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Information last revised February 2014

Puck Wind River Tobacco Company, LLC Moist Snuff 6/15/2011 American Bison - Fine Cut Wintergreen 1.2 oz

If there are insufficient shared savings to recoup the prepaid shared savings made to an ACO for a performance year, we would hold paying future prepaid shared savings payments and carry forward the remaining balance owed to subsequent performance year(s) in which the ACO achieves shared savings

Monitoring ACO Eligibility for and Use of Prepaid Shared Savings To provide CMS with a clear indication of how ACOs intend to spend prepaid shared savings, help provide adequate protection to the Medicare Trust Funds, and prevent funds from being misdirected or appropriated for activities that do not fall within the parameters set forth within proposed 425.640(e), we propose in 425.316(f)(1) to monitor ACOs receiving prepaid shared savings for compliance with 425.640(e) and to determine whether it would be appropriate to withhold or terminate an ACO's prepaid shared savings under 425.640(h)(1) and (h)(2)