HomeMy WebLinkAboutIndigent Care
Augusta Richmond GA
DOCUMENT NAME: '\C\Oj2f'-1- QD.X ~
DOCUMENT TYPE: ~~E:~~~
YEAR: ~<6
BOX NUMBER: .C)....\
FILE NUMBER: \ 6l..o 319
NUMBER OF PAGES: 'f()
AUGUSTA-RICHMOND COUNTY INDIGENT CARE AGREEMENT
This Agreement is effective the 1st day of January, 1998, by and between Augusta,
Georgia, acting by and through the Augusta-Richmond County Commission (hereinafter
referred to as the "County") and University Health Services, Inc, d/b/a University Hospital
(hereinafter referred to as "University"), upon the terms and conditions set forth below.
WIT N E SSE T H:
WHEREAS, County and University have contracted for over thirty years for the
provision of certain health care services to the indigent residents of Augusta, Georgia; and
WHEREAS, County and University entered into that certain Amendment to
Agreements (the "Amendment") effective December 13, 1994, which Amendment governed
the provision of certain health care services to the indigent residents of Augusta, Georgia;
and
WHEREAS, the Amendment expired as of January 31, 1996; and
WHEREAS, for calendar year 1997, the parties operated under the same terms and
conditions as~ set forth in the Amendment; and
WHEREAS, County and University desire to contract for the provision of certain
health care services to the indigent residents of Richmond County for calendar year 1998;
NOW, THEREFORE, for and in consideration of the promises and covenants
contained herein, and for other good and valuable consideration, the receipt and sufficiency
of which is hereby acknowledged, the parties hereto, intending to be legally bound, do
hereby agree as follows.
SECTION I.
TERM OF AGREEMENT
This Agreement shall be for a term beginning January 1, 1998 and continuing until
the termination date provided by this Agreement of December 31, 1998.
SECTION II.
PROVISION OF HEALTH CARE SERVICES TO CERTIFIED
INDIGENTS; PAYMENTS BY COUNTY
County and University agree to the following terms and conditions for the providing
of certain Covered Health Care Services to the indigent residents of Richmond County
beginning January 1, 1998 and continuing until December 31, 1998:
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A. Provision oLServices
University covenants and agrees to provide to the certified indigent residents of
Richmond County all Covered Health Care Services (as defined in Section II,D. below)
usually and customarily provided by it, including emergency room, outpatient clinic, inpatient
and physician services, in a prompt and proper manner consistent with professional
standards and all applicable laws and regulations, University further covenants and agrees
to provide said services to said patients in the same manner and quality as provided to other
patients of University. It is understood that University customarily provides physician
selVices only in a limited number of specialties, and only to a limited extent in those
specialties, Nothing in this Agreement is intended to or shall have the effect of expanding
University's obligation to provide services to certified indigents beyond those selVices
provided on January 1, 1994,
University reserves the right to deny services to any patient who engages in dangerous
or disruptive behavior.
B, Certification of Residency
In order to receive Covered Health Care Services (as hereinafter defined), a patient
or responsible household member must have been a resident of Richmond County for at
least six (6) consecutive months prior to the date Covered Health Care Services are sought,
Responsible household members are persons legally married (whether by ceremony or
common-law) or living in a domestic relationship (as defined in guidelines for purposes of
Aid to Families with Dependent Children eligibility), and the legally responsible parents or
guardians of children under the age of 18. If there is doubt as to who are the legally
responsible parents of children under the age of 18, a copy of the child's birth certificate
shall be required to verify parentage.
Residency must be confirmed by at least one (1) of the following:
1. rent receipts for a period of six (6) consecutive months, a lease,
or a statement by a rental agency or established real estate business that the patient has
resided in the County for at least 6 months;
2. a valid Georgia driver's license showing an examination date at
least 6 months old and a Richmond County address;
3, employment check stubs showing the patient's (or a responsible
household member's) address during the preceding 6-month period, or a statement from the
patient's (or a responsible household member's) employer attesting to residence in
Richmond County;
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4. utility bills or payment stubs (at least one of which is current and
at least one of which is between 6 and 12 months old) in the patient or a responsible
household member's name;
5. a telephone book or city directory listing showing the patient's
or responsible household member's name;
6. a voter registration card issued at least 6 months before and
showing a Richmond County polling place;
7. attestations of residency (in the form of affidavits) for at least
6 months from the patient and two other people, one of whom must be a minister with a
Richmond County congregation or the director of a private relief organization such as the
Salvation Army;
8. a letter from DFACS verifying receipt of food stamps from
Richmond County DFACS; or
9. a currently valid University certification card issued under
Section B.5, below.
No bill for a patient whose residency cannot be certified according to the above
requirements shall be submitted to, or paid by, the County. University agrees to notify the
County immediately should it receive information that any certification is in error, or that
any patient is attempting to certify residency falsely.
C. Certification of Indigency
In order to receive Covered Health Care Services (as hereinafter defined) each
patient must be certified as indigent according to this Agreement. As a preliminary matter,
such certification shall confirm that each said patient is with respect to the Covered Health
Care Service "self-pay", that is
a. does not have valid health insurance and/or medical payments coverage
for the Covered Health Care Service (per diem hospitalization reimbursement policies shall
not be considered health insurance or medical payments coverage, but rather will be
included as an asset for purposes of determining resources, and whenever such assets are
involved, each inpatient hospitalization will require separate certification);
b, does not have Medicare or Medicaid insurance coverage (except that
persons with Medicare or Medicaid insurance coverage may qualify as indigent with respect
to outpatient pharmacy services); and
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c.
Care SeIVice.
does not have worker's compensation coverage for the Covered Health
Unless otheIWise disqualified, a patient will be ceriified as indigent under this
Agreement if the sum of hisfher gross income plus other responsible household members'
gross income(s), is equal to or less than that listed in the attached income scale (based upon
the Federal Poverty Guidelines) for the applicable household size. The attached income
scale shall be amended January 1 of each calendar year in order to correspond with the then
current Federal Poverty Guidelines.
For purposes of this section, responsible household members' gross income includes
the gross income of any dependent children. For purposes of this section, any child
(regardless of age) who is or could be claimed as a dependent on hisfher parent's income
tax return will be considered for indigency certification according to hisfher parent's gross
income (with respect to a minor with an absent parent who is not providing support to that
minor, the minor shall not be considered as having income from that absent parent),
1. Determination of Gross Income
For purposes of this section, gross income means any and all income before
deductions, and includes the following:
a, wages and salaries before any deductions;
b. receipts from self-employment before any deductions, or from
an owned farm or business after farm and business deductions;
c, public assistance in any form;
d. social security payments;
e. supplemental security income (SSI);
f, unemployment compensation;
g. workers' compensation payments;
h. veterans's benefits;
I. training stipends;
J. alimony payments;
k. child support payments;
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1. military family allotments;
m. regular support from absent family members or
persons not living in the household;
n. government employee pensions;
o. private pensions;
p. insurance benefits paid on a regular, annuity-like basis;
q,
annuity payments;
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r. dividends, interests, rents, royalties, income form estates and
trusts;
s. union payments or assistance of any kind; and
1. any other form of income which results in disposable spendiI1g
ability (such as student loans used for living expenses).
2. Verification of Gross Income
Gross income shall be verified as follows:
a. Possession of a currently valid Outpatient Clinic card issued
under Section C.5 below; or
b. For food stamp recipients, gross income shall be determined
from DFACS records (unless such records are more than 12 months old); or
c. For other than food stamp recipients (or for those whose
DFACS records are more than 12 months old), gross income shall be determined from
federal and/or state income tax returns for the immediately preceding year for the patient
and all responsible household members and with all children (except those born after the
end of the last tax year) accounted for as dependents, with adjustments made to bring
figures current; or
d, Where income tax returns are not available, the patient and all
responsible household members shall be required to disclose under oath all income (as
defined in this Section II.C.) received in the last 8 weeks from all sources, Income shall be
verified according to DF ACS routine standards.
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University shall require patients to authorize DFACS to access their income records
from the computer records of the' Georgia Department of Labor. Any patient refusing to
provide such authorization shall not be certified as indigent. Within seven days of its receipt
of the authorization, DFACS will notify University if the DOL income exceeds the patient's
certified indigency level.
3. Resources
Once a patient's income is determined, DFACS shall determine the resources of that
patient. Any patient whose total resources exceed $1,500.00 shall not be certified as
indigent; provided, however, that in the event said patient's resources later fall below
$1,500.00, said patient may reapply for indigent certification, and said patient will be allowed
to pay toward his/her billings from University for Covered Health Care Services until the
$1,500.00 figure is reached. For purposes of this section, "resources" include the following:
a. real estate equity value (real estate includes mobile or
manufactured homes);
b. cash reselVes (except that cash reselVes of $800.00 or less are
not counted as resources);
c. equity value of automobiles and other vehicles (except that up
to two vehicles used by the patient and/or household members for transportation to and
from work or used regularly for seeking work will not be counted as resources); and
d, life insurance (except that the first $3,000.00 of cash value for
life insurance for the patient and each responsible household member shall not be counted
as resources).
e. per diem hospitalization policy payments (each inpatient
admission involving a person with this resource must be separately certified).
A transfer of resources solely for the purpose of becoming or remaining eligible for
indigent status under this Agreement may result in disqualification of the applicant.
Determinations of whether a transfer of resources as contemplated herein has occurred, and
whether disqualification is warranted shall be made by DFACS, in its sole discretion,
applying current AFDC, or other appropriate guidelines,
4. Other Requirements and Standards for Patients
a. Medicaid/SSI
Unless excused in writing by DF ACS, within 60 days of the issuance of a certification
card as a Richmond County indigent, a patient must make a formal application through
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DFACS for Medicaid coverage. If a patient refuses to make such application, or if
Medicaid coverage is denied due to an excess in resources, the patient's indigent certification
will be retroactively revoked,
If determined by DFACS to be SSI eligible, within 30 days of notification from'
DFACS a patient must make a formal application through DFACS for SSI coverage. If a
patient refuses to make such application, or if SSI coverage is denied due to an excess in
resources, the patient's indigent certification will be revoked retroactive to the date of
notification to apply for SSI.
In the event an application for either Medicaid or SSI coverage is denied due to
procedural grounds (including, but not limited to the patient's failure to cooperate in the
application process), the patient's indigent certification will be retroactively revoked,
b. Unemployment
Any patient or responsible household member claiming to be unemployed must
produce evidence of disability or verification from the Georgia Department of Labor that
he/she has registered with them and has received an Employment Application Card and is
active in the "Peach Program"; provided, however, that this subsection does not apply to
adults legally responsible for the care of young children (under age 12) or a disabled
individual.
c, Food Stamps
If determined by DFACS to be eligible for food stamps, within 30 days of notification
from DFACS, a patient must make a formal application through DFACS for food stamps,
If a patient refuses to make such application, or if food stamp eligibility is denied due to an
excess in resources (except a vehicle exempt under II. C. 3,c, above), the patient's indigent
certification will be revoked, Further, if an application for food stamps is denied due to
procedural grounds (including, but not limited to the patient's failure to cooperate in the
application process), the patient's indigent certification will be revoked retroactive to the
date of notification to apply for food stamps,
d, Records
Unless a longer period is specified, patients must provide any information requested
in connection with the certification and billing process within fifteen (15) business days of
request, Failure to do so shall result in a denial of indigent certification or revocation
retroactive to the date of the request.
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5, Certification Process
All certification cards are to be provided by University ~nd issued by DFACS. Cards
are valid for any covered service event ending 60 days immediately preceding issuance and
for the 12 month period after issuance, Cards must be reissued at least every 12 months,
DFACS shall make all efforts to process certifications within 30 days from its receipt
of a request for certification. DF ACS shall station at least one employee to accept Medicaid
applications at University's outpatient clinics during clinic hours. This processing time shall
be tolled during any period within which the DF ACS worker is waiting for information from
the patient; provided, however, that if such information is not forthcoming in the time
period specified in Section II. C.4, above, certification shall be denied, In the event DFACS
does not process certifications in the time specified above, the patient shall be provisionally
certified as 100% indigent. In the event the patient is later determined by either DF ACS
or the County to be less than 100% indigent, the provisional certification shall be revoked
and the County shall receive a credit in accordance with Section II.H.3. below.
The application for indigency shall not require more than a sixth grade education to
complete, and shall not be longer than 1 page in length,
DFACS shall keep University apprised of the name, address and telephone number
provided by each patient seeking certification as indigent. University reserves the right to
assist DFACS in the certification process when deemed necessary, DFACS shall notify
University when an applicant has only 3 business days remaining before possible denial of
certification based on Section II,C. 4 above.
University agrees to inform DF ACS whenever it learns of a change in status of a
patient, or otheJWise obtains information suggesting that the certification level of a patient
should be changed.
Where certification is denied based upon an applicant's failure to provide
documentation or verification of information, or an applicant's income and/or resources, that
applicant may reapply for certification beginning on the 31st day following denial. Where
certification is denied based upon an applicant's residency status, the applicant may reapply
for certification in the month in which the residency requirement is met. Documentation
required for reapplication, including a new application where applicable, will be as is
determined by DF ACS.
6. Reports
University agrees, using information provided to it by DF ACS, to produce reports
in substantially the form attached hereto as Exhibit "A" and to provide such reports to the
County as they are created. University further agrees to create and provide to the County
such other reports as the County may reasonably request from time to time in order to
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evaluate the performance of University under this Agreement.
7. Appeals Process
Patients denied indigent certification, denied a higher certification level, or whose
indigent certification is revoked, may appeal such determinations to the Director of DF ACS.
Such appeal must be in writing and submitted to said Director no more than 30 days after
the date of denial or revocation, The Director shall make his determination on the issue
and submit it to the Appeals Board for final approval or disapproval. If the denial, lower
certification level, or revocation is overturned, all Covered Health Care Services from 60
days prior to the submission of the original request for certification shall be covered under
the indigent certification determined by the Appeals Board,
D. Non-Covered Health Care Services
Only those Covered Health Care Services which are medically necessary are to be
provided to certified indigent residents of Richmond County pursuant to this Agreement.
The following health care services are not covered and shall not be paid for by the County:
1. Inpatient and outpatient services and/or procedures not covered by the
Georgia Medicaid program or the federal Medicaid program; provided, however, that
outpatient prescription medicines dispensed by University's pharmacy are covered if
prescribed by a physician salaried by or under contract with University,
2, Services provided on an inpatient basis which are routinely provided
on an outpatient basis; provided, however, that inpatient diagnostic procedures will be
covered when performed in conjunction with treatment requiring an inpatient admission or
a 23-hour observation admission.
3,
covered service,
Cosmetic surgery; provided, however, that reconstructive surgery is a
4. Physician fees; provided, however, that the fees of physicians who are
salaried by or under contract with University are covered,
5. Ambulance and other transport services,
6. Abortions; provided, however, that an abortion performed when the
mother's life is in danger is covered.
7. Home Health Care Services; provided, however, that when a physician
states in writing that the providing of Home Health Care Services are necessary to avoid an
inpatient admission or to avoid extending an inpatient admission, those services will be
covered.
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8, Any service rendered more than 6 months' prior to a patient's initial
request for certification.
E. Non-Covered Patients
The individuals listed below are not eligible for indigent care payments by the
County:
1. Any person receiving Cancer State Aid except when program
funds are exhausted as to that person or the Covered Health Care Service is not covered
by Cancer State Aid,
2. Any veteran eligible for Veterans' Administration assistance for
the Covered Health Care Service; provided, however, that DFACS must establish non-
eligibility with some evidence beyond veteran status and a disability pension of 50% or less.
3. Any member of the military or any military member's
dependent( s).
4,Any person not a resident of Richmond County; provided,
however, that the coverage of a person while a resident who later moves away, is not
affected by this provision.
5. Any person who, within the last 3 years, was convicted of welfare
fraud, entered into a disqualification consent agreement, was determined at an
administrative hearing to have committed an intentional welfare program violation, or who
waived a disqualification hearing with respect to a charge of welfare fraud or intentional
program violation,
6, Any college student who is covered under his/her parent's
insurance coverage, or who is provided health care services by the college or institution in
which he/she is enrolled;
7. Any transient worker, such as a construction or agricultural
worker, who is domiciled outside of Richmond County,
8. Any resident of a public institution,
9. Any individual domiciled outside Richmond Count who is
present in Richmond County due to participation in a halfway house program or other
rehabilitation program.
10, Any illegal alien or illegal immigrant.
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11. Any patient who initiates a lawsuit to establish SSI disability;
provided, however, that the initiation of such a lawsuit only suspends coverage as an indigent
until successful resolution of the lawsuit, at which time any seIVices not reimbursed by
Medicare or Medicaid due to timeliness may be paid for by the County,
12. Any and all inmates whose health costs are covered by the local,
state or federal penal institution in which he/she is being housed.
F. Payments by Patient
Each certified indigent resident of Richmond County will be required to make
payments toward his/her bill in accordance with the provisions of the September 20, 1977
Agreement between University and the County concerning indigent care; however, a failure
to make payments will not automatically disqualify the resident. University may, in its
discretion, revoke a certification card after giving the holder thirty (30) days' advance written
notice that the card will be revoked for failure to make payment in accordance with the
cardholder's status, The revocation will have prospective effect only, The individual whose
card is revoked in this manner may not subsequently be issued an indigent certification card
without the written approval of University.
G, Payments by County
County shall not be responsible for the payment of any costs and/or charges for any
person not certified as an indigent resident of Richmond County in accordance with this
Agreement.
For all "certified", indigent residents of Richmond County, County shall be
responsible for payment within thirty days of receipt of a bill for Covered Health Care
Se1Vices provided by University pursuant to this Agreement as follows:
1. Emergency Room
For all certified indigent residents, County agrees to pay the "cost" for all Covered
Health Care Services provided in University's Emergency Room, including seIVices provided
by physicians either salaried by or under contract with University, less, where applicable, the
amount of patient payment required by the patient's certification level whether or not the
patient makes the payment. As to Covered Health Care SeIVices, "cost" means the product
of charges for such seIVices multiplied by University's most recent Medicare cost-to-charge
ratio, As to physicians' seIVices, "cost" means the physicians' fees as determined by CPT-4
billing codes and Medicaid fee schedule.
2. Outpatient Clinic
For all certified indigent residents, County agrees to pay the "cost" for all Covered
11
Health Care Services provided in University's Outpatient Clinics, including services provided
by physicians either salaried by or under contract with University, less, where applicable, the
amount of patient payment required by the patient's certification level whether or not the
patient makes the payment. As to Covered Health Care Services, "cost" means the product
of charges for such services multiplied by University's most recent Medicare cost-to-charge
ratio. As to physicians' services, "cost" means the physicians' fees as determined by CPT-4
billing codes and Medicaid fee schedule. As to pharmaceuticals, "cost" means University's
acquisition cost.
3, Inpatient
For all certified indigent residents, County agrees to pay the "cost" for all Covered
Health Care Services provided on an inpatient basis, including services provided by
physicians either salaried by or under contract with University, less, where applicable, the
amount of patient payment required by the patient's certification level whether or not the
patient makes the payment. As to Covered Health Care Services, "cost" means the product
of charges for such services multiplied by University's most recent Medicare cost-to-charge
ratio, As to physicians' services, "cost" means the physicians' fees as determined by CPT-4
billing codes and Medicaid fee schedule,
4, Cap on Payments
Regardless of actual costs and/or charges incurred and billed under this Section II"
County shall not payor be required to pay in excess of One Million Two Hundred Ninety
Three Thousand Seven Hundred Fifty Dollars ($1,293,750.00) (hereinafter referred to as
the "Cap") for Covered Health Care Services rendered pursuant to this Agreement,
H, Credits to County
University agrees to continue its collection efforts on all unpaid bills for which the
County is entitled to a credit under this Agreement. County is entitled to a credit, to the
extent of its payment on a particular patient account, on its next billing, as follows:
1. to the extent of University's recovery under any lien imposed
under Georgia law;
2. to the extent any indigent certification is revoked for any reason
(except as provided in Section II.F" above), or is denied after Covered Health Care Services
are provided; and
3, to the extent University collects more from a certified patient
than that patient's liability under the patient's certification level.
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I. Billings to County
1. University's billings to the County shall contain the following
inforiiiiition:
a. Name of patient; address of each patient; date of each
selVice; CPT code for each outpatient selVice or the
ICD-9 code for inpatient service; the charge for each
service; and, the County liability for each selVice
b, A summary by area (ER, Clinic, inpatient or outpatient)
which includes total charges, total County liability,
applicable cost to charge ratio, credits by type, and
errors or omissions discovered during the billing period
related to prior bills
c, A list of the current certified indigent care card holders
d, A statement signed by University's CFO and
Administrator that the billings comply with 'this
Agreement and that billings include only individuals
certified by DFACS
2, University shall provide County the following:
a. University's most recent Medicare Cost Report and all
subsequent changes thereto
b, Upon request, University will provide access to its
charge master as of January 1, 1997 and all subsequent
changes thereto. The County shall hold the charge
master in strict confidence and will not redisclose charge
master information
3, University shall provide County within a reasonable time after
a request for a specific account information, the payment detail
of any account upon which County makes a payment,
J, Review of 1998 Billings
The parties agree that County (or its designated agent) shall be allowed to review all
billings by University to the County and that University shall furnish to County (or its
designated agent) all documents and materials necessary for County to complete said review,
Unless County requests in writing additional specific documents, County shall be deemed
13
to have received all necessary documents and materials thirty days after receipt of each bill.
County shall have 90 days from the later of the receipt of each bill or its receipt of
specifically requested additional billings, documents and materials to complete its review.
After said 90 day period, the bills shall be final and uncontestable, except as limited by the
Cap. The payment of bi~ls shall not be delayed by review under this section.
IV. AMBULANCE SERVICES
No charges shall be made by University to the County under this Agreement with
regard to ambulance service provided by University to certified indigent residents of
Richmond County. All aspects of such ambulance services shall be covered by and under
the Agreement for ambulance services dated September 23, 1971 as amended.
VI. MISCELLANEOUS PROVISIONS
A. Amendment
This Agreement may be amended only by the express written consent and agreement
of both parties hereto.
B, Sole Agreement
This Agreement represents the entire agreement between the parties hereto and
supersedes any and all previous written and/or oral agreements or understandings,
C. Governing Law
This Agreement shall be governed by and construed in accordance with the laws of
the State of Georgia,
D, Severability
In the event any provision of this Agreement is rendered invalid or unenforceable
under any law or regulation, or declared null and void by any court of competent
jurisdiction, the remainder of the provisions of this Agreement shall, subject to this
paragraph, remain in full force and effect.
E. Waiver
Waiver of a breach of any provision of this Agreement shall not be deemed a waiver
of any other breach of the same or different provisions,
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F. Notices
Any notice to be given hereunder by one party to the other shall be effected in
writing and may be delivered either by certified U.S. mail with return receipt requested, by
regular U.S. mail, properly addressed and postage prepaid, by overnight mail or by hand-
delivery to the addresses listed below. Any party may change its address below by written
notice given in accordance with this Section. Notices delivered personally shall be deemed
received upon actual receipt. Notices mailed shall be deemed received no later than two
(2) United States Postal Service business days after the date of such mailing.
To University:
University Health Services, Inc.
Robert M. Taylor, Vice President for Finance
1350 Walton Way
Augusta, Georgia 30901-2629
To County:
Augusta-Richmond County Commission
c/o Charles R. Oliver, Administrator
8th Floor - City-County Building (11)
530 Greene Street
Augusta, Georgia 30911
IN WITNESS WHEREOF, the parties hereto have set their hands and seals as of
the day first above written.
By:
Title:
(i)
~
. ~fl,/
na B ner
Title: Clerk
[SEAL]
[SIGNATURES CONTINUE ON FOLLOWING PAGE]
15
ATTEST:
Cw-~{). ~
Name: arolyn D. MIlls
Title: Executive Assistant
[SEAL]
UNIVERSITY HEALTH SERVICES, INC.
Donald C. Bray
President/CEO
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