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BILLING SERVICES AGREEMENT <br />This Billing Services Agreement (the "Agreement") is made effective this ? day of <br />, 200_q, by and between LIFE FORCE MANAGEMENT, INC., an Ohio corporation <br />("Life Force"), with its principal office located at 9330 Market Square Suite 220, Streetsboro, Ohio 44241, and <br />Mayfield Village, 6622 Wilson Mills Rd, Mayfield Village. Ohio 44143 <br />WHEREAS, Life Force is a service company that provides billing and related services to providers <br />of ambulance services; <br />. WHEREAS, Client provides ambulance services and wishes to engage Life Force on an exclusive <br />basis to provide billing and related services to Client; <br />NOW, THEREFORE, in consideration therefore Life Force and Client hereby agree as follows: <br />SECTION 1- RESPONSIBILITIES OF LIFE FORCE. <br />A. Life Force shall perform billing and collection and related activities for all ambulance <br />services rendered by Client, collectively the "Ambulance Services." <br />B. Life Force shall establish, communicate to Client and monitor procedures for the <br />implementation of Life Force's billing for the Ambulance Services. Life Force shall <br />instruct Client and its employees on procedures and information to provide the <br />responsible party information to Life Force for the Ambulance Services as necessary <br />for Life Force's system of billing and collection. <br />C. Life Force shall prepare and submit initial claim forms for the Ambulance Services to <br />third-parly and governmental payors ("Payors") on a weekly basis and for self-pay <br />accounts on a monthly basis. <br />Commercial Payors. Life Force will bill Commercial Payors directly for the <br />Ambulance Services if it has received commercial insurance information <br />from Client. If Client was unable to obtain information at the time of the <br />Ambulance Services, Life Force will attempt to obtain insurance information <br />from the necessary responsible parties. Once sufficient information is <br />obtained to file a complete claim for the Ambulance Services, Life Force <br />will file the claim as follows : Electronic Submission/CT.S. Parcel Mail <br />Life Force shall rebill the Ambulance Services to Commercial Payors not <br />responding to initial claims at such times as Life Force deems appropriate <br />based upon experience with the particular payor. <br />22068/513664-1