2010-2013 AGREEMENT BETWEEN BERKSHIRE MEDICAL CENTER AND MASSACHUSETTS NURSES ASSOCIATION

2010-2013 AGREEMENT BETWEEN BERKSHIRE MEDICAL CENTER AND MASSACHUSETTS NURSES ASSOCIATION

T A B L E O F C O N T E N T S PAGE ARTICLE I...1 Section 1.1. Recognition...1 Section 1.2. Participation in Professional Association...1 Section 1.3. Dues Checkoff...2 ARTICLE II...2 Section 2.1. Definitions...2 Section 2.2. Change in Scheduled Hours...4 ARTICLE III...4 Section 3.1. Regular Salaries...4 Section 3.2. Shift Differentials...5 Section 3.3. Permanent Evening Shift Bonus and Permanent Night Shift Bonus...6 Section 3.4. Weekend Differential...6 Section 3.5. On-Call and Call-Back...7 Section 3.6. Charge Nurse and Clinical Leaders...7 Section 3.7. Rate After Promotion...8 Section 3.8. Appointment to Temporary Supervisory Position...8 Section 3.9. Certification/Recertification...8 Section 3.10. Benefits for Per Diem Nurses...10 Section 3.11. First Assistant in the Operating Room...10 Section 3.12. Payroll...10 ARTICLE IV...11 Section 4.1. Hours of Work...11 Section 4.2. Overtime/Mandatory Overtime...11 Section 4.3. Schedules...13 Section 4.4. Weekends...13 Section 4.5. Rotation...14 Section 4.6. Access to Chief Nursing Officer...14 Section 4.7. Principles Concerning Nursing and Quality Patient/Family Care...14 Section 4.8. Temporary Reassignment...15 Section 4.9. Four-Day 36-Hour Night Shift...15 Section 4.10. 12-Hour Shift Positions...16 Section 4.11. 10-Hour Shift Positions...17 Section 4.12. Clinical Development Program...18 Section 4.13. Master Schedule Program....19 ARTICLE V...22 Section 5.1. Holidays...22 -i-

ARTICLE PAGE ARTICLE VI...22 Section 6.1. Applicability of Earned Time Program...22 Section 6.2. Accrual of Earned Time...22 Section 6.3. Use of Earned Time...23 Section 6.4. Pay for Earned Time...26 Section 6.5. Earned Time Accrual in Excess of the Maximum...27 Section 6.6. Annual Conversion of Earned Time to Long-Term Illness Bank Hours...27 Section 6.7. Cash Surrender of Earned Time...27 Section 6.8. Long-Term Illness Bank...28 ARTICLE VII...28 Section 7.1. Medical Insurance...28 Section 7.2. Pre-Employment and Periodic Physical Examination...29 Section 7.3. Life Insurance...29 Section 7.4. Dental Insurance...29 Section 7.5. X-Ray Badges...30 Section 7.6. Information on Pay Stubs...30 Section 7.7. Long-Term Disability Insurance...30 Section 7.8. Pre-Tax Programs...30 Section 7.9. Mandated Treatment While On Duty...30 Section 7.10. Short-Term Disability Insurance...30 Section 7.11. Special Benefit Program for Senior Nurses...30 ARTICLE VIII...31 Section 8.1. Leaves of Absences...31 Section 8.2. Accrual of Benefits...33 Section 8.3. Payment of Benefits to Nurses on Leave...33 ARTICLE IX...33 Section 9.1. Seniority - Full-Time and Scheduled Part Time Nurses...33 Section 9.2. Seniority - Per Diem Nurses...35 Section 9.3. Loss of Seniority...35 Section 9.4. Reduction in Force...36 Section 9.5. Work Location...40 Section 9.6. Association Representatives...40 Section 9.7. Non-Discrimination...41 Section 9.8. Performance Evaluation...41 Section 9.9. Jury Duty and Court Appearances...41 Section 9.10. Discipline...41 Section 9.11. Promotions/Vacancies/Transfers...41 Section 9.12. Personnel Files...42 ARTICLE X...42 Section 10.1. Bereavement Leave...42 Section 10.2. Liability Insurance...43 Section 10.3. Workers Compensation...43 Section 10.4. Orientation...43 -ii-

ARTICLE PAGE Section 10.5. Bulletin Boards...43 Section 10.6. Pension Plan...43 Section 10.7. Notice of Resignation...44 Section 10.8. Mileage...44 Section 10.9. Professional Activities...44 Section 10.10. Tuition Reimbursement...44 Section 10.11. Continuing Education Units...45 Section 10.12. Preceptor Pay...45 Section 10.13. Safety Committee...45 Section 10.14. Latex Sensitivity...46 Section 10.15. Health and Safety...46 ARTICLE XI...46 Section 11.1. Nurses Committee...46 Section 11.2. Grievances...47 Section 11.3. Arbitration...48 Section 11.4. Association Grievances...48 Section 11.5. Other...48 ARTICLE XII...48 Section 12.1. Strikes and Lockouts...48 ARTICLE XIII...48 Section 13.1. Management Rights...48 ARTICLE XIV...49 Section 14.1. Duration...49 ARTICLE XV...49 Section 15.1. Successorship...49 -iii-

(d) The Medical Center shall grant time off without loss of pay for a nurse who is elected to the Association s Board of Directors in order to attend meetings of such -1- AGREEMENT AGREEMENT made and entered into this 22d day of July, 2011, by and between the Berkshire Medical Center (the Medical Center ) and the Massachusetts Nurses Association (the Association ). Section 1.1. Recognition ARTICLE I The Medical Center recognizes the Association as the sole and exclusive bargaining representative for all of its Registered Nurses employed at both its BMC campus and its Hillcrest campus, excluding the Chief Nursing Officer; Vice President, Medical/Surgical Nursing; Division Administrator, Specialty Services; Division Administrator, Maternal and Child Health; Department Directors/Weekend & Off-Shift Directors; Clinical Development Specialist; Assistant Administrator -- Nursing Systems; Coordinator of Medical/Nursing Quality Assurance; Assistant Department Directors; Neonatal Nurse Practitioner -- Clinical Director; Director of Berkshire Healthworks; Cardiac Rehabilitation Coordinator; Director, Education; Manager, Utilization Review; Coordinator of Nursing Finance; members of religious orders, confidential employees, managerial employees, guards and supervisors as defined in the National Labor Relations Act, and all other employees of the Medical Center. Section 1.2. Participation in Professional Association (a) The Medical Center will advise all new nurses at the time of employment that the Association is their bargaining representative. The Medical Center will notify the Association in writing on a monthly basis of the name, address, pay rate at hire, and classification of each newly-hired registered nurse, and the names of those nurses who have terminated, been promoted, had their scheduled hours changed, or go on a leave of absence. (b) The Medical Center will provide the Association on a quarterly basis (on or about January 1, April 1, July 1 and October 1) with a list of all registered nurses in the bargaining unit with their dates of hire and their addresses. (c) All full-time and scheduled part-time nurses hired after December 31, 1981, upon completion of 30 days of employment, shall as a condition of continued employment become a member of the Association or pay an Association Service Fee in such amounts as may be required by the Association, not in excess of its normal periodic dues. The Medical Center will not discourage, discriminate or in any other way interfere with the right of any nurse to become and remain a member of the Association. Any full-time or scheduled part-time nurse who was hired before January 1, 1982, and who is currently a member of the Association shall, as a condition of continued employment, remain a member for the term of this Agreement.

Board that are held on a day on which the nurse is scheduled to work, which shall be limited to one day per quarter and to one nurse per quarter. Any such paid time off will not count as time worked for purposes of the overtime calculation pursuant to Section 4.2. Section 1.3. Dues Checkoff The Medical Center agrees to deduct (i) annual Association membership dues or Association Service Fees and (ii) any monies voluntarily authorized by a nurse as local dues, on a monthly basis from the salary of the nurses and to remit the same to the Association on the following basis: (a) Each individual nurse must sign and have on file with the Medical Center Payroll Department a dues or agency fee check-off authorization card which authorizes such deduction. The authorization can be revoked by terminating employment. Such revocation shall become effective on the first payroll period of the month following the termination. (b) The Medical Center will remit to the Association the total sums so deducted together with (i) the list of the names of the nurses from whom the deductions were made and (ii) a breakdown of local and other dues and service fees, no later than the end of the month in which the deductions were made. Local dues will be remitted to the local Association Treasurer whose name shall be certified in writing by the Association to the Medical Center. (c) The Association shall indemnify and save the Medical Center harmless against any and all claims, demands, suits, or other forms of liabilities that shall arise out of or by reason of action taken or not taken by the Medical Center, for the purposes of complying with any of the provisions of this Article, or in reliance on any authorization, revocation, list, notice, or assignment furnished under any of such provisions. Section 2.1. Definitions ARTICLE II (a) Probationary Period - The first three months of employment or reemployment shall be the probationary period for full-time nurses, and the first 400 hours of employment or reemployment shall be the probationary period for part-time nurses (provided that, for a per diem nurse, such 400-hour probationary period shall in no event be less than three months or more than one year). In the event that a per diem registered nurse transfers to a full-time or to a scheduled part-time bargaining unit position without a break in service, such a nurse shall commence a new probationary period in accordance with the preceding sentence; provided, however, that this sentence shall not apply to a per diem registered nurse who has been in a full-time or scheduled part-time bargaining unit position within the 15 months preceding such transfer. Discharge will be at the sole discretion of the Medical Center. (b) Full-Time Registered Nurses are those hired to work a full schedule on a permanent basis. -2-

(c) Scheduled Part-Time Registered Nurses are those hired to work on a permanent basis to fill a regularly scheduled position of not less than 16 hours per week and who work in the same pattern as full-time registered nurses. Nurses who are hired to, and regularly scheduled to, work at least eight hours per week but less than 16 hours per week shall also be considered scheduled part-time registered nurses, but shall not be eligible for any economic benefits under this Agreement except for those described in Article VI (but at an accrual rate that is 50% of the accrual rate for other scheduled parttime nurses) and Section 3.9 ( Certification/Recertification ). (d) Per Diem Registered Nurses (also sometimes referred to as nonscheduled part-time nurses ) are those hired to work on a permanent or limited basis as fill-in or relief personnel but who do not work, normally, in the same pattern as full-time registered nurses within their department. As a condition of continued employment, a per diem nurse must work (i) at least 96 hours per calendar year, except to the extent that such nurse is unable to do so because of temporary medical incapacity (which shall be subject to verification that is reasonably satisfactory to the Medical Center) or because the Medical Center does not provide such nurse an opportunity to work, (ii) four weekend shifts during the period from June 1 through Labor Day week of any calendar year, and (iii) four additional weekend shifts during the calendar year; a per diem nurse must also commit to a particular service (which for the purpose of this Section 2.1(d) shall be the same as the units listed in Section 9.4(b) below), and (except for 15-year nurses to whom Section 4.5 applied immediately prior to their becoming per diem) must also be available to work for that particular service on at least two eight-hour alternate shifts during a calendar year, at least one of which will be during the period June 1 through Labor Day week. (e) Temporary Employees and Temporary Positions. (1) Temporary Employees are employed for positions that shall normally last no longer than six months. The termination of such an employee s temporary employment is at the discretion of the Medical Center and is not subject to grievance and arbitration under Article XI. (2) Temporary Positions. If the Medical Center determines that a temporary position will extend beyond six months, it will so inform the Association before such extension and will provide it with an opportunity to discuss such extension. A per diem nurse who is employed in a temporary position does not receive benefits, but a regularly-scheduled nurse who is employed in a temporary position will continue to receive benefits at the level determined by her/his regular commitment while so employed. A regularly-scheduled nurse whose application for a temporary position is approved and who is then employed in such a temporary position shall return to her/his regular position at the end of such a temporary position. -3-

A nurse on the recall list who assumes a temporary position shall remain on the recall list to the extent set forth in Section 9.4(f), and her/his having assumed a temporary position shall not adversely affect the duration of her/his recall rights. (f) Casual Employees are not covered by this contract and are used on an emergency basis. Section 2.2. Change in Scheduled Hours (a) Temporary overtime or a temporary reduction in hours worked shall not affect the category in which the nurse is classified hereunder, unless such change in hours is of such duration as to become part of the nurse s normally scheduled work week. (b) A nurse who desires a permanent change in scheduled hours because she/he has been regularly scheduled for and has worked such increased hours should submit a written request to the appropriate nursing director. Upon such written request, the hours worked by such nurse over the preceding six months shall be checked by the Medical Center. If an increased schedule, as set forth in the first sentence of this Section 2.2, is verified by the Medical Center, such nurse s request shall be approved to the extent necessary to conform to such verified schedule. In the event of such approval, all benefits to which a nurse having such approved schedule is entitled shall be made retroactive to the date of application for change in status. Notwithstanding anything else in this Section 2.2, a request for an increased schedule shall not be approved if the increase in scheduled hours during the six-month base period is due to other nurses temporary leaves of absences. (c) A nurse who wishes to reduce her/his scheduled hours on a permanent basis because of a medical condition that prevents her/his working her/his full regular schedule may submit a request to such effect, in writing, to the Chief Nursing Officer. In order to be eligible for approval of such request, such nurse (i) must have at least one year of continuous employment, at the time of such request, in her/his current position, (ii) must submit satisfactory medical verification in support of such request, (iii) may not request a reduction exceeding 16 hours per week, and (iv) may not request a reduction to a regular schedule of fewer than eight hours per week. Such request shall not be unreasonably denied. Section 3.1. Regular Salaries ARTICLE III The regular hourly salaries for nurses in the bargaining unit shall be as set forth in Appendices A, B, and C, which will incorporate the following; Effective October 2, 2011, each step of the salary grades will be increased by 2.0% Effective October 7, 2012, each step of the salary grades will be increased by 2.0% -4-

Nurses who have been at the top of their salary scale for at least one year as of October 1, 2010, or will reach one year at the top of their salary scale between October 1, 2010 and the ratification date, will receive a one-time, lump sum payment of 2.0% of their 2010 W-2 wages on the next payroll date that is two (2) weeks following the ratification of this 2010-2013 agreement. Nurses having anniversary dates between the ratification date and September 30, 2011, and who will have been at the top of their salary scale for one (1) year as of their anniversary date will receive a one-time, lump sum payment of 2.0% of their 2010 W-2 wages on their anniversary dates as they occur between the ratification date and September 30, 2011. (a) A nurse with a baccalaureate degree in nursing from an accredited institution and a nurse with a master s degree in nursing from an accredited institution shall receive an additional differential of $1.00 per hour. This Section 3.1(a) shall apply only to nurses in classifications A and B. A nurse who would otherwise have her/his pay rate reduced as a result of the preceding sentence shall be red circled. Those nurses who, as of the execution date of this Agreement, were receiving a differential for degrees other than nursing degrees shall continue to receive such differential. (b) Part-time nurses will be paid at the hourly rate set forth in the applicable Appendix, plus any differentials. (c) Newly-employed nurses will be placed in a step in the above rate range in accordance with their prior experience as determined by the Chief Nursing Officer or designee. (d) A nurse who transfers to per diem status shall remain on the step in the salary schedule which she/he was on at the time of the transfer. (e) Full-time and scheduled part-time nurses will advance on the salary schedule as follows: in order to advance to each step, such a nurse must complete 12 months of continuous employment at the immediately preceding step. (f) Per diem nurses will advance on the salary schedule as follows: in order to advance to each step, such a nurse must complete (i) at least 12 months of continuous employment since her/his last step increase and (ii) 800 hours of work since her/his last step increase. Section 3.2. Shift Differentials Nurses working between the hours of 3:00 p.m. and 11:30 p.m. shall receive $1.25 per hour for each hour worked during such period, provided that at least one such hour is worked and further provided that said differential shall not be applicable to any shift commencing prior to 10:00 a.m. Nurses working between the hours 11:00 p.m. and -5-

7:00 a.m. shall receive $2.00 per hour for each hour worked during such period, provided that at least one such hour is worked. A day shift nurse who is requested by the Medical Center to work prior to 7:00 a.m. shall receive the night shift differential, provided that at least one such hour is so worked in excess of her/his full shift; a day shift nurse who is requested by the Medical Center to work beyond 3:30 p.m. shall receive the evening shift differential, provided that at least one such hour is so worked beyond her/his full shift; and evening shift nurse who is requested by the Medical Center to work before the start of her/his shift or beyond 11:30 p.m. shall receive the night shift differential, provided that at least one such hour is so worked beyond her/his full shift; and a night shift nurse who is requested by the Medical Center to work before the start of her/his shift or beyond 7:00 a.m. shall continue to receive the night shift differential for the hours that she/he works beyond her/his full shift. Full-time and scheduled part-time nurses will have the shift differential computed into vacation pay, pay for Long-Term Illness Bank usage, and pay for Bereavement Leave, when the nurse has for a period of at least three months regularly worked on the evening or night shift. Section 3.3. Permanent Evening Shift Bonus and Permanent Night Shift Bonus (a) Each full-time nurse who permanently works on the evening shift (3:00 p.m. - 11:30 p.m.) for three consecutive months shall receive a bonus of $300 for each consecutive three-month period. Any scheduled part-time evening nurse and any full-time evening nurse on unpaid leave of absence during any three-month period shall receive the payment pro-rata for each period based on their paid hours during the period (excluding hours in excess of 48 paid out of the nurse s Long-Term Illness Bank pursuant to Section 6.8). The bonus described in this Section 3.3(a) shall be paid for eligible work through September 30 on a pro rata basis if fewer than three consecutive months have then been worked and a new three-month period shall commence October 1. (b) Each full-time nurse who permanently works on the night shift (11:00 p.m. to 7:00 a.m.) for three consecutive months shall receive a bonus of $500 for each consecutive three-month period. Any scheduled part-time nurse and any full-time night nurse on unpaid leave of absence during any three-month period shall receive the payment pro-rata for each period based on their paid hours during the period (excluding hours in excess of 48 paid for out of the nurse s Long-Term Illness Bank pursuant to Section 6.8). The bonus described in this Section 3.3(b) shall be paid for eligible work through September 30 on a pro rata basis if fewer than three consecutive months have then been worked, and a new three-month period shall commence October 1. Section 3.4. Weekend Differential Nurses working on weekend shifts (which for the purposes of this section shall mean all shifts starting with the tour of duty beginning with the night shift on Friday through the tour of duty ending with the evening shift on Sunday) shall receive additional compensation of $1.25 per hour for each hour worked during said period. -6-

Section 3.5. On-Call and Call-Back Nurses on-call shall be paid at the rate of $2.75 per hour for on-call on nonholidays or $4.10 per hour for on-call on holidays listed in Section 5.1(a). Each time they are called back to the Medical Center from on-call status, they shall be paid their on-call pay plus their regular rate of pay for all time worked, but in no event for less than two hours at the applicable rate. A nurse who is called in to work from on-call and who works any time between the hours of 11:00 p.m. and 4:00 a.m. will be given eight hours off without loss of pay before being required to report for a scheduled shift. When a nurse is called in to work from on-call and works between the hours of 11:00 p.m. and 4:00 a.m., and is later called in again on the same night between the hours of 4:00 a.m. and 7:00 a.m., such nurse will be eligible for eight hours off without loss of pay before being required to report for a scheduled day shift. If, as a result of this time off, the nurse would be required to report very close to the end of the scheduled day shift, she/he should consult with her/his supervisor concerning the advisability of reporting at that time. If the nurse and the supervisor agree that it is not desirable for the nurse to report at that time, the nurse may utilize Earned Time for the remainder of the shift or may take the time off without pay. If they do not so agree, the nurse will report for the balance of the shift. OR nurses who are assigned in-house call shall be provided with a private room with lock, which shall have a private bathroom, television and telephone for local calls; security rounds will be provided; family and significant others may visit; linen will be changed upon notification to Housekeeping by the nurse; and a meal ticket for each eight hour shift (having the same maximum as meal tickets provided to non-bargaining-unit on call employees) will be provided for the nurse. If a nurse is regularly scheduled for the day shift on Saturday, she/he shall be granted the preceding Friday off unless she/he requests otherwise. The in-house on-call rate for a nurse shall be her/his regular rate of pay, except that when assigned to in-house on-call on a holiday listed in Section 5.1(a), a nurse shall receive one-and-one-half times such rate. OR staff will have a day/evening alternative to provide relief for evenings (except for 15-year nurses subject to Section 4.5). An OR nurse who is assigned in-house call shall report her/his absence to the Nursing Service Office as soon as possible in accordance with Section 6.3(f), and the Nursing Service Office shall then be responsible for endeavoring to replace the ill nurse. The provisions of this paragraph are subject to the Medical Center s remaining a Trauma Center and shall become void if the Medical Center does not so remain. Section 3.6. Charge Nurse and Clinical Leaders Any staff nurse who is in charge of a floor for two hours or more shall receive an additional $1.50 per hour. A Clinical Leader shall also receive an additional $1.50 per hour. The Hospital and the Association agree that neither will assert in any proceeding that a nurse performing the duties of a charge nurse or clinical leader should be excluded from the bargaining unit on the asserted basis that such a nurse is supervisory. -7-

Section 3.7. Rate After Promotion Any nurse who is promoted from one classification to another will be placed in the step in said classification which will provide not less than $0.25 per hour increase over her/his previous salary and will thereafter receive appropriate length of service increases within the classification to which she/he has been promoted. Section 3.8. Appointment to Temporary Supervisory Position No staff nurse shall be appointed to a temporary supervisory position without her/his agreement. No such nurse who is so appointed shall be expected to exercise independent disciplinary authority to an extent greater than is expected of a charge nurse. Section 3.9. Certification/Recertification (a) A full-time or scheduled part-time nurse who successfully completes a certification/recertification examination in the specialty area in which she/he is working will be reimbursed for the cost of the examination fee. (b) A certification differential of $0.35 per hour (for not more than one such certification) will be paid to a full-time nurse, scheduled part-time nurse or per diem nurse who is working in a specialty nursing practice in which she/he is certified. (c) For the purposes of this Section 3.9, only those certification programs listed below (as well as all certification programs approved by the ANA) and the correspondingly listed Medical Center areas shall be applicable: Certification program Medical Center area ANA Adult/Family Nurse Practitioner Gerontological Nurse Practitioner Maternal Child Health Nurse Child and Adolescent Nurse High Risk Perinatal Nurse Pediatric Nurse Practitioner Medical/Surgical Nurse Neighborhood Health Center Employee Health Service Geriatric Nurse Clinical Coordinator Medical/Surgical nurses Neighborhood Health Center Maternity/Labor & Delivery/ Nursery/Pediatrics Pediatrics Nursery Pediatrics Medical/Surgical Respiratory Education -8-

X-Ray Nurse/Radiation Oncology Clinical Specialist-Medical/Surgical Nursing Psychiatric and Mental Health Clinical Specialist in Psychiatric/Mental Health Nursing, Adult, Child, Adolescent NAACOG National Association of American College of Obstetrics AACN Critical Care Association American Society of Post Anesthesia Nurses NAON National Association of Orthopedic Nursing Emergency Nursing E.T. (Enterostomal Therapist) CHN (Renal Dialysis) American Nephrology Nurses Association INS Intravenous Nursing Society CIC (Infection Control) CNRN (Neurosurgical Nursing) COHN Occupational Health Nursing -9- Medical/Surgical Education Psychiatric Registered Nurse Psychiatric Maternity Labor and Delivery Nursery Inpatient Obstetrical Nursing Neonatal Intensive Care Nursing Ambulatory Women s Health Care Nursing OB-GYN Nurse Practitioner Maternal/Newborn Intensive Care Unit Coronary Care Unit PACU Emergency Department Telemetry Respiratory Care Unit Education (if a Critical Care instructor) Cardiac Rehabilitation PACU Crane Center Orthopedic Unit Emergency Department nurse Enterostomal Therapy nurse Renal Dialysis nurses Renal Dialysis nurses I.V. Therapy registered nurse Infection Control nurse 2 East Neuro staff Intensive Care Unit registered nurse Rehab. registered nurses Employee Health registered nurse

CNOR Certified Nurse of the Operating Room Rehabilitation Nurse CRRN Certified Oncology Nurse ONS/ANA Operating Room registered nurses Crane Center Rehab. registered nurse Radiation Oncology Certified Diabetic Educator Certified Addictions RN (C.A.R.N.) Staff Development RNC Gerontological Nursing Certified Radiology Nurse (ARNA) Commission for Case Management Certification Behavioral sciences Staff Education Skilled Nursing Facility (SNF) Inpatient Rehab Unit Radiology Case Managers Section 3.10. Benefits for Per Diem Nurses Per diem nurses shall receive the following benefits: shift differential, weekend differential, charge pay, holiday time-and-one-half (if worked), and pension (if eligible). Section 3.11. First Assistant in the Operating Room A nurse assigned by the Medical Center to a position as a First Assistant in the Operating Room shall be paid at the Staff Nurse salary rate plus $0.60 per hour following completion of a formal program plus 120 hours of clinical training. Such a nurse shall initiate and continue progress toward certification and take the national certification examination when all practicum hours are completed. The Medical Center reserves the right, in its discretion, to determine the case types for which First Assistants will be assigned and to determine whether any such position will be continued. A nurse functioning as a First Assistant in the operating room will not combine that role with the role of scrub nurse on the same case. Section 3.12. Payroll As of the first payroll period of calendar year 2011, all Nurses will be paid via direct deposit to a bank or credit union account (within the United States) chosen by the nurse. -10-

ARTICLE IV Section 4.1. Hours of Work The regular work week shall consist of 40 hours, Sunday through Saturday. The regular work day shall consist of eight consecutive hours with a one half hour meal period on the day and evening shifts. The regular day shift shall be 7:00 a.m. to 3:30 p.m., the regular evening shift shall be 3:00 p.m. to 11:30 p.m., and the regular night shift shall be 11:00 p.m. to 7:00 a.m. except for positions that require a different schedule. Before establishing any such positions having a different schedule, the Medical Center will negotiate with the Association to the extent required by law. Section 4.2. Overtime/Mandatory Overtime (a) All authorized work performed in excess of a nurse s regular length of shift or in excess of eight hours in a day, whichever is greater, or in excess of 40 hours in a week shall be paid for at 1.5 times the nurse s regular rate. Instructor categories and O.R. nurses will be paid at time and one half for all overtime worked unless they request to take compensatory time off in lieu of overtime pay and such request is approved. Requests for compensatory time off will be approved at the discretion of the manager and, if approved, must be taken during the same week in which the overtime was worked. When overtime is used in this manner, it should equal to time-and-one-half. Unworked hours for which the nurse has been paid as Earned Time shall be counted in the determination of whether subsequent or other hours worked in the same work week shall be paid as overtime under this Section 4.2. There shall be no pyramiding of overtime, except as follows: during a pay period that includes a holiday listed in Section 5.1(a), overtime pay pursuant to this paragraph will be paid after 40 hours of work in a week, without regard to whether any of the first 40 hours are paid at holiday time-and-one-half pursuant to Section 5.1(b), provided that the hours that follow the 40 th hour are not holiday hours (in which event the no pyramiding rule would apply). If any nurse works a full double shift of 15.5 hours consecutively, the Medical Center shall pay the nurse for 16 hours of work. No nurse shall work more than one such double shift (day/evening or evening/night) within the same pay period, nor shall any nurse work such a double shift from the night shift onto the day shift, except with the specific advance approval of the Chief Nursing Officer or a Director of Nursing. If any nurse works two consecutive eight-hour shifts and then works into a third shift, the Medical Center shall pay the nurse double time for any time worked in the third shift. (b) 1. Mandatory overtime shall not be the established practice for staffing the Medical Center (i.e., mandatory overtime will be the exception, not the rule). The Medical Center will exercise good faith and reasonable efforts in filling committed RN positions, thereby recognizing its goal to keep mandatory overtime to a minimum. -11-

2. Before assigning mandatory overtime within a nursing unit, the Medical Center will use its best efforts to fill its needs with volunteers as follows: (a) (b) (c) The Medical Center will contact (i) unit nurses who are on duty, (ii) nurses on duty who regularly float to said unit, and (iii) nurses on duty who have previously been permanently assigned to that unit within the last 90 days, in order to seek volunteers to cover the hours. The Medical Center will attempt to contact (i) unit nurses who are off duty, (ii) nurses off duty who regularly float to said unit, and (iii) nurses off duty who have previously been permanently assigned to that unit within the last 90 days, in order to seek volunteers to cover the hours. The Medical Center will attempt to contact qualified per diem nurses to see if they are available. 3. In the event that the applicable supervisor/manager determines that there is still a need to mandate overtime in a particular unit, she/he will utilize the following process, in the order of the steps listed, until she/he receives approval for mandating overtime or until another resolution is reached that does not involve mandated overtime: (a) (b) (c) Phone the Chief Nursing Officer. If she/he cannot be reached to suggest another solution or to authorize mandatory overtime, then Phone the Vice President for Human Resources. If he/she cannot be reached to suggest another solution or to authorize mandatory overtime, then Contact the Administrator On Call, who will either suggest another solution or authorize mandatory overtime. 4. The Medical Center will mandate from among those full-time, scheduled part-time and per diem nurses who are on duty in the unit 1, according to the computerized inverse seniority list for that unit and/or the per diem inverse seniority list. These lists will be kept updated by the Medical Center with the dates that each nurse has been mandated to work overtime. The least senior nurse who has not been so mandated shall be mandated to work overtime. If all nurses on duty in that unit have been so 1 A nurse who has regular assignment but who is floated to another unit shall not be included in that unit s rotation list, but will rather be part of the rotation of the unit to which she/he is regularly assigned. A nurse who is a nursing office float or a specialty float will be exempted from any mandatory overtime assignment. The seniority date of a per diem nurse shall be determined as set forth in Sections 9.2(a) and 9.2(d) for purposes of assignment of mandatory overtime. -12-

mandated, the nurse with the least recent mandation date shall be mandated to work overtime. 5. An off-going shift nurse whose shift was worked in excess of her/his committed hours shall not be assigned mandatory overtime from such shift. 6. If the Medical Center assigns mandatory overtime to a nurse, the Medical Center will continue to attempt to cover her/his mandated assignment with volunteer overtime, per diems, floats or other appropriate solutions, with a goal of keeping the mandatory overtime to as short a time period as possible. 7. A nurse may refuse overtime for personal fatigue or personal illness. In such event, the Medical Center will not make an adverse judgment or take disciplinary action against such nurse. If such overtime is so refused, the overtime will be assigned per Section 4.2(b)(4). A nurse may also refuse to continue to work a mandated overtime period that has already begun for such reasons, in which event the Medical Center will not make an adverse judgment or take disciplinary action against such nurse. 8. Following every occurrence of mandatory overtime worked under Section 4.2(b)(4) above, an occurrence report documenting all of the Medical Center s efforts pursuant to Section 4.2(b)(2) and 4.2(b)(3) shall be prepared by the applicable unit supervisor/manager and sent to the Chief Nursing Officer, the Vice President for Human Resources, and the MNA Unit Chairperson. Such supervisor/ manager will be present at the next scheduled labor/management meeting to review the conditions that led to such overtime. The nurse(s) assigned such overtime will have the option to be present at such meeting. 9. This Section 4.2(b) will not be applicable to an emergency in which the Medical Center s Emergency Operations Plan is activated, provided that such Plan will not be activated solely because of understaffing. Section 4.3. Schedules Under normal circumstances, time schedules and days off shall be posted 16 days in advance of the four-week time block to which they are to apply. Thereafter schedules may be revised in emergencies. Section 4.4. Weekends The Medical Center will continue its present practice of endeavoring to grant every other weekend off unless the nurse requests to work more frequent weekends. A nurse shall not be required to work more than two extra eight-hour weekend shifts during the period July 1 through Labor Day week. -13-

Section 4.5. Rotation A full-time or scheduled part-time nurse working on the day shift can be required to rotate to other shifts when necessary to provide coverage for patient care, except that nurse(s) with 15 years of service in full-time and/or scheduled part-time status shall not be required to rotate shifts except in emergencies. At the time of employment, such nurse will be given the opportunity to indicate a preference for day-evening or day-night rotation. Changes in preference may be requested in writing by the nurse to the Chief Nursing Officer or her designee. The Medical Center will develop and implement a centralized system for assigning rotation, which it will endeavor to apply equitably to nurses on each shift within each unit, provided that no claim for economic compensation may be made under this sentence pursuant to Article XI. If the Medical Center decides to offer the option to a nurse to leave work (or to remain away from work) for all or part of an evening or night shift because of overstaffing on a unit, such offer will first be made to a nurse on such unit and shift who is working her/his alternate shift before such offer is made to a nurse who is regularly scheduled for such shift. If the Medical Center decides to float a nurse from a unit during an evening or night shift, a nurse regularly scheduled for such unit and shift shall be floated prior to a nurse working her/his alternate shift, subject to the provisions of Section 4.8 below. For the purposes of Sections 4.4 ( Weekends ) and 4.5 ( Rotation ), the weekend will be the 48 hours beginning at the commencement of the Saturday day shift for day shift nurses, the 48 hours beginning at the commencement of the Saturday evening shift for evening shift nurses, and the 48 hours beginning at the commencement of the Friday night shift for night shift nurses. Section 4.6. Access to Chief Nursing Officer While certain nursing departments may not be directly assigned to the Nursing Division, nurses in such departments shall have access to the Chief Nursing Officer or designee with respect to nurse practice and related matters. This in no way limits the normal supervisory relationships in such departments. Section 4.7. Principles Concerning Nursing and Quality Patient/Family Care (a) The Medical Center and the nurses jointly recognize that they share a commitment to the provision of quality patient/family care, and affirm their commitment to professional collaboration on issues that impact that care. The Medical Center will make good faith efforts to implement and maintain a plan of nursing care consistent with applicable law and with applicable professionally recognized standards of nursing practice and directed to safe and effective patient care, and to ensure that its written policies, procedures and protocols to this end are available to nursing staff. The Medical Center will also provide opportunities for nurses to participate on Medical Center committees in order to review and improve quality, including unit staff meetings and -14-

quality improvement teams. In recognition of the necessarily broad, general and philosophical nature of the principles stated in this Section 4.7(a), it is understood and agreed that the provisions of this Section 4.7(a), in whole or in part, are not susceptible to, shall not be subject to, and shall not be the basis for, any grievance or arbitration pursuant to Article XI. Rather, concerns arising under this Section 4.7(a) may be raised in the Nurses Committee under Section 11.1. (b) The Medical Center and the Association acknowledge the applicability of the Massachusetts Nurse Practice Act, Mass. G.L. ch. 112, 80B, and its lawful implementing regulations at 244 CMR Section 3.05. Within the context of said Section 3.05 as a whole, no nurse shall be required or directed to delegate nursing activities to other personnel in a manner that is contrary to said regulations and the Massachusetts Nurse Practice Act or that is inconsistent with the judgment of a reasonable and prudent nurse, and a nurse shall be reasonable and prudent in her/his exercise of the judgment accorded her/him with respect to such delegation. (c) Nurses perform many duties that support the delivery of quality patient care. Nurses are not to be assigned clerical duties (except in instances of light duty assignments) that are inappropriate to their professional status (e.g., being assigned to be unit secretaries). In the event of any such inappropriate assignment, the Association will promptly notify the Chief Nursing Officer. The provisions of this Section 4.7(c) are not intended to affect past practices in units where the staffing pattern does not include a regularly-scheduled unit secretary on a particular shift. Section 4.8. Temporary Reassignment The parties recognize the education, expertise and commitment of nurses to specialty nursing practice. The parties agree that nurses will not be temporarily reassigned unless they have had sufficient, current orientation to provide them with the competency to provide safe patient care. Section 4.9. Four-Day 36-Hour Night Shift Permanent full-time night nurses will work four nine-hour (between 10:30 p.m. and 7:30 a.m.) shifts (36-hour week). This program will only affect nurses who elect to work a permanent full-time night shift commitment as outlined in the preceding sentence. Nurses working the four-day 36-hour week (i) will receive 40 hours pay at the nurses regular hourly rate; (ii) will receive overtime premium for authorized work performed in excess of nine hours in a day or 36 hours in a week (overtime premium pay will be at the rate of 1.5 times the nurse s regular rate of pay); (iii) will accrue the same benefits afforded to permanent full-time nurses working a 40 hour week (this will include shift differential and night bonus); and (iv) will accrue Earned Time at the rate of 10 hours for each day scheduled. Vacancies for permanent 36-hour night shift positions will be filled in accordance with contract language concerning transfers (Section 9.11). -15-

If a night shift nurse to whom this Section 4.9 applies is requested by the Medical Center to work an alternate eight-hour shift, she/he will be paid her/his normal 10 hours pay for such alternate shift. Section 4.10. 12-Hour Shift Positions (a) The regular 12-hour shifts shall be day (e.g., 7:00 a.m. to 7:30 p.m.) or night (e.g., 7:00 p.m. to 7:30 a.m.), excluding a 30-minute unpaid meal period. The number and location of 12-hour positions will be determined by the Chief Nursing Officer in her sole discretion. No position that is filled shall be eliminated and its incumbent displaced for the purpose of creating a 12-hour shift. Such 12-hour shift positions shall be posted and filled in accordance with Section 9.11. (b) (1) Staff nurses whose regular weekly commitment is to work 12-hour day shifts will be paid based on their actual committed hours 2 and shall be eligible for weekend differential (subject to Section 3.4) and for evening shift differential (subject to Section 3.2, except that 12- hour shifts that commence prior to 10:00 a.m. shall not thereby be ineligible for evening shift differential, provided that the shift does not end before 7:00 p.m.). In addition, staff nurses whose regular weekly commitment is to work 12-hour day shifts that do not end before 7:00 p.m. shall be eligible for the evening shift bonus (subject to Section 3.3(a)), but pro rated on the basis of the number of such hours which the nurse actually works per week. If a nurse s regular committed 12-hour day shift ends at or after 7:00 p.m., she/he shall be eligible to receive evening shift differential for hours worked after 3:00 p.m. (subject to Section 3.2). A 12-hour day shift nurse who fails to work until at least 7:00 p.m. because (i) she/he is requested by the Medical Center to work a 12-hour day shift that ends before 7:00 p.m. instead of her/his regular committed shift, or (ii) she/he fails to complete her/his regular committed shift because of authorized paid time off (due, e.g., to illness or to absence on paid professional time pursuant to Section 10.9) will be eligible to receive evening differential for hours worked after 3:00pm. 2 Current nurses or nurses hired between the date of ratification and June 1, 2012 whose regular weekly commitment is to work three 12 hour shifts, and who are paid at the rate of 40 hours pay for those three 12 hour shifts, will continue to be paid on that basis until June 1, 2012. They will also continue until June 1, 2012 to be eligible for weekend differential (subject to Section 3.4), for night shift differential during their entire shift if they work three 12 hour night shifts (subject to Section 3.2), and for the night shift bonus (subject to Section 3.3(b)) but on a full-time basis. If they work shifts in addition to their 12 hour shifts, they will be paid for such work at straight time rates unless they work in excess of 12 hours in a day or have worked in excess of 36 hours in a week, in which case they shall be paid overtime in accordance with Section 4.2 for such excess. Such nurses will transition away from this premium pay arrangement in accordance with the side letter dated July 22, 2011 and attached hereto as Appendix D. -16-

(2) Staff nurses whose regular weekly commitment is to work one or two 12-hour night shifts will be paid based on their actual committed hours (e.g., a nurse who works two 12-hour night shifts shall be paid at the rate of 24 hours pay) and shall be eligible for weekend differential (subject to Section 3.4), for night shift differential during the entire shift (subject to Section 3.2) and for a pro-rata night shift bonus (subject to Section 3.3(b)). (c) Such nurses shall not be eligible for overtime pay pursuant to Section 4.2 during their 12-hour shifts. Such nurses who work shifts in addition to their 12-hour shifts will be paid for such work at straight time rates unless they work in excess of eight hours in the case of an eight-hour shift (or in excess of 12 hours in the case of a 12-hour shift) or have worked in excess of 40 hours in a week in which event they shall be paid overtime in accordance with Section 4.2 for such excess. (d) Such nurses shall be eligible for Earned Time pursuant to Article VI (not to accrue in excess of 12 hours in a day or 40 hours in a week), but pro rated on the basis of the number of hours which the nurse actually works per week. (e) In the event of a reduction in force, a nurse working a 12-hour shift commitment shall be considered to be working on the shift on which the majority of her/his scheduled hours fall. (E.g., a nurse working 7:00 a.m. to 7:30 p.m. shifts shall be considered to be working on the day shift, a nurse working 10:00 a.m. to 10:30 p.m. shifts shall be considered to be working on the evening shift, and a nurse working 7:00 p.m. to 7:30 a.m. shifts shall be considered to be working on the night shift.) (f) A 12-hour shift nurse who is requested by the Medical Center, for its convenience, to work a shift of fewer than 12 hours (instead of one of her/his 12-hour shifts) will be paid her/his normal 12 hours pay for such alternate shift. (g) An eight-hour shift nurse who is requested by the Medical Center to work a 12-hour shift for its convenience will be eligible for overtime in accordance with Section 4.2, but an eight-hour shift nurse who works a 12-hour shift other than by Medical Center request (e.g., at her/his own request or as the result of a switch with another nurse) will not be eligible for overtime pay during such 12-hour shift. Section 4.11. 10-Hour Shift Positions (a) The number and location of 10-hour shift positions will be determined by the Chief Nursing Officer in her sole discretion. No position that is filled shall be eliminated and its incumbent displaced for the purpose of creating a 10-hour shift position. Such 10-hour shift positions shall be posted and filled in accordance with Section 9.11. (b) A staff nurse whose regular weekly commitment is to work three or four 10-hour shifts will be paid at straight time and will be eligible for a shift differential to the extent set forth in Section 3.2. Such a nurse whose regular 10-hour shifts begin at or -17-

after 10:00 a.m. shall be eligible for the evening shift bonus (subject to Section 3.3(a)), but pro rated on the basis of the number of such hours that the nurse actually works per week. (c) Such a nurse will not be eligible for overtime pay pursuant to Section 4.2 during their 10-hour shifts. (d) 10-hour shift nurse who is requested by the Medical Center, for its convenience, to work a shift of fewer than 10 hours (instead of one of her/his 10-hour shifts) will be paid her/his normal 10 hours pay for such alternate shift. (e) An eight-hour shift nurse who is requested by the Medical Center to work a 10-hour shift for its convenience will be eligible for overtime in accordance with Section 4.2, but an eight-hour shift nurse who works a 10-hour shift other than by Medical Center request (e.g., at her/his own request or as the result of a switch with another nurse) will not be eligible for overtime pay during such 10-hour shift. Section 4.12. Clinical Development Program The Medical Center will provide full-time and scheduled part-time nurses an opportunity to practice in an area different from their current assignment, through a Clinical Development Program, subject to the following terms: In each calendar year, the Medical Center will offer Clinical Development program opportunities, each for at least a three-month period, in practice areas (and on shifts) determined by the Medical Center, provided that only one Clinical Development program opportunity will be made available (and in only one unit) for each such period. (a) In each calendar year, the Medical Center will offer at least two such opportunities. Clinical Development program opportunities will be posted for one week. (b) Each nurse must fulfill a one-year service commitment after completion of a Clinical Development program, which shall be at the same weekly-work-commitment level, unless otherwise approved by the Medical Center. If such nurse fails to so remain in the employ of the Medical Center (unless she/he is discharged or laid off or unless such failure is because of circumstances beyond her/his control), she/he shall reimburse the Medical Center in the amount of 40 Earned Time hours (or its equivalent) prorated on the basis of the of the one-year service commitment that remains unfulfilled. (c) To be eligible for a Clinical Development program opportunity, a nurse must have at least five years of seniority and must be employed in a position with a weekly work commitment of at least 24 hours per week. During the Clinical Development program, the nurse will have the same weekly work commitment, subject to the scheduling practices of the new department. (d) Eligible nurses who apply for a Clinical Development program opportunity will be selected by seniority, unless there exists a performance deficiency within the previous two years that is documented (e.g., in a performance appraisal or disciplinary action). The Medical Center will determine on the basis of operational -18-

considerations when the selected nurse s Clinical Development program will begin, which the Medical Center will endeavor to schedule within four weeks of her/his notification of selection. (e) An eligible nurse may apply for a second Clinical Development program opportunity if there are no other applications, and if the nurse has worked for the Medical Center for at least two years since completion of his/her last Clinical Development program opportunity. (f) Completion of a Clinical Development program will be considered in assessing applicants for a vacancy in the area of her/his Clinical Development program opportunity. (g) Before starting a Clinical Development program, the nurse shall have an informational interview with the Department Manager to discuss expectations for the Clinical Development program and the needs of the department. (h) A nurse who has successfully completed a Clinical Development program will thereafter be required to float to the area of her/his Clinical Development program if so assigned by the Medical Center, and will be assigned to do so for at least 12 shifts per year (with the further understanding that the Medical Center will endeavor to schedule such an assignment at least every two months). (i) To facilitate transition to the new practice area, the Medical Center will assign a nurse in the area of the Clinical Development program opportunity to work as a preceptor (whether or not such nurse has completed the Medical Center s preceptor program) to work with the nurse during her/his orientation whenever possible. (j) Upon completion of a Clinical Development program, a nurse shall be reinstated to her/his former position, subject to any impact of Section 9.4 ( Reduction in Force ) on such position. Section 4.13. Master Schedule Program. There will be a Master Schedule Program as follows: (a) (1) Any request for planned time off pursuant to Section 6.3(e) ( Use of Earned Time Usage for Planned Time Off ) must be requested at least 14 calendar days prior to the posting of the schedule on each unit, except as provided in Section 6.3(e). (2) Information regarding the schedule for positions will be included when posting vacant positions. Vacancies will be posted in accordance with Section 9.11 ( Promotions/Vacancies/Transfers ). (3) Schedules other than the master schedule may be assigned by the Medical Center during probation periods or when orienting/cross- -19-

training to a new position or area. During the period June 1 through Labor Day week, during holiday weeks, and in instances of compelling operational needs, adherence to the master schedule cannot be guaranteed. In instances of compelling operational needs in a unit, the Medical Center will first seek volunteers from the unit to cover its staffing needs, either (i) by switching their master schedules without adding shifts or (ii) by picking up additional shifts subject to Section 4.13(b) below. If no such volunteers become available, the Medical Center may (within shift and according to inverse seniority in rotation) alter the adherence to the master schedule weekly. Any such changes from the master schedule will be temporary, and will not result in the nurse s losing her/his original master schedule. (4) Holidays will continue to be scheduled pursuant to Section 5.1 ( Holidays ). (5) Sections 4.4 ( Weekends ) and 4.5 ( Rotation ) will continue to be applicable. (6) The Medical Center may adjust the master schedule, if needed, of each bargaining unit nurse up to two days within one specific week, in each time block. The Medical Center will endeavor to achieve as equitable a distribution as possible of such schedule adjustments among nurses on each unit. Nurses master schedules will not be adjusted, without their agreement, during the remaining three or four weeks of each time block except as provided in Section 4.13(a)(3) above. (7) In Departments with fewer than 18 regularly-scheduled nurses, schedules may be changed more often to assure staffing levels that are acceptable to the Medical Center: (a) Pediatrics (b) Partial Hospital Program (Behavioral Sciences) (c) IV Therapy (d) Special Procedures (RIN) (e) Endoscopy (f) Case Management (g) Other small departments including but not limited to, e.g., Occupational Health, Neighborhood Health Center, Sexually Transmitted Disease Clinic, Wound Clinic, Hillcrest Ambulatory Surgery Unit, Infection Control, Crisis, NE Pain Center, etc. (b) Nurses who request to work additional shifts shall so indicate on a unit needs list at least 14 calendar days prior to the posting of the schedule. Nurses who have indicated such requests will, in accordance with such requests, be offered the opportunity to work such shifts on the basis of the following priority: -20-

(1) scheduled part-time nurses who are regularly scheduled in the unit in which such shifts are available, in accordance with their seniority on a rotating basis; (2) scheduled part-time nursing office floats and specialty floats who are crosstrained on such unit, in accordance with their seniority on a rotating basis; (3) scheduled part-time nurses from other units, in accordance with their seniority on a rotating basis (provided that they have received orientation to the unit in accordance with Section 4.8 ( Temporary Reassignment )); (4) qualified per diem nurses 3 ; (5) full-time nurses who are regularly scheduled in the unit in which such shifts are available, in accordance with their seniority on a rotating basis; (6) scheduled full-time nursing office floats and specialty floats who are crosstrained on such unit, in accordance with their seniority on a rotating basis; and (7) full-time nurses from other units, in accordance with their seniority on a rotating basis (provided that they have received orientation to the unit in accordance with Section 4.8 ( Temporary Reassignment )). The above priorities will not be applicable to nurses who request to work additional shifts after the 14th calendar day preceding the posting of the schedule. Notwithstanding the preceding, (i) the Medical Center will have the discretion to offer the additional hours in such a way as to maximize its ability to fill an entire full- or partial shift, and (ii) the Medical Center will not be obligated to offer such work opportunity to any nurse if an overtime payment would result (provided, however, that if the Medical Center chooses to incur such an overtime payment, it will offer the work opportunity to nurses in the priority order set forth above). A grievance or claim may be made under this Section 4.13(b) by any nurse for such a non-economic remedy as a compensatory preference for future opportunity to work additional hours, but not for lost wages, unpaid premium pay, or any other form of economic compensation. 3 Per diem nurses shall not be incorporated into the posted schedule in violation of the first sentence of Section 2.1(d) ( Definitions Per Diem Registered Nurses ). -21-

(c) Requests for time changes that would alter the master schedule will not be accepted, unless a nurse who wishes such a change arranges her/his own coverage by a regularly-scheduled nurse within the same service or by a per diem nurse of equal skill level, provided that no overtime payment can result. (Requests for such time changes or time swaps must be submitted in writing, and are subject to approval by the Department Director.) Section 5.1. Holidays ARTICLE V (a) The following holidays shall be recognized for the purposes of this Article V for full-time and scheduled part-time nurses: New Year s Day Presidents Day - (Third Mon. in Feb.) Patriot s Day - (Third Mon. in April) Memorial Day - (Last Mon. in May) Independence Day Labor Day (First Mon. in Sept.) Columbus Day Thanksgiving Day Christmas Day (b) A nurse, regardless of category, working on the holiday will be paid at time-and-one-half for the hours worked. For purposes of computing the time-and-onehalf for work on the Christmas and New Year s holidays only, the holiday period will commence at 3:00 p.m. December 24 and end at 11:00 p.m. December 25 for Christmas, and will commence at 3:00 p.m. December 31 and end at 11:00 p.m. January 1 for New Year. (c) Holidays off will be rotated as equally as possible to afford each nurse a fair share of the holidays off. ARTICLE VI Section 6.1. Applicability of Earned Time Program The Earned Time ( ET ) program set forth in this Article shall be applicable to all full-time and scheduled part-time nurses, and shall replace the separate holiday, vacation, sick leave and personal time benefits which had previously applied to such nurses. The Earned Time program described in this Article shall not be applicable to per diem nurses. Section 6.2. Accrual of Earned Time rates: (a) Rates of Accrual. Each eligible nurse will accrue ET at the following (1) Nurses in salary classification A. Prior to a nurse s completing five years of continuous employment, she or he will accrue ET at the rate of 0.12307 hours for each hour paid (not to exceed 40 hours in a week) (e.g., 32 days annually for a full-time nurse). Upon completion of five years of continuous employment, she or -22-

he will accrue ET at the rate of 0.12692 hours for each hour paid (not to exceed 40 hours in a week) (e.g., 33 days annually for a full-time nurse). Upon completion of nine years of continuous employment, she or he will accrue ET at the rate of 0.14615 hours for each hour paid (not to exceed 40 hours in a week) (e.g., 38 days annually for a full-time nurse). Upon completion of 20 years of continuous employment, she or he will accrue ET at the rate of 0.17307 hours for each hour paid (not to exceed 40 hours in a week) (e.g., 45 days annually for a full-time nurse). (2) Nurses in salary classifications B, C and D. Prior to a nurse s completing five years of continuous employment, she or he will accrue ET at the rate of 0.13846 hours for each hour paid (not to exceed 40 hours in a week) (e.g., 36 days annually for a full-time nurse). Upon completion of five years of continuous employment, she or he will accrue ET at the rate of 0.14615 hours for each hour paid (not to exceed 40 hours in a week) (e.g., 38 days annually for a full-time nurse). Upon completion of 20 years of continuous employment, she or he will accrue ET at the rate of 0.17307 hours for each hour paid (not to exceed 40 hours in a week) (e.g., 45 days annually for a full-time nurse). (b) Maximum Accrual. Full-time and scheduled part-time nurses shall be entitled to accrue a maximum of 1.5 times their annual ET accrual (e.g., for a full-time staff nurse who upon completion of five years of continuous employment accrues 33 ET days [264 ET hours] annually, the maximum accrual will be 49.5 ET days [396 ET hours]). Upon reaching the applicable maximum accrual, no further accruals will be added until the nurse s ET balance falls below the maximum. (c) No Accrual. Earned time will not be accrued for hours that represent pay taken in lieu of time off. Section 6.3. Use of Earned Time (a) Initial Eligibility. A nurse shall not be eligible to use accrued ET until she or he has completed her or his probationary period. (b) Usage. All absences for, e.g., vacation, holidays, personal time and sickness will be charged to a nurse s accrued ET account, except for the following; (1) Absences pursuant to Section 9.9 (Jury Duty and Court Appearances) and Section 10.1 (Bereavement Leave). (2) Absences for which nurses are not entitled to be paid. (3) Absences due to personal illness where a nurse is eligible to, and elects to, utilize her or his Long-Term Illness Bank pursuant to Section 6.8 instead of utilizing ET. -23-

(4) Absences of up to eight hours on a day when both the nurse and the Medical Center agree that the nurse may be absent on that day because her or his services are not needed for staffing reasons: provided that (i) either the nurse or the Medical Center may initiate such a proposal; (ii) no such agreement may be made before the day on which the absence is to occur; and (iii) the Medical Center s judgment on releasing the nurse shall be final and not subject to Article XI. (5) Up to five holiday absences for a nurse who does not work on any holidays because her/his unit is closed on all holidays. (c) Yearly Minimum Usage. Full-time and scheduled part-time nurses are required to use a minimum number of ET days each calendar year that is one-half their annual ET accrual (e.g., for a full-time staff nurse who has completed five years of continuous employment, the yearly minimum usage will be 16.5 ET days [132 ET hours]). (d) Daily Minimum Usage. ET must be used in increments of one hour, except with the prior approval of the Nurse Manager or other applicable supervisor. (e) Usage for Planned Time Off (1) General. ET may be used for planned time off, i.e., time off for vacation or for personal reasons, as to which advance scheduling is possible. The Medical Center reserves the right to schedule ET for planned time off in accordance with required Medical Center coverage and service demands. Although ET usage will not be limited to weekdays, the availability of ET on weekdays or weekends will be subject to the preceding sentence. (2) Vacations. In assigning planned time off among nurses for vacations, the Medical Center will endeavor to give effect within a given nursing unit to nurses preferences; where staffing is affected by conflicting requested vacations, all other items being equal, preference shall be given in order of bargaining unit seniority (as defined in Section 9.1) if the requested vacation is during the period June 1 through Labor Day week ( prime time ), but preference shall be on a first come, first served basis if the request is submitted not more than one year in advance and is for vacation outside prime time. Where staffing is affected by conflicting vacation requests for the February/April school vacations, Thanksgiving week or Christmas week, a nurse who was granted vacation for the week in question during the previous year shall not be granted her/his request during the current year. All vacation scheduling shall be subject to the Medical Center s right to require nurses to express their preferences at least 14 days prior to the posting of the schedule on each unit pursuant to -24-

Section 4.3 to permit proper planning; provided, however, that nurses desiring to schedule vacation time off during the period June 1 through Labor Day week shall express their preferences in writing on or before April 1, and the vacation schedule shall be posted on or before May 1. A nurse s vacation shall be limited to two weeks during the period June 1 through Labor Day week; additional vacation time for such a nurse during such period may be approved only where the Medical Center deems this practicable in light of staffing considerations. Nurses denied one full week of time off during this time shall be given preference, in order of seniority, for any individual days that remain available for vacation time, provided that total time off selected by any such nurse shall not exceed his/her total weekly time commitment A nurse who has worked hours that average at least eight above her/his regularly scheduled hours may utilize her/his accumulated Earned Time pursuant to this Article VI in accordance with such higher hours, provided that (i) the requested vacation period is at least one week, (ii) the nurse has averaged such higher hours for at least the 120 days immediately preceding the date of such request, (iii) the request is made at least four weeks in advance of the date for which vacation time is requested, and (iv) the nurse continues to work at such higher hours (on average) during the period from the date of such request through the date of such vacation (provided that the opportunity to work at such higher hours is available). (3) Holidays. A nurse scheduled to be off on a holiday listed in Section 5.1(a) shall be paid from her or his ET account to the extent needed to make up the difference between the nurse s hours worked and regularly scheduled hours during the workweek in which the holiday falls. To be eligible for ET usage on a holiday off, a nurse must work her or his full scheduled work day before the holiday (if such work day falls within 48 hours of the holiday), her or his first scheduled work day after the holiday (if such work day falls within 48 hours of the holiday) and the holiday, if so scheduled, unless her or his absence is excused by the Chief Nursing Officer (or other applicable Department Head for nurses who are not part of the Nursing Division). In no event will a nurse be eligible for ET usage for a holiday which is observed during a calendar week in which the nurse has done no work for the Medical Center. In addition, scheduled part-time nurses who work less than five days per week will be entitled to such ET usage only if they work (or are authorized to be absent on) all the remaining scheduled hours for the week in which the holiday falls. -25-

(4) Management is responsible for covering the RN for time off that has been requested and approved prior to posting. If an RN desires a day off and her/his time has already been posted then she/he must find her/his own coverage to be granted that time off, provided that the requesting RN must have sufficient ET in her/his bank, the person selected to provide coverage must have comparable skills and qualifications as the requesting RN, and the coverage does not result in the payment of OT. (f) Usage for Unplanned Time Off (1) General. ET may be used for unplanned time off, i.e., time off where a nurse is unable to attend work because of personal illness, illness in the immediate family, and compelling personal business as to which advance scheduling is not possible. To be eligible to use ET for unplanned time off, a nurse (i) must have completed her or his probationary period and (ii) must give notice of her or his absence to the designated supervisor at least one hour prior to the nurse s scheduled starting time if she or he works the day shift or three hours prior to her or his scheduled starting time if she or he works the evening or night shift, unless her or his failure to give such notice is for reasons that are reasonably satisfactory to the Medical Center. In addition, the Medical Center may request, and the nurse shall provide if so requested, evidence satisfactory to the Medical Center with respect to such absence, provided that such request is approved by the Chief Nursing Officer or, in her absence, by a Director of Nursing. (2) Illness. To return to work following illness, a nurse must report to the Employee Health Office for clearance before returning to work if the illness or disability exceeds three days or if the Medical Center so requests; clearance by the nurse s personal physician will be considered, with final determination to be made by the Employee Health Office. In the case of a personal job-related disability, a nurse must apply for Workers Compensation benefits and, in the event that such benefits are received, must reimburse the Medical Center for any pay that has been advanced during the period of such nurse s absence. Section 6.4. Pay for Earned Time ET pay shall be the nurse s regular straight-time hourly rate plus (i) evening or night shift differential pursuant to Section 3.2 if the nurse is permanently assigned to the evening or night shift, and (ii) the applicable differential pursuant to Section 3.6 for Clinical Leaders and Permanent Charge Nurses, and shall not exceed eight hours in a day (or the nurse s regular length of shift if longer than eight hours). -26-

Section 6.5. Earned Time Accrual in Excess of the Maximum When a nurse s ET account exceeds the maximum ET accrual specified in Section 6.2(b), any further accruals will automatically be deposited into his/her Long-Term Illness Bank. Any time a nurse's account is at or below the maximum ET accrual, the nurse may dispose of his/her ET, at the nurse s election, as follows: (a) The nurse may schedule time off in accordance with Sections 6.3(e) and (f); or (b) The nurse may receive pay in lieu of time off in accordance with Section 6.7; or (c) The nurse may convert 40 ET hours into his/her Long-Term Illness Bank hours in accordance with Section 6.6. A nurse may combine any of these three elections in components of at least eight hours each. Section 6.6. Annual Conversion of Earned Time to Long-Term Illness Bank Hours A nurse who is at or under the maximum ET accrual specified in Section 6.2(b) may convert up to 56 of her/his accrued ET hours per calendar year into up to 96 Long- Term Illness Bank hours (which may be used pursuant to Section 6.8) as follows: up to 40 ET hours may be converted to up to 80 LTIB hours at a ratio of 1:2, and up to an additional 16 ET hours may be converted to up to 16 LTIB hours at a ratio of 1:1. Any conversion pursuant to the preceding sentence shall be subject to the following provisions: (a) that all such conversion requests by a nurse during a calendar year do not in the aggregate exceed 56 ET hours; and (b) that no such conversion request may be made for LTIB hours to be used with respect to an illness or injury that is in existence at the time that such conversion request is made. Section 6.7. Cash Surrender of Earned Time (a) Upon conversion to per diem status or upon voluntary resignation of her or his employment, a nurse who has completed her or his probationary period will be paid for all accrued ET in such nurse s account. In the case of an involuntary termination, such a nurse will be paid for all accrued ET. In the case of the death of such a nurse, all accrued ET in the nurse s account will be paid to her or his beneficiary. (b) Any nurse who is at or under the maximum ET accrual specified in Section 6.2(b) may cash in ET hours on the following basis: (i) up to 80 hours during a calendar year on a one-for-one (1:1) basis after having made election to cash in such hours before the beginning of the calendar year, and (ii) additional hours as may be elected by the nurse on a three-for-four (3:4) basis (e.g., reduce ET balance by four hours -27-

and receive cash for three hours). Prior election need not be made for hours cashed in on a 3:4 basis, and such election is not dependent upon the election for the initial 80 hours on a 1:1 basis. Section 6.8. Long-Term Illness Bank In the case of a nurse s absence due to personal illness that extends beyond two consecutive workdays for such nurse, she or he may elect to utilize her or his Long-Term Illness Bank instead of her or his ET account for such absences. In the case of a nurse s absence due to personal illness that extends for five or more consecutive workdays for such nurse, she or he may elect to utilize her or his LTIB account for all the days of the absence (including the first four days). Up to three weeks of accumulated LTIB may be used in cases of adoption, at the nurse s normal weekly commitment level, where the nurse is the primary caretaker of the adopted child. Usage of days in the nurse s Long- Term Illness Bank will be subject to the eligibility requirements of Sections 6.3(f) (1) and (f) (2), and unused days in the nurse s Long-Term Illness Bank will not be paid upon termination or upon conversion to per diem status. A full-time nurse who is hired after December 12, 1989 or who secures a committed position for the first time after December 12, 1989 shall have added to her/his Long-Term Illness Bank 40 hours upon the completion of her/his probationary period pursuant to Section 2.1(a), and an additional 40 hours upon the completion of one continuous year of full-time employment, which figures shall be prorated for such a scheduled part-time nurse on the basis of the hours for which she/he is hired to work. A nurse s Long-Term Illness Bank shall not exceed a maximum accrual of 960 hours for a full-time nurse, which figure shall be prorated for a scheduled part-time nurse on the basis of the hours for which such nurse is hired to work. Section 7.1. Medical Insurance ARTICLE VII Nurses shall have the option to be covered by all medical insurance programs that are available to non-bargaining unit employees at Berkshire Medical Center with the following contributions: (a) For all nurses who work a weekly commitment of at least 30 hours, the Medical Center will contribute an amount equal to 75% of the premium cost for family coverage or 90% of the premium cost for individual coverage, applied to any HMO option chosen by the nurse, or an amount equal to 75% of the premium cost (family coverage) or 90% of the premium cost (individual coverage) of Network Blue (or a substantially equivalent program) applied to Blue Care Elect (or a substantially equivalent non-hmo plan as offered by the hospital) if this option is chosen by the nurse. The nurse will pay the remaining portion of the premium (b) For all nurses who work a weekly commitment of at least 24 hours but less than 30 hours per week, the Medical Center will contribute an amount equivalent to 50% of the individual-coverage premium of any HMO chosen by the nurse, to be applied -28-

toward individual or family coverage with the remainder to be paid by the nurse. If a higher priced, non-hmo option is offered by the hospital and chosen by the nurse, the hospital will contribute an amount equivalent to 50% of the individual plan cost of Network Blue (or a substantially equivalent product that may be offered by the hospital). The nurse will pay the remaining portion of the premium. (c) Regular part-time nurses who have a weekly commitment of at least 16 hours, but less than 24 hours, shall have the option to be covered by any of the existing health plans, with the entire premium cost to be paid by the nurse. (d) The Medical Center will provide an opt-out cash payment of $750 per calendar year, paid in weekly installments, for a nurse whose weekly commitment is at least 30 hours and who does not elect medical insurance coverage for the year, subject to proof of existing medical coverage, to the same extent that this benefit is made available to non-bargaining-unit Medical Center employees, as it may be modified from time to time (or discontinued). Section 7.2. Pre-Employment and Periodic Physical Examination Every new nurse must pass a physical examination prior to employment. This will be conducted by the Medical Center Health Service Department, and is given without cost to the nurse. For the nurse s benefit and protection, a periodic physical examination will be conducted by the Medical Center Health Service Department, and is given without cost to the nurse. The physical examination includes but is not limited to a clinical examination, chest x-ray, and other diagnostic procedures deemed necessary by the Medical Center Health Service Department. Section 7.3. Life Insurance After completing three months of employment, all nurses who work 30 hours or more per week on a regular basis will be provided with group life insurance coverage in the amount of one-half of base annual salary rounded off to the next higher $500 (if not a multiple of $500), the cost of which will be paid by the Medical Center. A nurse may, at her/his own cost, participate in the option to purchase additional life insurance on the same basis as is available to other Medical Center employees and subject to the same limitations (e.g., amount, limitation of coverage to active employment, eligibility criteria). Section 7.4. Dental Insurance With respect to the dental plan for nurses who are hired to work 30 or more hours per week, the Medical Center shall pay 65% of the premium for individual coverage for all participating members, following their completion of three months of employment. For such nurses who are hired to work 24 or more hours but less than 30 hours per week, the Medical Center shall pay 50% of such premium. The Medical Center will provide for such nurses an option for an improved dental plan, the additional cost for which will be paid by such nurses who elect such option. -29-

Section 7.5. X-Ray Badges All nurses working in O.R., PACU, X-Ray, ICU/CCU, RCU/IMC and IV Therapy shall be provided with X-Ray badges if, upon the Medical Center s inquiry, they so request, and such nurses shall thereafter wear such badges while on duty as prescribed by the manufacturer. Section 7.6. Information on Pay Stubs For nurses who have completed their probationary period, the Medical Center will list on their pay stubs their accrued Earned Time. Section 7.7. Long-Term Disability Insurance A nurse is eligible to participate in the Medical Center s long-term disability group insurance program to the same extent that it is made available to non-bargainingunit Medical Center employees, as it may be modified from time to time (or discontinued). Section 7.8. Pre-Tax Programs Nurses may participate in Medical Center programs concerning pre-tax deductions for health/dental insurance and concerning pre tax spending accounts for health care and dependent care expenses on the same basis as other Medical Center employees. Section 7.9. Mandated Treatment While On Duty If a nurse is required by the Medical Center to be treated, while on duty, at the emergency room, occupational health service (BMC campus) or the family health service (Hillcrest campus), the nurse will pay for such services through her/his insurance, to the extent possible, and the balance, if any, will not be charged to such nurse. Section 7.10. Short-Term Disability Insurance A nurse is eligible to participate in the Medical Center s short-term disability group insurance program to the same extent that it is made available to non-bargainingunit Medical Center employees, as it may be modified from time to time (or discontinued). Section 7.11. Special Benefit Program for Senior Nurses (a) A nurse who has worked at least 24 hours per week for the previous 52 weeks, who is at least 62 years old, and who has at least 20 years of bargaining-unit seniority may elect during the annual open-enrollment-for-insurance-benefits period to reduce her/his weekly commitment to (or maintain it at) 24 hours per week and shall continue to be covered by the group medical insurance plan(s) that are generally available -30-

to other employees at the Medical Center. 4 For such a nurse who has so reduced/ maintained her/his weekly commitment, the Medical Center will pay 80% of the cost of the premium for individual plan coverage (with the nurse paying the remaining 20%), or 55% of the cost of the premium for family plan coverage (with the nurse paying the remaining 45%). In order to be eligible for such Medical Center contributions, the nurse must maintain the same level of coverage (i.e., individual or family). The Medical Center contributions will be based on Network Blue rates or a substantially equivalent program. (b) Nurses whose weekly commitments are reduced pursuant to Section 7.11(a) shall remain on their respective units and shifts, as applicable. (c) A nurse whose regular schedule includes an every-other-weekend requirement (see Section 4.4. [ Weekends ]) and who elects to reduce her/his weekly commitment to (or maintain it at) 24 hours per week pursuant to Section 7.11(a) shall work 13 weekends per calendar year (normally every fourth weekend), notwithstanding Section 4.4, and any scheduled weekend shifts that are not worked shall be made up on dates within the same calendar year that are mutually agreed upon between the nurse and the Nurse Manager 5 ; in the event that such a nurse does not fulfill this weekend commitment in any calendar year, she/he will be ineligible for such reduced weekend commitment, and Section 4.4 will apply to her/him for the following calendar year. Section 8.1. Leaves of Absences ARTICLE VIII (a) Personal Illness. A leave of absence without pay will be granted to nurses for personal illness. If the leave does not exceed 90 calendar days, the Medical Center shall reinstate her/him to her/his former position and department if it is possible to do so. If it is not possible to do so, the Medical Center will notify the nurse at the commencement of the leave (or as soon thereafter as possible) if her/his position will be posted, and she/he shall be reinstated to a substantially similar position and department without loss of any benefits accrued prior to her/his leave of absence; upon returning from a leave in excess of 90 days, she/he will be given the first opportunity to return to a 4 The right to elect such a reduction to 24 hours per week as set forth in this Section 7.11 shall be available/limited as follows: (i) such a nurse whose regular weekly schedule is three 12-hour shifts may elect a reduction to two 12-hour shifts, unless otherwise agreed to by the Administrative Director of Nursing Operations in her/his sole discretion, (ii) such a nurse whose regular weekly schedule is four 10- hour shifts may elect a reduction to three 10-hour shifts (i.e., 30 hours per week) or to three 8-hour shifts, (iii) such a nurse whose regular weekly schedule is four 9-hour shifts may elect a reduction to three 9-hour shifts (i.e., 27 hours per week) or to three 8-hour shifts, (iv) such a nurse whose regular weekly schedule is three 10-hour shifts may elect a reduction to three 8-hour shifts, (v) such a nurse whose regular weekly schedule is three 9-hour shifts may elect a reduction to three 8-hour shifts, and (vi) such a nurse whose regular weekly schedule is five 8-hour shifts or four 8-hour shifts may elect a reduction to three 8-hour shifts. 5 Any missed weekend shifts in December may be so made up in December or January and still count in the total for the calendar year preceding such January. -31-

position for which she/he is qualified and will be given the first opportunity to return to her/his former position and department when said position is available. (b) Industrial Accident. In the case of a nurse who is absent because of an industrial accident, the Medical Center shall reinstate her/him to her/his former position and department if it is possible to do so. If it is not possible to do so, the Medical Center will notify the nurse at the commencement of the leave (or as soon thereafter as possible) if her/his position will be posted, and she/he shall be reinstated to a substantially similar position and department upon her/his return. (c) Maternity. A leave of absence without pay will be granted a nurse for maternity for a period not to exceed six months after date of delivery. Nurses may use accrued Earned Time and accrued sick leave days from their Long-Term Illness Bank during the period of disability due to pregnancy, in accordance with Section 6.8. The Medical Center shall reinstate her to her former position and department if it is possible to do so. If it is not possible to do so, the Medical Center will notify the nurse at the commencement of the leave (or as soon thereafter as possible) if her/his position will be posted, and she shall be reinstated to a substantially similar position and department at the expiration of her leave. In the event that the Medical Center has excess staffing needs, a nurse on leave pursuant to this Section 8.1(c) and the Medical Center may agree to the nurse s working at the Medical Center during the term of such leave without jeopardizing and without extending such leave. (d) Critical Illness or Death In The Immediate Family. A leave of absence without pay will be granted to nurses for critical illness or death in the immediate family for a period up to 90 days. The Medical Center shall reinstate she/he to her/his former position and department if it is possible to do so. If it is not possible to do so, the Medical Center will notify the nurse at the commencement of the leave (or as soon thereafter as possible) if her/his position will be posted, and she/he shall be reinstated to a substantially similar position and department at the expiration of said leave. (e) Military. A nurse who enters the military service shall be deemed to be on a leave of absence and shall be reinstated to her/his former position and department or a substantially similar position or department if she/he returns to active employment within 90 days after her/his discharge. A nurse who is called for an annual two weeks Military Reserve training or National Guard training shall be paid the difference between her/his basic earnings and military pay and allowances. The nurse shall have her/his military pay certified by her/his commanding officer. (f) Educational. The Medical Center may allow a nurse who has completed her/his probationary period a leave of absence without pay up to 12 months for educational purposes. The Medical Center shall reinstate her/him to her/his former position and department if it is possible to do so. If it is not possible to do so, the Medical Center will notify the nurse at the commencement of the leave (or as soon thereafter as possible) if her/his position will be posted, and she/he shall be reinstated to a substantially similar position and department. In the event that the Medical Center has excess staffing needs, a nurse on leave pursuant to this Section 8.1(f) and the Medical -32-

Center may agree to the nurse s working at the Medical Center during such leave without jeopardizing and without extending such leave. (g) Paternity. A nurse shall be granted up to four weeks leave, without pay, for the birth of a child. (h) Other Leaves of Absence. Leaves of absence for reasons other than above may be granted on an individual basis at the discretion of the respective Department Director to a nurse who has completed her/his probationary period. The Medical Center shall reinstate her/him to her/his former position and department if it is possible to do so. If it is not possible to do so, the Medical Center will notify the nurse at the commencement of the leave (or as soon thereafter as possible) if her/his position will be posted, and she/he shall be reinstated to a substantially similar position or department if the leave does not exceed 90 calendar days. Upon returning from a leave in excess of 90 days, the nurse will be given the first opportunity to return to her/his former position and department if it is possible to do so. If it is not possible to do so, she/he shall be reinstated to a substantially similar position and department. Section 8.2. Accrual of Benefits Benefits for nurses employed on a permanent basis shall be accrued to the extent of the number of days of leave of absence shown in the following table for the various categories of benefit and the various types of leave of absence. Earned Time Medical Insurance Life Insurance Length of Service Personal Illness 30 90 90 90 Industrial Accident 60 90 90 90 Military (Active) 0 90 90 N/A (Reserve) 15 15 15 15 Maternity 60 90 90 90 Educational 15 30 30 60 Critical Illness or Death in Family 15 60 60 30 Other 15 30 30 30 Section 8.3. Payment of Benefits to Nurses on Leave A nurse on an unpaid leave of absence pursuant to Section 8.1 may request to have any accrued Earned Time allocated to her in a reasonable manner while she is on leave. Such request, if granted, shall in no event entitle the nurse to additional accrual of benefits beyond the limits provided in Section 8.2. Effective July 14, 1996, there was established a single, multi-location bargaining unit embracing the Hillcrest and BMC campuses and a single seniority list on which were integrated the nurses in the former Hillcrest and BMC bargaining units (using a seniority -33- ARTICLE IX Section 9.1. Seniority - Full-Time and Scheduled Part Time Nurses

date for each nurse determined in accordance with the collective bargaining agreement then applicable to her/him). Bargaining unit seniority for a full-time or scheduled part-time nurse means length of time that such a nurse has been continuously employed with the Medical Center from the last date of hire as a full time or scheduled part time registered nurse. A nurse will acquire bargaining unit seniority after completion of her/his probationary period, which seniority will be computed from the nurse s last date of hire as a registered nurse. Effective October 1, 1998, for the purpose of computing bargaining unit seniority, a nurse s continuous employment shall include her/his service prior to assuming a Berkshire Health Systems or Berkshire Healthcare Systems non-bargaining unit position (but not service in such position), provided that she/he had previously been in a bargaining unit position and returns to such a position within 18 months of leaving such a position. 6 Nurses having the same last date of hire as a registered nurse shall be ordered by the last two digits of their Social Security number for determining their relative bargaining unit seniority (i.e., a larger number, e.g., 47, would represent greater seniority than a lower number, e.g., 43). A seniority list shall be posted in March. The Medical Center will endeavor to send a notice of such posting to each nurse on layoff with recall rights pursuant to Section 9.4(f), and to each Medical Center unit; provided, however, that nonreceipt of any such notice shall not constitute the basis of any grievance or claim against the Medical Center except for a grievance to enforce the procedure set forth in this sentence. In the case of each posting, a nurse shall have 30 days after the first date of posting within which to raise objections to her/his seniority date. If a nurse does not file a written objection with the Chief Nursing Officer during the 30-day period in which her/his seniority date is first posted, she/he may not thereafter dispute her/his seniority date. The preceding sentence shall not prevent a nurse from grieving, subject to Article XI, another nurse s seniority date if it adversely affects her/him, provided that she/he has previously notified the Chief Nursing Officer as soon as practicable of her/his objection to such other nurse s seniority date. A nurse who has been continuously employed by the Medical Center for at least one year in a committed non-rn position shall be credited with one year of bargaining unit seniority under this Section 9.1, provided (i) that she/he successfully has passed or passes the Massachusetts Board of Registration Examination, (ii) that she/he successfully has applied for or applies for a vacant bargaining unit position that is vacant for reasons other than a reduction in force. In order to be eligible for the seniority credit described in the preceding sentence, a nurse who had fulfilled the aforementioned requirements prior to the effective date of this Agreement must (i) request such credit, in writing, within the four weeks following the effective date of this Agreement, and (ii) provide upon request verification satisfactory to the Medical Center that the aforementioned requirements have been fulfilled (provided that the Medical Center has first sought such verification by 6 In the case of a nurse continuously employed by the Medical Center since on or before March 7, 1997, such a nurse s bargaining unit seniority shall include her/his service as a graduate nurse, provided that she/he successfully passed her/his registration examination at the first opportunity after hire. -34-

reviewing such nurse s Medical Center personnel record). An eligible nurse shall be credited by the Medical Center with the additional seniority described in this paragraph as soon as practicable, and such additional seniority shall be applied prospectively only (and not retroactively for any purpose). In the event that the Hospital enters into a merger with another MNA-represented medical facility which creates one bargaining unit from the two former ones, it is agreed that the seniority system to be implemented will be decided by a proper vote of the Medical Center s MNA bargaining unit membership and management shall not dispute the method of the seniority system to be implemented in the newly formed bargaining unit by the MNA. Section 9.2. Seniority - Per Diem Nurses (a) The seniority of a per diem nurse shall be equal to the nurse s length of continuous employment as a full-time, scheduled part-time and per diem nurse and may be applied in relation to other per diem nurses and outside hires only. (b) A per diem nurse may not assert her/his seniority against a full-time or scheduled part-time nurse for bidding and reduction in force purposes. (c) A per diem nurse who returns to full-time or scheduled part-time status with no break in employment shall be considered to have the same seniority that she/he had as of the date such nurse transferred to per diem status, and the period in per diem status shall not count in the calculation of such nurse s seniority. (d) A per diem nurse must work 225 hours per calendar year in order to maintain seniority, except to the extent that such nurse is unable to do so because of temporary physical incapacity or because the Medical Center does not provide such nurse with an opportunity to work. Section 9.3. Loss of Seniority Seniority will be lost by: (i) resignation; (ii) discharge for just cause; (iii) accepting employment while on leave of absence without permission of the Medical Center; (iv) failure to return to a bargaining unit position within 18 months of leaving a bargaining unit position to take a Berkshire Health Systems or Berkshire Healthcare Systems non-bargaining-unit position (See Section 9.1 above); (v) failure to return from approved leave; (vi) failure to return to work when called from layoff within two days for a layoff that does not exceed the period during which an employee receives pay in lieu of notice from the Medical Center or within two weeks for a layoff that exceeds the pay-inlieu-of-notice period but does not exceed one calendar year after notice by certified mail to the nurse s last known address as indicated by Medical Center personnel records; (vii) failure to be recalled from layoff for a period equal to the seniority accumulation, but no greater than one year; or (viii) failure by a per diem nurse to work the minimum required hours pursuant to Section 9.2(d). -35-

Section 9.4. Reduction in Force In the event that the Medical Center decides to implement a reduction in force involving layoff, two weeks before such layoff the Medical Center will notify the Association that such a reduction is planned and will offer the Association an opportunity to confer relative to the procedure to be followed. Unless otherwise agreed during such conference, reduction in force shall be made using the following procedure: (a) Seniority Lists. The Medical Center will prepare three bargaining unit seniority lists as follows: (1) Temporary nurses (2) Per diem nurses (3) Part-time and full-time nurses (b) Units. Within each seniority group, there shall be the following unit groupings 7 for layoff and recall: (1) Medical/Surgical, Rehabilitation, Pre-Admission Testing, Critical Care Step Down Unit, Clinics, Infection Control, Radiation Oncology, Cardiac Rehabilitation, I.V. Therapy, Educator(s) not responsible for Critical Care Services or for Maternity, Surgical Day Care, Admitting Nurses, Observation Unit, Wound Center, Bloodmobile (2) Operating Room (including Crane Center OR), Ambulatory Surgery Unit, Educator(s) responsible for Surgery services (3) Radiology Department, Critical Care, Crisis Nurse, Emergency Department, Post Anesthesia Care Unit (including Crane Center PACU), Endoscopy, Educator(s) responsible for Critical Care Services or Emergency services, (4) Maternal Child Health (including Pediatrics, Mother/Baby Unit, Special Care Nursery and Labor & Delivery), Educator(s) responsible for Maternity (5) Psychiatric Units (including McGee and Partial Hospitalization) (6) Renal Dialysis (7) Case Managers 7 Each of the below-listed units and each Medical/Surgical unit shall be separate and independent for purposes of reduction (pursuant to Section 9.4(c)), but shall be aggregated into the below-listed groupings for purposes of displacement (pursuant to Sections 9.4(c)(2)(c), 9.4(c)(2)(d) and 9.4(c)(3)) and shall also be aggregated into the below-listed groupings for purposes of recall (pursuant to Section 9.4(f)). -36-

(8 et al.) Each Nurse Practitioner and each Clinical Nurse Specialist shall constitute an independent unit. 8 (c) Reduction Procedure. Within a unit that the Medical Center decides to reduce, the Medical Center will determine the number of committed hours on each shift within such unit to be reduced. Before implementing the procedure set forth below, the Medical Center will seek to ascertain from the nurses assigned to such shift within such unit whether any of them wishes to reduce voluntarily her or his committed hours, subject to the Medical Center s judgment as to its operating needs. If the Medical Center s reduction objectives are not satisfactorily met by this voluntary procedure, then the following reduction procedure will be used: (1) (a) Positions occupied by nurses on probation will be deemed vacancies for the purposes of Section 9.4(c)(2)(b), and any such nurse whose position is selected by a more senior nurse pursuant to Section 9.4(c)(2)(b) shall be laid off. In the event of any reduction in force, a full time or regular part-time nurse whose position is eliminated pursuant to Section 9.4(c) (2) and who is laid off shall be accorded the preference described in Section 9.4(g) for per diem hours and for temporary positions, and no per diem temporary or agency nurse may be used in a unit reduced by the RIF in violation of such preference. There is no intent to consistently assign temporary, per diem and/or agency nurses to a position in order to avoid creation of a permanent position. Reductions will be made, in order of seniority, of full-time and regular part-time nurses pursuant to the procedure set forth in Section 9.4(c)(2) below. (b) Positions that are vacant at the time of the Medical Center notification to the Association that a reduction in force is planned (and that the Medical Center wishes to fill) will not be filled until the procedure set forth in Section 9.4(c)(2) has been completed, unless the Medical Center and the Association agree otherwise. bargaining unit. 9 A nurse whose position is eliminated in part may elect either to retain the remaining hours (subject to the possibility of being displaced pursuant to Sections 9.4(c)(2)(c) or 9.4(c)(2)(d) above) or to be placed on the reduction list and be eligible for the listed options. -37- (2) Nurses on each shift in the units where hours are to be reduced shall be listed in order of seniority. Positions of part-time or fulltime nurses shall be eliminated in reverse order of seniority on each shift within such unit until the number of hours still to be reduced has been accomplished. This may result in the partial elimination of the position of the last nurse reached in this order. 9 8 Applicable only to the extent that such nurses are required to remain within the scope of the

Then each such nurse in the unit whose position is so eliminated shall be listed in order of her/his seniority, and in such order shall have the opportunity to select one of the following options: (a) (b) (c) (d) The nurse shall be laid off; or The nurse may select a job vacancy (if any) in the same job classification and in the same or another unit grouping, provided that the nurse and the Medical Center agree in their discretion that the nurse is qualified to perform the requirements of such position (with reasonable orientation); or The nurse may displace a less senior nurse (if any) in the same job classification and in the same unit grouping, provided that the nurse and the Medical Center agree in their discretion that the nurse is qualified to perform the requirements of such position (with reasonable orientation); or The nurse may, subject to the requirements and procedures of Section 9.4(c) (3) below, displace a less senior nurse in another unit grouping, if any. A nurse displaced by a more senior nurse in the same unit grouping pursuant to option (c) above shall be considered to have had her/his position eliminated and shall be placed on the reduction list in accordance with her/his seniority; and she/he shall have the opportunity to select from among options (a) to (d) above after the more senior nurses on such list. This reduction procedure shall be applied to a nurse on leave of absence in the same fashion as if such nurse were in active service. A nurse s request to assume a position in a different unit shall be subject to whether the particular unit and shift can accommodate such incoming nurses (or a limited number of them) consistent with the patient care needs of such unit and shift. If a nurse s request is denied, she/he shall exercise another of options (a) to (d) above, but she/he shall have a preference for filling a future vacancy in such unit, provided that she/he is then qualified for such vacancy in relation to the needs of the unit and further provided that she/he notifies the Medical Center of such preference at the time of application. In the event that an arbitrator overturns such denial, her/his remedy shall be limited to such nurse. (3) A nurse whose position is eliminated by the above procedure may displace a less senior nurse in another unit grouping as follows: In the event that a non-probationary nurse is scheduled to be laid off, -38-

the nurse may displace the least senior nurse in an equal or lower rated job classification in another unit grouping, provided (i) the RN has previously been permanently assigned to that position and performed all the duties of that position satisfactorily within the last 90 days, and (ii) the RN has more seniority than the person she/he is to displace and works the required hours. (4) In order to be eligible for any alternative to layoff under this procedure, a nurse must be readily available at the Medical Center or by telephone to exercise her/his choice (if any) and must exercise such choice within three hours of when she/he is requested to do so by the Medical Center. A nurse must be so available after the date specified in the Medical Center s announcement of the commencement date for the reduction procedure. (d) Vacancies. In the event that the Medical Center decides to fill on a continuing basis a vacancy in a bargaining unit position (other than those caused by the reduction in force) within one year of the date of the reduction in force, that job vacancy will be posted and a copy will be given to the Nurses Committee Chairperson or her designee. Nurses on layoff shall receive preference to other applicants, provided that they meet availability requirements of the posting and are in the judgment of the Medical Center qualified (with reasonable orientation) to perform all the duties of the position and work the required hours. Any laid-off employee who takes the position shall retain her/his recall rights to her/his former position for a period equal to her/his seniority accumulation or one year, whichever is less. (e) Accrued Benefits. A nurse who is laid off for a period exceeding 30 days will receive pay for accrued Earned Time, but she/he may receive such accrued pay earlier if she/he so requests. A nurse will not accrue benefits during the layoff. However, effective for layoffs that commence on and after June 4, 1997, a nurse will accrue seniority during the first 12 months of the layoff. (f) Recall. In the event that the Medical Center decides to restore, and to fill on a continuing basis, a position that had been eliminated by a reduction in force, the nurse who was displaced (pursuant to any of Sections 9.4(c)(2)(a), 9.4(c)(2)(b), 9.4(c)(2)(c) or 9.4(c)(2)(d) above) from the unit in which a position that had been eliminated by a reduction in force is restored shall be eligible for recall to such position (except for probationary nurses who have no recall rights), provided that such nurse is qualified (with reasonable orientation) to perform the duties of the position and work the required hours, and further provided that such nurse informs the Medical Center within 48 hours of notification of her/his acceptance of recall and returns to such position within the time period set forth in Section 9.3. The nurse shall retain recall rights for a period equal to her/his seniority accumulation or one year, whichever is less. A nurse who is eligible for recall pursuant to this Section 9.4(f) shall be preferred over other applicants for such position, notwithstanding the preference stated in Section 9.4(d). In the event that there are two or more such eligible nurses, the preference described herein will be applied to the most senior. -39-

(g) Temporary fill-ins. The Medical Center shall have the right to use temporary help for fill-ins. When the layoff procedures herein are commenced, nurses who are on layoff or reduced in hours shall, if they desire, be enrolled on the temporary recall list, indicating the areas of their interest and the times and shifts they are available, and shall be placed at the top of such list in the order of their seniority. Before hiring nurses not on such list, the Medical Center will attempt to contact nurses on the list whom it deems qualified to perform the necessary duties for fill-in purposes. Notification of any nurse whom the Medical Center attempted to contact shall be given to the head of the bargaining unit. A nurse who declines or is not available for such fill-in work may be passed over; however, she/he still retains her/his recall rights as above stated. Section 9.5. Work Location (a) A particular service or specialty at the BMC or Hillcrest campus may be located in several locations, buildings, or Medical Center units. Therefore, the Medical Center shall have the right to assign a nurse within her/his service or specialty from one such location, building, or Medical Center unit to another. Such assignment shall not constitute a transfer or the filling of a vacancy or a separate job under the Agreement. Except as provided in Section 4.8 ( Temporary Reassignment ) concerning sufficient, current orientation, nothing in this Agreement shall be interpreted or asserted so as to prohibit, impair or burden the temporary transfer or assignment of a Berkshire Medical Center campus nurse to the Hillcrest campus or of a Hillcrest campus nurse to the Berkshire Medical Center campus. (b) In the case of floating from one campus to the other, the Medical Center will first solicit volunteers from within the units(s) from which the nurse(s) are to be floated. If there are more volunteers than are needed, assignment(s) shall be offered to qualified volunteers in order of their seniority. If there are not sufficient qualified volunteers, the Medical Center will float the least senior qualified nurse(s) in the unit(s) from which floating is to take place. (c) The Medical Center may permanently relocate a unit (without substantially changing the service or specialty) from the BMC campus (including 510 North Street, 610 North Street, and the Ambulatory Surgery Center) to the Hillcrest campus, or from the Hillcrest campus to the BMC campus (including 510 North Street, 610 North Street, and the Ambulatory Surgery Center), without such relocation s being considered a Reduction in Force under Section 9.4, provided that: (i) the Medical Center shall have given the Association at least 90 days advance notice of such relocation, (ii) the relocation does not result in a change in a unit nurse s shift or committed hours per week, and (iii) the Association reserves the right, within 30 days following such notice, to demand that the Medical Center engage in impact bargaining concerning such relocation. Section 9.6. Association Representatives Authorized representatives of the Association may visit the Medical Center at any reasonable time for the purpose of discharging the Association s duties as the collective bargaining representative. Such Association representatives shall, at the time of calling at -40-

the Medical Center, give notice of their presence to the Medical Center Vice President of Human Resources or designee. Such visits by Association representatives shall insofar as it is practical to do so, be made during the first shift hours. Such visits shall not interfere with the normal operations of the Medical Center. Section 9.7. Non-Discrimination To give emphasis to their intent and desire to comply fully with their obligations under existing applicable laws relating to discrimination on the basis of race, color, age, creed, sex, sexual orientation, physical or mental disability, national origin, or marital status, the parties hereby agree to incorporate these obligations as part of this Agreement. Section 9.8. Performance Evaluation Upon request, each nurse will receive a copy of her/his performance evaluation. Section 9.9. Jury Duty and Court Appearances (a) Any full-time or scheduled part-time nurse called for jury duty will continue to receive the difference between her/his basic pay, excluding all bonuses, and her/his payments for jury service. Such jury service (including reporting for jury service), to the extent that it occurs within a nurse s regularly scheduled work time, will be considered as time worked. Full-time and scheduled part-time nurses regularly employed on the evening and night shift will have shift differential included with the basic pay; such nurses shall also be excused from working the immediately prior or following shift if they are serving on jury duty during the day. (b) Any nurse who is required or requested by the Medical Center to appear in court on its behalf shall be considered to be on working time during such appearance. Section 9.10. Discipline No nurse shall be disciplined or discharged except for just cause, provided that a nurse may be terminated during her/his first four months (in the case of a full-time nurse) or 533 hours (in the case of a part-time nurse) of employment or reemployment without recourse by the nurse or the Association. Section 9.11. Promotions/Vacancies/Transfers Vacancies for bargaining unit positions offering transfer will be posted on appropriate bulletin boards for a period of five days (exclusive of Saturdays, Sundays and holidays). These positions shall be filled on the basis of qualifications and where qualifications are relatively equal as determined in the discretion of the Chief Nursing Officer or designee, then seniority shall be the determining factor in filling such positions. If application is made by a nurse in the bargaining unit who has been employed in her/his position for less than six months (or for such longer periods as set forth in Section 10.4 ( Orientation )), such application shall be considered only at the discretion of the Chief Nursing Officer; provided, however, that a nurse shall be entitled to one exception to this six-month rule during the term of this Agreement. The successful -41-

applicant will assume her/his new position not later than four weeks from the date such applicant is notified that she/he has been selected (however, if such four-week period expires during prime time [i.e., June 1 through Labor Day week], such an applicant may be retained in her/his current position for up to eight weeks, but not beyond Labor Day week). A master list of all vacant bargaining unit positions that the Medical Center wishes to fill will be kept in Nursing Administration for review by interested nurses, and a copy will be given to the MNA Chairperson upon her/his request. The Medical Center will continue the practice of posting eight (8) hour positions (or other single shift positions) only in the departments in which the vacancies exist. Section 9.12. Personnel Files A nurse may review the contents of her/his personnel file upon making an appointment with the Vice President of Human Resources or designee. If a nurse objects to a written reprimand, negative letter, or other adverse material in such file, she/he will have the right to submit a written response/rebuttal to such material, which will be reviewed by the Chief Nursing Officer and attached to the file copy. When a complaint, negative letter, or other adverse material is received by the Medical Center about one of its nurses, the material will not be placed in the nurse s personnel file until an investigation has been conducted and unless the Medical Center believes that some or all of the allegations appear to be warranted, in which event such material will be shown to the nurse, who will have the right of response/rebuttal set forth above. Section 10.1. Bereavement Leave ARTICLE X A full-time nurse or scheduled part-time nurse who has completed three months of employment shall be eligible for (i) three scheduled days off at basic pay within the seven calendar days that begin on the date of death of her/his grandparent, grandchild, parent-in-law, foster parent or foster child; or (ii) five scheduled days off at basic pay within the seven calendar days that begin on the date of death of her/his parent, spouse, child, sibling, or a significant other who is resident in the same household. Notification must be given to the Medical Center by the nurse. One or more of the scheduled days off to which a nurse is entitled under this Section 10.1 may be reserved by the nurse for attending a funeral or memorial service that is scheduled to occur subsequent to such seven-calendar-day period. If a death to which Bereavement Leave as set forth in the first paragraph of this Section 10.1 applies occurs during a nurse s vacation, the benefit described in this Section 10.1 will be utilized, to the extent that it is applicable, instead of Earned Time pursuant to Section 6.3(e)(2). -42-

Section 10.2. Liability Insurance The Medical Center shall, without cost to the nurse, continue to provide liability insurance coverage in the amount of $100,000/$300,000. Section 10.3. Workers Compensation The Medical Center will continue to insure each nurse under the Massachusetts Workers Compensation Law. A nurse may draw upon her/his Earned Time and/or his/her Long Term Illness Bank for the difference between Workers Compensation benefits and her/his basic salary. The Medical Center will compensate a nurse for any wages lost during the first five calendar days after he/she has experienced a physical assault at work that results in a physical injury. Section 10.4. Orientation Every new nurse will participate in an orientation program. The implementation of Nursing Department Orientation Guidelines will be reviewed on an ongoing basis pursuant to Section 11.1. The Medical Center will make available 15 minutes of the weekly general Medical Center group orientation for participating newly hired RNs to meet with a Bargaining Committee member or designee to orient them about their MNA representation. The bargaining unit representative shall utilize her/his off-duty time for such meetings. A nurse hired into or transferring to a bargaining-unit position in a specialty unit (e.g., OR, ED, ICU/CCU, Radiology) will be not eligible for future transfer until she/he has completed a one-year post-orientation period in that position (but not less than six months, as set forth in Section 9.11 [ Promotions/Vacancies/Transfers ]), except as otherwise agreed between the nurse and the Nursing Director. Section 10.5. Bulletin Boards The Medical Center will provide bulletin board space for posting Association notices. All notices shall be subject to Medical Center approval, which approval shall not be unreasonably withheld. Official chapter meeting notices only may be posted on nursing unit bulletin boards by the Association s Nurses Committee. Such notices must be removed in timely fashion. Section 10.6. Pension Plan Full-time nurses and all other eligible and entitled nurses under the Employee Retirement Income Security Act of 1974 shall participate in the pension plan available to Medical Center employees on the same basis as other Medical Center employees. The Medical Center will provide each participant with an individual pension estimate statement annually. Effective January 1, 2008, during the term of this Agreement (i.e., through September 30, 2010), the Medical Center will not reduce its core contribution -43-

below 2.5%, will not reduce its matching rate to below 50%, and will not reduce its matching contribution to below 2.0%. Section 10.7. Notice of Resignation When a nurse intends to resign, she/he shall give the Medical Center written notice of no less than three working weeks (exclusive of Earned Time utilization periods), except where conditions beyond the control of the nurse prevent compliance or when the nurse is resigning under a mutual agreement with the Medical Center. Section 10.8. Mileage Nurses using their cars on authorized Medical Center business will be reimbursed at the prevailing rates established by the Medical Center for all personnel. No mileage will be paid when commuting within the city or between Medical Center units. Section 10.9. Professional Activities Subject to the Medical Center s judgment as to its operating needs, a nurse shall be granted up to 16 hours off with pay (in the case of a nurse whose committed hours are 32 or more) or up to eight such hours (in the case of a nurse whose committed hours are at least 16 but less than 32) for the purpose of attending professional meetings, clinical conferences, conventions, advanced courses, or other similar activities. The Chief Nursing Officer may authorize additional time off without loss of pay and/or reimbursement of expenses for such activities. ACLS, PALS and TNCC classes or other courses mandated by the Hospital and/or required for an RN to maintain her/his position, shall be treated as a paid regular shift for the first day of such classes for any RN taking such a class. For the second day of such classes, if required, the RN will be paid for eight hours and, upon the approval of his/her manager, will either (a) take any time remaining on his/her shift off without pay; (b) work for the remainder of his/her shift; or (c) use ET to be compensated for any time remaining on his/her shift. For any course that exceeds two days, the RN will be paid for the actual time spent in class and, upon the approval of his/her manager, will either (a) take any time remaining on his/her shift off without pay; (b) work for the remainder of his/her shift; or (c) use ET to be compensated for any time remaining on his/her shift. Section 10.10. Tuition Reimbursement (a) Upon submission of evidence to the Medical Center of satisfactory completion of a course(s) of study or challenge exam(s) at the collegiate level and directly related to her/his field of endeavor at the Medical Center, the Medical Center will reimburse a full-time nurse as shown below provided that any course(s) or challenge exam(s) taken during the nurse s initial year of service shall only be reimbursed at the completion of said year, and further provided that any nurse eligible for this benefit agrees to work in the Medical Center as a full-time nurse for not less than a year after such reimbursement. A nurse whose tuition is reimbursed under this section and who terminates for any reason, other than circumstances beyond her/his control, without having worked for one year after such reimbursement, shall repay the amount of tuition -44-

cost paid by the Medical Center. Reimbursement shall only be made hereunder for a course of study or challenge exam previously approved by the Chief Nursing Officer or designee. Reimbursement during a calendar year shall be as follows: (i) 75% of the cost of tuition, up to $600; or (ii) 100% of the cost of programs offering continuing education units, up to $150, and 75% of the cost of tuition, up to the difference between such CEU program costs and $600; or (iii) 100% of the cost of tuition, up to $1,500, which may be applied only to a Bachelor of Science in Nursing (BSN) program or to a Master of Science in Nursing (MSN) program in which the nurse is enrolled; or (iv) 100% of the cost of tuition for courses pursuant to the University of Massachusetts Bachelor of Science in Nursing (BSN) program in which the nurse is enrolled. basis. (b) Scheduled part-time nurses will be eligible for this benefit on a prorated (c) All nurses who complete the Medical Center s Critical Care Course and are hired for a Critical Care position must work in the Critical Care area for one year or reimburse the Medical Center for the cost of the course (except in cases of hardship); such nurses who are per diem must also work at least three shifts per month as needed by the Medical Center, or else so reimburse the Medical Center. Section 10.11. Continuing Education Units The Medical Center will continue its practice of offering programs for continuing education units. Section 10.12. Preceptor Pay A nurse who is selected by the Medical Center to be a preceptor for a registered nurse (but not for a student) for a period of three weeks or more in duration shall be paid an additional $1.25 per hour for her/his time in the role of preceptor. Nurses may be paid for precepting assignments of less than three weeks, but not less than a full shift, provided that a specific precepting assignment for such shorter period has expressly been given to her/him by a nurse manager.. Section 10.13. Safety Committee The Medical Center shall appoint a nurse to its Safety Committee from a list of five names submitted on a prioritized list by the Chair of the bargaining unit. -45-

Section 10.14. Latex Sensitivity The Medical Center will continue its proactive policy with regard to latex sensitivity, will reasonably accommodate nurses with latex sensitivity, and will make reasonable effort to expedite testing and return-to-work. This Section 10.14 shall not prejudice either the Association s or the Medical Center s position concerning the applicability or non-applicability of the Workers Compensation statute or of any other State or Federal statute. Section 10.15. Health and Safety (a) Health and Safety. Management agrees to provide designated well lighted parking areas and to maintain patient call bells and a patient monitoring system in the crisis area rooms in the Emergency Department, or alternative safety systems designed to help an RN respond to an emergency situation. This section shall not be subject to the grievance and arbitration provision of this Agreement. If the Association has concerns about the Hospital's compliance with this provision, it should be raised during the meetings provided for in Section 11.1 of the Agreement. (b) Workplace Violence and Hostile Work Environment. If a nurse is physically assaulted while at work, his/her immediate supervisor or the alternate shift director shall, as soon as possible upon notification of the assault, ensure that the following services are made available to the nurse. Immediate medical treatment Counseling services (employee assistance program) Workers compensation as applicable Consultation if desired with the VP for human resources. This section shall not be subject to the grievance and arbitration provisions of this Agreement. Section 11.1. Nurses Committee ARTICLE XI There shall be a Nurses Committee consisting of five nurses from the bargaining unit which shall meet periodically with representatives from the Medical Center at the request of either party for the purpose of meaningful discussion and feedback concerning grievances, Medical Center policies, nursing practice issues, staffing patterns, orientation, non-nursing duties, release for professional education and other matters of mutual interest and concern. The parties shall meet at times mutually convenient to both. It is understood that any recommendations made by the Nurses Committee shall be advisory only. If the Nurses Committee submits a written recommendation and rationale and the Medical Center does not follow that recommendation, then the Medical Center shall respond in writing with its reasons. The parties will periodically review the success of the Optiflex system during these meetings. -46-

Section 11.2. Grievances Any complaint or dispute involving the interpretation or application of the Agreement shall be deemed a grievance and must be initiated under the procedures provided below within 30 calendar days after the facts or events occurred which the nurse or Association should have reasonably known about except those grievances involving discipline shall be initiated within 10 calendar days of the imposition of said discipline. Optional Informal Step. Prior to commencing the formal procedure set forth below, the grievant shall have the option to discuss the grievance informally with the appropriate Department Director in an effort to resolve the grievance. If the grievant exercises this option and is not satisfied with the result, she or he may file a formal grievance at Step 2 below (bypassing Step 1), provided that such filing is within the applicable 30- or 10-day filing period set forth above. If the grievant fails to exercise this option, or chooses not to await the Department Director s response, she or he must commence a formal grievance by filing at Step 1 below, provided that such filing is within the applicable 30- or 10-day filing period set forth above. Step 1. A Step 1 meeting shall be held among the nurse(s) involved, a member of the Nurses Committee and the Department Director or designee within 10 calendar days of the initial filing of the grievance. A written response will be provided within five calendar days of such meeting. If the grievant(s) is not satisfied with the decision of the Department Director or designee, the grievance shall be reduced to writing and submitted within five calendar days thereafter to the Chief Nursing Officer. Step 2. Within 10 calendar days of such submission, there shall be a Step 2 meeting among the nurse(s) involved, one or more members of the Nurses Committee (no more than two of whom may be released from work to attend the meeting), the Chief Nursing Officer or designee, and one or more members of the Medical Center management and/or administration. A representative of the Association may be present at the discussion of the grievance at this step. The Chief Nursing Officer or designee shall give her/his decision in writing within five calendar days after the Step 2 meeting, in the cases of grievances that do not involve allegations of disciplinary action or discharge, or within 10 calendar days after the Step 2 meeting, in the cases of grievances that involve allegations of disciplinary action or discharge. If the grievant(s) is not satisfied with the decision of the Chief Nursing Officer or designee, the grievance shall be submitted within five calendar days thereafter to the Chief Operating Officer. Step 3. Within 10 calendar days of such submission, a Step 3 meeting may be held by mutual agreement among the nurse(s) involved, one or more members of the Nurses Committee (no more than two of whom may be released from work to attend the meeting), the Chief Operating Officer or designee, and one or more members of the Medical Center management and/or administration. A representative of the Association may be present at the discussion of the grievance at this step. The Chief Operating Officer or designee shall give her/his decision in writing within 10 calendar days after the Step 3 meeting (or, if no meeting is held or pending, after the expiration of the aforesaid 10-calendar day period). -47-

The calculation of calendar days in Steps 1, 2 and 3 above shall not include Saturdays, Sundays and holidays. Section 11.3. Arbitration If the dispute is not resolved in the foregoing Sections of this Article, the Association may submit the matter to arbitration within 30 calendar days after the receipt of a written answer in Step 3. The Association shall so notify the Medical Center, and the parties shall thereupon attempt to agree upon an arbitrator. In the event that the parties cannot reach agreement, the dispute shall be submitted to the American Arbitration Association under its Voluntary Labor Arbitration rules and regulations. The decision of the arbitrator shall be final and binding on all of the parties. The costs of the arbitration assessed by the American Arbitration Association and the arbitrator shall be borne equally by the parties. The arbitrator shall have no authority to add to or subtract from or modify any of the terms of this Agreement. In the event that the Medical Center institutes a new bargaining unit classification and salary rate, such salary rate shall be subject to arbitration, and the arbitrator shall not be limited by the preceding sentence. Section 11.4. Association Grievances The Association shall have the right to file a grievance, which grievance shall be instituted at Step 2. Section 11.5. Other In the event that an appeal is not taken to the next step within the time limitations set forth under this Article, the matter shall be deemed to be resolved on the basis of the last written resolution of the matter. If the Medical Center fails to answer a grievance within the foregoing time limitations, the running of the time limitation for the Association s submitting the grievance to the next step shall be suspended until either (i) the Medical Center answers the grievance or (ii) the Association chooses to treat such failure to answer as a denial and elects to advance the grievance to the next step (up to and including submission to arbitration pursuant to Section 11.3 above). Section 12.1. Strikes and Lockouts ARTICLE XII It is mutually agreed that during the term of this Agreement there will be no stoppage of work, lockout, mass sick days, slow downs or any similar interference with the operation of the Medical Center. The Association also agrees that it will not foster or encourage mass resignation. Section 13.1. Management Rights ARTICLE XIII The Association recognizes that the Medical Center has the obligation of serving the public with the highest quality efficient and economical medical care and in meeting -48-

medical emergencies. The Association further recognizes the right to the Medical Center to operate and manage the Medical Center including but not limited to the right to require efficient standards of performance and the maintenance of discipline, order and efficiency, the right to determine medical and nursing care standards and methods, to direct nurses and determine professional assignments, to schedule work, to determine the quantity and types of equipment to be used, to introduce new methods and facilities, to determine efficient staffing requirements, to determine the number and location of facilities, to determine whether the whole or any part of the operation shall continue to operate, to select and hire employees, to determine qualifications for nursing positions, to promote, to demote, suspend, discipline or discharge employees for just cause, to layoff employees for lack of work or other lawful reasons, to recall employees, to determine that nurse employees shall not perform certain functions, to require reasonable overtime work, to promulgate reasonable rules and regulations provided that such rights shall not be exercised so as to violate any of the specific provisions of this Agreement. Section 14.1. Duration ARTICLE XIV This Agreement will be effective as of October 1, 2010 (except as otherwise noted herein) and remain in full force and effect until September 30, 2013, and will continue in effect unless written notice of a desire to modify or terminate this Agreement is given by either party to the other at least 90 days prior to September 30, 2013; provided, however, that in the event that such 90-day notice is given, this Agreement will remain in effect after September 30, 2013 until a successor agreement becomes effective or until terminated by either the Medical Center or the Association upon written notice of not less than 30 days, whichever first occurs. In the event that such a 30-day notice is given, a strike or picketing may not occur until at least the 31st day after such 30-day notice is received. Section 15.1. Successorship ARTICLE XV This Agreement shall remain in effect and shall be binding upon all successors and assigns of the Medical Center. The Medical Center shall include this requirement as a condition of sale or transfer of ownership or operation, and shall confirm to the Association in writing that it has done so and that it has notified any such successor or assign of any pending grievances, arbitrations, unfair labor practice proceedings and/or any other litigation between the Medical Center and the Association; provided, however, that nothing herein shall operate to impose this Agreement on any employees not includable in the bargaining unit described in Section 1.1 ( Recognition ) as a matter of law. After the finalization and execution of any agreement by the Medical Center to merge or affiliate with, or to sell its operation(s) to, another entity, but prior to the implementation of any such merger, affiliation or sale, the Medical Center agrees to provide notice to the Association of such agreement and, to the extent that such merger, -49-

affiliation or sale will have an impact on the terms and conditions of employment of members of the bargaining unit, the Medical Center further agrees to bargain with the Association over the impact of the merger, affiliation or sale. In witness whereof, the parties hereto have caused their names to be subscribed by their duly authorized officers and representatives on the day and year first above written. MASSACHUSETTS NURSES ASSOCIATION BERKSHIRE MEDICAL CENTER Julie Pinkham, R.N. Executive Director Diane Kelly Chief Operating Officer Patricia A. Williams Associate Director Labor Relations Program Arthur D. Milano, Jr. Vice President, Human Resources Alexandra Neary, R.N. Unit Co-Chair Gerri Jakacky, R.N. Unit Co-Chair -50-

APPENDIX A Position Salary Grades and Classifications (effective October 4, 2009; step 23 introduced on April 4, 2010): Grade A: Staff Nurse; IV Therapist Grade B: Education Specialist; Epidemiologist; Infection Control Nurse; Renal Home Training Coordinator; Case Manager; Radiation Oncology Nurse; Enterostomal Nurse; Coordinator Grade C: Clinical Nurse Specialist Grade D: Nurse Practitioner Salary Scales: Steps A B C D 3 31.44 31.44 36.63 36.63 4 32.08 32.08 37.39 37.39 5 32.72 32.72 38.14 38.14 6 33.36 33.36 38.89 38.89 7 34.03 34.03 39.67 39.67 8 34.72 34.72 40.45 40.45 9 35.40 35.40 41.24 41.24 10 36.11 36.11 42.09 42.09 11 36.85 36.85 42.93 42.93 12 37.57 37.57 43.80 43.80 13 38.33 38.33 44.68 44.68 14 39.10 39.10 45.56 45.56 15 39.90 39.90 46.45 46.45 16 40.68 40.68 47.39 47.39 17 41.51 41.51 48.35 49.85 18 42.33 42.33 49.33 52.45 19 43.20 43.20 50.33 53.51 20 44.05 44.05 51.33 54.57 21 44.93 44.93 52.36 55.66 22 45.83 45.83 53.40 56.77 23 46.75 46.75 54.47 57.91-51-

APPENDIX B Position Salary Grades and Classifications (effective October 2, 2011): Grade A: Staff Nurse; IV Therapist Grade B: Education Specialist; Epidemiologist; Infection Control Nurse; Renal Home Training Coordinator; Case Manager; Radiation Oncology Nurse; Enterostomal Nurse; Coordinator Grade C: Clinical Nurse Specialist Grade D: Nurse Practitioner Salary Scales: Steps A B C D 3 32.07 32.07 37.36 37.36 4 32.72 32.72 38.14 38.14 5 33.37 33.37 38.90 38.90 6 34.03 34.03 39.67 39.67 7 34.71 34.71 40.46 40.46 8 35.41 35.41 41.26 41.26 9 36.11 36.11 42.06 42.06 10 36.83 36.83 42.93 42.93 11 37.59 37.59 43.79 43.79 12 38.32 38.32 44.68 44.68 13 39.10 39.10 45.57 45.57 14 39.88 39.88 46.47 46.47 15 40.70 40.70 47.38 47.38 16 41.49 41.49 48.34 48.34 17 42.34 42.34 49.32 50.85 18 43.18 43.18 50.32 53.50 19 44.06 44.06 51.34 54.58 20 44.93 44.93 52.36 55.66 21 45.83 45.83 53.41 56.77 22 46.75 46.75 54.47 57.91 23 47.69 47.69 55.56 59.07-52-

APPENDIX C Position Salary Grades and Classifications (effective October, 2012): Grade A: Staff Nurse; IV Therapist Grade B: Education Specialist; Epidemiologist; Infection Control Nurse; Renal Home Training Coordinator; Case Manager; Radiation Oncology Nurse; Enterostomal Nurse; Coordinator Grade C: Clinical Nurse Specialist Grade D: Nurse Practitioner Salary Scales: Steps A B C D 3 32.71 32.71 38.11 38.11 4 33.37 33.37 38.90 38.90 5 34.04 34.04 39.68 39.68 6 34.71 34.71 40.46 40.46 7 35.40 35.40 41.27 41.27 8 36.12 36.12 42.09 42.09 9 36.83 36.83 42.90 42.90 10 37.57 37.57 43.79 43.79 11 38.34 38.34 44.67 44.67 12 39.09 39.09 45.57 45.57 13 39.88 39.88 46.48 46.48 14 40.68 40.68 47.40 47.40 15 41.51 41.51 48.33 48.33 16 42.32 42.32 49.31 49.31 17 43.19 43.19 50.31 51.87 18 44.04 44.04 51.33 54.57 19 44.94 44.94 52.37 55.67 20 45.83 45.83 53.41 56.77 21 46.75 46.75 54.48 57.91 22 47.69 47.69 55.56 59.07 23 48.64 48.64. 56.67 60.25 INDEX -53-

Accrual of Benefits, Leave of Absence...8.2 Annual Conversion of Earned Time to Long-Term Illness Bank Hours...6.6 Arbitration...11.3 Association Grievances...11.4 Association Representatives...9.6 Association Service Fee...1.2(c) Baccalaureate Degree Differential...3.1(a) Benefits for Per Diem Nurses...3.10 Bereavement Leave...10.1 Board of Directors (MNA)...1.2(d) Bulletin Boards...10.5 Cash Surrender of Earned Time...6.7 Certification/Re-Certification...3.9 Charge Nurse and Clinical Leaders...3.6 Clinical Development Program...4.12 Continuing Education Units...10.11 Court Appearances...9.9 Critical Illness or Death in the Immediate Family...8.1 Definitions...2.1 Degree, Baccalaureate...3.1(a) Degree, Masters...3.1(a) Dental Insurance...7.4 Discipline...9.10 Dues Checkoff...1.3 Duration...14.1 Earned Time...6 Earned Time Accrual in Excess of the Maximum...6.5 Earned Time Program, Applicability of...6.1 Earned Time, Accrual of...6.2 Earned Time, Annual Conversion to Long Term Illness Bank...6.6 Earned Time, Daily Minimum Usage...6.3(d) Earned Time, Holiday...6.3 Earned Time, Pay for...6.4 Earned Time, Planned Time Off...6.3 Earned Time, Time Off, Planned and Unplanned...6.3 Earned Time, Unplanned Time Off...6.3 Earned Time, Use of...6.3 Earned Time, Yearly Minimum Usage...6.3(c) Evaluations...9.8 First Assistant in the Operating Room...3.11 Four-Day 36-Hour Night Shift...4.9 Full Time Registered Nurses...2.1(b) Grievances...11.2 Grievances, Association...11.4 Grievances, Time Limits (other)...11.5-54-

Holidays...5.1 Holidays/Earned Time...6.3(b) Hours of Work...4.1 Illness, Earned Time...6.3 In House On-Call...3.5 Industrial Accident, L.O.A....8.1 Jury Duty and Court Appearances...9.9 Latex Sensitivity...10.14 Leave of Absence, Accrual of Benefits...8.2 Leave of Absence, Critical Illness...8.1 Leave of Absence, Death in Immediate Family...8.1(d) Leave of Absence, Educational...8.1(f) Leave of Absence, Industrial Accident...8.1(b) Leave of Absence, Maternity...8.1(c) Leave of Absence, Military...8.1(e) Leave of Absence, Other...8.1(h) Leave of Absence, Paternity...8.1(g) Leave of Absence, Payment of Benefits...8.3 Leave of Absence, Personal Illness...8.1(a) Leaves of Absences...8.1 Liability Insurance...10.2 Life Insurance...7.3 List(s)...1.2(a) Local Dues...1.3 Long-Term Illness Bank, Annual Conversion to Earned Time...6.6 Long-Term Disability Insurance...7.7 Long-Term Illness Bank...6.8 Loss of Seniority...9.3 Management Rights...13.1 Mandated Treatment While on Duty...7.9 Masters Degree Differential...3.1(a) Master Schedule Program... 4.13 Mileage...10.8 Military Leave of Absence...8.1(e) MNA Dues Check Off...1.3 Newly Employed Nurses...3.1(c) Night Shift/Four-Day/36-Hour...4.9 Non-Discrimination...9.7 Notice of Resignation...10.7 Nurses Committee...11.1 On-Call and Call-Back...3.5 On-Call, In House...3.5 Operating Room, First Assistant...3.11 Opt-Out Payment (medical insurance)...7.1 Orientation...10.4 Overtime/Mandatory Overtime...4.2-55-

Paternity, Leave of Absence...8.1(g) Patient Care...4.7 Pay Stubs, Information on...7.6 Pension Plan...10.6 Per Diem Nurses/Benefits...3.10 Per Diem Nurses/Definition...2.1(d) Performance Evaluation...9.8 Permanent Evening Shift Bonus and Permanent Night Shift Bonus...3.3 Personal Illness, L.O.A....8.1(a) Personnel Files...9.12 Physical Exam, Periodic and Pre-Employment...7.2 Preceptor Pay...10.12 Pre-Employment and Periodic Physical Examination...7.2 Pre-Tax Programs...7.8 Principles Concerning Nursing and Quality Patient/Family Care...4.7 Probationary Period...2.1(a) Professional Activities...10.9 Professional Association, Participation In...1.2 Promotion, Rate After...3.7 Promotions...9.11 Quality Patient/Family Care...4.7 Rate After Promotion...3.7 Re-Certification...3.9 Recognition...1.1 Reduction in Force...9.4 Reduction in Force, Accrued Benefits...9.4(e) Reduction In Force, Procedure...9.4(c) Reduction In Force, Recall...9.4(f) Reduction In Force, Unit Grouping...9.4(b) Resignation Notice...10.7 Rotation...4.5 Safety Committee...10.13 Salaries...3.1/Appendices Scheduled Part-Time Nurses, Definition...2.1(c) Schedules...4.3 Seniority Full Time and Scheduled Part-Time Nurses...9.1 Seniority Per Diem Nurses...9.2 Service Fee, Association...1.2(c) Short-Term Disability Insurance...7.10 Special Benefit Program for Senior Nurses...7.11 Step Movement...3.1(e), 3.1(f) Strikes and Lockouts...12.1 Successorship...15.1 Temporary Employees...2.1(e) Temporary Fill Ins...9.3(g) Temporary Reassignment...4.8-56-

Temporary Supervisory Position...3.8 Ten-Hour Shift Positions...4.11 Transfers...9.11 Tuition Reimbursement...10.10 Twelve-Hour Shift Positions...4.10 Unplanned Time Off (E.T.)...6.3 Usage Planned/Unplanned Time Off (E.T.)...6.3 Vacancies...9.11 Vacancies, Nurses on Lay Off...9.3 Vice President Acute Care Services, Access to...4.6 Weekend Differential...3.4 Weekends...4.4 Work Location...9.5 Worker s Compensation...10.3 X-Ray Badges...7.5-57-

Side Letter Agreement Regarding Nurses Located at the Great Barrington Renal Satellite Clinic Nurses employed by the Berkshire Medical Center located at the Great Barrington Renal Satellite Clinic are recognized as members of the MNA bargaining unit. For the purposes of Section 9.4(b) of the Agreement, these nurses will be considered to be part of the unit 6. -58-

Side Letter Agreement Regarding Acuity Tool Committee Within three months of the ratification of this 2010-2013 Agreement, the Hospital will form a committee to develop an acuity tool to be used in the Hospital. The Association may appoint up to three (3) representatives to the committee. Any decision on an acuity tool to be used by the Hospital shall remain within the sole judgment of the Hospital. -59-

Side Letter Agreement Regarding the Discontinuation of the 4 Hour Premium Pay Arrangment Effective June 1, 2012, the 4 hour premium pay arrangement applicable to nurses who are regularly scheduled to work three 12 hour shifts per week will be discontinued. All such nurses will be offered the opportunity to work an additional four hours per week and thus to be paid for a full forty hours of work per week, in accordance with the following process: 1. On or before April 1, 2012, nurses will be asked to advise the Department Director if they wish to make a 40 hour weekly commitment following June 1, 2012. Once the Department Director is able to determine the number of nurses who have elected to make a 40 hour weekly commitment, the Director will post enough 4 hour shifts for all nurses who wish to accept one. 2. Such shifts will not exceed 4 hours in length and may not follow, or immediately precede, a regularly scheduled 12 hour shift. The 4 hours will be scheduled on the same shift (e.g., 7:00am 7:30pm or 7:00pm 7:30am) as the nurse s current shift unless the nurse opts for a different shift. Such shifts will not be scheduled for weekends (unless a nurse requests a weekend 4 hour time block and his/her unit is able to accommodate such request) or holidays. Nurses will continue to work their full 12 hour shifts on assigned holidays. 3. Following the posting of the new 4 hours shifts, nurses who have indicated a desire to make a 40 hour weekly commitment will choose from among the newlyposted 4 hour shifts, in order of seniority. The new shifts will be posted for a sufficient amount of time in order to give each such nurse an opportunity to make an election. Once each nurse has had an opportunity to make an election, there will not be a further opportunity. If a nurse who does not opt to take a 4 hour shift later wishes to add 4 hours to his/her weekly commitment, he/she will be permitted to do so only if such an opportunity is posted in the future. The Hospital does not guarantee that 4 hour shifts will continue to be posted. 4. Once a nurse commits to an additional 4 hour shift, that shift will become a regularly assigned shift for that nurse. A nurse may decide at any time to give up the additional 4 hour shift and return to work three 12 hour shifts. In that event, however, the nurse will be paid for 36 hours of work and, should he/she desire at a later date to return to a 40 hour schedule, he/she will be permitted to do so only if such an opportunity is posted in the future. 5. Nurses who choose to continue their current three 12 hour shift weekly commitment will receive health and dental benefits on the same basis as a fulltime (40 hour) nurse. They may at any time pick up extra shifts. Such nurses who remain on the payroll of the Hospital as of June 1, 2012, as well as nurses who first elect a four hour shift but decide to drop that shift before December 1, 2012, will receive a one-time lump sum payment of $5000. -60-

6. For nurses who work in the Renal unit or the PACU, an opportunity to elect schedules of four 10 hour shifts will be presented. At the same time that the Director posts 4 hour shifts as provided for in paragraph 1, above, the manager of these units will post a proposed schedule that will include only four 10 hour shifts. The starting times for such shifts would be staggered such that some will begin at 6:00am and some will end at 11:30pm. Once the proposed schedule is posted, the nurses in those units will vote to accept or reject such schedule. The majority of nurses voting will determine whether the unit moves to four 10 hour shifts or continues with their schedules as presently configured. All nurses in that unit will be assigned to shifts of the same length and duration. 7. Effective June 1, 2012, except as specified above, all nurses will be compensated, and will accrue time and benefits in accordance with the terms of the Agreement. -61-