DESIGNATION OF AFFILIATED COVERED ENTITY

ADMINISTRATIVE POLICY STATEMENT

1.     Pursuant to 45 C.F.R. § 164.105(b), certain covered entities which are under common ownership and control designate themselves as an Affiliated Covered Entity (“Signature ACE”) solely for purposes of compliance with the HIPAA Privacy and Security Rules.

2.     This designation was approved by Signature Healthcare at Home Governing Body.

3.     Each of the Signature ACE covered entities is an independent company and having accepted designation as a Signature ACE does nothing to dimmish that independent entity status.   This affiliation does not apply to any other legal aspect of business operations or patient care.   Solely for purposes of compliance with the HIPAA Privacy and Security Rules, these components or entities will be treated as one common entity.

4.     Signature ACE entities shall develop and incorporate appropriate additional procedures (within the confines of the policies and guidelines) that correspond to the particular needs and functions of the entity to assure compliance with the HIPAA Privacy and Security Rules.

5.     A single Signature ACE Chief Privacy Officer will be designated and will be responsible for overseeing general compliance with the Signature ACE privacy and security programs.   Individual entities are responsible for day-to-day implementation and compliance with all applicable HIPAA Privacy and Security Rules, including but not limited to, the completion of education and training, adherence to policies and procedures, reporting incidents and concerns to the Chief Privacy Officer and investigation of privacy related incidents.

6.     See Appendix A for a list of Signature Affiliated Covered Entities.

APPENDIX A

LIST OF SIGNATURE AFFILIATED COVERED ENTITIES

Home Health Entities:

Avamere Home Health Care, LLC

Portland, Salem, Eugene, Albany and Medford, Oregon

Bellingham, Washington

Nampa and Payette, Idaho

Signature Coastal, LLC

Lincoln City, Oregon

A-One Home Health Services, LLC

Everett and Burlington, Washington

Prime Home Health, LLC

Federal Way, Washington

Signature Home Health Bend, LLC

Bend, Oregon

Hospice Entities:

Northwest Hospice, LLC

Portland, Oregon

Signature Hospice Medford, LLC

Medford, Oregon

Signature Hospice Eugene, LLC

Eugene, Oregon

Signature Hospice Nampa, LLC

Nampa and Payette, Idaho

Signature Hospice Bend, LLC

Bend, Oregon

Signature Hospice Oregon Coast, LLC

Lincoln City, Oregon

Other:

NP2U, LLC