APPENDIX CONFLICT OF INTEREST CODE OF THE COUNTY OF SANTA CLARA EXHIBIT A LIST OF DESIGNATED POSITIONS FOR
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1 APPENDIX CONFLICT OF INTEREST CODE OF THE COUNTY OF SANTA CLARA EXHIBIT A LIST OF DESIGNATED POSITIONS FOR SANTA CLARA VALLEY HEALTH & HOSPITAL SYSTEM INFORMATION SERVICES Designated Position Disclosure Category Business Information Technology Consultant, IS 5 Epic Application Manager, IS 5 Epic Instructional Designer, IS 5 Epic Interface Analyst II, IS 5 Epic Pharmacy Informaticist, IS 4 Epic Sr. Application Coordinator, IS 5 Epic Sr. Interface Analyst, IS 5 Epic Sr. Report Writer, IS 5 Epic Sr. Server Systems Engineer, IS 5 Information Systems Manager, IS 5 Information Technology Planner/Architect, IS 5 Management Analyst, IS 4 Management Information Services Manager, IS 5 Management Information Services Project Manager, IS 5 Program Manager, IS 4 Sr. Business Information Technology Consultant, IS 5 Sr. Information Technology Project Manager, IS 5 Sr. Management Analyst, IS 4 Sr. Management Info Systems Analyst, IS 5 Sr. Network Engineer, IS 5 Sr. Systems Software Engineer, IS 5 Exhibit A List of Designated Positions Page 1 of 2 rev 06/19/18 (eff 07/02/18) Santa Clara Valley Health and Hospital
2 Designated Position Disclosure Category Supervisor, Health Info Mgmt Svcs, IS 4 Systems Software Engineer, IS 5 Consultant 2 Exhibit A List of Designated Positions Page 2 of 2 rev 06/19/18 (eff 07/02/18) Santa Clara Valley Health and Hospital
3 APPENDIX CONFLICT OF INTEREST CODE OF THE COUNTY OF SANTA CLARA EXHIBIT B DISCLOSURE CATEGORIES FOR SANTA CLARA VALLEY HEALTH & HOSPITAL SYSTEM INFORMATION SERVICES Pursuant to the County of Santa Clara s Conflict of Interest Code, Disclosure Categories 1 and 2 shall read as follows for all Code Agencies. Disclosure Category 1: Persons in this category shall disclose: (1) all investments in, business positions in, and income (including gifts, loans and travel payments) from: (a) all sources that provide, plan to provide, or have provided in the last two years, facilities, goods, software, hardware, or related technology, equipment, vehicles, machinery or services, including training or consulting services, to the County; (b) all sources that are subject to the regulatory, monitoring, investigatory, enforcement, valuation, certification, permit or licensing authority of, or have an application for a license, permit or certificate pending before, the County; (c) all sources that receive, are planning to apply to receive, or have received in the last two years, grants or other monies from or through the County; and sources that receive referrals to provide assessments and/or treatments that are required or recommended by the County; and (2) all interests in real property in the County of Santa Clara located entirely or partly within the County, or within two miles of County boundaries, or of any land owned or used by the County. Disclosure Category 2: Each Consultant shall disclose: (1) all investments in, business positions in, and income (including gifts, loans and travel payments) from: (a) all sources that provide, plan to provide, or have provided in the last two years, facilities, goods, software, hardware, or related technology, equipment, vehicles, machinery or services, including training or consulting services, to the County; (b) all sources that are subject to the regulatory, monitoring, investigatory, enforcement, valuation, certification, permit or licensing authority of, or have an application for a license, permit or certificate pending before, the County; (c) all sources that receive, are planning to apply to receive, or have received in the last two years, grants or other monies from or through the County; and Exhibit B Disclosure Categories Page 1 of 4 08/16/16 (from 08/25/15 SCVHHS)
4 sources that receive referrals to provide assessments and/or treatments that are required or recommended by the County; and (2) all interests in real property in the County of Santa Clara located entirely or partly within the County, or within two miles of County boundaries, or of any land owned or used by the County, subject to the following limitation: the Code Agency for which a consultant works may determine in writing, following approval by County Counsel as to form and legality, that the particular consultant is hired to perform a range of duties that is limited in scope and, thus, is not required to comply with the full disclosure requirements described above, but instead must comply with more tailored disclosure requirements specific to that consultant. Such a determination shall include a description of the consultant's duties and, based upon that description, a statement of the extent of disclosure requirements. In addition to the above two categories, Santa Clara Valley Health and Hospital System Information Services shall have the following categories: Disclosure Category 3: Persons in this category shall disclose: (1) all investments in, business positions in, and income (including gifts, loans and travel payments) from: (a) all sources that are of the type to provide goods, services, facilities, treatment, medications or equipment relating to the treatment, planning, prevention or education of persons suffering from any mental illness or from alcohol or drug use or abuse; (b) all sources that provide, plan to provide, or have provided in the last two years, facilities, goods, treatment, medications, software, hardware, or related technology, equipment, vehicles, machinery, or services, including training or consulting services, to the Mental Health Department or the Department of Alcohol and Drug Services; (c) all sources that receive, are planning to apply to receive, or have received in the last two years, grants or other monies (i) from or through the Mental Health Department or the Department of Alcohol and Drug Services, or (ii) from or through the County of the type managed or administered by the Mental Health Department or the Department of Alcohol and Drug Services; and sources that receive referrals to provide assessments and/or treatments that are required or recommended by the Mental Health Department or the Department of Alcohol and Drug Services; and (2) all interests in real property in the County of Santa Clara located entirely or partly within the County, or within two miles of County boundaries, or of any land owned or used by the County. Exhibit B Disclosure Categories Page 2 of 4 08/16/16 (from 08/25/15 SCVHHS)
5 Disclosure Category 4: Persons in this category shall disclose all investments in, business positions in, and income (including gifts, loans and travel payments) from: (1) all sources that are health or mental health care providers, facilities, laboratories, clinics or nursing homes, or which provide goods, services, medication, or equipment to, or for the use by, health and mental health care providers; (2) all sources that provide, plan to provide, or have provided in the last two years, facilities, goods, treatment, medications, software, hardware, or related technology, equipment, vehicles, machinery, or services, including training or consulting services, to the Santa Clara Valley Health and Hospital System; and (3) all sources that receive, are planning to apply to receive, or have received in the last two years, grants or other monies (a) from or through the Santa Clara Valley Health and Hospital System, or (b) from or through the County of the type managed or administered by the Santa Clara Valley Health and Hospital System; and sources that receive referrals to provide assessments and/or treatments that are required or recommended by the Santa Clara Valley Health and Hospital System. Disclosure Category 5: Persons in this category shall disclose all investments in, business positions in, and income (including gifts, loans and travel payments) from all sources that provide facilities, goods, software, hardware, or related technology, equipment, machinery, or services, including training or consulting services, related to information systems, computers, networks, applications, technological infrastructures or architectures, or telecommunications of the type utilized by the Santa Clara Valley Health and Hospital System. Disclosure Category 6: Persons in this category shall disclose: (1) all investments in, business positions in, and income (including gifts, loans and travel payments) from: (a) all sources that provide, plan to provide, or have provided in the last two years, facilities, goods, treatment, medications, software, hardware, or related technology, equipment, vehicles, machinery, or services, including training or consulting services, to the Santa Clara Valley Health and Hospital System; (b) all sources that provide land or facility development, construction, management, expansion, or renovation, including but not limited to supplying construction equipment or materials, architecture, design, engineering, land use planning, maintenance, rehabilitation, acquisition, Exhibit B Disclosure Categories Page 3 of 4 08/16/16 (from 08/25/15 SCVHHS)
6 disposal, lease, sale, management or financing of real property, of the type utilized by the Santa Clara Valley Health and Hospital System; (c) all sources that receive, are planning to apply to receive, or have received in the last two years, grants or other monies (i) from or through the Santa Clara Valley Health and Hospital System, or (ii) from or through the County of the type managed or administered by the Santa Clara Valley Health and Hospital System; and sources that receive referrals to provide assessments and/or treatments that are required or recommended by the Santa Clara Valley Health and Hospital System; and (2) all interests in real property in the County of Santa Clara located entirely or partly within the County, or within two miles of County boundaries, or of any land owned or used by the County. Exhibit B Disclosure Categories Page 4 of 4 08/16/16 (from 08/25/15 SCVHHS)
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This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.staugustineinsurance.info or by calling 1-888-293-9229.
You don t have to meet deductibles for specific services.
Summary of Benefits and Coverage: What this Plan Covers & What You Pay For Covered Services Coverage Period: 01/01/2018-12/31/2018 Highmark Health Insurance Company: Shared Cost Blue PPO 7000 Coverage
You don t have to meet deductibles for specific services.
Summary of Benefits and Coverage: What this Plan Covers & What You Pay For Covered Services Coverage Period: 01/01/2018-12/31/2018 Highmark Blue Cross Blue Shield: my Priority Blue Flex HMO 6900S Coverage
Important Questions Answers Why this Matters:
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.healthscopebenefits.com or by calling 1-877-385-8820.
Medtronic HRA Plan Coverage Period: Beginning on or after
Medtronic HRA Plan Summary of Benefits and Coverage: What this Plan covers & What it Costs Coverage Period: Beginning on or after 01-01-2016 Coverage for: All Coverage Levels Plan Type: HDHP This is only
Monroe County, Tennessee Property Tax Incentive Program Policies and Procedures
Monroe County, Tennessee Property Tax Incentive Program Policies and Procedures Revised 1/2010 MONROE COUNTY, TENNESSEE PROPERTY TAX INCENTIVE PROGRAM POLICIES AND PROCEDURES Section I General Purpose
You don t have to meet deductibles for specific services.
Summary of Benefits and Coverage: What this Plan Covers & What You Pay For Covered Services Coverage Period: 01/01/2018-12/31/2018 Highmark Blue Cross Blue Shield: my Direct Blue EPO 1000G Coverage for:
Assurant Health Silver Plan 002: Time Ins. Co. Coverage Period: 01/01/ /31/2015 Summary of Benefits and Coverage:
Assurant Health Silver Plan 002: Time Ins. Co. Coverage Period: 01/01/2015-12/31/2015 Summary of Benefits and Coverage: What this Plan Covers & What it Costs Coverage for: Family Plan Type: PPO This is
University of Missouri System Accounting Policies and Procedures
University of Missouri System Accounting Policies and Procedures Policy Number: APM-20.05.10 Policy Name: Capital Assets Buildings and Improvements General Policy and Procedure Overview: This policy provides
Calvo s SelectCare: Standard Option Coverage Period: 01/01/ /31/2019 Coverage for: Self Only, Self Plus One or Self and Family Plan Type: HMO
Calvo s SelectCare: Standard Option Coverage Period: 01/01/2019 12/31/2019 This is only a summary. Please read the FEHB Plan brochure (73-874]) that contains the complete terms of this plan. All benefits
You don t have to meet deductibles for specific services.
Summary of Benefits and Coverage: What this Plan Covers & What You Pay For Covered Services Coverage Period: 01/01/2019-12/31/2019 Highmark Health Insurance Company: Shared Cost Blue PPO Bronze 7500 Coverage
Calvo s SelectCare: High Option Coverage Period: 01/01/ /31/2018 Coverage for: Self Only, Self Plus One or Self and Family Plan Type: HMO
Calvo s SelectCare: High Option Coverage Period: 01/01/2018 12/31/2018 This is only a summary. Please read the FEHB Plan brochure (73-874]) that contains the complete terms of this plan. All benefits are
$20,000 Family for nonparticipating. Important Questions Answers Why this Matters:
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.calcpahealth.com or by calling 1-877-480-7923. Important
STATE UNIVERSITY of NEW YORK PROJECT CAPITALIZATION FORM (PCF) INSTRUCTIONS
The Project Capitalization Form should be used for all capital projects on State University (SUNY) capital assets where design and construction costs are $100,000 or greater, and for all building and land
You can see the specialist you choose without permission from this plan.
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.chatn.org or by calling 1-800-580-8574. Important Questions
Your Plan: 2019 Advantage PPO Plan (S828 and Z0KC) Your Network: Prudent Buyer PPO
Anthem Blue Cross Your Plan: 2019 Advantage PPO Plan (S828 and Z0KC) Your Network: Prudent Buyer PPO ACWA JPIA C00361 This summary of benefits is a brief outline of coverage, designed to help you with
Important Questions Answers Why this Matters: Network: $500 Individual $1,000 Family Non-Network: $1,500 Individual $3,000 Family
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.inhealthohio.org or by calling 1-800-580-8502. Important
limit. The chart starting on page 2 describes any limits on what the plan will pay for specific covered services, such as office visits.
Medtronic BCBSMN PPO Plan Coverage Period: Beginning on or after 01-01-2016 Summary of Benefits and Coverage: What this Plan covers & What it Costs Coverage for: Single and family coverage Plan Type: PPO
You don t have to meet deductibles for specific services.
Summary of Benefits and Coverage: What this Plan Covers & What You Pay For Covered Services Coverage Period: 01/01/2019 12/31/2019 Highmark Delaware: Shared Cost Blue EPO Gold 1000-2 Free PCP Visits Coverage
Important Questions Answers Why this Matters:
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.wpsic.com or by calling 1-888-915-4001. Important Questions