**EXHIBIT      10.58**

**JUNE      2006 AMENDMENT**

**TO**

**SERVICES      AND LICENSE AGREEMENT**

**Annual      Adjustment**

**Term**

----

**,**

|                                                              |   |   |                                                                                                 |
|-------------------------------------------------------------------|--------|--------|------------------------------------------------------------------------------------------------------|
|                                                              |   |   |                                                                                                 |
| **CAREADVANTAGE,                INC.**                            |   |   | **BLUE                CROSS AND BLUE SHIELD OF VERMONT**                                             |
|                                                              |   |   |                                                                                                 |
| By: /s/                Dennis J. Mouras Title: CEO |   |   | By: /s/                Don C. George Title:Vice                President Managed Health Systems |
|  Date: 7/5/2006                                         |   |   | Date:June                27, 2006                                                                    |

----

**FEES      FOR ADDITIONAL SERVICES**

***The      following schedule shall apply from June 1, 2006 to December 31,      2006:***

|                                           |   | *CAI                  Standard Rates*  |   |
|------------------------------------------------|--------|---------------------------------------------|--------|
| *Consulting                  Level*            |   | *Hourly                  Rates*             |   | *Daily                  Rates* |   |
| Analyst                                        |   | $                                           | *      |   | $ | * |   |
| Consultant                                     |   | $                                           | *      |   | $ | * |   |
| Sr.                  Consultant                |   | $                                           | *      |   | $ | * |   |
| Manager                                        |   | $                                           | *      |   | $ | * |   |
| Sr.                  Manager                   |   | $                                           | *      |   | $ | * |   |
| Director                                       |   | $                                           | *      |   | $ | * |   |
| Sr.                  Medical Director          |   | $                                           | *      |   | $ | * |   |
| Vice                  President                |   | $                                           | *      |   | $ | * |   |
| VP,                  National Medical Director |   | $                                           | *      |   | $ | * |   |

***The      following schedule shall apply from January 1, 2007, to December 31,      2007:***

|                                           |   | *CAI                  Standard Rates* |   |
|------------------------------------------------|--------|---------------------------------------|--------|
| *Consulting                  Level*            |   | *Hourly                  Rates*       |   | *Daily                  Rates* |   |
| Analyst                                        |   | $                                     | *      |   | $ | * |   |
| Consultant                                     |   | $                                     | *      |   | $ | * |   |
| Sr.                  Consultant                |   | $                                     | *      |   | $ | * |   |
| Manager                                        |   | $                                     | *      |   | $ | * |   |
| Sr.                  Manager                   |   | $                                     | *      |   | $ | * |   |
| Director                                       |   | $                                     | *      |   | $ | * |   |
| Sr.                  Medical Director          |   | $                                     | *      |   | $ | * |   |
| Vice                  President                |   | $                                     | *      |   | $ | * |   |
| VP,                  National Medical Director |   | $                                     | *      |   | $ | * |   |

----

**PERFORMANCE      STANDARDS**

|  **Goal**                                                                                                     |   |  **Tasks**                                                                                                                                                                                                        |   |  **Criteria                  for Measuring Results**                |   |  **Deliverable**                                                                                                                                                              |   | **Penalty                  for Failure to Provide Deliverable** |
|--------------------------------------------------------------------------------------------------------------------|--------|------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|--------|--------------------------------------------------------------------------|--------|------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|--------|-----------------------------------------------------------------|
| *Provide                  current data in RPNavigator*                                                             |   | *Continue                  to work with BCBSVT staff and designated data vendors, to support                  accurate                  and timely submission of clean data extract by BCBSVT to                  CAI* |   | *Timely                  delivery of BCBSVT updated data in RPNavigator* |   | *Deliver                  release of BCBSVT data in RPNavigator no later than 8 weeks after                  receipt                  of clean data extract from BCBSVT*           |   | $*                  *                                           |
|                                                                                                               |   |                                                                                                                                                                                                                   |   |                                                                     |   |                                                                                                                                                                               |   |                                                            |
| *Provide                  actionable information with each release of BCBSVT data in                  RPNavigator* |   | *CareAdvantage                  will prepare and submit a written document to BCBSVT, containing                  findings                  and recommendations, after each release of                  RPNavigator*   |   | *Timely                  delivery of written report*                     |   | *Deliver                  written report containing findings and recommendations no later                  than 3                  weeks of release of BCBSVT data in RPNavigator* |   | $*                                                              |

----

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**SERVICES        AND LICENSE AGREEMENT**

| 1. | **Services**. |
|----|---------------|

**Implementation      Services**

**Recurring      Services**

**Additional      Services**

| 2. | **License**. |
|----|--------------|

**Definitions**

----

**Grant      of License**

**Portal      Access**

**Security**

**Ownership**

**Proprietary      Rights; Corporate Names**

**Authorized      Use of Portal and Information**

**Warranties**

**Ownership**

----

**No      Other Warranties**

**Limitation      of Liability**

| 3. | **Business                Associate Addendum**.                The parties agree that the terms of the Business Associate Addendum                set                forth in Attachment 3.3 shall be deemed a part of this                Agreement. |
|----|-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|

| 4. | **Compensation**. |
|----|-------------------|

**Generally**

**Additional      Services**

**Expenses**

----

**Adjustments**

**On      Account of Changes in Covered Population**

**Annual      Adjustmen**

| 5. | **Term                and Termination**. |
|----|------------------------------------------|

**Term**

**Termination**

| 6. | **Defense                of Litigation**Except                as provided by Section 2.8.1, each party shall be responsible at                its own                expense for defending itself in any litigation brought against it,                whether                or not the other party is also a defendant, arising out of any aspect                of                activities undertaken in connection with this Agreement. Each party                agrees                to provide the other party information in its possession which is                necessary to the other party's defense in such                litigation. |
|----|----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|

| 7. | **Additional                Requirements**. |
|----|---------------------------------------------|

**Independent      Contractors**

**Proprietary      Rights**

| 8. | **Miscellaneous**. |
|----|--------------------|

**Compliance      with Laws**

**Notice**

*If      to      BCBSVT:                     *

----

*If      to      CareAdvantage:         *

**Governing      Law**

**Entire      Agreement. **
** **

**Binding      Agreement; Assignability**

**Severability**

**Disputes**

**Injunctive      Relief**

**Waiver**

**Impossibility      of Performance**

**Counterparts**

----

| CAREADVANTAGE,                INC.                                  |   | BLUE                CROSS AND BLUE SHIELD OF VERMONT                                     |
|---------------------------------------------------------------------|--------|------------------------------------------------------------------------------------------|
|                                                                |   |                                                                                     |
| By:                 /s/ Dennis J. Mouras Title:  CEO |   | By:                /s/ Don C. George 9-2-2004Title: Vice                  President |

----

***IMPLEMENTATION      SERVICES***

*Information      Gathering*

|  | · | Review                business environment |
|--|--------|--------------------------------------------|
|   |   |   |
|--------|--------|--------|

|  | · | Gather                business rules |
|--|--------|--------------------------------------|
|   |   |   |
|--------|--------|--------|

|  | · | Review                claims system(s) |
|--|--------|----------------------------------------|
|   |   |   |
|--------|--------|--------|

|  | · | Develop                claims data requirements |
|--|--------|-------------------------------------------------|
|   |   |   |
|--------|--------|--------|

|  | · | Develop                system deployment, access and usage plan (i.e., user entitlements,                etc.) |
|--|--------|----------------------------------------------------------------------------------------------------------------|
|   |   |   |
|--------|--------|--------|

|  | · | Develop\finalize                implementation plan |
|--|--------|-----------------------------------------------------|
|   |   |   |
|--------|--------|--------|

|  | · | Prepare                processing environment |
|--|--------|-----------------------------------------------|
|   |   |   |
|--------|--------|--------|

|  | · | BCBSVT                prepare and deliver to CAI required claim data which will include                claims                incurred from January 1, 2001, through January 31, 2004, and paid                any                time |
|--|--------|---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|

*Weeks      1 to 2 (Begins when claims data is received)*

|  | · | Load                data into processing environment |
|--|--------|------------------------------------------------------|
|   |   |   |
|--------|--------|--------|

|  | · | Conduct                technical and initial clinical review of data (review for                completeness) |
|--|--------|---------------------------------------------------------------------------------------------------------------|
|   |   |   |
|--------|--------|--------|

|  | · | Begin                initial programming for data conversion |
|--|--------|--------------------------------------------------------------|
|   |   |   |
|--------|--------|--------|

|  | · | Produce                initial claims data review report |
|--|--------|----------------------------------------------------------|
|   |   |   |
|--------|--------|--------|

|  | · | Test                data conversion programming |
|--|--------|-------------------------------------------------|
|   |   |   |
|--------|--------|--------|

|  | · | Run                data through conversion program |
|--|--------|----------------------------------------------------|

*Weeks      3 to4*

|  | · | Validate                data conversion |
|--|--------|-----------------------------------------|
|   |   |   |
|--------|--------|--------|

|  | · | Prepare\run                data though CRGs algorithm |
|--|--------|-------------------------------------------------------|
|   |   |   |
|--------|--------|--------|

|  | · | Validate                CRG assignments (validity check) |
|--|--------|----------------------------------------------------------|
|   |   |   |
|--------|--------|--------|

|  | · | Conduct                a clinical analysis |
|--|--------|--------------------------------------------|
|   |   |   |
|--------|--------|--------|

|  | · | Configure                RPNavigator backend systems to support                BCBSVT |
|--|--------|---------------------------------------------------------------------------------------|
|   |   |   |
|--------|--------|--------|

|  | · | Program                reports to generate analyses against actual data                elements |
|--|--------|-------------------------------------------------------------------------------------------------|

----

*Weeks      5 to 6*

|  | · | Review                RPNavigator analyses results |
|--|--------|----------------------------------------------------|
|   |   |   |
|--------|--------|--------|

|  | · | Test                RPNavigator configuration against documented system deployment and                usage                plan |
|--|--------|---------------------------------------------------------------------------------------------------------------------------------|
|   |   |   |
|--------|--------|--------|

|  | · | Configure                and assign BCBSVT user entitlements |
|--|--------|--------------------------------------------------------------|
|   |   |   |
|--------|--------|--------|

|  | · | Conduct                two (2) days of on-site consulting to include user training, data                analytical review and operational                integration |
|--|--------|----------------------------------------------------------------------------------------------------------------------------------------------------------------------|
|   |   |   |
|--------|--------|--------|

|  | · | Provide                BCBSVT users access to RPNavigator Secure Information                Portal |
|--|--------|----------------------------------------------------------------------------------------------------|
|   |   |   |
|--------|--------|--------|

|  | · | Deliver                observations summary report |
|--|--------|----------------------------------------------------|

----

**RECURRING      SERVICES**

|  | · | Load                data into data processing environment |
|--|--------|-----------------------------------------------------------|
|   |   |   |
|--------|--------|--------|

|  | · | Conduct                technical and initial clinical review of data (review for                completeness) |
|--|--------|---------------------------------------------------------------------------------------------------------------|
|   |   |   |
|--------|--------|--------|

|  | · | Run                data through conversion program |
|--|--------|----------------------------------------------------|
|   |   |   |
|--------|--------|--------|

|  | · | Validate                data conversion |
|--|--------|-----------------------------------------|
|   |   |   |
|--------|--------|--------|

|  | · | Prepare\run                data files though CRG algorithms |
|--|--------|-------------------------------------------------------------|
|   |   |   |
|--------|--------|--------|

|  | · | Validate                CRG assignments (validity check) |
|--|--------|----------------------------------------------------------|
|   |   |   |
|--------|--------|--------|

|  | · | Conduct                clinical analysis |
|--|--------|------------------------------------------|
|   |   |   |
|--------|--------|--------|

|  | · | Program                reports to generate analyses with updated data                elements |
|--|--------|-----------------------------------------------------------------------------------------------|
|   |   |   |
|--------|--------|--------|

|  | · | Review                RPNavigator analyses results |
|--|--------|----------------------------------------------------|
|   |   |   |
|--------|--------|--------|

|  | · | Move                into production environment |
|--|--------|-------------------------------------------------|
|   |   |   |
|--------|--------|--------|

|  | · | Deliver                observations summary report (which includes changes from previous                periods) |
|--|--------|------------------------------------------------------------------------------------------------------------------|
|   |   |   |
|--------|--------|--------|

*(The      four-week schedule provided by Section 2 of this Attachment assumes that there      has been no change from Implementation in BCBSVT’s claims system(s) and business      rules. In the event of any such changes, the four-week schedule is subject      to      adjustment, and upon mutual agreement of the parties, any additional services      required by CAI on account of such changes will be billed in accordance with      Attachment 4.2.) In the event of any such changes and the parties’ failure to      agree on additional services thereby required, CAI may terminate this Agreement      on fifteen (15) days’ prior written notice.*

----

**BUSINESS      ASSOCIATE ADDENDUM**

| **A.** | **Background                Statements.** |
|--------|-------------------------------------------|

|   | 1. | The                Parties acknowledge that Plan is a Covered Entity required to comply                with                the Health Insurance Portability and Accountability Act of 1996 (HIPAA)                and its implementing regulations (45 C.F.R. Parts                160-164). |
|--------|----|----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|

|   | 2. | The                Parties agree that, pursuant to Agreement, CAI is performing certain                functions including, but not limited to, medical leadership and clinical                support, utilization review, grievance and appeals, after hours back-up                physician review coverage, and case management support on behalf                of Plan                and that when performing these functions CAI is acting as a Business                Associate of Plan. |
|--------|----|-----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|

|   | 3. | Plan                and CAI mutually agree to modify Agreement to incorporate the terms                of                this Addendum to comply with the requirements of the HIPAA and its                implementing regulations. |
|--------|----|--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|

| **B.** | **Privacy                of Protected Health                Information.** |
|--------|----------------------------------------------------------------------------|

|  | 1. | **Permitted                Uses and Disclosures****.**                CAI is permitted or required to use or disclose Protected Health                Information it creates or receives for or from Plan or to request                Protected Health Information on Plan’s behalf only as                follows: |
|--|----|----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|

|  | a) | Functions                and Activities on Plan’s Behalf.                Except as otherwise limited in this Addendum, CAI is permitted to                request                the minimum necessary protected health information on Plan’s behalf, and                to use and to disclose the minimum necessary Protected Health Information                to perform functions, activities, or services for or on behalf of                Plan, as                specified in Agreement. |
|--|----|----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|

|  | b). | CAI’sOperations.                CAI may use the minimum necessary Protected Health Information for                CAI’s                proper management and administration or to carry out CAI’s legal                responsibilities. CAI may disclose the minimum necessary Protected                Health                Information for CAI’s proper management and administration or to carry out                CAI’s legal responsibilities only                if: |
|--|-----|-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|

|   | (i) | The                disclosure is required by law; or |
|--------|-----|------------------------------------------------------|

|   | (ii) | CAI                obtains reasonable assurance, evidenced by written contract, from                any                person or organization to which CAI will disclose Protected Health                Information that the person or organization                will: |
|--------|------|---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|

|  | a. | Hold                such Protected Health Information in confidence and use or further                disclose it only for the purpose for which CAI disclosed it to the                person                or organization or as required by law;                and |
|--|----|-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|

|  | b. | Promptly                notify CAI (who will in turn promptly notify Plan) of any instance                of                which the person or organization becomes aware in which the                confidentiality of such Protected Health Information was                breached. |
|--|----|------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|

|  | c) | Data                Aggregation.                CAI may use Protected Health Information of Plan to provide Data                Aggregation Services to Plan. |
|--|----|---------------------------------------------------------------------------------------------------------------------------------------------------------------|

----

|  | **2.** | **Prohibition                on Unauthorized Use or Disclosure****.** CAI                will                neither use nor disclose Protected Health Information except as permitted                or required by this Addendum, as otherwise permitted in writing by                Plan,                or as required by law. This Addendum does not authorize CAI to use                or                disclose Protected Health Information in a manner that would violate                the                requirements of the Health Insurance Portability and Accountability                Act of                1996 and its implementing regulations (45 C.F.R. Parts 160-64) if                done by                Plan, except as set forth in Section                B(1)(b). |
|--|--------|------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|

|  | **3.** | **Information                Safeguards****.**CAI                will develop, implement, maintain, and use appropriate administrative,                technical, and physical safeguards, in compliance with Social Security                Act                §1173(d) (42 U.S.C. §1320d-2(d)), 45 Code of Federal Regulations                §164.530(c) and any other implementing regulations issued by the U.S.                Department of Health and Human Services. The safeguards will be designed                to preserve the integrity and confidentiality of, and to prevent                intentional or unintentional non-permitted or violating use or disclosure                of, Protected Health Information. CAI will document and keep these                safeguards current. |
|--|--------|----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|

|  | **4.** | **Sub-Contractors                and Agents****.**CAI                will require any of its subcontractors and agents, to which CAI is                permitted by this Addendum or in writing by Plan to disclose Protected                Health Information, to provide reasonable assurance, evidenced by                written                contract, that such subcontractor or agent will comply with the same                privacy and security obligations as CAI with respect to such Protected                Health Information. |
|--|--------|----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|

| **C.** | **Individual                Rights**. |
|--------|---------------------------------------|

|  | **1.** | **Access****.**CAI                will, within 15 days after Plan’s request, make available to Plan or, at                Plan’s direction, to the individual (or the individual’s personal                representative) for inspection and obtaining copies any Protected                Health                Information about the individual that is in CAI’s custody or control, so                that Plan may meet its access obligations under 45 Code of Federal                Regulations §164.524. |
|--|--------|------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|

|  | **2.** | **Amendment****.**                CAI will, upon receipt of notice from Plan, promptly amend or permit                Plan                access to amend any portion of the Protected Health Information,                so that                Plan may meet its amendment obligations under 45 Code of Federal                Regulations §164.526. |
|--|--------|-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|

|   | **3.** | **Disclosure                Accounting****.**                CAI shall document disclosures of Protected Health Information and                information related to such disclosures as would be required for                Plan to                respond to a request by an individual for an accounting of disclosures                of                Protected Health Information in accordance with 45 Code of Federal                Regulations §164.528 and shall provide such information to Plan upon                request so that Plan may meet its disclosure accounting obligations                under                45 Code of Federal Regulations§164.528. |
|--------|--------|-----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|

|  | **4.** | **Restriction                Requests; Confidential Communications****.**CAI                will comply with any agreements for confidential communications of                which                it is aware and to which Plan agrees pursuant to 45 C.F.R. §164.522(b) by                communicating with Members using agreed upon alternative means or                alternative locations. |
|--|--------|----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|

|  | **5.** | **Inspection                of Books and Records****.**CAI                will make its internal practices, books, and records, relating to                its use                and disclosure of Protected Health Information, available to Plan                and to                the U.S. Department of Health and Human Services to determine compliance                with 45 Code of Federal Regulations Parts 160-64 or this                Addendum. |
|--|--------|--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|

| **D.** | **Breach                of Privacy                Obligations.** |
|--------|------------------------------------------------------------------|

|  | **1.** | **Reporting****.**                CAI will report to Plan any use or disclosure of Protected Health                Information not permitted by this Addendum or in writing by Plan.                CAI will                make the report to Plan’s Legal Department not more than 5 days after CAI                learns of such non-permitted use or disclosure. CAI’s report will at                least: |
|--|--------|-----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|

|   | a) | Identify                the nature of the non-permitted use or                disclosure; |
|--------|----|-------------------------------------------------------------------------------------------|

|   | b) | Identify                the Protected Health Information used or                disclosed; |
|--------|----|--------------------------------------------------------------------------------------------|

----

|   | c) | Identify                who made the non-permitted use or disclosure and who received the                non-permitted or violating                disclosure; |
|--------|----|----------------------------------------------------------------------------------------------------------------------------------------------------------------|

|   | d) | Identify                what corrective action CAI took or will take to prevent further                non-permitted uses or disclosures; |
|--------|----|-------------------------------------------------------------------------------------------------------------------------------------------|

|   | e) | Identify                what CAI did or will do to mitigate any deleterious effect of the                non-permitted use or disclosure;                and |
|--------|----|--------------------------------------------------------------------------------------------------------------------------------------------------------------|

|   | f) | Provide                such other information, including a written report, as Plan may reasonably                request. |
|--------|----|---------------------------------------------------------------------------------------------------------------------------|

|  | **2.** | **Termination                of Agreement****.** |
|--|--------|--------------------------------------------------|

|  | a) | Right                to Terminate for Breach.                Plan may terminate Agreement if it determines, in its reasonable                discretion, that CAI has materially breached any provision of this                Addendum                and, on notice of such material breach or violation from Plan, CAI                fails                to take reasonable steps to cure the breach or end the violation.                If CAI                fails to cure the material breach or end the violation within 30                days                after receipt of Plan’s notice, Plan may terminate Agreement by providing                CAI written notice of termination, stating the uncured material breach                or                violation that provides the basis for the termination and specifying                the                effective date of the termination. |
|--|----|---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|

|  | b) | Obligations                upon Termination. |
|--|----|----------------------------------------------|

|  | (i) | Return                or Destruction.                Upon termination, cancellation, expiration or other conclusion of                Agreement, CAI will if feasible return to Plan or destroy all Protected                Health Information, including all Protected Health Information in                whatever                form or medium (including any electronic medium) and all copies of                and any                data or compilations derived from and allowing identification of                any                individual who is a subject of Protected Health Information. CAI                will                complete such return or destruction as promptly as possible, but                not later                than 60 days after the effective date of the termination, cancellation,                expiration or other conclusion of Agreement. CAI will identify any                Protected Health Information that cannot feasibly be returned to                Plan or                destroyed. CAI will limit its further use or disclosure of that Protected                Health Information to those purposes that make return or destruction                of                that Protected Health Information infeasible. Within 60 days after                the                effective date of the termination, cancellation, expiration or other                conclusion of Agreement, CAI will (a) certify on oath in writing                to Plan                that such return or destruction has been completed, (b) deliver to                Plan                the identification of any Protected Health Information for which                return or                destruction is infeasible, and (c) certify that it will only use                or                disclose such Protected Health Information for those purposes that                make                return or destruction infeasible. |
|--|-----|--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|

|  | (ii) | Continuing                Privacy Obligation.                CAI’s obligation to protect the privacy of the Protected Health                Information it created or received for or from Plan will be continuous                and                survive termination, cancellation, expiration or other conclusion                of                Agreement. |
|--|------|--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|

|  | (iii) | Other                Obligations and Rights.                CAI’s other obligations and rights and Plan’s obligations and rights upon                termination, cancellation, expiration or other conclusion of Agreement                will be those set out in Agreement. |
|--|-------|--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|

| **E.** | **Security                Rule***.*                The following provisions of this Addendum apply to the extent that                Company                creates, receives, maintains, or transmits electronic PHI on behalf                of                Plan. |
|--------|------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|

|   | 1. | Company                shall ensure that any agent, including a subcontractor, to whom it                provides electronic PHI agrees in writing to implement and use                administrative, physical, and technical safeguards that reasonably                and                appropriately protect the Confidentiality, Integrity, and Availability                of                the electronic PHI. Company must enter into the written contract                before                any use or disclosure of electronic PHI by such agent, and such written                contract must identify Plan as a direct and intended third party                beneficiary, with the right to enforce any breach of the contract                concerning the use or disclosure of electronic PHI. Company shall                provide                a copy of the written contract to Plan upon                request. |
|--------|----|-----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|

|   | 2. | Company                shall report in writing to Plan any Security Incident pertaining                to such                electronic PHI (whether involving Company or an agent, including                a                subcontractor) of which it becomes aware. Company shall provide such                written report promptly after it becomes aware of any such Security                Incident. |
|--------|----|-----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|

| **F.** | **Conflicts.**                 The terms and conditions of this Addendum will override and control                any                conflicting term or condition of Agreement. All nonconflicting terms                and                conditions of Agreement remain in full force and                effect. |
|--------|--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|

| **G.** | **General                Provisions****.** |
|--------|--------------------------------------------|

|  | **1.** | **Definitions****.**The                capitalized terms “Health Care Operations,” “Payment,” “Protected Health                Information,” and “Treatment” shall have the same meaning as in 45 C.F.R.                §164.501. The capitalized terms “Business Associate” and “Covered Entity”                shall have the same meaning as in 45 C.F.R. §160.102.** ** |
|--|--------|--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|

|  | **2.** | **Amendment                to Agreement****.**Upon                the effective date of any final regulation or amendment to final                regulations promulgated by the U.S. Department of Health and Human                Services with respect to Protected Health Information or Standard                Transactions, this Addendum and the Agreement of which it is part                will                automatically amend such that the obligations they impose on CAI                remain in                compliance with these regulations. |
|--|--------|-----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|

----

**FEES      FOR ADDITIONAL SERVICES**

| CAI                Standard Rates            |   |
|----------------------------------------------|--------|
|                                         |   |   |   |   |   |
| Consulting                Level              |   | Hourly                Rates |   | Daily                Rates |   |
| Analyst                                      |   | $ | * |   | $ | * |   |
| Consultant                                   |   | $ | * |   | $ | * |   |
| Sr.                Consultant                |   | $ | * |   | $ | * |   |
| Manager                                      |   | $ | * |   | $ | * |   |
| Sr.                Manager                   |   | $ | * |   | $ | * |   |
| Director                                     |   | $ | * |   | $ | * |   |
| Sr.                Medical Director          |   | $ | * |   | $ | * |   |
| Vice                President                |   | $ | * |   | $ | * |   |
| VP,                National Medical Director |   | $ | * |   | $ | * |   |

----