STATE OF MINNESOTA DISTRICT COURT

COUNTY OF RAMSEY SECO D JUDICIAL DISTRICT

Court File No. C5-05-10588

In the matter of Lake Region Healthcare Corporation AGREEMENT

WHEREAS, Lake Region Healthcare Corporation, along with other Minnesota health

systems, entered into an agreement with the Minnesota Attorney Genera l' s Office ("AGO") in

2005 relating to its patient bil ling and medical debt collection practices (the "Hospital

Agreement'');

WHEREAS, Lake Region Healthcare Corporation and the AGO renewed the Hospital

Agreement in 2007 and 2012 and now desire to renew the 201 2 Hospital Agreement;

NOW, THEREFORE, Lake Region Healthcare Corporation and the AGO agree as

follows:

The Hospital Agreement approved by the Ramsey County District Court on

September 12, 2012, Court Fi le o. C5-05- 10588, a copy ofwhich is attached hereto as Exhibit

A, shall continue in effect until July 1, 2022.

Dated: _ 5=--- _.._t-/ _- ...:..._/7_

Dated : oi/z?J/;7

LORI SWANSON Attorney General State of Minnesota

Assistant Attorney General

Lake Region Healthcare Corporation

~ ChiefExecutive Officer

STATE OF M£NNESOTA

COUNTY OF RAMSEY

SEP 1 2 2012

lky-Jii=-~

In the Matter of Lake Region Heallhcare Corporat ion

DISTRICT COURT

SECOND JUDICIAL DISTRICT

Court File No. CS-05-10588

AGREEMENT

WHEREAS, the Hospitals and Holding Companies named in this Agreement believe that

a hospital bill should never get in the way of a Minnesotan receiving essential health services;

and

WHEREAS, the Hospitals and Holding Companies named in this Agreement believe that

financial aid policies should be clear, understandable, and communicated in a dignified manner

and should be consistent with the mission and values of the hospital, taking into account each

individual's ability to contribute to the cost of his or her care and the hospital's financial ability to

provide the care; and

WHEREAS, the Hospitals and Holding Companies named in this Agreement believe t11at

debt collection policies - by both hospital staff and external collection agencies - should reOect

the mission and values of the hospital; and

WHEREAS, to convey this message to patients and the communities they serve, the

Hospitals and Holding Companies named in this Agreement entered imo an Agreement in 2005

and 2007 for purposes of memori alizing their desire to reform practices relating to collection of

medical debt and patient billing; and

WHEREAS, the Holding Companies and Hospitals set forth in this Agreement wish to

continue these policies and practices; and

EXHIBIT A

I NOW, THJt;REfORE, e Holding Companies and Hospitals named in this Agreement

sripula<e and agree ito ~e entry f the following Agreement

I I DEFINITIONS

A. The l tert "Chari y Care'' means the provision of free or discounte care ro a

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patient pursuant to r na cia! assi tance policies approved by the Hospital Board of Di ectors.

B. Thej ten "Holdi g Company" means the fo llowing parent organiza ions which I

are signatories to t~is greemen : Lake Region Healthcare Corporation and inclu es any free

standing physician Jclin,cs opera ed by those Holding Companies or their subsidiarie during the

term of thi s Agree~en , as well as all hospitals operated by those Holding Compan es. Un less

I otherwise indicated, fo purpose of this Agreement, the term "Hospital" is synonym

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term "Holding Co1~pan "and s all include all of the signatories to this Agreement. I

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C. The jte "Hospi I Board of Directors" shall mean the Board of Dire tors of the

particular Holding Co

• 1 LITIGATION PRACTICES , I

I. The iHot ital shall not give an y debt collection agency or attorney ny blanket

authorization to ta~e ltgal acti n against its patients for the collection of medica debt. The

Hospital shall not rk tny laws it against any panicular patient to collect medical ebt until a . I .

Hospital employee \witJ the app opriate level of authori ty authorizes the litigation aft r verifying

that: I 1

! a. Ther is a rea onable basis to bel ieve that the patient owes the debt

I b. Al l nown th1rd -party payors have been properly billed by the Ho pi tal. such

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1at any remaining debt is the financial responsibility of the patienl and

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provided that the Hospital shall not bi ll a patient for any amount that an

insurance company is obligated to pay;

c. Where the patient has indicated inabi lity to pay the full amount of the debt in

one payment, the Hospital has offered the patient a reasonable payment plan,

provided that the Hospital may require the patient to provide reasonable

verifi cation of the inability to pay the full amount of the debt in one payment:

d. The patient has been given a reasonable opportunity to submit an application

for Charity Care, if the facts and circumstances suggest that the patient may

be eligible for Charity Care, including, for example, if the patient is uninsured

or is on MinnesotaCare, Medical Assistance, or other relief based on need;

and

e. ln the case of a default judgment proceeding, verifying: that there is not a

reasonab le basis to believe: (i) that the patient may already consider that he or

she has adequately answered the complaint by calling or writing to the

Hospital, its debt collection agency, or its attorney; (ii ) that the patient is sick,

di sabled. in fi nn or so elderly so as to poten tially render the patient unable to

answer the complaint ; or (iii) the patient may not have received service of the

complaint.

2. The Hospital shall set forth in the policy developed pursuant to Paragraph 36(b)

of this Agreement the level of employee (i.e. supervisor, manager, Chief Financial Ofticer, etc.)

who is authorized to make the determinations required in the prior paragraph, which level may

vary based upon the amou nt of the debt.

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3. On rt 1 ast an a nual basis, the Hospital 's Chief Executive Offi cer hall review

and determ ine w~thj or not to issue to or renew any contract with any th ird party debt

collection attorney! I 1

detenni ing whether to issue or renew an y such contract, the Hospital

shall consider wh . herl the deb collection anorney has acted in a manner consistept wilh thi s

Agreement and with th Hospit 's mission and policies and applicable laws.

4. The jHo pita! sha I enter into a wntten contract directly wilh any atto ey or law

fi nn utilized by itl to ollect d bt from its pat ients and shall not subcontract or elegate the I

election of any tHi rd t collection attorney or law fi rm to its debt collect on agency. I l

Any contract betw~en e Hasp tal and the debt collection attorney or law firm shall require lhe I

attorney or law fmh to act in ac ordance with the terms of this Agreemenr , applicab e laws, and

the policies describbd i1 paragra h 36. i I I

5. The! Ho pita! s II not pay any debt collection attorney or Ia firm any

performance bonus, coqtingenc bonus, or other Similar payment which is calculated n the basis

not prohibit the Hpspi a! from paying an attorney a percentage of the debt coli ted from a I

particular patient, ~rO\ji ded tha the Hospital shall establish adequate contractual controls to i I

ensure that the attr rnt acts m a manner consistent wnh this Agreement and th Hospital 's

mission.

6. The I Ho pita!' General Counsel's Office or, if none exists, a Hospit I employee

w1th suitable experien e and a thority shall oversee the conduct of any third p l y attorney

retained by the H~sp i t l to col ect medi cal debt from its patients and shal l over. ee all debt

collection litigatiorl.

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7. The Hospital shall require that its third party debt collection attorneys take the

following actions with respect to the collection of medical debt from patients:

a. Fi le any lawsuits brought against the Hospital's patient for the collection of

medical debt with the applicable court no later than seven (7) days after the

lawsuit has been served upon the patient;

b. Sign and date all pleadings, including but not limited to all summonses and

complaints and garnishment summonses and related documents;

c. Ensure that all affidavits of service which purport to documem the service of

any pleading or legal papers state the following

(i) If the pleading is served by mai l, the affidavit of service shall state the

address to which it was mailed; and

(ii) If the pleading is served personally. the affidavit of service shall state the

name of the person to whom the pleading was del ivered . Generalized

statements, such as that the pleading was delivered to ·'a person of

suitable age," shall not suffice for purpose of this paragraph.

d. Serve along with any summons and complaint the form attached as Exhibit A,

or such other form approved in advance by the Anorney General's Office.

e. List in the case caption of all pleadings the county where the lawsuit is or will

be venued: and

f. The Hospital shall instruct its attorneys not to petition any court to have any

debtor arrested, or any arrest warrant or body attachment issued, or ro cause

such an action, as a resu lt of the debtor's failure to appear in court. to

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rm~lete pa rwork, or to otherwise respond to any request or at tion by the

r-Iost ital in c nnection with its efforts to collect medical debt from the patient.

8. If ilie H~spital h s knowledge of the identity of an attorney representi g a patient

in connection wi1 tht debt collection efforts. it shall not ify its third pany debt

I collection auomeyl la firm, nd agency of the identity of any attorney who re resents the

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patient. Neither t1e I ospital. or any debt collection agency or attorney retained by it, shall

directly contact ant pa .ient kno n to be represented by attorney with regard to the llection of

that debt without ~e pt mission of the patient's attorney.

I GARNISHMENTS I

9. The I Ho pita! sh II not give any debt collection agency or attorney ny blanket I

authori zation to pu~sue the gam shment of patients' wages or bank accounts. The H spital shall I

not authorize its 1ebt collectio agencies or attorneys to proceed with the garnis ment of a

particular patient's ranj account or wages until a Hospital employee wi th the appropr ate level of

authority authorizek th garnish ent for that particular patient after verifying that: I I

a. f hc I Hospital has no reasonable basis to believe that the patient s wages or

~n+ at a fi ancial insti tution are likely to be exempt from g rnishment.

I pucl infonn tion may include. but is not limited to. such factors as whether

~he !Patient is on Soc1al Security, :'viedical Assistance, or other reli f based on

hee~; b. ~he~e is a rej'onable basis to believe that the patient owes the deb :

c. f.,. tl ~nown third-party payors ha ve been properly billed by the H spital, such

that any re amwg debt IS the fi nancial responsi bility of the atient and

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provided that the Hospital shall not bill a patient for any amount that an

insurance company is obligated to pay;

d. Where the patient has indicated an inability to pay the full amount of the debt

in one payment, the Hospital has offered the patient a reasonable payment

plan, provided that the Hospital may require the patient to provide reasonable

verification of the inability to pay the full amount of the debt in one payment;

and

e. The patient has been given a reasonable opportunity to submit an application

for Charity Care, if the facts and circumstances suggest that the patient may

be eligible for Charity Care, including, for example, if the patient is uninsured

or is on MinnesotaCare, Medical Assistance, or other relief based on need.

10. The Hospital shall set forth in the policy developed pursuant to Paragraph 36 of

this Agreement the level of employee (i.e. supervisor, manager, Chief Fi nancial Officer, etc.)

who is authorized to make the detenni nations required in the prior paragraph, which le vel may

vary based upon the amount of the debt.

II . The Hospital shall not garnish the wages or bank account of any patient unless it

has first obtained a judgment against the patient in court for rhc amount of the debt.

12. The Hospital shall include with the initial notice it sends ro any patient of a

garnishment the form attached as Exhibit B, or such other form approved, in advance, by the

Attorney General 's Office.

13. If a patient submits a written claim that the patient's account or wages are exempt

from garnishment, the Hospital 's third party debt collection attorney shall not object to the claim

of exemption without receiving the specific, case-by-case approval of the Hospital's General

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counsel 's Office o~. if hone exi ts, a Hospital employee with sui table experience an8 authority. i I

In deciding wheth~r to ,grant su h approval in a particular case. the General Counsel's Office or

Hospital employed sh II revie ' all information submined by the patient in support of the I

patient's claim or ekem tion. I

I · COLLECTION AGENCIES , I

14 . On ft l~st an a nu al basis, the Hospital's Chief Executive Officer

determine whbthe~ or not to issue to or renew any contract with any third

all review

and party debt

collection agenc y. !In d termi ni g whether to issue or renew any such contract. the H spital shall

consider whether the debt co lection agency has acted in a manner consisten with this

Agreement and wil)J th Hospit 's mission and policies and applicable laws. I I

IS The!Ho ita! sha I enter into a wri tten contract with any collection age cy ut ilized I I

by it to collect de~ fr m its pa ients. The contract shall require the collection agcn y to act m

accordance with t~e t rm of is Agreement, applicable Jaws, and the policies escnbed In

i I paragraph 36 I I

16 The,Ho1pital sha I not refer any patient's account to a third party de t collection

agency unless the ~os~tal has c nfirmed that: i !

a. r he1e is a re onable basi s to believe that the patient owes the deb ;

b. All ~nown th rd-party payors have been properly billed by the H spttal, such

~at I any re aining debt is the financial responsibility of the patient and

rro1ded tha the Ho pital shall not bill a patient for any amo~t that an I .

lnsutance co pany is obligated to pay ;

c Wh re the pa ient has indica ted an inability to pay the fu ll amounL of the debt

in ope payment, the Hospital has offered the pallent a reasona~l e payment I

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plan , provided that the Hospital may require the patient to provide reasonable

verification of the inabil ity to pay the full amount of the debt in one paymem;

and

d. The patient has been given a reasonable opportun ity to submit an application

for Charity Care, if the facts and circumstances suggest that the patient may

be eligible for Charity Care, including, for example, if the patient is uninsured

or is on MinnesotaCare, Medical Assistance, or other relief based on need.

17. The Hospital shall set forth in lhe policy developed pursuant to Paragraph 36 of

this Agreement the process for satisfying the criteria required in lhe prior paragraph and the

person(s) accoun table for compliance with this agreement.

18. The Hospital shall not refer any medical debt to a third party debt collection

agency or artorney if the patient has made payments on that debt in accordance with the terms of

a payment plan previously agreed to by the Hospital.

19. rf a patient has submiaed an application for Charity Care after an account has

been referred for collection activity, the Hospital shall suspend all collection activity until the

patient's Charity Care application has been processed by the Hospita l and the Hospital has

notified the pat ient of its decision.

20. The Hospital shall not pay any debt collection agency any performance bonus,

contingency bonus. or other similar paymenr which is calculated on the basis of the amount or

percentage of debt collected from two or more patients. This paragraph shall not prohibit the

Hospital from paying a col lection agency a percentage of the debt collected from a pa.rlicular

patient, provided that the Hospi tal shall establish adequate contractual comrols to ensure that the

collection agency acts in a manner consistent with this Agreement and the Hospital's missiOn.

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2 I. The i Hojpital sh II require any thi rd pany debt collection agency a d attorney

util ized by it to ke~p a og of al oral and written complaints received by any patient concerning

! I the conduct of the ~ge~cy. urposes of this paragraph, a "complaint" is any co munication

from a patient or + ie 1t's repres ntati'e in which they express concerns about the cotduct of the

debt collection ag~ncy The H spital shall obtain a complete copy of the log at lfast six (6)

I times per year. Th~ H oncract with the debt collection agency shall state th t fai lure by

I the agency to log ~nd rovide II patient complaints in the manner required by thi paragraph

may result in tenn iratidm of the ospital's contract wi th the agency.

22. The! Hotpital sh II requi re any third party debt collection agency a d attorney

utilized by it to ket p a record 0 the date, time, and purpose of all communications t or from its

patients. ! / I

23. If a l pati~n t asks any thi rd party debt co llection agency or attorney fo the contact

informalion for th~ Htspita1, the Hospital shall instruct the agency or attorney to provide lhe I '

patient with the paone[ number and address described in Paragraph 28. The Hospi al shall not 1 1·

I I refuse to supply in om)ation to r speak with any of its patients on the basis that the account has

been placed wtth a th i r~ party d bt collection agency or attorney for collections.

I I 24. Th~ Hofp ital sh II train its outside debt collection agencies and au rneys about

the Hospital 's Chdrity I care po i~y and how a patient may obtain more informati n about the

Hospital's Charity Ca e policy or submit an appl ication for Charity Care. The

require its debt cpl le tion age 1cies and attorneys to refer patients who may be eligible for i

Charity Care to th1 Ho pita!.

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25. The Hospital shall include the fol lowing language on all collection notices sent to

patients by it or its third party debt collection agencies or attorneys, and on all cover letrers

serving all lawsuits and garnishment papers:

If you feel that your concerns have not been addressed, please contact ____ fi rst and all ow us the opportunity to try and address your concerns. If you continue to have concerns that have not been addressed, you may contact the Minnesota Attorney General's Office at 651-296-3353 or l-800-657-3787.

The Hospital shall print this language with the prominence required for notices under the federal

Fair Debt Collection Practices Act.

26. Neither the Hospital nor its debt collection agencies or attorneys shall report any

patient to a cred it reporting agency as a result of that patient 's failure to pay a medical bill.

CENTRAL BILLING OFFICE

27. The Hospital shall develop and implement policies and procedures to ensure the

timely and accurate submission of claims to third party payors. If the Hospital timely received

from a patient information about the patient's third party payor but does not timely submit a

claim to the thi rd party payor, the Hospital shall not bill the patient for any amount in excess of

that for which the patient would have been responsible had the thi rd party payor paid the claim.

The Hospital shall not refer any bil l to a third party collection agency or attorney for collection

activity whi le a clai m for payment of the bill is pending with a third party payor with which the

Hospital has a contract. The Hospital may refer a bill to a third party collection agency or

attorney fo ll owing an in itial denial of the claim by the third party payor. The Hospital shall not

refer any bi ll to a third party collection agency or auorney for collection activ ity when a claim is

denied by a third party payor due to the Hospital' s error. and such error results in the patient

becomi ng liable for tl1e debt when they would not otherwise be liable. The parties recognize

that. in order fo r the Hospital to properly bi ll a patient 's insurance company. the Hospi tal may

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need the patient's 4oop ration a d that the Hospital may not be able to properly bill ~he patient's ' I

insu rance compan~ w+out the atient's cooperation. in the event that the Hospital Believes that I 0

a private third parjy p~yor has mproperl y delayed or denied payment of a claim, ~e Hospital

i may file a comp .aint wirh th Minnesota Attorney General' s Office, which

assistance to the H~spi al or its atient in attempting to get the claim paid. I

28. Thel Ho pita! sh II develop a streamlined process for patients to uestion or I

dispute bills, inclu~ing a toll-fr e phone number patients may call and an address to which they

may write. The 1hon numbe and address shall be listed on all patient bills an collection

notices sent by thi Ho pital. !e Hospital shall return telephone calls made by pa ents to this

number as promp~ly a possibl , but in no event later than one business day afte the call is

received. The Ho~pi t I shall r spond to correspondence sent to this address by pat ems withi n I I

ten (I 0) days.

29.

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If J. . a patent I

the Hospital, its debt collection agency. or y attorney

utilized by the H~pit I that: ) the patient does not owe all or part of a bill, b) third party !

payor should pay tpe b ll. or c) e patient needs documentation concerning the bill , t e Hospital.

the collection age1cy, rnd its a tomey must cease funhe< collection effons Until the Hospital 0'

the agency providr t1e patien with documentation establishing that, as appl icable the patient

owes the debt or tijat t , e applic· ble third party payor has already paid all amounts f whtch n is I

obligated. The Hpspi al or th collection agency shall provide such documentatio in writi ng

within ten (10) dJys nd shall nor pursue fu rther collection activity for a period o thirty (30)

i days after providi!)g p oof that he debt is ov..-ed, so as to give the patient further o portunicy to

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i pay the bill or to ~all nge the ocumentation supplied by the Hospital. If the Hospital provides

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the required documenthtion and the patient does not respond within thirty (30) days, the Hospttal I

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may resume collecti on activity. This section should not be construed as preventing the Hospital

from addressing patient bi lling inquiries orally when appropriate.

30. The Hospital shall develop a system to record and log all patient complaints

received by its bi ll ing offices, includ ing at the locations identified in paragraph 28, regard ing the

collection of medical debt by the Hospital or its third party debt col lection attorneys or agencies.

The Hospital may maintain such records at more than one location.

BILLING TO THE UNINSURED

J l. If the Hospital demands that an uninsured patient pay a medical bill , upon request

by the uninsured patient, the Hospital shall provide to that patient a detailed, itemized bill.

32. The term "most favored insurer" means the nongovernmental third party payor

that provided the most revenue to the provider during the previous calendar year. The Hospital

shall not charge a patient whose annual household income is less than $125,000 for any

uninsured treatment in an amou nt greater than the amount which the provider would be

reimbursed for that service or treatment from its most favored insurer. The total charge for

uninsured treatment shall not be more than the provider would be reimbursed directly from its

most favored insurer and from that insurer' s policyholder under any applicable and allowable

copayments, deductibles, or coinsurance. The Hospnal shall apply the same percentage discount

to its charge description master for uninsured treatme nt that it would apply to charges incurred

by a policyholder of its most favored insurer. Beginning on the date of this Agreement. each

year the I Iospital and the Attorney General may agree in advance, by a confident ial letter

agreement, on the percentage discount from the charge description master that the Hospital

provides to its most favored insurer and which the Hospital shall provide for uninsu red treatment

under th is paragraph. The Hospital shall provide ro the Attorney General, pursuant to paragraph

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41 , any information r I

The Hospital shaili ut lize lhe

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the Attorney General for purposes of calculaung t1is discount.

same initial charge description master prices fo~ uninsured

treatment that it ut1~ize for trea ent provided to a policyholder of its most favored insurer. I

The term "~ nin ·ured tre trnent" means any treatment or services which are hot covered

I I by a plan, contract~ or ol icy w ich provides coverage to the patient through or is issued to the

patient by: (I) a "1ealt

(2) a self-funded e~pl yee bene

pany," as that term is defined in Minn. Stat. § 62Q.Pl, subd. 4:

t plan; (3) any governmental program, including buQ not limited

to MinnesotaCare, the Minnes ta Comprehensive Heal th AssociatiOn. Med1care, Medicaid, or

TriCarc; (4) any o er ype of h alth insurance, health maintenance, or health plan c verage, (5)

I any other type of i11surrce cov rage, including but not lim ited to no-faul t automobi e coverage,

workers' compen~atio 1 cover I ge, or liability coverage. l.n the event that tl e Hosp ital I !

madvertentl y send a ill to a atien t in excess of that which is allowed by this p ragraph 32

because the Hospital i not aw re that the treatment or service constitutes uninsure treatment.

and the Hospital tere fter lear s that the treatment or service constitutes uni nsure treatment,

the Hospital hall qro tly adju t its charge so as not to exceed the amount allowable under this I

paragraph 32. and 1he ~ospital all promptly notify the patient of the new amount o the bill.

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Th1 parag 1

aphtshall on apply to charges by or incurred at a facility dcfin d in Minn.

Stat. § 1-l-UO. subd. (20 10) or Minn . Stat. § 144.55. subd. 2 (2010). m<.: ludin those of a ' . i

provider who is e'npl yed by he Hospital when providing services to a patient t a faci lity

defined m Minn. Stat. 144.50 subd. 2 (20 I 0) and Minn. Stat. § 144.55, subd. 2 (10 10). This

paragraph shall o ly pply to edically necessary health care treatment and not o cosmeric

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procedures without an me 1cal necessny.

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33. In recognition that some patients express their financial concerns directly to their

u·earment prov iders (i.e. doctors, nurses, etc.), the Hospital shall trai n its staff responsible for

admi ssions, billing, and providing direct patient treatment, about the existence of the Hosp ital's

Charity Care policy and how a patient may obtain more information about the Hospital's Chari ty

Care policy or submit an application for Charity Care.

MISCELLANEOUS PROVISIONS

34. In the event that the Hospital concludes that any requirement of this Agreement is

no longer feasible, that the public may be better served by a modification of thi s Agreement, or

that it has evidence that the terms of this Agreement have caused those who can afford health

insurance coverage to vol untarily choose to go without it, the Hospital may request that the

Attorney General consent to a modifi cation of the terms of this Agreemenr. The Attorney

General shall make a good faith evaluation of the then-existing circumstances and, after

collecting information the Attorney General deems necessary, make a decision with in thirty (30)

days as to whether to consent to a modification of this Agreement.

35. The Hospital and its age nts shall not state or imply, directly or indirect ly. that the

State of Minnesota or the Attorney General' s Office has approved of, condones, or agrees with

any lawsu it, garnishment, or other attempt by the Hospital to collect debt from a patient.

36. The Hospital's Board of Directors shall adopt the following policies , which shall

not be inconsistent with this Agreement:

a. A zero tolerance policy fo r abusive, harassi ng, oppressive, fal se, deceptive, or

misleading language or collections conduct by its debt collection attorney and

agency, and their agents and employees, and Hospital employees responstble

for collecting medical debt from patiems;

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b. d bt collec ion li ti gation policy. which shall include a pol icy permitling the

~arryshmcnt f patient wages or accounts only after entry of a Judgment;

c. ~ p~Jicy est blishing the procedures to be utilized by the Hos ital'- thi rd I I

arty debt co lection agencies;

d. ~ policy e ablishing the procedures to be util ized by the I

emp~oyees w 0 partici pate in the collection of medical debt; and

e. l Jarity C re policy which takes into cons ide.ra tion the financi

~he vatient talpay a medical bill.

Hospital's

I ability of

37. The Ho pital's Board of Directors shall review. at least one time p r year. the I

Hospital's practice in e fo llowing areas:

a. rrlle fili ng of debt collection litigation against Hospital patients, iT eluding the

f patient wages or accounts subsequent to entry f a default

b. The, debt col~ection activity of its third party debt collection agcnc cs; I I

c. jThe,debt col ection activities of its internal debt collectors;

d. !The Hospital's compliance with this Agreement and the policies lescribed in I I

the reviews required by the Chief Executive Oftice: m

iPar graph 3 :

e. !The results of I

1Par*graphs 3 and 14 of this Agreement:

f. The1 results o the reviews required by Paragraph 38 of thi s Agree ent; and

g. Th~ Hospita 's Charity Care practices.

38 The Ho pita! sh II annually review rhe practice of irs third parry de 1 collection

agency and debt collection attorney, and its internal medical debt collection pracr~ces, at least

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one (I) time per year. The pUflJOSe is to review compliance with this Agreement and the

Hospital's pol icies.

39. This Agreemenr is not intended to assert, nor shall it be construed as, or deemed

to be, an admission or concession or evidence of any liabi lity or wrongdoing whatsoever on the

part of Hospital.

40. This Agreement shall remain in effect for five years after the entry of this

Agreement by the Court.

41. The Hospital shall cooperate wi th, respond to inquires o f, and provide information

to the Attomey General in a timely manner as necessary for the enforcement of thi s Agreement.

42. The Court shall rerajo jurisdiction to enforce the provisions of this Agreement.

43. The Hospital shall compl y with all applicable state and federal laws relating 10

bill ing and debt collection.

Dated: O'& lllo I ( (.. Lake Region Healtbcare Cofl)oration

By~-lrs: CEO

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Dated:

Dated:

STATE OF MINNESOTA Office of Attorney general

LORI SWANSON Accomey General State of Minnesota

445 Minnesota Street, Suite 1200 St. Paul, Minnesota 55101-2130 (65 1) 757-14 15 (Voice) (65 I) 296-1410 (TTY)

ATTORNEYS FOR STATE OF M

Based upo9 the above St pulation, IT [S SO ORDERED:

\./ BY THE COURT:

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ESOTA

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EXHIBIT A

[HOSPITAL NAME] Lawsuit Information Sheet

You are receiving this information sheer because you have been served with a Summons and Complaint (lawsuit) by [HOSPITAL NAME) (" "). [HOSPITAL NAME) cannot give you legal advice. Therefore, this document only provides basic information, and you should immediately discuss this matter with an attorney.

• Start of the Lawsuit. To start a lawsuir against you, [HOSPITAL NAME] has served a Summons and Complaint on you either: (a) by delivering it to you personally or leaving it at your home; or (b) by mail, if you agree in writing to accept ··service" of the Summons and Complaint by mail and sign a form that so indicates. The Summons infonns you that you must provide aformal, written Legal "answer" lO the complaint within 20 days after you receive the legal documents. The Complaint explains why fHOSPITAL NAME] is suing you and asks a court to make you pay money.

The Summons and Complaint may not include a court file number. They are, however, the lega l documents that begin the lawsu it. It is very important that yo u do not ignore the documents, or you will be in "defaul t." No court hearing is required for a default judgment to be entered against you if you do not respond to the Complaint .

• Answering a Complaint. The "Answer" is the fonnal legal name for your response to the Complaint. The Answer must meet certain requirements of the Minnesota Rules of Civil Procedure. Contacting [HOSPITAL NAME] or its attorney by telephone or written correspondence is not ((answering" th e Comp/oint. While [HOSPITAL NAME] encourages you to call if you have questions regard ing the bill that was sent to collections, doi ng so is nor a formal "Answer." Some court clerks have form ''Answers" which may be of assistance to you. You must serve a copy of your An wcr on [HOSPITAL NAME]'s attorney by majJ. fax , or hand delivery and complete an Affidavit of Service that explains who was served, how, and on what date. The Affidavit of Service form must be signed in front of a notary public or a court clerk. [f you want a judge ro hear the dispute, you should fi le the original Answer and Affidavit of Service with the coun in the county in which you are being sued after you have served your Answer on [HOSPITAL NAME]. You will be req uired to pay a court filing fee. (If you meet certain financial guidelines, however, you may not be requi red to pay the court fil ing fee. You may obtain more information regarding a waiver of the fee by contacting the clerk of coutt.)

• Failure to Ans·wer. If you do not ··answer" the Complaint, [HOSPITAL NAME] may get a "default" judgment entered against you requ iring you to pay money. By getting a default judgment. [HOSPITAL NAMEl may be able to iniuatc a separate garnishment action against you.

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i [H~SPITA NAME] Garnishment Information Sheet I .

You are redeivi g this information sheet because [HOSPITAL NAME] ("_1--_") has I

started a proce s tq get money from you by sending a •·garnishment summons" to a •· arnishee··--typicall y you r baqk o emplo~er. These proceedings are called "garni shmen t" roceedings. [HOSPITAL NA~E] cannot rovide you with legal advice. Therefore, th is do ument only provides basic inffn1a ion. Yo should immediately discuss this matter wllh an alto ey.

• Taking M ne) From our Wages. If [HOSPITAL NAME] is trying to from your wages y u shoul recei ve notice before your wages are garnishe · or taken. Generally, [HOSIUT L NAM ] cannot garnish more than 25% of your net wage , or any of your net wages if tpe~re less an $206 per week. Lf you have received public ass i tance based on need, [HOSPITA NAME cannot take any of your wages for 6 months after ou received the assistance, if yt u s bmit th proper paperwork on time. To claim that wages can ot be taken (i.e .. are ··exempt", y must p omptly return to [HOSPITAL NAME)' s attorney e "Debtor' s Exemption Claim !Not ce" that came with the "Garnishment Exemption Notice an Notice of Intent to Garnish ~am·ngs." alling [HOSPITAL NAME] is not sufficient. If [ OSPITAL NAME]' s attomex do s not re eive this exemption notice within 10 days, [Hospita Name] can seek co get mond fro your mployer. If [HOSPITA L NAME) d oes not agrc Lhat your wages are exempt, it ·an still eek to get money from your employer, and you will have to ask the court to d cidr that y r wages cannot be taken.

• Taking Mpne~ From our Bank Accounts. If [HOSPITAL NAME] is ying to take money from your pan~ account the bank will "freeze" enough money in your accou t to pay off your debt to [HO~PI'l'AL NA E]. You will not receive notice of the bank gam i hment until ajrer your funds qre [ready ozen. You will not have access to your f unds w ile they are frozen. Your chec~s m~y "bour ce," ~nd you may incur overdraft charges during thts time. You may want to conta t y~ur bank mmediately.

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If you deposit qual' ifie public ssistance checks (or wages if you are on or have rec~· ved publ ic assistance within he ast 6 m nths) in a bank account, [HOSPITAL NA MEl ca not garnish your account for 0 d ys, if Y<?U timely fill out the proper paperwork. To claim t at funds in your bank accoun~ ca o t be taken (i.e .. are ··exempt"). you must si1m and return wi hi n 14 days to the bank (and rtJ,o .. PITAL ~AME]' s attorney) the "Exempt ion Notice" (the for your bank sen! co you when lit r ceived Garnishment Summons from [HOSPJTAL NAM!j:)). Calling [HOSPITAL NA~E is not uffic ient. You may want to include copies of dodumcnts (i.e. benefi t letters, bank st tements, etc.) to show why your funds are exempt. If you do ' t claim an exemption within 14 days fr the date the bank mailed the exemption notic to you. the bank may turn ove your ozen funds to [HOSPITAL NAME]. If you o claim an exemption on time, th bank w II "unfreeze'' your funds and release them to you 1n days unless [HOSPITAL :"i~M •] "obj ts" to your "exemption clai m." If [HOSPIT L NA 1E] "objects." it musQ se d you a written ObJection to your exemption claim, along vith a fo rm entitled '·A Requdst f r Hcari o and Notice of Hearing." If [HOSPITAL NAM~] sends you this form, you must 1ll out a d file with the court the " Request for· Hearing•: form within 10 days of recciying the obj ction , or the bank can release your money to [f10SPITAL NAME]. 1

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