AMENDMENT TO EMPLOYMENT AGREEMENT

This amendment (Amendment) to the EMPLOYMENT AGREEMENTbetween and ______, MD (“Physician”), effective ______(the “Agreement”), is made and entered into as of the___ day of ______, 201__ and provides as follows:

  1. All terms used herein shall have the meaning as ascribed to them in the Agreement unless otherwise defined.
  1. The Agreement is amended by adding the following Paragraphs:

Clinical Chief of and Medical Director for :

Job Description: Partners with the VP & Senior Medical Director for ______with support from the assigned VP of Operations and Senior Operations Directors to define, plan, develop, implement and oversee clinical programs and systems to guide and attain the goals of the Division of .

Physician shall provide the following services for :

  1. In partnership with the leadership of , develop and implement internal goals for the Division
  2. Coordinate goals of the Division with corporate goals
  3. Participate in leadership activities as assigned by the Corporate VP and President including but not limited to serving on the Clinical Chiefs Council
  4. Develop in partnership with the Corporate VP and President and the Senior Medical Director for annual goals to determine the basis for the annual incentive opportunity as referenced below
  5. Develop in partnership with the Senior Medical Director for the structure, membership, roles and responsibilities of the Task Force
  6. Serve in the role of Services Medical Director

Terms and Additional Compensation: For the above services:

  1. Physician will maintain base salary draw at current level
  2. Physician will provide the services of the Clinical Chief of and Medical Director of Services as listed above for an additional stipend of per month.
  3. ______will establish % of Chief’s stipend as annual incentive opportunity contingent upon meeting mutually developed and agreed upon annual goals
  1. This Amendment shall terminate automatically upon termination of the Agreement; however, the parties may terminate this Amendment separately from the Agreement in accordance with the terms of the Agreement.

IN WITNESS WHEREOF, the undersigned has duly executed this instrument as of the day and year first written above.

PHYSICIAN

By: By: ______

Its:

Date: ______Date: ______

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