board finance committee meeting - palomar health...2012/12/03 · • maram f. zakko, md agreement...

BOARD FINANCE COMMITTEE MEETING * MONDAY, DECEMBER 3, 2012 6:00 (Buffet Dinner for Committee Members & Invited Guests Only) 456 E. Grand Avenue, Escondido, CA 1st Floor Conference Room ∗

Time Page Target

CALL TO ORDER ....................................................................................................................... .................. ................ 6:00 ADJOURNMENT TO CLOSED SESSION ......................................................................... .................. ............... 6:00

Pursuant to California Government Code §54954.5(h) REPORT INVOLVING TRADE SECRET Discussion will concern proposed new service Estimated date of public disclosure: January 2013 .............. 20 ............... 6:20

RESUMPTION OF OPEN SESSION ................................................................................. Immediately following end

of closed session Action Resulting From Closed Session Discussion – IF ANY ..................................... ................ 5 ............... 6:25 Public Comments ................................................................................................................. ................. 5 ............ 6:30

5 minutes allowed per speaker with a cumulative total of 15 minutes per group. For further details & policy, see Request for Public Comment notices available in meeting room.

Information Item(s)

• Program Review Schedule ..............................................................................................

................. 5 ............ 6:35 1. * Approval: Minutes – October 29, 2012 (ADD A-Pp6-13) .................................................. ................. 2 ....... 2 6:37 2. * Review/Approval: Arch Health Partners – Request for Line of Credit Increase ................ ............... 10 ....... 3 6:47 3. * Review/Approval: Summary of Prior Month’s Approved Budgeted Routine Physician

Agreements (ADD B-Pp14-29) ............................................................................................ ................. 3

....... 4

6:50

4. * Approval: October 2012 & YTD FY2013 Financial Report (ADD C-Pp30-66) ................. ............... 20 ....... 5 7:10 ADJOURNMENT ....................................................................................................................... .................... ............ 7:10

NOTE: If you have a disability, please notify us 72 hours prior to the event so that we may provide reasonable accommodations.

∗ Asterisks indicate anticipated action. Action is not limited to those designated items.

1

Minutes Finance Committee – Monday, October 29, 2012

Form A - Minutes.doc

TO: Board Finance Committee MEETING DATE: Monday, December 3, 2012 FROM: Tanya Howell, Secretary BY: Robert A. Hemker, CFO Background: The minutes of the Board Finance Committee meeting held on Monday, October 29, 2012, are respectfully submitted for approval (Addendum A).

Budget Impact: N/A

Staff Recommendation: Staff recommends approval of the Monday, October 29, 2012, Board Finance Committee minutes.

Committee Questions: COMMITTEE RECOMMENDATION: Motion: Individual Action: Information: Required Time:

2

Arch Health Partners Request for Increase to Line of Credit

TO: Board Finance Committee MEETING DATE: Monday, December 3, 2012 FROM: Cecil Dunagan, CPA, Chief Financial Officer, Arch Health Partners Background: Arch Health Partners has changed its fiscal year end from a calendar year to a June 30 FYE in order to coordinate with the fiscal year of Palomar Health. This will help to facilitate consolidation of Arch Health Partners financial statements with the Palomar Health financial statements.

This change of fiscal year has necessitated a six-month addition to the original operating budget submitted for calendar 2012. Since the Line of Credit (LoC) as originally requested and granted covered only calendar year 2012, Arch is requesting that an additional amount be added to the LoC to cover the additional six-month period ending June 30, 2013. Arch anticipated and conveyed to the Palomar Health Board that the LoC increase needed for the last six months of the fiscal year would be presented at the end of calendar year 2012

The six month operating budget extension was calculated at the same rates as those used in the original calendar year operating budget, thus requiring an increase to the LoC of one-half the amount of increase for the calendar year.

Budget Impact: This change from a calendar to fiscal year will require an increase to the LoC of $2,500,000 to cover expected cash flow needs for the six months ending June 30, 2013.

Staff Recommendation: The request from the Arch Health Partners Board of Directors to the Palomar Health Board is for an increase to the LoC of $2,500,000.

Palomar Health Management will make a Recommendation at the Finance Committee meeting.

Committee Questions:

COMMITTEE RECOMMENDATION: Motion: Individual Action: Information: Required Time:

3

Budgeted Routine Physician Agreements Board Summary Report

Form A - Physician Agreements.doc

TO: Board Finance Committee MEETING DATE: Monday, December 3, 2012 BY: Robert A. Hemker, CFO

Background: The following Budgeted Routine Physician Agreements became effective during the months of September and October, 2012. The standard Form A and Abstract Table for each signed Agreement are attached as Addendum C.


PHYSICIAN AND/OR GROUP TYPE OF AGREEMENT • Comprehensive Pain Management Specialists ActivCentre Provider Panel Agreement • Escondido Pulmonary Medical Group Critical Care Professional Services Agreement • Mark L. Kadden, MD Agreement for Services – ERCP Treatment – PMC • Sam Filiciotto, MD • Thomas Knutson, MD • Sabiha Pasha, MD • Thomas Velky, MD

Physician Independent Contractor Agreements for Information Systems Services

• The Regents of UCSD School of Medicine, Department of Reproductive Medicine 1st Amendment to Perinatology Agreement

• Maram F. Zakko, MD Agreement for Services – ERCP Treatment – PMC

4

October 2012 & YTD FY2013 Financial Report

Form A - Financial Report.doc

TO: Board Finance Committee MEETING DATE: Monday, December 3, 2012 FROM: Robert A. Hemker, CFO Background: The Board Financial Reports (unaudited) for October 2012 and YTD FY2013 are submitted for the Finance Committee’s approval (Addendum D).

Budget Impact: N/A

Staff Recommendation: Approval



5

ADDENDUM A

6

2012-10-29 Board Finance Minutes.doc 1

B O A R D F I N A N C E C O M M I T T E E M E E T I N G A T T E N D A N C E R O S T E R & M E E T I N G M I N U T E S C A L E N D A R Y E A R 2 0 1 2

MEETING DATES:

MEMBERS 2/6/12 2/27/12 3/26/12 5/7/12 6/4/12 6/25/12 7/30/12 8/27/12 9/24/12 10/29/12 11/26/12

DIRECTOR LINDA GREER, RN – CHAIR P P P P P E P P

CA

NC

EL

LE

D

P

DIRECTOR JERRY KAUFMAN, PT MA P P E E E E P P P

DIRECTOR STEVE YERXA P P P P P P E P P

MICHAEL COVERT, FACHE P P P P P P P P P

RICHARD C. ENGEL, MD P P P P P P E E P

ROGER ACHEATEL, MD E P P E P P E P E

MARCELO RIVERA, MD – ALTERNATE P P P

BRUCE KRIDER – 2ND ALTERNATE P

– 3RD ALTERNATE

– 4TH ALTERNATE

STAFF ATTENDEES

BOB HEMKER P P P P P P P P P

GERALD BRACHT P P P P P E P E P

DAVID TAM, MD P P E P P P P P P

TANYA HOWELL – SECRETARY P P P P P P P P P

INVITED GUESTS SEE TEXT OF MINUTES FOR NAMES OF GUEST PRESENTERS

7


BOARD FINANCE COMMITTEE – MEETING MINUTES – MONDAY, NOVEMBER 29, 2012

1. AGENDA ITEM

• DISCUSSION CONCLUSION/ACTION FOLLOW UP/RESPONSIBLE PARTY FINAL?

CALL TO ORDER • The meeting – held in the first floor conference room at 456 E. Grand Avenue, Escondido, CA – was called to order at 6:15 p.m. by Chair Linda Greer, RN

ESTABLISHMENT OF QUORUM • See roster

PUBLIC COMMENTS

• There were no public comments

INFORMATION ITEM(S)

Bob Hemker presented the following informational item

• ARCH EXPANSION o Effective October 1, 2012, Arch completed the acquisition of Escondido Cardiology

Associates as part of the continued expansion strategy for Arch

Information only • More information on Arch & ECA will be presented at the January meeting

N

1. MINUTES – AUGUST 27, 2012

• No discussion MOTION: By Director Kaufman, seconded by Director Yerxa and carried to approve the minutes of the August 27, 2012, Board Finance Committee. All in favor, none opposed.

Y

2. PROGRAM REVIEW – VHA GROUP PURCHASING ORGANIZATION Steve Ellis, Director of Supply Chain Services, presented, utilizing the presentation included as Addendum B of the agenda packet • Page 32 – Savings in the last three years

o The Foundation actually holds the share in VHA, which was an accommodation made by VHA to the Foundation as an affiliate of the District, since the District cannot own shares

o We were the first District in the nation to hold that relationship

o The Foundation gets any dividends, but all savings inure to the District

• Pages 34 & 35 – Benchmarking Results

o Comparison of the District to other like-sized organizations

Mr. Ellis recently performed a reconciliation with VHA, and the numbers are being accurately reported

• Page 38 – Analytical Tools

o Some are free, some bear a cost for use

• Page 41 – Performance Management with the Institute for Healthcare Improvement (IHI) o Dr. Lorie Shoemaker, Chief Nurse Executive, will be discussing IHI further during the

Annual Quality/Patient Safety Report to the Board this Thursday

Information only Forwarded to the November 12, 2012, Board of Directors meeting as information

• Mr. Ellis was requested to obtain a roster for committee membership to ensure that all our leaders who should be affiliated are included in forums

N

8



1. AGENDA ITEM


• Pages 43-45 – WestPac and WPC consolidation

o Created the West Coast Purchasing Coalition (WCPC)

o Includes Washington, Oregon, Arizona, California and Hawaii

o Will be leveraging the collective buying power with these 19 entities

Entities listed in bold font are new to the WCPC

Washington Hospital, a new member, is not listed

o Bob Hemker is the new Chair of the WCPC

o Steve Ellis is the new Chair of the Operations Group

o There have been enhancements in savings purely from the fact of the consolidation

• Page 49 – Structure of the Network

o Organizing the entity as an LLC shows commitment, and vendors prefer working with a corporate entity as opposed to a buying group

• Page 50 – Governance

o They will also be looking at a number of other committees

o One will be a Pharmacy Committee

o The committees will bring clinicians and physicians together

o With regard to physicians, VHA is working on key areas to target, as they want to build a portfolio and the process for involving physician champions

Also discussed how we are communicating concepts to our physicians locally, as we need to develop a disciplined process for working through initiatives and determining whether to go with them or not

3. SUMMARY OF PRIOR TWO MONTH’S APPROVED BUDGETED ROUTINE PHYSICIAN AGREEMENTS

• Referencing pages 4 and 53-93 of the agenda packet, Bob Hemker presented the agreements

o This is a recap of routine, non-exclusive agreements that have already been executed

o As there was not a meeting in September, this month’s report covers two months of agreements

MOTION: By Director Kaufman, seconded by Director Yerxa and carried to recommend approval of the physician agreements as presented. All in favor, none opposed. Director Yerxa abstained with regard to the Neighborhood Healthcare agreement.

Forwarded to the November 12, 2012, Board of Directors meeting with a recommendation for approval

Y

4. FY2013 INITIATIVES

• Bob Hemker stated that the FY2013 Initiatives were included in the Finance Committee’s Annual Agenda for review at this meeting; however, as those Initiatives were reviewed at the last Board Strategic Planning meeting, there will not be an update at this meeting

Information only N

9



1. AGENDA ITEM

• DISCUSSION CONCLUSION/ACTION FOLLOW UP/RESPONSIBLE PARTY FINAL? 5. SEPTEMBER 2012 AND YTD FY2013 FINANCIAL REPORT Utilizing select slides within the presentation included as Addendum D in the agenda packet, Bob Hemker presented the financial statements for September 2012 and YTD FY2013, stating that he would be focusing on the numbers for the quarter • This was a challenging quarter which included pre-opening readiness, the licensure

process and move day in July and August

o Elective surgeries were also suspended for a period of time pre-opening

o Began ramping back up into full operations through August and September

o Had similar volumes during the first quarter last year

Did not hit the volumes that we were hoping to see this quarter, and they still haven’t materialized

Because of the transition to the new hospital, staff couldn’t necessarily volume adjust or flex as we should have

• As we move into November and December, how we’re settling into the new state of the district is being assessed

• PERFORMANCE DASHBOARD (PP 97-98) o Growth is blue, but it trails back on a quarterly basis

o Expenses and EBIDA are red

o Cash collections were lower than budgeted at $123M vs. a target of $148M

Last year’s cash collections were at $110M, so they are up year-on-year

On a volume adjusted basis, approximately $5M behind target

o The graphs begin with the prior year’s average, with subsequent months stacked on

o Patient Days

The yellow is grouped as “Progressive/Med-Surg” As units at PMC begin getting more specificity, we should be able to break

that grouping down further o Payor Mix showed some movement in September in Managed Care, but it isn’t

enough to say it’s a trend Managed Care should be growing as a percentage to total as the Kaiser volumes

increase o Total Surgeries includes all venues of care, and volumes did come up a little during

the quarter o Total ER Visits (includes expresscare Plus) exceeded our expectations as to volumes,

but did not see an associated conversion rate to inpatient volume o Statistical Indicators

Adjusted Discharges are within 50 vs. prior year-to-date, virtually a mirror image of the first quarter last year

LOS at 3.97 was up vs. a budget of 3.75 and prior year of 3.76 Case Mix at 1.51 was up vs. budget and prior year, both at 1.44

MOTION: By Director Dr. Engel, seconded by Director Yerxa and carried to recommend approval of the September 2012 and YTD FY2013 Financial Statements as presented. All in favor. None opposed.

Forwarded to the November 12, 2012, Board of Directors meeting with a recommendation for approval

• It was noted that the Total ER Visits graph on page 97 was missing PHDC Urgent Care for the month of September

o Mr. Hemker will request that the slide be corrected before the next meeting

N

10



1. AGENDA ITEM


Births were down vs. budget and prior year ER to Admit Rate was also down vs. budget and prior year SNF Patient Days were also down slightly ER Visits & Admits were flat year-on-year, as were Outpatient Registrations Do not have a separate line item for expresscare Plus as there isn’t a solid

answer for what the target should be expresscare Plus should not be doing emergency level care

o Ratios FYE June 2012 is the entire year

o Balance Sheet Total Cash is down, in part due to having used some cash for the final

construction o Income Statement

Net Revenue is just under $17M negative vs. budget Total expenses looks positive vs. budget

• BALANCE SHEET – CONSOLIDATED (P99) o Cash and equivalents were up year-on-year o Net Accounts Receivable were up about $3M o The new facility was moved into Property Plant & Equipment and out of CIP as it is

now a depreciable asset o There was a significant year-on-year reduction in Accounts Payable, which requires

cash • INCOME STATEMENT – MONTH-TO-DATE (P100)

o Patient Days had a negative variance to budget of 1800 Equivalent to 60 ADC

o Adjusted discharges had a negative variance to budget of 385 o Salaries, Wages & Contract Labor (SWC) had a negative $1.5M rate efficiency

variance Still reflects the premium pay issue with extra staffing at the new facility

o Supplies were down $800K in terms of rate efficiency There is an adjustment going forward on what the real spend is

o Net Income had a $5.5M negative variance • INCOME STATEMENT – YEAR-TO-DATE (P101)

o Patient Days had a negative variance to budget of 3964 Equivalent to 43 ADC

o Adjusted Discharges had a negative variance to budget of 1518 If you took the revenue from those volume units, then removed the SWC and

Supplies (e.g., the direct costs that would go with that care) it would create a contribution margin of $4.8M on that difference

Removing that $4.8M from the $7.98M negative variance in Net Income brings it down to a $3M loss Still not good as a variance, but the volume is a key driver in explaining the

cause o Net Revenue had a $16.97M negative variance

11



1. AGENDA ITEM


o SWC had a $6.235M negative rate efficiency variance Attributed to transformation, as the move teams equal premium pay

We still have additional staff up with travelers, and a lot of overtime, but Joy Gorzeman, Chief Nursing Officer at PMC, stated that we are weaning off that extra staff

There are a few situations still under evaluation (e.g., greeter desks, multidisciplinary rooms, etc), but should begin seeing an improvement within a 6 month period

As we move out of that first quarter, we should also begin to have more ability to flex to volumes

o Supplies had a $2.375M negative rate efficiency variance, approximately $2M of which was for setting up initial inventory Would normally true up the inventory costs for start up of the new campus at year

end Across the board there are inventories that came in to stock up the new

facility that are currently being taken to expense (a) $1.5-$2M will be reversed from the expense and put into formal

inventories Can’t do a physical inventory, but will make adjustments that we can see, by

reviewing supply spend for the months of July & August and using it as the start up inventory

Cost of move day from recap was $1M o All things being equal, we should start getting back to budget

• INCOME STATEMENT – CURRENT VS. PRIOR YEAR-TO-DATE (P102) o Volumes were flat across the board o Adjusted Discharges were up 50 year-on-year

Ambulatory/outpatient volume continues to increase o Patient Days were down 184 year-on-year o Admissions were down 374 year-on-year o Continue to see LOA creep up (from 3.76 to 3.97)

Continued shift from the Inpatient to the ambulatory setting o Total Net Revenue had almost 3.6% growth year-on-year o Net Income Before Non-Operating Income was down $20M year-on-year

Depreciation will continue as a delta quarter on quarter o Professional Fees were up $4.7M year-on-year

In large part due to $2M in IT maintenance agreements • OBSERVATION PATIENTS(P106)

o Outpatient with Observation services o Viewed as Observation encounters, not Patient Days o Looked at prior year and reviewed it at the payor level

25% growth on Managed Care o If Kaiser was carved out, it would be 20% growth

• INPATIENT SURGERIES (P109) o Down across the board

12



1. AGENDA ITEM


o Evaluating if due to a shift in venue (e.g., inpatient vs. outpatient) or a market share shift

• TRAUMA CASES (P118) o Last year was unusually high, this year is more normal

• DELIVERIES (P120) o Both campuses were down vs. budget and prior year

• PAYOR MIX (P121) o No significant change compared to FY2012

• Volume was not achieved as budgeted and targeted • A conscious decision was made to ramp up volume to provide for safe patient care,

knowing it would also require premium pay

ADJOURNMENT The meeting was adjourned at 7:49 p.m.

SIGNATURES:

COMMITTEE CHAIR

Linda Greer, RN

COMMITTEE SECRETARY

Tanya Howell

13

ADDENDUM B

14

ActivCentre Provider Panel Agreements

Form A - CPMS Chisholm.doc

TO: Board Finance Committee MEETING DATE: Monday, December 3, 2012 FROM: Natalie Bennett, Manager Program Development Background: In September, a new pain management physician was added to the ActivCentre provider panel. The provider panel agreement focuses on delivering a standard of care when patients are referred to a provider from the ActivCentre. There is no budgetary impact of these agreements.

Budget Impact: $0




15

PALOMAR POMERADO HEALTH - AGREEMENT ABSTRACT Section

Reference

Term/Condition

Term/Condition Criteria TITLE ActivCentre Provider Panel Agreement Amendment

AGREEMENT DATE 9-21-2012

PARTIES Palomar Health and Comprehensive Pain Management

Specialists (Dr. Chris Chisholm)

PURPOSE To serve as a panel physician for the outpatient spine center.

SCOPE OF SERVICES Provider agrees to meet certain program standards to participate. The standards are focused around access, triage, nurse navigation, outcomes tracking, quality and education/marketing.

PROCUREMENT

METHOD Request For Proposal x Discretionary

TERM 1-year

RENEWAL Automatic renewal unless otherwise terminated

TERMINATION 30-day written notice

COMPENSATION

METHODOLOGY N/A

BUDGETED YES NO – IMPACT: N/A

EXCLUSIVITY xNO YES – EXPLAIN:

JUSTIFICATION

AGREEMENT NOTICED YES xNO Methodology & Response: any new providers on the staff are given an opportunity to be on the panel for the ActivCentre

ALTERNATIVES/IMPACT

Duties Provision for Staff Education Provision for Medical Staff Education Provision for participation in Quality Improvement Provision for participation in budget process development

COMMENTS

APPROVALS REQUIRED VP CFO CEO BOD Committee ____________ BOD

16

Palomar Health Critical Care Professional Services Physician Contract

Form A - Critical Care - EPMG.doc

TO: Board Finance Committee MEETING DATE: Monday, December 3, 2012 FROM: Robert Trifunovic, MD MBA FACOG Background: Currently at Palomar Health, the Critical Care Services for unassigned patients is administered through the Escondido Pulmonary Medical Group(“EPMG”). It has become exceptionally difficult to bring in new Critical Care physicians to cover the two hospitals of PMC and Pomerado. After a third party consultant delineated the Fair Market Value of the FTEs needed to administer the services of critical care at the two campuses, agreement was made for financial compensation over and above the billables to the services needed for the stated FTEs. Additionally, the contract will provide for a phased approach to eventually cover Pomerado in the most optimum fashion.

Budget Impact: The financial impact to the FY13 budget will vary based upon the exact month in which Phase II is implemented. The financial impact should be in the range of $620,551 - $773,745 depending on the date of the implementation of Phase II and if the group can demonstrate the increased burden of work at Pomerado was greater than originally theorized. These results would be within the budget for the 2013 fiscal year.

Staff Recommendation: Approve the Contract with EPMG for Critical Care Services at Palomar Health.



17

PALOMAR HEALTH – AGREEMENT ABSTRACT Section

Reference

Term/Condition

Term/Condition Criteria TITLE Critical Care Professional Services Agreement

AGREEMENT DATE October 1, 2012

PARTIES Palomar Health and Escondido Pulmonary Medical Group

PURPOSE This professional services agreement was created to procure a stable call coverage at the new PMC and POM and facilitate a physician FTE growth within the service line of Critical Care.

SCOPE OF SERVICES Coverage of services related to Critical Care with the ICUs of PMC and POM.

PROCUREMENT

METHOD Request For Proposal Discretionary

TERM 2 years

RENEWAL None at this point

TERMINATION September 30, 2014

COMPENSATION

METHODOLOGY Monthly payment based upon per diem stipend determined by FMV 3rd party evaluation.

BUDGETED YES NO – IMPACT: within budget

EXCLUSIVITY NO YES – EXPLAIN:

JUSTIFICATION Purpose is for stabilization of coverage across two campuses and growth of the model.

AGREEMENT NOTICED YES x NO Methodology & Response:

ALTERNATIVES/IMPACT


COMMENTS


18

Agreement for Service Mark L. Kadden, M.D.

Form A - Kadden.doc

TO: Board Finance Committee MEETING DATE: Monday, December 3, 2012 FROM: Gerald Bracht, Chief Administrative Officer Palomar Medical Center Background: Dr. Kadden provides Gastroenterology services to his patients at Palomar Medical Center. Under certain circumstances a provision of ERCP services to unfunded patients are provided to assure timely, safe care for such patients at Palomar Health. This service shall only be provided if and as requested by Palomar Health. It is projected that no more than twenty-nine of such cases will occur in a twelve month period.

Budget Impact: Unbudgeted




19

tlhd

Text Box


Reference

Term/Condition

Term/Condition Criteria Preamble TITLE Agreement for Service – Mark L. Kadden, M.D.

Preamble AGREEMENT DATE October 7, 2012

Preamble PARTIES 1. Palomar Health

2. Mark L. Kadden, M.D. Section 1 PURPOSE Under certain circumstances a provision of ERCP services

to unfunded patients are provided to assure timely, safe care for such patients at Palomar Health. This service shall only be provided if and as requested by Palomar Health. It is projected that no more than twenty-nine of such cases will occur in a twelve month period.

Section 1 SCOPE OF SERVICES Provision of ERCP services to unfunded patients are provided to assure timely, safe care for such patients at Palomar Health. This service shall only be provided if and as requested by Palomar Health.

PROCUREMENT


Section 5 TERM The term will commence on 10-7-12 and continue for one year.

Section 5 RENEWAL The term will automatically roll-over for one year unless terminated in accordance with the terms of this agreement

Section 5.1

TERMINATION Either party may terminate this agreement without cause, expense or penalty effective 30 days after written notice is given to the other party.

Section 2 COMPENSATION

METHODOLOGY Fair Market Value

BUDGETED YES NO – IMPACT:


JUSTIFICATION ERCP services to unfunded patients are provided to assure timely, safe care for such patients at Palomar Health.

AGREEMENT NOTICED YES NO Methodology & Response:

ALTERNATIVES/IMPACT


COMMENTS


20

PALOMAR HEALTH PHYSICIAN INDEPENDENT CONTRACTOR AGREEMENT

INFORMATION SYSTEMS SERVICES

FORM A it 12-03-12.doc

TO: Board of Directors MEETING DATE: Monday, December 3, 2012 FROM: Ben Kanter, MD, CMIO, Paul S. Peabody, CIO Background: Palomar Health (PH) requires the active involvement of physicians in many aspects of Information Systems programs. A Physician Advisor Council was active during the development phase of the Clarity Electronic Health Record. Now that Clarity has been implemented the Physician Advisor Council will reconvene to assist PH in improving the efficient and effective use of Clarity. The physicians indicated below will be reimbursed for their work effort according to standard and customary manners and rates. There are separate contracts with each of the following physicians:

• Dr. Sam Filiciotto • Dr. Thomas Knutson • Dr. Sabiha Pasha • Dr. Thomas Velky

Budget Impact: After discussion with many different sites across the U.S., a fair market value was established for the mean value hourly reimbursement for such work. All fees payable to medical staff members have been budgeted within the IT projects listed above. Staff Recommendation: Approval. Committee Questions:


21

PALOMAR POMERADO HEALTH - AGREEMENT ABSTRACT

Section Reference

Term/Condition

Term/Condition Criteria

TITLE Independent Contractor Agreement between Sam Filiciotto, M.D. and Palomar Pomerado Health


PARTIES San Filiciotto, M.D. PURPOSE To assist the CMIO in the implementation of Computerized

Physician Order Entry, computerized physician documentation, and any other required work on the Cerner Roadmap projects.

SCOPE OF SERVICES The physician will work as subject matter experts, may be asked to lead development teams, travel with PPH employees to do off site evaluations, and to attend Cerner training sessions here and in Kansas City.

PROCUREMENT METHOD Request For Proposal Discretionary TERM 1 year

RENEWAL No automatic renewal

TERMINATION 10 day notice by either party without cause

COMPENSATION

METHODOLOGY Hourly rate – itemized

BUDGETED YES NO – IMPACT: None

EXCLUSIVITY NO

JUSTIFICATION Medical and IT subject matter expert required to assist in the planning and design of the electronic record. Fee is standard for this process and is based upon analysis from similar projects across the U.S.

AGREEMENT NOTICED YES NO Methodology & Response: ALTERNATIVES/IMPACT n/a Duties Provision for Staff Education

Provision for Medical Staff Education Provision for participation in Quality Improvement Provision for participation in budget process development

COMMENTS Renewal of contract backdated to reflect expiration of contract from prior year.


22


Section Reference

Term/Condition


TITLE Independent Contractor Agreement between Thomas Knutson, M.D. and Palomar Pomerado Health


PARTIES Thomas Knutson, M.D. PURPOSE To assist the CMIO in the implementation of Computerized






COMPENSATION



EXCLUSIVITY NO






23


Section Reference

Term/Condition


TITLE Independent Contractor Agreement between Sabiha Pasha, M.D. and Palomar Pomerado Health


PARTIES Sabiha Pasha, M.D. PURPOSE To assist the CMIO in the implementation of Computerized






COMPENSATION



EXCLUSIVITY NO






24


Section Reference

Term/Condition


TITLE Independent Contractor Agreement between Thomas Velky, M.D. and Palomar Pomerado Health

AGREEMENT DATE 10/01/2012

PARTIES Thomas Velky, M.D. PURPOSE To assist the CMIO in the implementation of Computerized






COMPENSATION



EXCLUSIVITY NO






25

InInsert Subject Here

Form A - UCSD Regents.doc

PALOMAR HEALTH MEDICAL DIRECTOR – MULTIPLE SERVICES

TO: Board Finance Committee MEETING DATE: Monday, December 3, 2012 FROM: Lorie K. Shoemaker, Chief Nurse Executive

BACKGROUND: Palomar Health has contracted with Medical Directors and/or institutions that are required by Title XXII or other licensing and accrediting bodies with a limited scope of duties and responsibilities. There is a growing body of literature to suggest that nurses and physicians leading together can improve clinical operations and patient outcomes. High-performing organizations are moving away from the traditional nurse/physician roles and responsibilities and are redesigning them to achieve a new level of collaboration, mutual respect, and trust (Baldwin, Dimunation, & Alexander, 2011; Burroughs, 2012). To that end, Palomar Health is proposing the creation of nursing and medical director dyads for all of the nursing units at Palomar Medical Center, Palomar Health Downtown Campus, and Pomerado Hospital. These dyads will lead their clinical units in all phases of clinical operations including, but not limited to:

• Joint establishment of clinical and functional protocols and evidence-based practices • Joint oversight of supply chain management and inventory • Joint oversight for finance, quality, and patient satisfaction metrics • Joint modeling of effective collaborative culture, communication, and conflict resolution

The Regents of the University of California, San Diego School of Medicine – Department of Reproductive Medicine (University) has been contracted to appoint physicians to provide professional services in Perinatal Medicine at the Palomar Health Downtown Campus and Pomerado Hospital. Additionally, the Agreement provides for University to appoint a designated Perinatology Medical Services Director to provide oversight for Perinatology services. The original agreement, effective September 1, 2009 through August 31, 2012, has been extended one year by an Amendment effective September 1, 2012 through August 31, 2013. BUDGET IMPACT: Compensation to University shall remain at the original negotiated rate (September 1, 2009) of $260,000 per year, payable in monthly installments of $21,667. This agreement was budgeted in the FY’13 Operating Budget. STAFF RECOMMENDATION: Approval COMMITTEE QUESTIONS: COMMITTEE RECOMMENDATION: Motion: Individual Action: Information: Required Time:

26

PALOMAR HEALTH - AGREEMENT ABSTRACT

Section Reference

Term/Condition


TITLE First Amendment to Perinatology Services Agreement AGREEMENT DATE September 1, 2012

PARTIES 1) Palomar Health

2) The Regents of the University of California, San Diego Department of Reproductive Medicine

Exhibit A PURPOSE To provide professional services in Perinatal Medicine at PHDC and Pomerado Hospital and the appointment of a designated Perinatology Medical Services Director to provide oversight.

Section 2 and Exhibit A

SCOPE OF SERVICES Pursuant to Section 2 and Exhibit A of original Agreement dated 9/1/2009

N/A PROCUREMENT


Section 1 of Amendment

TERM One year beginning September 1, 2012 through August 31, 2013.

Section 10

RENEWAL Upon expiration of term, agreement may only be renewed upon the mutual written agreement of both parties. There is no automatic renewal for subsequent terms.

Sections 10.2 – 10.5

TERMINATION - Either party may terminate without cause with 30 days prior written notice.

- Either party may terminate immediately for cause as defined in the agreement.

Section 4.4 COMPENSATION

METHODOLOGY Annual rate paid monthly per Section 4.4 of original agreement.

N/A BUDGETED YES NO – IMPACT:

N/A EXCLUSIVITY NO YES – EXPLAIN:

N/A JUSTIFICATION Physician administration and oversight required by Title 22 code of the California DHHS.

N/A AGREEMENT NOTICED YES NO Methodology & Response: N/A ALTERNATIVES/IMPACT Contract with independent physician(s).

N/A Duties Provision for Staff Education


N/A COMMENTS


27

Agreement for Service Maram F. Zakko, M.D.

Form A - Zakko.doc

TO: Board Finance Committee MEETING DATE: Monday, December 3, 2012 FROM: Gerald Bracht, Chief Administrative Officer Palomar Medical Center Background: Dr. Zakko provides Gastroenterology services to his patients at Palomar Medical Center. Under certain circumstances a provision of ERCP services to unfunded patients are provided to assure timely, safe care for such patients at Palomar Health. This service shall only be provided if and as requested by Palomar Health. It is projected that no more than twenty-nine of such cases will occur in a twelve month period.

Budget Impact: Unbudgeted




28

tlhd

Rectangle


Reference

Term/Condition

Term/Condition Criteria Preamble TITLE Agreement for Service – Marem F. Zakko

Preamble AGREEMENT DATE October 15, 2012

Preamble PARTIES 1. Palomar Health

2. Maram F. Zakko, M.D. Section 1 PURPOSE Under certain circumstances a provision of ERCP services

to unfunded patients are provided to assure timely, safe care for such patients at Palomar Health. This service shall only be provided if and as requested by Palomar Health. It is projected that no more than twenty-nine of such cases will occur in a twelve month period.

Section 1 SCOPE OF SERVICES Provision of ERCP services to unfunded patients are provided to assure timely, safe care for such patients at Palomar Health. This service shall only be provided if and as requested by Palomar Health.

PROCUREMENT


Section 5 TERM The term will commence on 10-15-12 and continue for one year.

Section 5 RENEWAL The term will automatically roll-over for one year unless terminated in accordance with the terms of this agreement

Section 5.1

TERMINATION Either party may terminate this agreement without cause, expense or penalty effective 30 days after written notice is given to the other party.

Section 2 COMPENSATION

METHODOLOGY Fair Market Value

BUDGETED YES NO – IMPACT:


JUSTIFICATION ERCP services to unfunded patients are provided to assure timely, safe care for such patients at Palomar Health.

AGREEMENT NOTICED YES NO Methodology & Response:

ALTERNATIVES/IMPACT


COMMENTS


29

ADDENDUM C

30

FINANCIAL PERFORMANCE FOR OCTOBER 2012

FISCAL YEAR 2013

31

FISCAL YEAR 2013

TABLE OF CONTENTS

EXECUTIVE YEAR-TO-DATE FINANCIAL PERFORMANCE DASHBOARD ....................................................................................................................................... 3 BALANCE SHEET EXCLUDES G.O. BONDS ........................................................................................................................................................................................... 5 INCOME STATEMENT MONTH-TO DATE .................................................................................................................................................................................................... 6 YEAR-TO-DATE ...................................................................................................................................................................................................... 7 CURRENT VS. PRIOR YEAR-TO-DATE .......................................................................................................................................................................... 8 MONTHLY TREND ................................................................................................................................................................................................... 9 CASH FLOW STATEMENT ............................................................................................................................................................................................. 10 BUDGET COMPARISON GRAPHS STATISTICAL INDICATORS ....................................................................................................................................................................................... 11 PAYOR MIX ............................................................................................................................................................................................................... 28 CASE MIX INDEX ........................................................................................................................................................................................................ 29 CASH COLLECTIONS .................................................................................................................................................................................................... 32 SUPPLEMENTAL INFORMATION HEALTHWORX DASHBOARD ......................................................................................................................................................................................... 34 BALANCE SHEET INCLUDES G.O. BONDS ......................................................................................................................................................................................... 35 YEAR-TO-DATE SUPPLIES EXPENSE ................................................................................................................................................................................ 36

32

PATIENT DAYS - ACUTE

1,080

936

990

1,028

1,116

5,041

4,851

4,607

5,047

5,337

894

900

953

998

942

438

418

415

461

385

998

1,056

1,033

889

905

23

26

5

20

26

- 1,000 2,000 3,000 4,000 5,000 6,000 7,000 8,000 9,000 10,000

PY AVG

JUL

AUG

SEP

OCT

NOV

DEC

JAN

FEB

MAR

APR

MAY

JUN

ICU/CCU PROGRESSIVE/MED-SURG LAB/DEL/REC REHAB ACUTE MHU NICU

3 FISCAL YEAR 2013

EXECUTIVE YEAR-TO-DATE FINANCIAL PERFORMANCE DASHBOARD

TOTAL ER VISITS (INCLUDES EXPRESSCARE PLUS)

4,147

4,512

4,731

5,114

5,087

948

786

595

780

925

2,118

2,282

2,211

2,148

2,159

299

310

315

264

279

627

581

1,057

1,182

1,569

18

24

26

22

19

90

95

76

78

103

- 2,000 4,000 6,000 8,000 10,000 12,000

PY AVG

JUL

AUG

SEP

OCT

NOV

DEC

JAN

FEB

MAR

APR

MAY

JUN

PMC O/P PMC I/P POM O/P POM I/P PHDC EXPRESSCARE PLUS TRAUMA O/P TRAUMA I/P

PAYOR MIX

27

26

26

25

26

10

10

10

10

14

11

11

10

9

7

5

5

6

5

5

5

5

5

6

6

29

29

29

32

29

10

10

10

9

10

4

4

4

4

3

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

PY AVG

JUL

AUG

SEP

OCT

NOV

DEC

JAN

FEB

MAR

APR

MAY

JUN

MEDICARE MCAR MGD MEDI-CAL MCAL MGD SELF PAY MGD CARE CAP OTHER

EBIDA GROWTHTRAILING YTDJUN-12

EXPENSESCASH COLLECTIONS

ACTUAL BUDGET BUDGETACTUAL42.6 49.5 166.3 198.0

38.0

40.0

42.0

44.0

46.0

48.0

50.0

52.0

MTD

150.0

160.0

170.0

180.0

190.0

200.0

210.0

YTD

TOTAL SURGERIES

251

301

282

331

359

490

506

449

402

471

348

330

359

331

332

166

148

171

119

130

84

146

143

87

158

113

111

- 200 400 600 800 1,000 1,200 1,400 1,600 1,800

PY AVG

JUL

AUG

SEP

OCT

NOV

DEC

JAN

FEB

MAR

APR

MAY

JUN

PMC O/P PMC I/P POM O/P POM I/P PHDC O/P PHDC I/P 33

4 FISCAL YEAR 2013

EXECUTIVE YEAR-TO-DATE FINANCIAL PERFORMANCE DASHBOARD

Actual Budget Variance Var % Prior YTD Var % Actual Budget Variance FYE Jun12

13,812 15,796 (1,984) (12.6%) 13,458 2.6% 880,836 16,294,770 (15,413,934) 52,199,662 271 319 (48) (15.0%) 272 (0.4%) (931,801) 15,355,553 (16,287,354) 47,729,052

0.49% 7.95% (7.46%) 10.01%33,344 39,182 (5,838) (14.9%) 33,436 (0.3%) (.52%) 7.49% (8.01%) 9.15%

3.99 3.75 0.24 6.4% 3.86 3.4% 14,481 13,439 (1,042) 12,633 1.51 1.45 0.06 4.1% 1.45 4.1% 8,519 7,697 (822) 7,715

5,779 6,692 (913) (13.6%) 5,964 (3.1%) Supplies/Adj. Discharges 1,909 1,815 (94) 1,896 1,640 1,853 (213) (11.5%) 1,685 (2.7%) Productivity % 95.8% 100.0% (4.2%) 96.7%12.5% 17.5% (5.0%) (28.6%) 15.1% (17.2%) Days Cash-on-Hand 93.0 80.0 13.0 133.8

Days in Gross A/R 49.0 43.5 (5.5) 46.624,584 25,305 (721) (2.8%) 24,926 (1.4%) Collections as a % of NPR 95.28% 98.53% (3.25%) 92.57%37,330 33,802 3,528 10.4% 32,871 13.6% Cash Collections Bad Debt % 23.06% 42.47% (19.41%) 27.84%22,011 21,326 685 3.2% 19,515 12.8% Cushion Ratio 4.39 1.50 2.89 5.99

Current Month Prior Month FYE Jun12 Actual Budget Variance Var % Prior YTD Var %

737,111,241 787,504,525 (50,393,284) (6.4%) 653,319,248 12.8%

117,636,374 139,470,931 177,883,185 174,504,082 200,957,198 (26,453,116) (13.2%) 168,442,744 3.6%103,844,839 103,204,892 100,021,198 178,495,422 204,942,049 (26,446,627) (12.9%) 172,501,194 3.5%257,604,516 275,281,375 296,322,855

1,280,578,207 1,279,075,866 1,273,280,828 117,665,736 121,580,203 3,914,467 3.2% 100,710,178 (16.8%)1,679,066,418 1,686,627,777 1,701,807,047 26,367,332 28,668,933 2,301,601 8.0% 24,888,654 (5.9%)

16,145,766 18,258,448 2,112,682 11.6% 7,193,840 (124.4%)200,006,322 212,278,277 12,271,955 5.8% 165,726,768 (20.7%)

118,416,909 118,785,972 119,876,412 (21,510,900) (7,336,228) (14,174,672) (193.2%) 6,774,426 (417.5%)1,159,465,112 1,157,961,620 1,155,972,783 4,433,333 4,433,333 - 0.0% 4,347,779 2.0%

401,184,397 409,880,185 425,957,852 7,208,866 7,280,670 71,804 1.0% 964,506 (647.4%)903,133 685,661 217,472 31.7% 893,344 1.1%

(22,473,796) (9,244,348) (13,229,448) (143.1%) 11,422,875 (296.7%)

* Includes Board Designated Funds

Liabil ities: Total Expenses

Current Liabil ities Operating IncomeL-T Liabil ities Property TaxFund Balance Interest Expense

Interest IncomeNet Income

Net PPE SWBTotal Assets Supplies

Depreciation

Total Cash* Net Patient RevenueNet A/R Total Revenue

Current Assets

Income Statement

Assets:Gross Revenue

SNF Patient DaysTotal ER Visits & Admits

OP Registrations

Balance Sheet

Case Mix Index w/o deliveries SWB/Adj. DischargesTotal Surgeries

BirthsER to Admit Rate

EBIDA Margin w/Prop TaxAcute Patient Days OEBIDA Margin w/Prop Tax

Acute Average Length of Stay Expenses/Adj. Discharges

Average Daily Census OEBIDA w/Prop Tax

Statistical Indicators Ratios & Indicators

Adjusted Discharges EBIDA w/Prop Tax

34

5 FISCAL YEAR 2013

BALANCE SHEET CONSOLIDATED (EXCLUDES G.O. BONDS)

Current Prior Prior Fiscal Current Prior Prior Fiscal Month Month Year End Month Month Year End

Assets LiabilitiesCurrent Assets Current Liabilities Cash on Hand $5,899,429 $8,785,031 $6,432,548 Accounts Payable $20,470,274 $24,378,660 $41,855,366 Cash Marketable Securities 111,736,945 130,685,900 171,450,637 Accrued Payroll 12,705,147 14,237,783 14,498,569Total Cash & Cash Equivalents 117,636,374 139,470,931 177,883,185 Accrued PTO 19,523,674 19,398,309 18,681,196

Accrued Interest Payable 13,021,939 10,858,663 4,368,835Patient Accounts Receivable 292,884,135 294,808,015 262,010,549 Current Portion of Bonds 7,080,000 7,080,000 7,080,000 Allowance on Accounts (189,039,296) (191,603,123) (161,989,351) Est Third Party Settlements 4,844,869 3,486,664 1,673,242Net Accounts Receivable 103,844,839 103,204,892 100,021,198 Other Current Liabilities 34,900,004 34,495,899 24,333,951

Total Current Liabilities 112,545,907 113,935,978 112,491,159 Inventories 9,589,467 7,373,833 7,197,553 Prepaid Expenses 2,844,893 3,242,906 5,399,059 Long Term Liabilities Other 19,250,806 18,530,847 5,716,690 Other LT Liabilities 1,555,310 1,589,829 1,324,876Total Current Assets 253,166,379 271,823,409 296,217,685 Bonds & Contracts Payable 615,030,755 614,978,548 614,821,926

Total Long Term Liabilities 616,586,065 616,568,377 616,146,802Non-Current Assets Restricted Assets 83,890,215 75,595,275 83,077,521 General Fund Balance Restricted by Donor 327,767 327,336 326,320 Unrestricted 914,021,524 920,975,010 946,460,644 Board Designated 12,767,692 13,211,518 0 Restricted for Other Purpose 327,767 327,336 326,320Total Restricted Assets 96,985,674 89,134,129 83,403,841 Board Designated 12,767,692 13,211,518 0

Total Fund Balance 927,116,983 934,513,864 946,786,964 Property Plant & Equipment 1,513,114,580 1,513,220,804 443,081,964 Accumulated Depreciation (282,491,186) (277,351,109) (268,958,070) Total Liabilities / Fund Balance $1,656,248,955 $1,665,018,219 $1,675,424,925 Construction in Process 49,954,813 43,206,171 1,099,156,934Net Property Plant & Equipment 1,280,578,207 1,279,075,866 1,273,280,828

Investment in Related Companies 3,231,532 3,243,095 3,063,705 Deferred Financing Costs 13,117,173 13,187,713 13,399,333 Other Non-Current Assets 9,169,990 8,554,007 6,059,533Total Non-Current Assets 1,403,082,576 1,393,194,810 1,379,207,240

Total Assets $1,656,248,955 $1,665,018,219 $1,675,424,925

35

6 FISCAL YEAR 2013

INCOME STATEMENT: MONTH-TO-DATE CONSOLIDATED – ADJUSTED DISCHARGES

Variance $ /Adjusted DischargesActual Budget Variance Volume Rate/Eff Actual Budget Variance

Statistics: Admissions - Acute 2,204 2,806 (602) Admissions - SNF 112 104 8 Patient Days - Acute 8,711 10,585 (1,874) Patient Days - SNF 6,184 6,378 (194) ALOS - Acute 4.05 3.75 0.30 ALOS - SNF 55.21 60.17 (4.96) Adjusted Discharges 3,515 3,981 (466)

Revenue: Gross Revenue 196,330,649$ 212,537,980$ (16,207,331)$ U (24,878,849)$ 8,671,518$ 55,855.09$ 53,388.09$ 2,467.00$ Deductions from Rev (152,034,200) (158,760,232) 6,726,032 F 18,583,840 (11,857,808) (43,252.97) (39,879.49) (3,373.49) Net Patient Revenue 44,296,449 53,777,748 (9,481,299) U (6,295,009) (3,186,290) 12,602.12 13,508.60 (906.48) Other Oper Revenue 1,018,748 1,009,540 9,208 F (118,173) 127,381 289.83 253.59 36.24 T otal Net Revenue 45,315,197 54,787,288 (9,472,091) U (6,413,182) (3,058,909) 12,891.95 13,762.19 (870.24)

Expenses: Salaries, Wages & Contr Labor 24,306,844 24,173,188 (133,656) U 2,829,617 (2,963,273) 6,915.18 6,072.14 (843.04) Benefits 6,103,417 6,414,263 310,846 F 750,828 (439,982) 1,736.39 1,611.22 (125.17) Supplies 5,457,120 7,401,729 1,944,609 F 866,417 1,078,192 1,552.52 1,859.26 306.74 Prof Fees & Purch Svc 6,767,372 7,947,616 1,180,244 F 930,316 249,928 1,925.28 1,996.39 71.10 Depreciation 5,387,664 5,333,475 (54,189) U 624,315 (678,504) 1,532.76 1,339.73 (193.03) Other 3,086,747 3,121,454 34,707 F 365,385 (330,678) 878.16 784.09 (94.08) Total Expenses 51,109,164 54,391,725 3,282,561 F 6,366,879 (3,084,318) 14,540.30 13,662.83 (877.47)

Net Inc Before Non-Oper Income (5,793,967) 395,563 (6,189,530) U (46,303) (6,143,227) (1,648.35) 99.36 (1,747.72)

Property Tax Revenue 1,108,333 1,108,333 - - (129,737) 129,737 315.32 278.41 36.91 Non-Operating Income (2,711,132) (2,580,110) (131,022) U 302,017 (433,039) (771.30) (648.11) (123.20)

Net Income (Loss) (7,396,766)$ (1,076,214)$ (6,320,552)$ U 125,977$ (6,446,529)$ (2,104.34)$ (270.34)$ (1,834.01)$

Net Income Margin 1.80% 12.91% (11.11%)OEBITDA Margin w/o Prop Tax (0.90%) 10.46% (11.36%)OEBITDA Margin with Prop Tax 1.55% 12.48% (10.93%)

F= Favorable varianceU= Unfavorable variance

1= Property Tax Revenue does not include G.O. Bonds Levy2= Interest Expense does not include G.O. Bonds Interest

2

1

12212

36

7 FISCAL YEAR 2013

INCOME STATEMENT: YEAR-TO-DATE CONSOLIDATED – ADJUSTED DISCHARGES

VarianceActual Budget Variance Volume Rate/Eff Actual Budget Variance

Statistics: Admissions - Acute 8,419 10,380 (1,961) Admissions - SNF 428 414 14 Patient Days - Acute 33,344 39,182 (5,838) Patient Days - SNF 24,584 25,305 (721) ALOS - Acute 3.99 3.75 0.24 ALOS - SNF 57.98 60.11 (2.13) Adjusted Discharges 13,812 15,796 (1,984)

Revenue: Gross Revenue 737,111,241$ 787,504,525$ (50,393,284)$ U (98,911,685)$ 48,518,401$ 53,367.45$ 49,854.68$ 3,512.77$ Deductions from Rev (562,607,159) (586,547,327) 23,940,168 F 73,671,176 (49,731,008) (40,733.21) (37,132.65) (3,600.57) Net Patient Revenue 174,504,082 200,957,198 (26,453,116) U (25,240,509) (1,212,607) 12,634.24 12,722.03 (87.79) Other Oper Revenue 3,991,340 3,984,851 6,489 F (500,503) 506,992 288.98 252.27 36.71 T otal Net Revenue 178,495,422 204,942,049 (26,446,627) U (25,741,012) (705,615) 12,923.21 12,974.30 (51.09)

Expenses: Salaries, Wages & Contr Labor 93,747,028 96,695,102 2,948,074 F 12,145,042 (9,196,968) 6,787.36 6,121.49 (665.87) Benefits 23,918,708 24,885,101 966,393 F 3,125,604 (2,159,211) 1,731.73 1,575.41 (156.33) Supplies 26,367,332 28,668,933 2,301,601 F 3,600,859 (1,299,258) 1,909.02 1,814.95 (94.07) Prof Fees & Purch Svc 29,017,891 31,597,850 2,579,959 F 3,968,735 (1,388,776) 2,100.92 2,000.37 (100.55) Depreciation 16,145,766 18,258,448 2,112,682 F 2,293,287 (180,605) 1,168.97 1,155.89 (13.08) Other 10,809,597 12,172,843 1,363,246 F 1,528,926 (165,680) 782.62 770.63 (12.00) Total Expenses 200,006,322 212,278,277 12,271,955 F 26,662,453 (14,390,498) 14,480.62 13,438.74 (1,041.88)

Net Inc Before Non-Oper Income (21,510,900) (7,336,228) (14,174,672) U 921,441 (15,096,113) (1,557.41) (464.44) (1,092.97)

Property Tax Revenue 4,433,333 4,433,333 - - (556,833) 556,833 320.98 280.66 40.32 Non-Operating Income (5,396,229) (6,341,453) 945,224 F 796,495 148,729 (390.69) (401.46) 10.77

Net Income (Loss) (22,473,796)$ (9,244,348)$ (13,229,448)$ U 1,161,103$ (14,390,551)$ (1,627.12)$ (585.23)$ (1,041.89)$

EBIDA Margin 0.49% 7.95% (7.46%)OEBIDA Margin w/o Prop Tax (3.01%) 5.33% (8.34%)OEBIDA Margin with Prop Tax (0.52%) 7.49% (8.01%)



$/Adjusted Discharges

2

1

37

8 FISCAL YEAR 2013

INCOME STATEMENT: CURRENT VS. PRIOR YEAR-TO-DATE CONSOLIDATED – ADJUSTED DISCHARGES

Variance $/Adjusted Discharges

October 12 YTD October 11 YTD Variance Volume Rate/Eff Actual FY12 Actual FY11 VarianceStatistics: Admissions - Acute 8,419 8,685 (266) Admissions - SNF 428 394 34 Patient Days - Acute 33,344 33,436 (92) Patient Days - SNF 24,584 24,926 (342) ALOS - Acute 3.99 3.86 0.13 ALOS - SNF 57.98 64.08 (6.10) Adjusted Discharges 13,812 13,458 354

Revenue: Gross Revenue 737,111,241$ 653,319,248$ 83,791,993$ F 17,184,947$ 66,607,046$ 53,367.45$ 48,545.05$ 4,822.40$ Deductions from Rev (562,607,159) (484,876,504) (77,730,655) U (12,754,219) (64,976,436) (40,733.21) (36,028.87) (4,704.35) Net Patient Revenue 174,504,082 168,442,744 6,061,338 F 4,430,728 1,630,610 12,634.24 12,516.18 118.06 Other Oper Revenue 3,991,340 4,058,450 (67,110) U 106,754 (173,864) 288.98 301.56 (12.59) T otal Net Revenue 178,495,422 172,501,194 5,994,228 F 4,537,481 1,456,747 12,923.21 12,817.74 105.47

Expenses: Salaries, Wages & Contr Labor 93,747,028 78,280,390 (15,466,638) U (2,059,092) (13,407,546) 6,787.36 5,816.64 (970.72) Benefits 23,918,708 22,429,788 (1,488,920) U (589,994) (898,926) 1,731.73 1,666.65 (65.08) Supplies 26,367,332 24,888,654 (1,478,678) U (654,673) (824,005) 1,909.02 1,849.36 (59.66) Prof Fees & Purch Svc 29,017,891 23,524,540 (5,493,351) U (618,791) (4,874,560) 2,100.92 1,748.00 (352.92) Depreciation 16,145,766 7,193,840 (8,951,926) U (189,227) (8,762,699) 1,168.97 534.54 (634.43) Other 10,809,597 9,409,556 (1,400,041) U (247,509) (1,152,532) 782.62 699.18 (83.44) Total Expenses 200,006,322 165,726,768 (34,279,554) U (4,359,286) (29,920,268) 14,480.62 12,314.37 (2,166.25)

Net Inc Before Non-Oper Income (21,510,900) 6,774,426 (28,285,326) U 178,195 (28,463,521) (1,557.41) 503.38 (2,060.78)

Property Tax Revenue 4,433,333 4,347,779 85,554 F 114,364 (28,810) 320.98 323.06 (2.09) Non-Operating Income (5,396,229) 300,670 (5,696,899) U 7,909 (5,704,808) (390.69) 22.34 (413.03)

Net Income (Loss) (22,473,796)$ 11,422,875$ (33,896,671)$ U 300,468$ (34,197,139)$ (1,627.12)$ 848.78$ (2,475.90)$

EBIDA Margin 0.49% 11.35% (10.86%)OEBIDA Margin w/o Prop Tax (3.01%) 8.10% (11.11%)OEBIDA Margin with Prop Tax (0.52%) 10.62% (11.14%)



2

1

38

9 FISCAL YEAR 2013

INCOME STATEMENT: MONTHLY TREND CONSOLIDATED – ADJUSTED DISCHARGES

Jul Aug Sep Oct YTDStatistics: Admissions - Acute 2,032 2,147 2,036 2,204 8,419 Admissions - SNF 101 115 100 112 428 Patient Days - Acute 8,187 8,003 8,443 8,711 33,344 Patient Days - SNF 6,320 6,137 5,943 6,184 24,584 ALOS - Acute 3.99 3.86 4.05 4.05 3.99 ALOS - SNF 62.57 56.82 57.70 55.21 57.98 Adjusted Discharges 3,366 3,463 3,468 3,515 13,812

Revenue: Gross Revenue 179,398,229$ 178,114,379$ 183,267,986$ 196,330,649$ 737,111,241$ Deductions from Rev (135,837,825) (135,695,649) (139,039,488) (152,034,200) (562,607,159) Net Patient Revenue 43,560,404 42,418,730 44,228,498 44,296,449 174,504,082 Other Oper Revenue 1,096,528 1,025,311 850,753 1,018,748 3,991,340 T otal Net Revenue 44,656,932 43,444,041 45,079,251 45,315,197 178,495,422

Expenses: Salaries, Wages & Contr Labor 23,065,954 23,731,993 22,642,237 24,306,844 93,747,028 Benefits 6,057,240 5,941,559 5,816,492 6,103,417 23,918,708 Supplies 6,819,242 6,755,955 7,335,015 5,457,120 26,367,332 Prof Fees & Purch Svc 7,639,959 7,518,355 7,092,204 6,767,372 29,017,891 Depreciation 2,155,950 3,569,444 5,032,708 5,387,664 16,145,766 Other 2,773,415 2,558,730 2,390,706 3,086,747 10,809,597 Total Expenses 48,511,760 50,076,036 50,309,362 51,109,164 200,006,322

Net Inc Before Non-Oper Income (3,854,828) (6,631,995) (5,230,111) (5,793,967) (21,510,900)

Property Tax Revenue 1,108,333 1,108,333 1,108,333 1,108,333 4,433,333 Non-Operating Income 365,515 (283,305) (2,767,307) (2,711,132) (5,396,229)

Net Income (Loss) (2,380,980)$ (5,806,967)$ (6,889,085)$ (7,396,766)$ (22,473,796)$

EBIDA Margin 0.04% (1.96%) 1.99% 1.80% 0.49%OEBIDA Margin w/o Prop Tax (3.80%) (7.05%) (0.44%) (0.90%) (3.01%)OEBIDA Margin with Prop Tax (1.32%) (4.50%) 2.02% 1.55% (0.52%)


2

1

212

39

10 FISCAL YEAR 2013

CASH FLOW STATEMENT

October YTD

CASH FLOWS FROM OPERATING ACTIVITIES: Income (Loss) from operations (5,793,967) (21,510,900) Adjustments to reconcile change in net assets to net cash provided by operating activities: Depreciation Expense 5,387,664 16,145,766 Provision for bad debts 9,114,974 32,825,453

Changes in operating assets and liabilities: Patient accounts receivable (9,754,921) (36,649,095) Property Tax and other receivables (2,238,848) (19,847,562) Inventories (2,215,634) (2,391,914) Prepaid expenses and other current assets (110,318) (185,536) Accounts payable (3,908,909) (21,385,092) Accrued compensation (1,407,271) (950,944) Estimated settlement amounts due third-party payors 1,358,205 3,171,627 Other current liabilities 2,331,000 18,860,793 Net cash provided by operating activities (7,238,026) (31,917,403)

CASH FLOWS FROM INVESTING ACTIVITIES: Net (purchases) sales of investments 10,827,507 53,860,615 Income (Loss) on investments 23,098 903,133 Investment in affiliates (18,966) 430,722 Net cash used in investing activities 10,831,639 55,194,470

CASH FLOWS FROM NON-CAPITAL FINANCING ACTIVITIES: Receipt of G.O. Bond Taxes 269,829 667,032 Receipt of District Taxes 182,916 605,439 Net cash used in non-capital financing activities 452,745 1,272,472 CASH FLOWS FROM CAPITAL AND RELATED FINANCING ACTIVITIES: Acquisition of property plant and equipment (6,661,622) (16,213,750) Deferred Financing Costs 112,709 451,030 G.O. Bond Interest paid 0 (5,966,138) Revenue Bond Interest paid (383,047) (1,975,450) Payments of Long Term Debt 0 (1,378,350) Net cash used in activities (6,931,960) (25,082,657)

NET INCREASE (DECREASE) IN CASH AND CASH EQUIVALENTS (2,885,602) (533,118)

CASH AND CASH EQUIVALENTS - Beginning of period 8,785,031 6,432,548

CASH AND CASH EQUIVALENTS - End of period 5,899,429 5,899,42940

11 FISCAL YEAR 2013

BUDGET COMPARISON: STATISTICAL INDICATORS ADJUSTED DISCHARGES - CONSOLIDATED

PMCPOMCON

866 3,583 4,015 13,812 15,796 3,366 3,463 3,468 3,515

2,522 2,550 2,635 10,160 11,781 894 917 906

CON BUDGET

2,453

-

500

1,000

1,500

2,000

2,500

3,000

3,500

4,000

4,500

PMC POM CON PMC POM CON PMC POM CON PMC POM CON PMC POM CON PMC POM CON PMC POM CON PMC POM CON PMC POM CON PMC POM CON PMC POM CON PMC POM CON

JUL AUG SEP OCT NOV DEC JAN FEB MAR APR MAY JUN

-

2,000

4,000

6,000

8,000

10,000

12,000

14,000

16,000

18,000

PMC POM CON

YTD

41

12 FISCAL YEAR 2013

BUDGET COMPARISON: STATISTICAL INDICATORS PATIENT DAYS – ACUTE

PMCPOMCON

BUDGETCON

6,587 1,856 8,443

5,909 2,094 8,003

6,861 1,850 8,711

8,840 8,187

6,170 2,017

25,527 30,342

33,344 39,182 7,817

-

2,000

4,000

6,000

8,000

10,000

12,000



-

5,000

10,000

15,000

20,000

25,000

30,000

35,000

40,000

45,000

PMC POM CON

YTD

42

13 FISCAL YEAR 2013

BUDGET COMPARISON: STATISTICAL INDICATORS OBSERVATION DISCHARGES

126

158

130

141

146

159

218

222

204

189

122

126

143

147

145

19

18

17

16

17

23

26

34

36

25

12

13

14

9

9

4

4

4

6

5

- 100 200 300 400 500 600

PY AVG

JUL

AUG

SEP

OCT

NOV

DEC

JAN

FEB

MAR

APR

MAY

JUN

Medicare Managed Care Kaiser Medi-Cal Self Pay CMS Other

43

14 FISCAL YEAR 2013

BUDGET COMPARISON: STATISTICAL INDICATORS AVERAGE LENGTH OF STAY – ACUTE

PMCPOMCON

3.96

CON BUDGET

3.96 4.00 3.73

4.03 4.05 3.77 3.84 3.97 3.80

3.99 3.86 4.05 4.05

4.14 4.07

3.99 3.75

-

0.50

1.00

1.50

2.00

2.50

3.00

3.50

4.00

4.50



-

0.50

1.00

1.50

2.00

2.50

3.00

3.50

4.00

4.50

PMC POM CON

YTD

44

15 FISCAL YEAR 2013

BUDGET COMPARISON: STATISTICAL INDICATORS AVERAGE DAILY CENSUS – ACUTE

PMCPOMCON 264 259

CON BUDGET

199 191 220 221 208 247 65

282 281 64 72 68 62 60

271 319

-

50

100

150

200

250

300

350

400



-

50

100

150

200

250

300

350

PMC POM CON

YTD

45

16 FISCAL YEAR 2013

BUDGET COMPARISON: STATISTICAL INDICATORS SURGERIES – INPATIENT ONLY

PMCPOMCON

2,730 148 171 119 646 608 626 700

570 130

2,012 568 650

2,580 3,380

CON BUDGET

498 437 507

-

100

200

300

400

500

600

700

800

900



-

500

1,000

1,500

2,000

2,500

3,000

3,500

4,000

PMC POM CON

YTD

46

17 FISCAL YEAR 2013

BUDGET COMPARISON: STATISTICAL INDICATORS SURGERIES – OUTPATIENT ONLY

PMCPOMCON

CON BUDGET

447 425 418 517 1,807 1,862 330 332

3,159 3,275 359 331 1,352 1,413

777 784 749 849

-

100

200

300

400

500

600

700

800

900

1,000



-

500

1,000

1,500

2,000

2,500

3,000

3,500

PMC POM CON

YTD

47

18 FISCAL YEAR 2013

BUDGET COMPARISON: STATISTICAL INDICATORS SURGERIES - CVS

PMCPOMCON

8 12 8

40 37

12 - - 40 37

CON BUDGET

8 12 8 12

-

2

4

6

8

10

12

14



-

5

10

15

20

25

30

35

40

45

PMC POM CON

YTD

48

19 FISCAL YEAR 2013

BUDGET COMPARISON: STATISTICAL INDICATORS TOTAL SURGERIES

PMCPOMCON

3,859 4,629 953 874 933 1,099

5,779 6,692 450 462

1,431 1,404 1,383 1,561

CON BUDGET

1,920 478 530 2,063

-

200

400

600

800

1,000

1,200

1,400

1,600

1,800



-

1,000

2,000

3,000

4,000

5,000

6,000

7,000

8,000

PMC POM CON

YTD

49

20 FISCAL YEAR 2013

BUDGET COMPARISON: STATISTICAL INDICATORS OUTPATIENT REGISTRATIONS (EXCLUDES LAB)

PMCPOMCON

12,044 12,507

22,011 21,326 9,967 1,974 2,198 2,113 3,682

4,832 4,754 5,174 7,251 8,819

CON BUDGET

3,569 2,858 2,556 3,061

-

1,000

2,000

3,000

4,000

5,000

6,000

7,000

8,000



-

5,000

10,000

15,000

20,000

25,000

PMC POM CON

YTD

50

21 FISCAL YEAR 2013

BUDGET COMPARISON: STATISTICAL INDICATORS ER VISITS (INCLUDES TRAUMA & EXPRESSCARE PLUS) – OUTPATIENT ONLY

PMCPOMCON

C/Day

CON BUDGET

5,117 5,811 6,303 6,625 23,856 19,129 2,282 2,211

32,656 27,882 2,148 2,159 8,800 8,753

7,399 8,022 8,451 8,784

265 227 239 259 282 283

-

1,000

2,000

3,000

4,000

5,000

6,000

7,000

8,000

9,000

10,000



-

5,000

10,000

15,000

20,000

25,000

30,000

35,000

PMC POM CON

YTD

51

22 FISCAL YEAR 2013

BUDGET COMPARISON: STATISTICAL INDICATORS ER ADMISSIONS (INCLUDES TRAUMA) – INPATIENT ONLY

PMCPOMCON 4,674 5,920

264 279 1,168 1,357 1,191

CON BUDGET

881 674 873 1,078 3,506 4,563 310 315

989 1,137 1,357

-

200

400

600

800

1,000

1,200

1,400

1,600

1,800



-

1,000

2,000

3,000

4,000

5,000

6,000

7,000

PMC POM CON

YTD

52

23 FISCAL YEAR 2013

BUDGET COMPARISON: STATISTICAL INDICATORS TOTAL ER VISITS (INCLUDES TRAUMA, ADMISSIONS & EXPRESSCARE PLUS)

PMCPOMCON 9,588 10,141

CON

2,592 2,526 9,968 37,330 8,590 9,011

BUDGET

5,998 6,485 7,176 7,703 27,362 23,692 2,412 2,438 10,110

33,802

-

2,000

4,000

6,000

8,000

10,000

12,000



-

5,000

10,000

15,000

20,000

25,000

30,000

35,000

40,000

PMC POM CON

YTD

53

24 FISCAL YEAR 2013

BUDGET COMPARISON: STATISTICAL INDICATORS ER CONVERSION (ER ADMISSIONS AS %-AGE OF ER VISITS)

PMCPOMCON 17.5%

12.5% 11.7% 13.4%13.9% 11.0% 11.9% 13.4% 12.5%

BUDGET

14.7% 10.4% 12.2% 14.0% 12.8% 19.3%10.9% 11.4%

CON

12.0%

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%



0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

PMC POM CON

YTD

54

25 FISCAL YEAR 2013

BUDGET COMPARISON: STATISTICAL INDICATORS TRAUMA CASES

PMCPOMCON

CON BUDGET

119 102 100 122 443 443

119 102 100 - -

122 443 443

-

20

40

60

80

100

120

140



-

50

100

150

200

250

300

350

400

450

500

PMC POM CON

YTD

55

26 FISCAL YEAR 2013

BUDGET COMPARISON: STATISTICAL INDICATORS TRAUMA ADMISSIONS

PMCPOMCON

103

95 76 352 369 78 103 - -

CON BUDGET

95 76 78 352 369

-

20

40

60

80

100

120

140



-

50

100

150

200

250

300

350

400

PMC POM CON

YTD

56

27 FISCAL YEAR 2013

BUDGET COMPARISON: STATISTICAL INDICATORS DELIVERIES

PMCPOMCON 385 401

409 1,640 1,853

108 101 396 442 412

CON BUDGET

300 299 334 311 1,244 1,444 85 102

-

50

100

150

200

250

300

350

400

450

500



-

200

400

600

800

1,000

1,200

1,400

1,600

1,800

2,000

PMC POM CON

YTD

57

28 FISCAL YEAR 2013

PAYOR MIX

27

26

26

25

26

10

10

10

10

14

11

11

10

9

7

5

5

6

5

5

5

5

5

6

6

29

29

29

32

29

10

10

10

9

10

4

4

4

4

3

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

PY AVG

JUL

AUG

SEP

OCT

NOV

DEC

JAN

FEB

MAR

APR

MAY

JUN

MEDICARE MCAR MGD MEDI-CAL MCAL MGD SELF PAY MGD CARE CAP OTHER

58

29 FISCAL YEAR 2013

CASE MIX INDEX

PMCPOMCON 1.37 1.34

1.37 1.35 1.30 1.36 1.35

CON BUDGET

1.36 1.32 1.37 1.35 1.28

1.35 1.31 1.40 1.41 1.33 1.37

1.00

1.05

1.10

1.15

1.20

1.25

1.30

1.35

1.40

1.45



1.00

1.05

1.10

1.15

1.20

1.25

1.30

1.35

1.40

PMC POM CON

YTD

59

30 FISCAL YEAR 2013

CASE MIX INDEX (EXCLUDES DELIVERIES)

PMCPOMCON

CON BUDGET

1.54 1.43 1.52 1.49 1.54 1.49 1.51 1.45

1.45 1.55 1.59 1.49 1.55

1.50 1.51 1.46 1.55 1.47

1.00

1.10

1.20

1.30

1.40

1.50

1.60

1.70



1.00

1.10

1.20

1.30

1.40

1.50

1.60

PMC POM CON

YTD

60

31 FISCAL YEAR 2013

CASE MIX INDEX MEDICARE

PMCPOMCON 1.67 1.64

1.59 1.61 1.56 1.56 1.58

1.46 1.55

CON BUDGET

1.71 1.59 1.61 1.60 1.49

1.62 1.59 1.60 1.76

1.00

1.10

1.20

1.30

1.40

1.50

1.60

1.70

1.80



1.00

1.10

1.20

1.30

1.40

1.50

1.60

1.70

PMC POM CON

YTD

61

32 FISCAL YEAR 2013

CASH COLLECTIONS

Actual Budget

166.3 198.0


MTD 41.3 45.2 37.1 42.6 - - - - - - - -

BUDGET 49.5 49.5 49.5 49.5 49.5 49.5 49.5 49.5 49.5 49.5 49.5 49.5

PY 33.8 39.5 37.0 41.6 36.4 37.7 38.2 37.3 41.0 41.6 44.1 42.7

-

10.0

20.0

30.0

40.0

50.0

60.0

-

50.0

100.0

150.0

200.0

250.0

YTD

62

SUPPLEMENTAL INFORMATION

33 63

34 FISCAL YEAR 2013

HEALTHWORX DASHBOARD

64

35 FISCAL YEAR 2013

BALANCE SHEET CONSOLIDATED (INCLUDES G.O. BONDS)

Current Prior Prior Fiscal Current Prior Prior Fiscal Month Month Year End Month Month Year End

Assets LiabilitiesCurrent Assets Current Liabilities Cash on Hand $5,899,429 $8,785,031 $6,432,548 Accounts Payable $20,470,274 $24,378,660 $41,855,366 Cash Marketable Securities 111,736,945 130,685,900 171,450,637 Accrued Payroll 12,705,147 14,237,783 14,498,569Total Cash & Cash Equivalents 117,636,374 139,470,931 177,883,185 Accrued PTO 19,523,674 19,398,309 18,681,196

Accrued Interest Payable 16,084,964 12,900,680 9,522,438Patient Accounts Receivable 292,884,135 294,808,015 262,010,549 Current Portion of Bonds 9,887,977 9,887,977 9,311,650 Allowance on Accounts (189,039,296) (191,603,123) (161,989,351) Est Third Party Settlements 4,844,869 3,486,664 1,673,242Net Accounts Receivable 103,844,839 103,204,892 100,021,198 Other Current Liabilities 34,900,004 34,495,899 24,333,951

Total Current Liabilities 118,416,909 118,785,972 119,876,412 Inventories 9,589,467 7,373,833 7,197,553 Prepaid Expenses 2,844,893 3,242,906 5,399,059 Long Term Liabilities Other 23,688,943 21,988,813 5,821,860 Other LT Liabilities 1,555,310 1,589,829 1,324,876Total Current Assets 257,604,516 275,281,375 296,322,855 Bonds & Contracts Payable 1,157,909,802 1,156,371,791 1,154,647,907

Total Long Term Liabilities 1,159,465,112 1,157,961,620 1,155,972,783Non-Current Assets Restricted Assets 92,778,359 84,213,516 99,694,421 General Fund Balance Restricted by Donor 327,767 327,336 326,320 Unrestricted 388,088,938 396,341,331 425,631,532 Board Designated 12,767,692 13,211,518 0 Restricted for Other Purpose 327,767 327,336 326,320Total Restricted Assets 105,873,818 97,752,370 100,020,741 Board Designated 12,767,692 13,211,518 0

Total Fund Balance 401,184,397 409,880,185 425,957,852 Property Plant & Equipment 1,513,114,580 1,513,220,804 443,081,964 Accumulated Depreciation (282,491,186) (277,351,109) (268,958,070) Total Liabilities / Fund Balance $1,679,066,418 $1,686,627,777 $1,701,807,047 Construction in Process 49,954,813 43,206,171 1,099,156,934Net Property Plant & Equipment 1,280,578,207 1,279,075,866 1,273,280,828

Investment in Related Companies 3,231,532 3,243,095 3,063,705 Deferred Financing Costs 22,608,355 22,721,064 23,059,385 Other Non-Current Assets 9,169,990 8,554,007 6,059,533Total Non-Current Assets 1,421,461,902 1,411,346,402 1,405,484,192

Total Assets $1,679,066,418 $1,686,627,777 $1,701,807,047

65

36 FISCAL YEAR 2013

SUPPLIES EXPENSE: YEAR-TO-DATE

Account Description Actual Budget Variance631000 Prosthesis 6,151,695 7,036,992 885,297 641000 Supplies Other Medical 4,675,409 5,467,953 792,544 634000 Supplies Surgery General 2,272,909 2,946,918 674,009 643000 Supplies Food Other 1,038,915 1,205,044 166,129 636000 Supplies Oxygen/Gas 41,801 176,437 134,636 632000 Sutures/Surgical Needles 775,088 848,130 73,042 639000 Supplies Radioactive 170,030 237,663 67,633 649000 Other Minor Equipment 646,558 698,999 52,441 638000 Supplies Pharmaceutical 4,052,926 4,100,285 47,359 642000 Supplies Food/Meat 206,510 247,022 40,512 633000 Supplies Surgical Pack 844,024 874,229 30,205 646100 Supplies Forms 116,527 127,766 11,239 644000 Supplies Linen 11,160 10,460 (700) 635000 Supplies Anesthesia Material 17,686 16,422 (1,264) 640000 Supplies X-ray Material 8,801 6,753 (2,048) 645000 Supplies Cleaning 181,018 178,680 (2,338) 637000 Supplies IV Solutions 218,892 213,218 (5,674) 647000 Supplies Employee Apparel 125,784 112,997 (12,787) 697000 Other Transfer Supplies (37,265) (50,198) (12,933) 646000 Supplies Office/Administration 485,422 412,312 (73,110) 650000 Other Non Medical 3,738,572 3,489,294 (249,278) 648000 Instruments/Minor Equipment 624,870 311,557 (313,313)

Total Supplies 26,367,332 28,668,933 2,301,601 66

board finance committee meeting - palomar health...2012/12/03 · • maram f. zakko, md agreement...

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