Exhibit 10.55  
 ***  Confidential
Information Omitted and filed separately with the Securities and Exchange
Commission.  CONTRACT
FOR HOSPITAL INPATIENT SERVICES  Contract No.
  
  00-83122Hospital:
  
  ALTA LOS ANGELES HOSPITALS, INC.dba: LOS ANGELES COMMUNITY HOSPITALAddress:
  
  4081 East Olympic BoulevardLos Angeles, CA 90023ANDHospital:
  
  ALTA LOS ANGELES HOSPITALS, INC.dba: LOS ANGELES COMMUNITY HOSPITAL OF NORWALKAddress:
  
  13222 Bloomfield AvenueNorwalk, CA 90650Provider No.:
  
  HHC 30663F  Los Angeles Community HospitalHHC 30663F  Los Angeles Community Hospital of
  Norwalk   CONFIDENTIAL DO
NOT RELEASE Exempt
from Public Records Act (Government
Code Section 6254 [q])


TABLE
OF CONTENTS  ARTICLE 1 FORMATION1.1
  Identification Of Parties1.2
  Specification Of States Authority and Instrumentalities1.3
  Declaration That Beneficiaries Under the Medi-Cal Program Are Not
  Third Party Beneficiaries Under This Contract1.4
  Declaration Of Present Contractual IntentARTICLE 2 DEFINITIONS2.1
  General Meaning Of Words and Terms2.2
  Acute Administrative Day2.3
  Beneficiary2.4
  Department2.5
  Fiscal Intermediary2.6
  Inpatient Services2.7
  May2.8
  ShallARTICLE 3 PERFORMANCE PROVISIONS3.1
  General Agreement3.2
  Licensure and Certification As Conditions Precedent To States
  Payment Obligation3.3
  Utilization Controls: Compliance By Provider As Condition Precedent
  To Maturing States Payment Obligation3.4
  Appointment Of Liaisons and Agency Status Of Providers Liaison3.5
  Service Location3.6
  Quality Of Care3.7
  Open Staff3.8
  Assumption Of Risk By Provider3.9
  Delegation Of Providers Duties, When Permitted3.10
  Patient Rights3.11
  Beneficiary Evaluation Of Providers Services3.12
  Grievance ProcedureARTICLE 4 PAYMENT PROVISIONS4.1
  Rate Structure; Contingent Liability Of State4.2
  Rate Inclusive Of Physician, Transportation and Certain Prior Patient
  Services4.3
  Billing Procedures As Express Conditions Precedent To States Payment
  Obligation4.4
  Cost Reports4.5
  Recovery Overpayments To Provider; Liability For Interest4.6
  Customary Charges Limitation4.7
  Assumption of Debts, Liabilities, and respective other Obligations
  Deriving from Contracts No. 83-82927 and No. 82-80258ARTICLE 5 RECORDS AND AUDIT PROVISIONS5.1
  Onsite Reviews5.2
  Records to be Kept; Audit or Review; Availability Period of Retention


ARTICLE 6 GENERAL PROVISIONS6.1
  Integration Clause6.2
  Performance Obligations; Effective Date and Term of this Contract;
  Waiver of Providers Right to Administrative Hearing6.3
  Headings6.4
  Governing Authorities6.5
  Conformance with Federal Regulations6.6
  Application for Termination in the Face of a Declaration or Finding
  of Partial Invalidity6.7
  Restriction on Providers Freedom to Assign Benefits Only under this
  Contract or to Engage in Organic Change6.8
  Contract Officer  Delegation of Authority6.9
  Notice6.10
  Status as Independent Contractors6.11
  Informal Amendments Ineffective; Toleration of Deviation from Terms
  of Contract Not to be Construed as Waiver6.12
  Beneficiary Eligibility6.13
  Indemnification6.14
  Limitation of State Liability6.15
  Termination Without Cause6.16
  Termination for Default6.17
  Disputes6.18
  Conflict of Interest6.19
  Confidentiality of Information6.20
  Confidentiality of Contractual Provisions6.21
  Additional ProvisionsAPPENDIX AAPPENDIX B


ARTICLE 1
FORMATION  1.1Identification Of
Parties  This
Contract is between the State of California, hereinafter designated the State,
and ALTA LOS ANGELES HOSPITALS, INC. doing business as LOS ANGELES COMMUNITY
HOSPITAL and LOS ANGELES COMMUNITY HOSPITAL OF NORWALK, hereinafter designated the
Provider.  1.2Specification Of
States Authority and Instrumentalities  The
Provider hereby recognizes that this Contract is formed under the authority of
Sections 14081, et seq., of the Welfare and Institutions Code and the regulations adopted
pursuant thereto which authorize the Department of Health Services to contract
for provision of inpatient hospital services to beneficiaries eligible for such
services under the Medi-Cal program in accordance with the rates, terms and
conditions negotiated by the California Medical Assistance Commission.  1.3Declaration That
Beneficiaries Under the Medi-Cal Program Are Not Third Party Beneficiaries
Under This Contract  Notwithstanding
mutual recognition that services under this agreement will be rendered by the
Provider to beneficiaries under the Medi-Cal program, as more fully defined in
Paragraph 2.3, it is not the intention of either the State or Provider
that such individuals occupy the position of intended third party beneficiaries
of the obligations assumed by either party to this Contract.  1.4Declaration Of
Present Contractual Intent  The
State and the Provider, in consideration of the covenants, conditions,
stipulations, terms and warranties hereinafter expressed, presently contract as
follows.  1


ARTICLE 2
DEFINITIONS  2.1General Meaning Of
Words and Terms  The
words and terms used in this Contract are intended to have their usual meanings
unless a particular or more limited meaning is associated with their usage in
Sections 1400, et seq. of the Welfare and Institutions Code, or Title 22 of the California Code of Regulations pertaining to the rendition
of health care or unless specifically defined in this Article or otherwise
in this Contract.  2.2Acute Administrative
Day  Acute
Administrative Day means those days approved in an acute inpatient facility
which provides a higher level of care than that currently needed by the patient
(22 California Code of Regulations, Section 51173).  2.3Beneficiary  Beneficiary
means a person certified, pursuant to Sections 14016 and 14018 of the Welfare and Institutions Code, as eligible for Medi-Cal,
except that beneficiary shall not include Medi-Cal beneficiaries enrolled in Prepaid
Health Plans or other organized health systems which contract with the
Department under the provisions of Sections 14000, et seq.of
theWelfare and Institutions Code, and the
regulations and definitions adopted under Title 22 of the California Code of Regulations.  A beneficiary also includes that person whose
eligibility was not determined until after the rendition of inpatient
services.  Medi-Cal beneficiaries who are
also eligible for Medicare hospital benefits under the provisions of
Title XVIII of the Social Security Act, and who have not exhausted those
benefits, are not considered beneficiaries within the meaning of this
Contract.  Beneficiary does not include
those individuals receiving skilled nursing facility or long-term care services
or acute administrative day care.  2


2.4Department  Department
means the State Department of Health Services.  2.5Fiscal Intermediary  Fiscal
Intermediary means that person or entity who has contracted, as specified in Section 14104.3
of the Welfare and Institutions Code, with the
Department to perform fiscal intermediary services related to this Contract.  2.6Inpatient Services  Inpatient
Services includes, but is not limited to, the following services when rendered
in accordance with Sections 14133 and 14133.1 of the Welfare and
Institutions Code, and Section 51327 of Title 22 of the California Code of Regulations to a Medi-Cal beneficiary.  (a)Bed
and board;  (b)Medical,
nursing, surgical, pharmacy and dietary services;  (c)All
diagnostic and therapeutic services required by the beneficiary, including
physicians services, except as noted in Appendix A which is incorporated
herein by reference;  (d)Use
of hospital facilities, medical social services furnished by the hospital, and
such drugs, including take home drugs, biologicals, supplies, appliances and
equipment as are required by the beneficiary;  (e)Transportation
services subsequent to admission required in providing inpatient services under
this Contract.  (f)All
other services provided to hospital inpatients except as noted in Appendix A;  (g)Services
rendered by the Provider within 24 hours prior to the beneficiarys admission
as an inpatient, such as outpatient or emergency services which are related to
the condition for which the beneficiary is admitted as an inpatient;  3


(h)Administrative
services required in providing inpatient services under this Contract.  2.7May  May
is used to indicate a permissive or discretionary term of function.  2.8Shall  Shall
is used to introduce a covenant of either the State or the Provider, and is
mandatory.  4


ARTICLE 3
PERFORMANCE PROVISIONS  3.1General Agreement  (a)Provider
agrees to render inpatient services (Paragraph 2.7) to any eligible
beneficiary (Paragraph 2.3) in need of such services and assumes full
responsibility for provision of all inpatient services, either directly, or as
otherwise provided in this Contract. 
Provider agrees to accept as payment in full for these inpatient
services payment from the Department as provided in Article 4 of this
Contract.  The Department agrees to pay
the Provider for such services rendered in accordance with the terms and under
the express conditions of this Contract.  (b)Provider
shall, at its own expense, provide and maintain facilities and professional,
allied and supportive paramedic personnel to provide all necessary and
appropriate inpatient services.  (c)Provider
shall, at its own expense, provide and maintain the organizational and
administrative capabilities to carry out its duties and responsibilities under
the Contract and all applicable statutes and regulations pertaining to Medi-Cal
providers.  (d)For
the purpose of (a) of this Paragraph, any eligible beneficiary means any
individual who meets the criteria established in Paragraph 2.3 of this
Contract without reference to residence, domicile or any geographic factor.  (e)For
the purpose of (a) of this Paragraph, all inpatient services means those
services defined in Paragraph 2.7 of this Contract unless expressly
excluded in Appendix A of this Contract.  3.2Licensure and
Certification As Conditions Precedent To States Payment Obligation  (a)Provider
hereby represents and warrants that it is currently, and for the duration of
this Contract shall remain,  5


licensed
as a general acute care hospital in accordance with Sections 1250 et seq. of the Health and Safety Code
and the licensing regulations contained in Title 22 and Title 17 of
the California Code of Regulations.  (b)Provider
hereby represents and warrants that it is currently, and for the duration of
this Contact shall remain, certified under Title XVIII of the Federal
Social Security Act.  (c)Provider
agrees that compliance with its obligations to remain licensed as a general
acute care hospital as provided in (a) this Paragraph, and certified under
the Federal Social Security Act as provided in (b) of this
Paragraph shall be express conditions precedent to maturing the States
payment obligations under Paragraph 2.1(a) and Article 4 of this
Contract.  3.3Utilization
Controls:  Compliance By Provider As
Condition Precedent To Maturing States Payment Obligation  As
express conditions precedent to maturing the States payment obligations under
the terms of this Contract the Provider shall adhere to all utilization
controls and obtain prior authorization for services in accordance with the
statutes and, except for those provisions waived by the Director of the
Department of Health Services, regulations and Provider Bulletins governing the
Medi-Cal program (Paragraph 6.4[a][1]).  3.4Appointment Of
Liaisons and Agency Status Of Providers Liaison  (a)Provider
shall designate in writing a person to act as liaison to the Department.  Such person shall coordinate all
communication between the parties.  The
written designation of such person shall constitute the conferral of full
agency powers to bind the Provider as principal in all dealings with the
Department.  (b)The
Department shall designate a liaison in conformity with the procedures and with
such authority as specified in Paragraph  6


6.8
of this Contract.  Communications to the
Department shall be submitted to its liaison at the following address:  Contract
Officer
Medi-Cal Operations Division
Post Office Box 942732
Sacramento, California 94234-7320  3.5Service Location  Inpatient
services rendered pursuant to this Contract shall be rendered at the following
facilities:  LOS
ANGELES COMMUNITY HOSPITAL
4081 East Olympic Boulevard
Los Angeles, California 90023  and  LOS
ANGELES COMMUNITY HOSPITAL OF NORWALK
13222 Bloomfield Avenue
Norwalk, California 90650  3.6Quality Of Care  As
express conditions precedent to maturing the States payment obligation under
the terms of this Contract, the Provider shall:  (1)Assure
that any and all beneficiaries receive care as required by Sections 51207(a)(4) and
70703(a) of Title 22 of the California Code of
Regulations;  (2)Take
such actions as required by Providers Medical Staff Bylaws against medical
staff members who violate those bylaws, as the same may be from time-to-time
amended;  (3)Provide
inpatient services in the same manner to beneficiaries as it provides to all
patients to whom it renders inpatient services; and  (4)Not
discriminate against Medi-Cal beneficiaries in any manner, including admission
practices, placement in special or  7


separate
wings or rooms, provision of special or separate, meals or waiting time for
surgical procedures.  3.7Open Staff  Provider
shall not deny medical staff membership or clinical privileges for reasons
other than a physicians individual qualifications as determined by
professional and ethical criteria, uniformly applied to all medical staff
applicants and members.  Determination of
medical staff membership or clinical privileges shall not be made upon the
basis of:  (1)The
existence of a contract with the Provider or with others;  (2)Membership
in or affiliation with any society, medical group or teaching facility or upon
the basis of any criteria lacking professional justification, such as sex, race,
creed or national origin.  3.8Assumption Of Risk
By Provider  The
Provider shall bear total risk for the cost of all inpatient services rendered
to each beneficiary covered by this Contract. 
As used in this Paragraph, risk means that the Provider covenants to
accept as payment in full for any and all inpatient services
(Paragraph 2.6) payments made by the State pursuant to Article 4 of
this Contract.  Such acceptance shall be
made irrespective of whether the cost of such services, transportation and
related administrative expenses shall have exceeded the payment obligation of
the State matured under the conditions set forth in this Contract.  The term risk also includes, but is not
limited to, the cost of all inpatient services for illness or injury which
results from or is contributed to by catastrophe or disaster which occurs
subsequent to the effective date of this Contract, including, but not limited
to, acts of God, war or the public enemy.  3.9Delegation Of
Providers Duties, When Permitted  8


The
Provider and State recognize that the inpatient hospital services covered by
this Contract are personal and non-delegable. 
Any attempt by the Provider to delegate or otherwise vest responsibility
for performance of its duties in any manner shall constitute a present material
breach of this Contract.  3.10Patient Rights  The
Provider shall adopt and post in a conspicuous place a written policy on
patients rights in accordance with Section 70707 of Title 22 of the California Code of Regulations.  Procedures for resolving a beneficiarys
complaint involving patients rights may be combined with the grievance
procedure in Paragraph 3.12. 
Complaints by beneficiaries with regard to substandard conditions may be
investigated by the Departments Licensing and Certification Division or by the
Joint Commission on Accreditation of Healthcare Organization, or such other
agency, as required by law or regulation.  3.11Beneficiary Evaluation
Of Providers Services  The
Provider shall provide a written questionnaire to the beneficiary at the time
of the beneficiarys admission.  The
questionnaire shall be approved by the Department and offer the beneficiary the
opportunity to evaluate the care given. 
It shall be collected at the time of discharge and maintained in the
Providers file for four years and shall be made available to agents of the
Department.  3.12Grievance Procedure  The
Provider shall establish and maintain a procedure for resolving beneficiary
grievances.  Such procedure shall be
approved by the Department prior to implementation.  The grievance procedure shall include:  (1)Immediate
recording of all grievances received, including information sufficient to
identify the grievant, date of receipt, nature of the problem, date and
resolution or disposition of  9


the
grievance.  Such records and related
documents shall be open to inspection by the Department and the Federal
Department Of Health and Human Services for a period of four years.  (b)A
finding of fact and resolution within 30 days of receipt of grievance.  (c)In
those cases where the grievant is not identifiable, or when the problem cannot
be resolved, entry of notations to that effect in the record, including the
reasons why the grievance could not be resolved and the individual responsible
for that decision.  (d)If
the grievant is identifiable, transmittal of a copy of the finding of fact, and
an explanation of the resolution or disposition of the grievance to the
grievant and the Department within five days of the decision.  (e)If
the grievant is identifiable, notification to the grievant regarding a right to
appeal the disposition of the grievance in the form of a complaint with the
Departments liaison designated under Paragraph 6.8.  (f)A
grievance coordinator.  10


ARTICLE 4
PAYMENT PROVISIONS  4.1Rate Structure;
Contingent Liability Of State  Provided
that there shall first have been a submission of claims in accordance with
Paragraph 4.3 of this Contract, the Provider shall be paid at the
all-inclusive rate per patient per day of for inpatient services provided to
beneficiaries.  4.2Rate Inclusive Of
Physician, Transportation and Certain Prior Patient Services  The
rate structure under Paragraph 4.1 of this Contract is intended by both
the State and Provider to be inclusive of all inpatient services rendered by
the Provider and to constitute the States only financial obligation under this
Contract.  As nonlimiting examples:  (a)There
shall be no separate billing by either the Provider or physicians for inpatient
services rendered by physicians to beneficiaries covered by this Contract,
except for those inpatient services set forth in Appendix A previously
incorporated by reference as part of this Contract.  (b)There
shall be no separate billing for any transportation services required in
providing inpatient services under this Contract.  (c)There
shall be no separate billing for any services rendered by the Provider within a
24-hour period prior to the beneficiarys admission as an inpatient, such as
outpatient or emergency services which are related to the condition for which
the beneficiary is admitted as an inpatient. 
Such prior services shall be deemed inpatient services and included in
the rates set under Paragraph 4.1.  4.3Billing Procedures
As Express Conditions Precedent To States Payment Obligation  11


(a)As
an express condition precedent to maturing the States payment obligation under
Paragraph 4.1 of this Contract, the Provider shall determine that
inpatient services rendered directly are not covered, in whole or in part,
under any other state or federal medical care program or under any other
contractual or legal entitlement, including, but not limited to, a private
group indemnification or insurance program or workers compensation.  To the extent that such coverage is
available, the States payment obligation pursuant to Paragraph 4.1 shall
be reduced.  (b)As
a further express condition precedent to maturing the States payment
obligation under Paragraph 4.1 of this Contract, the Provider shall submit
claims to the fiscal intermediary for all services rendered under the terms of
this Contract, in accordance with the applicable billing requirements contained
in Title 22 of the California Code of Regulations.  (c)A
day of service shall be billed for each beneficiary who occupies an inpatient
bed as 12:00 midnight in the facilities of the Provider.  However, a day of service may be billed if
the beneficiary is admitted and discharged during the same day provided that
such admission and discharge is not within 24 hours of a prior discharge.  Only one patient day of service may be billed
for mother and newborn child (children) when both mother and newborn child (children)
are inpatients of the hospital.  4.4Cost Reports  Although
they shall not be used for payment purposes under this Contract, as an express
condition precedent to maturing the States payment obligation under
Paragraph 4.1 of this Contract the Provider shall complete and file
Medi-Cal cost reports in accordance with the requirements in effect during the
terms of this Contract.  4.5Recovery
Overpayments To Provider; Liability For Interest  12


(a)When
an audit performed by the Department, the State Controllers Office, or any
other State agency discloses that the Provider has been overpaid under this
Contract, or where the total payments exceed the total liability under this
Contract, the Provider covenants that any such overpayment or excess payments
over liability may be recouped by the Department withholding the amount due
from future payments, seeking recovery by payment from the Provider, or a
combination of these two methods.  (b)Overpayments
determined as a result of audits of periods prior to the effective date of this
Contract may be recouped by the Department withholding the amount due from what
would otherwise be the States liability under this Contract, seeking recovery
by payment from the Provider, or a combination of those two methods.  (c)When
the Department seeks recoupment or recovery under (a) of this
Paragraph the Provider may appeal according to applicable procedural
requirements of Sections 51016  51047 of Title 22 of the California Code of Regulations, with the following
exceptions:  (1)There
shall be no informal hearing.  (2)The
recovery or recoupment shall commence sixty (60) days after issuance of account
status or demand resulting from an audit or review and shall not be deferred b
the filing of a request for hearing pursuant to Section 51022 of
Title 22 of the California Code of
Regulations.  (3)The
Providers liability to the State for any amount recovered under this
Paragraph shall be as provided in Sections 14171 and 14171.5 of the Welfare and Institutions Code and regulations adopted
pursuant thereto.  4.6Customary Charges
Limitation  (a)No
provision in this Contract withstanding, the States total liability to the
Provider shall not exceed the Providers total customary charges for like
services during each hospital fiscal year  13


or
part thereof, in which this Contract is in effect.  The Department may recoup any excess of total
payments above such total customary charges under Paragraph 4.5.  (b)As
used in (a) of this Paragraph customary charges is defined in
conformity with 42 USC Section 1395(f) and the regulations
promulgated pursuant thereto.  4.7Assumption of Debts,
Liabilities, and respective other Obligations Deriving from Contracts No. 83-82927
and No. 82-80258  The
parties hereby agree to assume all their respective debts, liabilities, and
other obligations related to or deriving from Contracts No. 83-82927 and No. 82-80258
between LOS ANGELES COMMUNITY HOSPITAL and the Department of Health Services.  14


ARTICLE 5
RECORDS AND AUDIT PROVISIONS  5.1Onsite Reviews  (a)Agents
of the Department shall conduct periodic audits or reviews, including onsite
audits or reviews, of performance under this Contract.  These audits or reviews may evaluate the
following:  (1)Level
and quality of care, and the necessity and appropriateness of the services
provided.  (2)Internal
procedures for assuring efficiency, economy and quality of care.  (3)Grievances
relating to medical care and their disposition.  (4)Financial
records when determined necessary the Department to protect public funds.  (b)The
Provider shall make adequate office space available for the review team or
auditors to meet and confer.  Such space
must be capable of being locked and secured to protect the work of the review
team or auditors during the period of their investigation.  (c)Onsite
reviews and audits shall occur during normal working hours with at least
72-hour notice, except that unannounced onsite reviews and requests for
information may be made in those exceptional situations where arrangement of an
appointment beforehand is clearly not possible or clearly inappropriate to the
nature of the intended visit.  5.2Records to be Kept;
Audit or Review; Availability Period of Retention  The
Provider covenants that:  (1)It
shall maintain books, records, documents, and other evidence, accounting
procedures, and practices sufficient to reflect  15


properly
all direct and indirect costs of whatever nature claimed to have been incurred
in the performance of this Contract.  (2)The
above information shall be maintained in accordance with Medicare principles of
reimbursement and generally accepted accounting principles, and shall be
consistent with the requirements of the Office of Statewide Health Planning and
Development.  (3)The
Provider shall also maintain medical records required by Sections 70747 
70751 of the California Code of Regulations, and
other records related to a beneficiarys eligibility for services, the service
rendered the beneficiary to whom the service was rendered, the date of the
service, the medical necessity of the service and the quality of the care
provided.  Records shall be maintained in
accordance with Section 51475 of Title 22 of the California
Code of Regulations.  The
foregoing constitute records for the purposes of this Paragraph.  (4)The
facility or office, or such part thereof as may be engaged in the performance
of this Contract, and the information specified in this Paragraph shall be
subject at all reasonable times to inspection, audits and reproduction b any
duly authorized agents of the Department, the Federal Department of Health and
Human Services and Comptroller General of the United States are intended third
party beneficiaries of this covenant.  (5)Preserve
and make available its records relating to payments made under this Contract
for a period of four years from the close of the Providers fiscal year, or for
such longer period, required by subparagraphs (A) and (B) below.  (A)If
this Contract is terminated, the records relating to the work terminated shall
be preserved and made available  16


for
a period of four years from the date of the last payment made under the
Contract.  (B)If
any litigation, claim, negotiation, audit or other action involving the records
has been started before the expiration of the four year period, the related
records shall be retained until completion and resolution of all issues arising
therefrom or until the end of the four year period whichever is later.  17


ARTICLE 6
GENERAL PROVISIONS  6.1Integration Clause  The
State and Provider declare that this instrument, including Appendix A and
Appendix B, contains a total integration of all rights and obligations of
both parties.  There are no extrinsic
conditions or collateral agreements or undertakings of any kind.  In regarding this instrument as the full and
final expression of their Contract it is the express intention of both the
State and the Provider that any and all prior or contemporaneous agreements,
promises, negotiations, or representations, either oral or written, relating to
the subject matter and period of time governed by this instrument which are not
expressly set forth herein are to have no force, effect, or legal consequence
of any kind.  6.2Performance
Obligations; Effective Date and Term of this Contract; Waiver of Providers
Right to Administrative Hearing  Performance
obligations assumed under this Contract shall commence on the 14th
day of September, 2000, and shall apply to all inpatient admissions on or after
this date.  This Contract shall continue
indefinitely subject to the provisions of Paragraph 6.14 and the rights o
termination reserved under Paragraphs 6.14, 6.16 and 6.18.  However, the terms of this Contract shall
continue to apply to any beneficiary receiving inpatient services at the date
of termination.  There shall be no
entitlement to an administrative hearing pursuant to these sections.  The Provider waives any claim it may have to
such a hearing in consideration of the covenants, conditions and provisions of
this Contract.  6.3Headings  The
headings of articles and paragraphs contained in this  18


Contract
are for reference purposes only and shall not affect in any way its meaning or
interpretation.  6.4Governing
Authorities  (a)This
Contract shall be governed and construed in accordance with:  (1)Part 3,
Division 9 of the Welfare and Institutions Code;
Divisions 3 and 5 of Title 22 of the California
Code of Regulations; and all other applicable state laws and
regulations according to their content on the effective date stipulated in
Paragraph 6.2; and  (2)Titles 42
and 45 (Part 74) of the Code of Federal
Regulations and all other applicable federal laws and regulations
according to their content on and after the effective date stipulated in Paragraph 6.2,
except those provisions or applications of those provisions waived by the
Secretary of the Department of Health and Human Services.  (b)Any
provision of this Contract in conflict with the laws or regulations stipulated
in (a) of this Paragraph is hereby amended to conform to the provision of
those laws and regulations.  Such
amendment of the Contract shall be effective on the effective date of the
statute of the statute or regulation necessitating it, and shall be binding on
the parties even though such amendment may not have been reduced to writing and
formally agreed upon and executed by the parties as provided in
Paragraph 6.11.  6.5Conformance with
Federal Regulations  The
Provider stipulates that this Contract, in part, implements Title XIX of
the Federal Social Security Act and, accordingly, covenants that it will
conform to such requirements and regulations as the United States Department of
Health and Human  19


Services
may issue from time to time, except for those provisions waived by the
Secretary of Health and Human Services.  6.6Application for
Termination in the Face of a Declaration or Finding of Partial Invalidity  In
the event any provision of this Contract is declared null and void by any court
of law, either party may apply to that court for permission to immediately
rescind the remainder of the Contract. 
In ruling upon this request the court shall consider the impact upon the
affected Medi-Cal population as well as the relative degree of hardship which
would be imposed upon either or both of the parties if the request is denied.  6.7Restriction on
Providers Freedom to Assign Benefits Only under this Contract or to Engage in
Organic Change  The
State and Provider hereby declare their mutual recognition that the subject
matter of this Contract is personal, being founded upon the States confidence
in the reputation, type and location of facilities, and other personal
attributes of the Provider.  For this
reason:  (1)Unless
given prior written approval by the Department any attempt by the Provider to
make an assignment of the right to receive the contingent payment obligations
of the State under this Contract shall operate as an express condition
subsequent to those obligations discharging the State form what may otherwise
have been a matured obligation of performance.  (2)If
the Provider desires to make an assignment of rights only under this Contract
it shall submit a written application for approval to the Department.  Such an application shall identify the
proposed assignee and include a detailed explanation of the reason and basis
for the proposed assignment.  If the
Department is satisfied  20


that
the proposed assignment is consistent with the continued receipt of
satisfactory performance on the part of the Provider it shall be approved in
writing.  The effective date of the
assignment shall be the date upon which the Department issues written approval.  (3)Unless
given prior written approval by the Department any attempt by the Provider to
participate as a constituent entity in any merger, consolidation or sale or
assets other than in the regular course of business shall operate as an express
condition subsequent discharging the State form what may otherwise have been a
matured obligation of performance under this Contract.  (4)If
the Provider desires to participate as a constituent entity in any merger,
consolidation or sale of assets other than in the regular course of business it
shall submit a written application for approval to the Department.  The Department shall act upon such requests
within 30 days of the receipt of such requests.  (A)If
approval is sought for participation in a merger or consolidation the
application shall identify all proposed constituent entities and disclose the
rights and preferences of all classes of stock in the resulting or surviving
entity.  In addition, the application
shall inform the Department of the licensure and certification status of the
proposed resulting or surviving entity (Paragraph 3.2), and such other
information as the Department may require.  (B)If
application is sought for approval of a sale of assets other than in the
regular course of business it shall identify the purchaser; inform the
Department of licensure and certification status of the purchaser
(Paragraph 3.2; and, such other information as the Department may require.  21


(5)If
the Department is satisfied that the proposed merger, consolidation or sale of
assts other than in the regular course of business is consistent with the
continued satisfactory performance of the Providers obligations under this
Contract it shall be approved in writing. 
The effective date of the merger, consolidation of sale of assets other
than in the regular course of business shall be no earlier than the date upon
which the Department issues written approval.  6.8Contract Officer 
Delegation of Authority  The
Department will administer this Contract through a single administrator, the
Contract Officer.  Until such time as the
Director gives the Provider written notice of successor appointment, the person
designated above shall make all determinations and take all actions necessary
to administer this Contract, subject to the limitations of California laws and
state administrative regulations.  No
person other than the Contract Officer or the Director shall have the power to
bind the Department relative to the rights and duties of the Contractor and the
Department under this Contract, nor shall nay other person be considered to
have the delegated authority of the Contract Officer or to be acting on his
behalf unless the Contract Officer has expressly stated in writing that the
person is acting as his authorized agent.  6.9Notice  Any
notice required to be given pursuant to the terms and provisions of the
Contract shall be in writing and shall be sent by certified mail, return
receipt requested.  Notice to the
Department shall be sent to the following address:  22


Contract
Officer
Medi-Cal Operations Division
P.O. Box 942732
Sacramento, CA  94234-7320  Notice
to the Provider shall be sent to the Chief Executive Officer at the following
address:  LOS
ANGELES COMMUNITY HOSPITAL
4081 East Olympic Boulevard
Los Angeles, CA  90023  6.10Status as Independent
Contractors  The
State and Provider hereby acknowledge that they are independent contractors to
one another and neither is an officer, agent, or employee of the other for any
purpose.  6.11Informal Amendments
Ineffective; Toleration of Deviation from Terms of Contract Not to be Construed
as Waiver  (a)It
is the express intention of both the State and Provider that the terms of this
totally integrated writing shall comprise their entire Contract and are not
subject to rescission, modification or waiver except as defined in a subsequent
written instrument executed in the same manner and with the same authority.  In furtherance of this agreement the State
and Provider mutually covenant and request of any reviewing tribunal that any
claim of rescission, modification, or waiver predicated upon any evidence other
than a subsequent written instrument executed in the same manner and with the
same authority as this writing be regarded as void.  (b)The
informal toleration by either party of defective performance of any independent
covenant in this Contract shall not be construed as a waiver of either the
right to performance or the express conditions which have been created in this
Contract.  23


6.12Beneficiary
Eligibility  This
Contract is not intended to change the determination of Medi-Cal eligibility
for beneficiaries in any way.  However,
in the event the California State Legislature or Congress of the United States
enacts a statute which redefines Medi-Cal eligibility so as to affect the
provision of inpatient services under this Contract, this new definition shall
apply to the terms of this Contract.  6.13Indemnification  The
Provider covenants to indemnify, defend and hold harmless the State, its
officers, agents and employees from any and claims and losses accruing or
resulting to any and all contractors, subcontractors, materialmen, laborers or
any other person, firm or corporation furnishing or supplying work, services,
materials or supplies in connection with the performance of this Contract, and
from any and all claims and losses accruing or resulting to any person, firm or
corporation who may be injured or damaged by the Provider in the performance of
this Contract.  6.14Limitation of State
Liability  No
provision of this Contract withstanding, the liability of the State shall not
exceed the amount of funds appropriated in the support of this Contract by the
California Legislature.  Any requirement
of performance by the Department and Provider is dependent upon the
availability of appropriations by the Legislature for the purpose of this
Contract.  6.15Termination Without
Cause  The
Provider or the State may terminate this Contract without cause n accordance
with this Paragraph.  Termination without  24


cause
shall be effected by giving written notice of the termination to the other
party at least 120 days prior to the effective date of the termination and
stating the effective date of the termination.  6.16Termination for
Default  (a)The
State may terminate this Contract for default upon thirty (30) days written
notice to the Provider, except in cases where the Department determines that
the health and welfare of Medi-Cal beneficiaries is jeopardized b continuation
of the Contract, in which case the Contract may be immediately terminated.  Notification shall state the effective date
of and grounds for termination.  (b)The
State may terminate this agreement upon thirty (30) days written notice to the
Provider in the event that:  (1) The
Secretary of the Department of Health and Human Services determines that the
Provider does not meet the requirements for participation in the Medicaid
program, Title XIX of the Social Security Act; (2) The Provider has
violated the conflict of interest provisions contained in Paragraph 6.18
of this Contract; or (3) The Department determines that the Provider is
abusing or defrauding the Medi-Cal program or its beneficiaries.  6.17Disputes  (a)As
an alternative t the judicial remedy available to the Provider under Section 14087.27(a) of
the Welfare and Institutions Code the
Provider may appeal disputes relating to performance under this Contract to an
independent hearing examiner appointed by the Director of the Department.  The proceedings for review of such disputes
shall be conducted by the hearing examiner and a decision rendered pursuant to
the applicable procedural requirements of Sections 51016-51047 of
Title 22 of the California Code of
Regulations regarding provider audit appeals with the following
exceptions.  25


(1)There
shall be no informal hearing.  (2)All
references to a hearing officer shall apply to the independent hearing examiner
appointed by the Director of the Department.  (b)The
State and Provider stipulate recognition that the Provider Audit Appeals provisions
referenced in (a) of this Paragraph were enacted as an administrative
mechanism for disputing audit or examination findings regarding the Providers
cost report.  The obligations of the
parties to this Contract are not predicated upon a reimbursement of cost basis
and, for that reason, many of the provisions of Section 51016-51047 of
Title 22 of the California Code of
Regulations, such as cost reports, amended cost reports, audit
reports, amended audit reports, home office-chain organization related
entities, and informal hearing will not be applicable in the resolution of
disputes arising under this Contract.  Applicable
procedural requirements is employed in (a) of this Paragraph to render
irrelevant such inapplicable provisions.  6.18Conflict of Interest  (a)The
Provider is subject to the terms and conditions of Section 51466 of
Title 22 of the California Code of
Regulationsas promulgated pursuant to Sections 14022, 14124.5,
14030 and 14031 of the Welfare and Institutions
Code, and must submit a Medi-Cal Personal Disclosure Statement of
Significant Beneficial Interest form as provided by the Department.  (b)This
Contract shall be terminated immediately if it is determined that a state
officer or state employee responsible for development, negotiation, contract
management, or supervision of this Contract has a financial interest in the
Contract as that term is defined in Section 97103 of the Government Code
and the regulations  26


adopted
pursuant thereto.  6.19Confidentiality of
Information  (a)No
provision of this Contract withstanding, names of persons receiving public
social services are confidential and are to be protected from unauthorized
disclosure in accordance with Title 45, Code of Federal
Regulations Section 205.50; Sections 10850 and 14100.2 of the Welfare and Institutions Code; and, regulations adopted
pursuant thereto.  For the purpose of
this Contract, all information, records, and data elements pertaining to
beneficiaries shall be protected by the Provider from unauthorized disclosure.  (b)With
respect to any identifiable information concerning beneficiaries under this
Contract that is obtained by the Provider, the Provider:  (1)Shall
not use any such information for any purpose other than carrying out the
express terms of this Contract;  (2)Shall
promptly transmit to the Department all requests for disclosure of such
information;  (3)Shall
not disclose, except as otherwise specifically permitted by this Contract, any
such information to any party other than the Department without the Departments
prior written authorization specifying that the information may be released
under Title 45, Code of Federal
Regulations Section 205.50; Sections 10850 and 14100.2 of the Welfare and Institutions Code; and, regulations adopted
pursuant thereto; and  (4)Shall,
at the termination of this Contract, return all such information to the
Department or maintain such information according to written procedures sent to
the Provider by the Department for this purpose.  6.20Confidentiality of
Contractual Provisions  27


This
Contract and its terms shall remain confidential and the terms of the Contract
may be disclosed by the parties only in accordance with the disclosure time
limits set out in Government Code Section 6254(q).  6.21Additional Provisions  Provider
shall comply with Paragraphs 1.0 through 6.0 as set forth in Appendix B,
attached hereto and incorporated herein by this reference, but only to the
extent that it is mandated by law that the State incorporate and enforce such
provisions in this Contract, and the Provider reserves any and all rights it
may have to seek administrative and/or judicial review with respect to such
provisions.  28


EXECUTION  This
Contract shall be deemed duly executed and binding upon execution by both
Parties below.  Executed
  on,
  at(City,
  State, Zip)   Alta
  Healthcare System, Inc.BySignatureType
  Name and TitleExecuted
  on,
  atSacramento,
  CaliforniaSTATE OF
  CALIFORNIAByDiana
  M. Bontá, R.N., Dr. P.H.
  Director
  Department of Health Services  29


APPENDIX A  I.
  
  SERVICES NOT PROVIDED BY HOSPITAL OR ITS
  DELEGATE UNDER THIS CONTRACT AND NOT REIMBURSABLE  UNIVERSAL BILLING
  CODESINTENSIVE CARE, TRAUMA
  
  208INTENSIVE CARE, POST ICU
  
  206INTENSIVE CARE, PEDIATRIC
  
  203INTENSIVE CARE, LUNG TRANSPLANT
  
  083INTENSIVE CARE, HEART-LUNG TRANSPLANT
  
  084INTENSIVE CARE, HEART TRANSPLANT
  
  086INTENSIVE CARE, LIVER TRANSPLANT
  
  087INTENSIVE CARE, BONE MARROW TRANSPLANT
  
  088INTENSIVE CARE, KIDNEY TRANSPLANT
  
  089INTENSIVE CARE, BURN CARE IN LICENSED BURN
  CENTER BEDS
  
  207CORONARY CARE, GENERAL
  
  210CORONARY CARE, MYOCARDIAL INFARCTION
  
  211CORONARY CARE, OTHER
  
  219CORONARY CARE, PULMONARY CARE
  
  212CORONARY CARE, POST CCU
  
  214NURSERY, NEONATAL INTENSIVE CARE
  
  175LITHOTRIPSY
  
  090ADMINISTRATIVE DAY
  
  098
  *REHABILITATION - PRIVATE
  
  118REHABILITATION - SEMI-PRIVATE 2 BEDS
  
  128REHABILITATION - SEMI-PRIVATE 3 OR 4 BEDS
  
  138REHABILITATION - WARD (MEDICAL OR GENERAL)
  
  158  CPT-4 CODESCARDIAC CATHETERIZATION
  
  93501-93562CARDIOVASCULAR SURGERY
  
  33010-37799ABORTIONS
  
  59840-59857STERILIZATION
  
  55250,55450,56301,56302STERILIZATION
  
  58600,58605,58611,58615NEUROSURGERY
  
  61000-64999CORNEAL TRANSPLANTS
  
  65710,65730,65750,65755RADIATION THERAPY
  
  77261-77499,77750-77799THERAPEUTIC NUCLEAR MEDICINE
  
  79000-79999MAGNETIC RESONANCE IMAGING
  
  70336,70540MAGNETIC RESONANCE IMAGING
  
  70551-70553,71550MAGNETIC RESONANCE IMAGING
  
  72141-72142,72146-72149MAGNETIC RESONANCE IMAGING
  
  72156-72158,72196MAGNETIC RESONANCE IMAGING
  
  73220-73221,73720-73721MAGNETIC RESONANCE IMAGING
  
  74181,75552,75554-75556MAGNETIC RESONANCE IMAGING
  
  76093-76094,76400HYPERBARIC OXYGEN
  
  99183  
 *BILLABLE
ONLY OUTSIDE THE PROVISIONS OF THE CONTRACT.  30


APPENDIX B  1.0Fair
Employment Practices  (a)In
the performance of this Contract, the Provider shall not discriminate against
any employee or applicant for employment because of race, color, religion,
ancestry, sex, age, national origin, physical handicap, mental condition,
sexual orientation, or marital status. 
The Contractor shall take affirmative action to ensure that applicants
are employed and that employees are treated during employment without regard to
their race, color, religion, ancestry, sex, age, national origin, mental
condition, physical handicap, marital status, or sexual orientation.  Such action shall include, but not be limited
to the following:  employment, upgrading,
demotion or transfer; recruitment or recruitment advertising, layoff or
termination; rates of pay or other forms of compensation; and selection for
training, including apprenticeship.  The
Contractor shall post in conspicuous places, available to employees and
applicants for employment, notices to be provided by the State setting forth
the provisions of this Fair Employment Practices section.  (b)The
Provider shall permit access to his records of employment, employment
advertisements, application forms, and other pertinent date and records by the
State Fair Employment and Housing Commission, or any other agency of the State
of California designated by the State, for the purposes of investigation to
ascertain compliance with the Fair Employment Practices section of this
Contract  (c)Remedies
for Unlawful Employment Practice:  (1)The
State may determine an unlawful practice under the Fair Employment Practices
section of this Contract to have occurred upon receipt of a final judgment
having that effect from a court in an action to which Provider was a party, or
upon receipt of a written notice from the Fair Employment and Housing
Commission that it has investigated and determined that the Provider has
violated the provisions of the Fair Employment and Housing Act and has issued
an order, under Government Code Section 12970, which has become final.  (2)For
unlawful practices under this Fair Employment Practices section, the State
shall have the right to terminate this Contract after a determination pursuant
to (c)(1) of this section has been made.  Any
loss or damage sustained by the State in securing a replacement provider to
render the services contracted for under this Contract shall be borne and paid
for by the Provider and the State may deduct from any moneys due to that
thereafter may become due to the Provider, the difference between the price
named in the contract and the actual cost thereof to the State.  (d)Provider
agrees to comply with Title 2, Division 3, Part 2.8 (Government
Code Sections 12900 et seq.), any
amendments thereto, and any regulation adopted pursuant to that part.  1


2.0Nondiscrimination
in Services, Benefits and Facilities  (a)The
Provider shall not discriminate in the provision of services because of race,
color, religion, national origin, sex, age, mental or physical handicap or
sexual orientation as provided by state and federal law.  (b)For
the purposes of this Contract, distinctions on the grounds of race, color,
religion, national origin, sex, age or mental or physical handicap or sexual
orientation include but are not limited to the following:  denying a beneficiary any service or benefit
which is different, or is provided in a different manner or at a different time
from that provided other beneficiaries under this Contract; subjecting a beneficiary
to segregation or separate treatment in any matter related to his receipt of
any service; restricting a beneficiary in any way in the enjoyment, advantage
or privilege enjoyed by others receiving any service or benefit; treating a
beneficiary differently from others in determining whether the beneficiary
satisfied any admission, eligibility, other requirement or condition which
individuals must meet in order to be provided any benefit; the assignment of
times or places for the provision of services on the basis of the race, color,
religion, national origin, age, mental or physical handicap or sexual
orientation of the beneficiaries to be served.  (c)The
Provider shall take affirmative action to ensure that services to intended
beneficiaries are provided without regard to race, color, religion, national
origin, sex, age, mental or physical handicap or sexual orientation.  3.0Clean
Air and Water  (This
paragraph 3.0 applicable only if the Contract exceeds $100,000, or the Federal
Contracting Officer or State has determined that orders under an indefinite
quantity contract in any one year will exceed $100,000, or a facility to be
used has been the subject of a conviction under the Clean Air Act (42 USC
1857c-8(c)(1)) or the Federal Water Pollution Control Act (33 USC 1319(c) and
is listed by EPA, or the contract is not otherwise exempt.)  (a)The
Provider agrees as follows:  (1)To
comply with all the requirements of Section 114 of the Clean Air Act, as
amended (42 USC 1857, et seq., as
amended by Pub.L. 91-604) and Section 308 of the Federal Water Pollution
Control Act (33 USC 1351 et seq., as
amended by Pub.L., 92-500), respectively relating tot inspection monitoring,
entry, reports, and information, as well as other requirements specified in Section 114
and Section 308 of the Air Act and the Water Act, respectively, and all
regulations and guidelines issued thereunder before the award of this Contract.  (2)No
obligation required by this Contract will be performed in a facility listed on
the Environmental Protection Agency List of Violating Facilities on the date
when this contract was executed unless and until the EPA eliminates the name of
such facility or facilities from such listing.  2


(3)To
use its best efforts to comply with clean air standards and clean water
standards at the facility in which the services are being performed.  (4)To
insert the substance of the provisions of this Paragraph 3.0 into any
written delegation.  (b)The
terms used in this Paragraph have the following meanings:  (1)The
term Air Act means the Clean Air Act, as amended (42 USC 1857 et seq., as amended by Pub.L. 91-604).  (2)The
terms Water Act means Federal Water Pollution Control Act, as amended (33 USC
1251 et seq., as amended by Pub.L. 92-500).  (3)The
term clean air standards means any enforceable rules, regulations,
guidelines, standards, limitations, orders, controls, prohibitions, or other
which are contained in, issued under, or otherwise adopted pursuant to the Air
Act or Executive Order 11738, an approved implementation procedure or plan
under section 110(d) of the Clean Air Act (42 USC 1857c-5(d), an
approved implementation procedure or plan under section 111(c) or
section 111(d), or an approved implementation procedure under section 112(d) of
the Air Act (42 USC 1857c-7(d)).  (4)The
terms clean water standards means any enforceable limitation, control,
condition, prohibition, standard or other requirement which is promulgated
pursuant to the Water Act or contained in a permit issued to a discharger by
the Environmental Protection Agency or by a state under an approved program, as
authorized by Section 402 of the Water Act (33 USC 1317).  (5)The
term compliance means compliance with clean air or water standards.  Compliance shall also mean compliance with a
schedule or plan ordered or approved by a court of competent jurisdiction, the
Environmental Protection Agency or an air or water pollution control agency in
accordance with the requirements of the Air Act or Water Act and regulations
issued pursuant thereto.  (6)The
term facility means any building, plan, installation, structure, mine, vessel
or other floating craft, location, or site of operations, owned, leased, or
supervised by a Provider or delegate, to be utilized in the performance of a
contract of delegation.  Where a location
or site of operations contains or includes more than one building, plant,
installation, or structure, the entire location or site shall be deemed to be a
facility except where the Director, Office of Federal Activities, Environmental
Protection Agency, determines that independent facilities are collected in one
geographical area.  3


4.0Utilization
of Small Business Concerns  (a)It
is the policy of the Federal Government and the State as declared by the
Congress and the State Legislature that a fair proportion of the purchases and
contracts for supplies and services for the State be placed with small business
concerns.  (b)The
Provider shall accomplish the maximum amount of delegation to and purchases of
goods or services from small business concerns that the Contractor finds to be
consistent with the efficient performance of this Contract.  5.0Utilization
of Minority Business Enterprises  (a)It
is the policy of the Federal Government and the State that minority business
enterprises shall have the maximum practicable opportunity to participate in
the performance of State contracts.  (b)The
Provider agrees to use its best efforts to carry out this policy in its
delegations and purchases of goods to the fullest extent consistent with the
efficient performance of this Contract. 
As used in this Contract, the terms minority business enterprise means
a business, at least 50 percent of which is owned by minority group members or,
in the case of public owned business, at least 51 percent of the stock of which
is owned by minority group members.  For
the purpose of this definition, minority group members are Black, Asian, Spanish-speaking/Surnamed,
Filipino, Polynesian, American Indian, or Alaskan Native.  Non-minority women-owned firms may be
included when business is 50 percent owned and operated by a woman and the
co-owner is not her husband, or 51 percent (or greater) which owned and
operated by a woman and the co-owner is her husband, and/or is publicly
owned.  Providers may rely on written
representations from businesses regarding their status as minority business
regarding their status as minority business enterprises in lieu of an
independent investigation.  6.0Provision
of Bilingual Services  (a)When
the community potentially served by the Provider consists of non-English or
limited-English speaking persons, the Provider shall take all steps necessary
to develop and maintain an appropriate capability for communicating in any
necessary second language, including, but not limited to the employment of, or
contracting for, in public contact positions of persons qualified in the
necessary second languages in a number sufficient to ensure full and effective
communication between the non-English and limited-English speaking applicants
for, and beneficiaries of, the facilitys services and the facilitys
employees.  Provider
may comply with this paragraph 6.0 by providing sufficient qualified
translators to provide translation  4


in
any necessary second language for any patient, caller or applicant for service,
within ten minutes of need for translation. 
Provider shall maintain immediate translation capability in the
emergency room when five percent of the emergency room patients or applicants
for emergency room services are non-English or limited-English speaking
persons.  Provider
shall provide immediate translation to non-English or limited-English speaking
patients whose condition is such that failure to immediately translate would
risk serious impairment.  Provider shall
post notices in prominent places in the facility of the availability of
translation in the necessary second languages.  (b)As
used in this Paragraph:  (1)Non-English
or limited English speaking persons refers to persons whose primary language
is a language other than English;  (2)Necessary
second language refers to a language, other than English, which is the primary
language of at least five percent (5%) of either the community potentially
served by the contracting facility or of the facilitys patient population; and  (3)Community
potentially served by the contracting facility refers to the geographic area
from which the facility derives eighty percent (80%) of its patient population.  (4)Qualified
translator is a person fluent in English and in the necessary second language,
familiar with medical terminology, and who can accurately speak, read, write
and readily interpret in the necessary second language.  5


CONTRACT
FOR HOSPITAL INPATIENT SERVICES  Amendment
No. 1  Contract No.
  00-83122Hospital:
  ALTA LOS ANGELES HOSPITALS, INC.dba: LOS ANGELES COMMUNITY HOSPITALAddress:
  4081 East Olympic BoulevardLos Angeles, CA 90023ANDHospital:
  ALTA LOS ANGELES HOSPITALS, INC.dba: LOS ANGELES COMMUNITY HOSPITAL OF NORWALKAddress:
  13222 Bloomfield AvenueNorwalk, CA 
  90650  CONFIDENTIAL DO
NOT RELEASE Exempt
from Public Records Act
(Government Code Section 6254 [q])


AMENDMENT
NO. 1 TO CONTRACT NO. 00-83122 BETWEEN THE STATE OF CALIFORNIA AND ALTA LOS
ANGELES HOSPITALS. INC., DOING BUSINESS AS LOS ANGELES COMMUNITY HOSPITAL AND
LOS ANGELES COMMUNITY HOSPITAL OF NORWALK.  WHEREAS,
the State of California, hereinafter designated the State, and ALTA LOS
ANGELES HOSPITALS, INC., DOING BUSINESS AS LOS ANGELES COMMUNITY HOSPITAL AND
LOS ANGELES COMMUNITY HOSPITAL OF NORWALK, hereinafter designated the
Provider, entered into a contract (Contract No. 00-83122) for provision
of inpatient hospital services effective September 14, 2000.  NOW
THEREFORE, in accordance with the provisions for renegotiation and modification
set forth in Article 6, Section 6.11 of said Contract, the Contract
is amended as follows:  Paragraph
One  Amendment of 6.1 - Integration Clause  6.1
 Integration Clauseis hereby amended to
read:  The
State and Provider declare that this instrument, including Appendix A, Appendix
B and Appendix D, contains a total integration of all rights and obligations of
both parties.  There are no extrinsic
conditions or collateral agreements or  1


undertakings
of any kind. In regarding this instrument as the full and final expression of
their Contract it is the express intention of both the State and the Provider
that any and all prior or contemporaneous agreements, promises, negotiations,
or representations, either oral or written, relating to the subject matter and
period of time governed by this instrument which are not expressly set forth
herein are to have no force, effect, or legal consequence of any kind.  Paragraph
Two  Addition of Appendix D  Appendix
Dis hereby added as follows:  2


APPENDIX
D  EMERGENCY
SERVICES AND SUPPLEMENTAL PAYMENTS FUND  This
Appendix D is added to the Contract between the parties for the provision of
hospital inpatient services.  Pursuant
to the provisions of Welfare and Institutions
Code Section 14085.6 relating to negotiations and disbursements
from the Emergency Services and Supplemental Payments Fund, the parties hereby
additionally agree as follows:  A.            Services  In
addition to any other promises and services agreed to be provided pursuant to
this Contract, Provider agrees:  (1)           To remain a Contract provider within
the Selective Provider Contracting Program and not to issue a notice of
termination of this Contract pursuant to Section 6.15 until on or after March 1,
2001.  (2)           To maintain its current emergency
room licensure status until June 30, 2001.  3


B.            Payments  In
addition to any other payments made to Provider pursuant to this Contract, and
in consideration of the agreements set out in Section A above, the State
hereby agrees to pay the Provider a total of *** from the Emergency Services
and Supplemental Payments Fund for services rendered from July 1, 2000
through June 30, 2001.  Payments
shall be made in the following amounts on the following dates, or as soon
thereafter as practicable:  (1)           on October 1, 2000, the amount
of ***;  (2)           on December 1, 2000, the amount
of ***;  (3)           on February 1, 2001, the amount
of ***.  C.            Hold Harmless and Right Of
Set-Off  (1)           It is understood that payments made
to the Provider pursuant to this Appendix D include State and matching federal
funds.  The State shall be held harmless
from any federal disallowance or withholding resulting from payments made to
Provider pursuant to this Appendix D and the Provider shall be liable for any
reduced federal financial participation resulting from the payment of funds
pursuant to Appendix D.  In the event of
federal disallowance or withholding of federal financial participation for any
payments made to the Provider pursuant to Appendix D, at the time of the
federal disallowance or withholding, the State may, in its sole discretion,
recover from  4


the
Provider the amount of funds disallowed and paid by the State to the
Provider.  Provider agrees that the
amount of any such disallowance may be recouped by the Department by
withholding the amount due from what would otherwise be the States liability
to the Provider under this Contract or otherwise, seeking recovery by payment
from the Provider, or a combination of these two methods.  If after federal disallowance or withholding,
and State recovery or set-off of funds paid to the Provider, the State regains
the federal funds disallowed or withheld, then the funds shall be repaid by the
State to the Provider.  (2)           Any recoupment by the State pursuant
to subsection (1) shall be limited to the amount of federal financial
participation recouped from the State by the federal government with respect to
actual payments made to the Provider under this Appendix D.  D.            Breach  (1)           If, subsequent to receiving payments
pursuant to the provisions of this Appendix D, Provider breaches any of the
service provisions set forth in Section A above, the State may, in its
sole discretion, recover from the Provider the amount of funds paid by the
State to the Provider pursuant to Appendix D. 
Provider agrees that the amount of any such payments may be recouped by
the Department by withholding the amount due from what would otherwise be the
States liability to Provider under this  5


Contract
or otherwise, seeking recovery by payment from the Provider, or a combination
of these two methods.  (2)           The recovery of funds paid pursuant
to this Appendix D, however, shall not preclude the State from pursuing
additional damages in the event that the Provider breaches Section A(l) above
relating to termination.  In the event
Provider terminates this Contract in violation of Section A(l) above,
the State may, in its sole discretion, pursue all lawful remedies to recover its
damages caused by Providers breach.  Paragraph
Three  Effective Date of Contract Amendment  Contract
changes agreed to in this Amendment shall be effective on September 28,
2000.  Paragraph
Four  Incorporation of Contract Rights. Duties and Obligations  All
other terms and provisions of said Contract shall remain in full force and
effect, so that all rights, duties and obligations, and liabilities of the
parties hereto otherwise remain unchanged.  6


EXECUTION  This
Contract Amendment shall be deemed duly executed and binding upon execution by
both parties below.  Executed
  on,
  at(City,
  State, Zip)   HospitalBySignatureType
  Name and TitleExecuted
  on,
  atSacramento,
  CaliforniaSTATE OF CALIFORNIAByDiana
  M. Bontá, R.N., Dr. P.H.
  Director
  Department of Health Services  7


CONTRACT
FOR HOSPITAL INPATIENT SERVICES  Amendment
No. 2  Contract No.
  00-83122Hospital:
  ALTA LOS ANGELES HOSPITALS, INC.dba: LOS ANGELES COMMUNITY HOSPITALAddress:
  4081 East Olympic BoulevardLos Angeles, CA 90023-3330ANDHospital:
  ALTA LOS ANGELES HOSPITALS, INC.dba: LOS ANGELES COMMUNITY HOSPITAL OF NORWALKAddress:
  13222 Bloomfield AvenueNorwalk, CA 
  90650  CONFIDENTIAL DO
NOT RELEASE Exempt
from Public Records Act (Government
Code Section 6254 [q])


AMENDMENT
NO. 2 TO CONTRACT NO. 00-83122 BETWEEN THE STATE OF CALIFORNIA AND ALTA LOS
ANGELES HOSPITALS, INC., DOING BUSINESS AS LOS ANGELES COMMUNITY HOSPITAL AND
LOS ANGELES COMMUNITY HOSPITAL OF NORWALK.  WHEREAS,
the State of California, hereinafter designated the State, and Alta Los
Angeles Hospitals, Inc., doing business as Los Angeles Community Hospital
and Los Angeles Community Hospital of Norwalk, hereinafter designated the
Provider, entered into a contract (Contract No. 00-83122) for provision
of inpatient hospital services executed September 14, 2000, and
subsequently amended;  NOW
THEREFORE, in accordance with the provisions for renegotiation and modification
set forth in Article 6, Section 6.11 of said Contract, the Contract
is amended as follows:  Paragraph
One  Amendment of 4.1  Rate Structure; Contingent Liability of State  4.1
 Rate Structure; Contingent Liability of State is hereby amended to
read:  Provided
that there shall first have been a submission of claims in accordance with
Paragraph 4.3 of this Contract, the Provider shall be paid at the
all-inclusive rate per patient per day of *** for inpatient services provided
to beneficiaries.  1


Paragraph
Two  Addition of 6.22  Prohibition of Use of State Funds to Assist, Promote,
or Deter Union Organizing  6.22
 Prohibition of Use of State Funds to Assist, Promote, or Deter Union
Organizing is hereby added as follows:  In
accordance with Government Code Section 16645, et seq., Contractor shall
not use state funds to assist, promote, or deter union organizing during the
life of this Contract, including any extensions or renewals of this Contract.  Paragraph
Three  Effective Date of Contract Amendment  If
this Amendment is signed by the Provider and returned to the California Medical
Assistance Commission within thirty (30) days of January 25, 2001, then
the contract changes agreed to in this Amendment shall be effective on January 25,
2001.  If this Amendment is not signed
and returned within thirty days, then the contract changes agreed to in this
Amendment shall be effective on the date the contract is signed by both
parties.  2


Paragraph
Four  Incorporation of Contract rights, Duties and Obligations  All
other terms and provisions of said contract shall remain in full force and
effect, so that all rights, duties and obligations, and liabilities of the
parties hereto otherwise remain unchanged.  3


EXECUTION  This
Contract Amendment shall be deemed duly executed and binding upon execution by
both parties below.  Executed
  on,
  at(City,
  State, Zip)   HospitalBySignatureType
  Name and TitleExecuted
  on,
  atSacramento,
  CaliforniaSTATE OF CALIFORNIAByDiana
  M. Bontá, R.N., Dr. P.H.
  Director
  Department of Health Services  4


CONTRACT
FOR HOSPITAL INPATIENT SERVICES  Amendment
No. 3  Contract No.
  00-83122Hospital:
  ALTA LOS ANGELES HOSPITALS, INC.dba: LOS ANGELES COMMUNITY HOSPITALAddress:
  4081 East Olympic BoulevardLos Angeles, CA 90023-3330ANDHospital:
  ALTA LOS ANGELES HOSPITALS, INC.dba: LOS ANGELES COMMUNITY HOSPITAL OF NORWALKAddress:
  13222 Bloomfield AvenueNorwalk, CA 
  90650  CONFIDENTIAL DO
NOT RELEASE Exempt
from Public Records Act (Government
Code Section 6254 [q])


AMENDMENT
NO. 3 TO CONTRACT NO. 00-83122 BETWEEN THE STATE OF CALIFORNIA AND ALTA LOS
ANGELES HOSPITALS, INC., DOING BUSINESS AS LOS ANGELES COMMUNITY HOSPITAL AND
LOS ANGELES COMMUNITY HOSPITAL OF NORWALK.  WHEREAS,
the State of California, hereinafter designated the State, and ALTA LOS
ANGELES HOSPITALS, INC., doing business as LOS ANGELES COMMUNITY HOSPITAL and
LOS ANGELES COMMUNITY HOSPITAL OF NORWALK, hereinafter designated the Provider,
entered into a contract (Contract No. 00-83122) for provision of inpatient
hospital services executed September 14, 2000, and subsequently amended;  NOW
THEREFORE, in accordance with the provisions for renegotiation and modification
set forth in Article 6, Section 6.11 of said Contract, the Contract
is amended as follows:  Paragraph
One  Amendment of Appendix D  Appendix
Dis hereby amended as follows:  1


Appendix
D  EMERGENCY
SERVICES AND SUPPLEMENTAL PAYMENTS FUND  Pursuant
to the provisions of Welfare and Institutions
Code Section 14085.6 relating to negotiations and disbursements
from the Emergency Services and Supplemental Payments Fund, the parties hereby
additionally agree as follows:  A.Services  In
addition to any other promises and services agreed to be provided pursuant to
this Contract, Provider agrees:  (1)           To remain a contract provider within
the Selective Provider Contracting Program and not to issue a notice of
termination of this Contract pursuant to Section 6.15 until on or before March 1,
2002.  (2)           To maintain its current emergency
room licensure status until June 30, 2002.  2


B.            Payments  In
addition to any other payments made to Provider pursuant to this Contract, and
in consideration of the agreements set out in Section A above, the State
hereby agrees to pay the Provider a total of *** from the Emergency Services
and Supplemental Payments Fund for services rendered from July 1, 2001
through June 30, 2002.  Payments
shall be made in the following amounts on the following dates, or as soon
thereafter as practicable:  (1)           on November 15, 2001, the amount
of ***;  (2)           on February 1, 2002, the amount
of ***.  C.            Hold Harmless and Right of
Set-Off  (1)           Provider must promptly return to the
Department of Health Services (Department) all payments received under this
amendment from the Emergency Services and Supplemental Payments Fund (SB 1255
Fund) for the 2001-02 state fiscal year if the Department determines that the
Provider fails to meet the criteria for disproportionate share hospital (DSH)
status for the 2001-02 payment adjustment year. 
If the Provider fails to return the funds within 30 calendar days from
the time of the Departments notification, the Department may off-set the
amount to be recovered against any Medi-Cal payments which otherwise would be
payable by the Department to the Provider.  3


(2)           It is understood that payments made
to the Provider pursuant to this Appendix D include State and matching federal
funds.  The State shall be held harmless
from any federal disallowance or withholding resulting from payments made to
Provider pursuant to this Appendix D and the Provider shall be liable for
any reduced federal financial participation resulting from the payment of funds
pursuant to Appendix D.  In the
event of federal disallowance or withholding of federal financial participation
for any payments made to the Provider pursuant to Appendix D, at the time
of the federal disallowance or withholding, the State may, in its sole
discretion, recover from the Provider the amount of funds disallowed and paid
by the State to the Provider.  Provider
agrees that the amount of any such disallowance may be recouped by the Department
by withholding the amount due from what would otherwise be the States
liability to the Provider under this Contract or otherwise, seeking recovery by
payment from the Provider or a combination of these two methods.  If after federal disallowance or withholding,
and State recovery or set-off of funds paid to the Provider, the State regains
the federal funds disallowed or withheld, then the funds shall be repaid by the
State to the Provider.  (3)           Any recoupment by the State pursuant
to subsection (2) shall be limited to the amount of federal financial
participation recouped from the State by the federal government with respect to
actual payments made to the Provider under this Appendix D.  4


D.            Breach  (1)           If, subsequent to receiving payments
pursuant to the provisions of this Appendix D, Provider breaches any of
the service provisions set forth in Section A above, the State may, in its
sole discretion, recover from the Provider the amount of funds paid by the
State to the Provider pursuant to Appendix D.  Provider agrees that the amount of any such
payments may be recouped by the Department by withholding the amount due from
what would otherwise be the States liability to Provider under this Contract
or otherwise, seeking recovery by payment from the Provider, or a combination
of these two methods.  (2)           The recovery of funds paid pursuant
to this Appendix D, however, shall not preclude the State from pursuing
additional damages in the event that the Provider breaches Section A(1) above
relating to termination.  In the event
Provider terminates this Contract in violation of Section A(1) above,
the State may, in its sole discretion, pursue all lawful remedies to recover
its damages caused by Providers breach.  Paragraph
Two  Effective Date of Contract Amendment  Contract
changes agreed to in this Amendment shall be effective on September 20,
2001.  5


Paragraph
Three  Incorporation of Contract Rights, Duties and Obligations  All
other terms and provisions of said Contract shall remain in full force and
effect, so that all rights, duties and obligations, and liabilities of the
parties hereto otherwise remain unchanged.  6


EXECUTION  This
Contract Amendment shall be deemed duly executed and binding upon execution by
both parties below.  Executed
  on,
  at(City,
  State, Zip)   HospitalBySignatureType
  Name and TitleExecuted
  on,
  atSacramento,
  CaliforniaSTATE OF CALIFORNIAByDiana
  M. Bontá, R.N., Dr. P.H.
  Director
  Department of Health Services  7


CONTRACT
FOR HOSPITAL INPATIENT SERVICES  Amendment
No. 4  Contract No.
  00-83122Hospital:
  ALTA LOS ANGELES HOSPITALS, INC.dba: LOS ANGELES COMMUNITY HOSPITALAddress:
  4081 East Olympic BoulevardLos Angeles, CA 90023-3330  CONFIDENTIAL DO
NOT RELEASE Exempt
from Public Records Act (Government Code Section 6254 [q])


AMENDMENT
NO. 4 TO CONTRACT NO. 00-83122 BETWEEN THE STATE OF CALIFORNIA AND ALTA LOS
ANGELES HOSPITALS, INC., DOING BUSINESS AS LOS ANGELES COMMUNITY HOSPITAL.  WHEREAS,
the State of California, hereinafter designated the State, and ALTA LOS
ANGELES HOSPITALS, INC., doing business as LOS ANGELES COMMUNITY HOSPITAL,
hereinafter designated the Provider, entered into a contract (Contract No. 00-83122)
for provision of inpatient hospital services executed September 14, 2000,
and subsequently amended;  NOW
THEREFORE, in accordance with the provisions for renegotiation and modification
set forth in Article 6, Section 6.11 of said Contract, the Contract
is amended as follows:  Paragraph
One  Amendment of 6.1 Integration Clause  6.1
 Integration Clause is hereby amended to read:  The
State and Provider declare that this instrument, including Appendix A,
Appendix B and Appendix D, contains a total integration of all rights
and obligations of both parties.  There
are no extrinsic conditions or collateral agreements or undertakings of any
kind.  In regarding this instrument as
the full and final  1


expression
of their Contract it is the express intention of both the State and the
Provider that any and all prior or contemporaneous agreements, promises,
negotiations or representations, either oral or written, relating to the
subject matter and period of time governed by this instrument which are not
expressly set forth herein are to have no force, effect, or legal consequence
of any kind.  Paragraph
Two  Amendment of Appendix D  Appendix
Dis hereby amended to read:  2


Appendix
D  EMERGENCY
SERVICES AND SUPPLEMENTAL PAYMENTS FUND  Pursuant
to the provisions of Welfare and Institutions
Code Section 14085.6 relating to negotiations and disbursements
from the Emergency Services and Supplemental Payments Fund, the parties hereby
additionally agree as follows:  While
it is the intent of the parties that Provider receive the benefit of the
additional payments set forth herein for services provided to beneficiaries, it
is understood by the parties that the continued approval of the Selective Provider
Contracting Program (SPCP) waiver is pending with the Centers for Medicare &
Medicaid Services (CMS).  It
is also understood that CMS may place restrictions, limitations, or conditions
upon the continued operation of the SPCP that may affect the implementation of
the Emergency Services and Supplemental Payments Program (ESSPP) and the
provisions, terms, or funding intended by this Amendment.  It
is further understood and agreed that payments for services agreed to in this
Amendment are subject to any future restrictions, limitations or conditions
placed upon the Selective Provider Contracting Program by CMS, if any.  Further, the terms of this  3


Amendment
may need to be renegotiated to reflect any CMS restrictions, limitations or
conditions.  It
is recognized that the administration of the ESSPP and the terms of this
Amendment involve complex calculations and determinations affecting all ESSPP
eligible hospitals.  Further, the amount
available to any eligible hospitals. 
Further, the amount available to any eligible hospital is dependent upon
the total amount of funds that can be expended within the ESSPP and the
individual amounts paid to other eligible hospitals.  Therefore, it is agreed that the determination
of the effect of CMS action upon the SPCP waiver and the ESSPP and the
necessity to renegotiate the terms of this Amendment shall rest solely with the
California Medical Assistance Commission.  B.Services  In
addition to any other promises and services agreed to be provided pursuant to
this Contract, Provider agrees to maintain its current emergency room licensure
status until December 31, 2002.  4


B.            Payments  In
addition to any other payments made to Provider pursuant to this Contract, and
in consideration of the agreements set out in Section A above, the State
hereby agrees to pay the Provider a total of *** from the Emergency Services
and Supplemental Payments Fund for services rendered from July 1, 2002
through December 31, 2002.  Payments
shall be made in the following amounts on the following dates, or as soon
thereafter as practicable:  (1)           on November 21, 2002, the amount
of ***;  (2)           on January 15, 2003, the amount
of ***.  C.            Hold Harmless and Right of
Set-Off  (1)           Provider must promptly return to the
Department of Health Services (Department) all payments received under this
amendment from the Emergency Services and Supplemental Payments Fund (SB 1255
Fund) for the 2002-03 state fiscal year if the Department determines that the
Provider fails to meet the criteria for disproportionate share hospital (DSH)
status for the 2002-03 payment adjustment year. 
If the Provider fails to return the funds within 30 calendar days from
the time of the Departments notification, the Department may off-set the
amount to be recovered against any Medi-Cal payments which otherwise would be
payable by the Department to the Provider.  5


(2)           It is understood that payments made
to the Provider pursuant to this Appendix D include State and matching
federal funds.  The State shall be held
harmless from any federal disallowance or withholding resulting from payments
made to Provider pursuant to this Appendix D and the Provider shall be
liable for any reduced federal financial participation resulting from the
payment of funds pursuant to Appendix D. 
In the event of federal disallowance or withholding of federal financial
participation for any payments made to the Provider pursuant to
Appendix D, at the time of the federal disallowance or withholding, the
State may, in its sole discretion, recover from the Provider the amount of
funds disallowed and paid by the State to the Provider.  Provider agrees that the amount of any such
disallowance may be recouped by the Department by withholding the amount due
from what would otherwise be the States liability to the Provider under this
Contract or otherwise, seeking recovery by payment from the Provider or a
combination of these two methods.  If
after federal disallowance or withholding, and State recovery or set-off of
funds paid to the Provider, the State regains the federal funds disallowed or
withheld, then the funds shall be repaid by the State to the Provider.  (3)           Any recoupment by the State pursuant
to subsection (2) shall be limited to the amount of federal financial
participation recouped from the State by the federal government with respect to
actual payments made to the Provider under this Appendix D.  6


D.            Breach  (1)           If, subsequent to receiving payments
pursuant to the provisions of this Appendix D, Provider breaches any of
the service provisions set forth in Section A above, the State may, in its
sole discretion, recover from the Provider the amount of funds paid by the
State to the Provider pursuant to Appendix D.  Provider agrees that the amount of any such
payments may be recouped by the Department by withholding the amount due from
what would otherwise be the States liability to Provider under this Contract
or otherwise, seeking recovery by payment from the Provider, or a combination
of these two methods.  (2)           The recovery of funds paid pursuant
to this Appendix D, however, shall not preclude the State from pursuing additional
damages in the event that the Provider breaches Section A(1) above
relating to termination.  In the event
Provider terminates this Contract in violation of Section A(1) above,
the State may, in its sole discretion, pursue all lawful remedies to recover
its damages caused by Providers breach.  7


Paragraph
Three  Effective Date of Contract Amendment  Contract
changes agreed to in this Amendment shall be effective on November 21,
2002.  Paragraph
Four  Incorporation of Contract Rights, Duties and Obligations  All
other terms and provisions of said Contract shall remain in full force and
effect, so that all rights, duties and obligations, and liabilities of the
parties hereto otherwise remain unchanged.  8


EXECUTION  This
Contract Amendment shall be deemed duly executed and binding upon execution by
both parties below.  Executed
  on,
  at(City,
  State, Zip)HospitalBySignatureType
  Name and TitleExecuted
  on,
  atSacramento,
  CaliforniaSTATE
  OF CALIFORNIAByDiana
  M. Bontá, R.N., Dr. P.H.
  Director 
  Department of Health Services  9


FOR
HOSPITAL INPATIENT SERVICES  Amendment
No. 5  Contract No.
  
  00-83122Hospital:
  
  ALTA LOS ANGELES HOSPITALS, INC.dba: LOS ANGELES COMMUNITY HOSPITALAddress:
  
  4081 East Olympic BoulevardLos Angeles, CA 90023-3330  CONFIDENTIAL DO
NOT RELEASE Exempt
from Public Records Act (Government Code Section 6254 [q])


AMENDMENT
NO. 5 TO CONTRACT NO. 00-83122 BETWEEN THE STATE OF CALIFORNIA AND ALTA LOS
ANGELES HOSPITALS, INC., DOING BUSINESS AS LOS ANGELES COMMUNITY HOSPITAL.  WHEREAS,
the State of California, hereinafter designated the State, and ALTA LOS
ANGELES HOSPITALS, INC., doing business as LOS ANGELES COMMUNITY HOSPITAL,
hereinafter designated the Provider, entered into a contract (Contract No. 00-83122)
for provision of inpatient hospital services executed September 14, 2000,
and subsequently amended;  NOW
THEREFORE, in accordance with the provisions for renegotiation and modification
set forth in Article 6, Section 6.11 of said Contract, the Contract
is amended as follows:  Paragraph
One  Amendment of Appendix D  Appendix
Dis hereby amended to read:  1


Appendix
D  EMERGENCY
SERVICES AND SUPPLEMENTAL PAYMENTS FUND  Pursuant
to the provisions of Welfare and Institutions
Code Section 14085.6 relating to negotiations and disbursements
from the Emergency Services and Supplemental Payments Fund, the parties hereby
additionally agree as follows:  C.Services  In
addition to any other promises and services agreed to be provided pursuant to
this Contract, Provider agrees to maintain its current emergency room licensure
status until May 31, 2003.  2


B.            Payments  In
addition to any other payments made to Provider pursuant to this Contract, and
in consideration of the agreements set out in Section A above, the State
hereby agrees to pay the Provider a total of *** from the Emergency Services
and Supplemental Payments Fund for services rendered from January 1, 2003
through May 31, 2003.  Payments
shall be made in the following amounts on the following dates, or as soon
thereafter as practicable:  (1)           on April 10, 2003, the amount of
***;  (2)           on June 1, 2003, the amount of
***.  C.            Hold Harmless and Right of
Set-Off  (1)           Provider must promptly return to the
Department of Health Services (Department) all payments received under this
amendment from the Emergency Services and Supplemental Payments Fund (SB 1255
Fund) for the 2002-03 state fiscal year if the Department determines that the
Provider fails to meet the criteria for disproportionate share hospital (DSH)
status for the 2002-03 payment adjustment year. 
If the Provider fails to return the funds within 30 calendar days from
the time of the Departments notification, the Department may off-set the amount
to be recovered against any Medi-Cal payments which otherwise would be payable
by the Department to the Provider.  3


(2)           It is understood that payments made
to the Provider pursuant to this Appendix D include State and matching
federal funds.  The State shall be held
harmless from any federal disallowance or withholding resulting from payments
made to Provider pursuant to this Appendix D and the Provider shall be
liable for any reduced federal financial participation resulting from the
payment of funds pursuant to Appendix D. 
In the event of federal disallowance or withholding of federal financial
participation for any payments made to the Provider pursuant to Appendix D,
at the time of the federal disallowance or withholding, the State may, in its
sole discretion, recover from the Provider the amount of funds disallowed and
paid by the State to the Provider. 
Provider agrees that the amount of any such disallowance may be recouped
by the Department by withholding the amount due from what would otherwise be
the States liability to the Provider under this Contract or otherwise, seeking
recovery by payment from the Provider or a combination of these two
methods.  If after federal disallowance
or withholding, and State recovery or set-off of funds paid to the Provider,
the State regains the federal funds disallowed or withheld, then the funds
shall be repaid by the State to the Provider.  (3)           Any recoupment by the State pursuant
to subsection (2) shall be limited to the amount of federal financial
participation recouped from the State by the federal government with respect to
actual payments made to the Provider under this Appendix D.  4


D.            Breach  (1)           If, subsequent to receiving payments
pursuant to the provisions of this Appendix D, Provider breaches any of
the service provisions set forth in Section A above, the State may, in its
sole discretion, recover from the Provider the amount of funds paid by the
State to the Provider pursuant to Appendix D.  Provider agrees that the amount of any such
payments may be recouped by the Department by withholding the amount due from
what would otherwise be the States liability to Provider under this Contract
or otherwise, seeking recovery by payment from the Provider, or a combination
of these two methods.  (2)           The recovery of funds paid pursuant
to this Appendix D, however, shall not preclude the State from pursuing
additional damages in the event that the Provider breaches Section A(1) above
relating to termination.  In the event
Provider terminates this Contract in violation of Section A(1) above,
the State may, in its sole discretion, pursue all lawful remedies to recover
its damages caused by Providers breach.  5


Paragraph
Two  Effective Date of Contract Amendment  Contract
changes agreed to in this Amendment shall be effective on April 10, 2003.  Paragraph
Three  Incorporation of Contract Rights, Duties and Obligations  All other terms and
provisions of said Contract shall remain in full force and effect, so that all
rights, duties and obligations, and liabilities of the parties hereto otherwise
remain unchanged.  6


EXECUTION  This
Contract Amendment shall be deemed duly executed and binding upon execution by
both parties below.  Executed
  on                                                          ,
  at(City,
  State, Zip)HospitalBySignatureType
  Name and TitleExecuted
  on                                                          ,
  atSacramento,
  CaliforniaSTATE
  OF CALIFORNIAByDiana
  M. Bontá, R.N., Dr. P.H. 
  Director
  Department of Health Services  7


FOR
HOSPITAL INPATIENT SERVICES  Amendment
No. 6  Contract No.
  
  00-83122Hospital:
  
  ALTA LOS ANGELES HOSPITALS, INC.dba: LOS ANGELES COMMUNITY HOSPITALAddress:
  
  4081 East Olympic BoulevardLos Angeles, CA 90023-3330  CONFIDENTIAL
DO NOT RELEASE
Exempt from Public Records Act
(Government Code Section 6254 [q])


AMENDMENT
NO. 6 TO CONTRACT NO. 00-83122 BETWEEN THE STATE OF CALIFORNIA AND ALTA LOS
ANGELES HOSPITALS, INC., DOING BUSINESS AS LOS ANGELES COMMUNITY HOSPITAL.  WHEREAS,
the State of California, hereinafter designated the State, and ALTA LOS
ANGELES HOSPITALS, INC., doing business as LOS ANGELES COMMUNITY HOSPITAL,
hereinafter designated the Provider, entered into a contract (Contract No. 00-83122)
for provision of inpatient hospital services effective September 14, 2000
and subsequently amended;  NOW
THEREFORE, in accordance with the provisions for renegotiation and modification
set forth in Article 6, Section 6.11 of said Contract, the Contract
is amended as follows:  Paragraph
One - Amendment of 4.1 - Rate Structure; Contingent Liability of State  4.1Rate Structure; Contingent Liability
of State is hereby amended to read:  Provided
that there shall first have been a submission of claims in accordance with
Paragraph 4.3 of this Contract, the Provider shall be paid the all-inclusive
rate per patient per day of *** for inpatient services provided to
beneficiaries.  1


Paragraph
Two  Amendment of Appendix A  Appendix
Ais hereby amended to read:  2


APPENDIX AHOSPITAL NAME:
  
  Los
  Angeles CommunityHospital,
  A-6DATE PREPARED:
  
  April 22,
  2003EFFECTIVE DATE:
  
  May 8,
  2003PREPARED BY:
  
  Karen
  Thalhammer  I.SERVICES NOT PROVIDED BY HOSPITAL UNDER THIS
CONTRACT AND NOT REIMBURSABLE  CODES
  
  UNIVERSAL
  BILLINGINTENSIVE
  CARE, TRAUMA
  
  208INTENSIVE
  CARE, POST ICU
  
  206INTENSIVE
  CARE, PEDIATRIC
  
  203INTENSIVE
  CARE, LUNG TRANSPLANT
  
  083INTENSIVE
  CARE, HEART-LUNG TRANSPLANT
  
  084INTENSIVE
  CARE, HEART TRANSPLANT
  
  086INTENSIVE
  CARE, LIVER TRANSPLANT
  
  087INTENSIVE
  CARE, BONE MARROW TRANSPLANT
  
  088INTENSIVE
  CARE, KIDNEY TRANSPLANT
  
  089INTENSIVE
  CARE, BURN CARE IN LICENSEDBURN CENTER BEDS
  
  207CORONARY
  CARE, POST CCU
  
  214NURSERY,
  NEONATAL INTENSIVE CARE
  
  175LITHOTRIPSY
  
  090ADMINISTRATIVE
  DAY
  
  098
  *REHABILITATION
   PRIVATE
  
  118REHABILITATION
   SEMI-PRIVATE 2 BEDS
  
  128REHABILITATION
  SEMI-PRIVATE 3 OR 4 BEDS
  
  138REHABILITATION
   WARD (MEDICAL OR GENERAL)
  
  158  CPT
  CODESCARDIAC
  CATHETERIZATION
  
  93501-93562CARDIOVASCULAR
  SURGERY
  
  33010-37799ABORTIONS
  
  59840-59857NEUROSURGERY
  
  61000-64999CORNEAL
  TRANSPLANTS
  
  65710,
  65730, 65750, 65755RADIATION
  THERAPY
  
  77261-77499,77750-77799THERAPEUTIC
  NUCLEAR MEDICINE
  
  79000-79999MAGNETIC
  RESONANCE IMAGING
  
  70336,
  70540MAGNETIC
  RESONANCE IMAGING
  
  70551-70553,
  71550MAGNETIC
  RESONANCE IMAGING
  
  72141-72142,
  72146-72149MAGNETIC
  RESONANCE IMAGING
  
  72156-72158,72195-72197MAGNETIC
  RESONANCE IMAGING
  
  73218-73225,73718-73725MAGNETIC
  RESONANCE IMAGING
  
  74181-74185,75552-75556MAGNETIC
  RESONANCE IMAGING
  
  76093-76094,76400HYPERBARIC
  OXYGEN
  
  99183  
 *BILLABLE
ONLY OUTSIDE THE PROVISIONS OF THE CONTRACT.  3


II.ONLY
THE FOLLOWING PHYSICIAN SERVICES ARE INCLUDED IN THE ALL-INCLUSIVE RATE AND ARE
NOT SEPARATELY BILLED:  NONE  III.ONLY
THE FOLLOWING OTHER PROVIDER SERVICES MAY BE BILLED FEE-FOR-SERVICE BY
SUCH PROVIDER AND ARE NOT INCLUDED IN THE ALL- INCLUSIVE CONTRACT RATE AS
SPECIFIED IN SECTION 4.1:  HCPC
  CODESCLINICAL PSYCHOLOGISTS
  
  X9500-X9699   IV.ONLY
THE FOLLOWING OTHER DEVICES MAY BE BILLED FEE-FOR-SERVICE AND ARE NOT
INCLUDED IN THE ALL-INCLUSIVE CONTRACT RATE AS SPECIFIED IN SECTION 4.1:  HCPC
  CODESPROSTHETIC DEVICES
  
  L5000-L8699PROSTHETIC DEVICES
  
  X8800-X9299ORTHOTIC DEVICES
  
  L0100-L4398ORTHOTIC DEVICES
  
  X8100-X8599  4


Paragraph
Three  Effective Date of Contract Amendment  If
this Amendment is signed by the Provider and returned to the California Medical
Assistance Commission within thirty (30) days of
                    ,
then the Contract changes agreed to in this Amendment shall be effective on
                    .  If this Amendment is not signed and returned
within thirty days, then the Contract changes agreed to in this Amendment shall
be effective on the date the Contract is signed by both parties.  Paragraph
Four - Incorporation of Contract Rights, Duties and Obligations  All
other terms and provisions of said Contract shall remain in full force and
effect so that all rights, duties and obligations, and liabilities of the
parties hereto otherwise remain unchanged.  5


EXECUTION  This
Contract Amendment shall be deemed duly executed and binding upon execution by
both parties below.  Executed
  on                                                          ,
  at(City,
  State, Zip)HospitalBySignatureType
  Name and TitleExecuted
  on                                                          ,
  atSacramento,
  CaliforniaSTATE
  OF CALIFORNIAByDiana
  M. Bontá, R.N., Dr. P.H. 
  Director 
  Department of Health Services  6


FOR
HOSPITAL INPATIENT SERVICES  Amendment
No. 7  Contract No.
  
  00-83122Hospital:
  
  ALTA LOS ANGELES HOSPITALS, INC.dba: LOS ANGELES COMMUNITY HOSPITALAddress:
  
  4081 East Olympic BoulevardLos Angeles, CA 90023-3330  CONFIDENTIAL
DO NOT RELEASE
Exempt from Public Records Act
(Government Code Section 6254 [q])


AMENDMENT
NO. 7 TO CONTRACT NO. 00-83122 BETWEEN THE STATE OF CALIFORNIA AND ALTA LOS
ANGELES HOSPITALS, INC., DOING BUSINESS AS LOS ANGELES COMMUNITY HOSPITAL.  WHEREAS,
the State of California, hereinafter designated the State, and ALTA LOS
ANGELES HOSPITALS, INC., doing business as LOS ANGELES COMMUNITY HOSPITAL,
hereinafter designated the Provider, entered into a contract (Contract No. 00-83122)
for provision of inpatient hospital services effective September 14, 2000
and subsequently amended;  NOW
THEREFORE, in accordance with the provisions for renegotiation and modification
set forth in Article 6, Section 6.11 of said Contract, the Contract
is amended as follows:  Paragraph
One  Amendment of Appendix D  Appendix
Dis hereby amended to read:  1


APPENDIX D  EMERGENCY SERVICES AND SUPPLEMENTAL PAYMENTS
FUND  Pursuant
to the provisions of Welfare and Institutions Code Section 14085.6
relating to negotiations and disbursements from the Emergency Services and
Supplemental payments Fund, the parties hereby additionally agree as follows:  A.Services  In
addition to any other promises and services agreed to be provided pursuant to
this Contract, Provider agrees to maintain its current emergency room licensure
status until December 31, 2003.  B.Payments  In
addition to any other payments made to Provider pursuant to this Contract, and
subject to Subparagraph A above, the State hereby agrees to pay the Provider a
total of *** from the Emergency Services and Supplemental Payments Fund for
services rendered from July 1, 2003 through November 30, 2003.  Payments shall be made in the following
amounts on the following dates, or as soon thereafter as practicable:  (1)on
August 28, 2003, the amount of ***;  (2)on
December 1, 2003, the amount of ***.  2


C.Hold
Harmless and Right of Offset  (1)Provider
must promptly return to the Department of Health Services (Department) all
payments received under this amendment from the Emergency Services and
Supplemental Payments Fund (SB 1255 Fund) for the 2003-04 state fiscal year if
the Department determines that the Provider fails to meet the criteria for
disproportionate share hospital (DSH) status, under Welfare and Institutions
Code Sections 14105.98 and 14163, for the 2003-04 payment adjustment year.  If the Provider fails to return the fund
within 30 calendar days from the time of the Departments notification, the
Department may offset the amount to be recovered against any Medi-Cal payments
which otherwise would be payable by the Department to the Provider, pursuant to
Welfare and Institutions Code Section 14115.5.  (2)It
is understood that payments made to the Provider pursuant to this Appendix D
include State and federal funds.  The
State shall be held harmless from any federal disallowance or withholding
resulting from payments made to Provider pursuant to this Appendix D and the
Provider shall be liable for any reduced federal financial participation
resulting from the payment of funds pursuant to Appendix D.  In the event of federal disallowance or
withholding of federal financial participation for any payments made to the
Provider pursuant to Appendix D, at the time of the federal disallowance or
withholding the State may, in is sole discretion, recover from the Provider the
amount of funds  3


disallowed
and paid by the State to the Provider. 
Provider agrees that the amount of any such disallowance may be recouped
by the Department by withholding and offsetting, under Welfare and Institutions
Code Section 14115.5, the amount due from what would otherwise be the
States liability to the Provider under this Contract or otherwise, seeking
recovery by payment from the Provider, or a combination of these two
methods.  If, after federal disallowance
or withholding and State recovery or offset of funds paid to the Provider, the
State regains the federal funds disallowed or withheld, then the funds shall be
repaid by the State to the Provider.  (3)Any
recoupment by the State pursuant to subsection (2) shall be limited to the
amount of federal financial participation recouped from the State by the
federal government with respect to actual payment made to the Provider under
this Appendix D.  4


D.Breach  If,
subsequent to receiving payments pursuant to the provisions of this Appendix D,
Provider fails to comply with Subparagraph A above, the State may, in its sole
discretion, recover from the Provider the amount of funds paid by the State to
the Provider pursuant to Appendix D. 
Provider agrees that the amount of any such payments may be recouped by
the Department by withholding and offsetting, under Welfare and Institutions
Code Section 14115.5, the amount due from what would otherwise be the
States liability to Provider under this Contract or otherwise, seeking
recovery by payment from the Provider, or a combination of these two methods.  Paragraph
Two  Effective Date of Contract Amendment  Contract
changes agreed to in this Amendment shall be effective on August 28, 2003.  Paragraph
Three  Incorporation of Contract Rights, Duties and Obligations  All
other terms and provisions of said Contract shall remain in full force and
effect, so that all rights, duties and obligations, and liabilities of the
parties hereto otherwise remain unchanged.  5


EXECUTION  This
Contract Amendment shall be deemed duly executed and binding upon execution by
both parties below.  Executed
  on                                                          ,
  at(City,
  State, Zip)HospitalBySignatureType
  Name and TitleExecuted
  on                                                          ,
  atSacramento,
  CaliforniaSTATE
  OF CALIFORNIAByDiana
  M. Bontá, R.N., Dr. P.H. 
  Director
  Department of Health Services  6


FOR
HOSPITAL INPATIENT SERVICES  Amendment
No. 8  Contract No.
  
  00-83122Hospital:
  
  ALTA LOS ANGELES HOSPITALS, INC.dba: LOS ANGELES COMMUNITY HOSPITALAddress:
  
  4081 East Olympic BoulevardLos Angeles, CA 90023-3330  CONFIDENTIAL
DO NOT RELEASE
Exempt from Public Records Act
(Government Code Section 6254 [q])


AMENDMENT
NO. 8 TO CONTRACT NO. 00-83122 BETWEEN THE STATE OF CALIFORNIA AND ALTA LOS
ANGELES HOSPITALS, INC., DOING BUSINESS AS LOS ANGELES COMMUNITY HOSPITAL.  WHEREAS,
the State of California, hereinafter designated the State, and ALTA LOS
ANGELES HOSPITALS, INC., doing business as LOS ANGELES COMMUNITY HOSPITAL,
hereinafter designated the Provider, entered into a contract (Contract No. 00-83122)
for provision of inpatient hospital services executed September 14, 2000,
and subsequently amended;  NOW
THEREFORE, in accordance with the provisions for renegotiation and modification
set forth in Article 6, Section 6.11 of said Contract, the Contract
is amended as follows:  Paragraph
One  Amendment of Appendix D  Appendix
Dis hereby amended to read:  1


APPENDIX
D  EMERGENCY
SERVICES AND SUPPLEMENTAL PAYMENTS FUND  This
Appendix D supercedes any previous Appendix D of this Contract.  Pursuant
to the provisions of Welfare and Institutions
Code Section 14085.6 relating to negotiations and disbursements
from the Emergency Services and Supplemental Payments Fund, the parties hereby
additionally agree as follows:  D.Services  In
addition to any other payments made to Provider pursuant to this Contract, and
subject to Subparagraph B of this Appendix D, the State agrees to pay
the Provider a total of *** from the Emergency Services and Supplemental
Payments Fund for services rendered from January 1, 2004 through May 31,
2004.  Payments shall be made in the
following amount on June 1, 2004, or as soon thereafter as practicable:  (1)The
amount of ***.  2


B.Recovery,
Right of Offset, and Hold Harmless  (1)Provider
must promptly return to the Department of Health Services (Department) all
payments received under this amendment from the Emergency Services and
Supplemental Payments Fund (SB 1255 Fund) for the 2003-04 state fiscal year if
the Department determines that the Provider fails an anytime during the 2003-04
state fiscal year to meet the criteria for participation as specified in Welfare and Institutions Code Section 14085.6.  Such criteria includes, but is not limited
to, the Provider receiving and maintaining disproportionate share hospital
(DSH) status, under Welfare and Institutions
Code Sections 14105.98 and 14163, for the 2003-04 DSH payment
adjustment year.  If the Provider fails
to return the funds within 30 calendar days from the time of the Departments
notification, the Department may off-set the amount to be recovered against any
Medi-Cal payments which otherwise would be payable by the Department to the
Provider, pursuant to Welfare and Institutions
Code Section 14115.5.  (2)It
is understood that payments made to the Provider pursuant to this
Appendix D include State and matching federal funds.  The State shall be held harmless from any
federal disallowance or withholding resulting from payments made to Provider
pursuant to this Appendix D and the Provider shall be liable for any
reduced federal financial participation resulting from the payment of funds
pursuant to Appendix D.  In the
event of federal disallowance or withholding of federal financial participation
for any payments made to the Provider pursuant to Appendix D, at the time
of the  3


federal
disallowance or withholding, the State may, in its sole discretion, recover
from the Provider the amount of funds disallowed and paid by the State to the
Provider.  Provider agrees that the
amount of any such disallowance may be recouped by the Department by
withholding and offsetting, under Welfare and Institutions Code Section 14115.5,
the amount due from what would otherwise be the States liability to the
Provider under this Contract or otherwise, seeking recovery by payment from the
Provider, or a combination of these two methods.  If, after federal disallowance or
withholding, and State recovery or set-off of funds paid to the Provider, the
State regains the federal funds disallowed or withheld, then the funds shall be
repaid by the State to the Provider.  (3)Any
recoupment by the State pursuant to subsection (2) shall be limited
to the amount of federal financial participation recouped from the State by the
federal government with respect to actual payments made to the Provider under
this Appendix D.  C.Notice
of Termination  Notwithstanding Paragraph 6.15, Termination
Without Cause, Provider shall not exercise or attempt to exercise
paragraph 6.15 until After December 31, 2004.  4


D.Remedy
for Providers Breach  (1)If,
subsequent to receiving payments pursuant to the provisions of this
Appendix D, Provider fails to comply with Subparagraph C of this
Appendix D, the State may, in its sole discretion, recover from the
Provider the amount of funds paid by the State to the Provider pursuant to
Appendix D, which shall not be the States sole remedy.  Provider agrees that the amount of any such
payments may be recouped by the Department by withholding and offsetting, under
Welfare and Institutions Code Section 14115.5, the amount due from what
would otherwise be the States liability to Provider under this Contract or
otherwise, seeking recovery by payment from the Provider, or a combination of
these two methods.  Paragraph
Two  Effective Date of Contract Amendment  Contract
changes agreed to in this Amendment shall be effective on May 13, 2004.  5


Paragraph
Three  Incorporation of Contract Rights, Duties and Obligations  All
other terms and provisions of said Contract shall remain in full force and
effect, so that all rights, duties and obligations, and liabilities of the
parties hereto otherwise remain unchanged.  SIGNATURES  The
signatories to this Amendment warrant that they have full and binding authority
to make the commitments contained herein on behalf of their respective
entities.  Provider
  
  State of California 
  Department of Health ServicesSignature
  
  SignatureSandra
  ShewryType
  Name
  
  DirectorType
  TitleDate:
  
  Date:  6


CONTRACT
FOR HOSPITAL INPATIENT SERVICES  Amendment
No. 9  Contract No.
  
  
  00-83122Facility:
  
  
  ALTA LOS ANGELES HOSPITALS, INC.dba:
  LOS ANGELES COMMUNITY HOSPITALAddress:
  
  4081
  East Olympic BoulevardLos Angeles, CA 90023-3330  CONFIDENTIAL DO
NOT RELEASE Exempt
from Public Records Act (Government Code Section 6254 [q])


AMENDMENT
NO. 9 TO CONTRACT NO. 00 - 83122 BETWEEN THE STATE OF CALIFORNIA AND ALTA LOS
ANGELES HOSPITALS, INC., DOING BUSINESS AS LOS ANGELES COMMUNITY HOSPITAL.  WHEREAS,
the State of California, hereinafter designated the State, and ALTA LOS
ANGELES HOSPITALS, INC., doing business as LOS ANGELES COMMUNITY HOSPITAL,
hereinafter designated the Provider, entered into a contract (Contract No. 00-83122)
for provision of inpatient hospital services effective September 14, 2000
and subsequently amended;  NOW
THEREFORE, in accordance with the provisions for renegotiation and modification
set forth in Article 6, Paragraph 6.11 of the Contract, the Contract is
amended as follows:  Paragraph
One - Appendix D  Appendix
Dis hereby amended to read:  1


APPENDIX
D  EMERGENCY
SERVICES AND SUPPLEMENTAL PAYMENTS FUND  This
version of Appendix D governs dates of services and related Medi-Cal
supplemental reimbursements for State Fiscal Year (SFY) 2004-05.  Pursuant
to the provisions of Welfare and Institutions Code Section 14085.6
relating to negotiations and disbursements from the Emergency Services and
Supplemental Payments Fund (SB 1255 Program), the parties agree as follows:  A.Payment  (1)In
addition to any other payments made to Provider pursuant to this Contract, and
subject to Section B of this Appendix D, the State agrees to pay the
Provider a total of *** from the Emergency Services and Supplemental Payments
Fund for services rendered from July 1, 2004 through November 30,
2004.  Payment shall be made in the
following amount on December 1, 2004, or as soon thereafter as
practicable.  (a)           The amount of ***.  2


(2)           The above payment to Provider is
conditioned upon the Emergency Services and Supplemental Payments Fund having
received sufficient new funds during SFY 2004-05 to meet all the S8 1255
Programs payment objectives for services rendered from July 1, 2004
through November 30, 2004.  Until
such time as a sufficient amount of unencumbered funds has been deposited in
the Fund to support the non-federal portion of the SB 1255 Programs total
payment objectives for this service period, and the coinciding portion of
federal financial participation funds are available, the State shall have no
obligation to make the above payment.  B.Recovery,
Right of Offset, and Hold Harmless  (1)           Provider must promptly return to the
Department of Health Services (Department) all payments received under this
amendment from the Emergency Services and Supplemental Payments Fund (SB 1255
Fund) for the 2004-05 state fiscal year if the Department determines that the
Provider fails to meet the criteria for participation, as specified in Welfare
and Institutions Code Section 14085.6, at anytime during the 2004-05 state
fiscal year.  Such criteria includes, but
is not limited to, the Provider receiving and maintaining disproportionate
share hospital (DSH) status, under Welfare and Institutions Code Sections
14105.98 and 14163, for the 2004-05 DSH payment adjustment year.  If the Provider fails to return the funds
within 30 calendar days from the time of the Departments notification, the
Department may offset the amount to be recovered against any Medi-Cal payments
which  3


otherwise
would be payable by the Department to the Provider, pursuant to Welfare
and Institutions Code Section 14115.5.  (2)           It is understood that payment made to
the Provider pursuant to this Appendix D, and all prior versions of Appendix D,
include State and federal funds.  The
State shall be held harmless from any federal disallowance or withholding
resulting from payment made to Provider pursuant to this Appendix D, or any
prior version(s) of Appendix D, and the Provider shall be liable for any
reduced federal financial participation resulting from the payment of funds
pursuant to this Appendix D, or any prior version(s) of Appendix D.  In the event of federal disallowance or
withholding of federal financial participation for any payments made to the
Provider pursuant to this Appendix D, or any prior version(s) of Appendix
D, at the time of the federal disallowance or withholding the State may, in its
sole discretion, recover from the Provider the amount of funds disallowed and
paid by the State to the Provider. 
Provider agrees that the amount of any such disallowance may be recouped
by the Department by withholding and offsetting, under Welfare and Institutions
Code Section 14115.5, the amount due from what would otherwise be the
States liability to the Provider under this Contract or otherwise, seeking
recovery by payment from the Provider, or a combination of these two
methods.  If, after federal disallowance
or withholding and State recovery or offset of funds paid to the Provider, the
State regains the federal funds disallowed or withheld, then the funds shall be
repaid by the State to the Provider.  4


(3)           Any recoupment by the State pursuant
to subsection (2) shall be limited to the amount of federal financial
participation recouped from the State by the federal government with respect to
actual payment made to the Provider under this Appendix D. All other terms and
conditions of Appendix D remain unchanged.  Paragraph
Two - Effective Date of Contract Amendment  Contract
changes agreed to in this Amendment are effective on October 21, 2004.  Paragraph
Three - Obligations Incorporation of Contract Rights, Duties and Obligations  All
other terms and provisions of the Contract shall remain in full force and
effect, so that all rights, duties and obligations, and liabilities of the
parties hereto otherwise remain unchanged.  5


SIGNATURES  The
signatories to this Amendment warrant that they have full and binding authority
to make the commitments contained herein on behalf of their respective
entities.  State of CaliforniaProvider
  
  Department of Health
  ServicesSignature
  
  SignatureSandra
  ShewryType
  Name
  
  DirectorType
  TitleDate:
  
  Date:  6


CONTRACT
FOR HOSPITAL INPATIENT SERVICES  Amendment
No. 10  Contract No.
  
  00-83122Hospital:
  
  ALTA LOS ANGELES HOSPITALS, INC.dba: LOS ANGELES COMMUNITY HOSPITALAddress:
  
  4081 East Olympic BoulevardLos Angeles, CA 90023-3330  CONFIDENTIAL DO
NOT RELEASE Exempt
from Public Records Act (Government Code Section 6254 [q])


AMENDMENT
NO. 10 TO CONTRACT NO. 00-83122 BETWEEN THE STATE OF CALIFORNIA AND ALTA LOS
ANGELES HOSPITALS, INC., DOING BUSINESS AS LOS ANGELES COMMUNITY HOSPITAL.  WHEREAS,
the State of California, hereinafter designated the State, and Alta Los
Angeles Hospitals, Inc., doing business as: Los Angeles Community
Hospital, hereinafter designated the Provider, entered into a contract
(Contract No. 00-83122) for provision of inpatient hospital services
effective September 14, 2000 and subsequently amended;  NOW
THEREFORE, in accordance with the provisions for renegotiation and modification
set forth in Article 6, Paragraph 6.11 of the Contract, the Contract is
amended as follows:  Paragraph
One  Amendment of 3.4  Appointment of Liaisons and Agency Status of Providers
Liaison  3.4Appointment
of Liaisons and Agency Status of Provider s Liaisonis hereby amended to read:  (a)           Provider shall designate in writing a
person to act as liaison to the Department. Such person shall coordinate all
communications between the parties.  The
written designation of


such
person shall constitute the conferral of full agency powers to bind the
Provider as principal in all dealings with the Department.  (b)           The Department shall designate a
liaison in conformity with the procedures and with such authority as specified
in Paragraph 6.8 of this Contract. 
Communications to the Department shall be submitted to its liaison at
the following address:  Contract
Officer Medi-Cal
Operations Division P.O. Box
997419 MS
4506 Sacramento,
CA 95899-7419  Paragraph
Two  Amendment of 3.7  Open Staffing/Exclusive Staffing Contracts  3.7Open
Staffing/Exclusive Staffing Contractsis hereby amended to read:  (a)           As a Selective Provider Contracting
Program contractor, the Provider shall comply with Welfare and Institutions
Code section 14087.28.


(b)           Notwithstanding Subparagraph (a) above
and Welfare and Institutions Code section 14087.28, Provider may enter into
exclusive contracts for the provision of pathology, radiology, and
anesthesiology acute inpatient services, except for consulting services
requested by the admitting physician.  (c)           The Parties acknowledge that although
Paragraph 3.7 of this Contract and Section 14087.28 of the Welfare and
Institutions Code prohibit exclusive staffing arrangements for Selective
Provider Contracting Program hospitals, their applicability is limited to
physician staffing for acute inpatient services.  Therefore, contractual staffing arrangements
to provide outpatient services are not contrary to Paragraph 3.7 of this
Contract or Section 14087.28 of the Welfare and Institutions Code.  Paragraph
Three  Amendment of 4.1  Rate Structure; Contingent Liability of State  4.1Rate
Structure; Contingent Liability of Stateis hereby amended to read:  Provided
that there shall first have been a submission of claims in accordance with
Paragraph 4.3 of this Contract, the Provider shall be paid as follows:


(a)           For Inpatient Services provided to
Beneficiaries, the all-inclusive rate per patient per day of ***.  (b)           Commencing March 10, 2006, for
Inpatient Services provided to Beneficiaries, the all-inclusive rate per
patient per day of ***.  Paragraph
Four  Amendment of 4.2  Rate Inclusive of Physician, Transportation and
Certain Prior Patient Services  4.2Rate
Inclusive of Physician, Transportation and Certain Prior Patient Servicesis hereby amended to read:  The
rate structure under Paragraph 4.1 of this Contract is intended by both the
State and Provider to be inclusive of all Inpatient Services rendered by the
Provider and to constitute the States only financial obligation under this
Contract. As nonlimiting examples:  (a)           There shall be no separate billing by
either the Provider or physicians for the services specified in Appendix A, Section II,
rendered by physicians to Beneficiaries.  (b)           There shall be no separate billing
for any transportation services required in providing Inpatient Services under
this Contract.


(c)           There shall be no separate billing
for any services rendered by the Provider within a 24-hour period prior to the
Beneficiarys admission as an inpatient, such as outpatient or emergency
services, which are related to the condition for which the Beneficiary is
admitted as an inpatient.  Such prior
services shall be deemed Inpatient Services and included in the rates set under
Paragraph 4.1.  Paragraph
Five  Amendment of 4.3  Billing Procedures as Express Conditions Precedent to
States Payment Obligation  4.3Billing
Procedures as Express Conditions Precedent to States Payment Obligation is
hereby amended to read:  (a)           As an express condition precedent to
maturing the States payment obligation under Paragraph 4.1 of this Contract,
the Provider shall determine that inpatient services rendered are not covered,
in whole or in part, under any other state or federal medical care program or
under any other contractual or legal entitlement, including, but not limited
to, a private group indemnification or insurance program or workers
compensation.  To the extent that such
coverage is available, the States payment obligation pursuant to Paragraph 4.1
shall be reduced.  (b)           As a further express condition
precedent to maturing the States payment obligation under Paragraph 4.l of
this


Contract,
the Provider shall submit claims to the fiscal intermediary for all services
rendered under the terms of this Contract, in accordance with the applicable
billing requirements contained in Title 22 of the California Code of
Regulations.  (c)           A day of service shall be billed for
each beneficiary who occupies an inpatient bed at 12:00 midnight in the
facilities of the Provider.  However, a
day of service may be billed if the beneficiary is admitted and discharged
during the same day provided that such admission and discharge is not within
24-hours of a prior discharge. Only one patient day of service may be billed
for mother and newborn child (children) when both mother and newborn child
(children) are inpatients of the hospital.  (d)           The State may from time to time adopt
updated billing codes by means of regulation, Medi-Cal Provider Manual,
Medi-Cal Update Bulletin, or similar instruction, which shall automatically
replace the applicable billing codes expressly stated in this Contract and/or
its appendices, without the need to amend this Contract as set forth in
Paragraph 6.11.  Paragraph
Six  Amendment of 6.8  Contract Officer  Delegation of Authority  6.8           Contract Officer  Delegation of
Authorityis hereby amended to read:


The
Department will administer this Contract through a single administrator, the
Contract Officer.  Until such time as the
Director gives the Provider written notice of successor appointment, the person
designated above shall make all determinations and take all actions necessary
to administer this Contract, subject to the limitations of California laws and
State administrative regulations.  No
person other than the Contract Officer or the Director shall have the power to
bind the Department relative to the rights and duties of the Contractor and the
Department under this Contract, nor shall any other person be considered to
have the delegated authority of the Contract Officer or to be acting on his
behalf unless the Contract Officer has expressly stated in writing that that
person is acting as his authorized agent.  Paragraph
Seven  Amendment of 6.9  Notice  6.9          Notice is hereby amended to
read:  Any
notice required to be given pursuant to the terms and provisions of the
Contract shall be in writing and shall be sent by certified mail, return
receipt requested. Notice to the Department shall be sent to the following
address:  Contract Officer 
Medi-Cal Operations 
Division P.O. Box 997419 
MS 4506 
Sacramento, CA 95899-7419


Notice
to the Provider shall be sent to the Chief Executive Officer at the following
address:  Los Angeles Community
Hospital
4081 East Olympic Boulevard
Los Angeles, CA 90023-3330  Paragraph
Eight  Amendment of 6.15  Termination Without Cause  6.15      
 Termination Without Cause is hereby amended to read:  The
Provider or the State may terminate this Contract without cause in accordance
with this Paragraph.  Termination without
cause shall be effected by giving written notice of the termination to the
other party on or after November 10, 2006, and at least 120 days prior to
the effective date of the termination and stating the effective date of the
termination.  Paragraph
Nine  Deletion of 6.22  Prohibition Against Use of State Funds to Assist,
Promote. or Deter Union Organizing  6.22
 Prohibition Against Use of State Funds to Assist, Promote, or Deter Union
Organizing is hereby deleted.


Paragraph
Ten  Effective Date of Contract Amendment  If
this Amendment is signed by the Provider and returned to the California Medical
Assistance Commission within thirty (30) days of March 10, 2005, then the
Contract changes agreed to in this Amendment shall be effective on March 10,
2005.  If this Amendment is not signed
and returned within thirty days, then the Contract changes agreed to in this
Amendment shall be effective on the date the Contract is signed by both
parties.  Paragraph
Eleven  Incorporation of Contract Rights, Duties and Obligations  All
other terms and provisions of said Contract shall remain in full force and
effect, so that all rights, duties and obligations, and liabilities of the
parties hereto otherwise remain unchanged.


EXECUTION  This
Contract shall be deemed duly executed and binding upon execution by both
Parties below.  Executed
  on
                                                          ,
  at(City,
  State, Zip)HospitalBySignatureType
  Name and TitleExecuted
  on
                                                          ,
  atSacramento,
  CaliforniaSTATE
  OF CALIFORNIAByDiana
  M. Bontá, R.N., Dr. P.H.
  Director
  Department of Health Services


CONTRACT
FOR HOSPITAL INPATIENT SERVICES  Amendment
No. 11  Contract No.
  
  00-83122Hospital:
  
  ALTA LOS ANGELES HOSPITALS, INC.dba: LOS ANGELES COMMUNITY HOSPITALAddress:
  
  4081 East Olympic BoulevardLos Angeles, CA 90023-3330  CONFIDENTIAL DO
NOT RELEASE Exempt
from Public Records Act (Government Code Section 6254 [q])


AMENDMENT
NO. 11 TO CONTRACT NO. 00-83122 BETWEEN THE STATE OF CALIFORNIA AND ALTA LOS
ANGELES HOSPITALS, INC., DOING BUSINESS AS LOS ANGELES COMMUNITY HOSPITAL.  WHEREAS,
the State of California, hereinafter designated the State, and ALTA LOS
ANGELES HOSPITALS, INC., doing business as LOS ANGELES COMMUNITY HOSPITAL,
hereinafter designated the Provider, entered into a contract (Contract No. 00-83122)
for provision of inpatient hospital services effective September 14, 2000
and subsequently amended;  NOW
THEREFORE, in accordance with the provisions for renegotiation and modification
set forth in Article 6, Paragraph 6.11 of the Contract, the Contract is
amended as follows:  Paragraph
One  Appendix D  Appendix
Dis hereby amended to read:


APPENDIX
D  EMERGENCY
SERVICES AND SUPPLEMENTAL PAYMENTS FUND  This
version of Appendix D governs dates of services and related Medi-Cal
supplemental reimbursements for State Fiscal Year (SFY) 2004  05.  Pursuant
to the provisions of Welfare and Institutions Code Section 14085.6 (SB
1255 Program) relating to negotiations and disbursements from the Emergency
Services and Supplemental Payments Fund (SB 1255 Fund), the parties agree as
follows:  A.Payment  (1)           In addition to any other payments
made to Provider pursuant to this Contract, and subject to Section B of this
Appendix D, for services rendered from January 1, 2005 through May 31,
2005, the State agrees to pay the Provider *** from the SB 1255 Fund.  Payment shall be made on June 1, 2005,
or as soon thereafter as practicable.  (2)           The above payment to Provider is
conditioned upon the SB 1255 Fund having received sufficient new funds during
SFY 2004-05 to meet all the SB 1255 Programs payment objectives for services
rendered from January 1, 2005 through May 31, 2005.  Until such time as a sufficient amount of unencumbered
funds has been deposited in the SB 1255 Fund to support the non-federal portion


of
the SB 1255 Programs total payment objectives for this service period, and the
coinciding portion of federal financial participation funds are available, the
State shall have no obligation to make the above payment.  The State shall instead be obligated only to
pay a pro-rata portion of the above payment amount based on the ratio of total
funds available to total SB 1255 Program objectives for this service period.  B.Recovery,
Right of Offset, and Hold Harmless  (1)           The total payment received by
Provider from the SB 1255 Fund for the 2004-05 state fiscal year may be subject
to recovery by the Department of Health Services (Department) if the Department
determines that the Provider fails at anytime during the 2004-05 state fiscal
year to meet the criteria for participation in the SB 1255 Program, as
specified in Welfare and Institutions Code Section 14085.6.  If the Provider fails to return the funds
within 30 calendar days from the time of the Departments notification, the
Department may offset the amount to be recovered against any Medi-Cal payments
which otherwise would be payable by the Department to the Provider, pursuant to
Welfare and Institutions Code Section 14115.5.  (a)           Provider must promptly return to the
Department all payments received from the SB 1255 Fund for the 2004-05 state
fiscal year if the Department determines that the Provider fails at anytime
during the 2004-05 state fiscal year to receive and/or maintain
disproportionate share hospital (DSH)


status,
under Welfare and Institutions Code Sections 14105.98 and 14163, for the
2004-05 DSH payment adjustment year.  (b)           Unless paragraph (a) applies,
Provider must promptly return to the Department the pro-rata portion of the
payments, as determined by the Department, received from the S8 1255 Fund for
the 2004-05 state fiscal year if the Department determines that the Provider
failed to meet the criteria, other than DSH status addressed in paragraph (a),
for participation in the SB 1255 Program for the entire fiscal year or service
period, as specified in Welfare and Institutions Code Section 14085.6.  (2)           It is understood that payment made to
the Provider pursuant to this Appendix D, and all prior versions of Appendix D,
include State and federal funds.  The
State shall be held harmless from any federal disallowance or withholding
resulting from payment made to Provider pursuant to this Appendix D, or any
prior version(s) of Appendix D, and the Provider shall be liable for any
reduced federal financial participation resulting from the payment of funds
pursuant to this Appendix D, or any prior version(s) of Appendix D.  In the event of federal disallowance or
withholding of federal financial participation for any payments made to the
Provider pursuant to this Appendix D, or any prior version(s) of
Appendix D, at the time of the federal disallowance or withholding the State
may, in its sole discretion, recover from the Provider the amount of funds disallowed
and paid by the State to the


Provider.  Provider agrees that the amount of any such
disallowance may be recouped by the Department by withholding and offsetting,
under Welfare and Institutions Code Section 14115.5, the amount due from
what would otherwise be the States liability to the Provider under this
Contract or otherwise, seeking recovery by payment from the Provider, or a
combination of these two methods. If, after federal disallowance or withholding
and State recovery or offset of funds paid to the Provider, the State regains
the federal funds disallowed or withheld, then the funds shall be repaid by the
State to the Provider.  (3)           Any recoupment by the State pursuant
to subsection (2) shall be limited to the amount of federal financial
participation recouped from the State by the federal government with respect to
actual payment made to the Provider under this Appendix D. All other terms and
conditions of Appendix D remain unchanged.  Paragraph
Two  Effective Date of Contract Amendment  Contract
changes agreed to in this Amendment are effective on April 28, 2005.


Paragraph
Three  Incorporation of Contract Rights, Duties and Obligations  All
other terms and provisions of the Contract shall remain in full force and
effect, so that all rights, duties and obligations, and liabilities of the
parties hereto otherwise remain unchanged.  SIGNATURES  The
signatories to this Amendment warrant that they have full and binding authority
to make the commitments contained herein on behalf of their respective
entities.  State of CaliforniaProvider
  
  Department of Health
  ServicesSignature
  
  SignatureSandra
  ShewryType
  Name
  
  DirectorType
  TitleDate:
  
  Date:


CONTRACT
FOR HOSPITAL INPATIENT SERVICES  Amendment
No. 12  Contract No.
  
  00-83122Hospital:
  
  ALTA LOS ANGELES HOSPITALS, INC.dba: LOS ANGELES COMMUNITY HOSPITALAddress:
  
  4081 East Olympic BoulevardLos Angeles, CA 90023-3330  CONFIDENTIAL DO
NOT RELEASE Exempt
from Public Records Act (Government Code Section 6254 [q])


AMENDMENT NO.12 TO CONTRACT NO. 00-83122 BETWEEN THE STATE OF CALIFORNIA
AND ALTA LOS ANGELES HOSPITALS, INC., DOING BUSINESS AS LOS ANGELES COMMUNITY
HOSPITAL.  WHEREAS,
the State of California, hereinafter designated the State, and ALTA LOS
ANGELES HOSPITALS, INC., doing business as LOS ANGELES COMMUNITY HOSPITAL,
hereinafter designated the Provider, entered into a contract (Contract No. 00-83122)
for provision of inpatient hospital services effective September 14, 2000
and subsequently amended;  NOW
THEREFORE, in accordance with the provisions for renegotiation and modification
set forth in Article 6, Paragraph 6.11 of the Contract, the Contract is
amended as follows:  Paragraph
One  Appendix D  Appendix
Dis hereby amended to read:


APPENDIX
D  PRIVATE
HOSPITAL SUPPLEMENTAL FUND  This
version of Appendix D governs dates of services and related Medi-Cal
supplemental reimbursements for State Fiscal Year 2005-06.  Pursuant
to the provisions of Welfare and Institutions Code Section 14166.12
relating to negotiations and disbursements from the Private Hospital
Supplemental Fund (Fund), the parties agree as follows:  A.Payment  In
accordance with subdivisions (j) and (m) of Section 14166.12 of
the Welfare and Institutions Code, and subject to Section B of this
Appendix D, for services rendered from July 1, 2005 through November 30,
2005, the State agrees to pay the Provider *** from the Fund. Payment shall be
made on December 1, 2005, or as soon thereafter as practicable.  B.Recovery,
Right of Offset, and Hold Harmless  (1)           The total payment received by
Provider from the Fund for the 2005-06 state fiscal year
may be subject to recovery by the Department of Health Services (Department) if
the Department determines that the Provider fails at any time during the
2005-06 state fiscal year to meet the eligibility criteria for Fund


disbursements,
as specified In Welfare and Institutions Code Section 14166.12.  If the Provider fails to return the funds
within 30 calendar days from the time of the Departments notification, the
Department may offset the amount to be recovered against any Medi-Cal payments
which otherwise would be payable by the Department to the Provider, pursuant to
Welfare and Institutions Code Section l4115.5.  (a)           Provider must promptly return to the
Department all payments received from the Fund for the 2005-06 state fiscal
year if the Department determines that the Provider fails at any time during
the 2005-06 state fiscal year to receive and/or maintain disproportionate share
hospital (DSH) status, under Welfare and Institutions Code Sections 14166.11,
14105.98, and 14:63, for the 2005-06 DSH payment adjustment year.  (b)           Unless paragraph (a) applies,
Provider must promptly return to the Department the pro-rata portion of the
payments, as determined by the Department, received from the Fund for the
2005-06 state fiscal year if the Department determines that the Provider failed
to meet the criteria, other than DSP. status addressed
in paragraph (a), for participation in the Program for the entire fiscal year
or service period, as specified in Welfare and Institutions Code Section 14166.12.


(2)           It is understood that payment made to
the Provider pursuant to this Appendix D, and all prior versions of Appendix D,
include State and federal funds.  The
State shall be held harmless from any federal disallowance or withholding
resulting from payment made to Provider pursuant to this Appendix D, or any
prior version(s) of Appendix D, and the Provider shall be liable for any
reduced federal financial participation resulting from the payment of funds
pursuant to this Appendix D, or any prior version(s) of Appendix D. In the
event of federal disallowance or withholding of federal financial participation
for any payments made to the Provider pursuant to this Appendix D, or any prior
version(s) of Appendix D, at the time of the federal disallowance or
withholding the State may, in its sole discretion, recover from the Provider
the amount of funds disallowed and paid by the State to the Provider. Provider
agrees that the amount of any such disallowance may be recouped by the
Department by withholding and offsetting, under Welfare and Institutions Code Section 14115.5,
the amount due from what would otherwise be the States liability to the
Provider under this Contract or otherwise, seeking recovery by payment from the
Provider, or a combination of these two methods.  If, after federal disallowance or withholding
and State recovery or offset of funds paid to the Provider, the State regains
the federal funds disallowed or withheld, then the federal and related state
funds shall be repaid by the State to the Provider.


Paragraph
Two  Effective Date of Contract Amendment  Contract
changes agreed to in this Amendment are effective on November 3, 2005.  Paragraph
Three  Incorporation of Contract Rights, Duties and Obligations  All
other terms and provisions of the Contract shall remain in full force and
effect, so that all rights, duties and obligations, and liabilities of the
parties hereto otherwise remain unchanged.  SIGNATURES  The
signatories to this Amendment warrant that they have full and binding authority
to make the commitments contained herein on behalf of their respective
entities.  State of CaliforniaProvider
  
  Department of Health
  ServicesSignature
  
  SignatureSandra
  ShewryType
  Name
  
  DirectorType
  TitleDate:
  
  Date:


CONTRACT
FOR HOSPITAL INPATIENT SERVICES  Amendment
No. 13  Contract No.
  
  00-83122Hospital:
  
  ALTA LOS ANGELES HOSPITALS, INC.dba: LOS ANGELES COMMUNITY HOSPITALAddress:
  
  4081 East Olympic BoulevardLos Angeles, CA 90023-3330  CONFIDENTIAL
DO NOT RELEASE
Exempt from Public Records Act
(Government Code Section 6254 [q])


AMENDMENT NO.13 TO CONTRACT NO. 00-83122 BETWEEN THE STATE OF CALIFORNIA
AND ALTA LOS ANGELES HOSPITALS, INC., DOING BUSINESS AS LOS ANGELES COMMUNITY
HOSPITAL.  WHEREAS,
the State of California, hereinafter designated the State, and ALTA LOS
ANGELES HOSPITALS, INC., doing business as LOS ANGELES COMMUNITY HOSPITAL,
hereinafter designated the Provider, entered into a contract (Contract No. 00-83122)
for provision of inpatient hospital services effective September 14, 2000 and
subsequently amended;  NOW
THEREFORE, In accordance with the provisions for renegotiation and modification
set forth in Article 6, Paragraph 6.11 of the Contract, the Contract is
amended as follows:  Paragraph
One  Appendix D  Appendix
Dis hereby amended to read:


APPENDIX
D  PRIVATE
HOSPITAL SUPPLEMENTAL FUND  This
version of Appendix D governs dates of services and related Medi-Cal
supplemental reimbursements for State Fiscal Year 2005-06.  Pursuant
to the provisions of Welfare and Institutions Code Section 14166.12
relating to negotiations and disbursements from the Private Hospital
Supplemental Fund (Fund), the parties agree as follows:  A.Payment  In
accordance with Section 14166.12 of the Welfare and Institutions Code, and
subject to Section B of this Appendix D, for services rendered from December 1,
2005 through May 31, 2006, the State agrees to pay the Provider *** from
the Fund. Payment shall be made on June 1, 2006, or as soon thereafter as
practicable.  B.Recovery,
Right of Offset. and Hold Harmless  (1)           The total payment received by
Provider from the Fund for the 2005-06 state fiscal year
may be subject to recovery by the Department of Health Services (Department) if
the Department determines that the Provider fails at any time during the
2005-06


statefiscal year to meet the eligibility criteria for Fund disbursements, as
specified in Welfare and Institutions Code Section 14166.12.  If the Provider fails to return the funds
within 30 calendar days from the time of the Departments notification, the
Department may offset the amount to be recovered against any Medi-Cal payments
which otherwise would be payable by the Department to the Provider, pursuant to
Welfare and Institutions Code Section 14115.5.  (a)           Provider must promptly return to the
Department all payments received from the Fund for the 2005-06 state fiscal
year if the Department determines that the Provider fails at any time during
the 2005-06 state fiscal year to receive and/or maintain disproportionate share
hospital (DSH) status, under Welfare and Institutions Code Sections 14166.11,
14105.98, and 14163, for the 2005-06 DSH payment adjustment year.  (b)           Unless paragraph (a) applies,
Provider must promptly return to the Department the pro-rata portion of the
payments, as determined by the Department, received from the Fund for the
2005-06 state fiscal year if the Department determines that the Provider failed
to meet the criteria, other than DSH status addressed in paragraph (a), for
participation in the Program for the entire fiscal year or service period, as
specified in Welfare and Institutions Code Section 14166.12.


(2)           It is understood that payment made to
the Provider pursuant to this Appendix D, and all prior versions of Appendix D,
include State and federal funds.  The
State shall be held harmless from any federal disallowance or withholding
resulting from payment made to Provider pursuant to this Appendix D, or any
prior version(s) of Appendix D, and the Provider shall be liable for any
reduced federal financial participation resulting from the payment of funds
pursuant to this Appendix D, or any prior version(s) of Appendix D. In the
event of federal disallowance or withholding of federal financial participation
for any payments made to the Provider pursuant to this Appendix D, or any prior
version(s) of Appendix D, at the time of the federal disallowance or
withholding the State may, in its sole discretion, recover from the Provider
the amount of funds disallowed and paid by the State to the Provider.  Provider agrees that the amount of any such
disallowance may be recouped by the Department by withholding and offsetting,
under Welfare and Institutions Code Section 14115.5, the amount due from
what would otherwise be the States liability to the Provider under this
Contract or otherwise, seeking recovery by payment from the Provider, or a
combination of these two methods.  If,
after federal disallowance or withholding and State recovery or offset of funds
paid to the Provider, the State regains the federal funds disallowed or
withheld, then the federal and related state funds shall be repaid by the State
to the Provider.


C.            Notice of Termination  Notwithstanding
Paragraph 6.15, Termination Without Cause, Provider
shall not exercise or attempt to exercise Paragraph 6.15 until after December 31,
2006.  Paragraph
Two  Effective Date of Contract Amendment  Contract
changes agreed to in this Amendment are effective on April 27, 2006.  Paragraph
Three  Incorporation of Contract Rights, Duties and Obligations  All
other terms and provisions of the Contract shall remain in full force and
effect, so that all rights, duties and obligations, and liabilities of the
parties hereto otherwise remain unchanged.


SIGNATURES  The
signatories to this Amendment warrant that they have full and binding authority
to make the commitments contained herein on behalf of their respective
entities.  State of CaliforniaProvider
  
  Department of Health
  ServicesSignature
  
  SignatureSandra
  ShewryType
  Name
  
  DirectorType
  TitleDate:
  
  Date:


CONTRACT
FOR HOSPITAL INPATIENT SERVICES  Amendment
No. 14  Contract No.
  
  00-83122Hospital:
  
  ALTA LOS ANGELES HOSPITALS, INC.dba:  LOS
  ANGELES COMMUNITY HOSPITALAddress:
  
  4081 East Olympic BoulevardLos Angeles, CA 90023-3330  CONFIDENTIAL DO
NOT RELEASE Exempt
from Public Records Act (Government
Code Section 6254 [q])


AMENDMENT
NO. 14 TO CONTRACT NO. 00-83122 BETWEEN THE STATE OF CALIFORNIA AND ALTA LOS
ANGELES HOSPITALS, INC., DOING BUSINESS AS LOS ANGELES COMMUNITY HOSPITAL.  WHEREAS,
the State of California, hereinafter designated the State, and ALTA LOS
ANGELES HOSPITALS, INC., doing business as LOS ANGELES COMMUNITY HOSPITAL,
hereinafter designated the Provider, entered into a contract (Contract No. 00-83122)
for provision of inpatient hospital services effective September 14, 2000
and subsequently amended;  NOW
THEREFORE, in accordance with the provisions for renegotiation and modification
set forth in Article 6, Paragraph 6.11 of the Contract, the Contract is
amended as follows:  Paragraph
One  Appendix D  Appendix Dis hereby amended to read as attached.  Paragraph
Two  Notice of Termination  Provider
shall not submit a notice for the purpose of terminating this Contract,
pursuant to Paragraph 6.15, Termination without Cause, until on or after December 31,
2007.


Paragraph
Three  Effective Date of Contract Amendment  Contract
changes agreed to in this Amendment are effective on September 21, 2006.  Paragraph
Four  Incorporation of Contract Rights, Duties and Obligations  All
other terms and provisions of the Contract shall remain in full force and
effect, so that all rights, duties and obligations, and liabilities of the
parties hereto otherwise remain unchanged.  2


SIGNATURES  The
signatories to this Amendment warrant that they have full and binding authority
to make the commitments contained herein on behalf of their respective
entities.  Provider
  
  State of California
  Department of Health ServicesSignature
  
  SignatureSandra
  ShewryType
  Name
  
  DirectorType
  TitleDate:
  
  Date:  3


APPENDIX D  PRIVATE
HOSPITAL SUPPLEMENTAL FUND  This
version of Appendix D governs dates of services and related Medi-Cal
supplemental reimbursements for State Fiscal Year 2006-07.  Pursuant
to the provisions of Welfare and Institutions Code Section 14166.12
relating to negotiations and disbursements from the Private Hospital
Supplemental Fund (Fund), the parties agree as follows:  A.Payment  In
accordance with subdivisions (j) and (m) of Section 14166.12 of
the Welfare and Institutions Code, and subject to Section B of this
Appendix D, the State agrees to pay the Provider from the Fund as follows:  (1)***
for services rendered from July 1, 2006 through September 30, 2006,
if Provider is listed on the 2006-07 tentative Disproportionate Share Hospital
(DSH) list issued by the California Department of Health Services
(Department).  Payment will be made by October 15,
2006, or as soon thereafter as practicable after the issuance of the 2006-07
tentative DSH list.  4


2)***
for services rendered from October 1, 2006 through December 31, 2006,
if Provider is listed on the 2006-07 final DSH list issued by the
Department.  Payment shall be made by January 1,
2007, or as soon thereafter as practicable after the issuance of the 2006-07
final DSH list.  (3)***
for services rendered from January 1, 2007 through February 28, 2007,
if Provider is listed on the 2006-07 final DSH list issued by the
Department.  Payment shall be made by March 15,
2007, or as soon thereafter as practicable.  B.Recovery,
Right of Offset, and Hold Harmless  B.Payment(s) received
by Provider from the Fund for the 2006-07 state fiscal year may be subject to
recovery by the Department if the Department determines that the Provider fails
at any time during the 2006-07 state fiscal year to meet the eligibility
criteria for Fund disbursements, as specified in Welfare and Institutions Code Section 14166.12.  If the Provider fails to return the funds
within 30 calendar days from the time of the Departments notification, the
Department may offset the amount to be recovered against any Medi-Cal payments
which otherwise would be payable by the Department to the Provider, pursuant to
Welfare and Institutions Code Section 14115.5.  5


(a)Provider
must promptly return to the Department all payments received from the Fund for
the 2006-07 state fiscal year if the Department determines that the Provider
fails at any time during the 2006-07 state fiscal year to receive and/or
maintain final DSH status, under Welfare and Institutions Code Sections
14166.11, 14105.98, and 14163, for the 2006-07 DSH payment adjustment year.  (b)Unless
paragraph (a) applies, Provider must promptly return to the Department the
pro-rata portion of the payments, as determined by the Department, received
from the Fund for the 2006-07 state fiscal year if the Department determines
that the Provider failed to meet the criteria, other than DSH status addressed
in paragraph (a), for participation in the Program for the entire fiscal year
or service period, as specified in Welfare and Institutions Code Section 14166.12.  (2)It
is understood that payment made to the Provider pursuant to this
Appendix D, and all prior versions of Appendix D, include State and
federal funds.  The State shall be held
harmless from any federal disallowance or withholding resulting from payment
made to Provider pursuant to this Appendix D, or any prior version(s) of
Appendix D, and the Provider shall be liable for any reduced federal
financial participation resulting from the payment of funds pursuant to this
Appendix D, or any prior version(s) of Appendix D.  In the event of federal disallowance or
withholding of  6


federal
financial participation for any payments made to the Provider pursuant to this
Appendix D, or any prior version(s) of Appendix D, at the time
of the federal disallowance of withholding the State may, in its sole
discretion, recover from the Provider the amount of funds disallowed and paid
by the State to the Provider.  Provider
agrees that the amount of any such disallowance may be recouped by the
Department by withholding and offsetting, under Welfare and Institutions Code Section 14115.5,
the amount due from what would otherwise be the States liability to the
Provider under this Contact or otherwise, seeking recovery by payment from the
Provider, or a combination of these two methods.  If, after federal disallowance or withholding
and State recovery or offset of funds paid to the Provider, the State regains
the federal funds disallowed or withheld, then the federal and related state
funds shall be repaid by the State to the Provider.  7


CONTRACT
FOR HOSPITAL INPATIENT SERVICES  Amendment
No. 15  Contract No.
  
  00-83122Hospital:
  
  ALTA LOS ANGELES HOSPITALS, INC.dba: LOS ANGELES COMMUNITY HOSPITALAddress:
  
  4081 East Olympic BoulevardLos Angeles, CA 90023-3330  CONFIDENTIAL
DO NOT RELEASE
Exempt from Public Records Act
(Government Code Section 6254 [q])


AMENDMENT
NO. 15 TO CONTRACT NO. 00-83122 BETWEEN THE STATE OF CALIFORNIA AND ALTA LOS
ANGELES HOSPITALS, INC., DOING BUSINESS AS LOS ANGELES COMMUNITY HOSPITAL.  WHEREAS,
the State of California, hereinafter designated the State, and ALTA LOS
ANGELES HOSPITALS, INC., doing business as LOS ANGELES COMMUNITY HOSPITAL,
hereinafter designated the Provider, entered into a contract (Contract No. 00-83122)
for provision of inpatient hospital services effective September 14, 2000
and subsequently amended;  NOW
THEREFORE, in accordance with the provisions for renegotiation and modification
set forth in Article 6, Paragraph 6.11 of the Contract, the Contract is
amended as follows:  Paragraph
One  Appendix D  Appendix Dis hereby amended to read as attached.  Paragraph
Two  Notice of Termination  In
accordance with Welfare and Institutions Code section 14166.12(p), Provider
shall not submit a notice for the purpose of terminating this Contract as
provided in Paragraph 6.15 of


this
Contract, Termination without Cause, until on or after December 31, 2007.  Paragraph
Three  Addition of 6.30  Employee Education About False Claims Recovery  6.30
 Employee Education About False Claims Recovery is hereby added, which
reads as follows:  Provider
shall comply with 42 USC Section 1396a(a)(68), Employee Education About
False Claims Recovery, as a condition of receiving payments under this
Contract.  Upon request by the
Department, Provider shall demonstrate compliance with this provision, which
may include providing the Department with copies of Providers applicable
written policies and procedures and any relevant employee handbook excerpts.  Paragraph
Four  Effective Date of Contract Amendment  Contract
changes agreed to in this Amendment are effective on March 8, 2007.  2


Paragraph
Five  Incorporation of Contract Rights, Duties and Obligations  All
other terms and provisions of the Contract shall remain in full force and
effect, so that all rights, duties and obligations, and liabilities of the
parties hereto otherwise remain unchanged.  3


SIGNATURES  The
signatories to this Amendment warrant that they have full and binding authority
to make the commitments contained herein on behalf of their respective
entities.  Provider
  
  State of CaliforniaDepartment of Health
  ServicesSignature
  
  SignatureSandra
  ShewryType
  Name
  
  DirectorType
  TitleDate:
  
  Date:  4


APPENDIX D  PRIVATE
HOSPITAL SUPPLEMENTAL FUND  This
version of Appendix D governs dates of services and related Medi-Cal
supplemental reimbursements for State Fiscal Year 2006-07.  Pursuant
to the provisions of Welfare and Institutions Code Section 14166.12
relating to negotiations and disbursements from the Private Hospital
Supplemental Fund (Fund), the parties agree as follows:  A.Payment  In
accordance with subdivisions (j) and (m) of Section 14166.12 of
the Welfare and Institutions Code, and subject to Section B of this
Appendix D, the State agrees to pay the Provider from the Fund as follows:  (1)***
for services rendered from July 1, 2006 through September 30, 2006,
if Provider is listed on the 2006-07 tentative Disproportionate Share Hospital
(DSH) list issued by the California Department of Health Services
(Department).  Payment will be made by October 15,
2006, or as soon thereafter as practicable after the issuance of the 2006-07
tentative DSH list.  5


(2)***
for services rendered from October 1, 2006 through December 31, 2006,
if Provider is listed on the 2006-07 final DSH list issued by the
Department.  Payment shall be made by January 1,
2007, or as soon thereafter as practicable after the issuance of the 2006-07
final DSH list.  (3)***
for services rendered from January 1, 2007 through February 28, 2007,
if Provider is listed on the 2006-07 final DSH list issued by the
Department.  Payment shall be made by March 15,
2007, or as soon thereafter as practicable.  (4)For
services rendered from March 1, 2007 through April 30, 2007 as
follows:  (a)The
installment amount of *** will be made by April 1, 2007, or as soon
thereafter as practicable.  (b)The
installment amount of *** will be made by May 15, 2007, or as soon
thereafter as practicable.  B.Recovery,
Right of Offset, and Hold Harmless  (1)Payment(s) received
by Provider from the Fund for the 2006-07 state fiscal year may be subject to
recovery by the Department if the Department determines that the Provider fails
at any time during the 2006-07 state fiscal year to meet the eligibility
criteria for Fund disbursements, as specified in  6


Welfare
and Institutions Code Section 14166.12. 
If the Provider fails to return the funds within 30 calendar days from
the time of the Departments notification, the Department may offset the amount
to be recovered against any Medi-Cal payments which otherwise would be payable
by the Department to the Provider, pursuant to Welfare and Institutions Code Section 14115.5.  (a)Provider
must promptly return to the Department all payments received from the Fund for
the 2006-07 state fiscal year if the Department determines that the Provider
fails at any time during the 2006-07 state fiscal year to receive and/or
maintain final DSH status, under Welfare and Institutions Code Sections
14166.11, 14105.98, and 14163, for the 2006-07 DSH payment adjustment year.  (b)Unless
paragraph (a) applies, Provider must promptly return to the Department the
pro-rata portion of the payments, as determined by the Department, received
from the Fund for the 2006-07 state fiscal year if the Department determines
that the Provider failed to meet the criteria, other than DSH status addressed
in paragraph (a), for participation in the Program for the entire fiscal year,
as specified in Welfare and Institutions Code Section 14166.12.  (2)It
is understood that payment made to the Provider pursuant to this
Appendix D, and all prior versions of Appendix D,  7


include
State and federal funds.  The State shall
be held harmless from any federal disallowance or withholding resulting from
payment made to Provider pursuant to this Appendix D, or any prior version(s) of
Appendix D, and the Provider shall be liable for any reduced federal
financial participation resulting from the payment of funds pursuant to this
Appendix D, or any prior version(s) of Appendix D.  In the event of federal disallowance or
withholding of federal financial participation for any payments made to the
Provider pursuant to this Appendix D, or any prior version(s) of
Appendix D, at the time of the federal disallowance or withholding the
State, in its sole discretion, may limit its recovery from the Provider to the
amount of funds disallowed and paid by the State to the Provider.  Provider agrees that the amount of any such
recovery may be recouped by the State by withholding and offsetting, under
Welfare and Institutions Code Section 14115.5, the amount due from what
would otherwise be the States liability to the Provider under this Contact or
otherwise, seeking recovery by payment from the Provider, or a combination of
these two methods.  If, after federal
disallowance or withholding and State recovery or offset of funds paid to the
Provider, the State regains the federal funds disallowed or withheld, then the
federal and related state funds shall be repaid by the State to the Provider.  8


CONTRACT
FOR HOSPITAL INPATIENT SERVICES  Amendment
No. 16  Contract No.
  
  00-83122Facility:
  
  ALTA LOS
  ANGELES HOSPITALS, INC.dba:
  LOS ANGELES COMMUNITY HOSPITALAddress:
  
  4081 East
  Olympic BoulevardLos Angeles,
  CA 90023-3330AndALTA LOS
  ANGELES HOSPITALS, INC.,dba:
  LOS ANGELES COMMUNITY HOSPITALOF NORWALK13222
  Bloomfield AvenueNorwalk, CA
  90650-3249  CONFIDENTIAL
DO NOT RELEASE
Exempt from Public Records Act
(Government Code Section 6254 [q])


AMENDMENT
NO. 16 TO CONTRACT NO. 00-83122 BETWEEN THE STATE OF CALIFORNIA AND ALTA LOS
ANGELES HOSPITALS, INC., DOING BUSINESS AS LOS ANGELES COMMUNITY HOSPITAL AND
LOS ANGELES COMMUNITY HOSPITAL OF NORWALK.  WHEREAS,
the State of California, hereinafter designated the State, and Alta Los
Angeles Hospitals, Inc., doing business as Los Angeles Community Hospital
and Los Angeles Community Hospital of Norwalk, hereinafter designated the
Provider, entered into a contract (Contract No. 00-83122) for provision
of inpatient hospital services effective September 14, 2000 and
subsequently amended;  NOW
THEREFORE, in accordance with the provisions for renegotiation and modification
set forth in Article 6, Paragraph 6.11 of the Contract, the Contract is
amended as follows:  Paragraph
One  Amendment of 3.5  Service Location  3.5
 Service Location is hereby amended to read:  Inpatient
Services rendered pursuant to this Contract shall be rendered at the following
facilities:  LOS
  ANGELES COMMUNITY HOSPITAL 
  4081 East Olympic Boulevard 
  Los Angeles, CA 90023-3330AndLOS
  ANGELES COMMUNITY HOSPITAL OF NORWALK 
  13222 Bloomfield Avenue 
  Norwalk, CA 90650-3249  Paragraph
Two  Amendment of 3.7  Open Staffing/Exclusive Staffing Contracts  3.7
 Open Staffing/Exclusive Staffing Contracts is hereby amended to read:  Pursuant
to Welfare and Institutions Code section 14087.28, subdivision (b), Provider is
authorized to enter into an exclusive contract for the provision of pathology,
radiology, and anesthesiology Inpatient Services, except for consulting
services requested by the admitting physician.


Paragraph
Three  Amendment of 4.1  Rate Structure; Contingent Liability of State  4.1
 Rate Structure; Contingent Liability of State is hereby amended to
read:  Provided
that there shall first have been a submission of claims in accordance with
Paragraph 4.3 of this Contract, the Provider shall be paid as follows:  (a)For
Inpatient Services provided to Beneficiaries, the all-inclusive rate per
patient per day of ***.  (b)Commencing
August 10, 2008, for Inpatient Services provided to Beneficiaries, the
all-inclusive rate per patient per day of ***.  Paragraph
Four  Amendment of 6.15  Termination Without Cause  6.5
 Termination Without Cause is hereby amended to read:  The
Provider or the State may terminate this Contract without cause in accordance
with this Paragraph.  Termination without
cause shall be effected by giving written notice of the termination to the
other party on or after July 10, 2009 and at  2


least
120 days prior to the effective date of the termination and stating the
effective date of the termination.  Paragraph
Five  Addition of 6.30  Employee Education About False Claims Recovery  6.30
 Employee Education About False Claims Recovery is hereby added, which
reads as follows:  Provider
shall comply with 42 USC Section 1396a(a)(68), Employee Education About
False Claims Recovery, as a condition of receiving payments under this Contract.  Upon request by the Department, Provider
shall demonstrate compliance with this provision, which may include providing
the Department with copies of Providers applicable written policies and
procedures and any relevant employee handbook excerpts.  Paragraph
Six  Amendment of Appendix A  Appendix
Ais hereby amended to read as attached to
this amendment.  3


Paragraph
Seven  Effective Date of Contract Amendment  If
this Amendment is signed by the Provider and returned to the California Medical
Assistance Commission within thirty (30) days of May 10, 2007, then the
Contract changes agreed to in this Amendment shall be effective on May 10,
2007.  If this Amendment is not signed
and returned within thirty days, then the Contract changes agreed to in this
Amendment shall be effective on the date the Contract is signed by both
parties.  Paragraph
Eight  Incorporation of Contract Rights, Duties and Obligations  The
terms in this Amendment shall have no retroactive effect on any Department
audit determinations or related appeals for dates of service prior to the
effective date of this Amendment.  All
other terms and provisions of said Contract shall remain in full force and
effect, so that all rights, duties and obligations, and liabilities of the
parties hereto otherwise remain unchanged.  4


EXECUTION  This
Contract Amendment shall be deemed duly executed and binding upon execution by
both parties below.  Executed
  on,
  at(City, State, Zip)HospitalBySignatureType
  Name and TitleExecuted on,
  atSacramento,
  CaliforniaSTATE
  OF CALIFORNIABySandra
  Shewry
  Director
  Department of Health Services


EXECUTION  This
Contract Amendment shall be deemed duly executed and binding upon execution by
both parties below.  Executed
  on,
  at(City, State, Zip)HospitalBySignatureType
  Name and TitleExecuted
  on,
  atSacramento,
  CaliforniaSTATE
  OF CALIFORNIABySandra
  Shewry
  Director
  Department of Health Services


EXECUTION  This
Contract Amendment shall be deemed duly executed and binding upon execution by
both parties below.  Executed
  on,
  at(City, State, Zip)HospitalBySignatureType
  Name and TitleExecuted
  on,
  atSacramento,
  CaliforniaSTATE
  OF CALIFORNIABySandra
  Shewry
  Director
  Department of Health Services


APPENDIX A  HOSPITAL
  NAME:
  Los
  Angeles Community 
  Hospital & Los Angeles 
  Community Hospital of 
  NorwalkCONTRACT:
  00-83122,
  A-16EFFECTIVE
  DATE:
  May 10,
  2007  I.Provider
shall provide a Medi-Cal Beneficiary his/her specific Medi-Cal benefit Inpatient
Services if Provider renders those same services to a non-Medi-Cal beneficiary,
without exception.  As of the effective date of this Appendix
A, the common acute and/or intensive Inpatient Services listed below are not
directly, or indirectly, provided by Provider to any patients regardless of
payor source, i.e., Medi-Cal, Medicare, private pay, commercial insurance,
third-party payor, or other payor source.  If any of the Inpatient Services below
are subsequently made available to non-Medi-Cal patients and are a Medi-Cal
benefit, Provider shall provide such services to Medi-Cal Beneficiaries at the
all inclusive, general acute care hospital (GACH) per diem rate(s) specified
in Paragraph 4.1 of this Contract.  REVENUE CODESREHABILITATION 
  PRIVATE
  
  118REHABILITATION 
  SEMI-PRIVATE 2 BEDS
  
  128REHABILITATION 
  SEMI-PRIVATE 3 OR 4 BEDS
  
  138REHABILITATION  WARD
  (MEDICAL OR GENERAL)
  
  158NURSERY, NEWBORN LEVEL
  III
  
  173NURSERY, NEWBORN LEVEL
  IV
  
  174INTENSIVE CARE,
  PEDIATRIC
  
  203INTENSIVE CARE,
  INTERMEDIATE ICU
  
  206INTENSIVE CARE, BURN
  CARE
  
  207INTENSIVE CARE, TRAUMA
  
  208CORONARY CARE,
  INTERMEDIATE CCU
  
  214LITHOTRIPSY, GENERAL
  CLASSIFICATION
  
  790  Inpatient Transplant
Services:  TRANSPLANT RELATED SERVICE
  
  ICD-9 PROCEDURE CODE*BONE MARROW
  
  41.01, 41.02, 41.03,
  41.04, 41.05, 41.07, 41.08 or 41.09HEART
  
  37.5 or 37.51HEART-LUNG
  
  33.6KIDNEY
  
  55.61 or 55.69COMBINED
  KIDNEY/PANCREAS
  
  52.80 and 55.61 or
  55.69PANCREAS
  
  55.69LIVER
  
  50.51 or 50.59SMALL BOWEL
  
  46.97COMBINED LIVER/SMALL
  BOWEL
  
  46.97 and 50.59LUNG
  
  33.50, 33.51 or 33.52  
 *
Billed in conjunction with Revenue Code 201 or 203  *The
State may from time to time adopt updated billing codes by means of regulation,
Medi-Cal Provider Manual, Medi-Cal Update Bulletin, or similar instruction,
which shall automatically replace the applicable billing codes expressly stated
in this Contract and/or its appendices, to the extent the service remains a
Medi-Cal benefit, without the need to amend this Contract as set forth in
Paragraph 6.11.


APPENDIX
A (CONTINUED)  HOSPITAL
  NAME:
  Los
  Angeles Community 
  Hospital & Los Angeles 
  Community Hospital of 
  NorwalkCONTRACT:
  00-83122,
  A-16EFFECTIVE
  DATE:
  May 10,
  2007  CPT-4 CODESCARDIAC
  CATHETERIZATION
  
  93501-93562CARDIOVASCULAR SURGERY
  
  33010-37799ABORTIONS
  
  59840-59857NEUROSURGERY
  
  61000-64999CORNEAL TRANSPLANTS
  
  65710, 65730, 65750,
  65755RADIATION THERAPY
  
  77261-77499,
  77750-77799THERAPEUTIC NUCLEAR
  MEDICINE
  
  79000-79999MAGNETIC RESONANCE
  IMAGING
  
  70336, 70540MAGNETIC RESONANCE
  IMAGING
  
  70551-70553, 71550MAGNETIC RESONANCE
  IMAGING
  
  72141-72142,
  72146-72149MAGNETIC RESONANCE
  IMAGING
  
  72156-72158,
  72195-72197MAGNETIC RESONANCE
  IMAGING
  
  73218-73225,
  73718-73725MAGNETIC RESONANCE
  IMAGING
  
  74181-74185,
  75552-75556MAGNETIC RESONANCE
  IMAGING
  
  76093-76094, 76400HYPERBARIC OXYGEN
  
  99183  II.Professional
physician fees, excluding technical fees, for the following services provided
during an acute and/or intensive inpatient admission are included in Providers
all inclusive per diem rate(s) specified in Paragraph 4.1 of this Contract
and must not be separately claimed to the Medi-Cal Program by Provider,
the physician(s) providing the service, or other claimant.  Professional physician fees for services not
listed below may be separately claimed using applicable Medi-Cal Billing and
Payment Policies for reimbursement.  NONE  III.The
following allied health professional services, durable medical equipment, and
other listed items provided during an acute and/or intensive inpatient stay are
not included in the all inclusive per diem rate(s) specified in
Paragraph 4.1 of this Contract, and may be separately claimed.  HCPC CODESCLINICAL PSYCHOLOGISTS
  
  X9500-X9699PROSTHETIC DEVICES
  
  L5000-L8699PROSTHETIC DEVICES
  
  X8800-X9299ORTHOTIC DEVICES
  
  L0100-L4398ORTHOTIC DEVICES
  
  X8100-X8599  The
State may from time to time adopt updated billing codes by means of regulation,
Medi-Cal Provider Manual, Medi-Cal Update Bulletin, or similar instruction, which
shall automatically replace the applicable billing codes expressly stated in
this Contract and/or its appendices, to the extent the service remains a
Medi-Cal benefit, without the need to amend this Contract as set forth in
Paragraph 6.11.


CONTRACT
FOR HOSPITAL INPATIENT SERVICES  Amendment
No. 17  Contract No.
  
  00-83122Hospital:
  
  ALTA LOS ANGELES HOSPITALS, INC.dba: LOS ANGELES COMMUNITY HOSPITALAddress:
  
  4081 East Olympic BoulevardLos Angeles, CA 90023-3330  CONFIDENTIAL DO
NOT RELEASE Exempt
from Public Records Act (Government Code Section 6254 [q])


AMENDMENT
NO. 17 TO CONTRACT NO. 00-83122 BETWEEN THE STATE OF CALIFORNIA AND ALTA LOS
ANGELES HOSPITALS, INC., DOING BUSINESS AS LOS ANGELES COMMUNITY HOSPITAL.  WHEREAS,
the State of California, hereinafter designated the State, and ALTA LOS
ANGELES HOSPITALS, INC., doing business as LOS ANGELES COMMUNITY HOSPITAL,
hereinafter designated the Provider, entered into a contract (Contract No. 00-83122)
for provision of inpatient hospital services effective September 14, 2000
and subsequently amended;  NOW
THEREFORE, in accordance with the provisions for renegotiation and modification
set forth in Article 6, Paragraph 6.11 of the Contract, the Contract is
amended as follows:  Paragraph
One  Appendix D  Appendix
Dis hereby amended to read as attached.  Paragraph
Two  Notice of Termination  In
accordance with Welfare and Institutions Code section 14166.12(p), Provider
shall not submit a notice for the purpose of terminating this Contract as
provided in Paragraph 6.15 of this Contract, Termination without Cause,
until on or after


December 31,
2008, unless a later date is specified in Paragraph 6.15.  Paragraph
Three  Effective Date of Contract Amendment  Unless
otherwise specified herein, Contract changes agreed to in this Amendment are
effective on October 11, 2007.  Paragraph
Four  Incorporation of Contract Rights, Duties and Obligations  All
other terms and provisions of the Contract shall remain in full force and
effect, so that all rights, duties and obligations, and liabilities of the
parties hereto otherwise remain unchanged.  2


SIGNATURES  The
signatories to this Amendment warrant that they have full and binding authority
to make the commitments contained herein on behalf of their respective
entities.  Provider
  
  State of California 
  Department of Health Care 
  ServicesSignatureSignatureType
  Name
  
  Sandra
  ShewryDirectorType
  TitleDate:Date:  3


APPENDIX
D  PRIVATE
HOSPITAL SUPPLEMENTAL FUND  This
version of Appendix D governs dates of services and related Medi-Cal
supplemental reimbursements for State Fiscal Year 2007-08.  Pursuant
to the provisions of Welfare and Institutions Code Section 14166.12
relating to negotiations and disbursements from the Private Hospital
Supplemental Fund (Fund), the parties agree as follows:  A.Payment  In
accordance with subdivisions (j) and (m) of Section 14166.12 of
the Welfare and Institutions Code, and subject to Section B of this
Appendix D, the State agrees to pay the Provider from the Fund:  (1)For
services rendered from July 1, 2007 through November 30, 2007:  (a)The
installment amount of *** if Provider is listed on the 2007-08 tentative
Disproportionate Share Hospital (DSH) list issued by the California Department
of Health Care Services (Department). 
Payment will be  4


made
by September 27, 2007, or as soon thereafter as practicable.  (b)The
installment amount of *** if Provider is listed on the 2007-08 final DSH list
issued by the Department.  Payment shall
be made by December 1, 2007, or as soon thereafter as practicable after
the issuance of the 2007-08 final DSH list.  B.Recovery,
Right of Offset, and Hold Harmless  (1)Payment(s) received
by Provider from the Fund for the 2007-08 state fiscal year may be subject to
recovery by the Department if the Department determines that the Provider fails
at any time during the 2007-08 state fiscal year to meet the eligibility
criteria for Fund disbursements, as specified in Welfare and Institutions Code Section 14166.12.  If the Provider fails to return the funds
within 30 calendar days from the time of the Departments notification, the
Department may offset the amount to be recovered against any Medi-Cal payments
which otherwise would be payable by the Department to the Provider, pursuant to
Welfare and Institutions Code Section 14115.5.  (a)Provider
must promptly return to the Department all payments received from the Fund for
the 2007-08 state fiscal year if the Department determines that the Provider
fails at any time during the 2007-08 state  5


fiscal
year to receive and/or maintain final DSH status, under Welfare and
Institutions Code Sections 14166.11, 14105.98, and 14163, for the 2007-08 DSH
payment adjustment year.  (b)Unless
Subparagraph (a) applies, Provider must promptly return to the Department
amounts received from the Fund for the 2007-08 state fiscal year that equal the
pro-rata portion of Providers 2002-03 supplement fund amount plus any payments
over the Providers 2002-03 supplement fund amount received from the Fund for
the 2007-08 state fiscal year if the Department determines that the Provider
failed to meet participation criteria for the entire 2007-08 state fiscal year,
other than DSH status addressed in Paragraph (a), specified in Welfare and
Institutions Code Section 14085.6 and 14166.12, which includes, but is not
limited to, failed for any reason to maintain its Emergency Department as
operational and licensed at the Basic Level or higher level.  For purposes of this Subparagraph (b), the
amount equal to the pro-rata portion of Providers 2002-03 supplement fund
payment, pursuant to Welfare and Institutions Code Section 14166.12(j),
will be calculated on the number of days during the 2007-08 state fiscal year
that the Provider failed to meet participation criteria.  6


(2)It
is understood that payment made to the Provider pursuant to this Appendix D,
and all prior versions of Appendix D, include State and federal funds.  The State shall be held harmless from any
federal disallowance or withholding resulting from payment made to Provider
pursuant to this Appendix D, or any prior version(s) of Appendix D, and
the Provider shall be liable for any reduced federal financial participation
resulting from the payment of funds pursuant to this Appendix D, or any prior
version(s) of Appendix D.  In the
event of federal disallowance or withholding of federal financial participation
for any payments made to the Provider pursuant to this Appendix D, or any prior
version(s) of Appendix D, at the time of the federal disallowance or
withholding the State, in its sole discretion, may limit its recovery from the
Provider to the amount of funds disallowed and paid by the State to the
Provider.  Provider agrees that the
amount of any such recovery may be recouped by the State by withholding and
offsetting, under Welfare and Institutions Code Section 14115.5, the
amount due from what would otherwise be the States liability to the Provider
under this Contact or otherwise, seeking recovery by payment from the Provider,
or a combination of these two methods. 
If, after federal disallowance or withholding and State recovery or
offset of funds paid to the Provider, the State regains the federal funds
disallowed or withheld, then the federal and related state funds shall be
repaid by the State to the Provider.  7