Pcidonation Agreement

PCIDONATION AGREEMENT

This PCIDonation Agreement (the “Agreement”) is entered into this ____ day of ______, 20___, by and between Samaritan Ministries (“SMI”) and Physician Consulting Inc., (“PCI),”SMI and PCI referred to collectively as the “Parties”.

DEFINITIONS:

Eligible Prescription: A SLIT prescription written for sublingual immunotherapy (SLIT) treatment from the PCI designated SLIT supplier.

Member Physician: A medical provider who signs a PCI Clinician Agreement as a result of contact by a SMI member with the provider or the provider’s clinic.A Member Physician may be a Medical Doctor (M.D.), Doctor of Osteopathy (D.O.), Nurse Practitioner (N.P.), or Physician Assistant (P.A.) or other medical provider authorized to write prescriptions in the state where they conduct their practice. Physicians who have been previously contacted by a PCI consultant may not become a Member Physician.

WHEREAS, SMI desires to increase its funding in order to expand its charitable activities; and;

WHEREAS, SMI desires to provide its members with educational information about beneficial medical treatments; and

WHEREAS, PCIdesires to donate an amountof the commission it receives for SLIT prescriptions written for allergy treatment to SMI as set forth herein; and

WHEREAS, the Parties desire to work together in order to maximize the amount of the donation distributed to SMI andPCIcovenants and agrees to provide the mechanism by which these donation funds are realized and donated and to provide an accounting to SMI of the amount and distribution of these funds;

NOW THEREFORE, in consideration of the mutual covenants contained herein, and for other good and valuable consideration, the receipt of which is hereby acknowledged, the Parties, intending to be bound, hereby agree as follows:

1.PCI will donate $1.00 (One dollar) from each Eligible Prescription written by the Member Physicianto SMI.

2.SMI will continue to receive the donations from each Eligible Prescription as long as the Member Physician writes Eligible Prescriptions.

3.PCI will provide the donation funds to SMI within 30 days of receiving these funds from the PCI designated SLIT supplier.

4.PCI will provide SMI with a monthly accounting of the donation funds.

5.PCI will notify SMI if any contacted physician is ineligible due to previous contact by aPCI consultant.

SAMARITAN MINISTRIES INTERNATIONAL

By:

Name:

Title:

PHYSICIAN CONSULTING INC.

By:

Name:

Title:

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