Contract Access. Forms Required Membership application completed through US Rehab or VGM. See forms attached.

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1 New Contract Effective - April 1, 2013 US Rehab AS10231 Executive Resources Durable Medical Equipment/Services April 1, March 31, 2016 Supplier Information 1111 W. San Marnan Dr. Waterloo, IA Business Toll Free: (800) Business: (800) Website: Contract Highlights US Rehab is a National alliance for certified rehab technology equipment and accessibility providers. US Rehab has more than 380 members in over 1,200 locations nationwide. US Rehab promotes the uniqueness of the rehab technology industry. As a member benefits include vendor discount pricing and diverse product lines. US Rehab has many education opportunities including our Academy of Advanced Rehab Sciences which offers many rehab-related educational programs which consist of a 3 day Tech Training, and the Seating and Mobility Master Program. Members can also receive on-site training with Peggy Walker, RN, Ronda Buhrmester and Elizabeth Cole. US Rehab s goal is to offer a variety of ancillary programs that help members manage their businesses more effectively. Products Group purchasing on all complex rehab items, services, education programs, consulting, web design and hosting, marketing materials, managed care contracting, software solutions, other HME/DME/retail services. Eligible Facilities HME/DME - Retail Contract Access Geographic Service Area Available Nationwide Forms Required Membership application completed through US Rehab or VGM. See forms attached. Access Criteria VGM Membership Maximize Savings Identify yourself as an Amerinet member to capitalize on the VGM/US Rehab/Amerinet membership program. Payment Terms Non-contract monthly membership fees. Place An Order All product orders are placed directly with the US Rehab Participating Vendors. Contact: AS10231 US Rehab Frank Gillespie Page 1

2 Greg Packer Direct Cell: Delivery All orders placed will be shipped from the Participating Vendor. Price Or Discount Amerinet members receive a discounted US Rehab Membership at $100/month additional to VGM monthly membership dues. Product discount and pricing varies by product and service as defined in our Participating Vendor Contract Listing and our US Rehab Member Catalogs. Price Protection Contracted pricing exclusive to US Rehab Members. Freight Freight is defined under each Participating Vendor Contract. Minimum Order Minimum orders, account information and terms are defined under each Participating Vendor Contract. Supplier Diversity Not Applicable Failure to Supply/Perform Not Applicable Supplier Latex Information Not Applicable Medicare/Medicaid Disclosure Statement In accordance with the Medicare and Medicaid Patient and Program Protection Act of 1987 (P.L ), this is to notify you that payments, not to exceed three percent of all reported purchases made under the terms of this agreement, may be paid by the contract vendor or its authorized distributor(s) to Amerinet, Inc. to provide funding for continued program development and administration. Amerinet, through the organization with which you are affiliated, will disclose in writing to your facility, at least annually, the amount received from the above and/or its authorized distributor with respect to purchases made by or on behalf of your facility. Confidential Information All information herein listed is proprietary to Amerinet, Inc. Its use is strictly limited to the appropriate business purposes of the Amerinet Member facility to whom it has been provided, and may not be conveyed or provided in any way to any other party. AS10231 US Rehab Frank Gillespie Page 2

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4 History of VGM Van G. Miller founded VGM & Associates Sept. 3, 1986, as a national buying group for independent home medical equipment providers. In the ensuing decades, it has expanded to include buying groups for high-tech rehab and respiratory providers, orthotic and prosthetic practitioners, the golf and private club industry and HME providers in Canada. The organization has grown to include 15 companies, the majority of which are related to the HME industry. Collectively, they re known as The VGM Group, Inc. VGM is the largest group of its kind in the HME industry. VGM s story really begins in 1978, when Van founded Miller Medical Service, an HME business that grew into a franchise operation with 26 locations in the Midwest. Because of its size, the company received healthy volume discounts from nearly all its vendors, enabling even the small franchisee to realize very good pricing. He sold his 50 percent ownership of Miller Medical in 1986, and founded VGM & Associates. In 2005, VGM implemented an ESOP, which is the centerpiece of the company s plan for succession and continuity. On June 3, 2008, VGM became a 100 percent employee-owned company.

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6 U.S. Rehab is an organization for high-tech rehab providers. Acquired in 1997 by VGM, it has grown to an organization with more than 1,000 independently owned rehab member locations. Understanding the uniqueness of the rehab technology market, U.S. Rehab strives to assist members with services that will allow them to operate more efficiently and increase profitability. These services include excellent pricing from leading rehab equipment manufacturers, reimbursement and clinical advice from leading industry experts and top-notch educational programs, among other things. As a division of VGM, members can take advantage of a suite of products and services from the other 15 divisions within the organization. U.S. Rehab is proud that all members meet high-level admission standards and hold credentials from NRRTS and RESNA. A division of The VGM Group, Inc.

7 Elizabeth Cole Director of Clinical Rehab Services Carrie Etten Administrative Assistant Amanda Smith Marketing Coordinator Peggy Walker, RN Billing and Reimbursement Adviser Greg A. Packer Vice President

8 Member Communication U.S. Rehab communicates vital information to members via s. Information includes participating vendor promotions and rehab industry news. As a member, be sure to add to your address book to ensure you receive these communications. The U.S. Rehab website How to register for members-only online: 1. Go to and click on: Need a login? 2. Fill in the required information and create a password for your account. 3. Your registration will typically be approved within minutes, during business hours. 4. Sign-in using your address and password for members-only access to the website. Note: When registering for an account, be sure to check the box to begin receiving important updates. ListServ In keeping with the informational and communication needs of our membership, U.S. Rehab has established a ListServ. This ListServ makes it easier for members to communicate with one another. U.S. Rehab and members are able to quickly disseminate information and receive feedback and responses quickly by posting messages to this ListServ.

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10 Members-only Publications U.S. Rehab periodically publishes special tools for members to use. These have included a Standardized Service Rate Guide, Financial Survey and Salary Survey. The goal of the surveys is to offer a variety of metrics that give you the chance to compare your company results to a sample of your peers. All data collected is from participating U.S. Rehab members. Participation in these projects is vital to get the most accurate information. The rate guide assists service managers by serving as a reference document for determining time allotment for standard service and repairs on most manual and power wheelchairs. All publications are available online at For members convenience, the standardized labor rate tables are available online in an Excel file format (with formulas included) for you to complete and print. A division of The VGM Group, Inc.

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12 U.S. Rehab Technical Training The goal of U.S. Rehab s technical training is to create an elite group of Assistive Technology Technicians. The intensive, three-day sessions take place throughout the U.S., and are designed for service technicians who have worked with power rehab equipment for at least one year. Sessions are limited in size to ensure quality one-on-one training. Conducting the sessions, which cover everything from batteries to electronic troubleshooting, are U.S. Rehab Participating Vendors. Each vendor has assembled an open-book exam that features actual case studies. The timed replacement parts test covers all materials taught in the seminar, and focuses on efficiency and correct tool use. On the final afternoon, each attendee takes a comprehensive examination. Scores are used to provide certification recognition seals. Score Certification level 90 to 100 percent Red Star 80 to 90 percent White Star 70 to 80 percent Blue Star Upon successful completion of the training, you are able to receive additional discounts from participating vendors.

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14 Educational Offerings Customized education U.S. Rehab offers you continuing education at your own location. Through our Custom Seminar Program, your staff and referrals have the opportunity to boost their professional knowledge locally. You choose the topic and the audience, and we bring the education to you. A wide array of topics are available, including characteristics of primary disability groups, client evaluation, assessment for assistive technology, funding and reimbursement, and an overview of other assistive technology for the ATP. cademy A d v a n c e d R e h a b E d u c a t i o n f U.S. Rehab s Academy of Advanced Rehab Education is your source for online learning. The academy offers an array of rehabrelated educational programs, including the Assistive Technology Training Program (ATTP) for individuals seeking the ATP Credential. These unique educational offerings allow you to learn at your own pace and in your own environment. By enrolling in U.S. Rehab s Academy of Advanced Rehab Education, you will receive a first-rate learning experience and education credits. Remember to check back with the academy often as we continue to develop new courses tailored to meet your needs. The academy is available at:

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16 Billing and Reimbursement Help Peggy Walker, RN, serves as U.S. Rehab s billing and reimbursement adviser. She has special rehab expertise, and is available to help answer questions about Medicare requirements and billing for seating systems and high-tech rehab products. A frequent speaker at regional and national events, Peggy is also available to conduct inservices at member facilities. While working for HHE Consulting in South Carolina, she implemented a pre-screening program for specialty and rehab wheelchairs. Peggy also conducts a traveling road show. This hands-on workshop takes you through the Medicare billing process from start to finish. Several shows are held each year in various locations across the United States Clinical Rehab Services Elizabeth Cole has been involved for the past 25 years in many aspects of assistive technology. As a physical therapist, Elizabeth practiced in neuro-rehabilitation and ran a seating and mobility clinic. She then joined a major DME manufacturer, working first in seating and mobility sales and later as director of education, responsible for development and instruction of education programs in seating and mobility prescription. She has also used her industry experiences as a consultant, providing clinical and reimbursement consulting for HME and assistive technology. She has been published in national industry journals, is a member of the RESNA Board of Directors, a Friend of NRRTS and a member of the Clinician s Task Force

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18 U.S. Rehab FAQs Is there an advantage to U.S. Rehab membership in addition to my VGM membership? Absolutely! There are several differences that distinguish U.S. Rehab membership from VGM. You will have access to more than 20 vendor contracts that are not offered to VGM Members. In addition, you receive special pricing from certain VGM Group Vendors. U.S. Rehab is dedicated to keeping its members in the know when it comes to high-end rehab related industry news and updates through communication and exclusive consultants. This information is only distributed to members. How do I enroll in U.S. Rehab? It s simple to join. You simply complete the membership application and participating forms and fax them in or complete online at our website. We will process your application and assign you a membership number that starts with the letter U. Why do I have to fill out forms with my application? We work to ensure you have the best pricing available. In order to ensure participating vendors have your account connected to the U.S. Rehab contract, we require these forms. What happens after you assign us a member number? U.S. Rehab notifies all of our participating vendors that you have joined the group. You will now be able to sign up for members-only access to our website. You will also receive a complete participating vendor catalog in the mail.

19 Does membership in U.S. Rehab automatically establish accounts with each of the vendors? No, it does not. However, as part of the contract process and your affiliation with U.S. Rehab, we have made establishing an account with participating vendors less strenuous. What is the best way for the staff members to keep updated on U.S. Rehab vendors? The most current information, pricing details and current promotions can be found on our website (www.usrehab.com), under the members-only section. You should also register to receive our communications, as we send any time-sensitive materials with this method. To ensure you receive these s, add com to your address book. How do I know where upcoming U.S. Rehab classes are going to be? U.S. Rehab recently launched a new website with a calendar feature. By going to the calendar, you can view upcoming events and a link to registration. Does U.S. Rehab offer the ATP exam? We do not. The ATP exam is only given by RESNA, however, U.S. Rehab has several tools to assist you in your exam preparation. As a member, do you help me get a voice in the industry? Of course! We encourage all members to stay active with their state associations and boards and contact with your elected officials. U.S. Rehab is represented on several rehab boards such as NCART, CRMC, RESNA, NRRTS and AA Homecare.

20 For more information about joining U.S. Rehab, call us at or visit our website, A division of The VGM Group, Inc.

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22 THE VGM GROUP (Office use only) Member #: Dues: Member Service Rep: Start Date: MemberApplication M E M B E R S E RV I C E O R G A N I Z AT I O N Current VGM Member Number: Please print clearly and complete all fields: Legal Company Name: DBA: Mailing Address: City: State: ZIP code: Phone: Fax: 24-hr fax? Yes No Owner's Name(s): Store Contact (if different than owner): Medicare#: Medicaid#: Federal Tax ID#: NPI#: Do you have any branch stores? Yes No If yes, total number of branch stores: *Please include additional branch locations on back page List your top 5 product vendors and approx. annual volume with each: Accounts payable contact person at your company: Does your company have a website? Yes No If yes, the address: Is your company accredited? Yes No If yes, with whom? ACHC CHAPS HQAA JCAHO Other: Credentialed employees: (check all that apply) CRTS ATP PT OT What products or services do you provide? (Please check all that apply) Wheelchairs Ramps (built) ECUs (environmental control units) Custom rehab Patient lifts Wheelchair/scooter lifts Ramps (rental) Patient supports Vehicle modifications

23 Additional Branch Locations Branch Name: Store Contact: Branch Address: City: State: ZIP Code: Phone: Fax: Medicare#: Medicaid#: Federal Tax ID#: Branch Name: Store Contact: Branch Address: City: State: ZIP Code: Phone: Fax: Medicare#: Medicaid#: Federal Tax ID#: Branch Name: Store Contact: Branch Address: City: State: ZIP Code: Phone: Fax: Medicare#: Medicaid#: Federal Tax ID#: *Please include additional branch locations on a separate sheet Communication is key! At VGM, we send out timely s on the following topics: general announcements, legislative updates, vendor promotions, national competitive bidding updates and regulatory updates. Who at your office should receive information on these topics? Please log on to to sign up for a user name and password in the Members-Only Area of the website and check which s you would like to receive. I understand that my U.S. Rehab network dues will be an additional montly fee of $150 per month and that I must stay current (60 days) or will be subject to cancellation. This application is submitted in connection with business and commercial financing and NOT for personal, family or household purposes. You warrant the information on or relating to this application (the data ) is true and complete, and you will notify us of any material change therein. You consent to and authorize (i) us and our agents to obtain commercial and consumer credit reports, make other inquiries and investigate references and data, and (ii) anybody contacted by us or our agents to release credit and financial information. We comply with Section 326 of the USA Patriot Act, which mandates that we verify certain information about you while processing your account application. You also authorize us to offset any sums due from any of our affiliated companies, including but not limited to HOMELINK, against any unpaid sums you owe us, our affiliated companies, or VGM Financial Services, without notice. You hereby waive any and all claims for payment of any offset made and also release HOMELINK from any and all claims or liability for said payment. I understand that VGM enters into contracts with participating vendors to obtain discounted pricing for VGM Members, and that such vendors may pay a fee to VGM not exceeding 3 percent of the price of goods I purchase from the vendor. Any cancellations are required in writing. EQUAL CREDIT OPPORTUNITY ACT. If your application for business credit is denied, you have the right to a written statement of the specific reasons for the denial. To obtain the statement, please contact our customer service representative, within 60 days from the date you are notified of our decision. We will send you a written statement of reasons for the denial within 30 days of receiving your request for the statement. NOTICE: The federal Equal Credit Opportunity Act prohibits creditors from discriminating against credit applicants on the basis of race, color, religion, national origin, sex, marital status, age (provided the applicant has the capacity to enter into a binding contract); because all or part of the applicant s income derives from any public assistance program; or because the applicant has in good faith exercised any right under the Consumer Credit Protection Act. The federal agency that administers compliance with this law concerning this creditor is the Office of the Comptroller of the Currency, Customer Assistance Group, 1301 McKinney Street, Suite 3710, Houston, Texas By signing below, the undersigned principal or guarantor of the applicant hereby authorizes VGM to obtain one or more credit profiles on him, her and/or the applicant from a credit reporting agency for use in connection with (a) the transaction currently contemplated, (b) the extension of credit, (c) any subsequent updates, renewals, or extensions of the transaction currently contemplated or credit, and (d) review or collection of any resulting accounts. In addition, the undersigned hereby authorizes any bank, financial institution or trade reference listed herein to release usual and customary business or personal credit information to VGM. A copy of this signed authorization shall be deemed an original for all purposes. Owner s Signature: U.S. Rehab Associate: Please bookmark the following website for reference: Date: Date: U.S. Rehab Member Application

24 VGM PARTICIPATING VENDORS LIST Please mark the Vendors you purchase from and list your account numbers. This allows us to make sure the Vendor tags your account for the proper U.S. Rehab discounts. U.S. REHAB EXCLUSIVE PARTICIPATING VENDORS AbleNet Bodypoint Comfort Company Harmar Innovation In Motion Innovative Concepts Ki Mobility Leisure Lift LMN Builder Moen Home Care Motion Concepts Permobil PDG Product Design Group PRM (Signature 2000) Raz Designs Richardson Products Rifton Equipment Roho The Aftermarket Group Therafin Revised 04/16/2013 EH

25 Date Member# VGM U.S. Rehab Nationwide Respiratory NOTICE OF GROUP PURCHASING DECLARATION FORM has entered into a Group Purchasing Organization (GPO) Agreement with VGM & Associates, U.S. Rehab, Nationwide Respiratory) (VGM ). If you are currently crediting our purchases to another GPO, we wish to change our affiliation with that GPO for all purchases. Furthermore, we agree to comply with the GPO Purchasing Agreement between VGM and the Supplier. Declaration On behalf of and its legal affiliates purchasing your products, the undersigned hereby agrees to and certifies the following: Effective immediately, our company hereby declares that our GPO of record be VGM & Associates and/or U.S. Rehab and/or Nationwide Respiratory (VGM) for the purchase of your products. The undersigned has full power and authority to execute this Certification. Signature: Date: Print Name: Print Title:

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