CTR050598 A4.pdf
PDF 578 KB Posted
- Attached to
- Master Agreement AZ|CTR050598
- Contract number
- CTR050598
- Issued by
- Arizona
About this file
This document is a Contract Amendment (Amendment No. 4) between the Arizona Department of Health Services (ADHS), Office of Procurement, and Native Health, a Native American nonprofit community health organization located in Phoenix, Arizona. The contract number is CTR050598, and the amendment modifies the original contract's terms and conditions, specifically updating the Special Terms and Conditions and replacing the Fixed Price Sheet with a Cost Reimbursement Price Sheet.
The amended contract is for health services with a one-year term, renewable for up to five additional years in twelve-month increments. The total budget for State Fiscal Year 2024 (July 1, 2023 to June 30, 2024) is $232,535.00, broken down across several cost categories including Personnel ($201,622.22), ERE (Employer Related Expenses) of $17,440.00, Professional & Outside Services of $3,200.00, Travel Expenses of $24,247.00, Occupancy of $1,140.00, Other Operating Expenses of $900.00, and Capital Outlay Expense of $44,435.00. The contract is classified as a Cost Reimbursement type, meaning Native Health will be reimbursed for actual expenses incurred up to the budgeted amounts. Authorization for service purchases will be made through specific Purchase Orders issued by ADHS.
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09/05/2023 Gina Corwin
Digitally signed by Gina Corwin Date:
2023.09.07 11:31:21 -07'00'
8/30/23, 11:22 AM Arizona Corporations Commission https://ecorp.azcc.gov/BusinessSearch/BusinessInfo?entityNumber=01177286 1/2
ENTITY INFORMATION
Search Date and Time: 8/30/2023 11:22:28 AM
Title Name Attention Address Date of Taking Office
Last Updated
CEO (Chief Executive Officer)
WALTER
MURILLO
4041 N CENTRAL AVE, BLDG C,
PHOENIX, AZ, 85012, Maricopa County, USA
9/30/2000 2/1/2019
Entity Details
Entity Name: NATIVE HEALTH Entity ID: 01177286
Entity Type: Domestic Nonprofit Corporation Entity Status: Active
Formation Date: 8/31/1978 Reason for Status: In Good Standing
Approval Date: 8/31/1978 Status Date:
Original Incorporation Date:
8/31/1978 Life Period: Perpetual
Business Type: Other - NATIVE HEALTH Last Annual Report Filed: 2023
Domicile State: Arizona Annual Report Due Date: 1/31/2024
Years Due:
Original Publish Date: 9/19/1978
Statutory Agent Information
Name: WALTER MURILLO Appointed Status: Active
Attention:
Address: 4041 N CENTRAL AVE BLDG C , PHOENIX, AZ 85012, USA
Agent Last Updated: 12/28/2022 E-mail:
Attention: Mailing Address:
County: Maricopa
Principal Information
Privacy Policy (http://azcc.gov/privacy-policy) ǀ Contact Us (http://azcc.gov/corporations/corporation-contacts) http://azcc.gov/privacy-policy http://azcc.gov/corporations/corporation-contacts
8/30/23, 11:22 AM Arizona Corporations Commission https://ecorp.azcc.gov/BusinessSearch/BusinessInfo?entityNumber=01177286 2/2
Page 1 of 1, records 1 to 4 of 4
Title Name Attention Address Date of Taking Office
Last Updated
Director Jeanine Edaakie
4041 N CENTRAL AVE, BLDG C,
PHOENIX, AZ, 85012, Maricopa County, USA
6/20/2017 1/4/2022
CFO (Chief Financial Officer)
Cody Nelson
4041 N CENTRAL AVE BLDG C,
PHOENIX, AZ, 85012, Maricopa County, USA
7/6/2018 2/1/2019
Treasurer Brianna Jagelski
4041 N CENTRAL AVE BLDG C,
PHOENIX, AZ, 85012, Maricopa County, USA
8/1/2015 1/4/2022
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Return to Results
Document History Name/Restructuring History
Pending Documents Microfilm History
Address
Attention:
Walter Murillo
Address: 4041 N CENTRAL AVE BLDG C, PHOENIX, AZ, 85012, USA
County:
Maricopa
Last Updated: 12/28/2022
Entity Principal Office Address
Attention: Address: County: Last Updated:
Privacy Policy (http://azcc.gov/privacy-policy) ǀ Contact Us (http://azcc.gov/corporations/corporation-contacts) http://azcc.gov/privacy-policy http://azcc.gov/corporations/corporation-contacts
NATIVE HEALTH
Unique Entity ID
MQGXUX1QMZL8
CAGE / NCAGE
494S5
Purpose of Registration
All Awards
Registration Status
Active Registration
Expiration Date
Dec 6, 2023
Physical Address
4041 N Central AVE Building C
Phoenix, Arizona 85012-3313
United States
Mailing Address
4041 N Central AVE Building C
Phoenix, Arizona 85012-3313
United States
Business Information
Doing Business as
Native American Community Health Center
Division Name
(blank)
Division Number
(blank)
Congressional District
Arizona 09
State / Country of Incorporation
Arizona / United States
URL
(blank)
Registration Dates
Activation Date
Dec 8, 2022
Submission Date
Dec 6, 2022
Initial Registration Date
Jan 5, 2006
Entity Dates
Entity Start Date
Aug 30, 1978
Fiscal Year End Close Date
Sep 30
Immediate Owner
CAGE
(blank)
Legal Business Name
(blank)
Highest Level Owner
CAGE
(blank)
Legal Business Name
(blank)
Executive Compensation
Registrants in the System for Award Management (SAM) respond to the Executive Compensation questions in accordance with Section 6202 of
P.L. 110-252, amending the Federal Funding Accountability and Transparency Act (P.L. 109-282). This information is not displayed in SAM. It is sent to USAspending.gov for display in association with an eligible award. Maintaining an active registration in SAM demonstrates the registrant responded to the questions.
Proceedings Questions
Registrants in the System for Award Management (SAM.gov) respond to proceedings questions in accordance with FAR 52.209-7, FAR 52.209-9, or 2. C.F.R. 200 Appendix XII. Their responses are displayed in the responsibility/qualification section of SAM.gov. Maintaining an active registration in SAM.gov demonstrates the registrant responded to the proceedings questions.
Exclusion Summary
Active Exclusions Records?
No
SAM Search Authorization
I authorize my entity's non-sensitive information to be displayed in SAM public search results:
Yes
Entity Types
Business Types
Entity Structure
Corporate Entity (Tax Exempt)
Entity Type
Business or Organization
Organization Factors
(blank)
Profit Structure
Non-Profit Organization
Last updated by FRANCIE BROWN-SPENCER on Dec 06, 2022 at 04:17 PM NATIVE HEALTH
Aug 30, 2023 06:25:02 PM GMT https://sam.gov/entity/MQGXUX1QMZL8/coreData?status=Active Page 1 of 3
Socio-Economic Types
Minority-Owned Business
Native American Owned
Check the registrant's Reps & Certs, if present, under FAR 52.212-3 or FAR 52.219-1 to determine if the entity is an SBA-certified HUBZone small business concern. Additional small business information may be found in the SBA's Dynamic Small Business Search if the entity completed the
SBA supplemental pages during registration.
Federally Recognized Native American Entity
American Indian Owned
Financial Information
Accepts Credit Card Payments
Yes
Debt Subject To Offset
No
EFT Indicator
CAGE Code
494S5
Points of Contact
Electronic Business
Deanna Sangster, COO 4041 N Central Avenue
Building C
Phoenix, Arizona 85012
United States
WALTER Murillo 4041 N Central Avenue Building C
Building C
Phoenix, Arizona 85012
United States
Government Business
WALTER Murillo, CEO 4041 N Central Avenue
Building C
Phoenix, Arizona 85012
United States
Cody Nelson 4041 N Central Avenue Building C
Phoenix, Arizona 85012
United States
Past Performance
Deanna Sangster 4041 N Central Avenue Building C
Phoenix, Arizona 85012
United States
Francie Spencer 4041 N Central Avenue
Building C
Phoenix, Arizona 85012
United States
Service Classifications
NAICS Codes
Primary
Yes
NAICS Codes
621111
NAICS Title
Offices Of Physicians (Except Mental Health Specialists)
621210 Offices Of Dentists
621330 Offices Of Mental Health Practitioners (Except Physicians)
621420 Outpatient Mental Health And Substance Abuse Centers
Disaster Response
Yes, this entity appears in the disaster response registry.
No, this entity does not require bonding to bid on contracts.
Bonding Levels Dollars
Last updated by FRANCIE BROWN-SPENCER on Dec 06, 2022 at 04:17 PM NATIVE HEALTH https://sam.gov/entity/MQGXUX1QMZL8/coreData?status=Active Page 2 of 3
(blank)
States
Arizona
Counties
AZ: Maricopa
Metropolitan Statistical Areas
(blank)
Last updated by FRANCIE BROWN-SPENCER on Dec 06, 2022 at 04:17 PM NATIVE HEALTH https://sam.gov/entity/MQGXUX1QMZL8/coreData?status=Active Page 3 of 3
8/30/23, 11:21 AM OIG Search Results https://exclusions.oig.hhs.gov/SearchResults.aspx 1/1
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NATIVE AMERICAN COMMUNITY HEALTH CENTER
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Search conducted 8/30/2023 2:21:09 PM EST on OIG LEIE Exclusions database.
Source data updated on 8/10/2023 9:00:00 AM EST
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8/30/23, 11:22 AM Search Results - Arizona Secretary of State https://apps.azsos.gov/apps/tntp/rd.html 1/2
Result Detail Back
File ID: 9111025
Name: Native American Community Health Center
Business Address:
4041 N CENTRAL AVE BLDG C
PHOENIX, Arizona 85012
Mailing Address:
4041 N CENTRAL AVE BLDG C
PHOENIX, Arizona 85012
Phone: 602-279-5262
Nature of Business:
Community health and wellness services
Date of First Use:
August 20, 1996
Date Registered:
June 10, 2019
Expiration Date:
June 10, 2024
Applicants:
NATIVE HEALTH Arizona Corporation
Registration Information:
Registration Received:
June 10, Expires: June 10, (https://azsos.gov/)
(https://azsos.gov/webform/contact-azsos)
(https://www.facebook.com/SecretaryHobbs) (https://twitter.com/SecretaryHobbs) (https://www.instagram.com/azsecretaryhobbs)
(https://azsos.gov/)
Home (https://azsos.gov/)
Elections (https://azsos.gov/elections)
Business (https://azsos.gov/business)
Services (https://azsos.gov/services)
Rules (https://azsos.gov/rules)
About the Office (https://azsos.gov/about-office)
ELECTIONS (HTTPS://AZSOS.GOV/ELECTIONS) BUSINESS (HTTPS://AZSOS.GOV/BUSINESS) SERVICES (HTTPS://AZSOS.GOV/SERVICES) RULES (HTTPS://AZSOS.GOV/RULES)
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Correspondence History:
Trade Name Application:
Filed: June 10, 2019
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Phoenix AZ 85007
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