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HomeMy WebLinkAboutMinutes - January 15, 2002 SSCITY OF LODI INFORMAL INFORMATIONAL MEETING "SHIRTSLEEVE" SESSION CARNEGIE FORUM, 305 WEST PINE STREET TUESDAY, JANUARY 15, 2002 An Informal Informational Meeting ("Shirtsleeve" Session) of the Lodi City Council was held Tuesday, January 15, 2002 commencing at 7:02 a.m. A. ROLL CALL Present: Council Members — Hitchcock (arrived at 7:04 a.m.), Howard, Land, Nakanishi (arrived at 7:08 a.m.), and Mayor Pennino Absent: Council Members — None Also Present: City Manager Flynn, City Attorney Hays, and City Clerk Blackston B. CITY COUNCIL CALENDAR UPDATE City Clerk Blackston reviewed the weekly calendar (filed). C. TOPIC(S) C-1 "Paramedic Study' City Manager Flynn stated that it is important to determine whether or not paramedics are a core service. He explained that insurance companies provide reimbursement for transporting patients and consequently this element is critical in paying for the service. He noted that American Medical Response (AMR) has nearly a monopoly on ambulance service in the area. Fire Chief Pretz reported that he and other members of the Fire Department have spent several months developing a paramedic program study. He stated that fire based Emergency Medical System (EMS) is an extension of public health. In 2001 the Lodi Fire Department responded to 4,240 calls for assistance, which represents an increase of 13.1 % over the previous year. Of these calls, 70% were medical emergencies. The Fire Department arrived first on the scene of these medical emergencies 66.4% of the time. The City's General Plan provides for response to emergencies within three minutes driving time and one minute reaction time. San Joaquin County's response time criteria for Advanced Life Support (ALS) services is eight minutes, 59 seconds. Chief Pretz stated that a fire based paramedic program can be implemented without additional cost to the taxpayers. He noted that the Manteca Ambulance District is a not-for-profit agency that has been operating successfully for a number of years. Chief Pretz reviewed the following three options: Option #1 Places two Fire Department ambulances into service and requires hiring 12 new firefighter paramedics and an administrator. A third ambulance would be purchased and used as a reserve as necessary. He believed that this option would produce a revenue stream that covers the cost of providing the service, and qualified this statement by providing the following cost breakdown: • Based on the 2001 Census population of 57,000; 9.3% of the population uses emergency services, 75% of which require transport • 5% of the transports are canceled in route • 52% are categorized as ALS and 48% are basic life support • Annual gross billing is estimated at $1.4 million • 7.5% on the gross would be paid to a billing agency • Personnel costs are estimated at $844,000 0 Vehicle operation and maintenance (for two vehicles) is $56,000 Continued January 15, 2002 • A lease purchase (for three vehicles fully equipped) carried out over a seven year period would cost $54,000 • Net recovery cost is estimated at $103,000 Option #2 Places one Fire Department ambulance into service for an annual cost of $97,000 to the City. Option #3 Requires hiring 12 new firefighter paramedics and one administrator. Firefighter paramedics would be placed on current fire apparatus. No revenue stream would be generated. For Option #3, AMR has offered training, access to their supply networks, and payment of the differential between firefighter and paramedic salaries. Chief Pretz noted that he had spoken with several fire departments about this type of agreement and they advised him to be cautious. Mike McGrane, Budget and Policy Review Manager for the City of Sacramento, reported that in 1994 the Sacramento City Council authorized the Fire Department to implement paramedic and transport service, and since that time, they have operated it without tax subsidies. They have increased rates twice, at an average of less than 1% and have accumulated resources in excess of $4 million, which can be put back into the program or offset the cost of the dispatch center. Council Member Land asked whether there was a private company providing the ambulance service at the time the Sacramento Fire Department implemented their new services. Sacramento Deputy Fire Chief Rod Chong reported that there were four private companies providing ambulance service for Sacramento County. The Fire Department started with a trial run on one third of the city. He noted that AMR put an injunction on the Fire Department in 1995; however, the City won the suit. He stated that they have a "seamless system" with over 40 ambulances in operation. In response to Mayor Pennino, Deputy Chief Chong stated that it took 1.5 years to implement the service. In answer to questions posed by Council Member Nakanishi, Deputy Fire Chief Chong reported that their population is 420,000, they have over 500 firefighters, a $60 million budget, and over $8 million in gross annual revenue. They used Long Beach as a model when developing their firefighter paramedic transport service. Mr. McGrane replied that the City Council has chosen to keep the $4 million in reserves. Sacramento initially implemented the service in two phases and began with four ambulances at a cost of $70,000 each. In reply to Mayor Pennino, City Manager Flynn stated that this service could be set up as an enterprise fund. At the request of City Manager Flynn, Deputy Chief Chong explained that Sacramento has a dual role system. Firefighter paramedics work four shifts on the ambulance and then rotate to an engine and truck. He indicated that this boosts morale in the department, as the firefighter paramedics are able to explore other avenues in fire service. He described a problem they encountered initially when private ambulance companies were providing transport, and firefighter paramedics accompanied the ambulance to the hospital. This resulted in the firefighter paramedic needing transportation back to the fire station, which was less efficient than their current system. In response to Mayor Pro Tempore Hitchcock, Deputy Fire Chief Chong reported that they have 20 paramedics in their system and average a four to five minute response time from the fire station to the scene. Essentially, the Sacramento Fire Department operates using 0) Continued January 15, 2002 Option #1 as defined by Chief Pretz. He noted that they previously used Option #3. They use a fee for service program, which is presented to the City Council for approval. In Sacramento County, Folsom, Elk Grove, Galt, Sacramento, and Metro use dual role firefighter paramedics and provide transport. City Manager Flynn asked why they discontinued using Option #3. Deputy Fire Chief Chong explained that the Sacramento City Council wanted the transporting fees and felt that Option #1 provided more local control over the service. In reply to questions by Council Member Land, Chief Pretz reported that the service area would have to be expanded if paramedics and transport service was implemented. The City would essentially become part of the County's overall program. This would result in the City responding to approximately 1,000 medical emergencies a year originating outside of the city limits. He stated that there are eight ambulance districts in San Joaquin County, of which three have exclusive jurisdiction. If AMR remained in the Lodi area, the Lodi Fire Department would respond on a rotation basis to calls from Lockeford and surrounding areas. In response to Council Member Howard, Lou Meyer, Chief Executive Officer for AMR Northern Pacific Region, reported that AMR has entered into public/private partnerships through many of its operations in California. Mr. Meyer stated that he has extended an offer to Chief Pretz for scholarships to the Northern California Training Institute for paramedics, clinical education services, group purchasing capabilities, and augmentation of the differential between paramedic and firefighter wages. He stated that Options #1 and #2 do not enhance the level of service to the community, as they merely displace a private entity. He believed only Option #3 provided an enhanced level of care by allowing the private transport system to stay in place, and adding paramedics to fire engines for first response. In reply to Council Member Land, Mr. Meyer reported that AMR's statistics show that 57% of the time they arrive simultaneously, or before, the Fire Department. He stated that there are two ambulance units within the Lodi city limits. One ambulance is stationed at the Woodbridge Fire Department 24 hours a day, seven days a week. Occasionally, AMR calls for mutual aid from the City of Stockton to support Lodi. He explained that a percentage of transports require ambulances to go outside the Lodi city limits. When that occurs, they backfill the units with ambulances from other San Joaquin County operations. Addressing Mr. Meyer, Council Member Howard commented that it must be expensive to provide all the services that AMR offers, and stated that it appears they are willing to spend a lot of money in an attempt to eliminate competition. Mr. Meyer acknowledged that the cost for services is significant; however AMR is able to compete by spreading costs over a larger segment of the population because of the size of the organization. A zip code by zip code analysis of the usage of the service by payer source showed that while 17% of Lodi's population has Medicare, only 33% of the Medicare population used the ambulance service. Of Lodi's 14% Medi -Cal population, 11.4% use the service. Those that have contracts or private insurance equal 43%. He stated that section 1797 of the Health and Safety Code prohibits creating an exclusive operating area. He believed that the estimated net revenue numbers presented in Option #1 are flawed, because Lodi would be dealing with only half of the revenue. He advised against setting up a rotation system for ambulance service. In answer to Council Member Nakanishi, Mr. Meyer reported that AMR funds the additional expense between firefighter and paramedic wages through a joint powers agreement in San Mateo County, which has 17 fire districts. The rates there are significantly higher, however, with the average patient charge in San Joaquin County being $539 and in San Mateo it is $1,075. Continued January 15, 2002 PUBLIC COMMENTS: Walter Mayer introduced himself as a disabled American veteran of World War II. He stated that he had great respect for the Lodi Fire Department and relayed a personal medical emergency experience in which the Department provided assistance to him. He distributed copies of an AMR invoice (filed) for transporting him to Lodi Memorial Hospital. He stated that it was a distance of one -mile and he was charged for 15 miles. He was unsuccessful in his attempt to have the error corrected. He encouraged Council to support Fire Department paramedics and transport. Eileen St. Yves recalled that when Seattle changed from private ambulance service to firefighter paramedics, it was due to a monopoly situation with the private company. Ambulances would arrive at emergency scenes and individuals were charged for services regardless of whether they used it. She stated that it has been her experience that Lodi Fire Department is the first to arrive on the scene. The cost for AMR to transport an individual one -mile to the hospital is a minimum of $50. She believed that the Fire Department could provide far better service than AMR. Mayor Pennino noted that Council received a letter from Sharon Gardner in support of Lodi Fire Department providing paramedics and transport service (filed). Sandy Wichman, President of Local 1225 United Firefighters of Lodi, stated that Lodi firefighters are in support of the endeavor to provide paramedic ambulance service through the Fire Department and feel that they could greatly enhance the service. Currently they have to wait for AMR paramedics to arrive before any lifesaving drugs or procedures can be administered. Ambulance transport would allow the City to recoup the cost of providing this service and keep any profit within the City. He believed that Option #3 would result in AMR requesting that run times be extended, they would cut their staff, and the number of ambulances in the City would be decreased due to firefighter paramedics being on the engines. Margaret Talbot pointed out that the badges worn by AMR representatives are deceptively similar to firefighter badges and intimated that it is done to confuse the citizenry of who is providing the service. Council Member Nakanishi believed that the City should move slowly and cautiously in this endeavor and conduct further studies. He noted that it is very difficult to run a health care business at this time, with cuts being made and profit margins decreasing. Council Member Howard believed that this topic has been worthy of discussion for many years and was pleased that it has been brought before Council. She looked forward to additional information from an in-depth study. Council Member Land felt that having paramedics in the Fire Department was a quality of life issue that needs to be addressed and provided for the citizens of Lodi. He supported a phased in process; however, he also felt it was important to be in a position to come on line quickly and take over services if needed. He expressed interest in reviewing the offer that AMR made to the Fire Department. He suggested conducting further analysis of the numbers related to Option #1, assuming that the Fire Department would have half of the transport and AMR would have half. Mayor Pro Tempore Hitchcock expressed support for firefighter paramedics and transport. She noted that it is important to ensure that the City can fund up -front costs that will be necessary for the purchase of equipment, added personnel, and training. Mayor Pennino agreed that the process should be phased in over a period of time and stated that he is 100% supportive of paramedics on Fire Department vehicles. He suggested that benchmarks be determined, as well as further study on training levels and options. He requested that a plan of action for emergency transport be brought to Council 4 Continued January 1 S, 2002 at its next meeting on this subject, noting that he felt non -emergency transport was not an appropriate role for the City. To gain a better understanding of issues related to this subject, he stated that he will visit two cities that provide transport services and two cities that have firefighter paramedics without transport services. He expressed concern about the Lodi Fire Department responding to emergencies outside the city limits. He asked that staff confirm the legality of setting up the service as an enterprise fund, and find out whether the City could have sole jurisdiction. D. COMMENTS BY THE PUBLIC ON NON -AGENDA ITEMS Frank Alegre commended the Council for hiring Police Chief Adams, Fire Chief Pretz, Electric Utility Director Vallow, and City Clerk Blackston, as he felt they were doing a good job for the City. He urged Council to award the Shanghai building lease to Lodi Adopt -A -Child, noting that it is a local organization, which that has greatly benefited the children of Lodi. He believed that Community Partnership for Families is in less need for financial assistance. He stated that the 2% for public art should have gone to Parks and Recreation programs or Lodi Adopt -A -Child. Mr. Alegre pledged a donation of $10,000 toward renovation of the Shanghai building if it is awarded to Lodi Adopt -A -Child. E. ADJOURNMENT No action was taken by the City Council. The meeting was adjourned at 8:30 a.m. ATTEST: Susan J. Blackston City Clerk Mayor's A Council Member's Weekly Calendar WEEK OF JANUARY 15, 2002 Tuesday, January 15, 2002 7:00 a.m. Shirtsleeve Session 1. Paramedic Study (FD) 7:00 p.m. Pennino. Breakthrough Project's 5' annual Celebration of Ethnic and Cultural Unity in honor of Rev. Dr. Martin Luther King, Jr., Lodi Middle School - Multipurpose Room. Wednesday, January 16, 2002 7:00 p.m. City Council meeting 3 Closed Session items (NOTE: 5:45 3 Presentations 12 Consent Calendar items No Public Hearings 3 Regular Calendar items One Ordinance Thursday, January 17, 2002 4:00 - 6:00 p.m. Pennino. Lodi Conference and Visitors Bureau and Lodi Woodbridge Winegrape Commission joint presentation: Lodi Tourism Promotion and Lodi Wine Tasting 101, Visitors Center. 6:00 p.m. 49th Lodi District Grape Growers Annual Banquet, Grape Festival Grounds Chardonnay Hall. Friday, January 18, 2002 Saturday, January 19, 2002 Sunday, January 20, 2002 Monday, January 21, 2002 Disclaimer. This calendar contains only information that was provided to the City Clerk's office council\tnisc\zncalndr.doc 4` OF CITY OF LODI d H FIRE DEPARTMENT RTl�i� MEMORANDUM y�er D? DATE: January 15, 2002 TO: Dixon Flynn, City Manager FROM: Michael Pretz, Fire Chief SUBJECT: Shirt Sleeve, Paramedic Program In early 2001, the Fire Department, at the request of City Council, established a Paramedic Study Committee to develop the concept of providing paramedic services to the citizens of Lodi and the surrounding community. The committee researched several options and interviewed several fire - based Emergency Medical Systems (EMS). In addition, the committee utilized the services of Mr. Patrick Ho, President and CEO of Allied Information & Services to develop the financial model to determine economic feasibility for the program. Allied Information & Services provides billing services to several fire based EMS services including the Cities of Sacramento and San Francisco. After many months of work, the committee has developed three options for Council consideration. I have also included a proposal offered by American Medical Response (AMR) a commercial ambulance provider in San Joaquin County. Included in these options is financial information used to demonstrate revenue forecasts. The options offered for Council consideration are: Option 41: Place two Lodi Fire Department ambulances into service. Option #2: Place one ambulance into service. Option #3: Engine Company paramedics / private provider agreement. Lodi Fire Department Emergency Transport Program Option #1 requires hiring 12 firefighter paramedics, and administrator, and places two fire department operated ambulances into service. An additional ambulance would be purchased and used as a reserve unit when City ambulances respond into the County. By choosing this option, the City will not only cover its costs, but also produce a revenue stream estimated to be in excess of $100,000 annually. The Business Plan (page 3) demonstrates this program is self-sufficient and will add an additional revenue stream to the City's General Fund. Option #1 is predicated on AMR not providing emergency transportation services. Should AMR continue operating in the City, revenue estimates will be reduced. Staff Recommends Option#1. Option#2 requires hiring 6 paramedics, an administrator, and places one ambulance into service. Option #2 produces an estimated net annual loss of $97,918. The business plan for Option 42 is outlined on page 4. Option #2 is a variation of Option #1 and assumes a reduction in revenue of 60%. Option #3, requires hiring 12 paramedics, an administrator, and places firefighter paramedics on current fire apparatus (engine companies). The costs associated with Option #3 are outlined on page 5. There are several configurations in which Option #3 can be used to provide paramedic services 1 for the community. These configurations include, paramedics operating on squads, engine companies, etc. AMR proposal If Council chooses Option #3, American Medical Response (AMR) has proposed a public/private partnership. The AMR proposal utilizes Option #3 (firefighter paramedics on fire apparatus) and offers to pay the differential salary between firefighter and firefighter paramedic, train Lodi firefighter paramedic students, and allow access to AMR's supply system. The AMR proposal is designed to keep the City from emergency transportation. There is no revenue stream attached to this proposal and the City is still responsible for firefighter salary, equipment, ongoing training, etc. Approval of this option will require contract negotiations with City Labor units and AMR. Current Situation The Lodi Fire Department staffs 4 fire stations throughout the City with firefighter Emergency Medical Technicians (EMT). The firefighter/EMT's respond to medical emergencies as well as all other emergencies within the City. The fire stations are sited to allow maximum coverage. The City's General Plan calls for a 1 -minute reactions time and 3 minutes response time to all emergencies. According to response time statistics from 1999-2000, the fire department arrived first in 57% of medical emergencies, AMR units arrived between 1 and 10 minutes after fire department units. AMR arrived first on 21 % and both units arrived at the same time 22% of the calls. 2001 response data is not yet available. Lodi Fire Department EMT's are capable of providing basic life support, which includes, administration of Oxygen, CPR and automatic external defibrillation (AED). Fire Department EMT's are not capable of establishing patent airways, intravenous capabilities, or emergency drug intervention. During the course of this research, we have spoken to several fire departments already providing paramedic services. There are 915 registered EMS providers in the State. Of these 915 agencies, 251 are fire departments providing Advanced Life Support (ALS) services. 53% of the Fire Departments providing advanced life support do so with transport capable ambulances. There are 225 private ambulance companies in the State with AMR the largest. The remaining 915 EMS providers are volunteer fire departments, police agencies, California Department of Forestry (CDF) and hospital districts. The vast majority of the population is served by fire -based paramedic services. The survey cities ranged in size from large metropolitan areas, Los Angeles, Sacramento, and San Francisco to cities as small as Ripon. Of the 15 cities, Lodi uses in salary surveys, 6 fire departments provide ALS, 1 by emergency transport, and 6 do not provide ALS. Of the 6 agencies not providing ALS, all would provide ALS service if allowed to. We received no response from 3 departments. In 1987, the Supreme Court of the State of California granted counties the right to establish rules for the delivery of emergency medical services. Several of the fire departments we spoke with were not able to deliver transport services due to exclusive jurisdiction rights obtained by commercial ambulance providers. This exclusive jurisdiction agreement does not apply to the City of Lodi or to the surrounding areas. The City of Lodi and the surrounding ambulance zone is not an exclusive jurisdiction. As long as the City meets the criteria developed by the County EMS director, the City will be allowed to operate an ambulance. In those jurisdictions in which the fire department is excluded from providing emergency transport, agreements with private providers have been reached. These agreements are all very different and take into account many different issues. 2 Should Council chose Option 43, authorization to negotiate an agreement will also need to be approved as well as negotiation parameters. Business Plan Option #1 Paramedic Financial Analysis Total Call Volume @ 9.3% of population (57,000) = 5300 Transport 75% 3975 Non -transport 20% 1060 Cancelled in route 5% 265 Advanced Life Support (ALS) + 52% Basic Life Support (BLS) 48% Annual Billing Contracted Billing/Collections 7.5% Personnel Costs Vehicle Operation/Maintenance Vehicle Lease/Purchase Other (uniform, training, safety equipment) Net Cost Recovery K $1,423,740 EST. (106,780) (844,800) (56,820) (54,500) (257,035) $103,805 Business Plan Option #2 Paramedic Program Annual Billing $569,496 EST. Contracted Billing/Collection (42,712) Personnel Costs (490,200) Vehicle Operations/Maintenance (22,728) Vehicle Lease (24,000) Other (87,774) Net Cost Recovery/(loss) (97,918) 4 Option #3 Fire Department Costs 12 paramedics @ $58,800 $829,200 EMS coordinator $75,600 Medical Supplies $40,000 Medical Equipment $60,000 Other (uniforms, safety equipment)3$ 5.000 Estimated Costs $1,039,800 Pending approval of one of these options, the Fire Department will develop an implementation plan and present it to Council for approval. Michael E. Pretz, Fire Chief MEMO.ADM 5 November 5, 2001 Chief Michael Pretz City of Lodi Fire Department 217 West Elm Street Lodi, CA 95240 RE: Public -Private Partnership Dear Chief Pretz: Thank you for meeting with Jim Ridenour and me in your office on the afternoon of October 30`". We appreciated the opportunity to discuss our respective positions relative to the City of Lodi Fire Department contemplating providing emergency ambulance transportation with the City limits of Lodi, as well as the surrounding unincorporated area of San Joaquin County. As promised, this letter outlines some conceptual ideas relative to potential elements of a partnership between AMR and the City of Lodi, which assists you in reaching your goal of having paramedics within your department. I believe the following points, once flushed out, will assist in the development of a First Responder ALS System. Augmentation of Wages for ALS Accredited Personnel As you are aware, AMR has entered into Public -Private Partnerships with a number of fire agencies throughout Northern California. Each of these partnerships is structured to meet the individual needs of the agency and the EMS system, and therefore are not all alike. In some partnership arrangements, AMR provides remuneration to the fire agencies for the differential paid to ALS accredited personnel and other associated labor costs. AMR would also be willing to explore this concept with the City of Lodi. Paramedic Training AMR, through its affiliate Northern California Training Institute (NCTI), provides paramedic training year round in a variety of venues throughout California. In close proximity to Lodi are our classroom facilities in Roseville and Livermore. We can also explore bringing the training to you. 7575 Southfront Road • Livermore. CA 94550 (925) 454-6000 (925) 454-6009 fax As discussed, we can provide scholarships to Lodi personnel for paramedic training. In addition, we have the capability to provide an accelerated pathway for your personnel to participate in didactic, clinical and internship phases of the program. This level of commitment insures that your personnel receive the benefit from interning with local AMR care providers who are tenured and experienced in the local EMS system. Maintenance of Skills and Certifications AMR has an aggressive clinical education and training program that is designed to meet the challenges associated with our personnel being proficient in utilizing critical skills, and providing ongoing maintenance and renewal of the various certifications required of AIS personnel. We can extend these services to your department through cooperation of our Clinical and Education Services Department and our affiliate NCTI. Group Purchasinp, Capability Through our network of vendors for medical supplies, drugs and durable medical equipment, AMR would be willing to extend its pricing to the City of Lodi. Because we are a nationwide provider of ambulance and advanced life support services, we have been extended significant discounting from the nation's best suppliers. I wish to take this opportunity to thank you for your willingness to discuss the Public - Private Partnership concepts within your department, and look forward to a continuing dialogue with you surrounding this issue. Sincerely, Lou Meyer Chief Executive Officer Northern Pacific Region Alp 7,396 WALTER MAYER MOD0003548001 REMIT PAYMENT TO: 316 W OAK LODI CA 95240-3402 911 EMERGENCY SERVICES INC PO BOX 7423 SAN FRANCISCO, CA 94120 -ASE CHARGE MY: 0 MSA El MASTERCARD :;,u,T 111111110000 111111111111 [IF] EXPIRATION DATE 117 110 NATURE PLEASE ENTER AMOUNT PAID: PLEASE DETACH AND RETURN THIS PORTION WITH YOUR PAYMENT {MP.., B HIT MEA SSGES:, M 0 TA 4e have billed your secondary insurance as a courtesy. This Sunt still remains your responsibility. Unless we receive ent within 30 days of this invoice, the full balance of :his account will be due and payable by you. CODE DESCRIPTION UNITS UNTN(3.-60 TRIP N Nvoj 4ALTER MAYER ALS BASE 1 000123571-0001 MOD -00035480-01 09/29/19,97 k0390 ALS MILEAGE 15 :SERVICE )8/11/19971316 W OAKS EMERGENCY 1 ILODI MEMORIAL HOSPITAL {MP.., B HIT MEA SSGES:, M 0 TA 4e have billed your secondary insurance as a courtesy. This Sunt still remains your responsibility. Unless we receive ent within 30 days of this invoice, the full balance of :his account will be due and payable by you. CODE DESCRIPTION UNITS UNIT CHARGEBARGE- k0370 ALS BASE 1 519.00 519.00 k0390 ALS MILEAGE 15 11.00 165.00 k0999 EMERGENCY 1 .00 .00 k0422 OXYGEN 1 41.00 41.00 k0398 EKG PAPER 1 .00 .00 33041 EKG MONITOR 1 .00 .00 k0394 INFUSION SET W/3WAY 1 .00 .00 k0394 INFUSION SET MICRO 1 .00 .00 W394 I.V. START PAK 1 .00 .00 k4215 NEEDLES, ALL 1 .00 .00 W999 02 MASK/CANNULA 1 .00 .00 17070 IV MAIN SET UP 1 .00 .00 OTHER CHARGES .00 .00 PAYMENTS *** 533.41 - ADJUSTMENTS 58.24- *SPORT REASON: T11 ILLNESS TOTAL. CHARGES' Du 133.35 RCVD: 17:30 NOSIS: 7807 78702 78703 SEE REVERSE SIDE FOR INSURANCE INFORMATION Send billing inquiries to: American Medical Response, P.O. Box 7423, San Francisco, CA 94120 IROVIDER# ZZZ89622Z FED TAX ID: 94-1736160 ione Number: 1-800-913-9106 Keep this portion for your records. Local Number: 1-209-238-4710 GIP 7.660 CWTknuz American Medical Response P_0. Box 7423 - San Francisco, CA 94120-7423 s MOD -0662281 1 -00 " X00012357 WALTER MAYER 05/09/1996 10 1 .47 :SIN. 08/21/19! WALTER MAYER MOD0662281 1 00 REMIT PAYMENT TO: 316 W OAK LODI, CA 95240 AMR WEST - VALLEY PO BOX 7423 SAN FRANCISCO, CA 94120 ASE CHARGE MY: ❑VISA ❑ MASTERCARD �- :OUNT ❑�������❑������ EXPIRATIONDATE ❑❑❑0 NATURE PLEASE ENTER AMOUNT PAID: $ PLEASE DETACH AND RETURN THIS PORTION WITH YOUR PAYMENT gALTER MAYER )5/09/1996 IMPORTANT MESSAGES !'affli 311-1I IV JE HAVE BILLED YOUR INSURANCE COMPANY K WITH YOUR INSURANCE COMPANY AND ENT. IF NO CONTACT IS MADE WE WILL X0370 ALS BASE ►0390 ALS MILEAGE .'0002 NIGHT CHARGE 10422 OXYGEN 7070 IV MAIN SET UP L0398 INFECTION CONTROL L0999 OXYGEN MASK NON BREA 60394 I.V. START PAK r7050 NORMAL SALINE INFUSI 1 ** PAYMENTS *** .00 * ADJUSTMENTS** WITH NO RESPONSE. PLEASE CONTACT US REGARDING LOOK TO YOU FOR PAYMENT. 1 519.00 519.00 1 11.03 11.03 1 61.00 61.00 1 58.00 58.00 1 .00 .00 1 .00 .00 1 .00 .00 1 .00 .00 1 .00 .00 405.90- 141.66- 1��� �) It 101.47 SPORT REASON: T11 ILLNESS tow OFE. RCVD: 18:32 IAGNOSIS: 7802 780 SE REVERSE SIDE FOR INSURANCE INFORMATION Send billing inquiries to: AMBULANCE BUSINESS SERVICES, P.O. BOX 7423, SAN FRANCISCO, CA 94120-7423 ROVIDER# : ZZZ89622Z FED TAX ID: 94-1736160 ie Number 1-800-913-9106 Keep this portion for your records. Local Number: 1-209-238-4710 {{i{ni{i{iu{i{i�u{u{i{u{i{{�{nidi{�{{nnn{{n{{i{n{i� WALTER MAYER 1413 MARIPOSA WAY LODI CA 95242-2950 Your Medicare number is: 553-18-3563A Summary of this notice dated October 2, 1997 Total charges: $ 725.00 Total Medicare approved: $ 666.76 We paid your provider: $ 533.41 Your total responsibility: $ 133.35 Your provider accepted assignment, Details about this Asnoiic!eSy�e the back for more ihf�rmallon ) ... ,..:....:.......:.:...... BILL SUBMI'1"TED BY: Life Medical Industries Inc {ZZZ89622Z] Mailing address: Po Box 7423, San Francisco, CA 94120-7423 Notes: a The approved amount is based on the prevailing charge. b The approved amount is based on the customary charge, c Tins info.rma—,ion is CCL^,a Se;ii . y iur privai- al -tuner. They- It review :t o see if adePLik"nal benefits can be paid. Send any questions regarding your supplemental benefits to them. There is no need for you to send this notice to them. Your private insurer is AETNA. GENERAL INFORMATION ABOUT MEDICARE - Get a flu shot ..... not the flu! Generally, Medicare covers one flu shot per flu season. If your provider accepts what Medicare pays, there shouldn't be a charge to you. Get a Mammograin - A picture that can save your life. Your physician or carrier can provide information on this Medicare covered service. E See Medicare Notes Oates Services and Service Codes Char%! Approved Below Claim control number 02-97237-3117-920 c Aug 11, 1997 1 Adv er spec sery sep mi&supp IA0370-RHI $ 519-00 $ 475.01 a Aug 11, 1997 A" 15 Advanced life support mileag {A0390 -RHI 165.00 155.55 b Aug 11, 1997 1 Ambulance 02 life sustaining {A0422 -RHI + 41.00 + 36.20 b Total $ 725.00$ 666.76 Notes: a The approved amount is based on the prevailing charge. b The approved amount is based on the customary charge, c Tins info.rma—,ion is CCL^,a Se;ii . y iur privai- al -tuner. They- It review :t o see if adePLik"nal benefits can be paid. Send any questions regarding your supplemental benefits to them. There is no need for you to send this notice to them. Your private insurer is AETNA. GENERAL INFORMATION ABOUT MEDICARE - Get a flu shot ..... not the flu! Generally, Medicare covers one flu shot per flu season. If your provider accepts what Medicare pays, there shouldn't be a charge to you. Get a Mammograin - A picture that can save your life. Your physician or carrier can provide information on this Medicare covered service. E 404812822 Page 2 of 2 E Walter Mayer Your Medicare number is: 553-18-3563A If you change your address, please contact National Heritage Insurance Company by calling 1-800-952-8627 and the Social Security Administration by calling 1-800-772-1213. The Medicare handbook contains helpful information about Medicare coverage, including inpatient, outpatient, hospital, and benefit periods. Please call us at 1-800-952-8627 if you would like to receive a copy of the Medicare handbook. Medicare covers vaccination to prevent pneumococcal pneumonia. If you've never had a pneumococcal pneumonia shot, protect yourself and get one now. If your provider accepts what Medicare pays, there shouldn't be a charge to you. If you have a TTY machine, Medicare now offers TTY access for the hearing impaired. If you have questions regarding Medicare payments please call (916)634-7538. You can now find information about Medicare and NHIC on the World Wide Web. Our new Internet address is hitp://www.medicarenhic.com. We welcome your comments through the Internet. 3ere's an explanation of this notice: Of the total charges, Medicare approved Your 20% The 80% Medicare pays Medicare owes We are paying the provider Of the approved amount Less what Medicare owes Your total responsibility $ 666.76 Your provider agreed to accept this amount. See #4 on the back. - 133.35 We pay 80% of the approved amount; you pay 20%. $ 533.41 You have already met the deductible for 1997. $ 533.41 $ 533.41 $ 666.76 - 533.41 $ 133.35 Your provider may bill you for this amount. NAY ► AR Explanation of Benefits I.O. NumberPage Amount Not Covered R M Amount K Pending CLAIM DIVISION -UNIT 41 Balance 553-18-3563 Sequence Number 00576 -BAC -000950 NAVISTAR/AETNA BENEFITS PAYMENT OFFICE P.O. BOX 5367 C -S-A ICN Number Date Prepared Ambulance ROCKFORD, IL 61125 1000005-26-002 08993B 9/19/97 40 NAVISTAk I7v'.ERNATIONAL TRANSPORTATION CORP. 0- • W MAYER 1413 MARIPOSA WAY LODI CA 95242-2950 This is an explanation of the benefits for the bills received on 9/19/97. FOR CUSTOMER SERVICE, PLEASE CALL: 1-800-435-2969 OR WRITE TO THE ADDRESS SHOWN ABOVE. Patient: WALTER Benefit Year: 1997 TCN: 096-97262-0004934 Service Dates Bills Submitted Expenses Amount Not Covered R M Amount K Pending R Amount M Applied To K Deductible Balance Pay At Amount Payable AMERICAN MEDICAL RESPONSE 8/11 Ambulance $519.00 $380.01 1 $43.99 2 $95.00 100% $95.00 8/11 Ambulance $165.00 $124.44 1 $9.45 2 $31.11 100% $31.11 Totals $684.00 $557.89 1 $0.00 $0.00 $126.11 $126.11 Plan Information - 1997 Year to Plan Date Remainder Indiv. Deductible $214.00 $214.00 $0.00 REMARKS (RMK): 1 -THIS AMOUNT WAS PAID BY MEDICARE. Actual Benefits Paid $126.11 Patient's Portion: $0.00 2 -THE PROVIDER HAS AGREED TO ACCEPT THE AMOUNT MEDICARE APPROVED AS THE CHARGE FOR THIS SERVICE. BY LAW YOU DO NOT HAVE TO PAY THE AMOUNT THAT IS MORE THAN MEDICARE'S APPROVED AMOUNT. 00000000553183563 096972620004934 PAGE 1 PLEASE RETAIN FOR TAX PURPOSES -COPIES ARE NOT AVAILABLE 0001fi- -4— clic 1<5 NAYMAR Explanation of Benefits I.O. Number Amount Not Covered Page Sequence Number R Amount M Applied To K Deductible CLAIM DIVISION -UNIT 41 Pay At 553-18-3563 00576 -SAC -000951 AMERICAN MEDICAL RESPONSE NAVISTAR/AETNA BENEFITS PAYMENT OFFICE ' P.O. BOX 5367 ROCKFORDY IL 61125 C -S-A 000003-26-002 ICN Number 089938 Date Prepared 9/19/97 $28.96 NAVISTAR INTERNATIONAL TRANSPORTATION CORP. 0 10 W MAYER 1413 MARIPOSA WAY LODI CA 95242-2950 Patient: WALTER Benefit Year: 1997 TCN: 096-97262-0004935 Service Dates Bills Submitted Expenses Amount Not Covered R M Amount K Pending R Amount M Applied To K Deductible Balance Pay At Amcunt Payable AMERICAN MEDICAL RESPONSE V/ OI.brG $41.000 $28.96 $4.80 2 $7.24 100% $7.24 Totals $41.001$$33.76 $0.00 $0.00 $7.24 $7.24 Plan Information - 1997 Year to Plan Date - Remainder Indiv. Deductible $214.00 $214.00 $0.00 Actual Benefits Paid Patient's Portion: $0.00 REMARKS (RMK): 1 -THIS AMOUNT WAS PAID BY MEDICARE. 2 -THE PROVIDER HAS AGREED TO ACCEPT THE AMOUNT MEDICARE APPROVED AS THE CHARGE FOR THIS SERVICE. BY LAW YOU DO NOT HAVE TO PAY THE AMOUNT THAT IS MORE THAN MEDICARE'S APPROVED AMOUNT. Benefit Payment Summary Payments sent to: Date Amount AMERICAN MEDICAL RESPONSE 9/22/97 $133.35 00000000553183563 096972620004935 PAGE f2 -Po PLEASE RETAIN FOR TAX PURPOSES - COPIES ARE NOT AVAILABLE I � � o ican ,Medical Response_ The Industn- Leader Corporate Information http:/h,.i%--.amrnortheast.conVcmp.htm x'r C' 'l' r C[: �i ;`L:e�• ser-vACe ji ^'t': v. if"�£" } i4 ..i rirs<e�, ifs a C.C. r t`s ,tvr v AMR 's ` cr t rd tY M'f the,nation-is" fo, afn .=:.,e4g^nc a medical ��1''�r: We I earned 'his u['r;,fc` 7n. P`+'.�:h our �hwrC-,rve6.- several fundamental guiding principals: HIGH QUALITY AND EFFICIENT PATIENT CARE is always our number -one priority. 0U.- many Urmany American Medical Response (AMR) companies have long established local track records of dedicated caring and are recognized for providing high quality service to their communities as a trusted partner. LOCAL MANAGEMENT, SUPPORTED BY SUBSTANTIAL NATIONAL RESOURCES. AMR can meet your community needs. Our managers are civic leaders who plan locally to meet your specific needs and concerns. Local management is the key structure of American Medical Response, while having substantial national resources and solid corporate leadership. THE FUTURE NEEDS CAN NOT BE MET WITH THE SYSTEMS OF THE PAST. Through innovation, we are setting the standard for the delivery of emergency medical services into the 21 st Century. We continue bringing sophisticated medical techniques and equipment to the front line of care. We utilize the latest developments in technology in areas such as dispatch, system planning, accounts receivable management, and emergency medical technology. Awk A a ro r ez, cz% rz -© $. CJ 4"o 11/27/98 10:45 AM Vam/ ��'¢ ericatr Medical Response. The Industn- Leader http:/h%�-%r.ainTnortheast.com/corp.htin ]WHY IS � .' ° MEDICAL RESPONSE A StiCCESS? ",Vr- rer �0 fr 7'"entec art .�osrly .moi{, e- +c_•;; ar : T� ,� r C.+ ^tL-,.T , ith ecFs�, �a . _ y , lL -t - e� ... ��e,.. .. ;s .,. 4 U�r !: +•war e nwe r! :.. .7'G +;JC rG yi^� n r• n, -`.r t�•.: .J �_a ^�.pP �. .� • ...... �. .. :G ',. ..� �. .>.,� �; �s 4..�ue'. •*.. G2•u. �{ v city fie Vu. .y 4•..vu iif'.. �i` i}•. t P_:- e f`:: s E hichest standards cry • i �?g �i J �C Y'.. tib i` -n •�. 'mss 4 nC• 4, "n _!^ f`t+l (_...... `.._,_.. ire» t n tCNr .GS -l.iv tr ¢ �.. - �.. 1r.;• ,d .�aN ra,. eci m r�..a. r. e. ave rta t �� Team Members . r "%e - z-= rar r : ~ care at F .;,...e! 013, err,11-1 eeq are sTc0n_C r4!ti <-.[� in the �`ev;�,n +±.-, .fi 71 -.- ` . - WHO ------- iiHO IS , ` ..' .7 V .::= MEDICAL RESPONSE? i MR ;fit ft's curre� tt for r` was re-cf eated in 1997. Canadian based parent company, i_aidlaw, c pv cl^_aue: .MR of cs r ged ii s c, rbu ance division; MedTrans with AMR in February 1997. iC� lu I4C i i mer—i-ty'�i was _� : , —F.:iG �A �vr i. ^ • tie t R n r 4, Medical ,....,., v i vi .:.ated tl "t�«eYV" !'L te' a� Response. kVith bo`" col ^enies purchasing some of the oldest, most respected, and largest ambulance service providers in the country, AMR has become the leader in quality, service, and Injst. i' ??edre^c tr,ns ncrt2tfo^ if"t4(_JStri` .7�4•'( 1%;rleY Cf" ti f N'�r3. As the largest private medical transportation entity. we have been able to pool insurance: develop bonding programs; increase purchasing power; and create new standards. As we become the dominant force in the industry nationwide, we have developed unprecedented inancial stability. This sciid infrastructure supports our front-line Team Members in their sprit -second, life-saving decisions. AMR has grown through a deep, mutual understanding of the need to improve the delivery of emergency medical care in a changing and cost-conscious world. Together, our companies share their individual expertise; and migrate the be _,i aspects of each system throughout the -4 11/27/98 10:45 AM ( - 2 �r'� ierican Medical Response. The Industry Leader bttp://,A7%%,w.mnmortheast.com/corp.htrn V ;~• r DOES. C,_ rr.'V:0:�, calp eclor"0.1711es 01 S It- 61:5_ b S1qn:f;!,aM -u'-&asTn- power ,,tvinen tu; hrF -6+F?m is Cipnuir:'_rtert In fact AMR pur 11 C! ases 7, States. We can design. test, and stay -f 41 e chancinrp technollocies ncvv, availatie to improve emergency med c c �e- -rinfogy-bssed ccmrnunifTti 7 '71 S C' CC 7: C d(- —�menfat _j r IF v 7Fn 1 1 7n, 7: X05 '1- at 03 OU, a-0 "IE rn. ca, -Z r -e 0 CCm r -n stn 04,Q i"WR te "r .1 strY leacer Our com-,PanieE al. have d ..;1y ro L­ Pr-Irds of eXceilpnt service anc) reputations for putting P_ ub'ir. saxetv aid�sr we iong r ;-c t%e 0 -p -nv,.,o 'ne AMR oman'zat'of-, -,we -,o ­,e.egf r rn.! -g=s 6�+e,j. local am n 0 DS i bulance companies, and cl!! r local � local managers are partners in AMR's development. Many of our managers are key industry leaders who are nationally recognized authorities. Many provide development of nationa. and local standards in emergency pre -hospital care. AMR provides more industr,)f ic-acership as Directors. Officers, and Committee Chairs, of the American Ambulance Association than any other ambulance service provider in the nation. For Information regarding any of the various services we provide, please call our corporate clff,ices 1303*1 514-8500. As we look to the future of EMS. there's one name you can trust, Am.e-'c;an Medical Response. The quality, service, dedication, and tradition, you can always Count on. -4 11/27/98 10:45 AM Je;� 7 e r- 4— wv Sb:OI WLZ/I I OZ99-099 (909) :xe:j 0099-099 (909) :aeon 09L 60 sUesnyaessew `)PAeN 813MO 4381 ino,_q ;seetl:PoN esuodsaa leolpew usowq v�. Held puss asuodsatl le3ipaw ue:)ijewvj u1q-djoo/tuoo-iseoiDiounim-,k%4LMJ/:dutI lapm-I .uusupal aq.L •asuodsaa [eaipaWauaua Ward's Business Directory American of U.S. Private and Public Companies - 1998 American Marine Inc. 401 Shaarer Blvd. (407)636.5783 Cocoa. FL 32922 Safest $4-0 million FY End: 12-31 Employees: 26 Type: Private Founded:1967 SIC(s): 3533 Oil & Gas Field Machinery. Description: Manufacturing, 041 containment booms. Officer(s): James L. Pearce, CEO; Madynne J. Pearce, President; R. Kent Geis, Vice President. American Marine Ltd. 811 E. Maple 612)679-3811 Mora, MN 55051 Fax 612)679.3820 Sales: $10.0 million FY End: 7-31 Employees: 65 Type: Private Founded:1954 Export SIC(s): 3732 Boat Building & Repairing. Description: Manufaclunng: Yachts. Officer(s): James E. Klapineier, President, Connie Nordlander, Dir of Mfg: At Hagen, Senior VP. American Marketing and Events Inc- P.O. Box 50318 (805)969-5823 Santa Barbara, CA 93150 Fax: (8(15)969A752 operating Revenues: $3.0 million FY End: 12-31 Employees: 12 Type: Private Founded:1985 SIC(sj: 8742 Management Consulting Services. Descriptbn: Services: Marketirhg consulting }Irm- Offleer(s): Richard R. Allen, President, Michael McAU err, Exec VP; Steve Hensen. VP of MMg: Tom Coxwell, Vice President. American Marketing Industries Inc. 10450Holmes Rd. (816)943-5180 Kansas City, MO 64131 Fax: (816)943-5199 Sales: $21x1.0 million FY End: 12-31 Employees: 2,600 Type: Private Founded:1985 Import/Export SIC(s), 2329 Merl s/Boys' Clothing Nec: 2339 Women's/ Misses' Oulemear Nee: 2369 Gids'/Children's Outerwear Nee. Description: Manufacturing: Men's, women's and gids' outerwear. Officer(s): James Willcox, President: J.E. Jones, CFO; Sieve Eiserer. Dir of Info Systems: Bob Ostfieck, Dir of Hurnan Resources. American Mathematical Society P.O. Box 62.48 (401)455-4000 Providence. RI 02WO Fax: 0011331.3842 Sales: $37.0 nlfllinn FY End: 12-31 Employees: 225 Type: Private Founded: 1880 Export SIC(s): 2721 Periodicals. Description: Manulacluring: Publishing of periodicals and books. Publisher of weekly nerlodicats. Officer(s): John Ewing, Director Gary Brownell, Finance Officer. Paul Chambers. Dir of Mktg: James Maxwell, Dir of Persofinel. American Meat Packing 3946 S. Normal Ave. (312)5387000 Chicago, IL 60609 Fax: (312)538-8175 Sales: $112.0 million FY End: 12.31 Employees: 400 Type: Division Founded! 1959 Exchange: NYSE SIC(s): 2011 Meal Parking Plants. Description: Manufacturing: Hnq slaughleling and Pork processing. Publisher of weekly nerlodicats. Officer(s): Carl Hemnann, President: Waller Soliunas, VP of Fin: J F. Forbes, VP of Mktg & Sales, CFCI. fins n Chm Rd; x1,01. o' American Media Inc- (Lantana, Florida) 600 S. East Coast Ave. (561)540-1000 Linlan3. FL 33462 Fax: (561)547-1017 Sales: $295 I million FY End: 32.5 Employees: 1,720 Type: Public Ticker Symbol! ENO Exchange: NYSE Founded: 1990 SIC(s): 272.1 Periodicals: 6719 Holding Companies Men. Description: Mtnnutacyurinq Publisher of weekly nerlodicats. Finance Hr4dinq crnnpauy- Mkto A Fa1Ps 1 nska W-tillelly. 11' Officar(s): reser J CaII:rLnn, CFCI. fins n Chm Rd; x1,01. o' W. rickerb Senior VP A CFO: Susan. Napolilann, VP of Human Resor' .es. American Media Inc- (West Des Moines, Iowa) 4900 Uni,ercd Ave (515)224-41910 American Media Operations Inc. 600 S. East Coast Ave. (5(51)540.1000 Lantana, FL 33462 Fax: 1561)547-1017 Sales: $295.1 million FY End: 3-25 Employees: 1,720 Type: Private Subsidiary Immediate Parent: American Media Inc. (Lantana, Florida) SIC(s): 2721 Periodicals. Description: Manufacturing: Publisher of weekly periodicals. Officer(s): Peter J. Callahan, CEO. Pres & Chm ad: Richard W. l ickert, Senior VP & CFO. American Medical Alert Corp. 3265 Lawson Blvd. (516)536-5850 Oceanside, NY 11572 Fax: (516)536-5276 Sales: $5.4 million FY End: 12-31 Employees: BO Type: Public Ticker Symbol: AM1AC Exchange: NASDAQ Founded -1981 SIC(s): 3669 Communications Equipment Nec. Description: Manufacturing: Personal emergency response communication systems linked to an emergency response monitoring center by telephone. Officer(s): Howard M. Siegel. CEO. Pres & Chm Pd. John Rogers. VP of Operations. American Medical Claims IRC_ 8575 Olive Blvd. (314)569.2131 St. Louis. MO 63132 Sales: 5.5 million FY End: 8-31 Employees: 11 Type: Private Founded: 1984 SIC(s): frill last balite Agents, Brokers & Service. Description: Insurance: Vertical insurance expeditors. Officer(s): Peter Wetzel, President. American Medical Clinics Inc. 1055 Washington Blvd (203)327-0900 Stamford, CT 06901 SIC(s): 6011 Offices & Clinics of Medical Doctors, Description. Servioes: Opernlnr of morlir-al clinics. American Medical Electronics Inc. 250E. Arapaho Fid. (214)918.8300 Richardson, TX 75081 Fax: (2t4)918-8480 Sales: $38.3 million FY End: 12-31 Employees: 255 Type: Public Ticker Syymbol: AMEI Exchange: NASDAO Founded: 1962. SIC(s): 3842 Surgical Appliances & Supplies. Description: Manufaohaing: Orlhnpedic, and nenrosnrgical medial deviCos. Officer(s): John F. Clifford, CEO A Pre,,; Wesley E. Johnson Jr., VP R CFO, Thomas Vi Ross, VP ,;! P.4kig &Sales: Richard Phillips, VP of Operntions: LaVomne M, Chimhel, VP of Human Reso-c.ps. American Medica( image life. 20001 Chagrin Blvd (216)(331-4100 Cleveland, OH 44122 Fax: (216)831-0274 Operating Revenues: $ 4 million FY End: 1231 Employees: 7 Type: Private Founded:1985 SIC(s): 8742 Management Consubing Services. Description! Sorvicos: Medical matketinq and tnh!raclive media devalopinenl for physicians. manaued tarn networks. hospilals, professional societies anti medical products. OffiCer(s): Nancy Frank, Pte.<idenl: Tiam Minne. CFO. American Medical International Inc; P.O. Box 009006 (2:4)789-2200 Doilas, 1X 753130 Operating Revenues: 5:2.302.0 micron FY End: 0-31 Employees: 30.200 Type: Private Subs,diary Founded: 1957 immediate Parent: Tenet Iit4thCare Corp. SIC(s): 8062 General Medical & Surgical Hospitals. 0069 SI)ec;lllly Hospitals Except Psychiatric, Description: Services: General and aoule care hospital management. Officer(s)! Ruben W. O'Leary. CEO P• Chm Pd' Alan J. Chanison, Exec VP R CFO: •John T. Casey. Pres A COO. Sleven Brawn, Dir of inro Svaten,s: O Edwin French. APnioi VP c rldmirr. American Medical Laboratories Inc. 14225 Nm-Anook Dr. (7n3)802 -690t) Cheekily. 1;A 22021 Operating nevem"'-s: $rllomill:.", rY End: 12-31 Ern Moyrrs: mein w Tvpe: P,. ­w Fcunded: 1951? SIC(s): 8071 McJICaI I_nlro,alnrir s Description: Services Mcdicil and -let t?s.kinq laboratories- Officer(s): In n Gndwar, rrocod t: Jct; y remail-. Vr r.! Mkto A Fa1Ps 1 nska W-tillelly. 11' 0 Hurnan Re-It,rces. 112 American Medical Response Northwest 1240 S. E, 121h Ave.(, �7?%,� �r (0231.6 Portland. OR 97215 •" J G J (�, 3� Immediate Parent: American Medical nespase life-. SIC(s): 4119 Local Passenger Transportation Nee. Description: Transportation: Emergency, non-Pmergency and wheelchair service. American Medical Security Inc. P.O. Rox 19032 (414)561.241 Greeff Bay, WI 54307 Sales: $585.2 million FY End: 12.111 Employees: 3,000 Type: Private Subsilla0 Founded:1986 SIC(s): C411 Insurance Agents. Brokers & Servile. Description: Insurance: Third party administrator, Officer(s)! Wally Hilliard, President; Tim Day, CFO. Mike Va de Kamp. VP of Sales; Penny Paque, VP of Operational - John Witch, VP of Homan Resources. American Medical Services 825 W. Huron (810palf-Eft Pontiac, MI 48341 Sales: 53.0 million FY End: 127 Employees: 22 Type: Priya Founded:1959 SiC(s): 3842 Surgical AppllAnCes &Supplies; 5047 Medcalf Hospital Equipment. Oescripticn: Mantdaclurf!lg: Orthopedic devices. Whdesak Medical equipment and supplies. Of}icer(s): Lany L. Gaskins, Gen Mgr, Barbara Etapa, - Finance Officer Orioles Wolfe. Dir of Mkig. . American Medical Specialties Inc. 6090 McDonough Dr. (770)4465011 c. Norcross. GA 30093 Sales: 5.6' million FY End: 12! Employees: 5 Type: Pilo Founded: 1993 SIC(s): 3841 Surgical & Mlndical Instruments. Description: Manulacturing: Disposable burs. blades and pins used in powered surgical equipment. Officer(s): Joe Ashury, President. American Medical Systems Inc. 107n0 Bran Rd.'-'/. 1612)9334f1 Minrrmtnnka, PAN 55343 Sales: $110.0' million FY End: 124 Employees: GUO Type: Private Subsea Found -d:1972 Erpa Immediate Parent: Plizer Inc. SIC(s): 3842 Surgical Appliances & Supplies. Description: Manufacturing: Impolenr„e and inconlinern Offieer(sl: David Onoth, CEO A Pras; S.M. Lukas. VP urs A Admin. American M9edica! Technologies Inc, is 5847 San Felipe (713)793 :, Butalan. TX 77057 Fax: (713)76359r'�.2. Sales: $1x1.9 million FY End: 4f. n Emplovees: 8S Type: Pr[at°. Ticket Symbol AM4S Exchange:No.56 ' Founded: 1967 SIC(s): 3578 Calcuht'urg & Fcrnunling Equipn•e 1: 3663 Ricin -I''! ComnurnicaticcsEquip,men:. Description: M1tnnnfaclurina: Mrtomal'c I rr `e9-a`nhach !n -,agement <ecllr'i^f gyzten:; and F.IR4rerrnl"'1a, ,%x. rufer,ng sy'ler'ls. Officer(s): Jamr<, 'r. Rash, CBO R CFO: V.: hael F. H-,aw.e F. American fAegatrends Inc. 614F.P Nor.+bC!1 rl,,wy. r77012:i'E+^!. Norcross. GA 3W71 Sales: 5: 2.0' million FY End: iii;-' Employees: 150 Type: pav - Fouoded:14e5 SiCfrd: 3674 Semironduciom 3 Petaled Devices: 35771 1.' Cninpn:nr Parfrheral Equipment Ni c: 7377 orrFa: ��:';'_.. Sn11w:vP Description: MlanufaCtUdDg: Motherbonrds and p^,ipherals. Servic,s: Oevrloper of diagnosRc sether+?. Officer(s): S Shankar, Prpu,:rnY. Victor Kannan. Contrain', ,a Le:adni, M41g Mgr: Jeff ?;'hila, Info systems Afgr:!:n ;. T!p'',F IevnAn Restos: Ater. American Memormi Lite Insurance C . P0. Box 2730 nal,ia Ci!y, r^0 57%00 t TOlnl f..s-ikv- $11,3.7 miitirnt Enpivyces: 101 Type: rriv 'e Su7k:df " a- Imre diate Pa en llnw ;an A 1 r y r ,ram 11 zSd.( ): 31 i lrl Isuarce yAmerican Medical F3.^s :onse Inc- De rr:pin st :etre i,nd.r. n o „Inn , M- West Des Motors, IA 50286 FX: (51512o.4 425C• ?- F Offi, tris. Jr, ++ A S r C :0 A s.., hr . Operating Revenues: $20.0 million FY End: 63t' 2921 S. Parke! Rd i3031ri14.8500 I r: lV A CFC, I mr , r. 'dint VP f Ra(a Fiam'S 4 m1, ` Employees: 95 Type: P6valc Au m, a, CO 80014 ,r Snerinntf. !>ir t I fur•,an q,,,vrces Founded: 1177 Operating Revenues: $48.1 9 m,10- F1' End: IS: -31 SIC(s): 7912 Motion Picture & 'Jidmo Production: 2731 Hook Employees: 10.957. Type: Public P, Iblishing. Ticker Symbol: Fijir Excl,ange: NYSP Description: Services: Producer of co,porale haining videos SIC(s): 4119 p reap rassenumr I mnip-lAnn Nor,. AnlenCatl McSSenger Sertfk..'c7" M1-inaraClwiny POAsher of corpnrata Lam ny books Description: : r,spvnlat rn, r'r+vyf•v a t u - .^ P ri R„r. �n Ofricm(s): Arthur R. Bauer. PresOr-nb Dave Opie. CFO: Officer(s): Pao[ T Fhidey, ('170A r -,c.. Jf PumO, +,. NC 20175 fill-in Hr ybnet-Va,neu, Afkrg Mgr: A­eltn thenen. Int:: Ewer Vr A r-rO: ('rm,gr R Vmlidf Itt, I'.•.n�•uin•P Vice SIG<):.,;,I' r,;,. r,.+:, Sennrn•: E¢'pl by Air �.r• :praaurc Afar, Melissa ch.vas. Ri, n( Human R-wrns Pmcdnnl, f.! r r r,'Prrntir,a rMir.'riJe<:rimlinn. 7 nn<,r ort-r,.m narM tar •y c ) 1 c // � / /oa� 4poir �, I " % x �uy J�U`pp January 14, 2002 Mike Pretz, Chief Lodi Fire Department 217 W. Elm St. Bernell Wichman, President United Fire Fighters of Lodi I.A.F.F. Local 1225 P.O. Box 1841 Lodi CA 95241 Chief Pretz, This letter is a show of support for the Lodi Fire Department's endeavor to provide paramedic and ambulance transport service to the Citizens of Lodi. We of the U.F.L. feel the Citizens of Lodi deserve to have the best service possible and the Fire Department will surely enhance that service greatly. Through the Fire Department improved service will be provided in many facets. First and foremost will be reduced run times to the call for an emergency for advanced life support. The level of training for the Fire Fighters at this time provides for only basic life support. We have to wait for the paramedics to arrive on the ambulance before any life saving drugs or procedures can be administered. It is very frustrating for the Fire Fighters and the Citizens to stand by and not be able to help their loved ones. The Fire Fighters have to wait for the patient's situation to deteriorate to a point of no pulse and cessation of breathing before any further action can be taken. Then that action is defibrillation and or C.P.R. Ambulance transport will allow the city to recoup the cost of providing this service and keep any profit in the city itself instead of going to a company out of the country. This profit will enable the City to enhance the general fund and aid in providing other services for the Citizens of Lodi. The labor force for this enhancement will be extremely reliable for the fact they will be unable to strike or hold back services by law. The threat of bankruptcy will be eliminated and the possibility of paramedic transport service pulling out of the City at short or no notice is also eliminated. The infrastructure for this program is already in place. There are four Fire Stations in the City of Lodi, which will provide quicker run times because the Fire Department is already set to respond to the major portion of their calls within four minutes. Without transport and with paramedics on the engine only, the run times will be increased. The company providing transport service at this time will request that run times be extended and the amount of ambulances in the City are decreased because of paramedics on the engines. They will cut their staffing and ambulance fleet because of this factor thus decreasing the service to the citizens of Lodi. This plan is government subsidizing private business. We of the United Fire Fighters of Lodi are in agreement with the Lodi Fire Department's plan to provide paramedic and transport service to the Citizens of Lodi for all the reasons stated above and more. We feel that this will save lives and provide an enhanced quality of life for our Citizens. Anytime government can do that it is performing exactly what government is expected and required to do. To do otherwise would be dereliction of duty on the City's part. If I can be of any service or you have any questions please feel free to contact me or my staff at anytime. Respectfully, �� Ber�ll Wichman, President United Fire Fighters of Lodi I.A.F.F. Local 1225