BOARD MEETING: Regular Meeting     DATE: November 29, 2016     MEMBERS PRESENT: Helen Adger, Kenneth Clay, Robert T. Green, Jr., Mary Irvin, David Norman, Brenda D. Smith, Helen Godfrey-Smith, Patricia White       MEMBERS ABSENT:Bruce Walker      OTHERS PRESENT:David Jones, CEO, Pam Hughes, COO, Allyson Allums, CFO, Lanell Audirsch, Human Resources Director, Doug White, Hospital Attorney, Mary Coil, Foundation Director/Marketing Director,  John Woods, Chief of Staff, Dakota Robinson, NCMC Controller, John Wells, CPA, Mary Carroll, CPA – Lester, Miller & Wells; Mike  Gray, Susan Cross, Danny McCormick w/Caddo Parish Alliance      BOARD CHAIRMAN: Robert Green     SECRETARY:  David Jones      TIME CALLED TO ORDER: 5:30 p.m.      LOCATION: NCMC Events Center     I.  Called to Order:  Robert T. Green, Jr – Chairperson, called the meeting to order.     II. Invocation and Pledge of Allegiance:  Brenda D. Smith offered the Invocation and David Norman led the group in the Pledge of Allegiance.    III. Approval / Amend Agenda:Robert Green stated that the first item on the agenda is to approve or amend the agenda. There were no changes to the agenda noted.      Brenda Smith made a motion to approve the agenda as presented.  David Norman seconded the motion. The vote: yeas: Robert T. Green, Jr., Pat White, David Norman, Brenda Smith, Helen Adger, Kenneth Clay Nays: None; Absent: Bruce Walker; Helen Godfrey-Smith, Mary Irvin Abstained: None The motion passed.     IV. Community Comments: Robert Green, Chairperson, noted that there were two visitors that have come tonight and signed the required Visitor Recognition Card to speak to the Board. The first is Susan Cross. Robert Green noted the time limit per subject – First person is allowed (3) minutes and additional individuals wishing to comment will be limited to (1) minute per the same subject.      Robert Green submitted the floor to Susan Cross who noted on the Visitor Recognition Card that the subject to be discussed is “Support of Dr. Haynes”.          Susan Cross stated – we, the citizens gathered at this meeting, are here to announce our support for Dr. John Haynes. Dr. Haynes, being terminated from part-time employment, post his official retirement, is felt as a direct insult of the citizens of North Caddo Parish. Dr. Haynes has been the medical backbone of this community for 50 plus years. If not for him, it is doubtful there would be a hospital over the years, nor the new hospital being constructed. Representatives of this hospital courted the citizens of North Caddo Parish for voting and passing of the $25 million bond for the construction of the new hospital. We gave this vote to you with the anticipation of the up to date hospital of which we are waiting, still, to see the outcome. Along with the request from the hospital representatives, Dr. Haynes encouraged this growth for the potential of the North Caddo Parish. For those of you who are not from North Caddo Parish you do not understand the relationship that exists between Dr. Haynes and this community. Dr. Haynes has saved countless lives and given much needed support and compassion to so many during critical periods of their life. Dr. Haynes has dedicated his life and career to this community with all their medical needs. He went beyond the role of physician and to that of a trusted friend and confidant. As in any business world, sometimes actions are taken without thoughts of effect on people not directly involved. At this time the public is not privileged to what the reference recent events is related to. We only know that we are being denied the medical expertise of Dr. John Haynes – the original visionary of North Caddo and North Caddo Hospital. As with any decision it is clear there are two sides. We as citizens, neighbors and tax payers would like to ask the Board to please explain, from a hospital point of view, what Dr. John Haynes was released from his PRN, or part-time status, with North Caddo Hospital.          Robert Green thanked Susan Cross and acknowledged Danny McCormick and yielded the floor to him to speak.        Danny McCormick introduced himself to the Board stating he is speaking on behalf of an organization that he formed – The Caddo Parish Alliance, at Our goal is to help inform people about the negative influence of taxes and regulations that effects small businesses and middle class in Caddo Parish, Louisiana. He is here tonight on a fact finding mission to come up with the reason where you put the property tax on the ballot. He stated he has been informed that you will not be answering questions so I presume I’m not going to find out any facts. His question is this – why are we asking for a 5 mil property tax to finance an ambulance that creates enough revenue to finance itself? That is his question. He said that he does not have anything but the summary of the audit that is on the website. He does not have an itemized summary of the audit. He would like to have an itemized copy. According to the audit there is a million dollars’ worth of ambulance services charged out each year. So on the hospital’s numbers you said the cost is $750,000 not counting the $400,000 collected on property taxes. There is a significant amount of money that is being paid to the ambulance that should be able to support the ambulance without a property tax. Using your numbers that he found, if these numbers are correct, you should have a $6.5 million surplus over ten years; assuming you collect a million dollars a year and fees for riding in the ambulance plus the $400,000 a year in property tax. We have no desire to shut down the ambulance service. We know it is an asset to the community. We have no desire for people to be laid off. There is a suffering community out there. They are scared to speak for themselves because they are scared of retaliation from the hospital. Whether those are rightfully so – those are out there. Besides that, he did notice between 2012 and 2014 the expenditures have increased $2 million which seems excessive to him since there is no more income being created. As he said, he came here to ask questions but he was told the Board would not answer questions at the meeting. That is his question – why do we need a property tax for an ambulance that should be able to fund itself and why do we have $2 million in payroll from 2012 to 2014 increase without any increase in revenue. Thank you.

Robert Green thanked Danny McCormick. Robert Green stated that was the end of the community comments and thanked them for coming and he promised to get the answers to the questions. Danny McCormick stated that he would be reporting to the people so the sooner the better.         At that time Charlie Alexander spoke up – out of order – asking when he would be getting his answer regarding Dr. Haynes. Mr. Green assured him they would be getting the answer soon. Charlie Alexander stated he wanted his answer now – that everyone was under a gag order – he would like to hear it now. The hospital has been under a gag order for six months. David Jones won’t let anyone talk to him. He accused David Jones of making a private enterprise of a public facility.          There was several minutes of discussion from Charles Alexander and Robert Green.         Judy Wilson, Vivian City Council Woman, who also did not sign a visitor comment card, spoke up stating that she wanted everyone to know, including all the Board members that she thinks that Dr. Haynes has been blamed with ordering an audit of the hospital by the State Legislative Auditor. She wants all to know point blank that she is the one that requested the audit. She talked to Mr. Jones; he was supposed to tell all the Board members and all of the doctors – whoever it concerned. She wants everyone to know that she is the one that requested the audit. It didn’t have anything to do with Dr. Haynes. He didn’t ask for it. She wants to make sure that everyone understands that.           Further discussion was had regarding providing the answers to the questions presented tonight. Assurance was given to all parties that answers were forth coming to the questions that legally could be answered and in a timely manner by Robert Green. The additional attendees dispersed.      V.  Minutes – Regular Meeting September 27, 2016: The minutes of the October 25, 2016 regular Board meeting were mailed prior to today’s meeting for review.            Pat White made a motion to approve the minutes as mailed.  Brenda Smith seconded the motion. The vote: yeas: Robert T. Green, Jr., Pat White, David Norman, Brenda Smith, Helen Adger, Kenneth Clay, Mary Irvin, Nays: None; Absent: Bruce Walker, Abstained: None   The motion passed.

  1. Presentation of Fiscal Year End Audit – 2015 – 2016:Copies of the audited Financial Statements and Independent Auditors’ Report were distributed to the Board members.       John Wells introduced himself and Mary Carroll, CPA’s with the firm Lester, Miller and Wells from Alexandria, LA. He stated that Mary Carroll did most of the work and he would begin. His firm does an audit each year as required by the Louisiana Revised Statutes. You are a hospital service district and part of the Caddo Parish Commission. You, as Board members, are charged with directorship and administration is charged with the day to day operations of the hospital; an efficient way of making things work. Within the audit report there are reports on their letterhead. Those are their reports on your financial statements and their findings of things such as management comments, internal controls and things like that. That is the only thing in the report that is theirs. All of the financial statements are representation of management. In their duties as auditors they are to audit the financial statements to see that they are fairly presented in accordance with generally accepted in governmental auditing standards. We performed tests that we felt necessary. In the report you will find that we have given what is called a clean, unqualified opinion, which is the best opinion that accountants, auditors, CPA’s can give on financial statements. When we get through with this meeting these will be sent to the Legislative Auditor and probably in the next 30 to 45 days the Legislative Auditor will have these published at their website. They have to go through it and make sure that their firm did things the way they wanted them done. He will now go over the financial statements. The opinions in the report are theirs, the financial statements are representation of management. As with any audit, they do not look at every single transaction that went on during the year. You can’t do that financially nor timewise. They test based on what they think the risks are. In financial statements like this, for a hospital in particular, you make charges to patients. Those patients sometimes have third party payors – Medicare, Medicaid, Blue Cross, Aetna, etc. These third party payors typically have a substantial discount between what you charge and what they actually pay. A statement was made earlier about a million dollars’ worth of charges for the ambulance. That is true – but in the financial statement you will find there is about a 50% discount on that charge before you get down to what is actually paid by the individual or any of those third party payors. Hospitals are different from what you find in most businesses. In this business the government sets what we get paid. We don’t get to decide. We might set the charge but we don’t get to decide what we get paid. Medicare pays cost or something less. Commercial insurance pays what we negotiate to be paid and there are substantial discounts. If you have questions for Mary as she goes through the details of the financial statements on the work that they did please so. Thank you for having them here tonight.         Mary Carroll, wanted to say a big thank you to the staff of the hospital. She said we have a working relationship and they are always eager to supply any documents or help out with the audit to keep things moving smoothly. They really appreciate Dakota, Allyson and everybody in the Business Office that they work with for a real team effort to get the audit produced in this time frame. It feels like the audit report got thicker this year and that is because it did. She did have to mention that were a few major adjusting entries. June financial statements that were presented to the Board in July – there were differences. She reviewed the three main differences with the Board. They expensed some interest that had been capitalized because once the two sections of the hospital were moved into –they started recording interest expense on the loans financial part of the hospital. Also, there was some extra depreciation expense and then we have an estimated cost report receivable of about $1.2 million that we are anxiously awaiting on collecting. There are some lump sum adjustments and incentive payments that were misclassified that needed to go into income. The depreciation expense was an expense the others were incomes so that they offset each other.   She directed the Board members to page 4 –    In the business world you call that a balance sheet – on a governmental like this it is called a Statement of Net Position. The biggest change from last year is a requirement by GASB #68 – new this year – Differed outflows related to net pension liability that is $2.7 million; under long term liabilities there is a pension liability that is $1.6 million and then the differed inflows that are also related to the net pension liability that is ½ million dollars. New governmental rules that say that the retirement plan for the hospital employees has to be recorded on the balance sheet. There are about 50 different governmental units within Louisiana that are in this same pension plan. You are at the mercy of the stock market and the Actuary to determine what these numbers are. Every year the amount of the contributing will be changed. It is not a big deal.

She then went to Cash and Cash equivalents. This is where we see the money being spent. We’ve gone down from an average of 76 days cash on hand and we are now down to 24 days cash on hand. We are in a little bit of a cash crunch and that is why we are working on collecting all of our receivables. John Wells noted that also that $1 million that Medicaid owes us on the cost report that convert those charges to the actual cost or less that you incurred that you are going to get, as soon as we get that in that will bring that back to a much more reasonable number. Mary Carroll noted that you want to compare yourself to other hospitals that are your size and other Critical Access Hospitals statistically in the near west region and the average cash days on hand is 69 days. Your goal will be to be in the 75% range – the better performing hospitals have up to 144 days cash on hand – a goal to work for. Net accounts receivable – we’re hanging in there. Averaging just about the critical access average of 62 days. In 2014 we were at 64 and now in 2016 those extra cost report receivables have grown the accounts receivable days up to 72. Once we get that $1.2millon collected that will go back down. The current ratio – if we divide the current assets by current liabilities we are right at 2.0. Last year we were at 2.0 and the year before at 2.6.        Current Liabilities – Accounts payable and accrued expenses – we are hanging in there right about at the same level of 2014. The spike in 2015 was related to a draw on the hospital construction that made that spike. We are right at 37 days of expense in accounts payable. Consider the majority of vendors are in the net 30 payments – that is reasonable for accounts payable to have. The long term debt – you will see that rising as the hospital nears completion – total long term debt is at $20 million and the net position – in the business world it is called equity – a positive equity of right at $9 million dollars. Return on equity is not as good this year because we are in the red status. Return on equity on Critical Access Hospital in the near west would be about 4.5 so that would be your goal. In prior years -2014 was 9.5, dropping to 8.3 last year and this year we are at negative 9.6. There was a down turn this year.        Under Operating Revenues she noted the Net patient service revenues. She stated that the schedule in the back on pages 31-34 is a supplemental schedule that lists all of the revenues by department and at the bottom of that schedule lists all the contractual adjustments and reductions to gross charges. You want to make sure that this net patient service revenue on the first line on the income statement is the actual cash in the bank – what we expect to collect for these patient services. It is not gross charges – it has already been reduced by the contractual adjustments. We see that those net patient service revenue has grown steadily and right now our average net patient revenue per day is right at $5,100. The non-capital grants and contributions – part of the decline in the net bottom line is due to going from $1.5 million to $1.4 million and are now at $766,000. In that line is non-capital grants such as UCC grants covering patients with little or no coverage – that money has been dwindling. Salary expense – there is a sub schedule on salaries. In a hospital there are highly trained physicians and nurses. It is hard to get those quality people. You have to pay the market rate to get those employees. It is not uncommon to see those kind of increases go up. On page 36. Routine Nursing went from $1.6 million to $1.9 million then to $2.3 million. That is not just salary increased but increased staff. In statistics when they do the audit, they look as the average routine hours per acute patient stay where patient days have remained about stable the nursing staff has gone from under 20 fulltime employees to 24.2. Added almost 4 fulltime positions. Construction has been a factor in this. This will change. Other increases – emergency room – to improve continuity patient care a physician was hired for the coverage opposed to using contract services to save money. There will be an offsetting decrease in pro fees on another schedule to offset the increase in salaries.       Going back to page 5 – Benefits and payroll taxes. That amount has grown steadily and you probably remember a part of the cost cutting new this year – the hospital is a self-funded medical plan. Supplies and drugs is growing. You are in the process of adding a 340B plan to save on the rise in expenses. Under Professional Services – we previously discussed. Under Insurance – this is self-explanatory. We have grown in expenses and should be a good growth. Depreciation and amortization expense. You can see the significance of the new construction and the new hospital building – we are adding to depreciation expense. A sub-schedule is on page 39.  Utilities went up due to more square footage. You need to wait until the construction is complete and see when everything balances out and you get to a new normal. Capital Grants and contributions has been combined with the North Caddo Foundation. That includes contributions from individuals and companies to the Foundation. The Foundation is doing fund raising for capital items such as the Mammography machine, etc. The net bottom line – increase/decrease in net position. It is in the red at this time. You are doing a good job. Prior period adjustment is the GASB 68 pension note. They had to do something with the previous year’s numbers – that is where that number come in.   Cash Flow – this has basically been covered when she reviewed the notes of the Financial Statements. These are representation from management and they assist with the compilation. They are looking at it making sure they meet general accepted accounting principles and government accounting principles. Nothing has really changed on those until we get to page 12 which is explaining the new deferred outflows and inflows of resources. She has already covered on the balance sheet on page 13 note #2 – the prior period adjustment. This tells that they are restating the net fund balance. Days of cash on hand has already been covered.       John Wells reviewed note #4 on Accounts Receivable. There is a breakdown in the hospital patients, clinic patient’s full charges and reflecting the contractual adjustments. He noted the substantial discount between the $5.8 million and the $2.4 million written off as contractual adjustments. He noted that the collections for accounts receivable has improved over the years in spite of having the disruption of construction and such. The bad thing is the estimated third party settlement that has grown from a quarter of a million dollars to almost a half million – it’s now at $1.2 million. You have to wait until Medicare/Medicaid sends that money. Typically when management sends the cost report in it takes at least 30 to 90 days to send the money. Once that money is received that will restore some of the cash that you are down from last year. That will take this off the asset side and put it in accounts receivable into cash. Page 15 continues accounts receivable – the mix of what is in accounts receivable – 24% Medicare, 14% Medicaid, 38% commercial and other third-party payors and individual and self-pay is 24%. If you have a true self-pay account you are lucky to collect 5 cents on the dollar. In allowances typically run 90 – 95% uncollectable. That 24% is mostly uncollectable. Capital Assets – The building improvements is about $20 million dollars and added about $1.3 million in furniture and equipment. There is still significant construction progress of about $4.3 million dollars at the end of the year. The new building will go fully into service sometime in the current fiscal year that ends June 30, 2017. A substantial investment in the plant was needed. Lucky to be Critical Access because Medicare will pick up some of that cost on a cost basis through future cost reports. Remember – when we are 50% Medicare is paying 50% of the patients – they make 50% of the rules – When you hear Medicare is going to save money across the country – that will affect you directly. Comes out of the pockets of those that provide the services.         Mary Carroll reviewed the employee medical benefit plan. There is a stop loss insurance policy – while being self-insured, there is still a cap on the amount of exposure on the hospital. This is another accrual guestimates. This is an estimate of what they think all the claims that have incurred during the end of the year but not been reported yet. They accrue a liability of about $120,000 and that is how the self-funded plan works. That is subject to change because it is an estimate. Long-Term Debt – the financial for the notes payable increased by $5 million dollars and that was more interim financing on the construction. There was one capital lease on the cardiac monitors on the ambulances. On page 18 is all the verbiage for all the explanations for the notes and the interest rates and the bond covenants. On page 19 is the schedule of long-term debt and what happened is a huge increase of the 2018 long-term debt principal maturities. That is one of the interim loans that is going to mature. It got shifted to long-term because they knew that it would be refinanced with the permanent financing that is already in place. So they kept that out of current liabilities on purpose. Mary Carroll noted that the Commitments on the leases – this is on the long term leases that are over 12 months in time. They are listed as rental expense on the income statement and those are committed outflows of resources on the bottom of page 19. John Wells reviewed the net patient service revenue. In 2016 the gross services charges were $37,800,000. From that figure you have to back out contractual adjustments – the difference in the full charge and what Medicare, Medicaid or any third party payor doesn’t pay based on contractual arrangements you have with that third party payor. That cuts the $37 million down by $15.6 million dollars. That number is adjusted further by $19 million deductions resulting in a Net Patient Service revenue of $18.7 million. That is the difference in the full charge and what you actually get to collect. Medicare and Medicaid makes up about 50% of NCMC’s revenue whether it is gross charges or collections. That is why every time Medicare or Medicaid does something substantial it has a big impact on these financials and your operations that you have absolutely no control over what so ever. Something has to happen for rural hospital to continue to exist. Rural hospital have to collect a million to a million and one half in property taxes or sales taxes or some other kind of subsidies to keep the doors open in rural communities. If it’s a rural prospective payment hospital; one that gets DRG payments, those hospitals need more like $2 million in subsidies. What Medicare pays is something less than cost on a national basis. Watch the national scene because it will have an impact on you. John Wells stated that most is similar of what you have had in the past.            Mary Carroll reviewed the Subsequent Events Note 22 – included the new Bond Anticipation Note of $3.8 million dollars that was executed on September 26, 2016. We have that permanent financing saying that it is down the road. Mary stated that we do know that there is a sales tax revenue that was past for the hospital construction. The property ad valorem tax past 10 years previously. What is on the ballot is a renewal – not a new tax. John Wells noted Mary talked about the charges on pages 31through 33. The net patient services revenue for the ambulance is $1,165,000 in 2016 up from $1,055,000 last year and in 2014 it was $985,000. If you apply the 50% contractual adjustment and bad debt factor to that that number cuts in half. Mary noted then it does not cover payroll and there is depreciation expense. John stated that you have to go in and get direct cost – supplies, payroll, payroll taxes, benefits that go along with that and administrative overhead.         John Wells noted that in order to stay a critical access hospital you must keep your average length of stay for acute patients under 96 hours. The federal government has proposed that no one can stay here more than 96 hours but Congress has beaten it down. This is irrational. If you lose that cost based status that would hurt your revenue substantially. Management is aware of this. This is for acute days, not swing bed. There was a law that was put through the legislature that requires you to report the compensation and expenses paid on behalf of the Chief Executive Officer. The Legislative Auditor and Legislature also require that there is a schedule of per diem amounts that are paid for Board members as well as the mileage reimbursement. He noted another report from Lester, Miller and Wells talking about controls. This pertains to the Financial Audit to understand how the hospital operates. If they were to note an internal control issue they are required to report to the Board. They work with management but are hired by the Board and report to the Board. She noted on page 47 is another report on the USDA Financing requiring a single audit. This requires extra steps in order to make sure that the money spent from the financing for the construction of the hospital follows the normal procedures. They also have a summary on page 50 reporting they have an unmodified report and that they found no material weakness, significant deficiencies are less troublesome than material weakness. She is pleased that they have dropped their findings in half – they went from four to two. The first finding is just the nature of the beast. It is not economical feasible to segregate all the duties that need to be segregated. Managements response is there is a work around that they closely supervise and review duties to help to prevent errors and misappropriations. The second is on account reconciliations. We are still struggling to clean up some balance sheet accounts and we are working really hard with Allyson and Dakota being proactive to clean up some of those accounts. John Wells noted that the Legislative Auditor recently sent out notices that if they had a finding that has been on the audit report for more than three years that can be fixed in the third year they will contact to find out what you are going to do to correct it.         Right now there is a draft from the Legislative Auditor pending that has about 10-15 additional pages they are proposing that entities the size of NCMC and larger be performed each year. This will add as much as $5-$10 thousand dollars cost to the cost of the audit. It is in draft at this time. There must be accountability in a public body.         Helen Godfrey-Smith posed a question to John Wells regarding issue mentioned. He said this needs to be cleared before March 30th.         John Wells noted that the requested audit that was sent to the Legislative Auditor pertained to three issues that their firm was asked to look into. One was when the Board goes into Executive Session to talk about a new appointment to the Board. That is a personnel matter. Minutes need to reflect that. That is an allowed purpose under the Louisiana Revised Statutes. You can also go into Executive Session for strategic planning. This needs to be clearly defined. Another was ratification of a phone poll. If time permits, put it on the agenda in a prospective manner rather than a retrospective manner. The other was a question about full documentation regarding the bid process of some of the equipment bought. This issue was corrected as required. Because it has not happened since they reported last time, there is nothing new or substantial to report to the Legislative Auditor. They have done what was asked of them with those three things that were referred by the Legislative Auditor. If there are any questions by the Board, please do not hesitate to ask. John Wells stated they are proud to serve as auditors for NCMC working with the Board and Management and appreciate all the cooperation of all the Management staff.          He stated there was one other letter to review. It concerns their dealings with management talking about the major adjustments which is required disclosure and they did not have any disagreements with management over accounting principles on what should or should not be recorded. This is what should be reported to the Board.        Helen Godfrey Smith inquired about the GASB regarding Deferred Outflows of Resources. She asked for clarification. Mary Carroll stated that this is the employee pension plan. The Actuary are looking at the employee census data. They know the employees length of service. They anticipate when an employee is going to retire. They know when they expect the money to go out to the employee when they retire. It’s very complicated, but at the end of the day those numbers will swing since the employer contribution dropped from 9% to 8%. Now that projected liability went to $1.6 million. It is a defined benefit plan.          John Wells and Mary Carroll thanked the Board for having them tonight and for having the confidence in them.

Helen Godfrey Smith made a motion to approve the final Audited Financial Statements as prepared by Lester, Miller and Wells for the Fiscal Year Ending June 2016. Pat White seconded the motion.  The vote: yeas: Helen Adger, Kenneth Clay, Robert T. Green, Jr., Mary Irvin, David Norman, Brenda Smith, Helen Godfrey Smith, Pat White.  Nays: None; Absent: Bruce Walker, Abstained: None.   The motion passed.       VII. Old Business    1) Construction Update:David Jones stated that at the latest update meeting they were told the hospital would be finished in 29 days – this is questionable, especially since the rain. Pam Hughes stated the beams were being put up for the porte-cochere and the fountain. This will be the front entrance. Everything is going good but it will not be December 26th when it is finished. The pavement work was going good until the rain started.  Everything else is going good. David Jones noted that they are advancing. It will be late January or early February before it is complete.   2) Renewal of Ambulance Tax:Mr. Jones stated that has been some community push back on the Ambulance Tax. He is in hopes that maybe some discussion later on with the Caddo Parish Alliance could help to clear some of that up. There is still massive public support for EMS staff and service and he still feels we are looking solid in getting the tax passed. From a community standpoint, the job the EMS does is second to none. They respond timely and immediately for over 500 square miles. What they have done over the last three decades that they have been a unit is something the hospital board should be extremely proud of. He, as the CEO, is very proud of the job they have done. He is hopeful we will expand that service in the near future as the hospital service district expands, we can expand the active units. He and the EMS Director, Connie Alamond, have talked about getting that plan in place, when it does happen, there is a plan to get the eastern part of the hospital service district better covered. They have been going to community groups and continuing on. They have met with several of the mayors. They are behind the tax 100% and are supposed to be putting the information on their website and Facebook pages for support.         Brenda Smith stated that at one point it was stated that there may be a need for the Board members to help.        Robert Green asked the question about a public meeting. Had the visitors heard the Auditors report they would have better understood the need for the passing of the tax.         There was a discussion held. Doug White, Attorney, suggested to respond in writing. Try to answer the question very respectfully. Dr. Haynes would need to be the one to discuss specifics.         Helen Godfrey Smith said the hospital and Board have an attorney. All questions should be directed to that one source. Doug White said that might be an appropriate solution. Doug White noted that Ms. Cross and Mr. McCormick could be written to thank them for their comments and questions and addressing their questions, they would appropriately disseminate the response.           VIII. 1) Review October 2016 Statistics – Allyson Allums:Allyson Allums presented the October Statistical Report.  There were 73 Admissions and 70 Discharges with Total Days Stayed –267. The Average Length of Stay – 3.8 Days. Total In-patient Days – 298. The average Daily Census – 9.6 Our Total Occupancy Rate was 64.10%. Total Surgeries for October (In-patient – 3 / Outpatient – 1).  Endoscopies performed in October –5.  The total Emergency Room patients seen – 472.  Swing Bed Admission – 13. There were 118 Total E.M.S. runs in October. Observation Patients for October – 34.  There were 10 Newborns in October.  The total Patient Visits for the Medical & Surgical Clinic is 2109.  The Plain Dealing Clinic saw 708. Benton Medical saw 98. There were 44 Mammograms for October        2) Review October  2016 Financials – Allyson Allums: Allyson Allums presented the Financials. She reported Bad debt was 8.6% Days cash on hand 21.0. Hospital Revenue over Expense. Revenue –$3.7 million Expense – $1.8 million with a profit of $523,000. AR Days 52 days. The AR Days for all three facilities – 55. Plain Dealing Clinic – Revenue over Expense. Revenue –$129,634 Expense – $90,373 with a profit $51,607. Medical and Surgical Clinic – Revenue over Expense. Revenue – $469,391 Expense – $284,021 with a profit of $40,566. Benton Clinic – Revenue over Expense. Revenue –$19,203 Expense – $12,672 with a loss of $11,079. Self-Funded Insurance – Total Net Insurance Expense – $134,000.  We ended our first 12 months on the self-funded plan. We spent $120,000 for last year and $134,000 this month. The new graft will go forward comparing self-funded to self-fund.         Brenda Smith inquired how the year panned out with the self-funded insurance overall. David Jones stated we were slightly above what we paid the previous year – less than 5%. Based on if we had not gone self-funded – we shot under that number. We probably saved around 10% by going self-funded. The premium increases would have been between 9 and 14% easily.  Dakota Robinson noted that you saw $130,000 in this month that was booked. You will typically see higher amounts at early on in the year. As the year goes on those amounts will decrease because employees have hit that have hit aggregate limits and your stop loss insurance is kicking in and picking up that bill. David Jones stated that it was a good first year.         Pat White made a motion to accept the Statistical and Financial Reports as presented pending the audit. David Norman seconded the motion.       The vote: yeas: Helen Adger, Kenneth Clay, Robert T. Green, Jr., Mary Irvin, David Norman, Brenda Smith, Helen Godfrey Smith, Pat White.  Nays: None; Absent: Bruce Walker, Abstained: None.   The motion passed.        IX. New Business – 1) Sick Time Buy Back Discussion: David Jones stated we won’t need Board action. We will review the status. We have been doing this just about every year since he has been here. Our cash position right now with us expecting approximately $2.3 million dollars to come in. We just do not know when. Our cash position is down to the point that – at this time we can’t borrow money because of the Legislative Audit and the cash position we are at – we do not have the cash to do this. This could change tomorrow. Dakota has been trying to get the bulk of the $1.3 million from our cost report and other dollars from the UCC. For now we really can’t do this now. Helen Godfrey Smith inquired about the morale. Mr. Jones said it will be diminished some. It has been communicated to the Department Heads that it may not happen this year. It is communicated strongly that it is not a guarantee. This is the type of year he has been worried about. The preliminary number is the highest it has ever been for those that are eligible.  Last year it was about $62,000, this year high $70,000. The cash position could change tomorrow. He hopes it does. If so we may have to call a special board meeting to discuss the matter. Morale will be hit hard – it is a great program we do for the employees. The way all the audits hit us this year it crippled us from a cash standpoint. Then when we were turned in to the Legislative Auditor by Judy Wilson we were put under investigation which basically clamps down our ability to borrow any funds. The audit has been submitted so we are hopeful.  David Jones, Allyson Allums and Dakota Robinson are going to do everything possible to make this happen.          No action required at this time.       X. Administrative Report – 1) NCMC – Current Activity:    David Jones noted that there were invitations at each Board member seat. He noted the current activity would be about the retirement of Lanell Audirsch. As of right now she has agreed to come back to continue to be the recorder for the Board meetings. Also, we are in the process of hiring her replacement. We have had some excellent applicants. The applicants have been narrowed down to one and will offer the position. We will celebrate. When he first came he was 33 years old with little Administrative experience. He came into what was described as a nightmare situation. Her guidance and encouragement is appreciated and she will be missed.              Dakota Robinson spoke to the Board about the 340B Drug Program. We have been trying to implement pieces of it – phases of it. He noted that there are two different pieces – it is a federal program administered by HERSA to combat the rising cost of drugs. The cost of some drugs is astronomical. Some we can’t even provide the patient because of the cost. We are eligible for this program because we are a critical access hospital; an important factor. It allows us to purchase those drugs from the manufacturers at some time pennies on the dollar. From the pieces that we have now, we are buying drugs for a penny that we might have been paying $100. It is going to be a very good program. There a hospital side and contract pharmacy. On the hospital side the drugs are given to the eligible patients – those are only out-patients – Morrison Dickson furnished the software to do this. It is relatively easy – not adding a huge burden on the facility. A lot of what is through the E H R system. The estimates that we are doing early – we don’t really have any historical data to go on. Just what we have done in the past few months, we are expecting a $60,000 savings on the drugs purchased inside the hospital. That is a significant amount for what we are doing. On the contract pharmacy side – we have contracted with Sun Rx. Plain Dealing and Vivian are eligible to be processed at these pharmacies. Right now we have Walmart, Benzar Pharmacy and Kelly Pharmacy in Plain Dealing. The independents are a lot more difficult to get them signed up. Eligible patients will take their scripts to those specific pharmacies – cannot steer them only suggest. We purchase the drugs on the 340 program, paying a small dispensing fee, a change fee to process the script to Sun Rx. We make the difference between what insurance reimburses Walmart, Kelly Pharmacy, etc. – we make that difference in that cost and the cost of what we charge. Dakota reviewed the process with the Board to show how it works. It allows self-pay patients to benefit also. This is a great service that we can offer the community. A lot of work has gone into this. From Walmart alone we are predicting, in the first year, this should yield three quarters of a million dollars alone. Just from this one program going live, hopefully in the first quarter of 2017 you are looking at adding about $1.2 million dollars to the bottom line. There will be training and education involved.         David Jones gave recognition to Dakota Robinson for his role, our Pharmacist, Penny Dickens and team, for a good job in getting this program going.        2) Dialysis Clinic Partnership:     David Jones stated there is not much to report on this topic. He can report that the lot where the clinic is proposed to be located has been cleared. We are at a standstill at this time due to the legislative audit. We cannot enter into any contracts until that is behind us.         3) Foundation: Mary Coil noted that we are doing the Christmas Ornaments again this year. We have letters going out. What we normally do is a minimum donation of $10 per ornament giving in honor of or in memory of. She gets a lot of honorary donations for the Christmas season. There are those who want to let someone know that they are thinking about them and honor them in this way. End of the year donations are definitely coming up. A lot of people look at their yearend to see what they can do and what they can donate. As you know our industry around here has been different, but that does not mean there aren’t plenty of people who will be willing to donate to a cause such as ours. If there is someone you know that has a heart for the hospital and community please call her with the contact. She would certainly be happy to talk to them.         X. Medical Staff Report – 1) Recommendations – Allyson Allums: Allyson Allums presented the Medical Staff recommendations for the Governing Board approval:     MEDICAL STAFF   APPOINTMENTS:   1.) Yulia Bronstein, M. D. – Requests Provisional Privileges in the field of Radiology for the period of November 1, 2016 through November 30, 2017.     2.) Steven Lengle, M.D. –  Requests Provisional Privileges in the field of Radiology for the period of November 1, 2016 through November 30, 2017.   3.) Steven Davis, M. D. –– Requests Provisional Privileges in the field of Radiology for the period of November 1, 2016 through November 30, 2017.     REAPPOINTMENTS: ADVANCE PRACTICE PROFESSIONALS APPOINTMENTS/RE-APPOINTMENTS:     1.) William Wong, M. D. – Requests Courtesy Privileges in the field of Radiology for the period of January 1, 2017 through September 30, 2019.   2.) Shailendri E. Philip, M. D. – Requests Courtesy Privileges in the field of Radiology for the period of January 1, 2017 through September 30, 2019.  3.) Johnathan Bold, M. D. – Requests Courtesy Privileges in the field of Radiology for the period of February 1, 2017 through April 30, 2019.       4.) Kimberly Miller, M. D. – Requests Courtesy Privileges in the field of Radiology for the period of February 1, 2017 through February 29, 2019.    5.) Christian Binder, M. D. – Requests Courtesy Privileges in the field of Radiology for the period of January 1, 2017 through January 30, 2019.        6.) Jean-Paul Dym, M. D. – Requests Courtesy Privileges in the field of Radiology for the period of January 1, 2017 through October 31, 2019.    ADVANCE PRACTICE PROFESSIONALS APPOINTMENTS / REAPPOINTMENTS: None     EXTENSION REQUESTS:         1.)James Thomson, CRNA– Request extension for Privileges in the field of Certified Registered Nurse Anesthetist due to incompletion of application at time of reappointment date.            VOLUNTARY RESIGNATIONS:  1.) Richard Toothman, M.D. – Voluntary resigns Courtesy Privileges in the field of Radiology effective September 26, 2016.  2.) Eiel Ragsdale, M. D. – Voluntary resigns Active Privileges in Family Practice and OBGYN effective November 1, 2016.      Helen Godfrey Smith made a motion to accept the medical staff recommendations for medical staff appointments, reappointments, extension requests and voluntary resignations. Pat White seconded the motion.  The vote: yeas: Helen Adger, Kenneth Clay, Robert T. Green, Jr., Mary Irvin, David Norman, Brenda Smith, Helen Godfrey Smith, Pat White.  Nays: None; Absent: Bruce Walker, Abstained: None.   The motion passed.          2.) Chief of Staff Comments:    Dr. Woods, Chief of Staff, in review of the last meeting, he was asked to look into the age limitation on the Medical Staff By-laws. The reapplication for privileges for Dr. Haynes came to him as a surprise. He submitted him as requested. He told him that it has not been discussed yet. Dr. Haynes wanted to push forward. They still plan to discuss the request. It was noted that Dr. Chandler is doing a great job. It’s like he has always been here. It has been a very easy transition. He is well liked by the staff.         Brenda Smith wanted to say that her Dad was recently a patient and has been in the hospital on several occasions. She would like to reiterate from her Mom and herself the wonderful care that he received. They were so pleased with the good care he received while here as a patient. She was wanted to express her thanks to all who had a part in his care.         Robert Green, also had an occasion to be back. It makes you appreciate your hospital – from the cleanliness, staff and doctors. He really appreciated the care that he received as a patient.        He noted that his was the first time to have Community Comments and it will not, probably, be the last. We will continue to do what we feel is right for the community and the organization.  The Board continues to work as a team. We appreciate the advice of the hospital attorney, Doug White. It’s a good team.         XII. Adjourn:     There being no further business Kenneth Clay made a motion to adjourn. Helen Godfrey Smith seconded the motion. The vote: yeas: Helen Adger, Kenneth Clay, Robert T. Green, Jr., Mary Irvin, David Norman, Brenda Smith, Helen Godfrey Smith, Pat White, Nays: None; Absent: Bruce Walker, Abstained: None The motion passed.


North Caddo Medical Center
Vivian, Louisiana


David C. Jones, Secretary
Approved by the Board of Directors at the meeting held December 27, 2016