board of directors monthly meeting agenda · 8/20/2015 · august 20, 2015 2014 press ganey...

Southern Mono Healthcare District

Board of Directors Meeting Agenda

August 20, 2015

2014 Press Ganey Guardian of Excellence Award Winner

________________________________________________________________________________________________________ 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

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: August 20, 2015

Time: 8:00 a.m. Monthly Board Meeting Regular Session

8:05 a.m. Closed Session (approximate time)

8:40 a.m. Regular Session – continued (approximate time)

Place: Mammoth Hospital Administration Conference Rooms “A & B”

85 Sierra Park Road

Mammoth Lakes, CA 93546

Vice Chair Maria King, D.O., will attend via teleconference and will be located at: LeVerne Street,

Mammoth Lakes, CA 93546.

I. CALL TO ORDER

II. PUBLIC COMMENTS

III. CHIEF OF STAFF REPORT

IV. 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 LAFCO and Northern Inyo Healthcare District v. Southern Mono

Healthcare District, Inyo County Superior Court Case No. SICVPT 1558392.

2. Claim of Ashley A. Sciotto v. Southern Mono Healthcare District; threatened

litigation

3. Claim of newborn son of Ashley A. Sciotto (Name not provided by Claimant)

by Ashley A. Sciotto v. Southern Mono Healthcare District; threatened litigation

http://www.mammothhospital.com/



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CONFERENCE WITH REAL PROPERTY NEGOTIATORS (Government Code

§54956.8)

1. Proposed sale of commercial property of SMHD located at 699 West Line

Street, Bishop, County of Inyo, California; APN: 01-110-12 District Negotiators

for SMHD: Gary Myers, CEO; Melanie Van Winkle, CFO; David Baumwohl,

legal counsel; Negotiating Parties for Proposed Buyer: Cindy Freeman on behalf

of a proposed buyer.

QUALITY ASSURANCE – (Health and Safety Code §32155)

1. Chief of Staff Report.

2. CEO Report.

3. CNO Report.

QUALITY ASSURANCE QUARTERLY SUMMARIES - (Health and Safety Code

§32155)

1. Annual Evaluation of Critical Access Hospital Quality Improvement Activities

Fiscal Year 2014-2015.

HEALTH CARE FACILTY TRADE SECRETS (Health and Safety Code §32106)

1. Sierra Park Clinics/Mammoth Hospital.

PERSONNEL MATTERS (Government Code §54957)

1. CEO Evaluation.

CREDENTIALING

Reappointments

David Bassler, M.D. Emergency Medicine Active Staff

Amy Conrad, M.D. Pediatrics Active Staff

Kyle Howell, M.D. Emergency Medicine Active Staff

Michael Karch, M.D. Orthopedics Active Staff

Audrey Pauly, M.D. OB/GYN Active Staff

Marianne Cuttic, DPM Podiatry Courtesy Staff

Appointment to Provisional Staff

Craig Burrows, M.D. Hospitalist

Temporary Privileges

Jonathan Sales, P.A. Assist Dr. Thunder August 13, 2015

Noah Levit, M.D. Emergency Department 08/27 - 09/01/2015

Chi Truong, M.D. Emergency Department 08/27 - 09/01/2015

Sierra Bourne, M.D. Emergency Department 08/14 – 16/2015

Victoria Paterno, M.D. Pediatrics 08/21 – 23/2015

Carolyn Korfiatis, N.P. Family Medicine 07/17 - 09/24/2015 Craig Burrows, M.D. Hospitalist 07/19 – 08/21/2015



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V. REPORT ON CLOSED SESSION

VI. PUBLIC COMMENTS

VII. 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:

July 16, 2015 Regular Board Meeting

2. Chief Financial Officer Report

3. Chief Nursing Report

4. Information Technology Report

5. Human Resources Report

6. Facilities Report

7. ACHD Updates

8. Eide Bailly Letter Regarding Annual Audit

9. Beta Announcement

VIII. COMMITTEE REPORTS

1. Finance Committee Stephen Swisher, M.D., Helen Shepherd

2. Physician Compensation Helen Shepherd, Ryan Wood

3. Employee Relations Committee Helen Shepherd

4. Quality Committee Stephen Swisher, M.D., Lynda Salcido 5. CEO Annual Review Committee Lynda Salcido, Maria King, D.O.

6. IT Steering Committee Stephen Swisher, M.D., Ryan Wood

7. Facilities Committee Maria King, D.O., Ryan Wood

8. Ad Hoc, Special, or Other (as needed) Committees

IX. CHIEF EXECUTIVE OFFICER REPORT

X. FINANCE REPORT

1. June 2015 Pre-Audit Financial Statements.

2. July 2015 Financial Statements.

3. Investment Report.

4. Review and Discussion of Standard and Poor’s Credit Rating Report Dated July 29,

2015 of Southern Mono Healthcare District. 5. Review of Quarterly Capital Expenditure Status.

6. Finance Committee Report.

XI. OLD BUSINESS

1. Award of Contract to the Lowest Responsible Bidder for the Construction

Project Identified as Modification to Mammoth Hospital Medical Office

Building or Reject all Bids.



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XII. NEW BUSINESS

2. Presentation and Discussion of the HealthStream Employee Survey Results by

Jeff Byberg, Human Resources Manager.

3. Quarterly Review of the Retirement Plan Performance: 403(b) and 457

Employee Retirement Plans by Jeff Byberg, Human Resources Manager.

4. Approval of the Loma Linda University Medical Center (LLUMC) Affiliation

Agreement.

5. Review and Approval of the modified professional services agreement between

Southern Mono Healthcare District and Craig Burrows, M.D., Inc. a California

Corporation, David Araya, M.D., and Sean Park, M.D., for the provision of

Hospitalist Physician Services.

6. Declaration of Surplus Equipment.

XIII. CREDENTIALING Reappointments

David Bassler, M.D. Emergency Medicine Active Staff

Amy Conrad, M.D. Pediatrics Active Staff

Kyle Howell, M.D. Emergency Medicine Active Staff

Michael Karch, M.D. Orthopedics Active Staff

Audrey Pauly, M.D. OB/GYN Active Staff

Marianne Cuttic, DPM Podiatry Courtesy Staff

Appointment to Provisional Staff

Craig Burrows, M.D. Hospitalist


Jonathan Sales, P.A. Assist Dr. Thunder August 13, 2015

Noah Levit, M.D. Emergency Department 08/27 - 09/01/2015

Chi Truong, M.D. Emergency Department 08/27 - 09/01/2015

Sierra Bourne, M.D. Emergency Department 08/14 – 16/2015

Victoria Paterno, M.D. Pediatrics 08/21 – 23/2015

Carolyn Korfiatis, N.P. Family Medicine 07/17 - 09/24/2015 Craig Burrows, M.D. Hospitalist 07/19 – 08/21/2015

XIV. FUTURE BUSINESS

The next SMHD Board meeting will take place on September 24, 2015 (4th

Thursday of the month) at

8:00 a.m. in Conference Rooms A & B at Mammoth Hospital.

ADJOURN


Board of Directors Meeting Minutes

July 16, 2015


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


BOARD OF DIRECTORS MONTHLY MEETING MINUTES

Date: July 16, 2015

Attendance of Board Members: Helen Shepherd, Chair; Stephen Swisher, M.D., Treasurer; Ryan

Wood, Secretary; Lynda Salcido, Member at Large.

Vice Chair Maria King, D.O., attended via teleconference from 401 North River Point Boulevard,

Spokane, WA.

Attendance of Staff Members: Gary Myers, CEO; Melanie Van Winkle, CFO; Kathleen Alo,

CNO; David Baumwohl, Legal Counsel; Robin Conners,

Recording Secretary.

I. CALL TO ORDER

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

Gary Myers, CEO, introduced Mammoth Hospital’s new Chief Medical Officer, Craig Burrows.

Dr. Burrows will also work as an independent contractor hospitalist.

II. PUBLIC COMMENTS

Edyth Irvine, Mammoth Hospital Auxiliary Vice President, reported the following:

1. The Hospital Auxiliary held their annual budget meeting and will be offering $190,000 to

Mammoth Hospital for Capital Outlay equipment purchases and $20,000 for the hospital staff

Continuing Education program. The Auxiliary will continue to support the new baby t-shirt

program. The new officer Installation luncheon was held at their July meeting.

III. CHIEF OF STAFF REPORT

There was no Chief of Staff report.

IV. PUBLIC COMMENTS

Edyth Irvine, Mammoth Hospital Auxiliary Vice President, reported the following:




July 16, 2015

Page 2 of 7

1. At the Hospital Auxiliary annual budget meeting they also approved $30,000 for Medical

Related Scholarships and $7,000 for High School student awards.

Gary Myers, CEO, commented that the scholarship program is very important to hospital staff for

earning higher degrees in education. Thank you!

Lynda Salcido, SMHD Board member commented that the Cast Off thrift store is a great benefit to the

community by offering affordable clothing and other items for sale.

V. ADJOURN TO CLOSED SESSION

The Board adjourned to closed session at 8:03 a.m.

Dr. Tomi Bortolazzo requested to attend the Closed Session as Chief of Staff. The request was granted.

Dr. Craig Burrows, CMO, attended the Closed Session.

VI. REPORT ON CLOSED SESSION

The Board reconvened to open session at 9:03 a.m.

CONFERENCE WITH LEGAL COUNSEL – PENDING AND THREATENED

LITIGATION Existing Litigation and Significant exposure to litigation pursuant to

Government Code §54956.9.

1. Inyo Local Agency Formation Commission (LAFCO) v. Southern Mono

Healthcare District; threatened litigation.

2. Cheryl Hogan v. Mammoth Hospital, State of California, Department of Fair

Employment & Housing (DFEH), DFEH Case No. 223479-112637.

Chair Shepherd reported discussion of CONFERENCE WITH LEGAL COUNSEL on PENDING

AND THREATENED LITIGATION for the above items; no action taken.

CONFERENCE WITH REAL PROPERTY NEGOTIATORS (Government Code

§54956.8)

1. Proposed sale of commercial property of SMHD located at 699 West Line

Street, Bishop, County of Inyo, California; APN: 01-110-12 District Negotiators

for SMHD: Gary Myers, CEO; Melanie Van Winkle, CFO; David Baumwohl,

legal counsel; Negotiating Parties for Proposed Buyer: Cindy Freeman on behalf

of a proposed buyer.

Chair Shepherd reported that CONFERENCE WITH REAL PROPERTY NEGOTIATORS regarding

the item above was discussed; no action was taken.



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QUALITY ASSURANCE – (Health and Safety Code §32155)

1. Chief of Staff Report.

Chair Shepherd reported that QUALITY ASSURANCE issues were discussed with Tomi Bortolazzo,

MD., Chief of Staff; no action was taken.

2. CEO Report.

Chair Shepherd reported that QUALITY ASSURANCE issues were discussed with Gary Myers, CEO;

no action was taken.

3. CNO Report.

Chair Shepherd reported that QUALITY ASSURANCE issues were discussed with Kathleen Alo,

CNO; no action was taken.

QUALITY ASSURANCE QUARTERLY SUMMARIES - (Health and Safety Code

§32155)

Chair Shepherd reported that the QUALITY ASSURANCE QUARTERLY SUMMARIES were

reviewed; no action taken.

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; no action was taken.

PERSONNEL MATTERS (Government Code §54957)

1. CEO Evaluation.

Chair Shepherd reported PERSONNEL MATTERS was discussed; no action was taken.

CREDENTIALING

Reappointment

Lewis Greenstein, M.D. Anesthesia

Request for Additional Privilege

Donald Harrell, M.D. Radiology

Initial Appointment

Maxine Karimoto, M.D. OB/GYN




July 16, 2015

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Maxine Karimoto, M.D. OB/GYN July 1 – 31, 2015

Donald Harrell, M.D. Additional Privileges July 2 – 30, 2015

Chi Truong, D.O. Emergency Medicine July 2 – 7, 2015

Noah Levit, M.D. Emergency Medicine July 2 – 7, 2015

Pamela Simons, M.D. OB/GYN June 22 – 30, 2015

Faud Kuliyev, M.D. Hospitalist/Internal Medicine June 22 -25, 2015

Sierra Bourne, M.D. Emergency Medicine July 17 – 20, 2015

Victoria Paterno, M.D. Pediatrics June 26-29, 2015 July 24-26, 2015

Jonathan Sales, PA-C May 28, 2015 June 11, 2015

Chair Shepherd reported the foregoing physician CREDENTIALING was discussed; no action was

taken.

VII. 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:

June 18, 2015 Regular Board Meeting

2. Chief Financial Officer Report

3. Chief Nursing Report

4. Information Technology Report

5. Human Resources Report

6. Facilities Report

7. ACHD Updates

Stephen Swisher, M.D., 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 Information Technology report. A vote was

taken; the motion passed unanimously. Yes 5, No 0.

VIII. 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

Chair Shepherd congratulated Administration on the excellent Employee Satisfaction Survey results.



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4. Quality Committee Stephen Swisher, M.D., Lynda Salcido

There was no report.

5. CEO Annual Review Committee Maria King, D.O., Lynda Salcido


6. IT Steering Committee Stephen Swisher, M.D., Ryan Wood

There was no Information Technology (IT) Steering Committee meeting this month; no report.

7. Facilities Committee Maria King, D.O., Ryan Wood


8. Ad Hoc, Special, or Other (as needed) Committees


IX. CHIEF EXECUTIVE OFFICER REPORT

Gary Myers, CEO, reviewed the following highlights from his written report:

1. Demos for a new enterprise-wide EMR are being scheduled. The goal is to select a new system

by January 31, 2016.

2. Please save the date for the Strategic Plan Review on the morning of October 30, 2015.

X. FINANCE REPORT

1. June 2015 Preliminary Financial Statements.

2. Investment Report.

3. Finance Committee Report.

Melanie Van Winkle, CFO, reviewed and presented the Financial Statements, included in the packet

via PowerPoint presentation. Ms. Van Winkle reported the Fiscal Year 2015 Net Gain was $6,530,000

which resulted in a favorable budget variance of $2,354,000. The favorable variance is a result of

higher ancillary and clinic volume and maintaining expenses (especially salaries and wages) at a lower

level. Our fiscal audit will take place the second week of August and our final FY 2015 numbers

should be presented.

4. Review of the FY15 Annual Reimbursement Report and Disclosure.

The FY15 Annual Reimbursement Disclosure Report was included in the Board packet, no action

needed.

Slavka Crouthamel, Controller, was thanked for all her hard work on the budget.



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XI. OLD BUSINESS

1. Review and Discussion regarding the ACHD Board Self-Assessment.

Plans for the review of the ACHD Board Self-Assessment were discussed. Chair Shepherd distributed

a list of Board member responsibilities. It was decided to hold a Special Board meeting to discuss

Board Self-Assessment on Friday, August 21, 2015 at 8:00 a.m. in Conference Rooms A & B.

2. Modification to Mammoth Hospital Medical Office Building at Mammoth

Hospital: approval and authorization of the project, solicit bids, award the

project to the lowest responsible bidder, and then undertake the project as

previously approved by the Board.

Lynda Salcido made a motion seconded by Ryan Wood to approve and authorize the project, solicit

bids, award the project to the lowest responsible bidder, and then undertake the project as previously

approved by the Board. Chair Shepherd asked for comments; a brief discussion ensued. A vote was


XII. NEW BUSINESS

1. Discussion and Possible Action Regarding Electronic Board Packets and the Use

of Electronic Devices.

Electronic Board Packets and the Use of Electronic Devices were discussed. Commencing by the next

Board meeting, all open packets will be posted on the website electronically and no hard copy packets

will be printed. The closed packet will be distributed in hard copy form and will not be available

online. Each Board member will be issued an email from the Mammoth Hospital domain to be used for

hospital business. Note taking software will be purchased for those who would like this capability. No

further action needed.

2. Declaration of Surplus Equipment.

Ryan Wood made a motion seconded by Lynda Salcido to approve the disposal of surplus equipment

presented to the Board and to direct staff to dispose of the equipment in the manner most beneficial to

the District. The surplus equipment presented has 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.

XIII. CREDENTIALING Reappointment

Lewis Greenstein, M.D. Anesthesia

Request for Additional Privilege

Donald Harrell, M.D. Radiology

Initial Appointment



July 16, 2015

Page 7 of 7

Maxine Karimoto, M.D. OB/GYN


Maxine Karimoto, M.D. OB/GYN July 1 – 31, 2015

Donald Harrell, M.D. Additional Privileges July 2 – 30, 2015

Chi Truong, D.O. Emergency Medicine July 2 – 7, 2015

Noah Levit, M.D. Emergency Medicine July 2 – 7, 2015

Pamela Simons, M.D. OB/GYN June 22 – 30, 2015

Faud Kuliyev, M.D. Hospitalist/Internal Medicine June 22 -25, 2015

Sierra Bourne, M.D. Emergency Medicine July 17 – 20, 2015

Victoria Paterno, M.D. Pediatrics June 26-29, 2015 July 24-26, 2015

Jonathan Sales, PA-C May 28, 2015 June 11, 2015

Lynda Salcido made a motion seconded by Ryan Wood to approve the appointments as listed above

with the exception of Chi Truong, D.O., Noah Levit, M.D., and Sierra Bourne, 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., recused himself and left the room at 9:46 a.m.

Lynda Salcido made a motion seconded by Ryan Wood to approve the appointments of Chi Truong,

D.O., Noah Levit, M.D., and Sierra Bourne, 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


Stephen Swisher, M.D., returned to the room at 9:47 a.m.

XIV. FUTURE BUSINESS

The next SMHD Board meeting will take place on August 20, 2015 at 8:00 a.m. in Conference Rooms

A & B at Mammoth Hospital.

Chair Shepherd announced there will be a Meet & Greet for new physicians on July 23 in the Medical

Office Building lobby.

ADJOURN

There being no further business the meeting was adjourned at 9:50 a.m.


Report to the Board of Directors

CFO Report

August 20, 2015

2013 Press Ganey Beacon of Excellence Award Winner




DATE: August 20, 2015

TO: Board of Directors


FROM: Melanie Van Winkle, CFO/Physician Practice Administrator

RE: CFO Report, Regular Meeting of the Board of Directors

Old Business

Patient Account Billing/Collections – Another great month of collections in July at $4.9 million, but

is below goal (collections are just delayed due to the big increase in volumes in July). Gross AR

increased in July by $1.3 million to $14.7 million due to increased patient volume in July. Net AR

days increased slightly to 43, but is still very low. In July the percentage of AR aged over 120 days

decreased about 5%.

National Rural ACO (NRACO) – NRACO successfully submitted applications for both the Medicare

Shared Savings Program and the ACO Investment Model on behalf of 175 communities, in 24 ACOs,

across 32 states! Thus in two years the NRACO has grown from 9 communities to 175 across the

nation.

ICD-10 – Jane Grossblatt, HIMS Manager, in collaboration with a coder from UASI, has started

attending provider meetings to provide specific specialty training for ICD-10. As a reminder ICD-10

coding goes live 10-1-15.

Financial Audit FY2015 – The Eide Bailly audit team are on campus this week, August 10-14. Initial

assessment by the auditors indicates a strong comfort level with the financial results as reported and

great involvement and preparation by Slavka Crouthamel and her accounting team.

Public Safety Net Transformation and Improvement Project (Aka DSRIP) – A significant amount

of research and discussion is taking place with the key leaders of two of our projects; TR Miller –

Integration of Physical and Behavioral Health, Karilyn Myers – Chronic Pain Management/Opioid

addition. Data is being gathered to more specifically identify the problem in these two areas to support

the anecdotal assumptions. We will continue to gather information on the problem and the population

we would target. It is expected we will submit a high level application to CMS in November or later.

As a reminder, we as a California District hospital, have an opportunity to receive federal funding to

transform our care model. We have estimated the potential of getting $400 thousand a year for 5 years.




CFO Report

August 20, 2015

Page 2 of 3

New Business

Standard & Poor’s credit rating – Included in the board package is the Standard & Poor’s credit

rating letter and report. I am happy to report that our credit rate was increased to an A- rating from a

BBB+. The S&P staff noted that our strong balance sheet (high cash reserves, low patient accounts

receivable, and low debt) coupled with our strong financial results for the last few years, even in low

snow volume years, contributed to the increase in rating.

Bridgeport Rural Health Clinic move – We are scheduled to move into a new facility at the end of

September. It is a building located on the same property currently occupied by office staff of Mono

County. Mono County is making minor improvements to accommodate our clinic needs. This new

building will be a great improvement for the community and our patients. We will be contacting the

state to inform them of the move, which will most likely trigger a site visit.

New PA for Family Medicine/Bridgeport Clinics – I am pleased to announce that Evan Rowley, new

PA grad, will join our practice on September 14, 2015. We have been short a mid-level since Bill

Todd left in June. Evan will get training and experience in the Family Medicine clinic and eventually

rotate into the Bridgeport clinic with the other mid-levels. Evan graduated from the physician assistant

program at the University of Washington. Evan has family in Southern California and is excited to

move to Mammoth.

Birth Certificate accolades – Mammoth Hospital was recognized as 7th

in the state of California for

submitting accurate & timely birth certificates. Congratulations to our HIMS staff for their hard work.

Strategic Goals

Population Health

Facilitate regular NRACO Steering Committee Meetings – we continue to have monthly

meetings and address several projects/programs such as: Chronic Care Management,

Transitions Care Management, NurseWise program, IT clinical data transfer from Allscripts to

Lightbeam, Patient Engagement/Satisfaction Survey, Wellness Visits, Medicare Diabetic and

Hypertension patients, NRACO’s Evidenced Based Medicine Committee, Mammoth’s High

Risk Patients, and Medicare 2014 Quality reporting. .

Lightbeam system analytics – ensure EMR data from Allscripts is uploaded into Lightbeam and

gain knowledge on how to navigate the Lightbeam system. Mark Lind is working to finalize

the EMR upload into Allscripts and the process going forward for regular updates. I had

another WebEx training on the Lightbeam system to further my knowledge of navigating the

system and identify high risk patients.

Clinical interventions for high risk patients – Activity continues to take place to contact patients

recently discharged from the hospital and emergency room. In addition, FM clinic is working

the list of patients diagnosed with hypertension to ensure they are getting the care protocol for

this chronic condition.

Care Coordination Analyst – I am pleased to announce that Mike Miller has joined our team to

fill this position on June 29th

. Mike is diving into the reports and data needed for the NRACO

in his first two weeks.



CFO Report

August 20, 2015

Page 3 of 3

Expand Clinic Hours

FM Clinic Hours expansion – FM offers appointments on Monday evenings until 6:30pm.

Retail Clinic comprehensive plan – further legal research needs to be done to determine our

ability to offer a Retail Clinic service in our clinic setting.

Orthopedic Clinic patient access – with the addition of Brian Gilmer, additional days and hours

are being offered to our orthopedic patients. In addition, the new Bishop facility will facilitate

improved availability.

Centralized Clinic Services

Standardized procedures in clinics – The first step to centralize services is to standardize

processes over all clinics. A significant amount of activity is taking place on standardization.

The current focus is on: referrals, provider schedules, appointment scheduling, tasking,

scanning, and medication reconciliation. It is important to remove variation to ensure the

highest level of patient care is provided.

Develop a comprehensive plan – The centralized services plan has been reviewed by the clinic

managers and is being presented to the leadership team later this month.

Government Funding Opportunities

District Hospital Leadership Forum (DHLF) - One of the main goals of forming the DHLF

(in 2010) was to get the District hospitals included in the Section 1115 Waiver - Delivery

System Reform Incentive Program (DSRIP). We received notice on March 20, 2015 that due

to the advocacy efforts of the DHLF the DSRIP funding will be available to all public hospitals

(previously only available to Universities & County hospitals). This is a big win for the 40

District hospitals (of which 27 are rural). The California DSRIP proposal was submitted by the

California Department of Healthcare Services (CDHS) to CMS on March 27th

and could bring

$100 million per year for 5 years of funding to the District hospitals. The initial estimate

reflects Mammoth Hospital may be able to access about $400 thousand a year. Of course all of

this is pending CMS approval of the program and funding.

Over the last month there were further meetings by the DHLF to distribute $55 million of

AB113 funds for FY 2014-15 to the District hospitals. These funds are earmarked to

supplement the Medi-Cal managed care inpatient activity which is being paid less than cost.


Report to the Board of Directors August 20, 2015

CNO Report





FROM: Kathleen Alo, Chief Nursing Officer

RE: Nursing Administration Report, Regular Meeting of the Board of Directors

Executive Summary Old Business

None

New Business

Carrie Clotere, Emergency Department RN, and Deanna Dean, Med Surg RN are

commended for going above and beyond putting patients first.

Restructure of Hospital Nurse Management.

Customer Service/Spiritual Care Program is gaining momentum.

The Patient Family Centered Care initiative is moving forward.

The Annual Evaluation of the Quality Improvement Program is complete.

Medical Imaging formed and conducted the first Medical Imaging Committee

meeting.

Strategic Goal

Assigned goal: We will improve our morale, teamwork, civil behavior, employee engagement

scores, employee and provider retention, group harmony, and overall enjoyment in the

workplace by developing a multidisciplinary change management and communication team

that has representation from Medical Staff, Management Team, front line staff, and Senior

Management.

The feedback template has been built.

The feedback template will be in test mode over the next month.

Education of staff and physicians will be completed by the end of September.



CNO Report

Page 2 of 3

Report Detail

People

Carrie Clotere, Emergency Department RN is recognized for going above and beyond. After

caring for a couple involved in a motor vehicle accident that totaled their rent a car, Carrie

found that no other rentals were available for the couple to return to their home in San

Francisco. Carrie was planning a trip to the Bay area and offered to drive the couple back to

their home.

Deanna Dean, Med Surg RN, is recognized for going above and beyond putting patients first.

Deanna volunteered to go over to the Emergency Department on a very busy night shift where

eighteen patients had come in. Deanna was an incredible resource in assisting the Emergency

Room nurse with decompressing the Emergency Department in a timely manner.

I have restructured the hospital Nursing Management to improve efficiency and balance

workloads.

- Lori Baitx, RN, will continue as Nurse Manager of the Emergency Department.

- Nancie Hamilton, RN, will continue as Nurse Manager of Labor and Delivery and will

assume management responsibility over Respiratory Therapy and Chemotherapy.

- Brian Hilliard, RN, has been promoted from Med Surg Supervisor to Nurse Manager of

Med Surg and ICU.

- Roger Diaz, RN, will continue as Nurse Manager over OR/PACU/Central Supply and the

PASS Center.

- Michelle Weber, RN, is stepping down as Nurse Supervisor of PACU but will remain as a

per diem nurse for the PACU.

- We have posted a position for PACU supervisor. Jaymee Davis, RN, is covering the

position on an interim basis.

Quality

The Patient Family Centered Care (PFCC) initiative is moving forward. We have applied for

and have been approved by Beta Healthcare to be an official partner in the Beta/PFCC Partners

Gateways Collaborative – a 9 month project. Nursing staff attended the educational offering by

Libby Hoy during Nurses Week. Stephanie Stanton, RN, Quality Improvement Coordinator,

and Adrienne Burns, RN, Quality Improvement Specialist, attended the Kick Off meeting in

Walnut Creek on June 9 that introduced the program. We have submitted a Vision Statement

which was approved by Libby Hoy, Director of the program. We have submitted a Patient and

Family Advisory Council (PFAC) charter – approved by Libby Hoy and are waiting for

approval.

Scheduled webinars:

August 18 Recruitment Practices

October 21 Orientation and Preparation

December 16 First Meetings



CNO Report

Page 3 of 3

The annual evaluation of the Quality Improvement Program has been completed and

was discussed in the Closed Session today. This evaluation is a requirement of CMS

Service

Customer Service/Spiritual Care Program is gaining momentum. Lori Ciccarelli,

Patient Experience Manager, sees all in-house patients daily. Lori is a regular member

of the interdisciplinary rounding on the Med Surg Unit. She is regularly asked to

consult with patients by the Emergency Department, the Post Anesthesia Recovery Unit

and the Clinics. Lori addresses all social needs of patients and provides them with

resources available in our community. Lori supervises the Service Recovery Program

and works with the Volunteers to provide follow up home visits for patients. This is an

outstanding program for our patients and visitors.

Growth

Medical Imaging formed and conducted the first Medical Imaging Committee

meeting. All Radiologists were present, one via phone conference. They discussed

criteria for peer review, the MRI selection process and vendor meetings as well as

the possibility of expanding the interventional radiology suite. This newly formed

medical committee which will meet quarterly.



Information Technology

August 20, 2015


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





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 Assess Enterprise EMR Market through active involvement of the IT Steering

Committee members and report solution suitability back to the organization. The IT Steering Committee members and a few select subject matter experts

have now reviewed the primary EMR solutions from both Meditech and Cerner.

There has been nearly universal agreement by committee members that both

solution vendors have made significant improvements in their EMR, population

health, and other key modules this past year. The committee will meet on August

19th

to review where we are with our decision to move forward but there seems

to be at least informal consensus that either solution would be a dramatic

improvement over our current suite of software products. Beyond the meeting, I

am arranging for both vendors to provide a full vendor fair for our providers,

managers, and key stakeholders the first week of November.

Strategic Goals

Obtain HITECH Meaningful Use Stage 1, Year 2 objective in Federal Fiscal Year 2015.

o Ambulatory (Clinic) Attestation: Attestation completed for the past fiscal year. Our

ambulatory team has continued to refine the documentation process such that all

providers are documenting in such a way as to ensure that we capture the MU metrics.

Attestation for year two should be a simple matter given our excellent provider

compliance.




August 20, 2015

Page 2 of 6

Obtain HITECH Meaningful Use Stage 2 objective in Federal Fiscal Year 2014. o Inpatient (Hospital) Attestation: We are now in Year 2 of Meaningful Use Stage 2

(with three Stages of MU and two years for each stage) which runs from October 1st,

2014, to June 30th

, 2015. Although this period is for a year currently, CMS has released

a proposed rule change that will allow us to pick any 90 day period as our attestation

reporting period. As of August, the CMS has not yet released the new rule set and is

behind their established timeline. We remain hopeful that the new rules will be released

in time for us to be able to respond to them. As discussed previously, we will greatly

benefit from a 90 day attestation period versus the original year long period as we are

continuing to add surgeons to our CPOE process and continuing to refine processes like

the transitions of care (sending clinical summaries for patients from the hospital to the

clinics for follow up).

Report Detail

Hospital Information Systems:

In July, work was completed on our two new CMS note types for diabetes management and for

Medicare wellness in primary care. These new notes will allow us to more fully document to the

unique requirements of CMS in the standardized template versus constructing the documentation in a

more manual way. Work has also been ongoing into rebuilding the task list that providers and staff use

to manage their system tasks. Initially, too many task list filters were built making it difficult for users

to manage the tasks, with the cleanup, it is far simpler. Beyond system build work, Kate Bradbury, our

Ambulatory Nurse Informaticist has been leading an effort to bring up clinic-based super users to

provide an embedded resource within each clinic for EMR support. Currently we have a single

support person in Kate for all clinics, and she is spread thin. With the super user program we hope to

be able to develop someone that can answer at least the less complex issues with resorting to our

higher level support person. This greatly improves problem resolution time in the clinic as well and

lowers frustration levels. Finally, we performed a significant upgrade to our Dragon voice recognition

solution used by physicians to dictate their clinical notes this past month. The new version had proven

to be far more accurate in correctly translating dictation and has been widely hailed by the physicians

as a major improvement. Dr. Burrows has been incredible in promoting the adoption of the Dragon

tool as a major documentation timesaver, so the upgrade came at an ideal moment.

On the hospital side of the house, the team has been working to bring additional surgeons on to the

computerized provider order entry (CPOE) solution. The decision has been made at the physician and

senior leadership level that we can no longer tolerate a mix of paper orders and electronic orders. This

can have impacts to patient care as it greatly increases the complexity of medication order processing

in particular for our nursing staff. The plan is to build all of the common order sets required by those

physicians not yet processing electronic orders by October 1st. My team has a lot of work to make that

happen in this time period as well as the nursing staff must adapt to the new workflows. Beyond the

CPOE implementation work, my analysts are continuing to work on clean up and optimization of the

upgraded MedHost emergency department EMR upgrade performed back at the end of May. Given

the magnitude of the changes introduced by the upgrade, quite a few issues are still open.




August 20, 2015

Page 3 of 6

IS Operations Summary:

In July the team worked on deploying a couple of major systems replacements for our email filtering

and encryption as well as for our firewall, web-filter and active management solutions. We

consolidated what were five solutions into two, thereby greatly simplifying management and oversite

of the solutions. This cut our operational costs significantly while simultaneously significantly

improving the security of our network operations. Work is ongoing to fully optimize the systems given

our enterprise requirements.




August 20, 2015

Page 4 of 6

Biomed Summary:

The following chart indicates how well the Biomedical Department is performing on our preventative

maintenance compliance activity for organizational medical equipment. Note that we are using a new

system as of February which electronically tracks all required data to optimally comply with our

regulatory oversite.

Month Priority Total WOs WOs Closed Close %

February

HIGH 1 1 100.0

LOW 33 25 75.8

NONE 26 22 84.6

STANDARD 3 1 33.3

Total 63 49 77.8

March

HIGH 1 1 100.0

LOW 35 35 100.0

NONE 45 45 100.0

STANDARD 19 18 94.7

Total 100 99 99.0

April

DAILY ROUNDS 1 1 100.0

HIGH 6 6 100.0

LOW 26 22 84.6

NONE 85 75 88.2

STANDARD 34 33 97.1

Total 152 137 90.1

May

HIGH 1 1 100.0

LOW 37 23 62.2

NONE 18 15 83.3

STANDARD 58 56 96.6

Total 114 95 83.3

June

LOW 31 31 100.0

NONE 26 26 100.0

STANDARD 49 49 100.0

Total 106 106 100.0

July

LOW 21 21 100.0

NONE 13 13 100.0

STANDARD 93 93 100.0

Total 127 127 100.0

Total 662 613 92.6

Report Description: This report shows the preventative maintenance (WO) percentage by month and priority.

This report counts the scheduled work orders opened and closed in the same month (or closed prior to open)

77.8

99.0

90.183.3

100.092.6

0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

80.0

90.0

100.0

100.0%

February

March

April

June

July

Total




August 20, 2015

Page 5 of 6

Biomed had 42 responses to their monthly work order satisfaction survey. All responses were positive,

so the result was 100% for the month of July. This is up a bit from the June response of 97.7% positive

survey responses. Please note that our survey data starts in May of 2015 as that is when we fully

implemented our new HEMS tracking solution.

Telecom Summary:

The Telecom department has been working to finalize the capital project to replace our enterprise wide

phone system. The board-approved capital project will replace all main campus multi-line phone sets

and will replace our obsolete phone switching. This new Shoretel system will allow for a software-

based approach to managing incoming patient calls. Pools of staff will actively manage the incoming

calls to ensure that we answer them and correctly route them to ensure maximum patient satisfaction.

The new call center software will also allow our managers to monitor incoming call performance

ensuring that we are staffed correctly to deal with the incoming call volumes. In addition, the new call

center software will also enable automated appointment schedule reminders.

Jim Nelligan, Telecom Technician, is working to finalize the statement of work for final approval by

Senior Management in mid-August. While the project budget and general scope have been approved,

we are still working through the deployment details. It is our intention to roll out the new phone

system during our off-peak time in the fall when it will least impact our hospital and clinic operations.




August 20, 2015

Page 6 of 6

IT/Help Desk Report:

The Help Desk was considerably busier in July this year than in past years for the same period, with a

total of 482 work orders processed for IT/HIS. In July of FY 15 we processed 293 work orders and in

July of FY 14 we processed 213 work orders. The Help Desk entered a total of 616 total work orders

for the month of July for all service areas.

For our first month of the fiscal year, we had 330 positive IT work order satisfaction survey responses

and 1 negative response. This resulted in an overall score of 99.7% for the month of July.



Human Resources

August 20, 2015






TO: Board of Directors - Southern Mono Healthcare District

FROM: Jeff Byberg, Human Resources Manager

RE: Human Resources Report, Regular Meeting of the Board of Directors

Executive Summary

Old Business: None to report.

New Business: We are moving forward with Kronos Timekeeper upgrade and Kronos Workforce

and Payroll implementation. This will upgrade our current timekeeping system (Kronos) and

replace our existing HR and Payroll software with a single solution that will streamline

administration of these functions. Project timeline is expected to be September 1 – December 31.

Report Detail

People

Open Posted Positions as of August1, 2015:

11 full-time positions

0 part-time positions

6 per diem positions




Human Resources

August 20, 2015

Page 2 of 6

Three-month trend report:

Category May

2015 June 2015

August 2015

Aug. 2014

Active Employees (FT, PT, Per Diem & Seasonal) 332 333 338

313

Inactive Employees 6 7 7

4

# of Active, FT & PT Employees only** 271 274 276

258

# of Active Part Time Employees 13 13 13

13

Paid FTE’s 259.7 260.4 273.9

255.4

Clinical Travelers 2 2 3 3-Month

2

External & Internal Posted Positions 12 16 17 Total

8

Applications Received 86 142 126 354 90

Job Offers 6 11 7 24 11

Employees Hired (FT & PT) 1 3 6 10 CHA 1

Separations (FT & PT) 2 2 1 5 Average* 2

Turnover Rate % .7% .7% .4% 1.8% 2.1% .8%

Hire Rate % .4% 1.0% 2.2% 3.6% 2.7% .4%

Vacancy Rate % 4.4% 5.8% 6.1% 5.4% 4.2% 3.1%

*CHA Average from “Allied for Health Quarterly Turnover and Vacancy Report, 1Q2015”

** Excludes all per diem staff and seasonal staff

235.0

240.0

245.0

250.0

255.0

260.0

265.0

270.0

275.0

280.0

285.0

Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun

# o

f FT

E's

Full Time Equivalents (FTEs) - yearly comparison

FY2012 FY2013

FY2014 FY2015



Human Resources

August 20, 2015

Page 3 of 6

Employee Health Wellness Challenge: July’s challenge was for employees to track their physical activities and earn

40 points. 18 people returned their tracker, with points ranging from 43.5 (Natalie Sanders) to 415

(Tim Tollefson). The winner of the raffle was Karly Dawson, who earned a $100 gift card to the

local sports shop of her choice.

Work Injuries: There were two work related injuries in July, one resulting is a reportable workers

comp claim.

Modified Work Duty: There are four employees on modified work duty; two of those due to work

injuries.

Financial

Budget: Through June, the Human Resources department is favorable to budget by $44,458.

Employee Health is favorable by $6,720.

Health Plan

July 2015: Total paid claims of $225,492. Non domestic claims are 14.3% of total claims or

$32,145 and result in a 15.2% loss ratio compared to AIG contracted rates. There are no large

claims exceeding the specific deducible of $150,000 and 2 claimants who have exceeded 50% of

the ISL. July is the seventh month of the contract period and claimants begin accruing anew each

contract period.

July Mammoth Hospital paid claims account for 71% of claims, higher than the average Mammoth

0

1

2

3

4

5

6

7

8

Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec

2015 Employee Injuries

Total Injuries

Blood/Body Fluid Exposure

Trips, Slips & Falls

Repetitive Motion

Pushing, Pulling

Manual/Patient Handling

All Other

Filed a Work Comp Claim



Human Resources

August 20, 2015

Page 4 of 6

Hospital utilization compared to the 2014 plan year. Average claim costs are $989 per employee

per month excluding large claims.

Plan Year through July 2015 (Jan-July): Total non-domestic paid claims of $326,070 vs.

expected contract claims of $1,475,478 results in a loss ratio of 22.1%, lower than June' loss ratio of

23.3%, excluding large claims. Average claim costs are $756 per employee per month excluding

large claims. 96.4% of all claims are between $0 and $1,000 and represent 27.7% of total paid

claims.

Mammoth Hospital paid claims account for 51.4% of claims year to date. This is on par with June’s

share of 51.3%. Anthem’s network discounts year-to-date are 51.4% of all eligible costs, on par

with 2014 plan year’s discounts of 51.6%.

Monthly Census: July enrollment: 228 benefited employees, (6 more participants as prior year,

and 3 more than prior month). With 287 dependents, total census for the health plan is 515

participants.

Average Monthly Average Annual

Plan Number of Paid Claims Paid Claims

Year Employees Paid Claims Per Employee Per Employee

2007 251 $3,049,234 $1,014 $12,169

2008 265 $3,886,421 $1,224 $14,693

2009 261 $3,778,146 $1,206 $14,476

2010 234 $2,603,973 $926 $11,112

2011 224 $2,387,104 $889 $10,673

2012 223 $3,222,109 $1,203 $14,433

2013 222 $3,641,427 $1,644 $16,440

2014 221 $3,337,415 $1,258 $15,090

Note:

MAMMOTH HOSPITAL

Paid Claims Experience

2013 plan year was 10 month shortened policy period to account for January effective date change

Average YTD Monthly

Month/ Number of Monthly Paid Claims Year to Date Avg Pd Claim

Year Employees Paid Claims Per Employee Paid Claims Per Employee

Jan-15 230 $220,872 $960 $220,872 $960

Feb-15 230 $110,050 $478 $330,921 $207

Mar-15 229 $161,321 $704 $492,243 $308

Apr-15 227 $131,753 $580 $623,996 $391

May-15 226 $194,882 $862 $818,878 $513

Jun-15 226 $162,946 $721 $981,825 $615

Jul-15 228 $225,492 $989 $1,207,317 $756

Aug-15

Sep-15

Oct-15

Nov-15

Dec-15

Medical



Human Resources

August 20, 2015

Page 5 of 6

Plan

Year ISL Deductible

# of Large

Claims

Re-imbursed

amount

ISL Billed

Premium 1 Net Gain/Loss

2007 $50,000 12 $501,771 $467,797 107%

2008 $50,000 17 $740,022 $654,987 113%

2009 $50,000 17 $450,031 $808,830 56%

2010 $75,000 4 $685,697 $548,862 125%

2011 $100,000 1 $150,298 $522,537 29%

2012 $100,000 8 $379,972 $590,861 64%

2013 $125,000 4 $761,400 $402,935 189%

2014 $150,000 4 $241,821 $466,126 52%

Note:

MAMMOTH HOSPITAL

Paid Claims Experience and ISL Analysis

2013 plan year was 10 month shortened policy period to account for January effective date

Month/

Year

Number of

Employees

Monthly

Paid

Claims

ISL

Re-imbursement 2

Adjusted Year

to Date Paid

Claims

YTD Monthly

Avg Paid

Claim per

Employee

Jan-15 230 $220,872 $0 $220,872 $960

Feb-15 230 $110,050 $0 $330,921 $207

Mar-15 229 $161,321 $0 $492,243 $308

Apr-15 227 $131,753 $0 $623,996 $391

May-15 226 $194,882 $0 $818,878 $513

Jun-15 226 $162,946 $0 $981,825 $615

Jul-15 228 $225,492 $0 $1,207,317 $756

Aug-15

Sep-15

Oct-15

Nov-15

Dec-15

2 Re-imbursement represented amount earned/incurred for plan year over $150,000 specific

1 Billed premium estimated based on 2007-2009 enrollment snapshots taken from annual renewal

Mammoth Hospital

Month/

Year EEs RX Claims

2007 251 $772,922 $1,983,932 $292,380 $3,049,234 65%

2008 265 $1,361,652 $2,165,017 $359,751 $3,886,421 56%

2009 261 $944,191 $2,518,522 $315,433 $3,778,146 67%

2010 234 $1,037,066 $1,312,521 $254,386 $2,603,973 50%

2011 224 $765,471 $1,269,139 $352,494 $2,387,104 53%

2012 223 $1,571,197 $1,278,630 $372,282 $3,222,109 40%

2013 222 $1,917,283 $1,373,100 $351,044 $3,641,427 38%

2014 221 $1,689,468 $1,297,355 $350,592 $3,337,415 39%

Note:

Jan-15 230 $55,409 $124,313 $41,149 $220,872 56%

Feb-15 230 $27,968 $63,231 $18,850 $110,050 57%

Mar-15 229 $47,437 $79,184 $34,700 $161,321 49%

Apr-15 227 $39,335 $66,080 $26,339 $131,753 50%

May-15 226 $46,575 $108,960 $39,348 $194,882 56%

Jun-15 226 $77,200 $63,446 $22,300 $162,946 39%

Jul-15 228 $32,145 $160,134 $33,213 $225,492 71%

Aug-15

Sep-15

Oct-15

Nov-15

Dec-15

Year to

Date Total1,596 $326,070 $665,348 $215,899 $1,207,317 55%

2013 plan year was 10 month shortened policy period to account for January effective date change

MAMMOTH HOSPITAL

Paid Claims Non Mammoth, Mammoth and RX Cost Experience

Non Mammoth

Provider Claims

Mammoth Hospital

Claims

Total Claim

Cost

Percentage of

Total Claims



Human Resources

August 20, 2015

Page 6 of 6

Quality

Recruiting/Advertising: Applicant source by medium for month: (44) “Hospital web-site”, (31)

“Referral from Employee/Friend”, (10) “Other Job Board”, are top referrals for applications for

month.

Hire source by medium Fiscal Year-to-date: (109) “Referral from Employee/Friend, (55) “Other

Job Board, (51) “Hospital web-site”, (28) “Former Employee”, (7) “Walk in”, and (1) “Former

Patient”.

Anonymous Feedback submissions received by HR in July: 3

No identifiable trends to report from the above submissions.

Provider Eligible Total

Network

Discounts

Network

Discount % Total Paid

1. Mammoth Hospital

Inpatient $15,942 $7,971 50% $6,741

Outpatient $749,957 $374,126 50% $315,677

Room & Board $202,513 $101,257 50% $97,844

Surgeon/Anesthesiologist $276,008 $141,426 51% $122,581

Professional Services $214,645 $108,258 50% $83,464

X-ray $33,654 $16,827 50% $13,572

Laboratory $17,969 $8,985 50% $6,491

Psychiatric $2,410 $1,205 50% $1,085

Other $39,222 $19,544 50% $17,894

Total $1,552,320 $779,598 50% $665,348

2. Northern Inyo Hospital

Outpatient $93,748 $1,743 2% $70,687

Other $32,635 $326 1% $32,309

Total $126,383 $2,069 2% $102,996

3. Renown Regional Medical

Outpatient $69,981 $44,646 64% $23,061

Room & Board $73,802 $33,905 46% $39,897

Total $143,782 $78,551 55% $62,958

4. Siera Aviation

Other $44,260 $22,130 50% $14,791

Total $44,260 $22,130 50% $14,791

5. St Marys Regional Medical

Room & Board $42,093 $27,363 65% $14,730

Total $42,093 $27,363 65% $14,730

Top 5 Hospital Total Claims $1,908,838 $909,711 48% $860,823

All other claims $1,046,801 $609,050 58% $346,493

Total $2,955,639 $1,518,681 51% $1,207,317

MAMMOTH HOSPITAL

Top 5 Provider Utilization Detail

Policy Year to Date 2015


Board of Directors Report

Facilities Department

August 20, 2014


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





FROM: Dan Conners, Facilities Manager

RE: Facilities Report, Regular Meeting of the Board of Directors

Key Performance Indicators

Preventive Maintenance 98% complete

*Security Rounds Doors were found unlocked on 4 occasions

Projects 3 projects in progress

Work order reports for Environmental Services and Maintenance are

currently in development.

98%

4 doors found

unlocked Roof-top

mechanical room repair

60% complete

Parking lot repair

45% complete

Lab equipment installtion

20% complete


ACHD Monthly Update for July 2015

Executive Director Update Pepperdine University's School of Public Policy is now accepting applications for the 2015 Public Engagement Grant. If your organization has a public engagement project that could use financial support, the Annual Public Engagement Grant Program may be just what you need. This marks the 8th consecutive year of offering funded consulting services to California's cities, counties, Special Districts and civic organizations on a variety of issues. For more information on this grant opportunity click here. Sheila Johnston and I recently met with Eric Brown, President and CEO, California Telehealth Network (CTN), to discuss opportunities for collaboration between our two organizations. In addition, CTN and ACHD have agreed to look for grant opportunities that enhance our members’ ability to continue to improve their infrastructure needs. Jean Hurst, Partner at Brooks Hurst Espinosa, LLC, and I recently met with Martin Gonzalez, Executive Director, California Institute for Local Government. The Institute membership is comprised of the California County Supervisors Association, the California League of Cities, and the California Special Districts Association. Their mission is to provide shared educational services that will assist local governments to improve their governance and management through best practices. As ACHD is continuously evaluating the cost and variety of internal educational programs we provide our Members, we have been exploring opportunities to partner with the Institute on future programs that may benefit our Members, provide expanded networking with other elected officials statewide, and reduce costs. Neil McCormick, Executive Director, California Special Districts Association (CSDA), and I also had an opportunity to meet this month and discuss continued collaboration between CSDA and ACHD regarding advocacy and common interests. We discussed the impacts of LAFCOs with Special Districts and some recent activity in this regard. Lastly, we reaffirmed our continued commitment to collaborate with CSDA to monitor and evaluate potential state legislation that might impose consolidation of Special Districts in the future. Lisa Maas, Executive Director, California Allied for Patient Protection (CAPP), and I met this month to continue the collaboration between ACHD, CAPP and its partners. CAPP is a broad-based organization of physicians, dentists, hospitals, community clinics, health centers, nurses, emergency providers, public safety, local governments, labor unions, women's health advocates and other health care professionals throughout California whose sole purpose is to protect access to health care and patient safety through California's Medical Injury Compensation Reform Act (MICRA). Earlier in July I met with Lee Michelson, Chief Executive Officer of Sequoia Healthcare District. Lee presented the ACHD and ALPHA Fund with an Automated External Defibrillator to place in our Granite Bay office. I would like to extend a huge thank you to Sequoia Healthcare District for providing the ACHD and ALPHA Fund office with this life saving device. ACHD Staff will be recommending to the ACHD Education Committee and our Board, to establish a relationship with Capella University for online education programs primarily targeted toward nursing and other ancillary staff. At no cost to ACHD or Members, employees and their families will be entitled to a significant tuition discount and be eligible for tuition scholarship support. Capella University is a fully accredited educational organization that is also recognized by various California State professional licensing boards.

http://www.achd.org/2015/07/30/2015-public-engagement-grant-program-from-pepperdine-universitys-school-of-public-policy/

http://www.caltelehealth.org/

http://www.ca-ilg.org/

http://www.csda.net/

http://micra.org/

http://micra.org/micra/history-of-micra.html

http://micra.org/micra/history-of-micra.html

Lastly, if you can please make a note: ACHD’s Annual Dues Letters were mailed to our Members the week of July 27th. For the past several years, there has not been any dues increase. Therefore, your prompt payment will assist ACHD and our team in providing you with the best services possible and help us continue to operate efficiently without increasing costs to you.

Google - Brand Health: Health, Innovation and 10X Thinking Google has extended a special invitation to ACHD Members to attend a special educational event, being offered at their headquarters in Mountain View, California. The event, Brand Health: Health, Innovation and 10X Thinking, will take place on August 13th, 2015. Those who attended our Annual Meeting in May will recall the outstanding presentation given by Gyre Renwick of Google; Gyre provided a powerful presentation regarding the world of technology, and how consumers and the healthcare industry are adapting right alongside it. Consumers are increasingly making their health a top priority, and healthcare organizations that can provide innovative solutions will thrive. During this event you'll hear from various Googlers who are working on groundbreaking projects in the health and wellness space. To reserve your seat at this exciting event, click here.

ACHD Announces Expanded Downtown Office Space With the arrival of new furniture and work stations, ACHD is pleased to announce that the update of our expanded downtown office is nearly complete. The downtown office located at 1215 K Street is just a short walk from the State Capitol. It is home to the Advocacy Team, Member Services, Executive Director, and a conference facility. The office also provides members with comfortable seating, Wi-Fi, and business support services. Office artwork is still on order, but the photos that Members have provided will help ACHD capture the spirit and diversity of California’s Healthcare Districts. Healthcare District Trustees and Executives may utilize the ACHD office as a place to rest, connect on-line and work while in Sacramento on District business. ACHD invites you to visit the new space the next time you’re in Sacramento. Please contact Sheila Johnston at if you would like to schedule a visit or if you have any questions.

Panoramic Office View

https://docs.google.com/forms/d/1NyUPL3c50Z8-Fd68Zzxl164qOX13WYvaigL01e0VbHo/viewform

mailto:[email protected]

Conference Room

Reception

CEO Evaluation Available free of charge to all Member Healthcare Districts, ACHD offers an online Healthcare District CEO Evaluation Tool for assessing how each District Trustee perceives the CEO to be performing. There are two options; one for District CEOs no longer managing a hospital and one for District CEOs who do manage a hospital. The ACHD Board strongly encourages each District Board to complete a CEO Evaluation on an annual basis. Members interested in completing the CEO Evaluation may email Sheila Johnston.


Board Self-Assessment Tool ACHD makes available at no charge to its members, an on-line Board Self-Assessment Tool for assessing how each Trustee perceives the Board to be functioning. There are two Self-Assessment options; one for Districts no longer managing a hospital and one for Districts which do manage a hospital. The survey takes about 35 minutes to complete, responses are anonymous and the results only shared with the participating Board and Associations education committee. The ACHD Board strongly encourages each District Board to complete a Self-Assessment on an annual basis. For more information, please contact Sheila Johnston.

Certified Healthcare District As public entities, Healthcare Districts have well-defined obligations for conducting business in a manner that is open and transparent. To assist ACHD Members in demonstrating compliance with these obligations, the ACHD Governance Committee has developed a core set of standards referred to as Best Practices in Governance. Healthcare Districts that demonstrate compliance with these practices will receive the designation of ACHD Certified Healthcare District. Districts achieve Certification by demonstrating compliance with public agency reporting requirements in the following areas:

Transparency Website Content Executive Compensation and Benefits State Agency Reporting Financial Reporting

To date, the following Healthcare Districts have achieved certification status:

• Antelope Valley Healthcare District November, 2014

• Beach Cities Health District October, 2014

• John C. Fremont Healthcare District March, 2015

• Palomar Health August, 2014

• Petaluma Health Care District May, 2015

• Sequoia Healthcare District August, 2014

Members interested in applying for Certified Healthcare District status should contact Ken Cohen.



Legislative Updates Friday, July 17 was the deadline for policy committees to hear and pass bills; the Legislature left for their summer recess that week and is gone until August 17, 2015. The major health issues awaiting legislative discussion and potential action at the end of session include: 1) the Second Extraordinary Session on health care; 2) Medicaid Section 1115 waiver renewal legislation; and 3) the California Children’s Services (CCS) program. For a complete summary of the Legislative Update, please click here. To access the Legislative Report click here. To access the Watch Report click here.

A Report by ACHD’s Senior Legislative Advocate, Amber King Last week I attended the Annual Educational Conference hosted by the California Coalition on Workers’ Compensation (CCWC). With the changing landscape of workers’ compensation, there is often much to learn from each educational and general session. A number of lobbyists all working on workers’ comp in different industries are usually in attendance, creating the perfect opportunity for relationship building. The most informative session centered on the creation of a prescription formulary within the workers’ comp system in California. This session discussed the two other states that have created their own formulary, Texas and Washington, and how California can learn from those very different processes. In addition, the panel included a physician’s perspective that highlighted the need to keep the patient at the center of the discussion. This session is perfectly timed, as the Legislature is currently working on a bill, AB 1124 by Assemblymember Perea, to require the Administrative Director of the Division of Workers’ Compensation (housed within the Department of Industrial Relations) to create a formulary in California. ACHD and ALPHA Fund are actively involved in this discussion, working with a stakeholder group, which includes the CCWC. The highlight of the conference was hearing from the Secretary of the California Labor and Workforce Development Agency, David Lanier and the Director of the Department of Industrial Relations, Christine Baker. For the past few years they have each given an update on the Department and the forward progress toward full implementation of the reforms passed in 2012 through SB 563. This year David Lanier announced during his presentation that the Department will be moving forward with the creation of a prescription formulary using the authority they believe they currently have without legislation. This is a huge step in the right direction for decreased costs and friction in the system. Stay tuned for more information on workers’ comp legislation, and specifically on the creation of the formulary in California. Please contact Amber King with questions.

http://www.achd.org/wp-content/uploads/sites/6/2014/10/HBE-Leg-Update.pdf

http://www.achd.org/wp-content/uploads/sites/6/2015/08/Legislative-Report-August-2015-Update.pdf

http://www.achd.org/wp-content/uploads/sites/6/2015/08/Watch-Report-August-2015-Update.pdf

http://ccwcworkcomp.org/

http://ccwcworkcomp.org/

http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201520160AB1124


ACHD’s 2016 Events Please mark your calendars for our events taking place in 2016!

• January 20-22, 2016: Leadership Development Program, Sacramento, CA • April 4-5, 2016: Legislative Days, Sacramento, CA • May 3-6, 2016: Annual Meeting, Monterey, CA

ACHD is focused on Wellness For over a year and a half, ACHD and ALPHA Fund have been committed to company wellness. Formed in January of 2014, “Simple Steps to Wellness” is a program aimed to educate and promote wellness practices in our workplace and at home. Sheila Johnston, Member Services Specialist for ACHD; Diana Watts, Senior Administrative Assistant for ALPHA Fund; Jolie Bakken, Business Analyst for ALPHA Fund; and Betsy Leff, Loss Prevention Specialist for ALPHA Fund, make up the Wellness Team. The Wellness Team promotes health and wellness monthly, sending out tips and information, and creating a challenge aligned with each monthly theme. Past wellness themes and challenges have included:

• Commit to Fitness: Create or maintain a fitness and health routine for the month • Focus on Water: Drink 8, 8 ounce cups of water daily • An Apple a Day: Eat one apple a day

In addition to sending monthly tips and information, the Wellness Team profiles an employee that has embraced health and wellness in their lives each month. The Wellness Team also incorporated a “Footsteps to Success” challenge, where by our employees can commit to meeting weekly exercise benchmarks. During two separate sessions of Footsteps to Success, ACHD and ALPHA Fund employees achieved the following:

Activity Total Exercise (Miles or Hours)

Walking 2,648.14 Miles Cycling 3,896.2 Miles

Multisport (Tennis, Zumba, Interval, Hiking, etc). 1,145.24 Hours

ACHD and ALPHA Fund are very pleased with the success of the Wellness Program and look forward to promoting the health and wellness of all employees moving forward. For more information, please contact Sheila Johnston.






Strategic Planning Conference

Draft Agenda

October 30, 2015

1. Review of FY 2014-15 – Key Performance Indicators, statistics, overall results, successes and failures.

2. 5-minute presentations on existing initiatives a. Development of standardized clinic administrative services, EBP, team-based

care b. Development of regional orthopedic service c. Community health awareness/prevention/wellness d. Improvement of organizational culture e. Quality – accreditation, public reporting, total quality management f. Mammoth Hospital Foundation – growth and development g. Affiliation with academic medical center in S. CA

3. Emerging Priorities

a. Enterprise-wide EMR b. Do we need more clinic space? c. Priority of Community Needs Assessment – what, how, with whom? d. Review of Master Facilities Plan e. Creation of Long-Range Capital Plan? f. Chronic Pain Management / Opioid dependence Program/Clinic/Services g. Behavioral Health comprehensive access/care program h. What else??




CEO Report

August 20, 2015


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





FROM: Gary Myers, CEO

RE: CEO Report, Regular Meeting of the Board of Directors

Executive Summary Physician Recruiting Efforts

Hospitalist Program

Update on Affiliation Agreement with Loma Linda University Medical Center

Medical Office Building Improvement Project

Summer Maintenance Projects

EMR Selection Process

MRI Selection Process

Strategic Planning Conference Input for Agenda

Report Detail

Physician Recruiting Efforts

Dr. Burrows and Jeff Byberg are taking the lead in recruiting new Family Medicine physicians to our

Rural Health Clinic. We have reached out to final year residents at approximately 25 Family Practice

residency programs in California. We are also offering a finder’s fee to employees and medical staff

who refer a candidate that we ultimately contract with. We are evaluating search firms to assist us

with sourcing qualified applicants as well. At this point in time, I believe we will need to retain a

locum tenens physician beginning in November.

Hospitalist Program On August 1

st, we transitioned from Rural Physicians Group (RPG) providing hospitalist services to

directly contracting with a 3-member physician group: Drs. Burrows, Araya, and Park. RPG has

offered to provide any needed backup or emergency coverage that may be required in the future. We

have a modified agreement for your review and approval on the agenda this month.




CEO Report

July 16, 2015

Page 2 of 3

Affiliation Update

David Baumwohl is preparing the first draft of the Affiliation Agreement between the District and

Loma Linda University Medical Center. We hope to have that ready for your preliminary review at

your meeting. We will send the draft to Loma Linda officials once it is complete for their review and

comment or, hopefully, approval. We are currently working with Loma Linda’s Purchasing Director

to review potential cost saving opportunities that may exist through volume-based tier pricing.

Medical Office Building Improvement Project

We had one contractor submit a bid on the scaled down Medical Office Building project but the bid

came in over budget. We’ve asked our architect to value engineer the project one final time in the

hope that we can complete our goal of improving the safety of the north entrance of the building before

winter. We are recommending that you reject the bid we received and that you authorize us to solicit

bids again on the modified project.

Summer Maintenance Projects

Work is complete on parking lot repairs and Ron Kuppens Roofing is making good progress on

rehabilitating the south mechanical room exterior and should finish that project in the next couple of

weeks. We are replacing flooring in a room located in the 1978 hospital building. Asbestos abatement

is complete and new flooring should be laid in the next week. The chemistry analyzer replacement

project in the Lab is also progressing on schedule. We are currently obtaining bids to replace carpeting

and to paint the interior of the Mammoth S.P.O.R.T. Center building.

EMR Selection Process

The I.T. Steering Committee made a decision late this past spring to re-visit enterprise-wide EMR

systems for our hospital. We have had MediTech and Cerner provide high level overviews of their

systems and preliminary quotes. Either of these solutions could replace the three clinical systems we

now operate. The I.T. Steering Committee will meet later this month to determine if we want to move

ahead with a much more in-depth look at both of these systems to determine a preference and make a

final selection. This would be a huge undertaking for our hospital and clinics but is definitely needed

for us to continue to progress on the transition to value-based care.

MRI Replacement Project

We have had four vendors provide quotes on a turn-key MRI replacement project. We have a meeting

coming up later this month to analyze those quotes with our team and narrow the field. Some

discussion has come up in the review process of whether or not it is advisable to install a new unit in

the inpatient setting. More than 90% of our MRIs are outpatient-based. Our current lease agreement

on the mobile unit is very cost effective.

Strategic Planning Conference

As a reminder, our annual Strategic Planning Conference will be held on Friday, October 30th

from

0800-1200 at a location TBD. In addition to the Board, Management Team and Medical Staff, we are

inviting Mono County Public Health, Mono County Behavioral Health, representatives from Town

Council, the Board of Supervisors, MUSD, and MMSA to broaden our perspective. We will have a

preliminary agenda for your review in this month’s Consent Agenda and welcome any input for

additional agenda items that you may have.



CEO Report

July 16, 2015

Page 3 of 3

As always, please do not hesitate to contact me directly with any questions or concerns regarding

District operations.

Respectfully submitted,

Gary Myers, PT, MA, OCS

Chief Executive Officer

2013 Press Ganey Beacon of Excellence Award Winner

MEMORANDUM

==============================================================================


TO: The Board of Directors

FROM: Melanie Van Winkle, CFO

SUBJECT: Financial Statements for the 1 month ended July 2015

==============================================================================

This memorandum presents an overview of Mammoth Hospital operations.

BALANCE SHEET

Cash (including investments) totaled $38.0 million at the end of July 2015. This was a $516 thousand

decrease from June (see Cash Flow for further discussion). Net patient receivables totaled $6.9 million

at the end of July, which is $422 thousand higher than June, mainly due to higher patient volume in July.

Gross days in AR in July were 57.2 days, compared to 52 days in June. AR aged over 120 days decreased

in July to 22.9% from 27.6% in June mainly due to increased revenue for July. Debt Service Fund, accrued

interest on long term obligation and General obligation bonds decreased combined by $1 million due to

annual bond payment paid via Mono County. Due to (from) third party payers decreased by $843

thousand due to payment of FY 2011 Medi-Cal Cost Report settlement.

CASH FLOW

July resulted in a $516 thousand decrease in cash – mainly due to a large prior year Medi-Cal cost report

settlement of $870 thousand. Patient cash collections at $4.9 million were $655 thousand under target.

Days of cash on hand were 261.4 which is 3.5 days less than June. The June 30, 2016 days cash on hand

goal is 281.

VOLUMES

Total acute inpatient days were 102 in July, compared to June of 72. Increased patient days directly

correlate to increase in inpatient surgeries (30 in July vs 19 in June). Average length of stay was 1.8 in

July compared to 1.9 Budget and 2.3 for prior year. However the average daily census went up from 2.4

to 3.3. Case mix index (severity of inpatients treated at facility) – went up in July to 1.485 vs 1.288 in

June. In July we treated 56 inpatients vs 50 in July 2014.

Inpatient surgical cases in July were 30 which were 3 under budget; however outpatient surgeries

increased significantly to 86 – 14 more than budget and last year’s total (72).

ED visits were 1,090, which was higher than both last July’s total of 1,015 and budget of 1,050. Radiology

visits are trending higher due to increased ED visits volumes – 1,372 actual vs 1,230 budget. July clinic

visits continued to be higher than budget at 3,792 (741 visits over budget and 848 visits over last July’s

total). In particular, Family Medicine, Dental, Mammoth Ortho, Pediatrics, Bishop Ortho clinics far

exceeded budget and prior year.

INCOME STATEMENT

Revenue:

In July, gross patient revenue was $8.9 million which was at budget. Total operating revenue was $5.1

million, which was $340 thousand lower than budget.

Expenses:

Salaries expense was $1.5 million in July, $155 thousand under budget. The benefits expense in July

was $692 thousand which was $14 thousand over budget due to increase in-house claims. Total

productive FTE’s increased to 241 in July (223 in June) due to increase in summer business. Adjusted

Occupied Beds per productive FTE ratio went down from 23.5 in June to 17.6 in July due to increase in

business. Total operating expenses were $4.5 million in July - $426 thousand lower than budget.

Net Gain (Loss):

July’s gain was $589 thousand which was $96 thousand better than budget; and $136 thousand lower

than prior year. The total margin for July 2015 was 11.3% compared to the budgeted total margin of

8.9%.

8/12/2015

SOUTHERN MONO HEALTH CARE DISTRICT

Comparative Balance Sheet - July 31, 2015

Unaudited Unaudited Unaudited

Jul 31, Jun 30, Prior Month June 30,

ASSETS 2015 2015 Change 2015

CURRENT ASSETS:

Cash (including LAIF Fund) 29,188,336 29,717,792 ($529,456) $29,717,792

Investments 8,774,254 8,760,712 13,542 8,760,712

Total Cash 37,962,590 38,478,504 (515,914) 38,478,504

Patient accounts receivable 14,665,693 13,344,466 1,321,227 13,344,466

Less: Allow. for bad debts and contractuals (7,761,527) (6,861,970) (899,557) (6,861,970)

Net patient accounts receivable 6,904,166 6,482,496 421,670 6,482,496

Inventory 1,867,843 1,859,492 8,351 1,859,492

Prepaid expenses & deposits 627,639 431,457 196,182 431,457

Other current assets 897,220 590,460 306,760 590,460

Total Current assets 48,259,458 47,842,409 417,049 47,842,409

ASSETS LIMITED AS TO USE:

Bond funds held in trust by Mono County:

Mono Co Bond Capital Appreciation Fund 5,526,085 5,526,085 0 5,526,085

Debt service fund (82,145) 955,432 (1,037,577) 955,432

Restricted by contributors 202,818 206,542 (3,724) 206,542

Total Assets Limited As To Use 5,646,758 6,688,059 (1,041,301) 6,688,059

PROPERTY, PLANT & EQUIPMENT:

Land and improvements 5,453,480 5,453,480 - 5,453,480

Buildings and improvements 51,453,031 51,453,006 25 51,453,006

Major Moveable Equipment 19,736,897 19,710,562 26,335 19,710,562

Siemens implementation 2,630,555 2,625,312 5,243 2,625,312

Construction-in-progress 57,549 41,719 15,830 41,719

Total Property, Plant and Equipment 79,331,512 79,284,079 47,433 79,284,079

Less: Accumulated depreciation (38,204,386) (37,893,829) (310,557) (37,893,829)

Less: Accumulated amortization (1,949,168) (1,949,167) (1) (1,949,167)

Net Property, Plant and Equipment 39,177,958 39,441,083 (263,125) 39,441,083

Total Assets $93,084,174 $93,971,551 ($887,377) $93,971,551

Page 1

8/12/2015


Comparative Balance Sheet - July 31, 2015

Unaudited Unaudited Unaudited

Jul 31, Jun 30, Prior Month June 30,

LIABILITIES 2015 2015 Change 2015

CURRENT LIABILITIES:

Accounts payable and accrued expenses $2,074,203 $2,053,297 $20,906 $2,053,297

Accrued payroll-related liabilities 2,599,701 2,354,076 245,625 2,354,076

Patient refunds 130,314 90,383 39,931 90,383

Due to (from) third party payers 2,088,145 2,931,459 (843,314) 2,931,459

Accrued interest on long term obligations 6,541 255,520 (248,979) 255,520

Current portion of long-term debt 825,000 740,000 85,000 740,000

Health plan IBNR 323,623 323,623 0 323,623

Total Current liabilities 8,047,527 8,748,358 (700,831) 8,748,358

LONG-TERM DEBT:

Unamortized bond premium 1,567,468 1,578,137 (10,669) 1,578,137

Capital appreciation interest payable 6,081,383 6,017,997 63,386 6,017,997

General Obligation Bonds 16,699,555 17,524,555 (825,000) 17,524,555

Long-term debt - - 0 -

Total long term debt 24,348,406 25,120,689 (772,283) 25,120,689

Total Liabilities 32,395,933 33,869,047 (1,473,114) 33,869,047

NET ASSETS:

Invested in capital assets net of related liabilities 14,004,552 13,580,394 424,158 13,580,394

Restricted - expendable for specific operating activities 202,818 206,542 (3,724) 206,542

Restricted - expendable for capital acquisitions 0 0 0 0

Restricted - expendable for debt service 5,443,940 6,481,517 (1,037,577) 6,481,517

Unrestricted 40,447,468 33,411,364 7,036,104 33,411,364

Year to date earnings 589,463 6,422,687 (5,833,224) 6,422,687

NET POSITION: 60,688,241 60,102,504 585,737 60,102,504

Total Liabilities and Net Position $93,084,174 $93,971,551 ($887,377) $93,971,551

Page 2


Statement of Revenues & Expenses - July 31, 2015

Prior Month Actual Budget

Variance to

Budget Prior Year

Variance to

Prior Year OPERATING REVENUE Actual Budget

Variance to

Budget Prior Year

Variance to

Prior Year

(000s omitted)

$1,370 $1,762 $2,362 ($600) $2,445 ($683) Inpatient services $1,762 $2,362 ($600) $2,445 ($683)

3,586 4,816 4,179 637 4,063 753 Outpatient services $4,816 $4,179 637 4,063 753

1,379 1,648 1,701 (53) 1,758 (110) Professional fees services $1,648 $1,701 (53) 1,758 (110)

726 674 630 44 608 66 Clinic services $674 $630 44 608 66

7,061 8,900 8,872 28 8,874 26 Total Gross Revenue 8,900 8,872 28 8,874 26

(2,059) (3,455) (3,149) (306) (3,304) (151) Contractual & other discounts (3,455) (3,149) (306) (3,304) (151)

(239) (26) (167) 141 (85) 59 Charity write offs (26) (167) 141 (85) 59

712 (271) (68) (203) (252) (19) Provision for bad debts (271) (68) (203) (252) (19)

932 - - - - - Prior Year Adjustments - - - - -

6,407 5,148 5,488 (340) 5,233 (85) Net Patient Revenue 5,148 5,488 (340) 5,233 (85)

69 44 59 (15) 14 30 Other operating revenue 44 59 (15) 14 30

$6,476 $5,192 $5,547 ($355) $5,247 ($55) Total Operating Revenue $5,192 $5,547 ($355) $5,247 ($55)

OPERATING EXPENSES

1,473 1,554 1,709 155 1,400 (154) Salaries 1,554 1,709 155 1,400 (154)

641 692 678 (14) 651 (41) Benefits 692 678 (14) 651 (41)

1,052 1,142 1,154 12 1,170 28 Professional services 1,142 1,154 12 1,170 28

83 48 88 40 93 45 Contract services 48 88 40 93 45

272 494 538 44 492 (2) Supplies 494 538 44 492 (2)

1,044 627 816 189 602 (25) Services 627 816 189 602 (25)

4,565 4,557 4,983 426 4,408 (149) Total Expenses 4,557 4,983 426 4,408 (149)

1,911 635 564 71 839 (204) OPERATING GAIN (LOSS) 635 564 71 839 (204)

308 302 306 4 319 17 Depreciation & amort 302 306 4 319 17

$1,603 $333 $258 $75 $520 ($187) Operating Gain (Loss) after Depreciation $333 $258 $75 $520 ($187)

NON-OPERATING INCOME(EXPENSE)

- - - - - - Gain (loss) on sale of property - - - - -

(26) 4 5 (1) 2 2 Donation income 4 5 (1) 2 2

36 174 174 - 164 10 Bond property tax revenue 174 174 - 164 10

(109) (110) (112) 2 (110) - Bond interest expense (110) (112) 2 (110) -

247 163 166 (3) 161 2 Property tax revenue & interest income 163 166 (3) 161 2

(108) 25 2 23 (12) 37 Interest expense 25 2 23 (12) 37

40 256 235 21 205 51 Total Non-Operating Income (expense) 256 235 21 205 51

$1,643 $589 $493 $96 $725 ($136) Increase in net assets - net gain (deficit) $589 $493 $96 $725 ($136)

25.4% 11.3% 8.9% 2.5% 13.8% -2.5% Total Margin 11.3% 8.9% 2.5% 13.8% -2.5%

July-15 Year-to-Date

Page 3


Cash flow Report as of July 31, 2015

July 2015

Actual Budget Actual Budget

MTD MTD Variance CASH RECEIPTS YTD YTD Variance

$4,907,417 $5,273,356 ($365,939) Patient Account Payments $4,907,417 $5,273,356 ($365,939)

0 (33,333) 33,333 3rd Party Settlements 0 ($33,333) 33,333

0 0 0 Property Taxes 0 $0 0

13,542 2,977 10,565 Gain/Loss on Investments 13,542 $2,977 10,565

42,684 42,684 Other 42,684 0 42,684

$4,963,643 $5,243,000 ($279,357) Total Cash Receipts $4,963,643 $5,243,000 ($279,357)

DISBURSEMENTS

$1,983,456 $2,386,417 $402,961 Salaries, Wages & Benefits $1,983,456 $2,386,417 $402,961

1,034,872 1,154,483 119,612 Physician Fees 1,034,872 $1,154,483 119,612

91,607 88,241 (3,366) Contracted Services 91,607 $88,241 (3,366)

529,571 538,215 8,644 Supplies 529,571 $538,215 8,644

854,519 816,047 (38,473) Services 854,519 $816,047 (38,473)

$4,494,025 $4,983,404 $489,379 Total Profit and Loss Disbursements $4,494,025 $4,983,404 $489,379

BALANCE SHEET ITEMS

$88,497 $197,463 $108,965 Capital Purchases $88,497 $197,463 $108,965

0 0 0 Debt Service/Land Purchase 0 $0 0

870,149 0 (870,149) Third Party Settlement 870,149 0 (870,149)

30,610 30,000 (610) Patient Refunds 30,610 30,000 (610)

$989,256 $227,463 ($761,793) Total Balance Sheet $989,256 $227,463 ($761,793)

$5,483,281 $5,210,867 ($272,414) TOTAL DISBURSEMENTS $5,483,281 $5,210,867 ($272,414)

($519,638) $32,133 ($551,771) Net Operating Cash ($519,638) $32,133 ($551,771)

RESTRICTED FUNDS BY CONTRIBUTORS

($3,724) Restricted by contributors ($3,724)

($515,914) $32,133 ($548,047) Net Cash After Restricted Fund Activity ($515,914) $32,133 ($548,047)

$38,478,504 $41,322,948 ($2,844,444) Beginning Cash $38,478,504 $38,425,000 $53,504

37,962,590 41,355,081 (3,392,491) Ending Cash 37,962,590 38,457,133 (494,543)

Year-to-Date

Page 4


Key Statistical Data -July 2015

Prior

Month Actual Budget

Variance

to Budget Prior Year

Variance

to Prior

Year Hospital Statistics Actual Budget

Variance

to Budget Prior Year

Variance to

Prior Year

30 31 31 31 Days in month 31 31 31

Acute Patient Days:

4 2 9 (7) 9 (7) ICU Days 2 9 (7) 9 (7)

54 90 89 1 96 (6) Med/Surg & Telemetry Days 90 89 1 96 (6)

14 10 19 (9) 8 2 Labor & Delivery Days 10 19 (9) 8 2

72 102 117 (15) 113 (11) Total Acute Patient Days 102 117 (15) 113 (11)

2.4 3.3 3.8 (0.5) 3.6 (0.4) Average Daily Census (ADC) 3.3 3.8 (0.5) 3.6 (0.4)

25.3% 24.0% 32.5% -8.5% 34.2% -10.2% % of IP Revenue to Ttl Revenue 30.1% 30.5% -0.4% 34.2% -4.1%

1.9 1.8 1.9 (0.0) 2.3 (0.4) Average Length of Stay (ALOS) 1.8 1.9 (0.0) 2.3 (0.4)

37 56 63 (7) 50 6 Discharges 56 63 (7) 50 6

1.288 1.485 NA NA 1.542 (0.057) Case Mix Index 1.485 NA NA 1.542 (0.057)

Other Key Hospital Statistics:

745 1,090 1,015 75 1,010 80 ED Visits 1,090 1,015 75 1,010 80

444 790 725 65 675 115 Observation Hours 790 725 65 675 115

7 7 9 (2) 5 2 Deliveries 7 9 (2) 5 2 `

19 30 33 (3) 32 (2) IP Surgeries 30 33 (3) 32 (2)

61 86 72 14 72 14 OP Surgeries 86 72 14 72 14

80 116 105 11 104 12 Total Surgeries 116 105 11 104 12

59 64 62 2 63 1 MRI Procedures 64 62 2 63 1

129 177 138 39 136 41 CT Scans 177 138 39 136 41

65 58 61 (3) 58 - Mammography Procedures 58 61 (3) 58 -

99 107 112 (5) 122 (15) Ultrasound 107 112 (5) 122 (15)

709 966 857 109 825 141 Radiology 966 857 109 825 141

1,061 1,372 1,230 142 1,204 168 Total Imaging 1,372 1,230 142 1,204 168

5,839 6,721 6,391 330 6,454 267 Lab Tests 6,721 6,391 330 6,454 267

15,729 21,457 17,752 3,705 18,910 2,547 Pharmacy Units 21,457 17,752 3,705 18,910 2,547

89,310 101,910 83,651 18,259 81,270 20,640 PT/OT/HP Minutes 101,910 83,651 18,259 81,270 20,640

Clinic Visits

1,152 1,283 988 295 982 301 Family Medicine clinic 1,283 988 295 982 301

436 404 283 121 290 114 Pediatrics clinic 404 283 121 290 114

391 395 422 (27) 428 (33) Women's - OB/GYN clinic 395 422 (27) 428 (33)

482 521 459 62 396 125 Mammoth Ortho clinic 521 459 62 396 125

175 224 159 65 150 74 Bishop Ortho clinic 224 159 65 150 74

260 229 220 9 212 17 Bridgeport clinic 229 220 9 212 17

96 73 62 11 62 11 Surgery clinic 73 62 11 62 11

151 125 125 - 133 (8) Urology clinic 125 125 - 133 (8)

50 51 33 18 28 23 Behavioral clinic 51 33 18 28 23

325 487 300 187 263 224 Dental clinic 487 300 187 263 224

3,518 3,792 3,051 741 2,944 848 Total Clinic visits 3,792 3,051 741 2,944 848

July 2015 Year-to-Date

Page 5

Mammoth Hospital Mammoth Hospjtal

Statistical Analysis Statistical Analysis

Budget

Dept # Dept Name Unit of Service Desc

Apr

2015

May

2015

June

2015

July

2015

Budget

July 2016

Actual

July 2014

YTD

Total

YTD

Budget

% of change

to Budget

Level of

concern

6010 ICU Patient Days 1 0 4 2 9 9 2 9 -77% 23%

6170 Med/Surg Patient Days 55 37 37 68 67 69 68 66 3% 103%

6170 Telemetry Patient Days 16 33 17 22 22 27 22 22 0% 100%

7400 L & D Patient Days 8 21 14 10 19 8 10 19 -48% 52%

Total Acute Patient Days 80 91 72 102 117 113 102 116 -12% 88%

6380 Observation Patient Days 20 18 19 33 30 28 33 30 9% 109%

6380 Observation Hours 482 430 444 790 725 675 790 725 9% 109%

6530 Nursery Patient Days 9 21 16 10 17 7 10 17 -39% 61%

7400 L & D Pre-delivery hours 69 113 123 49 82 70 49 82 -40% 60%

7400 L & D Deliveries 7 13 7 7 9 5 7 9 -19% 81%

7180 Surgery Clinic Patient Visits 83 63 96 73 62 62 73 62 18% 118%

7180 Urology Clinic Patient Visits 133 120 151 125 125 133 125 125 0% 100%

7050 OB/GYN Patient Visits 427 381 391 395 422 428 395 421 -6% 94%

7060 Dental Clinic Patient Visits 383 351 325 487 300 263 487 300 62% 162%

7080 Family Medicine Patient Visits 1,178 1,129 1,152 1,283 988 990 1,283 989 30% 130%

7090 Peds Clinic Patient Visits 391 445 436 404 283 289 404 284 42% 142%

7140 Bishop Clinic Patient Visits 149 119 175 224 159 156 224 160 40% 140%

7160 Mammoth Ortho Patient Visits 553 499 482 521 459 398 521 459 14% 114%

7170 Bridgeport Clinic Patient Visits 186 172 260 229 220 212 229 220 4% 104%

7840 Behavioral Health Patient Visits 60 34 50 51 33 28 51 33 55% 155%

Total Clinics 3,543 3,313 3,518 3,792 3,051 2,959 3,792 3,052 24% 124%

7010 ED Patient Visits 583 490 745 1,090 1,015 1,010 1,090 1,015 7% 107%

7040 Ambulance Work days 22 21 22 23 23 23 23 22 5% 105%

7420 Surgery Minutes 13,770 10,575 8,775 13,755 11,799 12,840 13,755 11,799 17% 117%

7420 IP surgeries Procedures 25 21 19 30 33 32 30 33 -9% 91%

7420 OP surgeries Procedures 82 56 61 86 72 72 86 72 19% 119%

7427 PACU Minutes 26,685 19,560 19,650 20,520 20,328 21,750 20,520 20,328 1% 101%

7500 Lab Tests/Units 5,319 5,131 5,839 6,721 6,391 6,454 6,721 6,390 5% 105%

7520 Pathology only Tests/Units 171 153 185 173 162 173 173 162 7% 107%

7591 EKG's IP Procedures 8 13 13 15 25 26 15 25 -41% 59%

7591 EKG's OP Procedures 61 58 111 149 164 177 149 164 -9% 91%

7641 Chemotherapy Patient Visits 35 28 28 24 6 22 24 6 300% 400%

7710 Pharmacy Tests/Units 24,426 17,735 15,729 21,457 17,752 18,910 21,457 17,752 21% 121%

7720 Respiratory Unique Patients 355 322 348 407 525 513 407 525 -22% 78%

7630 Radiology Procedures 748 530 709 966 857 825 966 858 13% 113%

7635 Mammography Procedures 71 51 65 58 61 58 58 63 -8% 92%

7660 MRI Procedures 71 58 59 64 62 63 64 62 3% 103%

7670 Ultrasound Procedures 103 81 99 107 112 122 107 111 -4% 96%

7680 CT Scan Procedures 102 79 129 177 138 136 177 138 28% 128%

Total Imaging Procedures 1,095 799 1,061 1,372 1,230 1,204 1,372 1,232 11% 111%

7770 Physical Therapy Minutes 50,130 42,960 48,195 55,065 41,806 40,245 55,065 41,806 32% 132%

7772 Bishop Physical Therapy Minutes 39,825 33,255 36,030 38,475 37,309 36,795 38,475 37,309 3% 103%

7780 Speech Therapy Minutes 1,560 1,140 585 840 583 90 840 583 44% 144%

7790 Occupational Therapy Minutes 9,045 6,255 4,500 7,530 3,953 4,140 7,530 3,953 91% 191%

Total Minutes PT/ST/OT 100,560 83,610 89,310 101,910 83,651 81,270 101,910 83,649 22% 122%

Mammoth Hospital

Dashboard Analysis

For the Month Ending - July 31, 2015

Indicator Definition July 2014

April

2015 May 2015

June

2015 July 2015 Year-to-Date

Year-to-Date

Budget

Year-to-Date

Prior Year

Level of

Concern

Total revenue less total expense $725 $370 $178 $1,643 $589 $589 $493 $725

Total operating revenue less total operating

expense (except depreciation)$839 $457 $154 $1,911 $635 $635 $564 $839

Volume

Midnight Census 3.6 2.7 2.9 2.4 3.3 3.3 3.1 3.6

Clinic Visits Number of patient visits 2,959 3,543 3,313 3,518 3,792 3,792 3,052 2,959

ER Visits Number of patient visits 1,010 583 490 745 1,090 1,090 1,015 1,010

Payer MixMedicare Based on gross charges 24.4% 18.5% 21.8% 19.9% 19.2% 19.2% 20.0% 21.9%

Medi-Cal Based on gross charges 19.3% 22.3% 26.5% 23.6% 23.9% 23.9% 24.0% 17.2%

Blue Cross Based on gross charges 20.7% 31.0% 22.9% 23.2% 19.4% 19.4% 27.0% 25.4%

Commercial Based on gross charges 28.2% 23.6% 21.5% 27.6% 31.3% 31.3% 24.0% 26.6%

Self Pay Based on gross charges 1.8% 1.3% 2.0% 1.9% 2.2% 2.2% 1.0% 3.8%

Other Based on gross charges 5.5% 3.4% 5.4% 3.8% 4.0% 4.0% 4.0% 5.0%

RevenueNet Patient Revenue (in thousands) Total net patient revenue $5,233 $4,799 $4,273 $6,407 $5,148 $5,148 $5,488 $5,233

Net Revenue per APDTotal net patient revenue divided by adjusted

patient days$15,824 $17,990 $13,897 $22,533 $12,099 $12,099 $14,931 $15,824

Charity Writeoffs ( in thousands) Actual writeoffs $85 $47 $180 $239 $26 $26 $167 $85

Bad Debt (in thousands) Provision for doubtful accounts $252 ($139) $315 ($712) $271 $271 $68 $252

Bad Debt Percentage Bad debt divided by gross patient revenue 2.8% -1.7% 4.7% -10.1% 3.0% 3.0% 0.8% 2.8%

Net Income/(Loss)

(in thousands)

Operating Income/(Loss)

(in thousands)

Average Daily Census

(excl. Nursery)

Mammoth Hospital

Dashboard Analysis



April

2015 May 2015

June


Year-to-Date

Budget

Year-to-Date

Prior Year

Level of

Concern

Salaries and Benefits

Total salary and benefits expenses $2,051 $2,012 $2,112 $2,114 $2,246 $2,246 $2,387 $2,051

BenefitsBenefits, Taxes, Health Insurance, Workers

Comp., etc.$651 $569 $607 $641 $692 $692 $678 $651

Benefits Percentage Benefits divided by total productive salaries 48.7% 42.8% 43.8% 48.2% 46.4% 46.4% 41.3% 48.7%

Salaries and Benefits per APDTotal salary and benefits expense divided by

adjusted patient days$6,201 $7,541 $6,869 $7,434 $5,280 $5,280 $6,492 $6,201

Productive Full Time Equivalents Productive FTEs not including contract labor 227.2 229.2 225.3 222.8 241.4 241.4 260.8 227.2

Paid Full Time Equivalents Paid FTEs not including contract labor 259.5 263.1 259.7 260.4 273.9 273.9 296.2 259.5

Productive FTEs per AOBProductive FTEs divided by adjusted occupied

beds 21.3 25.8 22.7 23.5 17.6 17.6 22.0 21.9

Average Hourly Rate Average hourly rate of pay $34.87 $36.82 $37.80 $33.00 $36.46 $36.46 $37.09 $34.87

Non-Wage ExpensesPhysician Fees Physician Fee expense $1,170 $1,109 $888 $1,052 $1,142 $1,142 $1,154 $1,170

Contracted Services Contracted services expense $93 $48 $69 $83 $48 $48 $88 $93

Supplies Supplies expense $492 $523 $473 $272 $494 $494 $538 $492

Services Services expense $602 $666 $654 $1,044 $627 $627 $816 $602

Total Salaries and Benefits (in

thousands)

Mammoth Hospital

Dashboard Analysis



April

2015 May 2015

June


Year-to-Date

Budget

Year-to-Date

Prior Year

Level of

Concern

Accounts Receivable

Balance of net AR at the end of the month $9,086 $6,859 $6,018 $6,482 $6,904 $6,904 $7,252 $9,086

Net days in A/R12-month average of outstanding net AR divided

by 12 months net revenue60.1 42.9 37.7 40.4 43.1 43.1 45.0 60.1

Percent A/R over 120 days AR over 120 days old divided by total AR 26.8% 22.6% 26.3% 27.6% 22.9% 22.9% 27.4% 26.8%

Cash

Cash CollectedCash collected during the month for patient

services$5,137 $5,901 $5,308 $5,182 $4,907 $4,907 $5,544 $5,137

Current cash divided by average 218.9 254.6 258.4 264.9 261.4 261.4 252.3 218.9

Z:\Finance\2015-16 FINANCIALS\FY 2016 Reports\01 Jul 15 FY 2016\[01.2016 Financial Summary & Dashboard.xlsx]Dshbrd FY2015

Days cash on hand

A/R net of contractuals

(in thousands)

Executive Summary

For Period Ended: July 31, 2015 DRAFT Table of Contents FINANCE COMMITTEE DRAFT August 18, 2014

Page

Charts -- Volume ............................................................................................................................................................................... 2

Charts -- Revenue ............................................................................................................................................................................. 4

Charts -- Expenses ............................................................................................................................................................................ 9

2

VOLUME

Inpatient Volume

20

25

30

35

40

45

50

55

60

65

70

Admissions - All Excluding Nursery

Current Year Prior Year 2 Years Ago Budget

0

5

10

15

20

25

30

35

40

Inpatient Surgery Volume


1.5

2.0

2.5

3.0

3.5

4.0

4.5

5.0

Average Daily Census - All Excuding Nursery


3

Outpatient Volume

80

90

100

110

120

130

Clinic Volume (per day) - All Clinics


20

30

40

50

60

70

80

90

100

Outpatient Surgery Volume


0

5

10

15

20

25

30

35

40

Emergency Department Volume (per day)


4

REVENUE

Gross Charges

0

1,000

2,000

3,000

Thousands

Gross Inpatient Revenue


0

1,000

2,000

3,000

4,000

5,000

6,000

Thousands

Gross Outpatient Revenue


0

100

200

300

400

500

600

700

800

900

Thousands

Gross Clinic Revenue


0

500

1,000

1,500

2,000

2,500

3,000

Thousands

Gross Professional Fees Revenue


5

Net Revenue

1,000

2,000

3,000

4,000

5,000

6,000

7,000Thousands

Net Patient Revenue


1,000

4,000

7,000

10,000

13,000

16,000

19,000

22,000

25,000

Net Revenue per Adjusted Patient Day


6

Payer Mix

Revenue Cycle

FY 2012 FY 2013 FY 2014 FY 2015 Jul-14 Mar-15 Apr-15 May-15 Jun-15 Jul-15

YTD FY

2016

Budget FY

2016

Payer Mix

Medicare 16.0% 16.0% 21.9% 19.9% 24.4% 13.5% 18.5% 21.8% 19.9% 19.2% 19.2% 18.0%

Medi-Cal ** 12.2% 11.6% 17.2% 21.7% 19.3% 23.2% 22.3% 26.5% 23.6% 23.9% 23.9% 13.0%

Blue Cross * 27.8% 32.2% 25.4% 25.8% 20.7% 28.4% 31.0% 22.9% 23.2% 19.4% 19.4% 27.0%

Commercial * 32.1% 30.8% 26.6% 26.9% 28.3% 29.2% 23.6% 21.5% 27.6% 31.3% 31.3% 28.0%

Self Pay ** 6.5% 5.1% 3.8% 1.7% 1.7% 1.4% 1.3% 2.0% 1.9% 2.2% 2.2% 6.0%

Other * 5.3% 4.3% 5.0% 4.2% 5.5% 4.3% 3.4% 5.4% 3.8% 4.0% 4.0% 8.0%

Total 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%

2,000

2,500

3,000

3,500

4,000

4,500

5,000

5,500

6,000

6,500

7,000

Thousands

Cash Collections ($000,s omitted)


7

50.0

55.0

60.0

65.0

70.0

75.0

80.0

85.0

90.0

AR Days Outstanding - Gross


35.0

40.0

45.0

50.0

55.0

60.0

65.0

70.0

75.0

AR Days Outstanding - Net


0

10,000

20,000

30,000

40,000

50,000

60,000

70,000

Thousands

Cumulative Cash Collections ($000,s omitted)


80.0%

90.0%

100.0%

110.0%

120.0%

130.0%

140.0%

Cumulative Cash Collections as a % of Net Collectible Revenue


8

Payer Inhouse 1 to 30 31 to 60 61 to 90 91 to 120 121 + Total

Blue cross ($802) $1,038,444 $195,578 $80,479 $212,748 $511,278 $2,037,725

Commercial 4,350 2,013,883 $774,719 211,193 320,892 1,162,203 4,487,240

Medical 2,527 1,659,014 $489,874 111,523 198,266 523,957 2,985,161

Medicare 25,478 1,241,962 $175,952 44,771 29,325 124,848 1,642,336

MH employee 10,153 176,531 $129,921 84,988 29,305 63,812 494,710

Other 196 307,526 $188,749 77,547 16,618 35,143 625,779

Self Pay 19,590 173,315 $81,815 107,032 49,521 170,540 601,813

CHMB* 370,648 265,148 161,206 116,503 742,037 1,655,542

Total $61,492 $6,981,323 $2,301,756 $878,739 $973,178 $3,333,819 $14,530,306

Percent of Dollars Over 120 Days 22.9%

0%

5%

10%

15%

20%

25%

30%

35%

40%

% A/R > 120 Days


9

EXPENSES

Salaries, Wages and Benefits

1,700

1,800

1,900

2,000

2,100

2,200

2,300

2,400

2,500

2,600

Thousands

Salaries, Wages and Benefits


5,000

6,000

7,000

8,000

9,000

10,000

11,000

Labor Cost per Full Time Equivalent


300

400

500

600

700

800

900

1,000

Thousands

Benefits


10

Full Time Equivalents

`

200.0

210.0

220.0

230.0

240.0

250.0

260.0

270.0

280.0

290.0

300.0

Productive Full Time Equivalents


230.0

250.0

270.0

290.0

310.0

330.0

350.0

Paid Full Time Equivalents


10.0

15.0

20.0

25.0

30.0

35.0

Productive FTEs per Adjusted Occupied Bed


11

Professional and Contracted Services

Supplies

0

20

40

60

80

100

120

140

160

180

200

Thousands

Contracted Services


500

600

700

800

900

1,000

1,100

1,200

1,300

1,400

1,500

Thousands

Professional Fees


200

250

300

350

400

450

500

550

600

650

700

Thousands

Supply Expense


400

900

1,400

1,900

2,400

2,900

Supply Expense per Adjusted Patient Day



LAIF Investment

8/13/2015

Balance as of June 30, 2014 30,026,314.15

Deposit 7/4/14 250,000.00

Deposit 7/11/14 300,000.00

Interest Income 2nd Qtr CY 2014 16,086.60

Deposit 7/18/14 800,000.00

Deposit 7/25/14 500,000.00

Balance as of July 31, 2014 31,892,400.75

Deposit 8/1/14 150,000.00

Withdrawal 8/8/14 (150,000.00)

Deposit 8/14/14 600,000.00

Withdrawal 8/22/14 (750,000.00)

Deposit 8/29/14 900,000.00

Balance as of August 31, 2014 32,642,400.75

Withdrawal 9/5/14 (300,000.00)

Deposit 9/11/14 200,000.00

Withdrawal 9/19/14 (800,000.00)

Deposit 9/26/14 650,000.00

Withdrawal 9/29/14 (2,300,000.00)

Balance as of September 30, 2014 30,092,400.75

Withdrawal 10/3/14 (750,000.00)

Deposit 10/10/14 550,000.00

Interest Income 3rd Qtr CY 2014 19,340.76

Withdrawal 10/17/14 (550,000.00)

Deposit 10/27/14 1,000,000.00

Withdrawal 10/31/14 (250,000.00)

Balance as of October 31, 2014 30,111,741.51

Deposit 11/7/14 400,000.00

Withdrawal 11/14/14 (50,000.00)

Withdrawal 11/20/14 (5,000,000.00)

Withdrawal 11/21/14 (710,000.00)

Withdrawal 11/25/14 (1,238,000.00)

Withdrawal 11/26/14 (497,000.00)

Balance as of November 30, 2014 23,016,741.51

Withdrawal 12/5/14 (150,000.00)

Withdrawal 12/12/14 (500,000.00)

Withdrawal 12/19/14 (100,000.00)

Withdrawal 12/24/14 (800,000.00)

Balance as of December 31, 2014 21,466,741.51

Deposit 1/2/15 2,450,000.00

Withdrawal 1/9/15 (550,000.00)

Interest Income 4th Qtr CY 2014 17,078.38

Deposit 1/16/15 950,000.00

Withdrawal 1/23/15 (650,000.00)

Deposit 1/30/15 450,000.00

Z:\BankAccounts\LAIF\LAIF Activity.xlsx


LAIF Investment

8/13/2015

Balance as of January 31, 2015 24,133,819.89

Deposit 2/13/15 450,000.00

Withdrawal 2/20/15 (600,000.00)

Deposit 2/27/15 1,000,000.00

Balance as of February 28, 2015 24,983,819.89

Withdrawal 3/6/15 (1,000,000.00)

Deposit 3/13/15 750,000.00

Withdrawal 3/20/15 (400,000.00)

Deposit 3/27/15 1,200,000.00

Balance as of March 31, 2015 25,533,819.89

Deposit 4/3/15 400,000.00

Deposit 4/10/15 1,250,000.00

Interest Income 1st Qtr CY 2015 15,538.03

Deposit 4/24/15 700,000.00

Balance as of April 30, 2015 27,899,357.92

Deposit 5/8/15 1,900,000.00

Withdrawal 5/22/15 (400,000.00)

Withdrawal 5/29/15 (300,000.00)

Balance as of May 31, 2015 29,099,357.92

Deposit 6/5/15 750,000.00

Withdrawal 6/12/15 (500,000.00)

Deposit 6/19/15 200,000.00

Withdrawal 6/26/15 (600,000.00)

Balance as of June 30, 2015 28,949,357.92

Deposit 7/3/15 800,000.00

Interest Income 2nd Qtr CY 2015 20,172.15

Withdrawal 7/17/15 (250,000.00)

Withdrawal 7/24/15 (800,000.00)

Balance as of July 31, 2015 28,719,530.07

Deposit 8/7/15 100,000.00

Deposit 8/14/16 1,150,000.00

Balance as of August 14, 2015 29,969,530.07

Z:\BankAccounts\LAIF\LAIF Activity.xlsx


Comparative Balance Sheet - June 30, 2015

Unaudited Preliminary

Jun 30, Jun 30,

ASSETS 2015 2015 Change

CURRENT ASSETS:

Cash (including LAIF Fund) 29,717,792 29,660,773 57,019

Investments 8,760,712 8,760,712 0

Total Cash 38,478,504 38,421,485 57,019

Patient accounts receivable 13,344,466 13,326,946 17,520

Less: Allow. for bad debts and contractuals (6,861,970) (6,853,625) (8,345)

Net patient accounts receivable 6,482,496 6,473,321 9,175

Inventory 1,859,492 1,859,492 0

Prepaid expenses & deposits 431,457 431,457 0

Other current assets 590,460 761,423 (170,963)

Total Current assets 47,842,409 47,947,178 (104,769)

ASSETS LIMITED AS TO USE:

Bond funds held in trust by Mono County:

Mono Co Bond Capital Appreciation Fund 5,526,085 5,500,481 25,604

Debt service fund 955,432 925,643 29,789

Restricted by contributors 206,542 206,542 -

LaSalle Cash - New Bldg./Rad./HIS 0 0 0

Total Assets Limited As To Use 6,688,059 6,632,666 55,393

PROPERTY, PLANT & EQUIPMENT:

Land and improvements 5,453,480 5,453,480 0

Buildings and improvements 51,453,006 51,453,006 0

Major Moveable Equipment 19,710,562 19,710,562 0

Siemens implementation 2,625,312 2,625,312 0

Construction-in-progress 41,719 41,719 0

Total Property, Plant and Equipment 79,284,079 79,284,079 0

Less: Accumulated depreciation (37,893,829) (37,893,631) (198)

Less: Accumulated amortization (1,949,167) (1,949,309) 142

Net Property, Plant and Equipment 39,441,083 39,441,139 (56)

0

Total Assets $93,971,551 $94,020,983 ($49,432)


Comparative Balance Sheet - June 30, 2015

Unaudited Preliminary

Jun 30, Jun 30,

LIABILITIES 2015 2015 Change

CURRENT LIABILITIES:

Accounts payable and accrued expenses $2,053,297 $2,006,458 $46,839

Accrued payroll-related liabilities 2,354,076 2,360,071 (5,995)

Patient refunds 90,383 90,383 0

Due to (from) third party payers 2,931,459 2,915,896 15,563

Accrued interest on long term obligations 255,520 255,520 0

Current portion of long-term debt 740,000 740,000 -

Health plan IBNR 323,623 323,623 0

Total Current liabilities 8,748,358 8,691,951 56,407

LONG-TERM DEBT:

Unamortized bond premium 1,578,137 1,578,137

Capital appreciation interest payable 6,017,997 6,016,317 1,680

General Obligation Bonds 17,524,555 17,524,555 0

Long-term debt - -

Total long term debt 25,120,689 25,119,009 1,680

0

Total Liabilities 33,869,047 33,810,960 58,087

NET ASSETS:

Invested in capital assets net of related liabilities 13,580,394 13,582,130 (1,736)

Restricted - expendable for specific operating activities 206,542 206,542 -

Restricted - expendable for capital acquisitions 0 0 0

Restricted - expendable for debt service 6,481,517 6,426,124 55,393

Unrestricted 33,411,364 33,465,020 (53,656)

Year to date earnings 6,422,687 6,530,207 (107,520)

NET POSITION: 60,102,504 60,210,023 (107,519)

0

Total Liabilities and Net Position $93,971,551 $94,020,983 ($49,432)

0


Statement of Revenues & Expenses - June 30, 2015

Reconciliation from Preliminary to Pre-AuditNotes

OPERATING REVENUE Pre-Audit Preliminary Change

(000s omitted)

Inpatient services 22,247$ 22,247$ -$

Outpatient services 45,210 45,210 -

Professional fees services 17,874 17,874

Clinic services 8,194 8,194 -

Total Gross Revenue 93,525 93,525 -

Contractual & other discounts (34,067) (33,802) (265) Settlements

Charity write offs (1,144) (1,144) -

Provision for bad debts (221) (217)

Prior Year Adjustments 388 139 249 Settlements

Net Patient Revenue 58,481 58,501 (16)

Other operating revenue 528 510 18

Total Operating Revenue $59,009 59,011$ 2$

OPERATING EXPENSES

Salaries 17,656 17,656 -

Benefits 6,867 6,878 11

Professional services 12,887 12,870 (17)

Contract services 813 805 (8)

Supplies 5,733 5,728 (5)

Services 7,638 7,614 (24)

Total Expenses 51,594 51,551 (43)

OPERATING GAIN (LOSS) 7,415 7,460 (41)

Depreciation & amort 3,762 3,762 -

Operating Gain (Loss) after Depreciation $3,653 3,698$ (41)$

NON-OPERATING INCOME(EXPENSE)

Gain (loss) on sale of property - - -

Donation income 157 157 -

Bond property tax revenue 1,845 1,973 (128) Bond revenue reversal - dated back to 2009-2010

Bond interest expense (1,286) (1,285) (1)

Property tax revenue & interest income 2,077 2,010 67 additional revenue

Interest expense (23) (23) -

Total Non-Operating Income (expense) 2,770 2,832 (62)

Increase in net assets - net gain (deficit) $6,423 6,530$ (103)$

Total Margin 10.9% 11.1% -0.2%

Year-to-Date

Page 3


Investments Summary - July 31, 2015

Certificates of Deposit (CDs)

Interest

RatePurchase Date Maturity Date Broker Cost Basis Estimated Market Value

First Eagle Bank CD 1.05% 11/21/2014 11/21/2017 Union Banc Investment Services $248,000 $247,130

Premier Business Bk CA 1.10% 11/26/2014 11/27/2017 Union Banc Investment Services 249,000 248,355

Sallie Mae Bk Slt Lake City UT 1.50% 11/26/2014 11/27/2017 Union Banc Investment Services 248,000 247,360

American Express Centrn 1.50% 11/28/2014 11/28/2017 Union Banc Investment Services 248,000 248,759

Bank North Carolina NC 1.00% 11/28/2014 11/28/2017 Union Banc Investment Services 249,000 248,176

Third Fed Svgs & Ln Assn Of 2.00% 11/24/2014 11/25/2017 Union Banc Investment Services 248,000 246,086

Capital One Bk Usa Natl Assn 2.10% 11/26/2014 11/26/2019 Union Banc Investment Services 247,000 246,079

Discover Bk CD 2.10% 11/26/2014 11/26/2019 Union Banc Investment Services 247,000 246,079

Goldman Sachs Bk USA NY 2.20% 11/26/2014 11/26/2019 Union Banc Investment Services 247,000 246,081

State Bk India NYC 2.20% 12/5/2014 12/5/2019 Union Banc Investment Services 247,000 246,014

Luana svgs Bnk Iowa 1.05% 12/19/2014 12/19/2017 Union Banc Investment Services 248,000 247,169

Bank Baroda New York 0.45% 3/10/2015 12/10/2015 Union Banc Investment Services 249,000 249,120

Everbank Jacksonville FLA 0.35% 3/13/2015 9/14/2015 Union Banc Investment Services 249,000 249,047

Safra Natl Bnk New York 0.40% 3/16/2015 12/16/2015 Union Banc Investment Services 249,000 249,075

United Bk Vernon Rockville CT 0.40% 3/20/2015 12/21/2015 Union Banc Investment Services 249,000 249,075

$3,722,000 $3,713,604

Government / Agency Securities

Federal Farm Cr Bks Cons Bd 1.80% 11/21/2014 11/12/2019 Union Banc Investment Services 5,011,900 5,060,650

$8,733,900 $8,774,254

Local Agency Investment Fund (LAIF)

Interest

Rate

Beginning

BalanceActivity Ending Balance

0.24% $28,949,358 (229,828) $28,719,530 $28,719,530

Total Investments $37,453,430 $37,493,784

PF Ratings U.S. (7/18/14)

July 29, 2015

Mammoth Hospital P.O. Box 660 85 Sierra Park Road Mammoth Lakes, CA 93546 Attention: Ms. Melanie Van Winkle, Chief Financial Officer Re: Southern Mono Healthcare District dba Mammoth Hospital, California, General Obligation

Bonds, Various Series Dear Ms. Van Winkle:

Standard & Poor's Ratings Services ("Ratings Services") has reviewed the rating on the above-listed obligations. Based on our review, we have raised the underlying rating (SPUR) from "BBB+" to "A-" while affirming the stable outlook. A copy of the rationale supporting the rating and outlook is enclosed. This letter constitutes Ratings Services’ permission for you to disseminate the above rating to interested parties in accordance with applicable laws and regulations. However, permission for such dissemination (other than to professional advisors bound by appropriate confidentiality arrangements) will become effective only after we have released the rating on standardandpoors.com. Any dissemination on any Website by you or your agents shall include the full analysis for the rating, including any updates, where applicable. To maintain the rating, Standard & Poor’s must receive all relevant financial and other information, including notice of material changes to financial and other information provided to us and in relevant documents, as soon as such information is available. Relevant financial and other information includes, but is not limited to, information about direct bank loans and debt and debt-like instruments issued to, or entered into with, financial institutions, insurance companies and/or other entities, whether or not disclosure of such information would be required under S.E.C. Rule 15c2-12. You understand that Ratings Services relies on you and your agents and advisors for the accuracy, timeliness and completeness of the information submitted in connection with the rating and the continued flow of material information as part of the surveillance process. Please send all information via electronic delivery to [email protected]. If SEC rule 17g-5 is applicable, you may post such information on the appropriate website. For any information not available in electronic format or posted on the applicable website, Please send hard copies to:

Standard & Poor’s Ratings Services Public Finance Department 55 Water Street

One California Street, 31st Floor San Francisco, CA 94111-5432 tel 415 371-5000 reference no.: 40262547

Page | 2


New York, NY 10041-0003 The rating is subject to the Terms and Conditions, if any, attached to the Engagement Letter applicable to the rating. In the absence of such Engagement Letter and Terms and Conditions, the rating is subject to the attached Terms and Conditions. The applicable Terms and Conditions are incorporated herein by reference. Ratings Services is pleased to have the opportunity to provide its rating opinion. For more information please visit our website at www.standardandpoors.com. If you have any questions, please contact us. Thank you for choosing Ratings Services. Sincerely yours,

Standard & Poor's Ratings Services

tw enclosure cc: Ms. Slavka Crouthamel, Controller

Mammoth Hospital


July 29, 2015

Mammoth Hospital P.O. Box 660 85 Sierra Park Road Mammoth Lakes, CA 93546 Attention: Ms. Melanie Van Winkle, Chief Financial Officer Re: Southern Mono Healthcare District dba Mammoth Hospital, California, General Obligation

Bonds, Various Series Dear Ms. Van Winkle:

Standard & Poor's Ratings Services ("Ratings Services") has reviewed the rating on the above-listed obligations. Based on our review, we have raised our credit rating from "BBB+" to "A-" while affirming the stable outlook. A copy of the rationale supporting the rating and outlook is enclosed. This letter constitutes Ratings Services’ permission for you to disseminate the above rating to interested parties in accordance with applicable laws and regulations. However, permission for such dissemination (other than to professional advisors bound by appropriate confidentiality arrangements) will become effective only after we have released the rating on standardandpoors.com. Any dissemination on any Website by you or your agents shall include the full analysis for the rating, including any updates, where applicable. To maintain the rating, Standard & Poor’s must receive all relevant financial and other information, including notice of material changes to financial and other information provided to us and in relevant documents, as soon as such information is available. Relevant financial and other information includes, but is not limited to, information about direct bank loans and debt and debt-like instruments issued to, or entered into with, financial institutions, insurance companies and/or other entities, whether or not disclosure of such information would be required under S.E.C. Rule 15c2-12.You understand that Ratings Services relies on you and your agents and advisors for the accuracy, timeliness and completeness of the information submitted in connection with the rating and the continued flow of material information as part of the surveillance process. Please send all information via electronic delivery to [email protected]. If SEC rule 17g-5 is applicable, you may post such information on the appropriate website. For any information not available in electronic format or posted on the applicable website, Please send hard copies to:

Standard & Poor’s Ratings Services

One California Street, 31st Floor San Francisco, CA 94111-5432 tel 415 371-5000 reference no.: 40399057

Page | 2


Public Finance Department 55 Water Street New York, NY 10041-0003

The rating is subject to the Terms and Conditions, if any, attached to the Engagement Letter applicable to the rating. In the absence of such Engagement Letter and Terms and Conditions, the rating is subject to the attached Terms and Conditions. The applicable Terms and Conditions are incorporated herein by reference. Ratings Services is pleased to have the opportunity to provide its rating opinion. For more information please visit our website at www.standardandpoors.com. If you have any questions, please contact us. Thank you for choosing Ratings Services. Sincerely yours,

Standard & Poor's Ratings Services

tw enclosure cc: Ms. Slavka Crouthamel, Controller

Mammoth Hospital


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Mammoth Hospital Confidential 8/10/2015 Page 1

FY15 Capital Plan - Board Summary 4th Quarter Update Through June, 2015

Project # Name of Project BudgetSpent or

Committed Balance Funding

BUDGETED - BOARD APPROVED1 Exterior Paint (portions of A, B, & D buildings) 30,000$ 30,000$ -$ Capital

2 S.P.O.R.T. Center refurbishing 40,000$ -$ 40,000$ Capital

3 Painting/Remodel of Exterior on MOB Building 140,000$ -$ 140,000$ Capital

4 ED Stretchers - 4 total 22,000$ 22,000$ -$ Auxiliary

5 Bili-Blanket system 8,300$ 11,000$ (2,700)$ Auxiliary

6 MP 30 Monitor - PACU 24,000$ 24,000$ -$ Capital

7 Vital Signs Monitor - Ortho Clinic 5,100$ -$ 5,100$ Capital

8 Bishop PT/Ortho Clinic upgrades 250,000$ -$ 250,000$ Capital

9 Bishop X-Ray Machine for new Ortho Clinic 106,000$ 106,000$ -$ Capital

10 Bishop Ortho - Equipment and furniture 29,000$ 29,000$ -$ Capital

11 Tissue Embedding Center-Pathology 12,200$ 12,200$ -$ Auxiliary

12 Emerald Hematology Analyzer 16,600$ 16,600$ -$ Capital

13 Anesthesia Machines(Narkomed GS) 84,000$ 84,000$ -$ Auxiliary

14 High Definition Arthroscopy Towers - 2 towers 180,500$ 281,000$ (100,500)$ Capital

15 Storage system upgrade 20,200$ 20,200$ -$ Capital

16 Additional LAN switch-Building E 10,200$ 10,200$ -$ Capital

17 Additional LAN switch-IT 10,200$ 10,200$ -$ Capital

18 Additional Vmware Licensing 13,100$ 13,100$ -$ Capital

19 Replacement Virtual Server 8,800$ 8,800$ -$ Capital

20 New Virtual Server - Host 7 8,800$ 8,800$ -$ Capital

21 Data Warehouse Server 13,000$ 13,000$ -$ Capital

22 Radiologist Exam Monitors - 2 monitors 9,500$ 9,500$ -$ Capital

Totals 1,041,500$ 709,600$ 331,900$

FY15 BUDGETED BUT COMPLETED IN FY14

23 Seal (repair) parking lots 10,000$ -$ -$ Capital

24 Asset/maintenance and PM program 39,000$ -$ -$ Capital

25 PACU Gurney 5,100$ -$ -$ Capital

26 Mist Therapy - PT 22,750$ -$ -$ Capital

Totals 76,850$ -$ -$

BUDGETED - ABANDONED/DELAYED

27 NEC Call Center Solution 48,000$ -$ 48,000$ Capital

28 Dental Remodel 10,000$ -$ 10,000$ Capital

29 Seal (repair) parking lots $10K MOVED TO 2014 15,000$ -$ 15,000$ Capital

30 Med/Surg Telemetry Upgrade 125,000$ -$ 125,000$ Capital

Totals 198,000$ -$ 198,000$

CONTNGENCY

Contingency Budget 183,650$ -$ -$

31 Blue-U Blue Light Photodynamic Therapy Illuminator 11,500$ -$ Capital

32 Surgical Microscope for Spinal and Hand Surgeries 44,100$ -$ Auxiliary

33 Fire Hydrant Repair & Replacement 13,400$ -$ Capital

34 Hot Water Tank, Bldg A 28,125$ -$ Capital

35 Change Order - Nurse Call System 5,250$ -$ Capital

36 FollowMyHealth for Inpatient Portal 26,500$ -$ Capital

37 MedHost Upgrade and Clinical Interface 34,925$ -$ Capital

38 Transformer Power Source for Mammography 6,300$ -$ Capital

39 WebCTRL software upgrade 5,800$ -$ Capital

40 Bldg A- Hot water Tank Re-lining 7,800$ -$ Capital

41 Stryker Small Battery Drill system 45,650$ -$ Capital

42 Pharmacy Refrigerator/Freezer combo with Recorder 11,700$ -$ Capital

43 Tenet Beach Chair 12,700$ -$ Capital

44 Biotendenesis Tray 7,250$ -$ Capital

45 Pilates Reformer 7,700$ -$ Capital

46 Keiser Functional Trainer 7,450$ -$ Capital

47 Intellivue MP30 Monitor 17,000$ -$ Capital

48 Fortinet ForGate-300D 26,850$ -$ Capital

49 Trend Micro InterScan Messaging 6,850$ -$ Capital

50 Dell PowerEdge R730 Server 14,800$ -$ Capital

51 CX-4 SAN Chassis Expansion 19,600$ -$ Capital

52 LED Upgrade 55,000$ -$ Capital

53 Stryker OB Gurney 7,400$ -$ Capital

54 Patient Payment Portal/835 File Transfer 5,500$ -$ Capital

Totals 183,650$ 429,150$ (245,500)$

Summary of Capital funds FY15 1,500,000$ 1,138,750$ 361,250$

NEW BISHOP ORTHOPEDIC CLINIC

55 Building Tenant Improvements -$ 758,225$ -$ Capital

Totals -$ 758,225$ -$

C:\Users\mvanwinkle\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\2GZ0CYBO\FY15 4th QTR Board Capital Update.8.10.15V2.xls



Retirement Plan Summary

August 20, 2015


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


To: Board of Directors, Southern Mono Healthcare District

From: Jeff Byberg / Darin Kaylor / EPOCH Consulting

Date: August 21, 2015

Re: 1st Quarter 2015 Retirement Plan Update

_____________________________________________________________________________

3/31/2015 6/30/2015

Total Plan Assets $22,016,669 $22,382,531 Average Account Balance $71,251 $71,738 Active Participants(Eligible) 191(341) 194(345)

Fund Rankings Morningstar Criteria: (page 26 of QMR)

1st quartile: 31 funds (71% of assets)

2nd

quartile: 8 funds (13% assets)

3rd

quartile: 0 fund

4th

quartile: 0 funds

Overview: Lackluster 2015 and still waiting on interest rates…….

2015 continues to be a challenging one for the Global Markets. As of 6/30/15 the

domestically based S&P500 Index has posted a meager 1.23%. As mentioned in prior reports,

the mystery surrounding the Federal Reserve and interest rates are namely to blame. Many

uncertainties are at play in the Global markets and it will take several quarters to see how all of

these will be digested by Wall Street and Main Street respectively.

Participation continues to be the focus as we move forward. This Fall we will be rolling out a

marketing campaign to boost plan participation as well as increase current participant

contributions.

Lincoln provides slightly different plan metrics than Security Benefit. As such you will

see a minor overall tweak in this quarterly report. Future reports will be in this new

format.




August 20, 2015

Page 2 of 3

Annualized Historical Plan Performance vs. S&P500 Index as of 6/30/15:*

1 year 3 year 5 year 10 year

403b: 3.34% 13.12% 13.17% 7.56%

S&P 500 Index: 7.41% 17.29% 17.33% 7.89%

*actual account performance per individual will vary. Assets have only been in the illustrated funds since the

transition on 2/4/15. Performance is hypothetical past performance vs. S&P500 Index 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: 56% (National Average* 72%)

This number is slightly misleading in that all employees (part-time, per diem, etc) are

eligible to participate in the plan. Many part-time and per diem employees do not work

enough hours to become vested, thus they do not participate in the plan. As directed in a

previous board meeting we did explore the ‘auto-enroll’ feature. Unfortunately due to our

non-ERISA plan status and the general guidance provided by compliance at Lincoln

Financial we cannot institute an ‘auto-enroll’ program at this time. However; we are

working on a multi-faceted marketing campaign that will target non-participants as well

as getting current participants to increase their contributions. We are targeting the release

date for Fall of 2015.

By Age:

Average Account Balance: $71,738 (National Average* $54,840)

Average Number of Investment Options Held: 11.4 (National Average* 4.8)




August 20, 2015

Page 3 of 3

Below is a list of the top funds in the portfolio based on asset level. These funds were

mapped from Security Benefit over to Lincoln. EPOCH provided the fund mapping

strategy.

Fixed Fund: $3,530,968

Dodge & Cox Stock Fund: $2,061,471

Loomis Sayles Core Bond Plus: $1,975,024

Vanguard S&P500 Index: $1,951,810

Invesco Equity and Income: $1,325,982

American Funds EuroPacific Growth: $1,272,234

Vanguard Inflation Protected Securities: $1,054,238

Vanguard Long-term Investment Grade: $987,030

Average Balance by Age Group

*Benchmark: PlanSponsor 2014 survey of 4,573 plan sponsors from a broad array of retirement plans. This is the same

benchmark used for all items in the report.

3/31/2015 6/30/2015

Ages <20 $0 $0

Ages 21-30 $13,342 $13,389

Ages 31-40 $26,939 $24,751

Ages 41-50 $50,237 $52,812

Ages 51-60 $109,687 $108,036

Ages >61 $130,105 $141,465

Date Purchased Item Description Value Reason for Disposal

Unknown Floor sink basin 0 Cracked & old no longer used

Unknown 3 shelf file or book case 0 Old, not in use / stored

Unknown Desk 0 Damaged in storage

Unknown 3 Desks 0

Old, not in use / left behind at

old PT building

August 20, 2015

Obsolete Equipment - Facilities

The list of equipment below is either no longer functional or so obsolete as to no longer be useful to our

facility. Please approve our proposal to dispose of the equipment in the most economically and

environmentally responsible way.

board of directors monthly meeting agenda · 8/20/2015 · august 20, 2015 2014 press ganey...

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