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PREMIER HOME HEALTH CARE SERVICES, INC., ITS SUBSIDIARIES AND d/b/a COMPANIES POLICY AND PROCEDURE MANUAL <br />2 <br />MAY NOT BE REPRODUCED OR USED IN WHOLE OR PART WITHOUT THE EXPRESSED WRITTEN CONSENT OF PREMIER HOME HEALTH CARE SERVICES, INC. <br /> <br />G. Third-party payers for the Agency. <br /> <br />H. Agencies, organizations, or associations whose activities effect the operations of <br />Premier Home Health Care Services, Inc. <br /> <br />I. Financial situations receiving money from, or loaning money to, the Agency. <br /> <br /> <br />J. Persons or entities who seek to acquire or engage in business arising out of inventions, <br />creations, ideas, or items created in whole or in part out of an employee’s services to The <br />Agency during an employee’s work time at the Agency or by use of the Agency facilities <br />or equipment. <br /> <br />Such a Conflict of Interest would arise when an employee, officer, agent, or any member <br />of his or her immediate family, his or her partner, or an organization which employs or is <br />about to employ any of the parties indicated herein, has a financial or other interest in or <br />may receive a tangible personal benefit from a firm considered for a contract. <br /> <br />Annually, each covered person must review and disclose each potential conflict of <br />interest. This responsibility is continuing; covered persons must scrutinize their <br />transactions, and if any potential conflict of interest arises during the year, the <br />covered person must immediately report the potential conflict. <br />Disclosure shall be made to the Compliance and Privacy Officer (CPO). The CPO shall <br />then determine whether a conflict exists. <br /> <br /> <br />CERTIFICATE OF CONFLICT OF INTEREST <br />I have carefully read the foregoing Statement of Policy concerning Conflicts of Interest. <br />In signing this certificate, I hereby certify that except as here in stated, I do not have any <br />of the relations described in Section IV <br /> <br /> <br /> <br />Signature: ________________________________ Dated: __________________ <br />Name (Print) ______________________________ <br /> <br /> <br />Instructions <br />If you are in doubt whether a conflict or potential conflict of interest exist, please <br />describe below the circumstances <br />Docusign Envelope ID: A279FDA3-A3EA-4462-96A1-4D0131C7C9ED