Agenda Cover Memorandum for 02/ - City of West Palm Beach
Agenda Cover Memorandum for 02/ - City of West Palm Beach
Agenda Cover Memorandum for 02/ - City of West Palm Beach
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Originating Department:<br />
Human Resources (HR)<br />
Subject:<br />
WEST PALM BEACH CITY COMMISSION<br />
<strong>Agenda</strong> <strong>Cover</strong> <strong>Memorandum</strong><br />
Meeting Type:<br />
Regular<br />
Special<br />
<strong>Agenda</strong> Date:<br />
<strong>02</strong>/22/2011<br />
Advertised:<br />
Required?: Yes No<br />
Date:<br />
Paper: PB Post<br />
ACM#:<br />
18366<br />
Resolution No. 41-11 authorizing the Mayor to execute an Employee Health Center Agreement<br />
between the <strong>City</strong> <strong>of</strong> <strong>West</strong> <strong>Palm</strong> <strong>Beach</strong> and H2U Wellness Centers LLC <strong>for</strong> the operation and<br />
management <strong>of</strong> the <strong>City</strong>'s Employee Health Clinic; and Resolution No. 48-11(F) to appropriate<br />
funds <strong>for</strong> the buildout and operations <strong>of</strong> the Health Clinic.<br />
Ordinance/Resolution:<br />
RESOLUTION NO. 41-11: A RESOLUTION OF THE CITY COMMISSION OF THE<br />
CITY OF WEST PALM BEACH, FLORIDA, AUTHORIZING THE MAYOR TO<br />
EXECUTE AN EMPLOYEE HEALTH CENTER AGREEMENT BETWEEN THE CITY<br />
OF WEST PALM BEACH AND H2U WELLNESS CENTERS LLC, FOR THE<br />
OPERATION AND MANAGEMENT OF THE CITY’S EMPLOYEE HEALTH CLINIC.;<br />
PROVIDING FOR AN EFFECTIVE DATE; AND FOR OTHER PURPOSES.<br />
RESOLUTION NO. 48-11(F): A RESOLUTION OF THE CITY COMMISSION OF THE<br />
CITY OF WEST PALM BEACH, FLORIDA, AUTHORIZING THE APPROPRIATION<br />
OR TRANSFER OF CITY FUNDS IN FISCAL YEAR 2010/2011 IN ACCORDANCE<br />
WITH SECTION 4.03 OF THE CITY CHARTER OF THE CITY OF WEST PALM<br />
BEACH, FLORIDA, FOR THE PURPOSE OF AMENDING THE GENERAL FUND<br />
AND VARIOUS FUNDS BUDGETS TO PROVIDE APPROPRIATIONS FOR THE<br />
CITY’S EMPLOYEE HEALTH CLINIC; PROVIDING AN EFFECTIVE DATE; AND<br />
FOR OTHER PURPOSES.<br />
Staff Recommended Motion:<br />
Approve Resolution No. 41-11 and Resolution No. 48-11(F).<br />
Background:<br />
The <strong>City</strong> <strong>of</strong> <strong>West</strong> <strong>Palm</strong> <strong>Beach</strong> has determined that there are significant benefits and savings to<br />
the <strong>City</strong> from operating a Health Clinic <strong>for</strong> <strong>City</strong> employees. The <strong>City</strong> conducted an Invitation to<br />
Negotiate process in search <strong>of</strong> a vendor to operate the <strong>City</strong> Employee Health Clinic. H2U<br />
Wellness LLC, d/b/a "First Onsite" was selected by a panel <strong>of</strong> <strong>City</strong> staff, a local physician and a<br />
local hospital administration executive. First Onsite will provide management and administrative<br />
services <strong>for</strong> the clinic.
AGENDA COVER MEMORANDUM Page 2<br />
C.M. #________ Date:__________<br />
The Clinic will <strong>of</strong>fer pre-employment physicals, primary care to eligible employees and their<br />
dependents, prescription dispensing, disease management, injections, exams and screening, as<br />
well as, occupational health services including, but not limited to, evaluation and treatment <strong>of</strong><br />
work related injuries and illnesses and occupational health exams. In an ef<strong>for</strong>t to attract<br />
employees to the Clinic, employees who use the Clinic will not incur out <strong>of</strong> pocket expenses.<br />
The Agreement provides <strong>for</strong> a term <strong>of</strong> three (3) years with an option to renew <strong>for</strong> two (2)<br />
consecutive one (1) year terms. The Clinic will operate <strong>for</strong> a minimum <strong>of</strong> 40 hours per week<br />
with the initial hours <strong>of</strong> operation being Monday and Friday 7am - 4pm; Tuesday and Thursday<br />
10am - 7pm; Wednesday 7am - 12 noon and Saturdays 8am to 1pm. These hours will be<br />
evaluated and modified as necessary to meet the needs <strong>of</strong> the <strong>City</strong>. The Clinic will be staffed by<br />
a Physician, Nurse Practitioner or Physician’s Assistant, Nurse and a Medical Technician.<br />
The annual management fee to First Onsite will be the lesser <strong>of</strong> $131,040 or 20% <strong>of</strong> the salary<br />
wages and benefits <strong>for</strong> the personnel. Furthermore, the Agreement provides <strong>for</strong> Per<strong>for</strong>mance<br />
Guarantees, whereby a portion <strong>of</strong> the management fee is at risk <strong>of</strong> <strong>for</strong>feiture <strong>for</strong><br />
under-per<strong>for</strong>mance <strong>of</strong> specified benchmarks. A Review Board; consisting <strong>of</strong> outside healthcare<br />
pr<strong>of</strong>essionals and staff, will be established to provide oversight <strong>of</strong> the clinic. The Agreement<br />
authorizes the Mayor to execute amendments to the Agreement <strong>for</strong> operational changes such as<br />
hours <strong>of</strong> operation.<br />
The proposed location <strong>for</strong> the Clinic is 464 Fern Street, a vacant historic building which is<br />
owned by the <strong>City</strong> and centrally located to <strong>City</strong> operations. The windows are badly deteriorated<br />
and will be replaced with hurricane resistant windows. Interior buildout will include electrical,<br />
plumbing and structural repairs to facilitate three (3) examination rooms, an imaging/x-ray room,<br />
a small lab, medical storage area, patient waiting area and administrative <strong>of</strong>fices.<br />
The Fern street location provides <strong>for</strong> adequate patron parking consisting <strong>of</strong> four (4) on-site<br />
parking in the alley and two dedicated on-street parking spaces. The building is also equipped<br />
with an existing handicap ramp. To maintain the historic integrity <strong>of</strong> the structure, there will be<br />
no changes to the building exterior and the interior buildout will not jeopardize the historic<br />
character.<br />
The budget needed <strong>for</strong> Fiscal Year 2011 is:<br />
$200,000 Building Renovations<br />
90,000 Equipment (x-ray machine)<br />
85,000 Start-up Expenses (includes hearing and eye testing equipment <strong>for</strong> firefighter<br />
physicals)<br />
225,000 July - September contract with H2U Wellness <strong>for</strong> staff, supplies, and drugs<br />
$600,000 Total<br />
In an ef<strong>for</strong>t to control cost, the required landscaping <strong>of</strong> the property and parking lot repairs and<br />
striping will be done in-house by our Parks Maintenance and Public Works employees. The<br />
health clinic is expected to be operational in July 2011.<br />
Fiscal Note
AGENDA COVER MEMORANDUM Page 3<br />
C.M. #________ Date:__________<br />
Current Year:<br />
$600,000.00<br />
Annualized: Budgeted: Unbudgeted: Funding Source:<br />
Operating<br />
Comment: Resolution No. 48-11(F) transfers $300,000 from available funds with the Other<br />
Post Employment Benefit (OPEB) expenses with the remaining $300,000 from departments<br />
(General Fund - $205,440; Building Permit Fund - $6,679; Waterfront District Fund - $1,509;<br />
Parking Operating Fund - $3,567; Water & Sewer Operating Fund - $61,017; Storm Water<br />
Operating Fund - $7,467; MIS Fund - $8,378; Printing Fund - $309; Fleet Maintenance Fund -<br />
$4,914; & Self Insurance Fund - $720).<br />
Electronic Attachments: Click here <strong>for</strong> assistance with naming convention.<br />
Is this ACM related to a Grant? Yes No<br />
Originating Department - Approved by: Patrick Cooney on <strong>02</strong>/11/2011<br />
<strong>02</strong>/11/2011 Finance Department<br />
<strong>02</strong>/11/2011 <strong>City</strong> Attorney's Department<br />
Human Resources Department<br />
<strong>02</strong>/11/2011 Asst. <strong>City</strong> Administrator<br />
<strong>02</strong>/11/2011 <strong>City</strong> Administrator<br />
Other<br />
Other<br />
Return to <strong>Agenda</strong>
February 7, 2011<br />
RESOLUTION NO. 48-11(F)<br />
A RESOLUTION OF THE CITY COMMISSION OF THE CITY OF WEST PALM BEACH,<br />
FLORIDA, AUTHORIZING THE APPROPRIATION OR TRANSFER OF CITY FUNDS<br />
IN FISCAL YEAR 2010/2011 IN ACCORDANCE WITH SECTION 4.03 OF THE CITY<br />
CHARTER OF THE CITY OF WEST PALM BEACH, FLORIDA, FOR THE PURPOSE OF<br />
AMENDING THE GENERAL FUND AND VARIOUS FUNDS BUDGETS TO PROVIDE<br />
APPROPRIATIONS FOR THE CITY’S EMPLOYEE HEALTH CLINIC; PROVIDING AN<br />
EFFECTIVE DATE; AND FOR OTHER PURPOSES.<br />
******<br />
NOW, THEREFORE, BE IT HEREBY RESOLVED BY THE CITY COMMISSION OF THE<br />
CITY OF WEST PALM BEACH, FLORIDA, that:<br />
SECTION 1: Funds are hereby appropriated within various funds as follows:<br />
FUND 506 - HEALTH INSURANCE FUND<br />
REVENUES<br />
Health Clinic Charges 506-<strong>02</strong>3703-000-341200 $ 300,000<br />
EXPENDITURES<br />
OPEB Expense 506-014100-590-50<strong>02</strong>45 $ (300,000)<br />
Building Improvements 506-<strong>02</strong>3703-590-500621 200,000<br />
Equipment - Health Clinic<br />
Equipment<br />
Operational Expense - Start Up<br />
Costs<br />
Pr<strong>of</strong>essional Services - Health Care<br />
Provider<br />
506-<strong>02</strong>3703-590-500640 90,000<br />
506-<strong>02</strong>3703-590-500490 85,000<br />
506-<strong>02</strong>3703-590-500310 225,000<br />
Total Expenditures: $ 300,000<br />
FUND 001 - GENERAL FUND<br />
EXPENSES<br />
Health Clinic Expense 001-010100-511-50<strong>02</strong>30 $ 1,418<br />
Health Insurance 001-010100-511-50<strong>02</strong>31 (1,418)<br />
Health Clinic Expense 001-010101-512-50<strong>02</strong>30 2,284<br />
Health Insurance 001-010101-512-50<strong>02</strong>31 (2,284)<br />
Health Clinic Expense 001-0101<strong>02</strong>-512-50<strong>02</strong>30 2,042
February 7, 2011<br />
RESOLUTION NO. 48-11(F)<br />
Health Insurance 001-0101<strong>02</strong>-512-50<strong>02</strong>31 (2,042)<br />
Health Clinic Expense 001-010300-539-50<strong>02</strong>30 612<br />
Health Insurance 001-010300-539-50<strong>02</strong>31 (612)<br />
Health Clinic Expense 001-010500-519-50<strong>02</strong>30 773<br />
Health Insurance 001-010500-519-50<strong>02</strong>31 (773)<br />
Health Clinic Expense 001-010900-569-50<strong>02</strong>30 1,016<br />
Health Insurance 001-010900-569-50<strong>02</strong>31 (1,016)<br />
Health Clinic Expense 001-011100-511-50<strong>02</strong>30 1,567<br />
Health Insurance 001-011100-5115<strong>02</strong>31 (1,567)<br />
Health Clinic Expense 001-013100-513-50<strong>02</strong>30 954<br />
Health Insurance 001-013100-513-50<strong>02</strong>31 (954)<br />
Health Clinic Expense 001-018100-513-50<strong>02</strong>30 500<br />
Health Insurance 001-018100-513-50<strong>02</strong>31 (500)<br />
Health Clinic Expense 001-018150-513-50<strong>02</strong>30 309<br />
Health Insurance 001-018150-513-50<strong>02</strong>31 (309)<br />
Health Clinic Expense 001-018200-513-50<strong>02</strong>30 3,221<br />
Health Insurance 001-018200-513-50<strong>02</strong>31 (3,221)<br />
Health Clinic Expense 001-018300-513-50<strong>02</strong>30 1,834<br />
Health Insurance 001-018300-513-50<strong>02</strong>31 (1,834)<br />
Health Clinic Expense 001-018600-513-50<strong>02</strong>30 1,175<br />
Health Insurance 001-018600-513-50<strong>02</strong>31 (1,175)<br />
Health Clinic Expense 001-018650-513-50<strong>02</strong>30 309<br />
Health Insurance 001-018650-513-50<strong>02</strong>31 (309)<br />
Health Clinic Expense 001-019225-519-50<strong>02</strong>30 1,533<br />
Health Insurance 001-019225-519-50<strong>02</strong>31 (1,533)<br />
Health Clinic Expense 001-019275-519-50<strong>02</strong>30 612<br />
Health Insurance 001-019275-519-50<strong>02</strong>31 (612)<br />
Health Clinic Expense 001-<strong>02</strong>3100-513-50<strong>02</strong>30 1,133
February 7, 2011<br />
RESOLUTION NO. 48-11(F)<br />
Health Insurance 001-<strong>02</strong>3100-513-50<strong>02</strong>31 (1,133)<br />
Health Clinic Expense 001-<strong>02</strong>3150-513-50<strong>02</strong>30 155<br />
Health Insurance 001-<strong>02</strong>3150-513-50<strong>02</strong>31 (155)<br />
Health Clinic Expense 001-<strong>02</strong>3500-513-50<strong>02</strong>30 968<br />
Health Insurance 001-<strong>02</strong>3500-513-50<strong>02</strong>31 (968)<br />
Health Clinic Expense 001-<strong>02</strong>3850-513-50<strong>02</strong>30 510<br />
Health Insurance 001-<strong>02</strong>3850-513-50<strong>02</strong>31 (510)<br />
Health Clinic Expense 001-<strong>02</strong>7100-514-50<strong>02</strong>30 4,213<br />
Health Insurance 001-<strong>02</strong>7100-514-50<strong>02</strong>31 (4,213)<br />
Health Clinic Expense 001-<strong>02</strong>9125-554-50<strong>02</strong>30 500<br />
Health Insurance 001-<strong>02</strong>9125-554-50<strong>02</strong>31 (500)<br />
Health Clinic Expense 001-<strong>02</strong>9250-554-50<strong>02</strong>30 1,895<br />
Health Insurance 001-<strong>02</strong>9250-554-50<strong>02</strong>31 (1,895)<br />
Health Clinic Expense 001-030100-515-50<strong>02</strong>30 346<br />
Health Insurance 001-030100-515-50<strong>02</strong>31 (346)<br />
Health Clinic Expense 001-03<strong>02</strong>00-515-50<strong>02</strong>30 1,837<br />
Health Insurance 001-03<strong>02</strong>00-515-50<strong>02</strong>31 (1,837)<br />
Health Clinic Expense 001-03<strong>02</strong>52-515-50<strong>02</strong>30 510<br />
Health Insurance 001-03<strong>02</strong>52-515-50<strong>02</strong>31 (510)<br />
Health Clinic Expense 001-030400-515-50<strong>02</strong>30 612<br />
Health Insurance 001-030400-515-50<strong>02</strong>31 (612)<br />
Health Clinic Expense 001-030600-515-50<strong>02</strong>30 356<br />
Health Insurance 001-030600-515-50<strong>02</strong>31 (356)<br />
Health Clinic Expense 001-031200-521-50<strong>02</strong>30 9,403<br />
Health Insurance 001-031200-521-50<strong>02</strong>31 (9,403)<br />
Health Clinic Expense 001-031201-521-50<strong>02</strong>30 449<br />
Health Insurance 001-031201-521-50<strong>02</strong>31 (449)<br />
Health Clinic Expense 001-031300-521-50<strong>02</strong>30 47,924
February 7, 2011<br />
4<br />
RESOLUTION NO. 48-11(F)<br />
Health Insurance 001-031300-521-50<strong>02</strong>31 (47,924)<br />
Health Clinic Expense 001-0313<strong>02</strong>-521-50<strong>02</strong>30 2,901<br />
Health Insurance 001-0312<strong>02</strong>-521-50<strong>02</strong>31 (2,901)<br />
Health Clinic Expense 001-031303-521-50<strong>02</strong>30 6,044<br />
Health Insurance 001-031303-521-50<strong>02</strong>31 (6,044)<br />
Health Clinic Expense 001-031320-521-50<strong>02</strong>30 7<strong>02</strong><br />
Health Insurance 001-031320-521-50<strong>02</strong>31 (7<strong>02</strong>)<br />
Health Clinic Expense 001-031600-521-50<strong>02</strong>30 14,203<br />
Health Insurance 001-031600-521-50<strong>02</strong>31 (14,203)<br />
Health Clinic Expense 001-031601-521-50<strong>02</strong>30 12,536<br />
Health Insurance 001-031601-521-50<strong>02</strong>31 (12,536)<br />
Health Clinic Expense 001-031700-521-50<strong>02</strong>30 8,917<br />
Health Insurance 001-031700-521-50<strong>02</strong>31 (8,917)<br />
Health Clinic Expense 001-031715-521-50<strong>02</strong>30 429<br />
Health Insurance 001-031715-521-50<strong>02</strong>31 (429)<br />
Health Clinic Expense 001-032100-522-50<strong>02</strong>30 623<br />
Health Insurance 001-032100-522-50<strong>02</strong>31 (623)<br />
Health Clinic Expense 001-032110-526-50<strong>02</strong>30 411<br />
Health Insurance 001-032110-526-50<strong>02</strong>31 (411)<br />
Health Clinic Expense 001-032200-522-50<strong>02</strong>30 385<br />
Health Insurance 001-032200-522-50<strong>02</strong>31 (385)<br />
Health Clinic Expense 001-032300-526-50<strong>02</strong>30 256<br />
Health Insurance 001-032300-526-50<strong>02</strong>31 (256)<br />
Health Clinic Expense 001-032410-522-50<strong>02</strong>30 618<br />
Health Insurance 001-032410-522-50<strong>02</strong>31 (618)<br />
Health Clinic Expense 001-033200-524-50<strong>02</strong>30 786<br />
Health Insurance 001-033200-524-50<strong>02</strong>31 (786)<br />
Health Clinic Expense 001-041125-539-50<strong>02</strong>30 623
February 7, 2011<br />
5<br />
RESOLUTION NO. 48-11(F)<br />
Health Insurance 001-041125-539-50<strong>02</strong>31 (623)<br />
Health Clinic Expense 001-041126-529-50<strong>02</strong>30 3,<strong>02</strong>6<br />
Health Insurance 001-041126-529-50<strong>02</strong>31 (3,<strong>02</strong>6)<br />
Health Clinic Expense 001-041500-534-50<strong>02</strong>30 13,367<br />
Health Insurance 001-041500-534-50<strong>02</strong>31 (13,367)<br />
Health Clinic Expense 001-041600-541-50<strong>02</strong>30 1,222<br />
Health Insurance 001-41600-541-50<strong>02</strong>31 (1,222)<br />
Health Clinic Expense 001-041700-541-50<strong>02</strong>30 4,905<br />
Health Insurance 001-041700-541-50<strong>02</strong>31 (4,905)<br />
Health Clinic Expense 001-042100-539-50<strong>02</strong>30 7,290<br />
Health Insurance 001-042100-539-50<strong>02</strong>31 (7,290)<br />
Health Clinic Expense 001-066150-571-50<strong>02</strong>30 6,860<br />
Health Insurance 001-066150-571-50<strong>02</strong>31 (6,860)<br />
Health Clinic Expense 001-070100-572-50<strong>02</strong>30 623<br />
Health Insurance 001-070100-572-50<strong>02</strong>31 (623)<br />
Health Clinic Expense 001-07<strong>02</strong>00-572-50<strong>02</strong>30 340<br />
Health Insurance 001-07<strong>02</strong>00-572-50<strong>02</strong>31 (340)<br />
Health Clinic Expense 001-070600-572-50<strong>02</strong>30 5,680<br />
Health Insurance 001-070600-572-50<strong>02</strong>31 (5,680)<br />
Health Clinic Expense 001-070610-572-50<strong>02</strong>30 773<br />
Health Insurance 001-070610-572-50<strong>02</strong>31 (773)<br />
Health Clinic Expense 001-070700-572-50<strong>02</strong>30 20,950<br />
Health Insurance 001-070700-572-50<strong>02</strong>30 (20,950)<br />
FUND 130 - BUILDING PERMIT FUND<br />
EXPENSES<br />
Health Clinic Expense 130-033300-524-50<strong>02</strong>30 $ 6,679<br />
Health Insurance 130-033300-524-50<strong>02</strong>31 (6,679)
February 7, 2011<br />
FUND 133 - WATERFRONT DISTRICT FUND<br />
EXPENSES<br />
6<br />
RESOLUTION NO. 48-11(F)<br />
Health Clinic Expense 133-07<strong>02</strong>00-574-50<strong>02</strong>30 87<br />
Health Insurance 133-07<strong>02</strong>00-574-50<strong>02</strong>31 (87)<br />
Health Clinic Expense 133-07<strong>02</strong>06-574-50<strong>02</strong>30 71<br />
Health Insurance 133-07<strong>02</strong>06-574-50<strong>02</strong>31 (71)<br />
Health Clinic Expense 133-07<strong>02</strong>07-574-50<strong>02</strong>30 179<br />
Health Insurance 133-07<strong>02</strong>07-574-50<strong>02</strong>31 (179)<br />
Health Clinic Expense 133-07<strong>02</strong>50-574-50<strong>02</strong>30 452<br />
Health Insurance 133-07<strong>02</strong>50-574-50<strong>02</strong>31 (452)<br />
Health Clinic Expense 133-070700-572-50<strong>02</strong>30 720<br />
Health Insurance 133-070700-572-50<strong>02</strong>31 (720)<br />
FUND 442 - PARKING OPERATING FUND<br />
EXPENSES<br />
Health Clinic Expense 442-051700-545-50<strong>02</strong>30 $ 1,710<br />
Health Insurance 442-051700-545-50<strong>02</strong>31 (1,710)<br />
Health Clinic Expense 442-051800-545-50<strong>02</strong>30 411<br />
Health Insurance 442-051800-545-50<strong>02</strong>31 (411)<br />
Health Clinic Expense 442-051900-545-50<strong>02</strong>30 1,446<br />
Health Insurance 442-051900-545-50<strong>02</strong>31 (1,446)<br />
FUND 450 - WATER & SEWER OPERATING FUND<br />
EXPENSES<br />
Health Clinic Expense 450-097100-536-50<strong>02</strong>30 $ 4,275<br />
Health Insurance 450-097100-536-50<strong>02</strong>31 (4,275)<br />
Health Clinic Expense 450-097150-536-50<strong>02</strong>30 6,086<br />
Health Insurance 450-097150-536-50<strong>02</strong>31 (6,086)
February 7, 2011<br />
7<br />
RESOLUTION NO. 48-11(F)<br />
Health Clinic Expense 450-097155-536-50<strong>02</strong>30 5,123<br />
Health Insurance 450-097155-536-50<strong>02</strong>31 (5,123)<br />
Health Clinic Expense 450-097220-536-50<strong>02</strong>30 2,103<br />
Health Insurance 450-097220-536-50<strong>02</strong>31 (2,103)<br />
Health Clinic Expense 450-097225-536-50<strong>02</strong>30 660<br />
Health Insurance 450-097225-536-50<strong>02</strong>31 (660)<br />
Health Clinic Expense 450-097230-536-50<strong>02</strong>30 7,156<br />
Health Insurance 450-097230-536-50<strong>02</strong>31 (7,156)<br />
Health Clinic Expense 450-097240-536-50<strong>02</strong>30 9,250<br />
Health Insurance 450-097240-536-50<strong>02</strong>31 (9,250)<br />
Health Clinic Expense 450-097245-536-50<strong>02</strong>30 2,412<br />
Health Insurance 450-097245-536-50<strong>02</strong>31 (2,412)<br />
Health Clinic Expense 450-097320-536-50<strong>02</strong>30 3,<strong>02</strong>6<br />
Health Insurance 450-097320-536-50<strong>02</strong>31 (3,<strong>02</strong>6)<br />
Health Clinic Expense 450-097330-536-50<strong>02</strong>30 8,064<br />
Health Insurance 450-097330-536-50<strong>02</strong>31 (8,064)<br />
Health Clinic Expense 450-097340-535-50<strong>02</strong>30 11,732<br />
Health Insurance 450-097340-535-50<strong>02</strong>31 (11,732)<br />
Health Clinic Expense 450-097350-536-50<strong>02</strong>30 565<br />
Health Insurance 450-097350-536-50<strong>02</strong>31 (565)<br />
Health Clinic Expense 450-097500-536-50<strong>02</strong>30 565<br />
Health Insurance 450-097500-536-50<strong>02</strong>31 (565)<br />
FUND 481 - STORM WATER OPERATING FUND<br />
EXPENSES<br />
Health Clinic Expense 481-041760-541-50<strong>02</strong>30 $ 1,330<br />
Health Insurance 481-041760-541-50<strong>02</strong>31 (1,330)<br />
Health Clinic Expense 481-041765-541-50<strong>02</strong>30 1,277
February 7, 2011<br />
8<br />
RESOLUTION NO. 48-11(F)<br />
Health Insurance 481-041765-541-50<strong>02</strong>31 (1,277)<br />
Health Clinic Expense 481-041770-541-50<strong>02</strong>30 3,685<br />
Health Insurance 481-041770-541-50<strong>02</strong>31 (3,685)<br />
Health Clinic Expense 481-041780-541-50<strong>02</strong>30 1,175<br />
Health Insurance 481-041780-541-50<strong>02</strong>31 (1,175)<br />
FUND 501 - MANAGEMENT INFORMATION SYSTEMS FUND<br />
EXPENSES<br />
Health Clinic Expense 501-019200-590-50<strong>02</strong>30 $ 3,410<br />
Health Insurance 501-019200-590-50<strong>02</strong>31 (3,410)<br />
Health Clinic Expense 501-019300-590-50<strong>02</strong>30 1,330<br />
Health Insurance 501-019300-590-50<strong>02</strong>31 (1,330)<br />
Health Clinic Expense 501-019400-590-50<strong>02</strong>30 2,359<br />
Health Insurance 501-019400-590-50<strong>02</strong>31 (2,359)<br />
Health Clinic Expense 501-019500-590-50<strong>02</strong>30 767<br />
Health Insurance 501-019500-590-50<strong>02</strong>31 (767)<br />
Health Clinic Expense 501-019600-590-50<strong>02</strong>30 512<br />
Health Insurance 501-019600-590-50<strong>02</strong>31 (512)<br />
FUND 5<strong>02</strong> - PRINTING FUND<br />
EXPENSES<br />
Health Clinic Expense 5<strong>02</strong>-019290-590-50<strong>02</strong>30 $ 309<br />
Health Insurance 5<strong>02</strong>-019290-590-50<strong>02</strong>31 (309)<br />
FUND 503 - FLEET MANAGEMENT FUND<br />
EXPENSES<br />
Health Clinic Expense 503-019280-590-50<strong>02</strong>30 $ 155<br />
Health Insurance 503-019280-590-50<strong>02</strong>31 (155)
February 7, 2011<br />
9<br />
RESOLUTION NO. 48-11(F)<br />
Health Clinic Expense 503-019295-590-50<strong>02</strong>30 4,759<br />
Health Insurance 503-019295-590-50<strong>02</strong>31 (4,759)<br />
FUND 504 - SELF INSURANCE FUND<br />
EXPENSES<br />
Health Clinic Expense 504-018900-590-50<strong>02</strong>30 $ 720<br />
Health Insurance 504-018900-590-50<strong>02</strong>31 (720)<br />
SECTION 2: The <strong>City</strong> Clerk is hereby directed to furnish one (1) certified copy <strong>of</strong> this<br />
resolution to the Director <strong>of</strong> Finance, one (1) certified copy to the Budget Office and<br />
one (1) copy to the Purchasing Division <strong>of</strong> the <strong>City</strong> <strong>of</strong> <strong>West</strong> <strong>Palm</strong> <strong>Beach</strong> after<br />
passage.<br />
SECTION 3: This Resolution shall take effect as provided by law.<br />
PASSED AND ADOPTED THIS DAY OF , 2011.<br />
CORPORATE SEAL<br />
ATTEST:<br />
CITY CLERK<br />
CITY OF WEST PALM BEACH<br />
BY ITS CITY COMMISSION<br />
PRESIDING OFFICER
RESOLUTION NO. 41-11<br />
A RESOLUTION OF THE CITY COMMISSION OF THE CITY OF WEST PALM<br />
BEACH, FLORIDA, AUTHORIZING THE MAYOR TO EXECUTE AN EMPLOYEE<br />
HEALTH CENTER AGREEMENT BETWEEN THE CITY OF WEST PALM BEACH<br />
AND H2U WELLNESS CENTERS LLC, FOR THE OPERATION AND MANAGEMENT<br />
OF THE CITY’S EMPLOYEE HEALTH CLINIC.; PROVIDING FOR AN EFFECTIVE<br />
DATE; AND FOR OTHER PURPOSES.<br />
*******************<br />
WHEREAS, the <strong>City</strong> issued Invitation to Negotiate #08/09-131(“ITN”) seeking<br />
proposals to administer an onsite employee health center <strong>for</strong> the <strong>City</strong>; and<br />
WHEREAS, First Onsite, a wholly owned subsidiary <strong>of</strong> HCA, Inc., is a provider <strong>of</strong> health<br />
care services and employs or contracts with Medical Pr<strong>of</strong>essionals duly licensed and qualified to<br />
provide such services and to manage and operate the Clinic; and<br />
WHEREAS, First Onsite’s proposal was determined to be the best value to the <strong>City</strong>; and<br />
WHEREAS, it is the desire <strong>of</strong> the parties hereto to enter into a contractual agreement<br />
whereby First Onsite will provide the clinical and management services <strong>for</strong> the <strong>City</strong>’s Employee<br />
Health Clinic.<br />
NOW, THEREFORE, BE IT RESOLVED BY THE CITY COMMISSION OF THE CITY<br />
OF WEST PALM BEACH, FLORIDA, THAT:<br />
SECTION 1: The <strong>City</strong> Commission <strong>of</strong> the <strong>City</strong> <strong>of</strong> <strong>West</strong> <strong>Palm</strong> <strong>Beach</strong>, Florida hereby<br />
authorizes the Mayor to execute an Employee Health Center Agreement between the <strong>City</strong><br />
<strong>of</strong> <strong>West</strong> <strong>Palm</strong> <strong>Beach</strong> and H2U Wellness Centers LLC in substantially the <strong>for</strong>m attached<br />
hereto as Exhibit “A” (“Agreement”) and, in accordance with the Agreement, to execute<br />
amendments <strong>for</strong> changes relating to the operation <strong>of</strong> the Clinic such as staffing levels,<br />
per<strong>for</strong>mance guarantees and hours <strong>of</strong> operation.<br />
SECTION 2: Upon execution <strong>of</strong> two (2) originals <strong>of</strong> the Agreement by the Mayor, one<br />
original shall be <strong>for</strong>warded to Suzanne Payson, Assistant <strong>City</strong> Attorney, <strong>for</strong> further<br />
handling. A fully-executed original <strong>of</strong> the Amendment shall be retained by the <strong>City</strong><br />
Clerk as a public record <strong>of</strong> the <strong>City</strong>.
SECTION 3: This Resolution shall take effect as provided by law.<br />
PASSED AND ADOPTED THIS _____ DAY OF __________________, 2011.<br />
RESOLUTION NO. 41-11<br />
(CORPORATE SEAL) CITY OF WEST PALM BEACH<br />
BY THE CITY COMMISSION<br />
ATTEST: ____________________________<br />
PRESIDING OFFICER<br />
____________________<br />
CITY CLERK<br />
CITY ATTORNEY’S OFFICE<br />
Approved as to <strong>for</strong>m and legal sufficiency<br />
By:_______________________<br />
Date:______________________
Matter No. 10067<br />
ITN No. 08/09-131<br />
Resolution No. 41-11<br />
CITY OF WEST PALM BEACH<br />
EMPLOYEE HEALTH CENTER AGREEMENT<br />
THIS EMPLOYEE HEALTH CENTER AGREEMENT (the “Agreement”) is by and<br />
between H2U WELLNESS CENTERS LLC, a Tennessee Limited Liability Company<br />
authorized to do business in the state <strong>of</strong> Florida, d/b/a “First Onsite”, with an address <strong>of</strong> 3322<br />
<strong>West</strong> End Avenue, Suite 400, Nashville, TN 37203 (“First Onsite”), and the CITY OF WEST<br />
PALM BEACH, a Florida municipal corporation, with an address <strong>of</strong> 401 Clematis Street, <strong>West</strong><br />
<strong>Palm</strong> <strong>Beach</strong>, Florida 33401 (“<strong>City</strong>”).<br />
RECITALS:<br />
WHEREAS, the <strong>City</strong> seeks to provide access to quality health care and to improve the<br />
health and wellness <strong>of</strong> its employees and other eligible persons through the provision <strong>of</strong> clinical<br />
services at an employee health center (the “Clinic”); and<br />
WHEREAS, the <strong>City</strong> specifically wishes to <strong>of</strong>fer primary care and occupational health<br />
services including but not limited to evaluation and treatment <strong>of</strong> work related injuries and<br />
illnesses, occupational health exams, health assessments, call support, immunizations, injections,<br />
exams and screenings, prescription dispensing, disease management and primary case<br />
management at the Clinic to its employees and other eligible persons; and<br />
WHEREAS, the <strong>City</strong> issued Invitation to Negotiate #08/09-131(“ITN”) seeking<br />
proposals to administer an onsite employee health center <strong>for</strong> the <strong>City</strong>, the terms <strong>of</strong> which are<br />
incorporated herein by reference; and<br />
WHEREAS, First Onsite responded to the ITN by submitting a proposal dated<br />
September 10, 2009 and amended March 16, 2010, (collectively, “Proposal”), the terms <strong>of</strong><br />
which are incorporated herein by reference; and<br />
WHEREAS, First Onsite, a wholly owned subsidiary <strong>of</strong> HCA, Inc., is a provider <strong>of</strong> health<br />
care services and employs or contracts with Medical Pr<strong>of</strong>essionals duly licensed and qualified to<br />
provide such services and to manage and operate the Clinic; and<br />
WHEREAS, First Onsite’s Proposal was determined to be the best value to the <strong>City</strong>; and<br />
WHEREAS, it is the desire <strong>of</strong> the parties hereto to enter into a contractual agreement<br />
whereby First Onsite will provide clinical and management services under the terms and<br />
conditions herein.<br />
NOW, THEREFORE, in consideration <strong>of</strong> the promises and the mutual covenants<br />
contained herein, the parties hereto do agree as follows.
DEFINITIONS<br />
“Benefits” shall have the meaning set <strong>for</strong>th in Section 1.6.<br />
“Clinic” shall mean a facility owned or leased by the <strong>City</strong>, at a location selected by the<br />
<strong>City</strong>, which shall be known as the “<strong>City</strong> <strong>of</strong> <strong>West</strong> <strong>Palm</strong> <strong>Beach</strong> Employee Health Clinic”.<br />
“Clinical Services” shall have the meaning set <strong>for</strong>th in Section 1.1.<br />
“<strong>Cover</strong>ed Persons” shall mean (i) Eligible Employees, (ii) Eligible Dependents, (iii)<br />
Prospective Employees, and (iv) General, Police and Fire Rescue employees <strong>for</strong><br />
Occupational Health coverage; and (v) General, Police and Fire Rescue employees and<br />
<strong>of</strong>ficial <strong>City</strong> volunteers <strong>for</strong> Worker’s Compensation coverage. The <strong>City</strong> shall have the<br />
right, upon notification to First Onsite, to include Fire Rescue employees as <strong>Cover</strong>ed<br />
Persons at no additional charge.<br />
“Delivery Date” shall have the meaning set <strong>for</strong>th in Section 3.1.<br />
“Effective Date” shall have the meaning set <strong>for</strong>th in Section 4.1.<br />
“Eligible Dependent” means an individual enrolled as a qualified dependent <strong>of</strong> a <strong>City</strong><br />
employee or COBRA participant currently participating in the <strong>City</strong>’s health insurance<br />
plan <strong>for</strong> General Employees or Police Employees. The minimum age shall be established<br />
by First Onsite based upon the Medical Pr<strong>of</strong>essionals’ expertise but in any event the<br />
minimum age established shall not be more than eight (8) years old.<br />
“Eligible Employee” means a current, regular status employee or COBRA participant<br />
who is currently participating in the <strong>City</strong>’s health insurance plans.<br />
“EMR” shall mean First Onsite’s electronic medical records system.<br />
“Equipment” shall mean the equipment reasonably necessary <strong>for</strong> the delivery <strong>of</strong> the<br />
Clinical Services including but not limited to medical examination tables, diagnostic<br />
equipment, chairs, occasional tables and stands, lamps, shelves, storage cabinets,<br />
computers, and printers all as set <strong>for</strong>th in the Inventory.<br />
“HIPAA” shall mean the Health Insurance Portability and Accountability Act <strong>of</strong> 1996, as<br />
amended.<br />
“Inventory” shall have the meaning set <strong>for</strong>th in Section 1.5.<br />
“Management Services” shall have the meaning set <strong>for</strong>th in Section 1.2.<br />
“Management Fee” shall have the meaning set <strong>for</strong>th in Section 5.1.<br />
“Medical Assistant” shall mean a certified medical assistant and x-ray technician duly<br />
licensed in the State <strong>of</strong> Florida to provide medical assistance to the Medical<br />
Pr<strong>of</strong>essionals.<br />
2
“Medical Pr<strong>of</strong>essionals” shall mean a Physician, Physician Assistant, Nurse or Nurse<br />
Practitioner, as described herein, or other pr<strong>of</strong>essional duly licensed in the State <strong>of</strong><br />
Florida to provide medical services.<br />
“Nurse” shall mean, and is inclusive <strong>of</strong>, a Registered Nurse and a Licensed Practical<br />
Nurse, appropriately licensed in the State <strong>of</strong> Florida, operating within the scope <strong>of</strong> their<br />
license.<br />
“Nurse Practitioner” shall mean an Advanced Registered Nurse Practitioner (“ARNP”)<br />
appropriately licensed within the State <strong>of</strong> Florida operating within the scope <strong>of</strong> their<br />
license.<br />
“Opening Day” shall have the meaning set <strong>for</strong>th in Section 1.4.<br />
“Per<strong>for</strong>mance Guarantees” shall have the meaning set <strong>for</strong>th in Section 2.1.<br />
“Personnel” shall collectively refer to the Medical Pr<strong>of</strong>essionals and any support<br />
personnel.<br />
“Physician” shall mean a board certified or board eligible Medical Doctor (“M.D.”) or<br />
Doctor <strong>of</strong> Osteopathy (“D.O.”) appropriately licensed in the State <strong>of</strong> Florida operating<br />
within the scope <strong>of</strong> their license and licensed to dispense pre packaged medications.<br />
“Physician Assistant” means a Physician Assistant appropriately licensed within the<br />
State <strong>of</strong> Florida operating within the scope <strong>of</strong> their license.<br />
“Prospective Employees” shall mean post <strong>of</strong>fer applicants <strong>for</strong> employment with the<br />
<strong>City</strong> who are eligible to receive pre employment physicals and drug testing at the Clinic.<br />
“Protected Health In<strong>for</strong>mation” or “PHI” shall mean in<strong>for</strong>mation as defined by the<br />
Health Insurance Portability and Accountability Act <strong>of</strong> 1996, as amended, and by all<br />
federal and state privacy requirements.<br />
“Reimbursable Expenses” shall have the meaning set <strong>for</strong>th in Section 5.2.<br />
“Services” shall refer collectively to the Clinical Services and the Management Services.<br />
“Start Up Costs” shall have the meaning set <strong>for</strong>th in Section 1.5.<br />
“Supplies” shall mean the supplies reasonably necessary <strong>for</strong> the delivery <strong>of</strong> the Clinical<br />
Services including but not limited to pharmaceuticals, dressings, bandages, syringes,<br />
blood draw supplies, patient <strong>for</strong>ms, and in<strong>for</strong>mation pamphlets all as set <strong>for</strong>th in writing<br />
provided by First Onsite to the <strong>City</strong>.<br />
“Workers’ Compensation Services” shall mean services provided in accordance with<br />
Chapter 440, Florida Statutes.<br />
3
SECTION 1. Covenants and Responsibilities <strong>of</strong> First Onsite.<br />
1.1 Clinical Services. First Onsite shall provide those clinical services (“Clinical<br />
Services”) set <strong>for</strong>th in the Scope <strong>of</strong> Clinical Services attached hereto as Exhibit A and<br />
incorporated herein.<br />
a. Workers Compensation. The Clinical Services shall include Worker’s<br />
Compensation services provided that prior to treating <strong>City</strong> employees <strong>for</strong> injuries on the job,<br />
First Onsite shall establish written protocols in compliance with Chapter 440, Florida Statutes.<br />
First Onsite shall provide the protocols to the <strong>City</strong>’s Project Representative <strong>for</strong> review prior to<br />
the Opening Day <strong>for</strong> the Clinic. Any fines or assessments issued by the State <strong>of</strong> Florida <strong>for</strong><br />
failure to comply with Section 440.13 <strong>of</strong> the, Florida Statutes, shall be the responsibility <strong>of</strong> First<br />
Onsite.<br />
b. Physicals. First Onsite shall, in consultation with the <strong>City</strong>’s Project<br />
Representative and Risk Manager, develop minimum standards <strong>for</strong> all physicals. Such<br />
minimum standards shall be finalized <strong>for</strong> the <strong>City</strong>’s approval prior to Opening Day.<br />
c. Laboratory Testing. First Onsite shall contract with a provider <strong>for</strong><br />
laboratory testing, including drug testing, <strong>for</strong> those tests that can not be provided at the Clinic.<br />
1.2 Management Services. First Onsite shall provide those management and<br />
administrative services (“Management Services”) necessary <strong>for</strong> the effective and efficient<br />
operation <strong>of</strong> the Clinic, subject to the reasonable policies set <strong>for</strong>th by the <strong>City</strong>, as more<br />
specifically described in the Scope <strong>of</strong> Management Services attached hereto as Exhibit B and<br />
incorporated herein. As part <strong>of</strong> the Management Services, First Onsite shall provide Health<br />
Risk Assessments to all <strong>City</strong> employees and will <strong>of</strong>fer the programs described in Exhibit C to<br />
Eligible Employees at no additional cost.<br />
1.3 Licensing. First Onsite shall obtain all licenses required to provide the Services at<br />
the Clinic at the sole cost <strong>of</strong> the <strong>City</strong>.<br />
1.4 Opening Commitment; Online Scheduling. First Onsite shall open the Clinic fully<br />
staffed and operational within ten (10) business days <strong>of</strong> delivery <strong>of</strong> the Clinic to First Onsite by<br />
the <strong>City</strong> (“Opening Day”). First Onsite shall use its best ef<strong>for</strong>ts to provide an online<br />
appointment scheduling system that shall be operational within six (6) months from Opening<br />
Day. In the event the scheduling system is not operational within the six (6) month timeframe<br />
the Per<strong>for</strong>mance Guarantee set <strong>for</strong>th in Section 2 shall apply and be the <strong>City</strong>’s sole remedy.<br />
1.5 Equipment and Supplies.<br />
a. Start Up Equipment and Supplies. A detailed inventory <strong>of</strong> Supplies and<br />
Equipment needed <strong>for</strong> startup and operation <strong>of</strong> the Clinic is attached hereto as Exhibit D<br />
(“Inventory”). The <strong>City</strong> shall have the right to purchase the Supplies and/or Equipment directly<br />
or to authorize First Onsite to purchase the Supplies and Equipment and be reimbursed by the<br />
<strong>City</strong>. The total cost <strong>of</strong> the Equipment, Supplies purchased by First Onsite shall not exceed One<br />
Hundred Seventy Three Thousand Four Hundred Thirty One and 35/100 Dollars ($173,431.35)<br />
4
less the estimated cost <strong>of</strong> any Supplies and Equipment the <strong>City</strong> elects to purchase (“Start Up<br />
Costs”).<br />
b. Ongoing Equipment and Supplies. First Onsite shall be responsible <strong>for</strong><br />
replenishing the Equipment and Supplies as reasonably required <strong>for</strong> the provision <strong>of</strong> the Clinical<br />
Services and such costs shall be reimbursed by the <strong>City</strong> in accordance with Section 5.2.<br />
c. The Equipment and Supplies shall be the property <strong>of</strong> the <strong>City</strong> and, upon<br />
payment to First Onsite <strong>for</strong> the Equipment and Supplies purchased by First Onsite, First Onsite<br />
shall deliver a bill <strong>of</strong> sale, with warranty <strong>of</strong> title, to the <strong>City</strong>, including serial numbers <strong>for</strong> the<br />
Equipment, where applicable. First Onsite shall comply with the <strong>City</strong>’s asset inventory<br />
procedures. If any portion <strong>of</strong> the Equipment and Supplies is defective or otherwise not operating<br />
properly, it shall be the responsibility <strong>of</strong> First Onsite and the Medical Pr<strong>of</strong>essionals to take all<br />
action reasonably necessary to ensure that such Equipment and Supplies do not create a risk <strong>of</strong><br />
injury to any person at the Clinic.<br />
d. Except as otherwise provided <strong>for</strong> in the Inventory, First Onsite shall not<br />
make any single expenditure that will be passed through to the <strong>City</strong> (i) in excess <strong>of</strong> Two<br />
Thousand Five Hundred Dollars ($2,500); or (ii) not identified in Section 5.2 as a Reimbursable<br />
Expense, without the <strong>City</strong>’s prior approval.<br />
1.6 Personnel.<br />
a. First Onsite will provide a sufficient number <strong>of</strong> Medical Pr<strong>of</strong>essionals and<br />
support personnel as needed, based on number <strong>of</strong> visits, to per<strong>for</strong>m the Clinical Services at the<br />
Clinic. Initial staffing <strong>for</strong> the Clinic shall include a Physician, Nurse Practitioner or Physician’s<br />
Assistant, Nurse and Medical Technician. The salaries shall not exceed the hourly rates<br />
(including benefits) set <strong>for</strong>th on Exhibit E attached hereto the benefits will be consistent with the<br />
HCA benefit plan and all benefits that are greater than the HCA benefit plan shall be approved<br />
by the <strong>City</strong> (“Benefits”).<br />
b. The Physician shall be dedicated full time to the Clinic, shall be on site a<br />
minimum <strong>of</strong> <strong>for</strong>ty (40) hours <strong>of</strong> week, excluding vacation, holidays, training and sick time,<br />
unless otherwise approved by the <strong>City</strong>, and shall have no other employment or practice without<br />
the <strong>City</strong>’s prior written approval. First Onsite’s contract with the Physician shall be in the <strong>for</strong>m<br />
attached hereto as Exhibit F (“Physician’s Agreement”) unless otherwise approved by the<br />
<strong>City</strong>. Notwithstanding anything in the Physician’s Agreement to the contrary, travel <strong>for</strong> medical<br />
conferences or otherwise shall be limited to the continental United States unless otherwise<br />
approved by the <strong>City</strong> and costs shall be in accordance with the <strong>City</strong>’s Travel Expense Policy<br />
attached hereto as Exhibit G (“Travel Expense Policy”). The <strong>City</strong> shall not pay a Management<br />
Fee on any severance payable under the Physician’s Agreement or on travel and training.<br />
c. The <strong>City</strong> shall have the opportunity to interview any initial, replacement or<br />
temporary Physician and Nurse Practitioner or Physician Assistant candidates identified by First<br />
Onsite and determine if such candidates will be acceptable to the <strong>City</strong>. First Onsite shall not<br />
commit to provide any particular person as a Medical Pr<strong>of</strong>essional, and First Onsite shall have<br />
5
the right at any time and from time to time, with or without cause, to change a Medical<br />
Pr<strong>of</strong>essional provided to the Clinic; provided however that First Onsite shall notify the <strong>City</strong> <strong>of</strong><br />
the termination and the reason <strong>for</strong> such termination. The <strong>City</strong> shall have the right to require<br />
First Onsite to remove a Medical Pr<strong>of</strong>essional with or without cause upon prior written notice,<br />
which notice shall specify the time by which the Medical Pr<strong>of</strong>essional shall be removed.<br />
1.7 Standards <strong>of</strong> Medical Pr<strong>of</strong>essional’s Per<strong>for</strong>mance. First Onsite shall contract with<br />
the Medical Pr<strong>of</strong>essionals such that the Medical Pr<strong>of</strong>essionals are obligated to per<strong>for</strong>m or<br />
deliver the following:<br />
a. The Medical Pr<strong>of</strong>essional shall determine their own means and methods <strong>of</strong><br />
providing the Services with oversight and quality control functions<br />
per<strong>for</strong>med by First Onsite.<br />
b. Referrals by the Medical Pr<strong>of</strong>essionals <strong>for</strong> additional medical care shall be<br />
made according to evidence based medicine and best practice protocols and<br />
will be tracked through First Onsite’s Electronic Medical Records Program.<br />
Unless patient preferences dictates otherwise, the Medical Pr<strong>of</strong>essionals shall<br />
use their best ef<strong>for</strong>ts to utilize the providers in the <strong>City</strong>’s applicable health<br />
plan networks or the <strong>City</strong>’s Third Party Administrator’s provider network <strong>for</strong><br />
Worker’s Compensation, as applicable, taking into account geographical<br />
convenience <strong>for</strong> the employee.<br />
c. The Medical Pr<strong>of</strong>essionals shall comply with all applicable laws and<br />
regulations with respect to the licensing and regulations <strong>of</strong> medical<br />
pr<strong>of</strong>essionals.<br />
d. The Medical Pr<strong>of</strong>essionals shall provide the Services in a manner consistent<br />
with all applicable laws and regulations and in a pr<strong>of</strong>essional manner<br />
consistent with medical services provided in the community.<br />
e. The Medical Pr<strong>of</strong>essionals shall not bill or otherwise solicit payment from<br />
<strong>Cover</strong>ed Persons <strong>for</strong> the Services provided at the Clinic. Neither First Onsite<br />
nor the Medical Pr<strong>of</strong>essionals shall engage in the practice <strong>of</strong> “back billing”<br />
with regard to the Services.<br />
f. The Medical Pr<strong>of</strong>essionals shall maintain, during the term <strong>of</strong> this Agreement,<br />
appropriate credentials including (i) a duly issued and active license to<br />
practice medicine in the State <strong>of</strong> Florida without limitation or restriction; (ii)<br />
good standing with his or her pr<strong>of</strong>ession and state pr<strong>of</strong>essional association;<br />
(iii) the absence <strong>of</strong> any license restriction, revocation or suspension; (iv) the<br />
absence <strong>of</strong> any involuntary restriction placed on his or her federal Drug<br />
En<strong>for</strong>cement Administration (“DEA”) registration; and (v) the absence <strong>of</strong><br />
any conviction <strong>of</strong> a felony.<br />
g. In the event that any Medical Pr<strong>of</strong>essionals (i) has his or her license<br />
restricted, revoked or suspended, (ii) has an involuntary restriction placed on<br />
his or her federal DEA registration, (iii) is convicted <strong>of</strong> a felony; or (iv) is no<br />
6
longer in good standing with his or her pr<strong>of</strong>ession and/or state, First Onsite<br />
shall immediately remove that Medical Pr<strong>of</strong>essional and immediately replace<br />
such Medical Pr<strong>of</strong>essional with another Medical Pr<strong>of</strong>essional that meets the<br />
requirements <strong>of</strong> this Agreement.<br />
1.8 Training and Expertise. First Onsite represents and warrants that the person or<br />
persons per<strong>for</strong>ming the Services specified herein have the requisite training, licenses and<br />
expertise necessary to fully and satisfactorily complete their obligations hereunder. First Onsite<br />
agrees that if further training or expertise is or becomes necessary or is required to fully and<br />
satisfactorily complete their obligations that First Onsite, or the person or persons employed by<br />
First Onsite, shall obtain such training, licenses or expertise. This provision shall not apply to<br />
the costs <strong>of</strong> any continuing education included as a Benefit. First Onsite further acknowledges<br />
that the <strong>City</strong> shall have no responsibility or duty to provide any such training, licenses or<br />
expertise <strong>for</strong> First Onsite which may be necessary or required <strong>of</strong> First Onsite in order to fully<br />
and satisfactorily complete its obligations, and that any fees in connection therewith shall be<br />
borne solely by First Onsite, and not the <strong>City</strong>. Prior to commencement <strong>of</strong> the Services under<br />
this Agreement, First Onsite shall provide to the <strong>City</strong> reasonable evidence <strong>of</strong> the qualifications<br />
<strong>of</strong> such Personnel. First Onsite will ensure that all Personnel complete and pass background<br />
checks to verify licensing and training in accordance with First Onsite’s Credentialing Process<br />
set <strong>for</strong>th in Exhibit H attached hereto.<br />
1.9 Quality <strong>of</strong> Work. First Onsite represents and warrants that:<br />
a. the Services to be per<strong>for</strong>med by it hereunder shall be accomplished in a<br />
pr<strong>of</strong>essional and competent manner consistent with the level <strong>of</strong> care and skill ordinarily<br />
exercised in the trade under similar circumstances;<br />
b. all deliverables and Services provided hereunder will be <strong>of</strong> merchantable<br />
quality and fit <strong>for</strong> the particular purposes <strong>of</strong> the <strong>City</strong>;<br />
c. First Onsite will comply with all applicable federal, state and local laws,<br />
rules, regulations and orders in connection with the per<strong>for</strong>mance <strong>of</strong> its obligations hereunder;<br />
d. First Onsite shall establish protocols <strong>for</strong> the operation <strong>of</strong> the Clinic <strong>for</strong> use<br />
by the Personnel and shall, upon request, provide such protocols to the <strong>City</strong>. Such protocols<br />
shall remain the proprietary in<strong>for</strong>mation <strong>of</strong> First Onsite and shall be returned to First Onsite<br />
after the termination <strong>of</strong> this Agreement; and<br />
e. First Onsite shall have annual Quality Assurance Reviews conducted <strong>for</strong><br />
the operations <strong>of</strong> the Clinic and shall promptly provide the results to the <strong>City</strong>.<br />
1.10 Hours <strong>of</strong> Operation. First Onsite shall provide the Services at the Clinic <strong>for</strong> a<br />
minimum <strong>of</strong> <strong>for</strong>ty (40) hours per week in accordance with the schedule attached hereto as<br />
Exhibit I. Any modifications to the operating schedule based on demand are subject to the<br />
<strong>City</strong>’s prior approval. The Physician, Physician Assistant or Nurse Practitioner shall be on site<br />
at all times that the Clinic is open.<br />
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1.11 Eligibility. Eligibility to receive Clinical Services is limited to <strong>Cover</strong>ed Persons.<br />
First Onsite shall verify that a person coming to the Clinic is a <strong>Cover</strong>ed Person and <strong>City</strong> shall<br />
require <strong>Cover</strong>ed Persons to produce photo identification.<br />
1.12 Compliance with Laws. First Onsite covenants and agrees that it and any <strong>of</strong> its<br />
subcontractors and agents are bound by and will observe and per<strong>for</strong>m all duties required under<br />
all applicable local, state and federal laws, ordinances, rules and regulations including but not<br />
limited to Title VII <strong>of</strong> the Civil Rights Act <strong>of</strong> 1964 (Pub. L. 88-352), as amended, Occupational<br />
Safety and Health Act <strong>of</strong> 1970 29 U.S. C. Section 651 et seq., as amended, Employee<br />
Retirement Income Security Act <strong>of</strong> 1974, the Health Insurance Portability and Accountability<br />
Act <strong>of</strong> 1996, as amended, the Consolidated Omnibus Budget Reconciliation Act, the Social<br />
Security Act, the United States Fair Labor Standards Act and the Immigration Re<strong>for</strong>m and<br />
Control Act. First Onsite further covenants and agrees that with respect to laws applicable to<br />
the establishment or maintenance <strong>of</strong> an on-site health clinic First Onsite shall take any and all<br />
actions necessary to con<strong>for</strong>m to such laws.<br />
1.13 Project Representative. First Onsite hereby designates Debbie Sullivan, Director<br />
<strong>of</strong> Operations, as First Onsite’s project representative (“First Onsite Project Representative”)<br />
to represent First Onsite in all <strong>of</strong> its dealings with the <strong>City</strong> relating to the operation and<br />
management <strong>of</strong> the Clinic. First Onsite may replace the Project Representative at its sole<br />
discretion upon prior written notice to the <strong>City</strong>.<br />
1.14 Dispensing Pre Packaged Prescriptions. The Clinic shall dispense pre packaged<br />
prescription drugs to <strong>Cover</strong>ed Persons. The basic <strong>for</strong>mulary will be determined based on the<br />
prescription utilization and financial benefit to the <strong>City</strong> versus costs through the insurance plan<br />
or as agreed upon should changes and adjustments be desired by the <strong>City</strong> in accordance with the<br />
dispensing laws <strong>of</strong> the State <strong>of</strong> Florida. All medications will be stocked in accordance with<br />
applicable regulations. No controlled substances will be stocked. First Onsite will track and<br />
make every reasonable ef<strong>for</strong>t to maintain inventory levels necessary to meet patient needs as<br />
<strong>for</strong>ecasted through expected utilization with the understanding the Medical Pr<strong>of</strong>essional<br />
maintains autonomy when it comes to medication prescribing and determining what is<br />
medically necessary with regard to patient care.<br />
1.15 First Onsite agrees to use best ef<strong>for</strong>ts to make available to the Clinic any<br />
programs used in its other facilities, provided that they are not proprietary to other facilities, to<br />
increase the efficiency <strong>of</strong> the Clinic operations including but not limited to making pre<br />
appointment paperwork available on line.<br />
SECTION 2. Per<strong>for</strong>mance Guarantees.<br />
2.1 First Onsite provides the following per<strong>for</strong>mance guarantees (“Per<strong>for</strong>mance<br />
Guarantees”) and, unless otherwise indicated, agrees to achieve each metric and that each<br />
metric will be measured on a quarterly basis. The percentages listed in the columns styled “1 st<br />
Year” and “2 nd & Subsequent Years” below, constitute that portion <strong>of</strong> 50% <strong>of</strong> Management Fee<br />
that is at risk <strong>of</strong> <strong>for</strong>feiture. Thus, by means <strong>of</strong> example: <strong>for</strong> each month in the second year in<br />
which First Onsite’s electronic medical records system is not fully functional 95% <strong>of</strong> the time,<br />
First Onsite agrees to <strong>for</strong>feit one-twelfth <strong>of</strong> the 8% <strong>of</strong> the 50% <strong>of</strong> the annual Management Fee at<br />
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isk; thus, the amount <strong>for</strong>feited in this example is $119.63 calculated as follows: ((($35,889 x<br />
50%) x 8%) x (1/12)) = $119.63. First Onsite shall deduct such amount(s) from the monthly<br />
invoice applicable to the last month <strong>of</strong> the contract quarter and from each monthly invoice<br />
thereafter until said amount is credited to the <strong>City</strong> by means <strong>of</strong> deduction from the invoices as<br />
described herein. If, at the end <strong>of</strong> the term <strong>of</strong> this Agreement, there are not sufficient invoices<br />
from which to deduct such amount(s), First Onsite agrees to pay the <strong>City</strong> such amount(s), in the<br />
<strong>for</strong>m <strong>of</strong> a check, that First Onsite shall remit to the <strong>City</strong> no later than thirty (30) days subsequent<br />
to the end <strong>of</strong> the term <strong>of</strong> this Agreement.<br />
2 nd & Subsequent<br />
1 st Year Years<br />
a. Implementation<br />
3% 0% 1. EMR: First Onsite’s electronic medical records<br />
system (“EMR”) shall be fully functional upon opening <strong>of</strong> the Clinic.<br />
10% 0% 2. Implementation Date:<br />
First Onsite shall have the Clinic open <strong>for</strong> business, including being<br />
staffed with one physician, nurse practitioner or physician assistant, one<br />
nurse and one medical assistant, no later than ten (10) business days from<br />
delivery <strong>of</strong> the space to First Onsite.<br />
10% 10% 3. On Line Appointment Scheduling.<br />
First Onsite shall have its online appointment scheduling system<br />
operational and available <strong>for</strong> <strong>City</strong> employees no later than six (6) months<br />
from Opening Day.<br />
b. Administration<br />
2%<br />
time.<br />
4% 1. EMR: EMR will be fully functional 95% <strong>of</strong> the<br />
2% 4% 2. Reports: First Onsite shall provide the standard<br />
reports as indicated below by the fifteenth (15 th ) day <strong>of</strong> the month<br />
following the month to which the reports apply.<br />
- Monthly Stats Report<br />
- Top Fifteen Diagnosis<br />
- Medication Dispensing reports – all medicines to include quantity,<br />
unique patients, and medication cost.<br />
- Referral Report<br />
2% 4% 3. Complaints: First Onsite shall effectively<br />
address all complaints within 48 hours <strong>of</strong> such complaints. First Onsite<br />
shall notify the <strong>City</strong> <strong>of</strong> such complaints and resolution within 48 hours.<br />
5% 5% 4. Timely Appointments:<br />
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Provided that First Onsite has not requested additional staffing by the <strong>City</strong>,<br />
<strong>Cover</strong>ed Persons shall not wait more than 30 minutes <strong>for</strong> an appointment<br />
that was properly scheduled 80% <strong>of</strong> the time.<br />
5% 5% 5. Scheduling <strong>of</strong> Appointments:<br />
Provided that First Onsite has not requested additional staffing by the <strong>City</strong>,<br />
Eligible Employees shall be able to schedule primary care appointments<br />
within ten (10) days.<br />
5% 10% 6. Staffing:<br />
The Physician, Nurse Practitioner or Physician’s Assistant shall be on site<br />
at the Clinic at least 98% <strong>of</strong> the time.<br />
c. Satisfaction. First Onsite shall provide a client satisfaction survey<br />
via the internet at least quarterly to patients <strong>of</strong> the clinic that have visited<br />
the clinic in the past quarter, including a means by which patient feedback<br />
may be provided anonymously. In the event that the results <strong>of</strong> the survey<br />
are not satisfactory <strong>for</strong> the categories <strong>of</strong> (i) Service; (ii) Staff; and (iii)<br />
Facility, Satisfactory shall mean that 80% <strong>of</strong> the scores shall be a rating <strong>of</strong><br />
satisfactory or better.<br />
2% 2% 1. Service<br />
2% 2% 2. Staff<br />
2% 2% 3. Facility<br />
d. First Onsite will schedule and conduct quarterly review meetings<br />
(quarter is contract quarter, not calendar quarter) with the <strong>City</strong> which will<br />
include review <strong>of</strong> all facets <strong>of</strong> the Clinic’s operations, including, but not<br />
limited to the per<strong>for</strong>mance guarantees set <strong>for</strong>th herein and First Onsite’s<br />
provision <strong>of</strong> applicable reports. Quarterly review meetings shall be<br />
conducted by First Onsite on or be<strong>for</strong>e the 15 th day <strong>of</strong> the month following<br />
the end <strong>of</strong> the quarter to which the quarterly review meeting applies.<br />
e. First Onsite will participate in the <strong>City</strong>’s annual health fair.<br />
f. First Onsite will meet and participate with <strong>City</strong> staff and any<br />
designated advisory board up to four (4) meetings per year.<br />
2.2 First Onsite and the <strong>City</strong> shall periodically review the Per<strong>for</strong>mance Guarantees<br />
and determine whether the Per<strong>for</strong>mance Guarantees are still effective measures <strong>of</strong> First Onsite’s<br />
per<strong>for</strong>mance. First Onsite and the <strong>City</strong> agree, from time to time, as needed to replace the<br />
Per<strong>for</strong>mance Guarantees with mutually agreed upon guarantees to measure per<strong>for</strong>mance.<br />
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SECTION 3. Covenants and Responsibilities <strong>of</strong> the <strong>City</strong>.<br />
3.1 Site; Delivery. The <strong>City</strong> agrees to provide space to First Onsite where First<br />
Onsite will operate the Clinic. Such space will satisfy the minimum square footage requirements<br />
set <strong>for</strong>th in Exhibit J attached hereto and will be delivered to First Onsite upon completion <strong>of</strong> all<br />
renovations deemed necessary by <strong>City</strong> (“Delivery Date”).<br />
3.2 Clinic Renovations. The <strong>City</strong> shall be responsible <strong>for</strong>, and bear all expense <strong>for</strong><br />
renovations necessary or required to permit the Services to be provided at the Clinic (including<br />
any alterations required <strong>for</strong> patient safety, patient privacy and/or required by law). The <strong>City</strong> will<br />
also provide a voice telephone infrastructure and functionality and reimburse First Onsite <strong>for</strong><br />
costs <strong>for</strong> hardware and s<strong>of</strong>tware connectivity to enable First Onsite to use its portable electronic<br />
medical records.<br />
3.3 Utilities and Cleaning. The <strong>City</strong> shall provide heat, air-conditioning, electricity,<br />
water and sewer utilities, telephone access, and internet access to the Clinic sufficient <strong>for</strong><br />
providing the Services. The <strong>City</strong> shall provide general cleaning services <strong>for</strong> the Clinic. First<br />
Onsite shall be responsible <strong>for</strong> overseeing functionality <strong>of</strong> utilities and cleaning and shall notify<br />
the <strong>City</strong>’s Project Representative <strong>of</strong> any items not satisfactorily functioning <strong>for</strong> Clinic operation.<br />
3.4 Zoning, Consents, Etc. Any required zoning changes or other approvals or<br />
consents <strong>for</strong> the Clinic site other than licensing, approvals or consents relating to the provision<br />
<strong>of</strong> clinical services at the Clinic shall be obtained by the <strong>City</strong> at the <strong>City</strong>’s expense.<br />
3.5 <strong>Cover</strong>ed Persons. The <strong>City</strong> shall provide access to the Clinic only to <strong>Cover</strong>ed<br />
Persons as defined above, unless otherwise agreed to by the parties. The <strong>City</strong> will make its best<br />
ef<strong>for</strong>ts to ensure that <strong>Cover</strong>ed Persons are aware <strong>of</strong> the availability <strong>of</strong> First Onsite’s Services.<br />
Prior to the first (1 st ) <strong>of</strong> each month, the <strong>City</strong> shall provide First Onsite a listing <strong>of</strong> all “<strong>Cover</strong>ed<br />
Persons” in mutually agreed upon file <strong>for</strong>mat. The <strong>City</strong> shall identify Prospective Employees on<br />
an ongoing, as needed basis.<br />
3.6 Project Representative. The <strong>City</strong> hereby designates Patricia Brosamer, Benefits<br />
Manager, as the <strong>City</strong>’s project representative (“<strong>City</strong>’s Project Representative”) to represent<br />
the <strong>City</strong> in all <strong>of</strong> its dealings with First Onsite relating to the operation and management <strong>of</strong> the<br />
Clinic.<br />
SECTION 4. Term and Termination.<br />
4.1 Term. This Agreement shall commence on the date executed by the later <strong>of</strong> the<br />
<strong>City</strong> and First Onsite (“Effective Date”) and shall continue <strong>for</strong> a term <strong>of</strong> three (3) years. Unless<br />
terminated as provided <strong>for</strong> herein, the <strong>City</strong> shall have the right to renew the Agreement <strong>for</strong> a<br />
maximum <strong>of</strong> two (2) consecutive one (1) year terms prior to the expiration <strong>of</strong> each term <strong>of</strong> the<br />
Agreement.<br />
4.2 Termination. Notwithstanding anything herein to the contrary, this Agreement<br />
may be terminated at any time as follows:<br />
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in writing; or<br />
a. Whenever the <strong>City</strong> and First Onsite shall mutually agree to the termination<br />
b. Except as provided elsewhere in this Agreement, with cause by either party<br />
upon the default by the other party <strong>of</strong> any term, covenant or condition <strong>of</strong> this Agreement, where<br />
such default continues <strong>for</strong> a period <strong>of</strong> ten (10) business days after the defaulting party receives<br />
written notice there<strong>of</strong> from the other party specifying the existence <strong>of</strong> such default; or<br />
c. At any time and without liability and <strong>for</strong> any or no reason, or <strong>for</strong> its<br />
convenience, by the <strong>City</strong> upon at least ninety (90) days prior written notice to First Onsite; or<br />
d. After one (1) year from the Opening Date, by First Onsite upon at least one<br />
hundred eighty (180) days prior written notice to the <strong>City</strong>; or<br />
e. Upon the filing <strong>of</strong> voluntary or involuntary bankruptcy by either the <strong>City</strong> or<br />
First Onsite; or<br />
f. Upon First Onsite’s loss <strong>of</strong> license, accreditation or certification.<br />
4.3 Effect <strong>of</strong> Termination. The <strong>City</strong> agrees to reimburse First Onsite <strong>for</strong> any Services<br />
satisfactorily provided as <strong>of</strong> the date <strong>of</strong> termination, even if payment is not due until after<br />
termination.<br />
4.4 Non-Competition. In the event <strong>of</strong> termination <strong>of</strong> this Agreement by the <strong>City</strong>, <strong>for</strong><br />
a period <strong>of</strong> one (1) year after termination, the <strong>City</strong> shall not use the onsite pr<strong>of</strong>essional<br />
healthcare services <strong>of</strong> any Medical Pr<strong>of</strong>essional provided by First Onsite to the <strong>City</strong> during the<br />
Term without First Onsite’s prior written consent.<br />
SECTION 5. Management Fee and Reimbursable Expenses.<br />
5.1 Management Fee. In consideration <strong>of</strong> the satisfactory per<strong>for</strong>mance <strong>of</strong> the<br />
Services by First Onsite, and the per<strong>for</strong>mance <strong>of</strong> all <strong>of</strong> its other duties and obligations as set<br />
<strong>for</strong>th in this Agreement, the <strong>City</strong> shall pay First Onsite an annual management fee equal to the<br />
lesser <strong>of</strong> (a) One Hundred Thirty One Thousand Forty Dollars ($131,040.00) or (b) twenty<br />
percent (20%) <strong>of</strong> the salary, wages and benefits <strong>for</strong> the Personnel (“Management Fee”). In the<br />
event additional personnel are approved by the <strong>City</strong> <strong>for</strong> the Clinic and the total cost <strong>of</strong> the<br />
salary, wages and benefits <strong>for</strong> the Personnel exceed $655,200.00, the calculation <strong>of</strong> the<br />
Management Fee shall be adjusted accordingly. The obligation to pay the Fee shall commence<br />
upon the Delivery Date and shall be prorated <strong>for</strong> partial months. The <strong>City</strong> shall have no<br />
obligation to pay any fees to First Onsite <strong>for</strong> any period <strong>of</strong> time prior to the Delivery Date.<br />
Notwithstanding the <strong>for</strong>egoing, the Management Fee shall not apply to any severances payable<br />
to Personnel or travel or training expenses <strong>for</strong> Personnel. Except <strong>for</strong> the Reimbursable Expenses<br />
set <strong>for</strong>th below, the Management Fee set <strong>for</strong>th herein shall be the sole compensation paid to<br />
First Onsite in connection with the delivery <strong>of</strong> the Services.<br />
5.2 Reimbursable Expenses. The <strong>City</strong> shall reimburse First Onsite <strong>for</strong><br />
a. salary, wages and Benefits <strong>for</strong> Personnel;<br />
12
Exhibit K<br />
b. Start Up Costs;<br />
c. the pass through expenses identified in the summary attached hereto as<br />
(collectively, the “Reimbursable Expenses”). No other expense shall be passed through to the<br />
<strong>City</strong> without the <strong>City</strong>’s prior written consent.<br />
5.3 Best Obtainable Prices. In purchasing and replenishing the Equipment and<br />
Supplies, First Onsite shall use reasonable ef<strong>for</strong>ts to find the best obtainable prices. The <strong>City</strong>’s<br />
obligation to reimburse First Onsite shall be “at cost” and less any applicable discounts, rebates<br />
and other savings passed on to First Onsite by suppliers and without any additional mark up or<br />
overhead charge.<br />
5.4 Invoices. On the fifteenth (15 th ) <strong>of</strong> each calendar month commencing after the<br />
Delivery Date, First Onsite shall submit to the <strong>City</strong> an invoice <strong>for</strong> (a) the Management Fee, and<br />
(b) reimbursement <strong>of</strong> the prior month’s expenditures <strong>for</strong> the Reimbursable Expenses. Invoices<br />
must identify the PO number and shall be submitted to the <strong>City</strong>’s Project Representative.<br />
Invoices <strong>for</strong> salary, wages and benefits shall show the actual hours worked, person per<strong>for</strong>ming<br />
services, hourly rate, and dates(s) <strong>of</strong> service. Invoices <strong>for</strong> Reimbursable Expenses shall<br />
include an itemized breakdown <strong>of</strong> each expense and the cost and any back up documentation<br />
reasonably requested by the <strong>City</strong>.<br />
5.5 Payment <strong>of</strong> Fees and reimbursements <strong>for</strong> Start Up Costs and purchases <strong>of</strong><br />
Equipment and Supplies will be made in accordance with the Local Government Prompt<br />
Payment Act, Section 218.70, et al., Florida Statutes, as amended, which provides prompt<br />
payment, interest payments, a dispute resolution process and payments <strong>for</strong> all purchases be<br />
made in a timely manner <strong>for</strong> properly executed invoices by local governmental entities.<br />
5.6 No payment made under this Agreement shall be conclusive evidence <strong>of</strong> the<br />
per<strong>for</strong>mance <strong>of</strong> this Agreement by First Onsite, either wholly or in part, and no payment shall<br />
be construed to be an acceptance <strong>of</strong> or to relieve First Onsite <strong>of</strong> liability <strong>for</strong> the defective,<br />
faulty or incomplete rendition <strong>of</strong> the Services.<br />
SECTION 6. Records.<br />
6.1 Medical Records. First Onsite shall maintain medical records <strong>for</strong> each <strong>Cover</strong>ed<br />
Person who receives services per<strong>for</strong>med by First Onsite at the Clinic in a pr<strong>of</strong>essional manner<br />
consistent with the accepted practice <strong>of</strong> the community in which the Physician provides the<br />
Services. Such medical records shall be the property <strong>of</strong> First Onsite. First Onsite shall be<br />
solely responsible <strong>for</strong> the storage, maintenance and confidentiality <strong>of</strong> such records in<br />
accordance with the provisions <strong>of</strong> Section 11.2 below. First Onsite shall be responsible <strong>for</strong><br />
fulfilling all requirements imposed by state, local and federal law with respect to the<br />
preparation, maintenance, security, disclosures, and retention <strong>of</strong> medical records. First Onsite<br />
agrees to keep and maintain any medical records <strong>for</strong> the longer <strong>of</strong> twelve (12) years or as required<br />
by Florida law. Upon expiration or earlier termination <strong>of</strong> this Agreement, First Onsite agrees,<br />
with proper consent, to provide an electronic medical record to a successor on-site clinic vendor<br />
or doctor. At <strong>City</strong>’s election and in accordance with applicable federal and state law, First<br />
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Onsite shall deliver the electronic medical records to a designee <strong>of</strong> the <strong>City</strong> to maintain the<br />
records in accordance with Florida law.<br />
6.2 Employment Records. All other records and documents, including but not<br />
limited to those records that constitute employment records <strong>of</strong> <strong>Cover</strong>ed Persons, created as a<br />
result <strong>of</strong> First Onsite’s per<strong>for</strong>mance under this Agreement shall at all times be considered the<br />
property <strong>of</strong> the <strong>City</strong>. The <strong>City</strong> will maintain its records in accordance with the provisions <strong>of</strong><br />
Section 11.2 below. Both during and after the term <strong>of</strong> this Agreement, First Onsite or its<br />
designees shall be permitted to inspect or duplicate any pertinent chart or record to the extent<br />
necessary to meet pr<strong>of</strong>essional responsibilities to a <strong>Cover</strong>ed Person and/or to assist in the<br />
defense <strong>of</strong> any pr<strong>of</strong>essional liability or similar claim; provided, however, that such inspection<br />
and duplication shall be permitted and conducted in accordance with applicable legal<br />
requirements.<br />
SECTION 7. Reporting and Right to Audit.<br />
7.1 Right to Audit. The <strong>City</strong> shall have the right to per<strong>for</strong>m a full operational and<br />
financial audit <strong>of</strong> First Onsite at least once a year during the term <strong>of</strong> the Agreement and at any<br />
time within the twelve (12) months following the termination <strong>of</strong> the Agreement. Any such audit<br />
shall not be limited temporally and/or in scope, except as determined by the <strong>City</strong>. Audits may<br />
be conducted by the <strong>City</strong> or by an auditor/consultant <strong>of</strong> the <strong>City</strong>’s choosing. Should shortfalls<br />
be identified, First Onsite shall develop and implement any necessary corrective plan(s), which<br />
shall be approved by the <strong>City</strong> prior to implementation <strong>of</strong> the corrective plan(s), and the <strong>City</strong><br />
shall have the right to re-audit the plan as needed to ensure proper quality <strong>of</strong> Services and<br />
per<strong>for</strong>mance <strong>of</strong> duties by First Onsite. First Onsite shall provide all resources requested by the<br />
<strong>City</strong>, including resources and in<strong>for</strong>mation from third-parties (including but not limited to<br />
contracts with hospitals and other providers), and First Onsite shall cooperate in all respects in<br />
connection with the per<strong>for</strong>mance <strong>of</strong> the audit and shall initiate any needed corrective actions, all<br />
without additional charges to the <strong>City</strong>. This paragraph shall survive the termination or cessation<br />
<strong>of</strong> this Agreement. Failure by First Onsite to permit such audit shall be grounds <strong>for</strong> termination<br />
<strong>of</strong> this Agreement by the <strong>City</strong>.<br />
7.2 Reporting Requirements. First Onsite shall provide the reports detailed on<br />
Exhibit L in accordance with the frequency described therein. All reports shall be submitted to<br />
the <strong>City</strong>’s Project Representative. All reports due monthly shall be due on the fifteen <strong>of</strong> the<br />
month; all reports due quarterly shall be due on the fifteenth day <strong>of</strong> the first month following the<br />
quarter; all reports due annually shall be due by March 15 th . No additional fees shall be charged<br />
to the <strong>City</strong> by First Onsite <strong>for</strong> the provision <strong>of</strong> these reports, data or in<strong>for</strong>mation.<br />
7.3 Application <strong>of</strong> Law to Audit and Reporting Requirements. Notwithstanding the<br />
preceding Section 7.1 and 7.2 and as more particularly set <strong>for</strong>th in Section 11 below, nothing in<br />
this Agreement nor in the <strong>City</strong>’s policies shall require First Onsite to violate any federal or state<br />
law or regulation regarding the confidentiality <strong>of</strong> such medical in<strong>for</strong>mation. The <strong>City</strong> shall<br />
ensure that it and any third party conducting an audit shall be duly authorized by <strong>Cover</strong>ed<br />
Persons to obtain and review the records.<br />
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SECTION 8. Indemnification.<br />
First Onsite agrees to indemnify, defend, save and hold harmless <strong>City</strong>, its <strong>of</strong>ficers, agents and<br />
employees, from any claim, demand, suit, loss, cost or expense <strong>for</strong> any damages that may be<br />
asserted, claimed or recovered against or from <strong>City</strong>, its <strong>of</strong>ficials, agents, or employees by reason<br />
<strong>of</strong> any damage to property or personal injury, including death and which damage, injury or death<br />
arises out <strong>of</strong> or is incidental to or in any way connected with First Onsite’s per<strong>for</strong>mance <strong>of</strong> the<br />
Services or caused by or arising out <strong>of</strong> (a) any act, omission, default or negligence <strong>of</strong> First Onsite<br />
in the provision <strong>of</strong> the Services under this Agreement; (b) property damage or personal injury,<br />
which damage, injury or death arises out <strong>of</strong> or is incidental to or in any way connected with First<br />
Onsite’s execution <strong>of</strong> Services under this Agreement; or (c) the violation <strong>of</strong> federal, state, county<br />
or municipal laws, ordinances or regulations by First Onsite. This indemnification includes, but<br />
is not limited to, the per<strong>for</strong>mance <strong>of</strong> this Agreement by First Onsite or any act or omission <strong>of</strong><br />
First Onsite, its Personnel, agents, servants, contractors, patrons, guests or invitees and includes<br />
any costs, attorneys’ fees, expenses and liabilities incurred in the defense <strong>of</strong> any such claims or<br />
the investigation there<strong>of</strong>. First Onsite agrees to pay all claims and losses and shall defend all<br />
suits, in the name <strong>of</strong> <strong>City</strong>, its employees, and <strong>of</strong>ficers, including but not limited to appellate<br />
proceedings, and shall pay all costs, judgments and attorneys’ fees which may issue thereon.<br />
<strong>City</strong> reserves the right to select its own legal counsel to conduct any defense in any such<br />
proceeding and all costs and fees associated therewith shall be the responsibility <strong>of</strong> First Onsite<br />
under this indemnification provision. To the extent considered necessary by <strong>City</strong>, any sums due<br />
First Onsite under this Agreement may be retained by <strong>City</strong> until all <strong>of</strong> <strong>City</strong>’s claims <strong>for</strong><br />
indemnification have been resolved, and any amount withheld shall not be subject to the<br />
payment <strong>of</strong> interest by <strong>City</strong>. This indemnification agreement is separate and apart from, and in<br />
no way limited by, any insurance provided pursuant to this Agreement or otherwise. This<br />
paragraph shall not be construed to require First Onsite to indemnify <strong>City</strong> <strong>for</strong> its own negligence,<br />
or intentional acts <strong>of</strong> <strong>City</strong>, its agents or employees. This clause shall survive the expiration or<br />
termination <strong>of</strong> this Agreement.<br />
SECTION 9. Insurance. First Onsite shall maintain and shall require all subcontractors to<br />
maintain the following insurance coverage during the term <strong>of</strong> this Agreement.<br />
9.1 Carriers. First Onsite and all subcontractors shall have insurance placed with<br />
insurance carriers that are acceptable to the <strong>City</strong>. First Onsite and all subcontractors shall<br />
maintain this insurance at all times during per<strong>for</strong>mance <strong>of</strong> this Agreement. In addition, if<br />
insurance is written on a “claims made” basis, such insurance shall be maintained by First Onsite<br />
and all subcontractors <strong>for</strong> a minimum period <strong>of</strong> five (5) years after the expiration or earlier<br />
termination <strong>of</strong> this Agreement. First Onsite and all subcontractors may elect to extend the<br />
discovery period under the existing policy (or policies) <strong>for</strong> not less than five (5) years.<br />
9.2 Terms <strong>of</strong> Policies. First Onsite and all subcontractors shall have the <strong>City</strong> named<br />
as an additional insured under its Commercial General Liability, Business Auto and Commercial<br />
Umbrella Liability insurance policies listed below. The coverage will be provided on a primary<br />
non-contributing basis and the limits will be exhausted be<strong>for</strong>e any other insurance is to apply.<br />
9.3 Subcontractors. First Onsite shall require all subcontractors to the extent such are<br />
permitted, to furnish insurance listed below and such insurance shall be in accordance with all<br />
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equirements <strong>of</strong> this section. Each insurance policy required by this section shall contain a<br />
waiver <strong>of</strong> the right <strong>of</strong> subrogation, as well as the right <strong>of</strong> set <strong>of</strong>f and any right <strong>of</strong> deduction, by<br />
the respective underwriter(s) <strong>of</strong> such policy, and shall be endorsed to provide <strong>for</strong> severability <strong>of</strong><br />
interest, cross liability or cross suit protection, so that each insured is treated separately under the<br />
policy. The waiver <strong>of</strong> the right <strong>of</strong> subrogation, set<strong>of</strong>f and deduction shall also extend to parent<br />
companies, subsidiaries and affiliates <strong>of</strong> the <strong>City</strong> and the <strong>of</strong>ficials, directors, agent, and<br />
employees <strong>of</strong> such entities. These provisions shall survive the expiration, termination or<br />
cancellation <strong>of</strong> this Agreement.<br />
9.4 Workers’ Compensation and Employer’s Liability Insurance. First Onsite and all<br />
subcontractors shall maintain Workers’ Compensation with statutory limits and Employer’s<br />
Liability Insurance with $1,000,000 limits in the state in which the services are to be per<strong>for</strong>med.<br />
a. A Firm or subcontractor that is a legally permitted and qualified<br />
self-insurer in the state in which services are to be per<strong>for</strong>med, may<br />
furnish pro<strong>of</strong> that it is such a self-insurer in lieu <strong>of</strong> submitting<br />
pro<strong>of</strong> <strong>of</strong> insurance.<br />
b. First Onsite shall determine if the work to be per<strong>for</strong>med under this<br />
Agreement requires coverage by any Federal Compensation<br />
statutes including, but not limited to, the Longshoremen’s and<br />
Harbor Workers’ Compensation Act or Jones Act and provide such<br />
coverage.<br />
c. The Commercial Umbrella and/or Employer’s Liability insurance<br />
against claims <strong>for</strong> bodily injury and death, af<strong>for</strong>ding minimum<br />
single limit protection <strong>of</strong> One Million Dollars ($1,000,000)<br />
resulting from one occurrence.<br />
9.5 Commercial General Liability and Commercial Umbrella Liability Insurance.<br />
Commercial General Liability, Business Auto and Commercial Umbrella Liability Insurance.<br />
Commercial general liability insurance, business auto insurance and commercial umbrella<br />
liability insurance af<strong>for</strong>ding minimum single limits coverage <strong>of</strong> not less than Two Million<br />
Dollars ($2,000,000) each occurrence, and Five Million Dollars ($5,000,000) in the aggregate.<br />
Such insurance policies must include, at a minimum, coverage <strong>for</strong> contractual liability, personal<br />
injury, death, broad <strong>for</strong>m property damage, damage to rented premises, premises/operations,<br />
independent contractors, products and completed operations along with broad <strong>for</strong>m named<br />
insured provision and coverage <strong>for</strong> owned, hired and non-owned automobiles.<br />
9.6 Pr<strong>of</strong>essional Liability Insurance. Pr<strong>of</strong>essional liability insurance (including<br />
technology errors, omissions, and medical malpractice) with a limit <strong>of</strong> not less than Ten Million<br />
Dollars ($10,000,000) each occurrence and in the aggregate covering First Onsite and all<br />
Personnel. This is to provide coverage <strong>for</strong> claims arising out <strong>of</strong> the per<strong>for</strong>mance <strong>of</strong> the Services<br />
under this Agreement and caused by an error, omission or negligent act <strong>for</strong> which First Onsite or<br />
any subcontractors are held liable. First Onsite and all subcontractors shall maintain this<br />
insurance <strong>for</strong> a minimum period <strong>of</strong> five (5) years after the expiration or earlier termination <strong>of</strong> the<br />
Agreement.<br />
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9.7 Certificates <strong>of</strong> Insurance. First Onsite or any subcontractor will not be permitted<br />
to bring its employees, materials or equipment on the site until the <strong>City</strong> receives from First<br />
Onsite, and any subcontractors, certificates <strong>of</strong> insurance acceptable to the <strong>City</strong> in its sole<br />
discretion. Such certificates shall state that the insurance carrier has issued the policies<br />
providing <strong>for</strong> the insurance specified herein, that such policies are in <strong>for</strong>ce, that the <strong>City</strong> is an<br />
additional insured under the Commercial General Liability, Business Auto and Commercial<br />
Umbrella Liability policies, that the Commercial General Liability policy contains contractual<br />
liability coverage, that all policies contain a waiver <strong>of</strong> the right <strong>of</strong> subrogation in favor <strong>of</strong> the<br />
<strong>City</strong> and that all policies are endorsed to provide that the insurance carrier will give the <strong>City</strong><br />
thirty (30) days prior written notice <strong>of</strong> any material change in, or cancellation <strong>of</strong>, such policies.<br />
If such insurance policies are subject to any exceptions to the terms specified herein, such<br />
exceptions shall be explained in full in such certificates. The <strong>City</strong> may, at its discretion, require<br />
First Onsite, or any subcontractor, to obtain insurance policies that are not subject to any<br />
exceptions. First Onsite and all subcontractors shall provide the <strong>City</strong> with current certificates <strong>of</strong><br />
insurance during the term <strong>of</strong> this Agreement.<br />
9.8 Failure to maintain the insurance coverage provided herein throughout the Term<br />
<strong>of</strong> this Agreement shall constitute a material breach <strong>of</strong> the Agreement.<br />
SECTION 10. Use <strong>of</strong> Name.<br />
First Onsite and the <strong>City</strong> shall allow the other party to review in advance any press release<br />
pertaining to the Agreement. No press releases shall be issued by either party without the prior<br />
written consent <strong>of</strong> the reviewing party and such consent shall not be unreasonably withheld.<br />
SECTION 11. Records.<br />
11.1 Public Records Act. It is understood by the parties that the <strong>City</strong> is subject to the<br />
provisions <strong>of</strong> the Florida Public Records Act, Section 119.011 et seq, Florida Statutes, and that<br />
absent any exemptions or provisions <strong>for</strong> confidentiality contained in state or federal statutes,<br />
generated records may be open to the public <strong>for</strong> inspection and copying. First Onsite shall assist<br />
the <strong>City</strong> in responding to any public records requests.<br />
11.2 <strong>Cover</strong>ed Person Records. First Onsite and the <strong>City</strong> agree that they will adopt<br />
such policies and procedures, execute such written amendments to this Agreement or enter into<br />
such other agreement(s) as may be required to make their activities under the Agreement<br />
compliant with the Federal Health In<strong>for</strong>mation Technology <strong>for</strong> Economic and Clinical Health<br />
Act <strong>of</strong> 2009 (“HITECH Act”), the Administrative Simplification Provisions <strong>of</strong> the Health<br />
Insurance Portability and Accountability Act <strong>of</strong> 1996, as codified at 42 U.S.C.A. 1320d-8<br />
(“HIPAA”), and any current and future regulations promulgated under either the HITECH Act or<br />
HIPAA, including without limitation the federal privacy standards contained in 45 C.F.R. Parts<br />
160 and 164 and the federal security standards contained in 45 C.F.R. Parts 160, 162 and 164 as<br />
amended, and other applicable local, state and federal privacy laws. In furtherance <strong>of</strong> this<br />
agreement, First Onsite and the <strong>City</strong> will execute the “Business Associate Agreement”. First<br />
Onsite shall take steps to safeguard the confidentiality and privacy <strong>of</strong> member/participant<br />
identifiable in<strong>for</strong>mation and to prevent unauthorized disclosure <strong>of</strong> the same by its employees and<br />
agents. The <strong>City</strong> acknowledges that in receiving or otherwise dealing with any records or<br />
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in<strong>for</strong>mation about <strong>Cover</strong>ed Persons receiving treatment <strong>for</strong> alcohol or drug abuse, First Onsite<br />
may be bound by the provisions <strong>of</strong> the federal regulations governing Confidentiality <strong>of</strong> Alcohol<br />
and Drug Abuse Patient Records (42 C.F.R. Part 2, as amended from time to time), as well as<br />
any state laws that govern HIV/AIDS and mental health treatment. First Onsite, at the <strong>City</strong>’s<br />
expense, will resist in judicial proceedings any ef<strong>for</strong>t to obtain access to such records or<br />
in<strong>for</strong>mation relating to the Clinical Services except such access as is expressly permitted by the<br />
a<strong>for</strong>ementioned federal regulations and/or State law and will notify the <strong>City</strong> <strong>of</strong> any such judicial<br />
proceedings.<br />
The parties acknowledge that certain records and documents created or maintained by First<br />
Onsite may constitute employment records not subject to HIPAA and others may include<br />
protected health in<strong>for</strong>mation (“PHI”) as that term is defined by HIPAA. The parties shall<br />
collaboratively develop policies and procedures to segregate PHI subject to HIPAA and other<br />
state and federal privacy laws from employment records and to ensure the parties preserve the<br />
privacy and confidentiality <strong>of</strong> PHI in accordance with HIPAA and other applicable state and<br />
federal laws. The <strong>City</strong> will ensure that First Onsite is provided with appropriate authorization<br />
from <strong>Cover</strong>ed Persons to disclose employment in<strong>for</strong>mation and PHI to the <strong>City</strong> regarding<br />
<strong>Cover</strong>ed Persons.<br />
The obligations created by this section shall remain in effect indefinitely, and shall survive the<br />
termination or cessation <strong>of</strong> this Agreement.<br />
11.3 Confidential and Proprietary In<strong>for</strong>mation. First Onsite and <strong>City</strong> agree that all<br />
materials containing confidential and proprietary in<strong>for</strong>mation developed in whole or in part or<br />
produced by either party shall not be disclosed to any third party without the written consent <strong>of</strong><br />
the other party, except as necessary to implement the terms <strong>of</strong> this Agreement and only on a need<br />
to know basis, unless disclosure is required by the Florida Public Records Act.<br />
SECTION 12. General Provisions.<br />
12.1 Upon adoption <strong>of</strong> any state or federal legislation or upon the issuance <strong>of</strong> a<br />
determination by a governmental entity, a Medicare carrier or intermediary, or an independent<br />
third party absolutely acceptable to each party that the arrangement evidenced by this Agreement<br />
violated any Federal or State law, rule, or regulation, including fraud and abuse issues, this<br />
Agreement shall terminate within sixty (60) days thereafter or sooner if such determination so<br />
advises; provided however, that in the event that such a determination is issued, the <strong>City</strong> may<br />
elect to continue this Agreement by reorganizing its internal structure or its agreements so that<br />
such are in accordance with the law, rule, or regulation in question. In such event, within sixty<br />
(60) days <strong>of</strong> the issuance <strong>of</strong> such determination, the <strong>City</strong> shall deliver notice to First Onsite <strong>of</strong> its<br />
intentions to continue this Agreement as provided herein. In such case, the terms and conditions<br />
<strong>of</strong> this Agreement shall remain in full <strong>for</strong>ce and effect.<br />
12.2 Notices. All notices, <strong>of</strong>fers, requests, demands and other communications<br />
pursuant to this Agreement shall be given in writing by personal delivery, by prepaid first class<br />
registered or certified mail properly addressed with appropriate postage paid thereon, telegram,<br />
telex, telecopier, facsimile transmission, and shall be deemed to be duly given and received on<br />
the date <strong>of</strong> delivery if delivered personally, on the second day after the deposit in the United<br />
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States Mail if mailed, upon acknowledgment <strong>of</strong> receipt <strong>of</strong> electronic transmission if sent by<br />
telecopier or facsimile transmission, or on the first day after delivery to the telegraph <strong>of</strong>fice if<br />
given by prepaid telegraph. Notices shall be sent to the parties at the following addresses:<br />
If to First Onsite:<br />
Brian Jones, Vice President<br />
3322 <strong>West</strong> End Ave, Suite 400<br />
Nashville, TN 37203<br />
Facsimile No.: (866) 666-6082<br />
If to the <strong>City</strong>:<br />
<strong>City</strong> Administrator<br />
<strong>City</strong> <strong>of</strong> <strong>West</strong> <strong>Palm</strong> <strong>Beach</strong><br />
401 Clematis Street, 2 nd Floor<br />
<strong>West</strong> <strong>Palm</strong> <strong>Beach</strong>, FL 33401<br />
Facsimile No.: (561) 822-1424<br />
With a Copy to:<br />
<strong>City</strong> Attorney<br />
<strong>City</strong> <strong>of</strong> <strong>West</strong> <strong>Palm</strong> <strong>Beach</strong><br />
401 Clematis Street, 5 th Floor<br />
<strong>West</strong> <strong>Palm</strong> <strong>Beach</strong>, FL 33401<br />
Facsimile No.: (561) 822-1373<br />
Or to such other address as any party may have furnished to the others in writing in accordance<br />
herewith, except that notices <strong>of</strong> change <strong>of</strong> address shall only be effective upon receipt.<br />
12.3 Independent Contractor. It is understood and agreed that First Onsite in<br />
per<strong>for</strong>ming all Services hereunder, shall be an independent contractor and shall be responsible<br />
<strong>for</strong> accomplishing the results contracted <strong>for</strong> under this Agreement. Neither party shall in any<br />
way represent that it is an employer, employee, agent, partner or legal representative <strong>of</strong> the other<br />
party. As an independent contractor, First Onsite is not authorized to make any contract,<br />
agreement, warranty, or representation on behalf <strong>of</strong> the <strong>City</strong>.<br />
12.4 Waiver. No covenant or condition <strong>of</strong> this Agreement can be waived except by the<br />
written consent <strong>of</strong> First Onsite and the <strong>City</strong>. Forbearance or indulgence by either party in any<br />
regard whatsoever shall not constitute a waiver <strong>of</strong> the covenant or condition to be per<strong>for</strong>med by<br />
the party which the same may apply and, until complete per<strong>for</strong>mance by the other party <strong>of</strong> said<br />
covenant or condition, either party shall be entitled to invoke any remedy available to it under<br />
this Agreement or by law or in equity despite said <strong>for</strong>bearance or indulgence.<br />
12.5 Non-Assignability. This Agreement may not be assigned by either party without<br />
the express prior written consent <strong>of</strong> the other party which may be given or withheld by the other<br />
party in its sole discretion.<br />
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12.6 Governing Law. The laws <strong>of</strong> the State <strong>of</strong> Florida shall govern this Agreement<br />
without giving effect to the conflict <strong>of</strong> laws provisions there<strong>of</strong>.<br />
12.7. Venue. Any claim or dispute between First Onsite and the <strong>City</strong>, if not settled by<br />
in<strong>for</strong>mal negotiations, shall be settled by litigation in a court <strong>of</strong> competent jurisdiction located in<br />
<strong>Palm</strong> <strong>Beach</strong> County, Florida. The <strong>City</strong> and First Onsite submit to the jurisdiction <strong>of</strong> Florida<br />
courts and federal courts located in Florida. The parties agree that proper venue <strong>for</strong> any suit<br />
concerning this Agreement shall be <strong>Palm</strong> <strong>Beach</strong> County, Florida, or the Federal Southern District<br />
<strong>of</strong> Florida. First Onsite agrees to waive all defenses to any suit filed in Florida based upon<br />
improper venue or <strong>for</strong>um nonconveniens. TO ENCOURAGE PROMPT AND EQUITABLE RESOLUTION<br />
OF ANY LITIGATION, EACH PARTY HEREBY WAIVES ITS RIGHTS TO A TRIAL BY JURY IN ANY<br />
LITIGATION RELATED TO THIS AGREEMENT.<br />
12.8 Severability.The provisions <strong>of</strong> the Agreement shall be severable, and if any<br />
clause, sentence, paragraph, provision or other part here<strong>of</strong> shall be adjudged by any court <strong>of</strong><br />
competent jurisdiction to be invalid, such judgment shall not affect, impair or invalidate the<br />
remainder here<strong>of</strong>, which remainder shall continue in full <strong>for</strong>ce and effect.<br />
12.9 Entire Agreement. It is understood that the <strong>for</strong>egoing represents the entire<br />
agreement between the parties hereto. This Agreement supersedes all prior contracts and<br />
understandings between the parties with respect to the subject here<strong>of</strong>. No amendment to or<br />
modification <strong>of</strong> this Agreement shall have any effect unless agreed upon in writing by the<br />
authorized representatives <strong>of</strong> each party. The Mayor shall have the authority to execute<br />
amendments to this Agreement <strong>for</strong> changes relating to the operation <strong>of</strong> the Clinic such as staffing<br />
levels, per<strong>for</strong>mance guarantees and hours <strong>of</strong> operation.<br />
12.10 Gender; Number. Whenever the context <strong>of</strong> this Agreement requires, the masculine<br />
gender shall include the feminine or neuter, and the singular number shall include the plural.<br />
12.11 Third-Party Beneficiary. First Onsite and the <strong>City</strong> acknowledge that nothing<br />
contained herein is intended to nor shall it cause any person, including any individual partner <strong>of</strong><br />
First Onsite, or entity to become a third-party beneficiary <strong>of</strong> any <strong>of</strong> the provisions or obligations<br />
<strong>of</strong> this Agreement.<br />
12.12 Corporate Authorization. Each individual executing this Agreement on behalf <strong>of</strong> a<br />
corporation or company represents and warrants that he or she is duly authorized to execute and<br />
deliver this Agreement on behalf <strong>of</strong> said corporation; that this Agreement is binding on said<br />
corporation or company in accordance with its terms; and that this Agreement is not in violation<br />
<strong>of</strong> or inconsistent or contrary to provisions <strong>of</strong> any other agreement which such corporation or<br />
company is a party.<br />
12.13 Section and Other Headings. The article and other headings contained in this<br />
Agreement are <strong>for</strong> reference purposes only and shall not affect in any way the meaning or<br />
interpretation <strong>of</strong> this Agreement.<br />
12.14 Counterparts. This Agreement may be executed in one or more counterparts, all <strong>of</strong><br />
which together shall constitute only one Agreement.<br />
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12.15 No Discrimination in Employment. First Onsite shall not discriminate against any<br />
employee or applicant <strong>for</strong> employment to be employed in the per<strong>for</strong>mance <strong>of</strong> this Agreement,<br />
with respect to his hire, tenure, terms, conditions or privileges <strong>of</strong> employment, or any matter<br />
directly or indirectly related to employment, or in the provision <strong>of</strong> Services under this<br />
Agreement, because <strong>of</strong> race, religion, color, sex, disability, national origin, ancestry, age,<br />
disability, familial status, marital status, sexual orientation, gender identity or expression, or any<br />
other factor which cannot be lawfully used as a basis <strong>for</strong> service delivery or employment.<br />
12.16 Representations and Warranties.<br />
a. First Onsite represents and warrants that it and its representatives<br />
providing services hereunder: (i) are not currently excluded, debarred, or otherwise ineligible to<br />
participate in the Federal health care programs as defined in 42 U.S.C. Section 1320a-7b(f) (the<br />
“Federal health care programs”); (ii) are not convicted <strong>of</strong> a criminal <strong>of</strong>fense related to the<br />
provision <strong>of</strong> health care items or services but have not yet been excluded, debarred or otherwise<br />
declared ineligible to participate in the Federal health care programs, and (iii) are not under<br />
investigation or otherwise aware <strong>of</strong> any circumstances which may result in the party or any <strong>of</strong> its<br />
representatives being excluded from participation in the Federal health care programs. This will<br />
be an ongoing representation and warranty during the term <strong>of</strong> this Agreement and First Onsite<br />
will immediately notify the <strong>City</strong> <strong>of</strong> any change in status <strong>of</strong> the representation and warranty set<br />
<strong>for</strong>th in this section. Any breach <strong>of</strong> this Section will give the <strong>City</strong> the right to immediately<br />
terminate this Agreement <strong>for</strong> cause.<br />
b. First Onsite represents that it is duly licensed to per<strong>for</strong>m the Services<br />
under this Agreement and that it will continue to maintain all licenses and approvals required to<br />
conduct its business.<br />
c. First Onsite warrants that it has not employed or retained any company or<br />
person, other than a bona fide employee working solely <strong>for</strong> First Onsite, to solicit or secure this<br />
Agreement and that it has not paid or agreed to pay any person, company, corporation,<br />
individual, or firm, other than a bona fide employee working solely <strong>for</strong> First Onsite, any fee,<br />
commission, percentage, gift, or any other consideration contingent upon or resulting from the<br />
award or making <strong>of</strong> this Agreement. In the event <strong>of</strong> a breach or violation <strong>of</strong> this provision by<br />
First Onsite, the <strong>City</strong> shall have the right to terminate the Agreement without liability and, at its<br />
discretion, to deduct from the fee, or otherwise recover, the full amount <strong>of</strong> such fee, commission,<br />
percentage, gift, or consideration.<br />
d. First Onsite represents that the execution <strong>of</strong> this Agreement will not<br />
violate the Public Entity Crimes Act (Section 287.133, Florida Statutes), and certifies that First<br />
Onsite and its subcontractors, if any, under this Agreement have not been placed on the<br />
convicted vendor list maintained by the State <strong>of</strong> Florida Department <strong>of</strong> Management Services<br />
within 36 months from the date <strong>of</strong> submitting a proposal <strong>for</strong> this Agreement or entering into this<br />
Agreement. Violation <strong>of</strong> this section may result in termination <strong>of</strong> this Agreement and recovery<br />
<strong>of</strong> all monies paid hereto, and may result in debarment from <strong>City</strong>’s competitive procurement<br />
activities.<br />
21
12.17 No Conflicts.<br />
a. First Onsite represents that it presently has no interest and shall acquire no<br />
interest, either direct or indirect, which would conflict in any manner with its per<strong>for</strong>mance under<br />
this Agreement. First Onsite further represents that no person having any interest shall be<br />
employed or engaged by it <strong>for</strong> said Services.<br />
b. First Onsite, its <strong>of</strong>ficers, personnel, subsidiaries and subcontractors shall<br />
not have or hold any continuing or frequently recurring employment, contractual relationship<br />
business association or other circumstance, which may influence or appear to influence First<br />
Onsite’s exercise <strong>of</strong> judgment or quality <strong>of</strong> the Services being provided under this Agreement.<br />
First Onsite, its <strong>of</strong>ficers, personnel, subsidiaries and subcontractors shall not per<strong>for</strong>m services <strong>for</strong><br />
any third party that would in any way be in conflict with the Services to be provided to the <strong>City</strong><br />
under this Agreement.<br />
c. First Onsite shall promptly notify the <strong>City</strong> in writing by certified mail <strong>of</strong><br />
all potential conflicts <strong>of</strong> interest or any event described in this Section. Said notification shall<br />
identify the prospective business interest or circumstance and the nature <strong>of</strong> work that First Onsite<br />
intends to undertake and shall request the opinion <strong>of</strong> the <strong>City</strong> as to whether such association,<br />
interest or circumstance would, in the opinion <strong>of</strong> the <strong>City</strong>, constitute a conflict <strong>of</strong> interest if<br />
entered into by First Onsite. The <strong>City</strong> agrees to notify First Onsite by certified mail <strong>of</strong> its<br />
opinion within thirty (30) calendar days <strong>of</strong> receipt <strong>of</strong> the said notification and request <strong>for</strong><br />
opinion. If, in the opinion <strong>of</strong> the <strong>City</strong>, the prospective business association, interest or<br />
circumstance would not constitute a conflict <strong>of</strong> interest by First Onsite, the <strong>City</strong> shall so state in<br />
its opinion and First Onsite may, at its option, enter into said association, interest or circumstance<br />
and it shall be deemed not in conflict <strong>of</strong> interest with respect to services provided to the <strong>City</strong> by<br />
First Onsite under this Agreement.<br />
d. In the event First Onsite is permitted to utilize subcontractors to per<strong>for</strong>m<br />
any services required by this Agreement. First Onsite agrees to prohibit such subcontractors, by<br />
written contract, from having any conflicts as within the meaning <strong>of</strong> this section.<br />
12.18 Taxes. First Onsite understands that in per<strong>for</strong>ming the Services <strong>for</strong> the <strong>City</strong>, First<br />
Onsite is not exempt from paying sales tax to First Onsite’s suppliers <strong>for</strong> materials required <strong>for</strong><br />
First Onsite to per<strong>for</strong>m under this Agreement. First Onsite shall not be authorized to use the<br />
<strong>City</strong>’s tax exemption number <strong>for</strong> purchasing supplies or materials.<br />
12.19 Availability <strong>of</strong> Funds. This Agreement is expressly conditioned upon the<br />
availability <strong>of</strong> funds lawfully appropriated and available <strong>for</strong> the purposes set out herein as<br />
determined in the sole discretion <strong>of</strong> the <strong>City</strong>. In the event funds to finance this Agreement<br />
become unavailable, the <strong>City</strong> may terminate this Agreement upon no less than twenty-four (24)<br />
hours notice to First Onsite. The <strong>City</strong> shall be the sole and final authority as to the availability <strong>of</strong><br />
funds.<br />
12.20 Force Majeure. Any deadline provided <strong>for</strong> in this Agreement may be extended, as<br />
provided herein, if the deadline is not met because <strong>of</strong> one <strong>of</strong> the following conditions occurring<br />
with respect to that particular project or parcel: fire, strike, explosion, power blackout,<br />
22
earthquake, volcanic action, flood, war, civil disturbances, terrorist acts, hurricanes and acts <strong>of</strong><br />
God. When one <strong>of</strong> the <strong>for</strong>egoing conditions interferes with contract per<strong>for</strong>mance, then the party<br />
affected may be excused from per<strong>for</strong>mance on a day-<strong>for</strong>-day basis to the extent such party’s<br />
obligations relate to the per<strong>for</strong>mance so interfered with; provided, the party so affected shall use<br />
reasonable ef<strong>for</strong>ts to remedy or remove such causes <strong>of</strong> non-per<strong>for</strong>mance. The party so affected<br />
shall not be entitled to any additional compensation by reason <strong>of</strong> any day-<strong>for</strong>-day extension<br />
hereunder.<br />
12.21 Controlling Provisions. Except as otherwise specifically provided herein, in the<br />
event <strong>of</strong> any conflict between the specific provisions <strong>of</strong> this Agreement and the requirements or<br />
provisions <strong>of</strong> the ITN and/or Proposal, the provisions shall be given precedence in the following<br />
order: (1) this Agreement, (2) the ITN; and (3) the Proposal. Wherever possible, the provisions<br />
<strong>of</strong> the documents shall be construed in such manner as to avoid conflicts between provisions <strong>of</strong><br />
the various documents.<br />
23
IN WITNESS WHEREOF the parties hereto have caused the Agreement to be executed<br />
by their duly authorized representatives as <strong>of</strong> the day and year first above written.<br />
Attest:<br />
<strong>City</strong> Clerk<br />
24<br />
CITY OF WEST PALM BEACH<br />
By:<br />
Lois J. Frankel, Mayor<br />
Office <strong>of</strong> the <strong>City</strong> Attorney<br />
Approved as to <strong>for</strong>m<br />
And legal sufficiency<br />
By:<br />
Date:<br />
WITNESS: H2U WELLNESS CENTERS, LLC<br />
___________________________ By:<br />
Name:<br />
Its:
Exhibit A Scope <strong>of</strong> Clinical Services<br />
Exhibit B Scope <strong>of</strong> Management Services<br />
Exhibit C Programs<br />
Exhibit D Inventory<br />
Exhibit E Salary, Wages and Benefit Cap<br />
Exhibit F Physician’s Agreement<br />
Exhibit G Travel Expense Policy<br />
Exhibit H Credentialing Process<br />
Exhibit I Operating Hours Schedule<br />
Exhibit J Minimum Square Footage<br />
Exhibit K Pass Through Expenses<br />
Exhibit J Reporting Requirements<br />
EXHIBIT LIST<br />
25
EXHIBIT A<br />
SCOPE OF CLINICAL SERVICES<br />
PRIMARY, OCCUPATIONAL HEALTH AND URGENT CARE<br />
The Clinical Services to be per<strong>for</strong>med by the Medical Pr<strong>of</strong>essionals at the Clinic are to be<br />
determined by the Medical Pr<strong>of</strong>essionals but generally shall include those services normally<br />
provided in a primary medical care facility as permitted by the licensure <strong>of</strong> the Medical<br />
Pr<strong>of</strong>essionals, and by the equipment and physical restrictions <strong>of</strong> the Clinic, and at a minimum<br />
shall include the following services:<br />
� Chronic illness evaluation, treatment and management (i.e., diabetes, high cholesterol,<br />
hypertension, asthma, obesity)<br />
� Acute Conditions (i.e., sore throats, ears ache, head ache, cough, sinus, strains, sprains,<br />
musculoskeletal problems, acute urinary complaints).<br />
� Primary Care, health risk assessments, preventative and disease management strategies<br />
including one-on-one health education counseling to high risk employees<br />
� Phone support (1-800 Ask-a-Nurse service)<br />
� Reasonable accommodations determinations – consult with Director <strong>of</strong> Human Resources<br />
and the <strong>City</strong>’s Risk Manager with regard to reasonable accommodations <strong>for</strong> employees<br />
with medical conditions that have altered their ability to per<strong>for</strong>m an essential job task.<br />
� Occupational Conditions<br />
o On the Job Injuries/Work-related injuries or illnesses<br />
o Minor surgical procedures, within the scope <strong>of</strong> the Medical Pr<strong>of</strong>essional, such as<br />
sutures <strong>for</strong> laceration treatment, etc.<br />
o Pre-employment and routine physicals<br />
o Pre-employment drug testing<br />
Medications<br />
Class examples include, but are not limited to the following:<br />
o Anti-infective<br />
o Antihypertensive<br />
o Anti-hyperlipidemics<br />
o Antidepressants<br />
o Anti-diabetics<br />
o Antihistamines<br />
o Acid-reflux medications<br />
o Antibiotics<br />
o Hypertensive & cardiac medications<br />
o Anti-lipids<br />
o Pulmonary<br />
o Gastro Intestinal<br />
o Psychiatric<br />
o Vaccinations<br />
26
Medical Surveillance<br />
� Hearing - Administration and per<strong>for</strong>mance <strong>of</strong> audiometric exam, STS review, work<br />
relationship determination and report/documentation, including employee notification<br />
letters.<br />
� Respiratory - Administer all medical elements <strong>of</strong> respiratory protection program<br />
including spirometry testing/Pulmonary Functional Testing (PFT) <strong>for</strong> employees required<br />
to wear a respirator.<br />
� Mobile Equipment Exams - Conduct medical history review, vision testing, and<br />
medical exam <strong>for</strong> employees required to operate mobile equipment; <strong>for</strong>k truck physicals<br />
� Drug Screen/Alcohol - Collect pre-employment samples; urine <strong>for</strong> random and<br />
reasonable suspicion; breathalyzer <strong>for</strong> alcohol in compliance with collective bargaining<br />
agreements and <strong>City</strong> policy. Administer random selection program and post rehabilitation<br />
random testing. Provide Medical Review Officer and reporting services.<br />
Exams<br />
� Pre Employment - Coordinating/conducting physicals, drug screening, medical history,<br />
audiometric testing, biometrics, etc.<br />
� Fitness <strong>for</strong> Duty - Conduct fitness <strong>for</strong> duty exams <strong>for</strong> both work related cases and <strong>for</strong><br />
employees returning from personal medical leave.<br />
� Department <strong>of</strong> Transportation/Commercial Drivers License exams<br />
� <strong>City</strong> Exams<br />
Labs<br />
� Onsite collection <strong>of</strong> specimens and blood draws<br />
� Manage lab provider arrangement to include logistics <strong>for</strong> specimen pick up,<br />
� Reporting <strong>of</strong> results to medical providers<br />
� System integration <strong>of</strong> lab data within medical records system<br />
Governmental Regulations and Compliance<br />
Ensure compliance with all applicable medical and government regulations <strong>for</strong> CLIA, OSHA,<br />
DOT, and Bloodborne Pathogen training.<br />
Long Term Prevention Programs Available<br />
First Onsite will work closely with the <strong>City</strong> <strong>for</strong> the purpose <strong>of</strong> financial review, reporting, as well<br />
as to identify major cost drivers. First Onsite will make recommendations and develop strategies<br />
<strong>for</strong> the <strong>City</strong> to mitigate such costs. Some <strong>of</strong> these services are listed below.<br />
� Health Risk Assessment <strong>for</strong> all <strong>City</strong> employees with comprehensive lab analysis, (lab<br />
analysis is not included in H2U membership) will help to proactively identify patient<br />
health risks<br />
27
� Aggregate data analysis from your employee population to develop the right programs <strong>for</strong><br />
your Pharmaceutical Program Management<br />
� Aggregate clinical data analysis to determine wellness effectiveness on population health<br />
� Physician/Nurse “Reach Out” Program to communicate with people with the greatest<br />
health risks<br />
� Population Health Management programs targeted <strong>for</strong> the greatest impact (obesity,<br />
diabetes, high blood pressure, etc.)<br />
� Disease/Case Management – First Onsite’s providers will proactively promote disease<br />
case management<br />
� Self Care Education Tools<br />
� H2U Wellness membership program provided at no cost to <strong>Cover</strong>ed Persons.<br />
� Health Education Training<br />
� Physician Health Seminars<br />
� Population Promotions<br />
Per<strong>for</strong>mance Requirements:<br />
� First Onsite shall report the results <strong>of</strong> routine annual employee physicals required by the<br />
<strong>City</strong> and post-<strong>of</strong>fer physicals within three (3) business days <strong>of</strong> the date <strong>of</strong> the initial<br />
patient visit. Results <strong>of</strong> Post-Offer Physicals must be e mailed to the Director <strong>of</strong> Human<br />
Resources or their designee. Results <strong>of</strong> routine employee annual physicals shall be e<br />
mailed to the <strong>City</strong>’s Risk Manager or designee.<br />
� First Onsite shall report the results <strong>of</strong> complex post-<strong>of</strong>fer physicals and periodic physicals<br />
requiring MRI’s and/or Cardiac Stress Testing within five (5) business days <strong>of</strong> the date <strong>of</strong><br />
the initial patient visit.<br />
� All physical examinations must be consistent with the guidelines <strong>of</strong> NFPA 1582:<br />
“Comprehensive Occupational Medical Program <strong>for</strong> Fire Departments” as well as<br />
existing OSHA/EPA requirements (comprehensive physical examinations are required<br />
<strong>for</strong> all Firefighters and Special Operations personnel annually).<br />
� First Onsite shall work with Fire Rescue Administration to develop a schedule <strong>for</strong> Fire<br />
Rescue physicals which will provide an orderly flow <strong>of</strong> employees to and from the Clinic<br />
with a minimum <strong>of</strong> interruption to Fire Rescue Operations.<br />
� Appointments <strong>for</strong> Fitness-<strong>for</strong>-Duty evaluations must be scheduled by First Onsite within<br />
48 hours.<br />
� First Onsite shall use its best ef<strong>for</strong>ts to timely respond to all <strong>City</strong> voicemails and e mails<br />
28
EXHIBIT B<br />
SCOPE OF MANAGEMENT SERVICES<br />
� Manage and supervise daily operation <strong>of</strong> the Clinic in accordance with all applicable<br />
local, state, and federal laws.<br />
� Obtain and maintain all necessary licenses, certifications, and accreditations <strong>for</strong> the<br />
operation <strong>of</strong> the Clinic.<br />
� Recruit, employ, and supervise all medical and non-medical staff necessary <strong>for</strong> the<br />
operation <strong>of</strong> the Clinic.<br />
� Provide appropriate physician supervision <strong>for</strong> nurse practitioners and other licensed staff.<br />
� Prepare reports <strong>of</strong> operations and activity required by the <strong>City</strong> or the state, local or federal<br />
regulatory agencies.<br />
� Maintain patient files as required by industry standards and applicable laws including an<br />
electronic medical record.<br />
� Purchase with the <strong>City</strong>’s approval and at the <strong>City</strong>’s expense equipment and supplies<br />
necessary <strong>for</strong> the operation <strong>of</strong> the Clinic.<br />
� Maintain, or arrange <strong>for</strong> the maintenance <strong>of</strong> all technical, mechanical or electronic<br />
equipment used in the operation <strong>of</strong> the Clinic.<br />
� Regularly assess and recommend cost-saving measures while maintaining high quality <strong>of</strong><br />
care.<br />
� Participate in meetings with the <strong>City</strong> at the reasonable request <strong>of</strong> the <strong>City</strong>.<br />
� Provide Clinic newsletter and internet health portal services available through the<br />
optional H2U Wellness membership program.<br />
� Maintain practice management system and electronic medical record system.<br />
� Provide customer service line<br />
� Consult on Clinic layout and design<br />
� Setup Clinic<br />
� Online system <strong>for</strong> scheduling appointments according to Section<br />
� Provide Medical Supply and Equipment inventory management<br />
� Participate in the <strong>City</strong>’s annual health fair<br />
� Contract <strong>for</strong> disposal <strong>of</strong> biomedical waste<br />
29
EXHIBIT C<br />
PROGRAMS<br />
(attached hereto)<br />
30
EXHIBIT D<br />
INVENTORY<br />
(attached hereto)<br />
31
EXHIBIT E<br />
SALARY, WAGES AND BUDGET CAP<br />
Physician not to exceed $160/hour<br />
Nurse Practitioner/Physician Assistant not to exceed $80.00/hour<br />
Nurse not to exceed $45.00/hour<br />
Medical Assistant not to exceed $30.00/hour<br />
32
EXHIBIT F<br />
PHYSICIAN’S AGREEMENT<br />
(attached hereto)<br />
33
EXHIBIT G<br />
TRAVEL EXPENSE POLICY<br />
(attached hereto)<br />
34
EXHIBIT H<br />
CREDENTIALING PROCESS<br />
(attached hereto)<br />
35
1. Schedule:<br />
EXHIBIT I<br />
OPERATING HOURS SCHEDULE<br />
The schedule shall be mutually agreed up by the <strong>City</strong> and First Onsite. Initial hours <strong>of</strong><br />
operation shall be:<br />
Monday 7:00 am – 4:00 pm<br />
Tuesday 10:00 am – 7:00 pm<br />
Wednesday 7:00 am – 12:00 pm<br />
Thursday 10:00 am – 7:00 pm<br />
Friday 7:00 am – 4:00 pm<br />
Saturday 8:00 am – 1:00 pm<br />
Sunday Closed<br />
2. Holidays:<br />
The Clinic shall be closed on the following holidays: New Years Day, Martin Luther King Day,<br />
Memorial Day, Independence Day, Labor Day, Thanksgiving Day, the Friday following<br />
Thanksgiving Day, Christmas Eve Day, Christmas Day. When a holiday falls on a Saturday, the<br />
observance <strong>of</strong> the holiday will be the previous Friday. When a holiday falls on a Sunday, the<br />
observance <strong>of</strong> the holiday will be the following Monday.<br />
36
EXHIBIT J<br />
MINIMUM SQUARE FOOTAGE REQUIREMENTS FOR THE CLINIC<br />
Reception (Admin. and Waiting) 270 sq ft<br />
Procedure Room 140 sq ft<br />
Exam Room 1 85 sq ft<br />
Exam Room 2 85 sq ft<br />
Office 1 260 sq ft<br />
Office 2 260 sq ft<br />
Radiology / X-ray 120 sq ft<br />
BAT/PFT (and circulation space) 130 sq ft<br />
Laboratory 60 sq ft<br />
Medication Dispensary 40 sq ft<br />
Drug Screening Restroom 50 sq ft<br />
Janitorial Closet 10 sq ft<br />
Audio Screening 50 sq ft<br />
Soiled Holdings 8 sq ft<br />
Clean Linen 8 sq ft<br />
Filing 100 sq ft<br />
Supply Storage 115 sq ft<br />
Staff Restroom 65 sq ft<br />
Telephone/Data Storage 65 sq ft<br />
________________________________________________<br />
Total = 1,921 sq ft<br />
37
EXHIBIT K<br />
PASS THROUGH EXPENSES<br />
38
EXHIBIT L<br />
REPORTING REQUIREMENTS<br />
(attached hereto)<br />
39
H2U Wellness Program<br />
<strong>City</strong> <strong>of</strong> <strong>West</strong> <strong>Palm</strong> <strong>Beach</strong><br />
January 18, 2011<br />
First Onsite <strong>of</strong>fers its clients access to a robust and comprehensive wellness program called<br />
Health To You (H2U). H2U is a health promotion program that educates, assists and<br />
motivates individuals to engage in healthy behaviors. Our Personal Health Assessments and<br />
biometric screenings help identify risk factors and health issues in the [CLIENT NAME]’s<br />
population and is the basis <strong>of</strong> individualized care delivery plans. Combining wellness<br />
initiatives with the other health services provided at the clinic supports our patient-centered<br />
delivery model and helps our clinicians deliver more targeted and comprehensive care.<br />
We <strong>of</strong>fer a full the following suite <strong>of</strong> capabilities through our Health to You (H2U)<br />
program.<br />
Health Pr<strong>of</strong>ile & Follow-Up<br />
Features <strong>of</strong> H2U Health & Wellness Program<br />
� Health Risk Assessment (HRA)<br />
� Individual Wellness Pr<strong>of</strong>ile<br />
� Employer Aggregate Health Report<br />
� Employer Executive Summary<br />
� Biometric Health Screenings*<br />
� On-line Wellness Coaching*<br />
� Customized messages to high risk employees*<br />
Online Tools & Content<br />
� Interactive Web Tools<br />
� H2U.com web portal with two million pages <strong>of</strong> health content<br />
� Health quizzes, calculators, and videos<br />
� E-Newsletter with personalized health messages, screening guidelines, and health reminders<br />
Employee Communications<br />
� Welcome package with membership card<br />
� Health Awareness Materials<br />
� Health2You magazine (mailed to homes 4 times a year)<br />
� Health2You newsletter (mailed to homes 8 times a year)<br />
� Employee Engagement Communications*<br />
� Posters, tent cards, FAQ’s, etc.*<br />
Additional Benefits<br />
� National discounts on pharmacy, medical alert, travel, hotels, and more<br />
*Optional services. Additional fees apply.<br />
Proprietary & Confidential 1
Assessing Health Risks<br />
Personal Health Assessment<br />
<strong>City</strong> <strong>of</strong> <strong>West</strong> <strong>Palm</strong> <strong>Beach</strong><br />
January 18, 2011<br />
Our Personal Health Assessment (PHA) is a confidential and customized version <strong>of</strong> the<br />
Trale health risk questionnaire that captures a range <strong>of</strong> in<strong>for</strong>mation about an employee’s<br />
health status. The PHA is the first step toward improving individual health awareness<br />
because knowing health risks encourages the adoption <strong>of</strong> healthy lifestyle choices and<br />
facilitates targeted support <strong>for</strong> those changes.<br />
The following risk factors are identified through the PHA:<br />
� Weight<br />
� Exercise<br />
� Nutrition<br />
� Stress<br />
� Smoking<br />
� Alcohol<br />
� Cancer<br />
� Heart Disease<br />
� Diabetes<br />
� Cholesterol<br />
� Blood Pressure<br />
In addition to identifying risk factors, the PHA assesses readiness to change <strong>for</strong> each risk<br />
factor. Available through a private and secure web link, the PHA takes approximately 15<br />
minutes to complete, is available in English and Spanish, and is written at a 6th grade<br />
reading level <strong>for</strong> easy comprehension.<br />
Using algorithms based on current health protocols, the member’s health is scored and a<br />
personalized report is provided that recommends actions to reduce risks and improve<br />
health. The PHA also provides the clinic’s practitioners and wellness coach with rich data<br />
that helps facilitate the delivery <strong>of</strong> targeted education and the development <strong>of</strong> care plans. In<br />
addition, the data captured through the PHA establishes a baseline <strong>for</strong> measurement and<br />
comparison year over year to track behavior change and health improvement on an<br />
individual and group basis.<br />
Proprietary & Confidential 2
A copy <strong>of</strong> our PHA is provided in Appendix 2.<br />
Biometric Screening<br />
<strong>City</strong> <strong>of</strong> <strong>West</strong> <strong>Palm</strong> <strong>Beach</strong><br />
January 18, 2011<br />
In addition to the subjective data collected from the PHAs, we encourage the <strong>City</strong> to also<br />
collect objective health in<strong>for</strong>mation through biometric screenings. Through the screening<br />
process, we are able to collect the following data on each member:<br />
� Height, weight and BMI<br />
� Blood pressure<br />
� Cholesterol – HDL, LDL, total, and ratio<br />
� VLDL<br />
� Triglycerides<br />
� Glucose<br />
We can also screen <strong>for</strong> additional metrics at your request including iron, sodium, potassium,<br />
chloride, carbon dioxide, calcium, phosphorus, uric acid, total protein, albumin, globulin,<br />
A/G ratio, alkaline phosphastes, ALT, AST, bilirubin, LDH, GGT, hemoglobin A1C, TSH,<br />
PSA, Hepatitis B, and cotinin/nicotine. We can conduct finger stick or venipuncture draws<br />
depending on the metrics that the <strong>City</strong> would like to track and measure. Once the lab data<br />
is received by the clinic, the member’s personal health report will be updated with the<br />
screening results and the employee will be notified via email.<br />
First Onsite works with national screening vendor, eHealthScreenings (EHS), to facilitate the<br />
biometric screening events. EHS is a leading provider <strong>of</strong> comprehensive wellness screening<br />
services, specializing in the facilitation <strong>of</strong> on-site biometric data collection and transfer <strong>for</strong><br />
third party administrators, wellness providers, Fortune 1000 companies and other<br />
businesses. EHS has a national network <strong>of</strong> several thousand lab locations, 250 affiliated<br />
<strong>of</strong>fice locations, and over 5,000 paramedical staff members.<br />
First Onsite can provide screening activities in the clinics as well as through deployed<br />
screening teams to multiple sites. EHS is highly experienced in conducting a variety <strong>of</strong><br />
screening activities across multiple sites simultaneously. For example, we are just<br />
concluding a screening project that screened over 80,000 people in more than 260 locations<br />
and more than 560 screening sites.<br />
Proprietary & Confidential 3
<strong>City</strong> <strong>of</strong> <strong>West</strong> <strong>Palm</strong> <strong>Beach</strong><br />
January 18, 2011<br />
EHS will work with the <strong>City</strong>’s clinic to coordinate and staff biometric screening events,<br />
minimizing the impact on clinic staffing, allowing consistency in reporting, and ensuring<br />
the easy transmittal <strong>of</strong> data from EHS to the clinic. EHS will assume responsibility <strong>for</strong> the<br />
following event details:<br />
� Provide a guide to the clinic regarding their role in conducting the screening event;<br />
� Supply online appointment scheduling and customer service;<br />
� Supply and manage trained phlebotomists;<br />
� Determine member eligibility;<br />
� Collect lab specimens and biometric in<strong>for</strong>mation (BP, height, weight) from employees at<br />
the event; and<br />
� Transmit electronic data to the clinic provide members with instructions <strong>for</strong> accessing<br />
lab tests results.<br />
Health Improvement Programs & Tools<br />
On-site Wellness Coaching<br />
First Onsite is proposing to staff the <strong>City</strong>’s clinic with a dedicated Wellness Coach to help<br />
facilitate the <strong>City</strong>’s wellness initiatives. The Wellness Coach will collaborate with the <strong>City</strong>’s<br />
WellAdvantage Manager to understand or help define the <strong>City</strong>’s wellness plan, and identify<br />
integration and coordination points, referral procedures, tracking mechanisms, and<br />
reporting.<br />
The First Onsite Wellness Coach will help you create a healthier workplace by:<br />
� Consulting face-to-face with individuals on setting and achieving health goals;<br />
� Providing medical referrals, health resources and other services to employees,<br />
based on their specific health risks;<br />
� Motivating members to actively engage in available wellness initiatives;<br />
� Educating members on specific topics through group seminars and lunch and<br />
learns; and<br />
� Coordinating health screenings, fitness classes and health challenges.<br />
Proprietary & Confidential 4
Lifestyle Management Programs<br />
<strong>City</strong> <strong>of</strong> <strong>West</strong> <strong>Palm</strong> <strong>Beach</strong><br />
January 18, 2011<br />
The <strong>City</strong> can also choose to implement our online Lifestyle Management Programs provided<br />
by HealthMedia® to support health improvement <strong>for</strong> your population with the following<br />
risks:<br />
� Weight Management<br />
� Smoking Cessation<br />
� Stress Management<br />
� Nutrition - making healthy eating decisions<br />
� Physical Activity<br />
� Self-management skills around chronic conditions<br />
� Care <strong>for</strong> Your Back (prevention and management <strong>of</strong> low back pain)<br />
� Diabetes Management<br />
� Pain Prevention and Management<br />
� Overcoming Depression<br />
� Overcoming Insomnia<br />
� Overcoming Binge Eating<br />
� Control Blood Pressure<br />
� Cholesterol Management<br />
� Hip Pain, Replacement and/or Recovery<br />
Employees will be identified <strong>for</strong> program eligibility based on their complete health<br />
assessment pr<strong>of</strong>ile (i.e., PHA and/or biometric screening) and will be referred to the<br />
program by the clinic’s staff.<br />
The HealthMedia® programs emulate a health coaching session using an advanced<br />
technology that creates a personal action plan <strong>for</strong> every member. The digitized sessions<br />
deliver a high-quality coaching experience every time. The coaching session begins with an<br />
in-depth consultation where the coach asks questions about your personal situation, your<br />
motivation to deal with health issues, your self-confidence, and what you perceive to be<br />
barriers to your success. The system then builds a personalized success plan by combining:<br />
Proprietary & Confidential 5
� What the coach has learned about the member;<br />
� All the clinical training and experience the coach has on this topic; and<br />
<strong>City</strong> <strong>of</strong> <strong>West</strong> <strong>Palm</strong> <strong>Beach</strong><br />
January 18, 2011<br />
� Which behavior change models are most likely to get the member to change.<br />
The coach then goes over the plan to help the member to realize where they are, where they<br />
want to be, and how they can get there. The coach provides a personal action plan, tools and<br />
resources to help the member meet their goals and follows up with the member over time to<br />
see if the plan has achieved the desired results.<br />
This level <strong>of</strong> high-quality coaching is what produces the<br />
revolutionary outcomes <strong>for</strong> HealthMedia® programs in the<br />
areas <strong>of</strong> wellness, behavioral health, disease management,<br />
and medication adherence. They use validated methods to<br />
measure outcomes including claims based studies,<br />
randomized control trials, time 1 / time 2 comparisons, and<br />
self-report outcomes. HealthMedia’s outcomes speak<br />
volumes:<br />
� 90% <strong>of</strong> members reported improvement in ability to prevent back pain<br />
� 88% <strong>of</strong> members reported improvements in doctor-patient communications and<br />
86% said their health improved<br />
� 70% <strong>of</strong> members reported improvements in medication adherence<br />
� 60% <strong>of</strong> members reported reduced stress<br />
� 39% reported a decrease in average Center <strong>for</strong> Epidemiologic Studies Depression<br />
Scale (CES-D) scores from 5.29 to 3.24<br />
� 50% <strong>of</strong> members reported that they lost weight<br />
� 60% <strong>of</strong> members reported improved nutrition habits<br />
� 40% <strong>of</strong> members reported decrease in difficulty falling asleep ratings<br />
� $1,000 demonstrated projected productivity savings <strong>for</strong> members with chronic<br />
conditions (per member, per year)<br />
Proprietary & Confidential 6
<strong>City</strong> <strong>of</strong> <strong>West</strong> <strong>Palm</strong> <strong>Beach</strong><br />
January 18, 2011<br />
In addition, First Onsite <strong>of</strong>fers a tobacco cessation program.<br />
The Quit For Life® Program is a collaboration between the<br />
American Cancer Society® and Free & Clear®. As the<br />
nation’s leading tobacco cessation program, it employs an evidence-based combination <strong>of</strong><br />
physical, psychological and behavioral strategies to enable members to take responsibility<br />
<strong>for</strong> and overcome their addiction to tobacco use.<br />
Using an integrated mix <strong>of</strong> medication support, phone-based cognitive behavioral coaching<br />
and web-based learning and support tools, the Quit For Life® Program produces an average<br />
quit rate <strong>of</strong> 45% <strong>for</strong> employers, making it nine times more effective than quitting cold<br />
turkey.<br />
The Quit For Life® Program treats every tobacco user as a unique individual and tailors a<br />
quitting plan that is based on the member’s lifestyle, preferences and tobacco use history.<br />
On the initial call, a Quit Coach assesses the member’s tobacco use history and individual<br />
needs in order to help the member identify destructive thought patterns and situational<br />
triggers that cause the desire to smoke.<br />
The Quit Coach then helps the member develop a personalized plan to prepare <strong>for</strong> his or her<br />
quit date. The initial call also includes decision support <strong>for</strong> medications. If appropriate,<br />
nicotine replacement therapy can be delivered directly to the member’s home. Follow-up<br />
phone calls with a Quit Coach and interaction with Web Coach provide members with the<br />
knowledge, behavioral strategies and cognitive skills necessary to successfully quit tobacco<br />
<strong>for</strong> life.<br />
Proprietary & Confidential 7
Online Content & Tools<br />
<strong>City</strong> <strong>of</strong> <strong>West</strong> <strong>Palm</strong> <strong>Beach</strong><br />
January 18, 2011<br />
The <strong>City</strong>’s eligible population will have access to online wellness education and tools at<br />
www.h2u.com. The H2U health portal provides access to:<br />
� Health library with<br />
▫ More than 2 million pages <strong>of</strong> health<br />
content<br />
▫ Quizzes and calculators<br />
▫ Videos and animation <strong>of</strong> procedures<br />
� Interactive health content<br />
▫ My Health Newsletter (e-newsletter)<br />
▫ My Health Reminders<br />
▫ My Health Reminders <strong>for</strong> Loved<br />
Ones<br />
▫ My Baby Expectations<br />
▫ And more…<br />
� e-Messaging and e-Marketing<br />
Member Education<br />
We use a variety <strong>of</strong> educational materials to in<strong>for</strong>m employees about important health<br />
topics, disease prevention, managing chronic conditions, care giving, and lifestyle issues<br />
because we know education and awareness drive sustainable behavior change. Printed and<br />
mailed educational materials include:<br />
� Wellness program Welcome Packet<br />
▫ Welcome letter<br />
▫ Membership card<br />
▫ Directory <strong>of</strong> program benefits<br />
▫ Monthly health newsletters<br />
▫ Quarterly health magazines<br />
Proprietary & Confidential 8
� Campaigns <strong>for</strong> Good Health materials<br />
▫ Flyers<br />
▫ Posters<br />
▫ Take one cards<br />
▫ Table tents<br />
▫ Email<br />
<strong>City</strong> <strong>of</strong> <strong>West</strong> <strong>Palm</strong> <strong>Beach</strong><br />
January 18, 2011<br />
The Campaigns <strong>for</strong> Good Health materials can be branded with the <strong>City</strong>’s logo and topics<br />
can be coordinated with monthly on-site education classes. Self-care books are also<br />
available on many health conditions that are free or are provided by pharmaceutical<br />
companies. We will coordinate access to these resources as well. Additional in<strong>for</strong>mation<br />
about these materials is included in our response to question 5 <strong>of</strong> the Collaboration and<br />
Communication section below.<br />
Program Engagement Tools<br />
One <strong>of</strong> the keys to a successful wellness program is<br />
engagement and participation. First Onsite will provide the<br />
<strong>City</strong> with materials to help promote the program including<br />
an introduction letter and<br />
brochure. We will support<br />
various member recruitment<br />
campaigns designed to<br />
encourage participation in the<br />
PHA and increase awareness<br />
<strong>of</strong> events such as health<br />
screenings and classes. We<br />
such as postcards, flyers, posters, and take-one cards.<br />
can provide the <strong>City</strong> with customizable communication tools<br />
Another tool that we know drives participation is the use <strong>of</strong> incentives. Our experience has<br />
proven that the greater the incentive, the greater the program participation. The greater the<br />
Proprietary & Confidential 9
<strong>City</strong> <strong>of</strong> <strong>West</strong> <strong>Palm</strong> <strong>Beach</strong><br />
January 18, 2011<br />
participation in a wellness program, the greater the impact will be on health status resulting<br />
in a greater return on investment. Our incentive solutions are designed to maximize<br />
enrollment and keep members engaged in the health improvement program. If requested,<br />
we will work with the <strong>City</strong> to develop incentives that include tracking and management <strong>of</strong><br />
incentives.<br />
National Discount Program<br />
Through partnerships with national companies, First Onsite <strong>of</strong>fers members valuable<br />
discounts on a variety <strong>of</strong> services to support healthy lifestyles, including such services as:<br />
caregiver videos, home safety services, prescription drug discounts, dental plans, and eye<br />
care. Plus, other discounts are available to members, such as discounts on flowers and gifts,<br />
books and videos, special travel packages, outdoor gear, home and outdoor furnishings,<br />
moving services, movies, plays, and theme park tickets.<br />
Customer Service Center<br />
The customer service team at First Onsite <strong>of</strong>fers support to those who participate in H2U<br />
programs via a toll-free phone number or email responses. The customer service center<br />
handles technical issues, pertaining to online resources, including the personal health<br />
assessment and H2U web tools; general program in<strong>for</strong>mation; feedback regarding program<br />
enhancements or suggestions; and triage to the <strong>City</strong>’s clinic or lifestyle management<br />
programs. The service center is staffed from 7:00 a.m. to 7:00 p.m., central time, Monday<br />
through Friday. Calls received during non-business hours will be returned within 24<br />
business hours. Responses to emails are also sent within 24 business hours <strong>of</strong> the initial<br />
inquiry.<br />
Proprietary & Confidential 10
COMPREHENSIVE SUPPLIES AND EQUIPMENT START UP COST 1/31/2011<br />
Description UoM Qty Price<br />
eClinicalWorks EA 1 $19,500.00<br />
Pharmacy Dispensing System inventory EA 1 $4,200.00<br />
Systoc Claims System EA 1 $6,500<br />
Occupational medical system EA 1 $10,000<br />
Titmus vision machine EA 1 $2,000.00<br />
Intoximeter EA 1 $2,600.00<br />
Lab Refridgerator EA 1 $350.00<br />
$45,150<br />
Medical Suppiles and equipment<br />
BASIN, EAR GLDNAMER EA 1 $8.70<br />
TOWELETTE, ANTISEPTIC BZK (100BX) BX 100 $1.33<br />
SWABSTICK, TINC BENZ 1'S (50/BX) BX 50 $9.63<br />
PAD, ALCOHOL PREP MED (200/BX) BX 200 $1.25<br />
HYDROGEN PEROXIDE, 3% 16OZ (12/CS) CS 12 $7.94<br />
SCISSOR, LISTER BANDAGE 5 1/2" EA 1 $2.13<br />
HAMMER, TAYLOR PERCUSSION ORG 7 1/2" EA 1 $1.66<br />
MOUTHPIECE, DISP #4 ADLT (100/CS) CS 100 $18.75<br />
REMOVAL TRAY, SKIN STAPLE (48/CS) CS 48 $50.00<br />
SPHYG, ANEROID DLX BLK ADLT EA 1 $17.64<br />
INFLATION SYSTEM, BLK CHLD EA 1 $13.43<br />
INFLATION SYSTEM, BLK LG ADLT EA 1 $17.88<br />
STETHOSCOPE, S/S BLK EA 1 $28.30<br />
AMMONIA, AMP INHALANT (10/B X) BX 10 $1.98<br />
WIPE, SANICLOTH GERMICIDE LG (160/BX 12BX/CS) BX 160 $5.18<br />
CONTAINER, SHARPS 5.4QT (20/CS) CS 20 $118.00<br />
BANDAGE, GZE STRCH 4" PERFM N/S (12RL/BX) BX 12 $1.76<br />
SALINE, STR UNIT DOSE 3ML (100/BX 10BX/CS) BX 100 $11.25<br />
SOAP, ANTIMICRO HAND PERFM W/PUMP 18OZ (12/CS) CS 12 $37.71<br />
SPONGE, N/WOVN 2"X2" PERFM+ N/S (200/PK) PK 200 $0.93<br />
SYRINGE/NDL, INTEGRA 3CC 23GX1" (100/BX) BX 100 $54.63<br />
BANDAGE, ELAS SLF-CLSR PREM N/S LF 2X5YDS BX 10 $4.86<br />
BANDAGE, ELAS SLF-CLSR PREM N/S LF 3X5YDS BX 10 $5.94<br />
BANDAGE, ELAS SLF-CLSR PREM N/S LF 4X5YDS BX 10 $6.91<br />
TAPE, ADHSV CLOTH SILK LF 1/2"X10YD(24RL/BX)PERFM+ BX 24 $8.66<br />
TAPE, ADHSV CLOTH SILK LF 1"X10YD (12RL/BX)PERFM+ BX 12 $8.59<br />
TAPE, ADHSV CLOTH SILK LF 2"X10YD (6RL/BX)PERFM+ BX 6 $8.75<br />
WASHER, ELEPHANT EAR W/3TIPS EA 1 $18.75<br />
TRIPLE ANTIBIOTIC, OINT 0.5GM (144/BX) BX 144 $14.61<br />
SANITIZER, HAND/ALOE W/PUMP PERFM 15OZ (12/CS) EA 1 $3.41<br />
BANDAGE, ADHSV FABR KNCKL 1.5X3 PERFM (100/BX 24BX BX 100 $5.25<br />
BANDAGE, ADHSV SHR STRP 1X3 PERFM (100/BX 24BX/CS) BX 100 $2.21<br />
LANCET, PRESS-ACT SFTY 1.5MM BLD 1.8MM LF GRN(100/ BX 100 $16.04<br />
CHART, EYE TEST ILLUM 10' 14"X9" SNELLEN LF EA 1 $10.63<br />
TAPE, MEASURE RETR LINEN 72" LF (6/BX) BX 6 $12.19<br />
BLADE, TONGUE SR 6" N/S LF PERFM (500/BX 10BX/CS) BX 1 $3.59<br />
SPECULA, KLNSPC 4.25MM (34/TU 25TU/BG 10BG/CS) BG 25 $25.50<br />
SPECULA, 2.75MM DISPOSABLE (850/BG 10BG/CS) BG 850 $24.65<br />
INFLATION SYSTEM, THIGH BLK LF PERFM+ EA 1 $25.34<br />
LAMP, 3.5VOLT F/MACROVIEW OTOSCOPE EA 1 $16.50<br />
BULB, INSUFFLATION F/MACROVIEW OTOSCOPE EA 1 $6.70<br />
GLOVE, EXAM VNYL STRTCH PF PRFM+ WHT SM (100/BX 10 BX 1 $5.13<br />
GLOVE, EXAM VNYL STRTCH PF PRFM+ WHT MED(100/BX 10 BX 1 $5.13<br />
GLOVE, EXAM VNYL STRTCH PF PRFM+ WHT LG (100/BX 10 BX 1 $5.13<br />
SWAB, STING & BITE (10/BX) BX 10 $2.14<br />
BANDAGE, ADHSV SHR PTCH 2X4 STR LF(50/BX 24BX/CS) BX 1 $3.29<br />
LAMP, REPLCMNT F/03000 3.5V (6/BX) EA 1 $11.66<br />
CURETTE, EAR SPOON DISP N/S LF ADLT/LG (50/BX 4BX/ BX 50 $28.88<br />
CURETTE, EAR LOOP END DISP N/S LF (50/BX 4BX/CS) BX 50 $28.88<br />
CURETTE, EAR SCOOP DISP N/S LF INF/SM (50/BX 4BX/C BX 50 $28.88<br />
TOWEL, PAPER C-FOLD (150/PK 16PK/CS) CS 16 $26.06<br />
EYE WASH, SOL REFILL STR 32OZ EA 1 $12.94<br />
SYRINGE/NDL, TB 1CC 27GX1/2" (100/BX 8BX/CS) BX 100 $77.50<br />
GLASS, MAGNIFYING RECTGL EA 1 $17.30<br />
CLEANSER, WOUND SALINE 7.1OZ (12/CS) EA 1 $5.40<br />
FORCEP, THUMB STR DISP 5"(20BX)S2501-5" BX 20 $19.31<br />
BOTTLE, EYE WASH 32OZ EA 1 $7.94<br />
TABLE, EXAM BASE ONLY DRWR EA 4 $2,565.00<br />
CAN, WASTE STEP-ON SQ MTL RED 32QT EA 4 $156.10<br />
CAN, WASTE STEP-ON SQ MTL WHT 32QT EA 4 $156.10<br />
OXIMETER, FINGER TIP PULSE EA 1 $156.25<br />
SCALE, BALANCE BEAM LB & KILO W/HT ROD CAP 500LB EA 1 $195.00<br />
SPILL KIT, EZ CLEAN (24/CS) EA 1 $7.10<br />
URINE TEST STRIP, CLARITY UROCHECK 10SG (100TEST/B BX 1 $23.00<br />
TIMER, TRACEABLE 99M595 EA 1 $15.64<br />
MASK, POCKET W/POLY BAG EA 1 $7.65<br />
THERMOMETER, TRACEABLE FRIG, FREEZER EA 1 $40.25<br />
SPONGE, GZE 4"X4" 16PLY PERFM+ STR LF (10/TR 72TR TR 1 $0.68<br />
TEST KIT, PREG HCG URINE CLARITY (25/BX) BX 1 $18.69<br />
TIP, SNGL USE EAR WASHER (20/PK) PK 20 $11.25<br />
SPONGE, GZE 2"X2" 8PLY PERFM STR (2/PK 50PK/BX 30B BX 50 $1.89<br />
BAG, BRN PAPER GROC C#4 5X3 1/3X9 3/4 (500/PK 8PK/ CS 8 $68.33<br />
FLOWMETER (12/CS) CS 12 $142.50<br />
FUL-GLO, STRIP OPHTH 1MG (100/BX) BX 1 $9.74<br />
GOWN, FLD-RESIST PERFM LF FULL EL CUF(10/PK 5PK/CS PK 10 $12.05<br />
TISSUE, FACIAL KLEENEX (36BX/CS) CS 36 $51.75<br />
1 <strong>of</strong> 6
COMPREHENSIVE SUPPLIES AND EQUIPMENT START UP COST 1/31/2011<br />
WICK, EAR STR 1SZ (5/PK 20PK/CS) PK 1 $2.96<br />
COTTON BALL, 65CT STR ABSRB LFPERFM+ (48BX/CS) BX 1 $1.51<br />
STOOL, STEP 8 3/4" EA 4 $92.15<br />
BAG, BIOHAZ RED 24X24 6MIC (1000/CS) CS 1000 $19.88<br />
TOWEL, DISINFC BLCH CLNR (60/PK 12PK/CS) PK 1 $9.68<br />
CUP, SPCMN STR GRN UNWRAPPED 4OZ (100/CS) CS 100 $19.76<br />
ANALYZER, HB201 W/MICROCUVETTE 1BX "INTRO" D/S EA 1 $397.50<br />
ANALYZER, URINE CLINITEK STATUS D/S EA 1 $562.50<br />
BRACKET, WALL SHARPS CONT 5.4QT (10/CS) CS 10 $194.13<br />
CHAIR, SIDE W/O ARMS CLAY EA 1 $228.75<br />
CHART, EYE TEST 20' 22"X11" KNDERGRTN LF EA 1 $5.19<br />
CHART, EYE TEST 20' 22"X11" SNELLEN LF EA 1 $5.19<br />
DEFIBRILLATOR, AED G3 DLX RECHARGABLE EA 1 $1,043.75<br />
DISPENSER, ALCHL 8OZ IMPRNTD LF EA 1 $5.31<br />
DISPENSER, F/GLOVE BOX EA 1 $11.50<br />
DISPENSER, TOILET SEAT COVER WHT PLAS EA 1 $5.45<br />
ECG, IQ MARK DIGITAL INTERP C MPLT D/S EA 1 $3,075.00<br />
LAMP, EXAM HALOGEN W/STAND WHT EA 4 $504.90<br />
LIGHT, DIAGNOSTIC COBALT PEN (3/PK) PK 3 $7.43<br />
LIGHT, UV WOODS HND HELD 31501 EA 1 $323.75<br />
METER, PEAKFLOW STD ADLT (12/CS) CS 48 $679.75<br />
OPHTHALMOSCOPE, HALOGEN 3.5V EA 4 $734.25<br />
OTOSCOPE, DIAGNOSTIC W/SPECULA 3.5V EA 4 $418.00<br />
NEBULIZER, PULMO AIDE 2PRONG COMPRESSOR EA 1 $25.61<br />
SCALE, BALANCE BEAM W/HEIGHT ROD 450LB CAPACITY EA 1 $153.75<br />
SPHYG, ANEROID WALL MT LF BLK EA 1 $51.70<br />
SPIROMETER, IQ MARK DIGITAL W/CALIBRATION D/S EA 1 $1,756.25<br />
STAND, MAYO INSTUMENT DBL POSTBASE EA 4 $373.55<br />
STOOL, EXAM SCREW ADJ BLK EA 4 $279.00<br />
THERMOMETER, SURETEMP W/WALL MOUNT EA 4 $829.00<br />
TOP, UPHOLSTERY F/204 SOFT TOUCH NAVY EA 4 $850.00<br />
TRANSFORMER, WALL UNIT 767 W/HDL 3.5V EA 4 $1,035.50<br />
TEST STRIP, BLD GLUC TRUETRAK (50/BX 24BX/CS) BX 1 $21.25<br />
METER KIT, BLD GLUC TRUETRAK STARTER (6/CS) "PROMO EA 1 $0.01<br />
ELECTRODE, EKG MEDI-TRACE (30/BG 20BG/CS) BG 30 $4.88<br />
LANCET, MONOLET STR BLU 21G (100/BX) BX 100 $5.94<br />
LANCET, 2.3MM BLADE BLU (100/BX) BX 100 $15.15<br />
LANCET, ORANGE 2.2 MM (100/BX 15BX/CS) BX 100 $13.84<br />
FINGER COT, ALUM PADDED 2 1/4" (12/PK) PK 12 $12.75<br />
FINGER SPLINT, CRVD PADDED 4" (12/PK) PK 12 $12.06<br />
FINGER SPLINT, CRVD PADDED 3" (12/PK) PK 12 $12.06<br />
FINGER SPLINT, CRVD PADDED 6" (12/PK) PK 12 $12.06<br />
WRIST/FOREARM SPLINT, COLLES PADDED LT MED EA 1 $6.00<br />
WRIST/FOREARM SPLINT, COLLES PADDED LT LG EA 1 $6.00<br />
WRIST/FOREARM SPLINT, COLLES PADDED RT MED EA 1 $6.00<br />
WRIST/FOREARM SPLINT, COLLES PADDED RT LG EA 1 $6.00<br />
HEEL CUP, SIL SM/MED PR 1 $21.88<br />
HEEL CUP, SIL LG/XLG PR 1 $21.88<br />
ANKLE BRACE, SURROUND FLOAM REG EA 1 $26.13<br />
ELBOW SUPPORT, PULL-ON CTN/ELAS MED EA 1 $3.06<br />
ELBOW SUPPORT, PULL-ON CTN/ELAS LG EA 1 $3.06<br />
ELBOW SUPPORT, PULL-ON CTN/ELAS XLG EA 1 $3.06<br />
ANKLE SUPPORT, DBL STRAP SM EA 1 $10.50<br />
ANKLE SUPPORT, DBL STRAP MED EA 1 $10.50<br />
ANKLE SUPPORT, DBL STRAP LG EA 1 $10.50<br />
ANKLE SUPPORT, DBL STRAP XLG EA 1 $10.50<br />
MESH, HEEL/ELBOW PR 1 $5.19<br />
KNEE WRAP, PATELLA W/BUTTRESS NYLN 2SIDES UNIV EA 1 $18.69<br />
ELBOW STRAP, SURROUND W/FOAM BLADDER UNIV EA 1 $10.19<br />
ARM SLING, DLX CTN/POLY W/PAD MED EA 1 $4.38<br />
ARM SLING, DLX CTN/POLY W/PAD LG EA 1 $4.38<br />
ARM SLING, DLX CTN/POLY W/PAD XLG EA 1 $4.38<br />
SHOULDER IMMOBILIZER, DLX RT/LT W/STRAP&CUFF UNIV EA 1 $9.88<br />
WRIST SUPPORT, COMFORT FORM RT MED EA 1 $9.56<br />
WRIST SUPPORT, COMFORT FORM RT LG EA 1 $9.56<br />
WRIST SUPPORT, COMFORT FORM LT SM EA 1 $9.56<br />
WRIST SUPPORT, COMFORT FORM LT MED EA 1 $9.56<br />
WRIST SUPPORT, COMFORT FORM LT XLG EA 1 $9.56<br />
WRIST SUPPORT, W/ABDUCTED THUMB RT SM EA 1 $20.13<br />
WRIST SUPPORT, W/ABDUCTED THUMB RT MED EA 1 $20.13<br />
WRIST SUPPORT, W/ABDUCTED THUMB RT LG EA 1 $20.13<br />
WRIST SUPPORT, W/ABDUCTED THUMB LT SM EA 1 $20.13<br />
WRIST SUPPORT, W/ABDUCTED THUMB LT MED EA 1 $20.13<br />
WRIST SUPPORT, W/ABDUCTED THUMB LT LG EA 1 $20.13<br />
RIB BELT, MALE 6" UNIV EA 1 $5.31<br />
RIB BELT, FML 6" UNIV EA 1 $5.38<br />
BACK SUPPORT, COMFORT FORM MED EA 1 $19.94<br />
BACK SUPPORT, COMFORT FORM LG EA 1 $19.94<br />
BACK SUPPORT, COMFORT FORM XLG EA 1 $19.94<br />
BACK SUPPORT, COMFORT FORM 2XLG EA 1 $19.94<br />
SHOE, POST-OP VELCRO OPEN-TOE MALE SM EA 1 $7.13<br />
SHOE, POST-OP VELCRO OPEN-TOE MALE MED EA 1 $7.13<br />
SHOE, POST-OP VELCRO OPEN-TOE MALE LG EA 1 $7.13<br />
SHOE, POST-OP VELCRO OPEN-TOE FML LG EA 1 $7.13<br />
BACITRACIN, OINT 500U/GM 1/32OZ (144/BX) BX 144 $16.20<br />
CRUTCH, ALUM PSH-BTN ADJ ADLT LF PERFM (8PR/CS) PR 1 $13.85<br />
CRUTCH, ALUM PSH-BTN ADJ TL ADLT LF PERFM (8PR/CS) PR 1 $13.85<br />
BANDAGE, ELAS SLF-CLSR PREM N/S LF 3X5YDS BX 10 $5.94<br />
2 <strong>of</strong> 6
COMPREHENSIVE SUPPLIES AND EQUIPMENT START UP COST 1/31/2011<br />
BANDAGE, ELAS SLF-CLSR PREM N/S LF 4X5YDS BX 10 $6.91<br />
BANDAGE, CNFRM STRCH 2" STR LF PERFM+ (12/BG 8BG/CS) BG 1 $3.70<br />
BANDAGE, CNFRM STRCH 3" STR LF PERFM+ (12/BG 8BG/CS) BG 1 $4.68<br />
BANDAGE, CNFRM STRCH 4" STR LF PERFM+ (12/BG 8BG/CS) BG 1 $5.20<br />
PAD, EYE OVAL STR 1 5/8"X2 5/8" (1/PK 50PK/BX 12BX BX 50 $5.84<br />
PAD, EYE OVAL STR 2 1/8"X2 5/8" (1/PK 50PK/BX 12BX BX 50 $7.29<br />
TAPE, ADHSV PAPER LF 1"X10YDS (12RL/BX 12/CS)PERF+ BX 12 $5.98<br />
BANDAGE, ADHSV FABR STRP 1X3 PERFM (100/BX 24BX/CS BX 100 $3.13<br />
CLOSURE, SKIN 1/8X3" REINF LF PERFM* (50PK/BX 4BX/ BX 50 $30.31<br />
CLOSURE, SKIN 1/4X3" REINF LF PERFM+(50PK/BX 4BX/C BX 50 $30.31<br />
CLOSURE, SKIN 1/2X4" REINF LF PERFM+(50PK/BX 4BX/C BX 50 $51.19<br />
TEST KIT, INFLUENZA A+B QUICKVUE (25/KT 10KT/CS) KT 25 $417.80<br />
EPI-PEN JR, SYR .15MG AUTO INJ EA 1 $67.49<br />
EPI-PEN, SYR .3MG AUTO INJ EA 1 $67.49<br />
TEST KIT, INFLUENZA A+B QUICKVUE (25/KT 10KT/CS) KT 15 $217.80<br />
TEST KIT, MONO OSOM WAIVED (25/KT 6KT/CS) KT 1 $68.75<br />
TEST KIT, PREG HCG URINE QUICKVUE 1STEP (12KT/CS) KT 25 $44.74<br />
TEST KIT, QUICKVUE INLINE STREP A (25/KT 12KT/CS) KT 1 $79.83<br />
TEST KIT, STREP A ULTRA OSOM WAIVED (50/KT) KT 50 $103.10<br />
CONTROL, URINE DIPPER LEV 1&2 15ML (6/BX) BX 6 $98.00<br />
INFANRIX, SDV 25-58-10MG/0.5ML 0.5ML (10/PK) PK 10 $261.94<br />
RECOMBIVAX HB, SDV 5MG/0.5ML 0.5ML (10/BX) BX 10 $173.06<br />
RECOMBIVAX HB, VL 10MCG/ML 1ML (10/BX) BX 10 $360.50<br />
IPOL, MDV 5ML 10DOSE EA 1 $299.35<br />
M-M-R II, SDV (10/BX) BX 10 $542.41<br />
DECAVAC TETANUS DIP TOX, SYR 5-2LFU/0.5 (10/CT) CT 10 $244.29<br />
PNEUMOVAX, MDV 25MCG/0.5ML 2.5ML EA 1 $206.18<br />
HAVRIX, SDV 1440U/ML 1ML ADLT (10/PK) PK 10 $458.63<br />
TEST KIT, ALT-AST (10/BX) BX 10 $45.26<br />
CONTROL, MULTI ANALYTE (6/BX) BX 6 $118.36<br />
TEST CASSETTE, LIPID PROFILE + GLU (10/BX 5BX/CS)) BX 10 $111.94<br />
TEST CASSETTE, TC HDL GLU PANEL (10/BX) BX 10 $87.10<br />
AUDIOMETER PKG, W/PRINTER/PAPER/OTO-CHK EA 1 $2,795.00<br />
WHEELCHAIR, FX FUL ARM FX FT BLK 18" LF PERFM EA 1 $147.13<br />
Vizatek CR System (x-ray) EA 1 $29,800.00<br />
Visatek Uarm EA 1 $58,750.00<br />
Furniture (detailed list provided separately) $12,640.00<br />
Total $127,276.35<br />
Office Supplies (contract pricing propritary <strong>for</strong> single items)<br />
Quantity Price<br />
3 ring binder 1 inch ea<br />
3 ring binder 1 ½ ea<br />
3 ring binder 2 inch ea<br />
Post it notes 18/pack<br />
Sharpie - Fine, black 12/pack<br />
Kleenex facial tissue ea<br />
Paper towels - multifold 16 packs <strong>of</strong> 250 ea<br />
Toilet paper 24 rolls<br />
Toilet seat dispenser ea<br />
Toilet seat covers 1000/case<br />
Purell instant hand sanitizer with aloe ea<br />
Moisturizing lotion ea<br />
Trash bags, white 13 gallon 120/box<br />
Trash bags, black 33 gallon 70/box<br />
Shredder bags 100/box<br />
Copy Paper - 1 case 10 reams <strong>of</strong> 500 sheets ea<br />
Spiral Notebook ea<br />
Phone Message book 2/pack<br />
Expanding File Pocket folder ea<br />
Hanging File Folders 25/box<br />
Expanding file folder - <strong>for</strong> lab receipts ea<br />
File box ea<br />
3 drawer - 8.5x11 ea<br />
Vinyl sheet protectors 50/box<br />
Dividers set <strong>of</strong> 8 tabs<br />
Folder - pocket - light green 10/pack<br />
Folder - pocket - gray 10/pack<br />
Folder - pocket - red 10/pack<br />
Folder - pocket - dark blue 10/pack<br />
Folder - pocket - light blue 10/pack<br />
Folder - pocket - black 10/pack<br />
Folder - pocket - teal 10/pack<br />
Folder - pocket - violet 10/pack<br />
Mailing Labels box <strong>of</strong> 750<br />
Stapler ea<br />
Staplers box <strong>of</strong> 5000<br />
Staple remover ea<br />
Scissors 2/pack<br />
Rubber bands bag<br />
Binder Clips 90/pack<br />
Paper Clips - small 100/box<br />
Paper Clips - Jumbo 100/box<br />
Paper Clip holder ea<br />
Tape dispenser with refill rolls ea<br />
Rape refills 10/pack<br />
Faxed - stamper ea<br />
Received - stamper ea<br />
3 <strong>of</strong> 6
COMPREHENSIVE SUPPLIES AND EQUIPMENT START UP COST 1/31/2011<br />
Date - stamper ea<br />
Liquid paper - correction tape 2/pack<br />
Yellow Highlighter 10/pack<br />
#2 Pencils 12/pack<br />
Pencil sharpener ea<br />
Appointment book ea<br />
Copier Toner refill ea<br />
Batteries - AAA 12/pack<br />
Batteries - AA 12/pack<br />
Batteries - C 4/pack<br />
Batteries - D 4/pack<br />
Batteries - 9-volt 2/pack<br />
Step files ea<br />
Windex wipes pack<br />
Lysol wipes 80/box<br />
Feather Duster ea<br />
Lysol toilet bowl cleaner ea<br />
Antimicrobial Soap - 1 gallon gallon<br />
Antimicrobial Soap - 7.5 oz dispenser ea<br />
Oust air freshener ea<br />
DustPan & Brush ea<br />
Angled Broom ea<br />
Trash Cans - Beige ea<br />
Large Trash can - gray ea<br />
Large Trash can tilt-top lid ea<br />
Recycling container ea<br />
Clipboard - 9x12.5 (2 pk) 2/pack<br />
4 foot folding Table ea<br />
Clear Business Card holders ea<br />
Stackable letter trays (6) 6/pack<br />
Drawer organizer ea<br />
Literature holder ea<br />
Brochure holder ea<br />
Will Return Clock ea<br />
Desk Calculator ea<br />
Shredder ea<br />
4 <strong>of</strong> 6<br />
Total $1,005.05<br />
Top 150 Pharmacy Medications<br />
Actual Pharmacy Formulary will be determined by CWPB and First Onsite<br />
Drug Description Strength Form Count Comp Unit Rx Dispensed Rank*<br />
LIPITOR 10MG # 30 TABS 10mg Tablet 30 LIPITOR $ 92.48<br />
1<br />
HYDROCODONE/APAP (5/500MG) TABS C3 5mg/500mg Tablets 20 Vicodin $ 2.06<br />
2<br />
HYDROCODONE/APAP 7.5/500 TABS C3 7.5mg/500mg Tablets 20 Lortab $ 2.30<br />
3<br />
LEVOTHYROXINE 0.05MG TABS 0.05mg Tablets 30 Synthroid $ 4.43<br />
4<br />
AMOXICILLIN 500MG CAPS 500mg Capsules 21 Amoxil $ 3.93<br />
5<br />
LISINOPRIL 10MG TABS 10mg Tablets 30 Zestril/Prinivil $ 1.97<br />
6<br />
NEXIUM 20mg Tablets 20 Nexium $ 119.71<br />
7<br />
LEVOTHYROXINE 0.<strong>02</strong>5MG TABS 0.<strong>02</strong>5mg Tablets 30 Synthroid $ 4.22<br />
8<br />
LEXAPRO 10mg Tablets 20 LEXAPRO $ 64.93<br />
9<br />
SINGULAIR 10MG TABS 10mg Tablet 30 Singulair $ 119.21 10<br />
PLAVIX 75mg Tablets 20 Plavix $ 114.49 11<br />
SIMVASTATIN 20MG TABS 20mg Tablets 30 Zocor $ 2.48 12<br />
HYDROCHLOROTHIAZIDE 12.5MG CAPS 12.5mg Capsules 30 HydroDIURIL $ 4.79 13<br />
AMLODIPINE 5MG TABS 5mg Tablets 30 Norvasc $ 4.08 14<br />
AZITHROMYCIN 250MG TABS #6 250mg Tablets 6 Zithromax $ 6.12 15<br />
WARFARIN 2.5MG TABS 2.5mg Tablets 30 Coumadin $ 4.41 16<br />
FUROSEMIDE 20MG TABS 20mg Tablets 30 Lasix $ 1.75 17<br />
AZITHROMYCIN 5000MG TABS #6 500mg Tabets 3 Zithromax $ 8.18 18<br />
LEVOTHYROXINE 0.075MG TABS 0.075mg Tablets 30 Synthroid $ 4.82 19<br />
ADVAIR 250/50MCG DISKUS 60 DOSE 250/50mcg Inhalation 1 ADVAIR $ 205.71 20<br />
METOPROLOL TARTRATE 50MG TABS 50mg Tablets 30 Lopressor $ 2.10 21<br />
DIOVAN 80MG TABS 80mg Tablets 30 Diovan $ 55.75 22<br />
VENLAFAXINE 37.5MG TABS 37.5mg Tablets 20 Effexor XR $ 29.45 23<br />
CRESTOR 5mg Tablets 20 Crestor $ 35.21 24<br />
OXYCODONE/APAP 5MG/325MG 30 TABS/BOTTLE C2 5mg/325mg Tablets 30 Percocet $ 4.81 25<br />
CEPHALEXIN 250MG CAPS 250mg Capsules 20 Keflex $ 2.69 26<br />
METOPROLOL TARTRATE 100MG TABS 100mg Tablets 30 Lopressor $ 2.64 27<br />
PROAIR HFA 90MCG 8.5GM INHALER 90MCG Inhalation 8.5 Ventolin Hfa $ 37.40 28<br />
METFORMIN 500MG TABS 500mg Tablets 30 Glucophage $ 1.98 29<br />
VYTORIN 10/10mg Tablets 20 VYTORIN $ 76.60 30<br />
PREVACID 30MG CAPS 30mg Capsule 30 Prevacid $ 116.75 31<br />
SEROQUEL 25mg Tablets 20 SEROQUEL $ 61.60 32<br />
SIMVASTATIN 40MG TABS 40mg Tablets 30 Zocor $ 3.99 33<br />
CYMBALTA 30MG DR BTL #30 CAPS 30mg Capsules 30 Cymbalta $ 130.58 34<br />
SERTRALINE 25MG TABS #30 25mg Tablets 30 Zol<strong>of</strong>t $ 3.77 35<br />
DIOVAN HCT 40mg Tablets 30 Diovan $ 49.99 36<br />
LEVAQUIN 500MG TABS 500mg Tablets 10 Levaquin $ 150.54 37<br />
LISINOPRIL/HCTZ 10MG/12.5MG TABS 10mg/12.5mg Tablets 30 Zestoretic $ 3.84 38<br />
FLOMAX .4mg Tablet 20 Flomax $ 128.37 39<br />
ACTOS 30MG TABS 30mg Tablet 30 Actos $ 209.34 40<br />
ALPRAZOLAM 0.25MG TABS C4 0.25mg Tablets 20 Xanax $ 1.71 41<br />
ZETIA 10mg Tablets 20 ZEITA $ 75.62 42<br />
FLUOXETINE 10MG CAPS 10mg Capsules 30 Prozac $ 2.<strong>02</strong> 43<br />
TRICOR 145MG BTL #30 TABS 145mg Tablets 30 Tricor $ 134.<strong>02</strong> 44<br />
TRAZODONE 50MG TABS 50mg Tablets 30 Desyrel $ 1.89 45
COMPREHENSIVE SUPPLIES AND EQUIPMENT START UP COST 1/31/2011<br />
ATENOLOL 25MG TABS 25mg Tablets 30 Tenormin $ 1.84 46<br />
CELEBREX@ 200MG CAPSULES 200mg Capsules 20 Celebrex $ 78.07 47<br />
LANTUS - - 10ml Lantus $ 99.99 48<br />
AMLODIPINE 10MG TABS 10mg Tablets 30 Novasc $ 4.82 49<br />
ZOLPIDEM 5MG TABS C4 5mg Tablets 30 Ambien $ 2.27 50<br />
METROPROLOL SUCCINATE 25mg Tablets 20 TOPROL XL $ 20.51 51<br />
LIZINOPRIL 40MG TABS 40mg Tablets 30 Zestril $ 4.18 52<br />
NASONEX@ 50MCG 17GM 50mcg Inhaler 17 Nasonex $ 87.03 53<br />
PREDNISONE 10MG TABS 10mg Tablets 20 Orasone $ 1.74 54<br />
PROPOXACET-N 100MG TABS C4 100mg Tablets 20 Darvocet-N $ 2.25 55<br />
CLONAZEPAM 0.5MG TABS C4 0.5mg Tablets 30 Klonopin $ 1.86 56<br />
ALBUTEROL 2MG TABS 2mg Tablets 30 Proventil $ 3.36 57<br />
SERTRALINE 50MG TABS 50mg Tablets 30 Zol<strong>of</strong>t $ 4.56 58<br />
IBUPROFEN 200MG TABS 200mg Tablets 20 Motrin $ 1.61 59<br />
HYDROCHLOROTHIAZIDE 25MG TABS 25mg Tablets 30 HydroDIURIL $ 1.58 60<br />
ALPRAZOLAM 0.5MG TABS .5mg Tablets 30 Xanax $ 2.22 61<br />
LYRICA 75MG CAPS 75mg Capsules 30 Lyrica $ 74.63 62<br />
ARICEPT - - - - N/A 63<br />
YAZ-28 - Pack 28 Yaz $ 214.20 64<br />
METROPROLOL SUCCINATE 50mg Tablets 20 TOPROL XL $ 20.51 65<br />
GABAPENTIN 100MG CAPS 100mg Capsules 30 Neurontin $ 3.10 66<br />
ALPRAZOLAM 1MG TABS 1mg Tablets 30 Xanax $ 2.31 67<br />
VIAGRA 100MG TABLETS 100mg Tablets 10 Viagra $ 33.44 68<br />
OXYCODONE/APAP 10MG/325MG 30 TABS/BOTTLE C2 10mg/325mg Tablets 30 Percocet $ 19.29 69<br />
ACETAMINOPHEN/COD #3 TABS C3 300-30mg Tablets 20 Tylenol/Codeine #3 $ 4.07 70<br />
ACETAMINOPHEN TR/CLAVULANATE POTASSIUM 500/125mg Tablets 20 Augmentin $ 23.17 71<br />
OMEPRAZOLE DR 20MG CAPS 20mg Capsules 30 Prilosec $ 9.67 72<br />
ALENDRONATE 35MG TABS 4X1 35mg Tablets 4 Fosamax $ 6.47 73<br />
COZAAR 25mg Tablets 20 Cozaar $ 24.44 74<br />
PREMARIN@ 0.625MG TABS 0.625mg Tablets 30 Premarin $ 51.19 75<br />
ACTONEL 5mg Tablets 20 Actonel $ 73.59 76<br />
VALTREX 500mg Tablets 20 Valtrex $ 147.58 77<br />
SIMVASTATIN 80MG TABS 80mg Tablets 30 Zocor $ 4.50 78<br />
LEVOXYL - - 20 LEVOXYL $ 22.22 79<br />
HYDROCODONE/APAP 10/500 TABS C3 10mg/500mg Tablets 30 Lortab $ 5.72 80<br />
ATENOLOL 50MG TABS 50mg Tablets 30 Tenormin $ 1.89 81<br />
TRAMADOL 50MG TABS 50mg Tablets 20 Ultram $ 1.98 82<br />
AMLODIPINE BSYLATE AND BENAZEPRIL 2.5/10mg Tablets 30 Lotrel $ 5.98 83<br />
LISINOPRIL 20MG TABS 20mg Tables 30 Zestril/Prinivil $ 2.74 84<br />
AMPHETAMINE SALT COMBO 5MG BTL #30 TABS C2 5MG Tabs 30 ADDERALL $ 9.47 85<br />
METOPROLOL TARTRATE 25mg Tablets 20 Lopressor $ 1.99 86<br />
PAROXETINE 10MG TABS #30 10mg Tablets 30 Paxil $ 5.83 87<br />
OMEPRAZOLE DR 40MG CAPS 40mg Capsules 30 Prilosec $ 10.67 88<br />
TOPIRAMATE 25MG TABS #60 25mg Tablets 60 Topamax $ 4.64 89<br />
OMEPRAZOLE 20mg Capsules 60 Prilosec $ 16.41 90<br />
AMOXICILLIN 250MG CAPS 250mg Capsules 21 Amoxil $ 3.25 91<br />
SIMVASTATIN 10 MG TABS 10mg Tablets 30 Zocor $ 1.99 92<br />
METFORMIN 850MG TABS 850mg Tablets 30 Glucophage $ 3.01 93<br />
FEXOFENADINE 60MG TABS 60mg Tablet 30 Allegra $ 20.55 94<br />
ZOLPIDEM 10MG TABS C4 10mg Tablets 30 Ambien $ 2.28 95<br />
FUROSEMIDE 40MG TABS 40mg Tablets 30 Lasix $ 1.78 96<br />
FLUTICASONE 50MCG 16GM NASAL SPRAY 50mcg Nasal Spray 16 Flonase $ 12.45 97<br />
PANTOPRAZOLE SODIUM EC 40MG TABS 40mg Tablets 30 Protonix D-R $ 101.45 98<br />
SPIRIVA HANDIHALER - Inh 30 Spiriva $ 197.83 99<br />
TRIAMTERENE/HCTZ 37.5MG/25MG TABS 37.5mg/25mg Tablets 30 Maxzide $ 2.44 100<br />
CONCERTA 18MG BTL #30 TABS C2 18MG Tablets 30 Concerta $ 134.06 101<br />
CLONIDINE 0.1MG TABS 0.1mg Tablets 30 Catapres $ 2.36 1<strong>02</strong><br />
TRIAMTERENE/HCTZ 50/25MG CAPS 50mg/25mg Capsules 30 Maxzide $ 34.59 103<br />
ATENOLOL 100MG TABS 100mg Tablets 30 Tenormin $ 3.24 104<br />
BENICAR 20mg Tablets 20 Benicar $ 47.28 105<br />
XALATAN - - 20 XALATAN $ 26.67 106<br />
DIAZEPAM 5MG TABS C4 5mg Tablets 30 Valium $ 1.89 107<br />
GLYBURIDE 2.5MG TABS 2.5mg Tablets 30 Glycron $ 2.75 108<br />
AMOXICILLIN/POT CLAV 500-125MG TABS #20 500mg/125mg Tablets 20 Augmentin $ 22.69 109<br />
POTASSIUM CHLORIDE 10MEQ TABS 10meq Tablets 30 Klor-Con $ 6.06 110<br />
FLUCONAZOLE 150MG TABS 150mg Tablets 1 Diflucan $ 1.29 111<br />
NAMEDA 5mg Tablets 20 Nameda $ 62.22 112<br />
LORAZEPAM 0.5MG TABS C4 0.5mg Tablets 30 Ativan $ 2.06 113<br />
FLUOXETINE 20MG CAPS 20mg Capsules 30 Prozac $ 1.88 114<br />
IBUPROFEN 400MG TABS 400mg Tablets 20 Motrin $ 1.83 115<br />
RISPERDAL .5mg Tablets 20 RISPERDAL $ 88.24 116<br />
ABILIFY 5mg Tablets 20 Abilify $310.04 117<br />
ALBUTEROL 4MG TABS 4mg Tablets 30 Proventil $ 4.35 118<br />
HYZAAR 50mg/12.5mg Tablets 20 Hyzaar $ 51.81 119<br />
BENICAR 20/12.5mg Tablets 20 Benicar $ 50.80 120<br />
OMEPRAZOLE 40mg Capsules 60 Prilosec $ 16.81 122<br />
PANTOPRAZOLE SODIUM 20mg Tablets 30 Protonix D-R $ 89.78 123<br />
ALPRAZOLAM 2MG TABS 2mg Tablets 30 Xanax $ 3.43 124<br />
NAPROXEN 375MG TABS 375mg Tablets 20 Naprosyn $ 2.35 125<br />
ORTHO TRI-CYCLEN - Pack 28 Orth Tri Cyclen $ 67.95 126<br />
WARFARIN 5MG TABS 2mg Tablets 30 Coumadin $ 4.00 127<br />
DETROL LA 2mg Tablets 20 Detrol LA $ 88.93 128<br />
LORAZEPAM 1MG TABS 5mg Tablets 30 Ativan $ 2.08 129<br />
LAMOTRIGINE TAB 25MG 25mg Tablets 20 Lamictal 3.12 130<br />
CYCLOBENZAPRINE 5MG TABS #20 5mg Tablets 20 Flexeril $ 2.74 131<br />
BUDEPRION XL 300mg Capsules 20 Wellbutrin XL $ 4.80 132<br />
FUROSEMIDE 50MCG 16GM NASAL SPRAY 50mcg Nasal Spray 16 Flonase $ 12.40 133<br />
ACIPHEX 20MG BTL #30 TABS 20mg Tablet 30 Aciphex $ 196.26 134<br />
5 <strong>of</strong> 6
COMPREHENSIVE SUPPLIES AND EQUIPMENT START UP COST 1/31/2011<br />
LUNESTA 2MG BTL 30 TABS C4 2mg Tablets 30 Lunesta $ 168.65 135<br />
CLONAZEPAM 1MG TABS C4 1mg Tablets 30 Klonopin $ 2.32 136<br />
PROMETHAZINE 25MG TABS 25mg Tablets 20 Phenergan $ 6.36 137<br />
SULFAMETH/TRIMETH DS TABS 800mg/160mg Tablets 20 Bactrim D.S. $ 4.00 138<br />
METFORMIN 1000MG TABS 1000mg Tablets 30 Glucophage $ 2.82 139<br />
ALLOPURINOL 100mg Tablets 20 ZYLOPRIM $ 2.57 140<br />
SULFAMETH/TRIMETH 400mg/80mg Tablets 20 Bactrim $ 2.25 141<br />
CIALIS 10MG TABS 10mg Tablets 30 Cialis $ 270.86 142<br />
PROVENTIL HFA 90MCG 6.7GM INH 90mcg Inhalation 6.7gm Albuterol $ 37.14 143<br />
VITAMIN D 2000IU S<strong>of</strong>tgels 75 Vitamin D $ 7.89 144<br />
PENICILLIN VK 250MG TABS 250mg Tablets 20 Pen-Vee-K $ 3.25 145<br />
RANITIDINE 150MG TABLETS 150mg Tablets 20 Zantac $ 1.80 146<br />
TRINESSA - Pack 28 ORTHO TRI CYCLEN $ 13.21 147<br />
AVAPRO 150mg Tablets 20 Avapro $ 50.37 148<br />
AMITRIPTYLINE 10MG TABS 10mg Tablets 30 Elavil $ 1.80 149<br />
POTASSIUM CHLOR 10MEQ TABS 10meq Tablets 30 K-Dur $ 5.18 150<br />
6 <strong>of</strong> 6
PHYSICIAN EMPLOYMENT AGREEMENT<br />
(NON-HOSPITAL SETTING)<br />
HCAPS-459 Rev 12/2010<br />
Contract,__________________ Supplement ______________<br />
THIS PHYSICIAN EMPLOYMENT AGREEMENT (the “Agreement”) is made and entered into by and between H2U<br />
Wellness Centers, LLC d/b/a <strong>West</strong> <strong>Palm</strong> <strong>Beach</strong>-First OnSite (“Employer”), and_____________ (“Physician”).<br />
RECITALS<br />
WHEREAS, Employer is engaged in the business <strong>of</strong> operating and managing medical practices and other health care<br />
services in <strong>Palm</strong> <strong>Beach</strong> County, Florida (the "County");<br />
WHEREAS, Physician is licensed in the state in which the County is located and specializes in ______ ("Specialty"); and<br />
WHEREAS, Employer desires to employ Physician, and Physician desires to be employed by Employer, to render<br />
pr<strong>of</strong>essional physician services, in accordance with the terms and conditions specified herein.<br />
NOW, THEREFORE, in consideration <strong>of</strong> the <strong>for</strong>egoing recitals and the mutual promises and conditions set <strong>for</strong>th herein,<br />
and other good and valuable consideration, the receipt and sufficiency <strong>of</strong> which are hereby acknowledged, Employer and<br />
Physician, intending to become legally bound, agree as follows:<br />
1. ENGAGEMENT<br />
A. Employer engages Physician, and Physician accepts such engagement, as a physician in the Specialty primarily at the<br />
medical practice <strong>of</strong>fice located at (the "Practice"), and such other practice sites<br />
as may be reasonably designated by Employer from time to time, in accordance with the terms and conditions <strong>of</strong> this<br />
Agreement.<br />
2. TERM<br />
A. Term. The term <strong>of</strong> this Agreement shall be <strong>for</strong>_______ year(s) (the "Agreement Term"), commencing on or be<strong>for</strong>e________,<br />
but in no event later than three months after that date, and continuing until __________, subject to earlier termination <strong>of</strong> this<br />
Agreement pursuant to the Termination Section, here<strong>of</strong>. The first date that Physician reports to work and is eligible to work<br />
pursuant to this Agreement shall be referred to herein as the “Effective Date”.<br />
3. DUTIES AND SERVICES<br />
A. Work Schedule. During the Agreement Term, Physician agrees to devote his/her full pr<strong>of</strong>essional working time and<br />
attention, at a minimum <strong>of</strong> 40 hours per work week (excluding time spent on-call), to the practice <strong>of</strong> medicine <strong>for</strong> the benefit<br />
<strong>of</strong> Employer under the terms <strong>of</strong> this Agreement. Employer shall establish Physician's work schedule and on-call schedule,<br />
which schedule shall be inclusive <strong>of</strong> hours providing patient care at the facilities <strong>of</strong> Employer, any and all Medical Staff<br />
obligations, and administrative duties.<br />
B. Non-Physician Personnel. Employer will provide Physician with a reasonable level <strong>of</strong> non-physician personnel support, in<br />
Employer's discretion, including, but not limited to, nurses, technicians, secretarial staff, and other medical and non-medical<br />
personnel, to assist Physician in the per<strong>for</strong>mance <strong>of</strong> his/her duties. Physician shall report to, consult with, and use the input <strong>of</strong><br />
Employer regarding the hiring and firing <strong>of</strong> medical staff who work within the Practice and the overall operations <strong>of</strong> the<br />
Practice. All final decisions regarding hiring and firing <strong>of</strong> Practice personnel shall rest with Employer.<br />
C. Availability and Duties. Physician shall be responsible <strong>for</strong> such duties as assigned to him or her from time to time by<br />
Employer commensurate with his/her Specialty. Physician shall make him/herself available to provide pr<strong>of</strong>essional medical<br />
services to, and treat patients <strong>of</strong> Employer, whether such patients are in Employer's <strong>of</strong>fice, a hospital, or another treatment<br />
location covered by Employer. Physician hereby agrees to devote his/her full working time and attention, together with<br />
Physician's best endeavors and skill, <strong>for</strong> the interest, benefit and best advantage <strong>of</strong> Employer and shall provide services on<br />
behalf <strong>of</strong> Employer in a manner that shall maintain the productivity <strong>of</strong> the Practice. Physician shall provide all pr<strong>of</strong>essional<br />
medical services in accordance with the policies and procedures established by Employer, and the appropriate standards <strong>of</strong><br />
care <strong>of</strong> the community. Physician shall have the authority to refuse to treat a specific patient or to dismiss any particular<br />
patient if the patient has been abusive, disruptive or threatening or has refused to comply with Physician's orders, or <strong>for</strong> other<br />
reasons <strong>of</strong> a similar nature. In the case <strong>of</strong> any such dismissal, Physician agrees that appropriate notice by certified letter shall<br />
Page 1 <strong>of</strong> 16<br />
Deleted: 401 Clematis Street, <strong>West</strong><br />
<strong>Palm</strong> <strong>Beach</strong>, Florida 33401<br />
Formatted: Underline<br />
Formatted: Bullets and Numbering
e sent to such patient and emergency care shall be provided by Physician to such patient <strong>for</strong> an appropriate period after such<br />
dismissal. Notwithstanding the <strong>for</strong>egoing, Physician agrees that he/she will not refuse to treat a patient and will not<br />
discriminate with respect to quality <strong>of</strong> care <strong>of</strong> a patient or otherwise on the basis <strong>of</strong> such patient's race, color, national origin,<br />
ancestry, religion, sex, marital status, sexual orientation, age, disability or medical condition, or as otherwise set <strong>for</strong>th in<br />
applicable federal and state laws. Except as otherwise stated herein, Physician specifically understands that Employer shall<br />
have the final authority over the acceptance or refusal <strong>of</strong> any person <strong>for</strong> whom pr<strong>of</strong>essional services may be rendered and the<br />
amount <strong>of</strong> fees to be charged to such patients. Physician shall not refuse to see any patient assigned by Employer because <strong>of</strong><br />
the source <strong>of</strong> payment <strong>for</strong> services rendered by Physician or because the patient is or is not employed by any particular<br />
employer or is or is not a member <strong>of</strong> any particular insurance plan or HMO. During the Agreement Term, Physician shall be<br />
required to be "on-call" or "on-duty" as reasonable and appropriate. Physician shall not substitute a physician to provide<br />
service in his or her place without Employer's prior approval except that such approval shall not be required if the physician<br />
substituting "on-call" or "on-duty" coverage with Physician is an employee <strong>of</strong> Employer and has full active privileges at the<br />
facility where Physician has coverage requirements and Employer is provided advance notice <strong>of</strong> such substitution. Physician<br />
shall accept and receive consultations and requests <strong>for</strong> pr<strong>of</strong>essional services from physicians employed by Employer, as well<br />
as from other physicians with whom Employer has contractual relationships <strong>for</strong> the provision <strong>of</strong> medical services. In the<br />
event a patient <strong>of</strong> the Practice requires (i) hospitalization, (ii) outpatient services, (iii) diagnostic, lab, physical therapy, or<br />
other ancillary services, or (iv) any other healthcare services, Physician shall take all necessary and appropriate actions.<br />
D. Patient Care. Nothing in this Agreement shall be interpreted to dictate Physician's practice <strong>of</strong> medicine, delivery <strong>of</strong> direct<br />
patient care or independent judgment in the practice <strong>of</strong> medicine. Physician shall have complete control over the diagnosis<br />
and treatment <strong>of</strong> patients, and neither Employer nor any employee <strong>of</strong> Employer shall exercise any direct supervision or<br />
control over the individual treatment <strong>of</strong> the patient. Physician agrees that Physician's treatment and diagnosis <strong>of</strong> patients will<br />
be consistent with all rules and regulations promulgated by Employer dealing with the general treatment <strong>of</strong> patients. In<br />
rendering medical services to patients, Physician shall satisfy the standards and requirements <strong>of</strong> all state and federal statutes<br />
and all standards, rulings, or regulations <strong>of</strong> the Board <strong>of</strong> Medicine/Medical Examiners (or other equivalent board or agency),<br />
the Department <strong>of</strong> Health <strong>of</strong> the state in which the Practice is located, or any other applicable governmental agency or<br />
individual having authority to administer, regulate, accredit, or otherwise set standards <strong>for</strong> the Practice.<br />
E. Per<strong>for</strong>mance Standards. In per<strong>for</strong>ming services under this Agreement, Physician shall comply with the following<br />
Per<strong>for</strong>mance Standards:<br />
i. promote cooperation and teamwork among other physicians and other employees and personnel <strong>of</strong> Employer;<br />
ii. develop standardization <strong>of</strong> Specialty practices and procedures;<br />
iii. attend all required management meetings;<br />
iv. assist Employer as requested in the efficient and effective day-to-day management <strong>of</strong> the Practice;<br />
v. respond to patient and referring physician needs and concerns regarding patient diagnosis and treatment as expeditiously<br />
as reasonably possible;<br />
vi. fully support Employer's overall quality improvement and quality assurance initiatives;<br />
vii. recommend pr<strong>of</strong>essional, technical, and support staff needs to Employer;<br />
viii. recommend policies and procedures regarding scheduling <strong>of</strong> patients to the end that the safety and health <strong>of</strong> patients<br />
takes precedence over other concerns;<br />
ix. direct other employees <strong>of</strong> the Practice in the provision <strong>of</strong> medical services, especially with regard to patient safety;<br />
x. maintain and timely update patient medical records;<br />
xi. adhere to all reasonable Policies and Procedures adopted by Employer; and<br />
xii. adhere to such other per<strong>for</strong>mance standards as established by Employer from time to time.<br />
F. Location(s) <strong>for</strong> Services. Physician shall per<strong>for</strong>m his/her duties at the Practice, those hospital facilities at which Physician<br />
maintains medical staff privileges and such other practice locations <strong>of</strong> Employer as may be reasonably designated by<br />
Employer from time to time. Employer shall have reasonable discretion to consolidate and relocate practices operated by<br />
Employer, including the Practice.<br />
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G. Pr<strong>of</strong>essional Fees/Outside Activities. Physician agrees not to engage in any medical pr<strong>of</strong>essional business activity (whether<br />
or not such business activity is pursued <strong>for</strong> gain, pr<strong>of</strong>it or other pecuniary advantage), without the prior written consent <strong>of</strong><br />
Employer, other than (i) rendering services on behalf <strong>of</strong> Employer pursuant to this Agreement, (ii) maintaining an ownership<br />
interest <strong>of</strong> less than five percent (5%) <strong>of</strong> the issued and outstanding stock <strong>of</strong> a publicly-traded corporation, or (iii) teaching,<br />
writing, lecturing, or providing expert witness testimony on Specialty topics; provided such activities shall not interfere or<br />
conflict with the per<strong>for</strong>mance <strong>of</strong> Physician's duties or provision <strong>of</strong> services under this Agreement. Physician shall not enter<br />
into any other physician employment contract or otherwise engage in the practice <strong>of</strong> medicine other than <strong>for</strong> the benefit <strong>of</strong><br />
Employer. All remuneration and accounts receivable arising from or related to Physician's provision <strong>of</strong> any medical services<br />
pursuant to this Agreement are the property <strong>of</strong> Employer, and Physician agrees to provide to Employer any such<br />
remuneration immediately after it is received by Physician. Physician agrees to take all reasonable actions requested by<br />
Employer to assist in the collection <strong>of</strong> accounts receivable <strong>for</strong> services provided by Physician. Unless otherwise agreed, all<br />
fees, honoraria, payments, stipends, or remuneration arising from or related to teaching assignments, lectures, speeches,<br />
publications, research, or expert witness testimony by Physician on or about matters related to the practice <strong>of</strong> the Specialty<br />
shall also be considered compensation or pr<strong>of</strong>essional service revenues to which Employer is entitled hereunder. The size or<br />
source <strong>of</strong> any item <strong>of</strong> income shall not affect the <strong>for</strong>egoing obligations.<br />
H. Workplace Rules. Physician shall observe and comply with the rules, regulations, policies and procedures established by<br />
Employer with respect to the per<strong>for</strong>mance <strong>of</strong> Physician's duties. In the event <strong>of</strong> any inconsistency between such rules,<br />
regulations, policies and procedures and this Agreement, the provisions <strong>of</strong> this Agreement shall prevail.<br />
I. Managed Care. Physician shall complete/submit all necessary credentialing documentation which will enable Physician to<br />
participate in all managed care arrangements made available by or through Employer at least 90 days prior to the Effective<br />
Date <strong>of</strong> this Agreement (or such other period as Employer may request) and within 15 days <strong>of</strong> all subsequent requests.<br />
Employer shall have the sole and exclusive right and authority to enter into contractual relationships with HMOs, IPAs,<br />
PPOs, PHOs, IDSs, employer groups, provider networks and other managed care organizations and third party payors.<br />
Physician shall not otherwise contract with any managed care organization or third party payor. In connection with such<br />
managed care arrangements, Employer shall negotiate such managed care arrangements with the proviso that Physician shall<br />
not be individually responsible to the managed care company <strong>for</strong> any withhold and that no hold harmless provision shall be<br />
applicable to, or en<strong>for</strong>ceable upon, Physician. Employer shall use reasonable ef<strong>for</strong>ts to ensure that any capitation rates,<br />
discounted fees or other risk based arrangements are consistent and competitive with the rates accepted by other physicians<br />
practicing in Physician's specialty in the County.<br />
J. Other Services. During the Agreement Term, Physician and Employer may mutually agree to Physician's rendering<br />
additional services. Such duties may include service on hospital staff committees, peer review organizations, or other<br />
committees <strong>of</strong> Employer, and serving on national and regional committees <strong>of</strong> Employer's Affiliates (which term as used in<br />
this Agreement shall include any person, corporation, partnership, general partner or other entity that directly, or indirectly<br />
through one or more intermediaries, controls or is controlled by or is under common control with Employer); provided that<br />
such duties shall not interfere with the pr<strong>of</strong>essional services provided by Physician on behalf <strong>of</strong> Employer pursuant to this<br />
Agreement.<br />
K. Additional Physicians. Employer and Physician agree as an essential term <strong>of</strong> this Agreement that it is the intent <strong>of</strong> the<br />
parties to develop a comprehensive medical practice. It is further understood that Employer intends to negotiate and enter into<br />
employment relationships with additional qualified physicians. Physician agrees to use his/her best ef<strong>for</strong>ts to <strong>for</strong>ge and<br />
establish an ongoing relationship and team approach with such additional physicians <strong>for</strong> the furnishing <strong>of</strong> physician and<br />
related services to patients.<br />
4. COMPENSATION<br />
A. Compensation. During the Agreement Term, Employer shall pay Physician compensation as set <strong>for</strong>th on the attached<br />
Exhibit(s) ("Physician Compensation").<br />
B. Leave. Physician shall be entitled to leave as set <strong>for</strong>th on the attached Exhibit(s) ("Physician Compensation").<br />
C. Travel Reimbursement. Employer, in its sole discretion, may reimburse Physician pursuant to Employer's policies <strong>for</strong><br />
reasonable travel expenses incurred by Physician in providing pr<strong>of</strong>essional services, on-call coverage, or any other services<br />
as Employer may approve. Any such reimbursement must be pre-approved by Employer and shall not be paid until Physician<br />
has submitted travel records or receipts to Employer <strong>for</strong> the period <strong>for</strong> which reimbursement is requested in a <strong>for</strong>m acceptable<br />
to Employer.<br />
D. Benefits. Employer shall provide Physician with medical benefits <strong>for</strong> Physician and Physician's beneficiaries that are<br />
comparable to the coverage available, from time to time, to the other employees <strong>of</strong> Employer. Employer will provide health,<br />
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life, disability, and dental benefits <strong>for</strong> Physician on similar terms as the other employees <strong>of</strong> Employer. Employer's life<br />
insurance company may require Physician to satisfactorily pass a physical examination in order to issue a life insurance<br />
policy to Physician. In addition, Employer may elect to obtain key-man life insurance coverage on Physician, and Physician<br />
hereby agrees to submit to any required physical there<strong>for</strong>e. If Physician Compensation is specified on Exhibit A or Exhibit B,<br />
the employee portion <strong>of</strong> the costs <strong>of</strong> all such benefits shall be deemed to be Physician Expenses (as defined on such exhibit).<br />
Physician shall be entitled to participate in Employer’s retirement and other benefit plans as <strong>of</strong>fered from time to time at a<br />
level commensurate wit the retirement benefits <strong>of</strong>fered to other employees <strong>of</strong> Employer.<br />
E. Income and Employment Taxes. Physician shall be an employee <strong>of</strong> Employer <strong>for</strong> all purposes. Employer shall withhold<br />
amounts from Physician Compensation in accordance with the requirements <strong>of</strong> applicable law <strong>for</strong> federal income tax, FICA,<br />
FUTA, and other employment or payroll tax purposes. It shall be Physician's responsibility to report and pay all federal taxes<br />
arising from Physician's receipt <strong>of</strong> compensation hereunder.<br />
5. INSURANCE<br />
A. Medical Liability Insurance. Employer agrees directly to pay the premium <strong>for</strong> Physician's pr<strong>of</strong>essional medical liability<br />
insurance during the Agreement Term, with minimum coverage <strong>of</strong> $1,000,000 per occurrence with a yearly maximum <strong>of</strong><br />
$3,000,000 in the aggregate (occurrence type policy). If Physician Compensation is specified on Exhibit A or Exhibit B, the<br />
cost <strong>of</strong> such insurance shall be treated as a Practice Operating Expense. Such pr<strong>of</strong>essional medical liability insurance<br />
coverage may be coverage established through an insurance affiliate <strong>of</strong> Employer.<br />
B. In exchange <strong>for</strong> Employer providing pr<strong>of</strong>essional medical liability insurance, Physician agrees to participate in the insurance<br />
carrier’s risk management and loss prevention programs, which may include successfully completing risk management<br />
continuing medical education courses or classes approved by malpractice insurance carrier during the Agreement Term.<br />
6. TERMINATION<br />
A. Termination by Employer "For Cause." The Agreement Term (including any renewal term) may be terminated prior to its<br />
expiration, at the election <strong>of</strong> Employer, under any <strong>of</strong> the following circumstances:<br />
i. Upon written notice to Physician, if Physician is in a material breach, default or violation <strong>of</strong> any provision <strong>of</strong> this<br />
Agreement and fails to cure such material breach, default or violation to the reasonable satisfaction <strong>of</strong> Employer within<br />
thirty (30) days after notice in writing by Employer to do so or within said thirty (30) days to commence such cure and<br />
thereafter diligently to prosecute such cure to completion;<br />
ii. Upon written notice to Physician, if Physician fails to meet utilization per<strong>for</strong>mance, efficiency, or quality standards<br />
established by Employer or fails to con<strong>for</strong>m and comply with Employer's pr<strong>of</strong>essional requirements concerning<br />
maintenance <strong>of</strong> medical records, and fails to cure such failure to the reasonable satisfaction <strong>of</strong> Employer within ten (10)<br />
days after notice in writing by Employer to do so or within such ten (10) days to commence such cure and, thereafter,<br />
diligently to prosecute such cure to completion. The opportunity to cure in this Section shall be available only once<br />
during the Agreement Term; or<br />
iii. Immediately upon written notice by Employer to Physician (or Physician's estate) <strong>for</strong> any <strong>of</strong> the following reasons:<br />
a. Physician's death or permanent disability. The term “disability” shall be defined as a physical or mental impairment<br />
that causes the Physician to be unable to per<strong>for</strong>m the essential functions <strong>of</strong> his or her job as set <strong>for</strong>th in this<br />
Agreement, with or without reasonable accommodation, after consideration <strong>of</strong> any job protection benefits af<strong>for</strong>ded<br />
by applicable state or federal law;<br />
b. Physician's license to practice medicine is suspended, subject to probation, revoked, or canceled or a restriction or<br />
limitation by any governmental authority having jurisdiction over Physician is placed or imposed upon him/her so<br />
that he/she cannot per<strong>for</strong>m the pr<strong>of</strong>essional services <strong>for</strong> which he/she was engaged hereunder;<br />
c. Physician is terminated or suspended from Medicare, Medicaid or other state or federal government healthcare<br />
entitlement program, or any successor program;<br />
d. Physician's failure to maintain unrestricted staff membership or privileges on the medical staff <strong>of</strong> any facility<br />
operated by Employer or its Affiliates;<br />
e. Physician's medical staff membership or clinical privileges at any acute care hospital or <strong>of</strong> any facility affiliated with<br />
Employer are suspended, curtailed, revoked, or terminated as a result <strong>of</strong> an adverse action taken by such hospital;<br />
f. Physician is convicted <strong>of</strong> a felony or a crime <strong>of</strong> moral turpitude;<br />
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g. Physician conducts him/herself in a manner that Employer determines in good faith to be unethical, unpr<strong>of</strong>essional,<br />
unlawful, or fraudulent, is detrimental to patient care, or impairs the reputation or operations <strong>of</strong> Employer;<br />
h. Upon repeated failure by Physician to meet utilization, per<strong>for</strong>mance, efficiency, or quality standards established by<br />
Employer after a one-time opportunity to cure as described in Paragraph 6.A.ii;<br />
i. Upon repeated failure by Physician to con<strong>for</strong>m and comply with Employer's pr<strong>of</strong>essional requirements concerning<br />
maintenance <strong>of</strong> medical records;<br />
j. Upon cancellation <strong>of</strong> Physician's coverage, or Physician's uninsurability, under the terms and conditions <strong>of</strong> the<br />
pr<strong>of</strong>essional liability insurance provided;<br />
k. Upon the determination by the Employer that Physician has reported to work with a measurable quantity in blood or<br />
urine <strong>of</strong> non-prescribed narcotics, hallucinogenic drugs, marijuana or other non-prescribed controlled substances or<br />
that the Physician is working while impaired by alcohol or prescribed narcotics while on the Employer’s property or<br />
during working hours.<br />
l. Physician breaches any material rules, policies and/or procedures <strong>of</strong> Employer;<br />
m. Upon the imposition <strong>of</strong> any restriction or limitation on Physician by any governmental or pr<strong>of</strong>essional authority<br />
having jurisdiction over Physician to such an extent that Physician cannot engage in the practice <strong>of</strong> medicine as<br />
required hereunder;<br />
n. Upon the determination <strong>of</strong> Employer in good faith that Physician is not providing adequate patient care or that the<br />
health, safety, or welfare <strong>of</strong> patients is jeopardized by continuing the employment <strong>of</strong> Physician;<br />
o. Physician's ability to prescribe controlled substances is suspended, subject to probation, revoked, or restricted in any<br />
way; or<br />
p. Any <strong>of</strong> the representations <strong>of</strong> Physician is false or incorrect when made or thereafter becomes false or incorrect, or<br />
any warranty <strong>of</strong> Physician is breached.<br />
B. Termination by Physician "For Cause." The Agreement Term (including any renewal term) may be terminated prior to its<br />
expiration, at the election <strong>of</strong> Physician, under any <strong>of</strong> the following circumstances:<br />
i. Upon written notice to Employer, if Employer is in material breach, default or violation <strong>of</strong> any provision <strong>of</strong> this<br />
Agreement and fails to cure such material breach, default or violation within thirty (30) days after notice in writing by<br />
Physician to do so or within said thirty (30) days to commence such cure and thereafter diligently to prosecute such cure<br />
to completion; or<br />
ii. Immediately upon written notice by Physician to Employer <strong>for</strong> any <strong>of</strong> the following reasons:<br />
a. bankruptcy or receivership <strong>of</strong> Employer; or<br />
b. revocation or suspension <strong>of</strong> Employer from the Medicare or Medicaid Programs or any successor program.<br />
C. Termination by Employer or Physician "Without Cause." Employer or Physician may terminate this Agreement<br />
hereunder, without cause, at any time upon 90 days prior written notice to the other party provided, however, that, at<br />
Employer's sole and exclusive option, Employer may terminate this Agreement immediately and elect to "pay-out" the<br />
<strong>for</strong>egoing ninety-day notice period (subject to applicable payroll withholdings) and <strong>of</strong>fset therefrom any amounts owed by<br />
Physician to Employer.<br />
D. Obligations After Termination. Upon termination <strong>of</strong> this Agreement <strong>for</strong> any reason, Physician Compensation shall<br />
immediately cease and Physician (or Physician's estate) shall be entitled to receive only those amounts earned or accrued on<br />
services provided by Physician up to the date <strong>of</strong> termination. Physician's rights to any on-going or continuing benefits shall<br />
be determined in accordance with the terms <strong>of</strong> the applicable benefit plan <strong>of</strong> Employer. Termination <strong>of</strong> this Agreement shall<br />
not release or discharge Employer from any obligation, debt or liability incurred prior to the date <strong>of</strong> termination <strong>of</strong> this<br />
Agreement. Following any notice <strong>of</strong> termination <strong>of</strong> employment hereunder, whether given by Employer or Physician,<br />
Physician shall fully cooperate with Employer in all matters relating to the winding down <strong>of</strong> his or her pending work on<br />
behalf <strong>of</strong> Employer and the orderly transfer <strong>of</strong> such work to the other pr<strong>of</strong>essional employees <strong>of</strong> Employer, if applicable. On<br />
or after the tendering <strong>of</strong> notice <strong>of</strong> termination hereunder and during any notice period, Employer shall be entitled to such fulltime<br />
or part-time services <strong>of</strong> Physician as Employer may reasonably require, and Employer shall specifically have the right to<br />
terminate, in whole or in part, the active services <strong>of</strong> Physician at the time such notice is given and to pay to Physician the<br />
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compensation due to him or her <strong>for</strong> the duration <strong>of</strong> the notice period. The right <strong>of</strong> the parties to terminate this Agreement<br />
shall be without prejudice to any other right or remedy as may be available to a party at law or in equity upon the breach <strong>of</strong><br />
this Agreement. Notwithstanding the <strong>for</strong>egoing, neither party shall be liable to the other <strong>for</strong> any indirect, incidental, or<br />
consequential damages or losses, including lost pr<strong>of</strong>its, arising out <strong>of</strong> the breach <strong>of</strong> this Agreement by the other party, except<br />
as provided in the following sentence or as specified on any exhibit or addendum hereto. If Physician provides less than the<br />
required notice prior to terminating this Agreement, Physician shall reimburse Employer <strong>for</strong> its "Excess Cost" during the<br />
"Shortage Period" within 10 business days after Employer's written demand there<strong>for</strong>e. For purposes <strong>of</strong> this Agreement, (i)<br />
the term "Excess Cost" shall mean the amount expended by Employer in securing coverage <strong>for</strong> Physician during the Shortage<br />
Period in excess <strong>of</strong> the amount that would have been paid to Physician in accordance with this Agreement during such<br />
period, and (ii) the term "Shortage Period" shall mean the difference between the actual number <strong>of</strong> days notice given by<br />
Physician and the number <strong>of</strong> days <strong>of</strong> notice required to be given hereunder.<br />
E. Other Requirements Upon Termination. Upon termination <strong>of</strong> this Agreement <strong>for</strong> any reason: (i) Physician's participation<br />
in any <strong>of</strong> Employer's fringe benefit plans shall immediately cease (subject to any post termination benefits, if any, expressly<br />
stated in the then current plans <strong>for</strong> such benefits); and (ii) the provisions <strong>of</strong> Sections 8, 9, and 10 here<strong>of</strong> shall remain in full<br />
<strong>for</strong>ce and effect, except as otherwise specifically provided herein.<br />
7. COVENANTS, REPRESENTATIONS, AND WARRANTIES<br />
A. Physician covenants, represents, or warrants at all times during the Agreement Term (including any renewal term) that:<br />
i. Physician is not in breach <strong>of</strong>, and will not during the Agreement Term be in breach <strong>of</strong>, any other contract, obligation, or<br />
covenant that could affect his or her ability to per<strong>for</strong>m hereunder and, as a result <strong>of</strong> entering into this Agreement, will not<br />
breach any such contract, obligation, or covenant.<br />
ii. Physician is duly licensed and registered and in good standing under the laws <strong>of</strong> the state in which the Practice is located<br />
to engage in the practice <strong>of</strong> medicine and to prescribe and administer controlled substances, and that such license and<br />
registration have not been suspended, revoked or restricted in any manner. As a condition <strong>of</strong> employment hereunder,<br />
Physician, at his or her sole expense unless specifically provided <strong>for</strong> in this Agreement, shall secure and maintain at all<br />
times during the Agreement Term an unrestricted, non-probational license to practice medicine in the state in which the<br />
Practice is located. Physician shall report, in writing, any probation, suspension, restriction, limitation, or revocation on<br />
any license related to the practice <strong>of</strong> medicine on the day <strong>of</strong> such probation, suspension, restriction, limitation, or<br />
revocation.<br />
iii. Physician shall maintain in good standing unrestricted staff membership and privileges on the medical staff <strong>of</strong> a hospital<br />
facility owned by Employer or its Affiliates.<br />
iv. Physician has current controlled substances certifications and registrations issued by the state in which the Practice is<br />
located and the United States Drug En<strong>for</strong>cement Administration, which certifications and registrations have not been<br />
surrendered, suspended, revoked, expired or restricted in any manner. As a condition <strong>of</strong> employment hereunder,<br />
Physician shall, at his or her sole expense unless specifically provided <strong>for</strong> in this Agreement, secure and maintain at all<br />
times during the Agreement Term unrestricted, non-probational certifications and registrations with the state in which the<br />
Practice is located and the United States Drug En<strong>for</strong>cement Administration to administer and prescribe controlled<br />
substances. Physician shall report, in writing, any probation, suspension, restriction, limitation, or revocation on any<br />
certification or registration related to the practice <strong>of</strong> medicine on the day <strong>of</strong> such probation, suspension, restriction,<br />
limitation, or revocation.<br />
v. Physician has disclosed and will disclose to Employer the following matters, whether occurring at any time during the<br />
past five (5) years prior to the date <strong>of</strong> this Agreement or at any time during the Agreement Term:<br />
a. any actual or threatened malpractice suit, any actual or constructive known claim (whether or not filed in court),<br />
settlement, settlement allocation, judgment, verdict or decree against Physician;<br />
b. any actual or threatened disciplinary, peer review or pr<strong>of</strong>essional review investigation, proceeding or action<br />
instituted against Physician by any licensure board, hospital, medical school, health care facility or entity,<br />
pr<strong>of</strong>essional society or association, third party payor, peer review or pr<strong>of</strong>essional review committee or body, or<br />
governmental agency;<br />
c. any criminal complaint, indictment or criminal proceeding in which Physician is named as a defendant;<br />
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d. any actual or threatened investigation or proceeding, whether administrative, civil or criminal, relating to an<br />
allegation against Physician <strong>of</strong> filing false health care claims, violating anti-kickback laws, violating fee-splitting<br />
laws, or engaging in billing improprieties;<br />
e. any organic or mental illness or condition that impairs or is likely to impair Physician's ability to practice medicine;<br />
f. any dependency on, or habitual use or abuse <strong>of</strong>, alcohol or controlled substances, or any participation in any alcohol<br />
or controlled substance detoxification, treatment, recovery, rehabilitation, counseling, screening or monitoring<br />
program;<br />
g. any actual or threatened allegation, or any investigation or proceeding based on any allegation, against Physician <strong>for</strong><br />
violating pr<strong>of</strong>essional ethics or standards, or engaging in illegal, immoral or other misconduct (<strong>of</strong> any nature or<br />
degree); and<br />
h. any denial or withdrawal <strong>of</strong> an application in any state <strong>for</strong> licensure as a physician, <strong>for</strong> medical staff privileges at<br />
any hospital or other health care entity, <strong>for</strong> board certification or recertification, <strong>for</strong> state or federal controlled<br />
substances registration, or <strong>for</strong> malpractice insurance.<br />
i. any denial <strong>of</strong> appointment or reappointment <strong>of</strong> membership on the medical staff <strong>of</strong> any hospital; any suspension,<br />
curtailment, revocation, or termination <strong>of</strong> any hospital medical staff membership or clinical privileges; or any<br />
voluntary relinquishment <strong>of</strong> such staff membership or clinical privileges by Physician while a charge <strong>of</strong> substandard<br />
quality <strong>of</strong> patient care was pending against him/her (regardless <strong>of</strong> the veracity <strong>of</strong> the charge).<br />
vi. Physician is board certified or board eligible in the Specialty by the applicable board <strong>of</strong> medical specialization.<br />
vii. Physician shall at all times render services to patients in a competent, pr<strong>of</strong>essional and ethical manner, in accordance<br />
with prevailing standards <strong>of</strong> medical practice in the relevant community, per<strong>for</strong>m pr<strong>of</strong>essional and supervisory services<br />
in accordance with recognized standards <strong>of</strong> the medical pr<strong>of</strong>ession, and act in a manner consistent with the Principles <strong>of</strong><br />
Medical Ethics <strong>of</strong> the American Medical Association and all applicable statutes, regulations, rules, orders and directives<br />
<strong>of</strong> any and all applicable governmental and regulatory bodies having competent jurisdiction.<br />
viii. In connection with the provision <strong>of</strong> pr<strong>of</strong>essional services to patients <strong>of</strong> Employer, Physician shall use the equipment,<br />
instruments, pharmaceuticals and supplies furnished by or on behalf <strong>of</strong> Employer <strong>for</strong> the purposes <strong>for</strong> which they are<br />
intended and in a manner consistent with sound medical practice.<br />
ix. Physician shall participate in the Medicare and Medicaid Programs, workers compensation, other federal and state<br />
reimbursement programs, and the payment plan <strong>of</strong> any commercial insurer, health maintenance organization, preferred<br />
provider organization, accountable health plan, or other health benefit program.<br />
x. Physician shall keep and maintain (or cause to be kept and maintained) appropriate records, consistent with prevailing<br />
standards <strong>of</strong> medical practice in Physician's relevant community, relating to all pr<strong>of</strong>essional services rendered by him<br />
under this Agreement and shall prepare and attend to, in connection with such services, all reports, claims, and<br />
correspondence necessary or appropriate in the circumstances, as determined mutually by Employer and Physician, all <strong>of</strong><br />
which records, reports, claims, and correspondence shall belong to Employer.<br />
xi. Physician covenants not to use, or permit any other personnel under the supervision <strong>of</strong> Physician to use, any part <strong>of</strong> the<br />
premises <strong>of</strong> Employer <strong>for</strong> any purpose other than the per<strong>for</strong>mance <strong>of</strong> services hereunder.<br />
xii. Physician (A) is not currently excluded, debarred, or otherwise ineligible to participate in the Federal health care<br />
programs as defined in 42 U.S.C. § 1320a-7b(f) (the "Federal health care programs"); (B) is not convicted <strong>of</strong> a criminal<br />
<strong>of</strong>fense related to the provision <strong>of</strong> health care items or services but has not yet been excluded, debarred, or otherwise<br />
declared ineligible to participate in the Federal health care programs, and (C) is not under investigation or otherwise<br />
aware <strong>of</strong> any circumstances which may result in Physician's being excluded from participation in the Federal health care<br />
programs.<br />
The representations, warranties, and covenants contained in this Section shall be ongoing representations, warranties, and<br />
covenants during the Agreement Term, and Physician shall immediately notify Employer <strong>of</strong> any change in the status <strong>of</strong> the<br />
covenant, representation, or warranty set <strong>for</strong>th in this Section. Any breach <strong>of</strong> this Section by Physician shall give Employer<br />
the right to terminate this Agreement immediately <strong>for</strong> cause.<br />
8. DISCLOSURE OF INFORMATION<br />
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A. Custody <strong>of</strong> Medical Records. Physician understands and agrees that during the Agreement Term and therafter all medical<br />
records, case records, case histories, x ray files or personal or regular files concerning patients <strong>of</strong> Employer or any <strong>of</strong> it Affiliates,<br />
or patients consulted, interviewed or treated and cared <strong>for</strong> by Physician, shall belong to and remain the property <strong>of</strong> Employer.<br />
Upon termination <strong>of</strong> this agreement, Physician shall not be entitled to keep original records or preserve records <strong>of</strong> Employer or<br />
any <strong>of</strong> its Affiliates as to any patient unless the patient shall specifically request a different disposition <strong>of</strong> his or her records or<br />
copies there<strong>of</strong>, and in no event shall Physician be entitled to the records or copies there<strong>of</strong>, <strong>of</strong> patients not treated by Physician.<br />
Employer agrees at all times, both during and after termination <strong>of</strong> this Agreement, to maintain and preserve such records in a<br />
manner consistent and in compliance with all applicable laws and regulations. If Employer provides Physician with original<br />
patient records pursuant to the terms here<strong>of</strong>, Physician shall retain all <strong>of</strong> such records and upon Employer’s request, shall make<br />
such originals available to Employer. If any medical malpractice or other claim, aut\dit or business need <strong>of</strong> Physician arises and<br />
involves records which are retained by Employer pursuant to the terms here<strong>of</strong>, Employer agrees to make such original medical<br />
records available to Physician, or Physician’s designated counsel or representative <strong>for</strong> inspection and copying, during regular<br />
business hours, in accordance with applicable law.<br />
B. Disclosure <strong>of</strong> In<strong>for</strong>mation. Physician recognizes and acknowledges that all records, files, reports, protocols, policies,<br />
manuals, databases, processes, procedures, computer systems, materials and other documents pertaining to services rendered<br />
by Physician hereunder, or to the operations <strong>of</strong> Employer, belong to and shall remain the property <strong>of</strong> Employer and constitute<br />
proprietary in<strong>for</strong>mation and trade secrets <strong>of</strong> Employer. Physician recognizes and acknowledges that the terms <strong>of</strong> this<br />
Agreement, as well as Employer's proprietary in<strong>for</strong>mation and trade secrets as they may exist from time to time, are valuable,<br />
special, and unique assets <strong>of</strong> Employer's business. Physician shall not, during or after the Agreement Term, disclose such<br />
proprietary in<strong>for</strong>mation <strong>of</strong> Employer or trade secrets <strong>of</strong> Employer to any other firm, person, corporation, association or other<br />
entity <strong>for</strong> any reason or purpose whatsoever, or use such in<strong>for</strong>mation <strong>for</strong> Physician's own benefit, without the prior written<br />
consent <strong>of</strong> Employer, unless otherwise required to disclose such in<strong>for</strong>mation in accordance with appropriate judicial process.<br />
C. Injunction. Physician acknowledges that the confidentiality restrictions contained in this Section are a reasonable and<br />
necessary protection <strong>of</strong> the legitimate trade secrets and business interests <strong>of</strong> Employer. In the event <strong>of</strong> any violation <strong>of</strong> these<br />
restrictions, Employer shall be entitled to preliminary and permanent injunctive relief, in addition to any other remedy, and<br />
shall be entitled to be reimbursed by Physician <strong>for</strong> any attorneys' fees and costs, at all pre trial and appellate levels, incurred<br />
as a result there<strong>of</strong>. Nothing herein contained shall be construed as prohibiting Employer from pursuing any other legal or<br />
equitable remedies available to Employer due to a violation <strong>of</strong> the restrictions set <strong>for</strong>th in this Section, including monetary<br />
damages and relief.<br />
9. COVENANT NOT TO COMPETE<br />
A. Acknowledgments by Physician. Physician recognizes and acknowledges the following:<br />
i. Employer's decision to enter into this Agreement is induced primarily because <strong>of</strong> the covenants and assurances made by<br />
Physician in this Agreement;<br />
ii. Employer has devoted a considerable amount <strong>of</strong> time, ef<strong>for</strong>t, and expense to establish Employer's medical practice,<br />
patient base, and service agreements;<br />
iii. Employer's goodwill, medical practice, patient base, and service agreements are valuable assets <strong>of</strong> Employer, and, as a<br />
result <strong>of</strong> Physician's providing services under this Agreement, Physician will have access to Employer's proprietary and<br />
confidential in<strong>for</strong>mation, patient base, and representatives <strong>of</strong> entities with which Employer contracts;<br />
iv. During the Agreement Term, Physician will not, directly or indirectly, participate in the unauthorized use, disclosure, or<br />
conversion <strong>of</strong> any confidential in<strong>for</strong>mation or goodwill <strong>of</strong> Employer and will not use either <strong>for</strong> his or her sole benefit or<br />
<strong>for</strong> the benefit <strong>of</strong> any individual or entity other than Employer, or in any other way that harms Employer or diminishes<br />
the confidential in<strong>for</strong>mation or goodwill to Employer;<br />
v. Irrevocable harm and damage will be done to Employer if Physician competes with Employer, solicits Employer's<br />
patients to become patients <strong>of</strong> Physician or others, or solicits representatives <strong>of</strong> entities with which Employer contracts to<br />
contract with Physician or with another organization other than Employer;<br />
vi. Physician's covenant not to compete and covenants not to solicit Employer's patients or contracts in this Section are<br />
necessary (i) to ensure the continuation <strong>of</strong> the business <strong>of</strong> Employer and the good reputation and goodwill <strong>of</strong> Employer,<br />
and (ii) to facilitate the en<strong>for</strong>cement <strong>of</strong> Physician's promises to ensure the confidentiality <strong>of</strong> in<strong>for</strong>mation provided to<br />
Physician and to promote the goodwill <strong>of</strong> Employer;<br />
vii. To the extent Physician's covenant not to compete and covenants not to solicit Employer's patients or contracts in this<br />
Section contain limitations as to time, geographical area, or scope <strong>of</strong> activity to be restrained, those limitations are<br />
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easonable and do not impose a greater restraint than is necessary to protect the goodwill or other business interests <strong>of</strong><br />
Employer; and<br />
viii. Although Physician is a medical doctor and Physician's livelihood depends on the pr<strong>of</strong>essional experience and skill<br />
developed during Physician's pr<strong>of</strong>essional practice, Physician's covenant not to compete and covenants not to solicit<br />
Employer's patients or contracts in this Section will not deprive Physician <strong>of</strong> the ability to earn a livelihood as a medical<br />
doctor and Employer has no intent to do so.<br />
B. Restrictive Covenant. Physician agrees and acknowledges that the covenants contained in this Section are reasonable and<br />
necessary <strong>for</strong> the protection <strong>of</strong> the interests covered in the fully en<strong>for</strong>ceable and ancillary agreements contained in this<br />
Agreement, including, without limitation, the covenants contained in this Section. With the exception <strong>of</strong> the services and<br />
duties that Physician per<strong>for</strong>ms <strong>for</strong> Employer or on Employer's behalf pursuant to the terms <strong>of</strong> this Agreement, Physician<br />
agrees that during the Agreement Term and <strong>for</strong> a period <strong>of</strong> _______________(___) year(s) after the termination <strong>of</strong> the<br />
Agreement Term <strong>for</strong> any reason whatsoever, Physician shall not: i) Within a ________________ (____) mile radius <strong>of</strong> the<br />
Practice, as determined at the time <strong>of</strong> termination, (the "Restricted Territory") (a) engage in any medical practice, engage in<br />
any business, or per<strong>for</strong>m any service, directly or indirectly, in competition with the medical services <strong>of</strong> Employer, (b) have<br />
any interest, whether as a proprietor, partner, employee, shareholder, principal, agent, consultant, director, <strong>of</strong>ficer, or in any<br />
other capacity or manner whatsoever, in any enterprise that shall so engage in medical services, or (c) have any financial<br />
interest in any inpatient or outpatient healthcare facility (other than a financial interest <strong>of</strong> less than five percent (5%) <strong>of</strong> the<br />
issued and outstanding stock <strong>of</strong> a publicly-traded corporation or a financial interest in a facility owned or operated by an<br />
Affiliate <strong>of</strong> Employer), in each case, that is located in, provides services in, or does any business whatsoever within, the<br />
Restricted Territory; or ii) Solicit, recruit or hire any person who is or was an employee <strong>of</strong> Employer or any <strong>of</strong> its Affiliates,<br />
whether <strong>for</strong> Physician's benefit or <strong>for</strong> others with whom Physician may become associated.<br />
C. Nonsolicitation <strong>of</strong> Employees. Within the Restricted Territory, Physician further agrees that <strong>for</strong> a period <strong>of</strong> time equal to<br />
one (1) year after termination <strong>of</strong> the Agreement Term <strong>for</strong> any reason whatsoever (including expiration), Physician shall not,<br />
within the Restricted Territory, solicit the services <strong>of</strong> any employee, consultant, or provider which renders services to, or <strong>for</strong><br />
the benefit <strong>of</strong>, Employer or any <strong>of</strong> its Affiliates <strong>for</strong> Physician's use or benefit or <strong>for</strong> any other person's or company's use or<br />
benefit, or induce or help to induce any employee, consultant or provider that renders services to, or <strong>for</strong> the benefit <strong>of</strong>,<br />
Employer or any <strong>of</strong> its Affiliates to leave <strong>for</strong> other employment, without Employer's prior written consent.<br />
D. Nonsolicitation <strong>of</strong> Business. Within the Restricted Territory, Physician further agrees that <strong>for</strong> a period <strong>of</strong> time equal to one<br />
(1) year(s) after termination <strong>of</strong> the Agreement Term <strong>for</strong> any reason whatsoever (including expiration), Physician shall not,<br />
within the Restricted Territory, solicit, serve or accept any business from patients, insurance companies, managed care plans,<br />
employers or other customers <strong>of</strong> the business conducted by Employer or its Affiliates, <strong>for</strong> services competitive with those <strong>of</strong><br />
Employer and the Practice or request, induce or advise patients, insurance companies, managed care plans, employers or<br />
other customers <strong>of</strong> the business as conducted by Employer to withdraw, curtail or cancel their business with Employer or<br />
assist, induce, help or join any other person or company in doing any <strong>of</strong> the above activities;<br />
E. No Running <strong>of</strong> Covenant During Breach. With respect to any restrictive covenant which applies after termination <strong>of</strong> this<br />
Agreement, if Physician violates such restrictive covenant and Employer brings legal action <strong>for</strong> injunctive or other relief,<br />
Employer shall not, as a result <strong>of</strong> the time involved in obtaining the relief, be deprived <strong>of</strong> the benefit <strong>of</strong> the full period <strong>of</strong> such<br />
restrictive covenant. Accordingly, after the termination <strong>of</strong> the Agreement Term <strong>for</strong> any reason, <strong>for</strong> any time period that<br />
Physician is in violation <strong>of</strong> the restrictive covenants set <strong>for</strong>th in this Section, such time period shall not be included in<br />
calculating any such restrictive covenant time period described in this Section.<br />
F. Buy Out and Alternative Application <strong>of</strong> Covenants. Provided that Physician is not terminated by Employer <strong>for</strong> cause<br />
pursuant to Paragraphs 6.A.i, 6.A.ii, or 6.A.iii ("Termination") here<strong>of</strong>, in lieu <strong>of</strong> complying with the provisions <strong>of</strong> the<br />
Restrictive Covenant Section here<strong>of</strong>, Physician may pay Employer the Buy-out Amount. The "Buy-out Amount" shall be the<br />
greater <strong>of</strong> (a) $_____________ (equivalent to Physician compensation during the first year <strong>of</strong> the Agreement Term), and (b)<br />
the fair market value <strong>of</strong> such provisions at the time <strong>of</strong> expiration or earlier termination <strong>of</strong> this Agreement as determined by an<br />
independent, third-party appraiser to be retained by Employer. In the event Physician chooses to pay the Buy-out Amount to<br />
Employer, such amount shall be paid to Employer in full, in cash or other immediately-available funds, within five (5)<br />
business days <strong>of</strong> Physician's provision <strong>of</strong> written notice to Employer <strong>of</strong> his/her election to pay the Buy-out Amount.<br />
Alternatively, and provided that Physician is not terminated by Employer <strong>for</strong> cause pursuant to Paragraphs 6.A.i, 6.A.ii, or<br />
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6.A.iii here<strong>of</strong>, Employer agrees that the restrictive covenants <strong>of</strong> the Restrictive Covenant Section here<strong>of</strong> shall be null and<br />
void and <strong>of</strong> no further <strong>for</strong>ce or effect in the event any one <strong>of</strong> the following occurs: (i) Employer discontinues providing the<br />
Specialty in the community served by the Practice; (ii) Physician enters the private practice <strong>of</strong> medicine either as a solo<br />
practitioner practice or in a group practice, provided that such practice does not affiliate with any entity that competes,<br />
directly or indirectly, with the business <strong>of</strong> Employer or any <strong>of</strong> its Affiliates, and provided that Physician remains on the<br />
medical staff <strong>of</strong> an acute care hospital located in the community served by the Practice (<strong>for</strong> purposes <strong>of</strong> this subsection (ii),<br />
joining the medical staff <strong>of</strong> an acute care hospital shall not be deemed as "affiliating" with such an entity); or (iii) Physician<br />
terminates this Agreement with cause pursuant to Paragraphs 6.B.i or 6.B.ii here<strong>of</strong>; provided, however, that the <strong>for</strong>bearance<br />
specified in Subsection (ii) shall be available only at Employer's sole and absolute discretion. Notwithstanding the generality<br />
<strong>of</strong> the <strong>for</strong>egoing, neither the payment by Physician <strong>of</strong> the Buy-out Amount nor the satisfaction by Physician <strong>of</strong> one <strong>of</strong> the<br />
post-termination conditions specified in this Section shall relieve Physician from any other obligation arising under this<br />
Agreement.<br />
G. Continuity <strong>of</strong> Care. Notwithstanding any other provision <strong>of</strong> this Agreement to the contrary, if a patient with whom<br />
Physician maintains a physician-patient relationship has an acute illness at the time <strong>of</strong> termination <strong>of</strong> this Agreement, Physician<br />
shall not be prevented from providing continuing care and treatment to that specific patient during the course <strong>of</strong> such patient's<br />
acute illness. In such situations, however, Physician shall terminate his physician-patient relationship with such patient at the<br />
conclusion <strong>of</strong> the patient's acute illness. For purposes <strong>of</strong> this section, "acute illness" shall mean an affliction, injury, or illness<br />
that requires hospitalization or constant medical supervision and is expected to resolve within two weeks <strong>of</strong> the onset <strong>of</strong> signs or<br />
symptoms.<br />
H. Ancillary Agreement. The provisions and covenants <strong>of</strong> this Section shall survive termination <strong>of</strong> this Agreement and shall be<br />
construed as an agreement ancillary to the other provisions <strong>of</strong> this Agreement.<br />
I. En<strong>for</strong>cement. The existence <strong>of</strong> any claim or cause <strong>of</strong> action <strong>of</strong> Physician against Employer, whether predicated on this<br />
Agreement or otherwise, shall not constitute a defense to the en<strong>for</strong>cement by Employer <strong>of</strong> the provisions and covenants <strong>of</strong><br />
this Section. In the event <strong>of</strong> breach or threatened breach by Physician <strong>of</strong> any provision <strong>of</strong> this Section, Employer shall be<br />
entitled to (i) injunctive relief by temporary restraining order, temporary injunction, and/or permanent injunction, such relief<br />
to be without the necessity <strong>of</strong> posting a bond; however, Physician agrees that in the event a bond is required if an injunction<br />
is sought by Employer, the agreed amount <strong>of</strong> the bond shall be no more than one thousand dollars ($1,000.00), (ii) recovery<br />
<strong>of</strong> all attorneys' fees and costs incurred by Employer in obtaining such relief, and (iii) any other legal and equitable relief to<br />
which Employer may be entitled, including, without limitation, any and all monetary damages that Employer may incur as a<br />
result <strong>of</strong> such breach or threatened breach. Employer may pursue any remedy available, including declaratory relief,<br />
concurrently or consecutively in any order as to any breach, violation, or threatened breach or violation, and the pursuit <strong>of</strong><br />
one such remedy at any time will not be deemed an election <strong>of</strong> remedies or waiver <strong>of</strong> the right to pursue any other remedy. If<br />
any provision contained in this Agreement is determined to be void, illegal, or unen<strong>for</strong>ceable, in whole or in part, then the<br />
other provisions contained herein shall remain in full <strong>for</strong>ce and effect as if the provision that was determined to be void,<br />
illegal, or unen<strong>for</strong>ceable had not been contained herein. If the restrictions in this Section are deemed unen<strong>for</strong>ceable as<br />
written, the parties expressly authorize the court or arbitrator to revise, delete, or add to the restrictions contained in this<br />
Section to the extent necessary to en<strong>for</strong>ce the intent <strong>of</strong> the parties and to protect Employer's goodwill, confidential<br />
in<strong>for</strong>mation, and other business interests.<br />
10. FEES<br />
I. Early Resolution Conference. This Agreement is understood to be clear and en<strong>for</strong>ceable as written and is executed by both<br />
parties on that basis. Should Physician challenge any provision, however, as unclear, unen<strong>for</strong>ceable, or inapplicable to any<br />
competitive activity that Physician intends to engage in, Physician first shall notify Employer in writing and meet with an<br />
Employer representative and a neutral mediator (if Physician elects to retain one at his or her expense) to discuss resolution<br />
<strong>of</strong> any disputes between the parties. Physician shall provide this notification at least fourteen (14) days be<strong>for</strong>e Physician<br />
engages in any activity on behalf <strong>of</strong> him/herself or a competing entity or engages in other activity that could <strong>for</strong>eseeably fall<br />
within a questioned restriction. The failure to comply with this requirement shall waive Physician's right to challenge the<br />
reasonable scope, clarity, applicability, or en<strong>for</strong>ceability <strong>of</strong> this Agreement and its restrictions at a later time. All rights <strong>of</strong><br />
both parties will be preserved if the early resolution conference requirement is complied with even if no agreement is<br />
reached in such conference.<br />
A. Fees <strong>for</strong> Services. Except as otherwise may be provided in Section 3.G, all fees, compensation, monies, and other things <strong>of</strong><br />
value received or realized as a result <strong>of</strong> the rendering <strong>of</strong> medical services by Physician, pursuant to this Agreement, shall<br />
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elong to and be paid and delivered to Employer. Remuneration received by Physician from business activities unrelated to<br />
the practice <strong>of</strong> medicine, which do not interfere or conflict with the terms <strong>of</strong> this Agreement, or with the applicable<br />
provisions <strong>of</strong> this Agreement, may be retained by Physician, so long as such activity is approved in advance by Employer,<br />
and is not per<strong>for</strong>med in the capacity <strong>of</strong> serving as an employee <strong>of</strong> Employer.<br />
B. Setting <strong>of</strong> Fees. Employer shall have exclusive authority to determine the fees, or a procedure <strong>for</strong> establishing the fees, to be<br />
charged patients, even though such patients may be treated by Physician in the course <strong>of</strong> Physician's employment by<br />
Employer. In all cases, such charges shall be comparable with the usual and customary charges <strong>for</strong> similar services in the<br />
local community. Employer shall determine whether and upon what terms Physician and Employer shall participate in any<br />
program or contract, whether government-sponsored or privately-sponsored.<br />
C. Power <strong>of</strong> Attorney. Physician does hereby appoint Employer as Physician's attorney-in-fact to execute, deliver or endorse<br />
checks, applications <strong>for</strong> payment, insurance claim <strong>for</strong>ms or other instruments required or convenient, as determined by<br />
Employer in its sole discretion, to fully collect, secure or realize all sums lawfully due to Employer, <strong>for</strong> services rendered by<br />
Physician under this Agreement during the Agreement Term. The power <strong>of</strong> attorney is coupled with an interest, is irrevocable<br />
and shall survive expiration or termination <strong>of</strong> this Agreement.<br />
D. Billing and Collection. Physician agrees that, during the Agreement Term, Physician shall not bill to or collect from any<br />
patient or third party payor any amount <strong>for</strong> services rendered hereunder. Physician hereby irrevocably assigns and grants to<br />
Employer the right to bill and collect from patients or third party payors <strong>for</strong> all services rendered by Physician hereunder,<br />
regardless <strong>of</strong> the location where any such services may be rendered by Physician. Physician agrees to execute any and all<br />
documents deemed necessary or desirable by Employer to carry out the provision <strong>of</strong> this Section. Unless otherwise agreed by<br />
Physician, all billing and collection activities shall be conducted as part <strong>of</strong> the regular business operations <strong>of</strong> the Practice.<br />
Such procedures shall include, but not be limited to, sending bills, filing insurance claims, and making phone calls. Physician<br />
shall complete billing and charge in<strong>for</strong>mation on all patients, even if Physician desires to waive or discount charges. If<br />
Physician wishes to waive or discount any charges on any patient <strong>for</strong> Physician's services, Physician shall not do so without<br />
the consent <strong>of</strong> Employer unless such waiver or discount is within Employer's established policy guidelines.<br />
E. Accounting Reports and Review. Employer shall have available <strong>for</strong> Physician lists <strong>of</strong> fees charged <strong>for</strong> particular services<br />
<strong>for</strong> particular payors and shall update these lists on a regular basis as fees and payors change. Employer also shall provide to<br />
Physician, on a monthly basis, production reports which list the billings attributable to services provided by Physician and in<br />
the Practice, the collections in connection with the services provided by Physician and the Practice, and accounts receivable<br />
in connection with provision <strong>of</strong> said services, such reports to be provided within thirty (30) days after the applicable month to<br />
which such reports relate.<br />
11. LIMITATIONS OF AUTHORITY<br />
A. Physician agrees not to enter into any transactions on Employer's behalf without the express written consent <strong>of</strong> Employer,<br />
including, but not limited to, the following actions:<br />
i. Pledge the credit <strong>of</strong> Employer or any <strong>of</strong> its other employees;<br />
ii. Bind Employer under any contract, agreement, note, mortgage or other agreement;<br />
iii. Bind, release, or discharge any debt due Employer; or<br />
iv. Sell, mortgage, transfer or otherwise dispose <strong>of</strong> any assets <strong>of</strong> Employer.<br />
B. Physician shall hold Employer harmless from any loss attributable to a violation <strong>of</strong> this covenant. Notwithstanding anything<br />
to the contrary in this Section, Physician shall advise and assist Employer in securing and retaining contracts in the name and<br />
<strong>for</strong> the account <strong>of</strong> Employer with such individuals or entities necessary <strong>for</strong> the proper and efficient functioning <strong>of</strong> Employer.<br />
12. NOTICE<br />
A. All notices required or permitted to be given under the terms <strong>of</strong> this Agreement shall be in writing, and shall be effective<br />
upon delivery if delivered to the addressee in person, effective three (3) business days after mailing if mailed by certified<br />
mail, postage prepared, return receipt requested, or effective the next business day if delivered by overnight courier with<br />
charges prepaid, as follows:<br />
If to Employer:<br />
H2U Wellness Centers, LLC<br />
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Attn: Brian Jones, Vice President<br />
3322 <strong>West</strong> End Avenue, Suite 400<br />
Nashville, Tennessee 37203<br />
With Copy to:<br />
One Park Plaza<br />
P O Box 550<br />
Nashville, TN 372<strong>02</strong>-0550<br />
Attn: General Counsel<br />
If to Physician:<br />
Name___________<br />
Address_________<br />
or to such other address as either party shall have designated <strong>for</strong> notices to be given to him or it in accordance with this<br />
Section.<br />
13. MISCELLANEOUS<br />
A. Recitals. The recitals are true and correct and are incorporated herein in their entirety.<br />
B. Severability. If any provision <strong>of</strong> this Agreement shall be held invalid, illegal, or unen<strong>for</strong>ceable <strong>for</strong> any reason or in any<br />
respect, such invalidity, illegality, or unen<strong>for</strong>ceability shall not affect any other provision here<strong>of</strong>, and the remainder <strong>of</strong> this<br />
Agreement shall nevertheless remain in full <strong>for</strong>ce and effect. If any provision <strong>of</strong> this Agreement shall be held invalid or<br />
unen<strong>for</strong>ceable under any particular circumstances, it shall nevertheless remain in full <strong>for</strong>ce and effect in all other<br />
circumstances.<br />
C. Assignment. Employer may assign all <strong>of</strong> its rights and duties under this Agreement without recourse to any Affiliate or to<br />
any entity that purchases all or substantially all <strong>of</strong> the operating assets <strong>of</strong> Employer, provided that any such assignment shall<br />
not abrogate any compensation <strong>of</strong> Physician. Physician may not assign his/her rights or duties herein without the prior written<br />
consent <strong>of</strong> Employer. Any such assignment by Physician without the prior written consent <strong>of</strong> Employer shall be null and<br />
void. This Agreement may otherwise be assigned upon the written agreement <strong>of</strong> both parties.<br />
D. Offset. Employer hereby is authorized to <strong>of</strong>fset any sums owed by Physician to Employer hereunder, or owed by Physician<br />
to any Affiliate <strong>of</strong> Employer under any arrangement, against Physician Compensation or against any other sums payable to<br />
Physician by Employer or by any Affiliate <strong>of</strong> Employer.<br />
E. Governing Law and Venue. This Agreement shall be governed by, and construed and en<strong>for</strong>ced in accordance with, the laws<br />
<strong>of</strong> the state in which the Practice is located. Any action or claim arising from, under or pursuant to this Agreement shall be<br />
brought in the courts, state or federal, within the state in which the Practice is located, and the parties expressly waive the<br />
right to bring any legal action or claims in any other courts. The parties hereto hereby consent to venue in any state or federal<br />
court within the state in which the Practice is located having jurisdiction over the County <strong>for</strong> all purposes in connection with<br />
any action or proceeding commenced between the parties hereto in connection with or arising from this Agreement.<br />
F. Arbitration. Except as to the provisions contained in Sections 8 and 9, the exclusive jurisdiction <strong>of</strong> which shall rest with a<br />
court <strong>of</strong> competent jurisdiction in the state in which the Practice is located, any controversy or claim arising out <strong>of</strong> or related<br />
to this Agreement, or any breach there<strong>of</strong>, shall be settled by arbitration in the County, in accordance with the rules and<br />
procedures <strong>of</strong> alternative dispute resolution and arbitration established by the Alternative Dispute Resolution Service <strong>of</strong> the<br />
American Health Lawyers Association ("AHLA"), and judgment upon any award rendered may be entered in any court<br />
having jurisdiction there<strong>of</strong>. Such arbitration shall be conducted be<strong>for</strong>e a single AHLA arbitrator selected jointly by the<br />
parties, or in the event the parties are unable to agree, designated by the AHLA. To the extent permitted by law, the Parties<br />
hereby jointly and severally waive any and all right to trial by jury in any action or proceeding arising out <strong>of</strong> or relating to<br />
this Agreement, or the obligations hereunder. The Parties each represent to the other that this Waiver is knowingly, willingly<br />
and voluntarily given. This provision does not preclude Employer from filing any cross-claim or third-party claim against<br />
Physician in a court <strong>of</strong> law as a result <strong>of</strong> litigation initiated against Employer by a third party.<br />
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G. Waiver. Any waiver by any party hereto <strong>of</strong> a breach <strong>of</strong> any provision <strong>of</strong> this Agreement shall not operate or be construed as a<br />
waiver <strong>of</strong> any other provision here<strong>of</strong> and shall not be effective at all unless in writing. A waiver <strong>of</strong> any <strong>of</strong> the terms and<br />
conditions here<strong>of</strong> shall not be construed as a general waiver by either party, and such waiving party shall be free to reinstate<br />
any such term or condition, with or without notice to the other party.<br />
H. Entire Agreement/Amendment. This Agreement contains the entire agreement between the parties hereto and supersedes<br />
all prior agreements, whether oral or in writing, with respect to the subject matter here<strong>of</strong>. No change, addition, or amendment<br />
shall be made except by written agreement executed by all <strong>of</strong> the parties hereto. This Agreement shall be binding upon and<br />
inure to the benefit <strong>of</strong> the parties hereto and their respective successors and assigns, subject to the restriction on assignment<br />
set <strong>for</strong>th above.<br />
I. Survival. The provisions <strong>of</strong> this Agreement, including but not limited to Sections 8 and 9, shall survive the termination <strong>of</strong><br />
Physician's relationship with Employer and the assignment <strong>of</strong> this Agreement by Employer to any successor or assign.<br />
J. Confidentiality. Except as otherwise required by law, Physician hereby agrees to hold in the strictest confidence all <strong>of</strong> the<br />
terms and conditions set <strong>for</strong>th herein; provided, however, that Physician may disclose the terms here<strong>of</strong> to his/her attorneys,<br />
accountants and other financial and legal advisors as reasonably necessary. Failure to do so, at the discretion <strong>of</strong> Employer,<br />
may constitute cause <strong>for</strong> immediate termination <strong>of</strong> this Agreement.<br />
K. Expenses. Each party to this Agreement shall pay its own costs and expenses in connection with the transaction<br />
contemplated hereby.<br />
L. Counterparts. This Agreement may be executed by the parties in counterparts, each <strong>of</strong> which shall be deemed an original,<br />
and all <strong>of</strong> which together shall constitute one and the same instrument. Any signatures on behalf <strong>of</strong> Facility required by this<br />
Agreement or written approval required hereunder may be electronic signatures in accordance with law.<br />
M. Binding Effect. This Agreement shall not become effective or legally binding upon either party until signed by both<br />
Employer and Physician.<br />
N. Intellectual Property. All patents, <strong>for</strong>mulae, ideas, inventions, processes, copyrights, know-how, proprietary in<strong>for</strong>mation,<br />
trademarks, trade names, or other developments <strong>for</strong> future improvements to patients that are conceived or worked on by<br />
Physician while he or she is an employee under this Agreement are the property <strong>of</strong> Employer, and all royalties, fees or other<br />
income attributable thereto shall be the sole property <strong>of</strong> Employer, and Physician shall have no right thereto.<br />
O. Duty to Defend and Indemnify. To the extent not covered by liability insurance carried by the parties, each party shall be<br />
solely responsible <strong>for</strong> its own claims, liabilities, damages, injuries, suits, demands, and expenses <strong>of</strong> all kinds (including,<br />
without limitation, attorneys' fees and court costs), that may result or arise from tortious criminal, or discriminatory conduct<br />
by such party, or by any member, partner, employee, representative, agent, or contractor <strong>of</strong> such party, and such party shall<br />
defend, indemnify, and hold harmless the other party and any members, partners, employees, agents, representatives, and<br />
contractors <strong>of</strong> the other party from and against such losses or damages. In the event that a claim is made against both parties,<br />
it is the intent <strong>of</strong> both parties to cooperate in the defense <strong>of</strong> such claim and to cause their insurers to do likewise. Physician<br />
agrees to cooperate in all litigation matters affecting Employer to the extent Physician does not have a conflict <strong>of</strong> interest.<br />
P. Use <strong>of</strong> Physician's Name. In consideration <strong>of</strong> the salary, bonuses, and benefits as set <strong>for</strong>th in Section 4 here<strong>of</strong>, Physician<br />
hereby grants Employer the exclusive right to use his or her name and likeness in any lawful advertising and marketing<br />
conducted by Employer without any additional compensation or remuneration to Physician.<br />
Q. Medicare Access. Upon written request <strong>of</strong> the Secretary <strong>of</strong> Health and Human Services or the Comptroller General or any <strong>of</strong><br />
their duly authorized representatives, Physician shall make available to the Secretary or Comptroller General those contracts,<br />
books, documents, and records necessary to verify the nature and extent <strong>of</strong> the cost <strong>of</strong> providing his/her services. If Physician<br />
carried out any <strong>of</strong> the duties <strong>of</strong> this Agreement with a value <strong>of</strong> $10,000.00 or more over a twelve (12) month period through a<br />
subcontract with a related individual or organization, Physician shall include this requirement in all such subcontracts. The<br />
parties agree that any attorney-client, accountant-client, or any other legal privilege shall not be deemed waived by virtue <strong>of</strong><br />
this section.<br />
IN WITNESS WHEREOF, the parties hereto have executed this Agreement as <strong>of</strong> the day and year written below.<br />
PHYSICIAN:<br />
[[ContractorName]]<br />
Page 13 <strong>of</strong> 16
_______________________________________________________ Date:_____________________<br />
(Signature)<br />
EMPLOYER:<br />
H2U Wellness Centers, LLC d/b/a <strong>West</strong> <strong>Palm</strong> <strong>Beach</strong>-First OnSite<br />
By: Brian Jones Date: ______________<br />
Vice President<br />
Page 14 <strong>of</strong> 16
A. COMPENSATION<br />
(Base Salary Compensation Model)<br />
EXHIBIT A.<br />
PHYSICIAN COMPENSATION<br />
i. Employer shall pay Physician an annual salary <strong>of</strong> $__________ per year ("Salary"), payable in bi-weekly installments <strong>of</strong><br />
$_________ at the same frequency as payments by the Employer or other employees <strong>of</strong> the Employer who are exempt<br />
from overtime wages. The Salary payments shall be conditioned upon Physician's maintaining an annual threshold <strong>of</strong><br />
$___________ in Net Revenue as defined below (hereinafter, the "Threshold"). The salary payments shall be subject to<br />
all state and federal withholding taxes and any other applicable benefits.<br />
ii. Each quarter during the Agreement Term, Physician’s Net Revenue will be averaged, and such average will be compared<br />
to the Threshold. In the event that the average <strong>of</strong> Physician’s Net Revenue is less than the Threshold <strong>for</strong> two consecutive<br />
quarters, Physician’s Salary shall be reduced within fifteen (15) days, effective as <strong>of</strong> the first pay period <strong>of</strong> the current<br />
quarter, by a percentage equal to the average percentage shortfall between Physician’s Net Revenue and the Threshold<br />
<strong>for</strong> such two quarters. In the event that the average <strong>of</strong> Physician’s Net Revenue exceeds the Threshold <strong>for</strong> two<br />
consecutive quarters, Physician’s Salary shall be increased within fifteen (15) days, effective as <strong>of</strong> the first pay period <strong>of</strong><br />
the current quarter, by a percentage equal to the average percentage excess <strong>of</strong> Physician’s Net Revenue over the<br />
Threshold <strong>for</strong> such two quarters.<br />
iii. Notwithstanding the generality <strong>of</strong> the <strong>for</strong>egoing, at no time during the Agreement Term shall Physician Compensation<br />
exceed fair market value (“FMV”). Accordingly, Employer may conduct an FMV analysis <strong>of</strong> Physician Compensation<br />
during the term here<strong>of</strong> and will reduce Physician Compensation after completion <strong>of</strong> such analysis if necessary to reflect a<br />
reduction in FMV.<br />
iv. Capitation Payments is defined as all accrued revenues determined on a per capita or per member basis <strong>for</strong> physicianrelated<br />
services <strong>for</strong> which Physician is designated the designated primary physician <strong>for</strong> the covered individual or<br />
member, provided, however, that any accruals <strong>for</strong> covering, specialty or services provided by other physicians or other<br />
at-risk services (i.e., ancillary services, outpatient services, etc.) shall be excluded from the definition <strong>of</strong> “Capitation<br />
Payments,” and Capitation Payments shall be reduced by a reasonable reserve <strong>for</strong> claims incurred but not reported.<br />
Unless otherwise agreed in writing, Capitation Payments shall be pooled on a group basis among Physician and like<br />
compensated physicians assigned to the Practice, and allocated among said physicians and Physician.<br />
v. Net Revenue is defined as Gross Revenue minus Contractual Allowances and allowances <strong>for</strong> bad debt. Gross Revenue is<br />
defined as (i) charges <strong>for</strong> patient services provided after the Effective Date in the Practice locations(s) that are generated<br />
on behalf <strong>of</strong> the Practice as a result <strong>of</strong> pr<strong>of</strong>essional medical services personally furnished to patients by Physician, (ii)<br />
Capitation Payments, (iii) revenues from testing, clinical trials and other drug research studies, and (iv) the pr<strong>of</strong>essional<br />
component (but not the technical component) <strong>of</strong> revenue generated from the provision by Practice or any other Entity <strong>of</strong><br />
ancillary services, supplies, or “designated health services” to Physician’s patients (as such term is defined at 42 C.F.R. §<br />
411.351, as such section may be amended from time to time after the date here<strong>of</strong>) or on the “List <strong>of</strong> CPT/HCPCS Codes<br />
Used to Describe Certain Designated Health Services Under the Physician Referral Provisions (Section 1877 <strong>of</strong> the<br />
Social Security Act)” as published by the Centers <strong>for</strong> Medicare and Medicaid Services from time to time after the date<br />
here<strong>of</strong>, regardless <strong>of</strong> whether such services are rendered in an inpatient or outpatient setting and regardless <strong>of</strong> whether<br />
services are rendered to HMO, PPO, Medicare, Medicaid or other patients. Gross Revenue shall not include the technical<br />
component <strong>of</strong> revenue generated from the provision by Practice or any other Entity <strong>of</strong> ancillary services, supplies, or<br />
“designated health services” to Physician’s patients. Contractual Allowances and allowances <strong>for</strong> bad debt are defined as<br />
the value <strong>of</strong> services per<strong>for</strong>med <strong>for</strong> which payment is not expected, as calculated on an accrual basis by Employer in<br />
accordance with generally accepted accounting principles, including, without limitation, adjustments relating to charge<br />
restrictions imposed by Medicare, such as the difference between the full undiscounted charge and the Medicare limiting<br />
charge, contractual adjustments required by third party payors, and other adjustments such as charitable, pr<strong>of</strong>essional<br />
courtesy and employee discounts.<br />
B. OTHER<br />
i. Physician shall be entitled to _____ days <strong>of</strong> leave per year (to be pro-rated <strong>for</strong> partial years). Leave is to be used <strong>for</strong><br />
personal time, vacation time, and holidays. Unused days <strong>of</strong> leave cannot be carried over to the following calendar year.<br />
Leave may not be cashed out at any time, including at termination <strong>of</strong> employment. In addition, Physician shall be entitled<br />
Page 15 <strong>of</strong> 16<br />
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to use up to ____________ (_____) regular work days per calendar year <strong>for</strong> the purpose <strong>of</strong> attending medical<br />
conventions and/or continuing medical education seminars. All leave shall be pre-approved by Employer including, but<br />
not limited to, personal time, vacation, holidays and continuing medical education seminars. Physician agrees that all<br />
leave shall be scheduled to accommodate the needs <strong>of</strong> Employer.<br />
ii. In accordance with its policies, Employer shall reimburse Physician <strong>for</strong> Physician's attendance at medical conventions<br />
and/or seminars (including, but not limited to, registration, travel, lodging and meals), business-related cellular<br />
telephone, and/or pager expenses.<br />
iii. Physician shall be eligible <strong>for</strong> a productivity bonus based upon ____percentage (%) <strong>of</strong> base salary. Productivity criteria<br />
include:<br />
a. Patient Satisfaction<br />
b. Critical outcomes<br />
c. Other criteria agreed upon by client and First OnSite and/or recommended by First OnSite<br />
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Effective Date Chapter 5<br />
May 05, 2003 General<br />
Policy 5-1<br />
AUTHORITY<br />
TRAVEL POLICY<br />
This administrative policy is made pursuant to <strong>City</strong> Charter, Section 3.01(12) and is in keeping<br />
with the provisions <strong>of</strong> Florida Statutes Section 112.061, as modified by <strong>City</strong> ordinance.<br />
POLICY STATEMENT<br />
Travel must be <strong>for</strong> a public purpose and authorized in advance. Transportation <strong>for</strong> higher<br />
education is not a public purpose under this policy.<br />
PURPOSE<br />
The purpose is to provide a method <strong>for</strong> travel authorization and to set <strong>for</strong>th criteria and<br />
guidelines <strong>for</strong> travel and related expense reimbursement.<br />
SCOPE OF APPLICABILITY<br />
This policy applies to all travelers including elected <strong>of</strong>ficials, employees, or others approved by<br />
the Mayor. Where provisions <strong>of</strong> this policy conflict with a collective bargaining agreement, the<br />
collective bargaining agreement will prevail.<br />
DEFINITIONS<br />
A. Common Carrier - Train, bus, commercial airline operating scheduled flights, or rental<br />
cars.<br />
B. Immediate Vicinity – An area within 20 miles from the <strong>of</strong>ficial headquarters to the<br />
destination.<br />
C. Official Headquarters – <strong>City</strong> Hall or another <strong>City</strong> location where the employee reports<br />
to work on a normal workday.<br />
D. Travel - Authorized <strong>of</strong>ficial business away from the immediate vicinity.<br />
E. Travel Expense – Lodging, meals, transportation, gas purchased when using <strong>City</strong> car,<br />
mileage when using a personal vehicle, tolls, parking fees and other incidental expenses<br />
incurred when traveling.<br />
SECTION I - AUTHORITY TO INCUR TRAVEL EXPENSES<br />
All travel, except by the Mayor, a <strong>City</strong> Commissioner or the <strong>City</strong> Administrator, must be<br />
authorized in advance by the appropriate department director or designee. All travel by<br />
department directors must be approved by the <strong>City</strong> Administrator or an Assistant <strong>City</strong><br />
1
2<br />
Chapter 5<br />
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Policy 5-1<br />
Administrator. All travel by Assistant <strong>City</strong> Administrators must be approved by the <strong>City</strong><br />
Administrator or the Mayor.<br />
SECTION II – MEAL ALLOWANCE<br />
Allowances <strong>for</strong> meals will be based on the following schedule:<br />
Breakfast – When travel begins be<strong>for</strong>e 6 a.m. and extends beyond 8 a.m.<br />
Lunch – When travel begins be<strong>for</strong>e 12 noon and extends beyond 2 p.m.<br />
Dinner – When travel begins be<strong>for</strong>e 6 p.m. and extends beyond 8 p.m. or when travel<br />
occurs during nighttime hours due to special assignments.<br />
No allowance will be made <strong>for</strong> meals when travel is confined to the immediate vicinity. No one,<br />
whether traveling in the state or out <strong>of</strong> the state, will be reimbursed <strong>for</strong> any meal or lodging<br />
included in a convention or conference registration fee that was paid by the <strong>City</strong>. Continental<br />
breakfasts, receptions, and airline food are not considered meals.<br />
SECTION III - TRANSPORTATION<br />
A. Transportation must be by a usually traveled or most direct route. If a person travels by<br />
an indirect route or any preferred class <strong>for</strong> one’s own convenience, the traveler will pay<br />
the extra costs.<br />
B. Transportation must be by the most economical and efficient means <strong>of</strong> travel, keeping in<br />
mind:<br />
� The nature <strong>of</strong> the business;<br />
� The time <strong>of</strong> the traveler, impact on the productivity <strong>of</strong> the traveler, cost <strong>of</strong><br />
transportation, and other allowable expenses; and<br />
� The number <strong>of</strong> persons making the trip and the amount <strong>of</strong> equipment or material<br />
to be transported.<br />
C. Mode <strong>of</strong> Transportation:<br />
Transportation must be justified on the “Travel Request” <strong>for</strong>m.<br />
1. <strong>City</strong> Vehicle – will be used by a traveler on <strong>of</strong>ficial business when one is<br />
available and the use is feasible.<br />
2. Planes, Trains, Buses, etc. – will be used by a traveler when most economical<br />
and feasible. Only “coach class” fare will be paid by the <strong>City</strong>.<br />
3. Rental Car – may be used by a traveler only when most economical and<br />
absolutely necessary. Justification must be pre-approved on the “Travel Request”<br />
Formatted: Indent: Left: 0.25",<br />
Numbered + Level: 1 + Numbering<br />
Style: A, B, C, … + Start at: 1 +<br />
Alignment: Left + Aligned at: 0" +<br />
Tab after: 0.25" + Indent at: 0.25"<br />
Formatted: Indent: Left: 0.25",<br />
Hanging: 0.31", Numbered + Level:<br />
1 + Numbering Style: A, B, C, … +<br />
Start at: 2 + Alignment: Left +<br />
Aligned at: 0" + Tab after: 0.25" +<br />
Indent at: 0.25"<br />
Formatted: Indent: First line: 0.5",<br />
Bulleted + Level: 1 + Aligned at: 0"<br />
+ Tab after: 0.25" + Indent at:<br />
0.25"<br />
Formatted: Indent: Left: 0.75",<br />
Bulleted + Level: 1 + Aligned at: 0"<br />
+ Tab after: 0.25" + Indent at:<br />
0.25", Tabs: Not at 0.25"<br />
Formatted: Indent: Left: 0.75",<br />
Bulleted + Level: 1 + Aligned at: 0"<br />
+ Tab after: 0.25" + Indent at:<br />
0.25"<br />
Formatted: Indent: Left: 0.25",<br />
Numbered + Level: 1 + Numbering<br />
Style: A, B, C, … + Start at: 3 +<br />
Alignment: Left + Aligned at: 0" +<br />
Tab after: 0.25" + Indent at: 0.25"<br />
Formatted: Indent: Left: 0.63",<br />
Hanging: 0.38", Numbered + Level:<br />
1 + Numbering Style: 1, 2, 3, … +<br />
Start at: 1 + Alignment: Left +<br />
Aligned at: 0" + Tab after: 0.25" +<br />
Indent at: 0.25", Tabs: 1", List tab<br />
+ Not at 0.25"
3<br />
Chapter 5<br />
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Policy 5-1<br />
<strong>for</strong>m.<br />
4. Privately Owned Vehicles – may be used by a traveler on <strong>of</strong>ficial business, in<br />
lieu <strong>of</strong> <strong>City</strong> owned vehicles or common carrier, if pre-approved on the “Travel<br />
Request” <strong>for</strong>m. When authorized, the driver will be compensated <strong>for</strong> mileage at a<br />
fixed rate per mile as shown in Appendix 1, not to exceed the cost <strong>of</strong> travel by<br />
common carrier.<br />
� Reimbursement will not be allowed <strong>for</strong> expenditures related to the<br />
operation, maintenance, and ownership <strong>of</strong> the privately owned vehicle.<br />
� The traveler will be compensated <strong>for</strong> miles driven on <strong>of</strong>ficial business.<br />
� While at the travel destination, actual mileage may be allowed if driving is<br />
necessary and a satisfactory explanation is provided.<br />
� Odometer readings or mileage as published by the Department <strong>of</strong><br />
Transportation is required <strong>for</strong> claiming mileage.<br />
� Only one person per vehicle may be compensated <strong>for</strong> mileage.<br />
D. If a traveler uses a common carrier and personally pays <strong>for</strong> the transportation, pro<strong>of</strong> <strong>of</strong><br />
payment must be provided.<br />
SECTION IV – LODGING<br />
Overnight accommodations may be allowed when a traveler leaves the immediate vicinity to<br />
attend an event, such as a conference or training. Accommodations may be approved <strong>for</strong> the last<br />
day <strong>of</strong> the event if the traveler is expected to return home after 10:00 p.m. Accommodations<br />
may be approved <strong>for</strong> the night be<strong>for</strong>e an event if the traveler needs to begin travel be<strong>for</strong>e 6:00<br />
a.m. in order to reach the destination at the required time.<br />
The point <strong>of</strong> origin is as follows:<br />
� On a workday, the point <strong>of</strong> origin is the traveler’s residence or <strong>of</strong>ficial headquarters,<br />
whichever is closer to the destination.<br />
� On a non-work day, the point <strong>of</strong> origin is the traveler’s residence.<br />
The maximum rate allowable <strong>for</strong> a traveler is single-occupancy unless additional people who<br />
stay in the room are also authorized <strong>City</strong> travelers.<br />
Formatted: Indent: Left: 1.19",<br />
Bulleted + Level: 1 + Aligned at: 0"<br />
+ Tab after: 0.25" + Indent at:<br />
0.25", Tabs: 1.44", List tab + Not at<br />
0.25"<br />
Formatted: Indent: Left: 0.25",<br />
Hanging: 0.31", Numbered + Level:<br />
1 + Numbering Style: A, B, C, … +<br />
Start at: 4 + Alignment: Left +<br />
Aligned at: 0" + Tab after: 0.25" +<br />
Indent at: 0.25", Tabs: 0.56", List<br />
tab + Not at 0.25"<br />
Formatted: Indent: Left: 0.25",<br />
Bulleted + Level: 1 + Aligned at: 0"<br />
+ Tab after: 0.25" + Indent at:<br />
0.25"<br />
Formatted: Indent: Left: 0.25",<br />
Hanging: 1.25", Bulleted + Level: 1<br />
+ Aligned at: 0" + Tab after: 0.25"<br />
+ Indent at: 0.25"
SECTION V- MISCELLANEOUS PROVISIONS AND REGULATIONS<br />
4<br />
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General<br />
Policy 5-1<br />
The <strong>City</strong> allows reimbursement <strong>for</strong> some miscellaneous expenses but excludes others. The<br />
reimbursable expenses must be authorized, actually paid <strong>for</strong> by the traveler, and supported by<br />
receipts.<br />
A. Reimbursable Expenses<br />
1. Reasonable taxi or shuttle fare.<br />
2. Ferry fares; and bridge, road, and tunnel tolls.<br />
3. Parking fees or emergency car storage.<br />
4. Communication expenses (Must be documented as <strong>of</strong>ficial business).<br />
5. Gasoline and oil while driving <strong>City</strong> owned vehicles or rental cars.<br />
6. Convention, conference or training course registration fees.<br />
7. Room taxes when documented on a hotel bill. All travelers should use the Tax-Exempt<br />
Certificate <strong>for</strong> accommodations in Florida.<br />
B. Non-Reimbursable Expenses<br />
1. Tips and gratuities.<br />
2. Laundry and dry cleaning.<br />
3. Personal and local telephone calls.<br />
C. Incidental Expenses<br />
For overnight travel, an allowance <strong>of</strong> $2.00 per day may be claimed, without receipts, <strong>for</strong><br />
incidental expenses that are not reimbursable by the <strong>City</strong> as actual expenses.<br />
SECTION VI – TRAVEL FORMS<br />
A. Travel Request<br />
The “Travel Request” is used to pre-approve all travel except travel by the Mayor, a <strong>City</strong><br />
Commissioner, or the <strong>City</strong> Administrator. Any special circumstances must be justified on the<br />
<strong>for</strong>m and a cost-comparison provided.<br />
A copy <strong>of</strong> the <strong>for</strong>m and appropriate attachments must be included with every <strong>for</strong>m FN121 that is<br />
submitted to the Finance Department to request direct payment <strong>of</strong> travel expenses. The original<br />
must be submitted with the “Travel Expense Report” after the travel has been completed.<br />
Formatted: Indent: First line: 0",<br />
Numbered + Level: 1 + Numbering<br />
Style: 1, 2, 3, … + Start at: 1 +<br />
Alignment: Left + Aligned at: 0" +<br />
Tab after: 0.25" + Indent at: 0.25"<br />
Formatted: Indent: Left: 0.25",<br />
Numbered + Level: 1 + Numbering<br />
Style: 1, 2, 3, … + Start at: 1 +<br />
Alignment: Left + Aligned at: 0" +<br />
Tab after: 0.25" + Indent at: 0.25"<br />
Formatted: Indent: Left: 0",<br />
Hanging: 0.5", Numbered + Level: 1<br />
+ Numbering Style: A, B, C, … +<br />
Start at: 2 + Alignment: Left +<br />
Aligned at: 0" + Tab after: 0.25" +<br />
Indent at: 0.25"<br />
Formatted: Indent: First line: 0",<br />
Numbered + Level: 1 + Numbering<br />
Style: 1, 2, 3, … + Start at: 1 +<br />
Alignment: Left + Aligned at: 0" +<br />
Tab after: 0.25" + Indent at: 0.25"
B. FN121 – Direct Payment<br />
5<br />
Chapter 5<br />
General<br />
Policy 5-1<br />
FN121 is used to request advance payment <strong>of</strong> registration fees, hotel room, and plane fare. An<br />
invoice or written cost estimate must be provided.<br />
The <strong>for</strong>m may also be used <strong>for</strong> pre-travel reimbursement <strong>of</strong> personally paid expenses; written<br />
pro<strong>of</strong> <strong>of</strong> payment must be provided.<br />
C. FN118 – Travel Expense Report<br />
FN118 “Travel Expense Report” is used to provide a mandatory detailed record <strong>of</strong> all expenses<br />
<strong>for</strong> travel that is financed through expenditure <strong>of</strong> <strong>City</strong> funds. All travelers must submit FN118 to<br />
the Director <strong>of</strong> Finance within ten business days after returning from their trip.<br />
Every traveler must complete this <strong>for</strong>m even if all expenses were paid prior to the travel and no<br />
money is owed either to the <strong>City</strong> or to the traveler.<br />
If a traveler does not submit this <strong>for</strong>m or if the Finance Department does not approve it, the<br />
entire amount paid by the <strong>City</strong> will be reported to the IRS as personal, taxable income.<br />
All in<strong>for</strong>mation about the travel and every allowable expense must be provided in the appropriate<br />
sections <strong>of</strong> the <strong>for</strong>m.<br />
If reimbursement is requested <strong>for</strong> personally paid expenses, receipts or other pro<strong>of</strong> <strong>of</strong> payment<br />
must accompany the expense report.<br />
D. Local Mileage Reimbursement Report<br />
The “Local Mileage Reimbursement Report” is used to request payment when the only travel<br />
expense is mileage.<br />
� The driver must use a personal vehicle.<br />
� The distance must be 20 miles or less between locations.<br />
� Odometer readings and justification must be provided.<br />
Policy 5-1 is effective on this ______ day <strong>of</strong> ______________, 2003.<br />
___________________________<br />
Lois J. Frankel<br />
Mayor<br />
Formatted: Indent: Left: 0",<br />
Hanging: 1.06", Numbered + Level:<br />
1 + Numbering Style: A, B, C, … +<br />
Start at: 3 + Alignment: Left +<br />
Aligned at: 0" + Tab after: 0.25" +<br />
Indent at: 0.25", Tabs: 0.31", List<br />
tab + Not at 0.25"<br />
Formatted: Indent: First line:<br />
0.06", Bulleted + Level: 1 + Aligned<br />
at: 0" + Tab after: 0.25" + Indent<br />
at: 0.25"
Effective Date Chapter 5<br />
January 1, 2011 General<br />
Policy 5-1<br />
Appendix 1<br />
RATES FOR MEALS AND MILEAGE<br />
The Travel Policy <strong>of</strong> the <strong>City</strong> <strong>of</strong> <strong>West</strong> <strong>Palm</strong> <strong>Beach</strong>, Florida is set <strong>for</strong>th by <strong>City</strong> ordinance.<br />
The mileage reimbursement is set as the mileage rate <strong>of</strong> the Internal Revenue Service.<br />
The current reimbursement amounts (effective January 1, 2011) are:<br />
Breakfast $ 5.00<br />
Lunch 9.00<br />
Dinner 18.00<br />
Mileage $ .51<br />
Incidental Expenses $ 2.00<br />
Mileage rates in effect under this policy:<br />
February 20, 20<strong>02</strong> - December 31, 20<strong>02</strong>: .345<br />
January 1, 2003 – December 31, 2003 .36<br />
January 1, 2004 – December 31, 2004 .375<br />
January 1, 2005 – August 31, 2005 .405<br />
September 1, 2005 – December 31, 2005 .485<br />
January 1, 2006 – December 31, 2006 .445<br />
January 1, 2007 – December 31, 2007 .485<br />
January 1, 2008 – June 30, 2008 .505<br />
July 1, 2008 – December 31, 2008 .585<br />
January 1, 2009 – December 31, 2009 .55<br />
January 1, 2010 – December 31, 2010 .50<br />
January 1, 2011 .51
Hiring Processes – Credentialing & Background<br />
Investigatons<br />
<strong>City</strong> <strong>of</strong> <strong>West</strong> <strong>Palm</strong> <strong>Beach</strong><br />
First Onsite verifies the credentials, experience and background <strong>of</strong> all prospective clinic<br />
staff members prior to an <strong>of</strong>fer <strong>of</strong> employment. Reference checks are per<strong>for</strong>med <strong>for</strong><br />
three references by telephone using the First Onsite Reference Form, which can also be<br />
faxed or emailed when necessary. A background check is run to determine criminal,<br />
financial, and sex <strong>of</strong>fender status. Personality pr<strong>of</strong>iles are per<strong>for</strong>med <strong>for</strong> management<br />
level candidates using the DISC, Providers AI, and TTI methods.<br />
Limitations on Employment Policy<br />
SCOPE: Employees in all facilities affiliated with the Company including, but not limited to,<br />
hospitals, clinics, ambulatory surgery centers, home health agencies, physician practices and all<br />
Corporate Departments, Divisions, and Groups.<br />
PURPOSE: To define the legal or ethical limitations that may exist in establishing an<br />
employment relationship with an individual and the responsibility <strong>of</strong> the hiring manager to<br />
recognize these issues in the hiring process.<br />
POLICY:<br />
1. Hiring <strong>of</strong> Former Fiscal Intermediary Personnel<br />
a. To ensure compliance with 42 CFR 420.203 and the disclosure <strong>of</strong> hiring <strong>for</strong>mer<br />
employees <strong>of</strong> fiscal intermediaries, Human Resources will notify the Secretary <strong>of</strong> Health<br />
and Human Services <strong>of</strong> the hiring <strong>of</strong> persons who had been employed in a managerial,<br />
accounting, auditing or similar capacity by a fiscal intermediary during the previous 12<br />
months.<br />
b. Human Resources will send the letter <strong>of</strong> notification within 30 days <strong>of</strong> the first day <strong>of</strong><br />
employment.<br />
2. Prohibition Against Employment <strong>of</strong> Ineligible Persons<br />
a. For purposes <strong>of</strong> this policy, an “Ineligible Person” shall be any individual or entity that:<br />
i. is currently excluded, suspended, debarred or otherwise ineligible to participate in<br />
Federal health care programs;<br />
ii. Has been convicted <strong>of</strong> a criminal <strong>of</strong>fense related to the provision <strong>of</strong> health care items<br />
or services but has not yet been excluded, debarred, or otherwise declared ineligible;<br />
or<br />
iii. is currently excluded on a state exclusion list.<br />
b. No Company-affiliated facility, including hospitals, ambulatory surgery centers, home<br />
health agencies, and physician practices will make an <strong>of</strong>fer <strong>of</strong> employment to an<br />
applicant who is listed as an Ineligible Person.<br />
c. All applicants are required to answer the following question on the application <strong>for</strong><br />
All rights reserved. This document contains proprietary and confidential in<strong>for</strong>mation which may not be reproduced or shared without the written consent <strong>of</strong> First Onsite. 1
<strong>City</strong> <strong>of</strong> <strong>West</strong> <strong>Palm</strong> <strong>Beach</strong><br />
employment: Are you currently excluded, suspended, debarred or otherwise ineligible to<br />
participate in the Federal health care programs, or have you been convicted <strong>of</strong> a criminal<br />
<strong>of</strong>fense related to the provision <strong>of</strong> health care items or services but not yet been excluded,<br />
debarred, or otherwise declared ineligible?<br />
d. Each employee <strong>of</strong> a Company-affiliated facility must disclose immediately any<br />
debarment, exclusion or other event that makes him or her an Ineligible Person.<br />
e. All Company-affiliated facilities, including hospitals, ambulatory surgery centers, home<br />
health agencies, and physician practices must immediately terminate any current<br />
employee who is listed as an Ineligible Person.<br />
3. Employment <strong>of</strong> Minors<br />
Normally, candidates <strong>for</strong> employment must have reached their eighteenth birthday. However, persons who have reached their sixteenth<br />
birthday may be considered <strong>for</strong> employment within the limits <strong>of</strong> state and federal law.<br />
4. Employment <strong>of</strong> Relatives and employees with common domicile<br />
a. Employment <strong>of</strong> immediate family members and employees with common domicile at<br />
Company-affiliated facilities may cause the perception <strong>of</strong> inequitable hiring practices and/or<br />
conflicts <strong>of</strong> interest by fellow employees or others. There<strong>for</strong>e, prior written approval must<br />
be obtained from a manager one level above the hiring manager and may only be approved<br />
after determining that such employment will not create the appearance <strong>of</strong> a conflict <strong>of</strong><br />
interest or have other adverse consequences to business operations. Immediate family is<br />
defined as spouse, parent, parent-in-law, brother, sister, child, step-child and grandparent;<br />
common domicile is the same legal residence.<br />
b. Members <strong>of</strong> an immediate family or employees with common domicile shall not supervise<br />
one another directly.<br />
c. Members <strong>of</strong> an immediate family or employees with common domicile shall not supervise<br />
one another indirectly without prior written approval from a senior manager at least one<br />
level above the hiring manager.<br />
d. If marriage, promotion or other action creates a supervisory relationship among related<br />
employees or employees with common domicile, one <strong>of</strong> the related employees or<br />
employees with common domicile must either resign or transfer in order to resolve the<br />
situation within one calendar month.<br />
e. No Company affiliated facility shall employ a relative or an individual with common<br />
domicile <strong>of</strong> its Human Resources Director or any member <strong>of</strong> Senior Management without<br />
written approval <strong>of</strong> a senior manager at least one level above the hiring manager.<br />
5. Use <strong>of</strong> Contract Personnel<br />
a. Contracts with independent contractors should be reviewed in advance by the Legal<br />
Department. Generally, if an individual is subject to the Company’s control or direction<br />
only regarding end results (and not as to the details by which those results are<br />
accomplished), the individual may be classified as an independent contractor.<br />
b. The agreement should include the Federal Tax ID number and the pro<strong>of</strong> <strong>of</strong> workers<br />
compensation insurance certificate.<br />
DEFINITION<br />
SanctionCheck.com is the Compliance Concepts, Inc. (CCI) website that enables Companyaffiliated<br />
facilities to verify exclusions using an individual name or a batch file <strong>of</strong> multiple<br />
All rights reserved. This document contains proprietary and confidential in<strong>for</strong>mation which may not be reproduced or shared without the written consent <strong>of</strong> First Onsite. 2
<strong>City</strong> <strong>of</strong> <strong>West</strong> <strong>Palm</strong> <strong>Beach</strong><br />
individuals that is processed against the OIG Sanction Report and the GSA List at the same time.<br />
Instructions <strong>for</strong> individual and batch search using SanctionCheck.com are on the website at<br />
http://app.sanctioncheck.com.<br />
PROCEDURE:<br />
1. Hiring <strong>of</strong> Former Fiscal Intermediary(FI)/Medicare Administrative Contractor (MAC)<br />
Personnel<br />
a. In the event a facility hires a <strong>for</strong>mer FI/MAC employee, the Human Resources Director<br />
will prepare a letter similar to the attached example and <strong>for</strong>ward it to the Department <strong>of</strong><br />
Health and Human Services.<br />
b. The Human Resources Director will retain a copy <strong>of</strong> the letter to be available during a<br />
survey or certification visit. A copy will also be placed in the employee’s personnel file.<br />
2. Prohibition Against Employment <strong>of</strong> Ineligible Persons<br />
a. Screening Prior to Employment.<br />
i. Prior to hiring or re-hiring an employee, the Human Resources Director or designee<br />
must ensure that the individual being considered <strong>for</strong> employment has been checked<br />
against the:<br />
(a) General Service Administration’s List <strong>of</strong> Parties Excluded from Federal Programs<br />
(the “GSA List”);<br />
(b) HHS/OIG List <strong>of</strong> Excluded Individuals/Entities (the “OIG Sanction Report”); and<br />
(c) Any applicable state exclusion list.<br />
ii. The Human Resources Director or designee or the vendor providing background<br />
investigations will compare the name and address <strong>of</strong> each potential candidate <strong>for</strong><br />
employment to the GSA List and the OIG Sanction Report. Should an individual<br />
appear on either the GSA List or the OIG Sanction Report, the Company may not<br />
employ that individual.<br />
iii. The GSA List and the OIG Sanction Report are on the Internet in searchable <strong>for</strong>mats at,<br />
respectively:<br />
� http://epls.arnet.gov ; and<br />
� http://exclusions.oig.hhs.gov.<br />
� Alternatively, both lists may be searched simultaneously at:<br />
http://app.sanctioncheck.com. This is the recommended method <strong>of</strong> conducting<br />
ineligible persons searches.<br />
b. Screening Subsequent to Employment.<br />
i. Corporate Office-Based Screening.<br />
(a) On a monthly basis, Corporate In<strong>for</strong>mation Technology & Services (IT&S)<br />
will compare the Company’s employee database against the GSA List and the<br />
OIG Sanction Report and provide the report <strong>of</strong> the comparison, which lists<br />
potential matches, to the Corporate Human Resources’ VP, Employee<br />
Relations.<br />
(b) The VP, Employee Relations is responsible <strong>for</strong> confirming the match by<br />
reviewing the GSA list on a semi-annual basis and the OIG list on a monthly<br />
All rights reserved. This document contains proprietary and confidential in<strong>for</strong>mation which may not be reproduced or shared without the written consent <strong>of</strong> First Onsite. 3
<strong>City</strong> <strong>of</strong> <strong>West</strong> <strong>Palm</strong> <strong>Beach</strong><br />
basis.<br />
(c) If an employee is an Ineligible Person on either list, the VP, Employee<br />
Relations will notify the HR Director at the facility which employs the<br />
Ineligible Person.<br />
(d) The HR Director must terminate the employment relationship with that<br />
individual.<br />
(e) The VP, Employee Relations will report the match and the action taken by the<br />
facility to the VP, Reimbursement and Director, Internal Compliance<br />
Reporting<br />
ii. Facility-Based Screening.<br />
(a) Facilities located in states which maintain a state exclusion list must search the<br />
state exclusion list on a monthly basis to ensure that no employee is an ineligible<br />
person.<br />
(b) If an employee is an Ineligible Person on the state list, the HR Director must<br />
terminate the employment relationship with that individual.<br />
(c) A list <strong>of</strong> states with exclusion lists is available on Atlas.<br />
c. Each employee must immediately disclose to his or her supervisor any debarment,<br />
exclusion or other event that makes the employee an Ineligible Person. The supervisor<br />
must report such disclosures to the HR Director, and the HR Director must terminate the<br />
employment relationship with that individual.<br />
d. The HR Director must notify the facility’s Division Reimbursement Manager to address<br />
potential cost reporting issues and report the disclosure or match and subsequent actions,<br />
including the final disposition, to the facility Ethics and Compliance Officer (ECO).<br />
e. If the ineligible person is a Corporate payroll employee, the VP, Employee Relations, will<br />
work with the Corporate Reimbursement department to address cost reporting issues, and<br />
report the match or disclosure and subsequent actions, including the final disposition, to<br />
the Director, Internal Compliance Reporting.<br />
f. Documentation:<br />
i. Whenever a search <strong>of</strong> the GSA List, the OIG Sanction Report, or applicable state<br />
exclusion list is conducted by the background investigation vendor or a facility<br />
undertakes to confirm a possible match, the search results must be documented and<br />
copies <strong>of</strong> the search in<strong>for</strong>mation should be maintained in an electronic file,<br />
separate file or in a master exclusion verification file filed by year and<br />
alphabetized <strong>for</strong> applicants not employed.<br />
ii. Documentation required <strong>for</strong> searches per<strong>for</strong>med on SanctionCheck.com:<br />
a) Documentation required when batch file results from SanctionCheck.com indicate a possible<br />
OIG or GSA List match:<br />
� A Batch Summary Report must be printed.<br />
� An individual certificate summary must be printed <strong>for</strong> all “Positive Matches Only” (both<br />
OIG and GSA positive matches).<br />
b) Documentation required regardless <strong>of</strong> SanctionCheck.com search results:<br />
� The “All Names Submitted” file must be downloaded when the Batch Results page<br />
displays.<br />
� The list used to develop a batch search must be printed and saved.<br />
iii. Electronic storage is also an acceptable storage option provided the documents are<br />
readily available on demand. A procedure <strong>for</strong> backing up documents in the event<br />
<strong>of</strong> system malfunction should be established to ensure accessibility.<br />
iv. All records regarding ineligible persons search results must be maintained<br />
All rights reserved. This document contains proprietary and confidential in<strong>for</strong>mation which may not be reproduced or shared without the written consent <strong>of</strong> First Onsite. 4
<strong>City</strong> <strong>of</strong> <strong>West</strong> <strong>Palm</strong> <strong>Beach</strong><br />
according to the Company’s record retention schedules (i.e., five (5) years).<br />
v. All Company-affiliated facilities must comply with the Records Management<br />
Policy, EC.014.<br />
3. Hiring <strong>of</strong> Relatives<br />
a. Be<strong>for</strong>e extending an <strong>of</strong>fer <strong>of</strong> employment to the relative or to an individual with common<br />
domicile <strong>of</strong> an existing employee, the manager should consult with Human Resources to<br />
ensure proper written approval is obtained and that there will be no appearance <strong>of</strong> or actual<br />
conflict <strong>of</strong> interest.<br />
b. In situations where Human Resources believe a perceived or actual conflict will exist,<br />
Human Resources should consult with the local ECO be<strong>for</strong>e a final decision is made.<br />
4. Independent Contractors and Employees <strong>of</strong> Staffing Agencies or Contracted Service Entities<br />
All contract labor vendors <strong>for</strong> clinical and administrative staffing (i.e., “Subjects” as defined in<br />
policy HR.OP.0<strong>02</strong>, excluding students and volunteers) are to be contracted and managed by<br />
All About Staffing. Contract labor which falls within the definition <strong>of</strong> “Other Contract<br />
Worker” as defined in policy HR.OP.0<strong>02</strong> will continue to be managed by affiliated facilities<br />
and are excluded from the requirements set <strong>for</strong>th below (i.e., are not subject to ineligible<br />
persons screening).<br />
All About Staffing will compare its independent contractors, employees <strong>of</strong> staffing agencies or<br />
contracted service entities, as appropriate, to the GSA and OIG lists and the state exclusion list,<br />
if applicable, to confirm a potential match by reviewing the GSA list on a semi-annual basis<br />
and the OIG list and state exclusion list, if applicable, on a monthly basis.<br />
The CEO <strong>of</strong> each company-affiliated facility or designee is responsible <strong>for</strong> a process to<br />
conduct a search <strong>of</strong> the GSA and OIG lists to confirm a potential match <strong>of</strong> any contract labor<br />
provider (“Subjects”) not otherwise managed by All About Staffing.<br />
REFERENCES:<br />
1. 42 CFR 420.203<br />
2. 48 CFR Subpart 9.4, Federal Acquisition Regulation, 9.4 – Debarment, Suspension, and<br />
Ineligibility<br />
3. Records Management Policy, EC.014<br />
4. Background Investigations Policy, HR.OP.0<strong>02</strong><br />
5. Prohibition Against Contracting with Any Ineligible Person Policy, MM.001<br />
Background Investigations Policy<br />
SCOPE: All Company-affiliated subsidiaries including, but not limited to hospitals, ambulatory<br />
surgery centers, outpatient imaging centers, physician practices, All About Staffing, Corporate<br />
Departments, Groups, and Divisions (collectively, “Affiliated Employers” and individually,<br />
“Affiliated Employer”).<br />
PURPOSE: To ensure a standard requirement and process <strong>for</strong> obtaining and evaluating<br />
background in<strong>for</strong>mation on:<br />
All rights reserved. This document contains proprietary and confidential in<strong>for</strong>mation which may not be reproduced or shared without the written consent <strong>of</strong> First Onsite. 5
<strong>City</strong> <strong>of</strong> <strong>West</strong> <strong>Palm</strong> <strong>Beach</strong><br />
1. candidates <strong>for</strong> employment;<br />
2. individuals who provide clinical services at the facility (e.g., students), other than individuals<br />
who are solely privileged practitioners <strong>of</strong> the medical staff;<br />
3. individuals who provide clinical services under contract with the facility (e.g., independent<br />
contractors, employees or agents <strong>of</strong> staffing agencies); and<br />
4. individuals who are reasonably expected to interact with patients or members <strong>of</strong> the public at<br />
the facility (e.g., volunteers).<br />
Such individuals are collectively referred to as “Subjects” and individually as “Subject.” The<br />
background in<strong>for</strong>mation may include various components based on the level <strong>of</strong> responsibility <strong>of</strong><br />
the Subject.<br />
To ensure that all contractors sending individuals other than Subjects to per<strong>for</strong>m services in or on<br />
the premises <strong>of</strong> an HCA-affiliated facility (e.g., employees <strong>of</strong> contracted lawn service or<br />
contracted repair services) provide the HCA-affiliated facility with an attestation that the<br />
individuals sent to work in or on the premises <strong>of</strong> an HCA-affiliated facility are legally permitted<br />
to work in the United States. Such individuals are collectively referred to as “Other Contract<br />
Workers” and individually as “Other Contract Worker.”<br />
POLICY: An Affiliated Employer must not permit a Subject to commence employment or<br />
provide services in an Affiliated Facility until a satisfactory background investigation (otherwise<br />
known as an “investigative consumer report”) has been obtained (See Analysis <strong>of</strong> Background<br />
Investigation).<br />
A change <strong>of</strong> a Subject’s Social Security Number <strong>for</strong> any reason or a change <strong>of</strong> name <strong>for</strong> other<br />
than marital status requires a new, satisfactory background investigation.<br />
An Affiliated Employer must not permit Other Contract Workers to provide services in or on the<br />
premises <strong>of</strong> an Affiliated Facility until the Other Contract Workers’ employer provides an<br />
attestation that such individuals are legally permitted to work in the United States.<br />
Contract language <strong>for</strong> Other Contract Workers must include the following provision:<br />
Vendor will not employ or use any individual to per<strong>for</strong>m Services under this Agreement who is<br />
not legally authorized to work in the United States in the capacity required to per<strong>for</strong>m the<br />
Services. Vendor certifies that all employees and other individuals it assigns to per<strong>for</strong>m Services<br />
under this Agreement are legally authorized to work in the United States in the capacity required<br />
to per<strong>for</strong>m the Services and will provide upon request written documentation to support such<br />
certification. Vendor agrees that if the status <strong>of</strong> any employee or other individual so assigned by<br />
Vendor changes during the Term <strong>of</strong> this Agreement such that that person is not legally<br />
authorized to work in the United States in the capacity required to per<strong>for</strong>m the Services, Vendor<br />
shall provide notice there<strong>of</strong> to Purchaser and remove such employee or individual from<br />
per<strong>for</strong>ming any Services. Vendor agrees to defend, indemnify and hold Purchasers harmless in<br />
the event <strong>of</strong> any claim made against Purchaser related to any alleged failure <strong>of</strong> Vendor to comply<br />
with its warranties, representations, and certifications. Such failure shall constitute a material<br />
breach <strong>of</strong> this Agreement.<br />
All rights reserved. This document contains proprietary and confidential in<strong>for</strong>mation which may not be reproduced or shared without the written consent <strong>of</strong> First Onsite. 6
PROCEDURE:<br />
<strong>City</strong> <strong>of</strong> <strong>West</strong> <strong>Palm</strong> <strong>Beach</strong><br />
Background Investigations <strong>for</strong> Subjects<br />
1. Notice <strong>of</strong> Investigation. Subjects shall be provided with notice <strong>of</strong> the Affiliated Employer’s<br />
policy and practice <strong>of</strong> conducting background investigations. An Affiliated Employer must<br />
make clear that the Affiliated Employer has a policy <strong>of</strong> conducting background<br />
investigations. A signed disclosure/release <strong>for</strong>m is required prior to initiating the background<br />
investigation.<br />
2. Subjects.<br />
a. New Employee: A qualified individual evaluated to be the best candidate <strong>for</strong> a position<br />
may be extended an <strong>of</strong>fer <strong>of</strong> employment contingent upon, at a minimum, the completion<br />
<strong>of</strong> a signed application <strong>for</strong> employment and authorization <strong>for</strong> the procurement <strong>of</strong> a<br />
background investigation (i.e., an investigative consumer report) <strong>for</strong> employment<br />
purposes and a satisfactory report. The report must be received by the facility, as<br />
evidenced by the date on the report, and reviewed prior to the qualified individual’s first<br />
day <strong>of</strong> employment at the Affiliated Employer’s facility. The application <strong>for</strong><br />
employment, the authorization and the report are to be filed in the employee’s personnel<br />
file (paper records or electronic records will suffice) or <strong>for</strong> applicants not employed, in a<br />
master verification file in the Affiliated Employer’s Human Resources Department filed<br />
by year and alphabetized. Affiliated Employers should limit access to an employee’s<br />
personnel file in compliance to their policy and respective state law.<br />
b. New Employees via Acquisition: Prior to an acquisition which includes the employment<br />
<strong>of</strong> the seller’s employees, Corporate Human Resources will compare the seller’s<br />
background investigation policy to this policy in the required due diligence process.<br />
Corporate Human Resources will make a recommendation to the Division President<br />
expected to operate the newly acquired business based on that comparison. Without<br />
regard to the background investigation decision, all employees <strong>of</strong> the acquired business<br />
will be checked against the GSA List and OIG Sanction Report prior to the transaction<br />
close date to determine any match <strong>of</strong> an Ineligible Person.<br />
c. Transfers: Current employees may move among Affiliated Employers contingent upon,<br />
at a minimum, the completion <strong>of</strong> an authorization <strong>for</strong> the procurement <strong>of</strong> a background<br />
investigation and a satisfactory report. The report must be received by the facility, as<br />
evidenced by the date on the report, and reviewed prior to the employee’s first day <strong>of</strong><br />
employment in the transferred position.<br />
c. Promotions: Current employees who are not department managers or in a position with<br />
responsibilities that includes a consumer Credit Report in the background investigation<br />
report may be extended an <strong>of</strong>fer <strong>of</strong> promotion to a department manager position or a<br />
position with responsibilities that includes a Consumer Credit Report in the background<br />
investigation contingent upon, at a minimum, the completion <strong>of</strong> an authorization <strong>for</strong> the<br />
procurement <strong>of</strong> a background investigation and a satisfactory report. The report must be<br />
received by the facility, as evidenced by the date on the report, and reviewed prior to the<br />
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employee’s first day <strong>of</strong> employment in the promoted position.<br />
<strong>City</strong> <strong>of</strong> <strong>West</strong> <strong>Palm</strong> <strong>Beach</strong><br />
d. Rehires: If eligible <strong>for</strong> rehire, a background investigation report will be obtained in<br />
accordance with the position level later described. An applicant not eligible <strong>for</strong> rehire<br />
will be considered on a case by case basis and must be approved <strong>for</strong> employment by the<br />
Affiliated Employer’s Human Resources Director. The approval shall be noted in the<br />
electronic personnel/Human Resource system.<br />
e. Independent Contractors and Employees <strong>of</strong> Staffing Agencies or Contracted Service<br />
Entities that provide clinical services or otherwise could come into contact with patients<br />
or members <strong>of</strong> the public: Contracts or service agreements must be entered into with all<br />
third parties providing temporary, PRN, agency or contract employees who provide<br />
clinical services or otherwise could come into contact with patients or members <strong>of</strong> the<br />
public. Similarly, such contracts or service agreements must be entered into with third<br />
parties (other than State agencies or State employees) providing assistance to individuals<br />
in pursuing and/or obtaining Medicaid coverage. The contracts or agreements must<br />
address:<br />
i. Stipulation to background investigations based on standards herein.<br />
ii. Liability insurance coverage.<br />
iii. Indemnification.<br />
iv. Retention and Audit requirements <strong>for</strong> files <strong>for</strong> policy compliance.<br />
A background investigation report shall be completed in accordance with the position<br />
levels later described <strong>for</strong> individuals who provide clinical services pursuant to contracts<br />
with Staffing Agencies, Contracted Service Entities, or Independent Contractors. The<br />
contractor must have the completed background investigation report prior to the<br />
healthcare worker reporting <strong>for</strong> duty at a facility. A Contracted Service Entity or<br />
Staffing Agency must comply with the terms below <strong>of</strong> item 3, Third Party Ownership <strong>of</strong><br />
the Background Investigation Report. An employee <strong>of</strong> the contractor with derogatory<br />
in<strong>for</strong>mation in the report shall not be presented <strong>for</strong> utilization by the Affiliated Employer.<br />
An Independent Contractor must comply with the terms below <strong>of</strong> item 4, Company<br />
Affiliate Ownership <strong>of</strong> the Background Investigation Report.<br />
f. All About Staffing: Any Subject provided to an Affiliated Employer by All About<br />
Staffing (AAS), the Company’s subsidiary staffing agency, is subjected to a background<br />
investigation completed either by AAS or by the subcontracted staffing vendors with<br />
which AAS contracts. If a Subject does not have a satisfactory background investigation<br />
or is missing other in<strong>for</strong>mation, he or she shall not be permitted to be scheduled <strong>for</strong> work.<br />
AAS audits its own employees and staffing vendors pursuant to the audit requirements<br />
articulated below, and other Affiliated Employers are not required to audit AAS<br />
employees or AAS subcontracted staffing vendors.<br />
g. Volunteers and Auxiliary Organizations: As a requirement <strong>for</strong> participation, affiliated<br />
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<strong>City</strong> <strong>of</strong> <strong>West</strong> <strong>Palm</strong> <strong>Beach</strong><br />
volunteer organizations must agree to comply with this policy. The organization’s<br />
bylaws should reference the requirement. The cost <strong>of</strong> the background investigation may<br />
be negotiated between the Affiliated Employer and the volunteer organization.<br />
h. Students: School Affiliation Agreements should include language consistent with this<br />
policy as a requirement <strong>for</strong> student clinical rotation in affiliated facilities. The cost <strong>of</strong> the<br />
background investigation may be negotiated between the Affiliated Employer and the<br />
school. If a school should refuse to assume responsibility either <strong>for</strong> obtaining or paying<br />
<strong>for</strong> background investigations, the facility must make other arrangements <strong>for</strong> obtaining<br />
and paying <strong>for</strong> the background investigations prior to the start <strong>of</strong> student clinical rotation<br />
in an affiliated facility. Students who are not serving in a clinical rotation and will not be<br />
in the facility on a recurring basis (e.g., one-day job shadow by a high school student),<br />
should be treated like a visitor to the facility. All privacy and safety requirements <strong>of</strong><br />
visitors must be met.<br />
3. Third Party Ownership <strong>of</strong> the Background Investigation Report and Audit Requirements<br />
Volunteer organizations, schools, contract services entities, and staffing agencies that order a<br />
background investigation in compliance with this policy retain ownership <strong>of</strong> the report <strong>of</strong> the<br />
investigation. The volunteer organization, school, contract services entity, or staffing agency<br />
may attest in writing to the Affiliated Employer (including AAS) that it owns a satisfactory<br />
report in lieu <strong>of</strong> providing a copy to the Affiliated Employer. A model attestation is available<br />
on Atlas.<br />
If attestations are accepted, the Affiliated Employer (including AAS) must annually audit a<br />
sample <strong>of</strong> files <strong>for</strong> one-third <strong>of</strong> those entities that provide attestations. The Affiliated<br />
Employer must take into consideration the risk to patients presented by the type <strong>of</strong><br />
individuals provided by the entities that provide attestations and focus on those that present<br />
the greatest risk (e.g., direct care providers present a greater risk than those who undertake<br />
administrative support or property management services). A sufficient sample size will be<br />
the greater <strong>of</strong> five percent (5%) or thirty (30) files <strong>for</strong> each <strong>of</strong> the third parties. Market-wide<br />
audits are permissible under this policy in the event multiple hospitals in a market utilize the<br />
same third party vendor(s). Using the same guidelines as stated above, the pool <strong>of</strong> files<br />
audited must include all <strong>of</strong> the third party employees provided across the market and from<br />
that pool the greater <strong>of</strong> 5% or thirty (30) files are chosen.<br />
To permit Affiliated Employer review <strong>of</strong> files, the authorization <strong>for</strong> the procurement <strong>of</strong> a<br />
background investigation (otherwise known as an investigative consumer report) that the<br />
third party obtains must include the Affiliated Employer as well as the volunteer<br />
organization, school, contracted service entity, or staffing agency.<br />
4. Company Affiliate Ownership <strong>of</strong> the Background Investigation Report<br />
Affiliated Employers that order a background investigation <strong>for</strong> a Subject in compliance with<br />
this policy retain ownership <strong>of</strong> the report <strong>of</strong> the investigation.<br />
The authorization <strong>for</strong> the procurement <strong>of</strong> a background investigation (otherwise known as an<br />
investigative consumer report) should indicate the relationship <strong>of</strong> the Subject <strong>of</strong> the<br />
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<strong>City</strong> <strong>of</strong> <strong>West</strong> <strong>Palm</strong> <strong>Beach</strong><br />
investigation with the Affiliated Employer.<br />
Both the authorization and the report are to be filed by year and alphabetized if stored as hard<br />
copies. Electronic storage is also an acceptable storage option provided the documents are<br />
readily available on demand. A procedure <strong>for</strong> backing up documents in the event <strong>of</strong> system<br />
malfunction should be established to ensure accessibility.<br />
5. Minors<br />
Minors may sign, with or without the co-signature <strong>of</strong> a parent or guardian, an authorization<br />
<strong>for</strong> the procurement <strong>of</strong> a background investigation (otherwise known as an investigative<br />
consumer report) that should indicate the relationship <strong>of</strong> the Subject <strong>of</strong> the investigation to<br />
the Affiliated Employer, unless otherwise restricted by State law.<br />
6. International Applicants<br />
A properly documented U.S. visa, issued December 31, 2007 or later, satisfies the criminal<br />
search component <strong>of</strong> this Background Investigation policy <strong>for</strong> the time period prior to<br />
entering the United States.<br />
7. Background Investigation. All Subjects will have a Level I background investigation.<br />
Responsibilities may require a Level II and/or Level III background investigation as<br />
described below:<br />
Level I (All Subjects)<br />
Social Security Number Verification (non-employee student SSN’s will not be verifiable<br />
with the Social Security Administration)<br />
Criminal Search (7 years or up to 5 criminal searches)<br />
Employment Verification to include reason <strong>for</strong> separation and eligibility <strong>for</strong> re-employment<br />
<strong>for</strong> each employer <strong>for</strong> 7 years*<br />
Violent Sexual Offender and Predator Registry Search<br />
OIG List <strong>of</strong> Excluded Individuals/Entities<br />
GSA List <strong>of</strong> Parties Excluded from Federal Programs<br />
U.S. Treasury, Office <strong>of</strong> Foreign Assets Control (OFAC), List <strong>of</strong> Specially Designated Nationals (SDN)<br />
Applicable State Exclusion List on Atlas<br />
* This element <strong>of</strong> the Level I investigation is NOT required <strong>for</strong> students younger than 21 years <strong>of</strong> age. For students over 21 years <strong>of</strong><br />
age, the school may eliminate employment verification provided there is language included in the school affiliation agreement<br />
indemnifying the HCA affiliate and specifying that the school assumes full liability <strong>for</strong> any/all per<strong>for</strong>mance and/or behavior <strong>of</strong> the<br />
student during the clinical rotation.<br />
Level II (All licensed or certified caregivers, as well as finance personnel, and<br />
department managers)<br />
Social Security Number Verification<br />
Criminal Search (7 years or up to 5 criminal searches)<br />
Employment Verification to include reason <strong>for</strong> separation and eligibility <strong>for</strong> re-employment<br />
<strong>for</strong> each employer <strong>for</strong> 7 years<br />
Violent Sexual Offender and Predator Registry Search<br />
OIG List <strong>of</strong> Excluded Individuals/Entities<br />
GSA List <strong>of</strong> Parties Excluded from Federal Programs<br />
U.S. Treasury, Office <strong>of</strong> Foreign Assets Control (OFAC), List <strong>of</strong> Specially Designated Nationals (SDN)<br />
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Applicable State Exclusion List on Atlas<br />
Education Verification (highest level)<br />
Pr<strong>of</strong>essional License Verification<br />
Certification & Designations Check<br />
Pr<strong>of</strong>essional Disciplinary Action Search<br />
Department <strong>of</strong> Motor Vehicle Driving history, based on responsibilities.<br />
Consumer Credit Report, based on responsibilities.<br />
<strong>City</strong> <strong>of</strong> <strong>West</strong> <strong>Palm</strong> <strong>Beach</strong><br />
Level III (All senior level management to include Vice Presidents and above, facility CEO,<br />
COO, CFO, CNO)<br />
Social Security Number Verification<br />
Criminal Search (7 years or up to 5 criminal searches)<br />
Employment Verification to include reason <strong>for</strong> separation and eligibility <strong>for</strong> re-employment<br />
<strong>for</strong> each employer <strong>for</strong> 7 years<br />
Violent Sexual Offender and Predator Registry Search<br />
OIG List <strong>of</strong> Excluded Individuals/Entities<br />
GSA List <strong>of</strong> Parties Excluded from Federal Programs<br />
U.S. Treasury, Office <strong>of</strong> Foreign Assets Control (OFAC), List <strong>of</strong> Specially Designated Nationals (SDN)<br />
Applicable State Exclusion List on Atlas<br />
Education Verification (highest level)<br />
Pr<strong>of</strong>essional License Verification<br />
Certification & Designations Check<br />
Pr<strong>of</strong>essional Disciplinary Action Search<br />
Department <strong>of</strong> Motor Vehicle Driving history, based on responsibilities.<br />
Consumer Credit Report<br />
Newspaper Articles & Clippings<br />
Bankruptcy and Federal District Court Search<br />
3. Hiring/Rehiring Ineligible Persons. Affiliated Employers may not employ or contract with,<br />
and staffing agencies may not refer to an Affiliated Employer any Subject identified as an<br />
Ineligible Person. Ineligible Person is defined as any individual or entity who is currently<br />
excluded, suspended, debarred or otherwise ineligible to participate in the Federal health care<br />
programs; or has been convicted <strong>of</strong> a criminal <strong>of</strong>fense related to the provision <strong>of</strong> health care<br />
items or services and has not been reinstated in the Federal health care programs after a period<br />
<strong>of</strong> exclusion, suspension, debarment, or ineligibility, or any individual or entity currently<br />
excluded on a state exclusion list.<br />
4. Analysis <strong>of</strong> Background Investigation. The Affiliated Employer’s Human Resources<br />
Department or third party owner <strong>of</strong> the background investigation report, as applicable, shall<br />
notify the responsible Manager if a discrepancy arises between disclosed credentials and the<br />
verified in<strong>for</strong>mation or if the Subject is disqualified based upon the results <strong>of</strong> the background<br />
investigation.<br />
a. Derogatory in<strong>for</strong>mation <strong>of</strong> the following nature as the result <strong>of</strong> a background investigation is the basis to no longer consider a Subject<br />
qualified:<br />
i. Inclusion on the list <strong>of</strong> Ineligible Persons.<br />
ii. Ineligible <strong>for</strong> re-employment. (Any exception to this element must be approved by<br />
the Affiliated Employer’s Human Resources Director.)<br />
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iii. Termination from a previous job related to any <strong>of</strong> the following reasons:<br />
a.) Gross Misconduct;<br />
b.) Misconduct;<br />
c.) Policy violation; or<br />
d.) Unsatisfactory per<strong>for</strong>mance.<br />
<strong>City</strong> <strong>of</strong> <strong>West</strong> <strong>Palm</strong> <strong>Beach</strong><br />
b. Derogatory in<strong>for</strong>mation <strong>of</strong> the following nature as the result <strong>of</strong> a background investigation may be the basis to no longer consider a Subject<br />
qualified:<br />
i. Conviction <strong>of</strong> a felony or misdemeanor <strong>of</strong>fense, based on responsibilities.<br />
ii. Providing a false statement on credentials.<br />
iii. A documented financial problem or issue, based on responsibilities.<br />
iv. A documented traffic violation, based on responsibilities.<br />
v. Failure to maintain license.<br />
vi. Restriction on license.<br />
vii. Job abandonment.<br />
viii. Refused assignment.<br />
ix. Quit without notice.<br />
x. Absenteeism.<br />
This list is not exclusive or exhaustive. Managers should use good judgment when evaluating in<strong>for</strong>mation obtained through a background<br />
investigation report and, when in doubt, consult with the Corporate Employee Relations or Legal Department.<br />
Use <strong>of</strong> in<strong>for</strong>mation obtained from a background investigation report must be taken in context with the<br />
responsibilities intended <strong>for</strong> the Subject. Derogatory in<strong>for</strong>mation learned from a background<br />
investigation report should be considered with all other in<strong>for</strong>mation known, and a case-by-case<br />
determination should be made. The Affiliated Employer’s Human Resources Director or<br />
responsible Manager may seek clarification from the Subject regarding the derogatory<br />
in<strong>for</strong>mation. In<strong>for</strong>mation obtained from a background investigation report should remain<br />
confidential and not be shared with anyone except on a need to know basis.<br />
c. Be<strong>for</strong>e conveying an adverse action based on any in<strong>for</strong>mation in a background investigation<br />
(otherwise known as an investigative consumer report), the Subject must first be provided with:<br />
i. A copy <strong>of</strong> the background investigation (otherwise known as an investigative<br />
consumer report).<br />
ii. A written description <strong>of</strong> the Subject’s rights as prescribed by the FTC.<br />
iii. The name, address and phone number <strong>of</strong> the consumer reporting agency that<br />
provided the report.<br />
iv. A notice <strong>of</strong> the Subject’s right to dispute the accuracy or completeness <strong>of</strong> the report<br />
with the consumer reporting agency.<br />
Three days after the above is provided, the Subject must be provided with the following required<br />
disclosure:<br />
i. A notice <strong>of</strong> the adverse action.<br />
ii. A statement that the consumer reporting agency did not make the decision to take<br />
the adverse action and thus cannot tell the Subject the specific reason <strong>for</strong> the<br />
adverse action.<br />
5. Vendor. The Company recommends the background investigation reporting vendors listed on Atlas.<br />
Employer Attestation <strong>for</strong> Other Contract Workers<br />
Attestation. An Affiliated Employer must require individuals and entities with which it contracts <strong>for</strong> services that<br />
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<strong>City</strong> <strong>of</strong> <strong>West</strong> <strong>Palm</strong> <strong>Beach</strong><br />
will be conducted in or on the premises <strong>of</strong> the Facility to provide a written attestation that it has checked to ensure<br />
individuals provided to conduct services in or on the premises <strong>of</strong> the Facility are legally permitted to work in the<br />
United States. A single attestation stating any and all individuals provided are legally permitted to work in the<br />
United States is permissible.<br />
REFERENCES:<br />
1. Recruitment Policy, HR.OP.<strong>02</strong>7<br />
2. Transfer-Promotion-Demotion Policy, HR.OP.035<br />
3. Limitations on Employment Policy, HR.OP.019<br />
4. Employment Application<br />
5. Fair Credit Reporting Rights<br />
6. Fair Credit Reporting Act Background Research Form<br />
7. Enhanced Border Security and Visa Entry Re<strong>for</strong>m Act <strong>of</strong> 20<strong>02</strong><br />
All rights reserved. This document contains proprietary and confidential in<strong>for</strong>mation which may not be reproduced or shared without the written consent <strong>of</strong> First Onsite. 13
<strong>City</strong> <strong>of</strong> <strong>West</strong> <strong>Palm</strong> <strong>Beach</strong><br />
ESTIMATED PASS THROUGH CLINIC EXPENSES Y1 Y2 Y3 Y4 Y5 COMMENTS<br />
Annual Expense Growth Rate 3% 3% 3% 3%<br />
Supply Expense ($2.50 per visit) $6,730 $6,932 $7,140 $7,354 $7,575<br />
Contract Services (Bio-hazard removal and cleaning services) $800 $824 $849 $874 $900 Quote from Coast Medical Services<br />
Licensing & Maintenance (s<strong>of</strong>tware, dispensing equip.) $5,800 $5,974 $6,153 $6,338 $6,528 ECW s<strong>of</strong>tware license and Rx dispensing equipment maint.<br />
Rents & Leases (copier) $1,200 $1,236 $1,273 $1,311 $1,351<br />
Utilities (T1 line) $3,708 $3,708 $3,708 $3,708 $3,708 Quote from MegaPath $309/month<br />
Insurances (malpractice) $2,500 $2,750 $3,000 $3,250 $3,500 Not to exceed $3,500<br />
Marketing & Advertising $1,500 $1,545 $1,591 $1,639 $1,688<br />
Other (Medical Licensing) $455 $469 $483 $497 $512 State practitioner and pharmaceutical licenses<br />
Medical Review Officer Fee ($5 per drug screen) 10% $2,933 $3,<strong>02</strong>1 $3,112 $3,205 $3,301<br />
Firemen and Policemen annual drug test plus an additional<br />
10% <strong>of</strong> the remaining employees<br />
B Reader (Specialized X-ray reader) expense $75/per X-ray 10% $3,750 $3,863 $3,978 $4,098 $4,221 $75 per chest X-ray <strong>for</strong> all Firemen and Policemen new hires<br />
Radiology Reader expense 1% $2,019 $2,080 $2,142 $2,206 $2,272 $75 per X-ray<br />
Prescription Medication Expense ($4.55 ea.) $24,497 $25,232 $25,989 $26,769 $27,572 2 scripts per visit<br />
Lab Fees ($11 ea.) $45,903 $47,280 $48,698 $50,159 $51,664<br />
TOTAL ESTIMATED PASS THROUGH EXPENSES $101,795 $104,913 $108,116 $111,409 $114,792<br />
Firemen and Policemen annual exam plus an additional 25% <strong>of</strong><br />
the remaining employees and dependents
Report Name Description Frequency<br />
Claims Analysis Reports<br />
Utilization <strong>of</strong> Services<br />
Report<br />
Clinic Provider Utilization<br />
Report<br />
Population Summary<br />
Report<br />
Details number <strong>of</strong> on-site vs. <strong>of</strong>f-site visits by<br />
type <strong>of</strong> service.<br />
Details number <strong>of</strong> clinic visits by provider type.<br />
Details population numbers by demographics,<br />
insurance carrier, number <strong>of</strong> visits, and clinical<br />
indicators.<br />
Annually<br />
Monthly<br />
Annually<br />
Eligibility Report Eligible population by employees, spouses<br />
and dependents<br />
Monthly<br />
Patient Satisfaction Details patient satisfaction surveys by metric. Quarterly<br />
Utilization Reports<br />
Clinic Utilization Report Details clinic visit by type <strong>of</strong> service, provider<br />
type and capture rate.<br />
Participation Report by<br />
Program<br />
Clinical Reports<br />
Details number <strong>of</strong> patients by program type<br />
and number <strong>of</strong> referred versus number <strong>of</strong><br />
enrolled.<br />
Monthly<br />
Monthly<br />
Executive Summary Report Provides population summary <strong>of</strong> number <strong>of</strong><br />
participants by risk, demographics, stages <strong>of</strong><br />
change, and risk severity.<br />
Annually<br />
Aggregate Report Details all metrics captured from the PHA by<br />
number and percentage <strong>of</strong> overall population.<br />
Annually<br />
Medications Report Details <strong>of</strong> all medications prescribed from<br />
clinic staff.<br />
Monthly<br />
Top 15 Diagnosis Details top 15 diagnoses from clinic staff. Monthly<br />
Top 5 Referrals Details top 5 referrals from clinic staff. Monthly<br />
Condition Specific Report<br />
(DM)<br />
Details percentage <strong>of</strong> disease population in<br />
compliance with treatment protocols.<br />
Preventive Care Report Details preventive care visits and compliance<br />
with screenings and vaccinations.<br />
Outcomes/Financial Reports<br />
Annually<br />
Annually<br />
Productivity Summary Calculates lost work days Monthly<br />
Utilization Cost Avoidance<br />
Report<br />
Productivity Cost Avoidance<br />
Report<br />
Administrative Costs and<br />
ROI Report<br />
Details avoided cost savings by lab,<br />
procedure, diagnostic tests, specialist visits,<br />
and ER visits.<br />
Details productivity savings by type <strong>of</strong> visit <strong>for</strong><br />
procedures provided at the on-site clinic<br />
versus <strong>of</strong>f-site visit.<br />
Calculates net savings and ROI by measuring<br />
clinic management/operating costs and cost<br />
avoidance savings.<br />
Avoidable ER Visits Report Details potential avoidable ER visits expected<br />
across life <strong>of</strong> the contract.<br />
Occupational Health Reports<br />
Annually<br />
Annually<br />
Annually<br />
Annually
Report Name Description Frequency<br />
Occupational Examination<br />
Report<br />
Details employee in<strong>for</strong>mation, exam type, test<br />
results, qualifications, and physician sign-<strong>of</strong>f.<br />
Employee Injuries by Type Details employee injuries by type <strong>for</strong> a specific<br />
time frame.<br />
Employee Injury<br />
Comparison Report<br />
Provides comparison <strong>of</strong> employee injuries by<br />
type <strong>for</strong> multiple years.<br />
Injuries by Department Details number <strong>of</strong> injuries by department or<br />
group.<br />
Monthly<br />
Monthly<br />
Monthly<br />
Monthly