PinnacleHealth HOPE - Terms & Conditions
Hospital Sponsored Fundraising for Medical Bills & Expenses

Effective Date: November 1, 2014

The PinnacleHealth HOPE program is managed by Someone With Group, LLC. This policy, along with the Someone With Group, LLC Privacy Policy and the individual Cardholder Agreement covers the full breadth of terms and conditions for program participants.

The PinnacleHealth HOPE program site is a business website designed for use by cardholders, patient advocates and contributors who are of legal age eighteen (18) or older. If you are younger than eighteen (18) years old, then you are not authorized to utilize this program solution and site.

Participation Requirements
As a participant in the PinnacleHealth HOPE Program, there are terms and conditions that must be adhered to for continued participation.

• You confirm you are a patient of PinnacleHealth
• You agree to provide your best efforts towards running campaigns and raising funds to help pay for medical expenses incurred as a patient of PinnacleHealth
• You may not use the debit card to purchase non-medical related products

The PinnacleHealth HOPE site is made available for patients to create campaigns. All individuals creating campaigns and receiving debit cards are verified by the sponsoring organization, PinnacleHealth, and through formal financial regulation checks including the Customer Identification Program (“CIP”).

PinnacleHealth and/or Someone With Group, LLC reserves the right to remove any campaign that is found to be inappropriate or in violation of the Terms and Conditions of the program or any financial or legal regulation.

Any contribution made to the cardholder’s campaign is subject to a 6% processing fee. Contributions are processed by Sage Payment Solutions and deposited into Access National Bank’s FBO account for Transcard, and then allocated to a cardholder for use.

Financial Regulation
In partnership with our banking partner (Access National Bank) and debit card processor (Transcard), Someone With Group, LLC is committed to full compliance with all applicable laws and regulations regarding Anti-Money Laundering (“AML”). In addition to fully vetting cardholders, the contributor is also subject to an OFAC (Office of Foreign Asset Control) check. Contributors will not be able to process monetary contributions if they do not comply.

Any suspected activity in relation to money laundering, fraudulent schemes and other financial crimes, including terrorist financing, will be monitored and reported.

Card Use
The PinnacleHealth HOPE card may only be used towards medical related bills at healthcare providers or towards healthcare related products and services required to support your specific treatment. The card spending is restricted to the merchant category codes defined in Exhibit B below. The specific use of the debit card is defined in the cardholder agreement which is made available on the PinnacleHealth HOPE site, as well as provide in the mailer shipped with the debit card.

• Total balance allowed on the card: $10,000
• Daily load limits: $10,000
• Daily spend limits: $2,500

Card Revocation
PinnacleHealth, Someone With Group, LLC and the issuing bank, Access National Bank, reserve the right to revoke the debit card in the event that products and/or services have been purchased which do not address medical needs or have not been prescribed by a physician. This would include any non-medical related products at grocery stores, retail stores, pharmacies and any other merchants that supply products that are non-medical related in nature.

Fees
PinnacleHealth has agreed to subsidize the cost of the debit card for the first year of the program. If the cardholder would like to continue using the card beyond the first year, they may be subject to a renewal fee. There will always be an option to not renew the card.

All card-related fees are outlined within the debit card mailer which is sent to each cardholder once their registration is approved. They are also disclosed here for your understanding.

Exhibit A: Services and Fee Schedule

Transaction Description Fee Fee Description
Risk and Fraud Monitoring Free Using MasterCard’s Fraud Alert and Monitoring System
Customer Service (All calls free) Free Speaking to a live representative (24 X 7 X 365; Bilingual)
Balance Inquiry VRU Free Automated Phone System
Web Access Cardholder Portal Free Online access for cardholders
SMS/Email Alerts Free Optional Service to cardholders to utilize.
Cardholder Statements for 2 years Free All electronic statements are free to cardholder for 24 months
Point Of Sale PIN or Signature Transaction – Domestic or International Free Per retail transaction
Reissue and Replacement Card $10.00 For new card creation, shipment and balance transfer. ($20.00 for express service replacement)
Monthly maintenance fee $0.35 Monthly maintenance fee
Inactivity Fee $10.00 Per month after 12 months of no activity after card is activated and has a balance (Inactive defined as no loads and no transactions for a 12 month period.)
Paper Statement $2.50 Upon request, cardholder may request a paper statement to be mailed to them.

Exhibit B: Merchant Category Codes

Code Description
8021 Dentists, Orthodontists
8031 Osteopaths
8041 Chiropractors
8042 Optometrists, Ophthalmologist
8043 Opticians, Eyeglasses
8049 Chiropodists, Podiatrists
8050 Nursing/Personal Care
8062 Hospitals
8071 Medical and Dental Labs
8099 Medical Services
8111 Legal Services, Attorneys
5912 Drug Stores and Pharmacies
5122 Drugs, Drug Proprietaries, and Druggist Sundries
7261 Funeral Services, Crematories
6300 Insurance Underwriting, Premiums
6399 Insurance - Default
4119 Ambulance Services
5047 Dental/Laboratory/Medical/Ophthalmic Hospital Equipment and Supplies
5975 Hearing Aids-Sales, Service, Supply Stores
5976 Orthopedic Goods-Artificial Limb Stores
8011 Doctors-not elsewhere classified
5310 Discount Store

Use of Funds:
Cardholders may use the debit card towards healthcare related expenses, restricted by merchant category codes as defined by PinnacleHealth HOPE and Someone With Group, LLC. If there is any misuse of funds, your card may be revoked which could result in funds being transferred to the Someone With Foundation to be dispersed to individuals with like needs. If a cardholder passes away, the family may submit expenses to the issuing bank for reimbursement. If there is still a balance on the debit card after six months, the remaining funds will be transferred to the Someone With Foundation to be dispersed to other cardholders.

The PinnacleHealth Hope program is managed by Someone With Group, LLC. This policy, along with the Someone With Group, LLC privacy policy, is available for your review.

The PinnacleHealth Hope program site is a business website designed for use by cardholders, patient advocates and contributors who are of legal age (18) or older. If you are younger than eighteen (18) years old, then you are not authorized to utilize this program solution and site.

Terms and Conditions:

OFAC Checking
Contributors will be Office of Foreign Assets Control (OFAC) checked, prior to processing any monetary contributions. This is a banking regulation that is compliant with our Anti-Money Laundering policy. If the initial OFAC check fails, the contributor will be prompted to enter address information. If the OFAC check fails again, the contributor will be prompted to enter their Social Security Number. If the OFAC check fails, they will need to contact customer service for direct assistance. Your Social Security Number is encrypted, and only the last 3 digits are stored.

Contribution Type and Fee
1. Any contribution made towards an individual’s campaign is an irrevocable gift. It is non-refundable and is not eligible for a tax deduction. A receipt of the transaction will be provided.
2. The contribution will be applied to the cardholder’s restricted debit card, after they are first moved to our merchant bank account and then to the issuing banks master account for the benefit of the debit card processor. We do not handle your money, though we may assist with questions regarding your contribution. We do reserve the right to ensure all contribution are adherent to applicable laws.
3. If there are any problems associated with the receipt or handling of your contribution and/or for any other financial regulation or other processing so as to comply with legal requirements, we reserve the right to contact you directly or indirectly through the payment processor, or issuing bank which retains certain information relating to the information you have submitted.
4. As clearly shown in the processing procedures within the solution site, you will be charged a 6% processing fee on top of the contribution amount. Your contribution will appear as two line items on your credit card statement – one for the contribution amount and one for the processing fee. Both will read “Someone With Group LLC” , the organization that administers this program.