southern mono healthcare district september 2020 … · 1. the hospital incident management team...

2019 Press Ganey Guardian of Excellence Award Winner

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

www.mammothhospital.com

METICULOUS CARE * MEMORABLE PEOPLE * MAJESTIC LOCATION

SOUTHERN MONO HEALTHCARE DISTRICT

SEPTEMBER 2020 MONTHLY BOARD MEETING AGENDA

NOTICE IS HEREBY GIVEN that the Board of Directors of Southern Mono Healthcare District will convene at its regular monthly board meeting at the location and on the date and time set forth below. Pursuant to the current State of Emergency declared by the Governor and Executive Order N-29-20, this meeting will occur and be held via teleconferencing. The meeting will be accessible telephonically to all members of the public seeking to observe and to address the Board of Directors, including giving public comment. To access the meeting, the District has set up a toll-free open conference call. The Dial-in Number is 866.588.5540; Conference Code: 8359004536#. No members of the public may physically be present at the meeting location. Attendance and participation shall be via telephone only.

In compliance with the Americans with Disabilities Act (ADA), if you need special assistance to attend this meeting via telephone, please contact the District Board Administrative Assistant at Mammoth Hospital by telephoning 760.934.3311. Prompt notification prior to the meeting will enable the District to make reasonable arrangements to assist with accessibility to this meeting.

Date: September 17, 2020 Time: 8:00 a.m. Place: Mammoth Hospital Administration Conference Rooms A & B 85 Sierra Park Road Mammoth Lakes, CA 93546

I. CALL TO ORDER

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

III. PUBLIC COMMENTS

IV. CHIEF OF STAFF REPORT

http://www.mammothhospital.com/

Southern Mono Healthcare District Board of Directors Meeting Agenda September 17, 2020

V. ADJOURN TO CLOSED SESSION

CONFERENCE WITH LEGAL COUNSEL – PENDING AND THREATENED LITIGATION Existing Litigation and Significant exposure to litigation pursuant to Government Code §54956.9.

1. Inyo County Local Agency Formation Commission (LAFCO), Northern Inyo Healthcare District v. Southern Mono Healthcare District, Sacramento Superior Court Case No. 34-2015-80002247-CU-WM-GDS; 3rd District Court of Appeal Case Nos. C085138 & C086087.

CONFERENCE WITH REAL PROPERTY NEGOTIATORS (Government Code § 54956.8).

QUALITY ASSURANCE – (Health and Safety Code §32155) 1. Chief of Staff Report. 2. CEO Report. 3. CFO Report. 4. CNO Report. 5. CMO Report. 6. CIO Report.

QUALITY ASSURANCE QUARTERLY SUMMARIES - (Health and Safety Code §32155)

HEALTH CARE FACILTY TRADE SECRETS (Health and Safety Code §32106) 1. Sierra Park Clinics/Mammoth Hospital.

CREDENTIALING Re-Appointment to Courtesy Staff Richard Brown, MD – Orthopedics Initial Appointment to Tele-Medicine Staff via Proxy-Radiology Direct Radiology Providers Shameem Azizad, MD John Nwankwo, MD

Daniel Baker, MD William Phillips, MD Michael Berven, MD Teppe Popovich, MD John Boardman, MD Paul Ramirez, MD James Brull, DVM, DO Anjali Roy, MD Lawrence Bub, MD William Rusnak, MD Courtney Carter, MD Dishant Shah, MD Dhawal Goradia, MD Shree Shah, MD Kristen Grubb, MD Frank Snyder, MD Laura Hotchkiss, MD Joseph Trudeau, MD Miriam Hulkower, MD Charles Westin, MD Frederick Jones, MD Anthony Willis, MD Russell Kosik, MD Yuming Yin, MD A Bao Nguyen, MD


Initial Appointment to Tele-Medicine Staff via Proxy-Neurology Specialty Care Providers Jeffrey Cohen, MD Mark Ross, MD

Ron Tintner, MD Venkatesh Nagaraddi, MD Watcharasarn Rattananan, MD

PERSONNEL MATTERS (Government Code §54957) 1. Tom Parker, CEO.

VI. REPORT ON CLOSED SESSION

VII. PUBLIC COMMENTS

VIII. CONSENT AGENDA

(All matters on the consent agenda to be approved on one motion unless a Board Member requests separate action on a specific item) 1. Previous Minutes to be approved:

August 20, 2020 Regular Board Meeting 2. Chief Financial Officer Report 3. Chief Nursing Officer Report 4. Chief Medical Officer Report 5. Chief Information Officer Report 6. Human Resources Report

IX. COMMITTEE REPORTS

1. Finance Committee Stephen Swisher, M.D., Dave Anderson

2. Physician Compensation, Relations and Retention Committee Laurey Carlson, Joanne Hunt

3. Employee Relations Committee Yuri Parisky, M.D., Joanne Hunt

4. Quality Assurance Committee Stephen Swisher, M.D., Joanne Hunt

5. CEO Annual Review Committee Laurey Carlson, Dave Anderson

6. IT Steering Committee Stephen Swisher, M.D., Yuri Parisky, M.D.

7. Facilities Committee Yuri Parisky, M.D., Laurey Carlson

8. Board Member Recruitment Committee Laurey Carlson, Dave Anderson

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


X. CHIEF EXECUTIVE OFFICER’S REPORT

XI. FINANCE REPORT 1. August 2020 Financial Narrative. 2. Investment Report. 3. Capital Expenditure Review

XII. BOARD EDUCATION

Presentation of the Credentialing Process by Susan Craig, Medical Staff Coordinator, and Craig Burrows, M.D., Chief Medical Officer.

XIII. OLD BUSINESS

There is no old business to discuss.

XIV. NEW BUSINESS

1. Review, Update, and Approval of District Conflict of Interest Code. 2. Review and Approve the Credentialing by Proxy Policy & Procedure. 3. Review and Approval of Credentialing by Proxy Agreements with the following

entities:

• Direct Radiology California, P.C.

• SpecialtyCare IOM Services, LLC 4. Quarterly Review of New and Revised Policies. 5. Quarterly Review of New and Revised Contracts. 6. Review and Approval of professional services agreement between Southern Mono

Healthcare District and Dr. Lucienne Bouvier for the provision of OB/GYN Professional Services.

7. Review and Approval of professional services agreement between Southern Mono Healthcare District and Dr. Michelle Newkirk for the provision of Rheumatology Professional Services.

8. Declaration of Surplus District Property, Equipment and Supplies.

XV. CREDENTIALING

Re-Appointment to Courtesy Staff Richard Brown, MD – Orthopedics Initial Appointment to Tele-Medicine Staff via Proxy-Radiology Direct Radiology Providers Shameem Azizad, MD John Nwankwo, MD

Daniel Baker, MD William Phillips, MD Michael Berven, MD Teppe Popovich, MD John Boardman, MD Paul Ramirez, MD James Brull, DVM, DO Anjali Roy, MD


Lawrence Bub, MD William Rusnak, MD Courtney Carter, MD Dishant Shah, MD Dhawal Goradia, MD Shree Shah, MD Kristen Grubb, MD Frank Snyder, MD Laura Hotchkiss, MD Joseph Trudeau, MD Miriam Hulkower, MD Charles Westin, MD Frederick Jones, MD Anthony Willis, MD Russell Kosik, MD Yuming Yin, MD A Bao Nguyen, MD Initial Appointment to Tele-Medicine Staff via Proxy-Neurology Specialty Care Providers Jeffrey Cohen, MD Mark Ross, MD

Ron Tintner, MD Venkatesh Nagaraddi, MD Watcharasarn Rattananan, MD

XVI. PUBLIC COMMENTS

XVII. FUTURE BUSINESS

The next Regular meeting will take place on Thursday, October 15, 2020 at 8:00 a.m. via Microsoft Teams and on the Mammoth Hospital conference line.

ADJOURN


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AUGUST 2020 MONTHLY BOARD MEETING MINUTES Date: August 20, 2020 Place: Mammoth Hospital Administration Conference Rooms A & B 85 Sierra Park Road Mammoth Lakes, CA 93546 Meeting virtually via Microsoft Teams and broadcast live on Mammoth Hospital’s conference line. Attendance of Board Members: Dave Anderson, Chair; Laurey Carlson, Vice Chair; Stephen Swisher,

M.D., Treasurer; Joanne Hunt, Secretary; Yuri Parisky, M.D., Member at Large.

Attendance of Staff Members: Tom Parker, Chief Executive Officer; Melanie Van Winkle, Chief

Financial Officer; Caitlin Crunk, Chief Nursing Officer; Craig Burrows, M.D., Chief Medical Officer; Mark Lind, Chief Information Officer; Zack Brown, Director of Clinics; David Baumwohl, Legal Counsel; Sarah Rea, Recording Secretary.

I. CALL TO ORDER

Chair Anderson called the meeting to order at 8:05 a.m.

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

The meeting opened with the Pledge of Allegiance to the Flag and the reading of the SMHD Mission, Vision & Values lead by Chair Anderson.

III. PUBLIC COMMENTS There were no Public Comments.

IV. CHIEF OF STAFF REPORT Richard Koehler, M.D., gave a brief verbal report. A discussion was held about methods of communication within the organization.


Southern Mono Healthcare District

Board of Directors Meeting Minutes

August 20, 2020

V. ADJOURN TO CLOSED SESSION

The Board adjourned to closed session at 8:17 a.m.

VI. REPORT ON CLOSED SESSION

The Board reconvened to open session at 9:37 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 County Local Agency Formation Commission (LAFCO), Northern Inyo Healthcare District v. Southern Mono Healthcare District, Sacramento Superior Court Case No. 34-2015-80002247-CU-WM-GDS; 3rd District Court of Appeal Case Nos. C085138 & C086087.

David Baumwohl reported discussion of CONFERENCE WITH LEGAL COUNSEL on PENDING AND

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

CONFERENCE WITH REAL PROPERTY NEGOTIATORS (Government Code § 54956.8). David Baumwohl reported there were no matters to discuss: no action was taken.

QUALITY ASSURANCE – (Health and Safety Code §32155) 1. Chief of Staff Report.

David Baumwohl reported that QUALITY ASSURANCE issues were not reported by or discussed with Richard Koehler, M.D., Chief of Staff. No action was taken.

2. CEO Report. David Baumwohl reported that QUALITY ASSURANCE issues were not reported by or discussed with Tom Parker, CEO. No action was taken.

3. CFO Report. David Baumwohl reported that QUALITY ASSURANCE issues were not reported by or discussed with Melanie Van Winkle, CFO; no action was taken.

4. CNO Report. David Baumwohl reported that QUALITY ASSURANCE issues were not reported by or discussed with Caitlin Crunk, CNO; no action was taken.

5. CMO Report.



August 20, 2020

David Baumwohl reported that QUALITY ASSURANCE issues were not reported by or discussed with Craig Burrows, M.D., CMO. No action was taken.

6. CIO Report. David Baumwohl reported that QUALITY ASSURANCE issues were not reported by or discussed with Mark Lind, CIO. No action was taken.

QUALITY ASSURANCE QUARTERLY SUMMARIES - (Health and Safety Code §32155) 1. Review of the Performance Improvement and Patient Experience Report. 2. Review of the Quarterly Beta Report.

David Baumwohl reported that the quality assurance quarterly summaries were discussed, no action was taken.

HEALTH CARE FACILTY TRADE SECRETS (Health and Safety Code §32106) 1. Sierra Park Clinics/Mammoth Hospital.

David Baumwohl reported that HEALTH CARE FACILITY TRADE SECRETS were not discussed, no action was taken.

CREDENTIALING Initial Appointment to Provisional Michael Bryan-Dermatology Initial Appointment to Fellowship Evan Corning-Orthopedics Matthew Fournier-Orthopedics Re-appointment to Active Medical Staff Mel Cherne-Radiology Re-appointment to Courtesy Staff Paul Polishuk-Urology Sharon Meiselman-Radiology

David Baumwohl reported the foregoing physician CREDENTIALING was discussed; no action was taken.

PERSONNEL MATTERS (Government Code §54957) 1. Review of the Annual Workers Compensation Personnel Claims Report.

David Baumwohl reported that the Annual Workers Compensation Personnel Claims Report was reviewed, no action was taken.

2. Tom Parker, CEO.



August 20, 2020

David Baumwohl reported a discussion took place with Tom Parker, CEO; no action was taken.

Staff and legal counsel left the Board meeting at 9:07 a.m. Tom Parker, CEO, remained in the meeting.

Closed Session ended at 9:23 a.m.

VII. PUBLIC COMMENTS There were no additional Public Comments.

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

July 16, 2020 Regular Board Meeting 2. Chief Financial Officer Report 3. Chief Nursing Officer Report 4. Chief Medical Officer Report 5. Chief Information Officer Report 6. Human Resources Report

Stephen Swisher, M.D. moved, seconded by Joanne Hunt, to approve all items on the consent agenda as presented in the packet. Chair Anderson asked for comments; a brief discussion ensued including clarification on the strategic plan report, plans for the new hospital wing, Mammoth Hospital’s Elevate program, and physician recruitment. A roll call vote was taken; the motion passed unanimously. Stephen Swisher, M.D., Yes; Yuri Parisky, M.D., Yes; Joanne Hunt, Yes; Laurey Carlson, Yes; David Anderson, Yes. Yes 5, No 0.

IX. COMMITTEE REPORTS

1. Finance Committee (Met on August 17, 2020) Stephen Swisher, M.D., Dave Anderson

Details from the Finance Committee Meeting were covered in the Financial Report.

2. Physician Compensation, Relations and Retention Committee Laurey Carlson, Joanne Hunt

There was no Physician Compensation meeting; no report.

3. Employee Relations Committee Yuri Parisky, M.D., Joanne Hunt

There was no Employee Relations Committee meeting; no report. The next Employee Relations Committee will be held on August 28, 2020.

4. Quality Assurance Committee Stephen Swisher, M.D., Joanne Hunt



August 20, 2020

There was no Quality Assurance Committee meeting; no report.

5. CEO Annual Review Committee Laurey Carlson, Dave Anderson

There was no CEO Annual Review Committee meeting; no report.

6. IT Steering Committee Stephen Swisher, M.D., Yuri Parisky, M.D.

There was no Information Technology (IT) Steering Committee meeting this month; no report. The next IT Steering Committee will be held on October 13, 2020.

7. Facilities Committee Yuri Parisky, M.D., Laurey Carlson

There was no Facilities Committee meeting; no report. The next Facilities Steering Committee Meeting will be held on September 23, 2020. A brief discussion was held about the new hospital wing project.

8. Board Member Recruitment Committee Laurey Carlson, Dave Anderson

There was no Board Member Recruitment Committee meeting; no report.

9. Ad Hoc, Special, or Other (as needed) Committees There are no Ad Hoc, Special, or Other (as needed) Committees at this time.

X. CHIEF EXECUTIVE OFFICER’S REPORT Tom Parker, CEO, reviewed the following highlights from his written report:

1. The Hospital Incident Management Team (HIMT) is now housed within the Admin Team. The Hospital has seen a significant increase in the number of non-COVID patients. Personal Protective Equipment (PPE) supplies are at 60 days supply on hand at surge rates. A new antigen test has been introduced, which has a faster turnaround than previous tests.

2. A significant number of employees are working from home, and the IT department has been giving them a great deal of support with both technology and ergonomics.

3. There have been no staff infected due to their work in the Hospital. 4. Tom Parker discussed the Specialty Clinic and recognized the room donors. 5. Tom Parker discussed the Day of Golf to be held on September 25 to raise funds for the Cancer

Outreach fund. 6. Tom Parker discussed the newly-developed Strategic Plan. Twice a year, a consolidated report will

be delivered to the Board of Directors and monthly updates will be included in the reports produced by the senior managers.



August 20, 2020

There was a question from David Anderson regarding Labor and Delivery being used as a COVID-positive ward. Deliveries are occurring in Med/Surg. A discussion was held about what the trigger would be to move deliveries back to Labor and Delivery.

XI. FINANCE REPORT

1. July 2020 Financial Narrative. 2. Investment Report.

Melanie Van Winkle, CFO, reviewed and presented the Financial Statements, included in the packet via PowerPoint presentation. Ms. Van Winkle reported the July Net Gain was $541,000 which was $128,000 less than FY2020. Days of cash-on-hand were at 425.5 at the end of July.

XII. BOARD EDUCATION

1. Presentation of the Infusion Program.

Lisa Marusicz, RN, presented the Chemotherapy Infusion-Oncology Nurse Navigator Program. There were some comments and questions from the Board. No action needed.

XIII. OLD BUSINESS

1. Review of the FY 2020 Annual Reimbursement and Disclosure. The Fiscal Year 2020 Annual Reimbursement Report and Disclosure was reviewed. Joanne Hunt motioned to approve the FY 2020 Annual Reimbursement and Disclosure. Laurey Carlson seconded the motion. A roll call vote was taken; the motion passed unanimously. Stephen Swisher, M.D., Yes; Yuri Parisky, M.D., Yes; Joanne Hunt, Yes; Laurey Carlson, Yes; David Anderson, Yes. Yes 5, No 0.

XIV. NEW BUSINESS

1. Re-establish Mammoth Hospital Patient Grievance Committee, including approval of process and appointment of committee members. Presentation by Lindsey C. Sarullo, J.D., SMHD Compliance Officer.

Lindsey Sarullo, J.D., SMHD Compliance Officer, presented an overview of the patient grievance process approval and suggestion for committee delegation. It was noted that Stephanie Stanton, Risk Manager/Quality Improvement Specialist, reports patient grievances to the Admin Team on a monthly basis. These results are also reported to the Performance Improvement Committee on a quarterly basis, and to the Board through the Quality Assurance Committee. Stephen Swisher, M.D., moved to re-establish the Mammoth Hospital Patient Grievance Committee, including approval of the grievance process and appointment of committee members as presented today by Mammoth Hospital Compliance Officer Lindsey Sarullo, Director of Quality Lenna Monte, and Risk



August 20, 2020

Manager/QI specialist Stephanie Stanton. Joanne Hunt seconded the motion. Stephen Swisher, M.D., Yes; Yuri Parisky, M.D., Yes; Joanne Hunt, Yes; Laurey Carlson, Yes; David Anderson, Yes. Yes 5, No 0.

2. Declaration of Surplus District Property, Equipment and Supplies. None to declare.

XV. CREDENTIALING

Initial Appointment to Provisional Michael Bryan-Dermatology Initial Appointment to Fellowship Evan Corning-Orthopedics Matthew Fournier-Orthopedics Re-appointment to Active Medical Staff Mel Cherne-Radiology Re-appointment to Courtesy Staff Paul Polishuk-Urology Sharon Meiselman-Radiology

Yuri Parisky, M.D., motioned to extend Dr. Richard Brown’s temporary privileges for 31 days. His

credentialing will come to the September Board meeting along with a template of definition of privileges.

Joanne Hunt seconded the motion, a roll call vote was taken, the motion passed unanimously. A roll call

vote was taken, the motion passed unanimously. Stephen Swisher, M.D., Yes; Yuri Parisky, M.D., Yes;

Joanne Hunt, Yes; Laurey Carlson, Yes; David Anderson, Yes. Yes 5, No 0.

David Anderson moved, seconded by Laurey Carlson, to approve the appointments as listed above with the

change that Evan Corning and Matthew Fournier will be granted provisional appointment, and with the

exception of Sharon Meiselman and Mel Cherne. A roll call vote was taken, the motion passed

unanimously. Stephen Swisher, M.D., Yes; Yuri Parisky, M.D., Yes; Joanne Hunt, Yes; Laurey Carlson, Yes;

David Anderson, Yes. Yes 5, No 0.

David Anderson motioned, seconded by Joanne Hunt, to approve the appointments as listed above for Drs.

Cherne and Meiselman. Yuri Parisky, M.D., recused himself from the vote due to a conflict of interest. A roll

call vote was taken, the motion passed unanimously. Stephen Swisher, M.D., Yes; Joanne Hunt, Yes; Laurey

Carlson, Yes; David Anderson, Yes. Yes 4, No 0. One recusal, Dr. Yuri Parisky.

XVI. PUBLIC COMMENTS There were no additional public comments.

XVII. FUTURE BUSINESS



August 20, 2020

The next Regular meeting will take place on Thursday, September 17, 2020 at 8:00 a.m. via Microsoft Teams.

ADJOURN

There being no further business, the meeting was adjourned at 11:12 a.m.


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DATE: September 17, 2020 TO: Board of Directors FROM: Melanie Van Winkle, CFO RE: CFO Report, Regular Meeting of the Board of Directors

Strategic Updates Financial Viability Meet Budget Performance on Net Margin and Cash Flow

Title Description Update

Overall meet budget

• FY21 Net Margin is budgeted at 7%.

• FY21 Cash Flow is budgeted to end at 340 days cash on hand.

• YTD Net Margin at August 2020 is $1,173 and 9.3%.

• Days cash on hand on August 31, 2020 was 426 or $95.7 million ($30M operating funds, $10M COVID loan funds, and $56M building project fund).

Involvement in state and national rural health issues

Continue involvement in:

• ACO for Medicare members.

• PRIME/QIP3 for Medi-Cal members.

• District Hospital Leadership Forum (DHLF) for district hospital funding opportunities.

• Received a 93% quality score for meeting our CY19 metrics in the ACO.

• Pop Health team will be submitting the final FY20 metric results in September.

• Pop Health team submitted a survey of the quality metrics that we could do for the next 5-year project which could start January 1, 2021.

• Weekly calls with CFOs to ensure we attain all COVID-19 Emergency Funds as possible


Mammoth Hospital Report to the Board of Directors CFO Report September 17, 2020

Select Operational Updates Patient Accounts Receivable:

August activity and ending AR results are very similar to last August. Gross charges generated in August were slightly higher than last July. When compared to August 2019, volumes for August 2020 are similar in most departments; however, the emergency, radiology and clinics are still behind, but getting better. Financial Audit FY20: Slavka Crouthamel and her team are still answering questions of the auditors and supplying additional support. Additional reserves were booked for accounts receivable to better match the

Gross charges generated 11,555,849$ 13,880,346$ 9,723,718$ 2,690,963$ 6,426,984$ 10,796,836$ 12,309,166$ 12,033,202$

Discharged Not Final Billed 3,221,900$ 3,402,763$ 1,839,332$ 1,412,037$ 2,577,334$ 4,662,449$ 2,974,758$ 3,792,185$

DNFB Days 8.7 7.1 4.2 4.8 12.9 21.1 9.1 9.9

Revenue billed $14,854,625 $20,297,777 $16,661,397 $7,803,887 $6,515,359 $10,863,768 $17,790,165 $14,856,894

Clean Claims % 76% 74% 69% 54% 60% 61% 71% 72%

Pt Acct Collections 5,892,417$ 7,610,236$ 8,957,230$ 5,309,300$ 3,175,159$ 3,865,882$ 5,494,875$ 5,689,902$

AR balance 21,315,815$ 29,210,325$ 24,172,212$ 18,136,068$ 18,829,931$ 21,086,988$ 22,446,121$ 23,731,156$

Gross AR days 57.40 60.63 55.09 62.07 94.20 95.47 68.94 62.18

AR > 120 days 21.0% 19.2% 23.1% 39.4% 40.2% 30.9% 28.2% 23.1%

AR $$ > 120 days 4,478,669$ 5,623,151$ 5,572,581$ 7,141,798$ 7,573,743$ 6,506,881$ 6,325,261$ 5,487,955$

Aug 19

COVID19 Impact

May 20Feb 20 Aug 20July 20Mar 20 Apr 20 June 20

Analyze service line performance

ID high cost service lines. Develop priority for service line review.

• Developing reports to be pulled out of Cerner to start this process

Partner with tertiary hospitals

Potential benefits: Exchange physician services. Improve patient handoffs. Training for staff. Shared staffing. Improve physician satisfaction & retention.

• We have a signed MOU with Lake Tahoe Sports Medicine to share the Orthopedic Fellows this year.

• Fellow will start working with Drs. Crall and Gilmer in November.

Mammoth Hospital Report to the Board of Directors CFO Report September 17, 2020

recent collection averages. The financial results are still very strong with a total margin exceeding 17%. We still need to draft the audit report and write the narrative section. It is possible the draft audit report can be presented to the Board in October. Success Sharing 2019/20: The 2019/20 goals for the employee Success Sharing maximum distribution of $1,200 were met and we are targeting a pay out to employees on September 25, 2020. Budget 2020/21: With the August financials completed, we will resume the budgeting process for FY20/21. Monthly historical volumes by department will be reviewed and estimates will be made for the current year. Unfortunately, we have had too many “unprecedented events” that cause more than normal uncertainty for budgeting. Now with the fires and the closing of the National Forest, we are faced with another hinderance to normal visitors in our town. We plan to bring a draft budget to the Board Finance Committee in November or December. For now, we will continue to present financials with a comparison to the prior year monthly numbers—this is a good gage on how we are doing.


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DATE: September 17, 2020 TO: Board of Directors FROM: Caitlin Crunk RN BSN CNO RE: CNO Report, Regular Meeting of the Board of Directors

Strategic Plan Updates


Be a High Reliability Organization with Quality outcomes that exceed national benchmarks

Continue to work on process improvement and Just Culture

• Just Culture algorithms are being used during counseling and coaching with employees.

Right size the organization according to demand and community need

Explore new ways to create efficiency of staff and space resources.

• All meetings have been moved to web-based platforms.

• Staffing models designed to be “COVID-capable.”

• The majority of non-clinical staff is working from home when able.

Achieve better than national benchmark scores in customer satisfaction surveys and internal employee and provider satisfaction surveys

Increase awareness of customer issues.

• The Quality team and interpreters have designed a questionnaire to give to patients upon discharge to help identify issues regarding equity and diversity.

• Patient Family Advisory Council (PFAC) looking to recruit more diversity within the group.

Improve retention and reduce turnover

Analyze turnover of staff and providers.

• Quality team issued a survey to the


Mammoth Hospital Report to the Board of Directors CNO Report September 17, 2020

perioperative department, including staff and physicians, to get a better understanding of the turnover of the director role. Improvement project to follow to hopefully reduce turnover in this particular department and role.

Select Operational Updates People

• Staff is continuing to flex to volumes.

• Currently looking to fill the role of OR Manager.

• Dietary Supervisor position is still open. Nancy Vargas has begun her schooling for the role, with an anticipated completion date in eight months.

Quality and Safety

• Standardization of sedation protocols by RNs are being implemented in the radiology department.

• The night shift supervisors are performing annual regulatory training to all RNs.

Service

• Continuing to have successful deliveries and post-partum care on Med/Surg. The OB unit is still set up for COVID-19 patients. We have not had a positive COVID-19 patient in the hospital since August 16.

Growth

• We have acquired more ventilators and Vapotherm machines to have the ability to care for more COVID-positive patients if needed.


________________________________________________________________________________________________________




DATE: September 17, 2020 TO: Board of Directors FROM: Mark Lind, CIO RE: CIO Report; Regular Meeting of the Board of Directors

Strategic Plan Updates


Improve analytical tools for Population Health (automated vs. Excel)

Implement a Population Health software solution that is scaled to our managed population and community but still provides tools to automate registry management, care coordination, and regulatory reporting.

• Pop Health team worked with IT to select i2i. This solution is offered through Cerner as an integrated solution.

• Project kickoff completed. I2i project team working on integration and gathering reporting requirements. Kate Britton leading project.

Explore new ways to create efficiency of staff and space resources (work from home, additional space, and virtual environment)

• Metric: 10% of patient visits are telehealth.

• Metric: 80% of non-patient facing staff are set up to be able to work from home.

• Cerner Video Visits in place in March. In broad use during initial COVID lockdown through present. Significant improvement in performance with Cerner updates in July.

• Great majority of staff whose job does not require that they be on-site sent home with hospital laptops and support equipment. Massive IT push to facilitate Patient Accounting and other areas June-August.


Mammoth Hospital Report to the Board of Directors CIO Report September 17, 2020

Select Operational Updates Biomedical Engineering:

Two Hamilton ventilators, ordered back in April, arrived this month. The biomed techs are

working to set up, calibrate, and on-board the equipment for use. This brings our Hamilton

(state of the art ventilators) up to three units. Two additional VapoTherm units in service last

month in support of this more recent trend in COVID treatment. Removing some of the

antiquated ventilators we received from various donors to onsite disaster equipment storage as

the are not needed with current patient volumes. This surplus equipment is being carefully

protected and wrapped with plastic as well as being stored in a temperature-controlled location

to ensure it remains ready for use if needed.

Facilities and Safety:

In addition to standard maintenance activities, the team continues to work on projects. New

glass screens were installed in the Bishop Clinic, Women’s Clinic and Dental. We have an OSHPD

project underway to update the Admitting and Financial services windows with proper security

glass also, but this will take time to get through the regulatory process. Updated cameras are

now installed in many locations where we have high patient activity and need to actively

monitor.

The team has also been working to ready our buildings for the winter. Exterior paint touch-up

of the clinics is ongoing. Jeff McMillan will also be installing new coils in our secondary HVAC

unit this coming month. The existing unit has some small cracks in the existing coils due to age,

and we had to wait until cooler weather to take it offline.

In July and August, Trapper Felt, Safety and Security Specialist, implemented a new program to

replace our staff screening team with per diem staff. We had been staffing this function with

staff from our clinical areas. With our greatly increased patient volumes, it was very difficult to

Survey sent to managers this month to measure for established metric of 80% staff able to work at home threshold. Tentative score of 89%, so we seem to be exceeding the threshold. The weighted average for the percentage of time working from home versus at work is 57.2%.


keep this key COVID screening function working. Trapper worked with Human Resources to

develop a job description and in hiring staff from the community. The program has gone very

well with these new team members screening all staff as they come on site to the main

campus. Our logs are being kept per State requirements. Kudos to Trapper for stepping up into

this supervisory position and for creating this new function in a relatively short period of time.

Information Technology:

Work has shifted this month to a critical IT infrastructure project. Brian Weller is working on a

major replacement project for our server host solution. We are moving to a Dell integrated

solution to host our 100-plus onsite servers. Our old platform had reached end of life. The new

solution simplifies update and maintenance as our virtual software solution VMWare is now

owned by Dell and software releases are included in our support and validated and bundled

prior to release. This makes it much easier to stay current on releases, with one vendor to deal

with and not several. The project is expected to go well into October. Zero downtime is

projected as we can move server instances in real-time with no impact to the end user.

In Informatics, we released a new EMR Satisfaction survey this month. Last year we started this

process, which uses the results to determine which departments are struggling so that we can

work with them through our Sprint process to effect improvements in EMR setup, optimize

configuration, and provide training to staff and providers. To date, we have completed Sprints

in the PACU, PT-OT, and Perioperative Materials. The Periop Sprint is largely complete but is in

a bit of a holding pattern until we can get the OR3 and associate OR storage projects

completed. We have started a sprint in Chemo, but it is pending due to staff availability at

present. Once the results of this latest survey are reviewed by the EMR Governance Team, we

will identify which additional departments need attention and start new sprint projects. More

to come next month.

Laboratory:

Jaime Sallee, Lab Manager, has completed the process to set up our pathologist, Dr. Payton,

under our CLIA licensing to perform reads from his home office. As he commutes up from

Oceanside, and is only onsite several days a week, this will improve our turnaround time. The

lab will be able to overnight specimens to Dr. Payton for an immediate read any day of the

week, not just Thursday through Saturday. This also provides Dr. Payton some relief in dealing

with weather events or other issues with his long commute. Kudos to Jaime for stepping

through this involved process with CLIA.

Medical Imaging:

Clinical evaluation of the first of the new demo C-Arms for the OR3 and Interventional

Radiology went well this past month. Dr. Harrell reports he is happy with this unit. We have one

additional unit coming this month which is looks promising. Functionality of these state-of-the-


art C-Arms is much advanced over the older units, with better automatic tracking to account for

patient movement and clarity of the images.

A project to upgrade our Philips PACS is planned for kick off in September. This will upgrade our

onsite equipment to improve performance and storage as well as update our PACS version to

the current version. Changes to the software release will largely be incremental and of minimal

impact. Training for the Radiologists and Rad Techs to be scheduled when appropriate.


________________________________________________________________________________________________________




DATE: September 17, 2020

TO: Board of Directors

FROM: Sarah Vigilante, HR Director

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

Strategic Updates


Redesign Staff Education Program

• Consolidate staff development budget and administration under Human Resources.

• Work with nurse management to develop a strategic education plan for the organization.

• Develop a mentoring program for providers, staff and managers.

• Hired a Staff Development Coordinator with strong nursing education background to start September 14 per diem, then full time in November.

Explore new ways to create efficiency of staff and space resources (work from home, additional space, and virtual engagement)

• Set-up staff to work from home and rotate in the office.

• Conduct orientation via Teams.

• All direct reports are working remotely and splitting time in the office when necessary.

• Several orientation presenters are now presenting via Teams and the conference room has been physically spaced for new hires.

Analyze turnover of staff and providers

• Add exit interview for providers.

• Provide exit interview

• Senior Managers have begun taking over the exit interview process in order to deliver


Mammoth Hospital Report to the Board of Directors HR Report September 17, 2020

information to PI committee.

• Conduct stay interviews.

direct feedback and take action.

Evaluate our recognition programs

• Design recognition programs to enhance employee engagement.

• Management recognition will now be done in the individual departments with Senior Managers recognizing employees personally.

• Grateful patient recognition will be done at the departmental level with the Foundation Coordinator attending a departmental committee meeting to recognize any providers who receive donations in their name.

Conduct a comprehensive review and redesign of our annual performance review and compensation processes

• Develop a compensation philosophy.

• Create a timeline for implementation of changes.

• Pull custom CHA data report excluding Inland Empire.

• Perform detailed salary administration analysis.

• Work with Finance to understand budgetary implications and plan changes for July 2021.

• Senior Leaders met with Gallagher Consulting in June to revisit process.

• Senior Leaders had a special meeting to discuss compensation philosophy and make key decisions going forward.

• Plan presented to Employee Relations committee in August.

• Senior Admin are going over all pay policies in detail as a part of this review. At this time, the pay policy review is 95% completed.

Develop a coordinated onboarding process for providers

• Enhance onboarding process for new providers.

• Currently utilizing a checklist and form to be filled out by providers when they come on board.

• New providers also take a Healthstream course to

Mammoth Hospital Report to the Board of Directors HR Report September 17, 2020

Select Operational Updates:

• 90 employees have utilized FFCRA funds.

• As of September 8, we have not had a single employee exposure to COVID that has been

linked to the hospital. All COVID positive employees have been linked to a household

contact or other employment. At this time, we have <1% of our workforce not working

or on a reduced schedule due to childcare challenges, quarantining due to a household

or other exposure, and/or COVID-19. The staffing challenges that we experienced in July

and August have lessened over the past month, although working parents continue to

experience issues with school closures which are expected for the remainder of the

semester.

Employees Not Working Regular Schedule

26

COVID Sick (includes quarantining)

1

Other Sick 1

Intermittent Childcare Related Absence

24

COVID Kincare 0

• The Mammoth Hospital Foundation Board held a meeting last month and made the selection of an annual appeal item . This year’s item will be a SIM baby to be used by our Labor and Delivery department.

• Mammoth Hospital received a $12,000 annual donation (and pledge) for Rhiannon’s Kids fund which is used by pediatric patients that need to travel out of town for care.

• Employee Health has begun to administer the annual flu vaccines to staff.

• Tina Villa, HR Generalist – Benefits, is now on leave.

• Our widest-reaching social media post was by far our most recent press release on a COVID-related patient death. This post reached over 12,000 people and was shared 93 times. Our second most successful post was a video by Dr. Clark encouraging patients to not delay clinic appointments for routine care. Our clinics have remained below normal volumes and our print advertising has and will continue to be focused on the clinics.

introduce them to Mammoth Hospital policies and procedures.

Finance Committee Minutes Date: Monday, August 17, 2020 Time: 4:30 pm Location: Teams Attendees: Tom Parker; Stephen Swisher; Melanie Van Winkle; Slavka Crouthamel; Caitlin Crunk. The meeting was called to order by Dr. Swisher at 4:30 pm. Not present: Dave Anderson.

Agenda Item:

Discussion/Conclusion/Action

Follow-up

Review of Minutes • July 13, 2020 minutes were reviewed. No changes were requested. Minutes approved.

Follow-up • Dr. Swisher said that ER diagnostic test professional fee capture looks pretty good now.

• No update on the price transparency issue.

Financials – July 2020 Melanie went over the PowerPoint with the group.

• Pretty good collection month. Cash went down about $1.3 M from June to July due to the timing of accounts payable and accrued payroll. Basically reduced liability so cash went down.

• No budget yet. Red line is 3-year average on PowerPoint.

• Clinics not quite back up to regular volume.

• Payor mix was much better in July.

• Increased unemployment - 72 total employees. Benefits expense higher.

• Margin 8.6%, goal 7%.

• Cash $95.3 Total Cash = 425.5 days cash on hand. o $30.2 operating cash (135 days cash on hand), o $9.9 COVID loans/advances (44.5 days cash on hand), o $55.1 cash reserves (246 days cash on hand).

• See Financial PowerPoint.

Healthcare Spending Accounts and Billing

Melanie went over the memo regarding HSA and billing with the group. • See HSA memo.

Mammoth Hospital Finance Committee Minutes – August 17, 2020

Page 2 of 2

• There was discussion about the difference between HSA and FSA accounts. Requirements are slightly different.

• EOB is typically sufficient for flexible spending account documentation.

• We moved away from detailed billing to improve overall complaints about 10 years ago.

• Dr. Swisher agrees with Management’s recommendation not to make any changes to billing detail on patient statements.

Eide Bailly FY20 Audit Late Charge Revenue Postings

• Every year auditors point out how much revenue was generated at the end of the year that was not posted until July. Typically ~$200,000. This year $657,000. $450,000 this year related to surgery. Either way does not affect cash in the bank.

COVID-19 Activities Emergency Funding:

• We have not had any more COVID funding coming in.

• Have been looking at how to allocate COVID19 expenses and lost revenue.

• CFO Report: will probably start picking up on the budget in mid August.

Other Business • Dr. Swisher recommended that we move forward with hospital-wide 5% increase before budget is finalized. This would go to the board for approval at the September meeting.

• Melanie will bring back a recommendation in for the September board meeting.

Next Meeting • Next meeting: Monday, September 14, at 4:30 pm.

Meeting adjourned at 5:05 pm.


________________________________________________________________________________________________________




DATE: September 17, 2020 TO: Board of Directors FROM: Tom Parker, CEO RE: CEO Report, Regular Meeting of the Board of Directors

COVID-19 (C19): C19 planning continues to be done by the Admin Team having transitioned those duties from the Hospital Incident Management Team (HIMT). Personal Protective Equipment (PPE) supplies on hand remain high with 60-plus days at surge use rates for all critical supplies needed to manage C19 patients. This includes the new antigen test which provides 15-minute turnaround of results. As of the writing of this report, there have been 163 positive results from C19 testing in the community. That number has plateaued since mid-August. The seven-day positivity testing rate has been at zero since August 27. One new positive test came in on Friday, September 11. To date, there have been no cases of staff having been infected as a result of work in the hospital setting. All COVID-positive employees have been linked to a household contact or other employment. At this time, 1 percent of our workforce is not working or on a reduced schedule due to childcare challenges, quarantining due to a household or other exposure, and/or C19. This is down from 8 percent last month. Labor & Delivery services continue to operate out of Med/Surg. This has allowed for the L&D unit to serve as the inpatient unit for C19+ patients. The new screening team is now fully staffed and under the supervision of Safety and Security Specialist Trapper Felt. Our thanks to clothing brand Johnny Was for donating hundreds of fashionable masks for hospital staff! July Financial Results: Total Gross Revenue of $11.9m in August is $300k lower than July and $466k higher than August of last year. Net Gain in August was $633k, up from the July net gain of $541k and less than last year’s August Net Gain of $741k. Year-to-date Net Gain is $1.2m (9.3% Total Margin) compared to last year at this time of $1.4m (11.2% Total Margin).


Mammoth Hospital Report to the Board of Directors CEO Report September 17, 2020

Budget 2020/21: With the August financials completed, we will resume the budgeting for FY2020/21. Monthly historical volumes by department will be reviewed and estimates will be made for the current year. Note that we have many unprecedented events of late that increase the uncertainty in the budgeting. A draft budget will be presented to the Board at the November or December Board meeting. IT: The IT department began its work on the replacement of our server host in August, moving to a Dell integrated system for hosting over 100 onsite servers. The new system will facilitate simplified updating and maintenance and reduce maintenance-related downtime. Lab: Lab Manager Jamie Sallee has completed the process to set up our pathologist, Dr. Payton, under our CLIA licensing to perform reads from his home office. The lab will overnight specimens to him for immediate reads, greatly improving our turn-around time. Medical Imaging: Evaluation has been completed on the first of the new demo C-arm unit to be used for OR3 and interventional radiology. Dr. Harrell was happy with the unit. Another unit will be demoed and evaluated this month. A project to upgrade the Philips Picture Archiving Computer System (PACS) begins this month. The upgrade is expected to improve system performance and storage. Quality: The Quality team and interpreters have designed a questionnaire to give to patients upon discharge to help identify issues we may have with respect to equity and diversity. Also, the Patient and Family Advisory Council (PFAC) is working to recruit more members with a focus on improving the diversity of the group. The Quality team issued a survey to the Perioperative department including staff and physicians to get a better understanding of the turnover in the director role. The survey information will be used in an improvement project with the goal of reduced turnover in the department and the director role. Foundation: The Mammoth Hospital Foundation Board made the selection for the annual appeal item. The Foundation will raise funds for the purchase of the “SIM Baby” to be used for training of nurses and providers in Labor and Delivery. The simulation baby will provide more realistic hands-on training for low-volume high-risk situations such as neonatal resuscitation. The Cancer Outreach Day of Golf will take place on September 25 with COVID-safe requirements in place to ensure the safety of players and volunteers. The teams are nearly full and we have vendors who are sponsoring in compliance with the safety protocols. HR: Work continues on the comprehensive review and redesign of our annual performance review and compensation processes. Senior leaders met with Gallagher Consulting in June. Subsequently, senior leaders met to refine the compensation philosophy. The draft of the plan was presented to the Board’s Employee Relations Committee in August. As part of the comprehensive review, senior leaders are reviewing all pay policies at the weekly Admin Team meetings; 95 percent of that review process is complete.


MEMORANDUM

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

DATE: September 17, 2020

TO: The Board of Directors

FROM: Melanie Van Winkle, CFO & Slavka Crouthamel, Controller

SUBJECT: Financial Statements for two months ended August 2020

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

This memorandum presents an overview of Mammoth Hospital financial operations.

BALANCE SHEET

• The August month end Cash balance was $95.7 million – $271 thousand higher than July. Days

cash are 426 days in total.

o Operating cash at 135 days

o COVID advances & loans at 45 days

o Capital/Facility project reserve at 246 days

• Net Patient Accounts Receivable was $11.0 million, which is $617 thousand higher than prior

month.

• Prepaid expenses decreased by $311 thousand compared to July due in part to a $223 thousand

Beta Dividend check received in August, which offsets prepaid expenses.

• Due to Third party payers decreased by $256 thousand mainly due to IGT transfer for PRIME

project funding.

FINANCIAL INDICATORS

• Patient Cash Collections in August were $5.7 million, $280 thousand over prior month. YTD

patient account collections are $11.2 million compared to $13.1 million for the same period last

year

• Gross AR days increased to 67.9 from 64.8.

• AR over 120 days decreased to 23.1% at August month end compared to 27.9% in July.

• Gross revenue was $11.9 million in August – $300 thousand under July, but $466 thousand over

prior year.


Report to the Board of Directors

Financial Report

September 17, 2020 VOLUMES

Month of August summary:

• Inpatient days were 134 – 4 higher than prior month, but 14 less than August 2019. The Case Mix

index was 1.534, which is higher than our average due to the volume of ICU days.

• Total surgeries were 120 in August compared to 118 in July and 134 in the prior year. Inpatient

surgeries were 34 (prior year 37) and Outpatient surgeries were 86 (prior year 97).

o Endoscopies & Colonoscopies were 49 in August – versus 20 in July and 46 in the prior

year.

• The Emergency Department had 831 visits compared to 943 in July and 1,041 in the prior year.

• Clinic visits finished at 3,305 – lower than July by 178 visits and lower than prior year by 727

visits. The most significant decline was in Family medicine clinic visits – 450 visits less than

August 2019 and 112 visits lower than July 2020 – all FM providers had vacations during the

month of August.

INCOME STATEMENT

Month of August

Revenue:

Total Gross Revenue decreased slightly to $11.9 million versus $12.2 million in July, but was $466

thousand higher than August 2019. Net Patient Revenues as a percentage of Gross Revenue continued

to improve from July to August, 51.5% to 52.7% - due to more favorable payer mix and aging.

August 2020 Expenses:

OPERATING EXPENSES Current Prior

Year Variance

%

Variance Brief Comments

Salaries $2,050 $1,988 $62 3%

Benefits 953 754 $198 26% Health insurance expense increase

Professional services 1,233 1,406 ($173) -12% Lower than last year due to lower clinic, surgery and ER volumes

Contract services 65 36 $30 83%

Supplies 660 585 $75 13%

Services 689 737 ($48) -7%

Total Expenses $5,650 $5,507 $143


Report to the Board of Directors

Financial Report

September 17, 2020

Net Gain

• The August net gain was $633 thousand compared to July’s net gain of $541 thousand and $741

thousand net gain in August 2019.

Year to Date

• Total Gross Revenue of $24.1 million is $636 thousand higher than the prior year.

• Total Net Patient Revenue (collectable revenue) was $12.5 million, on par with the prior year.

• Total Operating Expenses of $11.4 million are $150 thousand higher than prior year.

o Both Salaries and Benefits are over prior year seeing unfavorable increases of $141 and

$319 thousand, respectively with the highest difference in employee insurance costs.

o Professional Services (physician payments) are $383 thousand under prior year – this is

due to lower volumes for some key areas

o The $123 thousand unfavorable variance in Supplies is offset by a $127 thousand

favorable variance in Services compared to prior year.

• The Year to date Net Gain was $1.2 million (9.3% total margin) compared to the prior year gain of

$1.4 million (11.2 % total margin).

9/9/2020

SOUTHERN MONO HEALTH CARE DISTRICT Comparative Balance Sheet - August 31, 2020

Unaudited Unaudited Unaudited

August 31, July 31, Prior Month June 30,

ASSETS 2020 2020 Change 2020

CURRENT ASSETS:

Cash (135 days operating expenses) $30,242,372 $30,242,430 ($58) $19,609,830

Cash (reserved for building projects) 63,676,097 63,405,021 271,077 75,333,596

Investments 1,743,179 1,743,179 0 1,745,882

Total Cash 95,661,648 95,390,630 271,019 96,689,308

Patient accounts receivable 23,825,084 22,540,069 1,285,015 21,212,228

Less: Allow. for bad debts and contractuals (12,794,757) (12,126,633) (668,124) (11,555,928)

Net patient accounts receivable 11,030,327 10,413,436 616,891 9,656,299

Inventory 1,950,711 1,930,393 20,317 1,945,031

Prepaid expenses & deposits 562,410 874,202 (311,792) 710,431

Other current assets 1,184,098 686,953 497,145 459,465

Total Current assets 110,389,194 109,295,614 1,093,581 109,460,534

ASSETS LIMITED AS TO USE:

Bond funds held in trust by Mono County:

Mono Co Bond Capital Appreciation Fund 10,544,488 10,544,488 0 10,544,488

Debt service fund 1,547,292 1,547,292 0 1,547,292

Restricted by contributors 168,606 142,056 26,550 121,565

Total Assets Limited As To Use 12,260,386 12,233,836 26,550 12,213,345

PROPERTY, PLANT & EQUIPMENT:

Land and improvements 7,933,576 7,933,576 0 7,933,576

Buildings and improvements 56,767,838 56,767,838 0 56,767,838

Equipment 35,497,431 35,497,431 0 35,497,431

Construction-in-progress 441,142 398,281 42,861 329,118

Total Property, Plant and Equipment 100,639,988 100,597,126 42,861 100,527,963

Less: Accumulated depreciation (58,735,034) (58,351,463) (383,571) (57,967,170)

Less: Accumulated amortization (2,077,080) (2,077,080) 0 (2,077,080)

Net Property, Plant and Equipment 39,827,874 40,168,584 (340,710) 40,483,714

Total Assets $162,477,455 $161,698,034 $779,421 $162,157,593

Page 1

9/9/2020

SOUTHERN MONO HEALTH CARE DISTRICT Comparative Balance Sheet - August 31, 2020

Unaudited Unaudited Unaudited

August 31, July 31, Prior Month June 30,

LIABILITIES 2020 2020 Change 2020

CURRENT LIABILITIES:

Accounts payable and accrued expenses $3,152,165 $3,304,015 ($151,850) $3,882,202

SBA Loan 5,265,405 5,265,405 0 5,265,405

Accrued payroll-related liabilities 4,396,041 4,010,730 385,311 4,685,002

Patient refunds 103,982 70,364 33,618 125,809

Due to third party payers 6,117,170 6,374,086 (256,916) 6,197,015

Accrued interest on long term obligations 242,143 211,144 30,999 180,146

Current portion of long-term debt 1,130,000 1,130,000 0 1,015,000

Health plan IBNR 822,000 822,000 0 822,000

Total Current liabilities 21,228,905 21,187,743 41,162 22,172,578

LONG-TERM DEBT:

Unamortized bond premium 916,699 927,367 (10,668) 938,036

Capital appreciation interest payable 10,589,481 10,499,692 89,788 10,409,904

General Obligation Bonds 12,509,555 12,509,555 0 12,624,555

Total long term debt 24,015,734 23,936,614 79,120 23,972,494

Total Liabilities 45,244,640 45,124,358 120,282 46,145,072

NET ASSETS:

Invested in capital assets net of related liabilities 14,682,140 15,101,970 (419,830) 15,496,219

Restricted - expendable for specific operating activities 168,026 141,476 26,550 121,045

Restricted - expendable for debt service 12,091,780 12,091,780 0 12,091,780

Unrestricted 89,117,616 88,697,786 419,830 73,481,336

Year to date earnings 1,173,252 540,665 632,588 14,822,139

NET POSITION: 117,232,814 116,573,677 659,138 116,012,520

Total Liabilities and Net Position $162,477,455 $161,698,033 $779,421 $162,157,592

Page 2

SOUTHERN MONO HEALTH CARE DISTRICT

Statement of Revenues & Expenses - August 31, 2020

Prior Month Actual Prior Year

Variance to Prior Year OPERATING REVENUE Actual Prior Year

Variance to Prior Year

(000s omitted)/1000

$3,333 $3,276 $2,849 $426 Inpatient services $6,608 $5,370 $1,238

5,781 5,940 5,904 37 Outpatient services 11,721 12,336 (615)

2,390 1,994 1,849 145 Professional fees services 4,384 4,047 337

690 669 811 (141) Clinic services 1,359 1,683 (323) 12,193 11,880 11,413 466 Total Gross Revenue 24,073 23,436 636

(5,056) (5,211) (5,015) (196) Contractual & other discounts (10,267) (9,794) (474)

(406) (65) (445) 381 Charity write offs (471) (834) 363 (446) (347) 222 (569) Provision for bad debts (793) (265) (529) - - - - Supplements/Settlements - - -

6,285 6,256 6,174 83 Net Patient Revenue 12,541 12,544 (3)

27 22 30 (8) Other operating revenue 49 66 (17)

6,312 6,278 6,204 75 Total Operating Revenue 12,590 12,610 (20)

OPERATING EXPENSES

$2,085 $2,050 $1,988 (62) Salaries $4,135 $3,995 (141)

932 953 754 (198) Benefits 1,885 1,566 (319)

1,332 1,233 1,406 173 Professional services 2,565 2,948 383

79 65 36 (30) Contract services 144 67 (78)

735 660 585 (75) Supplies 1,394 1,272 (123)

611 689 737 48 Services 1,300 1,428 127 5,774 5,650 5,507 (143) Total Expenses 11,425 11,275 (150)

537 628 697 (68) OPERATING GAIN (LOSS)/1000 1,165 1,335 (170)

$376 $375 $348 (27) Depreciation & amortization $751 $708 (43)

$161 $253 $348 ($95) Operating Gain (Loss) after Depreciation $414 $628 ($213)

NON-OPERATING INCOME(EXPENSE)/1000

$0 $0 $0 - Gain (loss) on sale of property $0 - -

- - - - Donation income - - -

227 227 215 12 Bond property tax revenue 454 431 23

(119) (119) (117) (1) Bond interest expense (237) (235) (2)

270 270 269 1 Property tax revenue & interest income 541 539 2

0 0 26 (25) Interest expense 1 48 (47) 379 379 393 (14) Total Non-Operating Income (expense) 759 783 (24)

$541 $633 $741 ($109) Increase in net assets - net gain (deficit) $1,173 $1,410 ($237)

8.6% 10.1% 11.9% -1.9% Total Margin 9.3% 11.2% -1.9%

August-20 Year-to-Date

Page 3


Key Statistical Data - August 2020

Prior Month Actual Prior Year

Variance to Prior

Year Hospital Statistics Actual Prior YearVariance to Prior Year

31 31 31 Days in month 62 62Acute Patient Days:

9 18 15 3 ICU Days 27 27 - 114 107 129 (22) Med/Surg & Telemetry Days 221 231 (10)

7 9 4 5 Labor & Delivery Days 16 20 (4) 130 134 148 (14) Total Acute Patient Days 264 278 (14)

4.2 4.3 4.8 (0.5) Average Daily Census (ADC) 4.3 4.5 (0.2) 33.6% 31.9% 29.2% 2.7% % of IP Revenue to Ttl Revenue 32.8% 27.4% 5.4%

2.1 2.7 2.4 0.3 Average Length of Stay (ALOS) 2.4 2.2 0.2

63 49 61 (12) Discharges 112 127 (15)

1.577 1.534 1.465 0.069 Case Mix Index 1.562 1.401 0.16

Other Key Hospital Statistics:943 831 1,041 (210) ED Visits 1,774 2,154 (380) 516 552 660 (108) Observation Hours 1,068 1,348 (280)

4 9 4 5 Deliveries 13 13 -

34 34 37 (3) IP Surgeries 68 67 1 84 86 97 (11) OP Surgeries 170 203 (33)

118 120 134 (14) Total Surgeries 238 270 (32)

85 84 89 (5) MRI Procedures 169 168 1 196 195 206 (11) CT Scans 391 414 (23)

65 68 85 (17) Mammography Procedures 133 156 (23) 146 131 128 3 Ultrasound 277 285 (8) 978 949 1,192 (243) Radiology 1,927 2,409 (482)

1,470 1,427 1,700 (273) Total Imaging 2,897 3,432 (535)

7,468 7,352 7,498 (146) Lab Tests 14,820 15,483 (663) 6,301 6,256 7,422 (1,166) Pharmacy Units 12,557 14,781 (2,225) 2,007 2,044 2,216 (172) PT/OT Visits 4,051 4,348 (297)

Clinic Visits1,216 1,094 1,544 (450) Family Medicine clinic 2,310 3,145 (835)

350 291 205 86 Behavioral Health clinic 641 388 253 307 262 315 (53) Women's clinic 569 624 (55) 357 302 416 (114) Pediatric clinic 659 809 (150) 473 583 619 (36) Ortho Mammoth clinic 1,056 1,193 (137) 272 247 294 (47) Ortho Bishop clinic 519 627 (108) 157 191 117 74 Specialty clinic 348 321 27

53 95 89 6 Surgical clinic 148 230 (82) 298 240 433 (193) Dental clinic 538 927 (389)

3,483 3,305 4,032 (727) Total Clinic visits 6,788 8,264 (1,476)

August-20 Year-to-Date

Page 4

Mammoth Hospital

All Statistical Analysis

Dept # Dept Name Unit of Service Desc

Jul 2020

Aug 2020

ActualAugust

2019

YTDTotal

6010 ICU Patient Days 9 18 15 276170 Med/Surg Patient Days 85 65 79 1506170 Telemetry Patient Days 29 42 50 717400 L & D Patient Days 7 9 4 16

Total Acute Patient Days 130 134 148 264

6380 Observation Patient Days 22 23 28 456380 Observation Hours 516 552 660 1,0686530 Nursery Patient Days 7 10 4 177400 L & D Pre-delivery hours 18 19 62 377400 L & D Deliveries 4 9 4 13

7080 Family Medicine Clinic Patient Visits 1,216 1,094 1,544 2,3107080 Behavioral Health Clinic Patient Visits 350 291 205 6417050 Women's Clinic Patient Visits 307 262 315 5697090 Pediatric Clinic Patient Visits 357 302 416 6597160 Ortho Mammoth Clinic Patient Visits 473 583 619 1,0567140 Ortho Bishop Clinic Patient Visits 272 247 294 5197180 Specialty Clinic Patient Visits 157 191 117 3487110 Surgical Clinic Patient Visits 53 95 89 1487060 Dental Clinic Patient Visits 298 240 433 538

Total Clinics 3,483 3,305 4,032 6,788

7010 ED Patient Visits 943 831 1,041 1,7747040 Ambulance Work days 22 21 22 437420 Surgery Minutes 15,930 17,580 17,235 33,5107420 IP surgeries Procedures 34 34 37 687420 OP surgeries Procedures 84 86 97 1707420 Colo/Endo Procedures Procedures 20 49 46 69

7427 PACU Minutes 13,770 13,695 16,200 27,4657500 Lab Tests 7,468 7,352 7,498 14,8207590 EKG's IP Procedures 16 12 29 287590 EKG's OP Procedures 146 161 185 3077641 Chemotherapy Patient Visits 36 39 56 757710 Pharmacy Units 6,301 6,256 7,422 12,5577720 Respiratory Unique Patients 198 173 630 371

7630 Radiology Patient Visits 978 949 1,192 1,9277635 Mammography Patient Visits 65 68 85 1337660 MRI Patient Visits 85 84 89 1697670 Ultrasound Patient Visits 146 131 128 2777680 CT Scan Patient Visits 196 195 206 391

Total Imaging Procedures 1,470 1,427 1,700 2,897

7770 Mammoth PT Visits 1,089 1,109 1,198 2,1987772 Bishop PT Visits 792 724 793 1,5167773 Bishop OT Visits 54 102 76 1567790 Mammoth OT Visits 72 109 149 181

Total Visits PT/ST/OT 2,007 2,044 2,216 4,051

Southern Mono Healthcare DistrictLAIF Investment

9/9/2020

Deposit 8/9/2019 300,000Withdraw 8/16/2019 (650,000)Deposit 8/23/2019 550,000Withdraw 8/30/2019 (600,000)

Balance as of August 31 2019 59,831,146

Deposit 9/6/2019 2,850,000Deposit 9/13/2019 200,000Deposit 9/20/2019 350,000Withdraw 9/27/2019 (650,000)

Balance as of September 30 2019 62,581,146

Z:\BankAccounts\LAIF\LAIF Activity.xlsx

Southern Mono Healthcare DistrictLAIF Investment

9/9/2020

Deposit 10/4/2019 650,000Withdraw 10/9/2019 (250,000)Interest 10/15/2019 373,352Deposit 10/16/2019 150,000Withdraw 10/25/2019 (900,000)

Balance as of October 31 2019 62,604,497

Withdraw 11/8/2019 (600,000)Deposit 11/15/2019 2,995,000

Balance as of November 30 2019 64,999,497

Balance as of December 31 2019 64,999,497

Deposit 1/10/2020 1,800,000Interest 1/15/2020 367,636Withdraw 1/17/2020 (1,000,000)Deposit 1/31/2020 400,000

Balance as of January 31 2020 66,567,134

Deposit 2/7 900,000Deposit 2/13 100,000Depost 2/28 600,000Withdraw 2/17/2020 (200,000)

Balance as of February 29 2020 67,967,134

Withdraw 3/13/2020 (1,500,000)Deposit 3/6 1,000,000Deposit 3/20 100,000Withdraw 3/27 (200,000)

Balance as of March 31 2020 67,367,134

Deposit 4/2 1,500,000Withdraw 4/10 (400,000)Interest 4/15/2020 337,833Deposit 4/16 300,000Deposit 4/27 5,800,000

Balance as of April 30 2020 74,904,966

Balance as of May 31 2020 74,904,966

Balance as of June 30, 2020 74,904,966

Interest 7/15/2020 95,034

Balance as of July 31, 2020 75,000,000

Balance as of August 31, 2020 75,000,000

Z:\BankAccounts\LAIF\LAIF Activity.xlsx


Investments Summary - July 31, 2020

Certificates of Deposit (CDs)

Interest Rate

Purchase Date Maturity Date Broker Cost BasisEstimated Current

Market ValuePercentage

of FundsBenchmarkComparison

Ally Bk Midvale UT 2.05% 11/24/2017 11/24/2020 Union Banc Investment Services 247,000 248,156 0.32%BMW Bk NA Salt Lake 2.05% 11/29/2017 11/30/2020 Union Banc Investment Services 247,000 248,237 0.32%American Exp Fed Svgs Bk 2.10% 12/5/2017 12/7/2020 Union Banc Investment Services 247,000 248,366 0.32%American Express Centrn 2.10% 12/5/2017 12/7/2020 Union Banc Investment Services 247,000 248,366 0.32%Capital One Natl Assn VA 2.10% 12/6/2017 12/7/2020 Union Banc Investment Services 247,000 248,366 0.32%Wells Fargo Bank Natl Assn 2.10% 12/8/2017 12/8/2020 Union Banc Investment Services 249,000 250,377 0.33%Sallie Mae Bk Slt Lake City UT 2.10% 12/13/2017 12/14/2020 Union Banc Investment Services 247,000 248,462 0.32%

1,731,000 1,740,330 2.27%

Local Agency Investment Fund (LAIF)Interest

RateBeginning Balance

Activity Ending Balance

1.36% $75,020,093 ($20,093) $75,000,000 $75,000,000 97.73%

Total Investments $76,731,000 $76,740,330

Note 1: These investments comply with the Districts Statement of Investment Policy and with Government Code §53600.Note 2: The District has the ability to meet all scheduled expenditures for the next 6 months.Note 3: The maximum allowed balance of LAIF is $75,000,000.

For Period Ended: August 31, 2020

Tables and Graphs

DRAFT

FINANCE COMMITTEE DRAFT September 14, 2020

Page 1

VOLUMEInpatient Volume

20.0

30.0

40.0

50.0

60.0

70.0

80.0

90.0Admissions - All Excluding Nursery

Current Year Prior Year 2 Years Ago

1.5

2.5

3.5

4.5

5.5

6.5

7.5

Average Daily Census - All Excuding Nursery


0

10

20

30

40

50

60

70

Inpatient Surgery Volume


Page 2

Outpatient Volume

50

60

70

80

90

100

110

120

130

140

150

160

Clinic Volume (per day) - All Clinics


0

200

400

600

800

1,000

1,200

1,400

Emergency Department Volume


0

20

40

60

80

100

120

140

Outpatient Surgery Volume


Page 3

REVENUEGross Charges

-

1,000

2,000

3,000

4,000

5,000

Thou

sand

sGross Inpatient Revenue


-

1,000

2,000

3,000

4,000

5,000

6,000

7,000

8,000

Thou

sand

s

Gross Outpatient Revenue


-

100

200

300

400

500

600

700

800

900

1,000

Thou

sand

s

Gross Clinic Revenue


-

500

1,000

1,500

2,000

2,500

3,000

3,500

4,000

Thou

sand

s

Gross Professional Fees Revenue


Page 4

Net Revenue

1,000

3,000

5,000

7,000

9,000

11,000

13,000Th

ousand

s

Net Patient Revenue


1,000

6,000

11,000

16,000

21,000

26,000

31,000

36,000

41,000

46,000

Net Revenue per Adjusted Patient Day


Page 5

Revenue Cycle

50%

100%

150%

200%

250%

Cumulative Cash Collections as a % of Net Collectible Revenue

Current Year Prior Year 2 Years Ago Budget

0

10,000

20,000

30,000

40,000

50,000

60,000

70,000

80,000

-

1,000

2,000

3,000

4,000

5,000

6,000

7,000

8,000

9,000

Jul

Aug

Sep Oct

Nov

Dec Jan

Feb

Mar

Apr

Ma

y

Jun

YT

D

2020

2019

2018

Th

ou

san

ds

Th

ou

san

ds

Monthly Collections

'Current Year" 'Year to Date" 'YTD Budget" 'Prior Year' 'Two Years Ago"

24 30 36 42 48 54 60 66 72 78 84 90 96

102

Millions

Cash Balance

Current Year As of June 30 Prior Year 2 Years Ago

50

100

150

200

250

300

350

400

450

Cash Days on Hand


Page 6

40.0

45.0

50.0

55.0

60.0

65.0

70.0

75.0

80.0

85.0

90.0AR 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%

5%

10%

15%

20%

25%

30%

35%

40%

45%

% A/R > 120 Days

Current Year 'Prior Year' 2 Years Ago Budget

Page 7

ExpensesSalaries, Wages and Benefits

-

500

1,000

1,500

2,000

2,500

3,000

3,500

4,000

Thou

sand

s

Salaries, Wages and Benefits


300

500

700

900

1,100

1,300

1,500

Thou

sand

s

Benefits


Page 8

Full Time Equivalents

200.0

220.0

240.0

260.0

280.0

300.0

320.0

340.0

Productive Full Time Equivalents


230.0

250.0

270.0

290.0

310.0

330.0

350.0

370.0

Paid Full Time Equivalents


-

10.0

20.0

30.0

40.0

50.0

60.0

Productive FTEs per Adjusted Occupied Bed


5,000

6,000

7,000

8,000

9,000

10,000

11,000

12,000

13,000Labor Cost per Productive Time Equivalent


Page 9

Professional Fees, Services and Contracted Services

500

700

900

1,100

1,300

1,500

1,700

1,900

2,100Th

ousand

s

Professional Fees


-

20

40

60

80

100

120

140

160

180

Thou

sand

s

Contracted Services


-

200

400

600

800

1,000

1,200

Thou

sand

s

Services


Page 10

Supplies

200

300

400

500

600

700

800

900

1,000

Thou

sand

s

Supply Expense


400

900

1,400

1,900

2,400

2,900

3,400

Supply Expense per Adjusted Patient Day


Page 11

Mammoth Hospital

FY 2020 Capital Plan - Board Summary

Name of Project Budget Actual Spent Balance Funding

Over/Under Budget

IndicatorBUDGETED - BOARD APPROVED

1 Auxiliary Donor Wall 21,600$ 13,500$ 8,100$ Capital $02 Stone Caps on Building Stone Facia 53,900$ 20,807$ 33,093$ Capital $03 Upper Parking Lot Lighting 40,000$ 11,218$ 28,782$ Capital $04 MOB Staircase Replacement 84,500$ 110,934$ (26,434)$ Capital 1.005 Driveway/Entrance Revamp 130,000$ 146,090$ (16,090)$ Capital 1.006 Back Lot Replacement 32,500$ -$ 32,500$ Capital $07 Kronos Time clock Replacement and Upgrade 27,900$ 28,675$ (775)$ Capital 1.008 Cerner Infection Control Module 66,600$ 67,020$ (420)$ Capital 1.009 ECG Machines Integration with Cerner 42,906$ 46,210$ (3,304)$ Capital 1.00

10 Fujitsu 7160 Scanners (11) 10,800$ 10,744$ 56$ Capital $011 Video Laryngoscope 18,000$ 17,698$ 302 Auxiliary $012 Physicians PowerScribe Upgrade (dictation) 49,000$ -$ 49,000$ Capital $013 Desktop Computers (25 units) Update total 52,000$ 23,977$ 28,023$ Capital $014 Family Med Clinic admitting remodel 22,500$ 6,087$ 16,413$ Capital $015 Transport Ventilator 26,300$ 26,217$ 83$ Capital $016 Infant Jaundice meter 8,100$ 8,080$ Capital12 Vision Screener for Pediatric Patients 7,600$ 6,231$ 1,369$ Capital $013 Nurse Call System 341,500$ 15,358$ 326,142$ Capital $014 Siemens RapidPoint 500 Blood Gas Analyzer ** 11,600$ 11,532$ 68$ Capital $015 Welch Allyn ELI 12 lead ECG Unit 12,632$ 13,611$ (979)$ Capital 1.00

1,059,938$ 583,989$ 475,949$

CONTINGENCY 16 Laptop Computers X 20 30,400$ Capital17 Automate Labor and Delivery Door 13,272$ Capital18 ED Fuel Asphalt Repair/Liquid Oxygen 20,264$ Capital19 Lupin Housing Remodel 44,229$ Capital20 Tamarack Housing Remodel 43,387$ Capital21 SGSA "OnCall" room flooring replacement 26,790$ Capital22 Upper Lot Driveway Alignment 19,453$ Capital23 Labor and Delivery Counter Top 6,200$ Capital24 Dental Chairs x 2 26,252$ Capital12 Fluent Management System-Mysosure 47,949$ Auxiliary25 Kronos Mobile App 1,935$ Capital26 System 8 Drill Set 123,541$ Capital27 Vacuum Pump Replacement 17,589$ Capital28 Blanket Warmer - OR2 Insurance replacement-water damage 8,900$ Capital29 Cerner Video Visit Solution 5,000$ Capital30 Replacment of Doors - Entrance A1 and B3 11,310$ Capital31 Replace Sprinkler Heads in all 3 OR's- Recessed Pendants 6,757$ Capital32 Ventilators(Crossvent 3+) 49,620$ Auxiliary33 Transport Ventilators (Hamilton T1) - Auxiliary

Spend in FY20 on Projects From FY1934 Laboratory Fridge for Micro 5,032$ Capital35 New Countertops in PACU 6,797$ Capital36 Third OR - Cabinets 32,878$ Capital37 New Exterior Signage for Facility 24,273$ Capital38 Philips MX500 Patient Monitor 36,933$ Capital39 New AC Units x2 - Bishop PT 3,517$ Capital40 Omnicom recorder for radio conversations 8,615$ Capital

375,062$ 620,892$ (245,830)$ 1.00

BUDGETED - ABANDONED/DELAYED41 Remodel PACU, add office 75,000$ 26,731$ 48,270 $042 Digital X-Ray Room Replacement 490,000$ -$ 490,000 $0

SUB TOTAL 565,000$ 26,731$ 538,270$

Summary of Capital funds FY20 TOTALS 2,000,000$ 1,231,611$ 768,389$ $0

Name of Project Estimated Cost Actual Spent Balance

SPECIAL PROJECTSAutoclave Replacement - 1/2 -$ 229,222$ (229,222)$

1 Autoclave Replacement - 2 of 2 units 273,631$ 495,810$ (222,179)$ 2 Specialty Clinic 1,800,000$ 2,266,618$ (466,618)$ 3 Lab Remodel 100,000$ 3,048$ 96,952$ 4 Dental Clinic Remodel 330,000$ 67,298$ 262,702$ 5 MRI Replacement Project - Estimated total $1.7 million 1,750,000$ 1,721,078$ 28,922$ 6 Chemo Mixing Room 500,000$ -$ 500,000$ 7 OR3 Plan & Build 530,000$ 74,645$ 455,355$ 8 Master Plan -$ 104,257$ (104,257)$

TOTALS 5,283,631$ 4,961,976$ 321,655$

Special Projects

As of June 30, 2020

CIP_Projects_FY_2020_Finance_Reconciliation.xlsx

CONFLICT OF INTEREST CODE

OF THE


REVISED AND ADOPTED,

AND EFFECTIVE,

September 17, 2020

1

CONFLICT OF INTEREST CODE

OF THE SOUTHERN MONO HEALTHCARE DISTRICT

Section 1. Conflict of Interest Code – Adopted and Revised.

The Political Reform Act (Government Code §§ 81000, et seq.) requires state and local

government agencies to adopt and promulgate conflict of interest codes. The Fair Political

Practices Commission has adopted regulations (2 CCR § 18730) which contain the terms of a

standard or model conflict of interest code. It can be incorporated by reference in an agency code,

and after public notice and hearing, it may be amended by the Fair Political Practices Commission

to conform to amendments in the Political Reform Act. Therefore, the terms of 2 CCR § 18730

(“The Model Code”) and any amendments to it duly adopted by the Fair Political Practices

Commission are hereby incorporated by reference.

Incorporation by reference of the terms of The Model Code, along with the designation of

employees and the formulation of disclosure categories in the Appendices referred to below,

constitute the adoption and promulgation of a conflict of interest code by the Southern Mono

Healthcare District (“District”) within the meaning of Government Code § 87300 or the

amendment of a conflict of interest code within the meaning of Government Code § 87306. The

Model Code and the attached Appendices designating officials and employees and establishing

disclosure categories shall constitute the Conflict of Interest Code (“Code”) of the District and are

revised and adopted hereby. This Code amends and replaces all previous versions of conflict of

interest codes of the District previously in effect.

Section 2. Statements of Economic Interest – Filing Officer.

Designated employees and Board members shall file their statements with the District,

which will make the statements available for public inspection and reproduction as provided by

law. Upon receipt of the statements of the Board and Chief Executive Officer, the District shall

make and retain a copy and forward the originals of these statements to the Mono County Clerk

for filing. Statements for all other designated officials and employees will be retained by the

District.

2

Section 3. Purposes and Goals.

The general purpose and goal of this Code is to afford the public an honest and impartial

government. More specifically, the Board wishes to achieve the following objectives via this

Code:

(1) To assure the independence, impartiality and honesty of public officials

in District actions and decisions;

(2) To inform citizens of the existence of personal economic interests which

may present a conflict of interest between an official’s public trust and

private gain;

(3) To prevent public office from being used for personal gain, other than

the remuneration provided by law;

(4) To assure that District decisions and policy be made in the proper course

according to the proper procedures and considerations;

(5) To prevent special interests from unduly influencing District decisions

and policy;

(6) To assure to the extent possible that District decisions and policy reflect

the public interest; and

(7) To assure that no official will have economic interests which are in

substantial conflict with the proper exercise of his official duties and

powers.

Section 4. Further Definitions.

In addition to the generality of definitions contained in The Model Code, the following

definitions shall apply:

“Board” shall mean the Board of Directors of the District.

“Bylaws” shall mean the Bylaws of the District as they now exist and may be amended or

modified from time to time.

“Chief Executive Officer” shall include the administrator of Mammoth Hospital and the

District.

“District” shall mean the Southern Mono Healthcare District, formerly known as the

Southern Mono Hospital District.

3

“District Law” shall mean the Local Healthcare District Law as set forth in Division 23 of

the Health & Safety Code, §§ 32000, et seq., as it now exists and may be amended or modified

from time to time.

“DNV” shall mean Det Norske Veritas, the accreditation body of the District.

“Facilities” shall mean a District healthcare facility, hospital, clinic, or other establishment

operated by the District.

“Governing Board” shall mean the Board of Directors of the District.

“Healthcare District” shall mean the Southern Mono Healthcare District, formerly known

as the Southern Mono Hospital District.

“Hospital” shall mean Mammoth Hospital.

Section 5. General Provisions.

(1) The Board, except as otherwise provided in the Code, may authorize any officer, or

officers, or agent, or agents, to enter into any contract or execute any contract or execute any

instrument in the name of and on behalf of the District, and such authority to bind the District by

any contract or engagement or to pledge its credit or to render it liable for any purpose or in any

amount. Such authority shall be pursuant to the District Law and the Bylaws, and as so authorized,

may additionally be by resolution or noted in the minutes of the Board.

(2) The fiscal year of the District shall commence on the first day of July of each year

and shall end on the last day of June of each year.

(3) The affairs and financial condition of the District shall be audited annually at the

end of each fiscal year by a certified public accountant selected by the Board and a written report

of such audit and appropriate financial statements submitted to the Board prior to completion of

the first quarterly report of the year. Additional audits may be authorized as considered necessary

or desirable by the Board. The annual audit report shall be reviewed and discussed by the Chief

Executive Officer and the Board, and a summary of the results thereof shall be published in a

newspaper of general circulation as provided for by law.

(4) The Code should be reviewed at least every two (2) years (i.e., biannually) and

revised as necessary.

(5) Any and all remedies provided by the Code, law, operation of law, or otherwise,

shall be deemed to be cumulative, and the choice of implementation of any particular remedy shall

not be deemed to be an election of remedies to the mutual exclusion of any other remedy provided.

4

(6) In the event any term or provision of the Code is deemed to be in violation of law,

null and void, or otherwise of no force or effect, the remaining terms and provisions of the Code

shall remain in full force and effect.

(7) The Code shall be interpreted under and shall be consistent with the laws of the

State of California, the District Law, and the Rules and Regulations of DNV, if applicable to the

governance and accreditation of the District.

(8) No waiver of any breach or violation of any term, provision, article, or section of

the Code shall be construed as a waiver of any succeeding breach or violation of the same. The

consent or approval of the District to or of any action or matter requiring consent or approval shall

not be deemed to waive or render unnecessary any consent or approval of any subsequent or similar

act or matter.

(9) Enforcement of any term, provision, article, or section of the Code shall be by

proceedings at law or in equity against any persons or entities violating or attempting to violate

the Code, either to restrain violation, compel compliance or action, or to recover damages.

(10) The District shall cause updated filings to be made upon the change in the roster of

officers or directors of the Board as the same may occur from time to time with the California

Secretary of State, County of Mono, and any other agency as may be applicable or required by

law.

(11) Unless otherwise stated in the Code, or unless context otherwise requires, the

definitions contained in the District Law shall govern the construction of the Code. Without

limiting the generality of the foregoing, the masculine gender includes the feminine and neuter,

the singular includes the plural, and the plural number includes the singular, and the word “person”

includes a corporation or other legal entity as well as a natural person.

Adopted as revised at the Regular Meeting of the Board of Directors of the Southern Mono

Healthcare District, September 17, 2020.

5

APPENDIX A

LIST OF DESIGNATED POSITIONS

Job Title Disclosure Category (ies)

Member, Board of Directors 3, 4, 5, 6

Chief Executive Officer (“CEO”) 3, 4, 5, 6

Chief Financial Officer 3, 4, 5, 6

Chief Operations Officer 5, 7

Chief Information Officer 5, 7

Chief Medical Officer 5, 7

Chief Nursing Officer 5, 7

Facilities Services Manager 5, 7

Purchasing Manager 5, 7

Human Resources Manager 5, 8

CEO, as Trustee of Mammoth Hospital

Employees’ Retirement Plan (403B)

5, 8


Employees’ Deferred Compensation Plan (457b)

5, 8


Employees’ 529 College Advantage Savings Plan

5, 8

Exempt Positions

Employees holding secretarial, clerical, or manual positions, and other officials whose

financial interests could not be affected materially by any action, failure to act, or decision taken

by them within the scope of their official duties shall not be required to file statements of financial

interest.

6

APPENDIX B

LIST OF DISCLOSURE CATEGORIES

Disclosure

Category

Required Disclosure

1 All interests in real property located in Mono and Inyo Counties, as well as

investments, business positions and sources of income, including gifts, loans,

and travel payments.

2 All investments, business positions and sources of income, including gifts,

loans, and travel payments.

3 All interests in real property located in the District’s jurisdiction.

4 Any source of gross income of $500 or more.

5 Any reportable gift received from sources in the District’s jurisdiction with a

fair market value of $50 or greater.

6 Any investments and business positions with sources* in the District’s

jurisdiction totaling $2,000 or more at any time during the reporting period.

7 Any reportable investments, business positions and income from sources* in

the District’s jurisdiction that provide leased facilities, goods, equipment,

vehicles, machinery, or services of the type utilized by the District.

8 Any reportable investments, business positions and income from sources* in

the District’s jurisdiction that provide leased facilities, goods, equipment,

vehicles, machinery, or services of the type used by the designated position’s

area of authority.

____________________

* As used in Categories 5, 6, 7, and 8, “sources” refers to any entity located in, doing

business in, planning to do business in, or which has done business during the prior two years in

the District’s jurisdiction.

RESOLUTION OF THE BOARD OF DIRECTORS OF SOUTHERN MONO HEALTHCARE DISTRICT

REAFFIRMING ADOPTION OF THE MODEL CONFLICT OF INTEREST CODE RESOLUTION 20-02

WHEREAS, the Political Reform Act, which is codified in Government Code Sections 81000, et seq. (the “Act”), prohibits public officials from using their official position to influence governmental decisions in which they have a financial interest; requires state and local government agencies to adopt and promulgate conflict of interest codes that identify all officials and employees within the agency who make governmental decisions; and provides that all persons in such designated positions must disclose their financial interests as specified in the agency’s conflict of interest code and as otherwise required by applicable law; and WHEREAS, pursuant to Government Code Section 83112, the Fair Political Practices Commission (“FPPC”) has promulgated certain regulations, set forth in 2 California Code of Regulations (“CCR”) Sections 18109, et seq. (the “Regulations”), to carry out the purposes and provisions of the Act; and WHEREAS, the FPPC adopted 2 CCR Section 18730, which sets forth a model conflict of interest code (“Model Conflict of Interest Code”) that governmental agencies may incorporate by reference along with the designation of the agency’s officials and employees who manage public investments and a list of disclosure categories identifying the types of investments, business entities, sources of income and real property interests that such officials and employees must disclose; and WHEREAS, on or about April 22, 1993, the Board of Directors (“Board”) of the Southern Mono Healthcare District (“District”) has incorporated by reference the Model Conflict of Interest Code, inclusive of any amendments thereto, as the District’s conflict of interest code (the “District’s Conflict of Interest Code”); and

WHEREAS, the Board has periodically reconfirmed its adoption of the Model Conflict of Interest Code, inclusive of any amendments thereto; and updated as necessary its lists of designated positions and disclosure categories; and

WHEREAS, the Board directed the District’s legal counsel and Compliance Officer to complete a biennial review of the District’s Conflict of Interest Code, the Act and the Regulations; and

WHEREAS, the District’s Compliance Officer determined that the FPPC recently amended

the Model Conflict of Interest Code to conform to amendments to the Act and Regulations; and WHEREAS, legal counsel and the Compliance Officer have determined that, except for

inclusion of the District’s Chief Medical Officer being added as a designated position, no substantive revisions to the District’s Conflict of Interest Code are currently required or recommended because the District’s Conflict of Interest Code adopts the Model Conflict of Interest Code, including the amendments, and because there have not been any changes to the designated positions (except as stated above) or disclosure categories set forth in the District’s Conflict of Interest Code; and

WHEREAS, the District would like to reaffirm its adoption of the Model Conflict of Interest

Code, inclusive of any amendments thereto, as the District’s Conflict of Interest Code;

NOW, THEREFORE, upon motion duly made and seconded, be it hereby resolved that:

1. The foregoing recitals are true and correct. 2. The Board hereby reaffirms its adoption of the Model Conflict of Interest Code,

inclusive of any amendments thereto, as the District’s Conflict of Interest Code, as set forth in Exhibit A, which is attached hereto and incorporated herein by reference. PASSED AND ADOPTED by the Board of Directors of Southern Mono Healthcare District, County of Mono, State of California, this 17th day of September 2020, at a regularly scheduled meeting of the Board of Directors held in accordance with the Bylaws of the District by the following votes: AYES: NOES: ABSENT: David Anderson, Chair of the Board ATTEST: Sarah Rea, Secretary to the Board

EXHIBIT “A”

SOUTHERN MONO HEALTHCARE DISTRICT CONFLICT OF INTEREST CODE

of 5

Printed copies are for reference only and are considered

null and void. Please refer to the electronic copy for the

current version of the policy.

POLICY: Credentialing by Proxy for Telemedicine Providers

EFFECTIVE DATE: 09/17/2020

REVISED DATE(S):

Purpose To outline how credentialing by proxy will be utilized for arrangements between Southern Mono Healthcare District d/b/a Mammoth Hospital (“Mammoth Hospital”) and external telemedicine providers through distant site hospitals or telemedicine entities in compliance with applicable laws, regulations, and accreditation standards.

Definitions Distant Site means:

A site where a health care provider who provides health care services is located while providing these services via a telecommunications system. This is referring to the Distant Site Hospital or Distant Site Telemedicine Entity.

Distant Site Hospital means: A Medicare-participating hospital.

Distant Site Telemedicine Entity means: An entity that provides telemedicine services, is not a Medicare-participating hospital, and provides such contracted services in a manner that enables a critical access hospital using its services to meet all applicable Conditions of Participation, particularly those requirements related to the credentialing and privileging of practitioners providing telemedicine services to the patients of the critical access hospital.

Governing Body means: The board of directors for Southern Mono Healthcare District d/b/a Mammoth Hospital.

Originating Site means: A site where a patient is located at the time health care services are provided via a telecommunications system or where the asynchronous store and forward services originates. This is referring to Mammoth Hospital.

Telemedicine Provider means: A provider who delivers health care services and public health via information and communication technologies (i.e. synchronous interactions and asynchronous store and forward transfers) to facilitate the diagnosis, consultation, treatment, education, care management, and self-management of a patient’s health care.

References

• 42 C.F.R. §485.616(c)

of 5




• 42 C.F.R. §485.635(c)(4)(ii)

• MS.18 Telemedicine - NIAHO Accreditation Requirements Interpretive Guidelines & Surveyor Guidance for Critical Access Hospitals (2020)

• California Business and Professions Code §2290.5

• Credentialing by Proxy Guidebook, National Association Medical Staff Services and American Telemedicine Association (2019)

• 3.1 Telemedicine Medical Staff - Mammoth Hospital Medical Staff Bylaws (2015)

Scope / Applicability

The scope of this policy is all arrangements for credentialing by proxy between Mammoth Hospital and a Distant Site Hospital or Distant Site Telemedicine Entity. This policy applies to the Medical Staff Coordinator, the Medical Executive Committee of the Medical Staff, the Director of Quality and the Governing Board of Mammoth Hospital.

Policy For telemedicine services, the traditional credentialing and privileging process is costly and burdensome for both practitioners and hospitals, particularly for critical access hospitals which often lack the resources to fully carry out the traditional credentialing process for every single Telemedicine Provider. Credentialing by proxy is an alternative credentialing mechanism whereby Originating Site hospitals seeking to obtain telemedicine services for their patients can credential Telemedicine Providers who deliver their services from the Distant Site Hospital or Telemedicine Entity by relying on the credentialing and privileging processes and actions of the Distant Site Hospital or Distant Site Telemedicine Entity when making privileging recommendations to its Governing Body. Credentialing by proxy is permitted by both federal and California law provided that certain requirements are met. However, the critical access hospital utilizing this alternative mechanism is still ultimately legally responsible for all privileging decisions. In accordance with the recommendation of the National Association Medical Staff Services, the Bylaws of the Medical Staff of Mammoth Hospital also provide for credentialing by proxy for Telemedicine Providers. It is the policy of Mammoth Hospital to utilize credentialing by proxy for Telemedicine Providers when appropriate and in accordance with applicable laws, regulations and accreditation standards.

Procedure

I. Initial Implementation. 1. Upon receiving confirmation from senior management that telemedicine services

will be provided to Mammoth Hospital by a Distant Site Hospital or Distant Site Telemedicine Entity, the Medical Staff Coordinator requests the Credentialing by Proxy Agreement from Distant Site Hospital. Medical Staff Coordinator or designee then confirms that the credentialing by proxy agreement includes the following stipulations:

• For Distant Site Hospitals: a. Distant Site Hospital is a Medicare-participating hospital. b. Distant Site Hospital warrants that each individual Distant Site

Hospital is privileged at the Distant Site Hospital providing the telemedicine services.

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c. Distant Site Hospital agrees to provide Mammoth Hospital with a current list of the Telemedicine Provider’s privileges at the Distant Site Hospital as well as all data elements necessary for Mammoth Hospital to complete National Practitioner Data Bank queries.

d. Distant Site Hospital warrants that any Telemedicine Provider providing telemedicine Services to Mammoth Hospital holds a license issued or recognized by California.

e. Once privileges are granted at Mammoth Hospital, Mammoth Hospital shall maintain evidence of an internal review each Telemedicine Provider’s performance of these privileges and shall send the Distant Site Telemedicine Entity such performance information for use in the periodic appraisal of the Telemedicine Provider. At a minimum, this information shall include all adverse events that result from the telemedicine services provided by the Telemedicine Provider to Mammoth Hospital patients, as well as all complaints Mammoth Hospital has received about the Telemedicine Provider.

f. Distant Site Hospital agrees to notify Mammoth Hospital within twenty-four (24) hours in the event that a Telemedicine Provider’s clinical privileges be modified or terminated as a result of an identified concern, and within thirty (30) days if corrective actions are taken by the Distant Site Hospital.

g. Distant Site Hospital agrees to notify Mammoth Hospital of any new Telemedicine Provider not less than thirty (30) days prior to the provision of telemedicine services by such Telemedicine Provider to Mammoth Hospital.

• For Distant Site Telemedicine Entities: a. Distant Site Telemedicine Entity warrants that it furnishes services that

permit Mammoth Hospital to comply with all applicable CMS conditions of participation for the contracted services.

b. Distant Site Telemedicine Entity warrants that its medical staff credentialing and privileging process and standards at least meet the standards stated in 42 C.F.R. §485.616(c)(1).

c. Distant Site Telemedicine Entity warrants that each individual Telemedicine Provider is privileged at the Distant Site Telemedicine Entity providing the telemedicine services.

h. Distant Site Telemedicine Entity agrees to provide Mammoth Hospital with a current list of the Telemedicine Provider’s privileges at the Distant Site Telemedicine Entity, as well as all data elements necessary for Mammoth Hospital to complete National Provider Data Bank queries.

d. Distant Site Telemedicine Entity warrants that any Telemedicine Provider providing telemedicine Services to Mammoth Hospital holds a license issued or recognized by California.

e. Once privileges are granted at Mammoth Hospital, Mammoth Hospital shall maintain evidence of an internal review each Telemedicine Provider’s performance of these privileges and upon request, shall send the Distant Site Telemedicine Entity such performance information for use in the periodic appraisal of the Telemedicine Provider. At a minimum, this information shall include all adverse events that result from the telemedicine services provided by the

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Telemedicine Provider to Mammoth Hospital patients, as well as all complaints Mammoth Hospital has received about the Telemedicine Provider.

f. Distant Site Telemedicine Entity agrees to notify Mammoth Hospital within twenty-four (24) hours in the event that a Telemedicine Provider’s clinical privileges be modified or terminated as a result of an identified concern, and within thirty (30) days if corrective actions are taken by the Distant Site Telemedicine Entity.

g. Distant Site Telemedicine Entity agrees to notify Mammoth Hospital of any new Telemedicine Provider not less than thirty (30) days prior to the provision of telemedicine services by such Telemedicine Provider to Mammoth Hospital.

2. The Medical Staff Coordinator sets up an initial coordination call with the credentialing representative of the Distant Site Hospital or Distant Site Telemedicine Entity to ensure alignment as to the go-forward process for the addition and removal of Telemedicine Providers as well as any modifications to the privileges of any such Telemedicine Providers at the Distant Site Hospital or Distant Site Telemedicine Entity. At minimum, the Medical Staff Coordinator shall obtain a copy of the credentialing policy and procedure of the Distant Site Hospital or Distant Site Telemedicine Entity to confirm it is sufficient based on Mammoth Hospital’s current credentialing processes.

3. The Medical Staff Coordinator shall create a file for the Distant Site Hospital or Distant Site Telemedicine Entity for credentialing by proxy. This file should always include at least (1) a copy of the credentialing policy and procedure of the Distant Site Hospital or Distant Site Telemedicine Entity, and (2) the credentialing by proxy agreement once fully executed after approval by the Governing Board.

4. Once the credentialing by proxy agreement is confirmed to contain all necessary elements and the Medical Staff Coordinator has confirmed that the Distant Site Hospital or Distant Site Telemedicine Entity’s credentialing and privileging processes are sufficient, the Medical Staff Coordinator adds the agreement to the agenda for the next Medical Executive Committee meeting for approval. Prior to adding the agreement to the agenda for approval by the Medical Executive Committee, the Medical Staff Coordinator may consult with Mammoth Hospital’s legal counsel as necessary regarding the agreement.

5. Upon receipt of the list of Telemedicine Providers who will be providing telemedicine services to Mammoth Hospital from the Distant Site Hospital or Distant Site Telemedicine Entity, the Medical Staff Coordinator queries the National Practitioner Data Bank for each Telemedicine Provider. The results of such queries are included in the blanket form referenced in step #6 below. This obligation may be waived by the Medical Executive Committee due to urgency and volume of providers needing approval only for Distant Site Hospitals or Distant Site Telemedicine Entities that are Joint Commission accredited.

6. The Medical Staff Coordinator compiles (1) the execution-ready credentialing by proxy agreement and (2) the blanket Telemedicine Staff appointment and privilege delineation form to encompass all Telemedicine Providers for that Distant Site Hospital or Distant Site Telemedicine Entity for submission to the Medical Executive Committee and then to the Governing Board for official appointment of such Telemedicine Providers to the Telemedicine Staff category of Mammoth Hospital’s Medical Staff and for the granting of privileges at Mammoth Hospital to those Telemedicine Providers.

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II. Ongoing Obligations.

1. The Medical Staff Coordinator works with the credentialing representative for the Distant Site Hospital or Distant Site Telemedicine Entity regarding the addition or removal Telemedicine Providers and modification of the privileges of such Telemedicine Providers at the Distant Site Hospital or Distant Site Telemedicine Entity.

2. At the time of reappointment and renewal of Mammoth Hospital privileges or upon the addition of a new Telemedicine Provider, the Medical Staff Coordinator queries the National Practitioner Data Bank for each Telemedicine Provider. This obligation may be waived by the Medical Executive Committee due to urgency and volume of providers needing approval only for Distant Site Hospitals or Distant Site Telemedicine Entities that are Joint Commission accredited. The Medical Staff Coordinator compiles the blanket Telemedicine Staff appointment and privilege delineation form to encompass all Telemedicine Providers for that Distant Site Hospital or Distant Site Telemedicine Entity that are to be newly appointed or reappointed to the Telemedicine Staff, and for the initial granting of privileges for new Telemedicine Providers or renewal or modification privileges already granted to existing Telemedicine Providers at Mammoth Hospital for submission to the Medical Executive Committee and then to the Governing Board. The same process shall be followed for removal of appointment and privileges of existing Telemedicine Providers.

3. The Medical Staff Coordinator has a touch base meeting annually or at an agreed upon frequency with the Distant Site Hospital or Distant Site Telemedicine Entity to review the Telemedicine Providers and credentialing by proxy agreement.

Responsible Department

Implementation, training, and monitoring regarding this policy and procedure are the responsibilities of the Medical Staff Coordinator, the Medical Executive Committee of the Medical Staff, the Director of Quality and the Governing Board of Mammoth Hospital.

Renewal/Review This policy and procedure is to be reviewed annually to determine if it complies with current recommendations, guidelines, mandates, statutes, practices, and Mammoth Hospital operations. In the event that changes are required, the policy and procedure will be updated as needed.

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PHYSICIAN CREDENTIALING AND PRIVILEGING AGREEMENT

THIS PHYSICIAN CREDENTIALING AND PRIVILEGING AGREEMENT (“Agreement”) is made by and between Direct Radiology (“Telemedicine Entity”) and Southern Mono Healthcare District d/b/a Mammoth Hospital (“Hospital”) effective as of this day of , 2020 (“Effective Date”).

The parties hereby agree as follows:

1. Contractor Relationship. Telemedicine Entity is a contractor of services to Hospital. Telemedicine Entity arranges for radiologists employed by or contracted with Telemedicine Entity, to provide remote specialty services to Hospital patients (“Contracted Services”). For purposes of this Agreement, each affiliated radiologist providing or anticipated to provide Contracted Services is a Physician (collectively, “Physicians”). Hospital and Telemedicine Entity shall agree on a process by which Telemedicine Entity may have access to all the necessary patient records from Hospital.

2. Compliance with Conditions of Participation. In accordance with §485.635(c)(4)(ii), Telemedicine Entity shall furnish Contracted Services to Hospital in a manner that permits Hospital to comply with all applicable Medicare conditions of participation related to the Contracted Services, including but not limited to the requirements of §485.616(c) with regard to the distant-site telemedicine entity’s physicians and practitioners providing telemedicine services, as well as the Joint Commission requirements for credentialing and privileging practitioners and Physicians for telemedicine services (collectively, the “Hospital Standards”). Telemedicine Entity represents that its credentialing and privileging standards meet the Hospital Standards.

3. Telemedicine Entity Credentialing and Privileging. Telemedicine Entity warrants that each Physician (i) will be credentialed and privileged by Telemedicine Entity according to Telemedicine Entity’s credentialing and privileging processes and standards; and (ii) shall render Contracted Services within the scope of the Physician’s respective privileges. Telemedicine Entity shall provide Hospital with a copy of Telemedicine Entity’s credentialing policies and procedures upon the execution of this Agreement and shall also provide Hospital with any changes to such policies and procedures during the term of this Agreement.

4. State Licensure. At all times while providing Contracted Services to Hospital, Telemedicine Entity shall ensure that each Physician providing the Contracted Services pursuant to this Agreement shall hold a valid and unrestricted license issued or recognized by the state in which Hospital is located.

5. Decision of Governing Body. Hospital’s governing body has chosen to rely on Telemedicine Entity’s credentialing and privileging decisions for purposes of Hospital’s medical staff determining whether or not to recommend privileges for a Physician. Hospital is responsible for determining whether or not reliance is warranted and for conducting its own internal process in a manner that complies with Medicare conditions of participation and the requirements of Hospital’s accrediting body.

6. Telemedicine Entity to Provide Current List of Privileges. Telemedicine Entity has supplied Hospital with Schedule 1, a list identifying each Physician and the scope of privileges granted by Telemedicine Entity. It is anticipated that this complement of physicians may change from time to time. The following procedures shall apply to any changes to Schedule 1:

(a) Action by Telemedicine Entity: Not later than thirty (30) days prior to any new Physician providing services under the base agreement between the parties, Telemedicine Entity shall provide Hospital with a revised Schedule 1 indicating the name of any new Physicians and an accompanying delineation of

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privileges for each new physician. If Telemedicine Entity has removed a Physician from the roster of physicians anticipated to provide Contracted Services going forward or if the Telemedicine Entity physician loses privileges, Telemedicine Entity will provide a revised Schedule 1.

(b) Action by Hospital upon Receipt of New Schedule from Telemedicine Entity: Hospital shall confirm the Physicians listed on Schedule 1 can provide the Contracted Services by signing and faxing or emailing the updated Schedule to Telemedicine Entity. If the only changes were removals, Hospital agrees that Telemedicine Entity may remove the Physician(s) without waiting for a signed Schedule 1 to be returned.

(c) Action by Hospital to Initiate Removal of a Physician. If Hospital no longer wishes to receive Contracted Services from a Physician for reasons not requiring a hearing, Hospital will request that Telemedicine Entity remove the Physician from the roster, following which, Telemedicine Entity will supply an updated Schedule 1 as described in Section 6(a).

7. Credentialing-Related Materials. Telemedicine Entity shall provide electronic copies of credentialing materials and other reasonable evidence of Telemedicine Entity’s compliance with the Hospital’s standards for each Physician upon request. Telemedicine Entity will not provide Hospital or its agent a copy of any reports it receives from The Data Bank or from a third party vendor or criminal background check services. Hospital remains responsible for querying The Data Bank.

8. Provision and Confidentiality of Quality Related Data.

(a) Hospital Duties. Hospital shall provide Telemedicine Entity evidence of its internal review of each Telemedicine Entity-affiliated Physician’s performance of the privileges, for use in Telemedicine Entity’s periodic appraisal of the Physicians. At a minimum, this information must include:

(i) all adverse events that result from a Physician’s Contracted Services provided to Hospital patients, and

(ii) all complaints Hospital has received about the Physician.

If Hospital is a critical access hospital, Hospital acknowledges it is responsible for periodic evaluation and quality assurance reviews that comply with 42 CFR 485.641(b)(4)(v).

9. Confidentiality. The parties shall treat all credentialing information shared pursuant to Sections 6 and 7 and all quality-related information shared pursuant to Section 8 as privileged and confidential. Such information is to be used for credentialing, quality improvement, and peer review activities only. Each party shall ensure that no portion of any materials or information received from the other party are disclosed by it or its agents to any employee or third party for reasons unrelated to evaluating the physician’s quality and credentials to provide Contracted Services, except as required by law.

10. Term and Termination. This Agreement shall be for an initial term of one (1) year commencing on the Effective Date and ending on the first anniversary of the Effective Date, thereafter, this Agreement shall automatically renew for subsequent one (1) year periods unless otherwise terminated as provided below:

(a) Upon Notice. Either party may terminate without cause on at least 30 days’ prior written notice to the other party.

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(b) Termination upon Material Breach. A non-breaching party may terminate this Agreement for cause at any time upon 30 days’ written notice of intent to terminate. In the event the defaulting party cures such default within such 30 day notice period, the non-breaching party may elect, at its discretion, to rescind the termination notice in writing, in which case this Agreement shall continue in full force and effect.

11. Legislative/Regulatory Modification. If any law, regulation or standard is enacted, promulgated, or modified in a manner that, in the opinion of a party’s legal counsel (i) prohibits, restricts or in any way materially affects this Agreement; (ii) subjects either Hospital or Telemedicine Entity to a fine or penalty in connection with its representations or responsibilities hereunder, or (iii) subjects either party to a loss of Medicare or Medicaid certification or Joint Commission-accreditation because of the existence of this Agreement or the applicable party’s representations or performance of obligations hereunder, then within 30 days following notice from one party to the other, the parties shall complete the good faith negotiation of an amendment to this Agreement or a substitute agreement that will carry out the original intention of the parties to the extent possible in light of such law, regulation or standard and each party shall execute such amendment or new agreement.

If the parties cannot reach agreement on new terms within 60 days following the notice provided hereunder or such earlier date as necessary to avoid substantial penalties or fines, then this Agreement shall immediately terminate, following written notice of termination from either party.

12. Indemnification. Each of the parties shall indemnify and hold the other harmless from and against all claims, liabilities, judgments, fines, assessments, penalties, awards, or other expenses, of any kind or nature whatsoever, including, without limitations, attorneys’ fees, expert witness fees, and costs of investigation, litigation or dispute resolution, relating to or arising out of any breach or alleged breach of this Agreement by either of the Parties, or by their respective employees, subcontractors or agents.

13. Notice. Any notice required by this Agreement shall be in writing and shall be deemed to have been properly given to a party (i) if hand delivered, (ii) if delivered overnight by courier service, effective on the first business day following delivery to such carrier, or (iii) if sent certified mail, return receipt requested, effective three (3) days after deposit in the United States mail, addressed to the address below or as the parties may designate by giving notice pursuant to this Section:

14. Third-Party Beneficiaries. This Agreement shall not confer any benefit or rights upon any person other than Hospital and Telemedicine Entity, and no third party shall be entitled to enforce any obligation, responsibility or claim of any party to this Agreement.

Direct Radiology 1839 N. Government Way, Ste. B Coeur d’ Alene, ID 83814 p. 855.687.7237 f. 855.673.9190

Mammoth Hospital 85 Sierra Park Road Mammoth Lakes, CA 93546

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15. Other Agreements. This Agreement, including all exhibits hereto, contains the entire understanding and agreement of the parties with respect to the credentialing and privileging of Telemedicine Entity Physician. In the event of a conflict between a provision contained in this Agreement and a provision contained in an agreement or arrangement that existed prior to the Effective Date of this Agreement, the terms of this Agreement shall control and govern the actions of the parties.

16. Arbitration. Except for a claim for injunctive relief as provided in Section 8.3, in the event of any dispute, claim or controversy between the parties hereto arising out of or relating to the formation, performance or termination of this Agreement, the parties hereby agree that such dispute, claim or controversy shall be submitted to a single arbitrator in Mono County, California for binding arbitration in accordance with the commercial arbitration rules of the American Arbitration Association. The arbitrator shall decide any such matter in accordance with California law. The arbitrator shall have the authority to award the prevailing party its fees and costs of arbitration, including reasonable attorneys’ fees. Except as otherwise provided in this Agreement, the parties expressly waive any claim of or right to any punitive or exemplary damages, any special, consequential, incidental or indirect damages, specific performance or injunctive or equitable relief (even if a party has been advised of the possibility of such damages). All such arbitration proceedings shall be conducted on a confidential basis. The determinations of the arbitrator shall be final and shall not be subject to judicial review; provided, however, that any award of the arbitrator may be entered in any court of competent jurisdiction. This Section 16 shall survive the termination of this Agreement for any reason.

17. Execution. This Agreement shall not be binding upon Hospital unless signed by Hospital’s CEO/Managing Director.

18. Assignment. This Agreement shall not be assignable by Telemedicine Entity.

19. Counterparts. This Agreement may be executed by facsimile signature, scanned signature or encrypted, digital signature, and by either of the parties in counterparts, each of which will be deemed to be an original, but all such counterparts will constitute a single instrument.

IN WITNESS WHEREOF, the undersigned parties hereto have executed this Agreement as of the day and year indicated below.

Hospital

By:

Direct Radiology

By:

Printed: Tom Parker Printed: Leah McClain

Title: Chief Executive Officer Title: Physician Services Manager

Date: Date:

3013-IM-PCA0102-FINAL.doc [090820] 1 OF 2 CONFIDENTIAL

Privileging and Credentialing Agreement

This Privileging and Credentialing Agreement (“PCA”) is entered into by and among SpecialtyCare IOM

Services, LLC (“SpecialtyCare”) and its managed physician group, Remote Neuromonitoring Physicians, PC

(“RNP”) located at 3 Maryland Farms, Suite 200, Brentwood, Tennessee 37027 and Southern Mono Healthcare

District d/b/a Mammoth Hospital ("Client") located at 85 Sierra Park Road, Mammoth Lakes, California 93546

with reference to the following facts:

RECITALS

WHEREAS, SpecialtyCare’s managed physician group, RNP is accredited by The Joint Commission (“TJC”);

WHEREAS, Client has determined that its Medical Staff may rely on the privileging and credentialing decisions

made by RNP when granting privileges to SpecialtyCare’s Providers; and

WHEREAS, Client desires to efficiently credential and privilege SpecialtyCare Providers who provide Services to

Client.

NOW, THEREFORE, SpecialtyCare and Client agree as follows:

AGREEMENT

1. Medicare Conditions of Participation Compliance

1.1. SpecialtyCare represents and warrants that its medical staff credentialing and privileging process and

standards meet the standards at § 485.616(c)(1).

1.2. SpecialtyCare is a contractor of services to Client and as such, in accordance with § 485.635(c)(4)(ii),

furnishes the contracted services in a manner that permits the hospital to comply with all applicable

conditions of of participation for the contracted services, including, but not limited to, the requirements

of § 485.616(c) with regard to the distant-site telemedicine entity’s physicians and practitioners

providing telemedicine services.

1.3. Each physician or practitioner provided by SpecialtyCare’s managed physician group, RNP is privileged

by RNP for the services to be provided by SpecialtyCare and RNP.

1.4. SpecialtyCare shall provide Client from time to time with a current list of RNP’s physician's and

practitioner's privileges.

1.5. Each RNP physician or practitioner shall hold a license issued or recognized by the State in which the

Client’s facility is located.

1.6. With respect to each RNP physician or practitioner, who holds privileges at the Client, the Client shall

conduct an internal review of the physician's or practitioner's performance of his or her privileges, in

accordance with applicable conditions of participation and shall send RNP such performance information

for use in its periodic appraisal of the applicable RNP physician or practitioner. At a minimum, the

information provided by Client shall include all adverse events that result from the telemedicine services

provided by the RNP physician or practitioner to the Client’s patients, and all complaints the Client has

received about the RNP physician or practitioner.

2. Joint Commission Compliance

2.1. RNP shall be and remain Joint Commission accredited during the term of the Agreement.

3013-IM-PCA0102-FINAL.doc [090820] 2 OF 2 CONFIDENTIAL

3. Documentation

3.1 SpecialtyCare will provide copies of the following documents to Client:

3.1.1 Application

3.1.2 Delineation of Privileges

3.1.3 Award Letter

3.1.4 Licensures

3.1.5 Board Certificates

3.1.6 Hospital Affiliation Verifications

3.1.7 Work History Verifications

3.1.8 Certificate of Insurance Verifications and Malpractice History Inquiries

3.1.9 Peer References

3.1.10 Case Log Data (24 months)

3.1.11 Licensure Verifications

3.1.12 Board Verifications

3.1.13 AMA/AOA profile

3.2 Client will complete the following:

3.2.2 NPDB Query

4. General Terms

4.1 This PCA shall be effective on the last date signed below and shall continue in effect unless terminated in

accordance with Section 4.2.

4.2 Either party may terminate this PCA with thirty (30) days prior written notice to the other party.

This PCA constitutes the entire understanding of the parties with respect to the subject matter hereof and

supersedes any prior understanding between them, whether oral or written, respecting the same subject matter.

IN WITNESS WHEREOF, the parties have executed this Agreement.

SPECIALTYCARE PARENT:

CLIENT:

SpecialtyCare IOM Services, LLC

_________________________________

Signature

By: Jonathan Walters

Title: President, IONM Services

Southern Mono Healthcare District d/b/a

Mammoth Hospital

_________________________________

Signature

By:

Title:

Remote Neuromonitoring Physicians, PC

_________________________________

Signature

By:

Title:

Manual Name Document Name/Policy Revision # Approved On

Laboratory Lab Microbiology Backup Procedures 3 4/30/2020

Laboratory Lab Microbiology Beta Lactamase - Cefinase Disk 3 4/30/2020

Laboratory Lab Microbiology Bile Solubility 3 4/30/2020

Laboratory Lab Microbiology Carbon Dioxide Detection Kit 3 4/30/2020

Laboratory Lab Microbiology Catalase 3 4/30/2020

Laboratory Lab Microbiology Coagulase 3 4/30/2020

Laboratory Lab Microbiology Critical Values 3 4/30/2020

Laboratory Lab Microbiology CSF Culture 2 4/30/2020

Laboratory Lab Microbiology Fyrite Operation and Maintenance 3 4/30/2020

Laboratory General Guidelines for Isolates 3 4/30/2020

Laboratory Lab Microbiology H pylori Urease Testing 3 4/30/2020

Laboratory Lab Microbiology Haemophilis ID Quad Plate 3 4/30/2020

Laboratory Lab Microbiology MRSA Admission Screening Culture 3 4/30/2020

Laboratory Lab Microbiology MRSA Nasal Swab Collection Protocol 3 4/30/2020

Laboratory Lab Microbiology MRSA Select II Agar 3 4/30/2020

Laboratory Lab Microbiology Routine Culture Set-up Protocol 2 4/30/2020

Laboratory Lab Microbiology Stock Cultures 3 4/30/2020

Laboratory Microbiology Ã¢â‚¬â€œ IQCP for BD Affirm VPIII 2 4/30/2020

Laboratory Microbiology - IQCP for Commercially Prepared CLSI Exempt Media 2 4/30/2020

Laboratory Microbiology - IQCP for Meridian STAT Campy Antigen 2 4/30/2020

Emergency Department Mammoth Hospital Transport Unit 7 5/4/2020

Emergency Department Nitronox 7 5/4/2020

Emergency Department Radiology-ED Interpretation Discrepancies 7 5/4/2020

Emergency Department Sexual Assault Exam 7 5/4/2020

Emergency Department Unresponsive patient in MRI 7 5/4/2020

Emergency Department Warming Cabinets and Fluid Rotation 7 5/4/2020

Emergency Department Patient Transports by Mono County Emergency Medical Services (MCEMS) 7 5/4/2020

Emergency Department ED Scope of Service 7 5/4/2020

Emergency Department Emergency Department Pain Assessment 7 5/4/2020

Emergency Department Rapid Response Team 6 5/4/2020

COVID COVID Document Control Plan 1 5/7/2020

COVID COVID Surge Charting Plan 1 5/8/2020

COVID COVID Surge Chart Scanning Workflow 1 5/8/2020

COVID COVID Hazard Pay Plan 1 5/12/2020

COVID COVID Logistics Meal Plan 1 5/12/2020

COVID COVID Dietary Surge Plan 1 5/12/2020

COVID COVID Respiratory Therapy Plan 1 5/12/2020

COVID Hospital Housing Use During COVID 1 5/12/2020

COVID COVID Safety and Security Plan 1 5/12/2020

COVID COVID Comfort Care Surge Plan 1 5/12/2020

COVID COVID Alternative Cleaning Plan 1 5/12/2020

COVID COVID Screeter Symptom Review 1 5/18/2020

COVID COVID Screener Pre-Appointment Questionnaire 1 5/18/2020

COVID COVID In-House Testing 2 5/20/2020

COVID COVID Safety Info & Mask Caring Instructions_English 1 5/20/2020

COVID COVID Safety Info & Mask Caring Instructions_Spanish 1 5/21/2020

COVID COVID Screening Entry Points 1 5/21/2020

COVID MH Intubated COVID-19 one-page Sheet 1 5/21/2020

Case Management Discharge Planning 7 5/22/2020

Respiratory Therapy Respiratory Therapists Duties 7 5/22/2020

Pharmacy Automatic Drug Stop Order 7 5/22/2020

Pharmacy Bedside Medications 6 5/22/2020

Pharmacy Computerized Physician Order Entry (CPOE) for Pharmaceuticals 7 5/22/2020

Pharmacy Drug Compounding and dispensing 7 5/22/2020

Pharmacy Drug Information 8 5/22/2020

Pharmacy Drug Procurement 7 5/22/2020

Pharmacy Medication/Drug Recall (Handling of Medications Lacking Quality or Strength) 7 5/22/2020

Pharmacy Medication orders 7 5/22/2020

Pharmacy Prescription Pad Security 7 5/22/2020

Pharmacy Sterile Compounding Quality Assurance Program 7 5/22/2020

Pharmacy Sterile compounding 7 5/22/2020

Pharmacy Theft or impairment 7 5/22/2020

ICU ICU Scope of Practice 7 5/22/2020

Med Surg / telemetry MedicalSurgical Scope of Service 7 5/22/2020

Med Surg Pediatric Pediatric Scope of Practice 7 5/22/2020

Perioperative Scope of Services of the Surgical Services Department 8 5/22/2020

Pharmacy Adverse Drug Reaction 6 5/22/2020

Med Surg Pediatric Pediatric Standards of Practice 6 5/22/2020

Pharmacy MERP (Medication Error Reduction Plan) 3 5/22/2020

Laboratory LIS - Laboratory Downtime Procedure 2 5/27/2020

Laboratory Serology - IQCP for Cepheid Xpert CT NG Assay 2 5/27/2020

Laboratory Serology - IQCP for Cepheid Xpert C. difficile/Epi Assay 2 5/27/2020

Laboratory Chemistry - Calibration Verification 2 5/27/2020

Laboratory ACTM - Acetaminophen 1 5/27/2020

Laboratory ALB - Albumin 1 5/27/2020

Laboratory ALKP - Alkaline Phosphatase 1 5/27/2020

Laboratory ALT - Alanine aminotransferase 1 5/27/2020

Laboratory AMM - Ammonia 1 5/27/2020

Laboratory AMY - Amylase 1 5/27/2020

Laboratory AST -- Aspartate Aminotransferase 1 5/27/2020

Laboratory BUN -- Urea Nitrogen 1 5/27/2020

Laboratory CA 125II 1 5/27/2020

Laboratory CA - Calcium 1 5/27/2020

Laboratory CCRP -- high sensitivity CRP 1 5/27/2020

Laboratory Chemistry Quality Control 1 5/27/2020

Laboratory CHIV -- HIV Ag/Ab Combo Assay 1 5/27/2020

Laboratory CHOL - Cholesterol 1 5/27/2020

Laboratory CK -- Creatine Kinase 1 5/27/2020

Laboratory CREA - Creatinine 1 5/27/2020

Laboratory DBIL -- Direct Bilirubin 1 5/27/2020

COVID COVID Screening Program SOP 2 6/1/2020

COVID COVID Mask and PPE Policy 2 6/2/2020

Laboratory DIG - Digoxin 1 6/3/2020

Laboratory ECO2 -- Enzymatic Carbonate 1 6/3/2020

Laboratory eE2 -- Enhanced Estradiol 1 6/3/2020

Laboratory ETOH -- Ethyl Alcohol 1 6/3/2020

Laboratory FERR -- Ferritin (HM Module) 1 6/3/2020

Laboratory First Sign Drug of Abuse Cup Test 1 6/3/2020

Laboratory FOLA -- Folate (Loci Module) 1 6/3/2020

Laboratory FSH -- Follicle-Stimulating Hormone 1 6/3/2020

Laboratory FT3 -- Free Triiodothyronine (Loci Module) 1 6/3/2020

Laboratory FT4 - Free Thyroxine (LOCI Module) 1 6/3/2020

Laboratory GGT - -Glutamyl Transferase 1 6/3/2020

Laboratory GLU - Glucose 1 6/3/2020

Laboratory HB1C - Hemoglobin A1c 1 6/3/2020

Laboratory HBsAG -- Hepatitis B Surface Antigen 1 6/3/2020

Laboratory HBsAg Confirmatory - Conf 1 6/3/2020

Laboratory HCG - Human Chorionic Gonadotropin (HM Module) 1 6/3/2020

Laboratory HCV - Hepatitis C Antibodies 1 6/3/2020

Laboratory HDL -- High-Density Lipoprotein Cholesterol 1 6/3/2020

Laboratory IBCT -- Total Iron Binding Capacity 1 6/3/2020

Laboratory Iron 1 6/3/2020

Laboratory LIP - Lipase 1 6/3/2020

Laboratory Lytes - Na+ / K+ / Cl 1 6/3/2020

Laboratory MG - Magnesium 1 6/3/2020

Laboratory MYO - Myoglobin 1 6/3/2020

Laboratory LNTP -- N-terminal Pro-Brain Natriuretic Peptide 1 6/3/2020

Laboratory PHOS - Phosphorus 1 6/3/2020

Laboratory PHYT - Phenytoin 1 6/3/2020

Laboratory PRGE - Progesterone 1 6/3/2020

Laboratory FPSA -- Free Prostate Specific Antigen 1 6/3/2020

COVID COVID Inpatient Outpatient Testing 3 6/4/2020

Laboratory TPSA -- Total Prostate Specific Antigen 1 6/4/2020

Laboratory Blood Gases 1 6/4/2020

Laboratory Rubella G (Rub G) 1 6/4/2020

Laboratory SAL - Salicylate 1 6/4/2020

Laboratory Siemens Centaur Chemistry Analyzer 1 6/4/2020

Laboratory Siemens EXL200 Chemistry Analyzers 1 6/4/2020

Laboratory SYPH - Syphilis 1 6/4/2020

Laboratory TBIL -- Total Bilirubin 1 6/4/2020

Laboratory TNI -- Cardiac Troponin I 1 6/4/2020

Laboratory TP -- Total Protein 1 6/4/2020

Laboratory TRIG - Triglycerides 1 6/4/2020

Laboratory TSH -- Thyroid Stimulating Hormone 1 6/4/2020

Laboratory TSTII -- Testosterone II 1 6/4/2020

Laboratory UCFP -- Urinary/Cerebrospinal Fluid Protein 1 6/4/2020

Laboratory URIC -- Uric Acid 1 6/4/2020

Laboratory VANC - Vancomycin 1 6/4/2020

Laboratory VB12 -- Vitamin B12 1 6/4/2020

Laboratory VitD -- Vitamin D Total 1 6/4/2020

Laboratory Leadcare II Procedure 1 6/4/2020

Laboratory Cepheid Xpert® Xpress SARS-CoV-2(EUA) Assay 1 6/4/2020

Accounting Accounting Scope of Service 7 6/8/2020

Accounts Payable Petty Cash Policy 7 6/8/2020

HIMS Contingency Plan for Damaged-Unavailable Records 6 6/8/2020

HIMS Transporting Protected Health Information 6 6/8/2020

HIMS Electronic Health Record Process 6 6/8/2020

HIMS Fax Machines - Setup and Operations 6 6/8/2020

HIMS Paper Document Storage, Retention and Destruction 6 6/8/2020

HIMS Scope of Services of the HIMS Dept 6 6/8/2020

COVID COVID Facility Screening Plan 2 6/8/2020

COVID Employee Health Sick Plan 3 6/9/2020

Laboratory Lab Microbiology Gram Stain Reporting 3 6/10/2020

Laboratory Lab Microbiology Gram Stain 3 6/10/2020

Laboratory IQCP for Cepheid Xpert Xpress SARS-CoV-2 1 6/10/2020

Laboratory IQCP for First Sign Drugs of Abuse Cup Test 1 6/10/2020

COVID COVID Pandemic Cleaning Plan 2 6/15/2020

COVID Visitation During COVID-19 Pandemic 2 6/16/2020

Dietary Manual Ware Washing 6 6/18/2020

Emergency Department Copying Medical Imaging CD'S 7 6/25/2020

Pharmacy Biologicals Storage 7 6/25/2020

Pharmacy Disposal of Outdated or Deteriorated Drugs 7 6/25/2020

Pharmacy Drug and Food Interactions 7 6/25/2020

Pharmacy Enoxaparin Administration Following Neuraxial Anesthesia (Epidural/Spinal Anesthesia) or Spinal Procedure 6 6/25/2020

Pharmacy Gentamycin Dosing and Monitoring 7 6/25/2020

Pharmacy Guidelines for use of parenteral promethazine 7 6/25/2020

Pharmacy Hazardous Materials and Pharmaceuticals 6 6/25/2020

Pharmacy Hospital Drug Formulary 6 6/25/2020

Pharmacy Pharamcy charge capture 6 6/25/2020

Pharmacy Splitting of Unscored Pills 6 6/25/2020

ICU ICU Nurse Practice Guidelines - Infection Control 7 6/25/2020

Dietary Chemical Control 9 6/26/2020

Admitting Authorization Scope of Practice 7 6/29/2020

Admitting Direct Admissions 7 6/29/2020

Admitting Electronic Document Management - Electronic Consent Forms 7 6/29/2020

Admitting Medicare Secondary Payer 7 6/29/2020

Admitting Patient Admission 7 6/29/2020

Admitting Type and Source of Admission 7 6/29/2020

Emergency Department EMTALA: Medical Screening Examinations 7 6/29/2020

Emergency Department Insulin Purchase after Pharmacies are Closed 7 6/29/2020

Emergency Department Mental Health Evaluation and transfer 7 6/29/2020

Emergency Department EMTALA: Patient Transfers from Mammoth Hospital 7 6/29/2020

Respiratory Therapy Chest Physiotherapy 7 6/29/2020

Respiratory Therapy Hand Held Nebulizer 7 6/29/2020

Respiratory Therapy High Humidity Aerosol 7 6/29/2020

Respiratory Therapy IPPB (Intermittent Positive Pressure Breathing) 7 6/29/2020

Respiratory Therapy Incentive Spirometry 7 6/29/2020

Respiratory Therapy Intubation Assist 7 6/29/2020

Respiratory Therapy Oxygen Services 7 6/29/2020

Respiratory Therapy Patient Progress Notes 7 6/29/2020

Respiratory Therapy Respiratory Care Staff Availability 7 6/29/2020

Respiratory Therapy Spirometry (PFT) 7 6/29/2020

Respiratory Therapy Suctioning with an Artificial Airway 7 6/29/2020

Respiratory Therapy Undesirable Side-Effects 7 6/29/2020

Med Surg / telemetry Admission of Patients, Routine 7 6/29/2020

Med Surg / telemetry Continuous Pulse Oximetry Monitoring 7 6/29/2020

Med Surg / telemetry Direct Admissions to an Inpatient Unit 7 6/29/2020

Med Surg / telemetry Emergency Management Plan - MedSurgICU 7 6/29/2020

Med Surg / telemetry Outpatient Procedures on the Medical Surgical Unit 7 6/29/2020

Med Surg / telemetry Safety on the MedicalSurgical Unit 7 6/29/2020

Respiratory Therapy Arterial Blood Gas Puntcture certification 6 6/29/2020

Admitting Observation Form 4 6/29/2020

Emergency Preparedness Evacuation 7 6/30/2020

Emergency Preparedness Equipment and Supplies 8 6/30/2020

Contract # Vendor NameContract Start

Date

Contract

Termination DateAgreement Type

Evergreen

Agreement

Contract Owner

Primary

Contract Owner

SecondaryContract Tags

8480-686000-

VMWare Support-

Bishop Clinics-

Insight

Insight Direct USA 07/18/2020 07/17/2021 IT Licensing No Alasdair Simonds Mark LindVMWare Support -

Bishop Server

84008510-GHX

EDI Data Exchange

Contract-GHX

GHX 06/23/2017 06/23/2021Contract

AgreementYes Andrew Crosby Melanie VanWinkle

GHX SOW for

Cerner

84000022-

PremierGPOMemb

ership-PremierInc

ADVENTIST

HEALTH06/09/2009 06/08/2020

Contract

AgreementNo Andrew Crosby Melanie VanWinkle GPO Agreement

8400669000-

ArthrexPricingAgre

ement-

SequoiaSurgical

Arthrex 08/01/2018 07/31/2020Contract

AgreementNo Andrew Crosby Melanie VanWinkle Pricing Agreement

86100069-

MammothSignedM

asterEquipmentAgr

eement-Mediserve

MEDISERVE,INC 08/01/2018 07/31/2021

Equipment

Maintenance

Agreement

No Andrew Crosby Melanie VanWinkle

Hospital Wide

Equipment Service

Agreement

77100086-

VisualSuperScriptS

oftware-DAA

Enterprises

DAA Enterprises,

Inc.07/23/2013 7/22/2021 Subscription Yes

Andrew

KhodaverdianCaitlin Crunk

Employee

prescriptions

61700076-DVT

Pump Lease-

Zimmer Biomet

Zimmer Biomet 08/01/2018 07/31/2021 Disposables No Brandy Wilt Caitlin CrunkDVT Pump no

charge lease

8530-66900

Reference Plus-

Craneware

CRANEWARE INC. 06/11/2019 06/10/2022Professional

ServicesYes Dawn Van Winkle Melanie VanWinkle

Reference Plus

software -

Craneware

85300065-

BadDebtCollection

Services-EOS.

CSB True North 06/01/2019 05/31/2021Contract

AgreementNo Dawn Van Winkle Melanie VanWinkle

Bad Debt

Collections

8530-insurance

payer-Affordable

Health Care

Concepts

Affordable Health

Care Concepts06/01/1995 01/01/2025

Contract

AgreementYes Dawn Van Winkle Melanie VanWinkle insurance payer

8530-insurance

payer-Beech StreetBeech Street 06/01/2008 01/01/2025

Contract


8530-insurance

payer-First HealthFirst Health 06/01/1995 01/01/2025

Contract


8530-insurance

payer-Galaxy

Health

Galaxy Health

Network06/12/2003 01/01/2025

Contract


8530-insurance

payer-Pacificare

United Healthcare

Pacificare United

Healthcare06/23/2006 01/01/2025

Contract


8530-insurance

payer-Interplan

Interplan

Corporation07/01/1997 01/01/2025

Contract


8530-insurance

payer-CCSCCS 08/19/1996 01/01/2025

Contract


8530-insurance

payer-CHDPCHDP 08/19/1996 01/01/2025

Contract


8530-insurance

payer-Three Rivers

Provider network

Three Rivers

Provider network08/07/2015 01/01/2025

Contract


75000069-CA-

660CoagAnalyzer-

Siemens

SIEMENS

HEALTHCARE

DIAGNOSTICS,

INC

06/08/2019 06/07/2024 Service and Maint. No Jaime Sallee Mark Lind

EQUIPMENT

SERVICE

AGREEMENT

75000069-EMD

Millipore Water

System Srvc-EMD

Millipore

EMD Millipore 07/31/2020 07/30/2021 Service and Maint. No Jaime Sallee Mark LindLab Water system

treatment

7500669000-

VenipunctureExtern

ship-Phlebotomy

Training Specialists

Phlebotomy

Training Specialists08/01/2018 01/01/2022

Contract

AgreementYes Jaime Sallee Mark Lind

Phlebotomy

Training

7500669000-Vitek2

Analyzer-MediserveMediserve Inc. 08/01/2018 07/31/2021 Service and Maint. No Jaime Sallee Mark Lind Vitek2Analyzer


Date

Contract


Evergreen

Agreement

Contract Owner

Primary

Contract Owner


75000076-

RubyHematologyA

nalyzer-

ThermoFisher

ABBOTT

LABORATORIES

INC.

08/12/2020 08/12/2021

Equipment

Maintenance

Agreement

Yes Jaime Sallee Mark LindAnalyzer Service

Agreement

87000069-

MediaWriterD200Sr

vcFee-Hyland LLC

Hyland LLC 06/01/2018 05/31/2020 Service and Maint. No Jane Grossblatt Melanie VanWinkleMedia writer

system

8450-669000-Fire

Alarm Monitoring-

A,C,E-Johnson

Controls

Johnson Controls 06/01/2019 05/31/2020 Fire Safety No John Chisum Mark LindFire Alarm

Monitoring

8450-669000-Fire

Alarm Monitoring-

Primary-Primary

Care Clinics-


Monitoring

8450-669000-Fire

Alarm Monitoring-

Sport Clinic-

Johnson Controls


Monitoring

8450-669000-Fire

Sprinkler

Inspection and

Testing-Delta Fire

Delta Fire Systems,

Inc06/01/2019 05/31/2020 Service and Maint. No John Chisum Mark Lind

Fire Sprinkler

Inspection and

Testing

84500075-

CernerOfficeSpace

Rental1401-

SierraVentures,LLC

Sierra Ventures,

LLC06/01/2019 05/31/2020 Rental Agreement No John Chisum Mark Lind Office space lease

84500069-

BoilerEvapCondSrv

c-

GarrattCallahanCo

GARRATT

CALLAHAN CO.06/01/2018 05/31/2020 Service and Maint. No John Chisum Mark Lind Boiler Treatment

90108320-

MMSSUnits-

BenLouie

07/01/2013 01/01/2021 Lease No John Chisum Mark Lind Storage unit rental

8440-

SierraNevadaLodg

e-

CorporateHousing

Sierra Nevada

Lodge08/01/2019 07/31/2021

Contract

AgreementNo John Chisum Mark Lind

Corporate Lodging

Agreement

84400069-

ConriquezCleaning

Contract

Conriquez Cleaning 08/22/2014 11/01/2020 Service and Maint. No John Chisum Mark Lind Cleaning Service

84500075-

OakTreeUnitCStora

ge-AllanBrown

Allan Brown 08/01/2017 07/31/2020 Rental Agreement No John Chisum Mark Lind Storage Rental

8450669000-

LegionellaWMP-

GarrattCallahan

Garratt-Callahan

Co.08/22/2018 08/21/2021

Contract

AgreementNo John Chisum Mark Lind

Legionella Water

Management Plan

8740-

HealthStreamEduc

ationContract2014-

HealthStream

HealthStream Inc. 06/30/2019 06/29/2022Dues and

SubscriptionsNo Kathy Romagnino Caitlin Crunk

RN Inservice

Education

76300069-

MediaWriterD200Sr

vcFee-Hyland LLC

Hyland LLC 06/01/2018 05/31/2020 Service and Maint. No Kevin Larsen Mark Lind Equipment Service

76300069-

PacScanSoftware2

yr-PacsGear

Hyland LLC 06/01/2018 05/31/2020Software License

AgreementNo Kevin Larsen Mark Lind

Software

Agreement

7630-669000-

AfterHoursRadiolog

yService-

DRTTeleRadiology

Direct Radiology

California, P.C.07/22/2020 07/21/2021

Professional

ServicesYes Kevin Larsen Mark Lind

Radiology Reading

Service for night

coverage

76800069-

DiamondSelectCTS

canner-

PhilipsMedicalSyst

Philips Medical

Systems07/20/2016 07/19/2021 Service and Maint. No Kevin Larsen Mark Lind Equipment Service

7630669000-

AMX4Portable-

Mammoth-

Mediserve

Mediserve Inc. 08/01/2018 07/31/2021 Service and Maint. No Kevin Larsen Mark LindXray Equipment

Service

7630669000-

DigitalDiagnostVM-

Mediserve

Mediserve Inc. 08/01/2018 07/31/2021 Service and Maint. No Kevin Larsen Mark Lind Equipment Service

7630669000-

FujiCRX3EDMortB

ort-Mediserve


7630669000-

GEBishopProteus-

Mediserve

Mediserve Inc. 08/01/2018 07/31/2021

Equipment

Maintenance

Agreement

No Kevin Larsen Mark Lind

EQUIPMENT

SERVICE

AGREEMENT


Date

Contract


Evergreen

Agreement

Contract Owner

Primary

Contract Owner


7630669000-

GEMammothProte

us-Mediserve

Mediserve Inc. 08/01/2018 07/31/2021

Equipment

Maintenance

Agreement

No Kevin Larsen Mark LindXray Equipment

Service

7630669000-

HologicDEXA-

Mediserve

Mediserve Inc. 08/01/2018 07/31/2021

Equipment

Maintenance

Agreement


Support-Bone

Densitometry/DEX

A

7630669000-

HologicSapphireUlt

rasound-Hologic

Hologic Inc. 08/01/2018 07/31/2022

Equipment

Maintenance

Agreement


Support-Breast

Biopsy/Sapphire

Equip

7630669000-

Insight2MiniC-Arm-

Mediserve


7630669000-

MultiDiagnstEleva-

Mediserve

Mediserve Inc. 08/01/2018 07/31/2021 Service and Maint. No Kevin Larsen Mark Lind

EQUIPMENT

SERVICE

AGREEMENT

7630669000-

PulseraC-Arm-O.R

New-Mediserve


7630669000-

PulseraC-

ArmOriginal-

Mediserve


7630669000-

QRadiologySystem

MAJ-Mediserve


7670669000-

AplioUltrasound-

Mediserve

Mediserve Inc. 08/01/2018 07/31/2021

Equipment

Maintenance

Agreement


EQUIPMENT

SERVICE

AGREEMENT

8750 MBQIP

Medicare Benficiary

Quality

Improvement

06/16/2016 01/01/2020 MOU No Lenna Monte Caitlin Crunk

MBQIP Medicare

Benficiary Quality

Improvement Pro

8750-Transfers-

LomaLindaLoma Linda 06/01/2005 01/01/2025

Transfer

AgreementsYes Lenna Monte Caitlin Crunk

Transfer

Agreement

8750-Transfers-

NorthernInyoHospit

al

Northern Inyo

Hospital06/19/2008 01/01/2025

Transfer

AgreementsYes Lenna Monte Caitlin Crunk

Transfer

Agreement

8750-

HospitalPatient

Satisfaction

Surveys-

Press Ganey

Associates, Inc.06/01/2016 05/31/2021

Contract

AgreementYes Lenna Monte Caitlin Crunk

Performance

Measurement

Service

87800069-

TrainingTranslation

sConsulting-

SierraSkyInterpreti

Sierra Sky

Interpreting07/15/2008 01/01/2019

Contract

AgreementNo Lenna Monte Caitlin Crunk

Language

Intepretation and

Translation

7010-Telepsych

Contract for

EDsigned-

CEPAmericaTelehe

CEP America-

Telehealth,PC06/15/2017 01/01/2025

Affiliation

AgreementYes Lori Baitx Caitlin Crunk

Telemedicine

services

7010669000-

Sonosite

Ultrasound Edge

P1500-11-

Mediserve Inc. 08/01/2018 07/31/2021

Equipment

Maintenance

Agreement

No Lori Baitx Caitlin Crunk

Equipment

Maintenance

Agreement

7770-

PhysicalTherapyCli

nical Education-

University of St.

University of St.

Augustine06/17/2016 06/16/2021

Contract

AgreementNo Lorraine Koenig Zachary Brown

Physical Therapy

Education

Agreement

7770-

PhysicalTherapyCli

nicalEducation-

SanDiego State

San Diego State

University06/17/2015 01/01/2025

Contract

AgreementYes Lorraine Koenig Zachary Brown

Student Education -

PT

7770-

ClinicalEducationfo

r

PhysicalTherapySt

University of the

Pacific07/12/2010 01/01/2025

Contract

AgreementYes Lorraine Koenig Zachary Brown

Student Education -

PT

7770-

MonoCountyOffice

OfEducationPTSer

vices-MonoCounty

mono county office

of education08/01/2020 07/31/2021

Professional

ServicesNo Lorraine Koenig Zachary Brown

consultation -

education

7772-MOU-BUHS-

MH for ATC

Service

Bishop Union High

School District08/15/2016 01/01/2025 MOU Yes Lorraine Koenig Zachary Brown

Certified Athletic

Trainer Service

8490-685000-

1GBMainCampusIn

ternetCircuit-

Telequality

Telequality, Inc. 06/29/2018 06/28/2021 Telecom Services No Mark Lind


Date

Contract


Evergreen

Agreement

Contract Owner

Primary

Contract Owner


84800083-

TeamViewer11Cor

porateLicense

TEAMVIEWER

GMBH06/11/2020 06/12/2021 IT Licensing Yes Mark Lind

8480683000-

VeemBackupReplic

ationLicense-

Insight

Insight Enterprises

Inc06/25/2020 06/25/2023 IT Agreement No Mark Lind

System Back up

and Maintnenace

Agreement

8490-685000-

InternetCircuit-

ENAHealthcare

ENA Healthcare

Services, LLC07/01/2020 06/30/2021 IT Agreement No Mark Lind

Internet Circuit fro

Hospital Campus

8610-669000-

CaseCoordinationf

orJoints-Johnson

and Johnson

07/22/2020 07/21/2023Contract

AgreementNo Mark Lind

Case Coordination

for Total Joints

8480-683000-HPE

Support - Citrix

Workspace

software solution -

Insight Enterprises

Inc08/01/2019 07/31/2020 IT Licensing Mark Lind

It Software &

Hardware Support

84800083-

HiveManagerSubsc

ription-Aerohive-

Invoice

Insight Enterprises

Inc09/28/2019 09/27/2020 IT Agreement No Mark Lind

IT License-100

License for

wireless network

mngmnt

8480669000-

DellServerSupport-

Mediserve

Mediserve Inc. 08/01/2018 07/31/2021 IT Agreement No Mark Lind Server Support

8481-683000-

Cerner Patient

Kiosk Monthly Fee-

Cerner

Cerner Corp 08/22/2018 08/21/2023Software License

AgreementYes Mark Lind

Shared Computing

Monthly Fee

8481-683000-

Nuance

PowerScribe 360

Upgrade-Nuance

NUANCE

DOCUMENT

IMAGING INC

08/01/2019 07/31/2022 IT Licensing Yes Mark LindPowerScribe Core

Reporting

84810069-

ParticipationAgree

mentHIE-

ManifestMedex

Inland Empire

Health Information

Exchange

08/01/2018 07/31/2020 IT Agreement Yes Mark LindHealth Information

Exchange Vendor

8610-

MammothHospitalP

ropertyInsurance

Alliant Insurance

Services, Inc.07/01/2020 06/30/2021

Contract

AgreementNo Melanie VanWinkle

insurance,HARPP,

APIP

8650-DO FOR

INFORMATION

ONLY DO-16-702-

Beta Healthcare

Beta Risk

Management

Authority

07/01/2019 06/30/2020Dues and

SubscriptionsNo Melanie VanWinkle

Directors and

Officers Liability

Coverage

8610-7160-

physician contract-

knechtstephen

Stephen Knecht,

MD07/01/2019 06/30/2022 Physician Contract Melanie VanWinkle

8610-7160-

physician contract-

urbandlindsey

07/01/2019 06/30/2022 Physician Contract Melanie VanWinkle Tabby Mannetter

7140-669000-M-

Turbo Ultrasound-

Fuji

Mediserve Inc. 08/01/2018 07/31/2021

Equipment

Maintenance

Agreement

No Michael McMahon Zachary Brown

EQUIPMENT

SERVICE

AGREEMENT

7160669000-

Sonosite

Ultrasound M-

Turbo

Mediserve Inc. 08/01/2018 07/31/2021

Equipment

Maintenance

Agreement

No Michael McMahon Zachary BrownUltrasound annual

calibration

7400669000-

Sonosite

Ultrasound Edge-

P1500-11-

Mediserve Inc. 08/01/2018 07/31/2021

Equipment

Maintenance

Agreement

No Nancie Hamilton Caitlin CrunkUltrasound annual

calibration

7720669000-

Ventilator,CpapV60-

Mediserve

Mediserve Inc. 08/01/2018 07/31/2021

Equipment

Maintenance

Agreement

No Nancie Hamilton Caitlin Crunk

Equipment

Maintenance

Agreement

74200069-

ArthrexScope/Tabl

etRepair/Synergy-

Arthrex

Arthrex 07/01/2018 06/30/2021 Service and Maint. Phyllis Meneses Caitlin Crunk

Arthroscope/Tablet

/Light Guide/Optical

Coupler

74200069-

ArthrexSynergySur

geonsVault-Crall-

Gilmer 3yr-Arthrex

Arthrex 07/01/2018 06/30/2021 Subscription No Phyllis Meneses Caitlin CrunkSurgeons Vault

Software

74200050-

BairPawsWarming

Kit-

ArizantHealthcare

ARIZANT

HEALTHCARE

INC. AUGUSTINE

MEDICAL INC.

07/15/2011 01/01/2022 Disposables Yes Phyllis Meneses Caitlin CrunkPatient Warming

systems

7420-669000-

LumenisLaser-

Mediserve

Mediserve Inc. 08/01/2018 07/31/2021 Service and Maint. Yes Phyllis Meneses Caitlin Crunk Lumenis Laser


Date

Contract


Evergreen

Agreement

Contract Owner

Primary

Contract Owner


7420-669000-SII

Sonosite

Ultrasound-Fuji

Mediserve Inc. 08/01/2018 07/31/2021

Equipment

Maintenance

Agreement

No Phyllis Meneses Caitlin Crunk

EQUIPMENT

SERVICE

AGREEMENT

74200069-

OlympusKESupport

Maintenance-

Olympus

OLYMPUS

AMERICAS INC08/15/2017 08/14/2020

Software

Maintenance

Agreement

No Phyllis Meneses Caitlin Crunk

Olympus Software

for Endoscopy

System

74200069-

SterradNXSterilizer-

AdvancedSterilizati

on

ADVANCED

STERILZATION

(JJ)

08/12/2019 08/11/2020 Service and Maint. No Phyllis Meneses Caitlin Crunk Sterilizer service

8610-

InmateMedicalCare-

MonoCounty

Mono County 07/18/2013 01/01/2025Contract

AgreementYes Sarah Rea Tom Parker

County Inmate

Care Agreement

8650-669000-

DocumentRetentio

nLicenseFee-

Treenosoftware

Treeno Software 07/01/2018 01/01/2025Software License

AgreementYes Sarah Vigilante Tom Parker

Document

Retention License

Fee

8650-StayStaffed Sta Stafffed 08/01/2014 01/01/2021 Subscription Yes Sarah Vigilante Tom Parker

Staffing needs

temporary and

permanent

85100076-

NeopostN-

710MailMachine-

MMSWest

Mail Finance Inc 06/01/2017 05/31/2022Equipment Lease

AgreementNo Slavka Crouthamel Melanie VanWinkle

Mail Machine

Lease

85100024-

AuditServices-

EideBailly

Eide Bailly 07/30/2009 01/01/2021Professional

ServicesNo Slavka Crouthamel Melanie VanWinkle Audit services

8750-Transfers-

CedarsSinai

Cedars-Sinai

Medical Center08/20/2010 01/01/2025

Transfer

AgreementsYes Stephanie Stanton Caitlin Crunk

Transfer

Agreement

8750-

PatientComplaints

Software-Verge

Verge Solutions,

LLC08/01/2012 07/31/2021

Contract

AgreementNo Stephanie Stanton Caitlin Crunk

Incident Reporting

and Patient

Complaint Software

8610-7080-

physician contract-

crunkdennis

Dennis Crunk, M.D. 06/01/2019 12/31/2021 Physician Contract No Tabby Mannetter Melanie VanWinklePHYSICIAN

CONTRACT

8610-

7160physiciancontr

act-cutticmarianne

Marianne Cuttic 06/01/2017 08/31/2020 Physician Contract No Tabby Mannetter Melanie VanWinklePHYSICIAN

CONTRACT

8610-6170-

physician contract-

hospitalist-araya-

burrows-park-

Craig Burrows, MD,

Inc.; Araya

Medicine, Inc.; KP1

and 2, Inc.

07/01/2017 12/31/2020 Physician Contract No Tabby Mannetter Melanie VanWinklePHYSICIAN

CONTRACT

8610-7080-

physician contract-

wardchristopher

Christopher Ward,

DO04/01/2019 12/31/2021 Physician Contract Tabby Mannetter Melanie VanWinkle

PHYSICIAN

CONTRACT

8610-7083-

physician contract-

craguntimothy

Timoth Cragun 08/01/2018 07/31/2021 Physician Contract Tabby Mannetter Melanie VanWinklePHYSICIAN

CONTRACT

8610-7060-

physician contract-

fujimotosteven

Steven Fujimoto,

DDS08/01/2017 01/01/2025 Physician Contract No Tabby Mannetter Melanie VanWinkle

PHYSICIAN

CONTRACT

8610-7010-

physician contract-

emergency

Mammoth

Emergency

Physicians

08/01/2016 07/31/2021 Physician Contract Yes Tabby Mannetter Melanie VanWinklePHYSICIAN

CONTRACT

8610-7160

physician contract-

MOI

Mammoth

Orthopedic Institute

(MOI)

08/01/2017 07/31/2022 Physician Contract Tabby Mannetter Melanie VanWinklePHYSICIAN

CONTRACT

7180669000-

Hitachi5500Ultraso

und-Mediserve

Mediserve Inc. 08/01/2018 07/31/2021 Service and Maint. No Teresa Toups Zachary BrownHitachi Ultrasound

Service

7090-2017-6-

UCDavis-

Telemedicine for

Peds

University of

California, Davis

Medical Center

07/01/2018 06/30/2020Affiliation

AgreementYes TR Miller Zachary Brown

Telemedicine

service

86100000_Toiyabe

_Indian_Health_Pr

oject_MOU

Toiyabe Indian

Health Project07/22/2015 01/01/2021 MOU Yes TR Miller Zachary Brown

Toiyabe Health

service MOU

7050669000-

SonositeUltrasound

Edge-P1500-11-

Mediserve

Mediserve Inc. 08/01/2018 07/31/2021

Equipment

Maintenance

Agreement

No TR Miller Zachary BrownUltrasound annual

calibration

1

AGREEMENT FOR PROVISION OF PHYSICIAN SERVICES

THIS AGREEMENT is made this 28th day of August 2020, by and between SOUTHERN MONO HEALTHCARE DISTRICT ("DISTRICT"), and LUCIENNE BOUVIER, M.D., Inc. (hereinafter referred to as "PHYSICIAN"), at the Town of Mammoth Lakes, County of Mono, State of California.

Recitals

A. The DISTRICT is a Local Health Care District duly organized and existing under the

laws of the State of California and more specifically the Local Health Care District Law, Health and Safety Code §§32000, et seq.

B. The DISTRICT owns and operates Mammoth Hospital to provide acute care, full service

medical services to the community in which it serves.

C. PHYSICIAN is an independent practicing physician duly licensed by the State of California and Board Certified in the practice area of obstetrics and gynecology.

D. The DISTRICT has determined that the making and entering into of this Agreement for

the providing of physician services in the area of obstetrics and gynecology is necessary for the provision of adequate health care services to the communities served by the DISTRICT.

E. It is further determined by the board of directors of the DISTRICT that this Agreement

allows the board of directors to ensure that fees and charges for these physician services rendered at Mammoth Hospital are reasonable, fair, and consistent with the basic commitment of the DISTRICT to provide adequate health care to all residents within the boundaries of the DISTRICT and visitors to the area.

Agreement

NOW, THEREFORE, IN CONSIDERATION OF THE MUTUAL COVENANTS AND CONDITIONS CONTAINED HEREIN, THE PARTIES AGREE AS FOLLOWS:

1. Term of Agreement. The DISTRICT hereby retains the services of PHYSICIAN for a term of three (3) years commencing on or about January 1, 2021 and terminating on December 31, 2023.

Notwithstanding the foregoing, either party may terminate this Agreement prior to the

expiration of any term hereof based on a finding of good cause. Good cause shall be limited to a default by either party herein. In the event either party elects to terminate this Agreement prior to the expiration of any term hereof based on cause or default, such party shall provide written notice to the other, setting forth in enough detail, the nature, extent, and scope of the default. Thereafter, the alleged defaulting party shall have thirty (30) days to remedy, cure, or otherwise correct the default. Should the alleged defaulting party not so remedy or otherwise cure the default within the thirty (30) day-time period, the no defaulting party may immediately terminate this Agreement

The DISTRICT may elect to immediately terminate this Agreement without first

complying with the foregoing provisions regarding good cause and notice of default in the event of:

(1) suspension, revocation, or expiration (without renewal thereof) of PHYSICIAN's license to practice

medicine in the State of California; (2) suspension (for 30 or more days), revocation, or other

termination of medical staff privileges of PHYSICIAN at Mammoth Hospital; (3) PHYSICIAN is

convicted of a felony (4) any event of default which cannot be cured within the time periods set forth

herein; (5) the reputation of PHYSICIAN or DISTRICT is adversely affected by some intentional act

of PHYSICIAN or (6) an emergent situation requiring termination as determined by the DISTRICT

in order to protect against or avoid adverse impacts to patients, staff, DISTRICT personnel or

DocuSign Envelope ID: 9C0555CD-0014-4923-AED2-8F19383F60BE

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facilities, or the health, safety and welfare of the residents and communities served by the DISTRICT.

The DISTRICT has the express right to take action under its Bylaws and the Medical

Staff Bylaws to ensure patient safety; in the event Medical Staff fails to take appropriate action

against any physician who provides substandard care or who engages in professional misconduct

which within the reasonable and lawful discretion of the DISTRICT is jeopardizing public safety, this

Agreement may be terminated by the DISTRICT and the physician may be removed from the

Medical Staff pursuant to the Medical Staff Bylaws.

2. Description of Duties. PHYSICIAN shall personally render the services to Mammoth

Hospital during the term of this Agreement. PHYSICIAN shall obtain the approval of the Chief

Executive Officer ("CEO") or hospital administrator before retaining the services of additional

physician personnel to perform identical services as PHYSICIAN and while PHYSICIAN is

performing such services. This provision shall not apply to substitute temporary staffing, including

locum tenens. See Exhibit A for details of duties and expectations.

1) It is expressly acknowledged by PHYSICIAN that Mammoth Hospital serves

a resort and tourist-based community. In connection therewith, PHYSICIAN's personal attendance

for staffing needs will be required during holiday and other high-volume periods. In order to minimize

the excess costs associated with substitute physician staffing, including locum tenens, PHYSICIAN

shall not take time off or vacations during such peak or holiday periods except pursuant to the

schedule agreed upon by PHYSICIAN and the other OB/GYN who will provide services at Mammoth

Hospital.

2) All physician services provided herein by PHYSICIAN shall be rendered by

PHYSICIAN in the exercise of the utmost degree of skill and care and within the sole and absolute

discretion and control of PHYSICIAN exercising independent professional judgment. The DISTRICT

shall not direct PHYSICIAN in the rendering of physician services hereby, and PHYSICIAN shall

not be considered an agent of DISTRICT.

3) PHYSICIAN shall be a permanent or temporary member of the medical staff

of Mammoth Hospital and shall be in good standing.

4) Performance by PHYSICIAN of his obligations pursuant to this Agreement shall be in compliance with all federal, state, and local laws, rules, regulations, and ordinances, and in full compliance of any such applicable rules and regulations of any governmental or accrediting agency or authorities relating to the licensure and regulations of physicians, medical practitioners, and acute care hospitals.

5) PHYSICIAN shall comply with all rules and regulations established at Mammoth Hospital, including without limitation, the Medical Staff Bylaws and the Bylaws of the Southern Mono Healthcare District, and as all may be amended from time to time.

6) All services rendered by PHYSICIAN hereunder shall be in accordance with the

standards, rules, regulations, and recommendations of the DISTRICT's current and any future accrediting agencies (e.g., DNV, the Joint Commission, and State of California, regardless of whether Mammoth Hospital is so accredited) and of the Medicare Conditions of Participation.

7) PHYSICIAN shall comply with and maintain professional and ethical standards

of conduct with respect to the issue of patient confidentiality. PHYSICIAN shall not use or disclose any protected health information or individually identifiable health information (as defined in the Health Insurance Portability and Accountability Act ("HIPM"; 45 CFR Part 164), the Confidentiality of Medical Information Act (:"CMIA", Civil Code §§56.05, et seq.), or Health.& Safety .Code §1280.15) (collectively, "Protected Health Information" or "PHI") concerning any patient of Mammoth Hospital or its affiliated


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clinics and facilities (whether or not PHYSICIAN renders services to such patient) other than as expressly permitted by this Agreement and the requirements of State and Federal privacy regulations and security standards. PHYSICIAN further agrees to comply with all policies, procedures and directives of the DISTRICT regarding the use and disclosure of Protected Health Information.

8) PHYSICIAN shall diligently and timely maintain, update, make entries in or to,

and file all necessary medical records and billings and charges. Such items include, without limitation, charts, charge slips, billing codes, physician charge codes, transcriptions, assignments of billings and charges, and orders. For the purposes of this provision, "diligently and timely" mean and refer to completing all tasks, including electronic health record task lists, within 48 hours of the time of the event, treatment, service, or transaction. PHYSICIAN shall use the EMR systems in connection with PHYSICIAN's obligations in this sub-paragraph.

9) During the term of this Agreement, PHYSICIAN shall maintain an active presence within the community served by the DISTRICT and engage in community functions. The activities contemplated hereby are to include, without limitation, spending a reasonable amount of time participating in health fairs, wellness awareness programs, school health programs, community education, and other service programs sponsored by the Hospital. At the end of each term year, PHYSICIAN shall provide to the hospital administrator a written report setting forth a summary of activities in compliance with this paragraph if requested to do so.

3. Effect of Consideration. No consideration being afforded PHYSICIAN by the DISTRICT pursuant to this Agreement is being made for the referral of patients to Mammoth Hospital. This Agreement in no way restricts PHYSICIAN from establishing staff privileges at, referring patients to, or generating business from another entity. PHYSICIAN retains sole and absolute professional discretion regarding PHYSICIAN's patient matters and referral practices.

No consideration being afforded PHYSICIAN by the DISTRICT pursuant to this Agreement is for any bonus, retention incentives, or otherwise. All such consideration being afforded PHYSICIAN by the DISTRICT pursuant to this Agreement is as expressly set forth in this Agreement.

Notwithstanding coverage and staffing obligations of PHYSICIAN as provided for in this Agreement, PHYSICIAN expressly acknowledges and agrees that the DISTRICT has not made, nor does this Agreement provide for, any of the following for the benefit of PHYSICIAN: (i) income guarantees, (ii) promises, representations, or guarantees of patient volumes or business volumes, (iii) exclusivity of medical services provided, (iv) minimum or guaranteed hours or days of coverage or office hours. The DISTRICT retains sole and absolute discretion regarding its business decisions and operations, including facilities and clinics staffed by PHYSICIAN as provided for in this Agreement. This discretion includes, without limitation, hours of operation, staffing, location, and whether to cease or suspend operations. Coverage obligations of PHYSICIAN are subject to and limited by the matters set forth in this paragraph. PHYSICIAN shall have no claims against the DISTRICT, including its agents, representatives, officers, directors, and affiliates, for any damages, loss of income, or otherwise resulting from decisions or actions by the DISTRICT as provided for in this paragraph.

4. Professional Fees to PHYSICIAN.

The DISTRICT shall pay to PHYSICIAN as and for professional services being rendered by PHYSICIAN

pursuant to this Agreement as specified in Exhibit B. PHYSICIAN and DISTRICT have reviewed the

compensation to be paid under this Agreement as outlined in Exhibit B to confirm it is consistent with fair

market value and does not violate of the federal Anti-kickback statute or Stark Act.

5. PHYSICIAN Billings for Patient Services and Care. The DISTRICT shall bill for all patient

services and care rendered by PHYSICIAN and any substitute physicians, including locum tenens,

pursuant to this Agreement. All such physician fees and billings shall remain the property of the

DISTRICT. It is expressly acknowledged and agreed to by and between the parties that the DISTRICT


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will not be realizing a profit in connection with the services being rendered by PHYSICIAN hereby. All

fees and rates for all services rendered and charges shall be set by the DISTRICT and shall be

reasonable, fair, and consistent with the basic commitment of the DISTRICT to provide adequate health

care to all residents and visitors within the boundaries of the DISTRICT.

6. Professional Liability (Malpractice) Insurance. PHYSICIAN has two options for Professional Liability Insurance: a) Obtain own professional liability coverage as outlined below or b) request that the DISTRICT add PHYSICIAN to the DISTRICT professional liability policy (see EXHIBIT B for option selected).

a) PHYSICIAN shall maintain professional liability/medical malpractice insurance, which the

DISTRICT approves in advance, and which approval shall not be unreasonably withheld. The DISTRICT shall be a named or additionally named insured under all such policies. All coverages shall include a statement to the effect that "coverage afforded under this Policy will act as primary insurance to that of the certificate holder and additional insured. PHYSICIAN shall provide to the DISTRICT upon reasonable request therefor a certificate or other proof that such insurance is in full force and effect. The limits of any liability policy shall be not less than $1,000,000 per occurrence. Insurance shall be maintained with an admitted carrier licensed by the State of California Department of Insurance with a Best rating of not less than A minus, and coverage shall be in conformance with the Medical Staff Bylaws (and as the same may be amended from time to time). PHYSICIAN shall immediately notify the DISTRICT of any change or cancellation of any insurance policy in effect pursuant to this Agreement. In the event of any notice of cancellation given to PHYSICIAN, PHYSICIAN shall reinstate all such insurance within thirty (30) days of such notice.

b) As of the date of this Agreement, PHYSICIAN has been able to be insured under the current DISTRICT policy with BETA Healthcare Group (BETA) with the DISTRICT paying all premiums related thereto. The DISTRICT shall continue to maintain professional liability/medical malpractice insurance for PHYSICIAN as provided for herein through the current policy of the DISTRICT provided by BETA. In the event such coverage through BETA is no longer available or the DISTRICT procures other coverage for the DISTRICT where the physicians cannot be included as determined by the DISTRICT, within its sole and absolute discretion, the parties shall meet and confer and modify this Agreement accordingly in order to ensure that PHYSICIAN can reasonably meet the obligation to have such insurance in place during the then remaining term of this Agreement.

7. Records. All books, records, patient medical records, and other documents pertaining to or relating to the care and treatment of patients at Mammoth Hospital and the services rendered by PHYSICIAN pursuant to this Agreement shall be and remain the property of the District. Upon termination, PHYSICIAN shall make entries in or to, and file as necessary medical records and billings and charges in accordance with subsection 8 of section 2 of this Agreement, and shall return any and all such property in PHYSICIAN’s possession to District by the date of termination.

8. Warranties of PHYSICIAN. In addition to all other warranties or representations made

by PHYSICIAN in connection with the making and entering into of this Agreement, whether oral or written, PHYSICIAN hereby represents and warrants to the DISTRICT the following:

1) PHYSICIAN is a duly licensed physician in good standing in the State of California. PHYSICIAN is registered with the DEA to prescribe controlled substances without restriction or limitation. Neither PHYSICIAN's medical license nor PHYSICIAN's DEA registration has ever been suspended, revoked, restricted, limited, or terminated. PHYSICIAN has disclosed to DISTRICT any type of disciplinary or corrective action taken by any medical licensing or certification authority, or any reprimand monetary fine or penalty relating to the rendering of medical services by PHYSICIAN. There exists no actual, pending, or threatened disciplinary proceedings against PHYSICIAN that could result in


5

the suspension or revocation of PHYSICIAN's license to practice medicine in the State of California.

2) PHYSICIAN is under no obligation, restriction or limitation, contractual or otherwise, to any other individual or entity that would prohibit or impede PHYSICIAN from undertaking and performing the duties, responsibilities, and obligations of PHYSICIAN pursuant to this Agreement. The terms and provisions of this Agreement do not affect or violate any agreement or obligation of PHYSICIAN with respect to the ability of PHYSICIAN to practice medicine.

3) PHYSICIAN is an independent physician, i.e., not an employee of the DISTRICT.

4) PHYSICIAN has never been removed for cause from any provider panel of any managed care organization, indemnity insurer or other third-party payer, or independent practice association, PHYSICIAN organization, PHYSICIAN-hospital organization, or other provider network.

5) PHYSICIAN is not a party to any pending malpractice or other patient-related

litigation, nor have any such claims been threatened, including any proceedings against PHYSICIAN before any professional licensing board.

6) To PHYSICIAN's best knowledge, he/she is not a party to any pending

investigation or proceeding the basis of which implicates his/her professional competence or that could lead to a suspension, revocation, restriction, limitation or termination of his/her medical license or medical staff privileges at any hospital. PHYSICIAN has not been involved in a violation of the Stark Law or the Anti-Kickback Statute.

PHYSICIAN shall immediately notify the DISTRICT in the event any of the foregoing representations are or become untrue for any reason. PHYSICIAN’s failure to immediately notify the DISTRICT in this event shall amount to a material breach of this Agreement for which the DISTRICT may immediately terminate this Agreement.

9. Effect of Relationship. This Agreement is not intended to nor shall it create any relationship of partnership, joint venture, employer/employee, master/servant, employment, agency or otherwise. PHYSICIAN is not receiving from the DISTRICT any monetary compensation in the nature of income guarantees, subsidies, referral fees, or otherwise. All compensation provided for herein is for services rendered for professional services of PHYSICIAN as has been expressly set forth herein. PHYSICIAN is at all times acting and performing under this Agreement as an independent contractor and as a medical practitioner and licensed physician in the State of California, with PHYSICIAN specializing in the area of medicine delineated herein. It is the intention of the DISTRICT to obtain the services of PHYSICIAN to ensure that the specialty services of PHYSICIAN are available to carry out health care services for the benefit of the communities served by the DISTRICT and that such services be performed in a competent, professional, appropriate, and efficient manner as set forth in this Agreement.

The DISTRICT shall not direct or supervise the way services are rendered by PHYSICIAN. PHYSICIAN shall render services pursuant to this Agreement within the sole, reasonable, and independent professional discretion of PHYSICIAN.

Unless otherwise required, PHYSICIAN shall have all compensation paid pursuant to

this Agreement subject to Form 1099 reporting. PHYSICIAN shall be fully responsible for the payment of all income taxes and the payment of all appropriate withholding of all payroll taxes and deductions for PHYSICIAN. In connection herewith, PHYSICIAN shall have no claims under this Agreement or otherwise, against the DISTRICT for vacation pay, sick leave or other paid leave, pension or retirement benefits, social security or FICA, worker's compensation, disability, unemployment insurance benefits, or any other benefits afforded to full-time benefitted employees at Mammoth Hospital.

10. Survival of Warranties and Representations. All warranties and representations of PHYSICIAN shall survive both the date of this Agreement and any eventual termination of this


6

Agreement.

11. Working Space. The DISTRICT shall provide PHYSICIAN with enough working space,

staffing of personnel (including support and clerical staff), and hospital facilities while PHYSICIAN is performing services at Mammoth Hospital, with the intent to enable PHYSICIAN to perform and render services as provided for herein.

12. No Assignment by PHYSICIAN. Due to the uniqueness of services being rendered by PHYSICIAN to the DISTRICT and the specific professional skill, competence, and experience of PHYSICIAN, PHYSICIAN shall not assign, sublet, delegate, or otherwise convey PHYSICIAN's rights and obligations pursuant to this Agreement. Any attempt to so assign by PHYSICIAN shall be deemed null and void and shall entitle the DISTRICT to immediately terminate this Agreement without first having to comply with any notice of default provisions (including those provided for in paragraph 1 above), termination provisions of any DISTRICT Bylaws or Medical Staff Bylaws, or otherwise. In the event PHYSICIAN forms or becomes part of a medical or other professional corporation, partnership, limited liability company, limited liability partnership, or other such entity, PHYSICIAN shall unconditionally guaranty any and all obligations, promises, covenants, and warranties of any such entity as provided for in this Agreement. All liability of PHYSICIAN hereunder shall be joint and several with that of any such entity. In such event, PHYSICIAN shall notify the DISTRICT within thirty (30) days.

13. Remedies. Any and all remedies provided by this Agreement, operation of law, or

otherwise, shall be deemed to be cumulative, and the choice or implementation of any particular remedy shall not be deemed to be an election of remedies to the mutual exclusion of any other remedy provided for herein, by operation of law, or otherwise. Enforcement of any provision of this Agreement shall be by proceedings at law or in equity against any persons or entities violating or attempting to violate any promise, covenant, or condition contained herein, either to restrain violation, compel action, or to recover damages.

14. Attorney's Fees. In the event any action at law or in equity is initiated to enforce or interpret the terms of this Agreement, or arises out of or pertains to this Agreement, the prevailing party shall be entitled to reasonable attorney's fees, costs, and necessary disbursements in addition to any other relief to which that party may be entitled.

15. Notices. Any notices to be given by either party to the other shall be in writing and shall be transmitted either by (1) personal delivery, (2) mail, registered or certified, postage prepaid with return receipt requested, (3) by an overnight delivery service (e.g., Federal Express), or (4) by facsimile or email service with a confirmation copy by regular mail, first class postage prepaid. Personal delivery or mailed notices shall be addressed to the parties at the addresses listed below. Notices shall be transmitted via the contact information listed below. Each party may change that address and facsimile telephone number by giving written notice in accordance with this paragraph. In the event of any mailing, notice shall be deemed given on the 3rd day after deposit. The addresses and facsimile telephone numbers of the parties are as follows:

SOUTHERN MONO HEALTH CARE DISTRICT Attn: Chief Executive Officer P.O. Box 660 Mammoth Lakes, CA 93546 Facsimile Telephone No.: (760) 924-4104 Email: [email protected]


mailto:[email protected]

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LUCIENNE BOUVIER, M.D., Inc. 385 L Street Fremont, CA 94536 E-mail: [email protected] Cell Phone: 510-710-3261

16. Integration. It is intended by the parties that this Agreement be the final expression of the

intentions and agreements of the parties. This Agreement supersedes all prior or contemporaneous agreements, either oral or in writing, between the parties hereto and contains all of the covenants and agreements between the parties. No other agreements, representations, inducements, or promises, not contained in this Agreement shall be valid or binding. Any modification of this Agreement shall be effective only if it is in writing and signed by both parties.

17. Binding Effect. This Agreement shall be binding upon and inure to the benefit of the

heirs, executors, administrators, personal representatives, successors, and assigns of each of the parties hereto.

18. Severance. In the event any term or provision of this Agreement is deemed to be in

violation of law, null and void, or otherwise of no force or effect, the remaining terms and provisions of this Agreement shall remain in full force and effect.

19. Governing Law. Venue. This Agreement shall be interpreted under the laws of the State

of California. Exclusive venue for any legal action shall be Mono County, California.

20. Effect of Waiver. No waiver of any breach of any term, covenant, agreement, restriction,

or condition of this Agreement shall be construed as a waiver of any succeeding breach of the same or any other covenant, agreement, term, restriction, or condition of this Agreement. The consent or approval of either party to or of any action or matter requiring consent or approval shall not be deemed to waive or render unnecessary any consent to or approval of any subsequent or similar act or matter.

21. Joint Preparation. This Agreement shall be deemed to be jointly prepared by all parties hereto. In connection therewith, the provisions of Civil Code §1654 shall not be deemed applicable in the event of any interpretation of this Agreement.

22. Access to Records Clause. If this Agreement is for the provision of services with a value of $10,000 or more over a twelve (12) month period, then until the expiration of four (4) years after the furnishing of the services provided under this Agreement, PHYSICIAN will make available to the Secretary, U.S. Department of Health and Human Services, the U.S. Comptroller General, and their representatives, this Agreement and all books, documents, and records necessary to certify the nature and extent of the costs of those services. If PHYSICIAN carries out the duties of this Agreement through a subcontract worth $10,000 or more over a twelve (12) month period with a related organization, the subcontract will also contain an access clause to permit access by the Secretary, Comptroller General, and their representatives to the related organization's books and records. This paragraph shall be in effect only to the extent required by law.

23. Time. Time is expressly declared to be of the essence of this Agreement.

24. Public Document; No Confidentiality. The parties agree and acknowledge hereby that

upon full execution of this Agreement and the filing hereof in the official records and files of the DISTRICT, this Agreement becomes a public document pursuant to the California Public Records Act.



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25. Final Authority. The DISTRICT shall have final authority over all hospital matters,

controls, functions, employment of personnel not employed by PHYSICIAN, and administration. Any interpretation of these matters shall be determined within the sole and absolute discretion of the DISTRICT. It is expressly acknowledged and agreed to by and between the parties that this provision shall in no way be construed as a usurpation, interference, or exercise of any control whatsoever of the right, duty, and obligation of PHYSICIAN to render independent medical opinions and care as provided for herein.

26. Counterparts. Facsimile signature pages shall be deemed original signature pages and

shall be admissible as the same in a court or other tribunal as though such were originals. This Agreement may be executed in one or more counterparts, each of which shall be deemed an original but all of which shall constitute one and the same instrument. All of such counterpart signature pages shall read as though one, and they shall have the same force and effect as though all the signers had signed a single signature page.

* * * End of Text***

IN WITNESS WHEREOF, this Agreement is executed as of the day and year first above written. SOUTHERN MONO HEALTHCARE DISTRICT BY: ____________________________________ Tom Parker, Chief Executive Officer ____________________________________ Lucienne Bouvier, M.D., Inc.


8/28/2020

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EXHIBIT A

DESCRIPTION OF DUTIES

PHYSICIAN duties/expectations are:

1. Provide clinical services for Mammoth Hospital and Mammoth Hospital Women’s Clinic. It is

assumed that PHYSICIAN will work in the Women’s Clinic 10 clinic days (exception for holiday

weeks) per month.

2. Shared hospital obstetrics on-call services are required, shared by 2 physicians. If the second

OB/GYN ceases to provide on-call services, the DISTRICT shall seek a replacement OB/GYN

as soon as possible and, during the interim period, contract a locum tenens physician(s) to

share on-call services with PHYSICIAN.

3. Women’s Clinic is opened Monday – Friday, except during recognized holidays.

4. Clinic hours for patient appointments can range from 8am – 6pm.

a. Specific hours worked by each provider can vary - coordinate with Clinic Manager to

ensure appropriate staffing is available.

5. Physician agrees to work with the other OB/GYN physician to ensure 1 OB provider provide

patient care during every regularly scheduled clinic day. If the other OB/GYN physician

ceases to provide clinical services at Mammoth Hospital Women’s Clinic, the DISTRICT shall

seek a replacement OB/GYN as soon as possible and, during the interim period, contract (at

the DISTRICT’s expense) a locum tenens physician(s) to share clinical duties with

PHYSICIAN.

6. With two OB physicians it is expected that the OB/GYN physicians will coordinate their

vacation and days off to maintain the normal clinic and hospital on-call coverage. Locums

will not be supplied by the hospital unless one physician is on an extended leave (ie., for 30

or more days) and requests a locum to maintain the needed coverage.

7. PHYSICIAN shall collaborate with the other OB/GYN physician to provide a hospital on-call

and clinic schedule to the Clinic Manager ninety (90) days in advance

8. PHYSICIAN shall participate in regular Women’s Clinic provider meetings (usually once a

month) to maintain good team communication on patient care, participate in the

development of departmental policy and procedure, development of EMR protocols,

focus on operational improvement, solve problems in services delivery, provide in-service

training for staff development, and develop consensus on methods of patient care, patient

education, and group practice.


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EXHIBIT B

COMPENSATION

1. Base Clinic Pay – PHYSICIAN will be compensated at fifteen thousand nine hundred fifteen

dollars ($15,915.00) each month. It is assumed that PHYSICIAN will work in the Women’s clinic approximately 10 clinic days (exceptions for holiday weeks) per month. It is encouraged that the two OB/GYN physicians come to agreement on coverage which equates to 50% throughout the year. If PHYSICIAN is unable to cover her agreed upon 50% coverage and the DISTRICT has to obtain locum coverage this monthly base pay will be prorated to the days worked.

2. Hospital On-Call Pay – PHYSICIAN will be compensated one thousand one hundred dollars

($1,100.00) for each 24-hour hospital on-call shift (if less than a 24-hour shift is worked the daily rate will be prorated).

3. Work Relative Value Unit (wRVU) Production Pay:

a. Clinic and hospital: Work Relative Value Unit (wRVU) Production Pay – PHYSICIAN

will be paid a rate of sixty-three dollars and 67 cents ($63.67) for every wRVU generated in excess of 250 per month.

The wRVU’s are subject to change each January 1st as regulated by the Centers for Medicare &

Medicaid ("CMS") and compensation for procedures that are coded with certain defined

modifiers, as is set forth on the list of modifiers and applicable adjustments (EXHIBIT C).

Pursuant thereto, the DISTRICT will modify the wRVU’s by the CMS adjustment as set forth on

the EXHIBIT C.

Actual amounts collected by the DISTRICT shall remain the property of the DISTRICT as provided

for in Section 5 of the Agreement.

4. Administrative Burden Pay – It is recognized that OB/GYN physicians are burdened with

administrative work associated with patient care. Each month the DISTRICT will pay one thousand six hundred dollars ($1,600.00) to PHYSICIAN. This covers administrative activities including meeting attendance at Maternal Child Health Committee of the medical staff, attendance at clinic staff meetings, attendance at other meetings as needed and participation in Community Birthing Classes.

5. Professional Liability Insurance Coverage Reimbursement – As of the start date it is

expected that the PHYSICIAN will be insured under the current DISTRICT policy with BETA Healthcare Group (BETA) with the DISTRICT paying all premiums related thereto, in accordance with Section 6b. of the Agreement.


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6. Forgivable Recruitment Loan – The DISTRICT shall pay $30,000 to PHYSICIAN to use for

relocation expenses, transitional housing and any other purposes PHYSICIAN deems necessary for establishing a residence in the Mammoth Lakes area to enable PHYSICIAN. Promissory Note is attached as Exhibit D.

7. Medical Staff Dues Deduction - The Medical Executive Committee of the Mammoth Hospital

Medical Staff have directed the DISTRICT to annually deduct medical staff dues from the above compensation the first month of each calendar year (or the first available month when PHYSICIAN has compensation pursuant to this Agreement)

8. Chart Delinquency Fines by Medical Staff - Fines for delinquent charting will be assessed

in accordance with the Medical Staff Fine Policy for Chart Delinquencies. The Medical Executive Committee has directed the DISTRICT to deduct any such fines from your compensation resulting from this Agreement

Timing of payments above (disbursements are processed every Thursday and checks/ACH payments distributed on Friday):

1) Payment for items 1, 2, and 4 above will be paid in arrears following month of services (will be paid not later than the 10th day following month of service).

2) Payment for item 3 above will be paid in arrears the following month of services provided (usually the 3rd week of the month following month of service).

3) Payment for item 6 above will be paid within 30 days of PHYSICIAN coverage commencement.


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Modifiers and Definitions

CMS %

Reimbursement

Adjustments

modifier = 22 = more complicated, complex, technically difficult, or needing significantly

more time than usual 50% increase

modifier = 50 = Bilateral Procedure 50% increase

Modifier 51 = Multiple Procedures 50% reduction

Modifier 52 = Reduced Services 30% reduction

Modifier 54 = Surgical Care Only 21% reduction

Modifier 55 = Post Operative Management Only 79% reduction

modifier = 56 = Preoperative Management Only 90% reduction

modifier = 62 = Two Surgeons 40% reduction

modifier=63 = Procedure performed on infants less than 4 kgs 50% increase

Modifier 80 = Assistant Surgeon 80% reduction

modifier=81 = Minimum Assistant Surgeon 80% reduction

modifier=82 = Assistant Surgeon (when qualified resident surgeon not available) 80% reduction

modifier = AS = non-MD surgical assist 85% reduction

Mammoth Hospital

Modifier Charge Adjustment for Physician Compensation

Effective 9-1-10 (updated 11-30-18)

EXHIBIT C


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Exhibit D

PROMISSORY NOTE (Forgivable Loan)

For value received, the undersigned, Lucienne Bouvier, M.D., hereinafter called Physician,

hereby promises to pay to Southern Mono Healthcare District, a Local Health Care District organized and

existing under the laws of the state of California and more specifically the Local Health Care District

Law, Health and Safety Code 32000 et seq, with its principal office located at 85 Sierra Park Road,

Mammoth Lakes, CA 93546, referred to herein as District, or pay to the order, at PO Box 660, Mammoth

Lakes, CA 93546, or such other place as District may designate in writing from time to time, in lawful

money of the United States of America, without demand, deduction, setoff or counterclaim, the principal

sum of thirty thousand dollars ($30,000). This Promissory Note shall bear no interest, except as provided

in Paragraph 4 below.

1. Payments.

All outstanding principal and accrued interest under this Promissory Note shall be due and

payable on the Due Date (as defined below); provided, however, that so long as Physician continues to

meet the Physician Services Agreement with the District, Physician’s obligation to pay principal and

interest under this Promissory Note shall be forgiven as follows: (i) principal in the amount of seven

thousand five hundred dollars ($7,500) shall be forgiven on December 31, 2021; (ii) principal in the

amount of fifteen thousand dollars ($15,000) shall be forgiven on December 31, 2022; and (iii) principal

in the amount of thirty thousand dollars ($30,000) shall be forgiven on December 31, 2023.

2. Due Date.

The Due Date shall be the earlier of (i) the date of termination or cessation of the Physician

Services Agreement by District, involuntarily for cause, or (ii) December 31, 2023. The loan will be

forgiven in full if the Physician Services Agreement is not terminated prior to the end of the three-year

term by District other than for cause or (iii) by District as a result of death or permanent disability of

Physician.

3. Purpose of Loan.

Physician acknowledges and agrees that District is making this loan to Physician for the express

purpose of recruiting Physician to the area of District’s hospital facility located in Mono County,

California. Physician represents and warrants to District that Physician will use all proceeds of this

Promissory Note for purposes of relocating, temporary housing or any other purposes Physician deems

necessary for establishing a residence in the Mammoth Lakes, California area.

4. Default.

In the event that Physician fails to timely pay any amount or perform any other obligation of

Physician under this Promissory Note, District may, at its option, declare the entire principal sum under

this Promissory Note immediately due and payable. In the event that District exercises this option, or the

principal balance of this Promissory Note otherwise becomes due and payable, all principal then

outstanding under this Promissory Note shall thereafter bear simple interest at the lesser of three and a

half percent (3.5%) per annum or the maximum rate permitted by law. Failure to exercise this option

shall not constitute a waiver of District’s right to exercise the same with respect to any prior or subsequent

defaults.


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5. Attorneys’ Fees.

In the event any legal action or proceeding is required to enforce or interpret any provision of this

Promissory Note, Physician shall pay to District upon demand all costs of collection and reasonable

attorneys’ fees incurred by District in connection therewith.

6. Miscellaneous.

The makers, signers, drawers, guarantors, sureties and endorsers hereof severally waive

presentation for payment, demand, protest, diligence in collecting, notice of dishonor, notice of extension

of time, and notice of protest or nonpayment. The provisions of this Promissory Note shall be governed

by California law.

IN WITNESS WHEREOF, District has executed this Promissory Note as of the 28th day of

August 2020.

____________________________________

Lucienne Bouvier, M.D.

____________________________________

Tom Parker, CEO

Mammoth Hospital


8/28/2020

1

AGREEMENT FOR PROVISION OF PHYSICIAN SERVICES

THIS AGREEMENT is made this 2nd day of September 2020, by and between SOUTHERN

MONO HEALTHCARE DISTRICT ("DISTRICT"), and MICHELLE NEWKIRK, D.O. (hereinafter referred to as "PHYSICIAN"), at the Town of Mammoth Lakes, County of Mono, State of California.

Recitals

A. The DISTRICT is a Local Health Care District duly organized and existing under the

laws of the State of California and more specifically the Local Health Care District Law, Health and Safety Code §§32000, et seq.

B. The DISTRICT owns and operates Mammoth Hospital to provide acute care, full service

medical services to the community in which it serves.

C. PHYSICIAN is an independent practicing physician duly licensed by the State of

California and Board Certified in the practice area of rheumatology.

D. The DISTRICT has determined that the making and entering into of this Agreement for

the providing of physician services in the area of rheumatology is necessary for the provision of adequate health care services to the communities served by the DISTRICT.

E. It is further determined by the board of directors of the DISTRICT that this Agreement

allows the board of directors to ensure that fees and charges for these physician services rendered at Mammoth Hospital are reasonable, fair, and consistent with the basic commitment of the DISTRICT to provide adequate health care to all residents within the boundaries of the DISTRICT and visitors to the area.

Agreement

NOW, THEREFORE, IN CONSIDERATION OF THE MUTUAL COVENANTS AND CONDITIONS CONTAINED HEREIN, THE PARTIES AGREE AS FOLLOWS:

1. Term of Agreement. The DISTRICT hereby retains the services of PHYSICIAN for a term commencing on June 1, 2021 and terminating on December 31, 2021 (stub year). This commencement date is predicated on PHYSICIAN obtaining her California medical license by December 31, 2020 (the commencement date will be proportionately delayed if licensed obtained after). This Agreement shall be renewed automatically for succeeding terms of one (1) year each, unless either party gives written notice to the other at least ninety (90) days prior to the expiration of any term hereof of an intention not to renew this Agreement. The total term of this Agreement shall not exceed three (3) years.

Notwithstanding the foregoing, either party may terminate this Agreement prior to the expiration of any term hereof based on a finding of good cause. Good cause shall be limited to a default by either party herein. In the event either party elects to terminate this Agreement prior to the expiration of any term hereof based on cause or default, such party shall provide written notice to the other, setting forth in sufficient detail, the nature, extent, and scope of the default. Thereafter, the alleged defaulting party shall have thirty (30) days to remedy, cure, or otherwise correct the default. Should the alleged defaulting party not so remedy or otherwise cure the default within the thirty (30) daytime period, the nondefaulting party may immediately terminate this Agreement

DocuSign Envelope ID: 2590B3D3-3A52-4A0A-8FA1-661B4201AF7A

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The DISTRICT may elect to immediately terminate this Agreement without first

complying with the foregoing provisions regarding good cause and notice of default in the event of:

(1) suspension, revocation, or expiration (without renewal thereof) of PHYSICIAN's license to practice

medicine in the State of California; (2) suspension, revocation, or other termination of medical staff

privileges of PHYSICIAN at Mammoth Hospital; (3) PHYSICIAN is convicted of a felony (4) any

event of default which cannot be cured within the time periods set forth herein; (5) the reputation of

PHYSICIAN or DISTRICT is adversely affected by some intentional act of PHYSICIAN or (6) an

emergent situation requiring termination as determined by the DISTRICT in order to protect against

or avoid adverse impacts to patients, staff, DISTRICT personnel or facilities, or the health, safety

and welfare of the residents and communities served by the DISTRICT.

The DISTRICT has the express right to take action under its Bylaws and the Medical

Staff Bylaws to ensure patient safety; in the event Medical Staff fails to take appropriate action

against any physician who provides substandard care or who engages in professional misconduct

which within the reasonable and lawful discretion of the DISTRICT is jeopardizing public safety, this

Agreement may be terminated by the DISTRICT and the physician may be removed from the

Medical Staff pursuant to the Medical Staff Bylaws.

2. Description of Duties. PHYSICIAN shall personally render the services to Mammoth

Hospital during the term of this Agreement. PHYSICIAN shall obtain the approval of the Chief

Executive Officer ("CEO") or hospital administrator before retaining the services of additional

physician personnel to perform identical services as PHYSICIAN and while PHYSICIAN is

performing such services. This provision shall not apply to substitute temporary staffing, including

locum tenens. See Exhibit A for details of duties and expectations.

1) It is expressly acknowledged by PHYSICIAN that Mammoth Hospital serves

a resort and tourist-based community. In connection therewith, PHYSICIAN's personal attendance

for staffing needs will be required during holiday and other high-volume periods. In order to minimize

the excess costs associated with substitute physician staffing, including locum tenens, PHYSICIAN

shall not take time off or vacations during such peak or holiday periods without first obtaining the

written approval of the CEO or hospital administrator. Vacations and extended periods of time off

(i.e., more than two consecutive days), shall be scheduled by PHYSICIAN to occur during non-peak

and non-holiday periods.

2) All physician services provided herein by PHYSICIAN shall be rendered by

PHYSICIAN in the exercise of the utmost degree of skill and care and within the sole and absolute

discretion and control of PHYSICIAN exercising independent professional judgment. The DISTRICT

shall not direct PHYSICIAN in the rendering of physician services hereby, and PHYSICIAN shall

not be considered an agent of DISTRICT.

3) PHYSICIAN shall be a permanent or temporary member of the medical staff

of Mammoth Hospital and shall be in good standing.

4) Performance by PHYSICIAN of his obligations pursuant to this Agreement shall be in compliance with all federal, state, and local laws, rules, regulations, and ordinances, and in full compliance of any such applicable rules and regulations of any governmental or accrediting agency or authorities relating to the licensure and regulations of physicians, medical practitioners, and acute care hospitals.

5) PHYSICIAN shall comply with all rules and regulations established at Mammoth Hospital, including without limitation, the Medical Staff Bylaws and the Bylaws of the Southern Mono Healthcare District, and as all may be amended from time to time.


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6) All services rendered by PHYSICIAN hereunder shall be in accordance with the standards, rules, regulations, and recommendations of the DISTRICT's current and any future accrediting agencies (e.g., DNV, the Joint Commission, and State of California, regardless of whether Mammoth Hospital is so accredited) and of the Medicare Conditions of Participation.

7) PHYSICIAN shall comply with and maintain professional and ethical standards

of conduct with respect to the issue of patient confidentiality. PHYSICIAN shall not use or disclose any protected health information or individually identifiable health information (as defined in the Health Insurance Portability and Accountability Act ("HIPM"; 45 CFR Part 164), the Confidentiality of Medical Information Act (:"CMIA", Civil Code §§56.05, et seq.), or Health.& Safety .Code §1280.15) (collectively, "Protected Health Information" or "PHI") concerning any patient of Mammoth Hospital or its affiliated clinics and facilities (whether or not PHYSICIAN renders services to such patient) other than as expressly permitted by this Agreement and the requirements of State and Federal privacy regulations and security standards. PHYSICIAN further agrees to comply with all policies, procedures and directives of the DISTRICT regarding the use and disclosure of Protected Health Information.

8) PHYSICIAN shall diligently and timely maintain, update, make entries in or to,

and file all necessary medical records and billings and charges. Such items include, without limitation, charts, charge slips, billing codes, physician charge codes, transcriptions, assignments of billings and charges, and orders. For the purposes of this provision, "diligently and timely" mean and refer to completing all tasks, including electronic health record task lists, within 48 hours of the time of the event, treatment, service, or transaction. PHYSICIAN shall use the EMR systems in connection with PHYSICIAN's obligations in this sub-paragraph.

3. Effect of Consideration. No consideration being afforded PHYSICIAN by the DISTRICT pursuant to this Agreement is being made for the referral of patients to Mammoth Hospital. This Agreement in no way restricts PHYSICIAN from establishing staff privileges at, referring patients to, or generating business from another entity. PHYSICIAN retains sole and absolute professional discretion regarding PHYSICIAN's patient matters and referral practices.

No consideration being afforded PHYSICIAN by the DISTRICT pursuant to this Agreement is for any bonus, retention incentives, or otherwise. All such consideration being afforded PHYSICIAN by the DISTRICT pursuant to this Agreement is as expressly set forth in this Agreement.

Notwithstanding coverage and staffing obligations of PHYSICIAN as provided for in this Agreement, PHYSICIAN expressly acknowledges and agrees that the DISTRICT has not made, nor does this Agreement provide for, any of the following for the benefit of PHYSICIAN: (i) income guarantees, (ii) promises, representations, or guarantees of patient volumes or business volumes, (iii) exclusivity of medical services provided, (iv) minimum or guaranteed hours or days of coverage or office hours. The DISTRICT retains sole and absolute discretion regarding its business decisions and operations, including facilities and clinics staffed by PHYSICIAN as provided for in this Agreement. This discretion includes, without limitation, hours of operation, staffing, location, and whether to cease or suspend operations. Coverage obligations of PHYSICIAN are subject to and limited by the matters set forth in this paragraph. PHYSICIAN shall have no claims against the DISTRICT, including its agents, representatives, officers, directors, and affiliates, for any damages, loss of income, or otherwise resulting from decisions or actions by the DISTRICT as provided for in this paragraph.

4. Professional Fees to PHYSICIAN. The DISTRICT shall pay to PHYSICIAN as and for professional services being rendered by PHYSICIAN

pursuant to this Agreement as specified in Exhibit B. PHYSICIAN and DISTRICT have reviewed the

compensation to be paid under this Agreement as outlined in Exhibit B to confirm it is consistent with fair

market value and does not violate of the federal Anti-kickback statute or Stark Act.


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5. PHYSICIAN Billings for Patient Services and Care. The DISTRICT shall bill for all patient

services and care rendered by PHYSICIAN and any substitute physicians, including locum tenens,

pursuant to this Agreement. All such physician fees and billings shall remain the property of the

DISTRICT. It is expressly acknowledged and agreed to by and between the parties that the DISTRICT

will not be realizing a profit in connection with the services being rendered by PHYSICIAN hereby. All

fees and rates for all services rendered and charges shall be set by the DISTRICT and shall be

reasonable, fair, and consistent with the basic commitment of the DISTRICT to provide adequate health

care to all residents and visitors within the boundaries of the DISTRICT.

6. Professional Liability (Malpractice) Insurance. PHYSICIAN has two options for Professional Liability Insurance: a) Obtain own professional liability coverage as outlined below or b) request that the DISTRICT add PHYSICIAN to the DISTRICT professional liability policy (see EXHIBIT B for option selected).

a) PHYSICIAN shall maintain professional liability/medical malpractice insurance, which the

DISTRICT approves in advance, and which approval shall not be unreasonably withheld. The DISTRICT shall be a named or additionally named insured under all such policies. All coverages shall include a statement to the effect that "coverage afforded under this Policy will act as primary insurance to that of the certificate holder and additional insured. PHYSICIAN shall provide to the DISTRICT upon reasonable request therefor a certificate or other proof that such insurance is in full force and effect. The limits of any liability policy shall be not less than $1,000,000 per occurrence. Insurance shall be maintained with an admitted carrier licensed by the State of California Department of Insurance with a Best rating of not less than A minus, and coverage shall be in conformance with the Medical Staff Bylaws (and as the same may be amended from time to time). PHYSICIAN shall immediately notify the DISTRICT of any change or cancellation of any insurance policy in effect pursuant to this Agreement. In the event of any notice of cancellation given to PHYSICIAN, PHYSICIAN shall reinstate all such insurance within thirty (30) days of such notice.

b) As of the date of this Agreement, PHYSICIAN has been able to be insured under the current DISTRICT policy with BETA Healthcare Group (BETA) with the DISTRICT paying all premiums related thereto. The DISTRICT shall continue to maintain professional liability/medical malpractice insurance for PHYSICIAN as provided for herein through the current policy of the DISTRICT provided by BETA. In the event such coverage through BETA is no longer available or the DISTRICT procures other coverage for the DISTRICT where the physicians cannot be included as determined by the DISTRICT, within its sole and absolute discretion, the parties shall meet and confer and modify this Agreement accordingly in order to ensure that PHYSICIAN can reasonably meet the obligation to have such insurance in place during the then remaining term of this Agreement.

7. Records. All books, records, patient medical records, and other documents pertaining

to or relating to the care and treatment of patients at Mammoth Hospital and the services rendered by PHYSICIAN pursuant to this Agreement shall be and remain the property of the District. Upon termination, PHYSICIAN shall make entries in or to, and file as necessary medical records and billings and charges in accordance with subsection 8 of section 2 of this Agreement, and shall return any and all such property in PHYSICIAN’s possession to District by the date of termination.

8. Warranties of PHYSICIAN. In addition to all other warranties or representations made

by PHYSICIAN in connection with the making and entering into of this Agreement, whether oral or written, PHYSICIAN hereby represents and warrants to the DISTRICT the following:

1) PHYSICIAN is a duly licensed physician in good standing in the State of California. PHYSICIAN is registered with the DEA to prescribe controlled substances without restriction


5

or limitation. Neither PHYSICIAN's medical license nor PHYSICIAN's DEA registration has ever been suspended, revoked, restricted, limited, or terminated. PHYSICIAN has never been the subject of any type of disciplinary or corrective action taken by any medical licensing or certification authority, or any reprimand monetary fine or penalty relating to the rendering of medical services by PHYSICIAN. There exists no actual, pending, or threatened disciplinary proceedings against PHYSICIAN that could result in the suspension or revocation of PHYSICIAN's license to practice medicine in the State of California.

2) PHYSICIAN is under no obligation, restriction or limitation, contractual or

otherwise, to any other individual or entity that would prohibit or impede PHYSICIAN from undertaking and performing the duties, responsibilities, and obligations of PHYSICIAN pursuant to this Agreement. The terms and provisions of this Agreement do not affect or violate any agreement or obligation of PHYSICIAN with respect to the ability of PHYSICIAN to practice medicine.

3) PHYSICIAN is an independent physician, i.e., not an employee of the DISTRICT.

4) PHYSICIAN has never been removed for cause from any provider panel of any managed care organization, indemnity insurer or other third-party payer, or independent practice association, PHYSICIAN organization, PHYSICIAN-hospital organization, or other provider network.

5) PHYSICIAN has disclosed to DISTRICT of any potential or pending malpractice

or other patient-related litigation, nor have any such claims been threatened, including any proceedings against PHYSICIAN before any professional licensing board.

6) To PHYSICIAN's best knowledge, he/she is not a party to any pending

investigation or proceeding the basis of which implicates his/her professional competence or that could lead to a suspension, revocation, restriction, limitation or termination of his/her medical license or medical staff privileges at any hospital. PHYSICIAN has not been involved in a violation of the Stark Law or the Anti-Kickback Statute.

PHYSICIAN shall immediately notify the DISTRICT in the event any of the foregoing representations are or become untrue for any reason. PHYSICIAN’s failure to immediately notify the DISTRICT in this event shall amount to a material breach of this Agreement for which the DISTRICT may immediately terminate this Agreement.

9. Effect of Relationship. This Agreement is not intended to nor shall it create any relationship of partnership, joint venture, employer/employee, master/servant, employment, agency or otherwise. PHYSICIAN is not receiving from the DISTRICT any monetary compensation in the nature of income guarantees, subsidies, referral fees, or otherwise. All compensation provided for herein is for services rendered for professional services of PHYSICIAN as has been expressly set forth herein. PHYSICIAN is at all times acting and performing under this Agreement as an independent contractor and as a medical practitioner and licensed physician in the State of California, with PHYSICIAN specializing in the area of medicine delineated herein. It is the intention of the DISTRICT to obtain the services of PHYSICIAN to ensure that the specialty services of PHYSICIAN are available to carry out health care services for the benefit of the communities served by the DISTRICT and that such services be performed in a competent, professional, appropriate, and efficient manner as set forth in this Agreement.

The DISTRICT shall not direct or supervise the manner in which services are rendered by PHYSICIAN. PHYSICIAN shall render services pursuant to this Agreement within the sole, reasonable, and independent professional discretion of PHYSICIAN.

Unless otherwise required, PHYSICIAN shall have all compensation paid pursuant to

this Agreement subject to Form 1099 reporting. PHYSICIAN shall be fully responsible for the payment of all income taxes and the payment of all appropriate withholding of any and all payroll taxes and deductions for PHYSICIAN. In connection herewith, PHYSICIAN shall have no claims under this


6

Agreement or otherwise, against the DISTRICT for vacation pay, sick leave or other paid leave, pension or retirement benefits, social security or FICA, worker's compensation, disability, unemployment insurance benefits, or any other benefits afforded to full-time benefitted employees at Mammoth Hospital.

10. Survival of Warranties and Representations. All warranties and representations of PHYSICIAN shall survive both the date of this Agreement and any eventual termination of this Agreement.

11. Working Space. The DISTRICT shall provide PHYSICIAN with sufficient working space,

staffing of personnel (including support and clerical staff), and hospital facilities while PHYSICIAN is performing services at Mammoth Hospital, with the intent to enable PHYSICIAN to perform and render services as provided for herein.

12. No Assignment by PHYSICIAN. Due to the uniqueness of services being rendered by PHYSICIAN to the DISTRICT and the specific professional skill, competence, and experience of PHYSICIAN, PHYSICIAN shall not assign, sublet, delegate, or otherwise convey PHYSICIAN's rights and obligations pursuant to this Agreement. Any attempt to so assign by PHYSICIAN shall be deemed null and void and shall entitle the DISTRICT to immediately terminate this Agreement without first having to comply with any notice of default provisions (including those provided for in paragraph 1 above), termination provisions of any DISTRICT Bylaws or Medical Staff Bylaws, or otherwise. In the event PHYSICIAN forms or becomes part of a medical or other professional corporation, partnership, limited liability company, limited liability partnership, or other such entity, PHYSICIAN shall unconditionally guaranty any and all obligations, promises, covenants, and warranties of any such entity as provided for in this Agreement. Any and all liability of PHYSICIAN hereunder shall be joint and several with that of any such entity. In such event, PHYSICIAN shall notify the DISTRICT within thirty (30) days.

13. Remedies. Any and all remedies provided by this Agreement, operation of law, or

otherwise, shall be deemed to be cumulative, and the choice or implementation of any particular remedy shall not be deemed to be an election of remedies to the mutual exclusion of any other remedy provided for herein, by operation of law, or otherwise. Enforcement of any provision of this Agreement shall be by proceedings at law or in equity against any persons or entities violating or attempting to violate any promise, covenant, or condition contained herein, either to restrain violation, compel action, or to recover damages.

14. Attorney's Fees. In the event any action at law or in equity is initiated to enforce or interpret the terms of this Agreement, or arises out of or pertains to this Agreement, the prevailing party shall be entitled to reasonable attorney's fees, costs, and necessary disbursements in addition to any other relief to which that party may be entitled.

15. Notices. Any notices to be given by either party to the other shall be in writing and shall be transmitted either by (1) personal delivery, (2) mail, registered or certified, postage prepaid with return receipt requested, (3) by an overnight delivery service (e.g., Federal Express), or (4) by facsimile or email service with a confirmation copy by regular mail, first class postage prepaid. Personal delivery or mailed notices shall be addressed to the parties at the addresses listed below. Notices shall be transmitted via the contact information listed below. Each party may change that address and facsimile telephone number by giving written notice in accordance with this paragraph. In the event of any mailing, notice shall be deemed given on the 3rd day after deposit. The addresses and facsimile telephone numbers of the parties are as follows:

SOUTHERN MONO HEALTH CARE DISTRICT Attn: Chief Executive Officer P.O. Box 660 Mammoth Lakes, CA 93546 Facsimile Telephone No.: (760) 924-4104 Email: [email protected]



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MICHELLE NEWKIRK, D.O. 12225 Olivetta Court Las Vegas, NV 89138 Email: [email protected] Cell Phone: 503-334-6258

16. Integration. It is intended by the parties that this Agreement be the final expression of the intentions and agreements of the parties. This Agreement supersedes any and all prior or contemporaneous agreements, either oral or in writing, between the parties hereto and contains all of the covenants and agreements between the parties. No other agreements, representations, inducements, or promises, not contained in this Agreement shall be valid or binding. Any modification of this Agreement shall be effective only if it is in writing and signed by both parties.

17. Binding Effect. This Agreement shall be binding upon and inure to the benefit of the

heirs, executors, administrators, personal representatives, successors, and assigns of each of the parties hereto.

18. Severance. In the event any term or provision of this Agreement is deemed to be in

violation of law, null and void, or otherwise of no force or effect, the remaining terms and provisions of this Agreement shall remain in full force and effect.

19. Governing Law. Venue. This Agreement shall be interpreted under the laws of the State

of California. Exclusive venue for any legal action shall be Mono County, California.

20. Effect of Waiver. No waiver of any breach of any term, covenant, agreement, restriction,

or condition of this Agreement shall be construed as a waiver of any succeeding breach of the same or any other covenant, agreement, term, restriction, or condition of this Agreement. The consent or approval of either party to or of any action or matter requiring consent or approval shall not be deemed to waive or render unnecessary any consent to or approval of any subsequent or similar act or matter.

21. Joint Preparation. This Agreement shall be deemed to be jointly prepared by all parties hereto. In connection therewith, the provisions of Civil Code §1654 shall not be deemed applicable in the event of any interpretation of this Agreement.

22. Access to Records Clause. If this Agreement is for the provision of services with a value of $10,000 or more over a twelve (12) month period, then until the expiration of four (4) years after the furnishing of the services provided under this Agreement, PHYSICIAN will make available to the Secretary, U.S. Department of Health and Human Services, the U.S. Comptroller General, and their representatives, this Agreement and all books, documents, and records necessary to certify the nature and extent of the costs of those services. If PHYSICIAN carries out the duties of this Agreement through a subcontract worth $10,000 or more over a twelve (12) month period with a related organization, the subcontract will also contain an access clause to permit access by the Secretary, Comptroller General, and their representatives to the related organization's books and records. This paragraph shall be in effect only to the extent required by law.

23. Time. Time is expressly declared to be of the essence of this Agreement.

24. Public Document; No Confidentiality. The parties agree and acknowledge hereby that

upon full execution of this Agreement and the filing hereof in the official records and files of the DISTRICT, this Agreement becomes a public document pursuant to the California Public Records Act.



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25. Final Authority. The DISTRICT shall have final authority over all hospital matters, controls, functions, employment of personnel not employed by PHYSICIAN, and administration. Any interpretation of these matters shall be determined within the sole and absolute discretion of the DISTRICT. It is expressly acknowledged and agreed to by and between the parties that this provision shall in no way be construed as a usurpation, interference, or exercise of any control whatsoever of the right, duty, and obligation of PHYSICIAN to render independent medical opinions and care as provided for herein.

26. Counterparts. Facsimile signature pages shall be deemed original signature pages and

shall be admissible as the same in a court or other tribunal as though such were originals. This Agreement may be executed in one or more counterparts, each of which shall be deemed an original but all of which shall constitute one and the same instrument. All of such counterpart signature pages shall read as though one, and they shall have the same force and effect as though all the signers had signed a single signature page.

* * * End of Text***

IN WITNESS WHEREOF, this Agreement is executed as of the day and year first above written. SOUTHERN MONO HEALTHCARE DISTRICT BY: ____________________________________ Tom Parker, Chief Executive Officer ____________________________________ Michelle Newkirk, D.O.


9/7/2020

9/10/2020

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EXHIBIT A

DESCRIPTION OF DUTIES

PHYSICIAN duties are:

1. Provide clinical services for the Mammoth Hospital Specialty Clinic

2. No hospital on-call services are required

3. Part-time medical provider services – maintain regularly scheduled office hours at the

Clinic, with the schedule to be not less than two (2) full workdays per month during each

term year – tentatively set for Friday and Saturday

4. Clinic will be scheduled during the 2nd full week of the month (week that has the 2nd

Monday)

5. PHYSICIAN is required to use the Mammoth Hospital electronic medical record (EMR)

for all patient charting, review of test results, ordering, referrals, etc… Remote access

to the EMR is available and PHYSICIAN is expected to log in as needed for appropriate

patient care issues and follow up.

6. All communications from Mammoth Hospital physicians and staff will either be made

through the EMR or a Mammoth Hospital Web based Outlook email address (which will

be provided). PHYSICIAN is expected to regularly log into these programs.

7. PHYSICIAN shall provide a schedule of requested workdays to the Clinic Manager ninety

(90) days in advance

8. PHYSICIAN acknowledges that he/she will be working in a Rural Health Clinic and due

to flat rate Medicare and Medi-Cal reimbursement per visit, resource intensive visits,

procedures, and treatments are to be avoided. PHYSICIAN should discuss specific high

cost procedures/treatments with the Clinic Manager prior to performing or committing to

perform to the patient.


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EXHIBIT B COMPENSATION

Below is the fair market (using MGMA & AMGA Rheumatology compensation survey data) compensation terms that the DISTRICT will compensate PHYSICIAN:

1. Production – PHYSICIAN will be compensated at a rate of $70.00 per wRVU generated each month (payments will be made to PHYSICIAN by the end of the following month):

The wRVU’s are subject to change each January 1st as regulated by the Centers for Medicare &

Medicaid ("CMS") for procedures that are coded with certain defined modifiers, as is set forth on

the list of modifiers and applicable adjustments (EXHIBIT C). Pursuant thereto, the DISTRICT

will modify the wRVU’s by the CMS adjustment as set forth on the EXHIBIT C.

Actual amounts collected by the DISTRICT shall remain the property of the DISTRICT as provided

for in Section 5 of the Agreement.

2. Transitional Housing – DISTRICT has an inventory of housing and shall provide housing for PHYSICIAN during the first 3 months of service. This housing will be available the day before through the day after the clinic days. Thus, typically would be Thursday check in and Sunday check out. If PHYSICIAN desires to continue to use the DISTRICT housing after the 3 months, if available, PHYSICIAN will be charged an amount for daily rent.

3. Professional Liability Insurance Coverage Reimbursement – As of the start date it is expected that the PHYSICIAN will be insured under the current DISTRICT policy with BETA Healthcare Group (BETA) with the DISTRICT paying all premiums related thereto, in accordance with Section 6b. of the Agreement.

4. Medical Staff Dues Deduction - The Medical Executive Committee of the Mammoth Hospital

Medical Staff have directed the DISTRICT to annually deduct medical staff dues from the above compensation the first month of each calendar year (or the first available month when PHYSICIAN has compensation pursuant to this Agreement)

5. Chart Delinquency Fines by Medical Staff - Fines for delinquent charting will be assessed in

accordance with the Medical Staff Fine Policy for Chart Delinquencies. The Medical Executive Committee has directed the DISTRICT to deduct any such fines from your compensation resulting from this Agreement.

Timing of payments above:

1) Payment for item 1 will be paid in arrears the following month of services provided (usually the 3rd week of the month).


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Modifiers and Definitions

CMS %

Reimbursement

Adjustments

modifier = 22 = more complicated, complex, technically difficult, or needing significantly

more time than usual 50% increase

modifier = 50 = Bilateral Procedure 50% increase

Modifier 51 = Multiple Procedures 50% reduction

Modifier 52 = Reduced Services 30% reduction

Modifier 54 = Surgical Care Only 21% reduction

Modifier 55 = Post Operative Management Only 79% reduction

modifier = 56 = Preoperative Management Only 90% reduction

modifier = 62 = Two Surgeons 40% reduction

modifier=63 = Procedure performed on infants less than 4 kgs 50% increase

Modifier 80 = Assistant Surgeon 80% reduction

modifier=81 = Minimum Assistant Surgeon 80% reduction

modifier=82 = Assistant Surgeon (when qualified resident surgeon not available) 80% reduction

modifier = AS = non-MD surgical assist 85% reduction

Mammoth Hospital

Modifier Charge Adjustment for Physician Compensation

Effective 9-1-10 (updated 11-30-18)

EXHIBIT C


Date Purchased Item Description Value Reason for Disposal Asset Tag:

N/A Shoretel Phone N/A Broken N/A

N/A Dell Monitor N/A Broken 001604

N/A Fujitsu 6110 N/A Broken 003570

N/A Dell 2330dn Printer N/A Broken 003063

N/A Optiplex 5040 N/A Broken 003999


N/A Dell Latitude e5570 N/A Broken Serial: 8R6VJC2

N/A Dell Latitude e5570 N/A Broken Serial: 94W7DC2

N/A Dell Latitude e5570 N/A Broken Serial: DQZ8KC2

N/A Dell Optiplex 7010 N/A Broken Serial: D0BT9Y1

N/A Dell Optiplex 7020 N/A Broken Serial: 79MMB42

N/A Dell Optiplex 7020 N/A Broken 003937









N/AAPC Rack Mounted Power Supply From

PTN/A Broken

Serial: SMT1500RM2U

N/A Dell Server - OpenLink Server1 N/A Broken 003421

N/A Dell Server - OpenLink Server2 N/A Broken 003422

N/A Dell Latitude E5540 N/A Broken 003824

N/A Dell Latitude XT3 N/A Broken 003695



N/A Dell Latitude E5570 N/A Broken Serial: HTSTKC2


N/A Dell Optiplex 7010 N/A Broken Serial: 79TT9Z1


N/A Dell Optiplex 320 N/A Broken Serial: GCMR23J


N/A Dell Latritude E5570 N/A Broken 004892



N/A Sony RMOS551 Tape Drive N/A Broken Serial: 520176







N/A Motorola EV2600 N/A Broken Serial: 158TDL3920

N/A Motorola EV2600 N/A Broken Serial: 158TDL3954

N/A WOW Cart Medix T19B N/A Broken Serial: 59IN03HA1528020

N/A WOW Cart Medix T19B N/A Broken 003976


The list of equipment below is either no longer functional or so obsolete as to longer be useful to our facility. Please

approve our proposal to dispose of the equipment in the most economically and environmentally responsible way. For the

computers and printers, that will mean donation to a company in Reno that remanufactures them for needy educational

institutions. Some of the equipment may need to go through a recycling program with a marginal per item cost.

September 17, 2020

Obsolete Equipment - Information Systems

southern mono healthcare district september 2020 … · 1. the hospital incident management team...

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