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1 a. ORGANIZATIONS NAME
SIMMONS -SLC, LLC
lb. INDIVIDUALS LAST NAME
FIRST NAME
MIDDLE NAME
SUFFIX
lc. MAILING ADDRESS
515 South 700 East, Suite 1C
CITY
Salt Lake City
STATE
UT
POSTAL CODE
84102
COUNTRY
USA
1d. TAX ID SSN OR EIN
ADD'L INFO RE I le. TYPE OF ORGANIZATION
ORGANIZATION I LLC
DEBTOR
1f. JURISDICTION OF ORGANIZATION
Utah
1 g. ORGANIZATIONAL ID if any
UT- 4877555 -0160 NONE
OR
2a. ORGANIZATIONS NAME
2b. INDIVIDUAL'S LAST NAME
FIRST NAME
MIDDLE NAME
SUFFIX
2c. MAILING ADDRESS
CITY
STATE
POSTAL CODE
COUNTRY
2d. TAX ID SSN OR EIN
ADD'L INFO RE 12e. TYPE OF ORGANIZATION
ORGANIZATION
DEBTOR I
2f. JURISDICTION OF ORGANIZATION
2g. ORGANIZATIONAL ID if any
n NONE
OR
3a. ORGANIZATION'S NAME
Goldman Sachs Specialty Lending Group, L.P., as Second Lien Agent
3b. INDIVIDUAL'S LAST NAME
FIRST NAME
MIDDLE NAME
SUFFIX
3c. MAILING ADDRESS
6011 Connection Drive
CITY
Irving
STATE
TX
POSTAL CODE
75039
COUNTRY
USA
UCC FINANCING STATEMENT
FOLLOW INSTRUCTIONS (front and back) CAREFULLY
A. NAME PHONE OF CONTACT AT FILER [optional]
B. SEND ACKNOWLEDGMENT TO: (Name and Address)
John A. Decker, Esq. c/o Hunton Williams
600 Peachtree Street, N.E., Suite 4100
Atlanta, Georgia 30308 -2216
L
1
J
1. DEBTOR'S EXACT FULL LEGAL NAME insert only gng debtor name (la or lb) do not abbreviate or combine names
2. ADDITIONAL DEBTOR'S EXACT FULL LEGAL NAME insert only one debtor name (2a or 2b) do not abbreviate or combine names
3. SECURED PARTY'S NAME (or NAME of TOTAL ASSIGNEE of ASSIGNOR S /P) insert only og secured parry name (3a or 3b
RECEIVED 2/1/2011 at 3:24 PM
RECEIVING 957880
BOOK: 761 PAGE: 660
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, WY
00C :c660
THE ABOVE SPACE IS FOR FILING OFFICE USE ONLY
4. This FINANCING STATEMENT covers the following collateral:
Collateral consists of all assets, personal property and /or goods of Debtor now owned or hereafter acquired which are or are to
become fixtures on the real property described on Exhibit "A" attached hereto and incorporated herein by reference. Note:
Retention of cash proceeds by any subordinate secured party violates the rights of the Secured Party identified herein.
5. ALTERNATIVE DESIGNATION [if applicable]:nLESSEE/LESSOR n CONSIGNEE/CONSIGNOR nBAILEE /BAILOR n SELLER /BUYER fl AG. LIEN nNON -UCC FILING
6, g {This FINANCING STATEMENT is to be filed [for record] (or recorded) in the REAL 17. Check to REQUEST SEARCH REPORT(S) on Debtor(s)
ESTATE RECORDS. Attach Addendum [if applicable] [ADDITIONAL FEE] [optional] All Debtors Debtor 1 Debtor 2
8. OPTIONAL FILER REFERENCE DATA
File with Lincoln County, Wyoming (Goldman /Simmons /65740.2)
FILING OFFICE COPY NATIONAL UCC FINANCING STATEMENT (FORM UCC1) (REV. 07/29/98)
OR
11a. ORGANIZATION'S NAME
11 b. INDIVIDUALS LAST NAME
FIRST NAME
MIDDLE NAME
SUFFIX
11c. MAILING ADDRESS
CITY
STATE
POSTAL CODE
COUNTRY
11d. TAX ID SSN OR EIN
ADD'L INFO RE 1 110. TYPE OF ORGANIZATION
ORGANIZATION
DEBTOR 1
11f. JURISDICTION OF ORGANIZATION
11g. ORGANIZATIONAL ID if any
fNONE
12.
OR
1 ADDITIONAL SECURED PARTY'S or fl ASSIGNOR S /P'S NAME insert only one name (12a or 12b)
12a. ORGANIZATIONS NAME
12b. INDIVIDUALS LAST NAME
FIRST NAME
MIDDLE NAME
SUFFIX
12c. MAILING ADDRESS
CITY
STATE
POSTAL CODE
COUNTRY
13. This FINANCING STATEMENT
collateral, or is filed as a
14. Description of real estate:
Description of real
attached hereto and
15. Name and address of a RECORD
(if Debtor does not have a record
covers timber to be cut or as- extracted
16. Additional collateral description:
fixture filing.
estate appears on "Exhibit A"
incorporated herein by reference.
OWNER of above described real estate
interest):
17. Check ony if applicable and check only one box.
to property
Estate
Debtor is a. Trust or, Trustee acting with respect
held in trust or. Decedent's
18. Check only If applicable and check Orly one box.
effective 30 years
effective 30 years
Debtor is a TRANSMITTING UTILITY
Filed in connection with a Manufactured -Home Transaction
1 Filed in connection with a Public- Finance Transaction
UCC FINANCING STATEMENTADDENDUM
AME OF FIRST DEBTOR (1a or 1b) ON RELATED FINANCING STATEMENT
9a. ORGANIZATIONS NAME
SIMMONS SLC, LLC
9b. INDIVIDUAL'S LAST NAME
MISCELLANEOUS:
FIRST NAME
MIDDLE NAME,SUFFIX
FOLLOW INSTRUCTIONS (front and back) CAREFULLY
9. N
OR
10.
11. ADDITIONAL DEBTOR'S EXACT FULL LEGAL NAME insert only one name (11a or 11b) do not abbreviate or combine names
FILING OFFICE COPY— NATIONAL UCC FINANCING STATEMENT ADDENDUM (FORM UCC1Ad) (REV. 07/29/98)
000661
THE ABOVE SPACE IS FOR FILING OFFICE USE ONLY
PARCEL 1:
COMMENCING at the Northwesterly corner of Block 19 of the First Addition to
the Town of Kemmerer, Lincoln County, Wyoming and running thence South
63 °26' West, 60 feet; thence South 84 °38' West, 131.14 feet to the point of
beginning; thence North 11 °36' East, 120.00 feet to a point on the Southerly right
of way boundary line of Wyoming State Highway #30 North; thence in a
Westerly direction along said right -of -way boundary thence in a Westerly
direction along said right -of -way boundary thence in a Westerly direction along
said right -of -way boundary following a 1.027 curve to the left, a distance of
501.33 feet; thence South 11 °26' West, 273 feet; thence along a curve to the left
with a radius of 250.00 feet and an internal angle of 180.00 a distance of 785.40
feet; thence North 11 °36' East 130.00 feet to the point of beginning; being situate
in the Southeast quarter of Section 14, Township 21 North, 116 West of the 6
P.M.
EXHIBIT A
Legal Description of Premises:
That certain real property situated in Lincoln County, State of Wyoming, more
particularly described as follows:
PARCEL 2:
COMMENCING at the Northwesterly corner of Block 19 of the First Addition to
the Town of Kemmerer, Lincoln County, Wyoming and running thence South
63 °26' West, 30.00 feet, to the point of beginning; thence South 63 °26' West,
30.00 feet; thence South 84 °38'30" West, 131.14 feet; thence North 11 °26' East,
120.00 feet; thence South 72 °45' East, 19.92 feet; thence South 17 °36' West,
12.26 feet; thence North 89 °38' East, 80.88 feet; thence South 26 °34' East, 83.65
feet to the point of BEGINNING.
Tax Notice Nos. 12- 2116- 14 -I -00- 025.00 and 12- 2116- 14 -I -00- 025.20
000662