!

une 23, 2013

lellow PMA Shareholders:

Cur flrm, Clenvlew CaplLal ManagemenL (Clenvlew"), has been a shareholder of PealLh ManagemenL
AssoclaLes, lnc. (PMA" or Lhe Company") for more Lhan Lwo years, and presenLly we own 14.6 of Lhe
Company. 1hls mornlng we seL ln moLlon a democraLlc process by whlch, pendlng flnallzaLlon of our
documenLaLlon afLer flllng wlLh Lhe SecurlLles and Lxchange Commlsslon (SLC"), we as shareholders wlll
be presenLed wlLh an opLlon Lo remove and replace Lhe slLLlng 8oard of ulrecLors of PMA wlLh elghL
hlghly quallfled, lndependenL, newly elecLed dlrecLors (collecLlvely, Lhe lresh AlLernaLlve") Lo lead our
Company forward.
We belleve Lhls declslon ls lmporLanL and ls worLhy of your Llme, full conslderaLlon and compleLe sLudy,
and ln supporL of LhaL our dlsclosure ls exLenslve. 1he background and raLlonale for Lhls exLraordlnary
sLep are seL forLh ln greaL deLall ln Lhe body of Lhls leLLer. lurLher supporLlng lnformaLlon presenLed ln
Lhe form of a sllde presenLaLlon LhaL wlll be flled wlLh Lhe SLC and ls avallable, along wlLh oLher
supporLlng documenLs, on Lhe publlc webslLe www.revlLallzehma.com. Powever, ln respecL of your
Llme Lhls mornlng we offer Lhe followlng execuLlve summary:
ln our role as suggesLlvlsLs", consLrucLlve shareholders LhaL ofLen suggesL Lo ManagemenL and
occaslonally Lo 8oards ways Lo lmprove value for all shareholders, we are brlnglng our suggesLlons
dlrecLly Lo you, our fellow owners of PMA:
a) lL ls wldely recognlzed by publlshlng analysLs, flnanclal press and professlonal lnvesLors LhaL
Lhere ls slgnlflcanL room for lmprovemenL aL PMA. lor over a decade, desplLe Lhe besL efforLs
of well-lnLenLloned lndlvlduals aL Lhe Company, PMA has fallen shorL ln Lhelr flnanclal reLurns
dellvered Lo shareholders, Lhelr flnanclal managemenL and focus, our shared asplraLlonal goals
on regulaLory compllance and Lhe pursulL of a sLable and effecLlve leadershlp Leam. CulLurally,
we belleve LhaL an overemphasls on aggregaLe growLh aL Lhe expense of per share value
creaLlon and opLlmal reLurn on caplLal has led Lo a subsLandard sLraLeglc and flnanclal approach.

b) As an alLernaLlve, we are seLLlng forLh a paLh LhaL we belleve creaLes Lhe sLrongesL fuLure for
PMA's paLlenLs, employees and lnvesLors whlle mlnlmlzlng Lhe rlsk Lo each vlLal consLlLuency.
We suggesL PMA shareholders consenL Lo fully reconsLlLuLe Lhe 8oard wlLh Lhe elghL hlghly
quallfled nomlnees proposed hereln. uurlng a managemenL LranslLlon perlod Lhe new 8oard
should conslder reLalnlng a senlor Leam from Alvarez & Marsal who has conflrmed Lo us lLs
avallablllLy Lo serve lmmedlaLely as lnLerlm managemenL for an lnlLlal perlod of sLablllzaLlon,
revlew and lmprovemenL aL Lhe dlscreLlon of Lhe new 8oard.

c) 1he nomlnees of Lhe lresh AlLernaLlve offer a sLrong blend of dlrecLly relevanL skllls (all
nomlnees are counLed more Lhan once ln Lhe followlng Lally):

l) All elghL dlrecLors have healLhcare provlder / faclllLles experlence,


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ll) A ma[orlLy of Lhe nomlnees have served ln a capaclLy as CLC, ClC or CCC of
meanlngfully slzed enLerprlses,
lll) Palf of Lhe nomlnees have sLrong corporaLe flnance backgrounds,
lv) 1wo nomlnees brlng speclallzed legal and regulaLory experlence whlle Lwo
oLhers brlng speclflc experlence ln Lurnaround slLuaLlons,
v) 1hree nomlnees brlng skllls and experlence ln human resources and managed
care areas,
vl) 1he nomlnees lnclude boLh long-Lerm buslness bullders and operaLors as well as
leaders who have sold or comblned buslnesses ln sLraLeglc or flnanclal
LransacLlons, and
vll) ConslsLenL wlLh Lhe deslre Lo consLlLuLe a fresh, lndependenL board, Lhere are
no currenL or former Clenvlew employees offered as nomlnees.

d) We belleve LhaL our shared lnvesLmenL ln PMA ls besL served wlLh a 8oard who has Lhe
capablllLles, vlslon, LenaclLy and splrlL Lo bulld a sLrong lndependenL PMA and resolve legacy
regulaLory lssues whlle concurrenLly belng open Lo all avenues of shareholder value creaLlon,
lncludlng sLrong caplLal allocaLlon and Lhe rlgorous evaluaLlon of all sLraLeglc alLernaLlves.

We urge PMA shareholders Lo read Lhe compleLe maLerlals carefully along wlLh any lnformaLlon offered
by Lhe slLLlng PMA 8oard so LhaL each shareholder can make a well lnformed declslon ln Lhls democraLlc
process. lor lmporLanL lnformaLlon on how Lo voLe your shares aL Lhe approprlaLe Llme, please refer Lo
Lhe lnformaLlon on Lhe 8evlLallze PMA webslLe www.revlLallzehma.com and Lhe deflnlLlve consenL
sLaLemenL when avallable.
We wlll now revlew Lhe slLuaLlon and our LhoughL process ln greaLer deLall.
* * *
Clenvlew ls an lnvesLmenL manager ln lLs LhlrLeenLh year of operaLlon, managlng more Lhan $6 bllllon
across Lwo famllles of lnvesLmenL funds. Cur lnvesLmenL ln hosplLals, whlch LoLals approxlmaLely $2.0
bllllon across flve ma[or uS hosplLal chalns, reflecL our afflnlLy for Lhe long-Lerm growLh and sLablllLy of
Lhe buslness, our recognlLlon of Lhe growLh opporLunlLles avallable Lhrough Lhe perlod of
lmplemenLaLlon of expanded lnsurance coverage, our bellef ln Lhe sLrucLural compeLlLlve advanLages of
for-proflL hosplLal chalns, and our exclLemenL abouL Lhe opporLunlLles for relnvesLmenL of Lhe lndusLry's
sLrong cash flows and growlng debL capaclLy as proflLablllLy bullds Lhrough Llme. As such, our lnlLlal
lnvesLmenL ln PMA began ln early 2011 and we became greaLer Lhan 3 shareholders ln Lhe Company
more Lhan one year ago.
Cur long-Lerm focus ln PMA ls noL unlque Lo our hlsLory buL raLher ls deeply lngralned ln our culLure.
Cver Lhe years, we and our lnvesLors have been prlvlleged Lo lnvesL ln a number of sLrong, secularly
growlng companles run by sLrong managemenL Leams ln con[uncLlon wlLh effecLlve and consLrucLlve
8oards of ulrecLors who have been wonderful sLewards of Lhe asseLs ln whlch Lhey have been enLrusLed
Lo lead by Lhe owners of Lhe Company: publlc shareholders. ln such cases, we have been able Lo
subsLanLlally lnvesL ln Lhe shares of Lxpress ScrlpLs over a 10 year holdlng perlod, Mckesson and
1hermollsher SclenLlflc (and lLs predecessors) for elghL and nlne years, respecLlvely, Clgna, Llfe


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1echnologles (and lLs predecessors), enLalr (and lLs predecessors), Aon, Amerlcan 1ower, Crown CasLle
and oLhers over a flve year holdlng perlod. ln facL, we have held over 90 lnvesLmenLs for longer Lhan
our currenL Lenure of PMA, solldlfylng our credenLlals as long-Lerm shareholders raLher Lhan LranslLory
opporLunlsLs. We have found Lhe comblnaLlon of a sLrong lndusLry, a sLrong buslness, a sLrong
managemenL Leam, an effecLlve 8oard and long-Lerm shareholders Lo be Lhe uream 1eam" of
shareholder value creaLlon.
1hroughouL Lhe years, we have come across slLuaLlons where we belleve Lhe lndusLry and buslness are
each aLLracLlve buL LhaL Lhe managemenL Leam, sLraLeglc dlrecLlon or long-Lerm caplLal allocaLlon plan
are subopLlmal. ln such cases, we aLLempL Lo use our conversaLlons wlLh managemenL as a Lwo-way
consLrucLlve dlalogue, where we noL only galn from Lhe beneflLs of Lhelr lnslghLs regardlng Lhe lndusLry
and long-Lerm rlsks and opporLunlLles buL where we may also share our vlews on lssues where we may
have a parLlcular experLlse, parLlcularly ln Lhe areas of caplLal allocaLlon, long-Lerm flnanclng,
shareholder communlcaLlons and sLraLeglc alLernaLlves. We do noL expecL nor demand perfecLlon ouL
of any managemenL Leam or 8oard, nor are we ourselves able Lo dellver perfecLlon Lo our own
lnvesLors. Powever, we have found LhaL organlzaLlons LhaL are Lruly open-mlnded and learn from boLh
prlor mlsLakes and Lhe experlences of oLhers wlLh slmllar challenges and opporLunlLles become Lhe mosL
effecLlve organlzaLlons for Lhelr buslness mlsslon, Lhelr cusLomer base, Lhelr employees and Lhelr
shareholders.
CfLenLlmes ln such slLuaLlons, Lhere has been a sLrong wllllngness of managemenL and Lhe 8oard, ln
whole or ln parL, Lo genulnely pursue all consLrucLlve suggesLlons Lo analyze Lhelr merlLs, and when Lhe
beneflLs are clear Lo acL upon Lhem ln a declslve fashlon. We belleve Lhls sLrong wllllngness Lo engage ln
healLhy and consLrucLlve debaLe resulLs from an allgnmenL of lnLeresLs beLween shareholders,
managemenL and 8oard members and Lhe sLrong passlon members of Lhe company have Lo dellghL noL
only Lhelr cusLomers buL Lhelr owners and caplLal provlders over Llme. ln oLher slLuaLlons, Lhe 8oard
may be more passlonaLe and capable Lhan Lhe slLLlng managemenL Leam, ln whlch case one sees a
8oard-led lnlLlaLlve down one of Lwo paLhs:
a) 1o explore alLernaLlves Lo dellver a sLrong lndusLrlal and compeLlLlve poslLlon and wonderful
collecLlon of asseLs Lo a sLraLeglc acqulrer wlLh a slLLlng managemenL Leam who may noL only
opLlmlze Lhe value of Lhose asseLs lndependenLly buL Lhen may add Lo Lhe economlc value
Lhrough cosL and revenue synergles and dellver a porLlon of LhaL synergy value Lo selllng
shareholders, or

b) ln Lhe absence of such an alLernaLlve, Lo go abouL Lhe buslness of sLrengLhenlng and rebulldlng a
managemenL Leam LhaL ls allgned wlLh shareholders' lnLeresLs.

1he mosL complex slLuaLlons, and Lhose LhaL carry wlLh Lhem boLh greaLer rlsks and greaLer
opporLunlLles, are Lhose ln whlch Lhe 8oard has been unable, unwllllng, or lneffecLlve aL esLabllshlng a
sLrong senlor managemenL Leam over Lhe medlum Lerm, whlch can lead Lo subopLlmal operaLlng
performance, a lack of sLraLeglc vlslon, a hlgher cosL of caplLal, hlgher regulaLory and compllance rlsk
and lower shareholder reLurns. As Lhe Lrue owners of Lhe buslness, shareholders can lmprove Lhe


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composlLlon of a 8oard, buL such LranslLlons can be cosLly, awkward and poLenLlally dlsrupLlve Lo Lhe
buslness.
Cur culLure aL Clenvlew ls Lo analyze Lhe facLs ln fronL of us, and Lo Lry Lo remove emoLlon or blas from
Lhe equaLlon. ln Pollywood Lerms, we are more Mr. Spock Lhan Wllllam Wallace. We were noL born Lo
lead flghLs, buL we are slmply programmed Lo follow Lhe loglc Lrall and acL accordlngly. lacLually
speaklng, PMA flLs Lhe small caLegory of companles wlLh a sLrong lndusLry and asseLs, a wllllng long-
Lerm shareholder base and a deflclency aL boLh Lhe 8oard and managemenL level. 1he facLs supporLlng
Lhese concluslons are as follows:
a) PMA compleLed a losL decade Lhrough 2012, generaLlng a compound annual reLurn for
shareholders of less Lhan 1 and underperformlng lLs peers over Lhe pasL 1, 3, 3 and 10 year
perlods.

b) PMA's ablllLy Lo properly forecasL and dellver upon managemenL's buslness plan ls well below
average ln Lhe lndusLry, and flnanclal leadershlp has falled Lo esLabllsh lnvesLor credlblllLy over
Llme. 1hls manlfesLs lLself wlLh a subsLandard caplLal allocaLlon plan.

c) 1he backbone of any hosplLal company musL be Lhe quallLy of care and Lhe lnLegrlLy or
relaLlonshlps wlLh paLlenLs and payors. unforLunaLely, PMA sLruggles under Lhe welghL of Lwo
unresolved ueparLmenL of !usLlce lnvesLlgaLlons and one SLC lnvesLlgaLlon.

d) 1he mlsallgnmenL of 8oard and shareholder prlorlLles has led Lo Lhe mlsappllcaLlon and poor
consLrucLlon of managemenL lncenLlves, a myoplc focus on acqulslLlons Lo Lhe excluslon of
hlgher reLurnlng share repurchase alLernaLlves, and a fallure Lo aLLracL sLrong sLable senlor
managemenL. WlLh Lhe CLC's recenL reslgnaLlon, PMA wlll be searchlng for lLs 3
Lh
CLC ln 13
years under a largely conslsLenL 8oard.

e) llnally, Lhe 8oard appears Lo be lnsular and does noL appear Lo have a paLh Lowards conLlnuous
lmprovemenL and growLh. Any such program offered now would be hlghly reacLlonary and ln
our oplnlon would fall shorL of Lhe reasonable expecLaLlons owners have for Lhelr ulrecLors.

A more comprehenslve presenLaLlon of Lhe hlsLorlcal shorLcomlngs of PMA's leadershlp ls seL forLh ln
Lhe sllde presenLaLlon we have prepared whlch walks Lhrough, ln someLlmes excruclaLlng deLall, Lhe
lssues LhaL glve rlse Lo our observaLlons hereln. Whlle raLlonal people may dlsagree abouL any one
elemenL or one lnLerpreLaLlon of Lhese lssues, we belleve LhaL a plurallLy of long-Lerm lnvesLors wlll flnd
LhaL Lhls supporLlng lnformaLlon ls boLh facLual and represenLaLlve of Lhelr own observaLlons of Lhe
Company LhroughouL Llme.
naLurally we began our conversaLlons wlLh senlor managemenL more Lhan Lwo years ago, lmmedlaLely
prlor Lo and concurrenL wlLh our lnvesLmenL ln PMA. lollowlng more Lhan 18 monLhs of conversaLlons
wlLh managemenL regardlng key sLraLeglc, operaLlng and caplLal allocaLlon lnlLlaLlves, Lhere was no
evldence LhaL managemenL was elLher wllllng Lo, or were ln a poslLlon Lo, be open mlnded or
lnLellecLually honesL ln Lhelr analysls. As many of Lhese lssues were 8oard level lssues, and wlLh a
managemenL Leam unrecepLlve Lo consLrucLlve dlscusslon, we engaged Lhe Chalrman and Lead
lndependenL ulrecLor of PMA ln boLh verbal and wrlLLen dlscusslons over Lhe pasL slx monLhs. PMA's


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Chalrman and Lead ulrecLor have Lold us LhaL Lhey have shared Lhe conLenL of our conversaLlons and
wrlLLen communlcaLlons wlLh Lhe full 8oard. uurlng our conversaLlons wlLh Lhe 8oard, we have
requesLed a face Lo face meeLlng wlLh Lhe Chalrman and Lead ulrecLor whlch has yeL Lo occur. We
offered Lo communlcaLe our vlews on Lhe Company Lo Lhe full 8oard ln person whlch has also yeL Lo
occur.
lL ls noL Lhe responslblllLy of a slgnlflcanL shareholder Lo perpeLually defer Lo Lhe 8oard and
managemenL. lL ls Lhe responslblllLy of a slgnlflcanL shareholder Lo approach a slLuaLlon wlLh an open
mlnd, analyLlcal lnLegrlLy, pollLe and respecLful communlcaLlon and a respecL for Lhe reasonable Llme
and resource consLralnLs of Lhe 8oard and managemenL. We have meL every responslblllLy ln our
holdlngs ln PMA and ln all of our holdlngs over Lhe pasL 13 years, and our lnablllLy Lo flnd common
ground Lo asslsL PMA ln flndlng a consLrucLlve paLh forward have lefL us wlLh Lhe followlng declslon
paLh.
ueclslon polnL #1 - lllghL or llghL
unforLunaLely, when a 8oard refuses Lo engage ln a consLrucLlve dlalogue, conLlnues upon a paLh LhaL
has dlsslpaLed shareholder value and lncreased Lhe rlsk proflle of Lhe flrm and Lhrough a long hlsLory of
lnflexlblllLy and underperformance has falled Lo llve up Lo Lhelr responslblllLy Lo publlc shareholders, a
company's owners are lefL wlLh Lwo subopLlmal cholces:
a) Sell your shares and abandon Lhe opporLunlLy seL offered by a sLrong lndusLry and sLrong
collecLlon of asseLs LhaL you own aL a dlscounL prlce, or

b) 1ake acLlon Lo lmprove Lhe 8oard and managemenL Lo unlock Lhe full poLenLlal of your
lnvesLmenL.

Whlle cholce A seems horrlble, cholce 8 ls noL wlLhouL rlsks. Whlle Lhere ls no doubL LhaL ln Lhe long-
Lerm a sLrong managemenL Leam and 8oard wlll proLecL and bulld value for shareholders, Lhe lnLerlm
LranslLlon perlod of achlevlng such an ouLcome can be long and dls[olnLed, leavlng some crlLlcal
buslness, compllance and flnanclal lssues unmonlLored. As Lhe largesL shareholder of PMA, we have Lhe
mosL Lo lose ln such a rlsky LranslLlon, and Lherefore have Lhe mosL lncenLlve Lo seek a soluLlon LhaL
offered all of Lhe long-Lerm rewards of lmproved governance and overslghL whlle slgnlflcanLly
dlmlnlshlng LranslLory execuLlon rlsk.
ueclslon polnL #2 -- Cradual change or compleLe overhaul?
ln order Lo lmprove Lhe effecLlveness of boLh managemenL and Lhe 8oard, one musL conslder wheLher
Lhls can be done ln a plecemeal fashlon, or wheLher lL ls advlsable Lo pursue a compleLe Lurnover of Lhe
8oard ln a manner LhaL provldes managemenL capablllLles and conLlnulLy. We belleve Lhe breadLh of
change LhaL ls approprlaLe aL Lhe 8oard level ls dlrecLly proporLlonal Lo Lhe breadLh of challenges and
Lhe duraLlon of lneffecLlve 8oard sLewardshlp. AfLer revlewlng Lhe speclflc facLs of PMA's 8oard, we
belleve LhaL a compleLe overhaul of Lhe 8oard ls noL only Lhe mosL approprlaLe and mosL effecLlve
course of acLlon buL also ls Lhe lowesL rlsk alLernaLlve for Lhe followlng reasons:


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a) 1he breadLh of Lhe challenges ls enormous aL PMA. 1here are deflclencles ln managemenL
quallLy and reLenLlon, regulaLory and compllance, flnanclal plannlng and analysls, caplLal
allocaLlon, sLraLeglc plannlng and dlrecLlon and ln governance. 1hese areas of sLrengLhenlng are
Loo large for any one or Lwo dlrecLors Lo Lackle alone, and Lhe areas of experLlse requlred
requlre a large number of 8oard members wlLh a myrlad of LalenLs and experlences.

b) 1he duraLlon of Lhese challenges ls long, and Lhe response has been de mlnlmls, lneffecLlve or
non-exlsLenL. 1he vasL ma[orlLy of Lhe board members aL PMA have conLlnuously preslded over
Lhese challenges for an exLended perlod of Llme wlLhouL Laklng acLlon.

c) 1he presenL board appears lnsular and sLale. Whlle we are respecLful of Lhe value of long-Lerm
dlrecLorshlp ln Companles wlLh proven Lrack records of long-Lerm achlevemenL, we belleve Lhe
average Lenure of 17 years amongsL PMA dlrecLors ls lndlcaLlve of an organlzaLlon reslsLanL Lo
change. lurLhermore, lndusLry observers have noLed LhaL Lhe sLrong, lnsular culLure of Lhe
8oard ls llmlLlng Lhe avallable pool of quallfled, sLrong leadershlp candldaLes Lo move PMA
forward.

d) 1lme ls of Lhe essence. PMA ls faclng a slgnlflcanL number of lmporLanL declslons currenLly and
a dlvlded 8oard would rlsk unhealLhy confllcL and unnecessary delay. 1hese lmporLanL declslons
lnclude mulLlple regulaLory and compllance lnvesLlgaLlons by governmenL auLhorlLles, an acLlve
CLC search, a revlew of sLraLeglc alLernaLlves for Lhe Company, Lhe need Lo esLabllsh conLracLual
frameworks for relmbursemenL under newly formed sLaLewlde healLh lnsurance exchanges
whlch wlll be lnLroduced Lo consumers ln CcLober and crlLlcal declslons LhaL balance cosL savlngs
wlLh long-Lerm lnvesLmenLs Lo poslLlon PMA for fuLure growLh and healLhy proflLablllLy.

e) llnally, and lmporLanLly, as we reached ouL Lo lndusLry leaders who would conslder servlng on
PMA's board, lL became very clear LhaL Lhe hlghesL quallLy 8oard candldaLes were ln much
greaLer supply lf lL was ensured LhaL any new PMA 8oard would conslsL of a clean slaLe of
consLrucLlve and colleglal members and would be free from a slgnlflcanL culLural rlfL or awkward
LranslLlon process. Slmply sLaLed, you cannoL aLLracL Lhe besL leaders wlLhouL glvlng Lhem Lhe
full power Lo lead.

ueclslon polnL #3 - Change ManagemenL or Sell Lhe Company
ConcurrenLly wlLh a dlscusslon of 8oard composlLlon, we know LhaL lnvesLors, Lhe publlshlng research
communlLy and Lhe flnanclal press have been asklng Lhe quesLlon of wheLher lL ls besL Lo sell Lhe
company or Lo change managemenL and bulld long-Lerm lndependenL value. Cur answer may surprlse
you: we don'L know.
ln our communlcaLlons wlLh Lhe Company we have noL asked PMA Lo deflnlLlvely sell Lhemselves Lo Lhe
hlghesL bldder, nor have we recommended LhaL Lhey lgnore such posslblllLles. 8aLher, we have
suggesLed LhaL Lhe Company conducL a rlgorous and unblased process Lo explore all avenues of
shareholder value creaLlon lncludlng lmproved caplLal allocaLlon as well as an evaluaLlon of a sale Lo
poLenLlal sLraLeglc acqulrers.


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ln our oplnlon, such a revlew cannoL be pre[udged by us or any lndlvldual shareholder, buL raLher ls besL
esLabllshed and execuLed by hlghly quallfled lndependenL dlrecLors. uesplLe Lhe announcemenL LhaL Lhe
8oard has reLalned Morgan SLanley as a flnanclal advlsor, we belleve an expedlLlous change Lo Lhe 8oard
ls prudenL for Lhe followlng reasons:
a) Any Lhorough revlew seeks Lo assess Lhe long-Lerm value of Lhe lndependenL company and Lo
ldenLlfy Lhe alLernaLlves for unlocklng value. Cf course, Lhe lndependenL, long-Lerm value of Lhe
Company ls dlrecLly proporLlonal Lo Lhe quallLy of Lhe 8oard and managemenL, and sLraLegles
and caplLal allocaLlon pollcles Lhey adopL. lor all of Lhe reasons clLed above, we sLrongly belleve
Lhls value ls maxlmlzed only Lhrough a fresh 8oard of ulrecLors.

b) Clven PMA's hlsLory and culLure, lL ls dlfflculL Lo have confldence ln Lhe currenL 8oard
conducLlng an unblased analysls of sLraLeglc alLernaLlves. Accordlng Lo press reporLs, slx years
ago PMA pald a subsLanLlal speclal dlvldend ln order Lo avold engaglng wlLh lnLeresLed prlvaLe
equlLy flrms who may have been lnLeresLed ln acqulrlng Lhe Company. AddlLlonally, as PMA's
hlsLory has only been of acqulslLlon, lL ls posslble LhaL Lhey could seek Lo acqulre boLh scale and
managemenL LalenL Lhrough an acqulslLlon of anoLher company raLher Lhan a sale of lLself,
perhaps welghLlng self-preservaLlon above a rlgorous analysls of rlsk ad[usLed reLurns Lo owners.

c) WlLhouL Lhe credlble alLernaLlve of a sLrong lndependenL Company, poLenLlal sLraLeglc parLles
lnLeresLed ln an acqulslLlon of PMA may feel empowered Lo offer lower prlces for PMA,
knowlng LhaL Lhe Company ls a dlsLressed seller". We belleve Lhe sLraLeglc and flnanclal loglc
of an acqulslLlon of PMA by a larger hosplLal chaln ls compelllng, and LhaL such an alLernaLlve
has Lhe capaclLy Lo offer PMA shareholders slgnlflcanL value should buyers be wllllng Lo
approprlaLely share Lhe beneflLs of such a comblnaLlon Lhrough full and falr conslderaLlon. As lL
remalns unclear lf any sLraLeglc ls Lruly commlLLed Lo blddlng for PMA, or aL whaL prlce such
commlLmenL exlsLs, lL would be lrresponslble Lo slmply hope for Lhe besL wlLhouL Laklng
proacLlve acLlon Lo bulld value ln all clrcumsLances.

d) Several lndusLry parLlclpanLs have lndlcaLed LhaL Lhey are only lnLeresLed ln frlendly mergers or
acqulslLlons, and by paLLern and pracLlce as well as ln descrlpLlons from Lhe press and publlshlng
flnanclal analysLs, PMA's 8oard and lLs Chalrman have been unwelcomlng of and unfrlendly
Lowards any suggesLlons LhaL PMA sell lLself. A hlghly quallfled reconsLlLuLed board ensures
LhaL any sale process would be professlonal and cooperaLlve and Lherefore llkely Lo surface
maxlmum value should such value be aLLalnable Lhrough sLraLeglc comblnaLlon.

e) Any sLraLeglc comblnaLlon of large hosplLal chalns ls llkely Lo lnvolve a proLracLed regulaLory
revlew. uurlng such Llme, PMA wlll be deallng wlLh Lhe crlLlcal lssues of regulaLory compllance,
exchange prlclng, lnformaLlon Lechnology lnvesLmenLs and compeLlLlve poslLlonlng Lhrough Lhe
lmplemenLaLlon of coverage expanslon under Lhe aLlenL roLecLlon and Affordable Care AcL.
Such lssues demand Lhe overslghL of a hlghly quallfled and hlgh funcLlonlng 8oard under any
clrcumsLances, lncludlng durlng an lnLerlm perlod of regulaLory revlew prlor Lo a buslness
comblnaLlon. We belleve poLenLlal sLraLeglc buyers should value such an enhancemenL and
would Lherefore llkely reflecL LhaL ln Lhelr bld for Lhe Company should one maLerlallze.



8


We belleve LhaL a new, hlghly quallfled, lndependenL 8oard offers mulLlple clear paLhs Lo maxlmlze
value for PMA and LhaL each should be pursued wlLh lnLellecLual honesLy and analyLlcal rlgor, free from
blas.
ueclslon polnL #4 LlemenLs of a Successful 1ranslLlon
We asked ourselves a slmple quesLlon: how would we feel lf anoLher shareholder presenLed Lo all of us
a comprehenslve soluLlon, and whaL elemenLs would be necessary Lo ensure such a soluLlon was ln facL
comprehenslve? Whlle Lhe answer Lo Lhe flrsL parL ls easy (we'd be ecsLaLlc!) Lhe elemenLs of a
comprehenslve soluLlon are as follows:
a) Assemble a blue-chlp 8oard wlLh Lhe followlng skllls:

l) SLrong healLh care lndusLry experlence,
ll) 8egulaLory and pollcy experLlse,
lll) Legal and compllance experLlse Lo ensure Lhe sacred LrusL beLween paLlenLs, provlders
and payors,
lv) SophlsLlcaLed flnanclal reporLlng experlence and proven caplLal allocaLlon effecLlveness,
v) ueep undersLandlng of shareholder lnLeresLs wlLh sLrong lnvesLmenL experLlse,
vl) roven ablllLy Lo work ln a collecLlve and colleglal aLmosphere Lo advance Lhe
Company's ob[ecLlves, and
vll) roven Lrack record ln human resource managemenL, Leam bulldlng and slmllar
LranslLlonal or LransformaLlonal roles.

b) Assemble, lmmedlaLely, a sLrong managemenL Leam wlLh CLC, ClC and legal capablllLles should
Lhey prove necessary.

c) An allgnmenL of shareholder, 8oard and managemenL lnLeresLs LhaL wlll lnevlLably lead Lo
meLhodlcal and well organlzed revlew of sLraLeglc alLernaLlves Lo deLermlne Lhe opLlmal caplLal
sLrucLure, caplLal allocaLlon plan and Lo compare Lhe long-Lerm rlsk ad[usLed value of
lndependence wlLh any and all offers for sLraLeglc comblnaLlon by credlble Lhlrd parLles who
may bulld upon Lhe sLrong presenL capablllLles of PMA.

We presenL Lhls wlsh llsL as Lhe only opLlon, raLher Lhan offerlng an alLernaLlve, because ln boLh belng
and Lhlnklng llke an owner, such a wlsh llsL ls Lhe necessary Lhreshold LhaL needs Lo be meL for a
compleLe overhaul Lo be feaslble and advlsable. CuLLlng any corners ln Lhls approach we belleve would
be lnherenLly rlsky and lead Lo subopLlmal long-Lerm ouLcomes. Slmply puL, Lhere ls no cholce buL for
shareholders Lo expecL and assemble a compleLe and Lhorough human caplLal soluLlon Lo lnfuse
analyLlcal rlgor, fresh perspecLlve and enLhuslasm lnLo a program Lo unleash Lhe full poLenLlal of PMA.
1he concepL of rlmum non nocere", or llrsL, do no harm" ls noL only appllcable Lo physlclans and
emergency personnel buL also ls lnsLrucLlve Lo us ln our approach ln PMA. As a large and lmporLanL
hosplLal operaLor ln Lhe u.S., we recognlze Lhe vlLal role LhaL Lhe Company plays ln dellverlng crlLlcal
healLhcare servlces Lo more Lhan one mllllon paLlenLs each year. We also recognlze LhaL Lhe employees
and assoclaLes of PMA are engaged ln llLerally llfe-savlng work and musL have an ablllLy Lo malnLaln


9

focus, quallLy and conLlnulLy of care Lhrough any corporaLe LranslLlon LhaL occurs ln a boardroom or
headquarLers offlce. lL ls wlLh Lhls overrldlng prlnclple LhaL we flrsL do no harm LhaL we have soughL Lo
fully ldenLlfy and assemble a 8oard wlLh broad skllls, deep experlence and Lhe ablllLy Lo lmmedlaLely
assume Lhe overslghL duLles requlred ln Lhls slLuaLlon, and LhaL concurrenLly we have ldenLlfled ready,
wllllng and able managemenL LalenL wlLh proven Lrack records of success Lhrough crlsls slLuaLlons wlLhln
healLh care dellvery provlders. 1he rlsk Lo paLlenLs, assoclaLes, payors, bondholders and shareholders
allke ls mlnlmlzed Lhrough an expedlLlous process and LranslLlon, whlch ls why shareholders musL acL
urgenLly Lo supporL such a plan forward.
ln order Lo provlde a new PMA 8oard wlLh Lhe resources and capablllLles Lo manage Lhe Company
lmmedlaLely upon assumpLlon of duLles, we have conflrmed Lhe avallablllLy of Alvarez & Marsal, a flrm
speclallzlng ln change managemenL and wlLh deep and successful healLhcare experlence, Lo serve ln Lhe
capaclLy of lnLerlm managemenL and Lo asslsL Lhe 8oard ln a Lhorough revlew of Lhe currenL challenges
and opporLunlLles faclng Lhe company from an operaLlonal, flnanclal, compllance and sLraLeglc
perspecLlve. 8ased upon our dlllgence and dlscusslons wlLh Lhe senlor professlonals aL Alvarez &
Marsal, we belleve Lhey are hlghly quallfled, would add slgnlflcanL sLablllLy Lo Lhe Company, provlde
Lransparency and lnslghL Lo Lhe 8oard and be very well recelved by lnvesLors.
* * *
lL ls wlLh greaL prlde LhaL we presenL Lhe followlng nomlnees for your conslderaLlon as Lhe lresh
AlLernaLlve Lo 8evlLallze PMA, along wlLh abbrevlaLed blographlcal lnformaLlon for your revlew.
Mary 1aylor 8ehrens

o LxLenslve healLhcare flnance experlence: served as Pead or Co-Pead of Merrlll Lynch
lnvesLmenL Managers, Amerlcas reglon, served as Pead of Puman 8esources and as a
member of execuLlve commlLLee aL Merrlll Lynch & Co., served as Managlng ulrecLor of
healLhcare lnvesLmenL banklng of Merrlll Lynch & Co., currenLly serves as resldenL of
newfane Advlsors, a prlvaLe consulLlng flrm she founded ln 2004
o LxLenslve knowledge and experlence ln execuLlve compensaLlon, human resources, sLraLeglc
plannlng, successlon plannlng and flnanclal LransacLlons ln Lhe healLhcare lndusLry

SLeven LpsLeln

o LxLenslve healLhcare legal experlence: lounder and name parLner of LpsLeln 8ecker &
Creen, a leadlng law flrm ln healLh care law whlch he founded ln 1973
o WlLh over 33 years of experlence ln healLhcare law, provldes a wlde range of healLh care
organlzaLlons wlLh sLraLeglc legal guldance






10

klrk Corman

o LxecuLlve hosplLal experlence: LxecuLlve vlce resldenL and Chlef llnanclal Cfflcer of
hlladelphla's !efferson PealLh SysLem slnce SepLember 2003, Senlor vlce resldenL and
Chlef llnanclal Cfflcer of unlversal PealLh Servlces and resldenL and Chlef llnanclal Cfflcer
of unlversal PealLh 8ealLy lncome 1rusL from Aprll 1987 Lo March 2003
o LxLenslve knowledge, experlence and Lrack record of hosplLal operaLlons, lnLegraLlng
hosplLal acqulslLlons, and execuLlve hosplLal leadershlp. LxLenslve experlence ln mergers
and acqulslLlons, corporaLe flnance, and corporaLe governance

SLephen Culllard

o LxecuLlve healLhcare faclllLles experlence: LxecuLlve vlce resldenL of PC8 ManorCare from
!une 2003 and Chlef CperaLlng Cfflcer from !anuary 2007 Lo hls reLlremenL ln uecember
2011, Chlef LxecuLlve Cfflcer of Parborslde PealLhcare from March 1996 Lo !une 2003 and
Chlef LxecuLlve Cfflcer of lLs predecessor companles slnce May 1998, Co-lounder, resldenL
and Chlef LxecuLlve Cfflcer of ulverslfled PealLh Servlces, a skllled nurslng operaLor
o ulverse execuLlve leadershlp ln posL-acuLe care faclllLles, successful operaLlonal Lrack-
record, and experlenced ln mergers and acqulslLlons

Larl Polland

o LxecuLlve hosplLal experlence: Served as vlce Chalrman, Chlef CperaLlng Cfflcer and varlous
oLher roles for PMA from 1981 unLll hls reLlremenL ln 2001. lrom 1973 Lo 1981, he served
as Lhe 8eglonal llnanclal CoordlnaLor for Lwelve hosplLals and Lhe Chlef LxecuLlve Cfflcer of
a Lwo hundred and flfLy bed hosplLal ln vlrglnla 8each, vA and a four hundred bed hosplLal
ln Cverland ark, kS for Pumana, lnc.
o LxLenslve knowledge, experlence and Lrack record of hosplLal operaLlons, lnLegraLlng
hosplLal acqulslLlons, and execuLlve hosplLal leadershlp

!ohn McCarLy

o LxecuLlve healLhcare servlces experlence: Chlef llnanclal Cfflcer of LabCne (acqulred by
CuesL ulagnosLlcs ln CcLober 2003) from Aprll 2000 Lo March 2003, Senlor vlce resldenL
and Chlef llnanclal Cfflcer of eal PealLhcare SLafflng SoluLlons (acqulred by 8ehab Care)
from !anuary 1999 Lo uecember 1999, Chlef llnanclal Cfflcer of unlLed uenLal Care from
november 1997 Lo november 1998, Chlef llnanclal Cfflcer of novaMed Lyecare
ManagemenL from May 1996 Lo CcLober 1997. AsslsLanL vlce resldenL of CorporaLe
llnance and vlce resldenL of Columbla CaplLal CorporaLlon for Columbla PCA prlor Lo 1996,
responslble for over $7 bllllon ln flnanclng
o SLrong buslness and flnanclal knowledge, experlence ln Lurnaround slLuaLlons, and dlverse
flnanclal leadershlp ln Lhe healLhcare lndusLry


11



SLeven Shulman
o LxecuLlve healLhcare servlces experlence: Chalrman and Chlef LxecuLlve Cfflcer of Magellan
PealLh Servlces from 2002 Lo 2008, Chalrman, resldenL and Chlef LxecuLlve Cfflcer of
rudenLlal PealLhcare from 1997 Lo 1999, has served ln leadershlp poslLlons aL ClCnA from
1983 Lo 1987 and kalser ermanenLe from 1973 Lo 1983, currenLly serves as a Senlor
Advlsor wlLh WaLer SLreeL PealLhcare arLners, a prlvaLe equlLy flrm. Co-founder of value
PealLh, lnc., a managed care company
o LxLenslve Lurnaround experlence ln Lhe healLhcare lndusLry: spearheaded Magellan PealLh
Servlces' Lurnaround and resLrucLurlng from bankrupLcy and rudenLlal PealLhcare's
Lurnaround and successful sale Lo AeLna

eLer urbanowlcz

o LxLenslve healLhcare regulaLory and legal experlence: Managlng ulrecLor aL Alvarez &
Marsal's PealLhcare lndusLry Croup slnce May 2008, where he leads Lhe flrm's healLhcare
compllance pracLlce, served as LxecuLlve vlce resldenL, Ceneral Counsel and SecreLary of
1eneL PealLhcare from !anuary 2004 Lo March 2008 and uepuLy Ceneral Counsel of Lhe u.S.
ueparLmenL of PealLh and Puman Servlces (PPS) from CcLober 2001 Lo uecember 2003.
uurlng hls Lenure aL 1eneL, was successful ln resolvlng ma[or federal crlmlnal lnvesLlgaLlons
and clvll lawsulLs faclng Lhe company. uurlng hls Lenure aL PPS, was a member of Lhe Leam
LhaL drafLed Lhe Medlcare rescrlpLlon urug AcL of 2003
o LxperLlse ln regulaLory, compllance, flnanclal and operaLlng lssues faclng Lhe healLhcare
lndusLry and regularly advlses boards of dlrecLors, senlor managemenL, and
lnvesLors/lenders

* * *
1ogeLher, we are Lhe owners of PMA. We belleve ln Lhe lndusLry, Lhe Company, Lhe people of PMA and
Lhe sLrengLh of lLs asseLs. We hope LhaL you [oln us ln Lhe democraLlc process Lo 8evlLallze PMA.
8especLfully yours,

Clenvlew CaplLal ManagemenL

* * *



12

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1hls presenLaLlon may lnclude forward-looklng sLaLemenLs" LhaL reflecL currenL vlews of fuLure
evenLs. SLaLemenLs LhaL lnclude Lhe words expecL," lnLend," plan," belleve," pro[ecL,"
anLlclpaLe," wlll," may," would" and slmllar sLaLemenLs of a fuLure or forward-looklng
naLure are ofLen used Lo ldenLlfy forward-looklng sLaLemenLs. Slmllarly, sLaLemenLs LhaL
descrlbe our ob[ecLlves, plans or goals are forward-looklng. Clenvlew's forward-looklng
sLaLemenLs are based on lLs currenL lnLenL, bellef, expecLaLlons, esLlmaLes and pro[ecLlons
regardlng Lhe Company and pro[ecLlons regardlng Lhe lndusLry ln whlch lL operaLes. 1hese
sLaLemenLs are noL guaranLees of fuLure performance and lnvolve rlsks, uncerLalnLles,
assumpLlons and oLher facLors LhaL are dlfflculL Lo predlcL and LhaL could cause acLual resulLs Lo
dlffer maLerlally. Accordlngly, you should noL rely upon forward-looklng sLaLemenLs as a
predlcLlon of acLual resulLs and acLual resulLs may vary maLerlally from whaL ls expressed ln or
lndlcaLed by Lhe forward-looklng sLaLemenLs. LxcepL Lo Lhe exLenL requlred by appllcable law,
no person underLakes any obllgaLlon Lo updaLe publlcly or revlse any forward-looklng
sLaLemenL, wheLher as a resulL of new lnformaLlon, fuLure developmenLs or oLherwlse.