EXHIBIT 10.4
| [AHCCCS LOGO] | **ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM ADMINISTRATION DIVISION OF BUSINESS AND FINANCE**SECTION A****: CONTRACT**
** **

1.  AMENDMENT      NUMBER:             **9**

2.  CONTRACT NO.:      **YH09-0001-07**

3.  EFFECTIVE DATE OF AMENDMENT**     October 1, 2009**

4.  PROGRAM  **DHCM - ACUTE**
 

5.  CONTRACTOR'S NAME AND ADDRESS:

VHS Phoenix Health Plan, LLC 7878 N. 16th St., Suite 105 Phoenix, AZ 85020

 

6.  PURPOSE OF AMENDMENT:****  To amend Section D.

 

7.  THE CONTRACT REFERENCED ABOVE FOLLOWS A.            Section D, Paragraph 53, Compensation Subparagraph 11 revised to the following language:

***Reconciliation of Prospective non-MED Costs to Reimbursement: For CYE AHCCCS will reconcile the Contractor's prospective non-MED medical cost expenses to prospective non-MEDcapitation paid to the Contractor for dates of service July 1, 2009 through September 30,2009. This reconciliation will limit the Contractor's profits and losses to 3%. Any losses in excess of 3% will be reimbursed to the Contractor,and likewise, profits in excess of 3% will be recouped.Adjudicated encounter data will be used to determine medical expenses. Refer to the *Prospective non-MED Reconciliation Policy* included in the ACOM for further details.
For CYE 10, AHCCCS will reconcile the Contractor's prospective non-MED medical cost expenses to prospective non-MED net capitation paid to the Contractor for dates of service during the contract year beingreconciled. This reconciliation will limit the Contractor's profits and losses to 2%. Any losses in excess of 2% will be reimbursed to the Contractor,and likewise, profits in excess of 2% will be recouped.Adjudicated encounter data will be used to determine medical expenses. Refer to the *Prospective non-MED Reconciliation Policy* included in the ACOM for further details.

NOTE:  Please sign, date, and return executed file by E-Mail to: *Mark Held* at Mark.Held@azahcccs.gov                                                                                                               *Sr. Procurement Specialist                                                                                                               AHCCCS Contracts and Purchasing                                                                                                               *and *Georgina Maya* at                                                                                                               *Georgina.Maya@azahcccs.gov*

 

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

**IN WITNESS WHEREOF THE PARTIES HERETO SIGN THEIR NAMES IN AGREEMENT**

9.  SIGNATURE OF AUTHORIZED REPRESENTATIVE:      /s/ Nancy Novick

TYPED NAME:    NANCY NOVICK TITLE:                    CHIEF EXECUTIVE OFFICER DATE:                    9/17/09

 

10.  SIGNATURE OF AHCCCSA CONTRACTING OFFICER:

       /s/ Michael Veit

 

 

MICHAEL VEIT

CONTRACTS & PURCHASING ADMINISTRATOR DATE:    SEP 16 2009***** |
|---------------|-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|