AHCC Contracts – please read, sign and print a copy for your files.
<h3>By Laws of Apollo Health Care Cooperative</h3>
<b>Section 1: BY-LAWS OF Apollo Health Care Cooperative (AHCC)</b>
The Association intends to enter into contracts on behalf of its members with health care providers to assure the quality and
availability of services to its membership.
Place of Meeting. AHCC location listed on enrollment application
Members’ List for Meeting. Association shall prepare an alphabetical list of the names of all Members prior to meetings.
Quorum. A majority of the votes entitled to be cast on a matter by a voting group, present in person or represented by proxy,
shall constitute a quorum.
Voting. Each Member Household shall be entitled to one (1) vote.
Proxies. Each Member may vote in person or by proxy.
Voting by Persons other than Members. Only members may vote either in person or by proxy given to another member or
to the Manager.
Manager’s powers shall be exercised under the authority of, and the direction of the Managers as elected by the members.
The Managers shall initially consist of the persons named in the articles of the Association. Thereafter, the managers shall
be elected from time to time by the Members. Each Manager shall hold office for six years until (i) the next annual meeting
of the Members after the expiration of the six year term and until that Manager’s successor is elected and qualified, or (ii)
the earlier death, resignation, removal or disqualification of a Manager.
Vacancies. Any vacancy occurring on the Manager Office for any reason may be filled by the affirmative vote of a majority
of the members. A Manager elected to fill a vacancy shall be elected for the unexpired term of the Manager’s predecessor in
Removal. The Manager may be removed, with or without cause, at a special meeting of Members called for that purpose, by
a vote of the majority of the shares then entitled to vote at an election of the Manager.
Organization. Meetings of the Manager and staff shall be presided over by the Manager, or in the Manager’s absence by the
next ranking officer. The secretary shall act as secretary of the meeting, but in the absence of the secretary, the person
presiding at the meeting may appoint any person to act as secretary of the meeting.
Compensation. Pursuant to membership resolution, Managers, as such, may receive such fees and other compensation for
their services as managers, including without limitation, their services as members of committees of the Managers and staff.
Executive Committee. The Managers, by resolution adopted by a majority of the members, may designate one or more of its
officer staff to constitute an executive committee or any other committee. Each committee shall have one or more members,
who serve at the pleasure of the Manager. If the Managers appoint an executive committee, the executive committee shall
have and may exercise all of the authority of the Manager when the Manager and staff officers are not in session.
Limits on Authority of Committees. No committee, including the executive committee, may do any of the following:
Authorize or approve distributions;
Approve or propose to Members actions that are required by law to be approved by Members;
Fill vacancies on the Manager or on any of its committees;
Amend articles of Organization;
Adopt, amend, or repeal By-laws; and
Approve a plan of merger not requiring Member approval.
OFFICERS. The Managers shall appoint a president and a secretary-treasurer.
Chief Executive Officer shall be the president and shall have the powers:
To act as the general manager and, subject to the control of the Managers, to have general supervision, direction and
control of the business and affairs of the Association;
To preside at all meetings of the Members and to preside at meetings of the Managers and staff;
To call meetings of the Members to be held at such times and, subject to the limitations prescribed by law or by
these By-laws, at such places as the chief executive officer shall deem proper;
To see that all orders and resolutions of the Managers are carried into effect;
To maintain records of and, whenever necessary, certify all proceedings of the Managers and the Members; and
To affix the signature of the Association to all deeds, conveyances, mortgages, guarantees, leases, obligations,
bonds, certificates and other papers and instruments in writing which have been authorized by the Manager or which, in the
judgment of the chief executive officer, should be executed on behalf of the Association; to sign certificates for the
Association’s shares; and, subject to the direction of the Manager, to have general charge of the property of the Association
and to supervise and control all officers, agents and employees of the Association.
Chief Financial Officer shall be the secretary-treasurer and the powers and duties shall be:
To keep accurate financial records for the Association;
To deposit all money, drafts and checks in the name of and to the credit of the Association in the banks and depositories designed by the Managers;
To endorse for deposit all notes, checks, drafts received by the Association as ordered by the Manager, making proper vouchers therefore;
To disburse corporate funds and issue checks and drafts in the name of the Association, as ordered by the Managers; and
To render to the chief executive officer and the Managers, whenever requested, an account of all transactions by the
chief financial officer and the financial condition of the Association.
A Manager or officer of the Association shall not be disqualified by the Manager’s office from dealing or contracting with the
Association either as a vendor, purchaser, or otherwise. The fact that any Manager or officer, or any firm of which any
Manager or officer of the Association is a Member, officer or Manager, is in any way interested in any transaction of the
Association shall not make such transaction void or require such Manager or officer of the Association to account to the
Association for any profits therefrom, provided that (a) the material facts of such transaction and the Manager’s interest are
disclosed to, or known by, the Managers or committee of the Managers at the time that the Manager or committee authorizes,
ratifies, or approves the transaction; (b) the material facts of such transaction and the Manager’s interest are disclosed to or known.
Monthly dues for each household in which there is a member are $15 per month for the new and renewal years. Dues
may be adjusted by the Manager with a majority approval of the membership in 2012 and yearly thereafter. There is a
one-time registration fee of $30 per household.
Name ______________________________________________________ Date ______________________
Signature ___________________________________________________ (parent sign for child under 18)
Witness’s Name ______________________________________________ Witness Signature _________________________________
AGREEMENT FOR PRIMARY CARE PHYSICIAN SERVICES PAYMENT PLAN
This Agreement for Primary Care Physician Services (hereinafter referred to as the “Agreement”) is made and entered into on the date the application was signed, by and between the named applicant and the named primary care provider.
PURPOSES OF THE PLAN
WHEREAS Patient wishes to be billed a preferred rate for the Physician’s services; WHEREAS Physician wishes to have a predictable source
of monthly income; WHEREAS Physician currently pays overhead for the submission of claims for payment and for efforts to collect payments not received at the time of service; WHEREAS physicians have traditionally accepted fees for parties who pay under preferred terms such as insurance and managed care companies; Therefore, premises considered, the parties agree as follows:
PHYSICIAN SERVICES PAYMENT PLAN (THE “PLAN”)
Patient will pay a yearly fee on an annual or monthly basis to be a member of the Plan. As a member, Patient is entitled to be billed
according to the Plan’s fee schedule (which is attached hereto) and to receive benefits listed upon the fee schedule without further charge.
AMENDMENTS & OPTING OUT
The fee schedule may need to be amended at a future date. Patient agrees that after notice of such amendment, Patient will be bound by
such amendment under the following terms. Physician agrees to notify Patient of any amendments to the fee schedule by mail at Patient’s last known address. Patient understands and accepts that it is their responsibility to inquire as to the most current fee schedule before services are rendered. The acceptance of services by Patient constitutes notice and acceptance of the current fee schedule. Upon notice of any amendments to the fee schedule, Patient may send notice in writing to Physician that Patient is opting out of the new fee schedule. When a Patient opts out of the new fee schedule, they will continue to be a member only until the end of the current term of the Agreement, and will be charged for services in accordance with the fee schedule in effect prior to the amendment. This Agreement is NOT INSURANCE. This Agreement DOES NOT PAY FOR HOSPITALIZATION nor any other service performed by anyone other than Physician or Physician’s staff, nor for any service performed any place other than at Physician’s office or personally performed by Physician at another facility. This Agreement only affects the price at which this Physician’s services are offered to this Patient while this Patient is a member of this Plan.
WARRANTIES AND LIMITATIONS
Physician will provide professional medical services for the Patient in a timely manner (which services include diagnosis, treatment, drug
prescription which is on the Physician’s formulary, well-person examination and tests at the Physician’ Patient will maintain sufficient funds on account and notify Physician’s agent of any change in banking information and will indemnify Physician for any and all banking charges for dishonored drafts, debits or any other charges resulting from insufficient funds being available in the designated account’s facilities that are within the scope of the Physician’s training and experience and which are usually performed in the Physician’s private practice). In this agreement “Physician” means a licensed health care provider who is an MD, DO, or Nurse-Practitioner and the person specifically named in the application.
If for any reason this Agreement violates any statute or law, or in the event the law changes in such a way as to make this Agreement illegal
or subject to additional regulation, either party may terminate this Agreement upon written notice. Should this Agreement be terminated for any reason, Patient understands that any damages for any liability that Physician may have to Patient or Patient’s estate under this Agreement, will be limited to the amount of membership fees paid during the current term of the Agreement. For any damages owed to Patient under this Agreement, Physician will be entitled to offset any such damages with the difference between fees for services charged at the preferred rate and the Physician’s customary rate for such services.
TERM AND RENEWAL
The term of this Agreement is one (1) year and it will automatically renew each year unless either party gives written notice by U.S.
certified mail return receipt requested, before the end of the current term. Either party may terminate this Agreement at will with proper written
notice at any time. If this Agreement is terminated by Physician, the outstanding balance of the yearly fee for the current term will be waived unless the Physician is terminating for failure of Patient to pay fees or charges owing under this agreement. If this Agreement is terminated by Patient, the outstanding balance of the yearly fee for the current term will continue to be owed.
No provision of this Agreement will be deemed waived by either party unless expressly waived in writing signed by the waiving party. No
waiver shall be implied by delay or any other act or omission of either party. Physician’s consent respecting any action by Patient shall not constitute a waiver of the requirement for obtaining Physician’s consent respecting any subsequent action.
ATTORNEY’S FEES, COUNTERCLAIMS AND VENUE
If Physician or any of its officers, directors, trustees, beneficiaries, partners, agents, affiliates or employees, shall be made a party to any
litigation commenced by or against Patient and are not found to be at fault, Patient shall pay all costs, expenses and reasonable attorney’s fees
incurred by Physician or any such party in connection with such litigation. Patient shall also pay all costs, expenses and reasonable attorney’s fees
that may be incurred by Physician in successfully enforcing this Agreement or in attempting to collect payment due under this Agreement. Any action or proceeding brought by either party against the other for any matter arising out of or in any way relating to this Agreement shall be heard, at Physician’s option, in the County where the Agreement was executed by the Physician.
Any notice which either party may, or is required to give, shall be given by mailing the same, postage prepaid, to Patient at his residence
listed on this document, or Physician at Physician’s office address, or at such other places as may be designated by the parties from time to time.
SURVIVAL OF OBLIGATIONS
All obligations (including indemnity obligations) or rights of either party arising during or attributable to the period prior to expiration or
earlier termination of this Agreement shall survive such expiration or earlier termination.
HEIRS, ASSIGNS, SUCCESSORS
This Agreement is binding upon and inures to the benefit of the heirs, assigns and successors in interest to the parties.
This Agreement shall be construed in accordance with the laws of the State and County in which the Agreement was executed by Physician.
This Agreement contains all the terms and provisions between Physician and Patient relating to the matters set forth herein and no prior or
contemporaneous Agreement or understanding pertaining to the same shall be of any force or effect. The signatures below attest to the fact that all
provisions have been read and fully understood by the parties prior to the signing of this Agreement.
CAPTIONS AND SEVERABILITY
The captions of the Articles and Paragraphs of this Agreement are for convenience of reference only and shall not be considered or referred
to in resolving questions of interpretation. If any term or provision of this Agreement or portion thereof shall be found invalid, void, illegal, or
unenforceable generally or with respect to any particular party, by a court of competent jurisdiction, it shall not affect, impair or invalidate any other terms or provisions or the remaining portion thereof, or its enforceability with respect to any other party.
Neither this Agreement, nor any term, provision, paragraph or article referenced above may be modified, except in writing signed by both
Patient agrees to pay a yearly membership fee on a monthly basis as shown on the attached fee schedule until this Agreement terminates
and fails to be renewed. Each yearly fee becomes fully owing at the beginning of the term. Patient agrees to make monthly membership fee payments by payroll deduction or by direct deposit as follows:
Patient authorizes Physician or its designated attorney-in-fact, Apollo Health Care Cooperative, to electronically draft my account or
charge my debit or credit card for my fees. The name of my bank or credit card company, its transit number and my account number are printed
below and I have attached a copy of a voided check as proof of my account and its proper numbers. I instruct the bank that I have named below to
honor checks drawn in the name of Physician or its designated agent acting as attorney in fact for Physician. And as a convenience to me to charge
my account and to pay their account the amount stated in the checks. This authorization is to remain in effect until revoked by me in writing and until you, the bank, actually receive notice, I agree that you shall be fully protected in honoring any such check or electronic debit. I agree that the bank’s treatment of each such check or debit shall be the same as if it were personally signed by me. I further agree that if any such check or debit is dishonored, whether with or without cause, the bank shall be under no liability. Physician or its designated agent is instructed to forward this
authorization to you, the bank named on the voided check provided by patient:
EVENTS UPON SIGNING OF AGREEMENT
Upon the signing of this Agreement, Patient must pay Physician the initial monthly fee specified above and must supply all information
required on the application that is with this document.
Signed this ___________________ day of ________________, 20____.
(Primary Care Provider)
Patient Full Name (Print)
Signatures of Patient _________________________________________
Address __________________________________________________ City _____________________State _____ Zip ___________
• Laboratory and diagnostic tests done by outside reference labs and facilities are not covered by this agreement and the cost of those
tests are to be paid directly to the Physician for payment to the lab based on the Lab’s fee agreement with the Physician’s clinic.