NOTICE OF REGULAR BOARD MEETING OF THE UPPER SAN …pagosaspringsmedicalcenter.org/wp-content/uploads/2016/04/Janua… · THE UPPER SAN JUAN HEALTH SERVICES DISTRICT DOING BUSINESS

NOTICE OF REGULAR BOARD MEETING OF THE UPPER SAN JUAN HEALTH SERVICES DISTRICT

DOING BUSINESS AS PAGOSA SPRINGS MEDICAL CENTER Tuesday, January 26, 2016

5:30 PM Conference Room, PSMC Main Building

95 South Pagosa Blvd., Pagosa Springs, CO 81147 AGENDA

I. CALL TO ORDER; MINISTERIAL MATTERS OF THE BOARD a. Call for quorum. b. Approval of the Agenda (and changes, if any)

II. MILESTONE MOMENT NO HEART ATTACK!

III. PUBLIC COMMENT (This is an opportunity for the public to make comment and/or address USJHSD

Board. Persons wishing to address the Board need to notify the Executive Coordinator, Jodi Scarpa, prior to the start of the meeting. All public comments shall be limited to matters under the jurisdiction of the Board and shall be expressly limited to three (3) minutes per person. The Board is not required to respond to or discuss public comments. No action will be taken at this meeting on public comments.)

IV. REPORTS

a. Medical Staff Chief of Staff, Dr. Ralph Battels b. Medical Staff Operations Chief Medical Officer, Dr. Rhonda Webb c. Report on IT Contract Only Chief Operating Officer, Kyle Kellum d. Hospital Operations Chief Nursing Officer, Kathee Douglas e. Report on financing & 2016 Goals Chief Administrative Officer, Ann Bruzzese f. Strategic Planning Dir. Mark Floyd g. Campus Planning Dir. Mark Floyd h. Contracts Dir. Jerry Baker i. CEO Report & 2015 Review Chief Executive Officer, Brad Cochennet j. Finance Report Dir. Karl Irons and Chief Financial Officer, Dennis Wilson k. Clerk of the Board Executive Coordinator, Jodi Scarpa

V. CONSENT AGENDA (The Consent Agenda is intended to allow Board approval, by a single motion, of matters that are considered routine. There will be no separate discussion of Consent Agenda matters unless requested.)

a. Approval of Minutes for the following meeting(s): i. Regular meeting of: 11/17/2015

ii. Special meeting of: 12/11/2015 iii. Regular meeting of: 12/15/2015

b. Medical Staff recommendations for new/renew provider privileges, policies.

VI. DECISION AGENDA (Matters to be discussed and possible action)

a. Consider for approval Resolution 2016-1: establish USJHSD 2016 notice-posting-locations and regular Board meeting schedule.

b. Consider for approval Resolution 2016-2: appoint Designated Election Official c. Consider for approval Resolution 2016-3: establish USJHSD terms for its regular May 3, 2016

election. d. Consider for approval Resolution 2016-4: affirm USJHSD “enterprise” status. e. Consider for approval Resolution 2016-5: approve 2016 facility-wide goals. f. Consider for approval Resolution 2016-6: approve contract for IT Services.

VII. EXECUTIVE SESSION

As and if needed, the Board reserves the right to meet in executive session for any purpose allowed and announced at the meeting, in accordance with C.R.S. Section 24-6-402(4).

VIII. OTHER BUSINESS a. Additional annual Special District obligations – all Board members submit completed and signed

conflict of interest statements IX. ADJOURN

THE UPPER SAN JUAN HEALTH SERVICES DISTRICT DOING BUSINESS AS PAGOSA SPRINGS MEDICAL CENTER

MEDICAL STAFF REPORT BY CHIEF OF STAFF, RALPH BATTELS

January 26, 2016

I. REPORT OF ACCOMPLISHMENTS/CHALLENGES OF THE MEDICAL STAFF

II. REPORT SUMMARIZING ANY NEW POLICIES OR PROCEDURES ADOPTED BY THE MEDICAL STAFF

• None to report.

III. STATEMENT OF THE MEDICAL STAFF’S RECOMMENDATIONS TO THE USJHSD BOARD REGARDING PROVIDER PRIVILEGES:

NAME INITIAL/REAPPOINT/CHANGE TYPE OF PRIVILEGES SPECIALTY Aaron Singh, PA Appointment AHP/Physician Assistant

Outpatient Clinic Family Medicine

Gitesh Chheda, MD Change in privileges: addition of core teleradiology privileges

Telemedicine/Teleradiology Diagnostic Radiology

Peter Dziad, MD Change in privileges: addition of central venous catheterization, arterial catheterization, colectomy, and gastrostomy feeding tube placement

Active/General Surgery General Surgery

Michelle Flemmings, MD Change in privileges: addition of central venous catheterization and arterial catheterization privileges

Active/Emergency Medicine and Outpatient Clinic

Emergency Medicine

Robert Halterman, DO Change in privileges: addition of arterial catheterization & central venous catheterization privileges

Active/Emergency Medicine Emergency Medicine

Baxter Tharin, MD Change in privileges: addition of core radiology and teleradiology privileges with some special privileges

Courtesy/Radiology Diagnostic Radiology

Dulcy Wolverton, MD Change in privileges: addition of core teleradiology privileges excluding CT and nuclear radiology

Telemedicine/Teleradiology Diagnostic Radiology

IV. REPORT OF NUMBER OF PROVIDERS BY CATEGORY

Active: 15 Courtesy: 38 Courtesy – Locum Tenens: 0 Telemedicine: 68 Allied Health Professionals: 19 Total: 140

COO Report Re: Phone and IT Services Agreement

• WHOo Synoptekhttps://synoptek.com/industry-solutions/it-services-healthcare/

• WHATo Telephoneequipment(byCisco)andphonesupporto ITServices–people,systemsandprocesses

§ Accountabilityandcomprehensive24X7infrastructureandproblemmanagement

• Level1,2,3skilledSME’so 99.99%NetworkUptimeo 99.95%SeverandStorageUptime

§ EndUserExperienceo 80%ofcallsanswered<1minute(company

average90%)o 85%customersatisfactionfromenduser

(companyaverage95%)§ Responsiveness§ RiskMitigation

• Backupsandrestorationofcriticalsystems§ Security

• Appropriatepatchesmadetoensureproactivesecurity§ Advisory-basedsupport

• VirtualCIOtosupportbusinessplanning/roadmapping

• WHEREo SynoptekwillbeoffsiteexceptSynoptekwillhireoneofourcurrent

employeeswhowillbeaSynoptekemployeeon-siteonafull-timebasis.

• WHENo Whenmutuallyexecuted,Synoptekwillbegintransitionwork.

• COSTo Initial1-timedeploymentcost:$25,000.o Monthlyrecurringcost$24,985.69(thephoneequipmentpurchaseis

includedandapproximately$4,834ofthemonthlyrecurring).

o ContractcostfortheportionofITServicesiscomparabletobudgetforITpersonnelwagesandbenefits.

• OTHERo Thecontracthasbeenfullynegotiatedandreviewedbylegal.o FinanceCommitteehasreviewedandrecommendsproceeding.o Exclusions:ITequipmentpurchase;HIPAAsecurity(being

outsourcedthroughanothercompany).

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HealthcareManaged IT Services for the Healthcare Industry

We Manage Your Technology so You Can Manage Your PatientsSynoptek Managed IT Services has a credited history of providing services to clients in thehealthcare industry over the past 20 years. Client types range from large hospitals, rural medicalcenters, to tissue and blood processing organizations, from individual doctor’s offices to multi-location clinics and full-service hospitals.

Synoptek Managed IT Services provides a full-lifecycle of HIPAA compliant health care informationtechnology solutions including on-site staff augmentation, trouble ticket processing, 24×7 Help Deskservices, server and application support, professional services (projects and IT architecture), hostedcommunication services (email and voice), remote and collocated infrastructure, and disasterrecovery platforms.

Our Healthcare Managed IT Service Categories Include:Professional Services (https://synoptek.com/it-infrastructure-services/it-consulting/)– SynoptekManaged Services is known for its comprehensive list of Information Technology consultingcapabilities specifically focused on health care providers, including strategic planning, migrations,system integration, IT audit services projects and IT program management. Our IT professionals willassess your IT infrastructure, policies, processes and key IT performance indicators and how theysupport your overall IT strategy. As a managed service provider we understand how to mitigate ITrisks while aligning with your budget and goals in a healthcare environment.

Industries We Serve (https://synoptek.com/industry-solutions/)

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Cloud Hosting (https://synoptek.com/it-infrastructure-services/cloud-hosting-services/) –Continuing to support an IT infrastructure is now conceded to be a poor utilization of businessresources for health care providers. Synoptek Managed Services healthcare clients have seen asignificant reduction in IT related operational and capital expenses. Reacquire your focus on patientcare and elevate service levels for your health care staff by outsourcing your Information Technologyactivities. Synoptek provides Public Cloud, Private Cloud and Hybrid Cloud hosting.

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Backup and Disaster Recovery (https://synoptek.com/it-infrastructure-services/cloud-hosting-services/backup-disaster-recovery/) – We can evaluate your networking and storage alternatives anddeliver your healthcare organization a comprehensive Backup and Disaster Recovery plan. Avoid thevulnerability of single-location storage and receive backup logs validating data is encrypted backedup and problem free. We will not only consider HIPPA compliant backup solutions (relatively easy)but timely recovery solutions (much more difficult). From simple file recovery to site-level recovery,we outline a list of deployment, cloud storage and operational services working with the vendors youchoose or use your/our facilities.

Applications Management (https://synoptek.com/it-infrastructure-services/application-services/) –Synoptek Managed Services manages many applications that are critical to daily operations withinthe healthcare industry. Our secure infrastructure can support a customized environment that won’tdisrupt any of your operational systems while developing and testing.

24×7 Help Desk, Service Desk (https://synoptek.com/it-infrastructure-services/it-support/24x7-help-desk/)– This is where it all comes together. Our U.S. based Help Desk is staffed by a team of ITProfessionals that have attained some of the highest first level resolution (FLR) rates in the industry. Have your talented IT team focus on your critical business objectives and not “basic” Help Desk”activities. Incidents are documented and added to our knowledge base in order to be tracked andused to proactively manage recurring problems.

What We Do for Healthcare Providers:Manage and monitor desktop computers, servers and networksInstall and manage servers, workstations and VoIP systems, Clinical and non-clinical supportInstall and manage firewalls, provide HIPAA, Meaningful Use compliant security with audittrailsProvide and update virus, spam, and spyware protectionInstall and manage Microsoft Exchange Servers, your email, and provide secure access toemail anywhere from any device, HIPAA compliant email archivingManage everything while hosting in our data centers, or in combination with hosting in yourown, or third party data centersProvide 24x7x365 Help Desk services from our Colorado/Idaho/California “Eyes On”Enterprise Operations CentersProvide secure data backup and disaster recoveryProvide mobile device management

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We have compiled a list below to help you determine if IT as aservice (ITaaS) is a good fit for your Healthcare orgainzation:

Growth of your data and EHR’s is increasing, and your infrastructure cannot keep upLegacy systems exist and are quickly becoming obsolete and harder to supportThe number of sites, devices, systems and users is increasingAs everything is growing so is your ability to manage risk, security and HIPAA complianceFinance wants to move from a capital to an operating expense modelExisting IT infrastructure is fragmented and becoming more complex to manage and monitorIt is harder to find skilled IT staffMaintenance is burdensome and licensing, and support contracts are becoming problems

If you accept that data is critical to your business and that the management of that data is equallyimportant, then you want to establish a relationship with a provider like Synoptek that will be apartner with you, and not a faceless vendor who just sells a commodity solution.

Synoptek “IT as a Service”Benefits Healthcare Providers by:

Synoptek’s IT Healthcare Services:By outsourcing your IT services to Synoptek Managed Services, you free up your IT staff to focus onpatient and client needs and not on the day-to-day management of infrastructure-based IT services.Synoptek Managed IT Services provides HIPAA compliant storage of Electronic Medical Records(EMR’s) for many of its healthcare clients and understands healthcare information systems supporttakes a 24×7 effort.

Help Desk operations based in California, Idaho and Colorado and manned 24x7x365Our Help Desk first-call resolution rate is above industry averageAn advanced incident management system that helps reduce or eliminate recurring problemsUse of the industry leading monitoring and management tools providing proactiveinfrastructure and applications monitoringData Center hosting, storage, backup and disaster recoveryA consumption-based pricing model with usage-based pricing or fixed rate pricingFull IT infrastructure services at fixed monthly rates eliminating the need for hardware(capital) investmentsCustom designed Service Level Agreements (SLA’s)

We are currently saving one Colorado medical facility over $1 million annually over their previous ITbudget and providing a higher grade of service. Hospitals, clinics and healthcare providers, can gainmore control over their IT services by using our expert IT technicians and only the infrastructureservices they need.

Take advantage of being able to scale infrastructure and achieve IT solutions your budget hasprevented you from implementing.

Providing secure access to critical information from any deviceImproving performance and security of EHR platformsDecreasing exposure to HIPAA violationsDelivering performance increases through an efficient well managed IT architectureGetting rapid scalability for backups and data storageProviding real-time U.S. based 24 x 7 support to address issues whenever neededAccessing skilled IT staff when neededReducing capital expenditures and moving to a fixed IT services budget

Give us a call to set up a meeting and find out more.

A few of our recent healthcare clients include:

(https://www.youtube.com/watch?v=qL-XzxtbFWY&feature=youtu.be)Healthcare IT – Customer CaseStudy

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CAO Report, January 2016

• Financing o We are proceeding with an anticipated closing on March 31 o Status Report (attached)

• Proposed 2016 Goals (attached)

CAO Financing Status Report (Jan. 2016) While our delay in financing was not intentional, a very good thing has resulted from the delay. With the new year, we were able to revisit the “additional bonds/debt test” contained in our 2006 and 2007 bonds. Because of our improved financial performance in 2015, we now meet the additional bonds/debt test! This allows us the option to pursue clinic financing without refinancing our 2006 and 2007 bonds and (as represented to us by Denver) while staying on track for closing at the end of March. For anyone who would like me to back all the way up and refresh memories on how we got here, I provide the following recap: In the Spring of 2015, we started the process of trying to obtain financing for the clinic building. After trying to work through the initial bank responses, we learned we had a significant issue: our existing 2006 and 2007 bonds precluded the District from having additional debt secured by the net revenues of the medical center unless we met at least one of two “additional bonds/debt tests”. The additional bonds tests are described in the 2006 and 2007 bonds and require us to demonstrate either: (1) that for the two prior full fiscal years, our mill levy was sufficient to pay 175% of the maximum annual debt on the 2006 and 2007 bonds and the new debt; or (2) for the two full fiscal years following the issuance of the new debt (or completion of the project, whichever is later), our mill levy is projected to be sufficient to pay 200% of the combined maximum annual debt service on the 2006 and 2007 bond debt and the new debt. When we examined this in the Spring of 2015, we did not meet either test. After reviewing our bonds with a bond attorney, we learned that our only option in 2015 would be to refund/refinance our 2006 and 2007 bonds (which involved escrowing the bond payments until the 2021 call date) and obtain new financing. By September of 2015, we were working with bond attorneys and investment bankers focused on three goals: (1) to finance approximately 20 million (approximately ten million designated to refund/refinance existing debt and approximately ten million for the clinic and OR renovation); (2) to allow the maximum flexibility for future lending/expansion (and avoid limitations similar to the 2006 and 2007 bonds); and (3) to meet a Spring 2016 ground-‐breaking date. This process directed us toward Certificate of Participation (“COP”) financing — which is a costly form of financing but was intended to allow us the most flexibility for future growth/financing. Despite having a plan to proceed forward with refinancing and COPs, at the start of 2016, we were able to revisit the additional bonds/debt tests. Because of our improved financial success in fiscal years 2014 and 2015, we now meet the first additional bonds/debt test. Since we now meet the first additional bond/debt test, we have the option to obtain additional debt, secured by the net revenues of the medical center, without refunding/refinancing our 2006 and 2007 bonds. Said another way, with the delay to 2016, we have flexibility of choice and can proceed to finance the clinic and OR expansion costs with revenue bonds and leave the existing 2006 and 2007 bonds in place. Our financial advisor retained to advise the District on our lending strategies advises us not to refinance our 2006 and 2007 bonds at this time even though they contain limitations that makes further expansion/debt challenging.

2016 MANAGEMENT GOALS FOR PSMC

(2016.01.16)

1) OUR PATIENTS – SATISFACTION, QUALITY OF CARE AND SAFETY a) By December 31, 2016, develop and implement (on a coordinated project by project basis) our own

measurable program for patient satisfaction. b) Expand our service recovery program including: revise the start of flow of patient complaints in Patient

Experience, select/employ software to track the nature of complaints and how fielded, implement staff education, establish a means to address the most common types of complaints.

c) Establish and achieve specific department goals to improve patient safety and quality; as a facility, create/implement a new Quality Review Committee to achieve best practice goals and consistently achieve quality clinical outcomes.

d) With respect to emergency operations plans, conduct annual risk assessment and complete emergency operations plans for three highest priority risks; conduct at least 2 mock incidents.

e) Establish and achieve department specific goals to improve compliance. f) Develop and implement a plan to meet or exceed patient access to primary care in our community.

2) OUR TALENT AND CULTURE

a) Establish and achieve specific department goals to improve how our facility makes decisions and interact with patients, Medical Staff, and all PSMC employees in a manner that is consistent with PSMC’s values (Wholeness, Integrity, Stewardship, Excellence and Respect “WISER”).

b) Elevate the role and accountability of managers/directors for their department’s performance and accomplishment of 2016 organizational and department goals.

c) Increase/elevate manager/leadership reporting including: (i) monthly interdepartmental reporting by managers/directors; and (ii) monthly long-term planning from the CTeam to the Board.

d) Develop and implement a sustainable annual performance bonus/incentive plan for employees based upon: (i) threshold financial performance; and (ii) successful accomplishment of 2016 organizational and department goals.

e) By December 31, 2016, develop and implement additional employee surveying as determined through work managers, directors and CTeam.

f) Develop and implement a plan to increase the depth of physician talent in primary care and hospitalist areas.

3) OUR FINANCIAL STABILITY a) By December 31, 2016, meet budgeted net income. b) On December 31, 2016, have 60 days cash on hand plus additional cash equal to fifty percent (50%) of

the Reserve Fund described in Resolution 2015-7 at paragraph 5 (see end note “3(b)” for detail). c) By December 31, 2016, reduce accounts receivable to no greater than 60 days. d) By December 31, 2016, revise and update charge-master. e) By December 31, 2016, prepare a capital equipment plan including identifying equipment that may

require debt or donations.

4) OUR STRATEGIC GROWTH a) Appropriately manage hospital renovation project in accordance with established budget, schedules and

plans. b) Appropriately manage clinic expansion building project in accordance with budgets, schedules and

plans. c) By December 31, 2016, identify and plan future services offered, provider recruiting needs and physical

structure needs (including update the Service Line analysis and evaluate and plan regional opportunities).

5) OUR COMMUNITY RELATIONSHIPS a) Build relationships with other healthcare facilities in our region and build relationships with

stakeholders in Pagosa Springs. b) By December 31, 2016, improve transparency to the public through web-based board packets. c) Develop and implement plan to educate the board, staff and community on TABOR.

End note 1: All goals have a facility-wide deadline of December 31, 2016; however, we will operationalize our work in staggered internal deadlines. Managers/Directors will make progress reports internally on a monthly basis and CTeam will make regular progress reports to the Board of Directors at Board meetings. End note 3(b): For reference, Paragraph 5 of Formal Written Resolution 2015-7 passed by the Board of Directors on November 17, 2015 states:

5) The Board resolves that PSMC staff shall establish a restricted reserve debt service fund balance (“Reserve Fund”) as follows: a) The Reserve Fund will be an amount equal to one annual principal and interest payment for the new

financing (the Reserve Fund is in addition to 60 days cash reserve); b). The Reserve Fund is to be funded by the end of 2017; c) The Reserve Fund may not be utilized except by approval vote of the Board; and d) Staff will report on the status of the Reserve Fund in monthly finance reports.

StrategicPlanningCommitteeReporttotheUSJHSDBoardofDirectors1/26/2016TheStrategicPlanningCommitteemeton1/12/2016and1/19/2016toreviewdraftsoftheStrategicPlan.Theplanhasbeendevelopedbymanagementina“bottomup”manner,wasinnearfinalconditionwhenpresented.Thecommitteeexaminedtheplanandsuggestedimprovementinsomeareas.Thesechangeshavebeenmade.TheplaninfrontoftheBoardtonightisforyourreviewonly.DiscussionwilloccurinFebruary2016.Theimplementationbystaffhasbegun.Somestatisticalinformationwillbeupdatedandre-presentedlaterintheyear.

Table of Contents

AppendixC ServiceAreaPhysicianSupplyandDemandPSMCVolumeForecasts

Page

PlanningProcess 2

MissionandVision 3

Values 4

2015Accomplishments 5

KeyStrategicAreas 8

Goals 9AppendixA: ServiceAreaDefiniIon

Demographics

AppendixB: PSMCInpaIentandOutpaIentVolumesOut-migraIonofArchuletaCountyResidents

Strategic Planning Process In 2011, the USJHD board of directors developed and approved a long-range strategic plan that covered the period of 2011 to 2020. The plan that follows in this document provides updates on the hospital’s recent accomplishments and arFculates the goals for the next 5 years.

In November and December of 2015, the C Team met several Fmes to review data trends and to brainstorm opportuniFes for the hospital’s future. Input was then sought from Board members, internal managers, and physicians. The ideas that emerged from these acFviFes form the foundaFon for this strategic plan update.

The appendices to this plan update key data points related to select hospital services. Forecasted physician supply and demand is included as are volume forecasts.

2

Mission and Vision

Our purpose is to provide quality, compassionate healthcare and wellness where we live.

Our vision is to build an organizaFon that has passion for doing the right thing for our paFents every day.

3

Values

WholenessWe value the physical, spiritual, and emo5onal aspects of all.

Integrity We strive for transparency, consistency, and clarity in our rela5onships.

Stewardship

Excellence

Respect

We work to deliver the best value for our community’s healthcare dollar.

We are focused on the best performance and outcome in all of our ac5ons.

We honor, in thought and ac5on, the worth of our pa5ents and employees.

4

2015 Accomplishments

5

§  Gained board approval to proceed with the new clinic building

•  Raised $2 million in pledges and donaFons •  Received $2 million grant from DOLA •  Completed design and construcFon

drawings

§  Achieved board approval to make needed building improvements

•  Convert the procedure room to an operaFng room •  Dedicate a room for infusion services •  Create a space for triage in the emergency department

§  Expanded management team to meet new demands •  Chief Medical Officer (CMO) •  Chief Medical InformaFon Officer (CMIO) •  Discharge Planner/Case Manager •  PaFent Experience Supervisor

2015 Accomplishments §  Improved financial performance

•  Generated posiFve operaFng margin which was the highest net income in PSMC’s history

•  Achieved 60 days of cash on hand by year-end •  Reduced days in accounts receivable by almost 1/3, from 95 to 67 (at 9/30/15, prior to

ICD-10 implementaFon)

§  Met EMR challenges •  Cerner opFmizaFons

•  HIMSS level 6 •  Achieved meaningful use objecFves •  ICD-10 transiFon

§  RecerFfied as a Level IV Trauma Center

§  Strengthened management •  TransiFoned to goal- and performance-based evaluaFons •  Integrated mission, vision, and values into management processes

•  Improved effecFveness via departmental restructuring

6

2015 Accomplishments §  Developed facility-wide emergency operaFng plan §  Created operaFonal status reports for the Board of Directors

§  Reduced registraFon errors

§  Reduced clinic no-show rates to less than 5%

§  Made presentaFons to a wide variety of consFtuents (e.g., local business owners, government officials, service clubs); held “meet and greets”

§  Developed incenFve pay plan for Emergency Department physicians

§  Automated hospital policy review process

§  Established values-based employee recogniFon program §  Provided managers with Lean training

§  Enhanced the services offered in the café

7

Key Strategic Areas

8

FinancialStability

StrategicGrowth

We are mindful of the need to maintain a strong financial posi5on and to be good stewards of our community’s resources to allow us to offer services at the

right 5me and for the right reasons. We rely on a wide variety of sources for funding, including the mill levy, pa5ent services, dona5ons, and grants.

Goal

1 60totaldaysofcashonhand,plusaddiIonalcashequalto50%ofthereservefunddescribedinBoardResoluIon2015-7atparagraph5

2 Reducedaysinaccountsreceivableto60byDecember31,2016

3 Annualnetincometargetsachieved

4 Long-rangecapitalplanupdatedduringtheannualbudgeIngprocessthatidenIfieswhatisneededandhowitmightbefunded(e.g.,debt,donaIons)a.  AssessneedfornewMRIb.  AssessneedfornewQuickResponseVehiclec.  Assesshospitalandcampusexpansionrequirements

5 2015profitabilitybyservicelineassessedbyendof2016

9

We are mindful of the need to maintain a strong financial posi5on and to be good stewards of our community’s resources to allow us to offer services at

the right 5me and for the right reasons. We rely on a wide variety of sources for funding, including the mill levy, pa5ent services, dona5ons, and grants.

Goal

6 ClinicexpansioncompletedonImeandatorbelowbudgetin2017a.  Securefinancing

7 ClinicoperaIonalimprovementopportuniIesidenIfiedandimplementeda.  IdenIfybyMarch2016b.  Implementshortlytherea_erc.  Measureatendof2016asabasisfor2017targets

8 ChargemasterrevisedandupdatedbyDecember31,2016

9 MulI-yearfundraisingplandevelopedbyendof2016a.  EngagefundraisingprofessionalnolaterthanJanuary2017b.  DevelopstrategiestoculIvatenewdonorsc.  ConInuecontactswithexisIngdonors

10

Goal

1 ProcedureroomconvertedtoanoperaIngroombyMay2016

2 BusinessplanforoncologysubmiaedtoBoardbyDecember2016

3 Businessplanforemergencymedicalservices(EMS)preparedin2017

4 FacilitymasterplanupdatedbyDecember2016toreflectservicedemandin2025a.  Plantoaddressinterimspaceneeds(parIcularlyadministraIveandemergency

department)developedbyJuly2016

5 FeasibilityofofferingorexpandingselectservicesassessedbyDecember2016a.  Cardiologyb.  Ophthalmologyc.  ENTsurgeryd.  Urologicalsurgerye.  Neurology

We are commi?ed to expanding our service offerings based on demonstrated community need. We prepare a business plan for each new service offering that

contains volume and financial forecasts, the expected impact on reducing out-migra5on, and the service’s expected impact on financial goals.

11

Goal

1 BepreparedforsuccessfulcerIficaIonsurveybyCDPHE.(Successful=eithernoorfewviolaIons)a.  Preparedepartment-specificplansthataddresspaIentsafetyandqualityb.  RestructuretheQualityprogram,includingtheQualityReviewCommiaeec.  Reviewandupdateatdepartmentalpoliciesonanappropriatescheduled.  Assurecompliance-relatedpoliciesandproceduresareinplaceandcurrent

2 PaIentsaIsfacIonmeasurementtoolsforinpaIentsandoutpaIentsdevelopedandimplementedbyDecember31,2016

3 ServicerecoveryprogramexpandedandenhancedbyDecember31,2016a.  ImproveprocessforpaIentcomplaintiniIaIonb.  Acquireso_waretotrackcomplaintsandtheirresoluIonc.  Educatestaffd.  Standardizeprocessforresolvingcommoncomplaints

We consider quality and pa5ent safety to be the founda5on of our responsibili5es to our pa5ents. We are commi?ed to achieving pa5ent safety

goals and to monitoring and improving the quality of care we offer.

12

Goal

4 PlaninplacebyDecember31,2016,foroperaIngunderemergencycondiIonsa.  Conductriskassessmentannuallyb.  PrepareemergencyoperaIonsplansfortopthreerisksc.  Conductatleasttwomockincidentdrillseachyear

We consider quality and pa5ent safety to be the founda5on of our responsibili5es to our pa5ents. We are commi?ed to achieving pa5ent safety

goals and to monitoring and improving the quality of care we offer.

13

Goal

1 Adequatenumberofprimarycarephysiciansandmid-levelprovidersengagedtomeetcommunityneeda. SecureresultsofworkforceanalysisprovidedthroughtheRuralHealthCenterb. Developrecruitmentplanbasedonneeds’analysis

2 AdequatenumberofhospitalistsengagedtocareforinpaIents,observaIonpaIents,andswing-bedpaIents

3 MarkeIngandcommunicaIonscoordinatorengagedduringfirstquarterof2016

4 SuccessionplanscreatedforkeyposiIonsa. CTeammembersbyendof2016b. Managementteambyendof2017

We are strong because of our culture and the talents of the people in our organiza5on. We are commi?ed to: a?rac5ng and retaining qualified physicians, nurses and other providers, leadership, support staff, and volunteers; suppor5ng

ac5vi5es and prac5ces that make us a desirable employer in the community; fostering a culture of excellence that is integral to everything we do; enhancing

our informa5on technology capabili5es; communica5ng openly and honestly with our cons5tuents; and, celebra5ng our individual and collec5ve successes.

14

Goal

5 Boardtrainingprogramimplementedduring2016

6 ConsultantidenIfiedandengagedforvalues-basedtrainingduringfirsthalfof2016

7 Controller’sroleexpandedbyJune2016

8 ChiefMedicalOfficerintegratedintomedicalstaffstructureduring2016

9 InterdepartmentalcommunicaIonsimproveda. ManagersanddirectorswillreportonaccomplishmentsandotherrelevantissuesduringmanagementmeeIngs




15

Goal

10 EmployeesaIsfacIonassessedbyendof2016;responseplansdevelopedwithinfourmonthsofassessment

11 EmployeeincenIveplandevelopedbyendof2016thatconsidersoverallfinancialperformance,organizaIon-widegoals,anddepartment-specificgoalsa.  IdenIfyperformanceobjecIvesandmeasurelevelofachievementbyendof2016b.  Assureemployeesareawareoftheirrolesinachievingthegoals




16

Goal

1 Plancra_ed,approved,andimplementedbyOctober2016toeducatethecommunityabouttheTaborissues

2 RelaIonshipsformedorenhancedwithenIIes—withinandoutsideofthelocalcommunity—thatimproveaccesstohealthcareservicesforarearesidents

3 AffiliaIonopportuniIesevaluatedduring2017

4 Boardpacketsavailabletothepubliconthehospital’swebsitebyendof2016

We ac5vely seek rela5onships with our cons5tuents and other en55es in the community.

17

Appendix A ServiceAreaGeographyandDemographics

The Market Area § ThemarketassessmentreliedondemographicdataforArchuletaCountyandDulce,NM.

•  Inthisassessment,ArchuletaCountyisconsideredthePrimaryServiceArea(PSA)—theUSJHDserviceareavariesslightlyfromthisdefiniIon--andDulcetheSecondaryServiceArea(SSA).

•  ThemaponthefollowingpageshowstheenIremarketarea.

§ FiveZipcodeswereusedasthebasisforobtaininginpaIentandoutpaIentdataforarearesidentsfromtheColoradoHospitalAssociaIon.

•  81121and81147•  81157and81128containP.O.BoxAddresses(no“geography”)

•  87528(Dulce,NM)ishometotheJicarillaApacheNaIon

19

The Market Area

20

Archuleta County Demographics

32%Growthfrom2010to2025

91%Growthfrom2010to2040

Popu

laIo

n

Source: Colorado Demographer

12,081 12,460 13,77515,955

23,093

Dulce, NM Demographics 4% Decrease in Population

Source: esri

3,417 3,400 3,345 3,290

%Change

54%

22%

(4%)

(8%)

(7%)

22

Market Area Demographics % of PopulaFon Age 65+

People age 65+ use significantly more

healthcare services than those under 65.

23

Appendix B PSMCTrends;Out-migraIonofArchuletaCountyResidents

PSMC PaFent Admissions

122

323 348

441 499

683

944 Volumes increased significantly (38%) between 2014 and 2015.

25

PSMC PaFent Days

346

849 949 950

1,111

1,387

1,698 Volumes increased significantly (22%) between 2014 and 2015. In 2009, the average daily census was .9, increasing to 4.7 in 2015. The occupancy rate was 42% in 2015.

26

Emergency Dept OP and Clinic Visits ED OP visits increased 75% between 2009 and 2015. Clinic visits more than quadrupled between 2010 and 2015. Between 2013 and 2014, ED visits increased as a result of a decline in clinic visits, but as clinic visits increased in 2015, ED visits conFnued to grow.

27

EMS Calls and Transports

28

1013

55%

1067 1103 1057

1184

1580

1896

61%

53%

59%

59%

64%

66%

The number of EMS calls increased 87% between 2009 and 2015. The number of transports to PSMC increased 82% over the period. The number of transports to other locaFons increased only 16%, and the number of calls that did not result in a transfer increased 163%.

OutpaFent Laboratory Tests

The number of outpaFent lab tests nearly doubled between 2009 and 2015. Over the period, growth averaged 12% per year.

29

OutpaFent Radiology PaFents

The number of radiology outpaFents quadrupled between 2009 and 2015. Growth has been steady at 27% per year on average. The number of imaging exams per paFent averaged 1.36 over the period. This is comparable to the average reported by terFary medical centers.

30

MRIs, CT Scans, and DiagnosFc X-rays The number of MRIs, CT scans, and diagnosFc imaging exams more than tripled between 2009 and 2015, with the greatest growth over the last two years. On a percentage basis, MRI has exhibited the most growth (379%.)

31

Other Imaging Exams Mammograms&BoneDensity

EchocardiogramsandUltrasound

32

Surgical Cases by Type

372

538 566

778

1013

+45%

+5%

+37%

+30%

33

InpaFent OutmigraFon: Archuleta County Residents

Hospital2008 2009 2010 2011

# % # % # % # %MercyMedCenter 499 83.3% 472 81.0 493 83.7% 482 80.8%

University 15 2.5 27 4.6 20 3.4 19 3.2

Children’s 15 2.5 6 1.0 13 2.2 11 1.8

Pres/St.Luke’s 13 2.2 22 3.8 7 1.2 4 0.7

MedCtrofAurora 12 2.0 5 0.9 1 0.2 4 0.7

Swedish 9 1.5 14 2.4 17 2.9 18 3.0

Porter 7 1.2 4 0.7 2 0.3 12 2.0

St.Mary’s 5 0.8 2 0.3 5 0.8 14 2.3

AllOtherCOHosp 24 4.0 31 5.3 33 5.3 35 5.8

TOTAL 599 100% 583 100% 591 100% 599 100%

Source: Colorado Hospital AssociaFon

34

Hospital2012 2013 2014 2015

# % # % # % # %MercyMedCenter 375 82.4% 371 78.8% 380 75.8% 378 74.4%

University 22 4.8 8 1.7 17 3.4 18 3.5

Children’s 12 2.6 8 1.7 13 2.6 10 2.0

Pres/St.Luke’s 5 1.1 5 1.1 14 2.8 16 3.1

MedCtrofAurora 2 .4 2 .4 1 .2 -- --

Swedish 4 .9 9 1.9 9 1.8 20 3.9

Porter 6 1.3 9 1.9 9 1.8 6 1.2

St.Mary’s -- -- 3 .6 3 .6 8 1.6

AllOtherCOHosp 29 6.4 56 11.9 55 11.0 52 10.2

TOTAL 455 100% 471 100% 501 100% 508 100%

35

Source: Colorado Hospital AssociaFon

InpaFent OutmigraFon: Archuleta County Residents

CEO Report, January 2016 Annual Goals – 2015 Year-End Report Dear Board Members, We worked very hard this year in a focused way to achieve our goals. While we acknowledge that we have more to do and ways to improve in 2016, when we look back at 2015, we feel we accomplished almost everything we set out to do. We have assessed ourselves as not having fully accomplished four of our sub-goals, and we learn from those short-comings as we move forward with our 2016 objectives. With respect to accomplishment of our 2015 goals, we evaluate ourselves overall as an 86% (82 of 95 possible points). ~ Brad

1. UTILIZE A LEADERSHIP STYLE THAT FOCUSES ON RESULTS AND ACCOMPLISHING GOALS, WORKING AS A TEAM, COMMUNICATING APPROPRIATELY, ACHIEVING EFFICIENCY, AND BEING ACCOUNTABLE TO CONSTITUENTS.

a. Use board-approved annual goals as the basis for evaluating staff and the organization’s performance. ACHIEVED (5)

• On February 24, 2015, the Board approved the 2015 goals proposed by C-

Team. In March 2015, C-Team began its process to transition goal-based performance through-out the organization.

• C-Team actions to transition to goal-based performance included education, shared responsibility, feedback including:

o Restructured management team. o Increased management training. o Transitioned manager practices to setting department goals in

alignment with facility-wide goals. o Participated in “Thank-You Tours” (3 rounds) for department-

specific open-forum discussion, including goal work. o Surveyed employees for feedback on matters that included goals

and mission, vision and values. o Assessed, through an Employee Committee, our

Mission/Vision/Values; redrafted and Mission/Vision and surveyed staff on proposed amendments; Board approved Mission/Vision at the November 2015 BOD (following evaluation and employee input, determined our Values are meaningful and do not need any updates).

o Awarded, throughout the year, twenty employees who consistently exemplified our values.

o Restructured departments to allow for better performance outcomes (e.g., quality department was restructured to report to the CMO and emphasize clinical outcomes; created separate compliance department which includes Policy/Procedures and

HIPAA; moved provider peer review from quality to the medical staff manager duties).

• Transitioned to performance-based accountability, review, and reward including:

o Revised employee performance review tool to focus on 2015 annual goals and mission/vision/values, and to set the employee’s following year responsibilities for accomplishing the next year’s annual goals (both for the facility and aligned department goals).

o Transitioned all employees to calendar-year performance evaluation.

o Charged managers with determining the pay raises (for the first time in PSMC history) of their staff based upon annual performance (raises were 0% to 4%, subject to an overall department cap).

o Rewarded all PSMC employees (excluding PRN employees) with a year-end reward for facility-wide financial performance. This is the first time in the history of PSMC that we were able to monetarily reward all employees for meeting a financial performance goal. It was one of the highlights of our year for all managers to participate in the preparation and delivery of the reward. All managers/staff have been educated about the final transition to performance-based work -- future monetary rewards will be based on accomplishment of all annual facility/department goals in accordance with an incentive pay plan.

b. Develop a CEO and C-Team transparency with our BOD of directors

utilizing dashboard indicators, monthly and quarterly reports. ACHIEVED (5)

• Expanded monthly board reporting -- all C-Team staff provided reports which included progress toward annual goals.

• Hired a Chief Medical Officer to strengthen relationship with providers and enhance leadership for clinical standards and quality.

• Hired a Chief Medical Information Officer to enhance leadership EHR leadership and improve provider utilization and/or efficiency of Cerner.

• Hired a Chief Administrative Officer to strengthen/enhance role of administrative support areas (human resources, compliance, medical staff office, legal and as of 2016, marketing and aspects of the foundation).

2. DEVELOP A CULTURE WHERE THE CUSTOMER/PATIENT EXPERIENCE IS THE DRIVING FORCE FOR ALL EMPLOYEES TO MAKE DECISIONS WHILE DEMONSTRATING ACHIEVEMENT TOWARDS OUR ANNUAL GOALS.

a. Improve our performance of our RHC through the use of various patient satisfaction metrics. ACHIEVED (4)

• During 2015, increased RHC volumes thirty-one percent (as of November 2015, RHC volumes increased 31% -- in November 2014 volumes were 11,568 and at the end of November 2015, volumes were 15,138).

• Completed an RHC audit, participated in a RHC optimization training, designed and began implementing LEAN project.

• Responded to the unexpected closing of Cornerstone with an immediate assessment and organized process to respond to patient needs to the maximum of our current capabilities.

• Hired a director for the Clinic with integrated health experience. • Service recovery process (noted below) created and implemented. • Used Hospital Consumer Assessment of Healthcare Providers and

Systems (“HCAHPS”) reporting company to conduct inpatient HCAHPS (called and interviewed patients and collected data). Scores were published quarterly in the Board packet and reported to the Board.

• Assessed that use of outside company does not provide sufficient meaningful data for us (an outside company is what CMS requires if our scores were required to be reported – currently a CAH has no obligation to gather/report HCAHPS). In process (manager-coordinated project) to implement our own delivery of HCAHPS questions.

• Associated with conversion to our own delivery of HCAHPS questions is a conversion of provider incentive pay to be based partially on patient responses to our HCAHPS questionnaire.

b. Have in place a service recovery process by the end of 2015. ACHIEVED (5)

• Hired a patient experience supervisor. • Planned and implemented a patient recovery process for patient

complaints. • Expanded nurse navigation roles to assist in patient satisfaction, patient

preauthorization and avoid the need for service recovery.

c. Research and define our use of the integrated care model. ACHIEVED (5) • Participated with community members to evaluate integrated care.

Created a series of maps and steps to define a community-based solution for integrated care and our behavioral health patients in need.

• Recruited/hired (during the summer of 2015) an additional Behavioral Health provider who commenced work in January 2016.

• Moved the Wellness program to the RHC. • Hired an RHC director with specific integrated care experience. • Achieved Trauma IV recertification.

d. Maximize Cerner’s capability in our organization-become a top 20%.

ACHIEVED (5) • Earned significant Cerner reference points. • Served as a Cerner reference site. • Achieved HIMMS level 6. • Hired a Chief Medical Information Officer to coordinate provider training

to increase the efficiency of our workflow and utilization of Cerner capabilities.

• Acknowledged repeatedly by Cerner Community Works for our outstanding performance and sophistication of our integration and manager capability. Received verbal acknowledgments from Cerner that we are among the highest achieving of Cerner Community Works (Critical Access Hospitals).

e. Meet CHA pricing transparency recommendations. ACHIEVED (5)

• Completed all work/documents consistent with CHA pricing transparency recommendations. Requested posting to our new PSMC website.

f. Create a process with accountability assigned to facilitate readiness for any regulatory visit with an ongoing offense directed at compliance, accreditation, regulatory requirements. ACHIEVED (5)

• Developed and implemented a CDPHE readiness plan. o Restructured and created the Compliance Department to manage

and lead implementation of the plan. Created department-specific readiness tools (for education, evaluation, and progress reports). All readiness tools were incorporated into department goals for 2016.

o Acquired and implemented a policy and procedure (P&P”) software for all policies and procedures. All staff now on a schedule of competency/education of P&P and update/revision of P&P.

• Created facility Emergency Operations Plan. Staff participated in table-top drills, fire drills and advanced emergency operation training.

• Prepared and met nationwide coding transition from ICD9 to ICD10, including trained staff and prepared and implemented process.

3. COMPLETE AND GAIN APPROVAL FOR A MULTI-YEAR EXPANSION PLAN

a. Clinic expansion planned/designed to break ground by 2016. ACHIEVED (5)

• Completed Construction Documents; received approval from the Town of Pagosa Springs in summer of 2015. Conducted ongoing meetings to prepare for construction. Planned commencement of construction (and soft groundbreaking) for April 4, 2016 and formal groundbreaking ceremony for May 24, 2016.

b. Complete debt negotiations and have in place by May 2015. NOT

ACHIEVED (1) • Debt negotiations were not accomplished by May 2015. When we set this

goal, we did not understand the challenges of our existing bond debt nor did we understand that our existing debt would require us to pursue more complex investment banking financing. We acknowledge and own that our lack of understanding resulted in delay, set unrealistic expectations, and led us to set an unachievable goal for ourselves (if we had understood the complexities of our financing needs, we would have realized that, even without any process confusion, financing with a refinancing component would realistically have taken us until around September to accomplish).

c. Secure pledges of Three Million no later than July 2015. NOT FULLY

ACHIEVED, BUT SIGNIFICANT PROGRESS MADE (3) • Achieved total pledges and donations for expansion of $2,460,062.

d. Complete grant processes with a goal of $2.0 million to be awarded for

campus expansion by August 2015. ACHIEVED (5) • Granted by DOLA in April of 2015, contract finalized and being executed.

e. Educate community and employees relative to expansion plans. ACHIEVED

(5) • Achieved community integration through the monthly radio talks, PR in

newspaper/television/radio, meet and greets, lunches and dinners with the CEO, community club participation on and off campus, meetings with

business and government leaders, house parties, Keyah Grande event, Jicarilla Tribal council meetings, Fundraiser Fridays.

• Community Clubs and government officials: 48 appointments • Meet and Greets: 5, approximately 350 attendees • Lunches and Dinners: 115 • Events:

o Cherokee Creek o Keyah Grande, 116 attendees, 802 donors o Jack and Katy Threet Art Show, attendees 15 o Oliver Cocktail Party, attendees 15 o Fundraiser Fridays, 6 events, average 45 attendees per event

4. PRODUCE A STRONG FINANCIAL OUTCOME a. $500,000 revenues over expenses for FY 2015. ACHIEVED (5)

• PSMC 2015 revenues over expenses were $1,600,000.

b. 60 days of cash on hand by 12/31/15. ACHIEVED (5) • As of end of 2015, we had 60 days cash on hand.

c. Reduce accounts receivable to 60 days by 10/1/15. NOT FULLY

ACHIEVED BUT SIGNIFICANT PROGRESS MADE (3) • On 10/1/15, we had reduced A/R to 67 days (reduction from 87 days on

10/1/14). We had an interim business office manager from April to October 2015 who furthered some improvements. In October of 2015, we hired a new business manager with the right skills to take our billing office to a higher level and she is already working to implement software and revised processes (including bill hold times) to further reduce our days of A/R in 2016.

d. Develop a dashboard to report financial measures to management and BOD.

ACHIEVED (5) • The CFO and finance team consistently provided detailed monthly

financial reports to the Board and managers including dashboards with net income, days in A/R, Gross Revenue and DNFB.

e. Update service line analysis by July 2015. NOT ACHIEVED (1)

• The service line analysis was not updated (it will be updated during 2016).

f. Develop a case manager function and hire by May 1, 2015. ACHIEVED (5) • Developed a case manager function and hired in May 2015.

Pagosa Springs Medical Center Updated through 12/31/2015Data Trend Analysis

Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec TOTAL2009 318 321 362 251 321 316 450 369 359 353 282 278 3,980

Cumulative 318 639 1,001 1,252 1,573 1,889 2,339 2,708 3,067 3,420 3,702 3,980 Moving Average 318 320 334 313 315 315 334 339 341 342 337 332

2010 307 246 354 210 276 441 513 455 426 338 316 346 4,228 6.2%Cumulative 307 553 907 1,117 1,393 1,834 2,347 2,802 3,228 3,566 3,882 4,228

Moving Average 307 277 302 279 279 306 335 350 359 357 353 352

2011 353 321 322 282 351 355 468 423 321 314 282 347 4,139 ‐2.1%Cumulative 353 674 996 1,278 1,629 1,984 2,452 2,875 3,196 3,510 3,792 4,139

Moving Average 353 337 332 320 326 331 350 359 355 351 345 345

2012 302 302 369 271 325 388 474 435 349 358 277 420 4,270 3.2%Cumulative 302 604 973 1,244 1,569 1,957 2,431 2,866 3,215 3,573 3,850 4,270

Moving Average 302 302 324 311 314 326 347 358 357 357 350 356

2013 393 325 368 284 397 443 507 491 451 342 301 480 4,782 12.0%Cumulative 393 718 1,086 1,370 1,767 2,210 2,717 3,208 3,659 4,001 4,302 4,782

Moving Average 393 359 362 343 353 368 388 401 407 400 391 399

2014 484 423 550 410 452 569 677 687 629 547 537 554 6,519 36.3%Cumulative 484 907 1,457 1,867 2,319 2,888 3,565 4,252 4,881 5,428 5,965 6,519

Moving Average 484 454 486 467 464 481 509 532 542 543 542 543

2015 477 483 599 426 524 705 749 677 582 557 538 666 6,983 7.1%Cumulative 477 960 1,559 1,985 2,509 3,214 3,963 4,640 5,222 5,779 6,317 6,983

Moving Average 477 480 520 496 502 536 566 580 580 578 574 582

At 12/31/15 2015 is on track for ED OP Visits Percent change: 2009 ‐ 2015: 75%2015 budget is: 6,269 ED OP Visits 2015 Actual Over/(Under) Budget: 11%

Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec TOTAL2009

CumulativeMoving Average

2010 5 13 17 3 11 15 9 16 13 9 8 8 127 Cumulative 5 18 35 38 49 64 73 89 102 111 119 127

Moving Average 5 9 12 10 10 11 10 11 11 11 11 11

% Change Over Prev Period


Emergency Department Outpatient Visits

Observation Outpatient Visits

0

100

200

300

400

500

600

700

800

Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec

2009

2010

2011

2012

2013

2014

2015

E.D. VISITS

40

50

60

2009

2010

2011

OBSERVATIONVISITS

2011 8 10 11 12 19 10 13 18 18 11 10 10 150 18.1%Cumulative 8 18 29 41 60 70 83 101 119 130 140 150

Moving Average 8 9 10 10 12 12 12 13 13 13 13 13

2012 18 13 23 17 25 21 20 22 15 16 20 20 230 53.3%Cumulative 18 31 54 71 96 117 137 159 174 190 210 230

Moving Average 18 16 18 18 19 20 20 20 19 19 19 19

2013 20 20 21 21 14 19 22 18 32 30 18 ‐ 235 2.2%Cumulative 20 40 61 82 96 115 137 155 187 217 235 235

Moving Average 20 20 20 21 19 19 20 19 21 22 21 20

2014 18 14 14 12 8 15 11 21 27 14 24 28 206 ‐12.3%Cumulative 18 32 46 58 66 81 92 113 140 154 178 206

Moving Average 18 16 15 15 13 14 13 14 16 15 16 17

2015 21 25 39 29 27 38 50 46 43 41 26 28 413 100.5%Cumulative 21 46 85 114 141 179 229 275 318 359 385 413

Moving Average 21 23 28 29 28 30 33 34 35 36 35 34

At 12/31/15 2015 is on track for Visits Percent change: 2009 ‐ 2015: 225%2015 budget is: 222 Visits 2015 Actual Over/(Under) Budget: 86%

0

10

20

30


2011

2012

2013

2014

2015

N:\Client Projects\CO ‐ Pagosa Springs Med Center Data Trends\Cumulative Volumes 2009 Forward.xlsx_files\Cumulative Volumes 2009 ForwardVolumes 1 of 17


Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec TOTAL2009 ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐

Cumulative ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ Moving Average ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐

2010 26 38 66 300 283 286 333 362 475 543 550 516 3,778 N/ACumulative 26 64 130 430 713 999 1,332 1,694 2,169 2,712 3,262 3,778

Moving Average 26 32 43 108 143 167 190 212 241 271 297 315

2011 717 821 969 812 765 951 895 1,168 888 964 775 824 10,549 179.2%Cumulative 717 1,538 2,507 3,319 4,084 5,035 5,930 7,098 7,986 8,950 9,725 10,549

Moving Average 717 769 836 830 817 839 847 887 887 895 884 879

2012 986 989 1,165 969 1,185 1,192 1,196 1,321 1,151 1,468 1,297 1,166 14,085 33.5%Cumulative 986 1,975 3,140 4,109 5,294 6,486 7,682 9,003 10,154 11,622 12,919 14,085

Moving Average 986 988 1,047 1,027 1,059 1,081 1,097 1,125 1,128 1,162 1,174 1,174

2013 1,135 1,023 1,212 1,193 1,325 1,302 1,326 1,482 1,260 1,598 1,273 1,309 15,438 9.6%Cumulative 1,135 2,158 3,370 4,563 5,888 7,190 8,516 9,998 11,258 12,856 14,129 15,438

Moving Average 1,135 1,079 1,123 1,141 1,178 1,198 1,217 1,250 1,251 1,286 1,284 1,287

2014 1,422 869 1,120 1,154 1,176 941 970 883 778 1,094 1,161 1,189 12,757 ‐17.4%Cumulative 1,422 2,291 3,411 4,565 5,741 6,682 7,652 8,535 9,313 10,407 11,568 12,757

Moving Average 1,422 1,146 1,137 1,141 1,148 1,114 1,093 1,067 1,035 1,041 1,052 1,063

2015 1,262 1,190 1,456 1,307 1,234 1,257 1,298 1,517 1,430 1,599 1,588 1,615 16,753 31.3%Cumulative 1,262 2,452 3,908 5,215 6,449 7,706 9,004 10,521 11,951 13,550 15,138 16,753

Moving Average 1,262 1,226 1,303 1,304 1,290 1,284 1,286 1,315 1,328 1,355 1,376 1,396

At 12/31/15 2015 is on track for Visits Percent change: 2009 ‐ 2015: 343%2015 budget is: 26,901 Visits 2015 Actual Over/(Under) Budget: ‐38%


Cumulative 711 1,482 2,442 3,407 4,286 5,222 6,244 7,191 8,143 9,069 9,837 10,561Moving Average 711 741 814 852 857 870 892 899 905 907 894 880

2010 817 735 841 878 884 1,100 1,047 1,027 1,082 1,031 824 850 11,116 5.3%Cumulative 817 1,552 2,393 3,271 4,155 5,255 6,302 7,329 8,411 9,442 10,266 11,116

Moving Average 817 776 798 818 831 876 900 916 935 944 933 926

2011 991 823 1 022 912 918 1 161 1 056 1 138 1 098 958 928 953 11 958 7 6%



Outpatient Laboratory Tests

Clinic Visits

‐

200

400

600

800

1,000

1,200

1,400

1,600

1,800


2010

2011

2012

2013

2014

2015

CLINIC VISITS

1500

2000

2500

2009

2010

2011

OUTPT LAB TESTS

2011 991 823 1,022 912 918 1,161 1,056 1,138 1,098 958 928 953 11,958 7.6%Cumulative 991 1,814 2,836 3,748 4,666 5,827 6,883 8,021 9,119 10,077 11,005 11,958

Moving Average 991 907 945 937 933 971 983 1,003 1,013 1,008 1,000 997

2012 1,020 1,016 1,152 975 1,231 1,253 1,235 1,380 1,189 1,233 1,123 1,064 13,871 16.0%Cumulative 1,020 2,036 3,188 4,163 5,394 6,647 7,882 9,262 10,451 11,684 12,807 13,871

Moving Average 1,020 1,018 1,063 1,041 1,079 1,108 1,126 1,158 1,161 1,168 1,164 1,156

2013 1,211 1,023 1,214 1,194 1,454 1,357 1,448 1,570 1,435 1,348 1,053 1,224 15,531 12.0%Cumulative 1,211 2,234 3,448 4,642 6,096 7,453 8,901 10,471 11,906 13,254 14,307 15,531

Moving Average 1,211 1,117 1,149 1,161 1,219 1,242 1,272 1,309 1,323 1,325 1,301 1,294

2014 1,314 1,106 1,348 1,381 1,483 1,500 1,732 1,526 1,541 1,560 1,392 1,576 17,459 12.4%Cumulative 1,314 2,420 3,768 5,149 6,632 8,132 9,864 11,390 12,931 14,491 15,883 17,459

Moving Average 1,314 1,210 1,256 1,287 1,326 1,355 1,409 1,424 1,437 1,449 1,444 1,455

2015 1,544 1,537 1,660 1,598 1,692 1,926 1,926 1,926 1,749 1,700 1,533 1,690 20,481 17.3%Cumulative 1,544 3,081 4,741 6,339 8,031 9,957 11,883 13,809 15,558 17,258 18,791 20,481

Moving Average 1,544 1,541 1,580 1,585 1,606 1,660 1,698 1,726 1,729 1,726 1,708 1,707

At 12/31/15 2015 is on track for Tests Percent change: 2009 ‐ 2015: 94%2015 budget is: 21,336 Tests 2015 Actual Over/(Under) Budget: ‐4%

0

500

1000


2012

2013

2014

2015




Cumulative 195 387 605 791 978 1,151 1,409 1,618 1,808 1,996 2,146 2,331 Moving Average 195 194 202 198 196 192 201 202 201 200 195 194

2010 194 167 232 199 164 225 246 240 263 244 212 272 2,658 14.0%Cumulative 194 361 593 792 956 1,181 1,427 1,667 1,930 2,174 2,386 2,658

Moving Average 194 181 198 198 191 197 204 208 214 217 217 222

2011 331 311 397 391 336 346 357 384 347 303 309 395 4,207 58.3%Cumulative 331 642 1,039 1,430 1,766 2,112 2,469 2,853 3,200 3,503 3,812 4,207

Moving Average 331 321 346 358 353 352 353 357 356 350 347 351

2012 362 341 424 302 353 382 412 438 352 385 319 431 4,501 7.0%Cumulative 362 703 1,127 1,429 1,782 2,164 2,576 3,014 3,366 3,751 4,070 4,501

Moving Average 362 352 376 357 356 361 368 377 374 375 370 375

2013 453 360 467 349 438 410 430 503 509 465 367 541 5,292 17.6%Cumulative 453 813 1,280 1,629 2,067 2,477 2,907 3,410 3,919 4,384 4,751 5,292

Moving Average 453 407 427 407 413 413 415 426 435 438 432 441

2014 754 540 672 592 699 730 801 767 719 805 659 712 8,450 59.7%Cumulative 754 1,294 1,966 2,558 3,257 3,987 4,788 5,555 6,274 7,079 7,738 8,450

Moving Average 754 647 655 640 651 665 684 694 697 708 703 704

2015 771 751 863 728 756 852 928 877 802 826 709 833 9,696 14.7%Cumulative 771 1,522 2,385 3,113 3,869 4,721 5,649 6,526 7,328 8,154 8,863 9,696

Moving Average 771 761 795 778 774 787 807 816 814 815 806 808

At 12/31/15 2015 is on track for radiology pts Percent change: 2009 ‐ 2015: 316%


Total Radiology Patients

‐

100

200

300

400

500

600

700

800

900

1,000


2009

2010

2011

2012

2013

2014

2015

RADIOLOGY PATIENTS



Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec TOTAL2009 ER 133 152 164 121 150 123 201 152 181 142 133 148 1,800

OP 31 42 36 43 32 33 60 45 21 37 28 33 441 IP 8 5 11 11 7 6 10 2 4 6 3 3 76 Total 172 199 211 175 189 162 271 199 206 185 164 184 2,317


Per ER Visit 0.42 0.47 0.45 0.48 0.47 0.39 0.45 0.41 0.50 0.40 0.47 0.53 0.45 Per Inpt 0.67 0.71 0.65 1.00 0.58 0.60 1.25 0.67 1.00 0.60 0.43 1.00 0.73

2010 ER 165 126 207 107 111 177 201 181 184 153 132 154 1,898 5.4%OP 24 33 31 74 57 45 48 57 71 75 65 70 650 47.4%IP 11 7 14 13 9 12 8 6 13 14 5 9 121 59.2%Total 200 166 252 194 177 234 257 244 268 242 202 233 2,669 15.2%


Per ER Visit 0.54 0.51 0.58 0.51 0.40 0.40 0.39 0.40 0.43 0.45 0.42 0.45 0.45 Per Inpt 1.00 1.17 1.00 0.68 0.75 0.52 0.67 0.67 0.76 1.00 0.50 0.45 0.72

2011 ER 170 150 180 124 148 166 176 160 144 135 138 181 1,872 ‐1.4%OP 98 97 147 104 92 117 121 125 95 95 107 131 1,329 104.5%IP 16 14 17 18 22 15 2 11 16 11 10 11 163 34.7%Total 284 261 344 246 262 298 299 296 255 241 255 323 3,364 26.0%

Cumulative 284 545 889 1,135 1,397 1,695 1,994 2,290 2,545 2,786 3,041 3,364 Moving Average 284 273 296 284 279 283 285 286 283 279 276 280

Per ER Visit 0.48 0.47 0.56 0.44 0.42 0.47 0.38 0.38 0.45 0.43 0.49 0.52 Per Inpt 0.84 1.00 1.00 1.64 1.57 0.83 0.40 0.92 0.73 0.92 0.83 1.00

2012 ER 170 157 181 124 149 162 207 204 172 179 140 257 2,102 12.3%OP 113 125 153 114 96 123 132 171 124 135 90 110 1,486 11.8%IP 17 8 13 3 10 18 5 15 19 20 8 21 157 ‐3.7%Total 300 290 347 241 255 303 344 390 315 334 238 388 3,745 11.3%

Cumulative 300 590 937 1,178 1,433 1,736 2,080 2,470 2,785 3,119 3,357 3,745 Moving Average 300 295 312 295 287 289 297 309 309 312 305 312


2013 ER 226 171 196 119 168 207 204 209 212 167 118 254 2,251 7.1%OP 155 140 143 127 169 142 200 188 187 184 148 205 1 988 33 8%


Diagnostic Imaging Procedures

‐

100

200

300

400

500

600

700

800


2009

2010

2011

2012

2013

2014

2015

DX RAD PROC

OP 155 140 143 127 169 142 200 188 187 184 148 205 1,988 33.8%IP 12 13 14 6 9 27 10 28 30 14 11 21 195 24.2%Total 393 324 353 252 346 376 414 425 429 365 277 480 4,434 18.4%



2014 ER 247 207 335 186 311 322 359 343 339 302 292 348 3,591 59.5%OP 216 168 224 233 270 217 278 272 252 295 243 230 2,898 45.8%IP 32 37 15 22 22 9 14 21 25 13 5 24 239 22.6%Total 495 412 574 441 603 548 651 636 616 610 540 602 6,728 51.7%



2015 ER 335 290 324 259 272 401 400 364 286 322 284 368 3,905 8.7%OP 312 264 296 236 226 306 305 272 298 257 205 217 3,194 10.2%IP 22 41 10 36 41 32 29 29 33 45 32 26 376 57.3%Total 669 595 630 531 539 739 734 665 617 624 521 611 7,475 11.1%

Cumulative 669 1,264 1,894 2,425 2,964 3,703 4,437 5,102 5,719 6,343 6,864 7,475 Moving Average 669 632 631 606 593 617 634 638 635 634 624 623


At 12/31/15 2015 is on track for Diagnostic Imaging Procedures Percent change: 2009 ‐ 2015: 223%2015 budget is: 6,988 Diagnostic Imaging Procedures 2015 Actual Over/(Under) Budget: 7%



Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec TOTAL2009 ER 48 20 40 36 51 42 71 49 38 37 26 32 490

OP 10 12 21 14 14 13 15 28 13 14 8 23 185 IP ‐ 7 3 2 1 2 3 1 2 2 2 5 30 Total 58 39 64 52 66 57 89 78 53 53 36 60 705

Cumulative 58 97 161 213 279 336 425 503 556 609 645 705 Moving Average 58 49 54 53 56 56 61 63 62 61 59 59

Per ER Visit 0.15 0.06 0.11 0.14 0.16 0.13 0.16 0.13 0.11 0.10 0.09 0.12 0.12 Per Inpt ‐ 1.00 0.18 0.18 0.08 0.20 0.38 0.33 0.50 0.20 0.29 1.67 0.29

2010 ER 39 30 44 25 31 53 52 57 51 34 26 42 484 ‐1.2%OP 6 13 9 21 5 7 9 13 17 12 11 13 136 ‐26.5%IP 2 ‐ 8 6 1 6 5 ‐ 16 3 1 6 54 80.0%Total 47 43 61 52 37 66 66 70 84 49 38 61 674 ‐4.4%


Per ER Visit 0.13 0.12 0.12 0.12 0.11 0.12 0.10 0.13 0.12 0.10 0.08 0.12 0.11 Per Inpt 0.18 ‐ 0.57 0.32 0.08 0.26 0.42 ‐ 0.94 0.21 0.10 0.30 0.32

2011 ER 36 30 28 28 29 37 52 42 59 48 36 60 485 0.2%OP 9 12 14 17 16 11 12 32 32 26 13 19 213 56.6%IP 5 7 8 4 3 4 2 3 4 1 5 4 50 ‐7.4%Total 50 49 50 49 48 52 66 77 95 75 54 83 748 11.0%



2012 ER 57 47 51 44 46 52 52 65 41 65 43 48 611 26.0%OP 19 25 24 20 30 23 25 29 23 27 29 18 292 37.1%IP 4 6 2 3 5 5 3 2 4 5 3 2 44 ‐12.0%Total 80 78 77 67 81 80 80 96 68 97 75 68 947 26.6%



2013 ER 51 59 49 50 53 65 70 100 108 70 57 73 805 31.8%OP 25 14 20 23 23 17 31 32 18 25 7 24 259 ‐11.3%IP 1 6 4 1 3 4 6 7 5 6 43 2 3%


CT Scan Procedures

‐

50

100

150

200

250

300


2009

2010

2011

2012

2013

2014

2015

2015

CT SCANS

IP 1 6 4 1 ‐ 3 4 6 7 5 ‐ 6 43 ‐2.3%Total 77 79 73 74 76 85 105 138 133 100 64 103 1,107 16.9%

Cumulative 77 156 229 303 379 464 569 707 840 940 1,004 1,107 Moving Average 77 78 76 76 76 77 81 88 93 94 91 92

Per ER Visit 0.13 0.18 0.13 0.18 0.13 0.15 0.14 0.20 0.24 0.20 0.19 0.15 Per Inpt 0.04 0.35 0.16 0.06 ‐ 0.13 0.22 0.26 0.23 0.23 ‐ 0.30

2014 ER 96 84 139 82 131 155 191 163 132 158 178 152 1,661 106.3%OP 22 15 63 52 54 45 40 28 31 40 31 25 446 72.2%IP 5 3 6 4 ‐ 2 10 4 8 4 1 9 56 30.2%Total 123 102 208 138 185 202 241 195 171 202 210 186 2,163 95.4%

Cumulative 123 225 433 571 756 958 1,199 1,394 1,565 1,767 1,977 2,163 Moving Average 123 113 144 143 151 160 171 174 174 177 180 180

Per ER Visit 0.20 0.20 0.25 0.20 0.29 0.27 0.28 0.24 0.21 0.29 0.33 0.27 Per Inpt 0.15 0.10 0.18 0.13 ‐ 0.05 0.24 0.10 0.16 0.08 0.03 0.20

2015 ER 131 111 123 110 127 215 217 214 167 172 148 212 1,947 17.2%OP 31 27 34 26 38 37 26 27 33 34 25 31 369 ‐17.3%IP 1 ‐ 2 7 10 3 13 7 11 15 14 25 108 92.9%Total 163 138 159 143 175 255 256 248 211 211 187 268 2,414 11.6%


Per ER Visit 0.27 0.23 0.21 0.26 0.24 0.30 0.29 0.32 0.29 0.31 0.28 0.32 Per Inpt 0.03 ‐ 0.04 0.21 0.24 0.07 0.38 0.13 0.28 0.31 0.26 0.42

At 12/31/15 2015 is on track for CT Scan Procedures Percent change: 2009 ‐ 2015: 242%2015 budget is: 2,360 CT Scan Procedures 2015 Actual Over/(Under) Budget: 2%



Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec TOTAL2009 23 9 12 17 11 14 11 12 6 15 11 15 156


2010 14 11 19 10 9 12 11 23 11 19 17 7 163 4.5%Cumulative 14 25 44 54 63 75 86 109 120 139 156 163

Moving Average 14 13 15 14 13 13 12 14 13 14 14 14

2011 26 22 23 15 23 15 20 15 26 22 20 17 244 49.7%Cumulative 26 48 71 86 109 124 144 159 185 207 227 244

Moving Average 26 24 24 22 22 21 21 20 21 21 21 20

2012 22 15 28 27 26 23 26 23 14 21 16 22 263 7.8%Cumulative 22 37 65 92 118 141 167 190 204 225 241 263

Moving Average 22 19 22 23 24 24 24 24 23 23 22 22

2013 16 14 11 14 16 13 18 18 10 23 22 13 188 ‐28.5%Cumulative 16 30 41 55 71 84 102 120 130 153 175 188

Moving Average 16 15 14 14 14 14 15 15 14 15 16 16

2014 53 33 34 45 67 64 42 63 45 65 56 62 629 234.6%Cumulative 53 86 120 165 232 296 338 401 446 511 567 629

Moving Average 53 43 40 41 46 49 48 50 50 51 52 52

2015 75 83 59 58 46 61 61 79 55 63 50 58 748 18.9%Cumulative 75 158 217 275 321 382 443 522 577 640 690 748

Moving Average 75 79 72 69 64 64 63 65 64 64 63 62

At 12/31/15 2015 is on track for MRI Procedures Percent change: 2009 ‐ 2015: 379%2015 budget is: 730 MRI Procedures 2015 Actual Over/(Under) Budget: 2%


MRI Procedures

‐

10

20

30

40

50

60

70

80

90


2009

2010

2011

2012

2013

2014

2015

MRIs



Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec TOTAL2010 29 59 88 N/A

Cumulative ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ 29 88 Moving Average ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ 29 44

2011 ER 7 6 14 11 4 14 15 8 8 8 17 9 121 OP 49 37 49 41 36 40 37 48 53 22 42 45 499 IP 6 1 5 2 7 5 ‐ 5 3 1 3 4 42 Total 62 44 68 54 47 59 52 61 64 31 62 58 662 652%


Per ER Visit 0.02 0.02 0.04 0.04 0.01 0.04 0.03 0.02 0.02 0.03 0.06 0.03 Per Inpt 0.32 0.07 0.29 0.18 0.50 0.28 ‐ 0.42 0.14 0.08 0.25 0.36

2012 ER 12 14 13 9 18 12 11 9 5 6 11 6 126 4.1%OP 43 41 41 31 68 52 67 57 45 50 61 48 604 21.0%IP 5 2 6 2 4 3 2 3 6 3 ‐ 4 40 ‐4.8%Total 60 57 60 42 90 67 80 69 56 59 72 58 770 16.3%


Per ER Visit 0.04 0.05 0.04 0.03 0.06 0.03 0.02 0.02 0.01 0.02 0.04 0.01 Per Inpt 0.56 0.10 0.43 0.20 0.27 0.18 0.17 0.16 0.30 0.15 ‐ 0.20

2013 ER 11 8 10 6 10 16 13 8 19 9 9 10 129 2.4%OP 65 42 63 53 43 55 47 64 34 51 46 43 606 0.3%IP 2 4 1 4 1 2 6 7 5 7 ‐ 2 41 2.5%Total 78 54 74 63 54 73 66 79 58 58 55 55 767 ‐0.4%


Per ER Visit 0.03 0.02 0.03 0.02 0.03 0.04 0.03 0.02 0.04 0.03 0.03 0.02 Per Inpt 0.08 0.24 0.04 0.22 0.06 0.08 0.33 0.30 0.16 0.32 ‐ 0.33

2014 ER 9 16 24 14 15 15 24 19 16 27 22 24 225 74.4%OP 63 42 41 56 77 58 52 60 57 53 43 51 653 7.8%IP 5 8 13 13 4 3 1 7 3 8 6 5 76 85.4%Total 77 66 78 83 96 76 77 86 76 88 71 80 954 24.4%




Ultrasound Procedures

‐

20

40

60

80

100

120

140


2010

2011

2012

2013

2014

2015

ULTRASOUNDS

2015 ER 13 20 22 11 16 16 27 11 15 14 14 25 204 OP 46 56 62 81 63 78 75 85 72 73 59 54 804 IP 3 3 3 5 4 10 14 9 12 5 13 7 88 Total 62 79 87 97 83 104 116 105 99 92 86 86 1,096

Cumulative 62 141 228 325 408 512 628 733 832 924 1,010 1,096 Moving Average 62 71 76 81 82 85 90 92 92 92 92 91


At 12/31/15 2015 is on track for Ultrasound Procedures Percent change: 2009 ‐ 2015: 66%2015 budget is: 1,090 Ultrasound Procedures 2015 Actual Over/(Under) Budget: 1%



Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec TOTAL2009 ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐

Cumulative ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ Moving Average ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐

2010 ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ Cumulative ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐

Moving Average ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐

2011 ER ‐ 1 ‐ 1 1 2 2 ‐ 3 2 ‐ 4 16 N/AOP ‐ 7 4 10 16 13 1 5 10 1 7 8 82 N/AIP ‐ 1 9 2 7 4 ‐ 2 6 1 ‐ 1 33 N/AStress ‐ 4 9 14 7 10 5 2 7 2 3 10 73 N/ATotal ‐ 13 22 27 31 29 8 9 26 6 10 23 204 N/A

Cumulative ‐ 13 35 62 93 122 130 139 165 171 181 204 Moving Average ‐ 7 12 16 19 20 19 17 18 17 16 17

Per ER Visit ‐ 0.003 ‐ 0.004 0.003 0.006 0.004 ‐ 0.009 0.006 ‐ 0.012 Per Inpt ‐ 0.071 0.529 0.182 0.500 0.222 ‐ 0.167 0.273 0.083 ‐ 0.091

2012 ER 2 2 4 ‐ 2 ‐ ‐ ‐ ‐ ‐ 2 1 13 ‐18.8%OP 10 4 8 1 4 ‐ ‐ ‐ ‐ 4 8 2 41 ‐50.0%IP 5 1 1 2 1 ‐ ‐ ‐ ‐ ‐ ‐ ‐ 10 ‐69.7%Stress 3 1 ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ 2 2 8 ‐89.0%Total 20 8 13 3 7 ‐ ‐ ‐ ‐ 4 12 5 72 ‐64.7%


Per ER Visit 0.066 0.026 0.035 0.011 0.022 ‐ ‐ ‐ ‐ 0.011 0.043 0.012 Per Inpt 2.222 0.400 0.929 0.300 0.467 ‐ ‐ ‐ ‐ 0.200 1.091 0.250

2013 ER 1 1 1 3 ‐ ‐ 1 ‐ ‐ ‐ 4 ‐ 11 ‐15.4%OP 2 1 5 6 7 7 5 8 6 9 7 8 71 73.2%IP ‐ 4 3 ‐ 1 1 2 4 1 3 1 4 24 140.0%Stress 8 3 5 3 2 ‐ ‐ ‐ ‐ 4 4 4 33 312.5%Total 11 9 14 12 10 8 8 12 7 16 16 16 139 93.1%



2014 ER ‐ ‐ 2 ‐ 1 1 1 ‐ ‐ 1 ‐ 2 8 ‐27.3%OP 17 4 12 16 19 14 5 ‐ 14 7 14 16 138 94.4%


Echocardiography Procedures

‐

5

10

15

20

25

30

35


2011

2012

2013

2014

2015

ECHOCARDIOGRAPHY

IP 1 1 2 ‐ 3 4 3 ‐ ‐ ‐ ‐ ‐ 14 ‐41.7%Stress 12 5 12 15 1 8 2 ‐ ‐ 14 3 6 78 136.4%Total 30 10 28 31 24 27 11 14 22 17 24 238 71.2%


Per ER Visit 0.035 0.009 0.022 0.039 0.042 0.025 0.007 ‐ 0.022 0.013 0.026 0.029 Per Inpt 0.353 0.167 0.364 0.484 0.023 0.211 0.048 ‐ ‐ 0.292 0.088 0.136

2015 ER 1 ‐ ‐ 1 2 1 ‐ ‐ ‐ ‐ ‐ 1 6 ‐25.0%OP 10 16 12 7 11 12 9 9 8 6 5 16 121 ‐12.3%IP 1 ‐ 1 ‐ ‐ ‐ 1 1 2 3 6 5 20 42.9%Stress 5 5 11 13 8 18 10 11 12 11 8 10 122 56.4%Total 17 21 24 21 21 31 20 21 22 20 19 32 269 13.0%


Per ER Visit 0.002 ‐ ‐ 0.002 0.004 0.001 ‐ ‐ ‐ ‐ ‐ 0.002 Per Inpt 0.029 ‐ 0.021 ‐ ‐ ‐ 0.029 0.019 0.050 0.061 0.113 0.085

At 12/31/15 2015 is on track for Echocardiography Procedures Percent change: 2009 ‐ 2015: 17%



Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec TOTAL2014 Total 90 30 16 71 55 57 37 31 33 75 54 36 585


2015 Total 46 39 53 52 62 66 55 57 54 109 60 47 700 20%Cumulative 46 85 138 190 252 318 373 430 484 593 653 700

Moving Average 46 43 46 48 50 53 53 54 54 59 59 58

At 12/31/15 2015 is on track for Mammograms Percent change: 2014 ‐ 2015: 20%

Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec TOTAL2014 Total 29 22 10 39 31 34 28 21 16 21 20 11 282


2015 Total 19 15 27 23 8 20 16 33 21 22 18 26 248 ‐12%Cumulative 19 34 61 84 92 112 128 161 182 204 222 248

Moving Average 19 17 20 21 18 19 18 20 20 20 20 21

At 12/31/15 2015 is on track for Bone Density Scans Percent change: 2014 ‐ 2015: ‐12%

At 12/31/15 2015 is on track for Mammo plus Bone Density2015 budget is: 1,262 Mammo plus Bone Density 2015 Actual Over/(Under) Budget: ‐25%

Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec TOTAL2015 Total 7 1 2 2 1 ‐ 13

Cumulative 7 8 10 12 13 13 Moving Average 7 4 3 3 3 2

At 12/31/15 2015 is on track for Nuclear Medicine scans




Mammograms

Bone Density Scans

Nuclear Medicine

‐20 40 60 80

100 120


2014

2015

MAMMOGRAMS

‐

10

20

30

40

50


2014

2015

BONEDENSITY SCANS




Dr. Meyer ‐ ‐ ‐ 3 ‐ ‐ ‐ 2 ‐ ‐ 3 ‐ 8 N/ADr. Shaeffer ‐ ‐ ‐ ‐ ‐ 10 17 29 37 11 32 29 165 N/A

Dr. Zak 23 ‐ 24 23 ‐ 29 26 19 ‐ 20 28 ‐ 192 N/ADr. Zostrosky ‐ ‐ ‐ ‐ ‐ ‐ 3 ‐ 2 ‐ ‐ 2 7 N/A

Total 23 ‐ 24 26 ‐ 39 46 50 39 31 63 31 372 N/ACumulative 23 23 47 73 73 112 158 208 247 278 341 372

Moving Average 23 12 16 18 15 19 23 26 27 28 31 31

2012Dr. Meyer 1 3 2 ‐ 3 4 5 ‐ ‐ 3 ‐ 3 24 200.0%

Dr. Shaeffer 14 26 32 39 30 33 34 29 22 42 26 23 350 112.1%Dr. Zak 19 18 22 5 14 12 4 9 ‐ 12 16 7 138 ‐28.1%

Dr. Reiss‐Holt ‐ ‐ ‐ ‐ ‐ 1 1 1 ‐ ‐ 1 ‐ 4 N/ADr. Ritz ‐ ‐ ‐ ‐ ‐ ‐ ‐ 3 4 3 2 5 17 N/A

Dr. Pinkerton ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ 1 1 ‐ 2 N/ADr. Zostrosky ‐ ‐ ‐ ‐ ‐ ‐ ‐ 3 ‐ ‐ 2 ‐ 5 ‐28.6%

Total 34 47 56 44 47 50 44 45 26 61 48 38 540 45.2%Cumulative 34 81 137 181 228 278 322 367 393 454 502 540

Moving Average 34 41 46 45 46 46 46 46 44 45 46 45

2013Dr. Meyer 3 3 ‐ 4 2 ‐ 3 2 1 ‐ 3 ‐ 21 ‐12.5%

Dr. Shaeffer 35 18 25 30 28 43 22 41 30 40 28 33 373 6.6%Dr. Zak 11 9 8 10 14 4 6 21 13 8 10 2 116 ‐15.9%

Dr. Reiss‐Holt 1 ‐ ‐ 2 1 ‐ ‐ 2 1 1 ‐ 4 12 200.0%Dr. Ritz ‐ 4 4 ‐ ‐ 4 ‐ 3 ‐ ‐ ‐ ‐ 15 ‐11.8%

Dr. Pinkerton ‐ ‐ ‐ ‐ 1 ‐ ‐ 1 ‐ 1 ‐ ‐ 3 50.0%Dr. Zastrocky ‐ ‐ 3 3 ‐ 4 5 4 ‐ ‐ 4 ‐ 23 360.0%Dr. Goodman ‐ 1 ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ 1 N/A


Moving Average 50 43 42 44 44 46 44 48 48 48 48 47

2014Dr. Meyer ‐ 1 2 ‐ 3 2 ‐ ‐ ‐ 4 ‐ 4 16 ‐31.3%


Dr Reiss Holt 1 1 2 1 1 6 100 0%


Surgical Services by Surgeon

‐

20

40

60

80

100

120


2011

2012

2013

2014

2015

SURGICALCASES

Dr. Reiss‐Holt 1 ‐ ‐ ‐ ‐ 1 ‐ 2 ‐ 1 ‐ 1 6 ‐100.0%Dr. Dziad ‐ ‐ ‐ ‐ ‐ 1 1 ‐ 1 ‐ ‐ ‐ 3 N/ADr. Ritz ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ N/A

Dr. Pinkerton ‐ ‐ ‐ ‐ 2 1 ‐ ‐ ‐ 1 1 ‐ 5 40.0%Dr. Zastrocky 1 1 ‐ 2 ‐ ‐ 1 ‐ ‐ ‐ 2 ‐ 7 ‐228.6%

Dr. Webb 8 15 11 17 9 18 18 12 18 15 19 14 174 N/ADr. Weber ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ 1 1 N/ADr. Duncan ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ 1 ‐ 2 3 N/A


Moving Average 47 55 52 54 55 57 60 61 60 63 64 65

2015Dr. Meyer ‐ 2 2 5 ‐ 4 ‐ 1 ‐ ‐ ‐ ‐ 14 ‐12.5%


Dr. Reiss‐Holt 1 1 2 1 1 ‐ 1 1 3 1 1 13 116.7%Dr. Dziad ‐ 3 4 ‐ 1 ‐ 4 6 6 ‐ 1 25 733.3%Dr. Ritz ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ #DIV/0!

Dr. Pinkerton ‐ ‐ ‐ 2 ‐ ‐ ‐ ‐ ‐ ‐ 1 3 ‐40.0%Dr. Zastrocky ‐ ‐ ‐ ‐ 3 ‐ 3 ‐ ‐ ‐ ‐ ‐ 6 ‐14.3%

Dr. Webb 22 19 20 22 12 26 23 10 24 20 29 20 247 42.0%Dr. Weber ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐100.0%Dr. Duncan ‐ ‐ 1 1 ‐ ‐ 1 ‐ ‐ ‐ ‐ 3 0.0%Dr. Layke ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ Dr. Siegel 2 ‐ ‐ ‐ ‐ ‐ 1 2 1 ‐ ‐ 6 Dr. Todd ‐ 2 ‐ 2 1 ‐ ‐ 1 1 ‐ 7

J. Aucoin, CRNA 5 7 3 5 3 7 7 3 4 ‐ 8 52 Total 68 72 79 86 92 98 96 74 78 104 82 84 1,013 30.2%

Cumulative 68 140 219 305 397 495 591 665 743 847 929 1,013 Moving Average 68 70 73 76 79 83 84 83 83 85 84 84

At 12/31/15 2015 is on track for surgical procedures Percent change: 2009 ‐ 2015: 172%2015 budget is: 865 surgical procedures 2015 Actual Over/(Under) Budget: 17%




Gastroenterology 318 General Surgery 39

GYN Surgery ‐ Ophthalmology 15

Orthopedic Surgery ‐ Cosmetic Surgery ‐

Total 372 2012

Gastroenterology 412 29.6%General Surgery 82 110.3%

GYN Surgery 2 Ophthalmology 28 86.7%

Orthopedic Surgery ‐ Cosmetic Surgery 14

Total 538 44.6%2013

Gastroenterology 400 ‐2.9%General Surgery 103 25.6%

GYN Surgery 3 50.0%Ophthalmology 44 57.1%

Orthopedic Surgery 1 Cosmetic Surgery 15 7.1%

Total 566 5.2%2014

Gastroenterology 25 38 22 30 36 36 46 49 28 52 36 40 438 9.5%General Surgery 13 8 10 12 11 9 11 9 9 17 9 17 135 31.1%

GYN Surgery ‐ ‐ ‐ ‐ 2 1 ‐ ‐ ‐ 1 1 ‐ 5 66.7%Ophthalmology 1 2 2 2 3 2 1 ‐ ‐ 4 2 4 23 ‐47.7%

Orthopedic Surgery 8 15 11 17 9 18 18 12 18 16 19 16 177 17600.0%Cosmetic Surgery ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐100.0%

Total 47 63 45 61 61 66 76 70 55 90 67 77 778 37.5% 2011 2012 2013 2014 20152015 Gastroenterology 318 412 400 438 461

Gastroenterology 23 31 24 32 52 37 48 42 30 56 44 42 461 5.3% General Surgery 39 82 103 135 214 General Surgery 21 15 23 21 20 26 14 12 19 22 8 13 214 58.5% GYN Surgery ‐ 2 3 5 10

GYN Surgery ‐ ‐ 2 2 ‐ 2 1 ‐ ‐ 1 1 1 10 100.0% Ophthalmology 15 28 44 23 20 Ophthalmology ‐ 2 2 5 3 4 3 1 ‐ ‐ ‐ ‐ 20 ‐13.0% Orthopedic Surgery ‐ ‐ 1 177 256

Orthopedic Surgery 24 19 21 23 12 26 23 12 26 21 29 20 256 44.6% Cosmetic Surgery ‐ 14 15 ‐ ‐ Cosmetic Surgery ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ Pain Management ‐ ‐ ‐ ‐ 52

Comparison of Surgical Volumes by Specialty

Surgical Services by Specialty % Change Over Prev Period

Cosmetic Surgery Pain Management 52 Pain Management ‐ 5 7 3 5 3 7 7 3 4 ‐ 8 52 Podiatry ‐ ‐ ‐ ‐ ‐

Podiatry ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ TOTAL 372 538 566 778 1,013 Total 68 72 79 86 92 98 96 74 78 104 82 84 1,013 30.2% % Change/Prev Year 45% 5% 37% 30%





2010 11 6 14 19 12 23 12 9 17 14 10 20 167 60.6%Cumulative 11 17 31 50 62 85 97 106 123 137 147 167

Moving Average 11 9 10 13 12 14 14 13 14 14 13 14

2011 19 14 17 11 14 18 5 12 22 12 12 11 167 0.0%Cumulative 19 33 50 61 75 93 98 110 132 144 156 167

Moving Average 19 17 17 15 15 16 14 14 15 14 14 14

2012 9 20 14 10 15 17 12 19 20 20 11 20 187 12.0%Cumulative 9 29 43 53 68 85 97 116 136 156 167 187

Moving Average 9 15 14 13 14 14 14 15 15 16 15 16 Low High Average

2013 25 17 25 18 16 24 18 23 31 22 6 20 245 31.0% 2009 3 17 8.7Cumulative 25 42 67 85 101 125 143 166 197 219 225 245 2010 6 23 13.9

Moving Average 25 21 22 21 20 21 20 21 22 22 20 20 2011 5 22 13.9

2014 34 30 33 31 44 38 42 40 50 48 34 44 468 91.0% 2012 9 20 15.6Cumulative 34 64 97 128 172 210 252 292 342 390 424 468 2013 6 31 20.4

Moving Average 34 32 32 32 34 35 36 37 38 39 39 39 2014 30 50 39.0

2015 34 34 47 33 41 45 34 54 40 49 53 59 523 11.8% 2015 33 59 43.6Cumulative 34 68 115 148 189 234 268 322 362 411 464 523

Moving Average 34 34 38 37 38 39 38 40 40 41 42 44

At 12/31/15 2015 is on track for Inpatient Admissions Percent change: 2009 ‐ 2015: 403%2015 budget is: 605 Inpatient Admissions 2015 Actual Over/(Under) Budget: ‐14%



2010 34 17 34 68 34 40 42 18 50 36 25 45 443 95.2%Cumulative 34 51 85 153 187 227 269 287 337 373 398 443

Moving Average 34 26 28 38 37 38 38 36 37 37 36 37 Average

2011 59 48 53 44 34 49 13 32 70 31 51 35 519 17 2% 2009 5 31 18 9



RANGE

RANGE

Inpatient Days

Inpatient Admissions

‐

10

20

30

40

50

60

70


2009

2010

2011

2012

2013

2014

2015

INPT ADMISSIONS

2011 59 48 53 44 34 49 13 32 70 31 51 35 519 17.2% 2009 5 31 18.9Cumulative 59 107 160 204 238 287 300 332 402 433 484 519 2010 17 68 36.9

Moving Average 59 54 53 51 48 48 43 42 45 43 44 43 2011 13 70 43.3

2012 31 61 32 21 47 55 27 42 72 60 35 48 531 2.3% 2012 21 72 44.3Cumulative 31 92 124 145 192 247 274 316 388 448 483 531 2013 15 121 58.9

Moving Average 31 46 41 36 38 41 39 40 43 45 44 44 2014 65 123 92.3

2013 59 44 59 47 63 85 55 121 74 41 15 44 707 33.1% 2015 80 125 104.3Cumulative 59 103 162 209 272 357 412 533 607 648 663 707

Moving Average 59 52 54 52 54 60 59 67 67 65 60 59

2014 84 79 65 82 79 72 107 122 123 82 107 105 1,107 56.6%Cumulative 84 163 228 310 389 461 568 690 813 895 1,002 1,107

Moving Average 84 82 76 78 78 77 81 86 90 90 91 92

2015 86 91 99 81 113 115 80 121 100 119 125 121 1,251 13.0%Cumulative 86 177 276 357 470 585 665 786 886 1,005 1,130 1,251

Moving Average 86 89 92 89 94 98 95 98 98 101 103 104

At 12/31/15 2015 is on track for Inpatient Days Percent change: 2009 ‐ 2015: 451%2015 budget is: 1,411 Inpatient Days 2015 Actual Over/(Under) Budget: ‐11%



Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec TOTAL2009 2.1 2.6 2.3 2.3 2.1 2.0 2.2 2.2 2.1 2.1 2.1 2.2 2.2 Moving Average 2.1 2.6 2.3 2.3 2.1 2.0 2.2 2.2 2.1 2.1 2.1 2.2

2010 3.1 2.8 2.4 3.6 2.8 1.7 3.5 2.0 2.9 2.6 2.5 2.3 2.7 22.7%Moving Average 3.1 3.0 2.7 3.1 3.0 2.7 2.8 2.7 2.7 2.7 2.7 2.7

2011 3.1 3.4 3.1 4.0 2.4 2.7 2.6 2.7 3.2 2.6 4.3 3.2 3.1 14.8%Moving Average 3.1 3.2 3.2 3.3 3.2 3.1 3.1 3.0 3.0 3.0 3.1 3.1

2012 3.4 3.1 2.3 2.1 3.1 3.2 2.3 2.2 3.6 3.0 3.2 2.4 2.8 ‐9.7%Moving Average 3.4 3.2 2.9 2.7 2.8 2.9 2.8 2.7 2.9 2.9 2.9 2.8

2013 2.4 2.6 2.4 2.6 3.9 3.5 3.1 5.3 2.4 1.9 2.5 2.2 2.9 3.6%Moving Average 2.4 2.5 2.4 2.5 2.7 2.9 2.9 3.2 3.1 3.0 2.9 2.9

2014 2.5 2.6 2.0 2.6 1.8 1.9 2.5 3.1 2.5 1.7 3.1 2.4 2.4 ‐17.2%Moving Average 2.5 2.5 2.4 2.4 2.3 2.2 2.3 2.4 2.4 2.3 2.4 2.4

2015 2.5 2.7 2.1 2.5 2.8 2.6 2.4 2.2 2.5 2.4 2.4 2.1 2.4 Moving Average 2.5 2.6 2.4 2.4 2.5 2.5 2.5 2.4 2.4 2.4 2.4 2.4

Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec TOTAL2009 3 3 3 ‐ 1 1 2 1 ‐ 1 1 2 18


2010 5 3 5 1 1 ‐ 2 3 1 5 ‐ 3 29 61.1%Cumulative 5 8 13 14 15 15 17 20 21 26 26 29

Moving Average 5 4 4 4 3 3 2 3 2 3 2 2

2011 2 3 4 5 2 5 2 3 2 ‐ 3 ‐ 31 6.9%Cumulative 2 5 9 14 16 21 23 26 28 28 31 31

Moving Average 2 3 3 4 3 4 3 3 3 3 3 3

2012 ‐ 3 1 1 1 2 4 ‐ 2 2 4 4 24 ‐22.6%Cumulative ‐ 3 4 5 6 8 12 12 14 16 20 24



Inpatient Average Length of Stay

Swing Bed Admissions

Moving Average ‐ 2 1 1 1 1 2 2 2 2 2 2

2013 ‐ 2 2 1 3 2 1 3 3 ‐ 1 1 19 ‐20.8%Cumulative ‐ 2 4 5 8 10 11 14 17 17 18 19

Moving Average ‐ 1 1 1 2 2 2 2 2 2 2 2

2014 3 1 1 2 ‐ ‐ ‐ ‐ 2 ‐ ‐ ‐ 9 ‐52.6%Cumulative 3 4 5 7 7 7 7 7 9 9 9 9

Moving Average 3 2 2 2 1 1 1 1 1 1 1 1

2015 ‐ 2 2 2 2 ‐ ‐ ‐ ‐ ‐ ‐ ‐ 8 ‐11.1%Cumulative ‐ 2 4 6 8 8 8 8 8 8 8 8

Moving Average ‐ 1 1 2 2 1 1 1 1 1 1 1

At 12/31/15 2015 is on track for Swing Bed Admissions Percent change: 2009 ‐ 2015: ‐56%2015 budget is: 5 Swing Bed Admissions 2015 Actual Over/(Under) Budget: 60%



Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec TOTAL2009 19 22 25 ‐ 5 8 9 8 ‐ 8 5 10 119


2010 60 53 40 5 4 ‐ 21 23 19 41 ‐ 13 279 134.5%Cumulative 60 113 153 158 162 162 183 206 225 266 266 279

Moving Average 60 57 51 40 32 27 26 26 25 27 24 23

2011 29 19 37 46 20 34 12 19 30 ‐ 30 4 280 0.4%Cumulative 29 48 85 131 151 185 197 216 246 246 276 280

Moving Average 29 24 28 33 30 31 28 27 27 25 25 23

2012 ‐ 12 34 1 10 15 39 ‐ 13 15 15 35 189 ‐32.5%Cumulative ‐ 12 46 47 57 72 111 111 124 139 154 189

Moving Average ‐ 6 15 12 11 12 16 14 14 14 14 16

2013 15 12 8 16 27 13 9 19 22 8 7 13 169 ‐10.6%Cumulative 15 27 35 51 78 91 100 119 141 149 156 169

Moving Average 15 14 12 13 16 15 14 15 16 15 14 14

2014 30 23 11 3 1 ‐ ‐ ‐ 6 ‐ ‐ 74 ‐56.2%Cumulative 30 53 64 67 68 68 68 68 74 74 74 74

Moving Average 30 27 21 17 14 11 10 9 8 7 7 6

2015 ‐ 6 11 7 10 ‐ ‐ ‐ ‐ ‐ ‐ ‐ 34 ‐54.1%Cumulative ‐ 6 17 24 34 34 34 34 34 34 34 34

Moving Average ‐ 3 6 6 7 6 5 4 4 3 3 3

At 12/31/15 2015 is on track for Swing Bed Days Percent change: 2009 ‐ 2015: ‐71%2015 budget is: 49 Swing Bed Days 2015 Actual Over/(Under) Budget: ‐31%

Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec TOTAL2009 6.3 7.3 8.3 ‐ 5.0 8.0 4.5 8.0 ‐ 8.0 5.0 5.0 6.6 Moving Average 6.3 6.8 7.3 7.3 7.1 7.2 6.8 6.9 6.9 6.9 6.8 6.6

2010 12.0 17.7 8.0 5.0 4.0 ‐ 10.5 7.7 19.0 8.2 ‐ 4.3 9.6 45.5%Moving Average 12.0 14.1 11.8 11.3 10.8 10.8 10.8 10.3 10.7 10.2 10.2 9.6



Swing Bed Average Length of Stay

Swing Bed Days

2011 14.5 6.3 9.3 9.2 10.0 6.8 6.0 6.3 15.0 ‐ 10.0 ‐ 9.0 ‐6.3%Moving Average 14.5 9.6 9.4 9.4 9.4 8.8 8.6 8.3 8.8 8.8 8.9 9.0

2012 n/a 4.0 34.0 1.0 10.0 7.5 9.8 n/a 6.5 7.5 3.8 8.8 7.9 ‐12.5%Moving Average 4.0 11.5 9.4 9.5 9.0 9.3 9.3 8.9 8.7 7.7 7.9

2013 6.0 4.0 16.0 9.0 6.5 9.0 6.3 7.3 7.0 13.0 8.9 13.0%Moving Average 13.5 8.8 10.2 9.8 9.1 9.1 8.5 8.3 8.8 8.7 8.9

2014 10.0 23.0 11.0 1.5 ‐ ‐ ‐ ‐ 3.0 ‐ ‐ ‐ 8.2 ‐7.9%Moving Average 10.0 13.3 12.8 9.6 9.7 9.7 9.7 9.7 8.2 8.2 8.2 8.2

2015 ‐ 3.0 5.5 3.5 5.0 ‐ ‐ ‐ ‐ ‐ ‐ ‐ 4.3 ‐47.6%Moving Average #DIV/0! 3.0 4.3 4.0 4.3 4.3 4.3 4.3 4.3 4.3 4.3 4.3



Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec TOTAL2009 1.4 1.7 1.8 0.9 0.7 0.8 1.1 0.5 0.2 1.0 0.7 0.7 0.9 Moving Average 1.4 1.5 1.6 1.5 1.3 1.2 1.2 1.1 1.0 1.0 1.0 0.9

2010 3.2 3.0 2.9 2.5 1.6 1.8 2.3 1.8 2.7 2.8 1.1 2.1 2.3 155.6%Moving Average 3.2 3.1 3.0 2.9 2.6 2.5 2.5 2.4 2.4 2.5 2.3 2.3

2011 3.1 2.8 3.3 3.4 2.4 3.1 1.2 2.2 3.9 1.4 3.0 1.6 2.6 13.0%Moving Average 3.1 2.9 3.0 3.1 3.0 3.0 2.7 2.7 2.8 2.7 2.7 2.6

2012 1.6 3.0 2.9 1.3 2.6 3.0 2.8 2.1 3.3 2.9 2.3 3.3 2.6 0.0%Moving Average 1.6 2.3 2.5 2.2 2.3 2.4 2.5 2.4 2.5 2.5 2.5 2.6

2013 3.0 2.7 2.8 2.8 3.4 3.9 2.8 5.1 4.3 2.5 1.3 1.8 3.0 17.1%Moving Average 3.0 2.9 2.9 2.9 3.0 3.1 3.1 3.3 3.4 3.3 3.2 3.0

2014 4.3 4.1 2.9 3.2 2.8 2.9 3.8 4.6 5.2 3.1 4.4 4.3 3.8 24.8%Moving Average 4.3 4.2 3.8 3.6 3.5 3.4 3.4 3.6 3.8 3.7 3.8 3.8

2015 3.5 4.4 4.8 3.9 4.8 5.1 4.2 5.4 4.8 5.2 5.0 4.8 4.7 22.4%Moving Average 3.5 3.9 4.2 4.1 4.3 4.4 4.4 4.5 4.5 4.6 4.6 4.7


Cumulative 91 166 251 313 392 481 591 686 774 863 930 1,013 Moving Average 91 83 84 78 78 80 84 86 86 86 85 84

2010 73 73 90 66 78 118 135 88 99 82 82 83 1,067 5.3%Cumulative 73 146 236 302 380 498 633 721 820 902 984 1,067

Moving Average 73 73 79 76 76 83 90 90 91 90 89 89

2011 94 77 84 89 85 88 105 96 112 98 76 99 1,103 3.4%Cumulative 94 171 255 344 429 517 622 718 830 928 1,004 1,103

Moving Average 94 86 85 86 86 86 89 90 92 93 91 92

2012 84 77 92 62 91 115 120 107 71 80 70 88 1,057 ‐4.2%Cumulative 84 161 253 315 406 521 641 748 819 899 969 1,057

Moving Average 84 81 84 79 81 87 92 94 91 90 88 88

2013 94 76 95 80 97 101 105 117 122 97 85 115 1,184 12.0%Cumulative 94 170 265 345 442 543 648 765 887 984 1,069 1,184

EMS Calls


Total Average Daily Census (IP + Swing Bed + Observation)


0%5%

10%15%20%25%30%35%40%45%

2009 2010 2011 2012 2013 2014 2015

8%

21%24% 24%

28%

35%

42%

Occupancy Rate

Moving Average 94 85 88 86 88 91 93 96 99 98 97 99

2014 87 104 108 84 115 131 179 185 146 158 135 148 1,580 33.4%Cumulative 87 191 299 383 498 629 808 993 1,139 1,297 1,432 1,580

Moving Average 87 96 100 96 100 105 115 124 127 130 130 132

2015 143 143 133 139 147 179 198 162 140 188 149 175 1,896 20.0%Cumulative 143 286 419 558 705 884 1,082 1,244 1,384 1,572 1,721 1,896

Moving Average 143 143 140 140 141 147 155 156 154 157 156 158

At 12/31/15 2015 is on track for EMS Calls Percent change: 2009 ‐ 2015: 87%





2010 45 48 66 37 48 79 69 59 61 50 49 55 666 ‐4.0%Cumulative 45 93 159 196 244 323 392 451 512 562 611 666

Moving Average 45 47 53 49 49 54 56 56 57 56 56 56

2011 59 49 54 61 51 53 67 67 61 58 41 63 684 2.7%Cumulative 59 108 162 223 274 327 394 461 522 580 621 684

Moving Average 59 54 54 56 55 55 56 58 58 58 56 57

2012 54 56 58 34 55 60 72 65 47 44 51 55 651 ‐4.8%Cumulative 54 110 168 202 257 317 389 454 501 545 596 651

Moving Average 54 55 56 51 51 53 56 57 56 55 54 54

2013 60 49 68 57 53 62 57 66 75 54 55 78 734 12.8%Cumulative 60 109 177 234 287 349 406 472 547 601 656 734

Moving Average 60 55 59 59 57 58 58 59 61 60 60 61

2014 54 70 67 59 69 73 104 104 87 76 86 84 933 27.1%Cumulative 54 124 191 250 319 392 496 600 687 763 849 933

Moving Average 54 62 64 63 64 65 71 75 76 76 77 78

2015 87 87 82 73 88 102 107 104 67 91 74 94 1,056 13.2%Cumulative 87 174 256 329 417 519 626 730 797 888 962 1,056

Moving Average 87 87 85 82 83 87 89 91 89 89 87 88

At 12/31/15 2015 is on track for EMS Transports Percent change: 2009 ‐ 2015: 52%2015 budget is: 910 EMS Transports 2015 Actual Over/(Under) Budget: 16%

EMS Transports % Change Over Prev Period





2010 36 26 38 24 28 52 42 34 36 30 29 28 403 5.8%Cumulative 36 62 100 124 152 204 246 280 316 346 375 403

Moving Average 36 31 33 31 30 34 35 35 35 35 34 34

2011 36 27 29 27 34 28 36 24 35 33 25 27 361 ‐10.4%Cumulative 36 63 92 119 153 181 217 241 276 309 334 361

Moving Average 36 32 31 30 31 30 31 30 31 31 30 30

2012 34 34 37 19 24 32 40 42 26 31 33 34 386 6.9%Cumulative 34 68 105 124 148 180 220 262 288 319 352 386

Moving Average 34 34 35 31 30 30 31 33 32 32 32 32

2013 41 34 39 33 37 35 29 35 39 31 34 48 435 12.7%Cumulative 41 75 114 147 184 219 248 283 322 353 387 435

Moving Average 41 38 38 37 37 37 35 35 36 35 35 36

2014 34 46 54 33 39 44 65 71 51 47 58 59 601 38.2%Cumulative 34 80 134 167 206 250 315 386 437 484 542 601

Moving Average 34 40 45 42 41 42 45 48 49 48 49 50

2015 61 65 60 41 53 61 67 68 50 56 50 61 693 15.3%Cumulative 61 126 186 227 280 341 408 476 526 582 632 693

Moving Average 61 63 62 57 56 57 58 60 58 58 57 58

At 12/31/15 2015 is on track for EMS Transports to PSMC Percent change: 2009 ‐ 2015: 82%

Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec TOTAL2009 64% 64% 63% 60% 61% 60% 59% 55% 55% 55% 55% 55% 55%Moving Average 64% 64% 63% 60% 61% 60% 59% 55% 55% 55% 55% 55%

2010 80% 54% 58% 65% 58% 66% 61% 58% 59% 60% 59% 51% 61% 5.6%Moving Average 80% 67% 63% 63% 62% 63% 63% 62% 62% 62% 61% 61%

2011 61% 55% 54% 44% 67% 53% 54% 36% 57% 57% 61% 43% 53% ‐7.7%Moving Average 61% 58% 57% 53% 56% 55% 55% 52% 53% 53% 54% 53%

2012 63% 61% 64% 56% 44% 53% 56% 65% 55% 70% 65% 62% 59% 6.5%

EMS Transports to PSMC

% EMS Transports to PSMC



Moving Average 63% 62% 63% 61% 58% 57% 57% 58% 57% 59% 59% 59%

2013 68% 69% 57% 58% 70% 56% 51% 53% 52% 57% 62% 62% 59% 0.0%Moving Average 68% 69% 64% 63% 64% 63% 61% 60% 59% 59% 59% 59%

2014 63% 66% 81% 56% 57% 60% 63% 68% 59% 62% 67% 70% 64% 5.2%Moving Average 63% 65% 70% 67% 65% 64% 64% 64% 64% 63% 64% 64%

2015 70% 75% 73% 56% 60% 60% 63% 65% 75% 62% 68% 65% 66% 1.2%Moving Average 70% 72% 73% 69% 67% 66% 65% 65% 66% 66% 66% 66%

# %2009 694 381 55% 313 2010 666 403 61% 263 2011 684 361 53% 323 2012 651 386 59% 265 2013 734 435 59% 299 2014 933 601 64% 332 2015 1,056 693 66% 363

2015 YTD as of

To PSMCTotal Others

TOTAL NUMBER OF EMS TRANSPORTS AND NUMBER OF TRANSPORTS TO PSMC

12/31/2015

381 403 361 386 435 601 693

313 263 323 265 299

332 363

‐

200

400

600

800

1,000

1,200

2009 2010 2011 2012 2013 2014 2015

Others

To PSMC


VolumeGraphsbyYearforthePagosaSpringsMedicalCenter

44494010 4229 4137 4270

4782

65196983

0

1000

2000

3000

4000

5000

6000

7000

8000

2008 2009 2010 2011 2012 2013 2014 2015

EmergencyRoomVisits

3778

10549

1408515776

12757

16753

0

5000

10000

15000

20000

2008 2009 2010 2011 2012 2013 2014 2015

NumberofClinicVisits

987 1013 1085 1103 10571184

1580

1896

0

500

1000

1500

2000

2008 2009 2010 2011 2012 2013 2014 2015

NumberofEMSCalls

372

531 561

780

1008

0

200

400

600

800

1000

1200

2008 2009 2010 2011 2012 2013 2014 2015

NumberofSurgeries

115 104167 166 184

245

468523

0

100

200

300

400

500

600

2008 2009 2010 2011 2012 2013 2014 2015

NumberofIn-PaKents

43578413

20251

3199537872

4290546474

55805

0

10000

20000

30000

40000

50000

60000

2008 2009 2010 2011 2012 2013 2014 2015

NumberofOut-PaKentVisits

5542

10561 11116 1195813871

1553117459

20573

0

5000

10000

15000

20000

25000

2008 2009 2010 2011 2012 2013 2014 2015

NumberofLabVisits

2199 2331 2658

4205 44145201

85789696

0

2000

4000

6000

8000

10000

12000

2008 2009 2010 2011 2012 2013 2014 2015

NumberofImagingVisits

RevenueGraphsbyYearforthePagosaSpringsMedicalCenter--Page1

2873.4836565 8080 9886 11979 14141

1948424777.316

0

18682304

21382126

1416

[VALUE]

1241.587

0

5000

10000

15000

20000

25000

30000

2008 2009 2010 2011 2012 2013 2014 2015

AnnualRevenuebyComponent&Year

Grants&OtherRevenue

NetPa<entRevenue

356 7571489 1559 1702

26523554.36

300549

566 427 375121

61.653

275 579

2225

2286.025

0

1000

2000

3000

4000

5000

6000

7000

2008 2009 2010 2011 2012 2013 2014 2015

In-PaRentRevenuebyComponent&Year

In-Pa<entSurgeryRevenue

SwingBedRevenue

In-Pa<entRevenue

9522 10868

1610020377

24349

34984

46227.059

0

5000

10000

15000

20000

25000

30000

35000

40000

45000

50000

2008 2009 2010 2011 2012 2013 2014 2015

GrossPaRentCharges


6312.8718253

866612606

1634619067

25506

34077.012

0

5000

10000

15000

20000

25000

30000

35000

40000

2008 2009 2010 2011 2012 2013 2014 2015

Out-PaIentRevenue

29002610

31273356

4206

6144

7487.071

0

1000

2000

3000

4000

5000

6000

7000

8000

2008 2009 2010 2011 2012 2013 2014 2015

EmergencyRoomRevenue

1028.453

2164 21092546

32033737

4390

5548.265

0

1000

2000

3000

4000

5000

6000

2008 2009 2010 2011 2012 2013 2014 2015

LaboratoryRevenue

6561306

20552261

2656

4998

5902.038

0

1000

2000

3000

4000

5000

6000

7000

2008 2009 2010 2011 2012 2013 2014 2015

In-PaIentRevenue

560

1533

21142384

1770

2506.745

0

500

1000

1500

2000

2500

3000

2008 2009 2010 2011 2012 2013 2014 2015

ClinicRevenue

303 324434

638809

14821349.666

0

200

400

600

800

1000

1200

1400

1600

2008 2009 2010 2011 2012 2013 2014 2015

PharmacyRevenue

1098 1078

1370

17861845.833

0

500

1000

1500

2000

2008 2009 2010 2011 2012 2013 2014 2015

AmbulanceRevenue

697

19011548

2963

5897.546

0

1000

2000

3000

4000

5000

6000

7000

2008 2009 2010 2011 2012 2013 2014 2015

Surgery/ORRevenue


643757

984

13771570.15

0

500

1000

1500

2000

2008 2009 2010 2011 2012 2013 2014 2015

Radiology(X-Ray)Revenue

8101154

0

500

1000

1500

2000

2500

3000

3500

2008 2009 2010 2011 2012

CTScanRevenueRevenue

406 431 393

998

1342.149

0

200

400

600

800

1000

1200

1400

1600

2008 2009 2010 2011 2012 2013 2014 2015

MRIRevenue

444 426

0

100

200

300

400

500

600

700

800

2008 2009 2010 2011 2012

UltrasoundRevenue

1422 14212304

2767

0

1000

2000

3000

4000

5000

6000

7000

8000

2008 2009 2010 2011 2012

AllImagingRevenue

306

799861

2232.182

0

500

1000

1500

2000

2500InfusionRevenue

188

116.263

0255075100125150175200225

2008 2009 2010 2011 2012 2013 2014 2015

MammographyRevenue

1000

2000

3000

4000

5000

6000

7000

8000ComponentsofOut-PaQentRevenue

EmergencyRoomRevenueLabRevenueImagingRevenueClinicRevenueSurgery/ORRevenueAmbulanceRevenueInfusionRevenue

0 2008 2009 2010 2011 2012 2013 2014 2015

0

1000

2008 2009 2010 2011 2012


1154

1576

2652

3166.827

2012 2013 2014 2015

CTScanRevenueRevenue

426491

569

701.706

2012 2013 2014 2015

UltrasoundRevenue

27673444

5784

6897.095

2012 2013 2014 2015

AllImagingRevenue

ComponentsofOut-PaQentRevenue

2012 2013 2014 2015

PatientRevenueGraphsbyMonthforthePagosaSpringsMedicalCenter

0

500

1000

1500

2000

2500

3000NetPaAentRevenuebyMonth

0

100

200

300

400

500

600

700

Jan'

Mar'

May'

Jul'0

Sep

' Nov'

Jan'

Mar'

May'

Jul'0

Sep

' Nov'

Jan'

Mar'

May'

Jul'1

Sep

' Nov'

Jan'

Mar'

May'

Jul'1

Sep

' Nov'

Jan'

Mar'

May'

Jul'1

Sep

' Nov'

Jan'

Mar'

May'

Jul'1

Sep

' Nov'

Jan'

Mar'

May'

Jul'1

Sep

'

In-PaAentRevenuebyMonth

0

500

1000

1500

2000

2500

3000

3500

4000

Jan'0

Mar'

May'

Jul'0

Sep

'0 Nov'

Jan'0

Mar'

May'

Jul'0

Sep

'0 Nov'

Jan'1

Mar'

May'

Jul'1

Sep

'1 Nov'

Jan'1

Mar'

May'

Jul'1

Sep

'1 Nov'

Jan'1

Mar'

May'

Jul'1

Sep

'1 Nov'

Jan'1

Mar'

May'

Jul'1

Sep

'1 Nov'

Jan'1

Mar'

May'

Jul'1

Sep

'1Out-PaAentRevenuebyMonth


Jul'1

Sep

' Nov'

Jan'

Mar'

May'

Jul'1

Sep

' Nov'

Jul'1

Sep

'1 Nov'

Jan'1

Mar'

May'

Jul'1

Sep

'1 Nov'


0

500

1000

1500

2000

2500

3000NetRevenuebyMonth

Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec20082009201020112012201320142015

Top Quartile Second Quartile Third Quartile Bottom Quartile

Monthly Net Patient Revenue Comparison within each Year


Bottom Six MonthsTop Six Months




Top Quartile Second Quartile Third Quartile Bottom Quartile



Bottom Six MonthsTop Six Months


NetPatientRevenueLessTotalOperatingExpensesbyMonth

-242.792-508.055

-288.597

384.859

-1589.303

-636.158

-1600

-1100

-600

-100

400

900

2008 2009 2010 2011 2012 2013 2014

OperaGngIncomebyYear

NotethatwechangedourtreatmentofNon-Oper-a4ngExpensesin2013.Underourcurrentguide-lines,2012wouldhavebeennega4ve.

-4000

-3500

-3000

-2500

-2000

-1500

-1000

-500

0

CumulaGveMonthlyNetPaGentRevenueLessAdjustedTotalOperaGngExpensesbyMonthandYear

-$600K

-$400K

-$200K

$0K

$200K

$400K

$600K

$800K

$1,000K

$1,200K Net Income by Month

NetPatientRevenueLessTotalOperatingExpensesbyMonth

-636.158

17.351

2014 2015

CumulaGveMonthlyNetPaGentRevenueLessAdjustedTotalOperaGngExpensesbyMonth

AnnualTaxRevenues,OperatingExpenses,&NetRevenue

1536 1863 18621320 1299

1106.311

0

200

400

600

800

1000

1200

1400

1600

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2008 2009 2010 2011 2012 2013 2014

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6445.49 67938681

1023812401

17084

21830.863

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2008 2009 2010 2011 2012 2013 2014

AnnualOperaMngExpensesPagosaSpringsMedicalCenter

6887.9999538.45 10775.886

16100.38920377.275

24349.053

34983.89

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2008 2009 2010 2011 2012 2013 2014

TotalAnnualNetRevenuePagosaSpringsMedicalCenter

AnnualTaxRevenues,OperatingExpenses,&NetRevenue

1106.311 1122.125

2015

21830.863

26001.351

2014 2015

34983.89

46227.165

2014 2015

MiscellaneousFinancialGraphs-Page1

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100015002000250030003500400045005000

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Net Revenue by Month

239.4569167527.6199167

673.3659167$824K

998.237251178.442833

1623.64575

1998.564

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2008 2009 2010 2011 2012 2013 2014 2015

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-423.609

610.43416.154284.776156.54219.479

781.748

1619.371

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NetIncome

219.8023333268.0376667374.8659167

528.46325648.68125

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537.1241667556.35625723.409

991.54758331033.399167

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648.68125790.57625

1055.5024171277.592667

2012 2013 2014 2015

AverageMonthlyPayroll&Benefits

1033.399167

1423.657833

1819.2385832080.038667

2012 2013 2014 2015

AverageMonthlyOperaMngExpenses

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AccountsPayableandAccountsReceivablebyMonth

FinanceCommitteeReport

January26,2016

HereisasummaryofwhatwasdiscussedatourJanuaryFinanceCommitteemeeting:

DecemberTopLine:GoodRevenue;lotsof“clean-up”adjustmentsresultinginanegativebottomline.

1. AfewhighlightsfromtheDecemberFinancials:

a. TotalPatientRevenue inDecemberwas$4.13MM,ourfifthhighestever. Itwas17%abovebudget,drivenbytheusualsuspects(OR,ER,Infusion,andImaging).

b. However, Contractual Allowances completely took away the $613K we were over

budget.CAwasoverbudgetby$778K. Onlyabout$319Kofthatwasduetothehighrevenuevolume.Another$300KwasallocatedforMedicareandMedicaid–anumbergenerated from two mini cost reports, and the rest of the overage was due to thechangingpayermix.

c. Salary & Wages were $208K over budget due to incentive pay (for physicians,

management,andemployees).d. Benefitswere$411Kunderbudgetasourhealthcoveragecostswerereconciled.2015

was a very good year for us relative to our self-insurance costs, and the adjustmentsreflectthat.

e. Most of the Professional Fee overage had to do with Auditing and Cost Report

preparationcosts.MostoftheContractLaboroveragehadtodowithourhighvolumelevels,though$45Kofthecostswere“catch-up”costsbecausewehadn’tbeenbilledbyCernerforthreemonths.

f. Supplieswereawhopping$376Koverbudget. About$49Kofthathadtodowiththe

highInfusionvolumeinDecember. Theother$327Khadtodowithsurgical implants.An inventorywas performed in December and the charges reflect the results. (Notealso that the InventoryAsset lineon theBalanceSheet is correspondingly reducedby$300K.)

g. Theresult isthatourbottomlinewasanegative$245K, leavinguswith$1.62MMon

thebottomlinefortheyear–afullthreeandathirdtimeswhatwe’dbudgeted.

h. Wefinished themonthandyearwith$4.84MM inCash. Thatequates to72DaysofCashonHand,nicelyexceedingour60-daytarget.

i. Partofthereasonthatweadded$735KtoourCashpositionhadtodowithDecember

beingastrongCollectionsmonth.InDecember,wecollected$2.28MM,makingitour

second strongest Collectionsmonth ever -- and thatwith the holidays shortening thenumberofdaysinwhichwecouldcollect.

j. Our Accounts Receivable balance dropped by $90K from $10.80MM to $10.71MM.

Thatitdroppedinashortenedmonthwithstrongrevenueisaverypositivesign.

k. We finished themonth and the yearwith 80 Days in A/R, 20 days above our target.Whilethat’snotgoodit’snotasbadasitseems,thoughalittleexplanationisrequired.InNovember, $270K and in December, $300Kwere reserved to account forwhatwethinkwe’regoingtooweMedicareforourstrongrevenueyear.That$570KaffectstheDays in A/R calculation. It’s real, but there is no facility in the calculation to spreadthosemoniesoverseveralmonths,whichiswhatthereservereflects.ThenetresultisthattheDaysinA/Rcalculationisnineto10dayshigherthanitwouldbeifwehadn’treserved the $570K. Over thenext fewmonths, this “overstatement”willwork itselfoutrelativetothecalculation.Nevertheless,wemissedourtarget.

2. WemanagedtosetafewimportantmonthlyrecordsthisDecember:

a. In-patientAdmissions(59,bestingAugustby5or9%)b. ClinicVisits(1,615,bestingOctoberby16or1%)c. InfusionRevenue($320K,bestingAugustby$47Kor17%)d. NetContractualAllowances($2.12MM,worsethanJuneby$226Kor12%)e. CashonHand($4.84MM,$462KbetterthanattheendofSeptember)

2015TopLine:A terrificRevenueyear;agoodyear forExpensecontrol; the first timethatOperatingRevenuelessOperatingExpenseswoundupatbreak-evenorbetter;agoodyearforhangingontoCash;anot-so-goodyearintermsofmanagingourAccountsReceivable;aso-soyearforCollections,thoughwebested lastyearbynearly$7MM;andayear inwhichwe increasedourTotalNetAssetsby$1.6MM,or41%.

3. KeyYear-over-Yearcomparisons:a. GrossPatientRevenue($46.23MM)--32%betterthan2014b. RevenueDeductions($21.45MM)–38%morethanin2014c. NetPatientRevenue($24.78MM)–27%betterthan2014d. TotalNetRevenues($26.02MM)–23%betterthan2014e. OperatingExpenses($26.00MM)–19%greaterthanin2014f. OperatingMargin($17K)–$653Kbetterthanlastyear’snegative$636Kg. NetIncome($1.62MM)–107%betterthan2014h. Year-endAccountsReceivable($10.71MM)--$1.9MMmorethan2014i. Collections($23.44MM)--$6.98MM,or42%morethanin2014j. Year-endCashonHand($4.84MM)–3.5timeslastyear’s$1.37MMk. TotalAssets($24.37MM)–$3.59MMmorethanattheendof2014l. CurrentLiabilities($5.72MM)--$2.56MMmorethanattheendof2014m. Long-TermLiabilities($13.06MM)--$58Klessthanattheendof2014

n. TotalNetAssets($5.59MM)--$1.62MM(+41%)morethanattheendof2014

4. Theonlyareaswherewedidnotsetannualrecordsin2015are:a. SwingBedAdmissions(8)--74%belowour2011highof31b. SwingBedDays(34)–88%belowour2011highof280c. SwingBedRevenue($62K)–89%belowour2011highof$566Kd. MammographyRevenue($116K)–38%belowour2014levelof$188Ke. RevenuefromGrants($325K)–63%belowour2014levelof$888Kf. AverageMonthlyCashonHand($2.93MM)--7%belowour2013highof$3.16MMg. MillLevyRevenue($1.12MM)--33%belowour2010&2011highof$1.68MMh. CharityWrite-offs($200K)–64%belowour2013highof$554Ki. BadDebtWrite-offs($1.85MM)–10%belowour2013highof$2.07MM

5. Insummary,fromafinancialperspective,2015wasyetanotherhighgrowthyear.Infact,Gross

Patient Revenue was 32% higher than last year and 90% higher than 2013. By keepingOperating Expenses in check, we managed to break even without counting the Mill Levy orDonations.Collectionsaregettingstronger,butremainachallenge,asdoesreducingourA/R.Most business lines had banner years, with exceptional revenue performances in Infusion(+159%versuslastyear),Surgery(+99%),theLab(+26%),theER(+22%),andallImaging(+19%).TheRuralHealthClinicisbackontrack,up41%versuslastyearintermsofrevenue,andup31%intermsofPatientVisits.Itwasagoodyearfinancially–andabusyone. Wehad55,800Out-patientvisits;20,800Labvisits,9,700Imagingpatients;16,800Clinicvisits,andjustunder7,000ERvisits.Wehad523In-patientswhooccupiedbeds for 1,251days. We conducted 54,000 Lab tests, 13,000 Imagingtestsand1,000surgeries.Wegave1,056Ambulancerides,66%ofthemtoPSMC.

6. Year-endgraphsareinaseparate(MicrosoftExcel)documentwiththecleverfilenameof“2015Year-endGraphs.”

7. Atourmeeting,wediscussedmanagement’sdesiretoupgradeandupdateourMRImachinery.Their plan will cost us approximately $20K more than we’d budgeted for 2016. Theirexpectationisthataddedusebecauseofmuchhigherqualityimageswillmorethanoffsettheadditionalcosts.Thedealonthetablerequiresafive-yearagreement,whichisaboutthelife-span of the equipment, but where we have an out-clause after two years. The FinanceCommittee supports management’s decision to proceed with the upgrade/update andrecommendsBoardapproval.

Page1

2015 Budget Difference Variance 2015 Budget Difference VarianceRevenue

2 In-patientRevenue3 In-Patients 342,132$ 285,987$ 56,145$ 20% 3,554,361$ 3,273,500$ 280,861$ 9%4 Surgery 150,617$ 193,580$ (42,963)$ -22% 2,286,023$ 2,419,747$ (133,724)$ -6%5 SwingBeds - 7,538 (7,538) -100% 61,653 84,100 (22,447) -27%6 TotalIn-patientRevenue 492,749 487,105 5,644 1% 5,902,037 5,777,347 124,690 2%8 Out-patientRevenue9 ER 676,840 526,381 150,459 29% 7,487,071 5,873,000 1,614,071 27%10 Lab 449,374 471,240 (21,866) -5% 5,548,265 5,236,000 312,265 6%11 Ambulance 163,442 171,198 (7,756) -5% 1,845,833 1,902,200 (56,367) -3%12 Clinic 233,873 363,570 (129,697) -36% 2,506,745 3,635,700 (1,128,955) -31%13 Imaging 647,134 536,898 110,236 21% 6,897,195 6,711,225 185,970 3%14 Surgery 475,102 351,981 123,121 35% 5,897,546 4,399,758 1,497,788 34%15 Other 544,570 218,476 326,094 149% 3,894,462 2,660,800 1,233,662 46%16 TotalOut-patientRevenue 3,190,335 2,639,744 550,591 21% 34,077,117 30,418,683 3,658,434 12%-18 ProfessionalFees 450,994 393,867 57,127 15% 6,248,010 4,734,300 1,513,710 32%-20 TotalPatientRevenue 4,134,078 3,520,715 613,363 17% 46,227,164 40,930,330 5,296,834 13%

22 RevenueDeductions&BadDebt23 ContractualAllowances 2,217,964 1,439,263 778,701 54% 20,917,916 16,636,342 4,281,574 26%24 Charity 2,731 34,593 (31,862) -92% 199,785 400,000 (200,215) -50%25 BadDebt 143,762 200,215 (56,453) -28% 1,854,382 2,315,100 (460,718) -20%26 ProviderFee&Other (95,354) (54,007) (41,347) 77% (1,522,232) (648,084) (874,148) 135%27 TotalRevenueDeductions&BadDebt 2,269,102 1,620,063 649,039 40% 21,449,850 18,703,358 2,746,492 15%

28 TotalNetPatientRevenue 1,864,976 1,900,652 (35,677) -2% 24,777,314 22,226,972 2,550,342 11%

30 Grants 10,633 21,351 (10,719) -50% 324,605 429,097 (104,492) -24%31 OtherOperatingIncome-Misc 68,482 60,851 7,631 13% 916,981 730,278 186,703 26%

34 TotalNetRevenues 1,944,090 1,982,855 (38,765) -2% 26,018,900 23,386,347 2,632,553 11%

35 OperatingExpenses36 Salary&Wages 1,290,831 1,082,430 208,401 19% 13,594,936 12,377,880 1,217,056 10%37 Benefits (410,783) 234,102 (644,884) -275% 1,930,587 2,751,100 (820,513) -30%38 ProfessionalFees 101,025 51,958 49,067 94% 802,614 599,800 202,814 34%39 ContractLabor 105,760 22,500 83,260 370% 650,376 260,000 390,376 150%40 PurchasedServices 93,465 103,340 (9,875) -10% 942,568 1,163,320 (220,753) -19%41 Supplies 622,585 246,509 376,076 153% 3,244,285 2,850,500 393,785 14%42 Rent&Leases 46,314 57,207 (10,892) -19% 548,221 650,600 (102,379) -16%43 Repairs&Maintenance 59,633 38,085 21,548 57% 490,434 436,568 53,866 12%44 Utilities 44,582 35,717 8,865 25% 389,023 353,000 36,023 10%45 Insurance 14,077 17,500 (3,423) -20% 191,606 210,000 (18,394) -9%46 Depreciation&Amortization 134,251 118,646 15,605 13% 1,444,888 1,423,750 21,138 1%47 Interest 71,712 49,814 21,898 44% 696,278 597,767 98,511 16%48 Other 44,909 64,245 (19,335) -30% 1,075,535 751,940 323,595 43%49 TotalOperatingExpenses 2,218,362 2,122,052 96,310 5% 26,001,350 24,426,225 1,575,125 6%

51 OperatingRevenueLessExpenses (274,272) (139,197) (135,075) 97% 17,550 (1,039,878) 1,057,428 -102%

53 Non-OperatingIncome54 TaxRevenue 24,539 22,660 1,879 8% 1,122,124 1,133,000 (10,876) -1%55 Donations 4,329 23,333 (19,005) -81% 479,698 280,000 199,698 71%

57 TotalNon-OperatingIncome 28,867 45,993 (17,126) -37% 1,601,822 1,413,000 188,822 13%

59 TotalRevenueLessTotalExpenses (245,404)$ (93,204)$ (152,200)$ 163% 1,619,372$ 373,122$ 1,246,250$ 334%

CurrentMonth Year-to-DateIncomeStatement---December31,2015

PagosaSpringsMedicalCenter

Page 2

Current Prior Current Prior1 Assets Month Month Liabilities Month Month2 Current Assets Current Liabilities3 Cash Accts Payable - System 826,899$ 259,217$ 4 Operating 4,657,228$ 3,697,707$ Accrued Expenses 2,056,373 2,116,841 5 Operating - Set Aside Cash Cost Report Settlement Res 1,538,035 1,399,994 6 Construction - - Wages & Benefits Payable 2,947 1,989 7 Bond Funds 27,311 251,930 Deferred Revenue 1,033,985 1,166,338 8 Capital Escrow 151,480 151,466 Current Portion of LT Debt 260,000 260,000 9 Total Cash 4,836,019 4,101,102 Total Current Liabilities 5,718,240 5,204,380 1011 Accounts Receivable12 Patient Revenue - Net 4,966,727 5,058,225 Long-Term Liabilities13 Taxes - - Leases Payable 563,951 570,778 14 Other Receivables 33,034 122,579 EHR Lease 1,555,639 1,610,858 15 Total Accounts Receivable 4,999,762 5,180,804 Bond Premium (Net) 285,826 286,938 16 Bonds Payable - 1998 - - 17 Inventory 913,222 1,213,233 Bonds Payable - 2006 & 2007 9,910,000 9,910,000 18 Line of Credit- Citizens Bank 550,000 550,000

Total Current Assets 10,749,003 10,495,138 1st Southwest Bank 192,358 195,798 Total Long-Term Liabilities 13,057,774 13,124,372

20 Fixed Assets21 Property Plant & Equip (Net) 10,458,006 10,550,815 Net Assets22 EHR in Progress 2,181,566 2,231,865 Un-Restricted 3,971,958 3,972,292 23 Clinic Expansion in Progress 743,299 708,543 Current Year Net Income/Loss 1,619,372 1,864,776 24 Equipment Lease - - Total Un-Restricted 5,591,331 5,837,069 25 Land 101,000 101,000 26 Total Fixed Assets 13,483,870 13,592,223 2728 Other Assets29 Bond Issuance Costs - Net - - Restricted - - 30 Prepaids & Other Assets 134,471 78,460 Total Net Assets 5,591,331 5,837,069

Total Other Assets 134,471 78,460 3132 Total Assets 24,367,344$ 24,165,821$ Total Liabilities & Net Assets 24,367,344$ 24,165,821$

Balance Sheet - - - December 31, 2015


Page3

Dec-14 Jan-15 Feb-15 Mar-15 Apr-15 May-15 Jun-15 Jul-15 Aug-15 Sep-15 Oct-15 Nov-15 Dec-15 YTDTotalActivity 31 31 28 31 30 31 30 31 31 30 31 30 31 365

2 In-PatientAdmissions 44 34 34 47 33 41 45 34 54 40 49 53 59 5233 In-PatientDays 105 86 91 99 81 113 115 80 121 100 119 125 121 1,2514 AvgStayDays(In-patients) 2.4 2.5 2.7 2.1 2.5 2.8 2.6 2.4 2.2 2.5 2.4 2.4 2.1 2.4

6 SwingBedAdmissions 0 0 2 2 2 2 0 0 0 0 0 0 0 87 SwingBedDays 0 0 6 11 7 10 0 0 0 0 0 0 0 348 AvgLengthofStay(Swing) 0.0 0.0 3.0 5.5 3.5 5.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 4.3

10 AverageDailyCensus 3.4 2.8 3.5 3.5 2.9 4.0 3.8 2.6 3.9 3.3 3.8 4.2 3.9 3.5

Out-PatientVisits13 E/R 554 477 483 599 426 524 705 749 677 582 557 538 666 6,98314 Observ 28 21 25 39 29 27 38 50 46 43 41 26 28 41315 Lab 1,576 1,544 1,537 1,660 1,598 1,692 1,926 1,963 1,981 1,749 1,700 1,533 1,690 20,57316 Radiology/CT/MRI 712 771 751 863 728 756 852 928 877 802 826 709 833 9,69617 OR/IP 0 5 5 12 0 3 9 3 2 9 15 8 6 7717 OR/OP 76 62 67 66 83 89 89 93 72 69 89 74 78 93118 Clinic 1,189 1,262 1,190 1,456 1,307 1,234 1,257 1,298 1,517 1,430 1,599 1,588 1,615 16,75319 Other 28 29 26 34 29 28 42 43 39 31 33 16 29 379

21 TotalO/PVisits 4,163 4,171 4,084 4,729 4,200 4,353 4,918 5,127 5,211 4,715 4,860 4,492 4,945 55,805

23 EMSCalls 148 143 143 133 139 147 179 198 162 140 188 149 175 1,89624 EMSTransports 84 87 87 82 73 88 102 107 104 67 91 74 94 1,05625 EMSTransportstoPMH 59 61 65 60 41 53 61 67 68 50 56 50 61 69326 PctTransportstoPMH 70% 70% 75% 73% 56% 60% 60% 63% 65% 75% 62% 68% 65% 66%

Revenue29 In-Patients 258,171$ 198,145$ 231,121$ 307,457$ 200,721$ 319,980$ 378,470$ 226,731$ 368,277$ 288,570$ 322,508$ 370,248$ 342,132$ 3,554,36030 I/PSurgery 80,375$ 202,920$ 224,571$ 303,922$ 126,458$ 144,927$ 171,180$ 118,323$ 152,492$ 260,557$ 276,476$ 153,582$ 150,617$ 2,286,02431 SwingBeds -$ 4,392$ 4,802$ 7,699$ 11,318$ 9,267$ 8,127$ -$ 16,048$ -$ -$ -$ -$ 61,65332 LabO/P 411,479$ 372,052$ 377,373$ 427,937$ 453,479$ 485,896$ 541,385$ 542,511$ 500,297$ 469,163$ 488,471$ 440,327$ 449,374$ 5,548,26533 Radiology 123,405$ 127,752$ 119,500$ 139,875$ 115,348$ 108,811$ 172,579$ 147,062$ 137,617$ 126,288$ 124,512$ 107,887$ 142,919$ 1,570,15034 CT 236,397$ 199,986$ 176,726$ 193,343$ 177,448$ 226,166$ 363,273$ 373,449$ 320,819$ 260,406$ 299,947$ 232,865$ 342,499$ 3,166,92735 MRI 92,442$ 117,176$ 108,071$ 100,415$ 109,872$ 88,247$ 148,314$ 113,285$ 149,405$ 102,892$ 124,154$ 88,020$ 92,298$ 1,342,14936 Ultrasound 60,724$ 31,437$ 38,160$ 53,888$ 69,424$ 61,561$ 151,824$ 69,646$ 74,002$ 36,545$ 39,276$ 34,118$ 41,825$ 701,70637 Mammography 11,517$ 11,018$ 4,991$ 4,958$ 4,903$ 2,863$ 21,674$ 5,256$ 4,786$ 6,825$ 3,654$ 17,742$ 27,593$ 116,26338 Surgery 409,201$ 454,037$ 452,445$ 473,184$ 554,035$ 436,918$ 523,599$ 600,117$ 351,871$ 475,643$ 524,196$ 576,399$ 475,102$ 5,897,54639 ERO/P 532,769$ 553,380$ 554,333$ 577,510$ 531,353$ 530,598$ 757,064$ 777,930$ 704,461$ 619,767$ 661,719$ 542,116$ 676,840$ 7,487,07140 OtherOut-patients 12,998$ 13,718$ 15,092$ 14,268$ 18,215$ 8,102$ 21,418$ 22,122$ 13,251$ 55,137$ 48,098$ 36,105$ 47,083$ 312,60941 Infusion 124,453$ 31,918$ 90,241$ 142,171$ 145,174$ 141,205$ 215,869$ 176,095$ 272,765$ 252,474$ 262,729$ 181,171$ 320,378$ 2,232,19042 PharmacyO/P 74,664$ 193,994$ 70,320$ 51,727$ 79,128$ 62,523$ 137,482$ 86,936$ 90,478$ 102,110$ 152,371$ 145,488$ 177,109$ 1,349,66643 Clinic 145,148$ 170,077$ 212,044$ 230,999$ 215,594$ 173,095$ 205,084$ 174,030$ 209,121$ 217,876$ 235,888$ 229,064$ 233,873$ 2,506,74544 PhysicianFees 380,248$ 539,774$ 495,638$ 530,974$ 493,834$ 408,131$ 534,862$ 530,701$ 603,076$ 573,446$ 548,828$ 537,751$ 450,994$ 6,248,01045 Ambulance 178,266$ 167,586$ 126,803$ 157,979$ 132,097$ 166,739$ 144,376$ 193,535$ 190,242$ 96,592$ 151,380$ 155,062$ 163,442$ 1,845,83446 Total 3,132,257$ 3,389,362$ 3,302,231$ 3,718,306$ 3,438,401$ 3,375,029$ 4,496,580$ 4,157,728$ 4,159,007$ 3,944,291$ 4,264,207$ 3,847,945$ 4,134,078$ 46,227,164

MonthlyTrends

Page 4

1 In-Patient2 Admissions:3 Acute 59 54 5 523 562 (39) 523 424 99 23%4 Swing Bed - - - 8 4 4 8 9 (1) -11%5 Total 59 54 5 531 566 (35) 531 433 98 23%

7 Patient Days:8 Acute 121 120 1 1,251 1,296 (45) 1,251 1,002 249 25%9 Swing Bed - - - 34 39 (5) 34 74 (40) -54%10 Total 121 120 1 1,285 1,335 (50) 1,285 1,076 209 19%

12 Average Daily Census:13 # Of Days 30 30 365 365 365 335 14 Acute 4.0 4.0 0.0 3.4 3.6 (0.1) 3.4 3.0 0.4 15%15 Swing Bed - - - 0.1 0.1 (0.0) 0.1 0.2 (0.1) -58%16 Total 4.0 4.0 0.0 3.5 3.7 (0.1) 3.5 3.2 0.3 10%

18 Length of Stay:19 Acute 2.1 2.2 (0.2) 2.4 2.3 0.1 2.4 2.4 0.0 1%20 Swing Bed #DIV/0! #DIV/0! #DIV/0! 4.3 9.8 (5.5) 4.3 8.2 (4.0) 0%21 Total 2.1 2.2 (0.2) 2.4 2.4 0.1 2.4 2.5 (0.1) -3%

23 Revenue:24 Acute 492,749 479,567 13,182 5,840,384 5,693,247 147,137 5,840,384 4,876,828 963,556 20%25 Swing Bed - 7,538 (7,538) 61,653 84,100 (22,447) 61,653 120,717 (59,064) -49%26 Total 492,749 487,105 5,644 5,902,037 5,777,347 124,690 5,902,037 4,997,545 904,492 18%

28 Revenue Per Pat Day:29 Acute 4,072 3,996 76 4,669 4,393 276 4,669 4,867 (199) -4%30 Swing Bed #DIV/0! #DIV/0! #DIV/0! 1,813 2,156 (343) 1,813 1,631 182 11%31 Total 4,072 4,059 13 4,593 4,328 265 4,593 4,645 (52) -1%

33 Out-Patient34 Out-Patient Visits35 E/R 666 562 104 6,983 6,269 714 6,983 6,519 464 7%36 Observ 28 20 8 413 222 191 413 206 207 100%37 Lab 1,690 1,750 (60) 20,573 19,448 1,125 20,573 17,459 3,114 18%38 Radiology/MRI/US/CT 833 891 (58) 9,696 11,976 (2,280) 9,696 8,480 1,216 14%39 OR 84 69 15 1,008 815 193 1,008 779 229 29%40 Clinic 1,615 2,690 (1,075) 16,753 25,631 (8,878) 16,753 12,757 3,996 31%41 Other 29 30 (1) 379 318 61 379 711 (332) -47%42 Total 4,945 6,012 (1,067) 55,805 64,679 (8,874) 55,805 46,911 8,894 19%

44 ER Physician 666 562 104 6,983 6,269 714 6,983 6,519 464 7%

46 Out-Patient Revenue47 E/R 622,372 508,869 113,503 6,606,855 5,654,100 952,755 6,606,855 6,001,184 605,671 10%48 Observ 54,468 17,512 36,956 880,216 218,900 661,316 880,216 184,786 695,430 376%49 Lab 449,374 471,240 (21,866) 5,548,265 5,236,000 312,265 5,548,265 4,411,190 1,137,075 26%50 Radiology 142,919 122,992 19,927 1,570,150 1,537,400 32,750 1,570,150 1,377,379 192,771 14%51 CT 342,499 239,096 103,403 3,166,927 2,988,700 178,227 3,166,927 2,651,544 515,383 19%52 Ultrasound 41,825 57,952 (16,127) 701,706 724,400 (22,694) 701,706 569,275 132,431 23%53 MRI 92,298 89,912 2,386 1,342,149 1,123,900 218,249 1,342,149 998,018 344,131 34%54 Mammography 27,593 26,946 647 116,263 336,825 (220,562) 116,263 188,206 (71,943) -38%55 OR 475,102 351,981 123,121 5,897,546 4,399,758 1,497,788 5,897,546 3,969,896 1,927,650 49%56 Clinic 233,873 363,570 (129,697) 2,506,745 3,635,700 (1,128,955) 2,506,745 1,770,019 736,726 42%57 Other 544,570 218,476 326,094 3,894,462 2,660,800 1,233,662 3,894,462 1,591,488 2,302,974 145%58 Total 3,026,893 2,468,546 558,347 32,231,284 28,516,483 3,714,801 32,231,284 23,712,985 8,518,299 36%

59 Physician 450,994 393,867 57,127 6,248,010 4,734,300 1,513,710 6,248,010 4,486,938 1,761,072 39%

61 Ambulance62 Ambulance Calls 175 1,896 1,896 1,299 597 46%63 Ambulance Transports 94 1,056 1,056 707 349 49%64 Transports to PMH 61 91 693 730 (37) 693 428 265 62%65 Transports to PMH % 65% 66% 66% 61%66 Transports to Other 33 363 363 279 84 67 Transports to Other % 35% 34% 34% 39%

69 Revenue: 163,442 171,198 (7,756) 1,845,833 1,902,200 (56,367) 1,845,833 1,786,421 59,412 3%70 Revenue Per Transport: 1,739 1,748 1,748 2,527 (779) -31%

71 Total Revenues 4,134,078 3,520,715 613,363 46,227,164 40,930,330 5,296,834 46,227,164 34,983,889 11,243,275 32%

Pagosa Springs Medical Center - - - Statistical Review

Statistical ReviewDecember Prior Y-T-D

VarianceY-T-D Actual Prior Y-T-D Actual DifferenceCurrent Month

ActualCurrent Month

Budget VarianceY-T-D Actual Y-T-D Budget Variance2015

December December Y-T-D

Page5

0-30Days 31-60Days 61-90Days 91-120Days 121-150Days 151-180Days 181+Days Total PercentofTotal

AcctssenttoCollections

2 Medicare -$ -$ -$ -$ -$ -$ 17,631$ 17,631$ 6%3 Medicaid - - - - - - 27,785 27,785 9%4 ThirdParty - - - - - - (2,614) (2,614) -1%5 Self-Pay - - - - - - 275,424 275,424 87%

CurrentMonthTotal -$ -$ -$ -$ -$ -$ 318,227$ 318,227$ 999$PctofTotal 0% 0% 0% 0% 0% 0% 100% 100% 100%

Nov-15 0% 0% 0% 0% 0% 0% 326,803$ 326,803$ 20,185$PctofTotal 0% 0% 0% 0% 0% 0% 100% 100% 100%

Oct-15 0% 0% 0% 0% 0% 0% 348,056$ 348,056$ 23,027$PctofTotal 0% 0% 0% 0% 0% 0% 100% 100%

Sep-15 -$ -$ -$ -$ -$ -$ 356,599$ 356,599$ -$PctofTotal 0% 0% 0% 0% 0% 0% 100% 100%

Aug-15 -$ -$ -$ -$ -$ -$ 366,454$ 366,454$ -$PctofTotal 0% 0% 0% 0% 0% 0% 100% 100%

Jul-15 -$ -$ -$ -$ -$ -$ 373,467$ 373,467$ 3,023$PctofTotal 0% 0% 0% 0% 0% 0% 100% 100%

Jun-15 -$ -$ -$ -$ -$ -$ 386,586$ 386,586$ 1,022$PctofTotal 0% 0% 0% 0% 0% 0% 100% 100%

May-15 - - - - - - 392,109 392,109$ 23,676PctofTotal 0% 0% 0% 0% 0% 0% 100% 100%

Apr-15 - - - - - - 274,243 274,243$ 14,409PctofTotal 0% 0% 0% 0% 0% 0% 100% 100%

Mar-15 827 - - - - 19,491 269,253 288,744$ 73,095PctofTotal 0% 0% 0% 0% 0% 7% 93% 100%

Feb-15 827 - - - 29,926 24,018 300,796 355,567$ 52,119PctofTotal 0% 0% 0% 0% 8% 7% 85% 100%

Jan-15 827 - - 51,075 47,904 14,967 326,891 441,664$ 23,539PctofTotal 0% 0% 0% 12% 11% 3% 74% 100%

Dec-14 827 - 58,299 55,752 16,123 18,975 376,081 526,057$ 31,903PctofTotal 0% 0% 11% 11% 3% 4% 71% 100%

Nov-14 2,314 111,895 91,825 82,365 67,989 48,983 505,241 910,612$ 36,426PctofTotal 0% 12% 10% 9% 7% 5% 55% 100%

Oct-14 134,742 137,281 95,237 98,975 60,532 44,223 587,841 1,158,831$ 113,027PctofTotal 12% 12% 8% 9% 5% 4% 51% 100%

Sep-14 144,501 108,743 132,437 104,031 87,499 38,549 713,343 1,329,104$ 205,698PctofTotal 11% 8% 10% 8% 7% 3% 54% 100%

Aug-14 183,633 153,267 132,655 76,222 51,955 28,333 797,487 1,423,552$ 217,000PctofTotal 13% 11% 9% 5% 4% 2% 56% 100%

Jul-14 190,035 154,858 81,004 73,883 32,982 120,185 814,640 1,467,586$ 182,156PctofTotal 13% 11% 6% 5% 2% 8% 56% 100%

Jun-14 305,240 97,411 80,757 58,104 126,707 105,731 758,403 1,532,354$ 434,861PctofTotal 20% 6% 5% 4% 8% 7% 49% 100%

May-14 226,929 181,040 67,195 340,065 174,974 99,266 703,019 1,792,488$ 177,796PctofTotal 13% 10% 4% 19% 10% 6% 39% 100%

Apr-14 127,749 82,721 407,726 626,567 110,591 76,128 666,294 2,097,776$PctofTotal 6% 4% 19% 30% 5% 4% 32% 100%

Mar-14 161,607 523,343 790,305 393,395 101,744 67,432 633,771 2,671,597 175,831$PctofTotal 6% 20% 30% 15% 4% 3% 24% 102%

AccountsReceivableforHospitalbyPayorandDaysOutstanding--AsofDecember,2015


8 Feb-14 1,270,278$ 1,077,827$ 479,290$ 290,291$ 76,976$ 89,730$ 569,871$ 3,854,263$9 PctofTotal 33% 28% 12% 8% 2% 2% 15% 100% 100% 254,437$

10 Jan-14 2,129,345$ 834,958$ 335,714$ 296,509$ 203,284$ 74,885$ 824,993$ 4,699,688$11 PctofTotal 45% 18% 7% 6% 4% 2% 18% 100% 187,666$

44 PctSettled(Current) #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0!

45 PctSettled(PrevMo) #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0!

23,539

0-30Days 31-60Days 61-90Days 91-120Days 121-150Days 151-180Days 181+Days Total PercentofTotal

AcctssenttoCollections

2 Medicare 1,386,993$ 202,174$ 254,960$ 81,793$ 72,294$ 55,060$ 305,104$ 2,358,378$ 23%3 Medicaid 601,559 106,534 60,851 113,763 43,127 104,710 320,399 1,350,943 13%4 ThirdParty 1,606,100 662,633 440,612 415,455 252,070 236,427 1,075,701 4,688,998 45%5 Self-Pay 402,416 155,045 213,446 169,119 146,528 154,193 750,075 1,990,822 19%

CurrentMonthTotal 3,997,068$ 1,126,386$ 969,869$ 780,130$ 514,019$ 550,390$ 2,451,279$ 10,389,141$ 145,958PctofTotal 38% 11% 9% 8% 5% 5% 24% 100% 100%

Nov-15 4,050,795$ 1,520,072$ 844,147$ 647,019$ 649,304$ 725,565$ 2,024,026$ 10,460,928$ 256,980PctofTotal 39% 15% 8% 6% 6% 7% 19% 100%

Oct-15 4,337,928.00 1,304,005.00 916,249.00 805,296.00 787,144.00 440,378.00 2,097,570.00 10,688,570$ 181,726PctofTotal 41% 12% 9% 8% 7% 4% 20% 100%

Sep-15 3,867,063$ 1,323,831$ 992,882$ 935,502$ 486,637$ 315,491$ 1,980,869$ 9,902,275$ 0PctofTotal 39% 13% 10% 9% 5% 3% 20% 100%

Aug-15 4,234,807$ 1,426,700$ 1,115,331$ 608,575$ 363,717$ 531,542$ 1,702,022$ 9,982,694$ 74,409PctofTotal 43% 17% 8% 5% 6% 4% 17% 100%

Jul-15 4,052,124$ 1,554,907$ 771,925$ 481,680$ 534,495$ 410,041$ 1,616,253$ 9,421,425$ 168,968PctofTotal 43% 17% 8% 5% 6% 4% 17% 100%

Jun-15 3,870,977$ 1,181,919$ 718,276$ 635,491$ 498,966$ 574,898$ 1,523,675$ 9,004,202$ 184,501PctofTotal 43% 13% 8% 7% 6% 6% 17% 100%

May-15 3,145,906 1,373,328 905,979 698,918 649,378 514,777 1,547,437 8,835,723 177,145PctofTotal 36% 16% 10% 8% 7% 6% 18% 100%

Apr-15 3,409,285 1,549,879 945,104 750,603 594,193 441,264 1,443,894 9,134,222 273,212PctofTotal 37% 17% 10% 8% 7% 5% 16% 100%

Mar-15 3,398,434 1,339,969 1,003,776 740,705 504,848 442,805 1,517,117 8,947,654 127,592PctofTotal 38% 15% 11% 8% 6% 5% 17% 100%

Feb-15 3,372,215 1,617,336 962,484 674,262 548,229 364,805 1,411,089 8,950,420 182,548PctofTotal 38% 18% 11% 8% 6% 4% 16% 100%

Jan-15 3,392,093 1,725,920 883,473 724,508 430,135 429,223 1,393,944 8,979,296 92,522PctofTotal 38% 19% 10% 8% 5% 5% 16% 100%

Dec-14 3,081,644 1,349,672 994,091 551,241 495,941 658,330 1,142,805 8,273,724 56,036PctofTotal 37% 16% 12% 7% 6% 8% 14% 100%

Nov-14 2,962,642 1,456,141 725,431 622,680 746,553 540,077 998,646 8,052,170 62,360PctofTotal 37% 18% 9% 8% 9% 7% 12% 100%

Oct-14 2,864,862 1,003,986 803,740 828,641 665,530 464,397 772,994 7,404,150 35,672PctofTotal 39% 14% 11% 11% 9% 6% 10% 100%

Sep-14 2,814,798 1,274,888 1,037,373 688,261 639,315 607,098 548,449 7,610,182 52,548PctofTotal 37% 17% 14% 9% 8% 8% 7% 100%

Aug-14 3,033,278 1,589,068 811,991 835,484 747,721 535,097 263,880 7,816,519PctofTotal 39% 20% 10% 11% 10% 7% 3% 100%

Jul-14 2,977,888 1,156,296 1,081,457 843,854 709,124 310,726 7,079,345PctofTotal 42% 16% 15% 12% 10% 4% 0% 100%

Jun-14 2,910,176 1,442,807 926,933 802,938 372,868 6,455,722PctofTotal 45% 22% 14% 12% 6% 0% 0% 100%

May-14 3,090,584 1,330,592 929,074 454,649 5,804,899PctofTotal 53% 23% 16% 8% 0% 0% 0% 100%


CernerAccountsReceivableforHospitalbyPayorandDaysOutstanding--AsofDecember31,2015

Apr-14 2,462,816 1,121,534 488,643 4,072,993PctofTotal 60% 28% 12% 0% 0% 0% 0% 100%

Mar-14 2,207,591 615,437 2,823,028PctofTotal 78% 22% 100%

8 Feb-14 858,879$ -$ -$ -$ -$ -$ -$ 858,879$9 PctofTotal 100% 0% 0% 0% 0% 0% 0% 100% 100%

10 Jan-14 -$ -$ -$ -$ -$ -$ -$ -$11 PctofTotal 0% 0% 0% 0% 0% 0% 0% 0%

12 PctSettled(Current) 72.2% 36.2% 7.6% 20.6% 15.2% -237.8%

13 PctSettled(NovfromOct) 65.0% 35.3% 29.4% 19.4% 7.8% -359.6%

14 PctSettled(OctfromSep) 66.3% 30.8% 18.9% 15.9% 9.5% -564.9%

15 PctSettled(SepfromAug) 68.7% 30.4% 16.1% 20.0% 13.3% -272.7%

16 PctSettled(AugfromJul) 64.8% 28.3% 21.2% 24.5% 0.6% -315.1%

Page7


Page8

31 28 31 30 31 30Jan-15 Feb-15 Mar-15 Apr-15 May-15 Jun-15

31 31 30 31 30 31Jul-15 Aug-15 Sep-15 Oct-15 Nov-15 Dec-15

12 Medicare 33% 21 62,045$ 429,971$13 Medicaid 7% 35 62,045$ 152,010$14 BlueCross 15% 45 62,045$ 418,803$15 Commercial 26% 60 62,045$ 967,900$16 SelfPay 19% 150 62,045$ 1,768,279$17 Total: 100% 3,736,963$18 62,045$19 60

75

9

10

2

3

4

5

7

8

NetDaysinA/RTarget

PagosaMountainHospital---NetDaysTarget

1,837,570$

NetAccountsReceivable 4,988,008$ 4,940,192$ 4,792,459$ 4,859,586$ 4,640,290$

NetPatientRevenue 1,976,827$

65,654$

1,891,119$ 1,904,569$

74

70,363$


PagosaSpringsMedicalCenter---NetDaysinA/R2015

2,443,471$

77

64,489$ 63,016$ 61,935$

4,844,178$

75 69

NetPatientRev/Day(2monthAvg) 61,549$

NetDaysinA/R 81

1,937,828$

NetPatientRevenue 2,247,838$ 2,240,757$ 2,309,718$ 2,202,881$ 1,919,762$ 1,864,976$

NetAccountsReceivable 4,975,122$ 5,133,489$ 5,106,408$ 5,330,400$ 5,058,225$ 4,966,727$

NetPatientRev/Day(2monthAvg) 76,980$ 72,397$ 74,637$ 74,026$ 67,526$ 62,076$

80NetDaysinA/R 65 71 68 72 75

PagosaSpringsMedicalCenterRevenueandUsagebyFinancialClassDecember,2015

RowLabels SumofInp.MTDTotal SumofOut.MTDTotal TotalMTD %MTDAuto/LiabilityInsurance - 2,858.50 2,859 0.07%BlueCross 110,851.05 572,981.70 683,833 16.54%Champus 4,042.00 3,437.00 7,479 0.18%CommercialInsurance 52,349.00 607,082.75 659,432 15.95%HMO(HealthMaintenanceOrganization) - - - 0.00%Medicaid 118,205.70 648,189.85 766,396 18.54%Medicare 259,493.71 1,163,009.95 1,422,504 34.41%MedicareHMO 15,841.00 71,717.95 87,559 2.12%SelfPay 5,781.00 413,820.39 419,601 10.15%SelfPay-ClientBilling - 1,818.00 1,818 0.04%VeteransAdministration 22,617.00 56,709.70 79,327 1.92%WorkersCompensation - 25,667.70 25,668 0.62%(blank) 202.00 (22,598.00) (22,396) -0.54%GrandTotal 589,382.46 3,544,695.49 4,134,078 100.00%

RowLabels SumofInp.YTDTotal SumofOut.YTDTotal TotalYTD %YTDAuto/LiabilityInsurance 15.00 210,732.85 210,748 0.46%BlueCross 946,777.39 5,561,803.86 6,508,581 14.09%Champus 4,042.00 36,949.80 40,992 0.09%CommercialInsurance 753,371.10 6,167,269.42 6,920,641 14.98%HMO(HealthMaintenanceOrganization) - 6,044.30 6,044 0.01%Medicaid 1,296,892.56 8,097,627.55 9,394,520 20.33%Medicare 3,289,808.53 13,014,992.39 16,304,801 35.29%MedicareHMO 316,592.67 877,571.90 1,194,165 2.58%SelfPay 178,435.05 4,055,288.39 4,233,723 9.16%SelfPay-ClientBilling - 39,644.00 39,644 0.09%VeteransAdministration 216,788.70 966,780.62 1,183,569 2.56%WorkersCompensation 11,758.00 315,920.00 327,678 0.71%(blank) (2,587.00) (158,845.30) (161,432) -0.35%GrandTotal 7,011,894.00 39,191,779.78 46,203,674 100.00%

2016 Annual Clerk for the USJHSD Board of Directors

Report

• Notice of Posting Places • Transparency Notice • Notice of Board Meetings • Conflict of Interest and Gift Disclosure Forms • Election notice and self nomination forms

MINUTES OF REGULAR BOARD MEETING

Tuesday, November 17, 2015 5:30 PM

The Great Room, Pagosa Springs Medical Center 95 South Pagosa Blvd.

Pagosa Springs, CO 81147

The Board of Directors of the Upper San Juan Health Service District held their regular board meeting on November 17, 2015, at Pagosa Springs Medical Center, The Great Room, 95 South Pagosa Blvd., Pagosa Springs, Colorado. Board members present were Chair Dr. Malcolm Rodger, Vice Chair Mark Floyd, Treasurer Karl Irons, Greg Schulte, Kate Alfred, Dr. Richard Zak. Call to Order: Ministerial Matters of the Board Chair Dr. Malcolm Rodger called the meeting to order at 5:30 pm and noted a quorum was established.

2016 Budget Public Hearing

Dr. Rodger opened the public hearing. There was no public comment. Dennis Wilson explained the purpose of the meeting. Dr. Rodger closed the public hearing. Public Comments Dr. Rodger asked for public comment. There was none. Reports Chief of Medical Staff Dr. Shaeffer presented the attached report and recommended approval. Chief Medical Officer Dr. Rhonda Webb presented her attached report and described provider retention issues. Dr. Webb and Kyle Kellum went to Mercy to improve communication, discussed a Quality Control Committee. Dr. Webb presented the attached Quality report. Karl Irons made some suggestions regarding the report.

COO Report Kyle Kellum presented the attached report highlighting communication with outside entities, the IT assessment being returned, pharmacy manager starting, using 2 travelling techs for the lab, Breast Cancer awareness outreach success, the LEAN project and LEAN Team here on Friday, a behavioral health professional starting mid January. A discussion was held regarding behavioral health and Axis. We have received 457 patient records back, 425 have been called. CAO Report Chief Administrative Officer, Ann Bruzzese, presented her attached report highlighting the Foundation and Development status, financing issues and contract issues, performance evaluations, managing to goals. Mark Floyd commented on measurement of 1d, and 3c is not aggressive enough. Strategic Planning Mark Floyd reported that the Strategic Planning Committee did not meet. Campus Planning Mark Floyd reported that the Campus Planning committee focused on financing related to the new building. Contracts Kate Alfred reported that the contracts committee met earlier today and were all accepted and within the norms. CEO Report Brad Cochennet presented the attached report. Mr. Cochennet highlighted the surgery director, clinic recruiting, ED recruiting, year end appeal, Jack and Katy Threet Art viewing, Fundraising Fridays, Community meet and greet at the Pagosa Brewing company, Caring for Colorado grant, Telluride leadership visit, Economic Forum, the Fire District Board meeting. Finance Report Karl Irons presented the attached report, highlighting revenue, clinic, operating expenses, 9th consecutive month of positive bottom line, accounts receivable at an all time high, good collections month, days in A/R back up to 72, cash balance under 4 million. Karl reminded the board that November is generally the worst month. A discussion was held regarding ICD 10 and staffing. Mr. Irons described the records, the term sheets for the loan for the building, the DOLA grant, the 2016 budget, and forecasts. The finance committee recommended that we go forward with the building project and handle the risk that goes with it. A lengthy discussion was held regarding the Clinic Expansion project. Consent Agenda Mark Floyd highlighted an error on 2nd page of the minutes in then moved to accept the minutes as corrected. Kate Alfred seconded. Dr. Zak moved to accept the credentialing, Kate Alfred seconded. Both motions passed unanimously.

Decision Agenda Mark Floyd moved to accept Resolution 2015-7. Dr. Zak seconded. A discussion was held regarding this. The motion passed unanimously. Brad Cochennet commented that he appreciated this stand from the board, and thanked the board for the support. Dr. Rodger responded that he is proud and grateful and thanked the board and staff. Executive Session There was none. Adjourn Dr. Rodger adjourned the meeting at 6:54 pm. Respectfully Submitted, Jodi Scarpa, serving as Clerk for the Board

MINUTES OF SPECIAL BOARD MEETING

Friday, December 11, 2015 12:00 PM Noon


Pagosa Springs, CO 81147

The Board of Directors of the Upper San Juan Health Service District held their regular board meeting on November 17, 2015, at Pagosa Springs Medical Center, The Great Room, 95 South Pagosa Blvd., Pagosa Springs, Colorado. Board members present were Chair Dr. Malcolm Rodger, Vice Chair Mark Floyd, Treasurer Karl Irons, and Greg Schulte.. Call to Order: Ministerial Matters of the Board Chair Dr. Malcolm Rodger called the meeting to order at 12:03 pm and noted a quorum was established.

Public Hearing

Dr. Rodger opened the public hearing. There was no public comment. Dennis Wilson explained the purpose of the meeting. Dr. Rodger closed the public hearing. Public Comments There were none. Reports There were none. Consent Agenda There was none. Decision Agenda

Karl Irons moved to accept Resolution 2015-8. Mark Floyd seconded the motion and the motion passed unanimously. Mark Floyd moved to accept the resolutions 2015-9 and 2015-10 and 2015-11. Greg Schulte seconded. A discussion was held regarding 2015-10 and 2015-11. Ann Bruzzese presented amended Resolutions 2015-10 and 2015-11. Mark Floyd moved to accept Resolution 2015-09, and Resolutions 2015-10 and 2015-11 as amended. Greg Schulte seconded. The motion passed unanimously. Dennis Wilson explained that the only change that has been made related to pledges based on the business plan. Executive Session There was none. Adjourn Dr. Rodger adjourned the meeting at 12:15 pm. Respectfully Submitted, Jodi Scarpa, serving as Clerk for the Board

MINUTES OF REGULAR BOARD MEETING

Tuesday, December 15, 2015 5:30 PM


Pagosa Springs, CO 81147 The Board of Directors of the Upper San Juan Health Service District held their regular board meeting on December 15, 2015, at Pagosa Springs Medical Center, The Great Room, 95 South Pagosa Blvd., Pagosa Springs, Colorado. Board members present were Vice Chair Mark Floyd and Treasurer Karl Irons in person, Kate Alfred and Jerry Baker via telephone. Call to Order: Ministerial Matters of the Board Vice Chair Mark Floyd called the meeting to order at 5:32 pm and noted a quorum was established.

Public Comments Mark Floyd asked for public comment. There was none. Reports Chief of Medical Staff Dr. Shaeffer presented the attached report via telephone and recommended approval with the addition of Dr Dziad requesting a change from courtesy to active status. Mark Floyd read the attached letter thanking and commending Dr. Shaeffer for his service as Chief of Staff. Consent Agenda Jerry Baker moved to accept the attached Medical Staff report as amended. Kate Alfred seconded and the motion passed unanimously. Decision Agenda Mark Floyd introduced the attached Amendment to Resolution 2015-11. Karl Irons moved to approve. Kate Alfred seconded and the motion passed unanimously. Executive Session There was none.

Adjourn Mark Floyd adjourned the meeting at 5:40 pm. Respectfully Submitted, Jodi Scarpa, serving as Clerk for the Board

UPPERSANJUANHEALTHSERVICESDISTRICTD/B/APAGOSASPRINGSMEDICALCENTER

FormalWrittenResolution2016-1

January26,2016

RESOLUTION REGARDING POSTING FOR MEETINGS and NOTICE OF REGULAR BOARD MEETING SCHEDULE FOR 2016

WHEREAS, Special Districts are required by Colorado Revised Statutes Section 24-6-402(2) to designate annually at the District Board’s first regular meeting of each calendar year, the place at which meeting notices will be posted at least 24 hours prior to each meeting; and

WHEREAS, Special Districts are required by Colorado Revised Statutes Section 32-1-903(2) to notice annually at the District Board’s first regular meeting of each calendar year, the 2016 schedule (location, time and dates) for the regular meetings of the USJHSD Board of Directors. NOW, THEREFORE, THE BOARD OF DIRECTORS OF THE UPPER SAN JUAN HEALTH SERVICE DISTRICT HEREBY RESOLVES AS FOLLOWS:

1. Notices of regular or special meetings required to be posted at three public places within the District and the office of the County Clerk and Recorder prior to said meeting shall continue to be posted at the locations listed below: Sisson Library/Pagosa Spring Public Library 811 San Juan Street Pagosa Springs, CO 81147 Archuleta County Clerk and Recorder’s Bulletin Board 398 Lewis Street Pagosa Springs, CO 81147 Pagosa Springs Chamber of Commerce 402 San Juan Drive Pagosa Springs, CO 81147

2. For 2016, the USJHSD Board of Directors shall meet at 5:30 p.m. mst on the

FOURTH TUESDAY of each month except in the months of November and December where the meeting is held on the third Tuesday of the month as noted below at Pagosa Springs Medical Center’s main meeting room located at 95 S. Pagosa Boulevard, Pagosa Springs.

SCHEDULE OF REGULAR MEETING DATES: January 26, 2016 July 26, 2016 February 23, 2016 August 23, 2016 March 22, 2016 September 27, 2016 April 26, 2016 October 25, 2016 May 24, 2016 November 15, 2016 (3rd Tuesday) June 28, 2016 December 13, 2016 (3rd Tuesday) Questions concerning meetings should be directed to the Clerk of the Board (Jodi Scarpa) at 95 S. Pagosa Blvd., Pagosa Springs, CO, telephone number 970-731-3700.

ADOPTEDandAPPROVEDbytheBoardofDirectorsoftheUpperSanJuanHealthServiceDistrictonthis26thdayofJanuary,2016.____________________________Dr.MalcolmRodger,asChairmanoftheBoard

Page 1 of 2

UPPER SAN JUAN HEALTH SERVICES DISTRICT

D/B/A PAGOSA SPRINGS MEDICAL CENTER

Formal Written Resolution 2016-2 January 26, 2016

APPOINTING A DESIGNATED ELECTION OFFICIAL AND AUTHORIZING DESIGNATED ELECTION OFFICIAL

TO CANCEL ELECTION

(C.R.S. Section 32-1-804(2), 1-1-111(2), 1-5-208(1.5), 1-11-103(3))

WHEREAS, pursuant to C.R.S. Section 32-1-804(2), the Board of Directors of the

Upper San Juan Health Services District, Archuleta, Hinsdale and Mineral Counties, Colorado is

authorized to designate a Designated Election Official to exercise the authority of the Board in

conducting the election; and

WHEREAS, pursuant to C.R.S. Section 1-5-208, the Board can authorize the Designated

Election Official to cancel the election upon certain conditions.

NOW, THEREORE, be it resolved by the Board of Directors of the Upper San Juan

Health Service District, Archuleta, Hinsdale, and Mineral Counties, Colorado that:

1. The Board hereby names Jodi Scarpa as the Designated Election Official (“DEO” for the regular special district election scheduled for the 3rd day of May, 2016;

2. The Board affirms the Designated Election Official will fulfill the standard duties described in Colorado laws including, without limitation, publishing a call for nominations.

3. If the only matter before the electors is the election of persons to office and if at the close of business on March 1, 2016 (the 63rd day before the election) there are not more candidates than offices to be filled, including candidates filing affidavits of intent to run as write-in candidates, then, and only then, the Board hereby authorizes and directs the Designated Election Official to take the following actions:

a. to cancel said election and declare the candidates elected; b. to publish and post a Notice of Cancellation of Election at each polling place and

in the offices of the Designated Election Official, the County Clerk and Recorder

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of each county in which the district is located, and file with the Division of Local Government; and

c. to notify the candidates that the election was cancelled and they are elected by acclamation.

4. Once the Designated Election Official has cancelled the election, the Board will formally cancel the election by resolution, pursuant to C.R.S. Section 1-11-103(3), and file said resolution with the Division of Local Government.

ADOPTED and APPROVED by the Board of Directors of the Upper San Juan Health Service District on this 26th day of January, 2016. ____________________________ Dr. Malcolm Rodger, as Chairman of the Board

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UPPER SAN JUAN HEALTH SERVICES DISTRICT D/B/A PAGOSA SPRINGS MEDICAL CENTER

Formal Written Resolution 2016-3

January 26, 2016

THE REGULAR DISTRICT ELECTION FOR MAY 2016

(C.R.S. Sections 32-1-804 and 1-1-111)

WHEREAS, in accordance with the Special District Act (“Act”) and the Uniform Election Code of 1992 (“Code”), the Upper San Juan Health Services District, Archuleta, Hinsdale and Mineral Counties, Colorado will hold a regular special district election on May 3, 2016 (“Election”) for the purpose of the election of certain Board members; and WHEREAS, the following Board seats will be on the ballot and elected at the Election:

A. The seat currently held by Dr. Malcolm Rodger: 4 year term; B. The seat currently held by Karl Irons: 4 year term; and C. The seat currently held by Kate Alfred: 4 year term.

WHEREAS, the terms of office of Directors named above shall expire after their successors are elected at the Election and the successors will take office;

NOW, THEREORE, be it resolved by the Board of Directors of the Upper San Juan Health Service District, Archuleta, Hinsdale, and Mineral Counties, Colorado that:

1. Pursuant to and in accordance with the Act, Code, and other applicable laws, the regular election of the eligible electors of the District shall be held on May 3, 2016 between the hours of 7:00 A.M. and 7:00 P.M.. At the time, three Directors will be elected to serve a four-year term.

2. USJHSD will hold either a polling place election or a mail-in ballot election, as will be subsequently determined by USJHSD subject to compliance with all applicable laws then in effect. Such election will be held by USJHSD and does not have to be a coordinated election with the counties where the district is located.

3. The Board of Directors have designated Jodi Scarpa as the Designated Election Official

of the District (the “DEO”), and the DEO is hereby authorized and directed to proceed with any action necessary or appropriate to effectuate the provisions of this Resolution and the Act, Code, TABOR or other applicable laws. The Election shall be conducted in accordance with the Act, Code, TABOR and other applicable laws. Among other matters, the DEO shall publish the call for nominations, appoint election judges as

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necessary, appoint the Canvass Board, arrange for the required notices of election, including the TABOR notice, and printing of ballots, and direct that all other appropriate actions be accomplished.

4. If applicable and if other special districts with overlapping boundaries of the District are conducting ballot issue elections on the Election Day, the District acknowledges that is required to enter into an intergovernmental agreement with such special districts concerning the preparation and mailing of the TABOR Notice to the registered electors within the overlapping area. The Designated Election Official is authorized, following consultation with legal counsel for the District, to enter into such agreement on behalf of the District.

5. Applications for mail-in ballots may be filed with the Designated Election Official at 95 S. Pagosa Blvd., Pagosa Springs, CO 81147, no later than 5:00 p.m. mountain standard time on Friday, April 29, 2016.

6. Self-Nomination and Acceptance forms are available at the Designated Election Official’s office located at 95 S. Pagosa Blvd., Pagosa Springs, CO 81147. All candidates must file a Self-Nomination and Acceptance form with the Designated Election Official no later than the close of business (time: 3:00 p.m.) on Friday, February 26, 2016.

7. If the only matter before the electors is the election of Directors of the District and if, at the close of business on March 1, 2016, there are not more candidates than offices to be filled at the Election, including candidates timely filing affidavits of intent no later than February 29, 2016, the Designated Election Official shall cancel the Election and declare the candidates elected. Notice of such cancellation shall be published and posted in accordance with the Code.

8. Pursuant to Section 1-11-203.5, C.R.S., any election contest arising out of a ballot issue or ballot question election concerning the order of the ballot or the form or content of the ballot title shall be commenced by petition filed with the proper court within five (5) days after the title of the ballot issue or ballot question is set.

9. If any part or provision of this Resolution is adjudged to be unenforceable or invalid, such judgment shall not affect, impair or invalidate the remaining provisions of this Resolution, it being the Board’s intention that the various provisions hereof are severable.

10. Any and all actions previously taken by the Designated Election Official or the Secretary of the Board of Directors or any other persons acting on their behalf pursuant to the Act, the Code or other applicable laws, are hereby ratified and confirmed.

11. All acts, orders, and resolutions, or parts thereof, of the Board which are inconsistent or in conflict with this Resolution are hereby repealed to the extent only of such inconsistency or conflict.

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12. The provisions of this Resolution shall take effect immediately.

ADOPTED and APPROVED by the Board of Directors of the Upper San Juan Health Service District on this 26th day of January, 2016. ____________________________ Dr. Malcolm Rodger, as Chairman of the Board

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UPPER SAN JUAN HEALTH SERVICES DISTRICT D/B/A PAGOSA SPRINGS MEDICAL CENTER

Formal Written Resolution 2016-4

January 26, 2016

RESOLUTION ESTABLISHING AND CONFIRMING A HEALTH CARE SERVICES ENTERPRISE

WHEREAS, Upper San Juan Health Service District (the “District”) is a special district created pursuant to Article 1, Title 32, C.R.S. (the “Act”), and is authorized to establish, maintain, or operate, directly or indirectly through lease to or from other parties or other arrangement, public hospitals, convalescent centers, nursing care facilities, intermediate care facilities, emergency facilities, community clinics, or other facilities providing health and personal care services, including but not limited to facilities licensed or certified pursuant to section 25-1.5-103 (1)(a), C.R.S., within and without the District (the “Health Care Services”) with the power to issue its own revenue bonds; and

WHEREAS, District has historically conducted and operated such Health Care Services as a government-owned business of the District providing services in exchange for the payment of fees and charges; and the Board of Directors of the District now desires to establish and confirm a Health Care Services Enterprise in order to exclude the Health Care Services Enterprise from the provisions of Article X, Section 20 of the State Constitution (“TABOR”); and

WHEREAS, in addition to any other authority or procedure provided by law, District desires to establish and confirm its Health Care Services Enterprise (the “Enterprise” or “Health Care Services Enterprise”), which shall be operated and maintained as an “enterprise” (as defined by TABOR) and which shall be separate and distinct from the governmental activities of the District (which are subject to TABOR); and

WHEREAS, the adoption of this Resolution and the establishment, operation, and continuation of the Health Care Services Enterprise of the District in conformance with TABOR will serve a public use and will promote the health, safety, prosperity, security, and general welfare of the customers of the Enterprise and the residents, taxpayers and visitors of the District and of the people of the State of Colorado.

NOW, THEREFORE, BE IT RESOLVED by the Board of Directors of the District that there is hereby established and confirmed a Health Care Services Enterprise

Upper San Juan Health Service District Resolution Establishing and Confirming a Health Care Services Enterprise January 26, 2016 Page 2 of 4

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to be operated and maintained as a government-owned business, so as to exclude its activities from the application of TABOR, in accordance with the following terms:

1. Health Care Services Enterprise Activities and Facilities. The Health Care Services Enterprise shall manage, operate, use, maintain, and conduct all Health Care Services, and facilities of the District, including the Pagosa Springs Medical Center and the Emergency Medical Services (“EMS”). The Health Care Services Enterprise is authorized to use, operate, improve, extend, enlarge, repair, replace, acquire, dispose of, encumber, contract with respect to, and otherwise control and supervise all facilities and property of the District related to Health Care Services. The Health Care Services Enterprise itself shall be wholly owned by the District. All facilities, property, and assets which are utilized by the Health Care Services Enterprise or form part of the Health Care Services Enterprise shall be the property of the District and upon termination of the Health Care Services Enterprise, shall be returned to the District.

2. Multiple Enterprises. All Health Care Services shall be conducted as a single Health Care Services Enterprise. The Board of Directors may, from time to time, establish other Health Care Services Enterprises, or designate any single health care facility or health care service as one or more separate Enterprises.

3. Governing Board. The Board of Directors of the District shall be the Governing Board of the Health Care Services Enterprise (the “Governing Board”). The Governing Board shall conduct the business of the Health Care Services Enterprise in the same manner and follow the same procedures as the Board of Directors of the District. All public business of the Health Care Services Enterprise shall be conducted only during regular or special meetings of the Board of Directors at which a quorum is present. The record of proceedings of the Governing Board may be incorporated into the minutes of the Board of Directors of the District. No additional oaths, bonds, or other qualifications shall be required of the Governing Board. All actions of the Governing Board shall be considered as the actions and business of the Health Care Services Enterprise undertaken by the Board of Directors acting as the Governing Board of the Health Care Services Enterprise. All business of the Health Care Services Enterprise and actions of the Governing Board shall be governed by and made subject to all requirements, privileges, immunities, protections, limitations, and other provisions of law.

4. Powers. The Governing Board of the Health Care Services Enterprise may, without limitation, exercise the District’s legal authority relating to Health Care Services or otherwise available to any enterprise, except as expressly provided herein. Such authority shall include all powers set forth in the Act which are consistent with the authorities of an enterprise under the provisions of TABOR and are necessary to operate the Health Care Services Enterprise, including, but not limited to, the power to issue or


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reissue bonds, notes, or other obligations payable from revenues derived or to be derived from the provision of services and to set rates, fees and charges for services provided by the Health Care Services Enterprise. The powers and authorities specifically conferred herein shall not modify, limit, or restrict the powers conferred by any other law directly or indirectly affecting the Health Care Services of the Health Care Services Enterprise, except as expressly provided herein. The Health Care Services Enterprise shall have no power which adversely affects the status of the Health Care Services Enterprise for purposes of the application of TABOR.

5. Taxes. In no event shall the Health Care Services Enterprise have the power to levy or assess any tax which is subject to TABOR or to direct the District to exercise its taxing powers on behalf of the Health Care Services Enterprise.

6. Grants. The Health Care Services Enterprise shall not accept or receive any revenue in “grants” (within the meaning of TABOR) from the District, State or any local governments, unless expressly authorized by the Board of Directors of the District. The purpose of this provision is to prevent without the District’s knowledge and consent, any violation of the rules of TABOR applicable to enterprises.

7. Contracts. All contracts relating to Health Care Services shall be approved by the Governing Board and executed by District officers with the District as the contracting party. Any pre-existing contract relating to Health Care Services shall be considered as having been approved by the Governing Board. All contracts relating to Health Care Services shall be implemented and discharged by the Health Care Services Enterprise, unless otherwise provided by the Board of Directors.

8. Revenue. All revenue derived from the provision of Health Care Services provided by the Health Care Services Enterprise, and all other income of the Health Care Services Enterprise shall be collected, used, and expended for Health Care Service purposes as determined by the Governing Board in accordance with applicable law. No revenue or spending of the Health Care Services Enterprise shall be subject to TABOR.

9. Enterprise Fund. One or more Health Care Services Enterprise Funds may be established to separately account for all revenue and expenditures of the Health Care Services Enterprise. The Health Care Services Enterprise may prepare an annual budget and perform an annual audit which may be included in the budget or audit of the District. All budgets, reports, audits, and financial operations of the Health Care Services Enterprise shall conform to and be prepared in accordance with generally accepted accounting principles applicable to governmental (enterprise) units and other requirements of State law.


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10. Miscellaneous. Nothing set forth in this Resolution shall be construed to limit the authority of the Governing Board or the Health Care Services Enterprise to utilize other policies or procedures for operating or continuing the Health Care Services Enterprise in conformance with TABOR, except as otherwise expressly provided herein. It is the intent of the Board of Directors to establish and confirm the Health Care Services Enterprise in conformance with the provisions of TABOR according to the most reasonable interpretations thereof.

11. Severability. If any part, section, subsection, sentence, clause or phrase of this Resolution is for any reason held to be invalid, such invalidity shall not affect the validity of the remaining provisions.

12. Effective Date. This Resolution shall take effect and be enforced immediately upon its approval by the District Board. The application and effect of this Resolution with respect to the Health Care Services Enterprise shall be both prospective and retrospective unless otherwise determined by the Board of Directors. This Resolution shall remain in effect, whether or not the Health Care Services Enterprise currently qualifies as an enterprise pursuant to TABOR, until modified or repealed by the Board of Directors.

ADOPTED and APPROVED by the Board of Directors of the Upper San Juan Health Service District on this 26th day of January, 2016. ____________________________ Dr. Malcolm Rodger, as Chairman of the Board Attest: Secretary



January26,2016

RESOLUTION REGARDING APPROVAL OF THE 2016 GOALS

WHEREAS, on January 26, 2016, management presented to the Board proposed 2016 goals and requests approval of the same. NOW, THEREFORE, THE BOARD OF DIRECTORS OF THE UPPER SAN JUAN HEALTH SERVICE DISTRICT HEREBY RESOLVES AS FOLLOWS: 1. The 2016 facility-wide goals (as attached) are hereby approved.




January26,2016

RESOLUTION TO APPROVE PHONE/IT CONTRACT

WHEREAS, management requests to proceed with execution of a 60-month contract for telephone equipment and IT Services (“Phone/IT Contract”) and the total cost of the contract requires the Board’s approval; and

WHEREAS, on January 26, 2016, the Board has received (a) the COO’s report regarding the Phone/IT Contract, and (b) the recommendation of the Finance Committee to proceed with the Phone/IT Contract. NOW, THEREFORE, THE BOARD OF DIRECTORS OF THE UPPER SAN JUAN HEALTH SERVICE DISTRICT HEREBY RESOLVES AS FOLLOWS: Management is authorized to proceed with execution of a Master Services Agreement (and documents contemplated therein) with Synoptek for the equipment, services and costs consistent with the COO’s written report to the Board in the January 26, 2016 Board packet.
