Northern Hospital of Surry County — Rural Health Care posted service request (HCF)

General Information HCP or Consortium: 14029 - Northern Hospital of Surry County Application Number: RHC46100022132 FCC Registration Number: 0005473160 Address: 830 Rockford Street , Mt. Airy, NC 27030 Application Nickname: 2026-C Funding Year: 2026 Funding Priority: Priority 5 Requested Services Type of Services Description for Other Min Download Speed Max Download Speed Min Upload Speed Max Upload Speed Speed Unit Allow Bids for Similar Services Data 1 999999 1 999999 Mbps Yes Will the selected service(s) support an off-site data center?: No Will the selected service(s) support an off-site administrative office?: No Dates and Timing What is the HCP's desired service contract length?: Up to 5 Year(s) Will the HCP consider bids with contract extension language?: Yes Will the HCP consider bids for month-to-month contracts?: Yes What is the HCP's desired time to publicly post this request for services?: 28 Day(s) What is the HCP's expected bid evaluation period after the public posting?: 2 Day(s) Page1 Bid Evaluation Select the criteria that will be used to evaluate the bids collected. Criteria Description Evaluation Weight (%) Minimum Requirement Price 34 Leverage existing resources 33 Must be compatible with existing ne twork Other Prior experience, including past per formance 33 No Minimum Does the HCP have any disqualifying factors that will remove bids or bidders from consideration?: Yes Disqualifying factors: If a posted bid pricing matrix is returned stating "No Bid" for a particular listed service, at a specified HCP, the bid will be disqualified for that service at that location. Main Contact Name Organization Title Phone Email Address David Wagner Northern Hospital of Su rry County Managing Member (203) 802-6223 david@pemfilings .com 3109 Grand Ave , Miami, FL 3 3133 RFP and Summary Is the HCP likely to request more than $100 000 in program support from this request for services?: No Do state, Tribal, or local procurement rules require the HCP to include an RFP with this request for services application?: No Will the HCP be including an RFP with this application?: No Summary of the HCP's requested services. : Please refer to attached document 'Bid Pricing Spreadsheet Instructions' for all further instructions. Email all questions regarding posting to info@pemfilings.com Page2 Additional Documentation Document Type Description for Other Document Uploaded On Other Bid Pricing Spreadsheet InstructionsBid Pricing Spreadsheet Instruction s.pdf 2/20/2026 11:47 AM EST Other Bid Pricing Spreadsheet Bid Pricing Spreadsheet-14029-202 6C-46100022132.xlsx 2/20/2026 11:47 AM EST Declaration of Assistance Name Organization Type Title Employer Nature of Relationship Email Telephone Kameron Heidka mp Consultant Consultant PEM Filings , LLC Consultant kameron@pemfili ngs.com (203) 437-6546 David Wagner Consultant Managing Member PEM Filings , LLC Consultant david@pemfilings .com (203) 802-6223 Tom Hurt Consultant Vice Presid ent, Rural H ealth Care Program SpectraCor p Technolo gies Group , Inc. Consultant thurt@spectracor p.com (972) 671-1700 Lisa Medina Consultant Director of Operations - Assisted i n data colle ction SpectraCor p Technolo gies Group , Inc. Consultant lmedina@spectra corp.com (469) 329-1378 Kerri Heidkamp Consultant Director of Operations PEM Filings , LLC Consultant kerri@pemfilings. com (203) 802-6223 Taylor Heidkamp Consultant Provisionin g Manager PEM Filings , LLC Consultant taylor@pemfilings .com (203) 802-6223 Luis Ocampo Consultant Project Coo rdinator PEM Filings , LLC Consultant luis@pemfilngs.c om (203) 802-6223 Page3 Certifications ✓ I certify under penalty of perjury that I am authorized to submit this request on behalf of the healthcare provider or c onsortium. ✓ I certify under penalty of perjury that I have examined this request and all attachments, and to the best of my knowle dge, information, and belief, all statements contained herein and in any attachments are true. ✓ I certify under penalty of perjury that the applicant seeking supported services has complied with any applicable stat e, Tribal, or local procurement rules. ✓ I certify under penalty of perjury that all requested RHC Program support will be used solely for purposes reasonabl y related to the provision of health care service or instruction that the health care provider is legally authorized to pr ovide under the law of the state in which the services are provided. ✓ I certify under penalty of perjury that the applicant seeking supported services satisfies all of the requirements under section 254 of the Communications Act, 47 U.S.C. § 254, and applicable Commission rules. ✓ I certify under penalty of perjury that the applicant seeking support has reviewed and is compliant with all applicable RHC Program requirements. ✓ I understand that all documentation associated with this request, including a copy of the signed Request for Service s (FCC Form 461), any bids/contracts resulting from the FCC Form 461 posting, scoring sheet, and other informatio n that was used in the decision making process, must be retained for a period of at least five years pursuant to 47 C FR § 54.631, or as otherwise prescribed by the Commission's rules. ✓ I certify under penalty of perjury that the applicant seeking supported services is a nonprofit or public entity that falls within one of the seven categories set forth in the definition of health care provider listed in 47 CFR §54.600 of the Commission's rules. ✓ I certify under penalty of perjury that the applicant seeking supported services is physically located in a rural area a s defined in section 47 CFR § 54.600 of the Commission's rules, or is a member of a consortium which satisfies the majority-rural composition requirements set forth in 47 CFR § 54.607 of the Commission's rules. ✓ I certify under penalty of perjury that the services will not be sold, resold, or transferred in consideration for money o r any other thing of value. Signature Name: Kameron Heidkamp Email: kameron@pemfilings.com Phone: (203) 437-6546 Employer: PEM Filings, LLC Title: Consultant Employer’s FCC RN: 0017572314 Certifier’s Full Name: Kameron Heidkamp Digital Signature: Kameron Heidkamp Date and time: 2/20/2026 11:48 AM EST Page4