BioElectronics Full Proposal Response to Post.pdf

8/20/2023 Bio-Electronics’ Response to NDVH Request for Proposal Page 1

Response to Request for Proposal

Date of Proposal: August 23, 2023 For: State of Nebraska Veterans Homes (NDVH):

Western Nebraska Veterans’ Home Norfolk Veterans’ Home Central Nebraska Veterans’ Home Eastern Nebraska Veterans’ Home

RFP 6798 Z1, Bio-Electronics

Submitted to: Matthew Hansen / Dianna Gilliand State Purchasing Bureau

Presented by: Christine Widman, MHA Senior Director of Operations Bio-Electronics

Bio-Electronics’ Mission

To serve as a quality, cost-effective resource of choice for medical equipment technology and service.

About Bio-Electronics

Bio-Electronics was established in 1976 and is a wholly-owned subsidiary of the Nebraska Hospital Association, governed by a Board of Directors comprised of Nebraska hospital administrators and other key hospital personnel elected by the membership of the Nebraska Hospital Association.

Bio-Electronics is dedicated to providing medical equipment management to include preventive maintenance and corrective maintenance to health care

3255 Salt Creek Circle, Suite 200 Lincoln, NE 68504 Phone: 402-742-8160 Fax: 402-742-8192 www.bio-electronics.com

8/20/2023 Bio-Electronics’ Response to NDVH Request for Proposal Page 2 facilities in Nebraska and the surrounding states. As a subsidiary of the Nebraska Hospital Association and the endorsed biomed partner of the Wyoming Hospital Association, Bio-Electronics prioritizes providing cost-effective solutions to maximize equipment uptime coupled with expert customer service. Bio-Electronics serves nearly 300-contracted customers, including hospitals, clinics, laboratories, medical teaching institutions, as well as non-medical facilities. Bio-Electronics’ programs ensure compliance with all regulatory accreditation bodies to meet the highest biomed standards.

Proposal Objective

To continue to provide expert medical equipment management to include preventive maintenance and corrective maintenance to the Nebraska Veterans’ Homes facilities to promote patient safety and maximize equipment uptime.

4.1 Price

Proposed Start Date: September 25, 2023.

4.1.1 – Price (year 1):

Western NE Vets Home ............................................................ $5,750.00 Central NE Vets Home ........................................................... $16,750.00 Norfolk Vets Home ................................................................ $22,600.00 Eastern NE Vets Home ............................................................. $7,000.00

4.1.1 – Equipment List: The proposed pricing is based on the service delivery of equipment as listed on the accompanying document labeled “Equipment List”. Pricing is contingent upon the Equipment list as provided by DHHS. If equipment is requested to be added during the agreement period, this will be handled via Addendum for any increased service time required to provide the added service. (Cost Proposal, Tables 1-4, Equipment Item Descriptions and quantities; Attachment A – Current Bio-Electronics’ Equipment File Listing as the current vendor)

4.1.2 – Affiliation: Bio-Electronics is a wholly-owned subsidiary of the Nebraska Hospital Association.

4.2 Terms and Conditions

4.2.1 – Term: 2 years beginning September 25, 2023 and extending through September 25, 2025, with the potential to extend for 3, one-year increments.

(Cost Proposal, Tables 1-4)

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4.2.2 – Annual Fixed Pricing: The price above is a fixed annual price for each of the first two years, as well as the potential additional years to renew under Bio-Electronics’ proposal. (Cost Proposal, Tables 1-4)

4.2.3 – Insurance Coverage: Bio-Electronics will maintain commercial liability insurance with minimum limits of liability of $1 million per occurrence, and a $3 million annual aggregate and also agree to carry a blanket additional insured endorsement for any entity that requires that endorsement by written contract. Included in proposed contract.

Such products/completed operations insurance will name NDVH as an additional insured. In addition to the liability coverage, Bio-Electronics will maintain other types of policies including, but not limited to, Workers Compensation, comprehensive general liability insurance, and any other employee liability insurance required by law for any employer to carry for employees.

4.2.5 – Governing Laws: This Agreement shall be construed and enforced pursuant to and in accordance with the laws of the State of Nebraska.

4.2.6 – Agreement Not Assignable: The Agreement may not be assigned by either party hereto, in whole or in part, without the prior written consent of the other party.

4.2.7 and 4.2.8 – Termination Clause: A thirty (30) day termination clause for cause or breach of contract terms that NDVH can exercise at any time and a thirty (30) day termination clause for convenience.

4.2.9 – Equipment Changes: Equipment may be added to the Agreement upon expiration of the equipment’s warranty and by the mutual consent of Bio-Electronics and NDVH via Addendum for any increased service time required by Bio-Electronics.

4.2.10 – Agreement Price Adjustments: The Agreement may be adjusted based on changes in the covered equipment inventory, and upon mutual agreement by both Bio-Electronics and NDVH. Any proposed price adjustments must be broken down by equipment line item and submitted to NDVH prior to the effective date of the proposed adjustment.

4.2.11 – Sample Contract: Bio-Electronics understands the NDVH will issue the Service Agreement. (See Exhibit 2)

4.2.12 – Certificates of Insurance: Bio-Electronics currently has active Certificates of Insurance as we are the current vendor for the NDVH’s (See Exhibit 6)

4.3 Service Delivery Schedule

1. Equipment Maintenance Policies and Procedures: Bio-Electronics must have a complete set of equipment maintenance policies and

8/20/2023 Bio-Electronics’ Response to NDVH Request for Proposal Page 4 procedures that meet or exceed regulatory requirements. This is Bio- Electronics’ Annotated Guide. (See Exhibit 3)

2. Schedule, Perform and Document Service: Bio-Electronics will properly schedule, perform, and document corrective maintenance, electrical safety testing, environmental testing and routine preventive maintenance on medical equipment covered by agreement.

3. Supply, Calibrate and Maintain Test Equipment: Test equipment owned by Bio-Electronics will be calibrated and maintained by Bio- Electronics.

4. Replacement Parts: Bio-Electronics will assist NDVH as requested to purchase good quality parts either from the OEM or a second-source vendor. This is offered at a 10% discounted price for any contracted customers.

5. Uptime of Biomedical Equipment of 98%: Bio-Electronics will strive to have an uptime for biomedical equipment of 98%.

4.3.2 Staff

1. 40 years+ Experience Managing Asset Management / Clinical Engineering Services: Bio-Electronics has been in business for 47 years servicing medical equipment throughout the Midwest.

2. Number of On-Site Technicians: Bio-Electronics will provide the necessary number of qualified technicians required to meet the performance objectives for each NDVH facility. One Primary Account Representative (PAR) Technician will be assigned to provide service at each site. This ensures consistent knowledge of each site as well as a direct point of contact between Bio-Electronics’ technical staff and each NDVH facility.

Bill Answine, BMET III, Regional Service Manager, Ventilator Specialist (Eastern NE Vets Home)

Bill is our Senior Regional Service Manager and has served as the biomed for this account since 2007. Bill has been with Bio-Electronics since 2006

Ryan Baumgard, BMET II (Norfolk Vets Home)

Ryan has served as the biomed for this account since 2015. Ryan has been with Bio-Electronics since 2015.

Jeff Shuey, BMET I, Ventilator Specialist (Western NE Vets Home)

Jeff has served as the biomed for this account since 2019. Jeff has been with Bio-Electronics since 2019.

Scott Ryan, BMET II (Central NE Vets Home)

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Scott has served as the biomed for this account since 2015. Scott has been with Bio-Electronics since 2015.

3. Location of Staff: Bio-Electronics’ Main Office is based out of Lincoln, NE.

One Primary Account Technician located closest to each NDVH site will be provided. For the Western NE Veterans’ Home, the Technician is based out of Scottsbluff, NE. For the Central NE Veterans’ Home, the Technician is based in Kearney, NE. For the Norfolk NE Veterans’ Home, the Technician is based in Norfolk, NE. For the Eastern NE Veterans’ Home, the Technician is based out of Omaha, NE. Bio-Electronics’ employees will be on call and available for emergency coverage 24/7.

4. Working Hours: Bio-Electronics will provide qualified and trained staffing from 8:00 A.M. to 5:00 P.M., Monday through Friday. On-site staffing hours subject to change. Detailed costs to maintain staff after hours, on weekends, and holidays are listed in the Cost Proposal, tab 3, table 6.

5. Ongoing technician training: Bio-Electronics will be responsible for ongoing technician training and will maintain appropriate technician credentials.

6. Supervision of Employees: Bio-Electronics shall provide appropriate and necessary management and supervision for all its employees and shall be solely responsible for instituting and invoking disciplinary action of employees not in compliance with Bio-Electronics’ policies and procedures, as well as any others established by NDVH. Bio-Electronics’ reporting structure provided. (See Exhibit 7)

4.3.3 Training and Assistance

1. Implementation Plan/Timeline: Bio-Electronics will be responsible for the implementation plan and timeline management mutually agreed upon by NDVH and Bio-Electronics. As Bio-Electronics’ is the current vendor, our Attachment A outlines the equipment test cycle, frequent and scheduled test dates for each NDVH facility. Bio-Electronics has had success implementing all size programs. (See Exhibit 4: Attachment A)

2. Centralized Service Dispatch/Customer Support Department: Bio- Electronics has a system capable of scheduling, dispatching, procuring/shipping parts, and tracking calls for preventive and corrective medical equipment service 24/7. Bio-Electronics does not maintain a parts inventory or order in bulk. We order on an as-needed basis for each customer upon request. Consequently, Bio-Electronics cannot offer a discount percentage off retail pricing for parts, as noted on the Cost Proposal.

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3. Reporting Tools: Bio-Electronics will provide NDVH with reporting tools and customer satisfaction surveys to measure the success of the program.

(See Exhibit 5)

4. Evaluation of Covered Equipment: Bio-Electronics will neutrally evaluate the covered equipment annually and assess for suitability and performance of the equipment as well as recommendations for equipment to be considered for replacement.

4.3.4 Documentation and Reporting

1. Web-Based Computerized Maintenance Management System: Bio- Electronics utilizes a computerized maintenance management system to track vendor, OEM and/or third-party service provider work that can be accessed by NDVH.

2. Documentation: To the extent applicable, Bio-Electronics will provide documentation that meets or exceeds the requirements and standards set by The Joint Commission and other applicable regulatory agencies. (See Exhibit 3)

3. On-Site Assistance: Bio-Electronics will provide assistance during regulatory inspections of NDVH by any surveyor as it relates to the services provided.

4. Documentation, Maintenance Records and Data: All documentation, maintenance records, and data are the property of NDVH. Upon completion of the service agreement, Bio-Electronics will provide NDVH with all service history and equipment-related data stored in its computerized maintenance management system.

5. Service Records: Bio-Electronics will maintain proper service records electronically, and provide NDVH with routine schedules and reports, in a format acceptable to NDVH administration. Routine reports will include the following (at a minimum). (See Exhibit 5)

Inventory to include: equipment identification number, NDVH’s asset number, department, model, manufacturer, serial number, equipment description, risk class, coverage, PM interval, last and next PM date, and service provider.

Annual preventive maintenance Preventive and corrective maintenance completion reports by equipment number and department Quarterly safety reports to include: preventive maintenance completion percentages, corrective maintenance exceptions trending, devices requiring excessive corrective maintenance, safety alert and recall maintenance records as applicable.

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6. Hazard/Recall Information: Documentation of hazard and recall information to assist NDVH in meeting the requirements of the Safe Medical Device Act (SMDA).

4.3.5 Additional Services

1. Asset Management Tracking: Bio-Electronics will provide an up-to-date inventory of equipment assets when requested. Also, an up-to-date inventory is sent to the facility point-of-contact(s) monthly along with other important documentation. In addition, this information is also available on Bio-Electronics’ customer portal website.

2. Resource for Surplus Equipment: Bio-Electronics will provide NDVH with an expert resource in acquiring and/or selling old equipment through our preferred business partner, Mazree, upon request.

3. Radiology Sales Partner: Bio-Electronics will provide free quotes for new radiology equipment and extended service at discounted customer pricing as requested, through our preferred business partner, Konica Minolta Healthcare, upon request.

4.4 User Reference List Bio-Electronics has served as the biomed service contractor for the following NE health care agencies:

1. Mark Callahan Chief Operating Officer MCallahan@marylanning.org Mary Lanning Healthcare ...................... Joint Commission Facility (Current Bio-Electronics’ Customer since 2009) 715 N. Saint Joseph Avenue Hastings, NE 68901

(402) 461-5107

2. Marty Fattig, FACHE Chief Executive Officer mfattig@nchnet.org Nemaha County Hospital ........................................... DNV Facility (Current Bio-Electronics’ Customer since 1978) 2022 – 13th Street Auburn, NE 68305 402-274-4366 *Assisted facility with ISO 9001 Certification

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3. Matt Crooker Director of Ancillary Services mdcrooker@phelpsmemorial.com Phelps Memorial Health Center .................................. DNV Facility (Current Bio-Electronics’ Customer since 1977) 1215 Tibbals Street Holdrege, NE 68849-1255

(308) 995-2857

4. LuAnne Jones Director of Materials Management luanne.jones@yorkgeneral.org York General Health Care Services ............ Critical Access Hospital (Current Bio-Electronics’ Customer since 1993) 2222 N. Lincoln Avenue York, NE 68467 402-362-8005

5. Lon Knievel Chief Executive Officer lknievel@oghne.com Osmond General Hospital ......................... Critical Access Hospital (Current Bio-Electronics’ Customer since 1985) P O Box 429 402 N. Maple Street Osmond, NE 68765 402-748-6112

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5 Standards, Regulations, and Guidelines

1. Requirements of Regulatory Agencies: To the extent applicable, Bio- Electronics maintenance program will conform to all relevant requirements of national and local regulatory agencies, including the State, CLIA, Joint Commission, DNV, HIPAA and CMS. (See Exhibit 3)

Bio-Electronics’ Commitment to NDVH

Since Bio-Electronics’ inception over 40 years ago, its original mission has remained unchanged…to provide quality, cost-effective and timely medical equipment service to health care facilities throughout the Midwest.

Bio-Electronics has provided biomedical service to the Nebraska Veterans’ Homes since our first agreement with the Western NE Veterans’ Home in 1994. We also proudly serve as the contracted biomedical engineering vendor for the Beatrice State Development Center, Lincoln Regional Center, as well as the Norfolk Regional Center.

We appreciate the opportunity to provide you with this proposal and will look forward to hearing from you in how you wish to proceed. If you have any questions, please call me at 402-742- 8161.

Christine Widman, MHA Senior Director of Operations, Bio-Electronics

Exhibits

1. Response to Request For Proposal 6798 Z1, Bio-Electronics

2. Sample Contract (Bio-Electronics understands that the NDVH Procurement team will issue their own contract)

3. Annotated Guide to Bio-Electronics’ Policies

4. Attachment A: Current NDVH Equipment File Lists with all equipment test cycles, frequencies, last test date, next scheduled test dates to demonstrate implementation plan for project

5. Sample Reports

5.1 – Equipment File List: this is the master list of all equipment that the hospital has indicated to be included. It can be biomedical, mechanical, or any other equipment whether on a PM program or not. This list is updated as changes occur.

5.2 – Scheduled Work Order: this lists the equipment scheduled for inspection/preventative maintenance (IPM) during a specific month. It is determined

8/20/2023 Bio-Electronics’ Response to NDVH Request for Proposal Page 10 by the “Test Cycle” assigned in the Equipment File List.

5.3 – Client Summary Activity Report: this is a quarterly report, identifying and locating historical data on all equipment.

5.4 – Quality Assurance Repair Report: this is for use in identifying repeat/recurring discrepancies which may require follow-up, if there were three or more repairs on that item in the previous six months.

5.5 – Lost and In-Service Report: a listing of Lost, In-Service, or Out for Repair the previous month which prohibits Bio-Electronics from completing the scheduled preventative maintenance.

6. Current NDVH Certificates of Insurance through Bio-Electronics

7. Bio-Electronics Organizational Chart

Bio-Electronics Service Agreement, SL-05 3255 Salt Creek Circle, Suite 200 ● Lincoln, Nebraska 68504 Page 1 Phone (402) 742-8160 ● 888-449-4980 (Toll Free) ● Fax (402) 742-8192

SERVICE AGREEMENT

INSPECTION AND PREVENTIVE MAINTENANCE

This Master Services Agreement ("Agreement") is made and entered into this 1st day of September 2023 by and between Bio-Electronics, a Nebraska corporation (hereinafter referred to as "Bio-Electronics"), and Nebraska Department of Veterans Homes (hereinafter referred to as "Facility"), individually referred to herein as "a party" and collectively, as "the parties."

WHEREAS, Bio-Electronics provides certain services, including inspection, preventive maintenance and repair services for biomedical equipment, to health care facilities; and

WHEREAS, Facility desires to retain Bio-Electronics to provide certain Equipment Services;

WHEREAS, Bio-Electronics desires to provide Equipment Services to Facility subject to the terms of which are hereinafter set forth in this Agreement.

NOW, THEREFORE, in consideration of the mutual covenants contained herein and other good and valuable consideration, the receipt and sufficiency of which, if performed, is hereby acknowledged, the parties agree as follows:

1. Term, Extension and Termination. The initial term of this Agreement shall be for two (2) years commencing on September 25, 2023 ("Effective Date"), and ending on September 24, 2025 .

Thereafter, this Agreement may be renewed for two additional terms of one (1) year each unless terminated sooner in a manner hereinafter provided. This Agreement may be terminated as follows:

a. By either party for any reason or no reason upon thirty (30) days prior written notice;

b. By Bio-Electronics upon thirty (30) days prior written notice to Facility in the event Facility shall fail to pay all amounts due and owing to Bio-Electronics within thirty (30) days following receipt of such notice;

c. By either party upon written notice in the event the other party is in material breach of this Agreement (other than nonpayment) and such breach is not cured within thirty (30) days following the receipt of such notice, or in the case of a breach which requires more than thirty (30) days to cure and which does not threaten to cause irreparable harm, such longer period as may be reasonable under the circumstances;

d. By either party if the other party becomes insolvent; there occurs an appointment of a receiver or the assignment for the benefit of creditors of any part of the other party's assets or any proceedings are commenced by or against the other party under any bankruptcy or insolvency laws; or

Exhibit 2

Bio-Electronics Service Agreement, SL-05 3255 Salt Creek Circle, Suite 200 ● Lincoln, Nebraska 68504 Page 2 Phone (402) 742-8160 ● 888-449-4980 (Toll Free) ● Fax (402) 742-8192

e. Immediately upon the occurrence of the exclusion of either party from participation in federally-funded health care program, or the conviction of either party of a criminal offense related to health care.

2. Equipment List. The Equipment Services as hereinafter provided shall apply to the equipment identified in the Equipment List, a copy of which is attached hereto as Exhibit "A.” The Equipment List shall identify each unit of equipment and designate the applicable service level. Facility shall provide Bio-Electronics with an updated and complete Equipment List within thirty (30) days following the effective date of this Agreement. The updated list and any subsequently updated Equipment Lists shall be appended hereto as an addition to Exhibit "A."

3. Identification and Availability of Equipment. Facility shall affix appropriate identification tags to each unit of equipment identified on the Equipment List. The Facility shall make all equipment identified on the Equipment List available to Bio-Electronics in a timely manner and during normal business hours. In the event equipment is not properly identified and available as set forth herein, Bio- Electronics shall not be responsible for locating equipment to be serviced nor shall Bio-Electronics be responsible for overdue inspections.

4. Compensation. Facility shall pay Bio-Electronics the sum of $ (plus any applicable sales tax) per year for the Equipment Services. If the yearly fee is less than $2,500.00, then Facility shall pay the total fee in advance. If the yearly fee is greater than or equal to $2,500.00, Facility shall pay the fee in monthly installments within 30 days after the work is completed. Bio-Electronics may make periodic fee changes in the event equipment is added to, or deleted from, the Equipment List.

5. Requested Repair Services. At Facility’s request, Bio-Electronics may, but is not obligated to, provide repair services for equipment not designated for repair on the Equipment List in accordance with the prevailing hourly rates set forth in Cost Proposal Tables 6-9.

a. Associated Repairs. For the purposes of this section, Associated Repairs shall mean all repairs performed by Bio-Electronics during regular business hours, Monday through Friday, 8:00 AM - 5:00 PM, that are in conjunction with an already scheduled trip and that do not require a make-up trip after regular business hours and/or that do not require repair time in excess of two hours.

b. Demand Repairs. For the purposes of this section, Demand Repairs shall mean all repairs that are not performed in conjunction with an already scheduled service trip.

c. Repair Requests. Requests for repairs may be made at any time by contacting Bio-Electronics’ Lincoln Office at 402-742-8160 or 888-449-4980 (toll free). Bio-Electronics shall contact Facility within one (1) hour of receipt of message.

6. Equipment Requiring Parts. Unless the equipment includes parts as designated on the Equipment

List, Bio-Electronics shall notify Facility when equipment requires parts to restore the equipment to proper and safe operating condition. In the event Facility does not authorize such repair, Bio-Electronics shall, when appropriate, tag the equipment to warn Facility that the equipment should not be used. Parts furnished by Bio-Electronics shall be billed at a ten percent (10%) discount from non-contracted customer rates.

7. Inspection and Preventive Maintenance for Equipment Designated for Inspection and Preventive Maintenance on Equipment List. Bio-Electronics shall provide inspection and preventive maintenance for the equipment designated for inspection and preventive maintenance on the Equipment List in accordance with the following guidelines:

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a. Inspection and Service Dates. Bio-Electronics shall determine the dates on which inspection and preventive maintenance services shall be performed. Bio-Electronics shall notify Facility of such dates.

b. Preventive Maintenance; Fees. The Equipment Service fee includes inspection and preventive maintenance fees. No additional preventive maintenance fee will be billed.

c. Preventive Maintenance Inspection Form. Bio-Electronics shall provide Facility with a digital preventive maintenance inspection form for all equipment designated for inspection and preventive maintenance on the Equipment List. The preventive maintenance inspection form shall include all pertinent information for the Equipment Services performed by Bio-Electronics hereunder. Facility shall be responsible for retaining the preventive maintenance inspection form as needed for accreditation and/or third-party payer review.

d. Exclusions. The following items are not included in the inspection and preventive maintenance program and will be invoiced separately as appropriate:

i. Repair and calibration costs for Facility-owned test equipment;

ii. Service manuals;

iii. Facility requested training for Bio-Electronics personnel;

iv. Repairs; and

v. Parts

8. Test Equipment. Where applicable, Facility shall provide and maintain test equipment utilized solely for Facility equipment.

9. Training. Where applicable, Facility requested training shall be at Facility's expense unless otherwise agreed upon by the parties.

10. Limitations. Bio-Electronics shall not be responsible for services performed on for the equipment listed on the Equipment List by any person or entity other than Bio-Electronics. Unless otherwise authorized in writing by Bio-Electronics, Facility will be responsible for the payment of any expense incurred by Facility for service provided by any person or entity other than Bio-Electronics.

11. Payment for Services. During the term of this Agreement, Facility agrees to pay Bio-Electronics for the Equipment Services provided to Facility pursuant to this Agreement as set forth herein. Bio- Electronics shall invoice Facility for such Equipment Services, and all amounts so billed shall be due and payable "Net 30-days.” At Bio-Electronics sole discretion, any compensation not paid when due may bear interest at a rate of 1.5% per month or, if less, the maximum legal rate permitted by applicable law from the date due, until paid in full.

12. Additional Services. Unless otherwise authorized in writing by the parties, Bio-Electronics shall charge Facility according to Bio-Electronics' prevailing rates for Facility-authorized Equipment Services performed on Equipment that is not included on the Equipment List.

13. Recall Response. Where applicable, Bio-Electronics shall provide recall response during non-business hours. Such response may be by telephone. Bio-Electronics shall respond within two hours of receipt of notification of problem requiring recall response. Requests for emergency service shall be reported to the proper service center as designated by Bio-Electronics. Requests for emergency service shall include the following information:

a. Unit Number on Equipment List;

b. Nomenclature;

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c. Specific Problem(s).

14. Demand Overtime Authorization. It is the intent of Bio-Electronics to charge for any demand overtime authorized by the Facility.

15. Consultation and Evaluation Services. Upon request, Bio-Electronics shall provide Facility a total of four (4) hours of consultation and evaluation services for each proposed purchase of new equipment by Facility. In the event Bio-Electronics provides more than four (4) hours of consultation and evaluation services for a proposed purchase, the parties shall negotiate an appropriate fee for such services.

16. Electrical Safety Seminars. Upon request, Bio-Electronics shall provide two (2) in-service seminars on electrical safety.

17. Electrical Safety Checks. Upon request, Bio-Electronics shall perform electrical safety checks and equipment operation tests on new units purchased by Facility.

18. Preventive Maintenance Training. Upon request, Bio-Electronics shall provide training of Facility in-house staff to perform preventive maintenance on as much equipment as interest, time, ability, and availability of test equipment will allow.

19. Relationship Between Parties. In the performance of this Agreement, the relationship between Bio-

Electronics and Facility shall at all times be that of independent contractors and all employees of each party shall remain solely as employees of such party. Each party is and shall be responsible for paying its own respective employee's benefits, withholding taxes, social security, and other employee taxes.

Each party shall be responsible for obtaining and maintaining worker's compensation insurance and/or self-insurance on its own respective employees.

20. Bio-Electronics Technicians. Unless otherwise authorized in writing by Bio-Electronics and Facility, Facility shall not employ any Bio-Electronics technician during the term of this Agreement and for one

(1) year following the termination of this Agreement.

21. Records. A copy of this Agreement, together will all accompanying referenced material will be retained by each party for the life of this Agreement plus four (4) years. Bio-Electronics records, documents, and books necessary to certify the nature and extent of the costs and services provided by Bio-Electronics under this Agreement, including, but not limited to, information regarding equipment services, inspection and repairs, must be retained until the patient reaches the age of majority plus two

(2) years.

22. Confidentiality. Neither party shall during the term of this Agreement and at all times following the expiration or termination thereof, disclose to any third party, other than its employees, or use for any purpose other than compliance with this Agreement, any information provided to it by the other party which is marked “Confidential”, or “Proprietary” or a similar legend, or which is orally identified as such at the time of disclosure, unless authorized in writing by both parties. This includes all medical records and other confidential medical information.

For purposes of this Agreement, Proprietary Information shall mean any non-public information regarding the business of Bio-Electronics including, but not limited to, customers, client lists, business plans, and business practices of either party.

Failure to follow the terms of Bio-Electronics' Confidentiality Agreement as stated above could result in financial penalties per infraction.

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23. Insurance. Bio-Electronics and Facility each hereby agree to purchase and maintain commercial liability insurance with minimum limits of liability of $1 million per occurrence, and a $3 million annual aggregate and also agree to carry a blanket additional insured endorsement for any entity that requires that endorsement by written contract. Upon request, Bio-Electronics and Facility shall each furnish certificates to one another evidencing such insurance is in force.

24. Indemnity. Each party shall indemnify and hold the other, its officers, employees and agents harmless from any and all liability and damages, costs and expenses, including reasonable attorney’s fees and costs, that the other or its officers, employees or agents become obligated to pay due to the negligent, reckless or intentional acts or omissions of the party or any of its personnel arising out of its duties and obligations under this Agreement.

25. Safe Working Environment. Facility agrees to provide and maintain at all times a safe working environment for all of Bio-Electronics’ personnel and to comply at all times with all safety, health and work environment laws, regulations, ordinances, directives, and rules imposed by all applicable federal, state, and local governmental bodies. Facility shall immediately report to Bio-Electronics all accidents and injuries involving Bio-Electronics’ personnel providing services under this Agreement.

26. Notices. All notices and other communications which are required or may be given under this Agreement shall be in writing and shall be deemed received on delivery if delivered by hand, or three days after being placed in the mail, postage prepaid, certified, and addressed to the other party at the following respective addresses, unless notice is received of an address change:

To Bio-Electronics: Bio-Electronics

3255 Salt Creek Circle, Suite 200 Lincoln, Nebraska 68504 Attention: Senior Director of Operations

To Facility: Nebraska Veterans Homes

27. Amendment. This Agreement may only be altered or amended by a written agreement signed by both

Bio-Electronics and Facility.

28. Counterparts. This Agreement may be signed in two or more counterparts, each of which shall be deemed an original, but all of which shall be considered together one and the same instrument.

29. Exhibits. All exhibits which are attached hereto, as the same now exist or may hereafter be amended pursuant to this Agreement, are incorporated herein and made a part hereof with the same force and effect as if the same were fully set forth herein in their entirety.

30. Entire Agreement: Nonassignment. Except as otherwise provided herein, this Agreement and all

Exhibits, both now existing and as hereafter amended, constitutes the entire understanding and agreement between the parties covering the Equipment Services provided herein and any rights, duties and/or obligations hereunder may not be assigned by either party hereto, in whole or in part, without the prior written consent of the other party.

31. Governing Law. This Agreement shall be construed and enforced pursuant to and in accordance with the laws of the State of Nebraska.

32. Waiver of Breach. The waiver by either party of a breach or violation of any provision of this

Agreement shall not operate as, or be construed to be, a waiver of any subsequent breach of the same or other provision hereof.

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33. Force Majeure. No party shall be liable nor deemed to be in default for any delay or failure in performance under this Agreement or other interruption of service resulting, directly or indirectly, from acts of God, civil or military authority, acts of public enemy war, accident, fire, explosions, earthquakes, floods, failure of transportation, strikes or other work interruptions by either party's employees, or any other cause beyond the reasonable control of the party.

34. Severability. Except to the extent the same would operate to deprive either party of the economic benefit of its bargain, in the event any provision of this Agreement is held to be unenforceable for any reason, the unenforceability thereof shall not affect the remainder of this Agreement, which shall remain in full force and effect and be enforceable in accordance with its terms.

35. Binding Effect. This Agreement shall be binding upon and inure to the benefit of the parties and their successors and permitted assigned.

IN WITNESS WHEREOF, the parties hereto have executed and delivered this Agreement to be effective as of the Effective Date.

By:

(Authorized Signature) Date

(Please Print Name)

Title:

BIO-ELECTRONICS

By:

Senior Director of Operations Date

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Exhibit 3

(1) Annotated Guide to

Bio-Electronics' Policies

(2) Bio-Electronics' Policy and Procedures Manual Subset

(3) Appendix I-

IPM and Vulnerability Risk Assessment

(4) Appendix J-

IPM Inclusion Table

(5) Appendix K-

Performance Standards

(6) Appendix L-

User's Instruction

(7) Model Equipment

Management Plan and Model Policies

(8) Adoption of

Bio-Electronics' Policies

*Available upon request

GUIDE TO BIO-ELECTRONICS’ POLICIES

A primary purpose of Bio-Electronics’ operating policies and procedures is to provide guidelines for maintaining a quality equipment management program for its contracted customers. To that end, it is necessary that established policies promote compliance with standards set forth by various Federal, State, and local regulating agencies, as well as those of a voluntary nature. The following criteria and guidelines provide an overview of Bio-Electronics’ medical equipment management program and identify quick references to that program. It is not required to sign the Adoption Letter and return it to Bio-Electronics, as a facility may choose to incorporate this program into its own policies. The Adoption Letter can serve as internal documentation for the facility’s purposes as needed. The circumstances and practices of each local hospital will vary. Therefore, you are encouraged to work out details and questions with your Primary Account Representative and Regional Service Manager to best support the facility’s compliance program.

The items that follow are organized according to The Joint Commission Accreditation Manual, the DNV-GL Interpretive Guidelines, and the Center for Improvement in Healthcare Quality accreditation standards and are referenced to specific paragraphs or sections in the Bio-Electronics Operations Manual. Items which are typically under the purview of Bio-Electronics are in bold face type and specific references are in italics. A facility may adopt Bio-Electronics’ program along with their own policies in such a way as to provide an integrated response to these criteria (Appendix P).

AHC – Ambulatory Health Care ALC – Assisted Living Community BHC – Behavioral Health Care CAH – Critical Access Hospital HAP – Hospital OBS – Office-Based Surgery Lab – Laboratory NCC – Nursing Care Centers Ⓓ Indicates written documentation is required to demonstrate compliance OME – Home Care

X Indicates applicability R Indicates an identified risk Revised 02/24/23, Page 2

The Joint Commission Environment of Care – Essentials for Health Care (effective January 2023)

Standard EC.01.01.01 AHC ALC BHC CAH HAP LAB NCC OBS OME

Applies to X X X X X X X

The [organization] plans activities [to/that] minimize risks in the environment of care.

Note 1: One or more persons can be assigned to manage risks associated with the management plans described in this standard. [AHC, BHC, CAH, HAP, LAB, NCC]

Elements of Performance for EC.01.01.01 AHC ALC BHC CAH HAP LAB NCC OBS OME

EP 3 X X X

The [organization] has a library of information regarding inspection, testing, and maintenance of its equipment and systems.

NOTE: This library includes manuals, procedures provided by manufacturers, technical bulletins, and other information.

Section 2.208

Elements of Performance for EC.01.01.01 AHC ALC BHC CAH HAP LAB NCC OBS OME

EP 8 Ⓓ Ⓓ Ⓓ Ⓓ

The [organization] has a written plan for managing the following: Medical equipment. [AHC, CAH, HAP]

The laboratory has a written plan for managing the following: Laboratory equipment. [LAB]

Section 2.208, Appendices K, M and P

Standard EC.02.01.01 AHC ALC BHC CAH HAP LAB NCC OBS OME

Applies to X X X X X X X X X

The [organization] manages safety and security risks.

Elements of Performance for EC.02.01.01 AHC BHC CAH HAP LAB NCC OBS OME

EP 11 X X X X X X X

The [organization] responds to product notices and recalls. (See also MM.05.01.17, EPs 1, 3, 4) [AHC, CAH, HAP, OBS]

The organization acts in accordance with product notices and recalls. (See also MM.05.01.17, EPs 1, 3, 4)

[BHC, NCC]

The laboratory acts in accordance with product notices and recalls. [LAB]

Section 2.201.6

OBS – Office-Based Surgery Lab – Laboratory NCC – Nursing Care Centers Ⓓ Indicates written documentation is required to demonstrate compliance OME – Home Care

X Indicates applicability R Indicates an identified risk Revised 02/24/23, Page 3

Standard EC.02.04.01 AHC ALC BHC CAH HAP LAB NCC OBS OME

Applies to X X X X X X

The [organization] manages medical equipment risks. [AHC, ALC, CAH, HAP, NCC, OBS]

The laboratory manages laboratory equipment risks. [LAB]

Elements of Performance for EC.02.04.01 AHC ALC BHC CAH HAP LAB NCC OBS OME

EP 2 Ⓓ

R

The organization maintains either a written inventory of all medical equipment or a written inventory of selected equipment categorized by physical risk associated with use (including all life-support equipment) and equipment incident history. The [organization] evaluates new types of equipment before initial use to determine whether they should be included in the inventory. [AHC, HAP]

The organization maintains either a written inventory of all medical equipment. [AHC deemed ASCs and outpatient surgery, CAH, HAP deemed]

The laboratory maintains a written inventory of laboratory equipment and equipment incident history. The laboratory evaluates new types of equipment before initial use to determine whether they should be included in the inventory. [LAB]

Sections 201, 208.3.1, 208.3.3-4, 208.6.2 and Appendices I, K and M

Elements of Performance for EC.02.04.01 AHC ALC BHC CAH HAP LAB NCC OBS OME

EP 3 Ⓓ Ⓓ Ⓓ Ⓓ Ⓓ Ⓓ

The organization identifies the activities and frequencies for maintaining, inspecting, and testing for all medical equipment on the inventory. Various maintenance strategies may be used to ensure reliable performance (for example: predictive maintenance, reliability-centered maintenance, interval-based inspections, corrective maintenance, or metered maintenance). Defined intervals may be based on criteria such as manufacturers’ recommendations, risk levels, and current organization experience. [AHC]

The organization identifies the activities and frequencies for maintaining, inspecting, and testing for all medical equipment on the inventory. These activities and frequencies must follow manufacturers’ recommendation or other federal or state requirements. [AHC deemed ASCs and outpatient surgery]

The [organization] identifies high-risk medical equipment on the inventory for which there is a risk of serious injury or death to a patient or staff member should the equipment fail. [CAH, HAP]

The laboratory identifies, in writing, the activities and frequencies for inspecting, testing (including function checks), and maintaining laboratory equipment based on the following:

Manufacturers’ recommendations when available Identified risks Clinical Laboratory Improvement Amendments of 1988 (CLIA ’88) guidelines History and experience with the laboratory equipment

(See also QSA.02.02.01, EP 5) [LAB]

The organization identifies, in writing, the activities for maintaining, inspecting, and testing for all medical equipment on the inventory. [ALC, NCC]

NOTE: High-risk medical equipment includes life-support equipment. [CAH, HAP]

OBS – Office-Based Surgery Lab – Laboratory NCC – Nursing Care Centers Ⓓ Indicates written documentation is required to demonstrate compliance OME – Home Care

X Indicates applicability R Indicates an identified risk Revised 02/24/23, Page 4

NOTE: This requirement also applies whenever the laboratory modifies commercially available equipment or for equipment that is used in a test system developed by the laboratory. [LAB]

NOTE: Organizations may use different strategies for different items as appropriate. For example, strategies such as predictive maintenance, reliability-centered maintenance, interval-based maintenance, corrective maintenance or metered maintenance may be selected to provide for reliable performance. [ALC, NCC]

Sections 201, 206, 208.1, 208.3.1, Appendices I, J and M

Elements of Performance for EC.02.04.01 AHC ALC BHC CAH HAP LAB NCC OBS OME

EP 4 Ⓓ

R

Ⓓ R Ⓓ R Ⓓ

The [organization] identifies the activities and associated frequencies, in writing, for maintaining, inspecting, and testing all medical equipment on the inventory. These activities and associated frequencies are in accordance with manufacturers’ recommendations or with strategies of an alternative equipment maintenance (AEM) program. [CAH, HAP]

The organization identifies, in writing, frequencies for inspecting, testing, and maintaining medical equipment on the inventory based on criteria such as manufacturers’ recommendations, risk levels, or current organization experience. [ALC, NCC]

The practice identifies frequencies for inspecting, testing, and maintaining medical equipment based on criteria such as manufacturers’ recommendations, risk levels, or current practice experience. [OBS]

Note 1: The strategies of an AEM program must not reduce the safety of equipment and must be based on accepted standards of practice, such as the American National Standards Institute/Association for the Advancement of Medical Instrumentation handbook ANSI/AAMI EQ56: 2013, Recommended Practice for a Medical Equipment Management Program. [CAH, HAP]

Note 1/2: Medical equipment with activities and associated frequencies in accordance with manufacturers’ recommendations must have 100% completion rate. [CAH, HAP, NCC]

Note 2/3: Scheduled maintenance activities for both high-risk and non-high-risk medical equipment in an alternative equipment maintenance (AEM) program inventory must have a 100% completion rate. AEM frequency is determined by the organization’s AEM program. [CAH, HAP, NCC]

Sections 201, 206, 208.3.1, 208.6.4, Appendices I, J, K and M

Elements of Performance for EC.02.04.01 AHC ALC BHC CAH HAP LAB NCC OBS OME

EP 5 Ⓓ Ⓓ

Deemed

The organization’s activities and frequencies for inspecting, testing, and maintaining the following items must be in accordance with manufacturers’ recommendations:

Equipment subject to federal or state law or Medicare Conditions of Participation in which inspecting, testing, and maintaining must be in accordance with the manufacturers’ recommendations, or otherwise establishes more stringent maintenance requirements

Medical laser devices Imaging and radiologic equipment (whether used for diagnostic or therapeutic purposes) New medical equipment with insufficient maintenance history to support the use of alternative maintenance strategies.

OBS – Office-Based Surgery Lab – Laboratory NCC – Nursing Care Centers Ⓓ Indicates written documentation is required to demonstrate compliance OME – Home Care

X Indicates applicability R Indicates an identified risk Revised 02/24/23, Page 5

Note: Maintenance history includes any of the following documented evidence:

Records provided by the [organization’s] contractors Information made public by nationally recognized sources Records of the [organization’s] experience over time

Sections 201, 208.3 and Appendices J

Elements of Performance for EC.02.04.01 AHC ALC BHC CAH HAP LAB NCC OBS OME

EP 6 Ⓓ Ⓓ Ⓓ

Deemed

Ⓓ R R

The [organization] has written procedures to follow when medical equipment fails, including using emergency clinical interventions and backup equipment. [AHC, NCC]

A qualified individual(s) uses written criteria to support the determination whether it is safe to permit medical equipment to be maintained in an alternate manner that includes the following:

How the equipment is used, including the seriousness and prevalence of harm during normal use Likely consequences of equipment failure or malfunction, including seriousness of and prevalence of harm Availability of alternative or backup equipment in the event the equipment fails or malfunctions Incident history of identical or similar equipment Maintenance requirements of the equipment

(For more information on defining staff qualifications, refer to Standard HR.01.01.01) [CAH, HAP deemed]

The practice has written procedures to follow when medical equipment fails, including using emergency clinical interventions and backup equipment. [OBS]

Sections 201, 202.2, 208.3.1, 208.3.3, Appendices I and L

Elements of Performance for EC.02.04.01 AHC ALC BHC CAH HAP LAB NCC OBS OME

EP 7 Ⓓ Ⓓ

The [organization] identifies medical equipment on its inventory that is included in an alternative equipment maintenance program.

Sections 201.4 and 208.3.1, Appendices I, J and M

Elements of Performance for EC.02.04.01 AHC ALC BHC CAH HAP LAB NCC OBS OME

EP 9 Ⓓ

R Ⓓ R

The [organization] has written procedures to follow when medical equipment fails, including using emergency clinical interventions and backup equipment.

Sections 201, 202.2, 208.3.1, 208.3.3, Appendix I and L

OBS – Office-Based Surgery Lab – Laboratory NCC – Nursing Care Centers Ⓓ Indicates written documentation is required to demonstrate compliance OME – Home Care

X Indicates applicability R Indicates an identified risk Revised 02/24/23, Page 6

Standard EC.02.04.03 AHC ALC BHC CAH HAP LAB NCC OBS OME

Applies to X X X X X X X X

The [organization] inspects, tests, and maintains medical equipment. [AHC, ALC BHC, CAH, HAP, NCC, OBS]

The laboratory inspects, tests, and maintains laboratory equipment. [LAB]

Elements of Performance for EC.02.04.03 AHC ALC BHC CAH HAP LAB NCC OBS OME

EP 1 X X R R R X

Before initial use of medical equipment on the medical equipment inventory, the [organization]…