Document:

Officer Retention Plan

 Exhibit 10.4 
 COCA-COLA BOTTLING CO. CONSOLIDATED 
 OFFICER RETENTION PLAN 
 (AS AMENDED AND RESTATED EFFECTIVE JANUARY 1, 2007) 

 COCA-COLA BOTTLING CO.
CONSOLIDATED 
 OFFICER RETENTION PLAN 
 (AMENDED AND RESTATED EFFECTIVE JANUARY 1, 2007) 
 Table of Contents 
  

					
	 	  	Page
	 ARTICLE I DEFINITIONS
	  	1
	 1.1
	  	 Affiliate
	  	1
	 1.2
	  	 Annuity Starting Date
	  	1
	 1.3
	  	 Authorized Leave of Absence
	  	1
	 1.4
	  	 Beneficiary
	  	1
	 1.5
	  	 Board
	  	2
	 1.6
	  	 Change in Control
	  	2
	 1.7
	  	 Change in Control Benefit
	  	3
	 1.8
	  	 Code
	  	3
	 1.9
	  	 Committee
	  	3
	 1.10
	  	 Company
	  	4
	 1.11
	  	 Disability Retirement
	  	4
	 1.12
	  	 Employee
	  	4
	 1.13
	  	 ERISA
	  	4
	 1.14
	  	 Normal Retirement
	  	4
	 1.15
	  	 Normal Retirement Date
	  	4
	 1.16
	  	 ORP Accrued Retirement Benefit
	  	4
	 1.17
	  	 ORP Agreement
	  	4
	 1.18
	  	 Participating Company
	  	4
	 1.19
	  	 Plan
	  	5
	 1.20
	  	 Plan Administrator
	  	5
	 1.21
	  	 Postponed Retirement
	  	5
	 1.22
	  	 Retire
	  	5
	 1.23
	  	 Retirement
	  	5
	 1.24
	  	 Retirement Benefit
	  	5
	 1.25
	  	 Service
	  	5
	 1.26
	  	 Severance
	  	5
	 1.27
	  	 Severance Benefit
	  	5
	 1.28
	  	 Surviving Spouse
	  	6
	 1.29
	  	 Termination for Cause
	  	6
	 1.30
	  	 Termination of Employment
	  	6
	 1.31
	  	 Total Disability
	  	6
	 1.32
	  	 Vested Percentage
	  	6
	 1.33
	  	 Year of Plan Participation
	  	7
		
	 ARTICLE II ELIGIBILITY AND PARTICIPATION
	  	8
			
	 2.1
	  	 Eligibility
	  	8
	 2.2
	  	 Participation
	  	8

  

 i 

					
	 ARTICLE III RETIREMENT BENEFIT
	  	9
			
	 3.1
	  	 Retirement Benefit
	  	9
	 3.2
	  	 Reemployment
	  	10
		
	 ARTICLE IV DEATH BENEFIT
	  	11
			
	 4.1
	  	 Amount of Death Benefit Before Payment Begins
	  	11
	 4.2
	  	 Amount of Death Benefit After Annuity Payments Begin
	  	11
	 4.3
	  	 Form of Benefit
	  	11
	 4.4
	  	 Time of Payment
	  	11
		
	 ARTICLE V SEVERANCE BENEFIT
	  	12
			
	 5.1
	  	 Severance Benefit
	  	12
	 5.2
	  	 Reemployment
	  	12
		
	 ARTICLE VI CHANGE IN CONTROL BENEFIT
	  	13
			
	 6.1
	  	 Change in Control
	  	13
	 6.2
	  	 Enlargement of Benefits
	  	15
		
	 ARTICLE VII CONDITIONS
	  	16
			
	 7.1
	  	 Suicide
	  	16
	 7.2
	  	 Noncompetition
	  	16
	 7.3
	  	 Forfeiture for Cause
	  	16
	 7.4
	  	 Special Provisions for “Specified Employees”
	  	16
		
	 ARTICLE VIII ADMINISTRATION OF THE PLAN
	  	17
			
	 8.1
	  	 Powers and Duties of the Plan Administrator
	  	17
	 8.2
	  	 Agents
	  	17
	 8.3
	  	 Reports to the Committee
	  	17
	 8.4
	  	 Limitations on the Plan Administrator
	  	17
	 8.5
	  	 Benefit Elections, Procedures and Calculations
	  	18
	 8.6
	  	 Instructions for Payments
	  	18
	 8.7
	  	 Claims for Benefits
	  	18
	 8.8
	  	 Hold Harmless
	  	19
	 8.9
	  	 Service of Process
	  	20
		
	 ARTICLE IX DESIGNATION OF BENEFICIARIES
	  	21
			
	 9.1
	  	 Beneficiary Designation
	  	21
	 9.2
	  	 Failure to Designate Beneficiary
	  	21

  

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	 ARTICLE X WITHDRAWAL OF PARTICIPATING COMPANY
	  	22
			
	 10.1
	  	 Withdrawal of Participating Company
	  	22
	 10.2
	  	 Effect of Withdrawal
	  	22
		
	 ARTICLE XI AMENDMENT OR TERMINATION OF THE PLAN
	  	23
			
	 11.1
	  	 Right to Amend or Terminate Plan
	  	23
	 11.2
	  	 Notice
	  	24
		
	 ARTICLE XII GENERAL PROVISIONS AND LIMITATIONS
	  	25
			
	 12.1
	  	 No Right to Continued Employment
	  	25
	 12.2
	  	 Payment on Behalf of Payee
	  	25
	 12.3
	  	 Nonalienation
	  	25
	 12.4
	  	 Missing Payee
	  	26
	 12.5
	  	 Required Information
	  	26
	 12.6
	  	 No Trust or Funding Created
	  	26
	 12.7
	  	 Binding Effect
	  	26
	 12.8
	  	 Merger or Consolidation
	  	27
	 12.9
	  	 Entire Plan
	  	27
	 12.10
	  	 Withholding
	  	27
	 12.11
	  	 Compliance with Section 409A of the Code
	  	27
	 12.12
	  	 Construction
	  	27
	 12.13
	  	 Applicable Law
	  	27

  

 iii 

 Coca-Cola Bottling Co. Consolidated 
 Officer Retention Plan 
 (Amended and Restated Effective January 1, 2007)

 PREAMBLE 
 This Plan is
designed to enhance the earnings and growth of each Participating Company. The Plan rewards selected key Employees with retirement and survivor benefits. Such benefits are intended to supplement retirement and survivor benefits from other sources.
By providing such supplemental benefits, the Plan enables the Participating Company to attract superior key Employees, to encourage them to make careers with the Participating Company, and to give them additional incentive to make the Participating
Company more profitable. 
 The Plan became effective on January 1, 1991 and was amended and restated effective January 1,
1997, July 1, 1998, January 1, 2001 and January 1, 2005. By this Instrument, Coca-Cola Bottling Co. Consolidated is amending and restating the Plan effective January 1, 2007 to make desired changes. The Committee
has reserved the right to amend the Plan from time to time in whole or in part, and the Committee has authorized the amendment and restatement of the Plan set forth below. 

 ARTICLE I 
 DEFINITIONS 
 Whenever used herein and capitalized, the following terms shall have the respective
meanings indicated unless the context plainly requires otherwise. 
  

	1.1	Affiliate 

 Any corporation or other entity with
respect to which the Company owns directly or indirectly 100% or more of the corporation’s or other entity’s outstanding capital stock or other equity interest, and any other entity with respect to which the Company owns directly or
indirectly 50% or more of such entity’s outstanding capital stock or other equity interest and which the Committee designates as an Affiliate. 
  

	1.2	Annuity Starting Date 

 The Annuity Starting Date
has the following meanings: 
  

	 	(a)	For payments of a Retirement or Severance Benefit (unless otherwise required by Section 7.4), the first day of the third month following such Retirement or Severance;

  

	 	(b)	For payments made on account of death, the first day of the third month following receipt by the Plan Administrator of satisfactory proof of death of the Participant; and

  

	 	(c)	For payment of a Change in Control Benefit (unless otherwise required by Section 7.4 or otherwise elected by the Participant pursuant to Section 6.1(b)(2)), the first day
of the third month following the Change in Control. 

  

	1.3	Authorized Leave of Absence 

 Either (a) a
leave of absence authorized by the Participating Company, in its sole and absolute discretion (the Participating Company is not required to treat different Employees comparably), provided that the Employee returns to a Participating Company within
the period specified, or (b) an absence required to be considered an Authorized Leave of Absence by applicable law. 
  

	1.4	Beneficiary 

 The beneficiary or beneficiaries
designated by a Participant pursuant to Article IX to receive the benefits, if any, payable on behalf of the Participant under the Plan after the death of such Participant, or when there has been no such designation or an invalid designation, the
individual or entity, or the individuals or entities, who will receive such amount. 

	1.5	Board 

 The Board of Directors of the Company.

  

	1.6	Change in Control 

 Any of the following:

  

	 	(a)	The acquisition or possession by any person, other than Harrison Family Interests (as defined in Paragraph (e)(1) of this Section), of beneficial ownership of shares of the
Company’s capital stock having the power to cast more than 50% of the votes in the election of the Board or to otherwise designate a majority of the members of the Board; or 

  

	 	(b)	At any time when Harrison Family Interests do not have beneficial ownership of shares of the Company’s capital stock having the power to cast more than 50% of the votes in the
election of the Board or to otherwise designate a majority of the members of the Board, the acquisition or possession by any person, other than Harrison Family Interests, of beneficial ownership of shares of the Company’s capital stock having
the power to cast both (i) more than 20% of the votes in the election of the Board and (ii) a greater percentage of the votes in the election of the Board than the shares beneficially owned by Harrison Family Interests are then entitled to
cast; or 

  

	 	(c)	The sale or other disposition of all or substantially all of the business and assets of the Company and its subsidiaries (on a consolidated basis) outside the ordinary course of
business in a single transaction or series of related transactions, other than any such sale or disposition to a person controlled, directly or indirectly, by the Company or to a person controlled, directly or indirectly, by Harrison Family
Interests that succeeds to the rights and obligations of the Company with respect to the Plan; or 

  

	 	(d)	Any merger or consolidation of the Company with another entity in which the Company is not the surviving entity and in which either (i) the surviving entity does not succeed to
the rights and obligations of the Company with respect to the Plan or (ii) after giving effect to the merger, a “Change in Control” under Subsection (a) or (b) of this Section would have occurred as defined therein were the
surviving entity deemed to be the Company for purposes of Subsections (a) and (b) of this Section (with appropriate adjustments in the references therein to “capital stock” and “the Board” to properly reflect the voting
securities and governing body of the surviving entity if it is not a corporation). 

  

	 	(e)	For purposes of this Section: 

  

	 	(1)	 “Harrison Family Interests” means and includes, collectively, the lineal descendants of J. Frank Harrison, Jr. (whether by blood or adoption), any
decedent’s estate of any of the foregoing, any trust primarily for the benefit of any one or more of the foregoing, any person controlled, 

  

 2 

	 	 
directly or indirectly, by any one or more of the foregoing, and any person in which any one or more of the foregoing have a majority of the equity
interests; 

  

	 	(2)	“person” includes an entity as well as an individual, and also includes, for purposes of determining beneficial ownership, any group of persons acting in concert to
acquire or possess such beneficial ownership; 

  

	 	(3)	“beneficial ownership” has the meaning ascribed to such term in Rule 13d-3 of the Securities Exchange Act of 1934; 

  

	 	(4)	“control” of a person means the possession, directly or indirectly, of the power to direct or cause the direction of the management and policies of such person; and

  

	 	(5)	“subsidiary” of the Company means any person as to which the Company, or another subsidiary of the Company, owns more than 50% of the equity interest or has the power to
elect or otherwise designate a majority of the members of its board of directors or similar governing body. 

  

	 	(f)	Notwithstanding any other provision of this Section, the revocable appointment of a proxy to vote shares of the Company’s capital stock at a particular meeting of shareholders
shall not of itself be deemed to confer upon the holder of such proxy the beneficial ownership of such shares. If any person other than Harrison Family Interests would (but for this sentence) share beneficial ownership of any shares of the
Company’s capital stock with any Harrison Family Interests, then such person shall be deemed the beneficial owner of such shares for purposes of this definition only if and to the extent such person has the power to vote or direct the voting of
such shares otherwise than as directed by Harrison Family Interests and otherwise than for the benefit of Harrison Family Interests. 

  

	1.7	Change in Control Benefit 

 The benefit paid to a
Participant or, in the event of the Participant’s death, to the Participant’s Beneficiary, in accordance with Section 6.1. 
  

	1.8	Code 

 The Internal Revenue Code of 1986, as
amended. References thereto shall include the valid and binding governmental regulations, court decisions and other regulatory and judicial authority issued or rendered thereunder. 
  

	1.9	Committee 

 The Compensation Committee of the Board.

  

 3 

	1.10	Company 

 Coca-Cola Bottling Co. Consolidated, a
Delaware corporation, and where appropriate any subsidiary thereof, or any entity which succeeds to its rights and obligations with respect to the Plan; provided, however, that for purposes of Section 1.6, “Company” shall mean only
Coca-Cola Bottling Co. Consolidated, a Delaware corporation, and any entity which succeeds to its rights and obligations with respect to the Plan. 
  

	1.11	Disability Retirement 

 A Termination of Employment
on account of Total Disability which occurs prior to a Participant’s Normal Retirement Date. 
  

	1.12	Employee 

 A person who is a common-law employee of
a Participating Company. 
  

	1.13	ERISA 

 The Employee Retirement Income Security Act
of 1974, as amended. References thereto shall include the valid and binding governmental regulations, court decisions and other regulatory and judicial authority issued or rendered thereunder. 
  

	1.14	Normal Retirement 

 Participant’s Termination
of Employment, other than on account of death, on the last day of the month coinciding with or during which the Participant attains age 60. 
  

	1.15	Normal Retirement Date 

 The last day of the month
coinciding with or during which the Participant attains age 60. 
  

	1.16	ORP Accrued Retirement Benefit 

 A
Participant’s ORP Accrued Retirement Benefit shall be as stated in the schedule attached to the Participant’s ORP Agreement. An example of such a schedule is attached hereto as Exhibit B. The Participant’s ORP Accrued Retirement
Benefit shall increase with each Year of Plan Participation the Participant completes. 
  

	1.17	ORP Agreement 

 The Agreement the Participating
Company and the Participant enter into pursuant to Article II. 
  

	1.18	Participating Company 

 Subject to the provisions of
Article X, “Participating Company” means the Company and any Affiliate which adopts the Plan for the benefit of its selected key Employees. Each Participating Company shall be deemed to appoint the Committee its exclusive agent to 

  

 4 

 
exercise on its behalf all of the power and authority conferred by the Plan upon the Company and accept the delegation to the Plan Administrator of all the
power and authority conferred upon the Plan Administrator by the Plan. The authority of the Company to act as such agent shall continue until the Plan is terminated as to the Participating Company. The term “Participating Company” shall be
construed as if the Plan were solely the Plan of such Participating Company, unless the context plainly requires otherwise. 
  

	1.19	Plan 

 The Coca-Cola Bottling Co. Consolidated
Officer Retention Plan, as contained herein and as it may be amended from time to time hereafter. 
  

	1.20	Plan Administrator 

 The Executive Vice President
and Assistant to the Chairman or such other person designated by such individual or by the Chief Executive Officer of the Company. 
  

	1.21	Postponed Retirement 

 A Participant’s
Termination of Employment, other than on account of death, after the date on which the Participant’s Normal Retirement would occur. 
  

	1.22	Retire 

 The act of taking Retirement. 

 

	1.23	Retirement 

 A Participant’s Normal Retirement,
Postponed Retirement or Disability Retirement. 
  

	1.24	Retirement Benefit 

 The benefit paid to a
Participant in accordance with the provisions of Article III. 
  

	1.25	Service 

 Employment with any Participating Company,
including in the discretion of the Plan Administrator, any period during which severance payments are made. 
  

	1.26	Severance 

 Termination of Employment prior to a
Participant’s Normal Retirement Date other than on account of Total Disability or death. 
  

	1.27	Severance Benefit 

 The benefit paid to a
Participant in accordance with the provisions of Article V. 
  

 5 

	1.28	Surviving Spouse 

 The survivor of a deceased
Participant to whom such deceased Participant was legally married (as determined by the Plan Administrator) immediately before the Participant’s death. 
  

	1.29	Termination for Cause 

 Termination prior to a
Change in Control by reason of (a) the Employee’s commission of an act of embezzlement, dishonesty, fraud, gross neglect of duties, or disloyalty to any Participating Company, (b) the Employee’s commission of a felonious act or
other crime involving moral turpitude or public scandal, (c) the Employee’s alcoholism or drug addiction, or (d) the Employee’s improper communication of confidential information about any Participating Company or other conduct
committed which the Employee knew or should have known was not in any Participating Company’s best interest. 
  

	1.30	Termination of Employment 

 The date on which the
Participant is no longer employed by any Participating Company. For purposes of this Section, a Termination of Employment occurs on the earlier of: 
  

	 	(a)	The later of the date (i) as of which the Employee quits, is discharged, terminates employment in connection with incurring a Total Disability, Retirement or death, or
(ii) at the discretion of the Plan Administrator, the Employee is no longer receiving severance payments; or 

  

	 	(b)	The first day of absence of an Employee who fails to return to employment at the expiration of an Authorized Leave of Absence. 

  

	1.31	Total Disability 

 A physical or mental condition
under which the Participant qualifies as totally disabled under the group long-term disability plan of the Participating Company; provided, however, that if the Participant is not covered by such plan or if there is no such plan, the Participant
shall be under a Total Disability if the Participant is determined to be disabled under the Social Security Act. Notwithstanding any other provisions of the Plan, a Participant shall not be considered Totally Disabled if such disability is due to
(i) war, declared or undeclared, or any act of war, (ii) intentionally self-inflicted injuries, (iii) active participation in a riot or (iv) the Participant’s intoxication or the Participant’s illegal use of drugs.

  

	1.32	Vested Percentage 

 The percentage in which the
Participant is vested in benefits attributable to the Participant’s ORP Accrued Retirement Benefit shall be 100% upon (i) Retirement, (ii) death while an Employee or while Totally Disabled but prior to reaching Disability Retirement,
or (iii) a Change in Control while an Employee or while Totally Disabled but prior to reaching Disability Retirement. Unless otherwise provided in a Participant’s 

  

 6 

 
ORP Agreement, prior to the occurrence of any of the above events, the Participant’s Vested Percentage in benefits attributable to the
Participant’s ORP Accrued Retirement Benefit shall be determined according to the following schedule: 
  

				
	 Age
	  	Vested
Percentage	 
	 50 and before
	  	50	%
	 51
	  	55	%
	 52
	  	60	%
	 53
	  	65	%
	 54
	  	70	%
	 55
	  	75	%
	 56
	  	80	%
	 57
	  	85	%
	 58
	  	90	%
	 59
	  	95	%
	 60
	  	100	%

  

	1.33	Year of Plan Participation 

 A Participant shall be
credited with a Year of Plan Participation for the calendar year in which the Participant’s participation in the Plan begins if the Participant remains in Service through the end of such calendar year. With respect to each calendar year
following the calendar year in which the Participant’s participation begins, the Participant shall be credited with a Year of Plan Participation for each such calendar year during which the Participant is in Service for the entirety of such
calendar year. Notwithstanding any other provision of this Section, a Participant who is an Employee shall be credited with a Year of Plan Participation for the year in which and at the time the Participant attains Normal Retirement. 
  

 7 

 ARTICLE II 
 ELIGIBILITY AND PARTICIPATION 
  

	2.1	Eligibility 

 An Employee (a) who is a member
of the Participating Company’s “select group of management or highly compensated employees,” as defined in Sections 201(2), 301(a) (3) and 401(a) of ERISA, and (b) who is designated by the Committee, shall be eligible to
become a Participant in the Plan. 
  

	2.2	Participation 

 An Employee who is eligible to
become a Participant shall become a Participant upon the execution and delivery to the Plan Administrator of an ORP Agreement substantially in the form attached hereto as Exhibit A. 
  

 8 

 ARTICLE III 
 RETIREMENT BENEFIT 
  

	3.1	Retirement Benefit 

  

	 	(a)	Eligibility for Retirement Benefit: Upon a Participant’s Normal Retirement, Postponed Retirement or Disability Retirement, the Participating Company shall pay the
Participant a Retirement Benefit subject to the conditions and adjustments described in this Section. 

  

	 	(b)	Election of Payment Form: 

  

	 	(1)	Special Payment Election in 2005: Each Participant who is an Employee during 2005 shall be given the opportunity during 2005 to make a payment election applicable to the
Participant’s ORP Accrued Retirement Benefit. The Participant may elect that the Participant’s ORP Accrued Retirement Benefit be paid in equal monthly installments over 10, 15 or 20 years. If a Participant described in this Paragraph fails
to make a payment election described in this Paragraph, the Participant’s ORP Accrued Retirement Benefit shall be paid in equal monthly installments over 20 years. Any election made pursuant to this Paragraph shall be irrevocable on
December 31, 2005. 

  

	 	(2)	Payment Election after 2005: Each individual who first becomes a Participant after 2005 shall elect that the Participant’s ORP Accrued Retirement Benefit be paid in
equal monthly installments over 10, 15 or 20 years. Such election must be filed with the Plan Administrator within 30 days following the date of the Participant’s ORP Agreement. If a Participant described in this Paragraph fails to make a
payment election described in this Paragraph, the Participant’s ORP Accrued Retirement Benefit shall be paid in equal monthly installments over 20 years. Any election made pursuant to this Paragraph shall be irrevocable 30 days following the
date of the Participant’s ORP Agreement. 

  

	 	(c)	Amount and Commencement of Retirement Benefit: 

  

	 	(1)	The present value of the Retirement Benefit as of the Annuity Starting Date, determined by using a discount rate of 8% per annum using simple interest computed on a monthly
basis, shall equal the ORP Accrued Retirement Benefit the Participant accrued as of the Participant’s Retirement. 

  

	 	(2)	 Payment of a Participant’s Retirement Benefit shall be made to the Participant beginning on the Annuity Starting Date described in Section 1.2(a) and
continuing on the first day of each month thereafter until 

  

 9 

	 	 
expiration of the period certain. The present value of the monthly installments as of the Annuity Starting Date, determined by using a discount rate of
8% per annum using simple interest computed on a monthly basis, shall equal Participant’s ORP Accrued Retirement Benefit accrued as of the date of the Participant’s Retirement. 

  

	3.2	Reemployment 

 If a Retired Participant again
becomes an Employee, such reemployment shall not affect in any way the Participant’s Retirement Benefit; and unless the Plan Administrator otherwise decides, the Participant shall not accrue any additional benefit under the Plan on account of
such reemployment. 
  

 10 

 ARTICLE IV 
 DEATH BENEFIT 
  

	4.1	Amount of Death Benefit Before Payment Begins 

 If a
Participant dies before receiving any payment under the Plan, the death benefit shall equal the Vested Percentage of the Participant’s ORP Accrued Retirement Benefit as of the Participant’s death. Notwithstanding the preceding sentence:

  

	 	(a)	No death benefit shall be paid if the Participant dies after a Termination for Cause; or 

  

	 	(b)	If a Participant entitled to a Change in Control Benefit under Section 6.1 dies before payment of the Participant’s Change in Control Benefit has begun, the amount of the
death benefit shall be determined in accordance with Section 6.1(b)(3). 

  

	4.2	Amount of Death Benefit After Annuity Payments Begin 

 If a Participant dies after monthly installments begin but before all payments have been made, the monthly installments remaining shall be paid to the Participant’s Beneficiary in a single lump sum, the present value of which shall be
determined by using a discount rate of 8% per annum using simple interest computed on a monthly basis applied to the remaining monthly installments. 
  

	4.3	Form of Benefit 

 Payment of all death benefits
shall be made in a single lump sum. 
  

	4.4	Time of Payment 

 The payment of a death benefit
under this Article shall be made on the Annuity Starting Date described in Section 1.2(b). 
  

 11 

 ARTICLE V 
 SEVERANCE BENEFIT 
  

	5.1	Severance Benefit 

  

	 	(a)	Eligibility for Severance Benefit: Upon a Participant’s Severance, the Participating Company shall pay the Participant a Severance Benefit subject to the conditions and
adjustments described in this Section. 

  

	 	(b)	Election of Payment Form: The Participant’s Severance Benefit shall be paid in the form elected under Section 3.1(b). 

  

	 	(c)	Amount and Commencement of Severance Benefit: 

  

	 	(1)	The present value of the Severance Benefit as of the Annuity Starting Date, determined by using a discount rate of 8% per annum using simple interest computed on a monthly
basis, shall equal the Vested Percentage of the Participant’s ORP Accrued Retirement Benefit as of the date of the Participant’s Severance. 

  

	 	(2)	Payment of the Participant’s Severance Benefit shall be made to the Participant beginning on the Annuity Starting Date described in Section 1.2(a) and continuing on the
first day of each month thereafter until the expiration of the period certain. The present value of the monthly installments as of the Annuity Starting Date, determined by using a discount rate of 8% per annum using simple interest computed on
a monthly basis, shall equal the Vested Percentage of the Participant’s ORP Accrued Retirement Benefit accrued as of the Participant’s date of Severance. 

  

	5.2	Reemployment 

 Except as otherwise provided in this
Section, if a Participant who has had a Severance again becomes an Employee, such reemployment shall not affect in any way the Participant’s Severance Benefit; and unless the Plan Administrator decides otherwise, the Participant shall not
accrue any additional benefit under the Plan on account of such reemployment. 
  

 12 

 ARTICLE VI 
 CHANGE IN CONTROL BENEFIT 
  

	6.1	Change in Control 

  

	 	(a)	Eligibility for Change in Control Benefit: Upon a Change in Control, the Participating Company shall pay to each Participant who is an Employee on the date of the Change in
Control a Change in Control Benefit in lieu of any other benefits to which the Participant may be entitled under the Plan. The Change in Control Benefit shall be subject to the conditions and adjustments described in Subsection (b) of this
Section. 

  

	 	(b)	Amount, Form and Commencement of Change in Control Benefit: 

  

	 	(1)	The present value of the Change in Control Benefit as of the Annuity Starting Date, determined by using a discount rate of 8% per annum using simple interest computed on a
monthly basis, shall equal the Participant’s CIC Amount. The “CIC Amount” means the ORP Accrued Retirement Benefit that the Participant would have accrued as of the Participant’s Normal Retirement Date had the Participant’s
Years of Plan Participation continued unbroken through the Participant’s Normal Retirement Date. (Solely for illustration purposes, the CIC Amount of a Participant whose ORP Accrued Retirement Benefit schedule attached to the Participant’s
ORP Agreement was Exhibit B hereto would be $500,000, irrespective of the plan year or the Participant’s age during which the Change in Control occurred.) 

  

	 	(2)	The Participant (i) may make an election to have the Participant’s Change in Control Benefit paid in a single lump sum or in equal monthly installments over 10, 15 or 20
years, and (ii) may make an election to have payment of the Participant’s Change in Control Benefit commence at a time later than the Annuity Starting Date described in Section 1.2(c). Such elections must be made in accordance with
the provisions of Section 3.1(b); provided, however, that if a Participant fails to make a payment election for the Participant’s Change in Control Benefit, the Participant’s Change in Control Benefit shall be paid in a single lump
sum as of the Annuity Starting Date described in Section 1.2(c). 

  

	 	(3)	If a Participant elects payment of the Participant’s Change in Control Benefit in monthly installments for a period certain, then payment shall be made to the Participant
beginning on the Annuity Starting Date and continuing on the first day of each month thereafter until expiration of the period certain. The present value of the monthly installments as of the Annuity Starting Date, determined by using a discount
rate of 8% per annum using simple interest computed on a monthly basis, shall equal the Participant’s CIC Amount. 

  

 13 

	 	(4)	If a Participant elects to have payment of the Participant’s Change in Control Benefit commence at a time later than the Annuity Starting Date, then payment shall be made to
the Participant beginning on the date elected and, if in monthly installments, continuing on the first day of each month thereafter until the expiration of the period certain. If payment is in a single lump sum, the amount of the lump sum shall
equal the Participant’s CIC Amount, increased at the rate of 8% per annum using simple interest computed on a monthly basis for the period from the Annuity Starting Date to the date of payment of the single lump sum; provided, however,
that no increase shall apply after the Participant’s Normal Retirement Date. If payment is made in monthly installments, the present value of the monthly installments as of the date payment commences, determined by using a discount rate of
8% per annum simple interest (not compounded), shall equal the Participant’s CIC Amount, increased at the rate of 8% per annum using simple interest computed on a monthly basis for the period from the Annuity Starting Date to the date
payment of the monthly installments commence; provided, however, that no increase shall apply after the Participant’s Normal Retirement Date. 

  

	 	(5)	If a Participant entitled to a Change in Control Benefit dies before payment of the Participant’s Change in Control Benefit has begun or been completed, then full payment of
the Change in Control Benefit, as determined under this Section, shall still be made, and the payment(s) remaining to be paid shall be paid instead to the Participant’s Beneficiary in a lump sum on the Annuity Starting Date described in
Section 1.2(b). If payment of the Change in Control Benefit had not begun before the Participant’s death, the amount of the lump sum shall be the Participant’s CIC Amount, increased, if the Participant had elected a benefit
commencement date later than the Annuity Starting Date provided in Section 1.2(c), at the rate of 8% per annum using simple interest computed on a monthly basis for the period from said Annuity Starting Date to the Annuity Starting Date
described in Section 1.2(b); provided, however, that no such increase shall apply after the Participant’s Normal Retirement Date. If payment of the Change in Control Benefit had begun before the Participant’s death, the amount of the
lump sum shall be the present value of the remaining monthly installments as determined in Section 4.2. 

  

	 	(c)	Benefits of Other Participants: If, as of the date of a Change in Control, a Participant is not entitled to a Change in Control Benefit under the preceding provisions of this
Section but is entitled to one or more future payments under Article III or Article V, such benefits shall be paid when, as and in the amount(s) provided in Article III or V, and Article IV if he dies before all benefit payments have been made. If,
as of the date of a Change in Control, any death benefit remains to be paid with respect to a deceased Participant, such death benefit shall be paid when, as and in the amount provided in Article IV. 

  

 14 

	6.2	Enlargement of Benefits 

 Notwithstanding any
provision in the Plan to the contrary, the Committee shall have the right prior to (but not after) a Change in Control to unilaterally increase the amount of any benefit for any Participant or Beneficiary. 
  

 15 

 ARTICLE VII 
 CONDITIONS 
  

	7.1	Suicide 

 Notwithstanding any provision in the Plan
to the contrary, if any Participant dies as a result of suicide within 30 months of entering into an ORP Agreement, then the Participant’s benefits under the Plan shall be forfeited, and no benefit shall be paid to the Participant’s
Beneficiary. 
  

	7.2	Noncompetition 

 In the event a Participant, during
the period of the Participant’s employment and for 3 years following the Termination of Employment for any Cause or without Cause, (i) directly or indirectly, engages in the same or similar line of business carried on by any Participating
Company in any territory in which any Participating Company is doing business during the period of one year preceding the Participant’s Termination of Employment, (ii) directly or indirectly, either for the Participant’s own account
or for the account of any other person or entity, hires, solicits or attempts to persuade any employee, agent or consultant of any Participating Company to terminate or alter such person’s relationship with any Participating Company to any
Participating Company’s detriment, or (iii) persuades, encourages or causes, directly or indirectly, any supplier or customer of any Participating Company, including but not limited to any supplier or customer with whom the Participant had
or has material contacts in the course of the Participant’s employment with any Participating Company, to terminate such person’s relationship with any Participating Company or divert any business from any Participating Company, then the
Participant shall forfeit any benefit to which the Participant may be entitled hereunder and within 30 days of a written request of the Company shall reimburse the Company for any benefit paid to Participant hereunder. This Section shall not apply
to any actions which occur after both a Participant’s Termination of Employment and a Change in Control. 
  

	7.3	Forfeiture for Cause 

 Notwithstanding any provision
in the Plan to the contrary, a Participant shall forfeit all rights to any benefits under the Plan if the Participant is Terminated for Cause by any Participating Company. 
  

	7.4	Special Provisions for “Specified Employees” 

 Notwithstanding any other provision of the Plan to the contrary, to the extent applicable, in no event shall a Retirement Benefit or Severance Benefit be made to a “specified employee” within the meaning of Section 409A of
the Code earlier than 6 months after the date of the Participant’s Termination of Employment, except in connection with the Participant’s death. 
  

 16 

 ARTICLE VIII 
 ADMINISTRATION OF THE PLAN 
  

	8.1	Powers and Duties of the Plan Administrator 

 The
Plan Administrator shall have general responsibility for the administration of the Plan (including but not limited to complying with reporting and disclosure requirements and establishing and maintaining Plan records). In the exercise of the Plan
Administrator’s sole and absolute discretion, the Plan Administrator shall interpret the Plan’s provisions (and all ambiguities) and, subject to the Committee’s approval, determine the eligibility of individuals for benefits.

  

	8.2	Agents 

 The Plan Administrator may engage such
legal counsel, certified public accountants and other advisors and service providers, who may be advisors or service providers for one or more Participating Companies, and make use of such agents and clerical or other personnel, as it shall require
or may deem advisable for purposes of the Plan. The Plan Administrator may rely upon the written opinion of any legal counsel or accountants engaged by the Plan Administrator, and may delegate to any person or persons the Plan Administrator’s
authority to perform any act hereunder, including, without limitation, those matters involving the exercise of discretion, provided that such delegation shall be subject to revocation at any time at the discretion of the Plan Administrator.

  

	8.3	Reports to the Committee 

 The Plan Administrator
shall report to the Committee as frequently as the Committee shall specify, with regard to the matters for which the Plan Administrator is responsible under the Plan. 
  

	8.4	Limitations on the Plan Administrator 

 The Plan
Administrator shall not be entitled to act on or decide any matter relating solely to Plan Administrator or any of Plan Administrator’s rights or benefits under the Plan. In the event the Plan Administrator is unable to act in any matter by
reason of the foregoing restriction, the Committee shall act on such matter. The Plan Administrator shall not receive any special compensation for serving in the capacity but shall be reimbursed for any reasonable expenses incurred in connection
therewith. Except as otherwise required by ERISA, no bond or other security shall be required of the Plan Administrator in any jurisdiction. The Plan Administrator or any agent to whom the Plan Administrator delegates any authority, and any other
person or group of persons, may serve in more than one fiduciary capacity with respect to the Plan. 
  

 17 

	8.5	Benefit Elections, Procedures and Calculations 

 The
Plan Administrator shall establish, and may alter, amend and modify from time to time, the procedures pursuant to which Participants and Beneficiaries may make their respective elections, requests and designations under the Plan. The Plan
Administrator shall also establish the election and designation forms that Participants and Beneficiaries must use for such purposes. No election, request or designation by a Participant or a Beneficiary shall be effective unless and until it has
been executed and delivered to the Plan Administrator (or the Plan Administrator’s authorized representative) and has also satisfied any other conditions or requirements that may apply to such election, request or designation under any other
applicable provision of the Plan. 
  

	8.6	Instructions for Payments 

 All requests of or
directions to any Participating Company for payment or disbursement shall be signed by the Plan Administrator or such other person or persons as the Plan Administrator may from time to time designate in writing. This person shall cause to be kept
full and accurate accounts of payments and disbursements under the Plan. 
  

	8.7	Claims for Benefits 

  

	 	(a)	General: In the event a claimant has a claim under the Plan, such claim shall be made by the claimant’s filing a notice thereof with the Plan Administrator. (A claimant
may authorize a representative to act on the claimant’s behalf with respect to the claim.) Each such claim shall be referred to the Plan Administrator for the initial decision with respect thereto. Each claimant who has submitted a claim to the
Plan Administrator shall be afforded a reasonable opportunity to state such claimant’s position and to submit written comments, documents, records, and other information relating to the claim to the Plan Administrator for Plan
Administrator’s consideration in rendering Plan Administrator’s decision with respect thereto. A claimant shall also be provided, upon request and free of charge, reasonable access to, and copies of, all documents, records, and other
information relevant to the claim. 

  

	 	(b)	Plan Administrator’s Decision: The Plan Administrator will consider the claim and make a decision and notify the claimant in writing within a reasonable period of time
but not later than 90 days after the Plan Administrator receives the claim. Under special circumstances, the Plan Administrator may take up to an additional 90 days to review the claim if the Plan Administrator determines that such an extension is
necessary due to matters beyond the Plan Administrator’s control. If this happens, the claimant will be notified before the end of the initial 90-day period of the circumstances requiring the extension and the date by which the Plan
Administrator expects to render a decision. If any part of the claim is denied, the notice will include specific reasons for the denial and specific references to the pertinent Plan provisions on which the denial is based, describe any additional
material or information necessary to file the claim properly and explain why this material or information is necessary, and describe the Plan’s review procedures, including the claimant’s right to bring a civil action under
Section 502(a) of ERISA following an adverse benefits determination on review. 

  

 18 

	 	(c)	Review of Decision: The claimant may have the denial of any part of the claim reviewed. The denial will be reviewed by the Committee. To obtain a review, the claimant must
submit a written request for review to the Committee within 90 days after the claimant receives the written decision of the Plan Administrator. The written request may include written comments, documents, records, and other information relating to
the claim. The claimant will be provided upon request and free of charge reasonable access to and copies of all documents, records, and other information relevant to the claim. 

 The Committee will review the case and notify the claimant of its decision, whether favorable or unfavorable, within a reasonable period of time, but no
later than 60 days after it receives the claim. The review will take into account all comments, documents, records, and other information the claimant submits, without regard to whether such information was submitted or considered in the initial
benefit determination. Under special circumstances, the Committee may take up to an additional 60 days to review the claim if it determines that such an extension is necessary due to matters beyond its control. If this happens, the claimant will be
notified before the end of the initial 60-day period of the circumstances requiring the extension and the date by which the Committee expects to render a decision. 
 The notification to the claimant will be in writing, specify the reasons for its decision, make specific references to the Plan provisions on which the denial was based, and include a statement that the claimant is
entitled to receive, upon request and free of charge, reasonable access to, and copies of, all documents, records, and other information relevant to the claim and a statement regarding the claimant’s right to bring a civil action under
Section 502(a) of ERISA. 
 The decision of the Committee will be final and conclusive upon all persons interested therein, except to the
extent otherwise provided by applicable law. 
  

	8.8	Hold Harmless 

 To the maximum extent permitted by
law, no member of the Committee or the Plan Administrator shall be personally liable by reason of any contract or other instrument executed by the Plan Administrator or a member of the Committee or on such member’s behalf in such member’s
capacity as a member of the Committee nor for any mistake of judgment made in good faith, and each Participating Company shall indemnify and hold harmless, directly from its own assets (including the proceeds of any insurance policy the premiums of
which are paid from the Company’s own assets), the Plan Administrator and each member of the Committee and each other officer, employee, or director of any Participating Company to whom any duty or power relating to the administration or
interpretation of the Plan against any cost or expense (including counsel fees) or liability (including any sum paid in settlement of a claim with the approval of any Participating 

  

 19 

 
Company) arising out of any act or omission to act in connection with the Plan unless arising out of such person’s own fraud or bad faith or such
indemnification is contrary to law. 
  

	8.9	Service of Process 

 The Secretary of the Company or
such other person designated by the Board shall be the agent for service of process under the Plan. 
  

 20 

 ARTICLE IX 
 DESIGNATION OF BENEFICIARIES 
  

	9.1	Beneficiary Designation 

 Every Participant shall
file with the Plan Administrator a written designation of one or more persons as the Beneficiary who shall be entitled to receive the benefits, if any, payable under the Plan after the Participant’s death. A Participant may from time to time
revoke or change such Beneficiary designation by filing a new designation with the Plan Administrator. The last such designation received by the Plan Administrator shall be controlling; provided, however, that no designation, or change or revocation
thereof, shall be effective unless received by the Plan Administrator prior to the Participant’s death, and in no event shall it be effective as of any date prior to such receipt. All decisions of the Committee concerning the effectiveness of
any Beneficiary designation and the identity of any Beneficiary shall be final. If a Beneficiary dies after the death of the Participant and prior to receiving the payment(s) that would have been made to such Beneficiary had such Beneficiary’s
death not occurred, and if no contingent Beneficiary has been designated, then for the purposes of the Plan any remaining payments that would have been received by such Beneficiary shall be made to the Beneficiary’s estate. 
  

	9.2	Failure to Designate Beneficiary 

 If no Beneficiary
designation is in effect at the time of the Participant’s death (including a situation where no designated Beneficiary is alive or in existence at the time of the Participant’s death), the benefits, if any, payable under the Plan after the
Participant’s death shall be made to the Participant’s Surviving Spouse, if any, or if the Participant has no Surviving Spouse, to the Participant’s estate. If the Plan Administrator is in doubt as to the right of any person to
receive such benefits, the Plan Administrator may direct the Participating Company to withhold payment, without liability for any interest thereon, until the rights thereto are determined, or the Plan Administrator may direct the Participating
Company to pay any such amount into any court of appropriate jurisdiction; and such payment shall be a complete discharge of the liability of the Participating Company. 
  

 21 

 ARTICLE X 
 WITHDRAWAL OF PARTICIPATING COMPANY 
  

	10.1	Withdrawal of Participating Company 

 A
Participating Company (other than the Company) may withdraw from participation in the Plan by giving the Board prior written notice approved by resolution by its board of directors or similar governing body specifying a withdrawal date, which shall
be the last day of a month at least 30 days subsequent to the date on which notice is received by the Board. The Participating Company shall withdraw from participating in the Plan if and when it ceases to be either a division of the Company or an
Affiliate. The Committee may require the Participating Company to withdraw from the Plan, as of any withdrawal date the Committee specifies. 
  

	10.2	Effect of Withdrawal 

 A Participating
Company’s withdrawal from the Plan shall not in any way modify, reduce or otherwise affect benefits accrued as of the date of withdrawal. With respect to former Employees, “accrued benefits” are benefits to which the former Employees
are entitled under the provisions of the Plan as the provisions existed immediately before the withdrawal. With respect to Employees, “accrued benefits” are the benefits to which the Employees would be entitled under the provisions of the
Plan as the provisions existed immediately before the withdrawal if their employment had terminated (other than on account of death or Total Disability) on the day before the withdrawal. Withdrawal from the Plan by any Participating Company shall
not in any way affect any other Participating Company’s participation in the Plan. 
  

 22 

 ARTICLE XI 
 AMENDMENT OR TERMINATION OF THE PLAN 
  

	11.1	Right to Amend or Terminate Plan 

  

	 	(a)	By the Board or the Committee: Subject to Subsection (c) of this Section, the Board or the Committee reserves the right at any time to amend or terminate the Plan, in
whole or in part, and for any reason and without the consent of any Participating Company, Participant, or Beneficiary. Each Participating Company by its participation in the Plan shall be deemed to have delegated this authority to the Committee.

  

	 	(b)	By the Plan Administrator: Subject to Subsection (c) of this Section, the Plan Administrator may adopt any ministerial and nonsubstantive amendment which may be
necessary or appropriate to facilitate the administration, management and interpretation of the Plan, provided the amendment does not materially affect the estimated cost to the Participating Companies of maintaining the Plan. Each Participating
Company by its participation in the Plan shall be deemed to have delegated this authority to the Plan Administrator. 

  

	 	(c)	Limitations: In no event shall an amendment or termination of the Plan modify, reduce or otherwise affect benefits accrued as of the date of the amendment or termination.
With respect to former Employees, “accrued benefits” are benefits to which the former Employees are entitled under the provisions of the Plan as the provisions existed immediately before the amendment or termination. With respect to
Employees, “accrued benefits” are the benefits to which the Employees would be entitled under the provisions of the Plan as the provisions existed immediately before the amendment or termination if their employment had terminated without
Cause (other than on account of death or Total Disability) on the day before the amendment or termination. Notwithstanding the preceding provisions of this Subsection, from and after the date of a Change in Control no amendment or termination may be
made to the Plan that, without the express written consent of the affected Participant or Beneficiary (as the case may be), directly or indirectly changes the amount, time or method of payment of (i) any Change in Control Benefit resulting from
the Change in Control or (ii) any Retirement Benefit, Severance Benefit, death benefit or other benefit that had accrued by the date of the Change in Control. 

  

	 	(d)	Effect of Amendment and Restatement: This amendment and restatement of the Plan shall not affect the time, amount or method of payment of Plan benefits paid on or after the
Effective Date to any Participant whose employment with the Company terminated on or before the Effective Date, and such Participant’s benefits (including any death benefits) shall be determined under the provisions of the Plan as in effect
immediately prior to the Effective Date; provided, however, upon a Change in Control, the provisions of Section 6.1(c) and Subsection (c) of this Section shall apply to any remaining benefits of such Participant. 

 

 23 

	11.2	Notice 

 Notice of any amendment or termination of
the Plan shall be given by the Board or the Committee, whichever adopts the amendment, to the other and to all Participating Companies. 
  

 24 

 ARTICLE XII 
 GENERAL PROVISIONS AND LIMITATIONS 
  

	12.1	No Right to Continued Employment 

 Nothing contained
in the Plan shall give any Employee the right to be retained in the employment of any Participating Company or affect the right of any such employer to dismiss any Employee with or without Cause. The adoption and maintenance of the Plan shall not
constitute a contract between any Participating Company and Employee or consideration for, or an inducement to or condition of, the employment of any Employee. Unless a written contract of employment has been executed by a duly authorized
representative of a Participating Company, such Employee is an “employee at will.” 
  

	12.2	Payment on Behalf of Payee 

 If the Plan
Administrator finds that any person to whom any amount is payable under the Plan is unable to care for such person’s affairs because of illness or accident, or is a minor, or has died, then any payment due such person or such person’s
estate (unless a prior claim therefor has been made by a duly appointed legal representative) may, if the Plan Administrator so elects, be paid to such person’s spouse, a child, a relative, an institution maintaining or having custody of such
person, or any other person deemed by the Plan Administrator to be a proper recipient on behalf of such person otherwise entitled to payment. Any such payment shall be a complete discharge of the liability of the Plan and every Participating
Company. 
  

	12.3	Nonalienation 

 No interest, expectancy, benefit,
payment, claim or right of any Participant or Beneficiary under the Plan shall be (a) subject in any manner to any claims of any creditor of the Participant or Beneficiary, (b) subject to the debts, contracts, liabilities or torts of the
Participant or Beneficiary or (c) subject to alienation by anticipation, sale, transfer, assignment, bankruptcy, pledge, attachment, charge or encumbrance of any kind. If any person attempts to take any action contrary to this Section, such
action shall be null and void and of no effect; and the Plan Administrator and the Participating Company shall disregard such action and shall not in any manner be bound thereby and shall suffer no liability on account of its disregard thereof.

 If any Participant or Beneficiary hereunder becomes bankrupt or attempts to anticipate, alienate, sell, assign, pledge, encumber, or charge
any right hereunder, then such right or benefit shall, in the discretion of the Plan Administrator, cease and terminate; and in such event, the Plan Administrator may hold or apply the same or any part thereof for the benefit of the Participant or
Beneficiary or the spouse, children, or other dependents of the Participant or Beneficiary, or any of them, in such manner and in such amounts and proportions as the Plan Administrator may deem proper. 
  

 25 

	12.4	Missing Payee 

 If the Plan Administrator cannot
ascertain the whereabouts of any person to whom a payment is due under the Plan, and if, after five years from the date such payment is due, a notice of such payment due is mailed to the last known address of such person, as shown on the records of
the Plan Administrator or any Participating Company, and within three months after such mailing such person has not made written claim therefore, the Plan Administrator if the Plan Administrator so elects, after receiving advice from counsel to the
Plan, may direct that such payment and all remaining payments otherwise due to such person be canceled on the records of the Plan and the amount thereof forfeited; and upon such cancellation, the Participating Company shall have no further liability
therefore, except that, in the event such person later notifies the Plan Administrator of such person’s whereabouts and requests the payment or payments due to such person under the Plan, the amounts otherwise due but unpaid shall be paid to
such person without interest for late payment. 
  

	12.5	Required Information 

 Each Participant shall file
with the Plan Administrator such pertinent information concerning himself or herself, such Participant’s Beneficiary, or such other person as the Plan Administrator may specify; and no Participant, Beneficiary, or other person shall have any
rights or be entitled to any benefits under the Plan unless such information is filed by or with respect to the Participant. 
  

	12.6	No Trust or Funding Created 

 The obligations of
each Participating Company to make payments hereunder constitutes a liability of such Participating Company to a Participant or Beneficiary, as the case may be. Such payments shall be made from the general funds of the Participating Company; and the
Participating Company shall not be required to establish or maintain any special or separate fund, or purchase or acquire life insurance on a Participant’s life, or otherwise to segregate assets to assure that such payment shall be made; and
neither a Participant nor a Beneficiary shall have any interest in any particular asset of the Participating Company by reason of its obligations hereunder. Nothing contained in the Plan shall create or be construed as creating a trust of any kind
or any other fiduciary relationship between any Participating Company and a Participant or any other person, it being the intention of the parties that the Plan be unfunded for tax purposes and for Title I of ERISA. The rights and claims of a
Participant or a Beneficiary to a benefit provided hereunder shall have no greater or higher status than the rights and claims of any other general, unsecured creditor of any Participating Company; and the Plan constitutes a mere promise to make
benefit payments in the future. 
  

	12.7	Binding Effect 

 Obligations incurred by any
Participating Company pursuant to the Plan shall be binding upon and inure to the benefit of such Participating Company, its successors and assigns, and the Participant and the Participant’s Beneficiary. 
  

 26 

	12.8	Merger or Consolidation 

 In the event of a merger
or a consolidation by any Participating Company with another corporation, or the acquisition of substantially all of the assets or outstanding stock of a Participating Company by another corporation, then and in such event the obligations and
responsibilities of such Participating Company under the Plan shall be assumed by any such successor or acquiring corporation; and all of the rights, privileges and benefits of the Participants and Beneficiaries hereunder shall continue. 

 

	12.9	Entire Plan 

 This document, any elections provided
for in the Plan, any written amendments hereto and the ORP Agreements contain all the terms and provisions of the Plan and shall constitute the entire Plan, any other alleged terms or provisions being of no effect. 
  

	12.10	Withholding 

 Each Participating Company shall
withhold from benefit payments all taxes required by law. 
  

	12.11	Compliance with Section 409A of the Code 

 The
Plan is intended to comply with Section 409A of the Code. Notwithstanding any provision of the Plan to the contrary, the Plan shall be interpreted, operated and administered consistent with this intent. 
  

	12.12	Construction 

 Unless otherwise indicated, all
references to articles, sections and subsections shall be to the Plan as set forth in this document. The titles of articles and the captions preceding sections and subsections have been inserted solely as a matter of convenience of reference only
and are to be ignored in any construction of the provisions of the Plan. Whenever used herein, unless the context clearly indicates otherwise, the singular shall include the plural and the plural the singular. 
  

	12.13	Applicable Law 

 The Plan shall be governed and
construed in accordance with the laws of the State of Delaware, except to the extent such laws are preempted by the laws of the United States of America. 
  

 27 

 IN WITNESS WHEREOF, the Company has caused this Plan to be executed this 28th day of February, 2007. 
  

					
	COCA-COLA BOTTLING CO. CONSOLIDATED
		
	 By:
	 	/s/ Henry W. Flint

					
	 Officer’s Name:
	 	 Henry W. Flint

	 Officer’s Title:
	 	 Executive Vice President

  

 28 

 EXHIBIT A 
 ORP AGREEMENT 
 THIS ORP AGREEMENT is made this      day of
                    , 200  , by and between Coca-Cola Bottling Co. Consolidated (the “Company”) and
                                , an employee of the Participating Company (the
“Participant”). 
 W I T NE S S E T H : 
 WHEREAS, the Company has adopted the Coca-Cola Bottling Co. Consolidated Officer Retention Plan (the “Plan”) for the purpose of providing additional incentives to a select group of highly compensated or
management employees of the Participating Company; and 
 WHEREAS, the Participant has been selected for participation in the Plan; and

 WHEREAS, this Agreement is made to evidence the Participant’s participation in the Plan and to set forth certain bases for
determining the Participant’s benefits under the Plan. 
 NOW, THEREFORE, the Company and the Participant hereby agree as follows:

 1. Incorporation of Plan. The Plan (and all its provisions), as it now exists and as it may be amended hereafter, is incorporated
herein and made a part of this Agreement. 
 2. Definitions. When used herein, terms that are defined in the Plan shall have the
meanings given them in the Plan unless a different meaning is clearly required by the context. 
 3. No Interest Created. Neither the
Participant, the Participant’s Beneficiary, nor any other person claiming under the Participant shall have any interest in any assets of the Company, including policies of insurance. The Participant and such Beneficiary shall have only the
right to receive benefits under and subject to the terms and provisions of the Plan and this Agreement. 
 4. Benefits. The amount of
the Participant’s benefits, if any, shall be determined according to the Schedule attached hereto and made a part hereof. 
 5.
Benefit Elections. The Participant may make an election regarding the form of payment of the Participant’s Retirement Benefit and Severance Benefit and the form and timing of payment of the Participant’s Change in Control Benefit on
an election form provided by the Plan Administrator. To be effective, such elections must be filed with the Plan Administrator within 30 days following the date of this Agreement. Such elections shall become irrevocable 30 days from the date of this
Agreement; no subsequent change to the election is permitted. 
 6. Noncompetition. As provided in the Plan, the Company shall have no
obligation to pay any benefits to or on behalf of the Participant if, within 3 years of Termination of Employment, the Participant competes with or becomes interested in a business which competes with any Participating Company. This provision shall
not apply, however, if the Participant’s Termination of Employment occurs after a Change in Control. 
  

 Exhibit A-1 

 7. Suicide. As provided in the Plan, the Company shall have no obligation to pay any benefits on
behalf of the Participant if the Participant commits suicide within 30 months of date of this Agreement. If this Agreement replaces a prior ORP Agreement evidencing the Participant’s participation in the Plan, this 30 month period shall be
measured from the date of the prior ORP Agreement. 
 8. Governing Law. This Agreement and all rights thereunder shall be construed
and enforced in accordance with the Employee Retirement Income Security Act of 1974, as amended, and, to the extent that state law is applicable, the laws of the State of Delaware. 
 9. Notices. Whenever notices are required by the Plan, they shall be deemed given if sent by first class mail, postage prepaid, to the parties of
the following addresses or at such other addressee as may be designated in writing by the applicable party: 
  

									
		 	Coca-Cola Bottling Co. Consolidated	 		 		 	
		 	4100 Coca-Cola Plaza	 		 		 	
		 	Charlotte, North Carolina 28211	 		 		 	
		 	Attention: Plan Administrator	 		 		 	

  

															
	 b.  
	 	Participant:	 	  
	 		 		 		 	
		 		 	  
	 		 		 		 	
		 		 	  
	 		 		 		 	

 10. Entire Agreement. This Agreement contains the entire agreement and understanding of the
Company and the Participant with respect to the matters contained herein and supersedes and replaces all prior agreements and understandings, written or oral, with respect thereto. Not in limitation of the foregoing, if the Participant has
participated in the Plan, this Agreement supercedes and replaces any prior ORP Agreement evidencing the Participant’s participation in the Plan. 
 11. Receipt of Plan. The Participant acknowledges the receipt of a copy of the Plan. 
 IN WITNESS
WHEREOF, the parties have executed this Agreement on the day and year first above written. 
  

					
	COCA-COLA BOTTLING CO. CONSOLIDATED
		
	 By:
	 	  

			
	 Officer’s Name:
	 	  

	 Officer’s Title:
	 	  

	
	  

	 Participant
	 	

  

 Exhibit A-2 

 SCHEDULE TO ORP AGREEMENT 
  

 Name of Participant 
  

					
	 Plan Year
	 	 Age
	 	 Benefit Earned
 (subject to vesting)

  

 Exhibit A-3 

 EXHIBIT B 
 SCHEDULE TO ORP AGREEMENT 
 [Name of Participant] 
 ------------------------------------------Example---------------------------------------- 
  

								
	 	 	Plan Year	 	Age	 	Benefit Earned
(subject to vesting)
	0	 	2000	 	44	 	$	 
	1	 	2001	 	45	 	$	 31,250.00
	2	 	2002	 	46	 	$	 62,500.00
	3	 	2003	 	47	 	$	 93,750.00
	4	 	2004	 	48	 	$	125,000.00
	5	 	2005	 	49	 	$	156,250.00
	6	 	2006	 	50	 	$	187,500.00
	7	 	2007	 	51	 	$	218,750.00
	8	 	2008	 	52	 	$	250,000.00
	9	 	2009	 	53	 	$	281,250.00
	10	 	2010	 	54	 	$	312,500.00
	11	 	2011	 	55	 	$	343,750.00
	12	 	2012	 	56	 	$	375,000.00
	13	 	2013	 	57	 	$	406,250.00
	14	 	2014	 	58	 	$	437,500.00
	15	 	2015	 	59	 	$	468,750.00
	16	 	2016	 	60	 	$	500,000.00Seventh Amendment dated January 25, 2007 to Managed Care Alliance Agreement

 Exhibit 10.1 
 SEVENTH AMENDMENT TO 
 MANAGED CARE ALLIANCE AGREEMENT 
 THIS AMENDMENT (the “Amendment”) is entered into this 25th day of January, 2007 by and between CIGNA Health Corporation, for and on behalf of its CIGNA Affiliates (individually and collectively,
“CIGNA”) and Gentiva CareCentrix, Inc. (“MCA”). 
 WITNESSETH 
 WHEREAS, CIGNA and MCA entered into a Managed Care Alliance Agreement which became effective January 1, 2004, as amended from time to time, (the
“Agreement”) whereby MCA agreed to provide or arrange for the provision of certain home health care services to Participants, as that term is defined in the Agreement; 
 WHEREAS, the parties wish to amend the Agreement to change the capitation and fee for service rates effective February 1, 2007. 
 NOW THEREFORE, CIGNA and MCA agree to amend the Agreement as follows: 
  

	 	1.	This Amendment shall be effective on February 1, 2007. 

  

	 	2.	The definition for the term Home Setting is replaced in its entirety with the following: 

 Home Setting means the Participant’s primary place of residence or the residence (including Skilled Nursing Facility) where the Participant is
receiving Home Care Services. 
  

	 	3.	Exhibit A HMO Program Attachment – Fee for Service Reimbursement For Other Services is hereby deleted and replaced with a new Exhibit A HMO Program Attachment – Fee
for Service Reimbursement For Other Services attached hereto.  

  

	 	4.	Exhibit A PPO & Indemnity Program Attachment – Fee for Service Reimbursement For Other Services is hereby deleted and replaced with a new Exhibit A
PPO & Indemnity Program Attachment Reimbursement For Other Services attached hereto.  

  

	 	5.	Exhibit A Gatekeeper Program Attachment – Fee for Service Reimbursement For Other Services is hereby deleted and replaced with a new Exhibit A Gatekeeper Program
Attachment – Fee for Service Reimbursement For Other Services attached hereto.  

  

	 	6.	Exhibit A HMO Program Attachment – Capitation Schedule of Capitation Rates is hereby deleted and replaced with a new Exhibit A HMO Program Attachment – Capitation
Schedule of Capitation Rates attached hereto. 

	 	7.	Exhibit A Gatekeeper Program Attachment – Capitation Schedule of Capitation Rates is hereby deleted and replaced with a new Exhibit A Gatekeeper Program Attachment
– Capitation Schedule of Capitation Rates attached hereto.  

  

	 	8.	To the extent that the provisions in the Agreement, including any prior amendments, conflict with the terms of this Amendment (including the exhibits and schedules hereto),
the terms in this Amendment shall supersede and control. All other terms and conditions of the Agreement, including the Program Attachments and the Exhibits attached thereto, shall remain the same and in full force and effect. Capitalized terms not
defined herein but defined in the Agreement shall have the same meaning as defined in the Agreement. 

 IN WITNESS WHEREOF, CIGNA and MCA have
caused their duly authorized representatives to execute this Amendment as of the date first written above. 
  

									
	CIGNA HEALTH CORPORATION	 	 
					
	By:	 		 		 	 /s/ Allan E. Hanssen
	 	
	Its:	 		 		 	Vice President, Network Performance Management	 	
	Dated:	 		 		 	2/1/07	 	
		
	GENTIVA CARECENTRIX, INC.	 	
					
	By:	 		 		 	 /s/ Robert Creamer
	 	
	Its:	 		 		 	Senior Vice President	 	
	Dated:	 		 		 	1/25/07	 	

 EXHIBIT A 
 HMO PROGRAM ATTACHMENT - FEE FOR SERVICE 
 REIMBURSEMENT FOR OTHER SERVICES 
 RATE AREA DESIGNATIONS: 
  

					
	 STATE
	  	 RATE AREA
	  	 RATE DESIGNATION

	 Alabama
	  	 *
	  	 *

	 Alaska
	  	 *
	  	 *

	 Arizona
	  	 *
	  	 *

	 Arkansas
	  	 *
	  	 *

	 California
	  	 *
	  	 *

	 Colorado
	  	 *
	  	 *

	 Connecticut
	  	 *
	  	 *

	 Delaware
	  	 *
	  	 *

	 District of Columbia
	  	 *
	  	 *

	 Florida
	  	 *
	  	 *

	 Georgia
	  	 *
	  	 *

	 Hawaii
	  	 *
	  	 *

	 Idaho
	  	 *
	  	 *

	 Illinois
	  	 *
	  	 *

	 Indiana
	  	 *
	  	 *

	 Iowa
	  	 *
	  	 *

	 Kansas
	  	 *
	  	 *

	 Kentucky
	  	 *
	  	 *

	 Louisiana
	  	 *
	  	 *

	 Maine
	  	 *
	  	 *

	 Maryland
	  	 *
	  	 *

	 Massachusetts
	  	 *
	  	 *

	 Michigan
	  	 *
	  	 *

	 Minnesota
	  	 *
	  	 *

	 Mississippi
	  	 *
	  	 *

	 Missouri
	  	 *
	  	 *

	 Montana
	  	 *
	  	 *

	 Nebraska
	  	 *
	  	 *

	 Nevada
	  	 *
	  	 *

	 New Hampshire
	  	 *
	  	 *

	 New Jersey
	  	 *
	  	 *

	 New Mexico
	  	 *
	  	 *

	 New York
	  	 *
	  	 *

	 North Carolina
	  	 *
	  	 *

	 North Dakota
	  	 *
	  	 *

	 Ohio
	  	 *
	  	 *

	 Oklahoma
	  	 *
	  	 *

	 Oregon
	  	 *
	  	 *

	 Pennsylvania
	  	 *
	  	 *

	 Rhode Island
	  	 *
	  	 *

	 South Carolina
	  	 *
	  	 *

	 South Dakota
	  	 *
	  	 *

	 Tennessee
	  	 *
	  	 *

	 Texas
	  	 *
	  	 *

	 Utah
	  	 *
	  	 *

	 Vermont
	  	 *
	  	 *

	 Virginia
	  	 *
	  	 *

	 Washington
	  	 *
	  	 *

	 West Virginia
	  	 *
	  	 *

	 Wisconsin
	  	 *
	  	 *

	 Wyoming
	  	*	  	*

	*	Confidential Treatment Requested. 

 TRADITIONAL HOME HEALTH FEE-FOR-SERVICE RATE 
 HMO RATES EFFECTIVE FEBRUARY 1, 2007 - JANUARY 31. 2008 
 The following Traditional Home Health Services have both Visit and Hourly rates. 
  

													
	Notes 1, 2, 3, 4, 5 and 6 apply	  	Area 1	  	Area 2	  	Area 3
	 	  	Visit	  	Hour	  	Visit	  	Hour	  	Visit	  	Hour
	 CERTIFIED NURSES AIDE
	  	*	  	*	  	*	  	*	  	*	  	*
	 HOME HEALTH AIDE
	  	*	  	*	  	*	  	*	  	*	  	*
	 LVN/LPN
	  	*	  	*	  	*	  	*	  	*	  	*
	 LVN/LPN - HIGH TECH
	  	*	  	*	  	*	  	*	  	*	  	*
	 PEDIATRIC HIGH TECH LVN/LPN
	  	*	  	*	  	*	  	*	  	*	  	*
	 PEDIATRIC HIGH TECH RN
	  	*	  	*	  	*	  	*	  	*	  	*
	 PEDIATRIC LVN/LPN
	  	*	  	*	  	*	  	*	  	*	  	*
	 PEDIATRIC RN
	  	*	  	*	  	*	  	*	  	*	  	*
	 RN
	  	*	  	*	  	*	  	*	  	*	  	*
	 RN HIGH TECH INFUSION
	  	*	  	*	  	*	  	*	  	*	  	*
	 RN HIGH TECH OTHER
	  	*	  	*	  	*	  	*	  	*	  	*
	
	The following Traditional Home Health Services have Visit only rates.
				
	Notes 1, 3, 4, 5, 7 and 8 apply	  	Area 1	  	Area 2	  	Area 3
	 	  	Visit	  	Hour	  	Visit	  	Hour	  	Visit	  	Hour
	 DIABETIC NURSE
	  	*	  	N/A	  	*	  	N/A	  	*	  	N/A
	 DIETITIAN
	  	*	  	N/A	  	*	  	N/A	  	*	  	N/A
	 ENTEROSTOMAL THERAPIST
	  	*	  	N/A	  	*	  	N/A	  	*	  	N/A
	 MATERNAL CHILD HEALTH
	  	*	  	N/A	  	*	  	N/A	  	*	  	N/A
	 MEDICAL SOCIAL WORKER
	  	*	  	N/A	  	*	  	N/A	  	*	  	N/A
	 OCCUPATIONAL THERAPIST
	  	*	  	N/A	  	*	  	N/A	  	*	  	N/A
	 OCCUPATIONAL THERAPIST ASSISTANT
	  	*	  	N/A	  	*	  	N/A	  	*	  	N/A
	 PHLEBOTOMIST
	  	*	  	N/A	  	*	  	N/A	  	*	  	N/A
	 PHOTOTHERAPY PACKAGE SERVICE
	  	*	  	N/A	  	*	  	N/A	  	*	  	N/A
	 PHYSICAL THERAPIST
	  	*	  	N/A	  	*	  	N/A	  	*	  	N/A
	 PHYSICAL THERAPIST ASSISTANT
	  	*	  	N/A	  	*	  	N/A	  	*	  	N/A
	 PSYCHIATRIC NURSE
	  	*	  	N/A	  	*	  	N/A	  	*	  	N/A
	 REHABILITATION NURSE
	  	*	  	N/A	  	*	  	N/A	  	*	  	N/A
	 RESPIRATORY THERAPIST
	  	*	  	N/A	  	*	  	N/A	  	*	  	N/A
	 RN ASSESSMENT, INITIAL
	  	*	  	N/A	  	*	  	N/A	  	*	  	N/A
	 RN SKILLED NURSING VISIT-EXTENSIVE
	  	*	  	N/A	  	*	  	N/A	  	*	  	N/A
	 SPEECH THERAPIST
	  	*	  	N/A	  	*	  	N/A	  	*	  	N/A
	
	The following Traditional Home Health Service has Hourly only rates.
				
	Notes 3, 4 and 5 apply	  	Area 1	  	Area 2	  	Area 3
	 	  	Visit	  	Hour	  	Visit	  	Hour	  	Visit	  	Hour
	 HOMEMAKER
	  	N/A	  	*	  	N/A	  	*	  	N/A	  	*
	
	The following Traditional Home Health Service is priced on a Per Diem basis.
				
	Notes 3, 4 and 5 apply	  	Area 1	  	Area 2	  	Area 3
	 	  	 	  	Per Diem	  	 	  	Per Diem	  	 	  	Per Diem
	 COMPANION/LIVE IN
	  		  	*	  		  	*	  		  	*

 NOTES: 
  

	1.	Visits are defined as two (2) hours or less in duration (EXCEPT MATERNAL CHILD HEALTH VISITS, which have no maximum duration). 

  

	2.	Hourly rate for visits exceeding two (2) hours in duration, starting with hour 3. 

  

	3.	CIGNA does not reimburse for travel time, weekend, holiday or evening differentials. 

  

	4.	Above prices have no exclusions. 

  

	5.	All services not listed above will be billed at * until rates are mutually established and become part of the fee schedule. 

  

	6.	RN High Tech Infusion visit and hourly utilization/costs to be reported with HIT. 

  

	7.	Respiratory Therapist visit utilization/costs to be reported with HME/RT. 

  

	8.	Diabetic Nurse, Psychiatric Nurse and Rehabilitation Nurse assume specialty certification which is not readily available in the home care environment. Use requires special
coordination. 

  

	9.	There shall a ceiling for annual inflation increases in Home Health Services of *. 

	*	Confidential Treatment Requested. 

 HOME INFUSION RATES 
 HMO RATES EFFECTIVE FEBRUARY 1, 2007 - JANUARY 31. 2008 
  

							
	The following Home Infusion Therapy service rates EXCLUDE drugs. Drugs are priced as a percentage discount off AWP (if applicable), and there is NO price difference between
primary and multiple therapies
				
	 	  	 Primary or
 Multiple Therapy
Per Diem
	  	 Primary or
 Multiple Therapy
Dispensing Fee
	  	 Primary or
 Multiple Therapy
Drug Discount off AWP

	 Ancillary Drugs
	  		  	*	  	*
	 Biological Response Modifiers
	  		  	*	  	*
	 Cardiac (Inotropic) Therapy
	  	*	  		  	*
	 Chelation Therapy
	  	*	  		  	*
	 Chemotherapy
	  	*	  		  	*
	 Enteral Therapy
	  	*	  		  	*
	 Enzyme Therapy
	  	*	  		  	*
	 Growth Hormone
	  		  	*	  	*
	 IV Immune Globulin
	  	*	  		  	*
	 Other Injectable Therapies
	  		  	*	  	*
	 Other Infusion Therapies
	  	*	  		  	*
	 Pain Management Therapy
	  	*	  		  	*
	 Steroid Therapy
	  	*	  		  	*
	 Thrombolytic (Anticoagulation) Therapy
	  	*	  		  	*
	 Synagis
	  		  	*	  	*
	 Remodulin Therapy
	  	*	  		  	*
	
	The following Home Infusion Therapy service rates EXCLUDE drugs. Drugs are priced as a percentage discount off AWP, and there IS a price difference between primary and multiple
anti-infective therapies
				
	 	  	Per Diem	  	 	  	Drug Discount Off AWP
	 Anti-Infectives - Primary Anti-Infective
	  	*	  		  	*
	 Anti-Infectives - Multiple Anti-Infective
	  	*	  		  	*
	
	The following Home Infusion Therapy service rate EXCLUDES drugs. Drugs are priced per vial, and there is NO price difference between primary and multiple anti-infective
therapies
				
	 	  	 Primary or
 Multiple Therapy
Per Diem
	  	 	  	Cost of Drug
		  		  		  	
	 Flolan Therapy
	  	*	  		  	
	 Flolan 0.5 mg vial
	  		  		  	*
	 Flolan 1.5 mg vial
	  		  		  	*
	 Flolan diluent vial
	  		  		  	*
	
	The following Home Infusion Therapy service rates INCLUDE drugs, and there is NO price difference between primary and multiple therapies
				
	 	  	Primary or
Multiple Therapy
Per Diem	  	 	  	 
	 Enteral Therapy
	  	*	  		  	
	 Hydration Therapy
	  	*	  		  	
	 Total Parenteral Nutrition
	  	*	  		  	
	
	SCHEDULE 2A, PAGE 2: HOME INFUSION HMO/FLEX FEE-FOR-SERVICE THERAPY RATES
	
	NOTES:
	
	 1.      Per Diems EXCLUDING drugs include all costs related to the
therapy except the cost of drugs, including but not limited to facility overhead, supplies, delivery, professional labor including compounding and monitoring, all nursing required, maintenance of specialized catheters, equipment/patient supplies,
disposables, pumps, general and administrative expenses, etc.
  
 2.      Per Diems INCLUDING drugs include ALL costs - including but not limited to cost of drugs, facility overhead, supplies, delivery, professional labor including compounding and
monitoring, all nursing required, maintenance of specialized catheters, equipment/patient supplies, disposables, pumps, general and administrative expenses, etc.
  
 3.      "DISPENSING FEE" is defined as per each time the drug is dispensed by the home infusion
provider.
  
 4.      "PER DIEM" costs are the same for primary or multiple treatments for all drug categories, except ANTI-INFECTIVES.
  
 5.      The per diem rate shall only be charged for those days the Participant receives
medication.
  
 6.      For home infusion pharmaceuticals not listed on fee schedule, * will apply.
  
 7.      There shall be a ceiling for annual inflation increases in Home Infusion Therapy of
*.
  
 8.      There
shall be a ceiling for annual inflation increases in Medications under CAP of *.
  
 9.      All Medications are subject to MAC pricing, where applicable.

	
	The following are for the stated item ONLY. Unless otherwise noted, nursing, supplies, etc. are NOT included.
				
	 Blood Transfusion per Unit (Tubing, Filters)
	  		  		  	*
	 Catheter Care Per Diem
	  		  		  	*
	 Midline Insertion (Catheter & Supplies)
	  		  		  	*
	 PICC Line Insertion (Catheter & Supplies)
	  		  		  	*
	 Blood Product
	  		  		  	*
	
	SCHEDULE 2A, PAGE 3: HOME INFUSION THERAPY HMO/FLEX FEE-FOR-SERVICE RATES
	
	Factor Concentrates
	 	  	 	  	Vial price	  	Unit Price
	Factor VII	  		  		  	
	 Novoseven 1200MCG Vial
	  		  	*	  	
	 Novoseven 4800MCG Vial
	  		  	*	  	
	 Novoseven in 1200MCG or 4800MCG QTY
	  		  		  	*
				
	Factor VIII (Recombinant)	  		  		  	
	 Recombinate
	  		  		  	*
	 Kogenate or Helixate
	  		  		  	*
	 Bioclate
	  		  		  	*
	 Helixate FS
	  		  		  	*
	 Kogenate FS
	  		  		  	*
	 Refacto
	  		  		  	*
	 Advate
	  		  		  	*
				
	Factor VIII (Monoclonal)	  		  		  	
	 Hemofil-M or A. R. C. Method M
	  		  		  	*
	 Monoclate P
	  		  		  	*
	 Monarc-M
	  		  		  	*
				
	Factor VIII (Other)	  		  		  	
	 Koate
	  		  		  	*
	 Humate
	  		  		  	*
	 Alphanate SDHT
	  		  		  	*
				
	Factor IX (Recombinant)	  		  		  	
	 BeneFix
	  		  		  	*
				
	Factor IX (Monoclonal/High Purity)	  		  		  	
	 Mononine
	  		  		  	*
	 Alphanine
	  		  		  	*
				
	Factor IX (Other)	  		  		  	
	 Konyne - 80
	  		  		  	*
	 Proplex T
	  		  		  	*
	 Bebulin
	  		  		  	*
	 Profilnine SD
	  		  		  	*
				
	Anti-Inhibitor Complex	  		  		  	
	 Autoplex-T
	  		  		  	*
	 Feiba-VH
	  		  		  	*
	 Hyate-C
	  		  		  	*
				
	HEMOSTATIC AGENTS	  		  		  	
	 DDAVP - 10ml vial
	  		  		  	*
	 Stimate - 2.5ml vial
	  		  		  	*
	
	Above rates include all necessary ancillary supplies and waste disposal unit; 24-hour on-call clinical support; home infusion monitoring system; product delivery nationwide; patient
training, education, and evaluation

	*	Confidential Treatment Requested. 

 DME / HME RESPIRATORY RATES: 
 HMO RATES EFFECTIVE FEBRUARY 1, 2006 - JANUARY 31. 2009 
  

																	
	 CAT
	 	 TYPE
	 	 HCPCS
CODE
	 	 CHC
CODE
	 	 CareCentrix
Code
	 	 DESCRIPTION
	 	 PURCHASE
PRICE
	 	 RENTAL
PRICE
	 	 DAILY
PRICE

	 HME
	 		 	A4230	 	A4230	 		 	Infusion set for external insulin pump, non-needle cannula Type	 	*	 		 	
									
	 HME
	 		 	A4231	 	A4231	 		 	Infusion set for external insulin pump, needle type	 	*	 		 	
									
	 HME
	 		 	A4232	 	A4232	 		 	Reservoir/Syringe with needle for external insulin pump	 	*	 		 	
									
	 HME
	 		 	A4632	 	A4632	 		 	Replacement battery for external insulin pump, any type, each	 	*	 		 	
									
	 HME
	 		 	A5119	 	A5119	 		 	Skin Barrier, wipes, box per 50	 	*	 		 	
									
	 HME
	 		 	A6257	 	A6257	 		 	Transparent film/dressing	 	*	 		 	
									
	 HME
	 	INSULPP	 	E0784	 	E0784	 	2158	 	PUMP (E0784), EXT AMBULATORY INFUSION, MINIMED, INSULIN	 	*	 		 	
									
	 HME
	 	INSULPP	 	E0784	 	E0784	 	6771	 	PUMP (E0784), INSULIN EXT INFUSION DISETRONICS OR OTHER	 	*	 		 	
									
	 HME
	 	INSULPP	 	E0784	 	E0784	 	7704	 	PUMP, EXT INFUSION, DANA DIABECARE, INSULIN (E0784)	 	*	 		 	
									
	 HME
	 	INSULPP	 	E0784	 	E0784	 	7731	 	PUMP, EXT INFUSION, ANIMAS, INSULIN (E0784)	 	*	 		 	
									
	 HME
	 	INSULPP	 	E0784	 	E0784	 	7773	 	PUMP (E0784), EXT AMBULATORY INFUSION, DELTEC, INSULIN	 	*	 		 	
									
	 HME
	 	OTHER	 	E0746	 	DM570	 	2109	 	ELECTROMYOGRAPHY (EMG) (E0746), BIOFEEDBACK DEVICE	 	*	 	*	 	
									
	 HME
	 	OTHER	 	E0935	 	E0935	 	2125	 	PASSIVE MOTION (E0935) EXERCISE DEVICE	 		 		 	*
									
	 HME
	 	OTHER	 	E0935	 	E0935	 	2857	 	PASSIVE MOTION (E0935) EXERCISE DEVICE, HAND	 		 		 	*
									
	 HME
	 	OTHER	 	E0935	 	E0935	 	2858	 	PASSIVE MOTION (E0935) EXERCISE DEVICE, SHOULDER	 		 		 	*
									
	 HME
	 	OTHER	 	E0935	 	E0935	 	2859	 	PASSIVE MOTION (E0935) EXERCISE DEVICE, ANKLE	 		 		 	*
									
	 HME
	 	OTHER	 	E0935	 	E0935	 	2860	 	PASSIVE MOTION (E0935) EXERCISE DEVICE, ELBOW	 		 		 	*
									
	 HME
	 	OTHER	 	E0935	 	E0935	 	2861	 	PASSIVE MOTION (E0935) EXERCISE DEVICE, WRIST	 		 		 	*
									
	 HME
	 	OTHER	 	E1300	 	DM570	 	2062	 	WHIRLPOOL (E1300), PORT (OVERTUB TYPE)	 	*	 		 	
									
	 HME
	 	OTHER	 	E1310	 	DM570	 	2061	 	WHIRLPOOL (E1399), NON-PORT (BUILT-IN TYPE)	 	*	 		 	
									
	 HME
	 	OTHER	 	E1399	 	E1399	 	2327	 	DURABLE MEDICAL EQUIP (E1399), MISCELLANEOUS	 	*	 		 	
									
	 HME
	 	STIM_BO	 	E0747	 	DM570	 	6875	 	STIMULATOR, OSTEOGENIC, ULTRASOUND	 	*	 		 	
									
	 HME
	 	STIM_BO	 	E0747	 	DM570	 	8386	 	STIMULATOR (E0747), OSTEOGENIC, NON-INVASIVE, EBI	 	*	 		 	
									
	 HME
	 	STIM_BO	 	E0747	 	DM570	 	8387	 	STIMULATOR (E0747), OSTEOGENIC, NON-INVASIVE, ORTHOFIX	 	*	 		 	
									
	 HME
	 	STIM_BO	 	E0747	 	DM570	 	8388	 	STIMULATOR (E0747), OSTEOGENIC, NON-INVASIVE, ORTHOLOGIC	 	*	 		 	
									
	 HME
	 	STIM_BO	 	E0748	 	DM570	 	2124	 	STIMULATOR (E0748), OSTEOGENIC NON-INVASIVE, SPINAL APPLICATIONS	 	*	 		 	
									
	 HME
	 	STIM_BO	 	E0748	 	DM570	 	8389	 	STIMULATOR (E0748), OSTEOGENIC NON-INVASIVE, SPINAL, EBI	 	*	 		 	
									
	 HME
	 	STIM_BO	 	E0748	 	DM570	 	8390	 	STIMULATOR (E0748), OSTEOGENIC NON-INVASIVE, SPINAL, ORTHOFIX	 	*	 		 	
									
	 HME
	 	STIM_BO	 	E0748	 	DM570	 	8391	 	STIMULATOR (E0748), OSTEOGENIC NON-INVASIVE, SPINAL, ORTHOLOGIC	 	*	 		 	
									
	 HME
	 	WDSUCT	 	K0538	 	DM570	 	6873	 	WOUND SUCTION DEVICE (K0538)	 		 		 	*
									
	 HME
	 	WDSUCT	 	K0539	 	DM570	 	7914	 	DRESSING SET, FOR WOUND SUCTION DEVICE (K0539)	 	*	 		 	
									
	 HME
	 	WDSUCT	 	K0540	 	DM570	 	7915	 	CANISTER SET, FOR WOUND SUCTION DEVICE (K0540)	 	*	 		 	
	
	The following may be charged under extraordinary circumstances:
									
	 HME
	 	SUP	 	E1399	 	E1399	 	4551	 	LABOR/SERVICE/SHIPPING CHARGES	 	*	 		 	
									
	 HME
	 	SUP	 	E1399	 	E1399	 	2731	 	SHIPPING AND HANDLING FEES	 	*	 		 	
	
	The following may be charged if over and above routine on rental equipment:
									
	 RESP
	 	EQUIP	 	E1350	 	E1350	 	2382	 	REPAIR OR NON-ROUTINE (E1350) SERVICE REQUIRING SKILL OF A TECH	 	*	 		 	
									
	 HME
	 	SUP	 	E1399	 	E1399	 	4552	 	MISCELLANEOUS SUPPLIES	 	*	 		 	*

 NOTES: 
 1. Whether
rental or purchase, rates include all shipping, labor and set-up. 
 2. If item is rented, rates include all supplies to enable the equipment to function
effectively with the exception Suction and CPM. Such exception supplies will be billed at *. 
 3. If item is rented, rates include repair and maintenance
costs. 

	*	Confidential Treatment Requested. 

 EXHIBIT A 
 PPO & INDEMNITY PROGRAM ATTACHMENT - FEE FOR SERVICE 
 REIMBURSEMENT FOR OTHER SERVICES

 RATE AREA DESIGNATIONS: 
  

					
	 STATE
	  	 RATE AREA
	  	 RATE DESIGNATION

	 Alabama
	  	*	  	*
	 Alaska
	  	*	  	*
	 Arizona
	  	*	  	*
	 Arkansas
	  	*	  	*
	 California
	  	*	  	*
	 Colorado
	  	*	  	*
	 Connecticut
	  	*	  	*
	 Delaware
	  	*	  	*
	 District of Columbia
	  	*	  	*
	 Florida
	  	*	  	*
	 Georgia
	  	*	  	*
	 Hawaii
	  	*	  	*
	 Idaho
	  	*	  	*
	 Illinois
	  	*	  	*
	 Indiana
	  	*	  	*
	 Iowa
	  	*	  	*
	 Kansas
	  	*	  	*
	 Kentucky
	  	*	  	*
	 Louisiana
	  	*	  	*
	 Maine
	  	*	  	*
	 Maryland
	  	*	  	*
	 Massachusetts
	  	*	  	*
	 Michigan
	  	*	  	*
	 Minnesota
	  	*	  	*
	 Mississippi
	  	*	  	*
	 Missouri
	  	*	  	*
	 Montana
	  	*	  	*
	 Nebraska
	  	*	  	*
	 Nevada
	  	*	  	*
	 New Hampshire
	  	*	  	*
	 New Jersey
	  	*	  	*
	 New Mexico
	  	*	  	*
	 New York
	  	*	  	*
	 North Carolina
	  	*	  	*
	 North Dakota
	  	*	  	*
	 Ohio
	  	*	  	*
	 Oklahoma
	  	*	  	*
	 Oregon
	  	*	  	*
	 Pennsylvania
	  	*	  	*
	 Rhode Island
	  	*	  	*
	 South Carolina
	  	*	  	*
	 South Dakota
	  	*	  	*
	 Tennessee
	  	*	  	*
	 Texas
	  	*	  	*
	 Utah
	  	*	  	*
	 Vermont
	  	*	  	*
	 Virginia
	  	*	  	*
	 Washington
	  	*	  	*
	 West Virginia
	  	*	  	*
	 Wisconsin
	  	*	  	*
	 Wyoming
	  	*	  	*

	*	Confidential Treatment Requested. 

 TRADITIONAL HOME HEALTH FEE-FOR-SERVICE RATE 
 PPO AND INDEMNITY RATES EFFECTIVE FEBRUARY 1, 2007 - JANUARY 31. 2008 
 The following Traditional Home Health Services have both Visit and Hourly rates. 
  

													
	Notes 1, 2, 3, 4, 5 and 6 apply	  	Area 1	  	Area 2	  	Area 3
	 	  	Visit	  	Hour	  	Visit	  	Hour	  	Visit	  	Hour
	 CERTIFIED NURSES AIDE
	  	*	  	*	  	*	  	*	  	*	  	*
							
	 HOME HEALTH AIDE
	  	*	  	*	  	*	  	*	  	*	  	*
							
	 LVN/LPN
	  	*	  	*	  	*	  	*	  	*	  	*
							
	 LVN/LPN - HIGH TECH
	  	*	  	*	  	*	  	*	  	*	  	*
							
	 PEDIATRIC HIGH TECH LVN/LPN
	  	*	  	*	  	*	  	*	  	*	  	*
							
	 PEDIATRIC HIGH TECH RN
	  	*	  	*	  	*	  	*	  	*	  	*
							
	 PEDIATRIC LVN/LPN
	  	*	  	*	  	*	  	*	  	*	  	*
							
	 PEDIATRIC RN
	  	*	  	*	  	*	  	*	  	*	  	*
							
	 RN
	  	*	  	*	  	*	  	*	  	*	  	*
							
	 RN HIGH TECH INFUSION
	  	*	  	*	  	*	  	*	  	*	  	*
							
	 RN HIGH TECH OTHER
	  	*	  	*	  	*	  	*	  	*	  	*
	
	The following Traditional Home Health Services have Visit only rates.
				
	Notes 1, 3, 4, 5, 7 and 8 apply	  	Area 1	  	Area 2	  	Area 3
	 	  	Visit	  	Hour	  	Visit	  	Hour	  	Visit	  	Hour
	 DIABETIC NURSE
	  	*	  	N/A	  	*	  	N/A	  	*	  	N/A
							
	 DIETITIAN
	  	*	  	N/A	  	*	  	N/A	  	*	  	N/A
							
	 ENTEROSTOMAL THERAPIST
	  	*	  	N/A	  	*	  	N/A	  	*	  	N/A
							
	 MATERNAL CHILD HEALTH
	  	*	  	N/A	  	*	  	N/A	  	*	  	N/A
							
	 MEDICAL SOCIAL WORKER
	  	*	  	N/A	  	*	  	N/A	  	*	  	N/A
							
	 OCCUPATIONAL THERAPIST
	  	*	  	N/A	  	*	  	N/A	  	*	  	N/A
							
	 OCCUPATIONAL THERAPIST ASSISTANT
	  	*	  	N/A	  	*	  	N/A	  	*	  	N/A
							
	 PHLEBOTOMIST
	  	*	  	N/A	  	*	  	N/A	  	*	  	N/A
							
	 PHOTOTHERAPY PACKAGE SERVICE
	  	*	  	N/A	  	*	  	N/A	  	*	  	N/A
							
	 PHYSICAL THERAPIST
	  	*	  	N/A	  	*	  	N/A	  	*	  	N/A
							
	 PHYSICAL THERAPIST ASSISTANT
	  	*	  	N/A	  	*	  	N/A	  	*	  	N/A
							
	 PSYCHIATRIC NURSE
	  	*	  	N/A	  	*	  	N/A	  	*	  	N/A
							
	 REHABILITATION NURSE
	  	*	  	N/A	  	*	  	N/A	  	*	  	N/A
							
	 RESPIRATORY THERAPIST
	  	*	  	N/A	  	*	  	N/A	  	*	  	N/A
							
	 RESPIRATORY THERAPIST - CPAP clinic
	  	*	  	N/A	  	*	  	N/A	  	*	  	N/A
							
	 RN ASSESSMENT, INITIAL
	  	*	  	N/A	  	*	  	N/A	  	*	  	N/A
							
	 RN SKILLED NURSING VISIT-EXTENSIVE
	  	*	  	N/A	  	*	  	N/A	  	*	  	N/A
							
	 SPEECH THERAPIST
	  	*	  	N/A	  	*	  	N/A	  	*	  	N/A
	
	The following Traditional Home Health Service has Hourly only rates.
				
	Notes 3, 4 and 5 apply	  	Area 1	  	Area 2	  	Area 3
	 	  	Visit	  	Hour	  	Visit	  	Hour	  	Visit	  	Hour
	 HOMEMAKER
	  	N/A	  	*	  	N/A	  	*	  	N/A	  	*
	
	The following Traditional Home Health Service is priced on a Per Diem basis.
				
	Notes 3, 4 and 5 apply	  	Area 1	  	Area 2	  	Area 3
	 	  	 	  	Per Diem	  	 	  	Per Diem	  	 	  	Per Diem
	 COMPANION/LIVE IN
	  		  	*	  		  	*	  		  	*

 NOTES: 
  

	1.	Visits are defined as two (2) hours or less in duration (EXCEPT MATERNAL CHILD HEALTH VISITS, which have no maximum duration). 

  

	2.	Hourly rate for visits exceeding two (2) hours in duration, starting with hour 3. 

  

	3.	CIGNA does not reimburse for travel time, weekend, holiday or evening differentials. 

  

	4.	Above prices have no exclusions. 

  

	5.	All services not listed above will be billed at * until rates are mutually established and become part of the fee schedule. 

  

	6.	RN High Tech Infusion visit and hourly utilization/costs to be reported with HIT. 

  

	7.	Respiratory Therapist visit utilization/costs to be reported with HME/RT. 

  

	8.	Diabetic Nurse, Psychiatric Nurse and Rehabilitation Nurse assume specialty certification which is not readily available in the home care environment. Use requires special
coordination. 

  

	9.	There shall be a ceiling for annual inflation increases in Home Health Services of *. 

	*	Confidential Treatment Requested. 

 HOME INFUSION RATES 
 PPO AND INDEMNITY RATES EFFECTIVE FEBRUARY 1, 2007 - JANUARY 31. 2008 
 The following Home Infusion Therapy
service rates EXCLUDE drugs. Drugs are priced as a percentage discount off AWP (if applicable), and there is NO price difference between primary and multiple therapies 
  

							
	 	  	 Primary or
 Multiple Therapy
Per Diem
	  	 Primary or
 Multiple Therapy
Dispensing Fee
	  	 Primary or
 Multiple Therapy
Drug Discount off AWP

	 Ancillary Drugs
	  		  	*	  	*
	 Biological Response Modifiers
	  		  	*	  	*
	 Cardiac (Inotropic) Therapy
	  	*	  		  	*
	 Chelation Therapy
	  	*	  		  	*
	 Chemotherapy
	  	*	  		  	*
	 Enteral Therapy
	  	*	  		  	*
	 Enzyme Therapy
	  	*	  		  	*
	 Growth Hormone
	  		  	*	  	*
	 IV Immune Globulin
	  	*	  		  	*
	 Other Injectable Therapies
	  		  	*	  	*
	 Other Infusion Therapies
	  	*	  		  	*
	 Pain Management Therapy
	  	*	  		  	*
	 Steroid Therapy
	  	*	  		  	*
	 Thrombolytic (Anticoagulation) Therapy
	  	*	  		  	*
	 Synagis
	  		  	*	  	*
	 Remodulin Therapy
	  	*	  		  	*
	
	The following Home Infusion Therapy service rates EXCLUDE drugs. Drugs are priced as a percentage discount off AWP, and there IS a price difference between primary and multiple
anti-infective therapies
				
	 	  	Per Diem	  	 	  	Drug Discount Off AWP
	 Anti-Infectives - Primary Anti-Infective
	  	*	  		  	*
	 Anti-Infectives - Multiple Anti-Infective
	  	*	  		  	*
	
	The following Home Infusion Therapy service rate EXCLUDES drugs. Drugs are priced per vial, and there is NO price difference between primary and multiple anti-infective
therapies
				
	 	  	Primary or
Multiple Therapy
Per Diem	  	 	  	Cost of Drug
	 Flolan Therapy
	  	*	  		  	
	 Flolan 0.5 mg vial
	  		  		  	*
	 Flolan 1.5 mg vial
	  		  		  	*
	 Flolan diluent vial
	  		  		  	*
	
	The following Home Infusion Therapy service rates INCLUDE drugs, and there is NO price difference between primary and multiple therapies
				
	 	  	 Primary or
 Multiple Therapy
Per Diem
	  	 	  	 
	 Enteral Therapy
	  	*	  		  	
	 Hydration Therapy
	  	*	  		  	
	 Total Parenteral Nutrition
	  	*	  		  	
	
	SCHEDULE 2A, PAGE 2: HOME INFUSION PPO & INDEMNITY FEE-FOR-SERVICE THERAPY RATES
	
	 NOTES:
  
 1.      Per Diems EXCLUDING drugs include all costs related to the therapy except the cost of
drugs, including but not limited to facility overhead, supplies, delivery, professional labor including compounding and monitoring, all nursing required, maintenance of specialized catheters, equipment/patient supplies, disposables, pumps, general
and administrative expenses, etc.
  
 2.      Per Diems INCLUDING drugs include ALL costs - including but not limited to cost of drugs, facility overhead, supplies, delivery, professional labor including compounding and monitoring, all nursing
required, maintenance of specialized catheters, equipment/patient supplies, disposables, pumps, general and administrative expenses, etc.
  
 3.      "DISPENSING FEE" is defined as per each time the drug is dispensed by the home infusion
provider.
  
 4.      "PER DIEM" costs are the same for primary or multiple treatments for all drug categories, except ANTI-INFECTIVES.
  
 5.      The per diem rate shall only be charged for those days the Participant receives
medication.
  
 6.      For home infusion pharmaceuticals not listed on fee schedule, * will apply.
  
 7.      There shall be a ceiling for annual inflation increases in Home Infusion Therapy of
*.
  
 8.      There
shall be a ceiling for annual inflation increases in Medications under CAP of *.
  
 9.      All Medications are subject to MAC pricing, where applicable.

	
	The following are for the stated item ONLY. Unless otherwise noted, nursing, supplies, etc. are NOT included.
				
	 Blood Transfusion per Unit (Tubing, Filters)
	  		  		  	*
	 Catheter Care Per Diem
	  		  		  	*
	 Midline Insertion (Catheter & Supplies)
	  		  		  	*
	 PICC Line Insertion (Catheter & Supplies)
	  		  		  	*
	 Blood Product
	  		  		  	*
	
	SCHEDULE 2A, PAGE 3: HOME INFUSION THERAPY PPO & INDEMNITY FEE-FOR-SERVICE RATES
				
	 Factor Concentrates
	  		  		  	
	 	  	 	  	Vial price	  	Unit Price
	Factor VII	  		  		  	
	 Novoseven 1200MCG Vial
	  		  	*	  	
	 Novoseven 4800MCG Vial
	  		  	*	  	
	 Novoseven in 1200MCG or 4800MCG QTY
	  		  		  	*
				
	Factor VIII (Recombinant)	  		  		  	
	 Recombinate
	  		  		  	*
	 Kogenate or Helixate
	  		  		  	*
	 Bioclate
	  		  		  	*
	 Helixate FS
	  		  		  	*
	 Kogenate FS
	  		  		  	*
	 Refacto
	  		  		  	*
	 Advate
	  		  		  	*
				
	Factor VIII (Monoclonal)	  		  		  	
	 Hemofil-M or A. R. C. Method M
	  		  		  	*
	 Monoclate P
	  		  		  	*
	 Monarc-M
	  		  		  	*
				
	Factor VIII (Other)	  		  		  	
	 Koate
	  		  		  	*
	 Humate
	  		  		  	*
	 Alphanate SDHT
	  		  		  	*
				
	Factor IX (Recombinant)	  		  		  	
	 BeneFix
	  		  		  	*
				
	Factor IX (Monoclonal/High Purity)	  		  		  	
	 Mononine
	  		  		  	*
	 Alphanine
	  		  		  	*
				
	Factor IX (Other)	  		  		  	
	 Konyne—80
	  		  		  	*
	 Proplex T
	  		  		  	*
	 Bebulin
	  		  		  	*
	 Profilnine SD
	  		  		  	*
				
	Anti-Inhibitor Complex	  		  		  	
	 Autoplex-T
	  		  		  	*
	 Feiba-VH
	  		  		  	*
	 Hyate-C
	  		  		  	*
				
	HEMOSTATIC AGENTS	  		  		  	
	 DDAVP - 10ml vial
	  		  		  	*
	 Stimate - 2.5ml vial
	  		  		  	*
	
	Above rates include all necessary ancillary supplies and waste disposal unit; 24-hour on-call clinical support; home infusion monitoring system; product delivery nationwide; patient
training, education, and evaluation

	*	Confidential Treatment Requested. 

 DME / HME RESPIRATORY RATES: 
 PPO and INDEMNITY RATES EFFECTIVE FEBRUARY 1, 2006 - JANUARY 31. 2009 
  

																	
	 CAT
	  	 TYPE
	  	 HCPCS
CODE
	  	 CHC
CODE
	  	 CareCentrix
Code
	  	 DESCRIPTION
	  	PURCHASE
PRICE	 	RENTAL
PRICE	  	DAILY
PRICE
	HME	  		  	A4230	  	A4230	  		  	Infusion set for external insulin pump, non-needle cannula Type	  	*	 		  	
									
	HME	  		  	A4231	  	A4231	  		  	Infusion set for external insulin pump, needle type	  	*	 		  	
									
	HME	  		  	A4232	  	A4232	  		  	Reservoir/Syringe with needle for external insulin pump	  	*	 		  	
									
	HME	  		  	A4632	  	A4632	  		  	Replacement battery for external insulin pump, any type, each	  	*	 		  	
									
	HME	  		  	A5119	  	A5119	  		  	Skin Barrier, wipes, box per 50	  	*	 		  	
									
	HME	  		  	A6257	  	A6257	  		  	Transparent film/dressing	  	*	 		  	
									
	HME	  	INSULPP	  	E0784	  	E0784	  	2158	  	PUMP (E0784), EXT AMBULATORY INFUSION, MINIMED, INSULIN	  	*	 		  	
									
	HME	  	INSULPP	  	E0784	  	E0784	  	6771	  	PUMP (E0784), INSULIN EXT INFUSION DISETRONICS OR OTHER	  	*	 		  	
									
	HME	  	INSULPP	  	E0784	  	E0784	  	7704	  	PUMP, EXT INFUSION, DANA DIABECARE, INSULIN (E0784)	  	*	 		  	
									
	HME	  	INSULPP	  	E0784	  	E0784	  	7731	  	PUMP, EXT INFUSION, ANIMAS, INSULIN (E0784)	  	*	 		  	
									
	HME	  	INSULPP	  	E0784	  	E0784	  	7773	  	PUMP (E0784), EXT AMBULATORY INFUSION, DELTEC, INSULIN	  	*	 		  	
									
	HME	  	OTHER	  	E0746	  	DM570	  	2109	  	ELECTROMYOGRAPHY (EMG) (E0746), BIOFEEDBACK DEVICE	  	*	 	*	  	
									
	HME	  	OTHER	  	E0935	  	E0935	  	2125	  	PASSIVE MOTION (E0935) EXERCISE DEVICE	  		 		  	*
									
	HME	  	OTHER	  	E0935	  	E0935	  	2857	  	PASSIVE MOTION (E0935) EXERCISE DEVICE, HAND	  		 		  	*
									
	HME	  	OTHER	  	E0935	  	E0935	  	2858	  	PASSIVE MOTION (E0935) EXERCISE DEVICE, SHOULDER	  		 		  	*
									
	HME	  	OTHER	  	E0935	  	E0935	  	2859	  	PASSIVE MOTION (E0935) EXERCISE DEVICE, ANKLE	  		 		  	*
									
	HME	  	OTHER	  	E0935	  	E0935	  	2860	  	PASSIVE MOTION (E0935) EXERCISE DEVICE, ELBOW	  		 		  	*
									
	HME	  	OTHER	  	E0935	  	E0935	  	2861	  	PASSIVE MOTION (E0935) EXERCISE DEVICE, WRIST	  		 		  	*
									
	HME	  	OTHER	  	E1300	  	DM570	  	2062	  	WHIRLPOOL (E1300), PORT (OVERTUB TYPE)	  	*	 		  	
									
	HME	  	OTHER	  	E1310	  	DM570	  	2061	  	WHIRLPOOL (E1399), NON-PORT (BUILT-IN TYPE)	  	*	 		  	
									
	HME	  	OTHER	  	E1399	  	E1399	  	2327	  	DURABLE MEDICAL EQUIP (E1399), MISCELLANEOUS	  	*	 		  	
									
	HME	  	STIM_BO	  	E0747	  	DM570	  	6875	  	STIMULATOR, OSTEOGENIC, ULTRASOUND	  	*	 		  	
									
	HME	  	STIM_BO	  	E0747	  	DM570	  	8386	  	STIMULATOR (E0747), OSTEOGENIC, NON-INVASIVE, EBI	  	*	 		  	
									
	HME	  	STIM_BO	  	E0747	  	DM570	  	8387	  	STIMULATOR (E0747), OSTEOGENIC, NON-INVASIVE, ORTHOFIX	  	*	 		  	
									
	HME	  	STIM_BO	  	E0747	  	DM570	  	8388	  	STIMULATOR (E0747), OSTEOGENIC, NON-INVASIVE, ORTHOLOGIC	  	*	 		  	
									
	HME	  	STIM_BO	  	E0748	  	DM570	  	2124	  	STIMULATOR (E0748), OSTEOGENIC NON-INVASIVE, SPINAL APPLICATIONS	  	*	 		  	
									
	HME	  	STIM_BO	  	E0748	  	DM570	  	8389	  	STIMULATOR (E0748), OSTEOGENIC NON-INVASIVE, SPINAL, EBI	  	*	 		  	
									
	HME	  	STIM_BO	  	E0748	  	DM570	  	8390	  	STIMULATOR (E0748), OSTEOGENIC NON-INVASIVE, SPINAL, ORTHOFIX	  	*	 		  	
									
	HME	  	STIM_BO	  	E0748	  	DM570	  	8391	  	STIMULATOR (E0748), OSTEOGENIC NON-INVASIVE, SPINAL, ORTHOLOGIC	  	*	 		  	
									
	HME	  	WDSUCT	  	K0538	  	DM570	  	6873	  	WOUND SUCTION DEVICE (K0538)	  		 		  	*
									
	HME	  	WDSUCT	  	K0539	  	DM570	  	7914	  	DRESSING SET, FOR WOUND SUCTION DEVICE (K0539)	  	*	 		  	
									
	HME	  	WDSUCT	  	K0540	  	DM570	  	7915	  	CANISTER SET, FOR WOUND SUCTION DEVICE (K0540)	  	*	 		  	
	  
 The following may be charged under extraordinary
circumstances:
  

	HME	  	SUP	  	E1399	  	E1399	  	4551	  	LABOR/SERVICE/SHIPPING CHARGES	  	COST+10%	 		  	
									
	HME	  	SUP	  	E1399	  	E1399	  	2731	  	SHIPPING AND HANDLING FEES	  	COST+10%	 		  	
	  
 The following may be charged if over and above routine on rental
equipment:
  

	RESP	  	EQUIP	  	E1350	  	E1350	  	2382	  	REPAIR OR NON-ROUTINE (E1350) SERVICE REQUIRING SKILL OF A TECH	  	*	 		  	
									
	HME	  	SUP	  	E1399	  	E1399	  	4552	  	MISCELLANEOUS SUPPLIES	  	*	 		  	*

 NOTES: 
 1. Whether
rental or purchase, rates include all shipping, labor and set-up. 
 2. If item is rented, rates include all supplies to enable the equipment to function
effectively with the exception Suction and CPM. Such exception supplies will be billed at *. 
 3. If item is rented, rates include repair and maintenance
costs. 

	*	Confidential Treatment Requested. 

 EXHIBIT A 
 GATEKEEPER PROGRAM ATTACHMENT - FEE FOR SERVICE 
 REIMBURSEMENT FOR OTHER SERVICES 

RATE AREA DESIGNATIONS: 
  

					
	 STATE
	  	 RATE AREA
	  	 RATE DESIGNATION

	 Alabama
	  	*	  	*
	 Alaska
	  	*	  	*
	 Arizona
	  	*	  	*
	 Arkansas
	  	*	  	*
	 California
	  	*	  	*
	 Colorado
	  	*	  	*
	 Connecticut
	  	*	  	*
	 Delaware
	  	*	  	*
	 District of Columbia
	  	*	  	*
	 Florida
	  	*	  	*
	 Georgia
	  	*	  	*
	 Hawaii
	  	*	  	*
	 Idaho
	  	*	  	*
	 Illinois
	  	*	  	*
	 Indiana
	  	*	  	*
	 Iowa
	  	*	  	*
	 Kansas
	  	*	  	*
	 Kentucky
	  	*	  	*
	 Louisiana
	  	*	  	*
	 Maine
	  	*	  	*
	 Maryland
	  	*	  	*
	 Massachusetts
	  	*	  	*
	 Michigan
	  	*	  	*
	 Minnesota
	  	*	  	*
	 Mississippi
	  	*	  	*
	 Missouri
	  	*	  	*
	 Montana
	  	*	  	*
	 Nebraska
	  	*	  	*
	 Nevada
	  	*	  	*
	 New Hampshire
	  	*	  	*
	 New Jersey
	  	*	  	*
	 New Mexico
	  	*	  	*
	 New York
	  	*	  	*
	 North Carolina
	  	*	  	*
	 North Dakota
	  	*	  	*
	 Ohio
	  	*	  	*
	 Oklahoma
	  	*	  	*
	 Oregon
	  	*	  	*
	 Pennsylvania
	  	*	  	*
	 Rhode Island
	  	*	  	*
	 South Carolina
	  	*	  	*
	 South Dakota
	  	*	  	*
	 Tennessee
	  	*	  	*
	 Texas
	  	*	  	*
	 Utah
	  	*	  	*
	 Vermont
	  	*	  	*
	 Virginia
	  	*	  	*
	 Washington
	  	*	  	*
	 West Virginia
	  	*	  	*
	 Wisconsin
	  	*	  	*
	 Wyoming
	  	*	  	*

 * Confidential Treatment Requested. 

 TRADITIONAL HOME HEALTH FEE-FOR-SERVICE RATE 
 GATEKEEPER RATES EFFECTIVE FEBRUARY 1, 2007 - JANUARY 31. 2008 
 The following Traditional Home Health Services have both Visit and Hourly rates. 
  

													
	Notes 1, 2, 3, 4, 5 and 6 apply	  	 Area 1
	  	Area 2	  	Area 3
	 	  	Visit	  	Hour	  	Visit	  	Hour	  	Visit	  	Hour
	 CERTIFIED NURSES AIDE
	  	*	  	*	  	*	  	*	  	*	  	*
							
	 HOME HEALTH AIDE
	  	*	  	*	  	*	  	*	  	*	  	*
							
	 LVN/LPN
	  	*	  	*	  	*	  	*	  	*	  	*
							
	 LVN/LPN - HIGH TECH
	  	*	  	*	  	*	  	*	  	*	  	*
							
	 PEDIATRIC HIGH TECH LVN/LPN
	  	*	  	*	  	*	  	*	  	*	  	*
							
	 PEDIATRIC HIGH TECH RN
	  	*	  	*	  	*	  	*	  	*	  	*
							
	 PEDIATRIC LVN/LPN
	  	*	  	*	  	*	  	*	  	*	  	*
							
	 PEDIATRIC RN
	  	*	  	*	  	*	  	*	  	*	  	*
							
	 RN
	  	*	  	*	  	*	  	*	  	*	  	*
							
	 RN HIGH TECH INFUSION
	  	*	  	*	  	*	  	*	  	*	  	*
							
	 RN HIGH TECH OTHER
	  	*	  	*	  	*	  	*	  	*	  	*
	
	 The following Traditional Home Health Services have Visit only rates.
  

	Notes 1, 3, 4, 5, 7 and 8 apply	  	Area 1	  	Area 2	  	Area 3
	 	  	Visit	  	Hour	  	Visit	  	Hour	  	Visit	  	Hour
	 DIABETIC NURSE
	  	*	  	N/A	  	*	  	N/A	  	*	  	N/A
							
	 DIETITIAN
	  	*	  	N/A	  	*	  	N/A	  	*	  	N/A
							
	 ENTEROSTOMAL THERAPIST
	  	*	  	N/A	  	*	  	N/A	  	*	  	N/A
							
	 MATERNAL CHILD HEALTH
	  	*	  	N/A	  	*	  	N/A	  	*	  	N/A
							
	 MEDICAL SOCIAL WORKER
	  	*	  	N/A	  	*	  	N/A	  	*	  	N/A
							
	 OCCUPATIONAL THERAPIST
	  	*	  	N/A	  	*	  	N/A	  	*	  	N/A
							
	 OCCUPATIONAL THERAPIST ASSISTANT
	  	*	  	N/A	  	*	  	N/A	  	*	  	N/A
							
	 PHLEBOTOMIST
	  	*	  	N/A	  	*	  	N/A	  	*	  	N/A
							
	 PHOTOTHERAPY PACKAGE SERVICE
	  	*	  	N/A	  	*	  	N/A	  	*	  	N/A
							
	 PHYSICAL THERAPIST
	  	*	  	N/A	  	*	  	N/A	  	*	  	N/A
							
	 PHYSICAL THERAPIST ASSISTANT
	  	*	  	N/A	  	*	  	N/A	  	*	  	N/A
							
	 PSYCHIATRIC NURSE
	  	*	  	N/A	  	*	  	N/A	  	*	  	N/A
							
	 REHABILITATION NURSE
	  	*	  	N/A	  	*	  	N/A	  	*	  	N/A
							
	 RESPIRATORY THERAPIST
	  	*	  	N/A	  	*	  	N/A	  	*	  	N/A
							
	 RN ASSESSMENT, INITIAL
	  	*	  	N/A	  	*	  	N/A	  	*	  	N/A
							
	 RN SKILLED NURSING VISIT-EXTENSIVE
	  	*	  	N/A	  	*	  	N/A	  	*	  	N/A
							
	 SPEECH THERAPIST
	  	*	  	N/A	  	*	  	N/A	  	*	  	N/A
	
	 The following Traditional Home Health Service has Hourly only rates.
  

	Notes 3, 4 and 5 apply	  	Area 1	  	Area 2	  	Area 3
	 	  	Visit	  	Hour	  	Visit	  	Hour	  	Visit	  	Hour
	 HOMEMAKER
	  	N/A	  	*	  	N/A	  	*	  	N/A	  	*
	
 * Confidential Treatment Requested.
	  	
							
	 The following Traditional Home Health Service is priced on a Per Diem basis.
  
	  		  		  		  		  		  	
	Notes 3, 4 and 5 apply	  	Area 1	  	Area 2	  	Area 3
	 	  	 	  	Per Diem	  	 	  	Per Diem	  	 	  	Per Diem
	 COMPANION/LIVE IN
	  		  	*	  		  	*	  		  	*

 NOTES: 
  

	1.	Visits are defined as two (2) hours or less in duration (EXCEPT MATERNAL CHILD HEALTH VISITS, which have no maximum duration). 

  

	2.	Hourly rate for visits exceeding two (2) hours in duration, starting with hour 3. 

  

	3.	CIGNA does not reimburse for travel time, weekend, holiday or evening differentials. 

  

	4.	Above prices have no exclusions. 

  

	5.	All services not listed above will be billed at * until rates are mutually established and become part of the fee schedule. 

  

	6.	RN High Tech Infusion visit and hourly utilization/costs to be reported with HIT. 

  

	7.	Respiratory Therapist visit utilization/costs to be reported with HME/RT. 

  

	8.	Diabetic Nurse, Psychiatric Nurse and Rehabilitation Nurse assume specialty certification which is not readily available in the home care environment. Use requires special
coordination. 

  

	9.	There shall a ceiling for annual inflation increases in Home Health Services of *. 

	*	Confidential Treatment Requested. 

 HOME INFUSION RATES 
 GATEKEEPER RATES EFFECTIVE FEBRUARY 1, 2007 - JANUARY 31. 2008 
 The following Home Infusion Therapy service rates
EXCLUDE drugs. Drugs are priced as a percentage discount off AWP (if applicable), and there is NO price difference between primary and multiple therapies 
  

							
	 	  	 Primary or
 Multiple Therapy
Per Diem
	  	 Primary or
 Multiple Therapy
Dispensing Fee
	  	 Primary or
 Multiple Therapy
Drug Discount off AWP

	 Ancillary Drugs
	  		  	*	  	*
	 Biological Response Modifiers
	  		  	*	  	*
	 Cardiac (Inotropic) Therapy
	  	*	  		  	*
	 Chelation Therapy
	  	*	  		  	*
	 Chemotherapy
	  	*	  		  	*
	 Enteral Therapy
	  	*	  		  	*
	 Enzyme Therapy
	  	*	  		  	*
	 Growth Hormone
	  		  	*	  	*
	 IV Immune Globulin
	  	*	  		  	*
	 Other Injectable Therapies
	  		  	*	  	*
	 Other Infusion Therapies
	  	*	  		  	*
	 Pain Management Therapy
	  	*	  		  	*
	 Steroid Therapy
	  	*	  		  	*
	 Thrombolytic (Anticoagulation) Therapy
	  	*	  		  	*
	 Synagis
	  		  	*	  	*
	 Remodulin Therapy
	  		  		  	*
	
	The following Home Infusion Therapy service rates EXCLUDE drugs. Drugs are priced as a percentage discount off AWP, and there IS a price difference between primary and multiple
anti-infective therapies
				
	 	  	Per Diem	  	 	  	Drug Discount Off
AWP
	 Anti-Infectives - Primary Anti-Infective
	  	*	  		  	*
	 Anti-Infectives - Multiple Anti-Infective
	  	*	  		  	*
	
	The following Home Infusion Therapy service rate EXCLUDES drugs. Drugs are priced per vial, and there is NO price difference between primary and multiple anti-infective
therapies
				
	 	  	Primary or
Multiple Therapy
Per Diem	  	 	  	Cost of Drug
	 Flolan Therapy
	  	*	  		  	
	 Flolan 0.5 mg vial
	  		  		  	*
	 Flolan 1.5 mg vial
	  		  		  	*
	 Flolan diluent vial
	  		  		  	*
	
	The following Home Infusion Therapy service rates INCLUDE drugs, and there is NO price difference between primary and multiple therapies
				
	 	  	Primary or
Multiple Therapy
Per Diem	  	 	  	 
	 Enteral Therapy
	  	*	  		  	
	 Hydration Therapy
	  	*	  		  	
	 Total Parenteral Nutrition
	  	*	  		  	
	
	SCHEDULE 2A, PAGE 2: HOME INFUSION HMO/FLEX FEE-FOR-SERVICE THERAPY RATES
	
	 NOTES:
  
 1.      Per Diems EXCLUDING drugs include all costs related to the therapy except the cost of
drugs, including but not limited to facility overhead, supplies, delivery, professional labor including compounding and monitoring, all nursing required, maintenance of specialized catheters, equipment/patient supplies, disposables, pumps, general
and administrative expenses, etc.
  
 2.      Per Diems INCLUDING drugs include ALL costs - including but not limited to cost of drugs, facility overhead, supplies, delivery, professional labor including compounding and monitoring, all nursing
required, maintenance of specialized catheters, equipment/patient supplies, disposables, pumps, general and administrative expenses, etc.
  
 3.      "DISPENSING FEE" is defined as per each time the drug is dispensed by the home infusion
provider.
  
 4.      "PER DIEM" costs are the same for primary or multiple treatments for all drug categories, except ANTI-INFECTIVES.
  
 5.      The per diem rate shall only be charged for those days the Participant receives
medication.
  
 6.      For home infusion pharmaceuticals not listed on fee schedule, * will apply.
  
 7.      There shall be a ceiling for annual inflation increases in Home Infusion Therapy of
*.
  
 8.      There
shall be a ceiling for annual inflation increases in Medications under *.
  
 9.      All Medications are subject to MAC pricing, where applicable.

	
	The following are for the stated item ONLY. Unless otherwise noted, nursing, supplies, etc. are NOT included.
				
	 Blood Transfusion per Unit (Tubing, Filters)
	  		  		  	*
	 Catheter Care Per Diem
	  		  		  	*
	 Midline Insertion (Catheter & Supplies)
	  		  		  	*
	 PICC Line Insertion (Catheter & Supplies)
	  		  		  	*
	 Blood Product
	  		  		  	*
	
	SCHEDULE 2A, PAGE 3: HOME INFUSION THERAPY HMO/FLEX FEE-FOR-SERVICE RATES
				
	Factor Concentrates	  		  		  	
	 	  	 	  	Vial price	  	Unit Price
	Factor VII	  		  		  	
	 Novoseven 1200MCG Vial
	  		  	*	  	
	 Novoseven 4800MCG Vial
	  		  	*	  	
	 Novoseven in 1200MCG or 4800MCG QTY
	  		  		  	*
				
	Factor VIII (Recombinant)	  		  		  	
	 Recombinate
	  		  		  	*
	 Kogenate or Helixate
	  		  		  	*
	 Bioclate
	  		  		  	*
	 Helixate FS
	  		  		  	*
	 Kogenate FS
	  		  		  	*
	 Refacto
	  		  		  	*
	 Advate
	  		  		  	*
				
	Factor VIII (Monoclonal)	  		  		  	
	 Hemofil-M or A. R. C. Method M
	  		  		  	*
	 Monoclate P
	  		  		  	*
	 Monarc-M
	  		  		  	*
				
	Factor VIII (Other)	  		  		  	
	 Koate
	  		  		  	*
	 Humate
	  		  		  	*
	 Alphanate SDHT
	  		  		  	*
				
	Factor IX (Recombinant)	  		  		  	
	 BeneFix
	  		  		  	*
				
	Factor IX (Monoclonal/High Purity)	  		  		  	
	 Mononine
	  		  		  	*
	 Alphanine
	  		  		  	*
				
	Factor IX (Other)	  		  		  	
	 Konyne - 80
	  		  		  	*
	 Proplex T
	  		  		  	*
	 Bebulin
	  		  		  	*
	 Profilnine SD
	  		  		  	*
				
	Anti-Inhibitor Complex	  		  		  	
	 Autoplex-T
	  		  		  	*
	 Feiba-VH
	  		  		  	*
	 Hyate-C
	  		  		  	*
				
	HEMOSTATIC AGENTS	  		  		  	
	 DDAVP - 10ml vial
	  		  		  	*
	 Stimate - 2.5ml vial
	  		  		  	*
	
	Above rates include all necessary ancillary supplies and waste disposal unit; 24-hour on-call clinical support; home infusion monitoring system; product delivery nationwide; patient
training, education, and evaluation

 * Confidential Treatment Requested. 

 DME / HME RESPIRATORY RATES: 
 GATEKEEPER RATES EFFECTIVE FEBRUARY 1, 2006 - JANUARY 31. 2009 
  

																	
	 CAT
	 	 TYPE
	 	 HCPCS
CODE
	  	 CHC
CODE
	  	 CareCentrix
Code
	  	 DESCRIPTION
	  	 PURCHASE
PRICE
	  	 RENTAL
PRICE
	  	 DAILY
PRICE

	 HME
	 		 	A4230	  	A4230	  		  	Infusion set for external insulin pump, non-needle cannula Type	  	*	  		  	
									
	 HME
	 		 	A4231	  	A4231	  		  	Infusion set for external insulin pump, needle type	  	*	  		  	
									
	 HME
	 		 	A4232	  	A4232	  		  	Reservoir/Syringe with needle for external insulin pump	  	*	  		  	
									
	 HME
	 		 	A4632	  	A4632	  		  	Replacement battery for external insulin pump, any type, each	  	*	  		  	
									
	 HME
	 		 	A5119	  	A5119	  		  	Skin Barrier, wipes, box per 50	  	*	  		  	
									
	 HME
	 		 	A6257	  	A6257	  		  	Transparent film/dressing	  	*	  		  	
									
	 HME
	 	INSULPP	 	E0784	  	E0784	  	2158	  	PUMP (E0784), EXT AMBULATORY INFUSION, MINIMED, INSULIN	  	*	  		  	
									
	 HME
	 	INSULPP	 	E0784	  	E0784	  	6771	  	PUMP (E0784), INSULIN EXT INFUSION DISETRONICS OR OTHER	  	*	  		  	
									
	 HME
	 	INSULPP	 	E0784	  	E0784	  	7704	  	PUMP, EXT INFUSION, DANA DIABECARE, INSULIN (E0784)	  	*	  		  	
									
	 HME
	 	INSULPP	 	E0784	  	E0784	  	7731	  	PUMP, EXT INFUSION, ANIMAS, INSULIN (E0784)	  	*	  		  	
									
	 HME
	 	INSULPP	 	E0784	  	E0784	  	7773	  	PUMP (E0784), EXT AMBULATORY INFUSION, DELTEC, INSULIN	  	*	  		  	
									
	 HME
	 	OTHER	 	E0746	  	DM570	  	2109	  	ELECTROMYOGRAPHY (EMG) (E0746), BIOFEEDBACK DEVICE	  	*	  	*	  	
									
	 HME
	 	OTHER	 	E0935	  	E0935	  	2125	  	PASSIVE MOTION (E0935) EXERCISE DEVICE	  		  		  	*
									
	 HME
	 	OTHER	 	E0935	  	E0935	  	2857	  	PASSIVE MOTION (E0935) EXERCISE DEVICE, HAND	  		  		  	*
									
	 HME
	 	OTHER	 	E0935	  	E0935	  	2858	  	PASSIVE MOTION (E0935) EXERCISE DEVICE, SHOULDER	  		  		  	*
									
	 HME
	 	OTHER	 	E0935	  	E0935	  	2859	  	PASSIVE MOTION (E0935) EXERCISE DEVICE, ANKLE	  		  		  	*
									
	 HME
	 	OTHER	 	E0935	  	E0935	  	2860	  	PASSIVE MOTION (E0935) EXERCISE DEVICE, ELBOW	  		  		  	*
									
	 HME
	 	OTHER	 	E0935	  	E0935	  	2861	  	PASSIVE MOTION (E0935) EXERCISE DEVICE, WRIST	  		  		  	*
									
	 HME
	 	OTHER	 	E1300	  	DM570	  	2062	  	WHIRLPOOL (E1300), PORT (OVERTUB TYPE)	  	*	  		  	
									
	 HME
	 	OTHER	 	E1310	  	DM570	  	2061	  	WHIRLPOOL (E1399), NON-PORT (BUILT-IN TYPE)	  	*	  		  	
									
	 HME
	 	OTHER	 	E1399	  	E1399	  	2327	  	DURABLE MEDICAL EQUIP (E1399), MISCELLANEOUS	  	*	  		  	
									
	 HME
	 	STIM_BO	 	E0747	  	DM570	  	6875	  	STIMULATOR, OSTEOGENIC, ULTRASOUND	  	*	  		  	
									
	 HME
	 	STIM_BO	 	E0747	  	DM570	  	8386	  	STIMULATOR (E0747), OSTEOGENIC, NON-INVASIVE, EBI	  	*	  		  	
									
	 HME
	 	STIM_BO	 	E0747	  	DM570	  	8387	  	STIMULATOR (E0747), OSTEOGENIC, NON-INVASIVE, ORTHOFIX	  	*	  		  	
									
	 HME
	 	STIM_BO	 	E0747	  	DM570	  	8388	  	STIMULATOR (E0747), OSTEOGENIC, NON-INVASIVE, ORTHOLOGIC	  	*	  		  	
									
	 HME
	 	STIM_BO	 	E0748	  	DM570	  	2124	  	STIMULATOR (E0748), OSTEOGENIC NON-INVASIVE, SPINAL APPLICATIONS	  	*	  		  	
									
	 HME
	 	STIM_BO	 	E0748	  	DM570	  	8389	  	STIMULATOR (E0748), OSTEOGENIC NON-INVASIVE, SPINAL, EBI	  	*	  		  	
									
	 HME
	 	STIM_BO	 	E0748	  	DM570	  	8390	  	STIMULATOR (E0748), OSTEOGENIC NON-INVASIVE, SPINAL, ORTHOFIX	  	*	  		  	
									
	 HME
	 	STIM_BO	 	E0748	  	DM570	  	8391	  	STIMULATOR (E0748), OSTEOGENIC NON-INVASIVE, SPINAL, ORTHOLOGIC	  	*	  		  	
									
	 HME
	 	WDSUCT	 	K0538	  	DM570	  	6873	  	WOUND SUCTION DEVICE (K0538)	  		  		  	*
									
	 HME
	 	WDSUCT	 	K0539	  	DM570	  	7914	  	DRESSING SET, FOR WOUND SUCTION DEVICE (K0539)	  	*	  		  	
									
	 HME
	 	WDSUCT	 	K0540	  	DM570	  	7915	  	CANISTER SET, FOR WOUND SUCTION DEVICE (K0540)	  	*	  		  	
	
	The following may be charged under extraordinary circumstances:
									
	 HME
	 	SUP	 	E1399	  	E1399	  	4551	  	LABOR/SERVICE/SHIPPING CHARGES	  	*	  		  	
									
	 HME
	 	SUP	 	E1399	  	E1399	  	2731	  	SHIPPING AND HANDLING FEES	  	*	  		  	
	
	The following may be charged if over and above routine on rental equipment:
									
	 RESP
	 	EQUIP	 	E1350	  	E1350	  	2382	  	REPAIR OR NON-ROUTINE (E1350) SERVICE REQUIRING SKILL OF A TECH	  	*	  		  	
									
	 HME
	 	SUP	 	E1399	  	E1399	  	4552	  	MISCELLANEOUS SUPPLIES	  	*	  		  	*

 NOTES: 
 1. Whether
rental or purchase, rates include all shipping, labor and set-up. 
 2. If item is rented, rates include all supplies to enable the equipment to function
effectively with the exception Suction and CPM. Such exception supplies will be billed at *. 
 3. If item is rented, rates include repair and maintenance
costs. 

	*	Confidential Treatment Requested. 

 EXHIBIT A 
 HMO PROGRAM ATTACHMENT - CAPITATION 
 SCHEDULE OF CAPITATION RATES 
 CAPITATION RATES EFFECTIVE 2/1/07 - 1/31/08 
 These
are the capitation rates that apply to services rendered to Patient Panel Participants enrolled in HMO Programs. An "HMO Program" means a non-governmental, fully insured HMO or Point of Service product that is underwritten based on a community
rating methodology (i.e. community rating, community rating by class, adjusted community rating by class). 
  

			
	 	  	 Gentiva
HomeHealth,
Infusion,
 DME/HME
Capitation Rates
PMPM

	 All Commercial HMO Program Capitated Affiliates
	  	*

 Capitation Rate Compensation Terms 
 The following rates are established for the provision of Home Care Services rendered to Program Participants covered under the HMO and Gatekeeper plans: 
  

			
	 February 1, 2006 - January 31, 2007
	 	$ * per member per month
	 February 1, 2007 - January 31, 2008
	 	$ * per member per month
	 February 1, 2008 - January 31, 2009
	 	$ * per member per month

 The capitation rate listed above will be allocated between HMO and Gatekeeper Program participants in accordance
with established business practices. On or about December 1 of each year, the parties shall reconcile the allocation and settle any payment difference no later than December 31 of each calendar year. 
 If an outlier calculation for * demonstrates a patient per thousand (PPK) increase in excess of *, (* ppk), then MCA reserves the right to propose an * pmpm outlier
adjustment. CIGNA may elect to accept this adjustment or * from this agreement. 

	*	Confidential Treatment Requested. 

 EXHIBIT A 
 GATEKEEPER PROGRAM ATTACHMENT - CAPITATION 
 SCHEDULE OF CAPITATION RATES 
 CAPITATION RATES EFFECTIVE 2/1/07 - 1/31/08 
 These
are the capitation rates that apply to services rendered to Patient Panel Participants enrolled in Gatekeeper Programs. A "Gatekeeper Program" means (i) a product that includes fully insured Standard HMO, Point of Service, or Gatekeeper PPO benefits
and which is underwritten by a licensed insurance company based on an experience rating methodology, or (ii) a self funded product which includes Standard HMO, Point of Service, or Gatekeeper PPO benefits. This definition includes, but is not
limited to, Participants covered under FlexCare plans insured/administered by Connecticut General Life Insurance Company. 
  

			
	 	  	 Gentiva
HomeHealth,
Infusion,
 DME/HME
Capitation Rates
PMPM

	 All Gatekeeper (FlexCare) Capitated Affiliates
	  	*

 Capitation Rate Compensation Terms 
 The following rates are established for the provision of Home Care Services rendered to Program Participants covered under the HMO and Gatekeeper plans: 
  

			
	 February 1, 2006 - January 31, 2007
	 	$ * per member per month
	 February 1, 2007 - January 31, 2008
	 	$ * per member per month
	 February 1, 2008 - January 31, 2009
	 	$ * per member per month

 The capitation rate listed above will be allocated between HMO and Gatekeeper Program participants in accordance
with established business practices. On or about December 1 of each year, the parties shall reconcile the allocation and settle any payment difference no later than December 31 of each calendar year. 
 If an outlier calculation for * demonstrates a patient per thousand (PPK) increase in excess of *, ( * ppk), then MCA reserves the right to propose an * pmpm outlier
adjustment. CIGNA may elect to accept this adjustment or * from this agreement. 

	*	Confidential Treatment Requested.

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