SOUTHERN COOS HEALTH DISTRICT Board of Directors Regular Meeting & Executive Session January 24, :00 p.m. AGENDA

Transcription

1 SOUTHERN COOS HEALTH DISTRICT Board of Directors Regular Meeting & Executive Session January 24, :00 p.m. AGENDA I. Call to Order II. III. IV. Public Input Consent Agenda A. Regular Minutes 12/20/2018 B. Special Meeting Minutes 01/10/2019 Staff/Committee Reports A. CEO Report B. CFO Report C. Medical Staff Report D. Southern Coos Health Foundation E. Performance Improvement Committee Report V. Old Business A. Consideration of CEO Agreement VI. VII. VIII. New Business Executive Session under ORS (2)(a) and (7) to consider the employment of an officer, employee, staff member or agent and ORS (2)(f) to consider information or records that are exempt from disclosure by law Open Discussion Adjournment Next Regular Meeting February 28, 2019 SCHHC 1

2 CONSENT AGENDA Minutes December 20, 2018 Regular Meeting January 10, 2019 Special Meeting 2

3 Southern Coos Health District Board of Directors Regular Meeting Minutes December 20, :00 p.m. I. Call to Order This regular meeting of the Board of Directors for Southern Coos Health District was called to order at 7:00 p.m. by Esther Williams, Board Chair. Members Present: Esther Williams, Board Chair; Tom Bedell, Secretary; Brian Vick, Treasurer; Carol Acklin, David Allen. Administration: Alan Dow, Interim CEO; Amy Fine, CFO; Rachel Beissel, CNO; Megan Holland, MD. Other staff present: Cathy Mann, Megan McCrorey, Margaret McLain, Marlene Rocha, Rachelle Stickroth. Public: Amy Moss-Strong, News Media. At this time Ms. Williams announced an addition to the agenda: An Executive Session was added to the agenda on December 19 with 24-hour notice provided to the media posted publicly as required by law. II. Public Input None. III. Consent Agenda Brian Vick moved to approve the November Minutes. Carol Acklin seconded the motion. All in favor. Unanimous decision. IV. Staff Reports A. CEO Report Alan Dow, Interim CEO, provided a summary of his CEO Report included in the Board packet. Hospital staff, volunteers and Board members enjoyed a holiday party on December 1. Appreciation was given to the Employee Activity Committee and other volunteers who worked to make it a nice evening. During the event the employee of the year awards were announced with Ed Shoemaker from Medical Imaging receiving Clinical Employee of the Year and Non-Clinical Employee of the Year was Sabrina Johnson, Marketing/Foundation. Also in December, staff received the Board-approved year-end bonus with a number of staff asking Mr. Dow to express their appreciation to the Board. Surgery Update: Dr. Raphael El Youssef, MD, has confirmed his plan to increase his surgical days at Southern Coos. Dr. Stanley Pense, MD who has been at Southern Coos since January 2016 will no longer provide care here after the end of December and hospital Administration and staff wish to thank him for his service. Patient and referring provider communication is to go out this week to help facilitate this transition. Mid- Year Rate Increase: SCHHC rates have not increased in two years. A rate increase proposal was approved by the Finance Committee this month with Board SCHD Board of Directors Meeting Minutes Page 1 of 4 December 20,

4 consideration on tonight s agenda. Marketing: Scott McEachern, CIO/Marketing/Foundation Director was unable to attend this meeting. Mr. Dow referred to the written report in the Board Packet available on the Southern Coos Website at B. CFO Report Amy Fine, CFO, presented the financial report for the month of November. Statistics include the number of inpatient days, swing bed and surgeries have outpaced the prior year, with the number of swing bed days increasing by 646.7%. We see a downward trend in Radiology and the Specialty Clinic. Carol Acklin wished to congratulate the swing bed coordinator, Deborah Ellis, for her work in building that program. Contractual adjustments were accrued in anticipation of the YTD cost report settlement due to growth in volume with costs not increasing with revenue. Days of Cash on Hand at 67.6 is lower than 2017, but trending upward from prior months. Collections, or Days in A/R, at 55.1 increased from October. Net patient revenue in November was $1.3M, after contractual adjustments of $1M, and net expenses at $1.7, resulting in a loss for the month of ($403K). The full report is available within the board packet published each month to the hospital website at C. Medical Staff Report Megan Holland, MD, presented the Medical Staff Report and privileging for approval, forwarded from the December Medical Staff meeting: Consideration For Two-Year Privileges Brett Greene, MD (EMCare) Daniel Y. Lee (Ophthalmology) Debra S. Guzman, FNP (Family Medicine) Consideration For Six-Month Provisional Privileges Richard Wakamiya, MD (EMCare) Carol Acklin moved to accept the Medical Staff Report as presented. Tom Bedell seconded the motion. All in favor. Unanimous decision. D. Southern Coos Health Foundation Report Scott McEachern, CIO/Marketing & Foundation Director was absent from the meeting. The Board reviewed the written report with no questions. E. Performance Improvement Committee Esther Williams attended as the Board member liaison for the November Performance Improvement meeting and was impressed with the reports given this month by Radiology, Pharmacy, Primary Care Clinic, Outpatient Clinic, SCHD Board of Directors Meeting Minutes Page 2 of 4 December 20,

5 Engineering and Respiratory Therapy. Of particular note was the new Medical Imaging service of providing x-ray and CT scans for dental patients, and that 360 flu shots were administered during the free community drive through flu clinic. Volume has dropped at the Outpatient/Would Care clinic; referrals are being tracked and a marketing plan is being developed. V. Old Business None. VI. New Business A. Consideration of Mid-Year Rate Increase Mr. Dow expressed concern that, though a noble effort, the hospital has not raised rates in two years. Each year the hospital has seen its costs increase due to inflation for supplies and services purchased, and for staffing costs. Additionally, the hospital has incurred increased traveler staff costs due to poor clinical staff retention related to the cost of housing in Bandon. Mr. Dow recommended a 5% mid-year increase to be effective to meet these increases. The hospital Finance Committee reviewed this proposal and approved for Mr. Dow to bring before the Board of Directors for consideration. David Allen moved to impose a 5% mid-year price increase to be effective Brian Vick seconded the motion. Discussion: This will primarily affect commercial insurance patients. Hospital rates are competitive, averaging 50 th percentile. All in favor. Unanimous Decision. VII. Executive Session Under ORS (2)(a) and (7) to consider employment of an officer, employee, staff member or agent. At 7:25 pm the Board moved to Executive Session. All staff were excused. Return Open Session at 8:28 p.m. No decision was made upon Return to Open Session. There will be a Special Meeting on Thursday, January 10, at 5:30 p.m. with an Executive Session also under ORS (2)(a) and (7) to consider employment of an officer, employee, staff member or agent. VIII. Open Discussion The Board of Directors expressed their condolences to staff and to the family of Sandra Hoskins, EVS Supervisor, who passed away this month. They also wished everyone a safe and happy holiday. SCHD Board of Directors Meeting Minutes Page 3 of 4 December 20,

6 Adjournment Ms. Williams adjourned the meeting at 8:35 p.m. The next regular meeting of the Southern Coos Health District Board of Directors will be held on Thursday, January 24 at 7:00 p.m. There will also be a Special Meeting on Thursday, January 10, at 5:30 p.m. Both will be held in the the SCHHC Main Conference Room. Esther Williams, Board Chair Tom Bedell, Secretary SCHD Board of Directors Meeting Minutes Page 4 of 4 December 20,

7 I. Call to Order Southern Coos Health District Board of Directors Special Meeting Minutes January 10, :30 p.m. This regular meeting of the Board of Directors for Southern Coos Health District was called to order at 5:30 p.m. p.m. by Esther Williams, Board Chair. Members Present: Esther Williams, Board Chair; Tom Bedell, Secretary; Brian Vick, Treasurer; Carol Acklin, David Allen. Administration: Alan Dow, Interim CEO II. Public Input None. III. Executive Session under ORS (2)(a) and ORS (7) to consider the employment of an officer, employee, staff member or agent At 5:31 p.m. the board moved to Executive Session, excusing all staff. No media was present. At 6:15 Mr. Dow was invited to return for discussion. IV. Return to Open Session At 6:35 p.m. the Board returned to Open Session. Tom Bedell made the motion that the Southern Coos Hospital and Health Center Board of Directors hire Amy Fine, current SCHHC CFO/Clinic Practice Administrator, as interim Chief Executive Officer and Alan Dow, current interim CEO, as Chief Financial Officer. Carol Acklin seconded the motion. David Allen abstained. The motion passed with 3 ayes 1 nay and 1 abstention. Discussion: The Board requested monthly reports on Primary Care Clinic finances for the remainder of this fiscal year with Administration to present a plan by June on how to proceed with losses of less than $100,000 per year. The Board then requested from Mr. Dow that he draft the new agreements for both he and Ms. Fine. V. Open Discussion None. SCHD Board of Directors Special Meeting Minutes Page 1 of 2 January 10,

8 VI. Adjournment Ms. Williams adjourned the meeting at 6:50 p.m. The next regular meeting of the Southern Coos Health District Board of Directors will be held on Thursday, January 24, at 7:00 p.m. in the SCHHC Main Conference Room. Esther Williams, Board Chair Tom Bedell, Secretary SCHD Board of Directors Special Meeting Minutes Page 2 of 2 January 10,

9 FOUNDATION REPORT 9

10 Southern Coos Health Foundation Director s Report January 2019 Year-End Campaign The year-end campaign netted just under $80,000 so far. Our goal is $115,000 to purchase an endoscopy unit. We are sending out another community letter next week and will likely surpass the $80,000 mark by the end of January. We likely will not achieve the total goal, so the Foundation and the hospital are working together to determine how to proceed. Golf for Health Classic The date of the 12 th Annual Golf for Health Classic fundraiser is June 1, Note the date change. We will kick off the event on Friday, May 31, with a small skills challenge and a sponsor reception. Saturday, June 1, will bring the golf scramble itself, with tee off at 11am. We hope to have a great turnout this year! We are inserting a flyer in the Bandon Western World and the World newspapers next week (January 28 and February 1), kicking off our promotion. 10

11 CEO REPORT 11

12 CEO REPORT January, 2019 Accolades Over the last month, we have received accolades from patients. Copies of those compliments will be shared during the meeting. Recognition Events In alignment with our strategic plan, we have incorporated recognition events accordingly. The following activities support our development of a peer recognition program focused on creating an environment that demonstrates our values. January recognitions are as follows: Clinical Employee of the Month is Kristina Campina, Emergency Room RN Non-Clinical Employee of the Month is Cathy Mann, Revenue Cycle Manager There were no AHA recognition weeks in December or January. In February we will recognize PeriAnesthesia Nurse Awareness Week February 4-10 Outpatient Clinic Move Back To Our Clinic Building The Multi-Specialty Clinic has excess capacity allowing for the return of the Outpatient Clinic Services Department. This will eventually allow for savings of $2,000 per month in rent expense along with some other anticipated savings as a result of this move. Intent to Contract with Quest for Reference Lab Purchased Services - SCHHC s lab performs many tests in house, however there are some tests that are more cost-effective to send out to a reference lab. Due to an additional $21,000 savings offered from Quest, the annual projected cost to switch to them has dropped to $139,000 which is below the $150,000 requiring a formal bid process. Not having to go through the formal bid process will allow us to proceed to make this change and still meet our Athena go-live time frame. Helicopter landing zone assessment by REACH REACH is one of two providers of air ambulance helicopter service, and at our request they came on site and did an assessment of our landing zone and in their written report to us they concurred with our Fire Chief that we should no longer have night landings here at the hospital. We had already committed to comply with the recommendation of our local Fire Chief, and based on this formal assessment conducted by REACH they have also concluded and confirmed that night helicopter transports need to be conducted from the airport location going forward. President of the Medical Staff Update After serving as the President of our Medical Staff for more than 10 years Dr. Holland said during the Medical Staff meeting held on January 8 that she was ready for someone else to serve, and announced that this would be her last meeting serving as President. Dr. Keiser will serve as acting President until elections are held to fill this position. We join the members of the Medical Staff in thanking Dr. Holland for her many years of service in this leadership role. 12

13 CEO Transition I have enjoyed working with Amy Fine and I am very pleased to handoff to her capable hands the CEO responsibility as I take on the CFO role once again here at SCCHC. I am especially pleased this change will allow me to continue to work as a member of our great team here. As departing CEO I want to take this opportunity to thank all of our staff, our providers, and our Board for the great job they do every day. I look forward to continuing to work with you. Marketing SCHHC Healthcare Events - Prostate Cancer Support Group and Prostate Cancer Wives and Partners Support Group, January 28, Seabird Chapel, 7pm. Social Media - SCHHC continues to promote our services on our Facebook page and via our website. Please be sure to visit the hospital Facebook page often and like our posts. We have developed a video promoting lab services that we will show at the board meeting. Upcoming Marketing Initiatives - Dr. Baharloo & Podiatry Services Vaccines for Children Medical Imaging Laboratory Services 13

14 CFO REPORT 14

15 Southern Coos Hospital and Health Center CFO Report December,

16 Southern Coos Hospital and Health Center for the Month Ending December 31, 2018 Utilization FY FY % Variance FY FY % Variance Actual Prior Year To Prior Year Actual Prior Year To Prior Year Hospital In Patient Days % % Swing Days % % Major Departments Emergency Visits % 2,261 2, % Radiology Procedures % 4,327 3, % Laboratory Tests 3,701 4, % 22,966 23, % Respiratory Visits % 2,744 2, % Surgeries and Endoscopies % % Pain Clinic % % Podiatry Clinic % 1,512 1, % Specialty Clinic Visits % 2,012 2, % Primary Care Clinic % 2,201 1, % Inpatient and Swing Days continue to outpace 2017 volume by 200%. Month Year To Date Year to Date most departments have increased volume significantly over We are experiencing a decrease in Lab and Radiology visits which we believe are partially due to Coats Community Health Center sending their orders to other facilities. Specialty clinic visits have also continued to decrease and we are investigating the cause. 16

17 Southern Coos Hospital and Health Center Summary Income Statement for the Month Ending December 31, 2018 Current Month Fiscal Year-To-Date Actual $ $ Budget Variance Actual Budget Variance Gross Patient Revenue $ 2,474,759 $ 2,442,265 $ 32,494 $ 15,352,157 14,160,851 1,191,306 Contractual Adjustments (705,161) (722,216) 17,055 (5,160,859) (4,643,762) (517,097) Net Patient Revenue 1,769,599 1,720,050 49,549 10,191,298 9,517, ,209 Other Operating Revenue ,324 10,760 14,564 Net Operating Revenue 1,769,884 1,720,188 49,696 10,216,622 9,527, ,772 Operating Expenses 1,863,969 1,598,982 (264,988) 10,626,841 9,530,389 (1,096,452) Operating Income (Loss) (94,085) 121,206 (215,291) (410,219) (2,540) (407,679) Non-Operating Inc./(Exp) 74,849 56,525 18, , ,903 52,718 Donations and Grants ,054 (17,039) Net Assets Increase (Decrease) $ (19,237) $ 177,731 $ (196,967) $ 10,417 $ 382,417 $ (372,000) Note: In the month of December an additional $25,000 expense was accrued for the estimated YTD Cost Report payable to Medicare. This brings the total accrual for the year to $375,

18 Patient Accounts Receivable 4,682,234 4,179,538 3,329,101 Less: Reserve for Uncollectibles (1,189,253) -25.4% (960,284) -23.0% (1,205,335) -36.2% Net Patient Accounts Receivable 3,492,982 3,219,254 2,123,766 Other Receivables 1, ,687 1,012,882 Inventory 299, , ,543 Prepaid Expense 93, , ,381 Property Tax Receivable - Current (343,878) (326,319) (317,795) Total Current Assets 7,624,043 7,796,878 7,865,095 Property Tax Receivable - Prior Years 23,589 26,944 19,514 Restricted Grant Award Plant & Equip (Net of Depreciation) 6,109,672 6,731,910 6,657,307 Southern Coos Hospital and Health Center Balance Sheet As of 12/31/2018, 12/31/2017 and 12/31/ /31/ /31/ /31/2016 Assets Cash - Operating $ 712,861 $ 542,150 $ 735,475 Investment - Unrestricted 1,151,635 1,134,213 1,613,366 Investment - Restricted 9,488 9,488 9,488 Investment - USDA Restricted 233, , ,705 Investment - Health Information System Investment - Board Designated Funds 1,972,783 1,972,783 1,923,283 Cash and Cash Equivalents 4,080,472 3,892,339 4,515,318 Total Assets $ 13,757,304 $ 14,555,731 $ 14,541,916 18

19 12/31/ /31/ /31/2016 ent Loans Payable l Leases y Loans Payable 3,220,280 3,305,248 3,386,558 AO Loan Payable 1,595,000 1,720,000 1,845,000 urrent Portion of Long Term Debt (209,969) (206,310) (202,809) l Non-Current Liabilities 4,605,311 4,818,938 5,028,749 l Liabilities 6,899,686 6,997,915 6,921,143 Southern Coos Hospital and Health Center Balance Sheet As of 12/31/2018, 12/31/2017 and 12/31/2016 and Fund Balance nts Payable $ 459,569 $ 730,452 $ 501,535 d Salaries & Employee Benefits 1,182,003 1,106,434 1,048,993 st and Other Payable 442, , ,057 t Portion of Long Term Debt 209, , ,809 l Current Liabilities 2,294,375 2,178,977 1,892,394 ed Tax/Grant Revenue alance 6,857,619 7,557,816 7,620,772 l Net Equity 6,857,619 7,557,816 7,620,772 l Liabilities and Fund Balance $ 13,757,304 $ 14,555,731 14,541,916 19

20 Total Patient Revenue 2,474,759 2,442,265 2,522,746 32,494 (47,987) 15,352,157 14,160,851 13,441,734 1,191,306 1,910,423 Less Contractual (632,358) (690,084) (766,481) 57, ,123 (4,867,340) (4,419,768) (4,052,581) (447,572) (814,760) Less Charity Care (13,852) (2,644) (3,534) (11,208) (10,318) (69,431) (27,096) (47,186) (42,335) (22,246) Less Bad Debt Expense (58,951) (29,487) (22,575) (29,464) (36,376) (224,087) (196,898) (185,451) (27,190) (38,636) Total Deductions (705,161) -28.5% (722,216) -29.6% (792,590) -31.4% 17,055 87,430 (5,160,859) -33.6% (4,643,762) -32.8% (4,285,217) -31.9% (517,097) (875,642) Net Patient Revenue 1,769,599 1,720,050 1,730,156 49,549 39,442 10,191,298 9,517,089 9,156, ,209 1,034,781 Other Operating Revenue ,324 10,760 1,632 14,564 23,692 Total Operating Revenue 1,769,884 1,720,188 1,730,176 49,696 39,708 10,216,622 9,527,849 9,158, ,772 1,058,473 Expenses Salaries and Benefits 1,073,438 1,016,690 1,050,620 (56,748) (22,818) 6,016,108 5,618,655 5,706,592 (397,453) (309,516) Professional Fees 200, , ,502 (21,623) (5,911) 1,314,346 1,181,440 1,224,746 (132,906) (89,600) Purchased Services 205, , ,015 (61,767) (70,932) 1,079, , ,482 (276,846) (212,912) Medical Supplies 149, , ,548 (26,602) (14,541) 907, , ,790 (158,204) (111,732) Supplies 31,151 21,806 33,185 (9,346) 2, , , ,370 (13,286) (4,637) Other Operating Expense 114, ,038 94,629 5,197 (20,211) 629, , ,118 19,119 (79,631) Insurance and Utilities 28,787 25,581 25,140 (3,206) (3,647) 161, , ,767 (11,095) (16,672) Depreciation 60,304 (30,589) 52,328 (90,893) (7,976) 351, , ,593 (125,781) (97,683) Total Operating Expense 1,863,969 1,598,982 1,719,966 (264,988) (144,003) 10,626,841 9,530,389 9,704,456 (1,096,452) (922,384) Operating Income (94,085) 121,206 10,210 (215,291) (104,295) (410,219) (2,540) (546,308) (407,679) 136,089 Southern Coos Hospital and Health Center Income Statement For the 6 Months Ending 12/31/2018 and 12/31/2017 Variance to Variance to Budget Prior Year $ $ Current Month Year to Date Actual Budget Prior Year Variance to Variance to Budget Prior Year Actual Budget Prior Year Revenue Inpatient $ 495,307 $ 380,941 $ 470,624 $ 114,365 $ 24,683 $ 2,857,297 $ 2,131,082 $ 1,832, ,215 1,024,890 Outpatient 1,979,452 2,061,324 2,052,122 (81,871) (72,670) 12,494,860 12,029,769 11,609, , ,533 20

21 Non-Operating Income Property Taxes 73,141 73,273 70,862 (132) 2, , , ,174 (794) 13,671 Other 14,089 6,588 6,923 7,501 7,166 80,684 46,844 52,442 33,841 28,242 Total Non-Operating Revenue 87,230 79,861 77,786 7,368 9, , , ,616 33,047 41,914 Non-Operating Expense Interest Expense 20,681 23,336 21,466 2, , , ,393 11,344 6,162 Other (8,300) 1 (0) 8,300 8,300 (8,323) ,328 8,372 Total Non-Operating Expense 12,381 23,337 21,466 10,956 9,085 98, , ,442 19,671 14,534 Excess Revenue (19,237) 177,731 66,529 (196,967) (85,766) 10, ,364 (182,134) (354,961) 192,536 Southern Coos Hospital and Health Center Income Statement For the 6 Months Ending 12/31/2018 and 12/31/2017 Current Month Year to Date Actual Budget Prior Year Variance to Variance to Budget Prior Year Actual Budget Prior Year Variance to Budget Variance to Prior Year Donations $ $ $ ,054 35,005 (17,039) (34,990) Grant Income - - 4,016 - (4,016) Increase in Net Assets $ (19,237) $ 177,731 $ 66,529 $ (196,967) $ (85,766) $ 10,417 $ 382,417 (143,113) (372,000) 153,530 21

22 December 2018 Days Cash on Hand Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Calculation: Total Unrestricted Cash on Hand Daily Operating Cash Needs Definition: This ratio quantifies the amount of cash on hand in terms of how many "days" an organization can survive with existing cash reserves. Year Average Desired Position: Upward trend, above the median Benchmark 80 Days How ratio is used: This ratio is frequently used by bankers, bondholders and analysts to gauge an organization's liquidity--and ability to meet short term obligations as they mature. Fiscal Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun

23 Days in A/R as of 12/31/ Days Jan-18 Feb-18 Mar-18 Apr-18 May-18 Jun-18 Jul-18 Aug-18 Sep-18 Oct-18 Nov-18 Dec-18 Calculation: Gross Accounts Receivable Average Daily Revenue Definition: Considered a key "liquidity ratio" that calculates how quickly accounts are being paid. Desired Position: Downward trend below the median, and below average. Benchmark 50 How ratio is used: Used to determine timing required to collect accounts. Usually, organizations below the average Days in AR are likely to have higher levels of Days Cash on Hand. Dec-17 Jan-18 Feb-18 Mar-18 Apr-18 May-18 Jun-18 Jul-18 Aug-18 Sep-18 Oct-18 Nov-18 Dec-18 A/R (Gross) 4,179,538 4,388,957 4,153,899 4,309,277 4,505,738 4,468,340 4,651,883 4,653,166 4,736,825 4,775,343 4,630,797 4,590,872 4,682,234 23

24 2016 US Favorable Indicator Median Trending Days in Accounts Receivable Down Days Cash on Hand Up Total Margin 2.74% Up Operating Margin 0.93% Up Salaries to Net Revenue 44.90% Down July August September October November December Month YTD Indicator Trend December Days in Accounts Receivable Up Days Cash on Hand Up 63.4 Total Margin 4.05% 7.68% 0.44% 7.27% % -1.04% Up 0.10% Operating Margin 0.34% 4.31% -3.60% 3.33% % -5.32% Up 4.02% Salaries to Net Revenue 45.39% 43.66% 46.35% 44.14% 55.81% 48.44% Down 46.89% CAH Financial Indicator Medians, 2016 Southern Coos Hospital Comparision 24

25 Southern Coos Health Center Payor Mix as of 12/31/2018 Medicare 58.5% Medicaid 16.4% Commercial 23.6% Private Pay 1.5% 100.0% 25

26 Southern Coos Health District and Foundation Investment State Pool 31-Dec-18 Balance for the Month Beginning Dec 01, 2018 $ 3,173,111 Interest Net of Fees $ 7,284 Deposits 250,000 Withdrawals Subtotal 257,284 Balance for the Month Ending Dec 31, 2018 $ 3,430,395. Historical Data Description Date Balance Annualized ROI Quarter Ending Balance Sep-17 $ 4,363, % Quarter Ending Balance Dec-17 $ 3,446, % Quarter Ending Balance Mar-18 $ 3,160, % Quarter Ending Balance Jun-18 $ 3,141, % Quarter Ending Balance Sep-18 $ 3,159, % Month Ending Balance Oct-18 $ 2,916, % Month Ending Balance Nov-18 $ 3,173, % Month Ending Balance Dec-18 $ 3,430, % Investment State Pool Balances 88.00% Annualized ROI $5,000,000 $4,500,000 $4,000,000 $3,500,000 $3,000,000 $2,500,000 $2,000,000 $1,500,000 $1,000,000 $500,000 $- Sep-17 Dec-17 Mar-18 Jun-18 Sep-18 Oct-18 Nov-18 Dec % 2.50% 2.00% 1.50% 1.00% 0.50% 0.00% Sep-17 Dec-17 Mar-18 Jun-18 Sep-18 Oct-18 Nov-18 Dec-18 FUND BALANCES: Foundation - Investment 62,784 USDA Investment $ 233,705 Scott Annuity - Investment 9,488 Board Designated - Investment 1,972,783 Unrestricted - Investment 1,151,635 Total State Pool Account 3,430, ADDL FUND BALANCES - TOTAL RESERVES $ 3,430,395

27 MEDICAL STAFF REPORT 27

28 MEDICAL STAFF REPORT January 2019 Consideration For 6-month Provisional Privileges: Scott Levitt, MD (Emcare) 28