Independent Contractor Representations

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These Independent Contractor Representations are intended to ensure that Helios Home Health only does business with individuals who truly are self-employed.

I understand that Helios Home Health is asking me to complete this document to avoid any misunderstanding by me as to the nature of the contractual relationships that Helios Home Health offers; and that if I cannot honestly make the representations contained in this document then the contractual relationships that Helios Home Health offers are not suitable for me.

Accordingly, I hereby represent and affirm that:

I operate my own business as a self-employed care provider.

Initials*

- I am engaging Helios Home Health to provide my business with the following services, namely, (i) background screening, (ii) referrals of client opportunities, and (iii) assistance in certain administrative aspects of billing and collection.

Initials*

- I am not seeking employment with Helios Home Health and am aware that other firms exist that do offer employment opportunities for care providers, but prior to entering into a contractual relationship with Helios Home Health, I made the decision to operate my own business as a self-employed care provider.

Initials*

- I understand that Helios Home Health represents only one channel through which I can market my business, and that Helios Home Health does not restrict me in any way from marketing my business through other means.

Initials*

- I am responsible for my own profit and loss and do not intend to rely exclusively on Helios Home Health as my sole means for obtaining new clients.

Initials*

- I am responsible for paying all taxes and for filing all tax returns with respect to all income I derive from performing services for clients referred to me by Helios Home Health.

Initials*

- I understand that I am solely responsible for any work-related injuries to me or to my employees, if any, and for complying with any State laws that relate to such injuries.

Initials*

- I understand that, as a sole proprietor of my business, my relationship with Helios Home Health will not make me eligible for unemployment compensation benefits.

Initials*

- I do not anticipate receiving any training, instructions, equipment, materials or supplies from Helios Home Health.

Initials*

By signing below, I hereby represent and warrant that I have carefully read and fully understand each and every one of the foregoing representations and that I initialed only those statements that are true and correct with respect to me. I understand that Helios Home Health relies upon these representations as a condition for entering into an agreement with me.

Name of Independent Contractor:*

Signature:*

Date:*

Name

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