Loading...
HomeMy WebLinkAboutOrdinance 13667ORDINANCE NO. / ~ ~ ( ~ AN ORDINANCE AMENDING CHAPTER 5 OF THE CODE OF THE CITY OF FORT WORTH, "AMBULANCES/EMERGENCY MEDICAL SERVICES" BY ENACTING A NEW CHAPTER ESTABLISHING A REGULATED SOLE-PROVIDER AMBULANCE SERVICE SYSTEM ADMINISTERED BY THE AREA METROPOLITAN AMBULANCE AUTHORITY, AN AGENCY CREATED BY INTERLOCAL AGREEMENT, AND SUBJECT TO MEDICAL AND CLINICAL REGULATION BY THE EMERGENCY PHYSICIANS ADVISORY BOARD; PROVIDING FOR REPEAL OF CONFLICTING ORDINANCES; PROVIDING A SEVERABILITY CLAUSE; PROVIDING FOR PUBLICATION IN ACCORDANCE WITH STATE LAW; AND PROVIDING AN EFFECTIVE DATE. I. Ordinance Enacted. That Chapter 5 of the Code of the City of Fort Worth (1986), as amended, is hereby repealed and there is hereby enacted in lieu thereof a new Chapter, entitled "Ambulance/Emergency Medical Services", the text of which shall read as set forth in Exhibit "A", attached hereto and incorporated herein. II. Repealer Ordinances and any resolutions in conflict herewith are hereby repealed effective August 1, 1999 III. Severability It is the intention of this Jurisdiction that the separate provisions of this Ordinance and applicable Rules and Regulations shall be deemed independent of all other provisions contained herein and it is further intended that if any of the provisions of this Ordinance and/or Rules be declared invalid, all other provisions hereof and thereof shall remain valid and enforceable. IV. Publication. That the City Secretary of Fort Worth, Texas is hereby directed to publish the caption summarizing the purpose of this grdinance and the penalty clause prescribing the penalties for violation of this Ordinance in the manner provided by applicable state law V. Effective Date. This Ordinance shall be effective August 1, 1999 Secs.5-7--5-15. Reserved. ARTICLE II. EMERGENCY PHYSICIANS ADVISORY BOARD Sec. 5-16. Created. There is hereby created an emergency physicians advisory board (EPAB) which shall oversee and regulate on behalf of this city all medical aspects of the ambulance system which affect patient care. Sec.5-17. Membership. The EPAB shall consist of a board whose .membership shall be composed of licensed physicians as follows: (1) The medical director, or his designee; of each hospital emergency department which is located within the service area and which maintains an emergency medical services department staffed twenty-four (24) hours per day, seven (7) days per week by in-house physicians, all EPAB members shall be licensed physicians. (2) Five (5) additional licensed physicians with active specialties or sub- specialties of benefit in developing standards for emergency prehospital care, and who are appointed by and serve at the pleasure of the Tarrant County Medical Society The EPAB may, at its option, elect from among its members an executive board consisting of not less than seven (7) nor more than nine (9) physicians, which executive board shall exercise such powers and duties of EPAB as are set forth in written by-laws approved by atwo-thirds majority vote of the entire EPAB membership Sec. 5-18. Medical director The EPAB shall appoint a medical director who shall be responsible for the day- to-day affairs of the EPAB in carrying out its duties under this chapter The medical director shall be a licensed physician who is board-certified in emergency medicine. The medical director shall serve at the pleasure of EPAB Sec. 5-19. Powers and duties. The EPAB shall have the following powers and duties: (1) To recommend to the ambulance authority medically appropriate response time standards for this jurisdiction, (2) To establish standards for patient care, including standards for ambulance and first responder vehicles and on-board equipment; (3) To develop medical protocols for ambulance and first responder services and periodically revise same, (4) To develop communications center protocols and periodically revise same, (5) To conduct medical audits and develop standards and procedures for the conduct of such audits, (6) To develop and periodically revise and administer both written and practical tests for the certification and licensing of emergency medical services personnel, including ambulance personnel, first responders, and EMS communications center personnel, (7) To develop and periodically revise and administer educational material, programs and/or tests to ensure that base station physicians are knowledgeable of the local ambulance system, its medical protocols, radio procedures, and transport protocols; and to certify qualified physicians as base station physicians, (8) To conduct inspections of vehicles, equipment and supplies on both an announced and unannounced basis; (9) To monitor response time performance, in this regard, the ambulance authority shall furnish such statistical information regarding response time performance as may be requested by EPAB, (10) To develop standards and procedures for the resolution of disputes regarding the application of exemptions from late run penalties assessed against the ambulance service contractor for failure to meet response time standards, (11) To periodically conduct intensive reviews of the system's performance relative to specific clinical types and to revise medical protocols and such other standards of the system as may be appropriate in light of the findings; (12) To conduct medical audits of individual cases as requested by the ambulance authority, by any elected official of a member jurisdiction, by any licensed physician regarding a patient of such physician, or by any paramedic involved in the case which is the subject of the audit request; (13) To annually present a written and oral report to the ambulance authority concerning the state of clinical performance of the ambulance systems each member jurisdiction shall be informed of the time and place of such oral report at least thirty (30) days in advance of that meeting and shall be invited to send representatives, and shall be furnished a copy of the written report; (14) To establish such committees as may be necessary to aid in the performance of its powers and duties; (15) To approve standards governing the operation of specialized mobile intensive care units, including standards limiting the types of patients which may be transported thereby, and to issue, suspend, revoke and renew permits for the operation of such units as required by this chapter; (16) To approve standards governing the operation of aeromedical transportation units, including standards defining the circumstances under which such units may be deployed to emergency scenes, and to issue, suspend, revoke, and renew permits for the operation of such units as required by this chapter; and (17) To approve standards governing the operation of point-to-point wheelchair transport units, stretcher vans and other types of patient transportation, including standards limiting the types of patients which may be transported thereby, and to issue, suspend, revoke and renew permits for the operation of such units as required by this chapter Sec. 5-20. Fee payments; use of funds. For each patient transported by the ambulance authority or its contractor, and for each patient transported by ambulance by any other provider issued permits pursuant to this chapter, the transporting provider shall pay to EPAB a fee of five dollars and 10 cents ($5 10), which sum shall be used to defray the costs of medical regulation of the EMS system. Such payments shall be made monthly by the fifteenth day of each month for services rendered during the previous calendar month Such funds shall be maintained in a separate account administered by the ambulance authority on EPAB's behalf, and shall be expended solely for the purposes set forth in this article as approved by EPAB or its executive board This per-transport fee may be periodically increased at the discretion of EPAB, but not more often than annually, and no single increase may exceed five percent (5%). Sec. 5-21. Indemnification This jurisdiction shall indemnify and hold harmless EPAB, its members, its medical director, and EPAB staff members from liability for actual damage, including costs and attorney's fees, .arising from any claim, lawsuit, or judgment resulting from an act or omission of said EPAB member, the medical director, or EPAB staff member while acting in the scope and course of his office, provided that such liability arises out of or in connection with the provision of ambulance services or first responder services originating within the corporate limits of this jurisdiction. Secs.5-22--5-30. Reserved. ARTICLE III. AREA METROPOLITAN AMBULANCE AUTHORITY Sec. 5-31. General provisions. By adopting this chapter, and concurrently therewith executing and approving the restated interlocal cooperative agreement, there is hereby established an area metropolitan ambulance authority; which is herein called the "ambulance authority"; and in regard to that ambulance authority the following shall apply (1) The ambulance authority is hereby designated as the sole provider of all ambulance services within this jurisdiction pursuant to the terms, conditions and provisions of the restated interlocal cooperative agreement, except for those services exempted by section 5-4(6) (2) The ambulance authority shall comply with all terms of the restated interlocal cooperative agreement, and have all of the duties, powers and responsibilities enumerated therein (3) The ambulance authority is required to provide this jurisdiction with advanced life support ambulance service Such service shall comply with all applicable state laws and rules, as well as all rules, regulations, standards and response times as the ambulance authority or the EPAB may from time to time promulgate. EXHIBIT A Chapter 5 AMBULANCES/EMERGENCY MEDICAL SERVICES ARTICLE I. IN GENERAL Sec. 5-1. Statutory Authority This chapter is enacted by the City Council of Fort Worth, Texas, pursuant to Sec. 773 051 of the Texas Health & Safety Code, which provides that municipalities may establish standards for ambulances, and to Sec. 791 001 of the Texas Government Code which provides that combinations of local govemmental units may contract for the provision of govemmental services. Sec. 5-2. General purposes and intent of chapter. It is the purpose of this chapter (1) To establish a regulated ambulance service system which can provide state-of--the-art clinical quality of care, with reasonable, reliable response time standards, and with the goal of furnishing the best possible chance of survival, without disability or preventable complication, to each ambulance patient. (2) To establish asole-provider ambulance system, because it is unreasonable to have unnecessarily high rates and/or public subsidy to make needed improvements to ambulance service in the service area, when a more efficiently designed system can achieve the same results at lower cost. The most efficient design to achieve the goals ofhigh-quality service, at the lowest cost, consistent with the quality of care required, is the implementation of the system described herein (3) To provide more effective system performance through the provision of services by a competitively selected qualified private operator, rather than direct govemmental operation of ambulance services. (4) To provide more effective medical control by establishing amulti- jurisdictional emergency physicians advisory board (EPAB) and by empowering that board to oversee and regulate all clinical aspects of the emergency medical system which affect patient care Sec.5-3. Definitions For the purposes Qf this chapter, the following words and phrases shall have the meanings respectively ascribed to them by this section Advanced life support ambulance. Any vehicle which is equipped to provide treatment of life-threatening emergencies through the use of advanced airway management, intravenous therapy, and other advanced prehospital care procedures, and which is equipped to transport sick or injured persons to or from health care facilities. Approved rate schedule Those fees for ambulance services rendered which have been established for this jurisdiction by the ambulance authority from the uniform schedule of price/subsidy options. Area Metropolitan Ambulance Authority ("ambulance authority") That public administrative agency established to oversee the operation of the ambulance system established by this chapter Base station physician. A physician licensed to practice medicine in the State of Texas, knowledgeable in the prehospital emergency medical protocols, EMS radio procedure and the general operating policies of the ambulance system, and a person from whom ambulance .personnel may take medical direction by radio or other remote communications device. Contractor That person selected by the ambulance authority, pursuant to the request for proposal process, which is awarded the right to provide all ambulance services in this jurisdiction, except those specifically exempted by this chapter Emergency medical technician ("EMT") A person certified as an "emergency medical technician" as defined by Sec. 773 047, Texas Health and Safety Code EMS Communications Center The single facility designated by the ambulance authority as the central communications center from which all ambulances operating in the service area shall be dispatched and controlled Emergency physicians advisory board ("EPAB") The medical board created by this chapter and empowered to promulgate the various standards, rules and regulations related to clinical aspects of ambulance service and first responder and other services within the service area, and to perform medical audits and otherwise monitor system performance. First responder. Any person, fire department vehicle, police vehicle, or other vehicle not normally used for purposes of patient transport, but which vehicle and on-board personnel are capable of providing first responder services in medical emergencies. Aeromedical transportation unit. Any rotary wing aircraft providing basic or advanced life support services and patient transportation originating from the scene of emergency incidents which occur within the service area Medical audit. An official inquiry into the circumstances involving an ambulance run or request for ambulance service, conducted by the medical director or a licensed physician designated by the medical director Medical control Direction given ambulance personnel by a base station physician through direct voice contact, with or without vital sign telemetry, as required by applicable medical protocols promulgated by the EPAB, and by Sec.773 003(18), Texas Health and Safety Code Medical director The licensed physician appointed by the EPAB serving as administrative officer in carrying out the duties and powers of the EPAB Medical protocol Any diagnosis-specific or problem-oriented written statement of standard procedure, or algorithm, promulgated by the EPAB as the normal standard of prehospital care for a given clinical condition. Mutual aid agreement. A written agreement between the ambulance authority and one or more entities whereby the signing parties agree to provide backup ambulance service to one another under conditions and pursuant to terms specified in the agreement as approved by the ambulance authority Paramedic. A person qualified as a certified '"paramedic" as defined by Sec. 773.049, Texas Health and Safety Code. Patient. An individual who is ill, sick, injured, wounded or otherwise incapacitated and is in need of or is at risk of needing medical care during transport to or from a health care facility Person Any individual, firm, association, partnership, corporation, governmental entity, or other group or combination acting as a unit. Response time The actual elapsed time between receipt of notification at the EMS communication center that an ambulance is needed at a location within the service area and the actual arrival of an ambulance at that location. Restated Interlocal Cooperative Agreement ("Agreement") That contract adopted by this jurisdiction concurrently with the passage of this chapter, which contract is entered into by this jurisdiction pursuant to Chapter 791 of the Texas Government Code, more commonly known as the "Interlocal Cooperation Act." Senior paramedic in charge That person among the certified personnel assigned to an ambulance, not the driver, who is a certified paramedic designated as the individual in command of the ambulance Service area. That geographical area which is contained within the boundaries of all of the.jurisdictions which adopt this uniform EMS ordinance, and which adopt and execute the restated interlocal cooperation agreement implementing the ordinance, thereby becoming members of the ambulance authority Special event. Any public event located within the service area, for which standby ambulance service is arranged in advance, and for which an ambulance (or ambulances) is hired by the sponsor of the event or other interested party Specialized mobile intensive care unit. A vehicle which is specially constructed, equipped, staffed, and employed in the interfacility transport of patients whose requirements for enroute medical support are likely to exceed the clinical capabilities of an advance life support ambulance. Wheelchair transport service The transportation of a person (not a "patient" as defined herein) who is situated in a wheelchair and is capable of sitting in said wheelchair for at least one hour, where no treatment is required or expected in route, and where the person and transporting vehicle have no medical equipment that requires adjustment or monitoring Sec.5-4. Violations. It shall be unlawful.. (1) To perform duties as an ambulance driver, attendant (EMT or paramedic), or EMS dispatcher without a current certification issued by the EPAB, (2) To permit a person to work as an ambulance driver, attendant or EMS dispatcher without a current license issued by the EPAB, (3) To use, or cause to be used, any ambulance service other than that of the contractor authorized to operate in this jurisdiction by virtue of its contract with the ambulance authority, except those services described in subsection (6) of this section 5-4, (4) For any person, firm or organization to provide ambulance service within this jurisdiction, other than the contractor which contracts with the ambulance authority; or to provide point-to-point wheelchair transport, or stretcher van or other patient transportation services to or from health care facilities, aeromedical transportation unit services, or specialized mobile intensive care services except in accordance with EPAB regulations governing the delivery of such services, and then only pursuant to a permit issued by EPAB for the operation of such units; or to provide first responder services without a first responder permit issued by EPAB All such special permits when issued by EPAB shall be valid for a period of two years, and then shall be subject to provisions governing renewal, such provisions to be developed by EPAB Holders of such permits shall comply with requirements for payment of permit fees as set forth in this chapter; or (5) To knowingly give false information to induce the dispatch of an ambulance or aeromedical transportation unit; (6) It shall be a defense to any alleged violation of this section 5-4 that the vehicle is being used solely in any of the following manners. a. A privately owned vehicle not ordinarily used in the business of transporting persons who are sick, injured, wounded, incapacitated or helpless. b A vehicle rendering service as an ambulance in the event of a major catastrophe or extreme .system overioad.when such condition is declared by the medical director, the executive director ofi the ambulance authority, or by an authorized representative of the ambulance authority's contracted ambulance service provider, and such assistance has been requested by the communication center c. Any ambulance owned or operated by the federal or state government. d Any transport to a location within the service area, which transport originated from a point outside the service area. e. Mutual aid calls when rendered pursuant to a mutual aid agreement approved by the ambulance authority f Special events coverage, so long as such service is provided without charge by an emergency medical services volunteer provider, as defined in section 773 003(13) of the Texas Health .and Safety Code. g Wheelchair transport services which are not provided on a point-to-point basis, but which provide pickup and delivery by way of regularly scheduled routes. h. Medical transports by aeromedical where such transports originate outside the service area or at a hospital location within the service area. Sec.5-5. Penalties. The following provisions for application of penalties .for violation of this chapter shall apply < (1) Any person convicted of violating the provisions of this chapter shall be fined no more than five hundred dollars ($500 00). This does not serve to limit any other remedies available to this jurisdiction in law or equity (2) Each violation of this chapter that is committed shall constitute a separate offense Sec. 5-6. Traffic laws; exemption. When the ambulance vehicle operator has reasonable grounds to believe that an emergency exists, as determined by the EMS Communication Center, the ambulance vehicle operator may; (1) Park or stand, irrespective of the otherwise applicable provisions of law, ordinance or regulations, (2) Proceed past a red or stop signal or stop sign, but only after slowing down as may be necessary for safe operation, (3) Exceed the maximum speed limits permitted by law, ordinance or regulation, provided, however, that life and property are not endangered thereby; (4) Disregard laws, ordinances and regulations governing directions or movements or turning in specified directions, (5) Provided, however, that any exemption herein granted shall apply only when such ambulance is operating with siren and emergency lights in operation, and when such audible and visual signals meet the requirements of law, ordinance or regulation, and provided further, that the foregoing provisions shall not operate to relieve the ambulance vehicle operator from the duty to drive with due regard for the safety of all persons, nor shall such provisions protect the driver from the consequences of his reckless disregard for the safety of others APPROVED AS TO FORM AND LEGALITY: ~i',t:l~ Assistant City Attorney ADOPTED: ~a - /S_ 9~ ~XHISIT A. 1UNIFORM Eli/IS ®RDINANCE Be it ordained by the City Council of FORI 1l~loRTH , Texas: SEC. 1 STATUTORY AUTHORITY. This Ordinance is enacted by the City Council of ~ o~ UJoa-n+ , Texas, pursuant to Sec. 310, Art. 44470 Texas Civil Statutes, which provides that local governmental units may establish standards for ambulances, and to Sec. 4(a), Art 4413(32c) Texas Civil Statutes which provides that combinations of local governmental units may contract for the provision of governmental services. SEC. 2 GENERAL PURPOSES AND INTENT OF ORDINANCE. It is the purpose of this Ordinance• A. To establish a regulated ambulance service system which can provide state-of-the-art clinical qual~.ty of care, with reasonable, reliable response time standards, and with the goal of furnishing the best possible chance of survival, without disability or preventable complication, to each ambulance patient. B. To establish asole-provider ambulance system, because it is unreasonable to have unnecessarily high rates and/or public subsidy to make needed improvements to ambulance service in the Service Area, when a more efficiently designed system can achieve the same results at lower cost. The most efficient design to achieve the goals of high-quality service, at the lowest cost, consistent with the quality of care required, is the implementation of the system described herein. (Exhibit A. Uniform EMS Ordinance, cont....) C. To provide more effective system performance through the provision of services by a competitively selected qualified private operator, rather than direct governmental operation of ambulance services. D. To provide more effective medical control by establishing a multi-jurisdictional Emergency Physicians Advisory Board (EPAB) and by empowering that Board to oversee and regulate all clinical aspects of the emergency medical system which affect patient care. SEC.3 DEFINITIONS. For the purposes of this chapter, the following words and phrases shall have the meanings respectively ascribed to them by this section: A. Advanced Life Support Ambulance. Any vehicle which is equipped to provide treatment of life-threatening emergencies through the use of advanced airway management, intravenous therapy, and other advanced prehospital care procedures, and which is equipped to transport sick or injured persons to or from health care facilities. B. Approved Rate Schedule. Those fees for ambulance services rendered which have been established for this Jurisdiction by the Ambulance Authority from the Uniform Schedule of Price/Subsidy Options. C. Area Metropolitan Ambulance Authority ("Ambulance Authority"). That public administrative agency established to oversee the operation. of the ambulance system established by this Ordinance. 2 D. Base Station Physician. A physician licensed to practice medicine in the State of Texas, knowledgeable in the (Exhibit A. Uniform EMS Ordinance, cont....) prehospital emergency medical protocols, EMS radio procedure and the general operating policies of the ambulance system, and a person from whom ambulance personnel may take medical direction by radio or other remote com- munications device. E. Contractor. That person selected by the Ambulance Authority, pursuant to the Request for Proposal process, which is awarded the right to provide all ambulance services in this Jurisdiction, except those specifically exempted by Section 6F of this Ordinance F . Emergency Medical Technician (EMT). An individual who is a "specially skilled emergency medical technician" under Sec. 1.03 (10) of Art. 44470, Texas Civil Statutes. G. EMS Control Center or Control Center. The single facility designated by the Ambulance Authority as the central communications center from which all ambulances operating in the Service Area shall be dispatched and controlled. H. Emergency Physicians Advisory Board ("EPAB"). The medical board created by this Qrdinance and empowered to promulgate the various standards, rules and regulations related to clinical aspects of ambulance service and first responder services within the Service Area, and to perform medical audits and otherwise monitor system performance I. First Responder. Any person, fire department vehicle, police vehicle, or other vehicle not normally used for purposes of patient transport, but which vehicle and on-board personnel are capable of providing first responder services in medical emergencies. 3 J. Helicopter Rescue Unit. Any rotary wing aircraft , providing basic or advanced life support services and patient (Exhibit A. Uniform EMS Ordinance, cont....) transportation originating from the scene of emergency incidents which occur within the Service Area. K. Interlocal Cooperative Agreement ("Agreement"). That contract adopted by this jurisdiction concurrently with the passage of this Ordinance, which contract is entered into by this Jurisdiction pursuant to Art 4413(32c) Texas Civil Statutes more commonly known as the "Interlocal Cooperation Act." L. Medical Audit. An official inquiry into the circumstances involving an ambulance run or request for ambulance service, conducted by the Medical Director or a licensed physician designated by the Medical Director M. Medical Control. Direction given ambulance personnel by a base station physician through direct voice contact, with or without vital sign telemetry, as required by applicable medical protocols promulgated by the EPAB, and by Sec. 10.3(19), Art. 44470, Texas Civil Statutes N. Medical Director. The licensed physician appointed by the EPAB serving as administrative officer in carrying out the duties and powers of the EPAB. O. Medical Protocol. Any diagnosis-specific or problem- oriented written statement of standard procedure, or algorithm, promulgated by the EPAB as the normal standard of prehospital care for a given clinical condition. P. Mutual Aid Agreement. A written agreement between the Ambulance Authority and one or more entities whereby the signing parties agree to provide backup ambulance service to one another under conditions and pursuant to terms specified in the agreement as approved by the Ambulance Authority. 4 (Exhibit A. Uniform EMS Ordinance, cont....} Q. Paramedic. A person qualified as a certified "paramedic emergency medical technician" as defined by Sec. 103(11) of Axt 44470, Texas Civil Statutes. R. Patient. An individual who is ill, sick, injured, wounded or otherwise incapacitated and is in need of or is at risk of needing medical care during transport to or from a health care facility S. Person. Any individual, firm, association, partnership, corporation, governmental entity, or other group or combination acting as a unit. T. Response Time. The actual elapsed time between receipt of notification at the EMS Control Center that an ambulance is needed at a location within the Service Area and the actual arrival of an ambulance at that location. U. Senior Paramedic in Charge. That person among the certified personnel assigned to an ambulance, not the driver, who is a certified paramedic designated as the individual in command of the ambulance. ~T. Service Area. That geographic area whic~t is contained within the boundaries of all of the jurisdictions which adopt this Uniform EMS Ordinance, and which adopt and execute the Interlocal Cooperation Agreement implementing the Ordinance, thereby becoming members of the Ambulance Authority. W. Special Event. Any public event located within the Service Area, for which standby ambulance service is arranged in advance, and for which an ambulance (or ambulances) are hired by the sponsor of the event or other interested party. 5 ~C. Specialized Mobile Intensive Care Unit. A vehicle wluch is specially constructed, equipped, staffed, and employed in the (Exhibit A. Uniform EMS Ordinance, cont....) interfacility transport of patients whose requirements foI• enroute medical support are likely to exceed the clinical capabilities of an advanced life support ambulance. SEC. 4 EMERGENCY PHYSICIANS ADVISORY BOARD (EPAB). There is hereby created an Emergency Physicians Advisory Board which shall oversee and regulate on behalf of this city all medical aspects of the ambulance system which affect patient care A. The EPAB shall consist of a board whose membership shall be composed as follows• (1) The medical director, or his designee, of each hospital emergency department which is located within the Service Area and which maintains an emergency medical services department staffed twenty-four (24) hours per day, seven (7) days per week by in-house physicians; all EPAB members shall be licensed physicians, preferably engaged in the full-time practice of emergency medicine; and, (2) Five (5) additional licensed physicians with active specialties or sub-specialties of benefit in developing standards for emergency prehospital care, and who are appointed by and serve at the pleasure of the Tarrant County Medical Society. (3) The EPAB may, of its option, elect from among its members an Executive Board consisting of not Iess than seven nor more than nine physicians, which Executive Board shall exercise such powers and duties of EPAB as are set forth in written by-laws approved by atwo-thirds majority vote of the entire EPAB membership 6 (Exhibit A. Uniform EMS Ordinance, cont....) B. The EPAB shall appoint a Medical Director who shall be responsible for the day-to-day affairs of the EPAB in carrying out its duties under this Ordinance. The Medical Director shall be a licensed physician who is board-certified in emergency medicine. The Medical Director shall serve at the pleasure of EPAB. C. The EPAB shall have the following powers and duties: (1) To recommend to the Ambulance Authority medically appropriate response time standards for this Jurisdiction; (2) To establish standards for patient care, including standards for ambulance and first responder vehicles and on-board equipment, (3) To develop medical protocols for ambulance and first responder services and periodically revise same, (4) To develop control center protocols and periodically revise same; (5) To conduct medical audits and develop standards and procedures for the conduct of such audits; (6) To develop and periodically revise and administer both written and practical tests for the certification and licensing of emergency medical services personnel, including ambulance personnel, first responders, and EMS control center personnel, (7) To develop and periodically revise and administer educational material, programs and/or tests to insure that base station physicians are knowledgeable of the local ambulance system, its medical protocols, radio 7 (Exhibit A. Uniform EMS Ordinance, cont....) procedures, and transport protocols; and to certify qualified physicians as base station physicians; (8) To conduct inspections of vehicles, equipment and supplies on both an announced and unannounced basis, (9) To monitor response time performance, in this regard, the Ambulance Authority shall furnish such statistical information regarding response time performance as maybe requested by EPAB, (10) To develop standards and procedures for the resolution of disputes regarding the application of exemptions from late run penalties assessed against the ambulance service contractor for failure to meet response time standards, (11) To periodically conduct intensive reviews of the system's performance relative to specific clinical types and to revise medical protocols and such other standards of the system as may be appropriate in light of the findings; (12) To conduct medical audits of individual cases as requested by the Ambulance Authority, by any elected. official of a member jurisdiction, by any licensed physician regarding a patient of such physician, or by any paramedic involved in the case which is the subject of the audit request; (13) To annually present a written and oral report to the Ambulance Authority concerning the state of clinical performance of the ambulance system; each member jurisdiction shall be informed of the time and place of such oral report at least 30 days ~n advance of that 8 (Exhibit A. Uniform EMS Ordinance, cont....) meeting and shall be invited to send representatives, and shall be furnished a copy of the written report; (14) To establish such committees as may be necessary to aid in the performance of its powers and duties, (15) To approve standards governing the operation of specialized mobile intensive care units, including standards limiting the types of patients which may be transported thereby, and to issue, suspend, revoke, and renew permits for the operation of such units as required by this Ordinance, (16) To approve standards governing tl~e operation of helicopter rescue units, including standards defining the circumstances under which such units maybe deployed to emergency scenes, and to issue, suspend, revoke, and renew permits for the operation of such units as required by this Ordinance, and, (17) To approve standards governing the operation of point-to-point wheelchair transport units, including standards limiting the types of patients which may be transported thereby, and to issue, suspend, revoke, and renew permits for the operation of such units as required by this Ordinance. D For each patient transported by the Ambulance Authority or its contractor, and for each patient transported by other providers issued permits pursuant to this Ordinance, the transporting provider shall pay to EPAB a fee of three dollars ($3 00), which sum shall be used to defray the costs of medical regulation of the EMS system. Such payments shall be made monthly by the fifteenth (15th) day of each month for services rendered during the previous calendar month. Such funds shall be maintained in a separate account administered by the 9 (Exhibit A. Uniform EMS Ordinance, cont....) Ambulance Authority on EPAB's behalf, and shall be expended solely for the purposes set forth in this Sec. 4 as approved by EPAB or its Executive Board. Effective August 1, 1990, this per-transport fee shall be automatically increased to four dollars ($4.00) per patient transported, and may thereafter be periodically increased at the discretion of EPAB, subject to approval by the Ambulance Authority, but not more often than annually, and no single increase may exceed five percent (5%). E. Effective August 1, 1988, funds then remaining in the account of the Emergency Physicians Advisory Board of the City of Fort Worth shall be automatically transferred to the EPAB account established and maintained by the Ambulance Authority F. This Jurisdiction shall indemnify and hold harmless EPAB, its members, its Medical Director, and EPAB staff members from liability for actual damage, including costs and attorney's fees, arising from any claim, lawsuit, or judgement resulting from an act or omission of said EPAB member, the Medical Director, or EPAB staff member while acting in the scope and course of his office, provided that such liability arises out of or in connection with the provision of ambulance services or first responder services originating within the corporate limits of this Jurisdiction. SEC. 5 AREA li~IETROPOLITAN AMBULANCE AUTHORITY. By adopting this Ordinance, and concurrently therewith executing and approving the Interlocal Cooperative Agreement, there is hereby established an Area Metropolitan Ambulance Authority, which is herein called the "Ambulance Authority;" and in regard to that Ambulance Authority the following shall apply: 10 A. The Ambulance Authority is hereby designated as the sole provider of all ambulance services within this Jurisdiction, (Exhibit A. Uniform EMS Ordinance, cont....) pursuant to the terms, conditions and provisions of the Interlocal Cooperative Agreement, except for those services exempted by Sec. ~F, below B. The Ambulance Authority shall comply with all terms of the Interlocal Cooperative Agreement, and have all of the duties, powers and responsibilities enumerated therein. C . The Ambulance Authority is required to provide this Jurisdiction with advanced life support ambulance service Such service shall comply with all applicable state laws and rules, as well as all rules, regulations, standards and response times as the Ambulance Authority or EPAB may from time to time promulgate D. After termination of the current competitively-awarded contract between the City of Fort Worth and Texas Lifeline Corporation, which amended contract shall be assigned to the Ambulance Authority effective August 1, 1988, and any extensions thereof, the Ambulance Authority shall provide such ambulance service by the award of a contract to a qualified provider after a competitive bid process However, compliance with response time and quality of care standards are the non-delegable duty of the Ambulance Authority. SEC.6 VIOLATIONS. It shall be unlawful. A. To perform duties as an ambulance driver, attendant (EMT or paramedic), or EMS dispatcher without a current certification issued by the EPAB, B. To permit a person to work as an ambulance driver, attendant or EMS dispatcher without a current license issued by the EPAB, 11 (Exhibit A. Uniform EMS Ordinance, cont....) C . To use, or cause to be used any ambulance service other than that of the contractpr authorized to operate in this Jurisdiction by virtue of its contract with the Ambulance Authority, except those services described in Paragraph F of this Section 6. D. For any person, firm or organization to provide ambulance service wnthin this Jurisdiction, other than the contractor which contracts with the Ambulance Authority; or to provide point- to-point wheelchair transport services to or from health care facilities, helicopter rescue services, or specialized mobile intensive care services except in accordance with EPAB regulations governing the delivery of such services, and then only pursuant to a permit issued by EPAB for the operation of such units; or after August 1, 1989 to provide first responder services without a first responder permit issued by EPAB. All such special permits when issued by EPAB shall be valid for a period of two (2) years, and then shall be subject to provisions governing renewal, such provisions to be developed by EPAB Holders of such permits shall comply with requirements for payment of permit fees as set forth in Section 4D, hereof. E To knowingly give false information to induce the dispatch of an ambulance or helicopter rescue unit F. It shall be a defense to any alleged violation of this Section 6 that the vehicle is being used solely in any of the following manners. (1) A privately owned vehicle not ordinarily used in the business of transporting persons who are sick, injured, wounded, incapacitated or helpless (2) A vehicle rendering service as an ambi}lance in the event of a mayor catastrophe or extreme system overload 12 (Exhibit A. Uniform EMS Ordinance, cont....) when such condition is declared by the Medical Director, the Executive Director of the Ambulance Authority, or by an authorized representative of the Ambulance Authority's contracted ambulance service provider, and such assistance has been requested by the Control Center. (3) Any ambulance owned or operated by the federal or state government. (4) Any transport to a location within the Service Area, which transport originated from a point outside the Service Area (5) Mutual aid calls when rendered pursuant to a mutual aid agreement approved by the Ambulance Authority (6) Special events coverage, so long as such service is provided without charge by an emergency medical services volunteer provider, as defined in Sec. 1 03(18), Art 44470, Texas Civil Statutes. (7) Wheelchair transport services which are not provided on a point-to-point basis, but which provide pickup -and delivery by way of regularly scheduled routes. (8) Medical transports by helicopter where such transports originate outside the Service Area or at a hospital location within the Service Area. 13 (9) Point-to-point wheelchair transport services rendered by not-for-profit organizations. (Exhibit A. Uniform EMS Ordinance, cont....) SEC.7 PENALTIES. The following provisions for application of penalties for violation of this Ordinance shall apply: A. Any person convicted of violating the provisions of this Ordinance shall be fined no more than five hundred dollars ($500.00). This does not serve to limit any other remedies available to this Jurisdiction in law or equity. B. Each day that any violation of this article is committed or permitted to continue shall constitute a separate offense SEC. 8 TRAFFIC LAWS; EXEMPTION. When the driver of an ambulance has reasonable grounds to believe that an emergency exists, as determined by the EMS control center, the driver of the ambulance may• A. Park or stand, irrespective of the otherwise applicable provisions of law, ordinance or regulations; B. Proceed past a red or stop signal or stop sign, but only after slowing down as may be necessary for safe operation; C . Exceed the maximum speed limits permitted by law, ordinance or regulation, provided, however, that life and property are not endangered thereby; D . Disregard laws, ordinances and regulations governing directions or movements or turning in specified directions. E. Provided, however, that any exemption herein granted shall apply only when such ambulance is operating with siren and emergency lights in operation, and when such audible and visual signals meet the requirements of law, ordinance or regulation, and provided further, that the foregoing provisions 14 (Exhibit A. Uniform EMS Ordinance, cont. ) shall not operate to relieve the driver of any ambulance from the duty to drive with due regard for the safety of all persons, nor shall such provisions protect the driver from the consequences of his reckless disregard for the safety of others. 15 ' Exhibit S Uniform Schedule of Price/Subsidy Options for ALS Fyrst Respoader I 'T`his exhibit does not exist since no city has registered recognihan as an l~LS First Responder Exhibit C Uniform Schedule of Price/Subsidy Options for BLS First Responder This exhibit is the current years Pricc/Subsidy Options, Area Metropaiitan Ambulance Authority Price/Subsidy Options FY 1998-99 Patient Fee Per Fees Transport Billed Patient Net Fees Subsidy Total Per Capita Collection Ilected Reaulred Revenue Sub i Rate 41 2,0$3,292 1,800,171 10,026,237 11,$26,408 16.12 86.41% 42 2,134,104 1,$29,317 9,997,091 11,826,408 16,07 85.72°~ 43 2,184,916 1,858,221 9,968,T$7 11,826,448 16.03 85.05% 44 2,235,728 1,886,916 9,939,492 11,826,408 15.98 $4 40% 45 2,286,540 1,915,431 9,910,977 11,828,408 15.93 83.77% 46 2,337,352 1,943,797 9,8$2,611 11,826,408 15.89 83.16% 47 2,3$$,164 1,971,804 9,854,604 11,826,408 15.84 82.57% 48 2,438,976 1,$99,712 9,828,896 11,826,408 15.80 81.99% 49 2,4$9,788 2,027,553 9,798,855 11,826,408 15.75 8143% 54 2,540,600 2,0,5,5,101 9,771,307 11,826,408 15.71 80.$9% 51 2,591412 2,082,371 9,744,037 11,$26,408 15.67 80.36% 52 2,642,224 2,109,644 9,716,764 11,826,40$ 15.62 79.$49'0 53 2,693,036 2,13fi,fi$0 9,689,728 11,$26,408 15.5$ 79.34% 54 2,743,848 2,163,495 9,662,913 11,$26,408 15.54 78.85% 55 2,794,660 2,190,102 9,636,306 11,826,408 15.49 78.37°/a 56 2,845,472 2,216,519 9,609,889 11,$26,408 15.45 77.90% 57 2,896,284 2,242,759 9,583,fi49 11,826,408 15.41 77.44% 58 2,947,096 2,268,838 9,557,570 11,826,408 15.37 76.99°k 59 2,997,908 2,294,771 9,531,837 11,826,408 15.32 76.55°/a 60 3,04$,720 2,320,574 9,505,834 11,826,408 15.28 76.12% 61 3,089,532 2,346,262 9,480,146 11,826,40$ 15.24 75.70% 62 3,150,344 2,371,850 9,454,558 11 $2$,40$ 15.20 75.29% 63 3,201,156 2,397,353 9,429,055 11,$26,40$ 15.16 74,89% 64 3,251,968 2,422,787 9,403,621 11,826,408 15.12 74.50% 65 3,302,7$0 2,448,167 9,37$,241 11,$26,40$ 15.08 7412% 66 3,353,592 2,473,170 9,353,238 11,826,4Q$ 15.04 73.75% 67 3,404,404 2,498,140 9,328,268 11,$26,408 15.00 73,38% 68 3,4$5,216 2,523,091 9,303,317 11,$26,408 14.96 73.02°~ 69 3,506,02$ 2,547,6$6 9,278,722 11,826,408 14.92 72.67% 70 3,556,840 2,572,283 9,254,125 11,$26,408 14.88 72.32°k 71 3,607,652 2,596,$97 9,229,511 11,826,408 14.84 71.98% 72 3,658,464 2,621,175 9,205,233 11,826,408 14.80 71.65% 73 3,709,276 2,645,491 9,180,917 11,826,40$ 14.76 71.329'0 74 3,76Q,088 2,669,482 9,156,926 11,828,408 14 72 71.00°k 75 3,810,900 2,693,530 9,132,878 71,826,408 14.68 70.6$°k 76 3,861712 2,717,651 9,108,757 11,826,408 14.64 70.37°~ 77 3,912,524 2,741,467 9,084,941 11,826,408 14.61 70.07% 78 3,963,336 2,765,376 9,061,032 11,826,408 14.57 89.77% 79 4,014,148 2,788,991 9,037 417 11,826,408 14.53 69.48% 80 4,064,960 2,$12,719 9,013,6$9 11,826,4p$ 14.49 69.19% 81 4,115,772 2,$36,162 8,990,246 11,826,4p$ 1445 68.91% 82 4186,584 2,$59,321 $,967,087 11,826,408 14,42 68.63% $3 4,217,396 2,882,619 8,943,7$9 11,826,408 14.38 6$.35% $4 4,268,20$ 2,905,642 8,920,768 11,$26,408 14.34 6$.08% 85 4,319,020 2,92$,825 8,897,583 11,826,408 14.31 67,$1% 86 4,369,632 2,951,743 8,$74,665 11,$26,40$ 14.27 67.55% 87 4,420,644 2,974,841 8,851,567 11,826,408 14.23 67.29% 88 4,471,456 2,997,685 8,828,723 11,826,408 1419 67.04% 89 4,522,268 3,420,275 8,8Q6,133 11,826,408 1416 88.79°/a 90 4,573,0$0 3,043,069 8,783,339 11,$26,40$ 14.12 66,54% 91 4,623,$92 3,065,620 8 760 788 11,826,408 14.09 6fi.30% 92 4,674,704 3,087,927 8,738,481 11,826,408 14 OS 66.06% 93 4,725,516 3,110,464 8,715,944 11,$2fi,40$ 14.01 65.82% 94 4,776,328 3,132,768 8,693,640 11,826,408 13.98 65,59% 95 4,827,140 3,154,837 8,571,571 11,826,408 13.94 65.3E% 96 4,877,952 3,177,163 8,649,245 11,826,44$ 13.91 65.13% 97 4,928,764 3,199,265 $,fi27,143 11,626,40$ 13.87 64.91% 98 4,979,576 3,221,143 $,605,265 11,$2fi,408 13.$4 64.699'° 99 5,030,388 3,243,302 8,583106 11,826,408 13.80 84.479'° 100 5,0$1,200 3,265,248 6,561,160 11,$2$,408 13.76 64.26% 101 5,132,012 3,288,981 8,539,427 11,826,408 13,73 64.05% 102 5,182,$24 3,30$,500 8,517,908 11,828,408 13.69 63.$4% 103 5,233,636 3,330,331 8,496,077 11,826,408 13.66 63.63% 104 5,284,448 3,351,959 8,474,449 11,826,408 13.62 63.43°h 105 5,335,260 3,373,383 $,453,025 11,826,408 13.59 63.23% 106 5,386,072 3,394,604 8,431,804 11,826,40$ 13.56 63.03°h 107 5,436,$$4 3,4161$$ 8,410,240 11,$26,408 13.52 62.83% 10$ 5,487,696 3,437,538 8,388,87Q 11,826,408 13.49 62.649'° 109 5,53$,50$ 3,458,715 $,367,693 11,826,408 13,45 62.45% 110 5,589,320 3,479,699 8,345,709 11,826,40$ 13.42 62.26% 111 5,640132 3,501,055 8,325,353 11,$26,408 13.39 62.07% 112 5,690,944 3,522,229 8,304,179 11,826,408 13.35 67,89% 113 5,741,756 3,543,220 8,283,188 11,826,408 13.32 6171% 114 5 792,568 3,564.,028 8,262,380 11,826,408 13.2$ 61.53% 115 5,843,380 3,584,653 8,241,755 11,826,408 13.25 61.35% 118 5,894,192 3,605,686 8,220,722 11,826,408 13.22 B1 17% 117 5,945,004 3,626,54$ $,199,862 11,826,40$ 13.18 61.00% 11$ 5,995,$16 3,647,233 8,179,175 11,$26,408 13.15 60,$3% 119 6,046,628 3,687,748 8,158,660 11,826,408 13.12 60.68% 120 6,097,440 3,688,090 $,13$,318 11,826,408 13,08 60.4996 121 6,148,252 3,70$,$76 8,117,532 11,826,40$ 13.05 60.32% 122 6,199,064 3 729 499 8,096,909 11,$26,408 13.02 6016% 123 6,249,876 3,749,960 8,076,446 11,826,408 72.$8 60.00% 124 6,300,668 3,770,258 8,056,150 11,826,408 12.95 59.84% 125 6,351,500 3,790,393 8,038,015 11,$26,408 12.92 59.6$% 126 6,402,312 3,610,366 8,016,042 11,$26,408 12.89 59.52% '127 6,453,124 3,830,823 7,995,5$5 11,826,408 12.85 59.36% 128 6,503,93fi 3,851,128 7,975,280 11,826,4Q8 12.82 21% 59 129 6,554,748 3,$71,2$0 7,955,128 11,826,40$ 12.79 , 59.06% 130 6,605,560 3,891,2$0 7,935,128 11,826,408 12.76 5$ 91% 131 6,656,372 3,911,127 7,915,281 11,826,408 12.73 , 58.76% 132 6,707,184 3,930,822 7,895,586 11,826,408 12.89 58.61% 133 6,757,996 3,951,042 7,$75,366 11,$26,40$ 72,66 58.46% 134 6,808,808 3,971,120 7,855,288 11,826,408 12.83 58,32% 135 6,859,620 3,991,056 7,$35,352 11,$26,408 12.60 58.1$°~ 138 6,910,432 4,010,849 7,815,559 11,826,40$ 12.57 58.04% 137 6,961,244 4,030,500 7,795,908 11,826,408 12.53 57,9D°.6 138 7,012,056 4,050,008 7 776,400 11,826,408 12.50 57 7fi% 139 7,062,$6$ 4,069,375 7,757,033 11,826,408 12.47 57.62% 140 7,113,680 4,088,599 7,737,809 11,826,40$ 12.44 57.48% 141 7,164,492 4,108,399 7,71$,009 91,826,4Q8 12.41 57.34°.6 142 7,215,304 4,128,067 7,698,341 11,828,408 12,3$ 57.21% 143 7,266,116 4,147,602 7,878,80(1 11,$ZB,408 12,35 57.08% 144 7,316,928 4,167,008 7,659,402 11,826,40$ 12.31 58.95% 145 7,367,740 4186,278 7,640,130 11,826,408 12.2$ 56.829'° 146 7,418,552 4,205,417 7,620,991 11,826,408 12,25 56.69% 147 7,469,364 4,224,424 7,601,984 11,826,40$ 12,22 56.56% 148 7,520,176 4,243,299 7,583,109 11,826,408 12.19 56.43% 149 7,570,988 4,262,801 7,563,607 11,626,408 12,16 56.30% 150 7,621,800 4,282,1$1 7,544,227 71,826,408 12.13 56.16% 151 7,672,612 4,301,439 7,524,969 11,826,408 12.10 56.06% 152 7,723,424 4,320,575 7,505,$33 11,826,40$ 12.07 55.94% 153 7 774,236 4,339,589 7,4$6,819 11,826,4D8 12.04 55.82% 154 7,$25,048 4,35$,481 7,467,927 11,826,408 12.01 55,70% 155 7,$75,860 4,377,251 7,449157 11,826,408 11.98 55.58% 156 7,926,672 4,395,900 7,430,508 11,$26,408 11,95 55.46°k 157 7,977,484 4,414,426 7,411,982 11,826,408 11,92 55.34°'° 15$ 8,028,296 4,432,830 7,393,578 11,826,40$ 11.89 55.22% 159 8,079,10$ 4,451,922 7,374,4$6 11,$2fi,408 11.86 55.10x/° 160 8,129,920 4,470,902 7,355,506 11,826,408 11.$3 54.99% 161 8,180,732 4,489,771 7,338,837 11,826,409 11.80 54.88% 152 8,231,544 4,508,527 7,317,$89 71,626,40$ 91 77 54 77% 163 8,282,356 4,527,172 7,299,236 11,826,408 1174 54.66% 164 8,333,168 4,545,705 7,280.703 11,$26,408 1171 54.55% 165 8,3$3,9$0 4,564,126 7,262,282 11,826,408 11.68 54.44% 166 $,434,792 4,582,436 7,243,972 11,826,408 11.55 54.33% 167 8,485,604 4,600,633 7,225,775 11,826,408 1162 54.22% 16$ 8,536,416 4,61$,719 7,207,689 11,826,408 11.59 6411% 169 8,587,22$ 4,638,693 71$9,715 11,826,408 19.56 54.00% 170 8,63$,040 4,655,421 7,770,987 11,$26,408 11.53 53.89% 171 8,688,852 4,674,047 7,152,361 11,828,408 11.50 53.79% 172 8,739,664 4,692,572 7,133,836 11,826,408 11.47 53.89% 173 8,790,476 4,710,995 7,115,413 11,826,408 11.44 53.59% 174 $,841,288 4,729,316 7,097,092 71,828,408 11.41 53.49% 175 8,892,100 4,747,536 7,078,$72 11,826,408 11.38 53.39% 176 8,942,912 4,765,654 7,060,754 11,826,408 11.35 53.29°.6 177 8,993,724 4,783,870 7,042,738 11,$2fi,408 11.32 53.19°~ 178 9.,044,536 4,$01,585 7,024,823 11,826,408 11.29 53.09% 179 9,095,34$ 4,819,398 7,007,01q 11.826,408 11.27 52.99°,6 180 9,f46,160 4,837,110 6,9$9,298 11,82$,408 11.24 52.89°~ 181 9,196,972 4;854,720 6,971,5$8 11,$26,408 11.21 52.79% 1$2 9,247,784 4,872,228 6,954,180 11,828,408 1118 52.69°k 183 9,298,596 4,890,566 6,935,842 11,828,408 1115 52.59% 184 9,349,408 4,908,813 6,917,595 11,826,408 1112 52.50% 185 9,40Q,22Q 4,926,968 6,899,440 11,826,40$ 11.09 52.41'Y° 1$8 9,451032 4,945,032 6,8$1,376 11,826,408 11.06 52.329'° 187 9,507,844 4,963,004 6,863,4Q4 11,826,4Q8 11.03 52.23% 188 9,552,656 4,980,8$5 6,846,523 11,826,408 11.07 52.14% 189 9,603,468 4,998,675 8,827,733 11,828,408 10.98 52,05% 190 9,654,2$Q 5,016,373 6,810,036 11,826,408 10.95 51.96% 191 9,705,092 5,033,979 6,792,429 11,828,408 10.92 51.$7% 192 9,755,904 5,051,494 6,774,914 11,826,408 10.89 51.7$9'° 193 9,80$,716 5,068,918 6,757,49Q 11,826,408 1Q,86 51.69% 194 9,857,528 5,Q86,260 6,740,15$ 11,$26,408 10.84 51.60% 195 9,90$,340 5,1Q3,491 6,722,917 11,826,40$ 10.$1 51.51% 196 9,959,152 5,120,64Q 6,705,7$8 11,$26,408 10.78 5142% 197 10,009,964 5,137,697 6,6$8,711 11,826,40$ 10.76 51.33% 19$ 10,060,776 5,154,664 6,671,744 11,$26,408 10.73 51.24% 199 10,111,588 5,172,551 6,653,857 11.826,40$ 10.70 5115% 200 10,162,400 5,190,35$ 6,636,050 11,$26,408 10.67 51 07% 201 10,213,212 5,208,083 8,618,325 11,826,408 10.64 . 50.99% 202 1Q,z64,024 5,225,727 6,600,681 11,$26,408 10.61 50.91°~ 203 10,314,836 5,243,289 6,5$3,119 11,826,408 10.58 50.83°~ 204 10,365,fi48 5,2$0,770 6,565,638 11,$26,408 10.56 50.75% 205 10,416,460 5,278,170 6,548,238 11,82$,408 1Q,53 50.67% 206 10,487,272 5,295,489 6,530,999 11,825,408 10.50 50.59% 207 10,518,084 5,312,726 6,513,682 11,826,408 10.47 50.519'° 209 10,568,896 5,329,882 fi,495,526 11,828,408 1044 50.43% 209 10,619,708 5,346,956 6,479,452 11,826,408 10.42 50.35% 210 10,670,520 5,363,950 6,452,458 11,826,408 10.39 50.27°~ 211 10,721,332 5,380,$62 6,445,546 11826,408 10.36 50.19% 212 10,772,144 5,397,693 6,428,715 11,826,408 10.34 50.114° 213 10,$22,956 5,414,442 6,411,966 11,$26,408 10.31 50.03% 214 1Q,873,768 5,431,110 6,395,298 11,826,408 10.2$ 49.959'0 215 10,924,580 5,447,697 6,37$,711 11,826,408 10.26 49.87% 215 10,975,392 5,464,203 6,362,205 11 $2fi,408 10.23 49.799'0 217 19,025,204 $,4$0,627 5,345,781 11,825,40$ 1Q.20 49 719'0 218 11,07y,018 5,496,970 8,328,438 17,828,408 10.18 49.63 219 11,127,828 5,514,346 6,312,062 11,$26,408 10.15 49.55% 22Q 11,178,640 5,531,651 6,294,757 11,826,40$ 10.12 49.4$% 221 11,229 452 5,548,885 6,277,523 11,$25,408 10.09 49 414'0 222 11,280,264 5,566,048 6,260,360 11,826,408 10.07 49.34% 223 11,331,076 5,583,139 6,243,2fi9 11,$26,408 10.04 4927°1° 224 11,381,888 5,600,160 6,226,248 11,826,408 10.01 49.20% 225 11,432,700 5,617,109 6,209,299 71,826.408 9.98 49.13% 226 91,483,512 5,633,987 6,192,429 11,828,408 9.98 49.06% 227 11,534,324 5,850,794 6,175,814 11,82$,40$ 9.93 4$.99% 228 11,585,136 5,667,530 6,158,878 11,826,408 9.90 4$,92°~ 229 11,635,948 5,684,195 6,142,213 11,826,40$ 9.88 48,85% 230 (1,686,760 5,700,7$$ 6,125,620 11,826,408 9.85 48.78% 237 f 1,737,572 5,7t7,311 6,109,097 11,826,40$ 9.82 48.71% 232 11,788,384 5,733,762 6,092.646 11,$26,408 9.$0 48.64% 233 11,839,196 5,750,143 6,076,265 11,826,408 977 48.5?% 234 11,$90,008 5,766,452 6,059,956 11,82fi,40$ 9 74 48.50% 235 11,940,820 5,782,690 6,043,718 11,826,408 9 72 48.43% 236 11,991,632 5,79$,856 6,027,552 11,826,408 9.B9 4$ 36°/a 237 12,042,444 5,814,952 6,011,456 11,826,408 9.66 , 4$.29% 238 12,093,256 5,830,977 5,995,431 11,826,408 9.64 48.22% 239 12,14'4 O6$ 5,846,930 5,979,47$ 11,$26,408 9.61 48.15% 240 12,194,880 5,$62,812 5,963,596 11,826,408 9.59 48.08% 241 12,245,692 5,878,823 5,947,785 11,826,408 9.56 48.09% 242 12,296,504 5,894,363 5,932,045 11,826,408 9.54 47.94% 243 12,347,316 5,911,269 5,915,139 11,826,408 9.51 47.$7% 244 12,388,128 5,928,113 5,$98,295 11,826,40$ 9.48 47.81% 245 12,448,940 5,944,896 5,881,512 11,$26,408 9.46 47 75% 246 12,499752 5,961,61$ 5,864,790 11,826,408 943 47.69°fo 247 12,550,564 5,978,280 5,$4$,12$ 11,826,40$ 9.40 47.639'° 248 12,801,376 5,994,880 5,831,528 1(,$26,408 9.3$ 47.579'° 249 12,652,($$ 6,011,420 5,814,988 11,826,408 9,35 47.5196 250 12,703,000 6,027,$98 5,798,590 11,826.408 9.32 47.45°~b 251 12,753,812 6,044,395 5,782,093 19,826,408 9.30 47.39% 252 (2,$04,624 6,060,672 5,765,736 11,826,408 9.27 47.33% 253 12,855,438 6,076,967 5,749441 11,826,40$ 9.24 47,27% 254 12,908,248 6,093,202 5,733,206 11,$2$,408 9.22 47.219'° 255 12,957,460 6,109,376 5,797,032 11,$26,408 9.19 47 i5% 256 13,007,872 6,125,488 5,700,920 1(,826,408 9.17 47.09% 257 13,058,684 6,14(,540 5,6$4,$68 11,$26,408 914 47,03% 258 13109,496 6,157,530 5,868,87$ 11,826,40$ 9.11 46.9796 259 13,160,30$ 6,173,460 5,652,948 11,826,408 9.09 46.91% 260 13,211,120 6,189,329 5,637,079 11,826,40$ 9A6 46.$5% 261 13,261,932 6,205,136 5,621,272 11,826,408 9.04 46.799'° 262 13,312,744 6,220,8$3 5,605,525 11,826,40$ 9,01 46.73°,6 263 13,363,556 6,236,569 5,5$9,839 11,826,408 8,99 46.87% 264 13,414,368 8,252,194 5,574,2(4 11,826,408 8.96 46.61% 265 13,465,180 6,267,75$ 5,558,650 11,826,408 8.94 46.559'0 266 13,515,992 6,2$3,260 5,543,148 11,82B,d0$ 8.91 48.49% 267 13,'566,$04 6,298,702 5,527 706 11,826,408 8.$9 46.43°Yo 26$ 93,69fi,616 6,3(4,083 5,512,325 11,826,40$ 8.86 46.37% 2$9 13,$68,428 8,329,403 5,497,005 1(,826,408 $.84 46.31 270 13,719,240 6,344,662 5,481,746 11,828,408 8.81 46.25% 271 13,770,052 6,359,$60 5,466,548 11,826,408 8.79 46.199'° 272 13,$20,864 6,374,997 5,451,411 11,826,408 8.76 46.13% 273 13,$71,876 6,390,073 5,436,335 11,826,408 8.74 46.07°~ 274 13,922,488 6,405,088 5,421,320 11,826,408 8.72 46.01°.6 275 13,973,300 6,420,042 5,406,366 11,826,40$ 8.69 45.95% 276 94,024,112 6,436,339 5,390,069 11,826,408 8,67 45.$9°k 277 14,074,924 6,452,586 5,373,822 11,$26,408 8.64 45.$4°k 278 14,125,736 $,46$,781 5,357,627 11,826,40$ 8.61 45.79% 279 14,176,548 8,484,926 5,349,4$2 11,826,40$ 8.59 45.74% 280 14,227,360 6,501,020 5,325,388 11,826,40$ 8.56 45.69°~ 289 14,27$,972 6,597,pFi3 5,309,345 11,826,408 8.54 45.64% 2$2 14,328,984 6,533,055 5,293,353 11,826,408 $.51 45,59% 283 14,379,796 6,54$,997 5,277,411 11,826,40$ 8.48 45.549'0 2$4 14,430,608 8,564,$$8 5,261,520 f 1,$26,408 $.46 45.49°~6 285 14,481,420 6,580,728 5,245,680 11,826,40$ 8.43 45.44% 286 14,532,232 6,596,517 5,229,891 11,826,4D8 8.41 45.39% 287 14,583,044 6,612,255 5,214,153 11,826,40$ 8.38 45.34/° 288 14,$33,856 6,627,942 5,198,466 11,828,408 8.36 45,29% 289 14,684,868 6,643,579 51$2,829 11,$26,40$ 8.33 45,24% 290 14,735,480 6,659,165 5,167,243 11,826,408 8.31 45.19% 291 14 786,292 6,674,700 5,151,70$ 11,826,408 $.2$ 45.14% 292 14,837,104 6,690,184 5,136,224 11,826,408 8.26 45.09% 293 14,8$fi,916 6,705,617 5120,791 11,826,40$ 8.23 45.04°r6 294 14,938,728 6,721,000 5,105,408 11,$26,408 8.21 44.99% 295 14,989,540 6 736,332 5,090,076 11,826,408 8.18 44,9496 298 15,040,352 6,751,613 5,074,795 11,826,408 8.16 44,899'° 297 15,091,164 6,766,843 5,059,565 11,826,408 8.13 44.849'° 298 15,141,976 6,782,022 5,444,386 11,826,408 8.11 44 79% 299 15,192,788 6,797,151 5,029,257 11,826,408 8.09 44,74% 300 15,243,600 6,$12,228 5,014,180 11,826,408 $.p$ 44 69°k 301 15,294,412 6,827,255 4,999,153 11,826,408 $.04 44.64% 302 15,345,224 6,842,231 4,9$4,177 11,$26,408 8.01 44.59% 303 15,396,036 6,857,156 4,969,252 11,826,408 7.99 44.54% 304 15,446,848 6,$72,031 4,954,377 11,826,408 7.97 44.499'0 305 15,497,660 6,886,855 4,939,553 11,826,408 7.94 44 449'0 306 15,548,472 6,901,627 4,924,781 11,826,408 7.92 44.39% 307 15,599,284 6,916.349 4,910,059 (1,826,408 7.$9 44.34% 308 15,650,096 6,931,021 4,895,387 11,$26,40$ 7.87 44.299'° 309 15,700,90$ 6,945,641 4,880,767 11,826,408 7.85 44.24% 310 75 751 720 6,960,211 4,866,197 11,826,408 7,$2 4419°~ 311 15,802,532 6,974,729 4,851,679 11,$26,40$ 7.80 44.14% 312 15,853,344 6,989,197 4,$37,211 11,826,408 7 78 44.09% 313 15,904,156 7,003,614 4,822,794 11,826,408 7 75 44.04% 314 15,954,96$ 7,D17,981 4,808,427 11,826,408 7 73 43.99% 315 16,OD5,7$D 7,032,296 4,794,112 11,826,408 7 71 4$.94% 316 16,056,592 7,046,561 4,779,847 11,826,408 7.6$ 43.$9% 317 16,107,404 7,060,775 4,765,633 11,$26,40$ 7,66 43.84° 318 16,15$,216 7,074,93$ 4,751,470 11,826,408 764 43.79% 319 18,209,028 7,0$9,050 4,737,35$ 11,$28,408 7,62 43.74% 320 16,259,840 7,103,112 4,723,296 11,$26,40$ 7.59 43.69% 321 16,310,652 7,118,755 4,707,653 11,826,408 7.57 43.649'° 322 16,361,464 7,134,358 4,692,050 11,826,40$ 7.54 43.80% 323 16,412,278 7,149,920 4,676,48$ 11,826,40$ 7.52 43.56% 324 16,463,0$8 7,165,441 4,660;967 11,826,408 7,49 43.52% 325 16,513,900 7,180,922 4645 486 11,826,408 7,47 43.48% 32fi 16,564,712 7,196,362 4,630,046 11,$26,40$ 7.44 43.4496 327 16,615,524 7,211,762 4,614,646 11,826,40$ 742 43.40°~ 32$ 16,868,336 7,227121 4,599,287 11,$26,408 7.39 43.36% 329 18,717,148 7,242,x39 4,583,969 11,626,x08 7.37 43.32% 330 16,767,960 7,257716 4,568,692 11,826408 7.35 43.28°~ 331 16,81$,772 7,272,953 4,553,455 11,826,40$ 7.32 43.2496 332 16,$69,584 7,288,150 4,538,25$ 11,826,408 7.30 43.20°(° 333 16,920,396 7,303,305 4,523,103 11,826,408 7.27 43.1696 334 16,971,20$ 7,318,420 x,507,9$8 11,826,408 7.25 43.12°~6 335 17,022,020 7,333,494 4 492,914 11,826,40$ 7.22 43.08°~ 336 17,072,832 7,34$,52$ 4,477,880 11,826,408 7.2D 43.04°.6 337 17,123,644 7,363,521 4,462,887 11,826,40$ 718 43.00°~ 338 17,174,456 7,378,473 4,447,935 11,$26,408 715 42.96% 339 17,225,268 7,393,385 4,433,023 11,826,408 7 i3 42.929'0 340 17,276,080 7,40$,256 4,418,152 11,826,408 7,10 42.889'0 341 17,328,892 7 423,086 4,403,322 11,$26,408 7.08 42.84% 342 17,377 704 7 437,876 4,388,532 11,$26,40$ 7.06 42.80% 343 17,42$,516 7,452,625 4,373,7$3 11,$26,408 7.03 42.76% 344 17,479,328 7 467,334 4,359,074 11,$26,40$ 7.01 42.72°1° 345 17,530,140 7,482,002 4,344,406 11,826,408 6.98 42.68% 346 17,580,952 7,49fi,829 4,329,779 i 1,826,408 B.96 42.64% 347 17,631,764 7,511,215 4,315,193 11,$26,408 6,94 42.fi0°h 348 17,682,578 7,525,761 4,300,647 11,$26,40$ 6.91 42,56% 349 17,733,388 7,540,266 4,2$6,142 11,826,408 6.89 42.52% 350 17,784,200 7,554,731 4,271,677 11,826,408 6.87 42.48% 351 17,835,012 7,569,155 4,257,253 11,826,40$ 6.54 42.44°!° 352 17,885,$24 7,583,538 4,242,$70 11,826,408 6.82 42.40% 353 17,936,636 7,597,8$1 4,228,527 11,826,408 6.80 42.36% 354 17,987,448 7,612.183 4,214,225 11,826,408 6.78 42.32% 355 18,038,260 7,626,444 4,199,984 11,826,408 6.75 42.28°k 35fi 18,089,072 7,64Q,664 4,185,744 11,826,408 6.73 42.24% 35T 18,1$9,$84 7,654,844 4,171,564 11,826,408 6.71 42.20% 388 1$,190,696 7,668,984 4,157,424 11,$26,408 6.68 42.16% 359 18,241,508 7,683,083 4,143,325 11;826,408 6.88 42,1 Z% 360 18,292,320 7,697,141 4,129,267 11,826,408 6.64 42.089`° 361 18,343,132 7,711,158 4,115,250 11,826,408 6.62 42.049`0 362 18,393,944 7,725,135 4,101,273 11,826,408 6.59 42.00% 363 18,444,756 7,739,071 4,087,337 11,826,408 6.57 41.98% 364 18,495,568 7,752,966 4,073,442 11,826,408 6.55 41.92% 365 18,546,380 7,766,821 4,059,587 11,$26,408 6.53 41.88% 366 18,597,192 7,780,635 4,045,773 11,826,408 6.50 41.84% 367 18,64$,004 7,794 409 4,031,999 11,826,408 6.48 41.80°~ 368 18,698,816 7,808,142 4,018,286 11,826,408 6.46 4176°~ 369 18,749,626 7,821,834 4,004,574 11,826,408 6.44 41 72% 370 18,8Q0,440 7,836,485 3,990,923 11,$26,408 6.42 41.68% 371 18,851,252 7,$49,096 3,977,312 11,826,408 6.39 41.649'0 372 18,902,064 7,862,667 3,963,741 11,826,408 8.37 41.60% 373 18,952,876 7,878,196 3,950,212 11,826,408 6.35 41.56% 374 19,003,688 7,889,685 3,936,723 11,826,408 6.33 41.52% 375 19,064,500 7,903,133 3,923,275 11,826,408 6.31 41,489'0 376 19,105,312 7,916,541 3,909.867 11,826,408 6.29 41.44°~ 377 19,156,124 7,929,908 3,896,500 11,826,408 6.26 4140% 378 19,206,936 7,943,234 3,883,174 11,828,408 6.24 41.36% 379 19,257,748 7,956,520 3,869,888 11,826,408 6.22 41.32% 380 19,308,560 7,969,765 3,858,643 11,826,408 6.20 41.28% 381 19,359,372 7,982,970 3,843,438 11,826,408 6.1$ 41.24% 382 19,410,1$4 7,996,133 3,830,276 11,826,40$ 6.16 41.20% 383 19,460,998 8,009,257 3,817,151 11,826,40$ 6.14 49,16% 3$4 19,511,808 8,022,339 3,804,069 11,$26,40$ 6.12 41129'° 385 19,562,820 8,035,381 3,791,027 11,826,40$ 6.10 41.0896 386 19,813,432 8,048,3$2 3,778,026 11,826,408 6.07 41.04% 387 19,664,244 8,083,311 3,763,097 17,826,40$ 6.05 41.00% 388 19,715,056 8,078,209 3,748,199 11,826,408 8.03 40.97% 389 19,765,$6$ 8,093,076 3,733,332 71,826,408 6.00 40.949'° 390 19,$1,6,680 8,107,914 3,718,494 11,826,408 5.98 40.91% 391 19,$67,492 8,122,720 3,703,6$$ 11,$26,408 5.95 40.88% 392 19,9118,304 8,137,496 3,688,912 11,826,408 5.93 40.$5% 393 19,969,116 8,152,242 3,674,166 11,826,408 5.9'1 40.82% 394 20,01,9,928 $,166,957 3,659,451 11,826,408 5.88 40.79% 395 20,070,740 8,181,642 3,644,766 11,826,408 5.86 40.7696 396 20,121,552 8,198,296 3,830,112 11,826,408 5.$4 40.73% 397 20,172,364 8,210,920 3,615,488 11,826,408 5.81 40.7p% 398 20,223,176 8,225,513 3,600,895 11,826,408 5.79 40 67% 399 20,273,988 8,240,076 3,58fi,332 11,$26,408 5.77 40.64% 400 20,324,800 8,254,608 3,571,800 11,828,408 5.74 40.61% 401 20,375,612 8,269.110 3,557,298 11,826,408 5.72 40.58°~ 402 20,426,424 8,283,581 3,542,827 11,826,408 5.70 40.559'° 403 20,477,236 8,298,022 3,528,386 11,826,408 5.67 40,52% 404 20,528.048 8,312,433 3,513,975 11,$26,408 5.65 40.49% 405 20,578.860 8,326,812 3,499,596 11,826,408 5.63 40.46% 406 20,829,672 8,341,162 3,485,246 11,828,408 5.60 40.43% 407 20,68Q,484 8,355,481 3,470,927 11,826,408 5.58 40.40% 408 20,731,296 8,389,769 3,456,639 11.826.408 5.56 40.37% 409 2Q,782,108 8,384,027 3,442,381 17,$2$,408 5.53 40.34% a1o 2x,$32,920 8,398,254 3,x2$,154 11,x26,408 5.51 40.39°~ 411 20,$83,732 8,412,451 3,413,957 11,826,40$ 5.49 40.28% 412 20,934,544 8,426,618 3,399,790 11;826,40$ 5.47 40.25% 413 20,985,356 8,440,754 3,385,654 11,828,408 5.44 40.22% 414 21,036,168 8,454,859 3,371,549 17,826,408 5.42 40.19% 415 21,086,980 8,46$,934 3,357,474 11,826,40$ 5.40 40.16% 416 21,137,792 $,482,979 3,343,429 11,826,408 5.38 40.13% 417 21,1$8,604 8,496,993 3,329,415 77,826,408 5.35 40.10°r6 418 21,239,416 8,510,976 3,315,432 11,826,408 5.33 40.07°~ 419 21,29D,228 8,524,929 3,301,479 11,$26,408 5.31 40 04% 420 21,341,040 8,53$,$52 3,287,556 11,826,408 5.29 40.01°~ 421 21,391,$52 $,552,744 3,273,664 11,826,408 5.26 39.98°~ 422 21,442,664 $,566,605 3,259,$03 11,826,408 5.24 39.95% 423 21,493,476 8,580,436 3,245,972 11,$2$,408 5.22 39.92°~ 424 21,544,288 $,594,237 3,232,171 11,826,408 5.20 39.89°1° 425 21,595,100 $,60$,007 3,21$,401 11,826,408 5.17 39.86% 426 21,645,912 8,621,747 3,204,661 11,826,40$ 5.15 39.$3% 427 2t,696,724 8,635,456 3,190,952 11,826,408 5.13 39.80% 428 21,747,536 $,649,134 3,177,274 11,828,408 5.11 39 77% 429 21,798,348 $,662,783 3,163,625 11,826,408 5.09 39 74% 430 21 $49,160 8,676,400 3,150,008 11,826,40$ 5.06 39.71% 431 21,899,972 $,6$9,9$7 3,136,421 11,$26,408 5.04 39.68% 432 21,950,784 8,703,544 3,122,864 11,828,408 5.02 39.65% 433 22,001,596 8,717,070 3,109,338 11,826,408 500 39.62% 434 22,052,40$ 8,730,566 3,095,842 11,826,408 4,98 39.59% 435 22,103,220 8,744,031 3,0$2,377 11,826,408 4,96 39.56% 436 22,154,032 8,757,466 3,068,942 11,826,408 4.93 39.53% 437 22,204,844 8,770,$70 3,055,538 11,826,408 4.91 39.50°~ 43$ 22,255,656 $,7$4,244 3,042,164 11,$26,408 4..89 39,47% 439 22,306,46$ 8,797,587 3,02$,$21 11,$26,408 4,$7 39.44% 440 22,357,280 8,810,900 3,015,508 11,826,408 4.85 39.41% 441 22,408,092 $,$24,1$2 3,002,226 1 1,$26,40$ 4.83 39.38% 442 22,458,904 8,$37,434 2,988,974 11,826,408 4.$1 39.35% 443 22,509,716 8,$50,656 2,975 752 11,826,408 4 78 39.32°~ 444 22,560,528 8,863,$46 2,962,562 11,$2$,408 4.76 39.29% 445 22,611,340 8,877,007 2,949 401 11,826,408 4 74 39.26% 448 22,662,152 8,890,137 2,936,271 11,826,408 472 39.23°.6 447 22,712,964 8,903,236 2,923,172 11,826,40$ 4 70 39.20% 448 22,763,776 8,916,305 2,910,103 11,$28,408 4.68 39.17% 449 22,$14,588 8,929,343 2,897,065 11,826,408 4:fifi 39.14% 450 22,865,400 8,942,351 2,$84,057 11,826,40$ 4.64 39.11 451 22,91~i,212 8,955,329 2,871,079 11,826,408 4.62 39.08°~ 452 22,967,024 8,988,276 2,858,132 11,$26,408 4.60 39.05% 453 23,017,$36 8,9$1,192 2,845,216 11,826,408 4.57 39.0296 454 23,06$,848 8,994,07$ 2,832,330 11,826,408 4.55 3$.99% 455 23,119,460 9,008,934 2,819,474 11,$26,408 4.53 38.96% 456 23,170,272 9,019,759 2,806,649 11,826,40$ 4.51 38.93% 457 23,221,0$4 9,032,553 2,793,855 11,826,408 4 49 38.90% 45$ 23,271,896 9,045,317 2,781,091 11,$26,408 447 38.$7°,6 459 23,322,708 9,058,051 2,7$8,357 11,826,408 445 3$.$49~a 460 23,373,520 9,070,754 2,755,654 11,826,408 4.43 38,$1% 461 23,424,332 9,0$3,426 2,742,982 11,826,408 4.41 3$_7$9'0 462 23,475,144 9,096,068 2,730,340 11,826,d08 4.39 38.75°~ 463 23,525,956 9,10$,680 2,717,72$ 11,826,408 4.3i 38,72°~ 464 23,576,768 9,121,261 2,705,147 11,$26,408 4.35 38.6996 465 23,627,5$0 9,133,872 2,692,596 11;826,408 4.33 38.6646 466 23,67$,392 9,146,332 2,680,076 11,826,408 4.31 3$.63% 467 23,729,204 9,158,821 2,667,587 11,826,408 4.29 38.60% 46$ 23,7$Q,016 9,171,281 2,655,127 11,826,40$ 4.27 3$.57% 469 23,830,828 9,183,709 2,642,899 11,826,40$ 4.25 38.54°k 470 23,881,640 9,196,107 2,630,301 11,$26,408 4.23 38.51% 471 23,932,452 9,208,475 2,617,933 11,826,408 4.21 38.48% 472 23,983,264 9,220,812 2,605,596 11,826,408 4 19 38.45% 473 24,034,076 9,233,119 2,593,2$9 71,826,408 417 38.42% 474 24,084,$$$ 9,245,395 2,581,013 11,$2fi,408 4.15 38.39°~ 475 24,135,700 9,257,641 2,568,767 11,$26,408 413 38.36% 476 24,18fi,512 9,269,856 2,556,552 11,$26,40$ 4.11 38.33% 477 24,237;,324 9,282,041 2,544,367 11,826,408 4.09 3$,30°~ 478 24,2$$,13fi 9,294,195 2,532,213 11,826,408 4A7 38.27% 479 24,338,948 9,306,319 2,520,089 11,826,408 4.05 38.2a°~° 480 24,3$9,780 9,318,412 2,507,996 11,826,408 4.03 38.279'° 4$1 24,440,572 9,330,475 2,496,933 11,826,408 4.01 38.1$°h 4$2 24,491,384 9,342,508 2,4$3,900 11,826,408 3.99 38.15% 4$3 24,542,198 9,354,509 2,471,899 11,82$,408 3.97 3$.12% 484 24,593,008 9,368,481 2,459,927 11,826,408 3.95 38.09% 485 24,643,820 9,378,422 2,447,9$6 11,826,408 3.94 38.06% 4$6 24,694,832 9,390,332 2,436,076 11,826,408 3.92 38.03% 487 24,745,444 9,402.,212 2,424196 11,826,408 3.90 38.00% 488 24,796,256 9,414,061 2,412,347 11,$26,408 3.88 37.97% 489 24,$47,068 9,425,880 2,400,528 11,$26,408 3.86 37.94% 490 24,$97,8$0 9 437,669 2,3$$,739 1 t ,$28,408 3.84 37.91 491 24,94$,892 9,449,427 2,376,9$1 11,826,408 3.82 37.88% 492 24,999,504 9,461,154 2,365,254 11,826,408 3.80 37.$6% 493 25,050,316 9,472,$51 2,353,557 11,826,408 3.7$ 37.$2% 494 25,101,128 9,484,518 2,341,890 11,826,40$ 3.77 3779% 495 25,151,940 9,496,154 2,330,254 11,$26,40$ 3.75 37 76% 496 25,202,752 9,507,759 2,318,649 11,826,408 3.73 37 73% 497 25,253,564 9,519,334 2,307,074 11,826,408 3.71 37 70% 498 25,304,376 9,533,411 2,292,997 11,826,408 3.69 37.67% 499 25,355,188 9,547,467 2,278,941 11,826,408 3.66 37.65% 500 25,408,000 9,561,503 2,264,905 11,826,40$ 364 37.63% 501 25,456,812 9,575,519 2,250,$89 11,$26,408 3.62 37.61°~ "" 502 25,507,624 9,5$8,316 2,23$,092 11,826,408 3.60 37.59% 503 25,558,436 9,601,100 2,225,308 11,826,408 3.5$ 37,57°/a 504 25,609,248 9,615,082 2,211,326 11,826,408 3.56 37,55% 505 25,660,060 9,629,044 2,197,364 11,826,408 3.53 37.53% 506 25,710,872 9,642,985 2,183,423 11,$2fi,40$ 3.51 37.51% 507 25,761,684 9,656,906 2,169,502 11,826,408 3.49 37.49% 508 25,812,496 9,67Q,806 2,155,602 11,$26,40$ 3.47 37 47% 509 25,$63,308 9,684,686 2,141,722 11,826,408 3.44 3745% 510 25,914,120 9,69$,548 2,127,862 11,826,40$ 3.42 37 43% .511 25,964,932 9,712,385 2,114,023 11,826,40$ 3.40 37.41% '512 26,015,744 9,726,205 2,100,203 11,826,408 3.38 37.39% 513 26,066,556 9,740,004 2,0$6,404 11,826,408 3.35 37.37°/O 514 26,117,368 9,753,7$2 2,072,62$ 11,826,40$ 3.33 37.35% 515 26,168,180 9,767,540 2,05$,$68 11,828,408 3.31 37.33°k 516 26,218,992 9,781,278 2,045,130 11,826,408 3.29 37.31% 517 26,269,804 9,794,996 2,031,412 11,826,408 3.27 37.29°I° 518 26,320,616 9,$0$,693 2,017,715 11,82fi,408 3.24 37.27% 519 2fi,371,42$ 9,822,370 2,004,038 11,826,408 3.22 37.259'° 520 26,422,240 9,836,026 1,990,382 11,826,408 3.20 37.23% 521 26,473,052 9,849,663 1,976,745 11,826,408 3.1$ 37.21% 522 28,523,$fi4 9,863,278 1,963,130 11,$26,408 3.16 37199'0 523 26,574,676 9,876,874 1,949,534 11,$26,408 3.13 3717% 524 26,fi25,48$ 9,890,449 1,935,959 11,826,40$ 3.11 3715% 525 26,678,300 9,904,004 1,922,404 11,826,408 3.p9 37139'° 52fi 26,727,112 9,917,539 1,908,869 11,826,408 3.07 3711°.6 527 26,777,924 9,931,053 1,895,355 11,826,408 3.05 37.09°~ 528 26,82$,73fi 9,944,547 1,881,861 11,$28,408 3.03 37.07% 529 26,$79,54$ 9,958,021 1,86$,387 17,$26,408 3.00 37.05% 530 28,930,360 9,971,474 1,$54,934 11,826,408 2.98 37.0396 531 26,9$1,172 9,9$4,907 1,841,501 11,826,40$ 2.96 37.01% 532 27,031,984 9,998,320 1,828,088 11,$26,40$ 2.94 38.99% 533 27,QS2,796 10,011,712 1,814,696 17,826,40$ 2.92 36.97% 534 27,133,608 10,025,0$4 i ,$01,324 1 i ,826,408 2.90 36.95% 535 27,184,420 10,03$,436 1,787,972 11,$26,408 2.87 36.93% 536 27,235,232 10,051,7fi7 1,774,641 11,826,408 2.85 36.919'° 537 27,288,044 10,065,078 1,7B1,330 11,$26,408 2.83 36.89°~b 538 27,336,856 10,078,369 1,748,039 11,$28,408 2,81 36.879'° 539 27,387,668 10,091,639 1,734,769 11,826,408 2.79 36.85% 540 27,438,480 10,104,889 1,721,519 11,826,408 2.77 36.83% 541 27,489,292 10,11$,119 1,708,289 11,826,408 2.75 36.81% 542 27,540,104 10,131,329 1,695,079 11,826,408 2.73 36.79% 543 27,590,918 10,144,518 1,681,890 11,826,408 2.70 36.77°1° 544 27,641,728 10,157,686 1,66$,722 11,826,408 2.68 36.75% 545 27,692,540 10.170,835 1,655,573 11,826,408 2.66 36.73°~6 546 27,743,352 10183,963 1,642,445 11,826,408 2,64 36.71% 547 27,794,164 10,197,071 1,629,337 11,826,408 2.62 36.69°/v 548 27,644,976 10,210,158 1,616,250 11,826,406 2.60 38.67°~ 549 27,885,788 10,223,225 1,fi03,183 11,$26,408 2.5$ 36.65% 550 27,946,600 10,236,272 1,590,136 11,826,408 2,56 36.63% 551 27,997,412 10,249,299 1,577,109 11,826,408 2.54 3fi,61°h 552 28,048,224 10,262,305 1,564,103 11,826,408 2.51 36.59°/v 553 28,099,036 10,275,291 1,551,117 11,$26,408 2.49 36.57°/v 554 28,149,$48 10,28$,256 1,538,152 11,826,408 2.47 36.55°/v 555 28,200,660 10,301,201 1,525,207 11,826,408 2.45 36.53% 556 28,25'1,472 10,314,128 1,512,2$2 11,826,408 2.43 36.51°h 557 28,302,284 10,327,037 1,499,377 11,826,409 2.41 36.49°!0 558 28,353,096 10,339,915 1,486,493 11,$26,408 2.39 36.47°/v 559 29403,908 10,352,779 1,473,629 11,828,408 2.37 36.4596 560 26,454,720 1p,365,623 1,460,785 11,826,408 2.35 36.4390 561 28,505,532 10,378,446 1,447,962 11,826,408 2.33 36.41% 562 28,556,344 10,391,249 1,435,159 11,826,408 2.31 36.399'0 563 28,607,156 10,404,031 1,422,377 11,$26,408 2.29 36.37°/v 564 2$ 65'T,968 10,416,794 1,409,614 11,$26,408 2.27 36.35°/v 565 28,708,780 10,429,536 1,396,872 11,826,408 2.25 36.33°k 566 28,759,592 10,442,257 1,384,151 11,$26,408 2.23 36.31% 567 28,810,404 10,454,958 1,371,450 11,826,408 2.20 36.29% 568 28,861,216 10,487,639 1,358769 11,826,408 2.18 36.27% 569 28,912,02$ 10,4$0,300 1,346,108 11,826,40$ 2.16 36.25% 570 28,962,840 10,492,940 1,333,488 11,826,40$ 2.14 36.23% 571 29,013,652 10,505,560 1,320,848 11,826,408 2.12 36.21% 572 29,064464 10,518,160 1,308,248 11,826,40$ 2.10 36.19% 573 29,115,276 10,530,739 1,295,869 11,$26,408 2.08 36.17% 574 29,166,088 10,543,298 1,283,110 11,826,408 2.06 36.15°,6 575 29,216,900 10,555,$37 1,270,571 11,826,40$ 2.04 36,13% 576 29,267,712 10,568,356 1,258,052 11,$26,408 2.02 36.11% 577 29,318,524 10,580,$54 1,245,554 11,$26,408 2.00 36,09% 578 29,369,335 10,593,331 1,2$3,077 11,826,408 1,9$ 36.07% 579 29,420,148 10,605,7$9 1,220,619 t 1,826,408 1.96 36.0596 580 29,470,960 10,61$,226 1,208,182 11,826,408 1,94 36.03% 581 29.521,772 10,630,643 1,195,765 11,826,408 1.92 36.01°~ 5$2 29,572,584 10,643,039 1,183,369 11,826,408 1.90 35.99°/v 583 29,623,396 10,655,415 1,170,993 11,826,408 1.$$ 35.97% 5$4 29,674,20$ 10,667,771 1,158,$37 11,$26,408 1.$6 35.95% 5$5 29,725,020 1p 680,106 1,146,302 11,$2$,408 1.$4 35.93% 586 29,775,832 10,692,421 1,133,987 11,826,40$ 1.82 35.91% 5$7 29,826,644 10,704,716 1,121,692 11,826,408 1.$0 35.89% 5$8 29,877,456 10,716,991 1,109,417 11,826,408 1.78 35.87% 589 29,928,268 10,725,245 1,097,163 11,826,408 176 35.$596 590 29,979,0$0 10,741,479 1,084,929 11,826,408 1 74 35.83°.6 591 30,029,$92 10,753,692 1,072,716 11,$26,40$ 1,72 35.81% 592 30,080,704 10,765,885 1,060,523 11,826,408 171 35.79% 593 30,131,516 10,778,058 1,048,350 11,$26,408 1.69 36.77% 594 30,182,328 70,790,211 1,036,197 11,$26,408 1.67 35.75% 595 30,233,140 10,802,343 1,024,065 11,926,408 1.65 35.73% 596 30,283,952 10,814,455 1,011,953 11,826,408 1.63 35.71°k 597 30,334,764 10,$26,546 999,$62 11.826,408 1.61 35.69°/v 598 30,3$5,576 10,$38,618 9$7,790 11,826,40$ 9.59 35.67% 599 30,438.388 10,850,668 975,740 11,826,408 1.57 35.65°.6 600 30,487,200 10,862,699 963,709 11,826,408 1.55 35.63°~ 601 30,538,012 10,874709 959,69$ 11,828,408 1.53 35.61°/v 602 30,588,824 10,886,699 939,709 11,826,408 1.51 35.59°10 603 30,839,636 10,898,669 927,739 11,826,408 1.49 35.57% fi04 30,690,448 10,910,61$ 915,790 11,826,408 147 35.55% 605 30,741,260 10,922,547 903,$61 11,$26,408 145 35.53% 606 30,792,072 10,934,456 891,952 11,826,40$ 143 35.51% 607 34,842.884 10,94fi,344 880,064 11,826,408 141 35.49% 808 30,893,696 10,958,212 868,196 11,826,408 140 35,47°~6 609 30,944,508 1Q,970,080 856,348 11,826,408 1.38 35.45°~ 610 3Q,995,320 10,981,$87 844,521 T 1,$28408 1.36 35.43°Yo 811 31,046,132 10,993,694 832,714 11,$2fi,408 1.34 35.41% 612 31,098,944 11,005,481 820,927 11,826,408 1,32 35.39% 613 31,147,756 11,017,247 $Q9,161 11,826,408 1.30 35.37% 614 31,19$,568 11,028,993 797,415 11,826,408 1.28 35.35% 615 31,249,380 11,040,719 785,689 71,826,4Q$ 1.26 35.3396 616 31,300,192 11,052,424 773,984 11,826,40$ 1.24 35.319'0 617 31,351,004 11,Q64,109 762,299 11,826,408 1.23 35.2936 618 31,401,816 11 075,774 750,534 11,826,408 1.21 35.27°~ 619 31,452,628 11,087,418 73$,994 11,826,408 119 35.25% 620 31,5Q3440 11,099,042 727,366 11,826,408 117 35.23% 621 31,55x,252 11,11Q,646 715,762 11,826,408 175 35.21% 622 31,605,064 11,122,230 704,178 11,826,408 113 35.19% 623 31,655,876 11,133,793 692,615 11,826,408 111 35.17% 624 31,706,688 11,145,335 6$1,073 11,826,408 1.09 35.15% 625 31,757,500 11,156,858 689,550 11,826,408 1.08 35.13% 626 31,$0$,312 11,168,360 658,048 11,$26,40$ 1.08 35.11 627 31,859,124 11,179,842 646,566 11,826,408 7.04 35.09% 628 31,909,936 11,191,303 635,105 11,82fi,408 1.02 35.07°Y° 629 31,980,748 11,202,744 623,664 11;826,408 1.00 36.Q5% 630 32,011,560 11,214165 612,243 11,826,408 Q.9$ 35.03% 631 32,062,372 11,225,566 600,842 11,826,408 0.97 35.01 632 32,113,1$4 11,236,946 589,462 11 $26,40$ 0.95 34.99% 633 32,163,996 11,248,306 578,102 11,$26,408 0.93 34.97% 634 32,214,808 11,259,645 566,763 11,826,408 0.91 34.95% 635 32.265,620 11,270,965 555,443 11,826,408 0.89 34.93% 638 32,316,432 11,282,263 544,145 11,826,408 0.87 34.91 B37 32,367,244 11,298,542 532,866 11,826,408 0.86 34.89°~, 638 32,418,066 11,304,800 521,608 11,826,408 0.84 34.87% 639 32,x6$,868 11,316,038 510,370 11,826,408 0.82 34.85% 640 32,519,680 11,327,256 499,152 11,826,408 0.80 34.83% 641 32,570,492 11,338,453 487,855 11,826,408 0.78 34.81 642 32,627,304 11,349,630 476,778 11,826,408 0.77 34.79% 643 32,672,116 11,360,786 465,622 11,$26,408 0.75 34 77°h 644 32,722,928 11,371,923 454,485 11,828,408 0.73 34 75°10 645 32,773,740 11.383,039 443,369 11,$26,408 0.71 3473°~ 646 32,$2!F,552 11,394,134 432,274 11,828,408 0.69 34 71°~ 647 32,875,364 11,405,210 421,198 11,$26,408 0.68 34.89% 648 32,928,176 11,416,265 410,143 11,826,40$ 0.66 34.67°~ 649 32,976,988 11,427,299 399,109 11,826,40$ 0,64 34,65°~ 650 33,027,800 11 438,314 3$$,094 11,826,408 0.62 34.63°!0 651 33,07$,612 11,449,308 377,100 11,826,408 0.61 34.61% 652 33,129,424 11,460,281 366,127 11,826,40$ 0.59 34.59% 653 33,180,236 11,471,235 355,173 11,826,408 0.57 34.57% 654 33,231,048 11,482,16$ 344,240 11,828,408 0.55 34.559'0 655 33,281,860 11,493,080 333,328 11,828,408 0.54 34.5336 856 33,332,672 11,503,973 322,435 11,826,40$ 0.52 34.51°k 657 33,383,4$4 11,514,845 311,563 11,826,408 0.50 34.49% 658 33,434,298 11,525,697 300,711 11,826,408 0.48 34.47°~ 659 33,485,108 11,536,528 288,880 11,826,408 0.47 3445% 660 33,535,920 11,547,339 279,069 11,826,408 0.45 3443% 661 33,586,732 71,558,130 26$,27$ 11,826,408 Q.43 34.41% 682 33,637,544 11,568,900 257,508 11,826,40$ 0.41 34.39°10 B63 33,68$,356 11,579,650 246,758 11,826,40$ 0.40 34.37°1° 664 33,739,168 11,69Q,380 236,028 11,826,40$ 0.38 34.35% 665 33,78$,880 11 601,090 225,318 11,826,408 0.38 34.33°/a fi66 33,840,792 11,611,779 214,629 11,82$,408 0.35 34.31% 667 33,891,604 11,622,448 203,980 11,826,408 0.33 34.29% 668 33,942,416 11,633,096 193,312 11,826,408 0.31 34.27°k 669 33,993,228 11,643,724 1$2,684 11,826,40$ 0.29 34.25% 670 34,044,040 11,654,332 172,076 11,826,408 0.28 34.23% 677 34,094,852 11,664,920 161,488 11,826,408 0.26 34.21 Q/° 672 34,145,664 11,675,4$7 150,921 11,826,408 O.z4 34.19% 673 34,186,476 11,686,034 140,374 11,826,40$ 0.23 34.17% 674 34,247,28$ 11,696,560 129,$48 11,826,408 0.21 34.15°~ 675 34,298,100 11,707,066 119,342 11,828,408 0.19 3413% 676 34,34$,912 11,717,552 108,856 11,826,40$ 018 34.11% 677 34,399,724 11,728,018 98,390 11,$26,408 0.16 34.09°,G 67$ 34,450,536 11,738,463 87,945 11,926,408 0.14 34.07% 679 34,501,348 11,748,888 77,520 11,826 408 0.12 34.05% 680 34,552,160 11,759,293 87,115 11,826,408 0.11 34.03°~ 681 34,602,972 11,769,677 58,731 11,826,408 0.09 34.01 682 34,6:-3,784 11,7$0,041 46,367 71,826,408 0.07 33.99% 683 34,704,596 17,790,384 36,024 11,826,408 0.06 33,97°~ fi&4 34,755,408 11,800,708 25,700 11,$26,408 0.04 33.95% 685 34,$Ofi,220 11,811,011 15,397 11,$26,408 0.02 33.93°~ 686 34,857,032 11,$21,293 5,115 11,826,408 0.01 33.91 6$7 34,907,844 11;831,556 (5,14$} 11,826,408 {0.01) 33.89% 688 34,958,656 11,841,798 (15,390) 11,826,408 (0.02) 33.87% 689 35,009,468 11,852,019 (25,611) 11,826,408 (0.04) 33.$5% 690 35A60,280 11,862,221 (35,813) 11,$26,408 (0.06} 33.$3% 691 35,111,092 11,872,402 {45,994) 11,626,408 (0.07) 33.81% 692 35,161,904 11,882,562 (56,154) 11,826,408 (0.09) 33.79% 693 35,212,716 11,892,703 (66,295) 11,826,408 (0.11} 33.77% 694 35,283,528 11,902,$23 (76,415) 11,$26,408 (0.12) 33.75% 695 35,314,340 11,912,922 (86,514) 11,826,408 (0.14) 33.73% 696 35,365,152 11,923,002 (96,594) 11,826,408 (016) 33.71% 697 35,415,964 11,933,061 (106,653) 11,826,408 (0.17) 33.699'0 698 35,466,776 11,943,f00 (716,692) 11,826,408 (0.19) 33.67% 699 35,51;7,588 11,953,11$ (126.710) 11,826,408 (0.20) 33.65% 700 35,56$,400 11,963,116 {138,708) 11,826,40$ (0.22) 33.63% 701 35 619,212 11,973,094 (146,686} 11,826,408 (0.24) 33 61% 702 35,67.0,024 11,9$3,051 (156,643} 11,$26,408 (0.25) 33.59% 703 35,720,836 11,992,988 {166,580} 11,$26,408 (0.27) 33.57% 704 35,771,648 12,002,905 (176,497) 11,826,408 (0.28} 33.55% 705 35,822,460 12,012,802 (186,394} 11,826,408 (0.30) 33.53% 706 35,$13,272 12,022,678 (196,270} 11,S26,a08 (0.32) 33.51% 707 35,924,084 12,032,534 (206,126) 11,$2fi,408 (0.33) 33.49% 708 35,974,896 12,042,369 {215,961) 11,826,408 (0.35) 33.47% 709 36,025,70$ 12,052,184 (225,776) 11,826,40$ (0.36) 33.45% 710 36,076,520 12,061,979 (235,571) 11,$26,408 (0.38) 33,43°~ 711 36,127,332 12,071,754 {245,346) 11,826,408 (0.39) 33.41% 712 36,178,144 12,0$1.508 (255,100) 11,826,408 (0.41) 33.39% 713 36,228,956 12,091,242 (264,834) 11,826,408 (p.a3) 33.37°i° 714 36,279,768 12,100,955 {274,547) 11826,408 (0.44} 33.35°~ 715 36,330,5$0 12,110,648 (284,240) 11,826,408 {0.4$) 33.33% 718 36,38~K,392 12,120,321 (293,913) 11,826,408 (047) 33,31% 717 35,432,204 12,129,974 (303,566) 19,626,408 {0.49} 33.29% 77$ 36,483,016 12,139,$06 (313,198) 11,826,408 (0.50) 33.27% 719 36,533,$2$ 12,149,218 (322,$10) 11,$26,40$ (0.52} 33.25% 720 36,584,640 12,158,810 (332,402) 11,$26,408 {0.53) 33.23% 721 36,635,452 72,168,381 (341,973) 11,$26,40$ (0.55) 33.21% 722 36,686,264 12,177,932 (351,5'24) 11,826,40$ (0.57) 33.19% 723 36,737,076 12,187 463 {361,055) 11,826,408 (0.58) 33.17`Y° 724 36,7$7,8$$ 12,996,973 {370,585) 11,826,408 (0.60) 33.15% 725 36,838,700 12,206,463 (380,055} 11,626,408 (0.61) 33.13% 726 36,889,512 12,215,932 (389,524} 11,826,408 {0.63) 33.11% 727 38,940,324 12,225,382 {398,974} 11,826,408 (0.64) 33.09% 728 36,991,136 12,234,811 (408,403) 11,826,408 {0.66) 33.07% 729 37,041,948 12,244,219 (417,811} 11,$28,408 (0.67) 33.06% 730 37,092,760 72,257,315 (430,907) 11,82fi,408 (0.69} 33.05% 731 37,143,572 12,270,407 (443,993) 11,826,408 {0.71) 33.04% 732 37,194,3$4 12,283,477 (457,069} 11,826,408 (0.73) 33.03% 733 37,245,196 12,296,542 (470,134) 11,$26,408 (0.76) 33.02% 734 37,296,00$ 12,309,598 (483,190) 11,826,408 (0 78) 33.01% 735 37,346,820 12,322,643 {49$,235) 11,$26,408 (0.80J 33.04% 736 37,397,fi32 12,335,678 (509,270) 11,826,408 (0.82) 32.99% 737 37,44$,444 12,34$,702 (522,294} 11,$26,408 (0.84) 32.98% 738 37,499,256 12,361,717 {535,309) 11,826,408 (0.86) 32.97°.6 739 37,550,068 12,374,722 (548,314) 11,826,408 {0.8$} 32.9696 740 37,fi00,$$0 12,387,716 (5fi1,308) 11,826,408 {0.90) 32.95°k 741 37,651,692 12,400,700 (574,292) 11,826,408 (0.92) 32.94°,6 742 37,702,504 12,413,674 (587,266) 11,$2fi,40$ (0.94) 32.93°~ 743 37,753,316 12,426,fi38 (600,230) 11,826,408 (0.97) 32.92% 744 37,804,128 12,439,591 (613,183) 11,826,408 (0.99} 32.91°k " Change the;papulation # in cell M11 $nd copy all the way down the spreadsheet Popul2tion of Authority 621,9$8 Transports 50,812 Base Collection Rate 0.3759 Change in Collections 0.33 TotallRevenue Required 11,826,408 Average BIII 502 Emergenry Rate Premium Percentage 0.57 Percentage of Emergency Calls to Total Calls 0.43 Non-Emergency Rate 403 Emer,~genry Rate 633 Exhibit D MEMpRANDUM OF UNDERSTANDING Phis Memorandum of Understanding is to confirm the discussion of the tentative al,~reements reached w2th respect to some of the issues involved in the conversion of the paramedic service arrangement to a countywide "Enterprise Fund Model " This understanding is based on previous discussions between representatives of Texas Lifeline Corporation (herein "TLC"), Richard Neuhaus, members of the Fort Worth Ambulance Authority, its consultant, Jack Stout, and the November 1987 report to the Fart Worth Ambulance Authority from the Fourth Party, Inc. by Jack Stout entitled "Expanding the MedStar System: l.ssues, Options, and Recorrnnendations" The parties acknowledge that this Memorandum of Understanding does not constitute a contract but will be attached to and incorporate in the Interlocal Cooperative Agreement and serve as a guide for the new contract to be executed between TLC and the Multi-Jurisdictional Ambulance Authority These understandings are summarized as follows: 1, Ambulance Authority The Fort Worth Ambulance Authority would be converted to a multi jurisdictional agency (herein the "Multi-Jurisdictional Ambulance Authority"} pursuant to the .Interlocal Cooperative Agreement. The Multi-Jurisdictional Ambulance Authority would be a legal entity separate from its city members and would own, control, manage, and admutister the accounts receivable and the billing system. Title to infrastructure property and equipment would be transferred to the Multi- Jurisdictional Ambulance Authority by the City of Fort Worth on some basis to be negotiated between the two on them. The contract between the City of .Fart Worth and TLC would be renegotiated and replaced with a new contract between TLC and the lv[ulti-Jurisdictional Atttbulance Authority on the basis of tears and conditions set forth in this Memorandum of Understanding and as negotiated to the extent not agreed to herein. The term of the contract would be extended by thirty-nine (39) months with'the same prov~sians for earned renewals as are included in the current contract. 2. Fer Capita Management Fee The contract between TLC and Multi-Jurisdictional Ambulance Authority will provide for compensation to the contractor on the basis of a per capita rate multiplied by the population in the service area under agreement with the Mu1ti- Jurisdictional Ambulance Authority each time a city is added. The per capita fee will be arrived at using the following methodology: l.) Using Fort Worth historical demand, determine the annual grass volume of infra jurisdictional transports and multiply times $230 00 per emergency transport and $153.33 per non-emergency transport to arrive at a projected gross revenue figure; 2.) Multiply the projected gross revenue figure by 63% to arrive at a projected net revenue (under the Faiisafe Franchise Model) figure; 3) Subtract the actual cast of billing and collection, ` 4) Subtract $3 00 per transport, far payment of the EPAB fee which will no Langer be the responsibility of the contractor; 5) Add the annual amount of first year subsidy from Fort Worth, $875,000 00; 6 }Divide the total amount by the population covered (using COG official figures), to arrive at a per capita figure; 7.} Adjust the per capita figure by the CFI; 8.) Adjust the per capita figure to account for the changes in the definition of the expanded Service Area. Bath parties agree that an adjustment needs tv be negotiated to reflect the differences in the extended Service Area, and then 9) Multiply the per capita fee, thus calculated, times the population in the newly contracted Service Area (again using the CaG figures), and dividing by 12 to determine a Base Monthly Fee for infra-jurisdictional work (excluding "extra-work" items). In na event will the total monthly payment be reduced (because o~ reduction in Service Area size or population} without at least 365 days prior notice unless a member city withdraws for due cause, based on contractor's default as defined in the Iriterlocal Cooperative Agreement. In addition, the contractor will be paid for "extra work", for long distance transfers, special events coverage, DRG transports, and transports in excess of the current per capita transport rate in the City of k'ort Worth. The fees for various categories of "extra. wank" have not yet been negotiated but would be similar to such terms as they appear in the Pinellas County RFP The per capita rate would be discounted by two percent (2%) after total population in the service area exceeds 700,OQ0 and by one percent (1%) additional for each incremental population increase of 42,000 up to a maximum discount of fourteen percent (14%). 3 Existinst Accounts Receivable The parties have agreed to conduct an independent appraisal of the net value of outstanding accounts receivable based on current collection practices less the reasonable casts of collection and will not be reduced by a present cash value discount. All outstanding accounts receivable would then be assigned by TLC to the new Multi-Jurisdictional Ambulance Authority The Multi-Jurisdictional Ambulance Authority would give TLC a negotiable promissory note for the agreed upon net value of transferred accounts receivable. The note would bear no interest for the first year, interest at the rate of nine (9%} thereafter ar the rate charged by Texas American Bank on the existing operating capital loans, whichever is less, and will be payable in twenty-four (24} months after the date on which the accounts receivable are transferred. That note andlor the accounts receivable would continue to collateralize the existing operating capital loans form Texas American Bank. TLC would continue to be responsible for interest on the operating capital loan For twelve (12} months after the date the accounts receivable are transferred. This arrangement will be subject to the approval of Texas American Bank. 4 Billing System Hardware, Software and Mana eg_nnent ' Consultuia/Maintenance TLC proposes to lease its billing system hardware, software and software support (including upgrades) to the new Multi-rur,sdictional Ambulance Authority for a monthly fee equal to its actual cost, beginning August 1, 1988. 1n addition, TLC will provide management consulting and system maintenance services for $2,500 per month. Bath arrangements will be for an Initial term of six (6) months, Thereafter the Multi-Jurisdictional Ambulance Authority will have the option to continue a]1 or a portion of the arrangement to purchase either the computer hardware (for its fair market value, but for not less than the amount of any unamortizcd debt on said hardware} or the software package or to terminate the use of the hardware and software without penalty In the event it ~s the Multi- Jurisdictional Ambulance Authority's decision to termnate said use, TLC shall cooperate fully in effecting the conversion of the data to the Authority's new system. 5 Three-Way Lease Agreement The existing three-way lease agreement covering ambulances and medical equipment between TLC and Fort Worth Ambulance Authority would be assigned by the Fort Worth Ambulance Authority to the Multi-Jurisdictional Ambulance Authority The Fort Worth Ambulance Authority would not be released under the current lease without the prior consent of Texas American Bank, however., under no circumstances would the dollar amount if its liability be increased above the then current level. All new equipment purchased by TLC to be used under the contract would be leased directly to the Multi-Jurisdictional Ambulance Authority and subleased to TLC. The Fort Worth Ambulance Authority would not be involved as a master lessee and there would be no actual or implied guaranty of the lease arrangement by the City of Fort Worth or the Fort Worth Ambulance Authority A11 ambulance and medical equipment currently owned by 1Vleissner- Brown which would be used under the contract would be leased by Meissner- Brown to the Multi-Jurisdictional Ambulance Authority which would sublease to TLC. The lease payments to Meissner-Brown will be set afi a monthly rate necessary to amortize the current value of the leased equipment over its remaining useful life, but not more than the amount of the sub-lease payments related to the sarne'equipment paid to the Multi-Jurisdictional Ambulance Authority by TLC. G. Subscription Program TLC will send a letter to all current subscribers soliciting renewals for a sixteen (16) month term beg,nning April 1, 14$$. TLC's direct costs will be reimbursed from the renewal proceeds anti the balance shall be divided pro rata as of the conversion date the Multi-Jurisdictional Ambulance Authority assumes control over the system. As consideration for transfer of the subscription rights, the Multi-Jurisdictional Arnbufance Authority will pay $5$,500. 7 Meissner-Brown The parties acknowledge that TLC has purchased the assets and goodwill of Meissner-Brown on an itt5tallment contract amortized over seven (7) years. The parties further acknowledge that the contemplated system conversion will result in a partial ar total merger of the Meissner-Brown operation into the Medstar operation, in the event the TLC contract should be terminated prior to full amortization of the purchase price of Meissner-Brawn, the Multi-J'urisdictianal Ambulance Authority will continue to make payments to Meissner-Brown for the amortized cost of the goodwill portton of the Meissner-frown purchase. In return, TLC and Meissner-Brown will waive any and all claim they .may otherwise have 'ta the assets and goodwill value in the Meissner-brown operations being contributed to the converted ambulance system. $ Service to Non-Conti aus Urban Areas and Suburban Areas The parties acknowledge that service to non-contiguous urban areas and to suburban areas is more expensive for the same level of service because of greater distances and time between revenue producing transports. Additionally, on a per capita contract, the population base is too small to justify the same level of response time commitment. Therefore, it is understood that the contract between TLC and the Multi-Jurisdictional Ambulance Authority will provide for a higher per capita fee to such areas or, in the alternative, a lower level of response time comtnitrnent commensurate with the greater expense attributable in fihose areas, provided however, that in na event shall the City of Fort Worth receive a lower level of service or a higher price/ subsidy cambinafiion than that already established under its current contract with TLC (except for ordinary inflation of the Uniform Schedule of Price(Subsidy aphons as approved by the Multi- Jurisdictional Ambulance Authority), Attached is a proposed table of response time commitments for the per capita fee described in paragraph #2 above. 9 Termination of Interim A rgreement Although no formal, written interim agreement was executed in the spring of 1987, the major elements of the recommendations included in the Fourth Party's "Twelve Thousand Mile Tune-Up" report have been Implemented. It is agreed that the new contract contemplated in this Memorandum of Understanding would supersede and terminate such intenm understandings, that the increase in subsidy payments will terminate with the March 10, 19$$ payment and that the increased fee for service will remain in effect until the new contract becomes effective August 1, 1988 This letter sets forth all the issues the resolution of which the parties considered critical to a determination to move forward with the contemplated EMS system conversion and expansion to a multi jurisdictional service. However, the parties acknowledge that there are many other issues which have been discussed and will be addressed in greater detail during ncgatiation of the new contract. Those additional issues include but are not necessarily limited to assignment of existing Messner-8tawn contracts to the Multi- Jurisdictional Ambulance Authority, drafting and executing an Interlocal Cooperative Agreement which includes provisions for first responders and agreement to appoint EPAE as the medical control authority, upgrading and/or replacing the dispatch center, establishing facilities for a training center, refinancing and remodeling the existing building, drafting and adopting a model ordinance including provisions regarding wheelchair service, and financing the acquisition of :ETAK. Contiguous 1Von-Contiguous CI P L a ~I Priori Time Reliability Priori Time Reliability 1 ° 8 min 90% 1 ° 10 nun 80% 2 ° l 0 min 90% 2 ° 12 min 80% 4 ° 3 ° 5 ° 60 min 90% 4 ° 3 ° S ° '90 min 80% , , , , Priori Time Reliability Priori Time Reliability 1 ° 20 nun 90% 1 ° 12 min 80% 2 ° 12 rtun 90% 2 ° 14 min 80% 4'° 3 ° S ° GO min 90% 5 4 4 ° 3 ° 90 rrun 80% , , , , Priori Time Reliabili 1 ° 15 min 70% 2 ° 1 S min 70% 3°,4°,S° 90 min rte 70% .