CTR054521_TB_Treatment_Services_A2.pdf

CONTRACT AMENDMENT

ARIZONA DEPARTMENT OF

HEALTH SERVICES

OFFICE OF PROCUREMENT

150 N 18th Ave., Ste. #530 Phoenix, Arizona 85007

CONTRACT NO.: CTR054521 AMENDMENT NO.: 2 Procurement Officer Nicole Marquez

TB Treatment Services

Effective upon signature by both parties, it is mutually agreed that the Contract referenced in this amendment is amended as follows:

1. Pursuant to the Special Terms and Conditions, Provision Three (3), Contract Extensions (5 Year Maximum), the

Contract is hereby extended through April 30, 2023.

ALL OTHER PROVISIONS SHALL REMAIN IN THEIR ENTIRETY

Contractor hereby acknowledges receipt and acceptance of above amendment and that a signed copy must be filed with the Procurement Office before the effective date

The above referenced Contract Amendment is hereby executed this _____ day of __________ 20______ at Phoenix, Arizona

(To be filled out by Procurement Office)

Contractor Signature

Contractor Signature Date

Authorized Signatory’s Name and Title

American Lung Association of Arizona

4/4/22

14th April 22

Christine Ruth

Digitally signed by Christine Ruth Date: 2022.04.14 12:53:55 -07'00'

4/19/22, 12:43 PM Arizona Corporation Commission https://ecorp.azcc.gov/BusinessSearch/BusinessInfo?entityNumber=00409579 1/3

ENTITY INFORMATION

Search Date and Time: 4/19/2022 12:43:07 PM

Entity Details

Entity Name:

AMERICAN LUNG ASSOCIATION OF THE SOUTHWEST, INC.

Entity ID:

00409579

Entity Type:

Domestic Nonprofit Corporation

Entity Status:

Inactive

Formation Date:

3/9/1948

Reason for Status:

Merged to/with other entity

Approval Date:

3/9/1948

Status Date:

6/30/2017

Original Incorporation Date:

3/9/1948

Life Period:

Perpetual

Business Type:

HOSPITAL/HEALTH CARE

Last Annual Report Filed:

Domicile State:

Arizona

Annual Report Due Date:

Years Due:

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Title Name Attention Address Date of Taking Office

Last Updated

Chairman of the Board of Directors

LARRY

BLUMENTHAL

102 WEST MCDOWELL

ROAD, PHOENIX, AZ,

85003, USA

7/1/2014 11/22/2016

Director

WENDY

LAWSON

102 W MCDOWELL ROAD,

PHOENIX, AZ, 85003, USA

7/1/2016 11/22/2016

Director

MICHAEL

SILER

102 W MCDOWELL ROAD,

PHOENIX, AZ, 85003, USA

7/1/2016 11/22/2016

Director

CHRIS

STANLEY

102 W MCDOWELL ROAD,

PHOENIX, AZ, 85003, USA

7/1/2015 11/22/2016

Director

JULIE

WILDER

102 W MCDOWELL ROAD,

PHOENIX, AZ, 85003, USA

7/1/2015 11/22/2016

3/9/1948

Statutory Agent Information

Name:

BILL J PFEIFER

Appointed Status:

Active

Attention:

Address:

102 W MCDOWELL ROAD , PHOENIX, AZ 85003, USA

Agent Last Updated:

7/7/2006

E-mail:

Attention:

Mailing Address:

102 W MCDOWELL ROAD , PHOENIX, AZ 85003, USA

County:

Principal Information

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Pending Documents Microfilm History

Address

Attention:

Address:

102 W MCDOWELL RD, PHOENIX, AZ, 85003, USA

County:

Maricopa

Last Updated:

12/3/2015

Entity Principal Office Address

Attention:

Address:

County:

Last Updated:

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