board mdeetins may 25, 2016bloximages.newyork1.vip.townnews.com/trinity...f'vit& a^,ci^, ^p...
TRANSCRIPT
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Board MDeetins
May 25, 20166:00 p.m.
Trinity County Library
Weaverville CA
Meetings convene at 6 p.m. on the last Wednesday of the month. Citizens wishing to schedule matters for Board consideration
or to appear before the Board must contact the Clerk of the Board m writing stating the action requested. Appropriate
requests will be scheduled before the Board as time allows. Deadline for submission of written materials is seven days iu
advance of the meeting.
Public Presentations; The law provides the opportunity for the public to be heard on any item within the subject matter
jurisdiction of the Board, before or during the consideration of that item by the Board. For all items, includmg items not on
the agenda, fhe public presentation time is appropriate. The President may set time limits as appropriate to manage the
Agenda. State law does not allow action to be taken on any item not on the Agenda.
The agenda shall be made available upon request ia alternative formats to persons wife a disability, as required by the
Americans with Disabilities Act of 1990 (U.S.C.§ 12132) the Ralph M. Brown Act (California Government Code § 54954.2).
Persons requesting a disability related modification or accommodation in order to participate in the meeting should contact
the Board Clerk at (530) 623-5541 Ext. 3255 during regular business hours, at least twenty four hours prior to the time offhe
meetmg.
Pursuant to the Brown Act as codified m Government Code Section 54957.5, any documents pertaining to a non-closed
agenda item distributed to a majority of the Board of Directors in less than 72 hours before a Board meeting shall be available
for public iaspection. Said documents shall be available for inspection at the Mountain Communities Healthcare District
Administrative Office located at 60 Easter Avenue, Weavenalle, California, Monday through Friday, except HoUdays,
between the hours of 9:00 a.m. and 12:00 p.m.
The Board may take action on any offhe items listed on this agenda regardless of whether the matter is described as action
item, a report, a communication, public input, or discussion item.
Call to order
Report from Closed Session on April 27. 2016 and May 10,2016
Public ItlpUt (3) Minute Time Limit)
2015 Audit Presentation
Reports
a. Medical Staff Report - Daoiel Harwood, MD/Donald Krouse, MD
b. Chief Executive Officer - Aaron Rogers, CEO
c. Financial Report - Jon Marshall, CFO and Jennifer Van Matre, Director of Finance
d. Chief Nursing Officer - Peggy Manning, RN, Chief Nursing Officer
e. Quality Improvement - Sarah Cordtz, RN, Coordinator
Mountain Comm.unities Healthcare District - Regular Bqa^d Meeting
April 27, 2016
Consent Agenda
All matters listed under the Consent Agenda, are considered by the Board to be routine, and will be
enacted by one motion in the form listed below. There will be no separate discussion of these items
unless a request for discussion is made prior to the time the Board votes on the motion to approve.
All policies have been approved by the Manager/Director, Midlevel/Interdisciplmary Practice
Committee, Medical Staff/Medical Director, and Chief Executive Officer per policy. The intent is
that the MCHD Board of Director's role is to assure the policy approval process for each policy.
a. Policies and Procedures - See Attached
b. Minutes from April 17, 2016
c. Minutes from May 10,2016
Discussion Items
a. Clinic
Actionltems
a. Items removed from the Consent Agenda
b. Approve Authorization to Bind for the Small Rural Hospital Improvement Program
c. Consulting Contract - Lew Edwards Group
BoardReports
a. Board Member Reports
Close Public Session
Closed Session
» MEDICAL STAFF PRWILEGES
Government Code Section 54962; Health and Safety Code
Section 1461
o Mary Baraccho, CNM
o Brett Williams, FNP
o Rodney Grover, DO
o Steven Lengle, MD
o Waikeong Wong, MD
a QUALITY MPROVEMENT/RISK MANAGEMENTGovernment Code Section 54962: Health and Safety Code
Section 32155
• PUBLIC EMPLOYEE PERFORMANCE EVALUATION
Government Code Section 54957 - Public Employee
Title: Chief Executive Officer
Adioum Closed Session and Reconvene in Public Session
Report of any actions taken during Closed Session
Adjourn
Posted: May 20, 2016 1600 By: Rebecca Huber
Audited Financial Statements
MOUNTAIN COMMUNITIES
HEALTHCARE DISTRICT
December 31,2015 and 2014
JWT & Associates, LLPAdvisory Assurance Tax
MOUNTAIN COMMUNTIES HEALTHCARE DISTRICT
Table of Contents
Report of Independent Auditors.................................................................................................................................!
Management's Discussion and Analysis....................................................................................................................3
Audited Fiaancial Statements:
Statements of Net Position.....................................................................................................................................5
Statement of Revenues, Expenses and Changes in Net Position............................................................................6
Statement of Cash Flows.......................................................................................................................................7
Notes to Financial Statements ............................................................................................................;...................9
Advisory Assurance Tax1111 E. Hemdon Avenue, Suite 211, Fresno, CA 93720
Voice: (559) 431-7708 Fax: (559) 431-7685
Report of Independent Auditors
To the Board of Directors
Mountain Communities Healthcare District
Weaverville, California
Report on the Financial Statements
We have audited the accompanying financial statements of Mountain Communities Healthcare District (the Disb-ict)
as of December 31,2015 and 2014 which comprise the statement of net position as of December 31,2015 and 2014
and the related statements of revenue, expenses and changes in net position and cash flow for the years then ended,
and the related notes to the financial statements.
Management's Responsibility for the Financial Statements
Management is responsible for the preparation and fair presentation of these financial statements in accordance with
the accounting principles generally accepted in the United States of America; this includes the design,
implementation and maintenance of internal control relevant to the preparation and fair presentation of consolidated
financial statements that are free from material misstatement, whether due to fraud or error.
Auditor's Responsibility
Our responsibility is to express an opinion on these financial statements based on our audits. We conducted our
audits in accordance with auditing standards generally accepted in the United States of America and the standards
applicable to financial audits contained in Government Auditing Standards, issued by the Comptroller General of
the United States. Those standards require that we plan and perform the audit to obtain reasonable assurance about
whether the financial statements are free of material misstatement.
An audit involves performing procedures to obtain audit evidence about the amounts and disclosures in the financial
statements. The procedures selected depend on the auditor's judgment, including the assessment of the risks of
material misstatement of the financial statements, whether due to fraud or error. In making those risk assessments,
the auditor considers internal control relevant to the entity's preparation and fair presentation of the financial
statements in order to design audit procedures that are appropriate in the circumstances, but not for the purpose of
expressing an opinion on the effectiveness of the entity's internal control. Accordingly, we express no such opinion.
An audit also includes evaluating the appropriateness of accounting policies used and the reasonableness of
significant accounting estimates made by management, as well as evaluating the overall presentation of the financial
statements.
We believe that the audit evidence we have obtained is sufficient and appropriate to provide a basis for our audit
opinion.
Opinion
In our opinion, the 2015 and 2014 financial statements referred to above present fairly, in all material respects, the
financial position of Mountain Communities Healthcare District at December 31,2015 and 2014, and the results of
its operations and its cash flows for the years then ended, in conformity with accounting principles generally
accepted in the United States of America.
Other Matters
Management's discussion and analysis is not a required part of the financial statements but is supplementary
mfonnation required by accounting principles generally accepted in the United States of America. We have applied
limited procedures, which consisted principally of inquiries of management regarding the methods of measurement
and presentation of the supplementary information. However, we did not audit the information and express no
opinion on it.
f'viT& a^,ci^, ^pMay 25,2016
MOUNTAIN COMMUNTIES HEALTHCARE DISTRICT
Management's Discussion and Analysis
Year Ended December 31, 2015
This discussion and analysis has been prepared by the management of Mountain Communities Healthcare District
(the District) in order to provide an overview of the District's financial and operating performance for the years
ended December 31, 2015 and 2014. This is in accordance with the Governmental Accounting Standards Board
Statement No, 34, Basic Financial Statements; Management's Discussion and Analysis for State and Local
Governments.
This discussion and analysis, read in conjimction with the District's audited financial statements for the years ended
December 31, 2015 and 2014, along with the accompanymg notes to the financial statements, is intended to help
the reader better understand the District's financial performance and position. It should be noted that the audited
financial statements prepared by JWT & Associates, LLP, Certified Public Accountants included an unmodified
opinion dated February 16, 2015. The District owns and operates Trinity Hospital (the Hospital) in Weaverville,
California. In addition to the Hospital's acute and skilled nursmg facility operation, there are community health
clinics in Weaverville and Hayfork, California.
The District increased its net position by $1,320,861 during the year ended December 31, 2015, compared to a
reduction of ($27,864) during the prior year. As a result, net position as of December 31, 2015 are $4,758,172.
The District's operating income during the year was $3,010,815, compared to the prior year operating loss of
($956,551). Total operating revenues grew by 36% from $13.1 millionm 2014 to $17.9 million m 2015. This $4.8
million growth in revenue is made up ofa$900k increase in patient revenues, along with $4,8 million of incoming
IGT funds (outgoing funds are recorded as a reduction in net position), and a decrease in Other Operating Revenue
of $900k due to a decline in meaningful use revenue. Total operating expenses grew with patient volumes as well
as inflation, from $14.1 million m 2014 to $14.9 million in-2015. Non-operating gains and losses this year uiclude
($2.6) million of outgoing IGT funds, plus incoming District Tax Revenue of$850k. Grant Revenue of$35k, the
receipt of a loan refinance rebate of $ 127k, and Interest Expense which is down to ($76k).
The net position of the District as of December 31,2015 are made up of $8.50 million in assets, including $290k in
Cash, $1.19 million in Patient Accounts Receivables, $645k in Other Accounts Receivables, and $4.33 milUon in
capital assets net of depreciation. The assets are offset by liabilities including $1.15 million in short and long term
debt, $687k in Accoimts Payable, $445k in Medicare cost report settlement liabilities, $65 5k in Accrued Payroll
Liabilities, and $929k in Deferred Inflows of Resources.
The District once again showed significantly improved results in 2015 compared to 2014, and the focus is in
business development, as a new clinic building has been acquired and is the basis of expansion plans. Hospital
senior leadership has been stable since changes in the CEO and CFO roles over the last two years. Focus areas
include the following:
® Continue to improve Swing bed utilization
o Identify and provide billable preventative healthcare services as a new source of revenue
• Recruit providers into Clinic and Hospital roles in order to increase capacity
MOUNTAIN COMMUNTmS HEALTHCARE DISTRICT
Management's Discussion and Analysis (continued)
Year Ended December 31, 2015
• Operate and demonstrate success ia the Skilled Nursing Facility
• Continue to effectively manage and collect the Patient and Other Accounts Receivable
» Continue to work towards paying off all debt
• Identify and participate m non-patient funding sources such as the AB-113 inter-govemmental transfer
program, grant funding for new and existing programs, and more
• Closely manage all expenses, including payroll, in order to drive efficiency in cost.
Mountain Communities Healthcare District, Trinity Hospital, Trmity Clinic, and Hayfork Clinic all remain
committed and available to meet the community healthcare needs.
Mountain Communities Healthcare District
Statements of Net Position
December 31, 2015 and 2014
2015 2014
Assets
Current Assets
Cash and cash equivalents
Patient accounts receivable, net ofallownaces
Other receivables and physician advances
Due from third-party payers
Supplies
Prepaid expenses and deposits
Total current assets
Assets whose use is limited, less current portion
Capital assets, net of accumulated depreciation
Total assets
Liabilities and Net Position
Current liabilities
Line of credit
Current portion of long-term debt
Accounts payable and accrued expenses
Accrued payroll and related liabilities
Thtrd-party payor settlements
Total current liabilities
Long-term debt, less current portion
Total liabilities
Deferred inflows of resources
Net position
Invested in capital assets, net of related debt
Unrestricted
Total net position
Total liabilities and net position
$ 1,905,399
1,192,243
645,419
149,106
252,264
4,144,431
24,818
4,334,564
$ 8,503,813_
$
^
426,795
1,387,429
829,287
219,209
151,434
186,522
3,200,676
35,072
5,030,616
8,266,364
224,606
687,371
655,861
445,323
$ 301,150
689,430
1,704,836
580,094
_$_
2,013,161
929,643
2,942,804
802,837
3,745,641
3,180,315
1,577,857
4,758,172
8,503,813 $_
3,275,510
724,135
3,999,645
829,408
4,829,053
3,617,051
(179,740)
3,437,311
8,266,364
See accompanying notes to the financial statements
Mountain Communities Healthcare District
Statements of Revenues, Expenses and Changes m Net position
For The Years Ended December 31, 2015 and 2014
2015 2014
Operating revenues
Net patient service revenue
Capitation revenue
Other operating revenue
Total operating revenues
Operating expenses
Salaries & wages
Employee benefits
Professional Fees
Purchased services
Supplies
Repairs & maintenance
Utilities
Rentals and leases
Depreciation & amortization
Insurance
Other operating expenses
Total operating expenses
Operating loss
Nonoperating revenues (expenses)
District tax revenues
Grants and donations
Other non-operating revenue
Interest expense
Total nonoperatmg revenues (expenses)
Excess of revenues (expenses)
Inter-governmental transfers
Increase (decrease) in net position
Net position, beginning of the year
Net position, end of year
$ 17,317,429
502,550
144,501
17,964,480
6,490,225
1,679,500
2,529,794
635,513
1,455,833
207,453
242,307
102,521
1,116,112
128,359
366,048
14,953,665
3,010,815
850,905
34,904
127,503
(76,436)936,876
3,947,691
(2,626,830)
1,320,861
3,437,311
$ 4,758,172
$ 11,684,463
467,744
1,018,777
13,170,984
> 6,278,007
1,481,037
2,128,896
887,836
1,330,921
142,891
322,416
75,274
1,170,846
139,548
169,863
14,127,535
(956,551)
862,367
158,395
(92,075)
928,687
(27,864)
(27,864)
3,465,175
$ 3,437,311
See accompanying notes to the financial statements
Mountain Communities Healthcare District
Statements of Cash Flows
For The Years Ended December 31, 2015 and 2014
2015 2014
Cash flows from operating activities
Cash received from patients and third-party payers $ 18,679,697 $ 12,030,058
Cash received from other 328,890 452,854
Cash payments to suppliers and contractors (6,748,707) (4,568,044)
Cash payments to employees and benefit programs (8,093,958) _(7,679,102)
Net cash provided by operating activities 4,165,922 235,766
Cash flows from non-capital and related fisancing
activities
District tax revenue
Grant re venue
IGT transactions
Other non-operating revenue
Net cash provided by (used in) non-capital and related financing
activities (1,613,518) 1,020,762
Cash flows from capital and related financing activities
Purchase of property, plant & equipment (447,152) (249,736)
Proceeds from lon-tem debt borrowings 1,209,500
Payments of long-term debt (1,769,966) (763,490)
Interest paid on capital debt _(76,436) _(92,075)
Net cash used-in capital and related financing activities (1,084,054) (1,105,301)
Cash flows from investing activities
Net change in assets limited as to use 10,254 53,251
Net cash provided by (used in) investing activities
Increase (decrease) in cash and cash equivalents
Cash and cash equivalents at beginning of year
Cash and cash equivalents at end of year
See accompanying notes to the financial statements
850,905
34,904
(2,626,830)
127,503
862,367
158,395
10,254
1,478,604
426,795
_$_ 1,905,399 A.
53,251
204,478
222,317
426,795
Mountain Communities Healthcare District
Statements of Cash Flows (continued)
For The Years Ended December 31,2015 and 2014
2015 2014
Reconciliation of operating income (loss) to net cash
provided by operating activities
Operating iacome (loss)
Adjustments to reconcile operating income to net cash
provided by operating activities
Depreciation
Loss on disposal of property, plant and equipment
Changes in operating assets and liabilities
Patient accounts receivable
Other receivables
Supplies
Prepaid expenses
Accounts payable and accmed expenses
Accmed payroll and related expenses
Third-party payor settlements
Deferred revenue
Net cash provided by operating activities
$ 3,010,815 $ (956,551)
1,116,112
27,092
195,186
183,868
2,328
(65,742)
(1,017,465)
75,767
664,532
(26,571)
$ 4,165,922 -1-
1,170,846
374,260
(87,480)
8,053
28,811
592,737
79,942
(496,409)
(478,443)
235,766
See accompanying notes to the financial statements
MOUNTAIN COMMUNTIES HEALTHCARE DISTRICT
Notes to Financial Statements
December 31, 2015 and 2014
Note 1 - Organization
Reporting Entity - Mountain Communities Healthcare District (the District) is apublic entity organized under Local
Hospital District Law as set forth in the Health and Safety Code of the State of California. The District is a political
subdivision of the State of California and is generally not subject to federal or state income taxes. The District is
governed by a Board of Directors, elected from within the healthcare district to specified terms of office. The District
was approved by the voters residing within the District in November 2006 and began operations in January 2007.
The District owns and operates a hospital, Trinity Hospital (the Hospital), located in Weaverville, California. The
Hospital was donated to the District by Trinity County, the former owner and operator of the Hospital, in June 2007.
The District lias been responsible for the ownership and operation of the Hospital since that time. The Hospital is a
51 bed facility which provides acute care, skilled nursing care, 24-hour emergency care, surgery and other inpatient
and outpatient healthcare services. The District also operates two rural health clinics and a dental clinic.
Basis of Financial Statements Preparation - The accounting policies and financial statements of the Distinct
generally conform with the recommendations of the audit and accounting guide, Health Care Organizations,
published by the American Institute of Certified Public Accountants. The financial statements are presented inaccordance witih the pronouncements of the Governmental Accounting Standards Board (GASB). For purposes of
presentation, transactions deemed by management to be ongoing, major or central to the provision of health care
services are reported as operational revenues and expenses.
Based on GASB Statement Number 20, Accounting and Financial Reporting for Proprietary Funds and Other
Governmental Entities That Use Proprietaiy Fund Accounting, as amended, the District has elected to apply the
provisions of all relevant pronouncements of the Financial Accounting Standards Board (FASB), including those
issued after November 30,1989, that do not conflict with or contradict GASB pronouncements.
The District has also adopted the provisions of GASB 34, Basic Financial Statements - and Management's
Discussion and Analysis - for State and Local Governments (Statement 34), as amended by GASB 37, Basic
Financial Statements - and Management's Discussion and Analysis -for State and Local Governments: Omnibus,
and Statement 38, Certain Financial Statement Note Disclosures. Statement 34 established financial reporting
standards for all state and local governments and related entities. Statement 34 primarily relates to presentation and
disclosure requirements. The impact of this change was related to the format of the financial statements; the
iuclusion of management's discussion and analysis; and the preparation of the statement of cash flows on the direct
method. The application of these accountmg standards had no impact on the total net assets.
MOUNTAIN COMMUNTffiS HEALTHCARE DISTRICT
Notes to Financial Statements
December 31, 2015 and 2014
Note 2 - Summary of Significant Accounting Policies
The District has incorporated the following recent GASB issued statements within this financial statement
presentation: GASB 61 - The Financial Reporting Entity: Omnibus which helps better define financial presentation
and component units; GASB 62 - Codification of Accounting and Financial Reporting Guidance Contained in Pre-
November 30, 1989 FASB and AICPA Pronouncements which supercedes GASB 20; and GASB 65 - Items
Previously Reported as Assets and Liabilities relates to certain assets that are to be combined with deferred outflows
of resources and certam liabilities that are to be combined with deferred outflows of resources. For purposes of
financial statement presentation, deferred outflows are shown with the assets of the District on the balance sheet
and deferred inflows are shown with the liabilities of the District on the balarifce sheet. The adoption of these
pronouncements had no material effect to the District's financial statements.
Use of Estimates - The preparation of financial statements m conformity with accounting principles generally
accepted in the United States of America requires management to make estimates and assumptions that affect the
reported amounts of assets and liabilities and disclosure of contingent assets and liabilities at the date of the financial
statements and the reported amount of revenues and expenses during the reporting period. Actual results could
differ from those estimates.
Cash and Cash Equivalents and Investments - The District considers all highly liquid mvestments with an original
maturity of three months or less when purchased to be cash equivalents. Short-term investments consist solely of
certificates of deposit with original maturities greater than three months when purchased.
Assets Limited as to Use - Assets limited as to use include assets held by the District in trust accounts for current
patients and assets segregated and restricted by debt agreement.
Patient Accounts Receivable - Receivables from government agencies represent the only concentrated group of
credit risk for the District, Management does not beUeve that there is any significant credit risk associated with
these governmental agencies. Contracted and other receivables consist of receivables from various payors, includmg
mdividuals involved in diverse activities, subject to differing economic conditions and do not represent concentrated
credit risks to the District. Furthermore, management continually monitors and adjusts reserves and allowances
associated with these receivables to assure they are appropriately stated.
Supplies - Supplies are stated at cost, determined by the first-m, first-out method, which is not in excess of market.
Capital Assets - Property, plant, and equipment are recorded at cost at the date of acquisition or fair market value
at the date of donation, Expenditures, which increase values, change capacities, or extend useful Uves are
capitalized. The costs of normal mamtenance, repairs and minor replacements are charged to expense when
incurred. Depreciation of property and equipment and amortization of property under capital leases are computed
by the sti-aight-lme mefhod for both financial reporting and cost reimbursement purposes over the estimated useful
lives of the assets, which range from 5 to 50 years for buildings and improvements, and 3 to 20 years for equipment.
The District periodically reviews its capital assets for value impaument. As of December 31,2015, the District has
determmed that no capital assets are impaired.
10
MOUNTAIN COMMUNTIES HEALTHCARE DISTRICT
Notes to Financial Statements
December 31, 2015 and 2014
Note 2 - Summary of Significant Accounting Policies (continued)
Charity Care and Unsponsored Community Benefit - The District provides needed medical care to the community
regardless of ability to pay. The evaluation of the necessity for medical treatment of any patient is based upon
clinical judgment, irrespective ofthe financial status of the patient. Because the District does not pursue collection
of amounts determined to qualify as charity care, they are not included in net patient service revenue.
The District strives to assist patients, if qualified, to receive financial assistance for their care through available
government programs such as Medi-CaI and the County indigent services program. These programs typically
reimburse the District at substantial discounts from established rates, often below the actual cost of providing
services.
The District also provides a number of benefits and services to the community for which it receives no
reimbursement or where only a nominal fee is charged. These services mclude community medical and welhiess
education programs, medical screenmgs, support groups and other services.
Compensated Absences - The District's employees earn vacation benefits at varying rates depending on years of
service. Employees also earn sick leave benefits based on varying rates depending on years of service. Both benefits
can accumulate up to specified maximum levels. Employees are not paid for accumulated sick leave benefits if they
leave either upon termination or before retirement. However, accumulated vacation benefits are paid to an employee
upon either termination or retirement. Accrued vacation liability as of December 31, 2015 and 2014 is
approxunately $300,000 and $268,000 respectively.
Net Position - Net position is presented in three categories. The first category is net position "invested in capital
assets, net of related debt." This category of net position consists of capital assets (both restricted and unrestricted),
net of accumulated depreciation and reduced by the outstanding principal balances of any debt borrowings that were
attributable to the acquisition, construction, or improvement of those capital assets.
The second category is "restricted" net position. This category consists of externally designated constraints placed
on this net position by creditors (such as through debt covenants), grantors, contributors, law or regulations of other
governments or government agencies, or law or constitutional provisions or enabling legislation. The District has
no restricted net position at December 31,2015.
The third category is "unrestricted" net position. This category consists of net position that do not meet the definition
or criteria of the previous two categories.
Net Patient Service Revenues - Net patient service revenue is reported at estimated net realizable amounts from
patients, third-party payers and others for services rendered, including estimated retroactive adjustments under
reimbursement agreements with federal and state government programs and other third-party payors. In some cases,
reimbursement is based on formulas, which cannot be determined until after cost reports are filed and audited or
otherwise settled by the various programs. Estimation differences between final settlements and amounts accrued
in previous years are reflected in net patient service revenue.
11
MOUNTAIN COMMUNTIES HEALTHCARE DISTRICT
Notes to Financial Statements
December 31, 2015 and 2014
Note 2 - Summary of Significant Accounting Policies (continued)
Risk Management - The District is exposed to various risks of loss from torts; theft of, damage to, and destruction
of assets; business interruption; errors and omissions; employee mjuries and illnesses; natural disasters; and medical
malpractice. Commercial insurance coverage is purchased for claims arising from such matters.
Grants and Contributions - From tune to time, the District receives grants from various governmental agencies
and private organizations. The District also receives contributions from related auxiliary organizations, as well as
from individuals and other private organizations. Revenues from grants and contributions are recognized when aU
eligibility requirements, mcluding time requirements are met. Grants and contributions may be restricted for either
specific operating purposes or capital acquisitions. These amounts, when recognized upon meeting all requirements,
are reported as components of the statement of revenues, expenses and changes in net assets.
Operating Revenues and Expense - The District's statement of revenues, expenses and changes in net assets
distinguishes between operating and non-operating revenues and expenses. Operating revenues result &om
exchange transactions associated with providing healthcare services, which is the District's principal activity.
Operating expenses are all expenses incurred to provide healthcare services, other than financing costs. Non-
operating revenues and expenses are those transactions not considered du-ectly linked to providing healthcare
services.
Meaningful use incentives - The Hospital recognizes revenue related to meaningful use incentives foUowmg the
grant accounting model, recognizing income ratably over the applicable reporting period as management becomes
reasonably assured of meeting the required criteria.
Management's Discussion and Analysis - Statement 34 requires that financial statements be accompanied by a
narrative mtroduction and analytical overview of the District's financial activities in the form of "management's
discussion and analysis." This analysis is similar to the analysis provided in the annual reports of organizations in
the private sector.
Subsequent events - Subsequent events are events or transactions that occur after the balance sheet date but before
financial statements are available to be issued. The Hospital recognizes in the financial statements the effects of all
subsequent events that provide additional evidence about conditions that existed at the date of the balance sheet,
mcluding the estimates inherent m the process of preparing the financial statements. The Hospital's financial
statements do not recognize subsequent events that provide evidence about conditions that did not exist at the date
of the balance sheet but arose after the balance sheet date and before financial statements were available to be
issued. The Hospital has evaluated subsequent events through the date of the Independent Auditor's Report, which
is the date the financial statements were available to be issued.
Reclassiflcations - Certain financial statement amounts as presented in the prior year financial statements have been
reclassified in these, the current year financial statements, m order to conform to the current year financial statement
presentation.
12
MOUNTAIN COMMUNTIES HEALTHCARE DISTRICT
Notes to Financial Statements
December 31, 2015 and 2014
Note 3 ~ Cash and Cash Equivalents
As of December 31, 2015 and 2014, the District had deposits in various fmancial institutions in the form of cash
and cash equivalents amounting to $1,928,691 and $460,542. All of these funds were held in deposits, which are
collateralized in accordance with the California Government Code (CGC), except for $250,000 per account that is
federally insured.
Under the provisions of the CGC, California banks and savings arid loan associations are required to secure the
District's deposits by pledging government securities as collateral. The market value of pledged securities must
equal at least 110% of the District's deposits. California law also allows financial instihitions to secure Hospital
deposits by pledging first trust deed mortgage notes having a value of 150% of the District's total deposits. The
pledged securities are held by the pledging financial mstitution's tmst department m the name of the District.
Note 4 ~ Concentration of Credit Risk
The District grants credit without collateral to its patients and third-party payers. Patient accounts receivable from
government agencies rqpresent the only concentrated group of credit risk for the District and management does not
believe that there is any credit risk associated with these governmental agencies. Contracted and other patient
accounts receivable consist of various payors including individuals involved in diverse activities, subject to differing
economic conditions and do not represent any concentrated credit risks to the District.
Concentration of patient accounts receivable at December 31, 2015 and 2014 is as follows:
Medicare
Medi-Cal
Commercial insurance and other third-party payers
Private pay
Gross patient accounts receivable
2015
$ 1,017,185
849,581
649,010
739.298
3,255,074
$2014
1,488,370
1,282,212
590,411
619.396
3,980,389
Less allowances for contractual adjustments and bad debts ('2,062,831.') f2,592.96D
Net patient accounts receivable $ 1.192.243 $ 1.387.428
13
MOUNTAIN COMMUNTIES HEALTHCARE DISTRICT
Notes to Financial Statements
December 31, 2015 and 2014
Note 5 - Net Patient Service Revenues
The District has agreements with third-party payers that provide for payments to the District at amounts different
from its established rates. A summary of the payment arrangements with major third-party payers follows:
Medicare - Payments for iapatient and outpatient services to Medicare patients are based on prior years' cost
reports. The District is paid an interim rate per day based on these costs. The District submits an annual cost
report with final setdement determined by the Medicare fiscal intermediary. At December 31, 2015, cost reports
through 2013 have been audited or otherwise final settled.
Medi-Cal: Payments for inpatient services rendered to Medi-Cal and County Medical Services Program (CMSP)
patients are made based on reasonable costs wtiile outpatient payments are based on pre-determined fee
schedules. The District is paid for cost-based inpatient services at an interim rate with final settlement determmed
after submission of annual cost reports and audits thereof by the State of California. At December 31,2015, cost
reports through 2013, have been audited or otherwise final settled.
Other: Payments for services rendered to other than Medicare, Medi-Cal and CMSP patients are based on
established rates or on agreements with certain commercial insurance companies, health maintenance
organizations and preferred provider organizations which provide for various discounts from established rates.
Medicare andMedi-Cal revenue accoimts for approximately 80%, for the year ended December 31,2015, and 81%,
for the year ended December 31,2014, of the District's gross patient revenues. Laws and regulations governing the
Medicare and Medi-Cal programs are extremely complex and subject to interpretation. As a result, there is at least
a reasonable possibility that recorded estimates will change as additional information is received.
California Hospital Fee Program - In November 2009, the California Hospital Fee Program (the Program) was
initiated and signed into California state law. The Program provides supplemental Medi-Cal payments to certain
California hospitals. The Program is funded by a quality assurance fee paid in the form of an Inter-Govemmental
Transfer (the Fee) paid by participating hospitals and by matching federal fluids. Hospitals receive supplemental
payments from either DHS, managed care plans or a combination of both. The Program is administered the
California Hospital Association (CBA) and the California State Department of Health Care Services (DHS) and
requires final approval by the Federal Government's Center for Medicare and Medicaid Services (CMS). The
District has participated in this program since its incept. Program fee revenue for the year ended December 31,
2015 was $4,822,661, and corresponding Inter-Govemmental Transfer required to participate in the Program was
$2,626,830, resulting ia a net gain of $2,195,831. There was no fee revenue or corresponding Inter-Govemmental
Transfer for the year ended December 31, 2014, as the Program for that year had not yet been final approved by
CMS.
14
MOUNTAIN COMMUNTIES HEALTHCARE DISTRICT
Notes to Financial Statements
December 31, 2015 and 2014
Note 6 - Investments
The District's investment balances and average maturities were as follows at December 31,2015 and 2014:
2015 ,
Investment Maturities in Years
FairValue Less than 1 1 to 5 Over 5
Money market and other interest
bearing accounts $ 1,647,879 $ 1,647,879 $ -0- $_-_0^
Total investments $ 1.647.879 $ 1 -.647.879 S _-0= $_-0=.
2014
Investment Maturities in Years
FairValue Lessthmil U:o_5 Over 5
Money market and other interest
bearing accounts $ 40,363 $ 40.363 ^_-0^ $_-_Q^
Total investments $ 40,363 $ 40.363 S_=0= $_-Q^
The District's investments are reported at fair value as previously discussed. The District's investment policy allows
for various forms of investments generally set to mature within a few months to others over 15 years. The policy
identifies certain provisions which address interest rate risk, credit risk and concentration of credit risk.
Interest Rate Risk - Interest rate risk is the risk that changes in market interest rates will adversely affect the fair
value of an investment. Generally, the longer the maturity of an investment the greater the sensitivity of its fair
value to changes in market interest rates. The District's exposure to interest rate risk is minimal as 100% of their
investments have a maturity of less than one year. Information about the sensitivity of the fair values of the District's
investments to market interest rate fluctuations is provided by the preceding schedules that shows the distribution
of the District's investments by maturity.
Credit Risk - Credit risk is the risk that the issuer of an investment will not fulfill its obligation to the holder of the
investment. This is measured by the assignment of a rating by a nationally recognized statistical rating organization,
such as Ivloody's Investor Service, Inc. The District believes that there is mininial credit risk with their accounts at
this time.
Custodial Credit Risk - Custodial credit risk is the risk that, in the event of the failure of the counterparty (e.g.
broker-dealer), the District will not be able to recover the value of its investment or collateral securities that are in
the possession of another party. The District's investments are generally held by banks or government agencies.
The District believes that there is minimal custodial credit risk with their investments at this time. District
management monitors fhe entities which hold the various investments to ensure they remain in good standing.
15
MOUNTAIN COMMUNTffiS HEALTHCARE DISTRICT
Notes to Financial Statements
December 31, 2015 and 2014
Note 6 - Investments (continued)
Concentration of Credit Risk - Concentration of credit risk is the risk of loss attributed to the magnitude of the
District's investment in a single issuer. The District's investments are held 100% by banks. The District believes
that there is minimal custodial credit risk with their investments at this tune. District management monitors the
entities which hold the various investments to ensure they remain in good standing.
Note 7 - Capital Assets
Capital assets as of December 31,2015 and 2014 are comprised of the followmg:
Land
Buildings and improvements
Equipment
Construction in progress
Totals at historical cost
Less accumulated depreciadon for:
Buildings and improvements
Equipment
Total accumulated depreciation
Capital assets, net
Balance at
December 31,
2014
$ 440,000
6,177,736
3,955,403
42,092
Transfers &
Additions
$ 91,094
340,603
15,455
-0-
Transfers &
Retirements
$ -0-
-0-
-0-
27,092
Balance at
December 31,
2015
$ 531,094
6,518,339
3,970,858
15.000
S 5.030.616
10,615,231 $ 447.152 $, -ZLQ22
(2,640,301) $ (407,124) $
C2.944.314) . C708.988) _
f5.584.615'> $ ri.H6.112) $ -0-
-0-
_-0-
11,035,291
(3,047,425)
f3.653,302)
('6.700,727)
$ 4.334.564
16
MOUNTAIN COMMUNTIES HEALTHCARE DISTRICT
Notes to Financial Statements
December 31, 2015 and 2014
Note 7 - Capital Assets (continued)
Land
Buildings and improvements
Equipment
Construction in progress
Totals at historical cost
Less accumulated depreciation for:
Buildings and improvements
Equipment
Total accumulated depreciation
Capital assets, net
Balance at
December 31,
2013
$ 440,000
6,051,605
3,873,890
-0-
Transfers &
Additions
$ -0-
126,131
81,513
42.092
Transfers &
Retirements
$ -0-
-0-
-0-
-0-
Balance at
December 31,
2014
$ 440,000
6,177,736
3,955,403
42.092
10,365,495 $ 249.736
(2,239,397)
f2.174,372)
f4.413.7691 S ri.l70.846-)
(400,904)(-769.942)
$ 5.951.726
$
s_
-0-
-0-
-0-
-0-
10,615,231
(2,640,301)
f2.944.314)
f5.584.615)
S 5.030.616
Note 8 - Bank Line of Credit
In June 2015, the District obtained a line of credit from the Trinity Public Utilities District allowing borrowings up
to $250,000 to provide operating capital as needed. The line of credit bears an interest rate of 6.0%. The line of
credit matures in 2016. Interest is payable monthly calculated on any current outstanding balance and principal is
due at maturity. The outstanding balance for the line of credit at December 31, 2015 is $0.
17
MOUNTAIN COMMUNTIES HEALTHCARE DISTRICT
Notes to Financial Statements
December 31, 2015 and 2014
Note 9 - Debt Borrowings
Long-Term debt at December 31,2015 and 2014 consists of the following:
2015 2014
Note payable to a bank, original amount of $350,000, bearing interest at
5.25%, principal and interest payable monthly in the amount of $10,546for 36 months, maturing in December 2015, secured by patient and district
taxes receivable. $ -0- $ 123,019
Note payable to a bank, original amount of $1,209,500, bearing interest at
4.25%, principal and interest payable monthly, maturing in September2020, secured by certain assets of the District.
J
Note payable to UHC of California, original amount of $1,700,000,
bearing interest at 3.75%, principal payable per schedule in 2015,2015 and2016,securedby certain assets of the District. _-Q- 1,290.546
Total debt borrowings 1,154,249 1,413,565
Less current portion (224.606) C689.430')
Debt bon-owiags, net of current maturities $ 929.643 $ 724.135
Future required principal payments under the above long-term debt are as follows: $224,606 in 2016; $234,340 in
2017; $244,495 in 2018; $255,091 in 2019; and $195,717 in 2020.
18
MOUNTAIN COMMUNTIES HEALTHCARE DISTRICT
Notes to Financial Statements
December 31, 2015 and 2014
Note 10 -Deferred Inflow of Resources
Deferred inflows of resources are comprised of the following at December 31, 2015 and 2015:
2015 2014
Deferred tax revenue $ 802,837 $ 775,950
Deferred grant revenue - EMR _-^ 53,458
$ 802.837 $_ 829A08
Note 11 - Pension Plan
The Disb-ict has a defined contribution retirement plan covering substantially all of the District's employees. In a
defined contribution retirement plan, benefits depend solely on amounts contributed by the District and participants
to the plan plus iavestment earnings. The District contributes to the plan at a rate of two percent of eligible
compensation for all eligible employees, as defmed by the plan. Eligible employees have the option to make
additional contributions to the Plan individually, within certain limitations set forth in the Plan and as required by
regulation. The District's pension expense for the plan was approximately $53,000 during the year ended December
31,2015 and $47,000 during the year ended December 31, 2014
Note 12 - Mledical M[alpractice Insurance Coverage
The District purchases commercial malpractice liability insurance on an occurrence basis. The policy coverage is
$3,000,000 per occurrence for acute hospital services and $1,000,000 per occurrence for the skilled nursing facility,
with a $10,000 deductible for both. There is an aggregate limitation of $10,000,000 for acute hospital services and
$3,000,000 for the skilled nursing facility. The District accmes the deductible for all open claims,
Note 13 - Commitments and Contingencies
Litigation - The District is subject to legal proceedings and claims, which arise, in the ordinary course of its
business. After consultation with legal counsel, management estimates that matters existing as of December 31,
2015 will be resolved without material adverse effect on the District's future financial position, results from
operations or cash flows.
19
MOUNTAIN COMMUNTIES HEALTHCARE DISTRICT
Notes to Financial Statements
December 31, 2015 and 2014
Note 13 - Commitments and Contingencies (continued)
Health Care Reform - The health care industry is subject to numerous laws and regulations of federal, state and
local governments. These laws and regulations include, but are not necessarily limited to, matters such as licensure,
accreditation, governmental health care program participation requirements, reimbursement for patient services,
and Medicare and Medi-Cal fraud and abuse. Government activity has increased with respect to investigations and
allegations concerning possible violations of fraud and abuse statutes and regulations by health care providers.
Violations of these laws and regulations could result m expulsion from government health care programs together
with the imposition of significant fines and penalties, as well as significant repayments for patient services
previously billed. Management believes that the District is in compliance with fraud and abuse regulations as well
as other applicable government laws and regulations. While no material regulatory mquiries have been made,
compliance with such laws and regulations can be subject to future government review and interpretation as well
as regulatory actions imlaiown or unasserted at this tune.
Health Insurance Portability and Accountability Act - The Health Insurance Eprtability and Accountability Act
(HIPAA) was enacted August 21, 1996, to ensure health msurance portability, reduce health care fraud and abuse,
guarantee security and privacy of health mformation, and enforce standards for health information. Organizations
are subject to significant fines and penalties if found not to be compliant with the provisions outlined in the
regulations. The District's management has evaluated the impact of this legislation on its operations, rucludmg any
future financial commitments that may be required. Management feels that current policy and procedures m place
comply with the requirements ofEQPAA.
Note 14 - Medi-Cal Rate Reductions Under AB97
On March 24th of 2011, California's Governor Brown signed AB 97 (Budget Act of 2011), which included
significant cuts to Medi-Cal reimbursement rates for skilled-nursmg facilities that are distinct parts (DP/SNF's) of
hospitals. Medi-Cal rates for these facilities were to be reduced to rates fhat were applicable in the 2008-09 rate
year reduced by 10%." For most affected facilities, the reduction would haye resulted in a decrease of approximately
20% to 25% or more. Reimbursement reduction of this magnitude would have devastating consequences for the
California health care community, mcluding the Hospital. Also, this reduction would be retroactive to June 1,2011,
thus compounding the problem.
As a result, the California Hospital Association (CHA) filed a lawsuit dated November 1, 2011 against the
Department of Health Care Services (DHCS) and the Centers for Medicare and Medicaid Services (CMS)
challenging rate cuts to MIedi-Cal reimbursement for DP/SNF's within acute-care hospitals. The lawsuit asserts that
the rate reductions violate federal Medicaid law requiring that payment be sufficient to ensure access for Medicaid
beneficiaries, and that CMS did not act properly in approving the reductions.
20
MOUNTAIN COMMUNTIES HEALTHCARE DISTRICT
Notes to Financial Statements
December 31, 2015 and 2014
Note 14 - Medi-Cal Rate Reductions Under AB97 (continued)
In a hearing held December 19, 2011, the U.S. District Court, Central District, approved CHA's request for a
preliminary injunction prohibiting DHCS from implementing reductions to Medi-Cal reimbursement for DP/SNF' s.
CHA argued that the payment reduction and retroactive recoupment would cause m-eparable harm and lead to
additional facility closures and reductions of service,
The U. S. District Court ruled on the State's request for a modification of the court's previous order for apreliminary
injunction prohibiting DHCS from implementing reductions as mentioned above. The modification meant that the
State would be able to implement rate cuts on reimbursement paid for a limited period prior to December 28,2011,
the date of the injunction. Payments for services that had been provided, but not yet paid as of that date, would be
subject to the rate cut. In a decision handed down IVtarch 8, 2014, the judge agreed with the State's argument that
they should be able to recover the difference between the rate paid and the reduced rate for services provided prior
to December 28, 2011. The judge did however limit the retroactive implementation of the rate cuts to
reimbursements for Medi-Cal services rendered but not paid as of December 28, 2011. Subsequent to fhis, the
decision was overturned.
The U. S. District Court ruled on the State's request for a modification of the court's previous order for a prelmunary
injunction prohibiting DHCS from implementing reductions as mentioned above. The modification meant that the
State would be able to implement rate cuts on rehnbursement paid for a limited period prior to December 28,2011,
the date of the injunction. Payments for services that had been provided, but not yet paid as of that date, would be
subject to the rate cut. la a decision handed down March 8, 2014, the judge agreed with the State's argument that
they should be able to recover the difference between the rate paid and the reduced rate for services provided prior
to December 28, 2011. The judge did however limit the retroactive implementation of the rate cuts to
reimbursements for Medi-Cal services rendered but not paid as of December 28, 2011. Subsequent to this, the
decision was overturned.
Arguments, discussions and other legislation were proposed, such as AB900 and SB640, over the past two years,
Recent announcements have been most encouraging and the suit has been settled. A settlement which is intended
to exempt all rural and frontier DP/SNF's (Level B) from AB97 has been agreed to. Determination of "rural" status
will be defined by OSHPD that uses data from the 2011 Final Database Rural and Frontier from the Metropolitan
Study Services Areas Designations. The effective date for this exemption is September 1, 2015, or any other date
as approved by the Centers for Medicare and Medicaid Services.
This decision means that the DP/SNF's operated by the Hospital, as classified by the Department of Health Care
Services (DHCS) as "rural" facilities, are exempt from the 10% per diem rate reduction as of September 1, 2014
and the related "claw back" period between June 1, 201 1 and August 31, 2012 for which the Hospital was liable.
The potential liability amount had been estimated to be $386,129 by management and recorded at December 31,
2013. The Hospital also has chosen to participate in the DHCS's supplemental reimbursement program designed to
offset a portion of the DP/SNF liability noted above.
21
MOUNTAIN COMMUNTIES HEALTHCARE DISTRICT
Notes to Financial Statements
December 31, 2015 and 2014
Note 14 - Medi-CaI Rate Reductions Under AB97 (continued)
CHA is working closely with CMS to have them agree to exempt the DP/SWs also from the "claw back" period.
If CMS agrees to this later exemption, the State will then not be authorized to "claw back" it's part of the fundmg,
thus eliminating any possible liability. Though the Hospital believes this will be the likely outcome (since CMS has
ah-eady paid its share of the reimbursement and may not want to retroactively take the funding away) it has chosen
to reflect the liability till such time as a final decision is rendered.
22
TRINIPf HOSPITALOwned and Operated by
Mountain Communities Healthcare District
Chief Executive Officer
Report to the Board of DirectorsMay 2016
From Aaron Rogers, CEO:
The following is an update on the ongoing matters of interest as of this date. I will provide a
status update as appropriate, at the Board Meeting on April 25,2016.
Employee of the IVlonth: Laurie Olson—Skilled Nursing
Laurie Olson has stepped up and has been instrumental in supporting the changes on SNF.
She has worked additional shifts.
Recruitment:
We continue to recruit nurses, providers, physical therapist, and clinical laboratory scientist. HR
and administration are ramping up recruitment and working closely with departments who are
recruiting themselves.
Utilization:
Census was high in April with an average 8.1 per day.
Skilled Nursing Facility:We have completed the required information for Noridian and sent it in Friday, May 20.
Policies:
We are continuing to work on policy consolidation.
Mock Survey:
The staff is working very hard to get everything found by Carolyn St. Charles in compliance. We
are revamping swing paperwork along with other findings. Carolyn is very helpful and we
appreciate her expertise to assist us in being ready for future surveys.
Provider Stats:
Providers are delinquent on 3 of 31 discharge summaries. (90.5%). Discharge summaries must
be completed within seven days of discharge. Stats are continually improving and our goal is
100%.
Trinity Care:
We have been in discussions with Trinity Cares and the Lew Edwards Group regarding the tax
ballot. Kevin Cahill had been very active as we look to ramp up.
TRINITY HOSPITALOwned and Operated byMountain Communities
Healthcare District
Financial Narrative for the month of April 2016
Prepared by Jan Marshall
Sum mar v
Mountain Communities Healthcare District incurred a loss from operations of ($322,934) for the month, which
is ($251,844) worse than the budgeted operating loss of ($71,090). The month includes lower inpatient but
higher outpatient revenues, and expenses close to the anticipated amount, all of which are detailed below. For
the year-to-date, our loss from operations is ($823k) compared to a budget of ($447k).
200
0
(200)
(400)
(600)
Operating income/(loss) - Month 2016
Jan Feb Mar Apr May Jun Jui Aug Sep Oct Nov Dec,»_ Actual 2016 —•—Budget 2016 .-...5;,y.-".-. Actual 2015
Volume and Revenue
Patient days are under budget by 24 in Acute and 563 in SNF, but over by 110 in Swing
Outpatient volumes are under budget in most areas of the hospital except Lab and Imaging
Trinity Clinic visits are under budget by 45, Hayfork Clinic visits are over budget by 103
Total patient revenue is under budget by ($26k) or 1.1%
Net Patient Revenues are down to 39.3% of Total patient revenue (compared to budgeted 49.5%) as a
result of losing SNF volume, which pays at approximately 80% of charges. Net patient revenue is under
budget by $241k or 21%
For the year-to-date, net patient revenues are $4.4 million compared to a budget of $4.3 million
3,000
2,500
2,000
1,500
Gross Revenue - Month 2016
Jan Feb Mar Apr May Jun Jul Aug Sep
^-Actual 2016 —®—Budget 2016 .-- -;-'Actual 2015
Oct Nov Dec
Page 1 of 2
Expenses
Salaries, benefits, and registry expenses are down to $714kforthe month, $40k lower than budget
All other expense categories combined are over budget by $49k
SNF costs are up $50k compared to budget in Professional Fees alone
As a result, total expenses are $1.20 million, only $9k higher than budget of $1.19 million
Year-to-date expenses are $5.24 million compared to a budget of $4.81 million.
1,600
1,400
1,200
1,000
Total Expenses - Month 2016
Jan Feb Mar Apr May Jun Jul Aug Sep
,^^—Actual 2016 —B—Budget 2016 -—'Actual 2015
Oct Nov Dec
850
750
650
550
Labor Expense - Month 2016
Jan Feb Mar Apr May Jun Jul Aug Sep
"^—Actual 2016 Budget 2016 -^—Actual 2015
Oct Nov Dec
Non-Operating Revenue and Expense
® Non-operating activity includes a $736k payment from Partnership Health for IGT
® Net Income for the month is $484k compared to a budgeted loss of ($12k)
® Year-to-date net income is $218k compared to a budgeted loss of ($212k)
BalanceSheet
® Cash increased from 28 to 46 days this month
® Gross Accounts Receivable dropped due to payments coming in, and is now $3.64 million. Net
Accounts Receivable are also down, to $1.75 million.
® Days in Accounts Receivable are down to 46
® Days in Accounts Payable remain low at 41
• Debt borrowings are up with the recording of a loan for Ultrasound
® No other major fluctuations in the Balance Sheet
Page 2 of 2
Assets
Current assets:
Cash and cash equivalents
Gross accounts receivable
Net accounts receivable
Net % of gross
Other Receivables
Estimated third party settlements, net
Inventories
Prepaid expenses and deposits
Total current assets
Apr-16
(Unaudited)
1,911,793
3,640,660
1,758,758
48.31%
459,236
150,591
204,943
4,485,321
Mar-16
(Unaudited)
1,210,790
4,020,211
1,992,261
49.56%
518,151
148,671
185,648
4,055,521
Dec-15
(Unaudited)
1,905,399
3,255,074
1,192,243
36.63%
645,419
149,106
252,264
4,144,431
Assets limited as to use
Total capital assets
Total accumulated depreciation
Capital assets,net of accumulated depreciation
Total assets
Liabilities and Net Assets
Current Liabilities:
Current maturities of debt borrowing
Accounts payable and accrued expenses
Accrued payroll and related liabilities
Estimated third party settlements, net
Deferred Revenue
Total current liabilities
22,603 22,603 24,818
11,093,641
6,884,639
4,209,002
8,716,925
11,035,831
6,839,608
4,196,222
8,274,346
11,035,;
6,700,727
4,334,564
8,503,813
237,478
941,535
656,656
479,459
509,547
2,824,675
221,822
921,235
676,961
372,588
582,869
2,775,476
224,606
687,371
655,861
445,323
802,837
2,706,343
Debt borrowings,net of current maturities
Days in cash
Days in accounts receivable (gross)
Days in accounts payable
916,166 877,305 929,643
Total liabilities
Net assets:
Invested in capital assets, net of related debt
Unrestricted
Total net assets/deficit
Total liabilities and net assets
3,740,841
3,055,357
1,920,727
4,976,084
8,716,925
3,652,781
3,097,095
1,524,470
4,621,565
8,274,346
3,638,770
3,180,315
1,577,857
4,758,172
8,630,618
46
46
41
28
50
39
50
44
44
(322,934)
Mountain Communities Healthcare District
Statement of Operations
Apr-16
Actual
946,290
1,290,700
2,236,990
1,357,735
879,255
39.3%
1,717
880,972
571,914
110,334
32,231
205,134
107,906
90,024
14,680
45,031
26,652
1,203,906
Apr-16
Budget
1,076,246
1,186,731
2,262,977
1,143,034
1,119,943
49.5%
3,138
1,123,081
584,415
143,847
25,963
152,059
115,576
64,873
20,025
42,407
45,006
1,194,171
Monthly
Variance
(129,956)
103,969
(25,987)
214,701
(240,688)
(1,421)
(242,109)
(12,501)
(33,513)
6,268
53,075
(7,670)
25,150
(5,345)
2,624
(18,354)
9,735
Operating Revenues:
Inpatient revenue
Outpatient revenue
Total gross patient service revenue
Contractuals & Bad Debt
Net patient service revenue
Net Revenue as a % of gross
Other operating revenue
Total operating revenues
Operating expenses:
Salaries
Benefits
Registry
Professional fees
Supplies
Purchased services
Utilities
Depreciation and amortization
Other operating expenses
Total operating expenses
YTD
Actual
4,659,259
4,822,889
9,482,148
5,073,331
4,408,817
46.5%
15,785
4,424,602
2,353,600
612,981
227,736
817,068
507,828
298,478
87,916
183,913
158,956
5,248,476
YTD
Budget
4,340,859
4,461,786
8,802,645
4,446,233
4,356,412
49.5%
12,657
4,369,069
2,357,141
580,181
104,717
613,305
466,157
261,656
80,769
171,040
181,523
4,816,490
YTD
Variance
318,400
361,103
679,504
627,098
52,405
3,128
55,533
(3,541)
32,800
123,019
203,764
41,672
36,821
7,147
12,872
(22,567)
431,986
(71,090) (251,844)
736,757
73,323
1,000
_(4,152)
806.927
483,993
529,024
81.3%
136.9%
66,111
(7,665)
58,446
(12,644)
29,763
67.3%
106.6%
736,757
7,212
1,000
3,512
748,481
496,637
(277,903)
Operating gain/floss)
Non-operating revenues/expenses:
Intergovernmental Transfer
District tax revenue
Non-operatlng revenues/expenses
Grants and contributions
Interest expense
Total non-operating revenues/expenses
Net income/floss)
Trinity EBIDTA
Staffing costs as a % of net patient revenue
Total operating expenses as a % of net patient revenue
(823,874)
736,757
293,291
27,979
200
(16,441)
1,041,786
217,912
(447,421)
266,646
(30,914)
235,732
(211,689)
401,824
72.5%
119.0%
(40,649)
69.8%
110.6%
(376,453)
736,757
26,645
27,979
200
14,473
806,054
429,601
442,473
SNF Home Health
Trinity
Community
Health Clinic
Hayfork
Community
Health Clinic
Hospital with
Emergency
Department
attached
Total
14,053
15,792
(1,740)
6,264
(8,004)
1,351
(6,654)
13,571
6,9.17
121,616
89,694
31,922
23,894
8,028
5,151
16
13,195
51,763
64,957
62,259
56,385
5,874
13,722
(7,848)
2,958
(4,890)
29,725
24,836
681,328
701,940
(20,612)
296,219
(316,832)
63,863
(1,458)
(254,426)
641,709
387,283
879,255
863,812
15,443
340,100
(324,656)
73,324
(1,442)
(252,775)
736,768
483,993
Expected Net Revenue
Direct Expense
Direct Expense - Net Gain/floss)
Overhead Expense
Operating Gain/floss)
Non-operating revenues/expenses
District Tax Revenue
Non-operating revenues/expenses
Grants and contributions
Wet Income/floss) - Nonrecurring Items Excluded
Intergovernmental Transfers
Net lncome/(loss)
Note:
This supplemental schedule is designed to be an activity statement that shows details and results of the line ofbusiness's profit-related activities for a
period of time. Overhead and Non Operating Revenue/Expense Is allocated based on the most recent as filed Medicare Cost Report. This schedule is not
an income statement. This analysis is designed to determine if a line of business is covering direct expenses and is contributing towards overhead
expense.
Page 3 of 5
PATIENT DAYS:
Acute
Swing Bed
SNFTOTAL PATIENT DAYS:
TESTS/VISITS:
Observation
CT Scan Tests
Echocardlogram Tests
Emergency Department Visits
Hayfork Clinic Visits
Home Health Visits
laboratory Tests
Physicai Therapy Visits
Respiratory Therapy Tests
Top Care Visits
Trinity CIInfc Visits
Ultrasound Tests
Diagnostic Imaging Tests
TOTAL TESTS/VISITS:
Mountain Communities Healthcare District
Monthly Activity Log
Apr-15
91
84
556731
12
57
10
467
377
88
17,636
60
97918
945
57367
21,061
MavlS
94
87559740
04
58
IS
466355
69
15,166
eo
694
26
694
36257
17,896
Jun-15
86
88581
755
11
74
27
471378
84
19,259
64822
18
929
54
324
22,504
Jul-15
100
137595832
10
81
57513
372
81
20,828
77839
12
955
81296
24,192
AUK-15
104
165553822
12
7133
478
300
82
17,442
72
1,132
17
726
42
294
20,689
Sep-15
112
62519
693
14
6860
437
377
79
18,140
54
984
27
880
56302
21,464
Oct-15
69
72520
661
7
68
18
371
350
99
17,322
100
837
22
858
60
312
20,417
Npy-15
56
70490616
3
71
54
389
269
3715.S13
69
783
50
887
64
260
18,446
Oec-15
79
U4503696
264
42353
325
3717,231
91
763
37
933
73
284
20,233
2015 YTD
1,039
9766,623
8,638
146
792
355
5,178
4,227
8G7206.165
761
10,384
316
10,276
690
3,649
243,660
Jan-li
58
181
527766
2
56
30
357
322
3816,780
124
1,207
24
898
52
305
20,195
Feb-16
57
20643S701
1
77
27372
390
68
17,683
200
946
27
888
15328
21,022
Mar-16
57
239
266562
1
70
0394
476
6717,710
285
1,025
12
1,000
0
377
21,417
AET-16
68
1760
165
16
370
463
54
16.75S
264
651
12
940
69
347
20,007
zaieyro
240
8021,231
2,273
5
268
73
1,493
1,651
22768,928
873
3,829
753,726
1361,357
82,641
i016AorilBudget
9266
S63721
1666
21
417
360
70
16,414
856809
19
985
54299
20,386
March 2016 2015
Budget MQnthIv Monthly
Variance AveraRe Averaf
-38%
262%-53%
57
20943.0
86
36
S03-22%
-94%
6K-100%
-6%
32%-4%
8%-67%
27%-37%
2%-100%
26%
676
168
19374
396
58
17,391
2031,059
21
929
22
337
725
24
SB
21399
401
68
16,127
3D
895
17
957
59
365
SK 20,877 19,397
Cash Received
Beginning Cash Balance
Patient Receipts
1GT Activity
Cost Report Activity
Tax Receipts
Miscellaneous Cash Receipts
Total Cash Coliected
Total CashAvaHable
Cash Disbursed
Payroll
Accounts Payable
Cost Report Activity
Transfer to/f rom Cash Resi
IGT Activity
Cash Position
BaSance Before Financing
Financing
Total Disbursements
Mountain Communities Heatthcare District
Cash Projection - 2016
Actual
January, 2016
212,019
311,258
57,644
53,063
M.3S71.036,321
1,248340
736,462
489,106
161.000)
1,164,568
Actual
February, 2016
83,772
1,070,062
23,732
32.207
46,704
1,178,706
1,262,WL
756,528
577,119
(333,830}
993,817
Aetna!
March, 2016
268,661
827,999
32,554
20,874
88M27
1.150,088
764,227
3<8,598
101,526
(159,849)
1,054,503
Actual
April, 2016
35,585
1,117,536
736,757
54,564
1,988
1,910,846
2,006.430
7M.79S495,044
737,000
1.S1M43
Projection
May, 2015
59,588
907,439
7,365
3.190
918,595
978.183
688.203
607,394
1506,000)
789.603
Projection
June, 2016
188,580
863,536
40,097
3.190
906.824
1,095,403>
730,257
400,000
(soa/aoo)
690.000
1,020.257
Projection
July, 2016
75,146307,439
20,487
3.190
931.116
1,006,263
754,599
400,000
(250,000)
9B4.599
Projection
August 2015
101,664
900,004
9,422
3,190
312,616
1,OM,280
754,539
400,000
(250,000}
904,599
Projection
September. 2016
109,681
363,536
100,392
3,190
367.118
1.076,739
730,257
400,000
(150,000}
980,257
Projection
October, 2016
96,542
1,067,439
1,335.305
179.494
3,190
2.58S.429
2,681,371
754,599400,000
1,300,000
2,454,599
Projection
November, 2016
227,372
863,536
142,930
3,130
1,009,717
1,237,088
730.257
400,000
1.130.257
ProjectionDecember, 2025
106,831
907.439
100,677
3,1SO
1,011,307
1,118,139
754,599
400,000
(150,000)
1,004,399
Cash Reserve Balance
Total Cash on Hand
l,514,8S4
1.698,657
I,Z75,DS4
1,543.715
1,115,205
1,210,790
1,852,205
1,911,793
1,346.205
1,534,785
546,205
6Z1.352
296,205
337.863
46,205
155,886
(103,795)
(•7,253)
1,196,205
1,423,577
1,196,205
1,31)S,037
1,046,205
1,159,745
TRINITY HOSPITALOwned and Operated by
Mountain Communities Healthcare District
Chief Nursing Officer
Report to the Board of DirectorsMay 2016
From Peggy Manning, BSN, CNO
Patient Acuity Meeting and new form: The staff and I met to fulfill our annual requirement. We
came up with the new form (attached). Each patient is evaluated in each area then the patient is
awarded a numerical value (acuity). Patient assignment is driven by these numbers. The form is
also sent to Gary to help justify charges. This has increased gross charges by $40,000 for 1
month (comparing April 2015 to April 2016)
On-line Learning platform: We are close to signing and implementing an on-line learning platform
which includes: procedures for nursing, respiratory therapy and physical therapy. This will
eliminate large portion procedures from Navex which will increase consistence across the
hospital system.
Pyxis: Fully implemented, this was the smoothest one I have ever been involved with. Patients
are now profiled with their medications from admit ion to discharge increasing patient and
employee safety.
2 new RNs hired, they will start soon.
Donor Network West awarded us the 2015 Bronze Award for our support of tissue recovery. Only
12 out of 170 hospitals were received awards.
^.L
'\li
Owned and Operated byMountain Communities Healthcare District
P.O. Box 1229
60 Easter Avenue
Weaverville, CA 96093
Phone: (530) 623-5541
To: BOD 5/16/2016Re: Quality Assurance
Greetings,
This is an update for the Quality Assurance Program. We have completed the 2016 1st
Quarter report. Attached is the scorecard for the hospital. Please note that there are measures
related to SNF for the months of January and February but are discontinued in March.
A few highlights:
• MedSurg Nutrional Screening is at 100%
® ER lobby to provider median time for the quarter was 9 minutes
• Active participation by BOD members in the CQI program was 100%
• Respiratory therapy patient satisfaction for March was 100%
• TCHC has started new projects related to a Partnership measure for controlling high blood
pressure. They exceeded their initial goal.
As intended by this process, we have identified area that provide opportunities for improvement and
will continue to work at reaching and exceeding our goals through process improvements, staff
education and continued monitoring.
Thank you for your time.
Sarah Cordtz, RN
Coordinator Quality Assurance / Risk Management.
Mountain Communities Healthcare District Scorecard 2015
Department / Service: Freformance Improvement 2015
•partment
dministratii
[i/Medical
Staff
Anesthesia
Biomed/
Maint
Bus Svs
Dietary
DP/UR
Employee
Health
Fin Svs
Hayfork
clinic
HIM
HH
HR
Infection
control
IT
Lab
Nursing
•asure
INV prevention
Work orders 85%
completed
:rease clean claims b}
> / month
lys
admissions within 30 days
/ cause/ reduce to 5%
admissions within 15 days
^ cause.
nployee Health
lysical, fit mask, PPD
•ported Occupational
•edle stick and
iposures
u shots for employee:
•view of policies that are
rrent
)l5 Phy. Reviews
ompletion of swg
3C
F referrals
mployee Turnover ra
ackground ck rehune
/ company within 24
rs
eference ck
[and Hygiene
iMEdeanmgER/ME
SNF/ THCC/ RAD/
ab
IRSAptedu
UP:AUTI occurances
jmual Staff PPE
raining
mnual 1C staff
Latio: Open to dosed
ictets
JRTrop.TAT
R: Resp Rate assessment ai
ocumentation
,R: Discharge VS
2015
nnual
0;
87'
4'
^
5'
6'
90'
A
85
A
A
56
NA
3
[A
83
77
79%
TJ
c
89%
90%
8(
61
5l
rget
;%
85°
1°
90°
5"
5'
90'
36'
100
80
50
5%
100
100
80
80
80
IOC
8E
9C
1:
8;
9;
9:
I b ^r
No submmission
0%| 0°, 05
No submission
-6%
100% I 100%| 67°
No Submission
No Submission
90% I 100" 89'
No data
33% | 5- 24'
97%
0%| 50' 25
31%
3.2% |
80% |90% I80%
83% |100% I
IA
60% |90% I
40/298
74.2% |
100%
76%
'•)'
36
100
77
88
100
IA
100
100
07/3<
91.7
10C
81
1.8
100
100
78
82
0
IA
89
8S
44/31
90.(
10C
8(
:Qtr
0°;
:fr
89°
93'
1"-%'
97
"M
2
97
78
84
e»
JA
c
83
93
85.5C
10C
7S
rget EL :a2_ jie idQtr irget il5_ ug !EL -dQtr arget )ct lov )ec thQtr
Discontinue
Mountain Communities Healthcare District Scorecard 2015
Phannacy
FT
Radiolog
(Diagnost
imaging)
QA
RT
Admission Med Rec
Admission VS
Reassessment after pain
I
Care plan in 24 hr
Pain Level documneted q
Nursing nutrition
wiing
: Nutritional rescreening ii
eek
Lobby to Provider in
mtes
Lobby to Dishcarge in
mtes
Lobby to Acute Floor
: Restraint Log
.armadst verification
orders in 24 hr
itimicrobial
•wardship
.ily check for
sdlcation outdafces
it pt FT baling withi
hrs
TCumentation DLP o]
'porting of CT exam
suiting in >20% of
)rmal radiation
nployee film badge
onitor
aily DME cleaning
ismfecting US
idocavity transducer
ithHLD
TSTATfromMDI
:tive participation by MD
i visor
:tive participation by BOD
embers
k Satisfaction
esp med errors RT
.ati
ransfer check list
/eekly summaries
miplete
/ound Assessment /
^assessment
4 hr Chart check%
hange of Condition
)M; careplanning
ypo/hyperglycemic
:ocumentation
48°,
96°,
^.
45°
91'
V
1
67.
197,
100'
93'
40
100
A
100
100
100
10C
10C
9;
5C
^
10(
IA
z
7:
81
8:8'
9:
7i
50°,
95°,
95?
95°
95°
95°
95'
3
12
24
100'
90'
100
95
6t
10C
8C
8(
10(
10(
101
101
101
101
101
Hold
98% I
80%]
info
info
info
info
6411471
\
94% I
100°i
63°,
27°,
13°
100°
66°
1
7
19
A
96'
55°,
66°
100°
100°
6
18
A
90-
No Data
No Data
A 100 98
No submission
No submission
No submission
No submission
No submission
No submission
0%
100% I
fA
IA
67.0% |
98.5% I
75.0% |
ioo.o%'|
92.87. |
100.0% I
100.0% ]
100
10G
IA
IA
100.C
90.;
83.:
1A
93.:
100.(
100.1
0
100
10C
10C
IA
IA
JA
1A
JA
<TA
^A
99°,
:''SK
^ 31"
^Ms
100°
•{%y2
6
17
93.33'
99
.^5'
10G
100
IOC
•%ISt;
%ii3S
10C
^MS10(
10(
I T I" r i T T -
Discontinued I 99%
Discontinue
Mountain Communities Healthcare District Scorecard 2015
SNFIC
Staff
Development
TCHC
lM Mar have all
laments
all Risk Care planning
'ost fall charting
omplete
'PD
umual PPE braining
3ME Cleaning
annual 1C in-sennce
land Hygiene
land Hygiene
3ME Cleaning
Vnnual PPD
\imual PPE
\imualIC
<TEO
Turn away
Controlled substance
program.
ControUingHighBP
85%
82%
921
JA
JA
IA
JA
JA
;TA
•IA
sTA
<IA
<TA
95°,
•JA
94?
100%
100%
100%
100%
100%
l00°i
100°<
100°i
80%
80%
100°1
85'),
90°,
100°,
;5%
80°,
50°
100.0% ]
ioo,o%|
100.07.1
100.0% I
100.0% I
7.4% |
ioo.o%|
86.7%]
77.0% |
0.0%|
100.0% I
100.0% I
100.0% I
100% I
2% I
100.0%
100.0%
100.0%
<IA
100.0%
32.0%
100.0%
92.6°i
79.0°i
41.0°<
100.0%
100.0°^
100.0%
100°,
6°,
•IA
^A
•}A
-IA
\TA
<SA
<SA
\IA
78.0°i
76.5°!
100.0%
100.0°i
100.0»/
100°,
4°,
95%
NA% NA 53°
100%
100%
100%
100%
100%
-;;"20Si
100%~;ss
78%
'-;=s@
ICOT
100?
100°,
100°,
4°;
95°
53° I:
100%
100%
100%
100%
4%
95%
53%
Color Key
Meets or Exceeds goal
Within 3% of meeting goal
missed goal but made
improvement
Hospital
Wide Pattentl
Safety Goals. I
Misses goal by >3% and
improvment
Patient identifiers
Hand Hygiene
OR has
arge
no large
California Transplant Donor Network
All Deaths
Eligible deaths
Hospital Referrals
Missed Referrals
Missed Imminent/
Eligible
3rt
3~0
3
0
0/0
Mov
2~0
2
0
0/0
Sec
1~0
1
0
0/0
Donor Network West
lan
2\~CT1
2|
0|
0/0
:eb
1~0
1
0
0/0
Mar
3~u
3
0
0/0
Apr
2~D
2
0
0/0
May
3~D
3
0
0/0
lun
0~0
0
0
0/0
lul
2~D
2
0
0/0
'\ug
40
4
0
0/0
Sep
3~0
3
0
0/0
Oct
3"0
3
0
0/0
Mov
1^0
1
0
0/0
Dec
2
Owned and Operated by
Mountain Communities Healthcare District
Policies Completing the Internal Review Process for May, 2016
In accordance with Mountain Communities Healthcare District guidelines for review and update for
administrative, operational and patient care poficies, I hereby certify the following:
Nursing patient care policies were reviewed by no less than the Chief Nursing Officer, Medical
Director, Interdisciplinary Practice Committee, Medical Staff Committee and Chief Executive
Officer.
Ancillary patient care policies were reviewed by no less than the Medical Director, Interdisciplinary
Practice Committee, Medical Staff Committee and Chief Executive Officer.
Operational and Administrative policies were reviewed by no less than the Department Manager,
Department Director and Chief Executive Of
Jennifer Van Matre,T5if@ctor5fFinance
All policies are maintained within the Navex Policy Tech system which is a secure, centralized and
auditable repository. Each approver has electronically approved each document within Navex
which ensures audit tracking and accountability for ali documents. The following is a listing of
policies that have completed the District's policy and procedure review and approval process and
are now ready for publication. Once the Board has approved the listing, a Board designee wiil
complete the electronic approval process in Navex allowing publication of the finai document.
Aaron Rogers, Chief Executive Officer
Jerry Cousins, Board President
(on behalf of the Board of Directors)
Document ID Group
6550 Board of Directors
6551 Board of Directors
6676 Board of Directors
6552 Board of Directors
6553 Board of Directora
6554 Board afDireclors
6555 Board of Directors
6556 Board of Directors
3765 Board of Directors
6557 Board of Directors
6823 Board of Directore
5954 Board of Direclors
6558 Board of Directors
G559 Board of Directors
3769 Board of Directors
6886 Board of Directors
6667 Board of Directors
6560 Board of Directors
3783 Board of Directors
5993 Board of Directors
5989 Board of Directors
6561 Board of Directors
6562 Board of Directors
6670 Board of Directors
6563 Board of DErectora
6564 Board of Directors
6635 Board of Directors
6565 Board of Directors
3801 Board of Directors
6636 Board of Directors
6638 Board of Directors
6567 Board of Directors
6568 Board of Directors
6640 Board of Directors
6569 Board of Directors
6642 Board of Directors
5973 Board of DErecfore
6643 Board of Directors
6570 Board of Directors
6645 Board of Directors
3803 Board of Directors
6646 Board of Directors
6573 Board of Dlrectore
6574 Board of Directors
6648 Board of Directors
6649 Board of Directors
3690 Board of Directors
6650 Board of Directors
6575 Board of Dlrectore
6800 Board of Directors
6576 Board of Directors
8758 Board of Dlrectora
6577 Board of Directors
6652 Board of Directors
6578 Board of Directore
6655 Board of Dirsctore
6579 Board of Direclore
5988 Board of Directors
6629 Board of Directors
5994 Board of Directors
6581 Board of Directors
6632 Board of Directors
6582 Board of Directors
6826 Board of Directors
6633 Board of Directors
SiteMountain Communities Heaithcare District
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Mountain Communities Healthcare District
Mountain Communities Healthcare District
Mountain Communities Healthcare District
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MOUNTAIN COMMUNITIES HEALTHCARE DISTRICTMEETING MINUTES
BOARD MEETING
April 27, 2016
6:00 p.m.
Trinity County Library
Weavendlle CA
DISTRICT BOARD MEMBERS
GERALD BRASUELL DEROFORSLUND JERRY H. COUSINS LYNN JUNGWIRTH FRANCIS MOORE
Vice-President Clerk President Treasurer Member
Note: These minutes contain a description for each item to be considered. Supporting documentation is
available in the public packet at the Board meeting or at the Administrative Office at Trinity Hospital.
District Board Members Present:
Dero Forshmd, Clerk
Gerald Brasuell, Vice-President
Jerry H. Cousins, President
Lymi Jungwirth, Treasurer
Francis Moore
District Board Members Absent:
None
Staff Present:
Aaron Rogers, CEO
Peggy Manning, RN, Chief Nursing Officer
Jeamie Silvers, Executive Assistant
Jennifer Van Matre, Director of Finance
Michael Novak, PA, Director of Clinic Services
Donald Krouse, MD, Vice Chief of Staff
6LOO_PM CALLS MEETING TO ORDER IN OPEN SESSION
Report from Closed Session on March 30,2016
The Board entered into closed session at 6:54 pm on the following:
• MEDICAL STAFF PRIVILEGES
Government Code Section 54962; Health and Safety Code
Section 1461
The Board came out of Closed Session at 7:00 pm and immediately reconvened ia Open Session.
Treasurer Jungwirfh reported that the Board reviewed the recommended actions on Medical Staff Privileges. For each
applicant the followmg mformation has been reviewed and/or verified:
Privilege List, NPDB Report, and AMA Profile, peer references and verifications of staff privileges at other facility and
ongoing professional practice evaluations. Items verified were Liability Insurance Coverage, Licenses, Certifications, and the
Medicare exclusion list was checked.
Mountain Communities Healthcare District
Board of Directors Board Meeting
April 27, 2016
On motion of Director Moore seconded by Director Forslund approves the following appomtments/reappointments and
accepts the resignations upon the recommendation from the Medical Staff.
Appointments/Reappoititments:
Frank Welte, MD Provisional Staff Specialty: Emergency Medicine
Alison Robiaetter, MD Consultmg Staff Specialty: Tele-radiology
Resignations
Clara Gordon, PA
Stanley Nyarko, MD
The motion passed with the following voice vote:
Ayes: Dero Forslund; Lynn Jungwirth; Francis Moore
Noes: None
Absent: Gerald Brasuell; Jerry Cousins
Abstain: None
Public Input - SNF Closure and Special Focus Facility Program
Reports
Medical Staff Report
Received written /verbal report from Daniel Harwood, MD, Chief of Staff and/or Donald Krouse, MD,
Vice Chief of Staff on the Trinity hospital Medical Staff. Other items discussed:
• Donald Krouse, MD and Randall ]V[eredith, MD have been reviewing the plans for the clinic
expansion with Michael Novak, PA.
Chief Executive Officer
Received written /verbal report from Aaron Rogers, CEO on the current operations of the hospital.
a Letter from Noridan regarding SNF closure. Our attorney is reviewing the letter and whether the
statute referenced applies to our facility.
Chief Financial Officer
Received written /verbal report from Jon Marshall, CFO and Jennifer Van Matre, Director of Finance,
on the current financial states and current status of revenue cycle management and accounts receivable.
Other items discussed:
» Our line of credit with Redding Bank of Commerce will not be renewed. Staff is researching
other options.
Chief Nursing Officer
Received written/verbal report from Peggy Maiming, RN, CNO on the current status of the nursing
departments.
® Pyxis medication system will be installed and ready for staff to implement on April 28., 2016
Mountain Communities Healthcare District
Board of Directors Board Meeting
April 27,2016
Quality Improvement
Received written/verbal report from Sarah Cordtz, RN, Coordinator, Q/RM on the cuiTent status of the
Quality Program. The Board reviewed the data which included the Annual Critical Access Hospital
Evaluation for 2015.
Consent Agenda
All matters listed under the Consent Agenda, are considered by the Board to be routine, and will be
enacted by one motion in the fonn listed below. There will be no separate discussion of these items
unless a request for discussion is made prior to the time the Board votes on the motion to approve.
On Motion of Director Brasuell and seconded by Director Jungwirth approves the following consent
items:
a. Policies and Procedures - See Attached
The motion passed with the following voice vote:
Ayes: Dero Forslund; Gerald Brasuell; Jerry Cousins; Lymi Jungwirth
Francis Moore
Noes: None
Absent: None
Abstain: None
Discussion Items
a. Clinic
Michael Novak, PA reported that there was a meeting with Jack Freeman regarding the floor
plan, rendering and use permit for the clinic expansion on Monday. The expectation is that
we will be able to submit the use permit to the Planning Commission in June.
There was a 20% increase in visits at the Hayfork Community Health Clinic last month and a
10% increase at the Trinity Community Health Clinic.
There are three practitioner interviews scheduled. Telemedicine is increasing every month
and we have had a good response for visits with the dietician. In the near future, there will
be a Certified Nurse Midwife applying for privileges to work one day per week in the clinic.
b. Parcel Tax
Aaron Rogers reported that he met with Catherine Lew from "The Lew Edwards Group"
regarding collaboration for the vote to renew the parcel tax.
Action Items
a. Items removed from the Consent Agenda
None
b. Minutes from April 13,2016
On Motion of Director Brasuell and seconded by Director Jungwirth approves the
minutes from April 13, 2016
Mountain Communities Healthcare District
Board of Directors Board Meeting
April 27, 2016
The motion passed with the following voice vote:
Ayes: Dero Forslund; Gerald Brasuell; Jerry Cousins; Lynn Jungwirth
Francis Moore
Noes: None
Absent: None
Abstain: None
c. Minutes from March 30,2016
On IVIotion of Director Forslund and seconded by Director Moore approves the minutes
from April 13, 2016
The motion passed with the following voice vote:
Ayes: Dero Forslund; Gerald Brasuell; Jerry Cousins; Lynn Jungwirth
Francis Moore
Noes: None
Absent: None
Abstain: None
Board Reeprts
Director Jungwirth reported that the residents ofHayfork have expressed that they are excited about the
changes at the Hayfork Community Health Clinic. The CEO from Southern Trinity has stated that they
now have resources to expand but does not want to infringe on services that we already offer.
Close Public Session
Closed Session
The Board entered into closed session at 6:45 pm on the following:
9 MEDICAL STAFF PRIVILEGES
Government Code Section 54962; Health and Safety Code
Section 1461
• QUALITY IMPROVEMENT/RISK MANAGEMENT
Government Code Section 54962: Health and Safety Code
Section 32155
» PUBLIC EMPLOYEE PERFORMANCE EVALUATION
Government Code Section 54957 - Public Employee
Title: Chief Executive Officer
The Board came out of Closed Session at 7:45 pm and immediately reconvened in Open Session.
President Cousins reported that the Board reviewed the recommended actions on IVledical Staff
Privileges. For each applicant the following information has been reviewed and/or verified:
4
Mountain Communities Healthcare District
Board of Directors Board Meeting
April 27, 2016
Privilege List, NPDB Report, and AMA Profile, peer references and verifications of staff privileges at
other facility and ongoing professional practice evaluations. Items verified were Liability Insurance
Coverage, Licenses, Certifications, and the Medicare exclusion list was checked.
On motion of Director Moore seconded by Director Forslund approves the following
appointments/reappointments and accepts the resignations upon the recommendation from the Medical
Staff.
Appomtments/Reappointments:
Jon Fong, DO
Aymel Tarar, MD
Paulalan Genstler, MD
Robert Evans, MD
Aaron Castro, MD
Andrea McCullough, MD
Kevin McDoimell, MD
Provisional Staff
Provisional Staff
Provisional Staff
Provisional Staff
Provisional Staff
Provisional Staff
Consulting Staff
Specialty: Emergency Medicine
Specialty: Emergency Medicine
Specialty: Emergency Medicine
Specialty: Emergency Medicine
Specialty: Emergency Medicine
Specialty: Emergency Medicine
Specialty: Tele-radiology
The motion passed with the following voice vote:
Ayes: Dero Forslund; Gerald Brasuell; Jerry Cousins; Lynn Jungwirth; Francis Moore
Noes: None
Absent; None
Abstain: None
QUALITY IMPROVEMENT/RISK MANAGEMENT
President Cousins reported that the Board thoroughly reviewed the quality data presented and there no
action was taken.
PUBLIC EMPLOYEE PERFORMANCE EVALUATION
President Cousins reported that the Board discussed the evaluation of the Chief Executive Officer.
Adjourn:
There being no further business, the meeting was adjourned at 7:50 p.m.
Dero Forslund, Clerk of the Board
Mountain Commimities Healthcare District
MOUNTAIN COMMUNITIES HEALTHCARE DISTRICTMEETING MINUTES
"SPECIAL" BOARD MEETING
May 10,20166:00 p.m.
Trinity Hospital
Weaverville CA
DISTRICT BOARD MEMBERS
GERALD BRASUELL DERO FORSLUND JERRY H. COUSINS LYNN JUNGWIRTH FRANCIS MOORE
Vice-President Clerk President Treasurer Member
Note: These minutes contain a description for each item to be considered. Supporting documentation is
available m the public packet at the Board meeting or at the Administrative Office at Trinity Hospital.
District Board Members Present:
Dero Forslund, Clerk
Gerald Brasuell, Vice-President
Jerry H. Cousins, President
Lymi Jungwirth, Treasurer
Francis Moore
District BoardMembers Absent:
None
Staff Present:
None
10:30 AM CALLS MEETING TO ORDER IN OPEN SESSION
Public Input - None
Close Public Session
Closed Session
The Board entered into closed session at 10:31 am on the following:
• PUBLIC EMPLOYEE PERFORMANCE EVALUATIONGo'vermnent Code Section 54957 — Public Employee
Title: CMef Executive Officer
The Board came out of Closed Session at 11:45 am and immediately reconvened in Open Session.
Mountain Communities Healthcare District
Board of Directors "Special" Board Meeting
May 10, 2016
PUBLIC EMPLOYEE PERFORMANCE EVALUATION
President Cousins reported that the Board discussed the evaluation for the Chief Executive Officer.
Adjourn:
There being no further business, the meeting was adjourned at 11 :46 a.m.
Dero Forslund, Clerk of the Board
Mountain Communities Healthcare District
Department Health Care ServicesPrimary, Rural, and Indian Health Care Division
Small Rural Hospital Improvement ProgramAuthorization to Bind
The Authorization to Bind permits the designee(s) listed below to negotiate and sign the SmallRural Hospital Improvement Program Application and/or Grant Agreement for any paymentrequests that may result.
The Board of Directors of Mountain Communities Healthcare , in a duly executed meeting and
held on ygy 25, 2016 where a quorum was present, resolved to authorize:
Aaron Rogers ^^ designee Jennifer van Matre
(Typed Name) (Typed Name)
Chief Executive Officer Director of Finance
(Title) (Title)
(Signature) (Signature)
The undersigned hereby affirms he/she is a duly authorized officer of the corporation andstatements contained in this application package are true and complete to the best of the his/herknowledge, and accepts as a condition of a grant award the obligation to comply with theapplicable state and federal requirements, policies, standards, and regulations. The undersignedrecognizes this is a public document and open for public inspection.
Authority to contract:
If someone other than the corporate board of director's chairperson is to negotiate and sign anyresultant grant of this application, a letter of agreement and authorization must be signed anddated by the board of director's chairperson, indicating the name of such person and stating thatperson's area of responsibility in this matter.
Board Chairperson: jerry H. Cousins
(Typed Name)
(Chairperson's Signature)
(Date)
Board ChairpersonMailing Address: P 0 Box 1229
City: Weaverville
Zip Code: gg093
Please mail one original copy to Department of Health Care Services, Primary, Rural, and Indian
Health Division, 1500 Capitol Avenue, Suite 72-338, MS 8502, Sacramento, CA 95899-7413 and
e-mail or fax a duplicate copy- (916) 449-5777.
Reset Form Print Form
To: Mr. Aaron Rogers/ CEO
Mountain Communities Healthcare District
From: Catherine Lew, CEO
The Lew Edwards Group
Date: May 12, 2016
Re; DRAFT Proposal/Background Document
Dear Aaron:
Thank you for convening such a helpful team of folks for our call last week. The Lew Edwards
Group (LEG) is looking forward to another effective collaboration with Mountain Community
Healthcare District (MCHD) for its 2016 No Tax Increase Funding Renewal.
This document includes the following:
-As our firm is not new to the District but the two of us haven't worked together before/ background
and typical scope of services on our firm
-Background on LEG'S past collaborations with the District
-Thoughts and perspectives on the upcoming environment
This document should be treated as a discussion draft which is not for public dissemination.
Following our discussion/ this draft will be refined so it is appropriate as a final document.
ABOUT THE LEW EDWARDS GROUP
The Lew Edwards Group (LEG) offers significant expertise m effective California public revenue
measure preparation and healthcare election preparation. A collaboration with LEG in 2016 offers
MCHD the following:
•^ A successful track record of success in California revenue, healthcare communications and
revenue projects;
^ Understanding unique opportunities, risks/ and sensitivities related to California revenue and
public healthcare measures specifically;
m
^ Strong experience and success in mountain and rural communities and districts;
^ Extensive experience enacting tough finance measures— more than $33 Billion enacted in
California revenue measures, with a. 95% success rate;
^ Nationally recognized/ award-wirming communications products and experience
developing effective community communications plans; and
^ A community and stakeholder-supportive management style in workmg effectively to meet
your revenue objectives.
The Lew Edwards Group (LEG) is a top California consulting firm providing revenue measure
preparation and strategic communications services and strategic advice to municipalities/ counties/
public agencies/ special districts, and healthcare clients.
LEG'S clients benefit from its experienced team of communications experts, who between them have
decades of experience in cutting edge strategies and tactics. The firm and its specialists represent
public agencies (cities, counties/ and special districts) and healthcare clients throughout California.
Pertinent Healthcare Experience
In 2005 and 2006, L£G zoas pleased to represent TPUD/M.CM.S in their effort to successftilly establish M.CHD
and pass its parcel tax through Measures 0 &' P. In 2010 and 2011, LEG was also pleased to collaborate with
M.CHD on its effort to enact M-easin'e T to continue that local funding measure/ with NO increase in tax
rate.
The Lew Edwards Group also led efforts on behalf of Proposition BB for San Diego County's Palomar
Pomerado Health, CaUfornia's larsest Public Healt'hcare District raisins $496 Million, the larses-t Svecial
District Hospital Bond in California history. In addition, LEG has represented the followmg healthcare
organizations in their revenue and communications efforts: Palm Drive Healthcare District
(Sonoma County); Tri-City Healthcare District (San Diego County); Antelope Valley Healthcare
District (Los Angeles County); Catholic Healthcare West (Santa Clara County); Sierra Kings
Healthcare District (Tulare County); Sutter Health (Alameda and San Francisco Counties); Kaiser
Permanente (Santa Clara, Marin and San Francisco Counties); Alta Bates Medical Center (City of
Berkeley); Summit Hospital (City of Oakland); and St. Luke's Hospital (City of San Francisco).
For a comprehensive list of LEG clients, visit i^Q^vilewedj^ardsgnxip^coM
LEG'S typical scope of services uicludes:
• Recommend a community outreach plan to expand awareness of the Hospital's current funding
and service needs and what is at stake;
• Conceiving, writing and producing informational brochures/ letters, mailers, presentation
materials, and advertising;
• Recommending an overall timeline and project budget;
• Recommending/identifying other professionals as needed;
® Working with MCHD's Special Counsel on the ballot question and other submittals during all
phases of project planning/ to ensure that effective communication as well as legal requirements
are met; and
® Developing an Earned (nonpaid) Media plan for informational press coverage.
The Lew Edwards Group continues to recommend the firm of FM3 Research — one of California's
leading public opinion research firms/ to meet MCHD's needs as the District plans for its measure.
VM3 conducted two community surveys in your previous planning, leading to the successful
outcomes in Measures 0/P and Measure T. FMS's extensive healthcare experience includes several
joint projects with LEG cited above, and others such as Scripps Health/ Saint John's Health Center/
UCLA Medical Center/ Northern Inyo County Hospital District, the American Hospital
Association/ the Arizona Hospital and Healthcare Association, the Community Hospitals of
Central California/ Community Medical Centers, Downey Community Hospital/ Fountain Valley
Hospital/ Jackson Memorial Hospital (Dade County, Florida)/ John Muir Hospital, Mills Peninsula
Health Services/ the Northern Inyo County Hospital District/ Valley Care Health System/ and the
Washington State Hospital Association.
Both LEG and FM3 offer institutional knowledge of your District and its past successful planning
efforts/ an unmatched combination of in-depth experience with healthcare as an issue and successful
California revenue measures of all types.
OVERALL ENVIRONMENT FOR CALIFORNIA REVENUE MEASURES
Environment
As we discussed last week:
• Since our Measure T collaboration, additional healthcare districts have shuttered. Others have
not been successful at the ballot box/ most recently Kaweah Delta Local Health Care District
(not a LEG client).
• Voters continue to be concerned about the economy and "government handouts." And the
upcoming Presidential election presents both an opportunity and a risk. On the one hand, a
high turnout election will bring diverse constituencies to the ballot, which typically favors a
two-thirds requirement measure. On the other hand/ in your region's case/ the message of one
of the Presidential candidates may draw larger numbers of anti-establishment or angry voters
to the polls/ which could be a wildcard factor in your case. In the last two even numbered
November election years (2012 and 2014), only 44% and 48% of two-thirds requirement taxes
for Special Districts passed.
• However/ LEG still finds that messages and information that speak to the issue of all parcel tax
funds staying local/ and none of the money going to Sacramento/ remain compelling to voters.
And as in our past collaborations/ it will be necessary to create an appropriate and compelling
sense of urgency as to the information about the consequences to the Hospital if the parcel tax
is not renewed.
HIGHLIGHTS OF PAST MCHD PLANNING
This section will address LEG'S scope of legally-permissible services related to our past collaborations
with MCHD.
Measures 0/P (High Turnout Election)
® A baseline public opinion research survey was conducted by FM3 Research to assess measure
viability, tax tolerance, and areas of concern for the community/ mduding a hypothetical ballot
question approved by Counsel which was tested. Baseline survey results were utilized by all
parties to inform, the basis of the planning and to craft informational messages to educate the
public,
® A Community Outreach Plan was developed which included the following components:
o A message focused exclusively in potential Hospital closure and the availability of a 24-
hour Emergency Room.
o Informational community materials/ including Powerpoint presentation materials/ flip
charts. Frequently Asked Questions, and website copy.
o Five Town Hall meetings were conducted (in addition to smaller organizational
presentations and one-on-one Key Influential outreach) in Junction City/ Lewiston/
Trinity Center/ Hyampom/ and Hayfork.
o Regular media releases and media placements.
o Key Influential updates.
o Seven district informational (nonadvocacy) mailers paid for by MCMS/TPUD, in
addition to the two mailers developed by Trinity Cares.
• Following all of these activities/ a tracking survey was conducted to reassess support and
finalize effective ballot measure language prior to placing the measures on the ballot.
® Once the measures were placed on the ballot:
o MCMS/TPUD continued legally-permissible informational efforts up until Election Day/
including the mailings and outreach activities described above,
o Per California law, a public hearmg was conducted in the event that the measures failed
and the Hospital needed to close.
o Kevm Cahill and Trinity Cares identified 2000 supporters and hundreds of endorsers,
and effectively localized the message. Both the Trinity Journal and Record Searchlight
endorsed the measures.
Measure T (Low Turnout Election)
An updated baseline public opinion research survey was conducted by FM3 Research which revealed
that:
o Respondents exhibited cost-sensitivity, leading to our recommendation that no increase
to the tax rate be made
o Defining the issue as one of "Keeping Trinity Hospital Open" was critical to our
branding
o The Hospital's favorability rating had increased and for those that had utilized the
Hospital, quality of care remained consistently positive
o However/ 21% fewer respondents than in. 2005 felt that the lack of adequate emergency
care is an extremely or very serious problem
o The top priorities for Parcel Tax spending were:
• Continuing to provide 24-hour emergency care at Trinity Hospital, with a doctor
on duty
" Continuing to provide emergency medical care locally/ rather than an hour to 90
minutes away
• Keeping Trinity Hospital open
• A Community Outreach Plan was developed which included:
o Branding the message of Keeping Trinity Hospital Open
o Informational community materials were developed similar to the 2005/2006 effort
o There was a greater emphasis placed on Letters to the Editor and media release
coverage
o As it was a low turnout election and the Renewal was the only item on the ballot/ only
two district informational (nonadvocacy) mailers were disseminated in. addition to the
mailers developed by Trinity Cares
® Trinity Cares identified 700 supporters through its advocacy efforts (the number was lower as
it was a low turnout election)
KEY CONSIDERATIONS & RECOMMENDED ACTIVITIES MOVING FORWARD
Demographic Considerations
Previous polling showed that support for your past measures was highest among women/ older
voters, and No Party Preference voters. Women will constitute half of your electorate/ voters age 65+
two-thirds/ and NPP voters about 30%.
Essential Planning and Outreach Activities
The approach previously deployed by our team on behalf of MCHD has continued to be critical to the
success of our revenue measure clients in. today's challenging economic environment. The District's
2016 No Tax Increase Renewal Program will need to include the following components/scope of
services:
1. Update Public Opinion Survey Research
As we discussed, it will be necessary for MCHD to invest in an updated community survey as the
first step tn your Renewal process^ to assess and evaluate current attitudes and how they have shifted
or evolved over the past five years/ identify specific information that constituents need to know about
your parcel tax renewal, and to re-assess tax tolerance, sunset, exemption and other issues. Doing so
will allow our team to:
^ Statistically assess preferences and attitudes across different demographic categories,
mcluding evaluating similarities and differences among your voters geographically/ by age,
party affiliation, gender/ and income, among other factors;
^ Evaluate how to maximize opportunities and minimize risks;
^ Assess today's tax tolerance and other parcel tax nuances (sunset clause/ exemption, inflation
factor/ oversight/ etc.)/ to determine the most acceptable proposal for your public at this time;
^ Fully test a variety of informational messages m the research, allowing MCHD to identify and
understand the information/messages your constituents need at this time;
^ Inform the development/ refinement and deployment of MCHD's Community Outreach
Program to maximize the feasibility and viability of your Parcel Tax Renewal.
LEG and FM3 will work in close consultation with MCHD on the design of the survey questionnaire.
Several drafts of the survey will be developed to ensure that we fully explore all the information
desired by MCHD in an impartial, third party fashion that independently assesses the feasibility of
your Parcel Tax Renewal.
Please note that how people receive or respond to information, including survey research/ has
changed dramatically since our 2010-2011 collaboration. As such/ far fewer people answer their
landlines or even cell phones. An innovation that FM3 has implemented smce 2011 is that all
interviews are now done both by telephone (landline and cell), AND online/ which is called a "dual-
mode survey."
2. Recommend and Implement Community Outreach Program
Following the updated baseline survey/ LEG will evaluate survey results and can develop the
following strategies:
• Identify Key Informational Messages
• Develop an Outreach Communications Plan to Internal/External Stakeholders
® Conceive a Direct Mail/ Paid Media/ and Earned IVtedia Plan
® Design an Orgardzing/Outreach Plan to Build Awareness of What's at Stake and Current Needs
a Develop Community Presentation/Information Mlaterials
a Conduct Communications Training for Staff/Stakeholders
Project Components would be implemented with the following objectives:
a Effectively Frame the issue
a M.ethodicall-y Inform &' Educate Key Audiences and Stakeholders
» Effectively Address Community Questions
• M.axmme and. increase Awareness of Hospital Needs
Develop Informational Messages. The updated public opinion research will identify informational
messages that resonate with the public and their attitudes towards various aspects of the Parcel Tax
Renewal. Messages that effectively explain information to the community will be maximized to their
fullest effect in a disciplined and focused fashion. As noted, in 2011 the key message was Keeping
Trinity Hospital Open.
Implement a focused Communications Plan to key Opinion Leaders. This component of the plan is
primarily targeted to Key Influentials and stakeholders within the District:
c Develop regular Informational Updates.
a Produce visual aids for a Speakers' Bureau.
® Write "Keep Trinity Hospital Open" fact sheets.
• Develop "Commonly Asked Questions &' Answers."
Conceive a Direct Mail and Earned Media Plan. As m our 2006 and 2011 plarmmg, LEG
recommends that an informational direct mail program be implemented/ to educate your community
on current Hospital needs. The topics and information provided in these mailings is determined by
the updated community survey. Implementing these mailings is particularly important as your
District is geographically diverse, comprised of unique communities, and not concentrated within a
concentrated urban core, making various and methodical forms of communications critical.
As in the past/ any information provided m these mailings is factual, not advocacy/ and would be
approved by the District's Special Counsel. An example of a past mailing is contained in the
Appendix.
In balancing the need for these mailings to provide information in an "alphabet soup" of a busy
election and communications environment, for planning purposes we would suggest three
informational mailings as being prudent, though polling results could dictate that additional
education is necessary. Remember that there will be as many as two dozen measures on the
November ballot.
Community Meeting Outreach Plan: As in the past/ LEG can provide MCHD with suggestions on
any Town Hall or other community engagement as needed.
3. Effective Presentation of the No Tax Increase Renewal Measure in the Voter Handbook
As in the past/ LEG will work with District Counsel on the wordmg and presentation of Voter
Handbook materials for viability. District Counsel will finalize and transmit all official documents to
the Registrar of Voters, but LEG will collaborate with Counsel to add critical value to these
documents.
CONSULTANT FEES and RECOMMENDED PROJECT COSTS
The below are what our records show as being spent by the District in our past collaborations. The
below reflects District budgeting only and does not include Trmity Care's separate expenditures.
Measure T
$45,000
$22/500-0-
$300
$15,000
$3,500
$86,000+
Proposed 2016 Planning Model
In the past two collaborations/ LEG consulted with the District through Election Day. For this
collaboration, in consideration of your frugal budget and the fact that this will be the District's third
partnership with LEG, we recommend only consulting with the District through the end of August to
Category of Expenditure
LEG Professional Fee
Baseline Survey
Tracking Poll
Mailing Data
Direct Mail
Travel/Out of Pocket NTE
TOTAL
Measures 0/P
$70,000
$25,000
$15/000
$1/500
$25,000
$3/500
$140,000
save money. We would then prepare all the collaterals needed by the District before our exit/ so that
the District can be self sufficient in the Fall weeks September through Election Day.
LEG'S proposed consulting fee for these services is $25,000, not including travel expenses/ as we
believe that it is possible to save money and time by doing our Message Training and other planning
through teleconference or Skype,
As m our Measure T collaboration/ the District needs to budget separately for its polling and mailing
costs. Last time/ the District contracted separately with FM3 Research and did its printing/mailing
locally through your own area vendors. LEG assisted by recommending the data universe and
graphics and the data/graphics providers billed the District directly.
In general/ LEG would recommend the following budget:
-As noted/ our professional services through August would be $25,000
-The District should budget $28/850 for polling (polling costs have increased because dual mode is
more expensive) through a separate contract with FM3 Research
-Data costs are likely to run about $300 again from the same data vendor the District has used
-The District should budget $6,000 for graphics if using the same artist the District has used
-As for printing/mailing, LEG has no idea what your area vendors would charge; the District should
get bids for printing/mailing about 3/500 units per mailing (three are recommended currently)
SAMPLE TIMELINE
MOUNTAIN COMMUNITY HEALTHCARE DISTRICT
SAMPLE TIMELINE As
MAY 2016
JUNE 2016
JULY 2016
LAUNCH PARTNERSHIP
Q Review additional District background information and media clips
1-1 Conduct KickOff Teleconference
Q Develop and finalize Opinion Research Survey
CONTINUE PREPARATIONS
Q Initiate survey interviews
LI Identify outreach engagement opportunities (District)
1.-1 Assess and update database of Opinion Leaders (District)
Q Update Speaker Training Materials
ASSESS CURRENT VIABILITY, PREPARE FOR MEASURE PLACEMENT
Q Complete survey interviews and analysis
a Present results to District Staff/ reach consensus on communications
approach
a Present results to Board
Q Assist with staff reports and measure preparation
Q Advise on Media Strategy
a Assist in preparing for Board adoption vote
AUGUST 2016
SEPTEMBER-
OCTOBER 2016
Q Media Updates
Q Community participation
PLACE MEASURE/ ADDRESS POST-PLACEMENT NEEDS
L] District Board acts to place measure on Ballot
Q Measure materials are submitted to County Elections Office by statutory
deadline of August 12th
Q Issue Opinion Leader Update announcing placement of the measure on
the ballot
1-1 Address Rapid Response Needs as necessary
1_] Draft Information Collaterals (Community Powerpoint/ FAQs)
Q Update District website and other informational vehicles (District) with
information developed by LEG
a Develop answers for community questions/ continue to update
communications/engagement materials
Q Update Speakers Message Training Toolkit
U Conduct Speakers Training
Q Copy write Opinion Leader updates and develop Mailer texts
MCHD opt to its
cannot in LEG at
POST ADOPTION ACTIVITIES
t-l Implement mformation-only presentations (District)
Q Implement Earned Media/Internet Communications
Q Issue three (3) informational ballot measure mailings
Q Address Rapid Response Needs as necessary
[-] Provide two-way media comments
1-1 Thank the community for participating in the election (District)^
APPENDIX
^oyn-htte CtHitEKtir^ie-tHs-<i^fn<ir» 0-ithlri
Dear
Trinity Hospital ensures that lite-saving, 24-bour emergency care with a
doctor on duty is avaitabte for you or someone you low.
Every year we have atmost 5,000 visits to our emcrgenc}' room, and
<iy-£r..A£,!3S.tfQMtJ?ar^1_rmin> HQspi|iiiJias_s3v.cd.soine,o!i.e_*»li{.c
255 times.
In addition to providing bigh-quality, 24-bour emergency care. Trinity
Hospital's tocat lab, ctinics and skilled nursing services ensure Aaf
residents and local businesses have access co cost-eftecriw primar)- and
preventive bealthcarc services.
• FutI-Swicc, Walk-in Rural Health Clinics in Weawn'aie and
Hayfork receive 12,000+ visits aiinuaUy.
• Local lab runs 200,000+ cluiicat tests and receives 6.000+ visits
annuaHy.
• Hospital performs almost 6,000 annual imaging procedures,
inctudmg x-ray, ultrasound, mobtle mammograph}', and CT scans.
Trinity Hospital is proud to be the comerstotic for emergency and
primary care in Trinity County and our doors are always open vvtwnever
you need us.
Please visit www.mcmc-dical.org for more information.
Sincerely,
^';^.Dc Hauk Edctsicin
Director, Trinity Hospital ER
A)Diane Rieke
Chief Nursing Officec, Truuty Hospitsd