ALLIANCE HEALTHCARE SERVICES, INC. POLICY AND PROCEDURE MANUAL POLICY CHARITABLE DONATIONS POLICY Effective December 31, 2013 To purpose of this policy is to articulate Alliance policy toward charitable contributions to ensure that charitable giving complies with all applicable federal and state laws, including but not limited to the Federal Anti-Kickback Statute and the Stark Law. SCOPE This policy applies to Alliance Team Members and contractors working on behalf of Alliance. This policy governs the charitable contribution process for Alliance. The following definitions apply for the purposes of this policy: Charitable Donations Financial or in-kind support provided to a 501(c)(3) organization whose mission supports a public benefit. Examples of public benefits that Alliance support are advancing medical care, improving patient outcomes, conducting patient education, and supporting disease research. Charitable Organization A Charitable Organization is an organization whose mission includes providing help to those in need or providing educational or scientific assistance to members of the public. Generally charitable organizations are non-profit corporations established under state law and with an IRS designation such as 501(c)(3) that enable the organization to receive tax-deductible contributions. Alliance donations are motivated by bona fide charitable purposes and are generally made only to bona fide Charitable Organizations or, in rare instances, to individuals and organizations engaged in genuine charitable activities for the support of a bona fide charitable mission. Special Events Special events include, but are not limited to award ceremonies, galas, walk-a-thons, biking, and golf events organized by independent 501(c)( 3) with the goal of raising funds to support its mission. Special Events do not include
educational seminars or continuing medical education sponsored by Alliance. Those are addressed in other Alliance Compliance Policies. Covered Person - (i) physicians, dentists, hospital employees, or others in a position to refer to Alliance or to a client of Alliance; (ii) any Immediate Family Member of any employee or representative of a person listed in item, above, such as a nurse, receptionist, etc.; (iii) current or prospective clients or an employee or representative such entities. This policy also provides guidelines for the provision of meals and entertainment to Government Representatives. Physician is defined as a doctor of medicine or osteopathy, a doctor of dental surgery or dental medicine, a doctor of podiatric medicine, a doctor of optometry, or a chiropractor. Immediate family member is defined as a husband or wife; birth or adoptive parent, child, or sibling; stepparent, stepchild, stepbrother, or stepsister; father-in-law, mother-in-law, son-in-law, daughter-in-law, brother-in-law, or sister-in-law; grandparent or grandchild; and spouse of a grandparent or grandchild. Government Representative refers to any government employee or anyone acting on behalf of the government (e.g., Medicare Administrative Contractors and Recovery Audit Contractors). BACKGROUND Delivering exceptional patient care by providing diagnostic imaging and radiation oncology solutions with unparalleled passion and commitment is a major component of the Alliance mission. This mission is not achieved in isolation; Alliance partners with hospitals, physicians and other healthcare providers to meet these objectives. In addition, there are a host of organizations dedicated to the support medical education, patient education, and other worthwhile endeavors that increase health and disease knowledge or improve patient outcomes and quality of life. In addition to a history of providing philanthropic support to large well-known national organizations such as the American Cancer Society and United Way, Alliance has traditionally provided funding to smaller organizations in the form of independent grants and charitable contributions. Given that our business partners and customers are often involved in these same organizations, or may function as nonprofit entities, Alliance has developed charitable giving guidelines. These Charitable Donation Policy Page 2 of 6
guidelines help ensure that federal and state anti-kickback laws, which prohibit providing any remuneration as inducement or compensation for the referral of health care services, are not violated. These guidelines also support compliance with Stark and state physician self referrals laws, which prohibit referrals of diagnostic imaging and radiation therapy services by physicians to entities in which the physicians have a financial interest. GUIDELINES Charitable Donations A. The provision of educational or charitable support to charitable entities by Alliance is in no way, economically motivated or influenced by the maintenance of current customers or to encourage agreements with potential customers. Support shall be offered without regard to the volume or value of business referred and the purpose of the support should not be to induce or compensate for the referral of patients. B. All Charitable Donations shall be pre-approved by the Chief Financial Officer and the Alliance Compliance Officer using Appendix A Charitable Donation/Special Event Request Form. C. Alliance Team Members shall clearly indicate on the check request form that the expenditure is for a donation, and include the name and description of the entity receiving the contribution. When applicable, documentation of the organization s tax exempt status and number shall be attached to the check request. Donations to non-tax exempt entities have different accounting requirements; therefore, the requestor must acknowledge the tax status of the organization requesting the contribution. D. Personnel involved in the sales, marketing or account development/relations functions may provide input about the suitability of a proposed charitable contribution, but shall not control or unduly influence the decision regarding whether or not a donation is made. E. Team Members shall not commit to making a Charitable Donation without obtaining written pre-approval of Chief Finance Officer and the Alliance Compliance Officer. F. Alliance Team Members shall maintain accurate and appropriate documentation of all Charitable Donations. Special Events A. The provision of support by Alliance for Special Events shall in no way, economically motivated or influenced by the maintenance of current customers or to encourage agreements with potential customers. Support shall be offered without regard to the volume or value of business referred and the purpose of the support should not be to induce or compensate for the referral of patients. Charitable Donation Policy Page 3 of 6
A. All contributions related to Special Events shall be pre-approved by the Chief Finance Officer and the Alliance Compliance Officer using Appendix A Charitable Donation / Special Event Request Form. C. Generally, Special Events are supported when they are hosted by an IRS Section 501(c)(3) organization, although in rare instances Alliance will support a Special Event when the proceeds of the event are intended to support a bona fide charitable mission. D. Alliance Team Members may attend a Special Event organized by a customer or potential customer if the purpose of that event is related to a bona fide charitable purpose. E. Alliance Team Members should clearly indicate on the check request form and expense report that the expenditure is a donation for a Special Event and include the name and description of the entity receiving the contribution. When applicable, documentation of the organization s tax exempt should be attached to the check request. F. Alliance shall not support the cost of attendance at Special Events for Covered Persons. G. Alliance may invite Covered Persons to Special Events, provided the Covered Person pays Alliance for the full price of the ticket and provided that the appropriate pre-approvals have been obtained. H. Team Members shall not invite Covered Persons to a Special Event more than once a year. I. Alliance Team Members may not commit to supporting a Special Event without obtaining preapproval of the Chief Finance Officer and Alliance Compliance Officer. J. Alliance Team Members are required to maintain accurate and appropriate documentation of all donations. K. Special Events shall be attended by Alliance Team Members; unused tickets shall be offered to other Alliance employees or returned to the event organizers. L. Alliance Team Members are required to maintain accurate and appropriate documentation of attendance and reimbursement for Special Events. The Alliance Compliance Officer has the authority to request copies and review these reports at any time. Failure to maintain and produce accurate records shall be considered a violation of this policy. Alliance Team Members shall not commit to or provide any form of Charitable Donations outside the parameters of this policy. TRACKING A. Alliance Team Members shall maintain a copy of all Charitable Donation documentation. This shall include the Charitable Donation / Special Event Request Form (appendix A) with signatures, as well as any additional related documentation such expense reports, check requests and documentations of the organizations status as 501(c)(3) entity. Charitable Donation Policy Page 4 of 6
B. Alliance Team Member supervisors shall track contributions to ensure no entity is funded by Alliance more than once annually. C. On a semi-annual basis, the supervisors of Alliance Team Members shall review the documentation maintained for Charitable Donations to ensure it includes relevant details and that the Team Members they are supervising are in compliance with this Policy. D. No later than the last business day of July and January of each year, Alliance team member supervisors shall provide to the Vice President of Finance in their region, a line-item report of donations provided during the preceding six-month calendar period (i.e., January through June and July through December), summarizing the information for each individual request (e.g. requesting organization, Team Member coordinator, purpose of grant, etc.) The Vice President shall then review the reports and alert the supervisors of any violations of this Policy. E. The Alliance Compliance Officer has the authority to request copies and review these reports at any time. Failure to maintain and produce accurate records shall be considered a violation of this policy. Charitable Donation Policy Page 5 of 6
APPENDIX A CHARITABLE DONATION / SPECIAL EVENT REQUEST FORM Requesting Organization Name: Address: City: State: Zip: Contact Person at Organization: Email: Phone: Organization Website: Organization Status: 501(c)(3) Other Non-Profit Designation For Profit Type of Donation (e.g. charitable contribution, special event, etc.) / Objective How Funds Will Be Used: Relevant Dates / Locations Covered Persons Associated With This Request Team Member Coordinating Request: Immediate Supervisor Approval: Chief Financial Officer Approval: Compliance Officer Approval: Denial (insert name): Printed Name Signature Charitable Donation Policy Page 6 of 6