amendment to agreement documents/medical ga… · sarasota memorial ambulatory care heritage...

COOPERATWESERWCES 0 F F L 0 A I 0 A, I N C

AMENDMENT TO AGREEMENT

This Amendment ("Amendment"), dated March 21 , 2016, shall amend and modify the original Cylinder Gas Purchase Agreement, effective June 1, 2007, between Cooperative Services of Florida and Airgas-South, Inc. as follows:

1. Effective as of June 1, 2016, the Agreement is hereby amended to expire on October 31 , 2016.

2. Effective as of June 1, 2016, Section 9.5 Notices, with a copy to, is changed to Williams, Parker, Harrison, Dietz & Getzen, 200 South Orange Avenue, Sarasota, FL, 34236, Attention: Zach Buffington.

3. Effective as of June 1, 2016, the Facility Listing is deleted in its entirety and replaced with a new Facility Listing attached hereto and incorporated herein.

4. Effective as of June 1, 2016, Exhibit A, Products and Pricing, is deleted in its entirety and replaced with a new Exhibit A, Products and Pricing, attached hereto and incorporated herein.

5. Effective as of April 1, 2016, Exhibit A-1, Special Delivery Services, is added, attached hereto and incorporated herein.

6. Except as modified hereby, the Agreement shall remain in full force and effect. The Agreement and this Amendment shall be read and interpreted as a single document; provided, however, that this Amendment shall control in the event there is overlapping subject matter or a conflict between the Agreement and this Amendment. The enforceability of this Amendment shall not be affected by any integration clause in the Agreement.

7. Counterparts. This Amendment may be executed in counterparts, each of which shall be deemed an original instrument, but all of such counterparts together shall constitute but one instrument.

This Amendment is hereby executed as of the Effective Date by the parties' authorized representatives set forth below:

Title: President and CEO

Date 3~ 7

f Florida: Airgas-South, Inc.:

By £2,f? :f ~ Printed Name: rU I C.N-Hi { ' Tf c 1 Title: Jh SW d- fM.1J· Date: 3 h .J.ft ~

I I

2727 Winkler Avenue, Fort Myers, FL 33901

f Part1c1pa mg M b em er an ac11ty IS d F Tt L' t Lee Memorial Health System (EIN: 59-0714812)

Lee Memorial Hospital HealthPark Medical Center 2776 Cleveland Avenue 9981 HealthPark Circle Ft. Myers, FL 33901 Ft Myers FL 33908 Golisano Children's Hospital of Southwest Florida Gulf Coast Medical Center Lee Memorial Health System 9981 HealthPark Circle 13681 Doctor's Way Ft. Myers, FL 33908 Fort Myers, FL 33912

Lee Memorial Hospital Outpatient Surgery Center Regional Cancer Center Pharmacy 8960 Colonial Center Drive 8931 Colonial Center Drive Fort Myers FL 33905 Fort Myers FL 33905 The Rehabilitation Hospital Lee Memorial Health System Radiology 2776 Cleveland Avenue 12600 Creekside Lane Ft. Myers, FL 33901 Fort Myers, FL 33919

Lee Memorial Health System Employee Pharmacy Lee Memorial Health System Radiology 636 Del Prado Boulevard 16281 Bass Road Cape Coral. FL 33990 Fort Myers, FL 33908 Advanced Heart Center Access Infusion 14051 Metropolis Ave. 11220-31 Metro Parkway Ft. Myers, FL 33912 Fort Myers FL 33908 Lee Memorial Surgery Center Sanctuary 8970 Colonial Center Drive Ft. Myers, FL 33905

Physicians/Clinics (60) locations -upon request specific locations provided

Cape Memorial Hospital, Inc. (EIN: HealthPark Care Center, Inc. Lee Memorial Home Health, Inc. (EIN: 65-066651 6) (EIN: 65-0319983) 59-21861 01 ) Cape Coral Hospital HealthPark Care Center Lee Memorial Home Health 636 Del Prado Boulevard 16131 Roserush Court 2776 Cleveland Avenue Cape Coral, FL 33990 Ft. Myers, FL 33908 Ft. Myers, FL 33901

Sarasota County Public Hospital District (EIN: 59-6012500) Sarasota Memorial Hospital Bayside Center for Behavioral Health 1700 S. Tamiami Trail 1650 S. Osprey Avenue Sarasota FL 34239 Sarasota, FL 34239 Waldemere Medical Plaza Sarasota Memorial Care Center 1921 Waldemere Street Bee Ridge, 5682 Bee Ridge Road Sarasota, FL 34239 Sarasota, FL 34239

Community Medical Clinic North Port After-Hours Care Center 1700 So. Tamiami Trail North Port Clinic Shoppes Sarasota, FL 34239 14999 Tamiami Trail

North Port FL 34287 Outpatient Imaging/Breast Health Center Women's Diagnostic Center FDA Certified Mammography Facillly FDA Certified Mammography Facility Waldemere Medical Plaza 1801 Arlington Street 1921 Waldemere Street Sarasota, FL 34239 Sarasota, FL 3423 Sarasota Memorial Hospital Health Care BlackBurn Point Pain Care 6075 Rand Boulevard, Suite 2 929 South Tamiami Trail Sarasota, FL 34238 Osprey, Fl. 34229-0000

Sarasota Memorial Eastgale Rehabilitation Services Sarasota Memorial Gulfgate Rehabilitation Services 943 So. Beneva Road 6130-A Tamiami Trail Sarasota, FL 34232 Sarasota, FL 34231 Sarasota Memorial Southgate Rehabilitation Services Sports Medicine Center at Sarasota Memorial Hospital 3530 So. Tamiami Trail 4937 Clark Road Sarasota, FL 34239 Sarasota, FL 34233 Sports Medicine Center at The Evalyn Sadlier Jones Sarasota Memorial Lakeside Terrace Skilled Nursing Center Sarasota Family YMCA 5640 Rand Boulevard


Sarasota County Public Hospital District (EIN: 59-6012500) 8301 Potter Park Drive Sarasota, FL 34238 Sarasota, FL 34238 Sarasota Memorial Hospital Walk In Clinic Pain Care Center of Sarasota Memorial Health Care At Gulf 6130 S. Tamiami Trail Gate Sarasota, FL 34231 5880 Rand Blvd., Suit 206

Sarasota, FL 34238 Sarasota Memorial Ambulatory Care Heritage Harbour North Port Medical Plaza 1040 River Heritage Blvd 2345 Bobcat Village Center Road Bradenton, FL 34212-6348 North Port FL 34288 Sarasota Memorial Hospital Walk In Center The Cape Outpatient Surgery Center 2401 University Pkwy Ste. 105 941 Waldemere Street Sarasota, FL 34243 Sarasota, FL 34239

Health care Authority of Athens and Limestone Colbert County N.W. Alabama Healthcare Authority d/b/a (EIN: County d/b/a (EIN: 63-6002175) Athens-Limestone Hospital 700 West Market Street Athens, AL 35611

Marshall Medical Center South 2505 US Highway 431 Boaz, AL 35957

Marshall Cancer Care Center 11491 US Highway 431 Albertville, AL 35959

Decatur Morgan Hospital 1201 Seventh Street SE Decatur, AL 35601

Decatur General Oncology Center 1312 Seventh Street SE Decatur, AL 35601

Surgery Center of Decatur 1122 14th Avenue SE Decatur AL, 35601

Lawrence Medical Center 202 Hospital Street Moulton, AL 35650

63-0288825) Helen Keller Hospital Red Bay Hospital 1300 South Montgomery Avenue 211 Hospital Road Sheffield, AL 35660 Red Bay, AL 35582

Marshall Health System d/b/a (EIN: 63-6004458)

Marshall Medical Center North 8000 AL Highway 69 Guntersville, AL 35976

Decatur Morgan Hospital (EIN: 63-6000260)

Decatur General West 2205 Beltline RD SW Decatur, AL 35609

Surgery Center of Decatur (EIN: 48-1272405)

Lawrence Medical Center (EIN: )


The Healthcare Authority of the City of Huntsville d/b/a (EIN: 63-0845288}_

Huntsville Hospital Huntsville Hospital Employee Health Huntsville Hospital Pharmacy W&C 101 Silvey Road 101 Silvey Road 911 Big Cove Road Huntsville AL 35801 Huntsville, AL 35801 Huntsville AL 35801

Madison Hospital Parkway Medical Center Huntsville Hospital for Women & Children 8375 Hwy 72 W 1874 Beltline Rd. SW 245 Governors Drive Madison, AL 35758 Decatur, AL 35601 Huntsville, AL 35801

Heart Center Pharmacy Hospice Family Care Med Mall Pharmacy

930 Franklin Street 3304 Westmill Drive 1963 South Parkway

Huntsville AL 35801 Huntsville, AL 35805 Huntsville, AL 35801

Central Florida Health Alliance, Inc. d/b/a (EIN: 33-1197054) Leesburg Regional Medical Center The Villages Regional Hospital 600 East Dixie Avenue 1451 El Camino Real LeesburgLFL 34748 The VillaQes, FL 32159 Alliance Urgent Care (Riverside) OHME Rehab 3631 W Burleigh Blvd 700 N Palmeto Street Tavares, FL 32778 Leesburg, FL 34748 LRDSC The Villages Regional Hospital Out Patient 601 East Dixie Ave 8900 NE 134lh Ave Leesburg, FL 34748 Lady Lake FL 32159

OTHER Hope Hospice and Community Services, Inc Bonita Community Health Center (EIN: 59-2128697) (EIN: 59-3544102) 94 70 Health Park Circle 3501 Health Center Boulevard Fort Mvers FL 33908 Bonita Springs, FL 34135 Shell Point (EIN: 20-98293409) Lee County Board Of County Commissioners 15101 Shell Point Blvd 14752 Six Mile Cypress Fort Myers, FL 33908 Fort Myers, FL 33912

Hendry County Board of County Commissioners (EIN: Collier County Board of County Commissioners (EIN: 59-6000558) 56-6000639) 3327 Tamiami Trail East 1050 Forestry Division Road Naples, FL 34112 LaBelle, FL 33935 Sanibel Fire and Rescue Captiva Island Fire Control District (EIN: 59-2047287) (EIN:85-8012618982C-4) 14981 Captiva Drive 2351 Palm Ridge Rd Captiva, FL 33924 Sanibel FL 33957 The Pavilion at HealthPark, LLC dba Park Royal Southwest Florida Repackaging Psychiatric Hospital (EIN : 26-2955988) 2727 Winkler Avenue 9241 Park Royal Drive Fort Myers, FL 33901 Fort Myers, FL 33908 Surgery Center of Mount Dora, LLC (EIN: 26- Alliance Labs 2446297) (EIN: 264-322547) 3710 Lake Center Drive 1456 William Street Mount Dora FL 32757 LeesburQ, FL 34748

STS. Peter & Paul Church Globus Relief

404 Hudson Street {EIN: 84-1369453)

Hoboken, NJ 07030 1775 West 1500 South Salt Lake City, UT 84104

Bonita Springs Fire Control & Rescue District (EIN: Sarasota Manatee Jewish Housing Council, Inc. (EIN: 65-0091 025) 59-129205

27701 Bonita Grande Drive 1951 North Honore Avenue

Bonita S_mings, FL 34135 Sarasota, FL 34235

Miami Children's Hospital (EIN: 59-0638499) Surgery Center of SW Florida. d/b/a Cape Health Surgery Center 3100 S.W . 62"d Avenue (EIN: 45-4068750) Miami, FL 33155 665 Del Prado Blvd. S.

Cape Coral. FL 33990


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OTHER Gladiolus Surgery Center (EIN: 65-1025514) Surgical Specialists of Southwest Florida, P.A. & SWFL Vascular 7431 Gladiolus Drive Center (EIN: 59-1218806) Fort Myers, FL 33908 6821 Palisades Park Court, Suite 1

Fort Myers, FL 33912 Gulfcoast Surgeons, PL (EIN: 20-0690469) Florida Cancer Specialists PL (EIN: 65-0825133) 8010 Summerlin Lakes Drive, Suite 100 4371 VeronicaS. Shoemaker Blvd Ft. Myers, FL 33907 Fort Myers, FL 33916

Paramount Surgery Center LLC, d/b/a The Center for Florida Surgery Center Enterprises, LLC d/b/a Tampa Outpatient Specialized Surgery (EIN: 45-2232749) Surgical Facility (EIN: 20-8493127) 2565 Cleveland Avenue 5013 N. Armenia Avenue Fort Myers, FL 33901 Tampa, FL 33603 Garramone Plastic Surgery (EIN: 65-1 006094) Doctors Outpatient Surgery Center (EIN: 41-2097984) 12998 S. Cleveland Avenue 1005 Crosspointe Drive #2 Fort Myers, FL 33907 Naples, FL 34110

Schneider Center for Plastics (EIN: 65-0446788) Oral Facial & Implant Surgery PA (EIN: 59-2013100) 12751 S. Cleveland Avenue #102 1537 Brantley Road Fort Myers, FL 33907 Fort Myers, FL 33907

Physicians Day Surgery Center (EIN: 59-3438026) Heart to Heart Mission (EIN: 65-0763136) 850 111 th Avenue North 6910 Old Whiskey Drive Naples, FL 34168 Ft. Myers, FL 33919

Samaritan Health and Wellness Center, Inc. (EIN: The Salvation Army Fort Myers Area Command (EIN: 58-0660607) 46-0922358) PO Box 60087 643 Cape Coral Pkwy East Fort Myers, FL 33906-6087 Cape Coral , FL 33904 Summerlin Bend Surgery Center, LLP, dba Adult and Southwest FL Institute of Plastic Surgery Inc. dfb/a SWFL Institute Children's Surgery Center of SW FL (EIN: 59- of Ambulatory Surgery (EIN: 59-2430569) 2430569) 3700 Central Avenue, Ste. 1 5238 Mason Corbin CT. Suite 101 Fort Myers , FL 33901 Fort Myers, FL 33907 Surgery Center of Southwest Florida (EIN: 65- Collier Health Services, Inc. dfb/a Healthcare Network of Southwest 1022543) Florida (EIN: 59-1741277) 12631 Whitehall Drive 1454 Madison Avenue W Fort Myers FL 33907 Immokalee, FL 34142 Eye Physicians and Surgeon of FL dfb/a Snead Eye Family Health Centers of Southwest Florida, Inc (EIN: 59-1741273) Group (EIN: 59-2559784) 2256 Heitman Street 4790 Barkley Circle C103 Fort Myers, FL 33902 Fort Myers, FL 33907 Neighborhood Health Clinic (EIN: 59-3546884) Charlotte County, a political subdivision of the State of Florida (EIN: 121 Goodlette Road N 59-6000541) Naples, FL 34103 18500 Murdock Circle, Suite 344

Port Charlotte FL 33948 The Clinician, Primary and Urgent Care {EIN: 36- Promise Hospital of Lee dfb/a Promise Hospital of Ft. Myers (EIN: 4780075) 03-0508552) 1 0970 Cross Creek BLVD. 3050 Champion Ring Rd. Tampa, FL 33647 Ft. Myers FL 33905 Riverwalk Endoscopy & Surgery Center LLC {EIN: Internal Medicine Associate of Lee County, P.A. (EIN: 59-1614118) 20-1692912) 1400 Colonial Blvd. Ste 1 8380 Riverwalk Park Boulevard, Ste. 220 Fort Myers, FL 33901 Fort Myers, FL 33919 Air Trek Inc. {EIN: 59-1915238) White Sands Treatment (EIN: 46-1540462) 28000 A -5 Airport Road 1870 Colonial BLVD. Punta Gorda, FL 33982 Fort Myers, FL 33907

USEPPA Island Volunteer Fire Company, Inc. (EIN: Florida Heart Associates (EIN: 65-0690931) 65-0327797) 1550 Barkley Circle 200 Useppa Island Fort Myers, FL 33907 Bokeelia. FL 33922


OTHER Eye Centers of Florida, PA (EIN: 59-1429153) Gardner Orthopedics (EIN: 47-2702713) 2665 Oakridge Ct., Suite B 3033 Winkler Avenue Fort Myers, FL 33901 Fort Myers, FL 33916

South Florida Eye Clinic (EIN: 59-2159184) Lee Island Coast Surgery Center (EIN: 592-92-41 83) 3700 Central Avenue, Suite 2 4035 Evans Avenue Fort Myers, FL 33901 Fort Myers, FL 33901

Town of Longboat Key (EIN: 59-6017152) Gulf Coast Endoscopy Center (EIN: 62-1767599) 501 Bay Isles Road 7152 Coca Sabal Lane Longboat Key, FL 34228 Fort Myers, FL 33918

Seaside Surgery Center LLC {EIN: 47-2399984) Naples Urgent Care PL {E!N: 59-3649884) 1879 Veterans Park Dr. #11 01 1713 SW Health Parkway Naples, FL 34109 Naples, FL 34109

Cypress Cove at HealthPark Florida {E!N: 65-061085) 10200 Cypress Cove Drive Ft. Myers, FL 33908


Vendor Item Number

ACT1

ACT2

ACT 4, per hcf

AGM25

AGM 7.5·125

AIR 262-MED

AIRE

ARG 125

ARG 336

C02 50

C02 50-MED

C02 50-SYPH-MED

C02E

HEL110

HEL 221

HEL 221-MED

HELD

HEL E

HEL FILLER

MIX 200·10-99

MIX 200-188

MIX 200-189

MIX 200·3

MIX 200-4

MIX 200-57-20

MIX 200-57-30

MIX 200-57-40

MIX 200-70

MIX 200-79

MIX300-10

MIX 300-6

MIX E-102

MIX E-4

MIX E-4-99

MIX E-57-20

MIX E-57-25

MIX E-57-99

MIX E-6

MIX E-9

NIT20

NIT230

NIT 230-NF

NIT80

NITD

NITE

NIT LIQ 160

NIT LIQ 180

Exhibit A Products and Pricing

Purchase Description UM

Acetylene, MC CYL

Acetylene. B CYL

Acetylene, #4 per 100cf

Argon C02 125 cf CYL

Helium TriMix, 125 cf CYL

Air. Medical. H CYL

Air, Medical, E CYL

Argon. 125 cf CYL

Arg_on 336 cf CYL

C02, 50 lbs CYL

C02, Medical, 50 lbs CYL

C02, Medical syphon, 50 lbs CYL

C02, E CYL

Helium, 110 cf CYL

Helium. 221 c[ CYL

Helium. Medical 221 cf CYL

Helium. D CYL

Helium. E CYL

Helium filler EA

0.1 - 30% C02, Bal air CYL

0.3% CO, 0.3% Meth. 21% Oxy, Bal Nit CYL 0.3% CO, 0.3% Meth, 0.3% Act, 21% Oxy, Sal Nit CYL

5% C02, Balance Nitrogen CYL

0.3% CO, 10% Hel, 21% Oxv. Bal Nit CYL

20% Oxy, Bal Hel, USP CYL

30% Oxy, Sal Hel. USP CYL

40% Oxy, Sal Hel, USP CYL

5% C02 10% Hyd, Bal Nit, USP CYL 5% C02 10% Hyd, Bal Nit CYL

2.5% C02, Bal Air, Aerobic CYL

5% C02, Bal Nit, Anaerobic CYL

4% C02, 16% Oxv. Sal Nit. USP CYL

10% C02, Bal Nit, USP CYL

Clinical Blood Gas CYL

20% OX}', Bal Hel. USP. E CYL

25% Oxy, Bal Hel, USP, E CYL

QxvQen Bal Hel, USP CYL

4.5% C02 13.5% Nit. Bal Hel CYL

0.3% CO. 10% Hel, 21% Oxy, Bal Nit CYL

NitroQen. 20 cf CYL

Nitrogen, 230 cf CYL

Nltrog_en NF. 230 cf CYL

Nitrogen 80 cf CYL

Nitrogen, D CYL

Nitrogen E CYL

Nitrogen. liquid. low pressure CYL

Nitrogen, liquid, hlghpressure CYL

CylinCier Size

MC

8

Medium

M

M

H

E

M

T

G G

G E

M

K

K D

E

K K

K

K K

K

K K K K T

T

E

E

E

E

E

E

E

E R

K

K

Q

D

E

VGL VGL


PKG Level 1

Contract! Purchase ··cost UM QTY

$9.97 CYL 1

$15.06 CYL 1

$15.91 CYL 1

$17.05 CYL 1

$25.57 CYL 1

$5.68 CYL 1

$4.26 CYL 1

$11.36 CYL 1

$23.86 CYL 1

$11.74 CYL 1

$11 .74 CYL 1

$11 .74 CYL 1

$5.97 CYL 1

$24.76 CYL 1

$53.75 CYL 1

$53.75 CYL 1 $11.78 CYL 1

$11.78 CYL 1

$45.46 EA 1

$69.32 CYL 1

$120.18 CYL 1

$150.86 CYL 1

$52.27 CYL 1 $120.18 CYL 1

$51 .99 CYL 1

$54.26 CYL 1

$56.54 CYL 1

$67.05 CYL 1

$67.05 CYL 1

$78.41 CYL 1

$63.64 CYL 1

$58.13 CYL 1

$39.77 CYL 1 $46.59 CYL 1

$13.07 CYL 1

$13.07 CYL 1 $13.07 CYL 1

$45.46 CYL 1

$99.44 CYL 1

$4.55 CYL 1 $5.80 CYL 1

$5.80 CYL 1

$5.11 CYL 1 $3.41 CYL 1

$3.41 CYL 1

$41 .71 CYL 1

$43.1 8 CYL 1

PKG Level 1

ContracU .. Purchase Cylinder Purchase

Vendor Item Number Description UM Size Cost UM QTY

NOX20 Nitrous Oxide 20 lbs CYL F $18.94 CYL 1

NOXE Nitrous Oxide E CYL E $11 .84 CYL 1

NOXG Nitrous Oxide G CYL G $48.31 CYL 1

NOX LIQ 160 Nitrous Oxide, 180 liters CYL VGL $323.68 CYL 1

OXY20 Oxygen, 20 cf CYL R $3.41 CYL 1

OXY 282 Oxygen, 282 cf CYL H $4.72 CYL 1

SPC ARG-20 UHP Argon, 20 cf CYL R $25.11 CYL 1

SPC ARG-6000 Argon, 6,000 psi CYL 6K $150.86 CYL 1

SPC HEL-6000 Helium. 6,000 psi CYL 6K $164.21 CYL 1

SPC NIT-230-PP Nitrogen, prepure CYL K $13.07 CYL 1

TOX 282 Therapy Oxygen, 282 cf CYL K $5.40 CYL 1

TOX 336 Therapy Oxygen 336 cf CYL T $7.67 CYL 1

TOX80 Therapy Oxygen, 80 cf CYL Q $4.38 CYL 1

TOXD Therapy Oxygen, D CYL D $2.27 CYL 1

TOX E Therapy Oxygen, E CYL E $2.27 CYL 1 TOX E-REG Therapy Oxygen, E with regulator CYL E $2.67 CYL 1

Mix 200-70-5 5% C02, 5% Hy_d, Balnit, anerobic mix CYL K $69.06 CYL 1 Mix 200-117 .3% CO 5% Neon, 21% Oxy, Bal Nit CYL K $123.78 CYL 1

Nit Bulk Nitrogen Bulk Liquid CYL her $1 .05 CYL 1

SPC Hei-CHR-286 Helium, Chromatographic CYL T $259.52 CYL 1

SPC Air-312 Dry Specialty Gas Air 312 cf Dry CYL T $17.61 CYL 1

SPC Nit-304 Spec Gas Nitrogen UPC grade CYL T $39.77 CYL 1 TOX Liberator or equiv liquid Oxygen base unit for portable Oxygen CYL $0.51 CYL 1

Rental Charges

D & E cylinders per cylinder per month $1.56

E regulated cylinders per cylinder per month $3.1 2

Lab and Spec Gas per cylinder per month $3.64

Other high pressure 6000 psi cylinders per cylinder per month $26.00

Liquid per cylinder per month $31 .20

liberator or Equiv liquid Oxygen base unit 567.60 Other Charges

HazmaVCompliance $0.00

Cylinder Maintenance $0.00

Standard Delivery $15.60


Health System

Exhibit A-1 Special Delivery Services

Description

Sarasota Memorial Health Care System Custom Delivery three (3) times per week


Monthly Charge

$2 ,000.00

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