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HomeMy WebLinkAbout31. 17-617 DECEMBER 12, 2017 17-617 RESOLUTION (CARRIED 7-0 LOST LAID OVER WITHDRAWN ) PURPOSE: RENEW AGREEMENT WITH INTERRA HEALTH, INC. FOR THE PROVISION OF EMPLOYEE HEALTH CLINIC SERVICES AT THREE WAVES HEALTH CLINIC & WELLNESS CENTER INITIATED BY: CITY ADMINISTRATION WHEREAS, the City of Oshkosh, Winnebago County, and the Oshkosh Area School District have entered into an Intergovernmental Agreement to cooperate in the provision of health and wellness services for members of their health plans through the operation of an employee health and wellness clinic; and WHEREAS,representatives of the City, County, and School District have explored the various options for the provision of these services, and recommend that the City, County, and School District continue their partnership and renew the existing agreement with Interra Health, Inc., a Wisconsin Corporation (Interra Health) for the provision of the Employee Health Clinic Services. NOW, THEREFORE, BE IT RESOLVED by the Common Council of the City of Oshkosh that an Addendum to the Services Agreement with Interra health, Inc. for the provision of Employee Clinic Services is hereby approved and the proper City officials are hereby authorized to execute and deliver the agreement in substantially the same form as attached hereto, any changes in the execution copy being deemed approved by their respective signatures. BE IT FURTHER RESOLVED that the appropriate City officials are authorized and directed to take those steps necessary to implement the terms and conditions of the agreement. TO: Honorable Mayor and Members of the Common Council FROM: John Fitzpatrick, Assistant City Manager/Director of Administrative Services DATE: December 7, 2017 RE: Renew Agreement with Interra Health, Inc. for the provision of employee health clinic services at Three Waves Health Clinic & Wellness Center BACKGROUND For the past three years, the City of Oshkosh, Winnebago County, and the Oshkosh Area School District have partnered through an Intergovernmental Agreement in order to cooperate in the provision of health and wellness services for members of their health plans through the operation Three Waves Health Clinic & Wellness Center, an employer based clinic. ANALYSIS In advance of the expiration of our service agreement ending after 2017, staff representatives of the City, County, and School District have explored various options for the provision of these services and recommend that the City, County, and School District continue their partnership by renewing the existing agreement with Interra Health, Inc., a Wisconsin Corporation (Interra Health) for the provision of the employee health clinic services. FISCAL IMPACT Although establishing initial staffing at the clinic was challenging, this partnership has been successful for everyone involved. For the City of Oshkosh specifically, the stability of the clinic has enabled the city to explore several health insurance options over the past three years, providing for approximately $2 million dollars in savings. Additionally, city return on investment (ROI) savings for the clinic over this time period has steadily increased. Beginning with approximately $9,000 in 2015, then increasing to approximately $82,000 in 2016, and up to $104,000 so far for 2017, including quarter three of this year. Total cumulative ROI for the City of Oshkosh as a result of clinic operations currently stands at approximately $195,000. RECOMMENDATION Through the support of the City Council, this intergovernmental initiative has not only benefitted the employees, organization and the taxpayers of the City of Oshkosh, but also the employees, organizations and taxpayers of the Oshkosh Area School District, as well as those of Winnebago County. Based on the analysis conducted and the success realized, staff recommends renewal of the three year agreement with Interra Health, Inc. for the provision of employee health clinic services at Three Waves Health Clinic & Wellness Center beginning in 2018. It is my understanding that the Oshkosh Area School District has already renewed their agreement with Interra Health Inc., and that Winnebago County will be renewing their agreement on the third week of December. Please let me know if you have any questions regarding this matter and thank you for your consideration. Respectfully Submitted, Approved: John M. Fitzpatrick Mark A. Rohloff Assistant City Manager / City Manager Director of Administrative Services Attachments: Three Year Extension Addendum Attachment B Attachment C cc: Pam Resch, HR Manager 2 ADDENDUM TO SERVICES AGREEMENT THIS ADDENDUM TO SERVICES AGREEMENT (this "Addendum") is made by and between Interra Health, Inc., a Wisconsin corporation ("Interra Health"), and the City of Oshkosh, a Wisconsin corporation ("Client"). This Addendum shall be effective as of January 1St, 2018 and will remain in effect until the expiration of the Agreement. WHEREAS, Interra Health and Client are parties to the certain Services Agreement ("Agreement") dated January 1, 2015, pursuant to which, among other things, Interra Health may, pursuant to the terms contained therein, to provide wellness and clinical Services on behalf of Client; WHEREAS, the Parties now desire to enter into this Addendum to amend and supplement the Agreement in the manner set forth in this Addendum. NOW THEREFORE, in consideration of the mutual covenants, agreements, representations and warranties contained herein, and for other good and valuable consideration, both the receipt and legal sufficiency of which are hereby acknowledged, the Parties agree as follows: 1. Clinic Programming: 0 eClinicalWorks* (eCW) One Time Setup fee of $520.00. 0 Physician Assistant/Nurse Practitioner(s) for a fee of $113.94/hour, which includes eCW electronic medical records (EMR) monthly licensing fees. Client will pay 20% of the total physician assistant/nurse practitioner charges for the clinic or such other percentage as may result from an agreed adjustment under the Intergovernmental Cooperation Agreement. After each year, Interra Health will reconcile the eCW EMR costs which may include additional fees or a credit issued to the Client. The amount due or credited shall be reconciled February of each year (starting in 2019). Three EMR license fees (one license needed per nurse practitioner/physician assistant) are estimated at $27,426.96 per year but may vary based on actual costs from eClinicalWorks*. Client will pay or be credited** 20% of the charges for eCW EMR or such other percentage as may result from an agreed adjustment under the Intergovernmental Cooperation ,Agreement. ❑x Medical Assistant(s) for a fee of $30.60/hour. Client will pay for 20% of the total medical assistant charges for the clinic or such other percentage as may result from an agreed adjustment under the Intergovernmental Cooperation Agreement. 0 Other Available Options 0 Healow* online appointment booking ■ $693.60 per provider (NP, PA, MD, etc.) ■ $346.80 per resource (medical assistant) ■ Client will pay 20% of the Healow online appointment booking charges for the clinic or such other percentage as may result from an agreed adjustment under the Intergovernmental Cooperation Agreement. 0 eClinical Messenger* ■ $0.17 per text/phone call appointment reminder ■ Client will pay 20% of eClinical Messenger for the clinic or such other percentage as may result from an agreed adjustment under the Intergovernmental Cooperation Agreement. 0 Provider iPads ■ $800.00 per Wad (one-time fee) ■ Client will pay 20% of the Provider iPads for the clinic or such other percentage as may result from an agreed adjustment under the Intergovernmental Cooperation Agreement. El eCW Digital Fax* ■ $555.00/year for one eCW digital fax line ($46.25 is invoiced monthly). Client will pay 20% of the fax line fees or such other percentage as may result from an agreed adjustment under the Intergovernmental Cooperation Agreement. ■ This covers up to 1,000 outgoing pages per line. After that point every outgoing fax will be $.04 per page. Summary of Optional Services ■ Provider Wad (one-time fee) o Three iPads at $800.00 per provider. ■ Total cost is $2,400.00. ■ Additional providers will incur fees for additional iPads. Client will pay 20% of the provider iPads ($480.00) for the clinic or such other percentage as may result from an agreed adjustment under the Intergovernmental Cooperation Agreement. ■ Estimated Monthly fees o Healow online appointment booking + eCW Digital Fax ■ Current staffing of 3 providers will incur $203.75 per month. ■ Additional providers may incur additional monthly fees as outlined above. Client will pay 20% of the Healow online appointment booking and eCW Digital Fax fees ($40.75/month) for the clinic or such other percentage as may result from an agreed adjustment under the Intergovernmental Cooperation Agreement. o eClinical Messenger fees are incurred as outlined above. *All fees are flow through from eClinicalworks. Any changes in fees from eClinicalworks will result in reduced or increased fees to Client when applicable. **$7.86 ($113.94-$106.08) per nurse practitioner/physician assistant hour will go towards the annual estimated fee of $27,426.96. 2. Lease Extension EI Please see Attachment B (Lease) for original terms of the Lease. I] Please see Attachment C (Addendum to Lease) for the three year Lease extension terms. 3. Prior Addendum(s) to Services Agreement 0 Any and all prior Addendums (e.g. Health Coaching Services and Data Analytics) to the Service Agreement shall remain in effect. 4. Three Year Extension — January 1, 2018 — December 31, 2020 The following Article in the Services Agreement shall be amended as such: Article IX. Term Unless terminated earlier as provided in this Article IX, this Agreement shall have a term of thirty-six (36) months from the Service Start Date (January 1, 2018), and thereafter on each annual anniversary of the Service Start Date (beginning with the first anniversary) the term of this Agreement shall automatically be extended an additional twelve (12) months unless on or before ninety (90) days immediately preceding any such anniversary date, either Party gives notice to the other that the term shall not be extended beyond the expiration date of the then -current term. Expiration of this Agreement shall not relieve Interra Health of its obligation to perform certain functions required of Interra Health following expiration as those functions are identified in this Agreement. IN WITNESS WHEREOF, the parties hereto have executed this Addendum effective as of January 1, 2018 (the "Effective Date"). CLIENT INTERRA HEALTH CITY OF OSHKOSH: INTERRA HEALTH, INC. M M. Name: Name: Title: Title: Attachment B COMMERCIAL LEASE AGREEMENT THIS LEASE AGREEMENT ("Lease"), is made by, between and among BRIDGEVIEW HOLDINGS, LLC, a Wisconsin limited liability company ("Landlord"), whose mailing address is 300 Ohio Street, Oshkosh, Wisconsin 54902, and INTERRA HEALTH, INC., a Wisconsin corporation ("Tenant"), whose mailing address is 1675 North Barker Rd, Suite 200, Brookfield Wisconsin 53045. For good and valuable consideration, the receipt and legal sufficiency of which is hereby acknowledged by the parties hereto, it is agreed as follows: DEMISE: In consideration of the rents, covenants, and agreements contained in this Lease, Landlord hereby demises and leases to Tenant, and Tenant hereby takes and leases from Landlord, the following described premises: a. Leased Premises: A portion of the approximately 12,791 square foot commercial building and land located at 290 through 300 Ohio Street, City of Oshkosh, Winnebago County, Wisconsin (the "Office Building"), the combined suite of 292 and 296 Ohio Street, to be designated as 292 Ohio Street, containing 3,011 square feet, more or less (the "Leased Premises"). b. Parking Areas: The right to use in common with Landlord and Landlord's other tenants and their employees, invitees and customers, the parking area provided by the Landlord in the designated areas for the parking of automobiles continuous to the Office Building; provided that the Landlord retains the right to make reasonable rules and regulations with reference to the use of said parking area, including the right to provide certain reserved parking. Landlord hereby grants Tenant the right to designate 3 parking spaces in front of the Leased Premises as reserved parking for Tenant customers. 2. COMPLETION OF THE LEASED PREMISES: Landlord shall remodel and finish the interior of the Leased Premises as identified in the plans and specifications attached hereto as Exhibit A ("Plans"). Any work other than, or in addition to, the items specifically set forth in the Plans shall be performed for Tenant at its own cost and expense. a. Approval of Changes: Landlord shall deliver any subsequent substantial changes to the Plans to Tenant and Tenant shall have seven (7) calendar days from the receipt of the changes to notify Landlord, in writing, of any objection. Tenant's failure to give such notice within the time specified shall constitute approval of the changes to the Plans. b. Delivery: Landlord shall deliver the Leased Premises, with work substantially complete, to the Tenant not later than January 1, 2015 ("Delivery Date"). c. Tenant Inspection: Tenant acknowledges that: (1) Tenant has inspected the Leased Premises and hereby accepts the same in its "as is" condition, except for work identified in the Plans, and (2) Landlord has made no warranties or representations regarding the condition of the Leased Premises. Tenant shall re -inspect the Leased Premises within ten (10) calendar days of the Delivery Date and if no written objection is received to Landlord within those ten (10) calendar days, Tenant shall be deemed to accept the Leased Premises in its "as is" condition at that time. 3. TERM AND RENEWAL: a. Original Term: The original term of this lease shall be a period of three (3) years, commencing January 1, 2015. 4. RENT. a. Minimum Rent: Commencing January 1s', 2015 and continuing for the term of the lease, Tenant agrees to pay to Landlord a minimum monthly rent at the rate of $3387.375 per month, ("Minimum Rent"). All rent and other payments shall be sent to Landlord at the address set forth above, or to such other address as may be furnished. b. Additional Rent: All costs, charges, expenses and adjustments of rent which Tenant assumes, agrees or is obligated to pay to Landlord pursuant to this Lease shall be deemed "Additional Rent". Minimum Rent and Additional Rent shall be referred to collectively as "Rent". d. Time of Payment: Each monthly Rent payment shall be due and payable on or before the first day of each calendar month. In the event that any payment is received more than ten (10) calendar days after its due date, Tenant shall pay to Landlord, as additional rent, interest on the delinquent amount at the rate of 12% per annum. e. No Set Off: Tenant shall pay the Minimum Rent promptly when due without notice or demand therefore and without any abatement, deduction, or setoff for any reason whatsoever, except as herein otherwise provided. f. Receipt of Lesser Amounts: No payment by Tenant or receipt or acceptance by Landlord of a lesser amount than the correct Minimum Rent shall be deemed to be other than a payment on account. 5. TRUE NET LEASE: Tenant shall pay as Additional Rent Tenant's proportionate share of Taxes, Landlord's Insurance, and Operating Expenses (collectively "Impositions"), all as hereinafter defined. Tenant's proportionate share is 23.5% (based on 3,011/12,765). a. Tenant's Obligations: Tenant covenants to reimburse Landlord, as additional rent, for i. all taxes, lowest allowable installments of assessments (including but not limited to, all assessments for public improvements or benefits, whether or not commenced or completed within the term of this Lease), excises, levies, license and permit and inspection fees and other governmental charges, which at any time prior to or during the term of this Lease may have been or may be assessed or become due and payable ("Taxes"), ii. Landlord's insurance related to the Leased Premises ("Landlord's Insurance"), iii. Landlord's maintenance and operation of the Office Building and all common areas, such as: dumpster expense, shared utilities, snow removal, and lawn care ("Operating Expenses").Tenant shall pay any and all personal property taxes levied on the equipment, improvements, inventory or other personal property owned or leased by Tenant, and iv. payment of any federal, state, or local tax or surcharge imposed on the rent E payments, in accordance with current or subsequently implemented federal, state, or local legislation. b. Estimated Payments and Reconciliation: Tenant shall pay to Landlord, as Additional Rent, payments in the annual amount of $3.00 per square foot, for the 3,011 square feet of the Leased Premises, totaling $9,033.00 annually ("Estimated Payments"). Estimated Payments shall be payable monthly in installment amounts of 1/12th of the annual Estimated Payments, or $752.50, at the same time and in the same manner as Minimum Rent is due. At the end of each year of the term of the Lease, Landlord shall submit to Tenant an annual reconciliation statement setting forth the annual amount of the total Impositions and Tenant's Share of the Impositions ("Reconciliation Statement"). If such Reconciliation Statement shall show that the Estimated Payments paid by Tenant exceeded Tenant's Share of the Impositions for the year, Tenant shall be entitled to a credit in the amount of such excess against the next year's Estimated Payments. However, if such Reconciliation Statement shall show that the Estimated Payments were less than Tenant's Share of the Impositions for the year, Tenant shall pay the amount of such deficiency to Landlord within thirty (30) days after being furnished with the Reconciliation Statement. c. Landlord's Obligations: Landlord shall pay those Impositions that are invoiced in Landlord's name and billed directly to Landlord before the same shall be reduced to a lien upon the Leased Premises. Landlord shall keep the Leased Premises insured against loss or damage by fire or other casualty insurable under standard fire and extended coverage insurance in an amount determined by Landlord. d. Utilities: All electric light, heat, power, sewerage, fuel, internet, phone, cable, and other utility service charges and assessments that are separately metered shall be paid by the Tenant, for the benefit of the Leased Premises, prior to any fine, penalty, interest or cost may be added for non-payment. 6. INSURANCE: a. Tenant, at Tenant's expense, shall obtain and keep in full force and effect (1) an insurance policy for all of Tenant's property and alterations (including the alterations provided for herein) in an amount equal to 100% of the replacement value thereof ("Tenant's Property Policy"), and (2) a policy of commercial general liability and property damage insurance on an occurrence basis ("Tenant's Liability Policy"). The Landlord shall be named as additional insured on Tenant's Liability Policy. b. Tenant's Liability Policy shall contain a provision that (1) no unintentional act or omission of Tenant shall affect or limit the obligation of the insurer to pay the amount of any loss sustained, and (2) the policy is non -cancelable with respect to the Landlord unless at least thirty (30) days of advance written notice is given to Landlord, except that Tenant's Liability Policy may be cancelable on no less than ten (10) days of advance written notice to Landlord for nonpayment of premium. If Tenant receives any notice of cancellation or any other notice from the insurance carrier, which may adversely affect the coverage of the insureds under Tenant's Property Policy or Tenant's Liability Policy, then Tenant shall immediately deliver to Landlord a copy of such notice. The minimum amounts of liability under Tenant's Liability Policy shall be a combined single limit with respect to each occurrence in the amount of $2,000,000.00 for injury (or death) to persons and damage to property. 3 C. Tenant shall cause Tenant's Liability Policy and Tenant's Property Policy to be issued by reputable and independent insurers. The Tenant's Liability Policy and Tenant's Property Policy shall have a maximum deductible of $25,000.00 per occurrence. 7. DAMAGE TO PROPERTY: a. The Landlord shall not be liable in damages, by abatement in rent or otherwise, for any damage either to the person or the property of the Tenant, or for the loss of or damage to any property of the Tenant from any cause whatsoever. The Landlord shall not be liable for any injury or damage to persons or property, or loss or interruption to business resulting from fire, explosion, falling plaster, steam, gas, electricity, water, rain, snow, or leaks from any part of the building, or by any cause of whatsoever nature; nor shall the Landlord be liable for any damage caused by other tenants or persons in said building, or caused by operations in construction of any private or public or quasi -public work. None of the limitations of the liability of Landlord provided for in this subsection (a) shall apply if such loss, injury or damages are proximately caused by the gross negligence or breach by the Landlord, its employees, or independent contractor of the Landlord. b. The Tenant shall be liable for any damage to the building or property therein which may be caused by its act or negligence, or the acts of his or her employees or customers, and the Landlord may, at its option, repair such damage, and the said Tenant shall thereupon reimburse and compensate the Landlord, as additional rent, within thirty (30) days after rendition of a statement by the Landlord, for the total cost of such repair and damage. 8. INDEMNIFICATION, DEFENSE AND HOLD HARMLESS: Tenant shall defend, indemnify and hold Landlord harmless against all expenses, liabilities, and claims of every kind, including actual attorneys' fees, to the extent arising out of either (1) a failure by Tenant to perform any of the terms or conditions of this Lease required to be performed by Tenant hereunder, (2) any injury, death, or damages happening to any persons or property due to Tenant's use of the Leased Premises, or (3) a failure by Tenant to comply with any applicable law of any governmental authority; provided, however, that the foregoing obligations shall not apply to the extent such expenses, liabilities, or claims arise from the negligence or intentional misconduct of Landlord. Landlord shall defend, indemnify and hold Tenant harmless against all expenses, liabilities, and claims of every kind, including actual attorneys' fees, to the extent arising out of either (1) a failure by Landlord to perform any of the terms or conditions of this Lease required to be performed by Landlord hereunder, (2) any injury, death, or damages happening to any persons or property due to Landlord's use of the Leased Premises, or (3) a failure by Landlord to comply with any applicable law of any governmental authority; provided, however, that the foregoing obligations shall not apply to the extent such expenses, liabilities, or claims arise from the negligence or intentional misconduct of Tenant. Notwithstanding anything to the contrary provided in this Lease, it is understood and agreed that there shall be absolutely no personal liability on the part of any officer, director, shareholder, partner, member, employee or agent of Landlord or Tenant with respect to any of the terms, covenants and conditions of this Lease. 4 9. MUTUAL WAIVER OF SUBROGATION: Nothing herein shall be construed as authorizing or permitting the insurers of either party to be subrogated to any of either such party's rights_against the other party, such right of subrogation being hereby expressly waived and disclaimed by both parties. This waiver of subrogation shall not be enforced if it will invalidate or impair the coverage under any policy. 10. TENANT'S USE: Tenant shall use and occupy the Leased Premises in a careful, safe and proper manner, and will not occupy or use the Leased Premises for any unlawful purpose or business. Tenant will comply with all laws, ordinances, rules and regulations of all governmental authorities pertaining to the use and occupancy of the Leased Premises. In addition, Tenant, at its sole expense, agrees to resolve promptly any and all disputes with any neighbors, governmental bodies or departments, or any other third parties relating to violations or problems generated by its operations. 11. MAINTENANCE OF PREMISES: a. Landlord's Obligations: Landlord will make all structural repairs to the Leased Premises and will keep in good order and repair the roof, foundations, load bearing walls, subsurface conditions, and the exterior of the Leased Premises except any doors, windows and glass, upon notification of the necessity for such repairs, and further provided that if the need for the repair shall be attributable to any act or omission of Tenant, Tenant shall be responsible therefor. Landlord shall maintain the common areas. b. Tenant's Obligations: Tenant will keep all non-structural elements, the interior of the Leased Premises, and the storefront, doors and glass, together with all electrical, plumbing, ventilating, heating, air conditioning, and other mechanical installations therein, in good order and repair at its expense; and will surrender the Leased Premises at the expiration of the Term or at such other time as it may vacate the same in as good condition as when received, excepting ordinary wear and tear. 12. LANDLORD'S RIGHT TO PERFORM. In the event Tenant refuses and neglects to make repairs or maintain the Leased Premises properly as required herein, and to the reasonable satisfaction of Landlord, and within fifteen (15) calendar days after written demand, Landlord may undertake such repairs without liability for any loss or damage to Tenant's fixtures, business or other property, Tenant shall be obligated to pay Landlord the costs of making such repairs as additional rent. 13. ALTERATIONS: Tenant shall not make any alterations, additions, or improvements to the Leased Premises without the prior written consent of Landlord, whose consent shall not be unreasonably withheld. All such alterations, additions or improvements shall be performed at the expense of Tenant. All alterations, additions or improvements shall be installed in a first class, workmanlike manner. All alterations, additions or improvements so made by Tenant shall become part of the Leased Premises, and as a consequence of which, Tenant, upon expiration of the lease term or cancellation thereof, shall not have the right to remove the same. 14. LANDLORD'S AND TENANT'S PROPERTY: All fixtures, equipment, improvements and appurtenances attached to or built into the Leased Premises at the commencement of or during the term of this Lease, whether or not by or at the expense of Tenant, shall be and remain a part of the Leased Premises and shall be deemed the property of Landlord and 5 shall not be removed by Tenant. Landlord shall retain any equipment, furniture or other assets that Landlord provided in connection with the Leased Premises. All business and trade fixtures, machinery and equipment, communications equipment and office equipment, whether or not attached to or built into the Leased Premises, which are installed in the Leased Premises by or for the account of Tenant without expense to Landlord and can be removed without structural damage to the building, and all furniture, furnishings and other articles of movable personal property owned by Tenant and located in the Leased Premises (herein collectively called "Tenant's Property") shall be and shall remain the property of Tenant and may be removed by Tenant at any time during the term of this Lease; provided that if any of Tenant's Property is removed, Tenant shall repair or pay the cost of repairing any damage to the Leased Premises resulting from the installation and/or removal thereof. At or before the termination of this Lease, Tenant, at its expense, shall remove from the Leased Premises all of Tenant's Property (except such items thereof as Landlord shall have expressly permitted to remain and such items attached to or built into the Leased Premises, which property shall become the property of Landlord), and Tenant shall repair any damage to the Leased Premises of the building resulting from any installation and/or removal of Tenant's Property. Any other items of Tenant's Property which shall remain in the Leased Premises after the termination of this Lease, abandonment by the Tenant or the surrender of the Leased Premises by Tenant may be deemed to have been abandoned, and in such case such items may be retained by Landlord as its property or disposed of by Landlord, without accountability, in such manner as Landlord shall determine, at Tenant's expense. Landlord will not store any item of personal property or Tenant's Property that Tenant leaves behind when the Tenant moves from the Leased Premises. 15. DESTRUCTION OF PREMISES: In the event of a partial destruction of the Leased Premises during the term from any cause, Landlord shall repair the same, provided insurance proceeds are sufficient to make such repairs and the repairs can be made within 120 days under the laws and regulations of applicable governmental authorities. Any partial destruction shall neither annul nor void this Lease, except that Tenant shall be entitled to a proportionate reduction of rent while the repairs are being made, based on the extent the repairs interferes with Tenant's business on the Leased Premises. If the insurance proceeds are insufficient to make such repairs or the repairs cannot be made in the specified time, Landlord may, at Landlord's option, make repairs within a reasonable time, this Lease continuing in full force and effect and the rent to be proportionately abated as previously set forth in this Section. In the event that Landlord does not elect to make such repairs, this Lease may be terminated at the option of either party. In the event of any partial destruction that Landlord is obligated to repair or may elect to repair under the terms of this Section, Landlord shall proceed to complete such repairs as quickly as may be practical under the circumstances, and Tenant waives any right to make repairs at the expense of Landlord. Should the Leased Premises be destroyed to the extent of more than 50% percent of the replacement cost thereof, this Lease shall be terminated at the option of either party. 16. SIGNAGE: Tenant shall obtain Landlord's prior written consent and approval to the type and placement of any sign or other advertising on the Office Building. Tenant expressly agrees that no sign shall be installed until all approvals and permits are first obtained. All N costs associated with the installation of any sign, including but not limited to, the fabrication of the sign, installation costs, and the approvals and permits shall be borne solely by the Tenant. 17. LIENS: In no event shall Tenant create or permit any construction, mechanic or other liens to be attached or filed against the Leased Premises, Office Building, the Landlord or any tenants of the Landlord. In the event that Landlord is forced to satisfy or dismiss any such lien, Tenant shall indemnify Landlord for all costs associated with dismissing the lien, including court costs and reasonable attorneys' fees. 18. BROKERS: The parties represent and warranty one another that neither party has dealt with any broker or person in connection with this Lease other than Mr. Curt Pitzen, agent of NAI MLG Commercial (which broker will be compensated by Landlord pursuant to a separate agreement). 19. SURRENDER OF PREMISES: Tenant will deliver up and surrender possession of the Leased Premises to Landlord upon the expiration of this Lease or upon its termination, in a good and substantial state of repair, excepting reasonable wear and tear and damage by fire or other insured casualty. 20. EMINENT DOMAIN: If the Leased Premises, or any part thereof, shall be taken under eminent domain proceedings, or transferred to a public authority in lieu of such proceedings, Landlord may terminate this Lease as of the date when possession is taken. All damages awarded for such taking shall belong to and be the property of Landlord. Tenant shall have no claim against Landlord by reason of such taking or termination and shall not have any claim or right to any portion of the amount that may be awarded or paid to Landlord as a result of any such taking, except that Tenant shall have the right to make a claim against such public authority for its loss of business and for any other relief available to Tenant by law in the event such taking involves the physical taking of all or a portion of the Leased Premises, and in such event Tenant shall also have the right to terminate this Lease as of the date when possession is taken by the public authority. 21. EVENTS OF DEFAULT. The occurrence and continuance of any of the following events shall constitute an Event of Default under this agreement: a. Default in Payment: Tenant shall be in arrears in the payment of any payment due Landlord pursuant to this Lease for a period of ten (10) calendar days from the time such payment is due; or b. Default in Performance of Agreement: Tenant shall default in the performance or observance of any of the agreements or conditions herein to be observed or performed by Tenant continuing for a period of ten (10) calendar days following written notice thereof to Tenant by Landlord; or c. Default in Insurance Coverage: If Tenant shall fail or neglect to maintain any insurance coverage required by this Lease and such failure or neglect shall continue for a period of not less than 48 hours after Landlord has notified Tenant in writing of such failure or neglect. d. Insolvency: If Tenant shall file a petition in bankruptcy or for reorganization or for an arrangement pursuant to any present or future federal or state bankruptcy law or under 7 any similar federal or state law, or shall be adjudicated a bankrupt or insolvent or shall make an assignment for the benefit of its creditors or shall admit in writing its inability to pay its debts generally as they become due, or if a petition or answer proposing the adjudication of Tenant as a bankrupt or its reorganization under any present or future federal or state bankruptcy law or any similar federal or state law shall be filed in any court and such petition or answer shall not be discharged or denied within 120 days after the filing thereof; or e. Receivership: If a receiver, trustee, or liquidator of Tenant or of all or substantially all of the assets of Tenant or of the Leased Premises shall be appointed in any proceeding brought by Tenant, or if any such receiver, trustee, or liquidator shall be appointed in any proceeding brought against Tenant and shall not be discharged within 120 days after such appointment, or if Tenant shall consent to or acquiesce in such appointment; or f. Levy or Executions: If the interest of Tenant in this Lease shall be levied on under execution or other legal process, and unless such execution or legal process shall within 30 days from the date of levy be nullified or otherwise rendered ineffective, or if any assignment of Tenant's property shall be made for the benefit of creditors, or if Tenant shall abandon or vacate the Leased Premises. 22. LANDLORD'S REMEDIES: Upon a breach of this Lease or an Event of Default: a. Landlord may terminate this Lease and the term created hereby, in which event Landlord may repossess the Leased Premises and be entitled to recover as damages a sum of money equal to the value of the remaining portion of this Lease; to be determined on the basis of the rent paid or payable, less the fair rental value of the Leased Premises for said period, and any other sum of money and damages owed by Tenant to Landlord; or b. Landlord may terminate Tenant's right to possession and may repossess the Leased Premises without demand or notice of any kind to Tenant and without terminating this Lease, in which event Landlord shall make a reasonable effort to re -let the same for the account of Tenant for such rent and upon such terms as shall be reasonably satisfactory to Landlord; if Landlord shall fail to re -let the Leased Premises, or the Leased Premises are re -let at a lesser rate, then Tenant shall pay to Landlord as damages a sum equal to the amount of the rental reserved in this Lease for such period or periods, or, if the Leased Premises have been re -let, Tenant shall satisfy and pay any such deficiency upon demand therefore, from time to time, and Tenant agrees that Landlord may file suit to recover any sums falling due under the terms of this Section and that no suit or recovery of any portion due Landlord shall be a defense to any subsequent action brought for any amount not reduced to judgment in favor of Landlord. 23. DEFAULT BY LANDLORD: In the event Landlord breaches any of the terms or provisions of this Lease and Landlord has not cured such breach within 30 days after Landlord's receipt of written notice thereof, or made arrangements to cure any breach which could not reasonably be cured within said period, Tenant shall have the right to cure such default on behalf of Landlord and to recover the reasonable cost thereof from Landlord or offset such cost against future rent payable hereunder. Nothing provided herein shall limit Tenant's right to terminate the Lease, at its sole discretion, in the event 0 of default by Landlord. Landlord agrees that Tenant may file suit to recover any damages incurred by Landlord's default under this Lease. 24. PARTY'S RIGHTS ARE CUMULATIVE: No remedy herein or otherwise conferred upon or reserved by Landlord or Tenant shall be considered exclusive of any other remedy, but the same shall be cumulative and shall be in addition to every other remedy given to Landlord or Tenant. None of the rights given hereunder to sue for rent or to prevent the breach or nonobservance of any of the terms hereof, or the exercise of any such rights, shall in any way affect or impair the right of Landlord to declare the term hereby granted at an end and to terminate this Lease as herein provided because of any default in or breach of any of the covenants, provisions or conditions of this Lease. 25. QUIET ENJOYMENT. Landlord hereby covenants and agrees with Tenant that if Tenant shall perform all of the covenants and agreements, Tenant shall, at all times during the Original Term or Renewal Term, have the quiet enjoyment and possession of the Leased Premises. 26. SUBORDINATION: This Lease and Tenant's rights hereunder shall be subject and subordinate to the lien of any mortgage which the Landlord has placed or may place upon the Leased Premises and to all terms, conditions and provisions thereof, to all advances made, and to any renewal, extensions, modifications or replacement thereof. Upon request by Landlord, Tenant shall subordinate its rights hereunder to the lien of any mortgage or mortgages, or the lien resulting from any other method of financing or refinancing. 27. ACCESS TO PREMISES BY LANDLORD: Landlord shall have access to the Leased Premises at all reasonable hours and upon reasonable notice during the Original Term and any Renewal Terms for the purpose of examining the same; provided, however, that Landlord shall not interfere in any way with the business operation of Tenant. Landlord acknowledges that Tenant is subject to the provisions of the Health Insurance Portability and Accountability Act of 1996 and related regulations ("HIPAA"), and that HIPAA requires Tenant to ensure the safety and confidentiality of patient medical records. Landlord further acknowledges that, in order for Tenant to comply with HIPAA, Tenant must restrict access to the portions of the Leased Premises where patient medical records are kept or stored. Landlord hereby agrees that, notwithstanding the rights granted to Landlord pursuant to this Lease, Landlord or Landlord's employees, agents, representatives, or contractors may not enter those areas of the Leased Premises designated by Tenant as locations where protected health information, including patient medical records, are kept and/or stored unless Landlord is accompanied by an authorized representative of Tenant or unless an emergency situation exists. 28. ASSIGNMENT AND SUBLETTING BY TENANT. Tenant shall not have the right to assign this Lease, or let or sublet the whole or any part of the Leased Premises, without the prior written consent of Landlord, which consent shall not be unreasonably withheld. Landlord shall have the absolute right to withhold consent to any requested assignment by Tenant if Landlord is not satisfied that the proposed assignee is in a suitable financial condition. 29. ASSIGNMENT BY LANDLORD: Landlord shall have the right to transfer, assign and convey in whole or in part, any and all of the rights of Landlord in and to the Leased Premises and under this Lease. 0 31. ESTOPPEL CERTIFICATE. Tenant shall, without charge, at any time and from time to time at reasonable intervals, within twenty (20) calendar days after request by Landlord, execute, acknowledge, and deliver to Landlord or any other person, firm, or corporation specified by Landlord, an estoppel certificate in such form as may from time to time be provided by Landlord. 32. NON -WAIVER: Landlord's failure to insist upon strict performance of any covenant of this Lease or to exercise any option or right herein contained shall not be a waiver or relinquishment for the future of such covenant, right or option. 33. CONSTRUCTION OF LEASE: Words of any gender used in this Lease shall be held to include any other gender, and words in the singular number shall be held to include the plural. Wherever used herein, the words "Landlord" and "Tenant" shall be deemed to include the heirs, personal representatives, successors, sub -Tenants of said parties, unless the context excludes such construction. 34. INVALIDITY OF PROVISIONS: If any portion or provision of this agreement shall to any extent be held invalid or unenforceable, the remainder of this agreement shall not be affected thereby, and each portion and provision of this agreement shall continue to be valid and enforceable to the fullest extent permitted by law. 35. SERVICE OF NOTICE: Notices hereunder shall be provided in writing and sent via U.S. Mail to the address of the party as set forth above, or to such other address as either party may have furnished. Notice shall be deemed to have been given as of the time said notice is deposited in the U.S. Mail, unless otherwise provided herein. 36. SURVIVAL OF LEASE COVENANTS: The terms, conditions and covenants of this Lease shall be binding upon and shall inure to the benefit of each of the parties hereto, their heirs, personal representatives, successors or, and shall run with the land. 37. HEADINGS: It is understood and agreed that the headings are inserted only as a matter of convenience and for reference, and in no way define, limit or describe the scope or intent of this Lease, nor in any way affect this Lease. 38. AUTHORITY. Parties warrant and represent to each other that necessary company or corporate action has duly authorized, and execution of this Lease and is the binding act of the respective company or corporation. Dated this /0 day of N 6 y 2014. Landlord: BRIDGEVIEW HOLDINGS LLC ' By: Willia Steiner, Managing Member :n 10 Tenant INTERRA HEALTH INC By:_ Ryan Executive Vice President Javad Ahmad, Managing Member 11 Exhibit A The Plans To be attached. 12 Attachment C SECOND AMENDMENT TO LEASE This Second Amendment of Lease ("Amendment') is by and between Bridgeview Holdings LLC ("Landlord"), a Wisconsin limited liability company, and Interra Health, Inc. ("Tenant'), a Wisconsin corporation, who are parties to a Commercial Lease Agreement entered into on the 10th day of November, 2014, as amended by a First Amendment to Lease dated (collectively the "Lease"), for property located at 292 Ohio Street, Oshkosh, Wisconsin (the "Leased Premises" as further described in the Lease). WHEREAS the parties desire to amend the Lease to amend the term, renewal option and address certain other concerns with the Lease: NOW, THEREFORE, in consideration of the foregoing, the covenants set forth hereafter, and other good and valuable consideration, the receipt and sufficiency of which is hereby acknowledged, it is agreed: 1. Recitals: The recitals are a part of this Amendment. 2. Effective Date: The terms and conditions of this Amendment shall be effective , 2017 (the "Effective Date"). 3. Renewal Term: Section 3(b) of the Lease shall be created as follows: b. Renewal Term: So long as Tenant is not in default of this Lease, Tenant shall have the right, at its election, to extend the term of this Lease for three (3) years (a "Renewal Term"), commencing January 1, 2018, provided that Tenant shall give Landlord notice of the exercise of such election by October _, 2017. Except as expressly otherwise provided in this Lease, all the agreements and conditions in this Lease shall apply to any Renewal Term. 4. Minimum Rent for Renewal Term: Section 4(c) of the Lease shall be created as follows: c. Rent Increase for Renewal Term: In the event Tenant exercises its right to renew this Lease, the Minimum Rent amount applicable in the Renewal Term shall be$3,556.74 per month, an amount equal to five percent (5%) greater than the rent paid during the previous Term. Ratification of Other Provisions: Landlord and Tenant agree that, except as modified by this Amendment, the original Lease and all terms and conditions contained therein shall remain in full force and effect. Defined Terms: Words and phrased having defined meanings in the Lease shall have the same respective meanings when used herein, unless otherwise expressly defined herein. Binding Effect: This Amendment shall be binding on and shall inure to the benefit of the parties hereto and their respective successors and assigns. Counterparts: This Amendment may be executed in counterparts, each of which shall be deemed to be an original and all of which, collectively, shall be deemed to constitute one and the same Amendment. A PDF or facsimile signature of this Amendment shall be deemed an original and shall be binding against any party whose signature is set forth on such PDF or facsimile copy. IN WITNESS WHEREOF, the Landlord and Tenant have caused this Amendment to be signed by their duly authorized officer or member on the dates set forth above their signatures. Date: LANDLORD: Bridgeview Holdings LLC By: William Steiner, Managing Member By: Javad Ahmad, Managing Member Date: TENANT: Interra Health, Inc. By: Ryan Sommers, Executive Vice President