DHHS – Nebraska Loan Repayment Program Agreement Rev. 07/2021

NEBRASKA LOAN REPAYMENT PROGRAM AGREEMENT

BETWEEN THE

NEBRASKA DEPARTMENT OF HEALTH AND HUMAN SERVICES

AND

AND

This Loan Repayment Agreement (“Agreement”) is entered into by and between the Nebraska Department of Health and Human Services, Division of Public Health, Office of Rural Health (hereinafter “DHHS”), and hereinafter “Local Entity”) and

(hereinafter “Health Professional”).

PURPOSE: The purpose of this Agreement is to provide for the repayment of education loans for health professionals pursuant to the Nebraska Rural Health Systems and Professional Incentive Act (hereinafter “the Act”), (Neb. Rev. Stat. §§ 71-5650 et seq.).

DEFINITIONS: The terms in this Agreement not specifically defined herein shall have the definitions and meanings provided in the Act. For purposes of this Agreement, “practice” shall include actual practice time in the shortage area but shall not include time spent driving to or from the shortage area.

FUNDING: This Agreement involves state funds.

1. DURATION

1.1. TERM. This Agreement is in effect from through .

1.2. TERMINATION. This Agreement may be terminated at any time upon mutual written consent of all parties. DHHS may also terminate the Agreement to the extent otherwise provided herein.

2. LOAN REPAYMENT TO HEALTH PROFESSIONAL

2.1. TOTAL PAYMENT. DHHS shall pay the Health Professional a total amount not to exceed

$ ( ) for repayment of education loans.

2.2. LOAN REPAYMENT STRUCTURE. Payment shall be structured as follows.

2.2.1. Following each quarter and upon verification of the Health Professional’s practice in the shortage area, DHHS shall make a payment to the Health Professional in the amount of

2.2.2. The Local Entity shall provide matching funds by making the following payments to DHHS, unless other payment arrangements are approved, in writing, by DHHS:

Fiscal Year Amount Paid by

DHHS

Amount to be Paid by Local Entity Due Date

Docusign Envelope ID: A9D388B5-062D-4FCD-9D0A-38E7822FF601

Breanna Fiene, Nurse Practitioner

2,605.22

West Holt Memorial Hospital

January 31, 2029

31,262.52

February 1, 2026 two thousand six hundred and five dollars and twenty two cents thirty one thousand two hundred sixty two dollars and fifty two cents

Breanna Fiene, Nurse Practitioner

West Holt Memorial Hospital

YEAR 1: July 1 through June 30 $ $ 30 days after signed

YEAR 2: July 1 through June 30 $ $ August 1st

YEAR 3: July 1 through June 30 $ $ August 1st

2.2.3. The Local Entity shall not use, withhold, or otherwise deny payment of funds otherwise due and owing to the Health Professional in order to meet the local match requirement of this Agreement. No funds from the Health Professional may be used to meet the Local Entity’s payment obligations under this Agreement.

3. RESPONSIBILITIES

3.1. THE HEALTH PROFESSIONAL shall do the following:

3.1.1. Practice , an approved specialty as defined in the Act, an average of hours per month, in

, an approved shortage area or an approved shortage area with a successor local entity providing a local match, for the term of the Agreement, and to accept Medicaid patients in his or her practice. It is the Health Professional’s responsibility to locate a successor practice and/or local entity if necessary.

3.1.2. Cash or deposit the loan repayment checks within sixty days from the date the check was issued.

3.1.3. Use the funds received through the Nebraska Loan Repayment Program to pay the Health Professional’s qualified education debt as documented in the Health Professional’s application and as approved by the Rural Health Advisory Commission.

3.1.4. Upon request from the DHHS Office of Rural Health, submit, within 30 (thirty) days from the date of the request, documentation of current loan balances of qualified education debt as documented in the Health Professional’s application and as approved by the Rural Health Advisory Commission.

3.2. THE LOCAL ENTITY shall do the following:

3.2.1. Provide a local match to DHHS pursuant to this Agreement.

3.2.2. Upon request by DHHS, provide DHHS with the following information:

3.2.2.1. Confirmation of the Health Professional’s practice in the shortage area.

3.2.2.2. A copy of any written agreement between the Health Professional and the Local

Entity regarding the Health Professional’s practice in the shortage area, if available.

3.2.3. Cooperate with DHHS with necessary amendments to effectuate the substitution of the successor local entity.

3.2.4. Verify to DHHS the practice hours of the Health Professional.

4. HEALTH PROFESSIONAL REPAYMENT TO DHHS

4.1. The Health Professional shall repay DHHS, as set forth in Neb. Rev. Stat. § 71-5668, in the event that the Health Professional discontinues practice of an approved specialty in an approved shortage area under a contract with the Local Entity.

4.2. The Health Professional shall repay one hundred fifty percent (150%) of the total amount of funds provided to the Health Professional for loan repayment, with interest at a rate of eight percent (8%) simple interest per year, beginning at the date of default.

4.3. Repayment to DHHS shall be made as follows:

4.3.1. Monthly payments shall commence within three months from the date the Health Professional discontinued practice of an approved specialty in an approved shortage area under a contract

Docusign Envelope ID: A9D388B5-062D-4FCD-9D0A-38E7822FF601

Family Medicine

4,342.02 2,171.01

10,420.88

$3,039.37 August 1stYEAR 4: July 1 - June 30

5,210.44

5,210.4410,420.88

Holt County

$6,078.74 with the Local Entity, and shall not exceed the number of months the Health Professional received payments under this Agreement.

4.3.2. If the Health Professional fails to make a scheduled payment, DHHS shall submit to the Health Professional notice of payment due.

4.3.3. If payment is not received within thirty days of the notice of the payment due, DHHS may demand payment in full of the outstanding balance owned to DHHS and the default costs incurred by DHHS. Said payment shall be made within 30 days of the DHHS demand. If payment in full is not then received, DHHS may pursue any legal remedies available to it to ensure collection.

5. DHHS REPAYMENT TO LOCAL ENTITY

5.1. In the event that the Health Professional is required to repay as set forth in Section 4, above, DHHS shall reimburse the Local Entity the share of the funds provided by the Local Entity under this Agreement, as follows:

5.1.1. Such reimbursements to the Local Entity shall be made out of the payments made by the

Health Professional to DHHS.

5.1.2. Such reimbursement shall be made by an annual payment to the Local Entity.

5.1.3. In no event will the total amount of reimbursement to the Local Entity exceed the total amount the Local Entity paid under this Agreement.

5.1.4. If the Health Professional’s payment obligation is cancelled or suspended pursuant to the terms of this Agreement, the Local Entity will not receive any further reimbursement.

5.2. DHHS shall return to the Local Entity any unused local match funds received from the Local Entity that were intended for any period of time in which the Health Professional did not fulfill his or her obligations under this Agreement.

6. GENERAL TERMS

6.1. AMENDMENT. This Agreement may be modified only by written amendment, executed by both parties. No alteration or variation of the terms of this Agreement shall be valid unless made in writing and signed by all parties.

6.2. ASSIGNMENT. Neither the Local Entity nor the Health Professional may assign or transfer any interest, rights, or duties under this Agreement to any person, firm, or corporation without prior written consent of DHHS. In the absence of such written consent, any assignment or attempt to assign shall constitute a breach of this Agreement.

6.3. BREACH OF AGREEMENT. DHHS may terminate this Agreement, in whole or in part, if either the Local Entity or the Health Professional fails to perform their obligations under this Agreement in a timely and proper manner.

6.4. COMPLIANCE WITH CIVIL RIGHTS AND EQUAL OPPORTUNITY EMPLOYMENT LAWS. The Health Professional and Local Entity shall comply with all applicable local, state and federal law regarding civil rights, including but not limited to: Title VI of the Civil Rights Act of 1964, 42 U.S.C. §§ 2000(d) et seq.; the Rehabilitation Act of 1973, 29 U.S.C. §§ 794 et seq.; the Americans with Disabilities Act of 1990, 42 U.S.C. §§ 12101 et seq.; the Age Discrimination in Employment Act, 29 U.S.C. §§ 621 et seq.; the Age Discrimination Act of 1975, 42 U.S.C. §§ 6101 et seq.; and the Nebraska Fair Employment Practice Act, Neb. Rev. Stat. §§ 48-1101 to 48-1125.

6.5. CONFLICT OF INTEREST. In the performance of this Agreement, the Health Professional and Local Entity shall avoid all conflicts of interest and all appearances of conflicts of interest. The Health Professional and Local Entity shall immediately notify DHHS of any such instances encountered so that other arrangements can be made for the Health Professional to complete his/her practice obligation.

6.5.1. In no way a limitation of the above, a Conflicts of Interest include, but is not limited to, if the

Local Entity is operated by the Health Professional as manager or chief officer, or the Local Entity is owned in whole or in part by the Health Professional. In this instance, DHHS may, in writing, waive the conflict if it is satisfied that the purposes of the Act and this Agreement are still being met.

6.6. CREDIT REPORTING. DHHS reserves the right to report any default of the terms of this Agreement on the part of Health Professional to any credit-reporting agency to which it may lawfully make such a report.

Docusign Envelope ID: A9D388B5-062D-4FCD-9D0A-38E7822FF601

6.7. DISABILITY OR DEATH. Any practice or payment obligation incurred by the Health Professional under this Agreement is canceled in the event of the Health Professional’s total and permanent disability or death.

6.8. DOCUMENTS INCORPORATED BY REFERENCE. All references in this Agreement to laws, rules, regulations, guidelines, directives, and attachments which set forth standards and procedures to be followed by the Health Professional and Local Entity in discharging their obligations under this

Agreement shall be deemed incorporated by reference and made a part of this Agreement with the same force and effect as if set forth in full text, herein.

6.9. DRUG-FREE WORKPLACE. The Health Professional and Local Entity certify that they maintain a drug-free workplace environment to ensure worker safety and workplace integrity. The Health Professional and Local Entity shall provide a copy of its drug-free workplace policy at any time upon request by DHHS.

6.10. FUNDING AVAILABILITY. DHHS may terminate the Agreement, in whole or in part, in the event funding is no longer available. Should funds not be appropriated, DHHS may terminate the Agreement with respect to those payments for the fiscal years for which such funds are not appropriated. DHHS shall give the Local Entity and Health Professional written notice thirty (30) days prior to the effective date of any termination. DHHS will return to the Local Entity any unused local match funds received from the Local Entity not already disbursed to the Health Professional.

6.11. GOVERNING LAW.

6.11.1. Notwithstanding any other provision of this Agreement, or any amendment or addendum(s) entered into contemporaneously or at a later time, the parties understand and agree that (1) the State of Nebraska is a sovereign state and DHHS’ authority to grant is therefore subject to limitation by the State’s Constitution, statutes, common law, and regulation; (2) Agreement will be interpreted and enforced under the laws of the State of Nebraska, except where preempted by federal law; (3) any action to enforce the provisions of Agreement must be consistent with federal and state law; (4) the person signing Agreement on behalf of DHHS does not have the authority to waive the State's sovereign immunity, statutes, common law, or regulations; (5) the indemnity, limitation of liability, remedy, and other similar provisions of the final agreement, if any, are entered into subject to the State of Nebraska's Constitution, statutes, common law, regulations, and sovereign immunity; and, (6) all terms of the final Agreement, including but not limited to any clauses concerning third party use, licenses, warranties, limitations of liability, governing law and venue, usage verification, indemnity, liability, remedy or other similar provisions of the final agreement are entered into specifically subject to the State of Nebraska's Constitution, statutes, common law, regulations, and sovereign immunity.

6.11.2. The parties shall comply with all applicable federal, state, and local law in the performance of this Agreement.

6.12. INDEMNIFICATION

6.12.1. The Health Professional shall defend, indemnify, hold, and save harmless DHHS and its employees, volunteers, agents, and its elected and appointed officials (“the indemnified parties”) from and against any and all claims, liens, demands, damages, liability, actions, causes of action, losses, judgments, costs, and expenses of every nature, including investigation costs and expenses, settlement costs, and attorney fees and expenses (“the claims”), sustained or asserted against DHHS, arising out of, resulting from, or attributable to the willful misconduct, negligence, error, or omission of Health Professional, his or her employees, consultants, representatives, and agents, except to the extent such Health Professional’s liability is attenuated by any action of DHHS that directly and proximately contributed to the claims.

6.12.2. The Local Entity shall defend, indemnify, hold, and save harmless DHHS and its employees, volunteers, agents, and its elected and appointed officials (“the indemnified parties”) from and against any and all claims, liens, demands, damages, liability, actions, causes of action, losses, judgments, costs, and expenses of every nature, including investigation costs and expenses, settlement costs, and attorney fees and expenses (“the claims”), sustained or asserted against DHHS, arising out of, resulting from, or attributable to the willful misconduct, negligence, error, or omission of the Local Entity, its employees, consultants, representatives, and agents, except to the extent such Local Entity’s liability is attenuated by any action of DHHS that directly and proximately contributed to the claims.

6.12.3. DHHS’ liability is limited to the extent provided by the Nebraska Tort Claims Act, the Nebraska Contract Claims Act, the Nebraska Miscellaneous Claims Act, and any other applicable provisions of law.

6.12.4. Notwithstanding the above, if the Local Entity is a local governmental agency or political subdivision of the State of Nebraska, nothing in this Agreement shall be construed as an indemnification by DHHS or the Local Entity of the other for liabilities of a party or third parties for property loss or damage or death or personal injury arising out of and during the performance of Agreement. Any liabilities or claims for property loss or damages or for death or personal injury by a party or its agents, employees, contractors or assigns or by third persons shall be determined according to applicable law.

6.13. INTEGRATION. This written Agreement represents the entire agreement between the parties, and any prior or contemporaneous representations, promises, or statements by the parties, that are not incorporated herein, shall not serve to vary or contradict the terms set forth in this Agreement.

6.14. NEW EMPLOYEE WORK ELIGIBILITY STATUS. The Local Entity shall use a federal immigration verification system to determine the work eligibility status of new employees physically performing services within the State of Nebraska. A federal immigration verification system means the electronic verification of the work authorization program authorized by the Illegal Immigration Reform and Immigrant Responsibility Act of 1996, 8 U.S.C. § 1324(a), known as the E-Verify Program, or an equivalent federal program designated by the United States Department of Homeland Security or other federal agency authorized to verify the work eligibility status of a newly hired employee.

6.14.1. If the Health Professional or the Local Entity is an individual or sole proprietorship, the following applies:

6.14.1.1. The Health Professional or the Local Entity must complete the United States

Citizenship Attestation Form, available on the Department of Administrative Services website at https://das.nebraska.gov. If Health Professional or the Local Entity indicates on such attestation form that he or she is a qualified alien, Health Professional or the Local Entity agrees to provide the U.S. Citizenship and Immigration Services documentation required to verify Health Professional or the Local Entity lawful presence in the United States using the Systematic Alien Verification for Entitlements (SAVE) Program.

6.14.1.2. The Health Professional or the Local Entity understands and agrees that lawful presence in the United States is required and Health Professional or the Local Entity may be disqualified or the Agreement terminated if such lawful presence cannot be verified as required by Neb. Rev. Stat. § 4-108.

6.15. SEVERABILITY. If any term of this Agreement is declared by a court of competent jurisdiction to be illegal or in conflict with any law, the validity of the remaining terms and conditions shall not be affected, and the rights and obligations of the parties shall be construed and enforced as if Agreement did not contain the particular provision held to be invalid.

7. NOTICES

7.1. Notices shall be in writing and shall be effective upon mailing. Written notices shall be sent to the following addresses:

FOR HEALTH PROFESSIONAL: FOR LOCAL ENTITY:

4023368447 breannanfiene@gmail.com

Breanna Fiene

Oneill, NE, 68763

1014 Tee St

Atkinson, NE 68713

4029251947 bauerj@westholtmed.org

406 W Neely St

Jeremy Bauer, CEO https://das.nebraska.gov/ https://das.nebraska.gov/

DHHS AGREEMENT MANAGER:

Rachael Wolfe, Health Program Manager NE DHHS - Office of Rural Health PO Box 95026

Lincoln, NE 68509-5026 402-471-2337 rachael.wolfe@nebraska.gov

7.2. The Health Professional must notify DHHS immediately in the event of either of the below, or both:

7.2.1. A name or address change or of any change in circumstances that may affect the Health

Professional’s ability to perform the terms of this Agreement, including a change in scope or practice location; or

7.2.2. A name or address change or of any change in circumstances that may affect the Health Professional’s ability to perform the terms of this Agreement, including a change in scope or practice location.

7.3. The Local Entity must notify DHHS immediately in the event of any change in the scope or location of the Health Professional’s practice, or of any change in the contact person, address, or phone number for the Local Entity.

7.4. The parties may change the individuals to be notified under this section via letter sent by U.S. Mail, postage prepaid, or via email, to all other parties.

IN WITNESS THEREOF, the parties have duly executed this Agreement hereto, and that the individual signing below has authority to legally bind the party to this Agreement.

HEALTH PROFESSIONAL:

FOR LOCAL ENTITY:

FOR DHHS:

Department of Health and Human Services 301 Centennial Mall South P.O. Box 95026 Lincoln, NE 68509-5026

Docusign Envelope ID: A9D388B5-062D-4FCD-9D0A-38E7822FF601

WHMS

1/5/2026 | 18:26:00 CST

FNP-C

Breanna Fiene

West Holt Memorial Hospital

1/7/2026 | 09:21:30 CST

Jeremy Bauer, CEO

CEO

Director, Public Health

Ashley L. Newmyer

1/12/2026 | 11:41:48 CST

mailto:rachael.wolfe@nebraska.gov