HEALTH MANAGEMENT ASSOCIATES, INC.

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Tell us at once if you begin work in any state listed in Item 3,C, of the Information Page, PART FOUR YOUR DUTIES IF INJURY OCCURS Tell us at once if Injury occurs that may be cov- ered by this policy. Your other duties are listed here, 1. Provide for immediate medical and other ser- vices required by the workers compensation law, 2. Give us or our agent the names and ad- dresses of the injured persons and of wit- nesses, and other informatton we may need, 3. Promptly give us all notices, demands and legal papers related to the injury, claim, pro- ceeding or suit, 4. Cooperate with us and assist us, as we may request, in the investigation, settlement or defense of any claim, proceeding or Suit, 5. Do nothing after an injury occurs that would interfere with our right to recover from others, 6. Do not voluntarily make payments, assume obligations or Incur expenses, except at your own cost, A. Our Manuals All premium for this policy will be determined by our manuals of rules, rates, rating plans and clas- sifications. We may change Out' manuals and ap- ply the changes to this policy if authorized by law or a governmental agency regulating this insur- ance, B. Classifications Item 4 of the Information Page shows the rate and premiurn basis for certain business or work classifications. These classifications were as- signed based on an estimate of the exposures you would have during the policy period. If your actual exposures are not properly described by those classifications, we will assign proper classi- fications, rates and premium basis by endorse- ment to this policy, C. Remuneration Premium for each work classlfication is deter- mined by multiplying a rate times a premiurn ba- sis. Remuneration is the most common premium basis. This premium basis includes payroll and all other remuneration paid or payable during the policy period for the services of: 1. all your officers and employees engaged in work covered by this policy; and 2. all other persons engaged in work that could make us liable under Part One (Workers Compensation Insurance) of this policy, if you do not have payroll records for these persons, the contract price for their services and inaterials, may be used as the premium basis. This paragraph 2 will not apply if you give us proof that the employers of these persons lawfully secured their workers com- pensation obligations. D. Premium Payments You will pay A premium when due. You Witt pay the premium even if part or all of a workers com- pensation law is not valid, E. Final Premium The premium shown on the Information Page, schedules, and endorsements is an estimate. The final premium will be determined after this policy ends by using the actual, not the estimated, pre- mium basis and the proper classifications and rates that lawfully apply to the business and work covered by this policy. If the final premium is more than the premium you paid to us, you must pay us the balance, If it is less, we will refund the balance to YOLL The final premium will not be less than the highest minimum premium for the classi- fications covered by this policy. If this policy is canceled, final premium will be determined in the following way unless our manuals provide otherwise: 1. If we cancel, final premium will be calculated pro rata based on the time this policy was in force, Final premium will not be less than the pro rata share of the minimum premium. 2. If you cancel, final premium will he more than pro rata; it will be based on the time this pol- icy was in force, and increased by our short - rate cancelation table and procedure. Final prernium will not be less than the minimum premium. @ Copyright 2013 National Council on Compensation Insurance, Inc. AP Rights Reserved, Divishm REVIEWED & APPROVEDBY. 0 IF MM RIsk Monagemerl 5Pecialht