Document:

EX-10.2 Management Services Agreement

 

EXHIBIT
10.2

AMENDMENT NUMBER 1

TO

MANAGEMENT SERVICES AGREEMENT

EFFECTIVE September 1, 2004

     This Amendment to Primary Care Services Agreement (the “Amendment”), effective as of
September 1, 2004, is by and among Vista Healthplan, Inc. (“VHP”), Vista Insurance Plan,
Inc. (“VIP”; VHP and VIP collectively referred to as “VISTA”) and MIAMI DADE HEALTH
CENTERS, INC. (”Provider”).

     WHEREAS, VISTA and Provider entered into that certain Primary Care Provider Services
Agreement (the “Agreement”); and

     WHEREAS, Pursuant to Section 9.5 of the Agreement, VISTA desires to amend the
Agreement in the manner set forth herein.

     NOW, THEREFORE, in consideration of the mutual promises and covenants contained
herein, the parties hereby agree to amend, the Agreement as follows:

I. Amendments.

	 	A.	 	Section 2.17 Disparagement Prohibited. Delete.
	 
	 	B.	 	Section 2.22 Hospitalist Program. Add. PCP retains the right to
coordinate hospital admissions for the PCP’s patients and bypass participation
in VISTA’s hospitalist program.
	 
	 	C.	 	Section 9.17 Enforcement. Delete and replace with: A material inducement for
PCP’s engagement by VISTA are the covenants set forth in this Section 9.1, and that
monetary damages in an action of law would not provide adequate remedy in the event of a
breach of this Section 9.1. PCP further acknowledges and agrees that the covenants set
forth in this Section 9.1 are necessary for the protection of VISTA’s legitimate business
and professional duties, ethical obligations, and interests and are reasonable in scope
and content. Accordingly, in the event of PCP’s breach of this Section 9.1, or any part of
this Section 9.1, this Section 9.1 may be enforced by the obtaining of an injunction to
restrain the violation thereof by PCP and all persons acting for or with PCP.
	 
	 	D.	 	Section 9.2. Assignment Delete and replace with: PCP shall not assign,
delete, subcontract, or otherwise transfer rights, obligations and/or interests arising
under this Agreement, including, but not limited to a transfer resulting from either an
asset or stock purchase, without the

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	 	 	 	express written consent of VISTA. VISTA may assign, delegate, subcontract or otherwise
transfer its rights, obligations and/or interests under this Agreement to any successor,
VISTA Affiliate or a party to which any of VISTA’s line(s) of business are sold, with
written notification to provider. This Agreement shall be binding upon and inure to the
benefit of the successors and permitted assigns of the parties.
	 
	 	E.	 	Section 9.8 Non-Exclusive. Delete “commercial” from 1st sentence.
	 
	 	F.	 	Schedule 4.1 Exhibit 2 HMO Individual. Change Capitation Fee Rate to
“N/A” effective December 1, 2003.
	 
	 	G.	 	Schedule 4.1 Exhibit 3 Letter of Credit. Delete.
	 
	 	H.	 	Schedule 4.1 Exhibit 4 Letter of Credit. Delete.
	 
	 	I.	 	Schedule 4.1 Exhibit 5 Healthy Kids. Change Capitation Fee Rate to “N/A”
effective December 1, 2003.
	 
	 	J.	 	Schedule 4.1 Exhibit 11 Medicare Choice Advantage. Settlement B. Change
amount equal to fifty percent (50%) of the Deficit to read  amount equal to one hundred
percent (100%) of the Deficit.
	 
	 	K.	 	VISTA will make best faith efforts to produce and provide management and financial
reports to provider to enable provider to manage provider’s VISTA’s members.

II.
Miscellaneous.

	 	A.	 	Except as provided herein above, all of the terms and conditions contained in the
Agreement shall remain unchanged and in full force and effect.
	 
	 	B.	 	This Amendment is made pursuant to and in accordance with the terms and conditions
of the Agreement.
	 
	 	C.	 	All capitalized but not defined terms used herein shall have those meanings
ascribed to them in the Agreement.

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IN WITNESS WHEREOF, the parties to this Amendment have
cause the executions of this Amendment as of the first day
and year first above written.

	 	 	 	 	 	 	 
	 	 	VISTA HEALTHPLAN, INC.	 	 
	 
	 	 	 	 	 	 
	 

	 	By:
	 	/s/ Duell O. Wise
 

	 	 
	 	 	Print Name: Duell O. Wise	 	 
	 	 	Its: Executive Vice President	 	 
	 
	 	 	 	 	 	 
	 	 	VISTA INSURANCE PLAN, INC	 	 
	 
	 	 	 	 	 	 
	 

	 	By:
	 	/s/ Duell O. Wise
 

	 	 
	 	 	Print Name: Duell O. Wise	 	 
	 	 	Its: Executive Vice President	 	 
	 
	 	 	 	 	 	 
	 	 	PROVIDER	 	 
	 
	 	 	 	 	 	 
	 

	 	By:
	 	/s/
 

	 	 
	 	 	Print Name: 	 	 
	 	 	Its: Chief Operating Officer	 	 

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MANAGEMENT SERVICES AGREEMENT

     This Management Services Agreement (the “Agreement”) is effective as of the 1st day of
September, 2004 (the “Effective Date”) by and between Vista Healthplan, Inc., a Florida corporation
(“VISTA”) and Miami Dade Health Centers Inc, a Florida corporation (hereinafter referred to as
“MSO”). If MSO is a sole proprietorship, professional association, partnership, limited liability
company or corporation as described on Schedule A, attached hereto and incorporated herein,
or if MSO employs, or is associated or contracts with physicians, administrative staff or other
health care professionals (“MSO Staff’), including MSO Providers, as defined below, all references
to MSO herein, unless clearly inapplicable, shall apply to all MSO Staff, and it shall be MSO’s
obligation to ensure such compliance.

RECITALS

	A.	 	VISTA is a health maintenance organization licensed in accordance with Chapter 641 of the
Florida Statutes that operates various health service plans (the “Benefit Programs”) and
arranges for the provision of certain health care services to Members.
	 
	B.	 	MSO developed and manages a network of MSO Providers licensed to provide certain health care
services to Members and is experienced and qualified, as required by law, to provide certain
administrative services, as described below.
	 
	C.	 	VISTA desires to engage MSO to provide MSO Services and arrange for the provision of Provider
Services to Members participating in certain Benefit Programs, as specifically identified on
Schedule D, attached hereto and incorporated herein, and MSO desires to provide MSO
Services and arrange for the provision of Provider Services to such Members, subject to the
terms and conditions set forth in this Agreement.

     NOW, THEREFORE, in consideration of the promises and covenants contained in this Agreement,
and other good and valuable consideration, the receipt and adequacy of which are hereby forever
acknowledged and confessed, the parties mutually agree as follows:

	1	 	DEFINITIONS. All capitalized but not otherwise defined terms shall have the meanings
ascribed to such terms in Schedule 1, attached hereto and incorporated herein.
	 
	2	 	MSO’S RESPONSIBILITIES.

	 	2.1	 	Services. MSO shall provide MSO Services and shall ensure that MSO
Providers render services, as set forth in Schedule 2.1, attached hereto and
incorporated herein (“Provider Services”), to Members in accordance with the terms and
conditions of this Agreement, professionally recognized standards of health care, VISTA
Policies, the applicable VISTA Coverage Plan and all applicable laws and regulations
and rules of Accreditation Organizations.

					
	 	 	 	 	 
	S. FL MSO Agmt. 

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	 	2.2	 	MSO Providers.

	 	2.2.1	 	Credentials. MSO shall ensure that MSO Providers are duly
licensed in the State of Florida, participate in Medicare and Medicaid and submit
all information requested by VISTA in accordance with VISTA’s Credentialing
Criteria. MSO acknowledges and agrees that any MSO Provider not approved by
VISTA’s Credentialing Committee, excluded from participation in Medicare or
Medicaid or who opted out of Medicare or Medicaid shall be prohibited from
rendering Provider Services to Members.
	 
	 	2.2.2	 	Composition of MSO. MSO shall contract with a sufficient
number of MSO Providers located throughout the Service Area to provide convenient
and adequate access to inpatient and outpatient Provider Services to Members in
accordance with VISTA Policies and applicable law, as determined in VISTA’s sole
discretion. The current panel of MSO Providers is set forth on Schedule
2.2.2, attached hereto and incorporated herein, and shall be subject to
approval by VISTA, in VISTA’s sole discretion (the “Initial MSO”). MSO shall
ensure that there will not be a MSO Provider attrition rate in excess of ten
percent (10%) of the Initial MSO.
	 
	 	2.2.3	 	Hospital Privileges; Availability. MSO shall ensure an
appropriate number of MSO Providers, as determined in VISTA’s sole discretion,
maintain privileges at Participating Hospitals to furnish Provider Services to
Members within the Service Area. MSO shall ensure that each MSO Provider is
available twenty-four (24) hours per day, seven (7) days per week to furnish
Provider Services to Members both in MSO Provider’s office and arrange or furnish
Provider Services to Members in an inpatient facility.
	 
	 	2.2.4	 	Addition or Removal of MSO Providers. MSO shall provide
VISTA with notice of any termination or expiration of a Provider Contract, as
defined below, by a MSO Provider together with a statement reflecting the
effective date of such termination/expiration within two (2) days of MSO’s receipt
of notice of such termination from MSO Provider. MSO shall obtain VISTA’s prior
written consent prior to MSO’s terminating or non-renewing a Provider Contract.
Any proposed additions of MSO Providers to the panel must be approved and
credentialed by VISTA prior to any such MSO Providers’ provision of Provider
Services to Members. Immediately upon receipt of written notice by VISTA, MSO
shall ensure that the MSO Provider(s) no longer renders Provider Services to
Members as required by such notice. Upon VISTA’s request, MSO shall use its best
efforts to enter into a Provider Contract with certain providers subject to VISTA
Credentialing Criteria and as contemplated by this Agreement.
	 
	 	2.2.5	 	Contracts with MSO Providers. The relationship between MSO
and MSO Providers shall be that of independent contractors governed by a
contractual

					
	 	 	 	 	 
	S. FL MSO Agmt. 

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	 	 	 	agreement in writing (“Provider Contracts”), subject to approval by VISTA
prior to the effective date of the Provider Contract. Provider Contracts shall
be substantially in conformance with the form attached hereto as
Schedule 2.2.5a and incorporated herein, as applicable, and
shall expressly require MSO Providers’ compliance with any and all federal and
state statutory and regulatory requirements, mandates of Accreditation
Organizations and VISTA Policies, Provider Contracts shall contain provisions
setting forth the compensation due MSO Providers from MSO for the rendering of
Provider Services to Members which are subject to VISTA’s approval prior to the
effective date of such Provider Contracts to ensure, among other things, that
the Provider Contracts comply with the Physician Incentive Plan Regulations
contained in 42 C.F.R. 422.208 and 42 C.F.R. 422.210, as amended (“PIP
Regulations”). MSO shall provide VISTA with current and any updated schedules of
rates for payment to MSO Providers by MSO for VISTA’s approval prior to use. MSO
shall obtain VISTA’s written consent prior to revision of its reimbursement
methodology with any MSO Provider. All Provider Contracts shall require MSO
Providers to abide by the provisions of this Agreement, as applicable to MSO
Providers. All Provider Contracts shall specifically state that the agreement by
and between VISTA and the MSO Provider (the “VISTA Provider Agreement”) shall
govern in the event there is a conflict between a Provider Contract and a VISTA
Provider Agreement, unless otherwise set forth in the Addendum to VISTA Provider
Agreement, attached hereto as Schedule 2.2.5b and incorporated herein.
MSO shall provide VISTA with copies of any and all Provider Contracts within
five (5) days of VISTA’s request for such documents at no cost to VISTA.
	 
	 	2.2.6	 	Participation of MSO Providers. With respect to Medicare
Members only, MSO shall provide for the participation and management of MSO
Providers through reasonable procedures, including:

	 	2.2.6.1	 	Written notice to MSO Providers and VISTA of rules of participation such
as terms for payment, credentialing, and other rules directly related to
participation decisions;
	 
	 	2.2.6.2	 	Written notice to MSO Providers and VISTA of material changes in
participation rules prior to the effective date of such changes;
	 
	 	2.2.6.3	 	Written notice to MSO Providers and VISTA of participation decisions
with respect to an MSO Provider that are adverse to the MSO Provider; and
	 
	 	2.2.6.4	 	A process for appealing adverse participation decisions by MSO
Providers, including the MSO Provider’s right to present information and
their views on the decision.

					
	 	 	 	 	 
	S. FL MSO Agmt. 

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	 	2.2.7	 	Independent Contracts with MSO Providers. Notwithstanding
any agreement, written or oral, MSO may have with any MSO Provider, VISTA shall
have the right to enter into an agreement directly with any such MSO Provider
for the arranging or providing of Provider Services to Members upon whatever
terms and conditions VISTA and the MSO Provider mutually agree.
	 
	 	2.2.8	 	Medicaid. MSO shall ensure that if an MSO Provider
participates in VISTA’s Medicaid program, as indicated on Schedule 2.2.2,
such MSO Provider shall comply with all applicable Medicaid requirements set forth
in Schedule 2.2.8, attached hereto and incorporated herein, with respect
to any Medicaid Member.

	 	2.3	 	Coordination of Benefits. MSO agrees that payment for Provider Services
furnished to Members is subject to coordination with any other benefits payable or paid
to or for a Member. Such benefits include, but are not limited to, any group insurance
coverage, contract, prepayment plan or governmental program and any claims that may
give rise to compensation to a Member from a third party, including, without
limitation, workers’ compensation and automobile insurance. VISTA shall be subrogated
to all rights of recovery of a Member against any person or entity for such benefits or
payments as permitted under applicable law and this Agreement. MSO shall and shall
cause MSO Providers to use their best efforts to determine whether a Member has any
benefits as described above or whether a third party may be responsible for payment.
MSO shall and shall cause MSO Providers to assist VISTA in coordination of benefits by
(i) requiring a Member so covered to sign all necessary documents to give effect to
this Section 2.3; and (ii) signing any other documents and providing any information
and records so requested by VISTA at no cost to VISTA. Unless otherwise required by
law, neither MSO nor MSO Providers shall be entitled to reimbursement by any third
party for Provider Services rendered to Members, including, Medicare intermediaries or
carriers, and all sums recovered pursuant to this Section 2.3 shall be retained by
VISTA. Unless required by law or the applicable VISTA Coverage Plan, in the event VISTA
is the primary carrier, payments made by VISTA to an MSO Provider plus allowed
Co-Payments, Deductibles and Co-Insurance shall be deemed payment in full for all
services rendered by MSO and MSO Providers hereunder. In the event VISTA is the
secondary carrier (except in the case of Medicare or where otherwise provided by law),
VISTA, as applicable, shall pay for all services rendered to Members in accordance with
the applicable VISTA Provider Agreement and applicable law that were not paid by the
primary carrier; provided, however, that the combined payments made by the primary and
secondary carriers shall not exceed one hundred percent (100%) of the compensation due
MSO Provider under the applicable Provider Contract or VISTA Provider Agreement, as
applicable. If VISTA is the secondary carrier to Medicare, VISTA’s liability shall be
limited to Deductible and Co- Insurance amounts, unless otherwise required by federal
law.

					
	 	 	 	 	 
	S. FL MSO Agmt. 

January 9, 2004
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	 	2.4	 	Collection of Charges From Members. MSO shall not and shall ensure
that in no event, including but not limited to non-payment by VISTA, insolvency of
VISTA, or breach of this Agreement, shall any MSO Provider or any employee or
contractor of MSO, bill, charge, collect a deposit from, seek compensation,
remuneration or reimbursement from, or have any recourse against Members or persons
(other than VISTA) acting on a Member’s behalf for Covered Services provided pursuant
to this Agreement, including but not limited to any and all amounts equal to the
difference between MSO Providers’ Billed Charge for a Covered Service and the
applicable Allowance for the particular Covered Service. Additionally, MSO shall not
and shall ensure that neither any MSO Provider nor any employee or contractor of MSO
collects or attempts to collect money from, maintains any action at law against, or
reports to a credit agency a Member for payment of a claim for a Covered Service for
which VISTA is liable if MSO Provider in good faith knows or should know that VISTA
is liable in accordance with Florida law, including, but not limited to pended claims
submitted by MSO Providers to VISTA for payment of the services and any legal
proceedings or dispute resolution process to determine whether VISTA is liable for
the services. Notwithstanding the foregoing, this Agreement does not prohibit MSO
Provider from collecting Co-Payments, Deductibles and Co-Insurance, as specifically
provided in the applicable VISTA Coverage Plan, or fees for non- Covered Services
delivered on a fee-for-service basis to Members. Nor does this Agreement prohibit MSO
Provider and a Member from agreeing to continue services solely at the expense of the
Member, as long as MSO Provider clearly informed the Member in advance and in writing
that VISTA might not cover or continue to cover such specific service(s). MSO shall
ensure that MSO Providers bill Members directly for any applicable Co-Payments,
Deductibles and Co-Insurance at the time Covered Services are rendered. MSO further
agrees that this Section 2.4 (i) shall survive the termination of this Agreement
regardless of the cause giving rise to such termination and shall be construed to be
for the benefit of Members; and (ii) supersedes any oral or written agreement to the
contrary now existing or hereafter entered into between MSO or an MSO Provider and a
Member or persons acting on a Member’s behalf. MSO agrees and shall cause MSO
Providers to agree that if non- Covered Services are to be provided to Members, it is
MSO Provider’s responsibility to inform the Member in writing prior to the provision
of such non-Covered Services that such services are not Covered Services and that the
Member will be responsible for payment for such non-Covered Services and to collect
the fees for such non- Covered Services directly from the Member. In the event that
the Member is not so informed, MSO agrees and shall cause MSO Providers to agree that
the Member shall not be liable to MSO or MSO Providers for payment for such
non-Covered Services.
	 
	 	2.5	 	Publication Authorization. MSO agrees and shall cause MSO
Providers to agree that VISTA may use MSO’s and MSO Providers’ name, address and
telephone number in VISTA’s provider directory and other marketing materials;
provided, however, that VISTA shall have no obligation to include MSO’s or any MSO
Provider’s name or other information in VISTA’s provider directory. Neither MSO

					
	 	 	 	 	 
	S. FL MSO Agmt. 

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	 	 	 	nor any MSO Provider shall advertise or market VISTA, any VISTA Affiliate or
any of their health care services or Benefit Programs, or utilize any trademarks,
trade names, logos or other VISTA property without VISTA’s prior written approval.
	 
	 	2.6	 	Nondiscrimination. MSO represents and warrants to VISTA that neither
MSO nor MSO Providers shall discriminate against Members with respect to the
availability or provision of health services based on a Member’s race, sex, age,
religion, place of residence, HIV status, source of payment, VISTA membership, color,
sexual orientation, marital status or any factor related to a Member’s health status,
including, but not limited to, a Member’s medical condition (including mental as well
as physical illness), claims experience, receipt of health care, medical history,
genetic information, evidence of insurability (including conditions arising out of acts
of domestic violence), disability or on any other basis otherwise prohibited by state
or federal law. Further, MSO shall and shall cause MSO Providers to comply with Title
VI of the Civil Rights Act of 1964, as implemented by regulations at 45 C.F.R. part 84;
Section 504 of the Rehabilitation Act of 1973; the Americans with Disabilities Act; the
Age Discrimination Act of 1975, as implemented by regulations at 45 C.F.R. part 91;
other laws applicable to recipients of federal funds; and all other applicable laws and
rules, as required by applicable laws or regulations. Neither MSO nor any MSO Provider
shall discriminate against a Member based on whether or not the Member executed an
advance directive.
	 
	 	2.7	 	Compliance with Requirements of CMS. MSO shall and shall cause MSO
Providers to comply with any and all applicable Medicare laws, regulations, CMS
instructions and VISTA’s obligations under its contract with CMS with respect to the
provision of Covered Services and all other activities relating to Medicare Members.
MSO shall ensure that MSO Providers represent and warrant that they participate as a
provider under Title XVIII of the Social Security Act (Medicare) in accordance with 42
C.F.R. Part 422, and shall maintain such participation throughout the Term. Further,
MSO shall and shall cause MSO Providers to allow CMS to evaluate the quality,
appropriateness, and timeliness of MSO Services and Provider Services rendered by MSO
and MSO Providers, as applicable, to Medicare Members and shall comply with and abide
by the results of any grievance procedures adopted by CMS.
	 
	 	2.8	 	Reporting.

	 	2.8.1	 	General Reporting. MSO shall provide VISTA all reports set
forth in Schedule 2.8, attached hereto and incorporated herein, and any
and all other reports which VISTA may request. MSO shall provide all requested
reports to VISTA in the manner and at such frequency as VISTA may determine.
	 
	 	2.8.2	 	Financial Reporting.

	 	2.8.2.1	 	During the Term, MSO shall provide to a VISTA on a quarterly basis a copy of MSO’s most
recent quarterly financial statements that shall

					
	 	 	 	 	 
	S. FL MSO Agmt. 

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	 	 	 	include a balance sheet, statement of income and a statement of
cash flow with footnotes (the “Financial Statements”) prepared in
accordance with generally accepted accounting principles. Such Financial
Statements shall be certified by MSO’s chief financial officer as
accurately reflecting the financial condition of MSO for the period
indicated.
	 
	 	2.8.2.2	 	On or before the beginning of the second quarter of every calendar year
throughout the Term, MSO shall provide VISTA with copies of MSO’s annual
and independently audited financial reports, including, but not limited to,
MSO’s income statement, balance sheet and such other financial reports as
are reasonably requested by VISTA.

	 	2.8.3	 	Failure to Comply. In the event MSO fails to comply with
the requirements set forth in this Section 2.8, MSO shall be subject to the
following penalties, as determined by VISTA: (i) for any reports or other
information requested by VISTA not received by VISTA within thirty (30) days of
their due date, as determined by VISTA, VISTA may deduct two percent (2%) from
the Compensation (as defined below) due to MSO for such Period (as defined
below) in which MSO failed to so comply (“Default Period”) or an equivalent
amount from any other Period in which there is a Surplus (as defined below) if
there is no Surplus during the Default Period; (ii) VISTA may deduct an
additional one percent (1%) from the Compensation due to MSO for each additional
Period in which VISTA does not receive the reports or other information as
requested by VISTA (“Additional Default Periods”) or an equivalent amount from
any other Period in which there is a Surplus if there is no Surplus during an
Additional Default Period.

	 	2.9	 	Disparagement Prohibited. MSO shall not and shall ensure that MSO
Providers do not disparage VISTA, any VISTA Affiliate or any VISTA Coverage Plan in any
form or manner whatsoever. In the event MSO or an MSO Provider is determined to have
disparaged VISTA or any VISTA Coverage Plan, in VISTA’s sole determination, such action
by MSO or MSO Provider may constitute a material breach of this Agreement.
	 
	 	2.10	 	Communications.

	 	2.10.1	 	Communication to MSO Providers. All communication, in any manner or
mode whatsoever, by MSO to MSO Providers with respect in any way to any and all
services provided under this Agreement, any VISTA Provider Agreement or any
Provider Contract shall be reviewed and approved by VISTA’s Executive Vice
President of Provider Operations or his/her designee prior to distribution by MSO
of such communication to MSO Providers.

					
	 	 	 	 	 
	S. FL MSO Agmt. 

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	 	2.10.2	 	Communication to Members. All communication, in any manner
or mode whatsoever, by MSO to Members in any way shall be reviewed and approved
by VISTA prior to distribution by MSO of such communication to MSO Providers.

	 	2.11	 	Grievances, Appeals and Disputes. VISTA has established and shall
maintain a grievance and appeal procedure for the resolution of grievances, appeals and
expedited grievances and appeals involving Members, a copy of which is available to MSO
and MSO Providers on request. MSO agrees and shall ensure MSO Providers agree that any
dispute, complaint, grievance, appeal or claim asserted pursuant to this Agreement, any
VISTA Coverage Plan or otherwise or in connection with the provision of Covered Services
shall be resolved in accordance with VISTA’s grievance and appeal procedure, including
procedures for expedited review of determinations and reconsiderations upon the request
of a Medicare Member and in accordance with Medicare law. MSO shall and shall cause MSO
Providers to cooperate with VISTA in connection with its resolution of any grievance or
appeal, including gathering and forwarding any and all information requested by VISTA in
connection with the investigation and resolution of such grievance or appeal, at no cost
to VISTA. VISTA shall have final authority over the resolution of all grievances and
appeals, and MSO shall and shall cause MSO Providers to comply with all final
determinations made by VISTA pursuant to VISTA’s grievance and appeal procedure. In the
event an oral or written grievance or appeal is presented to MSO or an MSO Provider by a
Member, MSO shall and shall cause MSO Providers to immediately notify VISTA of such
grievance or appeal and provide VISTA with a copy of the grievance or appeal if in
writing.
	 
	 	2.12	 	Notice of Certain Actions or Events. MSO shall immediately notify VISTA,
in writing, of any of the following actions taken by or against MSO or an MSO Provider:
(i) the surrendering, revocation or suspension of any license, certification,
registration or permit pertaining to services provided under this Agreement or the
applicable Provider Contract; (ii) any action to restrict, suspend or revoke an MSO
Provider’s right to participate in the Medicare or Medicaid program or an MSO Provider’s
clinical or staff privileges at any hospital or health care facility or if an MSO
Provider voluntarily relinquishes any of the foregoing; (iii) any claim alleging MSO’s
or an MSO Provider’s medical malpractice, Notice of Intent to Initiate Litigation filed
against MSO or an MSO Provider, as defined in Section 766.106, Florida Statutes, or
summons or complaint alleging MSO’s medical malpractice; (iv) any lapse or material
change in MSO’s or an MSO Provider’s professional liability insurance as required under
this Agreement; (v) any indictment or conviction of MSO or an
MSO Provider for a felony;
(vi) any disciplinary action, fine, penalty, or other sanction imposed upon MSO or an
MSO Provider by AHCA, CMS, OIR or any other local, state or federal regulatory agency or
notice of the commencement of a proceeding that could lead to any of the foregoing; or
(vii) any other situation, including MSO’s or an MSO Provider’s bankruptcy or insolvency
or loss of any board certification, which might materially adversely affect MSO’s or an
MSO

					
	 	 	 	 	 
	S. FL MSO Agmt. 

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	 	 	 	Provider’s ability to carry out their duties and obligations under this
Agreement, or which would materially change the representations made in an MSO
Provider’s credentialing or recredentialing application.
	 
	 	2.13	 	Administrative Guidelines. MSO shall and shall cause MSO Providers to
comply with VISTA Policies and cooperate with and participate in all internal and
external quality improvement organizations’ (“QIO”) review process; independent quality
review and improvement organizations’ activities; utilization management, including
patient assessment and disease management programs, credentialing and recredentialing,
and quality assurance and management or other administrative activities, including site
medical audit reviews, financial audits and post audit interviews by VISTA personnel or
internal or external financial or other audit programs; performance improvement
projects; Health Plan Employer Data and Information Set reporting requirements and
performance measurement and reporting activities, in each case consistent with
applicable law and as may be established or implemented by VISTA or its designees from
time to time. MSO shall and shall cause MSO Providers to comply with all final
determinations rendered by VISTA in connection with any of the foregoing. MSO shall and
shall cause MSO Providers to cooperate and participate in any program required for
VISTA’s compliance with the Medicare and Medicaid programs and any other federal or
state-laws and regulations or the rules and regulations of Accreditation Organizations.
MSO shall and shall cause MSO Providers to grant VISTA, AHCA, CMS, OIR, any
Accreditation Organization, any QIO and any other agency with governing or
accreditation authority over VISTA access to its facilities and records on reasonable
notice during ordinary business hours for the purpose of conducting any reviews, audits
or site visits in connection with the foregoing. To the extent permitted by applicable
law, MSO shall and shall cause MSO Providers to provide such medical and other records
or data required by VISTA or any regulatory agencies governing VISTA in connection with
the foregoing within ten (10) days of written notice without cost to VISTA.
	 
	 	2.14	 	Notice of Change of Condition. MSO shall and shall cause MSO Providers
to notify VISTA in writing in accordance with this Agreement at least forty five (45)
days prior to any change in MSO’s or an MSO Provider’s (i) office address; (ii) billing
address; (iii) phone number; (iv) name or fictitious name; or (v) MSO Provider’s tax
identification number. MSO shall notify VISTA in writing within fifteen (15) days in
the event of the death of a member of the MSO Staff.

	3	 	COMPENSATION.

	 	3.1	 	Compensation. As full compensation to MSO for the provision of MSO
Services under this Agreement, VISTA shall pay MSO the applicable compensation amount
as set forth in Schedule 3.1 and the Exhibits thereto, attached hereto
and incorporated herein, (the “Compensation”). To the extent required by law, VISTA
shall provide MSO with additional information regarding the Compensation under this
Agreement

					
	 	 	 	 	 
	S. FL MSO Agmt. 

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	 	9
	 	 

 

 

	 	 	 	upon MSO’s request. MSO acknowledges that VISTA is receiving federal funds and
that the Compensation may be, in whole or in part, from federal funds. To the extent
required by law, MSO shall be subject to all laws applicable to entities receiving
federal funds. MSO acknowledges the limitation on collection of charges from Members,
including, without limitation, that set forth in Section 2.4 hereof.
	 
	 	3.2	 	Utilization-Related Compensation. MSO acknowledges and agrees that any
and all decisions rendered by VISTA in its administration of this Agreement and all
Provider Contracts and VISTA Provider Agreements, including, but not limited to, all
decisions rendered in connection with VISTA’s utilization management activities are
based solely on the appropriateness of the care and services. Further, MSO acknowledges
and agrees that VISTA does not and MSO shall not compensate MSO or MSO Providers,
respectively, for denial of care or services and VISTA does not and MSO shall not offer
incentives to encourage denial of care or services. MSO recognizes that there is a need
for special concern about underutilization of care and services.
	 
	 	3.3	 	Physician Incentive Payments. The parties shall comply with the rules
applicable to Physician Incentive Plan Regulations contained in the PIP Regulations. MSO
shall incorporate the requirements of this Section 3.3 into all Provider Contracts. MSO
shall cooperate with and assist VISTA in complying with the PIP Regulations by providing
VISTA on a periodic basis as required by the PIP Regulations (i) a description of the
financial methodology between MSO and all MSO Providers; (ii) any applicable
attestations stating whether or not MSO placed MSO Providers at substantial financial
risk, as defined in the PIP Regulations; and (iii) taking any and all other actions as
VISTA may request in order for VISTA to comply with the PIP Regulations. MSO further
acknowledges and agrees that in the event MSO or any MSO Provider is deemed to be at
substantial financial risk under the PIP Regulations, MSO and/or MSO Providers shall (i)
cooperate and assist VISTA in conducting satisfaction surveys of Members using MSO
Providers deemed to be at substantial financial risk and (ii) obtain, at MSO and/or MSO
Providers’ sole expense, any additional stop loss insurance required pursuant to the PIP
Regulations. In the event MSO or an MSO Provider must obtain stop loss insurance
pursuant to the PIP Regulations, MSO shall and shall cause MSO Providers to obtain a
stop loss policy with the following terms: (i) the policy is guaranteed renewable; (ii)
termination of the policy shall not affect or reduce the policy insurer’s obligation to
cover, or responsibility for coverage of, MSO Providers’ claims for Covered Services
provided to Members during the term of such policy and which are covered under the
applicable VISTA Coverage Plan; (iii) VISTA is the designated beneficiary for Members
covered by the policy for incurred but unpaid benefits for the time frame for which
Capitation Fees were received by MSO Providers in the event VISTA is insolvent or
bankrupt; and (iv) the policy insurer will provide notice of termination or cancellation
of the policy to VISTA.

	4	 	MSO SERVICES. MSO shall perform those MSO Services in accordance with and as set

					
	 	 	 	 	 
	S. FL MSO Agmt. 

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	 	 	forth in Schedule 4, attached hereto and incorporated herein {“MSO Services”).
	 
	5	 	VISTA’S RESPONSIBILITIES.

	 	5.1	 	Accountability to CMS. To the extent required by law, VISTA shall oversee
and be accountable to CMS with respect to those services performed by MSO and MSO
Providers pursuant to this Agreement with respect to Medicare Members.
	 
	 	5.2	 	Oversight. To the extent required by law and applicable Accreditation
Organization requirements, VISTA shall retain and perform ongoing oversight and
monitoring to assess MSO’s performance of MSO Services. MSO shall cooperate with VISTA
in such oversight and monitoring activities.
	 
	 	5.3	 	Compliance. To the extent required by law and applicable Accreditation
Organization requirements, VISTA shall (i) retain ongoing responsibility for statutory
and regulatory compliance by MSO; and (ii) have ultimate accountability and
responsibility for ensuring that MSO Services are performed in accordance with all
applicable laws and regulations and requirements of Accreditation Organizations.
	 
	 	5.4	 	HIPAA. VISTA shall have responsibility for compliance with all
requirements of 42 U.S.C. 1171 et seq. enacted by the Health Insurance
Portability and Accountability Act of 1996 and regulations promulgated thereunder, as
amended from time to time (“HIPAA”) with respect to MSO Services to the extent required
under the final HIPAA Privacy Regulations. Such responsibility shall not be governed by
Sections 5.1 through 5.4 above.

	6	 	TERM AND TERMINATION.

	 	6.1	 	Term. Unless earlier terminated as provided in this Agreement, this
Agreement shall commence as of the Effective Date and shall end on the first (1st)
anniversary of the Effective Date and shall automatically renew for successive one (1)
year periods (the “Term”), unless either party provides the other party with written
notice of its intent to terminate this Agreement at least sixty (60) days prior to the
end of the then current Term.
	 
	 	6.2	 	Termination by Mutual Consent. The parties upon their mutual, written
consent may terminate this Agreement at any time.
	 
	 	6.3	 	Termination Without Cause. Either party may terminate this Agreement
without cause by providing sixty (60) days prior written notice to the other party.
	 
	 	6.4	 	Termination For Material Breach. Either party may terminate this
Agreement for material breach. If a party (the “Non-Breaching Party”) believes that the
other party (the “Breaching Party”) committed a material breach of this Agreement, the
Non- Breaching Party shall give the Breaching Party written notice specifically setting

					
	 	 	 	 	 
	S. FL MSO Agmt. 

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	 	11
	 	 

 

 

	 	 	 	forth the nature of the material breach (the “Notice”). The Breaching Party
shall have thirty (30) days from the date of the Notice to cure or otherwise
eliminate the circumstances constituting the material breach. If the Breaching Party
fails to cure or eliminate the breach within the thirty (30) day period, then the
Non-Breaching Party may terminate this Agreement effective sixty (60) days following
the date of the Notice.
	 
	 	6.5	 	Automatic Termination/Suspension. Notwithstanding Section 6.3 above,
VISTA may immediately terminate this Agreement or otherwise suspend MSO from providing
any and all services to Members under this Agreement, as determined by VISTA in
VISTA’s sole discretion, upon notice to MSO if (i) MSO becomes insolvent, files a
petition for protection from its creditors, enters into any general arrangement or
assignment for the benefit of its creditors, suffers or consents to the appointment of
a trustee or a receiver to take possession of substantially all of MSO’s assets, or in
the event of the attachment, execution or other judicial seizure of substantially all
of MSO’s assets; or (ii) VISTA determines, in VISTA’s sole discretion, that: (a) the
actions or inactions of MSO or an MSO Provider are causing or may cause imminent
danger to the health, safety or welfare of any Member, (b) an MSO Provider’s license,
DEA registration, hospital staff privileges, right to participate in the Medicare or
Medicaid program or other accreditation is restricted, suspended or revoked or an MSO
Provider voluntarily relinquishes any of the foregoing and such MSO Provider’s
Provider Contract is not immediately terminated by MSO; (c) an MSO Provider’s ability
to practice medicine is effectively impaired by an action of the Board of Medicine or
other governmental agency and such MSO Provider’s Provider Contract is not immediately
terminated by MSO; (d) MSO or an MSO Provider is convicted of a criminal offense
related to its/his/her involvement in Medicaid, Medicare or social service programs
under Title XX of the Social Security Act; (e) MSO or an MSO Provider demonstrates a
consistent pattern of behavior which violates or is contrary to VISTA Policies; or (f)
MSO or an MSO Provider engaged in any other behavior or activity that could be
hazardous or injurious to any Member.
	 
	 	6.6	 	OIR Cancellation of Agreement And Notice to OIR. This Agreement shall
be canceled immediately upon issuance of an order by OIR pursuant to Section 641.234 of
the Florida Statutes. Further, in the event that either VISTA terminates this Agreement
without cause under Section 6.3 hereof or MSO terminates this Agreement for any reason
whatsoever, the party so terminating this Agreement shall provide OIR and AHCA, as
required by applicable law, with sixty (60) days advance written notice of such
termination, or such longer time as required by law; provided, however, that if VISTA
terminates this Agreement for any other reason, VISTA shall immediately provide OIR and
AHCA notice of such termination, as required by applicable law.
	 
	 	6.7	 	Nonpayment. MSO acknowledges and agrees that nonpayment for goods or
services rendered by MSO and/or MSO Providers to Members shall not be a valid reason
for

					
	 	 	 	 	 
	S. FL MSO Agmt. 

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	 	12
	 	 

 

 

	 	 	 	avoiding the sixty (60) day prior notice requirement for termination of this
Agreement, as set forth above.
	 
	 	6.8	 	Notification by MSO to VISTA. Upon termination of this Agreement or any
Provider Contract for any reason whatsoever (including expiration of this Agreement
without renewal) MSO shall notify VISTA in writing:

	 	6.8.1	 	of the reason for MSO’s termination of this Agreement;
	 
	 	6.8.2	 	simultaneously with MSO’s provision of notification of termination
of this Agreement or a Provider Contract of all Members who are patients of MSO Providers or the terminated MSO Provider, as applicable,
who are seen by MSO Provider’s) on a regular basis; and
	 
	 	6.8.3	 	within fifteen (15) days of termination of this Agreement or a
Provider Contract of (i) a detailed list, in such format as required under VISTA
Policies, of all Members receiving Provider Services at the time of termination
of this Agreement who require continuation of care in any capacity whatsoever
with the Member’s name, address, phone number, identification number, type of
service required or equipment in use, frequency of such service and ordering
physician’s name and phone number; and (ii) copies of all medical records and
treatment plans related to Members being transitioned, in accordance with
applicable law at no cost to VISTA. In the event MSO fails to comply with this
Section 6.8.3, VISTA may withhold any and all payment due by VISTA to MSO until
such time as VISTA receives the requested information.

	 	6.9	 	Notification by MSO to MSO Providers. In the event MSO terminates a
Provider Contract for any reason whatsoever or suspends an MSO Provider pursuant to the
applicable Provider Contract, MSO shall provide the MSO Provider with written notice of
the:

	 	6.9.1	 	reasons for the action, including, if relevant, the standards and
profiling data used to evaluate MSO Providers and the numbers and mix of Providers
needed by MSO and VISTA; and
	 
	 	6.9.2	 	with respect to Medicare Members only, to the extent required by
applicable law, MSO Provider’s right to appeal the action and the process and
timing requirements for requesting a hearing.

	 	6.10	 	Effect of Termination. MSO shall ensure that each Provider Contract
provides that in the event this Agreement is terminated for any reason whatsoever, (i)
all of MSO’s rights under the Provider Contract may be assignable to VISTA at VISTA’s
sole discretion; (ii) MSO Providers shall enter into a direct agreement with VISTA for
the arranging or providing of Covered Services which agreement shall be effective as of

					
	 	 	 	 	 
	S. FL MSO Agmt. 

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	 	13
	 	 

 

 

	 	 	 	the effective date of termination of this Agreement at VISTA’s sole discretion;
and (iii) all VISTA Provider Agreements shall continue to be effective as of the
effective date of termination of this Agreement at VISTA’s sole discretion. Except as
otherwise set forth herein, the parties acknowledge and agree that neither party
shall have any right or obligation under this Agreement upon termination or
expiration of this Agreement for any reason whatsoever, including, but not limited to
any Compensation not expressly provided for herein.
	 
	 	6.11	 	Benefit Programs. VISTA may terminate any and all Benefit Programs with
respect to MSO or all MSO Providers or solely with respect to a particular MSO
Provider(s), at VISTA’s sole discretion, upon notice to MSO in accordance with this
Agreement; provided, however, that termination of this Agreement or a Vista Provider
Agreement with respect to a particular Benefit Program(s) shall have no effect on the
continuation of this Agreement or the applicable Vista Provider Agreement with respect
to all other Benefit Programs as listed on Schedule D. As such, this Agreement
and any applicable Vista Provider Agreement shall remain in full force and effect with
respect to any Benefit Program not specifically terminated.
	 
	 	6.12	 	Cooperation Upon Termination. Upon termination of this Agreement for
any reason whatsoever, the parties shall cooperate with each other to ensure compliance
with this Agreement and the parties’ continuing obligations as required under this
Agreement.

	7	 	RECORDS.

	 	7.1	 	Maintenance of Records.

	 	7.1.1	 	General Records; Member Records. MSO shall and shall cause
MSO Providers to create and maintain in accordance with general standards for book
and record keeping books; records; documents and other evidence of accounting
procedures and practices, physical facilities and equipment; records of account
for all financial transactions pertaining to the delivery of all services to
Members; records relating to Medicare Members; and any additional information
CMS, AHCA, OIR or VISTA may require in an accurate and timely manner as reasonably
necessary for VISTA to properly administer each VISTA Coverage Plan consistent
with state and federal law and VISTA Policies (“General Records”). MSO shall and
shall cause MSO Providers to maintain all Member medical records and patient care
documentation relating to all services provided to Members, in such form and
containing such information as required by applicable federal and state law in
accordance with the usual and customary practices in the State of Florida,
including, without limitation, medical histories, medical charts, records and
reports from Providers (“Member Records”).
	 
	 	7.1.2	 	Financial Records. MSO shall and shall cause MSO Providers to create and

					
	 	 	 	 	 
	S. FL MSO Agmt. 

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	 	 	 	maintain in accordance with Generally Accepted Accounting Principals for
book and record keeping financial records relating to the operation of MSO and
MSO Providers’ practices and the provision of MSO Services and Provider
Services, including, but not limited to (i) organizational and work flow
charts; (ii) shareholder lists; (iii) all agreements and amendments related
thereto, including, hut not limited to provider agreements; (iv) corporate
documents, including, but not limited to minutes of board of directors’
meetings, articles of incorporation and bylaws and all amendments thereto,
certifications and licenses, and insurance policies; (v) financial statements,
including, but not limited to financial opinions, balance sheets, profit and
loss statements, cash flow statements, applicable notes, interim financial
statements, inter-company transactions, lag reporting (e.g. claims paid, checks
issued for the last twelve (12) months, as applicable), copies of debt
instruments, notes and loan agreements, pending taxes, assessments, disputes
and/or investigations, bank statements and reconciliations and cancelled
checks; (vi) if applicable, the independent certification and reporting of
claim reserves; (vii) reinsurance agreements; (viii) data transmission logs;
and (ix) historical claims data (the “Financial Records;” General Records,
Member Records and Financial Records collectively referred to as the
“Records”).
	 
	 	7.1.3	 	Record Retention. All Records shall be treated as
confidential so as to comply with all state and federal laws regarding
confidentiality of patient records. Further, MSO shall and shall cause MSO
Providers to maintain Records until the expiration of six (6) years from the
effective date of termination of this Agreement or completion of an audit;
whichever is later, unless otherwise required by state or federal law.

	 	7.2	 	Provision, Inspection and Audit of Records. MSO shall and shall cause MSO
Providers to provide Records only to authorized individuals in accordance with this
Agreement and state and federal law. Neither MSO nor MSO Providers shall release
original medical records except in accordance with federal or state laws, court orders
or subpoenas. MSO shall and shall cause MSO Providers to permit DHHS, the United States
Comptroller General, VISTA, AHCA, CMS, OIR, any Accreditation Organization, and any
other state or federal agency with authority over VISTA, and/or their designees to
audit, evaluate, inspect and copy all Records, including pertinent books, contracts,
medical records, patient care documentation and other records that pertain to any aspect
of services performed, reconciliation of benefit liabilities, and determination of
amounts payable which are in MSO’s or MSO Providers’ possession or control as may be
necessary for compliance by VISTA with the provisions of state and federal laws and
regulations, the rules and regulations of Accreditation Organizations and MSO’s
compliance with this Agreement including, but not limited to, such books, contracts,
medical records, patient care documentation and other records necessary to certify the
nature and extent of costs of Medicare or Medicaid reimbursable services provided under
this Agreement or otherwise related to Medicare Members or Medicaid Members and any
additional information that

					
	 	 	 	 	 
	S. FL MSO Agmt. 

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	 	 	 	CMS or AHCA may require at no cost to VISTA or any such state or federal agency
or Accreditation Organization. Such right of audit, evaluation, inspection and copying
shall extend for at least six (6) years following the termination of this Agreement
and be retained further if such Records are under review or audit until such review or
audit is complete or as otherwise required by state or federal law. Further, upon
VISTA’s or any state or federal agency’s or any Accreditation Organization’s request
and subject to applicable patient confidentiality restrictions, MSO shall and shall
cause MSO Providers to provide a copy of all or part of a requested Record, including
a Member’s medical record, to VISTA at no cost to VISTA and/or such federal or state
agency or such Accreditation Organization, within fifteen (15) business days of
receipt of such request or such shorter period as required by law. MSO shall and shall
cause MSO Providers to comply with any requirements or directives issued by VISTA
which are consistent with the requirements of this Agreement, any Accreditation
Organization, AHCA, CMS, OIR or any other governmental authorities as a result of any
evaluation, inspection or audit of MSO or MSO Providers.
	 
	 	7.3	 	Member Consent. Where required by law, MSO shall and shall cause MSO
Providers to obtain specific written authorization from a Member prior to releasing such
Member’s medical records. MSO acknowledges and agrees and shall cause MSO Providers to
acknowledge and agree that the consent by Member in the applicable VISTA Coverage Plan
enrollment form and/or MSO Providers’ standard consent form is hereby deemed
satisfactory Member consent for the release of Members’ Records, to the extent required
by applicable law.
	 
	 	7.4	 	Members’ Rights. MSO shall and shall cause MSO Providers to ensure
timely access by Members to review, amend and obtain a copy of their medical records
upon
request, to the extent required by applicable law.
	 
	 	7.5	 	MSO Provider Information. Upon and in accordance with VISTA’s request,
MSO shall provide VISTA with any and all information VISTA requires to compile any and
all VISTA Provider Directories as may be required by VISTA or any governmental agency or
Accreditation Organization with authority over VISTA.

	8	 	INSURANCE. MSO shall (i) maintain throughout the Term, at its sole cost and expense,
professional liability insurance and general liability insurance in an amount equal to one
million dollars ($1,000,000) per claim and three million dollars ($3,000,000) in the
aggregate and (ii) cause MSO Providers to maintain throughout the term of their Provider
Contracts, at their sole cost and expense, professional liability insurance and general
liability insurance consistent with applicable law, VISTA Credentialing Criteria and VISTA
Policies as shall be necessary to insure MSO, MSO Providers and their employees and
contractors, as applicable, against any and all claims for damages arising by reason of death
or personal injuries occasioned directly or indirectly in connection with MSO’s or an MSO
Provider’s acts or omissions in the performance of Covered Services pursuant to this
Agreement (“Insurance”). MSO shall and shall cause MSO Providers to, to the extent reasonably
able to do so, obtain

					
	 	 	 	 	 
	S. FL MSO Agmt. 

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	 	 	Insurance on an occurrence basis. If MSO or an MSO Provider obtains claims-made
Insurance, MSO shall and shall cause MSO Providers to obtain “tail” coverage that is
effective upon termination of the claims-made policy and a retroactive effective date of such
policy to ensure there is no lapse in coverage. MSO shall and shall cause MSO Providers to
provide verification of compliance with this provision to VISTA upon VISTA’s request. MSO
shall and shall cause MSO Providers to ensure that their liability insurance company is
required to provide VISTA with thirty (30) days prior written notice of cancellation,
termination or non-renewal of MSO’s or an MSO Provider’s Insurance, as applicable. The
cancellation, termination and/or non-renewal of MSO’s or an MSO Provider’s Insurance, as
required under this Agreement, shall be deemed to be a “material breach” of this Agreement.
MSO shall and shall cause MSO Providers to immediately notify VISTA whenever a Member files a
claim or a notice of intent to commence legal action against MSO or an MSO Provider, if known
to MSO or an MSO Provider, including the details of the nature, circumstances and disposition
of such claim.
	 
	9	 	INDEMNIFICATION.

	 	9.1	 	MSO Indemnification. MSO shall indemnify, defend, and hold harmless,
VISTA, VISTA Affiliates and their officers, directors, employees, affiliates and
subsidiaries and agents from and against all expenses, claims, losses, damages, debts,
obligations and other liabilities (or actions in respect thereof), including reasonable
attorneys’ fees and court costs incurred in the investigation, settlement and defense of
any such action, whether threatened or actual, at trial level or on appeal, arising out
of or resulting from the acts or omissions of MSO or its officers, employees or agents
occurring during or in connection with the performance of MSO’s obligations under this
Agreement and the provision or failure to provide any and all services by MSO in
accordance with this Agreement.
	 
	 	9.2	 	Government Indemnification. In accordance with applicable federal and/or
state law, MSO shall indemnify, defend, and hold harmless Members, AHCA, CMS, OIR, and
any other governmental authority or agency, from and against all claims, damages, causes
of action, costs and expenses, including, court costs and reasonable attorneys’ fees
incurred in the investigation, settlement and defense of any such action, whether
threatened or actual, at trial level or on appeal, to the extent proximately caused by
any negligent action or other wrongful conduct arising from this Agreement, or arising
from any obligation for debts of MSO.
	 
	 	9.3	 	Coordination of Defense. The parties shall make all reasonable and
practicable efforts, consistent with the advice of counsel and the requirements of each
party’s insurance policy and/or carrier, to coordinate the defense of all claims in
which the other party is either a named defendant or has a substantial possibility of
being named as a defendant in a claim, dispute, proceeding or cause of action.
	 
	10	  NOTICE. Any notice required hereunder or otherwise given shall be in writing and sent
via (i) hand delivery, (ii) nationally recognized courier service, (iii) facsimile (provided
the

					
	 	 	 	 	 
	S. FL MSO Agmt. 

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	 	 	transmitting telecopier electronically confirms successful transmission of the notice
and a conformed copy is sent by another acceptable means within 24 hours thereafter), or
(iv) registered or certified mail, return receipt requested. Notices shall be sent to or by
VISTA or MSO at the addresses listed below, or at such other
addresses as either party may
designate to the other in writing:

	 	 	 	 	 	 	 
	 

	 	To VISTA:
	 	Vista Healthplan, Inc.	 	 
	 

	 	 	 	1340 Concord Terrace	 	 
	 

	 	 	 	Sunrise, Florida 33323	 	 
	 

	 	 	 	ATT: Executive Vice President	 	 
	 

	 	 	 	Fax: (954) 846-0331	 	 
	 
	 	 	 	 	 	 
	 

	 	With a copy to:
	 	Vista Healthplan, Inc.	 	 
	 

	 	 	 	300 South Park Road	 	 
	 

	 	 	 	Hollywood, Florida 33021	 	 
	 	 	 	 	ATT: Senior Vice President and General Counsel
	 

	 	 	 	Fax: (954) 985-4379	 	 
	 
	 	 	 	 	 	 
	 

	 	To MSO:
	 	MIAMI HEALTH CENTERS, INC.	 	 
	 

	 	 	 	3233 PALM AVE	 	 
	 

	 	 	 	HIALEAH, FL 33012	 	 
	 
	 	 	 	 	 	 
	 

	 	With a copy to:	 	 	 	 
	 

	 	 	 	 	 	 
	 
	 	 	 	 	 	 
	 

	 	 	 	 	 	 
	 
	 	 	 	 	 	 
	 

	 	 	 	 	 	 
	 
	 	 	 	 	 	 
	 

	 	 	 	 	 	 
	 
	 	 	 	 	 	 
	 

	 	To OIR:
	 	Office of Insurance Regulation	 	 
	 

	 	 	 	Department of Financial Services	 	 
	 

	 	 	 	Bureau of Market Conduct	 	 
	 

	 	 	 	200 East Gaines Street	 	 
	 

	 	 	 	Tallahassee, FL 32399-0300	 	 

	 	 	Notices shall be deemed given on the date of delivery as shown on the delivery receipt or
return receipt, or on the date noted on such receipt as the date delivery thereof was
refused, returned as unclaimed or determined impossible to accomplish due to an unnoticed
change of address. If any notice is transmitted by facsimile transmission, the notice shall
be deemed served upon electronic confirmation of receipt of the transmission.

	11	 	MISCELLANEOUS.

	 	11.1	 	Confidentiality.

	 	11.1.1	 	Confidential Materials. MSO acknowledges and agrees that as a result of
this Agreement, MSO may become informed of, and have access to, valuable

	 	 	 
	S. FL MSO Agmt.

	 	l8
	January 9, 2004
	 	 

 

 

	 	 	 	and confidential information of VISTA and VISTA Affiliates, including,
without limitation, (i) eligibility lists and any other information containing
the names, addresses and telephone numbers of Members; (ii) VISTA Policies and
all forms related thereto; (iii) other policy and procedure manuals; (iv) the
provisions of this Agreement; and (v) any other information compiled or created
by VISTA which is proprietary in nature, including names, payment rates and
methodologies, business methods, trademarks, logos, patents and copyrights (the
“Confidential Information”), and that the Confidential Information, even though
it may be contributed, developed or acquired, in whole or in part, by MSO, shall
remain the exclusive property of VISTA to be held by MSO in trust and solely for
VISTA’s benefit. Accordingly, except as required by law or expressly authorized
under this Agreement, MSO shall not and shall ensure that MSO Providers shall
not, at any time, either during or subsequent to the Term, use, reveal, report,
publish, copy, transcribe, transfer or otherwise disclose to any person,
corporation or other entity, any of the Confidential Information without the
prior written consent of VISTA, except to responsible persons who are in a
contractual or fiduciary relationship with VISTA and for information which
legally and legitimately is or becomes of general public knowledge from
authorized sources other than MSO or any person acting on MSO’s behalf.
	 
	 	11.1.2	 	Return of Confidential Information. Upon termination of this Agreement
to the extent permitted by applicable law, MSO shall and shall cause MSO
Providers to promptly deliver to VISTA all Confidential Information that is in
MSO’s or MSO Providers’ possession or control, including all copies and
abstracts of Confidential Information.
	 
	 	11.1.3	 	Confidential Operations Information. Unless otherwise required by law,
MSO shall not and shall ensure MSO Providers shall not disclose information
relating to the operations of VISTA to third parties without obtaining VISTA’s
prior written consent.
	 
	 	11.1.4	 	Confidentiality of Members’ Information. MSO shall and shall cause MSO
Providers to protect the confidentiality of Members’ information and records and
shall comply with VISTA Policies on the release of information (whether written or
oral) about Members and all applicable state and federal laws and regulations
protecting the confidentiality of Members’ records and disclosure of mental health
records, medical records and other health and member information, including, but
not limited to all requirements of HIPAA, as set forth in Schedule 11.1.4,
attached hereto and incorporated herein.
	 
	 	11.1.5	 	Ownership. Ownership of and right of control over all Confidential
Information shall vest exclusively in VISTA.

	 	 	 
	S. FL MSO Agmt.

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	January 9, 2004
	 	 

 

 

	 	11.1.6	 	Non-Solicitation of Members. MSO recognizes and agrees
that VISTA has a valuable business relationship with each of its Members and,
further, that MSO and MSO Providers stand in a position to influence Members’
decisions concerning insurers and health maintenance organizations. In
recognition of VISTA’s valuable business relationships with its Members, MSO
agrees that, during the Term, and upon termination of this Agreement for any
reason whatsoever, MSO shall not and shall ensure that MSO Providers shall not
solicit Members, directly or indirectly, to enroll in any other health
maintenance organization, health insurance or health coverage or alternative
health care delivery system. MSO’s obligation not to solicit Members is a
material inducement for MSO’s engagement by VISTA pursuant to
this Agreement.
This Section 11.1.6, however, is not intended to interfere with a Member’s right
to freely select a Provider or alternative health coverage subsequent to
termination of this Agreement. Further, MSO acknowledges and agrees that any and
all marketing or solicitation communication with Medicare Members and Medicaid
Members must be approved in advance of dissemination by CMS or AHCA, as
applicable, in accordance with applicable requirements.
	 
	 	11.1.7	 	Enforcement. MSO acknowledges and agrees that irreparable injury will
result to VISTA in the event of MSO’s breach of these covenants, that a material
inducement for MSO’s engagement by VISTA are the covenants set forth in this
Section 11.1, and that monetary damages in an action at law would not provide an
adequate remedy in the event of a breach of this Section 11.1. MSO further
acknowledges and agrees that the covenants set forth in this Section 11.1 are
necessary for the protection of VISTA’s legitimate business and professional
duties, ethical obligations, and interests and are reasonable in scope and
content. Accordingly, in the event of MSO’s breach of (i) this Section 11.1, or
any part of this Section 11.1, this Section 11.1 may be enforced by the obtaining
of an injunction to restrain the violation thereof by MSO and all persons acting
for or with MSO; or (ii) Section 11.1.6, as determined by a court of competent
jurisdiction, MSO shall pay to VISTA and amount equal to one thousand two hundred
dollars ($1,200) for each Member MSO inappropriately solicits, directly or
indirectly, to enroll in any other health maintenance organization, health
insurance or health coverage or alternative health care delivery system in
violation of Section 11.1.6, in addition to all other remedies VISTA may have at
law or in equity.

	 	11.2	 	Assignment. MSO shall not assign, delegate, subcontract, or otherwise
transfer its rights, obligations and/or interests arising under this Agreement,
including, but not limited to a transfer resulting from either an asset or stock
purchase, without the express written consent of VISTA. VISTA may assign, delegate,
subcontract or otherwise transfer its rights, obligations and/or interests under this
Agreement to any successor, a VISTA Affiliate or party to which any of VISTA’s line(s)
of business are sold, assigned or otherwise transferred, without MSO’s consent. This
Agreement

	 	 	 	 	 
	S. FL MSO Agmt.

	 	20	 	 
	January 9, 2004
	 	 	 	 

 

 

	 	 	 	shall be binding upon and inure to the benefit of the successors and permitted
assigns of the parties.
	 
	 	11.3	 	Severability. In the event that one or more provisions of this Agreement
are determined to be invalid, illegal or unenforceable, in whole or in part, the
validity, legality and enforceability of the remaining terms of this Agreement shall not
in any way be affected.
	 
	 	11.4	 	Attorneys’ Fees. In the event of any action, dispute, litigation or other
proceeding with respect to this Agreement or any specific term of this Agreement, the
prevailing party in such action, dispute, litigation or other proceeding shall be
entitled to recover reasonable fees, costs and expenses of counsel incurred in
connection with such proceeding, whether suit is instituted or not, and if instituted,
at both trial and appellate levels, in addition to any and all other relief to which it
may otherwise be entitled at law or in equity.
	 
	 	11.5	 	Modifications. VISTA may modify or amend one or more provisions of this
Agreement, including, but not limited to the addition of a new Benefit Program, upon
thirty (30) days notice to MSO. The failure of MSO to object to such modification in
writing to the Executive Vice President of Provider Operations during the thirty (30)
day notice period shall constitute acceptance of such amendment or modification as of
the effective date set forth in the notice. If MSO objects to such modification or
amendment, VISTA may terminate this Agreement upon its giving sixty (60) days prior
notice to MSO, or on such other date as is set forth in the notice to MSO; provided,
further, that this Agreement shall automatically be modified or amended without notice
or MSO’s ability to reject such modification or amendment, to the extent necessary from
time to time to comply with the requirements of state or federal laws or regulations or
to comply with the requirements or regulations of any Accreditation Organization, AHCA,
CMS, OIR, any other governmental agency with jurisdiction over VISTA or MSO, or the
requirements of any VISTA Coverage Plan. Notwithstanding the foregoing, any and all
changes or modifications to this Agreement made within thirty (30) days prior to the
effective date of termination of this Agreement shall be effective only if agreed to by
the parties.
	 
	 	11.6	 	Incorporation of Schedules. All schedules and exhibits to this Agreement
are considered part of this Agreement and are fully incorporated in this Agreement, with
the same effect as if such schedules and exhibits were restated in their entirety in the
body of this Agreement.
	 
	 	11.7	 	Governing Law. This Agreement is made, delivered in and shall be governed
by and construed and enforced in accordance with all applicable laws of the State of
Florida and the United States of America, including without limitation: (i) the Florida
Health Maintenance Organization Act, as amended, and the regulations promulgated
thereunder by OIR; (ii) the Federal Health Maintenance Organization Act of 1973, as
amended, and the regulations promulgated thereunder by DHHS; (iii) the Florida

	 	 	 	 	 
	S. FL MSO Agmt.

	 	21	 	 
	January 9, 2004
	 	 	 	 

 

 

	 	 	 	Insurance Code, as amended, and the regulations promulgated thereunder by OIR;
(iv) Title XVIII of the Social Security Act as amended, and the regulations promulgated
thereunder by CMS; (v) the Employee Retirement Income Security Act of 1974, as amended;
(vi) Title XIX of the Social Security Act and the regulations promulgated thereunder;
and (vii) Sections 409.901 — 409.920 of the Florida Statutes, and the regulations
promulgated thereunder by AHCA. This Agreement is also subject to the applicable rules
and regulations of AHCA, CMS and OIR. Any provisions required by any laws and
regulations to be included in this Agreement shall be binding upon VISTA and MSO
whether or not expressly included or referenced in this Agreement. Any and all
references to specific laws or regulations in this Agreement shall include any
successor laws or regulations and any and all amendments. MSO shall comply with all
applicable federal, state and local laws, rules and regulations of all governing
authorities over their respective businesses.
	 
	 	11.8	 	Non-Exclusive. VISTA acknowledges and
agrees that this Agreement in no
way prohibits or restricts MSO from entering into a contract with any other health
maintenance organization. MSO acknowledges and agrees that this Agreement in no way
prohibits or restricts VISTA or any VISTA Affiliate from entering into a contract with
any other health care provider or management services organization, inside or outside of
the Service Area.
	 
	 	11.9	 	Waiver. If any party decides not to terminate this Agreement, even though
it has the right to do so in a particular instance, or delays its decision to terminate,
such decision shall not be considered a waiver of its right to terminate on a future
occasion for the same or any other reason, and any other waivers of the breach or
violation of any provision of this Agreement shall not operate as, or be construed to
be, a waiver of any subsequent breach of the same or another provision of this
Agreement. To be effective, a waiver of any of MSO’s obligations under this Agreement
must be in writing and signed by an authorized representative of VISTA.
	 
	 	11.10	 	Independent Contractors.

	 	 	 	11.10.1 The relationship between VISTA and MSO is an independent contractor
relationship. The parties acknowledge and agree that neither party has the
authority to make any representation, warranty or binding commitment on behalf of
the other party, except as expressly provided in this Agreement or as otherwise
agreed to in writing by the parties, and nothing contained in this Agreement
shall be deemed or construed to (i) create a partnership or joint venture between
the parties or any affiliate, employee or agent of a party; or (ii) constitute
any party or employee, agent or associate of a party as an employee, agent or
associate of the other party. No party shall represent to any third party that it
is an employee of another party. MSO shall be responsible and shall pay in a
timely manner, FICA and all other taxes relating to payments made by VISTA to MSO
in accordance with this Agreement.

	 	 	 	 	 
	S. FL MSO Agmt.

	 	22	 	 
	January 9, 2004
	 	 	 	 

 

 

	 	11.10.2	 	MSO acknowledges and agrees that VISTA shall have no
responsibility for MSO’s or MSO Providers’ license, income, FICA,
unemployment or any and all other taxes, fees or levies upon MSO. MSO shall
and hereby does indemnify and save harmless VISTA, VISTA Affiliates and their
directors, officers, employees, representatives and affiliated and subsidiary
companies from and against all liability for the same.

	 	11.11	 	Construction; Acknowledgment. All parties have participated in the
negotiation of this Agreement and, accordingly, the parties agree that this Agreement
shall be construed and interpreted without regard to any presumption or other rule
requiring construction against the party causing this Agreement to be drafted. MSO read
this Agreement in its entirety, understands its contents, and had the advice of counsel
as to this Agreement’s meaning and intent.
	 
	 	11.12	 	Physician-Patient Relationship. The parties acknowledge and agree that
any and all decisions rendered by VISTA in its administration of this Agreement,
including, but  not limited to, all decisions with respect to the determination of
whether or not a service is a Covered Service, are made solely to determine if payment
of benefits under the applicable VISTA Coverage Plan is appropriate. The parties
further acknowledge and agree that any and all decisions relating to the necessity of
the provision or non-provision of medical services or supplies shall be made solely by
the Member and Provider in accordance with the usual provider-patient relationship.
Providers shall have sole responsibility for the medical care and treatment of Members
under Providers’ care. MSO further acknowledges and agrees that it is possible that a
Member and Provider may determine that certain services or supplies are appropriate
even though such services or supplies are not Covered Services under the applicable
VISTA Coverage Plan and will not be paid for or arranged by VISTA. MSO shall cause MSO
Providers to inform Members in writing prior to provision of such non-Covered Services
that such services are not Covered Services and that the Member will be responsible for
payment for such non-Covered Services and collect the fees for such non-Covered
Services directly from the Member.
	 
	 	11.13	 	Anti-Gag Clause. Nothing contained in this Agreement is intended to
interfere with the provider-patient relationship or to prohibit or otherwise restrict
Providers from freely communicating with or advising or advocating on behalf of a Member
regarding the Member’s health status, medical care or treatment options, including any
alternative treatments that may be
self-administered, medication treatment options and
any other medical care and treatment options for the Member which a Provider deems
knowledge of such information to be in the Member’s best interest, regardless of benefit
coverage limitations, including Provider’s provision of sufficient information to the
individual to provide an opportunity to decide among all relevant treatment options; the
risks, benefits and consequences of treatment or non- treatment; or the opportunity for
the individual to refuse treatment and to express preferences about future treatment
decisions.

	 	 	 	 	 
	S. FL MSO Agmt.

	 	23	 	 
	January 9, 2004
	 	 	 	 

 

 

	 	11.14	 	Headings. The headings contained in this Agreement are merely for
the purpose of convenience of reference only and do not in any way affect the meaning
or interpretation of this Agreement.
	 
	 	11.15	 	Entire Agreement. Except as otherwise provided herein, this Agreement
and all schedules and exhibits constitute the entire agreement and understanding
between the parties relating to the subject matter of this Agreement and supersede all
prior agreements between the parties, oral or written, regarding the subject matter of
this Agreement. Except as otherwise provided herein, in the event MSO previously
entered into a Management Services Agreement or any similar agreement with VISTA and/or
a VISTA Affiliate relating to the subject matter of this Agreement or the provision of
MSO Services that has not expired or been otherwise terminated, such agreement shall be
deemed to have been superseded by this Agreement as of the Effective Date.
	 
	 	11.16	 	Counterparts. This Agreement may be executed in multiple counterparts,
each of which shall be deemed an original and all of which together shall constitute a
single agreement.
	 
	 	11.17	 	Jurisdiction; Venue; Inconvenient Forum; Jury Trial. Any suit, action
or proceeding with respect to this Agreement shall be brought in federal or state court
located in Broward County, Florida and the parties accept the exclusive personal
jurisdiction of those courts for the purpose of any suit, action or proceeding. THE
PARTIES KNOWINGLY, VOLUNTARILY AND INTENTIONALLY WAIVE THE RIGHT EITHER PARTY MAY HAVE
TO A TRIAL BY JURY IN RESPECT OF ANY LITIGATION BASED ON THIS AGREEMENT, OR ARISING OUT
OF, UNDER OR IN CONNECTION WITH THIS AGREEMENT AND ANY AGREEMENT CONTEMPLATED TO BE
EXECUTED IN CONJUNCTION WITH THIS AGREEMENT OR ANY COURSE OF CONDUCT, COURSE OF
DEALING, STATEMENTS (WHETHER ORAL OR WRITTEN) OR ACTION OF ANY PARTY. THIS PROVISION IS
A MATERIAL INDUCEMENT FOR THE PARTIES TO ENTER INTO THIS AGREEMENT.
	 
	 	11.18	 	Interpretation of Certain Terms. When the context of this Agreement
requires, the gender of all words shall include the masculine, feminine and neuter, and
the number of all words shall include the singular and plural. All references herein to
“Member” shall be deemed only to refer and apply to Medicare Members and Medicaid
Members, as applicable to (i) the particular context of the Agreement; and (ii) those
certain Benefit Programs listed on Schedule D hereof.
	 
	 	11.19	 	Cumulative Remedies. Except as otherwise provided for to the contrary
in this Agreement, remedies provided for in this Agreement shall be in addition to and
not in lieu of any other remedies available to any party and shall not be deemed a waiver
or substitution for any action or remedy the parties may have at law or in equity.
Pursuit of a particular remedy by a party shall not be deemed to constitute a waiver
of

	 	 	 	 	 
	S. FL MSO Agmt.

	 	24	 	 
	January 9, 2004
	 	 	 	 

 

 

	 	 	 	any other right or remedy such party may have at law or in equity.
	 
	 	11.20	 	Sabcontracts. Except as otherwise permitted in this Agreement, MSO shall
not delegate or subcontract any of its obligations under this Agreement without the
prior written consent of VISTA. If MSO, with VISTA’s consent, carries out any of its
obligations or duties under this Agreement through a subcontract, such subcontract shall
contain a clause which requires the subcontractor to comply with any and all obligations
and duties imposed on MSO in this Agreement, including Medicare and Medicaid laws and
regulations. Such subcontract shall provide that the performance of the parties is
monitored by VISTA on an ongoing basis and that VISTA may take enforcement actions in
the event such subcontractor fails to comply, in VISTA’s determination, with any
obligation or duty imposed on MSO in this Agreement, including the Medicare and Medicaid
laws and regulations.
	 
	 	11.21	 	Force Majeure. No party to this Agreement shall be liable for any
default or delay in the performance of its obligations hereunder if and to the extent
the default or delay is caused, directly or indirectly, by strikes, picketing,
insurrection, acts of God, military actions, terrorist attacks, war, emergencies,
shortages or unavailability of materials or other causes beyond a party’s reasonable
control (a “Force Majeure Event”), and such party shall be excused from performance and
shall not be considered to be in default hereunder in respect to the affected
obligation. The suspension of performance due to a Force Majeure Event shall be of no
greater scope and no longer duration than that which is reasonably necessary. The
excused party shall use its reasonable best efforts to remedy its inability to perform
as soon as possible.
	 
	 	11.22	 	No Third Party Beneficiary. Except as otherwise expressly provided
herein, nothing in this Agreement is intended to, or shall be deemed or construed to
create any rights or remedies in any third party, including but not limited to a Member
or an MSO Provider.
	 
	 	11.23	 	Participation in Benefit Programs. MSO acknowledges and agrees and shall
cause MSO Providers to acknowledge and agree that, notwithstanding of the listing of a
Benefit Program on Schedule D, an MSO Provider’s participation in any one or
more Benefit Program(s) is under no circumstances whatsoever conditioned by VISTA or a
VISTA Affiliate or dependent on an MSO Provider’s participation or non- participation in
any other Benefit Program, relationship, arrangement, contract, line of business or
other agreement with VISTA or any VISTA Affiliate.
	 
	 	11.24	 	Execution by Authorized Representatives. An authorized representative of
each party shall execute this Agreement and an authorized representative of a party
shall execute any and all notices given by such party hereunder. MSO represents and
warrants that the individual executing this Agreement is authorized to bind MSO and all
MSO Staff to the rights, obligations, conditions and terms set forth in this Agreement.

	 	 	 	 	 
	S. FL MSO Agmt.

	 	25	 	 
	January 9, 2004
	 	 	 	 

 

 

	 	11.25	 	Survival. Article 2, Section 6.12, Article 7, Article 8, Article 9,
and Article 11 of this Agreement shall survive termination or expiration of this
Agreement for any reason whatsoever.

	 	 	IN WITNESS WHEREOF, the parties executed this Agreement as of the Effective Date.

	 	 	 	 	 	 	 	 	 	 	 
	 	 	 	 	 	 	VISTA HEALTHPLAN, INC.	 	 
	 
	 	 	 	 	 	 	 	 	 	 
	BY:

	 	/s/
	 	 	 	BY:
	 	/s/ Duell O. Wise	 	 
	 

	 	 
	 	 	 	 	 	 	 	 
	TITLE:

	 	Chief Operating Officer
	 	 	 	TITLE:
	 	Executive Vice President	 	 
	DATE:

	 	10/16/04
	 	 	 	DATE:
	 	10/27/04	 	 

	 	 	 	 	 
	S. FL MSO Agmt.

	 	26	 	 
	January 9, 2004
	 	 	 	 

 

 

AMENDMENT NUMBER 1

TO

PRIMARY CARE PROVIDER SERVICES AGREEMENT

EFFECTIVE September 1, 2004

     This Amendment to Primary Care Services Agreement (the “Amendment”), effective as of
September 1, 2004, is by and among Vista Healthplan, Inc. (“VHP”), Vista Insurance Plan, Inc.
(“VIP”; VHP and VIP collectively referred to as “VISTA”) and MIAMI DADE HEALTH CENTERS, INC.
(“Provider”).

     WHEREAS, VISTA and Provider entered into that certain Primary Care Provider Services
Agreement (the “Agreement”); and

     WHEREAS, Pursuant to Section 9.5 of the Agreement, VISTA desires to amend the Agreement in
the manner set forth herein.

     NOW, THEREFORE, in consideration of the mutual promises and covenants contained herein, the
parties hereby agree to amend the Agreement as follows:

I. Amendments.

	 	A.	 	Section 2.17 Disparagement Prohibited. Delete.
	 
	 	B.	 	Section 2.22 Hospitalist Program. Add. PCP retains the right to coordinate hospital
admissions for the PCP’s patients and bypass participation in VISTA’s hospitalist
program.
	 
	 	C.	 	Section 9.17 Enforcement. Delete and replace with: A material inducement for PCP’s
engagement by VISTA are the covenants set forth in this Section 9.1, and that monetary
damages in an action of law would not provide adequate remedy in the event of a breach of
this Section 9.1. PCP further acknowledges and agrees that the covenants set forth in this
Section 9.1 are necessary for the protection of VISTA’s legitimate business and
professional duties, ethical obligations, and interests and are reasonable in scope and
content. Accordingly, in the event of PCP’s breach of this Section 9.1, or any part of
this Section 9.1, this Section 9.1 may be enforced by the obtaining of an injunction to
restrain the violation thereof by PCP and all persons acting for or with PCP.
	 
	 	D.	 	Section 9.2. Assignment Delete and replace with: PCP shall not assign,
delete, subcontract, or otherwise transfer rights, obligations and/or interests arising
under this Agreement, including, but not limited to a transfer resulting from either an
asset or stock purchase, without the

1

 

	 	 	 	express written consent of VISTA. VISTA may assign, delegate, subcontract or otherwise
transfer its rights, obligations and/or interests under this Agreement to any successor,
VISTA Affiliate or a party to which any of VISTA’s line(s) of business are sold, with
written notification to provider. This Agreement shall be binding upon and inure to the
benefit of the successors and permitted assigns of the parties.
	 
	 	E.	 	Section 9.8 Non-Exclusive. Delete “commercial” from 1st sentence.
	 
	 	F.	 	Schedule 4.1 Exhibit 2 HMO Individual. Change Capitation Fee Rate to
“N/A” effective December 1, 2003.
	 
	 	G.	 	Schedule 4.1 Exhibit 3 Letter of Credit. Delete.
	 
	 	H.	 	Schedule 4.1 Exhibit 4 Letter of Credit. Delete.
	 
	 	I.	 	Schedule 4.1 Exhibit 5 Healthy Kids. Change Capitation Fee Rate to
“N/A” effective December 1, 2003.
	 
	 	J.	 	Schedule 4.1 Exhibit 11 Medicare Choice Advantage. Settlement B. Change
amount equal to fifty percent (50%) of the Deficit to read amount equal to one hundred
percent (100%) of the Deficit.
	 
	 	K.	 	VISTA will make best faith efforts to produce and provide management and
financial reports to provider to enable provider to manage provider’s VISTA’s members.

II. Miscellaneous.

	 	A.	 	Except as provided herein above, all of the terms and conditions contained in
the Agreement shall remain unchanged and in full force and effect.
	 
	 	B.	 	This Amendment is made pursuant to and in accordance with the terms and
conditions of the Agreement.
	 
	 	C.	 	All capitalized but not defined terms used herein shall have those meanings
ascribed to them in the Agreement.

2

 

IN WITNESS WHEREOF, the parties to this Amendment have cause the executions of this Amendment as of
the first day and year first above written.

	 	 	 	 	 	 	 
	 	 	VISTA HEALTHPLAN, INC.	 	 
	 
	 	 	 	 	 	 
	 

	 	By:
	 	/s/ Duell O. Wise
 

	 	 
	 	 	Print Name: Duell O. Wise	 	 
	 	 	Its: Executive Vice President	 	 
	 
	 	 	 	 	 	 
	 	 	VISTA INSURANCE PLAN, INC.	 	 
	 
	 	 	 	 	 	 
	 

	 	By:
	 	/s/ Duell O. Wise
 

	 	 
	 	 	Print Name: Duell O. Wise	 	 
	 	 	Its: Executive Vice President	 	 
	 
	 	 	 	 	 	 
	 	 	PROVIDER	 	 
	 
	 	 	 	 	 	 
	 

	 	By:
	 	 /s/
 

	 	 
	 	 	Print Name:	 	 
	 	 	Its: Chief Operating Officer	 	 

3

 

VISTA HEALTHPLAN, INC.
 VISTA INSURANCE PLAN. INC.

AMENDED AND RESTATED
 PRIMARY CARE PROVIDER SERVICES AGREEMENT

     This
PRIMARY CARE PROVIDER SERVICES AGREEMENT (the
“Agreement”) is entered into as of the
1st day of
September, 2004 by and among Vista Healthplan, Inc. (“VHP”), a
Florida corporation, Vista Insurance Plan, Inc., a Florida corporation, (“VIP”; VHP and VIP
collectively referred to as “VISTA”) and Miami Dade Health Centers, Inc (“PCP”). If PCP is a sole
proprietorship, professional association, partnership, limited liability company or corporation as
described on Schedule A, attached hereto and incorporated herein, or if PCP employs, or is
associated or contracts with other physicians, administrative staff or other health care
professionals, as listed on Schedule B, attached hereto and incorporated herein
(collectively, “PCP Staff”), all references to PCP herein, unless clearly inapplicable, shall apply
to all PCP Staff, and it shall be PCP’s obligation to ensure such compliance.

RECITALS

	A.	 	VHP is a health maintenance organization licensed in accordance with Chapter 641 of the
Florida Statutes that operates various health service plans and other network access
arrangements (the “Benefit Programs”) and arranges for the provision of certain healthcare
services to Members.
	 
	B.	 	VIP is a licensed health insurance company in the State of Florida that offers various health
service plans, including preferred provider organization plans, and arranges for the provision
of certain healthcare services to Members through a preferred provider panel.
	 
	C.	 	PCP is or offers the services of a physician licensed by the State of Florida to practice
medicine who acts as a Primary Care Physician.
	 
	D.	 	VISTA desires to engage PCP to provide Primary Care Services,
as set forth on Schedule C,
attached hereto and incorporated herein, to Members participating in certain Benefit
Programs, as specifically identified on Schedule D, attached hereto and incorporated
herein, and PCP desires to provide Primary Care Services to such Members subject to the terms
and conditions set forth in this Agreement.

     NOW, THEREFORE, in consideration of the promises and covenants contained in this Agreement,
and other good and valuable consideration, the receipt and adequacy of which are hereby forever
acknowledged and confessed, the parties mutually agree as follows:

	1	 	DEFINITIONS. All capitalized but not otherwise defined terms shall have the meanings
ascribed to such terms in Schedule 1, attached hereto and incorporated herein.
	 
	2	 	DUTIES OF PCP.

	 	2.1	 	PCP’s Responsibilities. During the Term (as defined below), PCP shall
provide Primary Care Services to Members within the Service Area in accordance with
the terms and conditions of this Agreement, and shall be available, either through PCP
or a Covering Physician, twenty-four (24) hours per day, seven (7) days per week, to
provide Primary Care Services to Members in PCP’s office and arrange or provide
Primary Care Services to Members in any inpatient facility. PCP shall maintain an
appropriately staffed office within the Service Area to provide Primary Care Services
to Members. PCP or a

June 1, 2004

 

 

	 	 	 	Covering Physician shall maintain appropriate staff privileges with at least one
Participating Hospital in the Service Area. PCP shall comply with the PCP Requirements set
forth on Schedule 2.1, attached hereto and incorporated herein, and VISTA
Policies.
	 
	 	2.2	 	Standard of Care. All Primary Care Services provided by PCP shall be provided in
accordance with professionally recognized standards of healthcare and
VISTA Policies.
	 
	 	2.3	 	Referrals and Pre-Authorizations. PCP shall make appropriate Referrals and obtain
required Pre-Authorizations for all Covered Services in accordance with this Agreement, the
applicable VISTA Coverage Plan and VISTA Policies. PCP shall use his/her best efforts to
provide Members with any necessary Referral or obtain any required Pre-Authorization from
VISTA while the Member is in PCP’s office. VISTA shall use its best efforts to provide
requested Pre-Authorization immediately upon PCP’s request; provided, however, that PCP
agrees to take a pending or tracking number with respect to a Pre-Authorization request in
the event VISTA requires further information in making the Pre-Authorization coverage
decision. Except in the case of Emergency Services or Urgently Needed Services or upon the
prior written approval of VISTA’s Medical Director or his/her designee, PCP agrees that all
charges incurred for Covered Services by VISTA which fail to comply with VISTA’s Referral
and Pre-Authorization requirements, including those set forth in VISTA Policies or the
applicable VISTA Coverage Plan, shall be borne by PCP, including all related costs, fees,
charges and expenses. PCP hereby agrees to indemnify and hold harmless Members, AHCA, CMS
and DOI against charges for Covered Services for which PCP failed to comply with VISTA’s
Referral and Pre-Authorization requirements, as required under VISTA Policies, the applicable
VISTA Coverage Plan or this Agreement.
	 
	 	2.4	 	Participating Providers. Except in the case of Emergency Services or Urgently Needed
Services, upon the prior written approval of VISTA’s Medical Director or his/her designee, as
permitted under the applicable VISTA Coverage Plan or as otherwise required by applicable law,
all Referrals and Pre-Authorizations for Covered Services, including, but not limited to
ancillary services such as laboratory and radiology services, shall be made to Participating
Providers in accordance with VISTA Policies. If PCP fails to comply with this Section 2.4, PCP
shall be responsible for all charges incurred for Covered Services by VISTA rendered by a
Non-Participating Provider without the required Pre-Authorization, including all related
costs, fees, charges and expenses. PCP hereby agrees to indemnify and hold harmless Members,
AHCA, CMS and DOI against charges for Covered Services rendered by a Non-Participating
Provider for which PCP failed to obtain the required Pre-Authorization.
	 
	 	2.5	 	Covering Physicians. PCP shall make necessary and appropriate arrangements with
Covering Physicians to ensure the availability of Primary Care Services to Members twenty-four
(24) hours per day, seven (7) days per week, including arrangements to ensure coverage of
Members after hours or when PCP is otherwise unavailable. PCP shall ensure that Covering
Physicians are Participating Providers, except as otherwise consented to by VISTA in writing.
PCP shall ensure that Covering Physicians adhere to the terms of this Agreement and all VISTA
Policies and that Covering Physicians seek required Pre-Authorization from VISTA, or Refer the
Member back to PCP, as required by VISTA Policies, except for Emergency Services or Urgently
Needed Services or as otherwise permitted under the applicable VISTA Coverage Plan. Except for
Hospitalist Physicians (as defined below), with respect to Capitated Services (as defined
below), PCP shall be solely liable to Covering Physicians for the amount and manner in which

2

 

	 	 	 	Covering Physicians are reimbursed or otherwise compensated for services rendered to
Members on PCP’s behalf. PCP acknowledges and agrees that VISTA shall not have any
financial obligation whatsoever to Covering Physicians with respect to Capitated Services.
PCP shall ensure that Covering Physicians do not, under any circumstances, bill Members
for Covered Services other than for applicable Co-Payments, Deductibles and Co-Insurance.
PCP hereby agrees to indemnify and hold harmless Members, AHCA, DOI, and CMS against
charges for Covered Services rendered by Covering Physicians. All charges incurred for
services rendered pursuant to a Pre-Authorization or Referral made by a Covering
Physician, other than a Referral back to PCP, shall, unless such Pre-Authorization or
Referral was approved by VISTA in advance and in writing or as otherwise permitted under
the applicable VISTA Coverage Plan, be borne by PCP who shall be liable for all costs,
fees, charges and expenses associated with such services.
	 
	 	2.6	 	Coordination of Benefits. PCP agrees that payment for Covered Services provided to
Members is subject to coordination with any other benefits payable or paid to or for a
Member. Such benefits include, but are not limited to, any group insurance coverage,
contract, prepayment plan or governmental program and any claims that may give rise to
compensation to a Member from a third party, including, without limitation, workers’
compensation and automobile insurance. VISTA shall be subrogated to all rights of recovery
of a Member against any person or entity for such benefits or payments as permitted under
applicable law and this Agreement. PCP shall use its best efforts to determine whether a
Member has any benefits as described above or whether a third party may be responsible for
payment. PCP shall assist VISTA in coordination of benefits by (i) requiring a Member so
covered to sign all necessary documents to give effect to this Section 2.6; and (ii) signing
any other document and providing any other information or records so requested by VISTA at
no cost to VISTA. Unless otherwise required by law, PCP shall not be entitled to
reimbursement by any third party for Covered Services rendered to Members, including,
Medicare intermediaries or carriers, and all sums recovered pursuant to this Section 2.6
shall be retained by VISTA. Unless required by law or the applicable VISTA Coverage Plan, in
the event VISTA is the primary carrier, payments made by VISTA to PCP plus allowed
Co-Payments, Deductibles and Co-Insurance shall be deemed payment in full for all services
rendered by PCP hereunder. In the event VISTA is the secondary carrier (except in the case
of Medicare or where otherwise required by law), VISTA shall pay for all services rendered
to Members in accordance with this Agreement and applicable law that were not paid by the
primary carrier, provided, however, that the combined payments made by the primary and
secondary carriers shall not exceed one hundred percent (100%) of the compensation due PCP
by VISTA under Schedule 4.1 of this Agreement. If VISTA is the secondary carrier to
Medicare, VISTA’s liability shall be limited to Deductible and Co-Insurance amounts, unless
otherwise required by federal law.
	 
	 	2.7	 	Collection of Charges From Members. PCP agrees that in no event, including but not
limited to non-payment by VISTA, insolvency of VISTA, or breach of this Agreement, shall PCP,
or any representative of PCP, bill, charge, collect a deposit from, seek compensation,
remuneration or reimbursement from, or have any recourse against Members or persons (other
than VISTA) acting on a Member’s behalf for Covered Services provided pursuant to this
Agreement. Additionally, PCP, or any representative of PCP, shall not collect or attempt to
collect money from, maintain any action at law against, or report to a credit agency a Member
for payment of a claim for a Covered Service for which VISTA contested or denied PCP’s claim,
including, but not limited to pended claims submitted by PCP to VISTA for payment of the
services or claims

3

 

	 	 	 	investigated under VISTA’s internal dispute resolution process to determine whether VISTA
is liable for the services. For a pended claim, pendency applies from the date the claim or
portion of the claim is denied until the date of the completion of VISTA’s internal dispute
resolution process, not to exceed sixty (60) days. Notwithstanding the foregoing, this
Agreement does not prohibit PCP from collecting Co-Payments, Deductibles and Co-Insurance,
as specifically provided in the applicable VISTA Coverage Plan, or fees for non-Covered
Services delivered on a fee-for-service basis to Members. Nor does this Agreement prohibit
PCP and a Member from agreeing to continue services solely at the expense of the Member, as
long as PCP clearly informed the Member in advance and in writing that VISTA might not
cover or continue to cover such specific service(s). PCP shall bill Members directly for
any applicable Co-Payments, Deductibles and Co-Insurance at the time Covered Services are
rendered. PCP further agrees that this Section 2.7 (i) shall survive the termination of
this Agreement regardless of the cause giving rise to such termination and shall be
construed to be for the benefit of Members; and (ii) supersedes any oral or written
agreement to the contrary now existing or hereafter entered into
between PCP and a Member
or persons acting on a Member’s behalf. PCP agrees that if non-Covered Services are to be
provided to Members, it is PCP’s responsibility to inform the Member in writing prior to
the provision of such non-Covered Services that such services are not Covered Services and
that the Member will be responsible for payment for such non-Covered Services and to
collect the fees for such non-Covered Services directly from the Member. In the event that
the Member is not so informed, PCP agrees that the Member shall not be liable to PCP for
payment for such non-Covered Services.
	 
	 	2.8	 	Publication Authorization. PCP agrees that VISTA may use PCP’s name, address and
telephone number in VISTA’s provider directory and other marketing materials; provided,
however, that VISTA shall have no obligation to include PCP’s name or other information in
VISTA’s provider directory. PCP shall not advertise or market VISTA, any VISTA Affiliate or
any of their healthcare services or Benefit Programs, or utilize any trademarks, trade names,
logos or other VISTA property without VISTA’s prior written approval.
	 
	 	2.9	 	Nondiscrimination. PCP represents and warrants to VISTA that PCP shall not
discriminate against Members with respect to the availability or provision of health services
based on a Member’s race, sex, age, religion, place of residence, HIV status, source of
payment, VISTA membership, color, sexual orientation, marital status or any factor related to
a Member’s health status, including, but not limited to, a Member’s medical condition
(including mental as well as physical illness), claims experience, receipt of health care,
medical history, genetic information, evidence of insurability (including conditions arising
out of acts of domestic violence), disability or on any other basis otherwise prohibited by
state or federal law. Further, PCP shall comply with Title VI of the Civil Rights Act of 1964,
as implemented by regulations at 45 C.F.R. part 84; the Rehabilitation Act of 1973; the
Americans with Disabilities Act; the Age Discrimination Act of 1975, as implemented by
regulations at 45 C.F.R. part 91; other laws applicable to recipients of federal funds; and
all other applicable laws and rules, as required by applicable laws or regulations. PCP shall
not discriminate against a Member based on whether or not the Member executed an advance
directive.
	 
	 	2.10	 	Compliance with Requirements of CMS:. PCP shall comply with any and all applicable
Medicare laws, regulations, CMS instructions and VISTA’s obligations under its contract with
CMS with respect to the provision of Covered Services and all other activities

4

 

	 	 	 	relating to Medicare Members. PCP represents and warrants that he/she participates as a
provider under Title XVIII of the Social Security Act (Medicare) in accordance with 42
C.F.R. Part 422, and shall maintain such participation throughout the Term. Further, PCP
shall allow CMS to evaluate the quality, appropriateness, and timeliness of Primary Care
Services rendered by PCP to Medicare Members and shall comply with and abide by the
results of any grievance procedures adopted by CMS.
	 
	 	2.11	 	Encounter Data. As required by VISTA and applicable law, PCP shall submit complete
Encounter Data to VISTA on a monthly basis on or before the last day of each month, or such
lesser time period as may be required by VISTA or applicable law, for encounters occurring in
the immediately preceding month. PCP shall submit Encounter Data in accordance with VISTA
Policies or as otherwise required by VISTA or state or federal laws or regulations, and shall
certify the accuracy, completeness and truthfulness of such Encounter Data in such form as
required by VISTA Policies. PCP acknowledges and agrees that in the event PCP fails to comply
with this Section 2.11, (i) VISTA may withhold any and all payments due by VISTA to PCP until
such time as VISTA receives the current and complete Encounter Data that it requested; and
(ii) such failure may be deemed a material breach of this Agreement, as determined by VISTA in
VISTA’s sole discretion.
	 
	 	2.12	 	Suspension. If PCP is the subject of a notice of suspension, limitation or
restriction on PCP’s license to practice medicine in any jurisdiction or is excluded from or
voluntarily opts out of the Medicare or Medicaid program, PCP shall not render any services to
Members during such period of suspension, exclusion or non-participation in the Medicare or
Medicaid program or violate the terms of such suspension, limitation, restriction or
exclusion, unless otherwise permitted by VISTA in accordance with applicable law; and,
further, PCP shall notify VISTA of such suspension, limitation or restriction, exclusion or
non-participation in the Medicare or Medicaid program in accordance with Schedule 2.1.
Any Member seeking Primary Care Services from PCP during such period of suspension, exclusion
or non-participation in the Medicare or Medicaid program, or requiring Primary Care Services
which PCP is then restricted or limited from providing, may be referred by VISTA to another
Primary Care Physician for such Primary Care Services upon receipt by VISTA of any such
notice. In the event PCP is suspended, limited, restricted, excluded or does not participate
in the Medicare or Medicaid program, VISTA shall have the right to terminate any and all
payments due to PCP from VISTA under this Agreement during such period of suspension,
limitation, restriction, exclusion or non-participation in the Medicare or Medicaid program.
	 
	 	2.13	 	Verification of Eligibility. Prior to providing any services to a Member, PCP shall
cause the Member to produce his/her VISTA membership card or, if the Member represents that
such membership card was not yet issued by VISTA, the Member’s enrollment form. VISTA shall
make reasonable efforts to confirm or deny eligibility using the most current information
provided by the Subscriber Group, CMS or any other governmental agency, as applicable;
provided, however, that PCP’s compliance with such verification procedures and/or VISTA’s
confirmation of a Member’s eligibility does not constitute a guarantee of such Member’s
eligibility or VISTA’s coverage of any services provided by PCP in reliance on such
confirmation. In the event VISTA determines that a Member was ineligible at the time services
were provided by PCP to such Member, VISTA may recover payments made by VISTA to PCP for that
Member retroactive to the first (1st) day of the month in which the Member became
ineligible for coverage. VISTA may retroactively add Members to PCP’s panel for a period of up
to ninety (90) days from the

5

 

	 	 	 	date VISTA determines, in VISTA’s sole discretion, that the particular Member should
have been included in PCP’s panel and PCP shall receive applicable Capitation Fee payments
on behalf of that Member for such period. If, in VISTA’s determination, Member was
erroneously or inappropriately placed on PCP’s Member list or is retroactively terminated,
VISTA may offset any Capitation Fee payment previously paid to PCP on behalf of such Member
for a period of up to one (1) year from future payments due to PCP; provided, however, that
such one (1) year limitation shall not apply to Members covered under Federal Employee
Health Benefit Program, Medicare or Medicaid pursuant to an adjustment made by CMS or AHCA,
as applicable. If the Member loses eligibility during hospitalization, PCP may collect from
the Member any amounts for services rendered subsequent to the loss of coverage under the
applicable VISTA Coverage Plan; provided, however, that any such loss of eligibility shall
be subject to applicable law, the applicable VISTA Coverage Plan and VISTA Policies.
	 
	 	2.14	 	Consultations. PCP shall participate in all programs instituted by VISTA to consult
with its Participating Providers regarding VISTA Policies to assure compliance with federal,
state and Accreditation Organization standards.
	 
	 	2.15	 	Provision of Treatment Options. PCP shall provide information in a culturally-
competent manner to all Members and consider and take measures to accommodate, at PCP’s sole
cost and expense, Members’ English proficiency, reading skills, diverse cultural and ethnic
backgrounds and physical or mental disabilities when discussing a Member’s treatment options,
including the option of no treatment.
	 
	 	2.16	 	Direct Access and Cost-Sharing. PCP shall, as mandated by state or federal law, the
applicable VISTA Coverage Plan and VISTA Policies; allow Members direct access to certain
Specialist Physicians; not inhibit Members’ self-referral for certain services, including
mammography screening and influenza vaccinations; and not impose cost- sharing on any Member
for influenza or pneumococcal vaccines.
	 
	 	2.17	 	Disparagement Prohibited. PCP shall not disparage VISTA, any VISTA Affiliate or any
VISTA Coverage Plan in any form or manner whatsoever. In the event PCP is determined to have
disparaged VISTA, any VISTA Affiliate or any VISTA Coverage Plan, in VISTA’s sole
determination, such action by PCP may constitute a material breach of this Agreement.
	 
	 	2.18	 	Consumer Assistance Notice. PCP shall post a prominently displayed and clearly
noticeable consumer assistance notice in PCP’s reception area which states the addresses and
toll-free telephone numbers of AHCA, the Statewide Provider and Subscriber Assistance Program
and the DOI and states that the address and toll-free telephone number of VISTA’s grievance
department shall be provided upon request.
	 
	 	2.19	 	Medicaid. If PCP participates in VISTA’s
Medicaid program as indicated on Schedule D,
PCP shall comply with all Medicaid requirements set forth in Schedule 2.19, attached
hereto and incorporated herein, with respect to any Medicaid Member.
	 
	 	2.20	 	Risk Management and Adverse or Untoward Incident Reporting Requirements. If an Adverse
or Untoward Incident occurs to a Member, PCP shall report the Adverse or Untoward Incident to
VISTA’s Risk Manager within three (3) working days after its occurrence. PCP shall (i) participate
in and cooperate with VISTA’s Risk Management Program; (ii) provide such medical and other records
without charge within ten (10) days

6

 

	 		 	of receipt of written notice; (iii) share such investigation reports and other
information as may be required or requested by VISTA’s Risk Manager to determine if
an Adverse or Untoward Incident is reportable as a “Code 15” to AHCA; and (iv) in
all other respects comply with and abide by VISTA Policies. PCP’s failure to comply
with this Section 2.20 and applicable VISTA Policies may be deemed a material
breach of this Agreement, at VISTA’s sole discretion.
	 
	 	2.21	 	Notification of Change. PCP shall notify VISTA in writing in
accordance with this Agreement at least forty five (45) days prior to any change in
PCP’s (i) office address; (ii) billing address; (iii) phone number; (iv) PCP Staff,
such as addition or deletion of any PCP Staff; (v) name or fictitious name; or (vi)
taxpayer identification number. PCP shall notify VISTA in writing within fifteen (15)
days in the event of the death of a member of the PCP Staff.
	 
	 	2.22	 	Hospitalist Program. PCP hereby elects to participate in VISTA’s
Hospitalist Program (the “Program”) at certain Participating Hospitals unless
otherwise indicated on Schedule 2.22. attached hereto and incorporated herein.
Under the Program, PCP understands and agrees that physicians contracted, directly or
indirectly, with VISTA are responsible for certain Primary Care Services (“Hospitalist
Physicians”) PCP is otherwise obligated to provide under this Agreement on behalf of
Members assigned to or who select PCP as their Primary Care Provider (“PCP Members”)
who present to or are admitted as inpatients to a hospital, including, but not limited
to (i) evaluation of PCP Members presenting to the hospital’s emergency room; (ii)
conducting daily hospital rounds of PCP Members; (iii) coordinating care of PCP
Members and ensuring timely provision of Medically Necessary diagnostic tests and
procedures; (iv) communicating regularly with PCP, PCP Members and the PCP Members’
families, as appropriate; and (v) overseeing and coordinating discharge planning of
PCP Members with PCP, VISTA and the hospital. PCP hereby agrees to
assign responsibility of PCP Members to Hospitalist Physicians when
PCP Members present to the emergency department or
are inpatients of a hospital. Except in cases where PCP elects not participate in the
Program, PCP shall hot document any progress notes in the PCP Member’s record or issue
any orders on behalf of a PCP Member who is an inpatient in a hospital; provided,
however, that PCP shall continue to perform all other Primary Care Services with
respect to PCP Members, including, but not limited to (i) resuming responsibility for
all care, including follow-up care, of a PCP Member immediately upon the PCP Member’s
discharge from the hospital; (ii) communicating all medical information/history to the
Hospitalist Physician attending to a PCP Member which is necessary to the PCP Member’s
care and treatment in the hospital; and (iii) performing any and all other
requirements as requested by VISTA in connection with PCP’s participation in the
Program. PCP shall comply with any and all VISTA Policies governing PCP’s
participation in the Program.
	 
	 	2.23	 	Network Access Arrangement. If PCP participates in VISTA’s Network
Access Arrangement program as indicated on Schedule D, PCP shall comply with
all requirements set forth in Schedule 2.23, attached hereto and incorporated
herein, with respect to any Participant.

	3	 	DUTIES OF VISTA.

	 	3.1	 	Limitation on Selection of PCP. VISTA may limit, restrict or suspend
Members’ opportunity to select PCP for Primary Care Services, effective immediately
upon written notice to PCP. PCP shall comply with any such notice.

7

 

	 	3.2	 	Accountability to CMS. To the extent required by law, VISTA shall
oversee and be accountable to CMS with respect to those services performed by PCP
pursuant to this Agreement with respect to Medicare Members.
	 
	 	3.3	 	Verification of Eligibility. VISTA shall determine Members’
eligibility for Covered Services and shall provide Eligibility Information to PCP upon
request. VISTA shall ensure that each Member’s identification card identifies (i) the
person as a Member; (ii) PCP as the Member’s designated provider or arranger of Primary
Care Services, where the applicable VISTA Coverage Plan so provides; and (iii) the toll
free phone number established by VISTA for verification of eligibility or other
questions.

	4	 	COMPENSATION.

	 	4.1	 	Payment for Primary Care Services. As compensation in full for Primary
Care Services provided by PCP under this Agreement, VISTA shall pay PCP as set forth in
Schedule 4.1 and the Exhibits thereto, attached hereto and incorporated
herein, as amended by VISTA from time to time in VISTA’s sole discretion in accordance
with Section 9.5 of this Agreement PCP agrees that the compensation paid by VISTA to
PCP pursuant to Schedule 4.1, plus any applicable Co-Payments, Deductibles and
Co-Insurance shall serve as full and complete compensation to PCP for all Primary Care
Services rendered to Members under this Agreement, both in PCP’s office and in an
inpatient setting. To the extent required by law, VISTA shall provide PCP with
additional information regarding VISTA’s payment to PCP for Primary Care Services
provided by PCP under this Agreement upon PCP’s request. With respect to Medicare
Members, PCP acknowledges that VISTA is receiving federal funds and that payments to
PCP for Covered Services under this Agreement may be, in whole or in part, from federal
funds. To the extent required by law, PCP shall be subject to all laws applicable to
entities receiving federal funds. PCP acknowledges the limitation on collection of
charges from Members, including, without limitation, that set forth in Section 2.7
hereof.
	 
	 	4.2	 	Utilization-Related Compensation. PCP acknowledges and agrees that any
and all decisions rendered by VISTA in its administration of this Agreement, including,
but not limited to, all decisions rendered in connection with VISTA’s utilization
management activities are based solely on whether such services are covered under the
applicable VISTA Coverage Plan. Further, PCP acknowledges and agrees that VISTA does
not compensate PCP for denial of care or services and VISTA does not offer incentives
to encourage denial of care or services. PCP recognizes that there is a need for
special concern about underutilization of care and services.
	 
	 	4.3	 	Multiple Agreements. Notwithstanding Section 9.15 hereof, if PCP is a
party to more than one agreement with VISTA or a VISTA Affiliate for the provision of
Covered Services to Members, VISTA shall have the right to determine, in VISTA’s sole
discretion, whether this Agreement or such other agreement governs with respect to the
amount of reimbursement for Covered Services provided to a particular Member VISTA is
obligated to pay PCP.
	 
	 	4.4	 	Member Responsibility. PCP acknowledges and agrees that VISTA shall
have no financial or other liability with respect to a Member’s failure to pay PCP
amounts due PCP for Co-Payment, Co-Insurance, or Deductible as required under the
Member’s VISTA Coverage Plan or for non-Covered Services.

8

 

	5	 	TERM. Unless earlier terminated as provided in this Agreement, this Agreement
shall commence as of the Effective Date, as defined in Section 2.26 hereof, and shall end on
the first (1st) anniversary of the Effective Date and shall automatically renew for
successive one (1) year periods (collectively, the “Term”), unless either party provides the
other party with written notice of its intent to terminate this Agreement at least sixty
(60) days prior to the end of the then current Term.
	 
	6	 	TERMINATION.

	 	6.1	 	Termination by Mutual Consent. The parties may terminate this Agreement
at any time upon their mutual, written consent.
	 
	 	6.2	 	Termination Without Cause. Either party may terminate this Agreement
without cause by providing sixty (60) days prior written notice to the other party.
	 
	 	6.3	 	Termination For Material Breach. Either party may terminate this
Agreement for material breach. If a party (the “Non-Breaching Party”) believes that the
other party (the “Breaching Party”) committed a material breach of this Agreement, the
Non-Breaching Party shall give the Breaching Party written notice specifically setting
forth the nature of the material breach (the “Notice”). The Breaching Party shall have
thirty (30) days from the date of the Notice to cure or otherwise eliminate the
circumstances constituting the material breach. If the Breaching Party fails to cure or
eliminate the breach within the thirty (30) day period, then the Non-Breaching Party may
terminate this Agreement effective sixty (60) days following the date of the Notice.
	 
	 	6.4	 	Automatic Termination. Notwithstanding Section 6.3 above, VISTA may
terminate this Agreement immediately upon notice to PCP if (i) PCP becomes insolvent,
files a petition for protection from its creditors, enters into any general arrangement
or assignment for the benefit of its creditors, suffers or consents to the appointment
of a trustee or a receiver to take possession of substantially all of PCP’s assets, or
in the event of the attachment, execution or other judicial seizure of substantially all
of PCP’s assets; or (ii) VISTA determines, in VISTA’s sole discretion, that: (a) the
actions or inactions of PCP are causing or will cause imminent danger to the health,
safety or welfare of any Member; (b) PCP’s license, DEA registration, hospital staff
privileges, right to participate in the Medicare or Medicaid program or other
accreditation is restricted, suspended or revoked or PCP voluntarily relinquishes any of
the foregoing; (c) PCP’s ability to practice medicine is effectively impaired by an
action of the Board of Medicine or other governmental agency; (d) PCP is convicted of a
criminal offense related to his/her involvement in Medicaid, Medicare or social service
programs under Title XX of the Social Security Act; (e) PCP demonstrates a pattern of
behavior which violates or is contrary to VISTA Policies; or (f) PCP engaged in any
other behavior or activity that could be hazardous or injurious to any Member.
	 
	 	6.5	 	Termination on PCP’s Death or Disability. VISTA shall have the right to
terminate this Agreement immediately upon PCP’s death or disability where, as determined
by VISTA in VISTA’s sole judgment and discretion, PCP is unable to perform his or her
duties and obligations as required under this Agreement.
	 
	 	6.6	 	DOI Cancellation of Agreement and Notice to DOI and AHCA. This Agreement
shall be canceled immediately upon issuance of an order by DOI pursuant to Section
641.234 of the Florida Statutes. Further, in the event that either VISTA terminates this

9

 

	 	 	 	Agreement without cause under Section 6.2 hereof or PCP terminates this Agreement for any
reason whatsoever, the party so terminating this Agreement shall provide DOI and AHCA, as
required by applicable law, with sixty (60) days advance written notice of such
termination, or such longer time as required by law; provided, however, that if VISTA
terminates this Agreement for any other reason, VISTA shall immediately provide DOI and
AHCA notice of such termination, as required by applicable law.
	 
	 	6.7	 	Continuing Care Responsibilities. Except as otherwise provided in this Agreement,
upon termination of this Agreement for any reason whatsoever, the rights of each party shall
terminate; provided, however, that such termination shall not release PCP from: (i) PCP’s
agreement not to seek compensation from Members, other than as specifically permitted by
Section 2.7, for Covered Services provided by PCP to Members prior to the effective date of
termination of this Agreement, which agreement shall also be applicable after termination of
this Agreement with respect to Covered Services provided to Members during any period in
which PCP is providing continuing care to a Member as contemplated below; and (ii) PCP’s
obligation, under applicable law, to arrange and provide continuation of coverage and care
for those Members then utilizing PCP as their Primary Care Physician or for whom treatment
is otherwise active with PCP until the earlier of: (a) the completion of treatment of a
condition for which the Member is receiving care on the effective date of termination; (b)
the date on which the transfer of such Member’s care to another Primary Care Physician can
be arranged by VISTA; or (c) the next open enrollment period offered by the Subscriber
Group, if applicable; provided, however, that PCP shall not be required to provide such
continuation of coverage and care to any Member longer than six (6) months after the
effective date of termination of this Agreement. Notwithstanding the foregoing, VISTA shall
allow PCP and PCP shall continue to provide care after the termination of this Agreement for
any Member who initiated a course of prenatal care, regardless of the trimester in which
care was initiated, until completion of postpartum care. Notwithstanding anything herein to
the contrary, if termination of this Agreement occurs during the insolvency of VISTA or in
the event that the contract between CMS and VISTA terminates or is not renewed for any
reason whatsoever, PCP shall provide Primary Care Services to Members for the duration of
the later of: (i) the period for which the Member made payment under his/her VISTA Coverage
Plan or for the duration of the contract period for which CMS payments were made to VISTA on
behalf of the Member, as applicable; (ii) the duration of any stay by the Member in an
inpatient facility on the date of insolvency or, in the event that the contract between CMS
and VISTA expires or terminates, until the Member is discharged from such facility; or (iii)
such longer period of time as may be necessary for VISTA to remain in compliance with
federal and state laws and regulations, including, without limitation, Medicare and
Medicaid. During any such continuation of care period, VISTA shall compensate PCP in
accordance with Schedule 4.1 of this Agreement for care rendered to any Member and
PCP shall be bound by the terms of this Agreement. PCP further agrees that (i) this Section
6.7 shall survive the termination of this Agreement regardless of the cause giving rise to
termination and shall be construed to be for the benefit of the Member; and (ii) this
Section 6.7 supersedes any oral or written agreement to the contrary, whether now existing
or hereafter entered into between PCP and a Member, or persons acting on a Member’s behalf.
	 
	 	6.8	 	Notification by PCP to VISTA. Upon termination of this Agreement for any reason
whatsoever (including expiration of this Agreement without renewal), PCP shall notify VISTA
in writing:

10

 

	 	6.8.1	 	of the reason for PCP’s termination of this Agreement; and
	 
	 	6.8.2	 	within fifteen (15) days of termination of this Agreement of
(i) a detailed list, in such, format as required under VISTA Policies, of all
Members receiving Primary Care Services at the time of termination of this
Agreement who require continuation of care in any capacity whatsoever with the
Member’s name, address, phone number, identification number, type of service
required or equipment in use, frequency of such service and ordering
physician’s name and phone number; and (ii) copies of all medical records and
treatment plans related to Members being transitioned, in accordance with
applicable law at no cost to VISTA. In the event PCP fails to comply with this
Section 6.8.2, VISTA may withhold any and all payment due by VISTA to PCP
until such time as VISTA receives the requested information.

	 	6.9	 	Notification by VISTA to PCP. In the event VISTA terminates this
Agreement for any reason whatsoever or suspends PCP pursuant to Section 2.12, VISTA
shall provide PCP with written notice of the:

	 	6.9.1	 	reasons for the action, including, if relevant, the
standards and profiling data used to evaluate PCP and the numbers and mix of
Primary Care Physicians needed by VISTA; and
	 
	 	6.9.2	 	with respect to Medicare Members only, PCP’s right to appeal
the action and the process and timing requirements for requesting a hearing.

	 	6.10	 	Nonpayment. PCP acknowledges and agrees that nonpayment for goods or
services rendered by PCP to Members shall not be a valid reason for avoiding the sixty
(60) day prior notice requirement for termination of this Agreement, as set forth
above, or PCP’s compliance with Section 6.7 hereof.
	 
	 	6.11	 	Benefit Programs. VISTA may terminate any and all Benefit Programs with
respect to all Participating Providers or solely with respect to PCP, at VISTA’s sole
discretion, upon notice to PCP in accordance with this Agreement; provided, however,
that termination of this Agreement with respect to a particular Benefit Program(s)
shall have no effect on the continuation of this Agreement with respect to all other
Benefit Programs as listed on Schedule D. As such, this Agreement shall remain
in full force and effect with respect to any Benefit Program not specifically
terminated.
	 
	 	6.12	 	Effect of Termination. Except as otherwise set forth herein, the
parties acknowledge and agree that neither party shall have any right or obligation
under this Agreement upon termination or expiration of this Agreement for any reason
whatsoever, including, but not limited to any Compensation not expressly provided for
herein.
	 
	 	6.13	 	Cooperation Upon Termination. Upon termination of this Agreement for
any reason whatsoever, the parties shall cooperate with each other to ensure compliance
with this Agreement and the parties’ continuing obligations as required under this
Agreement, including but not limited to obligations of the parties set forth in Section
6.7 hereof.

	7	 	RECORDS. PCP shall maintain, provide and allow access to records as set forth on
Schedule 7,
attached hereto and incorporated herein, and otherwise set forth in VISTA Policies and
applicable laws and regulations. In the event PCP fails to comply with any requirement set
forth in Schedule

11

 

		 	7 and otherwise set forth in VISTA Policies and applicable laws and regulations, VISTA may
withhold any and all payment due by VISTA to PCP until such time as PCP complies with
VISTA’s request.
	 
	8	 	NOTICE. Any notice required hereunder or otherwise given shall be in writing and
sent via (i) hand delivery, (ii) nationally recognized courier service, (iii) facsimile
(provided the transmitting telecopier electronically confirms successful transmission of the
notice and a conformed copy is sent by another acceptable means within 24 hours thereafter),
or (iv) registered or certified mail, return receipt requested. Notices shall be sent to or
by VISTA or PCP at the addresses listed below, or at such other addresses as either party
may designate to the other in writing:

	 	 	 
	To VISTA:

	 	Vista Healthplan, Inc.
	 

	 	1340 Concord Terrace
	 

	 	Sunrise, Florida 33323
	 

	 	ATT: Senior Vice President of Provider Operations
	 
	 	 
	with a copy to:

	 	Vista Healthplan, Inc.
	 

	 	300 South Park Road
	 

	 	Hollywood, Florida 33021
	 

	 	ATT: Senior Vice President and General Counsel
	 
	 	 
	To
PCP:

	 	MIAMI DADE HEALTH CENTERS,
INC.
	 

	 	3233 PALM AVE
	 

	 	HIALEAH, FL 33012
	 
	 	 
	To DOI:

	 	Department of Insurance
	 

	 	Division of Specialty Insurers
	 

	 	200 East Gaines Street
	 

	 	Tallahassee, FL 32399-0300
	 

	 	ATT: Health Section

	 	 	Notices shall be deemed given on the date of delivery as shown on the delivery receipt or
return receipt, or on the date noted on such receipt as the date delivery thereof was
refused, returned as unclaimed or determined impossible to accomplish due to an unnoticed
change of address. If any notice is transmitted by facsimile transmission, the notice shall
be deemed served upon electronic confirmation of receipt of the transmission.
	 
	9	 	MISCELLANEOUS.

	 	9.1	 	Confidentiality.

	 	9.1.1	 	Confidential Materials. PCP acknowledges and agrees
that as a result of this Agreement, PCP may become informed of, and have
access to, valuable and confidential information of VISTA and VISTA
Affiliates, including, without limitation, (i) eligibility lists and any
other information containing the names, addresses and telephone numbers of
Members; (ii) VISTA Policies and all forms related thereto; (iii) other
policy and procedure manuals; (iv) the provisions of this Agreement; and (v)
any other information compiled or created by VISTA

12

 

	 	 	 	which is proprietary in nature, including names, payment rates and methodologies, business
methods, trademarks, logos, patents and copyrights (the “Confidential Information”), and
that the Confidential Information, even though it may be contributed, developed or
acquired, in whole or in part, by PCP, shall remain the exclusive property of VISTA to be
held by PCP in trust and solely for VISTA’s benefit. Accordingly, except as required by
law or expressly authorized under this Agreement, PCP shall not, at any time, either
during or subsequent to the Term, use, reveal, report, publish, copy, transcribe, transfer
or otherwise disclose to any person, corporation or other entity, any of the Confidential
Information without the prior written consent of VISTA, except to responsible persons who
are in a contractual or fiduciary relationship with VISTA and for information which
legally and legitimately is or becomes of general public knowledge from authorized sources
other than PCP or any person acting on PCP’s behalf.
	 
	 	9.1.2	 	Return of Confidential Information. Upon termination of this Agreement to the extent
permitted by applicable law, PCP shall promptly deliver to VISTA all Confidential Information
that is in PCP’s possession or control, including all copies and abstracts of Confidential
Information.
	 
	 	9.1.3	 	Confidential Operations Information. Unless otherwise required by law, PCP shall not
disclose information relating to the operations of VISTA or VISTA Affiliates to third parties
without obtaining VISTA’s prior written consent.
	 
	 	9.1.4	 	Confidentiality of Members’ Information. PCP shall protect the confidentiality of
Members’ information and records to the extent consistent with applicable law and shall comply
with VISTA Policies on the release of information (whether written or oral) about Members and
all applicable state and federal laws and regulations protecting the confidentiality of
Members’ records and disclosure of mental health records, medical records and other health and
member information, including, but not limited to all requirements of
42 U.S.C. 1171 et seq.
enacted by the Health Insurance Portability and Accountability Act of 1996 and regulations
promulgated thereunder, as amended from time to time.
	 
	 	9.1.5	 	Ownership. Ownership of and right of control over all Confidential Information shall
vest exclusively in VISTA.
	 
	 	9.1.6	 	Non-Solicitation of Members. PCP recognizes and agrees that VISTA has a valuable
business relationship with each of its Members and, further, that PCP stands in a position to
influence Members’ decisions concerning insurers. In recognition of VISTA’s valuable business
relationships with its Members, PCP agrees that, during the Term, and upon termination of this
Agreement for any reason whatsoever, PCP shall not solicit Members, directly or indirectly, to
enroll in any other health insurance or health coverage or alternative healthcare delivery
system. PCP’s obligation not to solicit Members is a material inducement for PCP’s engagement
by VISTA pursuant to this Agreement. This Section 9.1.6, however, is not intended to
interfere with a Member’s right to freely select a Primary Care Physician or alternative
health coverage subsequent to termination of this Agreement. Further, PCP acknowledges and
agrees that any and all marketing or solicitation communication with Medicare Members and
Medicaid

13

 

	 	 	 	Members must be approved in advance of dissemination by CMS or AHCA, as
applicable, in accordance with applicable requirements.
	 
	 	9.1.7	 	Enforcement. PCP acknowledges and agrees that irreparable injury
will result to VISTA in the event of PCP’s breach of these covenants, that a material
inducement for PCP’s engagement by VISTA are the covenants set forth in this Section
9.1, and that monetary damages in an action at law would not provide an adequate
remedy in the event of a breach of this Section 9.1. PCP further acknowledges and
agrees that the covenants set forth in this Section 9.1 are necessary for the
protection of VISTA’s legitimate business and professional duties, ethical
obligations, and interests and are reasonable in scope and content. Accordingly, in
the event of PCP’s breach of (i) this Section 9.1, or any part of this Section 9.1,
this Section 9.1 may be enforced by the obtaining of an injunction to restrain the
violation thereof by PCP and all persons acting for or with PCP; or (ii) Section
9.1.6, as determined by a court of competent jurisdiction, PCP shall pay to VISTA,
and amount equal to one thousand two hundred dollars ($1,200) for each Member PCP
inappropriately solicits, directly or indirectly, to enroll in any other health
insurance or health coverage or alternative healthcare delivery system in violation
of Section 9.1.6, in addition to all other remedies VISTA may have at law or in
equity.

	 	9.2	 	Assignment. PCP shall not assign, delegate, subcontract, or otherwise transfer its
rights, obligations and/or interests arising under this Agreement, including, but not limited
to a transfer resulting from either an asset or stock purchase, without the express written
consent of VISTA. VISTA may assign, delegate, subcontract or otherwise transfer its rights,
obligations and/or interests under this Agreement to any successor, VISTA Affiliate or a
party to which any of VISTA’s line(s) of business are sold, without PCP’s consent. This
Agreement shall be binding upon and inure to the benefit of the successors and permitted
assigns of the parties.
	 
	 	9.3	 	Severability. In the event that one or more provisions of this Agreement are
determined to be invalid, illegal or unenforceable, in whole or in part, the validity,
legality and enforceability of the remaining terms of this Agreement shall not in any way be
affected,
	 
	 	9.4	 	Attorneys’ Fees. In the event of any action, dispute, litigation or other proceeding
with respect to this Agreement or any specific term of this Agreement, the prevailing party in
such action, dispute, litigation or other proceeding shall be entitled to recover reasonable
fees, costs and expenses of counsel incurred in connection with such proceeding, whether suit
is instituted or not, and if instituted, at both trial and appellate levels, in addition to
any and all other relief to which it may otherwise be entitled at law or in equity.
	 
	 	9.5	 	Modifications. VISTA may modify or amend one or more provisions of this Agreement,
including, but not limited to the addition of a new Benefit Program, upon thirty (30) days
notice to PCP. The failure of PCP to object to such modification in writing to the Senior Vice
President of Provider Operations during the thirty (30) day notice period shall constitute
acceptance of such amendment or modification as of the effective date set forth in the notice.
If PCP objects to such modification or amendment, VISTA may terminate this Agreement upon its
giving sixty (60) days prior notice to PCP, or on such other date as is set forth in the
notice to PCP; provided, further, that this Agreement shall automatically be modified or
amended upon notice from VISTA to PCP to that effect, without PCP’s ability to reject such
modification or amendment, to the extent necessary

14

 

	 	 	 	from time to time to comply with the requirements of state or federal laws or regulations
or to comply with the requirements or regulations of any Accreditation Organization,
AHCA, CMS, DOI, any other governmental agency with jurisdiction over VISTA or PCP, or the
requirements of any VISTA Coverage Plan. Notwithstanding the foregoing, any and all
changes or modifications to this Agreement made within thirty (30) days prior to the
effective date of termination of this Agreement shall be effective only if agreed to by
the parties.
	 
	 	9.6	 	Incorporation of Schedules. All schedules and exhibits to this Agreement are
considered part of this Agreement and are fully incorporated in this Agreement with the same
effect as if such schedules and exhibits were restated in their entirety in the body of this
Agreement.
	 
	 	9.7	 	Governing Law. This Agreement is made, delivered in and shall be governed by and
construed and enforced in accordance with all applicable laws of the State of Florida and the
United States of America, including without limitation: (i) the Florida Health Maintenance
Organization Act, as amended, and the regulations promulgated thereunder by DOI; (ii) the
Federal Health Maintenance Organization Act of 1973, as amended, and the regulations
promulgated thereunder by DHHS; (iii) the Florida Insurance Code, as amended, and the
regulations promulgated thereunder by DOI; (iv) Title XVIII of the Social Security Act as
amended, and the regulations promulgated thereunder by CMS; (v) the Employee Retirement Income
Security Act of 1974, as amended; (vi) Title XIX of the Social Security Act and the
regulations promulgated thereunder; and (vii) Sections 409.901 — 409.920 of the Florida
Statutes, and the regulations promulgated thereunder by AHCA. This Agreement is also subject
to the applicable rules and regulations of AHCA, CMS and DOI. Any provisions required by any
laws and regulations to be included in this Agreement shall be binding upon VISTA and PCP
whether or not expressly included or referenced in this Agreement. Any and all references to
specific laws or regulations in this Agreement shall include any successor laws or regulations
and any and all amendments. PCP shall comply with all applicable federal, state and local
laws, rules and regulations of all governing authorities over their respective businesses.
	 
	 	9.8	 	Non-Exclusive. VISTA acknowledges and agrees that this Agreement in no way prohibits
or restricts PCP from entering into a commercial contract with any other health maintenance
organization. PCP acknowledges and agrees that this Agreement in no way prohibits or restricts
VISTA or any VISTA Affiliate from entering into a commercial contract with any other health
care provider, inside or outside of the Service Area.
	 
	 	9.9	 	Waiver. If any party decides not to terminate this Agreement, even though it has the
right to do so in a particular instance, or delays its decision to terminate, such decision
shall not be considered a waiver of its right to terminate on a future occasion for the same
or any other reason, and any other waivers of the breach or violation of any provision of this
Agreement shall not operate as, or be construed to be, a waiver of any subsequent breach of
the same or another provision of this Agreement. To be effective, a waiver of any of PCP’s
obligations under this Agreement must be in writing and signed by an authorized representative
of VISTA.
	 
	 	9.10	 	Independent Contractors.

	 	9.10.1	 	The relationship between VISTA and PCP is an independent contractor relationship.
The parties acknowledge and agree that neither party has the authority to make any
representation, warranty or binding commitment on behalf

15

 

	 		 	of the other party, except as expressly provided in this Agreement or as otherwise
agreed to in writing by the parties, and nothing contained in this Agreement shall
be deemed or construed to (i) create a partnership or joint venture between the
parties or any affiliate, employee or agent of a party; or (ii) constitute any party
or employee, agent or associate of a party as an employee, agent or associate of the
other party. No party shall represent to any third party that it is an employee of
another party. PCP shall be responsible and shall pay in a timely
manner, FICA and
all other taxes relating to payments made by VISTA to PCP in accordance with this
Agreement.
	 
	 	9.10.2	 	PCP acknowledges and agrees that VISTA shall have no responsibility for PCP’s
license, income, FICA, unemployment or any and all other taxes, fees or levies upon
PCP. PCP shall and hereby does indemnify and save harmless VISTA and VISTA
Affiliates and their respective directors, officers, employees, representatives and
affiliated and subsidiary companies from and against all liability for the same.

	 	9.11	 	Construction; Acknowledgment. All parties have participated in the negotiation of
this Agreement and, accordingly, the parties agree that this Agreement shall be construed and
interpreted without regard to any presumption or other rule requiring construction against the
party causing this Agreement to be drafted, PCP read this Agreement in its entirety,
understands its contents, and had the advice of counsel as to this Agreement’s meaning and
intent.
	 
	 	9.12	 	Physician-Patient Relationship. The parties acknowledge and agree that any and all
decisions rendered by VISTA in its administration of this Agreement, including, but not
limited to, all decisions with respect to the determination of whether or not a service is a
Covered Service, are made solely to determine if payment of benefits under the applicable
VISTA Coverage Plan is appropriate. The parties further acknowledge and agree that any and
all decisions relating to the necessity of the provision or non-provision of medical services
or supplies shall be made solely by the Member and PCP in accordance
with the usual
provider-patient relationship. PCP shall have sole responsibility for the medical care and
treatment of Members under PCP’s care. PCP further acknowledges and agrees that it is
possible that a Member and PCP may determine that certain services or supplies are appropriate
even though such services or supplies are not Covered Services under the applicable VISTA
Coverage Plan and will not be paid for or arranged by VISTA. PCP shall inform Members in
writing prior to provision of such non-Covered Services that such services are not Covered
Services and that the Member will be responsible for payment for such non-Covered Services and
collect the fees for such non-Covered Services directly from the Member.
	 
	 	9.13	 	Anti-Gag Clause. Nothing contained in this Agreement is intended to interfere with
the provider-patient relationship or to prohibit or otherwise restrict PCP from freely
communicating with or advising or advocating on behalf of a Member regarding the Member’s
health status, medical care or treatment options, including any alternative treatments that
may be self-administered, medication treatment options and any other medical care and
treatment options for the Member which PCP deems knowledge of such information to be in the
Member’s best interest, regardless of benefit coverage limitations, including PCP’s
provision of sufficient information to the individual to provide, an opportunity to decide
among all relevant treatment options; the risks, benefits and consequences of treatment or
non-treatment; or the opportunity for the individual to

16

 

	 	 	 	refuse treatment and to express preferences about future treatment decisions.
	 
	 	9.14	 	Headings. The headings contained in this Agreement are merely for the purpose of
convenience of reference only and do not in any way affect the meaning or interpretation of
this Agreement.
	 
	 	9.15	 	Entire Agreement. Except as otherwise provided herein, this Agreement and all
schedules and exhibits constitute the entire agreement and understanding between the parties
relating to the subject matter of this Agreement and supersede all prior agreements between
the parties, oral or written, regarding the subject matter of this Agreement. Except as
otherwise provided herein, in the event PCP previously entered into a Primary Care Provider
Services Agreement or any similar agreement with VISTA and/or a VISTA Affiliate relating to
the subject matter of this Agreement or the provision of Primary Care Services that has not
expired or been otherwise terminated, such agreement shall be deemed to have been superseded
by this Agreement as of the Effective Date.
	 
	 	9.16	 	Counterparts. This Agreement may be executed in multiple counterparts, each of which
shall be deemed an original and all of which together shall constitute a single agreement.
	 
	 	9.17	 	Jurisdiction; Venue; Inconvenient Forum; Jury Trial. Any suit, action or proceeding
with respect to this Agreement shall be brought in federal or state court located in Broward
County, Florida and the parties accept the exclusive personal jurisdiction of those courts for
the purpose of any suit, action or proceeding. THE PARTIES KNOWINGLY, VOLUNTARILY AND
INTENTIONALLY WAIVE THE RIGHT EITHER PARTY MAY HAVE TO A TRIAL BY JURY IN RESPECT OF ANY
LITIGATION BASED ON THIS AGREEMENT, OR ARISING OUT OF, UNDER OR IN CONNECTION WITH THIS
AGREEMENT AND ANY AGREEMENT CONTEMPLATED TO BE EXECUTED IN CONJUNCTION WITH THIS AGREEMENT OR
ANY COURSE OF CONDUCT, COURSE OF DEALING, STATEMENTS (WHETHER ORAL OR WRITTEN) OR ACTION
OF ANY PARTY. THIS PROVISION IS A MATERIAL INDUCEMENT FOR THE PARTIES TO ENTER INTO THIS
AGREEMENT.
	 
	 	9.18	 	Interpretation of Certain Terms. When the context of this Agreement requires, the
gender of all words shall include the masculine, feminine and neuter, and the number of all
words shall include the singular and plural. All references herein to “Member” shall be deemed
only to refer and apply to VHP Members, VIP Members, Medicare Members, Medicaid Members or
Participants, as applicable to (i) the particular context of the Agreement; and (ii) those
certain Benefit Programs listed on Schedule D hereof.
	 
	 	9.19	 	Cumulative Remedies. Except as otherwise provided for to the contrary in this
Agreement, remedies provided for in this Agreement shall be in addition to and not in lieu of
any other remedies available to any party and shall not be deemed a waiver or substitution for
any action or remedy the parties may have at law or in equity. Pursuit of a particular remedy
by a party shall not be deemed to constitute a waiver of any other right or remedy such party
may have at law or in equity.
	 
	 	9.20	 	Subcontracts. Except as otherwise permitted in this Agreement, PCP shall not delegate
or subcontract any of its obligations under this Agreement without the prior written consent
of VISTA. If PCP, with VISTA’s consent, carries out any of its obligations or duties under
this Agreement through a subcontract, such subcontract shall contain a

17

 

	 	 	 	clause which requires the subcontractor to comply with any and all obligations and duties
imposed on PCP in this Agreement, including Medicare and Medicaid laws and regulations.
Such subcontract shall provide that the performance of the parties is monitored by VISTA
on an ongoing basis and that VISTA may take enforcement actions in the event such
subcontractor fails to comply, in VISTA’s determination, with any obligation or duty
imposed on PCP in this Agreement, including the Medicare and Medicaid laws and
regulations.
	 
	 	9.21	 	Force Majeure. No party to this Agreement shall be liable for any default or delay in
the performance of its obligations hereunder if and to the extent the default or delay is
caused, directly or indirectly, by strikes, picketing, insurrection, acts of God, military
actions, terrorist attacks, war, emergencies, shortages or unavailability of materials or
other causes beyond a party’s reasonable control (a “Force Majeure Event”), and such party
shall be excused from performance and shall not be considered to be in default hereunder in
respect to the affected obligation. The suspension of performance due to a Force Majeure Event
shall be of no greater scope and no longer duration than that which is reasonably necessary.
The excused party shall use its reasonable best efforts to remedy its inability to perform as
soon as possible.
	 
	 	9.22	 	No Third Party Beneficiary. Except as otherwise expressly provided herein, nothing in
this Agreement is intended to, or shall be deemed or construed to create any rights or
remedies in any third party, including but not limited to a Member.
	 
	 	9.23	 	Participation in Benefit Programs. PCP acknowledges and agrees that, notwithstanding
of the listing of a Benefit Program on Schedule D, PCP’s participation in any one or
more Benefit Program(s) is under no circumstances whatsoever conditioned by VISTA or a VISTA
Affiliate or dependent on PCP’s participation or non-participation in any other Benefit
Program, relationship, arrangement, contract, line of business or other agreement with VISTA
or any VISTA Affiliate.
	 
	 	9.24	 	No Joint and Several Liability. Each of VHP, VIP and any Payor shall be severally
liable for its own actions or inactions arising under, relating to or resulting from this
Agreement. There shall be no joint liability between or among any of VHP, VIP or any Payor.
	 
	 	9.25	 	Execution by Authorized Representatives. An authorized representative of each party
shall execute this Agreement and an authorized representative of a party shall execute any and
all notices given by such party hereunder. PCP represents and warrants that the individual
executing this Agreement is authorized to bind PCP and all PCP Staff to the rights,
obligations, conditions and terms set forth in this Agreement.
	 
	 	9.26	 	Effective Date. This Agreement shall be effective the first of the month following
execution of this Agreement by VISTA.
	 
	 	9.27	 	Survival. Article 2, Section 6.7, Section 6.12, Article 7, Article 8, and Article 9
of this Agreement shall survive termination or expiration of this Agreement for any reason
whatsoever.

18

 

     IN
WITNESS WHEREOF, the parties have executed this Agreement effective as of the Effective
Date.

	 	 	 	 	 	 	 	 	 	 	 
	VISTA HEALTHPLAN, INC.	 	 	 	MIAMI DADE HEALTH CENTERS, INC.	 	 
	 
	 	 	 	 	 	 	 	 	 	 
	By:

	 	/s/ Duell O. Wise
 

	 	 
	 	By:
	 	/s/ 

	 	 
	Print Name: Duell O. Wise	 	 	 	Print Name:	 	 
	Title: Executive Vice President	 	 	 	Title:	 	 
	Date: 10/27/04	 	 	 	Date: 10/16/04	 	 
	 
	 	 	 	 	 	 	 	 	 	 
	 	 	 	 	 	 	Tax ID #: 65-1019326	 	 
	 
	 	 	 	 	 	 	 	 	 	 
	VISTA INSURANCE PLAN, INC.	 	 	 	 	 	 	 	 
	 
	 	 	 	 	 	 	 	 	 	 
	By:

	 	/s/ Duell O. Wise
 

	 	 	 	 	 	 	 	 
	Print Name: Duell O. Wise	 	 	 	 	 	 	 	 
	Title: Executive Vice President	 	 	 	 	 	 	 	 
	Date: 10/27/04	 	 	 	 	 	 	 	 
	 
	 	 	 	 	 	 	 	 	 	 
	FOR INTERNAL PURPOSES ONLY	 	 	 	 	 	 	 	 
	TO BE COMPLETED BY VISTA:	 	 	 	 	 	 	 	 
	 
	 	 	 	 	 	 	 	 	 	 
	EFFECTIVE DATE:	 	 	 	 	 	 	 	 

19EX-10.3 Agreement dated September 26, 2006

 

EXHIBIT
10.3

			
	
	 	WCMA®
REDUCING REVOLVERSM LOAN AND SECURITY AGREEMENT

WCMA
REDUCING
REVOLVERSM LOAN AND SECURITY AGREEMENT NO. 81V-02074 (“Loan Agreement”) dated as of
September 22, 2006, between CONTINUCARE MDHC, LLC, a limited liability company organized and
existing under the laws of the State of Florida having its principal office at 7200 Corporate
Center Drive, Suite 600, Miami, FL 33126 (“Customer”), and MERRILL LYNCH BUSINESS FINANCIAL
SERVICES INC., a corporation organized and existing under the laws of the State of Delaware having
its principal office at 222 North LaSalle Street, Chicago, IL 60601 (“MLBFS”).

Pursuant to that certain WORKING CAPITAL MANAGEMENT® ACCOUNT AGREEMENT NO. 81V-02074 and the
accompanying Program Description (as the same may be, or have been, amended, modified or
supplemented, the “WCMA Agreement”) between Customer and MLBFS’ affiliate, MERRILL LYNCH, PIERCE,
FENNER & SMITH INCORPORATED (“MLPF&S”), Customer opened, or shall prior to the Activation Date
open, a Working Capital Management Account pursuant to the “WCMA Service” and the “WCMA Program”
described in the WCMA Agreement and any documents incorporated therein. The WCMA Agreement is by
this reference incorporated as a part hereof. In conjunction therewith, Customer has requested that
MLBFS make a reducing revolving credit facility available to Customer (the “Reducing Revolver”) in
the amount and upon the terms hereafter specified, and, subject to the terms and conditions
hereafter set forth, MLBFS has agreed to provide a Reducing Revolver
for Customer.

Accordingly, and in consideration of the premises and of the mutual covenants of the parties
hereto, Customer and MLBFS hereby agree as follows:

Article I. DEFINITIONS

1.1 Specific Terms. In addition to terms defined elsewhere in this Loan Agreement, when used herein
the following terms shall have the following meanings:

“Anti-Terrorism and Anti-Money Laundering Laws” shall mean (a) all applicable laws, regulations,
executive orders and government guidance on the prevention and detection of money laundering
(including 18 U.S.C. §§ 1956 and 1957), drug trafficking, terrorist-related activities, or
financial or other fraud; (b) the Bank Secrecy Act (31 U.S.C. §§ 5311 et seq. and 12 U.S.C.
§§1818(s), 1829(b) and 1951-1959) and its implementing regulations, and (c) all regulations and any
other requirements of any governmental authority (including, without limitation, the United States
Department of the Treasury Office of Foreign Assets Control) addressing, relating to, or attempting
to eliminate drug trafficking, terrorist acts and acts of war.

“Activation Date” shall mean the date upon which
MLBFS shall cause the WCMA Line of Credit to be
fully activated under MLPF&S’ computer system as part of the WCMA Program.

“Bankruptcy Event” shall mean any of the following: (i) a proceeding under any bankruptcy,
reorganization, arrangement, insolvency, readjustment of debt, liquidation, winding up or
receivership law or statute shall be commenced, filed or consented to by any Credit Party; or (ii)
any such proceeding shall be filed against any Credit Party and shall not be dismissed or withdrawn
within sixty (60) days after filing; or (iii) any Credit Party shall make a general assignment for
the benefit of creditors; or (iv) any Credit Party shall generally fail to pay or admit in writing
its inability to pay its debts as they become due; or (v) any Credit Party shall be adjudicated a
bankrupt or insolvent; or (vi) any Credit Party shall take advantage of any other law or procedure
for the relief of debtors or shall take any action for the purpose of or with a view towards
effecting any of the foregoing; or (vii) a receiver, trustee, custodian, fiscal agent or similar
official for any Credit Party or for any substantial part of any of their respective property or
assets shall be sought by such Credit Party or appointed.

“Business Day” shall mean any day other than a Saturday, Sunday, federal holiday or other day on
which the New York Stock Exchange is regularly closed. 

“Business Guarantor” shall mean every
Guarantor that is not a natural person.

“Certificate of Compliance” shall mean, as applicable, that duly executed certificate,
substantially the same form as Exhibit B attached hereto to the extent such certificate shall be
applicable, of the president, chief financial officer or chief executive officer of Customer,
certifying as to the matters set forth in such certificate.

“Closing Date” shall mean the date upon which all conditions precedent to MLBFS’ obligation to make
the Loan shall have been met to the satisfaction of MLBFS.

“Collateral” shall mean all Accounts, Chattel Paper, Contract Rights, Inventory, Equipment,
Fixtures, General Intangibles, Deposit Accounts, Documents, Instruments, Investment Property and
Financial Assets of Customer, howsoever arising, whether now owned or existing or hereafter
acquired or arising, and wherever located; together with all parts thereof (including spare parts),
all accessories and accessions thereto, all books and records (including computer records) directly
related thereto, all proceeds thereof (including, without limitation, proceeds in the form of
Accounts and insurance proceeds), and the additional collateral described in Section 4.6 (b)
hereof.

“Commitment
Expiration Date” shall mean September 29, 2006.

“Commitment Fee” shall mean a fee of $30,000.00 due to MLBFS in connection with this Loan
Agreement.

“Credit Party” and “Credit Parties” shall mean, individually or collectively, the Customer, all
Guarantors and all Pledgers.

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“Default” shall mean either an “Event of Default” as defined in Section 4.5 hereof, or an event
which with the giving of notice, passage of time, or both, would constitute such an Event of
Default.

“Default Rate” shall mean an annual interest rate equal to the lesser of: (i) two percentage points
over the Interest Rate; or (ii) the highest interest rate allowed by applicable law.

“Event
of Loss” shall mean the occurrence whereby any tangible Callateral is damaged beyond repair,
lost, totally destroyed or confiscated.

“Excess Interest” shall mean any amount or rate of interest (including the Default Rate and, to the
extent that they may be deemed to constitute interest, any prepayment fees, late charges and other
fees and charges) payable, charged or received in connection with any of the Loan Documents which
exceeds the maximum amount or rate of interest permitted under
applicable law.

“GAAP” shall mean the generally accepted accounting principles in effect in the United States of
America from time to time.

“General Funding Conditions” shall mean each of the following conditions precedent to the
obligation of MLBFS to make the Loan or any Subsequent WCMA Loan hereunder: (i) Customer shall have
validly subscribed to and continued to maintain the WCMA Account with MLPF&S, and the WCMA Account
shall then be reflected as an active “commercial” WCMA Account (i.e., one with line of credit
capabilities) on MLPF&S’ WCMA computer system; (ii) no Default or Event of Default shall have
occurred and be continuing or would result from the making of the Loan or such Subsequent WCMA Loan
by MLBFS; (iii) there shall not have occurred and be continuing any material adverse change in the
business or financial condition of any Credit Party; (iv) all representations and warranties of all
of the Credit Parties herein or in any of the Loan Documents shall
then be true and correct in all
material respects; (v) MLBFS shall have received this Loan Agreement and all of the other Loan
Documents (including, without limitation, each of the Loan Documents described in the definition of
“Real Property Funding Condition”), duly executed and filed or recorded where applicable, all of
which shall be in form and substance reasonably satisfactory to MLBFS; (vi) the Commitment Fee
shall have been paid in full; (vii) MLBFS shall have received, as and to the extent applicable,
copies of invoices, bills of sale, loan payoff letters and/or other evidence reasonably
satisfactory to it that the proceeds of the Loan will satisfy the Loan Purpose; (viii) MLBFS shall
have received evidence reasonably satisfactory to it as to the ownership of the Collateral and the
perfection and priority of MLBFS’ liens and security interests thereon, as well as the ownership of
and the perfection and priority of MLBFS’ liens and security interests on any other collateral for
the Obligations furnished pursuant to any of the Loan Documents; (ix) MLBFS shall have received
evidence reasonably satisfactory to it of the insurance required hereby or by any of the Loan
Documents; and (x) any additional conditions specified in the “WCMA Reducing Revolver Loan
Approval” letter executed by MLBFS with respect to the transactions contemplated hereby shall have
been met to the reasonable satisfaction of MLBFS.

“Guarantor” shall mean each Person obligated under a guaranty, endorsement or other undertaking by
which such Person guarantees or assumes responsibility in any capacity for the payment or
performance of any of the Obligations.

“Individual Guarantor” shall mean each Guarantor who is a natural person.

“Interest Due Date” shall mean the first Business Day of each calendar month during the term
hereof.

“Interest Rate” shall mean a variable per annum rate of interest equal to the sum of 2.40%, plus
the One-Month LIBOR. “One-Month LIBOR” shall mean, as of the date of any determination, the
interest rate then most recently published in the “Money
Rates” section of The Wall Street Journal as the one-month London Interbank Offered Rate (or if more than one such rate is published, the
highest of such rates). The interest Rate will change as of the date of publication in The Watt
Street Journal of a One-Month LIBOR that is different from that published on the preceding Business
Day. In the event that The Wall Street Journal shall, for any reason, fail or cease to publish the
One-Month LIBOR, MLBFS will choose a reasonably comparable index or source to use as the basis for
the Interest Rate.

“Loan” shall mean the specific Reducing Revolver by MLBFS to Customer pursuant to this Agreement
for the Loan Purpose and in the Loan Amount.

“Loan Amount” shall mean an amount equal to the lesser of: (i) 75% of the aggregate fair market
value of the Real Properties, as determined by the appraisal required to be furnished by Customer
to MLBFS pursuant hereto, (ii) the aggregate amount which Customer shall request be advanced by
MLBFS on account of the Loan Purpose on the Closing Date, or (iii) $6,000,000.00.

“Loan Documents” shall mean this Loan Agreement, any indenture, any guaranty of any of the
Obligations and all other security and other instruments, assignments, certificates, certifications
and agreements of any kind relating to any of the Obligations, whether obtained, authorized,
authenticated, executed, sent or received concurrently with or subsequent to this Loan Agreement,
or which evidence the creation, guaranty or collateralization of any of the Obligations or the
granting or perfection of liens or security interests upon any Collateral or any other collateral
for the Obligations, including any modifications, amendments or restatements of the foregoing.

“Loan Purpose” shall mean the purpose for which the proceeds of the Loan will be used; to wit: to
finance the acquisition of the Real Properties as hereafter defined, and to refinance equipment
debt and working capital debt being assumed with the acquisition of Miami-Dade Health Centers and
affiliated companies.

“Location of Tangible Collateral” shall mean the address of Customer set forth at the beginning of
this Loan Agreement, together with any other address or addresses set forth on an exhibit hereto as
being a Location of Tangible Collateral.

“Maximum WCMA Line of Credit” shall mean the maximum aggregate line of credit which MLBFS will
extend to Customer subject to the terms and conditions hereof, as the same shall be reduced each
month in accordance with the terms hereof. On the Closing Date, the Maximum WCMA Line of Credit
will equal the Loan Amount.

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“Obligations” shall mean all liabilities, indebtedness and other obligations of Customer and
Continucare Corporation (“CC”) to MLBFS, howsoever created, arising or evidenced, whether now
existing or hereafter arising, whether direct or indirect, absolute or contingent, due or to become
due, primary or secondary or joint or several, and, without limiting the generality of the
foregoing, shall include principal, accrued interest (including without limitation interest
accruing after the filing of any petition in bankruptcy), all advances made by or on behalf of
MLBFS under the Loan Documents, collection and other costs and expenses incurred by or on behalf of
MLBFS, whether incurred before or after judgment, and all present and future liabilities,
indebtedness and obligations of Customer under this Loan Agreement (as amended from time to time)
and under that certain WCMA Reducing Revolver Loan and Security Agreement No. 81V-02075 (as amended
from time to time), and of CC under that certain WCMA Loan and Security Agreement No. 81V-07064 (as
amended from time to time).

“Permitted Liens” shall mean with respect to the Collateral: (i) liens for current taxes not yet
due and payable, other non-consensual liens arising in the ordinary course of business for sums not
due, and, if MLBFS’ rights to and interest in the Collateral are not materially and adversely
affected thereby, any such liens for taxes or other non-consensual liens arising in the ordinary
course of business being contested in good faith by appropriate proceedings; (ii) liens in favor of
MLBFS; (iii) liens which will be discharged with the proceeds of the initial WCMA Loan; and (iv)
any other liens expressly permitted in writing by MLBFS.

“Person” shall mean any natural person and any corporation, partnership (general, limited or
otherwise), limited liability company, trust, association, joint venture, governmental body or
agency or other entity having legal status of any kind.

“Pledger” shall mean each Person who at any time provides collateral, or otherwise now or
hereinafter agrees to grant MLBFS a security interest in any assets as security for Customer’s
Obligations.

“Real Properties” shall mean the parcels of real property and improvements thereon commonly known
as 442 Washington Avenue, Homestead, FL 33030 and 3233 Palm Avenue,
Hialeah, FL 33012.

“Real Property Funding Condition” shall mean that Customer, at Customer’s expense, shall have
furnished or caused to be furnished to MLBFS all of the following, in form and substance reasonably
satisfactory to MLBFS: (i) a first mortgage or deed of trust upon each of the Real Properties in
favor of MLBFS (including an assignment of rents and a security agreement granting to MLBFS a first
security interest upon all fixtures now or hereafter located upon each of the Real Properties);
(ii) a policy or commitment for a policy of ALTA mortgagee’s title insurance insuring MLBFS’ lien
upon each of the Real Properties for the full amount of the Loan, issued by Chicago Title Insurance
Company, Lawyers Title Insurance Company or one of their agents, or another title company selected
by MLBFS, with such special endorsements as may reasonably be required by MLBFS and subject only to
exceptions reasonably acceptable to MLBFS; (iii) if the Real Property is over 25 years old, a
Property Condition Report prepared by an engineer selected by MLBFS setting forth any deferred
maintenance on each of the Real Properties and capital improvements required to maintain the Real
Properties during the term of the credit facilities being provided by MLBFS; (iv) a Phase 1
Environmental Audit Report on each of the Real Properties, prepared by an environmental specialist
selected by MLBFS, disclosing no conditions that are reasonably unacceptable to MLBFS; (v) an
appraisal of each of the Real Properties prepared by an M.A.I. appraiser selected by MLBFS
demonstrating an aggregate fair market value of $6,670,000.00; (vi) a current as-built ALTA survey
of each of the Real Properties certified in favor of MLBFS and the title insurance company; and
(vii) such other agreements, documents and instruments in connection with each of the Real
Properties or MLBFS’ lien thereon as MLBFS or the title insurance company may reasonably require.

“Subsequent WCMA Loan” shall mean each WCMA Loan other than the Loan, including, without
limitation, each WCMA Loan to pay accrued interest.

“Termination Date” shall mean the first to occur of: (i) the last Business Day of the sixtieth
(60th) full calendar month following the Closing Date, or (ii) if earlier, the date of termination
of the WCMA Line of Credit pursuant to the terms hereof.

“WCMA Account” shall mean and refer to the Working Capital Management Account of Customer with
MLPF&S identified as WCMA Account No. 81V-02074 and any successor Working Capital Management
Account of Customer with MLPF&S.

“WCMA Line of Credit” shall mean the line of credit funded by MLBFS through the WCMA Account.

“WCMA Loan” shall mean each advance made by MLBFS pursuant to the WCMA Line of Credit, including
the Loan and each Subsequent WCMA Loan.

“WCMA Loan Balance” shall mean an amount equal to the aggregate unpaid principal balance of all
WCMA Loans.

“UCC” shall mean the Uniform Commercial Code of Illinois as in effect in Illinois from time to
time.

1.2 Other Terms. Except as otherwise defined herein: (i) all terms used in this Loan Agreement
which are defined in the UCC shall have the meanings set forth in the UCC, and (ii) capitalized
terms used herein which are defined in the WCMA Agreement (including, without limitation, “Money
Accounts”, “Minimum Money Accounts Balance”, and “WCMA Directed Reserve Program”) shall have the
meanings set forth in the WCMA Agreement; and (iii) accounting terms not defined herein shall have
the meaning ascribed to them in GAAP.

1.3 UCC Filing. Customer hereby authorizes MLBFS to file a record or records (as defined or
otherwise specified under the UCC), including, without limitation, financing statements, in all
jurisdictions and with all filing offices as MLBFS may determine, in its sole discretion, are
necessary or advisable to perfect the security interest granted to MLBFS herein. Such financing
statements may describe the Collateral in the same manner as described herein or may contain an
indication or description of collateral that describes such property in any other manner as MLBFS
may determine, in its sole discretion, is necessary, advisable or prudent to ensure the perfection
of the security interest in the Collateral granted to the MLBFS herein.

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Article II. THE LOAN

2.1 Commitment. Subject to the terms and conditions hereof, MLBFS hereby agrees to make the Loan
to Customer, and Customer hereby agrees to borrow the Loan from MLBFS. Except as otherwise provided
in Section 3.1 hereof, the entire proceeds of the Loan will be disbursed by MLBFS out of the WCMA
Line of Credit either directly to the applicable third party or parties on account of the Loan
Purpose or to reimburse Customer for amounts directly expended by it for the Loan Purpose; all as
directed by Customer in a Closing Certificate to be executed and delivered to MLBFS prior to the
date of funding.

2.2 Conditions of MLBFS’ Obligation. The Closing Date and MLBFS’ obligations to activate the WCMA
Line of Credit, as hereafter set forth, and make the Loan on the Closing Date are subject to the
prior fulfillment of each of the following conditions: (a) not less than two Business Days prior to
any requested funding date, MLBFS shall have received a Closing Certificate, duly executed by
Customer, setting forth, among other things, the amount of the Loan and the method of payment and
payee(s) of the proceeds thereof; (b) after giving effect to the Loan, the WCMA Loan Balance will
not exceed either the Maximum WCMA Line of Credit or the Loan Amount; (c) the Commitment Expiration
Date shall not then have occurred; and (d) each of the General Funding Conditions and the Real
Property Funding Condition shall then have been met or satisfied to the reasonable satisfaction of
MLBFS.

2.3 Commitment Fee. In consideration of the agreement by MLBFS to extend the Loan and any
Subsequent WCMA Loans to Customer in accordance with and subject to the terms hereof, Customer has
paid or shall, on or before the Closing Date pay, the Commitment Fee to MLBFS. Customer
acknowledges and agrees that the Commitment Fee has been fully earned by MLBFS, and that it will
not under any circumstances be refundable.

2.4 Use of Loan Proceeds. Unless otherwise agreed by MLBFS in writing, the proceeds of the Loan
shall be used solely for the Loan Purpose. The Proceeds of each Subsequent WCMA Loan initiated by
Customer shall be used by Customer solely for working capital in the ordinary course of its
business, or, with the prior written consent of MLBFS, for other lawful business purposes of
Customer not prohibited hereby. Customer agrees that under no circumstances will the proceeds of
the Loan or any Subsequent WCMA Loan be used: (i) for personal, family or household purposes of any
person whatsoever, or (ii) to purchase, carry or trade in securities, or repay debt incurred to
purchase, carry or trade in securities, whether in or in connection with the WCMA Account, another
account of Customer with MLPF&S or an account of Customer at any other broker or dealer in
securities, or (iii) unless otherwise consented to in writing by MLBFS, to pay any amount to
Merrill Lynch and Co., Inc. or any of Its subsidiaries, other than Merrill Lynch Bank USA, Merrill
Lynch Bank & Trust Co. or any subsidiary of either of them (including MLBFS and Merrill Lynch
Credit Corporation).

Article III. THE WCMA LINE OF CREDIT

3.1
Activation of the WCMA Line of Credit. Subject to the terms and conditions hereof, on the
Closing Date MLBFS will activate a WCMA Line of Credit for Customer
in the Loan Amount. The Loan
will be funded out of the WCMA Line of Credit immediately after such activation (or, if and to the
extent otherwise expressly contemplated in the definition of Loan
Purpose or otherwise directed in
the Closing Certificate and hereafter expressly agreed by MLBFS, all or part of the Loan may be
made available as a WCMA Line of Credit and funded by Customer.)

3.2 Subsequent WCMA Loans. Subject to the terms and conditions hereof, during the period from and
after the Closing Date to the Termination Date: (a) Customer may repay the WCMA Loan Balance in
whole or in part at any time without premium or penalty, and request a re-borrowing of amounts
repaid on a revolving basis, and (b) in addition to Subsequent WCMA Loans made automatically to pay
accrued interest, as hereafter provided, MLBFS will make such Subsequent WCMA Loans as Customer may
from time to time request or be deemed to have requested in accordance with the terms hereof.
Customer may request Subsequent WCMA Loans by use of WCMA Checks,
FTS, Visa â charges, wire
transfers, or such other means of access to the WCMA Line of Credit as may be permitted by MLBFS
from time to time; it being understood that so long as the WCMA Line of Credit shall be in effect,
any charge or debit to the WCMA Account which but for the WCMA Line of Credit would under the terms
of the WCMA Agreement result in an overdraft, shall be deemed a request by Customer for a
Subsequent WCMA Loan.

3.3 Conditions of Subsequent WCMA Loans. Notwithstanding the foregoing, MLBFS shall not be
obligated to make any Subsequent WCMA Loan, and may without notice refuse to honor any such request
by Customer, if at the time of receipt by MLBFS of Customer’s request: (a) the making of such
Subsequent WCMA Loan would cause the Maximum WCMA Line of Credit, as reduced pursuant to the
provisions of Section 3.6 hereof, to be exceeded; or (b) the Termination Date shall have occurred;
or (c) an event shall have occurred and be continuing which shall have caused any of the General
Funding Conditions to not then be met or satisfied to the reasonable satisfaction of MLBFS. The
making by MLBFS of any Subsequent WCMA Loan (including, without limitation, the making of a
Subsequent WCMA Loan to pay accrued interest or late charges, as hereafter provided) at a time when
any one or more of said conditions shall not have been met shall not in any event be construed as a
waiver of said condition or conditions or of any Default, and shall not prevent MLBFS at any time
thereafter while any condition shall not have been met from refusing to honor any request by
Customer for a Subsequent WCMA Loan.

3.4 WCMA Note. Customer hereby promises to pay to the order of MLBFS, at the times and in the
manner set forth in this Loan Agreement, or in such other manner and at such place as MLBFS may
hereafter designate in writing: (a) the WCMA Loan Balance; (b) interest at the Interest Rate on the
outstanding WCMA Loan Balance (computed for the actual number of days elapsed on the basis of a
year consisting of 360 days), from and including the date on which the Loan is made until the date
of payment of all WCMA Loans in full; and (c) on demand, all other sums payable pursuant to this
Loan Agreement, including, but not limited to, any late charges. Except as otherwise expressly set
forth herein, Customer hereby waives presentment, demand for payment, protest and notice of
protest, notice of dishonor, notice of acceleration, notice of intent to accelerate and all other
notices and formalities in connection with this WCMA Note and this Loan Agreement.

3.5 Interest. (a) An amount equal to accrued interest on the daily WCMA Loan Balance shall be
payable by Customer monthly on each Interest Due Date, commencing with the first Interest Due Date
after the Closing Date shall occur. Unless otherwise hereafter directed in writing by MLBFS on or
after the

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Termination Date, such interest will be automatically charged to the WCMA Account on the applicable
interest Due Date, and, to the extent not paid with free credit balances or the proceeds of sales
of any Money Accounts then in the WCMA Account, as hereafter provided, such interest will be paid
by a Subsequent WCMA Loan and added to the WCMA Loan Balance. All interest shall be computed for
the actual number of days elapsed on the basis of a year consisting of 360 days.

(b) Upon the occurrence and during the continuance of any Default, but without limiting the rights
and remedies otherwise available to MLBFS hereunder or waiving such Default, the interest payable
by Customer hereunder shall at the option of MLBFS accrue and be payable at the Default Rate. The
Default Rate, once implemented, shall continue to apply to the Obligations under this Loan
Agreement and be payable by Customer until the date MLBFS gives written notice that such Default
has been cured to the satisfaction of MLBFS.

(c) Notwithstanding any provision to the contrary in any of the Loan Documents, no provision of
the Loan Documents shall require the payment or permit the collection of Excess interest. If any
Excess Interest is provided for, or is adjudicated as being provided for, in the Loan Documents,
then; (i) Customer shall not be obligated to pay any Excess Interest; and (ii) any Excess Interest
that MLBFS may have received hereunder or under any of the Loan Documents shall, at the option of
MLBFS, be either applied as a credit against the then unpaid WCMA Loan Balance, or refunded to the
payor thereof.

3.6 Periodic Reduction of Maximum WCMA Line of Credit. Commencing on the last Business Day of the
first full calendar month following the Closing Date, and continuing on the last Business Day of
each calendar month thereafter to and including the last Business Day of the fifty-ninth (59th)
such calendar month, the Maximum WCMA Line of Credit shall be reduced by an amount equal to one-two
hundred fortieth (1/240th) of the Loan Amount per month. Unless the WCMA Line of Credit shall have
been earlier terminated pursuant to the terms hereof, on the last Business Day of the sixtieth
(60th) such calendar month, the WCMA Line of Credit shall, without further action of either of the
parties hereto, be terminated, Customer shall pay to MLBFS the entire WCMA Loan Balance, if any,
and all other Obligations, and the WCMA Account, at the option of Customer, will either be
converted to a WCMA Cash Account (subject to any requirements of MLPF&S) or terminated. No failure
or delay on the part of MLBFS in entering into the WCMA computer system any scheduled reduction in
the Maximum WCMA Line of Credit pursuant to this Section shall have the effect of preventing or
delaying such reduction.

3.7 Mandatory Payments. CUSTOMER AGREES THAT IT WILL, WITHOUT DEMAND, INVOICING OR THE REQUEST OF
MLBFS, FROM TIME TO TIME MAKE SUFFICIENT PAYMENTS ON ACCOUNT OF THE WCMA LOAN BALANCE TO ASSURE
THAT THE WCMA LOAN BALANCE WILL NOT AT ANY TIME EXCEED THE MAXIMUM WCMA LINE OF CREDIT, AS REDUCED
EACH MONTH PURSUANT TO SECTION 3.6 HEREOF.

3.8
Method of Making Payments. All payments required or permitted to be made pursuant to this Loan
Agreement shall be made in lawful money of the United States. Unless otherwise hereafter directed
by MLBFS, such payments may be made by the delivery of checks (other than WCMA Checks), or by means
of FTS or wire transfer of funds (other than funds from the WCMA Line of Credit) to MLPF&S for
credit to the WCMA Account. Payments to MLBFS from funds in the WCMA Account shall be deemed to be
made by Customer upon the same basis and schedule as funds are made available for investment in the
Money Accounts in accordance with the terms of the WCMA Agreement. The acceptance by or on behalf
of MLBFS of a check or other payment for a lesser amount than shall be due from Customer,
regardless of any endorsement or statement thereon or transmitted therewith, shall not be deemed an
accord and satisfaction or anything other than a payment on account, and MLBFS or anyone acting on
behalf of MLBFS may accept such check or other payment without prejudice to the rights of MLBFS to
recover the balance actually due or to pursue any other remedy under this Loan Agreement or
applicable law for such balance. All checks accepted by or on behalf of MLBFS in connection with
this Loan Agreement are subject to final collection.

3.9 Irrevocable Instructions to MLPF&S. In order to minimize the WCMA Loan Balance, Customer
hereby irrevocably authorizes and directs MLPF&S, effective on the Closing Date and continuing
thereafter so long as this Loan Agreement shall be in effect: (a) to immediately and prior to
application for any other purpose pay to MLBFS to the extent of any WCMA Loan Balance or other
amounts payable by Customer hereunder all available free credit balances from time to time in the
WCMA Account; and (b) if such available free credit balances are insufficient to pay the WCMA Loan
Balance and such other amounts, and there are in the WCMA Account at any time any investments in
Money Accounts (other than any investments constituting any Minimum Money Accounts Balance under
the WCMA Directed Reserve Program), to immediately liquidate such investments and pay to MLBFS to
the extent of any WCMA Loan Balance and such other amounts the available proceeds from the
liquidation of any such Money Accounts.

3.10 Late Charge. Any payment or deposit required to be made by Customer pursuant to the Loan
Documents not paid or made within ten (10) days of the applicable due date shall be subject to a
late charge in an amount equal to the lesser of: (a) 5% of the overdue amount, or (b) the maximum
amount permitted by applicable law. Such late charge shall be payable on demand, or, without
demand, may in the sole discretion of MLBFS be paid by a Subsequent WCMA Loan and added to the WCMA
Loan Balance in the same manner as provided herein for accrued interest with respect to the WCMA
Line of Credit.

3.11 Prepayment. Customer may prepay the Loan and any Subsequent WCMA Loan at any time in whole or
in part without premium or penalty.

3.12 Option of Customer to Terminate. Customer will have the option to terminate the WCMA Line of
Credit at any time upon written notice to MLBFS. Concurrently with any such termination, Customer
shall pay to MLBFS the entire WCMA Loan Balance and all other Obligations.

3.13 Limitation of Liability. MLBFS shall not be responsible, and shall have no liability to
Customer or any other party, for any delay or failure of MLBFS to honor any request of Customer for
a WCMA Loan or any other act or omission of MLBFS, MLPF&S or any of their affiliates due to or
resulting from any system failure, error or delay in posting or other clerical error, loss of
power, fire, Act of God or other cause beyond the reasonable control of MLBFS, MLPF&S or any of
their affiliates unless directly arising out of the willful wrongful act or active gross negligence
of MLBFS. In no event shall MLBFS be liable to Customer or any other party for any incidental or
consequential damages arising from any act or omission by MLBFS, MLPF&S or any of their affiliates
in connection with the WCMA Line of Credit or this Loan Agreement.

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3.14 Statements. MLPF&S will include in each monthly statement it issues under the WCMA Program
information with respect to WCMA Loans and the WCMA Loan Balance. Any questions that Customer may
have with respect to such information or the Loan should be directed to MLBFS; and any questions
with respect to any other matter in such statements or about or affecting the WCMA Program should
be directed to MLPF&S.

Article IV. GENERAL PROVISIONS

4.1 Representations and Warranties. 

Customer represents and warrants to MLBFS that:

(a) Compliance
with Anti-Terrorism, Embargo, Sanctions and Anti-Money Laundering Laws. Without
limiting the generality of any other provision in this Loan Agreement (i) each Credit Party has
taken all reasonable measures, in accordance with all applicable Anti-Terrorism and Anti-Money
Laundering Laws with respect to each holder of a direct or indirect interest in such Credit Party,
to assure that funds invested by such holders in the Credit Parties are derived from legal sources;
(ii) to Customer’s knowledge after making due inquiry, neither any of the Credit Parties nor any
holder of a direct or indirect interest in the Credit Parties: (a) is under investigation by any
governmental authority for, or has ever been charged with, or convicted of, any violation of any
Anti-Terrorism and Anti-Money Laundering Laws or any other criminal activity, (b) has been assessed
civil penalties under any Anti-Terrorism and Anti-Money Laundering Laws, (c) has had any of its
funds seized or forfeited in an action under any Anti-Terrorism and Anti-Money Laundering Laws or
(d) is a Person with whom a citizen of the United States is prohibited to engage in transactions
pursuant to any Anti-Terrorism and Anti-Money Laundering Laws; (iii) each Credit Party has taken
reasonable steps, consistent with industry practice for comparable organizations and in any event
as required by law, to ensure that such Credit Parties are and shall be in compliance with all
Anti-Terrorism and Anti-Money Laundering Laws; provided
however, Sections (i) and (ii) of
this provision shall not apply to the extent that such Person’s interest is in or through an entity
whose securities are traded on a national securities exchange.

(b) Organization and Existence. Customer is a limited liability company, duly organized and
validly existing under the laws of the State of Florida; and, where applicable, each Business
Guarantor is duly organized, validly existing and in good standing under the laws of the state of
its formation and is qualified to do business and in good standing in each other state where the
nature of its business or the property owned by it make such qualification necessary.

(c) Execution, Delivery and Performance. Each Credit Party has the requisite power and
authority to enter into and perform the Loan Documents. The Customer holds all necessary permits,
licenses, certificates of occupancy and other governmental authorizations and approvals required in
order to own or operate the Customer’s business. The execution, delivery and performance by
Customer of this Loan Agreement and by each of the other Credit Parties of such of the other Loan
Documents to which it is a party: (i) have been duly authorized by all requisite action, (ii) do
not and will not violate or conflict with any law, order or other governmental requirement, or any
of the agreements, instruments or documents which formed or govern any of the Credit Parties, and
(iii) do not and will not breach or violate any of the provisions of, and will not result in a
default by any of the Credit Parties under, any other agreement, instrument or document to which it
is a party or is subject.

(d) Notices and Approvals. Except as may have been given or obtained, no notice to or consent
or approval of any governmental body or authority or other third party whatsoever (including,
without limitation, any other creditor) is required in connection with the execution, delivery or
performance by any Credit Party of such of the Loan Documents to which it is a party.

(e) Enforceability. The Loan Documents to which any Credit Party is a party are the respective
legal, valid and binding obligations of such Credit Party, enforceable against it or them, as the
case may be, in accordance with their respective terms, except as
enforceability may be limited by
bankruptcy and other similar laws affecting the rights of creditors generally or by general
principles of equity.

(f) Collateral. Except for priorities afforded to any Permitted Liens: (i) Customer has good
and marketable title to the Collateral, (ii) none of the Collateral is subject to any lien,
encumbrance or security interest, and (iii) upon the filing of all Uniform Commercial Code
financing statements authenticated or otherwise authorized by Customer with respect to the
Collateral in the appropriate jurisdiction(s) and/or the completion of any other action required by
applicable law to perfect its liens and security interests, MLBFS will have valid and perfected
first liens and security interests upon all of the Collateral.

(g) Financial Statements. Except as expressly set forth in Customer’s or any Business
Guarantor’s financial statements, all financial statements of Customer and each Business Guarantor
furnished to MLBFS have been prepared in conformity with generally accepted accounting principles,
consistently applied, are true and correct in all material respects, and fairly present the
financial condition of it as at such dates and the results of its operations for the periods then
ended (subject, in the case of interim unaudited financial statements, to normal year-end
adjustments); and since the most recent date covered by such financial statements, there has been
no material adverse change in any such financial condition or operation. All financial statements
furnished to MLBFS of any Guarantor other than a Business Guarantor are true and correct in all
material respects and fairly represent such Guarantor’s financial condition as of the date of such
financial statements, and since the most recent date of such financial statements, there has been
no material adverse change in such financial condition.

(h) Litigation; Compliance With All Laws. No litigation, arbitration, administrative or
governmental proceedings are pending or, to the knowledge of Customer, threatened against any
Credit Party, which would, if adversely determined, materially and adversely affect (i) such Credit
Party’s interest in the Collateral or the liens and security interests of MLBFS hereunder or under
any of the Loan Documents, or (ii) the financial condition of such Credit Party or its continued
operations. Each Credit Party is in compliance in all material respects with all laws, regulations,
requirements and approvals applicable to such Credit Party.

(i) Tax
Returns. All federal, state and local tax returns, reports and statements required to be
filed by any Credit Party have been filed with the appropriate governmental agencies and all taxes
due and payable by any Credit Party have been timely paid (except to the extent that any such
failure to

6

 

file or pay will not materially and adversely affect (i) either the liens and security interests of
MLBFS hereunder or under any of the Loan Documents, (ii) the financial condition of any Credit
Party or (iii) its continued operations).

(j) Collateral Location. All of the tangible Collateral is located at a Location of Tangible
Collateral.

(k) No Default. No “Default” or “Event of Default” (each as defined in this Loan Agreement or any
of the other Loan Documents) has occurred and is continuing.

(l) No Outside Broker. Except for employees of MLBFS, MLPF&S or one of their affiliates, Customer
has not in connection wiih the transactions contemplated hereby directly or indirectly engaged or
dealt with, and was not introduced or referred to MLBFS by, any broker or other loan arranger.

(m) Owner-Occupied. Not less than 80% of the Real Property is regularly occupied for use in a
business operated by Customer or one or more entities which are either (i) more than 50% owned and
controlled by Customer or a Guarantor, or (ii) if Customer is an entity, which own and control more
than 50% of Customer.

Each of the foregoing representations and warranties: (i) has been and will be relied upon as an
inducement to MLBFS to make any WCMA Loan, and (ii) is continuing and shall be deemed remade by
Customer on the Closing Date, and concurrently with each request by Customer for a Subsequent WCMA
Loan.

4.2 Financial and Other Information.

(a) Customer shall furnish or cause to be furnished to MLBFS during the term of this Loan
Agreement all of the following:

(i) Annual Financial Statements. Within 120 days after the close of each fiscal year of Customer, a
copy of the annual audited financial statements of Continucare
Corporation, Including in reasonable
detail, a balance sheet and statement of retained earnings as at the close of such fiscal year and
statements of profit and loss and cash flow for such fiscal year;

(ii) Certificate of Compliance. Within 45 days after the close of each fiscal quarter of Customer,
a Certificate of Compliance, duly executed by an authorized officer of Customer, in the form of
Exhibit B attached hereto, or such other form as reasonably required by MLBFS from time to time;

(i) Interim
Financial Statements. Within 45 days after the close of each fiscal quarter of Customer,
a copy of the interim financial statements of Continucare Corporation for such fiscal quarter
(including in reasonable detail both a balance sheet as of the close of such fiscal period, and
statement of profit and loss for the applicable fiscal period);

(ii) Paid Tax Bills. A copy of each real estate tax bill on or issued in connection with the Real
Property, together with evidence of payment of such tax bill; and

(iii) Other Information. Such other information as MLBFS may from time to time reasonably request
relating to Customer, any Credit Party or the Collateral.

(b) General Agreements With Respect to Financial Information. Customer agrees that except as
otherwise specified herein or otherwise agreed to in writing by MLBFS: (i) all annual financial
statements required to be furnished by Customer to MLBFS hereunder will be prepared by either the
current independent accountants for Customer or other independent accountants reasonably acceptable
to MLBFS, and (ii) all other financial information required to be furnished by Customer to MLBFS
hereunder will be certified as correct in all material respects by the party who has prepared such
information, and, in the case of internally prepared information with respect to Customer or any
Business Guarantor, certified as correct by their respective chief financial officer.

4.3 Other Covenants. Customer further covenants and agrees during the term of this Loan Agreement
that:

(a) Compliance with Anti-Terrorism, Embargo, Sanctions and Anti-Money Laundering Laws. Each
Credit Party (i) shall take all reasonable measures in
accordance with all, applicable
Anti-Terrorism and Anti-Money Laundering Laws with respect to each holder of a direct or indirect
interest in such Credit Party, to assure that funds invested by such holders in the Credit Parties
are derived from legal sources; (ii) shall not violate any Anti-Terrorism and Anti-Money Laundering
Laws, and (iii) shall take reasonable steps, consistent with industry practice for comparable
organizations and in any event as required by law, to ensure that such Credit Parties are and shall
be in compliance with all Anti-Terrorism and Anti-Money Laundering Laws; provided however,
Sections (i) and (ii) of this provision shall not apply to the extent that such Person’s interest
is in or through an entity whose securities are traded on a national securities exchange.

(b) Financial Records; Inspection. Each Credit Party (other than any Individual Guarantor) will:
(i) maintain at its principal place of business complete and accurate books and records, and
maintain all of its financial records in a manner consistent with the financial statements
heretofore furnished to MLBFS, or prepared on such other basis as may be approved in writing by
MLBFS; and (ii) permit MLBFS or its duly authorized representatives, upon reasonable notice and at
reasonable times, to inspect its properties (both real and personal), operations, books and
records.

(c) Taxes. Each Credit Party will pay when due all taxes, assessments and other governmental
charges, howsoever designated, and all other liabilities and obligations, except to the extent that
any such failure to file or pay will not materially and adversely affect either the liens and
security interests of MLBFS hereunder or under any of the Loan Documents, the financial condition
of any Credit Party or its continued operations.

(d) Compliance With Laws and Agreements. No Credit Party will violate (i) any law, regulation or
other governmental requirement any judgment or order of any court or governmental agency or
authority; (ii) any agreement, instrument or document which is material to its operations or to the
operation or use of

7

 

any Collateral, in each case as contemplated by the Loan Documents; or (iii) any agreement,
instrument or document to which it is a party or by which it is bound, if any such violation will
materially and adversely affect either the liens and security interests of MLBFS hereunder or under
any of the Loan Documents, the financial condition of any Credit Party, or its continued
operations.

(e) No Use of Merrill Lynch Name. No Credit Party will directly or indirectly publish, disclose
or otherwise use in any advertising or promotional material, or press release or interview, the
name, logo or any trademark of MLBFS, MLPF&S, Merrill Lynch and Co., Incorporated or any of their
affiliates.

(f) Notification By Customer. Customer shall provide MLBFS with prompt written notification of:
(i) any Default; (ii) any material adverse change in the business, financial condition or
operations of any Credit Party; (iii) any information which indicates that any financial statements
of any Credit Party fail in any material respect to present fairly the financial condition and
results of operations purported to be presented in such statements; (iv) any threatened or pending
litigation involving any Credit Party; (v) any casualty loss, attachment, lien, judicial process,
encumbrance or claim affecting or involving $25,000 or more of any Collateral; and (vi) any change
in Customer’s outside accountants. Each notification by Customer pursuant hereto shall specify the
event or information causing such notification, and, to the extent applicable, shall specify the
steps being taken to rectify or remedy such event or information.

(g) Entity Organization. Each Credit Party which is an entity will (i) remain (A) validly
existing and in good standing in the state of its organization and (B) qualified to do business and
in good standing in each other state where the nature of its business or the property owned by it
make such qualification necessary, and (ii) maintain all governmental permits, licenses and
authorizations. Customer shall give MLBFS not less than 30 days prior written notice of any change
in name (including any fictitious name) or chief executive office, place of business, or as
applicable, the principal residence of any Credit Party.

(h) Merger, Change in Business. Except upon the prior written consent of MLBFS, Customer shall not
cause or permit any Credit Party to (i) be a party to any merger or consolidation with, or purchase
or otherwise acquire all or substantially all of the assets of, or any material stock, partnership,
joint venture or other equity interest in, any Person, or sell, transfer or lease all or any
substantial part of its assets; (ii) engage in any material business substantially different from
its business in effect as of the date of application by Customer for credit from MLBFS, or cease
operating any such material business; or (iii) cause or permit any other Person to assume or
succeed to any material business or operations of such Credit Party.

(i) Real Estate Expense Deposit. Customer has heretofore paid to MLBFS a “Real Estate Expense
Deposit” in the aggregate amount of $25,000.00. Said deposit, which shall not bear interest and
which need not be segregated from other funds of MLBFS, shall be applied by MLBFS on account of the
out-of-pocket expenses to third parties incurred in fulfilling the Real Property Funding
Condition. On the final Closing bate, or if this Loan Agreement and any commitment of MLBFS to make
the Loan shall for any reason be terminated without a funding of any portion of the Loans, then
promptly after the date of such termination, any unused portion of the Real Estate Expense Deposit
shall be refunded to Customer. Nothing herein shall alter the primary liability of Customer to pay
or reimburse MLBFS for all of the out-of-pocket expenses to third parties incurred in fulfilling
the Real Property Funding Condition, whether or not the Loan is funded.

(j) Minimum Tangible Net Worth. Continucare Corporation and Continucare MDHC, LLC’s consolidated
“Tangible Net Worth” shall at all times exceed $14,000,000.00. For the purposes hereof, the term
“Tangible Net Worth” shall mean Continucare Corporation and Continucare MDHC, LLC’s consolidated
net worth as shown on Continucare Corporation and Continucare MDHC, LLC’s consolidated regular
financial statements prepared in accordance with GAAP, but excluding an amount equal to: (i) any
Intangible Assets, and (ii) any amounts now or hereafter directly or indirectly owing to
Continucare Corporation or Continucare MDHC, LLC by officers, shareholders or affiliates of
Continucare Corporation or Continucare MDHC, LLC. “Intangible Assets” shall mean the total amount
of goodwill, patents, trade names, trade or service marks, copyrights, experimental expense,
organization expense, unamortized debt discount and expense, the excess of cost of shares acquired
over book value of related assets, and such other assets as are properly classified as “intangible
assets” of Continucare Corporation or Confinucare MDHC, LLC determined in accordance with GAAP.

(k) Debt Service Coverage Ratio. Continucare Corporation and Continucare MDHC, LLC’s consolidated
“Debt Service Coverage Ratio” shall at all times exceed 1.25 to 1. For purposes hereof, “Debt
Service Coverage Ratio” shall mean the ratio of: (a) income before interest (including payments in
the nature of interest under capital leases), taxes, depreciation, amortization, and other non-cash
charges, to (b) the sum of the aggregate principal and interest paid or accrued, the aggregate
rental under capital leases paid or accrued, any dividends and other distributions paid or payable
to shareholders, and taxes paid in cash; all as determined on a trailing 12-month basis as set
forth in Continucare Corporation and Continucare MDHC, LLC’s regular consolidated quarterly
financial statements prepared in accordance with GAAP.

(l) Repairs. Within 30 days after the Closing Date, Customer shall repair all damaged windows and
curtain walls at the Real Property located at 3233 Palm Avenue, Hialeah, FL 33012, in accordance
with the Property Condition Report dated September 11, 2006, prepared by LandAmerica Assessment
Corporation for the benefit of MLBFS.

4.4 Collateral

(a) Pledge of Collateral. To secure payment and performance of the Obligations, Customer hereby
pledges, assigns, transfers and sets over to MLBFS, and grants to MLBFS first liens and security
interests in and upon all of the Collateral, subject only to priorities afforded to Permitted
Liens.

(b) Liens. Except upon the prior written consent of MLBFS, Customer shall not create or permit to
exist any lien, encumbrance or security interest upon or with respect to any Collateral now owned
or hereafter acquired other than Permitted Liens.

(c) Performance of Obligations. Customer shall perform all of its obligations owing on account of
or with respect to the Collateral; it being understood that nothing herein, and no action or
inaction by MLBFS, under this Loan Agreement or otherwise, shall be deemed an assumption by MLBFS
of any of Customer’s said obligations.

8

 

(d) Sales and Collections. Customer shall not sell, transfer or otherwise dispose of any
Collateral, except that so long as no Event of Default shall have occurred and be continuing,
Customer may in the ordinary course of its business: (i) sell any Inventory normally held by
Customer for sale, (ii) use or consume any materials and supplies normally held by Customer for use
or consumption, and (iii) collect all of its Accounts.

(e) Account Schedules. Upon the request of MLBFS, which may be made from time to time, Customer
shall deliver to MLBFS, in addition to the other information required hereunder, a schedule
identifying, for each Account and all Chattel Paper subject to
MLBFS’ security interests hereunder,
each Account Debtor by name and address and amount, invoice or contract number and date of each
invoice or contract. Customer shall furnish to MLBFS such additional information with respect to
the Collateral, and amounts received by Customer as proceeds of any of the Collateral, as MLBFS may
from time to time reasonably request.

(f) Alterations and Maintenance. Except upon the prior written consent of MLBFS, Customer shall
not make or permit any material alterations to any tangible Collateral which might materially
reduce or impair its market value or utility. Customer shall at all times (i) keep the tangible
Collateral in good condition and repair, reasonable wear and tear excepted, (ii) protect the
Collateral against loss, damage or destruction, and (iii) pay or cause to be paid all obligations
arising from the repair and maintenance of such Collateral, as well as all obligations with respect
to each Location of Tangible Collateral (e.g., all obligations under any lease, mortgage or
bailment agreement), except for any such obligations being contested by Customer in good faith by
appropriate proceedings.

(g) Location. Except for movements required in the ordinary course of Customer’s business,
Customer shall give MLBFS 30 days’ prior written notice of the placing at or movement of any
tangible Collateral to any location other than a Location of Tangible Collateral. In no event shall
Customer cause or permit any material tangible Collateral to be removed from the United States
without the express prior written consent of MLBFS. Customer will keep its books and records at its
principal office address specified in the first paragraph of this Loan Agreement. Customer will
not change the address where books and records are kept, or change its name or taxpayer
identification number. Customer will place a legend acceptable to MLBFS on all chattel paper that
is Collateral in the possession or control of Customer from time to time indicating that MLBFS has
a security interest therein.

(h) Insurance. Customer shall insure all of the tangible Collateral under a policy or policies of
physical damage insurance for the full replacement value thereof against such perils as MLBFS shall
reasonably require and also providing that losses will be payable to MLBFS as its interests may
appear pursuant to a lender’s or mortgagee’s long form loss payable endorsement and containing such
other provisions as may be reasonably required by MLBFS. Customer shall further provide and
maintain a policy or policies of commercial general liability insurance naming MLBFS as an
additional party insured. Customer and each Business Guarantor shall maintain such other insurance
as may be required by law or is customarily maintained by companies in a similar business or
otherwise reasonably required by MLBFS. All such insurance policies shall provide that MLBFS will
receive not less than 10 days prior written notice of any cancellation, and shall otherwise be in
form and amount and with an insurer or insurers reasonably acceptable to MLBFS. Customer shall
furnish MLBFS with a copy or certificate of each such policy or policies and, prior to any
expiration or cancellation, each renewal or replacement thereof.

(i) Event of Loss. Customer shall at its expense promptly repair all repairable damage to any
tangible Collateral. In the event that there is an Event of Loss and the affected Collateral had a
value prior to such Event of Loss of $25,000.00 or more, then, on or before the first to occur of
(i) 90 days after the occurrence of such Event of Loss, or (ii) 10 Business Days after the date on
which either Customer or MLBFS shall receive any proceeds of insurance on account of such Event of
Loss, or any underwriter of insurance on such Collateral shall advise either Customer or MLBFS that
it disclaims liability in respect of such Event of Loss, Customer shall, at Customer’s option,
either replace the Collateral subject to such Event of Loss with comparable Collateral free of all
liens other than Permitted Liens (in which event Customer shall be entitled to utilize the proceeds
of insurance on account of such Event of Loss for such purpose, and may retain any excess proceeds
of such insurance), or permanently prepay the Obligations by an amount equal to the actual cash
value of such Collateral as determined by either the insurance company’s payment (plus any
applicable deductible) or, in absence of insurance company payment, as reasonably determined by
MLBFS; it being further understood that any such permanent prepayment shall cause an immediate
permanent reduction in the Maximum WCMA Line of Credit in the amount of such prepayment and shall
not reduce the amount of any future reductions in the Maximum WCMA Line of Credit that may be
required hereunder. Notwithstanding the foregoing, if at the time of occurrence of such Event of
Loss or any time thereafter prior to replacement or line reduction, as aforesaid, an Event of
Default shall have occurred and be continuing hereunder, then MLBFS may at its sole option,
exercisable at any time while such Event of Default shall be continuing, require Customer to either
replace such Collateral or prepay the Obligations and reduce the Maximum WCMA Line of Credit, as
aforesaid.

(j) Notice of Certain Events. Customer shall give MLBFS immediate notice of any attachment, lien,
judicial process, encumbrance or claim affecting or involving $25,000.00 or more of the Collateral.

(k) Indemnification. Customer shall indemnify, defend and save MLBFS harmless from and against any
and all claims, liabilities, losses, costs and expenses (including, without limitation, reasonable
attorneys’ fees and expenses) of any nature whatsoever which may be asserted against or incurred by
MLBFS arising out of or in any manner occasioned by (i) the ownership, collection, possession, use
or operation of any Collateral, or (ii) any failure by Customer to perform any of its obligations
hereunder; excluding, however, from said indemnity any such claims, liabilities, etc. arising
directly out of the willful wrongful act or active gross negligence of MLBFS, This indemnity shall
survive the expiration or termination of this Loan Agreement as to all matters arising or accruing
prior to such expiration or termination.

4.5 Events of Default.

The occurrence of any of the following events shall constitute an “Event of Default” under this
Loan Agreement:

(a) Anti-Terrorism, Embargo, Sanctions and Anti-Money Laundering Laws. (i) Any Credit Party (a)
becomes under investigation by any governmental authority for any violation of any Anti-Terrorism
and Anti-Money Laundering Laws, (b) is assessed civil penalties under any Anti-Terrorism and
Anti-Money Laundering Laws, (c) has any of its funds seized or forfeited in an action under any
Anil-Terrorism and Anti-Money Laundering Laws, or (d) is identified as a Person with whom a citizen
of the United States is prohibited to engage in transactions by any Anti-Terrorism and Anti-Money
Laundering Laws; (ii) any

9

 

representation or warranty made by any Credit Party in this Loan Agreement or any of the other Loan
Documents with respect to any Anti-Terrorism and Anti-Money Laundering Laws shall at any time prove
to have been incorrect when made or (ii) any Credit Party shall default in the performance or
observance of any covenant or agreement related to any Anti-Terrorism and Anti-Money Laundering
Laws contained in any of the Loan Documents.

(b) Failure to Pay. (i) Customer shall fail to deposit into the WCMA Account an amount
sufficient to assure that the WCMA Loan Balance does not exceed the Maximum WCMA Line of Credit
(ii) Customer shall fail to pay to MLBFS or deposit into the WCMA Account when due any other amount
owing or required to be paid or deposited by Customer under the Loan Documents, or (iii) Customer
shall fail to pay when due any other Obligations; and any such failure as described in this
subparagraph shall continue for more than five (5) Business Days after written notice thereof shall
have been given by MLBFS to Customer.

(c) Failure to Perform. Any Credit Party shall default in the performance or observance of any
covenant or agreement on its part to be performed or observed under
any of the Loan Documents (not
constituting an Event of Default under any other clause of this Section), and such default shall
continue unremedied for ten (10) Business Days (i) after written notice thereof shall have been
given by MLBFS to Customer, or (ii) from Customer’s receipt of any notice or knowledge of such
default from any other source.

(d) Breach of Warranty. Any representation or warranty made by any Credit Party contained in
any of the Loan Documents shall at any time prove to have been incorrect in any material respect
when made.

(e) Default Under Other ML Agreement. A default or event of default by any Credit Party shall
occur under the terms of any other agreement, instrument or document with or intended for the
benefit of MLBFS, MLPF&S or any of their affiliates, and any required notice shall have been given
and required passage of time shall have elapsed, or the WCMA Agreement shall be terminated for any
reason.

(f) Bankruptcy Event. Any Bankruptcy Event shall occur.

(g) Material Impairment. Any event shall occur which shall reasonably cause MLBFS to in good
faith believe that the prospect of full payment or performance by the Credit Parties of any of
their respective liabilities or obligations under any of the Loan Documents has been materially
impaired. The existence of such a material impairment shall be determined in a manner consistent
with the intent of Section 1 -208 of the UCC.

(h) Default Under Other Agreements. Any event shall occur which results in any default of any
material agreement involving any Credit Party or any agreement evidencing any indebtedness of any
Credit Party of $100,000.00 or more.

(i) Collateral Impairment. The loss, theft or destruction of any Collateral, the occurrence of any
material deterioration or impairment of any Collateral or any
material decline or depreciation in
the value or market price thereof (whether actual or reasonably anticipated), which causes any
Collateral, in the sole opinion of MLBFS, to become unsatisfactory as to value or character; or any
levy, attachment, seizure or confiscation of the Collateral which is not released within ten (10)
Business Days.

(j) Contested Obligation. (i) Any of the Loan Documents shall for any reason cease to be, or are
asserted by any Credit Party not to be a legal, valid and binding obligations of any Credit Party,
enforceable in accordance with their terms; or (ii) the validity, perfection or priority of MLBFS’
first lien and security interest on any of the Collateral is contested by any Person; or (iii) any
Credit Party shall or shall attempt to repudiate, revoke, contest or dispute, in whole or in part,
such Credit Party’s obligations under any Loan Document.

(k) Judgments. A judgment shall be entered against any Credit Party in excess of $25,000 and the
judgment is not paid in full and discharged, or stayed and bonded to the satisfaction of MLBFS.

(l) Change in Control/Change in Management. (i) Any direct or indirect sale, conveyance, assignment
or other transfer of or grant of a security interest in any ownership interest of any Credit Party
which results, or if any rights related thereto were exercised would result, in any change in the
identity of the individuals or entities in control of any Credit Party; or (ii) the owner(s) of the
controlling equity interest of any Credit Party on the date hereof shall cease to own and control
such Credit Party; or (iii) the Person (or a replacement who is satisfactory to MLBFS in its sole
discretion) who is the chief executive officer or holds such similar position, or any senior
manager of such Credit Party on the date hereof shall for any reason cease to be the chief
executive officer or senior manager of such Credit Party.

(m) Withdrawal, Death, etc. The incapacity, death, withdrawal, dissolution, or the filing of
dissolution of: (i) any Credit Party; or (ii) any controlling shareholder, partner, or member of
any Credit Party.

4.6 Remedies.

(a) Remedies Upon Default. Upon the occurrence and during the continuance of any Event of Default,
MLBFS may at its sole option do any one or more or all of the following, at such time and in such
order as MLBFS may in its sole discretion choose:

(i) Termination. MLBFS may without notice terminate its obligation to extend any credit to or for
the benefit of Customer (it being understood that upon the occurrence of any Bankruptcy Event all
such obligations shall automatically terminate without any action on the part of MLBFS).

(ii) Acceleration. MLBFS may declare the WCMA Loan Balance and all other Obligations to be
forthwith due and payable, whereupon all such amounts shall be immediately due and payable, without
presentment, demand for payment, protest and notice of protest, notice of dishonor, notice of
acceleration, notice of intent to accelerate or other notice or formality of any kind, all of which
are hereby expressly waived; provided, however, that upon the occurrence

10

 

of any Bankruptcy Event the WCMA Loan Balance and other Obligations shall automatically become due
and payable without any action on the part of MLBFS.

(iii) Exercise Other Rights. MLBFS may exercise any or all of the remedies of a secured party under
applicable law and in equity, including, but not limited to, the UCC, and any or all of its other
rights and remedies under the Loan Documents.

(iv) Possession. MLBFS may require Customer to make the Collateral and the records pertaining to
the Collateral available to MLBFS at a place designated by MLBFS which is reasonably convenient to
Customer, or may take possession of the Collateral and the records pertaining to the Collateral
without the use of any judicial process and without any prior notice to Customer.

(v) Sale. MLBFS may sell any or all of the Collateral at public or private sale upon such terms and
conditions as MLBFS may reasonably deem proper, whether for cash, on credit, or for future
delivery, in bulk or in lots. MLBFS may purchase any Collateral at any such sale free of Customer’s
right of redemption, if any, which Customer expressly waives to the extent not prohibited by
applicable law. The net proceeds of any such public or private sale and all other amounts actually
collected or received by MLBFS pursuant hereto, after deducting all costs and expenses incurred at
any time in the collection of the Obligations and in the protection, collection and sale of the
Collateral, will be applied to the payment of the Obligations, with any remaining proceeds paid to
Customer or whoever else may be entitled thereto, and with Customer and each Guarantor remaining
jointly and severally liable for any amount remaining unpaid after
such application.

(vi) Delivery of Cash, Checks, Etc. MLBFS may require Customer to forthwith upon receipt, transmit
and deliver to MLBFS in the form received, all cash, checks, drafts and other instruments for the
payment of money (properly endorsed, where required, so that such items may be collected by MLBFS)
which may be received by Customer at any time in full or partial payment of any Collateral, and
require that Customer not commingle any such items which may be so received by Customer with any
other of its funds or property but instead hold them separate and apart and in trust for MLBFS
until delivery is made to MLBFS.

(vii) Notification of Account Debtors. MLBFS may notify any Account Debtor that its Account or
Chattel Paper has been assigned to MLBFS and direct such account debtor to make payment directly to
MLBFS of all amounts due or becoming due with respect to such Account or Chattel Paper; and MLBFS
may enforce payment and collect, by legal proceedings or otherwise, such Account or Chattel Paper.

(viii) Control of Collateral. MLBFS may otherwise take control in any lawful manner of any cash or
non-cash items of payment or proceeds of Collateral and of any rejected, returned, stopped in
transit or repossessed goods included in the Collateral and endorse Customer’s name on any item of
payment on or proceeds of the Collateral.

(b) Set-Off. MLBFS shall have the further right upon the occurrence and during the continuance of
an Event of Default to set-off, appropriate and apply toward payment of any of the Obligations, in
such order of application as MLBFS may from time to time and at any time elect, any cash, credit,
deposits, accounts, financial assets, investment property, securities and any other property of
Customer which is in transit to or in the possession, custody or control of MLBFS, MLPF&S or any
agent, bailee, or affiliate of MLBFS or MLPF&S. Customer hereby collaterally assigns and grants to
MLBFS a continuing security interest in all such property as Collateral and as additional security
for the Obligations. Upon the occurrence and during the continuance of an Event of Default, MLBFS
shall have all rights in such property available to collateral assignees and secured parties under
all applicable laws, including, without limitation, the UCC.

(c) Power of Attorney. Effective upon the occurrence and during the continuance of an Event of
Default, Customer hereby irrevocably appoints MLBFS as its attorney-in-fact, with full power of
substitution, in its place and stead and in its name or in the name of MLBFS, to from time to time
in MLBFS’ sole discretion take any action and to execute any instrument which MLBFS may deem
necessary or advisable to accomplish the purposes of this Loan Agreement and the other Loan
Documents, including, but not limited to, So receive, endorse and collect all checks, drafts and
other instruments for the payment of money made payable to Customer included in the Collateral. The
powers of attorney granted to MLBFS in this Loan Agreement are coupled with an interest and are
irrevocable until the Obligations have been indefeasibly paid in full and fully satisfied and all
obligations of MLBFS under this Loan Agreement have been terminated.

(d) Remedies are Severable and Cumulative. All rights and remedies of MLBFS herein are severable
and cumulative and in addition to a!l other rights and remedies available in the Loan Documents, at
law or in equity, and any one or more of such rights and remedies may be exercised simultaneously
or successively.

(e) No Marshalling. MLBFS shall be under no duty or obligation to (i) preserve, protect or
marshall the Collateral; (ii) preserve or protect the rights of any Credit Party or any other
Person claiming an interest in the Collateral; (iii) realize upon the Collateral in any particular
order or manner, (iv) seek repayment of any Obligations from any particular source; (v) proceed or
not proceed against any Credit Party pursuant to any guaranty or security agreement or against any
Credit Party under the Loan Documents, with or without also realizing on the Collateral; (vi)
permit any substitution or exchange of all or any part of the Collateral; or (vii) release any part
of the Collateral from the Loan Agreement or any of the other Loan Documents, whether or not such
substitution or release would leave MLBFS adequately secured.

(f) Notices. To the fullest extent permitted by applicable law, Customer hereby irrevocably waives
and releases MLBFS of and from any and all liabilities and penalties for failure of MLBFS to comply
with any statutory or other requirement imposed upon MLBFS relating to notices of sale, holding of
sale or reporting of any sale, and Customer waives all rights of redemption or reinstatement from
any such sale. Any notices required under applicable law shall be reasonably and properly given to
Customer if given by any of the methods provided herein at least 5 Business Days prior to taking
action. MLBFS shall have the right to postpone or adjourn any sale or other disposition of
Collateral at any time without giving notice of any such postponed or adjourned date. In the event
MLBFS seeks to take possession of any or all of the Collateral by court process, Customer further
irrevocably waives to the fullest extent permitted by

11

 

law any bonds and any surety or security relating thereto required by any statute, court rule or
otherwise as an incident to such possession, and any demand for possession prior to the
commencement of any suit or action.

4.7 Miscellaneous.

(a) Non-Waiver. No failure or delay on the part of MLBFS in exercising any right, power or remedy
pursuant to the Loan Documents shall operate as a waiver thereof, and no single or partial exercise
of any such right; power or remedy shall preclude any other or further exercise thereof, or the
exercise of any other right, power or remedy. Neither any waiver of any provision of any of the
Loan Documents, nor any consent to any departure by Customer therefrom, shall be effective unless
the same shall be in writing and signed by MLBFS. Any waiver of any provision of any of the Loan
Documents and any consent to any departure by Customer from the terms thereof shall be effective
only in the specific instance and for the specific purpose for which given. Except as otherwise
expressly provided herein, no notice to or demand on Customer shall in any case entitle Customer to
any other or further notice or demand in similar or other circumstances.

(b) Disclosure. Customer hereby irrevocably authorizes MLBFS and each of its affiliates, including
without limitation MLPF&S, to at any time (whether or not an Event of Default shall have occurred)
obtain from and disclose to each other, and to any third party in connection with Section 4.7 (g)
herein, any and all financial and other information about Customer. In connection with said
authorization, the parties recognize that in order to provide a WCMA Line of Credit certain
information about Customer is required to be made available on a computer network accessible by
certain affiliates of MLBFS, including MLPF&S. Customer further
irrevocably authorizes MLBFS to
contact, investigate, inquire and obtain consumer reports, references and other information on
Customer from consumer reporting agencies and other credit reporting services, former or current
creditors, and other persons and sources (including, without limitation, any Affiliate of MLBFS)
and to provide to any references, consumer reporting agencies, credit reporting services, creditors
and other persons and sources (including, without limitation, affiliates of MLBFS) all financial,
credit and other information obtained by MLBFS relating to the Customer.

(c) Communications. Delivery of an agreement, instrument or other document may, at the discretion
of MLBFS, be by electronic transmission. Except as required by law or otherwise provided herein or
in a writing executed by the party to be bound, all notices demands, requests, accountings,
listings, statements, advices or other communications to be given under the Loan Documents shall be
in writing and shall be served either personally, by deposit with a reputable overnight courier
with charges prepaid, or by deposit in the United States mail by certified mail return receipt
required. Notices may be addressed to Customer as set forth at its address shown in the preamble
hereto, or to any office to which billing or account statements are sent; to MLBFS at its address
shown in the preamble hereto, or at such other address designated in writing by MLBFS. Any such
communication shall be deemed to have been given upon, in the case of personal delivery the date of
delivery, one Business Day after deposit with an overnight courier, two (2) Business Days after
deposit in the United States by certified mail (return receipt required), or receipt of electronic
transmission (which shall be presumed to be three hours after the time of transmission unless an
error message is received by the sender), except that any notice of change of address shall not be
effective until actually received.

(d) Fees,
Expenses and Taxes. Customer shall pay or reimburse MLBFS for: (i) all UCC, real
property or other filing, recording, and search fees and expenses incurred by MLBFS in connection
with the verification, perfection or preservation of MLBFS’ rights hereunder or in any Collateral
or any other collateral for the Obligations; (ii) any and all stamp, transfer, mortgage,
intangible, document, filing, recording and other taxes and fees payable or determined to be
payable in connection with the borrowings hereunder or the execution, delivery, filing, and/or
recording of the Loan Documents and any other instruments or documents provided for herein or
delivered or to be delivered hereunder or in connection herewith; (iii) any and all fees and
out-of-pocket expenses to third parties incurred by MLBFS in connection with the title insurance,
environmental audit, appraisal, survey and other instruments or documents referred to in the
definition of Real Property Funding Condition; and (iv) all fees and out-of-pocket expenses
(including, attorneys’ fees and legal expenses) incurred by MLBFS in connection with the
preparation, execution, administration, collection, enforcement, protection, waiver or amendment of
this Loan Agreement, the other Loan Documents and such other instruments or documents, and the
rights and remedies of MLBFS thereunder, and all other matters in connection therewith. Customer
hereby authorizes MLBFS, at its option, to either cause any and all such fees, expenses and taxes
to be paid with a WCMA Loan, or invoice Customer therefore (in which event Customer shall pay all
such fees, expenses and taxes within 5 Business Days after receipt of such invoice). The
obligations of Customer under this paragraph shall survive the expiration or termination of this
Loan Agreement and the discharge of the other Obligations.

(e) Right to Perform Obligations. If Customer shall fail to do any act or thing which it has
covenanted to do under any of the Loan Documents or any representation or warranty on the part of
Customer contained in the Loan Documents shall be breached, MLBFS may, in its sole discretion,
after 5 Business Days written notice is sent to Customer (or such lesser notice, including no
notice, as is reasonable under the circumstances), do the same or cause it to be done or remedy any
such breach, and may expend its funds for such purpose. Any and all reasonable amounts so expended
by MLBFS shall be repayable to MLBFS by Customer upon demand, with interest at the Interest Rate
during the period from and including the date funds are so expended by MLBFS to the date of
repayment, and all such amounts shall be additional Obligations. The payment or performance by
MLBFS of any of Customer’s obligations hereunder shall not relieve Customer of said obligations or
of the consequences of having failed to pay or perform the same, and shall not waive or be deemed a
cure of any Default.

(f) Further Assurances. Customer agrees to do such further acts and things and to execute and
deliver to MLBFS such additional agreements, instruments and documents as MLBFS may reasonably
require or deem advisable to effectuate the purposes of the Loan Documents, to confirm the WCMA
Loan Balance, or to establish, perfect and maintain MLBFS’ security interests and liens upon the
Collateral, including, but not limited to: (i) executing financing statements or amendments thereto
when and as reasonably requested by MLBFS; and (ii) if in the reasonable judgment of MLBFS it is
required by local law, causing the owners and/or mortgagees of the real property on which any
Collateral may be located to execute and deliver to MLBFS waivers or subordinations reasonably
satisfactory to MLBFS with respect to any rights in such Collateral.

12

 

(g) Binding Effect. The Loan Documents shall be binding upon, and shall inure to the benefit of
MLBFS, Customer and their respective successors and assigns. MLBFS reserves the right, at any time
while the Obligations remain outstanding, to sell, assign, syndicate or otherwise transfer or
dispose of any or all of MLBFS’ rights and interests under the Loan Documents. MLBFS also reserves
the right at any time to pool the WCMA Loan with one or more other loans originated by MLBFS or any
other Person, and to securitize or offer interests in such pool on whatever terms and conditions
MLBFS shall determine. Customer consents to MLBFS releasing financial and other information
regarding Credit Parties, the Collateral and the WCMA Loan in connection with any such sale,
pooling, securitization or other offering. Customer shall not assign any of its rights or delegate
any of its obligations under any of the Loan Documents without the prior written consent of MLBFS.
Unless otherwise expressly agreed to in a writing signed by MLBFS, no such consent shall in any
event relieve Customer of any of its obligations under this Loan Agreement or any of the other Loan
Documents.

(h) Interpretation; Construction. (i) Captions and section and paragraph headings in this Loan
Agreement are inserted only as a matter of convenience, and shall not affect the interpretation
hereof; (ii) no provision of this Loan Agreement shall be construed against a particular Person or
in favor of another Person merely because of which Person (or its representative) drafted or
supplied the wording for such provision; and (iii) where the context requires: (a) use of the
singular or plural incorporates the other, and (b) pronouns and modifiers in the masculine,
feminine or neuter gender shall be deemed to refer to or include the other genders.

(i) Governing Law. This Loan Agreement and, unless otherwise expressly provided therein, each of
the Loan Documents, shall be governed in all respects by the laws of the State of Illinois, not
including its conflict of law provisions.

(j) Severability of Provisions. Whenever possible, each provision of this Loan Agreement and the
other Loan Documents shall be interpreted in such manner as to be effective and valid under
applicable law. Any provision of the Loan Documents which is prohibited or unenforceable in any
jurisdiction shall, as to such jurisdiction, be ineffective only to the extent of such prohibition
or unenforceability without invalidating the remaining provisions of the Loan Documents or
affecting the validity or enforceability of such provision in any other jurisdiction.

(k) Term. This Loan Agreement shall become effective on the date accepted by MLBFS at its office in
Chicago, Illinois, and, subject to the terms hereof, shall continue in effect so long thereafter
as: (i) the WCMA Line of Credit shall be in effect, (ii) there shall be any moneys outstanding
under this Loan Agreement, or (iii) there shall be any other Obligations outstanding. Customer
hereby waives notice of acceptance of this Loan Agreement by MLBFS.

(l) Exhibits. The exhibits to this Loan Agreement are hereby incorporated and made a part hereof
and are an integral part of this Loan Agreement

(m) Counterparts. This Loan Agreement may be executed in one or more counterparts which, when taken
together, constitute one and the same agreement.

(n) Jurisdiction; Waiver. Customer acknowledges that this Loan Agreement is being accepted by MLBFS
in partial consideration of MLBFS’ right and option, in its sole discretion, to enforce the Loan
Documents in either the State of Illinois or in any other jurisdiction where Customer or any
Collateral may be located. Customer irrevocably submits itself to jurisdiction in the State of
Illinois and venue in any state or federal court in the County of Cook for such purposes, and
Customer waives any and all rights to contest said jurisdiction and venue and the convenience of
any such forum, and any and all rights to remove such action from state to federal court. Customer
further waives any rights to commence any action against MLBFS in any jurisdiction except in the
County of Cook and State of Illinois. Customer agrees that all such service of process shall be
made by mail or messenger directed to it in the same manner as provided for notices to Customer in
this Loan Agreement and that service so made shall be deemed to be completed upon the earlier of
actual receipt or three (3) days after the same shall have been posted to Customer or Customer’s
agent. Nothing contained herein shall affect the right of MLBFS to serve legal process in any other
manner permitted by law or affect the right of MLBFS to bring any action or proceeding against
Customer or its property in the courts of any other jurisdiction. Customer waives, to the extent
permitted by law, any bond or surety or security upon such bond which might, but for this waiver,
be required of MLBFS. Customer further waives the right to bring any non-compulsory counterclaims.

(o) Jury Waiver. MLBFS and Customer hereby each expressly waive any and all rights to a trial by
jury in any action, proceeding or counterclaim brought by either of the parties against the other
party with respect to any matter relating to, arising out of or in any way connected with the Loan,
the Obligations, this Loan Agreement, any of the other Loan Documents and/or any of the
transactions which are the subject matter of this Loan Agreement.

(p) Integration. This Loan Agreement, together with the other Loan Documents, constitutes the
entire understanding and represents the full and final agreement between the parties with respect
to the subject matter hereof, and may not be contradicted by evidence of prior written agreements
or prior, contemporaneous or subsequent oral agreements of the parties. There are no unwritten oral
agreements of the parties. Without limiting the foregoing, Customer acknowledges that: (i) no
promise or commitment has been made to it by MLBFS, MLPF&S or any of their respective employees,
agents or representatives to make any WCMA Loan on any terms other than as expressly set forth
herein, or to make any other loan or otherwise extend any other credit to Customer or any other
party; and (ii) except as otherwise expressly provided herein, this Loan Agreement supersedes and
replaces any and all proposals, letters of intent and approval and commitment letters from MLBFS to
Customer, none of which shall be considered a Loan Document. No amendment or modification of any of
the Loan Documents to which Customer is a party shall be effective unless in a writing signed by
both MLBFS and Customer.

(q) Survival. All representations, warranties, agreements and covenants contained in the Loan
Documents shall survive the signing and delivery of the Loan Documents, and all of the waivers made
and indemnification obligations undertaken by Customer shall survive the termination, discharge or
cancellation of the Loan Documents.

13

 

(r) Customer’s
Acknowledgments. The Customer acknowledges that the Customer: (i) has had ample
opportunity to consult with counsel and such other parties as deemed advisable prior to signing and
delivering this Loan Agreement and the other Loan Documents; (ii) understands the provisions of
this Loan Agreement and the other Loan Documents, including all waivers contained therein; and
(iii) signs and delivers this Loan Agreement and the other Loan Documents freely and voluntarily,
without duress or coercion.

This Loan Agreement and the other Loan Documents are executed under seal and are intended to take
effect as sealed instruments.

IN WITNESS WHEREOF, this Loan Agreement has been executed as of the
day and year first above written.

CONTINUCARE MDHC, LLC

BY CONTINUCARE CORPORATION, ITS SOLE MEMBER

	 	 	 	 	 	 	 
	By:

	 	/s/ Richard C. Pfenniger, Jr.
	 	/s/ Fernando L. Fernandez	 	 
	 	 	 	 	 
	 

	 	          Signature (1)
	 	Signature (2)	 	 
	 
	 	 	 	 	 	 
	 

	 	          Richard
C. Pfenniger, Jr.
	 	Fernando L. Fernandez	 	 
	 	 	 
	 

	 	          Printed Name
	 	Printed Name	 	 
	 
	 	 	 	 	 	 
	 

	 	          CEO
	 	CFO	 	 
	 	 	 
	 

	 	          Title
	 	Title	 	 

	 	 	 	 	 	 	 
	STATE OF Florida

	 	 	}	 	 	 
	 

	 	 	}	 	 	SS.
	COUNTY OF Dade

	 	 	}	 	 	 

The foregoing instrument was acknowledged before me this day of Sept. 26 AD, 2006 by Richard
Pfenniger, Fernando Frenandez CONTINUCARE MDHC, LLC, a Florida limited liability company, on behalf
of the limited liability company. Said person is personally known to
me or has
produced                                          as identification.

	 	 	 	 	 
	/s/ Jodi Garcia
 

     NOTARY PUBLIC

	 	 	 	 
	 
	 	 	 	 
	Jodi Garcia
 

     PRINTED NAME OF NOTARY PUBLIC

	 	 	 	 
	 
	 	 	 	 
	My Commission Expires:

 

                         [SEAL]

	 	 	 	 

Accepted at Chicago, Illinois:

MERRILL LYNCH BUSINESS FINANCIAL

SERVICES INC.

	 	 	 	 	 
	By:
	 	 	 	 
	 

	 	 

	 	 

14

 

EXHIBIT A

ATTACHED TO AND HEREBY MADE A PART OF WCMA REDUCING REVOLVER LOAN AND SECURITY AGREEMENT NO.
81V-02074 BETWEEN MERRILL LYNCH BUSINESS FINANCIAL SERVICES INC. AND CONTINUCARE MDHC, LLC

Additional Locations of Tangible Collateral:

Source: [{"source": "alea-institute/alea-institute/kl3m-data-edgar-agreements/train-00113-of-00352.parquet"}, [{"source": "alea-institute/alea-institute/kl3m-data-edgar-agreements/train-00113-of-00352.parquet"}]]