HomeMy WebLinkAboutAdden 1 •1mA CAG-19-320, Adden #1-19
HEALTHCARE MANAGEMENT ADMINISTRATORS
Addendum to the Administrative Services Agreement
ACA Reporting Services Contract
We appreciate your decision to engage HMA and our partner MZQ Consulting, LLC to provide ACA
Reporting Services. This confirms our understanding with you regarding the services offered.
This Agreement(the"Agreement")is between HMA and City of Renton("the City"), (collectively,the
"Parties").
Article 1:Services:
The City wishes to engage HMA/MZQ to provide one or more of the ACA Reporting Services ("Services")
listed below: (check the options desired)
X Option 1:2019 Reporting Service: MZQ will prepare and file Form 1094-C and Form 1095-Cs with
the IRS on behalf of the City for the 2019 calendar year, print and distribute Form 1095-Cs to employees,
and will provide an electronic file of the appropriate Form 1095-Cs to the City for its records.
Option 2: Full-Time Employee Tracking: MZQ will analyze payroll data to assist the City in
determining who is a "Full Time"employee for purposes of Section 4980H of the Internal Revenue Code.
Such services will be provided for the stability period(s) beginning: N/A
Fee Summary
Option 1:
Base Fee for Reporting Services $4,000
Estimated Form 1095-C Count(565*$14)t $7,910
Additional EINs for reporting(0 * $500) $0
Total Estimated Cost (for 2019) $11,910
t If actual forms produced deviate by 10%or more from the initial form estimate to be produced herein,then the pricing shall be adjusted,if
applicable,accordingly to the corresponding pricing tier as published. Final cost obligations are determined by the final count of approved forms
actually produced.
The form counts herein are estimates only based on the number of forms that you forecast to be
produced. If your forecasted form count needs have changed, please notify us immediately.
For reporting services, an initial deposit of$7,955.00 which is comprised of the base fee plus 50%of the
total estimated per form cost, is due upon completion of this agreement. The balance owed will be
determined based on the actual number of forms ultimately produced and approved by the City,and
will be due March 1,2020.
ACA reporting Services 2019
Fulfillment costs: Fees include the submission of Forms 1094-C and 1095-C to the IRS and the printing
and mailing of Form 1095-Cs to employees.
Additional entities: if additional EINs are to be reported on behalf of,an additional$500 fee applies per
EIN supplied.
EIN to be filed for:91-6001271
Additional EINs: N/A
Option 2:
Annual Fee for FTE Tracking$15 per Employee per year(710* $15) Not Purchased
Additional calculations requested during the year: ($500 each time): Annual Only
_Semi-annual: (1*$500=$5000)
_Quarterly: (3*500=$1,500)
Monthly: (11*$500=$5,500)
Additional EINs to be processed: $500 per each additional EIN _ Not Purchased
Total Estimated Cost (for 2019) Not Purchased
For FTE tracking services, annual fee of N/A is due upon completion of this agreement.
Payment Schedule
An initial deposit of the base fee plus 50%of the total estimated per form cost is due December 1, 2019.
HMA will bill you on your next regular invoice for the fees owed at this time.
The balance for 2019 reporting costs is due March 1,2020.
Description Date Due Amount
Deposit: Base Fee(s) and 50% of Estimated Per December 1, 2019 $7,955
Form Fees.
Final Balance: Account Balance Based on Forms March 1,2020 To be determined based on
Filed year-end true up
Article 2:Terms&Conditions:
The City acknowledges and understands that the City authorizes and directs HMA and MZQ to perform
the services specified above. Neither HMA nor MZQ is rendering legal or financial advice in connection
with the Services nor will HMA or MZQ be deemed a fiduciary of the City or the employer or co-
employer of the City's employees for purposes of providing Services. Neither HMA nor MZQ will be
responsible for the City's compliance with federal,state,or local statutes regulations,or ordinances.
ACA reporting Services 2019
2.1 Terms.The initial term will be from the date of this Agreement until March 31"of the following year.
The City acknowledges that each of the Services may have separate"Service Effective Date"and MZQ
may commence performance of one (1) or more of the Services without obligating itself to commence
all of the Services selected by the City. Until the Service effective Date,the City shall continue to provide
for itself the Services requested of HMA/MZQ. Neither HMA nor MZQ is responsible for the payment of
penalties or the filings of returns prior to the Service Effective Date.
The City acknowledges and understands that to the extent it fails to furnish complete calendar year
information,and as applicable Plan year data for Option 2,HMA/MZQ will not be able to fulfill its
obligations under this Agreement. In such cases, MZQ will notify the City of its inability to perform and
the City shall assume responsibility for completing and timely filing its forms. No fees will be refunded.
HMA/MZQ will provide the City access to all Information the City had provided. Additionally,should the
the City terminate its TPA Services with HMA,or request to terminate these Services prior to the end of
a calendar year, HMA/MZQ will not complete forms 1094-C or 1095-C, as applicable, but will provide the
City access to its information for a period of six(6) months after termination. If the City requires
information after this time frame, MZQ, may in its sole discretion,apply an information retrieval fee.
2.2 Termination. HMA reserves the right on behalf of itself and MZQ to terminate this contract if the
City fails to timely pay any fees and/or expenses that have been billed to the City.The City fails to timely
pay any fees and/or expenses that have been billed to the City. The City may terminate this Agreement
at any time upon written notice to HMA. If the engagement is terminated,the City will be liable for all
fees and expenses incurred to the date of termination. For this purpose,the base fee, or annual fee will
be considered "incurred"as the date this Agreement is signed. Notwithstanding the foregoing,in the
event that the Administrative Services Agreement between the City and HMA is terminated for any
• reason,the services under this Agreement will automatically terminate as of the date the ASA
terminates and will not be available for run-out purchase.
Article 3: Billing&Payment
3.1 Billing. HMA will bill the City according to the fees Schedule set out above for all fees and expenses.
3.2 Late Payment interest charges.Any bill outstanding more than 60 days will incur an interest carry
charge of 1% per month,which will be added automatically to the bill/Statement,and which the City
agrees to pay.
3.3 Other Expenses. In addition to the fees outlined above, HMA will charge the City for any actual out-
of-pocket costs that are incurred in rendering services. These costs may include travel expenses,
delivery and courier services, express mail,air courier services and outside contractor document
reproduction. HMA may ask the City to pay directly any expenses in excess of$100.00.There is no mark-
up on out-of-pocket costs.
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ACA reporting Services 2019
Article4:GeneralTermsandConditions4.1DisclaimerofWarranties.InnoeventwillHMAorMZQhaveliabilityforanyconsequential,special,punitiveorindirectlossordamagesregardlessofwhethersuchdamagesarebasedoncontract,tort(includingnegligence)orstrictliability,oranyothertheoryorformofactionorwhetherproviderkneworshouldhaveknownofthelikelihoodofsuchdamagesinanycircumstances.TheCityacknowledgesthatHMAandMZQmakenowarranties,expressorimplied,includingwithoutlimitationthewarrantiesofmerchantabilityandoffitnessforaparticularpurpose.4.2Confidentiality.MZQ,itsemployeesandagentswillholdinstrictconfidencealldatafurnishedbytheCityorproducedbyMZQunderthisAgreement.However,suchpartieswillnotbeheldliableifsuchdataisreleasedthroughothersources,orifMZQ,itsemployeesandagentsreleasethedatabecausetheCityhasconsentedtosuchdisclosure.TheCityacknowledgesandagreesthatHMAshallbeentitledtoatminimumstatisticalinformationregardingtheCity’suseoftheServicesanditsaffiliatesforanalysispurposes.4.3RecordRetention.ThisAgreementdoesnotrelievetheCityoftheCity’sobligationsunderFederalorStateLawsorregulationstoretainrecordsrelatingtothedatacontainedinHMAorMZQ’sfiles.4.4Assignability.ThisAgreementmaynotbeassignedbyeitherpartywithouttheexpresswrittenconsentoftheotherparty,whichconsentshallnotbeunreasonablywithheld,exceptthatHMAandMZQmaydelegateandassignanyofitsdutieshereundertoanyaffiliateortoathirdpartysubcontractor,withouttheneedforpriorapproval.4.5Authority.TheundersignedwarrantsandrepresentsthattheundersignedhasfullpowerandauthoritytoenterintothisAgreement,tobindeachPartyhereto,andtogranttherightssetforthherein.4.6Severability.IfanyterminthisAgreementisheldbyacourtofcompetentjurisdictiontobeinvalidorunenforceable,thentheAgreement,includingalloftheremainingterms,willremaininfullforceandeffectasifsuchinvalidorunenforceableprovisionhadneverbeenincluded.Pleaseindicateyouracceptanceofthesetermsbydating,signingandreturningacopyofthisAgreement.ThepricingoutlinedhereinisonlyvalidforAgreementssignedandreturnedtoHMAbyNovember26th2019.ThePartiesherebyenterintothisAgreementasofthedatesignedbytheCitybelow.TheCityofRentonHealthcareManagementAdministrators,Inc.By:___________________________By:___________________________Name:tJ119-4m.-‘)-‘ttkName:___________________Title:&dfrv,y5vC7LDyTitle:_______________________Title:cSITitle:______________________ACAreportingServices2019DocuSign Envelope ID: 98015C22-76B5-4E9D-9D51-5A33FD1562EFChief Growth OfficerJanuary 7, 2020 | 7:41 AM PSTLindsay Harris