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Southern Mono Healthcare District

Board of Directors Meeting Agenda

December 20, 2018

2017 Press Ganey Guardian of Excellence Award Winner 2017 Hospital Quality Institute Award Winner

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Southern Mono Healthcare District P.O. Box 660 | 85 Sierra Park Road | Mammoth Lakes, CA 93546 | 760.924.4114 | Fax 760.924.4104

www.mammothhospital.com

METICULOUS CARE * MEMORABLE PEOPLE * MAJESTIC LOCATION

BOARD OF DIRECTORS MONTHLY MEETING AGENDA

In compliance with the Americans with Disabilities Act (ADA), if you

need special assistance to participate in or to attend this meeting, please

contact the District Board Administrative Assistant at Mammoth Hospital

by telephoning (760) 924.4114. Notification 48 hours prior to the meeting

will enable the District to make reasonable arrangements to assist with

accessibility to this meeting.

Date: December 20, 2018

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

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

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

Place: Mammoth Hospital Administration Conference Rooms A & B

85 Sierra Park Road

Mammoth Lakes, CA 93546

I. CALL TO ORDER

II. PLEDGE ALLEGIANCE TO THE FLAG AND READING OF THE SMHD

VISION, MISSION AND VALUES

III. INTRODUCTION OF SMHD CHIEF EXECUTIVE OFFICER THOMAS

PARKER

IV. SEATING OF NEW SMHD BOARD MEMBERS, YURI PARISKY, M.D.,

AND JOANNE HUNT; ADMINISTRATION OF OATH OF OFFICE

V. PUBLIC COMMENTS

VI. CHIEF OF STAFF REPORT

VII. 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.

http://www.mammothhospital.com/



December 20, 2018

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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 and C086087.

2. Susan Corning v. Mammoth Hospital, et al., United States District Court,

Eastern District, Case No. 2:18-CV-02295

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.

7. HR Report.

QUALITY ASSURANCE QUARTERLY SUMMARIES - (Health and Safety Code

§32155)

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

1. Sierra Park Clinics/Mammoth Hospital.

PERSONNEL MATTERS (Government Code §54957)

1. Tom Parker, CEO

CREDENTIALING

There is no Credentialing to review this month.

VIII. REPORT ON CLOSED SESSION

IX. PUBLIC COMMENTS

X. 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:

October 26, 2018 Strategic Planning Meeting

November 15, 2018 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



December 20, 2018

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7. Recognition of Drs. Brian Gilmer, Tim Crall, Jennifer Harkins, Mike Karch and

athletic trainer Sarah Lang for published research in academic journals during

their tenure at Mammoth Hospital.

8. Recognition of Dr. Brian Gilmer as a top CORR (Clinical Orthopaedics and

Related Research) reviewer of 2018.

XI. COMMITTEE REPORTS

1. Finance Committee Stephen Swisher, M.D.

2. Physician Compensation and Relations Committee

Laurey Carlson

3. Employee Relations Committee David Anderson

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

5. CEO Annual Review Committee Laurey Carlson

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

7. Facilities Committee

8. Board Member Recruitment Committee Laurey Carlson, David Anderson

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

a. CEO Recruitment Stephen Swisher, M.D.

XII. CHIEF EXECUTIVE OFFICER REPORT

XIII. FINANCE REPORT

1. November 2018 Financial Narrative

2. Investment Report.

XIV. BOARD EDUCATION

1. Orientation for New Members of the Southern Mono Healthcare District Board

of Directors and Review of the Ralph M. Brown Act.

XV. OLD BUSINESS

There is no old business to discuss.

XVI. NEW BUSINESS

1. Review and Approve the 2019 Monthly Board of Directors Regular Meeting

Schedule.

2. Review and Make Appointments to Committees due to Changes to the SMHD

Board of Directors.

3. Gary Myers, former CEO, part-time employment; approval of agreement for

employment.

4. McFlex Community Parcel Update; no action proposed.

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

XVII. CREDENTIALING

There is no Credentialing to review this month.



December 20, 2018

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XVIII. FUTURE BUSINESS

The next Regular meeting will take place on January 17, 2019 at 8:00 a.m. in Conference Rooms A &

B at Mammoth Hospital.

ADJOURN


Strategic Plan Conference

Board of Directors Meeting Minutes

October 26, 2018


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BOARD OF DIRECTORS MEETING MINUTES

STRATEGIC PLAN CONFERENCE 2018

Date: October 26, 2018

Place: The Village Lodge

Emerald Room and Palisades Room

1111 Forest Trail, Mammoth Lakes, CA 93546

Attendance of Board Members: Ryan Wood, Chair; David Anderson, Vice Chair; Stephen

Swisher, M.D., Treasurer; Laurey Carlson, Secretary; one

vacancy.

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

CNO; Mark Lind, CIO; Craig Burrows, M.D.,CMO; Sarah Rea,

Recording Secretary; Brian Gilmer, M.D., Chris Hummel, M.D.,

Jacob Eide, John Payton, D.O., Jonathan Bourne, M.D., Pete

Clark, M.D., Sarah Sindell, M.D., Eric Bourne, M.D., Sierra

Bourne, M.D., Tim Crall, M.D., Chief of Staff, Yuri Parisky,

M.D., Britt Cogan, Carolyn Korfiatis, Caitlin Crunk, Cammy

Staker, Casey Piercey Michel, Chris Matteson, Dawn Van

Winkle, Gabi MacMillan, Jane Grossblatt, John Chisum, Kevin

Larsen, Lenna Monte, Lori Baitx, Lori Ciccarelli, Lorraine

Koenig, Michael McMahon, Nancie Hamilton, Rick Benz, Sarah

Vigilante, Slavka Crouthamel, Stephanie Stanton, T.R. Miller,

Teresa Toups, Ehren Goetz.

Attendance of Public: Robin Roberts, Sandra Pearce, Grady Dutton, Joanne Hunt, Judy

Bornfeld, Lois Klein, Jack Benham.

I. CALL TO ORDER

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





Strategic Plan Workshop


October 26, 2018

Page 2 of 2

The meeting was opened with the Pledge of Allegiance to the Flag and the reading of the SMHD

Mission, Vision & Values lead by Chair Wood.

III. PUBLIC COMMENTS

There were no Public Comments.

IV. STRATEGIC PLANNING CONFERENCE

The 2018 Strategic Planning Conference was held. No action was taken.

V. ADJOURN TO CLOSED SESSION

The Board adjourned to closed session at 9:50 a.m.

David Baumwohl, Legal Counsel, attended via teleconference.


54956.8).

1. McFlex Parcel Reconfiguration. Southern Mono Healthcare District (SMHD)

Parcel located at APN # 035-010-065. Discussion of proposal from the County of

Mono to reconfigure the planned Government Center parcels, including

acquisition of additional land to annex or merge with the current SMHD McFlex

parcel. SMHD negotiators are Gary Myers, CEO, and David Baumwohl, SMHD

General Counsel.

VI. REPORT ON CLOSED SESSION

The Board reconvened to Open Session at 10:20 a.m.


54956.8).

1. McFlex Parcel Reconfiguration. Southern Mono Healthcare District (SMHD)

Parcel located at APN # 035-010-065: Action on proposal from the County of

Mono to reconfigure the planned government center parcels, including

acquisition of additional land to annex or merge with the current SMHD McFlex

parcel.

The Board discussed the McFlex Parcel Reconfiguration. No action was taken.

In Open Session, Laurey Carlson made a motion, seconded by Stephen Swisher, M.D., to approve the

concept of working with Mono County regarding the McFlex Parcel. Vice Chair David Anderson

recused himself from the vote due to his determination of a conflict of interest. A vote was taken, the

motion passed 3-0. Yes, 3. No, 0.

ADJOURN

The meeting was adjourned at 12:05 p.m.



November 15, 2018


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BOARD OF DIRECTORS REGULAR MEETING MINUTES

Date: November 15, 2018

Place: Mammoth Hospital Administration Conference Rooms A & B

85 Sierra Park Road

Mammoth Lakes, CA 93546

Attendance of Board Members: Ryan Wood, Chair; David Anderson, Vice Chair; Stephen

Swisher, M.D., Treasurer; Laurey Carlson, Secretary; one

vacancy.

Attendance of Staff Members: Gary Myers, Chief Executive Officer; Melanie Van Winkle,

Chief Financial Officer; Kathleen Alo, Chief Nursing Officer;

Craig Burrows, M.D., Chief Medical Officer; Mark Lind, Chief

Information Officer; David Baumwohl, Legal Counsel; Sarah

Rea, Recording Secretary.

I. CALL TO ORDER

Chair Wood called the meeting to order at 9:03 a.m.



The meeting opened with the Pledge of Allegiance to the Flag and the reading of the SMHD Mission,

Vision & Values lead by Ryan Wood.

III. PUBLIC COMMENTS

There were no Public Comments.

IV. CHIEF OF STAFF REPORT

There was no Chief of Staff report.

V. ADJOURN TO CLOSED SESSION

The Board adjourned to closed session at 9:08 a.m.




November 15, 2018

Page 2 of 7

VI. REPORT ON CLOSED SESSION

The Board reconvened to open session at 10:23 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 and C086087.

David Baumwohl reported discussion of CONFERENCE WITH LEGAL COUNSEL on PENDING

AND THREATENED LITIGATION for the above item; no action was taken.

QUALITY ASSURANCE – (Health and Safety Code §32155)

1. Chief of Staff Report

Dr. Timothy Crall, Chief of Staff, requested to attend the Closed Session at 9:15 a.m. The request was

granted. The Quality Assurance Report was taken out of order. Dr. Crall made several comments; no

action was taken. Dr. Crall left the closed session at 9:29 a.m.


54956.8).

David Baumwohl reported there were no matters to discuss: no action was taken.

David Baumwohl reported that the discussion of Quality Assurance matters resumed.

2. CEO Report.

David Baumwohl reported that QUALITY ASSURANCE issues were discussed with Gary Myers, Chief

Executive Officer; and that there were comments from the CEO. No action was taken.

3. CFO Report.

David Baumwohl reported that QUALITY ASSURANCE issues were discussed with Melanie Van

Winkle, Chief Financial Officer, and that there were comments from the CFO. No action was taken.

4. CNO Report.

David Baumwohl reported that Kathleen Alo, Chief Nursing Officer, did not have any comments

regarding QUALITY ASSURANCE issues. No action was taken.



November 15, 2018

Page 3 of 7

5. CMO Report.

David Baumwohl reported that QUALITY ASSURANCE issues were discussed with Craig Burrows,

M.D., Chief Medical Officer, and that there were comments from the CMO. No action was taken.

QUALITY ASSURANCE QUARTERLY SUMMARIES - (Health and Safety Code

§32155)

1. Review of Quarterly BETA Report

David Baumwohl reported that Lenna Monte, Director of Quality, entered Closed Session at 9:49 a.m.

and that there was a discussion of Quality Assurance Quarterly Summaries. No action was taken. Lenna

Monte left Closed Session at 9:58 a.m.

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

1. Sierra Park Clinics/Mammoth Hospital.

David Baumwohl reported HEALTH CARE FACILITY TRADE SECRETS were discussed regarding

Sierra Park Clinics/Mammoth Hospital, and that there were comments from Gary Myers, CEO. No

action was taken.

PERSONNEL MATTERS (Government Code §54957)

1. Gary Myers, CEO.

2. Review of the Quarterly Work Comp Report.

David Baumwohl reported the above matters were discussed; no action was taken.

CREDENTIALING

Reappointment to Active Staff

Melvin Cherne, M.D.

Reappointment to Courtesy Staff

Ronald Otto, M.D. Radiology

Sharon Meiselman, M.D. Radiology

Adriane Jaffer, M.D. Rheumatology & Allergy

Appointment to Provisional Staff

Lindsay Urband, M.D. Orthopedics – Hand specialty

Kimberly Nortdstrom, M.D. Psychiatry ED Telemedicine

Temporary Privileges

Armisa Cullens, M.D. Pediatrics

Broooks Rohlen, M.D. Anesthesia

Yousef Tourshani, M.D. Pediatrics

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

taken.

The Closed Session ended at 10:05 a.m.



November 15, 2018

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VII. PUBLIC COMMENTS

There were no additional Public Comments.

VIII. CONSENT AGENDA

(All matters on the consent agenda to be approved on one motion unless a Board

Member requests separate action on a specific item)

1. Previous Minutes to be approved:

August 23-24, 2018 Special Board Meeting

September 19, 2018 Special Board Meeting



September 27, 2018 Regular Board Meeting

October 8, 2018 Special Board Meeting

October 10, 2018 Special 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

7. BETA Healthcare Group Quest for Zero: OB Initiative in 2018

8. Dividend Installment for BETA Risk Management Authority Members

Dave Anderson moved, seconded by Laurey Carlson, to approve all items on the consent agenda as

presented in the packet. A vote was taken; the motion passed unanimously. Yes 4, No, 0.

IX. COMMITTEE REPORTS

1. Finance Committee Stephen Swisher, M.D., Ryan Wood

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

2. Physician Compensation and Relations Committee

Ryan Wood, Laurey Carlson

There was no Physician Compensation meeting; no report.

3. Employee Relations Committee David Anderson

There was no Employee Relations Committee meeting; no report.

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

There was no Quality Assurance Committee meeting; no report.

5. CEO Annual Review Committee Ryan Wood, Laurey Carlson

There was no CEO Annual Review Committee meeting; no report. This committee is inactive at this

time.



November 15, 2018

Page 5 of 7

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

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

7. Facilities Committee Ryan Wood

There was no Facilities Committee meeting; no report.

8. Board Member Recruitment Committee Laurey Carlson, David Anderson

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

X. CHIEF EXECUTIVE OFFICER REPORT

Gary Myers, CEO, presented the following additional information to his written report:

1. New Mammoth Hospital CEO Tom Parker has requested a list of documents for his review,

Gary Myers and Tom Parker will speak on the phone next week about this list. Tom and his

wife have closed escrow on a house in Old Mammoth, and are hoping to arrive in Mammoth

the last week of November.

2. It has been a privilege and an honor to serve with the Board of Directors of the Southerm Mono

Healthcare District.

XI. FINANCE REPORT

1. October 2018 Financial Narrative

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

via PowerPoint presentation. Ms. Van Winkle reported the October Net loss was $66,000 which

resulted in a favorable budget variance of $17,000. The favorable variance is a result of higher total

operating revenue and non-operating income for the month, thus creating higher than budgeted

operating gain for the month. The year-to-date Net Gain was $395,000 resulted in an unfavorable year-

to-date budget variance of $393,000. Days of cash-on-hand were at 293.5 at the end of October.

2. Investment Report.

3. Review of Quarterly Capital Expenditure Status

The Quarterly Capital Expenditure Report was reviewed; no action needed.

XII. BOARD EDUCATION

There was no Board Education Presentation this month.

XIII. OLD BUSINESS

1. Review and Approval of the Annual Healthstream Employee Survey Results.

Sarah Vigilante, Human Resources Director, Reviewed the annual Healthstream Employee Survey

Results. Dave Anderson moved, seconded by Laurey Carlson, to approve the Annual Healthstream

Employee Survey results. A vote was taken; the motion passed unanimously. Yes: 4, No: 0.



November 15, 2018

Page 6 of 7

XIV. NEW BUSINESS

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

Employee Retirement Plans by Sarah Vigilante, Human Resources Director

Sarah Vigilante, Human Resources Manager, reviewed the Quarterly Retirement Plan Performance:

403(b) and 457 Employee Retirement Plans.

2. Approval of the Quarterly Performance Improvement Report

Dave Anderson moved, seconded by Laurey Carlson, to approve the Quarterly Performance

Improvement Report. A vote was taken, the motion passed unanimously. Yes: 4, No: 0.

3. Quarterly Review and Approval of New & Revised Contracts

Laurey Carlson moved, seconded by Dave Anderson, to approve the Quarterly New and Revised

Contracts as listed. A vote was taken; the motion passed unanimously. Yes: 4, No: 0.

4. Quarterly Policies Review and Approval

Laurey Carlson moved, seconded by Stephen Swisher, M.D., to approve the Quarterly New and

Revised Policies as listed. A vote was taken; the motion passed unanimously. Yes: 4, No: 0.

5. Review, Update and Approval of the Updated Conflict of Interest Bi-annual

Code.

Legal Counsel David Baumwohl discussed the above. There were no material changes. The Code must

be ratified by the Mono County Board of Supervisors, and the item will come up for review in two

years.

Laurey Carlson moved, seconded by Dave Anderson, to approve Resolution 18-02: Conflict of Interest

Bi-annual Adoption of the updated Conflict of Interest Code. Chair Wood asked for comments; a brief

discussion ensued. A roll call vote was taken; the motion passed unanimously. Ryan Wood: Yes; Dave

Anderson: Yes; Laurey Carlson: Yes; Stephen Swisher, M.D.: Yes. One vacancy.

6. Review of Professional Services Agreement between Southern Mono Healthcare

Distict and John Roberts, M.D., for provision of pathology services.

Dave Anderson moved, seconded by Laurey Carlson, to approve the professional services agreement

between the Southern Mono Healthcare District and John Roberts, M.D., for the provision of

pathology services. A vote was taken; the motion passed unanimously. Yes: 4, No: 0.

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

Ryan Wood moved, seconded by Dave Anderson, to approve the disposal of surplus District property,

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

beneficial to the District. The surplus District property, equipment and supplies presented have

nominal or no value. A vote was taken; the motion passed unanimously. Yes 4, No 0.



November 15, 2018

Page 7 of 7

XV. CREDENTIALING Reappointment to Active Staff

Melvin Cherne, M.D.

Reappointment to Courtesy Staff

Ronald Otto, M.D. Radiology

Sharon Meiselman, M.D. Radiology

Adriane Jaffer, M.D. Rheumatology & Allergy

Appointment to Provisional Staff

Lindsay Urband, M.D. Orthopedics – Hand specialty

Kimberly Nortdstrom, M.D. Psychiatry ED Telemedicine

Temporary Privileges

Armisa Cullens, M.D. Pediatrics

Broooks Rohlen, M.D. Anesthesia

Yousef Tourshani, M.D. Pediatrics

Laurey Carlson moved, seconded by Dave Anderson, to approve the appointments as listed above.

Chair Wood asked for comments; it was noted that the appointments were discussed in closed session

and no action was taken. A vote was taken; the motion passed unanimously. Yes 4, No 0.

XVI. FUTURE BUSINESS

The next Regular meeting will take place on Thursday, December 20, 2018 at 8:00 a.m. in Conference

Rooms A & B at Mammoth Hospital.

ADJOURN

The meeting was adjourned at 11:00 a.m.


Report to the Board of Directors

CFO Report

December 20, 2018


________________________________________________________________________________________________________




DATE: December 20, 2018

TO: Board of Directors - Southern Mono Healthcare District

FROM: Melanie Van Winkle, CFO

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

November Financial Results –

The month of November resulted in $52 thousand Net Gain; $342 thousand unfavorable budget

variance. Unfortunately the Gross Revenue was lower than expected, which caused the unfavorable

budget variance. For the 5 months ended November the Net Gain is $446 thousand, which is $735

thousand under budget. The main contributor to the YTD unfavorable variance is the payer mix of

patients treated – government payers do not pay for the additional expenses incurred by the very ill

patients.

Cerner Revenue Cycle –

Significant activity has taken place over the last month to facilitate patient account resolution and

collections.

1) Secondary insurance billing in now automated – thus claims are being submitted electronically,

where as previously secondary bills had to be printed and mailed.

2) Three new biller/follow up staff members have been trained and now making good progress in

their new roles – all of these staff previously had no healthcare experience.

3) We still are looking for a resolution to automate Work Comp claim submission. However, one

of the new billers made great progress at “hard copy” mailing of claims that had been delayed

due to staffing shortages. We started to see payments for Work Comp claims in November due

to these efforts.

4) Workflows for our two external agencies have smoothed out and we realized increased

collections in November: BDM Inc. for International Collections and HRG for patient

responsibility.

Below are the trends of Discharge Not Final Billed (DNFB) at each month end. November’s DNFB

increased by $675 thousand in November, as the volume of accounts in “standard delay” was over $1.8

million. Standard delay is the “hold” we have on accounts to allow final documentation and charging.

There were several high dollar inpatient and surgical cases performed in the last few days of November




CFO Report

December 20, 2018

Page 2 of 2

(17 accounts represented $900 thousand – half of the total Standard Delay). As of the writing of this

report the Standard Delay dropped to less than $1 million.

Direct patient account collections in November were $4.6 million (excluding our own employee claims

from Delta Health). November and December tend to be lower collections months due to the slower

fall season and the holidays. This year’s November collections are the highest November in the last 5

years. Gross AR decreased $674 thousand to $21.6 million but the days in AR increased to 72.5.

The Gross AR at November month end of $21.6 million is slightly lower than October, but the AR

days increased due to the slower volume months. With $7 million of AR aged over 120 days from date

of service, about $5.6 million is concentrated in 3 payer categories. 1) Self-pay/Patient Responsibility

represents $2.9 million, 2) Commercial payers represents about $1.3 million – the billing team is

focusing on this area to resolve these accounts, and 3) Medi-Cal represents $1.4 million.

Total DNFB 5,498,339$ 5,448,536$ 4,950,156$ 4,103,976$ 3,833,915$ 2,979,791$ 1,911,658$ 2,586,125$

DNFB Days 18.1 18.7 16.0 13.2 11.1 8.6 6.0 8.7

April May June July August September October November

Pre-Go-Live Go-Live

Sept 2017 Oct 2017 July 2018 Aug 2018 Sept 2018 Oct 2018 Nov 2018

Gross AR:

MS4 (Hospital) 18,108,048$ 12,712,598$

Allscripts (Clinics) 1,902,317$ 1,619,813$

Cerner (All) -$ 3,579,916$ 25,638,355$ 26,249,910$ 26,038,536$ 22,313,777$ 21,640,044$

Total 20,010,365$ 17,912,327$ 25,638,355$ 26,249,910$ 26,038,536$ 22,313,777$ 21,640,044$

Gross AR Days 68.7 60.8 82.6 75.98 74.80 70.24 72.51

Payments:

MS4 (Hospital) 4,502,501$ 5,015,395$ 43,883$ 76,530$ 17,998$ 11,338$ 72,282$

Allscripts (Clinics) 470,914$ 375,939$ 343$ 1,889$ 3,313$ 307$ 55$

Cerner (All) -$ 3,034$ 6,314,436$ 5,978,591$ 5,371,131$ 5,862,277$ 4,643,738$

Total 4,973,415$ 5,394,368$ 6,358,662$ 6,057,010$ 5,392,442$ 5,873,922$ 4,716,075$

Post Go-Live



CNO Report December 20, 2018


_______________________________________________________________________________________________________





TO: Board of Directors—Southern Mono Healthcare District

FROM: Kathleen Alo, Chief Nursing Officer

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

Executive Summary

Old Business

Community Health Needs Assessment update

New Business

Ali Miller and Jesse Wagner, both Emergency Department RNs, are commended for the

additional hands-on classes they created for the Pediatric Advanced Life Support (PALS) and

Advanced Cardiac Life Support (ACLS) classes.

Rosemary Sachs, Paramedic Liaison Nurse, is commended for her work with Crafton Hills

College.

Lori Baitx, Emergency Department Manager and her task force, are commended for their work

on improving Ligature Risk Mitigation.

Pharmacy and Administration has been working closely with our consultant for the 340B drug

program and are making changes to improve revenue through the program.

Report Detail

People

Ali Miller and Jesse Wagner, both Emergency Department RNs, are commended for the

additional hands-on classes they created for the Pediatric Advanced Life Support (PALS) and

Advanced Cardiac Life Support (ACLS) classes. A little over three years ago, Mammoth

Hospital implemented an online version of these classes with periodic computer-based

manikins for practice. Although the program was generally well received, we were given a lot




December 20, 2018

Page 2 of 3

of feedback on how much the staff valued additional training by instructors. This training

included review of the crash carts and other equipment based review. This additional time is

highly valued by staff.

Rosemary Sachs, Paramedic Liaison Nurse, is commended for her work with Crafton Hills

College. Rosemary developed and provided the first Mobile Intensive Care Nurse (MICN)

training program for our nurses. She hit many stumbling blocks, as Crafton Hills had never

provided remote education before. She persevered and saved the hospital thousands of dollars

by not having to bring an instructor up her for the 5-day class. We will also be able to have new

nurses attend the class each semester, eliminating the long wait between classes offered in our

area.

Quality

Community Health Needs Assessment next steps are to send out surveys to our community.

Surveys will be available in English and Spanish. They will be posted electronically on the

website of Mono County Public Health and Mammoth Hospital. The surveys will also be

available in paper form at the Mammoth Hospital outpatient clinics, inpatient units and the

Health Department.

Lori Baitx, Emergency Department Manager, and her task force are commended for their work

on improving Ligature Risk Mitigation. Lori Baitx, Caitlin Crunk (Med/Surg Manager), Ali

Miller (ED Educator) and Brandy Wilt (Med/Surg Educator) formed the task force to mitigate

ligature risk at Mammoth Hospital. Ligature Risk is a current hot topic with the Centers for

Medicare and Medi-Cal, and Mammoth Hospital is doing its best to improve the care of the

suicidal ideation patient. The following the list describes what has been accomplished:

1) Room assessment completed on ED Room #2 for all ligature risks:

a. All cords covered and not accessible.

b. New handles put on cabinets.

c. New faucet ordered and awaiting placement by maintenance.

d. Breakaway curtain hooks ordered and will be put up when they arrive.

2) Use of Behavioral Sitter Policy updated and pushed through policy manager system—new

version is live in MCN.

3) Suicide Risk reduction policy updated—updated version is live in MCN.

4) Behavioral Health Observation record created—approved by forms committee—Live in

FormFast

5) Behavioral Health Environmental Safety Checklist created—approved by forms

committee—Live in FormFast.

6) Sitter Care and Documentation Checklist created and available for real time Quality Audit

and post-Quality Audit.



December 20, 2018

Page 3 of 3

7) Behavioral Health Sitter educational PowerPoint created placed in Healthstream (Mammoth

Hospital’s online learning software) and assigned to 155 employees, with 52% completed as of

Tuesday, November 27. Reminders sent to employees who have not completed education. ED

is at 99% completion. This list will be placed in the Behavioral Health Competency notebook

for a real time list of eligible sitters. The list will be updated regularly.

8) Behavioral Health Sitter educational PowerPoint updated again to be more inclusive of the

whole facility. This will be used for the 2019 competency.

9) Competency notebook created for ED and one for Med/Surg with all information needed

readily accessible.

10) Competency form created. Ali Miller, ED RN, has begun doing 1:1 competency with all

ED staff. Brandy Wilt, Med/Surg RN, will be doing all Med/Surg. This competency will

include all medical staff who may order a BH sitter.

11) Screen shots of all the required documentation in Cerner created and added to competency.

We feel these measures are best in breed and will provide additional safety to our patients.

Growth

Pharmacy and Administration has been working closely with our consultant for the 340B drug

program and are making changes to improve revenue through the Program. Our contracted

consultant, Vizient, sent a representative to the hospital to look for ways to improve revenue in

this program.

The 340B Drug Discount Program is a U.S. federal government program created in 1992 that

requires drug manufacturers to provide outpatient drugs to eligible health care organizations

and covered entities at significantly reduced prices. The intent of the program is to allow

covered entities to stretch scarce federal resources as far as possible, reaching more eligible

patients and providing more comprehensive services. Maintaining services and lowering

medication costs for patients is consistent with the purpose of the program, which is named for

the section authorizing it in the Public Health Service Act (PHSA). It was enacted by Congress

as part of a larger bill signed into law by President George W. Bush.

Vizient has assisted us in identifying more physicians that can be enrolled in the program,

additional outpatient areas that can be included, supplies that are eligible and the possibility of

adding Rite Aid to our program. Most of these suggestions will be implemented over the next

quarter and should generate additional revenue for the hospital.

https://en.wikipedia.org/wiki/US_federal_government

https://en.wikipedia.org/wiki/Public_Health_Service_Act

https://en.wikipedia.org/wiki/George_HW_Bush



CMO Report

December 20, 2018

2017 Press Ganey Guardian of Excellence Award Winner

2017 Hospital Quality Institute Award Winner



FROM: Craig Burrows, CMO

RE: CMO Report, Regular and Annual Meeting of the Board of Directors

Medical staff

As a result of our recent DNV survey, we continue with our efforts to comply with our plan of

correction as follows:

All resident-and hospital-based medical staff will be certified in BLS or ACLS by the end of the

1st quarter of 2019. This will encompass a total of 29 staff members.

The Quality Department will be working to create and maintain a scorecard for each medical

staff member, and will be monitoring a number of different parameters. This will include blood

utilization, antibiotic selection and administration, readmission rates, influenza vaccination rates,

medical reconciliation rates, number of return visits to the ED within 72 hours for the same

complaint, H&P completion rate within 24 hours of encounter, and physician case reviews

resulting in findings other than “acceptable” or “acceptable with educational opportunity.”

A formal Peer Review Committee will be formed and commence with meetings for the purpose

of peer review in January 2019. The committee will tentatively be made up of the CMO, Chief of

Staff, and representation from Orthopedics, Surgery, ER, Medicine, and Pediatrics. Ad hoc

members will be as needed for specialties such as OB/GYN, ENT, etc. A formal policy and

charter are being drafted.

Medication Assisted Treatment

Mammoth Hospital is in the process of creating a program for Medication Assisted Treatment, or

MAT. This is a treatment consisting of patient assessment and then management of opioid

withdrawal with Buprenorphine, an opioid agonist-antagonist. This class of medication works by

satisfying the craving for opioids while preventing the patient from getting any of the pain or

sedating drug effect, and allows for a return to a more productive quality of life. The physician

champions for this project are Dr. Stephen Swisher and Dr. Craig Burrows. We are in the process

of applying for a grant from the Public Health Institute to help launch this effort. As the initial



CMO Report

September 27, 2018

Page 2 of 3

phase of this treatment program, the emphasis will be on patients presenting with opioid

withdrawal symptoms. They will be treated acutely in the ER, and then follow up in a clinic

setting for ongoing management and treatment of their opioid addiction.

Medical Staff – Physician Recruitment

Urology services - Dr. Paul Polishuk from San Diego remains slated to begin assuming urology

services January 21, 2019. The model would be for him to be the one consistent provider each

month, with support from the Mammoth Hospital staff, including a PA for the times he is not

physically here.

Pediatrics - We continue our search for a full time pediatrician. There is a candidate, Dr. Mary

Bissell, who is in her third year of residency at Loma Linda, and interviewed here at Mammoth

last weekend. She would not be available until July 1, 2019 at the earliest, but we remain very

optimistic at this time. Dr. Maria Saavedra, is also providing coverage, and the pediatric group is

presently working on a 4 person plan to provide fulltime coverage moving forward.

OB/GYN - Currently, we are utilizing a locums, Dr. Joseph Edwards, to provide OB/GYN

coverage. He is scheduled to provide coverage from December 22–January 7, 2019, at which

time his assignment will be completed. From that time through April 1, 2019, Dr. Valerie Wang

will be alternating weeks with Dr. Larry Fakinos.

Dr. Larry Fakinos will assume a full time position January 7, 2019, and will be providing

coverage every other week with Dr. Wang. Dr. Wang started her assignment here on December

10, 2018. She is based out of Sacramento, and is contemplating where she would like to be on a

full time basis.

As of this writing, we will have had a video interview with Dr. Patricia Faraz. Dr. Faraz is

currently a solo practitioner in Orange County, California, and has worked with Dr. Fakinos.

Lastly, Maureen Fakinos, NP, has accepted an offer for hire to work in the Women’s Health

Clinic. Ms. Fakinos has a great deal experience in women’s health, and has been providing

patient care in Dr. Fakinos’ clinic for the last several years.

Psychiatry - Dr. Dhossche currently is in practice in Mississippi, and remains non-committal to

our offer.

Anesthesia - We have been in contact with 2 potential candidates, Dr. Nat Parker in Los

Angeles, and Dr. Steve Turnland, who lives in the Bay Area. Dr. Turnland has made a visit to the

area, and is still contemplating a permanent move to Mammoth. Dr. Parker had a very successful

site visit in September 2018, and will be providing coverage for a week this month. We remain

very optimistic that Dr. Parker will then sign on as permanent staff, and move to the Mammoth

area. Coverage currently consists of Dr. Jon Bourne, Dr. Larry Silver, and Dr. Eric Bourne.



CMO Report

September 27, 2018

Page 3 of 3

Additional coverage in the next few months consists of Dr. Caroline Saba, who currently resides

in Arizona, but is also potentially interested on providing coverage on a regular basis.

The desired model for anesthesia remains 4 full time anesthesiologists, with 2 available and in

town every day of the year. We are hopeful to be able to staff this model in the very near future.

Given the increasing surgical volume at our facility, this has become a necessity.

Cancer Management at Mammoth Hospital

We continue with ongoing meetings of the Cancer Committee, which consists of Yuri Parisky,

M.D., Lisa Marusicz, RN, Lori Ciccarelli, Kathleen Alo, CNO, Kelli Moore, patient navigator,

and Craig Burrows, CMO. What we discovered during this meeting is that the management of

these patients is an opportunity for improvement in coordination. An initial PDCA was

performed on November 15, 2018 to review this entire service line, and ensure that we at

Mammoth Hospital are all on the same page with respect to every aspect of the care of our

cancer patients. A follow-up meeting took place earlier this month, and the next meeting

regarding biopsy results took place on December 12. This is a large scale quality improvement

project involving multiple departments and personnel.

Hand washing

At the most recent department of medicine meeting, we learned that our hand washing rate is

now at 90%. This is a remarkably high compliance rate! Great job by all—and please wash your

hands!



Information Technology, Facilities

December 20, 2018



________________________________________________________________________________________________________






FROM: Mark Lind, Chief Information Officer

RE: Biomed, Environmental Services, Facilities, and Information Technology

Report, Regular Meeting of the Board of Directors

Executive Summary

New Business

o Candidate Application Solution. The current Job Science applicant tracking and

processing solution is dated and no longer adequately supported by the vendor. A

survey of the current market found that the state of the art has moved a great deal in

recent years and that cloud-based solutions are much more affordable and feature-

rich than Job Science. Implementation and support for most of the higher-rated

solutions is less than the annual support we pay for Job Science, so we are moving

to evaluation and replacement. An exhaustive market survey, as well as product

evaluation demos, has been performed by the Human Resources department and IT

and a final solution is close to being selected. This project will ideally be

implemented this winter.

Old Business

o Optimize the Cerner EMR to Improve Efficiencies and to Enable the Maximum

Productivity by Staff and Providers. The EMR Change Committee continues to

actively meet and to work through integration and system issues with Cerner. In

addition, there are now three Quality Improvement projects underway, using the

PDCA (Plan Do Check Act) process to address system and process issues with the

EMR. The PDCA projects include a Patient Portal Workgroup, an Alert Fatigue

Taskforce, and a Physician Onboarding Workgroup. To date, the Patient Portal

Workgroup has dramatically reworked our portal invitation and information pages

on the Hospital website, moving to clearer language, the inclusion of Spanish and

the incorporation of help videos to explain how to perform tasks in the portal. The

Alert Fatigue Taskforce has now fixed a major process problem with medication

order alerting that was causing the nursing staff to go back through the alerts

generated during the ordering process, this has now been remedied. The Physician

Onboarding Workgroup has also made significant progress in better planning,

preparing for, and training providers when they start. Each major stakeholder in the





December 20, 2018

Page 2 of 9

process has a part to play in this much better-coordinated process. To date, three

providers have gone through this new onboarding approach. The provider

satisfaction with the process, which makes sure that they have all of the tools in

place to document, order, and access hospital systems, as well as basic training in

the EMR in both the clinic and hospital, has been really high.

Report Detail

Biomedical Engineering Summary:

Jan Feb Apr Jun Jul Sep Nov Total

58 102 120 83 39 110 74 956

58 102 120 83 39 110 60 942

100.00 100.00 100.00 100.00 100.00 100.00 81.08 98.28

1 1 6 2 0 6 0 32

1.72 0.98 5.00 2.41 0.00 5.45 0.00 2.82

0 1 1 1 0 0 2 8

0.00 0.98 0.83 1.20 0.00 0.00 2.70 0.75

1 6 9 3 0 7 0 46

1 6 9 3 0 7 0 46

100.00 100.00 100.00 100.00 0.00 100.00 0.00 100.00

0 0 0 0 0 0 0 0

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0

0 0 2 0 0 0 0 2

0.00 0.00 22.22 0.00 0.00 0.00 0.00 2.02

1 1 0 0 1 1 1 8

1 1 0 0 1 1 0 7

100.00 100.00 0.00 0.00 100.00 100.00 0.00 100.00

0 0 0 0 0 0 0 0

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

0 0 0 0 0 0 0 0

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

4 1 1 8 5 7 1 38

1 1 1 4 1 1 0 15

33 69 21 147 73.5 52.5 9 607

10 19 16 11 12 30 2 142

2 3 5 5 9 6 2 66

2 39 0 3 31 0 0 79

2 39 0 3 31 0 0 79

100.00 100.00 0.00 100.00 100.00 0.00 0.00 100.00Work Orders - Closed % 100.00 0.00 100.00 0.00

Work Orders - Closed 2 0 2 0

Work Order - Opened 2 0 2 0

6. Recall/Alert

Added 5 6 21 2

Retired 8 10 22 2

5. Equipment

Total Cost (in $) 120 21 18 43

Equipment Abuse 2 1 2 1

User Errors 2 2 4 3

4. User Error / EQ Abuse

PM Failures - % 0.00 0.00 0.00 0.00

PM Failures 0 0 0 0

Unable to Locate - % 0.00 0.00 0.00 0.00

Unable to Locate 0 0 0 0

PM WO Compliant % 100.00 100.00 100.00 0.00

PM WO Compliant 1 1 1 0

PM WO Opened 1 1 1 0

3. High Risk (Non Life

Sup -PM)

PM Failures - % 0.00 0.00 0.00 0.00

PM Failures 0 0 0 0

Unable to Locate - % 0.00 0.00 0.00 0.00


PM WO Compliant - % 100.00 0.00 100.00 100.00


PM WO Opened 3 0 8 9

2. Life Support (PM)

PM Failures - % 0.00 0.00 0.00 2.50

PM Failures 0 0 0 3

Unable to Locate - % 7.14 0.00 0.00 8.33


PM WO Compliant - % 100.00 100.00 100.00 100.00


PM WO Opened 84 55 111 120

1. Non Life Support (PM)

Mar May Aug Oct

Regulatory Compliance Monthly Report - 2018 BIOMEDICAL ENGINEERING




December 20, 2018

Page 3 of 9

The Biomedical Engineering department opened 75 preventative maintenance work orders in

November. Preventative maintenance was focused almost exclusively on the Laboratory this month.

On time compliance was 81.08% for Non-Life Support equipment. There were no life support PMs

conducted during the month. We had one High Risk medical device up for maintenance in November,

and it was pushed to the first week in December as it was not lab-related. There was one instance of

user error and zero instances of equipment abuse by staff during the month of November. 2 devices

were retired, and 2 new devices added to the biomedical device inventory. We had no device recalls in

November.

We had 23 repair work order surveys for Biomedical Engineering in November and all responded with

“Satisfied” for 100% of the responses. We had no “Unsatisfied” or “No Opinion” survey responses.

The PACU had the largest number of repair work order responses, followed by the OR.

Department

% # # %

PACU 100% 0 0 0%

OR 100% 0 0 0%

Family Medicine Clinic 100% 0 0 0%

Pediatric Clinic 100% 0 0 0%

Physical Therapy 100% 0 0 0%

Urology Clinic 100% 0 0 0%

Labor and Delivery 100% 0 0 0%

Med/Surg 100% 0 0 0%

Emergency Department 100% 0 0 0%1 0%

2 0%

1 0%

1 0%

3 0%

2 0%

2 0%

# %

6 0%

5 0%

----------Satisfied---------- -------Unsatisfied------- ------No Opinion------

Quality Survey Analysis BIOMEDICAL ENGINEERING




December 20, 2018

Page 4 of 9

IT/Informatics Report

Summary:

The IT team has been focused on a couple of key initiatives this past month beyond our routine system

and user support tasks. Key project items include the Windows 10 Desktop Upgrade, the Office 365

roll out, the data warehouse project, wireless network access upgrade, ShoreTel phone system

installation for Bishop Clinic, and our four quality projects (PDCAs).

The Windows 10 upgrade and Office 365 roll out projects are occurring concurrently. We are replacing

roughly 100 workstations this quarter that are not able to meet our current standards and run the new

operating system. In addition, we are starting a rolling upgrade project for Office 365. As a note, the

Windows upgrade to our staff computers is in response to the required Cerner EMR operating system

deadline next calendar year, when earlier versions of Windows will no longer be supported. The Office

365 roll out is required to bring all our workstations to a single consistent platform and is less

expensive than the OEM purchase model we have been using for some years. We plan to have all

workstations brought up to Windows 10 and Office 365 by October of 2019.

To better meet our reporting and data management requirements, our DBA John Kokado has been

working closely with Cerner to develop a complete set of data extract processes that allow us to pull in

important financial and clinical data into our data warehouse. We realized the need for this project

once we started to replicate our existing standard reports in the Cerner DA2 reporting module. As the

solution is hosted in the cloud and requires Cerner to maintain the data that is available, we lost a great

deal of our ability to create reports. Perhaps as important, any reports that we build in DA2 take many

hours to run given the shared domain and cloud-based nature of the solution. We have found that we

can run reports in our data warehouse in minutes that would take hours in Cerner. Given our very data-

focused approach to both finance and clinical reporting, this project is much needed. To date, John has

managed to pull in much of the data needed for reports like physician compensation. John is currently

working closely with our report writers Keith and Jessica to fine tune the data pulled and its format to

best meet their needs.

We performed both a full security assessment of our wireless network this past quarter as well as a

wireless coverage and signal strength validation. Secureworks, the Dell Security service company,

completed their wireless security assessment in October and November. Results were excellent, with

no significant issues being found. More in-depth details of this assessment will be found in Erick

Sugimura’s IT Security summary. On the physical coverage side, Brian Weller completed a full

physical review of the facility wireless access points. He found that in some high-volume areas, like

the clinics, that we still had some of the older model wireless access points mixed in with the newer

models. As the most current models use a different wireless topology and follow a different standard

(while maintaining backwards compatibility) moving towards only using the new models really helps

performance. Roaming hand-off, channel management, and even connection handling are done with

much more capability in terms of supported clients and much better performance. Brian will have the

remaining legacy access points replaced by no later than the end of December.




December 20, 2018

Page 5 of 9

Installation of the new ShoreTel VOIP (Voice Over IP) has been somewhat delayed due to our change

in scope. We decided to go with a digital phone circuit for the clinic versus the original plan to stick

with old analog phone lines. This decision was made as we found that call volumes have been

consistently higher than the old analog lines could handle, resulting in patients getting busy signals.

More importantly, moving to the ShoreTel phone system allows us to route calls from Mammoth to

Bishop and back through our existing data circuit avoiding the tolls we now pay for calling back and

forth. This savings in tolls pays for the upgrade to the digital circuit and upgraded ShoreTel phone

switch several times over in just the first year. Finally, once the phone system is upgraded, the system

will become just an extension of our existing main campus phone system with four digit calling

between extensions and even the ability to forward calls received in Bishop to Mammoth extensions

for call coverage. Given our current timeline, we are looking at an early calendar year wrap up of the

project.

To meet our organizational challenge to perform at least one quality improvement project using the

PDCA process, my teams have come up with the following: Per Diem Return to Work Process,

Physician On-Boarding Process, the Patient Portal Workgroup, and the Alert Fatigue Task Force.

Each PDCA project addresses critical issues in our workflows or system configuration. Each team also

pulls in key stakeholders from across the organization with representation by our CMO, nurse

managers and even some of our mid-levels. More to come on these projects as they work through their

deliverables.

Help Desk and Desktop Support:

The IT Help Desk opened 314 new IT/Telecom work orders in November and closed 269, or 85.7%.

This compares with 415 new work orders in October, indicating a decrease in volume likely due to the

Thanksgiving holiday.




December 20, 2018

Page 6 of 9

Work order survey responses for IT/Telecom were 100% positive in November. Responses to the work

order surveys indicating they were “Satisfied” with the work performed. There were no “No Opinion”

or “Unsatisfied” survey responses during the month. We had 284 survey responses for November.

Security Officer Report

From: Erick Sugimura, IT Security Officer

Dell Secureworks Wireless Penetration Test

Mammoth Hospital contracted Dell Secureworks to conduct a Wireless Penetration Test against our

wireless infrastructure. The popularity of mobile computing devices, such as laptops, tablets, and

phones, has led to an increase in wireless use within the hospital and clinics. Unlike a traditional wired

network where everything requires physical cables, plugs and connections, a wireless or WIFI network

communicates over broadcast signals that transmit beyond normal physical boundaries. Due to the

openly transmitted nature of WIFI signals, it’s important to ensure that we are protecting the data being

transmitted, as well as ensuring that the hospital’s internal network cannot be compromised by an

attacker who gains access wirelessly.

To better understand the results of the Wireless Penetration Test, it helps to understand some basic

concepts. Wireless signals are openly transmitted and there is really no way to stop any nearby device

from receiving signals that you send out. By definition, wireless communications are broadcast out to

anyone and everyone within range.

Laptops, tablets and phones can communicate more securely by using encryption—so the data may be

broadcast to everyone, but it won’t be ‘readable’ except by the intended recipient. However, an

unencrypted signal can be ‘seen’ by pretty much anyone with a little knowhow. This means that when

you go to an unencrypted web page, for example, and read articles or look at photos, anyone within

range around you could be seeing what you’re seeing. Encrypting your communication is vital for

maintaining privacy.




December 20, 2018

Page 7 of 9

Networks, like in the hospital or your home, can be protected by requiring some form of authentication

so that only specific devices can ‘talk’ to it. This way, if a device is not approved (either it’s on a list or

it knows the WiFi password), a network will simply ignore the signals that device transmits. So, if you

have a wireless router at home with no password, anyone within range could connect to it and

potentially to any other devices also connected to your router, be it wired or wireless.

There is much more to the securing of wireless networks than this, but it gives you an idea of how

vulnerable wireless networks can be.

From October 29 through November 2, a Dell Secureworks consultant was on-site attempting to use

standard cybercriminal methodologies to identify vulnerabilities that both internal and external

adversaries could exploit. During the testing period, Secureworks was unable to gain access to our

internal network and deemed that “Mammoth Hospital’s wireless networks are adequately secured.”

Secureworks noted that our guest network password was easily crackable, but also that this network

was properly segregated from our internal network and so the consultant was not able to access any

sensitive data. Since the guest network is intended to supply internet-only access to patients and guests,

Secureworks reported this as a low risk finding, but still recommended the use of a more complex

password. The concern with an easily accessible guest network is that a user could potentially connect

a hospital-owned device to the guest network and that would expose it, and any data on it, to an

adversary.

While the Wireless Penetration Test report is assuring that we do not appear to have any wireless

vulnerabilities at this time, it is important to remember that this test was conducted over a week. That

said, new types of attacks are always being discovered by cybercriminals and new, improved

technologies are always being developed, bringing with them new and unanticipated vulnerabilities.

Security experts generally accept that a determined adversary—given enough time and resources—will

eventually succeed. It is a constant challenge to stay on top of the shifting landscape between

cybercriminals, evolving technologies, and business operations.

Recent Information Security Incidents of Interest

A second employee received an extortion email that contained one of their personal passwords in the

subject line of the message. Another employee received a similar email last month, but that message

was showing their hospital password, which was more alarming. The recipient of this second email

went about changing their personal passwords and IT changed their hospital passwords just to be safe.

This incident was reported to the FBI Cybercrime reporting website.

A contractor for one of our vendors appeared to have their email account hijacked for the purpose of

sending a malicious link to a OneDrive file. The email appeared to be sent to several of the vendors

clients and not just Mammoth Hospital. The unusual email was reported to IT and we notified the

vendor who immediately took steps to remediate the situation. No one who received the link in the

hospital clicked on it.




December 20, 2018

Page 8 of 9

A hospital-issued tablet was reported lost, most likely offsite. The device was registered with our

Mobile Device Management application and a remote wipe command was issued to it. The nature of

the device indicates that no patient data would be present on it.

A hospital employee received two unusual emails with nonsensical subject lines from an obviously

fictitious email account. They were reported to IT, but there was no content in the email. Possibly,

these were probing attempts to see if emails were being received by a valid email account.

Dozens of attacks continue to be detected and blocked by our firewall. As usual, some appear to be

originating within the U.S., but most seem to be coming from other countries.

Facilities Report

From: John Chisum, Facilities Manager

Environmental Services

Brief summary of the happenings in EVS for the month of November/December:

1. We added a new chemical from the LAB to our CERS Chemical inventory.

2. We have interviewed a few candidates for a per diem EVS technician position.

3. We will have an EVS meeting on High Touch cleaning and PPE for the month of December

2018.

The day shift: 1 technician is unable to return to the EVS department. We are unsure when to expect

him back. Another EVS Day shift worker is scheduled to return from leave on January 8, 2019.

The night shift: We are waiting for a RTW note from one employee.

We continue to be short staffed due to scheduled time off, call-ins, FMLA and day off requests for

urgent matters.

Maintenance

The 3D Tomosynthesis (new mammography machine) project has been signed off as completed by the

OSHPD Area Compliance Officer.

The OSHPD ACO also signed off as completed the domestic hot water tank installation.

Rudolph construction is awaiting a couple of final quotes in order to provide us a final cost for the

Specialty Clinic remodel.

Have completed corrections for all initial findings listed under the Physical Environment heading for

the DNV. Anti-ligature corrections have been made as much as possible from the facilities perspective.

With the snowfalls from Thanksgiving Day on, the Facilities crew has been busy clearing snow and

keeping the entrances cleared for patient and staff access.




December 20, 2018

Page 9 of 9

The donor plaque for the 3D Tomosynthesis has been installed and looks very nice.

A candidate/ applicant has been selected, and a job offer is going out to replace the Maintenance

Technician/Security Guard position that was vacated by the previous employee. This position will have

the hours adjusted to reflect the hospital’s needs. Shift will run from 1600-0030, Wednesday-Sunday.

This will allow for redundant coverage of the security portion of the position.

Upcoming projects include:

1. Specialty Clinic

2. Sterilizer Project: Installing 2 sterilizers to provide for redundancy

3. Dental Clinic Remodel

4. Lab Remodel

5. MRI install



HR Report

December 20, 2018




FROM: Sarah Vigilante, HR Director

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

Executive Summary

Old Business

The HR Department is finishing the scanning of personnel files into Treeno. We have already

scanned over 2,000 files which is almost 99% of all HR/Employee Health files! Every file is

being double-checked by a team member before it is shredded. The steady state with Treeno has

really increased the team’s efficiency with locating and reviewing employee files. This project

has been a great success!

We recently concluded our open enrollment for health insurance. This process involves an

annual review of our health insurance premiums and a determination on the premium rates for

the upcoming year. This year did result in an overall 2.4% increase in the employee contribution

toward the total premium. Our wellness discount is a 20% reduction from the regular premium.

Employees must do a wellness check with their primary care provider in order to get this

discount.

Enrollment Status Full Time Status – 30+ Hours/Week Part Time Status –

20-29 Hours/Week

Total

Premium

2019

Wellness

Discount

2018

Wellness

Discount

2019

Regular

2018

Regular

2019

Wellness

Discount

2019

Regular

Employee Only $903.72 $115.84 $109.18 $144.80 $141.93 $397.47 $415.51

Employee+Spouse $1,552.51 $312.00 $295.32 $390.00 $383.91 $678.19 $733.21

Employee+Child(ren) $1,453.21 $280.32 $258.52 $350.40 $336.08 $615.23 $663.73

Employee+Family $2,134.64 $496.48 $468.58 $620.60 $609.16 $912.89 $1,002.52

New Business

The HR Team organized the annual Hospital Holiday party. With almost 400 employees,

physicians and their spouses in attendance, this event was a huge success. Many thanks to Melia

Anderson for organizing this event.



HR Report

December 20, 2018

Page 2 of 10

The Workplace Violence Committee recently completed the first round of annual staff training

on workplace violence prevention and response. This included training the entire hospital

through HealthStream online as well as a select group of over 100 employees in “high risk”

departments for a hands-on de-escalation training. The Workplace Violence training has also

been incorporated into new hire orientation to ensure all new hires understand the hospital’s

workplace violence plan and procedures in the event of an emergency. The Workplace Violence

Committee has been meeting for over a year, however I recently took over as Chair. The above-

mentioned training is a new annual requirement for all staff and there are a number of other

communication initiatives the committee will be undertaking to ensure all staff, patients, and

visitors are protected in the event of a workplace violence event.

Report Detail

People 18 Open Posted Positions as of December 12, 2018:

10 full-time positions

0 part-time positions

4 per diem position

4 physician positions

Three-month trend report:

Category Sept 2018

Oct 2018

Nov 2018

Nov 2017

Active Employees (FT, PT, Per Diem & Seasonal) 390 381 389 396

Inactive Employees 9 14 11 8

# of Active, FT & PT Employees only** 311 311 315 312

# of Active Part Time Employees 13 13 13 12

Paid FTE’s 318 314.8 318.1

Clinical Travelers 5 5 5 3-Month 5 Posted FT/PT Positions (excluding

physicians) 11 11 14 Total 22

Total Applications Received 57 78 49 184 103

Total Job Offers 5 17 10 32 18

FT/PT Employees Hired (per diems) 1(2) 4(1) 6 (8) 11 CHA 8

FT/PT Separations (per diems) 3(1) 5(3) 2 (5) 10 Average* 5

FT/PT Turnover Rate % .95% 1.61% .63% 3.19% 3.3% 3.2%

FT/PT Hire Rate % .32% 1.29% 1.9% 3.51% 3.4% 2.6%

Average FT/PT Vacancy Rate % 2.8% 2.8% 2.5% 2.7%*** 4% 5.6%

*CHA Average for Southern California from “Allied for Health Quarterly Turnover and Vacancy Report, 1Q2018”

Turnover and hire rates are both sums and the vacancy rate is an average.

** Excludes all per diem staff and seasonal staff

*** This value represents an average.



HR Report

December 20, 2018

Page 3 of 10

Employee Health Report

Wellness Challenge

November’s Wellness Challenge marked the beginning of our traditional Maintain No Gain in

which employees are encouraged to fight the weight gain battle that typically occurs during the

holiday season. They will have three weigh-ins – one in each month of November, December,

and January. 45 employees weighed-in in November.

Ergonomics

There were 6 ergonomic assessments done in November.

Do Not Work List

There was 1 person on the Do Not Work list for November.



HR Report

December 20, 2018

Page 4 of 10

Work Injuries

There were two work injuries in October.

Injury/Illness Department Action Saw MD?

11/8/18 Burning of the eyes

due to smoke in the

office and stairwell.

Population Health John Chisum called the

building landlord who

contacted the new tenant

who had been smoking.

Yes. Work

comp claim

filed.

11/14/18 Employee had a

syncopal event after

assisting with a

procedure.

Women’s Health Clinic Employee was evaluated in

the ED. EH Coordinator

spoke with employee who

reports a similar incident

before that occurred outside

of work. Employee followed

up with Dr. Ward. Employee

did not wish to file a work

comp claim.

Yes. ED and

FMC.

11/16/18 Employee

complaining of dry,

irritated eyes.

Population Health Humidifier purchased. John

Chisum has contacted the

landlord asking him to check

the filters and possibly add a

charcoal filter media.

No.

11%

27%

19%

12%

8%

4%

19%

Employee Injuries 2018

Blood/Body Fluid Exposure

Trips, Slips & Falls

Repetitive Motion

Strain or Injury, NOS

Pushing, Pulling

Manual/Patient Handling

All Other



HR Report

December 20, 2018

Page 5 of 10

Modified Work Duty

There are two employees on modified work duty. One is on reduced hours. The other is able to

continue working in one area but there is no available modified work in the other department this

employee works in.

Financial

Budget: The Human Resources department is currently favorable to the budget by $51,447.

Employee Health is currently favorable to the budget by $10,176. The Community Relations

Department is currently favorable to the budget by $13,445. The Fund Development Department

is currently favorable to the budget by $3,213.

Health Plan

Monthly Census: 266 employees, 326 dependents, 592 total

November 2018: Total paid claims of $441,631. Non-domestic claims are 59.5% of total claims

or $262,605 and result in a 143.1% loss ratio compared to AIG contracted rates for the month.

This is the 11th month of the plan year and of the ISL contract, 1 claimant has exceeded the ISL

deductible of $175,000 by $199,000 totaling $379,488 excluding an Anthem/DHS overpayment

of $112,085 paid directly from Anthem on December 2, 2018.

Plan year through November 2018:

Total non-domestic paid claims of $1,239,938 vs. expected contract claims of $2,014,120 results

in a loss ratio of 61.6%, including large claims. Year-to-date average claim costs are $906.49 per

22%

34%11%

11%

0%0%

22%

Employee Injuries Fiscal Year 2019

Blood/Body Fluid Exposure

Trips, Slips & Falls

Repetitive Motion

Strain or Injury, NOS

Pushing, Pulling

Manual/Patient Handling

All Other



HR Report

December 20, 2018

Page 6 of 10

employee per month excluding large claims. 95.1% of all claims are between $0 and $1,000 and

represent 20.8% of total paid claims.

Mammoth Hospital paid claims account for 47.1% of claims year to date. This is higher than

2017’s share of 46.5%. Anthem’s network discounts year to date are 57% of all eligible costs,

lower than 2017 plan year’s discounts of 54.2%.



HR Report

December 20, 2018

Page 7 of 10



HR Report

December 20, 2018

Page 8 of 10

Recruitment

*This graph represents all hires (including per diem, seasonal, FT/PT).

Employee Referral39%

Other (Indeed, newspaper, niche

websites)26%

Hospital website21%

Family/Friend14%

Hires by Source since June 2016



HR Report

December 20, 2018

Page 9 of 10

Community Relations

Priorities: Producing our Heartbeats newsletter was one of the top priorities this month.

Distribution for this publication this season is 2,400 inserted in the Mammoth Times (December

27th) and 6,000 inserted in the Inyo Register (December 29th). Copies are also being mailed to all

local PO Boxes. Topics covered included a welcome to our new CEO, a feature on 50 years of

the Mammoth Hospital Auxiliary, and spotlights on spiritual care, population health, and new

Board members.

Departmental Projects:

Ehren is updating all

print material throughout

the hospital, including

new clinic instruction

documents for General

Surgery for all surgical

procedures the

department provides.

Website Updates: This

month’s focus was on

the patient portal page.

Ehren has been working

closely with the Patient

Portal team to add more

clear and user-friendly

instructions on how to

sign up. This involved producing a video tutorial on how to sign up, posting on our YouTube

channel and embedding the link on our site.

Sponsorships: Donating helmets to this year’s Whiteout Extravaganza put on by Disabled

Sports Eastern Sierra.

Print Advertising: Mammography Promotion / Nursing Jobs / Inyo Register Medical Directory

Ad

Social Media: Our top Facebook post this month was a post sharing the fresh snowfall with a

view of the hospital from the street. This post reached 4,848 people, had 712 reactions (likes and

comments) and was shared 45 times! The same photo was shared on Instagram and received 136

likes!



HR Report

December 20, 2018

Page 10 of 10

Mammoth Hospital Foundation

The Foundation just completed sending out a 3,000+ letter annual mailing campaign seeking

funding for the Dental and Specialty Clinic Expansions. This is the first Foundation mailing of this

size. We are eager to see what kind of results it garners.

In addition, the Mammoth Foundation Board met in November to review information from two

conferences attended by the Foundation Coordinator. Based on discussions in that meeting, it was

determined that the Foundation Coordinator would initiate an Employee Giving campaign starting

with the Management Team.

At the November Management Team meeting, Talene presented to the group about the need for

the Foundation and the current Dental and Specialty Clinic Expansions. Members of the Senior

Administration and Management teams have stepped up with contributions totaling over $11,000

thus far. The goal is to reach $15,000—the amount needed to adopt a room in the new Specialty

Clinic.

Lastly, we recently completed and installed the donor wall display in order to thank all of the

tomosynthesis fundraising donors. It is in the room with the actual tomosynthesis machine. This

wall display came out extremely well and will greet every patient having a mammogram in this

room. I encourage the Board to come to the upcoming open house to see the new machine and the

plaque. We will be sending out information on this event soon.



CEO Report

December 20, 2018


________________________________________________________________________________________________________






FROM: Tom Parker, CEO

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

As of the writing of this report I have completed my second week as CEO. I am most grateful for

the warm reception I have received from the Board, medical staff, management team, employees,

and members of the community. Much of my schedule has been, and continues to be,

introductory meetings and I am enjoying learning about our wonderful community and how the

hospital successfully fulfills its vital role in supporting area residents and guests.

To you, the Board, and Gary Myers I express my thanks for your wisdom, plus Gary’s

willingness to allow for an overlap period. Gary is providing me with a wealth of information

and advice and I expect I will continue to have questions for some time to come.

My wife Kristen and I are thrilled to be here and introduce our family to Mammoth over

Christmas and New Year’s.

Medical Staff

Please refer to Dr. Burrows’ report on medical staff recruitment containing information on

completed and pending additions to the medical staff in Urology, Pediatrics, OB/GYN, and

Anesthesia.

People

The management team and Dr. Swisher recently completed a day and a half of training on Just

Culture. The Just Culture methods are based on understanding incidents by focusing on systems

issues and organizational culture rather than individuals. It recognizes that humans are fallible

and our work as a management team is to develop and adhere to systems and processes that

support individuals by creating environments with barriers to error. Attendees completed

evaluation of four case scenarios based on actual events at other hospitals. We were trained to

evaluate incidents using the Just Culture Algorithm, which systematically guides the evaluation

process through a number of inquiries about the event and leads to conclusions about risk,

reckless behavior, coaching, support of employees, and/or punitive action.




CEO Report

December 20, 2018

Facilities

The chiller unit providing cold air to the main server room failed on December 8. Facilities and

IT teams did an amazing job in establishing temporary chilling capability, bringing systems back

on line, and repairing the unit. Jeff McMillan, Chief Engineer, traveled to multiple suppliers in

southern California to obtain parts. With the repair completed by the Facilities team, they report

that the chiller unit is now in excellent working condition.

Finance

In November, cash declined $1.3m to $53.3m due to payments for the new mammography

machine, Cerner, and PRIME intragovernmental transfer. Gross revenue was $8.6m which is

lower than budget by $382k but higher than prior year by $103k. Volumes were 10% lower than

budget for inpatient days and case mix index continues to run higher than last year. Inpatient

surgeries were 31, one over budget. Outpatient surgeries were 81, 11 under budget. ED visits

were 500, 23 less than budget. Clinic visits were on budget. Expenses exceeded budget by less

than 1% with Salaries, Benefits, and Pro Fees coming in under budget and Contract Services,

Supplies, and Other Services coming in over budget. Net gain was $52k compared to the budget

of $394k and net margin YTD is 1.6%.

Respectfully submitted,

Tom Parker, CEO



MEMORANDUM

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


TO: The Board of Directors

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

SUBJECT: Financial Statements for four months ended November 30, 2018

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

This memorandum presents an overview of Mammoth Hospital operations.

BALANCE SHEET

The November month end Cash balance was $53.3 million – $1.3 million lower than October due

to large payments for the new mammography machine, Cerner payment and PRIME

intragovernmental transfer (match received in December 2018).

Net Patient Accounts Receivable was $10.4 million which is consistent with prior month (see CFO

report in the Consent Agenda for more information)

Due from third party payers increased by $587 thousand due to receipt of RHC reconciliation

monies ($103 thousand) and IGT transfer to State for PRIME PY14 (received double in December).

Prepaid expenses increased by $260 thousand mainly due to Cerner invoices recorded

Other current assets increased due to monthly Mono county revenue accrual

Equipment increased by $260 thousand mainly due to the purchase of the mammography

machine ($391 thousand) offset by a reclass.

FINANCIAL INDICATORS

Cash Collections in November were $5.0 million; below goal of $5.4 million (November

collections are historically lower). YTD collections are $30.2 million compared to the goal of

$28.1 million and prior year of $24.6 million.

Gross AR days continue to decrease each month with November ending at 69.9 (65 goal)

AR over 120 days increased to 32.4% at November month end compared to 28.8% in October -

target is to be under 25%

Gross revenue was $8.6 million in November which is lower than budget by $382 thousand but

higher than prior year by $103 thousand



Financial Report

December 20th, 2018 VOLUMES

Month of November summary:

Inpatient days were 90 – lower than budgeted at 100, and lower than last year’s inpatient days at

125. Case Mix index was 1.42 which is similar to October but still higher than the prior year

Inpatient surgeries were 31, higher than budget of 30

Outpatient surgeries were 81 - 11 cases lower than budget and prior year

o Majority of surgeries (66%) in November were Orthopedic cases, 9% General surgery

cases

o Endoscopies & Colonoscopies were 16 – 9 below budget (however YTD the case volume

has exceeded budget)

Emergency Department visits in November were 500 – slightly lower than budget by 23

Clinic visits were 3,848 were at budget for the month.

INCOME STATEMENT

Month of November

Revenue:

Total Gross Revenue of $8.6 million was $382 thousand lower than budget

Total Operating Revenue was $5.3 million which is $271 thousand lower than budget

Contractuals and allowances against Gross Revenue:

o The actual collectable revenue was 61.6% of Gross Charges which is at budget.

November 2018 Expenses:

OPERATING EXPENSES Current Budget Variance %

Variance Brief Comments

Salaries 1,785 1,842 56 3% Lower than budget due to Thanksgiving holiday

Benefits 694 793 99 12% Lower employee claims

Professional services 1,217 1,286 69 5% Aligned with lower professional revenue

Contract services 115 62 (53) -85% Several travellers in Lab, Med Surg, L&D and Patient Accounting

Supplies 617 589 (29) -5%

Services 822 638 (184) -29%Higher than budgeted due to Cerner expenses, IT expenses and maintenance

expenses

Total Expenses $5,250 $5,210 (41)



Financial Report

December 20th, 2018

Net Gain

November’s net gain was $52 thousand compared to a budgeted gain of $394 thousand

Year to Date

Total Gross Revenue of $47.6 million is higher than budget by $3.4 million and $4.4 million higher

than last year at this time (major increase in inpatient revenue due to higher inpatient surgeries

and higher patient days and length of stay)

Total Operating Revenue (collectable revenue) is at $27.7 million which is at budget and $994

thousand higher than last year

o The additional gross revenue is not converting to collectable revenue due to the payer

mix. All of the increase in gross revenue is in the government payers which do not pay

as well as commercial payers.

Total Operating Expenses of $27.2 million are $905 thousand higher than budget, and $1.7

million higher than prior year

o Supplies represent the largest monthly and YTD unfavorable variance. YTD Supplies

expense of $3.4 million is $638 thousand higher than budget.

Year to date Net Gain of $446 thousand or 1.6% Total Margin which is $735 thousand lower than

budget and $620 thousand lower than last year

12/11/2018

SOUTHERN MONO HEALTH CARE DISTRICT

Comparative Balance Sheet - November 30, 2018

Unaudited Unaudited Audited

November 30, October 31, Prior Month June 30,

ASSETS 2018 2018 Change 2018

CURRENT ASSETS:

Cash (135 days operating expenses) $25,219,786 $25,154,719 $65,067 $19,609,830

Cash (reserved for building projects) 18,285,317 19,709,410 (1,424,093) 23,909,594

Investments 9,833,921 9,819,496 14,425 9,825,829

Total Cash 53,339,024 54,683,626 (1,344,601) 53,345,253

Patient accounts receivable 22,181,839 22,994,309 (812,469) 26,486,857

Less: Allow. for bad debts and contractuals (11,805,322) (12,751,052) 945,730 (13,962,204)

Net patient accounts receivable 10,376,518 10,243,256 133,261 12,524,652

Inventory 1,808,522 1,788,399 20,123 1,779,165

Due to from third party payers 779,648 192,364 587,284 180,659

Prepaid expenses & deposits 798,820 538,836 259,984 673,375

Other current assets 1,999,728 1,627,057 372,671 269,214

Total Current assets 69,102,260 69,073,539 28,722 68,772,318

ASSETS LIMITED AS TO USE:

Bond funds held in trust by Mono County:

Mono Co Bond Capital Appreciation Fund 8,575,953 8,575,953 0 8,530,645

Debt service fund 160,924 160,924 0 1,409,910

Restricted by contributors 152,939 159,325 (6,386) 151,110

Total Assets Limited As To Use 8,889,817 8,896,203 (6,386) 10,091,665

PROPERTY, PLANT & EQUIPMENT:

Land and improvements 7,768,033 7,768,033 0 7,768,033

Buildings and improvements 53,937,274 53,937,274 0 53,849,263

Equipment 31,424,396 31,164,671 259,725 29,683,142

Construction-in-progress 678,436 600,758 77,678 573,488

Total Property, Plant and Equipment 93,808,139 93,470,737 337,402 91,873,926

Less: Accumulated depreciation (50,866,169) (50,475,885) (390,285) (49,070,243)

Less: Accumulated amortization (2,069,550) (2,065,997) (3,553) (2,051,785)

Net Property, Plant and Equipment 40,872,420 40,928,855 (56,435) 40,751,898

Total Assets $118,864,498 $118,898,596 ($34,100) $119,615,881

Page 1

12/11/2018


Comparative Balance Sheet - November 30, 2018

Unaudited Unaudited Audited

November 30, October 31, Prior Month June 30,

LIABILITIES 2018 2018 Change 2018

CURRENT LIABILITIES:

Accounts payable and accrued expenses $2,686,826 $2,851,414 ($164,588) $2,746,157

Accrued payroll-related liabilities 3,389,163 3,267,578 121,585 3,962,878

Patient refunds 532,798 676,353 (143,554) 328,948

Due to third party payers 0

Accrued interest on long term obligations 157,786 118,073 39,713 216,268

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

Health plan IBNR 568,000 568,000 0 602,000

Total Current liabilities 8,464,574 8,611,418 (146,844) 8,871,251

LONG-TERM DEBT:

Unamortized bond premium 1,140,734 1,151,403 (10,668) 1,194,076

Capital appreciation interest payable 8,858,473 8,780,381 78,092 8,468,014

General Obligation Bonds 13,639,555 13,639,555 0 14,769,555

Long-term debt - - 0 -

Total long term debt 23,638,762 23,571,339 67,424 24,431,644

Total Liabilities 32,103,336 32,182,757 (79,421) 33,302,895

NET ASSETS:

Invested in capital assets net of related liabilities 16,103,658 16,227,516 (123,859) 15,305,254

Restricted - expendable for specific operating activities 152,429 158,751 (6,321) 150,589

Restricted - expendable for capital acquisitions 0 0 0 0

Restricted - expendable for debt service 8,736,878 8,736,878 0 9,940,555

Unrestricted 61,321,851 61,198,057 123,794 53,023,508

Year to date earnings 446,346 394,639 51,707 7,893,079

NET POSITION: 86,761,161 86,715,840 45,321 86,312,985

Total Liabilities and Net Position $118,864,498 $118,898,597 ($34,100) $119,615,881

Page 2


Statement of Revenues & Expenses - November 30, 2018

Prior Month Actual Budget

Variance to

Budget Prior Year

Variance to

Prior Year OPERATING REVENUE Actual Budget

Variance to

Budget Prior Year

Variance to

Prior Year

(000s omitted)/1000

$1,976 $1,926 $2,022 ($95) $2,021 ($94) Inpatient services $13,326 $10,023 $3,302 $9,921 $3,405

3,809 4,349 4,470 (121) 4,135 215 Outpatient services 22,091 22,170 (79) 21,416 675

1,360 1,561 1,678 (117) 1,557 5 Professional fees services 8,382 8,103 279 7,820 562

787 725 775 (50) 747 (22) Clinic services 3,830 3,906 (75) 4,024 (193)

7,931 8,563 8,945 (382) 8,459 103 Total Gross Revenue 47,629 44,201 3,428 43,181 4,448

(3,302) (3,122) (3,122) (0) (2,418) (704) Contractual & other discounts (21,239) (15,428) (5,811) (16,281) (4,958)

(180) (30) (138) 108 (132) 102 Charity write offs (496) (680) 184 (633) 137

(152) (321) (176) (146) (258) (64) Provision for bad debts 636 (868) 1,504 (561) 1,197

714 183 - 183 - 183 Prior Year Adjustments 897 - 897 448 449

5,011 5,272 5,510 (237) 5,652 (380) Net Patient Revenue 27,427 27,226 201 26,153 1,274

42 61 95 (34) 31 30 Other operating revenue 261 471 (210) 541 (280)

5,053 5,333 5,604 (271) 5,683 (350) Total Operating Revenue 27,688 27,697 (9) 26,695 994

OPERATING EXPENSES

$1,783 $1,785 $1,842 56 $1,762 (23) Salaries $9,088 $9,287 199 $9,109 21

834 694 793 99 590 (104) Benefits 3,929 3,974 46 3,910 (19)

1,172 1,217 1,286 69 1,207 (9) Professional services 6,443 6,401 (42) 6,003 (440)

152 115 62 (53) 78 (37) Contract services 655 458 (197) 350 (305)

591 617 589 (29) 711 94 Supplies 3,432 2,794 (638) 3,034 (397)

660 822 638 (184) 728 (94) Services 3,680 3,408 (272) 3,120 (561)

5,193 5,250 5,210 (41) 5,076 (174) Total Expenses 27,227 26,322 (905) 25,527 (1,700)

(140) 83 395 (312) 606 (524) OPERATING GAIN (LOSS)/1000 461 1,375 (913) 1,168 (706)

$376 $385 $347 (38) $344 (42) Depreciation & amortization $1,772 $1,745 (27) $1,452 (320)

($516) ($303) $47 ($350) $263 ($565) Operating Gain (Loss) after Depreciation ($1,310) ($370) ($940) ($284) ($1,026)

NON-OPERATING INCOME(EXPENSE)/1000

$0 $0 $0 - $0 - Gain (loss) on sale of property $0 $0 - 1 (1)

- - 9 (9) 30 (30) Donation income - 47 (47) 30 (30)

204 204 207 (4) 193 11 Bond property tax revenue 1,019 1,037 (18) 960 59

(116) (116) (112) (4) (114) (2) Bond interest expense (578) (559) (19) (568) (10)

353 236 194 42 192 44 Property tax revenue & interest income 1,236 968 269 983 253

9 30 48 (17) (80) 110 Interest expense 79 58 21 (55) 134

450 354 346 8 221 133 Total Non-Operating Income (expense) 1,757 1,551 206 1,350 406

($66) $52 $394 ($342) $484 ($432) Increase in net assets - net gain (deficit) $446 $1,181 ($735) $1,066 ($620)

-1.3% 1.0% 7.0% -6.1% 8.5% -7.5% Total Margin 1.6% 4.3% -2.7% 4.0% -2.4%

November-18 Year-to-Date

Page 3


Statement of Cashflows - November 30, 2018

October 31,

2018

November 30,

2018Current YTD

Operating Activities

Receipts from and on behalf of patients 5,730,093$ 4,623,708$ 28,975,223$

Payments to suppliers and contractors (2,458,401) (3,731,521) (16,014,720)

Payments to and on behalf of employees (2,522,178) (2,358,231) (13,624,581)

Other receipts 42,427 60,803 260,991

Net Cash from Operating Activities 791,942 (1,405,240) (403,087)

Noncapital Financing Activities

Property taxes received 379,644 379,644 768,218

Noncapital grants and contributions - - -

Net Cash from Noncapital Financing Activities 379,644 379,644 768,218

Capital and Related Financing Activities

Purchase of capital assets (1,172,722) (205,952) (1,934,213)

Principal payments on long-term debt (1,130,000) (1,130,000) (1,130,000)

Capital contributions - - -

Property taxes restricted to debt service 1,130,000 1,130,000 1,130,000

-

Net Cash used for Capital and Related Financing Activities (1,172,722) (205,952) (1,934,213)

Net Cash from Investing Activities

Purchases of investments

Maturity of Investments

Investment income 183,468 27,348 364,881

Net Cash (used for) from Investing Activities 183,468 27,348 364,881

Net Change in Cash and Cash Equivalents 182,331 (1,204,202) (1,204,202)

Cash and Cash Equivalents, Beginning of Period 53,611,088 53,611,088 53,611,088

Cash and Cash Equivalents, End of Period 53,793,419$ 52,406,886$ 52,406,886$

Reconciliation of Cash and Cash Equivalents

to the Balance Sheets

Cash and cash equivalents (including restricted cash)

in current assets $45,036,425 $43,677,994 $43,677,994

Cash and cash equivalents (including restricted cash)

in noncurrent cash 8,735,279 8,728,892 8,728,892

Total cash and cash equivalents $53,771,704 $52,406,886 $52,406,886

Reconciliation of Operating Income (Loss) to Net

Cash from Operating Activities

Operating income (loss) (524,488) (310,965) (1,352,412)

Adjustments to reconcile operating income (loss) to net cash

from operating activities

Depreciation and amortization 384,814 393,838 1,813,692

Changes in assets and liabilities

Receivables 1,417,699 (61,493) 2,146,976

Inventories 6,561 (20,123) (29,356)

Prepaid expenses and other (163,213) (632,655) (1,919,802)

Accounts payable and third-party settlements (424,655) (895,427) (454,470)

Accrued liabilities 174,223 121,585 (573,715)

Estimated liability for health care costs (79,000) - (34,000)

Net Cash from Operating Activities 791,942$ (1,405,240)$ (403,087)$

Page 4


Key Statistical Data - November 2018

Prior

Month Actual Budget

Variance

to Budget Prior Year

Variance

to Prior

Year Hospital Statistics Actual Budget

Variance

to Budget Prior Year

Variance to

Prior Year

31 30 30 30 Days in month 153 153 153

Acute Patient Days:

3 7 3 4 3 4 ICU Days 31 18 13 19 12

61 75 79 (4) 104 (29) Med/Surg & Telemetry Days 537 429 108 440 97

11 8 18 (10) 18 (10) Labor & Delivery Days 85 69 16 69 16

75 90 100 (10) 125 (35) Total Acute Patient Days 653 515 138 528 125

2.4 3.0 3.3 (0.3) 4.2 (1.2) Average Daily Census (ADC) 4.3 3.4 0.9 3.5 0.8

31.5% 27.7% 28.2% -0.5% 28.9% -1.2% % of IP Revenue to Ttl Revenue 34.5% 27.9% 6.6% 27.2% 7.3%

1.7 2.0 2.0 (0.0) 2.2 (0.2) Average Length of Stay (ALOS) 2.2 2.0 0.2 1.9 0.3

43 46 50 (4) 56 (10) Discharges 292 258 34 271 21

1.429 1.424 NA NA 1.256 0.168 Case Mix Index 1.456 NA NA 1.344 0.11

Other Key Hospital Statistics:

425 500 523 (23) 523 (23) ED Visits 3,485 3,565 (80) 3,565 (80)

303 250 367 (117) 375 (125) Observation Hours 1,780 2,718 (938) 2,900 (1,120)

5 5 11 (6) 11 (6) Deliveries 45 46 (1) 46 (1)

26 31 30 1 30 1 IP Surgeries 193 138 55 138 55

62 81 92 (11) 92 (11) OP Surgeries 370 370 - 370 -

88 112 122 (10) 122 (10) Total Surgeries 563 508 55 508 55

65 61 70 (9) 68 (7) MRI Procedures 361 358 3 355 6

111 89 105 (16) 127 (38) CT Scans 703 674 29 714 (11)

95 155 96 59 100 55 Mammography Procedures 350 411 (61) 391 (41)

104 133 96 37 91 42 Ultrasound 621 545 76 560 61

746 819 784 35 853 (34) Radiology 4,561 4,212 349 4,235 326

1,121 1,257 1,152 106 1,239 18 Total Imaging 6,596 6,201 395 6,255 341

5,926 5,587 5,478 109 5,495 92 Lab Tests 32,258 31,049 1,209 31,107 1,151

3,998 4,745 5,641 (896) 5,593 (848) Pharmacy Units 31,002 31,236 (233) 104,692 (73,690)

2,281 1,940 1,933 7 1,689 251 PT/OT Visits 10,283 10,357 (74) 9,412 871

Clinic Visits

1,649 1,600 1,513 87 1,513 87 Family Medicine clinic 8,221 7,643 578 7,643 578

186 188 150 38 84 104 Behavioral Health clinic 690 750 (60) 727 (37)

401 299 364 (65) 364 (65) Women's clinic 1,758 1,795 (37) 1,795 (37)

408 410 469 (59) 495 (85) Pediatric clinic 1,944 2,307 (363) 2,271 (327)

539 515 457 58 488 27 Ortho Mammoth clinic 2,640 2,302 338 2,506 134

285 246 232 14 243 3 Ortho Bishop clinic 1,245 1,120 125 1,167 78

156 116 168 (52) 85 31 Specialty clinic 787 998 (211) 529 258

68 61 70 (9) 59 2 Surgical clinic 373 350 23 194 179

445 413 425 (12) 476 (63) Dental clinic 2,206 2,033 173 2,040 166

4,137 3,848 3,848 (0) 3,807 41 Total Clinic visits 19,864 19,298 566 18,872 992

November-18 Year-to-Date

Page 5

Mammoth Hospital Mammoth Hospjtal

All Statistical Analysis Statistical Analysis

Budget

Dept # Dept Name Unit of Service Desc

Jul

2018

Aug

2018

Sep

2018

Oct

2018

Nov

2018

Budget

Nov 2019

Actual

Nov 2018

YTD

Total

YTD

Budget

% of change

to Budget

Level of

concern

6010 ICU Patient Days 13 3 5 3 7 3 3 31 18 75% 175%

6170 Med/Surg Patient Days 106 82 90 49 60 56 89 387 307 26% 126%

6170 Telemetry Patient Days 39 55 29 12 15 22 15 150 121 24% 124%

7400 L & D Patient Days 24 25 17 11 8 18 18 85 69 23% 123%

Total Acute Patient Days 182 165 141 75 90 100 125 653 515 27% 127%

6380 Observation Patient Days 18 15 18 13 10 15 16 74 113 -35% 65%

6380 Observation Hours 427 358 442 303 250 367 375 1,780 2,718 -35% 65%

6530 Nursery Patient Days 25 21 19 11 9 19 19 85 71 20% 120%

7400 L & D Pre-delivery hours 96 90 76 19 10 88 75 291 368 -21% 79%

7400 L & D Deliveries 14 10 11 5 5 11 11 45 46 -2% 98%

7080 Family Medicine Clinic Patient Visits 1,728 1,719 1,525 1,649 1,600 1,513 1,513 8,221 7,643 8% 108%

7080 Behavioral Health Clinic Patient Visits 79 109 128 186 188 150 84 690 750 -8% 92%

7050 Women's Clinic Patient Visits 325 398 335 401 299 364 364 1,758 1,795 -2% 98%

7090 Pediatric Clinic Patient Visits 339 400 387 408 410 469 495 1,944 2,307 -16% 84%

7160 Ortho Mammoth Clinic Patient Visits 424 615 547 539 515 457 488 2,640 2,302 15% 115%

7140 Ortho Bishop Clinic Patient Visits 213 249 252 285 246 232 243 1,245 1,120 11% 111%

7180 Specialty Clinic Patient Visits 194 184 137 156 116 168 85 787 998 -21% 79%

7110 Surgical Clinic Patient Visits 74 75 95 68 61 70 59 373 350 7% 107%

7060 Dental Clinic Patient Visits 469 479 400 445 413 425 476 2,206 2,033 8% 108%

Total Clinics 3,845 4,228 3,806 4,137 3,848 3,848 3,807 19,864 19,298 3% 103%

7010 ED Patient Visits 1,064 841 655 425 500 523 523 3,485 3,565 -2% 98%

7040 Ambulance Work days 21 23 19 23 21 21 21 107 107 0% 100%

7420 Surgery Minutes 14,835 15,285 17,145 11,985 12,555 14,733 13,635 71,805 62,623 15% 115%

7420 IP surgeries Procedures 46 51 39 26 31 30 30 193 138 40% 140%

7420 OP surgeries Procedures 70 74 83 62 81 92 92 370 370 0% 100%

7427 PACU Minutes 15,570 15,300 15,255 12,330 14,505 17,352 16,830 72,960 72,252 1% 101%

7500 Lab Tests 7,731 7,020 5,994 5,926 5,587 5,478 5,495 32,258 31,049 4% 104%

7590 EKG's IP Procedures 30 37 20 14 14 25 34 115 74 55% 155%

7590 EKG's OP Procedures 184 127 129 121 82 77 69 643 555 16% 116%

7641 Chemotherapy Patient Visits 12 16 7 17 9 20 20 61 131 -53% 47%

7710 Pharmacy Units 8,282 7,147 6,831 3,998 4,745 5,641 5,593 31,002 31,236 -1% 99%

7720 Respiratory Unique Patients 440 402 384 254 266 144 171 1,746 987 77% 177%

7630 Radiology Patient Visits 1,000 1,063 933 746 819 784 806 4,561 4,212 8% 108%

7635 Mammography Patient Visits 51 52 34 58 155 96 100 350 411 -15% 85%

7660 MRI Patient Visits 87 87 61 65 61 70 68 361 358 1% 101%

7670 Ultrasound Patient Visits 132 119 133 104 133 96 89 621 545 14% 114%

7680 CT Scan Patient Visits 199 170 134 111 89 105 116 703 674 4% 104%

Total Imaging Procedures 1,469 1,491 1,295 1,084 1,257 1,152 1,179 6,596 6,201 6% 106%

7770 Mammoth PT Visits 1,058 1,172 1,027 1,119 1,013 1,017 853 5,389 5,576 -3% 97%

7772 Bishop PT Visits 697 675 658 851 725 761 615 3,606 3,888 -7% 93%

7773 Bishop OT Visits 118 116 131 145 101 56 115 611 278 120% 220%

7790 Mammoth OT Visits 138 147 125 166 101 99 108 677 616 10% 110%

Total Visits PT/ST/OT 2,011 2,110 1,941 2,281 1,940 1,933 1,691 10,283 10,357 -1% 99%


Investments Summary - November 30, 2018

Certificates of Deposit (CDs)

Interest

RatePurchase Date Maturity Date Broker Cost Basis

Estimated Current

Market Value

Third Fed Svgs & Ln Assn Of 2.00% 11/24/2014 11/25/2019 Union Banc Investment Services 247,000 245,427

Capital One Bk Usa Natl Assn 2.10% 11/26/2014 11/26/2019 Union Banc Investment Services 247,000 245,417

Discover Bk 2.10% 11/26/2014 11/26/2019 Union Banc Investment Services 247,000 245,441

Goldman Sachs Bk USA NY 2.20% 11/26/2014 11/26/2019 Union Banc Investment Services 247,000 245,419

State Bk India NYC 2.20% 12/5/2014 12/5/2019 Union Banc Investment Services 247,000 245,617

Ally Bk Midvale UT 2.05% 11/24/2017 11/24/2020 Union Banc Investment Services 247,000 242,013

BMW Bk NA Salt Lake 2.05% 11/29/2017 11/30/2020 Union Banc Investment Services 247,000 241,944

American Exp Fed Svgs Bk 2.10% 12/5/2017 12/7/2020 Union Banc Investment Services 247,000 241,415

American Express Centrn 2.10% 12/5/2017 12/7/2020 Union Banc Investment Services 247,000 241,415

Capital One Natl Assn VA 2.10% 12/6/2017 12/7/2020 Union Banc Investment Services 247,000 242,124

Wells Fargo Bank Natl Assn 2.10% 12/8/2017 12/8/2020 Union Banc Investment Services 249,000 244,052

Sallie Mae Bk Slt Lake City UT 2.10% 12/13/2017 12/14/2020 Union Banc Investment Services 247,000 242,070

2,966,000 2,922,355

Government / Agency Securities

Federal Farm Cr Bks Bond 1.8% 1.80% 11/21/2014 11/12/2019 Union Banc Investment Services $5,011,900 $4,955,100

Federal Farm Cr Bks Bond 2.23% 2.23% 11/20/2017 11/15/2022 Union Banc Investment Services 2,000,000 1,944,500

$7,011,900 $6,899,600

$9,977,900 $9,821,955

Local Agency Investment Fund (LAIF)

Interest

Rate

Beginning

BalanceActivity Ending Balance

0.55% $43,837,474 ($400,000) $43,437,474 $43,437,474

Total Investments $53,415,374 $53,259,429


LAIF Investment

12/13/2018

Balance as of November 30, 2017 41,149,180

Withdraw 12/8/2017 (300,000)

Withdraw 12/15/2017 (200,000)

Withdraw 12/22/2017 (1,200,000)

Deposit 12/29/2017 850,000

Balance as of December 31, 2017 40,299,180

Withdraw 1/5/2018 (450,000)

Withdraw 1/12/2018 (250,000)

Interest 1/12/2018 123,400

Withdraw 1/19/2018 (1,100,000)

Deposit 1/26/2018 300,000

Balance as of January 31, 2018 38,922,579

Deposit 2/9/2018 150,000

Withdraw 2/16/2018 (950,000)

Deposit 2/23/2018 1,000,000

Balance as of February 28 2018 39,122,579

Withdraw 3/2/2018 (150,000)

Deposit 3/9/2018 900,000

Withdraw 3/16/2018 (1,000,000)

Deposit 3/23/2018 750,000

Withdraw 3/30/2018 (2,700,000)

Balance as of March 31 2018 36,922,579

Deposit 4/6/2018 1,300,000

Withdraw 4/13/2018 (100,000)

Interest 4/13/18 145,692

Withdraw 4/20/2018 (850,000)

Withdraw 4/27/2018 (850,000)

Balance as of April 30 2018 36,568,271

Deposit 5/4/2018 1,500,000

Withdraw 5/11/2018 (700,000)

Deposit 5/18/2018 350,000

Deposit 5/25/2018 450,000

Balance as of May 31 2018 38,168,271

Deposit 6/1/2018 600,000

Deposit 6/15/2018 3,500,000

Withdraw 6/22/2018 (600,000)

Withdraw 6/26/2018 (2,400,000)

Balance as of June 30 2018 39,268,271

Z:\BankAccounts\LAIF\LAIF Activity.xlsx


LAIF Investment

12/13/2018

Deposit 7/6/2018 3,500,000

Interest 7/13/2018 182,298

Deposit 7/13/2018 900,000

Withdraw 7/20/2018 (1,100,000)

Deposit 7/27/2018 500,000

Balance as of July 31 2018 43,250,569

Deposit 8/10/2018 1,000,000

Withdraw 8/17/2018 (800,000)

Deposit 8/24/2018 650,000

Withdraw 8/31/2018 (250,000)

Balance as of August 31 2018 43,850,569

Deposit 9/7/2018 900,000

Withdraw 9/21/2018 (150,000)

Withdraw 9/28/2018 (200,000)

Balance as of September 30 2018 44,400,569

Withdraw 10/12/2018 (600,000)

Interest 10/15/2018 236,905

Withdraw 10/19/2018 (100,000)

Withdraw 10/26/2018 (100,000)

Balance as of October 31 2018 43,837,474

Deposit 11/2/2018 400,000

Deposit 11/9/2018 150,000

Withdraw 11/16/2018 (200,000)

Withdraw 11/23/2018 (1,000,000)

Deposit 11/30/2018 250,000

Balance as of November 30 2018 43,437,474

Deposit 12/7/2018 850,000

Deposit 12/14/2018 1,350,000

Balance as of December 14 2018 45,637,474

Z:\BankAccounts\LAIF\LAIF Activity.xlsx

For Period Ended: November 30, 2018

Tables and Graphs

DRAFT

FINANCE COMMITTEE DRAFT December 18, 2018

Page 1

VOLUMEInpatient Volume

20.0

30.0

40.0

50.0

60.0

70.0

80.0

90.0

Admissions - All Excluding Nursery

Current Year Prior Year 2 Years Ago Budget

1.5

2.0

2.5

3.0

3.5

4.0

4.5

5.0

5.5

6.0

6.5

Average Daily Census - All Excuding Nursery


0

10

20

30

40

50

60

Inpatient Surgery Volume


Page 2

Outpatient Volume

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


20

30

40

50

60

70

80

90

100

110

Outpatient Surgery Volume


Page 3

REVENUEGross Charges

-

1,000

2,000

3,000

4,000

Thousands

Gross Inpatient Revenue


-

1,000

2,000

3,000

4,000

5,000

6,000

7,000

Thousands

Gross Outpatient Revenue


-

100

200

300

400

500

600

700

800

900

1,000

Thousands

Gross Clinic Revenue


-

500

1,000

1,500

2,000

2,500

3,000

Thousands

Gross Professional Fees Revenue


Page 4

Net Revenue

1,000

2,000

3,000

4,000

5,000

6,000

7,000

8,000

9,000

10,000Th

ousands

Net Patient Revenue


1,000

4,000

7,000

10,000

13,000

16,000

19,000

22,000

25,000

Net Revenue per Adjusted Patient Day


FY 2016 FY 2017 FY 2018 Nov-17 Jul-18 Aug-18 Sep-18 Oct-18 Nov-18

YTD FY

2019

Budget FY

2019

Payer Mix

Medicare 19.4% 18.5% 19.6% 21.1% 24.8% 27.2% 30.6% 31.2% 23.9% 27.5% 18.0%

Medi-Cal ** 22.9% 21.4% 21.6% 17.7% 24.4% 22.3% 26.9% 18.6% 24.3% 23.5% 22.0%

Blue Cross * 22.0% 22.1% 22.5% 32.2% 16.3% 22.5% 14.6% 22.4% 16.9% 18.4% 23.0%

Commercial * 28.8% 29.2% 28.3% 20.2% 27.2% 22.1% 23.3% 18.4% 24.2% 23.3% 29.0%

Self Pay ** 2.4% 2.9% 2.5% 2.2% 2.5% 3.3% 1.6% 3.1% 3.4% 2.7% 2.0%

Other * 4.4% 5.7% 5.5% 6.6% 4.9% 2.6% 3.0% 6.3% 7.2% 4.6% 6.0%

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

Page 5

Revenue Cycle

60%

70%

80%

90%

100%

110%

120%

130%

Cumulative Cash Collections as a % of Net Collectible Revenue


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

Ju

l

Aug

Sep

Oct

Nov

Dec

Jan

Feb

Mar

Ap

r

May

Jun

YT

D

2018

2017

2016

Th

ou

san

ds

Th

ou

san

ds

Monthly Collections

'Current Year" 'Year to Date" 'YTD Budget"

'Prior Year' 'Two Years Ago" 'Budget'

24

30

36

42

48

54

60

Millions

Cash Balance

Current Year As of June 30 Prior Year 2 Years Ago

50

100

150

200

250

300

350

Cash Days on Hand


Page 6

40.0

50.0

60.0

70.0

80.0

90.0

100.0

110.0

AR Days Outstanding - Gross


35.0

45.0

55.0

65.0

75.0

85.0

95.0

AR Days Outstanding - Net


0%

5%

10%

15%

20%

25%

30%

35%

% A/R > 120 Days

Current Year 'Prior Year' 2 Years Ago Budget

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

Blue cross $1,295,085 $482,833 $302,184 $50,692 $153,131 $2,283,925

Commercial 2,124,062 516,374 701,162 502,482 1,332,137 5,176,217

Medical 1,968,800 543,285 599,032 184,868 1,392,833 4,688,819

Medicare 1,843,398 232,560 187,609 148,527 425,921 2,838,015

Other 676,576 257,430 299,558 118,521 808,522 2,160,606

Self Pay 119,154 309,803 560,248 556,320 2,878,802 4,424,327

Total $8,027,075 $2,342,285 $2,649,793 $1,561,410 $6,991,346 $21,571,909

Percent of Dollars Over 120 Days 32.4%

Page 7

ExpensesSalaries, Wages and Benefits

-

500

1,000

1,500

2,000

2,500

3,000

3,500

4,000

Thousands

Salaries, Wages and Benefits


300

400

500

600

700

800

900

1,000

1,100

1,200

Thousands

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


-

5.0

10.0

15.0

20.0

25.0

30.0

35.0

40.0

Productive FTEs per Adjusted Occupied Bed


5,000

6,000

7,000

8,000

9,000

10,000

11,000

12,000

13,000

Labor Cost per Productive Time Equivalent


Page 9

Professional Fees, Services and Contracted Services

500

700

900

1,100

1,300

1,500

1,700Th

ousands

Professional Fees


(100)

(50)

-

50

100

150

200

250

Thousands

Contracted Services


-

200

400

600

800

1,000

1,200

Thousands

Services


Page 10

Supplies

200

300

400

500

600

700

800

900

1,000

Thousands

Supply Expense


400

900

1,400

1,900

2,400

2,900

Supply Expense per Adjusted Patient Day


Page 11

Week of the

MonthDate Time

3rd week January 17, 2019 8AM - 12PM

3rd week February 21, 2019 8AM - 12PM

3rd week March 21, 2019 8AM - 12PM

3rd week April 18, 2019 8AM - 12PM

3rd week May 16, 2019 8AM - 12PM

3rd week June 20, 2019 8AM - 12PM

3rd week July 18, 2019 8AM - 12PM

3rd week August 15, 2019 8AM - 12PM

4th week September 26, 2019 8AM - 12PM

3rd week October 17, 2019 8AM - 12PM

4th weekOctober 25, 2019

Strategic Plan Conference8AM - 12PM

3rd week November 21, 2019 8AM - 12PM

3rd week December 19, 2019 8AM - 12PM

2019 SMHD Board Meeting Calendar

Date Purchased Item Description Value Reason for Disposal

June 1, 2014 Mist Therapy system - Mammoth $ - Obsolete

June 1, 2014 Mist Therapy system - Bishop $ - Obsolete

? Acquired used from

Myers and Associates PT

in 2004 weighted pulley system $ -

Pulley Broken - not needed

in dept have 2

15 + years ago Old Staff BBQ $ - Was replaced

June 1, 2018 ABLATION UNIT, RF $ - returned for new unit

n/a Alarm, Blood Bank $ - not being used anymore

n/a CART, OTHER $ - not being used anymore

July 31, 2015 COMPRESSION UNIT, SEQUENTIAL traded in for new unit













n/a Light, Speculum obsolete

6/17/2016 NEBULIZER unable to locate

July 25, 2016 NEBULIZER unable to locate

July 25, 2016 NEBULIZER unable to locate

n/a OPHTHALMOSCOPE / OTOSCOPE unrepairable

October 2, 2015

SPHYGMOMANOMETER, ANEROID

(ARTERIAL PRESSURE) unrepairable

November 18, 2015 THERMOMETER (LAB) missing

November 18, 2015 THERMOMETER (LAB) missing

n/a

THERMOMETER, ELECTRONIC,

CLINICAL broken

n/a Tissue Processor replaced with new unit

Date Purchased Item Description Value Reason for Disposal Asset Tag:

02/23/09 Dell 960 (MAHO724PASS) N/A Obsolete 002215

04/08/15 Samsung SM-T700 N/A Screen broken 003795

11/24/15 Dell Optiplex 7020 (MAHOORTHODOC) N/A Obsolete 003919

Unknown Dell 3330dn printer N/A Feeder broken N/A

03/09/12 Dell 790 (MAHOLDRIGHT) N/A Obsolete 003441

07/01/14 Dell 7010 (MAHO724RAD) N/A Obsolete 003750

11/1/2012 Dell 790 (MAHOLDLEFT) N/A Obsolete 003566

4/26/2011 Dell 980 (MAHOADMITOUT) N/A Obsolete 003699

2/18/2011 Dell 980 (MAHOADMITOUT2) N/A Obsolete 003332

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.

December 20, 2018

Surplus District Property, Equipment and Supplies

board of directors monthly meeting agendamammothhospital.org/wp-content/uploads/minutes... ·...

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