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CEO REPORT

Board of Directors Meeting

November 29, 2012

1. USDA meeting on November 13tha. Status of projectJim Bachrach and Deborah Huckeba, Weems Board of Directors

(BOD), and Pinki Jackel (by phone) and Noah Lockley, Jr., County Board of

Commissioners (BOCC) met with Mary Gavin, USDA, Steve Lanier and myself to reinitiate

the application process.

b. Outcome The USDA would not make a recommendation on the loanable amount, butinstead has recommended that Weems engage a CPA to determine the debt load that

the hospital can carry. Based upon this determination, a work group of board members,

staff, and other stakeholders at some time in the future will participate in updating the

scope of work consistent with the loanable amount. This strategy makes the most sense

from a financial standpoint and is what I call backing into the project and is one that I

have utilized on various projects.

c. CPA engagement Based on discussions with BOD and I have contacted BDK to provideWeems with a proposal. This vendor was chosen due to their previous involvement in

providing the feasibility study for Weems. Hopefully, this will arrive by the time of the

board meeting.

2. Weems West OP Clinica. Progress activity continues in preparation for the December 4th opening. A wide

variety of staff are involved in the planning and preparation activities.

b. Reimbursement Discussion with TMH indicate that Weems will only receive 85% ofwhat a physician could bill due to our use of Susan Hardin, ARNP. Additionally, WMH

will not be able to bill the facility fee since the location is inside the hospital. As volumes

ramp up and an off campus site is secured, WMH will be able to bill for this component.

c. Bulletin boards have been secured to advertise the East Clinic and the West Clinic.Heather is in the process of securing a third billboard to be located in Eastpoint which

will advertise the clinics and the hospital. See attachment A.

d. We have been advised by TMH to be cautious about the use of the term Urgent Careas we are licensed for Primary Care instead. I am recommending the use of Quick Care

instead as will be noted in Attachment A. With the dash between the terms, it can both

serve to tell people that the clinic is an alternative to the ER as well as a description of

the quality of our service. This seems to be more defensible than Urgent Care and is in

use in various markets.

3. Blue Manta Contracta. Notice of intent to renegotiate has been provided to Blue Manta which is due for

renewal on February 28, 2013. The reason for this is to re-evaluate the scope of work

being performed by Blue Manta as well as the cost effectiveness of the engagement.

b. I have met with Charles Edwards from Blue Manta and discussed my rationale for thisand the necessity on my part to assure Weems Memorial Hospital is getting a market

competitive price for the services provided. As part of this and other recent discussions,

it appears that Blue Manta is providing a much wider scope of services than merely IT

services. This is of assistance to WMH especially in light of recent efforts related to

Financial Services. I have however asked that Blue Manta provide me regularly with a

log of activities being performed in order to help evaluate their contract.

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4. Computer systema. RFP has been published and bids are due to be opened December 4th at BOC meeting.b. After this, there will be a period of due diligence to evaluate the bids. This evaluation

will involve a wide variety of stakeholders including physicians, nurses, business office

staff, board members and potentially external parties.

5. Swing Bedsa. Over the last couple of weeks, we have had between 2-4 skilled care patients at one

time. This coming week, Dr. Chumney will begin his review of TMH patients qualifying

for transfer to WMH for skilled care. Over the next several weeks, I will also be speaking

with representatives from Capital Regional Medical Center, Sacred Heart Medical Center

and Gulf Coast Medical Center. On December 3rd, I will be meeting with Dr. Perkins from

Madison Hospital where they have developed a robust Swing Bed program with his

help. This meeting is being set up my Mary OBryant at TMH. It may also be in our best

interest to proceed with hiring a part time Swing Bed Coordinator to facilitate receipt of

patients from the other organizations just mentioned. This program has the single

greatest potential to drive WMHs financial success of any service.

b. With the expansion of the Swing Bed program, we will be faced with the challenge ofwhere to provide therapeutic services. We may need to consider the use of the

conference room for this and finding an alternate site for our Board Meetings.

c. Recently it was brought up that our Physical Therapy vendor was not responding in atimely basis. Becky and Paula have spoken with the vendor and no further instances of

this have occurred but it will be essential to closely monitor their performance.

6. PT OtherWe have had a request to consider the provision of PT at our location in Carrabelle. This may be

a discussion that we can have with Tom Brocato. I hope to meet with him soon to discuss

possible collaborative efforts.

7. Ambulance repairsOver the last several months, several of our ambulances have broken down and required

repairs. This has at times left WMH without a backup ambulance. We will need to monitor this

closely to see if we need to implement a replacement plan. Tim Andrews and I spoke of the

potential of buying a low mileage used ambulance. He will investigate this and update me in the

near future.

8. Signing up with Medicare vendorsa. As most of you may be aware, Florida is being divided in regions which will have two

Medicare health plans each. It is my understanding that one of these will be an HMO

plan and the other is a PPO.

b. I have signed a contract with Humana to accept them as our Medicaid HMO provider.Ultimately the state will select the final plans and signing with a particular plan does not

obligate us to them currently, but instead is used by the company to demonstrate

market share to the state when making a selection.

c. This week I will be meeting with Prestige to consider them for the PPO option and willbe including Dr. Charbonneau in the discussions.

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9. Townhall meetingsa. Several weeks ago, I had a series of townhall meetings with staff in regards to proposed

policy changes. This was well received by staff despite the fact there was significant

concern about the policies. I was pleased to see staff turnout for these meetings and be

involved in the decision making.

b. To me this was a demonstration of our commitment to transparency and staffinvolvement and is something that will continue in the future. The policies are being

presented to the board for approval this month after taking staff concerns into account

and revising the policies. I think it is important that people involved in policies or other

decisions have the chance for input. This type of process has been well supported by

the Admin Team also.

10.Audit of billing companies and their performancea. This past month, a lot of time has been spent with various leaders and staff looking at

the performance of our billing companies. From this, it has become apparent that a lot

of opportunity exists for improvement.

b. Opportunity - It is our hope to meet with the hospitals billing company, ARx, the firstweek in December to discuss their performance and how we can drive our success. In

regards to Weems East, Steve will be working with the billing person to improve

timeliness of billing and improve collections. Tim Andrews our EMS Director will be

setting up a meeting with the ambulance billing company to likewise initiate discussion

and action plans to improve EMS billing and collections. Overall, for each 1% increase in

collections we will gain $80,000 in cash even without any growth in services.

c. The Rural Flex Program through Hometown Health is working with Weems to provideauditing services of these billing companies and to clean up our Account Receivables.

They are also seeking a grant to help fund this.

11.Cash vs. Net ProfitAt the end of last year, the hospital showed a net profit of $1.1 million which sounds very good.

Unfortunately, our net increase in current assets was only about $290,000. Of this, the increase

in cash was only $67,000.

12.PEOThis past month we indicate our anticipation of moving to a new PEO. After notifying our

current vendor, Fortune Business Solutions of our intent to terminate the contract we receive a

counter proposal from them which represented an even better saving to WMH than the

alternate company offered. As a result, we are staying with Fortune Business Solutions. Ginny

and Steve did a very good job on making this possible.

13.Status of DONa. In our last months meeting, we discussed filling the empty chief clinician with a DON

rather than a CNO. I have spoken with TMH about this and they are willing to do

whatever we want from a contract standpoint and still provide access to training and

support. I bring this up as we need a board consensus to direct TMH on the matter.

b. Very few applications have been received despite increasing the number of places thejob opening is posted. Most likely, we will close out the applications at soon and

determine how to proceed.

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14.Point of Service vendorsa. Steve, the Admissions staff and IT have been evaluating two vendors for point of service

products which would increase our up front collection of cash. Geri Forbes in Perry, FL

has increased Doctors Memorials upfront collections by three-fold after implementing

the nTeligent product for about $5.00 per admission. We continue in our review of the

products and vendors to determine an ROI.

15.BP/Amoco claima. While attending a rural hospital conference this past week, I sat in on a presentation

related to the Deepwater Horizon spill and claims that can be made due to a recent

settlement by BP/Amoco. It appears that an Economic Damage claim may be possible

as relates to a decrease in Hospital Sales tax revenues, the loss of service line revenues,

and an increase in bad debt. I have not collected and evaluated the historical data

related to this yet, but based upon the impact on the local economy in general would

anticipate finding the basis for a claim.

b. It is my understanding, though I have not validated it, that Sacred Heart Hospital in St.Joe has been awarded $200,000 from a spill claim.

c. I would like the boards permission to speak with the county attorney to determine ifany merit exists for further action.

16.HB711a. We have discussed previously the directive of HB711 (currently law number unknown

but the bill was signed into law). In this, the board of public hospitals must determine

whether or not the hospital should be sold or lease rather than stay as a public hospital.

This must be initiated by the end of December 2012. At the same conference noted

above, I attended a session on HB711. Several hospitals of our size have paid between

$30,000-$75,000 for a vendor to perform this evaluation. Options do however exist as

the only part that must be outsourced is the business valuation. The rest can be

performed using existing sources if desire and available.

b. We have received one proposal of $30,000 but I have solicited other proposals to seewhat the range of prices might be. I anticipate a proposal by the board meeting that will

provide tiered pricing from the vendor doing the business valuation only to them doing

the entire project. This will give us options to consider. The vendor is CRI which has

previously done our financial audits and thus has a good feel for us already. This should

lend itself to better pricing. I will provide more information at the meeting.

17.Provider meetingsSince our last meeting, I have met with Dr. Head, Pediatrician from Sacred Heart; Sheila Allen,

ARNP from North Florida Health Center; Dr. Shezad Sanaullah; and Dr. Helen Nitsios. I tried to

meet with Dr. Stephen Miniat and Mr. Tom Brocato, PT.

18.Free EquipmentI received a call from a nearby clinic that wishes to donate its dexascan and x-ray equipment to a

hospital. The only costs would be that of removal and installation. I have committed to the

dexascan and asked our Radiology Director to evaluate it and make a recommendation.

19.Sunshine Law EducationPlease remember to turn in your attestations of education.

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Attachment A

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Governing Board of Directors 2012

October 25, 2012

Page 1 of7

Members Present: Tammi Hardy, Chair; Jim Bachrach, Vice-Chair; Duffie Harrison, Secretary; Pat Conrad MD, Robert Davis,Deborah Huckeba

Staff Present: Craig Gibson, Plant Operations Director; Becky Gibson, Nurse Manager; Steve Lanier, Controller;Ginny Griner, HR/ Med Staff Coordinator; Heather Guidry, Administrative Assistant, Ray Brownsworth, CEO

Guests Present: Erica Ceska, RD; Rachel Chesnut, Foundation President; Alan Pfeifer, Concerned Citizens of Franklin County;Carl Mahler, TMH Liaison; Comm. Pinki Jackel

TOPIC DISCUSSION ACTIONCall to Order/

Approval of Minutes The meeting was called to order at 09:08 am. BOD minutes from September 27, 2012 were presented and

reviewed.

Motion made by Huckeba toapprove minutes as presented,second by Davis. Motioncarried unanimously.

County Report Comm. Jackel present by phone.

Restore Act

A Restore Act Council has been established by the BOCC.Comm. Jackel requested a representative from WMH to sit onthe council.

o Recommendation made to appoint Bachrach asrepresentative to the Restore Act Council.

oRecommendation made to appoint an internalcommittee to consist of Bachrach, Brownsworth,Hardy, and Davis.

Restore Act

Motion made by Harrison toappoint Bachrach as theRestore Act Council hospitalrepresentative, second byDavis. Motion carried

unanimously. Motion made by Bachrach to

accept internal committeeappointments, second byHarrison. Motion carriedunanimously.

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Governing Board of Directors 2012

October 25, 2012

Page 2 of7

Loan Repayment

Comm. Jackel is working with Erin Griffith from the countyfinance department to finalize information regarding thehospitals proposed debt to the county. Comm. Jackel stated

the loans are related to DaSee. Per Comm. Jackel, preliminaryinformation is as follows:

o There were four transfers approved from the countysGeneral and Road Paving fund between January 2006and April 2006. The first two transfers were $100,000each; the subsequent two transfers were $500,000 each.

o On 12/29/2005, there was a transfer authorized fromthe county General funds for $81,000 for hospitalpayroll. In February 2006, there was a $469,000transferred from the General funds to the hospital.

o Total amount owed equals approximately $1.8 million.o OTTED loans are separate from the hospitals debt to

the county.

Comm. Jackel recommended the raw information be reviewedby Lanier, Griffith and herself before final presentation to theBOD.

Davis requested the debt be booked on the hospitals budgetfor accountability purposes.

Hardy requested time to research the debt and proposedrepayment before the hospital board enters any commitment.

TMH Report Introduction was made for Carl Mahler, the new hospitalliaison with TMH. Mahler is the Administrator for TMHBehavioral Health Center.

Mahler reviewed recommendations to improve the hospitals

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Governing Board of Directors 2012

October 25, 2012

Page 3 of7

Swingbed Program. Recommendations included thefollowing:

o Physician collaboration with the TMH casemanagement department

o Collaboration with Ann Smith, CRMC CNOo TMH electronic health record training and access for

Brownsworth

Brownsworth will be attending TMH Executive Teammeetings on the first Monday of every month.

CEO Report Swingbed Program

Improvement of the hospital Swingbed Program is a toppriority. Brownsworth has met internally as well as with TMHexecutives to improve Swingbed program.

USDA Update

A public meeting has been set with a representative of theUSDA on November 13th at 12:30pm. The meeting time willbe posted appropriately.

Outpatient Clinic An outpatient clinic for Apalachicola will be opened the first

week of December. Initially the clinic will be locatedinternally to the hospital. The days will be Tuesday,Wednesday, and Thursday with the hours of 8:30 am to 4:00pm. It will be staffed by Susan Hardin, ARNP and the WeemsEast staff. The hours, days, and providers will be expanded asneeded. Billboards will be a source of advertising for theclinics and the hospital.

Due to potential ED billing changes associated with opening

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Governing Board of Directors 2012

October 25, 2012

Page 4 of7

an internal clinic, Conrad recommended Brownsworth andLanier speak to Linda Bell and Paul Hart, MD of Southland.

Brownsworth will be working with TMH and FSU School ofMedicine to potentially recruit primary care physicians to area.

Marketing

Services will be promoted through various venues to includebillboards, mail advertisements, radio, television, communityevents, and the regular BOCC meetings.

Comm. Jackel requested WMH participate at the next FoodFair.

o Griner stated the hospital has the ability to assistpeople in signing up for Medicaid services. Comm.Jackel requested this service be promoted to schools.

Increased promotion of available specialties services wasrequested.

GI Program

Two upper endoscopy scopes are unusable. One needsreplacement; the other scope may be repairable. Lanier statedthat TMH felt the price of $14,700 was fair. A demonstration

has been set for a day with Dr. Stockwell is here. A loanerscope will be provided until repair or purchase is made.

Electronic Health Record

RFP will be published for Electronic Health Record byNovember 1, 2012.

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Governing Board of Directors 2012

October 25, 2012

Page 5 of7

Chief Clinical Position

The advertisement for Chief Nursing Officer will be revised toDirector of Nursing. This position change will provide a moredirect clinical role.

Patient Satisfaction

September Patient Satisfaction survey results presented forindividual review.

Risk Management

Risk Management and Regulatory Board Report 3 rd QuarterSummary presented. The BOD had no questions.

Policies presented for approval:o Advance Directiveso Reporting of Occurrences

Internal Risk Manager designated to Becky Gibson, RN,Interim Nurse Manager.

Risk Management

Motion made by Huckeba toaccept policies as presented,second by Davis. Motioncarried unanimously.

BOD By-Law Revision

A revision to the by-laws has been made removing the CEOfrom the Board of Directors.

Financial Update

September 2012 and Year-to-Date Income Statement reviewedin detail.

o Total year-to-date income after subsidies is$1,131,978.00.

o Davis questioned the need to reallocate clinic funds inregards to salaries. Expenses are allocated to separatedepartments to track department costs appropriately.

September 2012 Financial Summary reviewed in detail.

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Governing Board of Directors 2012

October 25, 2012

Page 6 of7

o Total of bank balances to date is $1,535,270.49o Total of accounts payable is down $52,000 from last

montho Total of accounts receivables is down $323,000 from

last month. Percent of AR collected for the year is44%.

o The clinic accounts receivable process was discussed.Lanier has recommended changing the billing from aninternal process to ARx. Brownsworth recommendedthe development of a strategy to increase cliniccollections and a formal action plan be brought back tothe board.

o Lanier will research why the accounts receivableamounts differ on the financial summary and thebalance sheet.

Old Business House Bill 711

House Bill 711 has been signed into law by the governor. Thislaw requires the hospital have an assessment made todetermine viability. Brownsworth is receiving proposals atthis time and anticipates bringing proposals to the board for

review in November. The assessment process must be initiatedbefore the end of 2012.

Sunshine Law

Education on the FL Sunshine Law has been provided to eachboard member for individual review. Members are to returntheir signed attestation form to Guidry after review.

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Governing Board of Directors 2012

October 25, 2012

Page 7 of7

Board Terms

Initially board expiration dates were in November and werestaggered by year to avoid multiple terms ending at the sametime. New board member terms will be adjusted to the positionthey replaced.

Officer positions will expire in November. These positionswill be discussed at the next regular meeting.

New Business Dietary Contract

Presentation made by Janet S. McKee, Owner of NutritiousLifestyles, Inc.

Adjournment The meeting was adjourned at 11:49 am.

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George E. Weems Memorial Hospital

Oct 2012 and Year-to-Date Income Statement for Fiscal Year 2013 (Oct 1, 2012 to Oct 31, 2012)

October 2012 October 1, 2011 to October 31, 2012 (1 month)

Operating Revenues (amount billed to patient Hospital Clinic Ambulance Total Hospital Clinic Ambulance Total

Inpatient Revenue (billed not collected) 174,477.00$ -$ 174,477.00$ 174,477.00$ -$ 174,477.00$

Outpatient Revenue (billed not collected) 337,029.50$ 88,371.25$ 56,057.60$ 481,458.35$ 337,029.50$ 88,371.25$ 56,057.60$ 481,458.35$

Emergency Dept Revenue (billed not collected) 447,435.50$ -$ 447,435.50$ 447,435.50$ -$ 447,435.50$

Total Amount Billed to Patient 958,942.00$ 88,371.25$ 1,103,370.85$ 958,942.00$ 88,371.25$ 1,103,370.85$

Less

Insurance Adjustments (429,635.67)$ (42,974.71)$ (56,653.65)$ (529,264.03)$ (429,635.67)$ (42,974.71)$ (56,653.65)$ (529,264.03)$

Bad Debt and Charity Write-Offs (186,990.01)$ -$ (186,990.01)$ (186,990.01)$ -$ (186,990.01)$

LIP & DSH Allocations -$ -$

Total Collected 342,316.32$ 45,396.54$ (596.05)$ 387,116.81$ 342,316.32$ 45,396.54$ (596.05)$ 387,116.81$

Operating Expenses Hospital Clinic Ambulance Total Hospital Clinic Ambulance Total

Salaries and Wages 185,142.44$ 39,444.31$ 51,693.70$ 276,280.45$ 185,142.44$ 39,444.31$ 51,693.70$ 276,280.45$

Employee Benefits 34,681.82$ 5,484.67$ 9,634.50$ 49,800.99$ 34,681.82$ 5,484.67$ 9,634.50$ 49,800.99$

Professional Fees 79,412.92$ 817.17$ 5,089.14$ 85,319.23$ 79,412.92$ 817.17$ 5,089.14$ 85,319.23$

Purchased Services 38,448.38$ 1,059.30$ 2,000.00$ 41,507.68$ 38,448.38$ 1,059.30$ 2,000.00$ 41,507.68$

Clinical Supplies 29,361.07$ 1,522.75$ 259.35$ 31,143.17$ 29,361.07$ 1,522.75$ 259.35$ 31,143.17$

Non-Clinical Supplies 12,874.67$ 3,633.39$ 546.58$ 17,054.64$ 12,874.67$ 3,633.39$ 546.58$ 17,054.64$

Repairs & Maintenance 14,305.01$ 443.53$ 927.59$ 15,676.13$ 14,305.01$ 443.53$ 927.59$ 15,676.13$

Utilities 11,560.66$ 2,032.46$ 1,413.67$ 15,006.79$ 11,560.66$ 2,032.46$ 1,413.67$ 15,006.79$

Insurance 5,901.00$ -$ -$ 5,901.00$ 5,901.00$ -$ -$ 5,901.00$

Interest Expense 883.29$ -$ -$ 883.29$ 883.29$ -$ -$ 883.29$

Training & Development 147.99$ 481.88$ -$ 629.87$ 147.99$ 481.88$ -$ 629.87$

Marketing 2,746.98$ 39.00$ -$ 2,785.98$ 2,746.98$ 39.00$ -$ 2,785.98$

Other (fuel, travel, rent, misc items) 8,400.30$ 3,365.40$ 5,413.73$ 17,179.43$ 8,400.30$ 3,365.40$ 5,413.73$ 17,179.43$

Depreciation 23,075.69$ -$ -$ 23,075.69$ 23,075.69$ -$ -$ 23,075.69$

Total Operating Expenses 446,942.22$ 58,323.86$ 76,978.26$ 582,244.34$ 446,942.22$ 58,323.86$ 76,978.26$ 582,244.34$Net Income or (Loss) from Operations (104,625.90)$ (12,927.32)$ (77,574.31)$ (195,127.53)$ (104,625.90)$ (12,927.32)$ (77,574.31)$ (195,127.53)$

Non-Operating Revenues & Expenses

County EMS Subsidy -$ -$ -$ -$ -$ -$ -$ -$

Weems East Clinic Subsidy -$ -$ -$ -$ -$ -$ -$ -$

Sales Tax Capital -$ -$ 42,132.67$ 42,132.67$ -$ -$ 42,132.67$ 42,132.67$

Sales Tax Receipts 58,207.84$ 10,000.00$ -$ 68,207.84$ 58,207.84$ 10,000.00$ -$ 68,207.84$

Interest Income 217.27$ -$ -$ 217.27$ 217.27$ -$ -$ 217.27$

Grant Income 5,384.05$ -$ -$ 5,384.05$ 5,384.05$ -$ -$ 5,384.05$

Miscellaneous Income 758.65$ -$ -$ 758.65$ 758.65$ -$ -$ 758.65$

Total Non-Operating Revenues & Expenses 64,567.81$ 10,000.00$ 42,132.67$ 116,700.48$ 64,567.81$ 10,000.00$ 42,132.67$ 116,700.48$

Total Net Income or (Loss) from Operations (40,058.09)$ (2,927.32)$ (35,441.64)$ (78,427.05)$ (40,058.09)$ (2,927.32)$ (35,441.64)$ (78,427.05)$

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George E. Weems Memorial Hospital

Oct 2012 and Year-to-Date Income Statement for Fiscal Year 2013 (Oct 1, 2012 to Oct 31, 2012)

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