Document:

f8k1010ex10vii_amsurg.htm

Exhibit 10.7

 

THREE RIVERS PROVIDER NETWORK

AGREEMENT WITH

______________________________

This Agreement is made this 23rd day of October 2008, by and between Three Rivers Provider Network, Inc., a Nevada Corporation (“TRPN”) and Woodbridge SA Services a Provider Group of health care services.  TRPN contracts with hospitals, physicians, ancillaries and entities hereinafter referred to as “Provider” rendering medical and health care services at pre-determined rates as follow.

1.  Clients.  Covered Services. Contract Rates: TRPN contracts with insurance companies, third party administrators, health plans, individuals and entities hereinafter referred to as “Clients” that directly or indirectly access TRPN contracted providers for covered services.  Covered Services shall include all services that are medically necessary including health, workers’ compensation, automobile and general liability.  The rate used in conjunction with this Agreement will be a * discount off of Provider’s usual charge for covered services, less any applicable co-payments, co-insurance or deductibles.  Clients are obligated to make payment directly to provider only at the contracted rate as payment in full.  Provider shall not balance bill the patient upon receipt of payment in full at the contracted rate.  TRPN has no responsibility to make payments on behalf of Clients.  Payments shall be made within thirty (30) calendar days of receipt of clean claim.  Where a state mandated fee schedule exists, provider agrees to accept a * discount below the state schedule.  Payments made and cashed by the provider shall be accepted as payment in full and fulfillment of all terms of the agreement, providing the total payment including the member’s portion is not less than the contracted rate.

2.  Licenses, Standards of Care:  Provider agrees to deliver health care services that meet all legal standards of care complying with applicable Federal, State and Local laws and maintains the standards of NCQA and/or JCAHO.  The provider is delegated by TRPN to carry out and/or assign credentialing responsibilities.  Evidence of such licenses, certificates and standards shall be made available to TRPN upon request.

3.  Term and Termination:  This Agreement shall continue in effect for a period of one (1) years with automatic successive one (1) year terms.  This Agreement may be terminated by either party without cause with a ninety (90) day prior written notice to the other party at the mailing addresses listed under the signatures.  This Agreement may be immediately terminated with cause by TRPN should Provider lose applicable licenses, malpractice coverage, fail to honor the applicable contracted rates pursuant to this Agreement, or if any information provided in Attachment A is illegible, incomplete, or invalid.

4.  Dispute Resolution:  This Agreement shall be construed and interpreted in accordance with the laws of the State of Nevada.  Provider agrees to meet and confer in good faith to resolve any disputes that may arise under this Agreement. If a dispute between TRPN and Provider arises out of this Agreement and is not resolved, either party may submit the dispute to arbitration which shall be commenced and conducted in accordance with the Rules of Practice and Procedures of the Judicial Arbitration and Mediation Services, Inc. (“JAMS”) as in effect at the time (“JAMS Rules”).

5.  Attachment A:  All information provided in Attachment A of this Agreement is complete and accurate to the best of Provider’s knowledge and Provider shall immediately notify TRPN of any changes thereto.  Provider agrees to mark “N/A” next to any blank that is not applicable to Provider’s business.

6.  Faxed Signatures:  The parties agree that facsimile signatures of authorized representatives of the parties shall legally bind the parties to the terms and conditions of this Agreement as if the signatures were original and shall be considered evidence of a fully executed Agreement.

 

	
*

	
Portions of this document omitted pursuant to an application for an order for confidential treatment pursuant to Rule 24b-2 under the Exchange Act.  Confidential portions of this document have been filed separately with the Securities and Exchange Commission.

 

  

Page 1

  

 

IN WITNESS WHEREOF, the authorized parties hereto have executed this Agreement and intend to be bound thereby.

 

 

	PROVIDER GROUP NAME (Please Print): 	 	ATTENTION:LANI HAZELTON
	 	 	TRPN CONTRACTING COORDINATOR
	 	 	 
	 	 	THREE RIVERS PROVIDER NETWORK
	 	 	 
	 	 	 
	Signature:  /s/ Jaime Olmo	 	Signature:
	 	 	 
	Title:    COO	 	 
	 	 	 
	Date:     10/23/08	 	 
	 	 	NAME:  Todd Breeden, C.O.O.
	 	 	Mailing Address:  1620 Fifth Avenue Suite 900
	 	 	San Diego, CA 92101    Phone:  (619) 230-0530
	 	 	Date: 

 

 

ATTACHMENT A: PROVIDER INFORMATION

(Please attach a roster of all the provider’s full names, titles, NPI#s, and all locations under the group’s Tax Id#, use Addendum A)

 

 

	Tax ID:  35-2318351	Practice Name:  Woodbridge SA Services
	 	 
	National Provider Identifier (NPI):	Group / IPA Affiliation:___________
	1902053903	 
	(If there is more than one NPI Number, please attach a listing.)	 
	 	 
	 	 
	Degree:  LSA, CSA,SA-C, CST/CFA, CRNFA, RN, CNOR	Office Hours:  8-4:30
	Specialty :  Surgical Assisting	 
	                    First Assist	Primary Address:  P.O. Box 720417
	 	 
	 	County:  _____________________
	 	Phone:  713-779-9800  Fax:  713-779-9862
	 	 
	 	Email:  Jaimeolmo@me.com
	 	 
	 	Other Practice and/or Billing Address:  Yes □  No □
	 	If “yes”, attach page with additional information
	 	 
	 	Hospital Affiliations (list name, date and type):
	 	 
	 	 
	 	 
	 	 

 

Provider agrees to mark “N/A” next to any blank that is not applicable to Provider’s business.

 

  

Page 2

  

 

ADDENDUM A:

MEDICAL STAFF LISTING & FACILITY LOCAITONS

_______________________________

 

 

	i.   	The attached roster of providers and or locations will be participating under this Agreement between Woodbridge SA Services and Three Rivers Provider Network and shall include Tax Indentification Numbers, NPI Numbers, Address(s), Phone and Fax Numbers.

 

 

  

Page 3

  

Provider List

10/23/2008

                                                                                                                         

                                                           

	Code 	Name 	 	Credentials	License Number
	  Last Name 	 	National Provider Identifier	 
	 	 	 	 	 
	
WB

   BERRY

	
BERRY, WILLIAM

	
 

1851589386

	
CST/CFA

	
109540

	
LF

   FLORES

	
FLORES, LETICIA

	
 

1053502385

	
CNOR

	
030775

	
AG

   GARCIA

	
GARCIA, ABEL

	
 

1013193721

	
LSA

	
SA00073

	
JRO1

   RIOS

	
RIOS,  JIMMI

	
 

1760500789

	
SA-C

	
A05263

	
SR

   ROBIN

	
ROBIN, SCOTT

	
 

1437134962

	
LSA

	
SA00090

	
JR

RUSSELL

	
RUSSELL, JAMES

	
 

1801871363

	
CST/CFA

	
CST85399

	
JS

   SKORUPPA

	
SKORUPPA, JACOB

	
 

1215113022

	
CST/CFRA

	
109194

	
PTO1

   TAMARGO

	
TAMARGO, PEDRO

	
 

1114199809

	
SA-C

	
08120

	
PT

TROMBLEY

	
TROMBLEY, PATRICIA

	  	
LSA

	
SA00156

	  	  	  	  	  

 

  

1

  

 

	
WOODBRIDGE SA SERVICES

	
  Christus Spohn Health System

  600 Elizabeth Street

  Corpus Christi TX 78404

	
  Corpus Christi Medical Center

  1533 South Brownlee

  Corpus Christi TX 78404

 

  

 

  

 

AMENDMENT TO

AGREEMENT

BETWEEN

THREE RIVERS PROVIDER NETWORK

AND

WOODBRIDGE SA SERVICES, INC.

This AMENDMENT to the Agreement between THREE RIVERS PROVIDER NETWORK (“TRPN”) AND (Tax  Id# 35-2318351), dated 10-23-2008 (“Agreement”), is entered into and made effective as of   05-07-2010.

FOR VALUABLE CONSIDERATION, the receipt and sufficiency of which is hereby acknowledged, and in consideration of the mutual promises and mutual covenants of the parties, the parties agree that the Agreement is hereby amended as follows:

1.           This Agreement is being amended due to renegotiations of the reimbursement rate in Section 1. and will now reflect the following change in rate:

a) The rate used in conjunction with this Agreement will be * discount off of Provider’s usual charge for covered services, less any applicable co-payments, co-insurance or deductibles.

2.           The remaining terms and conditions of the Agreement shall remain in full force and effect unless so amended pursuant to the terms of the Agreement.

IN WITNESS WHEREOF, the parties have executed this Amendment to the Provider Service Agreement to be effective as of the Effective Date.

 

 

	 	 	THREE RIVERS PROVIDER NETWORK
	 	 	 
	 	 	 
	By /s/   Jaime A. Olmo	 	By /s/   Todd Breeden 
	Signature	 	Signature
	 	 	 
	Name: /s/ Jaime A. Olmo	 	Name Todd Breeden
	 	 	 
	Title:  COO                         	 	Title   Chief Operating Officer
	 	 	 
	Date   5/7/2010                   	 	Date    5/7/2010                             

 

        

	
*

	
Portions of this document omitted pursuant to an application for an order for confidential treatment pursuant to Rule 24b-2 under the Exchange Act.  Confidential portions of this document have been filed separately with the Securities and Exchange Commission.f8k1010ex10viii_amsurg.htm

Exhibit 10.8

 

THREE RIVERS PROVIDER NETWORK

AGREEMENT WITH

______________________________

This Agreement is made this 23rd day of October 2008, by and between Three Rivers Provider Network, Inc., a Nevada Corporation (“TRPN”) and Brazos SA Services a Provider Group of health care services.  TRPN contracts with hospitals, physicians, ancillaries and entities hereinafter referred to as “Provider” rendering medical and health care services at pre-determined rates as follow.

1.  Clients. Covered Services. Contract Rates:  TRPN contracts with insurance companies, third party administrators, health plans, individuals and entities hereinafter referred to as “Clients” that directly or indirectly access TRPN contracted providers for covered services.  Covered Services shall include all services that are medically necessary including health, workers’ compensation, automobile and general liability.  The rate used in conjunction with this Agreement will be a * discount off of Provider’s usual charge for covered services, less any applicable co-payments, co-insurance or deductibles.  Clients are obligated to make payment directly to provider only at the contracted rate as payment in full.  Provider shall not balance bill the patient upon receipt of payment in full at the contracted rate.  TRPN has no responsibility to make payments on behalf of Clients.  Payments shall be made within thirty (30) calendar days of receipt of clean claim.  Where a state mandated fee schedule exists, provider agrees to accept a * discount below the state schedule.  Payments made and cashed by the provider shall be accepted as payment in full and fulfillment of all terms of the agreement, providing the total payment including the member’s portion is not less than the contracted rate.

2.  Licenses, Standards of Care:  Provider agrees to deliver health care services that meet all legal standards of care complying with applicable Federal, State and Local laws and maintains the standards of NCQA and/or JCAHO.  The provider is delegated by TRPN to carry out and/or assign credentialing responsibilities.  Evidence of such licenses, certificates and standards shall be made available to TRPN upon request.

3.  Term and Termination:  This Agreement shall continue in effect for a period of one (1) years with automatic successive one (1) year terms.  This Agreement may be terminated by either party without cause with a ninety (90) day prior written notice to the other party at the mailing addresses listed under the signatures.  This Agreement may be immediately terminated with cause by TRPN should Provider lose applicable licenses, malpractice coverage, fail to honor the applicable contracted rates pursuant to this Agreement, or if any information provided in Attachment A is illegible, incomplete, or invalid.

4.  Dispute Resolution:  This Agreement shall be construed and interpreted in accordance with the laws of the State of Nevada.  Provider agrees to meet and confer in good faith to resolve any disputes that may arise under this Agreement. If a dispute between TRPN and Provider arises out of this Agreement and is not resolved, either party may submit the dispute to arbitration which shall be commenced and conducted in accordance with the Rules of Practice and Procedures of the Judicial Arbitration and Mediation Services, Inc. (“JAMS”) as in effect at the time (“JAMS Rules”).

5.  Attachment A:  All information provided in Attachment A of this Agreement is complete and accurate to the best of Provider’s knowledge and Provider shall immediately notify TRPN of any changes thereto.  Provider agrees to mark “N/A” next to any blank that is not applicable to Provider’s business.

6.  Faxed Signatures:  The parties agree that facsimile signatures of authorized representatives of the parties shall legally bind the parties to the terms and conditions of this Agreement as if the signatures were original and shall be considered evidence of a fully executed Agreement.

 

	
*

	
Portions of this document omitted pursuant to an application for an order for confidential treatment pursuant to Rule 24b-2 under the Exchange Act.  Confidential portions of this document have been filed separately with the Securities and Exchange Commission.

 

  

Page 1

  

 

IN WITNESS WHEREOF, the authorized parties hereto have executed this Agreement and intend to be bound thereby.

 

 

	 PROVIDER GROUP NAME (Please Print):	 ATTENTION:LANI HAZELTON
	 	 TRPN CONTRACTING COORDINATOR
	 	 
	 	 THREE RIVERS PROVIDER NETWORK
	 	 
	 Signature:  /s/ Jaime Olmo            	 Signature: _________________________________
	 	 
	 Title:    COO	 
	 	 
	 Date:     10/22/08	
 

	 	 NAME:  Todd Breeden, C.O.O.
	 	 Mailing Address:  1620 Fifth Avenue Suite 900
	 	 San Diego, CA 92101    Phone:  (619) 230-0530
	 	 Date:  ___________________________________
	 	 

 

ATTACHMENT A: PROVIDER INFORMATION

(Please attach a roster of all the provider’s full names, titles, NPI#s, and all locations under the group’s Tax Id#, use Addendum A)

 

 

 

	Tax ID:  35-2318350	Practice Name:  Brazos SA Services
	 	 
	National Provider Identifier (NPI):	 
	 	 
	1033382668	Group / IPA Affiliation:___________
	(If there is more than one NPI Number, please attach a listing.)	 
	 	 
	 	 
	Degree:  LSA, CSA,SA-C, CST/CFA, CRNFA, RN, CNOR	Office Hours:  8-4:30
	Specialty :  Surgical Assisting	 
	                    First Assist	Primary Address:  P.O. Box 1172
	 	Alief TX 7741
	 	 
	 	County:  Harris
	 	Phone:  713-779-9800  Fax:  713-779-9862
	 	 
	 	Email:  Jaimeolmo@me.com
	 	 
	 	Other Practice and/or Billing Address:  Yes □  No □
	 	If “yes”, attach page with additional information
	 	 
	 	Hospital Affiliations (list name, date and type):
	 	 
	 	 
	 	 
	 	 
	 	 
	 	 

 

Provider agrees to mark “N/A” next to any blank that is not applicable to Provider’s business.

 

  

Page 2

  

 

ADDENDUM A:

MEDICAL STAFF LISTING & FACILITY LOCATIONS

_______________________________

	
i. 

	
The attached roster of providers and or locations will be participating under thisAgreement between Brazos SA Services and Three Rivers Provider Network and shall include Tax Identification Numbers, NPI Numbers, Address(s), Phone and Fax Numbers.

 

  

  

  

 

Provider List

10/23/2008

 

	Code 	Name 	National Provider Identifier	Credentials 	License Number
	Last Name 	 	 	 	 
	 	 	 	 	 
	
OA

   AKUPUE

	
AKUPUE, OKECHUHUKWU

	
 

1346368917

	
LSA

	
SA00307

	
MC

   COLELLO

	
COLELLO, MARY

	
 

1386829521

	
SA-C

	
07272

	
BE

   EATON

	
EATON, BRENT

	
 

1699894378

	
CRNFA,SA-C

	
061022

	
DG

  GRIFFITH

	
GRIFFITH, DAWN

	
 

1558548578

	
SA-C

	
07336

	
WY

   YANG

	
YANG, WEN

	
 

1588849939

	
LSA

	
SA00306

 

  

1

  

 

	
BRAZOS SA SERVICES

	
 Southwestern Medical Center

 1602 Southwest 82nd Street

 Lawton OK 73505

 

 

  

  

  

 

 

AMENDMENT TO

AGREEMENT

BETWEEN

THREE RIVERS PROVIDER NETWORK

AND

BRAZOS SA SERVICES, INC.

This AMENDMENT to the Agreement between THREE RIVERS PROVIDER NETWORK (“TRPN”) AND (Tax  Id# 35-2318350), dated 10-23-2008 (“Agreement”), is entered into and made effective as of   05-07-2010.

FOR VALUABLE CONSIDERATION, the receipt and sufficiency of which is hereby acknowledged, and in consideration of the mutual promises and mutual covenants of the parties, the parties agree that the Agreement is hereby amended as follows:

1.           This Agreement is being amended due to renegotiations of the reimbursement rate in Section 1. and will now reflect the following change in rate:

a) The rate used in conjunction with this Agreement will be * discount off of Provider’s usual charge for covered services, less any applicable co-payments, co-insurance or deductibles.

2.           The remaining terms and conditions of the Agreement shall remain in full force and effect unless so amended pursuant to the terms of the Agreement.

IN WITNESS WHEREOF, the parties have executed this Amendment to the Provider Service Agreement to be effective as of the Effective Date.

 

 

 

	 	 	THREE RIVERS PROVIDER NETWORK
	 	 	 
	 	 	 
	By /s/ Jaime A. Olmo, Jr.	 	By /s/ Todd Breeden 
	Signature	 	Signature
	 	 	 
	Name: /s/ Jaime A. Olmo, Jr.	 	Name Todd Breeden
	 	 	 
	Title:  COO                               	 	Title   Chief Operating Officer
	 	 	 
	Date   5/7/2010                       	 	Date    5/7/2010                                
	 	 	 

 

        

	
*

	
Portions of this document omitted pursuant to an application for an order for confidential treatment pursuant to Rule 24b-2 under the Exchange Act.  Confidential portions of this document have been filed separately with the Securities and Exchange Commission.

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