HomeMy WebLinkAbout14-127 - American Healthways Services - Reimbursement for Facility Usage by Members (Tukwila Community Center)14 -127
Council Approval N/A
HEALTHWAYS PROVIDER AGREEMENT
This Healthways Provider Agreement, its Program Schedules, exhibits and attachments, and any amendments
thereto, (collectively the "Agreement ") is entered into between AMERICAN HEALTHWAYS SERVICES, LLC, for itself
and on behalf of its subsidiaries (hereinafter referred to as "Healthways "), a Delaware limited liability company, and the
undersigned Facility (as defined below) (Healthways and Facility are collectively referred to herein as the "Parties "). This
Agreement replaces and supersedes any other agreement between or among Facility and Healthways and its subsidiaries and
affiliates for the Healthways programs and products represented herein. Following the execution hereof, all such other
agreements shall be terminated on the effective date of this Agreement.
PREAMBLE
WHEREAS, Healthways has entered into agreements with Sponsoring Organizations (as defined below) to provide
fitness services, benefits, and programs to eligible Members (as defined below) within an established network of fitness centers;
WHEREAS, Facility offers health and fitness programming and services; and
WHEREAS, Healthways would like to include Facility, and Facility desires to be included, as a member of the network
of facilities for one or more Healthways products to provide subsidized basic fitness memberships and services, all on the terms
and conditions set forth below.
NOW, THEREFORE, in consideration of the mutual premises set forth above and the promises hereinafter appearing,
and for other good and valuable consideration, the receipt, sufficiency and adequacy of which is hereby acknowledged, the Parties
agree as follows:
AGREEMENT
1. Definitions. The terms defined in this section shall have the meanings specified for all purposes of this Agreement.
a) "Confidential Information" means all provisions of this Agreement and any business expertise, manuals, videos,
trade secrets, compensation, Sponsoring Organization Member information and any and all Healthways intellectual
property subject to the Washington State Public Records Act.
b) "Facility" means the undersigned Facility whose name and other identifying information appear herein and any
additional participating locations of Facility as mutually agreed to and set forth in Exhibit A, which have entered into this
Agreement with Healthways to be part of its Healthways Network, on the terms and conditions set forth herein.
c) "Healthways Network" means, collectively, all participating locations that have entered into a contract agreement with
Healthways to provide the Program.
d) "Member" means a Sponsoring Organization member, employee, dependent or other person eligible for the Program as
determined by the Sponsoring Organization's criteria.
e) "Program" means each of the Healthways programs described in the Program Schedules.
f) "Program Schedule" means each, and "Program Schedules" shall mean all, of the program schedules attached to this
Agreement, and incorporated herein by reference, that describe the Healthways programs provided by Facility to
Members of Sponsoring Organizations. Healthways and Facility acknowledge and agree that notwithstanding any
other provision of this Agreement, Healthways may amend this Agreement upon sixty (60) days prior written notice
to Facility to modify existing Program Schedules or to add one or more new Program Schedules, and that Facility
may decline participation in a new Program Schedule or decline proposed modifications to an existing Program Schedule
upon written notice to Healthways within such sixty (60) day period if such modified or new Program Schedule would
have a demonstrable material adverse effect on Facility.
g)
"Reference Guide" means the procedures and guidelines established by Healthways for participation in the
Healthways Network by Facility and under which the Program is administered. The Reference Guide, which shall be
provided to Facility prior to the commencement of this Agreement, is incorporated herein by reference; the
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Reference Guide may be periodically updated by Healthways and updated copies shall be provided to Facility from
time to time.
h) "Sponsoring Organization" means any organization, employer group, health plan or subset thereof that is contracted
with Healthways to provide the Program to its members and whose members may therefore utilize Facility in
accordance with the terms of this Agreement. Facility shall provide the Program to eligible Members of all
Sponsoring Organizations. Sponsoring Organization information shall be available to Facility, and such Sponsoring
Organization information shall be incorporated herein by reference.
i) "Term" means the Initial Term of the Agreement and each successive one (1) year period as provided in the Term
section of this Agreement.
2. Duties and Obligations of Facility.
a) Acceptance to and Participation in the Healthways Network. Healthways' execution of this Agreement shall serve as
notice of Facility's acceptance into the Healthways Network. In order to become and remain a participant in the
Healthways Network, Facility shall throughout the Term of this Agreement comply with the Reference Guide (including
any updates thereto), including all quality assurance standards, operations, protocols, policies, procedures, follow -up
guidelines, and health and safety standards of Healthways.
b) Member Program Rights. Facility shall not impose any charges on Members for Program services covered under this
Agreement. At no charge to the Member, each Member shall establish and maintain a basic fitness membership with
unrestricted hours at Facility, provided that such individual remains an eligible Member and this Agreement remains in
effect. The Program excludes programs and services offered by Facility which carry additional charges beyond basic
fitness membership services, such as racquetball, tennis, massage and similar fee -based activities. If a Member requests
services after being informed that the services are not covered under the Program, Healthways is not responsible for
payment to Facility.
c) Joint Marketing and Public Relations. During the Term of this Agreement, Facility agrees to allow Healthways and
Sponsoring Organization to use the name, address, phone, amenities and web site information provided in Exhibit A in
marketing and advertising materials and campaigns. All marketing and advertising materials, and materials intended for
distribution to Members prepared by Facility that refer to the Program, Healthways, or Sponsoring Organization shall be
approved by Healthways in writing prior to their distribution. Facility agrees to make best efforts to coordinate all media
communications through the Healthways Public Relations Department, and immediately inform Healthways of all media
inquiries regarding the Program, Healthways, or Sponsoring Organization.
d) Limited Facility Use of Healthways Trademarks, Logos, and Copyrighted Materials. Facility agrees that for the Term of
this Agreement, all external marketing and advertising of all Healthways trademarked and service marked names, logos,
identities, formats, and materials (the "Marks and Materials "), including the Program name, will first be approved in
writing by Healthways, and that at the conclusion of this Agreement, Facility shall cease all advertising, marketing, and
references to the same. Nothing in this Agreement grants or shall be deemed to grant to either Party any right, title or
interest in or to the other Party's Marks and Materials. All use by Facility of Healthways' Marks (including any
goodwill associated therewith) shall inure to the benefit of Healthways.
e) Dispute Resolution. Facility agrees that in the event any disagreement arises between Facility, Healthways and /or
Sponsoring Organization on any matter whatsoever, Healthways, Facility, and/or Sponsoring Organization or any subset
thereof shall work with the other party(ies) to reach a resolution of the disagreement, and no one shall involve Members
in any matter concerning such a disagreement. Facility shall not contact a member for any reason related to a dispute
between Healthways, Facility and /or Sponsoring Organization.
f) Research Studies. Facility shall obtain prior written approval from Healthways for any research or clinical studies of
Members or the Program. Facility shall provide study findings and results to Healthways prior to any publication or
presentation of such findings or results.
g)
Membership Conversion. Facility agrees that Members eligible for a fully subsidized Program who are currently
members of Facility will be able to inactivate or "freeze" their memberships for the duration of this Agreement and
pay no monthly dues, cancellation fee, or other fees during the inactivation period so that they may attend Facility at
no charge under the Program. At the time this Agreement terminates, or if applicable Members terminate their
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membership in Sponsoring Organization, those Members will then be responsible for the remaining terms of their
individual memberships with Facility. Facility shall not refuse or dissuade eligible Members from participating in
the Program.
h) Healthways Network Reciprocity. For the Term of this Agreement, all Members utilizing the Program will be
allowed, after completing Program enrollment, to visit any and all Healthways Network participating locations
offering the Healthways Program for which they are eligible. Reciprocity rights under this Agreement shall not
include locations of Facility or other affiliated facilities not specifically set forth in Exhibit A.
i) Healthways Fitness Provider Portal. All Facility participating locations shall create and maintain user accounts on the
web -based Healthways Fitness Provider Portal. Facility shall utilize the Healthways Fitness Provider Portal to
verify Member eligibility and to obtain and access Healthways materials, including Sponsoring Organization
information, training materials, Program forms, Program reports, and the Reference Guide.
3. Compensation. As payment for Program services, Healthways shall pay Facility according to the terms set forth in each
applicable Program Schedule attached hereto for services provided on or after the Program Ready Date. Compensation
paid by Healthways is inclusive of any and all taxes which Facility may be required to pay to any governmental
authority. Healthways will make payment to Facility via electronic funds transfer.
4. Term.
a) Initial Term and Ready Date. This Agreement will commence upon execution by the Parties, and shall continue in
full force and effect until December 31, 2014 ( "Initial Term "), subject to cancellation as provided in the
Cancellation section below. Services to Members and payment for such services shall commence on a date
following the commencement of this Agreement that shall be communicated to Facility by Healthways ( "Ready
Date "). The Initial Term and any and all Renewal Terms are referred to herein as the "Term ".
b) Renewal of Agreement. This Agreement shall be automatically renewed for successive one year terms after the Initial
Term (the "Renewal Term ") unless either party gives written notice of termination at least one hundred twenty (120)
days prior to the expiration of the Initial Term or the current Renewal Term of the Agreement or unless the Agreement is
canceled pursuant to the Cancellation section below.
5. Cancellation.
a) Mutual Change in Terms; Poor Usage. Both Parties retain, upon thirty (30) days' written notice, the right to terminate
this Agreement or the participation by Facility under any Program Schedule for any location of Facility in Exhibit A on
the basis of, in either Parties sole and reasonable discretion, poor usage of Facility by Members or upon termination or
change in terms of a Sponsoring Organization's contract with Healthways. In the event either Party removes Facility
from the Healthways Network, Facility shall be compensated per this Agreement for services rendered up to and
including the date of cancellation.
b) Bankruptcy. Notwithstanding any provision in this Agreement, if at any time there shall be filed by or against a party to
this Agreement, in any court, tribunal, administrative agency, or any other forum having jurisdiction, pursuant to any
applicable law, either of the United States or of any state, a petition in bankruptcy or insolvency or for reorganization or
for the appointment of a receiver, trustee, or conservator of all or a portion of the party's property, or if a party makes an
assignment for the benefit of creditors, and if this action is not dismissed after ninety (90) calendar days, this Agreement
may be immediately canceled and terminated by the other party.
c) Material Breach. If either party breaches any material term or condition of this Agreement, this Agreement may be
terminated after written notice of such breach or default by the non- breaching party to the breaching party. The
notice must specify the nature of said material breach and provide the breaching party thirty (30) days from receipt
of the notice to correct the material breach. In the event the breaching party fails to cure the material breach within
the thirty (30) day period, this Agreement shall automatically terminate upon completion of the thirty (30) day
period, notwithstanding any other provision in this Agreement.
d) Early Termination. Notwithstanding any other provision of this Agreement, Healthways may terminate this
Agreement at any time upon notice to Facility due to 1) failure of Facility to maintain required insurance coverage as
set forth in this Agreement; 2) closure of Facility, resulting in denial of Program services to Members, without at Least
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thirty (30) days' prior written notice to Healthways; 3) fraudulent Program utilization reporting by Facility; or 4)
Healthways' reasonable determination that the health or safety of Members may be in jeopardy if this Agreement is
not terminated.
e) Default. In the event that Facility defaults under this Agreement or the Agreement is terminated pursuant to the
Material Breach section or the Early Termination section above, Healthways may, at its sole discretion and without
limiting other remedies available to Healthways at law or in equity, withhold payment of any amounts otherwise due
and payable to Facility under this Agreement.
6. Confidentiality. All Confidential Information between Healthways and Facility are shared in strictest confidence. During
the Term and at all times thereafter, Facility shall not divulge, furnish or make accessible to anyone or use in any way
(other than use in the ordinary course of providing services under this Agreement) any Confidential Information is
subject to disclosure by Facility pursuant to legal discovery or state or federal law, including but not limited to
the Washington State Public Records Act. Facility shall return to Healthways all of Healthways' materials (including
any and all copies of such materials) used in the provision of the Program, including the Reference Guide and Member
files, upon completion of this Agreement or in the event of its termination, or at any other time upon request from
Healthways.
7. Member Contact. Facility agrees to not directly contact Members during the Term of this Agreement in regard to
business related matters pertaining to the Program, such as, but not limited to, switching health care plans, disenrolling,
enrolling with other health care plans or similar entities, or contracting directly with Facility instead of Healthways and
Sponsoring Organization.
8. Insurance. Parties agree that Facility has liability coverage under an intergovernmental self- insurance and risk
management pool and shall maintain in force insurance coverage in an amount of at least $1,000,000 per occurrence, and
shall cause such insurance to require that the carrier will provide Healthways written notice of expiration, termination, or
cancellation at least thirty (30) days prior to any expiration, termination, or cancellation of such policy. As proof of the
aforementioned, Facility shall provide from time to time to Healthways evidence reasonably acceptable to Healthways
attesting self- insurance and risk management pool coverage within ten (10) days of request by Healthways.
9. Notices. Unless expressly provided otherwise, all notices, requests, demands and other communications required or
permitted under this Agreement shall be in writing and shall be deemed to have been duly given, made and received
when sent by 1) facsimile transmission using equipment that provides automatic verification of transmission; 2) hand
delivery, including by a recognized courier service; or 3) registered or certified mail, postage prepaid, return receipt
requested. Notices under the Agreement to Facility shall be to the Contract Administrator in Exhibit A -2. Notices under
the Agreement to Healthways shall be to: Healthways Provider Networks Department, 1445 South Spectrum Blvd.,
Suite 100, Chandler, Arizona 85286; Fax: 602 - 391 -2138.
Facility shall provide a minimum of ten (10) days notice to Healthways in the event of a change in any of the information
provided in Exhibit A of this Agreement. Either party may alter the address to which communications or copies are to be sent
by giving notice of such change of address in conformity with the provisions of this section for the giving of notice.
10. Miscellaneous.
a) Mutual Compliance with Federal and State Rules and Regulations. For the Term of this Agreement, both Parties shall
comply with all applicable federal and state rules and regulations regarding services provided to Members.
b) Business License and Regulatory Standards. Facility shall hold an active and unrestricted business license as
required by law, covering all aspects of services offered, and meet occupational health and safety requirements and
regulatory standards in the state and jurisdiction in which Facility operates.
c) Priority of Documents. Any conflict, ambiguity or inconsistency between the terms and conditions in this
Agreement, the Program Schedules, the Exhibits and any document referred to in or incorporated into this
Agreement shall be resolved in accordance with the following decreasing order of priority: i. this Agreement; ii. The
Program Schedules; iii. the Exhibits; and iv. such other referenced or incorporated documents.
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d) Severability. Should any provision herein be determined by any court of competent jurisdiction to be illegal, invalid
or unenforceable in any respect, in whole or in part, the offending provisions shall not affect the enforceability of the
remaining provisions of this Agreement.
e) Amendment of Agreement to Comply with Law. Healthways and Facility acknowledge and agree that Healthways
may amend this Agreement in order to comply with applicable law, by sixty (60) days' prior written notice to
Facility, and that Facility may elect to withdraw its acceptance with regard to such amendment within such sixty (60)
day period if such amendment would have a demonstrable material adverse effect on Facility. If Facility elects not to
accept such amendment, this Agreement will terminate and each Party's obligations shall cease with regard to the
other, except that Healthways shall be obligated to pay, within thirty (30) days of the effective date of termination,
any unpaid amounts owed to Facility.
f) Applicable Law. The validity of this Agreement and of any of its terms and provisions, as well as the rights and
duties of the Parties hereunder, shall be interpreted and enforced pursuant to and in accordance with the laws of the
State of Washington.
Counterparts. This Agreement may be executed in any number of counterparts and by different Parties hereto in
separate counterparts, with the same effect as if all Parties had signed the same document. All such counterparts
shall be deemed an original, shall be construed together and shall constitute one and the same instrument.
h) Entire Agreement. This Agreement, together with any Exhibits and Schedules hereto, represents the entire
understanding and agreement among the Parties with respect to the subject matter hereof and shall supersede any
prior writings, understandings, or agreements among the Parties with respect to the subject matter hereof.
Modification. Unless specifically set forth in this Agreement, no alteration, amendment, waiver, cancellation or any
other change in any term or condition of this Agreement shall be valid or binding on either Party unless the same
shall have been mutually agreed to in writing by both Parties.
Sale of Business/Transfer of Assets. If Facility desires to sell or transfer all or substantially all of its assets or
business to another entity, or transfers to a third party a controlling interest in its assets or business, Facility shall so
advise Healthways in writing at least ninety (90) days' prior to the sale or transfer date. Upon notification of sale,
Healthways may, in its sole discretion, choose to terminate the Agreement effective on date of sale or extend the
terms of the Agreement to the new entity.
k) Authority to Sign. The individual signing below on behalf of Facility represents and warrants that he /she has all
requisite corporate power and authority to enter into this Agreement on behalf of Facility.
IN WITNESS WHEREOF, the Parties have agreed as set forth above.
AMERICAN HEALTHWAYS SERVICES, LLC 11) KiAsZ 1 a- Co m rn u ftl `- J -r
Name of Facility
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Mary Jo Ferron
Vice President, Fitness Programs
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Date
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Signature
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Printed Name
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Title
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PROGRAM SCHEDULE
Program Name: Mature Market Fully Subsidized Program
Program Brands:
Silver Sneakers® Fitness Program, SilverSneakers Private Brand, and other brand names
for the Mature Market Fully Subsidized Program •communicated to Facility by
Healthways from time to time
Member Type: Medicare, Group Retirees and Older Adults
Program Description:
The Program is offered to Members of the Sponsoring Organization. The Program
includes SilverSneakers exercise classes and basic fitness membership services, which
may include other Healthways services, for Members provided through a network of
facilities; also included in the Program are all facets presented in the Duties and
Obligations of Facility section of the Agreement.
1. Program Duties and Obligations of Facility. In exchange for the compensation to be paid by Healthways,
Facility shall perform the following services:
a) Program Implementation Process. To prepare for Program commencement, Facility agrees to participate in
the following 1) coordination with Healthways of electronic reporting containing the required data
elements; 2) Healthways- scheduled and led training; and 3) Healthways' evaluation of Facility prior to the
Program Ready Date to certify Facility's preparedness to provide Program.
b) Staffed Hours. Facility shall be appropriately staffed in accordance with professionally - recognized
standards of fitness programs a minimum of six (6) hours per day, Monday through Friday.
c) Program Enrollment. Facility shall enroll Members in the Program in accordance with the protocol defined in
the Reference Guide or other protocol mutually agreed between the Parties.
d) Reporting Obligations of Facility. Facility shall report Program utilization to Healthways on a monthly
basis. Program utilization reporting shall consist of all 1) Program forms completed during the previous
month as applicable; and 2) visits for the month. Facility shall prepare a report of daily visits and utilization
from the month summarizing activity and containing the required data elements and submit it electronically to
Healthways no later than the fifth (5th) day of the following month. The required file format, data elements and
submission options are defined in the Reference Guide. The Parties to this Agreement shall work cooperatively
to establish correct and acceptable electronic monthly utilization data reporting; Healthways may provide
technical support to Facility if necessary.
e) SilverSneakers Classes. Facility shall provide Healthways' group exercise class, the basic, signature
SilverSneakers class, a minimum of two (2) days per week on non - consecutive days. All SilverSneakers
classes shall be offered during Members' primary hours of utilization. Facility agrees to add additional
classes if the current classes remain at capacity for four (4) or more consecutive weeks, or as demand
dictates, and will solely bear the costs of adding such classes. Facility and Healthways agree to work
cooperatively to add optional SilverSneakers classes as needed.
f) SilverSneakers Class Equipment. Healthways shall ensure that Facility has all required equipment for the
classes available by the Program Ready Date, including chairs, elastic tubing with handles, hand -held
weights, the SilverSneakers ball and appropriate music, and shall provide such equipment to Facility as
necessary. Following the Program Ready Date, Facility shall be responsible for maintaining and
replenishing the equipment, and shall comply with the exact specifications for this equipment as defined in
the Reference Guide.
g)
Instructor and Facility Staff Training. Facility staff who have regular contact with Members are required to
participate in Healthways training prior to commencement of the Program and as needed thereafter to
account for staff turnover and to ensure proper service for Members. Healthways will hold an instructor
training workshop to provide Facility instructors with the necessary guidelines to teach the SilverSneakers
class according to Program specifications. Two (2) instructors from Facility will be able to attend the initial
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workshop at no charge; additional instructors who pre - register may attend the initial workshop for a
nominal fee.
h) Facility Staff Qualifications. All fitness professionals who come in contact with Members shall be qualified
for their respective positions. All group exercise instructors must 1) possess current CPR certification; 2) be
eighteen years of age or older; and 3) either hold a two (2) or four (4) year degree in health, exercise
science, recreation or physical activity related field; or hold a current license for the following: RN, LPN,
LMT, LPT, RYT; or hold a nationally recognized instructor /trainer certification that is available to the
general population and requires continuing education courses and CPR certification as criteria for
recertification. Each instructor teaching a SilverSneakers group format class must complete the Healthways
instructor training workshop for that class prior to teaching and once every four (4) years thereafter.
i) SilverSneakers Program Advisor. Facility shall designate one staff member as the SilverSneakers Program
Advisor, who shall serve as a liaison to Healthways and as a resource person for SilverSneakers Members
utilizing the Healthways Network, and is knowledgeable concerning all services provided by Facility to
Members.
J)
Guest Pass Program. Facility shall provide Program services to persons presenting a Healthways guest pass.
Properly documented guest visits will be counted the same as a Member visit for purposes of calculating
Facility's compensation.
2. Medicare Compliance for Program(s) Provided to Medicare Recipients. In recognition that Sponsoring
Organization and its subcontractors may be obligated to comply with all applicable federal governmental
regulations regarding services to Medicare members, including the rules and regulations of the Centers for
Medicare and Medicaid Services (CMS), Healthways and Facility mutually agree to comply with the following
for services provided to Medicare members.
a) Compliance with Federal and State Laws. Facility acknowledges that payments made to Facility under this
Agreement may be made from federal funds. Therefore, in connection with all services rendered under the
Agreement, Facility agrees to comply with the requirements of the contracts between Healthways'
customers and CMS (the "CMS Contracts "), and all applicable federal and state laws and regulations and
CMS guidance and instructions, including, but not limited to all Medicare laws, such as the Medicare
Modernization Act and the regulations contained in 42 CFR Parts 422 and 423; all applicable state and
federal privacy and security requirements, including but not limited to the confidentiality, privacy and
security provisions for Medicare health plans contained in the regulations found at 42 CFR 422.118 and 42
CFR 423.136; and all applicable laws, regulations and guidance designed to prevent fraud, waste or abuse
of federal funds, including the False Claims Act (31 U.S.C. 3729 et seq.), the Anti - kickback statute (Social
Security Act § 1128B(b)), and HIPAA administrative simplification rules (45 CFR Parts 160, 162, and
164).
b) Right to Inspect. Facility acknowledges and agrees that the Department of Health and Human Services
(HHS), the Comptroller General, or their designees, or any applicable state or federal governmental entity,
or Sponsoring Organization, shall have the right to inspect, evaluate, and audit any pertinent contracts,
books, documents, papers, and records involving transactions related to services provided under this
Agreement to Medicare Members. Facility shall maintain accurate records of compliance with this
Agreement ( "Records ") in accordance with recognized accounting and document retention practices and in
a format that shall permit audit. Such Records shall be maintained by Facility for a period of ten (10) years
following expiration or termination of this Agreement. This right to inspect shall extend for a period of ten
(10) years from the termination date of the CMS Contracts (or applicable CMS Contract), or the date of
completion of any audit in connection with the Medicare health plans, whichever is later. Facility will make
its books and other records available in accordance with 42 CFR 422.504(i)(2) and 42 CFR 423.505(i)(2)
and any other applicable laws and regulations. In the event Facility is unable to retain such records for ten
(10) years, Facility shall provide the records to Healthways at the conclusion of this Agreement and
Healthways will retain the records on behalf of Facility.
c) External Review. Facility agrees to cooperate with all independent quality review and improvement
organization activities required by CMS and /or Sponsoring Organization pertaining to the provision of
services to Sponsoring Organization Members.
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d) Privacy /Confidentiality. Facility agrees to safeguard the privacy of any information that identifies a
particular Sponsoring Organization Member in accordance with federal and state laws and Sponsoring
Organization policy and to maintain Sponsoring Organization Members' records in an accurate and timely
manner.
e) Non - Discrimination. Facility agrees to not discriminate against any person because of race, sex, age,
marital status, national origin, religion, color, citizenship, disability, health status, health insurance
coverage or veteran status. As applicable, Facility agrees to comply with 1) Title VI of the Civil Rights Act
of 1964 as implemented by regulations at 45 CFR Part 84; 2) The Age Discrimination Act of 1975 as
implemented by regulations at 45 CFR Part 91; 3) The Americans With Disabilities Act; 4) The
Rehabilitation Act of 1973; 5) Other laws applicable to recipients of federal funds; and 6) All other
applicable laws and rules. This Agreement incorporates by reference and is subject to the following
regulations of the Office of Federal Contract Compliance Programs, Department of Labor: 41 C.F.R. §60-
1.4, Equal Opportunity Clause; 41 C.F.R. §60- 250.5, Equal Opportunity Clause and Affirmative Action
Clause for Special Disabled Veterans and Veterans of the Vietnam Era; 41 C.F.R §60- 741.5, Equal
Opportunity Clause and Affirmative Action Clause for Handicapped and Disabled Persons. Facility agrees
not to discriminate against any Medicare Member on the basis of any factor that is related to health status,
including, but not limited to the following: (1) medical condition, including mental as well as physical
illness; (2) claims experience; (3) receipt of health care; (4) medical history; (5) genetic information; (6)
evidence of insurability, including conditions arising out of acts of domestic violence; and (7) disability.
f) Exclusion of Certain Persons. Facility certifies that neither it nor any of its principals (officers, directors,
owners, partners, key employees, principal investigators, researchers or management or supervisory
personnel) (Principals) is presently debarred, suspended, proposed for debarment, declared ineligible or
excluded from participation in any federal grant, benefit, contract or program (including, but not limited to,
Medicare and Medicaid) by any Federal department or agency. Facility agrees to provide immediate written
notice to Healthways if it learns at any time that the certification herein was erroneous when submitted or if,
during the Term of this Agreement, it, or any of its Principals, is debarred, suspended, proposed for
debarment, declared ineligible or excluded from participation in any federal grant, benefit, contract or
program. If subcontracting is permitted by the Agreement, Facility agrees that its subcontractors will comply
with the foregoing covenant. Facility agrees that debarment, suspension, proposed debarment or suspension,
ineligibility or exclusion of either party, or any of its principals or subcontractors, shall constitute cause for
immediate termination of this Agreement. Facility further agrees to comply with all Federal anti - terrorism
rules and regulations. Each party's signature below shall serve as certification that, to the best of the party's
knowledge, the party 1) is not; 2) has not been designated as; 3) is not owned, affiliated, or controlled by;
and 4) does not support, assist or aid a suspected terrorist organization or individual as defined by Federal
law including, but not limited to, Executive Order 13224.
g)
Hold Harmless. With the exception of charges for services not covered under this Agreement, Facility shall
in no event bill, charge, collect a deposit from, or hold liable for any debts of Healthways or Facility,
Members or any applicable government agency. In the event a Member provides payment to Facility for
services provided pursuant to this Agreement, Healthways retains the right to deduct an equivalent amount
from the compensation payable to Facility for the purpose of Member reimbursement. All obligations under
this section shall survive the termination of this Agreement, regardless of the cause giving rise to such
termination, including, without limitation, insolvency of either party or breach of this Agreement.
h) Mutual Waiver of Claims and Indemnity. Unless caused by the negligence or intentional wrongdoing of
either Party, Sponsoring Organization, or any applicable government agency, the Parties hereby waive and
release all claims against the other Party, Sponsoring Organization, and applicable government agency,
and /or any of their respective officers, directors, shareholders, employees, or representatives, in respect of a
Member participating in the Healthways Network, and Parties, Sponsoring Organization, and government
agency shall not be liable for injury to person or damage to property sustained by Sponsoring
Organization's Members as a result of participation in any activities which may be undertaken in or
sponsored by Facility, including, but not limited, to any accident, or from any occurrence, or act, or from
negligence or omission on the part of Facility or any employee or agent thereof. Parties shall indemnify,
defend, and hold harmless the other Party, Sponsoring Organization, Members, and applicable
government agency and their respective officers, directors, shareholders, employees, and representatives,
on a current basis, from any and all claims, demands, suits, liabilities, damages, obligations, and expenses
(including without limitation reasonable attorneys' fees) arising out of or in any way related to any
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negligent act or other wrongful conduct by either Party under this Agreement, except to the extent caused
by the negligence or intentional wrongdoing of either Party, Sponsoring Organization, or applicable
government agency.
Healthways and Facility agree that to the extent permitted by law, the Parties shall cooperate with one
another in the defense of any claim arising from alleged tortious acts of their respective officers,
shareholders, employees, or agents and to give one another written notice of any claims covered by this
paragraph. All obligations under this section shall survive the termination of this Agreement, regardless of
the cause giving rise to such termination, including, without limitation, insolvency of either party or breach
of this Agreement.
i) Professionally - Recognized Standards. Healthways and Facility shall provide the Program to Sponsoring
Organization Members in a manner consistent with quality assurance standards, the Reference Guide, and
professionally - recognized standards of fitness and wellness programs.
3. Compensation.
a) Program Utilization Payment. Healthways shall compensate Facility $3.00 per Program Visit, up to a
maximum of $30.00 per Program Participant per month. Program Visit shall mean one distinct occasion,
recorded and reported by Facility in accordance with procedures specified in the Reference Guide, during
which a Member enters Facility to enroll in or use the Program. Healthways shall not compensate Facility
for more than one Program Visit per day. Program Participant shall mean a Member, who, after completing
the Program enrollment, has used the Program at a facility in the Healthways Network at least once in a
given month.
b) Payment Schedule. Payment shall be processed for direct deposit by Healthways by the last day of the month
following the month in which Program Visits occurred ( "following month "), provided Healthways receives
Facility's monthly utilization data by the fifth (5th) day of the following month. In the event utilization data is
not received in a timely manner, payment may be delayed. Payment for monthly utilization received after the
last day of the following month will be denied for non - timely filing and will not be eligible for reimbursement
or appeal. Appeals must be brought to the attention of Healthways within thirty (30) days of receipt of
payment; appeals brought at a later date will not be eligible for review.
A6_City of Tukwila_WA_39886_V2013 -3 9 of 14
Program Name:
Program Brands:
Member Type:
Program Description:
PROGRAM SCHEDULE
Commercial Fully Subsidized Program
Prime ®, Prime MCA, and other brand names for the Commercial Fully Subsidized
Program communicated to Facility by Healthways from time to time
Commercial
The Program is offered to Members of the Sponsoring Organization. The Program
includes basic fitness membership services for Members provided through a network of
facilities; also included in the Program are all facets presented in the Duties and
Obligations of Facility section of the Agreement.
1. Program Duties and Obligations of Facility. In exchange for the compensation to be paid by Healthways,
Facility shall perform the following services:
a) Program Implementation Process. To prepare for Program commencement, Facility agrees to participate in
the following 1) coordination with Healthways of electronic reporting containing the required data
elements; and 2) Healthways- scheduled and led training.
b) Introductory Orientation for Prime Members. Facility shall offer the Program to all Members identified by
Healthways as eligible for the Program. In addition to a basic fitness membership at no cost to the Member,
Facility shall provide Members with an added value program component (i.e., a thirty (30) minute
personalized orientation session or personal training session).
c) Reporting Obligations of Facility. Facility shall report Program utilization to Healthways on a monthly
basis. Program utilization reporting shall consist of all a) Program forms, and b) Member visits for the
month. Facility shall prepare a report of daily visits and utilization from the month summarizing activity and
containing the required data elements and submit it electronically to Healthways no later than the fifth (5th) day
of the following month. The required file format and data elements are defined in the Reference Guide. The
Parties to this Agreement shall work cooperatively to establish correct and acceptable electronic monthly
utilization data reporting; Healthways may provide technical support to Facility if necessary.
d) Program Training for Facility Staff. Facility staff who have regular contact with Members are required to
participate in Healthways training prior to commencement of the Program and as needed thereafter to
account for staff turnover and to ensure proper service for'Members.
2. Medicaid Compliance for Program(s) Provided to Medicaid Recipients. In recognition that Sponsoring
Organization and its subcontractors may be obligated to comply with all applicable federal governmental
regulations regarding services to Medicaid members, including the rules and regulations of the Centers for
Medicare and Medicaid Services (CMS), Healthways and Facility mutually agree to comply with the following
for services provided to Medicaid members.
a) Compliance with Federal and State Laws. Healthways and Facility acknowledge that payments made to
Facility under this Agreement may be made from federal funds. Therefore, in connection with all services
rendered under the Agreement, Healthways and Facility agree to comply with the requirements of the
contracts between Healthways' customers and CMS (the "CMS Contracts "), and all applicable federal and
state laws and regulations and CMS guidance and instructions, including, but not limited to all Medicaid
laws, such as the Medicare Modernization Act and the regulations contained in 42 CFR Parts 422 and 423;
all applicable state and federal privacy and security requirements, including but not limited to the
confidentiality, privacy and security provisions for Medicare health plans contained in the regulations
found at 42 CFR 422.118 and 42 CFR 423.136; and all applicable laws, regulations and guidance designed
to prevent fraud, waste or abuse of federal funds, including the False Claims Act (31 U.S.C. 3729 et seq.),
the Anti - kickback statute (Social Security Act § 1128B(b)), and HIPAA administrative simplification rules
(45 CFR Parts 160, 162, and 164).
b) Right to Inspect. Healthways and Facility acknowledge and agree that the Department of Health and
Human Services (HHS), the Comptroller General, or their designees, or any applicable state or federal
A6_City of Tukwila_WA_39886_V2013 -3 10 of 14
governmental entity, or Sponsoring Organization, shall have the right to inspect, evaluate, and audit any
pertinent contracts, books, documents, papers, and records involving transactions related to services
provided under this Agreement to Medicaid Members. Healthways and Facility shall maintain accurate
records of compliance with this Agreement ( "Records ") in accordance with recognized accounting and
document retention practices and in a format that shall permit audit. Such Records shall be maintained by
Healthways and Facility for a period of ten (10) years following expiration or termination of this
Agreement. This right to inspect shall extend for a period of ten (10) years from the termination date of the
CMS Contracts (or applicable CMS Contract), or the date of completion of any audit in connection with the
Medicaid health plans, whichever is later. Healthways and Facility will make its books and other records
available in accordance with 42 CFR 422.504(i)(2) and 42 CFR 423.505(i)(2) and any other applicable
laws and regulations. In the event Facility is unable to retain such records for ten (10) years, Facility shall
provide the records to Healthways at the conclusion of this Agreement and Healthways shall retain the
records on behalf of Facility.
c) External Review. Healthways and Facility agree to cooperate with all independent quality review and
improvement organization activities required by CMS and /or Sponsoring Organization pertaining to the
provision of services to Sponsoring Organization Members.
d) Privacy /Confidentiality. Healthways and Facility agree to safeguard the privacy of any information that
identifies a particular Sponsoring Organization Member in accordance with federal and state laws and
Sponsoring Organization policy and to maintain Sponsoring Organization Members' records in an accurate
and timely manner.
e) Non - Discrimination. Healthways and Facility agree to not discriminate against any person because of race,
sex, age, marital status, national origin, religion, color, citizenship, disability, health status, health insurance
coverage or veteran status. As applicable, Healthways and Facility agree to comply with 1) Title VI of the
Civil Rights Act of 1964 as implemented by regulations at 45 CFR Part 84; 2) The Age Discrimination Act
of 1975 as implemented by regulations at 45 CFR Part 91; 3) The Americans With Disabilities Act; 4) The
Rehabilitation Act of 1973; 5) Other laws applicable to recipients of federal funds; and 6) All other
applicable laws and rules. This Agreement incorporates by reference and is subject to the following
regulations of the Office of Federal Contract Compliance Programs, Department of Labor: 41 C.F.R. §60-
1.4, Equal Opportunity Clause; 41 C.F.R. §60- 250.5, Equal Opportunity Clause and Affirmative Action
Clause for Special Disabled Veterans and Veterans of the Vietnam Era; 41 C.F.R §60- 741.5, Equal
Opportunity Clause and Affirmative Action Clause for Handicapped and Disabled Persons. Healthways and
Facility agree not to discriminate against any Medicaid Member on the basis of any factor that is related to
health status, including, but not limited to the following: (1) medical condition, including mental as well as
physical illness; (2) claims experience; (3) receipt of health care; (4) medical history; (5) genetic
information; (6) evidence of insurability, including conditions arising out of acts of domestic violence; and
(7) disability.
f) Exclusion of Certain Persons. Healthways and Facility each certify that neither it nor any of its principals
(officers, directors, owners, partners, key employees, principal investigators, researchers or management or
supervisory personnel) (Principals) is presently debarred, suspended, proposed for debarment, declared
ineligible or excluded from participation in any federal grant, benefit, contract or program (including, but
not limited to, Medicare and Medicaid) by any Federal department or agency. Facility agrees to provide
immediate written notice to Healthways if it learns at any time that the certification herein was erroneous
when submitted or if, during the Term of this Agreement, it, or any of its Principals, is debarred, suspended,
proposed for debarment, declared ineligible or excluded from participation in any federal grant, benefit,
contract or program. If subcontracting is permitted by this Agreement, Healthways and Facility agree that its
subcontractors will comply with the foregoing covenant. Healthways and Facility agree that debarment,
suspension, proposed debarment or suspension, ineligibility or exclusion of either party, or any of its
Principals or subcontractors, shall constitute cause for immediate termination of this Agreement. Healthways
and Facility further agree to comply with all Federal anti - terrorism rules and regulations. Each party's
signature below shall serve as certification that, to the best of the party's knowledge, the party 1) is not; 2)
has not been designated as; 3) is not owned, affiliated, or controlled by; and 4) does not support, assist or aid
a suspected terrorist organization or individual as defined by Federal law including, but not limited to,
Executive Order 13224.
A6_City of Tukwila_WA_39886_V2013 -3 11 of 14
g)
Hold Harmless. With the exception of charges for services not covered under this Agreement, Healthways
and Facility shall in no event bill, charge, collect a deposit from, or hold liable for any debts of Healthways
or Facility, Members or any applicable government agency. In the event a Member provides payment to
Facility for services provided pursuant to this Agreement, Healthways retains the right to deduct an
equivalent amount from the compensation payable to Facility for the purpose of Member reimbursement.
All obligations under this section shall survive the termination of this Agreement, regardless of the cause
giving rise to such termination, including, without limitation, insolvency of either party or breach of this
Agreement.
h) Mutual Waiver of Claims and Indemnity. Unless caused by the negligence or intentional wrongdoing of
either Party, Sponsoring Organization, or any applicable government agency, the Parties hereby waive
and release all claims against the other Party, Sponsoring Organization, and applicable government agency,
and /or any of their respective officers, directors, shareholders, employees, or representatives, in respect of a
Member participating in the Healthways Network, and Parties, Sponsoring Organization, and government
agency shall not be liable for injury to person or damage to property sustained by Sponsoring
Organization's Members as a result of participation in any activities which may be undertaken in or
sponsored by Facility, including, but not limited, to any accident, or from any occurrence, or act, or from
negligence or omission on the part of Facility or any employee or agent thereof. Parties shall indemnify,
defend, and hold harmless the other Party, Sponsoring Organization, Members, and applicable
government agency and their respective officers, directors, shareholders, employees, and representatives,
on a current basis, from any and all claims, demands, suits, liabilities, damages, obligations, and expenses
(including without limitation reasonable attorneys' fees) arising out of or in any way related to any
negligent act or other wrongful conduct by either Party under this Agreement, except to the extent caused
by the negligence or intentional wrongdoing of either Party, Sponsoring Organization, or applicable
government agency.
Healthways and Facility agree that to the extent permitted by law, the Parties shall cooperate with one
another in the defense of any claim arising from alleged tortious acts of their respective officers,
shareholders, employees, or agents and to give one another written notice of any claims covered by this
paragraph. All obligations under this section shall survive the termination of this Agreement, regardless of
the cause giving rise to such termination, including, without limitation, insolvency of either party or breach
of this Agreement.
i) Professionally- Recognized Standards. Healthways and Facility shall provide the Program to Sponsoring
Organization Members in a manner consistent with quality assurance standards, the Reference Guide, and
professionally - recognized standards of fitness and wellness programs.
3. Compensation.
a) Program Utilization Payment. Healthways shall compensate Facility $3.50 per Program Visit, up to a
maximum of $30.00 per Program Participant per month. Program Visit shall mean one distinct occasion,
recorded and reported by Facility in accordance with procedures specified in the Reference Guide, during
which a Member enters Facility to enroll in or use the Program. Healthways shall not compensate Facility
for more than one Program Visit per day. Program Participant shall mean a Member, who, after completing
the Program enrollment, has used the Program at a facility in the Healthways Network at least once in a
given month.
b) Payment Schedule. Payment shall be processed for direct deposit by Healthways by the last day of the month
following the month in which Program Visits occurred ( "following month "), provided Healthways receives
Facility's monthly utilization data in a timely manner. In the event utilization data is not received in a timely
manner, payment may be delayed. Payment for monthly utilization received after the last day of the following
month will be denied for non - timely filing and will not be eligible for reimbursement or appeal. Appeals must
be brought to the attention of Healthways within thirty (30) days of receipt of payment; appeals brought at
a later date will not be eligible for review.
A6_City of Tukwila_WA_39886_V2013 -3 12 of 14
PROGRAM SCHEDULE
Program Name: Commercial Member Pay Program
Program Brands: Prime PB and other brand names for the Commercial Member Pay Program -
communicated to Facility by Healthways from time to time
Member Type: Commercial
Program Description: The Program is offered to Members of the Sponsoring Organization. The Program
includes basic fitness membership services for Members provided through a network of
facilities; also included in the Program are all facets presented in the Duties and
Obligations of Facility section of the Agreement. For purposes of this Program, Member
Pay is defined as a monthly payment made by Member to Healthways to participate in
the Program.
1. Program Duties and Obligations of Facility. In exchange for the compensation to be paid by Healthways,
Facility shall perform the following services:
a) Program Implementation Process. To prepare for Program commencement, Facility agrees to participate in
the following 1) coordination with Healthways of electronic reporting containing the required data
elements; and 2) Healthways - scheduled and led training.
b) Introductory Orientation for Prime Members. Facility shall offer the Program to all Members identified by
Healthways as eligible for the Program. In addition to a basic fitness membership at no cost to the Member,
Facility shall provide Members with an added value program component (i.e., a thirty (30) minute
personalized orientation session or personal training session).
c) Reporting Obligations of Facility. Facility shall report Program utilization to Healthways on a monthly
basis. Program utilization reporting shall consist of all a) Program forms, and b) Member visits for the
month. Facility shall prepare a report of daily visits and utilization from the month summarizing activity and
containing the required data elements and submit it electronically to Healthways no later than the fifth (5th) day
of the following month. The required file format and data elements are defined in the Reference Guide. The
Parties to this Agreement shall work cooperatively to establish correct and acceptable electronic monthly
utilization data reporting; Healthways may provide technical support to Facility if necessary.
d) Program Training for Facility Staff. Facility staff who have regular contact with Members are required to
participate in Healthways training prior to commencement of the Program and as needed thereafter to
account for staff turnover and to ensure proper service for Members.
2. Compensation.
a) Program Utilization Payment. Healthways shall compensate Facility $3.50 per Program Visit, up to a
maximum of $30.00 per Program Participant per month. Program Visit shall mean one distinct occasion,
recorded and reported by Facility in accordance with procedures specified in the Reference Guide, during
which a Member enters Facility to enroll in or use the Program. Healthways shall not compensate Facility
for more than one Program Visit per day. Program Participant shall mean a Member, who, after completing
the Program enrollment, has used the Program at a facility in the Healthways Network at least once in a
given month.
b) Payment Schedule. Payment shall be processed for direct deposit by Healthways by the last day of the month
following the month in which Program Visits occurred ( "following month "), provided Healthways receives
Facility's monthly utilization data in a timely manner. In the event utilization data is not received in a timely
manner, payment may be delayed. Payment for monthly utilization received after the last day of the following
month will be denied for non - timely filing and will not be eligible for reimbursement or appeal. Appeals must
be brought to the attention of Healthways within thirty (30) days of receipt of payment; appeals brought at
a later date will not be eligible for review.
A6_City of Tukwila_WA_39886_V2013 -3 13 of 14
ADDENDUM
Facility hereby agrees to provi. : the Affinity product to commercial members under the terms . d conditions set forth in this
Agreement, and as described belo
Product Description:
Affinity Discount:
The Affinit product is a discount cash payment arrang• ent whereby Facility agrees to provide
to individual eligible for Affinity access to Facilit services at a specific discount percent off
Facility's publis ' ed fee schedule.
Facility agrees to e end to individuals e1' .ib1e for the Healthways Affinity product discounted
services as follows. T following disc. ∎ nts represent a minimum of 10% off at least one of the
rates:
Standard Initiation Rate: % Discount
Monthly Membership
% Discount
des 1A(64- 440'
if?, 14
A6_City of Tukwila_WA_39886_V2013 -3 14 of 14
EXHIBIT A -1
FACILITY INFORMATION
The information in the box below is intended for distribution to Members. Please confirm that it is accurate.
Facility Name:
Physical Address:
Phone Number:
Web Site Address:
Tukwila Community /Senior Citizen Center
12424 42nd Ave., S.
Tukwila, WA 98168
(206) 768 -2822
http://www.tukwilawa.gov/recreation/reetcc.html
Please check the following amenities offered by Facility:
Amenity /Program
Offered as part of basic
membership at no additional
cost to Members
Not offered as part of basic
membership - additional
cost to Members
Cardiovascular Equipment
Group Exercise /Aerobics Area
Hot Tub/Whirlpool
Resistance Training Equipment
Steam and /or Sauna
Swimming Pool — Seasonal (not available .
throughout the year)
Swimming Pool — Year -Round
Acupuncture
Child Care
Chiropractic Services
Group Cycling
Indoor Track
Massage
Nutritional Services
Personal Training
Physical Therapy
Pilates
x
Fax:
General Email:
( 9_04, )
payKSC tL)t<bfl lOLu)Q. g0V
Who will be our primary location contact (Healthways Program Advisor)? This individual will be responsible for
KDirect Fax O Need to call first
scheduling training, coordinating with our Fitness Account Manager, and will need access to member records.
Contact Person: .Sre v- e. -Fzci- 2_
Contact Title: IZ Lu .R.(M 1 t 64.0..4S4-
Contact Phone: (2OLe ) 717 - 1 I
Contact Fax: (a0 ) "71D "1 05 PA--., `
Contact Email: 51reve- • ��-I 2..� t V t< LLn C& 1))OL.
A6_City of Tukwila_WA_39886_V2013 -3
3ov
EXHIBIT A -2
Name:
Title:
Mailing Address:
Phone:
Fax:
Email:
CONTRACT ADMINISTRATOR
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The Contract Administrator shall receive legal correspondence regarding the Agreement, shall have access to
payment information for all Facilities in Exhibit A -1 to this Agreement, and shall be responsible for setting up
Healthways Fitness Provider Portal accounts for Facility staff.
Who should Healthways contact to coordinate the technical aspects of monthly utilization data reporting? This
individual will need to have specific information about your location's reporting capabilities, and be responsible
for obtaining management approval for establishing a reporting method.
Name:
Phone:
Email:
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A6_City of Tukwila_WA_39886_V2013 -3
Mailing Address (if not the same as Physical Address):
Mailing Address:
Shipping Address (if not the same as Physical Address):
Shipping Address:
Staffed Hours of Operation
Are Members able to access Facility during unstaffed hours? 111 No O Yes
What non - English languages does staff speak fluently? Please list:
Please select one category that best describes Facility:
O Commercial
JCC
O Medical/hospital
Municipal
O YMCA
O YWCA
O Other not - for - profit
Please select one location type:
Men and women
O Women only
O Men only
A6_City of Tukwila_WA_39886_V2013 -3
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Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
45a -8',
Saturday
Open
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Low -1r
Lot — 9ja
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Closed
Are Members able to access Facility during unstaffed hours? 111 No O Yes
What non - English languages does staff speak fluently? Please list:
Please select one category that best describes Facility:
O Commercial
JCC
O Medical/hospital
Municipal
O YMCA
O YWCA
O Other not - for - profit
Please select one location type:
Men and women
O Women only
O Men only
A6_City of Tukwila_WA_39886_V2013 -3
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