Personnel Policies and Procedures by aZQK8Zp

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									                 Triangle Orthopaedic Associates, P.A.
                          Mission Statement

Triangle Orthopaedic Associates, P.A. is a physician-directed medical practice,
caring for patients with musculoskeletal and pain problems through “state-of-the-
art” medical treatment, surgery, physical medicine & rehabilitation, physical
therapy, occupational (hand) therapy, a chronic pain program, and other medical
and diagnostic services responsive to the needs of patients living within the counties
that we serve.

      We are here to care for patients; their needs will be given the highest priority and
       they will be treated with the highest level of respect, compassion, and dignity at
       all times.
      We will support each community we serve and utilize local hospitals when
       possible.
      We will provide care regardless of the patient’s ability to pay.
      Business operations, including the coding and billing of services, will be
       conducted with the highest ethical standards.




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             TRIANGLE ORTHOPAEDIC ASSOCIATES, P.A.

                                  Welcome to TOA!

Triangle Orthopaedic Associates, P.A.(from here forward noted as TOA) is a physician-
directed medical practice, caring for patients with musculoskeletal and pain problems
through “state-of-the-art” medical treatment, surgery, physical medicine & rehabilitation,
physical therapy, occupational (hand) therapy, a chronic pain program, and other medical
and diagnostic services responsive to the needs of patients living within the counties that
we serve. We are here to care for patients; their needs are given the highest priority, and
they are treated with the highest level of respect, compassion, and dignity at all times. We
support each community we serve and utilize local hospitals when possible. We provide
care regardless of the patient’s ability to pay. Business operations, including the coding
and billing of services, are conducted with the highest ethical standards.

We strive to make sure that TOA is a good place to work and a place where employees
will be treated with dignity and fairness. We take great pride in believing that TOA is
different from most. We all work very hard to foster and maintain good communications
and working relationships among all of our employees. This handbook will provide
employees with information on TOA policies and benefits and provide employees with
positive guidance in their daily working life.

All employees should realize that the future opportunities that may come to them are
dependent, to a great extent, on the manner in which each employee applies and conducts
him/herself in the performances of his/her job duties. Employees should realize that their
jobs are important ones. Each job must be performed in a satisfactory manner if TOA is
to continue the established standards of excellence.




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             TRIANGLE ORTHOPAEDIC ASSOCIATES, P.A.
                           Personnel Policies and Procedures

DISCLAIMER: These policies do not constitute an employment agreement and should
not be construed as a contract of employment. When no longer required by the holder,
or upon termination, please return this copy of the Personnel Policies Manual to the
Human Resources Manager.

Please note that no employee or manager of TOA, other than the Board of Directors, has
the authority to enter into any agreement for employment or to make any agreement
contrary to the office personnel policies. In no event are these personnel policies to be
construed as or determined to create any contract by implication. Only the Board of
Directors has the authority to make commitments on behalf of TOA having the force and
effect of contract.

All TOA employees are at will, which means that they may be terminated at any time for
any reason, with or without advance notice. Employees are also free to resign at any
time.

This handbook is not an employment contract and may not be all-inclusive. Changes will
be made from time to time based on employee input and the needs of TOA. Therefore,
TOA reserves the right to modify the handbook in whole or in part, as required.
Employees will be notified of changes as soon as possible; however, where differences
occur, official policies, procedures or benefit plans are the governing documents.

Please read this manual carefully. It will provide answers to questions concerning
personnel policies that affect an employee’s working relationship with TOA. Welcome to
TOA. Management hopes that employees will find this a pleasant and satisfying place to
work. Please pay close attention to our Mission Statement. TOA is here to care for
patients. Management encourages employees to express their interests and concerns
about any problem area, whether it pertains to a patient or to internal working relations.
Every person and every job in TOA is important. What employees do and how they do it
reflects directly upon the work, reputation and image of all of TOA.

First: Employees are expected to master and maintain his/her own work with a high
degree of efficiency.

Second: Employees are expected “to fit” the team and work harmoniously with all other
employees.

Third: TOA hopes that employees will take a personal interest in and obtain personal
satisfaction from serving the patients. Remember, that is the main reason TOA is here.
Patients have made it their choice to use the services of TOA for their medical care.
They deserve to be treated with the highest level of respect, compassion and dignity at all
times. Please make each patient contact as pleasant as possible. Rude treatment of any
patient will not be tolerated.




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This manual is intended to be a general explanation of policies for all employees. The
practice retains the right to terminate this relationship at any time for any reason with or
without cause or notice. The officers of the Corporation have the sole discretion to
interpret any situation, and that decision will be final. Appeals may be made to the
Executive Committee.




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Employment Policies
TOA is an equal opportunity employer. It is TOA’s policy to comply with applicable
federal and state laws and regulations prohibiting discrimination on the grounds of race,
color, religion, gender, national origin or citizenship status, age, disability, or veteran’s
status in matters related to employment.

This policy applies to all terms and conditions of employment, including but not limited
to, hiring, placement, promotion, termination, layoff, recall, transfer, leave of absence,
compensation and training.


Immigration Reform and Control Act of 1986

The IRCA prohibits the hiring and retention of aliens not authorized to work in the
United States, requires all employers to verify employment eligibility and retain certain
records, prohibits discrimination on the basis of national origin and citizenship status, and
imposes substantial civil and criminal penalties for violation of the law. IRCA makes it
unlawful to hire any individual without verifying his/her employment authorization and
identity.

All new employees hired by TOA must provide the required documentation within three
(3) business days of actual commencement of employment to maintain his/her position.
A new employee and Human Resources are required to complete Form I-9, verifying that
the employee is not an unauthorized alien. TOA will maintain these records according to
the rules and regulations set forth in this Act.


Compliance Plan

TOA has adopted a compliance plan to ensure that it is compliant with federal rules and
regulations in billing and collections for patients covered by federal and state health plans
including Medicare, Medicaid, and Champus. This Plan is reviewed and monitored for
on-going changes by our Medical Director, Compliance Officer and approved by the
Board of Directors. A complete copy of this policy begins after the Personnel Policies
Manual at the back of this booklet. By signing this acknowledgement, employees
acknowledge this monitoring.




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Software Piracy/Office Technology (Telephones. Computers, E-Mail and Internet
Access)

The Board of Directors of TOA has approved and implemented a policy for use of all
electronic equipment. Copyright laws protect computer software. No computer software
is to be copied for personal use. Office technology, such as telephones, computers, e-mail
and Internet access are to be used for official TOA business only and not to conduct
personal business except in an emergency. Employees are strictly prohibited from
sending e-mail or using the Internet to view materials that could be construed to be of a
harassing, sexual, offensive, discriminatory or intimidating nature. Such conduct and
other conduct in violation of TOA’s computer policies adopted from time to time may
result in disciplinary action, including termination. TOA reserves the right to monitor all
practice-related technologies including, but not limited to telephones, computers, e-mail
and Internet access without notice to the employee. A copy of this entire policy begins
immediately following the Compliance Plan at the end of this booklet. By signing this
acknowledgment, employees acknowledge this monitoring.


Confidential Information

The medical care TOA provides to patients is personal and highly confidential.
Employees should never disclose or distribute any information or documents regarding
TOA, including, but not limited to, TOA’s policies, practices and fees, its patients
(including the patient’s name, diagnosis, treatment or any other information relating to
the patient), the doctors, or co-workers to anybody for whom the information is
unauthorized or unnecessary (together referred to as “confidential information”). Patient
charts and other computer-based or other information are highly confidential information.
Confidential information may not be discussed in hallways, stairways and other public
places whether within or outside of TOA. All confidential information must be properly
secured at the end of each day. Absolutely no information may be released to any
unauthorized person, either orally or in writing, except in accordance with a written
authorization signed by a person with legal authority to do so. In addition, an employee
may only refer to a patient’s chart when it is essential to his or her work responsibilities.
Referring to medical information for other purposes or otherwise breaching this duty of
confidentiality may be a cause for immediate dismissal.


Practice Managers/Supervisors

Practice Managers and Supervisors have the responsibilities to act in the place of the
Physicians for all of the administrative duties in TOA. These duties include the
responsibility for all personnel, whether the duties are clinical or clerical in nature, or a
combination of both. Employees should look to the Manager/Supervisor for guidance in
relation to the quality and quantity of his/her work, for information about work
procedures, and for job training and work coordination within the department.
Managers/Supervisors also determine employees’ work schedule. If employees have any
questions or problems regarding their work, rate of pay or TOA policies, they should talk
to their Manager/Supervisor. Do not hesitate to go to them with anything that is


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troubling. He/She can help with most work-related problems and, on occasion, even
some private ones.

TOA is interested in an employee as a person and wants to help them achieve their
highest potential as an employee. An employee’s interest in quality patient care,
compassion for people, assisting the physician, and creating a happy work environment
that is fair to all are the goals of TOA, and loyal cooperation with the
Manager/Supervisor will help achieve these goals. Politeness and firmness should be
used in dealing with difficult people. Conflicts with Managers/Supervisors or co-workers
are to be handled outside the presence of patients or the general public and in a
professional and courteous manner.


Probationary (Get to Know) Period of Employment

New employees are on a probation (get to know) period for the first three (3) months of
employment. During this period, the manager/supervisor will be evaluating how the
employee fits into the practice, and likewise, the employee should be evaluating how
much they enjoy working at TOA. The employee will be evaluated on his/her response to
training, ability to do the job assigned, and ability to work with other people. Continued
employment will be based upon this evaluation. If it is determined that an employee’s
performance at any given time during this three month period does not meet the
established standards of the job, he/she may be dismissed and the two-week notice
usually given to a regular employee will not apply. If, at the end of those ninety days,
TOA and the employee are both happy with the other’s performance, then he/she will
become an employee of TOA, entitled to all the benefits as set out herein for regular full-
time employees.

During the first 90 days, no benefits are accrued for vacation, personal or sick time.
Except as otherwise determined at the time of hire (exceptions are health insurance and
holiday pay), no benefits will be available as detailed in subsequent sections of this
policies manual during the Probationary Period of Employment. An employee may be
terminated, without notice, in the event his or her performance does not meet TOA’s
standards or for any other reason, or for no reason, during the Probationary Period of
Employment or thereafter. Employees who terminate voluntarily or for any cause during
the probationary period are not entitled to any benefits. The Manager/Supervisor will be
glad to answer any questions and consult with employees as to their progress on the job.




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Grievance

It is the policy of TOA to encourage employees to bring their complaints about work
related situations to the attention of management. An opportunity will be provided to
employees to present complaints and appeal decisions made by management through a
formal grievance procedure. If any employee of TOA has a complaint relating to his/her
employment, he/she may address that concern to his/her Manager/Supervisor. If the
direct Manager is unavailable, contact the Chief Operating Officer or the Human
Resources Manager, in that order. If neither is available, the Chief Executive Officer
should be contacted. The managing Physician may be contacted if none of these are
available. Under no circumstances may employees be penalized for using the grievance
procedure. Time spent by aggrieved employees in grievance discussions with
management during their normal working hours will be considered hours worked for pay
purposes.

All complaints or grievances will be resolved fairly and promptly. Managers are
responsible for ensuring that a grievance is fully processed until the employee’s right of
appeal is exhausted.

Management’s decisions on grievances will not be precedent-setting or binding on future
grievances, unless those decisions are officially stated as TOA policy. Whenever
possible, decisions will be retroactive to the date of the employee’s official complaint.

If the aggrieved employee is not satisfied with the final decision, he/she will be permitted
to appeal to the final level in the grievance procedure, the Executive Committee. The
Executive Committee will discuss the matter with the employee after reviewing the
grievance, the facts as recorded and the decisions of the Chief Executive Officer. A final
decision will be communicated in writing to the employee within a reasonable time
frame.


Dress Code/ Manners (Revised 1/1/2010)

Conduct, personal appearance, and the appearance of work areas are a direct reflection of
the quality of the services provided. Professional conduct includes cooperation for the
common good and mutual respect for each other’s position and responsibilities.

All front desk patient support (or anyone that covers front desk) and physical therapy
staff will be required to wear TOA specified tops. Patient Support front desk staff will be
required to wear specified colors on given days (list can be obtained from manager).
Colors are subject to change on an annual basis. Any basic, professional black or khaki
pants can be worn by patient support staff and shorts of the same colors for Physical
Therapy clinical staff. There is a website available for employees to purchase TOA
approved apparel http://www.companycasuals.com/TriangleOrthopaedic.

Purchases can be paid in full at the time of order or each employee will be given a credit
line of up to $150 through the website to make this purchase. Full time employees are
allowed a credit line of up to $150 and part-time employees, working at least 20 hours
per week, will be given up to $75. The credited amount will be payroll deducted up to 10

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pay periods. If the line of credit is used, it will apply to one order only and must be paid in full
before using additional credit. New hires must purchase and be wearing these tops within
their first 2 weeks of employment. This applies to all regular full tine and part time
employees. If an employee leaves the practice, any unpaid balance will be deducted from
their final check.

Appearance must be neat and clean. Clinical employees are expected to wear appropriate
uniforms and clean shoes such as sneakers. No open toed shoes are permitted for clinical
employees. Flip flops of any type or Birkenstocks are not permitted for any employee.
All business office and front desk staff are expected to wear appropriate professional
business attire. Jeans, leggings, stretch pants, track/jogging pants, sweat clothes, shorts,
tank tops, and tee shirts are not acceptable attire for TOA employees and may not be
worn by employees at any time while engaging in TOA business. Jewelry such as
bracelets, finger rings and earrings, and/or some other personal items may be worn,
provided such items are appropriate business accessories and are not excessive in amount
or size. TOA will not permit employees to display jewelry in pierced body parts other
than pierced ears, and no more than three earrings in the same ear. Hair must be neat,
clean, dry, and well groomed; good personal hygiene is essential. Heavy perfumes or
colognes should not be used.

TOA reserves the right to have employees who are unsuitably attired go home and
change. That time away from the office will not be paid. Repeated failure to adhere to
these dress code guidelines may be cause for immediate termination.

Definitions:
Jeans-Allowed on approved days.
Track/jogging Attire-Includes fleece, velour, cotton, and nylon sports attire.
Shorts-Allowed for Clinical P.T. staff. Must be professional looking, appropriate color
and length as specified by manager.
Sweatshirts-TOA Sweatshirts are allowed.
T-Shirts-TOA logo and plain shirts are allowed. No commercial logos or screen printed
t-shirts are allowed (an example would be "Old Navy" and "John Deere" logos).

Employees, who change clothes to participate in any exercise program during the
workday, must change back to appropriate attire before returning to work.


Communications Systems

TOA is committed to ensuring that its employees utilize its various electronic
communication systems in an appropriate manner. These systems include, but are not
limited to, E-Mail, Internet, Fax, Voice Mail, etc., and the following rules apply:

All electronic communication systems should be used primarily for company business.
Personal communications must be held to a minimum and at no cost to the company.
TOA communications property or equipment may not be removed from the premises
without authorization from the employee’s supervisor.



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The transmission of sexually explicit images, messages, and cartoons as well as use of
ethnic slurs, racial epithets, threats, profane language, or anything that may be construed
as harassment by employees is expressly prohibited.

Users should be aware that all communication software/systems are owned by TOA and
the company reserves the right to inspect files, access voice mail, pull records of dialed
numbers and the duration of all long-distance and local telephone calls at any time to
ensure that the system is being appropriately used in accordance with the policy. TOA
may access and monitor employee communications and files as it considers appropriate.

Users should not permit non-employees (other than approved vendors or trainers) access
to any electronic communication systems.

All communications on any TOA owned electronic communication system must be in
accordance with all HIPAA/confidentiality policies.

Failure to follow these rules subjects the employee to disciplinary action, up to and
including termination.

Remember that public relations can be won or lost on the telephone. Employees should
state his/her name to the caller. Be as polite and helpful as if the caller were there in
person.

Office telephones are very busy. The capacity of our lines is required for essential
practice business. Each person is requested not to make unnecessary personal calls.
Relatives and friends should be discouraged from calling unless it is urgent.

Profane language will not be tolerated under any circumstances.


Employee ID Badge

All TOA employees are required to wear picture identification badges whenever they are
at work. Employees are required to wear their badge at all times. This badge allows
access to the building. Under no circumstances should an employee allow anyone to have
access to his/her building badge. If the badge is lost, the replacement fee is $10.00.


Employee Parking

All employees at the WPP office will park on the outer perimeter of the parking lots on
both sides of the building. The front spaces are reserved for TOA patients. Satellite
employees should also leave front spaces for patient parking.


Security

Inspections: Packages, purses, briefcases, lockers and containers are subject to
inspection upon request by Human Resources or Chief Operating Officer.
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Company Responsibility: TOA endeavors to maintain a secure working environment,
but accepts no responsibility for loss or damage to personal items or vehicles. Employees
are urged to protect personal property (purses, clocks, calculators, computers, etc.) by
securing them at all times; however, the best prevention is to leave valuable items, not
required by your job, at home.

Incident Reporting: All employees are expected to report any situations or incidents on
TOA property that could compromise the safety or security of TOA employees, visitors
or customers to Human Resources or Chief Operating Officer. All information will be
maintained confidentially.


Layoffs

Business conditions sometimes change to the point that there is not enough work to keep
all employees on the payroll. Should this situation ever occur, the work force may be
reduced, by laying off the number of employees over and above those needed to perform
the work available. Layoffs will be determined by performance ranking.


Beverage/Snack Breaks (revised 1/15/10)

There is no stated time for a beverage/snack break. If schedule and time permits, your
manager may allow a 15 minute break in the morning and afternoon. Employees may
consume beverages and simple snacks at their desk, (except for the Clinical area)
provided they are in a covered container and cannot easily be knocked over. Use good
judgment when consuming beverages or snacks in patient areas. No food may be
consumed at employees’ desks, in clinical and front desk areas. Please use the
lunchroom for all other eating purposes.


Lunch Breaks (revised 1/15/10)

The normal lunch break is one (1) hour, and this time must be taken. This lunch break is
non-compensated time; therefore, employees may leave the office during this period.
Lunch breaks will be scheduled by the Managers/Supervisors to assure coverage of all
office duties during lunch breaks. Employees cannot interrupt someone on a scheduled
lunch break, nor can an employee change working hours or scheduled lunch times
without prior approval of the Manager/Supervisor. Employees must clock out when the
lunch break begins, and clock in upon return to work. Lunch breaks may not be taken at
the end of the shift, unless approved in advance by the Manager/Supervisor.

Due to patient schedules, Clinical employees may not always get their full lunch and will
be paid for this time. Always try to get at least a 30-minute break, when at all possible. If
you take less than 30 minutes, you are not required to punch out.




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Change of Address/Personal Status Change

It is very important that TOA has employees’ correct home address and telephone
numbers at all times. Report any changes immediately to the supervisor and the Human
Resources Department.

This is important for several reasons, including reaching an employee or his/her family in
case of an emergency, and being able to mail important personal information. Also, an
employee may need to change insurance coverage, change withholding deductions for
state and federal taxes, be notified of insurance continuation benefits should his/her
employment be discontinued, or other important records employees need to keep current.


OSHA

TOA provides occupational health and safety services to employees based on their work
and work environment needs. All employees who are potentially at risk for exposure to
hazardous substances are required to undergo annual training. Employers are required to
comply with safety regulations as mandated by OSHA and TOA’s OSHA SOP.

If an employee is exposed to hazardous medical waste, or incurs a needle puncture,
he/she should report this to the Clinical Department Manager immediately, with the name
of the patient involved. Then, contact Research Triangle Occupational Health Services at
919-560-4027, or go directly to Durham Regional Hospital emergency room.


Facilities and Property Use

Use of the TOA telephone for outside calls or personal matters must be held to a
minimum. Personal phone calls that interrupt an employee’s job responsibilities or
interfere with another employee’s job responsibilities are not allowed under any
circumstances. Urgent or emergency local calls may be made at the employee’s
discretion.

No employee will use or remove from the premises, TOA equipment, instruments,
documents, records or other property of any kind belonging to TOA or under its control,
without prior written authorization. This includes use of the TOA’s postage meter,
delivery accounts and so on.

In addition, unless prior approval is granted, no children, other family members or friends
may be brought into the office while an employee is working. Exceptions, of course, are
made if these people are being seen that day as a patient of TOA. Such persons are
requested to remain outside of patient or work areas, for instance in the lunch area, so as
to minimize any potential disruption to TOA business.




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Personnel Files and Records

Necessary job-related and personal information about each employee will be retained in
an official personnel file kept by TOA. The contents of these files will include:
     Basic identifying information
     Completed employment applications
     Other hiring-related documents
     Notice of pay changes and benefit coverage information
     Performance evaluations and information other than employment-related actions
     Other job-related information or documents deemed essential by management.

Essential records of current workers are kept indefinitely. Records of former workers are
kept the length of time as required by law and then destroyed.

Current employees have the right to inspect the information contained in their files.
Individuals will be allowed access to their files only in the presence of a management
official and at a mutually convenient time and place. An employee may respond in
writing to items contained within his/her personnel file.

Personnel files are kept in locked cabinets and internal access to an individual’s file is
limited to the CEO, CFO, COO and HR. Files many be viewed by management personnel
who have a legitimate, verifiable need to know specific information about the employee.

No information in a personnel file will be disclosed to anyone outside the organization
without a signed consent from the employee specifically authorizing the release of the
information. TOA reserves the right, however, to verify basic information, such as
employment status and job title, without notification to the individual involved, and to
cooperate with law enforcement, public safety, or medical officials who have a valid need
to ascertain limited, specific information about an individual.


Performance Appraisals

Salary levels will normally be reviewed annually during the month of October.
Employees will receive annual merit performance reviews at this time, with salary
increases, if there are to be any, to take effect the first pay period in November.

Performance appraisals provide the basis for establishing an understanding among the
Chief Executive Officer, the physicians and the employee concerning job responsibilities
and individual performance. Merit increases are granted to recognize “good” or better
performance. The amount of the increase is determined by the rating given on the
performance appraisal form.

TOA’s most valuable assets are the employees, so employee development and motivation
are a primary concern to management. Similarly, TOA considers our patients’
satisfaction to be of paramount importance. Employee/patient interactions are therefore
also important. The factors TOA looks for in employees, and upon which their success
here is evaluated are the following:

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              Cooperation with other staff members
              Responsiveness to patient needs and sympathy for their problems
              Clinical/administrative competence to perform the duties of the position
              Willingness to perform the tasks assigned and to look for new ways for
               TOA to maximize each patient's satisfaction with provided services.
              Integrity and maintenance of standards of professional conduct and
               decorum in the office and among the patients


Employees are asked to sign their performance appraisals to indicate that they have read
and understand them, and that those appraisals have been discussed with the employee.
The employee’s signature does not necessarily signify agreement with the appraisal.
There is room on the appraisal for the employee to comment, and TOA encourages
employees to do so

Employees who are still on a probationary basis will be reviewed periodically during that
time.


Re-Hires

If an employee leaves on good terms and is rehired, he/she may have an adjusted “hire”
date. If he/she is re-hired within 6 months of leaving, the hire date will revert back to the
original hire date. If he/she is gone longer than 6 months but not more than 2 years, the
length of time gone from TOA will be adjusted from the original hire date to become the
new hire date.

Re-hires will get the appropriate longevity bonus based on the revised hire date, but all
other bonuses, if any, will be pro-rated on actual time worked for the year.

Re-hires do have to complete eligibility waiting periods for all insurance benefits and a
90 day probationary period.


Transfers within TOA

When job openings become available within TOA, it is possible to transfer from one
department to another. If an employee is interested in applying for a posted position,
he/she must complete an “Internal Transfer Request Form” and attach the appropriate
documentation to support his/her qualifications and education. The completed form will
be given to the manager for signature and then given to the Human Resources Manager.
To be considered for an internal transfer, an employee must have completed a minimum
of one (1) year of service in his/her current position. Employees will be interviewed for
that position based on job qualifications and seniority if there is more than one worker
interested in the job. TOA Administration does reserve the right to make staff changes in
some circumstances without posting the position and also regardless of length of service
in current position. A 90-day probationary period will apply to the new position upon
transfer.

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Nepotism

TOA intends that employees not be involved in decisions affecting the employment of
individuals who are members of their immediate and additional families. Individual
consideration will be given in cases where the relative clearly demonstrates unique and
unusual skills necessary for the position and these skills are not readily available in the
labor market. When these conditions are present, the Chief Executive Officer, Chief
Operating Officer and the Human Resources Manager may make an exception based on a
decision.

In cases where a relative has been hired, no manager/supervisor will be in a position to
make decisions affecting retention, promotion, salary and leave of absence for family
members in that department. The Chief Operating Officer or the next level of supervision
must make these decisions.

Immediate family: Spouse, children, parents, brothers, sisters, stepparents, stepchildren,
stepbrothers and stepsisters.

Additional family: Grandparents, parents-in-law, brother-in-law, sister-in-law, son-in-
law, daughter-in-law, aunts, uncles, grandchildren, and great grandparents.


Outside Employment

Permission for outside employment concurrent with employment here will not be granted
if the outside employment is likely to:

      Hinder the employee’s ability to work overtime as the job may require;
      Compete with the services of the office;
      Become so demanding on the employee’s time and energy that it negatively
       affects the employee’s job performance at this office for any reason.

Employees have a duty of loyalty to their employers. Outside employment that has any
of the above effects will be considered a breach of that duty and would be grounds for
dismissal. No outside employment may be accepted without prior discussion with and
approval from an employee’s manager.



Bad Weather Conditions

TOA personnel are needed to maintain essential office services. If an employee is absent
due to bad weather, no compensation is paid unless a vacation or personal day is used.

TOA usually remains open in inclement weather. In the unusual event of severe weather,
office closing or delayed opening will be announced on the local TV Stations, WRAL-
TV (Channel 5) and WTVD-TV (Channel 11). The Senior Administrative Team of TOA
will make the decision and alert all Managers. Employees should make sure the direct

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Manager/Supervisor has his/her correct home telephone number. Managers and other
employees will follow the departmental phone trees to follow-up about such closings. In
the case of bad weather, employees should notify the Manager/Supervisor as soon as
possible that they will not be able to come into the office until the weather conditions
improve.

If TOA is forced to close the office due to bad weather or other reasons beyond our
control, no compensation is paid to non-exempt employees unless a vacation or personal
day is used.




Pay and Work Hours
Compensation (revised 1/1/09)

Employees are hired to perform a specific series of tasks. TOA expects to pay employees
at a rate that is competitive. As skills improve, salary will increase. If an employee learns
other jobs that make him/her more valuable, he/she may be able to move to a higher job
title when available. Everyone is paid based on the tasks performed and on the manner in
which he/she performs those tasks.

Pay day, for all employees, is bi-weekly on Friday, for the preceding period. The pay-
period ends on a Saturday and all employees are paid the following Friday. The salary
will be in your account on Friday. In the event payday falls on a holiday, paychecks will
be issued on the last working day prior to the normal pay date.

All employees are required to be paid by way of direct deposit, and statements can be
viewed on-line (see Human Resources for instructions).

No advance in salary will be made under any circumstances.

All compensation paid to employees will be subject to federal, state and local
withholding and to Social Security taxes based on exemption information supplied by the
employee. TOA contributes an equal amount to each employee’s share of the Social
Security paid. Full information on the Social Security Act and its application to
employees may be obtained from a local Social Security office.

Careful records will be kept regarding hours worked. This will be done whether or not
the employee is on an hourly basis or fixed salary in order to comply with federal and
state employment regulations.

Automatic raises are not given at TOA. Everyone is evaluated in relation to the
practice’s reason for existence—quality patient care. Evaluations are done once a year.

Salaries are strictly confidential. No one, other than the employee, the Chief Executive
Officer, Physicians, Chief Operating Officer, Chief Financial Officer, Human Resource


                                                                                          16
Department and Finance Department is authorized to have information about the salary
rates of employees.

Bonuses (unless specified in employment agreement), including Christmas bonuses, are
not routinely provided.

Deductions and Assignments

The following required deductions will be taken from each paycheck:
           Social Security (F.I.C.A.)
           Federal and State Income tax. An employee desiring to change the number
              of dependents claimed for Federal and State Income Tax purposes will
              complete a new W-4 and NC-4 form.
           Health Insurance premiums for eligible dependents
           Deductions as requested by each employee
           Garnishment of wages as required by Federal and State regulations.
           Flexible Benefits deductions. A voluntary Flexible Benefits Program is
              available that will allow TOA to withhold dependent childcare and
              medical reimbursement costs at pre-tax dollars.

Employees’ paycheck stubs will reflect all deductions. After the 90th day of employment
each check stub for non-exempt employees will also indicate the number of vacation and
sick hours available.


Payment for Business Miles

Reimbursement will be paid to all staff members for business errands performed at the
request of TOA.
            Business miles will include travel from the office to a destination and back
              to the office.
            In order to be reimbursed, the following information must be provided in
              an expense report, including employee’s name, date included in the
              request, date of each use of car, destination, miles per trip, and total miles.

The report should be given to the Manager/Supervisor for approval and then forwarded to
the Finance Department. Reimbursement checks will be issued at the end of each month.


Employee Classifications (Revised 8/11/08)

Full-time and part-time employees are classified by the hours worked weekly. These
classifications shall be used to determine eligibility for employee benefits, except when
defined otherwise in the policy for a specific benefit.

Full time employees are those working at least 36 hours per week on a regular basis.



                                                                                            17
Part-time are those working less than 36 hours on a regular basis. The average
workweek for part-time employees will determine eligibility for participation in
company-sponsored retirement and fringe benefits programs.

PRN Employees hired for a clearly defined temporary period of time shall be considered
as temporary employees and will not receive any benefits.

Working Hours/Overtime/Make-up Time

TOA is usually staffed at 8:00 A.M., Monday through Friday, with ending times
dependent upon patient schedules. Business hours for non-clinical employees are 8:00
A.M. to 5:00 P.M. Starting hours will vary by position. Some employees may start
earlier than 8:00 A.M., while others will be expected to start later than 8:00 A.M. Urgent
Care and MRI/CT is staffed Monday through Sunday with various shifts. A
Manager/Supervisor will tell each employee his/her starting time. All employees are
expected to be punctual. Chronic lateness will not be tolerated and will result in
disciplinary action that could include termination. If an employee is absent because of
illness or an emergency, he/she should notify his/her Manager/Supervisor as soon as
possible, and the Manager should be informed of the expected length of the absence.

Circumstances will sometimes arise that necessitate working beyond normal closing
times. Employees are expected to stay when required. Non-exempt employees will be
paid at the standard rate up to forty-hours (40) and at the rate of time-and-one-half, if the
aggregate time worked is more than forty-hours (40) in a particular week. Overtime,
however, must be authorized in advance by the Manager/Supervisor or with the approval
of the Chief Operating Officer.


Overtime

In accordance with the Fair Labor Standards Act of 1938 (FLSA), employees with a non-
exempt status (that is, employees who are not executive, administrative, or professional
personnel) are eligible to receive overtime compensation at the rate of one and one-half
(1/1/2) times their base hourly rate for all hours worked over forty (40) in one week.

The overtime compensation requirements of the FLSA do not apply to employees who
are exempt or employed in an executive, administrative or professional capacity.

Exempt/non-exempt status is determined at the time of hire (or promotion), based upon
the type of work performed and job responsibilities. The Chief Executive Officer, Chief
Operating Officer, and Human Resources Manager, in conjunction with FLSA
regulations, assign these classifications. Employees are informed of their classification at
the time of hire.

All overtime work must be assigned and/or approved in advance as follows: Clinical
Staff by Clinical Manager and other staff by their department head. The
Managers/Supervisors for any changes must initial time sheets. Hours paid for but not
actually worked (e.g. vacation days, sick days, holidays) are not counted for
overtime purposes.
                                                                                           18
Make-up time

All hours that are being “made-up” shall only be done so after approval of the
Manager/Supervisor. If an employee is not “physically” in the office for a 40-hour week,
and wishes to “make up” the time missed, he/she must have approval from the
Manager/Supervisor and time must be made up within the work week that time is missed.

Hourly employees must maintain their own time worked by clocking in and out four
times per day. Employees should never ask a fellow-employee to clock in or out for
him/her. Employees must document on the time sheet (or tell their Manager/Supervisor)
whenever he/she is absent or fails to clock in or out. Failure to do so will result in
delayed compensation.


Pay Increases

TOA recognizes its responsibility to see that employees are paid properly for the jobs
they are performing. It is a company policy to maintain pay levels which compare
favorably with those paid by other practices in the area that have similar or comparable
jobs. Furthermore, wage and salary surveys are conducted on a systematic period basis,
and pay ranges are normally adjusted on a regular basis to keep up with economic
changes.

Any adjustment to an employee’s salary must be authorized prior to the change and fall
into the categories as follows:

      Annual Review – An adjustment will be effective November 1st each year, based
       on the Annual Employee Performance Evaluation.
      Promotion – An employee is promoted to a higher paying position.
      End of 90-Day Probation Period – A salary adjustment may be considered if the
       employee has met or exceeded job expectations.
      Extraordinary Situations – A salary adjustment will be made in the event in
       which extraordinary circumstances warrant consideration of such at a time other
       than annual review. This situation will be very rare.




                                                                                           19
Benefits
Triangle Orthopaedic Associates, P.A. Paid Time Off (PTO) P olicy (effective 1/1/09)
Revised 11/23/09

Triangle Orthopaedic Associates, P.A. recognizes the need for employees to have time
off from the daily job routine for rest, recreation, relaxation, etc. which TOA considers
necessary for the employees’ and the company’s benefit. TOA has developed a Paid
Time Off (PTO) policy for regular, full-time and regular, part-time employees. This
plan is designed to provide time off, with pay, for time away from work (e.g., personal
reasons, vacations, and to provide income in the event of illness/injury). TOA currently
has separate vacation, PTO, and sick hours. This policy will combine the three to PTO
hours.

Your accrued unused sick balances, prior to the new PTO plan, will be converted to your
personal individual sick bank. Employees may use time from this bank for medical
absences (conditions meeting FMLA requirements) more than 3 days. Sick bank will
remain active until all time is depleted or employment ends (unused sick time is lost).

Non-Exempt-Regular, full-time and part-time employees accrue PTO based on average
weekly hours paid. Paid hours exclude overtime. The accrual rate is determined by hours
worked per pay period and years of service. Employees are eligible to accrue and use
PTO after 90 days of employment.

All regular exempt and non-exempt, full-time and regular, part-time employees accrue
PTO up to a maximum of 60 days or 480 hours, after which, accrual will stop, until a
reduction in accumulated PTO hours. Employees must use a minimum of 2 weeks (based
on regular weekly work schedule) of PTO per calendar year, with the option to rollover
all unused time. You also have the option to be paid out accrued PTO at the start of the
next calendar year, as long as you have rolled over a minimum of 1 week (based on
regular weekly work schedule). The minimum 2 weeks does not apply to an employee
starting mid-year and all unused PTO must be rolled over, with no pay out option. Any
hours accrued over 480 at years end, will automatically be paid out at the start of the next
calendar year. Accruals are based on regular weekly work schedule and not on average
hours worked.

Non-Exempt - Accrual of PTO for non-exempt employees (with the exception of non-
exempt mid-levels) is as follows, beginning at the end of the 90 day probationary period.
Employees accrue time on the basis of their regular weekly scheduled hours. Accrual
hours are based on a bi-weekly payroll, which equates to 26 pay periods per year.




                                                                                         20
 PTO Accrual Non-Exempt
(Based on 40 Hour Work
Week)

 Accrual
  Hours
 Per Pay Years of      Days
 Period Service* Accrued
   5.23    0-5 yrs       17
   6.77   5-10 yrs       22
   8.31     10 +         27
*Completed years of service
         Days               17      22      27
         Hours            136      176     216
         Hours       0-5       5-10    10
         Per         years     years   years +
    FTE Week         Accrual Accrual Accrual

1.00      40.00      5.23       6.77       8.31

0.95      38.00      4.97       6.43       7.89

0.90      36.00      4.71       6.09       7.48

0.85      34.00      4.45       5.75       7.06

0.80      32.00      4.18       5.42       6.65

0.75      30.00      3.92       5.08       6.23

0.70      28.00      3.66       4.74       5.82

0.65      26.00      3.40       4.40       5.40

0.60      24.00      3.14       4.06       4.98

0.55      22.00      2.88       3.72       4.57

0.50      20.00      2.62       3.38       4.15


Exempt/Mid-Level - Accrual of PTO for full time exempt and non-exempt mid-level
employees is as follows, beginning at the start of employment. The first accrual may be
prorated, depending on start date and accruals for mid-year terminations are prorated
from the start of the year through last day worked. Payouts upon termination are for
prorated accrued balances only. Accrual hours are based on a bi-weekly payroll, which
equates to 26 pay periods per year.
                                                                                    21
 PTO Accrual – Exempt/Mid
            Level
   (Based on 40 hours per
            week)
 Accuals
 Per Pay Years of      Days
 Period Service* Accrued
  6.77     0-7 yrs       22
  8.31     7 + yrs       27
*Completed years of service
         Days               22      27
         Hours            176      216
         Hours       0-7       7 years
         Per         years     +
   FTE Week          Accrual Accrual

1.00     40.00      6.77        8.31

0.95     38.00      6.43        7.89

0.90     36.00      6.09        7.48

0.85     34.00      5.75        7.06

0.80     32.00      5.42        6.65

0.75     30.00      5.08        6.23

0.70     28.00      4.74        5.82

0.65     26.00      4.40        5.40

0.60     24.00      4.06        4.98

0.55     22.00      3.72        4.57

0.50     20.00      3.38        4.15


PROCEDURE

1. Scheduling of PTO

   a. Non-exempt employees: A minimum of one (1) hour must be taken when PTO
      will be used. PTO time must be rounded to the nearest ½ hour. Time equal to or
      less than 1 hour does not require use of PTO (employees can make up the time or

                                                                                   22
      take without pay upon approval from their manager). Employees will be
      required to use PTO time for any time missed more than 1 hour up to 40 hrs a
      week or their normal scheduled work hours.
   b. PTO requests should ideally be submitted via the current time system, at least two
      (2) weeks in advance, to the employee’s team leader/supervisor or manager for
      approval. Occasionally, last minute requests will be granted by manager, if
      accommodations can be made. All PTO requests will be approved, put on wait
      list or denied by the supervisor within 72 hours of receipt of the request.
      Employees should make sure there are available current and future PTO hours by
      checking the time system before submitting a request.
   c. Requests for Paid Time Off for each employee will be considered when
      scheduling vacations. These requests will be scheduled by the employees’ team
      leader/supervisor or manager in order to guarantee no interruption in business
      activities. Where conflicts occur within a department, preference will be given to
      the earliest request submitted. The team leader, supervisor/manager or
      department head is responsible for approving/denying the requests at the earliest
      convenient date. Vacation requests around the holidays will be granted on an
      alternating yearly schedule within the department. Additional holiday PTO
      requests will be maintained on a waiting list. If department staffing needs are
      met, these additional PTO requests will be considered. Holiday schedules will be
      finalized two weeks before the holiday. Where conflicts occur within a
      department, preference will be given to the earliest request submitted. The team
      leader/supervisor/manager or department scheduler is responsible for
      approving/denying the request at the earliest convenient date.
   d. Time off without pay will be granted for emergency situations and must be
      approved by the team leader/supervisor/manager.
   e. Employees must use PTO, if available, for all absences except:
          1.   Absence is unauthorized; or
          2.   Absence is related to a death in the family*, or
          3.   Absence is related to military leave (see Military Policy in handbook); or
          4.   Absence is related to failure to renew required license/certificate; or
          5.   Employee is non-exempt and is released from work due to “lack of work”
               for more than one (1) hour of the employee’s shift or work day (employee
               will be given the option of taking PTO or time off without pay).

          * An employee, who has a death in the family, while on a PTO Leave, may
            have the PTO time rescheduled. Bereavement leave will be applied in
            accordance with the TOA Bereavement Policy.

   f. The employee’s team leader/supervisor/manager or department scheduler will
      have the final discretion in granting PTO, just before or after previously
      scheduled PTO, holiday, vacation or weekend.

2. Unauthorized Absences




                                                                                      23
       a.   If an employee is scheduled to work but fails to call in or fails to call in
           within the established time frame per department procedure, the absence will
           be unexcused and unauthorized, and will result in loss of pay.
       b. PTO can not be used to recover pay for any unauthorized absence.

3. Illness/Injury

   Notification of absence due to illness/injury should be made as soon as possible, but
   before the start of the scheduled workday. In the case of an emergency, an employee
   must make a reasonable effort to contact his/her team leader/supervisor or manager as
   soon as possible. Prior notification to the employee’s team leader/supervisor or
   manager will be a prerequisite for the use of PTO.
      a. Employees who are sick for more than one work day are responsible for
           keeping in touch with their team leader/supervisor or manager daily, unless
           other arrangements have been made (e.g., the employee is on leave of
           absence). In any event, the team leader/supervisor or manager must be
           notified of the employee’s date of return to work.
      b. Employees who are sick for more than three days will be required to present a
           doctor’s note releasing the employee to return to work, prior to the employee
           reporting for duty. This certification is at the employee’s expense.
      c. In the event of absences from work that result in a paid leave of absence,
           including, but not limited to, workers’ compensation and short term disability,
           employees may not use accrued PTO to make up the difference between what
           is received from their paid benefits and their regular base salary.
      d. In the case of an emergency (e.g., auto accident, etc.) or an unforeseen
           event(s), an employee must make a reasonable effort to contact his/her team
           leader/supervisor or manager as soon as possible. TOA reserves the right to
           verify the nature of the emergency or unforeseen event(s). PTO hours will be
           permitted to be used in the event of an accident or a disaster.

4. PTO Donation
In the spirit of promoting an atmosphere of caring and concern, employees will be given

the opportunity to donate paid time off (PTO) in hourly increments to other employees

who are experiencing personal or family crisis (e.g., personal or family medical crisis or a

financial hardship). A medical crisis requires leave from work for more than three days

and physician documentation. Employees are eligible to receive up to 80 hours (or

average hours worked in a 2 week period) per event.

   All regular, full-time and regular, part-time employees are eligible to donate or to
   receive donated PTO hours.

       a. An employee who wishes to “receive” PTO donations must:


                                                                                         24
            1. Submit a Paid Time Off (PTO) Donation Request form to his/her team
               leader/supervisor or manager. Human Resources is responsible for
               approval/denial of the request. All approved completed forms will be
               forwarded to Human Resources for approval. Human Resources will then
               notify the affected employee of the status of their request. Human
               Resources will give the forms to the Payroll Department for processing.
            2. Use all accrued PTO, and currently be ineligible to receive group
               disability before being eligible to receive a PTO donations(s) from another
               employee(s); and

         b. Employee requesting to “donate” PTO hours must:

            1. Submit a Request to Donate Paid Time Off (PTO) form to Human
               Resources no later than one (1) pay period prior to the pay period in which
               the PTO hour(s) will be donated. Human Resources and Senior
               Administration are responsible for approving/denying the request. The
               Human Resources department will notify the “donating” employee of the
               status of his/her request and have payroll deduct the donated hours from
               the employee’s PTO bank, and
            2. Maintain a PTO balance of forty (40) hours for personal use (after
               deducting the “donated” PTO hour(s)).

All donated hours will be transferred on an hour for hour basis. Donated PTO hours

are non-reversible.    Employees receiving donated PTO hours are responsible for

applicable federal and/or state taxes. Employees will receive pay for any unused, PTO

hours in accordance with the “Termination/Change of Employment Status” section

below.

5. Leaves of Absence

         a. An employee going on an approved leave of absence must use accrued PTO
            for any leave for which the employee is not otherwise entitled to disability
            benefits, workers’ compensation or any TOA extended payroll benefit, except
            in the case of a military leave.

         b. Such used PTO will run concurrently with FMLA entitlement, where a
            determination of eligibility and final designation has been made. All
            employees are not eligible for FMLA. See Family and Medical Leave
            policy found in employee handbook.

         c. PTO will continue to accrue, if employee is working in some reduced capacity
            (e.g., light duty), regardless of whether the employee works a complete pay
            period. Otherwise, PTO will not accrue during approved, unpaid leaves of
            absences. Upon return from any leave of absence, employees will begin

                                                                                       25
            accruing PTO upon their return, regardless of whether they return to work a
            complete pay period.

6. Termination/Change in Employment Status

       a. Employees whose loss of employment is initiated by TOA for performance or
          disciplinary reasons forfeit entitlement to accrued PTO, unless otherwise
          prohibited by federal, state or local statute. In all other situations, except as
          noted below, employees are entitled to receive pay for any unused, accrued
          PTO upon the termination of employment or when employment status
          changes from regular, full-time or regular, part-time to PRN, up to the
          maximum allowable accrual. The maximum accrual amount is 480 hours.


       b. Employees who resign can not use PTO in lieu of notice, unless approved by
          management. Furthermore, employees who resign without giving an adequate
          2 week notice will not be paid unused, accrued PTO, unless otherwise
          prohibited by federal, state or local statute. In addition, if an employee does
          not work the entire length of the notice she/he forfeits entitlement to accrued
          PTO, unless otherwise approved by management or prohibited by statute(s).

7. Rehired employees

       a.   Rehired employees are eligible to accrue PTO according to policy, provided
            his/her employment status upon rehire is regular, full-time or regular, part-
            time (see Rehire Policy found in employee handbook).


       b.   If an employee is rehired within 6 months of their termination date, accruals
            will start back accordingly. If an employee is rehired after 6 months of their
            termination date, the employee will begin accruing PTO according to policy at
            the new employee rate.

8. Recordkeeping

   In adhering to all aspects of this policy, it is the responsibility of each team
   leader/supervisor or manager to maintain accurate records of PTO accrued and taken
   on each employee. These records should match records in the current time system.


Holidays (revised 6/15/10)

Each year the Board of Directors will declare the holidays to be observed and the specific
dates involved.

Should the holiday fall on a Saturday or Sunday, either the preceding Friday or following
Monday will be observed as the holiday. This will be determined on the basis of office
needs and what other employers in the community are observing.


                                                                                        26
Holiday leave will be provided during the probationary period. However, if the
employee terminated for any reason prior to completion of the ninety-day (90) period, the
holiday hours paid will be taken out of the last check.

All employees, with the exception of PRN employees (hired for a temporary period of
time with no set schedule and working as needed with no benefits) are eligible for
holiday pay. For employees on a flex schedule or part time employees, holiday pay is
received only if the employee is normally scheduled to work on the day the holiday is
observed. Holiday pay will be equivalent to scheduled hours normally worked that day.
Per the manager’s discretion, flex hours may be adjusted during a holiday week, which
means weekly schedule is subject to change.

If an employee is scheduled to work on the actual holiday or the TOA observed holiday,
then the employee will be paid at time and one half. Any other day(s) worked, including
the weekend following a holiday, will be at the regular pay rate.

An employee who has an unexcused absence (absence that is not planned) the day before
or the day after the scheduled holiday is not eligible for holiday pay. In case of illness,
employees must bring a note from a physician in order to be paid for the holiday.


Bereavement

In recognition of the fact that a death in the family will require time away from the job,
the following bereavement leave policy is established:

A three (3) day paid leave will be granted to all regular full-time and part-time employees
on a prorated basis, for the following losses: Spouse, Child, Stepchild, Mother,
Stepmother, Father, Stepfather, Mother-in-Law, Father-in-Law, Grandchildren or
Siblings.

One (1) day of leave will be granted for the loss of: Aunt, Uncle, Grandparent, Niece,
Nephew, Sister and Brother-in Law

For any losses of other family members or friends, time away from the office will be
taken from an employee’s PTO time or as unpaid leave.

Flexible Benefits Program

A Flexible Benefits program is available that allows us to withhold your out-of-pocket
medical and dependent childcare expenses at pre-tax dollars.

On January 1, after you have completed your 90 days, you are eligible for unreimbursed
medical expenses (expenses not paid by your insurance carrier and considered out-of-
pocket) and child care expense reimbursement. You are given an opportunity to sign up
for this each year in December.




                                                                                             27
FMLA

The Family and Medical Leave Act entitles an employee up to 12 full weeks of unpaid,
job protected leave in a 12 month period for the birth or adoption of a child; placement of
a child for adoption or foster care; to care for a spouse, child or parent with a serious
health condition or the employee’s own serious health condition. Employees requesting
leave under FMLA may be required to provide certification of a serious health condition
from a health care provider. While on FMLA, employees will be required to use any
accrued vacation or sick time. A manager may allow an employee to save a designated
amount of PTO time to use upon return from leave. TOA designates the 12-month period
as a rolling 12 months.

There are a number of qualifications and considerations with regard to specific provisions
of the Family and Medical Leave Act. If you have specific questions about the FMLA
and its provisions, check with the Human Resources Manager.

Reinstatement Rights: Eligible employees under FMLA are entitled, on return from
leave, to be reinstated to their former position or an equivalent position with equivalent
employment benefits, pay, and other terms and conditions of employment. Exceptions to
this provision may apply if business circumstances have changed (e.g. if the employee’s
position is no longer available due to a job elimination). In addition, employees on a
leave extension are not guaranteed reinstatement.

Sick Leave (revised 1/1/09)

Employees with accrued unused sick balances, prior to the new PTO plan effective
1/1/09, will have balances converted to a personal individual sick bank. Employees may
use time from this bank for medical absences (conditions meeting FMLA requirements)
more than 3 days. Sick bank will remain active until all time is depleted or employment
ends (unused sick time is lost).

In the event of an illness, please notify your Manager/Supervisor prior to 8:00 A.M. Sick
bank may be used to care for the illness of dependent family members, if sickness meets
FMLA requirements, and employee is absent for more than 3 days. Remember, if you
are ill for an extended period of time, TOA does provide a disability income policy to
qualified employees that pays a percentage of their salary. Employees are eligible for
disability coverage at the end of 90 days of employment. Refer to the disability booklet
for details of this coverage.

If an employee has been out of work for more than two weeks, before he/she can
return to work, a note must be provided from the treating physician stating the
employee is able to return to work and whether or not there are any restrictions.


Leave of Absence (Revised 9/30/08)

An employee, who has completed the probationary period of employment, will be
eligible for a leave of absence with or without pay at the discretion of the Board of
Directors. Requests must be made in writing with supporting medical evaluations if
                                                                                         28
necessary. Up to six months time off for leave without pay for illness or short-term
disability will be allowed for a full-time employee.

At the commencement of any leave of absence, the employee will be asked to provide the
office with written notification of their intent to return to work.

Employees with less than 15 years of service are responsible to pay health insurance and
other benefits after twelve weeks of leave (runs concurrent with FMLA), and, after all
accrued PTO and sick bank time have been used. After twelve weeks, group health
benefits can be elected through COBRA.

Employees with 15 years of service and over are provided benefits by TOA as normal for
up to six months of leave (employees are responsible for dependent and supplemental
premiums). After six months, group health benefits can be elected through COBRA.

Holiday pay will be provided per regular policy if a holiday falls during the paid portion
of a leave.

No benefits accrue during the leave period, whether paid or unpaid.

The Board of Directors of TOA will approve all leaves of absence in accordance with the
Family and Medical Leave Act of 1993.


Jury Duty

TOA recognizes that you may be called to serve as a juror from time to time. This is a
responsibility that you as a citizen should fulfill.

If you are required to serve as a jury member or are subpoenaed as a witness, such
absence will be in the nature of a leave with pay. Any compensation you receive from
the court is yours to keep. Your job position will not be jeopardized by any absence due
to jury duty. As soon as you receive your notice, please bring it to your manager so that
coverage may be arranged. If you are excused from such duty at any time, you are
expected to return to your work.

Jury duty/witness pay will not be paid when the employee is a direct party to the
proceeding, such as a defendant or litigant.


Military Leave (Revised 2/16/10)

A military leave of absence will be granted if an employee is absent in order to serve in
the uniformed services of the United States. Such absences will be in the nature of leave
without pay, except as designated below. Employees who perform and return from
service in the military will retain certain rights with respect to reinstatement, seniority,
layoffs, compensation, length of service promotions, and length of service pay increases
as required by applicable federal or state law.


                                                                                           29
Per the Uniformed Services Employment and Reemployment Rights Act of 1994
(USERRA), Employees must provide advance notice of military service to employers.
Notice may be either written or oral by the employee or an appropriate officer of the
branch of military in which the employee will be serving.

The cumulative length of absence of an employee to serve in the uniformed services,
after December 12, 1994, may not exceed five years, with certain exceptions under
USERRA. The employee must report back to work or apply for reemployment within the
following guidelines:

1-30 days of service           Report next scheduled work day (After 8 hours rest plus
                               normal travel time from military training site to place of
                               employment.

31-180 days of service         Apply within 14 days following completion of service.

181 + days of service          Apply within 90 days following completion of service.

Employees serving 1 to 90 days will be reemployed in the position the person would have
held had the person been continuously employed, so long as the person is qualified for
the position or can become qualified after reasonable efforts by the supervisor to qualify
the person.

Employees serving 91 days or more will be reemployed in (1) the position the person
would have held had the person been continuously employed, or (2) a position of
equivalent seniority, status, and pay, so long as the person is qualified for the position or
can become qualified after reasonable efforts to qualify the person. If the person cannot
become qualified in (1) or (2), the person will be reemployed in any other position of
lesser status and pay that the employee is qualified to perform will full seniority.

Employees who are absent for a period of service of 31 days or more, may be require to
documents the period of military service to show that the application for reemployment
was timely, the person has not exceeded the five year limitation, and the person’s
character of service was honorable. If documentation indicates that one or more of the
reemployment requirements was not met, the individual may then be terminated. Where a
person was absent for 91 days or more, employers may delay making retroactive pension
contributions until the person submits satisfactory documentation.

Benefits will be continued during leave according to applicable state and Federal
regulations. Upon reemployment, persons are entitled to all seniority related benefits as if
they had remained continuously employed. If, prior to leaving military service, an
employee knowingly provides clear written notice of an intent not to return to work after
military service, the employee waives entitlement to non-seniority leave of absence rights
and benefits.

Notice of intent not to return to work can waive only non-seniority leave of absence
rights and benefits. Service members cannot surrender other rights and benefits that a
person would be entitled to under the law, particularly reemployment rights. Service


                                                                                            30
members will be required to pay the employee cost, if any, of any funded benefits to the
extent that other employees on leave of absence would be required to pay.

Employees are asked to discuss any potential absence due to military services with the
Manager well in advance. While on military leave, employees have the option to use
accrued PTO hours or take unpaid leave.


Health Insurance

TOA provides a group health insurance policy for all regular full-time employees. New
employees are eligible to enroll in this program as soon as the waiting period is satisfied.
TOA pays the premium for individual coverage for regular employees who work at least
36 hours per week on average. For any employee desiring to add family members, the
additional premium will be paid through payroll deduction. All details of the plan are
covered in the handbook provided by the plan. Part time regular employees scheduled to
work 30 hours per week are eligible for coverage, and the employee pays premiums.


Declining our Health Insurance

Full-time employees who have health insurance through their spouse or have private
coverage may elect to decline TOA’s coverage. We will reimburse $50 per pay period
beginning with the date insurance would have been in effect, providing certification is
given that other coverage exists.


COBRA Continuation of Coverage

The federal Consolidated Omnibus Budget Reconciliation Act (COBRA) gives
employees and their qualified beneficiaries the opportunity to continue health insurance
coverage under TOA’s health plan when a “qualifying event” would normally result in
the loss of eligibility. Some common qualifying events are as follows: resignation,
termination of employment, death of an employee, a reduction in employee’s hours, a
leave of absence, an employee’s divorce or legal separation, or a dependent child no
longer meeting eligibility requirements.

Under COBRA, the employee or qualified beneficiary pays the full cost of coverage at
TOA group rates.

TOA provides each eligible employee with a written notice describing rights granted
under COBRA, when the employee has a qualifying event. The notice contains
important information about the employee’s rights and obligations.


Professional Courtesy for Employees

Employees of TOA, who are treated as patients, will not be responsible for any charges
beyond what is covered by their health insurance, except for DME. For DME items the
                                                                                          31
charge is cost plus 20%. Custom made orthotics and braces will be discounted
appropriately. Co-pay and deductible amounts will be waived for employees.

Immediate family members will follow the policy as stated above, but they will also be
responsible for the co-pay and deductible amounts or 130% of Medicare, whichever is
less. Immediate family members are: an employee’s spouse, children and stepchildren
or children of which you are legal guardian. This includes dependents that are full time
students up to age 24 and can be claimed as such on your income tax return.

 Dependents who have no insurance, or when insurance does not pay because of the
deductible or other reasons, will be responsible for no more than 130% of the Medicare
rate. Dependents will pay for DME at cost plus 20%, and custom made orthotics will be
discounted appropriately.


Disability and Life Insurance

Regular full-time employees are provided a short and long term disability policy that
becomes effective on the 90th day of employment. This provides a percentage of an
employee’s salary beginning on the 30th day of disability. This is provided at no charge
to full-time employees who work a minimum of 36 hours.

A life insurance policy is provided and begins on the 90th day of employment. This is
provided at no charge to full-time employees who work a minimum of 36 hours.


Dental & Supplemental Insurance

A dental policy is available through TOA. Employees are responsible for premiums.
Regular employees who work 20 hours or more are eligible for this coverage on the first
of the month following their 30th day. Employees will be given an opportunity to
purchase this through payroll deduction.

Employees may also purchase supplemental AFLAC, Vision, Long Term Care and other
various services, that are not sponsored by TOA, which are paid through payroll
deduction.


Employee Assistance Program

TOA provides an Employee Assistance Program (EAP) to help employees. The purpose
of the program is to provide counseling by appropriate professionals for problems
involving alcohol and drug abuse, child abuse, mental or emotional stress or illness,
financial or legal problems, and similar issues. TOA pays for this program, which
includes the expense of the initial counseling visits. If further professional assistance is
needed, the employee is required to pay the charges or fees involved unless otherwise
covered through TOA health benefits. Employees are encouraged to contact
representatives of the EAP directly.


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In a situation in which an employee is failing in his or her job performance, TOA may
recommend that the employee enter into counseling through the EAP. However, TOA
will only follow up on whether or not counseling appointments are being made and kept;
it may not, under its agreements with the EAP organization, ask or be told anything about
what is discussed in the counseling sessions without written release from the employee.

Employees who are referred to the EAP are expected to fully participate in the
recommendations received through the program. Merely utilizing the EAP services will
not alter the application of disciplinary actions, nor will it serve as an exemption from
disciplinary procedures. Improving job performance to an acceptable level is the only
basis for continued employment.

If the employee refuses the offer of help through the EAP and job performance does not
improve, disciplinary action will be taken which could result in termination. All matters
discussed are confidential, that is, they are strictly between the employee and the program
counselor.


Retirement Plan

TOA maintains a qualified pension and profit sharing plan. Employees are eligible for
contribution once they have met specified waiting requirements. All employees who
have attained the age of 21, have been employed at least 1 year and maintain 1,000 hours
of service per year shall participate in the plan at its plan year-end. Each year TOA shall
contribute such amount as its Board of Directors shall determine. TOA makes
contributions with no cost to the employee. Each employee will be given a Plan
Summary Description that more fully describes the administration of the Plan at the time
of eligibility.


Continuing Education, Dues, Meetings and Seminars

TOA will pay for expenses of Exempt or Mid-Level personnel in accordance to standard
company policy per position, when they are authorized to attend meetings related to their
assigned duties in the Professional Association.

TOA will pay dues and registration for licensures required for the employee related to
their job requirements.

Full-time Non-exempt Employees, who wish to continue their education by attending
classes after hours, may request tuition reimbursement from the Board of Directors.
Tuition costs are paid by TOA on an individual basis, if the Board determines the tuition
costs reasonable. If the course is approved, TOA will pay one-half (1/2) of the expenses
in the beginning, and the remainder is paid upon successful completion by maintaining an
overall “C” average.

Submit your requests to your Manager/Supervisor to begin the approval process.



                                                                                         33
Full-time Exempt or Mid-Level Non-exempt Employees will be given continuing
education allowances in accordance to standard company policy per position.


Credit Union

TOA has chosen to sponsor the Vision Financial Credit Union. Their office is located at
214 Pacific Avenue, Durham, NC 27704, and they can be reached by telephone at 477-
0696. There is also a branch in Roxboro.


Special Items (Safety, Housekeeping, etc.)
Accidents

An accident of any nature that occurs on the premises and involves one or more
employees, patients or other persons must be reported immediately to the Chief
Operating Officer, Manager of Human Resources, Risk Management Coordinator or
Human Resources Assistant. Each employee who was injured or witnessed the
occurrence should make a complete written report of the occurrence, including the time,
place, circumstances, names of persons involved, and the names of witnesses, if any.

Accidents specifically include:
      1. Injuries sustained by an employee, a patient, or any other person while on the
           premises.
      2. Injuries sustained by the employee while off the premises but in the course of
           TOA business.

It cannot be over-emphasized that all accidents must be reported, no matter how
slight the injury or damage might seem to be, or who was responsible for the occurrence.


Workers’ Compensation

An accident of any nature that occurs on the premises of TOA and involves one or more
employees must be reported immediately to the Chief Operations Officer, Manager of
Human Resources, Risk Management Coordinator or Human Resources Assistant. The
appropriate manager should make a complete written report of the occurrence, including
the time, place, circumstances, names of persons involved, and the names of witnesses, if
any. Appropriate corrective action will then be taken.

Time missed from work for treatment of a work related injury is not paid for by
TOA, only the services. Employees may use paid time off or sick bank, if available, or
take the time as unpaid. Compensatory benefits are not paid during the first seven (7)
days of disability, unless the disability continues for more than 21 days. The 21 days do
not have to be consecutive, and any day in which the employee does not earn full
wages because of the disability is counted as a full day of disability. After


                                                                                        34
disability continues for 21 days, the employee is entitled to compensation for the
first seven (7) days. Compensation is paid directly from the insurance carrier.

In connection with accidents involving employees, TOA is insured under the Workers’
Compensation Act. Under the terms of this insurance, accidents and injuries must be
reported promptly to the insurance company. If medical treatment is necessary,
information will be submitted to the insurance carrier to determine if the injury is
compensable.

Treatment of on-the-job injuries, referred outside TOA, must be prior approved by the
insurance company.

Bulletin Boards

Special notices and other information of interest to employees are posted on TOA
bulletin boards located in break areas. The bulletin boards are exclusively used for the
purpose of sharing authorized information and are not to be used for personal or public
notices. Examples of posted items would include, but are not limited to job vacancies,
policy or procedure changes, news of the community, Federal and State Labor Law
Postings, and employee informational materials.

For consistency in posting at all locations, the Human Resources Manager is responsible
for ensuring that only relevant information is posted. No personal or public use is
authorized, unless approved by Human Resources.


Solicitation and Distribution

Solicitation and distribution of literature by non-employees on TOA property is
prohibited.

Solicitation by employees on TOA during working time is prohibited. Working time is
the time an employee is expected to be performing his/her job duties and does not include
break periods, meal times or other periods when employees are not engaged in
performing their work.

Distribution of literature by employees on company property in non-working areas during
working time, as defined above, is prohibited.

Distribution of literature by employees on TOA property in working areas is also
prohibited.


Open Door Policy

TOA cannot emphasize enough that management wants to know when employees think
that they are not being treated fairly or a policy is not being administered properly or
consistently. Most problems arise from misunderstanding. The best way to clear up any


                                                                                           35
misunderstanding is to talk it over with people who have the authority to do something
about the problem. That is why we have an “Open Door Policy”.

If an employee has an issue that he/she wants to bring to management’s attention, this
issue can be presented informally through the Open Door Policy. The Open Door Policy
means that an employee can speak to any member of management he/she thinks is best
equipped to help with the particular concern. No doors are closed but, whenever possible,
an employee should go to his/her immediate manager or supervisor first.


Driving Triangle Orthopaedic Associates, P.A. Vehicle

Anyone that falls into the category of driving the TOA vehicle will provide a current
copy of their Drivers License and sign a release stating that TOA may obtain a copy of
their driving record to be placed in their file. Depending on the information obtained
from the driving record, TOA reserves the right to give or deny an employee the privilege
to drive the TOA vehicle. The driver and any passenger riding in the vehicle will wear a
seat belt at all times.

Smoke Free Facility (revised 1/15/10)

Triangle Orthopaedics is committed to providing a healthy environment by promoting a
‘tobacco free’ campus.

Triangle Orthopaedics prohibits the use of tobacco products on its campus and in its
facility and facility-owned vehicles. The term “tobacco” includes, but is not limited to
cigarettes, cigars, chewing tobacco, snuff and pipe smoking.

Patients, employees, visitors, vendors, contractors, and physicians may not smoke or use
tobacco products on Triangle Orthopaedics’ campus.

Smoke breaks are limited to two 15 minutes breaks per day. Breaks are granted per
manager’s discretion, which is based on volume of work load within the department.

Employees are prohibited from using tobacco products in personal or private vehicles, if
the vehicle is on Triangle Orthopaedic owned or leased properties.

Tobacco cessation materials will be available to all TOA employees through the HR
Department.

Employees, who utilize tobacco products on TOA premises, will be subject to corrective
action, up to and including termination from employment.




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Work Rules
Attendance/Absenteeism

Absenteeism is a serious loss to the employee, co-workers and TOA. Employees are
hired to be an important member of the TOA team. When an employee is absent,
someone else has to do his/her job. By reporting to work everyday and on time, the
employee is making an important contribution to the efficient and smooth operation of
the practice. Employees are expected to be at work regularly and on time.

The manager will record all absences, regardless of whether they are excused or
unexcused. Excusable absences from work fall into two categories: (1) paid time off from
work according to various company benefit and/or leave of absence programs; and (2)
those absences caused by emergency or accident. All other absences are considered
unexcused.

EXCUSED ABSENCE is classified as such when the absences are due to:
   Death in the family
   Military obligations
   Jury Duty
   Family/Medical Leave
   Paid Time Off (Vacation or PTO)
   Court ordered subpoena
   Prior approved school activities
   Personal Leave
   Hospital Confinement
   Holidays
   Paid Sick Leave

UNEXCUSED ABSENCE will be classified as such when the provisions listed do not cover
the reason (or reasons) for time away from the office.

UNREPORTED ABSENCE will be classified as an unexcused absence. An employee
incurring two (2) consecutive days of unreported absences will be considered as having
resigned without proper notice. Employees, who “walk off” the job without authorization,
shall be considered as having resigned without proper notice.

OCCURRENCE is classified as any unexcused absence.

This policy will be strictly enforced and corrective discipline will be administered
according to the following procedures: Each day of unexcused absence shall be recorded
as one occurrence, unless covered by vacation or leaves available under policy, or unless
time is made up within the workweek.

Employees who do not have paid time off will be charged with an unexcused absence for
each day of work missed.



                                                                                        37
Three (3) unexcused instances of tardiness will be equal to one (1) occurrence. Tardy is
defined as arriving at your workstation late, leaving work early or leaving and returning
during your regular scheduled work time. Any employee that encounters circumstances
of any nature that requires him or her to leave work before the end of the workday must
clear same with their department manager. Tardies will be recorded and this policy will
be enforced for essential personnel, including front desk employees, appointment
secretaries, and switchboard operator. Clinical staff’s arrival and departure times will be
determined by manager depending on provider schedules. As a disclaimer, extreme cases
of tardies among non-essential personnel will be addressed according to policy.

As stated above, this policy will be strictly enforced and corrective discipline will be
administered according to the following procedures. Only unexcused absences will be
used for corrective discipline purposes. Each unexcused period of absence shall be
recorded as one occurrence.

Period of Absence will be defined as any absence covering a period of not less than one
(1) day or greater than ten (10) days in duration. Should an employee realize the period
of absence is going to exceed the ten (10) day maximum, he should apply for a leave of
absence to maintain employee status, provided the employee is eligible for a leave of
absence.

Disciplinary Action -Each period of absence shall be recorded as one occurrence.

      Step One – Four (4) occurrences within a consecutive twelve (12) month
       period: Oral Warning.
      Step Two –Six (6) occurrences within a consecutive twelve (12) month period:
       Written Warning.
      Step Three – Eight (8) occurrences within a consecutive twelve (12) month
       period: Final Written Warning.
      Step Four – Ten (10) occurrences within a consecutive twelve (12) month period:
       Automatic Discharge.



Disciplinary/Corrective Action

Situations may arise in which corrective action is necessary. Each employee can be
assured that his/her Supervisor/Manager’s goal in taking action is to correct, not to
punish. Consistent with this philosophy, the normal sequence of corrective action will be
as follows:

       1.   First Occasion    Verbal Discussion
       2.   Second Occasion   Written Warning
       3.   Third Occasion    Final Written Warning
       4.   Fourth Occasion   Discharge

The above procedure will normally apply. However, some behaviors may warrant an
immediate Written Warning, Final Written Warning, or Discharge. TOA reserves the

                                                                                           38
right to administer such discipline as is appropriate for the circumstances of each
individual situation. In instances where a Verbal, Written, Final Written, or Discharge
action is conducted, the Human Resources Manager will review the case and be present
when the notice is given to the employee. All disciplinary action will be documented and
filed in the employee’s personnel file. Individuals who question the accuracy or
completeness of information contained in their file must bring such matters to the
attention of the Chief Operating Officer. The practice will consider the employee’s
objections and correct or remove erroneous or improper information. If management
decides to retain the disputed information in the file, the employee is entitled to place a
brief statement in the record identifying the alleged errors or inaccuracies. All rule
infractions, except those involving excessive absenteeism or tardiness, build upon each
other in the corrective action sequence.

Appeals may be brought to the Board of Directors at the request of the employee.


Termination for Cause (revised 7/31/08)

Not withstanding any provision herein to the contrary, employees may be terminated for
cause from their position at any time without notice. The term “cause” resulting in
immediate termination shall include, but is not limited to the following:

      Individual or collective falsification of employment, personnel or other company
       records. This includes, but is not limited to, application, time records, or work
       related records.
      Falsification / forgery of prescriptions for any reason will result in immediate
       notification to law enforcement officials.
      Willfully punching the time card of another employee, having one’s time card
       punched by another employee, or unauthorized altering of a time card.
      Abusive or inconsiderate treatment of patients.
      Gross insubordination, which is willful and deliberate refusal to follow a valid
       and reasonable order or assignment by a supervisor or other member of
       management.
      Stealing TOA property, or the property of any employee.
      Immoral or indecent conduct on TOA property.
      Neglect of duty.
      Reporting to work under the influence of alcohol, marijuana or other drugs or
       narcotics; possession, sale, or use of alcoholic beverages, marijuana, or illegal
       drugs on TOA property or during work hours regardless of whether on TOA
       property or not.
      Chronic tardiness or absenteeism per policy, excessive use of unpaid time off.
      Criminal offenses.
      Sabotage and willful destruction of property.
      Fighting, resulting in physical attack or bodily harm to any person, on TOA
       property.
      Possessing weapons, explosives, or cameras/recording devices on TOA property
       without written authorization from the Chief Executive Officer or Chief Operating
       Officer.

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      Repeated violation of the policies set forth herein.

Employees who are terminated for deliberate violation of policy shall not be entitled to
any accrued benefits that would normally be paid upon termination, or any severance
pay.


Termination Other than Resignation or For Cause

Employees may be terminated for reasons other than cause. Those who do not meet
performance requirements may be terminated without notice at any time during the
probationary period. Employees terminated during the probationary period are not
entitled to severance pay. TOA may terminate employees, who, after their probationary
period, are not meeting practice performance requirements, and two weeks notice will be
given. TOA shall have the right to issue two weeks’ severance pay in lieu of the two-
week notice requirement.

The employee shall be entitled to payment of any accrued benefits that would normally
be paid upon termination.

HR or a member of Administration will accompany all employees, who have been
terminated for cause or due to layoff, to their work areas to gather personal belongings
and then out of the building. All TOA property should be turned in at this time.


Termination by Voluntary Resignation

An employee who resigns must do so by informing TOA in writing and is required to
give a two weeks notice. All mid-level employees are required to give a ninety day
written notice.

Employees who do not give proper notice of termination will be required to forfeit any
accrued benefits that may have been otherwise paid upon termination.

Employees who do not give proper notice will not be re-hired.

Employees who are absent from their position for two days or more without proper
notification to their Manager/Supervisor will be considered as having resigned without
proper notice.

Employees, who walk off the job without authorization, shall be considered as having
resigned without proper notice. Please telephone your Manager/Supervisor and provide
the reason for the absence to prevent any misunderstanding.

Employees who voluntarily terminate and provide proper notice as outlined above, will
be paid for any accumulated vacation time, but not for accumulated sick leave.




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When an employee leaves TOA, the Manager of Human Resources conducts an exit
interview so that management can learn and verify the reasons for departure and work to
improve TOA where it is deficient. This interview will also be used to complete various
forms, arrange for a final paycheck, and verify the status of the employee’s benefits up to
and after departure.


Fraternization

TOA has implemented a Fraternization Policy so that TOA can operate effectively and
avoid problems with supervision, morale, and/or the creation of an environment that may
produce claims of sexual harassment or unfair, favorable or unfavorable treatment.

Conflict of Interest:

If a TOA employee becomes involved in an intimate relationship with an employee of
TOA (or any facility affiliated with TOA, including NCSH) whom he or she directly
supervises or an employee he or she reviews, then a conflict of interest exists. If a TOA
employee becomes involved in an intimate relationship with an employee whom he or
she indirectly supervises or an employee whom he or she may be asked to review, then a
potential conflict of interest exists.

If a conflict of interest or potential conflict of interest arises, TOA will take action to
remedy the conflict. That action may consist of any of the following, at TOA’s
discretion:

       Requiring the higher-ranked personnel to recuse himself or herself from
        reviewing the other employee and from any discussions concerning that
        employee’s reviews, advancement, performance management, salary, bonuses, or
        termination.
       Transferring either party to another suitable position if available and if the
        employee is qualified for it.
       Terminating one of the two employees.


Other Relationships:

Employees who are at the same level and who become involved in an intimate
relationship with each other and TOA employees who become intimately involved with
employees of any hospital in which TOA doctors perform services are required to abide
by TOA’s policies, as detailed below.

Furthermore, in cases where there are equivalent-level TOA employees in a relationship,
and one of those employees is promoted, then the rules regarding conflicts of interest and
potential conflicts of interest apply.



                                                                                              41
General Policies:

It is the responsibility of the higher-ranked employee to inform the TOA President,
Medical Director, or Chief Operating Officer of the existence of a relationship that causes
a conflict of interest or a potential conflict of interest as described above.

TOA employees in relationships with other TOA employees or with employees of a
hospital where TOA performs services are expected to conduct themselves professionally
both at TOA facilities and when representing TOA offsite. Such professionalism
includes refraining from public displays of affection.

A TOA employee in an intimate relationship with another TOA employee must not show
favoritism in work-related decisions.

Likewise, a TOA employee must not treat another TOA employee unfavorably in work-
related decisions based on the past or present existence of an intimate relationship or the
desire for an intimate relationship.

All personnel are required to abide by TOA’s non-discrimination and sexual harassment
policies and refrain from any actions that could be interpreted as discrimination or sexual
harassment, including sexual harassment of another employer’s employees.

The provisions of this policy apply regardless of the sexual orientation of the parties
involved.

TOA reserves the right to revise this Fraternization Policy. Any changes to this policy
will be distributed to all employees as soon as possible. No oral statements or
representations can in any way change or alter the provisions of this policy.


Sexual & Other Unlawful Harassment

TOA strives to maintain a climate of respect and consideration for each individual, and
one that recognizes the staff member for his or her contributions on the basis of merit.
Such an atmosphere requires that an individual should be free of intimidation created by
unwelcome, non-work related conduct or comments, including ethnic, racial, sexual, or
religious remarks, animosity, unwelcome sexual advances, requests for sexual favors or
other such conduct. These do not belong in the workplace and will not be tolerated. The
responsibility for assuring that the workplace is free from any type of harassment rests on
all employees. Because TOA does not tolerate offensive or inappropriate behavior, all
employees must avoid any action or conduct that could be viewed as harassment. Such
conduct will result in disciplinary action up to and including termination of employment.

Harassment of employees or of applicants by other employees, agents of the company or
third parties is prohibited. Harassment is verbal or physical conduct that denigrates or
shows hostility or aversion toward an individual because of individual’s race, color,
religion, gender, national origin, age, sexual orientation, or disability, and that:



                                                                                          42
      Has the purpose or effect of creating an intimidating, hostile, or offensive work
       environment;
      Has the purpose or effect of unreasonably interfering with an individual’s work
       performance; or
      Otherwise adversely affects the individual’s employment opportunities.

Harassing conduct includes, but is not limited to the following:

      Epithets, slurs, negative stereotyping, or threatening, intimidating, or hostile acts,
       that relate to race, color, religion, gender, nation origin, age, sexual orientation, or
       disability; and
      Written or graphic material that denigrates or shows hostility or aversion toward
       an individual or group because of race, color, religion, gender, national origin,
       age, sexual orientation, or disability and that is placed on walls, bulletin boards,
       desktops, or elsewhere on TOA’s premises, or in the workplace.

All individuals in management have the explicit responsibility to prohibit and prevent the
occurrence of harassment and to take immediate action to correct any harassment of
which they become aware.

Sexual harassment is defined as unwelcome sexual advances, requests for sexual favors,
and other verbal, graphic, physical or expressive behavior of a sexual nature where
    Submission to such conduct is made either explicitly or implicitly a term or
       condition of employment;
    Submission to or rejection of such conduct by an individual is used as the basis of
       employment decisions affecting the individual; or
    Such conduct has the purpose or effect of substantially interfering with an
       individual’s work performance or creating an intimidating, hostile or offensive
       working environment.

This policy applies to all TOA employees (both supervisory and non-supervisory) and to
other individuals encountered in the course of business (e.g., patients, vendors).
Any employee who feels he or she has encountered any type of harassment should notify
his or her Manager/Supervisor (or director, as appropriate) or the Chief Executive
Officer. If an employee should witness acts of harassment in which a fellow employee is
the recipient or the offender, then that employee should report the incident to his or her
relevant manager and/or the Chief Executive Officer. TOA will not retaliate against an
individual who makes a report of sexual harassment nor permit any manager/supervisor
or employee to do so.

All incidents or complaints of harassment must be reported to the Chief Executive
Officer and/or the President of TOA. The Chief Executive Officer and/or the President
of TOA will investigate the allegation of harassment immediately. Any employee who is
found to have engaged in any type of harassment will be subject to appropriate
disciplinary action, up to and including termination. In the event of an allegation
involving a non-TOA employee, TOA will take appropriate action indicated by the
outcome of an investigation. All complaints will be promptly handled. TOA will make
every effort to keep complaints confidential except to the extent reasonably necessary to

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conduct a thorough investigation and decide on an appropriate response when the
investigation is complete.

Deliberately false accusations also are serious and subject to appropriate disciplinary
action.


Weapons

Under no circumstances are the following items permitted on company property,
including parking areas: all types of firearms; switchblade knives and knives with a blade
longer than four (4) inches; dangerous chemicals; explosives including blasting caps;
chains and other objects used for the purpose of injuring and/or intimidating.

Disciplinary action, up to and including discharge, will be taken against any employee
engaging in threats directed at other employees or behavior of a threatening or
intimidating nature.


Alcohol-and Drug-Free office

TOA is committed to a drug-free-and alcohol-free work environment. The possession or
use of illegal drugs or alcohol or the illicit use of prescription medications during
working hours is prohibited. Anyone who violates this rule or is working under the
influence of alcohol or drugs (except in accordance with a physician’s directions) will be
subject to disciplinary action, including immediate termination.

In order to ensure our commitment to provide all employees with a safe, healthy, and
secure workplace, the company, at its discretion, may conduct drug and alcohol testing.
For cause testing may be required of current employees in the event of unusual behavior,
injury or accident, damage to company property, gross negligence or carelessness;
disregard for the safety, life or well-being of any employee or patient, reporting to or
remaining at work in an apparently unfit condition, or any other reason TOA deems
sufficient.

Testing for the presence of alcohol may be conducted in any of three ways. An employee
may be required to submit to a saliva, breathalyzer or blood alcohol test. A blood alcohol
test may be used to confirm initial screening done by some other testing procedure.

Refusal of an employee to submit to or cooperate with the administration of an alcohol or
drug test or any attempt to invalidate or circumvent an alcohol or drug test will result in
termination of employment.

The results of drug and alcohol tests will be treated as confidential. In conjunction with a
drug or alcohol test, employees may also be requested by management to submit to a
search of personal property. Employees refusing to allow a search will be terminated.




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Destruction of Personal Information Records Policy

According to North Carolina’s “Identity Theft Protection Act,” any business that
conducts business in North Carolina and any business that maintains or otherwise
possesses personal information of a resident of North Carolina must take reasonable
measures to protect against unauthorized access to or use of the information in
connection with its disposal. Personal information is defined as a person’s first name or
first initial and last name in combination with the following identifying information:

      Social security or employer taxpayer identification numbers.
      Driver’s license, State identification card, or passport numbers.
      Checking account numbers.
      Savings account numbers.
      Credit card numbers.
      Debit card numbers.
      Personal Identification (PIN) Code.
      Electronic identification numbers, electronic mail names or addresses, Internet
       account numbers, or Internet identification names.
      Digital signatures.
      Any other numbers or information that can be used to access a person's financial
       resources.
      Biometric data.
      Fingerprints.
      Passwords.
      Parent's legal surname prior to marriage.

Therefore, in response to this law, Triangle Orthopaedics is adopting the following
Destruction of Personal Information Policy (Policy), which is designed to prevent
unauthorized access to or use of consumer information in connection with its disposal.
The responsibility for managing the Policy is delegated to Karen May (the Policy
Administrator). The Policy Administrator shall be responsible for auditing the purpose of,
content of and compliance with this Policy and for interpreting any portions of the Policy
as they may apply to specific situations.

The Policy Administrator shall be responsible for providing employees with written
copies of the most current version of the Policy and circulating reminders to employees
regarding compliance with the Policy on at least an annual basis, or more frequently if
deemed necessary by the Policy Administrator. Employees shall abide and comply with
the terms of the Policy, and all questions regarding the Policy and its application shall be
submitted to the Policy Administrator for review and guidance. Employees should
promptly report any possible violations or deviations from the Policy to the Policy
Administrator.

When paper records containing personal information are disposed of, they must be
shredded so that the information cannot be read or reconstructed.

When electronic information containing personal information is disposed of, it must be
destroyed or erased so that the information cannot be read or reconstructed, simply

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deleting the files is not sufficient. We must ensure that all the information on the hard
drive, computer disks and any other memory systems cannot be retrieved.

The Policy Administrator shall be responsible for supervising the process of document
destruction that occurs under this policy and for monitoring compliance. No employee
may destroy any personal information records under this policy (paper or electronic)
without prior approval from the Policy Administrator.

The Policy Administrator shall suspend the application of the Policy with respect to the
destruction of any records or documents if litigation or a government investigation is
foreseeable or imminent or if the corporation's actions come under any type of outside
scrutiny, including scrutiny in the press. Upon the occurrence of one of the above-
referenced events, as determined by the corporation’s CEO with the advice of legal
counsel, the Policy Administrator shall promptly notify employees via written
communication of the suspension of the Policy until further notice.


General Work Rules (Revised 1/1/10)

TOA work rules are not created to restrict the rights of any individual, but to protect the
many privileges enjoyed by all the employees of TOA. The rules outlined in this section
are not all-inclusive and, like all TOA guidelines, are subject to change based on current
needs. However, they are representative of the types of conduct which cannot be
permitted in any efficient and harmonious business organization. As a general guide, the
following list describes conduct which is not permitted at TOA and will lead to corrective
action up to and including termination.

      Falsification of employment application, time records, or other TOA documents.
      Clocking in or out for another employee or having another employee clock in or
       out for you.
      Insubordination, which is refusal to work or perform a reasonable assignment.
      Abusive, threatening, profane, coercive or harassing language/conduct to, or in the
       presence of, a supervisor, co-worker(s), patients, or visitors.
      Indecent, lewd or offensive sexually suggestive behavior.
      Taking, selling, distributing or having possession of drugs/narcotics or alcoholic
       beverages while on TOA business or on TOA property at any time, or being under
       the influence of such substances while in the performance of one’s duties.
      Deliberate damage/abuse/destruction of TOA property, patients’ property, or the
       property of another employee.
      Unauthorized removal of TOA, patient or co-worker property or proprietary
       information.
      Fighting on TOA property or while on TOA business.
      Horseplay, pranks or other disruptive behavior on TOA property or while
       conducting TOA business at any time.
      Willful violation or disregard of safety rules.
      Failure to adhere to dress code or wear required safety equipment in areas where
       designated.


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   Negligence in the performance of duties resulting in, for example, damaged
    equipment, low productivity, personal injury or injury to others, or the
    concealment of defective work.
   Failure to wear identification badges in plain view where required, or permitting
    another individual to use your building badge access key.
   The use of TOA equipment, material or time for personal work without
    permission.
   Possession of weapons, explosives, or other illegal items while on TOA business
    or TOA property.
   Possession of cameras or other recording devices without written authorization
    from the Chief Executive Officer or Chief Operating Officer while on TOA
    property or while conducting TOA business.
   Obtaining or attempting to obtain authorization for any kind of absence under false
    pretenses.
   Unauthorized leaving of the facility during working time.
   Stopping work before regular quitting time or leaving assigned work areas without
    permission, sleeping, or abuse of lunch or break periods.
   Speeding, improper parking, or reckless driving of vehicles on TOA property or
    while on TOA business.
   Posting unauthorized notices, defacing walls, or tampering with bulletin boards.
   Violation of established, posted, no solicitation/distribution policy.
   Failure to report a personal injury to your Supervisor/Manger and Human
    Resources Manager on the day it occurs.
   Disregard of established availability for work guidelines, or failure to provide
    proper notice or to obtain authorization as appropriate for absences.
   Eating or drinking in prohibited areas.
   Smoking in any facility.
   Excessive use of internet and cell phone (includes making and receiving calls and
    text messaging) for personal use, while on company time.




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Summary

This Personnel Policies Handbook is designed to help employees become more familiar
with TOA. It is a summary of TOA policies and procedures, which apply to all
employees and will provide them with positive guidance in their day-to-day working life.
Please read it carefully. Since this handbook cannot provide all the details on any given
subject, feel free to ask a manager, supervisor, or the Human Resources Department
about any sections that need clarification.

This handbook is not an employment contract and may not be all-inclusive. Changes will
be made from time to time based on employee input and the needs of the business.
Therefore, TOA reserves the right to modify the handbook in whole or in part as
required. Employees will be notified of changes as soon as possible; however, where
differences occur, official policies, procedures or benefit plans are the governing
documents.

Note: The following “Employee Personnel Policies Handbook Acknowledgement Page”
should be the final page. Upon issuance of the handbook, a management representative
will have the employee sign and date the form, remove it from the handbook, and place
the completed form in the employee’s personnel folder.

Revision Date

The Revision date for this booklet is June 15, 2010




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PERSONNEL POLICIES HANDBOOK

ACKNOWLEDGEMENT PAGE

TRIANGLE ORTHOPAEDIC ASSOCIATES, P. A.

Property of: Triangle Orthopaedic Associates, P. A.

Issued to: _________________________________

Date Issued: _______________________________

Acknowledgment of Review of Corporate Policies

I have received a copy of TOA’s personnel policies and procedures
handbook that outlines my privileges and obligations as an employee of
TOA. I will familiarize myself with the information in this handbook.

Since the information in the handbook is necessarily subject to change by
actions of the Board of Directors/physician(s), it is understood that changes
in policies as listed here, may be modified, superseded, or eliminated at any
time. All personnel in the practice will be notified of such changes through
the proper channels.

This handbook contains only general policy statements and is not to be
construed as a contract or agreement with any employee. Employment is
provided “at will” and TOA reserves the right to discharge an employee at
any time for any reason.



_________________________________________ ________________
Signature                                  Date


Please sign and return this page to the Manager of Human Resources




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