INDEPENDENT CONTRACTOR AGREEMENT BETWEEN _______________________________ AND __________________________________ This agreement made and entered in this _____ day of _______________, 19___, by and between the parties, __________________________ (hereinafter “Contractor”) and ____________________ RECITALS Whereas, ______ wishes to allow the services of contractor as an independent contractor to perform chiropractic services at _________________________________________________________, and Whereas, the parties wish to reduce the terms of the Independent Contractor Agreement to writing. Now, Therefore, the parties agree as follows: 1. RELATIONSHIP OF THE PARTIES. CONTRACTOR shall become an independent contractor of ________ to perform chiropractic services at _______________________________________, within the __________ facility. 2. PURPOSE OF AGREEMENT. CONTRACTOR shall be entitled to continue to establish and maintain his own professional practice and treat his own patients within the facilities of ________. For all such CONTRACTOR patients, CONTRACTOR may establish and charge at his own professional rates. CONTRACTOR shall, from time to time as referred or requested by ______, diagnose and treat ________ patients who are assigned to CONTRACTOR. For any such professional services and other related services performed by CONTRACTOR at ______’s request, CONTRACTOR shall be entitled to bill for such professional services to patient at his own professional rates. These billings and collections therefore shall be collected in the same fashion as CONTRACTOR’S other patients and billings referenced herein. 3. It is agreed that, in the performance of services under this agreement, CONTRACTOR shall at all times act as an independent contractor with respect to ______ and not as an employee or agent of _____. Nothing contained in this Agreement shall be construed to create a joint venture, partnership, association or other affiliation between the parties, it being specifically agreed that the relationship is and shall remain that of independent parties to a contractual relationship as set forth in this Agreement. 4. ______ shall neither have nor exercise any specific control or direction over the particular methods by which CONTRACTOR shall perform the professional services required by this agreement, except as otherwise set forth in Paragraph 5 and 6 concerning professional standards. CONTRACTOR shall not have any claim under this Agreement or otherwise against ______ for retirement benefits, Social Security, worker’s compensation, professional malpractice or unemployment insurance benefits of any kind. CONTRACTOR shall not be treated as an employee of ______ for Federal, State or local tax purposes. ______ shall not withhold, on CONTRACTOR’S behalf, any sums for income tax, unemployment insurance, Social Security or any other withholding pursuant to any law or requirement of any governmental body. All of the payments, withholding and benefits, if any, are CONTRACTOR’S sole responsibility. CONTRACTOR shall indemnify and hold ______ harmless from any and all loss or liability, including reasonable attorney fees, penalties and interest, arising from his failure to make these payments, withholdings or benefits, if any. If the Internal Revenue Service or any other governmental agency should question or challenge CONTRACTOR’S independent contractor status, ______ shall, at its own expense, have the right to participate in any discussion or negotiation occurring within any agency or agencies regardless of with whom these discussions or negotiations are initiated. 5. CONTRACTOR shall, during the terms of this Agreement with respect to his professional services (whether such services are being performed with his own patients or _____ patients), perform such diagnosis and treatment of said patients assigned to him and/or performed by him to the best of his ability and in accordance with the standards, rules and regulations of the Michigan Board of Chiropractic Examiners. January 24, 2008 G://Frequently Used Articles/Independent Contractor Packet/Sample Independent Contractor Agreement 6. TERM OF THIS AGREEMENT. This Agreement shall become effective as of ______________, 20___, and shall continue until terminated by either party upon sixty (60) days’ written notice with or without cause or reason. Despite the indefinite duration of this Agreement, the terms of compensation and reimbursement, as set forth hereafter, shall not be modified during the first six (6) months of this Agreement. Following the completing of the first six (6) months of this Agreement, the parties may review the relationship and negotiate any changes. Notwithstanding the foregoing, ______ and CONTRACTOR shall have the absolute right to terminate this Agreement immediately and without prior written notice in the event: (a) ______ or CONTRACTOR loses proper licensing in the practice of chiropractic within the State of Michigan, (b) ______ or CONTRACTOR is convicted of a felony or other crime involving moral turpitude, (c) ______ or CONTRACTOR fails to conform their professional performance to the standard of quality, ethical standards and minimum requirements of good practice as defined by the Michigan Board of Chiropractic Examiners or intentionally commits any act that substantially interferes with and/or impairs their proper performance of their responsibilities hereunder or impairs the reputation standing or otherwise adversely affects ______ or CONTRACTOR with their patients or the community at large. (d) There is evidence of fraud, dishonesty or other misconduct by _____ or CONTRACTOR in the performance of their professional duties and responsibilities or with regard to any conduct adversely affecting ______ or CONTRACTOR’S professional practice or business premises, (e) CONTRACTOR fails or refuses to faithfully or diligently fulfill the provisions of the Agreement or fails or refuses to comply with the office policies, standards or regulations that are established or implemented from time to time, (f) of CONTRACTOR’S death, (g) of discontinuance of the business of CONTRACTOR, (h) CONTRACTOR becomes ill or disabled in the sole determination of ______ to the extent that CONTRACTOR cannot perform obligations as set forth in this Agreement for a continual thirty (30) days or more, (i) ______ or CONTRACTOR becomes ineligible for or otherwise ceases to maintain insurance coverage against claims for professional malpractice as set forth herein, (j) CONTRACTOR, in _____’s sole determination, willfully or recklessly disregards the well-being, safety or professional care of patients. 7. COMPENSATION/REIMBURSEMENT. A. PROCEDURES/RESPONSIBILITIES. The parties agree that ______ shall, directly or through an agent of ______’s choosing, bill and collect, in CONTRACTOR’S name (including CONTRACTOR’S Federal identification number), all fees for professional services rendered by CONTRACTOR. To the extent that CONTRACTOR has any specific billing instructions that do not conflict with ______’s billing practices or procedures and that do not cause ______ to incur any additional expenses, ______’s office shall attempt to follow CONTRACTOR’S special requests. Nothing in this Paragraph, however, shall provide ______ with the right to determine CONTRACTOR’S fee schedule, which shall remain CONTRACTOR’S sole right. Such right to bill and collect CONTRACTOR’S fees is deemed right of ______ in order to monitor and protect the amount of consideration ______ shall receive under this Agreement, however, his service is not deemed substantial consideration for CONTRACTOR to enter into this Agreement, rather, same is an incidental service being performed for ______’s benefit. As such, ______’s responsibility shall be limited to receiving route slips provided by CONTRACTOR and inputting such information into ______’s computer or tracking and billings, as necessary, on behalf of CONTRACTOR. Upon receipt of any payments due CONTRACTOR, ______ shall record receipt of same and promptly prepare a deposit slip if requested by CONTRACTOR and turn all such payments over to CONTRACTOR. CONTRACTOR further agrees to cooperate with any and all procedures reasonable or necessary to enable ______ or its agents to carry out the billing and collection of CONTRACTOR fees. January 24, 2008 G://Frequently Used Articles/Independent Contractor Packet/Sample Independent Contractor Agreement CONTRACTOR shall have reasonable access during established business hours to CONTRACTOR’S billing, files and other records related to the services billed by ______ for CONTRACTOR. CONTRACTOR shall not, however, have any right or entitlement to change, modify or alter billing records without ______’s express consent, which consent shall not be unreasonably withheld. ______ shall not have any liability or responsibility concerning collection of any unpaid CONTRACTOR accounts, except to rebill same on a monthly basis consistent with ______’s own billing procedures. ______ shall not have any liability or responsibilities for initiating collection activities through any third party collection agency nor shall ______ have any liability or responsibility to take legal action concerning collection of CONTRACTOR accounts. CONTRACTOR, with respect to all billing and collection activities and procedures, shall release and hold ______ and its agents, employees and persons acting on its/their behalf, harmless from any and all liabilities arising out of errors or mistakes in the billings and collection process, except for intentional acts of fraud. In the event mistakes or errors are made, ______ shall attempt to correct same provided such errors or mistakes are attributable to ______. B. Amount and Method of Payment. CONTRACTOR shall pay to ______, as consideration for the benefit and use of ______’s facilities and staff, the following: (1) CONTRACTOR shall pay the sum of 60% of the first $3,000 in monthly collections on or before ______________, 20__, 50% of the following from $3,001 to $7,999, and 40% of the total monthly collections over $8,000 thereafter. The monthly payments to ______ shall be made on the first (1st) business day of each month. Failure by CONTRACTOR to remit timely payment to ______ shall be deemed a default and breach of this Agreement. In the event said default or breach continues for more than five (5) calendar days, ______ shall be entitled to interest on the entire unpaid balance at the rate of ten (10%) percent per annum, plus any additional costs and expenses including attorney fees, incurred by ______, for collection of the unpaid amount. 8. OFFICE FACILITIES, ASSISTANTS AND SUPPLIES. CONTRACTOR shall be entitled to the reasonable use of the office adjusting rooms and shall be provided with the reasonable use of designated office space. ______ shall, at its expense, provide all necessary utilities, telephone for business purposes, gas, electric, heating/air conditioning, office receptionist, x-ray equipment and x-ray supplies. ______ shall, at its expense, provide reasonable office staffing, including billing staff, back office staff and assistants, making same available to CONTRACTOR to the extent reasonable necessary to operate the practice and in conformity with the staffing provided to the other chiropractors at the location. This provision, however, shall not be a guarantee or in any manner entitle CONTRACTOR to offsets or damages in the event any particular office staff member is unavailable on any particular occasion or occasions. 9. NUTRITION AND ORTHOPEDIC SUPPLIES. CONTRACTOR shall be solely responsible for obtaining any and all necessary nutrition and orthopedic supplies for his patients, not normally stocked by ______. Income derived from the sale of these supplies will not be considered part of total monthly collections and shall have no relationship to, or be considered part of, the compensation and/or reimbursement provisions herein. 10. PROFESSIONAL INSURANCE. CONTRACTOR shall be responsible for obtaining and maintaining his own professional malpractice insurance policy with minimum limits of One Hundred Thousand ($100,000.00) Dollars per person and Three Hundred Thousand ($300,000.00) Dollars per occurrence at his sole expense. Further, CONTRACTOR shall provide written proof of said insurance and provide a copy of the applicable declaration sheets on or before execution of this Agreement and shall at any time requested provide further copies of continuing coverage. CONTRACTOR shall provide and maintain on the premises at all times a current copy of all licenses and/or other certification necessary to practice chiropractic in the State of Michigan. January 24, 2008 G://Frequently Used Articles/Independent Contractor Packet/Sample Independent Contractor Agreement 11. RECORDS. CONTRACTOR agrees that all of CONTRACTOR’S patient records, whether administrative, financial or chiropractic, including patients’ records, shall remain in the possession of ______ during the term of this Agreement. Neither ______ nor CONTRACTOR shall remove or release these records to any third party or permit any records to be removed or released without either the written consent of the patient in regard to patient’s personal medical and chiropractic records or the written consent of both CONTRACTOR and ______ in regard to administrative or financial records. In the event this Agreement is terminated for any reason whatsoever, CONTRACTOR shall be entitled to the original medical chiropractic records of all of his patients. However, the original administrative and financial records shall remain in the possession of ______. With respect to the medical chiropractic records, ______ shall be entitled to copy all such original records prior to CONTRACTOR’S removal of same from the business premises, which copying task shall be requires to occur on or before the conclusion of the next business day following termination of this Agreement. Such copying by ______ shall be at its sole expense. Likewise, CONTRACTOR shall be entitled to copies of all of his administrative and financial records relating to his patients. Upon written request for same, ______ shall provide copies of same to CONTRACTOR on or before the conclusion of the next business day following termination of Agreement. The costs of such photocopying shall be incurred solely by CONTRACTOR. 12. SIGNAGE. CONTRACTOR shall be entitled to post and/or utilize signage at _____________________ as approved in writing by ______. ______ makes no representations, assurances or promises that CONTRACTOR shall be entitled to any signage whatsoever, except limited signage on the window of the building adjacent to the front entrance. 13. ADVERTISING In the event that CONTRACTOR chooses to advertise by printed media, television, radio, benches, posters, billboards, or any other means whatsoever, any such advertisement, if utilizing ______’s telephone number or address, shall be subject to prior written approval of ______, which will not be unreasonably withheld. 14. ADDRESS AND TELEPHONE NUMBER. CONTRACTOR acknowledges and agrees that all telephone numbers, name rights, except CONTRACTOR’S own personal and business name and his personal telephone number (if separately obtained and paid for by CONTRACTOR) shall remain the property of and be deemed proprietary property of _____. Upon termination of this Agreement, CONTRACTOR shall not in any manner whatsoever cause ______’s telephone number or address to be changed, terminated, altered, or otherwise interfered with. 15. ON-SITE ASSISTANCE/ENTRY. CONTRACTOR shall not hire any employees nor contract with any independent contractors to perform services at the business premises without prior written permission of ______. CONTRACTOR shall not permit any third party to use, copy or borrow the key to the business premises without the prior written permission of ______. 16. WORK HOURS. CONTRACTOR shall, unless otherwise agreed to in writing, establish normal working hours within the same normal working hours established by the balance of the professionals at ______. This provision shall not prevent CONTRACTOR from making special arrangements on occasion to see patients outside of the normal established office hours and shall not, in any manner whatsoever, dictate the number of hours or times that CONTRACTOR must work. The purpose of this provision is to require CONTRACTOR to establish his office hours during the same overall time periods that ______ is open for purposes of maintaining security and support staffing. 17. RESTRICTIVE COVENANTS. CONTRACTOR agrees that, during this Agreement’s term and for a period of one (1) year following this Agreement’s termination for any reason, CONTRACTOR shall not, directly or indirectly, alone or as an officer, director, employee, agent, shareholder, partner or fiduciary on his behalf or the behalf of any other chiropractor or chiropractic entity, solicit professional services to current or former patients of ______. Further, in the event CONTRACTOR, without solicitation, provides professional services for a fee to current or former patients of ______ during the period of this restriction and following termination of this Agreement, ______ shall be entitled twenty-five (25%) percent of any collections received by CONTRACTOR as a result of such professional services. January 24, 2008 G://Frequently Used Articles/Independent Contractor Packet/Sample Independent Contractor Agreement ______ and CONTRACTOR agree that, during this Agreement’s term or anytime thereafter, neither shall disclose to any third party or for their own use and benefit, or the benefit of any third party, any proprietary information possessed, owned or used by either concerning the other’s operation. ______ and CONTRACTOR agree that their remedies at law for a breach of this action will be inadequate and that, if a breach occurs, either party shall be entitled, in addition to any other available remedies, to temporary and permanent injunctive relief from any Court of competent jurisdiction, without the necessity of posting bond or proving actual damages. Both parties agree that the covenants in this paragraph are independent covenants and that, unless a breach renders the Agreement meaningless, neither party shall not be excused from compliance with these covenants by reason of any breach by either party of this Agreement’s terms and conditions or because of any other acts or omissions of the opposite party. 18. INDEMNIFICATION. CONTRACTOR shall indemnify ______ and its respective affiliates, officers, directors, governing board members, chiropractors and employees and hold them harmless against any and all liability, loss, damages, costs or expenses, including attorney fees, which it/they may incur, suffer or be required to pay in connection with the defense and/or settlement of any action, suit or proceeding based upon professional malpractice, general liability, or any other claims brought by any person, entity, or organization, arising out of any negligent, alleged negligent or other wrongful act or alleged wrongful act, omission or alleged omission by CONTRACTOR. 19. TERMINATION. Upon termination of this Agreement fro any reason, CONTRACTOR shall, within seven (7) calendar days, vacate the business premises. Following termination, ______ shall not be responsible or be liable for billing or collecting on CONTRACTOR’S patients’ accounts, except for one final billing for services rendered prior to termination of the Agreement. Each party shall be required to reasonably cooperate with the other to the extent necessary to facilitate a smooth transition of patient files (chiropractic, administrative and financial). CONTRACTOR agrees to reimburse ______ for any first class postage, or other reasonable expenses incurred with the forwarding of CONTRACTOR’S accounts, accounts receivable, or other mail or business matters following termination of the Agreement. ______ will have no liability to CONTRACTOR if CONTRACTOR fails to receive any accounts receivable, records or other documents mailed by ______ with sufficient postage. Alternatively, CONTRACTOR may, at his option, personally pick up in person any accounts receivable or mail to avoid the postage expenses. 20. NOTICES. Any notice to be given, pursuant to this Agreement, shall be written and shall be sent by regular mail, with postage prepaid, to the address set forth below, or to such other address as to which proper notice has been given pursuant to this Subsection: CONTRACTOR _________________________________________________ REPRESENTATIVE _____________________________________________ WITNESS ______________________________________________________ DATE ___________________________________________________________ NOTE: The information provided herein should not be construed as specific legal advice to anyone. No one should rely on this information without consulting an attorney to review his or her particular factual situation as it relates to the general legal principals as set forth herein. January 24, 2008 G://Frequently Used Articles/Independent Contractor Packet/Sample Independent Contractor Agreement
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