application for certificate of need

Application forCertificate of Need

Christian HospitalAcquire MRI System

Project #5907 HS

Submitted ToMissouri Health Facilities Review Committee

October 2021

luxm

Sticky Note

rec'd 10/22/21

Certificate of Need Program NEW OR ADDITIONAL EQUIPMENT APPLICATION Applicant’s Completeness Checklist and Table of Contents

Project Name:________________________________________________________ Project No:_____________________________

Project Description:_______________________________________________________________________________________________

Done Page N/A Description

Divider I. Application Summary:

__ ________ __ 1. Applicant Identification and Certification (Form MO 580-1861) __ ________ __ 2. Representative Registration (From MO 580-1869) __ ________ __ 3. Proposed Project budget (Form MO 580-1863) and detail sheet with documentation of costs.

Divider II. Proposal Description:

__ ________ __ 1. Provide a complete detailed project description and include equipment bid quotes.

__ ________ __ 2. Provide a timeline of events for the project, from CON issuance through project competition.

__ ________ __ 3. Provide a legible city or county map showing the exact location of the project.

__ ________ __ 5. Provide 2025 population projections for the proposed geographic service area.__ ________ __ 6. Provide other statistics to document the size and validity of any user-defined geographic service area.__ ________ __ 7. Identify specific community problems or unmet needs the proposal would address.__ ________ __ 8. Provide the historical utilization for each of the past three years and utilization projections through the

__ ________ __ 9. Provide the methods and assumptions used to project utilization.__ ________ __ 10. Document that consumer needs and preferences have been included in planning this project and describe

h how consumers had an opportunity to provide input.

__ ________ __ 11. Provide copies of any petitions, letters of support or opposition received.

Divider III. Service Specific Criteria and Standards:

__ ________ __ 1. For new units, address the need formula for the proposed geographic service area.

first three (3) FULL years of operation of the new equipment.

__ ________ __ 2. For new units, address the minimum annual utilization standard for the proposed geographic service area.

__ ________ __ 3. For any new unit where specific need and utilization standards are not listed, provide the methodology fordetermining need.

__ ________ __ 4. For additional units, document compliance with the optimal utilization standard, and if not achieved,provide documentation to justify the additional unit.

__ ________ __ 5. For evolving technology address the following:- Medical effects as described and documented in published scientific literature;

__ ________ __

- The degree to which the objectives of the technology have been met in practice;- Any side effects, contraindications or environmental exposures;

Divider IV. Financial Feasibility Review Criteria and Standards:

1. Document that sufficient financing is available by providing a letter from a financial institution or anauditor's statement indicating that sufficient funds are available.

2. Provide Service-Specific Revenues and Expenses (Form MO 580-1865) projected through three (3) FULLyears beyond project completion.

__ ________ __

3. Document how patient charges are derived.

- The relationships, if any, to existing preventive, diagnostic, therapeutic or management technologies and

__ ________ __

4. Document responsiveness to the needs of the medically indigent.

the effects on the existing technologies;

__ ________ __

- Food and Drug Administration approval;- The need methodology used by this proposal in order to assess efficacy and cost impact of the proposal;

__ ________ __

- The degree of partnership, if any, with other institutions for joint use and financing.

MO 580-2503 (03/20)

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4. Define the community to be served.

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Divider I. Application Summary:1. Applicant Identification and Certification (Form MO 580-1861).See attached.

2. Representative Registration (Form MO 580-1869).See attached.

3. Proposed Project Budget (Form MO 580-1863) and detail sheet.See attached.

CON #5907 Page 2

The information provided m .

Christian Hospital—add MRI 5907HS

11133 Dunn Rd, St. Louis, MO 63136 St. Louis County

Christian Hospital 11133 Dunn Rd, St. Louis, MO 63136 314-323-1231

Christian Hospital 11133 Dunn Rd, St. Louis, MO 63136 314-323-1231

Greg Bratcher Dir., Government Relations

314-323-1231 314-747-8893 [email protected]

CON #5907 Page 3

Christian Hospital NE/NW—Add MRI 5907HS

Greg Bratcher Dir., Gov. Relations

BJC HealthCare 314-323-1231

4901 Forest Park Ave, Suite 1220, MS 90-75-574, St. Louis, MO 63108

BJC HealthCare 314-323-1231

4901 Forest Park Ave, Suite 1220, MS 90-75-574, St. Louis, MO 63108

10/21/2021

Digitally signed by Greg BratcherDN: cn=Greg Bratcher, c=US,o=BJC HealthCare,[email protected]: 2021.10.22 00:06:38 -05'00'

GregBratcher

CON #5907 Page 4

$0

$3,008,074

$3,008,074$3,008,074

$3,008,074

$3,008,074

CON #5907 Page 5

Siemens Medical Solutions USA, Inc.40 Liberty Boulevard, Malvern, PA 19355

SIEMENS REPRESENTATIVEGregory Thudium

[email protected]

Created: 04/23/2021 20:22:05 Siemens Medical Solutions USA, Inc. Confidential Page 1 of 34P-CPQ-355343-0-4

Customer Number: 0000004627

BJC HEALTH SYSTEM4249 CLAYTON AVE STE 310SAINT LOUIS, MO 63110

Date: 04/23/2021

Siemens Medical Solutions USA, Inc. is pleased to submit the following quotation for the products and servicesdescribed herein at the stated prices and terms, subject to your acceptance of the terms and conditions on the faceand back hereof, and on any attachment hereto.

Table of Contents PageMAGNETOM Vida - System (Quote Nr. CPQ-355343 Rev. 0) ................................................................................ 3OPTIONS for MAGNETOM Vida - System (Quote Nr. CPQ-355343 Rev. 0) ..........................................................16General Terms and Conditions ..............................................................................................................................18Warranty Information .............................................................................................................................................29Detailed Technical Specifications ..........................................................................................................................30

Contract Total: $ 2,758,074(total does not include any Optional or Alternate components which may be selected)

Proposal valid until 06/30/2021

Estimated Delivery Date: 1/31/2022

Estimated delivery date is subject to change based upon factory lead times, acceptance date of this quote,customer site readiness, and other factors. A Siemens representative will contact you regarding the final deliverydate.

Delivery dates and other contractual obligations of Seller may change due to the effects of the Covid-19 epidemicor other epidemic, including delays and disruptions in the supply chain, manufacturing, or execution as well ordersby authorities and prioritization of (new and existing) orders of customers which are essential for the publichealthcare. The magnitude of such changes cannot be predicted and might be substantial because it depends onthe development of the Covid-19 epidemic or other epidemic.

This quote CPQ-355343 represents a conversion of Siemens quote # 1-QXP7QG Rev. 0 dated 9/18/2019, BJCHEALTH SYSTEM Purchase Order #1100344597 dated 09/18/2019, and Siemens Sales Order # 30230069, from aMAGNETOM Sola system to a MAGNETOM Aera system as quoted herein. Pricing is as quoted herein and termsand conditions are in accordance with those included in this quotation. Any change in price from the MAGNETOMSola system will require a new or revised PO from BJC HEALTH SYSTEM.

This offer is only valid if a firm, non-contingent order is placed with Siemens and a signed POS contract mustaccompany the equipment order.

Accepted and Agreed to by:

Siemens Medical Solutions USA Inc. BJC HEALTH SYSTEM

By (sign): By (sign):

Name: Gregory Thudium Name:

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[email protected]


Title: Title:

Date: Date:

By signing below, signor certifies that no modifications or additions have been made to the Quotation.Any such modifications or additions will be void.

By (Sign): ________________________________

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[email protected]


Quote Nr: CPQ-355343 Rev. 0

Terms of Payment: 00% Down, 80% Delivery, 20% InstallationFree On Board: Destination

Purchasing Agreement: VIZIENT SUPPLY LLC

VIZIENT SUPPLY LLC terms and conditions apply to QuoteNr CPQ-355343

Customer certifies, and Siemens relies upon suchcertification, that : (a) VIZIENT MR - XR0394 is the sole GPOfor the purchases described in this Quotation, and (b) theperson signing this Quotation is fully authorized under theCustomer’s policies to choose and indicate for Customersuch appropriate GPO.

MAGNETOM Vida - SystemAll items listed below are included for this system: (See Detailed Technical Specifications at end of Proposal.)

Qty Part No. Item Description1 14456200 MAGNETOM Vida - System

MAGNETOM Vida – the first BioMatrix system – leverages the intelligentcombination of Tim 4G and the Siemens unique BioMatrix technology to be ready toembrace the unique set of challenges that each and every patient brings to the MRIexam.

System Design- Short and open appearance (186 cm total system length cover-to-cover and 70 cmOpen Bore Design) to reduce patient anxiety and claustrophobia- Whole-body superconductive Zero Helium Boil-Off 3T magnet- Weight-optimized magnet technology based on high performance 7T magnetdesign- Actively Shielded water-cooled Siemens gradient system for maximumperformance

Evolving from Total imaging matrix, MAGNETOM Vida comprises a new technologythat addresses the intrinsic biovariability in humans - BioMatrix Technology.

Tim 4G (Total imaging matrix in the 4th generation) for excellent image quality andspeed- Siemens unique DirectRX technology enabling all digital-in/digital-out design- Dual-Density Signal Transfer Technology

Push-button exams with GO technologiesSelect&GODotGORecon&GOMR View&GO

Tim Application Suite allowing excellent head-to-toe imaging for- Neuro- Angio- Cardiac- Body- Onco

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- Breast- Ortho- Pediatric- Scientific

Further included- High performance host computer and measurement and reconstruction system- Patient communication including headphones- syngo MR software including- Turbo Suite Essential- 1D/2D PACE- BLADE- Phoenix- Inline Diffusion- MDDW (Multiple Direction Diffusion Weighting)- CISS- DESS- TGSE- Offline Composing

1 14460161 MR General Engine #Visyngo.MR General Engine extends Numaris/X by adding dedicated workflows andtools for routine and advanced reading of MR examinations.A generic MR Basic workflow is provided, as well as specific MR Neurology, MRProstate Reading, MR Breast Reading, and MR Cardio-Vascular workflows.

1 14456321 Brain Dot Engine #SeThe Brain Dot Engine provides guided and automated workflows customizable tothe site specific standards of care for general brain examinations. The Brain DotEngine supports the user in achieving reproducible image quality with increasedease of use and time efficient exams.The brain workflow can be personalized to the individual patient condition andclinical need. Several predefined strategies are included, which can be easilyselected with one click. They can be changed at any time during the brain workflow.

1 14461775 DotGO Routine Package #BMThe DotGO Routine Package includes both:- Spine Dot Engine and- Large Joint Dot Engine.

As a package they offer a comprehensive set of workflows with guidance andautomation, for standardized image quality in Spine and MSK MR imaging.The Spine Dot Engine provides the functionality of Inline Composing and TimPlanning Suite for streamlining workflows in all spine imaging. Tools, such as auto-positioning and vertebral recognition with AutoAlign Spine, AutoCoverage and SpineLabelling support and optimize reproducibility for your cervical, thoracic and lumbarspine imaging for all clinical indications.The Large Joint Dot Engine enhances standardization of the knee, hip and shoulderworkflows and optimizes reproducible image quality by incorporating automationtools, such as anatomically based auto-positioning (AutoAlign). Dedicated imagingtechniques, such as Advanced WARP, are included and can help to expand theaccess of diagnostic MRI to a broader range of patient types.

1 14441748 Quiet Suite #T+DQuiet Suite enables complete, quiet examinations for neurology and orthopedicswith at least 70% reduction in sound pressure levels.

1 14460162 Tim Whole Body Suite #ViTim Whole Body Suite puts it all together. This suite enables table movement forimaging of up to 205 cm (6' 9") FoV without compromise. In combination with Tim’snewly designed ultra-high density array higher spatial and temporal resolution canbe achieved along with unmatched flexibility of any coverage up to Whole Body.For faster exams and greater diagnostic confidence.

1 14460227 Tim Planning Suite #ViWith the Tim Planning Suite, multiple regions in the entire body can be examined ina minimum of time through measurement planning on a single FoV of any desiredsize.

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1 14456329 syngo TimCT FastView #ViTimCT FastView is the “one go” localizer for the whole body or large body regionssuch as the whole spine or the whole abdomen. It acquires the complete extendedField of View in one volume with isotropic resolution. Transverse, coronal andsagittal reformats of the volume are calculated Inline and displayed for planningsubsequent exams.- Inline reconstruction of the localizer images during the scan.- Localizing images in three planes over the maximum Field of View available forsubsequent planning in all orientations.- TimCT FastView runs without laser light positioning to further streamline theworkflow for several indications.

1 14460160 Advanced Diffusion #ViQuietX DWI and RESOLVE together make up the Advanced Diffusion package.

QuietX DWI enables quieter diffusion-weighted imaging of the brain with up to 70%reduction in sound pressure relative to conventional diffusion-weighted imaging.RESOLVE (Readout Segmentation Of Long Variable Echo-trains) is a multi-shot,readout segmented EPI sequence for high-resolution, low-distortion diffusion-weighted imaging (DWI). This technique is largely insensitive to susceptibilityeffects, providing anatomically accurate diffusion imaging for the brain, spine, breastand prostate. In combination with syngo.MR Tractography, RESOLVE enablesexcellent white-matter tract imaging even in regions of high susceptibility, such asthe spine.

1 14456327 WARP & Advanced WARP #ViWARP and Advanced WARP (SEMAC) integrates different techniques tailored toreduce susceptibility artifacts caused by orthopedic MR-conditional metal implants.

1 14456237 Advanced Cardiac incl. PSIR #ViThis package contains special sequences and protocols for advanced cardiacimaging including 3D and 4D BEAT functionalities. It supports advanced techniquesfor ventricular function imaging, dynamic imaging, tissue characterization, coronaryimaging, and more.

1 14456323 Inline Composing syngo #SeAutomatic anatomical or angiographic composing of multiple adjacent coronal orsagittal images for presentation and further evaluation. Composed images can beautomatically loaded into Graphical Slice Positioning for scan planning purposes.

1 14475338 syngo Expert-I XA31This software application enables remote access to the system (connected via localarea network) for planning and processing.

1 14456203 Tim [228x128] XT + TrueShape #ViTim [228x128] XT-gradients performance level

Tim 4G's RF system and innovative coil architecture enables high-resolutionimaging and increased throughput. The system provides a maximum number of 228channels (coil elements) that can be connected simultaneously. Flexible parallelimaging is achieved by 128 independent receiver channels that can be usedsimultaneously in one single scan and in one single FOV, each generating anindependent partial image.

XT - gradientsThe XT 60/200 gradients are the most powerful commercially available gradients at70 cm currently on the market. The XT gradients combine 60 mT/m peak amplitudewith a slew rate of 200 T/m/s, capable of driving higher SNR throughout all regionsof the body.The force compensated gradient system minimizes vibration levels and acousticnoise while the high-performancecooling for each individual axis allows full duty cycle over long-term measurementswith outstanding stability.

TimTX TrueShapeTimTX TrueShape is Siemens' architecture for parallel transmit (pTX) technology.

High-performance measurement and reconstruction system.

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1 14456215 Standard Coil Package, 128-ch #ViThis package includes (if not exchanged with different variants via respective quoteitems):- BioMatrix Head/Neck 20 tiltable with CoilShim- BioMatrix Spine 72 with Respiratory Sensor- Body 18- Flex Large 4- Flex Small 4- Flex Coil Interface

1 14456328 BioMatrix Technology #ViThe new and unique BioMatrix technology addresses the different aspects of patientbio-variability. It is based on threetechnological clusters:- BioMatrix Sensors address patient physiology, in order to anticipate challenges- BioMatrix Tuners address patient anatomy, in order to adapt to all patients,especially critical ones.- BioMatrix Interfaces address user interaction with the patient, to accelerate theworkflow in the face of patient variability.

1 14470783 BioMatrix Respiratory Sensors#Vi,SoHighly integrated BioMatrix Respiratory sensors measure the patient’s breathingcycle in head-first and feet-first orientation.

1 14470792 BioMatrix Coil Shim #Vi,SoBioMatrix CoilShim helps to reduce patient induced strongly localized B0inhomogeneities by dedicated local shim channels.

1 14470794 BioMatrix SliceAdjust #BMBioMatrix SliceAdjust helps to avoid station boundaries and apparent broken spineartifacts as well as to preserve the SNR for whole-body diffusion.

1 14456212 BioMatrix Dock. Table w/ eDrive #ViThe BioMatrix Dockable Table with eDrive is designed for maximum patient comfortand smooth patient preparation. The BioMatrix Dockable Table with eDrive cansupport up to 250 kg (550 lbs) without restricting the vertical or horizontalmovement. The BioMatrix eDrive provides motorized assistance for easymaneuverability of the table.

1 14470795 BioMatrix Select & GO #Vi,SoThe BioMatrix Select&GO interface enables fast and easy single-touch patientpositioning from both sides of the patient table. The interfaces are integrated left andright into the front covers. Correct positioning saves unnecessary wasted time forrepositioning and additional adjustments, therefore shortening the total room time.

1 14456206 Silver & White Design #ViMAGNETOM Vida is available in different light and appealing design variants whichperfectly integrate into different environments. The Silver &White Design Variantcomprises a brilliant white front design ring with integrated unique Select&GOpanels. The smoothly embracing deco area on the left side and the outer rings in thefront and the back of the system is colored in brilliant silver.The table cover is presented also in the same color and material selection.

1 14456270 PC Keyboard US English #ViStandard PC keyboard with 105 keys.

1 14456230 High-End Computing [228x128] #ViTim 4G power computing upgrade for MAGNETOM Vida with 128 receive channels.This upgrade brings a high-end image reconstruction computer to the Tim [228x128]configuration.

1 14460295 Advanced Host ComputerThe Advanced Host Computer offers increased computing power and increasedmemory for supporting an external syngo MR Workplace (optional) and/or to give aperformance boost to applications that generate and process large data sets (e.g.BOLD imaging, fMRI post-processing).

1 14456238 Peripheral Pulse Unit #ViPeripheral Pulse Unit for Pulse Triggering

1 14460313 Dual Monitor Package #BM

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The Dual Monitor Package provides a second 24” LCD monitor for the acquisitionworkplace, identical to the system main host monitor.The two monitors provide space for protocol planning and exam progress on the leftmonitor, as well as viewing and post-processing functionalities on the right monitor.The Dot Cockpit can be used on both monitors as a floating window. This improvesthe MR examination workflow by a smoother and more comfortable work space thatavoids interruptions between planning, scanning, viewing and post-processing. Itallows to keep running patient examinations always in sight to allow for fastinteractions.

1 14475291 SW syngo MR XA31Asyngo MR XA31A software with new features and applications.

Please be aware that certain or all positions of this quote have the software versionsyngo MR XA31A as prerequisite.

1 14470995 DotGO Advanced Package #NXThe following components are already included in the DotGO Advanced Package:- Angio Dot Engine- Abdomen Dot Engine

As a package they offer a comprehensive set of workflow with guidance andautomation, for standardized image quality in Vascular and Abdominal MR imaging.

The Angio Dot Engine provides semi-automatic detection of arterial and venoustiming windows using a test bolus technique.This information is feedback for next planning steps automatically adapting scanparameters to the individual patient and patient’s condition. Where needed,AutoVoice Commands support the communication with the patient and ensureoptimal timing of breathing, scanning and contrast media. All steps of contrastinjection are presented in a simple, automated graphic on the monitor.

The Abdominal Dot Engine offers intuitive guidance and a high level of automation.It allows automatic sequence scaling according to physiological characteristics.Auto Navigator detects breathing pattern detection. With Automatic FoV, the optimalFoV is automatically estimated based on the localizer images.Within the contrast-enhanced abdomen exam, multiple phases are acquired: native,arterial phase, portal-venous phase and late-phase.

1 14418746 Cardiac Dot Engine, USA #T+DCardiac examinations: Dot Cardiac - Customized workflows that are easier torepeat. Using anatomical landmarks, standard views of the heart (such asdedicated long axis and short-axis views), are easily generated and can easily bereproduced using different scanning techniques. Scan parameters are adjusted tothe patient’s heart rate and automatic voice commands are given.

1 14461619 Turbo Suite Essential #BMTurbo Suite Essential comprises established acceleration techniques to maximizeproductivity for all contrasts, orientations and all routine imaging applications fromhead-to-toe.

1 14469017 Turbo Suite Excelerate #BMTurbo Suite Excelerate comprises access to cutting edge acceleration techniquessuch as Simultaneous Multi-Slice and Compressed Sensing for static 2D and static3D imaging applications in Neuro, MSK and Body MRI.

1 14469020 Turbo Suite Excelerate SupportTurbo Suite Excelerate Support provides Future Security for Turbo Suite Excelerate:

With the release of syngo MR Numaris software XA20A and XA12M (Amira) thefollowing licenses will be delivered provided that Turbo Suite Excelerate and TurboSuite Excelerate Support were purchased: CS SPACE, CS SEMAC, CS TOF, SMSfor TSE_DIXON, SMS for RESOLVE and QDWI. This fulfills the delivery of the fouroptions defined in the Turbo Suite Excelerate Support Package.

1 14469015 Turbo Suite Elite #BMTurbo Suite Elite comprises cutting edge Compressed Sensing applications foradvanced abdominal and cardio-vascular imaging with dynamic 2D and dynamic 3D

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applications to significantly reduce scan times, counter patient motion andexpanding the patient population eligible for MRI.

1 14469016 Turbo Suite Elite Support #BMTurbo Suite Elite Support provides Future Security for Turbo Suite Elite:- In consideration of Customer’s purchase of the MAGNETOM MR scanner andsimultaneous purchase of a 4 year point of sale Service Agreement with Evolve, andshould such Evolve Upgrade installed during the term of the Service Agreementenable operation of dynamic Compressed Sensing options and/or SimultaneousMulti-Slice options, then Customer may choose to receive one such dynamicCompressed Sensing or Simultaneous Multi-Slice application option at no additionalcost.

1 14475287 Deep Resolve GainDeep Resolve Gain is an intelligent reconstruction method to increase the SNR(signal to noise ratio) of images so that either shorter scan times or higher imagequality with higher resolution can be achieved.

1 14475288 Deep Resolve Sharp 1Deep Resolve Sharp is a deep learning neural reconstruction network to improveimage quality by increasing the sharpness and reducing Gibbs ringing.

1 14402527 SWI #TimSusceptibility Weighted Imaging is a high-resolution 3D imaging technique for thebrain with ultra-high sensitivity for microscopic magnetic field inhomogeneitiescaused by deoxygenated blood, products of blood decomposition and microscopiciron deposits. Among other things, the method allows for the highly sensitive proofof cerebral hemorrhages and the high-resolution display of venous cerebral bloodvessels.

1 14441849 Diffusion Tensor Imaging #T+DDiffusion Tensor Imaging provides a Single Shot EPI sequence for measuringdiffusion-weighted data sets with up to 256 directions of diffusion weighting. Basedon these data sets, the diffusion tensor itself and parametric maps derived from it(e.g. fractional anisotropy) are calculated automatically and in real-time. Thepackage supports both clinical applications regarding diseases of the white matter(e.g. multiple sclerosis, brain maturation disorders, or displacement of nerve fibertracts through masses) and advanced research applications.Diffusion spectrum imaging (DSI), an extension of diffusion tensor imaging, isincluded in this package. DSI expands on the DTI acquisition capabilities byproviding the ability to resolve white matter fiber crossings.

1 14456233 Neuro fMRI Package #ViThis package combines- BOLD Imaging,- 3D PACE syngo, and- syngo.MR Neuro fMRI.

1 14405316 fMRI Trigger ConverterAn optical trigger signal is available to trigger external stimulation devices in fMRIexperiments.With the "fMRI Trigger Converter" this signal can be converted to an electrical signal(TTL/BNC and RS 232 interface for PC; modes: toggle or impulse).

1 14416946 Neuro Perfusion Package #T+DThe Neuro Perfusions Package helps to streamline the clinical workflow by inlinepost-processing in dynamic susceptibility contrast (DSC) based perfusion imaging.This makes it possible to see perfusion maps immediately.

Perfusion parameter maps are based on a Local Arterial Input function. A correctedrelCBV map calculation and motion correction is provided.

1 14461562 PCASL #BMBlood labeling technique Pseudo Continuous Arterial Spin Labeling (PCASL).

1 14416965 Arterial Spin Labeling 3D #T+D3D acquisition of non-contrast enhanced brain perfusion with a TGSE sequence formininal susceptibility and full brain coverage. Higher SNR, optimized contrastuniformity and reduced motion sensitivity. Inline calculation of PWI (perfusionweighted images) for a qualitative assessment of brain perfusion.

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1 14409110 Arterial Spin Labeling 2DASL is a non-contrast-enhanced brain perfusion technique. EPI sequence enhancedfor ASL (Arterial Spin Labeling) with preparation module (inversion pulse, saturationpulses) and selectable prospective motion correction. Perfusion-weighted colormaps and relative cerebral blood flow (relCBF) color maps are calculated with Inlinetechnology.

1 14405341 Mapit syngo #TimBased on the T1, T2 or T2* properties of the cartilage syngo ParametricMap allowsthe early detection of osteoarthritic break down of cartilage structures even beforemorphological changes occur. The method supports therapeutic decisions inindividual patients and can be used to control treatments non-invasively, replacingsurgeries or biopsies.The assessment of T1, T2 and T2* properties of tissues in other body regions isalso possible.syngo ParametricMap provides very fast 2D and 3D high-resolution imagingsequences and the Inline calculation of parametric maps for the T1, T2 and T2*properties of the imaged tissue.

1 14441761 LiverLab #T+DLiverLab is a system guided workflow to examine the hepatic fat and iron status, aspart of the Abdomen Dot Engine.

1 14409198 Native syngo #TimIntegrated software package with sequences and protocols for non-contrast-enhanced 3D MRA with high spatial resolution. syngo NATIVE particularly enablesimaging of abdominal and peripheral vessels and is an alternative to MRangiography techniques with contrast medium, especially for patients with severerenal insufficiency.

1 14441813 QISS #T+DSoftware package with QISS sequence, protocols and Dot AddIn for non-contrast-enhanced peripheral MRA. QISS particularly enables higher reproducibility thanexisting methods and is an alternative to MR angiography techniques with contrastmedium, especially for patients with severe renal insufficiency.

1 08464740 Flow Quantification #TimSpecial sequences for quantitative assessment of flow i

1 14446385 MyoMaps # 3TThis package contains special sequences and protocols for inline T1 and T2calculation at the heart. The generation of T1 and T2 parametric maps is enhancedby the use of motion correction. T1 and T2 parametric maps could be used tosupport assessment of cardiovascular disease.

1 14456255 Single Voxel Spectroscopy #ViIntegrated software package including sequences and protocols for protonspectroscopy to examine metabolic changes. Includes optimizations for brain tissueand for the breast (GRACE).In order to obtain best spectral quality in the breast, it is recommended to use one ofthe following breast coils: Breast 18, Breast BI 7, (2-/4-/)8-Channel, (2-/10-/)16-Channel Sentinelle Breast coil, Breast 4 or 4-ch BI Breast coil.

1 14413615 2D Chemical Shift Imaging #TimSequences and protocols for proton 2D Chemical Shift Imaging (2D CSI).

1 14413621 3D Chemical Shift Imaging #TimSequences and protocols for proton 3D Chemical Shift Imaging (3D CSI).

1 14446574 Body 18 -> Body 18 longThis option exchanges the Body 18 from the standard coil configuration for the Body18 long.

The long cable of the Body 18 enables flexible combinations with additional Body18, the Body 30 or Body 60 for extended anterior coverage.

1 14456222 Body 30 Duo Package #ViThe Body 30 Duo Package contains 2 Body 30 coils. The Tim 4G coil technologywith Dual Density Signal Transfer and SlideConnect Technology combines keyimaging benefits: excellent image quality, high patient comfort, and unmatched

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flexibility:- 2 coils with 30 channels each or up to 78 (both coils in combination with the Spine72)- Dual Density Signal Transfer- Ultra light-weight- Highly flexible viscoelastic material- SlideConnect Technology

Each Body 30 coil features:- 30-element design with 30 integrated preamplifiers (5 clusters of 6 elements each)- Can be combined with further coils for larger coverage- Can be positioned in different orientations (0°, 90°, 180°, 270°) for patient specificadaptations- No coil tuning- iPAT compatible in all directions

The highly flexible design allows the usage for:- Thorax (incl. heart)- Abdomen- Pelvis (incl. prostate)- Hip- Angiography

Typically combined with:- Spine 32- Spine 72 (optional)- Body 18- Body 18 long (optional)- Peripheral Angio 36 (optional)- Body 30 (optional)

1 14456221 Shoulder Shape 16 #ViThe Shoulder Shape 16 combines the known benefits of Tim 4G coil technologywith new highly flexible materials, resulting in unmatched image quality, high patientcomfort and easy handling. The Shoulder Shape 16 for examinations of the left orright shoulder consists of an iPAT-compatible 16-channel shoulder coil in a flexibleshoulder cup that can be shaped around small and large shoulders. An L-shapedcushion for easy positioning of the patient is included. The 16-element coil with 16integrated pre-amplifiers ensures maximum signal-to-noise ratio. Shoulder Shape16 will be connected via a SlideConnect plug for fast and easy coil set-up andpatient preparation.

1 14418513 Hand/Wrist 16 #SkThe new Tim 4G coil technology with Dual Density Signal Transfer andSlideConnect Technology combines key imaging benefits: excellent image quality,high patient comfort, and unmatched flexibility.

Hand/Wrist 16 for examinations of the left or right hand and wrist region consists ofa base plate and an iPAT compatible 16-channel coil and allows high-resolutionimaging of the wrist and the hand within one examination. Hand/Wrist 16 will beconnected via a SlideConnect plug for fast and easy patient preparation.

1 14456217 Tx/Rx Knee 18 #ViNew 18-channel transmit/receive coil optimized for knee imaging. The spaciousdesign with a flared opening towards the thigh allows scanning even of large andswollen knees with exceptional image quality and signal to noise ratio.Main features :- 18-element design (3x6 coil elements) with 18 integrated preamplifiers- iPAT-compatible- SlideConnect Technology

1 14418514 Foot/Ankle 16 #SkThe new Tim 4G coil technology with Dual Density Signal Transfer andDirectConnect Technology combines key imaging benefits: excellent image quality,high patient comfort, and unmatched flexibility.Foot/Ankle 16 for examinations of the left or right foot and ankle region consists of abase plate and an iPAT compatible 16-channel coil and allows high-resolution

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imaging of the foot and ankle within one examination. Foot/Ankle 16 is a cable-lesscoil and will be connected via DirectConnect for fast and easy patient preparation.

1 14418512 Peripheral Angio 36 #SkThe new Tim 4G coil technology with Dual Density Signal Transfer andSlideConnect Technology combines key imaging benefits: excellent image quality,high patient comfort, and unmatched flexibility:- 36 channels- Dual Density Signal Transfer- Ultra light-weight- SlideConnect TechnologyThe 36-channel coil includes 36 integrated pre-amplifiers for excellent signal-to-noise ratio. The single SlideConnect Plug allows for fast and easy patientpreparation.

The Peripheral Angio 36 features:- 36-element design with 36 integrated preamplifiers, distributed over 6 planes with6 elements each- Operates in an integrated fashion with Body coils and with Spine coil. For Whole-Body examinations also with a Head/ Neck coil.- Automatic table feed and active coil switch- Can be utilized head and feet first- Both legs are independently covered with coil elements, maximizing the coil fillingfactor and the signal-to-noise ratio- No coil tuning- iPAT-compatible- Dual-Density Signal Transfer enables ultra-high density coil designs by integratingkey RF components into the local coil- SlideConnect technology for easy coil set up- One cable only for easy handling- Includes special non-ferromagnetic coil cart for safe, user-friendly storage

Applications:- High-resolution angiography of both legs incl. Pelvis (by additional use of a Bodycoil) with highest signal-to-noise ratio- Visualization of the iliac arteries and aorta in combination with Body coils- Bilateral examinations of long bones of the legs

Typically combined with:Head/ Neck coil, Body coil, Spine coil and all flexible coils such as Flex Large 4 orFlex Small 4

1 14456220 Head/Neck 64 w/ CoilShim #ViThe BioMatrix Head/Neck 64 with CoilShim combines the known benefits of Tim 4Gcoil technology with those of the new Siemens unique BioMatrix technology,resulting in unmatched image quality, high patient comfort and easy handling.Integrated BioMatrix Tuners: The integrated CoilShim elements minimize patientinduced local anatomy-specific B0 field inhomogeneity, thus ensuring excellentimage quality.The very open design ensures that patients will feel comfortable, while the anatomicdesign ensures highest signal-to noise ratio.

The BioMatrix Head/Neck 64 features:- 64-element design with 64 integrated preamplifiers, 55 elements in the headregion, 9 elements in the neck region.- Integrated SlideConnect and DirectConnect technology- Combined head/neck coil for an optimized workflow of the head/neck region- Upper coil part removable- Lower coil part usable without upper part for highly claustrophobic patients- Smoothly integrated into the patient table with BioMatrix Spine- Cushioned head stabilizers (removable)- No coil tuning- iPAT-compatible in all directions- Optimized for sequences using iPAT²- Dual-Density Signal Transfer enables ultrahigh density coil designs by integratingkey RF components into the local coil- Rear opening for up to 128 EEG electrode leads

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- Detachable look-out mirror

Applications:- Head examination- Neck examination- Cervical spine examination- MR Head Angiography, also time-resolved- MR Neck Angiography- Combined head / neck examination- TMJ (temporo mandibular joints)

1 14469230 Flex -> UltraFlex Upgrade #3TThis option exchanges the Flex Small & Large 4 coils incl. the Flex Coil Interfacefrom the standard coil configuration for the superior UltraFlex Small & Large 18.These are two lightweight, iPAT compatible, 18-element no-tune receive coils madeof highly flexible and soft viscoelastic material.

UltraFlex Large 18Ideal for examinations of larger extremities (e.g. medium to large shoulder, hip,knee, ankle and hand) and for abdominal examinations. Dedicated positioning aidsfor larger extremities are delivered with the coil.

UltraFlex Small 18Ideal for examinations of smaller extremities (e.g. small to medium shoulder, smallerankle, elbow and hand) and for abdominal examinations. Dedicated positioning aidsfor smaller extremities are delivered with the coil.

1 14456282 Positioning Aids Shoulder&Ankle #ViThis package contains additional positioning aids that can be used for the UltraFlexLarge 18 and UltraFlex Small 18.

1 14456241 Separator 60kW/75kW #ViThe SEP (Separation cabinet) has to be used if a central hospital chilled watersupply is available or if a chiller of any brand/type is already available.The SEP is the interface between the on-site water chiller (of any brand or type) orthe interface to the central hospital cooling water supply.For the above-mentioned cases the SEP is mandatory!

In these cases, the primary water specifications must fulfill the requirements:XJ: 45kW; water temperature: 6 - 14°CXQ: 60kW; water temperature: 6 - 14°CXT: 75kW; water temperature: 6 - 12°C

For all gradient systems:Flow: 100+-10l/min; pH value 6-8; max working pressure 6 bar.

Dimensions: 1950mm x 650mm x 650mm (height x width x depth)Weight: approx. 350kg

1 14460249 UPS system #ViUPS system Liebert GXT4 3000RT230E for MAGNETOM Vida for safeguardingcomputers. Including Power Cable of 9 m for connecting the UPS.Power output: 3.0 kVA / 2.7 kWBridge time: 3 min full load / 12 min half loadInput voltage: 230 VAC

1 14456316 UPS Battery module (Libert GXT4 BATT)UPS battery module Liebert GXT4 72VBATTE for MAGNETOM Aera, Skyra,Prisma, ESSENZA, Amira, Spectra, C! for safeguarding computers.Extension for: Liebert GXT4 3000RT230E (14456315)Battery type: Closed, maintenance-freeExtension of the bridge time to: 21 minutes full load / 48 min half load with onemoduleDimensions (H x D x W): Battery module: 430 x 602 x 85 mm

Weight: approx. 46 kg1 14456228 System Start Timer #Vi

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Timer clock that can be installed together with the MAGNETOM MR system to startthe system automatically at user-definable times, eliminating waiting times duringsystem boot up.

1 MR_STD_RIG_INST

MR Standard Rigging and InstallationMR Standard Rigging and Installation

This quotation includes standard rigging and installation of your new MAGNETOMsystem

Standard rigging into a room on ground floor level of the building during standardworking hours (Mon. – Fri./ 8 a.m. to 5 p.m.)It remains the responsibility of the Customer to prepare the room in accordance withthe SIEMENS planning documentsAny rigging requiring a crane over 80 tons and/or special site requirements (e.g.removal of existing systems, etc.) is an incremental cost and the responsibility of theCustomer.All other “out of scope” charges (not covered by the standard rigging andinstallation) will be identified during the site assessment and remain theresponsibility of the Customer.

1 MR_BTL_INSTALL

MR Standard Rigging & Install

1 MR_PREINST_DOCK

T+D Preinstall kit for dockable table

1 MR_CRYO Standard Cryogens1 MR_PM MR Project Management

A Siemens Project Manager (PM) will be the single point of contact for theimplementation of your Siemen’s equipment. The assigned PM will work with thecustomer’s facilities management, architect or building contractor to assist you inensuring that your site is ready for installation. Your PM will provide initial and finaldrawings and will coordinate the scheduling of the equipment, installation, andrigging, as well as the initiation of on-site clinical education.

1 4MR5142869 Armrest #MR1 ML11685 MR Wall sign -English

Highly durable 1mm PVC wall signs with high-tack, double-back tape. Sticks to mostany surface. English. 12" x 18".

1 MRISMNS0001 MRI Patient Audio SystemThe MRI Patient Audio System is to be installed in the technologist room and isconnected to the Siemens intercom system. The package provides the followingbenefits:

• Create custom, commercial-free radio stations based on artist, song or genrepreferences• Avoid any AM/FM tuning issues that may occur in RF-shielded rooms• Compatible with all popular audio apps

Includes all cables and adapters; Bose Companion 2 technologist speakers; 3.5 mmto RCA cable; and customized iPAD Mini with all original accessories and iPadstand.

The MR Stereo can play internet radio (depending on quality of and access to Wi-Fisignals) and device (iPAD) stored audio content. Optimal performance requiresaccess to Wi-Fi signal for Internet radio through the facility’s wireless network.

The audio system is not MR safe and is only intended for use outside the MRI suite.

Installation is not included unless purchased with the Siemens system.

Includes 3 year limited liability warranty on all system components through MRIMed.

1 MR14416965PR Discount applied for ASL bundle pricingPromotional discount for ASL bundle

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1 SY_PR_TEAMPLAY

teamplay Welcome & Registration Packageteamplay is a cloud-based network that brings together your imaging modality users,the systems' dose and utilization data, and the users' expertise to help you improvethe delivery of care to your patients. Basic features are provided free of charge.Premium features (benchmarking, non-Siemens devices) are provided on a trialbasis for three months at no charge, and may be used thereafter on a subscriptionfee basis.To register: http://teamplay.siemens.com/#/institutionRegistration/1

1 MR14460428 ACR Phantom Holder (USA)An MR compatible cradle device used to consistently and precisely position theAmerican College of Radiology (ACR) MRI Accreditation phantom, for use withSiemens MAGNETOM standard Head Coil during test measurements for ACRsystem accreditation or QA testing

1 DTSWO2210000MR75

Dimplex chiller - 75 kWFor use with Siemens SEP cabinet.

The Dimplex Thermal Solutions outdoor, air-cooled, water/glycol chiller has beenspecially designed for medical applications to provide stable, fully dedicated cooling.75 kW water/glycol air-cooled heat exchanger/chiller package for outsideinstallation. Features dual tandem refrigerator circuits and dual redundant pumps.Unit also includes fluid reservoir and controls as well as remote control display tomonitor the heat exchanger package operation from indoors at the operator's workstation. This design also includes the features to meet the specification of OSHPDrequirements.

Koolant Koolers Chiller, WO2-2-10000-2P-NF-L-M-407C 800850, 297,000 BTUs perhour cooling capacity rating conditions, -20 to 100° F ambient with a 40° F leavingfluid temperature.

Pricing also includes:• Filter & flow meter kit• Service package including one start-up visits, two PM visit during 12 month P&Lwarranty period.• One year warranty through Dimplex Thermal Solutions.

Customer is responsible for rigging and installation. Customer is responsible forproviding glycol as specified by the manufacturer.

Product is approved for OSHPD sites.Coastal or low ambient temperature chillers are available and should be used if theinstall location is within 30 miles of saltwater (coastal) or the local ambienttemperature can reach -40F (low ambient).

1 XPAS_DTS_STARTUP

Start-up of DTS chiller

1 MR_ADDL_RIGGING

Additional Rigging MR $9,550

1 MR_BD_LV2 Essential Education Level 2 (MR)This Essential Education Bundle provides system training in a blended learningenvironment using training modules (typically 1 hour): This (12) month multi-modality e.learning subscription will provide access for (10) imaging professionals atthe customer site to utilize up to (50 CEUs). Essential Training Part 1- Up to (28)hours of on-site clinical education training, scheduled consecutively (Monday –Friday) during standard business hours for a maximum of (4) imaging professionals.Essential Training Part 2- Up to (24) hours of on-site clinical education training,scheduled consecutively (Monday – Friday) during standard business hours for amaximum of (4) imaging professionals. ONLINE Essential Training Part 2- Up to 24hours of ONLINE training, scheduled consecutively (Monday - Friday) duringstandards business hours for a maximum of (6) imaging professionals. One ONLINEworkshop up to 4 hours of training for up to a maximum of (8) technologists.Through the use of online training and/or remote simulation attendees will be able toincrease their knowledge and skills to help improve their clinical practice. One-2-dayonsite workshop for MR imaging professionals focuses on the MR syngo® Dot userinterface and operating software implemented on our MAGNETOM® MRI systems.

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Through the use of demonstrations, lecture, and hands-on labs using Siemens’simulation consoles, participants will learn the basic principles and workflow ofpatient examinations. This educational offering must be completed (12) months frominstall end date. If training is not completed within the applicable time period,Siemens obligation to provide the training will expire without refund.

2 MR_ADD_28 Additional onsite training 28 hoursUp to (28) hours of on-site clinical education training, scheduled consecutively(Monday – Friday) during standard business hours for a maximum of (4) imagingprofessionals. Training will cover agenda items on the ASRT approved checklist ifapplicable. This educational offering must be completed (12) months from installend date. If training is not completed within the applicable time period, Siemensobligation to provide the training will expire without refund.

1 MRLOC_CARDDOT

Local Offset - Cardiac Dot Engine, USA

1 MR_PR_DOTENG2

Dot Engine 2 pricing offsetTo be eligible for this promotion, a binding purchase order of the application(s) mustbe received by Siemens

System Total: $ 2,758,074.00

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OPTIONS on Quote Nr : CPQ-355343 Rev. 0

OPTIONS for MAGNETOM Vida - System

All items listed below are OPTIONS and will be included on this system ONLY if initialed: (See DetailedTechnical Specifications at end of Proposal.)

Qty Part No. Item DescriptionExtended Price Initial to

Accept1 BMRXP200 MRXperion injector

The MRXperion injector has the following features: Streamlined Injection WorkflowEnhanced Point of Care - On-board eGFR and Weight BasedDosing Calculators, an Injection Pressure Graph, and independentTest Inject and KVO functions.Informatics-ready - Connect with the Radimetrics EnterprisePlatform for automated documentation, advanced analytics andviewable patient histories to facilitate standardized injectionprotocols and enhanced operational consistency.Maximized Uptime Support - Connect to VirtualCare RemoteSupport for advanced injector system diagnostics, seamlesssoftware updates, and fast repairs.

Price includes installation, training and one year warranty throughBayer Healthcare.

+ $ 42,800.00 X________

1 BMRXPENPNL MRXperion penetration panelIncludes penetration panel and installation by Bayer.

To be selected only if the customer has no wall outlets in the MRsuite and requires the power to be sourced from outside the room.

+ $ 1,900.00 X________

1 14469205 Breast Biopsy #BMThe Breast Biopsy Software is a professional solution for a fastand accurate MR biopsy workflow.

+ $ 13,800.00 X________

1 14436666 2/10/16ch Sentinelle BreastCoil #SkThe 2/10/16-channel Sentinelle Breast Coil can be used as abreast imaging coil, a bilateral biopsy coil, as well as a unilateralbiopsy coil providing large biopsy access.

This coil consists of a positioning frame with exchangeable coilswith different numbers of channels as described in detail in the Etext.

The preamplifiers are integrated into the coil.The coil is iPAT-compatible.

+ $ 120,750.00 X________

2 14418519 Tim Coil Interface 3TCoil adapter plug for up to 8 receive and 1 transmit channels. Thisadapter will be required if the following Tim coils will be used on acompatible 3T MAGNETOM system with Tim 4G technology.

+ $ 7,360.00 X________

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FINANCING: The equipment listed above may be financed through Siemens. Ask us about our full range offinancial products that can be tailored to meet your business and cash flow requirements. For further information,please contact your local Sales Representative.

ACCESSORIES: Don't forget to ask us about our line of OEM imaging accessories to complete your purchase. Allaccessories can be purchased or financed as part of this order. To purchase accessories directly or to receive ouraccessories catalog, please call us directly at 1-888-222-9944 or contact your local Sales Representative.

COMPLIANCE: Compliance with legal and internal regulations is an integral part of all business processes atSiemens. Possible infringements can be reported to our communication channel “Let Us Know”.

Upgrades/Options/Software packages purchased and requiring installation by Siemens must be installed 60 dayspost shipment. If Siemens’ access to the equipment on which such package(s) are to be installed is not madeavailable within 60 days post shipment then invoicing will occur and payment will be due based upon contractualpayment terms.

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Siemens Medical Solutions USA, Inc. General Terms and Conditions

1. GENERAL1.1 Contract Terms and Acceptance. These termsand conditions constitute an integral part of anycontract between Seller and Purchaser identified on thefirst page hereof and shall govern the sale of theproducts identified in such contract (“Products”).Purchaser acknowledges that this is a commercial andnot a consumer transaction. Purchaser shall bedeemed to have assented to, and to have waived anyobjection to, this Agreement upon the earliest to occurof any of the following: Purchaser’s completion orexecution of this Agreement; Purchaser’s acceptanceof all or any part of the Products; Purchaser’s issuanceof a purchase order for any Products identified onSeller’s quotation or proposal; or delivery of theProducts to the common carrier for shipment pursuanthereto.1.2 Refurbished/Used Products. For Productsidentified on this Agreement as used or refurbishedProducts, these Products have been previously ownedand used. When delivered to Purchaser, such Productswill perform in accordance with the manufacturer’sspecifications. Since pre-owned Products may beoffered simultaneously to several customers, theavailability of such Products to Purchaser cannot beguaranteed. If the Products are no longer available,Seller will use its best efforts to identify other suitableproducts in its inventory. If substitute products are notacceptable to Purchaser, then Seller will cancel theorder and refund to Purchaser any deposits previouslypaid. The warranty period for any used or refurbishedProducts will be separately stated on the quotation. 1.3Third Party Products. If this Agreement includes thesale of third party products not manufactured by Seller,then Purchaser agrees and acknowledges that (a)Purchaser has made the selection of these products onits own, (b) the products are being acquired by Sellersolely at the request of and for the benefit andconvenience of Purchaser, (c) no representation,warranty or guarantee has been made by Seller withrespect to the products, (d) the obligation of Purchaserto pay Seller for the products is absolute andunconditional, (e) use of the products may be subject toPurchaser’s agreement to comply with any softwarelicensing terms imposed by the manufacturer; and (f)unless otherwise indicated by Seller in writing, Seller isnot responsible for any required installation, validation,product recall, warranty service, maintenance,complaint handling, or any other applicable FDA

regulatory requirements, and the Purchaser will looksolely to the manufacturer regarding these services andwill assert no claim against Seller with respect to theseproducts.

2. PRICES2.1 Quotations. Unless otherwise agreed to in writingor set forth in the quotation, all prices quoted by Sellerand amounts payable by Purchaser are in U.S. dollars,and include Seller’s standard packaging. The pricesquoted to Seller assume that the Seller is located in,and will use the Products in, the U.S. If not, suchquotation will be void. Unless otherwise stated, thequotation shall only be valid for forty-five (45) days fromthe date of the quotation.2.2 Delay in Acceptance ofDelivery. Should the agreed delivery date bepostponed by Purchaser, Seller shall have the right todeliver the Products to storage at Purchaser"s risk andexpense, and payments due upon delivery shallbecome due when Seller is ready to deliver.

3. TAXES3.1 Any sales, use or manufacturer"s tax which may beimposed upon the sale or use of Products, or anyproperty tax levied after readiness to ship, or anyexcise tax, license or similar fee (excluding the MedicalDevice Excise Tax as set forth in Section 4191 of theInternal Revenue Code of 1986, as amended) requiredunder this transaction, shall be in addition to the quotedprices and shall be paid by Purchaser. Notwithstandingthe foregoing, Seller agrees to honor any validexemption certificate provided by Purchaser.

4. TERMS OF PAYMENT; DEFAULT4.1 Payments; Due Date. Unless otherwise set forth inthe quotation, Purchaser shall pay Seller as follows: aninitial deposit of 10% of the purchase price for eachProduct is due upon submission of the purchase order,an additional 80% of the purchase price is due upondelivery of each Product, and the final 10% of thepurchase price is due upon completion of installation orwhen the Products are available for first patient use,whichever occurs first. Unless otherwise agreed, allpayments other than the initial deposit are due net thirty(30) days from the date of invoice. Seller shall have noobligation to complete installation until the payment dueupon delivery is received. Partial shipments shall bebilled as made, and payments for such shipments willbe made in accordance with the foregoing payment

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terms.4.2 Late Payment. A service charge of 1½% permonth, not to exceed the maximum rate allowed bylaw, shall be made on any portion of Purchaser"soutstanding balance which is not paid when due.Payment of such service charge shall not excuse orcure Purchaser’s breach or default for late payment.4.3Payment of Lesser Amount. If Purchaser pays, orSeller otherwise receives, a lesser amount than the fullamount provided for under this Agreement, suchpayment shall not constitute or be construed other thanas on account of the earliest amount due Seller. Noendorsement or statement on any check or payment orelsewhere shall constitute or be construed as anaccord or satisfaction. 4.4 Where Payment Due UponInstallation or Completion. Should any terms ofpayment provide for either full or partial payment uponcompletion of installation or thereafter, and completionof installation is delayed for any reason for which Selleris not responsible beyond the installation date set forthin the Notice to Manufacture Letter issued by Seller, asapplicable, then the balance of payments shall be dueon the day following such installation date.4.5 Default;Termination. Each of the following shall constitute anevent of default under this Agreement: (i) a failure byPurchaser to make any payment when due; (ii) a failureby Purchaser to perform any other obligation under thisAgreement within thirty (30) days of receipt of writtennotice from Seller; or (iii) the commencement of anyinsolvency, bankruptcy or similar proceedings by oragainst Purchaser. Upon the occurrence of any eventof default, at Seller’s election: (a) the entire amount ofany indebtedness and obligation due Seller under thisAgreement and interest thereon shall becomeimmediately due and payable; (b) Seller may suspendthe performance of any of Seller’s obligationshereunder, including, but not limited to, obligationsrelating to delivery, installation and warranty services;(c) Purchaser shall put Seller in possession of theProducts upon demand; (d) Seller may sell or otherwisedispose of all or any part of the Products and apply theproceeds thereof against any indebtedness orobligation of Purchaser under this Agreement; (e) if thisAgreement or any indebtedness or obligation ofPurchaser under this Agreement is referred to anattorney for collection or realization, Purchaser shallpay to Seller all costs of collection and realization(including, without limitation, a reasonable sum forattorneys’ fees); and Purchaser shall pay anydeficiency remaining after collection of or realization bySeller on the Products. In addition, Seller mayterminate this Agreement upon written notice toPurchaser in the event that Purchaser is not approvedfor credit or upon the occurrence of any material

adverse change in the financial condition or businessoperations of Purchaser.4.6 Financing.Notwithstanding any arrangement that Purchaser maymake for the financing of the purchase price of theProducts, the parties agree that any such financingarrangement shall have no effect on the Purchaser’spayment obligations under this Agreement, includingbut not limited to Sections 4.1 and 4.2 above.

5. EXPORT TERMS5.1 Unless other arrangements have been made,payment on export orders shall be made by irrevocableconfirmed letter of credit, payable in U.S. dollarsagainst Seller’s invoice and standard shippingdocuments. Such letter of credit shall be in an amountequal to the full purchase price of the Products andshall be established in a U.S. bank acceptable toSeller. Purchaser shall have sole responsibility toprocure all necessary permits and licenses forshipment and compliance with any governmentalregulations concerning control of final destination ofProducts.5.2 Purchaser agrees that Products shall notat any time directly or indirectly be used, exported,sold, transferred, assigned or otherwise disposed of ina manner which will result in non-compliance withapplicable export Control and US Sanction laws andregulations. If Purchaser purchases a Product at thedomestic price and exports such Product, or transferssuch Product to a third party for export, outside of theU.S., Purchaser shall pay to Seller the differencebetween the domestic price and the international retailprice of such Product. Purchaser shall deliver to Seller,upon Seller’s request, written assurance regardingcompliance with this Section in form and contentacceptable to Seller.

6. DELIVERY, RISK OF LOSS6.1 Delivery Date. Delivery and installation dates willbe established by mutual agreement of the parties asset forth in the Notice to Manufacture Letter issued bythe Seller, as applicable. Seller shall make reasonableefforts to meet such delivery date(s).6.2 Risk of Loss;Title Transfer. Unless otherwise agreed to in writing,the following shall apply: (a) For Products that do notrequire installation by Seller, and for options and add-on products purchased subsequent to delivery andinstallation of Products purchased under thisAgreement, delivery shall be complete upon transfer ofpossession to common carrier, F.O.B. Shipping Point,whereupon title to and all risk of loss, damage to ordestruction of the Products shall pass to Purchaser. (b)For Products that require installation by Seller, deliveryshall be complete upon delivery of the Products to

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Purchaser’s designated site, F.O.B. Destination;whereupon title to and all risk of loss, damage to ordestruction of such Products shall pass to Purchaserupon completion of delivery. (c) All freight charges andother transportation, packing and insurance costs,license fees, custom duties and other similar chargesshall be the sole responsibility of Purchaser unlessincluded in the purchase price or otherwise agreed to inwriting by Seller. In the event of any loss or damage toany of the Products during shipment, Seller andPurchaser shall cooperate in making any insuranceclaim.

7. SECURITY INTEREST/FILING7.1 Purchaser grants to Seller a security interest in theProducts until payment in full by Purchaser. Purchasershall sign any financing statements or other documentsnecessary to perfect Seller’s security interests in theProducts. Purchaser further represents and covenantsthat (a) it will keep the Products in good order andrepair until the purchase price has been paid in full, (b)it will promptly pay all taxes and assessments upon theProducts or the use thereof, (c) it will not attempt totransfer any interest in the Products until the purchaseprice has been paid in full, and (d) it is solvent andfinancially capable of paying the full purchase price forthe Products.

8. CHANGES, CANCELLATION, AND RETURN8.1 Orders accepted by Seller are not subject tochange except upon Seller’s written agreement.8.2Orders accepted by Seller are non-cancellable byPurchaser except upon Seller’s written consent andpayment by Purchaser of a cancellation charge equalto 10% of the price of the affected Products, plus anyshipping, insurance, inspection and refurbishmentcharges; the cost of providing any training, education,site evaluation or other services completed by Seller;and any return, cancellation or restocking fees withrespect to any Third Party Products ordered by Selleron behalf of Purchaser. Seller may retain any paymentsreceived from Purchaser up to the amount of thecancellation charge. In no event can an order becancelled by Purchaser or Products be returned toSeller after shipment.8.3 Seller reserves the right tochange the manufacture and/or design of its Productsif, in the judgment of Seller, such change does not alterthe general function of the Products.

9. FORCE MAJEURE9.1 Seller shall not be liable for any loss or damage fordelay in delivery, inability to install or any other failureto perform due to causes beyond its reasonable control

including, but not limited to, acts of God or the public,war, civil commotion, blockades, embargoes,calamities, floods, fires, earthquakes, explosions,storms, strikes, lockouts, labor disputes, orunavailability of labor, raw materials, power or supplies.Should such a delay occur, Seller may reasonablyextend delivery or production schedules or, at itsoption, cancel the order in whole or part without liabilityother than to return any unearned deposit orprepayment.

10. WARRANTY10.1 Seller warrants that the Products manufactured bySeller and sold hereunder shall be free from defects inmaterial or workmanship under normal use and servicefor the warranty period. The final assembled Productsshall be new although they may include certain used,reworked or refurbished parts and components (e.g.,circuit boards) that comply with performance andreliability specifications and controls. Seller’s obligationunder this warranty is limited, at Seller’s option, to therepair or replacement of the Product or any partthereof. Unless otherwise set forth in the ProductWarranty attached hereto and incorporated herein byreference (“Product Warranty”), the warranty periodshall commence upon the earlier of the date that theProducts have been installed in accordance withSection 12.5 hereof (which date shall be confirmed inwriting by Seller) or first patient use, and shall continuefor twelve (12) consecutive months. Seller makes nowarranty for any Products made by persons other thanSeller or its affiliates, and Purchaser’s sole warrantytherefor, if any, is the original manufacturer"s warranty,which Seller agrees to pass on to Purchaser, asapplicable. The warranty provided by Seller under thisSection 10 extends only to the original Purchaser,unless the Purchaser obtains the Seller’s prior writtenconsent with respect to any sale or other transfer of theProducts during the term of the warranty.10.2 Nowarranty extended by Seller shall apply to any Productswhich have been damaged by fire, accident, misuse,abuse, negligence, improper application or alteration orby a force majeure occurrence as described in Section9 hereof or by the Purchaser’s failure to operate theProducts in accordance with the manufacturer’sinstructions or to maintain the recommended operatingenvironment and line conditions; which are defectivedue to unauthorized attempts to repair, relocate,maintain, service, add to or modify the Products by thePurchaser or any third party or due to the attachmentand/or use of non-Seller supplied parts, equipment orsoftware without Seller’s prior written approval; whichfailed due to causes from within non-Seller supplied

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equipment, parts or software including, but not limitedto, problems with the Purchaser’s network; or whichhave been damaged from the use of operating suppliesor consumable parts not approved by Seller. Inaddition, there is no warranty coverage for anytransducer or probe failure due to events such ascracking from high impact drops, cable rupture fromrolling equipment over the cable, delamination fromcleaning with inappropriate solutions, or TEE bitemarks. Seller may effectuate any repairs at Purchaser’sfacility, and Purchaser shall furnish Seller safe andsufficient access for such repair. Repair or replacementmay be with parts or products that are new, used orrefurbished. Repairs or replacements shall notinterrupt, extend or prolong the term of the warranty.Purchaser shall, upon Seller’s request, return the non-complying Product or part to Seller with alltransportation charges prepaid, but shall not return anyProduct or part to Seller without Seller’s prior writtenauthorization. Purchaser shall pay Seller its normalcharges for service and parts for any inspection, repairor replacement that falls outside of Seller’s warranty.Seller’s warranty does not apply to consumablematerials, disposables, supplies, accessories andcollateral equipment, except as specifically stated inwriting or as otherwise set forth in the ProductWarranty.10.3 This warranty is made on condition thatimmediate written notice of any noncompliance begiven to Seller and Seller’s inspection reveals thatPurchaser"s claim is covered under the terms of thewarranty (i.e., that the noncompliance is due totraceable defects in original materials and/orworkmanship).10.4 Purchaser shall provide Seller withboth on-site and remote access to the Products. Theremote access shall be provided through thePurchaser’s network as is reasonably necessary forSeller to provide warranty services under thisAgreement. Remote access will be established througha broadband internet-based connection to either aPurchaser owned or Seller provided secure end-point.The method of connection will be a Peer-to-Peer VPNIPsec tunnel (non-client based) with specific inboundand outbound port requirements.10.5 Warranty servicewill be provided without charge during Seller"s regularworking hours (8:30-5:00), Monday through Friday,except Seller’s recognized holidays. If Purchaserrequires that service be performed outside these hours,such service can be made available at an additionalcharge, at Seller’s then current rates. The obligations ofSeller described in this Section are Seller’s onlyobligations and Purchaser’s sole and exclusive remedyfor a breach of product warranty.10.6 SELLER MAKESNO WARRANTY OTHER THAN THE ONE SET

FORTH HEREIN AND IN THE PRODUCTWARRANTY. SUCH WARRANTY IS IN LIEU OF ALLOTHER WARRANTIES, EXPRESS OR IMPLIED,INCLUDING BUT NOT LIMITED TO ANY EXPRESSOR IMPLIED WARRANTY OF MERCHANTABILITYOR FITNESS FOR PARTICULAR PURPOSES, ANDSUCH CONSTITUTES THE SOLE AND EXCLUSIVEWARRANTY MADE WITH RESPECT TO THEPRODUCTS, SERVICE OR OTHER ITEMFURNISHED UNDER THIS AGREEMENT.10.7 In theevent of any inconsistencies between the terms of thisSection 10 and the terms of the Product Warranty, theterms of the Product Warranty shall prevail.

11. LIMITATION OF LIABILITY11.1 In no event shall Seller’s liability hereunderexceed the actual loss or damage sustained byPurchaser, up to the purchase price of the Products.The foregoing limitation of liability shall not apply toclaims for bodily injury or damages to real property ortangible personal property to the extent arising fromSeller’s negligence or a product defect.11.2 SELLERSHALL NOT BE LIABLE FOR ANY LOSS OF USE,REVENUE OR ANTICIPATED PROFITS; COST OFSUBSTITUTE PRODUCTS OR SERVICES; LOSS OFSTORED, TRANSMITTED OR RECORDED DATA;OR FOR ANY INDIRECT, INCIDENTAL,UNFORESEEN, SPECIAL, PUNITIVE ORCONSEQUENTIAL DAMAGES WHETHER BASEDON CONTRACT, TORT, STRICT LIABILITY OR ANYOTHER THEORY OR FORM OF ACTION, EVEN IFSELLER HAS BEEN ADVISED OF THE POSSIBILITYTHEREOF, ARISING OUT OF OR IN CONNECTIONWITH THIS AGREEMENT OR THE SALE OR USE OFTHE PRODUCTS. THE FOREGOING IS ASEPARATE, ESSENTIAL TERM OF THISAGREEMENT AND SHALL BE EFFECTIVE UPONTHE FAILURE OF ANY REMEDY, EXCLUSIVE ORNOT.

12. INSTALLATION - ADDITIONAL CHARGES12.1 General. Unless otherwise expressly stipulated inwriting, the Products shall be installed by and at theexpense of Seller except that Seller shall not providerigging or site preparation services unless otherwiseagreed to in writing by Seller for an additional charge.Seller will not install accessory items such as cabinets,illuminators, darkroom equipment or processors for X-Ray and CT equipment, unless otherwise agreed to inwriting by Seller.12.2 Installation by Seller. If Sellerspecifies it will install the Products, the followingapplies: subject to fulfillment of the obligations set forthin Section 12.3 below, Seller shall install the Products

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and connect them to the requisite safety switches andpower lines to be installed by Purchaser. Except asotherwise specified below, if such installation andconnection are performed by Seller‘s technicalpersonnel, prices shown include the cost thereof,provided that the installation and connection can beperformed within the Continental United States orPuerto Rico and during normal business hours. Anyovertime charges or other special expenses shall beadditional charges to the prices shown.12.3Purchaser"s Obligations. Purchaser shall, at itsexpense, provide all proper and necessary labor andmaterials for plumbing service, carpentry work, conduitwiring, and other preparations required for suchinstallation and connection. All such labor and materialsshall be completed and available at the time of deliveryof the Products by Seller. Additionally, Purchaser shallprovide free access to the installation site and, ifnecessary, safe and secure space for storage ofProducts and equipment prior to installation by Seller.Purchaser shall be responsible, at its sole cost andexpense, for obtaining all permits, licenses andapprovals required by any federal, state or localauthorities in connection with the installation andoperation of the Products, including but not limited toany certificate of need and zoning variances. Purchasershall provide a suitable environment for the Productsand shall ensure that its premises are free ofhazardous conditions and any concealed or dangerousconditions and that all site requirements are met. Sellershall delay its work until Purchaser has completed theremoval of any hazardous materials or has taken anyother precautions and completed any other workrequired by applicable regulations. Purchaser shallreimburse Seller for any increased costs and expensesincurred by Seller that are the result of or are causedby any such delay. In the event that Seller is requestedto supervise the installation of the Products, it remainsthe Purchaser"s responsibility to comply with localregulations. Seller is not an architect and all drawingsfurnished by Seller are not construction drawings. Iflocal labor conditions, including a requirement to useunion labor, require the use of non-Seller employees toparticipate in the installation of the Product or otherwisecauses delays or any additional expenses, then anysuch additional costs shall be at Purchaser’s expense.12.4 Regulatory Reporting. In the event that anyregulatory activity is performed by anyone other thanSeller’s authorized personnel, then Purchaser shall beresponsible for fulfilling any and all reportingrequirements.12.5 Completion of Installation.Installation shall be complete upon the conclusion offinal calibration and checkout under Seller’s standard

procedures to verify that the Products meet applicablewritten performance specifications. Notwithstanding theforegoing, first use of the Products by Purchaser, itsagents or employees for any purpose after deliveryshall constitute completion of installation.

13. PATENT, COPYRIGHT AND OTHER INFRINGEMENT CLAIMS13.1 Infringement by Seller. Seller warrants that theProducts manufactured by Seller and sold hereunderdo not infringe any U.S. patent or copyright. IfPurchaser receives a claim that any such Products, orparts thereof, infringe upon the rights of others underany U.S. patent or copyright, Purchaser shall notifySeller immediately in writing. Provided that Purchasergives Seller information, assistance and exclusiveauthority to evaluate, defend and settle such claims,Seller shall at its own expense and option: indemnifyand defend Purchaser against such claims; settle suchclaims; procure for Purchaser the right to use theProducts; or remove or modify them to avoidinfringement. If none of these alternatives is availableon terms reasonable to Seller, then Purchaser shallreturn the Products to Seller and Seller shall refund toPurchaser the purchase price paid by Purchaser lessreasonable depreciation for Purchaser’s use of theProducts. The foregoing states Seller’s entire obligationand liability, and Purchaser’s sole remedy, for claims ofinfringement.13.2 Infringement by Purchaser. If someor all of the Products sold hereunder are made bySeller pursuant to drawings or specifications furnishedby Purchaser, or if Purchaser modifies or combines,operates or uses the Products other than as specifiedby Seller or with any product, data, software, apparatusor program not provided or approved by Seller, then theindemnity obligation of Seller under Section 13.1 shallbe null and void.

14. DESIGNS AND TRADE SECRETS; LICENSE;CONFIDENTIALITY14.1 Any drawings, data, designs, software programsor other technical information supplied by Seller toPurchaser in connection with the sale of the Productsshall remain Seller’s property and shall at all times beheld in confidence by Purchaser.14.2 For all Productswhich utilize software for their operation, such"Applications Software" shall be licensed to Purchaserunder the terms of Seller’s Software License Scheduleattached hereto.14.3 Seller and Purchaser shallmaintain the confidentiality of any information providedor disclosed to the other party relating to the business,customers and/or patients of the disclosing party, aswell as this Agreement and its terms (including thepricing and other financial terms under which the

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Purchaser will be purchasing the Products). Each partyshall use reasonable care to protect the confidentialityof the information disclosed, but no less than thedegree of care it would use to protect its ownconfidential information, and shall only disclose theother party’s confidential information to its employeesand agents having a need to know this information. Theobligations of confidentiality set forth herein shall notapply to any information in the public domain at thetime of disclosure or that is required to be disclosed bycourt order or by law.

15. ASSIGNMENT15.1 Neither party may assign any rights or obligationsunder this Agreement without the prior written consentof the other, which shall not be unreasonably withheld.Any attempt to do so shall be void, except that Sellermay assign this Agreement without consent to anysubsidiary or affiliated company, and may delegate toauthorized subcontractors or service suppliers anywork to be performed under this Agreement so long asSeller remains liable for the performance of itsobligations under this Agreement. This Agreement shallinure to and be binding upon the parties and theirrespective successors, permitted assigns and legalrepresentatives.

16. COSTS AND FEES16.1 In the event that any dispute or difference isbrought arising from or relating to this Agreement or thebreach, termination or validity thereof, the prevailingparty shall be entitled to recover from the other party allreasonable attorneys’ fees incurred, together with suchother expenses, costs and disbursements as may beallowed by law.

17. MODIFICATION17.1 This Agreement may not be changed, modified oramended except in writing signed by duly authorizedrepresentatives of the parties.

18. GOVERNING LAW; WAIVER OF JURY TRIAL18.1 This Agreement shall be governed by the laws ofthe state where the Product(s) will be installed, withoutregard to that state’s choice of law principles.18.2EACH OF THE PARTIES EXPRESSLY WAIVES ALLRIGHTS TO A JURY TRIAL IN CONNECTION WITHANY DISPUTE UNDER THIS AGREEMENT.

19. COST REPORTING19.1 Purchaser agrees that it must fully and accuratelyreport prices paid under this Agreement, net of alldiscounts, as required by applicable law and contract,including without limitation 42 CFR §1001.952(h),in all

applicable Medicare, Medicaid and state agency costreports. Purchaser shall retain a copy of thisAgreement and all other communications regarding thisAgreement, together with the invoices for purchase andpermit agents of the U.S. Department of Health andHuman Services or any state agency access to suchrecords upon request.

20. INTEGRATION20.1 These terms and conditions, including anyattachments or other documents incorporated byreference herein, constitute the entire, complete andexclusive statement of agreement with respect to thesubject matter hereof, and supersede any and all prioragreements, understandings and communicationsbetween the parties with respect to the Products.Purchaser’s additional or different terms and conditionsstated in a purchase order, bid documents or any otherdocument issued by Purchaser are specifically rejectedand shall not apply to the transactions contemplatedunder this Agreement.

21. SEVERABILITY; HEADINGS21.1 No provision of this Agreement which may bedeemed unenforceable will in any way invalidate anyother portion or provision of this Agreement. Sectionheadings are for convenience only and have nosubstantive effect.

22. WAIVER22.1 No failure and no delay in exercising, on the partof any party, any right under this Agreement willoperate as a waiver thereof, nor will any single orpartial exercise of any right preclude the furtherexercise of any other right.

23. NOTICES23.1 Any notice or other communication under thisAgreement shall be deemed properly given if in writingand delivered in person or mailed, properly addressedand stamped with the required postage, to the intendedrecipient at its address specified on the face hereof.

24. RIGHTS CUMULATIVE24.1 The rights and remedies afforded to Seller underthis Agreement are in addition to, and do not in anyway limit, any other rights or remedies afforded toSeller by any other agreement, by law or otherwise.

25. END USER CERTIFICATION25.1 Purchaser represents, warrants and covenantsthat it is acquiring the Products for its own end use andnot for reselling, leasing or transferring to a third party(except for lease-back financings).

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26. ACCESS TO BOOKS AND RECORDS26.1 To the extent required by Section 1861(v)(1)(I) ofthe Social Security Act and the regulations promulgatedthereunder, until the expiration of four (4) years afterthe furnishing of any Product or service pursuant to thisAgreement, Seller shall make available, upon writtenrequest by the Secretary of Health and HumanServices (the “Secretary”), or upon request by theComptroller General (the “Comptroller”), or any of theirduly authorized representatives, copies of thisAgreement and any books, documents, records orother data of Seller that are necessary to certify thenature and extent of any costs incurred by Purchaserfor such Products and services. If Seller carries out anyof its duties under this Agreement through asubcontract with a related organization involving avalue or cost of ten thousand dollars ($10,000) or moreover a twelve (12) month period, Seller will cause suchsubcontract to contain a clause to the effect that, until

the expiration of four (4) years after the furnishing ofany Product or service pursuant to said contract, therelated organization will make available upon thewritten request of the Secretary or the Comptroller, orany of their duly authorized representatives, copies ofrecords of said related organization that are necessaryto certify the nature and extent of cost incurred byPurchaser for such Product or service.

27. DISPOSITION OF PRODUCTS27.1 Purchaser expressly agrees that should Purchasersell, transfer or otherwise dispose of the Products,Purchaser shall notify Seller in writing and give Sellerthe opportunity to purchase such Products. WithPurchaser’s notice, Purchaser shall provide Seller witha copy of the third party’s binding offer to purchase theProducts and Seller shall have seven (7) days to notifythe Purchaser of an offer to purchase the Products.05/15 Rev.

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Software License Scheduleto the Siemens Medical Solutions USA, Inc. General Terms and Conditions

1. DEFINITIONS: The following definitions apply to this Schedule:“Agreement” shall mean the attached (i) Quotation for Products and/orServices including the Terms and Conditions of Sale and applicableschedules; and/or (ii) Software License Agreement describing the softwarelicensed herein and the specific system for which the license is issued.“Licensor” shall mean Siemens Medical Solutions USA, Inc.“Licensee” shall mean the end-user to whom Licensor provides Software orDocumentation for its internal use under the Agreement.“Software” shall mean the software described in the attached Agreement,including the following as contained therein: (i) software programs consistingof a series of statements or instructions to be used directly or indirectly in aprogrammable controller or computer to bring about a certain result and (ii)databases consisting of systemized collections of data to be used orreferenced directly or indirectly by a programmed controller or computer.Notwithstanding the foregoing, “Software” does not include “firmware” as suchterm is conventionally understood. Diagnostic/Maintenance Software also isnot included within the scope of the Software licensed under this Schedule,and is available only as a special option under a separate Diagnostic MaterialsLicense Agreement and may be subject to a separate licensing fee.“Documentation” shall mean the documents and other supporting materialswhich are intended to support the use of an associated product, including (butnot limited to) instructions, descriptions, flow charts, logic diagrams andlistings of the Software, in text or graphic form, on machine readable or printedmedia.“Designated Unit” shall mean a single control unit or computer identified onthe first page of the Agreement, on which Software licensed hereunder maybe used by Licensee.2. SCOPE: The following terms and conditions shall apply to all Software andDocumentation provided by Licensor to Licensee under the Agreement(whether included with other products listed in the Agreement or listedseparately in the Agreement), together with any updates or revisions theretowhich Licensor may provide to Licensee, and all copies thereof, except anySoftware and/or Documentation licensed directly by Licensor’s supplier undera separate end-user license agreement accompanying the Software or theDocumentation, in which case Licensee agrees to be bound by that licenseagreement as a condition to using the Software and/or Documentation.Except as expressly provided herein, and provided that in no event shall thewarranties or other obligations of Licensor with respect to such Software orDocumentation exceed those set forth in this Schedule, this Schedule shallbe subject to the liability limitations and exclusions and other terms andconditions set forth in the Agreement. ANY USE OF THE SOFTWARE,INCLUDING BUT NOT LIMITED TO USE ON THE DESIGNATED UNIT,WILL CONSTITUTE LICENSEE’S AGREEMENT TO THIS SOFTWARELICENSE SCHEDULE (OR RATIFICATION OF ANY PREVIOUSCONSENT).3. SOFTWARE AND DOCUMENTATION LICENSE: Subject to the paymentof any applicable annual license fee(s), whether stated separately or includedin the purchase price of another product, and to Licensee’s acceptance of allof the obligations set forth herein and to the fulfillment of those obligations,Licensor or, if applicable, its licensor or supplier, hereby grants to Licensee apaid-up, nonexclusive and nontransferable (except as expressly provided inthis Schedule) limited license to use the Software provided by Licensor underthe Agreement solely for Licensee’s own use on the Designated Unit and touse the Documentation in support of Licensee’s authorized use of theSoftware, for the purpose of operating the Designated Unit in accordance withthe instructions set forth in the user’s manual supplied with the DesignatedUnit and for no other purpose whatsoever. A separate license is required foreach Designated Unit on which the Software is to be used. Licensee mayobtain from Licensor one copy of the Software licensed hereunder for backupand archival purposes only as is necessary to support Licensee’s ownauthorized use of the Software, provided that Licensee includes on or in allcopies (in any form) all copyright, trade secret or other proprietary noticescontained on or in the Software as provided by Licensor. Additional copies ofthe Documentation may be licensed from Licensor at its then applicablecharges. Licensee may make the Software and Documentation (including anycopies) available only to its employees and other persons on Licensee’spremises to whom such disclosure is necessary to enable Licensee to use theSoftware or Documentation within the scope of the license provided in thisSchedule. If the Software is supplied to any unit or agency of the United

States Government other than the Department of Defense, the Software andDocumentation are classified as “restricted computer software” and theGovernment’s rights in the Software and Documentation shall be as providedin paragraph (c) (2) of the Commercial Computer Software-Restricted Rightsclause in FAR 52.227-19 and any successor laws, rules or regulations thereto.If the Software is supplied to the United States Department of Defense, theSoftware is classified as “commercial computer software” and theGovernment is furnished the Software and Documentation with “restrictedrights” as defined in paragraph (c) (1) of the Rights in Technical Data andComputer Software clause in DFARS 252.227-7013 and any successor laws,rules or regulations thereto.4. PROPRIETARY PROTECTION AND CONFIDENTIALITY: Ownership ofand title to the Software and Documentation and all copies, in any form,licensed under this Schedule are and will remain in Licensor or its suppliersat all times. Licensee shall not (i) remove any copyright, trade secret or otherproprietary right notices contained on or in the Software or Documentation asprovided by Licensor, (ii) reproduce or modify any Software or Documentationor copy thereof, (iii) reverse assemble, reverse engineer or decompile anySoftware, or copy thereof, in whole or in part (except and only to the extentthat such activity is expressly permitted by applicable law notwithstanding thislimitation), (iv) sell, transfer or otherwise make available to others the Softwareor Documentation, or any copy thereof, except as expressly permitted by thisSchedule, or (v) apply any techniques to derive any trade secrets embodiedin the Software or Documentation. Licensee shall take all appropriate actionsto ensure that: (i) the Software does not leave the Designated Unit’sequipment location as set forth above, (ii) the Software is not copied byLicensee or any third parties, and (iii) the Software is not used in anyequipment other than the Designated Unit. Licensee shall secure and protectthe Software and Documentation and copies thereof from disclosure and shalltake such actions with its employees and other persons who are permittedaccess to the Software or Documentation or copies as may be necessary tosatisfy Licensee’s obligations hereunder. Prior to disposing of any computermedium, computer memory or data storage apparatus, Licensee shall ensurethat all copies of Software and Documentation have been erased therefromor otherwise destroyed. In the event that Licensee becomes aware that anySoftware or Documentation or copies are being used in a manner notpermitted by the license, Licensee shall immediately notify Licensor in writingof such fact and if the person or persons so using the Software orDocumentation are employed or otherwise subject to Licensee’s direction andcontrol, Licensee shall use reasonable efforts to terminate such impermissibleuse. Licensee will fully cooperate with Licensor so as to enable Licensor toenforce its proprietary and property rights in the Software. Licensee agreesthat, subject to Licensee’s reasonable security procedures, Licensor shallhave immediate access to the Software at all times and that Licensor maytake immediate possession thereof upon termination or expiration of theassociated license or this Schedule. Licensee’s obligations under thisparagraph shall survive any termination of a license, the Schedule or theAgreement.5. UPDATES AND REVISIONS: During the warranty period or under aseparate service contract or software update subscription, revised or updatedversions of the Software licensed under this Schedule may be made available,at Licensor’s option, to Licensee to use or to test while Licensee continuesuse of a previous version. Licensee has the right to decide whether to installany such revised or updated versions or to continue use of the previousversion after giving due regard to the United States Food and DrugAdministration rules and regulations. However, Licensee shall pay Licensorfor any services necessitated by any modifications of the Software byLicensee or by Licensee’s failure to utilize the current non-investigationalversion of the Software provided by Licensor. Software updates that providenew features or capabilities or that require hardware changes will be offeredto Licensee at purchase prices established by Licensor. Licensor retains thesole right to determine whether an update represents an enhancement of apreviously purchased capability or a new capability for which the Licensee willbe charged. In addition, some updates may require Applications Trainingperformed by Licensor’s personnel that will be offered at Licensor’s prevailingrates. Licensor retains the sole right to determine whether an update requiressuch training.6. DELIVERY, RISK OF LOSS AND TITLE: Notwithstanding the provisionsof Section 6 of the attached Terms and Conditions of Sale, if any, the Software

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and Documentation licensed hereunder shall be delivered on or about thedelivery date stated in the Agreement unless a separate delivery date isagreed upon. If Software or Documentation licensed hereunder is lost ordamaged during shipment from Licensor, Licensor will replace it at no chargeto Licensee. If any Software or Documentation supplied by Licensor andlicensed hereunder is lost or damaged while in the possession of Licensee,Licensor will replace it at Licensor’s then current applicable charges, if any,for materials, processing and distribution. Notwithstanding the provisions ofSection 6 of the attached Terms and Conditions of Sale, if any, the Softwareand Documentation, in any form, and all copies made by Licensee, includingpartial copies, and all computer media provided by Licensor are and remainthe property of Licensor or its supplier. Licensee has no right, title or interestin the Software, the Documentation, or any computer media provided byLicensor, or copies, except as stated herein, and ownership of any suchSoftware, Documentation and computer media shall at all times remain withLicensor or its suppliers.7. LICENSE TRANSFER: The Software and Documentation, and the licensehereunder, may not be assigned, transferred or sublicensed except ashereinafter provided. Upon the sale or lease of the Designated Unit to a thirdparty, Licensee may transfer to such third party, with Licensor’s writtenconsent and in accordance with Licensor’s then current policies and charges,the license to use the Software and Documentation hereunder, together withthe Software, the Documentation, the computer media provided by Licensor,and all copies provided that: (i) Licensee notifies Licensor in writing of thename and address of such third party; (ii) such third party agrees in a writteninstrument delivered to Licensor to the terms of this Schedule; and (iii)Licensee does not retain any copies of the Software or Documentation in anyform.8. WARRANTIES: Licensor warrants that for the warranty period provided byLicensor under the attached Terms and Conditions of Sale, if any, theSoftware shall conform in all material respects to Licensor’s publishedspecifications as contained in the applicable supporting Documentation. Thisparagraph replaces Paragraphs 10.1 and 10.4 of any such Terms andConditions of Sale with respect to the Software and Documentation. SuchDocumentation may be updated by Licensor from time to time and suchupdates may constitute a change in specification. Licensee acknowledgesthat the Software is of such complexity that it may have inherent or latentdefects. As Licensee’s sole remedy under the warranty, Licensor will provideservices, during the warranty period, to correct documented Software errorswhich Licensor’s analysis indicates are caused by a defect in the unmodifiedversion of the Software as provided by Licensor. Licensor does not warrantthat the Software will meet Licensee’s requirements, or will operate incombinations which may be selected for use by Licensee, or that the operationof the Software will be uninterrupted or error free. Licensee is responsible fordetermining the appropriate use of and establishing the limitations of theSoftware and its associated Documentation as well as the results obtained byuse thereof.LICENSOR MAKES NO WARRANTY WITH RESPECT TO THESOFTWARE AND DOCUMENTATION OTHER THAN THOSE SET FORTHIN THIS SECTION. THE WARRANTY HEREIN IS IN LIEU OF ALL OTHERWARRANTIES, EXPRESS OR IMPLIED, INCLUDING BUT NOT LIMITEDTO ANY EXPRESS OR IMPLIED WARRANTIES OF MERCHANTABILITYOR FITNESS FOR A PARTICULAR PURPOSE, WHICH ARE HEREBYDISCLAIMED, AND CONSTITUTES THE ONLY WARRANTY MADE WITHRESPECT TO THE SOFTWARE AND DOCUMENTATION.9. LICENSE TERM AND TERMINATION: The license for the Software andDocumentation is effective on the shipment date of the Software andDocumentation (F.O.B. shipping point or F.A.S., as the case may be) andcontinues until Licensee’s possession of the Software and all copies ceases(except in connection with a transfer of the license as permitted by thisSchedule) or until otherwise terminated as provided herein. Licensee mayterminate the license for the Software and Documentation at any time afterdiscontinuance of use of the Software and Documentation and all copies,upon written notice to Licensor. If Licensee (i) fails to comply with itsobligations herein and does not cure such failure within ten (10) days afterreceipt of notice from Licensor, or (ii) attempts to assign the Agreement or thisSchedule or any rights or obligations hereunder without Licensor’s priorwritten consent, then Licensor may terminate the license hereunder andrequire the immediate discontinuance of all use of the Software andDocumentation and all copies thereof in any form, including modified versionsand updated works. Within five (5) days after the termination of the license,Licensee shall, at Licensor’s option either: (i) return to Licensor the Softwareand Documentation, and all copies, in any form, including updated versions,along with any computer media provided by Licensor; or (ii) destroy theaffected Software and Documentation, and all copies, in any form, includingupdated versions, and certify such return or destruction in writing to Licensor.

10. MISCELLANEOUS: Since the unauthorized use of the Software and/orDocumentation may leave Licensor without an adequate remedy at law,Licensee agrees that injunctive or other equitable relief will be appropriate torestrain such use, threatened or actual. Licensee further agrees that to theextent applicable, (i) any of Licensor’s suppliers of Software and/orDocumentation is a direct and intended beneficiary of this Schedule and mayenforce it directly against Licensee with respect to the Software and/orDocumentation provided by such supplier, and that (ii) NO SUPPLIER OFLICENSOR SHALL BE LIABLE FOR ANY GENERAL, SPECIAL, DIRECT,INDIRECT, CONSEQUENTIAL, INCIDENTAL OR OTHER DAMAGESARISING OUT OF ANY SUBLICENSE OF THE SOFTWARE AND/ORDOCUMENTATION. THIS LIMITATION ON LIABILITY SHALL APPLYEVEN IF ANY REMEDY FAILS OF ITS ESSENTIAL PURPOSE.11. ADDITIONAL PROVISIONS RELATING TO THIRD-PARTYSOFTWARE: If the Software includes software licensed by Licensor fromthird parties, the following additional provisions shall apply: (a) If Software is provided by Licensor on separate media and labeled“Recovery Media,” Licensee may use the Recovery Media solely to restore orreinstall the Software and/or Documentation originally installed on theDesignated Unit. (b) Licensee is licensed to use the Software to provide only the limitedfunctionality (specific tasks or processes) for which the Designated Unit hasbeen designed and marketed by Licensor. This license specifically prohibitsany other use of the software programs or functions, or inclusion of additionalsoftware programs or functions that do not directly support the limitedfunctionality, on the Designated Unit. If Licensee uses the Designated Unit toaccess or utilize the services or functionality of Microsoft Windows Serverproducts (such as Microsoft Windows NT Server 4.0 (all editions) or MicrosoftWindows 2000 Server (all editions)), or uses the Designated Unit to permitworkstation or computing devices to access or utilize the services orfunctionality of Microsoft Windows Server products, Licensee may be requiredto obtain a Client Access License for the Designated Unit and/or each suchworkstation or computing device. Licensee should refer to the end userlicense agreement for its Microsoft Windows Server product for additionalinformation. (c) The Software may contain support for programs written in Java. Javatechnology is not fault tolerant and is not designed, manufactured, or intendedfor use or resale as online control equipment in hazardous environmentsrequiring fail-safe performance, such as in the operation of nuclear facilities,aircraft navigation or communication systems, air traffic control, direct lifesupport machines, or weapons systems, in which the failure of Javatechnology could lead directly to death, personal injury, or severe physical orenvironmental damage. Sun Microsystems, Inc. has contractually obligatedLicensor’s supplier to make this disclaimer. (d) The Software may permit Licensor, its supplier(s), or their respectiveaffiliates to provide or make available to Licensee Software updates,supplements, add-on components, or Internet-based services components ofthe Software after the date Licensee obtains its initial copy of the Software(“Supplemental Components”). - If Licensor provides or makes available to Licensee Supplementalcomponents and no other end-user software licensing agreement terms areprovided along with the Supplemental Components, then the terms of thisSoftware License Schedule shall apply. - If a supplier of Licensor or affiliates of such a supplier make availableSupplemental Components, and no other end-user software licensingagreement terms are provided, then the terms of this Schedule shall apply,except that the supplier or affiliate entity providing the SupplementalComponent(s) shall be the licensor of the Supplemental Component(s).Licensor, its supplier(s), and their respective affiliates reserve the right todiscontinue any Internet-based services provided to Licensee or madeavailable to Licensee through the use of the Software. (e) The Software and Documentation supplied by Licensor’s suppliersare provided by such suppliers “AS IS” and with all faults. SUCHSUPPLIERS DO NOT BEAR ANY OF THE RISK AS TO SATISFACTORYQUALITY, PERFORMANCE, ACCURACY, OR EFFORT (INCLUDINGLACK OF NEGLIGENCE) WITH RESPECT TO SUCH SOFTWARE ANDDOCUMENTATION. ALSO, THERE IS NO WARRANTY BY SUCHSUPPLIERS AGAINST INTERFERENCE WITH LICENSEE’S ENJOYMENTOF THE SOFTWARE OR AGAINST INFRINGEMENT. IF LICENSEE HASRECEIVED ANY WARRANTIES REGARDING THE DESIGNATED UNITOR THE SOFTWARE, THOSE WARRANTIES DO NOT ORIGINATE FROM,AND ARE NOT BINDING ON, LICENSOR’S SUPPLIERS. (f) Licensee acknowledges that portions of the Software are of U.S. origin.Licensee agrees to comply with all applicable international and national lawsthat apply to the Software, including the U.S. Export AdministrationRegulations, as well as applicable end-user, end-use and destination

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restrictions issued by U.S. and other governments. For additional informationon exporting software supplied by Microsoft, seehttp://www.microsoft.com/exporting/.

Revised 03/15/05

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TRADE-IN EQUIPMENT REQUIREMENTS

THE FOLLOWING APPLIES ONLY TO THE EXTENT THAT THE QUOTATION INCLUDES AN EQUIPMENT TRADE IN OR IF A TRADE-INIS LATER ADDED TO THS QUOTATION VIA A CHANGE ORDER. THESE REQUIREMENTS ARE IN ADDITION TO ANY OTHERREFERENCED TERMS AND CONDITIONS OF THE QUOTATION AND SHALL REMAIN IN EFFECT REGARDLESS OF ANY CONTRARYLANGUAGE IN THE QUOTATION.

This Quotation includes the trade-in equipment described herein and referenced by either the Project Number identified in the Quotation hereof(non-Ultrasound) or the Trade In Part Number (Ultrasound) as further described in the associated Trade Sheet which is incorporated herein byreference. Purchaser certifies that the description of the trade-in equipment as set forth on the Trade Sheet is a true and accuraterepresentation of the equipment, and that the equipment is in good working condition unless otherwise noted on the Trade Sheet.

The trade-in equipment must be made available for removal no later than turnover of the new equipment. Purchaser must vacate the room of allitems not listed on the Trade Sheet, or otherwise clearly identify all items listed on the Trade Sheet, prior to the start of the de-installation. If thisis not done, Seller will have no liability for items which are subsequently removed or scrapped. If the de-installation or return of the trade-inequipment is delayed by Purchaser for reasons other than a force majeure event, or if upon inspection by Seller it is determined that theequipment does not meet the manufacturer’s operating specifications, or if any items listed as included on the Trade Sheet are not madeavailable at the time of de-installation, then trade-in value will be re-evaluated and any loss in value or additional costs incurred by Seller shallbe deducted from the established trade-in value and the pricing set forth on this Quotation will be adjusted by change order. In the event thataccess to the non-ultrasound trade-in equipment is denied past 14 days from turnover, or access to ultrasound trade-in equipment is deniedpast 30 days from turnover, then Purchaser shall pay to Seller a rental fee in the amount 3.5% of the total trade-in value plus any additionalvalue provided by an Elevate/Promotional program included in this quotation (no less than $1000) for each month, or part thereof, that access isdenied. In addition, if the purchase and installation of the new equipment covered by this Quotation is not completed, then Seller shall invoicePurchaser for all costs and expenses incurred by Seller in connection with the de-installation and removal of the trade-in equipment, includingbut not limited to labor, materials, rigging out, and transportation, which costs shall be paid by Purchaser within thirty (30) days of the invoicedate.

Purchaser further acknowledges and agrees that (i) the trade-in equipment will be free and clear of all liens and encumbrances including, but notlimited to, unpaid leases and loans, and that upon request, it will execute a bill of sale or other documents reasonably satisfactory to Siemens totransfer title and ownership of the equipment to Seller, (ii) it is Purchaser’s sole responsibility to delete all protected health information and anyother confidential information from the equipment prior to de-installation, without damaging or cannibalizing the equipment or otherwise affectingthe operation of the equipment in accordance with its specifications, (iii) the equipment, including all updates, upgrades, modifications,enhancements, revisions, software, S/W disks and manuals, shall be returned to Siemens in good operating condition, reasonable wear and tearexcepted, and (iv) to the extent not prohibited by applicable law, Purchaser shall indemnify and hold Seller harmless from and against any andall claims, demands, causes of action, damages, liability, costs and expenses (including reasonable attorney's fees) resulting or arising fromPurchaser’s failure to comply with item (i) above.

FOR MR SYSTEMS: cryogen levels must be least 65% upon time of de-installation. FOR MOBILE SYSTEMS: system must be road worthyand a state issued title transferring ownership to Seller (or Designee) must be received prior to the removal of the mobile system. FORMODALITY TRADE SYSTEMS (non-ultrasound): The trade-in equipment must be available for inspection within two weeks of the scheduledde-installation date. In addition, Purchaser must provide a clear path for the removal of the trade-in equipment and on the date of de-installationafter final inspection and test by the Seller (or Designee) has occurred, the Purchaser must supply licensed tradespeople to disconnect thepower and plumbing (including draining and removing and disposing of any hazardous materials including, but not limited to glycol from thechiller and oil from the transformer, as examples.) Any additional costs due to the need to use a larger rig (other than a standard 80 ton rig), aswell as any construction activities, street closings, permits, etc., required to de-install/remove the equipment are out-of-scope costs and will bethe responsibility of Purchaser. FOR ULTRASOUND SYSTEMS – Purchaser may provide transducers with the ultrasound unit being traded in,but will not receive additional credit for such transducers.

CON #5907 Page 33



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MR Warranty Information

Product(New Systems and"ECO" Refurbished Systems Only)

Period of Warranty1 Coverage

MR System (not including consumables) 12 months Full Warranty(parts & labor)

Principal CoveragePeriod8am-5pm Mondaythrough Friday 2

Post-Warranty (after expiration of system warranty) – Replacement parts only!

Magnet 12 months Parts only

Spare Parts 6 months Parts only

Consumables Not Covered

Note: Optional extended warranty coverage can be obtained by purchase of a service agreement.

1 Period of warranty commences from the date of first use or completion of installation, whichever occurs first. In the event the completion ofinstallation is delayed for reasons beyond Siemens' control, the stated warranty period shall commence 60 days after delivery of equipment.

2 Standard deliverable independent of subsequent service contract commitment

CON #5907 Page 34



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Detailed Technical Specifications

MAGNETOM Vida - System

Part No./Product Description14456200MAGNETOM Vida -System

14460161MR General Engine#Vi

14456321Brain Dot Engine#Se

14461775DotGO RoutinePackage #BM

14441748Quiet Suite #T+D

14460162Tim Whole BodySuite #Vi

14460227Tim Planning Suite#Vi

14460160Advanced Diffusion#Vi

14456327WARP & AdvancedWARP #Vi

14456237Advanced Cardiacincl. PSIR #Vi

14456323Inline Composingsyngo #Se

14475338syngo Expert-I XA31

14456203Tim [228x128] XT +TrueShape #Vi

14456215Standard CoilPackage, 128-ch #Vi

CON #5907 Page 35



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Part No./Product Description14456328BioMatrixTechnology #Vi

14470783BioMatrixRespiratorySensors#Vi,So

14470792BioMatrix Coil Shim#Vi,So

14470794BioMatrixSliceAdjust #BM

14456212BioMatrix Dock.Table w/ eDrive #Vi

14470795BioMatrix Select &GO #Vi,So

14456206Silver & WhiteDesign #Vi

14456270PC Keyboard USEnglish #Vi

14456230High-End Computing[228x128] #Vi

14460295Advanced HostComputer

14456238Peripheral Pulse Unit#Vi

14460313Dual MonitorPackage #BM

14470995DotGO AdvancedPackage #NX

14418746Cardiac Dot Engine,USA #T+D

14461619Turbo SuiteEssential #BM

14469017

CON #5907 Page 36



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Part No./Product DescriptionTurbo SuiteExcelerate #BM

14469020Turbo SuiteExcelerate Support

14469015Turbo Suite Elite#BM

14469016Turbo Suite EliteSupport #BM

14475287Deep Resolve Gain

14475288Deep Resolve Sharp1

14402527SWI #Tim

14441849Diffusion TensorImaging #T+D

14456233Neuro fMRI Package#Vi

14416946Neuro PerfusionPackage #T+D

14461562PCASL #BM

14416965Arterial SpinLabeling 3D #T+D

14409110Arterial SpinLabeling 2D

14405341Mapit syngo #Tim

14441761LiverLab #T+D

14409198Native syngo #Tim

14441813QISS #T+D

08464740Flow Quantification#Tim

CON #5907 Page 37



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Part No./Product Description14446385MyoMaps # 3T

14456255Single VoxelSpectroscopy #Vi

144136152D Chemical ShiftImaging #Tim

144136213D Chemical ShiftImaging #Tim

14456222Body 30 DuoPackage #Vi

14456221Shoulder Shape 16#Vi

14418513Hand/Wrist 16 #Sk

14456217Tx/Rx Knee 18 #Vi

14418514Foot/Ankle 16 #Sk

14418512Peripheral Angio 36#Sk

14456220Head/Neck 64 w/CoilShim #Vi

14469230Flex -> UltraFlexUpgrade #3T

14456282Positioning AidsShoulder&Ankle #Vi

14456241Separator60kW/75kW #Vi

14460249UPS system #Vi

14456228System Start Timer#Vi

4MR5142869Armrest #MR

14469205

CON #5907 Page 38



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Part No./Product DescriptionBreast Biopsy #BM(Optional)

144366662/10/16ch SentinelleBreastCoil #Sk(Optional)

14418519Tim Coil Interface 3T(Optional)

CON #5907 Page 39

Divider II. Proposal Description:1. Provide a complete detailed project description.Christian Hospital proposes to acquire a Siemens Magnetom Vida3-tesla1 MRI unit. The hospital has only one other MRI scanner, and it is 22-years-old.

MRI is an essential tool in modern medicine. Making use of the abundant hydrogenatoms in our body, an MRI unit generates a strong magnetic field to align thehydrogen atoms in one direction. Radio waves are rapidly pulsedto rhythmically disrupt this alignment. Between pulses, the hydrogen atoms emittheir own radio signals, which are collected, amplified, and reconstructed withcomputers to create MRI images.

MRI imaging uses no ionizing radiation. A growing body of research shows that aperson’s lifetime exposure to ionizing radiation—used in traditional X-rays and CTscans—needs to be carefully managed. This research was described in the National

1 1 NOTE: tesla is a measure of the strength of a magnetic field, such as that generated by an MRI scanner. Atypical refrigerator magnet has a field strength about 1,000 times less powerful than 1 tesla.

CON #5907 Page 40

Council on Radiation Protection and Measurements Report No. 160. In response tothese concerns, the US Food and Drug Administration launched its Initiative toReduce Unnecessary Radiation Exposure from Medical Imaging. Medical devicemanufacturers and providers are working hard to achieve the radiation reductiongoals agreed upon in these meetings. As MRI technology becomes more advanced,MRI scans are becoming more central in medical diagnoses, eliminating a source ofionizing radiation in patients.

The new machine offers the following improvements and advances: Innovative BioMatrix technology. This technology compensates

for anatomical and physiological differences to deliver more preciseimaging. Patient variability, such as obesity, can make MRI imagingchallenging. BioMatrix helps compensate for this "biovariability."

BioMatrix sensors that help technicians set-up and conduct MRI exams morequickly and with more consistency. BioMatrix interfaces use artificialintelligence to expedite patient positioning and deliver consistent results.

Respiratory sensors in the patient table that reduce or eliminate the need for apatient’s breath holds.

A camera system in the machine that enables technologists to visually monitorthe patient’s face, checking for discomfort or the first signs of more seriousproblems.

BioMatrix Tuners that improve the quality of head, neck, and spine imagingusing software and hardware that compensates for sources of distortion.

The proposed unit will provide greater capacity to perform advanced MRI studies,such as:

MRA (magnetic resonance angiography) capabilities, which offers imagingthat shows blood flow, commonly used today in diagnosing stroke, aorticaneurysm imaging, aortic dissections, and imaging of renal arteries.

Functional studies, which provide imaging of brain activity.

In summary, the proposed replacement will: Improve patient satisfaction and access. Speed image acquisition. Provide patients the full range of modern MRI studies. Accommodate larger patients and provide the claustrophobic with a larger

machine opening.

The total project cost, including the proposed unit, with the applicable optionalfeatures, software, and shielding is $3,008,074.

2. Provide a timeline of events for the project, from CON issuance through projectcompletion.

Construction is expected to start by year’s end and the project complete by earlysummer.

CON #5907 Page 41

3. Provide a legible city or county map showing the exact location of the project.

4. Define the community to be served.

Christian Hospital is one of the largest hospitals in metropolitan St. Louis. Located inSt. Louis County, it is the only hospital in the northern part of metro St. Louis. It hasone of the busiest emergency departments in the state.

Christian Hospital is a full service acute-care community hospital located inunincorporated north St. Louis County. Christian Hospital is noted for its excellencein heart services and lifesaving cardiothoracic surgery, emergency medicine, breasthealth services, orthopedic/spine surgery, hyperbaric wound care, pain management,vascular surgery, endocrinology, gastrointestinal care, stroke care, nephrology,therapy, radiology, urology, pulmonary care and treating sleep disorders.

Christian Hospital received the American College of Cardiology’s NCDR Chest PainMI Registry Silver Performance Achievement Award for 2020. Christian Hospital isone of only 124 hospitals nationwide to receive this honor. Christian HospitalEmergency Medical Services received the 2020 American Heart Association’sMission: Lifeline Gold Plus Award for the treatment of patients who experiencesevere heart attacks.

CON #5907 Page 42

5. Provide population projections.

Christian Hospital considers northern metropolitan St. Louis to be its primary servicearea. The following table reflects an estimate of the general metro service areapopulation from the State of Missouri, as required by CON rules, with 2020 USCensus data for Illinois counties:

County & State

US Census,April 1,

2020

Mo. Dep. HealthProjections,

2025

Mo. Dep. HealthProjections, 65+,

2025Lincoln County, Missouri 59,574 63,762 9,534Montgomery County, Missouri 11,322 11,192 2,740St. Charles County, Missouri 405,262 432,828 78,620St. Louis city, Missouri 301,578 277,256 45,114St. Louis County, Missouri 1,004,125 990,180 202,698Total 1,781,861 1,775,218 338,706

Calhoun County, Illinois 4,437Greene County, Illinois 11,985Jersey County, Illinois 21,512Macoupin County, Illinois 44,967Madison County, Illinois 265,859St. Clair County, Illinois 257,400Total 606,160

Grand Total 2,388,021

CON #5907 Page 43

6. Provide other statistics to document the size and validity of any user-definedgeographic service area.

Christian Hospital is uniquely located in north metropolitan St. Louis. It is the solehospital in the area and has one of the busiest emergency departments in the state.

7. Identify specific community problems or unmet needs the proposal wouldaddress.

As shown in the utilization figures, below, the hospital is consistently over the CONcriterion for average utilization of 3,000 cases per machine. MRI is an importantdiagnostic tool and its ready availability in a hospital of this size is essential. Thehospital currently has only one MRI unit—the proposed unit is needed to serve thecurrent volume and to proactively be in place to back-up the older existent machine.

8. Provide historical utilization for each of the past three years and utilizationprojections through the first three years of operation of the new equipment.

This table outlines the historical and projected MRI cases; all historical years exceedthe CON criterion (target = 3,000):

2018 2019 2020 2021 2022* 2023 2024 3,102 3,556 3,239 3,517 4,806 5,076 5,322

*First full year with additional MRI unit.

9. Provide the methods and assumptions used to project utilization.

Christian Hospital and BJC have extensive experience with MRI. The utilizationprojections in this application are based on that experience.

10. Document that consumer needs and preferences have been included inplanning this project and describe how consumers had an opportunity to provideinput.

Christian Hospital has a board comprised of community and business leaders. Thisgroup’s counsel has been solicited and many of their ideas have been incorporatedinto components of the project. In addition, a public notice, seeking comment, hasbeen published in the St. Louis Post-Dispatch, and was also posted to the paper’s website for a week. Furthermore, as is a standard process throughout BJC, departmentalplanning teams incorporate feedback received from doctors and from patient-carestaff, who aggregate the needs and preferences of patients.

11. Provide copies of any petitions, letters of support or opposition received.

Letters to be provided as they become available.

CON #5907 Page 44

Divider III. Community Need Criteria and Standards:

1. For new units address the need formula for the proposed geographic servicearea.

NA

2. For new units, address the minimum annual utilization standard for theproposed geographic service area.

NA

3. For any new unit where specific need and utilization standards are not listedprovide the methodology for determining need.

NA

4. For additional units, document compliance with the optimal utilization standard,and if not achieved, provide documentation to justify the additional unit.

The CON criterion for adding an MRI unit to a hospital is 3,000 cases per existingunit; the hospital meets the criterion.

2018 2019 2020 2021 2022* 2023 2024 3,102 3,556 3,239 3,517 4,806 5,076 5,322

5. For evolving technology address the following:

– Medical effects as described and documented in published scientific literature;

NA

– The degree to which the objectives of the technology have been met in practice;

NA

– Any side effects, contraindications or environmental exposures;

NA

– The relationships, if any, to existing preventive, diagnostic, therapeutic ormanagement technologies and the effects on the existing technologies;

NA

– Food and Drug Administration approval;

NA

CON #5907 Page 45

– The need methodology used by this proposal in order to assess efficacy and costimpact of the proposal; and

NA

– The degree of partnership, if any, with other institutions for joint use and financing.

NA

CON #5907 Page 46

Ad Proof

BJC HEALTH CARE-90-74-574 (LEGAL)

Tanya Lemons I023

4901 FOREST PARK AVE

3142860629

ST LOUIS MO 63108

Post - Dispatch

Legals

74264-1

9000 Public Notices

Kevin Weaks

Legal

Christian Hospital is applying

0.00

166.30

10/24/2021 - 10/24/2021

166.30

5

1

Notes

Keywords

Ad Key

Category

SubSection

Section

Fax

Phone

City St Zip

Address 2

Address 1

Contact

Publication

Taken By

Salesperson(s)

Size

Insertions

Start/End Dates

Amount Due

Amount Paid

Order Price

Rate

PO Number

10/22/2021 9:15:26 AMSTL\stlweakk 1 of 1

60000645 BJC HEALTH CARE-90-74-574 (LEGAL) Order Nbr 74264

Customer Ad Proof CON #5907 Page 47

Divider IV. Financial Feasibility Review Criteria & Standards:

1. Document that sufficient financing is available by providing a letter from afinancial institution or an auditor’s statement indicating that sufficient funds areavailable.

Audited statements were recently submitted.

2. Provide Service-Specific Revenues and Expenses (Form MO 580-1865) projectedthrough three (3) years beyond project completion.

See attached financial forms.

3. Document how patient charges were derived.

Charges, in general, are arrived at by determining the reasonable and customary unitcharge for delivering a given procedure through routine market checks of pricing atother facilities and comparing the expected unit cost using a cost accounting packagetailored specifically for hospitals. Finally, annual inflation adjustments are made,usually averaging 2% to 3%.

4. Document responsiveness to the needs of the medically indigent.

BJC is one of the largest providers of charity care, unreimbursed care, andcommunity benefits in the state of Missouri. All BJC hospitals have a long-standingpolicy of providing charity care and reduced-fee care to those in need. This policywill continue.

The hospital offers financial counseling for all patients to ensure adequate coverage isobtained. For patients who are indigent, our financial counselors assist these familiesin obtaining Medicaid assistance. If financial assistance is not attainable, charity caremay be extended as appropriate. The hospital financial assistance guidelines arebased on family size and income relative to the US poverty level guidelines. Eachcase is reviewed on an individual basis.

In 2019, BJC provide more than $785 million in total charity care and benefits to thecommunity.

BJC provides programs that bring health and wellness resources into schools,neighborhoods, workplaces, houses of worship and wherever neighbors gather.These programs provided more than 426,000 individual services to children, adults,and seniors.

BJC’s contributions also sustain the future of health care by investing in the educationof health professionals. BJC invested almost $215 million in the education of nurses,doctors, therapists, pharmacists, medical technologists and more during 2019.

CON #5907 Page 48

Christian Hospital

2018 2019 2020

3,102 3,556 3,239

$18,327 $19,248 $21,761

$56,850,354 $68,445,888 $70,483,87944,812,882 54,556,818 55,964,599

12,037,472 13,889,070 14,519,2800 0 0

$12,037,472 $13,889,070 $14,519,280

5,919,442 6,777,486 6,890,3580 0 0

1,852,464 2,023,967 2,098,5712,061,389 2,776,788 2,914,485

$9,833,295 $11,578,241 $11,903,414

0 0 00 0 00 0 0

5,519,421 6,658,747 6,765,824

$5,519,421 $6,658,747 $6,765,824

$18,669,238$15,352,716 $18,236,988

-$3,315,244 -$4,347,918 -$4,149,958

CON #5907 Page 49

Christian Hospital

2021 2022 2023

3,517 4,806 5,076

$21,246 $16,136 $16,397

$74,722,182 $77,549,616 $83,231,17258,635,377 62,312,126 67,353,652

16,086,805 15,237,490 15,877,5200 0 0

$16,086,805 $15,237,490 $15,877,520

8,487,686 6,919,893 7,412,5440 0 0

2,351,822 2,066,494 2,213,6143,047,162 2,835,133 3,036,976

$13,886,670 $11,821,520 $12,663,134

0 692,467 692,4670 0 00 0 0

6,759,752 7,073,821 6,785,064

$6,759,752 $7,766,288 $7,477,531

$20,140,665$20,646,422 $19,587,808

-$4,559,617 -$4,350,318 -$4,263,145

CON #5907 Page 50

Christian Hospital

2024

5,322

$16,756

$89,175,432 $0 $072,666,344

16,509,088 0 00 0 0

$16,509,088 $0 $0

7,861,0900 0 0

2,347,5643,220,749

$13,429,403 $0 $0

692,467 0 00 0 00 0 0

6,585,912

$7,278,379 $0 $0

$0$20,707,782 $0

-$4,198,694 $0 $0

CON #5907 Page 51

application for certificate of need

Documents