Southern Mono Healthcare District Board of Directors Meeting Agenda November 17, 2016

2015 Press Ganey Pinnacle of Excellence Award Winner

BOARD OF DIRECTORS MONTHLY MEETING AGENDA In compliance with the Americans with Disabilities Act (ADA), if you need special assistance to participate in or to attend this meeting, please contact the District Board Administrative Assistant at Mammoth Hospital by telephoning (760) 934.3311. Notification 48 hours prior to the meeting will enable the District to make reasonable arrangements to assist with accessibility to this meeting.

Date:

November 17, 2016

Time:

8:00 a.m. 8:05 a.m. 8:40 a.m.

Place:

Mammoth Hospital Administration Conference Rooms “A & B” 85 Sierra Park Road Mammoth Lakes, CA 93546

Monthly Board Meeting Regular Session Closed Session (approximate time) Regular Session – continued (approximate time)

I.

CALL TO ORDER

II.

PLEDGE ALLEGIANCE TO THE FLAG AND READING OF THE SMHD VISION, MISSION AND VALUES

III.

PUBLIC COMMENTS

IV.

CHIEF OF STAFF REPORT

V.

ADJOURN TO CLOSED SESSION CONFERENCE WITH LEGAL COUNSEL – PENDING AND THREATENED LITIGATION Existing Litigation and Significant exposure to litigation pursuant to Government Code §54956.9. 1. Inyo County Local Agency Formation Commission (LAFCO), Northern Inyo Healthcare District v. Southern Mono Healthcare District, Sacramento Superior Court Case No. 34-2015-80002247-CU-WM-GDS.

________________________________________________________________________________________________________ P.O. Box 660 | 85 Sierra Park Road | Mammoth Lakes, CA 93546 | 760.924.4114 | Fax 760.924.4104 www.mammothhospital.com

METICULOUS CARE

*

MEMORABLE PEOPLE

*

MAJESTIC LOCATION

Southern Mono Healthcare District Board of Directors Meeting Agenda November 17, 2016 QUALITY ASSURANCE – (Health and Safety Code §32155) 1. Chief of Staff Report. 2. CEO Report. 3. CNO Report. 4. CMO Report. QUALITY ASSURANCE QUARTERLY SUMMARIES - (Health and Safety Code §32155) HEALTH CARE FACILTY TRADE SECRETS (Health and Safety Code §32106) 1. Sierra Park Clinics/Mammoth Hospital. PERSONNEL MATTERS (Government Code §54957) 1. Gary Myers, CEO 2. CEO Evaluation CREDENTIALING Reappointment to Active Staff Jonathan Bourne, M.D. Timothy Crall, M.D. Chris Hummel, M.D. Edric Willes, M.D.

Anesthesia Orthopedic Surgeon Emergency Medicine Pathology

Reappointment to Consulting Staff Albert Douglas Will, M.D. Neurologist Addition of Moderate Sedation Privilege Joanne Feldman, M.D. Emergency Medicine Temporary Privileges Noah Levit, M.D. Jonathan Sales, P.A. Mark Merriman, M.D.

Emergency Medicine Surgical Assist for Dr. R. Thunder Anesthesia

VI.

REPORT ON CLOSED SESSION

VII.

PUBLIC COMMENTS

VIII. CONSENT AGENDA (All matters on the consent agenda to be approved on one motion unless a Board Member requests separate action on a specific item) 1. Previous Minutes to be approved: Page 2 of 4

Southern Mono Healthcare District Board of Directors Meeting Agenda November 17, 2016

2. 3. 4. 5. 6. 7.

IX.

X.

XI.

XII.

September 22, 2016 Regular Board Meeting October 20, 2016 Regular Board Meeting October 28, 2016 Strategic Planning Conference Special Board Meeting November 3, 2016 Special Board Meeting Chief Financial Officer Report Chief Information Officer Report Human Resources Report Facilities Report ACHD Meeting Information Beta Quest for Zero Certificates

COMMITTEE REPORTS 1. Finance Committee Stephen Swisher, M.D., Helen Shepherd 2. Physician Compensation Helen Shepherd, Ryan Wood 3. Employee Relations Committee Helen Shepherd, Jack Copeland 4. Quality Committee Stephen Swisher, M.D., Lynda Salcido 5. CEO Annual Review Committee Lynda Salcido, Jack Copeland 6. IT Steering Committee Stephen Swisher, M.D., Ryan Wood 7. Facilities Committee Ryan Wood, Jack Copeland 8. Policy and Contract Committee Stephen Swisher, M.D., Jack Copeland 9. Board Member Recruitment Committee Jack Copeland, Ryan Wood 10. Ad Hoc, Special, or Other (as needed) Committees 1. Northern Inyo Hospital Liaison Committee Lynda Salcido, Jack Copeland 2. Community Assessment Committee Lynda Salcido, Gary Myers

CHIEF EXECUTIVE OFFICER REPORT

FINANCE REPORT 1. September and October 2016 Financial Statements. 2. Investment Report. 3. Review of Quarterly Capital Expenditure Status.

BOARD EDUCATION There is no Board Education this month.

XIII. OLD BUSINESS There are no matters to discuss this month.

Page 3 of 4

Southern Mono Healthcare District Board of Directors Meeting Agenda November 17, 2016 XIV. NEW BUSINESS 1. Quarterly Review of the Retirement Plan Performance: 403(b) and 457 Employee Retirement Plans by Sarah Vigilante, Human Resources Manager. 2. Declaration of Board Vacancies: Board to determine process to fill vacancies upon expiration of terms of Board members Helen Shepherd and Jack Copeland. 3. Review of the SMHD Strategic Plan Quarterly Report. 4. Quarterly Review and Approval of New and Revised Contracts. 5. Review and Approval of Quality Improvement Plan. 6. Review and Approval of Medical Error Reduction Program (MERP) Plan. 7. Review and Approval of Risk Management Plan. 8. Review and Approval of Infection Control Plan. 9. Review and Approval of Case Management/Utilization Review Plan. 10. Review and Approval of Corporate Compliance Plan. 11. Review and Approval of professional services agreement between Southern Mono Healthcare District and Cecilia Rhodus, M.D., for the provisions of Pediatric Professional Services. 12. Declaration of Surplus District Property, Equipment and Supplies.

XV.

CREDENTIALING Reappointment to Active Staff Jonathan Bourne, M.D. Timothy Crall, M.D. Chris Hummel, M.D. Edric Willes, M.D.

Anesthesia Orthopedic Surgeon Emergency Medicine Pathology

Reappointment to Consulting Staff Albert Douglas Will, M.D. Neurologist Addition of Moderate Sedation Privilege Joanne Feldman, M.D. Emergency Medicine Temporary Privileges Noah Levit, M.D. Jonathan Sales, P.A. Mark Merriman, M.D.

Emergency Medicine Surgical Assist for Dr. R. Thunder Anesthesia

XVI. FUTURE BUSINESS The next Regular meeting will take place on Thursday, December 15, 2016 at 8:00 a.m. in Conference Rooms A & B at Mammoth Hospital.

ADJOURN Page 4 of 4

Southern Mono Healthcare District Board of Directors Meeting Minutes September 22, 2016

2015 Press Ganey Pinnacle of Excellence Award Winner

BOARD OF DIRECTORS MONTHLY MEETING MINUTES

Date:

September 22, 2016

Attendance of Board Members:

Helen Shepherd, Chair; Lynda Salcido, Vice Chair; Stephen Swisher, M.D., Treasurer; Ryan Wood, Secretary; Jack Copeland, Member at Large.

Attendance of Staff Members:

Gary Myers, CEO; Melanie Van Winkle, CFO; Kathleen Alo, CNO; Craig Burrows, M.D., CMO; Mark Lind, CIO; David Baumwohl, Legal Counsel; Robin Conners, Recording Secretary.

I.

CALL TO ORDER

Chair Shepherd called the meeting to order at 8:07 a.m.

II.

PLEDGE ALLEGIANCE TO THE FLAG AND READING OF THE SMHD VISION, MISSION AND VALUES

The meeting was opened with the Pledge of Allegiance to the Flag and the reading of the SMHD Mission, Vision & Values by Lynda Salcido.

III.

PUBLIC COMMENTS

There were no Public Comments. IV.

CHIEF OF STAFF REPORT

There was no Chief of Staff report. V.

ADJOURN TO CLOSED SESSION

The Board adjourned to closed session at 8:09 a.m.

________________________________________________________________________________________________________ P.O. Box 660 | 85 Sierra Park Road | Mammoth Lakes, CA 93546 | 760.924.4114 | Fax 760.924.4104 www.mammothhospital.com

METICULOUS CARE

*

MEMORABLE PEOPLE

*

MAJESTIC LOCATION

Southern Mono Healthcare District Board of Directors Meeting Minutes September 22, 2016 VI.

REPORT ON CLOSED SESSION CONFERENCE WITH LEGAL COUNSEL – PENDING AND THREATENED LITIGATION Existing Litigation and Significant exposure to litigation pursuant to Government Code §54956.9. 1. Inyo County Local Agency Formation Commission (LAFCO), Northern Inyo Healthcare District v. Southern Mono Healthcare District, Sacramento Superior Court Case No. 34-2015-80002247-CU-WM-GDS.

Chair Shepherd reported discussion of CONFERENCE WITH LEGAL COUNSEL on PENDING AND THREATENED LITIGATION for the above item; no action taken. QUALITY ASSURANCE – (Health and Safety Code §32155) 1. Chief of Staff Report. There was no Chief of Staff Report due to the absence of Yuri Parisky, MD., Chief of Staff. 2. CEO Report. Chair Shepherd reported that QUALITY ASSURANCE issues were discussed with Gary Myers, CEO; no action was taken. 3. CNO Report. There was no CNO Report. 4. CMO Report. Chair Shepherd reported that QUALITY ASSURANCE issues were discussed with Craig Burrows, M.D., CMO; no action was taken. QUALITY ASSURANCE QUARTERLY SUMMARIES - (Health and Safety Code §32155) There are no QUALITY ASSURANCE QUARTERLY SUMMARIES to discuss. HEALTH CARE FACILTY TRADE SECRETS (Health and Safety Code §32106) 1. Sierra Park Clinics/Mammoth Hospital. Chair Shepherd reported HEALTH CARE FACILITY TRADE SECRETS were discussed regarding Sierra Park Clinics/Mammoth Hospital. Stephen Swisher, M.D., declared a conflict of interest on the first item presented by Gary Myers, CEO. Dr. Swisher left the room at 8:43 a.m. and returned at 8:47 p.m. No action was taken. Page 2 of 9

Southern Mono Healthcare District Board of Directors Meeting Minutes September 22, 2016 PERSONNEL MATTERS (Government Code §54957) 1. Gary Myers, CEO Chair Shepherd reported a discussion took place with Gary Myers, CEO; no action was taken. 2. CEO Evaluation All staff left the room at 9:00 a.m. The CEO Evaluation was discussed; no action taken. All staff returned to the room at 9:58 a.m. Ryan Wood left the room at 9:45 a.m. Jack Copeland left the room at 9:45 a.m. and returned at 9:48 a.m. CREDENTIALING Appointment to Active Staff Melvin Cherne, M.D.

Radiology

Appointment to Affiliate Staff Robert Jungman, D.D.S.

General Dentistry

Appointment to Provisional Staff William Timbers, M.D. Emergency Medicine Amy Saft, CRNA Anesthesia Extension of Privileges Albert D. Will, M.D. Temporary Privileges Larry Silver, M.D. Ted McKeon, M.D. Mark Merriman, M.D. Christopher Davis, M.D. Bobby Alexander, M.D. Samuel Lee, M.D. Jonathan Sales, PA William Timbers, M.D.

Neurology

Anesthesia Anesthesia Anesthesia Anesthesia Urology Urology Surgical Assist for Dr. Thunder Emergency Medicine

Chair Shepherd reported the foregoing physician CREDENTIALING was discussed; no action was taken. Closed session ended at 10:02 a.m. Page 3 of 9

Southern Mono Healthcare District Board of Directors Meeting Minutes September 22, 2016 VII.

PUBLIC COMMENTS

There were no additional Public Comments. VIII. CONSENT AGENDA (All matters on the consent agenda to be approved on one motion unless a Board Member requests separate action on a specific item) 1. Previous Minutes to be approved: August 18, 2016 Regular Board Meeting 2. Chief Financial Officer Report 3. Chief Nursing Officer Report 4. Chief Information Officer Report 5. Human Resources Report 6. Facilities Report 7. LAFCO Letter regarding Regionalization Jack Copeland made a motion, seconded by Lynda Salcido to approve all items on the consent agenda as presented in the packet. Chair Shepherd asked for comments; a brief discussion ensued including clarification and comments on some items in the CFO report and CNO report. A roll call vote was taken; the motion passed unanimously. Yes 4, No 0. IX.

COMMITTEE REPORTS 1. Finance Committee

Stephen Swisher, M.D., Helen Shepherd

Details from the Finance Committee Meeting will be covered in the Financial Report. 2. Physician Compensation

Helen Shepherd, Ryan Wood

There was no Physician Compensation meeting; no report. 3. Employee Relations Committee

Helen Shepherd, Jack Copeland

There was no report. 4. Quality Committee

Stephen Swisher, M.D., Lynda Salcido

There was no report. The new Director of Quality is starting next week. 5. CEO Committee Jack Copeland reported that the CEO evaluation is in progress. 6. IT Steering Committee

Stephen Swisher, M.D., Ryan Wood Page 4 of 9

Southern Mono Healthcare District Board of Directors Meeting Minutes September 22, 2016

There was no Information Technology (IT) Steering Committee meeting this month; no report. 7. Facilities Committee Ryan Wood, Jack Copeland There was no report. 8. Policy and Contract Committee

Stephen Swisher, M.D., Jack Copeland

Jack Copeland reported there was a meeting to discuss the process for approving policies. The policies on the list in the packet were reviewed and approved by the committee. Policies will be reviewed and approved on a quarterly basis in the future. 9. Board Member Recruitment Committee

Jack Copeland, Ryan Wood

There will be two open seats as of the last Friday in November, 2016. It was noted that potential candidates should be invited to attend the November Board meeting. 10. Ad Hoc, Special, or Other (as needed) Committees 1. Northern Inyo Hospital Liaison Committee Lynda Salcido, Jack Copeland There was no report. 2. Community Assessment Committee

Lynda Salcido, Gary Myers

Kathleen Alo, CNO, reported that the Community Health Needs Assessment Implementation Planning meetings are scheduled for September 29 and 30. HealthTechs 3 will facilitate the meetings. The Implementation Plan needs to be filed before the end of this tax year. X.

CHIEF EXECUTIVE OFFICER REPORT

Gary Myers, CEO, presented the following additional information to his written report: 1. Mr. Myers attended the recent Beta Conference. Mammoth Hospital received awards for the Emergency Department, Labor and Delivery and the Surgery Departments for the Quest for Zero program as well as the Patient Family Advisory Committee. 2. The Beta Heart (Healing, Empathy, Accountability, Resolution, Trust) program was introduced at the conference. This is a well-structured Risk Management program. Beta will come to the Mammoth Hospital Strategic Plan Conference to introduce the program. 3. The annual review meeting was held with Wells Fargo, the hospital’s health plan consultants. Next year’s plan will have enhanced benefits with no increase in costs. 4. The agreements with the anesthesiologists have been extended for 90 day until the group contract can be finalized. 5. We are currently working with a company to salvage the old MRI equipment and remove it.

Page 5 of 9

Southern Mono Healthcare District Board of Directors Meeting Minutes September 22, 2016 6. Prop 52 is a top priority in legislation this year. It is being sponsored by CHA (California Hospital Association) and focuses on maintaining MediCal benefits. This proposition is very important to Mammoth Hospital. Marketing is working on community education. Ryan Wood returned to the meeting at 10:40 a.m. XI.

FINANCE REPORT 1. August 2016 Financial Statements. 2. Investment Report.

Melanie Van Winkle, CFO, reviewed and presented the Financial Statements, included in the packet via PowerPoint presentation. Ms. Van Winkle reported the August Net Gain was $360,000 which resulted in an unfavorable budget variance of $18,000. The unfavorable variance is a result of a lower payer mix for the month thus creating lower than budgeted operating gain for the month. The year-todate Net Gain was $672,000 which resulted in a favorable year-to-date budget variance of $417,000. Days of cash-on-hand were at 295.1 at the end of August. XII.

BOARD EDUCATION

There is no Education this month. XIII. OLD BUSINESS There are no matters to discuss this month. XIV. NEW BUSINESS 1. Presentation and Approval of Draft /Final Audited June 30, 2016 Financial Statements and the Draft Management Report by Scott Sisel, Partner of Eide Bailly. Jack left the room at 10:56 a.m. and returned to the room at 11:58 a.m. The Draft /Final Audited June 30, 2016 Financial Statements and the Draft Management Report was presented by Monica Theisen, CPA, Senior Manager, Eide Bailly and Scott Sisel, Partner of Eide Bailly, via teleconference. Lynda Salcido made a motion seconded by Jack Copeland to accept the Draft Audited June 30, 2016 Financial Statements and the Draft Management Report as presented. Chairman Shepherd asked for comments; a brief discussion ensued. It was noted that staff will publicize the summary of the audit in the local newspaper for general circulation. A roll call vote was taken; the motion passed unanimously. Yes 5, No 0.

XV.

PUBLIC COMMENTS Page 6 of 9

Southern Mono Healthcare District Board of Directors Meeting Minutes September 22, 2016 There were no additional Public Comments.

XVI. NEW BUSINESS (continued) 2. Presentation and Discussion of the HealthStream Employee Survey Results and the HealthStream Physician Survey Results by Sarah Vigilante, Human Resources Manager. The HealthStream Employee Survey Results and the HealthStream Physician Survey Results were presented by Sarah Vigilante, Human Resources Manager via PowerPoint presentation; no action needed. 3. Review of Patient Satisfaction Quarterly Reports by Kathleen Alo, CNO and Melanie Van Winkle, CFO. The Patient Satisfaction quarterly report was presented and reviewed by Stephanie Stanton, Quality Improvement Coordinator and Melanie Van Winkle, CFO; no action needed. 4. Annual Review and Approval of New and Revised Policies. Jack Copeland made a motion seconded by Ryan Wood to approve the policies as presented in the packet. Chair Shepherd asked for discussion. It was noted that the policies have been reviewed and approved by the appropriate committees. A roll call vote was taken; the motion passed unanimously. Yes: 5, No: 0. 5. Review and Approval of the Spiess Construction Company Contract in the amount of $588,500 for the Construction of the Mammoth Hospital Parking lot. Jack Copeland made a motion seconded by Lynda Salcido to approve the Spiess Construction Company Contract in the amount of $588,500 for the Construction of the Mammoth Hospital Parking lot. Chairman Shepherd asked for comments; a brief discussion ensued. A roll call vote was taken; the motion passed unanimously. Yes: 5, No: 0. 6. Review and Approval of the Proposal from Elliott Brainard, Architect, to Prepare the Schematic Design Drawings (Preliminary Design) for the Proposed Medical Office Building. Lynda Salcido made a motion seconded by Jack Copeland to approve the Proposal from Elliott Brainard, Architect, to prepare the Schematic Design Drawings (Preliminary Design) for the Proposed Medical Office Building. Chairman Shepherd asked for comments; a brief discussion ensued. A roll call vote was taken; the motion passed unanimously. Yes 5, No 0.

Page 7 of 9

Southern Mono Healthcare District Board of Directors Meeting Minutes September 22, 2016 7. Delegate authority to the CEO to approve and sign agreements approving the proposed merger of the ALPHA Fund and Beta Healthcare Group Risk Management Authority. Jack Copeland made a motion seconded by Ryan Wood to Delegate authority to the CEO to approve and sign agreements approving the proposed merger of the ALPHA Fund and Beta Healthcare Group Risk Management Authority. Chairman Shepherd asked for comments; a brief discussion ensued. A roll call vote was taken; the motion passed unanimously. Yes 5, No 0. 8. Review and Approval of Professional Services agreement between Southern Mono Healthcare District and Mammoth Emergency Group, Inc., for the provision of Emergency Medical Professional Services. Stephen Swisher, M.D. declared a conflict and left the room at 11:47 a.m. Jack Copeland made a motion seconded by Lynda Salcido to approve the professional services agreement between the Southern Mono Healthcare District and Mammoth Emergency Group, Inc., for the provision of Emergency Medical Professional Services with the non-material changes discussed in closed session. Chair Shepherd asked for discussion; there was none. A roll call vote was taken; the motion passed unanimously. Yes 4, No 0. Stephen Swisher, M.D. returned to the room at 11:48 a.m. 9. Review and Approval of Professional Services agreement between Southern Mono Healthcare District and Allan Lew, M.D., for the provision of Cardiology Professional Services. Lynda Salcido made a motion seconded by Jack Copeland to approve the professional services agreement between the Southern Mono Healthcare District and Allan Lew, M.D., for the provision of Cardiology Professional Services with the non-material changes discussed in closed session. Chair Shepherd asked for discussion; there was none. A roll call vote was taken; the motion passed unanimously. Yes 5, No 0. 10. Declaration of Surplus District Property, Equipment and Supplies. Ryan Wood made a motion seconded by Jack Copeland to approve the disposal of surplus District property, equipment and supplies presented to the Board and to direct staff to dispose of it in the manner most beneficial to the District. The surplus District property, equipment and supplies presented have nominal or no value. Chair Shepherd asked for discussion; a brief discussion ensued. A roll call vote was taken; the motion passed unanimously. Yes 5, No 0. XVII. CREDENTIALING Appointment to Active Staff Melvin Cherne, M.D.

Radiology Page 8 of 9

Southern Mono Healthcare District Board of Directors Meeting Minutes September 22, 2016 Appointment to Affiliate Staff Robert Jungman, D.D.S. General Dentistry Appointment to Provisional Staff William Timbers, M.D. Emergency Medicine Amy Saft, CRNA Anesthesia Extension of Privileges Albert D. Will, M.D. Temporary Privileges Larry Silver, M.D. Ted McKeon, M.D. Mark Merriman, M.D. Christopher Davis, M.D. Bobby Alexander, M.D. Samuel Lee, M.D. Jonathan Sales, PA William Timbers, M.D.

Neurology

Anesthesia Anesthesia Anesthesia Anesthesia Urology Urology Surgical Assist for Dr. Thunder Emergency Medicine

Stephen Swisher made a motion, seconded by Lynda Salcido to approve the appointments as listed above except for William Timbers, M.D. Chair Shepherd asked for comments: it was noted that the appointments were discussed in closed session and no action was taken. A roll call vote was taken; the motion passed unanimously. Yes 5, No 0. Stephen Swisher, M.D., left the room at 11:50 a.m. Lynda Salcido made a motion, seconded by Ryan Wood to approve the appointment as listed above for William Timbers, M.D. Chair Shepherd asked for comments: it was noted that the appointments were discussed in closed session and no action was taken. A roll call vote was taken; the motion passed unanimously. Yes 4, No 0. Stephen Swisher, M.D., returned to the room at 11:52 a.m. XVIII. FUTURE BUSINESS The next Regular meeting will take place on Thursday, October 20, 2016 at 8:00 a.m. in Conference Rooms A & B at Mammoth Hospital. The Strategic Plan Conference will be held on Friday, October 28, 2016 at 8:00 a.m. at the Sierra Conference Center, Sierra Center Mall. ADJOURN There being no further business the meeting was adjourned at 11:55 a.m. Page 9 of 9

Southern Mono Healthcare District Board of Directors Meeting Minutes October 20, 2016

2015 Press Ganey Pinnacle of Excellence Award Winner

BOARD OF DIRECTORS MONTHLY MEETING MINUTES Date:

October 20, 2016

Attendance of Board Members:

Helen Shepherd, Chair; Lynda Salcido, Vice Chair; Stephen Swisher, M.D., Treasurer; Ryan Wood, Secretary; Jack Copeland, Member at Large.

Treasurer Stephen Swisher, M.D., attended via teleconference and was located at: 3950 S. Las Vegas Boulevard, Las Vegas, Nevada. Attendance of Staff Members:

Gary Myers, CEO; Robin Conners, Recording Secretary.

Excused:

Melanie Van Winkle, CFO; Kathleen Alo, CNO; Craig Burrows, M.D., CMO; Mark Lind, CIO; David Baumwohl, Legal Counsel.

I.

CALL TO ORDER

Vice Chair Salcido called the meeting to order at 8:08 a.m.

II.

PLEDGE ALLEGIANCE TO THE FLAG AND READING OF THE SMHD VISION, MISSION AND VALUES

The meeting was opened with the Pledge of Allegiance to the Flag and the reading of the SMHD Mission, Vision & Values by Jack Copeland.

III.

PUBLIC COMMENTS

There were no Public Comments.

IV.

ADJOURN TO CLOSED SESSION

The Board adjourned to closed session at 8:10 a.m. Chair Helen Shepherd joined the meeting at 8:12 a.m.

________________________________________________________________________________________________________ P.O. Box 660 | 85 Sierra Park Road | Mammoth Lakes, CA 93546 | 760.924.4114 | Fax 760.924.4104 www.mammothhospital.com

METICULOUS CARE

*

MEMORABLE PEOPLE

*

MAJESTIC LOCATION

Southern Mono Healthcare District Board of Directors Meeting Minutes October 20, 2016 V.

REPORT ON CLOSED SESSION CONFERENCE WITH LEGAL COUNSEL – PENDING AND THREATENED LITIGATION Existing Litigation and Significant exposure to litigation pursuant to Government Code §54956.9. 1. Claim of Steve Searles v. Southern Mono Healthcare District; threatened litigation.

Jack Copeland made a motion, seconded by Lynda Salcido to reject the claim of Steve Searles v. Southern Mono Healthcare District. The CEO was directed to give notice of the rejection. A roll call vote was taken; the motion passed unanimously. Yes 5, No 0. PERSONNEL MATTERS (Government Code §54957) 1. CEO Evaluation Chair Shepherd reported PERSONNEL MATTERS was discussed; no action was taken. CREDENTIALING Appointment to Provisional Staff Christopher Davis, M.D., Anesthesiology Sharon Meiselman, M.D., Radiology Chair Shepherd reported the foregoing physician CREDENTIALING was discussed; no action was taken.

VI.

CREDENTIALING Appointment to Provisional Staff Christopher Davis, M.D., Anesthesiology Sharon Meiselman, M.D., Radiology

Jack Copeland made a motion, seconded by Lynda Salcido to approve the appointments as listed above. Chair Shepherd asked for comments: it was noted that the appointments were discussed in closed session and no action was taken. A roll call vote was taken; the motion passed unanimously. Yes 5, No 0.

VII.

PUBLIC COMMENTS

Gary Myers, CEO, reported: 1. Tom Wander, Beta CEO, asked Mr. Myers to join the Beta Board of Directors. The SMHD Board of Directors was supportive. 2. There are three candidates for the open Board seats: Laurey Carlson, General Manager, Mammoth Mountain Ski Area; Dave Anderson, Assistant District Attorney; Robin Roberts, Director of Mono County Behavioral Health. Page 2 of 3

Southern Mono Healthcare District Board of Directors Meeting Minutes October 20, 2016 VIII. FUTURE BUSINESS A Special meeting of the SMHD Board of Directors, the Strategic Plan Conference, will take place on Friday, October 28, 2016 at 8:00 a.m. in the Sierra Events Center, Sierra Center Mall, Second Floor, 425 Old Mammoth Road, Mammoth Lakes, CA 93546. A Special meeting of the SMHD Board of Directors will take place on Thursday, November 3, 2016 at 8:00 a.m. in Conference Rooms A & B at Mammoth Hospital. The next Regular meeting will take place on Thursday, November 17, 2016 at 8:00 a.m. in Conference Rooms A & B at Mammoth Hospital.

ADJOURN There being no further business the meeting was adjourned at 9:55 a.m.

Page 3 of 3

Southern Mono Healthcare District Strategic Plan Conference Board of Directors Meeting Minutes October 28, 2016

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BOARD OF DIRECTORS MEETING MINUTES STRATEGIC PLAN CONFERENCE 2016 In compliance with the Americans with Disabilities Act (ADA), if you need special assistance to participate in or to attend this meeting, please contact the District Board Administrative Assistant at Mammoth Hospital by telephoning (760) 934.3311. Notification 48 hours prior to the meeting will enable the District to make reasonable arrangements to assist with accessibility to this meeting. Date:

October 28, 2016

Attendance of Board Members:

Helen Shepherd, Chair; Lynda Salcido, Vice Chair; Stephen Swisher, M.D., Treasurer; Ryan Wood, Secretary.

Absent:

Jack Copeland, Member at Large.

Attendance of Staff Members:

Gary Myers, CEO; Melanie Van Winkle, CFO; Kathleen Alo, CNO; Craig Burrows, M.D., CMO; Robin Conners, Recording Secretary.

Absent:

Mark Lind, CIO; David Baumwohl, Legal Counsel. I.

CALL TO ORDER

Chair Shepherd called the meeting to order at 8:01 a.m. II.

PLEDGE ALLEGIANCE TO THE FLAG AND READING OF THE SMHD VISION, MISSION AND VALUES

The meeting was opened with the Pledge of Allegiance to the Flag and the reading of the SMHD Mission, Vision & Values by Stephen Swisher, M.D. III.

PUBLIC COMMENTS

There were no Public Comments.

IV.

NEW BUSINESS 1. Southern Mono Healthcare District Strategic Planning

________________________________________________________________________________________________________ P.O. Box 660 | 85 Sierra Park Road | Mammoth Lakes, CA 93546 | 760.924.4114 | Fax 760.924.4104 www.mammothhospital.com

METICULOUS CARE

*

MEMORABLE PEOPLE

*

MAJESTIC LOCATION

Southern Mono Healthcare District Strategic Plan Workshop Board of Directors Meeting Agenda October 28, 2016 Stephen Swisher, N.D. left the meeting at 8:42 a.m. and returned at 9:15 a.m. Ryan Wood joined the meeting at 10:10 a.m. The Southern Mono Healthcare District Strategic Plan for 2017 was discussed; no action needed.

V.

FUTURE BUSINESS

A Special meeting of the SMHD Board of Directors will take place on Thursday, November 3, 2016 at 8:00 a.m. in Conference Rooms A & B at Mammoth Hospital. The next Regular SMHD Board meeting is scheduled for November 17, 2016 at 8 a.m. in Conference Rooms A & B at Mammoth Hospital. ADJOURN There being no further business the meeting was adjourned at 11:06 a.m.

Page 2 of 2

Southern Mono Healthcare District Board of Directors Special Meeting Minutes November 3, 2016

2015 Press Ganey Pinnacle of Excellence Award Winner

MINUTES OF SPECIAL MEETING OF THE BOARD OF DIRECTORS OF SOUTHERN MONO HEALTHCARE DISTRICT

Date:

November 3, 2016

Attendance of Board Members:

Helen Shepherd, Chair; Lynda Salcido, Vice Chair; Stephen Swisher, M.D., Treasurer; Ryan Wood, Secretary; Jack Copeland, Member at Large.

Attendance of Staff Members:

Robin Conners, Recording Secretary.

Excused:

Gary Myers, CEO; Melanie Van Winkle, CFO; Kathleen Alo, CNO; Craig Burrows, M.D., CMO; Mark Lind, CIO; David Baumwohl, Legal Counsel.

I.

CALL TO ORDER

Chair Shepherd called the meeting to order at 8:05 a.m. Lynda Salcido joined the meeting at 8:09 a.m.

II.

PLEDGE ALLEGIANCE TO THE FLAG AND READING OF THE SMHD VISION, MISSION AND VALUES

The meeting was opened with the Pledge of Allegiance to the Flag and the reading of the SMHD Mission, Vision & Values by Ryan Wood.

III.

PUBLIC COMMENTS

There were no Public Comments.

P.O. Box 660٠ 85 Sierra Park Road ٠ Mammoth Lakes, CA 93546 ٠ 760/924-4011 Fax 760-924-4006 ٠ www.mammothhospital.com

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Southern Mono Healthcare District Board of Directors Special Meeting Minutes November 3, 2016 IV.

NEW BUSINESS 1. Review and Approval of the Community Health Needs Assessment Implementation Plan.

Linda Salcido made a motion seconded by Jack Copeland to approve the Community Health Needs Assessment Implementation Plan; a brief discussion ensued. Chair Shepherd asked for discussion; legal counsel stated there were no material changes. A vote was taken; the motion passed unanimously; Yes 5, No 0.

V.

ADJOURN TO CLOSED SESSION

The Board adjourned to closed session at 8:30 a.m.

VI.

REPORT ON CLOSED SESSION PERSONNEL MATTERS (Government Code §54957) 1. CEO Evaluation

Chair Shepherd reported that the CEO annual evaluation was discussed; no action taken.

ADJOURN There being no further business the meeting was adjourned at 9:32 a.m.

P.O. Box 660٠ 85 Sierra Park Road ٠ Mammoth Lakes, CA 93546 ٠ 760/924-4011 Fax 760-924-4006 ٠ www.mammothhospital.com

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Southern Mono Healthcare District Report to the Board of Directors CFO Report November 17, 2016

2015 Press Ganey Pinnacle of Excellence Award Winner

DATE:

November 17, 2016

TO:

Board of Directors Southern Mono Healthcare District

FROM:

Melanie Van Winkle, CFO/Physician Practice Administrator

RE:

CFO Report, Regular Meeting of the Board of Directors

Old Business Patient Account Billing/Collections – Patient account collections were $5.2 million in October. YTD collections are $23.4 million compared to goal of $21.6 million and prior year at $20.8 million. Net AR days dropped to 40 at the end of October from 44 in September. The percentage of AR aged over 120 days increased slightly to 25.3% compared to September which was at 24.8%. Although the percentage of AR greater than 120 increase the actual account dollars in this category decreased by $415 thousand. Collections from international travelers are slowly getting recovered by our international collection agency. Payments for international travelers were almost double in the first 4 months of this year ($560 thousand) compared to last year ($307 thousand). This also drives up the “Services” expenses due to the collection agency fees.

New Business Aperek Financial System Implementation (Accounting, Accounts Payable, and Fixed Asset system) – Significant activity has taken place in regards to the building and implementation of the financial system. Slavka has done an excellent job at leading this project. The organization and chart of accounts have been built and 5 years’ worth of data is being uploaded into the new system. Aperek system resources were on campus the week of October 17th for the build and configuration of the system. They also started meeting with the Accounting staff to teach them various aspects of using the system. They will return the week of November 28th. Target go-live is January 4, 2017.

Southern Mono Healthcare District Report to the Board of Directors CFO Report November 17, 2016

Population Health Activities – High Sierras – Northern Plains ACO On November 10, 2016 the Accountable Care Organization (ACO) had its quarterly Board meeting. Highlights are:  Approved adding another community to our ACO in January  Approved termination of Southern Inyo District Hospital due to lack of participation and response  Our community Steering Committee meeting is scheduled in December  2016 Quality reporting to CMS starts in January 2017  Patients with End Stage Renal Disease (ESRD) need to have a form completed and sent to CMS to allow a cost adjustment for these individuals in our population. We have reached out to those patients in our community.  January is the Accountable Care Symposium for all the Caravan Health clients across the nation. Meeting will be in Phoenix, Arizona – I will be attending  Our ACO communities and Mammoth Hospital are meeting all the required activities for the ACO (except SIHD).  Our ACO has 8,338 Medicare members assigned form CMS – Mammoth has about 938 of those members  Mammoth has 9.2% of our Medicare assigned members participating in our Care Coordination program with Monica Delson. This is a great percentage!  All communities need to review their coding practices to improve the Hierarchical Conditional Coding. Basically need to address and code each chronic disease/condition at least once a year. This creates a risk scoring for each patient and CMS adjust our cost to “normalize” the well from the very ill patients. This is critical to reflect high quality and obtain shared savings.  Our ACO is currently tracking to an $800 per member annual cost reduction (based on the 1st two quarters of claims). This amounts to annual savings of approximately $7 million! o Patients assigned to Mammoth Hospital are also reflecting savings of about $700 - $800 per year  The remainder of the meeting was spent discussing the compliance activities that are required at each facility. Michael Rudolf, Director of Quality has joined the Caravan Health compliance committee and is developing staff/provider education and policies as required for each community in the ACO.

Shared Savings – Royalties – Since Mammoth Hospital was one of the original founding members of the National Rural ACO, we receive a small percentage of shared savings distributed from any of the ACO’s that received services from Caravan Health. One ACO in Oregon realized shared savings for 2015 of $7 million. We received notice that Mammoth Hospital will receive $6 thousand in royalties from the CMS saving disbursement. It is not much, but we are hopeful these improved quality and reduced cost efforts will continue to spread to other communities. PRIME Projects – Lenna Monte, Project manager submitted the required reporting for the activity completed in FY2016. The reporting was accepted and we are awaiting a payment for $870 thousand. Page 2 of 3

Southern Mono Healthcare District Report to the Board of Directors CFO Report November 17, 2016

Dr. Craig Burrows has provided education to many providers in the clinics on various aspects of two projects. He has a plan to continue to roll out different aspects of the projects over the next few months. In October, Lenna and I attended a DHCS required PRIME meeting in San Francisco. The meeting was attended by approximately 200 people representing most all of the university, community and district hospitals participating in PRIME. The day was filled with experiences from other hospitals, challenges and suggestions on how to be successful in PRIME. The primary challenge that was universally identified is the ability to get the data needed to accurately report on the metrics. Upon returning from this meeting, I formed a PRIME data governance committee and we have met 3 times to go over the detailed requirements for the PRIME metric reporting. This has proven to be a major project as there are many intricate pieces to the required reporting. We have identified over 30 reports that need to be pulled out of our multiple systems and will further require consolidation and manipulation to get to the required metric reporting needs. We hope to finalize the report requirements this month and start testing the reports. The goal is to produce the reports monthly and report out on a dashboard our results compared to the required metric goals.

Page 3 of 3

Southern Mono Healthcare District Report to the Board of Directors Information Technology November 17, 2016 2015 Press Ganey Pinnacle of Excellence Award Winner

DATE:

November 17, 2016

TO:

Board of Directors Southern Mono Healthcare District

FROM:

Mark Lind, IT Director

RE:

Information Technology Report, Regular Meeting of the Board of Directors

Executive Summary •

Old Business o None

•

New Business o None

Strategic Goals o Cerner EMR Project Status  Current Status: Alignment of the organization to the project has been going well. To date, we have selected and oriented our department level build teams. We have put together the governance and project teams needed to lead and guide the project and most importantly we have provided Cerner with most of the prebuild data files. The EMR project team is currently working to plan for our clinical work flow designs, interface builds, system configuration, data conversion and super user training efforts next quarter. 

Next Steps: The Cerner project manager, clinical architect and many of the individual software module build resources will be either on site or are arranging web-sessions for all departments in early December. Each department from then on will be participating in bi-monthly calls with their Cerner counterpart. Work for most areas will be ongoing through the completion of the project in October of 2017.

o Premier Aperek Project Planning and Kick Off  Current Status: Work has continued briskly with the Premier general financial build. Data conversion is largely complete, the initial week of training was completed in October, and the numerous interface builds with our other systems and bank are going well. The Premier team is comfortable with the progress of ________________________________________________________________________________________________________ P.O. Box 660 | 85 Sierra Park Road | Mammoth Lakes, CA 93546 | 760.924.4114 | Fax 760.924.4104 | www.mammothhospital.com

Southern Mono Healthcare District Report to the Board of Directors Information Technology November 17, 2016 the build and training efforts and we are on track for the first week of January 2017 live date. 

Next Steps: Complete the data conversion and interface builds by mid-month. The work with the bank is just starting for the direct deposit interface. Training of the department managers on the new electronic invoicing process to occur in early December.

Report Detail Biomedical Engineering Summary:

Biomedical Engineering had 201 new work orders in October, with 193 work orders closed. 143 work orders were scheduled, which means that they are created to enable preventative maintenance tasks. We retired 7 pieces of equipment from our inventory. 16 work orders were created as repair work orders (categorized as “Routine”). 8 incoming inspection work orders were created for new equipment. Note, we are now tracking work orders for “User Error” work orders where the requesting employee either directly caused the failure our through negligence broke the device. These instances are going back to the department managers for remediation.

Page 2 of 4

Southern Mono Healthcare District Report to the Board of Directors Information Technology November 17, 2016

Work Order surveys for Biomedical Engineering in October were 100% positive. The department with the highest survey response rate was the OR with 7 responses. IT/Help Desk Report:

The Help Desk processed a total of 345 new work orders for Information Technology and Telecom in October. Work orders remain at a high volume likely due to high patient volumes in the clinics and hospital. 316 work orders were closed in the month, representing a slight increase in the backlog.

Page 3 of 4

Southern Mono Healthcare District Report to the Board of Directors Information Technology November 17, 2016

Work order survey responses were 99% positive for the 303 survey results received in October. We have 3 “Unsatisfied” responses for the month. Each negative response survey will be investigated to determine where we can do better. The department with the highest survey response rate was the Family Medicine Clinic again with 51 responses; the HIMS department had the second highest response rate at 25 responses.

Page 4 of 4

Southern Mono Healthcare District Report to the Board of Directors Human Resources November 17, 2016 2015 Press Ganey Pinnacle of Excellence Award Winner

DATE:

November 17, 2016

TO:

Board of Directors - Southern Mono Healthcare District

FROM:

Sarah Vigilante, Human Resources Manager

RE:

Human Resources Report, Regular Meeting of the Board of Directors

Executive Summary New Business: Physician Satisfaction Survey results in 91st percentile overall satisfaction. This is up from 78th percentile in 2014, the last year the survey was conducted. As of November 11, 2016 – 90.7% of benefited employees and spouses have made their Mammoth Hospital Preventative Screening appointments to get the Health Insurance Wellness Discount. This is a new program and the appointments must be completed by November 30th to get the discount next year.

Report Detail People Open Posted Positions as of November 4, 2016: • 5 full-time positions • 0 part-time positions • 3 per diem positions • 2 physician positions

________________________________________________________________________________________________________ P.O. Box 660 | 85 Sierra Park Road | Mammoth Lakes, CA 93546 | 760.924.4114 | Fax 760.924.4104 www.mammothhospital.com

METICULOUS CARE

*

MEMORABLE PEOPLE

*

MAJESTIC LOCATION

Southern Mono Healthcare District Report to the Board of Directors Human Resources November 17, 2016 Three-month trend report: August 2016

Sept 2016

Oct 2016

Aug 2015

372 4 301 15 303.1 2 12 74 6 5 1

368 2 300 14 311.1 1 12 83 5 1 6

370 2 302 15 1 10 119 6 4 3

3-Month Total 276 17 10 10

Average*

345 9 281 12 276.5 3 9 27 5 2 4

Turnover Rate %

.3%

2%

1%

3.3%

2.9%

Hire Rate %

1.7%

.3%

1.3%

3.3%

2.9%

Vacancy Rate %

3.2%

3.3%

2.7%

3.1%***

5.1%

Category Active Employees (FT, PT, Per Diem & Seasonal)

Inactive Employees # of Active, FT & PT Employees only** # of Active Part Time Employees Paid FTE’s Clinical Travelers Posted Positions Applications Received Job Offers Employees Hired (FT & PT) Separations (FT & PT)

CHA

*CHA Average for Southern California from “Allied for Health Quarterly Turnover and Vacancy Report, 2Q2016” ** Excludes all per diem staff and seasonal staff ***This number represents an average.

Page 2 of 9

Southern Mono Healthcare District Report to the Board of Directors Human Resources November 17, 2016

Employee Health Wellness Challenge: September’s Wellness Challenge was for employees to submit a picture of them on a hike. There were 23 participants. The winner was Jesse Heidmann who will get a $50 gift card to restaurant of his choice. Work Injuries There were four work injuries in September. There have been 5 injuries filed with Alpha Fund in 2016, and one in this fiscal year. Date

Injury/Illness

Action

9/19/2016

Stuck thumb while retracting a butterfly needle

Employee has not made contact.

9/26/2016

Back pain from preparing conference room for meeting

Employee will ask for help if she feels she needs it.

9/27/2016

Hit to chest and scratch to hand by combative patient

9/28/2016

Flu like symptoms employee attributed to the flu vaccine or exposure to patient with viral meningitis

This was discussed in the Safety Committee meeting on October 6. The committee recommended a de-escalation class and implementing training on how to deal with violent patients. I spoke with the employee who was feeling better at the time of the phone call. She did not feel a need for follow-up in FMC.

2016 Employee Injuries

Blood/Body Fluid Exposure Trips, Slips & Falls Repetitive Motion Pushing, Pulling Manual/Patient Handling All Other

Page 3 of 9

Southern Mono Healthcare District Report to the Board of Directors Human Resources November 17, 2016 Modified Work Duty There are two employees on modified work duty; one of those is due to a work injury.

Financial Budget: Through July 2016, the Human Resources department is favorable to budget by $20,039. Employee Health is favorable by $3,115.

Health Plan September 2016: Total paid claims of $204,196. Non domestic claims are 30.2% of total claims or $61,604 and result in a 35.8% loss ratio compared to AIG contracted rates. This is the ninth month of the plan year, and no claimants have exceeded the ISL deductible of $150,000. However, the plan was reimbursed $18,199 in February for a claim in the 2015 plan year. Only 3 claimants have exceeded $75,000 at $106k, $78k and $74k respectively. September Mammoth paid claims account for 47.9% of claims, lower than the average Mammoth Hospital utilization compared to the 2015 plan year when MH claims attributed 55% of total claims Average claim costs are $840 per employee per month excluding large claims, higher than 2015. Plan year through September 2016: Total non-domestic paid claims of $439,572 vs. expected contract claims of $1,567,336 and results in a loss ratio of 28.0%, higher than August’s loss ratio of 27.1%, excluding large claims. Average claim costs are $768.83 per employee per month excluding large claims. 96.6% of all claims are between $0 and $1,000 and represent 27.9% of total paid claims. Mammoth Hospital paid claims account for 52.3% of claims year to date. This is lower than August’s share of 52.8%. Anthem’s network discounts year to date are 46.8% of all eligible costs, lower than 2015 plan year’s discounts of 50%. Monthly Census: October Enrollment: 245 benefited employees (11 more participants than prior year, and 2 less than last month). With 310 dependents, the total census for the health plan is 555.

Page 4 of 9

Southern Mono Healthcare District Report to the Board of Directors Human Resources November 17, 2016

Page 5 of 9

Southern Mono Healthcare District Report to the Board of Directors Human Resources November 17, 2016

Page 6 of 9

Southern Mono Healthcare District Report to the Board of Directors Human Resources November 17, 2016

Page 7 of 9

Southern Mono Healthcare District Report to the Board of Directors Human Resources November 17, 2016

Page 8 of 9

Southern Mono Healthcare District Report to the Board of Directors Human Resources November 17, 2016

Recruitment

Recruitment Sources October 2016 35 30 25 20 15 10 5 0

*Other represents job specific websites as well as other sources

Hire Source Oct 2016 2.5 2 1.5 1 0.5 0 Other

Employee Referral

Family/Friend

Page 9 of 9

Southern Mono Healthcare District Board of Directors Report Facilities Department November 17, 2016 2015 Press Ganey Pinnacle of Excellence Award Winner

DATE:

November 17, 2016

TO:

Board of Directors Southern Mono Healthcare District

FROM:

Dan Conners, Facilities Manager

RE:

Facilities Report, Regular Meeting of the Board of Directors

Report Detail Environmental Services ‘Virex Plus’ is a new quaternary floor cleaner and deodorizer that we have adopted to replace our old product (Quat). The new product requires only a 3-minute dwell time. (Quat required a 10minute dwell time). EVS has also received approval to begin using ‘Virasept’ in specific situations. This is a non-bleach, ready to use, EPA-registered disinfectant effective against Clostridium difficile endospores, (C-diff). Maintenance The month of October has been very busy with key preventive maintenance projects such as boilers and ice machines. The construction of our new employee parking lot has stimulated a number of new additions and upgrades to our building controls such as lighting. October also triggers our winter preparations including water and weather proofing repairs. The early heavy rain periods confirm the success of our on-going roof maintenance efforts. Maintenance Outlook This new topic is intended as an alert to foreshadow projects we see in our not too distant future. Our primary sterilizer and sanitizing equipment is called the ‘Sanipak’. This is a large unit utilizing steam and pressure to render waste products to a harmless status. It is in its 21st year of use and we are managing the aging machine with TLC and weekly checks for efficacy. A replacement unit will likely cost about $300,000. We are hoping for several more years before replacement is required. Key Performance Indicators for October 2016 95%

84%

70%

Preventive Maintenance

Maintenance Work Orders

Environmental Services Work Orders Page 1 of 1

______________________________________________________________________________________________________________ P.O. Box 660 | 85 Sierra Park Road | Mammoth Lakes, CA 93546 | 760.924.4114 | Fax 760.924.4104 www.mammothhospital.com

METICULOUS CARE

*

MEMORABLE PEOPLE

*

MAJESTIC LOCATION

Southern Mono Healthcare District Report to the Board of Directors November 17, 2016

2015 Press Ganey Pinnacle of Excellence Award Winner

DATE:

November 17, 2016

TO:

Board of Directors Southern Mono Healthcare District

FROM:

Gary Myers, CEO

RE:

CEO Report, Regular Meeting of the Board of Directors

Executive Summary • • • •

People Facilities Technology Programs

Report Detail Medical Staff During the past 2 months, we have had significant activity related to medical staff services, recruitment and retention. Dr. Adrian Jaffer, Rheumatologist, began seeing patients in a monthly clinic out of the orthopedic facility. Dr. Jaffer is a colleague of the physicians with the Torrey Pines Orthopedic Group from San Diego. We welcome his expertise to our hospital and our community. Dr. Chad Davis also joined us in the Anesthesia Service replacing Dr. Jennifer Harkins who moved to Florida. He is an experienced physician well known to Dr. Bahiraei who comes to us from West Virginia. We have also retained the temporary services of Dr. Cecilia Rhodus, Pediatrician, who will be providing locum tenens coverage for Dr. Kris Wilson in the late stages of her pregnancy and following the birth of her child due in January. Dr. Rhodus is well known to one of our other pediatricians, Dr. Kris Collins. We are also actively recruiting a female Family Medicine Nurse Practitioner and interviewing candidates for our upcoming opening in Pathology when Dr. Edrick Willes retires in April 2017. Late in November we have a site visit coming up with a General Surgeon candidate who trained under Dr. Koehler in Washington and who is interested in becoming our third General Surgeon. Strategic Planning The Annual Strategic Planning Conference was well attended and hopefully thought provoking and informative to everyone. We have a lot going on in our world right now and there continues to be a lot of uncertainty regarding the role Critical Access Hospitals will ultimately play in the Pay-for-Value system. One thing is certain, there is a collective and deep commitment among our staff to thrive and improve the quality and scope of our services to our community. I hope to have a draft of the plan completed for review and comment in the next couple of weeks. In the meantime, we continue to work ________________________________________________________________________________________________________ P.O. Box 660 | 85 Sierra Park Road | Mammoth Lakes, CA 93546 | 760.924.4114 | Fax 760.924.4104 www.mammothhospital.com

METICULOUS CARE

*

MEMORABLE PEOPLE

*

MAJESTIC LOCATION

Southern Mono Healthcare District Report to the Board of Directors CEO Report November 17, 2016 on four major initiatives held over from last year: the Cerner implementation, improving access to care, pushing ahead on our Facility Master Plan, and improving efficiency in surgical services. Foundation We recently hosted Keller/McIntyre (KM) for a one-day assessment of our major capital needs in the District. KM is a Washington D.C. based consulting firm specializing in helping non-profits target federal grant opportunities to help their institutions win support for major projects to improve facilities, technology, and programs for the communities they serve. We will be working with them for the next couple of months on an initial proposal related to telemedicine planning. I will travel to Washington, D.C. in mid-December to lobby for support of this proposal along with staff from KM. Susan Corning, Mammoth Hospital Foundation Executive Director, has already begun to construct a proposal to the Health Resources Services Administration (HRSA) for a planning grant worth 100K due January 3rd. We are working potentially in partnership with Mono County Behavioral Health, UC San Diego, and USC to develop a telehealth network. Accreditation and Compliance We are undergoing our annual DNV survey during this writing. The team of 3 surveyors will be evaluating our compliance with ISO 9001 standards along with Title 22 and Medicare Conditions of Participation during the 2-day survey. We will receive a written report of any deficiencies and will supply a plan of correction back within the next few weeks. Finance We received the balance of our first year PRIME award this week worth over $800K. Big congrats to Melanie Van Winkle, CFO, for leading these initiatives to address chronic non-malignant pain management as well as improving access to behavioral health services for the community. Melanie and her team are responsible for garnering $1.2M in new revenue annually for the next 5 years to fund projects we were intending to pursue anyway. The month of October was more dismal than usual in terms of business volume. Low volume coupled with large contractual adjustments conspired to make it a large net negative month. See the monthly financials for details. Bridgeport Clinic We have advised Mono County CAO, Leslie Chapman that our last day of operations at the Bridgeport Clinic will be January 31st. We will provide notification to the state that the Bridgeport RHC should be deleted from our hospital license. The County is seeking another operator for the clinic and we are cooperating fully with all requests for information they have made to assist them in their search. Clinic volume has continued to decline since our cutback on days and it is no longer financially sustainable for us there. Election Results The election results present some significant uncertainties for the healthcare sector in light of President-elect Trump’s campaign promises to repeal Obamacare and replace it with a new plan of coverage. Whatever your politics, Obamacare has had the effect of increasing the insured population of Mono County and improved access to care. This has been a plus to our District with our Rural Health Clinic. We maintain cautious optimism that whatever changes come down from Washington will continue to preserve the progress that has been made to increase coverage for the low income sector of our society. We will keep a close eye as these changes develop and do what we can to position the District to maintain access for all residents and guests. Page 2 of 3

Southern Mono Healthcare District Report to the Board of Directors CEO Report November 17, 2016

I want to acknowledge the enormous contributions that Helen Shepherd has made to the Healthcare District and the community over her 14 years as a volunteer servant on our board. Her generous nature, good humor, strong financial knowledge, and wisdom will be missed here by all. Congratulations on a great run Helen, and know that you have the gratitude and admiration of the entire staff at Mammoth Hospital. We wish you only the best! Respectfully submitted, Gary Myers, CEO

Page 3 of 3

2015 Press Ganey Pinnacle of Excellence Award Winner

MEMORANDUM ============================================================================== DATE: November 17th, 2016 TO: The Board of Directors FROM: Melanie Van Winkle, CFO SUBJECT: Financial Statements for the four months ended October 2016 ============================================================================== This memorandum presents an overview of Mammoth Hospital operations. BALANCE SHEET Cash (including investments) totaled $47.2 million at the end of October, which is $448 thousand lower than September (see Cash Flow for further discussion). Net patient receivables totaled $7.3 million at the end of October, which is $876 thousand lower than September, mainly due to lower volumes. Net days in AR in October were 40.0 which were 4.2 days lower than September. AR aged over 120 days increased slightly in October to 25.3% from 24.8 % in September. Bond funds held by Mono County increased by $272 thousand as adjustments were made to statement received. Major moveable equipment increased by $102- thousand due to capitalization of a computer server and Construction in progress increased by $134 thousand due to several projects starting – new parking lot construction, implementation costs for the hospital information systems projects and cardiac monitors. Due to/from third party payers decreased by $350 thousand mainly due to the PRIME IGT funding (expect double back in November) offset by the receipt of a Medi-Cal inpatient cost true up for a prior year. CASH FLOW October resulted in a $448 thousand decrease in cash to $47.2 million. The reduction in cash is mainly attributed to funding the PRIME Intragovernmental Transfer (IGT) - $870 thousand (match expected in November 2016). Patient cash collections were $5.2 million and were 14% above target of $4.6 million. YTD collections are $23.4 million compared to goal of $21.6 million and prior year collections of $21.0 million (thus collections are already $2.6 million higher than last year). Days of cash on hand are 288.2 which are 3.3 days less than September. The June 30, 2017 days cash on hand goal is 299. VOLUMES Total acute inpatient days were 76 in October, which is at budget but lower than September’s total of 112. Average length of stay increased to 2.5 days in October compared to 1.9 in September. The average daily inpatient census was 2.5 –lower than last month at 3.7 and lower than prior year at 2.6. In October 2016, Mammoth Hospital treated 31 inpatients compared prior year of 38 and budget of 35. Case mix index increased in October increased to 1.471 due to more acutely ill patients and fewer L&D deliveries this month. Inpatient surgical cases were 18 (22 budget) and outpatient surgeries were 68 (85

Southern Mono Healthcare District Report to the Board of Directors CFO Report November 17, 2016 budget), 21 combined surgeries under budget. Year to date surgeries are 23 surgical cases under budget at 414 and 15 under last year’s total at 15. ED visits were 428, which were 19 visits more than budget of 409 visits and 11 visits higher than last year. Imaging procedures continued to be higher than budget at 1,001 which correlate to higher ED visits. Imaging & ER year to date visits are 20% and 12.5% over budget respectively at 5,214 and 3,393. Clinic visits in October were 3,612 compared to budget of 4,139, thus 527 less than budget, however only 102 less than prior year. Year to date clinic volumes are 1,790 lower than budget (11%) and 501 lower than last year’s total (3%). The clinics that contributed to the majority of the YTD variance from prior year are Bridgeport, Urology, Dental, and General Surgery INCOME STATEMENT Revenue: In October, gross patient revenue was $6.7 million which is $570 thousand lower than budget (all in Outpatient Services and Professional Fees). Proportionately, the deductions from revenue were higher in October compared to budget. Outpatient services revenue don’t generate as much payments as the inpatient revenue, thus contractuals were higher. In addition there were a few large dollar accounts inpatient accounts for a Medi-Cal managed care plan, thus the contractuals are higher for those cases. Total operating revenue was $3.6 million, which was $946 thousand lower than. Year-to-date total operating revenue was $19.9 million which was $1.2 million lower than budget however, $31 thousand higher than prior year. Expenses: Salaries expense was $1.7 million in October. The Paid Full Time Equivalent’s dropped in October with the slower volume, however there are additional staff working on the information system implementation in October. Benefits were $25 thousand higher than budget mainly due to an adjustment for FY16 workers’ compensation expenses. Professional services were $96 thousand lower than budget due to lower volumes in October. Supplies expense continues to run higher than budget resulting in a year-to-date unfavorable variance of $322 thousand. This is mainly due to additional pharmaceuticals and prosthetic implants being used, however there is offsetting gross revenue being charged for these supplies. Services expenses are running lower than budget, however higher than prior year due to system implementation costs. Total operating expenses were $4.5 million which $144 thousand less than budget. Year-to-Date total operating expenses were $19.4 million - $440 thousand lower than budget – with the biggest difference in salaries due to several unfilled positions. Net Gain (Loss): October’s loss was $782 thousand which was $673 thousand below budget; and $934 thousand lower than prior year. Year-to-Date gain is $364 thousand compared to $1.1 million budget and $1.5 million last year’s total. Total Year-to-Date margin is 1.8% compared to 5.1% budget.

11/10/2016

SOUTHERN MONO HEALTH CARE DISTRICT Comparative Balance Sheet - October 31, 2016

ASSETS CURRENT ASSETS: Cash (135 days operating expenses) Cash (reserved for building projects) Investments Total Cash

Unaudited October 31, 2016

$22,082,750 17,282,330 7,863,801 47,228,881

Unaudited September 30, 2016

$22,000,921 17,791,208 7,884,376 47,676,505

Prior Month Change

$81,829 (508,877) (20,575) (447,624)

Unaudited June 30, 2016

$21,591,360 16,260,715 7,909,206 45,761,281

Patient accounts receivable Less: Allow. for bad debts and contractuals Net patient accounts receivable

14,557,845 (7,233,106) 7,324,739

16,583,517 (8,382,737) 8,200,780

(2,025,672) 1,149,631 (876,041)

17,908,930 (8,294,284) 9,614,646

Inventory Prepaid expenses & deposits Other current assets Total Current assets

1,764,015 659,466 1,009,225 57,986,326

1,760,338 700,659 974,538 59,312,820

3,677 (41,193) 34,687 (1,326,494)

1,750,633 490,254 36,089 57,652,903

6,806,643 (13,815) 230,732 7,023,560

142,481 129,770 (12,719) 259,532

6,806,643 1,096,774 190,330 8,093,747

5,453,480 51,968,682 20,523,616 2,634,091 764,292 361,358 81,705,519 (42,433,463) (1,977,169) 37,294,887

22,988 102,389 57,600 134,177 317,154 (288,926) (3,553) 24,675

5,453,480 51,942,182 20,469,299 2,634,091 588,656 48,818 81,136,527 (41,564,544) (1,966,510) 37,605,473

ASSETS LIMITED AS TO USE: Bond funds held in trust by Mono County: Mono Co Bond Capital Appreciation Fund Debt service fund Restricted by contributors Total Assets Limited As To Use PROPERTY, PLANT & EQUIPMENT: Land and improvements Buildings and improvements Major Moveable Equipment Siemens Implementation EHR Implementation - Cerner Construction-in-progress Total Property, Plant and Equipment Less: Accumulated depreciation Less: Accumulated amortization Net Property, Plant and Equipment Total Assets

6,949,124 115,955 218,013 7,283,092

5,476,468 51,968,682 20,626,005 2,634,091 821,892 495,535 82,022,673 (42,722,389) (1,980,722) 37,319,562 $102,588,980

Page 1

$103,631,267

($1,042,287)

$103,352,123

11/10/2016

SOUTHERN MONO HEALTH CARE DISTRICT Comparative Balance Sheet - October 31, 2016

LIABILITIES

Unaudited October 31, 2016

Unaudited September 30, 2016

Prior Month Change

Unaudited June 30, 2016

CURRENT LIABILITIES: Accounts payable and accrued expenses Accrued payroll-related liabilities Patient refunds Due to (from) third party payers Accrued interest on long term obligations Current portion of long-term debt Health plan IBNR Total Current liabilities

$2,317,513 2,269,748 65,485 1,445,772 136,608 915,000 288,193 7,438,319

$2,401,967 2,161,723 70,167 1,796,195 91,072 915,000 310,663 7,746,787

($84,454) 108,025 (4,682) (350,423) 45,536 (22,470) (308,468)

$2,075,807 2,861,378 73,778 1,546,631 237,991 825,000 286,585 7,907,170

LONG-TERM DEBT: Unamortized bond premium Capital appreciation interest payable General Obligation Bonds Long-term debt Total long term debt

1,407,443 7,050,398 15,784,555 24,242,396

1,418,111 6,982,453 15,784,555 24,185,119

(10,668) 67,945 57,277

1,450,117 6,778,620 16,699,555 24,928,292

31,680,715

31,931,906

(251,191)

32,835,462

12,162,166 218,013 7,065,079 52,245,026 (782,019) 70,908,265

12,194,768 230,732 6,792,828 51,335,090 1,145,943 71,699,361

(32,602) (12,719) 272,251 909,936 (1,927,962) (791,096)

11,852,181 190,330 7,903,417 40,156,926 10,413,807 70,516,661

$103,631,267

($1,042,287)

$103,352,123

Total Liabilities NET ASSETS: Invested in capital assets net of related liabilities Restricted - expendable for specific operating activities Restricted - expendable for capital acquisitions Restricted - expendable for debt service Unrestricted Year to date earnings NET POSITION: Total Liabilities and Net Position

$102,588,980

Page 2

SOUTHERN MONO HEALTH CARE DISTRICT

Statement of Revenues & Expenses - October 31, 2016

October-16 Prior Month

Actual

Budget

Year-to-Date

Variance to Budget

Prior Year

Variance to Prior Year

OPERATING REVENUE

Actual

Budget

Variance to Budget

Prior Year

Variance to Prior Year

(000s omitted)

$2,261 3,978 1,478 806 8,523

$1,364 3,268 1,191 879 6,702

$1,365 3,580 1,475 852 7,272

($1) (312) (284) 27 (570)

$1,525 3,570 1,538 857 7,490

($161) (302) (347) 22 (788)

Inpatient services Outpatient services Professional fees services Clinic services Total Gross Revenue

$7,999 16,672 6,291 3,094 34,056

$8,097 15,169 6,716 3,356 33,338

($98) 1,503 (425) (262) 718

$8,125 15,770 6,254 3,084 33,233

($126) 902 37 10 823

(3,058) (25) (188) (300) 4,952 41 $4,993

(2,779) (128) (161) 3,634 14 $3,648

(2,455) (128) (128) 4,561 33 $4,594

(324) (33) (927) (19) ($946)

(2,565) (50) (256) 4,619 14 $4,633

(214) (78) 95 (985) ($985)

Contractual & other discounts Charity write offs Provision for bad debts Prior Year Adjustments Net Patient Revenue Other operating revenue Total Operating Revenue

(12,690) (289) (1,020) (300) 19,757 96 $19,853

(11,255) (588) (586) 20,909 133 $21,042

(1,435) 299 (434) (300) (1,152) (37) (1,189)

(12,326) (163) (753) (300) 19,691 131 $19,822

(364) (126) (267) 66 (35) $31

1,642 789 1,133 43 594 664 4,865

1,665 695 980 54 534 589 4,517

1,651 670 1,076 69 514 681 4,661

(14) (25) 96 15 (20) 92 144

1,563 647 1,006 104 444 640 4,404

(102) (48) 26 50 (90) 51 (113)

6,610 2,947 4,542 213 2,338 2,716 19,366

7,126 2,789 4,757 289 2,016 2,829 19,806

516 (158) 215 76 (322) 113 440

6,184 2,671 4,428 285 2,054 2,469 18,091

(426) (276) (114) 72 (284) (247) (1,275)

(1,098)

487

1,236

(749)

1,731

(1,244)

Depreciation & amortization

1,138

1,181

43

1,215

Operating Gain (Loss) after Depreciation

($651)

$55

-

22 732 (448) 674 35 1,015

OPERATING EXPENSES

128

(869)

(67)

(802)

229

284

284

295

11

302

($156)

($1,153)

($362)

($791)

($73)

-

-

174 (110) 170 (9) 225

18 ($1,080)

Salaries Benefits Professional services Contract services Supplies Services Total Expenses OPERATING GAIN (LOSS)

($706)

$516

77 ($1,167)

NON-OPERATING INCOME(EXPENSE) 137 (111) 173 14 213

(3) 283 (111) 212 (10) 371

6 183 (112) 168 8 253

(9) 100 1 44 (18) 118

$57

($782)

($109)

($673)

1.1%

-21.4%

-2.4%

-19.1%

$152 3.3%

-

Gain (loss) on sale of property Donation income Bond property tax revenue Bond interest expense Property tax revenue & interest income Interest expense Total Non-Operating Income (expense)

(3) 693 (447) 775 (3) 1,015

($934)

Increase in net assets - net gain (deficit)

$364

-24.7%

Total Margin

(3) 109 (1) 42 (1) 146

Page 3

1.8%

$1,070 5.1%

(25) (39) 1 101 (38) ($706) -3.3%

4 695 (439) 660 95 1,015 $1,531 7.7%

(7) (2) (8) 115 (98) ($1,167) -5.9%

SOUTHERN MONO HEALTH CARE DISTRICT Cash flow Report as of October 31, 2016

October 2016 Budget MTD

Actual MTD $5,544,140 15,103 0 (9,795)

Variance

$5,106,616 (33,333) 0 2,977

16,773

CASH RECEIPTS

$437,524 48,436 0 (12,772) 16,773

Patient Account Payments 3rd Party Settlements Property Taxes

Year-to-Date Budget YTD

Actual YTD $23,380,400 819,377 0

Gain/Loss on Investments Other

$5,566,221

$5,076,260

$489,961

Total Cash Receipts

$2,430,294

$2,320,942

($109,352)

Salaries, Wages & Benefits

1,105,007

1,075,732

(29,275)

Physician Fees

89,402

69,006

(20,396)

Contracted Services

576,101

513,671

(62,430)

Supplies Services

(2,276)

Variance

$22,319,402 ($133,332) $0 $11,908

$1,060,998 952,709 0 (14,184)

144,742

0

144,742

$24,342,243

$22,197,978

$2,144,265

$10,278,475

$9,915,801

($362,674)

4,581,680

4,756,884

175,204

297,174

289,823

(7,351)

2,275,828

2,015,353

(260,475)

DISBURSEMENTS

630,208

294,949

(335,258)

$4,831,012

$4,274,300

($556,712)

$196,021

$86,779

($109,242)

46,411

301,200

254,789

System Implementation

870,000

0

(870,000)

Third Party Settlement

Total Profit and Loss Disbursements

3,107,097

1,180,753

(1,926,344)

$20,540,253

$18,158,613

($2,381,640)

$603,825

$679,167

187,770

670,800

1,317,486

0

BALANCE SHEET ITEMS

83,119

30,000

(53,119)

$1,195,551

$417,979

($777,572)

$6,026,563

$4,692,280

($1,334,284)

$383,981

($844,323)

($460,342)

Capital Purchases

Patient Refunds

Total Balance Sheet TOTAL DISBURSEMENTS Net Operating Cash

$75,342 483,030 (1,317,486)

197,626

108,000

(89,626)

$2,306,707

$1,457,967

($848,740)

$22,846,960

$19,616,580

($3,230,380)

$1,495,283

$2,581,398

($1,086,115)

$1,467,600

$2,581,398

($1,113,798)

$45,761,281

$45,951,611

($190,330)

47,228,881

48,533,009

(1,304,128)

RESTRICTED FUNDS BY CONTRIBUTORS ($12,719) ($447,623)

Restricted by contributors $383,981

($831,604)

$47,676,505

$48,149,028

($472,523)

47,228,882

48,533,009

(1,304,127)

Net Cash After Restricted Fund Activity Beginning Cash Ending Cash

Page 4

$27,683

SOUTHERN MONO HEALTH CARE DISTRICT Key Statistical Data - October 2016

October 2016 Prior Month 30

Actual 31

Budget

Year-to-Date

Variance Variance to Prior to Budget Prior Year Year

31

31

Hospital Statistics Days in month Acute Patient Days: ICU Days Med/Surg & Telemetry Days Labor & Delivery Days Total Acute Patient Days Average Daily Census (ADC) % of IP Revenue to Ttl Revenue

Prior Year

Variance to Prior Year

Average Length of Stay (ALOS) Discharges Case Mix Index

14 374 41 429 3.5 29.2% 2.0 210 1.430

17 340 64 421 3.4 30.4% 2.1 200 NA

(3) 34 (23) 8 0.1 -1.2% (0.1) 10 NA

14 365 63 442 3.6 30.4% 1.9 238 1.406

9 (22) (13) (0.1) -1.2% 0.2 (28) 0.024

Other Key Hospital Statistics: ED Visits Observation Hours Deliveries

3,393 1,917 28

3,014 2,515 39

379 (598) (11)

3,202 2,563 40

191 (646) (12)

126 288 414

148 289 437

(22) (1) (23)

144 285 429

(18) 3 (15)

298 549 357 437 3,573 5,214

233 491 318 361 2,939 4,342

65 58 39 76 634 872

265 516 333 365 3,277 4,756

25,390 105,197 398,400

23,277 72,571 342,852

2,113 32,626 55,549

25,449 81,175 375,120

(59) 24,022 23,280

5,291 299 450 1,501 1,990 1,936 831 357 253 1,639 14,547

5,882 768 368 1,568 1,899 2,133 920 760 260 1,779 16,337

(591) (469) 82 (67) 91 (197) (89) (403) (7) (140) (1,790)

5,072 763 186 1,568 1,750 2,132 847 428 247 323 1,732 15,048

219 (464) 264 (67) 240 (196) (16) (71) (247) (70) (93) (501)

5 57 14 76 2.5 25.4% 2.2 35 NA

1 10 (11) 0.5% 0.3 (4) NA

5 61 14 80 2.6 27.8% 2.1 38 1.386

1 6 (11) (4) (0.1) -1.9% 0.3 (7) 0.085

681 569 11

428 238 3

409 525 8

19 (287) (5)

417 498 9

11 (260) (6)

37 63 100

18 68 86

22 85 107

(4) (17) (21)

22 82 104

(4) (14) (18)

IP Surgeries OP Surgeries Total Surgeries

90 148 72 117 855 1,282

55 83 149 91 623 1,001

59 96 126 72 559 912

(4) (13) 23 19 64 89

65 98 129 69 608 969

(10) (15) 20 22 15 32

MRI Procedures CT Scans Mammography Procedures Ultrasound Radiology Total Imaging

6,173 24,602 100,125

5,676 21,027 95,010

5,343 15,425 86,442

1,475 81 113 363 559 490 190 87 55 384 3,797

1,302 72 126 380 529 452 203 89 52 407 3,612

1,533 164 92 401 469 575 230 190 65 421 4,139

78 5,217 975

Variance to Budget

123

6 67 3 76 2.5 25.9% 2.5 31 1.471

5,598 15,810 94,035

Budget

123

2 93 17 112 3.7 32.3% 1.9 59 1.395

333 5,602 8,569

Actual

Lab Tests Pharmacy Units PT/OT/HP Minutes

`

123

`

-

33 33 24 72 296 458

Clinic Visits (231) (92) 34 (21) 61 (123) (27) (101) (13) (14) (527)

1,261 158 60 401 431 574 210 53 50 95 421 3,714

41 (86) 66 (21) 98 (122) (7) 36 (50) (43) (14) (102)

Family Medicine clinic Bridgeport clinic Behavioral Health clinic Women's clinic Pediatric clinic Ortho Mammoth clinic Ortho Bishop clinic Urol Mammoth clinic Urol Bishop clinic Surgical clinic Dental clinic Total Clinic visits

Page 5

Mammoth Hospital All Statistical Analysis

Dept # Dept Name

6010 6170 6170 7400

Unit of Service Desc

Jul 2016

Aug 2016

Sep 2016

Oct 2016

Budget Oct 2016

Actual Oct 2015

YTD Total

YTD Budget

% of change to Budget

Level of concern

ICU Patient Days Med/Surg Patient Days Telemetry Patient Days L&D Patient Days Total Acute Patient Days

4 81 47 9 141

2 57 29 12 100

2 62 31 17 112

6 44 23 3 76

5 39 18 14 76

5 41 19 14 79

14 244 130 41 429

17 254 86 64 421

-18% -4% 51% -36% 2%

6380 6380 6530 7400 7400

Observation Observation Nursery L&D L&D

Patient Days Hours Patient Days Pre-delivery hours Deliveries

29 703 9 39 7

17 407 12 38 7

24 569 19 40 11

10 238 3 49 3

22 525 14 64 8

22 517 15 94 9

80 1,917 43 166 28

105 2,515 77 312 39

-24% -24% -44% -47% -28%

76%

7080 7170 7840 7050 7090 7160 7140 7180 7130 7180 7060

Family Medicine Clinic Bridgeport Clinic Behavioral Health Clinic Women's Clinic Pediatric Clinic Ortho Mammoth Clinic Ortho Bishop Clinic Urol Mammoth Clinic Urol Bishop Clinic Surgical Clinic Dental Clinic Total Clinics

Patient Visits Patient Visits Patient Visits Patient Visits Patient Visits Patient Visits Patient Visits Patient Visits Patient Visits Patient Visits Patient Visits

1,163 60 88 352 381 484 203 86 0 67 417 3,301

1,351 86 123 406 521 510 235 95 0 79 431 3,837

1,475 81 113 363 559 490 190 87 0 55 384 3,797

1,302 72 126 380 529 452 203 89 0 52 407 3,612

1,533 164 92 401 469 575 230 190 0 65 421 4,139

1,260 135 60 401 431 575 210 53 50 95 421 3,691

5,291 299 450 1,501 1,990 1,936 831 357 0 253 1,639 14,547

5,882 768 368 1,568 1,899 2,133 920 760 0 260 1,779 16,337

-10% -61% 22% -4% 5% -9% -10% -53%

90%

-3% -8% -11%

97%

7010 7040 7420 7420 7420

ED Ambulance Surgery IP surgeries OP surgeries

Patient Visits Work days Minutes Procedures Procedures

1,272 21 14,250 36 88

1,012 23 11,625 35 69

681 22 12,255 37 63

428 21 9,540 18 68

409 21 10,517 22 85

417 22 12,060 22 85

3,393 87 47,670 126 288

3,014 88 42,503 148 289

13% -1% 12% -15% 0%

113%

7427 7500 7520 7591 7591 7641 7710 7720

PACU Lab Pathology only EKG's EKG's Chemotherapy Pharmacy Respiratory

Minutes Tests/Units Tests/Units IP Procedures OP Procedures Patient Visits Tests/Units Unique Patients

42,300 6,879 134 12 152 23 33,321 431

25,755 6,662 125 8 130 30 26,247 344

23,520 6,173 125 16 105 25 24,602 308

21,840 5,676 124 0 91 32 21,027 238

23,203 5,343 159 7 86 30 15,425 286

25,350 5,690 167 3 85 23 15,823 263

113,415 25,390 508 36 478 110 105,197 1,321

94,766 23,277 658 64 482 102 72,571 1,537

20% 9% -23% -44% -1% 8% 45% -14%

120%

7630 7635 7660 7670 7680

Radiology Procedures Mammography Procedures MRI Procedures Ultrasound Procedures CT Scan Procedures Total Imaging Procedures

1,109 72 75 116 167 1,539

986 64 78 113 151 1,392

855 72 90 117 148 1,282

623 149 55 91 83 1,001

559 126 59 72 96 912

606 129 65 69 98 967

3,573 357 298 437 549 5,214

2,939 318 233 361 491 4,342

22% 12% 28% 21% 12% 20%

122%

7770 7772 7780 7773 7790

Mammoth PT Minutes Bishop PT Minutes Speech Therapy Minutes Bishop OT Minutes Mammoth OT Minutes Total Minutes PT/ST/OT

50,385 40,845 90 2,820 5,655 99,795

53,085 40,680 0 4,110 5,595 103,470

52,380 40,995 0 1,935 4,815 100,125

47,970 39,675 90 2,055 5,220 95,010

47,576 35,496 870

49,260 34,080 870 0 6,735 90,945

203,820 162,195 180 10,920 21,285 398,400

186,096 143,051 3,705 0 10,000 342,852

10% 13% -95%

110%

113% 16%

213%

2,500 86,442

82% 96% 151% 64% 102%

76% 56% 53% 72%

39% 122% 96% 105% 91% 90% 47%

92% 89%

99% 112% 85% 100%

109% 77% 56% 99% 108% 145% 86%

112% 128% 121% 112% 120%

113% 5%

116%

Mammoth Hospital Dashboard Analysis For the Month Ending - October 31, 2016

Indicator

Net Income/(Loss) (in thousands)

Operating Income/(Loss) (in thousands)

Definition

October 2015

May 2016

June 2016

July 2016

August 2016

September 2016

October 2016

Year-to-Date

Year-to-Date Budget

Year-to-Date Prior Year

Total revenue less total expense

$152

$290

$1,704

$784

$305

$57

($782)

$364

$1,076

$1,530

Total operating revenue less total operating expense (except depreciation)

$229

$216

$1,471

$865

$364

$127

($869)

$487

$1,235

$1,731

2.5

2.5

5.0

4.5

3.2

3.7

2.5

3.5

3.5

3.6

Volume Average Daily Census (excl. Nursery)

Midnight Census

Clinic Visits

Number of patient visits

3,714

3,422

3,586

3,301

3,837

3,797

3,612

14,546

16,337

15,084

ER Visits

Number of patient visits

417

527

824

1,272

1,012

681

428

3,393

3,231

3,202

Medicare

Based on gross charges

22.3%

19.9%

22.4%

20.1%

19.9%

24.0%

23.7%

21.7%

20.0%

22.1%

Medi-Cal

Based on gross charges

32.1%

29.4%

24.4%

20.8%

26.3%

23.5%

23.9%

23.5%

24.0%

24.7%

Blue Cross

Based on gross charges

16.8%

23.3%

21.0%

21.0%

18.5%

21.8%

27.5%

21.8%

27.0%

19.3%

Commercial

Based on gross charges

20.8%

21.3%

24.9%

31.4%

27.1%

25.2%

20.4%

26.7%

24.0%

27.3%

Self Pay

Based on gross charges

2.2%

1.8%

3.2%

1.8%

3.0%

2.3%

1.4%

2.2%

1.0%

2.2%

Charity

Based on gross charges

0.0%

0.0%

0.0%

0.0%

0.0%

0.0%

0.0%

0.0%

0.3%

0.3%

Other

Based on gross charges

5.7%

4.3%

4.1%

4.8%

5.0%

3.3%

3.0%

4.2%

4.0%

4.4%

Payer Mix

Revenue Net Patient Revenue (in thousands)

Total net patient revenue

Net Revenue per APD

Total net patient revenue divided by adjusted patient days

Charity Writeoffs ( in thousands)

Actual writeoffs

Bad Debt (in thousands) Bad Debt Percentage

$4,619

$4,820

$6,211

$5,943

$5,228

$4,952

$3,634

$19,757

$20,907

$19,671

$16,228

$16,179

$12,185

$13,967

$13,418

$14,013

$12,768

$13,596

$15,090

$13,550

$50

$90

$236

$26

$110

$25

$128

$290

$588

$163

Provision for doubtful accounts

$256

($577)

$138

$450

$221

$188

$161

$1,021

$586

$757

Bad debt divided by gross patient revenue

3.4%

-8.1%

1.5%

4.5%

2.5%

2.2%

2.4%

1.8%

0.7%

3.0%

Level of Concern

Mammoth Hospital Dashboard Analysis For the Month Ending - October 31, 2016

Indicator

Definition

October 2015

May 2016

June 2016

July 2016

August 2016

September 2016

October 2016

Year-to-Date

Year-to-Date Budget

Year-to-Date Prior Year

Salaries and Benefits Total Salaries and Benefits thousands)

(in

Total salary and benefits expenses

$2,210

$2,398

$2,313

$2,425

$2,333

$2,422

$2,352

$9,533

$9,917

$8,854

$2,947

$2,790

$2,670

Benefits

Benefits, Taxes, Health Insurance, Workers Comp., etc.

$647

$735

$728

$773

$690

$790

$695

Benefits Percentage

Benefits divided by total productive salaries

43.2%

48.4%

47.7%

48.8%

43.8%

50.3%

43.7%

Salaries and Benefits per APD

Total salary and benefits expense divided by adjusted patient days

$7,765

$8,051

$4,538

$5,701

$5,988

$6,854

$8,263

$6,560

$7,156

$6,094

Productive Full Time Equivalents

Productive FTEs not including contract labor

245.2

257.1

259.5

259.5

261.9

253.2

260.2

258.7

269.0

243.2

Paid Full Time Equivalents

Paid FTEs not including contract labor

279.3

295.2

297.7

300.9

303.1

311.2

296.1

302.8

303.4

276.8

Productive FTEs per AOB

Productive FTEs divided by adjusted occupied beds

26.7

26.7

15.3

20.8

21.5

28.3

21.9

24.1

19.0

Average Hourly Rate

Average hourly rate of pay

$36.03

$36.59

$35.67

$36.00

$35.48

$37.70

$36.00

$36.29

$37.79

$36.28

Physician Fees

Physician Fee expense

$1,006

$996

$1,104

$1,282

$1,146

$1,133

$980

$4,542

$4,757

$4,427

Contracted Services

Contracted services expense

$104

$92

$101

$65

$49

$44

$53

$213

$290

$285

Supplies

Supplies expense

$444

$476

$695

$647

$562

$595

$534

$2,338

$2,015

$2,054

Services

Services expense

$640

$661

$673

$675

$788

$664

$589

$2,716

$2,830

$2,469

18.9

46.6%

40.6%

45.0%

Non-Wage Expenses

Level of Concern

Mammoth Hospital Dashboard Analysis For the Month Ending - October 31, 2016

Indicator

Definition

October 2015

May 2016

June 2016

July 2016

August 2016

September 2016

October 2016

Year-to-Date

Year-to-Date Budget

Year-to-Date Prior Year

Level of Concern

Accounts Receivable A/R net of contractuals (in thousands)

Balance of net AR at the end of the month

Net days in A/R

12-month average of outstanding net AR divided by 12 months net revenue

Percent A/R over 120 days

AR over 120 days old divided by total AR

$6,285

$8,733

$9,613

$10,259

$8,765

$8,201

$7,325

$7,325

$8,882

$6,285

34.4

47.8

52.6

55.4

47.2

44.2

40.0

40.0

50.0

38.1

21.9%

24.0%

21.5%

24.6%

25.7%

24.8%

25.3%

25.3%

25.0%

21.9%

Cash Cash Collected

Cash collected during the month for patient services

Days cash on hand

Current cash divided by average

$5,356

$6,638

$5,082

$5,634

$6,796

$5,782

$5,198

$23,410

$21,625

$20,780

242.5

283.0

285.8

288.5

295.1

291.5

288.2

288.2

275.4

260.9

Z:\Finance\2016-17 FINANCIALS\FY 2017 Reports\04 Oct 16 FY 2017\[04.2017 Financial Summary & Dashboard - MVW.xlsx]Dshbrd FY2017

Executive Summary For Period Ended: October 31, 2016 DRAFT Table of Contents

FINANCE COMMITTEE DRAFT

Page

Charts -- Volume ............................................................................................................................................................................... 2 Charts -- Revenue ............................................................................................................................................................................. 4 Charts -- Expenses ............................................................................................................................................................................ 9

VOLUME Inpatient Volume Average Daily Census - All Excuding Nursery

Admissions - All Excluding Nursery 90

6.5 6.0

80

5.5

5.0

70

4.5

60

4.0 50

3.5 3.0

40

2.5

30

2.0 1.5

20

Current Year

Prior Year

2 Years Ago

Budget

Current Year

Prior Year

2 Years Ago

Budget

Inpatient Surgery Volume 60 50 40 30

20 10 0

Current Year

Prior Year

2 Years Ago

Budget

2

Outpatient Volume

Emergency Department Volume (per day)

Clinic Volume (per day) - All Clinics 50

150

45

140

40

130

35

120

30

25 110

20 15

100

10

90

5

80

0

Current Year

Prior Year

2 Years Ago

Budget

Current Year

Prior Year

2 Years Ago

Budget

Outpatient Surgery Volume 100 90 80 70 60 50 40 30 20

Current Year

Prior Year

2 Years Ago

Budget

3

REVENUE Gross Charges Gross Outpatient Revenue

Gross Inpatient Revenue

6,000

4,000

5,000 4,000

Thousands

Thousands

3,000

2,000

3,000 2,000

1,000 1,000

0

0

Current Year

Prior Year

2 Years Ago

Current Year

Budget

Gross Professional Fees Revenue

Prior Year

2 Years Ago

Budget

Gross Clinic Revenue 1,000

3,000

900 800 700

2,000

Thousands

Thousands

2,500

1,500

1,000

600 500 400 300

500

200 100

0

0

Current Year

Prior Year

2 Years Ago

Budget

Current Year

Prior Year

2 Years Ago

Budget

4

Net Revenue

Thousands

Net Patient Revenue

Net Revenue per Adjusted Patient Day

8,000

25,000

7,000

22,000

6,000

19,000 16,000

5,000

13,000

4,000

10,000 3,000

7,000

2,000

4,000

1,000

1,000

Current Year

Prior Year

2 Years Ago

Budget

Current Year

Prior Year

2 Years Ago

Budget

Payer Mix FY 2011

Payer Mix Medicare Medi-Cal ** Blue Cross * Commercial * Self Pay ** Other * Total

19.0% 13.5% 26.0% 32.8% 4.3% 4.4% 100.0%

FY 2012

16.0% 12.2% 27.8% 32.1% 6.5% 5.3% 100.0%

FY 2013

16.0% 11.6% 32.2% 30.8% 5.1% 4.3% 100.0%

FY 2014

21.9% 17.2% 25.4% 26.6% 3.8% 5.0% 100.0%

FY 2015

19.9% 21.7% 25.8% 26.9% 1.7% 4.2% 100.0%

FY 2016

19.4% 22.9% 22.0% 28.8% 2.4% 4.4% 100.0%

Jun-16

22.4% 24.4% 21.0% 24.9% 3.2% 4.1% 100.0%

Jul-16

Aug-16

20.1% 19.9% 20.8% 26.3% 21.0% 18.5% 31.4% 27.1% 1.8% 3.0% 4.8% 5.0% 100.0% 100.0%

Sep-16

24.0% 23.5% 21.8% 25.2% 2.3% 3.3% 100.0%

Oct-16

23.7% 23.9% 27.5% 20.4% 1.4% 3.0% 100.0%

YTD FY 2017

21.7% 23.5% 21.8% 26.7% 2.2% 4.2% 100.0%

Budget FY 2017

20.0% 24.0% 27.0% 24.0% 1.0% 4.0% 100.0%

5

Revenue Cycle

Cash Collections ($000,s omitted) 7,000

Thousands

6,500 6,000 5,500 5,000 4,500 4,000 3,500 3,000 2,500 2,000

Current Year

Prior Year

2 Years Ago

Budget

6

Thousands

Cumulative Cash Collections ($000,s omitted) 70,000

140.0%

60,000

130.0%

50,000

Cumulative Cash Collections as a % of Net Collectible Revenue

120.0%

40,000 110.0%

30,000 100.0%

20,000 10,000

90.0%

0

80.0%

Current Year

Prior Year

2 Years Ago

Budget

Current Year

Prior Year

2 Years Ago

Budget

AR Days Outstanding - Net

AR Days Outstanding - Gross 80.0

65.0

75.0

60.0

70.0 65.0

55.0

60.0

50.0

55.0

45.0 50.0 45.0

40.0

40.0

35.0

Current Year

Prior Year

2 Years Ago

Budget

Current Year

Prior Year

2 Years Ago

Budget

7

Payer

Inhouse

Blue cross Commercial Medical Medicare MH employee Other Self Pay CHMB Total

$545 35,141 2,344 160 12,197 6,391 $56,778

1 to 30

$1,226,760 776,149 945,784 1,238,418 149,840 163,719 59,743 500,937 $5,061,350

31 to 60

$464,588 $890,202 $352,735 $215,298 $194,928 $184,340 $104,174 299,134 $2,705,399

61 to 90

$243,714 514,938 327,799 168,074 11,828 210,906 104,638 208,390 $1,790,287

91 to 120

$123,759 576,530 161,251 77,278 8,705 55,538 62,566 142,293 $1,207,920

Percent of Dollars Over 120 Days

121 +

$447,315 1,439,090 393,670 225,389 58,519 231,789 170,424 706,172 $3,672,368

Total

$2,506,681 4,196,909 2,216,380 1,926,801 423,980 858,489 507,936 1,856,927 $14,494,103

25.3%

% A/R > 120 Days 35% 30% 25% 20% 15% 10% 5% 0%

Current Year

Prior Year

2 Years Ago

Budget

8

EXPENSES Salaries, Wages and Benefits Benefits 1,000

2,900 2,500 2,800

900

2,700 2,000 2,600

Thousands

Thousands

Salaries, Wages and Benefits 3,000

2,500 1,500 2,400 1,000 2,300

800 700 600 500

2,200 500 2,100

400

2,000 0

300

Current Year

Prior Year

2 Years Ago

Budget

Current Year

Prior Year

2 Years Ago

Budget

Labor Cost per Full Time Equivalent 8,500 8,000 7,500 7,000 6,500 6,000

5,500 5,000

Current Year

Prior Year

2 Years Ago

Budget

9

Full Time Equivalents Productive Full Time Equivalents

Paid Full Time Equivalents

340.0

`

320.0

370.0 350.0

300.0

330.0

280.0

310.0

260.0

290.0

240.0

270.0

220.0

250.0

200.0

230.0 Current Year

Prior Year

2 Years Ago

Budget

Current Year

Prior Year

2 Years Ago

Budget

Productive FTEs per Adjusted Occupied Bed 35.0

30.0

25.0

20.0

15.0

10.0

Current Year

Prior Year

2 Years Ago

Budget

10

Professional and Contracted Services Contracted Services

Professional Fees 140

1,500 1,400

120

1,300 100

1,100

Thousands

Thousands

1,200

1,000

900 800

80 60 40

700 20

600 500

0

Current Year

Prior Year

2 Years Ago

Budget

Current Year

Prior Year

2 Years Ago

Budget

Supplies Supply Expense per Adjusted Patient Day

Supply Expense 800

2,900

700

2,400

Thousands

600

1,900 500 1,400 400 900

300

400

200

Current Year

Prior Year

2 Years Ago

Budget

Current Year

Prior Year

2 Years Ago

Budget

11

SOUTHERN MONO HEALTH CARE DISTRICT Investments Summary - October 31, 2016

Interest Purchase Date Maturity Date Rate Certificates of Deposit (CDs) First Eagle Bank CD Premier Business Bk CA Sallie Mae Bk Slt Lake City UT American Express Centrn Bank North Carolina NC Third Fed Svgs & Ln Assn Of Capital One Bk Usa Natl Assn Discover Bk CD Goldman Sachs Bk USA NY State Bk India NYC Luana svgs Bnk Iowa

Broker

Cost Basis

Estimated Current Market Value

1.05% 1.10% 1.50% 1.50% 1.00% 2.00% 2.10% 2.10% 2.20% 2.20% 1.05%

11/21/2014 11/26/2014 11/26/2014 11/28/2014 11/28/2014 11/24/2014 11/26/2014 11/26/2014 11/26/2014 12/5/2014 12/19/2014

11/21/2017 11/27/2017 11/27/2017 11/28/2017 11/28/2017 11/25/2017 11/26/2019 11/26/2019 11/26/2019 12/5/2019 12/19/2017

Union Banc Investment Services Union Banc Investment Services Union Banc Investment Services Union Banc Investment Services Union Banc Investment Services Union Banc Investment Services Union Banc Investment Services Union Banc Investment Services Union Banc Investment Services Union Banc Investment Services Union Banc Investment Services

$248,000 249,000 248,000 248,000 249,000 247,000 247,000 247,000 247,000 247,000 248,000 $2,725,000

$249,136 250,282 249,272 249,934 250,205 254,249 254,240 254,314 254,227 255,082 248,759 $2,769,701

1.80%

11/21/2014

11/12/2019 Union Banc Investment Services

5,011,900 $7,736,900

5,094,100 $7,863,801

Government / Agency Securities Federal Farm Cr Bks Bond

Local Agency Investment Fund (LAIF)

Interest Rate 0.55%

Total Investments

Beginning Balance

Activity

$39,558,220

$0

Ending Balance $39,558,220

$38,867,246

$47,295,120

$46,731,046

Southern Mono Healthcare District LAIF Investment

Balance as of July 31, 2015 Deposit 8/7/15 Deposit 8/14/15 Withdrawal 8/21/15 Deposit 8/28/15 Balance as of August 31, 2015 Withdrawal 9/4/15 Deposit 9/11/15 Deposit 9/18/15 Withdrawal 9/22/15 Balance as of September 30, 2015 Withdrawal 10/2/15 Deposit 10/9/15 Withdrawal 10/16/15 Interest Income 3rd Qtr CY 2015 Deposit 10/23/15 Balance as of October 31, 2015 Deposit 11/6/15 Withdrawal 11/13/15 Withdrawal 11/20/15 Withdrawal 11/25/15 Balance as of November 30, 2015 Withdrawal 12/4/15 Deposit 12/11/15 Deposit 12/24/15

28,719,530.07 100,000.00 1,150,000.00 (1,250,000.00) 750,000.00 29,469,530.07 (450,000.00) 750,000.00 850,000.00 (450,000.00) 30,169,530.07 (700,000.00) 1,000,000.00 (900,000.00) 23,698.20 550,000.00 30,143,228.27 650,000.00 (200,000.00) (100,000.00) (250,000.00) 30,243,228.27 (1,000,000.00) 150,000.00 1,100,000.00

Balance as of December 31, 2015

30,493,228.27

Deposit 1/4/16 Withdrawal 1/8/16 Deposit 1/15/16 Interest Income 4th Qtr CY 2015 Withdrawal 1/22/16 Deposit 1/29/16

1,200,000.00 (550,000.00) 800,000.00 27,810.18 (1,200,000.00) 500,000.00

Balance as of January 31, 2016 Withdrawal 2/5/16 Deposit 2/12/16 Withdrawal 2/19/16 Deposit 2/26/16

Z:\BankAccounts\LAIF\LAIF Activity.xlsx

31,271,038.45 (250,000.00) 1,850,000.00 (150,000.00) 900,000.00

11/9/2016

Southern Mono Healthcare District LAIF Investment

Balance as of February 29, 2016 Withdrawal 3/4/16 Deposit 3/11/16 Withdrawal 3/18/16 Deposit 3/25/16 Balance as of March 31, 2016 Withdrawal 4/1/16 Deposit 4/11/16 Withdrawal 4/15/16 Interest Income 1st Qtr CY 2016 Withdrawal 4/22/16 Withdrawal 4/25/16 Withdrawal 4/29/16 Balance as of April 30, 2016 Deposit 5/6/16 Deposit 5/13/16 Deposit 5/20/16 Deposit 5/27/16 Balance as of May 31, 2016 Deposit 6/3/16 Withdrawal 6/10/16 Deposit 6/30/16 Balance as of June 30, 2016 Withdrawal 7/8/16 Deposit 7/15/16 Interest Income 2nd Qtr CY 2016 Withdrawal 7/22/16 Deposit 7/29/16

Balance as of July 31, 2016 Deposit 8/12/16 Withdrawal 8/12/16 Deposit 8/25/16 Balance as of August 31, 2016 Deposit 9/9/2016 Withdrawal 9/15/16 Deposit 9/22/2016 Withdrawal 9/29/16 Deposit 10/7/2016 Withdrawal 10/13/16 Withdrawal 10/18/16 Withdrawal 10/20/16 Balance as of October 31, 2016 Withdrawal 11/3/2016 Withdrawal 11/10/2016 Balance as of October 31, 2016 Z:\BankAccounts\LAIF\LAIF Activity.xlsx

33,621,038.45 (200,000.00) 1,200,000.00 (750,000.00) 1,200,000.00 35,071,038.45 (250,000.00) 1,400,000.00 (100,000.00) 37,614.16 (250,000.00) (350,000.00) (750,000.00) 34,808,652.61 750,000.00 1,000,000.00 450,000.00 250,000.00 37,258,652.61 350,000.00 (150,000.00) 500,000.00 37,958,652.61 (1,000,000.00) 1,400,000.00 49,567.76 (850,000.00) 850,000.00

38,408,220.37 1,300,000.00 (1,000,000.00) 850,000.00 39,558,220.37 900,000.00 (900,000.00) 550,000.00 (550,000.00) 550,000.00 (350,000.00) (300,000.00) (700,000.00) 38,758,220.37 (200,000.00) (700,000.00) 37,858,220.37

11/9/2016

Mammoth Hospital FY17 Capital Plan - Board Summary 1st Quarter Update Through September 30th, 2016 Name of Project 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26

BUDGETED - BOARD APPROVED Exterior paint - SPORTS Building North Maintenance Roof-Top Mechanical Room Repairs Parking Lot Resurfacing Old O.R. Conversion Off-Site Work Space Start-Up Expenses Sanipak Repair LED Upgrade Cubicles and Office Furniture - Patient Accounting Logiquip Storage Solution High Speed Scanner Philips CT Software Upgrade Fuji CR to DR Upgrade Clinitek Advantus Urinalysis Analyzer Fresh Frozen Plasma Freezer Pathology Room Renovation Goby Urodynamic System with Cart Digital Censor for Hygienist Room III Trophon Disinfectant unit Dish Washing Machine Simplivity OmniCube CN 2400 PC Workstations Laptops Dual Monitor setups, mobile carts, desktop - Family Med Fetal Monitor Mod 259 Corometerics Drager Jaundice Meter JM-105 "C" Building 1st floor Office Remodel project

BUDGETED - ABANDONED/DELAYED 1 Laparoscopy Instruments 2 AccuVein Device

1 2 3 4 5

1 2 3 4 5 6

1 2 3

AUXILIARY PROJECTS Philips ICU/Tele Patient Monitoring system Gurneys - 2 Philips MP50 Cardiac Monitors - 2 AccuVein Device Hill-Rom Affinity 4 Birthing Bed

Budget $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ SUB TOTAL $

22,000 26,500 24,200 16,000 15,000 25,000 15,000 28,700 29,000 12,300 61,000 233,800 8,850 6,100 7,900 19,400 17,300 8,500 7,000 97,900 76,000 42,000 48,000 38,200 7,300 37,000 929,950

$ $ SUB TOTAL $

15,000 6,300 21,300

$ $ $ $ $ SUB TOTAL $

135,000 11,000 59,300 6,300 18,100 229,700

$

-

CONTINGENCY - $231,650 INITIAL BUDGET Dragon Medical License Facility Signage Upgrade Fire alarm Upgrade - OSHPD fee's Nurse Call System Upgrade - OSHPD fee's Boiler Upgrade Relyco AP Check Printing Solution

PROJECTS CARRIED OVER FROM FY2016 Kronos Upgrade/Chart of accounts expansion Lab Generator Relocation Workstations on Wheels - WoW's

Actual Spent $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $

$

24,689 26,500 22,979 8,436 6,211 8,819 18,733 17,307 8,302 6,333 94,086 18,393 60,244 17,163 16,413 354,609

-

Balance $

Funding

Over/Under Budget Indicator

Capital Capital Capital Capital Capital Capital Capital Capital Capital Capital Capital Capital Capital Capital Capital Capital Capital Capital Capital Capital Capital Capital Capital Capital Capital Capital

1.00 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 1.00 1.00 $0 1.00 $0 $0 $0 $0 1.00 $0 $0 $0 $0

$

(2,689) 0 1,221 16,000 15,000 25,000 15,000 28,700 29,000 12,300 61,000 233,800 414 (111) (919) 667 (7) 198 667 3,814 57,607 (18,244) 30,837 38,200 7,300 20,587 575,341

$0 $0

$

15,000 6,300 21,300

$0 $0 $0 $0 $0

$

-

$

135,000 11,000 59,300 6,300 18,100 229,700

10,995 14,596 13,964 10,128 28,750 5,875 84,308

$ $ $ $ $ $ $

147,342

Capital Capital Capital Capital Capital Capital

1.00 1.00 1.00 1.00 1.00 1.00

$

20,500 (12,708) 27,174 34,965

Capital Capital Capital

$0 1.00 $0

SUB TOTAL $

231,650

$ $ $ $ $ $ $

$ $ $ SUB TOTAL $

20,500 36,600 30,300 87,400

$ $ $ $

49,308 3,126 52,435

1,500,000

$

491,352

$

Summary of Capital funds FY17 TOTALS

$

$ 1,008,649

$0

http://sw1:11374/finance/Major Expenditures Page 1 Documents/FY17/CIP_Projects_FY_2017_Finance_Reconciliation.xlsx

Southern Mono Healthcare District Report to the Board of Directors Retirement Plan Summary November 17, 2016 2015 Press Ganey Pinnacle of Excellence Award Winner

To:

Board of Directors, Southern Mono Healthcare District

From:

Sarah Vigilante, Human Resources Manager Darin Kaylor / EPOCH Consulting

Date:

November, 2016

Re: 3rd Quarter 2016 Retirement Plan Update _____________________________________________________________________________

Total 403b Assets Average Account Balance Active Participants(Eligible)

3/31/2016

6/30/2016

9/30/2016

$23,197,095 $75,561 223(391)

$24,256,738 $77,251 227(391)

$24,340,075 $76,783 229(385)

Fund Rankings Morningstar Criteria: (page 24 of QMR)* 1st quartile: 30 funds (67% of assets) 2nd quartile: 8 funds (13% assets) 3rd quartile: 3 funds (4% of assets) 4th quartile: 0 funds *two funds not ranked and combine for 16% of plan assets.

Overview: Strong quarter and some light at the end of the tunnel…. Global unrest, interest rates and potentially lagging economic growth are still dominating the headlines. However; the markets are quietly having a decent year…. Let’s keep this between us as we would not want the media to know that things have been pretty good. Could we have forecasted back in January that as of the end of the 3rd quarter the S&P500 would be in positive territory at the tune of 7.82%. I am not surprised and you should not be either. That is what Mr. Market does….He prays on your emotions and rewards those who do not overreact. As with past board updates, remember that market volatility does create opportunities for patient investors and as such, the assets in the 403b plan have produced an YTD return of 8.32%. Participation increased by another 1% from the last report. However; we had several retirements during the past quarter which affects overall participation and asset levels. Two funds are now on the watch list- PIMCO Commodity Real Return and Ivy Science & Technology. The two funds represent 1.06% of plan assets. ________________________________________________________________________________________________________ P.O. Box 660 | 85 Sierra Park Road | Mammoth Lakes, CA 93546 | 760.924.4114 | Fax 760.924.4104 | www.mammothhospital.com

Southern Mono Healthcare District Report to the Board of Directors Retirement Plan Summary November 17, 2016 We are currently reviewing the quantity of funds available and we are working on reducing the total by nine underperforming funds that our fiduciary, Rick Tasker, has advised could result in a lower overall cost for both plans (still leaving us with 21 overall funds). We are also negotiating the possibility of lowering some of the plan fees. Stay tuned next quarter for updates on these two activities. Annualized Historical Plan Performance vs. S&P500 Index as of 9/30/2016:* 1 year 3 year 5 year 10 year 403b:

11.91%

6.86%

11.06%

6.80%

S&P 500 Index:

15.43%

11.16%

16.37%

7.24%

*actual account performance per individual will vary. Timeframes longer than one year are annualized returns. Assets have only been in the illustrated funds since the transition on 2/4/15. Performance is hypothetical past performance vs. S&P500 Index is for stated periods. The ‘Fixed Account’ balance is not reflected in these performance numbers.

We will continue to benchmark our plan and the investments that are made available to our employees. The Investment Policy Statement (IPS) and quarterly monitoring reports will keep us up to date on our investment lineup. Plan Highlights: Participation: 59% (National Average* 72%) This number is slightly misleading in that all employees (part-time, per diem, etc) are eligible to participate in the plan. We have actually seen an additional 1% increase in total participation since the last report. Many part-time and per diem employees do not work enough hours to become vested, thus they do not participate in the plan. Most retirement plans do not allow ‘per diem’ employees to participate. Average Account Balance: $76,783 (National Average* $58,373) Average Number of Investment Options Held: 10.8 (National Average* 5.6) By Age:

Page 2 of 3

Southern Mono Healthcare District Report to the Board of Directors Retirement Plan Summary November 17, 2016 Below is a list of the top funds in the portfolio based on asset level. Fixed Fund: $3,907,113 Vanguard S&P500 Index: $2,375,160 Loomis Sayles Core Bond Plus: $2,213,239 Dodge & Cox Stock Fund: $1,965,022 Invesco Equity and Income: $1,426,145 American Funds EuroPacific Growth: $1,334,711 Vanguard Long-term Investment Grade: $1,034,158 Vanguard Inflation Protected Securities: $1,019,768

Average Balance by Age Group 6/30/2016

9/30/2016

$0

$0

Ages 21-30

$14,715

$13,463

Ages 31-40

$24,052

$27,574

Ages 41-50

$57,896

$60,024

Ages 51-60

$120,404

$119,848

Ages >61

$164,564

$151,043

Ages