southern mono healthcare district july 2020 … · 2020-07-13 · assistant at mammoth hospital by...

2019 Press Ganey Guardian of Excellence Award Winner

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Mammoth Hospital P.O. Box 660 | 85 Sierra Park Road | Mammoth Lakes, CA 93546 | 760.924.4114 | Fax 760.924.4104

www.mammothhospital.com

METICULOUS CARE * MEMORABLE PEOPLE * MAJESTIC LOCATION

SOUTHERN MONO HEALTHCARE DISTRICT

JULY 2020 MONTHLY BOARD MEETING AGENDA (REVISED)

NOTICE IS HEREBY GIVEN that the Board of Directors of Southern Mono Healthcare District will convene at its regular monthly board meeting at the location and on the date and time set forth below. Pursuant to the current State of Emergency declared by the Governor and Executive Order N-29-20, this meeting will occur and be held via teleconferencing. The meeting will be accessible telephonically to all members of the public seeking to observe and to address the Board of Directors, including giving public comment. To access the meeting, the District has set up a toll-free open conference call. The Dial-in Number is 866.588.5540; Conference Code: 8359004536#. No members of the public may physically be present at the meeting location. Attendance and participation shall be via telephone only.

In compliance with the Americans with Disabilities Act (ADA), if you need special assistance to attend this meeting via telephone, please contact the District Board Administrative Assistant at Mammoth Hospital by telephoning 760.934.3311. Prompt notification prior to the meeting will enable the District to make reasonable arrangements to assist with accessibility to this meeting.

Date: July 16, 2020 Time: 8:00 a.m. Place: Mammoth Hospital Administration Conference Rooms A & B 85 Sierra Park Road Mammoth Lakes, CA 93546

I. CALL TO ORDER

II. PLEDGE ALLEGIANCE TO THE FLAG AND READING OF THE SMHD VISION, MISSION AND VALUES

III. PUBLIC COMMENTS

IV. CHIEF OF STAFF REPORT

http://www.mammothhospital.com/

Southern Mono Healthcare District Board of Directors Meeting Agenda July 16, 2020

V. ADJOURN TO CLOSED SESSION

CONFERENCE WITH LEGAL COUNSEL – PENDING AND THREATENED LITIGATION Existing Litigation and Significant exposure to litigation pursuant to Government Code §54956.9.

1. Inyo County Local Agency Formation Commission (LAFCO), Northern Inyo Healthcare District v. Southern Mono Healthcare District, Sacramento Superior Court Case No. 34-2015-80002247-CU-WM-GDS; 3rd District Court of Appeal Case Nos. C085138 & C086087.

CONFERENCE WITH REAL PROPERTY NEGOTIATORS (Government Code § 54956.8).

QUALITY ASSURANCE – (Health and Safety Code §32155) 1. Chief of Staff Report. 2. CEO Report. 3. CFO Report. 4. CNO Report. 5. CMO Report. 6. CIO Report.

QUALITY ASSURANCE QUARTERLY SUMMARIES - (Health and Safety Code §32155)

HEALTH CARE FACILTY TRADE SECRETS (Health and Safety Code §32106) 1. Sierra Park Clinics/Mammoth Hospital.

CREDENTIALING Initial Appointment to Provisional Staff Danish Atwal, MD – Cardiologist (Renown) Htet Khine, MD – Cardiologist (Renown) Re-appointment to Medical Staff Craig Burrows, MD - Hospitalist Kristin Collins, MD – Pediatrics Sean Park, MD - Hospitalist Re-appointment to Courtesy Staff Richard Brown, MD - Orthopedics

PERSONNEL MATTERS (Government Code §54957) 1. Tom Parker, CEO.

VI. REPORT ON CLOSED SESSION

VII. PUBLIC COMMENTS


VIII. CONSENT AGENDA (All matters on the consent agenda to be approved on one motion unless a Board Member requests separate action on a specific item) 1. Previous Minutes to be approved:

June 18, 2020 Regular Board Meeting 2. Chief Financial Officer Report 3. Chief Nursing Officer Report 4. Chief Medical Officer Report 5. Chief Information Officer Report 6. Human Resources Report

IX. COMMITTEE REPORTS

1. Finance Committee (Met July 13, 2020) Stephen Swisher, M.D., Dave Anderson

2. Physician Compensation, Relations and Retention Committee Laurey Carlson, Joanne Hunt

3. Employee Relations Committee Yuri Parisky, M.D., Joanne Hunt

4. Quality Assurance Committee (Met June 17, 2020) Stephen Swisher, M.D., Joanne Hunt

5. CEO Annual Review Committee Laurey Carlson, Dave Anderson

6. IT Steering Committee (Met June 16, 2020) Stephen Swisher, M.D., Yuri Parisky, M.D.

7. Facilities Committee Yuri Parisky, M.D., Laurey Carlson

8. Board Member Recruitment Committee (Met June 29, 2020) Laurey Carlson, Dave Anderson

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

X. CHIEF EXECUTIVE OFFICER’S REPORT

XI. FINANCE REPORT 1. June 2020 Financial Narrative. 2. Investment Report.

XII. BOARD EDUCATION

Presentation of the Dental program by Teresa Toups, Dental Clinic Manager.

XIII. OLD BUSINESS

There is no old business to discuss.


XIV. NEW BUSINESS

1. Presentation by Dr. Yuri Parisky for discussion and action pertaining to attendance by

members of the Mammoth Hospital Medical Staff at general meetings of Staff and providing reporting details to the Board of Directors regarding attendance.

2. Review and Approval of the Community Health Needs Assessment Fiscal Year 2020 Update.

3. Review of the FY 2020 Annual Reimbursement and Disclosure. 4. Declaration of Surplus District Property, Equipment and Supplies.

XV. PUBLIC COMMENTS

XVI. CREDENTIALING

Initial Appointment to Provisional Staff Danish Atwal, MD – Cardiologist (Renown) Htet Khine, MD – Cardiologist (Renown) Re-appointment to Medical Staff Craig Burrows, MD - Hospitalist Kristin Collins, MD – Pediatrics Sean Park, MD - Hospitalist Re-appointment to Courtesy Staff Richard Brown, MD - Orthopedics

XVII. FUTURE BUSINESS

The next Regular meeting will take place on Thursday, August 20, 2020 at 8:00 a.m. in Conference Rooms A & B at Mammoth Hospital.

ADJOURN


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SOUTHERN MONO HEALTHCARE DISTRICT

JUNE 2020 MONTHLY BOARD MEETING MINUTES Date: June 18, 2020 Place: Mammoth Hospital Administration Conference Rooms A & B 85 Sierra Park Road Mammoth Lakes, CA 93546 Attendance of Board Members: Laurey Carlson, Vice Chair; Stephen Swisher, M.D., Treasurer; Joanne

Hunt, Secretary; Yuri Parisky, M.D., Member at Large. Absent: David Anderson, Chair. Attendance of Staff Members: Tom Parker, Chief Executive Officer; Melanie Van Winkle, Chief

Financial Officer; Caitlin Crunk, Chief Nursing Officer; Craig Burrows, M.D., Chief Medical Officer; Mark Lind, Chief Information Officer; David Baumwohl, Legal Counsel; Sarah Rea, Recording Secretary.

I. CALL TO ORDER

Laurey Carlson, acting chair in the absence of David Anderson, called the meeting to order at 8:04 a.m.

II. PLEDGE ALLEGIANCE TO THE FLAG AND READING OF THE SMHD VISION, MISSION AND VALUES

The meeting opened with the Pledge of Allegiance to the Flag and the reading of the SMHD Mission, Vision & Values lead by Yuri Parisky, M.D.

III. PUBLIC COMMENTS

Sarah Rea, District Recording Secretary, read a comment from Lorrie Gould, Vice President, Mammoth Hospital Auxiliary: The Cast Off is opening for business on Saturdays and Thursdays starting June 20. It will be operating regular hours. The limited days are because all clothing must sit for three days prior to being handled or put on the floor. Donations will only be accepted on those days. No heavy or large items will be accepted. Lorrie Gould wished to thank Gardiner Miller, Foundation Coordinator, and Staci Brock, Infection Prevention Officer, for attending the Auxiliary’s meeting and giving advice and helpful ideas for reopening.

IV. CHIEF OF STAFF REPORT


Southern Mono Healthcare District Board of Directors Meeting Minutes June 18, 2020

The Chief of Staff report was included in the confidential packet.

V. ADJOURN TO CLOSED SESSION

The Board adjourned to closed session at 8:06 a.m.

VI. REPORT ON CLOSED SESSION

The Board reconvened to open session at 10:07 a.m.

CONFERENCE WITH LEGAL COUNSEL – PENDING AND THREATENED LITIGATION Existing Litigation and Significant exposure to litigation pursuant to Government Code §54956.9.

1. Inyo County Local Agency Formation Commission (LAFCO), Northern Inyo Healthcare District v. Southern Mono Healthcare District, Sacramento Superior Court Case No. 34-2015-80002247-CU-WM-GDS; 3rd District Court of Appeal Case Nos. C085138 & C086087.

Acting Chair Carlson reported discussion of CONFERENCE WITH LEGAL COUNSEL on PENDING AND THREATENED LITIGATION for the above items; no action was taken.

CONFERENCE WITH REAL PROPERTY NEGOTIATORS (Government Code § 54956.8). Acting Chair Carlson reported there were no matters to discuss: no action was taken.

QUALITY ASSURANCE – (Health and Safety Code §32155) 1. Chief of Staff Report.

Acting Chair Carlson reported that that QUALITY ASSURANCE issues were not reported by or discussed with Richard Koehler, MD., Chief of Staff; no action was taken.

2. CEO Report. Acting Chair Carlson reported that QUALITY ASSURANCE issues were not reported by or discussed with Tom Parker, CEO. No action was taken.

3. CFO Report. Acting Chair Carlson reported that QUALITY ASSURANCE issues were not reported by or discussed with Melanie Van Winkle, CFO; no action was taken.

4. CNO Report. Acting Chair Carlson reported that QUALITY ASSURANCE issues were not reported by or discussed with Caitlin Crunk, CNO; no action was taken.

5. CMO Report.


Acting Chair Carlson reported that QUALITY ASSURANCE issues were not reported by or discussed with Craig Burrows, M.D., CMO. No action was taken.

6. CIO Report.

Acting Chair Carlson reported that QUALITY ASSURANCE issues were not reported by or discussed with Mark Lind, CIO; no action was taken.

7. Review and Approval of the SMHD Quality Improvement Plan, FY 2020-2021. 8. Review and Approval of the SMHD Case Management/Utilization Plan, FY 2020-2021. 9. Review and Approval of the SMHD Risk Management Plan, FY 2020-2021.

10. Review and Approval of the SMHD Infection Prevention Plan, FY 2020-2021. Items 7-10 were taken as a block. Joanne Hunt moved, seconded by Yuri Parisky, M.D., to approve the above plans as presented. A roll call vote was taken; the motion passed unanimously. Laurey Carlson, Yes; Stephen Swisher, M.D., Yes; Joanne Hunt, Yes; Yuri Parisky, M.D., Yes.

QUALITY ASSURANCE QUARTERLY SUMMARIES - (Health and Safety Code §32155)

HEALTH CARE FACILTY TRADE SECRETS (Health and Safety Code §32106) 1. Sierra Park Clinics/Mammoth Hospital.

Acting Chair Carlson reported HEALTH CARE FACILITY TRADE SECRETS were not discussed regarding Sierra Park Clinics/Mammoth Hospital; no action was taken.

CREDENTIALING Re-appointment to Medical Staff David Araya, MD - Hospitalist Don Harrell, MD - Radiology Richard Shedd, MD - Emergency Re-appointment to Affiliate Staff Jason Bishop, DDS - Dentistry Steve Fujimoto, DDS – Dentistry Re-appointment to Locum Tenens Pamela Landsteiner - Dermatology Initial Appointment to Allied Health Chelsea Brown, PA - Orthopedics Re-appointment to Courtesy Staff Richard Brown, MD - Orthopedics Initial Appointment to Provisional Staff Michael Bryan, MD – Dermatology


Acting Chair Laurey Carlson reported the foregoing physician CREDENTIALING was discussed; no action was taken.

PERSONNEL MATTERS (Government Code §54957) 1. Tom Parker, CEO.

Acting Chair Carlson reported a discussion took place with Tom Parker, CEO; no action was taken. Staff and legal counsel left the Board meeting at 8:29 a.m. Tom Parker, CEO, remained in the meeting. Closed session ended at 9:55 a.m.

VII. PUBLIC COMMENTS

There were no additional Public Comments.

VIII. CONSENT AGENDA (All matters on the consent agenda to be approved on one motion unless a Board Member requests separate action on a specific item) 1. Previous Minutes to be approved:

May 21, 2020 Regular Board Meeting 2. Chief Financial Officer Report 3. Chief Nursing Officer Report 4. Chief Medical Officer Report 5. Chief Information Officer Report 6. Human Resources Report

Yuri Parisky, M.D., motioned, seconded by Joanne Hunt, to approve the Consent Agenda. Acting Chair Carlson asked for discussion, there was none. A vote was taken, the motion passed unanimously. Yes, 4; No, 0.

IX. COMMITTEE REPORTS

1. Finance Committee (Met June 15, 2020) Stephen Swisher, M.D., Dave Anderson

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

2. Physician Compensation, Relations and Retention Committee Laurey Carlson, Joanne Hunt

There was no Physician Compensation meeting; no report.

3. Employee Relations Committee Yuri Parisky, M.D., Joanne Hunt

There was no Employee Relations Committee meeting; no report.


4. Quality Assurance Committee (met June 17, 2020) Stephen Swisher, M.D., Joanne Hunt

The Quality Assurance Committee met on June 17, 2020. No further report.

5. CEO Annual Review Committee Laurey Carlson, Dave Anderson

There was no CEO Annual Review Committee meeting; no report.

6. IT Steering Committee (met June 16, 2020) Stephen Swisher, M.D., Yuri Parisky, M.D.

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

7. Facilities Committee Yuri Parisky, M.D., Laurey Carlson

There was no Facilities Committee meeting; no report.

8. Board Member Recruitment Committee Laurey Carlson, Dave Anderson

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

9. Ad Hoc, Special, or Other (as needed) Committees There are no Ad Hoc, Special, or Other (as needed) Committees at this time.

X. CHIEF EXECUTIVE OFFICER’S REPORT

Tom Parker, CEO, reviewed the following highlights from his written report: 1. COVID-19 continues to occupy much time and attention. The Hospital Incident Management Team

(HIMT) has been transferred to the Admin Team. 2. Hospital staff have been asked to work on returning to full volume in terms of capacity. The Surgery

Committee meeting reported today that we are approaching 75% of volume prior to March/April 2020.

3. A Joint Week was held this month. The Hospital is bringing its backlog down. 4. Mono County has petitioned to the state to further open local business activity. Mammoth Hospital

provided attestations that it was able to treat patients without crisis standards of care, test symptomatic patients, and that Mono County is able to track and trace cases.

5. Cammy Staker, former OR Director, has resigned and Phyllis Meneses is serving as interim director. Caitlin Crunk is heading up recruitment for a new OR Director.

6. An Oncology Navigation Committee has been launched. Yuri Parisky, M.D., is serving on this in a physician role.

7. The Daisy Awards went very well, and were held on Teams. Don Maddox received the annual award, Margy Klammer and Jeri Dostie received lifetime achievement awards.


8. The IT Steering Committee met and discussed departmental “sprints,” which are concerted efforts to help individual departments with their EMR use. Staff are currently in the middle of the Periop/Materials sprint. Implants are now being barcoded.

9. The Hospital is working on a plan to consolidate COVID testing within the facility. 10. The OR3 project is continuing, Tom is hopeful that this project will go live in July.

XI. FINANCE REPORT

1. May 2020 Financial Narrative. 2. Investment Report.

Melanie Van Winkle, CFO, reviewed and presented the Financial Statements included in the packet via PowerPoint presentation. Ms. Van Winkle reported the May Net Gain was $3,078,000 which resulted in a favorable budget variance of $3,038,000. The year-to-date Net Gain was $7,400,000 resulted in a favorable year-to-date budget variance of $2,814,000. Days of cash-on-hand were at 419.2 at the end of May.

XII. BOARD EDUCATION

Presentation of the ED Program by Lori Baitx, ED Manager.

Lori Baitx, ED Manager, presented a PowerPoint of the ED program. No action needed.

Presentation about the Mammoth Hospital Foundation and Introduction to new Foundation Coordinator Gardiner Miller.

Sarah Vigilante, HR Director, introduced Talene Shabanian, former Foundation Coordinator, and Gardiner Miller, new Foundation Coordinator. Talene Shabanian presented a PowerPoint on philanthropy and the Mammoth Hospital Foundation. A discussion was held about volunteerism and increasing the membership of the Mammoth Hospital Auxiliary. No action needed.

XIII. OLD BUSINESS There was no old business to discuss.

XIV. NEW BUSINESS

1. Review and Approval of the Revised Employee Success Sharing Program for FY2020. Melanie Van Winkle, CFO, reviewed the Revised Employee Success Sharing Program for Fiscal Year 2020 as presented in the packet. Stephen Swisher, M.D., moved, seconded by Yuri Parisky, M.D., to approve the Revised Employee Success Sharing Program for FY2020 as presented. A vote was taken; the motion passed unanimously. Yes 4, No 0.

2. Review and approve Management’s recommendation to forego obtaining earthquake insurance for the District properties.


Melanie Van Winkle, CFO, presented the recommendation to forego obtaining earthquake insurance for the District properties. Joanne Hunt moved, seconded by Stephen Swisher, M.D., to approve management’s recommendation to forego obtaining earthquake insurance for the District properties. A vote was taken; the motion passed unanimously. Yes 4, No 0.

3. Quarterly Review of New and Revised Policies. Joanne Hunt moved, seconded by Stephen Swisher, M.D., to approve the Quarterly New and Revised Policies as listed. A vote was taken; the motion passed unanimously. Yes: 4, No: 0.

4. Quarterly Review of New and Revised Contracts.

Joanne Hunt moved, seconded by Stephen Swisher, M.D., to approve the Quarterly New and Revised Contracts as listed. Chair Anderson asked for discussion. A vote was taken; the motion passed unanimously. Yes: 4; No: 0.

5. Declaration of Surplus District Property, Equipment and Supplies. Acting Chair Carlson moved, seconded by Joanne Hunt, to approve the disposal of surplus District property, equipment and supplies presented to the Board and to direct staff to dispose of it in the manner most beneficial to the District. The surplus District property, equipment and supplies presented have nominal or no value. A vote was taken; the motion passed unanimously. Yes 4, No 0.

XV. CREDENTIALING

Re-appointment to Medical Staff David Araya, MD - Hospitalist Don Harrell, MD - Radiology Richard Shedd, MD - Emergency Re-appointment to Affiliate Staff Jason Bishop, DDS - Dentistry Steve Fujimoto, DDS – Dentistry Re-appointment to Locum Tenens Pamela Landsteiner - Dermatology Initial Appointment to Allied Health Chelsea Brown, PA - Orthopedics Re-appointment to Courtesy Staff Richard Brown, MD - Orthopedics Initial Appointment to Provisional Staff Michael Bryan, MD – Dermatology


Stephen Swisher, M.D., introduced a discussion about credentialing definitions. Tom Parker and Craig Burrows, M.D., will follow up with Susan Craig, incoming Medical Staff Coordinator, regarding Dr. Swisher’s concerns. Stephen Swisher, M.D., moved to credential the list of doctors as noted above, with the exception of Drs. Shedd and Harrell and with the following statements: The credentialing for Drs. Bishop, Fujimoto and Araya remain unchanged. Temporary Privileges for Dr. Landsteiner were granted for July 20, 2020-July 17, 2020. Temporary Privileges for Dr. Richard Brown were granted from June 24, 2020-June 30, 2020. Yuri Parisky, M.D., seconded the motion. A vote was taken, the motion passed unanimously. Yes, 4; No, 0. Yuri Parisky, M.D., motioned to approve the credentialing as listed above for Chelsea Brown, PA. Joanne Hunt seconded the motion. A vote was taken, the motion passed unanimously. Yes, 4; No, 0. Dr. Swisher declared a conflict of interest in the vote regarding Dr. Shedd and recused himself from the vote. Joanne Hunt motioned, seconded by Yuri Parisky, M.D., to approve the privileges as listed above for Dr. Richard Shedd. A vote was taken, the motion passed unanimously. Yes, 3; No, 0. One recusal, Dr. Stephen Swisher. Dr. Parisky declared a conflict of interest in the vote regarding Dr. Harrell and recused himself from the vote. Stephen Swisher, M.D., motioned, seconded by Joanne Hunt, to approve the privileges as listed above for Dr. Don Harrell. A vote was taken, the motion passed unanimously. Yes, 3; No, 0. One recusal, Dr. Yuri Parisky. The vote on credentialing for Dr. Michael Bryan was postponed until the July 16, 2020 Board meeting.

XVI. PUBLIC COMMENTS

There were no additional public comments.

XVII. FUTURE BUSINESS The next Regular meeting will take place on Thursday, July 16, 2020 at 8:00 a.m. in Conference Rooms A&B at Mammoth Hospital.

ADJOURN

There being no further business, the meeting was adjourned at 12:24 p.m.


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



DATE: July 16, 2020 TO: Board of Directors FROM: Melanie Van Winkle, CFO RE: CFO Report, Regular Meeting of the Board of Directors

Strategic Updates Financial viability. Meet budget performance on Net Margin and Cash Flow.

Title Description Update

Overall meet budget

• FY20 Net Margin is budgeted at $5.2 million or 7%.

• FY20 Cash Flow is budgeted to end at 340 days cash on hand.

• YTD Net Margin at June 2020 is $16.3 million & 18.6%.

• CARES stimulus funds of $6.2 million has helped to offset the loss in volume thus far.

• Days cash on hand at June 30, 2020 was 422 or $96 million ($30M operating funds, $10M COVID loan funds, and $56M building project fund).

Involvement in state and national rural health issues

Continue involvement in:

• ACO for Medicare members.

• PRIME/QIP3 for Medi-Cal members.

• District Hospital Leader Forum (DHLF) for district hospital funding opportunities.

• Received a 93% quality score for meeting our CY19 metrics in the ACO.

• Pop Health team will be submitting the final FY20 metric results in September.

• Weekly calls with the CFOs to ensure we attain all COVID19 Emergency Funds possible.

• All other activity on hold.

Analyze service line performance

ID high cost service lines.

• Developing reports to be pulled out of Cerner to start this process.


Mammoth Hospital Report to the Board of Directors CFO Report July 16, 2020

Select Operational Updates COVID19 recovery: June was the first month of “regular” volumes where possible. Surgeries increased to more normal levels and the Med/Surg unit had about double the number of patients compared to May.

• June’s Gross Revenue was $10.7 million, exceeded budget.

• Over the last quarter of the fiscal year, we were able to collect ~$8.5 million in settlements/supplements from Medicare and Medi-Cal—these funds and the PRIME funds of $1.2 million were recognized in Net Patient Revenue and Other Operating Income in June which resulted in a very substantial net gain for the month.

• Net Gain for June was $8.9 million, without the recording of the supplemental funds the hospital would have lost ~$1 million for June. With the reduced visitor population, we are heavily weighted in patients who are covered by government insurances, thus less favorable reimbursement.

Financial Audit FY20: The Eide Bailly financial auditors are scheduled to perform their audit of our FY20 books the week of August 17. It is expected they will perform this audit remotely due to COVID19, but we expect effect on completing the audit to present to the Board in October. Budget 2020/21: Budget activity is still on hold due to COVID19. As the town opens and elective procedures/visits/surgeries continue to ramp up we will start the budget process again. It is difficult to predict with any level of certainty the volumes for FY21. We may start revisiting the budget activity in late July or August. Thus, hope to bring a FY21 budget to the Board in September or October.

Develop priority for service line review.

Partner with tertiary hospitals

Potential benefits: Exchange physician services. Improve patient handoffs. Training for staff. Shared staffing. Improve physician satisfaction & retention.

• Moving forward to share Ortho Sports fellowship with Barton. Expect to have two fellows for six months starting in November.

Mammoth Hospital Report to the Board of Directors CFO Report July 16, 2020

Patient Accounts Receivable:

Accounts Receivable continues to be impacted by COVID19. Gross charges generated for June were back to normal levels, as a result we experienced a slight increase in collections. It will take a few more normal months to start seeing the collections catch up. Revenue billed increased significantly as expected with the higher volume in June. The AR > 120 aged dropped by 10% from 40.2% to 30.9%. This is due to a year end push to clean up uncollectible accounts. You will notice a $508,000 adjustment on the income statement for charity write-offs. Dawn and her team are focusing efforts to collect and clean up as much as possible prior to year end however they are down six staff members due to COVID19 childcare issues.

Gross charges generated 9,967,709$ 13,880,346$ 9,723,718$ 2,690,963$ 6,426,984$ 10,796,836$

Discharged Not Final Billed 4,201,043$ 3,402,763$ 1,839,332$ 1,412,037$ 2,577,334$ 4,662,449$

DNFB Days 12.2 7.1 4.2 4.8 12.9 21.1

Revenue billed $11,184,724 $20,297,777 $16,661,397 $7,803,887 $6,515,359 $10,863,768

Clean Claims % 80% 74% 69% 54% 60% 61%

Pt Acct Collections 6,255,165$ 7,610,236$ 8,957,230$ 5,309,300$ 3,175,159$ 3,865,882$

AR balance 21,837,365$ 29,210,325$ 24,172,212$ 18,136,068$ 18,829,931$ 21,086,988$

Gross AR days 63.15 60.63 55.09 62.07 94.20 95.47

AR > 120 days 24.9% 19.2% 23.1% 39.4% 40.2% 30.9%

AR $$ > 120 days 5,444,423$ 5,623,151$ 5,572,581$ 7,141,798$ 7,573,743$ 6,506,881$

June 20Mar 20 Apr 20

COVID19 Impact

May 20Feb 20June 19


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DATE: July 16, 2020 TO: Board of Directors FROM: Caitlin Crunk, RN, BSN, CNO RE: CNO Report, Regular Meeting of the Board of Directors

Strategic Plan Updates


Implement Beta HEART Program

Beta HEART is a multi-year collaborative sponsored by Beta Healthcare to guide organizations in implementing a reliable and sustainable culture of patient safety that is grounded in a philosophy of HEART: Healing, Empathy, Accountability, Resolution, and Trust. In an endeavor to reduce harm in health, 5 domains will be implemented over the course of 3-5 years.

• Beta Quest for Zero: Starting Shoulder Dystocia education and drills in OB.

Journey to Become a High Reliability Organization

Mammoth Hospital will continue to progress toward high reliability, adopting the Joint Commission framework outlining the four stages of organizational maturity that define milestones for each of the fourteen specific characteristics of a health care organization.

• Continuing to use Just Culture throughout the organization to ensure standardization of employee treatment.

• Education and plans in place to prepare for inpatient Covid Surge to ensure highest level of patient and staff safety.


Mammoth Hospital Report to the Board of Directors CNO Report July 16, 2020

Select Operational Updates People

• Phyllis Meneses still acting as interim until we hire a full-time Perioperative Director.

• All departments are continuing to flex 10% in accordance with volumes while ensuring to not jeopardize patient safety.

• Ali Miller has been promoted to an ED/Lead Supervisor role. This is a new hybrid role that will combine ED Supervisor needs as well as coordination with all house supervisors. This will ideally streamline nursing education within the hospital setting.

Quality and Safety

• Community Health Needs Assessment (CHNA) update will be provided.

• Internal audit performed in June on Med/Surg for pain medication process. Waiting for the results of the audit.

Service

• Hospital returned to offering all surgical services and ramping up to work through back logs of elective cases.

• PACU divided to accommodate Covid positive, Covid Rule out and Covid negative patients. Accommodations made due to lack of rapid testing.

Growth

• Barcode scanning implemented in OR to help streamline documentation and charge capture.

• Heather Anderson is offering the Neonatal Resuscitation Program each month as needed to ensure staff is educated and within compliance.


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DATE: July 16, 2020

TO: Board of Directors

FROM: Craig Burrows, MD

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

Strategic Plan Updates Provide the Medical Services locally that are most needed by the community.


Grow Surgical Services OR room 3. Expected to go live in late August or September 2020.

Addition of Ortho PA. Chelsea Brown started July 6, 2020.

Neurology Need this service in Mono County.

Still looking for neurologist.

Rheumatology Replacement for Dr. Jaffer. Ongoing efforts to coordinate with Dr. Michelle Newkirk.

MAT clinic Treatment for patients with opioid abuse.

Anticipate beginning this service this year.

Cardiology Desire to increase local services.

Pre-COVID, I spoke with the CMO of Carson-Tahoe, who is interested in pursuing relationship.

Internal Medicine Establish Outpatient clinic. Interview with Dr. Andrew McAlpin in June 2020.

COVID-19 update: The hospital continues to return to full volumes Clinics have been given the direction to return to full volume capacity, and have ramped up significantly in the last few weeks. Likewise, the OR has returned to its normal block schedule, and elective surgeries are being scheduled and performed on a daily basis. All patients being seen in the facility are being screened for symptoms and temperature prior to entering. All


Mammoth Hospital Report to the Board of Directors CMO Report July 16, 2020

patients having a procedure performed are tested for COVID-19 to maintain our tenet of not allowing the hospital for be a vector for the spread of the virus. We have transformed the old specialty clinic into a sick clinic for all aspects of hospital operations. This clinic now serves as a location for patients to be seen through a car visit and in an exam room as necessary. The lab performs swabs for surgery patients there as well as patients referred by the public health department for tracer testing. As of a meeting with the EOC on July 3, 2020, there are plans for the Mono County Public Health department to develop a clinic location for patients calling the 211 hotline. Rather than having these patients present to the ER for a nurse visit and swabbing, they will instead be referred to the testing clinic which will likely be the community center. There, the patient can have a nurse visit and be swabbed for free without the need for a clinic visit or an ED visit. Certainly, patients that are more ill-appearing will be referred to the hospital for a more formal evaluation. This will ease congestion in the lab, the ED, and the clinics. COVID-19 in the community As of this writing, there are now 41 confirmed cases of COVID-19 in the community. There has not been a patient with an active infection admitted to the hospital since late March, which validates any newly identified cases are not impacting the hospital’s capacity to care for patients. Therefore, the triggers to move the community forward and open more aspects of business and lodging have not been compromised. The hospital is able to treat all patients without crisis standards of care, test all people with COVID-19 symptoms, and conduct active monitoring of confirmed cases and their contacts. There is however a severe shortage of the testing supplies needed for rapid testing. This has the potential impact of losing the integrity of having zones which are free of COVID-19. If we are unable to perform rapid tests, the entire hospital will need to be considered COVID-19 positive. This is a supply issue for many hospitals, and is not unique to Mammoth. As the rest of the state and many parts of the country see increases in cases, we remain hopeful that the efforts put forth by all of Mono County will prevent the pandemic from spreading in our area. Medical staff The Opioid Epidemic: With the completion of the specialty clinic and the easing of restrictions on which clinic patients may be seen, it is anticipated the Bridge clinic will be able to start seeing patients. The hospital has X-waivered providers in place, behavioral health, and a substance use navigator in place.


Multidisciplinary Peer Review Committee: This committee has resumed regular activity as of June 2020. Bylaws rewrite: This committee continues biweekly meetings to formally update the medical staff bylaws, and we are making good progress. The committee consists of Craig Burrows, DM, CMO, Peter Clark, MD, Rich Koehler, MD, COS, and Lindsey Sarullo, JD. Cerner: Efforts continue to enhance our providers’ experience with the EMR. Nearly all the ED physicians have all converted over to Dynamic Documentation, which is the supported format for documentation. The previously utilized PowerNote format is no longer an area of active research and development on the part of Cerner. In order to improve workflow and process, sprints have either been done or are underway in the PACU, PT/OT, and Materials Management. Other areas of consideration include the ED and the Med/Surg unit. Video Visits are now fully integrated into the system, which facilitates telemedicine visits and helps our providers and staff maintain the necessary physical distancing to keep patients and staff safe and minimize the spread of COVID-19. OR Services: Work continues in the area of optimizing efficiency in the OR with respect to minimizing delays between cases. It is anticipated that the addition of a third OR will help in this endeavor. Due to the severe shortage of the supplies necessary for rapid in-house testing, all patients scheduled for an elective procedure are being tested for COVID-19 5-7 days of advance with a send-out test. While this is creating a significant inconvenience in scheduling, we are hopeful this is a temporary situation, and that we will be able to replenish our stock of rapid tests. In the meantime, the entire team continues to find creative ways to preserve our supply. Physician Recruitment Orthopedics: We will be bringing on a new PA in July 2020, Chelsea Brown. She will be working with Dr. Knecht to enhance foot and ankle services. Urology services: Dr. Paul Polishuk from San Diego continues with a clinic week every month. Anesthesia: Coverage currently consists of Dr. Jon Bourne, Dr. Nat Parker, Dr. Larry Silver, and Dr. Eric Bourne, and Dr. Caroline Saba. The group has a plan in place to staff our expanding OR services. Family Medicine: Staffing continues with Drs. Ward, Clark, and Crunk, and Carolyn Korfiatis, NP and Cara Crosby, PA. There are no immediate plans to add another provider, but Dr. Crunk intends to slow down his practice and potentially retire in December 2020.


We interviewed Dr. Andrew McAlpin, an internist, in June 2020. He is a colleague of Dr. Koehler’s and is potentially interested in relocating to the area and providing outpatient internal medicine services. Plastic Surgery: Plastic surgery services with Dr. Monson are currently on hold due to limitations in clinic and OR space as well as the COVID-19 pandemic. However, with the opening of the specialty clinic and the third OR, it is anticipated this service line can once again be actively pursued. Rheumatology: We will be losing Dr. Adrian Jaffer to retirement in January, but there is another interested physician, Dr. Michelle Newkirk. Her status to provide services here at Mammoth remain uncertain. Dermatology: Dr. Mike Bryan will join Dr. Tim Cragun starting in November 2020, and the two will provide dermatology services every month of the year. Cardiology: Prior to the onset of the COVID-19 pandemic, I had had some preliminary discussions with the CMO for Carson-Tahoe about adding their cardiologists to our staff as visiting physicians. He was very interested in pursuing this, and we will resume discussions in the weeks to come as the pandemic becomes less of an immediate concern. PICC Line Placement Brandy Wilt, one of our Med/surg nurses, completed training on this procedure in October 2019, so we may offer it to our patients every day of the week. We also anticipate training Allison Miller, a nurse in the ED, to perform this procedure as well. Dr. Harrell of Radiology also performs this service.


________________________________________________________________________________________________________




DATE: July 16, 2020 TO: Board of Directors FROM: Mark Lind, CIO RE: CIO Report; Regular Meeting of the Board of Directors

Strategic Plan Updates


Execute the Facilities Development Plan

Expand clinic space for specialty practices, dentists and laboratory.

• The building was substantially completed in April. In use by the Family Medicine Clinic as the “Drive Up Sick Clinic” in May. Specialty Clinic moved over week of May 25. Project complete.

Improve pedestrian safety and parking for Medical Office Building.

• Completed projects to widen the upper driveway and replaced Medical Office Building stairs. Both projects greatly improve pedestrian safety. Currently working with civil engineer on South/Upper parking lot expansion. This project on hold pending resolution of pandemic.

Increase employee housing inventory.

• Reorganization of SGSA apartments to incorporate on call and temporary housing for providers and staff is completed. All call units have been cleaned up with paint, laminate flooring, and updated


Mammoth Hospital Report to the Board of Directors CIO Report July 16, 2020

furniture. Overall repairs to the SGSA have also been completed with interior and exterior painting, roof repairs, and repairs to the heating system. Item complete.

• Long delayed maintenance of our condo inventory has been completed with painting, flooring, and finish work done on all units. Currently working with the new housing committee on the L’Abri condos to repair or replace the stairs and decking. Repairs on hold pending resolution of the pandemic.

Maintain our medical imaging devices to provide high quality and high availability solutions to meet our patient care needs.

• Canon MRI now fully functional and in daily use. Project complete.

• Replacement for the Fluro modality, which is past end of life, has been agreed to by the stakeholders. The preferred unit is a Siemens RAX system which provides flour, weight bearing X-ray, and limited CT capability. It has been determined that we will need to widen the existing Fluro room in Radiology and move the patient restroom to a different wall to comply with Siemens’ size requirements for this robotic unit. Preliminary designs for the room have been done by our architect and provided to Siemens so that they can provide a


turn-key quote for the project. Project on hold.

• We plan to add a third C-Arm unit to our equipment inventory in support of the OR3 project. The C-Arm selection was made through soliciting feedback from our surgeons, Radiologists and rad tech team. Project on hold.

• Replacement of the obsolete ultrasound unit is being planned. Current unit at end of life. Project delayed until next fiscal year (FY ‘21) due to pandemic.

Convert underutilized space in A Building.

• The project is on hold pending completion of the planned new hospital wing.

Fully adopt and optimize our investments in information technology

Improve the hospital IT infrastructure to enhance performance, reliability, disaster preparedness, and security.

• Selection process for our virtual server host solution started as we are nearing end of life (and support) on our Simplivity hyperconvergence solution. Project on urgent list for FY ‘21 capital equipment.

• Upgrade to our Citrix Cloud web-application and virtual desktop solution complete as of May 2019. Recently moved our outside coding company and managers, who access systems remotely, to the new solution. Project complete.

Enhance and expand our existing device integration with the EMR to improve clinician workflow and to provide real-

• EKG integration project with Cerner underway. Family Medicine and Cardiology/Specialty now


time patient results and monitoring to clinical staff.

using. Informatics team training the ED physicians and hospitalists on the new workflow. Mid-July roll out to the hospital and ED.

• Investigating patient monitoring integration with Cerner. Raizel is a cellular network-based solution that integrates home monitoring devices (blood pressure, weight, glucose) with the EMR to allow the provider to better manage patients with chronic conditions. Work is ongoing to obtain grant funding to allow for this project.

Continue to provide support to providers and staff to enable their optimized use of our Cerner and associated EMR systems.

• Project to move Mammoth Hospital to a Cerner Reference site started in June 2019. Initial project step of surveying all MH Cerner EMR users complete in July with an average score of 3.3 (on a five-point scale, with five being the highest). The agreed goal is to bring the average score up to 4.0 or higher satisfaction rate.

• PACU Department Sprint complete in September. Work done to optimize and standardize workflows, short cuts published, issue with settings persistence take to Cerner and solution found. Follow up survey done which raised the score 0.7, representing a significant increase. Complete.


• PT/OT Sprint is now complete. Survey performed at project wrap up in May with an improvement from 3.07 to 3.20, so a total of 0.13 (scale of 1 to 5, 5 being the highest score). Complete until new DynDoc solution is released by Cerner in 2021.

• The Sprint on Perioperative Materials is nearing completion. Inventory for surgery has been reworked to standardize descriptions, eliminate duplicates, and integrate bar codes. OR team now using bar code scanning to add inventory to cases and subtract it as needed. Surgery physician preference cards have been updated to eliminate the low use items and to make them more accurate. Set up of a stand-alone inventory for the Periop department now in place. This will allow for much for accurate inventory tracking and replenishment. Finally, the implant log is in place and working as required to meet regulatory requirements. Kudos to Phyllis Meneses and the Periop team, as well as Purchasing and Informatics teams for their hard work on this project.

• The Laboratory Sprint has been placed on hold


pending a resumption of normal operations.

• The Chemotherapy Sprint started up the week of May 18. Improvements pending to get orders, referrals and follow up process automated and working more efficiently. Working to complete project in August.

• Note: Decision made at EMR Governance to send out the satisfaction survey to the organization again to see if there have been changes in Cerner perception. Will use updated survey data to identify which departments likely need assistance.

Select Operational Updates Laboratory: The new “consolidated drive up testing clinic” now in place behind Old Specialty

Clinic department. This clinic replaces the Sick Clinic staffed by Family Medicine in the back of

the New Specialty Clinic, the ED drive up clinic for County tracing referrals, and the Lab pre-

surgery clinic. Family Medicine is currently providing sick visits in the afternoons, while the Lab

team is performing pre-surgery testing, and Mono County COVID testing referrals throughout

the day. Family Medicine works out of a different room than the Lab in the back of the old

Specialty Clinic allowing for examinations if needed in an exam room.

Maintaining adequate rapid test PCR COVID test cassettes has been on ongoing struggle. Our

supplier for these cassettes, Cepheid, has not been fulfilling their weekly planned shipments

forcing the hospital to move to LabCorp send out testing, which can take several days, for all

but hospital admissions, emergency surgery, and critically ill patients with COVID symptoms.

Work is now ongoing to obtain a contract with a new lab instrument supplier to provide rapid,

in-house, testing capability.

The laboratory team took advantage of the slowdown in April and May to rework and publish a

large number of test/instrument policy and procedure documents. Great work was completed

by Lea Kirk in overall coordination of the policies, Jason Marx in Micro, Laura Gowing in


Chemistry, and Justin Phelps in Blood Bank. A special thank you is also extended to Kathy

Romagnino for her assistance in removing duplicates and archiving obsolete policies. It should

be noted that the Laboratory has by far the largest number of policies and procedures in the

organization.

Also accomplished during the slowdown, was bringing the rapid PCR COVID testing in-house on

our Cepheid test instrument. This took a lot of effort to build out the new test, set up the

quality control and other required steps.

Laboratory test volumes have largely returned to normal, with 6,184 tests being completed in

June versus a budget of 6,243. Essentially 99.0% of normal for the month. With staffing the

drive-up clinic and meeting the higher volumes, the lab staff have been working very hard to

meet the requirements of our patients and providers.


________________________________________________________________________________________________________




DATE: July 16, 2020

TO: Board of Directors

FROM: Sarah Vigilante, HR Director

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

Select Operational Updates

• Monday, July 6 was our first “normal” orientation. It went well and we have resumed

our regular orientation schedule with the goal of orienting no more than 5 employees at

a time in order to ensure physical distancing requirements can be met. Tom Parker has

taken over the introduction slides to Mammoth Hospital and we are excited to have him

join the orientation process.

• The Senior Admin Team met with Gallagher consulting in late June to pick back up work

on the compensation project. The goal of this project is to de-couple pay from

performance evaluations and move our compensation structure to a more progressive

best practice model using higher benchmarking data.

• We continue to have office staff work from home when they can. We anticipate this will

continue for quite some time. We still have some departments that are heavily

impacted by the school and childcare closures.

• Tom Parker and Sarah Vigilante have been meeting with Craig Albright and Debbie Teller

from Mammoth Mountain. We are working together to create a MOU for collaboration

on Kids Corner Childcare Center.

• The Foundation has raised $38,385 through the COVID relief fund. The Crowley Lake

Run this year will raise funds to be donated to the Hospital Foundation. The Crowley

Run will begin July 15 and end August 1 and there are three options for participation

(10k, 5k & a kids 1k). This money has been used for:

o Gas scavenging unit (removes excess nitrous oxide)

o Dental suction for aerosols

o Air filtration system for dental clinic

o Scrubs (180 pairs)

o Nebulizer for vents (adds moisture to prevent dry airways)

o ZipWall Containment Systems

o Covid-19 Express tests


Mammoth Hospital Report to the Board of Directors HR Report July 16, 2020

• The Cancer Outreach Committee has decided to hold a modified golf tournament on Friday, September 25, 2020. This tournament will have a staggered start to ensure no congregating at the start and there will be no group meals. We are hopeful that we will be able to continue to raise the funds needed for patients seeking cancer treatment at facilities outside of Mammoth.

• We had our annual meeting with USI (our insurance broker) to go over plan changes and prepare for open enrollment in the fall. Overall this was a positive meeting with no substantial problems with the plan and few modifications needed going forward.

Finance Committee Minutes Date: Monday, June 15, 2020 Time: 4:30 pm Location: Teams Attendees: Tom Parker; Stephen Swisher; Dave Anderson; Melanie Van Winkle; Slavka Crouthamel; Caitlin Crunk. The meeting was called to order by Dr. Swisher at 4:33 pm.

Agenda Item:

Discussion/Conclusion/Action

Follow-up

Review of Minutes • May 19, 2020 minutes were reviewed. No changes were requested.

Follow-up • There was no follow-up.

Financials – May 2020 Melanie went over the balance sheet and PowerPoint with the group.

• We have more cash than we have ever had $93.8 M = 419 days cash on hand.

• Received $10 M in CARES, $4.6 M in stimulus funds that we do not have to pay back and $5.2 M in PPP loan. Hopefully, we won’t have to pay that back but no clear direction yet.

• Received $3.6 M in Medi-Cal supplementation funds in May. Received $1 M IGT funds back – sent $500,000.

• Received another $1 M today for another Medi-Cal program for outpatient services.

• Most clinics increasing volumes. Family Medicine is probably at about 65% of normal. Manager feels like they are seeing everyone who wants to be seen.

• Tom noted that the managers did a great job flexing to volumes. Earthquake Insurance

• Earthquake insurance memo is in the board packet.

• Broker gave three options: Best coverage (still very limited) $100,000 deductible and premium is $181,000 a year (double what we pay for our regular property insurance).

• Broker noted that only two California hospitals carry earthquake insurance (one because it is mandated, the other is a long-standing decision).

• Dr. Swisher agreed with management’s recommendation to forego earthquake insurance at this time.

• See Financial PowerPoint.

Mammoth Hospital Finance Committee Minutes – June 15, 2020

Page 2 of 2

• Melanie included a motion suggestion in the packet.

• Melanie noted that our property insurance rates are all going up about 25%.

• Workers’ compensation also going up quite a bit. Success Sharing

• Likely to meet financial covenant.

• Beta cancelled the employee survey in March. Management recommends allocating survey dollars to the other two categories.

• Dr. Swisher and David Anderson agreed with the revision to the success sharing plan.

• Estimated payout ~$.5 M.

COVID-19 Activities Emergency Funding:

• $6.2 M stimulus that we don’t have to pay back, $10.3 that we do.

• $16.5 M postponed payback is why cash is so high.

• Without CARES we would be down $7.7 M. Financial Forecast:

• $6 M without CARES stimulus funds.

• $5.2 M PPP loan is not included because we don’t know if we have to pay it back yet.

Cash Projection:

• Could end up over $94 M, 420 days cash on hand.

• Possible profit in the month of June of over $5 M that would bring us to a net gain of ~$12.5 M for the year, which is phenomenal with everything we are going through.

• Do have $5.7 M we have to pay back to Medicare.

• Not expecting any more funds in June.

• See financial presentation.

Other Business • Auditors planning on doing remote audit in August.

• Budget: need to see what June brings.

• Facility project finance plan still on hold.

• Received additional bids from architects on facility project.

Next Meeting • Next meeting: Monday, July 13, at 4:30 pm.

Meeting adjourned at 5:07 pm.


________________________________________________________________________________________________________




SOUTHERN MONO HEALTHCARE DISTRICT BOARD OF DIRECTORS

QUALITY ASSURANCE COMMITTEE MEETING MINUTES

Date: June 17, 2020 Place: Microsoft Teams Attendance of Board Members: Stephen Swisher, M.D., Treasurer; Joanne Hunt, Secretary. Attendance of Staff Members: Tom Parker, Chief Executive Officer; Kathleen Alo, Chief

Nursing Officer; Lenna Monte, Director of Quality; Stephanie Stanton, Quality Improvement Coordinator; Sarah Rea, Recording Secretary.

I. CALL TO ORDER

Lenna Monte called the meeting to order at 3:02 p.m.

II. NEW BUSINESS

1. Review of Minutes The minutes from the December 17, 2019 meeting were reviewed and there were no changes.

2. Incident Reporting (VERGE)

Stephanie Stanton discussed Verge Reporting. Trends are good. There were some questions from Dr. Swisher regarding possible “Verge fatigue.” Stephanie suggested she could discuss this at the next Nurse Managers/Clinical Managers meeting. Stephanie would like to respond to filers to thank them for filing, similar to the way she follows up with those who report near misses. Stephanie also plans to “risk round” units moving forward. This would be a good item for Management Team—how do you communicate Verges that are happening in your department? A Verge is an invitation to discuss an issue.

3. Beta HEART Program Stephanie Stanton discussed the Beta HEART domains that Mammoth Hospital is currently working on. This is a multi-year project. Steering committee looks at domains and how to advertise Culture of Safety. Communication domain on hold due to COVID19. Did achieve continued validation for Culture of Safety and first-time validation for Care for the Caregiver.


Southern Mono Health Care District Quality Assurance Committee Meeting Minutes June 17, 2020

We will receive 2% off our premiums for each domain achieved. There was a question from Tom Parker regarding our domain achievement and continuation of premium discount.

4. NIAHO Standards Updates Lenna Monte discussed the NIAHO Standards Update. Much of these changes is the use of evidence-based practice. Measureable Objectives for each department in organization for QAPI Plan. Have until March of next year. Big changes to infection control section. DNV will be conducting survey via Teams. Joanne Hunt had questions regarding discharge planning and outpatient assessments.

5. Review of Fiscal Year 2021 Plans a) Quality Improvement b) Risk Management c) Infection Prevention d) Case management

There were no questions from the Committee regarding these plans.

6. Review PI Committee Meeting Minutes 3.9.2020, 5.11.2020, 6.8.2020 The PI Committee Meeting Minutes were included in the packet and were reviewed by the committee members prior to the meeting. Lenna Monte noted that there was no meeting in April due to COVID19. Dr. Swisher suggested that it might be a good time to lower Press Ganey priority. Dr. Swisher suggested putting Press Ganey entirely under Quality Assurance and not disseminating it to a wider audience. Lenna will discuss with Jaymee Peterson and will take findings back to PI Committee.

III. FUTURE BUSINESS

The next Quality Assurance Committee Meeting is scheduled for September 16, 2020 at 3:00 p.m.

ADJOURN



________________________________________________________________________________________________________




SOUTHERN MONO HEALTH CARE DISTRICT BOARD OF DIRECTORS

IT STEERING COMMITTEE MEETING MINUTES

Date: June 16, 2020 Time: 12:00 p.m. Place: Mammoth Hospital Administration, Teams Meeting 85 Sierra Park Road Mammoth Lakes, CA 93546 Attendance of Board Members: Stephen Swisher, M.D., Yuri Parisky, M.D. Attendance of Staff Members: Tom Parker, Chief Executive Officer; Melanie Van Winkle,

Chief Financial Officer; Mark Lind, Chief Information Officer; Caitlin Crunk, Chief Nursing Officer; Dr. Craig Burrows, Chief Medical Officer; Phyllis Meneses; Nicole Hook; Michael McMahon; Alasdair Simonds; Kevin Larsen; Alhaji Bah; Laurie Kalember; Dr. Peter Clark; Ed Lembcke; Sarah Rea (recording).

1. CALL TO ORDER

The meeting was called to order at 12:03 p.m.

2. REVIEW MINUTES

The minutes were reviewed. A discussion was held about the development of Dynamic Documentation for PT and Dr. Swisher’s request to be reimbursed for our time. The discussion was tabled due to presence of Ed Lembcke. The Committee did not complete the discussion. Ed Lembcke did not have a date for DynDoc for Physical Therapy being available. His best estimate is a year out.

3. NEW BUSINESS a. Exchange Migration and Teams

The Hospital has moved from an on premise to Office 365 cloud-hosted solution for email. Brian Weller reported today that he has moved the last of the staff over to the new solution. This allows for anywhere-access to email and cuts costs. Alasdair Simonds gave an explanation of this project. Staff are hoping to move from on-premise SharePoint to cloud as well. Staff could


2

have contracted outside support for this project, but there was a big cost savings on doing this in-house. Congratulations to Brian Weller on getting this done. Additional functionality with Teams, Breezy HR, and other third part solutions now available.

b. DR Teleradiology Yuri Parisky, M.D. explained this project. Tom discussed credentialing of teleradiology doctors/groups and delegating the credentialing process while still having the Board of Directors approve privileges.

c. VMWare Upgrade This hosts the virtual desktops/portal. Currently on v.6. Issue with Simplivity (our server host solution) and have until October to perform upgrade before support is no longer valid. There will be some impacts to coders and those working remotely when we make the transition. Further communications to follow.

d. Core Switch Failure One of two network core switches became unstable and had to be taken offline. Acquired refurbished unit as replacement. The Hospital only has one switch while waiting for the new one to be installed. If one failed, it would be approximately 24+ hours to fix. Switches cost approx. $50,000 for two new ones. Mark is hoping to schedule a new core switch replacement for next capital cycle. These are on the expedite list.

4. OLD BUSINESS

a. Nuance Projects Update i. PowerShare Deployment

HIMS is doing well with this new product, lots of studies being sent electronically. One of the two DVD burners has been removed from service. Keeping one as a backup. Would be wise to wait prior to eliminating old unit, but eventually would like to make this move to cut costs. Re: Referrals, Lenna is taking the lead and Lisa Marusicz also working on this. Anyone getting referrals gets studies they need with referring provider. Dr. Parisky recommending all oncology-related patients get their images sent as a default. Working out logistics. Will need to alert referral team that this imaging will get sent. Lenna’s team putting together this plan. Loopholes/HIPAA issues will be covered with PDCA.

ii. Nuance Actionable Findings

Nothing to report other than these are in capital plan.

iii. Follow Up Manager Solutions

3

Same as above.

b. Cerner Reference Site Project Good buy-in from Cerner management for improvement project. Have been getting higher level support, with direct access to solution owners for each module as we work the Sprints.

i. PACU sprint Complete Dec. 2019.

ii. PT/OT Sprint

Completed in May. Survey results were discussed. Lost ground on EMRs contributing to patient safety, which is of concern. Big difference between clinical and front office staff in PT. Lots of our gains were in front office workflows. Dyn Doc has potential to help clinical staff tremendously and score won’t improve until it is available.

iii. Periop/Materials Sprint In progress. Main goal to get perpetual inventory up and running for Periop, barcode scanning working, inventory reworked. Cerner implant log went live yesterday. Phyllis reported it is working wonderfully so far. A few issues with items not in system that need to be built. Big thanks to Andrew Crosby and his team, and IT Informatics team. Current goal is July 1 for perpetual inventory and completion of project.

iv. Laboratory Sprint Started project and identified some issues but had to place on hold as lab very busy with pandemic. Looking at starting back up in July.

v. Chemo Sprint Caitlin Crunk working with Chemo RN Lisa Marucisz. Agree to begin sprint in July. Currently a sensitive time with oncology patients due to pandemic as they don’t want other staff in department. Caitlin will ensure she and referrals team will not be duplicating efforts. Laurie Kalember is currently working on improvements. Collaborating with another site already doing Chemo in Cerner. Future surveys/sprints: Purchasing post-periop, Med/Surg and Emergency Department.

5. Q&A Dr. Clark discussed telemedicine: Best to do over video through portal in Cerner. Approx. 30% of patients have technical difficulties as they have poor internet or are don’t understand how to set up client. Dr. Clark requested that we revisit putting better effort into onboarding on portal.

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Currently relying on front office staff to explain this. Alhaji said that they have created an Excel spreadsheet of everyone in Mono County not on portal. This to be used to identify patients when setting up telemedicine visits. Have sent managers education on how to set up Video Visits through the portal. Nicole has been leading a telemedicine group for a few months, meeting with clinic staff to facilitate the process. Add this to agendas moving forward: How we are progressing on this. Ed Lembcke left the meeting at 1:08 p.m. and a conversation was held regarding sprints. Dr. Swisher suggested that future planning and process changes are helpful, but user satisfaction will not improve unless the systems already in place work consistently and efficiently. He asked that the IT Steering Committee needs to know what happens to unresolved issues.

6. FUTURE BUSINESS The next IT Steering Committee meeting will be held on October 13, 2020.

7. ADJOURN

The meeting adjourned at 1:23 p.m.


________________________________________________________________________________________________________




SOUTHERN MONO HEALTHCARE DISTRICT BOARD OF DIRECTORS BOARD MEMBER RECRUITMENT COMMITTEE MEETING MINUTES

Date: June 29, 2020 Time: 4:00 p.m. Place: Mammoth Hospital Administration, Teams 85 Sierra Park Road Mammoth Lakes, CA 93546

I. CALL TO ORDER

The meeting was called to order at 4:03 p.m.

II. NEW BUSINESS

1. Review of Minutes The minutes were reviewed. No changes.

2. Discussion of Next Election Cycle Sarah Rea discussed the process for the upcoming election on November 3, 2020. Both Dave Anderson and Laurey Carlson expressed that they were leaning towards retaining their seats. Luis Villanueva, VP of Lodging at Mammoth Resorts, was discussed as potential Board member. He is also a member of the Chamber of Commerce Board of Directors. He is active in the Spanish-speaking community. Laurey Carlson will approach him to gauge interest and will report back to the Committee.

III. FUTURE BUSINESS The next Board Member Recruitment Committee meeting is to be determined.

ADJOURN




________________________________________________________________________________________________________




DATE: July 16, 2020 TO: Board of Directors FROM: Tom Parker, CEO RE: CEO Report, Regular Meeting of the Board of Directors

COVID-19 (C19) C19 planning continues to be done by the Admin Team having transitioned those duties from the Hospital Incident Management Team. June saw continued ramp up of non-C19 patients in every area of the hospital and clinics. As shown in the finance report, gross patient revenues increased significantly in June reflecting the increase in patient care volume. PPE supplies on hand remain high with 60 plus days at surge use rates for all critical supplies needed to manage C19 patients. There is a supply shortage of rapid tests and conservation procedures are in place to prioritize their use of inpatients. Screening of all patients, staff, and patient companions continues at each entrance to the hospital and clinics. The PACU has been divided into zones to accommodate C19 positive, C19 rule-out and C19 negative patients. Jamie Sallee, Lab Manager, is working on new supplier options to provide rapid in-house testing. The car clinic that was located at the new Specialty Clinic has been moved to, and combined

with, pre-procedure testing being run out of the old specialty clinic. Cases have increased in

Mono County reflecting the general increase state-wide and nationally. As of the writing of this

report, no inpatients have tested positive since March.

Year-to-Date Financial Results Total Gross Revenue of $127.9 million is higher than budget by $5.5 million and $4.4 million higher than last year. Total Operating Revenue (collectable revenue) was $87.9 million which is $13.7 million higher than budget (mainly due to COVID and other supplements/settlements booked) and $6.1 million higher than last year. Total Operating Expenses of $72.6 million are $3.2 million higher than budget, and $4.6 million higher than prior year. Professional Services (physician payments) are $2.3 million over budget, mainly due to the first 8 months of high volume, Supplies are $1.0 million over budget due to


Mammoth Hospital Report to the Board of Directors CEO Report July 16, 2020

higher complex surgical cases prior to the COVID19 pandemic. These two above are offset by a $354,000 favorable Salaries and Benefit net expense. Year to date preliminary Net Gain of $16.3 million (18.6% total margin) which is $11.1 million higher than budget and $1.4 million higher than last year. IT and Informatics We are investigating patient monitoring integration with Cerner. Raizel is a cellular network-based solution that integrates home monitoring devices (blood pressure, weight, glucose) with the EMR to allow the provider to better manage patients with chronic conditions. Work is ongoing to obtain grant funding to allow for this project. The sprint on Perioperative Materials is nearing completion. Inventory for surgery has been reworked to standardize descriptions, eliminate duplicates, and integrate bar codes. The OR team is now using bar code scanning to add inventory to cases and subtract it as needed. Surgery physician preference cards have been updated to eliminate the low use items and to make them more accurate. Set up of a stand-alone inventory for the Periop department now in place. This will allow for much for accurate inventory tracking and replenishment. Finally, the implant log is in place and working as required to meet regulatory requirements. Kudos to Phyllis Meneses and the Periop team, as well as Purchasing and Informatics teams for their hard work on this project.

A decision was made at EMR Governance to send out a satisfaction survey to the organization again to see if there have been changes in user satisfaction with the EMR. Will use updated survey data to identify which departments likely need assistance.

Provider Recruitment Chelsea Brown has started work as a PA in orthopedics.

Dr. Andrew McAlpin, Internist, visited the hospital and interviewed with clinical and administrative staff. Both parties continue to show interest in his candidacy for working in the Family Medicine Clinic. Dr. Mike Bryan will join Dr. Tim Cragun starting in November 2020, and the two will provide dermatology services every month of the year. Clinics We have transformed the old specialty clinic into a sick clinic for all aspects of hospital operations. This clinic now serves as a location for patients to be seen through a car visit and in an exam room as necessary. The lab performs swabs for surgery patients there as well as patients referred by the public health department for tracer testing.

Mammoth Hospital Report to the Board of Directors CEO Report July 16, 2020

With the completion of the specialty clinic and the easing of restrictions on which clinic patients may be seen, it is anticipated the Bridge clinic will be able to start seeing patients. The hospital has X-waivered providers in place, behavioral health, and a substance use navigator in place. Patient Care Services and Nurse Staffing Phyllis Meneses continues to serve as interim director of perioperative services until we hire a full-time director. All departments are continuing to flex 10% in accordance with volumes while ensuring to not jeopardize patient safety. Ali Miller has been promoted to an ED/Lead Supervisor role. This is a new hybrid role that will combine ED Supervisor needs as well as coordination of all house supervisors. Heather Anderson is offering the Neonatal Resuscitation Program each month as needed to ensure staff is educated and within compliance. Human Resources/Marketing/Foundation We continue to have office staff work from home when they can. We anticipate this will

continue for quite some time. We still have some departments that are heavily impacted by the

school and childcare closures.

Sarah Vigilante and I have been meeting with Craig Albright and Debbie Teller from Mammoth

Mountain. We are working together to create a MOU for collaboration on Kids Corner Childcare

Center.

The Foundation has raised $38,385 through the COVID19 relief fund. The Crowley Lake Run this year will raise funds to be donated to the Hospital Foundation. The Cancer Outreach Committee has decided to hold a modified golf tournament on Friday, September 25, 2020. This tournament will have a staggered start to ensure no congregating at the start and there will be no group meals. We are hopeful that we will be able to continue to raise the funds needed for patients seeking cancer treatment at facilities outside of Mammoth. Respectfully submitted, Tom Parker, CEO


MEMORANDUM

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

DATE: July 16, 2020

TO: The Board of Directors

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

SUBJECT: Financial Statements for twelve months ended June 2020

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

This memorandum presents an overview of Mammoth Hospital financial operations. This report is a

preliminary year-end report as we will update with final Year End FY2020 numbers at the end of July

2020. Our annual fiscal year-end audit will be conducted the week of August 17, 2020 and expect to

bring the audited financial report to the Board in October 2020

COVID19 Summary of events

Patient volumes in June 2020 were much closer to normal in many areas. However, some departments

such as the emergency, rehab, clinics and some imaging services are still behind normal levels due to the

COVID19 pandemic.

BALANCE SHEET

• The June month end Cash balance was $96.2 million – $2.4 million higher than May

o Received $1.1 million for AB915 Outpatient Medi-Cal Supplement

o Received $1.8 million for Interim Rate Reimbursement Medicare Cost Report FY20

o Received $50 thousand for AB113 Inpatient Medi-Cal Supplement

• Net Patient Accounts Receivable was $10.6 million which is $758 thousand higher than prior

month

• Other current assets decreased by approximately $164 thousand – due to May reconciliation of

Mono county accounts

• Equipment increased by $120 thousand due to capitalization of the new ventilators and Cerner

Infection Control module

• Due to third party decreased by $6.6 million

o Recognized income for $4.6 million FY19 Medi-Cal managed care supplement

o Recognized income for $1.2 million for PRIME funds

o Recognized income for $600 thousand for HQAF funds

o Recognized income for $120 thousand for RHC Rate Reconciliation

Southern Mono Healthcare District

Report to the Board of Directors

Financial Report

July 16, 2020 FINANCIAL INDICATORS

• Cash Collections in June were $6.8 million – which included the $3.0 million from

supplements/settlements mentioned above (AB915, AB113 and Medicare Cost Report)

• Days Cash on Hand at June month-end was 430 days compared to May of 422 days

o Approximately 45 days of cash are COVID advances/loans

• Gross AR days increased to 60.9 from 54.7 in June (65 goal) – due to higher volume

• AR over 120 days decreased to 30.9% at June compared to 40.1% at May – part of this reduction

is a clean up of older accounts that qualified for charity adjustments

VOLUMES

Month of June summary:

• Inpatient days were 128 – compared to 76 in May and 128 in June of 2019. Case Mix index was

high at 1.487 due to increased IP surgical cases

• Total surgeries were 110 in June, compared to 74 cases in May and 114 in June of 2019

o Endoscopies & Colonoscopies were 15 in June, compared to 22 in May

• Emergency Department visits in June were 580 compared to 788 budgeted visits

• Clinic visits were 3,355, which is a nice increase from the 2,614 visits in May. Many of the part

time visiting physicians returned to the clinics in June

INCOME STATEMENT

Month of June

Revenue:

Total Gross Revenue of $10.7 million was $715 thousand higher than budget. Net Patient Revenue was

$13.4 million which includes $8.7 million in various supplements/settlements recognized in June which

were not related to June activity.

June reflected high percentages of revenue from government and uninsured payers. This results in

lower overall collection rates.

Other Operating Revenue:

Recognized $1.2 million in PRIME funding that we received throughout the year



Financial Report

July 16, 2020 June 2020 Expenses:

Net Gain

• June’s net gain was $8.9 million compared to a budgeted gain of $589 thousand – $6.3 million

favorable variance. This result is directly attributed to the above-mentioned

supplements/settlements booked in June. Without additional supplements/settlements and

$1.2 million PRIME funds (recognized as Other Operating Revenue) – net loss would have been

$1.0 million in June (this loss is directly related to continued slower volumes in some areas and

an unfavorable payer mix).

Year to Date

• Total Gross Revenue of $127.9 million is higher than budget by $5.5 million and $4.4 million

higher than last year

• Total Operating Revenue (collectable revenue) was $87.9 million which is $13.7 million higher

than budget (mainly due to COVID and other supplements/settlements booked) and $6.1 million

higher than last year

• Total Operating Expenses of $72.6 million are $3.2 million higher than budget, and $4.6 million

higher than prior year

OPERATING EXPENSES Current Budget Variance %

Variance Brief Comments

Salaries $2,480 $2,151 ($329) -15% Included Success Sharing accrual of $493K

Benefits 895 866 (29) -3%

Professional services 1,411 1,330 (81) -6% Increased due to higher volumes

Contract services 95 51 (43) -85%

Supplies 641 602 (39) -7% Higher surgeries

Services 623 665 42 6%

Total Expenses $6,144 $5,665 ($479)



Financial Report

July 16, 2020

o Professional Services (physician payments) are $2.3 million over budget – mainly due to

the first 8 months of high volume

o Supplies are $1.0 million over budget due to higher complex surgical cases prior to

COVID19 pandemic

o These two above are offset by a $354 thousand favorable Salaries and Benefit net

expense

• Year to date preliminary Net Gain of $16.3 million (18.6% total margin) which is $11.1 million

higher than budget and $1.4 million higher than last year

7/8/2020

SOUTHERN MONO HEALTH CARE DISTRICT DRAFT Comparative Balance Sheet - June 30, 2020

Unaudited Unaudited Audited

June 30, May 31, Prior Month June 30,

ASSETS 2020 2020 Change 2019

CURRENT ASSETS:

Cash (135 days operating expenses) $30,242,372 $30,019,172 $223,200 $19,609,830

Cash (reserved for building projects) 64,206,043 62,070,269 2,135,774 39,687,872

Investments 1,745,882 1,748,701 (2,819) 9,956,578

Total Cash 96,194,297 93,838,143 2,356,155 69,254,280

Patient accounts receivable 21,264,665 18,984,818 2,279,847 22,033,263

Less: Allow. for bad debts and contractuals (10,708,019) (9,186,384) (1,521,635) (10,553,766)

Net patient accounts receivable 10,556,645 9,798,434 758,211 11,479,496

Inventory 1,942,800 1,917,618 25,182 1,857,904

Prepaid expenses & deposits 726,969 489,524 237,444 739,481

Other current assets 562,093 726,579 (164,486) 448,300

Total Current assets 109,982,804 106,770,298 3,212,507 83,779,462

ASSETS LIMITED AS TO USE:

Bond funds held in trust by Mono County:

Mono Co Bond Capital Appreciation Fund 10,537,399 10,176,064 361,335 9,486,272

Debt service fund 1,529,118 992,057 537,061 1,659,212

Restricted by contributors 132,353 206,366 (74,013) 152,560

Total Assets Limited As To Use 12,198,870 11,374,488 824,382 11,298,045

PROPERTY, PLANT & EQUIPMENT:

Land and improvements 7,933,576 7,933,576 0 7,768,033

Buildings and improvements 56,742,372 56,742,372 0 54,203,335

Equipment 34,670,818 34,550,384 120,435 32,418,660

Construction-in-progress 1,184,596 1,204,625 (20,029) 357,886

Total Property, Plant and Equipment 100,531,363 100,430,958 100,406 94,747,915

Less: Accumulated depreciation (57,908,975) (57,511,024) (397,952) (53,412,736)

Less: Accumulated amortization (2,077,080) (2,077,080) 0 (2,077,080)

Net Property, Plant and Equipment 40,545,308 40,842,854 (297,546) 39,258,099

Total Assets $162,726,984 $158,987,640 $3,739,343 $134,335,606

Page 1

7/8/2020

SOUTHERN MONO HEALTH CARE DISTRICT DRAFT Comparative Balance Sheet - June 30, 2020

Unaudited Unaudited Audited

June 30, May 31, Prior Month June 30,

LIABILITIES 2020 2020 Change 2019

CURRENT LIABILITIES:

Accounts payable and accrued expenses $3,579,034 $2,920,465 $658,569 $2,854,315

SBA Loan 5,265,405 5,265,405 0 0

Accrued payroll-related liabilities 4,292,428 3,548,004 744,424 3,575,948

Patient refunds 171,388 158,647 12,741 199,734

Due to third party payers 5,872,237 12,506,417 (6,634,180) 250,000

Accrued interest on long term obligations 180,146 144,211 35,934 199,206

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

Health plan IBNR 822,000 888,625 (66,625) 828,000

Total Current liabilities 21,312,639 26,561,775 (5,249,136) 8,922,203

LONG-TERM DEBT:

Unamortized bond premium 938,036 948,704 (10,668) 1,066,056

Capital appreciation interest payable 10,409,904 10,326,172 83,732 9,405,117

General Obligation Bonds 12,509,555 12,509,555 0 13,754,555

Total long term debt 23,857,494 23,784,430 73,064 24,225,727

Total Liabilities 45,170,133 50,346,205 (5,176,072) 33,147,930

NET ASSETS:

Invested in capital assets net of related liabilities 15,557,814 15,928,424 (370,610) 14,017,372

Restricted - expendable for specific operating activities 131,774 205,787 (74,013) 152,041

Restricted - expendable for debt service 12,066,517 11,168,122 898,395 11,145,485

Unrestricted 73,484,533 73,939,150 (454,617) 60,995,187

Year to date earnings 16,316,213 7,399,954 8,916,260 14,877,592

NET POSITION: 117,556,850 108,641,436 8,915,415 101,187,676

Total Liabilities and Net Position $162,726,984 $158,987,640 $3,739,343 $134,335,606

Page 2

SOUTHERN MONO HEALTH CARE DISTRICT

DRAFTStatement of Revenues & Expenses - June 30, 2020

Prior Month Actual Budget

Variance to Budget Prior Year

Variance to Prior Year OPERATING REVENUE Actual Budget


Variance to Prior Year

(000s omitted)/1000

$1,690 $3,897 $2,548 $1,349 $2,319 $1,578 Inpatient services $35,011 $30,684 $4,327 $32,187 $2,824

3,268 4,433 4,876 (443) 5,092 (659) Outpatient services 61,908 60,468 1,440 59,530 2,377

864 1,630 1,715 (85) 1,676 (46) Professional fees services 22,025 21,526 499 22,516 (491)

515 721 827 (106) 744 (23) Clinic services 8,951 9,690 (739) 9,224 (273)

6,337 10,681 9,966 715 9,831 850 Total Gross Revenue 127,895 122,368 5,527 123,458 4,437

(2,628) (5,442) (3,589) (1,853) (3,973) (1,469) Contractual & other discounts (53,117) (46,530) (6,587) (48,807) (4,310)

(83) (508) (153) (355) (373) (135) Charity write offs (2,897) (1,881) (1,016) (2,293) (604)

267 (100) (161) 61 (13) (87) Provision for bad debts (1,074) (1,981) 907 186 (1,260)

- 8,753 83 8,670 5,404 3,349 Supplements/Settlements 8,976 1,000 7,976 7,502 1,473

4,642 4 - 4 - 4 HHS Stimulus 6,243 - 6,243 - 6,243

8,535 13,387 6,146 7,242 10,876 2,511 Net Patient Revenue 86,025 72,976 13,049 80,045 5,980

22 1,212 94 1,117 1,031 180 Other operating revenue 1,837 1,132 705 1,661 176

8,556 14,599 6,240 8,359 11,907 2,691 Total Operating Revenue 87,862 74,109 13,754 81,706 6,156

OPERATING EXPENSES

$2,035 $2,480 $2,151 (329) $1,872 (607) Salaries $25,490 $26,117 627 $22,412 (3,078)

974 895 866 (29) 998 103 Benefits 10,705 10,432 (273) 10,305 (400)

1,390 1,411 1,330 (81) 1,409 (2) Professional services 18,605 16,339 (2,266) 16,879 (1,726)

76 95 51 (43) 62 (32) Contract services 954 738 (216) 1,307 353

420 641 602 (39) 596 (45) Supplies 8,412 7,360 (1,052) 7,823 (589)

644 623 665 42 942 319 Services 8,415 8,383 (33) 9,208 793

5,539 6,144 5,665 (479) 5,880 (264) Total Expenses 72,581 69,368 (3,213) 67,934 (4,647)

3,017 8,455 575 7,880 6,028 2,427 OPERATING GAIN (LOSS)/1000 15,281 4,741 10,540 13,772 1,509

$389 $390 $385 (5) $362 (28) Depreciation & amortization $4,395 $4,484 89 $4,267 (128)

$2,629 $8,065 $190 $7,875 $5,666 $2,399 Operating Gain (Loss) after Depreciation $10,886 $257 $10,630 $9,505 $1,381

NON-OPERATING INCOME(EXPENSE)/1000

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

75 153 5 148 38 115 Donation income 293 105 188 343 (49)

215 288 223 65 484 (196) Bond property tax revenue 2,658 2,676 (18) 2,726 (68)

(117) (117) (117) (0) (116) (2) Bond interest expense (1,409) (1,409) (0) (1,387) (22)

279 524 272 252 155 369 Property tax revenue & interest income 3,777 3,265 512 3,360 417

(3) 3 16 (13) 30 (27) Interest expense 111 282 (171) 331 (220)

449 851 398 453 592 260 Total Non-Operating Income (expense) 5,430 4,918 512 5,373 58

$3,078 $8,916 $589 $8,328 $6,258 $2,659 Increase in net assets - net gain (deficit) $16,316 $5,175 $11,141 $14,878 $1,439

36.0% 61.1% 9.4% 51.6% 52.6% 8.5% Total Margin 18.6% 7.0% 11.6% 18.2% 0.4%

June-20 Year-to-Date

Page 3


DRAFTKey Statistical Data - June 2020

Prior Month Actual Budget


Variance to Prior

Year Hospital Statistics Actual Budget


Variance to Prior Year

31 30 30 30 Days in month 366 366 365

Acute Patient Days:

3 4 6 (2) 13 (9) ICU Days 90 91 (1) 110 (20)

62 115 117 (2) 104 11 Med/Surg & Telemetry Days 1,292 1,287 5 1,390 (98)

11 9 19 (10) 11 (2) Labor & Delivery Days 97 144 (47) 164 (67)

76 128 142 (14) 128 - Total Acute Patient Days 1,479 1,522 (43) 1,664 (185)

2.5 4.3 4.7 (0.5) 4.3 - Average Daily Census (ADC) 4.0 4.2 (0.1) 4.6 (0.5)

30.3% 43.2% 31.1% 12.2% 28.6% 14.6% % of IP Revenue to Ttl Revenue 33.0% 30.4% 2.6% 31.9% 1.1%

2.5 2.3 1.7 0.6 2.2 0.1 Average Length of Stay (ALOS) 2.2 2.0 0.1 2.2 (0.1)

31 55 81 (26) 58 (3) Discharges 682 751 (69) 745 (63)

1.184 1.487 NA NA 1.479 0.008 Case Mix Index 1.406 NA NA 1.457 (0.05)

Other Key Hospital Statistics:

418 580 788 (208) 802 (222) ED Visits 9,219 9,982 (763) 10,028 (809)

228 376 449 (73) 407 (31) Observation Hours 5,310 5,468 (158) 5,057 253

7 6 6 - 4 2 Deliveries 65 160 (95) 87 (22)

15 39 34 5 32 7 IP Surgeries 380 408 (28) 453 (73)

59 71 74 (3) 82 (11) OP Surgeries 1,022 958 64 981 41

74 110 108 2 114 (4) Total Surgeries 1,402 1,366 36 1,434 (32)

77 78 73 5 91 (13) MRI Procedures 934 935 (1) 1,002 (68)

88 135 185 (50) 196 (61) CT Scans 2,084 2,093 (9) 2,230 (146)

45 90 65 25 73 17 Mammography Procedures 872 851 21 842 30

123 119 120 (1) 135 (16) Ultrasound 1,593 1,435 158 1,529 64

563 802 966 (164) 1,027 (225) Radiology 12,211 12,785 (574) 13,331 (1,120)

896 1,224 1,409 (185) 1,522 (298) Total Imaging 17,694 18,099 (405) 18,934 (1,240)

5,221 6,198 6,243 (45) 6,844 (646) Lab Tests 77,545 73,666 3,879 76,691 854

3,880 6,126 6,500 (374) 6,082 44 Pharmacy Units 73,932 77,734 (3,802) 76,494 (2,562)

771 1,528 2,135 (607) 2,019 (491) PT/OT Visits 21,688 24,512 (2,824) 24,953 (3,265)

Clinic Visits

1,081 1,171 1,600 (429) 1,494 (323) Family Medicine clinic 16,673 18,600 (1,927) 19,764 (3,091)

334 342 300 42 172 170 Behavioral Health clinic 3,188 3,492 (304) 2,073 1,115

210 308 360 (52) 321 (13) Women's clinic 3,495 4,241 (746) 3,811 (316)

263 338 467 (129) 387 (49) Pediatric clinic 4,865 5,472 (607) 4,715 150

359 480 622 (142) 560 (80) Ortho Mammoth clinic 6,367 7,195 (828) 6,581 (214)

241 263 407 (144) 281 (18) Ortho Bishop clinic 3,405 4,682 (1,277) 3,096 309

78 246 90 156 128 118 Specialty clinic 1,694 1,560 134 1,694 -

30 59 75 (16) 129 (70) Surgical clinic 958 900 58 976 (18)

18 148 466 (318) 387 (239) Dental clinic 3,770 5,302 (1,532) 5,293 (1,523)

2,614 3,355 4,387 (1,032) 3,859 (504) Total Clinic visits 44,415 51,444 (7,029) 48,003 (3,588)

June-20 Year-to-Date

Page 4

Mammoth Hospital

All Statistical Analysis DRAFT

Dept # Dept Name Unit of Service Desc

Jul 2019

Aug 2019

Sep 2019

Oct 2019

Nov 2019

Dec 2019

Jan 2020

Feb 2020

Mar 2020

Apr 2020

May 2020

Jun 2020

BudgetJune 2020

ActualJune 2019

YTDTotal

YTDBudget

% of change to Budget

Level of concern

6010 ICU Patient Days 12 15 10 5 2 8 11 14 4 2 3 4 6 13 90 91 -1% 99%

6170 Med/Surg Patient Days 77 79 76 91 95 111 100 88 63 27 31 78 84 62 916 948 -3% 97%

6170 Telemetry Patient Days 25 50 26 22 9 35 40 58 30 13 31 37 33 42 376 339 11% 111%

7400 L & D Patient Days 16 4 8 4 10 10 8 8 3 6 11 9 19 11 97 144 -33% 67%

Total Acute Patient Days 130 148 120 122 116 164 159 168 100 48 76 128 142 128 1,479 1,522 -3% 97%

6380 Observation Patient Days 29 28 18 17 10 24 27 31 10 2 10 16 19 17 221 228 -3% 97%

6380 Observation Hours 688 660 434 418 236 574 643 746 249 58 228 376 449 407 5,310 5,468 -3% 97%

6530 Nursery Patient Days 16 4 10 7 11 10 8 10 8 7 12 9 10 9 112 154 -27% 73%

7400 L & D Pre-delivery hours 89 62 43 17 93 18 42 89 33 47 17 12 9 33 562 655 -14% 86%

7400 L & D Deliveries 9 4 4 3 7 5 4 7 4 5 7 6 6 4 65 160 -59% 41%

7080 Family Medicine Clinic Patient Visits 1,601 1,544 1,518 1,522 1,587 1,425 1,652 1,380 1,216 976 1,081 1,171 1,600 1,494 16,673 18,600 -10% 90%

7080 Behavioral Health Clinic Patient Visits 183 205 192 285 246 247 287 264 268 335 334 342 300 172 3,188 3,492 -9% 91%

7050 Women's Clinic Patient Visits 309 315 333 373 328 286 328 303 261 141 210 308 360 321 3,495 4,241 -18% 82%

7090 Pediatric Clinic Patient Visits 393 416 404 650 507 435 544 458 313 144 263 338 467 387 4,865 5,472 -11% 89%

7160 Ortho Mammoth Clinic Patient Visits 574 619 553 601 526 617 664 554 506 314 359 480 622 560 6,367 7,195 -12% 88%

7140 Ortho Bishop Clinic Patient Visits 333 294 286 390 266 339 354 287 265 87 241 263 407 281 3,405 4,682 -27% 73%

7180 Specialty Clinic Patient Visits 204 117 184 156 181 83 174 124 107 40 78 246 90 128 1,694 1,560 9% 109%

7110 Surgical Clinic Patient Visits 141 89 73 125 87 77 123 92 43 19 30 59 75 129 958 900 6% 106%

7060 Dental Clinic Patient Visits 494 433 372 430 412 382 460 366 243 12 18 148 466 387 3,770 5,302 -29% 71%

Total Clinics 4,232 4,032 3,915 4,532 4,140 3,891 4,586 3,828 3,222 2,068 2,614 3,355 4,387 3,859 44,415 51,744 -14% 86%

7010 ED Patient Visits 1,113 1,041 652 513 480 1,093 1,298 1,166 603 262 418 580 788 802 9,219 9,982 -8% 92%

7040 Ambulance Work days 22 22 20 23 20 21 22 19 22 20 20 22 22 20 253 255 -1% 99%

7420 Surgery Minutes 18,285 17,235 16,230 20,835 15,330 20,790 24,975 18,720 11,505 1,710 9,795 15,225 13,537 14,895 190,635 171,730 11% 111%

7420 IP surgeries Procedures 30 37 30 33 35 46 53 34 24 4 15 39 34 32 380 408 -7% 93%

7420 OP surgeries Procedures 106 97 84 111 85 113 129 106 51 10 59 71 74 82 1,022 958 7% 107%

7420 Colo/Endo Procedures Procedures 46 46 32 32 27 25 49 39 13 0 22 15 25 52 346 300 15% 115%

7427 PACU Minutes 17,745 16,200 15,345 17,265 14,595 20,325 22,965 17,670 9,525 2,205 9,465 12,945 14,496 12,900 176,250 184,295 -4% 96%

7500 Lab Tests 7,985 7,498 7,023 7,240 6,496 7,306 7,637 7,070 5,098 2,773 5,221 6,198 6,243 6,844 77,545 73,666 5% 105%

7590 EKG's IP Procedures 29 29 28 27 10 12 28 21 20 9 9 11 28 21 233 230 1% 101%

7590 EKG's OP Procedures 173 185 117 127 77 131 147 127 71 45 95 74 119 115 1,369 1,336 2% 102%

7641 Chemotherapy Patient Visits 37 56 52 46 40 29 25 28 28 31 21 33 23 65 426 258 65% 165%

7710 Pharmacy Units 7,359 7,422 6,263 6,651 5,958 7,520 8,419 7,696 4,755 1,881 3,880 6,126 6,500 6,082 73,932 77,734 -5% 95%

7720 Respiratory Unique Patients 718 630 473 427 226 403 429 440 310 148 191 250 361 555 4,645 4,237 10% 110%0

7630 Radiology Patient Visits 1,217 1,192 928 998 830 1,409 1,663 1,577 764 268 563 802 966 1,027 12,211 12,785 -4% 96%

7635 Mammography Patient Visits 71 85 69 123 119 73 72 68 50 7 45 90 65 73 872 851 2% 102%

7660 MRI Patient Visits 79 89 94 70 70 75 125 101 59 17 77 78 73 91 934 935 0% 100%

7670 Ultrasound Patient Visits 157 128 133 135 136 142 162 161 121 76 123 119 120 135 1,593 1,435 11% 111%

7680 CT Scan Patient Visits 208 206 156 138 125 248 301 308 128 43 88 135 185 196 2,084 2,093 0% 100%

Total Imaging Procedures 1,732 1,700 1,380 1,464 1,280 1,947 2,323 2,215 1,122 411 896 1,224 1,409 1,522 17,694 18,099 -2% 98%

7770 Mammoth PT Visits 1,143 1,198 1,094 1,243 1,038 1,074 1,266 1,041 725 419 453 854 1,176 1,056 11,548 12,893 -10% 90%

7772 Bishop PT Visits 727 793 687 858 682 746 895 772 465 189 245 551 723 709 7,610 8,666 -12% 88%

7773 Bishop OT Visits 107 76 106 148 124 115 143 126 77 19 30 42 121 106 1,113 1,454 -23% 77%

7790 Mammoth OT Visits 155 149 132 167 128 144 155 132 87 44 43 81 115 148 1,417 1,499 -5% 95%

Total Visits PT/ST/OT 2,132 2,216 2,019 2,416 1,972 2,079 2,459 2,071 1,354 671 771 1,528 2,135 2,019 21,688 24,512 -12% 88%


Investments Summary - June 30, 2020

Certificates of Deposit (CDs)

Interest Rate

Purchase Date Maturity Date Broker Cost BasisEstimated Current

Market ValuePercentage

of FundsBenchmarkComparison

Ally Bk Midvale UT 2.05% 11/24/2017 11/24/2020 Union Banc Investment Services 247,000 248,941 0.32%BMW Bk NA Salt Lake 2.05% 11/29/2017 11/30/2020 Union Banc Investment Services 247,000 249,020 0.32%American Exp Fed Svgs Bk 2.10% 12/5/2017 12/7/2020 Union Banc Investment Services 247,000 249,166 0.33%American Express Centrn 2.10% 12/5/2017 12/7/2020 Union Banc Investment Services 247,000 249,166 0.33%Capital One Natl Assn VA 2.10% 12/6/2017 12/7/2020 Union Banc Investment Services 247,000 249,166 0.33%Wells Fargo Bank Natl Assn 2.10% 12/8/2017 12/8/2020 Union Banc Investment Services 249,000 251,159 0.33%Sallie Mae Bk Slt Lake City UT 2.10% 12/13/2017 12/14/2020 Union Banc Investment Services 247,000 249,263 0.33%

1,731,000 1,745,881 2.28%

Local Agency Investment Fund (LAIF)Interest

RateBeginning Balance

Activity Ending Balance

1.22% $74,904,966 $0 $74,904,966 $74,904,966 97.72%

Total Investments $76,635,966 $76,650,847

Note 1: These investments comply with the Districts Statement of Investment Policy and with Government Code §53600.Note 2: The District has the ability to meet all scheduled expenditures for the next 6 months.

Southern Mono Healthcare DistrictLAIF Investment

7/7/2020

Balance as of May 31 2019 53,648,744

Deposit 6/7/2019 4,500,000Deposit 6/14/2019 1,100,000Withdraw 6/21/2019 (900,000)Deposit 6/28/2019 750,000

Balance as of June 30 2019 59,098,744

Withdraw 7/5/2019 (850,000)Deposit 7/12/2019 850,000Interest 7/15/2019 332,401Withdraw 7/19/2019 (500,000)Deposit 7/26/2019 1,300,000

Balance as of July 31 2019 60,231,146

Deposit 8/9/2019 300,000Withdraw 8/16/2019 (650,000)Deposit 8/23/2019 550,000Withdraw 8/30/2019 (600,000)

Balance as of August 31 2019 59,831,146

Deposit 9/6/2019 2,850,000Deposit 9/13/2019 200,000Deposit 9/20/2019 350,000Withdraw 9/27/2019 (650,000)

Balance as of September 30 2019 62,581,146

Z:\BankAccounts\LAIF\LAIF Activity.xlsx

Southern Mono Healthcare DistrictLAIF Investment

7/7/2020

Deposit 10/4/2019 650,000Withdraw 10/9/2019 (250,000)Interest 10/15/2019 373,352Deposit 10/16/2019 150,000Withdraw 10/25/2019 (900,000)

Balance as of October 31 2019 62,604,497

Withdraw 11/8/2019 (600,000)Deposit 11/15/2019 2,995,000

Balance as of November 30 2019 64,999,497

Balance as of December 31 2019 64,999,497

Deposit 1/10/2020 1,800,000Interest 1/15/2020 367,636Withdraw 1/17/2020 (1,000,000)Deposit 1/31/2020 400,000

Balance as of January 31 2020 66,567,134

Deposit 2/7 900,000Deposit 2/13 100,000Depost 2/28 600,000Withdraw 2/17/2020 (200,000)

Balance as of February 29 2020 67,967,134

Withdraw 3/13/2020 (1,500,000)Deposit 3/6 1,000,000Deposit 3/20 100,000Withdraw 3/27 (200,000)

Balance as of March 31 2020 67,367,134

Deposit 4/2 1,500,000Withdraw 4/10 (400,000)Interest 4/15/2020 337,833Deposit 4/16 300,000Deposit 4/27 5,800,000

Balance as of April 30 2020 74,904,966

Balance as of May 31 2020 74,904,966

Balance as of June 30, 2020 74,904,966

Z:\BankAccounts\LAIF\LAIF Activity.xlsx

For Period Ended: June 30, 2020

Tables and Graphs

DRAFT

FINANCE COMMITTEE DRAFT July 13, 2020

Page 1

VOLUMEInpatient Volume

20.0

30.0

40.0

50.0

60.0

70.0

80.0

90.0Admissions - All Excluding Nursery

Current Year Prior Year 2 Years Ago Budget

1.5

2.5

3.5

4.5

5.5

6.5

7.5

Average Daily Census - All Excuding Nursery


0

10

20

30

40

50

60

70

Inpatient Surgery Volume


Page 2

Outpatient Volume

50

60

70

80

90

100

110

120

130

140

150

160

Clinic Volume (per day) - All Clinics


0

200

400

600

800

1,000

1,200

1,400

Emergency Department Volume


0

20

40

60

80

100

120

140

Outpatient Surgery Volume


Page 3

REVENUEGross Charges

-

1,000

2,000

3,000

4,000

5,000

Thou

sand

sGross Inpatient Revenue


-

1,000

2,000

3,000

4,000

5,000

6,000

7,000

8,000

Thou

sand

s

Gross Outpatient Revenue


-

100

200

300

400

500

600

700

800

900

1,000

Thou

sand

s

Gross Clinic Revenue


-

500

1,000

1,500

2,000

2,500

3,000

3,500

Thou

sand

s

Gross Professional Fees Revenue


Page 4

Net Revenue

1,000

3,000

5,000

7,000

9,000

11,000

13,000

15,000Th

ousand

s

Net Patient Revenue


1,000

6,000

11,000

16,000

21,000

26,000

31,000

36,000

41,000

46,000

Net Revenue per Adjusted Patient Day


FY 2017 FY 2018 FY 2019 Jun-19 Jan-20 Feb-20 Mar-20 Apr-20 May-20 Jun-20YTD FY

2020

Budget FY

2020

Payer MixMedicare 18.5% 19.6% 22.4% 24.9% 23.8% 17.1% 28.8% 31.1% 28.7% 36.1% 26.8% 20.2%Medi-Cal ** 21.4% 21.6% 21.1% 19.7% 12.9% 15.9% 16.4% 23.7% 20.4% 20.1% 18.6% 20.5%Blue Cross * 22.1% 22.5% 21.5% 20.8% 20.3% 21.8% 24.2% 20.1% 22.0% 17.1% 20.7% 22.5%Commercial * 29.2% 28.3% 28.0% 27.8% 36.4% 37.6% 25.0% 22.9% 23.6% 21.8% 27.3% 29.5%Self Pay ** 2.9% 2.5% 2.2% 2.5% 2.2% 1.9% 1.0% 2.2% 2.5% 2.0% 2.0% 2.7%Other * 5.7% 5.5% 4.7% 4.2% 4.5% 5.7% 4.6% -0.1% 2.8% 2.9% 4.6% 4.6%

Total 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%

Page 5

Revenue Cycle

40%

90%

140%

190%

240%

Cumulative Cash Collections as a % of Net Collectible Revenue


0

10,000

20,000

30,000

40,000

50,000

60,000

70,000

80,000

90,000

-

1,000

2,000

3,000

4,000

5,000

6,000

7,000

8,000

9,000

10,000

Jul

Aug

Sep Oct

Nov

Dec Jan

Feb

Mar

Apr

Ma

y

Jun

YT

D

2019

2018

2017

Th

ou

san

ds

Th

ou

san

ds

Monthly Collections

'Current Year" 'Year to Date" 'YTD Budget"

'Prior Year' 'Two Years Ago" 'Budget'

1 7

13 19 25 31 37 43 49 55 61 67 73 79 85 91 97

103

Millions

Cash Balance

Current Year 2 Years Ago Prior Year

50

100

150

200

250

300

350

400

450

Cash Days on Hand


Page 6

40.0

50.0

60.0

70.0

80.0

90.0

100.0

110.0AR Days Outstanding - Gross


35.0

45.0

55.0

65.0

75.0

85.0

95.0

AR Days Outstanding - Net


0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

% A/R > 120 Days

Current Year 'Prior Year' 2 Years Ago Budget

Payer 1 to 30 31 to 60 61 to 90 91 to 120 121 + Total

Blue cross $1,542,442 $335,064 $72,385 $365,620 $820,187 $3,135,698Commercial $2,012,741 $512,277 $184,594 $318,020 1,258,844 4,286,476Medical $2,201,298 $470,957 $150,077 $383,063 796,047 4,001,442Medicare $3,759,831 $282,011 $44,682 $11,194 114,121 4,211,838Other $458,984 $94,863 $22,788 $58,853 1,274,756 1,910,244Self Pay $414,443 $364,351 $120,664 $401,720 2,242,926 3,544,104 Total $10,389,739 $2,059,523 $595,190 $1,538,469 $6,506,881 $21,089,802

Percent of Dollars Over 120 Days 30.9%

Page 7

ExpensesSalaries, Wages and Benefits

-

500

1,000

1,500

2,000

2,500

3,000

3,500

4,000

Thou

sand

s

Salaries, Wages and Benefits


300

500

700

900

1,100

1,300

1,500

Thou

sand

s

Benefits


Page 8

Full Time Equivalents

200.0

220.0

240.0

260.0

280.0

300.0

320.0

340.0

Productive Full Time Equivalents


230.0

250.0

270.0

290.0

310.0

330.0

350.0

370.0

390.0

Paid Full Time Equivalents


-

10.0

20.0

30.0

40.0

50.0

60.0

Productive FTEs per Adjusted Occupied Bed


5,000

6,000

7,000

8,000

9,000

10,000

11,000

12,000

13,000Labor Cost per Productive Time Equivalent


Page 9

Professional Fees, Services and Contracted Services

500

700

900

1,100

1,300

1,500

1,700

1,900

2,100Th

ousand

s

Professional Fees


-

50

100

150

200

250

Thou

sand

s

Contracted Services


-

200

400

600

800

1,000

1,200

Thou

sand

s

Services


Page 10

Supplies

200

300

400

500

600

700

800

900

1,000

Thou

sand

s

Supply Expense


400

900

1,400

1,900

2,400

2,900

3,400

Supply Expense per Adjusted Patient Day


Page 11


________________________________________________________________________________________________________




MEMO

DATE: July 16, 2020 TO: SMHD Board of Directors FROM: Melanie Van Winkle, CFO RE: Annual Reimbursement Report Disclosure

This report is provided in accordance with and pursuant to Government Code §53065.5, which reads as follows: Each special district, as defined by subdivision (a) of Section 56036, shall, at least annually, disclose any reimbursement paid by the district within the immediately preceding fiscal year of at least one hundred dollars ($100) for each individual charge for services or product received. ''Individual charge" includes, but is not limited to, one meal, lodging for one day, transportation, or a registration fee paid to any employee or member of the governing body of the district. The disclosure requirement shall be fulfilled by including the reimbursement information in a document published or printed at least annually by a date determined by that district and shall be made available for public inspection. I have reviewed the financial records of the SMHD District for the FY2020, ending June 30, 2020, and I found the following expenditures for the year (see attached sheet).

Employee Reimbursement Checks for FY 2020

Check NumberCheck Date Check Name Vendor No Check Amount

8735 1/10/2020 BUTTS, TASHINA 103692 3,006.00$ Food for Holiday Party

9168 2/7/2020 VARGAS, GUADALUPE 103782 1,900.00$ Phlebotomy Cert

6604 7/19/2019 VAN WINKLE, MELANIE 102468 1,131.30$ Office Furniture

8041 11/8/2019 WILT, BRANDY 103483 1,097.21$ Cert and Travel for PICC

6365 7/5/2019 BAITX, LORI 900057 1,049.01$ Department Food

10774 6/26/2020 MILLER, TR 103052 1,025.01$ Department Food

81702 3/12/2020 DEAN, DEANNA 901850 874.00$ Core Concepts Diabetes Course

8482 12/20/2019 BRITTON, KATHRYN 103615 866.84$ ACO Conf Travel

10417 5/22/2020 STOWERS, MICHAEL 103821 863.50$ MICN Course

8108 11/15/2019 VAN WINKLE, MELANIE 102468 852.85$ Caravan travel/ Deparment Food

10773 6/26/2020 MILLER, ALLISON 103624 809.00$ PICC & TCRN Course

6618 7/26/2019 BRITTANIA COGAN 103501 785.87$ Landscape Flowers

8484 12/20/2019 BUTTS, TASHINA 103692 687.28$ ACO Conf Travel

7680 10/11/2019 WILT, BRANDY 103483 687.08$ Reg & Milliage PICC

79865 9/12/2019 GRAVES, JOHN 900254 667.36$ Medivators trainging Travel

6652 7/26/2019 MORROW, GUY 900971 600.00$ ARRT CERT

82516 6/18/2020 HOOK, NICOLE 103609 595.00$ Core Concepts Diabetes Course

8891 1/17/2020 VAN WINKLE, MELANIE 102468 593.04$ Caravan Health Expenses

10387 5/22/2020 MARUSICZ, LISA 900115 558.90$ Millage

6637 7/26/2019 GRAVES, SANDY 103605 540.00$ ARRT CERT

10763 6/26/2020 GROSSBLATT, JANE 901058 483.80$

9525 3/6/2020 SHABANIAN, TALENE 103393 480.00$

8185 11/22/2019 MARUSICZ, LISA 900115 469.80$

79900 9/12/2019 WANAMAKER, REBECCA 900930 460.94$

79854 9/12/2019 DEAN, DEANNA 901850 445.00$

8353 12/6/2019 KORFIATIS, CAROLYN 103149 430.14$

7901 11/1/2019 KOENIG, LORRAINE 901044 420.46$

6784 8/9/2019 FEHLMAN, BRYANT 103608 400.00$

82564 6/25/2020 ORLOWSKI, VICTORIA 103837 395.00$

10752 6/26/2020 DILLON, ANDREA 901803 395.00$

10755 6/26/2020 DUVALL, ARIEL 901851 395.00$

10757 6/26/2020 ERNST, COURTNEY 103835 395.00$

10761 6/26/2020 GEORGESON, LANCE 103467 395.00$

10780 6/26/2020 PERUMAL, JULIE 901036 395.00$

10850 7/3/2020 MCCHESNEY, GILLIAN 901352 395.00$

80848 12/19/2019 LAGUNA, ALFREDO 103757 391.44$

9688 3/20/2020 MARUSICZ, LISA 900115 375.84$

10390 5/22/2020 MCMILLAN, JEFF 900194 368.00$

79371 8/1/2019 QUESSENBERRY, DEBRA 901382 360.42$

9136 2/7/2020 MCMAHON, MICHAEL 901348 355.65$

6403 7/5/2019 MARUSICZ, LISA 900115 349.16$

10404 5/22/2020 RODRIGUEZ, TINA 103822 349.00$

10462 5/29/2020 HORTON, HAYLEY 103827 349.00$

8508 12/20/2019 HAAKANA, HANNAH 900923 343.59$

10582 6/12/2020 COGAN, BRITTANIA 103501 326.57$

9218 2/14/2020 MARUSICZ, LISA 900115 313.20$

10598 6/12/2020 MARUSICZ, LISA 900115 310.50$

7968 11/8/2019 CROSBY, ANDREW 103742 309.54$

8529 12/20/2019 MARUSICZ, LISA 900115 307.22$

7987 11/8/2019 HAMILTON, NANCIE D. 101711 303.15$

10376 5/22/2020 LANG, SARAH 901853 302.05$

8614 12/27/2019 HUNT, JOANNE 900117 300.00$

6892 8/16/2019 MARUSICZ, LISA 900115 299.28$

9046 1/31/2020 MILLER, TR 103052 297.46$

8605 12/27/2019 DILLON, ANDREA 901803 295.00$

8608 12/27/2019 DUVALL, ARIEL 901851 295.00$

8622 12/27/2019 MCCHESNEY, GILLIAN 901352 295.00$

80958 1/2/2020 PERUMAL, JULIE 901036 295.00$

80965 1/2/2020 STEWART, ANDREW 103765 295.00$

8594 12/27/2019 BRITTON, KATHRYN 103615 291.30$

8001 11/8/2019 MARUSICZ, LISA 900115 280.13$

6409 7/5/2019 MILLER, TR 103052 269.39$

6436 7/5/2019 WAGNER, JESSICA 103445 259.99$

8372 12/6/2019 ROMAGNINO, KATHY 100582 251.08$

7656 10/11/2019 MARUSICZ, LISA 900115 250.56$

10297 5/15/2020 MICHEL, CASEY 901796 250.35$

9454 3/6/2020 ALO, KATHLEEN 900106 250.00$

8459 12/13/2019 WILT, BRANDY 103483 235.29$

7312 9/13/2019 MCMAHON, MICHAEL 901348 226.56$

9418 2/28/2020 LOGAN, ANCA 901740 224.40$

9414 2/28/2020 KHODAVERDIAN, ANDREW 103638 212.31$

9669 3/20/2020 GRAVES, JOHN 900254 210.49$


7483 9/27/2019 HUNT, JOANNE 900117 200.00$

80716 12/5/2019 EIDE, JACOB 103550 196.94$

8772 1/10/2020 MCMAHON, MICHAEL 901348 185.62$

7896 11/1/2019 HINEK, JANYEANN 103741 178.11$

10170 5/1/2020 HIDY, LAURA 901741 175.00$

7378 9/20/2019 CROUTHAMEL, SLAVKA 900736 174.72$

7239 9/6/2019 MARUSICZ, LISA 900115 174.58$

9403 2/28/2020 EIDE, JACOB 103550 170.11$

9346 2/21/2020 SACHS, ROSEMARY 900357 160.00$

9561 3/13/2020 CROUTHAMEL, JAMES A 103793 148.50$

9570 3/13/2020 GRAY, KARI 103794 148.50$

9845 4/3/2020 KHODAVERDIAN, ANDREW 103638 144.49$


7390 9/20/2019 FELT, GRANT 103598 134.00$

7243 9/6/2019 MILLER, ALLISON 103624 133.95$

8956 1/24/2020 MILLER, ALLISON 103624 132.61$


8301 11/29/2019 WAGNER, JESSICA 103445 120.00$

10143 5/1/2020 BAITX, LORI 900057 120.00$

10158 5/1/2020 CROUTHAMEL, JAMES A 103793 120.00$

10169 5/1/2020 GRAY, KARI 103794 120.00$

10354 5/22/2020 CLOTERE, CAROLINE 900040 120.00$

10490 5/29/2020 STOWERS, MICHAEL 103821 120.00$

6855 8/16/2019 CICCARELLI, ANTONETTE 900159 119.61$

10320 5/22/2020 ALLEC, TINA 900628 116.98$

7936 11/8/2019 ALO, KATHLEEN 900106 111.08$

79870 9/12/2019 KIMBRELL, KARRIE 901360 103.00$

8364 12/6/2019 MOFFETT, OLIVIA 900336 101.79$



Total 40,929.85$

southern mono healthcare district july 2020 … · 2020-07-13 · assistant at mammoth hospital by...

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