Procure-to-Pay

3835 Holdrege Street | Lincoln, NE 68583-0742 | 402.472.2126 nebraska.edu/p2p

University of Nebraska Contract Summary

CONTRACTOR/COMPANY INFORMATION

Supplier NEBRASKA HEALTHCARE

COLLABORATIVE INC

Contact Larra Petersen-Lukenda at

Sourcing Agent Sarah Johnson Email legal@cynchealth.org

REQUESTING DEPARTMENT

Participating Campuses

UNMC

Administrative Unit/Dept.

COPH Office of the Dean

Department Contact Pam Ehmke at pehmke@unmc.edu

CONTRACT DESCRIPTION/INFORMATION

Contract Summary (brief description and/ or event name)

Revised SOW/DUA for Dr. Crosby/Reisher RWJF grant as it was extended to

Contract Document Document Amt Total Amt Start Date End Date Notes

DUA $0.00 $0.00 06/15/2026 12/31/2026

COMPETITION/BID INFORMATION

Bid Number NA

Competition Zero-Dollar

Contract Information

NA

INTERNAL USE ONLY

CW45429

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STATEMENT OF WORK 03

This Statement of Work (SOW) 03 is issued pursuant to the Services Agreement (“Agreement”) entered into and currently in effect by and between The Board of Regents of the University of

Nebraska, a public corporate body, acting by and on behalf of the University of Nebraska Medical

Center (“UNMC”), College of Public Health (“COPH”) (“Company”) and the Nebraska

Healthcare Collaborative (“Collaborative”). The terms shall be in addition to all terms contained in the Agreement, which will continue in full force and effect.

Purpose

This document outlines the services for which Company is contracting with Collaborative.

Term

This SOW shall begin on the date last signed below and will continue for an initial period of one

(1) year (the “Initial Term”) or until the services described in this SOW have been provided, accepted and Completion of the Matter is final. Thereafter the parties may agree in writing to extend the SOW for an additional one (1) year period (each a “Renewal Term” and collectively with the Initial Term, the “Term”) or other time period as needed.

Privacy and Security Requirements

All data rights, terms, and permitted uses are outlined in the Data Use Agreement (DUA) between the Parties and attached hereto as Exhibit 1.

Scope of Services

Collaborative will assist Company to provide the data requested from Company and described in the attached Data Use Agreement (“DUA”) to support the research project of Postpartum Care

Disparities in Women with Gestational Diabetes: Current Care Patterns and Opportunities for

Improving Outcomes, in accordance with the DUA entered into between Collaborative and

Company, attached hereto as Exhibit 1.

Deliverables

We will provide the following in support of the project:

• Data Services to include extraction and normalization of the below Categories of Data, as also defined in the DUA:

o Mirror the data elements listed in the Request and agreed to between parties for the request as approved by DGC

• Analysis if requested:

o May provide analytics only as necessary to provide the limited data set.

Fees and Expenses. Fees will be invoiced as follows:

a. Service Fee for work up to March 31, 2026: $0.00

b. Any work or services requested or completed after March 31, 2026 will require an additional fee, to be agreed upon by the parties prior to commencement of any additional work or services.

c. Additional Consulting Services:

i. No additional consulting services provided with this data request.

Payments are due pursuant to Section 3 of the Agreement.

Completion of Matter

The matter will be considered complete upon delivery of Deliverables described above and all

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Consulting Services and evidenced by a written notice mailed or emailed to Company, provided that all fees have been paid in full by Company. Collaborative will close this SOW 30 days after written notice unless Company unless Company requests an extension of this SOW or Consulting services, which must be agreed to in writing.

Warranty Disclaimer and Limitation of Liability

1. Collaborative represents and warrants that all services shall be provided in accordance with this

Agreement. Collaborative has provided a good faith estimate of the data quality available.

Company agrees to accept the risk that the data requested may not meet their scope or expectation of data available. Company acknowledges that the data available to Collaborative is through a dynamic system and data available to Collaborative may change dependent on provider electronic health record information, and query logic may not produce exact matches over multiple queries.

2. OTHER THAN AS SET FORTH IN THIS SECTION OF THE AGREEMENT, THE DATA

COMPILED BY COLLABORATIVE IS PROVIDED “AS IS” AND “AS AVAILABLE”

WITHOUT ANY WARRANTY OF ANY KIND, EXPRESSED OR IMPLIED, INCLUDING

BUT NOT LIMITED TO, THE IMPLIED WARRANTIES OF MERCHANTABILITY AND

FITNESS FOR A PARTICULAR PURPOSE AND NON-INFRINGEMENT.

COLLABORATIVE DISCLAIMS ANY AND ALL RESPONSIBILITIES FOR ANY ACT OR

OMISSION TAKEN OR MADE BY COMPANYIN RELIANCE ON THE DATA PROVIDED,

INCLUDING, WITHOUT LIMITATION, INACCURATE OR INCOMPLETE

INFORMATION. EXCEPT FOR EITHER PARTY’S BREACH OF THE CONFIDENTIALITY

OBLIGATIONS OR VIOLATION OF APPLICABLE LAW, IT IS EXPRESSLY AGREED

THAT IN NO EVENT SHALL EITHER PARTY BE LIABLE TO THE OTHER FOR ANY

SPECIAL, INDIRECT, CONSEQUENTIAL, OR EXEMPLARY DAMAGES, INCLUDING

BUT NOT LIMITED TO, LOSS OF PROFITS OR REVENUES, LOSS OF USE, OR LOSS OF

INFORMATION OR DATA, WHETHER A CLAIM FOR ANY SUCH LIABILITY OR

DAMAGES IS PREMISED UPON BREACH OF CONTRACT, BREACH OF WARRANTY,

NEGLIGENCE, STRICT LIABILITY, OR ANY OTHER THEORIES OF LIABILITY, EVEN

IF SUCH PARTY HAS BEEN APPRISED OF THE POSSIBILITY OR LIKELIHOOD OF

SUCH DAMAGES OCCURRING. COLLABORATIVE DISCLAIMS ANY AND ALL

LIABILITY FOR ERRONEOUS TRANSMISSIONS AND LOSS OF SERVICE RESULTING

FROM COMMUNICATION FAILURES BY CARRIER LINES, TELECOMMUNICATION

SERVICE PROVIDERS, OR THE SYSTEM.

3. COLLABORATIVE IS NOT RESPONSIBLE FOR UNAUTHORIZED ACCESS TO

PARTICIPANT’S TRANSMISSION FACILITIES OR EQUIPMENT BY INDIVIDUALS OR

ENTITIES USING THE SYSTEM WHO ARE NOT AUTHORIZED PERSONNEL.

COLLABORATIVEIS NOT RESPONSIBLE FOR UNAUTHORIZED ACCESS TO, OR

ALTERATION, THEFT, OR DESTRUCTION OF, PARTICIPANT’S DATA FILES,

PROGRAMS, PROCEDURES, OR INFORMATION THROUGH THE SYSTEM.

PARTICIPANT IS SOLELY RESPONSIBLE FOR VALIDATING THE ACCURACY OF

ALL OUTPUT AND REPORTS OBTAINED THROUGH USE OF THE SYSTEM OR

SERVICES. PARTICIPANT IS RESPONSIBLE FOR MAKING REASONABLE EFFORTS

TO PROTECT PARTICIPANT’S OWN DATA AND PROGRAMS FROM LOSS BY

IMPLEMENTING APPROPRIATE SECURITY MEASURES, INCLUDING ROUTINE

BACKUP PROCEDURES. COMPANYHEREBY WAIVES ANY DAMAGES

OCCASIONED BY LOST OR CORRUPT DATA, INCORRECT REPORTS, OR

INCORRECT DATA FILES RESULTING FROM PROGRAMMING ERROR, OPERATOR

ERROR, EQUIPMENT OR SOFTWARE MALFUNCTION. COLLABORATIVE IS NOT

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RESPONSIBLE FOR THE CONTENT OF ANY INFORMATION TRANSMITTED OR

RECEIVED THROUGH COLLABORATIVE’S PROVISION OF THE SERVICES.

4. Each party shall procure and maintain insurance policies with such coverages and in such amounts and for such period of time as required by and set forth in this Agreement. TO THE

FULLEST EXTENT PERMITTED BY LAW, A PARTY’S TOTAL LIABILITY TO THE

OTHER PARTY FOR ANY AND ALL INJURIES, CLAIMS, LOSSES, EXPENSES OR

DAMAGES WHATSOEVER ARISING OUT OF, OR IN ANY WAY RELATED TO, THIS

AGREEMENT FROM ANY CAUSE OR CAUSES INCLUDING BUT NOT LIMITED TO

NEGLIGENCE, ERRORS, OMISSIONS, STRICT LIABILITY, BREACH OF CONTRACT OR

BREACH OF WARRANTY (HEREAFTER A “CLAIM”) SHALL NOT EXCEED THE SUM

PAID ON BEHALF OF, OR TO THE LIABLE PARTY, BY ITS INSURERS IN SETTLEMENT

OR SATISFACTION OF A CLAIM. IF NO SUCH INSURANCE COVERAGE IS PROVIDED

WITH RESPECT TO A CLAIM, THEN THE LIABLE PARTY’S TOTAL LIABILITY FOR

SUCH CLAIM SHALL NOT EXCEED AN AMOUNT EQUAL TO THE AGGREGATE FEES

ACTUALLY PAID BY PARTICIPANT UNDER THIS AGREEMENT FOR THE TWELVE (12)

MONTH PERIOD PRECEDING THE EVENT FIRST GIVING RISE TO THE CLAIM OR FIVE

HUNDRED THOUSAND DOLLARS ($500,000), WHICHEVER IS GREATER.

5. The Parties shall, to the extent permitted by Applicable Law, indemnify and hold the other harmless from any third-party claim, cost, or liability (including, without limitation, reasonable attorneys’ fees) arising from use that is in violation of this Agreement, or Applicable Law, unless caused solely by a Party’s or its agent’s gross negligence, recklessness, or willful misconduct or omission.

Acknowledgment

The Board of Regents of the University of

Nebraska, a public corporate body, acting by and on behalf of the University of

Nebraska Medical Center (“UNMC”), College of Public Health (“COPH”)

NEBRASKA HEALTHCARE

COLLABORATIVE

Signature:

Name: Name: Larra Petersen-Lukenda

Title: Title: CEO

Address: Address: 11412 Centennial Road

Suite 800

La Vista, NE 68128

Phone: Phone: (402) 506-9900

Email: Email: legal@cynchealth.org

Date: Date:

06/08/26 | 10:43 CDT

Michael Hrncirik

06/08/26 | 21:16 CDT

Assistant Vice Chancellor for Business F

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EXHIBIT 1

DATA USE AGREEMENT

SOW 03

THIS DATA USE AGREEMENT (“DUA”) is entered into between the Nebraska

Healthcare Collaborative (“Collaborative”) and University of Nebraska Medical Center

(“Research Institution”) and is effective as of the date of last signature to this Agreement

("Effective Date"). DUA is attached to SOW #03 and pursuant to the Services Agreement

(“Agreement”) entered into and currently in effect by and between The Board of Regents of the

University of Nebraska, a public corporate body, acting by and on behalf of the University of

Nebraska Medical Center (“UNMC”), College of Public Health (“COPH”) (“Company”) and the

Nebraska Healthcare Collaborative, Inc. (“Collaborative”).

RECITALS

Collaborative has agreements with the Nebraska Health Information Initiative, Inc., dba

CyncHealth Nebraska (“CyncHealth”) which maintains a health data utility that contains certain information that Research Institution wishes to use and/or disclose for research, public health, or health care operations purposes permitted under 45 C.F.R. § 164.514(e) of the Privacy Rule.

Prior to releasing any information to Research Institution, Research Institution must enter into an agreement with Collaborative under which Research Institution agrees to certain restrictions on the use and disclosure of the information.

NOW, THEREFORE, the parties agree as follows:

1. Definitions. Terms used but not otherwise defined in this Agreement shall have the meaning set forth in 45 C.F.R. §§160.103 and 164.501, or elsewhere in HIPAA.

A. “HIPAA” means the administrative simplification provisions of the Health

Insurance Portability and Accountability Act of 1996, 42 U.S.C. §§1320d to 1320d-

7, the privacy provisions of the Health Information Technology for Economic and

Clinical Health Act, 42 U.S.C. §§17921-17953, and future amendments thereto, and the final regulations issued thereunder, and future amendments thereto.

B. “Limited Data Set” means a compilation including PHI from which certain direct identifiers have been removed, as set forth in 45 C.F.R. § 164.514.

C. “PHI” means protected health information, as defined in 45 C.F.R. §160.103.

D. “Required By Law” means that a use or disclosure is required by an applicable and binding provision of law, not just permitted.

2. Purpose. Research Institution has requested that Collaborative furnish a Limited Data Set for the purposes described in this Agreement and in the Research Proposal, which shall be limited to research, public health activities, and health care operations as defined in the

Privacy Rule. Research Institution has specifically requested additional data elements, 5-11 namely CPT codes for gestational diabetes mellitus. HIPAA requires that Covered Entity first obtain satisfactory assurances from Research Institution. The purpose of this

Agreement is to obtain satisfactory written contractual assurances from Research

Institution that Research Institution will use the Limited Data Set only for permitted purposes and will appropriately safeguard such Limited Data Set.

Except as otherwise specified herein, Research Institution may use and disclose the Limited Data

Set only as necessary to conduct the research study entitled “Postpartum Care Disparities in

Women with Gestational Diabetes: Current Care Patterns and Opportunities for Improving

Outcomes” (the “Project”).

Data parameters are set forth in Appendix A (Limited Data Set).

3. Assurances of Research Institution. As an express condition of receiving the Limited Data

Set, Research Institution agrees to:

A. Use and disclose the Limited Data Set for the specific purpose(s) identified below, or as otherwise Required By Law.

X Research

□ Health Care Operations

□ Public Health

B. Use appropriate safeguards to prevent use or disclosure of the Limited Data Set other than as provided for in this Agreement.

C. Report to CyncHealth’s designated privacy officer(s), within three (3) calendar days of discovery by Research Institution, any use or disclosure of the Limited Data

Set, or any of the information contained therein, not provided for in this Agreement, together with any remedial or mitigating action taken or proposed to be taken with respect thereto. Research Institution shall cooperate with CyncHealth and/or

Collaborative to mitigate any such unauthorized use or disclosure in accordance with applicable HIPAA and industry standards, and shall pay all costs of that mitigation. Mitigation shall include, but not be limited to, meeting any applicable breach notification requirements under HIPAA.

D. Neither identify the information contained in the Limited Data Set nor contact the person(s) whose PHI is contained in the Limited Data Set.

E. Ensure that all agents, contractors, and subcontractors who will use or have access to the Limited Data Set agree in writing to adhere to the same restrictions and conditions on the use and/or disclosure of the Limited Data Set that apply to

Research Institution hereunder.

F. Ensure through policy and safeguards that only the Principal Investigator, and any persons under his or her supervision (collectively the “Authorized Parties”), are authorized to use the Limited Data Set on behalf of Research Institution’s research project(s) that were identified in the Research Proposal submitted to Collaborative

(“Research Proposal”). Research Institution agrees to ensure that Research

Institution’s Authorized Parties are aware of the scope of approval in the Research

Proposal and comply with the terms of this Agreement.

G. Not include any PHI contained in the Limited Data Set in any publication or presentation of the Project and/or its results.

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H. Not transfer or sell the Limited Data Set or any part of it to any third parties, other than Authorized Parties of Researcher assisting with the Research Proposal research project(s) without the prior written consent of Collaborative.

I. At the earliest opportunity consistent with the permitted uses set forth in this

Agreement, destroy the Limited Data Set or return the Limited Data Set to

Collaborative; or, if Research Institution represents and Collaborative agrees that neither return nor destruction is feasible, continue to extend the protections of this

Agreement to the Limited Data Set while it remains with the Research Institution.

4. Term and Termination.

A. Term. This Agreement shall become effective on the Effective Date and shall continue in effect until it is terminated in accordance with this Section 4. Upon termination of this Agreement for any reason, Research Institution shall promptly return or destroy the Limited Data Set, including any portions or copies thereof that

Research Institution has disclosed to its agents, contractors, and/or subcontractors, and certify in writing to Collaborative that return, or destruction in accordance with

HIPAA and applicable industry standards for data destruction, has occurred. Upon expiration or termination of this Agreement for any reason, Research Institution shall no longer be entitled to use the Limited Data Set.

B. Termination upon Project Completion. This Agreement will terminate upon written notification from Research Institution to Collaborative that the Project is complete. Termination requires return or destruction of the Limited Data Set in accordance with Section 4(a) of this Agreement.

C. Termination upon Mutual Agreement. The parties may mutually agree in writing to terminate this Agreement at any time. Termination requires return or destruction of the Limited Data Set in accordance with Section 4(a) of this Agreement.

D. Termination for Cause by Collaborative. Collaborative may immediately terminate this Agreement if it makes the determination that Research Institution has breached a material term of the Agreement. Alternatively, Research Institution may choose to provide Collaborative with written notice of the existence of an alleged breach.

Failure by Research Institution to cure any such breach within the reasonable time period specified in the written notice provided to Research Institution is grounds for immediate termination of this Agreement by Collaborative. Termination requires return or destruction of the Limited Data Set in accordance with Section

4(a) of this Agreement.

E. Continuing Privacy Obligations. It is expressly agreed that the terms and conditions of this Agreement obligating Research Institution to safeguard the Limited Data Set and any PHI contained therein in compliance with HIPAA shall survive any termination, cancellation, expiration or other conclusion of this Agreement.

5. Intellectual Property.

A. Derived Works and Publication. Research Institution agrees to provide

Collaborative with a copy of any results, reports, or other outputs derived from the

Limited Data Set and are intended to be included as part of a publication. Research

Institution must provide Collaborative with a reasonable opportunity, but not less than thirty (30) days, to review through the Data Governance Committee policies and procedures any reports or other publications derived from the Limited Data Set provided by Collaborative prior to distributing such materials outside of Research

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Institution, including, but not limited to, for purposes of any peer review, submission to any federal or state agency, demonstration, presentation of findings, synopsis of research, or publication. The retention and destruction requirements in

Section 3 apply to any Information or data contained in derived works. Research

Institution agrees to acknowledge Collaborative in any reports or other publications derived from the Limited Data Set. Such acknowledgment shall include the following:

This work was supported by The Nebraska Healthcare Collaborative powered by CyncHealth. The Nebraska Healthcare Collaborative is a nonprofit organization focused on improving the health of populations through research and program evaluation using CyncHealth’s regional health data utility which includes health records, pharmacy data, and social care data. The datasets generated and analyzed during the current study are not publicly available and are governed by a Data Use

Agreement. The views expressed herein are those of the author(s) and do not necessarily reflect the views of CyncHealth, its Affiliated

Organizations or funders.

B. Use of Name and Trademarks. Neither party shall use the name(s) or trademarks(s) of the other party in any advertising, publicity, endorsement, promotion, or other publicity available document without such party’s prior written consent.

WHEREFORE, the parties, through their authorized representatives, hereby accept and agree to the terms and conditions of this Agreement.

The Board of Regents of the University of

Nebraska, a public corporate body, acting by and on behalf of the University of

Nebraska Medical Center (“UNMC”), College of Public Health (“COPH”)

NEBRASKA HEALTHCARE

COLLABORATIVE

Name: Name: Larra Petersen-Lukenda

Title: Title: CEO

Address: Address: 11412 Centennial Road

Suite 800

La Vista, NE 68128

Phone: Phone: (402) 506-9900

Email: Email: legal@cynchealth.org

Date: Date:

Assistant Vice Chancellor for Business F

Michael Hrncirik

06/08/26 | 21:16 CDT

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APPENDIX A

Limited Data Set: A limited data set is not completely deidentified data, because it contains some of the identifiers listed above. While a limited data set is considered to be PHI under the HIPAA

Privacy Rule, it may be shared with you for research purposes provided a data use agreement is entered into with Collaborative and the appropriate approvals are obtained. Limited data sets may also be disclosed under HIPAA for public health purposes and for health care operations in accordance with 45 CFR § 164.514(e).

A limited data set is PHI that excludes the following direct identifiers of the individual (or the individual's relatives, employers or household members):

• Names;

• Address information, other than city, State and zip code;

• Telephone numbers;

• Fax numbers;

• E-mail addresses;

• Social Security numbers;

• Medical record numbers;

• Health plan beneficiary numbers;

• Account numbers;

• Certificate/license numbers;

• Vehicle identifiers and serial numbers, including license plate numbers;

• Device identifiers and serial numbers;

• Web Universal Resource Locators (URLs);

• Internet Protocol (IP) addresses;

• Biometric identifiers, including finger and voice prints;

• Full-face photographs and any comparable images.

Note that limited data sets can contain city, county and zip code (5 digit only), other information about an individual (such as age) as long as it is not one of the identifiers listed above, and dates that are directly related to an individual, including birth date, dates of service, admission date, and discharge date.

Before you will be furnished with a limited data set from Collaborative, you must agree to protect the information from being disclosed or used except for these research purposes. In addition, you must agree not to try to identify individuals whose information is included in the limited data set by linking that information with other identifiable information in other databases.

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APPENDIX B

Postpartum Care Disparities in Women with Gestational Diabetes:

Current Care Patterns and Opportunities for Improving Outcomes

Requestor(s) : Katilyn Crosby, PhD, MHA, BS

University of Nebraska Medical Center 984388 Nebraska Medical Center | Omaha, NE 68198-4355

What are the projects objectives?

This study aims to describe and identify the predictors of 1) the transition from postpartum obstetric care to postpartum primary care and 2) adherence to postpartum glucose testing among women with GDM in Nebraska and Iowa. Access to and utilization of healthcare services is limited by environmental factors related to rurality as they face more burdens due to travel distance and lack of providers. We hypothesize that location of residence in rural areas, greater distance to obstetric/ primary care providers, and lack of obstetric/primary care providers in a given area are associated with lower odds of transitioning to primary care and completing guideline recommended diabetic testing in the postpartum period.

What is the project methodology?

Through the Nebraska Health Collaborative data, a retrospective, cross-sectional cohort design, merged with AHRQ social determinants data, will be deployed and guided by the Andersen theoretical model. Multivariable logistic regression will be estimated to assess the associations and sensitivity analyses.

Who will access this data?

RWJF and UNMC Research Team.

What are the data points requested:

Table 1 below shows the CPT Codes needed for data production for this project.

Where and how long will data be stored; how will it be destroyed?

5 years

Identify expected data flow?

Limited Data Set provided via secure Box file.

Table 1: Data Variables

CPT Codes Meaning

59400 Global OB Code that covers routine obstetric care during pregnancy, including prenatal care, vaginal delivery, and postpartum care

59425 Prenatal care consisting of only 4-6 visits

59426 Prenatal care consisting of 7 or more visits

59510 Global OB code that covers routine prenatal care, cesarean delivery, and postpartum care.

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59610 Global OB code that covers routine prenatal care, vaginal delivery, and postpartum care, after previous cesarean delivery.

59618 Global OB code that covers routine prenatal care, cesarean delivery, and postpartum care, following attempted vaginal delivery after previous cesarean delivery.

99201-99205 Evaluation and management of a new patient, including initial pregnancy visit(s)

99211-99215 Evaluation and management of an established patient, including initial pregnancy visit(s)

99241-99245 Consultation codes

99483

99500

59409 Vaginal delivery only

59410 Vaginal delivery only, including postpartum care

59514 Cesarean delivery only

59515 Cesarean delivery only, including postpartum care

59612 Vaginal delivery only, after previous cesarean delivery

59614 Vaginal delivery only, after previous cesarean delivery, including postpartum care

59620 Cesarean delivery only, following attempted vaginal delivery after previous cesarean delivery

59622 Cesarean delivery only, following attempted vaginal delivery after previous cesarean delivery, including postpartum care

57170 Postpartum

58300 Postpartum

59430 Postpartum care only

99501 Home visit for postpartum care

99421,99422,99423 Online digital E&M visits

99202-99205 New patient visits

99211-99215 Established patient visits

99385-99395 Preventive Medicine

99394-99397 Preventive exam for postpartum visits

Z86 Personal history of GDM

Z13 Screening for diabetes mellitus

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99490 20 minutes

99439 Each additional 20 minutes

99491 Complex CCM

81002 Urinalysis, non-automated

81003 Urinalysis, automated

82947-82952 Glucose testing (various methods)

83037 Hemoglobin test

85018 Hemoglobin test

85025 Complete blood count with automated differential

36415 Routine venipuncture

Certificate Of Completion Envelope Id: 7FCC572D-5967-440D-9D0C-F67534993FFA Status: Completed

Subject: CW45429 - Nebraska Healthcare Collaborative_UNMC_COPH_EHMKE

Source Envelope:

Document Pages: 12 Signatures: 4 Envelope Originator:

Certificate Pages: 5 Initials: 0 Sarah Johnson

AutoNav: Enabled

EnvelopeId Stamping: Disabled

Time Zone: (UTC-08:00) Pacific Time (US & Canada)

1400 R Street

LINCOLN, NE 68588

sjohnson208@nebraska.edu

IP Address: 34.71.29.60

Record Tracking Status: Original

5/27/2026 8:10:59 AM

Holder: Sarah Johnson sjohnson208@nebraska.edu

Location: DocuSign

Signer Events Signature Timestamp Larra Petersen-Lukenda lpetersen-lukenda@cynchealth.org

Security Level: Email, Account Authentication (None)

Signature Adoption: Pre-selected Style

Using IP Address: 70.182.34.82

Sent: 5/27/2026 8:13:09 AM

Resent: 6/1/2026 8:01:57 AM

Resent: 6/4/2026 2:45:25 PM

Resent: 6/5/2026 7:04:32 AM

Viewed: 6/5/2026 11:01:04 AM

Signed: 6/8/2026 10:43:58 AM

Electronic Record and Signature Disclosure:

Accepted: 6/5/2026 11:01:04 AM ID: 5dbbeb14-9441-48e6-9df9-01a717a481b3

Michael Hrncirik mhrncirik@unmc.edu

Assistant Vice Chancellor for Business F

University of Nebraska Medical Center

Security Level: Email, Account Authentication (None)

Signature Adoption: Pre-selected Style

Using IP Address: 97.119.205.147

Signed using mobile

Sent: 6/8/2026 10:43:59 AM

Viewed: 6/8/2026 8:36:02 PM

Signed: 6/8/2026 9:16:24 PM

Electronic Record and Signature Disclosure:

Accepted: 6/8/2026 9:15:53 PM ID: 82154d4d-4542-4099-a273-5a0795467f4c

In Person Signer Events Signature Timestamp

Editor Delivery Events Status Timestamp

Agent Delivery Events Status Timestamp

Intermediary Delivery Events Status Timestamp

Certified Delivery Events Status Timestamp

Carbon Copy Events Status Timestamp Pam Ehmke pehmke@unmc.edu

Assistant Dean of Finance

College of Public Health

Security Level: Email, Account Authentication (None)

Sent: 6/8/2026 9:16:25 PM

Electronic Record and Signature Disclosure:

Accepted: 5/27/2026 4:28:10 PM ID: 699b54f3-3c2e-49ba-bca6-878caf24aba4

Carbon Copy Events Status Timestamp Susan Krupicka skrupicka@cynchealth.org

Security Level: Email, Account Authentication (None)

Sent: 6/8/2026 9:16:26 PM

Electronic Record and Signature Disclosure:

Not Offered via Docusign

Witness Events Signature Timestamp

Notary Events Signature Timestamp

Envelope Summary Events Status Timestamps Envelope Sent Hashed/Encrypted 5/27/2026 8:13:10 AM

Envelope Updated Security Checked 6/5/2026 7:04:31 AM

Envelope Updated Security Checked 6/8/2026 2:38:23 PM

Certified Delivered Security Checked 6/8/2026 8:36:02 PM

Signing Complete Security Checked 6/8/2026 9:16:24 PM

Completed Security Checked 6/8/2026 9:16:26 PM

Payment Events Status Timestamps

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Electronic Record and Signature Disclosure created on: 5/16/2023 6:53:28 PM Parties agreed to: Larra Petersen-Lukenda, Michael Hrncirik, Pam Ehmke

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To advise NU Contracts+Ariba of your new email address

To let us know of a change in your email address where we should send notices and disclosures electronically to you, you must send an email message to us at richard.horner@nebraska.edu and in the body of such request you must state: your previous email address, your new email address. We do not require any other information from you to change your email address.

If you created a DocuSign account, you may update it with your new email address through your account preferences.

To request paper copies from NU Contracts+Ariba

To request delivery from us of paper copies of the notices and disclosures previously provided by us to you electronically, you must send us an email to richard.horner@nebraska.edu and in the body of such request you must state your email address, full name, mailing address, and telephone number. We will bill you for any fees at that time, if any.

To withdraw your consent with NU Contracts+Ariba

To inform us that you no longer wish to receive future notices and disclosures in electronic format you may:

i. decline to sign a document from within your signing session, and on the subsequent page, select the check-box indicating you wish to withdraw your consent, or you may;

ii. send us an email to richard.horner@nebraska.edu and in the body of such request you must state your email, full name, mailing address, and telephone number. We do not need any other information from you to withdraw consent.. The consequences of your withdrawing consent for online documents will be that transactions may take a longer time to process..

Required hardware and software

The minimum system requirements for using the DocuSign system may change over time. The current system requirements are found here: https://support.docusign.com/guides/signer-guide-signing-system-requirements.

Acknowledging your access and consent to receive and sign documents electronically

To confirm to us that you can access this information electronically, which will be similar to other electronic notices and disclosures that we will provide to you, please confirm that you have read this ERSD, and (i) that you are able to print on paper or electronically save this ERSD for your future reference and access; or (ii) that you are able to email this ERSD to an email address where you will be able to print on paper or save it for your future reference and access. Further, if you consent to receiving notices and disclosures exclusively in electronic format as described herein, then select the check-box next to ‘I agree to use electronic records and signatures’ before clicking ‘CONTINUE’ within the DocuSign system.

By selecting the check-box next to ‘I agree to use electronic records and signatures’, you confirm that:

You can access and read this Electronic Record and Signature Disclosure; and

You can print on paper this Electronic Record and Signature Disclosure, or save or send this Electronic Record and Disclosure to a location where you can print it, for future reference and access; and

Until or unless you notify NU Contracts+Ariba as described above, you consent to receive exclusively through electronic means all notices, disclosures, authorizations, acknowledgements, and other documents that are required to be provided or made available to you by NU Contracts+Ariba during the course of your relationship with NU

Contracts+Ariba.

https://support.docusign.com/guides/signer-guide-signing-system-requirements https://support.docusign.com/guides/signer-guide-signing-system-requirements