Hospital/Group Application

ProMed Assistance Group will use its best efforts to find qualified CRNA (independent contractor) coverage for temporary needs for such time as both parties shall agree upon. Both parties understand that all CRNAs recommended to H/G are independent contractors and arein no way to be considered employees of the Finder. The independent CRNAs agree to belicensed in the state, in which they are working, and agree to provide all required professionalliability insurance. Finder will supply copies of all documentation required, including writtenand/or verbal references. Any cost for credentialing applicant, independent contractor, will bepaid by the hospital/group. Finder does not guarantee work performance. A writtenconfirmation is provided to the facility with each assignment. Any verbal agreement that isdifferent from this standard contract or pay schedule will be in written form via theconfirmation.

The Hospital/Group will pay to ProMed Assistance Group upon placement such amount as stated on the PAY SCHEDULE on the reverse side of this Contract, as well as the per diem and round-trip mileage or airfares for travel, unless otherwise arranged; as well as commercial ground travel or car allowance. Payment to ProMed Assistance Group is to be received within twenty (20) days of receipt of billing invoice via fax or email. If ProMed Assistance Group advancespayment to CRNA, this in no way constitutes an employee/employer relationship. Unless anending date was specified in the original agreement, the H/G must provide 30 days' writtennotice to cancel a temporary assignment, or be subject to terms of the Pay Schedule. Thisprovision shall also apply to pending assignments. If there are changes within the hospital administration or group over which ProMed Assistance Group has no control, the 30-day cancellation notice shall still apply.

The parties agree that the services provided herein shall be as an independent contractor, and accordingly, no employer-employee relationship shall be construed or created by this Agreement. Both parties agreed that the fees

Late charges shall accrue at 1-1.5% per month on any bill or charge referred to herein and not paid by the due date. If any past due account is referred for collection by or through an attorney, H/G agrees to pay all costs of collection, including reasonable attorney’s fees. Ahandling charge of $30.00 will be added for checks returned due to insufficient funds.

Nothing herein shall prevent H/G from using placement agencies in their search for anesthesia coverage. Please note: If Finder places a CRNA in H/G and H/G brings CRNA back, either on their own or through another agency, within 24 months following the last day of CRNAplacement with the H/G (from Finder); This action will result in a charge to H/G at Finder's standard hourly rate. If the CRNA were to return to work for the H/G permanently, the H/G will pay Finder a flatfee of $28,000.00. Such payment is due and payable on the starting date of the permanentstatus. This Contract contains the complete understanding between the parties, and shall bindand inure to the benefit of all parties, their successors, heirs and legal representatives.Amendment of the terms of this contract shall be invalid unless in writing and signed by allparties. All agreements and covenants herein are severable, and if any provision shall be held tobe invalid, this contract shall be interpreted as if such invalid agreements were not containedherein. This Agreement shall be construed and governed by the laws of the State of North Carolina.

The minimum daily guarantee shall be 8 continual hours per day, Monday through Friday (this does not include call back) unless otherwise negotiated. For example: 7:00 a.m. to 2:30 p.m. equals 8 hours. The minimum for any week will be 40 hours per week, excluding call and a minimum of 5 workdays each week unless otherwise negotiated at the time of ASSIGNMENT CONFIRMATION. A single day assignment or any assignment less than a week will be a guarantee of 8 hours per day unless negotiated prior to confirmation being faxed. Holidays that occur during a scheduled work week are payable by H/G even if the CRNA is not scheduled. This is a part of the contract, any changes with this or any other part of the pay schedule is to be negotiated with ProMed Assistance Group before the start date.

The weekend is the same rate with a minimum guaranteed eight (8) hours per day or billed actual hours worked, whichever is greater. These hours can be consecutive or nonconsecutive hours, with a minimum of one hour billed each call back, plus one surcharge hour per weekend day.

We do not have a higher rate for call back. The base rate is $ 140.00 per hour, with a minimum of one hour for each call back. In-house call is the base rate times the number of in-house hours.

A one-hour surcharge will be billed for beeper call. This is in addition to the actual call back time worked.

If the CRNA drives his/her own vehicle, a mileage allowance of $ .54 per mile (or current Federal gas allowance), round trip home and back one time along with $10.00 per day car allowance. If other types of travel (e.g. commercial) are necessary, the hospital/group is responsible for reimbursement upon receiving a copy of travel expense. Land transportation will also be provided for the CRNA by the hospital/group. Flight and Land Transportation would be approved by hospital/group prior to confirmation of assignment.

Lodging is to be provided by the hospital/group for the CRNA. The lodging must be acceptable to the CRNA. The lodging must be a private room with a private bath along with bath towels, washcloths, soap, shower, sink, water glass and access to ice, bed with clean linens, color TV and telephone will need to be addressed before the assignment. A good rule of thumb to follow — use lodging for the CRNA that you would choose for yourself or your family OR lodging allowance.

A per diem of $30.00 per day, including weekends and holidays, during the length of the assignment.

As stated in the contract, ProMed Assistance Group is to be paid directly within twenty (20) days of receipt of the billing invoice via fax, unless other arrangements are made prior to assignment. ProMed Assistance Group will work with you, the client, as to (possible change to: for) any special needs.