Resolution 2013-11-1 �.,�. RESOLUTION NO. 2013-11-1(R)
A RESOLUTION OF THE CITY COUNCIL OF THE CITY OF WYLIE,
TEXAS, HEREBY AUTHORIZING THE CITY MANAGER OF THE
CITY OF WYLIE, TEXAS, TO EXECUTE AN INDIGENT CARE
AFFILIATION AGREEMENT BETWEEN EAST TEXAS MEDICAL
CENTER AND THE CITY OF WYLIE.
NOW, THEREFORE, BE IT RESOLVED BY THE CITY COUNCIL OF THE
CITY OF WYLIE, TEXAS:
SECTION 1: The City Manager of the City of WYLIE, Texas, is hereby authorized to
execute, on behalf of the City Council of the City of WYLIE, Texas, an Indigent Care Affiliation
Agreement between the EAST TEXAS MEDICAL CENTER and the City of WYLIE, Texas.
SECTION 2: This Resolution shall take effect immediately upon its passage.
� RESOLVED THIS THE 28th day of May,2013.
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ERIC HOGUE, ay
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Resolution No.2013-11-1(R)—Indigent Care Affiliation Agreement
between the City of Wylie and the East Texas Medical Center Fage 1 of 1
.,,�,� INDIGENT CARE AFFILIATION AGREEMENT BETWEEN
CITY OF WYLIE AND
EAST TEXAS MEDICAL CENTER
This Indigent Care Affiliation Agreement (the Agreement) is entered into as of the
day of , 2013 (Effective Date), by and between City of
(the "Governmental Entity") and East Texas Medical Center (the "Affiliated
Hos�pital").
RECITALS:
WHEREAS, the Hospital and the Governmental Entity collectively provide a significant
amount of uncompensated care to the indigent annually in the communities they serve;
WHEREAS, reductions in reimbursement under the Medicaid program and the growing
unin,sured population have created a gap between the costs the Hospital incurs for treating
Meclicaid patients and the Indigent and the reimbursement the Hospital actually receives;
WHEREAS, the Governmental Entity and the Hospital recognize that the Indigent
num�bers in the Governmental Entity will continue to grow, and that the burden of providing
health care to the Indigent will continue to shift to the Hospital, the Governmental Entity, and the
local communities in the Governmental Entity;
WHEREAS, the Hospital and the Governmental Entity desire to collaborate to ensure
4 � that the Indigent have access to and receive quality health care services; and
WHEREAS, the Governmental Entity and the Hospital recognize that it is in their
mutual best interest and in the best interest of the Indigent population of the Governmental Entity
to increase Medicaid funding for the Medicaid population of the Governmental Entity and to
acce;ss local and federal funding to which the Hospital is entitled under the Section 1115
Demonstration Waiver for the Texas Healthcare Transfortnation and Quality Improvement
Pro�;ram (the Waiver Program);
WHEREAS, the Governmental Entity and Hospital recognize that they need to
coll��borate to ensure their ability to deliver health services to indigent patients in Governmental
Entity's community and to ensure the continued viability of the Governmental Entity's Medicaid
pro��iders;
WHEREAS, the Governmental Entity and Hospital intend this Agreement to satisfy the
lega.l and administrative requirements for participation in the Medicaid supplemental program
auth�orized under Waiver Program;
WHEREAS, there is no agreement between the Governmental Entity and Hospital that
conc�itions any amounts transferred by the Governmental Entity to fund supplemental Medicaid
pay�nents on the amount of indigent care Hospital has provided or will provide;
WHEREAS, there is no agreement between the Governmental Entity and Hospital that
conditions the amount of Hospital's indigent care obligation on the amount transferred by the
�`�'" Governmental Entity to fund supplemental Medicaid payments or on the amount of the
supplemental payment Hospital might receive;
INDIG�ENT CARE AFFILIATION AGREEMENT BETWEEN CITY OF WYLIE AND EAST TEXAS MEDICAL CENTER Page 1 of 11
WHEREAS, no escrow, trust, or other funding mechanism exists, the amount of which is .�,,,,
conditioned on the amount of indigent care services provided by Hospital, and any escrow, trust,
or other funding mechanism used in connection with an intergovernmental transfer by the
Governmental Entity has been disclosed to the state and is not used to effect a quid pro quo for
the provision of indigent care services by Hospital;
WHEREAS, the Governmental Entity has not received and will not receive refunds of
payr�ients the Governmental Entity has made or will make to Hospital for any purpose in
cons:ideration for an intergovernmental transfer made by the Governmental Entity to fiznd
supplemental Medicaid payments;
NOW, THEREFORE, in consideration of the promises and covenants contained in this
Agre:ement, and other good and valuable consideration, the receipt and adequacy of which are
hereby acknowledged and agreed, the parties agree as follows:
ARTICLE I
DEFINITIONS
1.1 State Fiscal Year means the twelve month period beginning September 1 and ending
August 31.
1.2 Health Care Services means primary and preventive services designed to meet the needs
of the community, including, without limitation: immunizations; medical screening
services and annual physical examinations; inpatient and outpatient hospital services;
rural health clinics; laboratory and x-ray services; family planning services; physician _...�.
services; payment for prescription drugs; skilled nursing facility services, regardless of a
person's age; and services that meet the District's criteria for indigent care provided
under Sections 61.028 and 61.0285 of Chapter 61 of the Texas Health and Safety Code.
1.3 Indigent means any person eligible to participate in a state Medicaid program, a county
program adopted under the Indigent Health Care and Treatment Act, as defined by the
eligibility criteria described in Chapter 61 of the TExAS HEALTx AtvD SaFETY CoDE, or a
hospital charity care program.
1.4 Indigent Care means treatment and services for the indigent, including inpatient and
outpatient hospital and medical professional services.
1.5 Waiver Program means the Section 1115 Demonstration Waiver for the Texas
Healthcare Transformation and Quality Improvement Program, under which the
Governmental Entity transfers Public Funds via intergovernmental transfer (IGT) to the
Texas Health and Human Services Commission (HHSC) to generate the non-federal
share of Waiver Program Payments, and the Hospital receives Waiver Program Payments
from HHSC.
1.6 Waiver Program Payments means any Medicaid payments received by the Hospital in
accordance with the Waiver Program.
1.7 Public Funds means public revenue, generated by the Governmental Entity, which the
Governmental Entity agrees to transfer in part to HHSC via lGT to serve as the non- �
federal share of Waiver Program Payments.
INDIGENT CARE AFFILIATION AGREEMENT BETWEEIY CITY OF WYLIE AND EAST TEXAS MEDICAL CENTER Page 2 of 11
��. ARTicLE II
COMMUNITY INDIGENT HEALTH CARE ASSESSMENT
2.1 Methodolo�v. Hospital shall collaborate with the Service Organization to develop a
process that solicits participation from the Governmental Entity, the community, and
other sources for assessing overall health care needs of the Governmental Entity and
specific unmet needs and needs of the uninsured, medically disadvantaged and the
indigent population in the Governmental Entity's service area and identifying options to
increase access to health care in the most cost efficient environment. The process shall
address at a minimum the following issues:
a. The volume and demographic make-up of the Governmental Entity Indigent
population;
b. Expenses incurred by Hospital and the Governmental Entity in providing care for
the indigent and the uninsured;
c. Community, state, and federal resources and assets available for the provision of
Indigent health care and uninsured;
d. Gaps in Indigent Care;
e. Barriers to health care access by medically disadvantaged, uninsured and
Indigents patients;
f. Opportunities for improving access to health care for all patients as well as
Indigents through participation in the 1115 Waiver supplemental payment
�,„, program.
2.2 Assessment. On at least an annual basis prior to the beginning of each state fiscal year or
within 90 days of the execution date of this agreement, if later, Hospital shall collaborate
with the Service Organization to develop an Indigent Health Care Assessment that
identifies existing health care services that Hospital, the Governmental Entity, and others
in the community have provided and gaps in available services.
ARTICLE III
REPRESENTATIONS AND WARRANTIES
3.1 Hospital's Representations and Warranties. The Hospital represents and warrants
that:
a. The Hospital is a Texas Corporation or partnership duly established and created
pursuant to applicable law with all requisite power and authority to enter into this
Agreement in all respects;
b. The execution, delivery, and performance by the Hospital of this Agreement are
within the Hospital's powers, and are not in contravention of any other
instruments governing the Hospital and have been duly authorized and approved
by the Hospital to the extent required by applicable law;
c. Neither the Hospital, nor any of their representatives are (i) currently excluded,
MY� debarred, or otherwise ineligible to participate in the Federal health care programs
as defined in 42 U.S.C. § 1320a-7b(� (the Federal health care programs); (ii)
convicted of a criminal offense related to the provision of health care items or
INDIGENT CARE AFFILIATION AGREEMENT BETWEEN CITY OF WYLIE AND EAST TEXAS MEDICAL CENTER Page 3 of 11
services but not yet excluded, debarred, or otherwise declared ineligible to ,,,�
participate in the Federal health care programs; or (iii) under investigation or
otherwise aware of any circumstances which may result in the exclusion of the
Hospital, or any of its representatives from participation in Federal health care
programs;
d. This Agreement has been duly and validly executed and delivered by the Hospital
and constitutes the valid, legal, and binding obligation of the Hospital,
enforceable against the Hospital in accordance with its terms;
e. No funds derived from any Waiver Program Payment received by the Hospital
have been or will be returned or reimbursed to the Governmental Entity;
f. No other funds have been used to reimburse the Governmental Entity in
consideration of any Waiver Program Payments paid to the Hospital;
g. The Hospital will not use any of the Waiver Program Payments to fund any
contingent fee arrangement or agreement or to pay for third-party consultant or
legal services;
h. The Hospital has not entered and will not enter into any agreement with the
Governmental Entity to condition either the amount of the Public Funds
transferred to HHSC via lGT by the Governmental Entity or the amount of
Waiver Program Payments the Hospital receives on the amount of indigent care
the Hospital has provided or will provide;
i. The Hospital has not entered and will not enter into any agreement with the �
Governmental Entity to condition the amount of the Hospital's indigent care
obligation on either the amount of Public Funds transferred by the Governmental
Entity to HHSC or the amount of Waiver Program Payments the Hospital may be
eligible to receive;
j. Neither the Hospital nor any other entity acting on behalf of the Hospital has
made or agreed to make cash or in-kind transfers to the Governmental Entity
other than transfers and transactions that:
(1) Are unrelated to the administration of the Waiver Program and/or the
delivery of indigent care services under this Agreement;
(2) Constitute fair market value for goods and/ar services rendered or
provided by the Governmental Entity to the Hospital; and
(3) Represent independent, bona fide transactions negotiated at arms-length
and in the ordinary course of business between the Hospital and
Governmental Entity; and
k. Neither the Hospital nor any other entity acting on behalf of the Hospital has:
(1) Taken assignment or agreed to take an assignment of a contractual or
statutory obligation of the Governmental Entity; or
(2) Authorized or consented to the assumption of a statutory or contractual `�"°
obligation of the Governmental Entity by the Hospital or any other entity
acting on behalf of the Hospital.
INDIGENT CARE AFFILIATION AGREEMENT BETWEEN CITY OF WYLIE AND EAST TEXAS MEDICAL CENTER Page 4 of 11
u».�4 3.2 Governmental Entitv Reqresentations and Warranties. The Governmental Entity
represents and warrants that:
a. It is a political subdivision of the State of Texas, duly established and created
pursuant to the Texas Constitution, with all requisite power and authority to enter
into this Agreement in all respects;
b. The execution, delivery, and performance by the Governmental Entity of this
Agreement are within the Governmental Entity's powers, are not in contravention
of any other instruments governing the Governmental Entity and have been duly
authorized and approved by the Governmental Entity Commissioners Court as
and to the extent required by applicable law;
c. Neither the Governmental Entity, nor any of its representatives are (i) currently
excluded, debarred, or otherwise ineligible to participate in the Federal health care
programs; (ii) convicted of a criminal offense related to the provision of health
care items or services but not yet excluded, debarred, or otherwise declared
ineligible to participate in the Federal health care programs; or (iii) under
investigation or otherwise aware of any circumstances which may result in the
exclusion of the Governmental Entity, or any of its representatives, from
participation in Federal health care programs;
d. This Agreement has been duly and validly executed and delivered by the
Governmental Entity and constitutes the valid, legal, and binding obligation of the
p�°°°° Governmental Entity, enforceable against the Governmental Entity in accordance
with its terms;
e. The Governmental Entity is legally authorized to and does receive ad valorem
taxes, generate public revenue, or receive and expend appropriated public funds
and will fund its obligations hereunder with such tax revenues;
f. The Governmental Entity has entered into this Agreement after a public meeting
held in compliance with the Texas Open Meetings Act in Chapter 551 of the
TExAS GovERN�vrENT CoDE at which a majority of the Governmental Entity
Commissioners Court voted to execute this Agreement;
g. The Governmental Entity has transferred or has agreed to transfer Public Funds to
HHSC via lGT for use as the non-federal share of Waiver Program Payments to
the Hospital in accordance the Waiver Program;
h. All transfers of Public Funds by the Governmental Entity to HHSC to support the
Waiver Program Payments to the Hospital under the Waiver Program comply
with:
(1) The applicable regulations that govern provider-related donations codified
at section 1903(w) of the Social Security Act (42 U.S.C. § 1396b(w)), and
Title 42, CoDE oF FEDERaL REGUr.aT�orrs, Part 433, subpart B, sections
433.52 and 433.54;
'°""' (2) The conditions approved by the federal Centers for Medicare and
Medicaid Services (CMS) for governmental entities' and private hospitals'
participation in the Waiver Program; and
INDIG�ENT CARE AFFILIATION AGREEMENT BETWEEN CITY OF WYLIE AND EAST TEXAS MEDICAL CENTER Page 5 of 11
(3) Such regulations established by HHSC pursuant to the Waiver Program; .,�
i. The Governmental Entity does not and will not at any time receive any part of the
Waiver Program Payments that are made by HHSC to the Hospital under the
Waiver Program;
j. The Governmental Entity has not entered into a contingent fee arrangement
related to the Governmental Entity's participation in the Waiver Program;
k. The Governmental Entity has not entered and will not enter into any agreement to
condition either the amount of the Public Funds transferred by the Governmental
Entity or the amount of the Waiver Program Payments the Hospital receive on the
amount of indigent care the Hospital has provided or will provide;
1. The Governmental Entity has not entered and will not enter into any agreement to
condition the amount of the Hospital's indigent care obligations on either the
amount of Public Funds transferred by the Governmental Entity to HHSC or the
amount of Waiver Program Payments the Hospital may be eligible to receive;
m. With regard to any escrow, trust or other financial mechanism (an Account)
utilized in connection with this Agreement or an IGT issued for a payment period
that occurs after the Effective Date of this Agreement, the following
representations are true and correct:
(1) The amount of any Account is not conditioned or contingent on the
amount of indigent care services that the Hospital provided or will ...._.
provide;
(2) The Governmental Entity has disclosed the existence of any Account to
HHSC; and
(3) Any such Account will not be used to affect a quid pro quo for the
provision of indigent care services by or on behalf of the Hospital;
n. The Governmental Entity has not received and will not receive refunds of
payments the Governmental Entity made or makes to the Hospital for any purpose
in consideration for an IGT of Public Funds by the Governmental Entity to HHSC
to support the Waiver Program Payments;
o. The Governmental Entity has not received and will not receive any cash or in-
kind transfers from the Hospital or any other entity acting on behalf of the
Hospital other than transfers and transactions that:
(1) Following the date this Agreement is executed, are unrelated to the
administration of the Waiver Program ar the delivery of indigent care
services under this Agreement;
(2) Constitute fair market value for goods or services rendered or provided by
the Governmental Entity to the Hospital; and
(3) Represent independent, bona fide transactions negotiated at arms-length
and in the ordinary course of business betweer� the Hospital and the �""
Governmental Entity; and
INDIGENT CARE AFF[LIATION AGREEMENT BETWEEN CITY OF WYLIE AND EAST TEXAS MEDICAL CENTER Page 6 of 11
,��� p. The Governmental Entity has not:
(1) Assigned or agreed to assign a contractual or statutory obligation of the
Governmental Entity to the Hospital or any other entity acting on behalf of
the Hospital; or
(2) Authorized ar consented to the assumption of a statutory or contractual
obligation of the Governmental Entity by the Hospital or any other entity
acting on behalf of the Hospital.
ARTICLE IV
OBLIGATIONS OF THE HOSPITAL
4.1 Agreement to Cooperate. The Hospital agrees to work cooperatively with the
Governmental Entity to improve access, availability, efficiency, delivery, and funding for
Health Care Services provided to the Indigent.
4.2 Provision of Care. The Hospital agrees to provide Health Care Services and meet all
requirements for treating the Indigent; provided, however, the Hospital shall not provide
Health Care Services for which the Governmental Entity has a continuing contractual or
statutory obligation to provide.
4.3 Reports to the Governmental Entity. To enable the Governmental Entity to perform its
retrospective evaluation of the Health Care Services under Section 4.2, the Hospital will
, � provide quarterly reports to the Governmental Entity regarding the amounts and types of
health care the Hospital has provided to the Indigent. The Hospital shall provide such
reports to the Governmental Entity within ninety (90) days after the end of each such
period.
4.4 Documentation of Health Care Services Provided. Hospital agrees to provide to the
Governmental Entity on a periodic basis, no more frequently than quarterly,
documentation of the amounts and types of healthcare services it has directly or indirectly
provided in the community.
4.5 Development of Community Indigent Care Assessment. Hospital shall participate in
the development the Community Indigent Health Care Assessment and provide any
required support for that purpose.
4.6 Supnort for Increased Medicaid Funding. Hospital agrees to work collaboratively
with the Governmental Entity to expand opportunities for Medicaid funding to which the
community is entitled.
ARTICLE V
OBLIGATIONS OF THE GOVERNMENTAL ENTITY
5.1 A�reement to Cooperate with the Hospital. The Governmental Entity agrees to work
cooperatively with the Hospital to improve access, availability, efficiency, delivery, and
°"�' funding for Health Care Services.
5.2 Funding Non-Federal Share of Private Hospital Medicaid UPL. The Governmental
Entity agrees that if it chooses to provide funding for the Medicaid 1115 Waiver
INDIG�ENT CARE AFFILIATION AGREEMENT BETWEEN CITY OF WYLIE AND EAST TEXAS MEDICAL CENTER Page 7 of 11
program, any funds it submits to the state for such funding will be from sources permitted „�,
by state and federal law and regulations and that the amount funded will not be
conditioned on a required amount of indigent care services from Affiliated Hospital.
5.3 Sunport for Increased Medicaid Fundin�. The Governmental Entity agrees to work
collaboratively with Affiliated Hospital to expand opportunities for Medicaid funding to
which the community is entitled.
5.4 Retrospective Evaluation of Services. Consistent with its constitutional, statutory and
fiduciary obligations, the Governmental Entity may retrospectively evaluate the amount
and impact of the Hospital's delivery of the Health Care Services and may rely on such
historical information in determining whether to continue this Agreement with the
Hospital, whether the Hospital's participation benefited the community, whether the
Hospital's continued participation is likely to continue to benefit the community and/or to
provide accountability to taxpayers.
ARTICLE VI
MISCELLANEOUS
6.1 Term and Termination. The term of this Agreement shall be one (1) year from the
Effective Date and shall automatically continue thereafter for additional terms of one (1)
year each, unless terminated in accordance with this Section 6.1. Either party may
terminate this Agreement with sixty (60) days advance written notice of termination.
6.2 Comnliance with HIPAA. To the extent applicable to this Agreement, the Hospital and �"
the Governmental Entity agree to comply with the Health Insurance Portability and
Accountability Act of 1996, as codified at 42 U.S.C. Section 1320d, et seq. (HIPAA) and
any current and future regulations promulgated thereunder, including, without limitation,
the federal privacy regulations contained in 45 C.F.R. Parts 160 and 164 (the Federal
Privacy Regulations), the federal security standards contained in 45 C.F.R. Parts 160, 162
and 164 (the Federal Security Regulations), and the federal standards for electronic
transactions contained in 45 C.F.R. Parts 160 and 162 (the Federal Electronic Transaction
Regulations), all as amended from time to time and, all collectively referred to herein as
HIPAA Requirements. The Hospital and the Governmental Entity agree not to use or
further disclose any Protected Health Information (as defined in the Federal Privacy
Regulations) or EPHI (as defined in the Federal Security Regulations), other than as
permitted by the HIPAA Requirements and the terms of this Agreement. In addition, the
Hospital and the Governmental Entity agree to comply with any state laws and
regulations that govern or pertain to the conf'identiality, privacy, security of, and
electronic transactions pertaining to, health care information.
6.3 Admission of New Affiliated Hospitals. Upon the prior written consent of Hospital, the
Governmental Entity may amend this Agreement to add one or more Hospitals. A copy
of any such amendment shall be provided to each party to this Agreement.
6.4 Withdrawal. Any party may terminate its participation in this Agreement by providing
sixty (60) days prior written notice to the other parties. So long as the Governmental �,
Entity does not elect to withdraw from this Agreement, its provisions shall continue for
INDIG'�ENT CARE AFFILIATION AGREEMENT BETWEEN CITY OF WYLIE AND EAST TEXAS MEDICAL CENTER Page 8 of 11
�.�. any remaining Hospital upon termination by a Hospital. In the event the Governmental
Entity elects to withdraw from this Agreement, the Agreement terminates immediately.
6.5 Chan�e in Law. If any provision of this Agreement or the plan to deliver health care
services pursuant to this Agreement is determined by the federal or state government or
by a court of law to be in violation of a federal or state law or regulation, or there is a
change in any state or federal law or regulation that adversely affects this Agreement,
then any party may propose by written notice a new basis for continuation of the
Agreement. If notice proposing a new basis for continuation of the Agreement is given
and the parties are unable to agree within thirty (30) days on a new basis for continuation
of the Agreement, any party may withdraw from the Agreement immediately upon
providing prior written notice to the other parties.
6.6 Access to Records. As and to the extent required by law, upon the written request of the
Secretary of Health and Human Services, the Comptroller General or any of their duly
authorized representatives, the Hospital or the Governmental Entity shall make available
those contracts, books, documents and records necessary to verify the nature and extent
of the costs of providing services under this Agreement. Such inspection shall be
available for up to four (4) years after the rendering of such services. If the Hospital or
the Governmental Entity carries out any of the duties of this Agreement through a
subcontract with a value of$10,000.00 or more over a twelve (12) month period with a
related individual or organization, the Hospital or the Governmental Entity agrees to
include this requirement in any such subcontract. This Section is included pursuant to
�'°' and is governed by the requirements of 42 U.S.C. § 1395x(v)(1) and the regulations
thereto.
6.7 Notices. All notices required or permitted hereunder shall be in writing and shall be
sufficiently given and deemed to have been received upon personal delivery, by
overnight carrier, ar by United States mail, postage prepaid, registered or certified mail,
addressed to the parties as follows:
If to Governmental Entity: City of Wylie
Attention: Mayor Hogue
300 Country Club Road
Wylie, TX 75098
If to Hospital: East Texas Medical Center
Attention: Byron Hale.
1000 South Beckham
Tyler, TX 75701
INDIGENT CARE AFFILIATION AGREEMENT BETWEEN CITY OF WYLIE AND EAST TEXAS MEDICAL CENTER Page 9 of 11
With copies to: Davis & Wright, P.C. ,.,�
Attention: Fletcher Brown
P.O. Box 2283
Austin, Texas 78768-2283
Discovery Healthcare Consulting Group
Attention: J. Brandon Durbin
2950 SOth Street
Lubbock, Texas 79413
6.8 Relationship between the Parties. The relationship between the Governmental Entity
and the Hospital is solely a contractual relationship between independent contractors.
Neither party hereto is an agent or employee of the other party.
6.9 Governing Law. This Agreement shall be governed by the laws of the State of Texas.
6.10 Venue. Venue for any action involving the Governmental Entity arising out of this
Agreement shall exclusively lie in State District Court in Fannin County, Texas.
6.11 Assignment. No party may assign any right, obligation, or responsibility under this
Agreement.
6.12 No Third Partv Beneficiarv. The parties to this Agreement do not intend to establish
any third party beneficiary relationships by virtue of this Agreement.
6.13 Entire Agreement. This Agreement represents the entire agreement and understanding `�"`
of the Parties hereto with respect to the subject matter hereof, and all prior and concurrent
agreements, understandings, representations and warranties with respect to such subject
matter, whether written or oral, are and have been merged herein and superseded hereby.
6.14 Counterparts. This Agreement may be executed in several counterparts, each of which
shall be deemed an original, but all of which together shall constitute one and the same
agreement, binding on all of the parties hereto. A facsimile copy or scanned image of an
executed, original counterpart shall be deemed for all purposes to be, and may be relied
upon as, an original, in which case each party shall immediately provide fully executed
originals to the others.
(Signature Page to follow)
INDIGENT CARE AFFILIATION AGREEMENT BETWEEN CITY OF WYLIE AND EAST TEXAS MEDICAL CENTER Page 10 of 11
w.�., IN WITNESS WHEREOF, the parties have executed this Indigent Care Affiliation
Agreement as of the date and year set forth above.
GOVERNMENTAL ENTITY
City of Wylie
Name: Eric Hogue
Title: Mayor
IN WITNESS WHEREOF,the parties have executed this Indigent Care Affiliation
Agr�eement as of the date and year set forth above.
AFFILIATED HOSPITAL
East Texas Medical Center
Byron Hale
Senior Vice President/CFO
INDIGENT CARE AFFILIAT[ON AGREEMENT BETWEEN CITY OF WYLIE AND EAST TEXAS MEDICAL CENTER Page 11 of ll