PARKLAND HEALTH & HOSPITAL SYSTEM - Dallas-Fort Worth News, Sports

DALLAS COUNTY HOSPITAL DISTRICT AND

PARKLAND COMMUNITY HEALTH PLAN

MEETINGS SCHEDULE

Tuesday, June 22, 2010

All meetings will be held in the Administrative Conference Room, First Floor of Parkland Memorial Hospital, (5201 Harry Hines Blvd. Dallas, Texas 75235) unless otherwise noted, and the Board or any Committee may recess for short periods at any time.

Meeting Time

1. PCHP, Inc. 8:00 a.m.

2. Quality and Risk Management 9:00 a.m. (or immediately following

PCHP, Inc.) 3. Budget and Finance 10:00 a.m.

(or immediately following Quality and Risk

Management) 4. Audit and Compliance

11:30 a.m.

(or immediately following Budget and Finance)

5. Board Executive Session (working lunch) 11:45 a.m. (or immediately followin g

Audit and Compliance)

6. Board of Managers p.m. (or immediately following

Executive Session )

Quality and Risk Management Committee Members

Dalton Lott – Chair Lauren McDonald, M.D.

Chad Park, DDS Agenda for the meeting of the Quality and Risk Management Committee of the Board of Managers of Parkland Health & Hospital System scheduled for Tuesday, June 22, 2010, at 9:00 a.m. or (immediately following Quality and Risk Management Committee Meeting) in the Administrative Conference Room, Parkland Memorial Hospital. The Quality and Risk Management Committee may take action on any item listed below. The Quality and Risk Management Committee and the Board of Managers reserve the right to exercise discretion and may convene in Executive Session as permitted by sections 551.071, et seq., of the Texas Government Code, and as otherwise authorized by law, on any item listed on the Committee agenda or the general Board of Managers’ agenda. Executive Sessions (if any) will be held at the time scheduled on the Meeting Schedule and not at the time scheduled for the Quality and Risk Management Committee. Time/Presenter I. Attendance/Call to Order Chair II. Information/Discussion Items A. Infant Warming 15 min. Paula Turicchi

Kurt Dierking B. Utilization Management 20 min. Stan Pomarantz, MD C. PHHS HIV Services 25 min. Josh Floren III. Action Items A. Any item listed under Section II IV. Adjourn

Follow-up Presentation on Preterm Infant Temperature for C-Section Deliveries (Nursery Services)

Presentation to the Medical Advisory Committee and the Board of ManagersJune 2010

Paula Turicchi, Sr. Vice President, Women & Infants Specialty Health

Kurt Dierking, Vice President, Facilities Development

What is the problem?

Parkland Hospital ranked low on recent study conducted on birth temperatures for infants. Body temperature is a significant factor in the success of infant resuscitation.Parkland C-Section OR Temperatures fall below WHO Recommendations for pre-term infants, but meet Texas Administrative Code

Room Temp WHO (76 or more)TAC (68-73)

Rm 2EE 71.3 Temp is Below RecGood



Rm 1E 72 Temp is Below RecGood

Rm 3E 71.6 Temp is Below RecGood

Rm 4E 71.5 Temp is Below RecGood

Rm 1A 72 Temp is Below RecGood

Rm 2A 72 Temp is Below RecGood

Parkland OR Performance

What newborn temperature data confirms this problem?

≥98.6 F

96.8-98.4 F

<96.8 F

<95.0 F

In the premature population,

hypothermia at birth is associated with increased risks for sepsis and death.

Therefore we would like to prevent it!

We have room for improvement.

Parkland Experience 56% too cold!

PMH

DATA From other area hospitals

WHO Recommendations vs. TAC Requirements

Suggested delivery room temperatures by age and birthweight*

* Table provided by WHO

WHO Recommended Delivery Room

Temperatures for Preterm deliveries are conflicting

with State (Texas Administrative Code)

Temperature Requirements for C-

Section Rooms

EGA and/or EBW Delivery room temperature

<26 EGA and/or 750 g EBW 76 °F or more; target: 78–80 °F

27–28 EGA and/or 1000 g EBW 74 °F or more; target: 78–80 °F

29–32 EGA and/or 1001–1500 g EBW 72 °F or more

33–36 EGA and/or 1501–2500 g EBW 72 °F or more

37–42 EGA or 2501 g EBW 70 °F or more

Figure: 25 TAC §133.169(c) TABLE 3VENTILATION REQUIREMENTS FOR HOSPITALS AND OUTPATIENT

FACILITIES1

NOTES:17 Some surgeons may require room temperatures that are outside of the indicated range. All operating room design conditions shall be developed in consultation with surgeons, anesthesiologists, infection control and nursing staff.

Area Designation Relative Humidity (%) Design Temperature (oF)

Operating Rooms 30%-60% 68-73 degrees F (17)

To raise the room temperature

would require special approval from DSHS, but

based on note 17, it may be allowed

Current Best Practices

We must utilize various techniques to keep the preterm baby warm in the delivery room.

Type of Heat Loss

Potential causes Possible interventions Current Best Practices

EvaporativeLoss

Wet skin or blankets; low humidity in ambient and/or inspired air

Rapid drying, plastic wrap or bag, increased humidity of ambient and inspired air

Plastic Bags - Polyethylene Occlusive wrapping

High Humidity

RadiantLoss

Large areas of exposed skin to cooler surroundings

Covering skin, warming surrounding structures

Infant HatsWarm BlanketsInfant Warmers

ConductiveLoss

Contact with low temp bedding materials

Pre-warming resuscitation surface and blankets

Blanket WarmersGel Mattress

ConvectiveLoss

Flow of low temp air across baby's skin or mucous membranes

Increased temperature of delivery and resuscitation room, reduction of drafts due to inappropriately placed air vents, covering baby's skin with blanket or plastic wrap, transfer to pre-warmed incubator as soon as feasible, warm inspired air

Blanket Warmers

http://images.dotmed.com/images/listingpics/410313.jpg

Recommended Improvements to Best Practices for Temperature Stabilization

• What are the proposed solutions for improving on the preterm infant temperature @ birth:

Upgrade the HVAC within the rooms to add peripheral heating zones along the room perimeter.Significant capital associated with this upgrade. Not recommended

Use of specialized medical equipment – Bair Paws Flex Gown & PerfectTemp CushionsRecommend testing these products to ensure compatibility

Use of specialized medical equipment – Bair HuggerSystem is not ideal because the infants are wet

Panda Warmer - Upgrade of existing infant warmers to incorporate weighing procedure to reduce the time the infant is out of warmer.Recommend making this upgrade.

http://images.dotmed.com/images/listingpics/410313.jpg

Bair Paws Flex Gown &LMA Perfect Temp Cushion

LMA PerfecTempTrial Capital Cost $25,000Long Term Capital Cost of $150k

Bair PawsNo Capital Costs Increased operating Costs of $30k / year

Proposed Roll-out – Trial use for a combination of both systems to occur for one year. Then

evaluate and propose long term solution

Both are recommended solutions . One independent study utilzing similar maternal warming protocol resulted in 1.6 Degree

Fahrenheit increase in infant temp at birth.

Upgrade Existing Infant Warmers w/ Integral Scale System

This upgrade is a recommended for all delivery rooms. This upgrade has already been established as a best practice for the NNICU environment. The benefit to having the in-bed scale is to keep the infant warm by not having to remove them from the warmer to obtain weight. Upgrade Cost $380k

Bair Hugger® TherapyUnderbody Series Blankets

This upgrade is not recommendedbecause of the evaporative heat loss

from amniotic fluids.

Existing C-Section OR LayoutPeripheral Zone Upgrades

elevators

West C-Section Rooms OR’s #1-4 (Bldg E)

East C-Section OR’s #1&2 (Bldg A)

# 4

# 3

# 2 # 3

# 5

# 1

# 2

# 1# 1

# 4

# 2

These rooms are controlled by one zone control for all rooms.

Peripheral Zone Upgrades and AHU Replacement for this area would be

$1.7MM

These rooms are controlled by one single zone control per room.


$1.2MM

These rooms are controlled by one zone control for both rooms.


$900k

West C-Section OR’s #1-5 (Bldg EE)

Major Project Risksa. Infection Controlb. Major disruptionsc. OR Downtime d. Phasing complexitye. Schedule riskf. Patient safety

Total Project Cost $3.8MMProject Schedule 12 months

Zone Control Within C-Section OR’s

Zone 1

Zone

2

Zone

2

ZONE CONTROLThe ideal C-Section ORenvironment would providea cold zone near the patientto provide the best defenseagainst infection and a hotzone which wouldcontribute to improvedinfant temperatures.

RETURN AIR GRILL NEAR THE FLOOR

TYPICAL LAMINAR AIR DIFFUSER LAYOUT ABOVE PROCEDURE TABLE

SUPPLY DIFFUSER INDEPENDENT ZONE CONTROL W/ REHEAT

Equipment Costs

Perfect Temp $150,000Bair Paws (Equip) $0Bair Paws (Supplies) (4-Year: excludes one year trial)

$120,000

Panda Warmer Upgrade

$380,000

Trial Costs (Perfect Temp)

$25,000

Trial Costs (Bair Paws)

$30,000

TOTAL $705,000

HVAC Costs

Peripheral Upgrade

$1,650,000

AHU Replacement $2,150,000TOTAL $3,800,000

vs

Cost of Medical Equipment Based Solution Versus HVAC Based Solution Over Five Years

Recommendations from Facilities Development &

Nursery Services

Recommendations1. Continue to Follow Current Best Practices2. Product evaluations for Bair Paws &

PerfecTemp Cushions. (Capital Request & operating costs to follow in 2011)

3. Introduce in-bed scale option to replace or upgrade current infant warmers. (Capital Request)

4. New Parkland Hospital – Consider an upgrade to the HVAC system within the new OR Suite.

Nursery Services

Questions?

Thank you for the opportunity to present this follow-up information regarding Nursery Services.

Utilization ManagementProgress and Promise

Board of ManagersStan Pomarantz, MD

June 22, 2010

UM Vision

To see PHHS as the recognized leader both locally and nationally for delivering efficient care to an underprivileged population.

UM Goals FY 2010

• Establish consistent, high quality, timely case review functions for the Case Management Department.

• Recognize and remedy inaccurate data within Epic that would adversely affect UM analysis.

• Implement Milliman and Allscripts software to improve the efficiency of the CM Department.

• Establish the PMH Utilization Management Committee in conjunction with the CM Department.

FY 2010: Case Management

• October 7 – took over 100% of case reviews from three Clinical Chiefs

o Converted from hybrid to 100% electronic processo Documented all responses in Interqual or Millimano From March –May 2010, 61% of cases done same day,

30% done in one day and 9% in 2 or more days• Worked with Care Management Staff and IT on implementation

of Milliman Care Guidelines and Allscripts case management software

• Created tracking tool for physician case reviews• Established position of Physician Advisors and recruited and

trained these physicians• Support high dollar case reviews with CM Department two days

a week, and OB Ante Partum case reviews once a week

FY 2010: Utilization Management

• Developed model for Inpatient Daily Census and correct attending physician attribution

• Studied frequent readmitters to hospital and main ED• Supported rollout of ED Observation Unit (2SS)• Reviewed Medicaid audit process/results quarterly and shared

data with relevant departments• Educated Faculty, Program Directors, and House Staff on

Milliman Care Guidelines prior to November 30

System Goals

System Goals supported by Utilization Management

• Chronic disease pathway development for Diabetes, CHF, and selected Behavioral Health Diseases

• Correct provider attribution with focus on inpatient care setting

• 25% reduction in 30 day readmission rates – HF, AMI, CAP

Back to BasicsAddress BacklogsAddress Unnecessary Hospital DaysSupport CM DepartmentSupport Clinical Guideline Development

Back to Basics

Admissions Without an Admission Order• BOM policy of “Zero Tolerance”• Implemented Best Practice Alert; produced daily report; continuous

attention by unit managers, division leaders, and CMs• Noted marked improvement• Still having weekly casesInpatient Daily Census• We have created a model Inpatient Daily Census (IDC) which can be

used by hospital departments, especially CM Dept and PFS, to perform business functions

• This census will provide the correct attending physician attribution• Will put this census into production in FY 2011

Back to Basics (cont.)

Wrong Admission Status – Inpatient; Outpatient Observation; Short Stay• CM Department and Chief of UM spending considerable time

“correcting” wrong designation (for Medicare condition code 44)• Planning educational program to coincide with new residents start

July 1. Working with CM Department to establish a feed back loop to individual residents and attending with monthly reports to Service Chiefs

• Will work with Dr. Treichler to start more cases from ED as observation

Backlogs

Backlogs in scheduling a number of procedures have been uncovered. A process will be established to evaluate to causes of these backlogs, and recommend action plans

Examples:

1. Laparoscopic cholecystectomy2. Lipoma resection3. Screenings:

• Diabetic Eye Exams – Optometric Services• Diabetic Foot Exams – Podiatry Services• Colonoscopies – Colon Cancer Screenings

4. Dental Services

Excessive Hospital Days

Unnecessary Hospital Days have been uncovered in a number of situations. An evaluation process for each situation with recommendations for action will be developed.

Examples:

1. Cardiac Stress Tests on Weekends2. Long term, inpatient wound care for unfunded patients3. Uncommon diseases with profound impact (e.g. small bowel syndrome)4. Ante Partum OB Care – lower cost facility

Collaboration with CM Dept.

• Strengthen relationship by establishing Chief UM as the Medical Director of CM Department

• As Medical Director, establish ongoing educational program to strengthen and enhance clinical review skills of CMs

• Work with CM leadership to establish policies and procedures to streamline review processes when referring cases to medical director

• Round regularly with CMs• Continue to enhance skills of Physician Advisors• Collaborate with CM leadership to strengthen physician

activities related to discharge planning

Clinical Guideline Development

• Collaborate with clinical departments to develop pathways for the management of

DiabetesHeart FailureBehavioral Health Issues

• Collaborate with Primary and Specialty Care Departments, IT, and with other areas of the Quality of Care Management Department in the development of clinical guidelines for a number of conditions chosen by the clinical departments

Metrics

Category Metric GoalBacklogs Identify all significant

backlogs and two areas of unneeded excessive days

Reduce two backlogs by 50% the first year

Back to BasicsAdmission without orders

Number of cases that leave the hospital without an admission

Goal is zero

Wrong Admission Status

Daily – when patient leaves hospitalDaily – initial designation

1. One/month2. Five/week

Unnecessary Hospital Days

Avoidable Days TBD

Utilization Management

PHHS Utilization ManagementIs at the intersection of strong business principles and efficient, evidence based clinical practice delivered to a patient population with challenges not experienced by most other patients.

HIV Services

Parkland Board of Managers PresentationJune 2010

-3 year overview of HIV services- Pharmaceutical Cost Review

- Routine Testing Program- Patient Satisfaction

Total Clients 5,514

Total Clients 5,629

Total Clients 5,670

New Clients 563

New Clients 603

New Clients 652

0 1,000 2,000 3,000 4,000 5,000 6,000

2009

2008

2007

HIV Patients Served

Transgender 38

Transgender 35

Transgender 33Unknown 5

Male 4,021

Male 4,158

Male 3,754

Female 1,570

Female 1,477

Female 1,722

0 500 1,000 1,500 2,000 2,500 3,000 3,500 4,000 4,500

2009

2008

2007

HIV Patients Served By Gender

295233 266

3,0643,124

2,909

2,0472,238 2,308

11782 1020

500

1,000

1,500

2,000

2,500

3,000

3,500

2007 2008 2009

Age 13 - 24 YearsAge 25 - 44 YearsAge 45 - 64 YearsAge 65 years or older

HIV Patients Served By Age

HIV Patients Served By Race

2008

Black2,78649%

White1,57828%

Hispanic1,22622%

AmericanIndian

15

PacificIslander

3

Unknown9

More thanone race

10

Asian47

2009

Black2,79650%

White1,50327%

Hispanic1,25822%

PacificIslander

3

AmericanIndian

15

Asian54

2007

More thanone race

51

Unknown129

White1,59629%

Pacific Islander

0

Black2,63948%

Hispanic1,04719% Asian

40

AmericanIndian

12

2009

No insurance2,474

Other Public285

Medicare942

Unknown857

Medicaid673

Other0

Private398

2008

No insurance2,284

Other Public242

Medicare900

Unknown1,200

Medicaid620

Other0

Private424

2007

Private73

Other71

Medicaid544

Unknown1,788

Medicare789

OtherPublic

7No insurance2,242

HIV Patients Served By Funding

0

500

1000

1500

2000

2500

3000

3500

2007 2008 2009

Year

Uni

que

Pat

ient

s Amelia CourtBluitt-FlowersDeHaro-SaldivarSE Suite 350WSC

HIV Patients In Care - Clinic Panels

HIV Patients In Care - Risk Factors

2007

145

7

2007

316

2007

183

2007

4

2007

108

1

2007

58

2007

0 2007

173

2007

591

2008

171

4

2008

234

2008

171

2008

5

2008

170

5

2008

4

2008

2

2008

40

2008

133

2009

189

3

2009

235

2009

166

2009

5

2009

185

3

2009

6

2009

6

2009

65

2009

108

0

200

400

600

800

1000

1200

1400

1600

1800

2000

MSM IDU

MSM and ID

U

HemophiliaHeter

osexu

al contac

tTran

sfusio

n of b

lood

Perinata

l tran

smiss

ion

Other

Unknown

HIV Patients In Care - Visits

2009 1,587

2009 1,495

2009 689

2009 566

2008 1,493

2008 1,357

2008 635

2008 523

2007 1,118

2007 1,461

2007 589

2007 695

0 200 400 600 800 1,000 1,200 1,400 1,600 1,800

1 Visit:

2:

3 to 4:

5 or more:

200720082009

2009 Pregnant Women

88 HIV+ women were reported pregnant in 2009

• 73 women were reported to be on antiretroviral medications

• 65 babies were delivered

Patients by Residence and Clinic Site

Patient's Home Clinic

Clients Receiving Care at

TotalAmelia Court Bluitt Flowers Southeast Women's Clinic DeHaro Saldivar

Amelia Court 707 59 35 26 13 840

Bluitt Flowers 561 258 49 84 26 978

East Dallas 605 49 78 57 15 804

Garland 172 6 65 33 4 280

Irving 281 32 15 15 5 348

Southeast 329 40 172 84 9 634

Out of County 296 19 54 39 7 415

Total Clients 2951 463 468 338 79 4299

Antiretroviral Medication Expenditures

Antiretroviral Expenditures

41%

59% 55%

45%

51%

49%

$22,092,094 $23,271,664 $24,734,765 $26,461,300

Blue = ARV Free Goods Green = ARV Purchases M&D/Direct Source 29 Categories ARV/Antiviral

50%

50%

$13,104,799$12,192,297

$10,384,082$9,048,403

$13,356,501$12,542,468$12,887,582$13,043,691

2006 2007 2008 2009

Antiretroviral Expenditures

41%

59% 55%

45%

51%

49%

$22,092,094 $23,271,664 $24,734,765 $26,461,300

Blue = ARV Free Goods Green = ARV Purchases M&D/Direct Source 29 Categories ARV/Antiviral

50%

50%

$13,104,799$12,192,297

$10,384,082$9,048,403

$13,356,501$12,542,468$12,887,582$13,043,691

2006 2007 2008 2009

PURCHASES

• Driver in increased ARV purchases since 2006 is implementation of Medicare Part D

• HIV patients may access their SS disability benefits and qualify for Medicare Parts A, B, and D

• Medicare Part D medications must be purchased by pharmacy then claims are adjudicated online and Centers for Medicare and Medicaid Services (CMS) reimburse money above acquisition cost

• Medicare Part D HIV patients have been infected for many years, take more expensive ARVs, and take multiple ARVs in an HIV regimen

FREE GOODS

• Majority of new HIV patients coming into Parkland system are eligible for free goods replacement, take fewer, and less expensive ARVs

Purchased ARVs Dispensed CY 2009

Medicare Part D Acquisition Cost

-$5,362,620

Medicaid Acquisition Cost -$2,581,045

RW / PHP / TS Cost-$3,243,854

LDR Grant $757,596

Medicare Part D Reimbursement

$8,503,609

Medicaid Reimbursement

$2,827,697 Net of Acquisition Cost and Reimbursement

$901,383

-$8,000,000

-$6,000,000

-$4,000,000

-$2,000,000

$0

$2,000,000

$4,000,000

$6,000,000

$8,000,000

$10,000,000January 2009 Pharmacy

challenged to decrease purchases for unfunded patients by

increasing enrollment in free goods replacement

January 2009 Pharmacy projected

ARV costs for unfunded patients at

$4.8 million

Texas ADAP - THMP - TDH

• Federal and state tax supported program part of the Ryan White Care Act that provides HIV medications to low income (<200% FPL adjusted) patients

• AIDS Drugs Assistance Program (ADAP) or Texas HIV Medication Program (THMP) administered by Texas Department of Health (TDH)

• Free Goods Replacement Program – THMP furnishes bottles of medications to dispensing pharmacies for individual patients, acts as a wholesaler does not pay $

• ALL medications must be preapproved for each patient by 7 THMP staff

• 100% manual process of submitting paper applications to Austin, updating HIV regimens by paper, ordering medications on paper orders

THMP Optimization January 2009 to 2010

January 20092,084 patients

18%

20%

11% 0%1%

50%

TDHMedicare Part DRyan WhiteMedicaidParkland Health PlusTax Support

January 20102,182 patients

59%18%

12%

10% 1% 0%

January 2010 – 87% ARVs free goods replacement or CMS reimbursed purchases

Increase 9% of patients filling ARVs on TDH (TMHP) January 2009 – January 2010

Medicare D and Medicaid Stable

True INCREASE in FREE GOODS

REPLACEMENT and DECREASE in RW!!!

Opportunities to Reduce Tax Support Expense

January 2009433 pts (20% HIV pts used

RW for meds)$4.8 million/yr drug expense

Pharmacy & HIV CM work to evaluate other funding

321 pts and new pts(TDH / Medicare / Medicaid)

GOAL decrease RW only to

low as possible

January 2010433 reduced to 274 pts

(12% HIV pts using RW for meds) $2.5 million/yr

GOAL ~10% HIV pts RW only (200 – 250 pts) <$2.5 million/yr drug expense

ACHIEVED $2.3 million COST AVOIDANCE

with TDH optimization

Barriers to Achieving 100%coverage for all HIV pts

1) Hospitalized patients with life threatening OIs

2) Pregnant HIV+ women3) Perinatally infected young

adults transitioning out of Children’s & off Medicaid

4) Patients in periods of coverage transition (Medicare Part D and Medicaid)

5) Patients can be over income for TDH but can’t afford $30,000 for HIV meds and still qualify for Ryan White

6) Unable to provide documentation for TDH (paid in cash, proof of residency)

7) TDH enrolled but HIV regimen change must be approved by limited number TDH employees

Conclusion & Future Directions

ARV purchases and free goods replacement have increased annually totaling ~$26.5 million for FY 2009

CMS reimbursements for ARVs $11.3 million for 2009 and exceed purchases for CMS and unfunded pts providing net benefit to Parkland

Opportunities for reducing ARV tax supported purchases were actively pursued and being maintained achieved $2.3 million cost avoidance with corresponding increase in free goods replacement

goal is to reduce tax supported patients to 10% of HIV+ pts servedimproved screening process for HIV patients at intakemaximizing THMP, Medicare Part D, and Medicaid enrollment

Continue to work together as a team – HIV Services, UTSW and Parkland Medical Staff, Pharmacy (including MAS) – to improve cost avoidance by maximizing free goods replacement and reimbursements

Parkland’s HIV Routine Testing Pilot

Routine HIV Testing

• In September 2006, the Centers for Disease Control and Prevention (CDC) revised its testing recommendations to include routine HIV testing in health care settings for patients ages 13 to 64.

• CDC suggests that any area where a population shows a positivity rate of 0.1% or greater warrants and will benefit from Routine HIV Screening.

Source: MMWR 2006; 55(No. RR-14):1-17

Background

Revised Recommendations

• Opt-out HIV screening recommended for patients ages 13-64

• Persons at high-risk for HIV infection should be screened for HIV at least annually.

• Separate written consent for HIV testing is not recommended

• Prevention counseling is not required with HIV diagnostic testing or as part of routine HIV testing in health care settings.

• HIV screening should be included in the routine panel of prenatal screening tests for all pregnant women.

• HIV screening is recommended after the patient is notified that testing will be done unless the patient declines (opt-out screening).

2009 HIV Testing at Parkland ESD

Program established January 2009• Test Technology

OraQuick 1/2, followed by Elisa and IFA • Testing

HIV tester collects and processes test• Results

Non-reactive results given by testerReactive given by provider and HIV Case Manager

• Linkage to CareHIV Case Manager counsels patient, makes intake

appointment and connects patient to HIV care

2009 HIV Testing at Parkland ESD

January 2009- December 2009

Unduplicated Rapid HIV Tests - 5,185

Demographics: 42% Female and 58% Male

All reactive tests were confirmed by Elisa and IFA.

2009 HIV Testing in ESD

HIV Positive Test – 47• Gender - 39 males and 8 females• HIV infections diagnosed – 28 or 78% of all positive• About 75% of patients who tested positive have entered care• About 47% of patients who tested positive were hospitalized, many with AIDS defining conditions

Recent data shows that a patient entering treatment with 200 or less T-Cells has a 5 year reduction in life expectancy compared to

a patient who enters treatment with at least 300 T-Cells.

2009 HIV Test in ESD

Reactive HIV Tests = 47

3

67

5

23

4 4

23

6

2

0

2

4

6

8

Jan

FebMarc

h Apri

l May

Ju

ne July

Augus

tSep

tembe

rOcto

ber

Novem

ber

Decem

ber

2009 HIV Test in ESD

0 2 4 6 8 10 12

Rash/AllergicReaction

Cough/RespiratoryDistress

Chest Pain

Abdominal

Other

Chief Complaints

Other includes: spider bite, hallucinations, hand evaluation, dysuria, abscess, renal failure, reaction to spinal tab.

2010 HIV Testing at Parkland

• Since February 1, 2010, Routine Universal Screening for HIV became operating procedure in the Emergency Services Department.

• Since March 3, 2010, Rapid HIV Testing has been available at the UCC four days/week.

2010 - HIV Tests

Routine HIV Testing in ESD• HIV Testing Orders have been added to EMR lab panels • Every blood draw on patients 18-64 in the ESD will include screening for HIV, unless patient opts-out

• Signage in ESD are posted to inform patients of routine HIV screening• Opt-Out Patient may opt-out from HIV testing. Opt-out is documented in the EMR by patients nurse.

If Elisa test is positive, confirmatory test is done from the same sample

Jan - Feb 2010

Nonreactive Reactive Total

Gender

Female 198 0 198

Male 230 2 232

Rapid Subtotal 428 2 430

Blood Subtotal 1178 34 1212

TOTAL 1606 36 1642

2010 – HIV Tests

2010 - HIV Tests

• Tests - 1346 patients were tested, of which 36 were reactive for Elisa, and 26 confirmed positive by IFA.

• Of the 26 confirmed positives, 11 were unaware of their HIV status.

• Link to care – Of the confirmed positives, 79% (20) of patients have been connected to HIV services and 21% (6) have been referred to care.

• Hospitalizations – 63% (16) of the confirmed positive patients were hospitalized, of which 8 were newly diagnosed.

Facilitators to Routine Testing

• Staff Buy-in:Increases once providers and staff witness the identification of HIV infection

in patients that were unaware of their HIV status. • Systems and Processes: Need to be established to facilitate

the HIV testing program in the Emergency Services Department including:Executive Sponsorship – Leadership support is instrumental in the

implementation of the program.Access to Lab Data – to identify HIV testing history of patient. HIV Case Manager – assist provider in result notification and

connects patient to care. Enhanced Protocols

Barriers to Routine Testing

• Resources • Testing• Giving the results• Case management staff to connect to care• Data Management and documentation• Follow-up of non-complaint patients

• Reimbursement • Medicare decision to pay for HIV testing under certain risk factors and if patient requests it• EPSDT pays for HIV test once per year

2010 HIV Services Patient Satisfaction

FY 2010 YTD Amelia Court Clinic

Questions?

Any Questions?

Budget and Finance Committee

Committee Members Alan Walne – Chair

Chris Luna Louis A. Beecherl, III

Agenda for the meeting of the Budget and Finance Committee of the Board of Managers of the Dallas County Hospital District scheduled for Tuesday, June 22, 2010 10:00 a.m. or (immediately following Quality and Risk Management Committee Meeting) in the Administrative Conference Room, Parkland Memorial Hospital. The Budget and Finance Committee may take action on any item listed below. The Budget and Finance Committee and the Board of Managers reserve the right to exercise discretion and may convene in Executive Session as permitted by sections 551.071, et seq., of the Texas Government Code, and as otherwise authorized by law, on any item listed on the Budget and Finance Committee agenda or the general Board of Managers’ agenda. Executive Sessions (if any) will be held at the time scheduled on the Meetings Schedule and not at the time scheduled for the Budget and Finance Committee. I. Attendance/Call to order Time/Presenter

II. Discussion Items Min.

A. PHHS Financial Statement and

Statistical Report for May John Dragovits B. Foundation Update David Krause C. Investment Committee Update John Dragovits D. Electronic Document Imaging System Robin Stults

III. Action Items Min.

A. Contracts over $200,000 John Dragovits B. Capital Contingency John Dragovits C. S.T.O.P VWA Recovery Act John Dragovits

D. Any item listed in Section II, III or IV IV. Information Items Min.

A Parkland Foundation Transfers John Dragovits B. Purchasing Activity Report John Dragovits C. Bond Funding Status John Dragovits D. Grants Policy Liz McMullen

V. Adjourn

Parkland Health & Hospital System

Dallas, Texas

June 9, 2010

Financial and Statistical Report

May 31, 2010

2

Parkland Health & Hospital System

Summary Narrative - Financial Performance For the Month Ended May, 2010

(Unconsolidated)

For the month of May, Parkland remains materially on target to the financial plan and budget. This period also compares favorably to forecast and the prior year. The following information focuses on key items and variances.

Patient Volume: Inpatient discharges are 2% under budget for the month. Adult occupancy is at 78%, 2% greater than budget. Deliveries are 19% below budget in May, and 10% below budget year to date. Outpatient activity continues to exceed both budget and prior year, with emergency visits 18% above budget, and ambulatory visits about 11% above budget for May. Patients leaving without completing treatment was 5% compared to a budget of 8%; still well below the 11% seen in 2009. Balance Sheet: The balance sheet remains strong with solid cash on hand (225 days) and a current ratio of 1.7. The material changes from last year are: Inventories & Other Assets increased by $14 million (46%), due to an increase in prepaid deposits and prepaid bond issue costs,

Capital Assets, Net increased by $83 million, due to land acquisitions, capital equipment purchases, and IT project implementations,

Assets Limited to Use increased $771 million due to bond proceeds and Board designated funding for the New Parkland Campus,

Long Term Debt increased by $707 million due to the bond issuance, and Net Assets increased by $98 million, or 11%.

Operating Income (Loss): For the month, Parkland recorded an operating loss of $10.3 million, which is slightly better than forecast and about $1.1 million less than last year. The material variances are: Patient Revenues approximately $3 million greater than budget. Salaries are at budget. Paid hours per adjusted patient day are favorable at 38, compared to a budget of 42. Benefits are over budget by about $2.5 million, primarily due to employee health plan utilization continuing to average 20% higher than anticipated. Unemployment expense is also over budget for the month by $356 thousand.

Supplies are at budget for the month. Pharmaceutical expenses are about $700 thousand under budget.

Parkland Health & Hospital SystemFor the periods ending May, 2010 and 2009

FY 2010May-10 May-10 May-09 May-10 May-10 May-09 AnnualActual Budget Actual Actual Budget Actual Budget

Inpatient Discharges Adult 3,317 3,383 3,287 26,574 26,652 26,014 40,117 Neonatal ICU 88 93 80 731 737 714 1,126Total 3,405 3,476 3,367 27,305 27,390 26,728 41,243

Census Days Adult 16,433 16,080 15,458 126,194 126,796 121,285 190,131 L&D 602 533 596 4,762 4,794 4,797 7,328 Neonatal ICU 2,012 2,194 2,156 15,835 15,290 16,370 24,000Total 19,047 18,808 18,210 146,791 146,880 142,452 221,459

Average Length of Stay Adult 5.1 4.9 4.9 4.9 4.9 4.8 4.9 Neonatal ICU 22.9 23.5 27.0 21.7 20.7 22.9 21.3Weighted Average Total 5.6 5.4 5.4 5.4 5.4 5.3 5.4

Adult Average Inpatient Available Beds (less L&D) 673 675 671 673 675 673 675Observation Unit Beds 16 16 0 16 16 0 16

Adult Inpatient Occupancy Rate 78% 77% 74% 77% 77% 74% 77%

Equivalent Patient Days Adult Census, NNICU, Observation, and Short Stay Days 20,132 19,419 19,032 153,311 151,843 148,242 228,837

Observation/Short Stay Discharges 695 412 4,736 3,349

Adjusted Occupancy Rate (includes Obs and Short Stay) Medicine/ Surgery 90% 86% 85% 86% 83% 84% 83% Psych 61% 77% 81% 61% 82% 72% 75% Rehab 99% 91% 95% 95% 96% 88% 95% WISH (Less: Newborn Nursery, NNICU, and L&D) 65% 60% 63% 66% 66% 65% 67%

Average Daily Inpatient Census Medicine/ Surgery 369 370 340 360 359 341 358 Psych 11 14 15 11 15 11 Rehab 17 15 16 16 16 15 WISH (Less: Newborn Nursery, NNICU, and L&D) 131 120 128 132 132 132 133 L&D 19

3

1316

17 19 20 20 20 20Total Adult Inpatient Census 547 536 518 538 542 519 541

Observation 35 20 27 27 20 24 20Total Adult Average Daily Census 582 556 544 565 562 543 561

Neonatal ICU 65 71 70 65 63 67 66Total Average Daily Census 647 626 614 630 625 610 627

Deliveries 1,029 1,263 1,187 8,924 9,959 9,779 15,192

SurgeriesOR Cases 600 631 616 4,789 4,588 4,552 6,816 Day Surgery Cases (Hospital) 540 505 533 4,447 4,007 4,089 6,089 Day Surgery Cases (ASC) 262 241 267 2,265 2,027 1,975 3,006Total Day Surgery Cases 802 746 800 6,712 6,034 6,064 9,095

Total Surgical Cases 1,402 1,377 1,416 11,501 10,622 10,616 15,911

Emergency Services Visits Main ER 8,572 7,140 6,483 63,021 55,600 52,107 84,000 Psych ER 862 818 800 6,109 5,884 5,776 9,000 ACC Urgent Care 4,565 3,680 3,413 34,133 27,444 23,739 42,223 ICC ER (OB/Gyn Intermediate Care) 1,622 1,632 1,469 11,976 12,204 11,512 18,494 Total Emergency Services Visits 15,621 13,270 12,165 115,239 101,132 93,134 153,717

Percent Left w/o Completing Treatment 5.3% 7.7% 10.8% 4.9% 7.6% 11.9% 7.5%

Ambulatory Visits COPC Visits 32,340 29,352 30,053 274,987 246,966 246,385 360,478 Women's Health Centers Visits 21,136 20,038 21,243 173,265 164,631 165,914 250,872 OPC Visits 25,822 22,353 23,019 206,755 174,202 187,893 266,217 Community Visits 5,514 4,489 4,595 52,124 44,791 43,860 63,737Total Ambulatory Visits 84,812 76,233 78,910 707,131 630,590 644,052 941,304

Year to DateMonth

4

PARKLAND HEALTH & HOSPITAL SYSTEMSTATEMENT OF REVENUES AND EXPENSESFor the Periods Ended May 31, 2010(dollars in thousands)

FY 2010 FY 2010FY 2010 FY 2010 FY 2010 FY 2009 FY 2010 FY 2010 FY 2010 FY 2009 Annual Annual

Actual Budget Forecast Actual Actual Budget Forecast Actual Budget ForecastOperating Revenues

$39,966 $37,017 $37,017 $34,677 Net Patient Revenues $300,543 $285,340 $285,340 $274,476 $434,150 $434,15037,067 37,524 37,066 35,912 Net Ad Valorem Taxes 296,533 300,193 296,533 287,297 450,290 444,799

1,882 1,917 1,917 2,033 Replacement Drugs 15,079 15,333 15,333 15,107 23,000 23,000 97 96 96 182 Campus Partners 799 757 757 1,652 1,225 1,225

3,657 3,637 3,637 2,951 PCHP 27,855 29,093 29,093 24,948 43,640 43,640 1,411 1,373 1,373 1,590 Foundation and Grants 13,858 13,548 13,548 14,482 21,532 21,532

367 113 113 409 Vendor Discounts and Rebates 1,737 928 928 1,301 1,402 1,402 281 1,095 281 1,340 Tobacco 7,131 8,759 7,131 9,680 13,139 8,254

1,872 1,389 1,389 1,708 Other 24,035 11,901 11,901 10,329 16,946 16,946

86,600 84,162 82,890 80,801 Total Operating Revenues 687,569 665,852 660,564 639,272 1,005,324 994,948

Operating Expenses45,856 45,920 45,920 44,808 Salaries & Wages 354,535 354,082 354,082 348,272 531,475 531,47510,828 8,282 8,282 9,383 Employee Benefits 69,332 62,906 62,906 62,188 87,641 87,641

9,949 9,693 9,693 9,721 Purchased Medical Services 78,069 77,974 77,974 79,662 116,745 116,74518,286 18,291 18,291 17,884 Supplies & Other 147,459 145,659 145,659 141,178 224,870 224,870

6,550 7,266 7,266 7,217 Pharmaceuticals 60,930 59,780 59,780 58,301 90,073 90,0735,398 4,167 4,167 3,167 Interest and Depreciation 36,107 33,333 33,333 25,333 50,000 50,000

96,867 93,619 93,619 92,180 Total Operating Expenses 746,431 733,735 733,735 714,935 1,100,804 1,100,804

($10,267) ($9,457) ($10,729) ($11,378) Operating Income (Loss) ($58,862) ($67,883) ($73,171) ($75,663) ($95,480) ($105,856)

Nonoperating RevenuesGME Reimbursement 27,979

14,833 14,833 14,833 12,362 Government Subsidies 119,027 118,667 118,667 120,748 178,000 178,000

Net Income Before Interest and4,566$ 5,376$ 4,104$ 984$ Investment Income 60,165$ 50,784$ 45,496$ 73,064$ 82,520$ 72,144$

1,144 667 667 304 Interest and Investment Income 10,183 4,667 4,667 5,756 8,000 8,000 4,732 - - - Unrealized Gain (Loss) on Investments 5,153 - - - - -

10,443 6,042 4,770 1,288 Net Income 75,502 55,451 50,163 78,821 90,520 80,144

1,108 - - - BABs Subsidy Income 7,758 - - - - - 1,225 - - - Bond Interest and Investment Income 2,321 - - - - - 2,765 - - - Unrealized Gain (Loss) on Investments (444) - - - - -

15,541$ 6,042$ 4,770$ 1,288$ Total Net Income 85,137$ 55,451$ 50,163$ 78,821$ 90,520$ 80,144$

Year to DateMonth

PARKLAND HEALTH & HOSPITAL SYSTEMBALANCE SHEETMay 31, 2010 and 2009(dollars in thousands)

FY 2010 FY 2009 ChangeAssetsCurrent Assets Cash, Cash Equivalents & Investments Operating $272,717 $320,970 (48,253)

Net Ad Valorem Taxes Receivable 12,572 22,020 (9,448) Net Patient Accounts Receivable 74,548 70,190 4,358 Other Receivables 41,839 64,982 (23,143) Inventories & Other Assets 44,188 30,333 13,855 Total Current Assets 445,864 508,495 (62,631)

Capital Assets, Net 398,802 315,772 83,030

Assets Limited to Use: Designated for New Parkland Campus 250,000 250,000 0 Designated for Future Reserves 80,044 16,644 63,400 Designated for Capital Use 55,005 59,954 (4,949) Designated for Bonds Payable 711,328 0 711,328 Other 5,769 4,763 1,006 Total Assets Limited to Use 1,102,146 331,361 770,785

Total Assets $1,946,812 $1,155,628 791,184

Liabilities and Net Assets Current Liabilities Accounts Payable $36,172 $54,286 (18,114) Accrued Payroll & Benefits 49,303 60,220 (10,917) Unamortized Ad Valorem Tax 148,266 143,648 4,618 Interest Payable 11,387 0 11,387 Due to Third Party 9,409 14,422 (5,013) Other Current Liabilities 8,480 9,510 (1,030) Total Current Liabilities 263,017 282,086 (19,069)

Long Term Debt 707,282 0 707,282 Other Non-Current Liabilities 14,011 9,576 4,435 Total Liabilities 984,310 291,662 692,648

Net Assets 962,502 863,966 98,536

Total Liabilities and Net Assets $1,946,812 $1,155,628 791,184

5

Parkland Health & Hospital SystemCash Flow StatementFor the Month and Year Ended May 31, 2010

(dollars in thousands)Current Month Year to Date

OperatingLimited as to

Use Total OperatingLimited as to

Use Total

Cash Flows from Operating Activities:Receipts from patients 36,618$ -$ 36,618$ 304,308$ -$ 304,308$ Ad Valorem Tax Receipts 2,430 - 2,430 441,482 - 441,482 Other Receipts 58,399 - 58,399 249,925 - 249,925 Payments to Suppliers (50,142) - (50,142) (317,599) - (317,599) Payments to Employees (50,679) - (50,679) (423,086) - (423,086) Net Cash Flow from Operations (3,374) - (3,374) 255,030 - 255,030

Cash Flows from Capital and Financing Activities:Purchases of Capital assets - (7,331) (7,331) - (78,522) (78,522) Interest Earned 9,439 - 9,439 16,694 - 16,694 Interest Paid - - - (16,051) - (16,051) Assets Transferred 4,857 (4,857) - (171,696) 171,696 - Net Cash Flows from Capital and Financing Activities 14,296 (12,188) 2,108 (171,053) 93,174 (77,879)

Net Change in Cash 10,922 (12,188) (1,266) 83,977 93,174 177,151

Beginning Cash Balance 261,795 1,114,334 1,376,129 188,740 1,008,972 1,197,712

Ending Cash Balance 272,717$ 1,102,146$ 1,374,863$ 272,717$ 1,102,146$ 1,374,863$

6

PARKLAND HEALTH & HOSPITAL SYSTEMCONSOLIDATED STATEMENT OF REVENUES AND EXPENSES(CONSOLIDATION INCLUDING PCHP)For the Periods Ended May 31, 2010(dollars in thousands)

FY 2010 FY 2010FY 2010 FY 2010 FY 2010 FY 2009 FY 2010 FY 2010 FY 2010 FY 2009 Annual Annual

Actual Budget Forecast Actual Actual Budget Forecast Actual Budget ForecastOperating Revenues

$39,966 $37,017 $37,017 $34,677 Net Patient Revenues $300,543 $285,340 $285,340 $274,476 $434,150 $434,15037,320 37,360 37,360 32,790 Premium Revenue 281,279 298,880 298,880 260,956 424,701 424,701 37,067 37,524 37,524 35,912 Net Ad Valorem Taxes 296,533 300,193 300,193 287,297 450,290 444,799

1,882 1,917 1,917 2,033 Replacement Drugs 15,079 15,333 15,333 15,107 23,000 23,000 97 96 96 182 Campus Partners 799 757 757 1,652 1,225 1,225

1,411 1,373 1,373 1,590 Foundation and Grants 13,858 13,548 13,548 14,482 21,532 21,532 367 113 113 409 Vendor Discounts and Rebates 1,737 928 928 1,301 1,402 1,402 281 1,095 1,095 1,340 Tobacco 7,131 8,759 8,759 9,680 13,139 8,254

1,872 1,389 1,389 1,708 Other 24,168 11,901 11,901 10,329 16,946 16,946

120,263 117,885 117,885 110,640 Total Operating Revenues 941,127 935,639 935,639 875,280 1,386,385 1,376,009

Operating Expenses45,856 45,920 45,920 44,808 Salaries & Wages 354,535 354,082 354,082 348,272 531,475 531,47510,828 8,282 8,282 9,383 Employee Benefits 69,332 62,906 62,906 62,188 87,641 87,64137,081 33,306 33,306 31,129 Claims Expense 270,823 266,448 266,448 232,801 378,589 378,589

9,949 9,693 9,693 9,721 Purchased Medical Services 78,069 77,974 77,974 79,662 116,745 116,74518,521 18,291 18,291 18,033 Supplies & Other 149,233 145,662 145,662 142,307 224,870 224,8706,550 7,266 7,266 7,217 Pharmaceuticals 60,930 59,780 59,780 58,301 90,073 90,0735,398 4,167 4,167 3,167 Interest and Depreciation 36,107 33,333 33,333 25,333 50,000 50,000

134,182 126,925 126,925 123,458 Total Operating Expenses 1,019,028 1,000,186 1,000,186 948,865 1,479,393 1,479,393

(13,918) (9,041) (9,041) (12,818) Operating Income (Loss) (77,900) (64,547) (64,547) (73,586) (93,008) ($103,384)

Nonoperating Revenues- - - - GME Reimbursement - - - 27,979 - -

14,833 14,833 14,833 12,362 Government Subsidiaries 119,027 118,667 118,667 120,748 178,000 178,000 Net Income Before Interest and

915 5,792 5,792 (456) Investment Income 41,127 54,120 54,120 75,141 84,992 74,616

1,943 867 867 218 Interest and Investment Income 12,870 6,267 6,267 8,031 8,000 10,400 4,732 - - - Unrealized Gain (Loss) on Inves 5,153 - - - - -

7,591 6,659 6,659 (238) Net Income 59,150 60,387 60,387 83,172 92,992 85,016

1,108 - - - BABs Subsidy Income 7,758 - - - - - Bond Interest and

1,225 - - - Investment Income 2,321 - - - - - 2,765 - - - Unrealized Gain (Loss) on Inves (444) - - - - -

12,689$ 6,659$ 6,659$ (238)$ Total Net Income 68,784$ 60,387$ 60,387$ 83,172$ 92,992$ 85,016$

Month Year to Date

7

Budget and Finance Committee

Financial UpdateJune 2010

Monthly StatisticsMay 2010

2

3


4


Fiscal 2008 Fiscal 2010

5

Deliveries

Deliveries were 1,029 for May 2010, 19% under budget, and 13% less than May 2009.

Fiscal 2009

6

Emergency Visits

Emergency visits for May 2010 were 15,621, 18% over budget, and 28% greater than May 2009.

Fiscal 2008 Fiscal 2009 Fiscal 2010

7

Cash and Investments (excluding Bond Funds; see footnote)

Cash and investments peak in February/March each year, with the collection of tax receipts.

(Dollars in Millions)


8

Cash Collections onPatient Services

Cash collections from patient services were $38.6 million in May 2010, which was $2.50 million greater than May 2009.



9

Monthly Income StatementMay 2010

(Dollars in Thousands)

10

Year to Date Income StatementMay 2010


11

Key Volume Performance Metrics

May 2010

Discharges

Average Daily Census

Deliveries

Favorable Unfavorable

Volume Metrics

Efficiency Metric

Neutral

Average Length of Stay ( Adult Only)

Ambulatory Visits

Emergency Visits

Fiscal 2009

12Discharges for May 2010 are 3,405, which is 2% less than budget and 1% greater than May 2009.

Discharges


Fiscal 2009Fiscal 2008

13

Equivalent Patient Days

Equivalent patient days are 20,132, 4% greater than budget, and 6% greater than May 2009.

Fiscal 2010

Fiscal 2008

14

Average Daily Census

Total average daily census for May 2010 was 647, 4% greater than budget, and 6% greater than May 2009.


15Ambulatory visits for May 2010 were 84,812, 11% greater than budget and 8% greater than May 2009.

Ambulatory Visits


16

Average Length of Stay(Adult Only)

In May 2010 the average length of stay for adult only of 5.1 was above budget, and greater than Moody’s A2 median of 4.7.


17

Forecast UpdateYear to Date through May, 2010


18

Labor SummaryYear to Date through May 2010

19

Key Operating Performance Metrics

May 2010

Operating Margin

Operating Cash Flow Margin

Operating Costs / Adj. Patient Day

Paid Hours / Adj. Patient Day


Operating Ratios

Revenue Metric

Efficiency Metrics

Neutral

Total Margin

Cash Collections

20

Operating Margin

Operating margin for May 2010 was 5%, compared to a forecast of 4%. Patient revenues were $3 million greater than forecast and tax revenues have been adjusted for the anticipated impact of future levy adjustments. Salaries were slightly under budget. Benefits were over budget due to an increase in health claims payments, related to a significant increase in utilization.(Operating revenues + government subsidies ‐ operating expenses) /(operating revenues + government subsidies)


21

Total Margin

Total margin for May 2010 was 11%, compared to a forecast of 6%.( (Total revenues ‐ operating expenses) / total revenues)


22

Operating Cash Flow Margin

Operating cash flow margin for May 2010 was 10%, compared to a forecast of 9%.(Operating revenues + government subsidies ‐ operating expenses + depreciation) /

(operating revenues + government subsidies)


23

Operating Costs per Adjusted Patient Day

Operating costs per adjusted patient day for May 2010 were $2,415, $225 less than the budgeted amount of $2,641. (Total operating costs / (patient days * (total charges / inpatient charges))



Fiscal 2008

24

Paid Hours per Adjusted Patient Day

Paid hours per adjusted patient day for May 2010 were 38, 4 hours under budget and 4 hours less than May 2009.

Paid hours / (patient days * (total charges / inpatient charges)


25

Summary Balance Sheet(Dollars in Thousands)

26

Cash and Investments(Dollars in Thousands)

27

Key Financial ConditionPerformance Metrics

May 2010

Days Cash on Hand

Debt to Capitalization

Days in Accounts Receivable

Days in Accounts Payable

Capital Expense


Liquidity Ratios

Capital Structure Ratios

Neutral

Days Cash on Hand


Year to date days cash on hand through May 2010 were 225 days, excluding cash received from bond issuance, greater than Moody’s median of 162 days. Ad valorem cash receipts begin decreasing at the time of year. (cash + investments) * # days in month/(operating expenses – depreciation) 28

29

Days in Accounts Receivable

Days in accounts receivable through May 2010 were at 56 days, higher than Moody’s A2 median of 49 days. The target days in accounts receivable for fiscal year 2010 is 60.

(Accounts receivable * # days in month / net patient revenues)


30

Days in Accounts Payable

Days in accounts payables reflect vendor payables only. May 2010 days were 11, lower than the Moody’s A2 median of 58 days. The target days for accounts payable for fiscal year 2009 is 30 days.

(Accounts payable * # days in month / (operating expenses ‐ depreciation)


31

Capital Expense Ratio

The capital expense ratio for May 2010 was 4.6%, which is in line with budget and less than the Moody’s A2 median of 6.8%. ((Depreciation + interest expense) / operating expenses)


32

Capital Budget Status

Capital spending and commitments through May 2010 was $99.2 million. Budget for the year, including the carry forward of project budgets from FY09, but excluding New Parkland Campus, totals $112 million.


Supply Cost per Adjusted Patient Day

33

34

Ambulatory Surgery Center

Jail Health Services

35

Ambulatory Surgery CenterMay 2010


36

Jail Health ServicesMay 2010


37

Benchmarking

Benchmarking compares Parkland’s performance to peer groups of other hospitals, based upon characteristics selected by Parkland. Two peer groups are used in this presentation: hospitals rated A2 by Moody’s Investors Service; and teaching hospitals over 600 beds participating in Solucient benchmarking.

Moody’s A2: Median ratios of 72 hospitals rated A2 by Moody’s. These hospitals are of various sizes and ownership types.

Solucient: Median ratios of 63 major teaching hospitals with over 600 adjusted occupied beds.

In addition, shaded boxes are used to indicate ranges of =/‐ one standard deviation for each median for Moody’s, and 20th and 80th percentiles for Solucient, as an indicator of a normal range of values and to provide further context for Parkland’s actual values compared to median values.

Moody’s range Solucient range

38

Benchmark RangesBenchmark ranges indicated in the shaded boxes on various following pages are as follows:

Benchmark Range Ratio Low End Median High EndMoody’s A2:Operating Margin ‐0.6% 2.0% 4.6%Total Margin 1.8% 4.7% 7.6%Operating Cash Flow Margin 6.4% 9.2% 12.0%Days Cash on Hand 86 162 248Days in Accounts Receivable 40 49 58Days in Accounts Payable 40 58 78Average Length of Stay 2.3 4.7 7.1

Solucient:Cost per Adjusted Patient Day (w/o bad debts)* $2,036 $2,465 $3,193Paid Hours per Adjusted Patient Day 33.2 38.5 44.7

Sources: Not‐for‐Profit Hospital Medians for Fiscal 2008, Moody’s Investors Service.Trend and Compare Group Report, 3Q 2009, Solucient.

* ‐ Normalized for Parkland’s cost advantages due to FICA opt out and professionalliability limits, and for Parkland’s low capital expense ratio.

Parkland Foundation UpdateParkland Foundation Update6/22/2010

Board’s Strategic Plan

• Campaign• Board DevelopmentBoard Development• Fundraising Infrastructure

2

Parkland Foundation Update

Campaign UpdateCampaign Update

3

Campaign Commitments

Total Gifts as of 5-31-10

$89 922 577$89 922 577$89,922,577$89,922,577

4

$50,000+ Gifts Granted(10-01-09/5-31-10)

Granted Donor(s)Granted Donor(s)$100,000 Mrs. Rosemary Briggs$100,000 Dr. and Mrs. Karl Rathjen$100,000 Dr. C.W. Hooser$150,000 Anonymous$150,000 Anonymous$150,000 M.B. & Edna Zale Foundation$250,000 The Pollock Foundation$500,000 Roger Horchow/The Horchow Family

Charitable Trust$827 858 C t l Ch it B ll$827,858 Crystal Charity Ball$1,000,000 The Eugene McDermott Foundation$1,000,000 Stemmons Foundation

5

FY 2010 Campaign Performance

6

FY 2010 Requests Trend

$ $

PROJECTED

7

YTD Requests through May are $7.6M compared to a budget of $16.3M.

One $5M request and three $1M requests are scheduled for June.

FY 2010 Gifts

PROJECTED

8

YTD Gifts through May are $5.4M compared to a budget of $6.8M.

Campaign Total Trend

110,000,000

100,000,000

105,000,000

85,000,000

90,000,000

95,000,000

Actual

Budget

75,000,000

80,000,000

70,000,000Sep-09 Oct-09 Nov-09 Dec-09 Jan-10 Feb-10 M ar-10 Apr-10 M ay-10 Jun-10 Jul-10 Aug-10 Sep-10

PROJECTED

9

Campaign total YTD through May is $89.8M compared to a targeted $91.2M

Planned Requests, Yield, and Donations by Fiscal YearDonations by Fiscal Year

Includes an estimate of how the prospects for FY12, FY13, and FY14 will be allocated among the years

10

FY14 will be allocated among the years.

Planned Requests by Fiscal Year

Includes an estimate of how the prospects for FY12 FY13 and

11

Includes an estimate of how the prospects for FY12, FY13, and FY14 will be allocated among the years.

Campaign Gifts by Fiscal Year

12

Campaign Asks Pending

34 asks ⇒ $7,521,250

13

Non-Campaign Asks Pending(FY10 Q1 –Q3 )(FY10 Q1 Q3 )

8 asks ⇒ $361,544

14

Asks

20092009

58 asks were made

2010Goal:Goal: 130

Asks to date:Asks to date: 34

Asks to be made by 9-30-10:

15

s s to be ade by 9 30 0117

2009 Giving USA

“Everything was much slower this year. What we have seen all year long in 2009 is people

delaying gifts, taking longer on pledges, and giving less.”

• Total giving dropped 3 2% in 2009 smaller drop than in 2008 which was 5 7%

y g g , g g p g , g g

William McGinly, President

Association of Healthcare Philanthropy

Total giving dropped 3.2% in 2009, smaller drop than in 2008 which was 5.7%

• Contributions to 433 hospitals and medical centers, 85 percent of which come from individuals, fell

by 11 percent last year (not counting inflation), in a survey by the Association for Healthcare

Philanthropy. py

• The total value of gifts of $1-million or more announced last year in The Chronicle totaled $4.4-

billion, a 64-percent drop from the nearly $12-billion reported in 2008.

• Total donated in 2009 = $303.75B75% individuals

13% foundations

8% bequests

4% corporations

16

4% corporations

* Slide courtesy of The Chronicle of Philanthropy, www.philanthropy.com

Parkland Investment CommitteeReport

June 2010June 2010

Report of the Parkland Investment CommitteeInvestment Committee

Agenda – Meeting of June 2, 2010

1 R i d t k t diti d t d1. Reviewed current market conditions and trends.

2. Interviewed candidates to manage new Emerging Market Equity and International Small

Cap Equity strategies in the Defined Benefit PlanCap Equity strategies in the Defined Benefit Plan.

3. Discussed the DB Plan’s portfolio structure and funding sources for new strategies.

4. Reviewed Defined Benefit and Defined Contribution Plans’ performance for the first quarter

of 2010.

1


Executive Summary – Defined Benefit Plan• Asset Growth – The market value of the Pension Plan totaled $454.1 million on March 31st; an increase

f $21 7 illi f th D b 31 2009 k t l Th i d t t i t tof $21.7 million from the December 31, 2009 market value. The increase was due to net investment

appreciation and income of $16.7 million coupled with net cash inflows of $5.0 million.

• Asset Allocation – All asset classes ended the quarter within their target allocation ranges as defined in• Asset Allocation – All asset classes ended the quarter within their target allocation ranges as defined in

the investment policy statement. The March 31 cash position was above target in anticipation of funding

the new Global Fixed Income strategy on April 1 ($10 million of cash was raised by withdrawals of $8

million from the Barrow Hanley account and $2 million from the Income Research & Management y $ g

account).

• Performance – The Plan gained 3.84% for the fourth quarter, topping the Policy Index by 60 basis

points and ranking above median compared to pension plans of similar size. Attribution analysis

explains that manager performance explained most of the relative outperformance for the quarter, most

notably via the Plan’s International Equities and Fixed Income managers.

2


Executive Summary – Defined Benefit Plan (Continued)Individual Manager Performance• 1st Quarter – Parkland’s managers provided strong absolute and relative performance during the

quarter. All three fixed income managers and both Non-US Equity managers added value versus their

respective benchmarks during the quarter. Additionally, two of the four active US Equity managers

t d th i i di f th ttopped their indices for the quarter.

• Recommendations: RogersCasey currently does not recommend any manager changes. The

Committee briefly discussed funding sources for new strategies and future rebalancing RogersCaseyCommittee briefly discussed funding sources for new strategies and future rebalancing. RogersCasey

continues to recommend delaying funding of the Real Estate allocation until markets have further

stabilized.

3


Defined Benefit Retirement Plan – 1st Quarter Performance

• The Plan’s total returns were 3.84% (0.60% higher than the aggregate benchmark) for the quarter.The Plan’s total one-year returns were 32 77% compared to the benchmark return of 33 80%The Plan s total one year returns were 32.77% compared to the benchmark return of 33.80%.

• First quarter performance for the plan is summarized below:

Strategy Manager Return Benchmark Index All C E it Ad i R h 7 48% 5 94% R ll 3000All Cap Equity Advisory Research 7.48% 5.94% Russell 3000Lg Cap Equity Mellon Capital 5.42% 5.39% S&P 500 Small Cap Value Netols Asset Mgmt 6.71% 10.02% Russell 2000 Value Small/Mid Cap Growth Wells Capital Mgmt 8.55% 8.81% Russell 2500 Growth Large Cap Growth Marsico Capital 5.75% 4.65% Russell 1000g p pInternational Equity Artio Global 1.77% 0.87% MSCI EAFE International Equity Dodge & Cox 3.71% 0.87% MSCI EAFE Core Fixed Income Barrow Hanley 2.04% 1.78% Barclays Capital Core Fixed Income Income Research 2.07% 1.78% Barclays Capital Core + Fixed Income Stone Harbor 3 14% 1 78% Barclays CapitalCore + Fixed Income Stone Harbor 3.14% 1.78% Barclays CapitalHedge Fund of Funds K2 Advisors 0.66% 1.94% HFRI FofF Index Hedge Fund of Funds Rock Creek Group* 2.55% 1.07% HFRI FofF Index Cash Dreyfus Money Market 0.27% 0.01% 90 Day TBill * data lags by one month data lags by one month

4

55


Defined Benefit Retirement Plan – Manager and Funding Status

• The Committee visited with representatives from two Emerging Market Equity management firms: Genesis Asset Managers, LLP and JPMorgan Asset Management. Both firms invest in company stocks based in developing countries, typically with 3 to 5 year holding periods.

• The Committee also visited with representatives from two International Small Cap Equity management firms: Highclere International Investors and Mondrian Investment Partners. Both firms invest in smallerfirms: Highclere International Investors and Mondrian Investment Partners. Both firms invest in smaller foreign companies that research has shown to be undervalued and that have strong balance sheets and cash flow potential.

• The Investment Committee recommends awarding the Emerging Market Equity allocation (up to $20 illi ) t G i d th I t ti l S ll C E it ll ti ( t $10 illi ) t M d imillion) to Genesis and the International Small Cap Equity allocation (up to $10 million) to Mondrian

Investment Partners. The Committee also discussed the volatile nature of these investments (higher risk accompanies higher earnings expectations) and recommends initial funding of $5 million for each manager.

• The new strategies will be largely funded from existing holdings in international funds (Artio and Dodge & Cox). RogersCasey recommends suspending the current monthly funding (approximately $2 million) from available cash flows and dedicate those funds to the new strategies and future portfolio rebalancing needs.

6


Defined Contribution Retirement Plan

• The Committee reviewed the performance of the 18 available funds in the Supplemental Retirement Plan.

• The assets totaled $370.9 million at March 31, 2010 compared to $351.0 million at December 31, 2009. The increase was due to $13.8 million of capital appreciation and income and net cash inflows of $6 1 millionof $6.1 million.

•Despite several funds underperforming for the quarter, all but four of the funds (Ranier Small/Mid Cap Equity, JPMorgan US Real Estate, Lord Abbett Small Cap Blend, and MFS Total Return) outperformed their respective benchmarks over the five year period ending March 31, 2010.

• The Committee will continue to monitor fund manager performance and make recommendations if deemed appropriate.

• The performance of the funds is summarized in the attached Appendix A.e pe o a ce o t e u ds s su a ed t e attac ed ppe d

7


Defined Contribution Retirement Plan – 1st Quarter Performance

S M R B h k I d Strategy Manager Return Benchmark IndexDomestic Equity American Beacon Lg Cap Value 6.58% 6.78% Russell 1000 Value Domestic Equity American Funds-Growth 4.17% 4.65% Russell 1000 Growth Domestic Equity Black Rock Mid Cap 8.27% 9.61% Russell Mid Cap Value Domestic Equity Buffalo Small Cap 10.77% 7.61% Russell 2000 Growth Domestic Equity Fidelity Contra Fund 3 60% 5 39% S&P 500Domestic Equity Fidelity Contra Fund 3.60% 5.39% S&P 500Domestic Equity Fidelity Spartan Ext Mkts 9.74% 9.82% Dow Jones Wilshire 4500 Domestic Equity Lord Abbett Small Cap Blend 7.47% 8.85% Russell 2000 Domestic Equity Ranier Small/Mid Cap 5.50% 8.81% Russell 2500 Growth Domestic Equity Royce Opportunity Fund 12.85% 10.02% Russell 2000 Value Domestic Equity Schwab S&P 500 5 42% 5 39% S&P 500Domestic Equity Schwab S&P 500 5.42% 5.39% S&P 500International Artio Global International II 0.60% 1.58% MSCI AC World ex USA International Oakmark International I 5.70% 1.43% MSCI World ex USA International Templeton World A 1.15% 3.35% MSCI AC World Fixed Income PIMCO Total Return 2.92% 1.78% Barclays Capital Aggregate Balanced MFS Total Return 3.63% 4.02% 60%S&P/40% Barclays Aggry ggSpecialty Fidelity Select Medical Delivery 8.97% 4.33% Dow Jones Healthcare Specialty JPMorgan US Real Estate A 10.29% 9.82% Dow Jones Wilshire REIT Other MetLife Stable Value/GIC* 0.84% 0.01% 90 Day T-Bill * Guaranteed current rate of 3.45%

8


Appendix A

Defined Contribution Retirement Plan – 1st Quarter 2010 Performance

9

10

11

Enterprise DocumentEnterprise DocumentEnterprise Document Enterprise Document Management and Imaging Management and Imaging

SolutionSolution

Project Update

SolutionSolution

Project UpdateEnterprise Document Imaging

Board of Directors

June 22 2010June 22, 2010

AgendaAgenda

Project GoalsOverview of FinalistsVendor Selection Process SummarySummarySummary of CostsR f S l tiReasons for SelectionRecommendation

2

Project GoalsProject Goals

C t d t l t i d t t t li d li i l• Capture and store non-electronic data to streamline and manage clinical and business processes in a common manner

• Provide an integrated, efficient workflow for physicians, clinical and non-li i l t ff ith d ll ti t i f ti ithi E iclinical staff with any and all patient information within Epic

• Support existing revenue cycle processes, including Epic integration for patient registration and billing

• Provide an enterprise-wide solution allowing deployment to other areas with minimal to no financial impact

• Support paperless processes and workflow within other departments whileSupport paperless processes and workflow within other departments while providing seamless integration with current applications

• Address paper-based documents that cannot be handled through departmental solutions in order to provide fully electronic solutionsdepartmental solutions in order to provide fully electronic solutions

Overview of Final VendorsVendors

COMPANY PROFILE Location of Headquarters Cleveland, OH Shawnee, KS Year founded 1991 1988Year imaging product d l d

1991 1995developedPercentage of ECM business 100% 100%Number of client

i ti8,300 clients 2,400 customers

organizationsPercent healthcare clients 7% healthcare 9% healthcare# Epic Clinical sites 50 2# Epic Financial sites 24 0# Lawson sites 24 150# PeopleSoft sites 35 225

Selection Process TimelineTimeline

Selection ProcessSelection Process• Review of RFP • ReferenceReview of RFP

responses (raw scores and

Reference evaluations

– 4 Written Evaluationsweighted scores)

• Review of RFP – 6 Reference Calls– 2 Site Visits

narrative responses• Evaluation of ease

f /d l

• Best and final offer reviews

of use/deployment• Evaluation of onsite

t ti

• Identification of Vendor of Choice

presentations

Summary of Costs

Vendor A Vendor BCategory One-Time

PurchaseAnnual

MaintenanceFive Year

CostOne-Time Purchase

Annual Maintenance

Five Year Cost

Hardware $306,384 $55,149 $582,130 $368,067 $66,252 $699,327

Software $1 500 000 $270 000 $2 850 000 $1 200 000 $240 000 $2 400 000Software $1,500,000 $270,000 $2,850,000 $1,200,000 $240,000 $2,400,000

Services $575,050 $575,050 $368,930 $368,930

Training $15,000 $15,000 $8,225 $8,225

Travel $115 000 $115 000 $48 000 $48 000Travel Expenses

$115,000 $115,000 $48,000 $48,000

TOTAL COSTS $2,381,434 $325,149 $3,555,050 $1,936,997 $306,252 $2,825,155

Summary of Evaluation ProcessEvaluation Process

PERCEPERCENT OF TOTAL

Vendor A Vendor BRank Score Rank Score

Company Characteristics 10% 2 20 2 20Women/Minority–Owned Business 5% 0 0 0 0Application Functional/Technical Requirements

RFP Responses 10% 1 10 2 20pDemonstrations 15% 2 30 1 15

Site Visit/Reference Calls 15% 2 30 1 15Ease of Use and Deployment 15% 2 30 1 15Ease of Use and Deployment 15% 2 30 1 155-Year Total Cost 30% 2 60 1 30

Vendor Final Ranking 2 180 1 115Vendor Final Ranking 2 180 1 115

Reasons for Chosen VendorVendor

• Implementation model is decentralized • Implementation timeframe was shorter• Implementation timeframe was shorter• Patented Technology• Scored higher in the following evaluation areas:Scored higher in the following evaluation areas:– Onsite presentations– Ease of Use evaluation– Site Visit EvaluationsSite Visit Evaluations

• Lower overall cost solution• Lawson and PeopleSoft integration • Future direction of healthcare solution • Functionally a better solution for Patient Financial

S i H R d d t tServices, Human Resources and document capture process

Recommended Vendor of ChoiceVendor of Choice

1. 3M2. Cerner

Vendor AVendor B Vendor C

3. CGI4. EDCO5. Hyland McKesson6. MedPlus7. Perceptive7. Perceptive8. Streamline Health

Vendor AVendor B

Vendor B Vendor B

Parkland New Hospital ConstructionOwner Controlled Insurance ProgramOwner Controlled Insurance Program

(OCIP)

Overview to Parkland Board MembersMarch 2009

Parkland New Hospital Construction

What is an Owner Controlled Insurance Program?g

Insurance purchased by the Owner for all activities of most of the ti i t t ti j b it f th d ti f thparticipants on a construction job site for the duration of the

construction and for some coverages extending past the date of occupancy of the facility.

Parkland New Hospital ConstructionParkland New Hospital Construction

What are the benefits of an Owner Controlled Insurance Program?Improved Insurance Coverages

Uniform CoveragesEnhanced Terms and ConditionsAdequate and Consistent LimitsAdequate and Consistent Limits

Availability of InsuranceCompleted Operations for the Statute of Repose

Control of Safety and Claims ManagementPrevention of LossesReduced cost by management of claim adjustments

Potential Cost SavingsReduced Premiums using buying cloutReduced Premiums using buying cloutLower premiums due to consolidated safety and claims management

Enhanced MWBE ParticipationAllows participation by those who might not otherwise have adequate insurance


What lines of coverage that can be included in an OCIP?

Workers Compensation

C i l G l Li bilitCommercial General Liability

Excess/Umbrella

Builders Risk

Professional/E&O

Pollution

Surety BondsSurety Bonds


Important Considerations:Commitment by the Owner to the OCIP.

Strong and efficient Administration by the Broker.

Control of Medical and First Aid on the Job site.

Possible Incentives for the CMAR to control claimsPossible Incentives for the CMAR to control claims.

Dispute Resolution for OCIP issues between Owner and Contractors.

Potential savings should not be the primary reason to use an OCIP.


Questions:

DALLAS COUNTY HOSPITAL DISTRICT: CONTRACTS > $200,000June 22, 2010

Item Service or Product Vendor Term

First Year/ Incremental

Contract AmountAggregate

Contract Amount Budgeted AdministratorROUTINE EXPENSE

1 Cardiac Cath Lab- Shared-Service Maintenance Contract GE Medical Systems 06/23/10 - 07/30/15 $190,495 $952,475 Yes Kurt Dierking

2 Outsource Coding and Abstracting Temporary and Permanent Placement Services Maxim Healthcare Services, Inc. 06/26/10 - 06/25/11 $1,400,000 $1,700,000 Yes Robin Stults

3 Viral Load Laboratory Testing Equipment and Supplies Roche Diagnostics Corporation 7/1/2010 - 06/30/15 $825,948 $3,561,432 Yes Vicki Crane

4 Outstation Eligibility Advisors Texas Health and Human Services Commission 09/01/10 - 08/31/11 $670,800 $670,800 Yes Richard Rhine

5 Dental Health ServicesTexas A&M University System Health Sciences (Baylor College of Dentistry)

09/01/10 - 08/31/14 $376,500 $1,506,000 Yes Sharon Phillips

6 Reimbursement Agreement for Resident Stipends and Fringe Benefits Department of Veterans Affairs 07/01/10 - 06/30/11 $9,876,148 $9,876,148 Yes Shelly R. Monks

7 First Amendment to Amelia Court Office Lease Agreement

The Board of Regents of the University of Texas System

04/01/10 - 03/31/11 $5,726 $68,706 Yes Walter B. Jones

8 Network and Cabling Services BlackBox, Inc. 12/01/09 - 06/30/10 $387,051 $387,051 Yes Jack Kowitt9 Change Orders #4 & #5 Structuretone Southwest 07/01/10 - 12/31/10 $388,138 $388,138 Yes Walter B. Jones

10New Parkland Professional Liability Insurance: Owner-Controlled Insurance Program

Zurich 07/01/10 - 12/31/14 $1,500,000 $2,975,000 Yes Walter B. Jones

REVENUE

REAL PROPERTY LEASES - REVENUE REQUIRES COURT APPROVAL

CAPITAL

NEW PARKLAND HOSPITAL CAPITAL

Page 1

CONTRACT RESOLUTIONBOARD OF MANAGERS

Be it resolved, the Parkland Health & Hospital System Board of Managers, by a vote of ________ Yes and ________ Nay, does by this resolution(adopt/reject) _________________ the following:

WHEREAS, PHHS management requested approval for certain contracts and approval/rejection is as checked below:

Approved Rejected Withdrawn Service or Product Vendor Contract Term

Aggregate Contract Amount

ROUTINE EXPENSECardiac Cath Lab- Shared-Service Maintenance Contract GE Medical Systems 06/23/10 - 07/30/15 $952,475

Outsource Coding and Abstracting Temporary and Permanent Placement Services Maxim Healthcare Services, Inc. 06/26/10 - 06/25/11 $1,700,000

Viral Load Laboratory Testing Equipment and Supplies Roche Diagnostics Corporation 7/1/2010 - 06/30/15 $3,561,432

Outstation Eligibility Advisors Texas Health and Human Services Commission 09/01/10 - 08/31/11 $670,800

Dental Health Services Texas A&M University System Health Sciences (Baylor College of Dentistry)

09/01/10 - 08/31/14 $1,506,000

Reimbursement Agreement for Resident Stipends and Fringe Benefits

Department of Veterans Affairs 07/01/10 - 06/30/11 $9,876,148

First Amendment to Amelia Court Office Lease Agreement

The Board of Regents of the University of Texas System 04/01/10 - 03/31/11 $68,706

Network and Cabling Services BlackBox, Inc. 12/01/09 - 06/30/10 $387,051 Change Orders #4 & #5 Structuretone Southwest 07/01/10 - 12/31/10 $388,138

New Parkland Professional Liability Insurance: Owner-Controlled Insurance Program

Zurich 07/01/10 - 12/31/14 $2,975,000

THEREFORE BE IT RESOLVED that the Parkland Health & Hospital System Board of Managers approves these contracts as noted

NEW PARKLAND HOSPITAL CAPITAL

June 22, 2010

PARKLAND HEALTH & HOSPITAL SYSTEMRESOLUTION NO. ______________________

REVENUE

REAL PROPERTY LEASES - REVENUE REQUIRES COURT APPROVAL

CAPITAL

THEREFORE, BE IT RESOLVED, that the Parkland Health & Hospital System Board of Managers approves these contracts as noted

Dated this 22nd of June, 2010.

_________________________________ _________________________________

Lauren McDonald, M.D., Chair Michael L. Silhol, Assistant Secretary

Louis A. Beecherl, III Yes _____ No _____ Abstain _____ Absent _____Dalton Lott Yes _____ No _____ Abstain _____ Absent _____Chris Luna Yes _____ No _____ Abstain _____ Absent _____

Lauren A. McDonald, MD Yes _____ No _____ Abstain _____ Absent _____Chad Park, BA, DDS Yes _____ No _____ Abstain _____ Absent _____

Cobie Russell Yes _____ No _____ Abstain _____ Absent _____Alan Walne Yes _____ No _____ Abstain _____ Absent _____

Budgeted

Yes

Yes

Yes

Yes

Yes

Yes

Yes

YesYes

Yes

Board Approval Request For

P:\KAREN LINDSEY\Board of Managers (D.S. files)\2010, 6-22\#3) Budget & Finance\#9) GE Medical Cath Lab Board Contract Summary 1a.doc 8311312: WD 07/04; RD 09/05, RD 10/05, RD 08/08

Contracts Over $200,000 Date: 05/26/10

Product or Service: Cardiac Cath Lab Shared-Service Maintenance Contract

Vendor/Supplier: GE Medical Systems

Selection Methodology: Sole Source

Price/Cost Validation: Negotiation

Revenue, Expense or Capital: Expense

Contract Dates: 06/23/10 - 07/30/15

Contract Price: $ 952,475

Is this contractor the lowest bidder/supplier? N/A The contract is for a shared-service agreement for maintenance for proprietary parts and software on the GE Cardiac Cath Labs. There are no alternative certain parts or software for these systems. The contract price reflects a cost avoidance of $369,275 for utilizing Parkland’s service staff and a multiyear discount.

Has this contract been reviewed and approved by Legal for legal sufficiency? Yes Does the contract have an “out” clause? Yes If “yes”, what is it? If “no”, why not? Either party may terminate with a 30 day written notice. Is this a grant-funded project or purchase? No If 100% of the related expenses are not covered by the grant, explain what expenses are not covered and why: Is Funding included in current FY Budget? Yes What percentage of this contract is WMBE? 0% N/A – GE Medical Systems is a publically owned and traded company. FTE Impact: No

Submitted By (Division VP): Kurt Dierking, MSHA, CHFM ,Vice President Facilities Support Services

DALLAS COUNTY HOSPITAL DISTRICT PARKLAND HEALTH & HOSPITAL SYSTEM BOARD BRIEFING DOCUMENT

SUBJECT: Cardiac Cath Lab Shared-Service Maintenance Contract VENDOR: GE Medical Systems COST: $952,475 Recommendation Approve the five year shared-service maintenance contract. Background The contract supports the maintenance, calibration, parts, and proprietary software for the Parkland Health & Hospital System Cardiac Cath Lab systems. With the shared-service agreement, the Clinical Engineering staff can be utilized to perform the preventive maintenance on the systems, reducing the downtime during peak hours of the department. Parts replaced in the last year totaled over $200,000 on two systems, one of which was under warranty. The contract price reflects a cost avoidance of $369,275, compared to a full service contract with GE over the five year period, by utilizing Parkland’s service staff combined with the multiyear discount.


SUBJECT: Outsource Coding and Abstracting Temporary and Permanent

Placement Services VENDOR: MAXIM Healthcare Services Inc. COST: $1,400,000 Amendment ($1,700,000 Total Contract) Recommendation Approve one year contract term renewal amendment. Background Coding and data abstracting services are essential to timely patient billing and cash flow. The Health Information Management Division of PHHS has insufficient resources to meet the growing demand for accurate and timely coding. At least fifty new coder positions must be added to meet current workload demand. Competition for skilled coding resources is strong and PHHS will need to utilize several outsource coding services to manage workflow and backlog. Failure to add the necessary resources will result in accounts receivable increases due to un-coded and unbilled accounts. A coder shortage exists nationally and recruitment is competitive. Outsource companies offer a variety of service options including local, remote, and traveling coders. PHHS will use a combination of these resources with a preference for local onsite support which will result in the MAXIM Healthcare Services Inc. contract increasing to $1,400,000 this year. The 2007 RFP from which these contracts flow articulated the intention for the resulting contracts to have a three-year term with two one-year options to renew. The competitive process was used to determine the best price for these services. The award was then given to one vendor and other vendors agreed to provide those same services for the same competitively bid price. This amendment is an exercise of one of the options to renew utilizing those competitively bid prices.

Board Approval Request For Contracts Over $200,000

Date: 05/26/10

Product or Service: Viral Load Laboratory Testing Equipment and Supplies

Vendor/Supplier: Roche Diagnostics Corporation



Revenue, Expense or Capital: Expense and Capital

Contract Dates: 07/0/10 – 06/30/15

Contract Price: $3,561,432

Is this contractor the lowest bidder/supplier? N/A Pursuant to Dallas County Code Section 78-66(7), the purchase of this equipment and the related supplies are excepted from the competitive process because it is sole source. Based on its review of publicly available Federal Drug Administration guidance, research and market analysis, the Pathology Department has concluded that the equipment, products and services provided by Roche are sole source because the Roche product is the only automated system that provides FDA-approved current generation (RT-PCR technology) molecular testing for HIV and HCV viral loads. Has this contract been reviewed and approved by Legal for legal sufficiency? Yes Does the contract have an “out” clause? Yes If “yes”, what is it? If “no”, why not? (1) Option to terminate once per year, with 90 days written notice. (2) In the event of loss of appropriated funding, 30 days written notice required. Is this a grant-funded project or purchase? No Is Funding included in current FY Budget? Yes What percentage of this contract is WMBE? 0% There are no WBME vendors for this type of laboratory equipment. FTE Impact: None

Submitted By (Division VP): Vicki Crane

P:\KAREN LINDSEY\Board of Managers (D.S. files)\2010, 6-22\#3) Budget & Finance\#13) Roche Viral Load Board Contract Summary 3a.doc 8311312: WD 07/04; RD 09/05, RD 10/05, RD 08/08, RD 10/01


SUBJECT: Viral Load Laboratory Testing Equipment and Supplies VENDOR: Roche Diagnostics Corporation COST: $3,561,432 Recommendation Approve a five year contract with Roche Diagnostics (Molecular Diagnostics Division) for the purchase of the capital equipment and operating supplies necessary to perform HIV and HCV viral load testing in-house, yielding a cost savings of $390,000. Background An important tool in the management of patients with HIV and Hepatitis C Virus (HCV) is the viral load test. A viral load test is the quantitative measurement of the number of virions in the patient’s blood. This information is used to assess the burden of infection and monitor the patient’s response to therapeutic interventions. Pathology currently refers samples for HIV and Hepatitis C Virus (HCV) viral load analysis to an outside laboratory. Viral loads are determined by real time polymerase chain reaction technology (RT-PCR). Annual testing volumes are approximately 14,000 for HIV and 2,400 for HCV. Technology improvements as well as decreasing costs for molecular testing now make this an attractive opportunity for performing these tests in-house. The new generation of analyzers is designed to contain the amplicons which result from the RT-PCR testing process, i.e. a “closed system”; so, this type of testing no longer requires dedicated controlled laboratory space. Robotics has automated several of the precision pipeting steps demanded by molecular testing thus reducing the technical labor requirements. Bringing this testing in-house will allow Parkland to realize $390,000 in savings over five years. On-site testing will also improve turnaround times by eliminating the inherit delays in sending samples to another laboratory as well as by allowing for the automated entry of results into Cerner and EPIC. This means earlier opportunities for clinical intervention in the care of the patient while at the same time providing a better value for our taxpayers. 1

2

Financials

Year 1 Year 2 Year 3 Year 4 Year 5 TOTAL

Capital equipment 182,501 --- --- --- --- 182,501

Reagents and Supplies* 643,447 659,072 675,230 691,944 709,238 3,378,931

Total Expenses 825,948 659,072 675,230 691,944 709,238 3,561,432Less current reference lab expense 755,188 772,463 790,294 808,706 827,721 3,954,372

Net Savings -70,760 113,391 115,064 116,762 118,483 392,940 * Assumes an annual test volume increase of 1.5% and 5% for HIV and HCV, respectively. Vendor Selection Pursuant to Dallas County Code Section 78-66(7), the purchase of this equipment and the related supplies are excepted from the competitive process. Based on its review of publicly available Federal Drug Administration guidance, research and market analysis, the Pathology Department has concluded that the equipment, products and services provided by Roche are sole source because the Roche product is the only automated system that provides FDA-approved current generation (RT-PCR technology) molecular testing for HIV and HCV viral loads. RT-PCR is the gold standard for viral load testing because the analytic range is vastly when compared to branching DNA technology (bDNA) HIV-1 HCV bDNA 75-500,000 copies/ml 615-7,690,000 IU/ml RT-PCR 48-10,000,000 copies/ml 43-69,000,000 IU/ml The lower limits of detection allow for the clinician to detect treatment failure earlier, and the higher limits of detection allow clinicians that have patients with extremely high viral loads to see the results of drug therapy that much sooner. A market analysis was conducted; the three potential vendors were evaluated: Roche Diagnostics, Vendor B, and Vendor C. Cost comparisons were also made to the major reference labs.

Market Analysis Major Criteria Cost/Test

Vendor

HIV and HCV

assays Automated

System RT-PCR

technology HIV HCV Rank Roche yes yes yes $35.43 $59.26 1 Vendor B no yes yes unavailable unavailable FF Vendor C yes yes no $39.98 $48.91 FF

Reference Lab Pricing

Quest* yes yes Roche $43.86 $59.00 Mayo yes yes Roche $99.00 $165.00 ARUP yes yes Roche $110.25 $99.23

* Current Vendor

3

1. Vendor B offers RT-PCR technology but does not have FDA approval for both

assays. Due to the regulatory burden of not doing so, Parkland Pathology only utilizes FDA approved assays.

2. Vendor C offers an earlier generation of viral load technology (branching DNA PCR) which does not meet Parkland’s needs for the following reasons: a. For both HIV and HCV assays, the range of virus detection is too narrow at

both the low and high ends of the spectrum to meet our patient management needs.

b. Current patients would have to be re-tested with branching DNA technology in order to establish a viral load baseline; estimated cost is $200,000.

c. Viral loads which fall outside the narrower assay range would have to be sent to a reference lab for testing. This would create an on-going additional expense as well as a potential delay in patient care at a critical intervention point.

d. This assay requires 50% more time to perform. 3. Only Roche Diagnostics offers FDA approved assays for the detection of HIV

and HCV using RT-PCR technology. In addition, the Roche system offers advantages in workflow, throughput, and automation. The proposed system also has the flexibility and throughput to accommodate additional assays in the future.

Contract Options Two contract proposals from Roche were evaluated, a capital equipment purchase option and a reagent rental option. The purchase option is recommended. Reagent rental would cost an additional $96,000 and offers no advantage. Expenses 1. In the proposed contract, supply costs are guaranteed not to increase for five years.

Additionally, there are pre-negotiated discounts in place for supplies should testing volume increase.

2. The Immunology Laboratory is able to perform this new testing with no new FTE’s because of the automation of the complex specimen pipeting steps which this system offers.


P:\KAREN LINDSEY\Board of Managers (D.S. files)\2010, 6-22\#3) Budget & Finance\#15) HHSC Board Contract Summary 4a.doc 8311312: WD 07/04; RD 09/05, RD 10/05, RD 08/08

Date: 05/26/10

Product or Service: Outstation Eligibility Advisors

Vendor/Supplier: Texas Health & Human Services Commission


Price/Cost Validation: Sole Source


Contract Dates: 09/01/10 - 08/31/11

Contract Price: $670,800

Is this contractor the lowest bidder/supplier? No, Sole Source If not, then what is the premium that will be paid for this contract over the lowest bidder? Please provide an explanation for not selecting the lowest bidder. For all contracts, please provide a comparison of the bids received (both dollars and criteria). The state’s Health & Human Services Commission is responsible for certifying individuals for Medicaid benefits.

Has this contract been reviewed and approved by Legal for legal sufficiency? Yes Does the contract have an “out” clause? Yes If “yes”, what is it? If “no”, why not? Either party may terminate this contract for convenience with 30 days notice. Is this a grant-funded project or purchase? No Is Funding included in current FY Budget? Yes What percentage of this contract is WMBE? 0 % Sole Source Contractor FTE Impact: NA

Submitted By (Division VP): Richard Rhine

P:\KAREN LINDSEY\Board of Managers (D.S. files)\2010, 6-22\#3) Budget & Finance\#15) HHSC Board Contract Summary 4a.doc 8311312: WD 07/04; RD 09/05, RD 10/05, RD 08/08


SUBJECT: Outstation Eligibility Advisors VENDOR: Texas Health & Human Services Commission COST: $670,800 Recommendation Approve this contract. Background Under Title XIX of the Social Security Act, Texas HHSC employees qualify eligible Parkland patients for Medicaid assistance. Parkland participates in a joint venture with the Commission to provide these services throughout the system. Parkland contributes one-half of the wages and benefits for the advisors and workspace in the hospital and clinics.


Date: 05/26/10

Product or Service: Dental Health Services

Vendor/Supplier: Texas A&M University System Health Sciences Center (Baylor College of Dentistry)

Selection Methodology: Exception to Competitive Process

Price/Cost Validation: Market Analysis


Contract Dates: 09/01/10 – 08/31/14

Contract Price: $1,506,000 (Total Contract) $376,500 (First Year)

Is this contractor the lowest bidder/supplier? Yes, contract is provided for cost. The department has utilized an exception to the competitive process pursuant to Dallas County Code 78-66(6) allowing for an exception where “Certain professional services including physician/professional medical services, or consultants, where obtaining these services through the competitive process is not practical.” Has this contract been reviewed and approved by Legal for legal sufficiency? Yes Does the contract have an “out” clause? Yes If “yes”, what is it? Either party may terminate with a 60 day notice. Is this a grant-funded project or purchase? No Is Funding included in current FY Budget? Yes What percentage of this contract is WMBE? N/A FTE Impact: None

Submitted By (Division VP): Sharon Phillips

P:\KAREN LINDSEY\Board of Managers (D.S. files)\2010, 6-22\#3) Budget & Finance\#17) Tx A&M Baylor Board Contract Summary 5a.doc 8311312: WD 07/04; RD 09/05, RD 10/05, RD 08/08


SUBJECT: Dental Health Services VENDOR: Texas A&M University System Health Sciences Center

(Baylor College of Dentistry) COST: $1,506,000 Total Contract ($376,500 First Year) Recommendation Approve this one year contract for dental services at two Dallas County jail locations. The department has utilized an exception to the competitive process pursuant to Dallas County Code 78-66(6) allowing for an exception where “Certain professional services including physician/professional medical services, or consultants, where obtaining these services through the competitive process is not practical.” Background The cost of this contract is remaining the same as the previous year, and Baylor has agreed to keep the price the same for three extensions in the next three years. Baylor requires separate contracts for each location. Baylor College of Dentistry has provided dental services to Dallas County inmates for the past four years. The current staffing plan includes a full-time (five days/week) dental team (Team 1; 100% FTE dentist and assistant) in Lew Sterrett and a second team (Team 2; 100% FTE dentist, 100% Dental Assistant/Clinic Manager and 100% FTE assistant) based in the Kays clinic. Team 2 currently treats patients two days per week in the Kays clinic and provides limited care (primarily triage) two days per week on various floors in Sterrett. The triage approach addresses treatment requests that are limited in scope and allows for prioritizing cases requiring treatment in the Sterrett clinic. Fiscal year 2011 includes funding for 100% of both a Dental Director and a second dentist. Overall contract cost remains the same.

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Should we attempt to bring this program in-house, salary surveys suggest that we would not be able to find dentists who will work in the jail for less than $125,000/year, which is what Baylor is asking in salaries for their dentists. They do not have an easy time recruiting staff for the jail program, and they obviously have many connections in the dental community that we do not have. Most dental students enter dental school with the goal of opening their own practices and are not interested in employment in a correctional facility. Baylor staffs the jail with students who are licensed dentists that have returned to school to obtain advanced degrees. Parkland would not have access to these students without the Baylor connection. We assessed bringing the program in-house, but the cost would be greater than the contract rate.

Baylor is doing this for cost. As a State school, they are not required to demonstrate a profit to be viable. As demonstrated below, we are only charged for salaries and supplies. They bring their dental and correctional programs expertise to the jail with no additional expense to us. Any private vendor would be forced to build a profit into their pricing structure. For these reasons we believe that a continued partnership with Baylor School of Dentistry is the best way for PHHS to meet the dental needs of inmates in the jail. Financials The total cost for FY10 is slightly less than FY11 which include an additional dental assistant. FTE FY 2010 FTE FY 2011 Dental Director 10% $16,000 Dental Director 100% $128,000 Dentist 1 90% $112,500 Dentist 1 100% $125,000 Dentist 2 100% $125,000 n/a Clinic Mgr 100% $58,350 Manager 100% $28,500 Dental Asst 1 100% $34,666 Dental Asst 1 100% $32,500 Dental Asst 2 n/a Dental Asst 2 100% $32,500 Supplies $30,000 $30,000 Total $376,516 $376,500


P:\KAREN LINDSEY\Board of Managers (D.S. files)\2010, 6-22\#3) Budget & Finance\#19) VA Board Contract Summary 6a.doc 8311312: WD 07/04; RD 09/05, RD 10/05, RD 08/08, RD 10/01

Date: 05/25/10

Product or Service: Reimbursement Agreement for Resident Stipends and Fringe Benefits

Vendor/Supplier: Department of Veterans Affairs

Selection Methodology: NA

Price/Cost Validation: NA

Revenue, Expense or Capital: Revenue

Contract Dates: 07/01/10 – 06/30/11


Is this contractor the lowest bidder/supplier? NA - Revenue If not, then what is the premium that will be paid for this contract over the lowest bidder? Please provide an explanation for not selecting the lowest bidder. For all contracts, please provide a comparison of the bids received (both dollars and criteria). Parkland Health & Hospital System and the Department of Veterans Affairs have a long-standing relationship that provides Parkland Health & Hospital System’s employed House Staff to complete clinical activities with the Department of Veterans Affairs. Has this contract been reviewed and approved by Legal for legal sufficiency? Yes Does the contract have an “out” clause? Yes, either party may terminate with a 90 day notice. Is this a grant-funded project or purchase? No Is Funding included in current FY Budget? Yes What percentage of this contract is WMBE? N/A FTE Impact: None

Submitted By (Division VP): Shelly R. Monks, Vice President of Medical Affairs


SUBJECT: Reimbursement Agreement for Resident Stipends and Fringe Benefits VENDOR: Department of Veterans Affairs COST: $9,876,148 Recommendation Approve as submitted. Background The Dallas County Hospital District d/b/a Parkland Health & Hospital System and the Department of Veterans Affairs have a long-standing relationship that provides the Parkland Health & Hospital System's employed House Staff to complete clinical activities with the Department of Veterans Affairs. The July 1, 2010 - June 30, 2011 Reimbursement Agreement for Resident Stipends and Fringe Benefits allows the Department of Veterans Affairs to reimburse Parkland Health & Hospital System for the stipends and fringe benefits of Parkland Health & Hospital System employed House Staff that complete clinical activities with the Department of Veterans Affairs. Each month there are approximately 159 FTEs of Parkland Health & Hospital System employed House Staff that complete clinical activities with the Department of Veterans Affairs.


Date: 06/22/10

Product or Service: First Amendment to Amelia Court Office Lease Agreement

Lessee: The Board of Regents of the University of Texas System

Selection Methodology: NA

Price/Cost Validation: Fair Market Value

Revenue, Expense or Capital: Revenue

Contract Dates: 04/01/10 – 03/31/11

Total Revenue: $68,706 Amendment

Is this contractor the lowest bidder/supplier? NA – Revenue

Has this contract been reviewed and approved by Legal for legal sufficiency? Yes Does the contract have an “out” clause? Yes, either party may terminate with 6 months prior written notice. Is this a grant-funded project or purchase? No Is Funding included in current FY Budget? Yes What percentage of this contract is WMBE? 0 %

Submitted By (Division VP): Walter B. Jones

P:\KAREN LINDSEY\Board of Managers (D.S. files)\2010, 6-22\#3) Budget & Finance\#21) Board of Regents UT Amelia Ct. Board Contract Summary 7a.doc 8311312: WD 07/04; RD 09/05, RD 10/05, RD 08/08


ACTION ITEM DATE: June 22, 2010 SUBJECT: First Amendment to Amelia Court Office Lease Agreement LESSEE: The Board of Regents of the University of Texas System TERM: One Year Extension of Existing Lease REVENUE: $68,706 Amendment Recommendation Approve this first amendment to office lease agreement for Amelia Court. Background UT Southwestern currently leases a 3,817 SF clinical office space in Parkland’s Amelia Court Professional Building for the operation of their HIV Research Clinic. This amendment will retroactively extend the original term, which expired March 31, 2010 by one year to a new expiration date of March 31, 2011. Details and Financials Type of Lease: Full Service Effective Date: April 1, 2010 Expiration Date: March 31, 2011 Improvement Allowance: None Additional Option to Extend: One year by written agreement of the parties at then-current lease rates All other terms and conditions remain unchanged. Rent: $18.00/SF $5,725.50/month $68,706/year


Date: 06/02/10

Product or Service: Network and Cabling Services

Vendor/Supplier: BlackBox, Inc.



Revenue, Expense or Capital: Capital

Contract Dates: 12/01/09 – 06/30/10

Contract Price: $387,051

Is this contractor the lowest bidder/supplier? N/A This request is to approve additional services for which the need was discovered during BlackBox’s performance of it’s competitively bid services.

Description Cost Hospital Network Upgrade (Wireless implementation) $162,1312SS Observation Unit (Low Bidder) 129,538IP Clin Doc Phase II (cabling for devices in HOD, OPC areas) 118,515Urban Taco repairs 10,485Renovation of Administration hallways 13,586Moves, Adds, Changes 12,796Credit (60,000) Total $387,051

Has this contract been reviewed and approved by Legal for legal sufficiency? Yes Does the contract have an “out” clause? Yes Is this a grant-funded project or purchase? No Is Funding included in current FY Budget? Yes What percentage of this contract is WMBE? 0% FTE Impact: None

Submitted By (Division VP): Jack P. Kowitt, SVP & CIO

P:\KAREN LINDSEY\Board of Managers (D.S. files)\2010, 6-22\#3) Budget & Finance\#23) BlackBox Board Summary 8a.doc 8311312: WD 07/04; RD 09/05, RD 10/05, RD 08/08


SUBJECT: Network and Cabling Services VENDOR: BlackBox, Inc. EXPENSE: $ 387,051 Recommendation Approve BlackBox services. Background In 2008, Parkland issued an RFP to supply and install a wireless antenna system to support the EPIC installation as well as additional future services, e.g. cellular, first responder radio, etc. BlackBox was the successful bidder and received Board approval for $3,100,000. This request covers additional services that were necessary in the installation and tuning of the wireless antenna system, as well as other projects that required expansion and repair of the antenna. The tasks comprising this payment request are shown and explained below.

Description Cost Hospital Network Upgrade (Wireless implementation) $162,1312SS Observation Unit (Low Bidder) 129,538IP Clinic Doc Phase II (cabling for devices in HOD, OPC areas) 118,515Urban Taco repairs 10,485Renovation of Administration hallways 13,586Moves, Adds, Changes 12,796Credit (60,000) Total $387,051

Additional antenna installation work was required due to the restrictive sizes of our network closets, which made in necessary for BlackBox to install a substantial number of access points (868) in a limited number of closets (28). In the process of remediating this issue, Parkland IT negotiated significant reductions of over $400,000 from BlackBox and other vendors involved in the remediation, reflecting their involvement in factors creating additional work. Specifically, closet size resulted in issues between access points because of the close proximity of each to another. In order to remediate the issues, each access point had to be enclosed in a mesh RF shield and special grounded network cables needed to be installed. The overall timeframe for troubleshooting and resolving this issue has been approximately ten months.

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The remaining work covers other construction projects requiring antenna services and/or cabling, i.e., the 2SS observation unit (for which BlackBox was the low bid vendor for cabling), continuing EPIC rollouts, emergency repairs caused by damage to the antenna during the renovation of the Urban Taco area, and the need to relocate parts of the antenna during the renovation of the Administration areas and the hallway on the first floor.

Board Approval Request For Change Order Approval

#25) StructureTone CO#4&5 Board Summary 9a 8311312: WD 07/04; RD 09/05, RD 10/05, RD 08/08

Date: 06/22/10 Product or Service: Change Orders #s 4 and 5

Vendor/Supplier: Structuretone Southwest

Selection Methodology: Existing Contract



Change Order Dates: 07/01/10 – 12/31/10

Change Order Price: $388,138

Is this contractor the lowest bidder/supplier? NA Change Order #4 is an unbudgeted change order for the construction relating to various design changes on the project.

Change Order #5 is an unbudgeted change order for the construction for some minor electrical work and to repair latent conditions on HVAC and sprinkler systems uncovered during construction.

The budget for Project 17571 has sufficient funds to cover the work in these change orders.

Has this contract been reviewed and approved by Legal for legal sufficiency? Yes, however, these are unbudgeted change orders on Structuretone’s existing contract for renovation of the Sterile Processing Department Spaces.

Does the contract have an “out” clause? Yes, termination for convenience and default clauses.

Is this a grant-funded project or purchase? No

Is Funding included in current FY Budget? Yes, Project No. 17571. Overall project is within budget although these are unplanned change orders.

What percentage of this contract is W/MBE? 30%

T&B Demolition 15105048933600, Terrell Glass: WFWB3754N0509, Flooring Perfections: WFDB339237Y1109, Naylor Commercial: WFWB1946N0604, Texas Specialties: WFWB43744Y1210, Roderick Lee: BMDB42003N0310, Real Network Services, Inc.: HMDB42251Y0910, Dallas Security: WFWB42535N0910

FTE Impact: NA

Submitted By (Division VP): Walter B. Jones, SVP Facilities Planning & Development


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SUBJECT: Change Orders #4 & #5 VENDOR: Structuretone Southwest COST: $388,138 Recommendation Approve Change Order #s 4 and 5 for the Sterile Processing (SPD) Renovation Project. Background

The original contract for the Sterile Processing Renovation project was awarded to Constructor’s & Associates Inc. for $785,314 after approval by the Board of Managers in February 2010. On April 1, 2010, Constructors & Associates, Inc. changed their name to Structuretone Southwest.

To date, three (3) change orders have been issued on Structuretone’s contract as shown in this table.

Signed and Executed Change Orders To Date Change Order # Purpose ApprovedOriginal Contract Construction Services $785,314

CO #1 Additional General Conditions $2,666CO #2 Hot water piping replacement $65,316CO #3 $78,975

Total Contract Value to Date: $932,271

Change Orders 4 and 5 are presented herein for approval and are for construction work to incorporate design changes required by the SVP for Surgical Services and Director for Ambulatory Surgery Center and the Texas Department of Safety Health Services (TDSHS), and latent defects identified during construction.

Proposed Change Orders Change Order # Purpose Requesting Approval

#4 Design Adjustments $295,229

#5 Code Adjustments and latent condition repair work $92,909

Total Value of Proposed Change Orders #4 and #5 $388,138

Total Contract Value to Date with Change Orders #4 and #5 $1,320,409


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Change Order #4 covers design revisions that create a small decontamination space for specialty items, a new D.I. water system, an enlarged sterile supply space, a dedicated corridor for soiled case cart transport, and a small Staff Lounge/Coffee Bar.

• Architectural Items in Change Order #4 include: washer equipment (and supporting water treatment system/Water Heater), 3-Compartment sink, scope cleaner (Medivator) and storage drying racks, pass thru window, pack/prep table; ante room to support staff traffic between clean and decontamination areas; Automatic sliding doors (3); New hard ceiling in the enlarged decontamination and sterile processing areas; Construction of 150LF of new partition to deck above in lieu of use of existing walls; New Floor finishes in all areas-previous plan maintained and patched (to protect kitchen below). The new decontamination area will be a 'self leveling' poured floor material. Also added are automatic door controls /card readers.

• Mechanical, Electrical and Plumbing Items in Change Order #4 include a new Seimens water treatment system and water heater. The existing HVAC mechanical systems support the new layout but with new SF the capacity is increased. Power, drain and water utilities to support the new Washer, clinical sink, medivator. New Light fixtures & sprinkler heads will be replaced due to rust and age of equipment.

Change Order #5 covers the costs associated with floorplan adjustments mandated by TDSHS after final review by a second reviewer; and the costs to replace corroded and leaking HVAC piping, sprinkler piping and sprinkler heads, and resolve moisture problems with the floor slab over the kitchen area (latent conditions); and costs to add additional switches and electrical and data outlets.

The budget for Project 17571 has sufficient funds to cover this change order work.

Board Approval Request For Change Order Approval

#27) Zurich (Prof Liability Ins) Board Summary 10a 8311312: WD 07/04; RD 09/05, RD 10/05, RD 08/08

Date: 06/22/10 Product or Service: New Parkland Professional Liability Insurance: Owner-Controlled Insurance Program (OCIP)

Vendor/Supplier: Zurich

Selection Methodology: Competitive

Price/Cost Validation: Best Value/Low Price


Contract Dates: 6/1/10 – 12/31/14


Is this contractor the lowest bidder/supplier? Yes

Has this contract been reviewed and approved by Legal for legal sufficiency? Yes

Does the contract have an “out” clause? Yes

Is this a grant-funded project or purchase? No

Is Funding included in current FY Budget? Yes, Project No. 17558.

What percentage of this contract is W/MBE? 0%

No WMBE insurance underwriters were found nor submitted for this competitive procurement.

FTE Impact: NA

Submitted By (Division VP): Walter B. Jones, SVP Facilities Planning & Development


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SUBJECT: New Parkland Professional Liability Insurance: Owner-Controlled

Insurance Program (OCIP) VENDOR: Zurich COST: $2,975,000 Background In December 2008, Parkland retained Bill Hammond, Cardinal Risk Management Alternatives, Inc., to assist with development and implementation of the indemnification and insurance coverages for the New Parkland Construction Program.

In March 2009, Mr. Hammond briefed Board of Manager’s Facilities Subcommittee members on OCIP (Owner-Controlled Insurance Programs). The briefing is also attached hereto.

Since March 2009, all of the major contracts let thus far for services in the New Parkland Program contain the same insurance and indemnification language and requirements.

In August 2009, the Board approved a contract with Marsh USA to serve as the insurance broker for the New Parkland Program. Marsh’s responsibilities include: designing, marketing, and implementing General Liability, Workers' Compensation and Employers' Liability, Builders' Risk, Environmental Liability, and Architects, Engineers and Design Professionals Errors and Omissions insurance coverages. Marsh’s responsibilities also include providing: an on-site administrator to interface with Parkland and contractors and others; an on-site safety manager; and claims management services after placement of the policies.

In March 2010, Marsh went to the insurance underwriting marketplace on behalf of Parkland for proposals for Architects, Engineers and Design Professionals Errors and Omissions insurance coverages.

• The Professional Liability insurance proposal for the New Parkland Hospital has been negotiated with Zurich. Marsh approached six insurance carriers. The finalists, willing to provide primary coverage for both the A&E's and Contractors, were Zurich and Lexington (formerly AIG). Marsh is recommending Parkland accept one of the two proposed alternatives by Zurich. There will be two separate policies sharing the limits selected from these two alternatives:

Project Specific Professional Liability (PSPL) (i.e., for the Design portion) -$20M limit $1M retention $2,200,000 -$20M limit $1.5M retention $2,000,000 Owner Protective Professional Liability (OPPI) (i.e., for the CM's, etc) -$20M limit $1M retention $1,750,000 -$20M limit $1.5M retention $ 975,000 Combined Total for Both Policies -$20M limit $1M retention $3,950,000 -$20M limit $1.5M retention $2,975,000


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• The coverage proposed by Zurich is unique in that it provides Professional Liability coverage for both the Architects & Engineers as well as design work done by the Contractors. According to Marsh and Cardinal Risk Management Alternatives, Zurich offered the best premium, deductibles, terms and conditions.

• This approach is not normally done on large OCIP projects. Cardinal Risk Management and Marsh representatives indicate that it is a tribute to this Parkland Project that underwriters are willing to propose these coverages for both the Architects & Engineers as well as the Contractors. Parkland, with this approach, will eliminate much if not all claim disputes as to the source or responsibility of Professional Liability claims. The coverage for both the A&E's and Contractors are with the same carrier and it becomes a matter as to which policy Zurich will use to pay the claim.

• There will be two separate policies sharing the limits from the alternative that is chosen.

• Staff recommends that the Board approve the $20M / $1.5M retention /$2,975,000 alternative.

In May 2010, Marsh went back into insurance underwriting marketplace for General Liability, Workers' Compensation and Employers' Liability, Builders' Risk, and Environmental Liability Insurance.

• On June 2, 2010, Parkland hosted a pre-proposal conference for the insurance writers for these coverages.

• Marsh will receive proposals for these policies on June 25, 2010.

• Recommendations and premiums for these insurance coverages will be submitted for approval at Board meetings in July 2010.

What will the General Liability, Workers' Compensation and Employers' Liability, Builders' Risk, and Environmental Liability cost? Marsh and Cardinal Risk Management both estimate that this coverage will range between 3% and 4% of the hard cost of work. The table presents a range of possible premiums.

Range of Potential Premiums Hard Cost of Work 3% 4%

$875,000,000 $26,250,000 $35,000,000 $900,000,000 $27,000,000 $36,000,000 $925,000,000 $27,750,000 $37,000,000 $950,000,000 $28,500,000 $38,000,000

How much would standard non-OCIP Insurance cost? Standard non-OCIP coverages would cost a minimum of between 3 and 4% of the cost of work. The disadvantage to this approach would be a lack of consistent Limits, Coverages, Deductibles and Safety coordination. Further it would preclude some MWBE contractors from participation due to their inability to provide the required insurance.


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Parkland New Hospital ConstructionOwner Controlled Insurance Program

(OCIP)

Overview to Parkland Board MembersMarch 2009


What is an Owner Controlled Insurance Program?

Insurance purchased by the Owner for all activities of most of the participants on a construction job site for the duration of the construction and for some coverages extending past the date of occupancy of the facility.


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What are the benefits of an Owner Controlled Insurance Program?Improved Insurance Coverages

Uniform CoveragesEnhanced Terms and ConditionsAdequate and Consistent Limits

Availability of InsuranceCompleted Operations for the Statute of Repose

Control of Safety and Claims ManagementPrevention of LossesReduced cost by management of claim adjustments

Potential Cost SavingsReduced Premiums using buying cloutLower premiums due to consolidated safety and claims management

Enhanced MWBE ParticipationAllows participation by those who might not otherwise have adequate insurance


What lines of coverage that can be included in an OCIP?

Workers Compensation

Commercial General Liability

Excess/Umbrella

Builders Risk

Professional/E&O

Pollution

Surety Bonds


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Important Considerations:Commitment by the Owner to the OCIP.

Strong and efficient Administration by the Broker.

Control of Medical and First Aid on the Job site.

Possible Incentives for the CMAR to control claims.

Dispute Resolution for OCIP issues between Owner and Contractors.

Potential savings should not be the primary reason to use an OCIP.


Questions:

Parkland Health & Hospital SystemCONTINGENCY CAPITAL REQUESTSFor June 2010 Board Meeting

Ref # Division Amount Description Explanation

1 Surgical Services

$328,000 Sterrad & Medivator Sterile Equipment

The current Steris sterilizer system has lost FDA approval and the FDA has set a time line of June 2010 for all equipment removal.

2 Information

Technology$600,000 Evaluation of criteria and

related programming to meet eligibility requirements for ARRA Stimulus funding

Evaluation of criteria and the related programming changes to meet eligibility requirements for ARRA Stimulus funding. Project funding was budgeted for EPIC Beacon, Stork and ICU functionality in 2009. The Stork and ICU functionalities were implemented as part of the EPIC Clinical Documentation project, and the Beacon module will be budgeted and implemented at a later date. This request is to reallocate the $600,000 budgeted for the EPIC Beacon, Stork/ICU project to the EPIC Meaningful Use Analysis and Implementation project.

3 Surgical Services

$420,000 Operating Room #4 Currently Operating Room (OR) 4 is a "Urology Only" OR because of the fixed urological equipment that is housed in the room. Once we remove the fixed equipment and control desk from the room, we would be able to install a general table and do almost any case in that room. This should allow for an additional 400 cases in the Main OR.

4 Surgical Services

$400,000 2 East Renovation To add more beds to the medical/surgery areas, 2 East will be renovated and turned into a surgical unit. Currently, the floor houses day surgery patients and is not equipped to function as an inpatient floor. This renovation should give Parkland an additional 24 beds for medical/surgical patients. We continue to have patients in the Emergency Department waiting for beds, and this renovation should help relieve some of the capacity issues we are experiencing.

1,748,000$

P:/Accounting/Capital/FYE 2008/Transfers/#29) Contingency Capital Requests 2010_06 06/17/2010

DALLAS COUNTY HOSPITAL DISTRICT PARKLAND HEALTH & HOSPITAL SYSTEM RESOLUTION

JUNE 22, 2010 ______________________________________________________________________________

Services*Training*Officers*Prosecutors (S.T.O.P.) Violence Against Women Recovery Act Grant

OVERVIEW: This proposal is for new funding from the Victims of Crime Act funds through the Office of the Governor, Criminal Justice Division. The program is to assist in developing and strengthening effective law enforcement and prosecution strategies to combat family violence, sexual assault, stalking and dating violence and to develop and strengthen victim services in such cases. The Services*Training*Officers*Prosecutors (S.T.O.P.) Violence Against Women Recovery Act (VAWA Recovery Act) Regional Training for Early Responders grant program is to train early responders to provide effective interventions for rape victims which will lessen trauma for victims. Training will also help improve sexual assault reporting rates, enhance victim cooperation with law enforcement and prosecution, and improve evidence collection and preservation. The grant period is from April 1, 2010 through March 31, 2011. The grant award amount is $76,459. The Criminal Justice Division requires a Board resolution approving submission of this grant and naming an Authorized Official.

DALLAS COUNTY HOSPITAL DISTRICT PARKLAND HEALTH & HOSPITAL SYSTEM RESOLUTION

____________________________________________________________________________________________

Grant Application Confirmation Number: 22965-01

WHEREAS, The Dallas County Hospital District Board of Managers finds it in the best interest of the citizens of Dallas County that the Services*Training*Officers*Prosecutors (S.T.O.P.) Violence Against Women Recovery Act (VAWA Recovery Act) Regional Training Program for Early Responders be operated for the grant period of April 1, 2010 through March 31, 2011; and WHEREAS, The Dallas County Hospital District Board of Managers agrees that in the event of loss or misuse of the Criminal Justice Division funds, Dallas County Hospital District assures that the funds will be returned to the Criminal Justice Division in full; and WHEREAS, The Dallas County Hospital District Board of Managers has authorized the Vice President of Finance and Controller as the grantee’s authorized official. The authorized official is given the power to apply for, accept, reject, alter or terminate the grant on behalf of the applicant agency. NOW THEREFORE, BE IT RESOLVED that Dallas County Hospital District Board of Managers approves submission of the grant application for the VAWA Recovery Act Regional Training Program for Early Responders to the Office of the Governor, Criminal Justice Division. Dated the________ day of _____________, 2010. __________________________________ _____________________________________ Lauren McDonald, M.D., Chair Michael L. Silhol, Assistant Secretary ______________________________________________________________________________ Louis A. Beecherl, III Yes________ No________ Abstain________ Absent________ Dalton Lott Yes________ No________ Abstain________ Absent________ Chris Luna Yes________ No________ Abstain________ Absent________ Lauren A. McDonald, M.D. Yes________ No________ Abstain________ Absent________ Chad Park Yes________ No________ Abstain________ Absent________ Cobie Russell Yes________ No________ Abstain________ Absent________ Alan Walne Yes________ No________ Abstain________ Absent________

Parkland Health & Hospital SystemFunds to be Remitted to the Parkland FoundationRequests from April 30, 2010 to May 24, 2010

Ref #Requesting

Division Amount Origination of Funds Reason for transfer 1 Finance $330.00 Employee payroll

deductionsEmployee deductions for Family Fund. Family Fund is administered by the Foundation.

2 Finance $80.00 Employee payroll deductions

Employee deductions for Burn Camp. Burn Camp is administered by the Foundation.

3 Finance $2,931.08 Employee payroll deductions

Employee deductions for I Stand For Parkland program, which is administered by the Foundation.

4 Finance $2,450.00 Employee payroll deductions

Employee deductions for emergency loans to employees, which is administered by the Foundation.

$5,791.08

P:Acctg/Fixed Assets/#32) Foundation Funds Transfers 5-1006/17/2010Page 1 of 1

Purchasing Activity ReportPurchasing Activity ReportParkland Health & Hospital System

June 2010

Prepared by: Supply Chain

Table of Contents

Emergency Purchases and Sole Sources Page 3Emergency Purchases and Sole Sources Page 3(Fiscal Manual 8311‐2‐07 & 8311‐2‐08)

Procurement of Consulting and Professional Services Page 4(Fiscal Manual 8311‐2‐22)

Non‐Compliance with Purchasing Requisition Policy Page 5‐6(Fiscal Manual 8311‐2‐04 – Purchasing Requisitions)

MWBE Participation Page 7

Yellow indicates an MWBE supplier.

Emergency Purchases & Sole Sources

D t D t tDescription of Product or Vendor or Service

Category (Emergency Dollar

Date DepartmentpServices Provider

(Emergency or Sole

Source)Amount

5/28/10 CLINICAL ENGINEERING ZONARE MEDICAL SYSTEMS ZONARE Z. ONE ULTRASOUND REPAIR SOLE SOURCE $ 4,500

5/26/10 CLINICAL ENGINEERING SIEMENS MEDICAL SOLUTIONS EVENING SERVICE CALL EMERGENCY ORDER $ 3,400

5/24/10 CLINICAL ENGINEERING FIRST CALL PARTS, INC MONITOR EMERGENCY ORDER $ 3,530

5/21/10 CLINICAL ENGINEERING SIEMENS MEDICAL SOLUTIONS EMERGENCY REPAIR EMERGENCY ORDER $ 30,000ORDER

5/21/10 ENGINEERING SERVICES

CRAWFORD ELECTRIC SUPPY CO.INC ELECTRIC CONDUCTOR EMERGENCY

ORDER $ 35

5/21/10 LINEN SERVICES MCCLURE INDUSTRIES INC 650 LB CART WITH 8 CASTERS SOLE SOURCE $ 1,531

5/14/10 CLINICAL ENGINEERING HOLOGIC INC SERVICE LORAD EMERGENCY $ 11 4145/14/10 CLINICAL ENGINEERING HOLOGIC INC SERVICE - LORAD ORDER $ 11,414

5/11/10 CLINICAL ENGINEERING GE MEDICAL SYSTEMS SERVICE FOR GE CATHLAB MACHINE

EMERGENCY ORDER $ 137,565

5/7/10 CLINICAL ENGINEERING JOHNSON & JOHNSON HEALTH CARE

REPAIR OF UVAR XTS SYSTEM

EMERGENCY ORDER $ 9,180

5/5/10 ENGINEERING SERVICES SPAETH INDUSTRIES REPAIR - FIRE PUMP EMERGENCY

ORDER $ 3,393

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Procurement of Consulting and Professional Services

Purpose of Service Provided Service Provider AmountContract Time Frame

Purpose of Service Provided Service Provider AmountEntrance Date to Complete

COPC FACILITY CONDITION ASSESSMENT FAITHFUL+GOULD $198,000 3/1/10 5/31/10

DEVELOP PLANS/SPECIFICATIONS TODEVELOP PLANS/SPECIFICATIONS TO CONVERT PART OF THE ED GARAGE

TO DISASTER MANAGEMENT STORAGE

GROMATZKY DUPREE & ASSOC. $8,432 4/1/10 7/31/10

AUDIT SUPPLEMENTAL RETIREMENT PLANS DELOITTE & TOUCHE, LLP $85,000 1/1/10 12/31/10

INVESTMENT CONSULTING ROGERSCASEY, INC $660,000 3/1/10 2/28/13

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Non-Compliance with Purchasing Requisition Policy

Department Supplier Name Product or Service Amount

AIDS ED & TRAINING CENTER ALLCRAFT PRINTING PRINTING $ 1,596AMBULATORY SURGICAL

CENTERBOB J JOHNSON & ASSOCIATES

INC DI WATER SERVICE $ 199

BIOTEL MIKE ANDERSON'S BARBEQUE BRISKET FOR EMS WEEK $ 900BIOTEL HOUSE BRISKET FOR EMS WEEK $ 900

CLINICAL ENGINEERING SIEMENS MEDICAL SYSTEM WORK AND CALL MANAGEMENT FEE $1,275

CLINICAL ENGINEERING SIEMENS MEDICAL SOLUTIONS SERVICE CALL ON SPECT CAMERA $ 7,528COMMUNITY SERVICES UNCLE BOBS SELF STORAGE STORAGE SPACE $ 187

CORPORATE COMMUNICATIONS IN MOTION IMAGERY EMPLOYEE VIDEO - INTRODUCTION TO HOSPITAL $10,457

EMPLOYMENT EXPERIENCE PROFORMA A Z SPECIALTIES WALL SIGNS & ART WORK $1,163EMPLOYMENT EXPERIENCE HOMER MILLER CO PROMOTIONAL PRODUCTS $ 2,033

$ 2 961ENVIRO SERV - PMH FRIENDLY CHEVROLET REPAIR - DAMAGE TO HOOD AND BUMPER $ 2,961FACILITIES DEVELOPMENT THOMAS REPROGRAPHICS PRINTING $ 501

IT-IT ADMINISTRATION JASON'S DELI LUNCHES $ 82

IT-IT ADMINISTRATION OFFICEMAX CONSULTING - ASSESSMENT OF PRINTER ENVIRONMENT $ 2,350ENVIRONMENT

JAIL HEALTH ADMIN GREGORY LEOS PARKING SERVICE $ 690

5

Non-Compliance with Purchasing Requisition Policy

Department Supplier Name Product or Service Amount

LABOR & DELIVERY MAQUET, INC. REPAIR - DELIVERY ROOM LIGHT $ 1,222MEDICAL STAFF OFFICE PROFORMA A Z SPECIALTIES PLAQUE $ 125

MINOR PROJECT RENOVATIONS CRADDOCK LUMBER CONSTRUCTION PROJECT PRODUCTS $ 3,316

OAKWEST WHC MJ ELECTRONICS LABOR SET-UP FOR DIGITAL ANTENNA-INSTALLATION $ 89

OPHTHALMOLOGY CLINIC ESSILOR CONTACT LENSES LENS $ 12

ORGANIZATIONAL MAJORS SCIENTIFIC BOOKSTORE BOOK $ 140DEVELOPMENT MAJORS SCIENTIFIC BOOKSTORE BOOK $ 140

PATHOLOGY ADMINISTRATION CLIA LABORATORY PROGRAM USER FEE $ 150

PATHOLOGY ADMINISTRATION COLLEGE OF AMERICAN PATHOLOGIS PROFICIENCY SERVICE TESTING $ 55

PERFORMANCE IMPROVEMENT AMERICAN COLLEGE OF SURGEONS TRAINING SESSION $ 2 500PERFORMANCE IMPROVEMENT AMERICAN COLLEGE OF SURGEONS TRAINING SESSION $ 2,500POLICE DEPARTMENT C & G WHOLESALE WINTER COAT FOR S. STORY $ 115RAD MAMMOGRAPHY CITY OF DALLAS ONE TIME CHARGE FOR FIRE LINE $ 13

RAD NUCLEAR MEDICINE GE HEALTHCARE NUCLEAR IMAGING PRODUCTS $ 609VOLUNTEER & GUEST SVCS PALFLEET TRUCK EQUIPMENT CO LABOR REMOVE GATE AND INSTALL BUMP $ 225VOLUNTEER & GUEST SVCS PALFLEET TRUCK EQUIPMENT CO LABOR - REMOVE GATE AND INSTALL BUMP $ 225

WOMEN & FAMILY EDUCATION THE FAMILY WAY PUBLICATIONS IN BOOKS- PREPARED CHILDBIRTH, QTY.100 IN SPANISH, QTY. 100 IN ENGLISH $ 888

6

MWBE Participation

FY10 YTD

Supplies Facilities New Parkland

Total Dollars $131,404,140 $6,141,239 $18,157,902

MWBE Percentage 26% 32.2% 29.4%

FY10 April

Supplies Facilities New Parkland

Total Dollars $18,371,902 $1,139,876 $655,029

MWBE Percentage 24% 28.6% 35.7%

7

PARKLAND HEALTH & HOSPITAL SYSTEMNEW PARKLAND CAMPUSSERIES 2009 LIMITED TAX BONDS FUND FLOWS AND BALANCESAs of May 31, 2010

Proceeds from Bond Sale 702,234,246$

Accrued Interest Income 10,933,302 Realized Gain/Loss (211,180) Unrealized Gain/Loss 2,321,019

Net Investment Income 13,043,141

Less: Investment Manager Fees January 7, 2010 (173,257)

March 11, 2010 (173,986) May 17, 2010 (171,693)

Capital Program Draws February 1, 2010 (8,101,977) May 21, 2010 (13,538,622)

Total Payments from Funds (22,159,534) Total Payments from Funds (22,159,534)

Total Assets (Including Income Receivable) 693,117,853$

PARKLAND HEALTH & HOSPITAL SYSTEMNEW PARKLAND CAMPUSSERIES 2009 LIMITED TAX BONDS DEBT SERVICE ACCOUNT BALANCESAs of May 31, 2010

Next Bond Payment - Interest Only Due 08/15/2010 19,521,088$

YTD Activity through April 30, 2010Year to Date Tax Receipts Deposited with Trustee 32,053,624 Year to Date Deposits - Hospital - Investment Income 11,546 Interest Payment on February 15, 2010 (16,050,672) Year to Date Federal Interest Rebate (rcvd 3/26/10) 5,467,285

Ending Balance April 30, 2010 21,481,783

Projected Activity to Next Bond Payment 8/15/2010Estimated Tax Receipts 500,000 Deposits - Hospital - Additional Investment Income 6,000 Federal Interest Rebate - 2/15/10 Payment - Federal Interest Rebate - 8/15/10 Payment 6,649,401

Total Activity 3/1/2010 - 08/15/2010 7,155,401

Total Debt Service Available 08/15/2010 28,637,184

Estimated Balance after 08/15/2010 Interest Payment 9,116,096$

82120 6.08

WD: 04/10

DALLAS COUNTY HOSPITAL DISTRICT

ACCOUNTING/FINANCE DEPARTMENT DIRECTIVE

GRANT INDIRECT COSTS PURPOSE: To document the policy for requesting and collecting indirect cost also referred to as Facilities and Administration (F&A) on grant applications. DEFINITION: Indirect costs are those: (a) incurred for a common or joint purpose benefiting more than one cost objective, and (b) not readily assignable to the cost objectives specifically benefitted, without effort disproportionate to the results achieved. The term "indirect costs," applies to costs of this type originating in the grantee department, as well as those incurred by other departments in supplying goods, services, and facilities. RATE DEVELOPMENT: Indirect cost reimbursement rate is calculated by Government Reimbursement and negotiated with the Department of Health and Human Services (DHHS). Once the rate is agreed upon, an Indirect Cost Rate Agreement is executed that establishes the allowable rates of reimbursement. POLICY: Parkland will request indirect cost reimbursement for all Federal, state, and local grants and contracts using the Federal rate as established in the Indirect Cost Rate Agreement or the maximum rate allowable by the grantor. ACCOUNTING: All expenses and revenue associated with the grant should be recorded in the cost center. The indirect costs expense will be a debit to the cost center with an offset to District Expense (net zero impact).

Grant Applications in Processas of 5/31/10

Dept Grantor Grant FON/CFDA #New or

Renewal Date SubmittedAmount

Requested Amount Funded

1 VIP CJD JJDP-Increasing Stability in High Risk Families 20791-03 R 02/08/2010 72,787$ $72,7872 VIP CJD VOCA-Enhanced Crisis Support Project 17510-06 R 02/08/2010 79,778$ $79,778

3 Strategic Planning UNTNIH Attrition in Diabetes Self Mgmt Prog 5 yr grant NA N 01/28/2010 1,562,291$

4 HIV Services HRSA Regional AIDS Education & Training Centers HRSA-10-132 R 02/19/2010 9,989,496$ 5 Medicine Services DSHS Epilepsy Services CHS/EPIL-0387.1 R 03/03/2010 542,702$ 6 Community Medicine Big Thought JJDP Subcontract to Big Thought, Inc. NA N 03/05/2010 -$ Non Financial

7 Community MedicineUTHSC-San

Antonio Project Support MOU-5 R 04/22/2010 1,116,446$ $1,116,4468 NTX Poison DSHS PHEP 2009-032073-001 R 05/11/2010 79,999$ $79,999

9 Center for InnovationCommonwealth

Fund Board Level Grant Proposal NA N 03/01/2010 396,067$

10 WISH CPRITCommunity Collaborative Prevention Programs and Services for BCCC RFA-P-10-CCP1 N 03/01/2010 2,996,800$ not funded

11 Center for Innovation NIH

Recovery Act Limited Competition: NIH Director’s Opportunity for Research in Five Thematic Areas (RC4) RFA-OD-10-005 N

3/15/2010 (subaward)

$3,167,683 (total) $1,853,002 (phhs subaward) not funded

12 VIP CJD VOCA-Comprehensive Interv & Advocacy 20105-05 R 02/08/2010 86,986$ $72,45513 WISH DHHS Eliminating Disparities in Perinatal Health HRSA-5-H49-10-001 R 03/24/2010 900,000$ 14 Community Medicine DSHS Primary Health Care CHS/PHC-0385.1 R 04/09/2010 1,974,970$ 15 VIP CJD Rapid Response for Victims 19281-04 R 02/22/2010 70,784$ 16 Facilities HRSA Health Care & Other Facilities (earmark funding) HRSA-10-041 N 04/29/2010 99,000$ 17 Clinical Support HRSA Health Care & Other Facilities (earmark funding) HRSA-10-041 N 05/11/2010 495,000$

18Performance Improvement HRSA ARRA Patient Safety (V&E/Grants Office) PAR 10 022 N18 Improvement HRSA ARRA- Patient Safety (V&E/Grants Office) PAR-10-022 N

19 Community Medicine HHSC Health Home Pilot Project RFP# 529-10-0057 N20 WISH/COPC DSHS Title V CHD/Prenatal RFP# DFCHS-0388.1 R 05/11/2010 1,888,418.30$ 21 Community Medicine DSHS OMH Region VI Mini-Grant N 05/28/2010 3,000$ 22 WISH DSHS Breast and Cervical Cancer Services RFP# CHS/BCCS-0398.1 R 03/31/2010 867,836.89$ 23 DCHDPD DOJ COPS Hiring Program ORI# TX05750 N

24 DCHDPD BJA Bulletproof Vest Partnership NA R 06/01/2010 $14,000

25 Center for Innovation HHSARRA - Strategic Health IT Advanced Research Projects (SHARP) - DFWHC=primary applicant HHS-2010-ONC-TR-005 N

1/21/2010 (subaward)

$16,621,226 (total) $1,084,151.44 (phhs subaward)

26 Center for Innovation AHRQCompetitive Effectiveness Delivery System Demonstration Grants (R18) RFA-HS-10-013 N 04/07/2010

$1,673,402 (phhs subaward)

27 Strategic Planning/IPC

Community Council of

Greater Dallas Walkability Project 93.994 N 05/20/2010 $ 10,000 10,000$ 28 WISH HHS/OAH Teenage Pregnancy Prevention AH-TP1-10-002 / 93.297 N 06/01/2010 $ 973,982 29 Strategic Planning/VIP OAG SAPCS-Federal 1014729 R 06/01/2010 $ 25,000 30 VIP HHSC Family Violence Program-Special Projects RFP# 529-11-0007 N

31Community

Medicine/Geriatrics DSHS Primary Health Care RFP# CHS/PHC-0385.1 R32 HIV Services DSHS HIV Rapid Testing NA R 06/03/2010 $ 190,000 33 WISH DSHS FY10 Title X HIV Supplemental Funding 93.217 R 05/07/2010 $ 200,000

Grant Submission Log.xls updated 1/04/2010

CHECK‐NUM Pay Vendor Name Check Date CK Amount

467680 HDR+CORGAN JOINT VENTURE 05/27/2010 3,271,547.03$ 454098 EPIC SYSTEMS CORPORATION 01/15/2010 3,135,448.00 451358 HDR‐CORGA JOINT VENTURE 12/15/2009 2,569,333.32 466729 AETNA US HEALTHCARE 05/17/2010 2,497,451.95 457773 AETNA US HEALTHCARE 02/18/2010 2,465,885.00 463028 AETNA US HEALTHCARE 04/14/2010 2,424,292.75 451432 AETNA US HEALTHCARE 12/16/2009 2,419,679.95 454111 AETNA US HEALTHCARE 01/15/2010 2,392,211.88 460654 AETNA US HEALTHCARE 03/18/2010 2,372,739.26 457320 MCKESSON INFORMATION SOLUT 02/16/2010 2,364,017.75 455470 IBM 02/01/2010 2,353,424.30 457021 A T & T DATACOM INC 02/10/2010 2,335,247.40 467383 DALLAS COUNTY BUDGET OFFIC 05/25/2010 2,012,370.00 459799 DELL 03/10/2010 1,444,264.62 450224 AFFILIATED COMPUTER SERVIC 12/03/2009 1,347,692.20 461753 HDR+CORGAN JOINT VENTURE 03/31/2010 1,212,906.93 453196 HDR‐CORGA JOINT VENTURE 01/06/2010 1,071,197.61 457386 AFFILIATED COMPUTER SERVIC 02/16/2010 1,040,584.75 451574 AFFILIATED COMPUTER SERVIC 12/17/2009 1 008 602 10

Accounts PayablePayments greater than $50,000.00

12/01/09 ‐ 5/31/10

451574 AFFILIATED COMPUTER SERVIC 12/17/2009 1,008,602.10 461118 MORRIS & DICKSON CO.,LTD 03/24/2010 990,387.05 450432 CERNER CORPORATION 12/07/2009 982,612.27 452870 RELIANT ENERGY INC 12/31/2009 911,719.10 459217 MORRIS & DICKSON CO.,LTD 03/04/2010 907,635.67 455377 HDR+CORGAN JOINT VENTURE 01/29/2010 905,526.69 464571 MORRIS & DICKSON CO.,LTD 04/29/2010 886,484.78 460278 MORRIS & DICKSON CO.,LTD 03/15/2010 854,976.97 450779 DALLAS CENTRAL APPRAISAL 12/10/2009 807,257.00 461458 DALLAS CENTRAL APPRAISAL 03/29/2010 807,257.00 451824 MORRIS & DICKSON CO.,LTD 12/21/2009 758,954.36 462218 MORRIS & DICKSON CO.,LTD 04/06/2010 669,828.78 451301 MORRIS & DICKSON CO.,LTD 12/15/2009 649,406.16 458331 MORRIS & DICKSON CO.,LTD 02/24/2010 629,655.56 451863 HIGHLAND BUILDERS 12/21/2009 624,641.79 465111 MORRIS & DICKSON CO.,LTD 05/04/2010 607,756.43 462596 MORRIS & DICKSON CO.,LTD 04/09/2010 607,091.79 458395 HILL ROM 02/25/2010 590,835.22 461372 CARDINAL HEALTH 03/26/2010 589,970.38 463724 PHILIPS MEDICAL SYSTEMS 04/22/2010 588,204.91 458111 BLACK BOX CORPORATION 02/22/2010 581,521.05 467202 HIGHLAND BUILDERS 05/21/2010 578,622.78

1



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453008 MORRIS & DICKSON CO.,LTD 01/05/2010 573,177.08 458820 MORRIS & DICKSON CO.,LTD 03/01/2010 563,485.26 451042 MORRIS & DICKSON CO.,LTD 12/11/2009 560,719.38 464432 MORRIS & DICKSON CO.,LTD 04/28/2010 555,431.69 458211 MORRIS & DICKSON CO.,LTD 02/23/2010 551,027.47 465348 MORRIS & DICKSON CO.,LTD 05/06/2010 519,786.02 450831 MORRIS & DICKSON CO.,LTD 12/10/2009 515,084.06 455579 MORRIS & DICKSON CO.,LTD 02/02/2010 512,292.94 466233 MORRIS & DICKSON CO.,LTD 05/12/2010 510,617.64 467371 MORRIS & DICKSON CO.,LTD 05/25/2010 509,180.13 453433 MORRIS & DICKSON CO.,LTD 01/08/2010 504,527.50 451847 DART 12/21/2009 498,288.00 454265 MORRIS & DICKSON CO.,LTD 01/20/2010 494,387.54 449759 AETNA US HEALTHCARE 12/01/2009 494,339.40 463425 AFFILIATED COMPUTER SERVIC 04/19/2010 488,848.26 466576 AFFILIATED COMPUTER SERVIC 05/14/2010 488,848.26 461420 DALLAS/FORT WORTH TECHNOLO 03/26/2010 487,300.02 453295 AFFILIATED COMPUTER SERVIC 01/07/2010 486,225.10 451940 MORRIS & DICKSON CO LTD 12/22/2009 482 040 28451940 MORRIS & DICKSON CO.,LTD 12/22/2009 482,040.28 450441 MORRIS & DICKSON CO.,LTD 12/07/2009 477,602.62 453752 CH2MHILL 01/12/2010 464,363.24 461851 UNIVERSITY OF TEXAS 04/01/2010 464,223.00 463370 MORRIS & DICKSON CO.,LTD 04/19/2010 464,128.59 452313 BARA, A JOINT VENTURE 12/24/2009 460,738.40 451233 DALLAS/FORT WORTH TECHNOLO 12/14/2009 459,095.50 454457 MORRIS & DICKSON CO.,LTD 01/21/2010 457,748.42 452685 TALYST INC 12/30/2009 457,321.84 457196 MAXIT HEALTHCARE, LLC 02/11/2010 451,772.72 459409 MORRIS & DICKSON CO.,LTD 03/05/2010 451,219.75 453921 MORRIS & DICKSON CO.,LTD 01/14/2010 450,441.53 463176 HILL ROM 04/16/2010 445,171.90 453261 MORRIS & DICKSON CO.,LTD 01/07/2010 444,008.19 454081 MORRIS & DICKSON CO.,LTD 01/15/2010 442,738.45 457618 RELIANT ENERGY INC 02/17/2010 441,305.68 454617 MORRIS & DICKSON CO.,LTD 01/22/2010 439,527.51 467155 MORRIS & DICKSON CO.,LTD 05/21/2010 438,992.81 467515 MORRIS & DICKSON CO.,LTD 05/26/2010 438,992.81 449742 MORRIS & DICKSON CO.,LTD 12/01/2009 438,001.94 466027 MORRIS & DICKSON CO.,LTD 05/10/2010 437,718.34 454774 MORRIS & DICKSON CO.,LTD 01/25/2010 436,742.28

2



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453692 MORRIS & DICKSON CO.,LTD 01/12/2010 434,922.80 459776 MORRIS & DICKSON CO.,LTD 03/10/2010 429,405.04 462095 RELIANT ENERGY INC 04/02/2010 422,416.65 463876 MORRIS & DICKSON CO.,LTD 04/23/2010 417,747.57 452428 DELOITTE & TOUCHE LLP 12/29/2009 412,600.00 460006 CIGNA 03/12/2010 410,891.51 463581 MORRIS & DICKSON CO.,LTD 04/21/2010 408,780.88 457311 MORRIS & DICKSON CO.,LTD 02/16/2010 406,108.23 462027 MORRIS & DICKSON CO.,LTD 04/02/2010 405,898.04 453926 CARDINAL HEALTH 01/14/2010 405,375.57 465296 CH2MHILL 05/05/2010 405,038.84 452912 DATEX‐OHMEDA 01/04/2010 402,806.78 467148 IBM 05/21/2010 397,389.60 450720 AFFILIATED COMPUTER SERVIC 12/09/2009 396,097.10 452802 CARDINAL HEALTH 12/31/2009 395,092.88 460137 RELIANT ENERGY INC 03/12/2010 392,480.81 454630 CDW GOVERNMENT 01/22/2010 384,314.42 453130 MORRIS & DICKSON CO.,LTD 01/06/2010 374,808.86 466282 FACTORY MUTUAL INSURANCE C 05/12/2010 370 915 00466282 FACTORY MUTUAL INSURANCE C 05/12/2010 370,915.00 457567 MORRIS & DICKSON CO.,LTD 02/17/2010 370,572.35 461754 CH2MHILL 03/31/2010 369,812.78 455146 MORRIS & DICKSON CO.,LTD 01/28/2010 367,917.02 463483 MORRIS & DICKSON CO.,LTD 04/20/2010 367,416.24 467774 MORRIS & DICKSON CO.,LTD 05/28/2010 359,706.71 464944 MORRIS & DICKSON CO.,LTD 05/03/2010 348,419.53 451677 CARDINAL HEALTH 12/18/2009 345,648.81 461368 MORRIS & DICKSON CO.,LTD 03/26/2010 345,632.08 464277 MORRIS & DICKSON CO.,LTD 04/27/2010 342,459.62 458995 AFFILIATED COMPUTER SERVIC 03/02/2010 342,356.80 457713 LANGUAGE LINE SERVICES 02/18/2010 341,983.31 451462 CH2MHILL 12/16/2009 335,945.52 467604 MORRIS & DICKSON CO.,LTD 05/27/2010 329,863.84 451521 MORRIS & DICKSON CO.,LTD 12/17/2009 329,393.52 452797 MORRIS & DICKSON CO.,LTD 12/31/2009 328,813.17 450173 MORRIS & DICKSON CO.,LTD 12/03/2009 324,478.24 458112 MORRIS & DICKSON CO.,LTD 02/22/2010 317,664.82 465564 CH2MHILL 05/07/2010 317,058.86 467779 CARDINAL HEALTH 05/28/2010 313,717.17 463051 DELTA DENTAL INSURANCE COM 04/14/2010 312,184.96 467734 LANGUAGE LINE SERVICES 05/28/2010 305,918.72

3



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452103 MORRIS & DICKSON CO.,LTD 12/23/2009 304,763.15 451412 MORRIS & DICKSON CO.,LTD 12/16/2009 304,683.80 459416 CARDINAL HEALTH 03/05/2010 303,757.12 451876 MARSH USA INC 12/21/2009 302,972.15 456991 MORRIS & DICKSON CO.,LTD 02/10/2010 300,837.03 460044 CARDINAL HEALTH 03/12/2010 300,175.18 459124 TEXAS MEDICAID AND HEALTHC 03/03/2010 299,922.00 458496 HIGHLAND BUILDERS 02/25/2010 299,688.55 462866 MORRIS & DICKSON CO.,LTD 04/13/2010 294,640.64 450551 MORRIS & DICKSON CO.,LTD 12/08/2009 288,029.15 462032 CARDINAL HEALTH 04/02/2010 286,822.62 455517 ISTONISH INC 02/01/2010 285,395.00 455880 ISTONISH INC 02/04/2010 285,395.00 463170 TEECOM/WAI‐WIZE LLC 04/15/2010 281,731.00 449803 CH2MHILL 12/01/2009 281,316.15 461226 CARDINAL HEALTH 03/25/2010 279,763.57 465479 MORRIS & DICKSON CO.,LTD 05/07/2010 279,221.79 450511 CH2MHILL 12/07/2009 272,791.67 450057 MORRIS & DICKSON CO LTD 12/02/2009 270 287 11450057 MORRIS & DICKSON CO.,LTD 12/02/2009 270,287.11 458949 ORACLE CORPORATION 03/02/2010 269,645.80 462135 MORRIS & DICKSON CO.,LTD 04/05/2010 263,948.86 459796 AETNA US HEALTHCARE 03/10/2010 262,767.65 455294 CARDINAL HEALTH 01/29/2010 262,667.22 455836 MORRIS & DICKSON CO.,LTD 02/04/2010 256,777.63 461869 AETNA US HEALTHCARE 04/01/2010 255,137.85 456898 AETNA US HEALTHCARE 02/09/2010 254,672.10 466146 AETNA US HEALTHCARE 05/11/2010 254,454.75 462792 MORRIS & DICKSON CO.,LTD 04/12/2010 253,685.04 455537 CH2MHILL 02/01/2010 250,842.44 464363 HILL ROM 04/28/2010 250,236.00 452934 MORRIS & DICKSON CO.,LTD 01/04/2010 248,734.50 457148 CARDINAL HEALTH 02/11/2010 247,914.25 453439 CARDINAL HEALTH 01/08/2010 247,853.05 456878 MORRIS & DICKSON CO.,LTD 02/09/2010 247,670.87 463249 CARDINAL HEALTH 04/16/2010 246,666.69 463315 STRUCTURE TONE SOUTHWEST 04/16/2010 245,246.00 459948 MINNESOTA LIFE INSURANCE C 03/11/2010 245,215.20 453702 STANDARD REGISTER 01/12/2010 242,610.08 458629 CARDINAL HEALTH 02/26/2010 242,371.87 458457 MORRIS & DICKSON CO.,LTD 02/25/2010 241,156.74

4



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454359 NUANCE COMMUNICATIONS 01/20/2010 240,878.03 461612 AFFILIATED COMPUTER SERVIC 03/30/2010 239,783.56 466531 CARDINAL HEALTH 05/14/2010 235,256.94 459894 MORRIS & DICKSON CO.,LTD 03/11/2010 233,731.54 457908 CARDINAL HEALTH 02/19/2010 232,488.21 452834 MILLIMAN USA 12/31/2009 231,398.65 453677 THYSSENKRUPP ELEVATOR CORP 01/12/2010 231,398.00 456768 MORRIS & DICKSON CO.,LTD 02/08/2010 231,384.23 455705 UNIVERSITY HEALTHSYSTEM 02/03/2010 229,992.00 464136 MORRIS & DICKSON CO.,LTD 04/26/2010 229,921.54 461388 PHILIPS MEDICAL SYSTEMS 03/26/2010 228,111.87 457141 MORRIS & DICKSON CO.,LTD 02/11/2010 226,753.42 464716 CARDINAL HEALTH 04/30/2010 223,819.15 456587 MORRIS & DICKSON CO.,LTD 02/05/2010 223,662.06 463884 CARDINAL HEALTH 04/23/2010 223,261.16 452849 WORKPLACE RESOURCE DALLAS 12/31/2009 220,915.11 463777 VITALIZE CONSULTING SOLUTI 04/22/2010 220,059.34 453571 MORRIS & DICKSON CO.,LTD 01/11/2010 217,753.83 460631 CARDINAL HEALTH 03/18/2010 216 484 90460631 CARDINAL HEALTH 03/18/2010 216,484.90 462107 GENE BURTON & ASSOCIATES 04/02/2010 215,641.20 463969 BELIMED INCORPORATED 04/23/2010 211,544.00 461609 SEARCH AMERICA, INC 03/30/2010 210,583.20 467160 CARDINAL HEALTH 05/21/2010 209,234.57 464212 CHILDREN'S MEDICAL CENTER 04/27/2010 208,960.81 454624 CARDINAL HEALTH 01/22/2010 208,793.82 459145 DELTA DENTAL INSURANCE COM 03/03/2010 207,983.12 465283 DELTA DENTAL INSURANCE COM 05/05/2010 207,416.76 465263 THE CITY OF GRAND PRAIRIE 05/05/2010 207,234.00 450705 ARUP LABORATORIES 12/09/2009 206,371.74 456657 DELTA DENTAL INSURANCE COM 02/05/2010 206,258.26 462793 CARDINAL HEALTH 04/12/2010 204,084.87 462798 STANDARD REGISTER 04/12/2010 203,444.37 456918 AFFILIATED COMPUTER SERVIC 02/09/2010 201,849.97 455091 ST JUDE MEDICAL 01/28/2010 199,900.00 450247 ANDERSON MECHANICAL, INC 12/03/2009 199,800.00 459549 MORRIS & DICKSON CO.,LTD 03/08/2010 199,288.82 450385 ANDERSON MECHANICAL, INC 12/04/2009 199,000.00 462097 BLACK BOX NETWORK SERVICES 04/02/2010 198,491.41 461571 MORRIS & DICKSON CO.,LTD 03/30/2010 198,094.82 467503 ATMOS ENERGY HOLDINGS INC 05/26/2010 194,962.53

5



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450496 DELTA DENTAL INSURANCE COM 12/07/2009 194,330.44 452875 ATMOS ENERGY HOLDINGS INC 12/31/2009 193,736.40 453740 DELTA DENTAL INSURANCE COM 01/12/2010 193,665.20 452528 KARL STORZ ENDOSCOPY 12/30/2009 192,630.80 450030 LANGUAGE LINE SERVICES 12/02/2009 192,018.49 466239 CARDINAL HEALTH 05/12/2010 191,119.01 451420 COMPTROLLER OF PUBLIC ACCO 12/16/2009 190,284.13 453935 HUMANA 01/14/2010 189,736.26 465486 CARDINAL HEALTH 05/07/2010 188,473.06 457610 LENOVO (U.S.) INC. 02/17/2010 186,329.14 459813 NACR 03/10/2010 186,061.15 467519 HILL ROM 05/27/2010 185,142.00 451603 GEORGE‐MCKENNA ELECTRICAL 12/17/2009 185,100.30 454429 A T & T 01/21/2010 183,987.24 455275 CERNER CORPORATION 01/29/2010 183,889.60 461554 LANGUAGE LINE SERVICES 03/30/2010 183,770.65 466808 FUJIFILM MEDICAL SYSTEMS U 05/18/2010 183,165.00 452559 LANGUAGE LINE SERVICES 12/30/2009 182,867.51 455288 MORRIS & DICKSON CO LTD 01/29/2010 182 807 90455288 MORRIS & DICKSON CO.,LTD 01/29/2010 182,807.90 460388 MEDTRONIC INC. 03/16/2010 182,674.73 461841 MORRIS & DICKSON CO.,LTD 04/01/2010 180,678.12 458621 IBM 02/26/2010 180,160.00 467113 DCMS FOUNDATION 05/21/2010 180,000.00 459125 J A ALEXANDER CO 03/03/2010 179,561.92 462602 CARDINAL HEALTH 04/09/2010 179,045.35 451046 CARDINAL HEALTH 12/11/2009 177,783.65 450314 MORRIS & DICKSON CO.,LTD 12/04/2009 175,983.02 460626 MORRIS & DICKSON CO.,LTD 03/18/2010 175,731.53 457316 E‐TECH 02/16/2010 174,993.00 452237 CARDINAL HEALTH 12/24/2009 174,449.91 466826 LAWSON SOFTWARE AMERICAS ‐ 05/18/2010 173,552.01 462196 OFFICEMAX 04/06/2010 173,373.60 453749 BARA, A JOINT VENTURE 01/12/2010 173,350.16 460040 MORRIS & DICKSON CO.,LTD 03/12/2010 172,883.54 451898 FURNITURE CONSULTANTS INC. 12/21/2009 171,783.00 453900 CARTER BLOODCARE 01/14/2010 171,750.93 449700 CHILDREN'S MEDICAL CENTER 12/01/2009 171,701.69 460814 CARDINAL HEALTH 03/19/2010 169,829.84 450513 ZANETT COMMERCIAL SOLUTION 12/07/2009 169,700.00 450885 AFFILIATED COMPUTER SERVIC 12/10/2009 169,320.66

6



12/01/09 ‐ 5/31/10

462782 CARTER BLOODCARE 04/12/2010 168,536.08 453827 ASD HEALTHCARE 01/13/2010 168,404.02 460288 STANDARD REGISTER 03/15/2010 168,352.08 463254 PARKLAND AUXILIARY 04/16/2010 166,000.00 467236 TERARECON, INC. 05/21/2010 166,000.00 466776 MINNESOTA LIFE INSURANCE C 05/17/2010 164,913.65 450178 CARDINAL HEALTH 12/03/2009 164,750.25 461440 INFINITY MEDICAL EQUIPMENT 03/26/2010 164,586.42 462522 MINNESOTA LIFE INSURANCE C 04/08/2010 164,113.68 467046 MORE DIRECT, INC. 05/20/2010 163,482.83 457577 STANDARD REGISTER 02/17/2010 162,958.22 464340 DALLAS/FORT WORTH TECHNOLO 04/27/2010 162,433.34 467055 DALLAS/FORT WORTH TECHNOLO 05/20/2010 162,433.34 464778 PHILIPS MEDICAL SYSTEM 04/30/2010 161,541.93 466393 STANDARD REGISTER 05/13/2010 159,882.15 456529 OFFICEMAX 02/05/2010 159,782.21 456936 MINNESOTA LIFE INSURANCE C 02/09/2010 159,323.44 463770 ZANETT COMMERCIAL SOLUTION 04/22/2010 159,210.00 451422 STANDARD REGISTER 12/16/2009 158 104 71451422 STANDARD REGISTER 12/16/2009 158,104.71 467237 LAWSON SOFTWARE AMERICAS ‐ 05/21/2010 157,670.42 466797 CARDINAL HEALTH 05/18/2010 157,506.28 451670 MORRIS & DICKSON CO.,LTD 12/18/2009 153,783.49 460963 ACS CONSULTANT COMPANY, IN 03/22/2010 152,008.03 462868 CARDINAL HEALTH 04/13/2010 151,458.00 458461 CARDINAL HEALTH 02/25/2010 148,971.22 457416 ATMOS ENERGY HOLDINGS INC 02/16/2010 148,334.81 465183 OFFICEMAX 05/05/2010 147,883.31 458877 ATMOS ENERGY HOLDINGS INC 03/01/2010 147,820.54 457001 STRYKER SALES CORPORATION 02/10/2010 146,120.88 455536 BARA, A JOINT VENTURE 02/01/2010 145,972.94 461480 MORRIS & DICKSON CO.,LTD 03/29/2010 145,752.77 452233 MORRIS & DICKSON CO.,LTD 12/24/2009 145,522.12 462221 CARDINAL HEALTH 04/06/2010 145,338.60 450319 CARDINAL HEALTH 12/04/2009 144,696.78 457121 CARTER BLOODCARE 02/11/2010 143,478.00 452420 MORRIS & DICKSON CO.,LTD 12/29/2009 142,109.37 462102 ATMOS ENERGY HOLDINGS INC 04/02/2010 141,927.17 451777 QUEST DIAGNOSTICS INC 12/21/2009 141,133.59 466501 CARTER BLOODCARE 05/14/2010 140,843.24 449697 ST JUDE MEDICAL 12/01/2009 140,720.00

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454013 HEIDELBERG ENGINEERING INC 01/14/2010 140,250.00 459385 CARTER BLOODCARE 03/05/2010 140,021.37 450129 OFFICEMAX 12/03/2009 139,602.17 452517 CHILDREN'S MEDICAL CENTER 12/30/2009 139,482.42 453080 OFFICEMAX 01/06/2010 138,942.28 463336 QUEST DIAGNOSTICS INC 04/19/2010 138,121.54 458244 REAL NETWORK SERVICES INC 02/23/2010 138,113.50 464649 MAYO MEDICAL LABORATORIES 04/30/2010 136,658.65 460436 VITALIZE CONSULTING SOLUTI 03/16/2010 136,482.33 454011 CORE BUSINESS TECHNOLOGIES 01/14/2010 134,720.00 453805 MORRIS & DICKSON CO.,LTD 01/13/2010 134,559.25 459613 OFFICEMAX 03/09/2010 133,187.95 460514 LEGACY DATA ACCESS INC 03/17/2010 132,480.00 455703 MORRIS & DICKSON CO.,LTD 02/03/2010 131,946.29 463290 RELIANCE WHOLESALE 04/16/2010 131,860.00 465230 MORRIS & DICKSON CO.,LTD 05/05/2010 131,729.14 467719 MAYO MEDICAL LABORATORIES 05/28/2010 131,228.07 461349 CARTER BLOODCARE 03/26/2010 131,077.32 464127 CARTER BLOODCARE 04/26/2010 129 945 00464127 CARTER BLOODCARE 04/26/2010 129,945.00 467403 FISHER & PHILLIPS 05/25/2010 127,046.17 453502 MZINGA, INC. 01/08/2010 126,420.00 467750 CARTER BLOODCARE 05/28/2010 126,351.06 465003 ACCUVANT INC 05/03/2010 125,428.00 460018 CARTER BLOODCARE 03/12/2010 125,266.52 458819 PROFESSIONAL RESEARCH 03/01/2010 124,350.00 462445 CARTER BLOODCARE 04/08/2010 124,193.00 453069 GEORGE‐MCKENNA ELECTRICAL 01/05/2010 124,066.70 459740 QUEST DIAGNOSTICS INC 03/10/2010 123,681.51 455463 CARTER BLOODCARE 02/01/2010 122,921.00 462008 CARTER BLOODCARE 04/02/2010 122,482.51 467592 CARDINAL HEALTH 200 LLC 05/27/2010 122,216.30 458516 SAF EXCHANGE PARK LTD 02/25/2010 122,060.23 467141 SYNTHES 05/21/2010 121,936.99 454461 CARDINAL HEALTH 01/21/2010 121,883.66 450407 MAYO MEDICAL LABORATORIES 12/07/2009 121,047.36 452193 QUEST DIAGNOSTICS INC 12/24/2009 120,906.57 455358 HOLOGIC INC 01/29/2010 120,780.00 455243 MAYO MEDICAL LABORATORIES 01/29/2010 119,364.92 461548 MAYO MEDICAL LABORATORIES 03/30/2010 119,118.42 461614 SAF EXCHANGE PARK LTD 03/30/2010 118,139.17

8



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467791 SOUTHWEST TRANSPLANT ALLIA 05/28/2010 118,000.00 464481 SAF EXCHANGE PARK LTD 04/28/2010 117,937.61 467486 SAF EXCHANGE PARK LTD 05/26/2010 117,937.61 461484 CARDINAL HEALTH 03/29/2010 117,685.94 459088 MORRIS & DICKSON CO.,LTD 03/03/2010 117,411.45 464337 DELCOM GROUP L.P. 04/27/2010 117,314.96 452491 SAF EXCHANGE PARK LTD 12/29/2009 115,876.30 454816 SAF EXCHANGE PARK LTD 01/25/2010 115,876.30 452272 VINSON & ELKINS 12/24/2009 115,659.92 464933 CARTER BLOODCARE 05/03/2010 115,617.01 464602 ASD HEALTHCARE 04/29/2010 115,394.10 464438 CARDINAL HEALTH 04/28/2010 115,329.29 458902 MAYO MEDICAL LABORATORIES 03/02/2010 115,325.17 459847 ST JUDE MEDICAL 03/11/2010 114,264.00 458380 FLAIR DATA SYSTEMS 02/24/2010 114,260.36 451017 CARTER BLOODCARE 12/11/2009 114,046.90 461853 CDW GOVERNMENT 04/01/2010 113,949.60 463357 CARTER BLOODCARE 04/19/2010 113,696.66 467375 CARDINAL HEALTH 05/25/2010 113 446 55467375 CARDINAL HEALTH 05/25/2010 113,446.55 452011 ST JUDE MEDICAL 12/23/2009 113,235.00 450212 HIGHLAND BUILDERS 12/03/2009 113,129.78 455520 RELIANT ENERGY INC 02/01/2010 113,000.22 450294 CARTER BLOODCARE 12/04/2009 112,802.15 456594 CARDINAL HEALTH 02/05/2010 112,597.11 465013 NETWORK SCIENCES, INC. 05/03/2010 112,218.75 455136 CARTER BLOODCARE 01/28/2010 112,096.70 461572 KCI USA 03/30/2010 111,989.49 461019 MORRIS & DICKSON CO.,LTD 03/23/2010 111,690.93 460810 MORRIS & DICKSON CO.,LTD 03/19/2010 111,128.70 450175 KCI USA 12/03/2009 110,940.93 458541 NETWORK SCIENCES, INC. 02/25/2010 110,531.25 463255 CDW GOVERNMENT 04/16/2010 110,433.51 457883 CARTER BLOODCARE 02/19/2010 110,257.93 467762 STANDARD TEXTILE 05/28/2010 109,788.14 452873 KARLSBERGER HEALTHCARE 12/31/2009 109,491.53 452280 TEXAS MEDICAID AND HEALTHC 12/24/2009 109,471.44 467132 CARTER BLOODCARE 05/21/2010 109,370.40 465112 KCI USA 05/04/2010 109,269.79 450592 UNITED HEALTHCARE SPECIALT 12/08/2009 109,025.60 453185 ACS CONSULTANT COMPANY, IN 01/06/2010 108,961.07

9



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452546 MAYO MEDICAL LABORATORIES 12/30/2009 108,849.39 463699 MORRIS & DICKSON CO.,LTD 04/22/2010 108,809.05 451792 UNIVERSITY OF TEXAS 12/21/2009 108,707.13 457570 CARDINAL HEALTH 02/17/2010 107,905.20 462251 LAWSON SOFTWARE AMERICAS ‐ 04/06/2010 107,869.04 458608 CARTER BLOODCARE 02/26/2010 107,664.97 452212 CARTER BLOODCARE 12/24/2009 107,209.26 458821 KCI USA 03/01/2010 107,180.63 459017 BOYLE & LOWRY LLP 03/02/2010 107,017.40 459013 RELIANT ENERGY INC 03/02/2010 106,595.84 463108 JOHNSON & JOHNSON 04/15/2010 106,350.38 453618 FURSTENBERG CONSTRUCTION C 01/11/2010 106,089.70 453850 PROFERO SOLUTIONS LLC 01/13/2010 106,058.60 452259 SANOFI PASTEURR 12/24/2009 105,627.23 459996 FACILITY SOLUTIONS GROUP, 03/12/2010 104,919.10 463258 MINNTECH CORPORATION 04/16/2010 104,716.20 457586 CITY OF DALLAS 02/17/2010 103,980.15 457757 KRONOS INCORPORATED 02/18/2010 103,724.39 454938 MORRIS & DICKSON CO LTD 01/26/2010 102 699 99454938 MORRIS & DICKSON CO.,LTD 01/26/2010 102,699.99 464274 RICHARD ALLAN SCIENTIFIC C 04/27/2010 102,239.27 455667 STRYKER SALES CORPORATION 02/03/2010 101,362.00 460516 ABBOTT VASCULAR 03/17/2010 101,170.00 453075 ST JUDE MEDICAL 01/06/2010 100,560.00 466226 MEDTRONIC INC. 05/12/2010 100,420.00 464792 ABBOTT VASCULAR 04/30/2010 99,975.00 466581 CHAMBERLIN EDMONDS & ASSOC 05/14/2010 99,433.80 450510 BARA, A JOINT VENTURE 12/07/2009 99,110.94 463919 CARDON HEALTHCARE NETWORK 04/23/2010 99,088.83 467846 ABBOTT VASCULAR 05/28/2010 98,135.00 461246 AMERICAN MEDICAL RESPONSE 03/25/2010 97,768.91 450063 CARDINAL HEALTH 12/02/2009 97,695.34 466719 CARDINAL HEALTH 05/17/2010 97,585.08 455206 BUSINESS COMPUTER APPLICAT 01/28/2010 97,570.37 451754 ZANETT COMMERCIAL SOLUTION 12/18/2009 96,320.00 455554 UNIVERSITY OF TEXAS 02/02/2010 96,288.72 457838 CHILDREN'S MEDICAL CENTER 02/19/2010 96,226.65 450846 ECLIPSYS SOLUTION CORP 12/10/2009 96,014.41 454441 CARTER BLOODCARE 01/21/2010 95,968.74 460889 CONSTRUCTOR'S & ASSOCIATER 03/19/2010 95,778.00 455823 CARTER BLOODCARE 02/04/2010 95,724.97

10



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463512 ABBOTT VASCULAR 04/20/2010 95,165.00 462233 AVAYA INC. 04/06/2010 95,097.36 450673 MORRIS & DICKSON CO.,LTD 12/09/2009 94,938.41 460530 SONUS 03/17/2010 94,633.40 466210 FACILITY SOLUTIONS GROUP, 05/12/2010 94,167.00 457044 NACR 02/10/2010 93,846.42 467526 ZIMMER 05/27/2010 93,829.88 450095 BUSINESS FURNITURE INSTALL 12/02/2009 93,800.00 465569 FURNITURE CONSULTANTS INC. 05/07/2010 93,524.00 465233 CARDINAL HEALTH 05/05/2010 93,499.94 463373 CARDINAL HEALTH 04/19/2010 93,462.57 466030 CARDINAL HEALTH 05/10/2010 93,334.91 455043 MORRIS & DICKSON CO.,LTD 01/27/2010 93,223.13 462396 LAWSON SOFTWARE AMERICAS ‐ 04/07/2010 93,080.00 453425 SYNTHES 01/08/2010 92,529.95 452515 DIVERSIFIED EMPIRE CENTER, 12/29/2009 92,302.08 454853 DIVERSIFIED EMPIRE CENTER, 01/25/2010 92,302.08 458543 KEYBANK REAL ESTATE CAPITA 02/25/2010 92,302.08 461631 KEYBANK REAL ESTATE CAPITA 03/30/2010 92 302 08461631 KEYBANK REAL ESTATE CAPITA 03/30/2010 92,302.08 464622 KEYBANK REAL ESTATE CAPITA 04/29/2010 92,302.08 467511 DIVERSIFIED EMPIRE CENTER, 05/26/2010 92,302.08 454940 KCI USA 01/26/2010 91,582.06 465391 ACS CONSULTANT COMPANY, IN 05/06/2010 91,340.97 458335 CARDINAL HEALTH 02/24/2010 91,263.92 464983 CITY OF FARMERS BRANCH 05/03/2010 90,915.27 450136 ZIMMER 12/03/2009 90,909.42 452600 MORRIS & DICKSON CO.,LTD 12/30/2009 90,796.34 459752 A T & T 03/10/2010 90,399.72 459998 A T & T 03/12/2010 90,323.69 463341 A T & T 04/19/2010 90,311.28 455084 DALLAS COUNTY MEDICAL SOCI 01/27/2010 90,000.00 457631 ST JUDE MEDICAL 02/18/2010 89,771.70 453747 UNIMERICA LIFE INSURANCE C 01/12/2010 89,587.88 458115 CARDINAL HEALTH 02/22/2010 89,353.66 450507 UNIMERICA LIFE INSURANCE C 12/07/2009 89,327.42 466106 A T & T 05/11/2010 89,210.45 457788 SYSMEX AMERICA, INC. 02/18/2010 89,127.75 450025 A T & T 12/02/2009 89,060.15 464281 CARDINAL HEALTH 04/27/2010 88,834.78 463693 STANDARD TEXTILE 04/22/2010 88,607.28

11



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465115 CARDINAL HEALTH 05/04/2010 88,511.98 455181 HIGHLAND BUILDERS 01/28/2010 88,385.83 452575 CARTER BLOODCARE 12/30/2009 88,352.02 467009 SIEMENS 05/20/2010 87,779.12 454137 MARSH USA INC 01/15/2010 87,500.00 462838 CHILDREN'S MEDICAL CENTER 04/13/2010 87,500.00 452300 GLOBAL HEALTHCARE EXCHANGE 12/24/2009 87,493.00 466882 CARDINAL HEALTH 05/19/2010 87,407.68 452095 STANDARD TEXTILE 12/23/2009 87,397.92 461361 SYNTHES 03/26/2010 86,897.66 454146 NATIONAL GUARDIAN LIFE INS 01/15/2010 86,783.96 458722 BARA, A JOINT VENTURE 02/26/2010 86,748.26 466130 CARDINAL HEALTH 05/11/2010 86,319.32 459769 STANDARD TEXTILE 03/10/2010 86,015.52 463399 TEXAS HEALTH & HUMAN SERVI 04/19/2010 85,987.33 461492 ERNST & YOUNG 03/29/2010 85,500.00 451342 SEARCH AMERICA, INC 12/15/2009 85,484.01 455278 TEXAS HOSPITAL ASSOCIATION 01/29/2010 85,404.00 467836 JJHCS 05/28/2010 85 353 26467836 JJHCS 05/28/2010 85,353.26 450837 CARDINAL HEALTH 12/10/2009 84,858.46 451525 CARDINAL HEALTH 12/17/2009 84,458.18 458326 STANDARD TEXTILE 02/24/2010 84,389.28 458119 MCKESSON INFORMATION SOLUT 02/22/2010 84,375.00 457950 JJHCS 02/19/2010 84,265.15 455007 ZIMMER 01/27/2010 84,170.08 467218 AFFILIATED COMPUTER SERVIC 05/21/2010 84,169.48 461359 STANDARD TEXTILE 03/26/2010 83,742.24 451591 SIX FLAGS 12/17/2009 83,633.17 459880 MEDTRONIC 03/11/2010 83,241.80 450691 ROCHE DIAGNOSTIC 12/09/2009 83,200.42 450358 ASD HEALTHCARE 12/04/2009 83,154.20 457285 SIEMENS MEDICAL SOLUTIONS 02/16/2010 82,745.14 458854 AFFILIATED COMPUTER SERVIC 03/01/2010 82,469.99 452976 FURNITURE CONSULTANTS INC. 01/04/2010 82,300.25 454949 UNIVERSITY OF TEXAS 01/26/2010 82,168.80 454950 UNIVERSITY OF TEXAS 01/26/2010 82,168.80 454951 UNIVERSITY OF TEXAS 01/26/2010 82,168.80 459426 UNIVERSITY OF TEXAS 03/05/2010 82,168.80 460290 UNIVERSITY OF TEXAS 03/15/2010 82,168.80 465123 UNIVERSITY OF TEXAS 05/04/2010 82,168.80

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451596 BUSINESS COMPUTER APPLICAT 12/17/2009 82,087.70 451647 CARTER BLOODCARE 12/18/2009 81,914.37 451346 FABULOUS FLOORS, INC. 12/15/2009 81,740.00 460976 ST JUDE MEDICAL 03/23/2010 81,620.00 451497 GROUP ONE 12/17/2009 81,225.00 464240 GROUP ONE 04/27/2010 81,225.00 452302 K & L GATES 12/24/2009 80,977.70 463970 GENE BURTON & ASSOCIATES 04/23/2010 80,819.43 452805 SULLIVAN, COTTER & ASSOCIA 12/31/2009 80,434.27 454473 UNIVERSITY OF TEXAS 01/21/2010 80,320.10 454474 UNIVERSITY OF TEXAS 01/21/2010 80,320.10 454475 UNIVERSITY OF TEXAS 01/21/2010 80,320.10 458467 UNIVERSITY OF TEXAS 02/25/2010 80,320.10 464958 UNIVERSITY OF TEXAS 05/03/2010 80,320.10 464959 UNIVERSITY OF TEXAS 05/03/2010 80,320.10 463116 CARDINAL HEALTH 04/15/2010 80,106.59 464508 VITALIZE CONSULTING SOLUTI 04/28/2010 79,898.81 454851 SONUS 01/25/2010 79,560.00 450783 UNIVERSITY OF TEXAS 12/10/2009 79 412 50450783 UNIVERSITY OF TEXAS 12/10/2009 79,412.50 467344 ROCHE DIAGNOSTICS 05/25/2010 79,407.12 452239 ORACLE CORPORATION 12/24/2009 79,164.61 449746 CARDINAL HEALTH 12/01/2009 79,044.44 467287 CARDINAL HEALTH 05/24/2010 78,967.54 449751 UNIVERSITY OF TEXAS 12/01/2009 78,919.20 467497 RELIANT ENERGY INC 05/26/2010 78,785.27 455867 FURSTENBERG CONSTRUCTION C 02/04/2010 78,732.84 462136 CARDINAL HEALTH 04/05/2010 78,693.54 461844 CARDINAL HEALTH 04/01/2010 77,765.90 450723 CHAMBERLIN EDMONDS & ASSOC 12/09/2009 77,481.71 454326 ARUP LABORATORIES 01/20/2010 77,349.88 464765 ARUP LABORATORIES 04/30/2010 77,347.48 461584 ROCHE DIAGNOSTIC 03/30/2010 77,266.65 455188 REAL NETWORK SERVICES INC 01/28/2010 77,227.75 463485 CARDINAL HEALTH 04/20/2010 76,827.66 467469 CITY OF DALLAS 05/26/2010 76,680.63 467854 FIRSTSOURCE HEALTHCARE 05/28/2010 76,472.79 460806 IBM 03/19/2010 76,292.63 464203 VITALIZE CONSULTING SOLUTI 04/26/2010 76,211.74 454654 KFORCE 01/22/2010 75,807.79 455229 KARL STORZ ENDOSCOPY 01/29/2010 75,745.10

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462914 GARTNER, INC 04/13/2010 75,700.00 452263 SKYTRON 12/24/2009 75,336.66 466737 ARUP LABORATORIES 05/17/2010 75,298.46 453810 CARDINAL HEALTH 01/13/2010 75,146.55 465022 ROCHE DIAGNOSTICS 05/04/2010 75,000.00 450786 UNIVERSITY OF TEXAS 12/10/2009 74,945.00 456642 AFFILIATED COMPUTER SERVIC 02/05/2010 74,466.35 466415 CYMETRIX 05/13/2010 74,178.60 455283 SYNTHES 01/29/2010 74,160.76 466584 PARAGON REVENUE GROUP 05/14/2010 73,947.75 454788 ALLIED INTERIORS 01/25/2010 73,813.40 455841 CARDINAL HEALTH 02/04/2010 73,532.77 461282 FIRSTSOURCE HEALTHCARE 03/25/2010 73,521.66 466497 DENTAL HEALTH PROGRAMS INC 05/14/2010 73,500.00 451563 JJHCS 12/17/2009 73,153.22 451553 ARUP LABORATORIES 12/17/2009 73,142.94 464304 CYMETRIX 04/27/2010 72,919.90 458534 TERRACON CONSULTANTA, INC. 02/25/2010 72,865.50 467471 CYMETRIX 05/26/2010 72 687 20467471 CYMETRIX 05/26/2010 72,687.20 461471 JOHNSON & JOHNSON 03/29/2010 72,673.49 451144 UNIVERSITY OF TEXAS 12/14/2009 72,642.00 467045 SEARCH AMERICA, INC 05/20/2010 72,466.78 452269 CYMETRIX 12/24/2009 72,401.90 463268 THOMSON REUTERS (HEALTHCAR 04/16/2010 72,400.01 455775 RODERICK LEE ELECTRICAL 02/03/2010 72,125.40 457031 HIGHLAND BUILDERS 02/10/2010 72,087.72 459459 JJHCS 03/05/2010 72,075.47 452509 UNITED HEALTHCARE SPECIALT 12/29/2009 72,067.04 461222 IBM 03/25/2010 72,065.00 458094 MERRITT INTERPRETING SERVI 02/22/2010 72,000.00 454346 JJHCS 01/20/2010 71,720.59 463407 CYMETRIX 04/19/2010 71,514.70 451663 SYNTHES 12/18/2009 71,372.08 467457 CARDINAL HEALTH 05/26/2010 71,091.29 464443 MEDQUIST / THE MRC GROUP 04/28/2010 71,047.18 465279 FIRSTSOURCE HEALTHCARE 05/05/2010 70,701.81 461117 TEXAS DEPARTMENT OF HUMAN 03/24/2010 70,570.71 461648 UNITED WAY 03/31/2010 70,546.68 459051 BOSTON SCIENTIFIC CORPORAT 03/03/2010 70,480.66 463930 SEARCH AMERICA, INC 04/23/2010 70,400.28

14



12/01/09 ‐ 5/31/10

454149 RELIANT ENERGY INC 01/15/2010 70,380.27 456913 SEARCH AMERICA, INC 02/09/2010 70,248.65 452306 BOYLE & LOWRY LLP 12/24/2009 70,191.55 453940 FFF ENTERPRISE, INC. 01/14/2010 70,119.60 467410 MZINGA, INC. 05/25/2010 69,792.13 466244 EPIC SYSTEMS CORPORATION 05/12/2010 69,685.00 461875 ARUP LABORATORIES 04/01/2010 69,328.25 464451 ROCHE DIAGNOSTIC 04/28/2010 69,194.33 466262 ELSEVIER 05/12/2010 68,952.00 454815 MUSCULOSKELETAL TRANSPLANT 01/25/2010 68,869.00 467315 UTMB ‐ BILLING 05/24/2010 68,839.22 453615 CUMMINGS ELECTRICAL,INC. 01/11/2010 68,804.51 451167 MEDTRONIC INC. 12/14/2009 68,745.14 452175 NATIONAL TELESYSTEMS, INC 12/23/2009 68,596.00 467311 KAYPENTAX 05/24/2010 68,402.00 455582 CARDINAL HEALTH 02/02/2010 68,344.36 467378 MEDQUIST / THE MRC GROUP 05/25/2010 67,989.37 463773 INCODE TELECOM 04/22/2010 67,924.14 464329 MORE DIRECT INC 04/27/2010 67 753 39464329 MORE DIRECT, INC. 04/27/2010 67,753.39 451179 CARDINAL HEALTH 12/14/2009 67,606.05 456771 CARDINAL HEALTH 02/08/2010 67,524.03 451937 DALLAS FT WORTH HOSPITAL 12/22/2009 67,344.18 450787 UNIVERSITY OF TEXAS 12/10/2009 67,340.00 450917 HDR‐CORGA JOINT VENTURE 12/10/2009 67,150.48 461597 CYMETRIX 03/30/2010 67,001.20 462100 BAPTIST HEALTH CARE LEADER 04/02/2010 66,945.32 460468 ZIMMER 03/17/2010 66,836.52 458237 ARUP LABORATORIES 02/23/2010 66,776.17 449790 PEOPLE 2.0 GLOBAL, INC. 12/01/2009 66,381.98 459126 ASD HEALTHCARE 03/03/2010 66,000.00 453797 DATASCCOPE 01/13/2010 65,929.23 455344 REAL NETWORK SERVICES INC 01/29/2010 65,291.25 450194 UNITED STATES POSTAL SERVI 12/03/2009 65,000.00 454787 UNITED STATES POSTAL SERVI 01/25/2010 65,000.00 455593 PARKLAND AUXILIARY 02/02/2010 65,000.00 461382 UNITED STATES POSTAL SERVI 03/26/2010 65,000.00 449727 LEICA MICROSYSTEMS INC. 12/01/2009 64,994.26 466997 VEOLIA TRANSPORTATION 05/20/2010 64,731.64 450395 GE MEDICAL SYSTEMS 12/07/2009 64,713.66 452106 CARDINAL HEALTH 12/23/2009 64,567.14

15



12/01/09 ‐ 5/31/10

461314 ZIMMER 03/26/2010 64,472.84 458406 ZIMMER 02/25/2010 64,446.14 461577 CARDINAL HEALTH 03/30/2010 64,328.48 460122 PARAGON REVENUE GROUP 03/12/2010 64,294.07 450788 UNIVERSITY OF TEXAS 12/10/2009 63,962.50 452424 UT SOUTHWESTERN UNIVERSITY 12/29/2009 63,797.25 452113 MEDQUIST / THE MRC GROUP 12/23/2009 63,527.07 463732 MILLIMAN USA 04/22/2010 63,408.63 462380 PARAGON REVENUE GROUP 04/07/2010 63,262.29 457516 ST JUDE MEDICAL 02/17/2010 63,170.00 455174 CYMETRIX 01/28/2010 63,126.10 459373 HONEYWELL INC. 03/05/2010 63,108.90 461696 CARDINAL HEALTH 03/31/2010 62,949.98 464236 UNIVERSITY OF TEXAS 04/27/2010 62,889.07 462592 SYNTHES 04/09/2010 62,795.44 458217 MEDQUIST / THE MRC GROUP 02/23/2010 62,681.43 455312 JOHN WALTER THOMPSON 01/29/2010 62,594.66 451177 MORRIS & DICKSON CO.,LTD 12/14/2009 62,576.12 460904 UNIVERSITY OF TEXAS 03/22/2010 62 561 47460904 UNIVERSITY OF TEXAS 03/22/2010 62,561.47 451848 ALLIED INTERIORS 12/21/2009 62,494.20 451271 UNIVERSITY OF TEXAS 12/15/2009 62,438.00 454467 MEDQUIST / THE MRC GROUP 01/21/2010 62,322.52 467765 SYNTHES 05/28/2010 61,823.75 457172 CYMETRIX 02/11/2010 61,651.10 452276 PARKLAND COMMUNITY HEALTH 12/24/2009 61,514.25 456643 CHAMBERLIN EDMONDS & ASSOC 02/05/2010 61,283.02 458829 ERNST & YOUNG 03/01/2010 61,260.00 459445 INO THERAPEUTICS, INC 03/05/2010 61,137.42 461135 UNIVERSITY OF OKLAHOMA HEA 03/24/2010 61,065.80 466090 SENTILLION INC. 05/10/2010 61,015.07 456651 FIRSTSOURCE HEALTHCARE 02/05/2010 61,005.10 466400 ROCHE DIAGNOSTIC 05/13/2010 60,634.51 458360 MORE DIRECT, INC. 02/24/2010 60,544.00 455632 HOLOGIC INC 02/02/2010 60,390.00 462520 CROWNE PLAZA HOTEL 04/08/2010 60,330.70 464617 STENTOR INC/PHILIPS 04/29/2010 60,330.00 454813 NACR 01/25/2010 60,298.44 462549 BOSTON SCIENTIFIC CORPORAT 04/09/2010 60,184.60 463242 SYNTHES 04/16/2010 60,172.17 459107 A T & T DATACOM INC 03/03/2010 60,118.75

16



12/01/09 ‐ 5/31/10

457070 ZANETT COMMERCIAL SOLUTION 02/10/2010 60,100.00 460819 MEDQUIST / THE MRC GROUP 03/19/2010 60,072.69 463012 CARDINAL HEALTH 04/14/2010 59,905.95 464947 CARDINAL HEALTH 05/03/2010 59,861.49 451493 UNIVERSITY OF TEXAS 12/17/2009 59,840.00 454164 INTERPRISE THE DESIGN 01/15/2010 59,680.89 454217 UNIVERSITY OF TEXAS 01/20/2010 59,585.50 450789 UNIVERSITY OF TEXAS 12/10/2009 59,550.00 455890 MIDWEST CONSULTING GROUP I 02/04/2010 59,332.39 464795 COVENTRY HEALTH CARE WORKE 04/30/2010 59,287.30 456794 POLK MECHANICAL CO. 02/08/2010 59,246.60 463048 NATIONAL GUARDIAN LIFE INS 04/14/2010 59,205.00 459221 CARDINAL HEALTH 03/04/2010 59,155.26 466430 NATIONAL GUARDIAN LIFE INS 05/13/2010 59,123.10 464924 DELL 05/03/2010 59,092.46 460054 SOUTHWEST TRANSPLANT ALLIA 03/12/2010 59,000.00 460131 NATIONAL GUARDIAN LIFE INS 03/12/2010 58,975.40 456652 NATIONAL GUARDIAN LIFE INS 02/05/2010 58,688.93 460309 CYMETRIX 03/15/2010 58 481 80460309 CYMETRIX 03/15/2010 58,481.80 459399 SYNTHES 03/05/2010 58,471.90 463749 CIMA SOLUTIONS GROUP 04/22/2010 58,368.00 462326 CARDINAL HEALTH 04/07/2010 58,321.51 452231 LINDE GAS NORTH AMERICA LL 12/24/2009 58,229.04 458487 CYMETRIX 02/25/2010 58,123.40 451058 ROCHE DIAGNOSTIC 12/11/2009 58,077.51 451738 FIRSTSOURCE HEALTHCARE 12/18/2009 57,994.19 459139 ABBOTT VASCULAR 03/03/2010 57,970.00 457133 SYNTHES 02/11/2010 57,951.88 463366 JOHNSON & JOHNSON HEALTHCA 04/19/2010 57,887.62 458694 ZONARE MEDICAL SYSTEMS 02/26/2010 57,769.00 452430 THOMSON HEALTHCARE INC 12/29/2009 57,750.00 457391 JON BARRY & ASSOCIATES, IN 02/16/2010 57,729.11 463506 TEXAS MEDICAID AND HEALTHC 04/20/2010 57,674.00 467509 FURNITURE CONSULTANTS INC. 05/26/2010 57,593.00 451834 MEDQUIST / THE MRC GROUP 12/21/2009 57,548.32 457089 ZIMMER 02/11/2010 57,546.62 450493 NATIONAL GUARDIAN LIFE INS 12/07/2009 57,533.59 454026 ST JUDE MEDICAL 01/15/2010 57,530.00 453997 FIRSTSOURCE HEALTHCARE 01/14/2010 57,490.63 461050 MCKESSON HEALTH SOLUTIONS 03/23/2010 57,400.08

17



12/01/09 ‐ 5/31/10

453961 CYMETRIX 01/14/2010 57,314.30 458515 MAXIT HEALTHCARE, LLC 02/25/2010 57,305.56 465520 TEXAS MEDICAID AND HEALTHC 05/07/2010 56,744.19 463148 DELCOM GROUP L.P. 04/15/2010 56,406.00 451730 JON BARRY & ASSOCIATES, IN 12/18/2009 56,395.33 453575 DALLAS SECURITY SYSTEMS/ D 01/11/2010 56,393.43 466938 ST JUDE MEDICAL 05/20/2010 56,373.00 463583 CARDINAL HEALTH 04/21/2010 56,253.09 466088 ENDO OPTIKS 05/10/2010 56,230.00 451262 COLLEGE OF AMERICAN PATHOL 12/15/2009 56,143.00 450169 BECKMAN COULTER INC 12/03/2009 56,133.50 464691 MEDTRONIC INC. 04/30/2010 56,108.00 453911 SYNTHES 01/14/2010 56,017.43 454255 UNITED STATES SURGICAL 01/20/2010 55,969.80 455745 ASD HEALTHCARE 02/03/2010 55,956.40 462127 CAREFUSION 211, INC. 04/05/2010 55,955.00 453984 AFFILIATED COMPUTER SERVIC 01/14/2010 55,914.15 451829 CARDINAL HEALTH 12/21/2009 55,640.29 457189 CUMMINGS ELECTRICAL INC 02/11/2010 55 383 57457189 CUMMINGS ELECTRICAL,INC. 02/11/2010 55,383.57 457882 BRENNEN MEDICAL, INC. 02/19/2010 55,114.50 451971 CARDON HEALTHCARE NETWORK 12/22/2009 55,060.82 463643 ST JUDE MEDICAL 04/22/2010 55,051.00 466588 RELIANCE WHOLESALE 05/14/2010 55,016.95 459897 CARDINAL HEALTH 03/11/2010 55,004.14 460493 CARDINAL HEALTH 03/17/2010 54,905.16 462322 MORRIS & DICKSON CO.,LTD 04/07/2010 54,846.00 458151 COVENTRY HEALTH CARE WORKE 02/22/2010 54,627.88 461757 ROCHE DIAGNOSTICS 04/01/2010 54,600.00 463920 MEDASSETS 04/23/2010 54,266.95 466566 TEXAS MEDICAID AND HEALTHC 05/14/2010 54,236.40 466011 PATTERSON DENTAL 05/10/2010 54,165.00 466715 CAREFUSION SOLUTIONS,LLC 05/17/2010 54,046.00 458491 MILLIMAN USA 02/25/2010 54,003.36 464137 CARDINAL HEALTH 04/26/2010 53,994.84 460802 STANDARD TEXTILE 03/19/2010 53,974.20 464427 SYNTHES 04/28/2010 53,901.00 460830 BELL, NUNNALLY & MARTIN, P 03/19/2010 53,863.21 455477 CARDINAL HEALTH 02/01/2010 53,822.33 453132 UT SOUTHWESTERN UNIVERSITY 01/06/2010 53,754.00 450782 UNIVERSITY OF TEXAS 12/10/2009 53,680.00

18



12/01/09 ‐ 5/31/10

457828 INTERPRISE THE DESIGN 02/18/2010 53,572.36 450236 K & L GATES 12/03/2009 53,518.97 452586 SYNTHES 12/30/2009 53,452.43 450110 CANON BUSINESS SOLUTIONS, 12/02/2009 53,408.70 463519 MEDICAL AUTOMATION SYSTEMS 04/20/2010 53,380.00 455699 OLYMPUS AMERICA, INC. 02/03/2010 53,060.00 450231 ROGERS CASEY INC. 12/03/2009 52,786.16 452792 SYNTHES 12/31/2009 52,620.38 453870 ZIMMER 01/14/2010 52,570.97 451672 KCI USA 12/18/2009 52,526.66 460353 INTERPRISE THE DESIGN 03/15/2010 52,436.44 457192 MORE DIRECT, INC. 02/11/2010 52,417.86 450813 HOLOGIC LIMITED PARTNERSHI 12/10/2009 52,254.19 460604 CARL ZEISS 03/18/2010 52,207.36 452823 CITY OF DALLAS 12/31/2009 52,157.20 462644 MORE DIRECT, INC. 04/09/2010 52,079.86 459782 ORACLE CORPORATION 03/10/2010 52,005.80 460645 CDW GOVERNMENT 03/18/2010 51,929.18 452975 RODERICK LEE ELECTRICAL 01/04/2010 51 916 50452975 RODERICK LEE ELECTRICAL 01/04/2010 51,916.50 466074 BOYLE & LOWRY LLP 05/10/2010 51,877.70 455048 CARDINAL HEALTH 01/27/2010 51,847.38 453134 CARDINAL HEALTH 01/06/2010 51,763.39 463606 PRIORITY HEALTHCARE CORPOR 04/21/2010 51,741.36 463804 ZIMMER 04/23/2010 51,599.00 461267 FURSTENBERG CONSTRUCTION C 03/25/2010 51,408.52 453888 COMPUTER TECHNOLOGY CORP 01/14/2010 51,380.00 460279 CARDINAL HEALTH 03/15/2010 51,219.58 458470 DELOITTE FINANCIAL ADVISOR 02/25/2010 51,147.59 463385 SULLIVAN, COTTER & ASSOCIA 04/19/2010 51,085.82 464787 FURSTENBERG CONSTRUCTION C 04/30/2010 51,039.13 451202 ALLIED INTERIORS 12/14/2009 50,889.60 464946 VEOLIA TRANSPORTATION 05/03/2010 50,864.06 457615 DEPT OF STATE HEALTH SERVI 02/17/2010 50,852.00 458253 STAPLES ADVANTAGE 02/23/2010 50,775.11 462009 JOHNSON & JOHNSON 04/02/2010 50,626.66 453483 JON BARRY & ASSOCIATES, IN 01/08/2010 50,518.08 464608 MORE DIRECT, INC. 04/29/2010 50,473.00 456611 ROCHE DIAGNOSTIC 02/05/2010 50,466.19 455708 CARDINAL HEALTH 02/03/2010 50,464.91 451841 DUNLEE 12/21/2009 50,449.50

19



12/01/09 ‐ 5/31/10

462538 ZIMMER 04/09/2010 50,384.04 466518 SYNTHES 05/14/2010 50,147.45 460825 DUNLEE 03/19/2010 50,014.28 460485 DALLAS FT WORTH HOSPITAL 03/17/2010 50,000.00

161,132,319.49$

20

New Parkland CampusExpenditures as of 5/31/2010

June 22, 2010

New Parkland CampusSummary Expenditures as of 5/31/2010

New Parkland CampusDetail Expenditures as of 5/31/2010

Audit and Compliance Committee

Committee Members Dalton Lott – Chair Louis Beecherl, III

Cobie Russell

Agenda for the Audit and Compliance Committee meeting of the Board of Managers of the Dallas County Hospital District scheduled for Tuesday, June 22, 2010 at 11:30 a.m. or (immediately following the Budget and Finance Committee meeting) in the Administrative Conference Room, First Floor, Parkland Memorial Hospital, 5201 Harry Hines Blvd., Dallas, TX 75235. The Audit and Compliance Committee may take action on any item listed below. The Audit and Compliance Committee and the Board of Managers reserve the right to exercise discretion and may convene in Executive Session as authorized by Sections 551.071, et seq., of the Texas Government Code and otherwise by law, on any item listed on the Audit and Compliance Committee or the general Board of Managers agenda. Executive Sessions (if any) will be held at the time scheduled on the Meeting Schedule and not at the time scheduled for the Audit and Compliance Committee. Time/Presenter I. Attendance/Call to Order Chair

II. Reports 15 min. Vic Summers

A. Cerner Pathnet Audit, Report No. 2010-203 III. Information Items

A. Internal Audit Services Monthly Status Report IV. Action Items

A. Any item listed in Sections II or III. V. Adjourn Chair

DALLAS COUNTY HOSPITAL DISTRICT PARKLAND HEALTH & HOSPITAL SYSTEM INTERNAL AUDIT SERVICES DATE: June 9, 2010

TO: Audit & Compliance Committee PHHS Board of Managers

FROM: Vic Summers, Senior Vice President Internal Audit Services

RE: Cerner PathNet Audit, Report No. 2010-203 Attached please find our final report on the Cerner PathNet Audit. Regards. Attachments

CC: Ron J. Anderson, M.D., President & Chief Executive Officer John Dragovits, Executive Vice President & Chief Financial Officer John Haupert, Executive Vice President & Chief Operating Officer Jack Kowitt, Senior Vice President & Chief Information Officer Vicki Crane, Senior Vice President, Clinical Support Nancy Folz-Murphy, Deputy Chief Information Officer Joe Longo, Director, Clinical Systems Debbie Perrault, Director, Pathology

DALLAS COUNTY HOSPITAL DISTRICT PARKLAND HEALTH & HOSPITAL SYSTEM INTERNAL AUDIT SERVICES Cerner PathNet Audit, Report No. 2010-203 June 9, 2010

A-2

Controls are functioning as intended.

Some controls are in place; however, several major issues were noted that could jeopardize the accomplishment of business objectives.

The control environment is lacking or not functioning as intended and is a contributing factor to non-achievement of business objectives.

EXPECTED CONTROLS STATUS 1. CANCELED PATHNET ORDERS

EPIC charge transactions should correspond to completed orders in the Cerner PathNet system.

2. CERNER ACTIVE RECOVERY

In case of a disaster the goal is to have the PathNet system fully operational in the Cerner Active Recovery system within one hour.

3. CACTUS PROVIDER INTERFACE

Each provider should have a unique identifying record per provider number in the PathNet system.


A-3

EXECUTIVE SUMMARY

Background:

The Pathology Department includes 15 cost centers - many of which operate 24 hours a day, 7 days a week. Diagnostic/therapeutic modalities include testing, analysis, screening, slide and case review, clinical and surgical specimen examination with diagnosis, result interpretation and autopsy services. Pathology has multiple on-site and off-site locations throughout Dallas County. The Department is responsible for all laboratory testing performed in those locations. In addition, Pathology has oversight responsibility for all point of care testing (POCT) that occurs in Parkland hospital, whether it is performed by laboratory or non-laboratory personnel.

In addition to providing laboratory services for all Parkland Hospital patients, the Department acts as a referral laboratory for Zale-Lipshy University Hospital, Aston Ambulatory Care Center, Children’s Medical Center, Cook Children’s in Fort Worth, Presbyterian Hospital, HealthSouth, and the Veterans Affairs Hospital. Pathology also participates in teaching and research activities for Parkland.

Human testing in U.S. laboratories is regulated by the Clinical Laboratory Improvement Amendments (CLIA). The PHHS laboratories have been issued a CLIA certificate of accreditation effective from February 2010 through February 2011. The College of American Pathologists (CAP) inspects the main Pathology laboratories. The last CAP inspection was performed in September 2009 with the Main Lab receiving no deficiencies, Transfusion Services received 6 deficiencies, Point of Care Testing receiving no deficiencies, and Anatomic Pathology received 2 deficiencies. All CAP noted deficiencies were resolved within the specified time frame and certificates issued. Additionally, Transfusion Services is accredited by the American Association of Blood Banks (AABB) and is registered with the Federal Drug Administration (FDA). AABB performed its last inspection in September 2009 with 3 deficiencies found. All AABB noted deficiencies were corrected within 30 days.

The Commission on Laboratory Accreditation (COLA) inspects the off-campus laboratory COPC/WISH sites and other off-site laboratories. COLA performed its last inspection in November 2009 with 25 deficiencies found. All deficiencies have been corrected and certificates issued that are valid for two years from date of issue.

For Fiscal Year (FY) 2009, Pathology’s gross patient revenue totaled $508,062,454, while operating expenses totaled $26,326,479. Pathology performed 8,100,444 single laboratory test procedures in FY 2009 from each of the modalities noted earlier as well as non-billable procedures. Examples of non-billable procedures are repeat tests, quality control, calibrations, and calculations.

PathNet replaced LabCare in October 2005 as part of the CITI 1.0 project with an estimated $5.5 million dollar implementation cost. Parkland pays Cerner an annual Support Services agreement of an estimated $1 million dollars. Information Systems is in a continuous improvement process of upgrading PathNet with Cerner releases. Currently, Pathology is focused on the front-end automation project.

Scope & Objectives:

The objective of this review was to determine data accuracy and integrity of the integration with Cerner PathNet system and EPIC.


A-4

To accomplish these objectives, Internal Audit Services (IAS) performed the following:

• Reviewed for Order Entry integration between PathNet and EPIC. • Validated that Order Results entered into PathNet are sent to EPIC. • Reconciled Charge Transaction generated in PathNet to EPIC. • Ensured Pathology Order Results are sent to UTSW vCDR for "view only" access to clinical

patient data. • Reviewed Pathology Billing Transactions that are sent to UTSW for Professional Fee billing. • Tested the specimen Bar Code Label Printing for accuracy with PathNet System data. • Reviewed the American Association of Blood Banks (AABB) inspection to identify deficiencies

with the ICCBBA database labeling system. • Reviewed previous tests of the Cerner PathNet Activity Recovery System to ensure in the event

of a unplanned computer outage the pathology system would be fully functioning in the Cerner PathNet Activity Recovery System within one hour.

• Reviewed quality assurance controls implemented by the Pathology Department to ensure order results transmitted via Medical Device Interface (MDI) are posted in PathNet and forwarded onto EPIC.

• Reviewed physician information in Cerner and compared to the data stored in the CACTUS credentialing system.

• Determine if sufficient user access information is logged in the PathNet system to assist the Information Security Officer and Privacy Officer determine if a HIPAA violation of Private Health Information (PHI) has occurred.

IAS performed its test work during January through May of 2010.

Conclusion:

IAS reviewed the following audit controls implemented by the Pathology Department to ensure data integrity in the Cerner PathNet system:

• Base interfaces appear to be operating as designed between Cerner PathNet and EPIC including Pathology Orders and Results, Charge Transactions, and Provider information.

• The Pathology Department has implemented controls to determine if EPIC Pathology test results and the UTSW vCDR are in sync with the original Pathology test results in Cerner.

• The Pathology Department periodically validates the ICCBBA database labeling system as required by the American Association of Blood Banks (AABB) for accuracy.

Opportunities to improve the Cerner PathNet system were noted below:

• IAS observed charge transactions that posted in EPIC where the order was canceled in Cerner PathNet. EPIC charge transactions should correspond to completed orders in the Cerner PathNet system. The cause of the charges being posted in EPIC from a canceled Cerner PathNet order is an anomaly that could not be identified by additional research by IAS, Information Systems, or the Pathology Department. (A-6)

• The Cerner Active Recovery (AR) disaster recovery system has not been fully tested as planned because Information Systems has not completed the implementation of the infrastructure required to have a fully integrated Cerner Active Recovery system. (A-7)

• Multiple provider records are in PathNet with duplicate Provider numbers. Each provider record in PathNet should have a unique identifying record per provider number in the CACTUS. These records are identified as the same provider with the same doctor number with no different alias, clinical, or billing necessity for having the duplicate record in the provider table. (A-7)


A-5

• Manual operations are in practice to extract data from CACTUS and transform data to be imported into the PathNet system resulting in operational inefficiencies. (A-8)

IAS would like to thank the Pathology Department, Medical Affairs, and the Office of the Chief Information Officer (OCIO) for their cooperation and participation in this review.

Observation Targeted Completion Date Risk Rating 1. Canceled PathNet Orders July 15, 2010 Moderate 2. Cerner Active Recovery Moderate 3. CACTUS Provider Interface Moderate

Responsible Management: Clinical Support: Executive Vice President & Chief Operating Officer: John Haupert Senior Vice President: Vicki Crane Director of Pathology: Debbie Perrault Office of the Chief Information Officer (OCIO): Executive Vice President & Chief Financial Officer: John Dragovits Senior Vice President & Chief Information Officer: Jack Kowitt, Deputy Chief Information Officer: Nancy Folz-Murphy Director of Clinical System: Joe Longo Audit Risk Assessment:

Performance

Low Moderate High This review received a moderate risk rating because charge transactions were posted in EPIC where the order was canceled in Cerner PathNet, Cerner Active Recovery (AR) system has not been fully tested as planned, and multiple provider records are in the PathNet application with duplicate provider identification numbers. Additionally, manual operations are in practice to extract data from CACTUS and transform data to the PathNet system.

Importance

Low Moderate High The Cerner PathNet laboratory information system is of high importance to Parkland because it provides clinicians with technology automating the operational and managerial sides of the Pathology Department. The Cerner PathNet system provides useful and timely information for monitoring the Organization’s Quality goal of Operational Excellence to meet Lab Turnaround Time.

DALLDALLAS COUNTY HOSPITAL DISTRICT PARKLAND HEALTH & HOSPITAL SYSTEM INTERNAL AUDIT SERVICES Cerner PathNet Audit, Report No. 2010-203

A-6

OBSERVATION RISK RECOMMENDATION MANAGEMENT RESPONSE 1. Canceled PathNet Orders

1 out of 6 (16%) Blood Bank accession numbers/patients tested had errors: the error was attributable to charge transactions posted in EPIC where the order was canceled in Cerner PathNet. IAS selected six accession numbers from each of the five Pathology areas, Anatomic Pathology, Cytology, General Chemistry, Microbiology, and Blood Bank totaling thirty accession numbers/patients and traced the Cerner PathNet orders, the results from those orders, and the subsequent posting of the orders, results, and charges generated in EPIC. For 1 of 30 accessions tested, the order was canceled in Cerner but appeared in Epic as a charge for services that had not been performed. IAS did not note any issues with the remaining twenty nine accession numbers. The cause of the charges being posted in EPIC from a canceled Cerner PathNet order is an anomaly that could not be identified by additional research of canceled PathNet orders by IAS, Information Systems, or the Pathology Department. IAS did not discover any control or another preventive measure to identify/stop charge transactions posted in EPIC where the order was canceled in Cerner PathNet.

The effect of charges transactions posted in EPIC from Pathology orders that were canceled in Cerner PathNet is the overbilling the patient for services not received.

EPIC charge transactions should correspond to completed orders in the Cerner PathNet system. The Pathology Department should implement a control to monitor the risk of charge transactions posted in EPIC from Pathology orders that were canceled in Cerner PathNet to determine the frequency and impact.

Management Response: Vicki Crane (6/7/10) Blood Bank Manager will audit 20 rule based cancellation orders per calendar year quarter. Findings of the audit will be reported to the Pathology Director and Senior Vice President each quarter along with action plans including persons responsible for the action plans and a time line. Audit result reports will be available for IA upon request. The first audit report will be available July 15th which will include April - June 2010. This audit will continue for 4 quarters. If no issues are identified, the formal audit report will discontinue and the rule based cancellation orders will be monitored for compliance. Targeted Completion Date: July 15, 2010


A-7

OBSERVATION RISK RECOMMENDATION MANAGEMENT RESPONSE 2. Cerner Active Recovery

The Cerner Active Recovery (AR) system has not been fully tested per the ACS Service Level Agreement (SLA) that states that the Cerner Active Recovery (AR) system will be tested twice a year. Information Systems has not completed the implementation of the infrastructure required to have a fully integrated Cerner Active Recovery (AR) system. In case of an unplanned computer outage the goal is to have the PathNet system fully operational in the Cerner Active Recovery system within one hour.

Loss of Cerner PathNet functionality due to a catastrophic computer failure.

Continue implementing the infrastructure required to perform a fully integrated Cerner Active Recovery test.

Management Response: Jack Kowitt () Targeted Completion Date:

3. CACTUS Provider Interface a. Duplicate Provider records

Multiple provider records are in the PathNet application with duplicate provider identification numbers. These records are identified as a provider with a unique identification number with no different alias, clinical, or billing necessity for having the duplicate records in the Cerner system. The duplicate records are created in PathNet provider table as a result of the CACTUS credentialing system interface when non-clinical, or billing necessity information is modified, added, or removed in the CACTUS system and imported into PathNet. Duplicate provider records can bloat the size of the provider table, skew statistics, and can be general obstacles to completing provider selection and reporting tasks efficiently.

Selection of the wrong provider record with information that is not current.

Clean up duplicate provider records in Cerner PathNet and determine how to consolidate those with clinical or billing information. Review the interface logic to avoid duplicate provider records in Cerner PathNet or implement detective controls to identify duplicate provider records.



A-8

OBSERVATION RISK RECOMMENDATION MANAGEMENT RESPONSE b. Manual processes during the CACTUS to Cerner interface

Manual operations are in practice to extract data from CACTUS and transform data to the downstream systems. The CACTUS system does not offer automated interfaces to extract and transform Provider Credentialing information into other systems. Information Systems has created a process using an Oracle database as an intermediary between CACTUS and other applications that depends on manual intervention.

There are operational inefficiencies as a result of manual intervention to extract and transform the data to be sent using the interface engine to downstream systems.

The extraction and transformation of data process should be automated. Replace manual processes from the CACTUS to Cerner PathNet interface with automated systems.


Dallas County Hospital District Parkland Health & Hospital System

Audit & Compliance Committee Meeting June 22, 2010

Internal Audit Services Monthly Status Report

Audit Committee Reports A. Cerner PathNet, Report No. 2010-203

Executive Session Reports

A. Radiology Audit, Report No. 2010-002 B. Durable Medical Equipment, Report No. 2009-306

Audits in Progress Status • Engineering Services Draft • E-Signatures Draft (JULY) • Post-Partum Draft (JULY) • Admission & Registration Planning • EPIC Hospital Billing Planning • Procurement Review Planning • Compensation Delayed • PACS Delayed

Audit Follow-up Summary Report Status • Audit Management Response Follow-up Audit, Quarterly (JULY)

Fiscal Year 2010 Compliance Reviews In Progress Status • Outpatient Procedure Area Coding Draft (JULY) • Evaluation & Management Fieldwork • Self Administered Drugs Fieldwork • Inpatient/Outpatient Services in Appropriate Setting Fieldwork • Review of Federal and State Government Excluded Individuals/Entities Quarterly (JULY) • Inpatient Coding Initiative Planning • Never Events Planning • Observation Services Planning • Texas Health Steps Planning • Pressure Ulcer Delayed • Mid-Level Provider Delayed

Consults and Other Status • Payroll Analysis Fieldwork • Cash Monitoring Quarterly (JULY) • HIPAA Privacy Monitoring Quarterly (JULY) • Deloitte External Audit Assistance Ongoing • Fraud Awareness Ongoing • Joint Commission Patient Rights & Responsibility Work Team Ongoing • New Parkland – Request for Proposal Scoring Ongoing • Remediation Activities Ongoing • CORE Cash Register System Planning • Physical Inventory, Fiscal Year 2010 Planning • Fixed Asset Monitoring Delayed • Patient Valuables and Patient Deposits Delayed

Executive Session Agenda for the Executive Session of the Board of Managers of the Dallas County Hospital District scheduled for Tuesday, June 22, 2010, at 11:45 a.m. (or immediately following the Audit and Compliance Committee meeting) in the Administrative Conference Room, First Floor, Parkland Memorial Hospital, 5201 Harry Hines Blvd., Dallas, TX 75235. Pursuant to the Texas Open Meetings Act, Texas Government Code Sections 551.071, 551.072, 551.074, 551.076 and 551.085 and Section 161.032(b) of the Texas Occupations Code, the Board of Managers shall discuss the following items listed below. The Board of Managers also reserves the right to exercise discretion and may convene in Executive Session on any item listed on any Committee agenda or the general Board of Managers’ agenda.

I. Attendance/Call to Order Time/Presenter II. Executive Session Items

A. Report from the Medical Advisory Council Appointments/Reappointments of Medical, House and Allied Health Staff to Parkland Health and Hospital System

10 min. Steven Bloom, MD

B. Compliance Officers Report 20 min Nancy Merritt

C. Legal Update 30 min.

1. LAZ Property Michael Silhol 2. Gentilello v. UTSW Michael Silhol 3. DOJ/DEA Pharmacy Matter Michael Silhol 4. Request for Indemnification –

Walker-El v. Barnett Michael Silhol

5. Billing Matters Update Michael Silhol

D. Great Western Erectors 10 min. Michael Silhol

E. Internal Audit – 1. Radiology Report – Report No. 2010-002 2. Durable Medical Equipment Audit, Report No. 2009-306 3. Documentation Project Update

45 min. Vic Summers

F. Joint Commission Communication 5 min. John J. Shannon, MD

G. Techforce Investigation 10 min. Nancy Merritt

H. Purchase of 5326 Redfield Street, Dallas, Texas 10 min Walter Jones

III. Action Items

A. Any item listed under Section II IV. Adjourn

Board of Managers Agenda Agenda for the Meeting of the Board of Managers of the Dallas County Hospital District scheduled for Tuesday, June 22, 2010 at 2:05 p.m. (or immediately following the Board Executive Session) in the Administrative Conference Room, First Floor, Parkland Memorial Hospital, 5201 Harry Hines Blvd., Dallas, TX 75235. The Board of Managers may take action on any item listed below. The Board of Managers reserves the right to exercise discretion and may convene in Executive Session as permitted by sections 551.071, et seq., of the Texas Government Code, and as otherwise authorized by law, on any item listed on the Board of Managers’ agenda. Executive Sessions (if any) will be held at the time scheduled on the Meetings Schedule and not at the time scheduled for the Board of Managers’ meeting.

Time/Presenter I. Attendance/Call to Order

Chair

II. Invocation III. CEO Report Ron J. Anderson, M.D. A. Legislative Update B. IT Update C. Key Budget Statistics D. Parkland Foundation E. Awards, Community Speeches, VIP visits F. Goal Achievement Update IV. Consent Agenda

A. Minutes of the Strategic Planning Committee Meeting (REVISION), January 7, 2010 B. Minutes of the Facilities Committee Meeting (REVISION), January 26, 2010 C. Minutes of the Information Systems Committee Meeting, May 20, 2010 D. Minutes of the Quality and Risk Management Committee Meeting, May 21, 2010 E. Minutes of the Facilities Committee Meeting, May 21,2010 F. Minutes of the Strategic Planning Committee Meeting, May 21,2010 G. Minutes of the Legislative Affairs Committee Meeting, May 24, 2010 H. Minutes of the Budget and Finance Committee Meeting, May 24, 2010 I. Minutes of the Quality and Risk Management Committee Meeting, May 25, 2010 J. Minutes of the Budget and Finance Committee Meeting, May 25, 2010 K. Minutes of the Audit and Compliance Committee Meeting, May 25, 2010 L. Minutes of the Human Resources Committee Meeting, May 25, 2010 M. Minutes of the Legislative Affairs Committee Meeting, May 25, 2010 N. Minutes of the Board of Managers Meeting, May 25, 2010

V. Committee Reports, Recommendations, Discussion Items (Subject and Committee Agendas Incorporated by Reference) A. Quality and Risk Management B. Budget and Finance

Board of Managers Meeting Agenda June 22, 2010 Page 2

C. Audit and Compliance D. Human Resources E. Legal Committee F. Facilities G. Strategic Planning

VI. Discussion/Action Items A. Wonderview B. Follow-Up List C. Any item under Executive Session VII. Public Comments VIII. Adjourn Chair

Minutes of the meeting of the Quality and Risk Management Committee of the Board of Managers of the Dallas County Hospital District, held Tuesday, May 25, 2010, at 8:05 a.m., in the Administrative Conference Room, Parkland Memorial Hospital. I. Attendance and Call to Order

Chairman Dalton Lott called the meeting to order at 8:05 a.m. Other members present were Lauren McDonald, M.D. and Chad Park, DDS. Additional attendees and/or presenters were:

Sharon Phillips

Stanley Pomarantz, MD Lou Saksen Brad Simmons Robin Stults Vic Summers Brent Treichler, MD Paula Turicchi Andrew Ulrich Marisa Valdes John Wood

Josh Floren April Foran Annie Franklin Frank Hemeon Pete Hoffmann, MD Walter Jones Jack Kowitt Karen Lindsey Marilyn Little Nancy Merritt Eleanor O’Conner Sherry Petrillo

Louis A. Beecherl, III Chris Luna Cobie Russell Ron Anderson, MD John Dragovits John Haupert John Jay Shannon, MD Miriam Sibley Michael Silhol Marshall J. Doke, Jr. Vicki Crane Chris Davis

II. Information/Discussion Items A. Performance Improvement Fair Winner

Heather Duncan and Gabriel Fruge gave a presentation on their winning entry in the recent Parkland PI Fair regarding their efforts in developing a glycemic management pilot program at Parkland.

B. Infection Prevention Evaluation and Plan

Thomas Button and Pranavi Sreeramoju, M.D. gave the Committee an overview of the Infection Prevention and Control Evaluation for 2009. The evaluation included the results of improvement efforts as well as elucidation of some processes and infections that deserve closer attention in the future.

C. Performance Improvement Evaluation Plan

Julia Napper gave a detailed report on the Performance Improvement Evaluation Plan (Plan) as required by The Joint Commission. The Plan is established under the direction of the Board of Managers and is designed to establish a formal, organization-wide system to monitor and continuously improve patient outcomes and services.

Quality and Risk Management Committee Meeting Minutes May 25, 2010 Page 2 of 3

Ms. Napper reviewed the purpose of the Plan which measures the extent of interdisciplinary collaboration, and reviewed the history of performance improvement at Parkland retrospectively. Ms. Napper presented to the Committee the redlined version of the Plan. Changes made to the Plan were due to legislative and Joint Commission changes. Additionally, some items of the Plan, such as a description of the responsibilities of various individuals, were deleted because these job responsibilities were better reflected in those individual job descriptions Mr. Luna expressed concern over the deletion in the Plan of the descriptions of responsibilities of certain individuals. Mr. Luna wanted to keep the job descriptions in the Plan for accountability purposes. Ms. Napper, however, reiterated that these responsibilities remain in the individuals’ job descriptions. Mr. Doke asked for clarification of the following sentence on page 4 of the Plan: “The elected and appointed leaders of the Medical Staff are responsible for the following….” Management confirmed that leaders of “Clinical Departments” are part of the Medical Staff at Parkland, and therefore, the deletion of the “leaders of the clinical departments” in the Plan will not remove their responsibility or accountability. Similarly, the deletion of “Directors” and “Department Managers” does not reduce their role, responsibility, or accountability for the deleted functions inasmuch as they are part of “Senior Leaders.” Mr. Silhol suggested additional minor changes be made for further clarity in the Plan and described those changes to the Committee. The Committee voted to recommend approval of the Plan to the Board of Managers for approval, with the changes suggested by Mr. Silhol.

D. Proposal for FY 2011 Quality of Care Initiatives

Peter Hoffmann, M.D. reviewed with the Committee the three proposed institutional quality initiatives for Parkland for FY 2011. They were: 1) reduce hospital acquired infections; 2) reduce 30-day readmission rate for heart failure, acute myocardial infarction and community acquired pneumonia; and 3) improve performance on mandated and/or publicly reported quality metrics. After discussion with the Committee, and upon motion duly made and seconded, the Committee voted to accept the three proposed institutional quality of care initiatives for FY 2011.

III. Adjourn

There being no further business to discuss, Mr. Lott adjourned the meeting at 9:22 a.m.

ATTESTED TO:


__________________________________ ___________________________ Dalton Lott Michael L. Silhol Chair Assistant Secretary

Budget and Finance Committee Meeting Minutes October 27, 2009 Page 1 of 6 Budget and Finance Committee Meeting Minutes October 27, 2009 Page 1 of 6 Minutes of the meeting of the Budget and Finance Committee of the Board of Managers of the Dallas County Hospital District, held Tuesday, May 25, 2010, at 9:30 a.m., in the Administrative Conference Room, Parkland Memorial Hospital. I. Attendance and Call to Order

Chairman Alan Walne called the meeting to order at 9:30 a.m. Members present were Louis A. Beecherl, III and Chris Luna. Additional attendees and/or presenters were:

II. Discussion Items

Kristi Padon Lynsey Purl Paul Ransom Rick Rhine Brad Simmons Robin Stults Vic Summers Paula Turicchi Andrew Ulrich Karen Van Compernolle

(Deloitte)

Candy Knowles Anthony Kouu (Med Student)

Jack Kowitt Karen Lindsey Marilyn Little Peggy Lundy Liz McMullen Nancy Merritt Andrew Montgomery Ciel Murphy

Marshall J. Doke, Jr. Vicki Crane Chris Davis April Foran Melissa Grych Frank Hemeon Sherri Jacobson (DMN)

Jim Johnson Vicki Keiser (Deloitte) Walter Jones

Lauren McDonald, MD Dalton Lott Chad Park, DDS Cobie Russell Ron Anderson John Dragovits John Haupert John Jay Shannon, MD Miriam Sibley Michael Silhol

A. FY 10 Audit Overview

Karen Van Compernolle and Vicki Keiser of Deloitte reviewed the Parkland Health and Hospital System 2010 Client Service Report with the Committee. Deloitte released Advancing Quality through Transparency, an inaugural transparency report as part of its ongoing commitment to quality. Deloitte reviewed the estimated fees for the 2010 engagements at Parkland Health and Hospital Systems to include Parkland Community Health Plan’s audit for the year ending December 31, 2010. Deloitte has a group located in Washington, DC focusing on Healthcare Reform and assures the Committee that they are monitoring issues surrounding it.

B. PHHS Financial Statement and Statistical Report for April, 2010

John Dragovits presented an overview of the financial statements and reviewed key statistics for PHHS for the month of April 2010. Deliveries continue to be slightly under budget. Emergency room visits exceed budget. Cash Collections remain strong. Discharges were greater than budget as well as equivalent patient days. Ambulatory visits and Average Daily census were also greater than budget.

Mr. Dragovits also gave a Forecast Update. Operating Costs per Adjusted Patient Day for the month of April were less than budgeted. Days in Accounts Receivable, Key

Budget and Finance Committee Meeting Minutes May 25, 2010 Page 2 of 6

Financial Condition Performance Metrics, Days Cash on Hand and Days in Accounts Payable were also reviewed. Tobacco money has decreased and salaries remain relatively flat. Pharmaceuticals are slightly over budget partially due to a single drug manufacturer who lost its generic license; the company will be taking it off the market as a generic.

Ambulatory Care Clinic (ACC) visits remain strong and there continues to be access issues in the Specialty Clinics. Louis Beecherl, III asked Management to review expanding the hours of operation for the ACC to potentially alleviate an increase in ER wait times due to space restraints. Management will provide a follow up report in 60 days to the Board.

C. Budget 11 Overview

Mr. Dragovits gave an update on the FY 2011 Budget. The budget process was reviewed as well as key assumptions, expectations, tax revenues and the projected shortfall. Key dates discussed for upcoming budget activity to include the Commissioners Court on July 27, 2010.

D. Real Estate Not presented to the Committee, pulled for further discussion. E. Vendor Management System

Paul Ransom defined Contingent Staff Management as an onsite vendor-neutral service for procuring contingent employees. This service allows a Vendor Neutral Management Service (VMS), on behalf of its client (Parkland Health and Hospital System), to negotiate with multiple independent staffing vendors to help identify and hire qualified candidates in a short time frame at favorable prices. American Healthcare Services Association (AHSA) is the suggested vendor. Mr. Ransom reviewed the features and benefits of AHSA and their twelve step process. Management recommends approval of American Healthcare Services Association for a one year contract with two year renewal at $6.2 million per year.

F. Inpatient Pharmacy Automation

Vivian Johnson gave a detailed report on Inpatient Pharmacy Automation. Phase I and II of the Inpatient Medication Management Transformation have been completed. Phase III is in progress and is necessary for several reasons. Among them are automation implementation and process redesign as well as barcode preparation, inventory management and security.


Management is recommending the purchase of a Swisslog Medication Robot. Committee expressed concerns that should this purchase be approved, Management would need to ensure that the Service Level Agreement is sufficient, inventory controls are in place and that process and procedures be put into place in the event of a power outage.

G. HIM Update

Robin Stults reviewed strategic initiatives for HIM, performance metrics, fiscal goals, coding production, coding focus, Clinical Documentation Improvement Program, CDIP reporting, record integrity, registry services, EDMS project goals, records management and HIM 3rd quarter focus.

An RFP was issued for the required EPIC Integration, seven vendors responded; the selection committee has short listed two vendors. After a recommended vendor is chosen, the Steering Committee will present their selection to the Board of Managers at the June meeting for approval.

H. Supply Chain Update

The Committee received a detailed report by Monty Montgomery regarding the Supply Chain Strategic Plan for FY 2010. Contracting, Value Analysis, Data Clean Up and Focused Departmental Support were among the Mid Course Corrections. The UHC Dashboard was presented to the Committee and Mr. Montgomery highlighted the areas for improvement indicated by the report. Data corruption issues were discovered in January. Outside resources were brought in from Lawson to help identify and correct the problem. Value Analysis, MWBE timeframe/status were also discussed. In an effort to support the strategic design of the new hospital to facilitate supply chain management, recruiting for a Program Director for Supply Chain will began the third quarter of fiscal year 2010. Cobie Russell suggested that Management schedule meetings to train and educate potential vendors on how to bid for contract work at Parkland Hospital.

III. Action Items

A. Contracts over $200,000 The following contract requests were presented to the Committee for approval:


ROUTINE EXPENSE 1. Financial Consulting Services – Alta Vista Financial Consultants, LLC, from 7/1/10

through 6/30/11 for a total of $360,000

2. Staffing Management Services – American HealthCare Services Association (AHSA), from 5/31/10 through5/1/11 for a total of $18,612,000

3. Outsource Clerical Temporary and Permanent Placement Services Amendment –

Kforce Healthcare, Inc. from 5/29/10 through 5/28/11 for a total of $350,000 4. Outsource Clerical Temporary and Permanent Placement Services Amendment –

Office Works (People 2.0) from 5/1/10 through 4/30/11 for a total of $365,000 5. Outsource Coding & Abstracting Temporary and Permanent Placement Services

Amendment – United Audit Systems, Inc. (UASI) from 5/1/10 through 4/30/11 for a total of $390,000

6. Allograft Tissues Supply – University of Texas Southwestern Medical Center at

Dallas, Transplant Services Center from 7/1/10 through 12/31/12 for a total of $1,494,135

REVENUE 7. Poison Center Services – Commission on State Emergency Communications from

5/1/10 through 8/31/11 for a total of $1,788,461 8. Ryan White Part A Formula – HIV/AIDS Service Deliveries – Dallas County Health

and Human Services from 3/1/10 through 2/28/11 for a total of $2,666,941 9. Ryan White Part A Supplemental – HIV/AIDS Service Deliveries – Dallas County

Health and Human Services from 3/1/10 through 2/28/11 for a total of $1,169,466 10. Ryan White Part B – HIV/AIDS Service Deliveries – Dallas County Health and

Human Services from 3/1/10 through 2/28/11 for a total of $1,194,449 11. Title V Child Health and Dental Grant Amendment – Department of State Health

Services from 9/1/09 through 8/31/10 for a total of $461,861 12. Title V Prenatal Services Amendment – Department of State Health Services from

9/1/09 through 8/31/10 for a total of $1,411,018 13. Health Center Cluster (HOMES Grant) Amendment – US Department of Health and

Human Services, Health Resources and Services Administration (HRSA) from 11/1/09 through 10/31/10 for a total of $1,104,274


REAL PROPERTY LEASES – EXPENSE REQUIRES COURT APPROVAL 14. Lease – 2608 Inwood Ltd. from 1/1/11 through 12/31/14 for a total $4,848,000

(WITHDRAWN) 15. Third Amendment – Add Suite 600 and Extend Lease Space –SAF Exchange Park,

Ltd. from 1/1/11 through 8/31/14 for a total of $2,916,510 (WITHDRAWN)

REAL PROPERTY LEASES – REVENUE REQUIRES COURT APPROVAL 16. Third Amendment – Extension of Lease – PGV Pediatrics, P.A. from a 4/1/10

through 5/31/13 for a total of $139,832 CAPITAL 17. Inpatient Pharmacy Automation – Translogic Corporation dba Swisslog Healthcare

Solutions (One Time Purchase + 5 year maintenance) for a total of $3,018,208 18. HOMES Shed and Parking Facility – Furstenberg Construction from 6/1/10 through

7/31/10 for a total of $368,085 NEW PARKLAND HOSPITAL CAPITAL 19. Mechanical & Electrical Preconstruction and Construction – Balfour Beatty, Austin

Commercial, H.J. Russell, Azteca Enterprises JV (BARA) from 6/1/10 - through 12/31/14 for a total of $10,675,440

20. Construct East Parking Lot – Balfour Beatty, Austin Commercial, H.J. Russell,

Azteca Enterprises JV (BARA) from 6/1/10 through 12/31/10 for a total of $7,448,039

INFORMATION ONLY: COST AVOIDANCE 21. Hospital Outpatient Assistance Program – Bristol – Myers Squibb Patient Asistance

Foundation, Inc. from 515/10 through 5/14/11 for a total of ($578,000) EMERGENCY CONTRACT FOR RATIFICATION 22. Organs for Transplant Program – Southwest Transplant Alliance from 4/28/10



Mr. Luna made a motion to approve the Contracts with the Committee’s understanding that Contract #17 will have a service level agreement that will have detailed language to include penalties for non-serviced items and delays. Mr. Beecherl, III seconded. The motion carried.

B. Capital Contingency

Pulled

IV. Adjourn

All other items on the agenda being information items and there being no further business to be brought before this Committee, Mr. Walne adjourned the meeting at 11:28 a.m.

ATTESTED TO: _________________________________ ___________________________________ Alan Walne Michael L. Silhol Chair Assistant Secretary

Minutes of the meeting of the Audit and Compliance Committee of the Board of Managers of the Dallas County Hospital District, held Tuesday, May 25, 2010, at 12:13 p.m., in the Administrative Conference Room, Parkland Memorial Hospital. I. Attendance and Call to Order

Chairman Dalton Lott called the meeting to order at 12:13 p.m. Members present were Louis Beecherl, III and Cobie Russell. Additional attendees and/or presenters were:

Frank Hemeon

Karen Lindsey Peggy Lundy Nancy Merritt Lynsey Purl Vic Summers Paula Turicchi

Jay Shannon, MD Miriam Sibley Michael Silhol Marshall J. Doke, Jr. Vicki Crane Jack Kowitt Kathy Haliburton

Lauren McDonald, MD Chris Luna Chad Park, DDS Alan Walne Ron Anderson, MD John Dragovits John Haupert

II. Reports A. Review of Federal and State Government Excluded Individuals/Entities, fiscal Year

2010 - 2nd Quarter, Report No. 2010-505 Internal Audit Services performed a review to determine that the process of verifying all active and inactive potential vendors, employees, independent contractors, and credentialed providers with the Federal and State government exclusion lists is working as intended. The review identified no confirmed matches and 2 potential matches remain. IAS will continue to investigate the 2 contractors noted as a potential match. IAS will conduct quarterly reviews of the government list comparisons.

B. Internal Audit Services Monthly Status Report Mr. Summers reviewed the 2nd Quarter Activity Report. A Financial Auditor position has been added.

III. Information Items Mr. Summers gave an update of the Internal Audit Services Monthly Status Report.

Audit and Compliance Committee Meeting Minutes May 25, 2010 Page 2 of 2

IV. Adjourn

There being no further business to discuss, Mr. Lott adjourned the meeting at 12:15 p.m.

ATTESTED TO:


Minutes of the meeting of the Human Resources Committee of the Board of Managers of the Dallas County Hospital District, held Tuesday, May 25, 2010, at 12:15p.m., in the Administrative Conference Room, Parkland Memorial Hospital. I. Attendance and Call to Order

Chairman Alan Walne called the meeting to order at 12:15p.m. Members present were Chris Luna and Chad Park, DDS. Additional attendees and/or presenters were:

Peggy Lundy Nancy Merritt Lynsey Purl Jody Springer Vic Summers Paula Turricchi Andrew Ulrich

Lauren McDonald, MD Louis Beecherl, III Cobie Russell Alan Walne Ron Anderson, MD John Dragovits John Haupert Jay Shannon, MD Miriam Sibley

II. Information/Discussion Items A. The Road to Nursing Magnet Designation Miriam Sibley gave a detailed report on the Magnet Recognition Program developed in

1993 to recognize organizations that demonstrate excellence in nursing practice. The designation is awarded by the American Nurses Credentialing Center, a division of the American Nurses Association.

Parkland Hospital has implemented a new shared governance model with several other

objectives in an effort to qualify for Nursing Magnet Designation.

Lauren McDonald, MD assured Management that the Board supports their efforts in trying to obtain the Magnet Designation.

B. Parkland Nurse Staffing Methodology

Ms. Sibley reported on the Nursing Administration and Centralized Staffing Office processes, functions and scope. Regulatory issues impact staffing needs. Parkland Hospital does not use standard agency nurses. The goal of the Centralized Staffing Office is to maximize productivity in the most cost-effective manner while ensuring safety and quality.

Michael Silhol Marshall J. Doke, Jr. Vicki Crane April Foran Kathy Haliburton Jack Kowitt Karen Lindsey Marilyn Little

Human Resources Committee Meeting Minutes May 25, 2010 Page 2 of 2

The Centralized Staffing Office does not operate with a budget, the cost is charged to the department using the services.

The Committee requested that Parkland Hospital track nursing satisfaction.

III. Adjourn There being no further business to discuss, Mr. Walne adjourned the meeting at 1:08 p.m.

ATTESTED TO:

__________________________________ ___________________________ Alan Walne Michael L. Silhol Chair Assistant Secretary

Minutes of the meeting of the Legislative Affairs Committee of the Board of Managers of the Dallas County Hospital District, held Tuesday, May 25, 2010 at 11:30 a.m., in the Administrative Conference Room, Parkland Memorial Hospital. I. Attendance and Call to Order

Chairperson Cobie Russell called the meeting to order at 11:30 a.m. Members present were Dalton Lott and Lauren McDonald, MD. Additional attendees and/or presenters were:

Louis A. Beecherl, MD Chris Luna Chad Park, DDS Alan Walne Ron Anderson, MD John Dragovits John Haupert Jay Shannon, MD Miriam Sibley Michael Silhol Marshall J. Doke, Jr. Cindi Berry – Polsinelli Shughart PC

Vicki Crane Steve Bristow Terry Brooks – Polsinelli Shughart PC

Chris Davis Josh Floren April Foran Sherri Jacobson (DMN) Jennifer Cutrer Julius Hobson – Polsinelli Shughart PC

Marsha Jones – HillCo Partners

Anthony Khuu-UTSW Med Student Karen Lindsey Marilyn Little Peggy Lundy Angela Morris Jody Springer

II. Information/Discussion/Action Items

A. Overview of Federal Healthcare Reform

Cobie Russell introduced Cindi Berry, Julius Hobson and Terry Brooks from Polsinelli Shughart PC.

The Polsinelli Shughart Team gave a detailed overview to the Board of Managers

regarding federal health reform including the political and economic landscape, the implications for Parkland and how the federal law interfaces with States’ efforts toward health reform and Medicaid.

Parkland Hospital’s roles with respect to health reform were defined in detail and

included a role as provider of services, safety net hospital, teaching institution, health system innovator, insurer, and employer.

B. Overview of State Matters

Cobie Russell introduced Marsha Jones, HillCo Partners. Ms. Jones reviewed health reform in Texas, including a legislative outlook for the upcoming 2010 Texas legislative session.

Legislative Affairs Meeting Minutes May 25, 2010 Page 2 of 2

Jody Springer discussed Parkland’s strategic position with respect to health reform to include a strengths, weaknesses, opportunities and threats analysis.

II. Adjourn

There being no further business to be brought before the Committee, Ms. Russell adjourned the meeting at 11:57 a.m.

ATTESTED TO:

____________________________ __________________________ Cobie Russell Michael L. Silhol Chair Assistant Secretary

Minutes of the meeting of the Board of Managers of the Dallas County Hospital District, held on Tuesday, May 25, 2010 at 1:10 p.m., in the Administrative Conference Room, Parkland Memorial Hospital.

I. Attendance and Call to Order The Chair, Lauren McDonald, MD, called the meeting to order at 1:10 p.m. Members

present were Louis Beecherl, Dalton Lott, Chris Luna, Chad Park, DDS, Cobie Russell and Alan Walne. Additional attendees and/or presenters were:

Adrian Magallanes Nancy Merritt Vic Summers Andrew Ulrich Kenya Woodruff

James Carpenter Leslie Allen Davis (public comment) Ruth Fitzgiven Kathy Haliburton Amy LaBarge Karen Lindsey David Marguiles

Ron Anderson, MD John Dragovits John Haupert John Jay Shannon, MD Miriam Sibley Michael Silhol Marshall Doke, Jr. Steve Bloom, MD

At 1:10 p.m., the Board went into Executive Session, pursuant to Texas Government Code, Section 551.071, et seq., to discuss the following:

• Report from the Medical Advisory Council Appointments/Reappointments of Medical, House and Allied Health Staff to Parkland Health and Hospital System

• Legal Update 1. LAZ Property 2. Gentilello v. UTSW 3. State Board of Pharmacy 4. Indemnification of Jail Health Employees 5. Responding to Public Information Act Requests/ Freedom of Information Act Requests (FOIA)

• Internal Audit 1. Radiology Report – Report No. 2010-002 2. Consultation with Internal Audit

• Joint Commission Communication • Techforce Investigation • Great Western Company

While in Executive Session, the Board voted to approve the Medical Staff Credentials report presented by the Medical Advisory Council. At 5:00 p.m. the Board came out of Executive Session and upon motions duly made and seconded approved the following:

Board of Managers Meeting Minutes May 25, 2010 Page 2 of 6

• Indemnification of Jail Health Employees – Dr. Waseem Ahmed and Dr. Zia Rehman

II. CEO Report Deferred III. Consent Agenda

A motion was made by Mr. Lott and seconded by Ms. Russell to approve the minutes of the meetings listed below:

A. Minutes of the Facilities Committee, April 9, 2010 B. Minutes of the Strategic Planning Committee, April 9, 2010 C. Minutes of the Information Systems Committee, April 15, 2010 D. Minutes of the Quality and Risk Management Committee, April 20, 2010 E. Minutes of the Budget and Finance Committee, April 20, 2010 F. Minutes of the Audit and Compliance Committee, April 20, 2010 G. Minutes of the Board of Managers Meeting, April 20, 2010 H. Minutes of the Legal Committee Meeting, May 5, 2010

IV. Committee Reports, Recommendations, Discussion Items

A. Report/Recommendations of the Quality and Risk Management Committee:

Mr. Lott reported that the Committee met on May 21, 2010 and discussed the following in Executive Session: Sterilization and Disinfection Report Infection Prevention Plan and Program Evaluation Performance Improvement Plan and Program Evaluation The Committee also discussed the Proposed Quality of Care Goals for FY 2011 and the presentation method of “Goals” to the Board of Managers. A recommendation was made by the Committee to the Board of Managers to approve the PI Plan with recommended revisions. Mr. Walne made a motion to approve the PI Plan with revisions. Dr. Park seconded. The motion carried.

B. Report/Recommendations of the Budget and Finance Committee:

Mr. Walne reported that the Committee met May 24, 2010 to discuss the following:


Supply Chain Update, Supply Chain Audit Approach, New Parkland Campus Construction Cost Controls and New Parkland Campus Audit Update. There were no action items. Mr. Walne reported that the Finance Committee met May 25, 2010 and reviewed the financial statements for May 2010. The Committee also received the following reports: FY 2010 Audit Overview, Budget 11 Overview, Real Estate, Vendor Management System, Inpatient Pharmacy Automation, an HIM Update and Supply Chain Update.

The Committee approved the following contracts over $200,000:

1. Financial Consulting Services – Alta Vista Financial Consultants, LLC, from 7/1/10 through 6/30/11 for a total of $360,000

2. Staffing Management Services – American HealthCare Services Association (AHSA), from 5/31/10 through5/1/11 for a total of $18,612,000

3. Outsource Clerical Temporary and Permanent Placement Services Amendment – Kforce Healthcare, Inc. from 5/29/10 through 5/28/11 for a total of $350,000

4. Outsource Clerical Temporary and Permanent Placement Services Amendment –Office Works (People 2.0) from 5/1/10 through 4/30/11 for a total of $365,000

5. Outsource Coding & Abstracting Temporary and Permanent Placement Services Amendment – United Audit Systems, Inc. (UASI) from 5/1/10 through 4/30/11 for a total of $390,000

6. Allograft Tissues Supply – University of Texas Southwestern Medical Center at Dallas, Transplant Services Center from 7/1/10 through 12/31/12 for a total of $1,494,135

7. Poison Center Services – Commission on State Emergency Communications from 5/1/10 through 8/31/11 for a total of $1,788,461

8. Ryan White Part A Formula – HIV/AIDS Service Deliveries – Dallas County Health and Human Services from 3/1/10 through 2/28/11 for a total of $2,666,941

9. Ryan White Part A Supplemental – HIV/AIDS Service Deliveries – Dallas County Health and Human Services from 3/1/10 through 2/28/11 for a total of $1,169,466

10. Ryan White Part B – HIV/AIDS Service Deliveries – Dallas County Health and Human Services from 3/1/10 through 2/28/11 for a total of $1,194,449

11. Title V Child Health and Dental Grant Amendment – Department of State Health Services from 9/1/09 through 8/31/10 for a total of $461,861

12. Title V Prenatal Services Amendment – Department of State Health Services from 9/1/09 through 8/31/10 for a total of $1,411,018

13. Health Center Cluster (HOMES Grant) Amendment – US Department of Health and Human Services, Health Resources and Services Administration (HRSA) from 11/1/09 through 10/31/10 for a total of $1,104,274

14. Lease – 2608 Inwood Ltd. from 1/1/11 through 12/31/14 for a total $4,848,000 (WITHDRAWN)

15. Third Amendment – Add Suite 600 and Extend Lease Space –SAF Exchange Park, Ltd. from 1/1/11 through 8/31/14 for a total of $2,916,510 (WITHDRAWN)


16. Third Amendment – Extension of Lease – PGV Pediatrics, P.A. from a 4/1/10 through 5/31/13 for a total of $139,832

17. Inpatient Pharmacy Automation – Translogic Corporation dba Swisslog Healthcare Solutions (One Time Purchase + 5 year maintenance) for a total of $3,018,208

18. HOMES Shed and Parking Facility – Furstenberg Construction from 6/1/10 through 7/31/10 for a total of $368,085

19. Mechanical & Electrical Preconstruction and Construction – Balfour Beatty, Austin Commercial, H.J. Russell, Azteca Enterprises JV (BARA) from 6/1/10 - through 12/31/14 for a total of $10,675,440

20. Construct East Parking Lot – Balfour Beatty, Austin Commercial, H.J. Russell, Azteca Enterprises JV (BARA) from 6/1/10 through 12/31/10 for a total of $7,448,039

21. Hospital Outpatient Assistance Program – Bristol – Myers Squibb Patient Asistance

Foundation, Inc. from 515/10 through 5/14/11 for a total of ($578,000) 22. Organs for Transplant Program – Southwest Transplant Alliance from 4/28/10


Mr. Walne asked for a motion to approve the above contracts excluding items #14 and #15. Dalton Lott made a motion to approve the Contracts. Cobie Russell seconded. The motion carried.

C. Report of the Audit and Compliance Committee:

Mr. Lott reported that the Committee received a report on the Review of Federal and State Government Excluded Individuals/Entities, Fiscal Year 2010 – 2nd quarter, Report No. 2010-505 and the Internal Audit Services monthly Status Report.

There were no action items.

D. Report of the Human Resources Committee Mr. Walne reported that the Committee received the following reports; The Road to

Nursing Magnet Designation and Parkland Nurse Staffing Methodology. There were no action items. E. Report of the Legislative Affairs

Ms. Russell reported that the Committee met on May 24 and May 25, 2010 with representatives from Polsinelli & Shughart PC and HillCo Partners. The Committee received an overview of Federal Healthcare Reform and an overview of State matters. The Committee also discussed Parkland’s Strategy and Preparation for Reform.

There were no action items.


F. Report of the Legal Committee

Mr. Luna reported that the Committee met May 5, 2010 and reviewed the following in Executive Session: Litigation Report, Hiring of Employees Out of State, Contract Certifications, Listing of Bidders in RFPs, Charitable Contributions from Vendors, Indemnification under MSA with UTSW, Policies Concerning Grants to Parkland, and Public Information Act Requests.

There were no action items. G. Report of the Information Systems Committee

Dr. Park reported that the Committee met May 20, 1010 as a continuation to the April 15, 2010 meeting. The Committee received Technology and Application updates and received detailed reports on the following; HITECH and Review of Financial & Service Levels for IT.

There were no action items. H. Report of the Facilities Committee

Mr. Beecherl reported that the Committee met May 21, 2010 and received a review of Schematic Pricing for the Hospital Project, a review of Final Space Program for Clinic and Administrative Space, review of the revised overall project budget and an update on the Prevailing Wage Rate/Davis-Bacon Issue. The Committee also received an update on Property Issues and Acquisitions in Executive Session. There were no action items.

I. Report of the Strategic Planning Committee

Mr. Walne reported that the Committee met May 21, 2010 to continue discussions regarding Strategic Planning framework. The Committee discussed the need for a series of meetings with UT Southwestern and the potential need for additional Strategic Planning Committee meetings. There were no action items.


V. Discussion/Action/Information Items

A. Transplant Services

Ellen Heck gave a compelling story of twins that received successful cornea transplants. Transplant Services expressed sincere gratitude for the support of the Board for services such as Transplant and encouraged it to continue.

Ms. Heck added another year to the Plaque given to Parkland Hospital for being a

continued supporter of Transplant Services. B. Appointment of Foundation Board Member – Randy Bowman

Mr. Silhol presented the resume of Randy A. Bowman to the Board of Managers as a potential candidate for the Parkland Foundation Board. Mr. Luna made a motion to approve. Mr. Lott seconded. The motion carried.

C. Resolution Regarding Certification of CEO’s Signature or Office

Mr. Silhol presented a resolution to the Board for consideration granting signature authority to the Chair and Vice Chair of the Board of Managers to certify or verify the CEO’s signature or office should the Assistant Secretary be unable to provide. Mr. Luna made a motion to approve the Resolution as presented. Mrs. Russell seconded. The motion carried.

VI. Public Comment

Adrian Magallanes Leslie Allen Davis

VII. Adjourn

With no further business to conduct, the Board adjourned at 5:20 p.m.

ATTESTED TO:

____________________________ _____________________________ Lauren McDonald, M.D. Michael L. Silhol Chair Assistant Secretary

BOARD OF MANAGERS FOLLOW-UP ITEMS

JUNE 2010

Committee Item Description Due Date Responsible Party Open/ Closed

Board Meeting

Current Status/Comments

Budget & Finance

Develop grant policy that includes overhead in all agreements, provides centralized management and provides regular reporting of grants in progress

Jun. ‘10

Dragovits

Open

Jan. ‘10

Provide report on 340B drug purchase program and how costs and pricing are monitored

Aug. ‘10

Dragovits

Open

May ‘10

Information Systems

Provide report on testing of data integrity in EPIC transition

Jul. ‘10

Kowitt

Open

Feb. ‘08

Still working on the report, will need a couple of months to complete testing.

Internal Audit

Provide estimate of amount of resources used to assist Deloitte in audit

May ‘10

Summers

Open

May ‘09

Human Resources

Report on reduction in FTEs attributable to introduction of position management program

Jun. ‘10

Haupert

Open

May ‘09

Briefing on how units are staffed

May ’10

Sibley

Closed

Mar. ‘10

Page 1

BOARD OF MANAGERS FOLLOW-UP ITEMS

JUNE 2010

Page 2

Committee Item Description Due Date Responsible Party Open/

Closed Board

Meeting Current Status/Comments

Present plan for increased colon cancer screening

Jul. ‘10

Shannon

Open

Mar. ‘09

Quality and Risk Management

Pilot Project of Specialty Clinics Resulting In Increase in Patient Satisfaction and Throughput

Jul. ‘10

Shannon

Open

Oct. ‘09

Present Quality Dashboard to Committee on a semi-annual basis

Nov. ‘10

Shannon

Open

May ‘10

Explore possibility of expanding ACC to accommodate additional ER patients

Jul. ‘10

Shannon/Haupert

Open

May ‘10

Strategic Planning

COPC Model Study

Ongoing

Springer/Phillips

Open

Ongoing

The Strategic Planning Committee has met to discuss this. A plan is expected to be presented in July 2010.

Minutes of the meeting of the Strategic Planning Committee of the Board of Managers of the Dallas County Hospital District, held Thursday, January 7, 2010 at 3:02 p.m., in the Administrative Conference Room, Parkland Memorial Hospital. I. Attendance and Call to Order

Chairman Alan Walne called the meeting to order at 3:02 p.m. Members present were Cobie Russell and Chad Park, DDS (filling vacancy left by Wendy Lopez). Additional attendees and/or presenters were:

Chris Davis Karen Lindsey Sharon Phillips Steve Roth Jody Springer Vic Summers Andrew Ulrich

Ron Anderson, MD John Dragovits John Haupert Jay Shannon, MD Miriam Sibley Michael Silhol

II. Information/Discussion Items A. NEXT STEPS FOR GRAND PRAIRIE COPC Ron Anderson, MD gave an update on the Grand Prairie COPC. The City Mayor and City

Council from Grand Prairie have given their approval for the project. Sharon Phillips reported that the Parkland Facilities department would like to look at the

proposed sites. Management has a meeting scheduled January 22, 2010 at the Grand Prairie location.

Dr. Anderson stated that the Parkland COPC would only service Dallas County Residents

as the Los Barrios Clinic and Tarrant County Clinic will treat the Tarrant County population. Scope of services would include both Adult and Pediatric services.

Alan Walne remarked that Parkland made a promise to provide four (4) COPC’s and two

(2) Specialty Clinics. This location would be included as one of the four. The Board understands that COPCs will not yield profits but asked that management identify dollars lost or gained as a result of adding additional COPCs.

Mr. Walne stated that he will ask the Board to revisit the implied policy of matching dollars

that are given by various cities to build a COPC in a particular location versus looking at a needs assessment provided by the Strategic Planning Committee to determine the areas of Dallas County with the greatest need.

Strategic Planning Committee Meeting Minutes January 7, 2010 Page 2 of 3

The Committee agreed to make a recommendation to the Board to move forward with the Grand Prairie COPC.

B. NEXT STEPS TO IMPLEMENT COPC EXPANSION DECISION HEIRARCHY John Haupert reviewed steps for the decision hierarchy for the COPC expansion which

included system framework and goals; determining current performance and estimate clinic access and gap, and identify additional clinic location candidates by applying various principles.

C. EVALUATE EXISTING CLINICS A designated facilities team will look at existing COPC’s to give the Committee and the

Board of Managers a description of each center and their current state. Management will then make recommendations according to their findings. The report will be brought to the Committee in July. Dr. Anderson suggests that some of the projects will need to run parallel to the assessment of the current COPC facilities.

Dr. Anderson gave a brief overview of presentations given by various cities that desire a

COPC in their area and discussed his meeting with John Price, Vice Chancellor for University of North Texas (UNT).

UNT has a desire for a School of Pharmacy in which Mr. Price would like to see Parkland

Hospital take part in. Discussion ensued regarding possible land swap between Methodist Hospital and UNT.

The Committee gave management the approval to continue to look at UNT property as a

potential COPC site without implying a commitment. However, the Committee requested that management not move additional COPC locations forward in discussions with various groups until the COPC report in July of where the need is.

D. OBTAINING ATTORNEY GENERAL OPINION ON LAND USE

Michael Silhol contacted Edward Burbach of Gardere Wynne Sewell, LLP as requested regarding the Board of Managers desire for the Attorney General’s opinion on Hospital land use.

John Haupert informed the Committee that the Blue Ribbon Panel information will be on the Facilities Agenda scheduled for Friday, January 15, 2010. Mr. Walne wants to discuss timing of a possible sub-committee for Strategic Planning at a future date.

Strategic Planning Committee Meeting Minutes January 7, 2010 Page 3 of 3

III. Adjourn

There being no further business to discuss, Mr. Walne adjourned the meeting at 4:31 p.m.

ATTESTED TO:


Minutes of the meeting of the Facilities Committee of the Board of Managers of the Dallas County Hospital District, held Tuesday, January 26, at 9:57 a.m., in the Administrative Conference Room, Parkland Memorial Hospital. I. Attendance and Call to Order Chairman Louis A. Beecherl, III called the meeting to order at 9:57 a.m. Members

present were Dalton Lott and Cobie Russell. Additional attendees and/or presenters were:

Ciel Murphy

Sharon Phillips Rick Rhine Lou Saksen Brad Simmons Jody Springer Robin Stults Vic Summers Paula Turicchi Andrew Ulrich Kenya Woodruff Kelvin Ziegler

Chris Davis Josh Floren April Foran Frank Hemeon Sherri Jacobson (DMN) Walter Jones Jack Kowitt Karen Lindsey Marilyn Little Dan Mergen Nancy Merritt Michael Moran (consultant)

Lauren McDonald, MD Chris Luna Chad Park, DDS Alan Walne Ron Anderson, MD John Dragovits John Haupert Jay Shannon, MD Michael Silhol Hank Adams (HDR)

Vicki Crane

Lauren McDonald, MD announced that the Committee members will remain the same for the 2010 year.

II. Information/Discussion Items A. Contract for New Parkland Campus Commissioning Services

Management is asking for approval of the CCRD Partners contract which is listed in the Budget and Finance contract section of the Board materials. CCRD Partners was chosen from among twenty-five professional engineering organizations that submitted statements of interest and qualifications for commissioning services for the New Parkland Campus. Commissioning services covers third-party design reviews, field inspections, system performance testing and verifications, and documentation on all heating, ventilating, air conditioning, and other mechanical systems installed on the New Parkland Campus.

Facilities Committee Meeting Minutes January 26, 2010 Page 2 of 2

III. Action Items

A. Review and Endorsement of the Steering Committee Approved Master Site Plan B. Review and Endorsement of the Steering Committee Approved Schematic Design for the Hospital Building

Hank Adams reported that meetings with end-users and steering committee have been completed. Review and Endorsement of the Steering Committee approved both the Master Site Plan on December 17, 2009 and the Hospital Schematic Design on January 14, 2010. Mr. Adams also reviewed the Hospital Design Progress schedule.

John Haupert assured the Committee that these are not the final plans but asked for the Committee to approve the current site plan.

Dalton Lott made a motion to approve the site plan in its current state, recognizing that it is not the final product. Cobie Russell seconded. The motion carried. Alan Walne wanted to ensure that the site plan fits within the budget that was allocated. Mr. Beecherl stated that at the Facilities Committee meeting scheduled in February, the Committee will look into the finances needed for clinical and administrative funds. BARA will present proposed construction costs in May 2010. Item B – approval of Schematic design for the Hospital Building was not considered or approved and remains open.

IV. Adjourn There being no further business, Mr. Beecherl adjourned the meeting at 10:08 a.m.

ATTESTED TO: ________________________________ ____________________________ Louis A. Beecherl, III Michael L. Silhol Chair Assistant Secretary

Minutes of the meeting of the Information Systems Committee of the Board of Managers of Parkland Health & Hospital System held Thursday, May 20, 2010 at 3:00 p.m. in the Administrative Conference Room, 5201 Harry Hines Blvd., Dallas, Texas. I. Attendance and Call to Order

Chairman Chad Park, DDS called the meeting to order at 3:00 p.m. Members present were Louis A. Beecherl, III and Chris Luna. Additional attendees and/or presenters were:

Marshall J. Doke, Jr. Nancy Folz-Murphy Alan Greenslade

Cobie Russell Ron Anderson, M.D. John Dragovits

Jack Kowitt Karen Lindsey Steven Roth Vic Summers

II. Discussion Items A. Technology Updates Al Greenslade gave a detailed Technology update which included the following:

Processor upgrade; Disk Storage (SAN) Strategy; Server Virtualization; Real-time Location Services (RTLS); Email replacement; and an ACS Data Center update.

The EPIC upgrade that was approved by the Board of Managers in December 2009 is

required and will take place in 2010. This upgrade will add 10 – 15% utilization to processors.

Server virtualization is being implemented today and will be the standard for

Parkland Hospital by the end of 2010 and will reduce operating cost and deployment time.

Real Time Location Services (RTLS) was defined as fully automated systems that continually monitor the locations of assets and personnel. The benefits of RTLS and its scope of services were also reviewed. An RFP for the RTLS service was written and submitted; responses have been received and the Information Systems will bring this item to the Board of Managers for approval in June. Mr. Greenslade reported that Parkland Hospital and its Campus Partners using Novell’s GroupWise email system but all are scheduled to migrate to Microsoft Exchanges 2010. The “Big Bang” cutover is tentatively scheduled for Labor Day, September 6, 2010.

ACS Data Center improvements were discussed. The Committee expressed concerns about the stability of another power failure with ACS and asked that an actual outage be simulated to insure that necessary systems are in place.

Information Systems Committee Meeting Minutes May 20, 2010 Page 2 of 2

B. HITECH Jack Kowitt reviewed in detail HITECH and Meaningful Use. Several billion dollars

have been earmarked by the ARRA to incentivize providers and healthcare organizations to move toward a comprehensive electronic healthcare record (HER). The expectation is that the data exchange provided by such an effort can lead to significant savings in the cost of healthcare for the nation. The measurement of achievement in HER implementation is a set of measures known as “meaningful use” and is defined in three stages.

Mr. Kowitt also reviewed the next steps for HITECH. The final rules will be

provided in June by ARRA. C. Application Update Nancy Folz-Murphy reviewed the latest go-lives for Parkland Hospital, Jail Health

Services and the Hospital Outpatient Procedure Areas (HOD). D. IT Review – Financial & Service Levels IT Risk Assessment Model was cited “Best Practice” by The Advisory Board. Mr. Kowitt reviewed the financials in detail with the Committee. Year-to-date, the IT

Committee expenses are unfavorable to budget. ACS Service Level Agreements were discussed and currently the Parkland

Management Team meets with ACS monthly to audit their reports. Chris Luna asked that Management add as a future agenda item copier maintenance,

disposal and recycling as most copiers have CPU’s that could hold very sensitive and confidential information.

III. Adjourn There being no further business to be brought before the Committee, Dr. Park adjourned the meeting at 4:55 p.m.

ATTESTED TO: __________________________ ___________________________ Chad Park, DDS Michael L. Silhol Chair Assistant Secretary

Minutes of the meeting of the Quality and Risk Management Committee of the Board of Managers of the Dallas County Hospital District, held Friday, May 21, 2010, at 7:05 a.m., in the Administrative Conference Room, Parkland Memorial Hospital. I. Attendance and Call to Order

Chairman Dalton Lott called the meeting to order at 7:05 a.m. Other members present were Lauren McDonald, M.D. and Chad Park, DDS. Additional attendees and/or presenters were:

Thomas Button

Pete Hoffmann, MD Karen Lindsey Nancy Merritt Julia Napper Pranavi Sreeramoju, MD Vic Summers Marisa Valdes

Louis A. Beecherl, III Cobie Russell Ron Anderson, MD John Dragovits John Haupert Miriam Sibley Michael Silhol Marshall J. Doke, Jr.

II. Executive Session

A. Mr. Lott announced an Executive Session beginning at 7:05 a.m.

Pursuant to the Texas Open Meetings Act, Texas Government Code sections 551.071, et seq., to discuss the following:

1. Sterilization and Disinfection Report 2. Infection Prevention Plan and Program Evaluation 3. Performance Improvement Plan and Program Evaluation

Mr. Lott returned the meeting to open session.

III. Discussions/Information Items A. Proposed Quality of Care Goals for FY 2011 Peter Hoffman, MD reviewed the proposed Institutional Initiatives for FY 2011 which include the following:

• Reduce Hospital Acquired Infections (HAI) • Reduce 30-day readmission rate for Heart Failure (HF), Acute Myocardial

Infarction (AMI), and Community Acquired Pneumonia (PN) • Improve performance on mandated and/or publicly reported quality metrics


B. Presentation Method of “Goals” to the Board of Managers

In 2012, the Hospital Pay for Quality program begins (House Ways and Means Ranking Member Report). CMS will require reporting on measures that are currently not a requirement for a total of 45 core measures. Dr. Hoffman stated that the mandated measure goals for CMS Core Measures for Parkland Hospital will be that all metrics will be at least 97% for those metrics that are not currently meeting the standard; those over 97% or equal to will maintain or improve performance.

III. Adjourn There being no further business to discuss, Mr. Lott adjourned the meeting at 8:43 a.m.

ATTESTED TO:


Minutes of the meeting of the Facilities Committee of the Board of Managers of the Dallas County Hospital District, held Friday, May 21, 2010, at 8:50 a.m., in the Administrative Conference Room, Parkland Memorial Hospital. I. Attendance and Call to Order Chairman Louis A. Beecherl, III called the meeting to order at 8:50 a.m. Members

present were Dalton Lott and Cobie Russell. Additional attendees and/or presenters were:

II. Discussion Items/Action Items

Marilyn Little Peggy Lundy Dan Mergen Pleas Mitchell (BARA) Lou Saksen Vic Summers Andrew Ulrich Bill Walther Kenya Woodruff

Hank Adams Juliann Cataldi Chris Davis Kathy Harper Frank Hemeon Walter Jones Suzan Kedron (Jackson Walker, LLP)

David Krause Karen Lindsey

Chad Park, DDS Alan Walne Ron Anderson, MD John Dragovits John Haupert Miriam Sibley Michael Silhol Marshall J. Doke, Jr.

A. Review of Schematic Pricing for the Hospital Project

Walter Jones reviewed the Acute Care Hospital (ACH) Project Description and the ACH estimate to budget reconciliation in detail. The team is working to bring the budget back to a zero variance for the project. Alan Walne asked that shelled spaces be identified in a chart or diagram for the Board of Managers to review.

B. Review of Final Space Program for Clinic and Administrative Space

Kathy Harper discussed the Clinical Project description which included capacity, current area space and programming as well as general information regarding a best fit exercise among other topics.

The Committee suggested that management revisit the plan initially discussed and approved as some dynamics may change due to Health Reform.

C. Review of Revised Overall Project Budget

Lou Saksen presented the current Project Budget Summary to the Committee. There is a significant budget gap. Management is working to bring the gap down to a zero variance. Additional cost mitigation strategies will need to be evaluated and incorporated to reduce the current project estimate variance from the budget. The

Facilities Committee Meeting Minutes May 21, 2010 Page 2 of 2

Committee encouraged Management to work with vendors to ensure the best pricing to help meet the financial goals for the new facility.

There are several activities currently in process or scheduled to begin. The design development for the ACH is scheduled for completion in October 2010.

D. Update on Prevailing Wage Rate/Davis-Bacon Issue

Kenya Woodruff and Dan Mergen updated the Committee on the Wage Rate issue. Joe Canterbury will perform a wage rate survey.

Preliminary data seems to indicate that the Davis-Bacon wage rate is comparable to other rates in the industry therefore there is no cost savings associated with not using this method. Further examination is being conducted to confirm this.

Alan Walne asked for clarification on overtime for Davis-Bacon wages.

III. Executive Session Mr. Beecherl announced an Executive Session beginning at 10:20 a.m.

Pursuant to the Texas Open Meetings Act, Texas Government Code sections 551.071, et seq., to discuss the following:

A. Update on Property Issues and Acquisitions

Mr. Beecherl returned the meeting to open session at 10:27 a.m. IV. Adjourn There being no further business, Mr. Beecherl adjourned the meeting at 10:27 a.m.

ATTESTED TO:

________________________________ ____________________________ Louis A. Beecherl, III Michael L. Silhol Chair Assistant Secretary

Minutes of the meeting of the Strategic Planning Committee of the Board of Managers of the Dallas County Hospital District, held Friday, May 21, 2010 at 10:34 a.m., in the Administrative Conference Room, Parkland Memorial Hospital. I. Attendance and Call to Order

Chairman Alan Walne called the meeting to order at 10:34 a.m. Members present were Cobie Russell and Dalton Lott. Additional attendees and/or presenters were:

Marilyn Little

Nancy Merritt Jody Springer Vic Summers Andrew Ulrich

Michael Silhol Marshall J. Doke, Jr. Chris Davis David Krause Karen Lindsey Peggy Lundy

Louis A. Beecherl, III Chad Park, DDS Ron Anderson, MD John Dragovits John Haupert Jay Shannon, MD Miriam Sibley

II. Information/Discussion Items A. Approach to Relationship Building with UT Southwestern

Ron Anderson, MD spoke about the current relationship with the University of Texas Southwestern Medical Center (UTSW) faculty and the importance of the relationship being a partnership versus a vendor relationship. The Committee discussed potential challenges of not having designated hospital faculty staff as the current plans evolve for both Parkland Hospital and University Hospitals to build new facilities. The Committee directed Management to define what the faculty structure needs to look like and plan to meet with UTSW leadership discuss. Alan Walne asked that a defined date be scheduled for a meeting between UTSW and Parkland Hospital.

B. Strategic Framework for fiscal 2010-2011 Strategic Initiative and 2011 System Goals

Jody Springer highlighted the Strategic Initiatives and System Goals and presented a timeline overview for Fiscal 2011 Planning and Budget. The Committee expressed concerns that the timeline may not be aggressive enough. Ms. Springer also reviewed in detail the Proposed System Goals.

Strategic Planning Committee Meeting Minutes May 21, 2010 Page 2 of 2

III. Adjourn There being no further business to discuss, Mr. Walne adjourned the meeting at 11:53 a.m.

ATTESTED TO:


Minutes of the meeting of the Legislative Affairs Committee of the Board of Managers of the Dallas County Hospital District, held Monday, May 24, 2010 at 1:55 p.m., in the Administrative Conference Room, Parkland Memorial Hospital. I. Attendance and Call to Order As permitted by the Bylaws of Dallas County Hospital District, Article VI, Section 3 and

Article VII, Section 11, Alan Walne, Board Vice Chair, in the absence of the Board Chair, appointed Louis A. Beecherl, III and Chris Luna as temporary Committee members of the Legislative Affairs Committee. Chairman Cobie Russell then called the meeting to order at 1:55 p.m.

Cindi Berry – Polsinelli Shughart PC

Steve Bristow Terry Brooks – Polsinelli Shughart PC

Jennifer Cutrer Julius Hobson – Polsinelli Shughart PC

Marsha Jones – HillCo Partners

Anthony Khuu-UTSW Med Student Karen Lindsey Marilyn Little Peggy Lundy Angela Morris Jody Springer

Alan Walne Ron Anderson, MD John Dragovits John Haupert Michael Silhol Marshall J. Doke, Jr.

II. Information/Discussion/Action Items

A. Overview of Federal Healthcare Reform

Cobie Russell introduced Cindi Berry, Julius Hobson and Terry Brooks from Polsinelli Shughart PC.

The Polsinelli Shughart Team gave a detailed overview of federal health reform

including the political and economic landscape, the implications for Parkland and how the federal law interfaces with States’ efforts toward health reform and Medicad.

Parkland Hospital’s roles with respect to health reform were defined in detail and

included a role as provider of services, safety net hospital, teaching institution, health system innovator, insurer, and employer.

B. Overview of State Matters

Cobie Russell introduced Marsha Jones, HillCo Partners. Ms. Jones reviewed health reform in Texas, including a legislative outlook for the upcoming 2001 Texas legislative session.

Ms. Jones reported on the budget issues for Texas. There are several policy considerations for health reform in Texas which include the possibility of public hospitals’ role being redefined and the possibility of restructuring the state’s indigent care and charity care statutes.

Legislative Affairs Meeting Minutes May 24, 2010 Page 2 of 2

According to Ms. Jones, a large majority of legislative interim study charges have a health care impact ranging from tax exemption review, emergency preparedness and health information technology to health care cost trends and regional cost variations. The Interim and Legislative outlook also includes the Senate Finance review of the property tax system and revenue, HHSC cost containment efforts, quality improvement initiatives, health information technology, Medicaid managed care expansion, and DSH and UPL. Jody Springer discussed Parkland’s strategic position with respect to health reform to include a strengths, weaknesses, opportunities and threats analysis. Alan Walne asked that an agenda item be added to the Strategic Planning Committee to discuss developing a plan to educate representatives in Washington, D.C. on Parkland’s strengths.

II. Adjourn

There being no further business to be brought before the Committee, Ms. Russell adjourned the meeting at 3:12 p.m.

ATTESTED TO:

____________________________ __________________________ Cobie Russell Michael L. Silhol Chair Assistant Secretary

Budget and Finance Committee Meeting Minutes October 27, 2009 Page 1 of 3 Budget and Finance Committee Meeting Minutes October 27, 2009 Page 1 of 3 Minutes of the meeting of the Budget and Finance Committee of the Board of Managers of the Dallas County Hospital District, held Monday, May 24, 2010, at 3:20 p.m., in the Administrative Conference Room, Parkland Memorial Hospital. I. Attendance and Call to Order

Chairman Alan Walne called the meeting to order at 3:20 p.m. Members present were Louis A. Beecherl, III and Chris Luna. Additional attendees and/or presenters were:

Cobie Russell Ron Anderson, MD John Dragovits John Haupert Michael Silhol Marshall J. Doke, Jr. Pat Baker (UHC)

Andrew Montgomery Ciel Murphy Vic Summers Andrew Ulrich Kenya Woodruff

Juliann Caltaldi Frank Hemeon Karen Lindsey Marilyn Little Vicky Lunar (UHC) Peggy Lundy Liz McMullen

II. Discussion Items A. Supply Chain Update B. Supply Chain Audit Approach

Monty Montgomery gave a detailed Supply Chain Update. The overview included organization, systems and processes for the department. Purchasing controls have been put into place which strengthens signature authority limits. The Lawson “Hard Stop” for Purchase Orders was fully implemented in April 2010. The daily expense monitoring for the Operating Room and Pharmacy were also reviewed. Mr. Montgomery introduced representatives from University HealthSystem Consortium (UHC), Vicky Lunar and Pat Baker. The UHC is made up of Academic Medical Centers, several affiliated hospitals and State/Government Hospital Systems. Parkland Hospital has been a member of UHC since 1996. The role of the Group Purchasing Organization (GPO) Program was defined as one that negotiates prices, terms and conditions for the products and services purchased by hospitals among other things. The Committee expressed concerns regarding the 340B Drug Pricing Program monitoring. The UHC has a department within Novation that is dedicated to monitoring the 340B Program. The Committee asked for a follow up of this item.


Internal Audit will help the department by confirming the integrity of hard stop purchase orders by the end of August after which efforts will control change efforts will continue. Parkland Hospital is a member of the State of Texas Purchasing Co-op. Texas procurement and Support Services (TPASS) awards and manages hundreds of statewide contracts on behalf of more than 200 state agencies and 1,800 cooperative purchasing members. Currently Parkland assesses the State contracts for Technology, Services and Products. Mr. Beecherl asked that approval matrix be reviewed and revised. Currently Purchasing Agents have $150,000 signature authority. The Committee suggests that this amount be lowered.

C. New Parkland Campus Construction Cost Controls

Frank Hemeon reported that Deloitte Financial Advisory Services LLP have been retained to perform a diagnostic assessment of its construction project management system (Prolog), its financial accounting system (Lawson) and associated controls. Deloitte assessment findings and status were discussed with the Committee and revealed the following issues: a lack of communication and alignment between facilities and accounting; the Facilities project management software (Prolog/Premavera) was being set up independent of accounting requirements. A weekly executive and senior management meeting is conducted to review the project including budget, commitments and expenditures prior to the meeting of the Facilities Committee of the Board. The final revised/re-cased budget should be developed and coordinated with the coding structures in Prolog and Lawson to support budget controls and reporting. The interface specifications between Prolog and Lawson are in development and August 31, 2010 is the scheduled go-live for the two systems. The report outlined several areas for improvement in addition to those previously mentioned. Lou Saksen explained in detail the process for change order invoices. Louis Beecherl, III asked that Management provide a recommendation for presenting change orders to the Board for review and approval. The current dollar amount is $100,000 and it is believed that the amount of request could become overwhelming to the Board of Managers.


D. New Parkland Campus Audit Update

Vic Summers and the Internal Audit department will provide an Audit update for the New Parkland Hospital.

III. Adjourn

There being no further business to be brought before this Committee, Mr. Walne adjourned the meeting at 5:02 p.m.

ATTESTED TO: _________________________________ ___________________________________ Alan Walne Michael L. Silhol Chair Assistant Secretary

Documents

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