VANGUARD HEALTH SYSTEMS, INC.



EXHIBIT 10.4


	
[AHCCCS

 LOGO]

	
ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM ADMINISTRATION

 DIVISION OF BUSINESS AND FINANCE

SECTION A: CONTRACT


	
 


	
1.  AMENDMENT

      NUMBER:

             9

	
2.  CONTRACT NO.:

      YH09-0001-07

	
3.  EFFECTIVE DATE OF AMENDMENT

      October 1, 2009

	
4.  PROGRAM

  DHCM - ACUTE


	
 


	
5.  CONTRACTOR'S NAME AND ADDRESS:


VHS Phoenix Health Plan, LLC

 7878 N. 16th St., Suite 105

 Phoenix, AZ 85020


	
 


	
6.  PURPOSE OF AMENDMENT:  To amend Section D.


	
 


	
7.  THE CONTRACT REFERENCED ABOVE FOLLOWS

 A.            Section D, Paragraph 53, Compensation Subparagraph 11 revised to the following language:





Reconciliation of Prospective non-MED Costs to Reimbursement: For CYE AHCCCS will reconcile the Contractor's prospective non-MED medical cost expenses to prospective non-MEDcapitation paid to the Contractor for dates of service July 1, 2009 through September 30,
2009. This reconciliation will limit the Contractor's profits and losses to 3%. Any losses in excess of 3% will be reimbursed to the Contractor,and likewise, profits in excess of 3% will be recouped.
Adjudicated encounter data will be used to determine medical expenses. Refer to the Prospective non-MED Reconciliation Policy included in the ACOM for further details.





For CYE 10, AHCCCS will reconcile the Contractor's prospective non-MED medical cost expenses to prospective non-MED net capitation paid to the Contractor for dates of service during the contract year being
reconciled. This reconciliation will limit the Contractor's profits and losses to 2%. Any losses in excess of 2% will be reimbursed to the Contractor,and likewise, profits in excess of 2% will be recouped.
Adjudicated encounter data will be used to determine medical expenses. Refer to the Prospective non-MED Reconciliation Policy included in the ACOM for further details.





NOTE:  Please sign, date, and return executed file by E-Mail to: Mark Held at Mark.Held@azahcccs.gov

                                                                                                               
Sr. Procurement Specialist

                                                                                                               
AHCCCS Contracts and Purchasing

                                                                                                               
and Georgina Maya at

                                                                                                               
Georgina.Maya@azahcccs.gov


	
 


	
8.  EXCEPT AS PROVIDED FOR HEREIN, ALL TERMS AND CONDITIONS OF THE ORIGINAL CONTRACT NOT HERETOFORE CHANGED AND/OR AMENDED REMAIN UNCHANGED AND IN FULL EFFECT.


IN WITNESS WHEREOF THE PARTIES HERETO SIGN THEIR NAMES IN AGREEMENT





	
9.  SIGNATURE OF AUTHORIZED REPRESENTATIVE:

      /s/ Nancy Novick


TYPED NAME:    NANCY NOVICK

 TITLE:                    CHIEF EXECUTIVE OFFICER

 DATE:                    9/17/09

	
 

	
10.  SIGNATURE OF AHCCCSA CONTRACTING OFFICER:


		
       /s/ Michael Veit


	
 

	
 


		
MICHAEL VEIT


		
CONTRACTS & PURCHASING ADMINISTRATOR

 DATE:    SEP 16 2009