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