CSP009743_DMH009_-_Amendment_6.pdf

Index No.: DMH009 Contract No.: CSP009743 Eff. Date: 07/01/25

STATE OF OHIO

DEPARTMENT OF ADMINISTRATIVE SERVICES

GENERAL SERVICES DIVISION

OFFICE OF PROCUREMENT SERVICES

4200 SURFACE ROAD, COLUMBUS, OH 43228-1395

AMENDMENT FOR CHANGE

AMENDMENT NO. 6

TO: LIMITED DISTRIBUTION – OHIO DEPARTMENT OF MENTAL HEALTH AND ADDICTION SERVICES

FROM: KATHLEEN C. MADDEN, DIRECTOR, DEPARTMENT OF ADMINISTRATIVE SERVICES

SUBJECT: CONTRACT FOR ELECTROENCEPHALOGRAM COMBINED TRANSCRANIAL MAGNETIC STIMULATION

(ETMS) PROGRAM

Attached are pages two, four, five, and six to this contract. Remove these pages from the existing contract and replace with the attached pages on the effective date.

This amendment is used to denote an update to the scope of work and the pricelist, effective on all orders placed on or after 07/01/25. Additionally, this amendment is issued to denote repagination.

All other prices, terms and conditions remain unchanged.

This Amendment, the main Requirements Contract and any additional amendments thereto are available from the DAS Web site at the following address:

http://www.ohio.gov/procure

Affected Contractor(s):

Perry Behavioral Health Choices Inc tkane@perrybhc.org 221 North Main Street New Lexington, OH 43764 0000047127

Eff. Date.: 07/01/25

MUTUALLY AGREED UPON CLARIFICATIONS / MODIFICATIONS TO THE RFP

*EFFECTIVE 07/01/25:

CSP907222 DMH009 - eTMS Deliverables SFY26

EFFECTIVE 07/01/24, AS APPLICABLE:

CSP009743 DMH009 - Cost_Summary_Form (V2)

EFFECTIVE 12/01/23-11/30/25, AS APPLICABLE:

CSP009743 DMH009 - eTMS Renewal Request for Submission 2.0 CSP009743 DMH009 - Cover Letter CSP009743 DMH009 - Table of Contents CSP009743 DMH009 - Addendum B. Candidate References CSP009743 DMH009 - Gantt Chart CSP009743 DMH009 - Cost_Summary_Form (V1)

EFFECTIVE 05/01/23, AS APPLICABLE:

DMH009 - April 2023 invoice DMH009 - 02_03_23_FINAL Replacement Personnel Corrective Action Plan

The following documents supplement/amend the Corrective Action Plan, as applicable:

DMH009 - DAS & OMHAS Request for Additional Information Concerning Corrective Action Plan DMH009 - 04_03_23_DAS_Response DMH009 - 03_24_23_DAS_Response DMH009 - 03_09_23_Response_DAS_updated DMH009 - Clinical and FDA Cost Summary Form 04_25_23 DMH009 - 03_24_23_CAP_Medical_Org_Chart DMH009 - Personal Profile Summaries DMH009 - Revised Gantt Chart DMH009 - Business Associate Agreement DMH009 - Clinical Services Agreement DMH009 - Equipment and Supplies List DMH009 - SOC 2 Report

DMH009 - Vendor Clarifications - 7.0 – Accepted 08/24/22 DMH009 - Revised Cost Summary 5s 6m – Accepted 07/21/22 DMH009 - Revised Gannt Chart 5s 6m – Accepted 07/21/22 DMH009 – Supplement S – Accepted 08/26/22

Professional Liability (Medical Malpractice) Insurance appropriate to the Contractor’s profession, with limits not less than $5,000,000 per occurrence or claim, $5,000,000 aggregate. Coverage shall be sufficiently broad to respond to the duties and obligations as is undertaken by Contractor in this agreement and shall cover all applicable Contractor personnel or subcontractors who perform professional services related to this agreement.

*Denotes an update to the scope of work and pricelist, effective on all orders placed on or after 07/01/25, per amendment 6.

Page No. 4

COST SUMMARY FORM

*The costs below will be paid in accordance with CSP907222 DMH009 - eTMS Deliverables SFY26, effective 07/01/25.

SERVICE DESCRIPTION QTY RATE

TOTAL

AMOUNT

1. DIRECT PATIENT CARE

eTMS Treatment [per patient] (includes evaluation, 20-30 sessions, monitoring, and follow-up; assumes one chair and one sonal per site)

$6,000.00

$48,000.00

2. EQUIPMENT AND TECHNOLOGY BY SITE

Wave Neuroscience eTMS Technical Support & Subscriptions 1 $6,700.00 $6,700.00

Equipment Rental and Maintenance 1 $2,500.00 $2,500.00

3. PROGRAM ADMINISTRATION BY SITE

Project Management and Operations 1 $7,133.33 $7,133.33

Training and Clinical Oversight 1 $9,000.00 $9,000.00

Marketing and Patient Recruitment 1 $10,000.00 $10,000.00

TOTAL MONTHLY BUDGET PER SITE $83,333.33

TOTAL MONTHLY BUDGET $416,666.66

Total Patients Served: 100 per year per site. 500 patients total per year.

*Denotes an update to the pricelist, effective on all orders placed on or after 07/01/25, per amendment 6.

*Page No. 5

CONTRACTOR INDEX

CONTRACTOR AND TERMS: CONTRACT NO: CSP009743

0000047127 Perry Behavioral Health Choices Inc TERMS: Net 30 Days

221 North Main Street New Lexington, OH 43764

CONTRACTOR’S CONTACT: Joe Charles Telephone: (330)-687-0742 Email: jcharles@jlcservicesinc.com

APPROVED SUBCONTRACTOR(S):

Brain Treatment Center - Columbus JLC Services, Inc Meridian HealthCare Wave Neuro Wright State University WVUMedicine Zeto

*Denotes repagination, per amendment 6.

jcharles@jlcservicesinc.com

Eff. Date.: 07/01/25

SUMMARY OF AMENDMENTS

Amendment Number

Effective Date

Description

6 07/01/25

This amendment is used to denote an update to the scope of work and the pricelist, effective on all orders placed on or after 07/01/25. Additionally, this amendment is issued to denote repagination.

All other prices, terms and conditions remain unchanged.

5 11/15/24

This amendment is issued to denote the addition of contract terms, an update to the Scope of Work, and an update to the pricelist with additional funds for deliverables, effective on all orders placed on or after 07/01/24.

All other prices, terms and conditions remain unchanged.

4 12/01/23

This amendment is issued to notify of a twenty-four (24) month renewal as a result of mutual agreement, effective 12/01/23 – 11/30/25. Additionally, this amendment is issued to denote an update to the Scope of Work and the pricelist, effective on all orders placed on or after 12/01/23.

All other prices, terms and conditions remain unchanged.

3 11/01/23

The State of Ohio elects to exercise its option to renew the subject contract for an additional one month effective 11/01/23 through 11/30/23.

All other prices, terms and conditions remain unchanged.

2 05/03/23

This amendment is issued to update the Ohio Buys pricelist to remove all items and replace them with a single amount (AMT) line item effective on all orders on or after 05/03/23.

Additionally, this amendment is issued to correct the agency’s name on page 1 of this contract and to add the asterisk to the bottom of page 3.

1 05/01/23

This amendment is issued to denote an update to the scope of work, update the approved subcontractors list, and the pricelist, effective on all orders placed on or after 05/01/23. Additionally, this amendment is issued to notify that as a result of mutual agreement between the State of Ohio and the Contractor, this contract is renewed for an additional four (4) months, effective 07/01/23 through 10/31/23.

All other prices, terms and conditions remain unchanged.