Document:

Exhibit 10.161

 

 

AMENDMENT TO

MEDICARE+CHOICE PHYSICIAN GROUP SERVICE AGREEMENT

 

This Amendment is entered into effective January 1,
2002, by and between
California Physicians’ Service, Inc. dba Blue Shield of California (“Health
Plan”) and NorthWest Orange County Medical Group (“Physician Group”) in
order to modify the Medicare+Choice Physician Group Service Agreement
(“Agreement”), which was effective September 1, 1990, as amended.

 

Recitals

 

A.                                   Whereas, Health
Plan and Physician Group entered into a Medicare+Choice Physician Group Service
Agreement on September 1, 1990;

 

B.                                     Whereas, Health
Plan and Physician Group have reached an agreement regarding Physician Group’s
outstanding deficit balance of $210,103.31 (“Deficit Balance”) for the Pharmacy
Risk Sharing Program for calendar years 1998 through 2000;

 

C.                                     Whereas, Health
Plan and Physician Group have reached an agreement regarding the disposition of
the pharmacy deficit for the Pharmacy Risk Sharing Program for calendar year
2001, which shall be determined in accordance with the terms of this Amendment
and the timeframes outlined in Section D. Reports and Timely Settlement of
Attachment B and Section 4. Reports and Timely Settlement of Attachment
B-3 of the Agreement; and

 

D.                                    Whereas, Health
Plan and Physician Group have agreed upon new contractual terms for the
Agreement.

 

NOW, THEREFORE, in consideration of the recitals,
covenants, conditions and promises contained in the Agreement, the parties
agree that the Agreement is hereby amended as follows:

 

1.                                       Health Plan and
Physician Group agree to resolve Physician Group’s $210,103.31 Deficit Balance
(such balance represents Physician Group’s share of Pharmacy Risk Sharing
Program deficits for calendar years 1998 through 2000) through the process
outlined below. Documentation of the Deficit Balance is set forth in Attachment
1, attached to this Amendment and incorporated herein.

 

A.                                   Health Plan shall
forgive forty percent (40%) of Physician Group’s Deficit Balance by writing off
$84,041.39. Physician Group will never be responsible for paying Health Plan
the $84,041.39.

 

B.                                     Physician Group
agrees to deductions in its Capitation Fees of $7,003.44 per month (“Monthly
Payment”) by Health Plan for the time period of April 2002 through
September 2003.  These eighteen
(18) Monthly Payments represent Physician Group’s payment in full of the
$126,061.92 portion of the Deficit Balance. 
If the Agreement is terminated for any reason during

 

 

*** Confidential Information
omitted and filed separately with the Securities and Exchange Commission.

 

1

 

this eighteen (18) month period,
then Physician Group shall make the remaining monthly payments to Health Plan
by the fifteenth (15th) of the month. Any payments not received by Health
Plan by the fifteenth (15th) of a month shall accrue interest at the
Bank of America reference rate, plus two percent (2%) per annum, until paid by
Physician Group.

 

C.                                     Physician Group shall provide Health Plan
with any proposed revisions to the Deficit Balance on or before March 29,
2002. Health Plan will deny any proposed revisions submitted by Physician Group
after this date. By May 15, 2002, Health Plan shall provide Physician Group
with the results of its review of any proposed revisions that were received
from Physician Group on or before March 29, 2002.  Health Plan shall incorporate any mutually
agreed upon revisions into the Deficit Balance to arrive at a revised balance
(“Revised Balance”). The Revised Balance, less the Monthly Payments already
received by Health Plan from Physician Group, shall be divided by the number of
remaining Monthly Payments in order to arrive at a revised monthly payment
(“Revised Monthly Payment”). The Revised Monthly Payment will be incorporated
into a written amendment to the Agreement, which shall be executed by both
parties. Such Revised Monthly Payment amount shall replace the Monthly Payment
amount stated in this amendment. In the absence of any mutually agreed upon
revisions to the Deficit Balance as delineated above, Physician Group shall
remain obligated to pay the Monthly Payments defined by this Amendment.

 

2.                                       Health Plan and Physician Group agree to
resolve Physician Group’s share of the pharmacy deficit for the calendar year
2001 Pharmacy Risk Sharing Program through the process outlined below.

 

A.                                   Health Plan shall forgive fifty percent
(50%) of Physician Group’s share of the pharmacy deficit by writing off such
amount. Physician Group shall only be responsible for paying Health Plan fifty
percent (50%) of Physician Group’s share of the pharmacy deficit, as defined by
Attachments B and B-3. Such payment shall represent payment in full by
Physician Group.  This reduced amount
shall be paid by Physician Group to Health Plan in six (6) equal monthly
payments by the fifteenth (15th) of the month for the time period of
October 2003 through March 2004. If Health Plan does not receive a
monthly payment from Physician Group by the fifteenth (15th) of any
month during this time period, then Health Plan may deduct such overdue monthly
payment from the Physician Group’s next monthly Capitation Fee.

 

B.                                     With regard to any proposed revisions to the
Pharmacy Costs for the calendar year 2001 Pharmacy Risk Sharing Program by
Physician Group, Health Plan and Physician Group agree to abide by the
provisions outlined under Section D. Reports and Timely Settlement of
Attachment B and Section 4. Reports and Timely Settlement of Attachment
B-3.

 

2

 

3.                                  Effective for dates of service on and after
January 1, 2002, the Agreement is hereby amended as follows:

 

A.                                   Attachment B-3, Fund Allocation and Risk
Sharing, for West Anaheim Medical Center is hereby deleted in its entirety and
is replaced with the attached Attachment B-4, Fund Allocation and Risk Sharing,
for West Anaheim Medical Center. All references in the Agreement to “Attachment
B-3” shall now be references to “Attachment B-4.”

 

B.                                     Attachment B, Fund Allocation and Risk
Sharing, for La Palma Intercommunity Hospital is hereby deleted in its entirety
and is replaced with the attached Attachment B-5, Fund Allocation and Risk
Sharing, for La Palma Intercommunity Hospital. All references in the Agreement
to “Attachment B” shall now be references to “Attachment B-5.”

 

C.                                     Beginning calendar year 2002, if any
calendar year’s Pharmacy Risk Sharing Program results in a pharmacy surplus,
then Physician Group’s share of the pharmacy surplus shall be offset against
the total dollar value of Physician Group’s remaining monthly payments, as defined
under Sections 1 and 2 above. This revised dollar value shall be divided by the
number of months remaining in the April 2002 through March 2004
payment cycle. This new per month payment amount shall be documented in an
amendment to the Agreement, which shall be executed by both parties. Such
amendment shall document Physician Group’s reduced monthly payments, which
shall be paid to Health Plan via deductions to Physician Group’s monthly
Capitation Fees or via monthly payments by Physician Group as defined in
Sections 1 and 2 above.  Physician
Group’s share of subsequent Pharmacy Risk Sharing Program surplus balances
would be offset against the total dollar value of Physician Group’s remaining
monthly payments in the same manner.

 

4.                                  All other provisions of the Agreement or its
Amendments or Addendums not inconsistent herein shall remain in full force and
effect.

 

IN WITNESS WHEREOF, the parties
hereto have executed this Amendment as of the date and year first written
above.

 

	
  BLUE
  SHIELD OF CALIFORNIA

  	
  NORTHWEST ORANGE COUNTY MEDICAL

  GROUP

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  By:

  	
  /s/ Lisa Rubino

  	
   

  	
  By:

  	
  /s/ Pratibha Patel

  	
   

  
	
   

  	
   

  	
   

  	
   

  
	
  Name:

  	
  Lisa Rubino

  	
   

  	
  Name:

  	
  PRATIBHA PATEL, MD

  	
   

  
	
   

  	
   

  	
   

  	
   

  
	
  Title:

  	
  Sr. VP IGBU

  	
   

  	
  Title:

  	
  PRESIDENT

  	
   

  
	
   

  	
   

  	
   

  	
   

  
	
  Date:

  	
  4/8/02

  	
   

  	
  Date:

  	
  3/18/02

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
  PREMIER PHYSICIAN SERVICES

  
	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
  By:

  	
  /s/ James P. Agronick

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
  Name:

  	
  JAMES P. AGRONICK

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
  Title:

  	
  CEO

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
  Date:

  	
  3/18/02

  	
   

  
							

 

3

 

ATTACHMENT B-4

 

FUND ALLOCATION AND RISK SHARING

 

	
  Hospital:

  	
   

  	
  West
  Anaheim Medical Center

  
	
   

  	
   

  	
   

  
	
  Physician Group:

  	
   

  	
  NorthWest
  Orange County Medical Group

  

 

1.                                       Allocation of CMS
Capitation. Each month,
Health Plan shall allocate the gross capitation that it receives from CMS, on
behalf of Enrollees affiliated with Hospital and Physician Group, as follows:

 

	
  Hospital Capitation

  	
   

  	
  ***

  	
   

  
	
  Physician Group Capitation

  	
   

  	
  ***

  	
   

  
	
  Pharmacy Capitation

  	
   

  	
  ***

  	
   

  

 

•                                          Hospital capitation shall be paid to
Hospital.

 

•                                          35.90% of the Monthly CMS Capitation
received by Health Plan from CMS and the equivalent percentage of the actual
Monthly Blue Shield 65 Plus Premium (as described below) which Health Plan
determines, according to its actuarial standards and methodology, to be for a
benefit that is included in the Enrollee’s basic benefit plan and for which
Physician Group bears financial risk, shall be paid to Physician Group as its
Capitation Fee. Health Plan will retain 100% of premiums collected for benefits
considered supplemental to the basic benefit plan (as described below). Health
Plan may make monthly retroactive adjustments to reflect any retroactive
adjustments made by CMS to the Monthly CMS Capitation.

 

The “Monthly CMS Capitation”
refers to the monthly premium payment made by CMS to Health Plan as payment to
Health Plan for the provision of services to the Blue Shield 65 Plus Enrollees
enrolled in Health Plan.

 

The “Monthly Blue Shield 65 Plus
Premium Payments” refers those additional premium payments which Health Plan
receives directly from the Enrollee or from the employer group for basic
benefit plan provisions.

 

“Supplemental Benefits” are
benefits offered to enhance the basic benefit provided by Health Plan in the
Enrollee’s county of residence. Additional premiums (beyond the base plan
premium, if applicable) are collected from Enrollees and employer groups for
such benefits. Physician Group shall have no financial responsibility for the
administration and/or delivery of such benefits.

 

•                                          Pharmacy Capitation shall be retained by
Health Plan to pay expenses of providing the outpatient prescription drug program.
Pharmacy, Capitation shall

 

4

 

include 7.25% of the Monthly CMS
Capitation received by Health Plan from CMS and 7,25% of the monthly premium
received by Health Plan from the Enrollee or from an Employer Group which
Health Plan determines, according to its actuarial standards and methodology,
to be for outpatient prescription drug services.

 

2.                                       Shared Risk Program Between
Hospital and Physician Group.   As
an incentive to control hospital service utilization a shared risk program
shall be established exclusively between the Hospital and the Physician Group.
A copy of the shared risk agreement between Hospital and Physician Group shall
be furnished to Health Plan.

 

2.1                                 Shared Risk
Services-Definition.   The
following are Shared Risk Services:

 

All Covered Services which are the financial responsibility of the
Hospital as set forth in Attachment A-3.

 

2.2                                 Physician Group Withhold. Physician Group agrees to establish
reserves in lieu of withhold, which reflect Physician Group’s potential
liability to Hospital under Shared Risk Program.

 

2.3                                 Copayments and COB. Copayments payable for Covered Services
shall be deducted from shared risk costs. Amounts payable, for Coordination of
Benefits or worker’s compensation shall be deducted from shared risk costs, up
to the amount of shared risk costs for the particular service.  Amounts actually received by Hospital
through third party liability recoveries for Shared Risk Services shall be
deducted from shared risk costs in the period in which such payment is actually
received, up to the amount of shared risk costs for the particular service.

 

3.                                       Pharmacy Risk Sharing Program.

 

3.1                                 Funding: For Enrollees enrolled in Blue Shield 65
Plus and assigned to Physician Group, Health Plan will allocate to a separately
administered Pharmacy Risk Sharing Fund the Pharmacy Capitation amount defined
above. All membership is subject to retroactive adjustments either upward or
downward due to retroactive changes in membership.

 

3.2                                 Charging of Payments:  
Health Plan will charge against the Pharmacy Risk Sharing Fund the
actual cost paid by Health Plan for outpatient prescription drug services
provided to Enrollees assigned to Physician Group, as well as a reasonable
allowance, as determined by Health Plan’s actuaries, for incurred but not paid
(IBNP) outpatient prescription drug claims. 
Pharmacy costs include the ingredient cost for Covered Services rendered
to Enrollees for which the Pharmacy Risk Sharing Fund is financially
responsible per Attachment A-3, professional dispensing fees paid to
participating pharmacies, less associated pharmacy Copayment revenue. Any costs
for outpatient prescription drug services not included in any annual settlement
shall be carried forward and included in the Pharmacy Risk Sharing Program
settlement for the succeeding

 

5

 

calendar year. In addition, if
this Agreement is replaced or superceded by any other agreement between the
parties which contained a risk sharing arrangement for similar services; then
the following shall also be charged against the shared savings fund described
herein: (i) any deficit in the final settlement of that risk sharing
arrangement and, (ii) any claims for risk services which were incurred but not
included in the settlement of the risk arrangement in the prior agreement.

 

3.3                                 Pharmacy Risk Sharing
Program Settlement  The Pharmacy Risk Sharing Program shall be
settled on an annual basis, within one hundred eighty (180) days following the
end of each calendar year (being a 120 day claims run out and a 60 day
determination period) or as State or Federal law dictates. In the event of
termination of the Agreement for any reason, final settlement of the Pharmacy
Risk Sharing Program shall be performed one hundred fifty (150) days after the
date of termination and any amounts due from Health Plan to Physician Group
shall be paid within thirty (30) days thereafter.

 

Surplus: If the total actual cost of outpatient
prescription drugs is less than the total allocation to the Pharmacy Risk
Sharing Fund, then Physician Group shall be entitled to fifty percent (50%) of
the amount by which the allocation exceeds the costs, minus any carry forward
resulting from deficits from previous calendar years. However, Physician
Group’s share of the Surplus for any calendar year shall not exceed twenty
percent (20%) of the total allocation to the Pharmacy Risk Sharing Fund.

 

Deficit: If the total actual cost of Pharmacy
services is more than the total allocation to the Pharmacy Risk Sharing Fund,
then fifty percent (50%) of the amount by which the actual costs exceed the
total allocation, not to exceed ten percent (10%) of the total allocation to
the Pharmacy Risk Sharing Fund, shall be allocated to Physician Group and shall
be handled as follows: (i) the excess may be deducted from any other
settlements or payments for any Health Plan contract, except capitation and
professional stop loss program payments, due to Physician Group from Health
Plan, and, (ii) any remaining amounts shall be carried forward into future
calendar years and shall be deducted from Pharmacy Risk Sharing Program
Payments to Physician Group and/or other settlements and payments due to
Physician Group from Health Plan in future years.

 

3.4                                 Summaries & Settlements:  Health Plan shall provide to Physician
Group, as further described in the Provider Manual, on a quarterly basis, a
summary of the Pharmacy Risk Sharing Program expenses along with a comparison
to the Pharmacy Risk Sharing Program funding and utilization data pertaining to
the cost of prescriptions written on a physician specific basis. Health Plan
shall also provide to Physician Group a Pharmacy Risk Sharing Program Annual
Settlement.

 

6

 

ATTACHMENT B-5

 

FUND ALLOCATION AND RISK SHARING

 

	
  Hospital:

  	
   

  	
  La Palma Intercommunity Hospital

  
	
   

  	
   

  	
   

  
	
  Physician
  Group:

  	
   

  	
  NorthWest Orange County Medical Group

  

 

1.                                       Allocation of CMS
Capitation. Each month, Health
Plan shall allocate the gross capitation that it receives from CMS, on behalf
of Enrollees affiliated with Hospital and Physician Group, as follows:

 

	
  Hospital Capitation

  	
   

  	
  ***

  	
   

  
	
  Physician Group Capitation

  	
   

  	
  ***

  	
   

  
	
  Pharmacy Capitation

  	
   

  	
  ***

  	
   

  

 

•                                          Hospital capitation shall be paid to
Hospital.

 

•                                          38.60% of the Monthly CMS Capitation
received by Health Plan from CMS and the equivalent percentage of the actual
Monthly Blue Shield 65 Plus Premium (as described below) which Health Plan
determines, according to its actuarial standards and methodology, to be for a
benefit that is included in the Enrollee’s basic benefit plan and for which
Physician Group bears financial risk, shall be paid to Physician Group as its
Capitation Fee. Health Plan will retain 100% of premiums collected for benefits
considered supplemental to the basic benefit plan (as described below). Health
Plan may make monthly retroactive adjustments to reflect any retroactive
adjustments made by CMS to the Monthly CMS Capitation.

 

The “Monthly CMS Capitation”
refers to the monthly premium payment made by CMS to Health Plan as payment to
Health Plan for the provision of services to the Blue Shield 65 Plus Enrollees
enrolled in Health Plan.

 

The “Monthly Blue Shield 65 Plus
Premium Payments” refers those additional premium payments which Health Plan
receives directly from the Enrollee or from the employer group for basic
benefit plan provisions.

 

“Supplemental Benefits” are
benefits offered to enhance the basic benefit provided by Health Plan in the
Enrollee’s county of residence. Additional premiums (beyond the base plan
premium, if applicable) are collected from Enrollees and employer groups for
such benefits. Physician Group shall have no financial responsibility for the
administration and/or delivery of such benefits.

 

•                                          Pharmacy Capitation shall be retained by
Health Plan to pay expenses of providing the outpatient prescription drug
program. Pharmacy Capitation shall

 

7

 

include 7.25% of the Monthly CMS
Capitation received by Health Plan from CMS and 7.25% of the monthly premium
received by Health Plan from the Enrollee or from an Employer Group which
Health Plan determines, according to its actuarial standards and methodology,
to be for outpatient prescription drug services.

 

2.                                       Shared Risk Program Between Hospital and Physician Group.  As an incentive to control hospital service utilization a shared risk program
shall be established exclusively between the Hospital and the Physician Group.
A copy of the shared risk agreement between Hospital and Physician Group shall
be furnished to Health Plan.

 

2.1                                 Shared Risk
Services—Definition.   The following are Shared Risk Services:

 

All Covered Services which are the financial responsibility of the
Hospital as set forth in Attachment A.

 

2.2                                 Physician Group Withhold. Physician Group agrees to establish
reserves in lieu of withhold, which reflect Physician Group’s potential
liability to Hospital under Shared Risk Program.

 

2.3                                 Copayments and COB. Copayments payable for Covered Services
shall be deducted from shared risk costs. Amounts payable, for Coordination of
Benefits or worker’s compensation shall be deducted from shared risk costs, up
to the amount of shared risk costs for the particular service.  Amounts actually received by Hospital
through third party liability recoveries for Shared Risk Services shall be
deducted from shared risk costs in the period in which such payment is actually
received, up to the amount of shared risk costs for the particular service.

 

3.                                      Pharmacy Risk Sharing Program.

 

3.1                                 Funding: 
For Enrollees enrolled in Blue Shield 65 Plus and assigned to Physician
Group, Health Plan will allocate to a separately administered Pharmacy Risk
Sharing Fund the Pharmacy Capitation defined above. All membership is subject
to retroactive adjustments either upward or downward due to retroactive changes
in membership.

 

3.2                                 Charging of Payments: 
Health Plan will charge against the Pharmacy Risk Sharing Fund the
actual cost paid by Health Plan for outpatient prescription drug services
provided to Enrollees assigned to Physician Group, as well as a reasonable
allowance, as determined by Health Plan’s actuaries, for incurred but not paid
(IBNP) outpatient prescription drug claims. 
Pharmacy costs include the ingredient cost for Covered Services rendered
to Enrollees for which the Pharmacy Risk Sharing Fund is financially
responsible per Attachment A, professional dispensing fees paid to
participating pharmacies, less associated pharmacy Copayment revenue. Any costs
for outpatient prescription drug services not included in any annual settlement
shall be carried forward and included in the Pharmacy Risk Sharing Program
settlement for the succeeding

 

8

 

calendar year. In addition, if this Agreement
is replaced or superceded by any other agreement between the parties which
contained a risk sharing arrangement for similar services; then the following
shall also be charged against the Shared Savings Fund described herein: (i) any
deficit in the final settlement of that risk sharing arrangement and, (ii) any
claims for risk services which were incurred but not included in the settlement
of the risk arrangement in the prior agreement.

 

3.3                                     Pharmacy Risk Sharing
Program Settlement  The Pharmacy Risk Sharing Program shall be
settled on an annual basis, within one hundred eighty (180) days following the
end of each calendar year (being a 120 day claims run out and a 60 day
determination period) or as State or Federal law dictates. In the event of
termination of the Agreement for any reason, final settlement of the Pharmacy
Risk Sharing Program shall be performed one hundred fifty (150) days after the
date of termination and any amounts due from Health Plan to Physician Group
shall be paid within thirty (30) days thereafter.

 

Surplus: If the total actual cost of outpatient
prescription drugs is less than the total allocation to the Pharmacy Risk
Sharing Fund, then Physician Group shall be entitled to fifty percent (50%) of
the amount by which the allocation exceeds the costs, minus any carry forward
resulting from deficits from previous calendar years. However, Physician
Group’s share of the Surplus for any calendar year shall not exceed twenty
percent (20%) of the total allocation to the Pharmacy Risk Sharing Fund.

 

Deficit: If the total actual cost of Pharmacy
services is more than the total allocation to the Pharmacy Risk Sharing Fund,
then fifty percent (50%) of the amount by which the actual costs exceed the
total allocation, not to exceed ten percent (10%) of the total allocation to
the Pharmacy Risk Sharing Fund, shall be allocated to Physician Group and shall
be handled as follows: (i) the excess may be deducted from any other
settlements or payments for any Health Plan contract, except capitation and
professional stop loss program payments, due to Physician Group from Health
Plan, and, (ii) any remaining amounts shall be carried forward into future
calendar years and shall be deducted from Pharmacy Risk Sharing Program
Payments to Physician Group and/or other settlements and payments due to
Physician Group from Health Plan in future years.

 

3.4                                     Summaries & Settlements: 
Health Plan shall provide to Physician Group, as further described in
the Provider Manual, on a quarterly basis, a summary of the Pharmacy Risk
Sharing Program expenses along with a comparison to the Pharmacy Risk Sharing
Program funding and utilization data pertaining to the cost of prescriptions
written on a physician specific basis. Health Plan shall also provide to
Physician Group a Pharmacy Risk Sharing Program Annual Settlement.

 

9

 

CareAmerica Southern California

Medicare Pharmacy Benefit Analysis

January-December 1998

 

NORTHWEST ORANGE COUNTY MED GROUP 
HLY

 

	
  Month

  	
   

  	
  Member

  Months

  	
   

  	
  Pharmacy

  Budget

  	
   

  	
  Med

  Impact

  Claims

  	
   

  	
  Completion

  Factor

  	
   

  	
  Incurred

  Claims

  	
   

  	
  Claims

  Outstanding

  	
   

  	
  Pharmacy

  Budget

  PMPM

  	
   

  	
  Incurred

  Claims

  PMPM

  	
   

  	
  Variance

  PMPM

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  January

  	
   

  	
  97

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  1.00

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  February

  	
   

  	
  97

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  1.00

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  March

  	
   

  	
  95

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  1.00

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  April

  	
   

  	
  97

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  1.00

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  May

  	
   

  	
  100

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  1.00

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  June

  	
   

  	
  97

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  1.00

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  July

  	
   

  	
  99

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  1.00

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  August

  	
   

  	
  99

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  1.00

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  September

  	
   

  	
  100

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  1.00

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  October

  	
   

  	
  103

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  1.00

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  November

  	
   

  	
  103

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  1.00

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  December

  	
   

  	
  101

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  0.98

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  1188

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  0.98

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  

 

Note:  The fractional components
of certain totals do not add exactly due to rounding

 

SUMMARY

 

	
  REVENUES:

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  
	
  Pharmacy Budget

  	
   

  	
  ***

  	
   

  
	
   

  	
   

  	
   

  	
   

  
	
  PHARMACY COSTS:

  	
   

  	
  ***

  	
   

  
	
   

  	
   

  	
   

  	
   

  
	
  MedImpact

  	
   

  	
  ***

  	
   

  
	
   

  	
   

  	
   

  	
   

  
	
  IBNR (Estimate)

  	
   

  	
  ***

  	
   

  
	
   

  	
   

  	
   

  	
   

  
	
  Claims Incurred

  	
   

  	
  ***

  	
   

  
	
   

  	
   

  	
   

  	
   

  
	
  Surplus (Deficit)

  	
   

  	
  ***

  	
   

  
	
   

  	
   

  	
   

  	
   

  
	
  Net Payable to
  (From) Physician Group

  	
   

  	
  ***

  	
   

  

 

	
  Pharmacy Shared Risk:

  	
   

  	
  Deficit: 
  50% of the deficit shall be paid by the Physician Group to the Health
  Plan.

  	
  ***

  
	
   

  	
   

  	
  Surplus: 
  50% of the surplus shall be paid by the Health Plan to the Physician
  Group.

  	
  ***

  

 

 

CareAmerica Southern California

Medicare Pharmacy Benefit Analysis

January-December 1998

 

NORTHWEST ORANGE COUNTY MED GROUP HLY

 

	
  Month

  	
   

  	
  Member

  Months

  	
   

  	
  Pharmacy

  Budget

  	
   

  	
  Med

  Impact

  Claims

  	
   

  	
  Completion

  Factor

  	
   

  	
  Incurred

  Claims

  	
   

  	
  Claims

  Outstanding

  	
   

  	
  Pharmacy

  Budget

  PMPM

  	
   

  	
  Incurred

  Claims

  PMPM

  	
   

  	
  Variance

  PMPM

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  January

  	
   

  	
  460

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  1.00

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  February

  	
   

  	
  458

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  1.00

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  March

  	
   

  	
  454

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  1.00

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  April

  	
   

  	
  443

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  1.00

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  May

  	
   

  	
  445

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  1.00

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  June

  	
   

  	
  439

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  1.00

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  July

  	
   

  	
  435

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  1.00

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  August

  	
   

  	
  435

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  1.00

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  September

  	
   

  	
  433

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  1.00

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  October

  	
   

  	
  423

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  1.00

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  November

  	
   

  	
  433

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  1.00

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  December

  	
   

  	
  432

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  .98

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  5,290

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  .99

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  

 

Note:  The fractional components
of certain totals do not add exactly due to rounding

 

SUMMARY

 

	
  REVENUES:

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  
	
  Pharmacy Budget

  	
   

  	
  ***

  	
   

  
	
   

  	
   

  	
   

  	
   

  
	
  PHARMACY COSTS:

  	
   

  	
  ***

  	
   

  
	
   

  	
   

  	
   

  	
   

  
	
  MedImpact

  	
   

  	
  ***

  	
   

  
	
   

  	
   

  	
   

  	
   

  
	
  IBNR (Estimate)

  	
   

  	
  ***

  	
   

  
	
   

  	
   

  	
   

  	
   

  
	
  Claims Incurred

  	
   

  	
  ***

  	
   

  
	
   

  	
   

  	
   

  	
   

  
	
  Surplus Deficit

  	
   

  	
  ***

  	
   

  
	
   

  	
   

  	
   

  	
   

  
	
  Net Payable To
  (From) Physician Group

  	
   

  	
  ***

  	
   

  

 

	
  Pharmacy Shared Risk:

  	
   

  	
  •                       Deficit:  50% of the deficit shall be paid by the
  Physician Group to the Health Plan.

  	
  ***

  
	
   

  	
   

  	
  •                       Surplus:  50% of the surplus shall be paid by the
  Health Plan to the Physician Group.

  	
  ***

  
	
   

  	
   

  	
   

  

 

	
  Completion

  Factor

  	
   

  	
  Incurred
  Claims

  	
   

  	
  Outstanding

  Claims

  	
   

  	
  Budget

  PMPM

  	
   

  	
  Incurred

  Claims PMPM

  	
   

  	
  Variance

  PMPM

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  ?

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  
	
  ?

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  ?

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  ?

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  ?

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  ?

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  ?

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  ?

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  ?

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  ?

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  ?

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  ?

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  ?

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  

 

 

BLUE SHIELD OF
CALIFORNIA

Medicare Pharmacy
Benefit Analysis

January 1999 -
December 1999

 

28                                    Northwest
Orange County Med Grp

 

Pharmacy Risk Sharing Arrangement:

 

Surplus:                            50.00%
maximum 25.00% Capitation

 

Deficit:                                  50.00%
maximum 25.00% Capitation

 

	
  Month

  	
   

  	
  Budget

  Allocation

  	
   

  	
  Member

  Months

  	
   

  	
  Budget

  	
   

  	
  Med Impact

  Claims

  	
   

  	
  Completion

  Factor

  	
   

  	
  Incurred
  Claims

  	
   

  	
  Outstanding

  Claims

  	
   

  	
  Budget

  PMPM

  	
   

  	
  Incurred

  Claims PMPM

  	
   

  	
  Variance

  PMPM

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  1/1/99

  	
   

  	
  6.05

  	
  %

  	
  428

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  100

  	
  %

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  
	
  2/1/99

  	
   

  	
  6.05

  	
  %

  	
  426

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  100

  	
  %

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  3/1/99

  	
   

  	
  6.05

  	
  %

  	
  428

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  100

  	
  %

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  4/1/99

  	
   

  	
  6.05

  	
  %

  	
  433

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  100

  	
  %

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  5/1/99

  	
   

  	
  6.05

  	
  %

  	
  429

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  100

  	
  %

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  6/1/99

  	
   

  	
  6.05

  	
  %

  	
  433

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  100

  	
  %

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  7/1/99

  	
   

  	
  6.05

  	
  %

  	
  431

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  100

  	
  %

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  8/1/99

  	
   

  	
  6.05

  	
  %

  	
  428

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  100

  	
  %

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  9/1/99

  	
   

  	
  6.05

  	
  %

  	
  418

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  100

  	
  %

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  10/1/99

  	
   

  	
  6.05

  	
  %

  	
  424

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  100

  	
  %

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  11/1/99

  	
   

  	
  6.05

  	
  %

  	
  425

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  100

  	
  %

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  12/1/99

  	
   

  	
  6.05

  	
  %

  	
  438

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  98

  	
  %

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  Total

  	
   

  	
   

  	
   

  	
  5,142

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  99

  	
  %

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  

 

	
  Pharmacy Budget:

  	
   

  	
  ***

  	
   

  
	
   

  	
   

  	
   

  	
   

  
	
  Pharmacy Costs:

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  
	
  Med Impact Claims

  	
   

  	
   

  	
   

  
	
  IBNR (Estimate):

  	
   

  	
  ***

  	
   

  
	
   

  	
   

  	
   

  	
   

  
	
  Total Claims
  Incurred

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  
	
  Surplus Deficit:

  	
   

  	
  ***

  	
   

  
	
   

  	
   

  	
   

  	
   

  
	
  Net
  Payable To (From) Physician Group:

  	
   

  	
  ***

  	
   

  

 

 

BLUE SHIELD OF
CALIFORNIA

Medicare Pharmacy
Benefit Analysis

January 1, 2000
- December 31, 1999

 

	
  SA

  	
   

  	
  Northwest Orange County Med Grp

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  
	
  Pharmacy Risk Sharing Arrangement:

  
	
   

  	
   

  	
   

  	
   

  	
   

  
	
  Surplus:

  	
   

  	
  50.00% maximum 0.00%

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  
	
  Deficit:

  	
   

  	
  50.00% maximum 0.00%

  	
  or

  	
  PMPM

  
	
   

  
	
  Deficit Carry Forwar

  	
   

  	
  No

  	
   

  	
   

  
											

 

	
  Month

  	
   

  	
  Budget

  Allocation

  	
   

  	
  Member

  Months

  	
   

  	
  Budget

  	
   

  	
  Argus

  	
   

  	
  Completion

  Factor

  	
   

  	
  Incurred
  Claims

  	
   

  	
  Outstanding

  Claims

  	
   

  	
  Budget

  PMPM

  	
   

  	
  Incurred

  Claims PMPM

  	
   

  	
  Variance

  PMPM

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  1/1/00

  	
   

  	
  ***

  	
   

  	
  0

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  100

  	
  %

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  
	
  2/1/00

  	
   

  	
  6.05

  	
  %

  	
  113

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  100

  	
  %

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  3/1/00

  	
   

  	
  6.05

  	
  %

  	
  113

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  100

  	
  %

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  4/1/00

  	
   

  	
  6.05

  	
  %

  	
  113

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  100

  	
  %

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  5/1/00

  	
   

  	
  6.05

  	
  %

  	
  127

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  100

  	
  %

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  6/1/00

  	
   

  	
  6.05

  	
  %

  	
  131

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  100

  	
  %

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  7/1/00

  	
   

  	
  6.05

  	
  %

  	
  134

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  100

  	
  %

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  8/1/00

  	
   

  	
  6.05

  	
  %

  	
  126

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  100

  	
  %

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  9/1/00

  	
   

  	
  6.05

  	
  %

  	
  142

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  100

  	
  %

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  10/1/00

  	
   

  	
  6.05

  	
  %

  	
  149

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  100

  	
  %

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  11/1/00

  	
   

  	
  6.05

  	
  %

  	
  179

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  100

  	
  %

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  12/1/00

  	
   

  	
  6.05

  	
  %

  	
  176

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  98

  	
  %

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  Total

  	
   

  	
   

  	
   

  	
  1,503

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  99

  	
  %

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  

 

	
  Pharmacy Budget:

  	
   

  	
  ***

  	
   

  
	
   

  	
   

  	
   

  	
   

  
	
  Pharmacy Costs:

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  
	
  Med Impact Claims

  	
   

  	
  ***

  	
   

  
	
  IBNR (Estimate):

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  
	
  Total Claims
  Incurred

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  
	
  Surplus/Deficit:

  	
   

  	
  ***

  	
   

  
	
   

  	
   

  	
   

  	
   

  
	
  Net
  Payable To (From) Physician Group:

  	
   

  	
  ***Exhibit
10.162

 

AMENDMENT
TO

MEDICARE+CHOICE PHYSICIAN GROUP SERVICE AGREEMENT

 

This Amendment is entered into effective May 1, 2002, by and between California
Physicians’ Service, Inc. dba Blue Shield of California (“Health Plan”) and NorthWest Orange County Medical Group
(“Physician Group”) in order to further modify the Medicare+Choice Physician
Group Service Agreement (“Agreement”), which was effective September 1, 1990,
as amended.

 

Recitals

 

A.                                   Whereas, Health Plan and Physician Group
entered into the Agreement on September 1, 1990;

 

B.                                     Whereas, Health Plan and Physician Group have
completed and agreed upon the reconciliation of the Pharmacy Risk Sharing
Program 1998 through 2000, pursuant to the terms of the January 1, 2002
amendment to the Agreement; and

 

C.                                     Whereas, Health Plan and Physician Group have
agreed upon new terms for the Agreement.

 

NOW,
THEREFORE, in consideration of the recitals, covenants, conditions and promises
contained in the Agreement, the parties agree that the Agreement is hereby
amended as follows:

 

1.                                       Physician Group and Health Plan agree that
the Revised Balance (as such term is defined in Section 1.C of the January 1,
2002, amendment to the Agreement) for the Pharmacy Risk Sharing Program for
calendar years 1998 through 2000 is $98,317.53.  Documentation of the Revised Balance is set forth in Attachment
1-R, attached to this Amendment and incorporated herein.  The April 2002 Monthly Payment of $7,003.44
is the only payment made by Physician Group to Health Plan as of the Effective
Date of this Amendment.  Thus, the
Revised Monthly Payment is $5,371.41 for the months of May 2002 through August
2003 and the Revised Monthly Payment for September 2003 is $5,371.53.  The total of the Revised Monthly Payments is
$91,314.09, which is equivalent to the Revised Balance of $98,317.53, less the
one Monthly Payment for April 2002 of $7,003.44.

 

2.                                       Physician Group agrees to deductions in its
Capitation Fees of $5,371.41 per month by Health Plan for the time period of
May 2002 through August 2003 and $5,371.53 in the month of September 2003.  These seventeen (17) Revised Monthly
Payments, plus the April 2002 Monthly Payment, represent Physician Group’s
payment in full of the $98,317.53 Revised Balance.  If the Agreement is terminated for any reason during this

 

1

 

seventeen (17) month
period, then Physician Group shall make the remaining monthly payments to
Health Plan by the fifteenth (15th) of the month.  Any payments not received by Health Plan by
the fifteenth (15th) of a month shall accrue interest at the Bank of
America reference rate, plus two percent (2%) per annum, until paid by
Physician Group.

 

3.                                       All
other provisions of the Agreement or its Amendments or Addendums not
inconsistent herein shall remain in full force and effect.

 

IN WITNESS WHEREOF, the parties hereto have executed this Amendment as
of the date and year first written above.

 

	
  BLUE
  SHIELD OF CALIFORNIA

  	
  NORTHWEST
  ORANGE COUNTY MEDICAL

  GROUP

  
	
   

  	
   

  
	
  By:

  	
  /s/ Lisa Rubino

  	
   

  	
  By:

  	
  /s/ Pratibha Patel

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  Name:

  	
  Lisa Rubino

  	
   

  	
  Name:

  	
  PRATIBHA PATEL, MD

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  Title:

  	
  Sr. V.P, IGBU

  	
   

  	
  Title:

  	
  PRESIDENT

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  Date:

  	
  5/6/02

  	
   

  	
  Date:

  	
  4/26/02

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
  PREMIER PHYSICIAN SERVICES

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
  By:

  	
  /s/ James P. Agronick

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
  Name:

  	
  JAMES P. AGRONICK

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
  Title:

  	
  CEO

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
  Date:

  	
  4/26/02

  	
   

  

 

2

 

Attachment 1-R

NWOC
(Corrected)

 

Northwest Orange County IPA (28, LY, SA)

 

1995-1998 Deficits Carried Forward

 

	
   

  	
   

  	
  Due-From

  NOCMG

  	
   

  	
  Adjustments

  	
   

  	
  Adjusted

  Amt Due

  	
   

  	
  Payments/

  Deductions

  	
   

  	
  Outstanding

  Balance

  	
   

  	
  Notes

  	
   

  
	
  28- La Palma

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  Per Letter of
  1/26/99

  	
   

  
	
  LY - Anaheim

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  Per Letter of
  1/26/99

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  See NWOC Cap
  Ded’

  	
   

  
	
  Total

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  tab for detail

  	
   

  

 

28 La Palma                   6.05%
of Revenue / 50% NTE 25% (Surplus) / 50% NTE 25% (Deficit)

 

	
  Month

  	
   

  	
  Budget

  Allocation

  	
   

  	
  Member

  Months

  	
   

  	
  Budget

  	
   

  	
  PMPM

  Budget

  	
   

  	
  Claims
  Total

  	
   

  	
  Claims

  PMPM

  	
   

  	
  Variance

  	
   

  	
  Due-From

  NOCMG

  	
   

  	
  Adjustments

  	
   

  	
  Adjusted

  Amt Due

  	
   

  	
  Payments/

  Deductions

  	
   

  	
  Outstanding

  Balance

  	
   

  	
  Notes

  	
   

  
	
  Jan-97

  	
   

  	
  6.05

  	
  %

  	
  487

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  ***

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  Feb-97

  	
   

  	
  6.05

  	
  %

  	
  477

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  ***

  	
   

  	
   

  	
   

  	
  10/15/98 Cap Ded

  	
   

  
	
  Mar-97

  	
   

  	
  6.05

  	
  %

  	
  475

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  ***

  	
   

  	
   

  	
   

  	
  11/15/98 Cap Ded

  	
   

  
	
  Apr-97

  	
   

  	
  6.05

  	
  %

  	
  477

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  ***

  	
   

  	
   

  	
   

  	
  12/15/98 Cap Ded

  	
   

  
	
  May-97

  	
   

  	
  6.05

  	
  %

  	
  478

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  ***

  	
   

  	
   

  	
   

  	
  2/15/99 Cap Ded

  	
   

  
	
  Jun-97

  	
   

  	
  6.05

  	
  %

  	
  474

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  3/15/99 Cap Ded

  	
   

  
	
  Jul-97

  	
   

  	
  6.05

  	
  %

  	
  473

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  Aug-97

  	
   

  	
  6.05

  	
  %

  	
  475

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  Sep-97

  	
   

  	
  6.05

  	
  %

  	
  475

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  Oct-97

  	
   

  	
  6.05

  	
  %

  	
  47

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  Nov-97

  	
   

  	
  6.05

  	
  %

  	
  473

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  Dec-97

  	
   

  	
  6.05

  	
  %

  	
  473

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  Total

  	
   

  	
   

  	
   

  	
  5,707

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
   

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
   

  	
   

  	
   

  	
   

  

 

LY Anaheim                  6.05%
of Revenue / 50% (Surplus) / 50% (Deficit)

 

	
  Month

  	
   

  	
  Budget

  Allocation

  	
   

  	
  Member

  Months

  	
   

  	
  Budget

  	
   

  	
  PMPM

  Budget

  	
   

  	
  Claims
  Total

  	
   

  	
  Claims

  PMPM

  	
   

  	
  Variance

  	
   

  	
  Due-From

  NOCMG

  	
   

  	
  Adjustments

  	
   

  	
  Adjusted

  Amt Due

  	
   

  	
  Payments/

  Deductions

  	
   

  	
  Outstanding

  Balance

  	
   

  	
  Notes

  	
   

  
	
  Jan-97

  	
   

  	
  6.05

  	
  %

  	
  84

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  10/15/98 Cap Ded

  	
   

  
	
  Feb-97

  	
   

  	
  6.05

  	
  %

  	
  85

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
   

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  11/15/98 Cap Ded

  	
   

  
	
  Mar-97

  	
   

  	
  6.05

  	
  %

  	
  178

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
   

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  12/15/98 Cap Ded

  	
   

  
	
  Apr-97

  	
   

  	
  6.05

  	
  %

  	
  93

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
   

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  2/15/99 Cap Ded

  	
   

  
	
  May-97

  	
   

  	
  6.05

  	
  %

  	
  98

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
   

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  3/15/99 Cap Ded

  	
   

  
	
  Jun-97

  	
   

  	
  6.05

  	
  %

  	
  94

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
   

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  4/15/99 Cap Ded

  	
   

  
	
  Jul-97

  	
   

  	
  6.05

  	
  %

  	
  97

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
   

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  5/15/99 Cap Ded

  	
   

  
	
  Aug-97

  	
   

  	
  6.05

  	
  %

  	
  95

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
   

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  6/15/99 Cap Ded

  	
   

  
	
  Sep-97

  	
   

  	
  6.05

  	
  %

  	
  94

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  7/15/99 Cap Ded

  	
   

  
	
  Oct-97

  	
   

  	
  6.05

  	
  %

  	
  90

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
   

  	
   

  
	
  Nov-97

  	
   

  	
  6.05

  	
  %

  	
  92

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
   

  	
   

  
	
  Dec-97

  	
   

  	
  6.05

  	
  %

  	
  93

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  Total

  	
   

  	
   

  	
   

  	
  1,193

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
   

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  1997 Total

  	
   

  	
   

  	
   

  	
  6,900

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
   

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
   

  	
   

  

 

28 La Palmo                   6.05
% of Revenue / 50% (Surplus) / 50% (Deficit)

 

	
  Month

  	
   

  	
  Budget

  Allocation

  	
   

  	
  Member

  Months

  	
   

  	
  Budget

  	
   

  	
  PMPM

  Budget

  	
   

  	
  Claims
  Total

  	
   

  	
  Claims

  PMPM

  	
   

  	
  Variance

  	
   

  	
  Due-From

  NOCMG

  	
   

  	
  Adjustments

  	
   

  	
  Adjusted

  Amt Due

  	
   

  	
  Payments/

  Deductions

  	
   

  	
  Outstanding

  Balance

  	
   

  	
  Notes

  	
   

  
	
  Jan-98

  	
   

  	
  8.00

  	
  %

  	
  450

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  Feb-98

  	
   

  	
  8.00

  	
  %

  	
  458

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  Mar-98

  	
   

  	
  8.00

  	
  %

  	
  454

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  Apr-98

  	
   

  	
  8.00

  	
  %

  	
  443

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  May-98

  	
   

  	
  8.00

  	
  %

  	
  446

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  Jun-98

  	
   

  	
  8.00

  	
  %

  	
  439

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  Jul-98

  	
   

  	
  8.00

  	
  %

  	
  435

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  Aug-98

  	
   

  	
  8.00

  	
  %

  	
  435

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  Sep-98

  	
   

  	
  8.00

  	
  %

  	
  433

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  Oct-98

  	
   

  	
  8.00

  	
  %

  	
  423

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  Nov-98

  	
   

  	
  8.00

  	
  %

  	
  433

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  Dec-98

  	
   

  	
  8.00

  	
  %

  	
  432

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  Total

  	
   

  	
   

  	
   

  	
  5,290

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
   

  	
   

  	
  ***

  	
   

  	
   

  	
   

  	
  ***

  	
   

  	
   

  	
   

  

 

LY Anaheim                  6.05%
of Revenue / 50% (Surplus) / 50% (Deficit)

 

	
  Month

  	
   

  	
  Budget

  Allocation

  	
   

  	
  Member

  Months

  	
   

  	
  Budget

  	
   

  	
  PMPM

  Budget

  	
   

  	
  Claims
  Total

  	
   

  	
  Claims

  PMPM

  	
   

  	
  Variance

  	
   

  	
  Due-From

  NOCMG

  	
   

  	
  Adjustments

  	
   

  	
  Adjusted

  Amt Due

  	
   

  	
  Payments/

  Deductions

  	
   

  	
  Outstanding

  Balance

  	
   

  	
  Notes

  	
   

  
	
  Jan-98

  	
   

  	
  8.00

  	
  %

  	
  97

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  Feb-98

  	
   

  	
  8.00

  	
  %

  	
  97

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  Mar-98

  	
   

  	
  8.00

  	
  %

  	
  95

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  Apr-98

  	
   

  	
  8.00

  	
  %

  	
  97

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  May-98

  	
   

  	
  8.00

  	
  %

  	
  100

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  Jun-98

  	
   

  	
  8.00

  	
  %

  	
  97

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  Jul-98

  	
   

  	
  8.00

  	
  %

  	
  99

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  Aug-98

  	
   

  	
  8.00

  	
  %

  	
  99

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  Sep-98

  	
   

  	
  8.00

  	
  %

  	
  100

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  Oct-98

  	
   

  	
  8.00

  	
  %

  	
  103

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  Nov-98

  	
   

  	
  8.00

  	
  %

  	
  103

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  Dec-98

  	
   

  	
  8.00

  	
  %

  	
  101

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  Total

  	
   

  	
   

  	
   

  	
  1,188

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
   

  	
   

  	
  ***

  	
   

  	
   

  	
   

  	
  ***

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  1988 Total

  	
   

  	
   

  	
   

  	
  6478

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
   

  	
   

  	
  ***

  	
   

  	
   

  	
   

  	
  ***

  	
   

  	
   

  	
   

  

 

1

 

Attachment 1-R

NWOC
(Corrected)

 

28 - La
Palma               6.05% of Revenue / 50%
(Surplus) / 50% (Deficit)

 

	
  Month

  	
   

  	
  Budget

  Allocation

  	
   

  	
  Member

  Months

  	
   

  	
  Budget

  	
   

  	
  PMPM

  Budget

  	
   

  	
  Claims
  Total

  	
   

  	
  Claims

  PMPM

  	
   

  	
  Variance

  	
   

  	
  Due-From

  NOCMG

  	
   

  	
  Adjustments

  	
   

  	
  Adjusted

  Amt Due

  	
   

  	
  Payments/

  Deductions

  	
   

  	
  Outstanding

  Balance

  	
   

  	
  Notes

  	
   

  
	
  Jan-99

  	
   

  	
  7.50

  	
  %

  	
  428

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  Feb-99

  	
   

  	
  7.50

  	
  %

  	
  428

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  Mar-99

  	
   

  	
  7.50

  	
  %

  	
  428

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  Apr-99

  	
   

  	
  7.50

  	
  %

  	
  433

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  May-99

  	
   

  	
  7.50

  	
  %

  	
  429

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  Jun-99

  	
   

  	
  7.50

  	
  %

  	
  433

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  Jul-99

  	
   

  	
  7.50

  	
  %

  	
  431

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  Aug-99

  	
   

  	
  7.50

  	
  %

  	
  428

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  Sep-99

  	
   

  	
  7.50

  	
  %

  	
  418

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  Oct-99

  	
   

  	
  7.50

  	
  %

  	
  424

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  Nov-99

  	
   

  	
  7.50

  	
  %

  	
  426

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  Dec-99

  	
   

  	
  7.50

  	
  %

  	
  438

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  Total

  	
   

  	
   

  	
   

  	
  5,142

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
   

  	
   

  	
  ***

  	
   

  	
   

  	
   

  	
  ***

  	
   

  	
   

  	
   

  

 

LY -
Anaheim               6.05% of Revenue /
50% (Surplus) / 50% (Deficit)

 

	
  Month

  	
   

  	
  Budget

  Allocation

  	
   

  	
  Member

  Months

  	
   

  	
  Budget

  	
   

  	
  PMPM

  Budget

  	
   

  	
  Claims
  Total

  	
   

  	
  Claims

  PMPM

  	
   

  	
  Variance

  	
   

  	
  Due-From

  NOCMG

  	
   

  	
  Adjustments

  	
   

  	
  Adjusted

  Amt Due

  	
   

  	
  Payments/

  Deductions

  	
   

  	
  Outstanding

  Balance

  	
   

  	
  Notes

  	
   

  
	
  Jan-99

  	
   

  	
  7.50

  	
  %

  	
  104

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  Feb-99

  	
   

  	
  7.50

  	
  %

  	
  113

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  Mar-99

  	
   

  	
  7.50

  	
  %

  	
  117

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  Apr-99

  	
   

  	
  7.50

  	
  %

  	
  120

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  May-99

  	
   

  	
  7.50

  	
  %

  	
  115

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  Jun-99

  	
   

  	
  7.50

  	
  %

  	
  116

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  Jul-99

  	
   

  	
  7.50

  	
  %

  	
  117

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  Aug-99

  	
   

  	
  7.50

  	
  %

  	
  114

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  Sep-99

  	
   

  	
  7.50

  	
  %

  	
  112

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  Oct-99

  	
   

  	
  7.50

  	
  %

  	
  111

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  Nov-99

  	
   

  	
  7.50

  	
  %

  	
  113

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  Dec-99

  	
   

  	
  7.50

  	
  %

  	
  107

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  Total

  	
   

  	
   

  	
   

  	
  1,359

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  1999 Total

  	
   

  	
   

  	
   

  	
  6,501

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
   

  	
   

  	
  ***

  	
   

  	
   

  	
   

  	
  ***

  	
   

  	
   

  	
   

  

 

28 - La
Palma               6.05% of Revenue / 50%
NTE 25% (Surplus) / 50% NTE 25% (Deficit)

 

	
  Month

  	
   

  	
  Budget

  Allocation

  	
   

  	
  Member

  Months

  	
   

  	
  Budget

  	
   

  	
  PMPM

  Budget

  	
   

  	
  Claims
  Total

  	
   

  	
  Claims

  PMPM

  	
   

  	
  Variance

  	
   

  	
  Due-From

  NOCMG

  	
   

  	
  Adjustments

  	
   

  	
  Adjusted

  Amt Due

  	
   

  	
  Payments/

  Deductions

  	
   

  	
  Outstanding

  Balance

  	
   

  	
  Notes

  	
   

  
	
  Jan-00

  	
   

  	
  6.05

  	
  %

  	
  436

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  Feb-00

  	
   

  	
  6.05

  	
  %

  	
  428

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  Mar-00

  	
   

  	
  6.05

  	
  %

  	
  430

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  Apr-00

  	
   

  	
  6.05

  	
  %

  	
  421

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  May-00

  	
   

  	
  6.05

  	
  %

  	
  422

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  Jun-00

  	
   

  	
  6.05

  	
  %

  	
  415

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  Jul-00

  	
   

  	
  6.05

  	
  %

  	
  406

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  Aug-00

  	
   

  	
  6.05

  	
  %

  	
  404

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  Sep-00

  	
   

  	
  6.05

  	
  %

  	
  416

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  Oct-00

  	
   

  	
  6.05

  	
  %

  	
  412

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  Nov-00

  	
   

  	
  6.05

  	
  %

  	
  408

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  Dec-00

  	
   

  	
  6.05

  	
  %

  	
  416

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  Total

  	
   

  	
   

  	
   

  	
  5,014

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
   

  	
   

  	
  ***

  	
   

  	
   

  	
   

  	
  ***

  	
   

  	
   

  	
   

  

 

LY -
Anaheim               6.05% of Revenue /
50% (Surplus) / 50% (Deficit)

 

	
  Month

  	
   

  	
  Budget

  Allocation

  	
   

  	
  Member

  Months

  	
   

  	
  Budget

  	
   

  	
  PMPM

  Budget

  	
   

  	
  Claims
  Total

  	
   

  	
  Claims

  PMPM

  	
   

  	
  Variance

  	
   

  	
  Due-From

  NOCMG

  	
   

  	
  Adjustments

  	
   

  	
  Adjusted

  Amt Due

  	
   

  	
  Payments/

  Deductions

  	
   

  	
  Outstanding

  Balance

  	
   

  	
  Notes

  	
   

  
	
  Jan-00

  	
   

  	
  6.05

  	
  %

  	
  112

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  Feb-00

  	
   

  	
  6.05

  	
  %

  	
  —

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  Mar-00

  	
   

  	
  6.05

  	
  %

  	
  —

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  Apr-00

  	
   

  	
  6.05

  	
  %

  	
  —

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  May-00

  	
   

  	
  6.05

  	
  %

  	
  —

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  Jun-00

  	
   

  	
  6.05

  	
  %

  	
  —

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  Jul-00

  	
   

  	
  6.05

  	
  %

  	
  —

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  Aug-00

  	
   

  	
  6.05

  	
  %

  	
  —

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  Sep-00

  	
   

  	
  6.05

  	
  %

  	
  —

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  Oct-00

  	
   

  	
  6.05

  	
  %

  	
  —

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  Nov-00

  	
   

  	
  6.05

  	
  %

  	
  —

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  Dec-00

  	
   

  	
  6.05

  	
  %

  	
  —

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  Total

  	
   

  	
   

  	
   

  	
  112

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
   

  	
   

  	
  ***

  	
   

  	
   

  	
   

  	
  ***

  	
   

  	
   

  	
   

  

 

2

 

Attachment 1 - R

NWOC
(Corrected)

 

SA - Anaheim       6.05% of Revenue / 50% (Surplus) / 50% (Deficit)

 

	
  Month

  	
   

  	
  Budget

  Allocation

  	
   

  	
  Member

  Months

  	
   

  	
  Budget

  	
   

  	
  PMPM

  Budget

  	
   

  	
  Claims
  Total

  	
   

  	
  Claims

  PMPM

  	
   

  	
  Variance

  	
   

  	
  Due-From

  NOCMG

  	
   

  	
  Adjustments

  	
   

  	
  Adjusted

  Amt Due

  	
   

  	
  Payments/

  Deductions

  	
   

  	
  Outstanding

  Balance

  	
   

  	
  Notes

  	
   

  
	
  Jan-00

  	
   

  	
  6.05

  	
  %

  	
  —

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  Feb-00

  	
   

  	
  6.05

  	
  %

  	
  113

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  Mar-00

  	
   

  	
  6.05

  	
  %

  	
  113

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  Apr-00

  	
   

  	
  6.05

  	
  %

  	
  113

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  May-00

  	
   

  	
  6.05

  	
  %

  	
  127

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  Jun-00

  	
   

  	
  6.05

  	
  %

  	
  131

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  Jul-00

  	
   

  	
  6.05

  	
  %

  	
  134

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  Aug-00

  	
   

  	
  6.05

  	
  %

  	
  128

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  Sep-00

  	
   

  	
  6.05

  	
  %

  	
  142

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  Oct-00

  	
   

  	
  6.05

  	
  %

  	
  149

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  Nov-00

  	
   

  	
  6.05

  	
  %

  	
  179

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  Dec-00

  	
   

  	
  6.05

  	
  %

  	
  176

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  Total

  	
   

  	
   

  	
   

  	
  1,503

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
   

  	
   

  	
  ***

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  2000 Total

  	
   

  	
   

  	
   

  	
  6,629

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
   

  	
   

  	
  ***

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  Summary

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  1995-1996 Totals

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
   

  	
   

  
	
  1997 Total

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
   

  	
   

  
	
  1998 Total

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
   

  	
   

  
	
  1999 Total

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
   

  	
   

  
	
  2000 Total

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
   

  	
   

  
	
  GRAND TOTAL

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
   

  	
   

  

 

Settlement Proposal

 

	
   

  	
   

  	
  Outstanding

  Balance

  	
   

  	
  2002

  Adjustment

  	
   

  	
  Final
  Amounts

  Due

  	
   

  
	
  1995-96

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  
	
  1997

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  
	
  1998

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  
	
  1999

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  
	
  2000

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  
	
  Total

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  	
  ***

  	
   

  

 

Reconciliation Adjustments:

-1998 budget recalculated at 8.00% of
revenue and 1999 budgets recalculated at 7.50% of revenue (for both IPAs)

 

3

 

Attachment 1- R

NWOC Cap
Ded

 

1995-1996 Deficits

	
  IPA Code

  	
   

  	
  Date of

  Cap Deduct

  	
   

  	
  Amount

  	
   

  
	
  28

  	
   

  	
  5/19/99

  	
   

  	
  ***

  	
   

  
	
  28

  	
   

  	
  9/15/99

  	
   

  	
  ***

  	
   

  
	
  28

  	
   

  	
  10/5/99

  	
   

  	
  ***

  	
   

  
	
  28

  	
   

  	
  11/19/99

  	
   

  	
  ***

  	
   

  
	
  28

  	
   

  	
  1/10/00

  	
   

  	
  ***

  	
   

  
	
  Total

  	
   

  	
   

  	
   

  	
  ***

  	
   

  

 

	
  IPA Code

  	
   

  	
  Date of

  Cap Deduct

  	
   

  	
  Amount

  	
   

  
	
  LY

  	
   

  	
  5/19/99

  	
   

  	
  ***

  	
   

  
	
  LY

  	
   

  	
  9/15/99

  	
   

  	
  ***

  	
   

  
	
  LY

  	
   

  	
  10/5/99

  	
   

  	
  ***

  	
   

  
	
  LY

  	
   

  	
  11/19/99

  	
   

  	
  ***

  	
   

  
	
  LY

  	
   

  	
  1/10/00

  	
   

  	
  ***

  	
   

  
	
  Total

  	
   

  	
   

  	
   

  	
  ***

  	
   

  

 

4

Source: [{"source": "alea-institute/alea-institute/kl3m-data-edgar-agreements/train-00067-of-00352.parquet"}, [{"source": "alea-institute/alea-institute/kl3m-data-edgar-agreements/train-00067-of-00352.parquet"}]]