expendable items normally used in the operation of a physician's office; 4. Office interior maintenance and janitorial service; 5. Fire and extended coverage insurance on furniture, fixtures and equipment used jointly, and depreciation on equipment used jointly; 6. Utilities; 7. Personal property taxes, and any other taxes, levied on equipment, furniture and fixtures used jointly; 8. (List other items) ___________________________________________ ________________________________________________________________. E. The following items are not included in overhead, and each party is responsible for the payment of the party's own expenses for such items: 1. Telephones, which shall be kept separately by each party; 2. License fees and taxes pertaining to a party individually, such as narcotics stamps, professional organization dues, occupation taxes and state licensing fees; 3. Automobile expenses, incident to both operation and maintenance; 4. Insurance coverage, such as errors and omissions coverage, malpractice coverage, health and accident coverage and insurance on any instruments and equipment not used jointly; 5. Contributions to various charities and projects; 6. Professional fees paid, such as those of accountants and attorneys; 7. Interest and other bank charges, it being the intent of the parties that each shall maintain separate banking arrangements; F. Dr. Two shall pay his share of the overhead to Dr. One on or before the _____ day of the month following the month in which the overhead was incurred. Dr. One will make the necessary disbursements to creditors. 5. Ownership of Lease and Equipment Ownership of the lease on the Premises and the equipment, furniture and fixtures used jointly in the Premises is and shall remain in Dr. One. A schedule of the equipment, furniture and fixtures is attached as Exhibit A and incorporated by this reference. 6. Restricted Use of Premises Use of the Premises shall be restricted to the practice of medicine. 7. Subtenancy and Assignment Construction of this Agreement shall be that Dr. Two is a subtenant under Dr. One and that Dr. Two cannot, without Dr. One's written consent, take a partner or employ an assistant physician in or about the Premises, assign any interest under this Agreement or sublet to any person, firm or corporation. 8. Severability The invalidity of any portion of this Agreement will not and shall not be deemed to affect the validity of any other provision. If any provision of this Agreement is held to be invalid, the parties agree that the remaining provisions shall be deemed to be in full force and effect as if they had been executed by both parties subsequent to the expungement of the invalid provision. 9. No Waiver The failure of either party to this Agreement to insist upon the performance of any of the terms and conditions of this Agreement, or the waiver of any breach of any of the terms and conditions of this Agreement, shall not be construed as subsequently waiving any such terms and conditions, but the same shall continue and remain in full force and effect as if no such forbearance or waiver had occurred. 10. Governing Law This Agreement shall be governed by, construed, and enforced in accordance with the laws of the State of _____________. 11. Notices Any notice provided for or concerning this Agreement shall be in writing and shall be deemed sufficiently given when sent by certified or registered mail if sent to the respective address of each party as set forth at the beginning of this Agreement. 12. Mandatory Arbitration Any dispute under this Agreement shall be required to be resolved by binding arbitration of the parties hereto. If the parties cannot agree on an arbitrator, each party shall select one arbitrator and both arbitrators shall then select a third. The third arbitrator so selected shall arbitrate said dispute. The arbitration shall be governed by the rules of the American Arbitration Association then in force and effect. 13. Entire AgreementThis Agreement shall constitute the entire agreement between the parties and any prior understanding or representation of any kind preceding the date of this Agreement shall not be binding upon either party except to the extent incorporated in this Agreement. 14. Modification of Agreement Any modification of this Agreement or additional obligation assumed by either party in connection with this Agreement shall be binding only if placed in writing and signed by each party or an authorized representative of each party. 15. In this Agreement, any reference to a party includes that party's heirs, executors, administrators, successors and assigns, singular includes plural and masculine includes feminine. WITNESS our signatures as of the day and date first above stated. ________________________ _________________________ (Printed name) (Printed name) ________________________ _________________________ (Signature of Dr. One) (Signature of Dr. Two)