Document:

EXHIBIT
        10.10.CE

    

     

    
      STOCK
        PURCHASE AGREEMENT

    

     

    THIS
      STOCK PURCHASE AGREEMENT (the “Agreement”) is made and entered into as of the
      28th day of August, 2008, by and between the ANTHONY M. FRANK KEOGH PLAN UTA
      CHARLES SCHWAB & CO., INC. (hereinafter referred to as “Buyer”) and MICRO
      IMAGING TECHNOLOGY, INC., a California corporation (hereinafter referred to
      as
      the “Company”).

    

    1. PURCHASE
      AND SALE OF SHARES

    

    (a)
      Effective on the date hereof, the Company hereby sells to Buyer and Buyer hereby
      purchases One Hundred Eighty Thousand (180,000) Shares of MICRO IMAGING
      TECHNOLOGY, INC. Common Stock (the “Shares”). The aggregate purchase price of
      the Shares is equal to Thirty Thousand Dollars ($30,000), or $0.16667 per
      share.

     

    
      	 	
              (b)

            	
              The
                Shares shall have the rights, preferences, privileges, restrictions
                and
                other terms set forth in the By-laws of the
                Company.

            

    

     

    2. REPRESENTATIONS
      AND WARRANTIES OF BUYER Buyer
      represents and warrants to the Company:

    

    (a) The
      Shares are being acquired by Buyer for investment for an indefinite period,
      for
      Buyer’s own account, not as a nominee or agent, and not with a view to the sale
      or distribution of any part thereof, and the Buyer has no present intention
      of
      selling, granting participations in, or otherwise distributing the same except
      as may be permitted by the Securities Act of 1933, as amended (the
“Act”).

    

    (b) Buyer
      does not have any contract, undertaking, agreement or arrangement with any
      person to sell, transfer, or grant participation to such person or to any third
      person, with respect to the Shares.

    

    (c) That
      Buyer understands that the Shares have not been registered under the Securities
      Act of 1933, as amended (the “Act”), in reliance upon the exemptions from the
      registration provisions of the Act contained in Section 4 (2) thereof, and
      any
      continued reliance on such exemption is predicated on the representations of
      the
      Buyer set forth herein.

    

    (d) Buyer
      understands that the Shares must be held indefinitely unless the sale or other
      transfer thereof is subsequently registered under the Act, as amended, or an
      exemption from such registration is available. Buyer further understands that
      the Company is under no obligation to register the Securities on its behalf
      or
      to assist him in complying with any exemption from registration except as
      otherwise provided herein.

    

    (e) Buyer
      (i)
      has adequate means of providing for his current needs and possible
      contingencies, (ii) has no need for liquidity in this investment, (iii) is
      able
      to bear the substantial

     

    
      
        
        

      

      
        Page
          1Note:
      Portions of this exhibit indicated by [*] are subject to a confidential
      treatment request, and have been omitted from this exhibit. Complete, unredacted
      copies of this exhibit have been filed with the Securities and Exchange
      Commission as part of the Company’s confidential treatment request.

    

    INDEPENDENT
      PRACTICE ASSOCIATION PARTICIPATION AGREEMENT

    

    COVER
      SHEET

    

    
      	
              General
                Information

            
	
              IPA
                Name: Metcare of Florida, Inc

            
	 
	
              Federal
                Tax ID Number: 65-0879131

            
	 
	
              IPA
                UPIN:

            

    

    

    
      	
              Service
                Address

            
	
              Service
                Address: 250 South Australian Ave., Ste 400

            
	 
	
              City:
                West Palm Beach

            
	 
	
              State:
                Florida

            
	 
	
              Zip:
                33401

            
	 
	
              Contact
                Person Name:

            
	 
	
              Email
                Address:

            
	 
	
              Telephone
                Number: 561-805-8500

            
	 
	
              Facsimile
                (FAX) Number: 561-805-8501

            
	 
	
              County:
                Palm Beach

            

    

    

    
      	
              Billing
                Address

            
	
              Billing
                Address: Same as Above

            
	 
	
              City:

            
	 
	
              State:

            
	 
	
              Zip:

            
	 
	
              Contact
                Person Name:

            
	 
	
              Email
                Address:

            
	 
	
              Telephone
                Number:

            
	 
	
              Facsimile
                (FAX) Number:

            

    

    

    
      
        
        

      

      
        
        

        
          

        

      

      
        
        

      

       

    

    
      	
              For
                Humana Use Only

            
	 
	
              Nomination  ̈
                Yes    o
                No

            

    

    

    INDEPENDENT
      PRACTICE ASSOCIATION PARTICIPATION AGREEMENT

    

    This
      Independent Practice Association Participation Agreement ("Agreement")
      is
      made and entered into by and between the party named on the signature page
      below
      (hereinafter referred to as "IPA")
      and
      Humana Insurance Company, Humana Health Insurance Company of Florida, Inc.,
      Humana Medical Plan, Inc. and their affiliates that underwrite or administer
      health plans (hereinafter referred to as “Humana”).

    

    RELATIONSHIP
      OF THE PARTIES

    

    
      	
              1.1

            	
              In
                performance of their respective duties and obligations hereunder,
                Humana
                and IPA,
                and IPA’s
                respective employees and agents, are at all times acting and performing
                as
                independent contractors, and neither party, nor their respective
                employees
                and agents, shall be considered the partner, agent, servant, employee
                of,
                or joint venturer with, the other party. Unless otherwise agreed
                to
                herein, the parties acknowledge and agree that neither IPA
                nor Humana
                will be liable for the activities of the other nor the agents and
                employees of the other, including but not limited to, any liabilities,
                losses, damages, suits, actions, fines, penalties, claims or demands
                of
                any kind or nature by or on behalf of any person, party or governmental
                authority arising out of or in connection with: (i) any failure to
                perform
                any of the agreements, terms, covenants or conditions of this Agreement;
                (ii) any negligent act or omission or other misconduct; (iii) the
                failure
                to comply with any applicable laws, rules or regulations; or (iv)
                any
                accident, injury or damage to persons or property. Notwithstanding
                anything to the contrary contained herein, IPA
                further agrees to and hereby does indemnify, defend and hold harmless
                Humana
                from any and all claims, judgments, costs, liabilities, damages and
                expenses whatsoever, including reasonable attorneys' fees, arising
                from
                any acts or omissions in the provision by IPA
                of
                medical services to Members. This provision shall survive termination
                or
                expiration of this Agreement.

            

    

    

    
      	
              1.2

            	
              The
                parties agree that Humana’s
                affiliates whose Members receive services hereunder do not assume
                joint
                responsibility or liability between or among such affiliates for
                the acts
                or omissions of such other affiliates.

            

    

    

    SERVICES
      TO MEMBERS

    

    
      	
              2.1

            	
              Subject
                at all times to the terms of this Agreement, IPA
                agrees to provide or arrange for medical and related health care
                services
                to individuals designated by Humana
                (herein
                referred to as “Members”)
                with an identification card or other means of identifying them as
                Members
                covered under a self-funded or fully insured health benefits plan
                to which
                IPA
                has agreed to participate as set forth in the product participation
                list
                attachment. 

            

    

    

    
      	
              2.2

            	
              IPA
                agrees to provide IPA’s
                services to individuals covered under other third party payors’
                (hereinafter referred to as “Payor”
                or “Payors”)
                health benefits contracts (hereinafter referred to as "Plan"
                or “Plans”)
                and agrees to comply with such Payors’ policies and procedures. For
                Covered Services rendered to such individuals, IPA
                acknowledges and agrees that all rights and responsibilities arising
                with
                respect to benefits to such individuals shall be subject to the terms
                of
                the Payor Plan covering such individuals. Individuals covered under
                such
                Plans will have an identification card as a means of identifying
                the Payor
                Plan which provides coverage. Such identification cards will display
                the
                Humana
                logo and/or name. 

            

    

    

    
      	
              2.3

            	
              For
                Covered Services provided to those individuals identified in Section
                2.2
                above, Payor will make payments for Covered Services directly to
                IPA
                in
                accordance with the terms and conditions of this Agreement and
                the rates
                set forth in the payment attachment applicable to the Plan type of
                such
                individual. IPA
                agrees that in no event, including, but not limited to, nonpayment
                by
                Payor, or Payor’s insolvency, shall IPA
                bill, charge, collect a deposit from, seek compensation, remuneration
                or
                reimbursement from, or have any recourse against Humana
                for services provided by IPA
                to
                Plans’ members. This provision shall not prohibit collection by
                IPA
                from Plans’ members for non-covered services and/or member cost share
                amounts in accordance with the terms of the applicable member Plan.
                Payors
                Plans will provide appropriate steerage mechanisms including benefit
                designs and/or IPA directory and web site listings to ensure their
                covered
                individuals will have incentives to utilize IPA’s
                services. All obligations of IPA
                under this Agreement with respect to Humana’s
                Members shall equally apply to the individuals identified in Section
                2.2
                above.

            

    

    

      
        	
                IPA_FL_08152006

              	
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    THIRD
      PARTY BENEFICIARIES

    

    
      	
              3.1

            	
              Except
                as is otherwise specifically provided in this Agreement, the parties
                have
                not created and do not intend to create by this Agreement any rights
                in
                other parties as third party beneficiaries of this Agreement, including,
                without limitation, Members.

            

    

    

    SCOPE
      OF AGREEMENT

     

    
      	
              4.1

            	
              This
                Agreement sets forth the rights, responsibilities, terms and conditions
                governing: (i) the status of IPA
                and IPA’s
                employees, subcontractors and/or independent contractors as health
                care
                providers (hereinafter referred to as "Participating
                Providers")
                providing health care services; and (ii) IPA’s
                provision of professional medical services (hereinafter referred
                to as
                "IPA
                Services")
                to Members. All terms and conditions of this Agreement which are
                applicable to “IPA”
                are equally applicable to each Participating Provider, unless the
                context
                requires otherwise. 

            

    

    

    
      	
              4.2

            	
              IPA
                represents and warrants that it is authorized to negotiate terms
                and
                conditions of provider agreements, including this Agreement, and
                further
                to execute such agreements for and on behalf of itself and its
                Participating Providers. IPA
                further represents and warrants that Participating Providers will
                abide by
                the terms and conditions of this Agreement, including each of IPA’s
                employed, subcontracted or independently contracted IPAs. The parties
                acknowledge and agree that nothing contained in this Agreement is
                intended
                to interfere with or hinder communications between IPA
                and Members regarding the Members’ medical conditions or treatment
                options, and IPA
                acknowledges that all patient care and related decisions are the
                sole
                responsibility of IPA
                and Humana
                does not dictate or control clinical decisions with respect to the
                medical
                care or treatment of Members.

            

    

    

    
      	
              4.3

            	
              IPA
                acknowledges and agrees that with respect to self-funded groups,
                unless
                otherwise provided herein, Humana’s
                responsibilities hereunder are limited to provider network administration
                and/or claims processing. 

            

    

    

    SUBCONTRACTING
      PERFORMANCE

    

    
      	
              5.1

            	
              IPA
                shall
                provide directly, or through appropriate agreements with IPAs and
                other
                licensed health care professionals and/or providers, IPA Services
                for
                Members. It is understood and agreed that IPA
                shall maintain written agreements with Participating Providers, if
                any, in
                a form comparable to, and consistent with, the terms and conditions
                established in this Agreement. IPA’s
                downstream provider agreements, if any, shall include terms and conditions
                which comply with all applicable requirements for provider agreements
                under state and federal laws, rules and regulations. In the event
                of a
                conflict between the language of the downstream provider agreements
                and
                this Agreement, the language in this Agreement shall
                control.

            

    

    

    
      	
              5.2

            	
              IPA
                shall
                provide Humana
                an
                executed letter of agreement (in a form substantially similar to
                the form
                attached hereto as the letter of agreement attachment) for each
                Participating Provider who is a IPA and who is subcontracted or
                independently contracted with IPA
                prior
                to the provision of services by such Participating Provider to Members.
                Such Participating Providers, if any, who do not execute a letter
                of
                agreement may not participate under this Agreement and may not be
                listed
                in Humana’s
                provider directories.

            

    

    
      

        
          	
                  IPA_FL_08152006

                	
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    TERM
      AND TERMINATION

     

    
      	6.1	
              
                The
                  term of this Agreement shall commence on _______________________,
                  20____
                  (the "Effective Date”).
                  The initial term of this Agreement shall be for five (5) years
                  (hereinafter referred to as “Initial Term”). This Agreement shall
                  automatically renew for subsequent one (1) year terms unless either
                  party
                  provides written notice of non-renewal to the other party at least
                  ninety
                  (90) days prior to the end of the initial term or any subsequent
                  renewal
                  terms.

              

            

    

    

    
      	6.2	
              Notwithstanding
                anything to the contrary herein, after the Initial Term, either party
                may
                terminate this Agreement without cause by providing to the other
                party one
                hundred and twenty (120) days prior written notice of
                termination.

            

    

     

    
      	6.3	
              Humana
                may terminate this Agreement, or any individual Participating Provider,
                immediately upon written notice to IPA,
                stating the cause for such termination, in the event: (i) IPA's,
                or any individual Participating Provider's, continued participation
                under
                this Agreement may adversely affect the health, safety or welfare
                of any
                Member or brings Humana
                or
                its health care networks into disrepute; (ii) IPA
                or
                any individual Participating Provider fails to meet Humana’s
                credentialing or re-credentialing criteria; (iii) IPA
                or
                any individual Participating Provider is excluded from participation
                in
                any federal health care program; (iv) IPA
                or
                any individual Participating Provider voluntarily or involuntarily
                seeks
                protection from creditors through bankruptcy proceedings or engages
                in or
                acquiesces to receivership or assignment of accounts for the benefit
                of
                creditors; or (v) Humana
                loses its authority to do business in total or as to any limited
                segment
                of business, but then only as to that segment. 

            

    

    

    
      	
              6.4

            	
              In
                the event of a breach of this Agreement by either party, the non-breaching
                party may terminate this Agreement upon at least sixty (60) days
                prior
                written notice to the breaching party, which notice shall specify
                in
                detail the nature of the alleged breach; provided, however, that
                if the
                alleged breach is susceptible to cure, the breaching party shall
                have
                thirty (30) days from the date of receipt of notice of termination
                to cure
                such breach, and if such breach is cured, then the notice of termination
                shall be void of and of no effect. If the breach is not cured within
                the
                thirty (30) day period, then the date of termination shall be that
                date
                set forth in the notice of termination. Notwithstanding the foregoing,
                any
                breach related to credentialing or re-credentialing, quality assurance
                issues or alleged breach regarding termination by Humana
                in
                the event that Humana
                determines that continued participation under this Agreement may
                affect
                adversely the health, safety or welfare of any Member or bring
                Humana
                or
                its health care networks into disrepute, shall not be subject to
                cure and
                shall be cause for immediate termination upon written notice to
                IPA.

            

    

    

    
      	
              6.5 

            	
              IPA
                agrees that the notice of termination or expiration of this Agreement
                shall not relieve IPA’s
                obligation to provide or arrange for the provision of IPA Services
                through
                the effective date of termination or expiration of this
                Agreement.

            

    

    

    POLICIES
      AND PROCEDURES

    

    
      	
              7.1
                

            	
              IPA
                agrees to comply with Humana’s
                quality assurance, quality improvement, accreditation, risk management,
                utilization review, utilization management and other administrative
                policies and procedures established and revised by Humana
                from time to time and, in addition, those policies and procedures
                which
                are set forth in Humana’s
                Physician Administration Manual, or its successor (hereinafter referred
                to
                as the “Manual”),
                and bulletins or other written materials that may be promulgated
                by
                Humana
                from time to time to supplement the Manual. The Manual and updated
                policies and procedures may be issued and distributed by Humana
                in
                electronic format. Paper copies may be obtained by IPA
                upon written request. Revisions to such policies and procedures shall
                become binding upon IPA
                ninety (90) days after such notice to IPA
                by
                mail or electronic means, or such other period of time as necessary
                for
                Humana
                to
                comply with any statutory, regulatory and/or accreditation requirements.
                

            

    

    

    
      	
              7.2

            	
              Humana
                shall
                maintain an authorization procedure for IPA
                to
                verify coverage of Members under a Humana
                health
                benefits contract. 

            

    

    

    
      	
              7.3

            	
              IPA
                agrees that it shall obtain preadmission authorization or provide
                admission notification with respect to Member inpatient admissions.
                IPA
                recognizes that failure to notify Humana
                of
                Member admission could result in limitation on Humana's
                ability to administer Members’ benefits. In the event that IPA
                fails to obtain preadmission authorization or notify Humana of a
                Member
                inpatient admission, the IPA’s
                claim will be pended and may either not be paid (if it is not Medically
                Necessary) or be subject to an administrative reduction in an amount
                equal
                to a
                fifty percent (50%) of the allowed amount. IPA
                agrees it shall not balance bill the Member for the amount of the
                reduction in payment. In the event the reduction described herein
                is
                effected, the Member's Copayments, if any, will be adjusted
                accordingly

            

    

    
      

        
          	
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    CREDENTIALING
      AND PROFESSIONAL LIABILITY INSURANCE

    

    
      	
              8.1

            	
              Participation
                under this Agreement by IPA
                and Participating Providers is subject to the satisfaction of all
                applicable credentialing and re-credentialing standards established
                by
                Humana.
                IPA
                shall provide Humana,
                or its designee, information necessary to ensure compliance with
                such
                standards at no cost to Humana
                or
                its designee. IPA
                agrees to use electronic credentialing and recredentialing processes
                when
                administratively feasible. IPA,
                as applicable, and all Participating Providers providing IPA Services
                to
                Humana
                Members shall be credentialed in accordance with Humana’s
                credentialing process prior to receiving participating status with
                Humana.

            

    

     

    
      	
              8.2

            	
              IPA
                shall maintain, at no expense to Humana,
                policies of comprehensive general liability, professional liability,
                and
                workers' compensation coverage as required by law, insuring IPA
                and IPA’s
                employees and agents against any claim or claims for damages arising
                as a
                result of injury to property or person, including death, occasioned
                directly or indirectly in connection with the provision of IPA Services
                contemplated by this Agreement and/or the maintenance of IPA’s
                facilities and equipment. Upon request, IPA
                shall provide Humana
                with evidence of said coverage, of which minimum professional liability
                coverage shall be two hundred and fifty thousand dollars ($250,000)
                per
                occurrence and seven hundred and fifty thousand dollars ($750,000)
                in the
                aggregate, or as required by state law. IPA
                shall provide Humana
                with written notice at least ten (10) days prior to any cancellations
                and/or modifications in the coverage. IPA
                shall within ten (10) business days following service upon IPA,
                or such other period of time as may be required by any applicable
                law,
                rule or regulation, notify Humana
                in
                writing of any Member lawsuit alleging malpractice involving a Member.
                

            

    

    

    PROVISION
      OF MEDICAL SERVICES

    

    
      	 	
              9.1

            	
              IPA
                shall provide Members all available medical services within the normal
                scope of and in accordance with IPA’s:
                (a) licenses and certifications, and (b) privileges to provide certain
                services based upon IPA’s
                qualifications as determined by Humana.
                IPA
                agrees to comply with all requests for information related to IPA’s
                qualifications in connection with Humana’s
                determination whether to extend privileges to provide certain services
                and/or procedures to Members. IPA
                shall not bill, charge, seek payment or have any recourse against
                Humana
                or Members for any amounts related to the provision of IPA Services
                for
                which Humana
                has notified IPA
                that privileges to perform such services have not been
                extended.

            

    

    

    
      	 	
              9.2

            	
              IPA
                shall maintain all office medical equipment including, but not limited
                to,
                imaging, diagnostic and/or therapeutic equipment (hereinafter referred
                to
                as “Equipment”)
                in acceptable working order and condition and in accordance with
                the
                Equipment manufacturer’s recommendations for scheduled service and
                maintenance. Such Equipment shall be located in IPA’s
                office locations that promote patient and employee safety. IPA
                shall provide Humana
                or
                its agents with access to such Equipment for inspection and an opportunity
                to review all records reflecting Equipment maintenance and service
                history. Such Equipment shall only be operated by qualified technicians
                with appropriate training and required licenses and
                certifications.

            

    

     

    
      	 	
              9.3

            	
              Equipment
                owned and/or operated by IPA
                shall
                comply with all standards for use of such Equipment and technician
                qualifications established by Humana.
                IPA
                agrees to comply with all requests for information related to Equipment
                and IPA’s
                and/or IPA’s
                staff, qualifications for use of same. In the event: (i) IPA’s
                Equipment fails to meet Humana’s
                standards; or (ii) IPA
                declines to comply with Humana’s
                standards for use of Equipment, IPA
                agrees that it will not use such Equipment while providing services
                to
                Members and shall not bill, charge, seek payment or have any recourse
                against Humana
                or
                Members for any amounts for services with respect to such
                Equipment.

            

    

     

    STANDARDS
      OF PROFESSIONAL PRACTICE

    

    
      	
              10.1

            	
              IPA
                Services shall be made available to Members without discrimination
                on the
                basis of type of health benefits plan, source of payment, sex, age,
                race,
                color, religion, national origin, health status or disability.
                IPA
                shall provide IPA Services to Members in the same manner as provided
                to
                their other patients and in accordance with prevailing practices
                and
                standards of the profession.

            

    

    
      

        
          	
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    MEDICAL
      RECORDS

    

    
      	
              11.1

            	
              IPA
                shall prepare, maintain and retain as confidential the medical records
                of
                all Members receiving IPA Services, and Members’ other personally
                identifiable health information received from Humana,
                in a form and for time periods required by applicable state and federal
                laws, licensing requirements, accreditation and reimbursement rules
                and
                regulations to which IPA
                is
                subject, and in accordance with accepted medical practice. IPA
                shall obtain authorization of Members permitting Humana,
                and/or any state or federal agency as permitted by law, to obtain
                a copy
                and have access, upon reasonable request, to any medical record of
                Member
                related to services provided by IPA
                pursuant to applicable state and federal laws. Copies of such records
                for
                the purpose of claims processing shall be made and provided by
                IPA
                at
                no cost to Humana
                or
                the Member. 

            

    

    

    
      	
              11.2

            	
              IPA and
                Humana
                agree to maintain the confidentiality of information maintained in
                the
                medical records of Members, and information obtained from Humana
                through the verification of Member eligibility, as required by law.
                This
                Section
                11
                shall survive expiration or termination of this Agreement, regardless
                of
                the cause.

            

    

    

    GRIEVANCE
      AND APPEALS PROCESS/BINDING ARBITRATION

    

    
      	
              12.1

            	
              IPA
                shall cooperate and participate with Humana
                in
                grievance and appeals procedures to resolve disputes that may arise
                between Humana
                and its Members. IPA
                and
                Humana
                further agree that in the event they are unable to resolve disputes
                that
                may arise with respect to this Agreement, IPA
                will
                first exhaust any internal Humana
                administrative review or appeal procedures prior to submitting any
                matters
                to binding arbitration. 

            

    

    

    
      	
              12.2

            	
              In
                the event of a dispute between IPA
                and Humana
                which is not resolved as set forth in Section
                22
                below, or which the parties cannot settle by mutual agreement, the
                dispute
                shall be resolved by binding arbitration, conducted by a single arbitrator
                selected by the parties from a panel of arbitrators proposed by the
                American Arbitration Association (“AAA”).
                This applies, without limitation, to any dispute arising out of the
                parties’ business relationship, including allegations or claims involving
                violations of state or federal laws or regulations. In the event
                the
                parties cannot agree on the arbitrator, then the arbitrator shall
                be
                appointed by the AAA. The arbitration shall be conducted in Ft.
                Lauderdale,
                Florida,
                in accordance with and subject to the Commercial Arbitration Rules
                of the
                AAA then in effect, or under such other mutually agreed upon guidelines.
                Judgment upon the award rendered in any such arbitration may be entered
                in
                any court of competent jurisdiction, or application may be made to
                such
                court for judicial acceptance and enforcement of the award, as applicable
                law may require or allow. The
                submission of any dispute to arbitration shall not adversely affect
                either
                party’s right to seek preliminary injunctive relief with respect to an
                actual or threatened termination, repudiation or rescission of the
                Agreement. Except as expressly set forth in Section
                22
                below, the costs of any arbitration proceeding(s) hereunder shall
                be borne
                equally by the parties, and each party shall be responsible for its
                own
                attorneys’ fees and such other costs and expenses incurred related to the
                proceedings. Notwithstanding the preceding sentence, in the event
                IPA
                is
                an individual practitioner or is a group practice consisting of less
                than
                six (6) IPAs and is the prevailing party in the arbitration, then
                Humana
                shall
                reimburse IPA
                any applicable filing fees or arbitrator fees paid by IPA.
                Arbitrations hereunder shall be conducted solely between IPA
                and Humana;
                class-based arbitration shall not be permitted. The parties agree
                this
                Agreement is a transaction involving interstate commerce and therefore
                that the Federal Arbitration Act, 9 U.S.C. §1 et seq. applies.
                

            

    

    
      

        
          	
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              12.3

            	
              Notwithstanding
                anything to the contrary in Section
                12.2
                above, Section
                12.2 shall
                not apply to any dispute between IPA
                and
                Humana:
                (i) which is subject to resolution through either Section 7.10 or
                Section
                7.11 of that certain settlement agreement dated October 17, 2005
                between
                Humana Inc. and Humana Health Plan, Inc. and the representative
                plaintiffs, the signatory medical societies, and class counsel
                (“MDL
                Settlement”);
                and (ii) for which IPA
                seeks resolution pursuant thereto; provided, however, any dispute
                subject
                to resolution under Section 7.11 of the MDL Settlement which does
                not
                result in a binding determination on the parties pursuant to the
                terms of
                Section 7.11 and for which IPA
                desires to continue to pursue shall be resolved by binding arbitration
                in
                accordance with Section
                12.2
                of
                this Agreement. A description of Sections 7.10 and 7.11 of the MDL
                Settlement are set forth in the Manual. All final determinations
                rendered
                in accordance with Sections 7.10 or 7.11 of the MDL Settlement are
                binding
                upon IPA
                and Humana.
                Notwithstanding
                anything to the contrary in this Section
                12.3
                or
                in Section
                22.1
                below, at Humana's
                option,
                Sections 7.10 or 7.11 or the MDL Settlement shall not apply to any
                physician, including a Participating Provider, who has opted-out
                of the
                MDL Settlement.

            

    

     

    USE
      OF IPA’S NAME

    

    
      	13.1	
              Humana
                may include the following information in any and all marketing and
                administrative materials published or distributed in any medium:
                IPA’s
                name, telephone number, address, office hours, type of practice or
                specialty, hospital affiliation, Internet web-site address, and the
                names
                of Participating Providers, including IPAs providing care at IPA’s
                office, and hospital affiliation, board certification, and other
                education
                and training history, if applicable, of Participating Providers.
                Humana
                will provide IPA
                with access to such information or copies of such administrative
                or
                marketing materials upon request. 

            

    

    

    
      	
              13.2
                

            	
              IPA
                may advertise or utilize marketing materials, logos, trade names,
                service
                marks, or other materials created or owned by Humana
                after obtaining Humana’s
                written consent. IPA
                shall not acquire any right or title in or to such materials as a
                result
                of such permissive use. 

            

    

    

    
      	
              13.3

            	
              IPA
                agrees to allow Humana
                to
                distribute a public announcement of IPA’s
                affiliation with Humana.
                

            

    

    

    PAYMENT
      

    

    
      	
              14.1

            	
              IPA
                shall accept payment from Humana
                for those services for which benefits are payable under a Member’s health
                benefits contract (hereinafter referred to as “Covered
                Services”)
                provided to Member in accordance with the reimbursement terms in
                the
                payment attachment. IPA
                shall collect directly from Member any co-payment, coinsurance, or
                other
                member cost share amounts (hereinafter referred to as "Copayments")
                applicable to the Covered Services provided and shall not waive,
                discount
                or rebate any such Copayments. Payments made in accordance with the
                payment attachment less
                the Copayments owed by Members pursuant to their health benefits
                contracts
                shall be accepted by IPA
                as
                payment in full from Humana
                for all Covered Services. This provision shall not prohibit collection
                by
                IPA
                from Member for any services not covered under the terms of the applicable
                Member health benefits contract. A reduction in payment as a result
                of
                claims policies and/or processing procedures is not an indication
                that the
                service provided is a non-covered
                service.

            

    

    

    
      	
              14.2

            	
              IPA
                agrees that payment may not be made by Humana
                for services rendered to Members which are determined by Humana
                not to be Medically Necessary. “Medically
                Necessary”
                (or “Medical
                Necessity”),
                unless otherwise defined by applicable law, shall mean health care
                services that a physician, exercising prudent clinical judgment,
                would
                provide to a patient for the purpose of preventing, evaluating, diagnosing
                or treating an illness, injury, disease or its symptoms, and that
                are (a)
                in accordance with generally accepted standards of medical practice;
                (b)
                clinically appropriate, in terms of type, frequency, extent, site
                and
                duration, and considered effective for the patient’s illness, injury or
                disease; and (c) not primarily for the convenience of the patient,
                physician, or other health care provider, and not more costly than
                an
                alternative service or sequence of services at least as likely to
                produce
                equivalent therapeutic or diagnostic results as to the diagnosis
                or
                treatment of that patient’s illness, injury or disease. For these
                purposes, “generally accepted standards of medical practice” means
                standards that are based on credible scientific evidence published
                in
                peer-reviewed medical literature generally recognized by the relevant
                medical community, physician specialty society recommendations and
                the
                views of physicians practicing in relevant clinical areas and any
                other
                relevant factors. IPA
                agrees
                that in the event of a denial of payment for IPA Services rendered
                to
                Members determined not to be Medically Necessary by Humana,
                that IPA
                shall not bill, charge, seek payment or have any recourse against
                Member
                for such services. Notwithstanding the immediately preceding sentence,
                IPA
                may bill the Member for services determined not to be Medically Necessary
                if IPA
                provides
                the Member with advance written notice that: (a) identifies the proposed
                services, (b) informs the Member that such services may be deemed
                by
                Humana
                to
                be not Medically Necessary, and (c) provides an estimate of the cost
                to
                the Member for such services and the Member agrees in writing in
                advance
                of receiving such services to assume financial responsibility for
                such
                services. 

            

    

    
      

        
          	
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              14.3
                

            	
              IPA
                agrees that Humana
                may recover overpayments made to IPA
                by
                Humana
                by
                offsetting such amounts from later payments to IPA,
                including, without limitation, making retroactive adjustments to
                payments
                to IPA
                for errors and omissions relating to data entry errors and incorrectly
                submitted claims or incorrectly applied discounts. Humana
                shall provide IPA
                thirty (30) days advance written notice of Humana’s
                intent to offset such amounts prior to deduction of any monies due.
                If
                IPA
                does not refund said monies or request review of the overpayments
                described in the notice within thirty (30) days following receipt
                of
                notice from Humana,
                Humana
                may without further notice to IPA
                deduct such amounts from later payments to IPA. Humana
                may make retroactive adjustments to payments for a period not to
                exceed
                eighteen (18) months from original date of payment or such other
                period as
                may be required by applicable law.

            

    

    

    
      	
              14.4

            	
               In
                the event Humana
                has access to IPA’s,
                or a Participating Provider’s, services through one or more other
                agreements or arrangements in addition to this Agreement, Humana
                will determine under which agreement or arrangement payment for Covered
                Services will be made.

            

    

    

    
      	
              14.5

            	
              Nothing
                contained in this Agreement is intended by Humana
                to
                be a financial incentive or payment that directly or indirectly acts
                as an
                inducement for IPA
                to
                limit Medically Necessary services.

            

    

    

    SUBMISSION
      OF CLAIMS

    

    
      	
              15.1

            	
              IPA
                shall submit all claims to Humana
                or
                its designee, as applicable, using the Health Insurance Portability
                and
                Accountability Act of 1996 (“HIPAA”)
                compliant 837 electronic format, or a CMS 1500 and/or UB-92, or their
                successors, within one hundred eighty (180) days from the later of:
                (i)
                the date of service; or (ii) the date of IPA’s
                receipt
                of the explanation of benefits from the primary payor when Humana
                is
                the secondary payor; provided, however, all claims under self-insured
                plans must be submitted within ninety (90) days of the date of service.
                Notwithstanding the foregoing, self-insured plans may specify a shorter
                period of time in which claims must be submitted. Humana
                may, in its sole discretion, deny payment for any claim(s) received
                by
                Humana
                after the later of the dates specified above. IPA
                acknowledges and agrees that Members shall not be responsible for
                any
                payments to IPA
                except for applicable Copayments and non-covered services provided
                to such
                Members

            

    

     

    
      	
              15.2

            	
              Humana
                will process IPA
                claims which are accurate and complete in accordance with Humana’s
                normal claims processing procedures and applicable state and/or federal
                laws, rules and regulations with respect to the timeliness of claims
                processing. Such claims processing procedures may include, without
                limitation, automated systems applications which identify, analyze
                and
                compare the amounts claimed for payment with the diagnosis codes
                and which
                analyze the relationships among the billing codes used to represent
                the
                services provided to Members. These automated systems may result
                in an
                adjustment of the payment to the IPA
                for the services or in a request, prior to payment, for the submission
                for
                review of medical records that relate to the claim. A reduction in
                payment
                as a result of claims policies and/or processing procedures is not
                an
                indication that the service provided is a non-covered service. In
                no event
                may IPA
                bill
                a member for any amount adjusted in payment.

            

    

    

    
      	
              15.3

            	
              IPA
                shall use best efforts to submit all claims to Humana
                by
                electronic means available and accepted as industry standards that
                are
                mutually agreeable, and which may include claims clearinghouses or
                electronic data interface companies used by Humana.
                IPA
                acknowledges that Humana
                may market certain products that will require electronic submission
                of
                claims in order for IPA
                to
                participate.

            

    

    
      

        
          	
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    COORDINATION
      OF BENEFITS

    

    
      	
              16.1

            	
              When
                a Member has coverage, other than with Humana,
                which requires or permits coordination of benefits from a third party
                payor in addition to Humana,
                Humana
                will coordinate its benefits with such other payor(s). In all cases,
                Humana
                will coordinate benefits payments in accordance with applicable laws
                and
                regulations and in accordance with the terms of its health benefits
                contracts. When permitted to do so by such laws and regulations and
                by its
                health benefits contracts, Humana
                will pay the lesser of: (i) the amount due under this Agreement;
                (ii) the
                amount due under this Agreement less the amount payable or to be
                paid by
                the other payor(s); or (iii) the difference between allowed billed
                charges
                and the amount paid by the other payor(s). In no event, however,
                will
                Humana,
                when its plan is a secondary payor, pay an
                amount, which, when combined with payments from the other payor(s),
                exceeds the rates set out in this Agreement; provided, however, if
                Medicare is the primary payer, Humana
                will, to the extent required by applicable law, regulation or Centers
                for
                Medicare and Medicaid Services (“CMS”)
                Office of Inspector General (“OIG”)
                guidance, pay IPA
                an
                amount up to the amount Humana
                would have paid, if it had been primary, toward any applicable unpaid
                Medicare deductible or coinsurance.

            

    

    

    NO
      LIABILITY TO MEMBER FOR PAYMENT

    

    
      	
              17.1

            	
              IPA
                agrees that in no event, including, but not limited to, nonpayment
                by
                Humana,
                Humana’s
                insolvency or breach of this Agreement, shall IPA
                or
                any Participating Provider bill, charge, collect a deposit from,
                seek
                compensation, remuneration or reimbursement from, or have any recourse
                against Members or persons other than Humana
                (or the payor issuing the health benefits contract administered by
                Humana)
                for Covered Services provided by IPA.
                This provision shall not prohibit collection by IPA
                from Member for any non-covered service and/or Copayments in accordance
                with the terms of the applicable Member health benefits
                contract.

            

    

    

    
      	
              17.2

            	
              IPA
                further
                agrees that: (i) this provision shall survive the expiration or
                termination of this Agreement regardless of the cause giving rise
                to
                expiration or termination and shall be construed to be for the benefit
                of
                the Member; (ii) this provision supersedes any oral or written contrary
                agreement now existing or hereafter entered into between IPA
                and
                Member or persons acting on their behalf; and (iii) this provision
                shall
                apply to all employees, agents, trustees, assignees, subcontractors,
                and
                independent contractors of IPA,
                and IPA
                shall
                obtain from such persons specific agreement to this
                provision.

            

    

    

    
      	
              17.3

            	
              Any
                modification to this Section
                17
                shall not become effective unless approved by the Commissioner of
                Insurance, in the event such approval is required by applicable state
                law
                or regulation, or such changes are deemed approved in accordance
                with
                state law or regulation.

            

    

    

    ACCESS
      TO INFORMATION

    

    
      	18.1	
              IPA
                agrees
                that Humana,
                or any state or federal regulatory agency as required by law, shall
                have
                reasonable access and an opportunity to examine IPA’s
                financial and administrative records as they relate to services provided
                to Members during normal business hours, on at least seventy-two
                (72)
                hours advance notice, or such shorter notice as may be imposed on
                Humana
                by
                a federal or state regulatory agency or accreditation organization.
                

            

    

    

    NEW
      PRODUCT INTRODUCTION

    

    
      	19.1	
              From
                time to time during the term of this Agreement, Humana
                may develop or implement new products. Should Humana
                offer participation in any such new product to IPA,
                IPA
                shall
                be provided with ninety (90) days' written notice prior to the
                implementation of such new product. If IPA
                does
                not object in writing to its participation in such new product within
                such
                ninety (90) day notice period, IPA
                shall
                be deemed to have accepted participation in the new product. In the
                event
                IPA
                objects
                to its participation in a new product, the parties shall confer in
                good
                faith to reach agreement on the terms of IPA’s
                participation. If agreement on such new product cannot be reached,
                such
                new product shall not apply to this Agreement. Humana
                may in its discretion, establish, develop, manage and market provider
                networks in which IPA
                may
                not be selected to participate.

            

    

    
      

        
          	
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    ASSIGNMENT
      AND DELEGATION

    

    
      	
              20.1

            	
              The
                assignment by IPA
                of
                this Agreement or any interest hereunder shall require notice to
                and the
                written consent of Humana.
                As used in this paragraph, the term “assignment” shall also include a
                change of control in IPA’s
                practice by
                merger, consolidation, transfer, or the sale of thirty-three percent
                (33%)
                or more stock or other ownership interest in IPA’s
                practice.
                Any attempt by IPA
                to
                assign this Agreement or any interest hereunder without complying
                with the
                terms of this paragraph shall be void and of no effect, and Humana,
                at its option, may elect to terminate this Agreement upon thirty
                (30) days
                written notice to IPA,
                without any further liability or obligation to IPA.
                Humana
                may assign this Agreement in whole or in part to any purchaser of
                or
                successor to the assets or operations of Humana,
                or to any affiliate of Humana,
                provided that the assignee agrees to assume Humana’s
                obligations under this Agreement. Upon notice of an assignment by
                Humana,
                IPA
                may
                terminate this Agreement upon thirty (30) days written notice to
                Humana.

            

    

    

    COMPLIANCE
      WITH REGULATORY REQUIREMENTS

    

    
      	
              21.1

            	
              IPA
                acknowledges,
                understands and agrees that this Agreement may be subject to the
                review
                and approval of state regulatory agencies with regulatory authority
                over
                the subject matter to which this Agreement may be subject. Any
                modification of this Agreement requested by such agencies or required
                by
                applicable law or regulations shall be incorporated herein as provided
                in
                Section
                23.10,
                of this Agreement.

            

    

    

    
      	21.2	
              IPA
                and
                Humana
                agree to be bound by and comply with the provisions of all applicable
                state and/or federal laws, rules and regulations. The alleged failure
                by
                either party to comply with applicable state and/or federal laws,
                rules or
                regulations shall not be construed as allowing either party a private
                right of action against the other in any court, administrative or
                arbitration proceeding in matters in which such right is not recognized
                or
                authorized by such law or regulation.  IPA
                and Participating Providers agree to procure and maintain for the
                term of
                this Agreement all license(s) and/or certification(s) as is required
                by
                applicable law and Humana’s
                policies and procedures. IPA
                shall
                notify Humana
                immediately of any changes in licensure or certification status of
                IPA
                or
                Participating Providers. If IPA
                or
                any individual Participating Provider violates any of the provisions
                of
                applicable state and/or federal laws, rules and regulations, or commits
                any act or engages in conduct for which IPA’s
                or
                Participating Providers’ professional licenses are revoked or suspended,
                or otherwise is restricted by any state licensing or certification
                agency
                by which IPA
                or
                Participating Providers are licensed or certified, Humana
                may immediately terminate this Agreement or any individual Participating
                Provider. 

            

    

    

    DISPUTE
      RESOLUTION/LIMITATIONS ON PROCEEDINGS

    

    
      	
              22.1

            	
              IPA
                may
                contest the amount of the payment, denial or nonpayment of a claim
                only
                within a period of eighteen (18) months following the date such claim
                was
                paid, denied or not paid by the required date by Humana.
                In order to contest such payments, IPA
                shall
                provide to Humana,
                at a minimum, in a clear and acceptable written format, the following
                information: Member name and identification number, date of service,
                relationship of the Member to the patient, claim number, name of
                the
                provider of the services, charge amount, payment amount, the allegedly
                correct payment amount, difference between the amount paid and the
                allegedly correct payment amount, and a brief explanation of the
                basis for
                the contestation. Humana
                will review such contestation(s) and respond to IPA
                within
                thirty (30) days of the date of receipt by Humana
                of
                such contestation. Notwithstanding the foregoing, in the event the
                claims
                contestation is subject to resolution under Section 7.11 of the MDL
                Settlement, IPA
                may
                elect to pursue resolution thereunder in lieu of the contestation
                procedure set forth in this Section
                22.1;
                provided, however, any commencement of an appeal under Section 7.11
                shall
                be brought within the eighteen (18) month timeframe set forth in
                this
                Section
                22.1
                or
                shall otherwise be barred. Further, in the event IPA
                fails to exercise the contestation rights set forth in this Section
                22.1,
                IPA
                shall not be entitled to pursue an appeal under Section 7.10 of the
                MDL
                Settlement. 

            

    

    
      

        
          	
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              22.2

            	
              In
                the event of a determination, following either the review of the
                claims
                contestations by Humana,
                or following the arbitration proceedings described in Section
                12.2
                above, that the claims in dispute, in the aggregate, were processed
                and
                paid correctly, IPA
                shall,
                upon request of Humana,
                reimburse Humana
                for its costs in reviewing the claims contestations and reprocessing
                the
                claims and, in the event the matter was submitted by either party
                for
                arbitration, the costs and expenses, and attorneys fees incurred
                by
                Humana
                that are attributable to the arbitration proceeding. In the event
                of a
                determination, following either the review of the claims contestations
                by
                Humana
                or
                following the arbitration proceedings described in Section
                12.2
                above, that the claims in dispute, in the aggregate, were not processed
                and paid correctly by Humana,
                Humana
                shall, upon request of IPA,
                reimburse IPA’s
                costs
                in preparing the claims contestation submission to Humana,
                and, in the event the matter was submitted by either party for
                arbitration, the costs and expenses, and attorneys fees incurred
                by
                IPA
                that
                are attributable to the mediation or arbitration
                proceeding.

            

    

    

    MISCELLANEOUS
      PROVISIONS

    

    
      	
              23.1

            	
              SEVERABILITY.
                If any part of this Agreement should be determined to be invalid,
                unenforceable, or contrary to law, that part shall be reformed, if
                possible, to conform to law, and if reformation is not possible,
                that part
                shall be deleted, and the other parts of this Agreement shall remain
                fully
                effective.

            

    

    

    
      	
              23.2

            	
              GOVERNING
                LAW.
                This Agreement shall be governed by and construed in accordance with
                the
                applicable laws of the State of Florida. The parties agree that applicable
                state and/or federal laws and/or regulations may make it necessary
                to
                include in this Agreement specific provisions relevant to the subject
                matter contained herein. Such state law provisions, if any, are set
                forth
                     in the state law coordinating provisions attachment hereto.
                Such federal law provisions, if any, are set forth in the Medicare
                Advantage provisions attachment hereto.
                The parties agree to comply with any and all such provisions and
                in the
                event of a conflict between the provisions in the state law coordinating
                provisions attachment and/or
                the Medicare Advantage provisions attachment and
                any other provisions in this Agreement, the provisions in those
                attachments, as applicable, shall control. In the event that state
                and/or
                federal laws and/or regulations enacted after the Effective Date
                expressly
                require specific language be included in this Agreement, such provisions
                are hereby incorporated by reference without further notice by or
                action
                of the parties and such provisions shall be effective as of the effective
                date stated in such laws, rules or
                regulations.

            

    

    

    
      	23.3	
              WAIVER.
                The waiver, whether express or implied, of any breach of any provision
                of
                this Agreement shall not be deemed to be a waiver of any subsequent
                or
                continuing breach of the same provision. In addition, the waiver
                of one of
                the remedies available to either party in the event of a default
                or breach
                of this Agreement by the other party shall not at any time be deemed
                a
                waiver of a party's right to elect such remedy at any subsequent
                time if a
                condition of default continues or
                recurs.

            

    

    

    
      	
              23.4

            	
              NOTICES.
                Any notices, requests, demands or other communications, except notices
                of
                changes in policies and procedures pursuant to Section
                7,
                required or permitted to be given under this Agreement shall be in
                writing
                and shall be deemed to have been given: (i) on the date of personal
                delivery; or (ii) provided such notice, request, demand or other
                communication is received by the party to which it is addressed in
                the
                ordinary course of delivery: (a) on the third day following deposit
                in the
                United States mail, postage prepaid or by certified mail, return
                receipt
                requested; (b) on the date of transmission by facsimile transmission;
                or
                (c) on the date following delivery to a nationally recognized overnight
                courier service, each addressed to the other party at the address
                set
                forth below their respective signatures to this Agreement, or to
                such
                other person or entity as either party shall designate by written
                notice
                to the other in accordance herewith. Humana
                may also provide such notices to IPA
                by
                electronic means to the e-mail address of IPA
                set
                forth on the Cover Sheet to this Agreement or to other e-mail addresses
                IPA
                provides
                to Humana
                by
                notice as set forth herein. Unless a notice specifically limits its
                scope,
                notice to any one party included in the term “IPA”
                or “Humana”
                shall constitute notice to all parties included in the respective
                terms.

            

    

     

    
      	
              23.5

            	
              CONFIDENTIALITY.
                IPA
                agrees that the terms of this Agreement and information regarding
                any
                dispute arising out of this Agreement are confidential, and agrees
                not to
                disclose the terms of this Agreement nor information regarding any
                dispute
                arising out of this Agreement to any third party without the express
                written consent of Humana,
                except pursuant to a valid court order, or when disclosure is required
                by
                a governmental agency. Notwithstanding anything to the contrary herein,
                the parties acknowledge and agree that IPA
                may
                discuss the payment methodology included herein with Members requesting
                such information.

            

    

    
      

        
          	
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              23.6

            	
              COUNTERPARTS,
                HEADINGS AND CONSTRUCTION.
                This Agreement may be executed in one or more counterparts, each
                of which
                shall be deemed an original, and all of which together constitute
                one and
                the same instrument. The headings in this Agreement are for reference
                purposes only and shall not be considered a part of this Agreement
                in
                construing or interpreting any of its provisions. Unless the context
                otherwise requires, when used in this Agreement, the singular shall
                include the plural, the plural shall include the singular, and all
                nouns,
                pronouns and any variations thereof shall be deemed to refer to the
                masculine, feminine or neuter, as the identity of the person or persons
                may require. It is the parties desire that if any provision of this
                Agreement is determined to be ambiguous, then the rule of construction
                that such provision is to be construed against its drafter shall
                not apply
                to the interpretation of the provision.

            

    

    

    
      	
              23.7

            	
              INCORPORATION
                OF ATTACHMENTS.
                All attachments attached
                hereto are incorporated herein by reference.

            

    

    

    
      	
              23.8

            	
              FORCE
                MAJEURE.
                Neither party to this Agreement shall be deemed to breach its obligations
                under this Agreement if that party's failure to perform under the
                terms of
                this Agreement is due to an act of God, riot, war or natural
                disaster.

            

    

    

    
      	
              23.9

            	
              ENTIRE AGREEMENT.
                This Agreement, including the attachments, addenda and amendments
                hereto
                and the documents incorporated herein, constitutes the entire agreement
                between Humana
                and IPA
                with
                respect to the subject matter hereof, and it supersedes any prior
                or
                contemporaneous agreements, oral or written, between Humana
                and IPA.

            

    

    

    
      	
              23.10

            	
              MODIFICATION OF AGREEMENT.
                 This
                Agreement may be amended in writing as mutually agreed upon by
                IPA
                and
                Humana.
                In addition, Humana
                may amend this Agreement upon ninety (90) days' written notice to
                IPA.
                Failure of IPA
                to
                object in writing to such amendment during the ninety (90) day notice
                period shall constitute acceptance of such amendment by IPA.
                

            

    

    

    
      	
              23.11

            	
              MATERIAL
                ADVERSE CHANGES.
                Notwithstanding anything to the contrary in Sections
                6,
                7.1,
                19.1,
                23.10
                or
                the payment attachment, in the event Humana
                makes
                a material adverse change in the terms of this Agreement it shall
                provide
                at least ninety (90) days written notice to IPA
                of
                such change; except where a shorter notice period is required to
                comply
                with applicable law or regulation. If IPA
                objects
                to the change that is the subject of the notice, then IPA
                must
                within thirty (30) days of the date of the notice give written notice
                of
                termination of this Agreement which notice shall be effective at
                the end
                of the notice period of the material adverse change; provided, however,
                if
                Humana
                provides
                written notice within sixty-five (65) days of the date of the original
                notice of the material adverse change that it will not implement
                such
                change as to IPA,
                then IPA’s
                notice of termination shall be of no force or effect.
                

            

    

    

    CONTRACTING
      LIMITATIONS

    

    
      	
              24.1

            	
              Unless
                otherwise agreed to in writing by Humana, IPA and its affiliated
                companies
                agree not to enter into any risk contract (including global, full
                and
                limited risk and capitated contracts) with any other health maintenance
                organization, health insurance company, health benefits organization,
                prepaid health plan or similar entity providing prepaid health services
                and/or any affiliated companies thereof and who underwrite, administer,
                market or otherwise participate in the Medicare Advantage (formerly
                known
                as Medicare+Choice) program and have a contract with the Centers
                for
                Medicare and Medicaid Services covering the following counties in
                the
                State of Florida, specifically: Martin, St. Lucie, Okeechobee and
                Glades
                counties (“Medicare
                Advantage Competitor”).
                Failure to comply with the provisions of this paragraph will constitute
                cause for termination of the Agreement.

            

    

    

    
      	
              24.2

            	
              IPA
                represents and warrants that the execution, delivery and performance
                of
                the terms of the “Contracting Limitations” provision does not and will not
                constitute a breach of any other contract to which IPA is
                subject.

            

    

    
      

        
          	
                  IPA_FL_08152006

                	
                  11

                	 

        

         

      

    

    
      
        
        

      

      
        
        

        
          

        

      

      
        
        

      

       

    

    
      	
              24.3

            	
              The
                parties agree that this “Contracting Limitations” Section 24 does not in
                any way: (a) require IPA to terminate his/her/its relationship with
                any
                Medicare Advantage Competitor or patient; or (b) restrict IPA’s ability to
                treat patients, including those currently enrolled in a Medicare
                Advantage
                Competitor, on a self-pay and/or out-of-network and/or emergency
                basis; or
                (c) apply or relate to any of IPA’s contractual relationships with health
                maintenance organizations, health insurance companies, health benefits
                organizations, prepaid health plans or similar entities providing
                coverage
                for health services and/or any affiliated companies thereof as they
                apply
                to commercial or self-insured programs or
                plans.

            

    

    

    
      	
              24.4

            	
              The
                parties hereby agree that this “Contracting Limitations” Section 24 shall
                terminate on December 31, 2013 (the “Contracting Limitations Termination
                Date”)

            

    

    

    NON-SOLICITATION

     

    
      	
              25.1

            	
              IPA
                acknowledges that Humana
                has invested and will invest substantial resources including funds,
                time,
                effort and goodwill in building a roll of Medicare Advantage Members
                to be
                treated by IPA
                or IPA Participating Provider.
                Therefore, IPA
                agrees that IPA
                and or any of IPA’s
                Participating Providers, employees, principals or financially related
                entities, shall not solicit, persuade, induce, coerce or otherwise
                cause
                the disenrollment of any Medicare Advantage Member at any time, directly
                or indirectly. If thirty-five (35) or more Medicare Members assigned
                to an
                individual IPA
                Participating Provider disenroll from Humana due to IPA’s
                directly or indirectly soliciting, persuading, inducing, coercing
                or
                otherwise causing the disenrollment of such Medicare Advantage Members
                to
                be treated by IPA
                or
                IPA's
                Participating Provider, employees, principals or other financially
                related
                entity under some other prepaid health care benefit plan other than
                Humana's,
                IPA
                shall pay Humana
                the amount of three thousand dollars ($3,000.00) for each disenrolled
                Medicare Advantage Member who is treated by IPA,
                or any of IPA’s
                Participating Provider, employees, principals or any financially
                related
                entity. IPA
                hereby agrees to agree that this amount is not a penalty and constitutes
                liquidated damages in as much as the actual damages are not and cannot
                be
                ascertained at the time of the execution of this Agreement. IPA
                understands that this liquidated damages clause does not apply to
                or
                require payment from the Medicare Advantage Members under any
                circumstance. IPA
                further acknowledges and agrees that in the event of termination
                of this
                Agreement, the amount calculated by Humana
                herein as liquidated damages shall be deducted from any amount
                Humana
                may owe IPA
                including, but not limited to any surplus amount owed for services
                rendered by IPA to Members as per the Payment Attachment referenced
                in
                this Agreement. 

            

    

     

    
      	
              25.2

            	
              Humana
                agrees with IPA
                that this paragraph shall not be applicable in the case of any Medicare
                Advantage Member who disenrolls and is treated by IPA
                or
                anyone else as a private patient (i.e. the Medicare Advantage Member
                does
                not enroll in another Medicare Advantage plan.) In addition, Medicare
                Advantage Members who were patients prior to IPA’s participation as a
                Humana Participating Provider under this Agreement or any other prior
                participating agreement with Humana, are excluded from this provision,
                if
                the IPA can furnish documentation to Humana in the form of a list
                of
                his/her patients prior to becoming a Humana Participating Provider.
                IPA
                has the obligation to and agrees to notify Humana immediately of
                the name
                of any Medicare Advantage Member of former Medicare Advantage Member
                treated by IPA or IPA Participating Provider or any other person
                covered
                by this provision. This paragraph shall survive for twelve (12) months
                following the termination or expiration of this Agreement, except
                in the
                event that IPA
                terminates
                this Agreement for material breach of this Agreement by Humana,
                which material breach is finally adjudicated by a court of competent
                jurisdiction or is finally adjudicated by an arbitrator through binding
                arbitration conducted in accordance with Section
                12.

            

    

     

    HUMANA
      CONTRACTING LIMITATIONS

     

    
      	
              26.1

            	
              [*]

            

    

    

    
      	
              26.2

            	
              [*]

            

    

    

    IN
      WITNESS WHEREOF,
      the
      parties have the authority necessary to bind the entities identified herein
      and
      have executed this Agreement to be effective as of the Effective
      Date.

    
      

        
          	
                  IPA_FL_08152006

                	
                  12

                	 

        

         

      

    

    
      
        
        

      

      
        
        

        
          

        

      

      
        
        

      

    

     

    
      
        	IPA/AUTHORIZED
                SIGNATORY	 	HUMANA	 
	 	 	 	 
	
                Signature:_________________________________

              	 	
                Signature:
                  _________________________________

              	 
	 	 	 	 
	
                Printed
                  Name:________________________________

              	 	
                Printed
                  Name:________________________________

              	 
	 	 	 	 
	Title:
                ____________________________________	 	Title:
                ____________________________________	 
	 	 	 	 
	
                Date:____________________________________

              	 	
                Date:
                  ____________________________________

              	 

      

    

     

    Address
      For Notice:

    

    
      	
              IPA:

            	 	
              HUMANA:

            
	 	 	 
	
              250
                South Australian Ave., Ste 400

            	 	
              3501
                SW 160th Ave

            
	
              West
                Palm Beach FL 33401

            	 	
              Miramar,
                FL 33027

            
	 	 	
              Attn:
                Provider Contracting

            
	 	 	 
	 	 	
              Copy
                to:

            
	 	 	
              Humana
                Inc.

            
	 	 	
              P.O.
                Box 1438

            
	 	 	
              Louisville,
                Kentucky 40201-1438

            
	 	 	
              Attn:
                Law Department

            

    

    
      

        
          	
                  IPA_FL_08152006

                	
                  13

                	 

        

         

      

    

    
      
        
        

      

      
        
        

        
          

        

      

      
        
        

      

    

    PRODUCT
      PARTICIPATION LIST

    ATTACHMENT

    

    IPA
      agrees
      to
      participate in the health benefits plan(s) selected below, whether self-funded
      or fully insured, that are offered or administered by Humana.
      

    

    Health
      Benefits Plan (Check only those which apply)

    

    
      	
              Commercial
                HMO Plans

            	
              X

            	 
	 	 	 
	
              Commercial
                HMO Choice Plans

            	
               

            	
              X

            
	 	 	 
	
              Commercial
                PPO Plans

            	
               

            	
              
                X

              

            
	 	 	 
	
              Commercial
                POS Plans

            	
               

            	X
	 	 	 
	
              Commercial
                EPO Plans

            	
               

            	
              X 

            
	 	 	 
	
              Medicare
                PPO Plans

            	
               

            	
              X

            
	 	 	 
	
              Medicare
                HMO Plans

            	
               

            	
              X 

            
	 	 	 
	
              Medicare
                POS Plans

            	
               

            	
              X

            
	 	 	 
	
              Medicaid
                HMO Plans

            	
               

            	
              N/A 

            
	 	 	 
	
              Traditional
                Plans

            	
                  

            	
              X 

            

    

    

      
        	
                IPA_FL_08152006

              	
                14

              	 

      

      

        
          
            
            

          

          
            
            

            
              

            

          

          
            
            

          

        

    

    IPA
      INFORMATION

    ATTACHMENT

    

    (To
      be
      provided by IPA
      prior to
      execution of this Agreement.)

    

    The
      following information is to be listed below for IPA
      and
      each
      Participating Provider: address, phone number, fax number, tax identification
      number, contact person, area of specialty, office hours, and area hospitals
      where IPA
      and
      Participating Providers have admitting privileges and the corresponding hospital
      privilege category.

    

    This
      Agreement is limited to IPA and Participating Providers located in the following
      counties in the state of Florida:

    

    Central
      Region: Marion, Sumter, Lake and Polk 

    

    Gulf
      Coast: Lee, Charlotte, Collier, Manatee and Sarasota

    

    Treasure
      Coast: Martin, St. Lucie, Okeechobee and Glades 

    

      
        	
                IPA_FL_08152006

              	
                15

              	 

      

      

        
          
            
            

          

          
            
            

            
              

            

          

          
            
            

          

        

    

    LETTER
      OF AGREEMENT

    ATTACHMENT

    

    WHEREAS,
      Humana
      Insurance Company, Humana Health Insurance Company of Florida, Inc., Humana
      Medical Plan, Inc., and their affiliates who underwrite or administer health
      plans (hereinafter referred to as "Humana")
      and
Metcare
      of Florida, Inc.
      (hereinafter referred to as "IPA")
      entered into a IPA Participation Agreement (hereinafter "Agreement")
      on
      ___________________,
      AND

    

    WHEREAS,
      IPA
      and
Humana
      agreed
      to be bound by the terms and conditions of the Agreement,
      AND 

    

    WHEREAS,
      the
      undersigned IPA (hereinafter referred to as "Participating
      Provider")
      is a
      member of IPA,
      and a
      Participating Provider pursuant to the Agreement between IPA
      and
      Humana
      ,
AND

    

    WHEREAS,
      Participating
      Provider
      acknowledges and agrees that the joinder of the Humana
      companies above shall not be construed as imposing joint responsibility or
      cross
      guarantee between or among Humana
      companies. 

    

    NOW,
      THEREFORE,
      the
      parties hereby agree as follows:

    

    Participating
      Provider
      agrees
      to abide by all of the terms and conditions set forth in the Agreement, and
      to
      abide by all Humana
      policies
      and procedures established and revised from time to time by Humana
      including, but not limited to, quality assurance, quality improvement, risk
      management, utilization management, credentialing and recredentialing, and
      grievances/appeals.

    

    Participating
      Provider
      unconditionally authorizes Humana
      and
IPA
      to share
      information, including but not limited to credentialing, recredentialing,
      quality management and utilization management information as related to
      treatment of individuals covered under those Humana
      health
      benefits plans covered under the Agreement (hereinafter "Members").
      However, it is understood expressly that the information shall not be shared
      with anyone not a party to the Agreement, unless required by law or pursuant
      to
      prior written consent of Participating
      Provider.

    

    Participating
      Provider
      acknowledges that Participating
      Provider
      has been
      provided an opportunity to read the Agreement, all of the terms of which are
      hereby incorporated by reference. 

    

    Participating
      Provider
      further
      agrees that payment to IPA
      or
Participating
      Provider,
      as
      applicable, from Humana,
      less
      any Copayments owed by the Member, is payment in full for health care services
      provided or arranged for Members in accordance with the applicable Member health
      benefits contract and the terms and conditions of this Agreement. Participating
      Provider
      shall
      look solely to IPA
      for
      payment and agrees that payments made by Humana
      to
IPA
      for
      Covered Services rendered to Members by Participating
      Provider
      constitutes payment in full to Participating
      Provider.
      

    

    Participating
      Provider
      further
      agrees that in the event of termination or expiration of the Agreement, or
      in
      the event IPA
      is
      dissolved for whatever reason, Participating
      Provider
      shall
      continue to provide health care services under the terms and conditions of
      the
      Agreement and Humana
      agrees
      to continue to pay Participating
      Provider
      in
      accordance with the fee-for-service payment arrangements stated in the payment
      attachment of the Agreement, for a period of one hundred and eighty (180) days
      after notice of dissolution of IPA
      or the
      effective date of termination or expiration of the Agreement, during which
      time
      a new IPA agreement may be negotiated between Humana
      and the
      individual Participating
      Provider.
      Humana
      may
      terminate such Participating
      Provider
      participation at any time after dissolution of IPA
      or
      termination or expiration of the Agreement upon written notice to Participating
      Provider.

    

    
      	
              HUMANA

            	 	
              PARTICIPATING
                PROVIDER

            	 
	 	 	 	 
	
              Signature:
                _________________________________

            	 	
              Signature:
                _________________________________

            	 
	
              Print
                Name: ________________________________

            	 	
              Print
                Name: ________________________________

            	 
	
              Date:
                ____________________________________

            	 	
              Date:
                ____________________________________

            	 

    

    

      
        	
                IPA_FL_08152006

              	
                16

              	 

      

      

        
          
            
            

          

          
            
            

            
              

            

          

          
            
            

          

        

    

    Ownership
      Disclosure Form

    

    IPA:

    

    Metcare
      of Florida, Inc 
      

    

    (Must
      be
      indentical to the name shown on the Cover Sheet.)

    

    STATUS:

    

    
      	
              __________________________________ 

            	 	
              Sole
                Proprietorship

            
	 	 	 
	
              __________________________________ 

            	 	
              Professional
                Association

            
	 	 	 
	
              __________________________________ 

            	 	
              Partnership
                or Limited Liability Company

            
	 	 	 
	
              ______________X_________________________________

            	 	
              Corporation

            

    

    

    List
      names and addresses of all principals and indicate percent of ownership, if
      applicable. (“Principal” means any shareholder, officer, director, partner,
      member, manager, joint venturer or anyone else having an ownership in or
      managerial control over IPA.) Attach additional sheets if
      necessary.

    

    
      	
               

            
	 
	
               

            
	 
	
               

            
	 
	 
	
               

            
	 
	
               

            
	 
	
               

            
	 
	 
	
               

            
	 
	
               

            
	 
	
               

            
	 
	 
	
               

            
	 
	
               

            
	 
	
               

            

    

    
      

        
          	
                  IPA_FL_08152006

                	
                  17

                	 

        

         

      

    

    
      
        
        

      

      
        
        

        
          

        

      

      
        
        

      

    

    

      Note:
        Portions of this exhibit indicated by [*] are subject to a confidential
        treatment request, and have been omitted from this exhibit. Complete, unredacted
        copies of this exhibit have been filed with the Securities and Exchange
        Commission as part of the Company’s confidential treatment request.

      

      Percentage
        of Premium Payment Attachment

      

      I:
        PAYMENT FOR MEMBERS ASSIGNED TO IPA PRIMARY CARE
        PHYSICIAN(S)

      

      
        	
                A:

              	
                PAYMENT
                  AND FUNDING
                  ARRANGEMENTS

              

      

      

      Humana
        agrees
        to pay IPA
        for
        Covered Services provided to Medicare HMO Members who have been assigned
        to
IPA
        Primary
        Care Physician(s) according to the payment arrangement set forth below.
IPA
        agrees
        that the payment arrangements and rates set out in below and as further
        identified below shall apply for Covered Services rendered to Humana
        Members.
        The following table sets out the risk shared between Humana
        and
IPA
        of any
        surplus/deficit in the Funds.

      

        
          	 	
                   

                	
                  Total % of

                   Premium 

                  Allocation**

                	
                   

                	
                  Part A

                  Fund Split 

                  IPA/HUMANA*

                	
                   

                	
                  Part B 

                  Fund

                  IPA/HUMANA*

                	
                   

                	
                  Stop-Loss

                  Fund Split 

                  IPA/HUMANA*

                	 
	
                  PRODUCT

                	 	 	 	 	 	 	 	 	 	 	 	 	 
	
                  Medicare
                    HMO

                  (Applicable
                    for Calendar Year 2008)

                	 	 	
                  
                  

                  [*]

                	
                  
                  

                  %

                	 	
                  
                  

                  [*]%/[*]

                	
                  
                  

                  %

                	 	
                  
                  

                  [*]%/[*]

                	
                  
                  

                  %

                	 	
                  
                  

                  [*]%/[*]

                	
                  
                  

                  %

                
	
                  Medicare
                    HMO

                  (Applicable
                    for Calendar Year 2009)

                	 	 	
                  
                  

                  [*]

                	
                  
                  

                  %

                	 	
                  
                  

                  [*]%/[*]

                	
                  
                  

                  %

                	 	
                  
                  

                  [*]%/[*]

                	
                  
                  

                  %

                	 	
                  
                  

                  [*]%/[*]

                	
                  
                  

                  %

                
	
                  Medicare
                    HMO

                  (Applicable
                    for Calendar Year 2010)

                	 	 	
                  
                  

                  [*]

                	
                  
                  

                  %

                	 	
                  
                  

                  [*]%/[*]

                	
                  
                  

                  %

                	 	
                  
                  

                  [*]%/[*]

                	
                  
                  

                  %

                	 	
                  
                  

                  [*]%/[*]

                	
                  
                  

                  %

                
	
                  Medicare
                    HMO

                  (Applicable
                    for Calendar Year 2011 and thereafter)

                	 	 	
                  
                  

                  [*]

                	
                  
                  

                  %

                	 	
                  
                  

                  [*]%/[*]

                	
                  
                  

                  %

                	 	
                  
                  

                  [*]%/[*]

                	
                  
                  

                  %

                	 	
                  
                  

                  [*]%/[*]]

                	
                  
                  

                  %

                

        

      

      

      
        	
                *

              	
                Percentage
                  of surplus or deficit allocated to IPA/Humana
                  as
                  described herein.

              

      

      

      
        	
                **

              	
                Percentage
                  of premium as described below in Section
                  B.

              

      

      
        
          
          

        

        
          
          

          
            

          

        

        
          
          

        

      

      B. PERCENT
        OF PREMIUM CALCULATION METHODOLOGY

      

      I. The
        Medicare HMO percentage of premium shall be based on the income Humana
        collects
        from CMS and any premium from Member for each Member assigned to IPA
        Primary
        Care Physician. 

      

      II. In
        the
        event Humana
        changes
        the benefits offered under Humana's
        health
        care benefit plans, all payments, allocations, fundings and tables established
        or provided for under this Attachment shall be increased or decreased as
        may be
        required in order to directly reflect the actuarial change. 

      

      C. FUND
        DESCRIPTIONS

      

      1. Part
        A Fund

      

      A
        Part A
        Fund shall be established which will consist of the "Part A Revenue" and
        "Part A
        Expenses". The fund shall be calculated as follows:

      

      Part
        A
        Fund Revenue

      

      Part
        A
        Fund Revenue shall consist of amounts equal to the appropriate funding as
        outlined in the Funding Table for those Medicare and Medicaid Members for
        each
        product covered under this Agreement multiplied by the number of Members
        assigned to IPA
        Primary
        Care Physician in each category covered under this Agreement. Such amounts
        shall
        be credited to the Part A Fund as "Part A Revenue".

      

      Part
        A
        Fund Expenses

      

      Part
        A
        Fund Expenses shall consist of amounts equal to the claims and/or capitation
        paid to providers by Humana
        for
        Covered Services provided to Members assigned to IPA
        Primary
        Care Physician, plus an actuarially determined amount for claims incurred
        but
        not reported or paid (IBNR) and a catastrophic withhold amount as calculated
        by
Humana
        for Part
        A Expenses.

      

      Part
        A
        Expenses include, but are not limited to, costs identified for inpatient
        hospital (medical and surgical services), inpatient hospital psychiatric
        services,
        selected outpatient surgery procedures at Humana
        contracted facilities,
        skilled
        nursing home services, applicable disease management programs, home health
        care
        services, and the cost of stop-loss coverage if provided by Humana.
        Part A
        Expenses also include the cost of other Covered Services or costs which may
        be
        determined to be Part A Expenses by Humana
        in the
        normal course of business

      

      2. Part
        B Fund

      

      A
        Part B
        Fund shall be established to pay for Part B Expenses. The fund shall be
        calculated as follows:

      

      Part
        B
        Fund Revenue

      

      Part
        B
        Fund Revenue shall consist of amounts equal to the appropriate funding as
        outlined in the Funding Table for those Medicare and Medicaid Members for
        each
        product covered under this Agreement multiplied by the number of Members
        assigned to IPA
        Primary
        Care Physician in each category covered under this Agreement. Such amounts
        shall
        be credited to the Part B Fund as "Part B Revenue". The funding is LESS amounts
        that may be paid by Humana
        to
IPA
        Primary
        Care Physician as a primary care capitation and amounts allocated to the
        Pharmacy Fund, if the Pharmacy Fund is carved out of the Part B
        Fund.

      

      Part
        B
        Fund Expenses

      

      Part
        B
        Fund Expenses shall consist of amounts equal to the claims and/or capitation
        paid to providers by Humana
        for
        Covered Services provided to Members assigned to IPA
        Primary
        Care Physician, plus an actuarially determined amount for claims incurred
        but
        not reported or paid (IBNR). 

      
        
          
          

        

        
          
          

          
            

          

        

        
          
          

        

      

      

      Part
        B
        Expenses are all costs for Covered Services not defined as Part A Expenses.
        Part
        B Expenses include, but may not be limited to, hospital based physician fees,
        specialists fees, hospital outpatient services, costs for applicable disease
        management programs, outpatient prescription drugs and the cost for stop-loss
        coverage if provided by Humana.
        Part B
        Expenses also include the cost of other Covered Services or costs which may
        be
        determined to be Part B Expenses by Humana
        in the
        normal course of business or as may be determined by CMS to be a Part B Covered
        Service.

      

      Payment
        for IPA Primary Care Physician Services - Capitation

      

      IPA
        agrees
        and shall accept as payment in full a primary care capitation payment for
        Medicare HMO Members which will be mailed to IPA
        for
        medical services on or about the 15th day of each month. The capitation shall
        be
        based on a mutually agreed upon amount on an actuarial equivalent for primary
        care services. The primary care capitation shall be carved out of the Part
        B
        Revenue Fund as defined above. 

      

      Payment
        for IPA Specialist Physician Services

      

      IPA
        agrees
        to accept as payment in full Humana's
        Fee
        Schedule, or Humana’s
        or
IPA’s
        Capitation Payment as applicable, or IPA's
        usual
        and customary charges, whichever is less, less any Co-payments owed by the
        Member, for Covered Services provided to Members. Such cost of IPA
        capitation or fee-for-service reimbursement will be expensed against the
        Part A
        and Part B Funds as described above.

      

      3.
         Stop-Loss
        Coverage

      

      IPA
        shall
        provide and maintain a Stop-Loss program, at IPA
        expense,
        providing protection against excessive Part A and/or Part B costs for Members
        as
        required by any applicable state or federal laws, rules and regulations.
        The
        Stop-Loss program shall be funded directly by IPA, in its sole discretion,
        and
not
        as a
        carve-out from the capitation allocated to the Part A and Part B Funds, with
        a
        stop loss insurance carrier on terms and conditions reasonably acceptable
        to
        IPA.

      

      4.
        Settlement, Reconciliation and Distribution of Funds

      

      The
        aforementioned Part A and Part B Funds (the “Funds”) shall be settled and
        reconciled as follows:

      

      At
        the
        close of each month, after the fourth (4th)
        month
        of this Agreement, any Part A and/or Part B surpluses shall be offset by
        any
        Part A and or Part B deficits. Any resulting net surplus shall be paid the
        IPA
        on or
        about the end of the following month. Any resulting net deficit shall be
        paid to
Humana
        upon
        notification by Humana
        of such
        deficits. In the event the deficit is not paid, the deficit amount will be
        offset against future IPA
        payments.

      

      Prior
        to
        the distribution of monies from any of the Funds, an actuarially justified
        reserve for incurred but not reported or paid (IBNR) and catastrophic withhold
        calculation claim costs will be calculated by Humana
        and such
        IBNR and catastrophic withhold calculation amounts will be held in the Funds.
        Upon termination, final reconciliation of the amounts funded and claims
        satisfied will be made twelve (12) months following the contract termination
        date (the “Final Settlement”). IPA
        will be
        responsible for any net Fund deficits resulting from the Final Settlement
        and
        shall reimburse Humana
        the
        amount of any such deficits within thirty (30) days of receipt of notice
        of such
        deficits. If the Final Settlement shows that the Funds have a positive net
        balance, the balance will be distributed to the IPA
        within
        thirty (30) days after such final settlement.

      
        
          
          

        

        
          
          

          
            

          

        

        
          
          

        

      

      

      Distribution
        of Settlement is
        outlined in the Funding Table above. 

      

      Notwithstanding
        anything to the contrary in this Agreement, IPA
        has the
        right to dispute only that portion of the Final Settlement amount distributed
        that is applicable to claims contested in accordance with Section 22.2
        of this
        Agreement for a period of up to forty-five (45) calendar days from receipt
        of
        such Final Settlement calculation. Regardless of any dispute, Humana
        agrees
        to
        pay any undisputed Final Settlement surplus amounts within forty-five (45)
        days
        of the Final Settlement calculation identified above and IPA
        agrees
        to pay any undisputed Final Settlement deficits amounts to Humana within
        forty-five (45) days of the Final Settlement calculation above. In the event
        of
        such dispute, the parties agree to work toward a mutually agreeable resolution.
        In order for contestations by IPA
        to be
        accepted for review by Humana,
        IPA
        must
        submit those contestations in Humana’s
        defined
        format and according to Humana’s
        specific
        guidelines. Failure to comply with Humana’s
        guidelines and formatting requirements will result in denial of such
        contestations without review and will be considered as if contestations were
        never submitted. If the IPA
        contests
        the payment of a claim as set forth herein, then the IPA
        shall
        provide at a minimum the following information: Member name and identification
        number, date of service, relationship of the Member-patient to the Member
        who
        completed the application for health care benefits coverage with Humana,
        claim
        number, name of the provider of medical services, charge amount, payment
        amount,
        the allegedly correct payment amount, difference between the amount paid
        and the
        allegedly correct payment amount and a brief explanation of the basis for
        the
        contestation. 

      

      The
        parties acknowledge and agree that Humana’s
        decision
        on any contestation of claims in the Final Settlement will be final. In the
        event Humana’s
        review
        of a contestation results in Humana’s
        identification of the need to readjudicate identified claim(s), such amounts
        recovered will be credited to the applicable Primary Care Physician Fund
        when
        such readjudication by Humana
        is
        complete. However, IPA
        agrees
        to pay to Humana
        any
        deficits identified in Humana’s
        review
        of the contestation within thirty (30) days of receipt of Humana’s
        written
        response to the contestation identified above. Failure to contest the amount
        of
        Final Settlement distribution within the time specified above shall result
        in
        the waiver of IPA’s
        right to
        contest such Final Settlement distribution.

      

      5.
        Method of Calculation

      

      Personnel
        from Humana
        will
        be
        available to IPA
        to
        explain the methodology employed in any calculation permitted or required
        hereunder. In addition, the Manual contains general principals to be employed
        in
        calculations and illustrative examples. The parties understand that the method
        of calculation may change if that is necessary to make the results more
        accurate.

      
        
          
          

        

        
          
          

          
            

          

        

        
          
          

        

      

    

    PAYMENT
      ATTACHMENT 

     

    
      
        1.  REIMBURSEMENT

      

    

     

    A. Commercial
      Plan(s) 

    

    IPA
      agrees
      to accept as payment in full from Humana
      for
      Covered Services rendered to Members of commercial plan(s) covered by this
      Agreement, the lesser of IPA’s
      billed
      charges or the amount specified below, less any Copayments due from Members.
      

    

    
      	
              Service:

            	
              Reimbursement:

            
	 	 
	
              Drugs
                & Biologicals

            	
              100
                %
                of Humana’s 201-544 fee schedule 

            
	 	 
	
              All
                other services

            	
              100
                %
                of Humana’s 006-333 fee schedule

            

    

     

    For
      any
      claims for Covered Services rendered to such Members that are billed under
      codes
      not listed on Humana’s
      (006-333) fee schedule, IPA
      agrees
      to accept as payment in full from Humana
      for such
      Covered Services one hundred percent (100%) of Humana’s
      (005-333) fee schedule or IPA’s
      billed
      charges, whichever is less, less any Copayments due from Members. 

    

    For
      services of a physician extender, IPA
      agrees
      and shall require the physician extender to agree to accept as payment in full
      from Humana
      for
      Covered Services rendered to Members of commercial plan(s) covered by this
      Agreement, eighty percent (80%) of Humana’s
      (006-333) fee schedule or IPA’s
      billed
      charges, whichever is less, less any Copayments due from Member.  For
      any
      claims for Covered Services rendered to such Members that are billed under
      codes
      not listed on Humana’s
      (006-333) fee schedule, IPA
      agrees
      and shall require the physician extender to agree to accept as payment in full
      from Humana
      for
      such
      Covered Services eighty percent (80%) of Humana’s
      (005-333)
      fee schedule or IPA’s
      billed
      charges, whichever is less, less any Copayments due from Members.

    

    B. Medicare
      PPO Plan(s) 

    

    IPA
      agrees
      to
      accept as payment in full from Humana
      for
      Covered Services rendered to Members of Medicare PPO plan(s) covered by this
      Agreement, one hundred percent (100%) of Humana’s
      (005-333) fee schedule or IPA's
      billed
      charges, whichever is less, less any Copayments due from Member. 

    

    For
      services of a physician extender, IPA
      agrees
      and shall require the physician extender to agree to accept as payment in full
      from Humana
      for
      Covered Services rendered to  Members
      of Medicare Advantage plan(s) covered by this Agreement, eighty percent (80%)
      of
Humana’s
      (005-333) fee schedule or IPA’s
      billed
      charges, whichever is less, less any Copayments due from Member. 

    

    C. Medicare
      HMO and POS Plan(s)

    

    See
      Percentage of Premium Payment Attachment

     

    
      
        
        

      

      
        
        

        
          

        

      

      
        
        

      

    

    

    D. Traditional
      Plan(s) 

    

    IPA
      agrees
      to accept as payment in full from Humana
      for
      Covered Services rendered to Members of traditional plan(s) covered by this
      Agreement, one hundred percent (100%) of Humana’s
      (005-333) fee schedule, or IPA’s
      billed
      charges, whichever is less, less any Copayments due from Members. 

    

    For
      services of a physician extender, IPA
      agrees
      and shall require the physician extender to agree to accept as payment in full
      from Humana
      for
      Covered Services rendered to Members of commercial plan(s) covered by this
      Agreement, eighty percent (80%) of Humana’s
      (005-333) fee schedule or IPA’s
      billed
      charges, whichever is less, less any Copayments due from Member.  

    

    2.
      Fee
      Schedule Description 

    

    201-544
      Fee Schedule: 

    

    Humana’s
      injectable fee schedule (201-544) uses a percentage of the CMS Average Sales
      Price (ASP) or another industry standard as the basis of the 201-544 fee
      schedule. The fee schedule includes the following administration codes: 90465,
      90466, 90467, 90468, 90471, 90472, 90473, and 90474. Notwithstanding anything
      to
      the contrary in the Agreement, in the event the basis for the schedule is
      changed from a percentage of ASP to another basis, then Humana
      will
      provide ninety (90) days advance notice to IPA,
      of the
      new basis. The list of codes and associated fees are reviewed and updated
      quarterly to reflect market pricing. These quarterly updates, if any, as well
      as
      any change in the basis may result in fees being adjusted either upwardly or
      downwardly. These updates shall be incorporated in the Humana
      injectable fee schedule (201-544) without notice to IPA,
      but will
      be made available to IPA, upon
      request.

    

    006-333
      Fee Schedule:

    

    Humana’s
      (006-333) fee schedule is based upon a modified version of the 2007 Medicare
      Resource Based Relative Value Scale (“RBRVS”)
      fee
      schedule and payment systems, including the site-of-service payment
      differential. Various percentages are applied by Humana
      to
      the
      fees in the schedule for specific Current Procedural Terminology (“CPT”)
      and
      Healthcare Common Procedure Coding System (“HCPCS”)
      codes
      or ranges of CPT and HCPCS codes.

    

    Humana
      may
      modify schedule (006-333) to include codes and/or fees for services that are
      not
      included in this fee schedule (hereinafter “Gap
      Codes”).
      In
      most cases, the Gap Codes are adjusted by Humana
      using
      the relative value unit (“RVU”)
      multiplied by Medicare’s conversion factor and geographic factor to assign the
      fee at the same percentage applied by Humana
      for
      other codes within that code range. 

    

    Additionally,
      Humana
      may
      incorporate new CPT and HCPCS codes into schedule (006-333). The fee
      attributable to such code(s) will be determined by applying the same percentage
      as Humana
      applied
      to other codes within such code range to that code’ s RBRVS which is current as
      of the date of creation of the code.

    

    Humana
      will
      also modify the fee for a code if the RVU for the code changes as herein
      described. RVU increases for a code will be measured by dividing the revised
      Total RVU by the prior Total RVU. “Total RVU” means the sum of all three RVU
      components, physician work, overhead and malpractice. If the resulting quotient
      is 1.25 or greater or .75 or lesser, the revised fee for such code will be
      determined by applying the same percentage as Humana
      applied
      to other codes within such code range to that code’s RBRVS which is current as
      of the date of publication of the revised RVU. 

    
      
        
        

      

      
        
        

        
          

        

      

      
        
        

      

    

    

    Periodic
      updates for new CPT codes, HCPCS codes and/or Gap Codes, or for modifications
      of
      fees resulting from adjustments to a code’s RVU as specified above, shall be
      incorporated into schedule (006-333) without notice to IPA,
      but
      will be available to IPA
      upon
      request. Humana
      may make
      other adjustments and modifications to this fee schedule. In such cases,
Humana
      will
      provide IPA
      a ninety
      (90) day written notice prior to implementation of any other modifications
      and
      adjustments to schedule (006-333). 

    

    005-333
      Fee Schedule:

    

    Humana’s
      (005-333) fee schedule is based on the RBRVS fee schedule and payment systems,
      including the site-of-service payment differential, in effect as of the
      effective date of this Agreement and will change thereafter to reflect the
      annual updates to the schedule made by the Centers for Medicare and Medicaid
      Services (“CMS”).
      Additionally, Humana
      will
      adjust the schedule to include and assign fees for services which are not
      covered by RBRVS. A list of those Humana
      adjusted
      codes and fees will be available to IPA
      upon
      request.

    

    Such
      annual updates by CMS and any corresponding adjustments by Humana
      shall be
      incorporated herein without notice to the IPA,
      but
      will be available to the IPA
      upon
      request. Humana
      may make
      other adjustments and modifications to the fee schedule. In such cases,
Humana
      will
      provide to IPA
      a ninety
      (90) day written notice prior to implementation of any other modifications
      and
      adjustments to the fee schedule.

    

    D. Fee
      Schedule Samples

    

    Humana
      has
      provided a representative sample of these fee schedules to IPA
      prior to
IPA’s
      execution of this Agreement, and thereafter will supply a sample upon written
      request by IPA.
      IPA
      hereby
      acknowledges receipt of fee schedule sample. 

    

    3.
       IPA
      EXTENDERS

    

    IPA
      agrees
      that in the event that IPA
      employs,
      subcontracts or dependently contracts with or uses the services of a physician
      extender (that is a physician assistant, advanced registered nurse practitioner,
      certified registered nurse anesthetist, certified nurse midwife, certified
      surgical assistant, certified registered nurse first assistant or such other
      similarly situated individual) who will be providing services to Humana
      Members
      under the supervision of IPA,
      IPA
      shall
      notify Humana
      in
      writing, upon execution of this Agreement and at any time during the term of
      this Agreement when such physician extenders are employed, subcontracted, or
      independently contracted with IPA,
      and the
      specific services that such physician extenders will be performing, prior to
      the
      provision of services to any Humana
      Member.
IPA
      represents that physician extenders employed by or under contract with
IPA
      will
      comply with the terms and conditions of this Agreement, maintain professional
      liability coverage and are appropriately licensed as required by applicable
      state and federal laws, rules and regulations. IPA
      acknowledges and agrees Humana
      retains
      the right to approve, suspend and/or terminate participation under this
      Agreement of any physician extender who will be providing services to
Humana
      Members.

    

    4.
      SPECIFIC REFERRALS

    

    IPA
      and
      other Participating Providers acknowledge and agree that certain referrals
      are
      required to be made to specific providers designated by Humana.
      The
      specific referral providers include but are not limited to:

     

    
      	
              Services:

            	 	
              Vendor
                Entity:

            
	
              Laboratory

            	 	
              Humana’s
                Current Participating Providers

            
	
              Mental
                Health

            	 	
              Humana’s
                Current Participating Providers

            
	
              Vision

            	 	
              Humana’s
                Current Participating Providers 

            
	
              Podiatry

            	 	
              Humana’s
                Current Participating Providers

            
	
              Dental

            	 	
              Humana’s
                Current Participating Providers

            
	
              Chiropractic

            	 	
              Humana’s
                Current Participating Providers 

            
	
              Hearing

            	 	
              Humana’s
                Current Participating Providers 

            
	
              Admitting

            	 	
              Humana’s
                Current Participating Providers

            
	
              Home
                Health/Infusion/DME

            	 	
              Humana’s
                Current Participating Providers

            

    

    
      
        
        

      

      
        
        

        
          

        

      

      
        
        

      

    

    

    IPA
      and
      other Participating Providers further acknowledge and agree that such specific
      providers may be changed or added to upon written notice by Humana
      to
IPA.

    

    5.
      MISCELLANEOUS 

    

    IPA
      understands that Humana
      may
      market or administer products that contain variable Copayment amounts due from
      the Member for Covered Services based on the medical specialty of certain
      physicians and the unit costs or reimbursement rates provided for in provider
      participation agreements. IPA
      agrees
      to participate in such products and to bill and accept as payment in full for
      Covered Services rendered to Members in such products the reimbursement rates
      set forth above less any Copayment amounts due from the Member. 

    

    In
      circumstances where the Member's Copayment for a Covered Service is equal to
      or
      greater than the rate set forth herein for that service, IPA
      agrees
      to accept as payment in full for the service the Member's Copayment, not to
      exceed the rates set forth herein. Furthermore, in such cases, IPA
      agrees
      to refund to Member the difference, if any, between the Copayment collected
      from
      the Member and such rate. 

    
      
        
        

      

      
        
        

        
          

        

      

      
        
        

      

    

     

    

    HMO
      PROVISIONS

    ATTACHMENT
      

    

    The
      following provisions apply solely to commercial HMO and/or Medicare Advantage
      HMO products and plans, as applicable. 

    

    
      	I.	
              Services
                to Members.  In the event IPA provides
                a Member a non-covered service or refers a Member to an out-of-network
                provider without pre-authorization from Humana,
                IPA shall, prior to the provision of such non-covered
                service or out-of-network referral, inform the Member: (i) of the
                service(s) to be provided or referral(s) to be made; (ii) that
                Humana will not pay or be liable financially for such
                non-covered service(s) or out-of-network referral(s); and (iii) that
                Member will be responsible financially for non-covered service(s)
                and/or
                out-of-network referral(s) that are requested by the Member.
                

            

    

    

    
      	II.	
              Continuity
                of Care. Subject to and in accordance with all
                applicable state and/or federal laws, rules and/or regulations, treatment
                following termination or expiration of this Agreement must continue
                until
                the Member: (i) has been evaluated by a new participating provider
                who has
                had a reasonable opportunity to review or modify the Member's course
                of
                treatment, or until Humana has made arrangements for
                substitute care for the Member; and (ii) until the date of discharge
                for
                Members hospitalized on the effective date of termination or expiration
                of
                this Agreement. IPA agrees to accept as payment in full
                from Humana for Covered Services rendered to such
                Members, the rates set forth in the payment attachment, less any
                Copayments due from such Members.

            

    

    

    
      	III.	
              Medical
                Records. Upon request from Humana or a
                Member, IPA shall transfer a complete copy of the medical
                records of any Member transferred to another IPA and/or facility
                for any
                reason, including termination or expiration of this Agreement. The
                copy
                and transfer of medical records shall be made at no cost to
                Humana or the Member and shall be made within a
                reasonable time following the request, but in no event more than
                five (5)
                business days, except in cases of emergency where the transfer shall
                be
                immediate. IPA agrees that such timely transfer of
                medical records is necessary to provide for the continuity of care
                for
                Members. IPA agrees to pay court costs and/or legal fees
                incurred by Humana or the Member to enforce the terms of this
                provision.

            

    

    

    
      	
              IV.

            	
              Acquisitions. In
                the event IPA acquires, through an asset acquisition,
                merger, consolidation, lease or other means, or enters into a management
                agreement to manage the practice(s) of IPA(s) or IPA group(s) in
                Marion,
                Sumter, Lake, Polk, Lee, Charlotte, Collier, Manatee, Sarasota, Martin,
                St
                Lucie, Okeechobee and Glades counties, and such practices or groups
                have
                in effect an agreement with Humana to provide services to
                Humana’s Members at rates which are more favorable to
                Humana than those contained herein, the rates of such
                acquired practices or groups shall survive and shall not be adjusted
                to
                reflect the rates contained in this Agreement unless agreed to in
                writing
                by both Humana and IPA.

            

    

    

    
      	V.	
              Equal
                Access.  IPA agrees to accept
                Humana Members as patients within the normal scope of
                IPA’s medical practice. If, due to overcapacity,
                IPA closes his/her practice to new patients, such
                closure
                will apply to all prospective patients without discrimination or
                regard to
                payor or source of payment for services. Should IPA
                subsequently reopen his/her practice to new patients, IPA
                agrees to accept Humana Members seeking assignment and/or
                referral to IPA’s practice to the same extent and in the
                same manner as all other non-Humana patients seeking
                IPA’s services. 

            

    

    

    
      	VI.	
              IPA
                Responsibilities. 

            

    

    

    A. Services

    

    IPA
      agrees
      to
      be responsible twenty-four (24) hours a day, seven (7) days a week for providing
      Covered Services for Members including, but not limited to, prescribing,
      directing and monitoring all urgent and emergency care for Members.

    

    IPA
      agrees
      to
      provide Humana
      upon
      request a written description of its arrangements for emergency and urgent
      care
      and service coverage in the event of unavailability due to vacation, illness,
      and after regular office hours. IPA
      shall
      ensure that all IPAs providing such coverage are contracted and credentialed
      IPAs with Humana.
      IPA
      will
      ensure that all IPAs providing such coverage render services under the same
      terms and conditions and in compliance with all provisions of this Agreement.
      Compensation to IPAs for "on call" coverage will be the responsibility of
IPA.

     

    
      
        
        

      

      
        
        

        
          

        

      

      
        
        

      

    

    

    In
      the
      event that emergency or urgent care services are needed by a Member outside
      the
      service area, IPA
      agrees
      to
      monitor and authorize the out-of-area care to provide direct care as soon as
      the
      Member is able to return to the service area for treatment without medically
      harmful or injurious consequences. 

    

    B. Specific
      Referrals 

    

    Except
      in
      the case of a medical emergency, IPA
      agrees
      to
      use its best efforts to admit, refer, and cooperate with the transfer of Members
      for Covered Services only to providers designated, specifically approved by
      or
      under contract with Humana.

    

    In
      addition,
      IPA acknowledges
      and agrees that certain Members may have health benefits contracts that limit
      coverage to certain types of participating providers. For such Members,
      referrals are required to be made to specific providers designated by
Humana.
      

    

    C. Disease/Case
      Management Programs

    

    IPA
      agrees
      to
      participate in Humana’s
      disease/case management programs as they are developed and
      implemented.

    

    D. Humana
      First

    

    IPA
      agrees
      to
      participate in Humana’s
      twenty-four
      (24) hours nurse call program, HumanaFirst, or any such successor
      program.

     

    E. Hospitalist
      Programs

    

    IPA
      agrees
      to
      cooperate with and participate in Humana’s
      hospitalist programs where applicable, as they are developed and
      implemented.

    

    F. Transplant
      Programs

    

    Upon
      request by Humana,
      IPA
      agrees
      to
      cooperate with and participate in Humana’s
      organ
      and tissue transplant programs as they are developed and
      implemented.

    

    G. Health
      Improvement Studies

    

    IPA
      agrees
      to
      participate in Humana’s
      health
      improvement studies as they are developed and implemented.

    

    H. Quality
      Improvement Activities

    

    IPA
      agrees
      to
      cooperate with Humana’s
      quality
      improvement activities and, upon request by Humana,
      to
      participate in Humana’s
      quality
      improvement activities as they are developed and implemented. 

    
      
        
        

      

      
        
        

        
          

        

      

      
        
        

      

    

     

    

    MEDICARE
      ADVANTAGE PROVISIONS

    

    The
      following additional provisions relate specifically to Medicare Advantage
      products and plans and are hereby incorporated by reference into the
      Agreement.

    

    
      	
              a)

            	
              IPA
                agrees to: (i) abide by all federal and state laws regarding
                confidentiality, privacy and disclosure of medical records or other
                health
                and enrollment information, (ii) ensure that medical information
                is
                released only in accordance with applicable state or federal law,
                or
                pursuant to court orders or subpoenas, (iii) maintain all Member
                records
                and information in an accurate and timely manner, and (iv) allow
                timely
                access by Members to the records and information that pertain to
                them.

            

    

    

    
      	
              b)

            	
              Humana
                and IPA agree that Humana will
                process all claims for Covered Services which are accurate and complete
                within thirty (30) days from the date of receipt.
                

            

    

    

    
      	
              c)

            	
              IPA
                agrees that in no event, including, but not limited to, nonpayment
                by
                Humana, Humana’s insolvency or breach of
                this Agreement, shall IPA bill, charge, collect a deposit
                from, seek compensation, remuneration or reimbursement from, or have
                any
                recourse against Members or persons other than Humana (or
                the payor issuing the health benefits contract administered by
                Humana) for Covered Services provided by IPA
                for which payment is the legal obligation of
                Humana. This provision shall not prohibit collection
                by
                IPA from Member for any non-covered service and/or
                Copayments in accordance with the terms of the applicable Member
                health
                benefits contract. IPA further agrees that: (i) this
                provision shall survive the expiration or termination of this Agreement
                regardless of the cause giving rise to expiration or termination
                and shall
                be construed to be for the benefit of the Member; (ii) this provision
                supersedes any oral or written contrary agreement now existing or
                hereafter entered into between IPA and Member or persons
                acting on their behalf; and (iii) this provision shall apply to all
                employees, agents, trustees, assignees, subcontractors, and independent
                contractors of IPA, and IPA shall obtain
                from such persons specific agreement to this
                provision.

            

    

    

    
      	d)	
              IPA
                agrees
                to cooperate with Humana
                in
                its efforts to monitor compliance with its Medicare Advantage contract(s)
                and/or Medicare Advantage rules and regulations and to assist Humana
                in
                complying with corrective action plans necessary for Humana
                to
                comply with such rules and
                regulations.

            

    

    

    
      	
              e)

            	
              IPA
                agrees that nothing in the Agreement shall be construed as relieving
                Humana of its responsibility for performance of duties
                agreed to through its Medicare Advantage contracts existing now or
                entered
                into in the future with CMS.

            

    

    

    
      	
              f)

            	
              IPA
                agrees to comply with and be subject to all applicable Medicare
                program laws, rules and regulations, reporting requirements, and
                CMS
                instructions as implemented and amended by CMS. This includes, without
                limitation, federal and state regulatory agencies’ including, but not
                limited to, HHS, the Comptroller General or their designees rights
                to
                evaluate, inspect and audit IPA’s operations, books,
                records, and other documentation and pertinent information related
                to
                IPA’s obligations under the Agreement, as well as all
                other federal and state laws, rules and regulations applicable to
                individuals and entities receiving federal funds. IPA
                further agrees HHS', the Comptroller General's, or their designees
                right
                to inspect, evaluate and audit any pertinent information for any
                particular contract period will exist through ten (10) years from
                the
                final date of the contract period between Humana and CMS
                or from the date of completion of any audit, whichever is later,
                and
                agrees to cooperate, assist and provide information as requested
                by such
                entities. 

            

    

     

    
      	g)	
              IPA
                agrees to retain all contracts, books, documents, papers
                and
                other records related to the provision of services to Medicare Advantage
                Members and/or as related to IPA’s obligations under the
                Agreement for a period of not less than ten (10) years from: (i)
                each
                successive December 31; or (ii) the end of the contract period between
                Humana and CMS; or (iii) from the date of completion of
                any audit, whichever is later.

            

    

    

    
      	
              h)

            	
              IPA
                agrees in the event certain identified activity(ies) have
                been
                delegated to IPA under the Agreement, any sub-delegation
                of the noted activity(ies) by IPA requires the prior
                written approval of Humana. Notwithstanding anything to
                the contrary in the Agreement, Humana will monitor
                IPA’s performance of any delegated activity(ies) on an
                ongoing basis and hereby retains the right to modify, suspend or
                revoke
                such delegated activity(ies) in the event Humana and/or
                CMS determines, in their discretion, that IPA is not
                meeting or has failed to meet its obligations under the Agreement
                related
                to such delegated activity(ies). In the event that Humana
                has delegated all or any part of the claims payment process to
                IPA under the Agreement, IPA shall
                comply with all prompt payment requirements to which Humana
                is subject. Humana agrees that it shall review
                the credentials of IPA or, if
                Humana has delegated the credentialing process to
                IPA, Humana shall review and approve
                IPA’s credentialing process and audit it on an ongoing
                basis. 

            

    

    
      
        
        

      

      
        1

        
          

        

      

      
        
        

      

    

    

    
      	i)	
              IPA
                agrees to comply with Humana’s policies and
                procedures. 

            

    

    

    
      	
              j)

            	
              IPA
                agrees to maintain full participation status in the federal
                Medicare program. This also includes all of IPA’s
                employees, subcontractors, and/or independent contractors
                who
                will provide services, including, without limitation, health care,
                utilization review, medical social work, and/or administrative services
                under the Agreement.

            

    

    

    
      	
              k)

            	
              IPA
                agrees that payment from Humana for services rendered to
                Humana’s Medicare Advantage Members is derived, in whole
                or in part, from federal funds received by Humana from
                CMS.

            

    

    

    
      	
              l)

            	
              IPA
                agrees to disclose to Humana, upon request and within
                thirty (30) days or such lesser period of time required for
                Humana to comply with all applicable state or federal
                laws, all of the terms and conditions of any payment arrangement
                that
                constitutes a “physician incentive plan” as defined by CMS and/or any
                federal law or regulation. Such disclosure should identify, at a
                minimum,
                whether services not furnished by the physician/provider are included,
                the
                type of incentive plan including the amount, identified as a percentage,
                of any withhold or bonus, the amount and type of any stop-loss coverage
                provided for or required of the physician/provider, and the patient
                panel
                size broken down by total group or individual physician/provider
                panel
                size, and by the type of insurance coverage (i.e., Commercial HMO,
                Medicare Advantage HMO, Medicare PPO, and Medicaid
                HMO).

            

    

    

    
      	
              m)

            	
              IPA
                agrees that in the event of Humana’s insolvency
                or termination of Humana’s contract with CMS, benefits to
                Members will continue through the period for which premium has been
                paid
                and benefits to Members confined in an inpatient facility will continue
                until their discharge.

            

    

    

    
      	
              n)

            	
              IPA
                agrees to provide or arrange for continued treatment, including,
                but not limited to, medication therapy, to Medicare Advantage Members
                upon
                expiration or termination of the Agreement. In accordance with all
                applicable state and federal laws, rules and/or regulations, treatment
                must continue until the Member: (i) has been evaluated by a new
                participating provider who has had a reasonable opportunity to review
                or
                modify the Medicare Advantage Member’s course of treatment, or until
                Humana has made arrangements for substitute care for
                the
                Medicare Advantage Member; and (ii) until the date of discharge for
                Medicare Advantage Members hospitalized on the effective date of
                termination or expiration of the Agreement. IPA agrees to
                accept as payment in full from Humana for Covered
                Services rendered to Humana’s Medicare Advantage Members,
                the rates set forth in the payment attachment which are applicable
                to such
                Member.

            

    

    

    
      	
              o)

            	
              IPA
                agrees to cooperate with the activities and/or requests
                of any
                independent quality review and improvement organization utilized
                by and/or
                under contract with Humana as related to the provision of
                services to Medicare Advantage
                Members.

            

    

    

    
      	p)	
              IPA
                agrees to cooperate with Humana’s health risk
                assessment program.

            

    

    

    
      	
              q)

            	
              IPA
                agrees to provide to Humana accurate and
                complete information regarding the provision of Covered Services
                by
                IPA to Members (“Data”) on a complete
                CMS 1500 or UB 92 form, or their respective successor forms as may
                be
                required by CMS, or such other form as may be required by law when
                submitting claims and encounters in an electronic format, or such
                other
                format as is mutually agreed upon by both parties. The Data shall
                be
                provided to Humana on or before the last day of each
                month for encounters occurring in the immediately preceding month,
                or such
                lesser period of time as may be required in the Agreement, or as
                is
                otherwise agreed upon by the parties in writing. The submission of
                the
                Data to Humana and/or CMS shall include a certification
                from IPA that the Data is accurate, complete and
                truthful. In the event the Data is not submitted to
                Humana by the date and in the form specified above,
                Humana may, in its sole option, withhold payment
                otherwise required to be made under the terms of the Agreement until
                the
                Data is submitted to Humana.

            

    

    
      
        
        

      

      
        2

        
          

        

      

      
        
        

      

    

    

    
      	
              r)

            	
              IPA
                agrees
                not to collect or attempt to collect copayments, coinsurance, deductibles
                or other cost-share amounts from any Humana
                Medicare Advantage Member who has been designated as a Qualified
                Medicare
                Beneficiary (“QMB”)
                by CMS. 

            

    

    

    
      	s)	
              IPA
                agrees to maintain written agreements with
                employed and contracted health care providers and health care
                professionals providing services under the Agreement in a form comparable
                to, and consistent with, the terms and conditions of the Agreement.
                IPA’s downstream provider agreements shall include terms
                and conditions which comply with all applicable requirements for
                provider
                agreements under state and federal laws, rules and regulations including,
                without limitation, the Medicare Advantage rules and regulations
                to which
                Humana is subject. In the event of a conflict between
                the
                language of the downstream provider agreements and the Agreement,
                the
                language in the Agreement shall control.

            

    

    
      
        
        

      

      
        3

        
          

        

      

      
        
        

      

    

     

    

    STATE
      LAW COORDINATING PROVISIONS

    ATTACHMENT

    

    FLORIDA

    

    [Please
      note that none of the provisions of this attachment apply to any Medicare
      line(s) of business covered by this Agreement.]

    

    Humana
      and
IPA
      agree
      that the following provisions are incorporated into the Agreement solely to
      the
      extent specifically required to ensure compliance with applicable Florida laws,
      rules and regulations.

     

    Term
      and Termination

    

    
      	 	
              1

            	
              This
                Agreement may be terminated upon issuance of an order by the Office
                of
                Insurance Regulation (“OIR”) requiring such termination pursuant to
                section 641.234, The issuance of such an order by the OIR will not
                affect
                the termination of the entire Agreement which shall remain in full
                force
                and effect with respect to Humana Health Insurance Company of Florida,
                Inc. and/or Humana Insurance Company and product lines contemplated
                in the
                Agreement to which this provision is made a
                part.

            

    

    

    
      	 	
              2

            	
              As
                required under Florida Statute §641.315, IPA shall
                provide the OIR and Agency for Health Care Administration (“AHCA”) with
                sixty (60) days notice of any intended termination of the Agreement
                Humana shall also provide sixty (60) days advance written
                notice to the IPA at the address listed in the “Notice”
                Article of this Agreement, and to the OIR before canceling, without
                cause,
                this Agreement with IPA. Nonpayment for goods or services
                rendered by IPA to Humana or any of its
                Members shall not be a valid reason for avoiding such sixty (60)
                day
                advance notice of cancellation. Upon receipt by Humana of
                a sixty (60) day cancellation notice, Humana, if
                requested by the IPA, may terminate the contract in less
                than sixty (60) days if Humana is not financially
                impaired or insolvent. 

            

    

    

    
      	 	
              3

            	
              Humana
                and IPA hereby acknowledge and agree that the provisions
                stated in the previous paragraph do not relieve the IPA
                of any of their other obligations under this Agreement that are not
                inconsistent with the foregoing, including without limitation, any
                obligation IPA has to provide more than sixty (60) days
                notice of cancellation of this Agreement to
                Humana.

            

    

    

    
      	 	
              4

            	
              In
                the event that this Agreement expires and/or is terminated for whatever
                reason, IPA shall continue Member(s)’ course of treatment
                at the payment rates set out in the payment attachment, including,
                but not
                limited to medication therapy, until the earlier of the following
                occurrence: (i) the expiration of six (6) months past the effective
                date
                of expiration or termination; or (ii) the Member(s) has been evaluated
                by
                a new Participating Physician and the new Participating Physician
                has had
                a reasonable opportunity to review or modify Member(s)’ course of
                treatment; or (iii) the completion of the Member’s course of treatment
                which the Member began prior to the effective date of expiration
                or
                termination of this Agreement; or (iv) for those Members who are
                pregnant,
                until completion of postpartum care.

            

    

    

    Grievance
      and Appeals/Binding Arbitration/Dispute Resolution

    

    
      	 	
              5

            	
              IPA
                shall post in its facility reception areas, a notice to Members on
                the
                process for resolving complaints with Humana. Such notice
                shall include the Florida Agency for Health Care Administration (AHCA),
                the Florida Subscriber Assistance Program and the Florida Office
                of
                Insurance Regulation respective addresses and toll-free telephone
                numbers
                for filing complaints. In addition, IPA will make
                Humana’s Grievance Department address and telephone
                number available to Members upon
                request.

            

    

    

    
      	 	
              6

            	
              Physician
                acknowledges and agrees that in the event it is unable to resolve
                directly
                disputes that may arise with Humana, IPA
                will exhaust all internal Humana administrative appeal,
                grievance or other dispute resolution mechanisms prior to the submission
                of any unresolved disputes to a third
                party.

            

    

     

    
      
        
        

      

      
        
        

        
          

        

      

      
        
        

      

    

    

    IPA
      has the
      right to dispute reimbursement of a claim for a period of up to twelve (12)
      months from the date such claim was paid or denied by Humana.
      In the
      event of such a dispute, the parties agree to work toward a mutually agreeable
      resolution of such dispute. IPA
      shall
      provide at a minimum the following information if the IPA
      contests
      the payment of a claim as set out herein: Member name and identification number,
      date of service, relationship of the Member-patient to the Member who completed
      the application for health benefits coverage with Humana,
      claim
      number, name of the IPA
      of
      medical and related health care services, charge amount, payment amount, the
      allegedly correct payment amount, difference between the amount paid and the
      allegedly correct payment amount and a brief explanation of the basis for the
      contestation. Humana
      will
      review such contestation(s) and respond to Group within thirty (30) days of
      the
      date of receipt by Humana
      of such
      contestation. The parties agree to use their best efforts to negotiate a
      mutually agreeable resolution within the sixty (60) day period following
      submission of the claim contestation to Humana.
      In the
      event the parties are unable to come to a mutually agreeable resolution within
      the above noted sixty (60) day time period, either party may submit such
      disputed claims to binding arbitration as stated below. Failure to contest
      the
      amount of any claim hereunder within the time specified above shall result
      in a
      waiver of IPA’s
      right to
      contest such claim amount distributed.

    

    In
      the
      event IPA
      continues to dispute or contest the payment or denial of a claim for Covered
      Services rendered Members, following the parties attempts to negotiate a
      mutually agreeable resolution, IPA
      may
      submit such claims payment disputes or contestations to the claim dispute
      resolution program established under §408.7057, Florida Statutes as provided for
      and in accordance with the specific terms and limitations set forth thereunder.
      The parties agree that the date a claim is paid or denied by Humana,
      or its
      designee, is the ‘final determination’ of Humana
      for
      purposes of any claims payment disputes that may be submitted to the Florida
      claim dispute resolution program hereunder. IPA
      acknowledges and agrees that should IPA
      continue
      to dispute the payment or denial of a claim for Covered Services following
      submission to the above noted Florida claim dispute resolution program, such
      unresolved claims disputes are subject to the binding arbitration provision
      set
      forth below. IPA
      further
      acknowledges and agrees that all other disputes under this Agreement are subject
      to the binding arbitration provision set forth below. 

    

    Notwithstanding
      the above and subject to Sections 21.1and 21.2 above, IPA
      may
      elect to submit such unresolved claim payment disputes or contestations for
      a
      claim for Covered Services rendered to Members to binding arbitration as set
      forth below. Should IPA
      elect to
      submit such unresolved claim disputes or contestations to binding arbitration,
      IPA
      acknowledges and agrees that such submission to binding arbitration is the
      final
      and exclusive remedy for such unresolved claim payment disputes or
      contestations.

    

    Subject
      to this section, in the event of a dispute between IPA
      and
Humana
      which is
      not resolved as set forth above or which the parties cannot settle by mutual
      agreement, the dispute shall be resolved by binding arbitration, conducted
      by a
      single arbitrator selected by the parties from a panel of arbitrators proposed
      by the American Arbitration Association (“AAA”).
      This
      applies, without limitation, to any dispute arising out of the parties’ business
      relationship, including allegations or claims involving violations of state
      or
      federal laws or regulations. In the event the parties cannot agree on the
      arbitrator, then the arbitrator shall be appointed by the AAA. The arbitration
      shall be conducted in Broward
      County,
      Florida, in accordance with and subject to the Commercial Arbitration Rules
      of
      the AAA then in effect, or under such other mutually agreed upon guidelines.
      Judgment upon the award rendered in any such arbitration may be entered in
      any
      court of competent jurisdiction sitting in Florida or Kentucky or application
      may be made to such court for judicial acceptance and enforcement of the award,
      as applicable law may require or allow. The submission of any dispute to
      arbitration shall not adversely affect any party’s right to seek preliminary
      injunctive relief with respect to an actual or threatened termination,
      repudiation or rescission of the Agreement. The cost of any arbitration
      proceeding(s) hereunder shall be borne equally by the parties. Each party shall
      be responsible for its own attorneys’ fees and such other costs and expenses
      incurred related to the proceedings. Arbitration proceeding(s) hereunder shall
      be conducted solely between IPA
      and
Humana,
      class-based arbitration shall not be permitted. The parties agree that in the
      event an issue or dispute is submitted by either party to the binding
      arbitration process set forth herein, the result will be the final and exclusive
      remedy and by submission to binding arbitration, the parties waive other
      remedies that may be available at law. The parties agree this Agreement is
      a
      transaction involving interstate commerce and therefore that the Federal
      Arbitration Act, 9 U.S.C. §1 et seq. applies.

    
      
        
        

      

      
        
        

        
          

        

      

      
        
        

      

    

    

    Claims
      Submission and Payment

    

    
      	 	
              7

            	
              IPA
                agrees to submit all claims eligible for payment as provided under
                this
                Agreement within: (i) one hundred eighty (180) days from the date
                of
                service or date of discharge from an inpatient facility, as applicable,
                for primary insurers; and (ii) ninety (90) days following the date
                of
                final determination by the primary insurer for secondary insurers.
                Humana
                may, at its sole discretion, deny payment for any such claim(s) received
                after the above noted time periods. IPA
                acknowledges and agrees that at no time shall Members be responsible
                for
                any payments in addition to applicable Copayments for Covered Services
                provided to such Members. In the event the payment is denied as described
                herein, the Member’s Copayment, if any, shall be adjusted
                accordingly.

            

    

    

    In
      accordance with requirements for requests for refund of overpayments of claims
      established under Florida law, IPA
      shall be
      notified in writing by Humana
      of any
      monies IPA
      may owe
Humana,
      for any
      reason, and Hospital shall have: (i) forty (40) days from receipt of such
      notification to refund overpayments of claims due to Humana
      under
      this Agreement; or (ii) thirty-five (35) days from receipt of such notification
      to contest or deny the request. The IPA’s
      contestation or denial of overpayment of claims owed must be in writing and
      must
      state the specific reason for contesting or denying. IPA
      agrees
      that as the mutually agreed upon method of reconciliation for requests for
      refund of overpayment of claims amounts due hereunder, Humana
      may
      deduct monies that otherwise may be due and payable to Humana
      from any
      outstanding monies that Humana
      may, for
      any reason, owe IPA,
      if: (a)
IPA
      agrees
      in writing to the offset of monies; or (b) IPA
      does not
      appropriately respond to a request for refund of overpayments as indicated
      hereunder within the above noted time periods. The parties agree that requests
      for refund of overpayments of claims are limited to the thirty (30) month period
      following the date the claim was paid, except in cases of fraud. 

    

    Notwithstanding
      anything to the contrary in this Agreement and subject to requests for refund
      of
      overpayments of claims, IPA
      agrees
      that Humana
      may make
      retroactive adjustments to the payments made in accordance with the payment
      arrangements outlined in the payment attachment for changes in enrollment and/or
      eligibility and other business reasons including, but not limited to, claims
      payment errors, data entry errors, capitation errors and incorrectly submitted
      claims. Excluding government programs, including without limitation any Medicare
      Advantage plan and/or Medicaid HMO plan, offered or administered by Humana
      and
      governed under federal laws, rules and regulations, and programs not otherwise
      governed under Florida law, the parties agree that retroactive adjustments
      to
      payments made to IPA
      for
      changes in enrollment and/or eligibility status are limited to the one (1)
      year
      period following the date the claim was paid or denied.  

    

    
      
        
        

      

      
        
        

        
          

        

      

      
        
        

      

    

     

    Amendment

    

    To
      Independent Practice Association Participation Agreement

     

    This
      AMENDMENT is entered into this __
      day
      of__________________,
      2008 by
      and between Metcare
      of Florida, Inc (herein
      referred to as “IPA”) and
      Humana
      Medical Plan, Inc., Humana Health Insurance Company Of Florida,
      Inc.,
      and,
Humana
      Insurance Company,
      and
      their affiliates who underwrite or administer health benefit plans
      (collectively, “HUMANA”).

    

    WHEREAS,
      the parties entered into an Independent Practice Association Participation
      Agreement effective ______________________,
      (“Agreement”);

    

    WHEREAS,
      the parties desire to further amend the terms of the Agreement:

    

    NOW,
      THEREFORE, for good and valuable consideration, the receipt and sufficiency
      of
      which are hereby acknowledged by the parties, the parties hereto agree as
      follows: 

    

    
      	 	
              1.

            	
              The
                Letter Of Credit Attachment, attached hereto, is hereby added to
                the Agreement.

            

    

     

    The
      effective date of this Amendment shall be ______________________. 

    

    ALL
      OTHER
      TERMS AND CONDITIONS REMAIN UNCHANGED.

    

    IN
      WITNESS WHEROF, the parties have executed the Amendment the day and year first
      above written.

    

    

      
        	
                IPA

              	 	 	
                HUMANA

              	 

      

    

    

    
      	
              By:
                

            	    
	 	
              By:
                

            	    

    

    

    
      	
              Print
                Name:

            	    
	 	
              Print
                Name:

            	   

    

    

    
      	
              Title:
                

            	   
	 	
              Title:
                

            	   

    

    

    
      	
              Date:
                

            	   
	 	
              Date:
                

            	   

    

    

    
      	
              Tax
                ID#: 65-0879131

            	
              Humana
                Medical Plan, Inc.

            
	 	
              Humana
                Health Insurance Co. of FL, Inc.

            
	 	
              Humana
                Insurance Company

            

    

     

    
      
        	
                Amendment

              	
                1
                  of 3

              	 
	
                June
                  19, 2008

              	 	 
	
                IPA_FL_08152006

              	 	 

      

    

     

    
      
        
        

      

      
        
        

        
          

        

      

      
        
        

      

    

    

    Amendment

    

    To
      Independent Practice Association Participation Agreement

     

    Letter
      of Credit 

    Attachment

    

    Metcare
      of Florida Inc (herein referred to as IPA) shall provide HUMANA, by September
      1,
      2008, with an irrevocable standby letter of credit initially in the amount
      of
      one million dollars ($1,000,000.00)
      (“Letter of Credit Amount”), a copy of which shall be attached hereto as
      Attachment A1.
      The
      Letter of Credit Amount shall be reviewed quarterly and may be adjusted with
      HUMANA’s approval. In the event the Letter of Credit Amount is to be increased
      or decreased as a result of the review described above, IPA shall cause to
      be
      issued a new or amended Letter of Credit to HUMANA for its written approval.
      The
      then current Letter of Credit shall not expire until such new or amended Letter
      of Credit is delivered to HUMANA and HUMANA has issued its written approval.
      

    

    Each
      Letter of Credit, and any drawing instructions contained therein, shall be
      in
      form and substance satisfactory to HUMANA and in HUMANA’s name, shall be
      irrevocable, shall be drawn on a financial institution acceptable to HUMANA,
      and
      shall be payable at sight and after the date of issuance at such financial
      institution or a branch or office thereof when accompanied by a written
      statement or drawing certificate signed by an authorized representative of
      HUMANA in the a form described in the Letter of Credit. 

    

    In
      the
      event HUMANA has received notice of cancellation or non-renewal from the issuer
      of the Letter of Credit within ninety (90) days prior to the expiration date
      of
      the Letter of Credit, or within ninety (90) days prior to the expiration date
      of
      any succeeding renewal period pertaining to a Letter of Credit, IPA shall have
      three (3) business days to obtain a renewal or a replacement Letter of Credit
      issued in accordance with the terms hereof. In the event that a renewed or
      replacement Letter of Credit is not provided by IPA to HUMANA within such time
      period, HUMANA may immediately draw down the entire amount, or balance thereof,
      of the Letter of Credit. In addition, such failure to renew or replace the
      Letter of Credit shall constitute a breach and default by IPA under this
      Agreement, and HUMANA may thereafter terminate this Agreement effective upon
      the
      earlier of the expiration date of the Letter of Credit or ninety (90) days
      notice to IPA, and hold all proceeds of the Letter of Credit until completion
      of
      the final settlement.

    

    In
      the
      event HUMANA at any time draws down the Letter of Credit, IPA shall, within
      three (3) business days of the satisfaction of the draw by the issuer, replenish
      the Letter of Credit by an amount equal to the amount of the draw. In the event
      that the Letter of Credit is not replenished in such amount within such time
      period, HUMANA may immediately draw down the balance of the Letter of Credit.
      In
      addition, such failure to replenish the Letter of Credit shall constitute a
      breach and default by IPA under this Agreement, and HUMANA may thereafter
      terminate this Agreement effective upon the earlier of the expiration date
      of
      the Letter of Credit or ninety (90) days following the end of the three (3)
      business day period described above, and hold all proceeds until completion
      of
      final settlement under the terms of this Agreement. 

     

    
      	
              Amendment

            	
              2
                of 3

            	 
	
              June
                19, 2008

            	 	 
	
              IPA_FL_08152006

            	 	 

    

    
      
        
        

      

    

    
      
        
        

      

      
        
        

        
          

        

      

      
        
        

      

    

    Amendment

    

    To
      Independent Practice Association Participation Agreement

    

    If
      at any
      time HUMANA determines that the total financial deficits attributable to IPA
      under this Agreement exceeds the Letter of Credit Amount, HUMANA shall give
      written notice to IPA of such deficits, together with its calculations thereof,
      IPA shall have ten (10) business days following such notice to increase the
      Letter of Credit Amount by an amount equal to the amount of the deficit which
      is
      in excess of the Letter of Credit Amount. In the event IPA does not increase
      the
      Letter of Credit by such amount within the ten (10) business day period
      described above, such failure shall constitute a breach and default by IPA
      under
      this Agreement, and HUMANA may draw upon the entire amount of the Letter of
      Credit and hold all proceeds until completion of final settlement under the
      terms of this Agreement and thereafter may terminate this Agreement effective
      upon the earlier of the expiration date of the Letter of Credit or upon ninety
      (90) days written notice of termination to IPA

    

    Notwithstanding
      anything to the contrary in this Agreement, HUMANA may upon written notice
      to
      IPA upon the failure of IPA to provide a Letter of Credit, or replacement or
      amendment thereof, or to replenish a drawn upon Letter of Credit, as required
      under this Agreement, and without prejudice to any other rights of HUMANA stated
      herein, offset any part or all of IPA payments from HUMANA under the terms
      of
      this Agreement up to the Letter of Credit Amount.

     

    
      	
              Amendment

            	
              3
                of 3

            	 
	
              June
                19, 2008

            	 	 
	
              IPA_FL_08152006

Source: [{"source": "alea-institute/alea-institute/kl3m-data-edgar-agreements/train-00147-of-00352.parquet"}, [{"source": "alea-institute/alea-institute/kl3m-data-edgar-agreements/train-00147-of-00352.parquet"}]]