Document:

Exhibit

EXHIBIT 10.7
Execution Copy
[**] designates portions of this document that have been omitted pursuant to a request for confidential treatment filed separately with the Securities and Exchange Commission.

AMENDED AND RESTATED SERVICES AGREEMENT

between

IHC Health Services, Inc.

and

R1 RCM Inc.

TABLE OF CONTENTS
	
				
	I.
	 
	DEFINITIONS
	2

	 
	1.1
	Key Terms
	2

	II.
	 
	STRUCTURE AND APPROACH
	2

	 
	2.1
	Services Agreement
	2

	 
	2.2
	References to Contract Documents
	3

	 
	2.3
	Transition from Original Services Agreement
	3

	III.
	 
	SERVICES AND COVERED IMH FACILITIES AND PROVIDERS
	4

	 
	3.1
	Services
	4

	 
	3.2
	Commencement Date
	4

	 
	3.3
	R1 Responsibility
	4

	 
	3.4
	Appointment
	4

	 
	3.5
	Competent Performance of Services
	5

	 
	3.6
	Service Levels and Other Performance Standards
	5

	 
	3.7
	Covered Facilities and Providers
	5

	 
	3.8
	New Services
	6

	IV.
	 
	TRANSITION OF SERVICES
	6

	 
	4.1
	Transition
	7

	 
	4.2
	Communication Plan
	7

	 
	4.3
	Alignment with Personnel Transition
	7

	V.
	 
	ACQUISITIONS AND DIVESTITURES
	8

	 
	5.1
	Acquisitions.
	8

	 
	5.2
	Divestitures
	8

	 
	5.3
	Divestiture to an Affiliate
	10

	 
	5.4
	Divestiture of all IMH Facilities and IMH Providers
	10

	VI.
	 
	TECHNOLOGY
	10

	 
	6.1
	R1 Technology
	10

	 
	6.2
	IMH IT Obligations
	10

	VII.
	 
	RESOURCE NEEDS AND ASSETS
	11

	 
	7.1
	Assets to be made Available to R1
	11

	 
	7.2
	Occupation of Intermountain Healthcare Space
	11

i

	
				
	 
	7.3
	Access to Areas
	12

	 
	7.4
	Additional Space
	12

	 
	7.5
	Intermountain Healthcare to Supply Data, Information, and Access to Computer System and Network
	12

	 
	7.6
	Third Party Software
	12

	 
	7.7
	Vendor Access Program
	13

	VIII.
	 
	GOVERNANCE AND RELATIONSHIP MANAGEMENT
	13

	 
	8.1
	Joint Review Board and Sponsors
	13

	 
	8.2
	Executive Sponsors
	13

	 
	8.3
	Operations Oversight Council
	13

	 
	8.4
	R1 Site Lead
	14

	 
	8.5
	Reliance on Authorized Personnel
	14

	IX.
	 
	CONFIDENTIALITY
	14

	 
	9.1
	Prior Non-Disclosure Agreements
	14

	 
	9.2
	Confidentiality of the Services Agreement
	14

	 
	9.3
	Confidentiality.
	15

	 
	9.4
	Good Faith and Cooperation
	18

	X.
	 
	PERSONNEL TRANSITION AND BACKGROUND CHECKS
	18

	 
	10.1
	Personnel Transition
	19

	 
	10.2
	Background Checks, Drug Screening and Immunizations of R1 Personnel.
	19

	XI.
	 
	CHARGES AND INVOICES
	20

	 
	11.1
	Charges for Services
	20

	 
	11.2
	Invoicing.
	20

	 
	11.3
	Payment of Charges
	21

	 
	11.4
	Incidental Expenses
	21

	 
	11.5
	Proration
	21

	 
	11.6
	Payment Disputes
	21

	 
	11.7
	Compliance with Laws
	21

	XII.
	 
	R1 CONTRACTORS
	22

	 
	12.1
	Use of R1 Contractors
	22

	 
	12.2
	New R1 Contractors
	22

	XIII.
	 
	R1 FACILITIES AND CENTER OF EXCELLENCE
	22

	 
	13.1
	Use of R1 Facilities
	22

	 
	13.2
	Outsourcing to Offshore Resources
	22

	 
	13.3
	Keeping Security Current
	23

	 
	13.4
	Center of Excellence
	23

ii

	
				
	XIV.
	 
	THIRD PARTY AGREEMENTS
	24

	 
	14.1
	In-Scope Agreements Managed by or Assigned to R1
	24

	 
	14.2
	Costs of Consents
	25

	 
	14.3
	No Obligation to Breach
	25

	 
	14.4
	Warranty of No Material Breach of In-Scope Agreements
	25

	 
	14.5
	[**]
	25

	 
	14.6
	Rights to In-Source or Terminate
	25

	XV.
	 
	INTELLECTUAL PROPERTY AND OTHER MATTERS
	26

	 
	15.1
	Intellectual Property
	26

	 
	15.2
	Incidental IP License
	27

	 
	15.3
	Software and Services License
	27

	 
	15.4
	Intermountain RCO Data
	28

	 
	15.5
	Consent to Use Data Analysis Results
	29

	 
	15.6
	R1 Analytics Data
	29

	 
	15.7
	Access Credentials
	30

	 
	15.8
	Authorization Limitations and Restrictions
	30

	 
	15.9
	Malware
	30

	 
	15.10
	Protection of Access Credentials
	30

	 
	15.11
	Changes to the R1 Technology
	31

	 
	15.12
	Suspension or Termination of Access
	31

	 
	15.13
	Consent to Monitoring
	31

	 
	15.14
	Monitoring by IMH
	32

	 
	15.15
	Replacement of R1 Personnel
	32

	XVI.
	 
	BUSINESS CONTINUITY
	32

	 
	16.1
	Recovery Environment and Continuity of Business
	32

	 
	16.2
	Disaster Recovery Plan
	33

	 
	16.3
	Source Code and Development Environment
	33

	 
	16.4
	Rights under the Bankruptcy Code
	33

	XVII.
	 
	DATA PRIVACY AND SECURITY
	34

	 
	17.1
	PHI and Data Privacy Policy
	34

	 
	17.2
	Business Associate Agreement
	34

	 
	17.3
	Malware and Security Agreement
	34

	 
	17.4
	Access and Confidentiality Agreement
	34

	XVIII.
	 
	COMPLIANCE AND AUDIT MATTERS
	34

	 
	18.1
	Compliance with Intermountain Healthcare’s Standards of Conduct
	34

	 
	18.2
	Compliance
	35

	 
	18.3
	R1 Contractor Compliance
	35

[**] designates portions of this document that have been omitted pursuant to a request for confidential treatment filed separately with the Securities and Exchange Commission.
iii

	
				
	 
	18.4
	Compliance Programs
	35

	 
	18.5
	Unauthorized Acts
	36

	 
	18.6
	Record Retention
	37

	 
	18.7
	Privilege Issues
	37

	 
	18.8
	Additional Compliance Obligations
	38

	 
	18.9
	Compliance Investigations, Notifications and Reports.
	38

	XIX.
	 
	AUDITS AND REPORTING
	39

	 
	19.1
	Audits and Inspections
	39

	 
	19.2
	Reports
	40

	 
	19.3
	Inspection of Servers
	41

	 
	19.4
	SOC 2 Type II Audits and Reports
	41

	 
	19.5
	Pre-Transition Audit
	41

	XX.
	 
	DISPUTE RESOLUTION
	41

	 
	20.1
	Compliance with Rights of Cure and Dispute Resolution
	42

	 
	20.2
	Referral of Dispute to Executive Sponsors
	42

	 
	20.3
	Referral of Dispute to the Operations Oversight Council and/or Joint Review Board
	42

	 
	20.4
	Arbitration
	42

	XXI.
	 
	INDEMNIFICATION AND LIABILITY
	43

	 
	21.1
	Indemnification by R1
	43

	 
	21.2
	Indemnification by Intermountain Healthcare
	43

	 
	21.3
	Liability Cap
	44

	 
	21.4
	Exception for Wrongful Termination
	44

	 
	21.5
	[**]
	44

	 
	21.6
	Acknowledged Direct Damages
	44

	XXII.
	 
	INSURANCE
	45

	 
	22.1
	R1 Insurance Requirements
	45

	 
	22.2
	IMH Insurance Requirements
	46

	XXIII.
	 
	TERM AND TERMINATION
	47

	 
	23.1
	Term
	47

	 
	23.2
	Terms of Work Orders
	47

	 
	23.3
	Termination for Cause.
	47

	 
	23.4
	[Intentionally Blank]
	48

	 
	23.5
	Termination for Exclusion from Federal Health Programs, Changes in Law, Adverse Judgments.
	48

	 
	23.6
	Termination for Insolvency
	51

	 
	23.7
	Return or Destruction of RCO Data
	52

	 
	23.8
	Disengagement Services
	52

[**] designates portions of this document that have been omitted pursuant to a request for confidential treatment filed separately with the Securities and Exchange Commission.
iv

	
				
	XXIV.
	 
	GENERAL TERMS OF AGREEMENT
	52

	 
	24.1
	Authority
	52

	 
	24.2
	Survival
	52

	 
	24.3
	Signing Authority
	53

	 
	24.4
	No-Hire
	53

	 
	24.5
	Disclaimers
	53

	 
	24.6
	Record Retention
	54

	 
	24.7
	Force Majeure
	54

	 
	24.8
	Taxes
	54

	 
	24.9
	Assignment
	55

	 
	24.10
	Relationship of Parties
	55

	 
	24.11
	Notice
	55

	 
	24.12
	Severability
	55

	 
	24.13
	No Third-Party Beneficiaries
	56

	 
	24.14
	Amendment
	56

	 
	24.15
	Entire Agreement
	56

	 
	24.16
	Governing Law
	56

	 
	24.17
	Subcontractors
	56

	 
	24.18
	Use of the Intermountain Name.
	56

	 
	24.19
	Appropriate Use
	57

	 
	24.20
	Counterparts and Execution
	57

AMENDED AND RESTATED SERVICES AGREEMENT
This Amended and Restated Services Agreement is entered into effective as of January 23, 2018 (the “Effective Date”), between IHC Health Services, Inc., a Utah non-profit corporation, (“IMH” or sometimes referred to as “Intermountain”, “Intermountain Healthcare” or “Client”) and R1 RCM Inc., a Delaware corporation, formerly known as Accretive Health, Inc. (“R1” or sometimes referred to as “R1 RCM”). Intermountain Healthcare and R1 are each sometimes referred to herein as a “Party”, and collectively, the “Parties.”
RECITALS
WHEREAS, IMH and R1 previously entered into an Accretive Health Services Agreement (together with all schedules, exhibits, annexes, attachments and amendments thereto, the “Original Services Agreement”) effective October 11, 2011 (“Original Effective Date”);
WHEREAS, IMH desires to procure from R1, and R1 desires to provide to IMH and the IMH Facilities and IMH Providers, the Services as defined and described herein; 

v

WHEREAS, R1 met with IMH leadership in developing the framework for furthering the existing revenue cycle relationship between the Parties and during those meetings, R1 made key commitments to IMH through a series of presentations to IMH;
WHEREAS, IMH and R1 have engaged in negotiations, discussions and due diligence that have culminated in the formation of the contractual relationship described in this Services Agreement; and
WHEREAS, IMH and R1 wish to amend and restate in its entirety the Original Services Agreement on the terms and conditions set forth herein.
AGREEMENT
NOW THEREFORE, in consideration of the mutual promises and covenants contained herein, and for other good and valid consideration, the receipt and sufficiency of which are hereby acknowledged, and incorporating the recitals above, the Parties hereby agree as follows:

1

I.    DEFINITIONS

1.1    Key Terms.  Certain capitalized terms used in this Services Agreement are defined in Exhibit 1.1 hereto, which is incorporated into this Services Agreement by this reference.

II.    STRUCTURE AND APPROACH

2.1    Services Agreement.  The body of this Services Agreement and all exhibits attached hereto and referenced herein (collectively, this “Services Agreement”) set forth terms and conditions pursuant to which R1 will render the Services to IMH.  Without limiting the above, this Services Agreement includes each of the following, all of which are incorporated into this Services Agreement by this reference:
Exhibit 1.1        Definitions
Exhibit 3.1        Services
Exhibit 3.6        Service Levels
Exhibit 3.7        IMH Facility and Provider List
Exhibit 3.7-A        IMH Facilities
Exhibit 3.7-B        IMH Providers
Exhibit 3.7-C        Facilities Managed, but not Owned, by IMH
Exhibit 3.8-1         Form of Work Order
Exhibit 4.1        Transition of Services
Exhibit 6.1        R1 Technology
Exhibit 7.1        IMH Assets to be Made Available to R1
Exhibit 8.1-A        Joint Review Board Charter
Exhibit 8.2        Executive Sponsors
Exhibit 8.3         Operations Oversight Council Charter
Exhibit 8.5        Authorized Personnel
Exhibit 9.1        Non-Disclosure Agreements
Exhibit 10.1        Transitioned Employee Terms

2

Exhibit 11.1        Charges for Services
Exhibit 11.1-A        Base Fee
Exhibit 11.1-B        Incentive Fee
Exhibit 11.1-C        Payment Terms
Exhibit 13.2        Outsourcing to Off-Shore Resources
Exhibit 13.2-1        Outsourcing to Off-Shore Resources [**]
Exhibit 14.1        Third Party Agreements
Exhibit 16.1        Recovery Environment and Continuity of Business Requirements
Exhibit 17.4        Access and Confidentiality Agreement
Exhibit 18.8        Additional Compliance Obligations
Exhibit 18.9        Elements for [**] Compliance Report
Exhibit 19.2        [**] Reports and Data Sets
Exhibit 23.8        Disengagement Services

2.2    References to Contract Documents.  References to any exhibit or section to this Services Agreement shall include all documents subsidiary to such exhibit or section (e.g., Section 11.1 includes Exhibit 11.1-A and 11.1-B, and Exhibit 3.8 includes Exhibit 3.8-1, etc.).

2.3    Transition from Original Services Agreement. This Services Agreement shall become effective and replace the Original Services Agreement as of the Effective Date, except as follows: 
		
	(a)
	Services and Charges.  

		
	(i)
	The Services and Charges set forth in this Services Agreement shall only be effective as of the Commencement Date as further specified in any Exhibits to this Services Agreement.  Prior to such time (i.e., the period between the Effective Date and the Commencement Date), the terms of the Original Services Agreement shall govern with respect to services and charges under the Original Services Agreement.

		
	(ii)
	All determinations of payments due for services rendered under the Original Services Agreement shall be determined and paid under the payment terms of the Original Services Agreement in effect when such services were delivered.  

[**] designates portions of this document that have been omitted pursuant to a request for confidential treatment filed separately with the Securities and Exchange Commission.
3

		
	(iii)
	All determinations relating to services rendered under the Original Services Agreement shall be determined under the applicable provisions of the Original Services Agreement in effect when such services were delivered. 

		
	(b)
	Employee Transitions.  The transition dates for any Transitioned Employees shall be the applicable Employment Effective Date for each such Transitioned Employee, as set forth in Exhibit 10.1.  

		
	(c)
	Third Party Relationships.  R1’s responsibility to manage and/or accept assignment of any In-Scope Agreement will only commence as of the date mutually agreed to by the Parties and set forth in an Exhibit 14.1 (or a subsequent amendment to Exhibit 14.1) for such In-Scope Agreement.

		
	(d)
	Other.  If circumstances giving rise to a contractual claim between the Parties continues for a period that starts before and ends after the Effective Date, then the claims under the Original Services Agreement and this Services Agreement shall be coordinated and allocated between the Original Services Agreement and this Services Agreement in a reasonable manner based on the date of the occurrence of such circumstances.

III.    SERVICES AND COVERED IMH FACILITIES AND PROVIDERS

3.1    Services.  The Parties hereby agree that, in cooperation with Intermountain Healthcare, R1 will implement the Services for Intermountain Healthcare to improve Intermountain Healthcare’s net revenue, specifically by providing the following services as they may be amended, supplemented, enhanced, modified or replaced in accordance with this Services Agreement (the “Services”)”: the services, functions, processes, and responsibilities described or identified in Exhibit 3.1 or elsewhere in this Services Agreement.  R1’s Services will improve net revenue and reduce the cost to collect through focused attention on operational key performance indicators.

3.2    Commencement Date.  R1 shall provide each Service during the period beginning upon the Commencement Date and ending on the expiration or earlier termination of the Term, except to the extent that the period of provision of such Service may be extended for Disengagement Services under Section 23.8 or by the written agreement of the Parties. 

3.3    R1 Responsibility.  R1 shall be responsible for the performance of the Services in accordance with this Services Agreement even if such Services are actually performed or dependent upon services performed by Affiliates of R1 or R1 Contractors.

3.4    Appointment.  Intermountain Healthcare hereby appoints R1 as the exclusive provider of the Services for the IMH Facilities and IMH Providers that are deemed to be in-scope and R1 accepts such appointment and agrees to provide the Services on the terms and under the conditions stated 

4

herein.  This exclusive provider appointment is subject to any out-of-scope agreements retained by IMH and any contrary provisions expressly set forth in this Services Agreement.  

3.5    Competent Performance of Services.  R1 covenants that all Services shall be delivered and performed by R1 (and if applicable, its Affiliates and R1 Contractors) in a professional and workmanlike manner by competent personnel having appropriate knowledge, experience and skill and in accordance with all applicable laws, rules and regulations, as more fully set forth in Article XVIII.  
(a)    R1 represents that it is a trusted service provider who can optimize the revenue cycle of IMH.  R1 is committed to building a high performing holistic and differentiated approach through the Services which includes: (i) bringing a robust and proven operating model leveraging R1 Technology and operating practices which provide increased gains (as described in Exhibit 11.1-B), process standardization, visibility, analytics and accountability; (ii) ability to efficiently manage acute and physician revenue cycle operations and varying delivery and payment models; and (iii) alignment with IMH strategic imperatives, which include: increasing performance at lower cost, focused innovation, improved integration of clinical and financial processes and job creation as described in Section 13.4.
(b)     Through the Services and performance of its obligations under this Agreement, R1 will bring enhanced expertise and capabilities to Salt Lake City targeting physician practice management, professional billing, and the related revenue cycle support.

3.6    Service Levels and Other Performance Standards.  Beginning on the Commencement Date, R1 shall perform the Services so as to meet or do better than the “Service Levels” set forth in Exhibit 3.6 (the “Service Levels”).  
		
	(a)
	Multiple Service Levels. If more than one Service Level applies to any particular obligation of R1, R1 shall perform in accordance with all applicable Service Levels.

		
	(b)
	Service Level Defaults.  Service Level Defaults shall be addressed by the Parties as set forth in Exhibit 3.6.  If the same Service Level is not met in multiple Measurement Windows, then there is a corresponding number of Service Level Defaults for that Service Level.  For example, if a Service Level is not met in one Measurement Window and then is subsequently not met in another Measurement Window, then there are two Service Level Defaults even though each such default applies to the same Service Level. 

3.7    Covered Facilities and Providers.  R1 shall provide the Services to the IMH facilities listed on Exhibit 3.7-A (each an “IMH Facility” and collectively the “IMH Facilities”) and the IMH medical group providers listed on Exhibit 3.7-B (each an “IMH Provider” and collectively the “IMH Providers”).  IMH may add facilities and providers to the IMH Facilities and IMH Providers covered under this Services Agreement by notice to R1, provided, however, that each such additional facility 

5

or provider shall be owned and controlled by IMH unless agreed to by R1 in writing.  For any additional IMH Facility or IMH Provider, the Parties will prepare an implementation and transition plan which will allow for a reasonable amount of time for the implementation and transition of Services to and for the additional IMH Facility or IMH Provider, including reasonable and appropriate implementation fees for any such new facilities or providers if and as those fees are agreed to by the Parties in writing, as determined by the Operations Oversight Council within [**] days following R1’s request for such fees.  The addition of any IMH Facilities and IMH Providers is subject to an adjustment of Charges pursuant to the terms of Section 11.1 and an adjustment to the Service Level obligations of each Party set forth in Sections 3.6.  This Section 3.7 is subject to the Acquisition and Divestiture Process set forth in Article V below.  Exhibit 3.7-C will govern Garfield Memorial Hospital, which is managed, but not owned, by IMH. 

3.8    New Services.  Without limiting the amendment process set forth in Section 24.14 below, the Parties agree that this Services Agreement may be amended to add, remove or change Services, as set forth in this Section 3.8 and substantially the form of Work Order set forth in Exhibit 3.8-A (a “Service Change”).  For purposes of clarity, each such Work Order shall not be effective unless signed in writing by each Party and shall only take place on the effective date set forth in such order.  The Party proposing a Service Change will provide the other Party with a written proposal, describing the proposed change, the anticipated effect that change will have on this Agreement, any applicable Work Order, Exhibits and/or the Services, and the rationale for such change.  No requested Service Change shall be implemented unless and until both Parties have signed the applicable Work Order; provided, however, that in case of any disagreement between the Parties on approving such Service Change, the same shall be settled through the Joint Review Board, and if necessary the dispute resolution procedure set forth in Article XX of this Agreement.  The Parties acknowledge that any addition to, removal of, or changes to the Services may result in additional, decreased or modified fees (except as set forth in the following sentence) which shall be set forth with specificity in each Work Order or via an amendment within the Work Order to the fee exhibits attached to this Services Agreement.  R1 has no obligation to perform and IMH has no obligation to pay for any additional or modified Services absent written agreement by the Parties with respect thereto.  
The Parties further agree that it is their mutual intent for the Services to be kept, to the extent practicable, current with advances in technology, methodology and processes and with revenue cycle industry standards and best practices for IMH’s business.  Accordingly, the Parties shall work collaboratively and in good faith to explore opportunities to improve the Services for such advances, standards and best practices and implement any changes which are mutually agreed to.  R1 will ensure that the Services keep current with Applicable Law during the Term.  Without limiting the generality of the foregoing, if any new or changed Applicable Law reasonably requires any addition to, removal of, or changes to the Services reasonably requested by IMH, R1 will cooperate with IMH to implement such addition, removal or change 

IV.    TRANSITION OF SERVICES

[**] designates portions of this document that have been omitted pursuant to a request for confidential treatment filed separately with the Securities and Exchange Commission.
6

4.1    Transition.  As part of the transition to the Services, the Parties will comply with a transition work plan that is acceptable to both Parties (the “Transition Work Plan”). The Transition Work Plan is for the transition to the Services and for the transition of employees to R1, and should not be confused with any Disengagement Services contemplated under Section 23.8.  The Transition Work Plan will also include, without limitation, a guiding principles document and a transformation plan.   An initial Transition Work Plan is attached hereto as Exhibit 4.1.  The Parties will work together in good faith to add and agree upon details and clarifications to the Transition Work Plan and to finalize it.  The R1 Executive Sponsor and the Intermountain Healthcare Executive Sponsor will each have responsibility for managing his or her Party’s personnel and obligations in implementing a successful transition to the Services in accordance with the Transition Work Plan. The Transition Work Plan will anticipate and address employee transition issues, communication issues, technology transition issues, data and security requirements, third party consents which are required in connection with the commencement of Services consistent with the Exhibits to this Services Agreement, and to the extent any Exhibits are not completed as of the Effective Date the finalization of such Exhibits will be part of the Transition Work Plan.  Each Party shall provide any data and information necessary for the successful completion of the transition.  If the Transition Work Plan has any gaps or fails to address any transition service or assistance reasonably needed for a successful transition to the Services or of the employees, then the Transition Work Plan will be enhanced and updated to address the gaps or failures as needed for a successful transition.

4.2    Communication Plan.  The Parties agree and understand that the appropriate communication of this transition to the Services is critical to the success of the initiative outlined in this Services Agreement, and therefore will agree to a communication plan as part of the Transition Work Plan.  Accordingly, the Parties agree that the specific elements of the communication plan (e.g., the terms of any press releases, written communications to IMH’s employees, etc., in each case prior to their release) are Confidential Information of IMH for purposes of, and in accordance with, the confidentiality obligations of Article IX.  The Parties will coordinate any communications in accordance with the communications plan in advance of the formal transition announcement and each Party will provide a copy of any such communications reasonably in advance of their release for the other Party’s input.  Following the formal transition announcement, if a Party believes it is necessary or reasonably advisable to deviate from the communications plan, it may do so as long as it follows the communication plan’s main talking points, is made in good faith, and is subject to compliance with SEC regulations or other Applicable Law.

4.3    Alignment with Personnel Transition.  It is the Parties’ intent that the initial Transition Services to be provided starting as of the Effective Date be aligned with the IMH Personnel Transition Process in Section 10.1 below.  IMH will assign certain of its personnel, mutually agreed to by R1, as designated “change champions” who will assist the Parties with certain tasks designed to enable a successful transfer of Transitioned Employees. The identity of the “change champions” and details of such assistance will be mutually determined by R1 and IMH at least [**] days prior to the Commencement Date.  R1 will not require any change champion to expend more than [**] of his or her working time on such assistance.

[**] designates portions of this document that have been omitted pursuant to a request for confidential treatment filed separately with the Securities and Exchange Commission.
7

V.    ACQUISITIONS AND DIVESTITURES

5.1    Acquisitions. 
		
	(a)
	IMH shall promptly notify R1 after IMH or any IMH Affiliate acquires any new hospital, medical group or other health care provider entity (each a “Potential Recipient”).  There is no obligation to notify R1 until after the acquisition is publicly announced by IMH, but IMH may provide an earlier notification.  After such notification to R1, then Subsections 5.1(b) and 5.1(c) will apply.  If notification is given prior to the public announcement of the acquisition, then R1 will keep information about the acquisition strictly confidential until the information becomes publicly known.

		
	(b)
	If IMH, or an IMH Affiliate if applicable, acquires a Potential Recipient that is performing for itself (or has an Affiliate perform for it) Similar Services, then promptly after such acquisition is closed and, solely in the case of such an acquisition, subject to any restrictions imposed as part of the terms of the acquisition that cannot be cured or removed using commercially reasonable efforts, IMH, or if applicable an IMH Affiliate, and R1 shall use their respective commercially reasonable efforts to transition such Similar Services to R1 and amend this Services Agreement as needed to reflect the change.  [**]   

		
	(c)
	If IMH or such IMH Affiliate acquires a Potential Recipient that is at the time of the acquisition receiving Similar Services from an unaffiliated third party under a contract with that third party, then such Potential Recipient may continue receiving such Similar Services from the third party (or its successor, if any) until the earlier of (A) the expiration or termination of such contract, without any termination fee or expenses or other adverse consequences, and (B) the time, if any, that is mutually agreed upon by IMH and R1. Notwithstanding the foregoing, R1 may require that such Potential Recipient terminate such contract with such third party and commence receiving the applicable Services under the terms of this Services Agreement, provided that there is a pre-existing right to terminate for convenience under the applicable contract, and provided further that R1 shall [**] any and all early termination charges and expenses under the applicable contract and any other reasonable costs and expenses of the transition as a result of such termination.  In the event that the contract includes any services that are not Similar Services or includes any license or right that is not the same or substantially the same as any license or right under this Services Agreement, then any obligation to terminate under this paragraph will not require any termination of the contract that would adversely impact the Potential Recipient with respect to any such services that are not Similar Services or any such license or right.  But IMH will attempt to terminate the services that are Similar Services consistent with the first two sentences of this paragraph, provided that this does not affect any other services, license or rights under the contract. 

5.2    Divestitures.  If IMH or an IMH Affiliate sells or divests (to an unaffiliated third party) an IMH Facility or IMH Provider that is then-currently receiving Services, IMH shall provide R1 with 

[**] designates portions of this document that have been omitted pursuant to a request for confidential treatment filed separately with the Securities and Exchange Commission.
8

no less than [**] days’ notice prior to the closing of such sale or divestiture (or such shorter period as may be required by applicable Law) (the “Required Divestiture Election Notice Period”).  R1 will keep information about the divestiture strictly confidential until the information becomes publicly known.  
		
	(a)
	Divestiture Options. That notification (the “Divestiture Election Notice”) shall set forth such divested or sold IMH Facility’s or IMH Provider’s decision to proceed under either (i) or (ii) below: 

		
	(i)
	continue receiving Services from R1 under the terms of this Services Agreement for up to one (1) year after the closing of such sale or divestiture (the “Interim Service Period”), after which time it must renegotiate new terms with R1 in order to continue receiving Services (otherwise its right to receive Services under this Services Agreement and any Software and Services License shall expire, subject to its receipt of Disengagement Services, pursuant to Section 23.8), and further subject to:

(A) Such divested or sold IMH Facility or IMH Provider (or the acquirer thereof) entering into a written agreement with R1 whereby such IMH Facility or IMH Provider (or acquirer, as the case may be) agrees to abide (or, in the case of the acquirer, cause the IMH Facility or IMH Provider to abide) by the terms and conditions of this Services Agreement applicable to the IMH Facility or IMH Provider during the Interim Service Period.
(B) During the Interim Service Period, such IMH Facility or IMH Provider (or acquirer, as the case may be) will be required to pay [**] is not paid and notice of nonpayment is given and then not cured within [**]of notice, then R1 may terminate Services to the sold or divested IMH Facility or IMH Provider.
(C) IMH will not be liable for any failure by such IMH Facility or IMH Provider (or acquirer, as the case may be) to abide by those terms and conditions or to make such payments – i.e., IMH does not guarantee their compliance with this Services Agreement after the sale or divestiture.  
OR
		
	(ii)
	terminate the provision of Services by R1 to such IMH Facility or IMH Provider (or acquirer, as the case may be) as of the date of consummation of the sale or divestiture, subject to its receipt of Disengagement Services, pursuant to Section 23.8.  IMH shall provide R1 with prompt written notice 

[**] designates portions of this document that have been omitted pursuant to a request for confidential treatment filed separately with the Securities and Exchange Commission.
9

of the consummation of such sale or divestiture of such IMH Facility or IMH Provider under this clause (ii).
		
	(iii)
	However, if IMH does not provide the Divestiture Election Notice within the Required Election Notice Period, IMH shall be deemed to have elected to proceed under clause (ii) above.

5.3    Divestiture to an Affiliate .  If IMH sells or divests any IMH Facility or IMH Provider to an Affiliate, (i) IMH shall provide R1 with prompt written notice of such sale or divestiture, and (ii) such IMH Affiliate shall continue receiving Services from R1 for such IMH Facility or IMH Provider after the closing of such sale or divestiture for the remainder of the Term and IMH shall ensure that the terms and conditions of this Services Agreement continue to apply thereto.

5.4    Divestiture of all IMH Facilities and IMH Providers.  If all of the then-current IMH Facilities and IMH Providers are sold or divested by Intermountain to an unaffiliated third party, then this Services Agreement will terminate unless IMH assigns this Agreement to the acquirer of the IMH Facilities and IMH Providers in accordance with Section 24.9 below.

VI.    TECHNOLOGY

6.1    R1 Technology.  In connection with the implementation of its revenue cycle operating model, and in a collaborative fashion with Intermountain Healthcare, R1 will deploy its management staff, subject matter experts, “R1 Technology” set forth in Exhibit 6.1 and operating methodology.  R1 will provide IMH with a new front-end revenue cycle solution by the end of [**].  R1 will ensure that the new front-end revenue cycle solution does not adversely affect the Service Levels.  For clarification, the definition of R1 Technology does not include any invention, work of authorship, data, knowledge, information, idea, or intellectual property of Intermountain Healthcare or any of its Affiliates.  R1 may update the R1 Technology listed in Exhibit 6.1 upon written notice to IMH to reflect the then-current R1 technology and methodology, provided, however, that such update right is not intended to and shall not be interpreted to permit R1 to unilaterally reduce the Services to be provided by R1 under this Services Agreement.

6.2    IMH IT Obligations.  The Parties acknowledge that IMH has in place various hardware or software products, or hardware or software configurations, as of the Effective Date which are used for revenue cycle management as of the Effective Date (“Existing Systems”).  R1 agrees that IMH may change the Existing Systems in its discretion at any time.  IMH will work with R1 and keep R1 informed of any anticipated changes to Existing Systems to the extent that those changes may impact the Services. The Parties will work together to reasonably resolve any impact by such changes on the Services, including planned replacement dates and schedules and conflicts with a migration event or system change planned by R1.  If any such changes result in a material decrease in functionality, efficiency, quality or other significant negative effect as compared to Existing Systems or reasonably would require R1 to take efforts to interface with the new or modified IMH hardware or software outside of ordinary course upgrades and configurations, the Parties shall enter into a 

[**] designates portions of this document that have been omitted pursuant to a request for confidential treatment filed separately with the Securities and Exchange Commission.
10

Work Order to compensate R1 for such efforts.  IMH shall work together with R1 with respect to such changes in order to ensure the continuity of the Services during the Term, including consultation with R1 and consideration of any input from R1 in connection with any such changes on a continuous basis.  IMH will use commercially reasonable efforts to notify R1 at [**] in advance of any material changes to Existing Systems in writing (which, for the avoidance of doubt, may be given by email communication and shall not require formal notice under Section 24.11). 

VII.    RESOURCE NEEDS AND ASSETS

7.1    Assets to be made Available to R1.  For Authorized Space (as defined in Section 7.2), the Parties will agree on a list of Intermountain Healthcare’s tangible assets (e.g., office equipment, but not software) to be made available by Intermountain Healthcare to R1 for use in the delivery of the Services, and may not be used by R1 for any other purpose. The list will be incorporated into this Services Agreement as Exhibit 7.1. Intermountain Healthcare will be responsible for securing all consents, if any, required in order for R1 to access and use these Intermountain Healthcare tangible assets as may be reasonably required by R1 in connection with the delivery of the Services, including for the deployment and utilization of R1 Technology. Intermountain Healthcare will be responsible for the maintenance, repair and replacement of these tangible assets, in their normal/customary cycle. R1 acknowledges that Intermountain Healthcare’s obligations under this Section are limited to Intermountain Healthcare using its commercially reasonable efforts, and that Intermountain Healthcare may be unable, or it may be commercially impractical, to obtain the consents required under this Section. If it is not practicable or commercially reasonable to obtain a consent, Intermountain Healthcare will not be liable for any failure to obtain the consent and the corresponding asset may be withheld from R1.

7.2    Occupation of Intermountain Healthcare Space.  Intermountain Healthcare hereby grants to R1 permission to occupy those areas within Intermountain Healthcare’s facilities as may be agreed upon by the Parties from time-to-time (“Authorized Space”).  Initially, Authorized Space includes the areas in the IMH Facilities where R1 personnel need to be located for purposes of the Services.  Authorized Space does not include any area within a facility or location leased or subleased to R1 or its Affiliate under a formal written lease or sublease.  From time-to-time, Intermountain Healthcare may relocate Authorized Space to other areas as reasonably designated by it, provided that such other locations are substantially similar to those locations as have been agreed to by IMH and R1 previously.  To the extent not occupied by R1 as of the Effective Date, the “move in” times will be on a mutually agreeable and reasonable schedule and will not interrupt other operations of those facilities. Intermountain Healthcare agrees to make all existing phone and data access lines in existence on the date hereof at the Authorized Space (or replacement or substitute lines) available to R1 personnel at the Authorized Space for their use in delivering the Services throughout the term of this Services Agreement, at no cost to R1 (those costs will not be included in the Base Fee calculation).  The Authorized Space and such lines will only be used by R1 to perform Services under this Services Agreement and are not for any other purpose.  Intermountain Healthcare agrees to provide necessary utilities and maintenance services for these areas in the Authorized Space at 

[**] designates portions of this document that have been omitted pursuant to a request for confidential treatment filed separately with the Securities and Exchange Commission.
11

no cost to R1 (those costs will not be included in the Base Fee calculation).  Adjustments (including substitutions) of these areas will be made from time to time at Intermountain Healthcare’s reasonable request.  Any areas or lines for the “Utah Center of Excellence” will be if and as agreed to by the Parties in writing.

7.3    Access to Areas.  During the Term of this Services Agreement, Intermountain Healthcare shall grant R1 personnel reasonable and mutually agreed upon access to the Authorized Space referred to in Article VII. Intermountain Healthcare shall provide all necessary keys and access cards to R1 employees to assure them of this access.  R1 and its personnel shall honor all Intermountain Healthcare policies, guidelines and requests regarding the use of or access to these areas or facilities and restrictions regarding access to those portions of the facilities which are not Authorized Space occupied by R1.  Such policies, requests, guidelines and restrictions may, without limitation, relate to safety, security, or health, and will be provided to R1.  Occupation and use of these areas by R1 must not interfere with the other operations of the facilities, including the delivery of healthcare services or the well-being of patients.

7.4    Additional Space. During the Term of this Services Agreement, Intermountain Healthcare may make available to R1 such additional Authorized Space as may be reasonably necessary to perform the Services in an efficient, economical and effective manner.  Requests for additional Authorized Space will be evaluated by the Operations Oversight Council, which will take into account availability and other considerations, and shall be reviewed by the R1 Site Lead and the Intermountain Healthcare Executive Sponsor, and shall not subject Intermountain Healthcare to additional expense (i.e., R1 will cover the additional expense) and will only be provided if and as mutually agreed by the Parties in writing.

7.5    Intermountain Healthcare to Supply Data, Information, and Access to Computer System and Network.  Intermountain Healthcare shall be responsible for supplying R1 with: (a) all data and information of Intermountain Healthcare reasonably required by R1 to perform the Services and measure the benefit of the Services in accordance with the terms of this Services Agreement (but this will not require Intermountain Healthcare to breach any agreement with or obligation to a third party or to violate any law, regulation or order of a court or government agency) and (b) all access to IMH’s computer systems and network reasonably required by R1 to provide the R1 Technology to Intermountain Healthcare or to perform and measure the Services, but to the extent that such computer systems are located at, and network access is from, areas other than Authorized Space, then the responsibility and costs of providing such access shall be at R1’s expense (and does not require Intermountain Healthcare to provide or purchase any additional computer systems or equipment), and (c) the maintenance and support of those computer systems located at the Authorized Space referred to in (b) that are used to maintain the data and information and any agreements with third parties regarding the maintenance or support of those computer systems.  

7.6    Third Party Software.  Use by R1 personnel of any third party computer software installed on IMH equipment to be used by R1 must not breach any agreement with the third party or infringe 

12

any third party intellectual property.  During the transition period the Parties will identify the third party software licenses and agreements that are applicable to use of the software by RI personnel at Authorized Space.  The Parties will cooperate to obtain for R1 such rights as may be needed for use of the software at Authorized Space.  This may be accomplished through assignment of licenses, agreements, sublicenses, expansion of license scope to cover R1 personnel, and/or any other legitimate means.  

7.7    Vendor Access Program.  All of R1’s personnel entering any Intermountain facility must comply with Intermountain’s Supplier Access Program. This program may require R1’s personnel to check in with Intermountain on each visit to an Intermountain facility to receive an identification badge for clinical areas; and as applicable, log onto www.reptrax.com and complete the registration requirements.

VIII.    GOVERNANCE AND RELATIONSHIP MANAGEMENT

8.1    Joint Review Board and Sponsors.  In order to assure that the spirit of cooperation and mutual interest which have led to this Services Agreement between the Parties continues, the Parties will establish a “Joint Review Board” that will be charged with responsibility for oversight of this strategic relationship.  The Joint Review Board will include two (2) representatives of each Party.  The Joint Review Board’s activities will be governed by its charter attached hereto as Exhibit 8.1-A, which sets forth the members of the Joint Review Board as of the Effective Date, the replacement process for members and other matters, including voting and decision making authority.  In the event of any conflict between this Agreement and the charter, this Agreement will govern.  [**].  In the event of any other tied vote by the Joint Review Board, the Parties will use the dispute resolution process described in Article XX, below.

8.2    Executive Sponsors.  Each Party shall designate an executive sponsor who shall be responsible for managing the relationship between the Parties as it relates to the implementation and execution of this Services Agreement on an ongoing basis (“Intermountain Healthcare Executive Sponsor” and “R1 Executive Sponsor”, respectively, each an “Executive Sponsor” and collectively the “Executive Sponsors”).  Each Party’s respective Executive Sponsor as of the Effective Date is set forth in Exhibit 8.2 which Executive Sponsor may be replaced by the Party who designated such Executive Sponsor with another executive with equal or greater responsibility within such Party’s organization, upon written notice to the other Party at its discretion and which notice shall be deemed to amend such Party’s Executive Sponsor listed in Exhibit 8.2.

8.3    Operations Oversight Council.  In addition to and without limiting the powers and responsibilities of the Joint Review Board, the Parties hereby establish an Operations Oversight Council with the authorities and responsibilities set forth in its charter at Exhibit 8.3.  In the event of any conflict between this Agreement and the charter, this Agreement will govern.  In the event of any tied vote by the Operations Oversight Council, the final decision will be made by the Joint Review Board.

[**] designates portions of this document that have been omitted pursuant to a request for confidential treatment filed separately with the Securities and Exchange Commission.
13

8.4    R1 Site Lead.  In addition to the R1 Executive Sponsor, R1 shall designate an individual to be responsible for day-to-day oversight of R1’s responsibilities under this Services Agreement (the “R1 Site Lead”).

8.5    Reliance on Authorized Personnel.  In performing their respective obligations under this Services Agreement, each Party and its employees and representatives shall have the right to rely on routine instructions, authorizations and approvals provided to it by authorized personnel of the other Party.  The authorized personnel of a Party shall be designated by the Party in writing, and are subject to change from time to time by providing advance written notice to the other Party.  The initial authorized personnel for Intermountain Healthcare and R1 will be listed in Exhibit 8.5, which may include listing of personnel by title instead of name.  If either Party lists personnel by title instead of name, it shall provide a list of names associated with such titles as of the Effective Date and promptly update such list in the event of any changes during the Term.  The authorized personnel of a Party do not have any authority under this Section to amend this Services Agreement or any other agreement between the Parties or to enter into any contract on behalf of a Party.  However, if any such personnel have authority independent of this Section to enter into amendments or contracts on behalf of a Party, then the foregoing sentence does not negate or limit that authority.  In addition to the authorized personnel identified under this Section 8.5, it is understood that the administrator, or his or her designee, of any IMH hospital, home health agency, rehabilitation agency (or any other provider type specified under the Medicare statute that becomes in-scope under this Agreement) or any other type of health care supplier (including physician locations) has the legal authority to direct in writing any action necessary for compliance with Medicare Conditions of Participation, conditions of coverage, or regulations applicable to the provider or IMH health care supplier.  IMH shall be responsible for any actions taken by R1 personnel in compliance with such directions that are documented in writing.  Accordingly, R1 personnel (including any sub-contractor personnel) shall comply with the directions of such administrators or their designees, pending resolution of any disputes related to such directions under the governance provisions of Sections 8.1, 8.2 and 8.3, as applicable. 

IX.    CONFIDENTIALITY

9.1    Prior Non-Disclosure Agreements.  The non-disclosure agreements between the Parties listed in Exhibit 9.1 (each an “NDA”) only apply to information first disclosed by one Party to the other Party prior to the Effective Date of this Services Agreement. The Confidential Information first disclosed by one Party to the other Party on or after the Effective Date will be governed by the confidentiality provisions of this Services Agreement.  Any confidentiality provisions in any other formal written agreements between the Parties will be apply to information disclosed under those agreements and not this Services Agreement.

9.2    Confidentiality of the Services Agreement.  The Parties will keep the details of this Services Agreement confidential. Notwithstanding the foregoing, the Parties acknowledge and agree that 

14

from time to time after the date hereof, it may be necessary or advisable for one or both of the Parties to disclose the terms and conditions of this Services Agreement to one or more third parties, including, without limitation, auditors, legal and tax advisors, accountants, investors, lenders, and acquirers, or when required by law, government regulation, the rules of any exchange on which the securities of a Party are listed, traded or qualified for trading, or when ordered or requested by a court or government agency.  As a result, in any such case, a Party may disclose the terms and conditions of this Services Agreement, but only as reasonably necessary and, to the extent reasonably possible, only on a confidential basis, unless such basis is not legally permissible.  In addition, each Party agrees to disclose such terms and conditions only to its personnel with a need to know or as otherwise required by applicable law or government regulation or by order of a court or government agency, and to take all appropriate steps to assure that those personnel understand the importance of this strict confidentiality and comply therewith. To the extent practicable and legally permissible, a Party (the “first Party”) will provide prompt notice of any legally required disclosure to the other Party and use commercially reasonable efforts to obtain a protective order or otherwise prevent any such public disclosure or otherwise seek confidential treatment of this Services Agreement, in which case the first Party shall only disclose this Services Agreement to the extent that it is advised by its counsel in writing that it is legally bound to disclose under such legal requirement.  Notwithstanding this Section 9.2, either Party may make general disclosures to others about the existence of this Services Agreement and the nature of the relationship of the Parties, which does not otherwise reveal any of the Confidential Information of the other Party – for example IMH may disclose to others that it is receiving the Services from R1 and may describe those Services.

9.3    Confidentiality.
		
	(a)
	Confidential Information. In connection with this Services Agreement (or any of the other agreements identified in Section 24.15, other than the NDA) or its performance, one Party (the “Receiving Party”) may learn, discover or have disclosed to it information from or about the other Party (the “Disclosing Party”) or its business, finances, plans, operations, software, computer systems, data, or networks. All information identified by the Disclosing Party as proprietary or confidential, or that is of a nature that it should reasonably be considered as proprietary or confidential (including, without limitation, Intellectual Property of a confidential nature such as a trade secret), shall be “Confidential Information” and shall not be disclosed by the Receiving Party to any third party without the express written consent of the Disclosing Party.  Confidential Information does not include (1) anything that is publicly known or generally known in the industry or profession of either Party, or (2) anything that is known to the Receiving Party prior to the time of first disclosure thereof by the Disclosing Party to the Receiving Party, as shown by the Receiving Party’s records or other credible evidence.  Confidential Information will cease to include (3) anything that becomes publicly known or generally known in the industry or profession of either Party through no fault of the receiving Party or its personnel, (4) anything that is lawfully disclosed by a third party (who did not receive the   

15

information directly or indirectly from the Disclosing Party) to the Receiving Party on a non-confidential basis, or (5) anything lawfully created by or for the Receiving Party without reference to or use of any of the Disclosing Party’s Confidential Information.  The requirements for consent in the second sentence of this Subsection (a) and for authorization in the first sentence of Subsection 9.3(b) do not apply to a disclosure by R1 of Intermountain Healthcare’s Confidential Information to an R1 Contractor as needed for the performance of Services, provided that R1 and the R1 Contractor comply with Section 18.3 and Section 24.17.
		
	(b)
	Protection of Confidential Information. Each Party agrees that it will: (i) treat as confidential all Confidential Information of the other Party, and (ii) not disclose or use the other Party’s Confidential Information except as expressly set forth herein or otherwise authorized by the Disclosing Party in writing. These restrictions do not apply to any disclosure required by applicable law or government regulation or by an order of a court or government agency; provided, however, that the Disclosing Party is provided with reasonable advance notice of such disclosure and thereafter the Receiving Party cooperates with any reasonable request of the Disclosing Party (at the Disclosing Party’s expense) to obtain a protective order or to otherwise protect the Confidential Information (unless the Receiving Party is prohibited by law or by order of a court or government agency from giving such notice to the Disclosing Party).

		
	(c)
	Injunctive Relief.  Failure on the part of Receiving Party to abide by this Section 9.3 will cause the Disclosing Party irreparable harm for which damages, although available, will not be an adequate remedy at law. Accordingly, the Disclosing Party has the right to seek preliminary and permanent injunctions to prevent any threatened or actual violations of this Section 9.3 in addition to all other available and applicable remedies.

		
	(d)
	Consultants. Intermountain Healthcare may disclose R1’s Confidential Information to Intermountain Healthcare’s consultants, vendors, service providers, licensors, and other contractors (“Consultants”) as reasonably needed or useful in connection with any services or solutions that any Consultants provide to Intermountain Healthcare. However, in each such case, the following will apply:

		
	(i)
	the disclosure of R1’s Confidential Information will be limited to that which is reasonably needed or useful for the services or solution to be provided by the Consultant to Intermountain Healthcare;

		
	(ii)
	the Consultant must agree in writing to keep the Confidential Information confidential and to not use the Confidential Information for any purpose other than services or solutions for Intermountain Healthcare (and if the Consultant is a competitor of R1 as described in subsection (d)(iv) below, then 

16

Intermountain Healthcare will (x) promptly notify R1 of any such disclosure of Confidential Information to such Consultant, and (y) use commercially reasonable efforts to make R1 a third party beneficiary in such written agreement with respect to the Consultant’s obligations described at the beginning of this sentence);
		
	(iii)
	if a Consultant breaches the obligations described above, Intermountain Healthcare will enforce those obligations against the Consultant and will cooperate with the reasonable requests of R1 in enforcing those obligations against the Consultant;

		
	(iv)
	Intermountain Healthcare shall not provide to any Consultant known by Intermountain Healthcare (at the time the materials are disclosed) to be a competitor of R1 with respect to the Services, any access (either directly or indirectly, such as providing such information to allow for replication) to Restricted Materials. The term “Restricted Materials” means R1’s software, source code, screen shots generated by that software, tool configuration documents, reports generated by that software, the specific analytics embodied in that software, user documentation for that software, and binders containing the proprietary Standard Operating Procedures (i.e., “SOPs”) of R1 for revenue cycle operations, in each case as provided by R1 to Intermountain Healthcare. R1 will keep Intermountain Healthcare informed of the  names of these competitors to which this Subsection (d)(iv) applies; and

		
	(v)
	It is agreed that [**] do not apply to [**].

		
	(e)
	Incidental and Permitted Disclosures. Nothing herein prohibits (and Section 9.3(d)) does not apply to) any use by Intermountain Healthcare or its Affiliates of any technology or R1’s Confidential Information as licensed or permitted by this Services Agreement or any incidental disclosure that reasonably occurs in connection with such licensed or permitted use or in the ordinary course of business (with the understanding that this sentence does not extend the duration or term of any license granted under this Services Agreement). By way of non-limiting example, screen displays generated by licensed software may be visible to patients and visitors to Intermountain Healthcare’s hospitals and clinics, and reports and other output generated by licensed software may be given to others as necessary or required in the ordinary course of business. Intermountain Healthcare makes limited disclosures of its operations, methods and practices to others and such limited disclosures may include incidental disclosures or disclosures of a general (i.e., not detailed nature) relating to R1’s Confidential Information, and therefore are permitted. Disclosures of R1’s Confidential Information to auditors, accountants and professional advisors 

[**] designates portions of this document that have been omitted pursuant to a request for confidential treatment filed separately with the Securities and Exchange Commission.
17

may be made by Intermountain Healthcare for legitimate purposes as needed in accordance with Section 19.1 (“Audits and Inspections”).
		
	(f)
	Patient Safety Information.  Notwithstanding anything in this Services Agreement or any other agreement of the Parties to the contrary, Intermountain Healthcare is under no obligation to suppress or refrain from disclosing or publishing any Patient Safety Information. “Patient Safety Information” means information that in the reasonable judgment of Intermountain Healthcare should or must be disclosed to others for the safety or wellbeing of the public or of any present or future patients of Intermountain Healthcare or any other health care providers or for any other ethical reasons.

		
	(g)
	Other Agreements. Nothing in this Section or elsewhere in this Services Agreement negates, limits or affects the BAA (as defined in Section 17.2), the Malware and Security Agreement (as defined in Section 17.3) or the Access and Confidentiality Agreement (as defined in Section 17.4), or excuses any breach of any of these agreements. 

(h)    Return or Destruction of Confidential Information.   Upon the later to occur of expiration or termination of this Services Agreement or any Disengagement Services, for any reason whatsoever, each Receiving Party shall ensure that it, its Affiliates and their respective authorized representatives shall, to the extent reasonably practicable, return to the Disclosing Party or destroy, upon request, all Confidential Information of the Disclosing Party that is in written or electronic form (including destroying all Confidential Information from any computer, server or other device containing such Confidential Information) and confirming the same in writing within [**] days of the notice described below, other than Confidential Information archived in the ordinary course of business on electronic storage systems or media, or retained pursuant to a bona fide document retention policy, or as required by Applicable Law, which retained Confidential Information shall continue to be Confidential Information and subject to the other terms hereof.  The Disclosing Party shall use reasonable efforts to identify with a reasonable level of specificity its Confidential Information that is subject to this obligation of return or destruction in its request to assist the Receiving Party with such obligation.  This Subsection will not come into effect until the Disclosing Party gives notice after this Services Agreement expires or otherwise terminates that the Disclosing Party expects the Receiving Party to comply.  This Section is subject to Section 15.2.

9.4    Good Faith and Cooperation.  The Parties agree to cooperate in good faith regarding the fulfillment of their respective responsibilities under this Services Agreement recognizing that their mutual cooperation and good faith are essential to the success of their relationship and the achievement of the business objectives that are basis of this Services Agreement.

X.    PERSONNEL TRANSITION AND BACKGROUND CHECKS

[**] designates portions of this document that have been omitted pursuant to a request for confidential treatment filed separately with the Securities and Exchange Commission.
18

10.1    Personnel Transition.  Terms (including Commencement Date) applicable to Transitioned Employees are set forth in Exhibit 10.1, including various Employment Effective Dates.

10.2    Background Checks, Drug Screening and Immunizations of R1 Personnel.
In addition to the Vendor Access Program of Section 7.7, R1 agrees to the following:
R1 will ensure that any of its personnel (employees and subcontractors) working in an Intermountain Healthcare facility will have:
		
	(a)
	Submitted to and successfully passed a standard SAM 5 drug screen;

		
	(b)
	Passed a criminal background check and is not listed on the sex offender website (http://www.nsopw.gov/Core/Portal.aspx?AspxAutoDetectCookieSupport=1) or any successor website thereto;

		
	(c)
	Obtained appropriate immunizations as described below; and

		
	(d)
	Completed all necessary training on Intermountain Healthcare policies and procedures (such training to be decided upon by the Parties as part of the transition to the Services).

R1 will ensure that any of its personnel (employees and subcontractors) working in an Intermountain Healthcare facility:
		
	(i)
	Is immune to measles, mumps and rubella, as demonstrated either by:

(1)    Showing proof that they have had two (2) Measles-Mumps-Rubella (MMR) immunizations; or
(2)    Submit to Intermountain Healthcare testing (positive antibody titer) to show Intermountain Healthcare they are immune.
		
	(ii)
	Has been screened for tuberculosis. Initial testing should be a two step tuberculin skin test (intradermal PPD) or a one-time BAMT (blood test). R1 will ensure that any R1 personnel who is PPD+ has had an adequate work-up for tuberculosis and is currently not communicable. (Chest x-ray report, physician or health department written note).

		
	(iii)
	Has completed a three (3) dose series of Hepatitis B vaccine if working directly with patients or body fluid specimens. Has provided documentation of Hepatitis B surface antibody results although routine Anti-HBs testing is not recommended if titer was not obtained 1 - 2 months after original vaccine series.

19

		
	(iv)
	Is immune to Varicella (Chickenpox). R1 will ensure that such immunity has been demonstrated by R1 personnel providing verification of one of the following:

(1)    Having had the disease (parent or R1 personnel may confirm history of the disease);
(2)    Documentation of 2 doses of Varicella vaccine given at least 28 days apart; or
(3)    Positive titer.
		
	(v)
	Has been immunized with one dose of Tdap.

		
	(vi)
	Has been immunized with the current, annual influenza vaccine on a yearly basis.

R1 agrees to provide documentation and attestation of compliance with this Section 10.2 for each R1 personnel promptly upon request by Intermountain Healthcare and at least [**].  
These requirements and this Section 10.2 may be revised as mandated by the CDC or, in the case of revisions by Intermountain Healthcare, upon reasonable written notice to R1. Such revised requirements and Section shall become binding upon and adhered to by the Parties on and after the effective date as designated by the CDC or, in the case of an effective date designated by Intermountain Healthcare, upon reasonable written notice to R1.
Nothing herein requires IMH to provide any vaccinations or immunizations or other healthcare services.

XI.    CHARGES AND INVOICES

11.1    Charges for Services.  The Charges for the Services are set forth in Exhibit 11.1 and include base and incentive fee components.

11.2    Invoicing. 
		
	(a)
	Invoicing Terms.  Invoicing terms for Charges are set forth in Exhibit 11.1.

		
	(b)
	Credits.  To the extent a credit may be due to IMH pursuant to this Services Agreement, R1 shall provide IMH with an appropriate credit against amounts then due and owing; if no further payments are due to R1, R1 shall pay such amounts to IMH within [**] days of the credit becoming due and payable.

		
	(c)
	Currency.  Unless otherwise specified in Exhibit 11.1, Charges for all Services shall be invoiced and paid in United States Dollars.

[**] designates portions of this document that have been omitted pursuant to a request for confidential treatment filed separately with the Securities and Exchange Commission.
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11.3    Payment of Charges.  In consideration of R1’s performance of the Services, IMH shall pay R1 the applicable Charges.  R1 acknowledges and agrees that there are no separate or additional costs, expenses, charges, fees or other amounts to be paid to R1 for such Services.  R1 shall continually seek to identify methods of reducing such Charges and will notify IMH of such methods and the estimated potential savings associated with each such method.

11.4    Incidental Expenses.  R1 acknowledges that, except as expressly provided otherwise in this Services Agreement, expenses that R1 incurs in performing the Services (including management, travel and lodging, document reproduction and shipping, and long-distance telephone) are included in the Charges and are not separately reimbursable by IMH unless IMH subsequently agrees in writing in advance to reimburse R1 for such expenses.

11.5    Proration.  Charges under this Services Agreement shall be prorated for any partial year during the Term as more specifically set forth in Exhibit 11.1. 

11.6    Payment Disputes.  In the event of a good faith dispute between the Parties regarding any fees or other payments payable by one Party (the “Paying Party”) to the other Party (the “Other Party”) under this Services Agreement (including any of its Exhibits), the Paying Party shall notify the Other Party of the dispute promptly in writing and any payment dispute shall be reviewed by the R1 Executive Sponsor and the Intermountain Healthcare Executive Sponsor who shall work, in good faith, to resolve the issue promptly. If such payment dispute has not been resolved within [**] days of referral to the R1 Executive Sponsor and the Intermountain Healthcare Executive Sponsor, the Parties shall refer the dispute to the Joint Review Board for resolution in accordance with Section 20.3.

		
	(a)
	The Paying Party shall not withhold any undisputed amounts of the fees or other payments. Any fees or payments that are disputed, but made, by the Paying Party (e.g., on a disputed invoice) shall be deemed to be made under protest with a reservation of rights by the Paying Party and without prejudice to its position, claims or defenses.

		
	(b)
	Each Party agrees to continue performing its obligations under this Services Agreement while any dispute is being resolved unless and until such obligations are terminated by the termination or expiration of this Services Agreement plus any extension attributable to Disengagement Services under Section 23.8. 

11.7    Compliance with Laws.  In the event that IMH’s legal counsel, upon consultation with R1’s legal counsel, reasonably determines that the methods for determining the Charges payable to R1 by IMH may violate any Healthcare Law or any other Applicable Law, the Parties shall, in good faith, determine an alternative method for determining such Charges that preserves the same economic benefits to R1 and IMH without such violation.

[**] designates portions of this document that have been omitted pursuant to a request for confidential treatment filed separately with the Securities and Exchange Commission.
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XII.    R1 CONTRACTORS

12.1    Use of R1 Contractors.  R1 may engage R1 Contractors (as subcontractors) to perform all or any portion of R1’s duties under this Services Agreement, provided that: (a) each R1 Contractor agrees in writing to be bound by confidentiality obligations at least as protective as the terms in this Services Agreement regarding confidentiality, (b) R1 remains responsible and liable for the performance, negligence, misconduct and breach of or by such R1 Contractor, (c) R1 remains responsible for ensuring that obligations with respect to the standards of Services set forth in this Services Agreement are satisfied with respect to any Services provided by such R1 Contractor and (d) R1 shall require each R1 Contractor to comply with all applicable terms of this Services Agreement, including but not limited to audit, privacy and data security and compliance provisions.  

12.2    New R1 Contractors.  Any new R1 Contractors (i.e., those who have not been used by R1 in connection with the services under the Original Services Agreement prior to the Effective Date), shall be selected by R1, subject to prior consultation within the Operations Oversight Council.  The Operations Oversight Council may provide input into the selection of New R1 Contractors and shall not have authority to waive privacy, data security and compliance requirements for any proposed New R1 Contractor that does not meet all such requirements, but IMH may grant such waiver pursuant to IMH’s policies, procedures and privacy, security and compliance practices.  Any such waiver must be agreed to by the Parties in writing.

XIII.    R1 FACILITIES AND CENTER OF EXCELLENCE

13.1    Use of R1 Facilities.  For purposes of clarity, R1 may utilize any of its or its Affiliates facilities located within the continental United States to provide the Services.  As used herein, the term “offshore” means outside of the continental United States.  Without limiting any other provisions of this Article XIII, in the event that R1 determines to change any of its facilities used to provide the Services it will provide IMH with written notice of such change within [**]  days of the change.  Subject only to Section 13.2, all Services and all “at rest” storage of Intermountain RCO Data by R1 must be within the continental United States.

13.2    Outsourcing to Offshore Resources [**].  R1 may utilize its or its Affiliates’ personnel located in India and listed in Exhibit 13.2 to provide any of the Services identified in Exhibit 13.2, or components thereof, provided that no Intermountain RCO Data is “transferred” to India, and further provided that [**].  For clarification, Intermountain RCO Data displayed, accessed, modified or processed through remote desktop virtualization methods or other secure remote systems access where the remote user’s access to Intermountain RCO Data prevents and does not include printing, copying or saving Intermountain RCO Data to offshore data storage devices in the performance of Services will not constitute a “transfer” of such data.  Access to Intermountain RCO Data by R1’s or its Affiliates’ personnel in India will otherwise be provided using remote desktop virtualization or other secure remote systems access methods that provide the ability to read, write and otherwise process such data, but not print, copy, or save such data offshore.  R1 and its Affiliates and its and their personnel located in India will comply with any applicable U.S. laws or regulations that would 

[**] designates portions of this document that have been omitted pursuant to a request for confidential treatment filed separately with the Securities and Exchange Commission.
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apply if the Intermountain RCO Data and the personnel were located in the United States.  R1 may, at its sole discretion, but with [**], move any Services within the approved outsourcing locations set forth in Exhibit 13.2.  Any other provision of the Services from, or transmission of Intermountain RCO Data to, any facility outside of the continental United States not listed in Exhibit 13.2 [**].  

13.3    Keeping Security Current.  The technology, practices and means used by R1 to protect Intermountain RCO Data and Intermountain’s use of the Services will be kept current by R1 with then-current industry standards and best practices, as defined and agreed upon by both Parties, and with IMH’s reasonable policies, procedures and guidelines.  R1 will also keep IMH informed with respect to such technology, practices and means. 

13.4    Center of Excellence. R1 agrees to the following in connection with the establishment of a center of excellence for revenue cycle management (the “Center of Excellence”):
		
	(a)
	R1 commits to establish the Center of Excellence in Utah;

		
	(b)
	R1 will select a location for the Center of Excellence accounting for the following factors (x) a centralized location to accommodate IMH transitioned employees, (y) a location with a sustainable pool of new employees for future growth, and (z) space with capacity for R1 investments in a new, modern and functional workspace; 

		
	(c)
	Over the course of the Term, R1 intends to grow the number of R1 employees located in Utah by [**]; and

		
	(d)
	R1 direct hires involved in the provision of the Services will be required to attend on-site IMH orientation to learn about the history, mission, vision and values of IMH.

		
	(e)
	The COE will anchor and expand value added capabilities, driving differentiation that includes:

i.             Best practice production operations in areas like financial clearance, financial counseling, coding, transcription, billing and follow-up, backstopped by operations in India;  

ii.            Establishing a performance analytics presence in Salt Lake City that includes the development of enhanced analytic reporting, advancing visualizations and data platforms, improved talent and robotics development, as well as real-time integration of analytics into operating processes.;  

iii.           Creating a development lab focused on the front-end of the future, integrated physician revenue cycle management, process automation, and by bringing key technology operations to Salt Lake City; and

[**] designates portions of this document that have been omitted pursuant to a request for confidential treatment filed separately with the Securities and Exchange Commission.
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iv.           Developing a revenue cycle institute in partnership with a reputable third party vendor [**] that will be known as a top revenue cycle management learning and development center.  This will be a forum for educating revenue cycle leaders of the future focused on continuous learning, and instruction on technologies and revenue cycle methods.”

XIV.    THIRD PARTY AGREEMENTS

14.1    In-Scope Agreements Managed by or Assigned to R1.  R1 and IMH desire to make the revenue cycle operations more efficient and cost effective for IMH. As such, at least [**] days prior to the Commencement Date, IMH shall prepare and deliver to R1 for its review a list of all third party agreements to which IMH or its Affiliate is a party and pursuant to which Similar Services are provided to IMH or its Affiliate (the “Similar Services List”).  Within [**] days after R1’s receipt of the Similar Services List, R1 and IMH shall agree on which third party agreements from the Similar Services List will be added to a schedule to this Services Agreement of agreements that will be managed by or assigned to R1 (each an “In-Scope Agreement” and collectively the “In-Scope Agreements”).  That schedule of In-Scope Agreements” will be added to this Services Agreement as part of Exhibit 14.1.  In deciding on which agreements shall become In-Scope Agreements, the Parties will consider, without limitation, the following:  (a) contractual or other legal reasons that may prevent the agreement from being made an In-Scope Agreement, (b) agreements that include a third party to the agreement, in addition to IMH and the primary provider of the Similar Services, (c) agreements that include services that are not Similar Services, (d) agreements with service providers where R1 also has an agreement with the same service provider, and (e) IMH or its Affiliate has an ownership interest in the third party.  If there is any disagreement as to whether or not an agreement should be added to the schedule or made an In-Scope Agreement, the final decision will be made by the Joint Review Board.  To the extent that any such third party agreement that includes Similar Services is not made an In-Scope Agreement, then IMH or its Affiliate may continue that third party agreement and Similar Services under it notwithstanding any other provision of this Agreement to the contrary, including Section 3.4 and the costs and expenses of such vendor will not be included in the Base Fee under Exhibit 11.1-A.  However, IMH will provide notice to R1 if and when the Similar Services under such third party agreement may be replaced by Services under this Agreement and the Parties will cooperate in good faith to add those Similar Services as Services to this Agreement after they can be replaced.  The schedule will be based on the template attached to this Services Agreement. Such Exhibit shall additionally identify whether R1 will manage the Similar Services under the In-Scope Agreement or if the In-Scope Agreement will be assigned to R1 (i.e., rights and obligations under the In-scope Agreement will be assigned to and assumed by R1) and whether IMH shall retain any responsibility for such In-Scope Agreement.  Exhibit 14.1 will further set forth which Party bears financial and operational responsibility for each In-Scope Agreement, [**].  To the extent that R1 assumes obligations under, or an assignment or management of, an In-Scope Agreement, R1 will indemnify IMH against any 

[**] designates portions of this document that have been omitted pursuant to a request for confidential treatment filed separately with the Securities and Exchange Commission.
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breach of the In-Scope Agreement except for any obligations retained by IMH pursuant to Exhibit 14.1.  For clarification and certainty, no agreement with Cerner will be an In-Scope Agreement.

14.2    Costs of Consents.  In the event that the assignment and assumption of rights and obligations (which may be referred to as an assignment of the agreement) or transfer of management of any In-Scope Agreement to R1 results in any fees, expenses or other costs charged by the third party service provider, such fees, expenses and costs shall be [**].

14.3    No Obligation to Breach; Impediments.  Nothing herein will require that R1 will manage, or be assigned rights under, an In-Scope Agreement if that would constitute a breach of such agreement, unless IMH obtains any required consent from the applicable third party vendor.  To the extent that any such consent is not obtained, IMH or its Affiliate may continue to receive the Similar Services from the third party service provider.  The Parties acknowledge that it may not be practical to try to anticipate and identify every possible legal or logistical impediment to the provision of Services hereunder.  Accordingly, each Party will promptly notify the other Party if it reasonably determines that there is any such impediment to the provision of any Services, and the Parties shall each use commercially reasonable efforts to overcome such impediments so that the Services may be provided otherwise in accordance with the terms of this Services Agreement.

14.4    Warranty of No Material Breach of In-Scope Agreements.  Intermountain Healthcare warrants that as of the date that the In-Scope Agreement is either assigned to R1 or R1 assumes management of the In-Scope Agreement that it is not in material breach of the In-Scope Agreements and that any breaches by IMH prior to such date have been fully resolved without any pending or current liabilities.  

14.5    [**]. 

14.6    Rights to In-Source or Terminate. 
		
	(a)
	 If an In-Scope Agreement is managed by or assigned to R1, then R1 may, subject to providing IMH with at [**] days’ written notice of its intent to terminate such agreement, terminate such agreement and make the Similar Services part of the Services under this Agreement.  If during such [**] notice period, IMH has any concerns regarding such action, IMH may raise such concerns with the Operations Oversight Council for discussion and R1 shall consider and attempt to address IMH’s concerns in good faith; notwithstanding the foregoing, the final decision to terminate an In-Scope Agreement that is assigned to or managed by R1 and to then make the applicable Similar Services part of the Services under this Agreement shall rest with R1 provided that the termination does not adversely affect IMH in any material manner and that termination is not a breach of the In-Scope Agreement.

		
	(b)
	Without limiting R1’s rights in Subsection (a) above, IMH agrees, promptly upon written request by R1, to provide R1 with a written analysis of the termination fees, 

[**] designates portions of this document that have been omitted pursuant to a request for confidential treatment filed separately with the Securities and Exchange Commission.
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if any, for the applicable In-Scope Agreement to be terminated, together with a copy of such contract and such other information reasonably required by R1 to verify such termination fees and the ability to terminate, subject to any confidentiality obligations under the In-Scope Agreement. Subject to IMH’s provision of such analysis and information, R1 shall be responsible for reimbursing IMH for any termination fees for the applicable In-Scope Agreement if R1 elects to terminate such agreement in accordance with the process in Subsection (a) above.  

XV.    INTELLECTUAL PROPERTY AND OTHER MATTERS

15.1    Intellectual Property.  R1 or, as applicable, its agents, subcontractors, R1 Contractors (and their respective agents and partners) and its delivery partners, shall have and retain all right, title and interest, including ownership of their respective copyrights, patents, trade secrets and other intellectual property rights, in and to methods, processes, techniques, strategies, materials, images, prototypes, software, source and object code and related materials that are owned or developed by R1 (the “R1 Intellectual Property”) and/or its agents, subcontractors, R1 Contractors (and their respective agents and partners) or any delivery partners during  the Term of this Services Agreement, including any modifications to, or derivative works or enhancements of, materials owned or licensed by R1, and any tools, utilities, prototypes, models, processes, methodologies and other such materials that are developed, enhanced or improved during the Term of this Services Agreement by R1 and/or any of its agents, subcontractors, R1 Contractors (and their respective agents and partners) or any delivery partners, which relate to the performance of the Services, or any modification of the Services to be provided under this Services Agreement.  Intermountain Healthcare acknowledges that it has been informed by R1 that all of the foregoing is R1 Intellectual Property or, as applicable, that of its agents, subcontractors, R1 Contractors (and their respective agents and partners) and its delivery partners, and Intermountain Healthcare agrees that no work of authorship developed or delivered by R1 or any of its agents, subcontractors, R1 Contractors (and their respective agents and partners) or its delivery partners is or will be a “work made for hire” as defined by U.S. copyright law, and that Intermountain Healthcare has no ownership of or exclusive rights to the R1 Intellectual Property owned and/or developed by R1 and/or its agents, subcontractors, R1 Contractors (and their respective agents and partners) or delivery partners except that Intermountain Healthcare will have the non-exclusive rights set forth in this Services Agreement with the understanding that neither this Services Agreement, including any of its Exhibits, nor any other agreement between the Parties grants to Intermountain Healthcare any exclusivity with respect to such R1 Intellectual Property. Conversely, R1 acknowledges that it has no right, title or interest in or to any copyrights, patents, trade secrets and other intellectual property rights, in and to methods, processes, techniques, strategies, materials, images, prototypes, software, source and object code and related materials of Intermountain Healthcare or any of its Affiliates (the “Intermountain Healthcare Intellectual Property”). Nothing in this Services Agreement, including any of its Exhibits, or in any other agreement between the Parties assigns, conveys or licenses to R1 or any other person or entity any Intermountain Healthcare Intellectual Property of Intermountain Healthcare or any of its Affiliates, 

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or grants any exclusivity to R1 or any other person or entity, except that R1 will have the non-exclusive rights expressly set forth in this Services Agreement.
Each Party will protect the other Party’s Intellectual Property with the same care and diligence as it would use to protect its own Intellectual Property, but in no event will such care and diligence be less than commercially reasonable care and diligence.  Consistent with each Party’s obligations in Section 9.3, each Party will take all necessary and appropriate steps to safeguard the other’s Intellectual Property against infringement by employees, former employees, vendors, affiliates and others to whom the Party has directly, or indirectly, made the other Party’s Intellectual Property available.

15.2    Incidental IP License.  R1 hereby acknowledges and agrees that Intermountain Healthcare shall have the right to use, and R1 hereby grants to Intermountain Healthcare an irrevocable, non-exclusive, world-wide license to use, the R1 Incidental IP (as defined immediately below) during the Term of this Services Agreement and thereafter, [**] in connection with, and in the ordinary course of, Intermountain Healthcare’s business (such right and license are referred to as the “Incidental IP License”). This Incidental IP License is personal to Intermountain Healthcare and may not be assigned, transferred, sublicensed or otherwise conveyed to any person or entity, except as part of an assignment of this Services Agreement that is permitted by Section 24.9.  “R1 Incidental IP” means any methods, processes, techniques, strategies, ideas, recommendations, and other know-how which are learned by or disclosed to Intermountain Healthcare or its employees as a result of R1’s delivery of Services under this Services Agreement and which subsequently become part of Intermountain Healthcare’s general knowledge or operations.  This Incidental IP License does not include any software.  This Incidental IP License is [**] if R1 owns or becomes the owner of any valid patent that claims any of the know-how included in the Incidental IP License, then R1 must give Intermountain Healthcare notice thereof and if Intermountain Healthcare uses that patented know-how, then Intermountain Healthcare will pay a reasonable license fee for that patent based on the extent to which Intermountain Healthcare uses the patented know-how. This Incidental IP License may also be exercised by Consultants, but only for the benefit of Intermountain Healthcare and subject to Section 9.3(d) to the extent it is applicable.

15.3    Software and Services License.  As part of the Services under this Services Agreement, R1 will provide and hereby grants to Intermountain Healthcare, during the Term, an irrevocable (except as provided in this Section 15.3) non-exclusive license to access and use the R1 Technology, and any other R1 software, R1 Intellectual Property, processes, methodologies, works of authorship and technology which are made available to Intermountain Healthcare in connection with the Services, solely for Intermountain Healthcare’s internal business activities and purposes relating to its revenue cycle operations or any other activity or purpose (e.g., training purposes) ancillary to those revenue cycle operations.  The term “use” as used in this license further includes installation (solely for purposes of exercising the Recovery Environment License for disaster recovery or to provide for business continuity), copying and other actions needed or useful for the exercise of this license. During the Term, R1 also will permit Intermountain Healthcare to access, use and make use of R1 

[**] designates portions of this document that have been omitted pursuant to a request for confidential treatment filed separately with the Securities and Exchange Commission.
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Analytics, by and through the Client Users, solely for the purpose of reporting and analyzing Intermountain RCO Data (as defined in Section 15.4 below).  A “Client User” means each of Intermountain Healthcare’s employees and Consultants designated by Intermountain Healthcare to use the R1 Technology; provided that with respect to Consultants this is subject to Section 9.3(d).  This service and license described in this Section 15.3 are referred to as the “Software and Services License” and further includes the right and license for Intermountain Healthcare to remotely access and use R1 software and R1 Analytics running on R1 Servers located at one or more SunGard, Microsoft Azure, or other data centers and the right to make backup copies of the Intermountain Healthcare revenue cycle production environment. The Software and Services License will continue after termination of this Services Agreement until the end of the Disengagement Services, after which it will terminate and IMH will cease all use of the R1 Technology, and any other R1 software, R1 Intellectual Property, processes, methodologies, works of authorship and technology licensed to IMH under the Software and Services License, subject to Section 15.2. Notwithstanding the foregoing, the Software and Services License will be revocable with respect to any R1 Technology that is dependent on software owned by an R1 Contractor and that R1 does not have the right to continue providing during the Term, provided that R1 must provide a suitable substitute under this license before revocation.  “R1 Servers” mean the servers, computer systems, storage devices, and other equipment used to run, store or back up the R1 Technology, and any other software that is used by in connection with the Services or revenue cycle operations, but this definition does not include any servers or other property owned by Intermountain Healthcare or leased by a third party to Intermountain Healthcare.  Upon request by Intermountain Healthcare for any of its Affiliates to access and use the R1 Technology under the above license and permission, such affiliates will be added to the Services, and acquire access to and use of the R1 Technology, through subsequent amendments to Exhibit 3.7 if and as mutually agreed upon in writing by the Parties with the understanding that R1 will not unreasonably refuse to allow such amendments and that the Parties also will reasonably increase the Charges as necessary to account for such additions in accordance with Exhibit 11.1. Any such use of the R1 Technology by Intermountain Healthcare’s Affiliates will be subject to the applicable provisions, limitations and protections of this Services Agreement.

15.4    Intermountain RCO Data. “Intermountain RCO Data” means the data of Intermountain Healthcare and all data applicable to the revenue cycle operations of Intermountain Healthcare, but does not include any information or data created by R1 to support its internal operations outside of the Services provided to Intermountain Healthcare (e.g., information or data R1 uses for purposes of creating internal financial and other records). To the extent needed or useful to do so for purposes of the Services or revenue cycle operations, Intermountain RCO Data will be stored on the R1 Servers (subject to Sections 6.2, 13.1, and 13.2 and any other provisions in this Services Agreement relating to the protection or storage of Intermountain RCO Data) and will be accessible by Intermountain Healthcare and R1 for purposes of retrieval, downloading, uploading, updating and otherwise using the Intermountain RCO Data. Notwithstanding anything to the contrary,   all Intermountain RCO Data is owned by Intermountain Healthcare, not R1 or any other person or entity. R1 will safeguard and keep confidential the Intermountain RCO Data and not use any of the Intermountain RCO Data for any purpose other than the performance of the Services and any other 

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purposes expressly permitted hereunder.  Any other purpose not expressly permitted under this Agreement, including other product, service and program development and improvement or research purposes, will require IMH’s approval (which may be withheld) and a separate written agreement or amendment to this Agreement.

15.5    Consent to Use Data Analysis Results. Except if and as otherwise agreed by the Parties in this Services Agreement or a separate agreement, (i) to the extent that the Services under this Services Agreement include data analysis of Intermountain RCO Data conducted for the benefit of Intermountain Healthcare, then the results of such data analysis may be used by R1 only for purposes of improving operational performance of the Services for the benefit of Intermountain Healthcare (with the understanding that those improvements may also benefit other R1 clients who receive services from R1 that are the same as or similar to the Services received by Intermountain Healthcare) and (ii) R1 shall specifically be permitted to use the Intermountain RCO Data in furtherance of benchmarking, quality control, and other internal business purposes, including improvements to R1 Services for the benefit of Intermountain Healthcare (with the understanding that those improvements may also benefit other R1 clients who receive services from R1 that are the same as or similar to the Services received by Intermountain Healthcare) (but no Intermountain RCO Data will be disclosed to others except for de-identified and aggregated Intermountain RCO Data as permitted below).  For purposes of clarity, during the Term (but not thereafter) R1 may incorporate non-identifiable aggregated data extracts from Intermountain RCO Data, including Intermountain RCO Data which constitutes PHI that has been de-identified and aggregated in accordance with HIPAA and cannot reasonably be re-identified by R1, into R1’s services, documentation and other materials regarding services which R1 provides. R1 agrees that it shall be responsible for any and all losses or other harm experienced by Intermountain arising out of any third party’s re-identification of any such de-identified aggregated Intermountain RCO Data which has been incorporated into R1’s services, documentation and other materials.     Intermountain and R1 agree that Intermountain shall retain sole ownership of any such de-identified aggregated Intermountain RCO Data which is incorporated into R1 documentation and materials and that Intermountain hereby grants to R1 a perpetual worldwide and royalty free license to such de-identified aggregated data for use as permitted by this Section 15.5.  Notwithstanding the foregoing, Intermountain acknowledges that R1 shall retain ownership of such R1 documentation and materials (other than the de-identified aggregated Intermountain RCO Data) and that such R1 documentation and materials (including the de-identified aggregated Intermountain RCO Data in them) may be disclosed to third parties.  All such data is subject to the BAA and Malware and Security Agreement (see Sections 17.2 and 17.3), and in no event may R1 disclose any protected health information, personally-identifiable information or payment card industry information to any third party (with the exception of R1 Contractors having a need to know for purposes of the Services and in compliance with Section 17.1 and this Services Agreement). 

15.6    R1 Analytics Data.  “R1 Analytics Data” means any Intermountain RCO Data used in or by R1 Analytics, and any queries used in the analytics of that data and the results of those queries and analytics.  All R1 Analytics Data will be backed-up and stored by R1 for Intermountain Healthcare.  

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R1 will provide R1 Analytics Data to Intermountain Healthcare if and as reasonably requested by Intermountain Healthcare before or during the Disengagement Services.

15.7    Access Credentials.  R1 will permit access to the R1 Technology software via the Internet (using Google Chrome or some other compatible web browser) solely through the use of Access Credentials assigned to the Client Users. “Access Credentials” means any unique user identification and password combination or other security code, method, or device used to verify a Client User’s identity and authorization to access and use the R1 Technology Access Credentials will be deemed Confidential Information of both Parties.

15.8    Authorization Limitations and Restrictions. Intermountain Healthcare shall not, and shall not permit any other person to, access or use the R1 Technology except as expressly permitted by this Services Agreement or some other agreement between the Parties or with the consent of R1. Without limiting the foregoing, but subject to the foregoing exception, Intermountain Healthcare shall not:
		
	(a)
	copy, modify or create derivative works of the R1 Technology or any part of such tools, except as permitted by or needed for this Services Agreement or that is otherwise a fair use or a non-infringing act under applicable law (but for the avoidance of doubt, Intermountain Healthcare may copy screen displays as needed for training or support purposes); or

		
	(b)
	rent, lease, lend, sell, sublicense, assign, distribute, publish, transfer or otherwise make available the R1 Technology to any third party; or

		
	(c)
	reverse engineer, disassemble, decompile, decode, adapt or otherwise attempt to discern or gain access to the source code of the R1 Technology, in whole or in part, except pursuant to this Services Agreement or an escrow agreement or the written permission of R1.

15.9    Malware. Intermountain Healthcare warrants that R1 will not receive Malware as the result of an intentional, negligent or malicious act of any Intermountain Healthcare employee. Intermountain Healthcare further warrants that it will use commercially available, reasonable efforts and means to ensure that R1 will not receive Malware from Intermountain Healthcare or any of its employees (via modem, VPN, Internet, or any other method or means).  If a Consultant intentionally, negligently or maliciously transmits any Malware to R1, Intermountain Healthcare and R1 will cooperate with each other in taking appropriate action against the Consultant.  “Malware” means any virus, worm, trap door, back door, snoopware, spyware, malicious logic, Trojan horse, time bomb or other malicious functionality that is designed to erase or alter data, programs or equipment or render any of them unusable, intentionally interfere with the R1 Technology, or otherwise intentionally cause the R1 Technology, or any other R1 software to become inoperable or incapable of being normally used. 

15.10    Protection of Access Credentials. Each Party will notify the other Party of any misuse or security breach involving any Access Credentials.

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15.11    Changes to the R1 Technology. R1 reserves the right to make any changes to the R1 Technology or specifications that it deems necessary or useful, provided that any such changes do not materially degrade the function or performance of the R1 Technology or the Services, or the usefulness of the foregoing to Intermountain Healthcare, or the security of Intermountain RCO Data.

15.12    Suspension or Termination of Access. R1 may suspend Intermountain Healthcare’s, any Client User’s, or any other person’s access to or use of all or any part of the R1 Technology, without any resulting obligation or liability, upon reasonable prior notice (if possible) if the suspension is necessary to comply with any applicable law, regulation, judicial order or other governmental demand, provided that any such suspension will only apply to the affected R1 Technology software or tools at issue, and further provided that representatives of the Parties will meet on an expedited basis and do all that is reasonably necessary to allow for a lifting of the suspension. Additionally, R1 may suspend, terminate or otherwise deny a Client User’s access to or use of all or any part of the R1 Technology, without any resulting obligation or liability, if such Client User is using the R1 Technology for fraudulent or unlawful activities, provided that R1 immediately notifies Intermountain Healthcare of such Client User’s suspension, termination or denial of access. R1 shall meet with Intermountain Healthcare representatives (including by telephone) within one business day of such suspension, termination, or denial of access (or as soon as possible thereafter if an Intermountain Healthcare representative is not available within such one business day timeframe) to discuss such Client User’s activities that were the basis for the suspension, termination or denial of access. Further, R1 may suspend, terminate or otherwise deny a Client User’s access to or use of all or any part of the R1 Technology, without any resulting obligation or liability, if such Client User has not accessed or used the R1 Technology in the immediately prior [**] days, provided that any such suspension, termination or denial will be without prejudice to a subsequent request to restore access to any such Client User. This Section 15.12 does not limit any of R1’s other rights or remedies, whether at law or in equity.

15.13    Consent to Monitoring. Intermountain Healthcare agrees that R1 may use the R1 software to review, monitor and record Intermountain Healthcare’s use of the R1 Technology to the extent permitted by law, including information reflecting access or use of the R1 Technology by any Client User. R1 may use the R1 software to monitor and measure Intermountain Healthcare’s use of the R1 Technology in connection with R1’s performance of the Services and to assist Intermountain Healthcare with measuring and achieving its business productivity goals. R1 also may use information it gains from such monitoring, recording and measuring to assess use by any Client User to determine compliance with this Services Agreement.  The scope of this review, monitoring, recording and measuring will be strictly limited by R1 to that which is necessary for the purposes articulated in this paragraph.  The results of the review, monitoring, recording and measuring will be disclosed by R1 to Intermountain Healthcare and will be discussed by the Parties as part of their regular business review process.  If R1 becomes aware that Intermountain Healthcare is not in compliance in all material respects with any applicable law, then such results will be fully and promptly made available by R1 to Intermountain Healthcare.  In the event that any non-compliance 

[**] designates portions of this document that have been omitted pursuant to a request for confidential treatment filed separately with the Securities and Exchange Commission.
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or other problem is discovered by a review, monitoring or recording, the Parties will discuss the non-compliance or other problem and work to promptly implement a remedy.  The results of the review, monitoring and recording will be kept confidential by R1, except for disclosure to Intermountain Healthcare. 

15.14    Monitoring by IMH.  Intermountain may monitor and record for security and privacy purposes, any access to or use of Intermountain RCO Data or IMH computer systems by R1 or its personnel.  R1 will cooperate with IMH in the implementation, operation and maintenance of such monitoring and recordation, at IMH’s expense.

15.15    Replacement of R1 Personnel.  If any of the personnel performing Services are reasonably objectionable to IMH, then IMH will consult with the R1 Site Lead and the Parties will determine whether to replace such personnel in accordance with R1 human resources policies and procedures.  If any matter with respect to the requested or actual replacement of such individual needs to be resolved that cannot be resolved by the R1 Site Lead, the matter will be discussed by the Operations Oversight Council.  The resolution must be reasonably acceptable to IMH.

XVI.    BUSINESS CONTINUITY

16.1    Recovery Environment and Continuity of Business.  IMH shall have the option to require R1 to implement a Recovery Environment subject to the requirements of this Section 16.1.  IMH may, but is not required to, exercise such option at any time during the Term of this Services Agreement by providing written notice to R1 (an “Election Notice”).  If IMH exercises such option, it shall provide R1 with a reasonable amount of time in which to create and implement the Recovery Environment and comply with this Section 16.1 and Exhibit 16.1, which shall not be less than [**] following receipt of an Election Notice by R1.  The “Recovery Environment” means those items reasonably needed by Intermountain Healthcare for disaster recovery or back up purposes and to provide for business continuity, and will include the software, configuration files, documents, information, instructions, data and other assets and resources identified in Exhibit 16.1.  If IMH exercises the option under this Section 16.1, it shall be the responsibility of R1 to establish and keep the Recovery Environment current and “up to date” and to work with the information technology personnel of intermountain Healthcare to ensure that this happens. This obligation to keep current and “up to date” includes software updates, data transfer and refresh on a timely basis, and all that is reasonably needed to make the Recovery Environment useful and reliable for the purposes described above and for business continuity. The Recovery Requirements Exhibit further describes the rights and obligations of the Parties with respect to the Recovery Environment, if established pursuant to this Section 16.1, and any testing and validation, including Intermountain Healthcare’s right to request that any periodic restoration and testing take place. The Recovery Environment may be located at Intermountain Healthcare facilities or at the data center(s) of its data center provider (e.g., Dell), or both, provided, however, that nothing herein or in Exhibit 16.1 shall require R1 to purchase or provide any computer systems or equipment for use at such facilities or data center(s).  If a Recovery Environment is established pursuant to this Section 16.1, R1 hereby grants to 

[**] designates portions of this document that have been omitted pursuant to a request for confidential treatment filed separately with the Securities and Exchange Commission.
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Intermountain Healthcare a non-exclusive, paid-up, royalty-free license to use, adapt, modify, run, test, and use the Recovery Environment as reasonably needed for disaster recovery or back up purposes or to provide for business continuity (the “Recovery Environment License”) during the term of this Agreement and the Disengagement Services; provided that in the event of termination of this Agreement for which no Disengagement Services are provided, such Recovery Environment License shall continue (but not any related support or other obligations set forth herein or in Exhibit 16.1) for the earlier of [**] or [**]. For clarity, the foregoing Recovery Environment License does not mean or imply that anything in the Recovery Environment that is owned by or proprietary to Intermountain Healthcare (e.g., the Intermountain RCO Data) is instead owned by R1 (i.e., Intermountain Healthcare retains ownership and does not need the Recovery Environment License for its rights) and there are no restrictions on Intermountain Healthcare with respect to the subject matter that it owns. 

16.2    Disaster Recovery Plan. In addition to the Recovery Environment, R1 will implement, maintain and ensure the continuation of a disaster recovery and business continuity plan as described in Section 7 of the Malware and Security Agreement. This plan will be updated from time to time as needed to keep it current and to provide no less than a commercially reasonable level of protection to Intermountain Healthcare.  R1 will implement and comply with the disaster recovery and business continuity plan.

16.3    Source Code and Development Environment. If and as requested by Intermountain Healthcare (the “Escrow Request”), and to the extent not included in the Recovery Environment (and without diminishing any obligations or rights with respect to the Recovery Environment), the Parties will establish an escrow of the source code and development environment for the R1 Technology, and any other R1 software used for the Services or revenue cycle operations, except for R1 Technology that is dependent on software owned by an R1 Contractor, with a software escrow company (e.g., Iron Mountain) that is acceptable to both Parties.  The software escrow agreement must provide meaningful protection to Intermountain Healthcare and properly account for bankruptcy issues, including, without limitation, the right and ability to make an election to retain under Section 365(n) of the U.S. Bankruptcy Code. 

16.4    Rights under the Bankruptcy Code. If this Services Agreement is rejected under the U.S. Bankruptcy Code, Intermountain Healthcare may elect to retain its licenses and rights as provided in Section 365(n) of the U.S. Bankruptcy Code. Nothing in this Section limits any other rights or remedies Intermountain Healthcare may have. The Parties intend that no bankruptcy or bankruptcy proceeding, petition, law or regulation will interfere with any license or right granted to Intermountain Healthcare in accordance with this Services Agreement with respect to any software or other forms or embodiments of intellectual property. The Parties agree that the software and other materials or media licensed or provided to Intermountain Healthcare are an “embodiment” of “intellectual property” as those terms are used in Section 365(n) of the U.S. Bankruptcy Code (11 U.S.C. 365(n)).

[**] designates portions of this document that have been omitted pursuant to a request for confidential treatment filed separately with the Securities and Exchange Commission.
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XVII.    DATA PRIVACY AND SECURITY

17.1    PHI and Data Privacy Policy.  As part of R1’s protected health information (“PHI”) privacy policy and its confidential information privacy compliance program, and in connection with its desire to uniformly protect PHI and other sensitive data, R1 maintains a HIPAA Mitigation of Unauthorized Uses and Disclosures of PHI Policy and a Data Handling and Classification Policy that, to the best of R1’s knowledge, comply with all applicable federal and state statutes and regulations. R1 will notify Intermountain Healthcare of any changes in those policies during the Term of this Services Agreement, and agrees to promptly share all such policies with Intermountain Healthcare and to comply with those policies.  This Section and such policies will not negate, limit or excuse any breach of any other section of this Services Agreement or of the BAA, Malware and Security Agreement, or Access and Confidentiality Agreement.

17.2    Business Associate Agreement. The Parties entered into a Business Associate Agreement, dated March 22, 2011, as amended effective on August 26, 2011, and as amended effective on October 31, 2011 (the “Prior BAA”).  The Parties later entered into a Business Associate Agreement dated June 8, 2016, as amended as of the Effective Date(the “BAA”) that superseded the prior BAA. The BAA is a standalone agreement and nothing in the BAA is negated, amended or limited by this Services Agreement.  

17.3    Malware and Security Agreement.  The Parties have entered into a Malware and Security Agreement, dated as of the Effective Date (the “Malware and Security Agreement”) that superseded any prior Malware and Security Agreement. The Malware and Security Agreement is a standalone agreement and nothing in the Malware and Security Agreement is negated, amended or limited by this Services Agreement.

17.4    Access and Confidentiality Agreement.  R1’s personnel who will have access to any computer system or network of Intermountain Healthcare must each agree to and sign the Access and Confidentiality Agreement, the form of which is attached hereto as Exhibit 17.4. Each signed original must be given by R1 to Intermountain Healthcare. All R1 personnel who will provide the Services hereunder have entered into a “Proprietary Interests and Protection Agreement” (or a predecessor agreement, i.e., a “Confidentiality and Non-Disclosure Agreement” which is substantively the same as the Proprietary Interest and Protection Agreement) with R1.

XVIII.    COMPLIANCE AND AUDIT MATTERS

18.1    Compliance with Intermountain Healthcare’s Standards of Conduct. R1 recognizes that it is essential to the core values of Intermountain Healthcare that all persons and entities employed by or otherwise contracting with Intermountain Healthcare at all times conduct themselves in compliance with the highest standards of business ethics and integrity and applicable legal requirements, as reflected in Intermountain Healthcare’s policies, as may from time to time be amended, by Intermountain Healthcare.  Subject to Section 18.4(b) below, R1 agrees that it will 

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comply with such policies to the extent that they are applicable and will cause its personnel to also comply.

18.2    Compliance with Law and Regulations. Each Party represents that it, its personnel (including R1 Contractors in the case of R1) and its agents will comply with (i) all applicable federal, state and local laws, regulations and rules, including those governing Intermountain Healthcare’s status as a tax-exempt organization, Healthcare Laws (as defined in Exhibit 1.1), including the anti­kickback statutes (as they are commonly known), the Stark II prohibitions on physician ownership and self-referrals, and all employment and labor relations statutes, including affirmative action and non-discrimination statutes, (ii) all applicable regulatory or accrediting agencies with jurisdiction over Intermountain Healthcare (including, but not limited to, the U.S. Department of Health and Human Services) and (iii) any requirements of any commercially reasonable financing arrangement undertaken by Intermountain Healthcare. Intermountain Healthcare retains ultimate decision-making authority on any patient or clinical issues. In addition, IMH has decision-making authority regarding any compliance issues affecting Intermountain facilities and providers, subject to referral of disputes with respect to any such decisions to the Joint Review Board for consideration consistent with the last two sentences of Section 8.1. 
R1 represents and warrants to Intermountain Healthcare that R1 and its directors, officers and employees are not excluded from participation in any federal health care programs, as defined under 42 U.S.C. §1320a-7b(f), or any form of state Medicaid program, and to R1’s knowledge, there are no pending or threatened governmental investigations that may lead to such exclusion.  Additionally, Intermountain Healthcare represents and warrants to R1 that, to Intermountain Healthcare’s knowledge, (i) there are no Intermountain Healthcare personnel, including Transition Employees for as long as they are employed by Intermountain Healthcare, excluded from participation in any federal health care programs, as defined under 42 U.S.C. §1320a-7b(f), or any form of state Medicaid program and (ii) there are no pending or threatened governmental investigations that may lead to such exclusion.  Each Party agrees to notify the other Party of the commencement of any such exclusion or investigation promptly after the first Party is made aware of any such matter.  

18.3    R1 Contractor Compliance. R1 represents and warrants that each of its agreements with R1 Contractors contains or will contain provisions regarding the protection of Intermountain Healthcare’s confidential information and regulatory compliance as contemplated herein, and that each of the R1 Contractors has entered into, or will enter into, a business associate agreement with R1 with respect to the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”). R1 further represents and warrants that none of the R1 Contractors is an “excluded provider” under any Federal Healthcare Program.  In the event that any of the R1 Contractors becomes an “excluded provider’’, R1 shall promptly terminate its use of that R1 Contractor and shall, as soon as practicable, notify Intermountain’s Compliance Department of all relevant facts and circumstances. 

18.4    Compliance Programs. 

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	(a)
	R1 and Intermountain Healthcare each represents to the other that throughout the Term of this Services Agreement they will each have, in effect, an appropriate corporate compliance program (a “Compliance Program”) designed to assure that their respective personnel and agents are aware of and fully observe the requirements of all applicable federal, state and local laws, regulations and rules. 

		
	(b)
	R1’s Executive Vice President, Compliance & Risk or his/her designee (the “R1 Compliance Officer”) and IMH’s Vice President, Business Ethics and Compliance or his/her designee (the “IMH Compliance Officer”) shall coordinate and cooperate with one another to: (i) provide each other with information reasonably requested by the other regarding the aspects of such Party’s Compliance Program relating to the Services; and (ii) in good faith keep each other updated about those aspects of the respective Compliance Programs that relate to the Services or the Party’s obligations under this Agreement.  

		
	(c)
	R1 acknowledges that all Services provided under this Services Agreement, and all of R1’s personnel, shall be explicitly subject to applicable Intermountain Healthcare policies and procedures which are provided to R1 prior to the Effective Date or thereafter upon [**] days notice.  Nothing in this section shall limit the authority of IMH Authorized Personnel pursuant to Section 8.5 of this Agreement.  Notwithstanding the foregoing, the R1 Compliance Officer may raise any proposed changes or issues with such policies with the IMH Compliance Officer and the IMH Compliance Officer shall consider such matters in good faith.  If the R1 Compliance Officer and the IMH Compliance Officer are unable to agree upon a resolution of any such matter, either Party may refer the matter to the Operations Oversight Council or the Joint Review Board under Section 8.3 or 8.1 for resolution. 

18.5    Unauthorized Acts.  In addition to its obligations under the NDAs, this Services Agreement, the Malware and Security Agreement and the BAA, each Party (the “First Party”) shall:
		
	(a)
	Notify the other Party promptly of any material unauthorized possession, use or communication of any PHI, data or Confidential Information of the other Party which becomes known to the First Party.

		
	(b)
	Promptly furnish to the other Party any information in the First Party’s possession related to the unauthorized possession, use or communication of any PHI, data or Confidential Information and reasonably assist the other Party in investigating the unauthorized conduct, and preventing the recurrence of any unauthorized conduct.  This Section 18.5(b) does not apply to any information that is subject to a privilege (e.g., attorney-client privilege or attorney work product) or to any obligation of confidentiality to a third party.

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	(c)
	Cooperate with the other Party in responding to any third parties entitled to a report of the unauthorized conduct and in determining the nature and content of any required reporting.

		
	(d)
	Take such remedial steps as might be appropriate to avoid any recurrence of any unauthorized conduct in the future.

18.6    Record Retention.  For a period of [**] years, or [**] years for Medicare Advantage records, after services are furnished under this Services Agreement, R1 shall retain and permit the Comptroller General of the United States, the U.S. Department of Health and Human Services and their respective duly authorized representatives access to examine or copy this Services Agreement and such books, documents, and records of R1 as are reasonably necessary to verify the nature and extent of the costs of the services supplied under this Services Agreement.  In the event R1 provides any of its Services under this Services Agreement pursuant to a subcontract and if (i) the services provided pursuant to such subcontract have a value or cost of ten thousand dollars ($10,000.00) or more over a twelve (12) month period and (ii) such subcontract is with a related organization, then R1 agrees that such subcontract shall contain a clause requiring the subcontractor to retain and allow access to its records on the same terms and conditions as required by Intermountain Healthcare. This provision shall be null and void should it be determined that Section 1861(v)(1)(I) of the Social Security Act is not applicable to this Services Agreement.  
In addition to the foregoing and to the extent that R1 in connection with the Services holds or keeps any records of Intermountain Healthcare that are not otherwise held by Intermountain Healthcare in the normal course of its business, such records will be held, kept and preserved in accordance with the then-current record retention polices of Intermountain Healthcare to the extent that those policies are communicated in writing to R1.

18.7    Privilege Issues. R1 acknowledges that Intermountain Healthcare believes that in connection with the delivery of the Services, information may be prepared under the direction of Intermountain Healthcare’s legal counsel in anticipation of litigation, or otherwise, that Intermountain Healthcare seeks to keep privileged under the applicable attorney/Intermountain Healthcare or attorney work product privileges conferred by applicable law (“Privileged Work Product”).  R1 acknowledges that under such circumstances, R1 is performing the Services as to Privileged Work Product as an agent of Intermountain Healthcare, and that all matters related thereto are protected from disclosure, at Intermountain Healthcare’s option, by Rule 26 of the Federal Rules of Civil Procedure and any other available rule or privilege.  Intermountain Healthcare shall notify R1 when it is to be provided access to Privileged Work Product or when its work is determined to be Privileged Work Product.  After R1 is notified or otherwise becomes aware that such documents, data, database, or communications are Privileged Work Product, only R1 personnel for whom such access is necessary for the purpose of providing Services to Intermountain Healthcare as provided in this Services Agreement may have access to Privileged Work Product.  Should R1 ever be notified of any judicial or other proceeding seeking to obtain access to Privileged Work Product, R1 shall, unless prohibited 

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by law, (a) immediately notify Intermountain Healthcare and (b) take such reasonable actions at Intermountain Healthcare’s expense as may be specified by Intermountain Healthcare to resist providing such access or to protect it through a protective order or other lawful means.    Intermountain Healthcare shall have the right and duty to represent R1 in such resistance or to select and compensate legal counsel to so represent R1, or to reimburse R1 for actual and reasonable attorneys’ fees, reasonable expenses and any damages arising from R1’s compliance with this section incurred in resisting such access.  Intermountain Healthcare shall indemnify and hold harmless R1 and its respective officers, directors, employees and representatives against any and all claims, damages, and expenses, including reasonable attorney’s fees, related to third party claims arising from R1’s compliance with this section, provided that R1 is not itself the target or subject of an investigation regarding the Services provided under this Services Agreement or in breach of a provision of this Services Agreement that is relevant to the matter.  If R1 is ultimately required, pursuant to an order of a court of competent jurisdiction, to produce documents, disclose data, or otherwise act in contravention of the confidentiality obligations imposed in this Services Agreement or otherwise with respect to maintaining the confidentiality, proprietary nature and secrecy of Privileged Work Product, R1 shall not be liable for breach of such obligation.  In such event, R1 agrees to disclose only that information minimally required to be disclosed by such legal action.  
Notwithstanding the foregoing, the Parties recognize that they may become joint defendants in proceedings to which the information covered by the protections and privileges identified in this Section 18.7 relates and they may share a common legal interest in disclosure between them that is subject to such privileges and protections, and in such event, if reasonably requested by R1 or IMH, the Parties shall enter into a joint defense agreement with respect thereto. R1 is not waiving, nor will it be deemed to have waived or diminished, any of its attorney work product protections, attorney-client privileges or similar protections and privileges recognized under applicable law of any jurisdiction as a result of disclosing information pursuant to this Agreement or the Services, or any of its Confidential Information (including Confidential Information related to pending or threatened litigation) to IMH, regardless of whether R1 has asserted, or is or may be entitled to assert, such privileges and protections.  In addition to the foregoing, this Section 18.7 shall not apply to potential litigation or disputes between the Parties. 

18.8    Additional Compliance Obligations.  In addition to any other compliance obligations R1 may have, R1 must meet the obligations of Exhibit 18.8. 

18.9    Compliance Investigations, Notifications and Reports.
		
	(a)
	During the Term and for a period of [**] thereafter, R1 and Intermountain Healthcare agree to cooperate with one another in good faith in the investigation and resolution of any compliance matter that may arise affecting the Services to be provided under this Agreement.  It is the Parties’ mutual intention that any investigations undertaken regarding the provision of the Services or this Agreement or the Business Associate Agreement or the Malware and Security Agreement will be undertaken jointly, and 

[**] designates portions of this document that have been omitted pursuant to a request for confidential treatment filed separately with the Securities and Exchange Commission.
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in a coordinated fashion, by the R1 Compliance Officer and the IMH Compliance Officer unless either Party has good cause or reason to proceed with an independent investigation. 
		
	(b)
	The R1 Compliance Officer shall maintain routine communications with the IMH Compliance Officer on aspects of the parties respective Compliance Program relating to the Services.  Such contacts shall occur on a regularly scheduled basis, subject to the Parties’ coordination.  The R1 Compliance Officer shall make an [**] report to the IMH Compliance Officer on the scope and effectiveness of the R1 Compliance Program with regard to the Services, to be delivered within [**] days after each anniversary of the Effective Date (or as otherwise agreed by the Parties) and shall include those elements set forth in Exhibit 18.9. 

		
	(c)
	Without limiting the above, each Party’s compliance head (i.e., the R1 Compliance Officer and the IMH Compliance Officer) shall promptly notify the other Party of (i) any and all actual or potential compliance issues identified by a Party’s Compliance Program relating to the Services, or (ii) any subpoena or similar compulsory request for information or documents relating to the Services.  The Parties shall develop a system to facilitate and document these communications.

		
	(d)
	Without limiting Section 18.9(c), whenever R1 or any of its subcontractors becomes aware of credible information by whatever means suggesting that IMH may have received an overpayment from Medicare, Medicaid, or any governmental payer, it shall promptly notify the IMH Compliance Officer or a designated IMH representative of that information.  The Parties will follow IMH policies and procedures related to overpayments and shall develop a system to facilitate and document these communications.

XIX.    AUDITS AND REPORTING 

19.1    Audits and Inspections. During the Term and for a period of [**] thereafter, upon reasonable advance written notice from Intermountain Healthcare and reasonable opportunity for coordination and alignment relating to scope between R1 and Intermountain Healthcare, R1 shall provide such auditors and inspectors as Intermountain Healthcare may designate in writing with access to any R1 employees, reports, security procedures/protocols and information used by R1 to deliver the Services for the purpose of performing audits or inspections of the Services; provided that, to the extent that R1 or its R1 Contractor has obtained a certification from a qualified third-party assessor which uses applicable industry methods and standards (e.g., HITRUST or SOC) and such certification covers all or any portion of the items that would otherwise be the subject of such audit or inspection, then such items shall be excluded from the scope of such audit or inspection (except with respect to any audit by a regulatory authority). With respect to any audit or inspection of the Services, apart from any audit or investigation performed by Intermountain Healthcare’s internal or external auditors or governmental or regulatory authority, Intermountain Healthcare shall not 

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use any auditor or inspector who (i) is a competitor of R1 or (ii) has a pre-existing conflict of interest with R1, in each such case without the prior written approval of R1 (such approval will not be unreasonably withheld and is now given with respect to any nationally recognized accounting firm). With respect to any such audit or investigation R1 shall have the right to demand appropriate protections against disclosure of its R1 Intellectual Property and Confidential Information (but if the auditor or investigator is part of a government entity that refuses to agree to such protections, the disclosure must proceed, and the auditor or investigator will be provided the information which is required by the auditor or investigator). R1 shall provide such auditors and inspectors with any reasonable assistance that they may require.  IMH shall provide R1 with a summary of the results of any such audit or inspection upon receipt. R1 and IMH will discuss and mutually determine audit items that may need resolution and/or mutually develop plans and procedures to address any changes based on the findings from the audit. If any audit or inspection by an auditor or inspector designated by Intermountain Healthcare or a governmental or regulatory authority results in R1 being notified that it is not in compliance with any law, regulation, audit requirement or generally accepted accounting principle relating to the Services, R1 shall take prompt, ongoing actions to comply therewith, and shall continue such actions diligently until the compliance deficiencies have been remedied. The forgoing sentence shall not be interpreted to limit IMH’s discretion to adopt improved compliance policies and procedures as contemplated by Section 18.1. To the extent feasible, all audits and inspections are to be conducted during R1’s normal business hours of operation and conducted in a manner that does not disrupt R1’s normal business operations.  Intermountain Healthcare’s auditors shall be required to comply with any reasonable security policies and procedures provided by R1 and shall execute any access and confidential information agreements reasonably requested by R1 and that are not any broader in scope than is reasonably necessary in light of any access or other disclosures requested by such auditors for the audit or inspection.  If an IMH audit is conducted to determine whether deficiencies identified in a prior audit have been remediated, and the results of the subsequent audit find that such deficiencies have not been remediated in accordance with the R1 management action plan, R1 will [**]. If an audit demonstrates that the fees paid by IMH were greater than the fees owed, then R1 will [**].

19.2    Reports. R1 shall provide IMH with [**]  reports and data sets set forth in Exhibit 19.2 (the “Reports”) to permit IMH to monitor and oversee R1’s performance of the Services along with any other reports to be provided under this Services Agreement.  In addition, from time to time, IMH or any IMH Facility administrator or his or her designee may request additional Reports to be generated by R1 and delivered to IMH on an ad hoc or periodic basis, if so requested, [**].  If IMH requests any report of the type or nature of a report under the Original Services Agreement, a report of the same type or nature will be generated by R1 and delivered to IMH as a Report under this Section 19.2.  All Reports shall be provided as part of the Services [**].  The Reports shall be provided in a network accessible format with ability for data to be downloaded to IMH’s then current standard spreadsheet application.  If problems with IMH’s IT Environment cause any delay in creating or providing Reports, R1 will not be responsible for the delay, but R1 must work in good faith with IMH and any applicable third party vendors or licensors to resolve those problems and overcome the delay.

[**] designates portions of this document that have been omitted pursuant to a request for confidential treatment filed separately with the Securities and Exchange Commission.
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19.3    Inspection of Servers.  At the reasonable request of Intermountain Healthcare, its personnel may inspect R1 Servers and the data center(s) where they are located for security and other legitimate reasons; provided that, to the extent that R1 or its R1 Contractor has a third-party attestation or certification (e.g., SOC 2 Type II) from a qualified third-party assessor that covers all or any portion of the items that would otherwise be the subject of such audit or inspection, then such items shall be excluded from the scope of such audit or inspection. R1 and IMH will mutually develop plans and procedures for addressing items outside the scope of available attestations.

19.4    SOC 2 Type II Audits and Reports.  Promptly after the Effective Date and at least [**] thereafter, R1 shall have conducted for it a SOC 2 Type II audit of each service center or other facility and servers, equipment and software at which any Intermountain RCO Data is stored or from which any Services are performed, and will provide a copy of the SOC 2 Type II report to IMH following the audit. R1 will promptly remedy any issues, deficiencies or security risks identified by the audit or report or if no remedy is necessary then provide a detailed response to the auditor explaining why no remedy is necessary with respect to an identified deficiency. On an [**] basis, R1 agrees to obtain a SOC 2 Type II report from each service center or other facility at which any Intermountain RCO Data is stored and will provide a copy of such SOC 2 Type II reports to IMH.  The term SOC 2 Type II will include any subsequent or successor industry accepted standard or requirements for similar audits and reports reasonably designated by IMH.   

19.5    Pre-Transition Audit.  Prior to the commencement of Services for any IMH Facility or IMH Provider, R1 shall be entitled to conduct (directly or through an agent of R1), at R1’s expense, a comprehensive compliance audit of all Services of such IMH Facility or IMH Provider (a “Pre-Transition Audit”).  R1 shall not use any auditor or inspector who has a pre-existing conflict of interest with IMH without the prior written approval of IMH (such approval will not be unreasonably withheld and is now given with respect to any nationally recognized accounting firm). IMH shall cooperate with R1 in connection with any Pre-Transition Audit, including by facilitating access to the applicable IMH Facility or IMH Provider and personnel of such IMH Facility or IMH Provider.  IMH shall use commercially reasonable efforts to correct any adverse findings of any Pre-Transition Audit.  If IMH disputes any findings, the dispute will be resolved in accordance with Article XX.  Notwithstanding anything in this Agreement to the contrary, R1 shall have no responsibility or liability for any non-compliance with any Law or this Agreement identified by a Pre-Transition Audit with respect to any IMH Facility or IMH Provider if such non-compliance continues to occur after the Commencement Date (either because IMH would not or was not able to remedy and/or R1 cannot reasonably remedy) (such noncompliance, “IMH Controlled Non-Compliance”). However, R1 shall be responsible for (i) performance of all of the Services and (ii) meeting its compliance obligations under the Agreement, in each case of (i) and (ii), to the extent such performance or compliance is not affected by any IMH Controlled Non-Compliance. While conducting these audits R1 remains subject to the terms of this Agreement.

XX.    DISPUTE RESOLUTION

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20.1    Compliance with Rights of Cure and Dispute Resolution.  Intermountain Healthcare and R1 each agrees that in the event of any breach of this Services Agreement, the Parties must follow and comply with the applicable provisions of this Services Agreement relating to the rights of cure, dispute resolution and termination for cause which are set forth in this Article XX and Article XXIII above.

20.2    Referral of Dispute to Executive Sponsors.  Except as otherwise specifically provided herein, any dispute arising under this Services Agreement shall first be referred to the Intermountain Healthcare Executive Sponsor and the R1 Executive Sponsor.

20.3    Referral of Dispute to the Operations Oversight Council and/or Joint Review Board.  Any dispute which is not resolved through a good faith dialogue by the Intermountain Healthcare Executive Sponsor and the R1 Executive Sponsor within [**] weeks (or such longer period as may be agreed upon by the Parties) may be referred, by either Party, to the Operations Oversight Council or Joint Review Board for resolution, depending on the nature of the dispute and the responsibilities of each body. In the event that a dispute is not resolved through a good faith dialogue by the Operations Oversight Council or Joint Review Board within [**] additional weeks (or such longer period as may be agreed upon by the Parties), then the dispute will be resolved in accordance with the following Section 20.4.

20.4    Arbitration.  Any dispute which is not resolved by agreement of the Parties as provided in Sections 20.2 and 20.3 shall, except as otherwise provided in this Services Agreement, be finally settled by arbitration, conducted on a confidential basis, under the US Arbitration Act, if applicable, and the then-current Dispute Resolution Procedures (‘‘Rules”) of the American Health Lawyers Association (the “Association”) strictly in accordance with the terms of this Services Agreement and the laws of the State of Utah, excluding its principles of conflicts of laws.
All arbitration hearings shall be held in Salt Lake City, Utah. The arbitration decision shall be made by one arbitrator who will be selected by mutual agreement of the Parties, or if they cannot agree, then by the Association in accordance with its applicable rules and procedures.  The arbitrator shall be a licensed practicing attorney, shall have no conflicts, shall be knowledgeable in the subject matter of the dispute, and shall have experience and education which qualify him or her to competently address the specific issues to be designated for arbitration.  Each Party shall bear its own costs of the arbitration and one-half of the arbitrator’s costs and the costs of the Association.  The arbitrator shall apply Utah substantive law to the proceeding.  The arbitrator shall have the power to grant all legal and equitable remedies and award compensatory damages provided by Utah law, subject to the limitations set forth in this Services Agreement; provided, however, the arbitrator shall not have the power to amend this Services Agreement, award punitive or exemplary damages, or award damages in excess of any applicable limits contained in the Services Agreement. The arbitrator shall prepare in writing and provide to the Parties any award, including factual findings and the reasons on which the decision is based.  The arbitrator shall not have the 

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power to commit errors of law, and the award may be vacated or corrected for any such error.
Any award shall be paid within [**] days of the issuance of the arbitrator’s decision. If any award is not paid within [**] days, any Party may seek entry of a judgment in state or federal courts located in the State of Utah in the amount of the award.
Neither Party shall be excluded from seeking provisional or equitable remedies in the courts of competent jurisdiction, including but not limited to, temporary restraining orders and preliminary and permanent injunctions, but such remedies shall not be sought as a means to avoid or stay arbitration. THE PARTIES IRREVOCABLY WAIVE ANY RIGHT TO TRIAL BY JURY. ANY LITIGATION BETWEEN THE PARTIES WILL BE CONDUCTED EXCLUSIVELY IN A STATE OR FEDERAL COURT IN THE STATE OF UTAH AND ITS COURTS OF APPEAL, BUT THIS DOES NOT EXCUSE ANY PARTY FROM AN OBLIGATION UNDER THIS SERVICES AGREEMENT TO ARBITRATE.  THE PARTIES AGREE AND SUBMIT TO SUCH JURISDICTION AND VENUE. THE REQUIREMENT OF ARBITRATION SET FORTH IN THIS SECTION SHALL NOT APPLY IN THE EVENT THAT THERE IS THIRD PARTY JOINDER BY EITHER PARTY OR A THIRD PARTY INSTITUTES AN ACTION AGAINST ANY PARTY TO THIS SERVICES AGREEMENT, AND SUCH THIRD PARTY IS NOT AMENABLE TO JOINDER IN THE ARBITRATION PROCEEDINGS CONTEMPLATED BY THIS SECTION.

XXI.    INDEMNIFICATION AND LIABILITY

21.1    Indemnification by R1. R1 shall indemnify and hold harmless Intermountain Healthcare, IMH Facilities, IMH Providers, and their respective directors, trustees, officers, representatives and employees from and against any and all claims, judgments, awards, settlements, liabilities, costs, attorneys’ fees and losses arising out of any third party claims, including, without limitation, any governmental claims or employment practice claims, based upon or resulting from R1’s (a) [**], (b) infringement of any patent, trademark, service mark, trade name or trade secret, (c) tortious conduct, (d) willful misconduct, (e) HIPAA violation, (f) [**]; (g) taxes assessed against Intermountain Healthcare which are the responsibility of R1, (h) violations by R1 of its obligations, representations and warranties hereunder; (i) [**]; and (j) damage, loss or destruction of any real or tangible personal property caused by the negligence or other tortious conduct of R1 or the failure of R1 to comply with its obligations under this Agreement, in each case of (a) to (j) above which are not caused or directed by Intermountain Healthcare.  For purposes of (i) above, [**].

21.2    Indemnification by Intermountain Healthcare. Intermountain Healthcare shall indemnify and hold harmless R1 and its directors, officers and employees and third party delivery partners from and against any and all claims, judgments, awards, settlements, liabilities, costs, attorneys’ fees and losses arising out of any third party claims, including any governmental  claims or employment practice claims, based upon or resulting from Intermountain Healthcare’s (a) [**], (b) 

[**] designates portions of this document that have been omitted pursuant to a request for confidential treatment filed separately with the Securities and Exchange Commission.
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infringement of any patent, trademark, service mark, trade name or trade secret, (c) tortious conduct, (d) willful misconduct, (e) HIPAA violation, (f) [**], (g) taxes assessed against R1 which are the responsibility of Intermountain Healthcare, (h) violations by Intermountain Healthcare of its obligations, representations and warranties hereunder, and (i) [**]; in each case of (a) to (i) above which are not caused or directed by R1, pursuant to the billing, coding and collection policies, practices and procedures of Intermountain Healthcare. For purposes of (i) above, [**].

21.3    Liability Cap.  Each Party’s monetary liability under this Services Agreement to the other Party, including this Article XXI, shall be capped at [**]. Such cap shall not apply to liability for (a) claims arising out of a Party’s, or such Party’s employees’, vendors’, agents’, or R1 Contractors’ willful or intentional misconduct or intentional breach or gross negligence, or breach of a warranty or misrepresentation; (b) personal bodily injury or death or physical property damage; (c) taxes assessed against one Party that are the responsibility of the other Party; (d) a Party’s infringement of any patent, trademark, service mark, trade name or trade secret belonging to the other Party or its Affiliate; (e) payments for Services rendered prior to termination of this Services Agreement or any other fees, payments or credits set forth in this Services Agreement (including any of its Exhibits); (f) any breach of any of the following Sections 9.3, [**], or [**]; (g) [**]; (h) a breach of the BAA or Malware and Security Agreement; (i) [**], (j) [**]; or (k) [**] (collectively, the “Uncapped Liabilities”). Notwithstanding anything to the contrary in this Article XXI or elsewhere in this Agreement, in no event will either Party be liable to the other Party for any consequential, incidental, punitive or exemplary damages, including lost profits, except that [**].

21.4    Exception for Wrongful Termination.  In the event of a Party’s wrongful termination of this Services Agreement, each Party’s monetary liability resulting from such termination shall be limited to the following (which are agreed to be direct damages): 
		
	(a)
	In the case of a wrongful termination by Intermountain, R1’s damages shall be [**]: (A) if such wrongful termination occurs prior to the date that is twelve (12) months after the first Commencement Date (the “Reference Date”), [**], and (B) if such wrongful termination occurs on or after the Reference Date, then [**]; and (ii) any direct damages not included in (i) above that can be established or documented by R1, including, without limitation, any direct damages under Section 21.6.  [**]  

		
	(b)
	In the case of a wrongful termination by R1, Intermountain’s damages shall be [**], and (iv) any direct damages not included in (i), (ii) or (iii) above that can be established or documented by IMH, including, without limitation, any direct damages under Section 21.6. [**]  

21.5    [**].  

		
	21.6
	Acknowledged Direct Damages.  The following categories of costs, expenses, damages, fines, penalties, amounts and losses shall be considered direct damages and neither Party 

[**] designates portions of this document that have been omitted pursuant to a request for confidential treatment filed separately with the Securities and Exchange Commission.
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shall assert that they are indirect, incidental, collateral, consequential or special damages or lost profits to the extent they result from either Party's failure to perform in accordance with this Agreement: 
		
	(i)
	Costs and expenses of recreating or reloading a Party's information which is lost, stolen or damaged as a result of the other Party's breach of its obligations under this Agreement. 

		
	(ii)
	[**] 

		
	(iii)
	[**] 

		
	(iv)
	[**] 

		
	(v) 
	[**] 

		
	(vi)
	Straight time, overtime or related expenses incurred by either Party for employees, wages and salaries additional employees, travel expenses, and overtime expenses. 

		
	(vii)
	Damages, fines, and penalties imposed by a regulatory agency for a Party's failure to comply with deadlines which is not the result of a Force Majeure Event. 

		
	(viii)
	[**] 

The absence of a direct damage listed in this Section 21.6 shall not be construed or interpreted as an agreement to exclude it as a direct damage under this Services Agreement. 

XXII.    INSURANCE

22.1    R1 Insurance Requirements.   R1 will obtain and continuously maintain the following insurance coverages:
		
	(a)
	Workmen’s Compensation - statutory limits in each state as applicable to R1 employees who work on the Services.

		
	(b)
	Comprehensive General Liability Insurance - [**].

		
	(c)
	Comprehensive Auto Liability Insurance - [**] per accident.

[**] designates portions of this document that have been omitted pursuant to a request for confidential treatment filed separately with the Securities and Exchange Commission.
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	(d)
	Umbrella excess liability coverage above the commercial general liability and comprehensive automobile liability described above in all amount not less than [**] per occurrence/accident.

		
	(e)
	Crime Insurance -- R1 is responsible for loss to owner and third party property/assets and shall maintain comprehensive crime insurance coverage for the dishonest acts of its employees in a minimum amount of [**]. Intermountain Healthcare is to be named loss payee with respect to the comprehensive crime insurance coverage.

		
	(f)
	Errors and Omissions Liability -- R1shall provide liability limits of at least [**] per claim and [**] in the aggregate. Coverage shall address the effects of any errors, omission, act, failure to act, neglect or breach of duty in the performance of Services or professional duties which are subject to this Services Agreement, including but not limited to, coverage for failure to properly maintain and/or protect personal information or confidential corporate information. The retroactive insurance date of such insurance shall be no later than the Effective Date of this Services Agreement. Such coverage must specifically identify Intermountain Healthcare and its officers, employees, and agents as additional insureds.  If such errors and omissions liability coverage is written on a “claims made” basis, coverage must be continued for [**] years following the termination of this Agreement.  All insurance required in this section must be with insurers holding AM Best rating no less than A VII. [**] If R1 becomes aware of a breach involving personal or patient information of Intermountain Healthcare, R1 must notify Intermountain Healthcare immediately and cooperate with Intermountain Healthcare in providing the appropriate breach response as directed and controlled by Intermountain Healthcare.

		
	(g)
	Network Security and Privacy Liability -- R1 shall provide third party liability limits of at least [**] per claim and [**] in the aggregate, including regulatory fines and penalties coverage. The retroactive insurance date of such insurance shall be no later than the Effective Date of this Services Agreement. Such coverage must specifically identify Intermountain Healthcare and its officers, employees, and agents as additional insureds.  If such network security and privacy liability coverage is written on a “claims made” basis, coverage must be continued for [**] following the termination of this Agreement.  All insurance required in this section must be with insurers holding AM Best rating no less than A VII. [**] If R1 becomes aware of a breach involving personal or patient information of Intermountain Healthcare, R1 must notify Intermountain Healthcare immediately and cooperate with Intermountain Healthcare in providing the appropriate breach response as directed and controlled by Intermountain Healthcare. 

22.2    IMH Insurance Requirements.

[**] designates portions of this document that have been omitted pursuant to a request for confidential treatment filed separately with the Securities and Exchange Commission.
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	(a)
	IMH will obtain and continuously maintain the following insurance coverages throughout the Term of this Services Agreement and where possible may do so in whole or in part through self-insurance:

		
	(i)
	Workers’ Compensation – statutory limits in each state as applicable to IMH employees who work on the Services.

		
	(ii)
	Comprehensive General Liability Insurance – [**]  

		
	(iii)
	Comprehensive Auto Liability Insurance – [**] per accident

		
	(iv)
	Umbrella excess liability coverage above the Comprehensive General Liability Insurance and Comprehensive Auto Liability Insurance described above in an amount not less than [**] per occurrence/accident.

XXIII.    TERM AND TERMINATION

23.1    Term Unless earlier terminated in accordance with this Article XXIII, the term of this Services Agreement shall commence on the Effective Date and will continue for ten (10) years thereafter (the “Term”). The Parties shall commence discussions in good faith upon the eighth (8th) anniversary of the Effective Date for a possible extension of the Term for an additional five (5) year period.  A Party is not required to agree to an extension.

23.2    Terms of Work Orders.  The term for each Work Order shall begin on the effective date set forth in such Work Order and continue for the rest of the Term, unless such Work Order sets forth an earlier expiration date or is earlier terminated in accordance with its terms.

23.3    Termination for Cause.
		
	(a)
	By Either Party.  If a Party commits a material breach of this Services Agreement, the Business Associate Agreement or the Malware and Security Agreement which material breach results in a Material Adverse Effect on the non-breaching Party and is not cured within [**] from the breaching Party’s receipt of a written notice of the breach, then the non-breaching Party may, by giving notice to the breaching Party, terminate this Services Agreement.  The notice of breach must specifically identify the provisions that are breached and must state the actions that the non-breaching Party believes are necessary for the breaching Party to cure the breach.  If more than [**] days are reasonably needed to cure the breach, then the breaching Party shall be allowed such additional time as is reasonably required provided that the breaching Party gives notice of the need and begins the cure within the [**] day period and the breaching Party is thereafter diligent in pursuing the cure to completion.  If the breach is not curable, then for the purposes of this Section, the breach shall be deemed cured 

[**] designates portions of this document that have been omitted pursuant to a request for confidential treatment filed separately with the Securities and Exchange Commission.
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if the breaching Party takes reasonable steps to prevent a repeat of the breach.  The breaching Party remains liable for damages caused by its incurable breach.  
		
	(i)
	Protection of IMH Against Termination.  In view of IMH’s critical reliance on the Services and this Services Agreement, if IMH disputes that a material breach has occurred, then the issue (i.e., whether or not a material breach by IMH has occurred) must first be decided by the dispute resolution provisions of Article XX, including arbitration if necessary.   If the Parties agree in writing that the material breach by IMH has occurred or if an arbitrator holds that the material breach by IHM has occurred, then IMH shall have an opportunity to cure the breach as described above (or to address an incurable breach as described above) in order to preserve this Services Agreement and to avoid termination by R1.  The [**] day cure period will begin when the Parties have agreed in writing that the material breach has occurred or when the Parties receive the final written decision of the arbitrator that the material breach by IMH has occurred, and such period is subject to extension as described above.

		
	(b)
	Service Level Issues.  If R1 has [**] or more Service Level Defaults over [**], then IMH may, upon at least [**] days’ prior written notice to R1, terminate this Services Agreement.  At IMH’s option, only a subset of the Services may be terminated and this Services Agreement will continue for the remaining Services.

		
	(c)
	[**].

		
	(d)
	[**].

		
	(e)
	[**]. 

23.4    [Intentionally Blank] 

23.5    Termination for Exclusion from Federal Health Programs, Changes in Law, Adverse Judgments.
		
	(a)
	Exclusion from Federal Health Care Program.  A Party shall have the right to immediately terminate, upon written notice to the other Party, this Services Agreement if the other Party is excluded from a Federal Health Care Program, subject to Section 23.8.

		
	(b)
	Changes in Law.  Upon expiration of the Workaround Period (during which no reasonable workaround has been agreed to in accordance with Section 23.5(d)), a Party, upon [**] days’ prior written notice to the other Party, may terminate the applicable portion of the Services if there is a change in a Healthcare Law but only 

[**] designates portions of this document that have been omitted pursuant to a request for confidential treatment filed separately with the Securities and Exchange Commission.
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to the extent that, as a result of such change: (i) it would be unlawful for the terminating Party to continue to perform or receive such applicable portion of the Services; or (ii) the continued performance or receipt by the terminating Party of such applicable portion of the Services would have a Material Adverse Effect on such Party’s business, taken as a whole.
		
	(c)
	Adverse Judgments.  

		
	(i)
	“Adverse Judgment” means an adverse judgment, injunction, order or decision made against a Party by a domestic or foreign national, state, county, municipal, local, territorial or other government body, authority, department, agency, court, official or public or statutory person of competent jurisdiction.

		
	(ii)
	Upon expiration of the Workaround Period (during which no reasonable workaround has been agreed to and implemented in accordance with Section 23.5(d)), if there has been an Adverse Judgment against IMH or any IMH Affiliate that receives the Services:

(1)    that is caused by the fault of R1 or any R1 Affiliate or R1 Contractor, and not by any fault or contributory acts or omissions by IMH or any IMH Affiliate the following will apply:
(A)    IMH may upon [**] days’ prior written notice to R1 terminate the applicable portion of the Services (or, solely with respect to subparts (II) and (III), this Services Agreement) if there is, and only to the extent that as a result of, such Adverse Judgement (I) it would be unlawful, in the judgment of IMH legal counsel, for IMH or the applicable IMH Affiliate to continue to receive such applicable portion of the Services; (II) there is a Material Adverse Effect on IMH’s or the applicable IMH Affiliate’s business; or (III) the continued receipt by IMH or the applicable IMH Affiliate of such applicable portion of the Services would have a Material Adverse Effect on IMH or the applicable IMH Affiliate’s business.  
(B)    R1 may terminate only the applicable portion of the Services upon [**] days’ prior written notice to IMH if it would be unlawful for R1 to continue to provide the applicable portion of the Services. 
(2)    that is not caused by the fault of R1 or an R1 Affiliate or an R1 Contractor, then:
(A)    R1 may upon [**] days’ prior written notice to IMH, terminate the applicable portion of the Services if it would be unlawful for R1 to continue to provide such applicable portion of the Services.  

[**] designates portions of this document that have been omitted pursuant to a request for confidential treatment filed separately with the Securities and Exchange Commission.
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(B)    IMH may terminate the applicable portion of the Services upon [**] days’ prior written notice to R1 if it would be unlawful for IMH or the applicable IMH Affiliate to continue to receive the applicable portion of the Services.  
		
	(iii)
	Upon expiration of the Workaround Period (during which no reasonable workaround has been agreed to and implemented in accordance with Section 23.5(d)), if there has been an Adverse Judgment against R1 or any R1 Contractor or R1 Affiliate that provides the Services: 

(1)    that is caused by the fault of IMH or any IMH Affiliate, and not by any fault or contributory acts or omissions by R1 or any R1 Affiliate or R1 Contractor:
(A)    R1 may upon [**] days’ prior written notice to IMH terminate the applicable portion of the Services if there is, and only to the extent that as a result of, such Adverse Judgement it would be unlawful for R1 to continue to provide such applicable portion of the Services.
(B)    IMH may terminate the applicable portion of the Services upon [**] days’ prior written notice to R1 if it would be unlawful for IMH or the applicable IMH Affiliate to continue to receive the applicable portion of the Services.  
(2)    that is not caused by the fault of IMH or any IMH Affiliate, then:
(A)    IMH may upon [**] days’ prior written notice to R1, terminate the applicable portion of the Services (or, solely with respect to subparts (II) and (III), this Services Agreement) if there is, and only to the extent that as a result of, such Adverse Judgment (I) it would be unlawful for IMH or the applicable IMH Affiliate to continue to receive such applicable portion of the Services; (II) there is a Material Adverse Effect on IMH’s or the applicable IMH Affiliate’s business; or (III) the continued receipt by IMH or the applicable IMH Affiliate of such applicable portion of the Services would have a Material Adverse Effect on IMH or the applicable IMH Affiliate’s business.
(B)    R1 may terminate the applicable portion of the Services upon [**] days’ prior written notice to IMH if it would be unlawful for R1 to continue to provide the applicable portion of the Services.  

[**] designates portions of this document that have been omitted pursuant to a request for confidential treatment filed separately with the Securities and Exchange Commission.
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	(d)
	Reasonable Workarounds.  Prior to either Party exercising any termination right in (b) or (c) above, unless a Party is prohibited from doing so by an Adverse Judgment, the Parties shall:

		
	(i)
	cooperate in good faith for at least [**] days to agree upon and implement a reasonable workaround that would eliminate the Material Adverse Effect, if applicable, and cure the violation of Applicable Law (either Party may extend that period by up to an additional [**] days); and  

		
	(ii)
	if such period has passed, or at such earlier time as mutually agreed to by the Parties, and no such workaround has been agreed to and implemented by the Parties, then either Party may submit the dispute to non-binding mediation with the American Health Lawyer’s Association.  The procedures for such mediation and related costs shall be substantially the same as those set forth in Section 20.4 for any arbitration under this Services Agreement, provided that the mediation shall not be binding.  The Parties shall be required to participate in such mediation in good faith and use all reasonable efforts to reach a mutually agreed workaround (including any increase in fees required to implement such workaround but only if the Adverse Judgement is not the fault of R1 or any R1 Contractor or R1 Affiliate that provides the Services), and a proposed implementation plan.  If a workaround is agreed to, then the Parties will implement it.

The processes set forth in Sections 23.5(d)(i) and 23.5(d)(ii) above, as applicable, shall be collectively referred to as the “Workaround Period”.  Nothing in this Section 23.5 will negate, limit or affect any right of termination under any other section of this Agreement.
		
	(e)
	Termination of a Portion of the Services.  In the event of a termination of a portion of the Services pursuant to Section 23.3(b) or this Section 23.4, the termination shall be applied to the IMH Facilities and IMH Providers that were previously receiving such Services and an equitable reduction will be made to the Charges and other fees to take into account the reduced scope of the Services being performed by R1 pursuant to Exhibit 11.1-A.  If the Parties cannot agree on the reduction, then the matter will be decided under Article XX.

23.6    Termination for Insolvency.  If any Party (the “Insolvent Party”) (a) files for bankruptcy, (b) becomes or is declared insolvent, or is the subject of any bona fide proceedings related to its liquidation, administration, provisional liquidation, insolvency or the appointment of a receiver or similar officer for it, (c) passes a resolution for its voluntary liquidation, (d) has a receiver or manager appointed over all or substantially all of its assets, or (e) makes an assignment for the benefit of all or substantially all of its creditors, then the other Party may terminate this Services Agreement upon prior written notice to the Insolvent Party; provided, however, that (x) any Insolvent Party subject to an involuntary proceeding will have a reasonable amount of time (and in no event less than [**]days) to have such proceeding dismissed or stayed prior to the other Party having the right to 

[**] designates portions of this document that have been omitted pursuant to a request for confidential treatment filed separately with the Securities and Exchange Commission.
51

terminate this Services Agreement pursuant to this Section 23.6, (y) R1 will not have the right to terminate this Services Agreement under this Section 23.6 so long as IMH is current in its payment of the Charges hereunder, and (z) IMH will not have the right to terminate this Services Agreement under this Section 23.6 so long as R1 continues to provide the Services and comply with this Agreement.

23.7    Return or Destruction of RCO Data.  Upon termination of this Agreement, R1 will return or destroy all Intermountain RCO Data and will not retain, nor allow any of its agents or subcontractors to retain, any Intermountain RCO Data. Further, R1 will certify in writing to Intermountain that R1 (including its agents and subcontractors) has returned or destroyed all Intermountain RCO Data in accordance with the return and destruction provisions set forth in the Business Associate Agreement. In the event R1 determines that the return or destruction of Intermountain RCO Data is infeasible, R1 shall notify Intermountain of the conditions that make return or destruction infeasible and upon mutual agreement of the Parties that return or destruction is infeasible, R1 shall extend the protections of this Agreement, as well as the protections set forth in the Business Associate Agreement and Malware and Security Agreement, as applicable, to such Intermountain RCO Data and limit further uses and disclosures to the specific and limited purpose(s) that makes return or destruction of the Intermountain RCO Data infeasible.

23.8    Disengagement Services.  Upon expiration or any other termination of this Services Agreement, R1 shall provide IMH with Continued Services and Disengagement Services subject to the requirements of and pursuant to the process set forth in Exhibit 23.8.  The Term of this Services Agreement will be extended for purposes of the Continued Services and Disengagement Services for the duration of the disengagement and the Continued Services and Disengagement Services.  Continued Services and Disengagement Services are considered part of the Services.  IMH may, at its discretion, request to receive less than all of the Continued Services and Disengagement Services.  If any IMH Facility or IMH Provider is sold or divested, then Continued Services and Disengagement Services will also be provided for the sold or divested IMH Facility or IMH Provider on an as-needed basis with Exhibit 23.8 reasonably adjusted to accommodate the sale or divestiture.  If any portion of the Services is terminated, including, without limitation, pursuant to Section 23.3(b) or Section 23.4, then Continued Services and Disengagement Services will also be provided for the terminated Services to the extent such Continued Services and Disengagement Services would not be in violation of Applicable Law.

XXIV.    GENERAL TERMS OF AGREEMENT

24.1    Authority.  Each Party represents and warrants that it has the authority to enter into this Services Agreement and to be bound by its terms, and that it has been executed by all necessary and authorized individuals.

24.2    Survival.  The terms of Articles XI, XXI, XXIII, XXIV and Sections 9.2, 9.3, 9.4, 14.1 (with respect to indemnification obligations), 15.1, 15.2, 15.4, 15.5 (solely with respect to the last three sentences and the perpetual license of 15.5, but not to any other use of Intermountain RCO Data), 

52

16.4, 18.5, 18.6, 18.7, 18.9(a)18.9, 19.1 and 20.4 of this Services Agreement shall survive the expiration or termination of this Services Agreement to the extent applicable, but no such survival will require a continuation of Services (or payment for Services performed) after expiration or termination except for Continued Services and Disengagement Services during the extended Term as provided in Section 23.8 and Exhibit 23.8.  Any other provisions that expressly or by their nature should survive expiration or other termination will also survive to the extent applicable.  Termination of this Services Agreement will not excuse any fees, payments or credits that accrue or become due prior to termination or any payments for Continued Services and Disengagement Services under Section 23.8 and Exhibit 23.8.

24.3    Signing Authority.  No amendment or contract between the Parties will be binding on Intermountain Healthcare or R1 unless signed by a Vice President or President in the case of Intermountain Healthcare, or a Senior Vice President, the General Counsel or the Chief Executive Officer in the case of R1.  

24.4    No-Hire.  As a result of, and in connection with, their respective activities under this Services Agreement, R1 and Intermountain Healthcare will become familiar with the employees of one another. During the Term of this Services Agreement, and for a period of eighteen (18) months thereafter, R1 agrees not to hire or offer employment to any employee of Intermountain Healthcare, without the express written consent of Intermountain Healthcare (such consent is deemed given for employees to be transitioned to R1 in accordance with the Transition Work Plan).   During the Term of this Services Agreement, and for a period of eighteen (18) months thereafter, Intermountain Healthcare agrees not to hire or offer employment or a service opportunity to any employee of R1 for employment or service, without the express written consent of R1; provided, however, that after the first five (5) months tollowing the Commencement Date, such restriction shall be limited to employment or service in the area of revenue cycle operations. This prohibition against offers is not breached by a Party by its advertisements (e.g., “help wanted ads”) or other solicitations that are of a general nature (e.g., in newspapers or other publications or on the Internet) that are not specifically targeted to the employees of the other Party (a “General Solicitation”).  Nothing herein prohibits IMH from hiring or soliciting for hire at any time any person whose employment with R1 is terminated by R1.  This Section 24.4 and these restrictions do not apply to a Party if this Services Agreement is terminated by such Party under Section 23.3, 23.5(e) or 23.6 of this Services Agreement or if the other Party seeks protection under the bankruptcy laws or becomes insolvent.  For example, in such situations, the terminating Party may solicit and make offers to, and may hire or engage the services of, any employees of the other Party.  Likewise, any solicitations or hiring permitted pursuant to Exhibit 23.8 (Disengagement Services) shall not be a violation of this Section 24.4.

24.5    Disclaimers.  EXCEPT AS SPECIFICALLY PROVIDED IN THIS AGREEMENT, NEITHER INTERMOUNTAIN HEALTHCARE NOR R1 MAKES ANY OTHER REPRESENTATION OR WARRANTIES WITH RESPECT TO THIS SERVICES AGREEMENT AND EACH EXPLICITLY DISCLAIMS ALL OTHER REPRESENTATIONS AND 

53

WARRANTIES, EXPRESS OR IMPLIED WITH RESPECT TO THIS SERVICES AGREEMENT. THESE DISCLAIMERS DO NOT NEGATE, LIMIT OR AMEND THE BAA, MALWARE AND SERVICES AGREEMENT, ACCESS AND CONFIDENTIALITY AGREEMENT, ANY INVESTMENT AGREEMENT OR ANY REAL ESTATE, LEASE, OR SUBLEASE AGREEMENT BETWEEN THE PARTIES.

24.6    Record Retention.  In addition to R1’s obligations in this Services Agreement, the Parties will each retain standard records and supporting documentation as required by applicable tax authorities and statutory legal requirements and will make those records available to one another upon reasonable request if and as required by Applicable Law.

24.7    Force Majeure.  Each Party will be excused from performance under this Services Agreement (other than obligations to make payments that become due under this Services Agreement) for any period and to the extent that it is prevented from or delayed in performing any obligation pursuant to this Services Agreement in whole, or in part, as a result of a Force Majeure Event (as defined below).  However, Intermountain Healthcare will not be required to make payment for Services that are not performed due to a Force Majeure Event.  If either Party is prevented from, or delayed in performing any of its obligations under this Services Agreement by a Force Majeure Event, it shall promptly notify the other Party of the occurrence of such Force Majeure Event and describe, in reasonable detail, the circumstances constituting the Force Majeure Event and the obligations which it will be delayed or prevented from performing as a result of the Force Majeure event. “Force Majeure Events” shall mean the occurrence of an event or circumstance beyond the reasonable control and anticipation of a Party, including, but not limited to, any change in state or federal statutes which would preclude a Party from performing its obligations under this Services Agreement, provided that (i) the non-performing Party is without fault in causing or failing to prevent such occurrence and (ii) such occurrence cannot be circumvented by reasonable precautions and could not have been circumvented through the use of commercially reasonable alternative sources, alternate plans or other means.  The excused Party must exercise its diligent and continuous best efforts to overcome the Force Majeure Event and resume performance. If a significant portion of the Services cannot be performed in all material respects because of a Force Majeure Event lasting more than four weeks, Intermountain Healthcare may terminate this Services Agreement upon notice to R1 without any liability for such termination and without any Termination Fee, but Section 23.8 (Disengagement Services) will apply and Section 24.4 will not restrict IMH or prevent it from any offering or hiring.

24.8    Taxes.  All service charges, fees, expenses and other amounts due under this Services Agreement are exclusive of all taxes.  Intermountain Healthcare shall be responsible for payment of all taxes incurred or assessed on the Services, including any applicable sales and use tax, if any. As a non-profit corporation, Intermountain Healthcare does not expect to be liable or obligated for any such taxes.  Intermountain Healthcare will provide evidence of its tax-exempt status to R1 upon request.  R1 will cooperate with Intermountain Healthcare’s reasonable requests to assert and 

54

preserve its tax-exempt status.  Each Party shall be responsible for taxes based on its own net income, employment taxes of its own employees and taxes on property it owns.

24.9    Assignment. This Services Agreement may not be assigned by either Party without the prior written consent of the other Party which may not be unreasonably withheld, provided, however, that this Services Agreement may be assigned by a Party, without the consent of the other Party, (i) in connection with the sale of substantially all of the assets of such Party, (ii) by operation of law in connection with a merger or reorganization (including a sale of all or a majority of the equity securities of the Party) that includes transfers of all or substantially all of the assets of the Party, or (iii) to a wholly owned subsidiary of such Party (provided that the Party guarantees in writing the performance and obligations of such subsidiary). Any assignee of this Services Agreement must confirm in writing to the non-assigning Party that the assignee has assumed all of the assigning Party’s duties and obligations under this Services Agreement.

24.10    Relationship of Parties. In connection with this Services Agreement, each Party is an independent contractor. Except as expressly provided in this Services Agreement, R1 does not undertake, hereunder or otherwise, to perform any obligation of Intermountain Healthcare, whether legal, regulatory or contractual, or to assume any responsibility for Intermountain Healthcare’s business or operations.  This Services Agreement establishes and shall only be construed as establishing a contract between unrelated business entities for the provision and purchase of certain services and does not and shall not be deemed to create a joint venture, partnership, fiduciary or agency relationship between the Parties for any purpose.  With respect to its own personnel, each Party is independently responsible for all obligations incumbent upon an employer, but this does not excuse R1 from its obligations to provide Services in accordance with this Services Agreement.

24.11    Notice. Notices to R1 and Intermountain Healthcare required by this Services Agreement shall be sent via certified first-class mail, or overnight delivery, to the following respective addresses, and shall be deemed received by the Receiving Party three (3) business days after being mailed certified first class, or one (1) day after being sent by overnight delivery:
	
		
	R1 RCM Inc.
Attention: Joseph Flanagan, 
President and CEO
401 N. Michigan 27th Floor
Chicago, Illinois 60611
	Intermountain Healthcare
Attention: Bert Zimmerli, 
Executive Vice President and CFO
36 South State Street
23rd Floor
Salt Lake City, UT 84111

	With a copy to: R1 RCM Inc.
Attention: General Counsel
401 N. Michigan
27th Floor
Chicago, Illinois 60611
	With a copy to: 
Intermountain Healthcare 
Attention: General Counsel
36 South State Street, 22nd Floor
Salt Lake City, UT 84111

24.12    Severability. If any provision of this Services Agreement is declared invalid, unenforceable or void by a court of competent jurisdiction, such decision shall not have the effect of invalidating 

55

or voiding the remainder of this Services Agreement.  Rather, it is the intent of the Parties that in such an event this Services Agreement will be deemed amended by modifying such provision to render it valid and enforceable while preserving the original intent of the Parties. If that is not possible, the Parties shall agree on a substitute provision which is legal and enforceable, and which achieves the same objective as the original provision to the extent possible.

24.13    No Third-Party Beneficiaries. Nothing in this Services Agreement is intended or shall be construed to confer upon any person (other than the Parties hereto and the indemnified parties specifically identified herein) any rights, benefits or remedies of any kind or character whatsoever, and no person or entity shall be deemed a third-party beneficiary under or by reason of this Services Agreement.

24.14    Amendment.  Except as explicitly provided for herein or in an Exhibit hereto, this Services Agreement may only be amended or modified by execution of a written amendment or modification signed by both Parties.

24.15    Entire Agreement.  This Services Agreement, including the Exhibits and accompanying schedules and plans contemplated by its terms, constitutes the entire agreement between the Parties with respect to its subject matter and supersedes all prior and contemporaneous agreements and understandings, whether written or oral, between the Parties with respect to the subject matter. There are no representations, understandings or agreements related to this Services Agreement which are not fully expressed in this Services Agreement. This Section does not negate, limit, or apply to any NDA, the BAA, the Malware and Security Agreement, or any Access and Confidentiality Agreement.

24.16    Governing Law. This Services Agreement will be governed by and construed in accordance with the laws of the State of Utah.

24.17     Subcontractors. To the extent that R1 uses any subcontractors, R1 Contractors and Affiliates for any Services or any other purpose relating to this Services Agreement, any provision (e.g., R1’s confidentiality obligations) in this Services Agreement that applies to R1 or its employee and should reasonably also apply to such subcontractors, R1 Contractors or Affiliates will also apply to them and R1 will be responsible for their compliance therewith and will be liable for their negligence, misconduct or breach. 

24.18    Use of the Intermountain Name. 
		
	(a)
	Use of the Intermountain Name.  The term “Intermountain Name” means Intermountain Healthcare or IHC Health Services, Inc. or any other name by which IMH is recognized or any logo of IMH.  R1 may use the Intermountain Name as reasonably needed to accurately identify Intermountain as a user of the Services.  But any such use of the Intermountain Name in a publication or press release, in marketing, promotional or advertising materials, on a website, or other than in private 

56

communications will require prior approval as described below.  The Intermountain Name may not be used by R1 as a service mark, trademark, or brand for any product or service of R1.
		
	(b)
	Approval.  Use by or for R1 of any Intermountain Name in a publication or press release, in marketing, promotional or advertising materials, on a website, or other than in private communications will require the prior written approval of the Communications Department of IMH.  To obtain approval, R1 must fully and accurately disclose to the Communications Department the manner and context of the use.  The manner and context of use may be considered in deciding whether or not to give the approval.  Once approval for a specific use is given, repeat approval of the same use is not needed unless there is a significant change in the manner or context in which the Intermountain Name is used.  But Intermountain may, at its reasonable discretion, withdraw approval of a particular use that was previously approved.

		
	(c)
	Endorsement, Sponsorship and Affiliation.  In no event, may R1 use any Intermountain Name in any manner or context that states, suggests or implies: (a) that IMH endorses or sponsors any products or services of R1 or a third party, or (b) that IMH is affiliated with R1 in any way other than as a minority owner of R1 or a customer of R1 consistent with the formal written agreements between the Parties.  Notwithstanding the foregoing, R1 shall be permitted to truthfully inform current and prospective customers that IMH is a customer of R1.

		
	(d)
	Names of Individuals.  In no event will R1 use the name of any Intermountain Individual on a website or in any manner to market, promote, or advertise any products or services without the prior written consent in each case of the Intermountain Individual and the approval of the Communications Department of IMH.  “Intermountain Individual” means a natural person who is in the management of IMH or its Affiliate or who is a physician, healthcare provider, researcher, employee or volunteer of IMH or its Affiliate.  With respect to such approval, the provisions of Subsections (b) to (d) will apply on a mutatis mutandis basis to the extent reasonable.  

		
	(e)
	Law or Regulation.  Disclosure of an Intermountain Name or Intermountain Individual’s name, to the extent required by applicable law or regulation (e.g., as needed to comply with the reporting requirements of federal or state law or regulation), will not be subject to the restrictions of this Section.  

24.19    Appropriate Use. In no event will any Party use any name or likeness of the other Party, including the Intermountain Name with respect to uses by R1, in any manner or context that is misleading, false, unethical or unlawful.

24.20    Counterparts and Execution. This Services Agreement may be executed in counterparts, each of which shall be deemed to be an original, which together shall constitute a binding agreement. Each person signing below represents that she or he has the authority to sign this Services Agreement for and on behalf of the Party for whom she or he is signing. 

57

 [Remainder of Page Intentionally Left Blank]

58

Agreed to and Accepted by:
	
		
	R1 RCM Inc.
By:/s/ Joseph Flanagan
Name: Joseph Flanagan
Its: President and CEO
	IHC Health Services, Inc.
By: /s/ Mark A. Runyon
Name: Mark A. Runyon
Its: VP Operational Finance

	
			
	 
	Amended and Restated Services Agreement Signature PageExhibit

Exhibit 10.8

[**] Designates portions of this document that have been omitted pursuant to a request for confidential treatment filed separately with the Securities and Exchange Commission.

AMENDED AND RESTATED SERVICES AGREEMENT

between

IHC Health Services, Inc.

and

R1 RCM Inc.

EXHIBIT 1.1

DEFINITIONS

Exhibit 1.1
Definitions
		
	1.
	Introduction. The terms defined in this Exhibit include the plural as well as the singular and the derivatives of such terms. Unless otherwise expressly stated, the words “herein,” “hereof,” and “hereunder” and other words of similar import refer to this Services Agreement as a whole and not to any particular Article, Section, Subsection or other subdivision.  Article, Section, Subsection and Attachment references refer to articles, sections and subsections of, and attachments to, this Services Agreement, unless specified otherwise.  The words “include” and “including” shall not be construed as terms of limitation and introduce a non-exclusive set of examples.  The words “day,” “month,” and “year” mean, respectively, calendar day, calendar month and calendar year.  As stated in Section 24.11 of this Services Agreement, the word “notice” and “notification” and their derivatives means notice or notification in writing.  Other terms used in this Services Agreement are defined in the context in which they are used and have the meanings there indicated.

		
	2.
	DEFINITIONS.

“Access and Confidentiality Agreement” has the meaning given in Section 17.4.
“Access Credentials” has the meaning given in Section 15.7.
“Adverse Judgment” has the meaning given in Section 23.5(c)(i).
“Affiliate” means, with respect to a Party, any entity at any time Controlling, Controlled by or under common Control with such Party.
“Applicable Law” means any Federal, State, local or municipal constitution, statute, treaty, rule, regulation or common law and any decree, injunction, judgment, order, formal interpretation or ruling issued by a court, governmental entity, or any other committee or body with the authority to make such decisions, that is pertinent to this Services Agreement and the Services provided under this Services Agreement.
“Association” has the meaning given in Section 20.4.  
“Audits and Inspections” has the meaning given in Section 19.1.
“Authorized Space” has the meaning given in Section 7.2.
“Business Associate Agreement” and “BAA” have the meaning given in Section 17.2.
“Cash Collections” means, unless otherwise agreed by the Parties, the amounts adjudicated and posted against individual patient accounts as payments or posted to unapplied cash accounts.  Sources of payments typically include payments from third-party Payers and patients.  Payments from 

1

patients include direct payments, cash collected through third-party collection agencies, legal collections, early out vendors and other contracted third-party service providers before deductions of fees for in-scope revenue cycle facilities.  In the event that collections related to specific patient activity are not posted/adjudicated at the patient account level, these payments are also included as part of Cash Collections (e.g., lump-sum underpayment settlements or take-backs).  For payers that have periodic interim payments, vouchered remittances will be considered cash. 
“Center of Excellence” has the meaning given in Section 13.4.
[**]
“Charges” and “Charges for Services” have the meaning given in Section 11.1.
“Client” has the meaning given in the Preamble of this Services Agreement.
“Client User” has the meaning given in Section 15.3.
“Compliance Program” has the meaning given in Section 18.4(a).
“Confidential Information” has the meaning given in Section 9.3(a).
“Confidentiality and Non-Disclosure Agreement” has the meaning given in Section 17.4.
“Consultants” has the meaning given in Section 9.3(d).
“Control” and its derivatives means: (a) the legal, beneficial, or equitable ownership, directly or indirectly, of (i) at least fifty percent (50%) of the aggregate of all voting equity interest in an entity or (ii) equity interest having the right to at least fifty percent (50%) of the profits of an entity or, in the event of dissolution, to at least fifty percent (50%) of the assets of an entity; (b) the right to appoint, directly or indirectly, a majority of the board of directors of the entity; (c) the right to control, directly or indirectly, the management or direction of the entity by contract or corporate governance document; or (d) in the case of a partnership, the holding by an entity (or one of its Affiliates) of the position of sole general partner.
“Disclosing Party” has the meaning given in Section 9.3(a).
“Disengagement Services” means the termination/expiration assistance and services requested by IMH to allow the Services to continue without interruption or adverse effect and to facilitate the orderly transfer of the Services from R1 to a substitute solution chosen by IMH or its designee(s), as such assistance and services are further described in Section 23.8. and Exhibit 23.8.  For clarity, any services or assistance under Exhibit 23.8 that are not Continued Services are Disengagement Services. 
“Divestiture Election Notice” has the meaning given in Section 5.2(a).

[**] designates portions of this document that have been omitted pursuant to a request for confidential treatment filed separately with the Securities and Exchange Commission.
2

“Effective Date” has the meaning given in the Preamble of this Services Agreement.
“Election Notice” has the meaning given in Section 16.1.
“Escrow Request” has the meaning given in Section 16.3.
“Executive Sponsor” and “Executive Sponsors” have the meaning given in Section 8.2.
“Existing Systems” has the meaning given in Section 6.2.
“Federal Health Care Program” means any plan or program providing health care benefits, whether directly through insurance or otherwise, that is funded directly, in whole or part, by the United States Government (other than the Federal Employees Health Benefits Program), including any State health care program that receives funding from the United States Government. 
[**].
“First Party” has the meaning given in Section 18.5.
“Force Majeure Event” has the meaning given in Section 24.7.
“General Solicitation” has the meaning given in Section 24.4.
“Governing Law” has the meaning given in Section 24.16. 
“Healthcare Law” means all Applicable Laws relating to healthcare regulatory matters, including (i) 42 U.S.C. § 1320a-7, 7a, and 7b, which are commonly referred to as the “Federal Fraud Statutes,” and any analogous anti-kickback law of any state; (ii) 42 U.S.C. § 1395nn, which is commonly referred to as the “Stark Statute”; (iii) 31 U.S.C. § 3729-3733, which is commonly referred to as the “Federal False Claims Act”; (iv) 42 U.S.C. §§ 1320d through 1320d-8 and 42 C.F.R. §§ 160, 162 and 164, which are commonly referred to as the “Health Insurance Portability and Accountability Act of 1996” or “HIPAA” and Title XIII of the American Recovery and Reinvestment Act of 2009, Pub. L. No. 111-5(2009), commonly referred to as the “HITECH Act”; (v) 18 U.S.C. § 1347 (Health Care Fraud); (vi) any state law regulating the interactions with healthcare professionals and reporting thereof; (vii) the Medicare Act, 42 U.S.C. § 1395 et seq., the Medicaid Act, 42 U.S.C. § 1396 et seq., TRICARE (f/k/a CHAMPUS) and such other government programs and commercial payors; (viii) or any other federal, state or local law that regulates false statements or claims, kickbacks, patient or program charges, referrals, the hiring of employees or acquisition of services or supplies from those who have been excluded from government health care programs, quality, safety, privacy, security, licensure, billing or accreditation.
“HIPAA” has the meaning given in Section 18.3.
“IMH” has the meaning given in the Preamble of this Services Agreement.

[**] designates portions of this document that have been omitted pursuant to a request for confidential treatment filed separately with the Securities and Exchange Commission.
3

“IMH Compliance Officer” has the meaning given in Section 18.4(b).
“IMH Controlled Non-Compliance” has the meaning given in Section 19.5.
“IMH Facility” and “IMH Facilities” have the meaning given in Section 3.7.
“IMH Provider” and “IMH Providers” have the meaning given in Section 3.7.
“IMH’s IT Environment” has the meaning given in Section 23.4 .
“In-Scope Agreement” and “In-Scope Agreements” have the meaning given in Section 14.1.
“Incidental IP License” has the meaning given in Section 15.2.
“Insolvent Party” has the meaning given in Section 23.6.
“Intellectual Property” means the Intermountain Healthcare Intellectual Property or the R1 Intellectual Property, as the context requires. 
“Interim Service Period” has the meaning given in Section 5.2(a)(i).
“Intermountain Healthcare Executive Sponsor” has the meaning given in Section 8.2.
“Intermountain Healthcare Intellectual Property” has the meaning given in Section 15.1.
“Intermountain Name” has the meaning given in Section 24.18(a).
“Intermountain RCO Data” has the meaning given in Section 15.4.
“Joint Review Board” has the meaning given in Section 8.1.
“Malware” has the meaning given in Section 15.9.
“Malware and Security Agreement” has the meaning given in Section 17.3.
“Material Adverse Effect” means any change, event or effect that, when taken individually or together with all other related adverse changes, events or effects, has had or would reasonably be expected to have a material adverse effect on the business, properties, assets, results of operations or condition, financially or otherwise, taken as a whole, of a Party; provided, however, that a “Material Adverse Effect” shall not include any change or effect:  (a) in general economic or business conditions; (b) financial, banking or securities markets of the U.S. in general (including any disruption thereof and any decline in the price of any security or any market index); (c) in national or international political or social conditions, including the engagement by the U.S. in hostilities, whether or not pursuant to the declaration of a national emergency or war, or the occurrence of any military or terrorist attack upon the U.S. or any of its territories, possessions or 

4

diplomatic or consular offices or upon any military installation, equipment or personnel of the U.S.; (d) affecting generally the industries or markets in which such Party operates; (e) related solely to the announcement or consummation of the matters contemplated by this Services Agreement; (f) resulting from the identity or business plans of such Party or any of its Affiliates; (g) resulting from any act taken by such Party in accordance with this Services Agreement; (h) resulting from changes in applicable Law; or (i) resulting from changes in reimbursement rates, including but not limited to changes in any reimbursement policies or fee schedules by Federal Healthcare Programs.  
[**]
[**]
“NDA” has the meaning given in Section 9.1.
“Operations Oversight Council” has the meaning given in Section 8.3.
“Original Effective Date” has the meaning given in the Recitals of this Services Agreement.
“Original Services Agreement” has the meaning given in the Recitals of this Services Agreement.
“Other Party” has the meaning given in Section 11.6.
“Patient Safety Information” has the meaning given in Section 9.3(f).
“Party” has the meaning given in the Preamble of this Services Agreement.
“Parties” has the meaning given in the Preamble of this Services Agreement.
“Paying Party” has the meaning given in Section 11.6.
“Plan” has the meaning given in Section 23.3(d).
“Potential Recipient” has the meaning given in Section 5.1(a).
“Pre-Transition Audit” has the meaning given in Section 19.5.
“Prior BAA” has the meaning given in Section 17.2.
“Privileged Work Product” has the meaning given in Section 18.7.
“Proprietary Interests and Protection Agreement” has the meaning given in Section 17.4.
“Protected Health Information” and “PHI” have the meaning given in Section 17.1.
“R1” and “R1 RCM” have the meaning given in the preamble of this Services Agreement.

[**] designates portions of this document that have been omitted pursuant to a request for confidential treatment filed separately with the Securities and Exchange Commission.
5

“R1 Analytics” means R1’s data analytics tool ‘Performance Management Monitoring Tool’ or ‘R1 Analytics’ (formerly known as PMMT) and all functionality supported in the various tabs, forms, extensions and reports associated with this tool, and, as notified in writing by R1 to IMH, all new versions, updates, revisions, improvements and modifications of, and substitutes for, this tool.
“R1 Analytics Data” has the meaning given in Section 15.6.
“R1 Compliance Officer” has the meaning given in Section 18.4(b).
“R1 Contractors” means a third party engaged by R1 to perform a portion of the Services on R1’s behalf.  R1 Contractors do not include third party vendors who indirectly support the Services or who provide general operational, administrative, technical or similar services for R1’s business, even though they may support R1’s provision of the Services. An individual (natural person) independent contractor or temporary employee hired by R1 for staff augmentation services is not considered an R1 Contractor for purposes of this Agreement, but will be considered as an employee of R1 for purposes of this Agreement.
“R1 Executive Sponsor” has the meaning given in Section 8.2.
“R1 Incidental IP” has the meaning given in Section 15.2.
“R1 Intellectual Property” has the meaning given in Section 15.1.
“R1 Servers” has the meaning given in Section 15.3.
“R1 Site Lead” has the meaning given in Section 8.4.
“R1 Technology” has the meaning given in Section 6.1.
“Receiving Party” has the meaning given in Section 9.3(a).
“Recovery Environment” has the meaning given in Section 16.1.
“Recovery Environment License” has the meaning given in Section 16.1.
“Reports” has the meaning given in Section 19.2. 
“Required Divestiture Election Notice Period” has the meaning given in Section 5.2.
“Restricted Materials” has the meaning given in Section 9.3(d)(iv).
“Rules” has the meaning given in Section 20.4.
“Service Change” has the meaning given in Section 3.8.
“Service Levels” has the meaning given in Section 3.6.

6

“Services” has the meaning given in Section 3.1.  
“Services Agreement” has the meaning given in Section 2.1.
“Similar Services” mean services from a third party service provider that are identical to or substantially the same as any of the Services provided by R1 under this Services Agreement.  
“Similar Services List” has the meaning given in Section 14.1.
“Software and Services License” has the meaning given in Section 15.3.
“Standard Operating Procedures” and “SOPs” have the meaning given in Section 9.3(d)(iv).
“Term” has the meaning given in Section 23.1.
“Transition Work Plan” has the meaning given in Section 4.1.
 “Uncapped Liabilities” has the meaning given in Section 21.3.
“Workaround Period” has the meaning given in Section 23.5(d).

The following terms are not defined above, but are defined in the Exhibits indicated below:  

	
		
	Defined Term
	Exhibit

	[**]
	[**]

	ABN   
	Exhibit 3.1

	Actual Result   
	Exhibit 11.1-B

	Acute Adjusted Admissions   
	Exhibit 11.1-A

	Acute Adjusted Admissions Percentage Change   
	Exhibit 11.1-A

	Advanced Beneficiary Notice   
	Exhibit 3.1

	Agent   
	Exhibit 17.4

	Aggregate Hold Time   
	Exhibit 3.6

	[**]
	[**]

	[**]
	[**]

	Balanced Score   
	Exhibit 11.1-B

	Base Fee   
	Exhibit 11.1-A

	[**]   
	[**]

	Baseline Year   
	Exhibit 11.1-A

	Benefit Plan   
	Exhibit 10.1

	[**]
	[**]

[**] designates portions of this document that have been omitted pursuant to a request for confidential treatment filed separately with the Securities and Exchange Commission.
7

	
		
	Defined Term
	Exhibit

	[**]
	[**]

	[**]
	[**]

	[**]
	[**]

	[**]
	[**]

	Book of Business   
	Exhibit 11.1-B

	Capped Score   
	Exhibit 11.1-B

	[**]
	[**]

	[**]
	[**]

	Coding Audit   
	Exhibit 3.6

	Commencement Date   
	Exhibit 10.1

	Confidential Information   
	Exhibit 17.4

	Contingent Services   
	Exhibit 3.6

	Continued Services   
	Exhibit 23.8

	Contract Quarter   
	Exhibit 11.1-A

	Contract Year   
	Exhibit 11.1-A

	Cost to Collect Factor   
	Exhibit 11.1-A

	Cost to Collect Numerator   
	Exhibit 11.1-A

	Council   
	Exhibit 8.3

	[**]
	[**]

	CPT   
	Exhibit 3.1

	CWL   
	Exhibit 6.1

	[**]
	[**]

	[**]
	[**]

	[**]
	[**]

	[**]
	[**]

	Disengagement Plan   
	Exhibit 23.8

	Disengagement Period   
	Exhibit 23.8

	Employment Effective Date   
	Exhibit 10.1

	EMR   
	Exhibit 3.1

	Equipment   
	Exhibit 23.8

	Facility Group   
	Exhibit 3.6

	Financial Clearance   
	Exhibit 3.6

	First SLA Effective Period   
	Exhibit 3.6

	[**]
	[**]

	Garfield   
	Exhibit 3.7-C

	Guiding Principles   
	Exhibit 11.1-B

	HCPCS   
	Exhibit 3.1

	IMH Charity Care and Financial Assistance Policies   
	Exhibit 18.8

	IMH Employee   
	Exhibit 10.1

	IMH Facilities Base Fee   
	Exhibit 3.6

	IMH Home Health   
	Exhibit 11.1-B

	IMH Providers Base Fee   
	Exhibit 3.6

[**] designates portions of this document that have been omitted pursuant to a request for confidential treatment filed separately with the Securities and Exchange Commission.
8

	
		
	Defined Term
	Exhibit

	IMH Support Issue   
	Exhibit 3.6

	[**]
	[**]

	Incentive Fees   
	Exhibit 11.1-B

	Initial Assessment   
	Exhibit 11.1-A

	Initial Cost to Collect Factor   
	Exhibit 11.1-A

	Inpatient Accuracy Score   
	Exhibit 3.6

	Inpatient Admissions   
	Exhibit 11.1-A

	Inpatient Revenue   
	Exhibit 11.1-A

	In-Scope Employees   
	Exhibit 11.1-A

	In-Scope Percentage   
	Exhibit 11.1-A

	In-Scope Vendors   
	Exhibit 11.1-A

	[**]
	[**]

	IT Host System Vendor   
	Exhibit 11.1-A

	JRB   
	Exhibit 8.1-A

	KPIs   
	Exhibit 19.2

	Lower Bound   
	Exhibit 11.1-B

	Management Employee   
	Exhibit 11.1-A

	Measurement Period   
	Exhibit 11.1-B

	Measurement Period Score   
	Exhibit 11.1-B

	Measurement Window   
	Exhibit 3.6

	Metric   
	Exhibit 11.1-B

	Metric Reset Percentage   
	Exhibit 11.1-B-1

	Metric Value   
	Exhibit 11.1-B

	Military Leave   
	Exhibit 10.1

	[**]
	[**]

	New Service Levels   
	Exhibit 3.6

	New SLA Measurement Commencement Date   
	Exhibit 3.6

	Old Metrics   
	Exhibit 3.6

	On-Leave Offer Period   
	Exhibit 10.1

	On-Leave Transition Employee   
	Exhibit 10.1

	Out of Scope Services   
	Exhibit 3.1

	Outpatient DX Score   
	Exhibit 3.6

	Outpatient Procedure Score   
	Exhibit 3.6

	Partially Related Vendors   
	Exhibit 11.1-A

	Patient   
	Exhibit 3.6

	Patient Accounting System   
	Exhibit 11.1-B

	[**]
	[**]

	[**]
	[**]

	Payor   
	Exhibit 11.1-B

	[**]
	[**]

	[**]
	[**]

	[**]
	[**]

[**] designates portions of this document that have been omitted pursuant to a request for confidential treatment filed separately with the Securities and Exchange Commission.
9

	
		
	Defined Term
	Exhibit

	PMMT   
	Exhibit 6.1

	[**]
	[**]

	Provider   
	Exhibit 17.4

	Provider Group   
	Exhibit 3.6

	Provider Visits   
	Exhibit 11.1-A

	[**]
	[**]

	PSAT   
	Exhibit 6.1

	Quarterly Base Fee Cash   
	Exhibit 11.1-A

	Remittance Posting Within One Business Day   
	Exhibit 3.6

	Remittance Posting Within Two Business Days   
	Exhibit 3.6

	Revenue Integrity Collected Accounts   
	Exhibit 19.2

	Risk Pool   
	Exhibit 11.1-B

	Scorecard Calculation   
	Exhibit 11.1-B

	Scorecard Review Period   
	Exhibit 11.1-B

	Self-pay Patients   
	Exhibit 11.1-B

	Service Level Credit   
	Exhibit 3.6

	Service Level Default   
	Exhibit 3.6

	Service Level Effective Date   
	Exhibit 3.6

	Service Levels   
	Exhibit 3.6

	[**]
	[**]

	SLA Initial Measurement Period   
	Exhibit 3.6

	SLA Measurement Commencement Date   
	Exhibit 3.6

	[**]
	[**]

	Target Level   
	Exhibit 3.6

	Temporary Incentive Fees   
	Exhibit 11.1-B

	[**]
	[**]

	Total Charges   
	Exhibit 11.1-B

	[**]
	[**]

	[**]
	[**]

	[**]
	[**]

	Total Weighted Value   
	Exhibit 11.1-B

	[**]
	[**]

	Transition Employee   
	Exhibit 10.1

	Transition Services   
	Exhibit 4.1

	Transitioned Employee   
	Exhibit 10.1

	[**]
	[**]

	[**]
	[**]

	Upper Bound   
	Exhibit 11.1-B

	Vendor   
	Exhibit 17.4

	Vendor Service   
	Exhibit 11.1-A

	VP-BEC   
	Exhibit 18.9

	[**]
	[**]

[**] designates portions of this document that have been omitted pursuant to a request for confidential treatment filed separately with the Securities and Exchange Commission.
10

	
		
	Weighting   
	Exhibit 11.1-B

	Welfare Plans   
	Exhibit 10.1

	Work Order   
	Exhibit 3.8-1

	Work Order Effective Date   
	Exhibit 3.8-1

	Workforce Member   
	Exhibit 17.4

	YBFU   
	Exhibit 6.1

11

AMENDED AND RESTATED SERVICES AGREEMENT

between

IHC Health Services, Inc.

and

R1 RCM Inc.

EXHIBIT 3.1

SERVICES

Exhibit 3.1  
Services
The Services described below are being undertaken for the purposes of optimizing the Revenue Cycle Operations process to maximize compliant collections from the amounts billable as a result of operations of IMH.  None of the Services described below are being undertaken to manage medical decisions or business operations of IMH, nor are any of the Services intended to increase the volume of operations of IMH.  

		
	1.
	Services.  In accordance with Section 3.1 of the Services Agreement, R1 shall provide the following Services in accordance with IMH policies and procedures.

		
	a.
	Functional Areas.  The Services shall include the following functional areas:

		
	i.
	FRONT END - Provide leadership, management oversight, staffing and technical expertise of and for: 

		
	(1)
	Scheduling (including inpatient, outpatient, and diagnostics, but excluding surgical) – In accordance with the technical systems, policies, practices, and standards of IMH, obtain required information and all core set of data elements from either the patient or the referring physician practice to enable successful subsequent front end processes. To aid scheduling processes, provide patient in advance with instructions based on the scheduled medical procedure, manage scheduling of physician-order services, manage IMH medical procedure facility schedule as directed, and provide follow up or reminders to patients of scheduled visits. 

		
	(2)
	On-Site Process of Pre-Registration – As a result of a scheduled service or a last minute add-on to the next day or current day’s schedule, gather as much demographic, clinical, and financial information from the patient or a prior visit as possible to allow (as a minimum) verification of current insurance and potential need for an authorization.  If time or situation permits, complete entire registration prior to patient arriving at the hospital.

		
	(3)
	Off-Site Process of Pre-Registration – As a result of a scheduled service or a last minute add-on to the next day or current day’s schedule, gather as much demographic, clinical, and financial information from the patient or a prior visit as possible to allow (as a minimum) verification of current insurance and potential need for an authorization.  If time or situation permits, complete entire registration prior to patient arriving at the hospital. 

[**] Indicates that text has been omitted which is the subject of a confidential treatment request. The text has been separately filed with the Securities and Exchange Commission.

Exhibit 3.1-1

		
	(4)
	Registration – Obtain all required patient liability (i.e., outstanding balance), clinical, demographic, and financial information from patients that was not obtained during scheduling or pre-registration when the patient is present for service regardless of status (Emergency Department, outpatient services or inpatient). Obtain information necessary to obtain financial clearance at time of service (to include collection of co-pay, deductible, or co-insurance); this includes documenting data into the system in order to set up an account.  This process is highly dependent on IMH’s Patient Accounting system and the physical layout driving patient arrivals at each IMH Facility.  Obtain completed IMH non-clinically-related forms, ensure forms have been completed fully and are signed, when required, and if applicable, scan documents into IMH’s document imaging system. Determine non-covered outpatient Medicare services, administer an “Advanced Beneficiary Notice” or (“ABN”) and note in the patient accounting system relevant ABN status for Medicare non-covered outpatient charges. For services that are not covered by the relevant third party payer for patients with insurance, take comparable action. 

		
	(5)
	Insurance Eligibility Verification – Once a payer is identified, check benefit eligibility and obtain verification from insurance (governmental or commercial) that the patient reported insurance for the applicable service is still in force and will reimburse the provider for the service.  Every effort will be made to do this verification prior to services rendered.  

		
	(6)
	Authorization – Communicate and coordinate with the referring physician practice and patient’s insurance (governmental or commercial) to obtain necessary authorization prior to service to ensure reimbursement and to minimize denials. If additional diagnostic procedures are identified and require an authorization, obtain required payer authorization. Document all payer authorizations in IMH’s patient accounting system.

		
	(7)
	Collection of Residual Patient Balances – As part of the patient education and communication process, present the opportunity for patients to pay their estimated residual prior to service as both a convenience and improvement to patient flow at the point of service. 

		
	(8)
	Self-Pay Financial Counseling and Eligibility of Services (e.g., self-pay conversions) – For those patients that are unaware of what insurance they have, or declare they have no insurance, work diligently and use proprietary tools to gather information from the patient to understand what might be an acceptable source of 

[**] Indicates that text has been omitted which is the subject of a confidential treatment request. The text has been separately filed with the Securities and Exchange Commission.

Exhibit 3.1-2

reimbursement for the hospital (e.g., public aid, COBRA, crime victim, third party liability, etc.).
		
	(9)
	Prior Balance Found Insurance – Continue to retroactively identify and pursue possible means for paying for services that were previously provided.

		
	(10)
	Admitting – Provide leadership and oversight of all activities involved in point of service operations including greeting patients and collecting financial information required for an accurate and complete registration in accordance with IMH and individual hospital policies and practices. 

		
	ii.
	MIDDLE - Provide leadership, management oversight, staffing and technical expertise of:

		
	(1)
	Chart Analysis and Assembly - Whether electronic or paper based, confirm that processes are followed to ensure medical records are complete in accordance with all applicable local and regulatory policies and practices.

		
	(2)
	Coding/Coding Audits –Once a medical record of service is completed, certified coders assign codes to inpatient and outpatient encounters, as appropriate, to create billable charges.  In accordance with the respective IMH Compliance and R1 Compliance Program coverage and other requirements set forth in the Agreement, perform coding audits and remediate any identified deficiencies. The IMH Compliance Officer shall have access, upon reasonable request to the R1 Compliance Officer, to all coding audit findings, including any adjusted claims which the R1 Compliance Officer or his/her staff has access to.

		
	(3)
	Record Retention/Record Management – Whether electronic or paper based, confirm that processes are in place to meet IMH policies and practices.  This includes: overseeing chart completion, capturing medical record documents via scanning post discharge, preparing and indexing the electronic medical record (“EMR”) as necessary, record reconciliation, record filing and retrieval, and generating relevant records for necessary governmental agencies.  

		
	(4)
	Transcription – Transcribe physician dictation of required reports into paper or electronic reports to become an official part of the medical record.  Manage transcription services and vendors, including coordinating work assignments, overseeing dictation quality, and managing internal/external report distribution.  

[**] Indicates that text has been omitted which is the subject of a confidential treatment request. The text has been separately filed with the Securities and Exchange Commission.

Exhibit 3.1-3

		
	(5)
	Lost Charges/Charge Capture Pre-Bill - Use automated and manual methods to assist IMH to correctly bill gross revenue and to capture all applicable and authorized charges by clinical departments before the bill is sent to the payer / patient.  

		
	(6)
	Lost Charges/Charge Capture Post-Bill – Analyze claims after the bill has been sent to identify groups of patient accounts that could have missing or incorrect charges, codes, documentation, or other information to identify cases involving undercharging or overcharging, and re-submit these bills to reflect correct charges for reimbursement. Use retrospective automated and manual methods to identify groups of patient accounts that could have missing or incorrect charges, codes, documentation, or other information, and resubmit related bills to the payer / patient. 

		
	(7)
	Transfer Diagnosis Related Group (DRG) Reconciliation and Follow-Up – Based on current Medicare reimbursement policies and requirements, identify, investigate and appeal claims (specific DRGs) that were paid at a lower level based on subsequent services (e.g., skilled nursing facility, home health, etc.) that did not subsequently occur. Once DRG is identified as appealable, construct appropriate case for DRG validation based on full review of medical record and official coding guidelines, and write appeal letters to the relevant party based on Medicare and applicable payer appeal guidelines.  The Operating Oversight Council shall approve all forms of any appeal letters and, as clarified in Exhibit 18.8,  in the event that legal counsel representing IMH needs to be engaged in connection with any appeal, the selection of such counsel shall be made by IMH in its sole discretion and at IMH’s sole expense.

		
	(8)
	Charge Description Master (CDM) Maintenance and Revenue Integrity - Review IMH’s CDM and analyze the following items with respect to the CDM: revenue codes, Current Procedural Terminology “CPT” codes, Healthcare Common Procedure Coding System “HCPCS” codes, and dosage multipliers. With IMH’s agreement, implement corrections to such codes to improve accuracy and avoid under-charging and/or over-charging for services.  Provide regulatory updates related to hospital CDM activity, including the AMA’s CPT coding updates at year end. Provide leadership and oversight regarding compliance issues related to the CDM, linking CDM associates to the appropriate IMH resource.  Assist IMH with implementation of updates and corrections to CDM, and provide support during the implementation phase.

[**] Indicates that text has been omitted which is the subject of a confidential treatment request. The text has been separately filed with the Securities and Exchange Commission.

Exhibit 3.1-4

		
	(9)
	Strategic Pricing - Develop comprehensive pricing recommendations that balance rational and defensible prices, market positioning, and revenue capture opportunities both in the short-term and long-term.  Deploy an iterative data driven process that focuses on selective price adjustments that yield greater net revenue potential for the organization than a standard across-the-board rate increase, Present recommendations to IMH leadership for approval.

		
	(10)
	Release of Information – Follow all applicable IMH privacy and security policies and procedures, HIPAA and privacy rules and laws, and other IMH external communication policies in providing copies of medical records or other patient or medical information to authorized person or parties.

		
	iii.
	BACK END - Provide leadership, management oversight, staffing and technical expertise of:

		
	(1)
	Billing (patient and payer) - Send all required information to the billing editor application or system so that a claim proceeds to the applicable payer.  Though the goal is to have no bill editor rejects, R1 will resolve all discrepancies in a timely manner for resubmission of the bill to the applicable payer.  Once the insurance balance is resolved, use the applicable patient billing system to send a bill for the residual patient responsibility. Recommend billing edits and bridge routines to improve the number of claims sent to the payer without intervention and/or to reduce denials.  

		
	(2)
	Cash Posting and Processing - Electronically and manually post cash from both payers’ and patients’ accounts and reconcile outstanding accounts receivable in a timely and accurate manner. Reconcile daily cash at patient account level to the extent reasonably feasible (except IMH will be responsible for general ledger and patient accounting reconciliation). Follow IMH’s cash control policies and procedures. Post payments not processed electronically (e.g., over-the-counter deposits, payroll deductions, returned lockbox items, bank credit/debit adjustments, credit card chargebacks) on the day such items are received or in a longer timeframe determined by IMH to be proper. Identify and reconcile unidentified cash receipts and daily lockbox deposits to payment posting in hospital’s patient accounting system on a daily basis.

		
	(3)
	Denial Management (Operational and Clinical) - Attempt to resolve all issues (e.g., registration, coding, billing, preauthorization, etc.) which have caused a partial or full denial. Resubmit the applicable bill to the payer as necessary and make/recommend systemic improvements to reduce or eliminate re-occurrence. 

[**] Indicates that text has been omitted which is the subject of a confidential treatment request. The text has been separately filed with the Securities and Exchange Commission.

Exhibit 3.1-5

Implement/recommend process improvements to reduce future denials based on root cause analysis of current denials.  
		
	(4)
	Underpayment Review/Recovery – Use a contract management system and other tools or vendors to identify claims that were underpaid by a payer (commonly due to a payer mistake or a misinterpretation of or a vague contractual term).  Once such claims have been identified, appeal such claims and follow-up until either the claim is paid correctly or the contract is clarified for re-modeling or changed.  In the event any such appeals take place, IMH shall have the right, but not the obligation, to hire its own legal counsel or participate in any such appeals, each at its own expense, upon reasonable request to R1.  In addition, to the extent any material overpayment issues are identified, such issues should be brought to the attention of both the IMH Compliance Officer and the R1 Compliance Officer in accordance with the policies and procedures of each Party’s respective Compliance Program.  

		
	(5)
	Patient Billing Customer Service/Patient Financial Services – Provide an inbound call center capability and mail response capabilities for patient inquires, complaints, and possible payment/resolutions via a phone number and address listed on the patient bill.  Customer service agent shall handle and resolve a wide range of questions, issues or include disputes.  R1 will record all relevant customer service calls and maintain recordings for a period of a least [**] days after the date of call or according to IMH’s Record Retention Policy, whichever is longer, making such recordings available to IMH upon request. Scan and manage all correspondence received by the call center or patient correspondence sent to IMH’s lockbox. This function will also include processing post-service financial assistance applications, Medicaid applications, and other patient liability functions (e.g. bankruptcy, attorney requests, etc.). This call center will receive calls relating to patient balances for the IMH Facilities and IMH Providers.  

		
	(6)
	Secondary Billing – Identify secondary payers as part of the registration process (preferred) or subsequently from the patient at time of patient billing.  Send a secondary payer bill for the patient responsibility portion of such bill after the primary insurance is settled to gain reimbursement from a secondary insurance payer.

		
	(7)
	Third Party Collections and Self-Pay Follow-Up (internal and external collection activities) - Manage the collection process in accordance with IMH standards and federal and state policies and practices.  Coordinate with third party collectors for debt in default. 

[**] Indicates that text has been omitted which is the subject of a confidential treatment request. The text has been separately filed with the Securities and Exchange Commission.

Exhibit 3.1-6

Attempt to resolve all issues (e.g., registration, coding, billing, clinical, etc.) which have caused a partial or full denial.  Perform denial and appeal service on third party claims including review of Remittance Advice and/or Explanation of Benefits and determine payment discrepancies between actual payment and expected payment. Subject to the Parties’ agreement on forms of appeal letters and associated policies and procedures as contemplated above, prepare and send appeal letters for accounts that have been denied by the insurance payer, including substantiation by clinically certified staff for clinically related denials (e.g. medical necessity, level of care, etc.   As necessary, resubmit all applicable bills to the payer and make/recommend improvements to attempt reduction or elimination of re-occurrence of such events.  This service includes all non-zero balances.  
		
	(8)
	Credits - Research credit balances and reasons for credit balances (e.g., over-contractualization, system processing issues, actual over-payments, etc.), and prepare appropriate account adjustments where no refund is due. R1 will process credit balances for refund payment for IMH's review and approval.  Implement processes necessary to comply with state escheatment laws for uncashed refund payments.

		
	(9)
	Finance and Managed Care Analytical Support as Appropriate to Support General Operations – Provide payer yield and other accounts receivable and operational data that will assist the managed care team with strengthening their interaction with payers and will allow finance to have better visibility into their reserving processes.

		
	(10)
	Bad Debt Management - Manage patient bad debt through internal means and/or third party vendors and maintain documentation to support bad debt logging.  

		
	iv.
	Other Services - Provide leadership, management oversight, staffing and technical expertise of:

		
	(1)
	Payer Audit and RAC Support - Support insurance account audits and Medicare RAC audits by performing account reviews and obtaining required documentation for appeal.

		
	(2)
	Revenue Cycle Analytics and Reporting - Provide detailed reports and analytical support to revenue cycle functions through data mining, analysis and report creation. 

		
	(3)
	Revenue Cycle Technology and Support - Revenue cycle support services including, but not limited to, technology support, training and special projects.

[**] Indicates that text has been omitted which is the subject of a confidential treatment request. The text has been separately filed with the Securities and Exchange Commission.

Exhibit 3.1-7

		
	(4)
	Revenue Cycle Training – Conduct training and quality assurance across all revenue cycle processes.

		
	(5)
	Vendor Management - Contracting for and management of vendor relationships specializing in revenue cycle sub-functions including areas such as authorization management, coding and debt collection. 

		
	b.
	Record Keeping.

R1 will supervise the preparation (and with respect to R1 data, the maintenance) of all files and contract records related to the Services provided to IMH including patient accounting, billing, patient records and collection records.  The preparation and management of the foregoing files and records will comply with applicable state and federal statutes and with all applicable IMH policies and procedures.

		
	2.
	In-Scope Departments. The Services outlined above will be limited to the areas included and characterized by the IMH departments as a part of Schedule 1 below. 

[**] Indicates that text has been omitted which is the subject of a confidential treatment request. The text has been separately filed with the Securities and Exchange Commission.

Exhibit 3.1-8

Schedule1:

[**] Indicates that text has been omitted which is the subject of a confidential treatment request. The text has been separately filed with the Securities and Exchange Commission.

Exhibit 3.1-9

[**] Indicates that text has been omitted which is the subject of a confidential treatment request. The text has been separately filed with the Securities and Exchange Commission.

Exhibit 3.1-10

		
	3.
	Out of Scope Services. 

The services listed below shall be considered “Out of Scope Services” unless agreed to in writing by R1 and IMH.  Notwithstanding that the services set forth below are not within the scope of Services, the Parties acknowledge that in the future, any of the services below may be provided by R1 for IMH in accordance with Section 3.8 of the Services Agreement. 

[**] Indicates that text has been omitted which is the subject of a confidential treatment request. The text has been separately filed with the Securities and Exchange Commission.

Exhibit 3.1-11

		
	a.
	Scheduling: surgical (operating room) and/or services directly scheduled by a clinician.

		
	b.
	Clinical Documentation – Ensure continued quality improvement for accurate and complete coding, resulting in increase in revenue and careful compliance with effective documentation.  Provide pre-billing audit of DRG change, Physician/ CDS/ Coder Training Program or CDI comprehensive program implementation that includes a DRG Integrity tool and interim CDI roles performed by AH specialist team.

		
	c.
	Managed Care Contract Negotiation - Manage relationships and conduct appropriate negotiations with managed care payers to maximize revenue for IMH.  Identify gaps in existing contractual agreements by comparing net to gross ratios across commercial payers against relevant benchmarks.  Provide insights and recommendations to support payer negotiations using detailed modeling of contract terms.

		
	d.
	Medicare Cost Reporting – Assist in identification of costs associated with categories eligible for reimbursement under a Medicare cost report.

		
	e.
	Case Coordination/Utilization Review/Case Management – Review patient cases to ensure the proposed level of care is appropriate for the condition of the patient and evaluate necessity and efficiency in the use of medical services and facilities.  This includes: ongoing certification and authorizations processing, routing processing of medical necessity, concurrent and retrospective clinical denial process, overseeing incomplete or pending physician order that require additional data, ongoing hiring and training for utilization management, charge defense audit process, management of claims that require utilization management attention for processing, analytical reporting of clinical denials, analysis and implementation of process improvement or systemic improvement intended to reduce clinical denials, and review of accounts for potential zero bill claims. 

		
	f.
	Social Work/Discharge Planning – Coordinate process in which patient receives assistance in developing a healthcare plan to make sure that the patient receives ongoing healthcare maintenance post discharge. Ensure open communication and comprehensive case management services are offered.

		
	g.
	Charge Entry – Entry of charges into patient accounting system for all services rendered. Collaborate with clinical system support teams to support charge entry management.

		
	h.
	Patient Outreach – Guide patients around barriers to care including patient enrollment in programs offering transportation, food, housing, child care, etc.

		
	i.
	Physician Advisory Services – Provide clinical resource support for concurrent review services, including assistance with compliance with payer policies regarding 

[**] Indicates that text has been omitted which is the subject of a confidential treatment request. The text has been separately filed with the Securities and Exchange Commission.

Exhibit 3.1-12

observation and inpatient vs. outpatient/observation admission classification status, level of care and other payer criteria, and write related clinical appeals.  Provide remote case management support.  

[**] Indicates that text has been omitted which is the subject of a confidential treatment request. The text has been separately filed with the Securities and Exchange Commission.

Exhibit 3.1-13

Execution Copy

AMENDED AND RESTATED SERVICES AGREEMENT

between

IHC Health Services, Inc.

and

R1 RCM Inc.

EXHIBIT 3.6

SERVICE LEVELS

Exhibit 3.6 
Specific Levels
1.    Definitions.
		
	•
	“Base Fee” means the base fee calculated with respect to the IMH Facilities and the IMH Providers under Exhibit 11.1-A.

		
	•
	“IMH Facilities Base Fee” means the portion of the Base Fee attributable to the IMH Facilities based on the Cash Collections received by the IMH Facilities during the [**] period that ends one month prior to the commencement of the relevant [**].

		
	•
	“IMH Providers Base Fee” means the portion of the Base Fee attributable to the IMH Providers based on the Cash Collections received by the IMH Providers during the [**] period that ends one month prior to the commencement of the relevant [**].

		
	•
	“Measurement Window” means the time during, or frequency by, which a Service Level shall be measured. The Measurement Window shall be [**], unless otherwise specified.

		
	•
	“New Service Levels” means any additional Service Levels agreed to by the Parties following the Commencement Date. After the Service Level Effective Date for any such New Service Level, each such New Service Level will be referred to herein simply as a “Service Level.”

		
	•
	“New SLA Measurement Commencement Date” means, for Service Levels 4 – 5 and for any New Service Levels, the first day of the next calendar [**] following the later of: (a) the Commencement Date and (b) written agreement of the Service Level definition and related Target Level.

		
	•
	“Old Metrics” means the performance metrics with respect to the services provided under the Original Services Agreement.

		
	•
	“Patient” means an individual who receives medical care from IMH.

		
	•
	“Service Level” means each Service Level set forth herein and any New Service Level.

		
	•
	“Service Level Default” means R1’s level of performance for a particular Service Level fails to meet the applicable Target Level during the applicable Measurement Window with respect to IMH.

		
	•
	“Service Level Effective Date” means: (i) for Service Levels 1 - 3 and 6 - 10, the first day of the next calendar [**] following the [**]-month anniversary of the Commencement Date; and (ii) for Service Levels 4 – 5 and for any New Service Levels, the [**]month anniversary of the New SLA Measurement Commencement Date.

[**] Indicates that text has been omitted which is the subject of a confidential treatment request. The text has been separately filed with the Securities and Exchange Commission.
	
			
	SMRH:484510755.9
	Exhibit 3.6-1
	 

	 
	 
	 

		
	•
	“SLA Initial Measurement Period” means the period of time beginning on the SLA Measurement Commencement Date or the New SLA Measurement Commencement Date, as applicable, and ending on the Service Level Effective Date.

		
	•
	“SLA Measurement Commencement Date” has the meaning set forth in Section 2.1.

2.    General.
		
	2.1
	As of the Commencement Date of Services by R1 for IMH (the “SLA Measurement Commencement Date”), or as otherwise specified in this Exhibit, R1 will perform the Services so as to meet or do better than the Target Levels (as defined below) for the Service Levels; provided, that the Service Levels will not be effective, measured and enforced until the applicable Service Level Effective Date for the Service Levels. For the avoidance of doubt, the Old Metrics shall apply to those services provided under the Original Services Agreement from the Effective Date until the Commencement Date of the corresponding Services, after which such services shall be replaced by Services under this Services Agreement and such Services will be subject to the provisions of this Exhibit regarding Service Levels.

		
	2.2
	The IMH Facilities and IMH Providers will be combined for purposes of monitoring, measuring, collecting, recording and reporting Service Levels 1, 4 and 8 - 10.

		
	2.3
	With respect to Service Levels 2 – 3 and 5 - 7, all IMH Facilities will be grouped together (the “Facility Group”), on the one hand, and all IMH Providers will be grouped together (the “Provider Group”), on the other hand, for purposes of monitoring, measuring, collecting, recording and reporting such Service Levels. The Facility Group and Provider Group shall be considered separately from each other when calculating any Service Level Credits resulting from a Service Level Default under Service Levels 2 – 3 or 5 - 7.

		
	2.4
	IMH will have the right to receive Service Level Credits in accordance with Section 7 below.

		
	2.5
	Beginning on the SLA Measurement Commencement Date or the New SLA Measurement Commencement Date, as applicable, R1 shall use reasonable commercial efforts to monitor, measure, collect and record R1’s performance with respect to the Service Levels and report its performance to IMH and shall continue to do so through the Term. R1 shall report to IMH R1’s performance against the Service Levels for each Measurement Window as specified in Section 6 below and as set forth in Section 19.2 of the Services Agreement.

		
	2.6
	During the [**] month period following the Service Level Effective Date (each such period, a “First SLA Effective Period”), the target with respect to each Service Level for IMH shall be equal to R1’s average performance regarding such Service Level 

[**] Indicates that text has been omitted which is the subject of a confidential treatment request. The text has been separately filed with the Securities and Exchange Commission.
	
			
	SMRH:484510755.9
	Exhibit 3.6-2
	 

	 
	 
	 

during each [**] month period during the SLA Initial Measurement Period. Service Level Credits may accrue with respect to a Service Level during the First SLA Effective Period (and thereafter) but a Service Level Default with respect to a Service Level that occurs during the First SLA Effective Period cannot count towards the determination of whether IMH has a right to terminate pursuant to Section 23.3(b) of the Services Agreement. Commencing upon the expiration of the First SLA Effective Period for IMH, such target shall cease to be effective for each such Service Level with respect to IMH and the target with respect to such Service Level for IMH shall equal the applicable target set forth in Article 4.
		
	2.7
	The Parties acknowledge and agree that, for purposes of this Agreement, the Service Level targets and metrics are intended to reflect rational and reasonable standards of performance in line with upper performance of industry standards. Following the Effective Date, the Parties shall work together in good faith during the [**] days following the Commencement Date to define the metrics (in Article 3) and the targets (in Article 4) with respect to Service Levels 4 and 5.

		
	2.8
	IMH will have the right to have reports and reporting from R1 audited and verified by IMH’s designees. R1 will fully cooperate with any such audits or verifications.

[**] Indicates that text has been omitted which is the subject of a confidential treatment request. The text has been separately filed with the Securities and Exchange Commission.
	
			
	SMRH:484510755.9
	Exhibit 3.6-3
	 

	 
	 
	 

3.    Service Level Criteria. R1 will measure R1’s performance against the following Service Levels and accurately report such results to IMH.
		
	3.1
	Service Level 1 - Customer Service Mean Speed to Answer (Mean wait time, in seconds, to answer calls at R1’s Customer Service Centers). This Service Level shall mean for a given Measurement Window, (a) the Aggregate Hold Time, divided by (b) the number of calls to R1’s Customer Service Center for which the caller requested to speak with a R1 representative during the Measurement Window. For purposes of calculating this Service Level, “Aggregate Hold Time” means the aggregated total amount of time during the Measurement Window that all callers to R1’s Customer Service Center (excluding “hang-ups”) remained on hold or in the interactive voice response unit after such callers requested to speak with a R1 representative with respect to R1’s Customer Service Center.

		
	3.2
	Service Level 2 - Percentage of scheduled Patients who have 100% Financial Clearance Completion. This Service Level shall mean for a given Measurement Window for IMH (a) the number of Patients (both inpatient and outpatient) who had an appointment at an IMH Facility or IMH Provider, as applicable and which appointment (1) was scheduled 48 hours or more prior to such Patient’s appointment, and (2) occurs during such Measurement Window and who had 100% Financial Clearance, divided by (b) the number of Patients, both inpatient and outpatient, who had an appointment and which appointment (1) was scheduled 48 hours or more prior to such Patient’s appointment and (2) occurs during such Measurement Window, expressed as a percentage. “Financial Clearance” shall mean that (i) the Patient’s eligibility has been identified and (ii) the requisite insurance authorization has been obtained.

		
	3.3
	Service Level 3 - Percentage of inpatients who presented as uninsured, were admitted, and were screened for a third party paying solution. This Service Level shall mean for a given Measurement Window (a) the number of Patients, who (1) were admitted as inpatients, (2) had their stay at an IMH Facility commence during such Measurement Window, (3) presented themselves as uninsured at or prior to the time of registering/checking-in, and (4) were screened for a third party paying solution, divided by (b) the number of inpatients who (1) had their stay at an IMH Facility commence during such Measurement Window, and (2) presented themselves as uninsured. If a change in IMH policy impedes or alters the ability of R1 to perform the applicable Services, the Parties shall meet to change this Service Level measurement and/or Target Level as applicable.

		
	3.4
	Service Level 4 - Associate Engagement. The Parties will mutually agree on a metric definition within [**] of the Commencement Date and will add that definition to this Section 3.4.

		
	3.5
	Service Level 5 - Patient Satisfaction survey. The Parties will mutually agree on a metric definition within [**] of the Commencement Date and will add that definition to this Section 3.5. IMH and R1 will develop an appropriate survey mechanism 

[**] Indicates that text has been omitted which is the subject of a confidential treatment request. The text has been separately filed with the Securities and Exchange Commission.
	
			
	SMRH:484510755.9
	Exhibit 3.6-4
	 

	 
	 
	 

working with IMH’s current provider, or such other provider as may be mutually acceptable. The survey will be designed to capture feedback and insight regarding patient experience with a focus on billing accuracy and customer service.
		
	3.6
	Service Level 6 – Credit AR Days. This Service Level shall mean for a given Measurement Window for IMH (a) the negative balance accounts receivable as of the last day of the Measurement Window, divided by (b) the average daily gross patient service revenue (GPSR) for such Measurement Window. Average daily GPSR is calculated by dividing the total GPSR for the applicable Measurement Window by the number of calendar days during such Measurement Window. The source data for measurement will be the Revenue Cycle Analytics Report.

		
	3.7
	Service Level 7 – Coding Quality. This Service Level shall mean, for any Measurement Window, the weighted average of each of [**].

 “Coding Audit” shall mean R1’s [**] sample based internal audit of the accuracy of the billing coding performed by R1 employees, which audit shall not (for the avoidance of doubt) including billing coding performed by any third party coding services provider (whether engaged by R1 or IMH). Cases coded by a Transitioned Employee shall be subject to the Coding Audits only after such Transitioned Employee has been employed by R1 for one full [**]. Each R1 coder shall be audited at least [**]. In conducting the Coding Audits, R1 shall use only personnel holding the following credentials: auditors of inpatient coding records must have at least [**] years of hospital inpatient coding experience and auditors of outpatient coding records must have at least [**] years of hospital outpatient coding experience. Additionally, each coding auditor must have any one or more of the following coding credentials: (i) RHIA, (ii) RHIT, (iii) CCS or (iv) CPC.
		
	3.8
	Service Level 8 – Remittance Posting. This Service Level shall mean, for any Measurement Window, each of (i) Remittance Posting Within One Business Day and (ii) Remittance Posting Within Two Business Days.

“Remittance Posting Within One Business Day” means, for any Measurement  Window, the result  (expressed  as  a percentage) of (a) the number of remittances (excluding zero dollar remittances) received by IMH during such Measurement Window that are reconciled and posted either to a Patient account or an Unapplied Cash Account within one (1) business day, divided by (b) the total number of remittances (excluding zero dollar remittances) received by IMH during such Measurement Window.
“Remittance Posting Within Two Business Days” means, for any Measurement Window, the result (expressed as a percentage) of (a) the number of remittances (excluding zero dollar remittances) received by IMH during such Measurement Window that are reconciled and posted either to a Patient account or an Unapplied Cash Account within two (2) business days, divided by (b) the total number of 

[**] Indicates that text has been omitted which is the subject of a confidential treatment request. The text has been separately filed with the Securities and Exchange Commission.
	
			
	SMRH:484510755.9
	Exhibit 3.6-5
	 

	 
	 
	 

remittances (excluding zero dollar remittances) received by IMH during such Measurement Window.
For purposes of calculating this Service Level, “Unapplied Cash Account” shall mean the general ledger accounts used to post unidentified payments.
		
	3.9
	Service Level 9 – Pre-Registration Mean Speed to Answer (Mean wait time, in seconds, to answer pre-registration calls at departments managed by R1 that are managing incoming calls). This Service Level shall mean for a given Measurement Window for IMH, (a) the Aggregate Hold Time, divided by (b) the number of calls to the pre-registration department managed by R1 with respect to IMH for which the caller requested to pre- register for service with a R1 representative during the Measurement Window. For purposes of calculating this Service Level, “Aggregate Hold Time” means the aggregated total amount of time during the Measurement Window that all callers to the pre-registration department managed by R1 with respect to IMH (excluding “hang-ups”) remained on hold or in the interactive voice response unit after such callers requested to speak with a R1 representative with respect to the pre-registration department managed by R1 with respect to IMH.

		
	3.10
	Service Level 10 – Customer Service Abandonment Rate. This Service Level shall mean for a given Measurement Window for IMH, (A) the number of calls to R1’s Customer Service Center with respect to IMH entering the queue that are abandoned, divided by (B) the total number of inbound calls.

4.    Target Levels.
The target level for each of the Service Level (“Target Level”) will be set as follows:
		
	4.1
	Service Level 1 – Less than or equal to [**].

		
	4.2
	Service Level 2 –

		
	a.
	IMH Facilities: Greater than or equal to [**].

		
	b.
	IMH Providers: Greater than or equal to [To Be Determined].

		
	4.3
	Service Level 3 – Greater than or equal to [**].

		
	a.
	IMH Facilities: Greater than or equal to [**].

		
	b.
	IMH Providers: N/A

		
	4.4
	Service Level 4 – The Parties will mutually agree on a service level within [**] of the Commencement Date.

[**] Indicates that text has been omitted which is the subject of a confidential treatment request. The text has been separately filed with the Securities and Exchange Commission.
	
			
	SMRH:484510755.9
	Exhibit 3.6-6
	 

	 
	 
	 

		
	4.5
	Service Level 5 –

		
	a.
	IMH Facilities: The Parties will mutually agree on a service level within [**] of the Commencement Date.

		
	b.
	IMH Providers: The Parties will mutually agree on a service level within [**] of the Commencement Date.

		
	4.6
	Service Level 6 –

		
	a.
	IMH Facilities: Less than or equal to [**].

		
	b.
	IMH Providers: Less than or equal to [**].

		
	4.7
	Service Level 7 –

		
	a.
	IMH Facilities: [**].

		
	b.
	IMH Providers: [**].

		
	4.8
	Service Level 8 – (i) for Remittance Posting Within One Business Day, greater than or equal to [**]; and (ii) for Remittance Posting Within Two Business Days, greater than or equal to [**]. For the avoidance of doubt, R1 must meet (i) and (ii) to achieve the Target Level for this Service Level.

		
	4.9
	Service Level 9 – Less than or equal to [**] seconds.

		
	4.10
	Service Level 10 – Less than or equal to [**].

5.    Changes to Existing Service Levels.
The number of Service Levels will not exceed [**] unless agreed otherwise by the Parties. An opportunity to reset or adjust the Target Levels for each of the Service Levels will occur every [**] years beginning on [**] during the Term. In the [**] months prior to the applicable opportunity to reset or adjust the Target Levels, R1 and IMH will meet to discuss whether to reset or adjust any Target Levels.
Any reset or adjustment to any Service Level or Target Level resulting from this Section 5 must be mutually agreed in writing in order to be effective, shall apply prospectively only, and shall not be applied to any period of time preceding the written agreement of the Parties with respect to such reset or adjustment.

[**] Indicates that text has been omitted which is the subject of a confidential treatment request. The text has been separately filed with the Securities and Exchange Commission.
	
			
	SMRH:484510755.9
	Exhibit 3.6-7
	 

	 
	 
	 

6.    Measurement and Reporting.
		
	6.1
	R1’s performance against the Service Levels and Target Levels will be measured for each Measurement Window as of the Service Level Effective Date (or, if later, the date R1 assumes responsibility for the applicable Services in accordance with the Transition Plan).

		
	6.2
	R1 will implement automated or other measurement and monitoring tools and procedures reasonably acceptable to IMH to measure R1’s performance against the Service Levels and Target Levels in a manner and at a level of detail approved by IMH. R1 will provide IMH with access to up-to-date problem management data and other data reasonably requested by IMH regarding the status of failures and/or user inquiries. Unless mutually agreed upon by R1 and IMH, the measurement of R1’s performance for a Measurement Window will be completed no later than [**] after the completion of such Measurement Window.

		
	6.3
	If R1 fails to measure its performance with respect to a Service Level and its Target Level so that it is not possible to confirm whether the level of performance specified for the Service Level has been achieved for a given Measurement Window, then, unless such failure to measure was previously excused in writing by IMH, such failure will be deemed a Service Level Default for the applicable Measurement Window.

		
	6.4
	R1 shall provide to IMH, as part of R1’s [**] performance reports, a set of hard- and soft-copy reports to verify R1’s performance and compliance with the Service Levels and Target Levels where data is available [**].

		
	6.5
	R1 shall provide detailed supporting information for each report to IMH in machine-readable form suitable for use on a personal computer running the Windows operating system version used by IMH for this purpose. The data and detailed supporting information shall be IMH Confidential Information, and IMH may access such information online, where technically feasible and permissible under R1’s applicable third party agreements, at any time.

7.    Service Level Credits.
		
	7.1
	If R1 fails to meet any Service Level and its Target Level, then R1 shall pay or credit IMH for the amounts described below (each, a “Service Level Credit”).  Except as otherwise provided in Section 23.3(b) of the Services Agreement, R1’s payment to IMH of Service Level Credits are the exclusive remedy for any Service Level Default, but not for any other default or breach of this Services Agreement or any of its Exhibits (including, without limitation, the other provisions of this Exhibit, e.g., Section 8). For example, to the extent IMH has a claim for breach of the Services Agreement by R1, this Exhibit does not preclude IMH from receiving remedies, nor shall it limit remedies, for such breach simply because the breach also resulted in a 

[**] Indicates that text has been omitted which is the subject of a confidential treatment request. The text has been separately filed with the Securities and Exchange Commission.
	
			
	SMRH:484510755.9
	Exhibit 3.6-8
	 

	 
	 
	 

Service Level Default and Service Level Credit. This exclusive remedy shall not prevent IMH from terminating this Services Agreement for Service Level Defaults as described in Section 23.3(b) of the Services Agreement. Service Level Credits will be deemed to be reductions in the charges reflecting the impact on the Services as a result of the Service Level Default, and not as a penalty. The Service Level Credits will be applied by R1 against any Charges or other amounts owed to R1 in the next practicable invoice following determination of the Service Level Credit. In the event that there are any unapplied Credits at the termination of the Services Agreement, then R1 will pay IMH an amount equal to the unapplied Credits.
		
	7.2
	If R1’s performance relative to any one of the Service Levels does not achieve the Target Level during a particular Measurement Window, such failure shall be deemed a Service Level Default, and R1 will perform the problem analysis described in Section 8. R1 will also propose a corrective action plan to improve R1’s performance in the upcoming Measurement Window, subject to IMH’s approval.

		
	7.3
	If R1’s performance for a Service Level does not achieve the Target Level in a Measurement Window, resulting in a Service Level Default for such Service Level, R1 shall apply a Service Level Credit on the next practicable invoice following determination of the Service Level Credit, equal to the product of (i) [**], divided by the number of Service Levels that have commenced their respective Service Level Effective Date and for which this Exhibit contains both a metric (in Section 3) and a Target Level (in Section 4), multiplied by (ii) [**] for such Measurement Window. Any Service Level credit resulting from a Service Level Default of Service Levels 2, 3, 5, 6 or 7 shall apply only to the IMH Facilities Base Fee or the IMH Providers Base Fee, as applicable, except to the extent that there are Service Level Defaults with respect to both the IMH Facilities and the IMH Providers for such Service Level.

		
	7.4
	If more than one Service Level has experienced a Service Level Default for a Measurement Window with respect to IMH, R1 will apply the sum of the Service Level Credit amounts for each of the Service Levels with respect to IMH that had Service Level Defaults during such Measurement Window. There shall be up [**] at risk with respect to such Measurement Window (and R1 shall in no event be liable for Service Level Credits in excess of such at risk amount).

		
	7.5
	In the event that IMH provides to R1 notice of its election to terminate less than all of the Services pursuant to Section 23.3(b) of the Agreement (such notice will be the first day of [**] day notice period), and R1 reasonably believes that either (a) it can remedy the issues giving rise to the applicable Service Level Default(s) within [**] notice period, or (b) as a result of the termination of such Services (i.e., the Services designated by IMH for termination), it would be impossible for R1 to provide any one or more other Services not subject to the termination right (“Contingent Services”), R1 may, within [**] days of receiving such notice, either (i) notify IMH of its intent to remedy such Service Level Defaults and provide to 

[**] Indicates that text has been omitted which is the subject of a confidential treatment request. The text has been separately filed with the Securities and Exchange Commission.
	
			
	SMRH:484510755.9
	Exhibit 3.6-9
	 

	 
	 
	 

IMH its proposal to remedy such issues and avoid termination of the designated Services in the case of Subsection 7.5(a), or (ii) notify IMH of the Contingent Services that must also be terminated if such Services are terminated and that R1 will cease to provide if IMH terminates the Services designated by IMH for termination in the case of Subsection 7.5(b). If at the end of the notice period IMH and R1 have not agreed in writing to an alternative arrangement to avoid termination of such Services, the designated Services shall be terminated, and in the case of Subsection 7.5(b), the Contingent Services shall also be terminated. IMH will be entitled to Disengagement Services with respect to any terminated Services in accordance with Section 23.8 of the Services Agreement.

8.    Problem Analysis and Correction.
R1 shall promptly investigate and correct each failure to meet a Service Level, by (i) promptly investigating and reporting on the causes of the problem; (ii) providing a root cause analysis of such failure as soon as practicable after such failure or at IMH’s request; (iii) correcting the problem as soon as practicable or coordinate the correction of the problem if R1 does not have responsibility for the cause of the problem; (iv) advising IMH of the status of remedial efforts being undertaken with respect to such problem; (v) demonstrating that the causes of such problem have been or will be corrected on a prospective basis; and (vi) taking corrective actions to prevent any recurrence of such problem. R1 shall complete the root cause analysis as quickly as possible, but in all events within [**]days, and shall notify IMH prior to the end of the initial [**] day period as to the status of the root cause analysis and the estimated completion and correction date. The Parties shall report on Service Level Defaults at each meeting of the JRB, including any disputes regarding problem analysis and correction steps, and without limiting any obligations of the Parties to implement any other decision of the JRB, each Party shall promptly implement or facilitate implementation of any resolutions determined by the JRB. This Section 8 does not negate or limit any other rights or remedies of IMH.

9.    Windfall Situations.
If any of the events described in Section 6 of Exhibit 11.1-A occur, and such event significantly affects the Service Level measurement, R1’s performance under any Service Level (including the amount of resources required to maintain such performance) or R1’s ability to measure its performance with respect to any of the Service Levels, then either Party shall have the right to request that the other Party consider a fair and appropriate adjustment to the affected Service Levels and/or Target Levels. Upon such a request, the Parties will, in good faith, discuss the impact of such event on (i) IMH and its operations and patients, (ii) R1’s performance under each such Service Level, (iii) the amount of resources required to maintain performance at or better than the applicable Target Levels and (iv) R1’s ability to measure such Service Levels, with the outcome to equitably reflect the impact of such considerations.

[**] Indicates that text has been omitted which is the subject of a confidential treatment request. The text has been separately filed with the Securities and Exchange Commission.
	
			
	SMRH:484510755.9
	Exhibit 3.6-10
	 

	 
	 
	 

In the event that IMH’s IT Environment experiences any outage or other support issue not attributable to R1 that materially affects R1’s ability to meet any Service Levels, as applicable (“IMH Support Issue”), IMH shall promptly work to resolve the IMH Support Issue. R1 will cooperate with IMH and provide data and assistance as reasonably needed by IMH in order resolve the IMH Support Issue. Until such time that the IMH Support Issue is resolved or a reasonable work around is implemented that eliminates the adverse effect of the IMH Support Issue on IMH and R1, the impacted Service Levels, as applicable, will be calculated as if failure to meet such Service Level, did not occur due to the IMH Support Issue.

[**] Indicates that text has been omitted which is the subject of a confidential treatment request. The text has been separately filed with the Securities and Exchange Commission.
	
			
	SMRH:484510755.9
	Exhibit 3.6-11
	 

	 
	 
	 

Execution Copy

AMENDED AND RESTATED SERVICES AGREEMENT

between

IHC Health Services, Inc.

and

R1 RCM Inc.

EXHIBITS 3.7-A, 3.7-B and 3.7-C

Exhibit 3.7-A  
IMH Facility List
IMH Facility List
		
	o
	IMH Facilities

		
	§
	Alta View Hospital

		
	§
	American Fork Hospital

		
	§
	Intermountain Medical Center

		
	§
	Orem Community Hospital

		
	§
	Riverton Hospital

		
	§
	TOSH - The Orthopedic Specialty Hospital

		
	§
	Utah Valley Hospital

		
	§
	Bear River Valley Hospital

		
	§
	Cassia Regional Hospital

		
	§
	Logan Regional Hospital

		
	§
	McKay-Dee Hospital

		
	§
	Delta Community Hospital

		
	§
	Dixie Regional Medical Center

		
	§
	Fillmore Community Hospital

		
	§
	Sanpete Valley Hospital

		
	§
	Sevier Valley Hospital

		
	§
	Cedar City Hospital

		
	§
	Heber Valley Hospital

		
	§
	Park City Hospital

		
	§
	LDS Hospital

		
	§
	Primary Children’s Hospital

Exhibit 3.7-A-1

		
	§
	McKay-Dee Surgical Center

Note:  McKay-Dee Surgical Center is co-owned by IMH with others and will be considered an IMH Facility for purposes of this Agreement.
		
	§
	Intermountain Rehab Agency

		
	§
	Avenues Surgical Center

		
	§
	Layton Hospital (New opening 2018)

Exhibit 3.7-A-2

Exhibit 3.7-B  
IMH Provider List
		
	o
	IMH Providers

		
	§
	Intermountain Medical Group

		
	§
	Intermountain Home Health

		
	§
	Intermountain Hospice

		
	§
	Intermountain Home Medical Equipment

		
	§
	Intermountain IV Therapy

Exhibit 3.7-B-1

Exhibit 3.7-C  
Facilities Managed, but not Owned, by IMH
Garfield Memorial Hospital.  Garfield Memorial Hospital (“Garfield”) may be added by IMH to Exhibit 3.7-A after the date hereof as one of the IMH Facilities although it is not owned by IMH.  If added, Garfield will be treated as an IMH Facility under this Agreement and any provisions in this Agreement applicable to an IMH Facility will apply mutatis mutandis to Garfield even though it is not owned by IMH, and the Parties will adjust the provisions of this Agreement and the related Services as necessary to account for this situation.  If Garfield is subsequently added to Exhibit 3.7-A, then IMH must obtain the legal right and authority to add Garfield to Exhibit 3.7-A and will be responsible for obtaining from Garfield all contractual obligations of Garfield that may reasonably be needed for purposes of this Agreement (including, without limitation, confidentiality obligations consistent with this Agreement).  

Exhibit 3.7-C-1

AMENDED AND RESTATED SERVICES AGREEMENT

between

IHC Health Services, Inc.

and

R1 RCM Inc.

EXHIBIT 3.8-1

FORM OF WORK ORDER

Exhibit 3.8-1 
Form of Work Order
WORK ORDER NO. __ TO AMENDED AND RESTATED SERVICES AGREEMENT
This Work Order No. __ to the Amended and Restated Services Agreement (this “Work Order”) is entered into effective as of __________ (the “Work Order Effective Date”) by and between IHC Health Services, Inc. (“Client”) and R1 RCM Inc. (“R1”, and together with Client, the “Parties”).
WHEREAS, Client and R1 are parties to that certain Amended and Restated Services Agreement entered into effective January 23, 2018 (the “Agreement”); and
WHEREAS, in accordance with Section 3.8 of the Agreement, the Parties desire to enter into this Work Order to add the services set forth herein as “New Services” to the scope of the Agreement.
NOW THEREFORE, in consideration of the mutual promises and covenants contained herein, and for other good and valid consideration, the receipt and sufficiency of which is hereby acknowledged, the Local Parties hereby agree as follows:
		
	1.
	Definitions.  Capitalized terms used in this Work Order but not defined herein shall have the meanings given in the Agreement.

		
	2.
	Term of Work Order.

The Term of this Work Order shall commence on the Work Order Effective Date and continue until the Agreement expires or is otherwise terminated.  [Or if a different term, then change this to reflect the different term.]  These New Services will be included in the Disengagement Services.
		
	3.
	New Services.

R1 will perform the following New Services as part of the Services under the Agreement.
		
	4.
	Certain Client Responsibilities.

[TO COME]. 
		
	5.
	Pricing.

In accordance with Section 3.8 of the Agreement, Client shall pay R1 the following fees, if applicable:
		
	6.
	Recitals and Counterparts.

The recitals set forth above are incorporated herein by reference and made a part of this Work Order.  This Work Order may be executed in several counterparts, all of which taken together will constitute one single agreement between the Parties.

[Remainder of Page Intentionally Blank]

Exhibit 3.8-1-1

IN WITNESS WHEREOF, the Parties have caused this Work Order to be executed by their authorized representatives. 
	
		
	 

IHC HEALTH SERVICES, INC.

By:                
 
Name:                
 
Title:               

Date:               

	 

R1 RCM INC.

By:                   
 
Name:                   
 
Title:                  

Date:                  

Exhibit 3.8-1-2

Execution Copy

AMENDED AND RESTATED SERVICES AGREEMENT

between

IHC Health Services, Inc.

and

R1 RCM Inc.

EXHIBIT 4.1

TRANSITION OF SERVICES

Exhibit 4.1 
Transition of Services
The initial Transition Work Plan will include and comply with the following:
		
	1.
	Generally: R1 will perform transition and implementation services as agreed in the Transition Work Plan (collectively, “Transition Services”). Transition Services will be Services under this Services Agreement. The Parties will work collaboratively to assure the successful completion of the Transition Services and implementation of the Services for IMH at [**].

		
	2.
	Governance: The transition team will periodically meet at regular intervals with the operations team to coordinate the Transition Services. The Parties will cooperate and collaborate as needed to monitor, test and participate in the Transition Services.

		
	3.
	Transition Team: A transition team inclusive of personnel from both Parties will be identified in the Transition Work Plan with clear accountability and decision rights relating to the transition and implementation.

		
	4.
	Transition Work Plan: The Transition Work Plan will include all the key services, activities, resources and implementation milestones needed for the transition of IMH’s revenue cycle operations (including the transition of IMH employees, asset transition, reporting and communication) to R1 and implementation of the Services for IMH. The Transition Work Plan will be amended and supplemented as needed. The Transition Work Plan will, at a minimum, include the following key components:

		
	a.
	Time Frame for Transition: The Transition Work Plan will specify the date for the commencement of Services for IMH and will address activities to be undertaken by each Party during the first three months of the Services for IMH.

		
	b.
	Leadership and Communication: The Transition Work Plan will include a schedule of leadership and communication initiatives with IMH approval.

		
	c.
	Training and Development: The Transition Work Plan will include a schedule of management and staff training and development.

		
	d.
	Process and Technology Initiatives: The Transition Work Plan will include identification, prioritization and implementation of key process and technology initiatives, including key dates, scope, and deliverables.

		
	e.
	Resources: The Transition Work Plan will include identification of resources required and available to execute the Transition Plan and implementation and commencement of Services.

		
	f.
	Financial Data: The Transition Work Plan will include a schedule for delivery of applicable financial data required to support the applicable measurement processes.

		
	g.
	Financial Assistance Policies: The Transition Work Plan will include identification of applicable policies affecting financial assistance and billing practices relating to the uninsured.

		
	h.
	System Access: The Transition Work Plan will include protocols and processes for required system access and for provisioning requests including application/solution and network access.

[**] Indicates that text has been omitted which is the subject of a confidential treatment request. The text has been separately filed with the Securities and Exchange Commission.
Exhibit 4.1-1

		
	i.
	Supplier Obligations: The Transition Work Plan will include supplier obligations that are related to regulatory and compliance training.

		
	j.
	Data Requests: The Transition Work Plan will include identification of both quantitative and qualitative data requests necessary to support operations.

		
	6.
	Preparation of the Transition Work Plan: Preparation of the Transition Work Plan beyond this Exhibit will begin on or before the Effective Date of this Agreement and will continue until completed to the reasonable satisfaction of the Parties, and consistent with this Exhibit. The Parties will work collaboratively to complete development of the Transition Work Plan within [**] of the Effective Date of this Agreement.

		
	7.
	The initial schedule draft is attached and is incorporated herein by this reference.

[**] Indicates that text has been omitted which is the subject of a confidential treatment request. The text has been separately filed with the Securities and Exchange Commission.
Exhibit 4.1-2

[**]

[**] Indicates that text has been omitted which is the subject of a confidential treatment request. The text has been separately filed with the Securities and Exchange Commission.
Exhibit 4.1-3

AMENDED AND RESTATED SERVICES AGREEMENT

between

IHC Health Services, Inc.

and

R1 RCM Inc.

EXHIBIT 6.1

R1 TECHNOLOGY

Exhibit 6.1 
R1 Technology
R1 Technology consists of the following software solutions:
1.1    R1 Access
1.2    R1 Decision
1.3    R1 Link
1.4    Yield Based Follow-up (YBFU)
1.5    ePARS
1.6    Patient Satisfaction Tool (PSAT)
1.7    R1 Contract
1.8    R1 Detect
1.9    Conversions Work List (CWL)
1.10    R1 Insight
1.11    R1 Analytics (formerly known as “PMMT”)

Exhibit 6.1-1

AMENDED AND RESTATED SERVICES AGREEMENT

between

IHC Health Services, Inc.

and

R1 RCM Inc.

EXHIBIT 7.1

IMH ASSETS TO BE MADE AVAILABLE TO R1 

Exhibit 7.1 
IMH Assets to be made available to R1 
As part of the transition to the Services, the Parties will work together to complete this Exhibit prior to the initial Employment Effective Date using a form of Asset Itemization similar to the chart attached hereto as Exhibit 7.1-A. 

Exhibit 7.1-1

Exhibit 7.1-A 
Form of Asset Itemization
Facility Name:
	
											
	Services
	Desktop/Laptop computers
	Scanners, printers, other similar devices
	Other office equipment
	General network connections
	Servers and other dedicated information technology HW or SW
	Phones and telecommunication (e.g. fax) devices
	Transcription or dictation equipment
	Others as relevant
	Location and description of Office space
	Notes/Comments

	Front End
	 
	 
	 
	 
	 
	 
	 
	 
	 
	 

	Scheduling (including inpatient, outpatient, and diagnostics, but excluding surgical)
	 
	 
	 
	 
	 
	 
	 
	 
	 
	 

	On-Site Process of Pre-Registration
	 
	 
	 
	 
	 
	 
	 
	 
	 
	 

	Off-Site Process of Pre-Registration
	 
	 
	 
	 
	 
	 
	 
	 
	 
	 

	Registration
	 
	 
	 
	 
	 
	 
	 
	 
	 
	 

	Insurance Eligibility Verification
	 
	 
	 
	 
	 
	 
	 
	 
	 
	 

	Authorization
	 
	 
	 
	 
	 
	 
	 
	 
	 
	 

	Collection of Residuals
	 
	 
	 
	 
	 
	 
	 
	 
	 
	 

	Self-Pay Financial Advocacy and Eligibility of Services (e.g., self-pay conversions)
	 
	 
	 
	 
	 
	 
	 
	 
	 
	 

	Prior Balance Found Insurance
	 
	 
	 
	 
	 
	 
	 
	 
	 
	 

	Admitting
	 
	 
	 
	 
	 
	 
	 
	 
	 
	 

	Across all Front-End Services
	 
	 
	 
	 
	 
	 
	 
	 
	 
	 

	Middle 
	 
	 
	 
	 
	 
	 
	 
	 
	 
	 

	Chart Analysis and Assembly
	 
	 
	 
	 
	 
	 
	 
	 
	 
	 

	Coding / Coding Audits
	 
	 
	 
	 
	 
	 
	 
	 
	 
	 

	Record Retention / Record Management
	 
	 
	 
	 
	 
	 
	 
	 
	 
	 

	Transcription
	 
	 
	 
	 
	 
	 
	 
	 
	 
	 

	Lost Charges/Charge Capture Pre-Bill
	 
	 
	 
	 
	 
	 
	 
	 
	 
	 

Exhibit 7.1-A-1

	
											
	Services
	Desktop/Laptop computers
	Scanners, printers, other similar devices
	Other office equipment
	General network connections
	Servers and other dedicated information technology HW or SW
	Phones and telecommunication (e.g. fax) devices
	Transcription or dictation equipment
	Others as relevant
	Location and description of Office space
	Notes/Comments

	Lost Charges/Charge Capture Post-Bill
	 
	 
	 
	 
	 
	 
	 
	 
	 
	 

	Charge Description Master (CDM) Maintenance / Revenue Integrity
	 
	 
	 
	 
	 
	 
	 
	 
	 
	 

	Strategic Pricing
	 
	 
	 
	 
	 
	 
	 
	 
	 
	 

	Release of Information
	 
	 
	 
	 
	 
	 
	 
	 
	 
	 

	Across all Middle Services
	 
	 
	 
	 
	 
	 
	 
	 
	 
	 

	Back End 
	 
	 
	 
	 
	 
	 
	 
	 
	 
	 

	Billing (Patient and Payor)
	 
	 
	 
	 
	 
	 
	 
	 
	 
	 

	Cash Posting and Processing
	 
	 
	 
	 
	 
	 
	 
	 
	 
	 

	Denial Management (Operational and Clinical)
	 
	 
	 
	 
	 
	 
	 
	 
	 
	 

	Underpayment Review / Recovery
	 
	 
	 
	 
	 
	 
	 
	 
	 
	 

	Patient Billing Customer Service / Patient Financial Services
	 
	 
	 
	 
	 
	 
	 
	 
	 
	 

	Secondary Billing
	 
	 
	 
	 
	 
	 
	 
	 
	 
	 

	Third Party Collections and Self-Pay Follow-up (internal and external collection activities)
	 
	 
	 
	 
	 
	 
	 
	 
	 
	 

	Credits
	 
	 
	 
	 
	 
	 
	 
	 
	 
	 

	Finance and Managed Care Analytical Support
	 
	 
	 
	 
	 
	 
	 
	 
	 
	 

	Bad Debt Management
	 
	 
	 
	 
	 
	 
	 
	 
	 
	 

	Across all Back-end Services
	 
	 
	 
	 
	 
	 
	 
	 
	 
	 

	Other Dependent Services
	 
	 
	 
	 
	 
	 
	 
	 
	 
	 

	Payor Audit and RAC support
	 
	 
	 
	 
	 
	 
	 
	 
	 
	 

	Revenue Cycle Analytics and Reporting
	 
	 
	 
	 
	 
	 
	 
	 
	 
	 

	Revenue Cycle Technology and Support
	 
	 
	 
	 
	 
	 
	 
	 
	 
	 

Exhibit 7.1-A-2

	
											
	Services
	Desktop/Laptop computers
	Scanners, printers, other similar devices
	Other office equipment
	General network connections
	Servers and other dedicated information technology HW or SW
	Phones and telecommunication (e.g. fax) devices
	Transcription or dictation equipment
	Others as relevant
	Location and description of Office space
	Notes/Comments

	Revenue Cycle Training
	 
	 
	 
	 
	 
	 
	 
	 
	 
	 

	Vendor Management
	 
	 
	 
	 
	 
	 
	 
	 
	 
	 

	General/Unspecified
	 
	 
	 
	 
	 
	 
	 
	 
	 
	 

Exhibit 7.1-A-3

AMENDED AND RESTATED SERVICES AGREEMENT

between

IHC Health Services, Inc.

and

R1 RCM Inc.

EXHIBIT 8.1-A

JOINT REVIEW BOARD CHARTER

Exhibit 8.1-A
Joint Review Board Charter
INTRODUCTION AND MISSION STATEMENT
The Joint Review Board (the “JRB”) is responsible for the governance of the relationship between the Parties created pursuant to the Amended and Restated Master Services Agreement entered into by and between R1 and IMH (the “Services Agreement”). 
PURPOSE
This Charter is created in order to define the JRB’s objectives, the range of its authority, the scope of its activities and its duties and responsibilities. It is intended to give JRB members a clear understanding of their roles. The Parties will review and assess the adequacy of this Charter to the extent the Parties determines it necessary to do so.
GENERAL GUIDELINES
Defined Terms
Any capitalized terms used but not defined herein shall have the meanings attributed to such terms under the Services Agreement. 
Size, Composition and Term of Appointment
The JRB shall consist of four (4) members and be staffed with two (2) representatives selected by IMH and two (2) representatives selected by R1.  Each of R1 and IMH shall have the right to remove and replace any member appointed by such Party or otherwise fill any vacancy caused by the resignation of any member that such Party appointed upon written notice to the other Party.
Meetings
Meetings of the JRB shall take place on an ad hoc basis as frequently as determined appropriate by the JRB, and may be held at any place within or outside the State of Utah that has been designated in the notice of the meeting or, if not stated in the notice or there is no notice, at the principal executive office of IMH. Any meeting may be held by conference telephone or similar communication equipment so long as all members participating in the meeting can hear one another, and all such members shall be deemed to be present in person at the meeting.  In alternate calendar years beginning in 2018, R1 and IMH shall designate one of its representatives on the JRB to serve as chairperson, with R1 appointing the chairperson in during the first calendar year.
The chairperson of the JRB shall be responsible for calling meetings, provided that the chairperson shall call a meeting of the JRB promptly upon the reasonable request of either Party.  The requesting Party shall disclose to the other Party the proposed agenda for a meeting along with appropriate information at least [**] days in advance of such meeting of the JRB; provided that under exigent circumstances, a Party may provide its agenda items to the other Party within a shorter period of time in advance of the meeting, or may propose that there not be a specific agenda for a 

[**] Indicates that text has been omitted which is the subject of a confidential treatment request. The text has been separately filed with the Securities and Exchange Commission.
Exhibit 8.1-A-1

particular meeting, so long as such other Party consents to such later addition of such agenda items or the absence of a specific agenda for such meeting, such consent not to be unreasonably withheld or delayed.  The chairperson shall appoint a secretary of the meeting who shall prepare and circulate for review and approval the minutes of such meeting within [**] days after such meeting.  The Parties shall agree on the minutes of each meeting promptly, but in no event later than the next meeting of the JRB.
Quorum and Voting
A majority of the JRB’s members will constitute a quorum. At any meeting of the JRB, the decision of [**] members present and voting will be determinative as to any matter submitted to a vote, provided, however, that [**].  The JRB may act by unanimous written consent in lieu of a vote at a meeting.  
Authority
The JRB derives its authority from the Services Agreement is hereby given all resources and authority necessary to properly fulfill its duties and responsibilities.
Duties and Responsibilities
The JRB shall:
		
	•
	be responsible for general oversight and management of the relationship between the Parties under the Services Agreement, including oversight of the Operations Oversight Council;

		
	•
	have authority to make final and binding decisions on behalf of the Parties;

		
	•
	make decisions relating to cost allocation, the Cost to Collect Factor and the Base Fee calculation, as such decisions may be required under the Services Agreement;

		
	•
	resolve payment disputes arising between the Parties pursuant to Section 11.6 of the Services Agreement;

		
	•
	serve as a critical step in the dispute resolution process set forth in Section 20.4 of the Services Agreement with respect to the matters under its responsibilities;

		
	•
	attempt to resolve any matters under the responsibility of the Operations Oversight Council that the Operations Oversight Council is unable to resolve;

		
	•
	approve any material modifications to the Services Agreement that revise commercial terms prior to signature;

		
	•
	evaluate Service Level Defaults and propose resolutions to the Parties; and perform such other functions as set forth in the Services Agreement or as the Parties may mutually agree in writing, except where in conflict with any provision of the Services Agreement

[**] Indicates that text has been omitted which is the subject of a confidential treatment request. The text has been separately filed with the Securities and Exchange Commission.
Exhibit 8.1-A-2

Oversight by the Joint Review Board
		
	•
	The JRB will report to, the Parties and the Parties shall be kept informed of its activities on a current basis. 

		
	•
	The JRB will record and keep minutes of all JRB meetings which will be available to each Party.

Limitations on Authority.  
Each Party shall retain the rights, powers and discretion granted to it under this Agreement and no such rights, powers, or discretion shall be delegated to or vested in the JRB unless such delegation or vesting of rights is expressly provided for in the Services Agreement or the Parties expressly so agree in writing.  The JRB shall not have the power to amend, modify or waive compliance with the Services Agreement.
Initial Members of the Joint Review Board
		
	•
	Bert Zimmerli

		
	•
	Mark Runyon

		
	•
	Joseph Flanagan

		
	•
	Gary Long

Exhibit 8.1-A-3

AMENDED AND RESTATED SERVICES AGREEMENT

between

IHC Health Services, Inc.

and

R1 RCM Inc.

EXHIBIT 8.2

EXECUTIVE SPONSORS

Exhibit 8.2 
Executive Sponsors
R1 Executive Sponsors: 
		
	•
	H. Jeffrey Brownawell

IMH Executive Sponsor: 
		
	•
	Todd E. Craghead

Exhibit 8.2-1

AMENDED AND RESTATED SERVICES AGREEMENT

between

IHC Health Services, Inc.

and

R1 RCM Inc.

EXHIBIT 8.3

OPERATIONS OVERSIGHT COUNCIL CHARTER

Exhibit 8.3
Operations Oversight Council Charter
INTRODUCTION AND MISSION STATEMENT
The Operations Oversight Council (the “Council”) is responsible for certain key operational and finance matters under the Amended and Restated Master Services Agreement entered into by and between R1 and IMH (the “Services Agreement”). 
PURPOSE
This Operations Oversight Council Charter is created in order to define the Council’s objectives, the range of its authority, the scope of its activities and its duties and responsibilities. It is intended to give Council members a clear understanding of their roles.  The Parties will review and assess the adequacy of this Charter to the extent the Parties determines it necessary to do so.
GENERAL GUIDELINES
Defined Terms
Any capitalized terms used but not defined herein shall have the meanings attributed to such terms under the Services Agreement.
Size, Composition and Term of Appointment
The Council shall consist of no less than 8 and no more than 12 members to be determined by R1 and IMH.  Each of R1 and IMH shall have the right to appoint an equal number of members to the Council.   Each of R1 and IMH shall have the right to remove and replace any member appointed by such Party or otherwise fill any vacancy caused by the resignation of any member that such Party appointed upon written notice to the other Party.
Meetings
Regular meetings of the Council shall take place quarterly, or at such other interval as deemed appropriate by the Council but no less frequently than quarterly, and may be held at any place within or outside the State of Utah that has been designated from time to time by resolution of the Board or by the Council. In the absence of such a designation, regular meetings shall be held at the principal executive office of IMH. Special meetings of the Council shall be held at any place within or outside the State of Utah that has been designated in the notice of the meeting or, if not stated in the notice or there is no notice, at the principal executive office of IMH. Any meeting, regular or special, may be held by conference telephone or similar communication equipment. So long as all members participating in the meeting can hear one another, and all such members shall be deemed to be present in person at the meeting.
Quorum and Voting

[**] designates portions of this document that have been omitted pursuant to a request for confidential treatment filed separately with the Securities and Exchange Commission.
Exhibit 8.3-1

A majority of the Council’s members will constitute a quorum. At any meeting of the Council, the decision of [**] members present and voting will be determinative as to any matter submitted to a vote, provided, however, that [**].  The Council may act by unanimous written consent in lieu of a vote at a meeting.  If the Council is unable to make any determinations for which it is allocated responsibility under this charter, such determinations shall be submitted to the Joint Review Board to attempt to resolve the matter.
Oversight by the Joint Review Board 
The Council will report to, and take direction from, the JRB, and the JRB shall be kept informed of its activities on a current basis. 
The Council will record and keep minutes of all Council meetings which will be available to all members of the JRB.
Authority
The Council derives its authority from the Services Agreement and is hereby given all resources and authority necessary to properly fulfill its duties and responsibilities. 
Duties and Responsibilities
The Council shall be responsible for the following activities set forth in the Services Agreement:
		
	•
	all decisions specially identified in the Services Agreement as requiring the consent, approval or vote of the Council; 

		
	•
	coordinate the Parties’ activities under the Services Agreement;

		
	•
	provide input on any concerns with R1’s decision to insource the services under an In-Scope Agreement or to subcontract such services to a new vendor;

		
	•
	make recommendations regarding additional offshore outsourcing of the Services which require prior approval of the JRB under the terms of the Services Agreement;

		
	•
	provide input on R1’s selection of New Technology Partners and have authority to waive privacy, data security and compliance requirements for any proposed New Technology Partners that do not meet all such requirements; 

		
	•
	review proposals for new reporting requested under Section 19.2 of the Services Agreement;

		
	•
	make recommendations to the Joint Review Board on operational matters;

		
	•
	serve as a critical step in the dispute resolution process set forth in Section 20.3 of the Services Agreement with respect to those matters under its responsibility;

[**] designates portions of this document that have been omitted pursuant to a request for confidential treatment filed separately with the Securities and Exchange Commission.
Exhibit 8.3-2

		
	•
	create such other operational committees with such responsibilities as the Parties may mutually agree to from time to time;

		
	•
	define operational strategies and oversee the Parties’ execution of such strategies; and

		
	•
	perform such other functions as are set forth in the Services Agreement or as the Parties may mutually agree in writing, except where in conflict with any provision of the Services Agreement.

ADDITIONAL PROCEDURES
		
	•
	The Council shall report to the JRB following regular meetings.

Limitations on Authority  
Each Party shall retain the rights, powers and discretion granted to it under this Agreement and no such rights, powers, or discretion shall be delegated to or vested in the Council unless such delegation or vesting of rights is expressly provided for in the Services Agreement or the Parties expressly so agree in writing.  The Council shall not have the power to amend, modify or waive compliance with the Services Agreement.

[**] designates portions of this document that have been omitted pursuant to a request for confidential treatment filed separately with the Securities and Exchange Commission.
Exhibit 8.3-3

AMENDED AND RESTATED SERVICES AGREEMENT

between

IHC Health Services, Inc.

and

R1 RCM Inc.

EXHIBIT 8.5

AUTHORIZED PERSONNEL

Exhibit 8.5 
Authorized Personnel
IMH Authorized Personnel:
		
	•
	Richard Bagley

		
	•
	Nancy Baxter

		
	•
	Todd Craghead

		
	•
	Rob Carlisle

		
	•
	Jeff Howes

		
	•
	Cindy Hutchinson

		
	•
	Kimberly Telford

		
	•
	Mike Weed

R1 Authorized Personnel:
		
	•
	Jana Anderson 

		
	•
	Jeff Brownawell

		
	•
	Jose Diaz

		
	•
	Jared Jorgensen

		
	•
	Sherilynn Quist 

		
	•
	Robert Troksa

		
	•
	Wes Arnett

Exhibit 8.5-1

AMENDED AND RESTATED SERVICES AGREEMENT

between

IHC Health Services, Inc.

and

R1 RCM Inc.

EXHIBIT 9.1

NON-DISCLOSURE AGREEMENTS

	
			
	 
	 
	 

	 
	 
	 

Exhibit 9.1 
Non-Disclosure Agreements
1.    Prior Non-Disclosure Agreements.
		
	•
	Non-Disclosure Agreement dated March 22, 2011 between Accretive Health, Inc. and IHC Health Services, Inc.

		
	•
	Mutual Non-Disclosure Agreement dated September 6, 2013 between Accretive Health, Inc. and IHC Health Services, Inc.

		
	•
	Mutual Nondisclosure Agreement, effective as of September 1, 2017, between IHC Health Services, Inc. and R1 RCM Inc.

Exhibit 9.1-1

AMENDED AND RESTATED SERVICES AGREEMENT

between

IHC Health Services, Inc.

and

R1 RCM Inc.

EXHIBIT 10.1

TRANSITIONED EMPLOYEE TERMS

Exhibit 10.1 
Transitioned Employee Terms 
1.    INTRODUCTION
		
	1.1
	Definitions.  Capitalized terms used but not defined in this Exhibit shall have the respective meanings set forth in the Services Agreement or the other Exhibits to the Services Agreement.

		
	(a)
	“IMH Employee” means any person who is employed by IMH.  

		
	(b)
	“Benefit Plan” means Welfare Plans, incentive, compensation and other employee programs and policies.

		
	(c)
	“Commencement Date” means April 8, 2018; [**].

		
	(d)
	“Employment Effective Date” means the Commencement Date, except that the Employment Effective Date for On-Leave Transitioned Employees shall be the date on which an On-Leave Transitioned Employee actually ceases employment with IMH, as applicable, and begins employment with R1 pursuant to the offer extended by R1 under Section 2.1 below.  

		
	(e)
	“Military Leave” means a leave of absence for purposes of active service in any branch of the United States Armed Services.

		
	(f)
	“On-Leave Transition Employee” has the meaning given in Section 2.2(e).

		
	(g)
	“On-Leave Offer Period” has the meaning given in Section 2.2(e).

		
	(h)
	“Transition Employee” means an IMH Employee who is designated by mutual agreement of the Parties to receive an offer of employment by R1 and who is not subject to any collective bargaining agreement immediately prior to the Employment Effective Date with respect to IMH.  Such designation will be accomplished by describing such IMH Employee as a Transition Employee in the Schedule of Transition Employees, substantially in the form of Schedule A attached hereto, to be completed by the Parties prior to the Employment Effective Date.

		
	(i)
	“Transitioned Employee” means an IMH Employee who accepts R1’s [**] offer of employment, successfully clears R1’s pre-hire checks and screening as described in this Exhibit, and who commences employment with R1.

		
	(j)
	“Welfare Plans” has the meaning given in Section 2.4(b).

2.    APPLICABLE EMPLOYEES
2.1    Obligation to Extend Offers to Transition Employees.  

[**] Indicates that text has been omitted which is the subject of a confidential treatment request. The text has been separately filed with the Securities and Exchange Commission.
Exhibit 10.1-1

R1 shall extend a [**] offer of employment to each Transition Employee, as identified in the Schedule of Transition Employees, as it may be amended.  Each such offer shall be delivered electronically by R1 to the applicable Transition Employee.  [**].
2.2    Employment Offer.
		
	(a)
	Provision of Employee Data; Notice of Offer.  To facilitate R1’s ability to extend offers and the IMH Employees’ likelihood of acceptance, IMH shall allow R1 reasonable access to the IMH Employees in order to allow for an orderly transition of their employment to R1.  R1 shall notify IMH at a reasonable time prior to making any offer of employment to any IMH Employee.  Such notice shall describe in reasonable detail the terms of each such offer.  For the purpose of facilitating R1’s ability to extend offers, IMH agrees to use commercially reasonable efforts to disclose to R1, within [**] of the Effective Date, [**] with respect to the applicable IMH Employees. IMH further agrees to provide R1, prior to each Employment Effective Date, an update with respect to all such data and information with respect to any changes thereto during the period of time from [**] until such Employment Effective Date.

		
	(b)
	Terms of Offer.  With regard to Transitioned Employees and all other R1 personnel providing Services, R1 agrees that: each [**] offer of employment for a Transition Employee shall: (x) be for full-time or part-time, [**] employment with R1 in a position comparable to the position that he or she held with IMH; and (y) include initial base wages or salary not less than the Transition Employee’s base wages or salary provided by IMH immediately prior to the Employment Effective Date, which shall not [**]. 

		
	(c)
	Offers Shall Comply with Laws.  R1 shall comply with all applicable laws and regulations, including laws and regulations related to employment requirements and employment transitions, in offering employment to the IMH Employees and in employing such individuals.  IMH shall comply with all applicable laws and regulations in connection with the termination of employment of Transitioned Employees.

		
	(d)
	Responses to Offers and Employment Effective Date.  R1 shall notify IMH within [**] days after offers of employment are made whether each IMH Employee has accepted such conditional offer.  Unless otherwise specified in the Schedule of Transition Employees or Section 2.2(e), Transitioned Employees shall commence employment with R1 on the Employment Effective Date.  R1 shall use all commercially reasonable efforts to employ the Transitioned Employees as of the date their employment with IMH ceases.

		
	(e)
	On-Leave Transition Employee.  With respect to each Transition Employee who [**] on an approved leave of absence in accordance with IMH’s on-leave policies (an “On-Leave Transition Employee”):

[**] Indicates that text has been omitted which is the subject of a confidential treatment request. The text has been separately filed with the Securities and Exchange Commission.
Exhibit 10.1-2

		
	(i)
	IMH shall provide R1 with the date when his or her applicable leave commenced and is expected to end (if known); and

		
	(ii)
	Upon each On-Leave Transition Employee’s return, subject to each such employee (A) being released to work prior to September 30, 2018, (B) being fully cleared to perform the responsibilities required for their position, and (C) clearing R1’s pre-hire screening as more fully set forth in this Exhibit, R1 shall make [**] employment offers meeting the requirements in this Section 2.2, except that, in the case of a Military Leave, the period for accepting such shall be as required by applicable law following the completion of active duty (“On-Leave Offer Period”).

If an On-Leave Transition Employee accepts such a [**] offer, R1 shall promptly notify IMH of such acceptance.  For purposes of clarity, (I) no On-Leave Transition Employee shall be deemed an employee of R1 (or eligible to receive the benefits described herein) for any period of time prior to such On-Leave Transition Employee’s Employment Effective Date, and (II) R1 shall be under no obligation to hold open an employment offer to an On‐Leave Transition Employee beyond the On-Leave Offer Period. 
[**] 
		
	2.3
	[**] Transitioned Employees.  [**].  Consistent with Section 2.2(a) above, IMH agrees to provide, where possible, evidence of compliance with background checks, drug screening, OIG checks and sex offender register checks. IMH acknowledges and agrees that, as a condition of continued employment, R1 may require the Transitioned Employees to undergo and clear R1’s standard background check, drug screening, OIG checks, and sex offender check after accepting R1’s job offer.  

		
	2.4
	Employee Benefit Plans.

		
	(a)
	Years of Service Credit.  Unless otherwise agreed by the Parties, Transitioned Employees shall receive credit for years of service with IMH under each R1 employee benefit plan, where applicable, for purposes of promotion consideration, vesting (other than for stock or option grants), participation, eligibility for benefits, benefit accrual, and/or optional forms of payment, [**] but subject to the provisions outlined in Section 2.6.  In the event the employment of a Transitioned Employee is terminated after [**], and said Transitioned Employee is eligible for severance under R1’s benefits plan as described in Section 2.6, credit for service shall be calculated from the Employment Effective Date for such Transitioned Employee. 

		
	(b)
	Employee Welfare Benefit Plans.  Each benefit-eligible Transitioned Employee, as determined by R1, shall be eligible to participate in R1’s employee welfare benefit plans (“Welfare Plans”). [**].  R1 will provide access [**], R1 will honor all out-of-pocket expenses already paid by the Transitioned Employees towards their annual deductible.  IMH shall be responsible for the provision of benefits with respect to 

[**] Indicates that text has been omitted which is the subject of a confidential treatment request. The text has been separately filed with the Securities and Exchange Commission.
Exhibit 10.1-3

each Transitioned Employee during the month in which the Employment Effective Date occurs and the Parties agree to coordinate the transition of benefits so that benefit-eligible Transitioned Employees do not experience a lapse in benefits coverage immediately following the Employment Effective Date. 
		
	(c)
	Paid-Time-Off (PTO) (Vacation/Sick Leave).  R1 shall make available to each Transitioned Employee paid-time-off benefits for vacation and sick leave consistent with R1’s applicable plans and policies, in each case beginning on his or her Employment Effective Date, with years of service of such Transitioned Employee determined in accordance with Section 2.4(a).  Unless otherwise set forth in this Section 2.4(a), R1’s policy shall govern the Transitioned Employee’s use of paid leave, as well as the other criteria governing paid leave.  

		
	(d)
	Incentive Bonus.  With respect to any Transitioned Employee that is entitled to an incentive bonus from IMH that is payable in a subsequent tax year following the Employment Effective Date, [**].

		
	(e)
	Pension Plans.  R1 shall not be responsible for any (and IMH shall be solely responsible for all) payments, responsibilities, and other obligations with respect to any current or former pension plans or pension obligations, whether or not accrued, with respect to any IMH Employees.  

		
	2.5
	Payment of Accrued PTO for IMH Employees.  Upon an IMH Employee’s cessation of employment with IMH, IMH shall pay to each such IMH Employee an amount equal to the value of such IMH Employee’s accrued paid time off as of the date of such cessation.

		
	2.6
	[**] for Transitioned Employees.   If a Transitioned Employee is terminated within [**] of the Commencement Date, then the Transitioned Employee will be eligible for [**].  R1 will provide to IMH the names of the Transitioned Employees to [**] of the Commencement Date. [**], and will provide such information to R1.  R1 will [**] the terminated Transitioned Employees.  Subject to the last sentence below, (i) R1 will be financially responsible for [**] to terminated Transitioned Employees and (ii) [**] terminated Transitioned Employees. [**] any terminated Transitioned Employees beyond [**]; provided that IMH’s total payments for [**] to terminated Transitioned Employees under this Section 2.6 shall not [**].

Transitioned Employees shall be subject to R1’s [**] plan on the Employment Effective Date.  R1 shall be responsible for paying the [**] owed (if any) if a Transitioned Employee is terminated more than [**] after his or her Employment Effective Date.  Any such [**] paid by R1 shall be calculated using [**].  Credit for service shall be calculated from the Employment Effective Date for all Transitioned Employees terminated more than [**].
R1 shall not be responsible for any severance, wages or other amounts with respect to any IMH Employee that does not accept or is not eligible to receive an offer of employment from R1.

[**] Indicates that text has been omitted which is the subject of a confidential treatment request. The text has been separately filed with the Securities and Exchange Commission.
Exhibit 10.1-4

		
	2.7
	Training and Skill Development.  Transitioned Employees will be provided skill development and career growth opportunities that are substantially similar to those provided to similarly situated R1 employees in the United States.  R1 will waive any waiting period for tuition reimbursement as long as the Transitioned Employee meets all other requirements and R1 offers the benefit.  If R1 does not offer tuition reimbursement and the Transitioned Employee is currently enrolled in and attending school during the semester/quarter when the transition occurs, then R1 will reimburse the Transitioned Employee the amount they would receive if still employed by IMH for that semester/quarter, provided that the Transitioned Employee meets all of the requirements.    

3.    GENERAL.
		
	3.1
	Employment Status with IMH.  The Parties agree that no Transitioned Employee shall be considered an employee of IMH on and after his or her Employment Effective Date.  In addition, the Parties shall conduct their respective businesses in a manner intended to eliminate or minimize the risk that, following any Transitioned Employee’s Employment Effective Date, IMH shall be considered an employer, co-employer or joint employer of any employee of R1 or any of its Affiliates or Subcontractors, including the Transitioned Employees.  Neither R1 nor its employees (including Transitioned Employees), subcontractors or agents shall be deemed employees or agents of IMH for any purpose including for: (a) federal, state or local tax, employment, withholding or reporting; (b) provident fund, gratuity, bonus, workers’ compensation, employee state insurance or disability coverage, severance pay and paid time off; or (c) eligibility or entitlement to any benefit under any of IMH’s Benefit Plans.  Neither IMH, nor its employees, subcontractors or agents shall be deemed employees or agents of R1 for any purpose including for: (i) federal, state or local tax, employment, withholding or reporting; (ii) provident fund, gratuity, bonus, workers’ compensation, employee state insurance or disability coverage, severance pay and paid time off; or (iii) eligibility or entitlement to any benefit under any of R1’s Benefit Plans.  R1, and not IMH, is responsible for payment of its own employees’ worker’s compensation, disability, unemployment and other insurance, for its social security and Benefit Plans and all applicable income and other taxes.  IMH, and not R1, is responsible for payment of its own employees’ worker’s compensation, disability, unemployment and other insurance, for its social security and Benefit Plans and all applicable income and other taxes.    

		
	3.2
	Equal Employment Opportunity Employers Statement.  IMH is an equal opportunity employer and federal contractor.  Consequently, the Parties agree that, to the extent applicable, they will comply with the following, which are incorporated herein by reference:  41 CFR 60 1.4(a), 41 CFR 60 300.5(a), 41 CFR 60 741.5(a), and Executive Order 13496 (29 CFR Part 471, Appendix A to Subpart A), relating to the notice of employee rights under federal labor laws, specifically: 

		
	(a)
	IMH and R1 shall abide by the requirements of 41 CFR 60 300.5(a), as applicable.  This regulation prohibits discrimination against qualified protected veterans, and 

Exhibit 10.1-5

requires affirmative action by covered prime contractors and subcontractors to employ and advance in employment qualified protected veterans.
		
	(b)
	IMH and R1 shall abide by the requirements of 41 CFR 60 741.5(a), as applicable.  This regulation prohibits discrimination against qualified individuals on the basis of disability, and requires affirmative action by covered prime contractors and subcontractors to employ and advance in employment qualified individuals with disabilities.

		
	3.3
	Other Employee Matters.  As of the Employment Effective Date, the Transitioned Employees shall be employees of R1 for all purposes.  R1 shall be responsible for all necessary recruiting and hiring costs associated with employing appropriate staff, including all travel and relocation requirements and costs of hiring or transitioning the Transitioned Employees.  In addition, R1 shall be responsible for funding and distributing benefits under the Benefit Plans in which benefit-eligible Transitioned Employees participate on or after the Transitioned Employee’s Employment Effective Date and for paying any compensation and remitting any income, disability, withholding and other employment taxes for such Transitioned Employees beginning on the Employment Effective Date.  IMH shall be responsible for funding and distributing benefits under the IMH Benefit Plans in which Transitioned Employees participated prior to the applicable Employment Effective Date and for paying any compensation and remitting any income, disability, withholding and other employment taxes for such Transitioned Employees for the period prior to the Employment Effective Date of such Transitioned Employee.  IMH shall provide R1 with such information in IMH’s possession reasonably requested by R1 in order to fulfill its obligations under this Exhibit 10.1. R1 acknowledges that there may be some employees of IMH who do not transition employment to R1 in accordance with this Exhibit 10.1, but continue to provide revenue cycle services.  For the avoidance of doubt, these employees shall remain and be considered employees of IMH and not R1, and accordingly shall be subject to IMH’s personnel policies and regulations.  R1 agrees to include Transitioned Employees working in and IMH Facility or IMH Provider location in IMH caregiver appreciation celebrations and activities.   

		
	3.4
	[**].

		
	3.5
	[**].

		
	3.6
	No-Hire After Transition. The Transitioned Employees shall be employees of R1 for all purposes. For the avoidance of doubt, as of the Employment Effective Date, the Transitioned Employees shall be subject to Section 24.4 of the Services Agreement. 

[**] Indicates that text has been omitted which is the subject of a confidential treatment request. The text has been separately filed with the Securities and Exchange Commission.
Exhibit 10.1-6

SCHEDULE A
TRANSITION EMPLOYEES 
	
					
	Empl ID
	Last Name
	First Name
	Description
	Transition Date by Employee

	XXXXXXXX
	Doe
	Jane
	Financial Counselor
	2/05/2018

	 
	 
	 
	 
	 

	 
	 
	 
	 
	 

	 
	 
	 
	 
	 

	 
	 
	 
	 
	 

	 
	 
	 
	 
	 

	 
	 
	 
	 
	 

	 
	 
	 
	 
	 

	 
	 
	 
	 
	 

	 
	 
	 
	 
	 

	 
	 
	 
	 
	 

	 
	 
	 
	 
	 

	 
	 
	 
	 
	 

	 
	 
	 
	 
	 

	 
	 
	 
	 
	 

	 
	 
	 
	 
	 

	 
	 
	 
	 
	 

	 
	 
	 
	 
	 

	 
	 
	 
	 
	 

	 
	 
	 
	 
	 

	 
	 
	 
	 
	 

	 
	 
	 
	 
	 

	 
	 
	 
	 
	 

	 
	 
	 
	 
	 

	 
	 
	 
	 
	 

	 
	 
	 
	 
	 

	 
	 
	 
	 
	 

	 
	 
	 
	 
	 

	 
	 
	 
	 
	 

	 
	 
	 
	 
	 

	 
	 
	 
	 
	 

	 
	 
	 
	 
	 

	 
	 
	 
	 
	 

	 
	 
	 
	 
	 

Exhibit 10.1 Schedule A

AMENDED AND RESTATED SERVICES AGREEMENT

between

IHC Health Services, Inc.

and

R1 RCM Inc.

EXHIBIT 11.1

CHARGES FOR SERVICES

Execution Copy

AMENDED AND RESTATED SERVICES AGREEMENT

between

IHC Health Services, Inc.

and

R1 RCM Inc.

EXHIBIT 11.1-A

BASE FEE FOR SERVICES

[**] designates portions of this document that have been omitted pursuant to a request for confidential treatment filed separately with the Securities and Exchange Commission.

Exhibit 11.1-A 
 
Base Fee for Services
1.    Base Fee.
For R1’s provision of Services, IMH will pay to R1 a single base fee with respect to the combined IMH Facilities and the IMH Providers (the “Base Fee”), which Base Fee shall be calculated in the aggregate and will be comprised of:
		
	1.1
	For the period from the Commencement Date through [**] fee (to be invoiced in accordance with Exhibit 11.1-C) equal to the product of :

		
	(i)
	The result of:

		
	a.
	the prior year [**] Cash Collections with respect to such quarter for the revenue cycle operations of the IMH Facilities and the IMH Providers in the aggregate, 

multiplied by 
		
	b.
	the sum of (A) one, plus (B) [**], plus (C) [**] (the result of (a) multiplied by (b) will be referred to herein as “[**] Base Fee Cash”),

multiplied by 
		
	(ii)
	the result of:

		
	a.
	the Cost to Collect Factor (as defined in Section 3.1),

minus
		
	b.
	[**] (as defined in Section 4.3),

minus
		
	c.
	[**] (as defined in Section 5).

		
	1.2
	For all periods beginning on or following [**], a [**] fee equal to (to be invoiced in accordance with Exhibit 11.1-C) the product of:

		
	(i)
	The result of:

		
	a.
	the prior year’s [**] Base Fee Cash with respect to such quarter, 

multiplied by 
		
	b.
	the sum of (A) one, plus (B) [**], plus (C) [**] 

[**] Indicates that text has been omitted which is the subject of a confidential treatment request. The text has been separately filed with the Securities and Exchange Commission.
11.1-A-1

multiplied by 
		
	(ii)
	the result of:

		
	a.
	the Cost to Collect Factor (as defined in Section 3.1),

minus
		
	b.
	[**] (as defined in Section 4.3),

minus
		
	c.
	[**] (as defined in Section 5).

It is the intent of the Parties to commence Services on the first day of any month; however, in the event any Services do not start on the first of a month, the Parties shall account for any proration in the Base Fee in accordance with Section 11.5 of the Services Agreement.
		
	1.3
	Certain Definitions

		
	(i)
	“Acute Adjusted Admissions” means, for any Contract Quarter, the quotient of: (x) Total Patient Revenue for such quarter, divided by (y) the quotient of (1) Inpatient Revenue for such quarter, divided by (2) Inpatient Admissions for such quarter.

		
	(ii)
	“Acute Adjusted Admissions Percentage Change” means, for any Contract Quarter, the quotient of: (x) the difference between (a) the Acute Adjusted Admissions for such Contract Quarter, minus (b) the Acute Adjusted Admissions for the prior Contract Quarter, divided by (y) the Acute Adjusted Admissions for the prior Contract Quarter. 

For example, to calculate the Acute Adjusted Admissions % Change for the quarter ended 6/30/2019, you would evaluate the percentage change in the Annual Adjusted Admissions from the 12 month period ended February 2018 to the 12 month period ended February 2019.
		
	(iii)
	“Baseline Year” means [**].

		
	(iv)
	“Contract Quarter” means each three-month period during a Contract Year during the Term (i.e., January 1st to March 31st, April 1st to June 30th, July 1st to September 30th and October 1st to December 31st).  Notwithstanding the foregoing, for the initial 2018 Contract Year, the first Contract Quarter shall be truncated, starting on the Commencement Date and ending at the first to occur of March 31st, June 30th, September 30th or December 31st of 2018; and the remaining Contract Quarters for 2018 shall follow the preceding methodology.

[**] Indicates that text has been omitted which is the subject of a confidential treatment request. The text has been separately filed with the Securities and Exchange Commission.
11.1-A-2

		
	(v)
	“Contract Year” means each calendar year during the Term, [**].

		
	(vi)
	[**]. 

		
	(vii)
	“Inpatient Admissions” means, for any Contract Quarter, the total number of Inpatient Admissions as set forth in IMH’s Enterprise Data Warehouse or equivalent reporting system.

		
	(viii)
	“Inpatient Revenue” means, for any Contract Quarter, the total dollar value of Inpatient Revenue as set forth in IMH’s Enterprise Data Warehouse or equivalent reporting system.

		
	(ix)
	[**].

		
	(x)
	“Provider Visits” means, for any Contract Quarter, the total number of Provider Visits as set forth in IMH’s Enterprise Data Warehouse or equivalent reporting system.

		
	(xi)
	“[**] Cash Collections” means, for each of the IMH Facilities and the IMH Providers (or both), the cumulative Cash Collections received by IMH for the IMH Facilities or the IMH Providers (or in the aggregate with respect to both), during the [**] period that ends one month prior to the commencement of the quarter for which the Base Fee with respect to IMH is payable. 

For example, to calculate the Base Fee for [**] ended 6/30/2018, the [**] Cash Collections would equal IMH’s Cash Collections for the IMH Facilities and the IMH Providers for [**], and [**].   
		
	(xii)
	[**].

2.    Initial Assessment.
		
	2.1
	Performance and Timing.  The Parties will perform and complete a collaborative initial assessment of the Services prior to the Commencement Date in order to determine the Initial Cost to Collect Factor (as defined in Section 3.1 below) (the “Initial Assessment”).  

		
	2.2
	Assessment Principles.  In connection with the Initial Assessment, the following principles will be followed. 

		
	(i)
	Payroll Expenses for IMH: All payroll costs and expenses at IMH for In-Scope Employees (defined below) and, to the extent not otherwise included in the definition of In-Scope Employees, all payroll costs and expenses for Management Employees (as defined in this Section 2.2), all of which shall be borne by R1. “In-Scope Employees” means:

[**] Indicates that text has been omitted which is the subject of a confidential treatment request. The text has been separately filed with the Securities and Exchange Commission.
11.1-A-3

		
	a.
	those non-clinical employees, as identified by job title, which are responsible for performing functions that relate to the Services which are designated, pursuant to the Initial Assessment, as having an In-Scope Percentage (as defined below) that is greater than or equal to [**] (all of which employees shall also be deemed to be In-Scope Employees); and

		
	b.
	if approved by the Joint Review Board, any non-clinical employees, as identified by job title, that are responsible for performing functions that relate to the Services and are designated, pursuant to the Initial Assessment as having an In-Scope Percentage higher than [**] but lower than [**]. 

Notwithstanding the foregoing, (y) subsection b of this definition shall include those employees working in departments which perform both the Services and services not qualifying as the Services, and (z) IMH may remove any Management Employee from the In-Scope Employees (in which case, R1 shall [**] for any payroll costs and expenses relating to such Management Employees). For the avoidance of doubt, if IMH removes an employee who is not a Management Employee from the In-Scope Employees, then such employee will remain an IMH employee, but the Cost to Collect Numerator will [**] with respect to any such employee.  R1 shall [**] relating to such employees for the period of time such employee remains an IMH employee and provide services for IMH that would otherwise be Services under the Agreement if such employee had transitioned to R1.
“In-Scope Percentage” shall mean, for any “Department” at IMH, the [**] divided by [**]. 
“Management Employee” shall mean any (i) [**] and (ii) any employees performing similar functions to any of the employees referenced in clause (i).
		
	(ii)
	IT Support/Real Estate Expenses for IMH: With respect to allocation of costs and expenses related to information technology support and real estate for purposes of inclusion in the Cost to Collect Numerator, the Parties shall, prior to the Commencement Date, mutually agree in good faith on a methodology that (A) represents an accurate reflection of the allocation of costs and expenses between the Parties including both operating expense and depreciation expense; and (B) favors simplicity in execution and invoicing and excludes any cost allocation for In-Scope Employees whom we reasonably expect to remain in Authorized Space. The Parties shall mutually agree in good faith on a mechanism to avoid a material amount of duplicate or unfunded costs or expenses related to IT support and real estate.

[**] Indicates that text has been omitted which is the subject of a confidential treatment request. The text has been separately filed with the Securities and Exchange Commission.
11.1-A-4

		
	(iii)
	Other Expenses for IMH: Allocation of all other expense categories shall be determined through mutual agreement of both Parties in good faith.

		
	(iv)
	[**] 

		
	(v)
	Non-Payroll Expenses for Third-Party Vendors:  The Cost to Collect Numerator, as defined below, will include all costs and expenses related to In-Scope Vendors (defined below), [**] shall [**], excluding any portion of the costs and expenses for Partially Related Vendors that are not related to the Services. 

“In-Scope Vendors” means third party vendors that perform functions as part of or related to the Services, including: (A) any vendor that, provides a product, solution or service (a “Vendor Service”) that is [**] related to the Services; and (B) any vendor that is, providing or offering a Vendor Service is partially related to the Services (“Partially Related Vendors”). 
In-Scope Vendors shall not include any (y) IT Host System Vendor; and (z) vendor with respect to a Vendor Service that is not related to the Services in any manner.  “IT Host System Vendor” means a third party vendor that provides a product, solution or service (including hosting or providing a platform or system) that is used to capture patient encounters and associated charges that result in generation of a patient statement or bill.
		
	(vi)
	Partially Related Vendors: For any Partially Related Vendors, the portion of the cost of the Partially Related Vendor that relates to the Services will be [**]. The Joint Review Board may review the list of vendors from time to time and, when appropriate, determine whether any such vendor is not an In-Scope Vendor.  If a vendor is deemed not to be an In-Scope Vendor, an adjustment to the Cost to Collect Numerator shall be made to [**] accordingly, and R1 shall [**], such costs.

		
	(vii)
	Additional Considerations:

		
	a.
	If a termination fee or other termination-related costs or expenses must be paid to allow for the termination or any splitting of an existing In-Scope Vendor contract, such fee will be [**], subject to Section 14.6 of the Agreement.  

		
	b.
	The allocation of one-time, lump-sum implementation and/or license fees for a particular In-Scope Vendor will be [**]the Cost to Collect Numerator. 

		
	c.
	R1 and IMH shall each be responsible for its own incurred costs associated with information technology, such as interface 

[**] Indicates that text has been omitted which is the subject of a confidential treatment request. The text has been separately filed with the Securities and Exchange Commission.
11.1-A-5

development, file transfers, and custom programming related to the R1 technology solutions and other third party vendors. 
		
	d.
	The allocation between the Parties of one-time costs related to information technology system conversion services, including consulting services, staff augmentation and training, will be excluded from the Cost to Collect Numerator.  

		
	e.
	Recurring maintenance, support, service, license, or contingency fees for all In-Scope Vendor products, solutions, and services, shall be included in the Cost to Collect Numerator, and [**] R1.

		
	f.
	The Parties will work together to identify any costs from the Initial Assessment that should be either added or removed from the Cost to Collect Numerator.

		
	2.3
	Determination of Initial Cost to Collect Factor.  The Initial Cost to Collect Factor shall be determined by the Joint Review Board after the completion of the Initial Assessment.  

		
	(i)
	Calculation Principles.  In addition to the principles listed in Section 2.2 above, the Joint Review Board shall also follow the methodology below with respect to completing the table set forth in Section 3.1 in order to establish the Initial Cost to Collect Factor:

		
	a.
	The fraction to be set forth in the table (expressed as a percentage) representing the Cost to Collect Factor as of the Effective Date will be calculated as follows:  (i) the aggregated annual value of all costs from the Initial Assessment for IMH, as approved by the Joint Review Board, and otherwise normalized to account for any extraordinary costs that do not relate to the Services provided during the Baseline Year or are not reasonably expected to continue (e.g. payroll costs related to Transcription) (collectively, “Cost to Collect Numerator”); and (ii) the denominator is equal to the aggregate amount of Cash Collections for the IMH Facilities and the IMH Providers, in the aggregate, during the Baseline Year.

		
	(ii)
	The Parties must determine the Initial Cost to Collect Factor prior to the Commencement Date.

3.    Cost to Collect Factor.
		
	3.1
	“Cost to Collect Factor” means the fraction (expressed as a percentage) which will be determined by the Parties and approved by the Joint Review Board after completion of the Initial Assessment (such fraction subject to any adjustment agreed by the Joint Review Board in accordance with Sections 3.2 and 3.3 below).  

[**] Indicates that text has been omitted which is the subject of a confidential treatment request. The text has been separately filed with the Securities and Exchange Commission.
11.1-A-6

	
				
	 
	Baseline Year Cash
	Cost to Collect Numerator
	Initial Cost to Collect Factor

	All IMH Facilities and IMH Providers
	$
	$
	%

The Cost to Collect Factor in the table above shall be referred to as the “Initial Cost to Collect Factor.”
For the avoidance of doubt, the Cost to Collect Factor that will be used in the Base Fee calculation in Section 1.1 shall equal the sum of: 
		
	(i)
	the Initial Cost to Collect Factor listed above, 

		
	(ii)
	any downward adjustments, as provided for in Section 3.2 below, and

		
	(ii)
	any upward adjustments, as provided for in Section 3.3 below.

For purposes of clarity, the Parties agree that the adjustments contemplated by subsections (ii) and (iii) directly above shall only be effective to Base Fee calculations prospectively, as of the latter to occur of: (x) the date of approval of the adjustment by the Joint Review Board; and (y) any later date as set forth in the approval by the Joint Review Board.  
		
	3.2
	Discontinued Services 

If any Service is approved to be discontinued by the Joint Review Board, or via a written amendment to the Services Agreement executed by the Parties, the Parties will conduct an assessment of the cost assumptions underlying the Cost to Collect Factor with respect to such Service and the Joint Review Board shall approve an equitable downward adjustment to the Cost to Collect Factor to account for such Discontinued Services.
		
	3.3
	New Services, Acquisitions and New Hospitals

		
	(i)
	For the avoidance of doubt, if IMH requests that R1 provide any services other than the Services or if IMH requests that R1 provide any Services which were not provided to IMH prior to the date of such request, all such requested services shall be New Services under Section 3.8 of the Services Agreement.  The Parties agree that for any such New Services, if the costs or expenses associated with such New Service are not accounted for in the determination of the Cost to Collect Factor as of the date such New Service would commence, then the Cost to Collect Factor will be equitably increased by an amount to be determined by the Joint Review Board, and such adjustments shall be effective as of the date R1 begins performing such New Service.  

		
	(ii)
	In the event that after the Commencement Date additional existing facilities and providers are added to the IMH Facilities or IMH Providers that result in an increase of [**] net patient services revenue, the Parties will perform and complete an assessment of such facilities and providers that is consistent 

[**] Indicates that text has been omitted which is the subject of a confidential treatment request. The text has been separately filed with the Securities and Exchange Commission.
11.1-A-7

in scope with the Initial Assessment and follows the principles set forth in Section 2.2. The results of any such assessment shall be submitted to the Joint Review Board and the Joint Review Board shall determine the proper increase to the Cost to Collect Factor in accordance with the guidelines and principles of this Exhibit 11.1-A.  If the additional facilities and providers result in an increase of [**] of net patient services revenue the Cost to Collect factor then in place will be applied to the new facilities and providers.
		
	(iii)
	In the event that after the Commencement Date IMH opens new facilities that are added to the IMH Facilities or IMH Providers,.  If IMH opens new facilities as described in this Section 3.3(iii), and R1 hires any employees who will perform the Services for such new facility more than [**] days in advance of IMH opening a new facility at IMH’s request, IMH shall reimburse R1 for the expenses incurred for hiring each such employee.

Any adjustments made for discontinuation of Services under Section 3.2 or addition of New Services under Section 3.3(i) will be based on the following fraction – the annualized expense for such Services divided by the trailing twelve months Cash Collections for the IMH Facilities and the IMH Providers – which fraction will be added or removed from the then current Cost to Collect Factor, depending on whether Services are being added or removed. 
4.    [**].
		
	4.1
	During the Term, Intermountain shall be entitled to a [**] each quarterly Base Fee invoice, as reflected in Section 1.1, of the applicable [**] (as defined below), which shall be phased in over the [**] period from the Commencement Date.

		
	4.2
	For each year that Intermountain receives Services from R1 during the Term, the Cost to Collect Factor shall be [**] to be calculated as follows:

		
	(i)
	For the period starting on the Commencement Date and ending [**] of the [**] shall be [**] from the Cost to Collect Factor;

		
	(ii)
	For the [**] of the [**] shall be [**] from the Cost to Collect Factor;

		
	(iii)
	For each subsequent calendar year during the term thereafter, [**] of the [**] shall be [**] from the Cost to Collect Factor.

		
	4.3
	“[**]” means the quotient (expressed as a percentage) of (x) [**] (the “[**]”), divided by (y) the aggregate Cash Collections of the IMH Facilities and the IMH Providers during the Baseline Year. 

[**] Indicates that text has been omitted which is the subject of a confidential treatment request. The text has been separately filed with the Securities and Exchange Commission.
11.1-A-8

	
			
	Period
	[**]
	[**]

	Commencement Date – [**]
	[**]
	--

	[**]
	[**]
	--

	[**]  – Term 
	[**]
	--

The Parties will finalize Cash Collections in the Baseline Year in accordance with Sections 2.3 and 3.1.
5.    [**].  
[**].
6.    Windfall Situations and Changes in the Environment
		
	6.1
	In the event that there is a Force Majeure Event, a material change in the environment in which IMH is operating its revenue cycles, or a material change in the laws and regulations that apply to IMH or R1 that significantly affects the economics of one or more of the Parties or frustrates the ability of a Party to perform its obligations hereunder, through no fault of its own, there will be a fair and appropriate adjustment (increase or decrease) to portions of the Base Fee.  Upon such request, the Parties will, in good faith, discuss the costs associated with the change in circumstance, with the outcome to equitably reflect the incremental change in costs to deliver the Services.  

		
	6.2
	Examples of matters that could trigger an adjustment to the Base Fee include the following:

		
	(i)
	Material changes in the form of reimbursement by commercial or government payors, including changes to a payment model such as an at-risk or partial or fully capitated system; 

		
	(ii)
	[**].

		
	(iii)
	Changes to the IMH IT Environment, which results in a material [**] in the cost of revenue cycle operations.

[**] Indicates that text has been omitted which is the subject of a confidential treatment request. The text has been separately filed with the Securities and Exchange Commission.
11.1-A-9

Execution Copy

AMENDED AND RESTATED SERVICES AGREEMENT

between

IHC Health Services, Inc.

and

R1 RCM Inc.

EXHIBIT 11.1-B

INCENTIVE FEES FOR SERVICES

	
			
	 
	 
	 

	 
	 
	 

Exhibit 11.1-B 
Incentive Fees for Services
1.    Definitions:
		
	•
	“Actual Result” means, with respect to any Metric, the value obtained by performing the calculation in accordance with the definition of such Metric.

		
	•
	[**]

		
	•
	“Book of Business” means the aggregate IMH Providers on the one hand and aggregate IMH Facilities on the other hand.

		
	•
	[**]

		
	•
	“Balanced Score” shall mean:

		
	o
	with respect to Metrics No. 1 to 3 and 5, the quotient of: 

		
	§
	(x) the difference between (1) the Lower Bound for each such Metric in Table 2.2(e), minus (2) the Actual Result for such Metric in the Measurement Period, divided by 

		
	§
	(y) the result of (1) the Lower Bound for each such Metric in Table 2.2(e), minus (2) the Upper Bound for such Metric.

		
	o
	with respect to Metric No. 4, the quotient of: 

		
	§
	(x) the difference between (1) the Actual Result for Metric No. 4 in the Measurement Period, minus (2) the Lower Bound for Metric No. 4, divided by 

		
	§
	(y) the difference between (1) the Upper Bound for Metric No. 4, minus the Lower Bound for Metric No. 4 in Table 2.2(e).

		
	•
	[**] 

		
	•
	“Capped Score” shall mean, the Balanced Score, as modified, if at all, in accordance with the following formula:

		
	o
	if the Balanced Score for each such Metric is [**], then the Capped Score for such Metric shall be equal to [**];

		
	o
	if the Balanced Score for each such Metric is greater than [**], then the Capped Score for such Metric shall be equal to [**]; and

		
	o
	if the Balanced Score for each such Metric is [**], then the Capped Score for such Metric shall be equal to [**].

[**] Indicates that text has been omitted which is the subject of a confidential treatment request. The text has been separately filed with the Securities and Exchange Commission.
11.1-B-1-1

		
	•
	[**]

		
	•
	“Contract Quarter” has the meaning given in Section 1.3(iv) of Exhibit 11.1-A.

		
	•
	“Contract Year” has the meaning given in Section 1.3(v) of Exhibit 11.1-A.

		
	•
	[**] 

		
	•
	[**]

		
	•
	[**] 

		
	•
	“Lower Bound” means, for any Metric, on a Book of Business specific basis, the lower bound result set forth in Table 2.2(e) for such Metric. The Joint Review Board will approve the Lower Bound for each Metric prior to the Commencement Date. For each Metric, the Parties intend to use as the Lower Bound [**]: (a) the Actual Result for such Metric [**]; and (b) the Actual Result for such Metric [**]. Notwithstanding the foregoing, the Parties intend that the Lower Bound for Metric Nos. 1 and 2 for the IMH Providers Book of Business will be the average of the Actual Results for each such Metric [**]. The Lower Bound for each Metric shall be adjusted [**], starting with the Lower Bound in effect for [**] as set forth in Exhibit 11.1-B-1.

		
	•
	“Measurement Period” means a period of measurement hereunder following the Commencement Date calculated at the end of each Contract Quarter during a Contract Year as follows: Starting at the beginning of each Contract Year, the initial Measurement Period will be the first Contract Quarter, and each subsequent Measurement Period will be equal to the sum of such Contract Quarter plus all previous Contract Quarters during such Contract Year.  Notwithstanding the foregoing, for the 2018 Contract Year, the initial Measurement Period shall be the shortened Contract Quarter described in the Contract Quarter definition above.

		
	•
	“Measurement Period Score” shall mean, for any Metric (expressed as a percentage) the Metric’s [**] Score for such Measurement Period.

		
	•
	“Metric” means each of the individual measurements set forth in Table 2.2(e), the “Metric Value Table,” or any other individual measurement agreed by the Parties in accordance with Section 3.1; provided that there shall not be more than [**] individual measurements in place for any Contract Year. 

		
	•
	“Metric Value” has the meaning set forth in Section 2.3(b).

		
	•
	[**]

		
	•
	“Patient” has the meaning given in Section 1 of Exhibit 3.6.  

[**] Indicates that text has been omitted which is the subject of a confidential treatment request. The text has been separately filed with the Securities and Exchange Commission.
11.1-B-1-2

		
	•
	“Patient Accounting System” means IMH’s iSeries, GE Centricity, Cerner CPR Plus or Horizon patient accounting system, as applicable for any Metric as of the date of determination.

		
	•
	[**] 

		
	•
	“Payor” means any third party that is contractually responsible for the payment of all or any portion of any Patient’s medical expenses, including, without limitation, commercial medical insurers and government insurers.

		
	•
	[**] 

		
	•
	[**] 

		
	•
	[**] 

		
	•
	“Risk Pool” shall mean for each Measurement Period, for each Book of Business: 

		
	o
	if total incentive fees paid to R1 in accordance with Section 2.3 [**], the Cash Collections for such Book of Business during such Measurement Period, multiplied by [**]; and

		
	o
	if total incentive fees paid to R1 in accordance with Section 2.3 [**], the Cash Collections for such Book of Business during such Measurement Period, multiplied by [**].

		
	•
	“Scorecard Calculation” means the process of calculating Incentive Fees described in Sections 2.2 and 2.3.

		
	•
	“Self-pay Patients” are those Patients that present at the time of admission or service as having no Payor obligated to pay for any portion of the care for which such individual is presenting.

		
	•
	“Total Charges” means, for any Measurement Period, the dollar value of total charged amounts posted for Patient services during such Measurement Period.

		
	•
	[**]

		
	•
	[**] 

		
	•
	“Total Weighted Value” shall mean the sum of each of the Metric Values for all Metrics as of the end of such Measurement Period.

		
	•
	[**] 

[**] Indicates that text has been omitted which is the subject of a confidential treatment request. The text has been separately filed with the Securities and Exchange Commission.
11.1-B-1-3

		
	•
	“Upper Bound” means, for each Metric, on a Book of Business specific basis, the upper bound value set forth in Table 2.2(e) for such Metric. The Upper Bound for each Metric may be [**] as described in Section 3.1.

		
	•
	“Weighting” means the weight of each Metric, expressed as a percentage, that is set forth in Table 2.2(e) of Exhibit 11.1-B, as specified for each Contract Year listed in such Table and as such weights may be adjusted by agreement of the Parties in accordance with Section 3.1.

		
	2.
	Incentive Fees.  IMH shall pay R1 any incentive fees earned for each Book of Business based on certain targeted performance metrics related to the successful delivery of the in-scope Services, and the amount of such incentive fees shall be determined in accordance with this Section 2 (“Incentive Fees”).

		
	2.1
	Guiding Principles.  R1 and IMH agree that the “Guiding Principles” set forth below, outline the Parties’ intent in establishing the Scorecard Calculation and the Incentive Fees.

		
	(a)
	The Parties intend that the performance measurement model reflect improvements in revenue cycle operations process effectiveness over time.

		
	(b)
	All calculations shall be based on the financial data as reported in IMH’s iSeries, GE Centricity, Cerner CPR Plus or Horizon patient accounting systems, or successor systems, as applicable, in the ordinary course of business.

		
	(c)
	In the event one of the Parties requests that, due to an intervening change in the healthcare industry or other external event or factor unrelated to the performance of IMH’s revenue cycle operations, the Parties consider whether any aspect of the measurement methodology outlined in this Section 2 should be revised (i.e., changes that would impact the Lower Bound or changes to the Metrics or the Metric Values in the Measurement Period), either as a one-time exception or as a going-forward amendment to this Exhibit 11.1-B, the Parties will meet to discuss such request in good faith (it being understood that any such exception or amendment would require the mutual agreement of the Parties). Such events could include, but are not limited to:

		
	(i)
	Major increases or decreases to the number of sites operated by IMH;

		
	(ii)
	Delayed implementation of agreed to contract rates between Payors and IMH;

		
	(iii)
	Third party settlements;

		
	(iv)
	Changes in accounting treatment;

		
	(v)
	Changes in self-pay discounts, insured patient residual discounts, and charity policies or practices; 

[**] Indicates that text has been omitted which is the subject of a confidential treatment request. The text has been separately filed with the Securities and Exchange Commission.
11.1-B-1-4

		
	(vi)
	Changes to payor relationship status (eg. Payors moving from in-network to out-of-network) as a direct result of contracting decisions by IMH Payor Contracting. 

Any adjustments to calculations under this Section 2.1(c) will take effect prospectively, and will not be retroactive.
		
	(d)
	The Parties acknowledge and agree that the Guiding Principles are meant to be a statement of intent only and are not meant to supersede, amend, waive or otherwise change the measurement methodology set forth in this Section 2. Any amendment, waiver, or change to the measurement methodology may only be made through a subsequent written agreement between the Parties.

2.2    Scorecard Calculations
		
	(a)
	The Parties shall calculate separate Scorecard Calculations for each Book of Business at the end of each Measurement Period and such calculations will be performed cumulatively throughout each Contract Year.

		
	(b)
	The Scorecard Calculations for each Book of Business will be performed in the aggregate for all entities within each such Book of Business and the impact of positive results at one facility/provider with respect to a given Metric can be offset by negative results at a different facility/provider within that Book of Business. 

		
	(c)
	Subject to Section 3.1, the Metrics, Weighting, and Upper Bounds will remain in effect for the duration of the Services Agreement. The calculation of Measurement Period Scores for each Metric in any Measurement Period will utilize the same definitions, data sources, and systems as were used in calculating the then-current Lower Bound for such Measurement Period. In the event that there is a change to source data or systems that impacts the Lower Bound or the Measurement Period Score for a Metric, then the Parties will discuss whether such Lower Bound, Measurement Period Score or both should be recalculated. For those Metrics or any subcomponents of such Metrics that are currently delineated in IMH’s internal financial statements or operating reports, unless the Parties agree otherwise, during the Term, IMH will continue to calculate each Metric in the same manner that it calculated such Metric immediately prior to the Commencement Date.

		
	(d)
	In the event that after the Commencement Date, facilities are added or removed to/from the IMH Facilities, then such IMH Facilities will be included/removed in the Scorecard Calculations beginning in the first full Contract Quarter following the closing of such acquisitions or divestitures. If such acquisitions or divestitures, individually or through a series of related transactions, result in a growth or reduction of [**], then the Parties agree to evaluate the Lower and/or Upper Bounds to account for the new or removed facilities or providers, as the case may be. Any adjustments to calculations under this Section 2.2(d) will take effect upon mutual agreement, prospectively applied, and will not be retroactive. The Lower and/or Upper Bounds 

[**] Indicates that text has been omitted which is the subject of a confidential treatment request. The text has been separately filed with the Securities and Exchange Commission.
11.1-B-1-5

shall be adjusted by agreement of the Parties based on [**]. IMH agrees to provide R1 the data reasonably required by R1 to perform the adjustments set forth in this Section 2.2(d).
		
	(e)
	The table below sets forth the Metrics, Weighting and Upper Bounds that the Parties agree will be used to perform the Scorecard Calculations for each Measurement Period for [**]. The table also contains the Lower Bound for each Book of Business that the Parties have agreed to for [**] as set forth in the table.

Table 2.2(e) “Metric Value Table”

	
								
	 
	Metric
	Weighting for [**] 
	Weighting for [**] 
	IMH Facilities
	IMH Providers
	IMH Facilities
	IMH Providers

	Lower Bound for [**] 
	Lower Bound for [**] 
	Upper Bound for [**] 
	Upper Bound for [**] 

	1
	[**]
	[**]
	[**]
	 
	 
	[**]
	[**]

	2
	[**]
	[**]
	[**]
	 
	 
	[**]
	[**]

	3
	[**]
	[**]
	[**]
	 
	 
	[**]
	[**]

	4
	[**]
	[**]
	[**]
	 
	 
	[**]
	[**]

	5
	[**]
	[**]
	[**]
	 
	 
	[**]
	[**]

     
		
	(f)
	Metric No. 1. [**]. 

		
	(g)
	Metric No. 2. [**].

		
	(h)
	Metric No. 3. [**] 

		
	(i)
	Metric No. 4. [**] 

		
	(j)
	Metric No. 5. [**] 

2.3    Incentive Fee Payments.
		
	(a)
	At the end of each Measurement Period, IMH shall pay to R1 fees equal to the following calculation if it results in a positive amount: (x) the Total Weighted Value for each Book of Business for such Measurement Period multiplied by the Risk Pool for such Book of Business for such Measurement Period; minus (y) any Incentive Fees previously paid by IMH for the same Contract Year.  If such calculation results in zero or a negative amount prior to the last Contract Quarter in a Measurement Period, no payment shall be made by IMH to R1 and if such calculation results in a negative amount for the last Measurement Period of a Contract Year, then R1 shall provide to IMH a credit memo that IMH may use as a credit against future payments to R1. 

[**] Indicates that text has been omitted which is the subject of a confidential treatment request. The text has been separately filed with the Securities and Exchange Commission.
11.1-B-1-6

		
	(b)
	For each Metric, the “Metric Value” for each Measurement Period shall be equal to the product of (x) the Measurement Period Score for such Metric for such Measurement Period, multiplied by (y) the Weighting for such Metric.

		
	(c)
	In the event of any adjustments to the Lower and/or Upper Bounds that take effect during a Contract Year in progress, pursuant to Section 2.1(c), Section 2.2(d) or Section 4.1, the Parties will equitably perform the Scorecard Calculations for the Contract Year to take into account such changes.

2.4    Delivery of Scorecards and Quarterly Incentive Fee Invoices.
		
	(a)
	Within [**] days following the last day of each month, IMH shall deliver to R1 a scorecard containing the Scorecard Calculations for the prior month. 

		
	(b)
	When the prior month is the last month of a Measurement Period, IMH shall deliver to R1 within [**] days following the end of the Measurement Period, a scorecard containing the Scorecard Calculations, including the Incentive Fees amount, for such Measurement Period; provided that if such Measurement Period occurs at the end of a Contract Year, then IMH shall deliver a preliminary scorecard by [**] and another scorecard within [**] days following the end of the Contract Year. If IMH has not delivered such scorecard within [**] days following the end of the Measurement Period, then R1 may perform the Scorecard Calculations and deliver the related scorecard to IMH. If the Party that receives the scorecard does not dispute the Scorecard Calculations within [**] days following delivery of such scorecard to such Party (the “Scorecard Review Period”), then that Party will be deemed to have consented to the Scorecard Calculations for purposes of invoicing and payment of the quarterly Incentive Fees only, provided that if the Measurement Period occurs at the end of a Contract Year, then the Scorecard Review Period will be calculated from the date of delivery of the second scorecard and Section 2.4(c) will apply. Subject to Section 2.4(e), upon the conclusion of the Scorecard Review Period, R1 will issue an invoice for the Incentive Fees owed for the applicable Measurement Period. 

		
	(c)
	When the Measurement Period occurs at the end of a Contract Year, then at the conclusion of the Scorecard Review Period and subject to Section 2.4(e) and Section 2.5, R1 will issue an invoice for the Incentive Fees owed for the Contract Year and the Scorecard Calculations and the amount of Incentive Fees shall be deemed to be final and binding upon the Parties, and such Scorecard Calculations and Incentive Fees shall no longer be subject to any adjustment or revision (including as a result of any audit or any newly discovered information or changes in data). 

		
	(d)
	IMH shall pay all invoices in full within [**] days following delivery of such invoice to IMH. 

		
	(e)
	In the event of a good faith dispute between the Parties regarding any quarterly scorecard, such payment dispute shall be resolved in accordance with Section 11.6 

[**] Indicates that text has been omitted which is the subject of a confidential treatment request. The text has been separately filed with the Securities and Exchange Commission.
11.1-B-1-7

of the Services Agreement, as amended herein. Pursuant to Section 11.6 of the Services Agreement, R1 may issue an invoice for any Incentive Fees owed for such Measurement Period based on Metric Values that are undisputed, if any, and IMH shall not withhold payment of such fees.
		
	(f)
	Once the payment dispute has been resolved, R1 will issue an invoice for the Incentive Fees owed for the Measurement Period, less any payments previously made by IMH for such Measurement Period. If the payment dispute occurs following the end of a Contract Year, then upon resolution, the Scorecard Calculations, including any adjustments agreed to by the Parties in connection with the dispute, shall be deemed to be final and binding upon the Parties, and shall no longer be subject to any adjustment or revision.

2.5    Adjustments to Calculations for each Contract Year and True-Up Process.
		
	(a)
	At the end of each Contract Year, the Parties will agree to adjustments to the [**] values and perform the Scorecard Calculations using such adjustments for [**]. The scorecard shall be delivered in accordance with the process set forth in Section 2.4(b). Upon the conclusion of the Scorecard Review Period, R1 will issue an invoice for such Contract Year and IMH shall pay to R1 the Incentive Fees, if any, owed for such Contract Year; however, such Scorecard Calculations will not be deemed final with respect to the Actual Results reflected therein for [**]. 

		
	(b)
	After [**] days but before [**] days after the end of each Contract Year, the Parties will re-run the Scorecard Calculations for the [**]. Upon the conclusion of the Scorecard Review Period for such Scorecard Calculations, such Scorecard Calculations and the amount of Incentive Fees shall be deemed final and binding upon the Parties with respect to the Actual Results reflected therein for [**], and shall no longer be subject to any adjustment or revision. If the fees paid to R1 for such Contract Year are greater than the actual Incentive Fees for such Contract Year, then R1 will provide IMH with a credit for such difference on the next available invoice, whether such invoice is for the Base Fee or Incentive Fees. If the fees paid to R1 for such Contract Year are less than the actual Incentive Fees for such Contract Year, then R1 will invoice IMH for, and IMH will pay, such additional amount. 

2.6    Process for Performing Calculations If Missing Data.  
		
	(a)
	In the event that all of the data required to complete a Scorecard Calculation is not available for any or all IMH Facilities or IMH Providers at the conclusion of a Contract Quarter, R1 shall bill IMH, and IMH shall pay Incentive Fees to R1, based on Scorecard Calculations using a Measurement Period Score of [**] for each Metric that lacks sufficient data to determine the Measurement Period Score based on Actual Results in accordance with Section 2.2 (the “Temporary Incentive Fees”). 

		
	(b)
	IMH agrees to use best efforts to include such missing data in a Scorecard Calculation as soon as possible. Once such information becomes available, the Parties agree to 

[**] Indicates that text has been omitted which is the subject of a confidential treatment request. The text has been separately filed with the Securities and Exchange Commission.
11.1-B-1-8

recalculate the Scorecard Calculation using the actual data for the Measurement Period within [**] days of receipt of the information. If the Temporary Incentive Fees paid to R1 for the Measurement Period are greater than the actual Incentive Fees for such Measurement Period, then R1 will provide IMH with a credit for such difference on the next quarterly invoice (or, if the Measurement Period includes the final Contract Quarter for the final Contract Year under the Services Agreement, R1 will remit the difference to IMH). If the Temporary Incentive Fees paid to R1 for the Measurement Period are less than the actual Incentive Fees for such Measurement Period, then R1 will bill IMH for such amount on the next quarterly invoice (or as part of a final invoice, if the Measurement Period includes the final Contract Quarter for the final Contract Year under the Services Agreement).
		
	(c)
	IMH recognizes the importance to R1 of finalizing the Incentive Fees for accounting and public reporting purposes.  Therefore, if the data required to complete a Scorecard Calculation remains unavailable for more than [**] the end of a Contract Year, the Parties agree that the Temporary Incentive Fees amount relating to such Scorecard Calculation shall be deemed final and binding upon the Parties, and shall no longer be subject to any adjustment or revision (including as a result of any audit or any newly discovered information or changes in data).

3.    Review of Performance and Measurement.
		
	3.1
	Review.  Starting with the Contract Year beginning on [**], the Parties agree to meet every to review the performance of IMH’s revenue cycle operations and to discuss the potential for amending the Scorecard Calculations set forth in Section 2.2 of this Exhibit 11.1-B to create other incentives for improvement. With respect to the Scorecard Calculations, beginning [**] and every [**] thereafter the Parties will have the opportunity to: (a) add new Metrics, provided that the Scorecard Calculations shall not use more than [**] Metrics at any time; (b) [**]; and (c) [**]. The Parties further agree that any such amendments to the Scorecard Calculation and Incentive Fees shall be completed in the first quarter of the Contract Year and shall apply to the Scorecard Calculations for that Contract Year.  Changes to Scorecard Calculations shall not be applied to a completed Contract Year. In the event that the Parties do not agree on changes to the Scorecard Calculation within [**] after the end of a Contract Year, the then-current Metrics, Weighting and Upper Bounds will remain in place for such Contract Year.

4.    [**].
		
	4.1
	Meaningful Improvements.  R1 acknowledges that IMH is working collaboratively with [**] to [**]. The Parties’ intent is that if the efficiency of such functionality is materially improved, then there should be a [**] for the IMH Facilities Book of Business. The Parties shall mutually agree as to what level of efficiency needs to be achieved [**] and make such determination no later than [**]. 

[**] Indicates that text has been omitted which is the subject of a confidential treatment request. The text has been separately filed with the Securities and Exchange Commission.
11.1-B-1-9

During each Review of Performance and Measurement, as provided in Section 3 above, the Parties will discuss in good faith as to whether the efficiency has been achieved and if so, will [**]. 
5.    IMH Provider Book of Business.  
		
	5.1
	Home Health Business.  R1 and IMH acknowledge and agree that post-acute care operations, including home health, skilled nursing and hospice care, (collectively “IMH Home Health”) are a distinct business unit within the IMH Providers Book of Business.  Accordingly, the Parties will work together in good faith during [**], to establish IMH Home Health as a separate Book of Business with a separate Incentive Fee from the IMH Providers Book of Business and the IMH Providers Incentive Fee.  If the Parties are not able to agree to the Metrics, Weighting, and Upper and Lower Bounds for a separate IMH Home Health Book of Business by [**], then either Party may submit the matter for resolution by the Joint Review Board.  Any determination by the Parties to separate IMH Home Health into a separate Book of Business that occurs prior to the last day of [**] or any later Contract Year shall be effective as of such Contract Year. If the Parties have not reached agreement by the end of the [**], then the separation of IMH Home Health into a separate Book of Business shall be effective in the Contract Year after the Contract Year in which the Parties mutually agreed to separate Metrics, Weighting and Upper and Lower Bounds for an IMH Home Health Book of Business.

6.    Windfall Situations 
6.1    In the event that IMH’s IT Environment experiences any outage or other support issue that materially affects the Actual Result or Balanced Score for any Metric (“IMH Support Issue”), the Parties shall promptly work to resolve the IMH Support Issue.  Until such time that the IMH Support Issue is resolved or a reasonable work around is implemented that eliminates the practical adverse effect of the IMH Support Issue on IMH and R1, the impacted Actual Result or Balanced Score for any such Metric will be calculated as if the IMH Support Issue did not occur, and IMH will pay Incentive Fees to R1 according to the revised calculations if payment is due based on the revised score.

[**] Indicates that text has been omitted which is the subject of a confidential treatment request. The text has been separately filed with the Securities and Exchange Commission.
11.1-B-1-10

Exhibit 11.1-B-1
Lower Bound Reset Calculation
Definitions:
		
	•
	“Metric Reset Percentage” means, for any Metric, the percentage set forth in the table below for such Metric.

	
			
	No.
	Metric
	Reset Percentage

	1
	[**]
	[**]

	2
	[**]
	[**]

	3
	[**]
	[**]

	4
	[**]
	[**]

	5
	[**]
	[**]

Reset Methodology: 
The Lower Bound for each Metric shall be adjusted [**], starting with the Lower Bound in effect for [**], as follows:
		
	1. 
	If the Metric’s Capped Score for [**] is equal to [**], then the Lower Bound shall not be adjusted.

		
	2.
	If the Metric’s Capped Score for [**] is equal to [**], then the Parties will discuss whether to adjust the Lower Bound and the Upper Bound, in accordance with Section 3.1 of Exhibit 11.1-B. The Parties intend that any adjustment of the Lower Bound of the Metric will be accompanied by an adjustment to the Upper Bound for the same Metric.

		
	3.
	In the event that the Metric’s Capped Score for [**] is equal to [**], then the Lower Bound for any such Metric shall be adjusted using [**] as the adjustment basis year [**].  

The Lower Bound shall be adjusted so that it is equal to the quotient of:
		
	a.
	the sum of: 

		
	i.
	the Actual Result for such Metric in [**], plus 

[**] Indicates that text has been omitted which is the subject of a confidential treatment request. The text has been separately filed with the Securities and Exchange Commission.
11.1-B-1-11

		
	ii.
	the product of (x) the Metric Reset Percentage for such Metric, multiplied by (y) the Upper Bound for such Metric in [**], less 

		
	iii.
	the product of: (x) the Upper Bound for such Metric in [**], multiplied by (y) the Balanced Score for such Metric in [**],

divided by
		
	b.
	the sum of: (i) one, plus (ii) the Metric Reset Percentage for such Metric, less (iii) the Balanced Score for such Metric in [**].  

		
	4.
	In the event that: (A) the Metric’s Capped Score for [**], then the Lower Bound for any such Metric shall be adjusted using [**] as the adjustment basis year [**].

The Lower Bound shall be adjusted so that it is equal to the quotient of:
		
	a.
	the sum of: 

		
	i.
	the Actual Result for such Metric in the [**] Year, plus 

		
	ii.
	the product of (x) the Metric Reset Percentage for such Metric, multiplied by (y) the Upper Bound for such Metric for the [**] Year, less 

		
	iii.
	the product of: (x) the Upper Bound for such Metric for the [**] Year, multiplied by (y) the Balanced Score for such Metric in the [**] Year,

divided by
		
	b.
	the sum of: (i) one, plus (ii) the Metric Reset Percentage for such Metric, less (iii) the Balanced Score for such Metric in the [**] Year.  

		
	5.
	Any such adjustments to the Lower Bound of any Metric shall be applied in the first quarter of the Contract Year and will take effect prospectively.  

[**] Indicates that text has been omitted which is the subject of a confidential treatment request. The text has been separately filed with the Securities and Exchange Commission.
11.1-B-1-12

Execution Copy

AMENDED AND RESTATED SERVICES AGREEMENT

between

IHC Health Services, Inc.

and

R1 RCM Inc.

EXHIBIT 11.1-C

PAYMENT TERMS

	
			
	 
	 
	 

	 
	 
	 

Exhibit 11.1-C 
Payment Terms
1.    Base Fees.
		
	1.1
	Base Fee Invoicing. The Base Fee will be invoiced [**] and paid [**].  R1 shall provide IMH with a properly stated invoice for the Base Fee [**] days before the [**] in which the Services applicable to IMH are to be provided. The [**]payment of the applicable portion of the properly stated invoice for Base Fee will be due on the [**] day of the applicable [**] and shall be made by wire transfer, or other mutually acceptable means. 

The properly stated Base Fee invoice shall [**] any earned Service Level Credits as described in Exhibit 3.6.
2.    Incentive Fees for Services.
		
	2.1
	Incentive Fee Invoicing.  Invoicing for Incentive Fees will be performed in the manner set forth in Exhibit 11.1-B. Payment for such properly stated invoices shall be made by wire transfer, or other mutually acceptable means, within [**] days after receipt of such invoice. 

3.    Miscellaneous.
		
	3.1
	Any disputes involving Base Fees or Incentive Fees shall be addressed in the manner set forth in Section 11 of the Services Agreement. 

		
	3.2
	All other charges, fees, reimbursements, and other amounts due or owing pursuant to this Agreement shall be paid by IMH by wire transfer or other mutually acceptable means, within [**] days after receipt of R1’s properly stated invoice with respect thereto.

[**] Indicates that text has been omitted which is the subject of a confidential treatment request. The text has been separately filed with the Securities and Exchange Commission.
11.1-C-1

AMENDED AND RESTATED SERVICES AGREEMENT

between

IHC Health Services, Inc.

and

R1 RCM Inc.

EXHIBIT 13.2

OUTSOURCING TO OFF-SHORE RESOURCES

[**] designates portions of this document that have been omitted pursuant to a request for confidential treatment filed separately with the Securities and Exchange Commission.

Exhibit 13.2 
Outsourcing to Off-Shore Resources
In accordance with Section 13.2 of the Services Agreement, R1 may provide the following Services from its shared services centers located in India:
		
	•
	[**];

		
	•
	[**];

		
	•
	[**];

		
	•
	[**];

		
	•
	[**];

		
	•
	[**];

		
	•
	[**]; 

		
	•
	[**];

		
	•
	[**]; 

		
	•
	[**]; 

		
	•
	[**].

Approved shared services centers locations/facilities:
		
	•
	Noida Shared Services Center: 
Building 3 and Building 9 Situated 
at IT/ITeS Sez, Sector 135 
Noida, India

		
	•
	Gurgeon Shared Services Center: 
Building 2, Tower A Situated at 
IT/ITeS Sez, Sector 21, 
Dundahera, Gurgaon, Haryana, India

		
	•
	Hyderabad Shared Services Center: 
NSL SEZ Arena, Survey No-1, Plot No. 6, Ramanthapur Road, Uppal, Gaddi, annaram, 
Hyderabad, Telangana 500039, India

		
	•
	Tikri Shared Services Center: 
Candor Gurgaon One Reality Projects 
Private Limited IT/ITES, SEZ 
2nd, 3rd and 4th floor, Building No. 1 
Village Tikri, Sector 48, Gurugram 122001

[**] Indicates that text has been omitted which is the subject of a confidential treatment request. The text has been separately filed with the Securities and Exchange Commission.
Exhibit 13.2-1

Exhibit 13.2-1 
Outsourcing to Off-Shore Resources [**]
In the event that R1 decides to shift the delivery of an approved Service to one of the shared service centers located in India or any other approved shared service center located outside of the continental United States, R1 will [**]. 
In harmony with the transition to the off-shore shared service center, R1 will update the Transition Work Plan (Exhibit 4.1) to include detailed milestones, tasks, and timelines for the related Service that will be moving to the off-shore service center.  The transition of the related Service will be done in harmony with all provisions in Section IV of the Services Agreement.  

[**] Indicates that text has been omitted which is the subject of a confidential treatment request. The text has been separately filed with the Securities and Exchange Commission.
Exhibit 13.2-1-1

Execution Copy

AMENDED AND RESTATED SERVICES AGREEMENT

between

IHC Health Services, Inc.

and

R1 RCM Inc.

EXHIBIT 14.1

THIRD PARTY AGREEMENTS

	
			
	 
	 
	 

	 
	 
	 

Exhibit 14.1 
Third Party Agreements
The table below will list all of the Third Party Agreements to be managed by or assigned to R1 RCM.  This form may be modified to include additional information about the Third Party Agreements, as necessary.
	
				
	Vendor
	Service Type
	Termination Date
	Scope/ Standard and Financial/Operational Responsibility (To Be Determined by the Parties)

	 
	 
	 
	 

	 
	 
	 
	 

	 
	 
	 
	 

	 
	 
	 
	 

	 
	 
	 
	 

	 
	 
	 
	 

	 
	 
	 
	 

	 
	 
	 
	 

	 
	 
	 
	 

	 
	 
	 
	 

	 
	 
	 
	 

	 
	 
	 
	 

	 
	 
	 
	 

	 
	 
	 
	 

	 
	 
	 
	 

	 
	 
	 
	 

	 
	 
	 
	 

	 
	 
	 
	 

	
			
	 
	Exhibit 14.1-1
	 

	 
	 
	 

Execution Copy

AMENDED AND RESTATED SERVICES AGREEMENT

between

IHC Health Services, Inc.

and

R1 RCM Inc.

EXHIBIT 16.1

RECOVERY ENVIRONMENT AND CONTINUITY OF BUSINESS REQUIREMENTS

	
			
	 
	 
	 

	 
	 
	 

Exhibit 16.1 
Recovery Environment and Continuity of Business Requirements 
Intermountain Healthcare desires to have uninterrupted access to the R1 Access technology in the event R1 enters bankruptcy protection and is no longer operating its business as a going concern, or otherwise abruptly ceases to operate its business, as specified in Section 16 of the Services Agreement.  To provide that access, R1 will:
		
	•
	Implement a sufficiently dedicated production environment for IMH that complies with the Malware and Security Agreement and provides segmentation of the IMH specific components to facilitate the creation of an independent, recoverable backup of the IMH production environment.

		
	•
	Execute scheduled, dedicated backups specifically for IMH’s production environment.

		
	•
	Contract with a 3rd party offsite backup storage vendor to hold the IMH production environment backup and make the backup available to IMH directly if and when a triggering event occurs (i.e., R1 enters bankruptcy protection and is no longer operating its business as a going concern, or otherwise abruptly ceases to operate its business).

		
	•
	[**] test the ability to restore individual servers from these backups.

		
	•
	At IMH’s discretion, execute [**] Q1 joint test of the Recovery environment.

R1 will provide the following dedicated production environment to support IMH (see definitions below for server type descriptions):
		
	•
	Separate directories will be used to receive IMH data on the [**] server.

		
	•
	Databases on separate logical portions of the storage area network (SAN) will be dedicated to IMH for use in the [**] servers.   

		
	•
	[**] servers will support user and partner interaction with each request logically separated from all other requests passing through the server.  These requests will not be stored on the server and will not survive a reboot.

The scheduled backups of the dedicated production environment will be executed in the following cycle:
		
	•
	Execute [**] system level backups for the [**] servers providing service to IMH.  These backups will (a) capture the configuration of each server and the services running on it and (b) allow a server to be restored to an empty “bare metal” server.

		
	•
	Execute [**] database server backups for the TRAN and CARE servers providing service to IMH.  These backups will capture (a) the configuration of the server and the services running on it, (b) the database including its configuration and stored procedures stored in it, and (c) the data in the database.

		
	•
	Execute [**] backups of the databases on the [**] servers providing service to IMH.  These backups will capture the current data in the database on the server.

The IMH backups will be written on dedicated sets of encrypted backup and, as noted above,  [**]:
		
	•
	[**] 

		
	•
	[**] 

		
	•
	R1 will notify IMH when changes are made in the technology used to back up the dedicated production environment. 

[**] Indicates that text has been omitted which is the subject of a confidential treatment request. The text has been separately filed with the Securities and Exchange Commission.
Exhibit 16.1-1

Independent of the joint [**] test, R1 will [**] restore each of the server types from encrypted backup to demonstrate that the above process is reliable in providing the ability to restore from the backups.  [**].  R1 will include this testing as part of its first fiscal quarter data center review process and will make the results of this testing available to IMH.
IMH and R1 will jointly document the procedures required to restore the Recovery Environment onto IMH’s owned or controlled hardware (i.e., at a non-R1 location).  IMH and R1 will review the recovery procedures [**] and, at IMH’s discretion, execute a joint test in the [**] of each [**] with the following parameters:
		
	•
	The test will consist of a pre-defined set of scripts created to validate key components of the application.

		
	•
	The test will simulate interactions with third party providers rather than create live connections. Detailed instructions will be created to implement live connections when required.

		
	•
	The test duration will be limited to [**] days.

		
	•
	IMH will maintain physical control over any back up media.

		
	•
	IMH will maintain access logs to the physical space, as well as to the information.

		
	•
	After the restoration is completed, IMH will dispose of or destroy the information and data in a secure manner consistent with the data destruction requirements in the Malware and Security Agreement between the Parties.

		
	•
	IMH agrees to be responsible for the protection and security of R1’s proprietary information and intellectual property, and as such, will indemnify R1, without limitation, from and against any claims, losses, damages and costs that result from any inappropriate disclosure, loss or misappropriation of the data and materials that are provided to IMH in connection with any periodic restoration that occurs in any non-R1 location.  In addition, IMH will be responsible for the incremental costs associated with performing the restoration at any such non-R1 location.

Definitions:
		
	•
	 [**]

		
	•
	 [**]

		
	•
	 [**]

		
	•
	 [**]

		
	•
	 [**]

		
	•
	 [**]

[**] Indicates that text has been omitted which is the subject of a confidential treatment request. The text has been separately filed with the Securities and Exchange Commission.
Exhibit 16.1-2

Execution Copy

AMENDED AND RESTATED SERVICES AGREEMENT

between

IHC Health Services, Inc.

and

R1 RCM Inc.

EXHIBIT 17.4

ACCESS AND CONFIDENTIALITY AGREEMENT 

	
			
	 
	 
	 

	 
	 
	 

Exhibit 17.4 
Access and Confidentiality Agreement
INTERMOUNTAIN HEALTHCARE  
ACCESS AND CONFIDENTIALITY AGREEMENT
Section 1. – Purpose and Definition
		
	1.1
	Purpose of this Agreement.   Federal and state laws, as well as Intermountain’s policies, protect Confidential Information, assure that it remains confidential, and permit it to be used for appropriate purposes.  Those laws and policies assure that Confidential Information,  which is sensitive and valuable, remains confidential. They also permit you to use Confidential Information only as necessary to accomplish legitimate and approved purposes. You need access to Confidential Information because you have one of the following roles:

		
	A.
	An Intermountain Workforce member, which includes volunteers (a ‘Workforce Member”): or

		
	B.
	An Intermountain-affiliated Provider, an Intermountain-credentialed  Provider, or a Provider’s employee  (a “Provider”) ;or

		
	C.
	A vendor or agent of IHC Health Services, Inc., or a Vendor’s or Agent’s employee or subcontractor (a “Vendor’’ or “Agent”).

		
	1.2
	Definition.  “Confidential Information” means data proprietary to Intermountain, other companies, or other persons, plus any other information that is private and sensitive and which Intermountain has a duty to protect. You may learn or access Confidential Information through oral communications, paper documents, computer systems, or through your activities at or with Intermountain. Examples of Confidential Information include the following information that is maintained by, or obtained from, Intermountain:

		
	A.
	An individual’s demographic, employment, or health information;

		
	B.
	Peer-review information;

		
	C.
	Intermountain’s business information, (e.g., financial and statistical records, strategic plans, internal reports, memos, contracts, peer review information, communications, proprietary computer programs, source code, proprietary technology, etc.); and

		
	D.
	Intermountain’s or a Third-party’s information (e.g., computer programs, client and vendor proprietary information, source code, proprietary technology, etc.).

Section 2. - Your Duties Under This Agreement
		
	2.1
	Compliance. To qualify to access or use Confidential Information, you will comply with the laws and Intermountain policies governing Confidential  Information.

	
			
	 
	Exhibit 17.4-1
	 

	 
	 
	 

		
	2.2
	Principal Duties. Your principal duties regarding Confidential Information include, but are not limited to, the following:

		
	A.
	Safeguard the privacy and security of Confidential Information;

		
	B.
	Use Confidential Information only as needed to perform your legitimate and Intermountain-approved responsibilities. This means, among other things, that you will not:

		
	(1)
	Access Confidential Information for which you have no legitimate need to know;

		
	(2)
	Divulge, copy, release, sell, loan, revise, alter, or destroy any Confidential Information except as properly authorized within the scope of your legitimate and Intermountain-approved  responsibilities; or

		
	(3)
	Misuse Confidential Information;

		
	C.
	Safeguard, and not disclose, your access code or any other authorization that allows you to access Confidential Information. This means, among other things, that you will:

		
	(1)
	Accept responsibility for all activities undertaken using your access code and other authorization; and

		
	(2)
	Report any suspicion or knowledge that you have that your access code, authorization, or any Confidential Information has been misused or disclosed without Intermountain’s permission(Report this suspicion or knowledge to  the Intermountain Compliance Hotline at 1-800-442-4845, or, if you are a member of Intermountain’s Workforce, to your supervisor or facility compliance coordinator.);

		
	D.
	Not remove Confidential Information from an Intermountain facility unless necessary for your legitimate and Intermountain-approved responsibilities (If removal of Confidential Information from an Intermountain facility is necessary, you will use reasonable and appropriate physical and technical safeguards-such as encrypting electronic Confidential Information.);

		
	E.
	Report activities by any Individual or entity that you suspect may compromise the confidentiality of Confidential Information (To the extent permitted by law, Intermountain will hold in confidence reports that are made in good faith about suspect activities, as well as the names of the individuals reporting the activities.):

		
	F.
	Not use or share Confidential Information after termination of your role triggering the requirement to sign this Agreement (For example, if you are a Workforce Member, when you leave Intermountain’s employment; if you are a Provider, when you lose your privileges at an Intermountain facility or your privileges to access Confidential 

	
			
	 
	Exhibit 17.4-2
	 

	 
	 
	 

Information; and if you are a Vendor or Agent, when you finish your assignment or project with Intermountain or when your company stops doing business with Intermountain, whichever is first.); and
		
	G.
	Claim no right or ownership interest in any Confidential Information referred to in this Agreement.

Section 3. Section 3.0 - Violation of Duty - Change of Status
		
	3.1
	Responsibility. You are responsible for your noncompliance with this Agreement.

		
	3.2
	Discipline. If you violate any provision of this Agreement, you will be subject to discipline, including but not limited to, the following:

		
	A.
	If you are a Workforce Member, to dismissal as a member of Intermountain’s Workforce, loss of employment with Intermountain, termination of your ability to access Confidential Information, and legal liability;

		
	B.
	If you are a Provider, a Vendor, or an Agent, to discipline, including revocation of your ability to access or use Confidential Information, and legal liability.

		
	3.3
	Relief. Any violation by you of any provision of this Agreement will cause irreparable injury to Intermountain that would not be adequately compensable in monetary damages alone or through other legal remedies, and will entitle Intermountain to the following:

		
	A.
	If you are a Workforce Member, or an Vendor or Agent, to preliminary and permanent injunctive relief, a temporary restraining order, and other equitable relief in addition to damages and other legal remedies; or

		
	B.
	If you are a Provider, to a court order prohibiting your use of Confidential Information except as permitted by this Agreement, and Intermountain may also seek other remedies: and

		
	3.4
	Authority. Intermountain may terminate your access to Confidential Information if your status as a Workforce Member, Provider, Vendor, or Agent changes, if Intermountain determines that to be in the best interests of Intermountain’s mission, or if you violate any provision of this Agreement.

Section 4. - Continuing Obligations. Your obligations under this Agreement continue after termination of your status as a Workforce Member, Provider, Vendor, or Agent.

Printed  Name:                        

Signature:                         Date:            

	
			
	 
	Exhibit 17.4-3
	 

	 
	 
	 

Execution Copy

AMENDED AND RESTATED SERVICES AGREEMENT

between

IHC Health Services, Inc.

and

R1 RCM Inc.

EXHIBIT 18.8

ADDITIONAL COMPLIANCE OBLIGATIONS
 

	
			
	 
	 
	 

	 
	 
	 

Exhibit 18.8
Additional Compliance Obligations
		
	1.
	Selection of Legal Counsel.  For avoidance of doubt, the selection of legal counsel, whether internal or external, to represent a Party in connection with the Services shall be made by such Party in its sole discretion.  

		
	2.
	IMH Compliance Policies and Procedures.  Subject to Section 18.7(b) of this Agreement, R1 and R1 Contractors shall comply with IMH policies and procedures relating to revenue cycle operations.

		
	3.
	Compliance Training Materials.  Without limiting Section 18.9 of the Services Agreement, the R1 Compliance Officer shall keep the IMH Compliance Officer informed of all material changes to R1 compliance training materials which are used to train R1 or IMH personnel in relation to Services provided under the Agreement.

		
	4.
	Communications.  The Parties agree that their respective communications departments will need to be coordinated and work in concert in order to provide for the efficient delivery of the Services.  Accordingly, each Party shall direct their respective communications’ departments and personnel to keep their counterparts at the other Party informed of and work collaboratively on all material form communications to patients, payers or regulators related to the Services.

		
	5.
	Authority of Intermountain Healthcare. Nothing in this Agreement shall be interpreted to restrict the rights or responsibilities of the governing body, medical staff, or the appointed administrator(s) of any IMH Facility or IMH Provider to exercise any authority or conduct any oversight required by Medicare conditions of participation, conditions of coverage, or other applicable laws or regulations. 

		
	6.
	IMH Budgets, Expenditures and Property.  IMH retains final approval authority and control over IMH’s annual budgets, capital expenditures, or disposition of IMH property.

		
	7.
	IMH 501(c)(3) Obligations.  The Parties expressly acknowledge that in furtherance of its charitable mission IMH has implemented charity care, billing and collection policies, procedures and guidelines (the “IMH Charity Care and Financial Assistance Policies”). Such policies may apply to both insured and uninsured patients and may require discounts to be given to both patients in financial need and those who are not.  R1 agrees to abide by the IMH Charity Care and Financial Assistance Policies or any amendment, replacements or additions thereto. The Parties further agree that IMH will promptly notify R1 of any such amendments, replacements or additions to said policies. The Parties additionally agree that there will be no targeting of uninsured patients in the course of implementing charge master and pricing initiatives. The Parties acknowledge that IMH is exempt from federal tax under Section 501(c)(3) of the Internal Revenue Code and that notwithstanding any other provision of this Services Agreement, IMH shall not be required to take any action or perform in a manner which jeopardizes its tax-exempt status, including IMH’s compliance with IRS 

	
			
	 
	Exhibit 18.8-1
	 

	 
	 
	 

Section 501(r).  R1 may raise any issues or proposed changes with the IMH Charity Care and Financial Assistance Policies to IMH via the Operations Oversight Council for IMH’s consideration in good faith, but the final determination regarding any such policies and procedures shall be made by IMH in its discretion.

	
			
	 
	Exhibit 18.8-2
	 

	 
	 
	 

Execution Copy

AMENDED AND RESTATED SERVICES AGREEMENT

between

IHC Health Services, Inc.

and

R1 RCM Inc.

EXHIBIT 18.9

ELEMENTS FOR [**] COMPLIANCE REPORT

[**] Indicates that text has been omitted which is the subject of a confidential treatment request. The text has been separately filed with the Securities and Exchange Commission.

Exhibit 18.9 
Elements for [**] Compliance Report
A.    Purpose
Pursuant to Section 18.9(b) of the Amended and Restated Services Agreement (“Agreement”), R1’s Compliance Officer (Executive Vice President, Compliance & Risk) will provide information regarding R1’s Compliance Program that relates to the Services or R1’s obligations under the Agreement, as requested by Intermountain’s Vice President, Business and Ethical Conduct (“VP-BEC”), regarding the scope and effectiveness of R1’s Compliance Program.  R1 shall deliver this information within [**] days after each [**] of the Effective Date (or as otherwise agreed to by the Parties) and will include an [**] compliance report to the VP-BEC as further set forth below in section B.  
B.    R1 Representations 
R1’s Compliance Officer will provide information about R1’s Compliance Program, including the following representations: 
		
	•
	Each of the activities described below have been initiated and/or completed for the applicable time period.

		
	•
	R1 maintains evidence to support the accomplishment of the activities included within this attestation.

		
	•
	Significant compliance matters have been disclosed to the VP-BEC and/or his/her designee. 

The [**] Compliance Report Attestation shall include the following information and supporting detail:
		
	1.
	High Level Oversight

		
	1.1
	Dedicated Compliance Officer

		
	1.2
	R1’s Compliance Officer will report to R1’s Board of Directors and/or any designated R1 committees or designees responsible for oversight of the Compliance Program, no less than [**] times [**].

		
	2.
	Risk Assessment

		
	2.1
	[**] risk assessment

		
	2.2
	Compliance work plan 

		
	3.
	Policies and Procedures

R1, through development by, oversight of, and/or monitoring led by its Compliance & Risk Department, has established and maintained policies and procedures in the following areas:
		
	3.1
	General Compliance Policy

		
	3.2
	Standards of Conduct

		
	3.3
	Criminal background testing

[**] Indicates that text has been omitted which is the subject of a confidential treatment request. The text has been separately filed with the Securities and Exchange Commission.
Exhibit 18.9-1

		
	3.4
	Excluded individuals/entities testing

		
	3.5
	Disciplinary sanctions for compliance violations

		
	3.6
	Reporting compliance issues

		
	3.7
	Investigation response

		
	3.8
	Conflicts of Interest

		
	3.9
	Coding and Billing procedures/guidelines

		
	3.10
	HIPAA/Privacy

		
	3.11
	HIPAA Security

		
	4.
	Training and Education

Under leadership by and management of R1’s Compliance & Risk Department, the company has established and maintained the following processes for compliance training and education:
		
	4.1
	[**] compliance training for all workforce members (employees, contractors)

		
	4.2
	Compliance onboarding training for all new workforce members

		
	4.3
	Written attestation of [**] review of Code of Conduct, Whistleblower & Anti-Retaliation Policy  

		
	4.4
	Focused compliance training for coding, billing and registration/admissions workforce members

		
	4.5
	Periodic compliance updates to all employees (e.g., online R1 Forum articles, e-mail communications)

		
	5.
	Open Lines of Communication

		
	5.1
	Anonymous compliance hotline

		
	5.2
	Compliance log/tracker of issues

		
	5.3
	Prompt response to compliance reports

		
	6.
	Auditing and Monitoring

		
	6.1
	Third-party coding and billing audits

		
	6.2
	Internal audits based on risks identified in compliance/compliance audit work plans

		
	7.
	Response to Detected Deficiencies

		
	7.1
	Action plan development and completion

		
	7.2
	Timely response to action plans

		
	8.
	Enforcement of Disciplinary Standards

		
	8.1
	Consistent discipline in response to violations of compliance policies

		
	8.2
	[**] review of excluded provider associates and contractors

		
	8.3
	Prompt response/corrective action in response to excluded provider testing

[**] Indicates that text has been omitted which is the subject of a confidential treatment request. The text has been separately filed with the Securities and Exchange Commission.
Exhibit 18.9-2

Execution Copy

AMENDED AND RESTATED SERVICES AGREEMENT

between

IHC Health Services, Inc.

and

R1 RCM Inc.

EXHIBIT 19.2

[**] REPORTS AND DATA SETS

[**] Indicates that text has been omitted which is the subject of a confidential treatment request. The text has been separately filed with the Securities and Exchange Commission.

Confidential Draft for Discussion Purposes Only

Exhibit 19.2 
[**] Reports and Data Sets
1.    Definitions
		
	•
	“Revenue Integrity Collected Accounts” has the meaning given in Section 3.6(a) of this Exhibit 19.2.

		
	2.
	General.  In accordance with Section 19.2 of the Services Agreement, R1 shall provide the following Reports and Data Sets on a [**] basis by no later than [**] days following the end of each [**], unless another deadline is explicitly specified within this Exhibit 19.2; provided that if problems with IMH’s IT Environment cause any delay in creating or providing Reports and Data Sets, then R1 will not be responsible for the delay in timely delivery of Reports and Data Sets but R1 must work in good faith with IMH and any applicable third party vendors or licensors to resolve those problems and overcome the delay.

		
	3.
	Dependent Standard Report Set

		
	3.1
	Summary.

		
	(a)
	Key Performance Indicators (“KPIs”) – R1 will provide all of the standard core operating metrics included in R1’s analytics platform on a [**] basis, as well as upon request. The standard core operating metrics will be provided for individual IMH Facilities and IMH Providers as well as at a consolidated levels for IMH Facilities, IMH Providers, and IMH.  IMH shall also have the right to request other key performance indicators not included in R1’s standard core operating metrics, and R1 will provide reasonable efforts to fulfill such request. Should R1 determine in good faith that such performance data cannot reasonably be provided or validated, or would be overly burdensome to provide or validate, the request will be referred to the Executive Council. The Executive Council will discuss possible approaches to providing the data, and determine whether and from where it will be obtained.

		
	(b)
	Any documentation required to support and comply with “Exhibit 3.6 – Service Levels” of the Services Agreement.

		
	(c)
	Any documentation or KPIs required to support and comply with Exhibit 11.1-A – Base Fee for Services” and “Exhibit 11.1-B – Incentive Fees” of the Services Agreement.

		
	3.2
	Registration.

		
	(a)
	[**] for each step of the registration process as currently agreed upon and calculated by the Parties.

		
	3.3.
	Self- pay and Uncompensated Care.

[**] Indicates that text has been omitted which is the subject of a confidential treatment request. The text has been separately filed with the Securities and Exchange Commission.
Exhibit 19.2-1

Confidential Draft for Discussion Purposes Only

		
	(a)
	Patient Totals – This report will provide metrics for all patients, broken out by patient type, who present as uninsured or self-pay during the period being measured.  The metrics will be [**] during the period.

		
	(b)
	Pending Conversion [**] – This report will detail the period end [**] who, as a result of the screening processes have been identified as potentially able to be converted to a paying solution. 

		
	3.4
	Patient Accounts Receivable - The total dollar amount of open accounts receivable from patients at the reporting date.  

		
	3.5
	Payor Accounts Receivable.

		
	(a)
	The total dollar amount of open accounts receivable from third party payors at the reporting date.  The total dollar amount will be stratified by payor.  The Payor Accounts Receivable report will also provide the aggregate amount of [**] at the reporting date.

		
	(b)
	Accounts Receivable [**].  This report will display the amount of patient accounts receivable at period end expressed in terms of [**], for self-pay as well as each third party payer.

		
	(c)
	[**] by Payor – This report will display the dollar amount of [**] by each third party payor at period end. To the extent reasonably available in IMH workflow and reporting tools, a breakdown of dollar amounts by hold reason and aging will also be included.

		
	(d)
	[**] Summary – This report will display by each third party payor the net dollar amount [**], and the net dollar amount of [**] during the prior rolling [**] months, as well as for all active accounts receivables.

		
	3.6
	Revenue Integrity Reports. On a [**] basis, Rl will deliver to IMH the following reports with respect to the Revenue Integrity Services:

		
	(a)
	a scorecard containing details on: [**]; and (iv) ideas for future projects.

		
	(b)
	a summary report of past, present and expected future projects and the status of such projects; and

		
	(c)
	a list of open issues, if any, or other items requiring discussion between the Parties.

		
	3.7
	Other Reports.  The Parties understand that the reports listed above are not all inclusive and R1 agrees to use reasonable efforts to provide to IMH such other reports as IMH reasonably requests. If R1 determines in good faith that any such additional reports cannot be provided or validated using reasonable efforts, then R1 may refer such request to the Operations Oversight Council to propose possible alternatives for producing the data 

[**] Indicates that text has been omitted which is the subject of a confidential treatment request. The text has been separately filed with the Securities and Exchange Commission.
Exhibit 19.2-2

Confidential Draft for Discussion Purposes Only

requested by IMH. The Operations Oversight Council also will provide guidance to R1 on where to obtain the data for any new reports.

[**] Indicates that text has been omitted which is the subject of a confidential treatment request. The text has been separately filed with the Securities and Exchange Commission.
Exhibit 19.2-3

Execution Copy

AMENDED AND RESTATED SERVICES AGREEMENT

between

IHC Health Services, Inc.

and

R1 RCM Inc.

EXHIBIT 23.8

DISENGAGEMENT SERVICES

	
			
	 
	 
	 

	 
	 
	 

Confidential Draft for Discussion Purposes Only

Exhibit 23.8 
Disengagement Services
1.    Definitions.
		
	•
	“Continued Services” means the portion of the Services under this Services Agreement that IMH requests to have continued during the Disengagement Period.

		
	•
	“Disengagement Period” has the meaning set forth in Section 2.1(a).

		
	•
	“Disengagement Plan” has the meaning set forth in Section 2.2(a).

		
	•
	“Disengagement Services” has the meaning set forth in Exhibit 1.1; for the avoidance of doubt, Disengagement Services exclude the Continued Services, but include any other services or assistance under this Exhibit.

		
	•
	“Equipment” has the meaning set forth in Section 2.2(e).

2.    Disengagement Services
		
	2.1
	Availability.  As part of the Services and subject to payment of fees substantively similar to the Charges, including as set forth in Sections 2.2(b) and 2.3 below or pursuant to any applicable Exhibit or Work Order, R1 shall provide to IMH and its designee(s) the Continued Services described in Section 2.2 below and any Disengagement Services requested by IMH pursuant to the terms of this Exhibit.

		
	(a)
	Period of Provision.  R1 shall provide Continued Services and Disengagement Services to IMH, commencing upon the effective date of a request for Continued Services and Disengagement Services, and, at IMH’s request, continuing for up to twelve (12) months following the effective date of the termination of the Services, or, if applicable, the expiration or termination of the Term of the Services Agreement (the “Disengagement Period”). Portions of the Continued Services could cease at different times during the Disengagement Period if and as requested by IMH.

		
	(b)
	Firm Commitment.  R1 shall provide any Continued Services and Disengagement Services regardless of the reason for termination of the Services or expiration or termination of the Services Agreement; provided, that if this Services Agreement is terminated by R1 under Section 23.3(a) of the Services Agreement for failure to pay undisputed amounts, R1 may require payment in advance at the beginning of each month for Disengagement Services to be provided or performed under this Exhibit 23.8.  Such advance payments shall be based on a reasonable estimate provided by R1 at least [**] days in advance of such month with any additional Charges or credits to be reflected on the next invoice.  In addition, if this Agreement is terminated by R1 under Section 23.3(a) for breach of R1’s Confidential Information or misuse of R1 Intellectual Property, then R1 may require that IMH provide reasonable assurance 

[**] Indicates that text has been omitted which is the subject of a confidential treatment request. The text has been separately filed with the Securities and Exchange Commission.

Exhibit 23.8-1

Confidential Draft for Discussion Purposes Only

of protection of R1’s Confidential Information or R1 Intellectual Property as applicable.
		
	(c)
	Performance.  All Continued Services and Disengagement Services shall be provided subject to and in accordance with the terms and conditions of this Agreement.  Without limiting the foregoing, R1 shall perform the Continued  Services with the same degree of accuracy, quality, and timeliness as it provided with respect to the same or similar Services during the Term, including compliance with the Service Levels and subject to Exhibit 3.6 and Service Level Credits (if applicable).  R1 personnel reasonably considered by IMH and R1 to be critical to the performance of the Continued Services and Disengagement Services shall be listed in the applicable Disengagement Plan and retained on the IMH account, unless reassignment is necessary for the retention of the employee by R1, as reasonably determined by R1 with notice to IMH (but reassignment will not excuse performance of the Continued Services or Disengagement Services as contemplated by this Exhibit).  Subject to the foregoing, assignment of personnel shall be consistent with the periods set forth in the Disengagement Plan.

		
	2.2
	Scope of Continued Services and Disengagement Services.  At IMH’s request, the Continued Services and Disengagement Services provided by R1 shall include the services, functions and responsibilities described below (in addition to any Disengagement Services described in the Disengagement Plan or in any particular Work Order under the Services Agreement).

		
	(a)
	General Support.  To the extent requested by IMH, R1 shall (i) use commercially reasonable efforts to assist IMH in developing a written disengagement plan (“Disengagement Plan”) to effect the disengagement, (ii) perform programming and consulting services to assist in implementing the Disengagement Plan, (iii) train personnel designated by IMH in the use of any business processes, work instructions and work procedures, any Equipment, materials or tools, and, subject to Section 2.2(g), third party software or systems used in connection with the performance of the Continued Services, (iv)  assist in the execution of a parallel operation, data migration and testing process until the successful completion of the transition or the end of the Disengagement Period, whichever is sooner, (v) create and provide copies of the Intermountain RCO Data stored or controlled by R1 in the format and on the media reasonably requested by IMH, (vi) provide a complete and up-to-date, electronic copy of R1’s SOPs for revenue cycle operations for the IMH Facilities and the IMH Providers and applicable business processes, work instructions and work procedures, subject to protection of R1’s Intellectual Property, including trade secrets and business processes, consistent with the Services Agreement (e.g., Section IX and XV), and (vii) provide other technical assistance requested by IMH that is reasonably related to the disengagement with respect to the Continued Services and transition to a substitute solution.

[**] Indicates that text has been omitted which is the subject of a confidential treatment request. The text has been separately filed with the Securities and Exchange Commission.

Exhibit 23.8-2

Confidential Draft for Discussion Purposes Only

		
	(b)
	Continuation of the Continued Services.  At and to the extent requested by IMH, R1 shall continue providing to IMH the Continued Services after their anticipated termination or the date of expiration or termination of the Services Agreement.  R1 shall provide any such Continued Services subject to and in accordance with the terms and conditions of this Services Agreement and IMH shall pay R1 the Charges specified in the Services Agreement that IMH would have been obligated to pay R1 for such Continued Services if the Agreement had not yet expired or been terminated or had the Continued Services not been terminated.  To the extent IMH requests a portion of the Services included in a particular Charge, the amount to be paid by IMH will be equitably reduced to reflect the portion of the Continued Services included in such Charge that R1 will not be providing or performing.

		
	(c)
	Hiring.  IMH shall be permitted to solicit during the provision of the Continued Services, but not hire, R1 employees assigned to the performance of Continued Services or Disengagement Services, during the Disengagement Period.  At the conclusion of the Disengagement Period, R1 shall waive its rights, if any, under contracts with such personnel restricting the ability of such personnel to be recruited or hired by IMH (and IMH may solicit and hire them notwithstanding Section 24.4 of the Services Agreement).  R1 shall provide IMH with reasonable assistance in its efforts to hire such R1 personnel, and shall give IMH reasonable access to such R1 personnel for interviews, evaluations and recruitment.  IMH shall endeavor to conduct the above-described hiring activity in a manner that is not unnecessarily disruptive of the performance by R1 of its obligations under this Services Agreement.

		
	(d)
	Software.  As provided in Section 15.3 of the Services Agreement and subject to payment of the Charges (or substantively similar fees) during the term of the Disengagement Services, R1 shall continue to provide and license to IMH the R1 Technology and the Software and Services License. The Software and Services License will terminate at the end of the Disengagement Period and IMH shall cease all use of the R1 Technology in accordance with Section 15.3 of the Services Agreement. Any license to the R1 Technology following the term of the Disengagement Services would be documented by the Parties in a separate agreement.

		
	(e)
	Equipment.  Except as otherwise agreed by the Parties, IMH shall have the right (but not the obligation) to purchase at [**], or assume the lease for, any equipment located in the Utah Center of Excellence owned or leased by R1 that is used by R1 exclusively to perform the Continued Services (“Equipment”).  In the case of R1-owned Equipment, at the time of such purchase, R1 will grant to IMH, a warranty of title and a warranty that such Equipment is free and clear of all liens and encumbrances.  

		
	(f)
	IMH Facilities, Equipment and Software.  To the extent that the Services requiring any IMH Facilities, equipment, materials and software are no longer being provided by R1, then R1 shall vacate the IMH Facilities and return to IMH, if not previously 

[**] Indicates that text has been omitted which is the subject of a confidential treatment request. The text has been separately filed with the Securities and Exchange Commission.

Exhibit 23.8-3

Confidential Draft for Discussion Purposes Only

returned, any such IMH owned equipment (including IMH provided equipment), IMH leased equipment, IMH owned materials and IMH licensed software, in condition at least as good as the condition when made available to R1, ordinary wear and tear excepted.  
		
	(g)
	Third Party Providers and In-Scope Agreements.   

		
	(i)
	R1 will use commercially reasonable efforts to make available to IMH on reasonable terms and conditions third party services then being utilized by R1 in the performance of the Services under shared agreements (e.g., agreements that R1 uses for multiple clients).

		
	(ii)
	IMH may, in its sole discretion, assume any third party license and service agreements used by R1 to provide the Services that are dedicated exclusively to IMH (e.g., agreements that are only used for IMH Services).

		
	(iii)
	At IMH’s request, R1 shall reassign to IMH any In-Scope Agreement that has been assigned to R1 pursuant to, and in accordance with, this Agreement and is still in effect at the time of the expiration or other termination of this Agreement, to the extent legally permitted and commercially practicable. R1 will not be liable for any breach by IMH of an assigned In-Scope Agreement.  Intermountain will not be liable for any breach by R1 of an assigned In-Scope Agreement.  Each Party will indemnify the other Party against any claims or damages to the extent arising from breach of an assigned In-Scope Agreement caused by the assigning Party.

		
	(iv)
	It is understood and agreed that, in all events, IMH retains the right to contract directly with any service provider, contractor or third party with which IMH was contracted prior to the Effective Date.

		
	2.3
	Rates and Charges.  Except as provided in Section 2.2(b) above, to the extent the Continued Services and Disengagement Services requested by IMH can be provided by R1 using personnel and resources already assigned to perform Services for IMH and where R1 is being compensated for such personnel or resource through payment of the Charges specified in the Services Agreement, there will be [**] to IMH for such Continued Services or Disengagement Services provided by such personnel or resource.  If material Disengagement Services requested by IMH cannot be provided by R1 using [**] without adversely affecting R1’s ability to meet its performance obligations under this Services Agreement, then IMH, in its sole discretion, may forego or delay any work activities or temporarily or permanently adjust the work to be performed by R1, the schedules associated with such work or the Service Levels to permit the performance of such Disengagement Services using such personnel.  To the extent IMH authorizes R1 to use additional R1 personnel to perform material Disengagement Services requested by IMH, IMH shall pay R1 the rates and charges specified in the Services Agreement, including any applicable Exhibit or Work Order, or, if no such rates and charges are specified in the Agreement, the Parties will come to agreement 

[**] Indicates that text has been omitted which is the subject of a confidential treatment request. The text has been separately filed with the Securities and Exchange Commission.

Exhibit 23.8-4

Confidential Draft for Discussion Purposes Only

on reasonable rates to be charged prior to R1 allocating additional resources or personnel to the IMH account. 
		
	2.4
	Intent.  The intent of this Exhibit, the Continued Services and Disengagement Services is to ensure a successful transition from the Services to a substitute solution for IMH and its revenue cycle operations.  Accordingly, if any additional services, information or assistance from R1 is reasonably requested by IMH, then R1 will provide the services, information and assistance to IMH as additional Disengagement Services, and they will be subject to any additional payment obligations under this Exhibit for Disengagement Services.  At IMH’s reasonable request, the Parties will amend the Disengagement Plan to better reflect the intent expressed above. The Disengagement Period may be extended by mutual agreement of the Parties.

[**] Indicates that text has been omitted which is the subject of a confidential treatment request. The text has been separately filed with the Securities and Exchange Commission.

Exhibit 23.8-5

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