> ## Documentation Index > Fetch the complete documentation index at: https://mso.getlemma.com/llms.txt > Use this file to discover all available pages before exploring further. # The complete agreement stack (checklist) > Master table of every document a mature MSO-PC group holds: parties, purpose, refresh cadence, and who typically drafts. Every document an MSO-PC group should hold, with who the parties are, what it does, how often it needs review, and who drafts it. Use it as a completeness check and as a diligence preparation list. ## The core five Required for any MSO-PC structure. See [Step 5: Sign the agreement stack](/start/zero-to-paid/sign-the-agreement-stack). | Document | Parties | Purpose | Refresh | Drafted by | | ---------------------------------------- | ------------------------------------ | -------------------------------------------------------------------------------- | ----------------------------------------------------- | ------------------------------- | | **Management services agreement** | MSO ↔ each PC | Defines services, fee, and the clinical carve-out | **Annually**, and on any state law change | Healthcare regulatory counsel | | **Stock transfer restriction agreement** | PC, its owner, and typically the MSO | Pre-wires succession on death, disability, license loss, exclusion, or departure | **Annually**, heavily targeted by current legislation | Healthcare regulatory counsel | | **Clinician employment agreements** | PC ↔ each clinician | Compensation, duties, malpractice, restrictive covenants | Annually; **immediately** on state noncompete changes | Employment + healthcare counsel | | **Business associate agreement** | Each PC ↔ MSO | HIPAA compliance; required content at 45 C.F.R. § 164.504(e) | Annually | Privacy counsel | | **IP / brand license** | MSO ↔ each PC | Lets the PC operate under the MSO's brand | On brand changes | Corporate counsel | **One MSA, one transfer restriction, and one BAA per PC.** Each professional entity is a separate contracting party and a separate covered entity. A ten-PC group holds ten of each. ## Corporate documents | Document | Entity | Purpose | Refresh | Drafted by | | ------------------------------------------ | ------------------------------- | ------------------------------------------------------------------- | ----------------------- | -------------------------- | | Articles of incorporation / organization | Each entity | Formation | On amendment | Counsel | | Bylaws or operating agreement | Each entity | Governance | On material change | Counsel | | Organizational consents | Each entity | Initial authorizations | Once | Counsel | | **Annual consents / minutes** | Each entity | Elect officers, ratify actions, **evidence PC clinical governance** | **Annually** | Internal, counsel-reviewed | | Stock ledger / membership register | Each entity | Ownership record | On any transfer | Internal | | Stock certificates with restrictive legend | Each PC | Enforceability against transferees | On issuance | Counsel | | Spousal consent | Each PC owner, where applicable | Community property states | On marriage or transfer | Counsel | ## Real estate and equipment | Document | Parties | Purpose | Refresh | | --------------------------------- | -------------- | ------------------------------------- | ---------------------------------------------------------- | | Lease | MSO ↔ landlord | Premises | At renewal | | Sublease or occupancy arrangement | MSO ↔ PC | How the PC uses the space | Annually, **FMV matters if a referral source is involved** | | Equipment leases | MSO ↔ vendor | Equipment | At renewal | | Equipment use arrangement | MSO ↔ PC | Provided under the MSA, or separately | Annually | Space and equipment arrangements with anyone who can refer patients need to satisfy fair market value and the shape of the AKS space and equipment rental safe harbors — written, at least one year, set in advance, FMV, and not varying with referrals. See [Stark and anti-kickback](/concepts/compliance/stark-and-anti-kickback). ## Vendor and technology | Document | Parties | Purpose | Refresh | | ---------------------------------- | ------------------------------ | ------------------- | ---------------------------------------- | | EHR / PM agreement | MSO ↔ vendor | System licensing | At renewal; **check data export rights** | | Clearinghouse agreement | MSO or PC ↔ clearinghouse | Claim transmission | At renewal | | **Subcontractor BAAs** | MSO ↔ each PHI-handling vendor | HIPAA chain | Annually; on every new vendor | | RCM services agreement | MSO or PC ↔ vendor | Outsourced billing | At renewal | | Payroll and benefits agreements | Each employer ↔ vendor | Payroll | At renewal | | Collections agency agreement + BAA | PC ↔ agency | Patient collections | Annually | ## Payer | Document | Parties | Purpose | Refresh | | ---------------------------------- | ------------------------ | ------------------------------- | ----------------------------------- | | Participation agreements | **Each PC** ↔ each payer | Network participation and rates | Annually, review rates | | Fee schedules | Attached or referenced | The real economics | Annually | | EDI / ERA / EFT authorizations | Each PC ↔ each payer | Electronic plumbing | On any bank or clearinghouse change | | Single-case agreements | PC ↔ payer | Out-of-network individual cases | Per case | | Delegated credentialing agreements | PC ↔ payer | Where applicable at scale | Per payer terms | ## Financial | Document | Parties | Purpose | Refresh | | ------------------------------------------- | ----------------------- | --------------------------------- | ------------------------------------------ | | **Intercompany promissory notes** | MSO ↔ PC | Documented loans, at AFR or above | On each new advance; amend on modification | | Bank account agreements and signature cards | Each entity ↔ bank | Accounts and authority | On signer change | | Credit facility documents | MSO, and sometimes PCs | Working capital | At renewal | | Deposit account control agreements | Entity ↔ bank ↔ lender | Where a lender requires | Per facility | | Merchant processing agreement | Each entity ↔ processor | Card acceptance | At renewal | | **FMV study / opinion** | Third party | Supports the management fee | **Annually**, and before any fee change | ## Insurance | Policy | Held by | Notes | | ------------------------------------ | --------------- | --------------------------------------------------------------------------------------------- | | Professional liability (malpractice) | **PC** | Occurrence vs claims-made; **tail responsibility must be addressed in employment agreements** | | General liability | MSO | | | Property | MSO | | | Cyber liability | Both | Post-2024, effectively standard | | Errors and omissions | MSO | | | Employment practices liability | Both | | | Directors and officers | Both | | | Workers' compensation | Both, per state | | ## Compliance | Document | Purpose | Refresh | | --------------------------------- | ---------------------------------- | ----------------------------------- | | HIPAA policies and procedures | Privacy and security program | Annually | | **Security risk analysis** | Required under the Security Rule | **Annually** and on material change | | Notice of Privacy Practices | Patient-facing | On material change | | Compliance program policies | Billing and coding compliance | Annually | | Financial policy (patient-facing) | Payment terms; chargeback evidence | Annually | | **BAA inventory** | Tracks the whole chain | Continuously | | Exclusion screening records | OIG LEIE, SAM.gov | **Monthly**, documented | | Training records | HIPAA and compliance | Annually | ## Diligence readiness What an acquirer or investor asks for, in roughly this order. Being able to produce it quickly is worth real money. * [ ] Every MSA, with all amendments * [ ] Every transfer restriction agreement, and the stock ledgers * [ ] Every clinician employment agreement * [ ] All BAAs, plus the inventory * [ ] Formation documents and good standing certificates, every entity, every state * [ ] **Board minutes and consents, all years**, including PC clinical governance records * [ ] Every payer contract and fee schedule * [ ] Intercompany notes and the payment history * [ ] FMV studies * [ ] Evidence the management fee was **paid in cash**, monthly * [ ] Per-entity financial statements plus consolidation with eliminations * [ ] Insurance policies and loss runs * [ ] The security risk analysis and HIPAA program * [ ] Exclusion screening records * [ ] Any regulatory correspondence, audits, or investigations **The most commonly missing items are board minutes and evidence of cash fee payment.** Both are cheap to maintain contemporaneously and expensive to reconstruct. See [Maintain corporate formalities](/guides/formation/maintain-corporate-formalities). ## Refresh calendar | Cadence | Documents | | ------------- | --------------------------------------------------------------------------------------------------------------- | | **Monthly** | Exclusion screening; management fee invoices | | **Quarterly** | State legislation scan; access review | | **Annually** | MSA and full stack review; FMV; security risk analysis; training; entity consents; insurance; payer rate review | | **On event** | State law change; new state; new entity; fee change; owner change; new vendor; bank change | ## Related topics - [Step 5: Sign the agreement stack](/start/zero-to-paid/sign-the-agreement-stack.md) - [Set up your compliance calendar](/start/first-90-days/compliance-calendar.md) - [Draft the management services agreement (MSA)](/guides/agreements/draft-a-management-services-agreement.md) - [Hire healthcare counsel (and use them well)](/guides/agreements/get-agreements-reviewed.md) - [Maintain corporate formalities](/guides/formation/maintain-corporate-formalities.md) - [MSA clause anatomy](/reference/legal/msa-clause-anatomy.md) - [Intercompany loans between MSO and PC: structure and example clause](/reference/legal/intercompany-loan-note.md)