public health trust financial recovery board

PUBLIC HEALTH TRUST FINANCIAL RECOVERY BOARD

COMMITTEE MEETINGS AGENDAS April 19, 2012

Ira C. Clark Diagnostic Treatment Center

1080 N. W. 19th Street Miami, Florida 33128


COMMITTEE MEETINGS SCHEDULE (April 2012)

LOCATION SITE Ira C. Clark Diagnostic Treatment Center (DTC)

1080 N. W. 19th Street Miami, Florida 33136

The Purchasing Subcommittee meeting is scheduled to begin at 7:15 a.m. and the Facilities Subcommittee meeting is scheduled to begin at 7:45 a.m. on Thursday, April 19, 2012. The Audit and Compliance Subcommittee meeting shall immediately follow the Facilities Subcommittee in the Diagnostic Treatment Center Conference Room 259, which will then be followed by the Standing Committee meetings.

Thursday, April 19, 2012

Subcommittees Time Conference Room Purchasing Subcommittee 7:15 a.m. to adjournment DTC 270 Facilities Subcommittee 7:45 a.m. to adjournment DTC 259 Audit and Compliance Subcommittee Immediately following the DTC 259 Facilities Subcommittee meeting Standing Committees Fiscal Committee Immediately following the DTC 259 Audit & Compliance Subcommittee meeting Joint Conference Immediately following the Fiscal DTC 259 & Efficiencies Committee Committee meeting Strategy & Growth Committee Immediately following the Joint DTC 259 Conference & Efficiencies

Committee meeting As of April 12, 2012

PURCHASING SUBCOMMITTEE

PUBLIC HEALTH TRUST FINANCIAL RECOVERY BOARD Purchasing Subcommittee Joaquin del Cueto, Chairperson Stephen S. Nuell, Vice Chairperson Michael Bileca Date, Time and Place April 19, 2012 – 7:15 a.m. to adjournment Ira C. Clark Diagnostic Treatment Center Conference Room 270

AGENDA Action Items: 1. Approval of the Previous Meeting Minutes (Joaquin del Cueto, Chairperson, Purchasing Subcommittee)

(a) * Meeting Minutes as of March 15, 2012

2. Review and Recommend Approval of the Purchasing Report (Rosa Costanzo, Vice President and Chief Procurement Officer, Strategic Sourcing and Supply Chain Management Division, Jackson Health System)

(a) * Purchasing Report as of April 2012

Informational Items: 3. *Monthly Report of Competitive Contracts Awarded or Renewed Under the Chief Procurement

Officer Authority in Accordance to Procurement Regulations – March 1, 2012 through March 31, 2012 (Fidel Alvarez, Manager, Procurement Management Department)

4. *Monthly Report of Non-Competitive Contracts Under $100,000 – March 1, 2012 through

March 31, 2012 (Fidel Alvarez, Manager, Procurement Management Department) 5. Key Performance Indicators (KPI’s) for Procurement Update (Rosa Costanzo, Vice President and

Chief Procurement Officer, Strategic Sourcing and Supply Chain Management Division, Jackson Health System)

Support document(s) will be distributed at the meeting.

Agenda item(s) noted with an asterisk (*) indicates that the supporting documents are attached.

1. Approval of the Previous Meeting Minutes

PUBLIC HEALTH TRUST FINANCIAL RECOVERY BOARD Purchasing Subcommittee Joaquin del Cueto, Chairperson Stephen S. Nuell, Vice Chairperson Michael Bileca Date, Time and Place March 15, 2012 – 7:15 a.m. to adjournment Ira C. Clark Diagnostic Treatment Center Conference Room 270

ATTENDANCE Purchasing Subcommittee Excused Joaquin del Cueto Michael Bileca Marcos Jose Lapciuc Stephen S. Nuell Jackson Health System Rosa Costanzo Mark T. Knight

Carlos A. Migoya Miami-Dade County Attorney’s Valda Christian Jeffrey Poppel

Eugene Shy, Jr.

Purchasing Subcommittee Meeting March 15, 2012 Page 2 Call to order With a quorum being present, the Purchasing Subcommittee meeting was called to order by Joaquin del Cueto, Chairperson at 7:24 a.m. ACTION ITEMS: 1. Approval of the Previous Meeting Minutes – February 13, 2012

Mr. del Cueto requested a motion approving the meeting minutes of February 13, 2012.

Mr. Lapciuc moved approval; seconded by Mr. Nuell, and carried without dissent.

2. Review and Recommend Approval – March 2012 Purchasing Report

Rosa Costanzo, Vice President & Chief Procurement Officer, Strategic Sourcing and Supply Chain Management Division, Jackson Health System presented for review and approval the March 2012 Purchasing Report. A detailed copy of the report was included in the agenda packet. Items from the Purchasing Report that was discussed: 2. (355873-KD) The Executive Office requests approval for a three-year contract award with

Two (2), One Year Options to Renew (OTRs), under a waiver of competition, to Reimbursement Advisory Services, LLC (“RAS”) for Medicare cost report and reimbursement consulting.

Reimbursement Advisory

Services, LLC. (RAS): $1,000,000

Estimated Contingency Payment: $1,000,000 Ms. Costanzo pointed out a correction to the item which required additional further review by the County Attorney’s Office and Risk Management Department. Mr. Knight provided an overview of Reimbursement Advisory Services, LLC (RAS’s) which primary focus is to file cost report recovery for Medicaid. Mr. Poppel confirmed contract pending vendor response to changes, as well as the sufficiency for waiver of insurance to the contract by Risk Management. Mr. Poppel stated that there is a conflict with the payment terms to the vendor in the contract which can be resolved, then due diligence by the County Attorney Office may be concluded. Mr. Nuell questioned if payment to vendor is contingent upon receipt of dollars by JHS. Mr. Poppel stated clarification needed is needed from the vendor regarding discrepancies in the contract. Mr. del Cueto requested that the matter be forwarded to the Fiscal Committee for approval contingent upon County Attorney’s completion of review.

Purchasing Subcommittee Meeting March 15, 2012 Page 3

5. (352407-TW) The Organ Transplant Center requests a new contract for organ air

transportation services for a period of one year (replacement purchase).

Florida Jet Services: $1,008,000 (for one year)

Total approved funding: $1,008,000

Mr. Migoya stated that Florida Jet Services is primarily owned by a personal friend, Mike Maroone, Chief Operating Officer of Auto Nation. Mr. Migoya stated that he has no interest in the company and was not involved in the process. For purposes of remaining transparent, Ms. Costanzo stated that conflict of interest forms were completed by anyone who was involved in the process. 6. (346859-MR) The Clinical Trials Department is requesting an agreement with CliniComp

Intl., Inc. for the implementation of their Essentris system for the Intensive Care Unit of the Ryder Trauma Center (grant pass through).

CliniComp Intl., Inc.: $1,294,983 (for three years) Total approved funding: $1,294,983

Ms. Costanzo stated that the item was a grant pass through, contingent upon receipt of the final vendor agreement with UM for JHS to procure and pay CliniComp Intl. Inc., which included reimbursements to JHS by UM. Ms. Costanzo further stated that final execution of the vendor agreement was being handled by the County Attorney’s Office in collaboration with Eve Sakran, Director of Clinical Research, and the Procurement Department. Ms. Costanzo mentioned if the vendor agreement is not executed by UM, the agreement with CliniComp Intl. Inc. would, therefore, not be executed. 7. (355872-MR) The Executive Office requests approval for a contract award to Healthcare

Financial Review Group, Inc. for the review of financial statements to determine potential Florida hospital assessment refunds and future savings for JHS as well as for the preparation of FY 2011 prior year report.

HealthCare Financial Review Group, Inc.: $1,000,000 (for five years) Estimated Contingency Fee: $1,000,000


Ms. Costanzo pointed out a correction to the item which is pending completion of Risk Management review. Eugene Shy, Jr., Assistant, Miami-Dade County Attorney, confirmed that a review of the item for legal sufficiency review was completed. Mr. Migoya commented on the vendor high credibility throughout the State. Personal references were also performed on the vendor. Mr. Nuell questioned if payment to vendor contingent upon receipt of funds by JHS. Mr. Shy stated that changes to the contract were recommended as it related to the receipt of funds by JHS before prior to payment. Mr. del Cueto inquired if funds were open for future auditing of overpayment with the possibility of having to return a portion of the funds that may be deemed paid to JHS in error, would JHS be able to recoup payment from individuals. Mr. Knight stated there was no recourse or recoup language notated in the agreement. Mr. Nuell requested that the County Attorney Office draft effective standardized recourse language for inclusion in contingency type contracts. Mr. Lapciuc questioned what would be expected given the volume could be the amount of money that can be recovered from previous billings on a go forward basis. Mr. Knight stated that the projected amount is $5 million for review and re-filing for years 1999 to 2011 to ensure the net revenue was properly assessed and included, respectively on a contingency basis, and prospectively under a fixed fee arrangement of approximately $30k annually that would not be contingency based. Mr. Knight further stated that the go forward projected annual savings is $300k to $400k on the assessment JHS paid to the State. Valda Christian, Assistant, Miami-Dade County Attorney shared a draft version of a contingency provision to be included in the contract language going forward to read as follows:

“If upon audit or other financial review, the Trust is obligated to refund any portion of the increased revenues received directly from the vendor’s performance of this contract, Trust and vendor shall reconcile payment to the vendor to reflect the final adjusted increased revenue received by the Trust from performance of this agreement. Said reconciliations shall take place no later than ____ days following termination or the expiration of this agreement. The reconciliation or related obligations hereunder shall survive termination or expiration of this agreement.” 8. (358351-KD) The Executive Office requests approval for a three-year contract award, under a

waiver of competition for Sellers Dorsey & Associates, LLC (“Sellers Dorsey”) for strategic advice and guidance in identifying and pursuing additional federal Medicaid revenues.

Sellers Dorsey & Associates, LLC: Monthly Payment - $2,500/month $90,000

(for three years) Estimated Contingency Fee: $6,300,000 (for three years) Total approved funding: $6,390,000


Ms. Costanzo stated that the monthly payment should read $7,500 retainer for the first year, totaling $90,000. Mr. Migoya pointed out that many of the past consultant fees were not contingency fees but were paid fixed fees for ideas that were implemented or not implemented. Mr. Migoya stated that going forward the consultant agreements would predominantly be contingency agreements. Mr. del Cueto pointed out the vendor registration was not completed. Ms. Costanzo stated that she will meet with the County Attorney’s Office to ensure roll out of vendor registration process is completed. 9. (356367-MR) The Executive Office requests a modification for additional time and funding

to the current contract with PricewaterhouseCoopers, LLC (“PwC”). PricewaterhouseCoopers, LLC: PHT Board approved amount: $ 9,998,560 (June 2010) Additional funding approved $ 907,738 under CPO Authority to allow for payment of invoices: (December 2011) This request for additional funding (Not to Exceed): $ 525,000

Total approved funding: $11,431,298 Mr. Nuell questioned if additional request for funding was included in the initial agreement. Mr. Knight and Mr. del Cueto explained that the initial agreement was for twenty-four months included three Scopes of Work (SOW). Mr. Knight stated that as the agreement with PwC was reaching an end, PwC needed to be reengaged to conduct quarterly reviews and address initial initiatives, as the debt service coverage requirements were not being met. Additionally, Mr. Knight stated that under the Procurement Policy, planned payments to be made are within the 10% variance under Chief Procurement Officer (CPO) authority, not to exceed a million dollars, allowed above the original purchase order issued and approved by the Board. Mr. del Cueto expressed concern regarding the increase of retroactive items presented to the Board for approval and requested advance notification when items are forthcoming. Mr. Knight reminded everyone that a separate purchase order depletion tool created by JHS IT Department was implemented and distributed to management that provides an update on invoices relative to the total purchase order and that will assist with identifying and reducing retroactive approvals. Mr. Knight stated that the Periscope tool is a broader product currently under review by the IT Department, Procurement and the Chief Transformation Officer to determine whether or not to move forward with the tool. Mr. Lapciuc questioned the terms of the purchase orders. Mr. Knight explained the terms of the purchase orders. Following the discussion Mr. Lapciuc requested to receive in the next two to three months, a report regarding purchase order security and controls, and next steps to begin the use of automated purchase order controls.

Purchasing Subcommittee Meeting March 15, 2012 Page 6 3. Resolution Recommended to be Approved

Resolution authorizing and ratifying emergency procurement in the amount of

$142,013 to DST Health Solutions, LLC for payment of past due invoices for support and maintenance as well as the implementation of the 5010 upgrade to the current managed care system utilized by the JMH Health Plan; and the approval of continued maintenance and support services of the system for a one year period in the amount of $216,142.20

Following the review of agenda item 2 (February 2012 Purchasing Report), and agenda item 3 (resolution recommended to be approved) Mr. del Cueto requested a motion to approving the items.

Mr. Nuell moved approval seconded by Mr. Lapciuc, and carried without dissent.

INFORMATIONAL ITEMS: 4. Monthly Report of Competitive Contracts Awarded or Renewed Under the Chief

Procurement Officer Authority in Accordance to Procurement Regulations – February 1, 2012 through February 29, 2012

There was no significant activity to report. A copy of the report was included in the agenda packet.

5. Monthly Report of Non-Competitive Contracts Under $100,000 – February 1, 2012 through

February 29, 2012

There was no significant activity to report. A copy of the report was included in the agenda packet.

6. KPI (Key Performance Indicators) for Procurement Update

Ms. Costanzo presented the monthly update of Procurement/Strategic Sourcing KPI’s. The report highlighted the cycle time improvement with one sole source outlier agreement under Pharmacy for Central Admixture Pharmacy Services, Inc. (CAPS) requiring complete detail for resolution.

Purchasing Subcommittee Meeting March 15, 2012 Page 7 Other Discussion

Bid Protests Ms. Costanzo stated that preliminary work on bid protest procedures have been initiated but currently not in final form. Ms. Costanzo further stated that a draft resolution has been completed pending additional review and changes by the County Attorney’s Office and Procurement Team. Further discussion and meeting will be scheduled with Hugo Benitez and the County Attorney’s Office regarding fee increases on bid protests. Mr. Nuell questioned if there was a need for a bid protest policy and what is the process for other not-for-profit and profit institutions. Mr. del Cueto questioned the process for other public institutions. Ms. Costanzo stated that she will conduct a research regarding the questions raised and report back to the Subcommittee.

Ms. Costanzo provided an update on release of information, competitive process under protest by Healthport, which was recommended under Chief Procurement Officer’s authority (CPO) to move forward with the award to Supna Healthcare Solutions after the County Attorney’s Office consultation. The Subcommittee supported Ms. Costanzo decision.

Adjournment The meeting of the Purchasing Subcommittee adjourned at 8:39 a.m. Transcribed by Terry D. Brown Executive Assistant Strategic Sourcing & Supply Chain Division

2. Review and Recommend Approval of the Purchasing Report

April 2012 PHT Financial Recovery Board 1

PUBLIC HEALTH TRUST FINANCIAL RECOVERY BOARD PURCHASING REPORT

APRIL 30, 2012

TO: PUBLIC HEALTH TRUST FINANCIAL RECOVERY BOARD FROM: PROCUREMENT MANAGEMENT DEPARTMENT The following recommendations are made in accordance with the Trust’s “Procurement Policy” and it’s implementing “Procurement Regulation.” This report includes competitively solicited contract awards over $1,000,000, waivers of formal competition over $100,000 and other categories for Board approval as prescribed by the Procurement Policy/Regulation. The entire report has been screened and assembled by the Procurement Management Department with the direct participation of the Administrator and staff, all subject to review by the Vice President, Strategic Sourcing Division, consultation with the President as needed, and review for legal sufficiency by the County Attorney’s Office. SECTION I. AWARDS UNDER INVITATIONS TO BID (ITB’s) This section consists of awards under competitively solicited Invitations to Bid (ITB’s) over $1,000,000. No items to report. SECTION II. AWARDS UNDER REQUESTS FOR PROPOSALS (RFP’s) This section consists of awards under competitively solicited Requests for Proposals (RFP’s) over $1,000,000. 1. (326415-HT) The Revenue Cycle Division, Practice Management Physician

Services Department, requests approval to award a contract to PST Services, Inc., resulting from a competitive Request for Proposals (RFP 11-10055-HT) for professional fee billing and collection services.

PST Services, Inc.: $ 1,685,085/Year (for three years)

Total approved funding $ 5,055,255


SECTION II. (cont’d.) Background

This competitive procurement was solicited and administered by the Procurement Management Department through a competitive Request for Proposal process (RFP #11-10055-HT) that was publicly advertised on 11/9/2011. The RFP document was distributed to forty-nine (49) firms. Responses were received from three (3) of these firms: Acadiana Computer Systems, Inc., PST Services, Inc. (A McKesson Company and legal entity for McKesson Revenue Management Solutions) and NCO Financial Systems, Inc. These three vendors submitted proposals (all within the competitive range) and were shortlisted and invited to provide oral presentations. Prior to the presentations but after preparation of the shortlist, the Selection Committee was provided with the pricing portion of the proposal responses which had initially arrived in a sealed envelope. The Selection Committee was able to discuss the individual proposal responses and pricing with each of the Proposers and at the end of the oral presentations, the Selection Committee rescored all responses. The highest ranked of the three was PST Services, Inc. The project manager for the resulting contract will be Ronald Loveless, Corporate Director of Practice Management for Physician Services. The proposed vendor will provide the requested services to the Trust’s Emergency Department (ED), Emergency Care Center (ECC), the Urgent Care Center (UCC), the Breast Center, Anesthesia Department, JHS satellites and the community hospitals governed by JHS. PST is the incumbent vendor and has a proven record with the Trust. The company has been providing collection services to the Trust for the last six years under the current contract which expires April 30, 2012. Pricing submitted by this vendor for the proposed contract was substantially lower than that of the existing contract and is projected to provide considerable savings over current expense. During negotiations, the pricing was reduced from that initially proposed on the original RFP response. The negotiation Team introduced a sliding scale that would reduce the already low fees and recommended an incentive greater than the standard rate for collection of professional fees that traditionally prove to be challenging to collect. The best and final offer reflected the Negotiating Team’s recommendation in the best interest of both the Trust and the Contractor. Recommendation

The three (3) voting members on the Selection Committee, in collaboration with Procurement Management, have prepared the final contract and this award recommendation in accordance with the Procurement Regulation.


SECTION II. (cont’d.)

The following chart provides the composite scores:

Selection Committee Composite Score Sheet

(Evaluation of “Best and Final Offers”)

RFP 11-10055-HT, Physician Billing and Collection Services Procurement Management Department

VENDORS

EVALUATION CRITERIA MAXIMUM

POINTS AVAILABLE

Acadiana PST NCO

Technical Considerations 40 28 38 18

Vendor Qualifications including Corporate Past Performance & Key Personnel

30 18 27 10

Price Considerations 25 10 21 9 Partnership Strength 5 4 5 3

TOTAL: 100 60 91 40

Additional Considerations

SBE Prime Vendor N/A Not applicable Local Preference N/A Not applicable

GRAND TOTAL: 60 91 40

The Three-day bid protest filing period has passed and no protest to this award recommendation was filed. This award recommendation represents procurement savings of $42,535 (proposer’s initial offer minus final negotiated Best and Final Offer [BAFO]) for the initial three-year term for all contracted services. The contract also provides the option to renew for two (2) one-year periods. Based on the final terms and pricing of the new contract, Jackson will capture estimated cost reductions of $890,082 over the initial three-year term (current contract spend minus the projected new contract spend). PST’s fees will be percentage based and flat fee depending on the type of account the vendor will be processing and collecting, and contract will be funded as a result of the company’s collection efforts. Additionally, incentives are built into the new contract to encourage PST to collect a greater number of accounts. The primary concern during negotiations related to the data being encrypted. However, PST agreed to encrypt all data in their servers for the safety of the patients and per the Joint Commission privacy rules and regulations.


SECTION II. (cont’d.) This contract can be terminated for convenience with a thirty (30) day notice and includes Living Wages, UAP and OIG provisions. The new contract will also include new business process improvements in the area of data encryption and the integration with existing systems such as Cerner and Allscripts. Additional data is also provided in the Selection Committee Composite Score Sheet below. (M. Knight) SECTION III. AWARDS UNDER THE COMPETITIVELY SOLICITED CONTRACTS OF OTHER PUBLIC PROCUREMENT ENTITIES This section consists of awards over $1,000,000 under competitively solicited (“ITB,” “RFP” or equivalent) contracts of other public and nonprofit entities. 2. (363846-CS) The Corrections Health Services Department (CHS) requests approval to award a contract for a period of Thirty Eight (38) months to Diamond Drugs, Inc for the provision of Correctional Pharmaceutical Services and staffing. Due to the urgency, identified by CHS, related to this procurement, Procurement Management proposes accessing the Commonwealth of Pennsylvania’s, Department of General Services for Corrections (PA DOC) Contract # 4400007074 with Diamond Drugs, Inc., for the provision of like services. The proposed contract award will run concurrent with the PA DOC contract until its expiration on June 30, 2015. The PA DOC contract was competitively awarded through RFP No. 6100014379 issued by the PA DOC, Department of General Services.

Diamond Drugs, Inc.: $1,280,752

(for thirty-eight months)

Total approved funding: $1,280,752 Background The Director and Medical Director of Corrections Health Services have requested this purchase as an emergency procurement. The most significant driver of this request is the enhancement of patient safety, with the incorporation of point of contact checks for allergies, drug to drug interactions, and/or other serious drug contraindications. Patient safety is the driving force behind this request. Therefore, it was given the title “Emergency Procurement of Pharmacy Services.” The nature of this procurement is emergent to ensure that inmates are not harmed. This contract will also incorporate computerized order entry for provider and nursing staff, eliminating transposing errors and will facilitate the transition for CHS nursing staff from a paper medication administration record (MAR) to an electronic one. The Diamond software was specifically designed to work in correctional facilities without internet capability.


SECTION III. (cont’d.) This system will provide detailed drug utilization and cost through a variety of comprehensive reports to allow CHS to track overutilization and non-compliance with the formulary in order to further contain costs. Current correctional pharmaceutical services provide no patient profiling, drug interaction software, medication list or any level of reporting. Diamond will also provide medications in properly labeled blister cards which inmates can keep on person (KOP). Each medication will be profiled and added to the patient medication list. It will also be verified by a pharmacist using MediSpan to ensure patient safety, ensuring no allergies or drug contraindications exist. Diamond software will manage electronic ordering, refills and reordering as well as manage the electronic Medication Administration Record, repackage the medications, and charge the Trust a lower packaging fee. To achieve such functionality without this proposed contract, the existing pharmacy staffing would need to be expanded to provide medication in blister (bubble/bingo) packaging. Blister packaging is the industry standard in Corrections. The present CHS Director supports the KOP model, as it reduces nursing staff time required to administer direct observation therapy medicines. Diamond is the only correctional pharmacy licensed in Florida to repackage 340-B medications through the prime 340-B vendor. The 340-B is a system that provides discounts on medications and is available only to entities that are eligible for grants. Through this contract, CHS will receive the lowest pricing available on medications. This agreement includes several services currently not available to CHS through the existing pharmacy program:

MediSpan allows users to check each patient medication against patient allergies, drug to drug interactions, appropriate dosing (based upon age, weight, diagnosis) and other contraindications.

Computerized Physician Order Entry (CPOE) allows providers and nursing staff to input new orders, refills and discontinuation orders electronically to eliminate transposing errors.

Electronic Medication Administration Records (eMAR). This allows the nursing staff to record medication administration electronically and is safer for the patients and provides a more efficient way to ensure transferred patients continue to receive prescribed medication. Sapphire, Diamond’s software, software incorporates all of this functionality.

Reporting. Diamond provides state of the art reporting which will allow CHS to better manage costs, non-formulary usage and providers with high utilization.


SECTION III. (cont’d.) The benefits of the Diamond services described above are far superior to what is currently available without investing substantial capital in software, equipment, and additional staffing. Recommendation Under the proposed contract, the cost of packaging per month is $33,704, an annual cost of $404,448. Presently, CHS employs 3-full time pharmacists and 3-full time pharmacy technicians at a cost to the Trust of $539,157, annually, plus benefit costs of $188,709. Therefore, the current total annual cost for pharmacy services is $727,866. The award of this contract as an alternative to this present arrangement will provide savings of $1,024,157 for the thirty-eight months of the contract ($323,418 annually). These savings are derived from the current annual CHS expense of $727,866 minus proposed annual cost of $404,448 (or $1,280,752 for the thirty-eight month contract term). The PA DOC is a huge contract covering 49,000 inmates in 27 facilities across the State and demonstrates Diamond’s ability to handle Pharmaceutical Services in a large correctional health environment. Award of this proposed agreement with Diamond Drugs will mirror the same conditions and technical components of the current PA DOC Contract # 4400007074. However, through negotiations, CHS will realize more advantageous pricing than the pricing provided under the PA DOC contract. ECRI and MD Buyline do not track this purchase. The proposed contract can be terminated for convenience with a thirty (30) day notice and includes UAP and OIG provisions. Conflict of Interest Certifications have been provided by Patrick Morse, Director of JHS Corrections Health Services, by Dr. Calixto Calderon, Medical Director of Corrections Health Services and by Mark J. Zilner, Chief Operating Officer, Diamond Drugs, Inc. with no reported disclosure. (J. Repique/D.Steigman) SECTION IV. AWARDS UNDER GROUP PURCHASING ORGANIZATION (“GPO”) CONTRACTS This section consists of awards over $3,000,000 under Group Purchasing Organization (“GPO”) contracts. GPOs are organizations that aggregate the purchasing volume of their members consisting of hospitals and other health care providers to leverage discounts with manufacturers, distributors and other vendors to realize administrative savings and efficiencies. The Trust’s GPO is MedAssets. No items to report.


SECTION V. AWARDS UNDER A WAIVER OF FORMAL COMPETITION

This section consists of awards over $100,000 without the formal solicitation of competitive bids or proposals. All award recommendations in this section have the approval of the President, are based on a finding that the waiver of competitive bidding is in the best interests of the Public Health Trust, and require a two-thirds affirmative vote of the Trustees present for approval. A. Sole Source

3. (0370717-KD) The Executive Office requests approval for a two-year contract award (with a single one-year option to renew), under a waiver of competition for Claims Recovery Company, LLC (CRC) for ERISA appeals.

Claims Recovery Company (CRC): $6,750,000 Contingency Fee: $6,750,000

Background The Executive Office seeks to engage CRC to collect healthcare claims that were previously ‘written off’ by the Trust. On a solely contingent fee basis, CRC will conduct its collection efforts utilizing the appeals standards outlined in pertinent Federal legislation, which will enable the appeal and/or reversal of prior adverse healthcare claims determinations by third-party payers. CRC reviews insured claims back to 2003 and can yield between 10% and 40% of amounts written off. The accounts included will be those that have gone cold where all previous collection efforts have failed to recoup 100% of billed charges. The process operates as a virtual “Employee Retirement income Security Act” (“ERISA”) appeals department. Essentially, any monies collected are totally new monies that Jackson would never have realized. The project proposes to yield up to an estimated maximum of $45M with potential cash flow commencing 45 to 60 days from the start date. CRC will exclude any Jackson receivables due from Jackson Health Plan or for JHS employees and/or their beneficiaries paid by JHS’ TPA, AvMed. The vendor has agreed to substantial reductions in their normal contingency fee and their average project rate is 25% less than other engaged reimbursement consultants. Nothing will be paid to vendor without Jackson first receiving cash. The original contingent fee was 45% of collections but was reduced to a substantially lower scaled structure. The Executive Office has provided information to support that by virtue of the company’s proprietary and trademark protected processes, procedures, technology and databases, it is a “sole source” provider of the comprehensive range of ERISA appeals services. The proposed initiative is linked to the Trust’s efforts to forestall the financial crisis by identifying additional sources of revenue and time is of the essence.


SECTION V. (cont’d.) Recommendation A contingency fee shall be paid to CRC based on an established sliding scale fee structure of 17% - 10%. The proposed Agreement can be cancelled by the Trust for convenience with a thirty (30) day notice of cancellation. A Sole Source Justification has been provided and Conflict of Interest Declarations signed by Donn Szaro and Dean Whitcomb, Managing Member, CRC, with no reported disclosures. (M. Knight) 4. (335223-JE) The Engineering Department requests an emergency purchase with GE Energy for the supply and installation of 16 relays to replace the existing malfunctioning devices at the Main Campus. General Electric International, Inc. (GE Energy): $172,356 (not to exceed) Total approved funding: $172,356 Background Since September 2011, Engineering has experienced nuisance tripping of circuit breakers due to malfunctioning of the relays which were installed in 1995. GE Energy has deemed the relays to be towards the end of their life expectancy. The normal power system at the Main Campus is distributed through medium voltage General Electric (GE) switchgear. There are two (2) gear sections, A & B with six (6) and eight (8) circuit breakers respectively and two (2) spares. This requires GE Energy to provide their parts/equipment and service in order to keep the system warranty in effect. GE Energy is the sole source for this proprietary equipment. Based on recent discussions with GE Energy, it was discovered that there is a two (2) week lead time for delivery of the relays, and another two (2) weeks for installation of all 16 relays and therefore it was determined that the risk of another power failure could potentially become a patient life safety concern that cannot be considered. Recommendation The Engineering Department recommends an emergency contract award to GE Energy. Under the scope of work GE Energy will be providing field engineering services to install new GE Multilin 750 feeder protection relays for the replacement of the existing relays in the GE PowerVac Switchgear. The services include providing the relays, and testing the relays off site prior to outage at the GE Energy local testing and inspection center.


SECTION V. (cont’d.) In addition to the relay replacement services, GE Energy will provide an additional discount to the original purchase price once the MDP relays are removed and processed as Returned Material by GE Multilin. This additional discount is shown in the pricing section below, and will be issued as a credit to the original invoice once the return has been processed by the factory and the serial numbers are recorded as no longer in service. Also included in the pricing below is coordination analysis and new protective settings for relays which will be provided at no additional cost. Pricing Summary Engineering Services: $107,656 (Engineering Study, Installation, Start-up & Commissioning) Equipment & Materials: $100,796 (Relays, Hardware, Wire & Sleeves, Mounting Plate/Cover, Supplies) Total for upgrade of 16 Relays: $208,452 Relay Rebate/Credit provided by factory upon receipt of old MDP Relays: ($ 36,096) Total (including Rebate): $172,356 An emergency procurement form has been provided and Conflict of Interest signed by Douglas Rodriguez, Electrical Engineer III, JHS, and by Jorge R. Diaz, Sr. Account Manager, GE Energy, with no reported disclosures (A. Contreras) B. Physician’s Preference Staff requests a waiver of formal competition for the contract items listed in this category because a physician or clinician has requested the particular item or service without which the physician or clinician cannot successfully and safely render patient care. 5. (360707-TW) Pathology Services Department requests funding for a period of one year for the continuation of specialty diagnostic laboratory services.

ViraCor-IBT Laboratory, Inc.: $1,300,000

(for one year)



SECTION V. (cont’d.) Background In August 2010, the Board approved a bid waiver contract award with ViraCor-IBT in the amount of $1,700,000 for a two-year period. The contract expires April 30, 2012. ViraCor-IBT provides quantitative real time bacterial and viral testing that is focused on molecular testing. The need for these services continues to increase considerably, as there has been an increase in test utilization by Infectious Diseases, Transplant and Pediatrics departments. Although the past six-months’ spend averaged $618,000, it has been projected that utilization will continue to increase based on current trend. Therefore, the estimated dollars requested will provide adequate funding to accommodate an increase in utilization. JHS pediatric and transplant physicians developed protocols that call for these tests on a regular basis for all patients. The physicians are pleased with the accuracy, reliability and turnaround time of the tests results and Viracor remain their preference. ViraCor-IBT is the only reference laboratory with the ability to deliver results of the labor-intensive quantitative Polymerase Chain Reaction (PCR) testing for viral markers within a 24 hour turn-around time of specimen receipt as required by JHS. ViraCor-IBT is the most qualified provider for this level of service. Recommendation Approval for this one year contract award for diagnostic testing services is requested - to avoid disruption of the real-time bacterial and viral testing services which is highly utilized by Pediatrics and Transplant Departments. Physicians would not be able to diagnose, treat and discharge patients quickly and effectively without the continuation of this service. Although the vendor is not on the MedAssets contract, a market analysis was conducted as part of a MedAssets initiative for savings. As a result, the current competitive “benchmark” pricing was determined. Negotiations with Viracor resulted in savings projected to be approximately $150,000 for the period of this contract. The contract can be cancelled for convenience with a thirty (30) day notice and includes the OIG and UAP provisions. The contract has been approved by Risk Management as to insurance and liability and by the County Attorney’s Office for legal sufficiency. A Bid Waiver Justification has been provided and Conflict of Interest Declarations have been signed by Maria Quintana, JHS Lab Operations Manager, and Matthew Urbanek, CFO, ViraCor-IBT, Inc., with no reported disclosures. ECRI and MD Buyline do not track these services. (A. Contreras)


SECTION V. (cont’d.) C. Standardization Items in this category have been established as the Trust standard. No items to report. D. Non-Competitive Cooperative Purchasing This subsection consists of awards under the contracts of other public entities that were not competitively solicited. No items to report. E. Miscellaneous Bid Waiver This subsection consists of awards not falling in the other categories of waiver of formal competition but where waiver is deemed to be in the best interests of the Trust. 6. (356348-HT) The Revenue Cycle Management Division requests a modification to the current contract with the Advisory Board Company to continue utilizing the Revenue Cycle Compass for a period of five-years.

The Advisory Board Company: (for five years)

Year 1 (5/14/12 - 5/13/13): $ 618,532 Year 2 (5/14/13 - 5/13/14): $ 632,132 Year 3 (5/14/14 - 5/13/15): $ 650,388 Year 4 (5/14/15 - 5/13/16): $ 650,388 Year 5 (5/14/16 - 5/13/17): $ 669,192

Total approved funding: $3,215,633 Background The Revenue Cycle Compass program represents a member network of health systems and hospitals focused on becoming best-in-class at revenue cycle management.


SECTION V. (cont’d.) The Revenue Cycle Compass (RCC) is the Trust’s claims scrubbing and clearinghouse system used for data integrity. All claims for patient accounts pass through this system before transmission to the payer for processing. Utilization of the Compass has allowed Jackson Health System (JHS) to increase the “First Pass Clean Claims Rate” from 3% to 70% since implementation two-years ago. Both the Siemens and Cerner systems feed information into the Revenue Cycle Compass allowing end users the capability of generating analytical financial reports for reconciliation. The user departments that access the Revenue Cycle Compass tool within JHS do not have the resources nor the skill sets to leverage and manipulate raw data from the independent proprietary systems into reports in the required format that can be produced by the RCC. The Revenue Cycle Compass program also includes an analytical infrastructure for data vetting and focused analysis of data, access to a web based reporting and business intelligence solution, onsite training, sessions with end users, and access to best practice research and tools to help member hospitals improve revenue cycle business performance. Members can access the Revenue Compass dashboard, reports and drill-down capabilities via internet to assist with revenue cycle performance monitoring, trend analysis, problem-solving and decision making. As an enhancement with this contract modification, the Compass will pull data directly from electronic remittance advice files for individual payers. It will also provide for advanced analytics of denials data to improve data integrity for the Trust with respect to denials management. Users will be able to look at their denials by patient type, by physician, by service line and by DRG and measure how many denials are ultimately recorded by the appeal and recovery process. Recommendation The Revenue Cycle Management Division recommends that it is in the best interest of the Trust to waive the competitive process because a change in vendor and implementation of a new system would require significant personnel training, excessive cost, and the need to dedicate resources to write, test and implement new system interfaces to replace ones that have been developed over the years. This would significantly delay the Trust’s cash flow and have a negative impact on revenue. The departments currently utilizing the Revenue Cycle Compass (Finance, IT, Budget, PMO) are familiar with this proprietary system and have proven working knowledge of its operation. The Advisory Board is currently considered a leader in its field. The RCC web-based system has been loaded over the years it has been in use with historical AR information from various patient account systems utilized by JHS. The vendor has maintained its standard increase over prior contract of approximately 3% to be applied throughout the five-year term of this contract modification with the exception of the period 2015 to 2016 when there will be no increase. Negotiations have yielded approximately $200,000 in savings over the five year


SECTION V. (cont’d.) term. In addition, cost avoidance for year 2015 to 2016 will be realized in the amount of $19,512; vendor will waive the customary 3% increase for this period. The contract can be terminated for convenience with a (90) day notice and includes the OIG and UAP provisions. The original contract was reviewed and approved by the County Attorney’s Office for legal sufficiency and by Risk as to insurance and indemnification. A Bid Waiver Justification has been provided and Conflict of Interest Declarations have been signed by Charlie Bearham, Administrator, Revenue Cycle Management Division, and Alison DeVault, Manager of Member Services, The Advisory Board Company, with no reported disclosures. ECRI and MD Buyline do not track this service. (C. Pla) 7. (361559-NSA) Strategic Planning/Executive Office requests a contract award to Robert J. Greene, Healthcare Consulting Service for the provision of consulting services relative to the application to the Florida Department of Health (DOH) for New Trauma Centers at Jackson South Community Hospital (JSCH) and Jackson North Medical Center (JNMC).

Robert J. Greene (Consultant):

Feasibility Study for Trauma Program: $29,562

(for three months)

Needs Assessment: $91,072 (for one year)

Total approved funding: $120,634

Background

The initiative to expand trauma services at Jackson South Community Hospital (JSCH) and Jackson North Medical Center (JNMC) is linked to preserving trauma services for the Jackson Health System. In August 2011 the Trust entered into a two-month Consulting Agreement with Robert J. Greene for a market assessment and feasibility study for the development of a trauma program at JSCH and JNMC. At the beginning of this first engagement Strategic Planning did not know the outcome of the market assessment and if or how we would need to proceed. As a result of that study, a determination was made to enter into another agreement with Robert J Greene in order to successfully complete the Level II Trauma Application opportunity and the Trauma appeal process for Jackson South and Jackson North. Bob Green will review the Level II Trauma application, and assist in the strategy development, develop a needs assessment which will accompany the level II


SECTION V. (cont’d.) application and conduct research and analysis due to the challenges with the current rule at the State level dealing with Trauma.

Recommendation If this particular service were not available, the department would not be able to effectively examine all aspects pertaining to this project. This is a very labor intensive and time sensitive project with several deadlines from the State of Florida. As the only vendor with the required credentials located within close proximity to the Health Trust, the vendor is ideally suited to satisfy these deadlines. It would also not be possible for staff to commit the time needed to this project without negatively impacting other priorities of the department. Under this agreement the Consultant will conduct research and analysis related to the 2011 Rule Challenge of the DOH rule on Trauma Center Need and Administrative Appeals of the 2010 applications for new Trauma Centers by Hospital Corporation of America (HCA). The Agreement will include the development of strategies and resources associated with a new Need methodology to support Jackson’s applications. The Consultant will develop a needs assessment element to the DOH application for new Trauma Centers and will work with JHS to ensure that JHS is positioned best for this process. Based on the foregoing, Strategic Planning/Executive Office considers issuance of an Agreement to Robert J. Greene Consultant for a period of One Year to be in the best interest of the Trust.). This contract can be terminated for convenience with a (30) day notice and includes UAP and OIG provisions. ECRI and MDBuyline do not track this purchase. (D.Steigman) 8. (370684-MR) Executive Leadership requests a modification to the current agreement with Maxor National Pharmacy Services (“Maxor”) for the development of a Specialty Pharmacy Program to include outsourcing. Maxor National Pharmacy Services Corp.: Previously Approved Amount (August 2010): $6,208,211 This request for funding: $ 400,000 Total approved funding: $6,608,211


SECTION V. (cont’d.) Background In August 2010, the Public Health Trust Board of Trustee’s approved a four year agreement with Maxor for Management Services of the Ambulatory Pharmacy pursuant to competitive RFP No. 09-5256. The contract allows for a modification to be entered into for the development of a specialty pharmacy program. The specialty pharmacy will dispense specialty prescriptions including, but not limited to, oncology and transplant medications through 340B pricing. The specialty pharmacy will be located on Jackson Memorial Hospital’s main campus. Maxor will rent the 1,700 sq. ft. space at its fair market value. Rent will be reduced from profit and loss as an expense and will be subject to profit sharing computation. With this modification for the specialty pharmacy, Maxor will provide management services as well as the appropriate staff needed to operate the program. All employees of the specialty pharmacy will be Maxor employees, including a pharmacy manager, pharmacists and technicians, as appropriately needed to operate specialty pharmacy. All staffing expenses will be paid directly by Maxor and repaid out of the specialty pharmacy working capital. Maxor will also provide start up costs for the development of the Specialty Pharmacy to be repaid to them upon expiration of the agreement at an amount not to exceed $400,000. Start up costs will include pharmacy fixtures, furniture, computer hardware/software, initial inventory, and required construction costs. The fees associated with the Specialty Pharmacy include a Specialty Pharmacy Annual Fee of $60,000 for the remaining term of the agreement through September 30, 2014 and a Specialty Pharmacy Administrative Overhead Fee of 6% gross revenue. Maxor will also maintain a shared savings of 20% of Net Profit which mirrors the Ambulatory Pharmacy shared savings percentage. All fees and shared savings will be deducted from the profit and loss statement as operating expenses for the computation of working capital. Maxor will provide the profit share of 80% net profit to the Trust. At the end of each calendar year, Maxor will provide an annual audit of the specialty pharmacy’s revenues, expenses and profits to assure that all accounting is done properly and that all funds are properly accounted for. Recommendation Executive Leadership recommends the award of this Modification to Maxor in the best interest of the Trust. By not moving forward with the specialty pharmacy, the Trust would continue to allow lucrative business to be outsourced to private pharmacies that do not share profit with JHS. Specialty patient populations generate very high revenue yielding prescriptions, it is expected that this new joint venture will generate very significant revenue to the Trust. Due to the fact that Maxor is currently providing management services to the Ambulatory Pharmacy, including the clinical information database, it is not


SECTION V. (cont’d.) reasonable to consider another vendor at this time. This Modification is not a significant change from the scope of the original RFP as Maxor will continue to manage all other ambulatory care pharmacies with over 50 JHS employees. The only difference with the specialty pharmacy is the outsourcing of approximately 7-9 Maxor employees. The Trust has and will continue to comply with all HR notice requirements. The contract can be terminated for convenience by either party with a ninety (90) day notice and includes the OIG and UAP provisions. The original contract was reviewed and approved by the County Attorney’s Office for legal sufficiency and by Risk as to insurance and indemnification. A Bid Waiver Justification has been provided and Conflict of Interest Declarations have been signed by Alejandro Contreras, Sr. VP and CAO, Jackson Health System, and Ryan Ahern, Director of Operations, Maxor, with no reported disclosures. (A. Contreras) SECTION VI. OPTIONS-TO-RENEW AND CONTRACT MODIFICATIONS FOR CONTRACTS THAT WERE COMPETITIVELY SOLICITED This section refers to existing contracts that were competitively bid (“ITB” or “RFP”) at their origin and consists of either (a) the exercise of established options-to renew or (b) the execution of contract modifications for which the Procurement Policy requires prior Board approval. 9. (331598-HT) The External Affairs Division, Jackson Health System, is requesting approval to modify the existing contract (previously awarded under RFP 06-5148) with Kelly Swofford Roy, Inc. (KSR) for an additional 90 days from June to August, 2012 to allow additional time to transition into a new contract resulting from a competitive Request for Proposals (RFP).

Kelley Swofford Roy, Inc. (KSR): Previously Awarded Amount: $ 995,600 (five years total)

This request for funding: $ 51,000

(for ninety days) Total approved funding: $1,046,000

The addition of $51,000 to the existing Agreement will fund the current contract for an additional 90-day period and will allow the continuation of day-to-day marketing services throughout the extended term. The original contract was awarded for three years with two Options to Renew (OTRs) which have been exercised. The Trust shall have no obligation


SECTION VI. (cont’d.) to pay the Contractor any additional sum in excess of $51,000 ($17,000 per month) for the continuation of services from June 1, 2012 – August 31, 2012. The original contract was reviewed and approved by the CAO for legal sufficiency and by Risk as to insurance and indemnification. This contract can be terminated for convenience with a thirty (30) day notice and includes UAP and OIG provisions (M. Pinzur) SECTION VII. OPTIONS-TO-RENEW AND CONTRACT MODIFICATIONS FOR CONTRACTS THAT WERE AWARDED UNDER A WAIVER OF FORMAL COMPETITION This section refers to existing contracts that were not competitively bid at their origin and consists of either (a) the exercise of established options-to renew or (b) the execution of contract modifications for which the Procurement Policy requires prior Board approval. All contracts in this section that are renewals not previously authorized by the Board have the written approval of the President, are based on a finding that the waiver of full and competitive bidding is in the best interest of the Public Health Trust, and require a two-thirds affirmative vote of the Trustees present for approval. 10. (339700, 354214-PE) The Jackson Medical Group (JMG) FIU Physician Services Administration and Jackson North Medical Center (JNMC) FIU Physician Services request a modification to the current JMG contract with Healthcare Data Solutions for provision of the Allscripts MyWay ASP Solution to FIU Physician Services. Healthcare Data Solutions, LLC: Previously approved amount: $153,000 This request for funding: JNMC FIU Physician Services: $ 21,000 (January 2012 thru March 2012) $ 49,000 (April 2012 thru October 2012)


SECTION VII. (cont’d.) JMG FIU Physician Services: $ 7,000 (March 2012) $ 49,000 (April 2012 thru October 2012) Total approved funding: $ 279,000 Background Allscripts MyWay is the leading Electronic Health Record and Practice Management solution providing a network-type automated connectivity to hospitals, labs, patients, pharmacies, and payers. Healthcare Data Solutions provides the Allscripts MyWay solution to automate clinical and financial workflow for FIU physician practices to optimize efficiency in scheduling, documentation, coding and billing. On November 1, 2011, JMG Physician Services Administration entered into a one-year contract with Healthcare Data Solutions to provide the Allscripts MyWay ASP Hosted solution including licenses, training and 24-hour support to the Jackson South, Biscayne and Sunset FIU Physician Services locations to standardize the use of the solution with Jackson North Medical Center (JNMC) Recommendation The current JMG contract with Healthcare Data ends on October 31, 2012. JMG Physician Services Administration is requesting an additional $49,000 to continue the contract through this period and for retrospective payment for the month of March 2012 in the amount of $7,000, as the funds initially approved were estimated and an increase in provider licenses has necessitated the need for additional funding. JNMC is also requesting approval for $49,000 to access the current JMG contract with Healthcare Data for continued provision of these services through October 31, 2012 and for retrospective payment of invoices in the amount of $21,000. When Jackson North’s contract ended, utilization of these services continued without a formal contract. Therefore, additional funding is needed for retrospective payment through March 2012 in the amount of $21,000 and to access the JMG contract for continued services at JNMC from April 2012 through October 2012. When the present contract ends in October 2012, JMG FIU Physician Services and JNMC FIU Physician Services anticipate that the solution will transfer to the Cerner System and eliminate the need for securing these services from Healthcare Data Solution. If indications are that this will not be realized, the user departments plan to request a formal competitive solicitation prior to the end of the current contract.


SECTION VII. (cont’d.) Healthcare Data Solutions has provided and continues to provide a 14.3% discount per license and waived its requirement of a three year minimum contract in order to add JNMC to the current JMG contract. The vendor has also waived its requirement that training must be purchased in 8 hour blocks and continues to provide training at $125 per hour; a cost savings of $25/hour based on MD Buyline and ECRI reporting typical cost of $150/hr. Service and support continues to be provided at no cost; a cost avoidance of $560 to the end of the contract period. Any additional remote training will continue to be at a cost of $85/hour. MD Buyline reports that this cost is typically between $250 and $500/hour. The vendor also provides 16 hours of remote training, at no additional cost, with each new license added to the contract. MDB and ECRI report the vendor’s offer to be aggressive. The original contract was approved by the County Attorney’s Office for Legal sufficiency and by Risk as to Insurance and Liability. The contract can be terminated for convenience with a thirty (30) day written notice and includes UAP and OIG provisions. A revised Bid Waiver Justification has been provided and Conflict of Interest signed by Bill McKeon, Director of Operations, JNMC, with no reported disclosures (G. Santorio/S. Sears) 11. (372020-PE) Patient Placement Services, in collaboration with the Information Technology Department (ITD), requests approval for a modification to extend the current contract with TeleTracking Technologies, Inc. under the same terms and conditions for a period of Sixty-Six (66) days through June 30, 2012 to allow sufficient time for preparation of the proper paperwork and approvals associated with the proposed expansion of the TeleTracking System.

TeleTracking: $38,364 (for sixty-six days)

Total approved funding: $38,364 Background The TeleTracking system is an integrated system for BedTracking, PreAdmit Tracking, TransportTracking and the XT platform that allows the hospital to efficiently plan, manage and expedite patient flow. These services are not provided by the Cerner system. Patient Placement Services and ITD intend to expand the system to allow for full automation of patient flow from a single location. The subscription will be renewed and additional features/functionality will be acquired to extend the use of the software to Jackson North Medical Center (JNMC) and Jackson South Community Hospital (JSCH).


SECTION VII. (cont’d.) The original contract was approved by Risk as to Insurance and Liability and by the County Attorney’s Office for legal sufficiency. The contract can be terminated by either party for cause and includes the OIG and UAP provisions. Recommendation FRB approval is being sought, as the current Board approved contract is set to end on April 25, 2012 and the additional funds requested for this extension will take the value of the contract in excess of the amount designated for approval under CPO authority. (F. Salgado)

SECTION VIII. MISCELLANEOUS

This section consists of procurement actions that require Board approval not included under any other section of the Purchasing Report. No items to report. A. Vendor Name Change This section refers to existing contracts requiring a vendor name change under any circumstance at any time after contract award and for the duration of contract performance. The Chief Procurement Officer is the approving authority when the original award of the subject contract was within the approval authority of the Chief Procurement Officer, and the Board of Trustees is the approving authority when the original award of the subject contract required the approval of the Board. The County Attorney’s Office has been consulted and has provided a determination of legal sufficiency. No items to report.

Monthly Report of Competitive Contracts Awarded or Renewed under the Chief Procurement Officer Authority in Accordance to Procurement RegulationsMarch 1, 2012 ‐ March 31, 2012

For Information Only

Vendor Name DescriptionCost Center & Director/VP

Contract Number Contract Date Contract Value Contract Term Procurement Method UAP

Fh PaschenSn Nielsen and Associates

Campus Wide ADA bathroom Compliance Project

94913 M Valdes

4101225 CAPS 3/9/2012 537,900.47$ One Time Job Order Contract E

Fh PaschenSn Nielsen and Associates

Renovation of 24 Bathrooms located on North Wing Main Campus

94913 M Valdes

4101231 CAPS 3/15/2012 265,893.34$ One Time Job Order Contract E

In Record Time Coding Services For Health Information System 71004

M Knight8104874 SERV 3/5/2012 901,049.00$ One Year ITB‐11‐10059‐MR Y

Modcomp System and Solutions Liebert/.Emerson PSI UPS Backup System100

M Garcia8105019 SERV 3/26/2012 223,598.35$ One Time RFQ‐12‐10477‐MM Y

Learnsoft Thecnology Group, IncLearning Management System Software for Educational courses

92812 M Garcia

8105031 SERV 3/28/2012 236,160.00$ Three Years ITB‐12‐10349‐CS Y

Greenberg Trauring LLP Federal Lobbying Services 99301 C Lago

8105042 SERV 3/30/2012 120,000.00$ One Year ( 1st OTR)

RFP‐ 10‐5164 Y

Steris CorporationDual VLED Surgical Lights for Ryder Trauma Exam Rooms

100 A Contreras

9100394 CAP 3/23/2012 126,688.60$ One Time MedAssets ES‐181 Y

1. "MedAssets" is the Trust's primary "Group Purchasing Organization" (GPO)2. "State Contract" and "Miami‐Dade Contract" mean a contract competively awarded by the State or County as a "cooperative contract"3. "US Communities" means a contract competively awarded by the U.S. Communities governmental purchasing alliance as a "cooperative contract"4. "OTR" means "Option to Renew".5. "Contract Value" corresponds to the fixed "Contract Term" that has been awarded or rewarded (not to future OTR's)6. "RFP" means competitive Request for Proposals (or Qualifications) procurement process performed by the JHS Procurement Management Department7. "ITB" means competitive Invitation to Bid (or Quote) procurement process performed by the JHS Procurement Management Department8. "UAP" means User Access ProgramE – Exclusion as per UAP program: ie, Federal Grant, etc.Y – Incorporated into the purchase as either discount on invoice or discount upfrontN/A – No, did not apply to procurement. Either an emergency purchase or contract was executed or extended before UAP was implemented

Monthly Report of Non‐Competitive Contracts Under 100KMarch 1, 2012 ‐ March 31, 2012

For Information OnlyVendor Description

Cost Center & Director/VP

Contract Number Contract Date Contract Value Contract Term Procurement

Method UAP

AS Software, IncMaintenance support for the OB/GYN ultrasound information system and interface with Cerner + PACS

73306A Behr

8104915 SERV 03/08/2012 $10,631.25 One Year Sole Source Y

Binding Site, IncReagents to use on the BNII instrument to determine free light chains

72105M Knight

12448771 03/15/2012 $67,575.00 One Year Sole Source Y

BLX Group, Llc Bond compliance services as required by external auditors90611

M Knight8104932 SERV 03/12/2012 $24,550.00 One Time Bidwaiver Y

Complete Consulting Services Parking consulting services89502

M Aprigliano8104998 SERV 03/21/2012 $30,000.00 One Year 2nd OTR Y

Consolidated Parking, Llc Parking space lease for Dupont employees (60 spaces)90511

B Dean8104965 SERV 03/16/2012 $64,080.00 One Year Sole Source Y

Florida Jet Service, Inc Emergency organ air transport75008

A Contreras8104872 SERV 03/05/2012 $51,585.62 One Time Emergency Y

Knight Software, Inc KIS behavioral health software license continuation88597

J Repique8104934 SERV 03/13/2012 $14,825.00 7 Months Bidwaiver Y

Sunshine Communication ServiceContinuation of after hours answering services for Health Plan

89014F Salgado

8104939 SERV 03/13/2012 $18,000.00 9 Months Bidwaiver Y

The Myers Group Satisfaction survey for JMH Health Plan members89005

F Salgado8104933 SERV 03/12/2012 $19,550.00 One Time Bidwaiver Y

Verathon, Inc Purchase of a Glidescope for Emergency department400

A Contreras9100395 CAP 03/23/2012 $15,836.50 One Time Sole Source Y

Weiss, LlcConsulting services to provide extensive savings in the area of affiliation Annual Operating Agreement (AOA) with UM

99301Executive

Office8104887 SERV 03/06/2012 $80,000.00 One Year Bidwaiver Y

Note: "Non‐competitive" procurement category includes: Sole Source, Physician's Preference, Standardization, Non‐Competitive Cooperate Purchasing, and Miscellaneous Bid Waiver.UAP ‐ User Access ProgramE – Exclusion as per UAP program: i.e., Federal Grant, etc.Y – Incorporated into the purchase as either discount on invoice or discount upfrontN/A – No, did not apply to procurement. Either an emergency purchase or contract was executed or extended before UAP was implemented

4/16/2012 3:16 PM 1 of 1

5. Key Performance Indicators (KPI’s) for Procurement Update (Support documents will be distributed at the meeting.)

FACILITIES SUBCOMMITTEE

PUBLIC HEALTH TRUST FINANCIAL RECOVERY BOARD Facilities Subcommittee

Darryl K. Sharpton, Chairperson Mojdeh L. Khaghan, Vice Chairperson Joe Arriola

Date, Time and Place April 19, 2012 – 7:45 a.m. to adjournment Ira C. Clark Diagnostic Treatment Center Conference Room 259

AGENDA

1. **Approval of the Previous Meeting Minutes (Darryl K. Sharpton, Chairperson, Facilities Subcommittee)

(a) Meeting Minutes as of March 15, 2012 2. Chairperson’s Report (Darryl K. Sharpton, Chairperson, Facilities Subcommittee) 3. Real Estate Update (Andrew Rachlin, Director, Real Estate, Jackson Health System) 4. * Financial & Budget Tracking Status Report as of February 2012 (Aurelio Gonzalez, Budget Director, Jackson Memorial Hospital) 5. *Capital Projects Construction Projects Update as of April 2012

(Madeline Valdes, Corporate Director, Property Management, Jackson Health System) The item(s) noted with an asterisk (*) indicates that the supporting documents are attached.

The item noted with two asterisks (**) indicates that voting is required by the Subcommittee.


Facilities Subcommittee Darryl K. Sharpton, Chairperson Mojdeh L. Khaghan Vice Chairperson Joe Arriola

Date, Time and Place March 15, 2012 – 7:15 a.m. to adjournment Ira C. Clark Diagnostic Treatment Center Conference Room 259

ATTENDANCE

Facilities Subcommittee Darryl K. Sharpton Mojdeh L. Khaghan Joe Arriola Marcos Jose Lapciuc

Jackson Health System Carlos A. Migoya Don S. Steigman Aurelio Gonzalez Madeline Valdes Andrew Rachlin

Miami-Dade County Attorney

Jeffrey Poppel

Facilities Subcommittee Meeting March 15, 2012 Page 2 CALL TO ORDER With a quorum being present, the meeting of the Facilities Subcommittee was called to order at 8:03 a.m. by Darryl K. Sharpton, Chairperson, Facilities Subcommittee. 1. APPROVAL OF THE PREVIOUS MEETING MINUTES – FEBRUARY 13, 2011

Mr. Sharpton requested a motion approving the meeting minutes of February 13, 2011. Mr. Arriola moved approval;

seconded by Ms. Khaghan, and carried without dissent.

2. CHAIRMAN’S REPORT No Report.

3. REAL ESTATE AND RETAIL UPDATE

Andrew Rachlin, Director, Property Management, Jackson Health System reported on the progress of the interactive facilities map that has been created to depict all the facilities and satellites owned and leased by Jackson Health System (JHS) map which has been complete will become available in the Net Portal for view by the JHS staff. Mr. Rachlin reported that the final negotiation for the management software program is scheduled to take place on March 15, 2012. There was a slight delay in the implementation and finalization of the contract documents due to specific language required in the contract by the Procurement Department and the County Attorney’s office that was unacceptable by the vendor. Following final negotiations, and terms agreed upon; Mr. Rachlin will update the Subcommittee at the April 2012 meeting with the final software recommendation. In addition, several software vendors have been evaluated in the event that a contract cannot be negotiated. Madeline Valdes, Corporate Director, Property Management, Jackson Health System reported on the initiative to determine and evaluate utilization of space needs within the hospital. The first area surveyed was the Ambulatory Care Center (ACC). The objective was to identify if proper controls are in place such as a lease and appropriate rent is being collected. Strategically as the system evaluates different services expansion etc., there is to better understand the space utilization. Mr. Sharpton expressed concern regarding equipment needs for the hospital. He requested a comprehensive list of unfunded equipment needs. With regards to equipment, Don S. Steigman, Chief Operating Officer, Jackson Health System stated that a comprehensive equipment list has not been created. The Finance Department; however, does have a capital equipment list and equipment needs are processed by individual departmental requests. At this time, the budget and planning process will be underway to determine needs and evaluate equipment utilization. The list of all requested items will be populated by hospital unit and presented to the Subcommittee. The list will be narrowed down to prioritize needs.

Facilities Subcommittee Meeting March 15, 2012 Page 3

Mr. Sharpton questioned why the Finance Department is the best avenue to evaluate utilization and needs; he questioned what would happen in the event a healthcare provider request equipment and how will it be prioritized. Mr. Steigman stated that the Finance Department will review to determine if funding is available and if there will be returns on investment or financial review. In addition, a determination will be made to define the type of equipment. Equipment can be categorized as fixed major equipment and infrastructure equipment requests. Fixed major equipment is defined as MRIs, physical plant needs such as boilers, air handlers etc. A list for this type of equipment will be created and through the planning process funding such as the Jackson Memorial Foundation, Operations or Revenue Bonds will be determined. Pertaining to the Master Developer Retail ITB, Mr. Rachlin reported that he has been working with the Procurement Management Department to finalize the ITB. The next step is review by the Legal Department to ensure legal sufficiency. The ITB will be advertised in JHS’s website and various newspapers. The team has finalized the cost estimates for phase I and phase II of the common areas. The estimate for Park Plaza West (PPW) is $1.3M and Park Plaza East (PPE) is estimated to be $800K.

4. *FINANCIAL & BUDGET TRACKING STATUS REPORT

The Financial and Budget Tracking Report was tabled. Aurelio Gonzalez, Corporate Director of Productivity, Jackson Memorial Hospital will provide a comprehensive report at the April 2012 PHT Financial Recovery Board meeting. A Copy of the report was included in the agenda packet.

OTHER BUSINESS Extensive discussion took place surrounding the current state of the bathrooms throughout the hospital. Mr. Arriola and Mr. Sharpton concurred that the current unsanitary and unsightly condition of the bathrooms is not an inconsequential issue and needs to be corrected to alleviate the reputation of the hospital. Mr. Steigman agreed with the sense of urgency and will work collaboratively with Capital Projects to renovate bathrooms that have outlived their cycle and will work with Environmental Services to address the cleanliness of the facilities. Campus signage was also discussed specifically as it relates to the condition of the banners. Matt Pinzur, Corporate Director, Public Relations Division provided an update regarding efforts in purchasing and installing new banners. ADJOURNMENT The meeting of the Facilities Subcommittee adjourned at 8:42 a.m. Transcribed by Monica Severiche Executive Assistant Property Management Division

2. Chairperson’s Report

3. Real Estate Update

Original Total Total Projected Revised V.P. Closed

# of NEW Project Budget Project Start Compl. Compl. Fund. Project Project Exec. Total YTD Life to Date Amount left out Balance

Proj. Proj.# Activity# Project Name Budget Changes Budget Date Date Date Source Manager Manager Spons. Feb.12 Feb.12 thru Feb.12 to Spend Variance Out

MULTIFUNDING SOURCE PROJECTS

1 C P-00632 52005003 J.South Community Hptal 102,425,000 100,000 102,525,000 CO Aug-05 Dec.10 Apr.12 Multi Clark JMH Garcia 65,659 3,417,655 100,502,937 2,022,063 - 102,525,000

2 J P-00949 51009046 WW-B Pharmacy Phase I 250,927 583,669 834,596 CN May-09 Mar.10 Jun.12 Multi Arnaldo JMH Contreras 25,460 51,724 491,894 342,702 - 834,596

3 K P-00952 51009047 SICU Reconfiguration 400,000 136,000 536,000 CO May-09 May.10 Apr.12 Multi Arnaldo JMH Contreras - 13,227 525,471 10,529 - 536,000

4 L P-00836 51007017 Rehab Building Renovation 16,670,411 (59,620) 16,610,791 CN Sep-07 Aug.10 Sept.15 Multi Frank JMH Contreras - - 158,547 16,452,244 - 16,610,791

5 M P-00904 51008026 C-4 Cath Lab #6 2,833,500 1,236,645 4,070,145 CAN Jul-08 Oct.09 TBD Multi Abby JMH Contreras - 22,446 102,277 3,967,868 - 4,070,145

6 O P-00566 51001001 Elevator Modernization 3,000,000 70,700 3,070,700 CN May-01 Mar.08 Mar.13 Multi Alana JMH Armstrong - - 2,022,856 1,047,844 - 3,070,700

7 Q P-00696 51008007 Underground Storage Tank Repl 3,000,000 (1,689,852) 1,310,148 CL May-08 Dec.09 Dec.11 Multi Allen Heery Valdes - - 1,166,697 0 143,450 1,310,148

8 R P-00763 59007009 JMT Elevator Modern#141-146 1,057,183 243,574 1,300,757 CN Jul-07 Sept.10 Dec.12 Multi Alana JMH Valdes 200,434 200,434 740,503 560,254 - 1,300,757

9 S P-00827 53008015 Jack.No Elevators 1 & 2 490,050 - 490,050 DEF Feb-08 Jan.09 Oct.10 Multi Abby JMH Sears - - 58,980 431,070 - 490,050

10 T P-00834 51008016 ADA Compl.#Pkg1 Restrooms 991,763 692,000 1,683,763 CN Oct-07 Apr.08 Dec.12 Multi Arnaldo JMH Valdes 2,728 7,918 730,823 952,941 - 1,683,763

11 U P-00854 53008020 Jack.No. Window Replacement 2,057,220 1,000,000 3,057,220 CN Jan-08 Jan.09 Jun.12 Multi Abby JMH Sears 53,035 326,390 2,440,389 616,831 - 3,057,220

12 V P-00606 59004002 JMT Elevators Moderniz. 931,591 (30,291) 901,300 D May-04 Feb.08 May.13 Multi Alana JMH Valdes - 26 23,739 877,561 - 901,300

13 W P-00655 56006004 JNCMHC Emerg. Generator 331,839 - 331,839 DEF Jul-06 Aug.07 Jun.11 Multi Camero JMH Valdes - - 17,470 314,369 - 331,839

14 X P-00724 51007008 Kitchen Equipment Modification 791,164 - 791,164 DEF Nov-06 Jun.07 TBD Multi Rob JMH Valdes - - 79,485 711,679 - 791,164

15 Y 51011105 Ryder Trauma Ext Hardening 8,589,588 - 8,589,588 D Dec-10 Aug.13 Multi Clark JMH Valdes 469,177 471,195 477,180 8,112,408 - 8,589,588

16 Z P-00928 51008032 ET- 1 Ortho Suite & ERA 1,706,000 700,000 2,406,000 CN Sep-08 Sep.09 Sep.13 Multi Frank JMH Valdes 16,465 163,766 880,602 1,525,398 - 2,406,000

17 AA 51011103 IT Infrastructure Renovat - 603,500 603,500 D Dec-10 Mar.12 Multi Frank JMH Martinez 7,532 13,657 589,704 13,796 - 603,500

18 AB PIP 31009002 Telecommunication 8,188,100 1,765,000 9,953,100 PIP Aug.09 Dec.11 Multi Niko JMH Martinez 184,135 1,074,043 7,378,839 2,574,261 - 9,953,100

19 AC P-00997 51009089 4160 Volt Oil Switch Repl 7,350,000 (2,565,000) 4,785,000 D Sep-09 Dec.12 Jun.14 Multi Douglas JMH Valdes 32,983 50,250 306,422 4,478,578 - 4,785,000

Total Mutifunding Source 161,064,336 2,786,325 163,850,661 1,057,607 5,812,731 118,694,814 45,012,397 143,450 163,850,661

1 O P-00566 51001001 Elevator Modernization 1,608,153 - 1,608,153 CN May-01 Mar.08 Mar.13 CC Alana JMH Armstrong - - 1,608,153 (0) - 1,608,153

2 X P-00724 51007008 Kitchen Equipment Modification 79,485 - 79,485 DEF Nov-06 Jun.07 TBD CC TBD JMH Valdes - - 79,485 (0) - 79,485

3 T P-00834 51008016 ADA Compliance Package#1 378,757 - 378,757 CN Oct-07 Apr.08 Dec.12 CC Arnaldo JMH Valdes - - 378,757 0 - 378,757

4 51011100 Highland Prof.Financ.Assessm 740,000 - 740,000 D Oct-10 Sep.11 Sep.12 CC Clark JMH Contreras 732 104,173 163,941 576,059 - 740,000

5 51011104 WW-15 Nursing Unit Moder 2,588,568 - 2,588,568 D Dec-10 Aug.12 Nov.12 CC Clark JMH Contreras - 815 165,166 2,423,402 - 2,588,568

6 Y 51011105 Ryder Trauma Ext Hardening 2,147,397 - 2,147,397 D Dec-10 Aug.13 CC Clark JMH Valdes - - - 2,147,397 - 2,147,397

7 51011106 Highland Prof. 6TH Floor 542,625 - 542,625 D Dec-10 Sep.11 Sep.12 CC Clark JMH Contreras - 2,725 42,117 500,508 - 542,625

8 51011107 ACC-W-1 Pharmacy Reno 1 - 1 D Dec-10 Dec.11 Jan.12 CC Arnaldo JMH Contreras - - - 1 - 1

9 C P-00632 52005003 J.South Community Hptal(661) 82,254 - 82,254 CO Aug-06 Dec.10 Apr.12 CC Clark JMH Garcia - - 82,254 0 - 82,254

10 S P-00827 53008015 Jack.No Elevators 1 & 2 52,317 - 52,317 DEF Feb-08 Jan.09 Jun.10 CC Abby JMH Sears - - 52,317 0 - 52,317

11 U P-00854 53008020 Jack.No. Window Replacement 85,608 - 85,608 CN Jan-08 Jan.09 Jun.12 CC Abby JMH Sears - - 85,608 0 - 85,608

12 W P-00655 56006004 JNCMHC Emerg. Generator 17,470 - 17,470 DEF Jul-06 Aug.07 Jun.11 CC Camero JMH Valdes - - 17,470 0 - 17,470

13 V P-00606 59004002 JMT Elevators Moderniz. 23,713 - 23,713 D May-04 Feb.08 May.13 CC Alana JMH Valdes - - 23,713 0 - 23,713

14 R P-00763 59007009 JMT Elevator Modern#141-146 24,135 - 24,135 CN Jul-07 Sept.10 Dec.12 CC Alana JMH Valdes - - 24,135 0 - 24,135

15 AA 51011103 IT Infrastructure Renovat - 368,500 368,500 D Dec-10 Mar.12 CC Frank JMH Martinez 7,532 13,657 354,704 13,796 - 368,500

16 58011110 Perdue Medical Center Reno 1,200,000 - 1,200,000 D Jan-11 May.12 CC TBD JMH Andrews - 23,558 25,887 1,174,113 - 1,200,000

17 51011111 NW-3 Floor Phase 1 347,750 275,400 623,150 CN Jan-11 Oct.11 May.12 CC Frank JMH Contreras 2,585 233,065 425,371 197,779 - 623,150

18 51011112 DTC PET Scan 2,467,000 - 2,467,000 CN Jan-11 Dec.12 CC Abby JMH Contreras - 41,141 1,912,570 554,430 - 2,467,000

19 51011119 WW-105 Government Relat 95,875 - 95,875 CN Sep-11 TBD CC Abby JMH Valdes - 19,490 65,853 30,022 - 95,875

BUDGET TRACKING REPORT FY 2012BY FUNDING SOURCE

stat

us Actuals FY12

CAPITAL CONTRIBUTION PROJECTS

Final report February 2012

Page 1 of 6





stat

us Actuals FY12


20 51012100 Human Resources Relocation 300,000 - 300,000 D Dec-11 TBD CC Abby JMH Hout-Barrientos 75,441 75,441 224,559 - 300,000

21 AB PIP 31009002 Telecommunication 2,000,000 - 2,000,000 PIP Aug.09 Dec.11 CC Niko JMH Martinez - - - 2,000,000 - 2,000,000

22 AC P-00997 51009089 4160 Volt Oil Switch Repl - 1,000,000 1,000,000 D Sep-09 Dec.12 Jun.14 CC Douglas JMH Valdes - - - 1,000,000 - 1,000,000

14,781,108 1,643,900 16,425,008 10,849 514,065 5,582,943 10,842,066 - 16,425,008

CAPITAL CONTRIBUTION

- - - - - - 0 - -


- - - - - - 0 - -


1 51010093 Centralized Registration 362,005 - 362,005 CN Feb-10 Oct.10 Nov.11 FS Lourdes JMH Pla 13,300 30,444 350,638 11,367 - 362,005

362,005 - 362,005 13,300 30,444 350,638 11,367 - 362,005


1 Q P-00696 51008007 Underground Storage Tank Repl 80,384 - 80,384 CL May-08 Dec.09 Dec.11 CC Allen Heery Valdes - - 80,384 0 - 80,384

2 51010102 Managed Care Relocation 952,906 952,906 CL Jul-10 Sep.11 Dec.11 CC Abby JMH Brady (7,583) 33,469 922,578 0 30,328 952,906

80,384 952,906 1,033,290 (7,583) 33,469 1,002,961 0 30,328 1,033,290

23 SUB TOTAL CAPITAL CONTRIBUTION PROJECTS 15,223,497 2,596,806 17,820,303 16,566 577,978 6,936,542 10,853,433 30,328 17,820,303

Total Strategic Initiative

Total Capital Contribution

JACKSON NORTH

Total Jackson North

STRATEGIC INITIATIVE (PROJECTS CANCELLED)

Total Financial Sustainability

CLOSED PROJECT FY 2011-2012

Total Closed Capital Contribution

FOUNDATION

FINANCIAL SUSTAINABILITY

Page 2 of 6





stat

us Actuals FY12


1 P-00659 51006005 Holtz-2 Pathology Renovat 2,000,000 - 2,000,000 CN Jul-06 Jul.08 Aug.12 F Frank JMH Contreras 79,081 564,221 1,848,041 151,959 - 2,000,000

2 51011117 DTC-1 Taylor Breast Ctr Reno 276,000 - 276,000 D Jul-11 Jul.12 Feb.13 F Alana JMH Contreras - - 700 275,300 - 276,000

3 51011118 C-5 NICU Intermed.Modern 100,000 - 100,000 D Aug-11 Apr.13 Jun.13 F Alana JMH Armstrong - - - 100,000 - 100,000

2,376,000 - 2,376,000 79,081 564,221 1,848,741 527,259 - 2,376,000

GOB GENERAL OBLIGATION BONDS

1 L P-00836 51007017 Rehab Building Renovation 16,400,000 16,400,000 D Sep-07 Aug.10 Sept.15 GOB JS Frank JMH Contreras - - - 16,400,000 - 16,400,000

2 P-00867 51008024 Campus Wide Pneumatic Tube S 3,629,400 - 3,629,400 CN Apr-08 Aug.10 Dec.13 GOB ED David JMH Valdes 394,885 397,495 1,260,619 2,368,781 - 3,629,400

3 P-00879 51008025 WW-4 CCU-B Expansion 1,854,812 - 1,854,812 CO Mar-08 Dec.08 Nov.11 GOB ED Arnaldo JMH Contreras - 35,929 1,796,581 58,231 - 1,854,812

4 M P-00904 51008026 C-4 Cath Lab # 6 2,833,500 786,645 3,620,145 CAN Jul-08 Oct.09 TBD GOB ED Abby JMH Contreras - - - 3,620,145 - 3,620,145

5 Z P-00928 51008032 ET- 1 Ortho Suite & ERA 1,706,000 - 1,706,000 CN Sep-08 Sep.09 Sept.13 GOB ED Frank JMH Contreras 16,465 163,766 880,602 825,398 - 1,706,000

Z P-00928 51008032 ET- 1 Ortho Suite & ERA - 700,000 700,000 CN Sep-08 Sep.09 Sept.13 RB INTER Frank JMH Contreras - - - 700,000 - 700,000

C P-00632 52005003 J.South Community Hptal 52,000,000 - 52,000,000 CO Aug-05 Dec.10 Apr.12 GOB JS Clark JMH Garcia 65,659 3,417,655 29,717,120 22,282,880 - 52,000,000

C P-00632 52005003 J.South Community Hptal (20,260,817) (20,260,817) CO Aug-05 Dec.10 Apr.12 GOB JS Clark JMH Garcia - - - (20,260,817) - (20,260,817)

62,023,712 (2,374,172) 59,649,540 477,009 4,014,845 33,654,922 25,994,618 - 59,649,540

2005 REVENUE BOND

L P-00836 51007017 Rehab Building Renovation 16,670,411 (59,620) 16,610,791 D Sep-07 Aug.10 Sept.15 RB REH Frank JMH Contreras - - 158,547 16,452,244 - 16,610,791

L P-00836 51007017 Rehab Building Renovation (16,400,000) (16,400,000) D Sep-07 Aug.10 Sept.15 RB REH Frank JMH Contreras - - - (16,400,000) - (16,400,000)

M P-00904 51008026 C-4 Cath Lab # 6 450,000 450,000 CAN Jul-08 Oct.09 TBD IRB INTER Abby JMH Contreras - 22,446 102,277 347,723 - 450,000

1 P-00932 51009033 HCH ET-5 Intake, ET-7 BMT Ph.I 1,758,649 (141,649) 1,617,000 CN Dec-08 May.10 Apr.12 RB PEDI Alana JMH Armstrong 46,569 188,739 1,157,913 459,087 - 1,617,000

2 P-00947 51009044 ET-5 Adolescen Unit 1,236,193 (200,000) 1,036,193 CN May-09 May.10 Sep.12 RB REH Alana JMH Armstrong - (11,810) 147,391 888,802 - 1,036,193

3 J P-00949 51009046 WW-B Pharmacy Phase I 250,927 470,000 720,927 CN May-09 Mar.10 Sep.12 RB ACU Arnaldo JMH Contreras 25,460 51,724 491,894 229,033 - 720,927

J P-00949 51009046 WW-B Pharmacy Phase I - 113,669 113,669 CN May-09 Mar.10 Sep.12 IRB INTER Arnaldo JMH Contreras - - - 113,669 - 113,669

4 K P-00952 51009047 SICU Reconfiguration 400,000 - 400,000 CO May-09 May.10 Nov.11 RB ACU Arnaldo JMH Contreras - - 400,000 (0) - 400,000

K P-00952 51009047 SICU Reconfiguration 136,000 136,000 CO May-09 May.10 Nov.11 RB PEDI Arnaldo JMH Contreras - 13,227 125,471 10,529 - 136,000

5 P-00953 51009048 ET-4 Fetal Surgery Office 653,549 - 653,549 CO May-09 Feb.10 Oct.11 RB PEDI Abby JMH Armstrong - 23,573 624,576 28,973 - 653,549

6 P-00959 51009054 ET-4 LDOR Fetal Surg.OR's 2,083,950 - 2,083,950 D May-09 Aug.10 Jan.13 RB PEDI Alana JMH Armstrong 444 10,892 399,621 1,684,329 - 2,083,950

7 51010096 WW-2 Angio Suite 2,000,000 2,000,000 D May-10 Oct.10 Dec.12 RB PEDI Abby JMH Cuming 116,476 1,211,986 1,272,941 727,059 - 2,000,000

8 51010097 DTC new MRI 2,500,000 2,500,000 D May-10 Oct.10 Oct.12 RB PEDI Abby JMH Cuming - 4,594 66,659 2,433,341 - 2,500,000

C P-00632 52005003 J.South Community Hptal 50,000,000 - 50,000,000 CO Aug-05 Dec.10 Apr.12 RB JS Clark JMH Garcia - - 50,000,000 (0) - 50,000,000

C P-00632 52005003 J.South Community Hptal 16,400,000 16,400,000 CO Aug-05 Dec.10 Apr.12 RB REH Clark JMH Garcia - - 16,400,000 (0) - 16,400,000

C P-00632 52005003 J.South Community Hptal 210,817 210,817 CO Aug-05 Dec.10 Apr.12 RB ACU Clark JMH Garcia - - 210,817 0 - 210,817

C P-00632 52005003 J.South Community Hptal 3,650,000 3,650,000 CO Aug-05 Dec.10 Apr.12 RB INTER Clark JMH Garcia - - 3,650,000 0 - 3,650,000

C P-00632 52005003 J South Community Hptal 100,000 100,000 CO Aug-05 Dec.10 Apr.12 RB INTER Clark JMH Garcia - - 100,000 0 - 100,000

Total Foundation

Total GOB Bonds

Page 3 of 6





stat

us Actuals FY12


9 53010091 JN Pharmacy Clean Room - 361,000 361,000 CN Jan-10 Feb.11 May.12 RB INTER Arnaldo JMH Sears 95,483 95,483 133,518 227,482 - 361,000

10 51011116 C-4 Cath Lab #5 454,000 - 454,000 D Apr.11 Oct.11 Jun.12 RB INTER Abby JMH Contreras - 1,875 27,470 426,530 - 454,000

11 51011120 ET-1 Admitting Renovation 258,000 - 258,000 CN Sep-11 Aug.12 Jun.12 RB&Inter Alana JMH Armstrong - - - 258,000 - 258,000

12 51012101 WW-6 Modernization 1,553,000 - 1,553,000 D Feb.12 Aug.12 RB INTER Arnaldo JMH Contreras - - - 1,553,000 - 1,553,000

13 51012102 SW-6 Modernization 482,320 - 482,320 D Feb.12 TBD RB INTER Alana JMH Contreras - - - 482,320 - 482,320

-

75,800,999 9,590,217 85,391,216 284,432 1,612,730 75,469,094 9,922,122 - 85,391,216

2009 INFRASTRUCTURE BOND

O P-00566 51001001 Elevator Modernization 1,391,847 70,700 1,462,547 CN May-01 Mar.08 Mar.13 IRB Alana JMH Armstrong - - 414,702 1,047,845 - 1,462,547

T P-00834 51008016 ADA Compliance Package#1 613,006 692,000 1,305,006 CN Oct-07 Apr.08 Dec.12 IRB Arnaldo JMH Valdes 2,728 7,918 352,065 952,941 - 1,305,006

1 P-00938 51009036 WW Fire Alarm 2,000,000 350,000 2,350,000 CN Apr-09 Sep.10 Feb.12 IRB David JMH Valdes 1,485 214,866 1,803,492 546,508 - 2,350,000

2 P-00957 51009052 PPW Cooling T.Chiller,AHU 1,496,790 (272,000) 1,224,790 CO Sep-09 Nov.11 Apr.11 IRB Frank JMH Valdes - - 1,155,719 69,071 - 1,224,790

3 P-00958 51009053 ET A/C Repl177-180,181Inst 2,653,370 465,710 3,119,080 CN Sep-09 Nov.10 Apr.12 IRB Frank JMH Valdes - 511,496 2,753,066 366,014 - 3,119,080

4 P-00961 51009056 Replace Paralleling Gear 4,361,250 928,122 5,289,372 D Sep-09 Dec.12 Dec.13 IRB Douglas JMH Valdes 26 119,245 119,288 5,170,084 - 5,289,372

5 P-00962 51009057 Utility Ctr-2 Emerg.Generat 2,135,000 123,215 2,258,215 CN Sep-09 Jan.12 May.12 IRB David JMH Valdes - 221,773 2,128,688 129,527 - 2,258,215

6 P-00967 51009062 Fire Alarm Upgrade Campus 4,815,000 (385,505) 4,429,495 D Sep-09 Dec.12 Feb.13 IRB Douglas JMH Valdes 69,914 165,495 205,007 4,224,488 - 4,429,495

7 P-00969 51009064 DTC,T,Rehab,WW&ACC-W AHU 6,541,500 - 6,541,500 CN Sep-09 Nov.12 Sept.15 IRB Frank JMH Valdes 338,827 606,435 2,536,568 4,004,932 - 6,541,500

8 P-00974 51009069 Campus Wide Roofing Repl. 1,500,000 - 1,500,000 D Sep-09 Dec.10 Feb.13 IRB Alana JMH Valdes - 204,263 368,900 1,131,100 - 1,500,000

9 P-00978 51009072 Fire Sprinkler Upgrade Campus 2,000,000 - 2,000,000 D Sep-09 Dec.12 Feb.13 IRB David JMH Valdes 13,690 30,722 165,032 1,834,968 - 2,000,000

10 P-00982 51009076 UC Emerg.Well Boilers 2,331,000 286,350 2,617,350 CN Sep-09 Jun.11 May.12 IRB David JMH Valdes 17,703 571,439 2,116,624 500,726 - 2,617,350

11 AC P-00997 51009089 4160 Volt Oil Switch Repl 7,350,000 (3,565,000) 3,785,000 D Sep-09 Dec.12 Jun.14 IRB Douglas JMH Valdes 32,983 50,250 306,422 3,478,578 - 3,785,000

12 51010098 Above Ground Tank Replacem - 369,580 369,580 D Jun-10 TBD IRB Camero JMH Valdes - - - 369,580 - 369,580

13 51010099 Concrete Struct Tank Farm - 100,000 100,000 D Jun-10 Mar-11 Aug.12 IRB Arnaldo JMH Valdes - 9,500 10,039 89,961 - 100,000

14 51010100 CampusW Underg Utilities - 3,200,000 3,200,000 CN Jul-10 Dec.11 Sep.12 IRB Allen Heery Valdes 142,181 394,465 1,096,189 2,103,811 - 3,200,000

AA 51011103 IT Infrastructure Renovat - 235,000 235,000 CN Dec-10 Mar.12 Oct.12 IRB TBD JMH Martinez - - 235,000 (0) - 235,000

C P-00632 52005003 J.South Community Hptal (661) 342,746 - 342,746 CO Aug-06 Dec.10 Apr.12 IRB Clark JMH Garcia - - 342,746 0 - 342,746

U P-00854 53008020 Jack.No. Window Replacement 1,971,612 1,000,000 2,971,612 CN Jan-08 Jan.09 Sep.12 IRB Abby JMH Sears 53,035 326,390 2,354,781 616,831 - 2,971,612

15 P-00960 53009055 Main/JNMC-outside. lights 922,500 (141,820) 780,680 CN Sep-09 Sep.10 Dec.12 IRB Arnaldo JMH Valdes - 21,215 131,635 649,045 - 780,680

16 P-00970 53009065 JNMC Hot Water/Boiler 630,000 2,470,000 3,100,000 D Sep-09 Jun.11 Jul.13 IRB Abby JMH Sears - 655,048 1,374,652 1,725,348 - 3,100,000

17 P-00972 53009067 JNMC Remaining Roof 527,383 (427,071) 100,312 D Sep-09 Mar.10 May.12 IRB Abby JMH Sears - - - 100,312 - 100,312

18 P-00983 53009077 JNMC Med Line Isolation Panel 288,750 (200,000) 88,750 D Sep-09 Oct.11 TBD IRB Abby JMH Sears - - 734 88,016 - 88,750

19 P-00989 53009081 JNMC ICU Commode Rep 52,500 400,000 452,500 CN Sep-09 Mar.10 Jul.12 IRB Abby JMH Sears - 12,790 368,855 83,645 - 452,500

20 P-00996 53009088 JNMC Emer.Switchgear 1,650,000 95,000 1,745,000 D Sep-09 Dec.12 Dec.13 IRB Douglas JMH Sears - 30,140 62,417 1,682,583 - 1,745,000

21 53010101 JNMC 40 Year Certification - 446,272 446,272 D Jul-10 Sep.12 IRB Abby JMH Valdes - - 65,260 381,012 - 446,272

V P-00606 59004002 JMT Elevators Moderniz. 907,878 (30,291) 877,587 D May-04 Feb.08 Aug.12 IRB Alana JMH Valdes - 26 26 877,561 - 877,587

R P-00763 59007009 JMT Elevator Modern#141-146 1,033,048 243,574 1,276,622 CN Jul-07 Sept.10 Oct.12 IRB Alana JMH Valdes 200,434 200,434 716,368 560,254 - 1,276,622

22 51011113 Reduction of NAP Utilization 300,000 569,824 869,824 D Apr-11 Sep.11 Sep.12 IRB Frank JMH Martinez 224 184,516 232,459 637,365 - 869,824

23 AB PIP 31009002 Telecommunication 6,000,000 1,765,000 7,765,000 PIP Aug.09 Dec.11 IRB Niko JMH Martinez 184,135 1,074,043 7,190,739 574,261 - 7,765,000

24 PIP 31011014 Reduction of NAP Utilization 300,000 (300,000) - PIP Apr-11 Sep.11 IRB Niko JMH Martinez - - - 0 - -

Total 2005 Revenue Bond

Page 4 of 6





stat

us Actuals FY12


54,115,180 8,488,660 62,603,840 1,057,362 5,612,467 28,607,473 33,996,367 - 62,603,840

2009 INFRASTRUCTURE REVENUE BOND DEFERRED PROJECTS

X P-00724 51007008 Kitchen Equipment Modification 711,679 - 711,679 DEF Nov-06 Jun.07 TBD IRB TBD JMH Valdes - - - 711,679 - 711,679

1 P-00964 51009059 Utility Ctr Chiller Replacem 2,810,370 - 2,810,370 DEF Sep-09 Dec.12 IRB TBD JMH Valdes - - - 2,810,370 - 2,810,370

2 P-00965 51009060 Chilled Water Loop Valves 315,000 - 315,000 DEF Sep-09 Dec.12 IRB TBD JMH Valdes - - - 315,000 - 315,000

3 P-00975 51009070 Heat Exchangers 420,000 - 420,000 DEF Sep-09 Mar.10 Oct.10 IRB Camero JMH Valdes - - - 420,000 - 420,000

4 P-00979 51009073 Public Area Bathrooms 210,000 - 210,000 DEF Sep-09 Oct.10 IRB TBD TBD Valdes - - - 210,000 - 210,000

5 P-00981 51009075 WW & C AHU Repl (14) 1,995,000 - 1,995,000 DEF Sep-09 Dec.12 IRB TBD JMH Valdes - - 95,926 1,899,074 - 1,995,000

6 P-00991 52009083 J.South Repl.2 Vacuum P 25,000 - 25,000 DEF Sep-09 Mar.10 Oct.10 IRB TBD JMH Garcia - - - 25,000 - 25,000

S P-00827 53008015 Jack.No Elevators 1 & 2 437,733 - 437,733 DEF Feb-08 Jan.09 Jun.10 IRB TBD JMH Sears - - 6,663 431,070 - 437,733

7 P-00968 53009063 JNMC AHU Replacement 2,908,500 - 2,908,500 DEF Sep-09 Dec.12 IRB Abby JMH Sears - - - 2,908,500 - 2,908,500

8 P-00971 53009066 JNMC Med. Air Compres 130,000 - 130,000 DEF Sep-09 Mar.10 Oct.10 IRB Abby JMH Sears - - - 130,000 - 130,000

9 P-00977 53009071 JNMC Repl.Conden.Coils 52,500 - 52,500 DEF Sep-09 Mar.11 IRB Abby JMH Sears - - - 52,500 - 52,500

10 P-00988 53009080 JNMC SICU Med Gas Colum 126,000 - 126,000 DEF Sep-09 Mar.10 Oct.10 IRB Abby JMH Sears - - - 126,000 - 126,000

11 P-00990 53009082 JNMC Vacuum System 78,750 - 78,750 DEF Sep-09 Mar.10 Oct.10 IRB Abby JMH Sears - - - 78,750 - 78,750

12 P-00993 53009085 JNMC Pat.R.Fan Coils 2,940,000 - 2,940,000 DEF Sep-09 Dec.12 IRB Abby JMH Sears - - - 2,940,000 - 2,940,000

W P-00655 56006004 JNCMHC Emerg. Generator 314,369 - 314,369 DEF Jul-06 Aug.07 Jun.11 IRB Abby JMH Valdes - - - 314,369 - 314,369

13 P-00994 56009086 Rose Lee W. Exp.Exam R 262,500 - 262,500 DEF Sep-09 Mar.10 Oct.10 IRB Camero JMH Contreras - - - 262,500 - 262,500

14 P-00995 56009087 Rose Lee W Med.Record 31,500 - 31,500 DEF Sep-09 Mar.10 Oct.10 IRB Camero JMH Contreras - - - 31,500 - 31,500

13,768,901 - 13,768,901 - - 102,589 13,666,312 - 13,768,901

AB pip 31009002 Telecommunication 188,100 - 188,100 PIP Aug.09 Dec.11 TF Niko JMH Martinez - - 188,100 0 - 188,100

188,100 - 188,100 - - 188,100 0 - 188,100

FEMA Grants

IN CONSTRUCTION

Y 51011105 Ryder Trauma Ext Hardening 6,442,191 - 6,442,191 D Dec-10 Aug.13 FEMA Clark JMH Valdes 469,177 471,195 477,180 5,965,011 - 6,442,191

NEW 56012103 Jefferson Reaves Wind Retro 601,281 - 601,281 D Mar.12 Sep.12 FEMA Arnaldo JMH Valdes - - - 601,281 - 601,281

7,043,472 - 7,043,472 469,177 471,195 477,180 6,566,292 - 7,043,472 Total FEMA Grants

Total 2009 Infrastructure Rev.Bond

Total 2009 Infrastructure Rev.Bond DEFERRED

TRUST FUND / GRANTS

Total Trust Fund

Page 5 of 6





stat

us Actuals FY12


ALL OTHER FUNDING SOURCES

Closed/Cancelled and Partially Capitalized FY 11-12

1 P-00941 51009038 Cooling Tower 4,100,000 150,000 4,250,000 CL Feb-09 Sep.10 Jan.12 IRB Camero JMH Valdes 140,783 140,783 4,238,534 0 11,466 4,250,000

2 53010095 JNMC Labor & Delivery 905,910 905,910 CL May-10 Oct.10 Oct.11 RB INTER Abby JMH Sears - 5,060 894,322 0 11,588 905,910

Q P-00696 51008007 Underground Storage Tank Repl 2,919,616 (1,689,852) 1,229,764 CL May-08 Dec.09 Dec.11 IRB Allen Heery Valdes - - 1,086,314 0 143,450 1,229,764

3 51010092 Institute Annex 3rd Floor - 91,620 91,620 CL Jan-10 Sep.10 Dec.11 RB REH Abby JMH Contreras - 227 89,049 0 2,571 91,620

4 51011102 Mainframe Retirement - - - CAN Dec-10 TBD IRB TBD JMH Martinez - (20,175) - 0 - -

5 P-00992 51009084 BackFl.&Byp.DomWater 250,000 117,000 367,000 CAN Sep-09 Mar.10 Dec.11 IRB Camero JMH Valdes (9) (0) (0) 0 367,000 367,000

6 P-00973 53009068 JNMC Roof No.So.ICU&ER 250,000 (250,000) - CAN Sep-09 Mar.10 TBD IRB Abby JMH Sears - - - 0 - -

7,519,616 (675,322) 6,844,294 140,774 125,894 6,308,219 - 536,075 6,844,294

45 TOTAL FOR OTHER FUNDINGS 222,835,980 15,029,383 237,865,363 2,507,836 12,401,353 146,656,319 90,672,969 536,075 237,865,363

68 GRAND TOTAL 238,059,477 17,626,189 255,685,666 2,524,403 12,979,332 153,592,861 101,526,402 566,403 255,685,666

LETTERS Denotes Multi Funding Sources (The sum of all sources equals the Total Funded Commitment or Total Project Budget)

New: Denotes a new project opened in the current month

Hold: Projects placed on hold by Capital Projects Department

Bold project numbers: Denotes changes in the project stages i.e.. From Design to Construction etc.

Bold budget amount: Denotes a change in the Total Project Budget

Bold date: Denotes changes in the projected completion/ revised completion date in the current month

Status CAN Cancelled Project CL Closed CN Construction CO Close-OutD DesignDEF DeferredPC Partial Capitalization

Total Closed Other Fundings

Page 6 of 6

JACKSON MEMORIAL HOSPITAL

MONTHLY STATUS REPORT

APRIL 2012


MASTER PLAN UPDATE Funding Source: JHS Capital Projects Total Project Budget: $264,500 Anticipated substantial completion date: December 30, 2011 Scope of the Work

To collect and validate volume data, update facility assessment, update planning/programming/operational recommendations, update infrastructure recommendations, refine phasing and enabling recommendations and update capital cost study

March 2012

On Hold Pending Validation of Strategic Plan April 2012

On Hold Pending Validation of Strategic Plan Meet with Strategic Planning Group

May 2012 Begin Strategic Visioning Begin Design Concepts Preliminary Cost & cash Flow Analysis Begin Distillation of Strategic Direction Finalize Design Concepts Validate Cost & Cash Flow Analysis

51010100 CAMPUS WIDE UNDERGROUND UTILITY SITEWORK IMPROVEMENTS Funding Source: IRB Total Project Budget: $ 3,200,000 Anticipated substantial completion date: July 31, 2012 (Contractors revised completion date is now Sept. 4, 2012) Scope of the Work

To upgrade water and fire lines in and around the Alamo Plaza along with canopy replacement, improvements to hardscape, lighting and landscape.

Scope of the Work:

To upgrade water and fire lines in and around the Alamo Plaza along with canopy replacement, improvements to hardscape, lighting and landscape.

March 2012

Continue Construction Activities Submit Additional Hardscape Improvements

April 2012 Continue Construction Activities Submit Memorial Park Design for Permit

May 2012 Continue Construction Activities



APRIL 2012

JACKSON MEMORIAL HOSPITAL 51008032 EAST TOWER FLOOR – ER-RENOVATION Funding Source: GOB& 2005 RB Total Project Budget: $ 2,406,000 Anticipated substantial completion date Phase III: March 31, 2013 PHASE 3 Scope of the Work

To refurbish and upgrade the ER-B & ER-C Patient Units including all existing bathrooms within the Department, discharge/cashier’s office and staff lounge.

March 2012

Phase 1-A (cashier’s office, Physician’s office, bathrooms #1050A&B) Construction to be completed April 2012

Phase 1-B (Trauma corridor, staff lounge, soil-clean rooms Ward H, New ADA bathrooms) Construction to be commenced

May 2012 Phase 1-B Construction in progress

51006005 EAST TOWER 2ND FLOOR PATHOLOGY LAB Funding Source: JMH Foundation Total Project Budget: $ 2,000,000 Anticipated substantial completion date: June 30, 2012 Scope of the Work:

To upgrade and refurbish the existing Pathology Laboratory. Project Designed in Five (5) construction phases: 1.-UM Chairman Office/Bathroom, 2.-Conference Room, 3.-North Lab, 4.-South Lab/Grossing Stations 5.-Residencies Lab.

March 2012 FAT to increase total project budget for review and approval

April 2012 Pathology Residencies Lab (Phase 5) construction to be commenced

May 2012 Pathology Residencies Lab (Phase 5) construction to be completed



APRIL 2012

JACKSON MEMORIAL HOSPITAL 51009033 ET-7 PEDIATRIC BMT Funding Source: 2005 RB Total Project Budget: $ 1,617,000 Projected Construction Completion Date: May 2012 Scope of work The scope of work entails the dispersement of the CCIU unit on the East Tower 7th floor in order to create a 7 bed Pediatric Bone Marrow Transplant Unit. The renovations will provide the modernization of 7 patient rooms and the addition of two (2) ADA Patient Restrooms, playroom and one (1) laundry facility. Upgrade of staff lounge, corridor and adjacent support areas. Total Square footage under this contract is approximately 3,382 sq. ft. March 2012

Construction Continues April 2012

Construction Continues Installation of GE Monitors Furniture to be delivered AHCA

May 2012 Begin Project Close-out

51009044 HCH ADOLESCENT UNIT RELOCATION Funding Source: 2005 RB Total Project Budget: $ 1,036,193 Projected Construction Completion Date: June 2012 Scope of work Renovation of an existing area on the East Tower 5th floor in the Infant Toddler Pediatric Patient Rooms for Adolescents. Remodel existing (6) six crib nursery and convert it into four (4) Private Patient rooms including the addition of four (4) new head walls and additional new ADA patient rest rooms by converting existing closets. Upgrade of existing Private and Semi-Private patient Rooms, staff lounge and corridor. February 2012

ON HOLD pending review of revised PER from executive Leadership March 2012

ON HOLD April 2012

ON HOLD



APRIL 2012

JACKSON MEMORIAL HOSPITAL 51011117 TAYLOR BREAST CENTER RENOVATION Funding Source: JMH Foundation Total Project Budget: $276,000 Anticipated Construction Completion Date: February 2013 This scope of work entails the renovation of the Taylor Breast Center located in the Diagnostic Treatment Center 1st floor. The upgrade will include renovation of the entrance / Reception Room. The Patient Changing Rooms will be relocated and converted into 3 Patient Intake areas. The Radiologist and Reading rooms will be relocated to accommodate new equipment. The upgrade will also include new furniture, paint, and lighting. March 2012

End User approve Schematic Design Architect to proceed with Design Development Documents

April 2012 Ongoing Design Services

May 2012 Ongoing Design Services 75% Construction Submittal to JMH

51011118 NICU B, C AND INTERMEDIATE MODERNIZATION Funding Source: JMH Foundation Approved Project Budget: $100,000 (Design) Estimated Project Budget: $2,000,000 Anticipated Construction Completion Date: June 2013 The Scope of Work entails the modernization of the NICU B, C and Intermediate Units. This includes the complete renovation of the Nursing Stations, Refurbishment of Patient Bays and Replacement of flooring and Wall protection to match the existing NICU Unit A. March 2012

Foundation Committed project funds confirmed with Budget / FAT funds into Project April 2012

Input Lawson Requisition for PO issuance to A/E Issuance of PO to A/E

May 2012 Notice to Proceed for design services to Naya Architects



APRIL 2012

JACKSON MEMORIAL HOSPITAL 51011116 CARDIAC CATH LAB #5 EQUIPMENT REPLACEMENT Funding Source: 2005 RB Total Project Budget: $454,000 Projected Construction Completion Date: June 2012 Construction to be performed by JOC Scope of work Replace Cardiac Cath Lab equipment for room 5 on Central 4th floor. Existing equipment is 23 years old and has not functioned for almost two years. March 2012

Pending Executive Approval April 2012

Receive ROI from JMH CAO New PER is approved and executed Procurement of Contractor with informal bid process

May 2012 PO issued to Contractor Construction Commences

51009054 ET-4 LABOR AND DELIVERY OPERATING ROOMS Funding Source: 2005 RB Total Project Budget: $2,083,950 Anticipated substantial completion date: TBD Scope of Work Remodeling and Renovation of 5 Labor and Delivery Operating Rooms and surrounding support areas at the East Tower 4th Floor – Holtz Children’s Hospital. Four (4) Operating Rooms will maintain the same size and configuration. Operating Room Five (5) will be demolished and redesigned to higher standards. Total Square footage under this contract is approximately 5,450 Sq. Ft. February 2012

ON HOLD Pending Executive Approval for procurement to review Contractor Bids March 2012

ON HOLD Pending Executive Approval for procurement to review Contractor Bids April 2012

ON HOLD Pending Executive Approval for procurement to review Contractor Bids



APRIL 2012

JACKSON MEMORIAL HOSPITAL 51010096 WW-2 ANGIO SUITE Funding Source: 2005 RB Total Project Budget: $ 2,000,000 Anticipated substantial completion date: December 2012 Construction to be performed by JOC Scope of work Removal of existing C-arm and replace with a new Siemens’ Zee in Interventional Radiology room #25. Renovation of abandoned Interventional Radiology area on WW2 to create a new recovery unit for Interventional Radiology. March 2012

Pending Executive Approval AHCA Approved IR Room #25 Construction Final March 13, 2012

April 2012 Receive ROI from JMH CAO New PER Signed for Project ITB process started for Recovery Area

May 2012 ITB Process Continues for Recovery Area

51008026 CARDIAC CATH LAB #6 Funding Source: GOB & 2005 RB Total Project Budget: $ 4,070,145 Projected Construction Completion Date: TBD Scope of work Construction of a new EP Cardiac Cath Lab on Central 4th Floor. Includes the Relocation of the storage areas into the unit. February 2012

On Hold March 2012

On Hold April 2012

On Hold



APRIL 2012

JACKSON MEMORIAL HOSPITAL 51009053 EAST TOWER 2 FLOOR A/C REPLACEMENT Funding Source: IRB Total Project Budget: $ 3,119,080.00 Anticipated substantial completion date: May 31, 2012 Scope of the Work:

To furnish the Five (5) custom Air Handling Units at the East Tower 2nd Floor of Holtz Children’s Hospital.

March 2012 City of Miami Mechanical Inspection

April 2012 City of Miami Electrical Inspection

May 2012 AHCA 100% Survey

51009072 FIRE SPRINKLER UPGRADE CAMPUS WIDE Funding Source: IRB Total Project Budget: $2,000,000 Anticipated substantial completion date: March 2013 Scope of the Work The campus-wide fire protection upgrades are to address all existing NFPA fire sprinkler codes in addition to installing new automatic sprinkler systems and other system components for each building as determined deficient by state and local authority having jurisdiction. These main campus building include Central, East Tower, North Wing, Rehabilitation, South Wing, West Wing, and Utility buildings. March 2012

Review and revised ITB language CSBE measures review

April 2012 JMH Procurement and Capital Projects to re-bid the fire sprinkler project in its entirety (all 6 patient

buildings) for public solicitation May 2012

Competitive proposal review for construction services (all 6 patient buildings) Proposal negotiations (all 6 patient buildings) PHT Board Approval for construction services (construction cost estimated to be over $1M) Lawson Input for purchase order issuance (all 6 patient buildings)



APRIL 2012

JACKSON MEMORIAL HOSPITAL 51011105 RYDER TRAUMA CENTER EXTERIOR HARDENING PROJECT Funding Source: FEMA (75%) / Capital Contribution (25%) Total Project Budget: $8,589,588 Anticipated substantial completion date: August 20, 2013 Scope of the Work The project scope of work is to structurally retrofit the building envelope. The project will be designed to install a wind abatement system of lightweight glass fiber reinforced concrete (GFRC) panels onto the Ryder Trauma Center. The components used for this wind retrofit project will meet the current Florida Building Code and Miami-Dade County specifications to withstand extreme hurricane conditions (Category IV storm conditions). March 2012

Completion of 100% Construction Drawings Submit 100% Construction Drawings to City of Miami Plan Review Review and revised ITB language CSBE measures review

April 2012 Solicit qualified construction managers / contractors through an ITB process

May 2012 Proposal review/ negotiations Contract review, approval, execution

51011106 HIGHLAND PROFESSIONAL BUILDING – TRANSPLANT RENOVATIONS Funding Source: Capital Contribution Total Project Budget: $542,625 Anticipated substantial completion date: September 2012(TBD due to project HOLD) Scope of the Work The scope of work is to renovate various areas of the 6th floor transplant floor of the Highland Professional Building in order to add Patient Exams room and work station to support the 6th Floor Transplant department. Additionally the scope of work includes interior renovations to the 1st floor lobby area, elevator lighting upgrade, interior/exterior signage and renovations to an unoccupied area to support daily clerical activities. March 2012

Ongoing Construction Services – ON HOLD Pending Executive Approval for procurement to release new/existing Purchase Orders

April 2012 Ongoing Construction Services – ON HOLD Pending Executive Approval for procurement to

release new/existing Purchase Orders May 2012




APRIL 2012

JACKSON MEMORIAL HOSPITAL 51011100 HIGHLAND PROFESSIONAL BUILDING – FINANCIAL ASSESSMENT Funding Source: Capital Contribution Total Project Budget: $740,000 Anticipated substantial completion date: September 2012(TBD due to project HOLD) Scope of the Work The scope of work is to renovate a portion of the first floor Highland Professional Building in order to relocate the Financial Assessment department into the renovated space. The proposed space is approximately 5,449 sq ft. The proposed renovation will provide six (6) offices, waiting/reception area, (1) copy room, (1) ADA Bathroom, and an open floor plan for cubicle work stations. March 2012

Ongoing Construction Services - ON HOLD Pending Executive Approval for procurement to release new/existing Purchase Orders

April 2012 Ongoing Construction Services - ON HOLD Pending Executive Approval for procurement to

release new/existing Purchase Orders May 2012


51009046 WEST WING BASEMENT PHARMACY CLEANROOM PHASE I / CAROUSELS PHASE II Funding Source: 2005 RB Total Project Budget: $ 834,596 Projected Construction Completion Date: Phase I July 2011 / Phase II July 2012 Phase I Construction Status: 100% Phase II Construction Status: 0% Scope of Work: Phase I: Installation of a new USP 797 complaint pharmacy clean-room in the West Wing basement. Phase II: Demolition of the old cleanroom to create an open space within the pharmacy to receive (3) new pharmaceutical carousel. This includes new finishes throughout the basement pharmacy. March 2012

Issue procurement required documentation to develop ITB package Submit documentation required to establish Dade County project measures

Dade County project measures established April 2012

Procurement ITB process continues May 2012

Procurement ITB process continues



APRIL 2012

JACKSON MEMORIAL HOSPITAL 51010097 DTC NEW MRI Funding Source: 2005 RB Total Project Budget: $ 2,500,000 Anticipated substantial completion date: October 2012 Construction to be performed by JOC Scope of the Work: Replacement of existing MRI in DTC 1st floor. Includes expansion of room and new back up chiller. March 2012

Pending Executive Approval April 2012

Receive ROI from JMH CAO New PER is approved and executed Redesign for new Code for Mobile Trailer Site

May 2012 Construction Commences in support Areas for MRI Permitting for Trailer Site with City of Miami Send updated code documents for Trailer site to AHCA for review

51009089/E10-JMH-01 MEDIUM VOLTAGE OIL SWITCHES REPLACEMENT AND ELECTRICAL SWITCHGEARS AT CENTRAL AND SOUTH WING REPLACEMENT: Funding Source: IRB Total project Budget: $3,785,000 Anticipated substantial completion date: Design March 2012 Construction October 2012

Scope of the Work Replace medium voltage oil switches in Central, South Wing, Institute, Rehabilitation and North Building. Central and South Wing: replace normal and emergency substations and main switchgears.

March 2012

Implementation AHCA - DD Comments April 2012

Submit plans for JMH staff review 100% CD Estimated construction cost analysis Determine CSBE measures before we proceed with an ITB

May 2012 PHT Board Approval for construction services (construction cost estimated to be over $5M)



APRIL 2012

JACKSON MEMORIAL HOSPITAL 51009056/E10-JMH-02 ENERGY CENTER REPLACE PARALLELING GEAR AND NEW EMERGENCY GENERATORS Funding Source: IRB Total project Budget: $ 5,289,372 Anticipated substantial completion date: Design May 2012 Construction May 2013

Scope of the Work Replace paralleling system and emergency distribution switchboard; provide new engines with the capability to operate in dual-fuel mode (natural gas component). Ryder Trauma Center emergency power system will be increased, with the intention of having the entire building on emergency power.

March 2012

Submit construction plans for Power Monitoring at Main Campus April 2012

The emergency power upgrade will be at Utility Center Plant Modify Essential Master Controls and two generator sections of the existing Essential switchgear

line up for compatibility with the Non-Essential line-up Determine CSBE measures before we proceed with an ITB Review estimate construction cost.

May 2012 Continue with construction plans Procurement to proceed with the ITB

59007009 JMT ELEVATOR MODERNIZATIONS #141 TO #148 Funding Source: Capital Contribution / IRB Total Project Budget: $1,300,757 Projected Completion Date: December 2012 Scope of Work Modernization and cab upgrade to Elevators #147 & 148 in Jackson Medical Towers March 2012

Input of Lawson Re. for Simplex Schindler complete Modernization of #146 Schindler begin Modernization of #144 Schindler submit updated Pay Application 03 Schindler submit updated pay application for Amendment 01

April 2012 Elevator Cab Interior approved Schindler continue with #144 PO Issuance to Simplex Shop drawings approved for Elevator Cab Interiors

May 2012 Schindler complete Modernization of #144 Issue PO to Simplex

Tracking 100% CD’s PPE



APRIL 2012

JACKSON MEMORIAL HOSPITAL 51009062/E10-JMH-03 P-00967 FIRE ALARM UPGRADE AT JACKSON MEMORIAL HOSPITAL. Funding Source: IRB Total project Budget: $ 4,429,495 Anticipated substantial completion date: March 2013

Scope of the Work Design and upgrade of existing hospital and business occupancy floor for: Rehabilitation, Trauma, Mental Health and Jackson Medical Towers buildings, replace all audio/visual devices provide new speakers, all older model addressable ceiling smoke detectors, heat sensors, manual pull station and duct detectors must be replaced, flow and tamper annunciation modules must be upgraded. Connect these building to the fire alarm loop/network. March 2012

Proposal negotiations w/ Simplex for (Trauma, Rehab, and North Wing 1st / 2nd floor) Tracking ongoing design services for remaining buildings (PPW, PPE, and Jackson Medical Towers)

April 2012 Lawson Input and Purchase Order Issuance (Trauma, North Wing, and Rehab) Ongoing Design Services – Track the completion of non-patient towers: Park Plaza East, park Plaza

West, and Jackson Medical Towers May 2012

Engage Simplex Grinnell for construction services for patient’s towers only. Commence construction Ongoing Design Services – Track the completion of non-patient towers: Park Plaza East, park Plaza

West, and Jackson Medical Towers

51009036 WEST WING AND CENTRAL FIRE ALARM UPGRADE PROJECT Funding Source: IRB Total Project Budget: $2,350,000 Projected Completion Date September 2012 Scope of Work Design and upgrade of existing patient occupancy towers for: West Wing and Central buildings, replace all audio/visual devices provide new speakers, all older model addressable ceiling smoke detectors, heat sensors, manual pull station and duct detectors must be replaced, flow and tamper annunciation modules must be upgraded. Connect these building to the fire alarm loop/network. March 2012

Ongoing City of Miami Fire Marshall inspections for the West Wing Tower Ongoing Fire Alarm installation, programming, trim-out for the Central Building

April 2012 100% AHCA inspection for Central Building week of 3/4/2012 (80% Inspection)

May 2012

Ongoing City of Miami Fire Marshall inspections for the West Wing Tower Ongoing City of Miami Fire Marshall inspections for the Central Building



APRIL 2012

JACKSON MEMORIAL HOSPITAL 51009057 UTILITY CENTER (2) EMERGENCY GENERATOR REPLACEMENT PROJECT Funding Source: IRB Total Project Budget: $2,251,728 Projected Completion Date May 2012 Scope of Work Modify the existing paralleling system and replace (2) existing generators with (2) 2000KW generators; Provide new engines with the capability to operate in dual-fuel mode (natural gas component). Patient Towers emergency power system will be increased, with the intention of having the entire building on emergency power. March 2012

Ongoing Generator installation – Final Terminations Paralleling Exercise (2) 2000KW Generators On-line for campus support Begin Project Closeout

April 2012 Misc. Construction closeout items Training / Testing / Monitoring

May 2012 Project Closeout Training / Testing / Monitoring Project Turnover

51009076 UTILITY CENTER BOILER REPLACEMENT PROJECT Funding Source: IRB Total Project Budget: $2,531,000 Projected Completion Date May 2012 Scope of Work Provide and install two (2) 1200HP boilers and associated equipment for the replacement of two (2) existing 600 HP boilers. The installation and operating capacity will function as it currently existing with a max capacity of 1200HP. If in the event for future growth and/or increase in demand an expand HP capacity will be available for boiler infrastructure support. March 2012

Boiler Start-up (2nd Boiler) – Commissioning Exercise Final Terminations Replacement Boiler On-line with campus support Re-commissioning the Boiler – (Equipment Vendor) Begin project closeout

April 2012 Misc. Construction closeout items Training / Testing / Monitoring

May 2012 Project Closeout Training / Testing / Monitoring Project Turnover



APRIL 2012

JACKSON MEMORIAL HOSPITAL 51011104 WEST WING 15 NURSING UNIT MODERNIZATION Funding Source: Capital Contribution Total Project Budget: $2,588,568 Projected Completion Date December 2012(TBD due to project on HOLD) Scope of Work The West Wing 15 Nursing Unit Modernization project has a vision towards creating a greater offering of single-occupancy rooms at Jackson Health System. The projects’ interior renovation would create twenty-five (25) single-occupancy rooms, one (1) VIP room, and other clinical support areas to current codes, hospital standards, and modernized finishes. March 2012 – ON HOLD Pending executive approval

Ongoing procurement process – “ITB for Qualified Contractor” Pre-Bid meeting and site walk through Cone of Silence

April 2012– ON HOLD Pending executive approval Received contractor proposals Proposal negotiations/reviews

May 2012– ON HOLD Pending executive approval Construction Contract review by PHT, CAO, Legal Lawson Input and Purchase Order Issuance for construction services

53009055 MAIN CAMPUS / JNMC CAMPUS-WIDE LIGHTING UPGRADE Funding Source: IRB Total Project Budget: $ 780,680 Projected Construction Completion Date: August 2012 Percentage of Construction Completed: 0% Scope of Work: Campus wide outdoor lighting upgrade throughout the JMH main campus and the Jackson North Medical Center. The first phase of this project will cover the Alamo plaza and 16th street portion of the project. March 2012

Issue procurement required documentation to develop ITB package Submit documentation required to establish Dade County project measures Dade County project measures established

April 2012 Procurement ITB process continues

May 2012 Procurement ITB process continues



APRIL 2012

JACKSON MEMORIAL HOSPITAL 51009069 CAMPUS WIDE ROOFING REPLACEMENT – EAST TOWER Funding Source: IRB Total Project Budget: $1,500,000 Projected Completion Date: TBD Scope of Work Replacement of East Tower Roof, approximately 90,000 SQFT March 2012

Submit documentation required to establish Dade County project measures Architect issue letter requested by Procurement for “green compliance.” Architect issue letter for “LEED Measure Compliance” as requested by OOC

April 2012 Dade County project measures established ITB procurement continues Procurement submit “LEED Measure Compliance” letter to MDC Sustainability Program

May 2012 ITB issued

51009064 REPLACEMENT OF 30 AIR HANDLING UNITS Funding Source: IRB Total Project Budget: $6,541,500 Anticipated substantial completion date: September 30, 2014 Scope of the Work:

To furnish and install thirty one (31) custom Air Handling Units:

March 2012 100% CDs for AHUs #145, 147, 227, 161, 164, 230, 25, 28, 238, 241, 242

April 2012 To commence procurement process to go out for BID

May 2012 AHCA STAGE III STAND UP PLAN REVIEW


INFRASTRUCTURE REVENUE BOND


APRIL 2012

JACKSON NORTH MEDICAL CENTER 53008020 JACKSON NORTH WINDOW REPLACEMENT Funding Source: Capital Contribution & IRB Total Project Budget: $ 3,057,220 Anticipated substantial completion date: September 2012 Construction to be performed by JOC Scope of Work: Replacement of all windows with new hurricane windows. Unforeseen conditions have been encountered and the wall systems on pavilion, pediatrics and Labor and delivery are being reconstructed and shored. March 2012

PO issued for Structural Change Issues April 2012

Construction recommences on 2nd Floor L & D /Pedi Areas Construction recommences on Pavilion Replacement of the entrance doors continues

May 2012 Construction continues on 2nd Floor L & D /Pedi Areas Construction continues on Pavilion Replacement of the entrance doors continues

53009065 JACKSON NORTH MEDICAL CENTER UTILITY PLANT REPLACEMENT Funding Source: IRB Total Project Budget: $2,000,000 Anticipated substantial completion date: July 2013 Scope of Work: Replacement of three chillers, two boilers and supporting systems, installation of a new cooling tower. Installation of new energy management system. March 2012

Final design continues Emergency chiller work is completed

April 2012 Funding reallocated to fund remaining project scope

May 2012 Final design is completed Project Submitted to AHCA for Construction Review Project Submitted to City of North Miami Beach for Dry Run Permitting

AUDIT AND COMPLIANCE SUBCOMMITTEE


Audit & Compliance Subcommittee Mojdeh L. Khaghan, Chairperson Darryl K. Sharpton, Vice Chairperson Michael Bileca Marcos Jose Lapciuc

Date, Time and Place April 19, 2012 – (Immediately following the Facilities Subcommittee Meeting) Ira C. Clark Diagnostic Treatment Center Conference Room 259

AGENDA

1. *Approval of the Previous Meeting Minutes (Mojdeh L. Khaghan, Chairperson, Audit & Compliance Subcommittee)

(a) *Meeting Minutes as of March 15, 2012

2. Review of Audited Financial Statements and KPMG Management Letters (a) *Audited Financial Statement – JMH Health Plan (Brian Dean, Vice President, Finance Division, Jackson Health System) (b) Review of KPMG Management Letter – Jackson Health System (Karen Mitchell, Partner, KPMG and Mark T. Knight, Chief Financial Officer, Jackson Health System)

3. Corporate Compliance Program Department Update (Diana Salinas, Corporate Director and Chief Compliance Officer, Compliance Department, Jackson Health System)

(a) *FY12 Audit Plan Update

(b) *Review of Finalized Audit Reports (Executive Summary)

(1) #28 – Ventilator Units (2) #40 – Short Stay Medical Necessity (3) #34 – EMTALA (4) #32 – Breast Center at Jackson South Re-assessment

(c) *Recovery Audit Contractor (RAC) Quarterly Update

(d) *2012 Training Quarterly Update

(e) *Compliance Hotline Quarterly Update

(f) *Berkely Research Group (BRG) Project Update

4. Internal Audit Update

(Stephen J. Weimer, Corporate Director, Internal Audit Department, Jackson Health System)

(a) *FY12 Audit Plan Update

(b) Review of Finalized Audit Reports

(1) *Vendor Analysis (2) *Change Management (3) *Audit Follow-up Review

Agenda items(s) noted with an asterisk (*) indicates that the supporting documents are attached.

PUBLIC HEALTH TRUST FINANCIAL RECOVERY BOARD Audit & Compliance Subcommittee Mojdeh L. Khaghan, Chairperson Darryl K. Sharpton, Vice Chairperson Michael Bileca Marcos Jose Lapciuc Date, Time & Place March 15, 2012 – Immediately followed the Facilities Subcommittee meeting Ira C. Clark Diagnostic Treatment Center Conference Room 259

ATTENDANCE

Audit & Compliance Subcommittee Darryl K. Sharpton

Marcos Jose Lapciuc Michael Bileca Mojdeh L. Khaghan

Financial Recovery Board Members

Joaquin del Cueto Stephen S. Nuell Joe Arriola

Jackson Health System Mark T. Knight Diana Salinas Stephen W. Weimer Don S. Steigman Carlos A. Migoya Donn Szaro

Miami-Dade County Attorney Valda Christian Laura Llorente

KPMG LLP Karen Mitchell Alex Lopez Marie Zimmerman Berkeley Research Group, LLC Denise Pedulla Amanda Asgeirsson

Audit & Compliance Subcommittee Meeting March 15, 2012 Page 2 Call to Order With a quorum being present, the Audit & Compliance Subcommittee meeting was called to order at 8:52 a.m. by Mojdeh L. Khaghan, Chairperson. 1. Approval of the Previous Meeting Minutes – February 13, 2012 Ms. Khaghan requested a motion approving the meeting minutes of February 13, 2012 Mr. Lapciuc moved approval; seconded by Mr. Sharpton, and carried without dissent. 3. Internal Audit Update

(a) FY 2012 Audit Plan Update Stephen W. Weimer, Corporate Director, Internal Audit Department, Jackson Health System presented an update regarding the fiscal year 2012 Audit Plan. Currently there are 5 audits in progress, 3 out of the 5 audits which are finalized audits will be presented to the Subcommittee ending the month of February approximately 21% of the Internal Audit Plan have been completed, and completed 1,000 hours of audit assistance with KPMG. It is anticipated that the Internal Audit Plan will be completed by the end of the 2012 calendar year. Ms. Khaghan questioned if audits will be added to the Internal Audit Plan in the near future. Mr. Weimer stated that on a monthly basis the Internal Audit Plan is reviewed to determine whether or not there will be changes. He stated that based upon the ongoing process changes there is a possibility that audits could be added or deferred.

(b) Review of the Finalized Audit Reports

Mr. Weimer presented a summary of the finalized audit reports regarding HIPAA Security Rule, Maintenance Contracts and Prior Audit Follow-up Report. Copies of the final audit reports were included in the agenda packet. (1) HIPAA Security Rule Audit

JHS is in overall compliance with HIPAA Security Rule: two minor findings and two process improvement opportunities were noted. The audit rating was “satisfactory”.

(2) Maintenance Contracts Audit Issues exist in the validation of invoices submitted by two vendors for maintenance services, and lack of a timely review of monthly vendor/category financial reports. The combination of these significant issues may create an opportunity for intentional or unintentional errors or diversion that may not be detected in a timely manner. The audit rating was “needs improvement”.

Audit & Compliance Subcommittee Meeting March 15, 2012 Page 3 (3) Prior Audit follow-up

The prior audit follow-up report for the month of February 2012 showed 3 fiscal year inventory audits for Jackson North Medical Center (JNMC) and Jackson South Community Hospital (JSCH) and agency staffing. Prior findings in JNMC and JSCH inventory audits were corrected. With regards to the agency staffing audit 2 out of the 3 findings have not been corrected. With regards to agency staffing which was one of the prior year audits follow up, Mr. Lapciuc requested for control purposes that one model be created to be used for all of agency staffing. Ms. Khaghan questioned the use of agency staffing. Mr. Knight explained that agency staffing is used when there is no full-time, part-time or pool work staff to cover a shift within a department. JHS utilize agency staffing over several of its support service and nursing areas. Mr. Weimer stated that overall a much better job is being performed to assure that audit reports are being reviewed and corrective action dates are being met.

2. Corporate Compliance Program Department Update

(a) FY12 Audit Plan Update

Diana Salinas, Corporate Director and Chief Compliance Officer, Corporate Compliance Department reported that for the month of February 2012 1 audit was completed, a total of 15 audits have been completed, 20 audits have not started, and currently is 37% complete with the Corporate Compliance Audit Plan. Since the fiscal year began 5 audits have been added to the Plan.

(b) Review of Finalized Audit Reports Executive Summary (1) #26 – Holtz Children’s Hospital

Ms. Salinas reported that the scope and objective of the audit was to assure that the respiratory billing meets all relevant regulations and internal polices. The conclusion of the audit showed a net cost error rate of .06%. There were process issues that were identified in the audit. A Task Force was created to address the issues identified in the audit. M. Salinas stated that 5 audits are currently in progress. A full report regarding the audits will be presented at the next meeting. A copy of the final audit report was included in the agenda packet.

Audit & Compliance Subcommittee Meeting March 15, 2012 Page 4

(c) Berkeley Research Group, LLC (BRG) Ms. Salinas reported that BRG was engaged to complete an evaluation and assessment of the hospital’s physician contracts processes. Upon completion of the evaluation and assessment (approximately 3-months) the research firm will report back with findings and recommendations for process improvements. Ms. Khaghan questioned if representatives from the research firm will work with Fernando Salgado, Chief Transition Officer, Jackson Health System to complete the evaluation and assessment process. Ms. Salinas stated that the representatives from the research firm will work with Gino Santorio, Director, Project Management Office and Ronald E. Loveless, Administrator, Physician Services regarding matters related to Physician Services and recommendations for process improvements. For purposes of the Annual Operating Agreements, Ms. Salinas reported that a meeting was held with Donn Szaro, Chief Strategic officer, Jackson Health System to discuss the evaluation and assessment process. She explained the main focus of the evaluation and assessment is physician contracts. Ms. Khaghan questioned who is primarily responsible for physician services and contracts. Ms. Salinas stated that the Physician Services Department is headed by Mr. Santorio and Mr. Loveless who work together with each Jackson Health System facility regarding physician contracts. Ms. Khaghan questioned the number of physician contracts currently being negotiated. Mr. Migoya stated that the information regarding the number of contracts that are being negotiated will be reviewed and will report back at the next Subcommittee meeting. He further stated that Mr. Santorio and the Physician Services staff are reviewing and evaluating the physician contracts. Denise Pedulla, Lead Project Manager, BRG, presented a brief summary of the scope of services regarding the evaluation and assessment process of physician contracts. Ms. Pedulla expressed appreciation for the support that representatives from BRG have received from the JHS staff regarding the evaluation and assessment project. An overview of the services that are provided by BRG including background information about the research firm, key objectives, and evaluation and assessment project timeline was included in the agenda packet.

Audit & Compliance Subcommittee Meeting March 15, 2012 Page 5 2. Discussion of Audited FY12 Financial Statements

Mark T. Knight, Chief Financial Officer, Jackson Health System (JHS) stated that the purpose of the audited FY12 Financial Statements discussion is to review the statements with the assistance of KPMG audit representatives. Relative to the statements, Mr. Knight stated that the statements were clean, fiscal year 2011 closed with a loss of $81.4 million, days cash on hand closed relatively flat, and there were included footnote disclosures that had to do with utilization, liquidity and performance concerns. Mr. Knight spoke about the fiscal year 2011 audit being among the most substantive audits that he has seen in his career and the most substantive audit that JHS has had in three years. Mr. Knight introduced Karen Mitchell, Partner, KPMG LLP, and members of the KPMG Audit Team, who were prepared to review the audit results, as of September 30, 2011. Ms. Mitchell began the review of the audit results with comments regarding KPMG’s opinion to the financial statements that had to do with the liquidity situation of JHS which is a different opinion from prior year end audits. Ms. Mitchell continued with a detailed review of KPMG responsibilities regarding the audit as well as audit results. Highlights of the audit results included significant changes to the Audit Plan and pending matters, also significant findings that focused on the following (areas of interest, audit misstatements, accounting policies and practices, methods used to account for significant or unusual transactions, KPMG reports, and other matters). As part of the audit Ms. Mitchell reviewed the different approaches that were taken during the audit that had to do with fraud risks and explanation regarding KPMG being independent with respect to JHS, as defined by professional standards. A copy of the audit results, as of September 30, 2011 and draft version of the financial statements and schedules were distributed at the meeting. Based on Mr. Knight’s comments regarding the audit being the most substantive audit that Jackson has seen in previous years, Mr. Sharpton requested Mr. Knight to elaborate on the differences of this fiscal year’s audit compared to previous audits. Mr. Knight stated that during the audit process there was a great deal of reliance on internal controls and reporting. He is of the opinion that that the balance sheet, income and cash flow statements were completed with a higher level of detail than that of the past which was helpful to the PHT FRB and gave management a higher level of certainty and representation of the statements. It was pointed out during the audit process that that there was an increased level of cleanup from prior years. Mr. Knight recognized the leadership of Dave Alexander, Controller, Jackson Memorial Hospital and members of the Accounting Staff for doing a yeoman’s job with the cleanup process in the accounting and financial areas. Mr. Sharpton questioned if the Subcommittee’s Chairperson reviewed the Management Letter. Ms. Khaghan replied no.

Audit & Compliance Subcommittee Meeting March 15, 2012 Page 6

With regards to the Management Letter, Mr. Knight stated that there have been discussions with KPMG representatives regarding the Management Letter however a formal draft of the Management Letter has not been presented. He further stated that it is anticipated that a draft of the Management Letter will be received next week, and a draft of the management’s response which will be shared with the Chairperson of the Audit & Compliance Subcommittee and presented at the appropriate committee(s) and full board for approval during the month of April 2012. With regards to the reclassification issue within the fiscal year 2011 audit, Mr. Knight stated that the reclassification does not change anything. It is a reclassification within the net assets which is referenced on the bottom page of the statement of net assets. The $25 million of bond proceeds that was segregated out of the proceeds was put into a debt reserve fund, as such the $25 million was reclassified out of the restricted for debt service and moved to investment in capital assets net of related debt. Also the Jackson Memorial Foundation had a format change to the income statement showing a breakdown between unrestricted and temporarily restricted.

Adjournment The meeting of the Audit & Compliance Subcommittee adjourned at 10:02 a.m. Transcribed by Ivenette Cobb, Executive Assistant Public Health Trust Financial Recovery Board

2. Review of Audited Financial Statements and KPMG Management Letters

DRAFT 4/16/2012 11:23 AM Management Letter Comment with Management Response 041612 d

March 15, 2012

The Financial Recovery Board of Trustees of the Public Health Trust Of Miami–Dade County, Florida Miami–Dade County, Florida

Ladies and Gentlemen:

In planning and performing our audit of the financial statements of the Public Health Trust of Miami-Dade County (the Trust) as of and for the year ended September 30, 2011, in accordance with auditing standards generally accepted in the United States of America, we considered the Trust’s internal control over financial reporting (internal control) as a basis for designing our auditing procedures for the purpose of expressing our opinion on the financial statements, but not for the purpose of expressing an opinion on the effectiveness of the Trust’s internal control. Accordingly, we do not express an opinion on the effectiveness of the Trust’s internal control.

Our consideration of internal control was for the limited purpose described in the preceding paragraph and was not designed to identify all deficiencies in internal control that might be significant deficiencies or material weaknesses and therefore, there can be no assurance that all deficiencies, significant deficiencies or material weaknesses have been identified. However, as discussed below, we identified a certain deficiency in internal control that we consider to be a material weakness.

A deficiency in internal control exists when the design or operation of a control does not allow management or employees, in the normal course of performing their assigned functions, to prevent, or detect and correct misstatements on a timely basis. A material weakness is a deficiency, or a combination of deficiencies, in internal control, such that there is a reasonable possibility that a material misstatement of the entity’s financial statements will not be prevented, or detected and corrected on a timely basis. We consider the deficiency described in Appendix A in the Trust’s internal control to be a material weakness.

A significant deficiency is a deficiency, or a combination of deficiencies, in internal control that is less severe than a material weakness, yet important enough to merit attention by those charged with governance. We consider the deficiencies described in Appendix B in the Trust’s internal control to be significant deficiencies.

The Trust’s written response to the material weakness and significant deficiencies identified in our audit has not been subjected to the auditing procedures applied in the audit of the financial statements and, accordingly, we express no opinion on it.


The Financial Recovery Board of Trustees of the Public Health Trust Of Miami–Dade County, Florida

March 15, 2012 Page 2 of 2

This communication is intended solely for the information and use of management, the Financial Recovery Board of the Public Health Trust of Miami-Dade County, Florida and others within the organization, and is not intended to be and should not be used by anyone other than these specified parties.

Very truly yours,


Attachment A

1

Current Year’s Observation and Recommendation Material Weakness

2011-01 Information Technology General Controls

Condition Found

In the course of planning for the 2011 audit, we noted a number of important weaknesses in the Trust’s IT general control environment.

Perspective

The finding is considered systemic in nature.

Cause and Effect

Based upon our evaluations as well as the reports from internal audit, we noted a number of important weaknesses, such as:

• Management does not perform a formal periodic review of the appropriateness of IT system access rights of active users;

• Management does not utilize an IT audit trail functionality enabled to track users that make changes to critical financial applications;

• Management does not perform a periodic review of access rights focused on segregation of duties within system profiles or transactions;

• And Management does not have updated documented policies and procedures addressing security, change management or computer operations.

Given these general control weaknesses, we were unable to rely on specific IT application controls throughout the significant transaction cycles. Had we tested such controls, additional weaknesses might have been identified that would have been reported to you.

Recommendation

We recommend that Management perform a comprehensive review of the Trust’s policies and procedures associated with the IT general controls environment to ensure that the critical risks associated with these weaknesses are well controlled.

Management’s Response

• Management does not perform a formal periodic review of the appropriateness of IT system access rights of active users.

The Information Technology Division, in October of 2011, began a formal process designed to periodically review the appropriateness of IT system access rights for active users. This formal process is codified in IT Security Policy 942 (Jackson Periodic Review of User Access), which requires the system/application Business Owners to perform an access rights review


for each active user. The first review has been completed and the next scheduled review is scheduled to take place in May, 2012. Additional IT Security Policies enforcing user account access control include: IT Policy 940 (User Account Management), 941 (Inactive Accounts), and 947 (Administration Documentation and Audit of User Accounts).

• Management does not utilize an IT audit trail functionality enabled to track users that make changes to critical financial applications.

Each of our critical financial applications has audit trail functionality enabled and built into the application to track user changes. An example of this audit trail for the LAWSON system is attached.

• Management does not perform a periodic review of access rights focused on segregation of duties within system profiles or transactions.

The Information Technology Division, in October of 2011, began a formal process designed to periodically review access rights focused on segregation of duties for active users within the system. This formal process is codified in IT Security Policy 942 (Jackson Periodic Review of User Access), which requires the system/application Business Owners to perform an access rights review for each active user. The first review has been completed and the next scheduled review is scheduled to take place in May, 2012. Additional IT Security Policies enforcing user account access control include: IT Policy 940 (User Account Management), 941 (Inactive Accounts), and 947 (Administration Documentation and Audit of User Accounts).

• And Management does not have updated documented policies and procedures addressing security, change management, or computer operations.

IT has documented and published policies and procedures that address IT Security, Change Management, and Computer Operations. Policies are attached.


Attachment B

3

Current Year’s Observation and Recommendation Significant Deficiencies

2011-02 Manual Accounting Processes

Condition Found

The Trust utilizes a manual process for analyzing, reconciling, and reporting certain critical and significant financial accounting data

Perspective


Cause and Effect

Management relies on a number of excel spreadsheets to analyze, reconcile and report certain critical and significant financial accounting data. Such a process introduces the risk of material financial reporting errors. Specifically, this process requires attention and an in-depth and intricate knowledge and understanding of the Trust’s complex and decentralized nature of its operations. Our procedures and resulting audit adjustments reveal that such knowledge and expertise currently in-place requires enhancements. During the course of the audit, we noted the following:

• Voluminous spreadsheets were used to analyze, reconcile, and report account balances such as allowances for doubtful accounts and contractual adjustments, patient refunds, unapplied cash, accrued liabilities (specifically, the amounts due to the University of Miami, accrued payroll, paid time off and sick leave).

• Lack of policies and procedures related to the access and maintenance of these spreadsheets; and

• Occasions when the preparers demonstrated less than a thorough understanding of the underlying business transactions leading to several reiterations of reports and analysis to support recorded amounts.

These matters relate to both automating and integrating several accounting systems from the different facilities and having appropriate accounting and finance resources that is commensurate with the size and complexity of the operations of the Trust.

Recommendation

We recommend that the Trust enhance its policies and procedures for analyzing, reconciling and reporting data that integrates the accounting systems within and across the different facilities. As spreadsheets continue to be utilized to analyze, reconcile and report data, management should establish policies and procedures around this manual process in order to ensure that such spreadsheets are properly reviewed by a supervisor at a level above the preparer and that these spreadsheets, as part of the Trust’s accounting records, are properly maintained with access


4

physical and ability to make changes) limited to appropriate individuals in order to ensure the integrity of these accounting records.


For clarification purposes, the Trust has made significant investments in information technology financial systems which are being utilized to analyze, reconcile and report account balances such as contractual adjustments, patient refunds, unapplied cash and accrued liability (specifically accrued payroll, paid time-off and sick leave) within and across different facilities. As requested by KPMG during the audit, many of these system generated reports were exported to excel for audit testing. The Trust’s routine closing process includes an analysis of account level activity at a more detailed level.

The skilled nursing facilities, physician services and property management divisions are on highly specialized revenue cycle systems that are appropriate for their business cycles, but are disparate from the Trust’s core financial information technology systems. Each of these divisions has appropriate operational and financial oversight on a monthly basis. During the audit, as requested by KPMG, the Trust prepared audit schedules in excel to consolidate and test the account balances for all of the disparate systems. These excel spreadsheets were created for audit testing.

All of the spreadsheets used during the audit were placed in a highly secured shared directory on the Trust’s network. Management will develop a policy and procedure related to access and maintenance of these spreadsheets before next year’s audit kick-off meeting.

Management agrees that there is an opportunity to migrate to a program based analysis for allowances for doubtful accounts and is currently in the final phases of user testing and acceptance.


Attachment B

5

2011-03 Pension Trust Fund

Condition Found

The financial reporting process related to the Pension Trust Fund did not appear to follow the policies and procedures in place at PHT. Specifically, we noted that changes were made to the financial records that were not supported nor reviewed by anyone other than the preparer. This resulted in audit adjustments required to properly report the net assets available for pension benefits.

Perspective


Cause and Effect

The underlying pension trust fund information is received from various third–party vendors. The financial reporting process includes gathering the information from these parties and preparing the financial reports and disclosures required to conform with generally accepted accounting principles. The financial reporting process was not properly supervised and erroneous changes were made into the financial records of the Pension Trust Fund.

Recommendation

We recommend that management establish formal policies and procedures that specifically address the financial reporting process over the Pension Trust Fund. Such policies and procedures should include a review and reconciliation of the statements of net assets available for pension benefits reported to the underlying records received from the third party vendors.


Management will establish formal policies and procedures that specifically address the financial reporting process over the Pension Trust Fund.


Attachment C

6

Comment Still Comment Cleared Description Relevant and Removed

2010-01 Monthly Reconciliation and Financial Statement Close Process X

3. Corporate Compliance Program Department Update

1

Total4

Risk Level Definition 18High Audits that were identified through the CMS RAC Approved Issues, the OIG Work Plan or AHCA

20Moderate or High

Reassessments and by Internal Risk Assessment

4342%

7

Audit # Audit Name Risk Assessment

Scope & Objectives

Status Completion Date1 Hospital to Hospital Transfer High RAC Approved Issue - To review if Inpatient hospital incorrectly reports the patient is discharged to home, when in

fact they have been discharged to another facility (SNF, IRF, or home health) or left against medical advice (and was later admitted to another facility on same day of discharge), which the inpatient hospital claim from the transferring facility fall under the post-acute transfer policy. According to the Post Acute Transfer policy, the transferring facility should be reimbursed on per-diem basis (up to the DRG full payment), while the receiving facility receive the full DRG or respective PPS reimbursement. All DRG's being reviewed are available in the Post Acute Transfer Policy.

Completed 11/20/20112 Incorrect billing of J1642 -

Heparin, up to 10 units (Hep-Lock, Hep-Flush) – Hospital

High RAC Approved Issue - To review if claims identified where J1642 (Heparin, up to 10 units (Hep-Lock), (Hep-Flush)) was billed for patients who receives Heparin for therapeutic infusion. The therapeutic infusion of Heparin should be J1644 (Heparin, up to 1000 units).

Completed 10/20/20113 Duplicate Claims - Outpatient High AHCA - To determine if an issue may exist when duplicate services are billed and reimbursed under Medicare.

Completed 2/1/20124 Inpatient Duplicate Payments High AHCA - To determine if two AHCA payments for inpatient services for the same date(s) of service were paid by

Medicaid. In certain circumstances, part of each payment is correct but there is a payment for the same date(s) of service included in each. In that case, only the duplicate per diem amount for that date is identified for recovery.

Completed 2/1/20125 Service Exclusions High AHCA - To determine if JHS was paid for services that are excluded from Medicaid payments including procedure

codes listed as not covered and services provided outside of the allowed place of service as listed the Medicaid Services Coverage and Limitations Handbooks and Medicaid Fee schedules.

Not Started6 Service Limitations High AHCA - To identify payments for claims that were paid for services that are in excess of the service limitations as

listed the Medicaid Fee Schedules. This includes services that are limited to a maximum number of times per year ( calendar of fiscal), per number of days, or per lifetime, per recipient, and services that overlap with another service concomitantly for the same recipient.

Not Started7 BAA review with focus on Health

Plan, Mental Health and International Program

Moderate HIPAA/Privacy Audit - To ensure that where a business associate agreement is required one would have been executed along with the underlying contract and that we are in compliance with JHS policies and procedures.

Not Started8 Patient Medical Record

AmendmentsModerate HIPAA/Privacy Audit - To ensure that patient amendment requests are in compliance with JHS policies and

procedures. Not Started9 Medical Director Agreements High Risk Assessment - Review timesheets to ensure they are in compliance with contract requirements. Not Started10 ER On-Call High Risk Assessment - To review records of ER on-call Not Started11 Clinical Agency Agreements High Risk Assessment - Review of agreements to verify that they are in compliance with Stark and Anti-Kickback

statutes.Not Started

12 Child Health Services Moderate Reassessment - To ensure that JHS is providing appropriate Child Health Services to children who are beneficiaries of Medicaid as indicated by AHCA/CMS.

Not Started13 ABN Review High Reassessment - To determine if Medicare beneficiaries are provided with timely ABN notices for non-covered

Medicare services. Not Started

New audits added to Original Plan

Total Audits on Plan% of Plan Completed

Corporate Compliance Department - FY 2012 Annual Audit Plan Audit SummaryIn Progress

Total Audits Completed

Not Started

2

Total4


20Moderate or High


4342%

7


Scope & Objectives

Status Completion Date





Not Started

14 Rehab Audit Outpatient Moderate Risk Assessment - As per CARF (Commission on Accreditation and Rehabilitation) requirements, an audit will be performed to evaluate outpatient rehabilitation services to ensure documentation supports billing appropriateness. The scope will focus on Prosthetics and Orthotics.

Completed 12/8/201115 In-Patient Rehabilitation Facilities High OIG - We will examine the appropriateness of admissions to IRFs. We will also examine the level of therapy being

provided in IRFs and how much concurrent and group therapy IRFs are providing. IRFs provide rehabilitation for patients who require a hospital level of care, including a relatively intense rehabilitation program and a multidisciplinary, coordinated team approach to improve their ability to function. Patients must undergo preadmission screening and evaluation to ensure that they are appropriate candidates for IRF care.

Not Started16 MSP- Medicare Secondary Payer High Reassessment - To determine if the online Medicare Secondary Payer questionnaire utilized by the hospital is

compliant with the rules and regulations set forth by CMS for the solicitation of MSP information from the beneficiary.

Not Started17 Monthly Short Stay Medical

Necessity - #1 Main and HoltzHigh RAC/Reassessment - To evaluate patients admitted and discharged the next day to determine if a stay in

observation would have been the most appropriate setting for care. If appropriate, review that condition code 44 was properly applied to Medicare claims per CMS guidelines.

Completed 10/14/201118 Bimonthly Short Stay Medical

Necessity - #1 NorthHigh RAC/Reassessment - To evaluate patients admitted and discharged the next day to determine if a stay in

observation would have been the most appropriate setting for care. If appropriate, review condition code 44 was properly applied to Medicare claims per CMS guidelines.

Completed 10/20/201119 Bimonthly Short Stay Medical

Necessity - #1 SouthHigh RAC/Reassessment - To evaluate patients admitted and discharged the next day to determine if a stay in

observation would have been the most appropriate setting for care. If appropriate, review condition code 44 was properly applied to Medicare claims per CMS guidelines

Completed 11/4/201120 Modifiers Moderate Risk Assessment - To ensure that Modifiers 73, 74, 91 and 51 are being utilized appropriately. The scope will focus

on the Cardiology, Radiology and Lab.

Not Started21 Transplant (Outpatient Bone

Marrow)High Risk Assessment - To determine if bone marrow transplants at Holtz are billed according to CMS.

Not Started22 Clinical Trials Moderate Reassessment - To review Clinical Trial Research billing and modifier used in accordance to CMS regulations and

guidelines. In addition to review that consent forms are completed in a timely manner In-Progress23 Community Mental Health Center-

PHPModerate Risk Assessment - To ensure that the billing meets all relevant regulations and internal policies

Completed 1/6/201224 Hospitalizations and

Rehospitalizations of Nursing Home Residents (both facilities)

High OIG - We will review the extent to which Medicare beneficiaries residing in nursing homes have been hospitalized and rehospitalized. We will also assess CMS’s oversight of nursing homes whose residents have high rates of hospitalization. Hospitalizations and rehospitalizations of nursing home residents are costly to Medicare and may indicate quality-of-care problems at nursing homes. A 2007 OIG study found that 35 percent of hospitalizations during a SNF stay were caused by poor quality of care or unnecessary fragmentation of services.

Not Started

3

Total4


20Moderate or High


4342%

7


Scope & Objectives






Not Started

25 Referrals and Discharges Moderate Risk Assessment - To ensure upon discharge that all patients have a right to choose where they are discharged to according to all relevant regulations and internal policies. Completed 2/1/2012

26 Holtz Children's Hospital High Risk Assessment - To ensure that the respiratory billing meets all relevant regulations and internal policies

Completed 3/2/201227 Hospice (Main & North) High OIG - To ensure Hospice billing and general meets all relevant regulations and internal policies

Not Started28 Ventilator Units Moderate Risk Assessment - To review the billing for the new Jackson North contracted unit to ensure compliance with all

relevant regulations and internal policiesCompleted 3/7/2012

29 Omnicell in Inpatient Surgery - Main

High Risk Assessment - To ensure that Omnicell dispensers are being used according to all relevant regulations and internal policies. The scope will focus on whether SurgiNet is reconciled correctly with Omnicell. Not Started

30 Pharmacy - Drug Diversion High Risk Assessment - To review the current policies and procedures related to narcotic counts and drug diversion to determine if there are any gaps or risk areas. The scope will include Holtz Oncology floor and Burn Center.

Not Started31 JMG Providers High Risk Assessment - To determine if professional billing is correct according to CMS guidelines for six providers. The

scope will include the timeliness of charges being entered.

Not Started32 Breast Center - South Moderate Risk Assessment - Review compliance with the Susan B. Komen grant and possible compliance issues related to

referrals to the Main campus.

Completed 4/3/201233 Charity Care Application Moderate Risk Assessment - To ensure that the Patient Financial Assessment is being completed appropriately according to

Federal Regulations and in a timely manner.Completed 10/31/2011

34 EMTALA Moderate Risk Assessment - To ensure the JHS is abiding by the EMTALA regulations

Completed 3/30/201235 Inpatient - Interrupted Inpatient

Psychiatry Facilities (IPF) - Reassessment

Moderate Reassessment - To review IPFs Emergency Department Mental Health claims for Medicare reimbursement in cases of transfers from IPFs to the same or other IPFs. To ensure that IPFs do not discharge and then readmit patients to obtain per diem payments with higher adjustments. Interrupted stays in which a patient is discharged and then readmitted to the same or another IPF within 3 days following the discharge will be treated as one continuous stay.

Not Started36 Physician Signatures documented

in Medical Records for Certified Nurse Midwife encounters for Jackson Main

Moderate Rollover: To ensure adherence to Florida Statutes and JHS policy: physicians are required to co-sign/attest to the care as provided by Certified Nurse Midwives.

Not Started

4

Total4


20Moderate or High


4342%

7


Scope & Objectives






Not Started

37 Monthly Short Stay Medical Necessity - #2 Main and Holtz

High RAC/Reassessment - To evaluate patients admitted and discharged the next day to determine if a stay in observation would have been the most appropriate setting for care. If appropriate, review that condition code 44 was properly applied to Medicare claims per CMS guidelines.

Completed 1/6/2012

38 Inpatient POCT Glucose Moderate Internal assessment: To assess the viability of clinical documentation at Jackson Memorial to begin charging for point of care testing for glucose services.

In-Progress

39 Community Mental Health Center - DTP

Moderate Risk Assessment - To ensure that billing meets all relevant regulations and internal policies Completed 1/6/2012

40 Monthly Short Stay - Medical Necessity - Main, North and South #1


Completed 3/26/2012

41 TEG (Thrombelastograph hemostatist system)

Moderate Internal assessment: To ensure that the current clinical documentation and billing is appropriate prior to beginning POC (point of care) services.

Completed 9/28/2011

42 Monthly Short Stay - Medical Necessity - Main, North and South #2


In-Progress

43 OIG Medicaid Payments for Therapy Services in Excess of State Limits

High OIG Assessment - To determine if JHS is vulnerable to improper payments because: (1) plans of care were incomplete or missing; (2) documentation was missing, or providers failed to respond to our request for documentation; or (3) providers lacked proper qualifications, or we could not determine whether they had proper qualifications.

In-Progress

OFFICE OF COMPLIANCE Jackson Medical Towers

1500 NW 12 Ave, Suite 102 Miami, Florida 33136-1094

(305)585-2902

EXECUTIVE SUMMARY COMPLIANCE AUDIT SUMMARY REPORT April 2012

1. #28 – Risk Assessment: Ventilator Units – Jackson North Scope/Objective: This is an internal risk assessment for services rendered at Jackson North for ventilator units to ensure compliance with regulatory and internal policies. Methodology: A random sample of 30 inpatient encounters from Jackson North was retrieved from the Compass system. The dates of services reviewed were October 10, 2010 through August 20, 2011. The primary payer was Medicare or managed Medicare with various payers documented as secondary. The UB-04 claim forms and Remittance Advices were obtained from EDM. Clinical documentation was retrieved from Cerner and HIM (hybrid record). Results: The review rendered a net cost error rate of 0%.

Recommendations: Compliance recommends quality checks by the Unit to ensure all medical documentation is scanned into the electronic medical record.

2. #40 – RAC Reassessment– Short Stay Medical Necessity Scope/Objective: To evaluate patients admitted and discharged the next day to determine if a stay in observation would have been the most appropriate setting for care. If appropriate, review that condition code 44 was properly applied to Medicare claims per CMS guidelines.

Methodology: Reviewed 30 inpatient encounters for the date of service December 1, 2011 to December 31, 2011, where Medicare was the primary payor and various secondary payers. Clinical documentation was obtained from Cerner; UB04s were and remittance advice was retrieved from EDM and MedAssets Contract Manager. Results: The review rendered a cost error rate of .07% Recommendations: Compliance recommends continuation of the newly implemented Case Management Protocol, as well as training with the physicians as to the CMS regulation regarding an appropriate inpatient admission order. Compliance will continue to audit and monitor short stays monthly.

3. # 34 - Risk Assessment: EMTALA – Jackson Memorial

Scope/Objective: To ensure Jackson Memorial in abiding by the EMTALA regulation based on section 1867 of the Social Security Act regarding providing medical screenings prior to determining an individual’s ability to pay for services.

Methodology: Reviewed 30 random patient encounters from Compass for date of service January 1, 2012 through January 31, 2012. The primary insurance was Medicare with various secondary payers. Patient medical records were reviewed to ensure medical documentation for services ordered, rendered and billed, as well as the Cerner event logs to verify timelines; UB04 and Remittance Notices were reviewed utilizing EDM and MedAssets Contract Manager.. Results: The review rendered a cost error rate of .02% Recommendations: Compliance recommends that Patient Access continues quality checks to ensure all proper documentation is obtained during the registration process. We also recommend that a time stamp be utilized in the Emergency Department when patients are given their registration forms to complete in order to preserve the integrity of events.

4. #32 – Re-assessment – Breast Center at Jackson South

Scope/Objective: The objective and scope of our audit was to determine if the correct Current Procedure Terminology Code (CPT Code) was assigned based on documentation Orders and reports of the procedures was documented in the patient’s medical chart. To ensure an ABN (Advance Beneficiary Notice) is obtained from Medicare beneficiaries, when required.

Methodology: Reviewed 30 random encounters from Compass for date of service of November 2010 thru September 2011. UB04, remittance advice and registration documentation was retrieved from EDM. Results: The review rendered a cost error rate of 0% Recommendations: Compliance recommends immediate IT attention to the production of the ABN for The Breast Center at Jackson South. The Cerner IT Team corrected the production of the ABN issue during the completion of this audit. We also recommend monthly quality checks be performed by Patient Access and the Clinical team responsible for the service to ensure required ABNs are being obtained, signed, dated and scanned according to CMS and JHS policy.

Recovery Audit Contractorthru March 31, 2012

Date of Audit Retained by JHS Recovered by RAC Total % Retained by JHS

12/3/2009 $1,129,535.17 $100,040.25 $1,229,575.42 91.9%

2/25/2010 $383,839.28 $233,408.10 $617,247.38 62.2%

3/22/2010 $1,759,193.46 $260,107.07 $2,019,300.53 87.1%

5/14/2010 $1,211,603.01 $256,295.03 $1,467,898.04 82.5%

7/14/2010 $922,698.60 $133,655.39 $1,056,353.99 87.3%

12/16/2010 $2,362,564.19 $523,432.41 $2,885,996.60 81.9%

2/22/2011 $1,253,530.74 $449,606.38 $1,703,137.12 73.6%

Total at Risk $9,022,964.45 $1,956,544.63 $10,979,509.08 82.2%

FY 2012 Compliance Training Overview

Course Through Q2# Completed

YTD % of Annual Goal

General Compliance Training

2,529 27%

Specific Compliance Training

TBD TBD

Jackson Health SystemCompliance (Hotline) Call 2nd Quarter SummaryAudit and Compliance Committee FY'12

Prepared by: Corporate ComplianceUpdated: 04/11/12

FY '12 YTDOct-11 Nov-11 Dec-11 Jan-12 Feb-12 Mar-12 TOTALS

1 Total calls received for each month 43 32 33 35 25 25 193

2Calls received requesting information or redirected 16 12 14 17 11 10 80

3Calls received inquiring about the status of calls 10 9 11 7 6 5 48

4 All calls resulting in Investigations 17 11 8 11 8 10 65

5 Calls Investigated and Closed 16 11 8 8 4 3 50

6 Compliance Investigations Still Open 1 0 0 3 4 7 15

FY'12 Calls Received via fax/walk-in/email/letter/direct calls to Compliance department generating hotline calls: 4Calls generated via direct call to hotline number 1.800.684.6457 61

QUARTER 1 QUARTER 2MONTH

Compliance Hotline Call Summary

Billing/Coding 4% COI

8%

Environmental 2%

Fraud 8%

Health Violation 0%

HIPAA 6%

HR & Labor Relations 35% Maintenance

0%

Medical Staff 2%

Other/Non Compliance 17%

Patient Care 11%

Policy Violation 2%

Substance Abuse/Drugs 2%

Sexual Harassment 3%

Theft 0%

FY'12 % of Hotline Calls for Each Category

Billing/Coding

Conflict of Interest

Environmental

Fraud

Health Violation

HIPAA

HR & Labor Relations

Maintenance

Medical Staff

Other/Non Compliance

Patient Care

Policy Violation

Substance Abuse/Drugs

Sexual Harassment

Theft

Project Launch Date (Beginning of Phase 1): February 28, 2012

Progress to Date: Phase 1 CompletePhase 1 of the project was completed on time, concluding the week of April 2, 2012. During Phase 1, BRG focused on gathering the necessary information to make a thorough and complete evaluation of JHS’ current policies, procedures and operational practices.

Current Status: Phase 2 in Progress

BRG’s anticipated completion date: June 1, 2012

1

Berkeley Research Group Project Update

Berkeley Research Group Project Update

Berkeley Research Group (BRG) provides expert services andconsulting to major health care providers and payors across thecountry.

JHS/BRG Project Summary: BRG is providing an independentevaluation, risk assessment, and recommendations for improvementregarding our arrangements with physicians. The project focuses onour policies, procedures and general operational strategies in theincreasingly complex legal and regulatory zone.

Project Goal: To enhance our physician arrangements in a manner thatachieves sustainable long term compliance.

2

4. Internal Audit Update

1

Internal Audit - FY12 Audit Plan

a/o 3/31/12

Risk Level Definition Audit Summary Total High Impact to company’s financial statements is considered material; non-financial

risk, such as patient outcome and visibility, is considered high. Other considerations include significant change in associated management and/or process, and prior internal or external audit findings.

In Progress 5

Medium Process impact to company’s financial statements may be material; other risk as described above is considered less significant.

Audits added to Original Plan 0

Less: audits deleted from Plan (2) Total Audits Completed 9 Not Started 17

Total Audits on Plan 28

% of Plan Completed 43%

Audit # Audit Name Risk Assessment Scope & Objectives Status Completion Date

Audit Rating

1 Med Assets - GPO High Analyze results achieved from Med Asset process. Fieldwork underway

2 Performance Reporting Medium Determine accuracy and appropriateness of performance reporting information provided to management.

Fieldwork underway

3 Admission/Registration and Insurance Verification

High Verify accuracy of capturing patient information and insurance verification; also includes Siemens/Cerner IT controls review.

Fieldwork underway

4 Initiatives High Determine adequacy of methodology to monitor strategic initiatives.

Fieldwork underway

5 Construction Projects Medium Review Jackson Main ER renovation project procedures/controls.

Fieldwork underway

6 Potential Medicaid Medium Review and evaluate process to monitor potential Medicaid.

7 Medicare Bad Debt Medium Review accuracy of Medicare bad debt submissions. Hold – management request

2

Audit # Audit Name Risk Assessment Scope & Objectives Status Completion Date

Audit Rating

8 AOA High Determine compliance with terms of AOA (UM and FIU).

9 Personal Leave Review Medium Perform analysis on capped PL (vacation and sick pay).

10 Financial Statement Close

Medium Evaluate the adequacy of internal controls over initiation, authorization, processing, recording, and reporting of transactions; ascertain the existence and effectiveness of current policies and procedures, and evaluate financial statement close activities.

11 Accounts Payable High Evaluate controls over vendor on boarding, invoice approval and payment, general computer controls, non-PO purchases.

12 Fixed Assets High Determine effectiveness of fixed assets controls including buildings, reconcilement, addition/deletions, depreciation, etc.

13 Maxor Pharmacy Services

High Evaluate physical receipt, and distribution controls over the pharmacy function (JMH).

14 Revenue Cycle Medium Audit of Denial Management, DNFB, and late charge processes and controls.

15 Rosie Lee Wesley Health Center, Palm Springs Middle School

Low General controls review of offsite location.

16 Physical Inventory Observation

Medium Observe FY12 physical inventory to determine the adequacy of physical inventory procedures.

Q3 observation added to plan.

17 Perdue Medical Center Low General controls review of offsite location

18 Patient Referrals Medium Perform quarterly review and analysis of patients referred from JHS to UM Hospital.

19 KPMG audit assistance n/a Provide 300 hours of audit assistance during Q4.

20 Inventory Control – Jackson North/South

High Assess internal controls related to OR and Pharmacy supplies. complete 10/30/2011 Needs Improvement

21 Sheraton Anesthesia Contract

Medium Determine if physician payments are consistent with the terms of the contract and services provided.

complete 12/31/2011 Good

22 Ward D/Corrections Health Services

Medium Review CHS charge capture and billing processes to determine adequacy of controls, completeness and accuracy of charges and billings.

complete 12/31/2011 Satisfactory

3

Audit #

HIPAA Security Rule High Assess compliance with required elements of the HIPAA Security Rule.

complete 1/31/2012 Satisfactory

23 Follow Up Activities varied Perform follow-up review of prior audit findings to ensure corrective action is completed as stated and adequate.

Performed monthly n/a n/a

24 Physical Security High Evaluate physical security of hospital to ensure access is restricted to authorized individuals and proper security policies are in place to prevent theft of JHS assets and protect the safety of staff, patients and visitors.

Hold – considering consultant n/a n/a

25 Maintenance Contracts High Review contract management process to determine if contracts exist for services, proper procurement processes were followed, and effectiveness of payment controls.

complete 2/29/2012 Needs Improvement

26 KPMG audit assistance n/a Provide 1,000 hours of audit assistance during Q1, Q2. completed 2/17/2012 n/a

27 Vendor Analysis High Evaluate data mining test results of vendor database, select various vendors and invoices for review to ensure proper on boarding, job performance, and payment approval.

Preliminary report issued 2/27/2012 Needs immediate

Improvement

28 Change Management High Review IT change management process to determine if changes to production systems are properly approved, tested, and controlled.

Fieldwork underway 3/31/12

Satisfactory

4

Process Life Cycle Audit # Audit Name Risk Assessment Status Completion Date 1 Periscope High Fieldwork underway

2 Electronic Medical Records

High Fieldwork underway

3 OR inventory, charge capture

High Fieldwork underway

4 Axiom (Cost Accounting) High

5 Med Assets Revenue/Supply High

6 ICD-10 High

7 QuickPay Medium Fieldwork underway

8 Denial Management Medium

9 Medicare Bad Debt Medium

10 Inpatient Financial Counseling Redesign

Medium

11 Accounts Payable – GHX/AP on demand Medium Fieldwork underway

12 Facilities Storeroom Medium Fieldwork underway

13 Personal Leave System Low

14 Kronos upgrade Low Completed 3/31/12

15 MSS – on boarding, off boarding

Low completed 3/31/12

4 (b) Review of Finalized Audit Reports

Office of Internal Audit Jackson Medical Towers

1500 NW 12th Avenue, #102 Miami, FL 33136

Page 1 of 3

To: Carlos Migoya, President and Chief Executive Officer CC: Fernando Salgado, SVP and Chief Information Officer

Scott Judd, Director Enterprise Operations IT Michael Garcia, Corporate Director IT Oscar Perez, Director of Informatics Timothy Tuohy, IT Team Leader

From: Richard Kugler, IT Audit Manager Steve Weimer, Corporate Director - Internal Audit

Date: April 6, 2012

Subject: Change Management Audit – Final Report

Background, Objective and Scope:

Change management is defined as the set of processes executed within the organization’s IT Department designed to manage the enhancements, updates, incremental fixes and patches to production systems. As part of the FY12 Audit Plan, a change management audit was performed. The objective of the audit is to provide an independent and objective assessment of the change management process across systems utilized at Jackson Health System. Given the new change management system was implemented in October 2011, the audit scope period is from October 2011 to January 2012.

The audit scope is the following:

• Documentation and proper approval of Change Advisory Board

• Quality assurance and timeliness

• Emergency change count and reasoning

• Review established policies & procedures

• Prevention and detection of unauthorized changes

• Change success rate.

Audit Rating: Satisfactory Executive Summary:

The change management system and process at JHS appears adequate to adequately control system changes, both from and emergency and non-emergency standpoint. Our two minor findings are detailed below.

of 3

Detailed Observations, Recommendations and Management Action Plans

1. System Change Impact process requirements need improvement

The "system change impact” on the process or department was not always quantified.

We recommend that management document its impact assessment to include an accurate and thorough assessment of the potential risks and vulnerabilities of the potential change. .

Action Plan Owners: Scott Judd, Director Enterprise Operations

Management Response: Management agrees. The business, technical, and clinical risk assessments are not always documented as thoroughly as our process dictates. This procedural requirement has been reiterated with our team members, and going forward, Requests for Change will no longer be approved by the Change Advisory Board without the risk assessments being properly completed.

Implementation Date: April 16, 2012

2. System Change back-out procedures need improvement. Best practice would require that most system changes have back out plans testing of system changes revealed that 30% did not contain back out plans.

We recommend that IT perform periodic updates through meetings and/or formal communication to identify critical changes and develop a consistent process to assess, verify and document the back out plans.

Action Plan Owners: Scott Judd, Director Enterprise Operations

Management Response: Management agrees. Proper back-out plans are not always documented as thoroughly as our process dictates. This procedural requirement has been reiterated with our team members, and going forward, Requests for Change will no longer be approved by the Change Advisory Board without back-out plans being properly documented.

Implementation Date: April 16, 2012

of 3

Process Improvement Opportunities (“PIO”)

Process improvement opportunities describe enhancements to existing operational and financial processes for more efficiency and effectiveness in delivery quality/quantitative controls and key performance indicators (KPI’s). 1. Enhancement of BMC change control system.

Enhancements for the BMC system would include creating a field in BMC to document the systems and the business stakeholders, allowing for better tracking of performance and giving the system enhanced capabilities to determine system process flows. We recommend that management consider implementing a field to document the systems and the business stakeholders of each system change.

Action Plan Owner: Scott Judd, Director Enterprise Operations

Management Response: Management agrees that this would be a helpful feature and will inquire with our vendor (Synergy) as to whether such a field can be added without incurring additional expenses. 2. Policy and Procedure enhancement for Emergency system changes

The 25 week trending report for Emergency changes in the BMC system shows a significant positive trending of Emergency system changes but still remain high as defined by Best Practices. We recommend that management continue its efforts to educate users on system change requirements in order to minimize emergency changes.

Action Plan Owner: Scott Judd, Director Enterprise Operations

Management Response: Management agrees. Emergency changes are those which must be implemented prior to the next gathering of the Change Advisory Board (CAB). The weekly CAB meeting enables all teams to properly discuss planned changes prior to approving for implementation. While the percentage of changes that are categorized as ‘Emergency’ has consistently trended downward since the program’s inception last October, we are not yet meeting our objective of ‘less-than 10 percent’. Therefore, both management and the CAB facilitator will continue to discourage the use of Emergency changes while and re-categorizing as many of these as possible to either Standard or Normal change types.

Jackson Health SystemPrior Audit Report Follow-Up

February, 2012

4/12/2012

Audit Audit Report Dated Original Number of Comments Follow-up Exceptions Noted Corrected during Audit? Exception RatioProcurement FY11 1 1 n/a 100%

Audit Original Finding Original Target Date Follow-up Finding Revised Target Date Responsible AreaProcurement Annual conflict of

interest training and attestation process does not exist for all employees.

9/30/2011 A process to require all employees to complete an annual conflict of interest training session and certification regarding inappropriate relationships has not been completed.

6/30/2012 Compliance - the annual electronic attestation process has been drafted and is in the final stages of review.

FISCAL COMMITTEE


Fiscal Committee Joe Arriola, Chairperson Darryl K. Sharpton, Vice Chairperson Michael Bileca Joaquin del Cueto Mojdeh L. Khaghan Marcos Jose Lapciuc Stephen S. Nuell

Date, Time and Place April 19, 2012 – Immediately following the Audit & Compliance Subcommittee meeting Ira C. Clark Diagnostic Treatment Conference Room 259

AGENDA

1. *Approval of the Previous Meeting Minutes (Joe Arriola, Chairperson)

(a) *Meeting Minutes as of March 15, 2012 2. *Financial Statements Report as of March 2012 (Mark T. Knight, Chief Financial Officer, Jackson Health System) (a) *Key Financial Information (March 2012)

3. *Fiscal Year 2012 Projections

(Mark T. Knight, Chief Financial Officer, Jackson Health System)

4. Cost Accounting – Timetable/Work Plan (Brian Dean, Vice President, Finance Division, Jackson Health System)

5. Accounts Receivable Aging Report (Carmen Pla, Vice President, Patient Financial Services, Jackson Health System) 6. Contracts & Agreements

There are no contracts or agreements to report.

7. Facilities Subcommittee Report (Darryl K. Sharpton, Chairperson, Facilities Subcommittee) 8. Purchasing Subcommittee Report

(Joaquin del Cueto, Chairperson, Purchasing Subcommittee)

(a) *Review and recommend approval of the April 2012 Purchasing Report (Rosa Costanzo, Vice-President and Chief Procurement Officer, Strategic Souring Division)

(Agenda items(s) noted with an asterisk (*) indicates that the supporting documents are attached.)

PUBLIC HEALTH TRUST FINANCIAL RECOVERY BOARD Fiscal Committee Joe Arriola, Chairperson Darryl K. Sharpton, Vice Chairperson Michael Bileca Joaquin del Cueto Mojdeh L. Khaghan Marcos Jose Lapciuc Stephen S. Nuell Date, Time and Place March 15, 2012 – (Immediately followed the Audit & Compliance Subcommittee meeting) Ira C. Clark Diagnostic Treatment Center Conference Room 259

ATTENDANCE

Fiscal Committee Joaquin del Cueto Marcos Jose Lapciuc Joe Arriola Stephen S. Nuell Darryl K. Sharpton Mojdeh L. Khaghan

Excused Michael Bileca

Jackson Health System Carlos A. Migoya Donn Szaro Mark T. Knight Brian Dean Carmen Pla Michael Butler, M.D. Donn S. Steigman

Miami-Dade County Attorneys

Eugene Shy, Jr. Jeffry Poppel

Fiscal Committee Meeting March 15, 2012 Page 2 Call to Order With a quorum being present, the meeting of the Fiscal Committee was called to order at 10:14 a.m. by Joe Arriola, Chairperson, Fiscal Committee. 1. Approval of the Previous Meeting Minutes

(a) Meeting Minutes as of February 13, 2012

Mr. Arriola requested a motion approving the meeting minutes of February 13, 2012.

Ms. Khaghan moved approval; seconded by Mr. Nuell, and carried without dissent. 4. Accounts Receivable Aging Report, as of February 2012

Carmen Pla, Vice President, Patient Financial Services reported that the cash goal was met which included last months short fall of $4.5 million. The actual cash collection for the month was $80.5 million. The point of service for cash exceeded its goal with is a result of a continued focus on ensuring staff accountability of point of service cash collection goals. Potential Medicaid conversion is trending upward, currently working with Department of Children and Families (DCF) to assist with expediting the Medicaid application process that is submitted to them and working with DCF to clear up the backlog. The accounts receivable over 90 continues to show a decrease and for the month of February was reduced by $5.2 million. Thirty percent of the $5.2 million is related to Potential Medicaid of the $92 million which is a reduction from the previous month of $2.9 million. Efforts continue to work on the credit balance which is attributed to a decrease of $208,000 from the previous month.

Physician Services Mr. del Cueto questioned the billing service Jackson Health System (JHS) is using for physician practice billing.

Mark T. Knight, Chief Financial Officer, JHS stated that McKesson provides the billing services JHS uses and is the outsource billing center for physician practice billing. He further stated that Gino Santorio, Director, Project Management Office oversees physician practices billing and is responsible for reporting on collection results.

After speaking with some of the physicians, Mr. del Cueto stated that he and Mr. Santorio have discussed concerns raised by some of the physicians regarding their charges not being processed particularly with managed care companies.

Ms. Khaghan stated that she had a conversation with Mr. Santorio who is in the process of revamping the Physician Service Department. She further stated that as part of the Audit and Compliance Subcommittee agenda will be a report from Mr. Santorio regarding the progress that has been and status report. She suggested that the same report be presented to the Fiscal Committee.

With regards to physician billing services, Don S. Steigman, Chief Operating Officer, JHS stated that next month the Committee will be presented with an update on the progress that has been made regarding physician practice billing and status report regarding revamping of the Physician Services Department. He further stated that Mr. Santorio is on track with physician billing issues as well as operations and will be prepared to present an update and action plan at the next Fiscal Committee as well as monthly reports going forward.

Fiscal Committee Meeting March 15, 2012 Page 3

Mr. Sharpton suggested that public relations initiatives be included to assist with implementing the plan to revamp the Physician Services Department.

After discussion, Mr. Arriola stated that in the next week the Committee will receive an update regarding physician services billing and revamping of the Physician Services Department and at the next meeting a full report regarding physician services will be presented.

Revenue Cycle Tour

Mr. Knight announced that on March 29, 2012 from 12:00 p.m. to 3:00 p.m. a Revenue Cycle Tour has been scheduled. The purpose of the tour is for the board members to participate in a walk through and see the day-to-day operation of the Patient Access Registration area. He stated that all PHT Financial Recovery Board members are invited and encouraged to attend.

2. Financial Statements Report, as of February 2012

Mr. Knight presented an overview of the Financial Statements Report, as of February 29, 2012. A copy of the report was forwarded to members of the Committee under a separate cover and distributed at the meeting. As part of the report, Mr. Knight highlighted information from the Key Performance Indicators, Combined Balance Sheet, Combined Statement of Revenues, Expenses & Change in Fund Net Assets, and P&L 12-Month Trend Analysis. JHS closed the month of February with a loss of $3.1 million versus $5.1 million in January which is an improvement from the prior month, continue to see improvements in sales tax dollars, continue to see flat volumes which has attributed to 6.6% under budget, there was a decrease in length of stay, average daily census throughout the system for the month was 1,078 inpatients, deliveries continues to be an area of opportunity, net revenue was strong on a per adjusted patient day/per admission basis which is attributed to an improved payor mix, continue to see strong results from the outsource Medicaid eligibility which attributed to increased net revenue, operating expenses continue to decline which is attributed to labor reductions, productivity remain strong, strong containment initiatives remain in place for FTE’s which attributed to FTE’s remaining flat, supplies and expense remain lower than anticipated which is the result of collaborative efforts between the Procurement Department and outsource arrangements with the GPO, cash days on hand for the month of February was 15 days which was fairly consistent and better than projected, nursing home occupancy has been less than projected although collections has been strong primarily due to Medicaid payments, and there were some one time events that occurred during the month of February that attributed to the bottom line performance. Mr. Knight stated that based on the month of February performance JHS continues to be profitable on a consolidated basis. He further stated that focus remain on the community medical practice that is tied to various service divisions as well as corrections health services, long-term care and primary care.

JMH Health Plan Flash Report, as of February 2012 Brian Dean, Vice President, Finance Division, Jackson Health System reported that JHS including the Health Plan is experiencing the 2011 audit and it is anticipated that the audit will be completed and presented to the Committee and FRB for approval in the month of April 2012. He reminded everyone that JHS and Miami-Dade County employees Medicaid and Commercial lines of business were eliminated. The Medicare line of business for the month of February showed a bottom line of $132,000, other revenue showed an increase of $130,000 which essentially was payments on insurance claims dating back to 2010, medical loss ratio is 81% which is a favorable medical loss ratio for this line of business, and currently doing some things internally to cap the administrative costs. As part of the report, Mr. Dean reviewed graphs showing various trends from July 2011 through February 2012 for Medicare admissions, average lengths of stay, enrollment, claim inventory and inpatient utilization. A copy of the Flash Report was distributed at the meeting. Mr. Lapciuc requested from the Committee and JHS Management to give some thought to the future of the Health Plan. Mr. Arriola suggested that the future of the Health Plan be addressed at the Strategic Retreat.


Projections for Fiscal Year 2012 Mr. Dean distributed for review the projections for fiscal year 2012. He stated that from October 2011 through projected September 2012 it is anticipated that JHS will experience a loss totaling $20.4 million for fiscal year 2012. He explained that the projections are based on actuals through February, analyzed trends on volumes, layering on productivity and labor initiatives that will be effectuated in May 2012 and running the trends through the end of the fiscal year. The report showed current year projections versus prior year projections. Mr. Knight reiterated that it is projected that JHS will experience a loss totaling approximately $20 million for fiscal year 2012. He reminded everyone that there are some items that are pending that may very well have a positive impact as well as other initiatives that are underway.

3. Cost Accounting Update As a follow up to where JHS is and moving forward regarding cost accounting, Mr. Dean reported that a product on service line managers was implemented in August of last year. He presented some high level information showing how cost is obtained. Patient account information is reviewed based on demographics, diagnostic information, procedural length of stay, revenue payor, physician, etc. The methodology used to arrive at cost for patients is the use of the Ratio Cost to Charge (RCC) method which is derived from the Medicare Cost Report from a departmental level and over head expenses are allocated on a step down method. There are pro and cons to the RCC method. The RCC method provides directionally accurate information relative to the service line but as more granular information is received the cost data becomes less reliable. He described JHS cost accounting system as a system wide detailed and accurate tool which is a key factor as JHS move forward with strategy and what is being done from a payor standpoint to drive future growth. Following the update presentation, Mr. Lapciuc expressed the need as a directive from the FRB to management to have an accurate cost accounting system, timeline for completing the implementing process and a system that becomes the tool through which all JHS decisions are based upon including charge master, growth initiatives, etc. Mr. Migoya stated that the integrated cost accounting system merged together within the current cost accounting system gives way to more granular and immediate information with increased amounts of update and accurate information.

5. Contracts & Agreements No contracts or agreements to report. 6. FY 2011 Audited Financial Statements

Mr. Knight reported that the FY 2011 Audited Financial Statements was thoroughly reviewed at the Audit & Compliance Subcommittee meeting and will be presented at the second special PHT FRB meeting scheduled to follow the committee meetings. A copy of the FY 2011 Audited Financial Statements was included in the agenda packet.

Fiscal Committee Meeting March 15, 2012 Page 5 7. Johnson Controls, Inc. Settlement Update

With regards to the item, a background memorandum was distributed to the committee prior to the meeting under a separate cover as well as distributed at the meeting. Mr. Knight stated that over the last several months he has been working with the County and Jason Bloch, Assistant Miami-Dade County Attorney regarding a settlement with Johnson Controls, Inc. Mr. Knight stated that staff is requesting authorization to enter into a Buyout and Release Agreement (Buyout Agreement) with MassMutual Asset Finance (MMAF), BAL Energy Management, LLC, (BAL) and Johnson Controls, Inc. (JCI). Staff also seeks approval to amend the Service Agreement effective March 7, 2008, between JCI and the Public Health Trust (Trust). By way of background information, Mr. Knight provided the committee with detailed information regarding the request. While the parties have engaged in settlement discussion recent developments have led to the transaction now recommended. MMAF and BAL have agreed to accept a buy-out price of $11,067,133, if made before May, 1, 2012 (plus an additional $2,015.51 per day from March 1, through the payment date). The Trust would then obtain ownership of the FIM’s and have no further savings payments obligations to the other parties. Further, MMAF has made available to the Trust 12-month financing which the Trust has the option, but not the obligation, to utilize. Staff intends to explore other financing alternatives and use the most favorable. The Buyout Agreement also contains mutual releases from each of the parties, and carves out limited remaining obligations, including the Trust’s obligation to defend and indemnify the other parties under certain circumstances. Separately, Mr. Knight explained that Miami-Dade County (County) has entertained contracting with JCI. on unrelated County projects. However, mindful of the Trust’s issues and concerns, the County (In collaboration with Trust staff) has obtained various assurances from JCI, and more significantly, financial concessions from JCI. The County has agreed to transfer to the Trust an amount equal to the concessions, having a value of $1,025,000. As a result, the net cost to the Trust to close out the Shared Savings Agreement would be $10,042,133, which represents a savings of approximately $3,000,000. Additionally, JCI has agreed to amend the services contract to allow the Trust to terminate without penalty. Staff expects to replace or self-perform the maintenance services at a significantly lower cost, after an appropriate transition period. Staff believes executing the Buyout Agreement and permitting an amendment of the service agreement are in the best interests of the Trust. With regards to attorney/client privileges, Mr. Nuell questioned why is the discussion, surrounding the matter in the public. Eugene Shy, Jr., Assistant Miami-Dade County Attorney stated normally there is not an attorney/client privileges unless there is pending litigation which there is no pending litigation in the matter. Jason Bloch, Assistant Miami-Dade County Attorney stated that as it now stands there is really no open or pending litigation. A settlement is a fair way to describe the matter because if there is not a resolution regarding the Buyout Agreement there will be future litigation. He further stated that the way the matter is postured he does not foresee a particular problem with having a discussion regarding with what is being presented by staff. Mr. Nuell stated that he is uncomfortable discussing whether the Trust is in litigation, whether the matter is pending an appeal on arbitration or whether or not it maybe future arbitration. He also stated that he is not in favor of discussing publicly what the Trust’s pluses and/or minuses are based on to make decisions. With regards to litigation, Mr. Shy explained that the Florida Statute of the Sunshine Law allows for a closed session to discuss settlement strategy. But without there being a pending litigation the discussion would have to be in the public. He stated that individual briefings between FRB members and staff regarding the matter could be done.


After discussion, regarding litigation issues, costs, savings, terms of the agreement, and terms of investment, Mr. Migoya recommended to focus on the financial upside toward reaching a settlement by March 31, 2012 which is at the request of the County. Regarding the information presented and discussion, members of the Committee stated that they are not in a position to approve staff’s request to enter into a settlement agreement. Mr. Migoya suggested that individual meetings between members of the committee and staff be scheduled to discuss the issues surrounding the matter, determine how to move forward and report back.

8. Update on AFSCME Negotiations Mr. Knight reported that discussions continue to be ongoing with the AFSCME Team to try to reach an agreement. Even though significant progress has been made, no agreement has been reached. At the request of Vivienne Dixon, President, AFSCME, Local 1363, who was unable to be present, Mr. Knight read into the record the following: AFSCME is continuing its discussion with Jackson’s management and remain hopeful that a mutual satisfactory collection bargaining agreement can be reached. Duane Fitz, of Fitz Healthcare has been providing clear direction authority to address the remaining open financial issues. We are pleased to note that significant progress has been made in recent weeks. Our members recognize that our harmonious relationship with Jackson is critical and sustainable efforts and they have therefore has been persistent in their support of a fair, respectful and equitable agreement. We are committed to working aggressively with Jackson and to the date that we reach an agreement that will be forwarded to the County for approval. We would also like to acknowledge our appreciation to members of the Financial Recovery Board. Mr. Knight stated that last evening a proposal was received from AFSCME and the discussions are moving forward.

9. Facilities Subcommittee Report

Darryl Sharpton, Chairperson, Facilities Subcommittee reported that the Subcommittee met on March 15, 2012. The Subcommittee was presented with regular monthly updates, with the exception of the approval of the previous meeting minutes there were no action items and no significant information to report. Next month an update report will be presented regarding initiatives, and Mr. Steigman presented an update report regarding the discussions having to do with the helipad.

7. Purchasing Subcommittee Report

Joaquin del Cueto, Chairperson, Purchasing Subcommittee reported that the Subcommittee met on March 15, 2012. The Subcommittee was presented with regular monthly reports, reviewed and approved the Purchasing Report for the month of March 2012 and resolution authorizing and ratifying emergency procurement in the amount of $142,013 to DST Health Solutions, LLC for payment of past due invoices for support and maintenance as well as the implementation of the 5010 upgrade to the current managed care system utilized by the JMH Health Plan; and the approval of continued maintenance and support services of the system for a one year period in the amount of $216,1142.20. The Purchasing Report for the month of March 2012 was forwarded to the Fiscal Committee for approval along with the resolution to be presented as an add-on agenda item for approval. (a) Review and recommend approval of the March 2012 Purchasing Report (Rosa Costanzo,

Vice President & Chief Procurement Officer, Strategic Sourcing Division, Jackson Health System)


Add-on Agenda Item Resolution authorizing and ratifying emergency procurement in the amount of $142,013 to DST Health Solutions, LLC for payment of past due invoices for support and maintenance as well as the implementation of the 5010 upgrade to the current managed care system utilized by the JMH Health Plan; and the approval of continued maintenance and support services of the system for a one year period in the amount of $216,1142.20 (Fernando Salgado, Chief Transformation Officer, Jackson Health System) Mr. Arriola requested a motion approving the March 2012 Purchasing Report and add-on agenda item. Mr. Sharpton moved approval; seconded by Ms. Khaghan, and carried without dissent.

Adjournment The meeting of the Fiscal Committee adjourned at 12:17 a.m. Transcribed by Ivenette Cobb Executive Assistant Public Health Trust Financial Recovery Board

Mar‐12 Mar‐12 Feb‐12 Mar‐11

Statistical Indicator Actuals Budget Actuals ActualsDays Net in Receivable 52.09 43.98 49.59 54.27Days (Unrestricted)Cash on Hand 12.76 10.00 14.96 21.03Admissions excl. Newborn 5,224 5,722 4,896 5,423Hospital Patient Census Days excl. Newborn 32,581 36,557 31,252 35,589Admissions % through ED 71.73% N/A 71.24% 74.29%Average Length of Stay 6.24 6.39 6.38 6.56Outpatient Visits 29,374 31,163 26,964 29,356 JHS FTE per Adjusted Occupied Bed 6.67 6.64 6.38 6.79 Jackson Health System FTE's 10,102 11,023 9,800 11,106

Public Health Trust: Key Financial InformationMarch FY 2012

FYE 2012 FYE 2011 FYE 2011Assets Mar‐12 Sep‐11 Mar‐11Cash & Investments 52,702$ 70,111$ 89,370$ Net Accounts Receivable 154,082$ 155,811$ 157,380$ Total Current Assets 366,551$ 429,546$ 457,718$ Total Non Current Assets 662,800$ 629,665$ 648,311$ Total Assets 1,029,351$ 1,059,211$ 1,106,029$ Liabilities & Net Assets Mar‐12 Sep‐11 Mar‐11Account Payable & Accrued Expenses 192,038$ 206,308$ 211,324$ Total Current Liabilities 537,316$ 540,495$ 540,266$ Other Long‐Term Liabilities 433,539$ 438,856$ 469,686$ Total Net Assets 58,496$ 79,860$ 96,079$ Total Liabilities & Net Assets 1,029,351$ 1,059,211$ 1,106,029$

Public Health Trust: Financial InformationMarch FY 2012($ in Thousands)

Mar‐12 Mar‐12 Feb‐12 Mar‐11Income Statement Actuals Budget Actuals ActualsNet Patient Revenue 91,995$ 90,971$ 97,291$ 102,027$ Other Operating Revenue 14,416$ 30,500$ (4,377)$ 28,971$ Salaries & Related Costs 78,938$ 70,746$ 70,532$ 78,766$ Contractuals & Purchased Serv. 27,253$ 28,844$ 28,907$ 36,529$ Supplies 14,909$ 16,305$ 14,843$ 20,975$ Non Operating Income & Expenses 35,291$ 28,359$ 33,952$ 31,180$ Excess of Revenue Over (Under) Expenses 6,205$ 1,567$ (3,144)$ (12,739)$

Public Health Trust: Financial InformationMarch FY 2012($ in Thousands)

4. Cost Accounting – Timetable-Work Plan

5. Accounts Receivable Aging Report

6. Contracts and Agreements (There are no contracts or agreements to report.)

7. Facilities Subcommittee Report

8. Purchasing Subcommittee Report


PUBLIC HEALTH TRUST FINANCIAL RECOVERY BOARD PURCHASING REPORT

APRIL 30, 2012

TO: PUBLIC HEALTH TRUST FINANCIAL RECOVERY BOARD FROM: PROCUREMENT MANAGEMENT DEPARTMENT The following recommendations are made in accordance with the Trust’s “Procurement Policy” and it’s implementing “Procurement Regulation.” This report includes competitively solicited contract awards over $1,000,000, waivers of formal competition over $100,000 and other categories for Board approval as prescribed by the Procurement Policy/Regulation. The entire report has been screened and assembled by the Procurement Management Department with the direct participation of the Administrator and staff, all subject to review by the Vice President, Strategic Sourcing Division, consultation with the President as needed, and review for legal sufficiency by the County Attorney’s Office. SECTION I. AWARDS UNDER INVITATIONS TO BID (ITB’s) This section consists of awards under competitively solicited Invitations to Bid (ITB’s) over $1,000,000. No items to report. SECTION II. AWARDS UNDER REQUESTS FOR PROPOSALS (RFP’s) This section consists of awards under competitively solicited Requests for Proposals (RFP’s) over $1,000,000. 1. (326415-HT) The Revenue Cycle Division, Practice Management Physician

Services Department, requests approval to award a contract to PST Services, Inc., resulting from a competitive Request for Proposals (RFP 11-10055-HT) for professional fee billing and collection services.

PST Services, Inc.: $ 1,685,085/Year (for three years)

Total approved funding $ 5,055,255