Document:

Amend #1 to Contract No. 0653 Georgia Dept. of Cummunity Health

 Exhibit 10.9 
  
 AMENDMENT #1 TO CONTRACT NO. 0653 BETWEEN 
 GEORGIA DEPARTMENT OF COMMUNITY HEALTH AND 
 PEACH STATE 
  
 This Amendment is between the Georgia Department of Community Health (hereinafter referred to as “DCH” or the
“Department”) and Peach State (hereinafter referred to as “Contractor”) and is made effective the 16th day of August, 2005 (hereinafter referred to as the “Effective Date”). Other than the changes, modifications and
additions specifically articulated in this Amendment #1 to Contract # 0653, the original Contract shall remain in effect and binding on and against DCH and Contractor. Unless expressly modified or added in this Amendment #1, the terms and conditions
of the original Contract are expressly incorporated into this Amendment #1 as if completely restated herein. 
  
 WHEREAS, DCH and Contractor executed a contract for the provision of services to Georgia Healthy Families; and, 
  
 WHEREAS, pursuant to Section 32.0, Amendments in
Writing, DCH and Contractor desire to amend the above-referenced Contract by adding additional funding as set forth below. 
  
 NOW THEREFORE, for and in consideration of the mutual promises of the Parties, the terms, provisions and conditions of this Amendment and other
good and valuable consideration, the sufficiency of which is hereby acknowledged, DCH and Contractor hereby agree as follows: 
  

	I.	To delete the current Attachment H in its entirety and insert in lieu thereof the Attachment H of this Amendment No. 1. 

  

	II.	DCH and Contractor agree that they have assumed an obligation to perform the covenants, agreements, duties and obligations of the Contract, as modified and amended herein, and agree
to abide by all the provisions, terms and conditions contained in the Contract as modified and amended. 

  

	III.	This Amendment shall be binding and inure to the benefit of the parties hereto, their heirs, representatives, successors and assigns. Whenever the provisions of this Amendment and
the Contract are in conflict, the provisions of this Amendment shall take precedence and control. 

  

	IV.	It is understood by the Parties hereto that, if any part, term, or provision of this Amendment or this entire Amendment is held to be illegal or in conflict with any law of this
State, then DCH, at its sole option, may enforce the remaining unaffected portions or provisions of this Amendment or of the Contract and the rights and obligations of the parties shall be construed and enforced as if the Contract or Amendment did
not contain the particular part, term or provision held to be invalid. 

  

	V.	This Amendment shall become effective as stated herein and shall remain effective for so long as the Contract is in effect. 

  

			
	 Amendment #1
	  	Page 1 of 4
	 Contract #0653
	  	 
	 Peach State for Provision of Services to Georgia Healthy Families
	  	 

	VI.	This Amendment shall be construed in accordance with the laws of the State of Georgia. 

  

	VII.	All other terms and conditions contained in the Contract and any amendment thereto, not amended by this Amendment, shall remain in full force and effect. 

 

	VIII. 	The Contractor and the Department agree that in the event of a disagreement regarding, arising out of, or related to contract language interpretation, the Department’s
interpretation of the contract language in dispute shall control and govern. The Department’s interpretation of the contract language in dispute shall not be subject to appeal under any circumstance. 

  

	IX.	In the event that the Department has entered into or enters into agreements with other Contractors for additional work related to the services rendered hereunder, the Contractor
agrees to cooperate fully with such other Contractors. The Contractor shall not commit any act that will interfere with the performance of work by any other Contractor. 

  
 Additionally, if the Department eventually awards this Contract to another Contractor, the Contractor agrees that it will
not engage in any behavior or inaction that prevents or hinders the work related to the services contracted for in this contract. In fact, the Contractor agrees to submit a written turn-over plan and/or transition plan to the Department within
thirty (30) days of receiving the Department’s intent to terminate letter. The Parties agree that the Contractor has not successfully met this obligation until the Department accepts its turn-over plan and/or transition plan. 

 
 The Contractor’s failure to cooperate and comply with this
provision, shall be sufficient grounds for the Department to halt all payments due or owing to the Contractor until it becomes comply with this or any other contract provision. The Department’s determination on the matter shall be conclusive
and not subject to appeal. 
  
 SIGNATURES ON THE FOLLOWING
PAGE 
  

			
	 Amendment #1
	  	Page 2 of 4
	 Contract #0653
	  	 
	 Peach State for Provision of Services to Georgia Healthy Families
	  	 

 IN WITNESS WHEREOF, DCH and Contractor, through their authorized officers and agents, have caused this Amendment
to be executed on their behalf as of the date indicated. 
  
 GEORGIA DEPARTMENT
OF COMMUNITY HEALTH 

	
	
	/s/    Tim Burgess        
	Tim Burgess, Commissioner

  

			
	CONTRACTOR
		
	BY:	 	/s/    Daniel R. Paquin        
	 	 	 * SIGNATURE

		
	 	 	 Daniel R. Paquin

	 	 	 Please Print/Type Name Here

  

	
	
	 
	 AFFIX CORPORATE SEAL HERE
 (Corporations without a
seal, attach a
Certificate of Corporate Resolution)

  

			
		
	ATTEST:	 	/s/    Brenda Williams        
	 	 	 ** SIGNATURE

		
	 	 	 Vice President

	 	 	 TITLE

	*	Must be President, Vice President, CEO or Other Authorized Officer 

	**	Must be Corporate Secretary 

  

									
	DOAS STATE PURCHASING REPRESENTATIVE, SIGNED AS TO FORM:
					
	By:	 	/s/    Ann Maize        	 	 	 	Date:	 	 8/18/05

									
	Printed Name and Title	 	        Ann Maize, Contracting Officer	 	 	 	 	 	 

  

			
	 Amendment #1
	  	Page 3 of 4
	 Contract #0653
	  	 
	 Peach State for Provision of Services to Georgia Healthy Families
	  	 

 CONFIDENTIAL – NOT FOR CIRCULATION 
 ATTACHMENT H 
  
 Amended August 16, 2005 
  
 Attachment H is a table displaying the
contracted rates by rate cell for each contracted region. These rates will be the basis for calculating capitation payments in each contracted Region. 
  

												
	Contracted Rates by Region	  	 	 	  	 	 
				
	CMO NAME	  	 	Peach State	  	 	 	  	 	 
				
	 Rate Category

	  	Atlanta

	  	Central

	  	Southwest

	 LIM/RSM/Refugee
	  	 	  	 	 	  	 	 	  	 	 
	 	  	0 - 2 Months Male & Female	  	$	1,104.24	  	$	1,103.50	  	$	1,110.28
	 	  	3 - 11 Months Male & Female	  	$	177.85	  	$	207.41	  	$	227.72
	 	  	1 - 5 Years Male & Female	  	$	106.42	  	$	115.05	  	$	129.47
	 	  	6 - 13 Years Male & Female	  	$	101.41	  	$	105.43	  	$	117.05
	 	  	14 - 20 Years Female	  	$	166.58	  	$	163.17	  	$	186.23
	 	  	14 - 20 Years Male	  	$	116.04	  	$	100.47	  	$	119.13
	 	  	21 - 44 Years Female	  	$	227.50	  	$	257.47	  	$	280.71
	 	  	21 - 44 Years Male	  	$	255.65	  	$	280.71	  	$	273.03
	 	  	45+ Years Female	  	$	388.74	  	$	467.06	  	$	498.66
	 	  	45+ Years Male	  	$	515.63	  	$	556.30	  	$	566.88
					
	 PeachCare
	  	 	  	 	 	  	 	 	  	 	 
	 	  	0 - 2 Months Male & Female	  	$	181.55	  	$	187.38	  	$	190.06
	 	  	3 - 11 Months Male & Female	  	$	181.55	  	$	187.38	  	$	199.92
	 	  	1 - 5 Years Male & Female	  	$	109.87	  	$	 124.44	  	$	138.65
	 	  	6 - 13 Years Male & Female	  	$	131.20	  	$	135.94	  	$	152.27
	 	  	14 - 20 Years Female	  	$	156.06	  	$	163.26	  	$	181.89
	 	  	14 - 20 Years Male	  	$	144.31	  	$	139.60	  	$	149.64
					
	 Female Services
	  	 	  	 	 	  	 	 	  	 	 
	 	  	Breast and Cervical Cancer	  	$	1,756.82	  	$	1,606.62	  	$	1.637.93
				
	 Maternity and Delivery Services

	  	Unit Cost

	  	Unit Cost

	  	Unit Cost

	 Kick Payment
	  	 	  	$	5,796.83	  	$	5,759.46	  	$	5,709.09

  

			
	 Amendment #1
	  	Page 4 of 4
	 Contract #0653
	  	 
	 Peach State for Provision of Services to Georgia Healthy FamiliesSettlement & Release Agreement with Aurora Health Care, Inc.

 Exhibit 10.10 
  

					
	 STATE OF WISCONSIN
	 	CIRCUIT COURT	 	MILWAUKEE COUNTY

  
 AURORA HEALTH CARE, INC. 

a Wisconsin nonprofit corporation 
 3000 West Montana 
 Milwaukee, Wisconsin 53215, 
  
 Plaintiff, 
  

			
	v.	  	 Case No: 03-CV-004712
 Case Code:
30303

  
 MANAGED HEALTH SERVICES 
 INSURANCE CORPORATION 
 c/o Robert J. Johannes, MIBEF Corporate 
 Services, Inc. Registered Agent 
 100 East Wisconsin Avenue 
 Suite 3300 
 Milwaukee, Wisconsin 53202, 
  
 Defendant. 
  

  
 CONFIDENTIAL SETTLEMENT AND RELEASE AGREEMENT 
  

  
 This Settlement and Release Agreement (“Agreement”) is made this
31st day of August, 2005, between Aurora Health Care, Inc. of 3000 West Montana, Milwaukee, WI 53215 (“Aurora”) and Managed Health Services Insurance Corporation, 1205 S. 70th Street, Suite 500, West Allis, WI 53214-3167 (“MHS”).

  
 I. PURPOSE 
  
 This agreement is made as a compromise between the parties for the complete
and final settlement of their claims, differences, and causes of action with respect to the dispute described below. 
  
 II. STATEMENT OF DISPUTE 
  
 The litigation captioned Aurora Health Care, Inc. v. Managed Health Services Insurance Corporation, Circuit Court Case No. 03-CV-004712; Appeal Case No. 2005AP001202 (“the Action”) has been
fully and finally resolved between the parties through this Agreement. Both MHS and Aurora stipulate and agree that the Action will be dismissed with prejudice and without costs within two business days after receipt of the wire transfer Payment
described in Section 3 below (hereinafter, the “Effective Date”). 

 III. TERMS OF SETTLEMENT 
  
 In consideration of the mutual covenants set forth, the parties agree as follows: 
  
 A. MHS agrees to pay to Aurora $9,500,000, to be paid as a lump sum on or
before September 2, 2005 (the “Payment”). The Payment shall be made payable to Aurora Health Care, Inc. 
  
 B. The Hospital Services Agreement (“HSA”) between the parties continues to operate by its terms except as amended herein. MHS agrees to amend
the HSA with Aurora and its affiliated organizations to reduce the required Notice of Termination period from 120 days to 90 days. 
  
 C. The Payment encompasses and resolves all Aurora ambulatory surgery reimbursement claims under the HSA presently submitted to, and marked for payment by
MHS, through August 31, 2005 (the “Submitted Date”). For ambulatory surgery submissions thereafter, Aurora agrees to accept MHS’s ambulatory surgery reimbursement as modified by the lists attached hereto and made a part hereof as
Exhibits A and B, at the ambulatory surgery rate through the remainder of the current Hospital Services Agreement that expires on December 31, 2005 for (1) any procedure listed in Exhibit A; and (2) for any procedure listed in Exhibit
B and billed with a 360 revenue code. 
  
 D. Aurora agrees to
withdraw its Notice of Termination dated August 24, 2005 on the Effective Date. 
  
 E. MHS and Aurora agree to engage in good faith negotiations to arrive at a new, long term Hospital Services Agreement that will become effective January 1, 2006. Nothing in this Agreement required the parties to
reach agreement or continue any contractual relationship. 
  

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 F. Upon execution of a new Hospital Services Agreement, MHS and Aurora both agree to issue a joint press
release that will address the resolution of this litigation as well as the positive nature of any agreed ongoing relationship between MHS and Aurora. 
  
 G. Both MHS and Aurora, on the Effective Date shall authorize their respective counsel to execute and cause to be filed a stipulation and order dismissing
the action with prejudice and without costs or attorneys’ fees to any party. Both parties also agree to withdraw their respective pending appeals. 
  
 IV. EFFECT OF AGREEMENT 
  
 A. MHS and Aurora hereby release and discharge each other, and each other’s parent, subsidiaries and other affiliated entities, successors, assigns,
officers, directors, shareholders, members, employees, attorneys, and agents, from any and all claims, obligations, and liabilities which either party ever had, or now has against each other, known or unknown, arising in any way out of the Action as
stated by the parties in their respective Complaint; Amended Complaint; and Second Amended Complaint for Declaratory Relief; and responses thereto, including all claims for payment under the Hospital Services Agreement for ambulatory surgery
reimbursement through the Submitted Date. 
  
 B. This agreement
shall be binding on and inure to the benefit of MHS, Aurora, and their respective legal representatives, successors, and assigns. 
  
 C. This Agreement contains the full and complete agreement of the parties, and all other prior negotiations and agreements pertaining to such subject
matter are merged into this Agreement. Both MHS and Aurora hereby expressly disclaim reliance upon any facts, promises, undertakings or representations made by any other party or person, or such party or person’s agents, representatives or
attorneys, prior to the date of execution of this Agreement. No oral representations or understandings concerning the subject matter herein shall operate to amend, supercede, or replace any of the provisions of this Agreement. Each party to this
Agreement has 

  

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had the benefit of counsel of its own choice, has been afforded the opportunity to review this Agreement with its chosen counsel, and executes this Agreement
of its own free will for the purposes and considerations expressed herein. 
  
 Dated this 31st day of August, 2005. 
  

									
	 AURORA HEALTH CARE, INC.
	 	 	 	 MANAGED HEALTH SERVICES
 INSURANCE CORPORATION

					
	 By:
	 	 /s/ Donald Nestor
	 	 	 	 By:
	 	 /s/ James D. Donovan

	 Title:
	 	 EVP & CFO
	 	 	 	 Title:
	 	 Director

  

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