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A TRUE COPY CERTIFICATION ON LAST PAGE J.R. SMITH, CLERK ii) Is the tax uniform across all entities being taxed? Based on 42 CFR § 433.68, a health care - related tax will be considered to be imposed uniformly even if it excludes Medicaid or Medicare payments (in whole or in part), or both; or in the case of health care -related tax based on revenue or receipts with respect to a class of items or services, if it excludes either Medicaid or Medicare revenue with respect to a class of items or services, or both. The exclusion of Medicaid revenue must be applied uniformly to all providers being taxed. Yes If no, please explain iii) Is the tax generally redistributive and a waiver of the broad-based or uniform tax requirement was granted in accordance with 42 CFR §433.68(e)? No If no please explain No waiver was requested iv) Does the tax program comply with the hold harmless provisions included in 42 CFR § 433.68(f)? Yes If no, please explain v) Does every tax paying entity receive a supplemental payment equal to or exceeding its tax cost? If yes, please explain The County is not involved in the distribution of funds following federal match. The County is not in a position to speak to the ultimate distribution to hospitals from the managed care organizations. 6. Please answer the following regarding provider funds received from the healthcare entity and/or other health care entities. a. Are provider voluntary payments or in-kind services received by the organization as defined in 42 CFR § 433.52? No How much of the organization's revenue is received from provider -related donations (Provide the total revenue and the provider -related donation amounts)? Amount Total Revenue $ - Provider Related Donations $ - c. Do individual provider donations exceed $5,000 per year or $50,000 per year for a health care organizational entity? No