EXHIBIT10.19

*ARIZONAHEALTH CARE COST CONTAINMENT SYSTEM ADMINISTRATION*DIVISION OF BUSINESS AND FINANCECONTRACT AMENDMENT

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| 1. AMENDMENT NUMBER:     21                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   |                                            | 2.  CONTRACTNO.:      YH8-0001-08                                                                                                                                                                                                                                                                                                                                              |  | 3.  EFFECTIVE DATE OFMENDMENT:      October 1, 2001 |  | 4.  PROGRAM:      OMC |
|--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|--------------------------------------------|---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|--|------------------------------------------------------------------------------|--|------------------------------------------------|
| 5. CONTRACTOR’S NAME AND ADDRESS:

VHS PhoenixHealth Plan 2700 N. Third Street, Suite 3000 Phoenix, Arizona  85004                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                |
| 6. PURPOSE OF AMENDMENT:  To adjust the capitation rates fora $50,000 reinsurance deductible.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           |
| 7. THE CONTRACT REFERENCED ABOVE IS AMENDED AS FOLLOWS:     A.   New Capitation Rates areprovided on page two (2) of this amendment.          *NOTE:  Please sign anddate both and then return oneto:          Michael Veit                                                                                               AHCCCS Contracts and Purchasing                                                                                               701 E Jefferson Street, MD 5700                                                                                              Phoenix, AZ  85034* |
| 8. EXCEPT AS PROVIDED FOR HEREIN, ALL TERMS AND CONDITIONS OFTHE ORIGINAL CONTRACT NOT HERETOFORE CHANGED AND/OR AMENDED REMAINUNCHANGED AND IN FULL EFFECT. IN WITNESS WHEREOF THE PARTIES HERETO SIGN THEIR NAMES INAGREEMENT                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         |
| 9.SIGNATURE OF AUTHORIZED REPRESENTATIVE:    /s/ NancyNovick                                    TYPED NAME:  NANCY NOVICK    TITLE:  CHIEF EXECUTIVE OFFICER                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               |         | 10.SIGNATURE OF AHCCCSACONTRACTING OFFICER:      /s/ MichaelVeit                                        MICHAEL VEIT      CONTRACTS & PURCHASINGADMINISTRATOR |
| DATE:  11/6/01                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     |                        | DATE:  NOV 012001                                                                                                                                                                                                                                                                                                                                                                             |

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ARIZONAHEALTH CARE COST CONTAINMENT SYSTEMCAPITATION RATE SUMMARY - ACUTE RATESPhoenix Health Plan/Community ConnectionCYE ’02 (AS OF 10/01/01)
| **Title XIXRates****:**                   |   | TANF<1, M/F     |   | TANF1-13, M/F     |   | TANF14-44, F     |   | TANF14-144, M      |   | TANF 45+, M/F |   | SSIw/Med |   | SSI w/o Med |   | SFP    |   | DELIVERYKICK |   | TITLEXIX WAIVER GROUP |   | HOSPITALIZEDKICK |
|-------------------------------------------|--------|--------------------|--------|-------------------|--------|------------------|--------|--------------------|--------|---------------|--------|----------|--------|-------------|--------|--------|--------|--------------|--------|-----------------------|--------|------------------|
| 8     Gila/Pinal |   | $383.31            |   | $84.16            |   | $153.39          |   | $109.89            |   | $317.20       |   | $205.87  |   | $425.70     |   | $19.69 |   | $5,188.60    |   | $368.42               |   | $13,967.42       |
| 12   Maricopa              |   | $355.28            |   | $76.87            |   | $123.50          |   | $  99.10 |   | $281.15       |   | $206.46  |   | $389.89     |   | $19.68 |   | $4,911.82    |   | $314.65               |   | $12,591.60       |
|                                      |   |               |   |              |   |             |   |               |   |          |   |     |   |        |   |   |   |         |   |                  |   |             |
|                                      |   |               |   |              |   |             |   |               |   |          |   |     |   |        |   |   |   |         |   |                  |   |             |
| **Title XXIRates****:**                   |   | KIDSCARE<1, M/F |   | KIDSCARE1-13, M/F |   | KIDSCARE14-18, F |   | KIDSCARE14-18, M   |   |          |   |     |   |        |   |   |   | DELIVERYKICK |   |                  |   |             |
| 8     Gila/Pinal |   | $278.21            |   | $80.63            |   | $130.57          |   | $81.74             |   |          |   |     |   |        |   |   |   | $5,188.60    |   |                  |   |             |
| 12   Maricopa              |   | $282.72            |   | $82.71            |   | $119.03          |   | $81.16             |   |          |   |     |   |        |   |   |   | $4,911.82    |   |                  |   |             |
|                                      |   |               |   |              |   |             |   |               |   |          |   |     |   |        |   |   |   |         |   |                  |   |             |
|                                      |   |               |   |              |   |             |   |               |   |          |   |     |   |        |   |   |   |         |   |                  |   |             |
| **PPCRates****:**                         |   | TANF<1, M/F     |   | TANF1-13, M/F     |   | TANF14-44, F     |   | TANF14-144, M      |   | TANF 45+, M/F |   | SSIw/Med |   | SSI w/o Med |   |   |   |         |   | TITLEXIX WAIVER GROUP |   |             |
| 8     Gila/Pinal |   | $849.22            |   | $38.77            |   | $146.46          |   | $77.78             |   | $227.98       |   | $14.40   |   | $44.14      |   |   |   |         |   | $254.23               |   |             |
| 12   Maricopa              |   | $1,164.82          |   | $32.70            |   | $136.50          |   | $76.91             |   | $180.25       |   | $14.50   |   | $61.79      |   |   |   |         |   | $229.19               |   |             |

*Rates have been adjustedfor $50,000 Reinsurance Deductible.

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*ARIZONAHEALTH CARE COST CONTAINMENT SYSTEM ADMINISTRATION*DIVISION OF BUSINESS AND FINANCECONTRACT AMENDMENT

| 1. AMENDMENT NUMBER:     22                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      |        | 2.  CONTRACTNO.:      YH8-0001-08                                                                                                                                                                                                                                                                                                                                              |  | 3.  EFFECTIVE DATE OFMENDMENT:      January 1, 2002 |  | 4.  PROGRAM:      OMC |
|---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|--------|---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|--|------------------------------------------------------------------------------|--|------------------------------------------------|
| 5. CONTRACTOR’S NAME AND ADDRESS:

VHS PhoenixHealth Plan 2700 N. Third Street, Suite 3000 Phoenix, Arizona  85004                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   |
| 6. PURPOSE OF AMENDMENT:  To incorporate changes to contractrequirements to add the Breast & Cervical Cancer TreatmentProgram.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         |
| 7. THE CONTRACT REFERENCED ABOVE IS AMENDED AS FOLLOWS:     A.   Breast & CervicalCancer Program.  The attached page represents modifications tothe contract           requirements toincorporated the Breast & Cervical Cancer TreatmentProgram.     B.   Included in this amendmentare revised capitation rates for the period beginning January 1,2002.          *NOTE:  Please sign anddate both and then return oneto:          Michael Veit, MD 5700                                                                                               AHCCCS Contracts and Purchasing                                                                                              701 E Jefferson Street                                                                                               Phoenix, AZ  85034* |
| 8. EXCEPT AS PROVIDED FOR HEREIN, ALL TERMS AND CONDITIONS OFTHE ORIGINAL CONTRACT NOT HERETOFORE CHANGED AND/OR AMENDED REMAINUNCHANGED AND IN FULL EFFECT. IN WITNESS WHEREOF THE PARTIES HERETO SIGN THEIR NAMES INAGREEMENT                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            |
| 9.SIGNATURE OF AUTHORIZED REPRESENTATIVE:    /s/ NancyNovick                                    TYPED NAME:  NANCY NOVICK    TITLE:  CHIEF EXECUTIVE OFFICER                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  |   | 10.SIGNATURE OF AHCCCSACONTRACTING OFFICER:      /s/ MichaelVeit                                        MICHAEL VEIT      CONTRACTS & PURCHASINGADMINISTRATOR |
| DATE:  12/19/01                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       |   | DATE:  DEC 17,2001                                                                                                                                                                                                                                                                                                                                                                            |

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PhoenixHealth Plan/Community ConnectionContract Amendment for Breast and Cervical Treatment Program(BCCPT)

By signing the amendment,effective January 1, 2002, the contractor agrees to provideservices to members enrolled with the health plan under the Breastand Cervical Cancer Treatment Program

Programrequirements

Members eligible underBCCPT are subject to all CYE ’02 acute care contractrequirements.  Additional case management and deliverablerequirements can be found in the AMPM.

Enrollment andEligibility

Members’ Enrollmentand Eligibility requirements are delineated in A.A.C. R-9-22,Chapter 20 and are incorporated by reference.

Reimbursement

For each member, thecontractor will be paid either the TANF 14-44F or TANF 45+ monthlycapitation rate, depending on the age of the member.  Inaddition to monthly capitation, the contractor will be reimbursed100% for all medically necessary medical expenses through theAHCCCS reinsurance program.  The contractor will not have tomeet a threshold to be eligible for reinsurance under theBCCTP.

|                         |   | TANF14-44F |   | TANF45+ |
|------------------------------|--------|------------|--------|---------|
| Prospective CapitationRates: |   |       |   |    |
| GSA# 8                       |   | $153.39    |   | $317.20 |
| GSA# 12                      |   | $123.50    |   | $281.15 |
|                         |   |       |   |    |
| PPC CapitationRates:         |   |       |   |    |
| GSA# 8                       |   | $146.46    |   | $227.98 |
| GSA# 12                      |   | $136.50    |   | $180.25 |

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**TITLEXIX WAIVER GROUP RISK BANDELECTION FORM**

Per Contract YH8-0001,Paragraph 37, Compensation, Risk Sharing for Title XIX WaiverMembers:  For CYE ’02 and CYE ’03,AHCCCSA will reconcile the contractor’s PPC and prospectivemedical cost expenses to PPC capitation, prospective capitation,and hospitalized supplements paid to the Contractor during theyear.  For CYE ’02, the contractor has choice toelect:
| R       |   | Default Method:  Thisreconciliation will limit the Contractor’s losses to 2% andprofits to 4%.  Any losses in excess of 2% will be reimbursedto the Contractor, and likewise, profits in excess of 4% will berecouped.     |
|---------|--------|--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
|    |   |                                                                                                                                                                                                                                       |
| £ |   | Alternative Method: This reconciliation will limit the Contractor’s losses to 1%and profits to 1%.  Any losses in excess of 1% will bereimbursed to the Contractor, and likewise, profits in excess of 1%will be recouped. |

/s/ NancyNovick                                                       11/29/01                     Signature                                                                     Date

Phoenix Health Plan& Community ConnectionHealth Plan

*Please sign and returnthis form to AHCCCS by December 1, 2001.  If not returned,AHCCCS will assign the Default Method as stated above.

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*ARIZONAHEALTH CARE COST CONTAINMENT SYSTEM ADMINISTRATION*DIVISION OF BUSINESS AND FINANCESECTION A.  CONTRACT AMENDMENT

| 1. AMENDMENT NUMBER:     23                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     |        | 2.  CONTRACTNO.:      YH8-0001-08                                                                                                                                                                                                                                                                                                                                                    |  | 3.  EFFECTIVE DATE OFMENDMENT:      October 1, 2001 |  | 4.  PROGRAM:      OMC |
|----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|--------|---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|--|------------------------------------------------------------------------------|--|------------------------------------------------|
| 5. CONTRACTOR’S NAME AND ADDRESS:

PhoenixHealth Plan, LLC 2700 N. Third Street, Suite 3000 Phoenix, Arizona  85004                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 |
| 6. PURPOSE OF AMENDMENT:  To establish new capitation ratesfor Title XIX Waiver Group effective April 1, 2002 and to allow theContractor to elect their risk band method of the Title XIX WaiverGroup effective October 1, 2001.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          |
| 7. THE CONTRACT REFERENCED ABOVE IS AMENDED AS FOLLOWS:     A.   New Capitation Rates forTitle XIX Waiver Group are changed to the rates provided onpage            two (2) of thisamendment effective April 1, 2002.     B.   The Contractor must selectone of the two methods of the Title XIX Waiver Group riskbands.            TheElection form is provided on page three (3) of this amendment andincorporated by reference herein.          *NOTE:  Please sign anddate both and then return oneto:          Michael Veit, MD 5700                                                                                               AHCCCS Contracts and Purchasing                                                                                               701 E Jefferson Street                                                                                               Phoenix, AZ  85034* |
| 8. EXCEPT AS PROVIDED FOR HEREIN, ALL TERMS AND CONDITIONS OFTHE ORIGINAL CONTRACT NOT HERETOFORE CHANGED AND/OR AMENDED REMAINUNCHANGED AND IN FULL EFFECT. IN WITNESS WHEREOF THE PARTIES HERETO SIGN THEIR NAMES INAGREEMENT                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           |
| 9.SIGNATURE OF AUTHORIZED REPRESENTATIVE:    /s/ NancyNovick                                    TYPED NAME:  NANCY NOVICK    TITLE:  CHIEF EXECUTIVE OFFICER                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 |   | 10. SIGNATURE OFAHCCCSA CONTRACTING OFFICER:      /s/ MichaelVeit                                        MICHAEL VEIT      CONTRACTS & PURCHASINGADMINISTRATOR |
| DATE:  3/28/02                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       |   | DATE:  MAR 012002                                                                                                                                                                                                                                                                                                                                                                                   |

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**ARIZONAHEALTH CARE COST CONTAINMENT SYSTEMCAPITATION RATE SUMMARY - ACUTE RATESPhoenix Health Plan/Community ConnectionCYE ’02 (as of 4/01/02)**

| **Title XIXRates:**           |   | **TITLEXIX**

**WAIVERGROUP** |
|-------------------------------|--------|-------------------------------|
| 8   Gila/Pinal |   | $214.97                       |
| 12 Maricopa              |   | $193.80                       |
|                          |   |                          |
| **PPCRates:**                 |   |                          |
| 8   Gila/Pinal |   | $189.16                       |
| 12 Maricopa              |   | $170.52                       |

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**TITLEXIX WAIVER GROUP RISK BANDELECTION FORM**

Per Contract YH8-0001,Paragraph 37, Compensation, Risk Sharing for Title XIX WaiverMembers:  For CYE ’02 and CYE ’03,AHCCCSA will reconcile the contractor’s PPC and prospectivemedical cost expenses to PPC capitation, prospective capitation,and hospitalized supplements paid to the Contractor during theyear.  For CYE ’02, the contractor has choice toelect:
| R       |   | Default Method:  Thisreconciliation will limit the Contractor’s losses to 2% andprofits to 4%.  Any losses in excess of 2% will be reimbursedto the Contractor, and likewise, profits in excess of 4% will berecouped.     |
|---------|--------|--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
|    |   |                                                                                                                                                                                                                                       |
| £ |   | Alternative Method: This reconciliation will limit the Contractor’s losses to 1%and profits to 1%.  Any losses in excess of 1% will bereimbursed to the Contractor, and likewise, profits in excess of 1%will be recouped. |

/s/ NancyNovick                                                       3/28/02                       Signature                                                                     Date

Phoenix HealthPlan                              Health Plan

*Please sign and returnthis form to AHCCCS with the signed contract amendment.  Ifnot returned, AHCCCS will assign the Default Method as statedabove.