BOARD MEETING: Regular Meeting    DATE: January 23, 2018    MEMBERS PRESENT:Robert T. Green, Jr., Mary Irvin, Kenneth Clay, Ronnie Festavan, David Norman, Brenda Smith, Helen Godfrey-Smith, Patricia White, Bruce Walker    MEMBERS ABSENT: None     TIME CALLED TO ORDER: 5:36 p.m     OTHERS PRESENT: David Jones, CEO, Pam Hughes, COO, Allyson Allums, CFO, Dakota Robinson, Controller, Lanell Audirsch, Admin. Asst., Allison Jones, Attorney, Walter D. (Doug) White, Attorney, Mary Coil, Foundation Executive Director/Marketing Director, Mike Viatkus, Security   LOCATION: NCMC Events Center     BOARD CHAIRPERSON:   Robert T. Green, Jr.     SECRETARY: David Jones     I.  Called to Order – Robert T. Green, Jr., Chairperson, called the meeting to order.     II.   Invocation and Pledge of Allegiance – Robert T. Green offered the Invocation and Ronnie Festavan led the group in the Pledge of Allegiance.   III. Approval / Amend Agenda – Robert T Green, Jr. stated it is time for approval or amendment of the agenda. He stated we are going to need an amendment to be added to the agenda. It would be Resolution #1 – 2018 granting signatory authority to David Jones, CEO/Administrator, to execute documents on behalf of the Board. It has been a while and we need to do this again.         Helen Godfrey-Smith asked if we could ask David Jones to talk just a little bit about the particular implications of the cuts that are being proposed now by Governor John Bel Edwards that relates to specifically safety net hospitals, but whether that is going to impact us, so maybe the State Budget cuts. If he could just give us a little bit of comfort about some things. Not in any deep detail but how his first take on all of that is.             Robert Green stated that David Jones could add that into his Administrative Report. Helen Godfrey Smith stated absolutely.        Brenda Smith made a motion to amend the agenda to add Item #3 under New Business for Resolution #1 – 2018. The motion was seconded by Ronnie Festavan.        Robert Green asked if there was any further discussion on the matter. If not he would entertain a vote.          The vote: Yea: Robert T. Green, Jr., Mary Irvin, Kenneth Clay, Ronnie Festavan, David Norman, Brenda Smith, Helen Godfrey-Smith, Patricia White, Bruce Walker. Nays: None. Absent: None. Abstained: None. The motion passed to approve Resolution #1 – 2018.        IV.   Community Comments – Robert T. Green, Jr., Chairperson, noted there were no signed Visitor Recognition Cards requesting to address the Board.       V.   Minutes – Regular Meeting December 19, 2017 –   Robert T. Green, Jr., Chairman, noted that we are now are at the       Approval or Amendment of our minutes from the meeting of December 19, 2017. What can he hear?        David Norman made a motion to approve the minutes of the Regular Meeting, held on December 19, 2017, as mailed.  Kenneth Clay seconded the motion.        Robert Green recognized Ronnie Festavan. Ronnie Festavan stated he has a quick question based on a discussion that we had earlier. Did we look into the possibility of getting the minutes in the format that is sent to the paper? David Jones stated that we did. That is actually a Board discretionary thing he believes. He talked to Mrs. Lanell and she was certainly knowledgeable of when we went to the format. He actually thinks that old format was at the request of Board meeting a long time ago which predates him of thirteen years. That is up to the Board if you would like to change formats. David Jones understands it the way Mr. Festavan does. It is certainly easier to read and we do put them in two different formats. Lanell works hard to put them in two different formats to read. If it is easier to some Board members that it is read in the current way, we can continue to do that as well. Robert Green noted that a copy of the format was included in the packet for your review. Some stated they didn’t get theirs until today. David Jones apologized for the delay. He thinks the weather actually slowed us down even further from the Board members getting their packets in a timely fashion. He knows some of them just got theirs today or yesterday. Mary Irvin stated that it is just a straight read what you read in the newspaper. David Jones stated it is two different formats. Mr. Festavan brought it up which like he said, it is really a matter of preference for the Board. What is read in the paper is more of a direct format and the way that we present them for approval is a broken down per section. It is a whole lot more paper the way we present it now versus that. We will do it either way the Board likes.        Ronnie Festavan ask to be recognized. Robert Green did so. Ronnie Festavan said he does not want to cause any extra labor. What he is hearing is perhaps, he made the suggestion purely because it is easier for him. Rather than have to go down this column and have to turn every page to the minutes and that sort of thing; for him it much easier just to get a couple or three sheets of paper and go through and make his notes on those papers. Now, if that is going to cause us too much change, surely there is an extra copy of that. He does not mind picking up a copy of that or if you could just send him a copy of that in his mail out. He hears you saying that if we went to that format that it might save some paper and time. David Jones said we do two different versions of it. Ronnie Festavan said he is good with whatever they want to do. He can get a copy of it like that on his own if we are not interested in doing that. There may be others that have no interest in doing it that way. You have been doing it this way for a long time. It just happens to be something that is easier for him to look at a print out of the minutes than to go through like it is currently. Robert Green repeated we have a sample of the form in the packet. Those who did not get your packet, we can provide you with a copy. We can come back and look at that again. He does not see any problem with that. He does not see a problem if they had both.         The vote: Yea: Robert T. Green, Jr., Mary Irvin, Kenneth Clay, Ronnie Festavan, David Norman, Brenda Smith, Helen Godfrey-Smith, Patricia White, Bruce Walker. Nays: None. Absent: None. Abstained: None The motion passed to approve the minutes of the December 19, 2017 minutes as mailed.        VI.                Old Business – Robert Green noted that there was no Old Business on the agenda.       VII. 1) Review December 2017 Statistics – Allyson Allums: Allyson Allums presented the December 2017 Statistical Report. For the month of December there were 66 admissions and 5 Swing Bed Admissions. She noted that over the course of 8-9 months, we have maintained about 65 patients. She thinks for us to maintain that during the holiday season is really good. Statistically we had a good month for December. There were 5 newborns for the month. The total in-patient days for the month was 195 days. These days are slightly less. We did have the holidays and we didn’t keep them quite as long. They have had, as an average, the same amount of patients, we just didn’t keep them quite as long; if they were probably truly sick and then those that could go home for the holidays, we sent home.  We had 13 endoscopies for the month. We performed 6 surgeries. Those 6 surgeries represent only Dr. Banda. We didn’t have any C-sections during the month of December. As of today, she had an update and as of tomorrow we will have performed 10 surgeries in January and all of those are Dr. Banda. They have been really busy. The Emergency Room – we are up 532 patients for the month. We have been extremely busy in the Emergency Room. The flu season has hit them heavy and hard and in one day they had 15 patients there at one time. There have been multiple other days to where they have had to pull stretchers into the halls of the ER and call in extra staff to help take care of the patients that have been coming to the ER. We have been really, really busy in the ER. Mammography – we had 25.  That is about our average for the month. We have maintained that.       2) Review December 2017 Financials – Allyson Allums:  Medical/ Surgical Clinic saw 1,718 patients for the month and they had a loss of a little over $14,000 for the month. This was due to some large contractual adjustments that we took cleaning up some accounts in an Accounts Receivable clean up. That did affect the bottom line for the facility.  Plain Dealing clinic saw 696 patients for the month, which is about their average. They have a profit of a little over $20,000 for the month. The Benton Clinic saw 323 patients. You look over the last 6 months since we have added our new Nurse Practitioner there. Our numbers have doubled, our revenue has doubled and she has done a really, really great job there. The clinic is growing. David Jones, said to jump in there real quick, he wanted to add that Dr. McCommon texted him about 30 minutes ago. She saw 27 patients there today. That is her all-time high. Allyson noted that is a really busy day for that clinic. They had a slight loss for the month of $1,900.  Some of that is due to the fact that they are not a rural health clinic like our other clinics are so they don’t get the same rates. So their contractual adjustments are higher which affects their bottom line at the end of the month. As of today, Pam received the Rural Health Clinic License for them. We still have to have an inspection and it will go to the State for the rate setting so their rate will come up to a higher rate that we get paid per patient there which will help alleviate that bottom line. Brenda Smith asked if there was a retro payment in that. The answer was no. Mary Irvin asked to speak. With the license and the next step it will become a Rural Health Clinic? Allyson answered yes. It is licensed as a Rural Health Clinic now then they have to have an inspection where they come in and they survey the clinic and then that survey goes to the State and the State sets our rate. Allyson continued stating that our Bad Debt Expense for the month is 1%. Allyson stated that you will probably see it come back up next month. Normally when you see a dive like that the next month it comes back up. Days Cash on Hand – we are sitting right at 14 days. So far in January, we have received a portion of our UCC dollars that was $715,000. We received $350,000 on our property taxes, which is our millage, which helps support our Ambulance Service. This week she spoke with Medicare and our estimated cost report, which they owe us back $720,000. They said we should receive this week or early next week. We have had an abundance of cash to come in January, so when we did that little down and dirty to see where we were today, we were about 10 days higher.. It is just an estimate that may change, we are looking at probably 24-25 days cash on hand next month. We have had a loss of $80,000 this month, even though our revenue was up we did over $3 million dollars, which is a good month for us. She is going to defer to Dakota to explain to you what actually causes that loss when you have a high month in revenue like that. Dakota asked them to turn in the Financials to Exhibit B, page 3 on the Income Statement for the Hospital. What Allyson was saying about the $3.3 million in Revenue, which is good, if you look at the contractual line right underneath that, those are all the adjustments that are done to the revenues in that month. If you did some ratios and some comparisons on that it has increased, and the reason why it increased is we pulled the most recent numbers – the PS&R –basically a receipt from Medicare/Medicaid that says you have been paid this much, you’ve charged this much and they basically set a contractual adjustment percentage. This comes straight from the government. We verified it with the auditors; checked it against the audit.  Those are the new numbers that we are using to figure that contractual. It made about a $200,000 difference in contractuals, based on past history. We had to increase the contractuals to fairly state the financial statements. So going forward those numbers will – Helen Godfrey-Smith spoke up and said the amount of the contractuals now is at 1.872. Dakota said had those numbers remained the same, it would have made about a $200,000 difference in the other direction. Helen Godfrey-Smith noted which would have given us a $120,000 positive on the bottom line. Dakota said correct. So that is why he is saying that we made that adjustment in this month to get it to match the audit and here going forward to fairly state these financials. If you go further down to Salaries and Wages – they are holding steady with the changes we’ve made. It looks good; it’s coming under what we did last year current at this time. The next line – Employee Benefits and Payroll Taxes – the majority of this change is in our Self-Funded Insurance Fund. At the beginning of the year with the way that the Aggregate Reinsurance – that we reinsure funds above $60,000 – where that insurance kicks in and starts paying those, we have had a few claims to hit us early in the year where we have met that $60,000 threshold and then now insurance is having to kick in, so that is why that column is higher as of right now than it was the previous year, because we have had more claims to hit us early in the year. As he said, going forward, those claims are not as big of an issue because they’ve met that $60,000 threshold and the insurance company pays 100% of every claim that comes in after that. The next biggest one that you will see is depreciation. We discussed that with the audit. You will continue to see this number rise compared to the 2016 number because we are booking a much larger number because the entire hospital is now being depreciated as a whole. That number will continue to outpace the 2016 number when you look at this – it will continue to grow. r. The same thing with interest expense. Interest expense used to be capitalized and put back into an asset to the balance sheet. Once construction is done, you can no longer capitalize interest expense and it has to be shown on the income statement. This is another column and line that you will see from the previous year is going to be exponentially greater and it will continue that way through the rest of this year until we can get 12 months of data on a set of financials. Go down to Grants, which is your largest line in non-operating revenues. We have currently booked six months of UCC money, which is what Allyson was talking about. We’ve received a portion of that in and we get down to our bottom line of an $80,000 loss this month. Dakota asked if there are any questions on that? Brenda Smith commented that there were many contributing factors. Dakota stated that it typically isThat depreciation number helps us on the cost report in years that is high. It counts as an expense when we file our cost report. It counts as an expense to the facility. Helen Godfrey-Smith asked if it would be possible to consider non-operating expenses to do a net change to assets before non-operating expenses so that it would make it clearer; so you could really see.  You just put the total and subtract in a different place. But it really shows the actual. She does not know if it would be appropriate for hospital finances or not. Dakota said it can be something that we can discuss. Helen Godfrey-Smith said at least we could talk to our new consultant and see just for clarity so we can see from an operating standpoint that the hospital is having a net profit during the course of a month rather than the loss. Dakota said we can certainly discuss that. No more questions? Brenda Smith thanked Dakota.         Allyson Allums continued. Our days in AR for all facilities is 55.8 days. The national average for the top 10 % of hospitals is 45 – 50 days, which is what we shoot for. Right now we are maintaining at about 55 days which she thinks is extremely well for a critical access hospital and rural health clinics. She thinks we are sitting really, really good right there. We are consistent. She is going to defer to Dakota to report on the 340B. Dakota stated that the 340B is still going strong. The graph shows Walmart, Benzer and Kelly’s are pretty much averaging out. We are seeing the top range of what we should be doing at those specific pharmacies. That graph looks good. If you go to the 340B revenue, you can see that we brought in $90,000 in revenue over those three pharmacies this month. $45,000 from Walmart – we expect that to be our largest grossing pharmacy. We are in the process – he said this month we were hoping to have Walker Brothers in Plain Dealing up and running. We are running a few weeks behind. The Vendors that set the accounts up had some issues on Walker Brother’s side. So, hopefully within the next week we can get that turned on. Hopefully at the next Board meeting we will have another slide to add to this report.      Helen Godfrey-Smith, just an observation that the revenue is increasing monthly and that is always a good sign. Pat White noted the new hospital is working. Allyson Allums said the next slide is the Fitness Center membership. She was asked to add that slide. The total membership for the month was 378. She asked if they have any other questions about this. Helen Godfrey-Smith inquired that this is not new memberships that is just the number of memberships. Is that correct. The answer was yes. David Jones said you will see it in the statistics –  the Fitness Center activity and members always was funny to him to see because the membership wains and comes but the activity pretty much stays the same. Which tells you the people that actually work out pretty much stay members.  Allyson stated that is the Statistical and Financial presentation. Does anyone have any questions or comments? Ronnie Festavan inquired about the Ambulance runs. Is that something that he saw before? Allyson stated that the Ambulance runs for the month was 157. Allyson stated they changed the slides a little. If he would like for her to add that back she will. That is about what they maintain. He asked to be recognized for a question.  Robert Green, Chairman, recognized Mr. Festavan. Ronnie Festavan noted from part of their meeting yesterday, the statement from Dakota that the Ambulance Service operates at a loss every year due to the fact the millage rate and reimbursements do not cover the cost. How do we operate at a loss every year, and more specifically, what covers that loss? The hospital general revenue. Allyson answered yes. You pick up some of that revenue through the ER. Ronnie Festavan asked is it that we just don’t get enough in tax millage. We have a millage, he knows, that pays for Ambulance. Dakota stated that it pays a portion of that expense. David Jones noted that when it was first approved it was in the late 80’s. We had one ambulance in service at the time, so the expenses were much lower. Going forward, speaking on it from when he came to now a long-term project was to go forward to try to build the hospital It was reviewed to see if we should possibly ask for an increase in millage, but we knew we were going to have to go the voters at some point if we wanted to build a hospital and ask for help that way. At the time we didn’t know if we were going to do millage or sales tax. He believes the Board, at that time, basically agreed to we are able to fund it with what we’ve got now, so let’s don’t ask for an increase; let’s keep where we are at because we know we are probably going to have to ask for more for another project. He thinks that is why we decided at that time not to go forward. We added an Ambulance crew shortly after he came. That is the crew that is at Oil City now. We have a fulltime crew in Oil City and a fulltime crew here in Vivian to split the hospital service district in half because they cover so much square mileage from that standpoint. They will put a third crew on, on occasion. With the bad weather they put a third crew on from that standpoint simply to be able to cover the hospital district at the time. He thinks that is was funded at one time and covered. As it grew, it out grew the funds. Ronnie Festavan said he knew we just went back and had that renewed not too long ago. He assumed then we renewed it at the current rate. So we renewed it really at a cost sum that still was not going to cover it but we are probably lucky to get what we got. The reply was yes. Dakota noted – how many millages failed during that time. All the Commissions that they tried to renew and a few fire departments. Ronnie Festavan said we will be thankful for what we have. Everyone agreed. Ronnie Festavan thanked the Chairman.         Robert Green stated, we have heard our Statistical and Financial Reports.  Is there any further discussion? There was none.     Pat White Made a motion to accept the Statistical and Financial Reports as presented subject to audit. Bruce Walker seconded the motion. The vote: Yeas: Robert T. Green, Jr., Mary Irvin, Kenneth Clay, Ronnie Festavan, David Norman, Brenda Smith, Helen Godfrey-Smith, Bruce Walker, Pat White. Nays: None. Absent: None. Abstained: None. The motion passed.      VIII.   New Business –   1) Radiology & ER Expansion:    David Jones is seeking a motion to move forward with the bid process for the Radiology and ER Expansion that has been previously under old business. If he can get a motion and a second he will be happy to discuss it further.     Mary Irvin made a motion to move forward with the bid process on the Expansion of Radiology and Emergency Room. The motion was seconded by Helen Godfrey-Smith.         Robert Green asked if there was any discussion. Ronnie Festavan asked to be recognized. Robert Green, Chairman recognized Mr. Festavan.        Ronnie Festavan stated that he is sure that part of this came about before he came on board. He wanted to get caught up just a little bit. He asked this earlier but he would like to get it on the record. He knows that he was told that we are spending existing funds. That is a good thing. We are not going out and going more in debt to do this. David Jones agreed. Ronnie Festavan stated that as he remembers; he has read so much he is not sure what he has read. He noted on the Financials in some point that ER visits tend to be up and down. He knows, he saw they went way up and you indicated the flu season; he made note of that.  But, he saw in review of the audit that through the years there had been somewhat, and very minor, decline in emergency room visits. What he wants to make sure of, and to get on the record is, to spend this additional money, and he knows it doesn’t have to be spent for an ER expansion, it can be spent for other needs. If we are going to spend it for ER expansion, he would hope that we have, for our public, some quantifying justification. Because, there may be questions to come up. We have this brand new, big, beautiful hospital that we just built and now we are adding on to this hospital and he thinks his explanation was great. We saw the need but we are now adding on. The general public, sometimes, doesn’t see that as we see it because they are not sitting in here. So, he wants to make sure that we get on the record that we had some type of evaluation of use of the current Emergency Room before we start spending money to increase the room. Now, obviously, if we went up to what you stated earlier and if that continues – and he is not against it, don’t misunderstand him. He wants to be able to be very transparent and very honest with the public, that if he gets asked, or you get asked; he wants to have a good answer. He wants to be able to say the business in there has increased and there’s more people and there was an absolute need to spend that money. If he can say that with a clear conscience he is o.k. He can answer that to anyone. But, he wants to make sure that he can answer that in that way with a clear conscience. That comes under your hat, and he will trust your judgement, but he would like to see something in the record as to why we are spending this money to expand the Emergency Room. Ronne Festavan thanked Robert Green, Chairman. Robert Green recognized Helen Godfrey-Smith. She said she would not presume to be able to address that as well as David Jones, but, as they have looked at the numbers over the last year or so, and tracking the different trends. There has not been that much of a reduction in Emergency Room traffic over the course of the year; it was very minor. With the new hospital with the grand opening 4 months ago – numbers are growing. The Emergency Room visits is not something that we can predict – it is what happens. What they believe, and an educated guess, is that the hospital attracts more traffic in general. As our brand is raised throughout the North Caddo community, it is going to naturally grow our population here. She asked if they remembered the Sunday newspaper – on the front page of the Shreveport Times, there was an encouragement – free PR, saying if you don’t want to wait four hours in the Emergency Room, to go to North Caddo Hospital and three or four other outlying hospitals. With that kind of PR, our Emergency Room visits are going to go up. Statistically, she thinks he is right; we need to make sure we quantify that and we put what we are talking about now in some form so that we can document and justify what we are doing. The other thing is there is going to be a large room for some particular procedures that can be done in the Emergency Room area. Those kinds of things she is so in favor of what you are saying, it is good for us to do it, but is also good for us to have it in a talking form so that when we are out there dealing with the public that we can express this in a unified way and a reasonable financial standpoint so we can let the public know that it makes sense.         Robert Green recognized Mary Irvin. Mary Irvin stated with all those thoughts in mind she just wanted to state that as a member of the community and a patient at North Caddo Medical Center, many times the Clinic and the ER, in her opinion, equally become the face of the hospital. Many times the ER may be their first experience in our hospital. She knows, just as we said today, we have had people, even with the expansion, in the hallways. Those beds, as we expand, will not always be filled but there will times that they will be filled; and if she is an emergency, she wants to be in one of those rooms, not in the hallway for one.  Also, as Helen stated, we also have to remember that I-49; isn’t it amazing; she loves seeing the progress that is happening with I-49. As I-49 becomes complete, it is going to make it so easy for people to come to our hospital. Old Board members know how she talks about North Oaks down in Hammond, Louisiana. That is going to happen for us. We, as a hospital, move in that direction and reaching out to our community and marketing ourselves, we definitely have something to market. Absolutely. Not to forget that the expansion is not only happening for some extra rooms in the ER but we are getting an MRI machine in our hospital. She knows, just personally speaking, two of her family members have had to go to Shreveport to have MRI’s. Yesterday, she was in Radiology, and as she walked out, she said she was so glad she didn’t have to go to Shreveport. Because when you need those services, it is so wonderful to have the benefit here. She thinks the whole catalyst was making room for this MRI and figuring out how to tweak some of those things that David addressed, we are going to tweak some of those things after we have built we can maybe make this a little better. She is excited about it and she really values everyone’s input in the financial side of it, but, she just sees that it is going to become the face of the hospital and she thinks I-49 is going to be a big impact on that especially as we market to those people, because people will drive, doctors will drive for an experience you can have in a hospital like ours. David Jones commented that was what the article spoke on. Mary Irvin said she did just want to ask, did we ever follow up with Mrs. Mary Haddox or did she make a connection with us on an interview. David Jones noted that Mary Coil is going to speak on that a little bit later. It was a very good idea. Robert Green thank them.         David Jones wanted to speak to Mr. Festavan’s point directly and a couple of the new Board members probably, and the old Board members. It has probably been so long you have even probably forgotten the detail of, but, there was a feasibility study that was done before the project even started. They projected out after grand opening what those volumes should probably be. They estimated, based off of other Critical Access Hospitals that had been newly constructed or newly replaced and what those volumes should look like over x-amount of time. Now, that being said, with the feasibility study the Architect, The Estopinal Group,  took that study and designed a hospital that would take in that volume of patients. Unfortunately, that is what he spoke a little earlier to you, unfortunately, that number to build that hospital, was well beyond our budget. We had to cut several areas that we would have expended and built a much larger place. One of those being the Emergency Room. So, from that standpoint, we tried to build, budgetary wise, the biggest and the best hospital that we could build for the amount that we could borrow; without thinking we could ever come in under budget, this amount of dollars. If we had known that going in, he knows Mrs. Hughes would speak on this because she worked directly with the project, that we would have already built that Emergency Room;  probably even one bed bigger than we are going to expand it. He believes 8 beds was the first project look as to what the Emergency Room looked like. That was one of the first areas that we cut trying to bring it down square footage wise so we could afford it from that standpoint. That is something he thinks we can reproduce and if you would like to take a look at, we certainly can get it. We did have to spend quite a few dollars to get the feasibility study done. We bid that out and got it done. That was probably 5 to 6 years ago. It has been a while. The construction project lasted a little bit longer than we expected it to.         Helen Godfrey-Smith stated that one more point that she would make to add on to what David Jones said. She thinks that it is really going to be important that we do have talking points because we’ve just built the hospital and all of a sudden we are back under construction 4 to 5 months later. It’s natural for people to say they didn’t do it right the first time so let’s get a heads up. David Jones stated to that point it was a suggestion of our Vice-Chair, to go ahead and have the Caddo Citizen to put out an article basically previewing what might possibly be coming for North Caddo Medical Center. Mary Coil drafted one that she has spoken with Mary Haddox about. David Jones asked Mary Coil if she would like to speak on this. Mary Coil said sure. She stated they did draft a press release for the Citizen newspaper. It is telling the public that we were $1.6 million under budget and that this is what we wanted to do with these funds. They gave an explanation of the Foundation that they have raised money – their capital campaign is for the MRI and also the benefits of the ER Expansion. They also went into the number of rooms that we will have after the expansion is something that was wanted during the initial building but because of being budget minded it is not often that you are under budget and that those funds will be used for this expansion; it is not any additional funding that we are asking or coming into play. That should be in this weeks or next week’s paper. Depending on the Citizen’s deadline.         Comments were that is a good proactive move. Robert Green asked if there were any other comments.         Brenda Smith asked to be recognized. Robert Green did so. Brenda Smith stated that it is not so much an expansion of the ER as it is making a space for the MRI, which frees up some space to be able to expand the ER. So it wasn’t like the expansion of the ER was the catalyst behind it, as Mary Irvin said,  it was more or less making the room for the MRI which changed some things around and allowed us to be able to expand the ER. David Jones stated that Radiology and the Emergency Room were two of the areas that were cut in the initial phase of trying to bring the building under budget for something that we can afford. Brenda Smith noted that those two are extremely high money makers for our hospital. David Jones stated that MRI is certainly one of those.         Helen Godfrey-Smith stated the focus on the MRI is a new service that we are going to bring to the hospital. With that positive focus that is what motivated this opportunity for these other things, but to keep the focus on the fact that we are bringing this new quality service to the community is going to be great.         Mary Irvin asked to speak. She was recognized. She said a big banner on the back of the hospital along with a catchy phrase would be good. She would like to have a copy of the press release shared with the Civic Groups and places that we are all involved with on what’s going on at the hospital and be an ambassador for it. Helen Godfrey-Smith said we don’t want to miss the opportunity of the Unity Breakfast that would be a great place. David Jones said he is typically asked to speak. That would be a great subject.         Robert Green asked if there was any further discussion. There was none offered. He called for a vote on the motion.         The vote: Yeas: Robert T. Green, Jr., Mary Irvin, Kenneth Clay, Ronnie Festavan, David Norman, Brenda Smith, Helen Godfrey-Smith, Bruce Walker, Pat White. Nays: None. Absent: None. Abstained: None. The motion to move forward with the bid process for the Radiology and ER Expansion passed.       2) Advisory Board for Benton Clinic:  David Jones stated this is a bit of housekeeping. One of the State requirements for Rural Health Clinic status is the creation of an Advisory Board. We have one for Medical & Surgical Clinic, we have one for Plain Dealing and we need one for Benton. David Jones is asking for a Board motion to approve Amy Cox Boyter to be on the Advisory Board for the Benton Clinic. If he can get the motion and the second he will speak more on that if possible.        Helen Godfrey-Smith made a motion to approve Amy Cox Boyter as a community member to the Benton Clinic Advisory Board. David Norman seconded the motion.        David Jones stated that he was a little late getting the background information on Amy Cox Boyter to get it in the mail out packets. As you can see she is self-employed. She has a salon business in Benton. She is an acquaintance of the Benton Nurse Practitioner. The Nurse Practitioner has known her through business and through other activities. The Nurse Practitioner presented to her and asked Amy Cox Boyter if she would be willing to serve on that Board. It is a voting position on the Board. They speak on anything relevant to the clinic. Pam Hughes stated some of the things they go over is Marketing; they do look at key things like what to do to help the budget. David Jones stated they are an Advisory Board. They have no true power to actually go and do things for the clinic, but they would advise things and if it’s a major thing they would bring it back to whoever the Chair is, could come and present to the Board on anything that they feel could help the Benton Clinic. It is a State requirement. That is why we have to do this – to be able to be a Rural Health Clinic. We already have an Advisory Board here and the community member is Mrs. Dempsey. They have to be a patient of the clinic to which Mrs. Boyter is.         Robert Green asked who the rest of the Board is. Pam stated the Nurse Practitioner, the Physician, Mr. Jones, herself, Rachel Bouchard and a Nurse, Chelsea, at the clinic.        Ronnie Festavan asked to be recognized. Robert Green did so. Ronnie Festavan asked if this is to fill an open position on the Board. David Jones stated yes. Ronnie Festavan asked if there was a resignation. David Jones answered no. It is a newly formed Board. Ronnie Festavan said – so all of those that were just named are on the Board. David Jones stated yes. Ronnie Festavan asked if this is the only application for that position that was received. David Jones said that is correct. Ronnie Festavan asked if it was advertised. David Jones stated it was not. Ronnie Festavan asked if it was sought out. Pam Hughes said yes. It does not have to be advertised. When you do a Rural Health Clinic you have to have an Advisory Board. They have no power, they just suggest things for the clinic. Ronnie Festavan stated that someone on the Board knew this lady and reached out to her and that is how we ended up with the paper work for her.          Helen Godfrey-Smith asked to be recognized. Robert Green did so. Helen Godfrey-Smith noted diversity on this; if you are talking rural, is there any diversity – older, younger, African-American. Pam Hughes stated that there is older and younger – she did not have an African-American. Helen Godfrey-Smith asked if there was Latino – any kind of ethnic diversity. That is one of the things that we really have to pay more attention to as we move forward. David Jones said that is something that we try to stay sensitive to. This is not a lifetime appointment by no means. At the next time we will have a larger pool of candidates to choose from. It is a smaller clinic and we are growing it at this time. That is certainly something that can be adjusted as time goes on. Brenda Smith asked how long the appointment is. Pam Hughes stated it is one year. She said the Stated requires you to have certain people on the Board. We had no choice on that. It has to be the Doctor and the Nurse Practitioner and one of the Administration. That has to be. Helen Godfrey-Smith said her question was not meant to criticize anything it is just to open up our thinking. Mary Irvin asked to be recognized. She said she wanted to ask some question. She stated that she served on an Advisory Board for Willis Knighton Hospice. Her Mom worked for them. She understood it was a formality. They did meet twice a year. It was very brief meetings. With us moving for the Benton Clinic to become a Rural Health Clinic, she is sure they were moving forward with it. If you wanted to expand the number of outside community members you could. There is no limit on that. If we need to do that that is certainly possible. They don’t meet every month. She always felt like when she was with the Hospice that if she had thoughts then she could share them at those meetings –just twice a year. She wasn’t a huge value Board member changing a lot. Is that fair to say that – It’s not like the Board we are serving on – a different type of Board. If we want to expand that to address that need, being that the other positions are already set by the State, she thinks that is something that draws more community members in. She really like serving – she learned about it and how it worked.          Robert Green asked if there was further discussion. None noted.         The vote: Yeas: Robert T. Green, Jr., Mary Irvin, Kenneth Clay, Ronnie Festavan, David Norman, Brenda Smith, Helen Godfrey-Smith, Bruce Walker, Pat White. Nays: None. Absent: None. Abstained: None. The motion to approve Amy Cox Boyter as Community member to the Benton Advisory Board passed.        3) Resolution #1 – 2018 – Granting Signatory Authority to David Jones, CEO/Administrator, to Execute Documents on Behalf of the Board:       David Jones stated this is also another housekeeping thing. Typically this is done yearly. It has not been done since January 2015. It is Resolution #1 – 2018 granting David Jones signatory authority to sign contract for the hospital. Once there is a motion and a second he will speak on the necessity.        Ronnie Festavan made a motion to approve Resolution #1 – 2018 granting signatory authority to David Jones, Administrator / CEO, to sign contracts for the hospital. Mary Irvin seconded the motion.         Robert Green asked if there was discussion.         David Jones stated we are working to try to obtain a grant through the Flex (a Federally Match Funding Program). He asked Mary Coil what the final amount they were trying to get funded. Mary stated they pulled quality measures to submit to CMS. They pick certain diagnosis and they want to pull those out of what we do so they can track hospitals that are working with Medicare. This company will actually do this for us and have the software to do this for us. Mary said the total is somewhere around $15,000. David Jones stated the immediacy need of the resolution is that yesterday he received an email from one of the ladies who is overseeing the project. On certain things, whether it be grants or certain loans that we procure via lease, the companies want the resolution from the Board stating that he can sign a contract for the hospital.  She stated she need a resolution no older than May 31, 2015. We started looking and it was outdated – January 2015. We didn’t know this at agenda setting.  They need it faxed back to them by 4:00 p.m. tomorrow to go forward with the grant. He apologized for the quickness of this. We normally did this on a yearly basis because more and more things needed it from that standpoint.  For some reason, most companies have gone away from this or they will take a year old one – 14 – 16 months in the past. This one is going on three years.        Robert Green asked if there was any further discussion on this. There was none.          The vote: Yeas: Robert T. Green, Jr., Mary Irvin, Kenneth Clay, Ronnie Festavan, David Norman, Brenda Smith, Helen Godfrey-Smith, Bruce Walker, Pat White. Nays: None. Absent: None. Abstained: None. The motion to approve Resolution #1 – 2018 granting signatory authority to David Jones, Administrator / CEO, execute contract documents on behalf of the Board.         IX.   Administrative Reports – 1)   NCMC Current Activity:  David Jones reported on the current activity. He noted that Christmas time came and went very well. Today we are currently at 27 patients for the 25 bed hospital that we have right now. Pretty much all month has been like that. To piggyback off of the free press that we got from a marketing standpoint, Mrs. Mary helped orchestrate a Channel 12 news event. We made sure we emphasized that we are open for more things than just the flu. Mary Coil did a great job doing the interview. On top of that, we’ve had three patients just today that stated that they come here specifically because they watched the news event and so they circumvented Shreveport hospitals and came here. It so happened that they picked the busiest day of the last 6 months to come here. Hopefully their wait time was up to their liking. We emphasized our average wait time is “this”, not guaranteed wait time as such. Pretty much, from walk in the door to see the doctor, average wait time is under an hour. I don’t know if anyone has been a patient of any of the Shreveport hospitals in the emergency room anytime lately, but their average wait time, I promise you, as of right now, is somewhere between five and six hours to be able to see a patient, unless you are coding. A forty-five minute drive and an hour wait still puts you three plus hours in the good to be able to see one of our doctors, and in his opinion, is as good as anything they will see in Shreveport. We piggybacked in the new building, helped us get that Channel 12 news report. He thanked Mary Coil very much for doing that. Pat White stated if you have an appointment, it is a five hour wait. To piggyback on that, he and Pam Hughes attended the Schumpert Grand Opening of the Micro hospital in Bossier. It is a 9 bed emergency room with six short stay beds that they have there. It is a new concept; one that Christus has developed in Texas. They feel, market wise, Bossier was the place to open that up in. It was really a neat little building.  It is a lot bigger inside than it looks on the outside. They had a large grand opening and we attended that and got to network with a few others there. As a resident of Bossier, opening up 9 more ER beds is certainly something. Willis Knighton Bossier’s Emergency Room is currently the busiest ER Willis Knighton Health System has.          He stated, regarding Christmas time again, he had bragged on her before, but the hospital was beautiful the way it was set up and that was all to do with Mrs. Hughes and how she did that. He can’t wait for more Christmases to come.         Ronnie Festavan inquired – under current activity – what are you willing to entertain under that – current activity? David Jones replied yes sir.  He asked David Jones, can you bring us up to date a little bit – he has asked this a couple of times before, and if you don’t have any more fine, he is o.k. with that. Our discussion with Willis Knighton. Helen Godfrey-Smith stated that is what she wanted to ask. David Jones stated he apologized; he does not know how it left his mind. There was supposed to be a micro meeting of Department Heads at Willis Knighton and himself and the CEO’s of Springhill Medical Center and DeSoto Regional Medical Center, last Tuesday. He does not know if anybody can remember what it looked like outside last Tuesday, it really was not conducive to a fairly large meeting at Willis Knighton so they cancelled it, and just so happened to reschedule it for today. He was unable to attend. That wasn’t going to finalize anything and Chris Mangin, one of the Vice-Presidents at Willis Knighton, contacted him about 8 to 9 days ago to let him know they are working on a response to our letter. So he is hoping, by the next Board meeting, for sure, to have that and be able to present to the Board. That is where we are on that. He unfortunately had to miss that meeting today, because that may have cleared some things up. The formal presentation of something, they are officially working on and are supposed to get back with us. Ronnie Festavan said thank you.         Robert Green asked Helen Godfrey-Smith if there was anything else. She stated that was exactly what she was going to ask for an update on. That was sufficient. Robert Green asked if he covered what she wanted earlier. David Jones noted it is under #4 of Administrative Reports.        2) Finance Committee Report:  Helen Godfrey-Smith noted the Finance Committee had to postpone their meeting from last week and they had the meeting yesterday. They had as their guest Ronnie Festavan. They had invited him to attend because there were questions related to the audit. He was kind enough to submit a list of questions. The Accounting Team addressed those with answers. She thinks it was decided to make those answers available to all the Board members. They were very good questions and the answers were very good. It would help all of us. We should have that audit update as a part of our agenda. We are looking at, within the Finance Committee, monthly that is where our focus is. Last month the Finance Committee submitted a “laundry list” of to do’s for 2018. One of those things was to be prepare any reconciling journal entries for the current hospital transactions. Also to hire outside accounting assistance to help us cure the un-reconciled areas of our general ledger. We have caused that to happen. Mr. Stansberry has been hired. She asked for someone to give a little update on this activity. Allyson Allums stated that he has made two visits to the facility. She stated that Dakota will report on what they worked on. Dakota Robinson said they have gone through a list of some things in the audit, about the reconciliation of some of the accounts. There were some issues and a lot of the accounts that date back a long time. They got the auditors’ permission and they made some journal entries to get those accounts cleared up. They have created an internal check list – these are the ones that have been addressed and here are the ones that remain to be addressed. We have started with three main areas that are issues and we are going to knock them out three at a time. We will start full steam next week. Mr. Stansberry had an audit himself this week. Mr. Stansberry will start digging into the information that he has already provided to him. Dakota has already uploaded numerous documents and internal documents for him to look at and he is going to get started next week. Helen Godfrey-Smith thanked Dakota. She noted that they are moving through their plan and their process and they are very optimistic that their deadline of having all of our audit findings corrected before our end of fiscal year at June 30th. During the course of our discussion in their Finance Committee meeting yesterday, they talked about the fact, that starting this month, they will have a “house note” – a $42,000 plus dollars every month that is going to begin to pay back the debt that we have incurred on this hospital. That is part of the reason we have been paying so much attention and planning so much with our finances so we could be prepared in order to handle that on a monthly basis. She called it a “house note” because it makes it real to us. We made a suggestion yesterday that we want to set up a contingency account, a physical account. Contingency accounts can be book entries and where the cash flow would stay within a lump sum account. We don’t want to set aside a number on the financials. We want an actual account that is going to start off with three months of $42,000 average, so we are going to put about $150,000 in a separate account. We will have to ask the Boards approval to set that up so that we will have these funds. We are not accustom to that payment. The committee has not talked about it but she would like to see them with 12 months payments at some point as their cash flow increases; as we get lump sum payments from different sources that are not dedicated, we can always carve out some more to put there. There is another goal that we want to have and that is to have at least three payroll amounts for our staff here at the hospital that is also set aside in a contingency fund. We have cash flow, but toward the end of last year there was a cash crunch. We don’t ever want the embarrassment of not being able to pay our employees – we don’t have the option not to pay our bond loan. We have to make sure that we take the necessary steps to have these finances and the cash available to take care of these obligations. We are going to ask the Board to give us permission today to set up the three month contingency fund and I think we are looking at Home Federal.  Dakota Robinson stated they are shopping rates. She said they will shop rates to figure out where to open up the account. She would like to ask the Board’s support for them to start to set aside these contingency accounts. Ronnie Festavan asked where is the money that is to go into that fund. Helen Godfrey-Smith stated that we have some windfalls. Allyson Allums noted that the money that we received from our UCC – the $715,000 –we’ve got the Medicare money that is coming in from the cost report  which is another $720,000. We have been operating how without touching that money. Ronnie Festavan commented sort of rainy day fund. Allyson said our goal is to continue to operate without having to touch these funds. But, if we get to a situation that we had to, they are not restricted that you can’t pull from if you had to. Helen Godfrey-Smith noted we would have to notify the Board. Allyson noted that any bank accounts that we have set up are set up to require two signatures. We always put the Chair and the Vice-Chair on these accounts. Ronnie Festavan said once those funds were deposited that you described, others that come along unexpectedly may also be a part of that. Allyson stated absolutely. He said if there were no unexpected funds it would simply be that plus interest. He assumes we would put it in some interest bearing accounts – best deal we can get. Possibly as other windfalls come along we would put that in there. We’ve not done that in the past? Allyson stated we have not been in a cash position to do that in the past. We have had a couple of years where we have had some audits that required take backs of money that we have had to pay back. Medicare said we were over paid– an audit required us to pay some money back. In the last couple of years we have taken some hits and now we are getting back on our feet again and we are getting to that point to where we can put back into reserves and we would like to do that. Helen Godfrey-Smith stated that this is a reflection of our new financial position. We’ve not had a $25 million dollar debt to retire. It has been a long time since this hospital has had a “house note”. If she can say it that way. It’s been a while. Every pay period we have to face the payroll of $350,000 just for our regular employees and the doctors is $190,000 a month – that is not anything to sneeze at. It would not take long for us to be in an embarrassing position if we are not very cautious as a Board and make sure that we are looking forward and preparing. We are not stopping with this. We are going to be looking for viable ways to begin not to depend so much on the windfalls. We are really working on the finances so we can have better control. Ronnie Festavan noted looking for possible ways to feed that account? Helen Godfrey-Smith said absolutely. Ronnie Festavan asked, putting in what we know we have right now, how long would that sustain us on the figures that Mrs. Smith just gave us – approximate is fine, he is not asking for exact. Dakota Robinson asked what you mean sustain us. Ronnie Festavan said she called out some figures of payroll and paying doctors – how long could you keep the hospital open with that money. Dakota Robinson said we have 14 days cash on hand now a rough estimate was about 24 – 25 with that cash that comes in. You are a little under a month – rough guestimate. Ronnie Festavan thanked the Chairman. Robert Green asked if anybody else to comment. Brenda Smith said this is probably going to prove her ignorance of these things, but if we are a non-profit. But we are not like Willis Knighton. So we can do that. She is asking the legal point that we can do this. David Jones stated yes. We are shifting money from one account to another. Brenda Smith said o.k. Helen Godfrey-Smith said we are a non-profit but we have to be profitable in order to sustain and be viable.         Robert Green said we have had all the discussion. Is there a motion.             Ronnie Festavan made a motion to approve setting up the contingency funds as discussed. Bruce Walker seconded the motion. The vote: Yeas: Robert T. Green, Jr., Mary Irvin, Kenneth Clay, Ronnie Festavan, David Norman, Brenda Smith, Helen Godfrey-Smith, Bruce Walker, Pat White. Nays: None. Absent: None. Abstained: None. The motion passed.         Robert Green thanked the Financial Committee for the great job that they are doing and encouraged them to continue your good work.             Helen Godfrey-Smith stated she would like for them to look at the budget that is in the Financial and Statistical Report. Just a couple of points from that budget. On page 7 – just to call attention we are looking at the December numbers here – midway through our year. We have year-to-date 2017; this is six months of our fiscal year that has passed. As you can see from our Total Operating Revenue – that net number – we are budgeted to be at $1,563,000 – we are at $1,484,000 for revenues. If you come down and look at expenses – we are a little bit up on expenses. Dakota explained to us why we were up a little bit and why we were having some fluctuations and why we are showing a net loss of $80,000. What she wants to call your attention to, is we have budgeted for December to be at $40,000 for the month – we are actually at a loss of $80,000. If you look at the year-to-date, which is 6 months in, we are actually, year-to-date, we have a net increase in assets of $1,329,000 – we had budgeted for $243,000 so we are really $1,100,00 ahead of the game for the year-to-date budget wise. With our reductions in salaries and wages we are just a little bit over budget, not much, in salaries and wages, and that was for December. If you look at year-to-date 2017 we are a little bit under for salaries and wages. It looks like our reductions is working to our advantage there. We are just very optimistic that as we move toward June our budget numbers will be back on target. She thanked the Chairman.     3) Foundation:  Mary Coil, Foundation Executive Director, reported that they had their January discussion of their annual event. This year will be the Gala with cocktail attire as in the very beginning. They have decided on the date of July 21st. This event will be held in memory of Billie Vick Van Hoose who was an original Board member, who we lost last year. She was just life in everything she ever did. She loved the Foundation and loved this hospital and she worked very hard on the Gala each year. It was very important to her. The Foundation Board had already asked that we do this and Mary talked to Mr. Van Hoose yesterday. He thought that it was wonderful and she would love it. We are really excited to do this for her. It happens that her birthday is the 22nd of July. They are very excited – it will be the best one yet. They have already been shopping around for bands – listening to them. As she understands Mr. Festavan went last weekend and heard a band. Ronnie Festavan stated he went shopping and had a good time shopping. Mary stated that they appreciate his research. Going forward she is excited what this year will bring and what this year’s benefit will bring as well – to be continued. We are also in the process of a few Board recruitments and prospects. Hopefully she will be able to tell you more next month as they talk with those individuals. She would like to remind you if you have someone in mind who would like to serve on the Foundation Board, we would be absolutely open to discuss the name and she would love for you to send their name her way. She actually recently had someone say you know I always wanted to serve on that Board and now they are not in a position where they can. She asked them why didn’t they tell her. Call her up if you have someone. That is all she has.       Brenda Smith asked if someone is coming off the Board. Mary Coil stated not this time. She said Patsy Hartzo termed out last year. They will be replacing that position and also just adding a few more members to the Board.         Robert Green thanked Mary Coil. He asked if there were any questions for Mary. There were none.         Robert Green stated that under current activities that Mary Irvin has something she wanted to share. Mary Irvin stated that in the pocket of your binders, we did put a copy of the dates of the next Louisiana Hospital Association meeting. As you see who should attend. This is one of those conferences that is all inclusive of people who are involved with the hospital business. Just notice those dates when we meet at our next Board meeting we’ll have more details available for you all to see what type things are going to be offered in the presentations. We are kind of looking at what it will cost to attend the meeting. We will be able to look at that as a Board at the next meeting. David Jones stated having attended those meetings in the past, there are quite a few Board members from each Louisiana hospitals that attend. They actually try to set sessions bending towards Board members as well. It is a very good networking event and of course it is a beautiful arena that they put it in. You are right there on the beach. It is a very nice conference and a very well attended conference. Mary Irvin stated that she thinks that for right now we just wanted you to know what the dates were. It is something that you can also get on the internet and explore yourself. At the next Board meeting, as she said, we can put some figures to it as to what it will cost and what the details are involved and what our days would look like. We have already done a little research on all that and we what transportation we can use. Look at those dates and explore it on the internet and bring something to the table next month so we can share about it. It would be a new experience for any of us. She knows that she thinks many of us have attended conferences and we always walk away with so much interaction with other people in the same business and learning how they do things and getting ideas from them. She thinks it would definitely, if it is doable, something we should definitely consider this summer as a Board for those who are interested and if the schedule works for you. Thank you.         Helen Godfrey-Smith stated that the Finance Committee members are determined that what we must do, is we’ve got to get out and find these other hospitals and look for ways and strengths of revenue and how to better prepare financially. That is one of their goals is that they will be out visiting and going to some conferences and looking for opportunities because they have a big challenge ahead of them. They are not panicking but they are definitely going to build a 5 year strategic plan that is going to help them to be more comfortable at this table and we are going to have our financials more than 30 days out. Mary Irvin said at just looking at lodging, there is affordable lodging that is still open right now. She thinks we would do ourselves justice to go ahead and block off some rooms and we can always cancel and do what we have to do to adjust it. At the next Board meeting it would be awesome if we kind of have an idea of how many Board members would be willing to consider it and then maybe at the following Board meeting have some commitments on it. There are things with the Board of Ethics; she has already looked into that. There is paperwork that we would all need to do and we would have all those figures and receipts and all the things that we would have to do to send it on to the Board of Ethics for them to know all the procedures that we are following are in accordance to their policies. Helen Godfrey-Smith noted that while we are looking at our travel we really want to talk about it and make sure that we are not just traveling and that we have a plan and that everybody does not go to the same conference. We look at three or four things where information is that we need. And we need to plan what it is that we are out here looking for and make sure that we are getting to where we need to be, because as Mr. Festavan would say, and she will say it too, is that the public really watches this sort of thing so we have to be very diligent and very responsible in how we do this. Mary Irvin state that if it is at the will of the Board that we do pursue it, it would be wonderful if we would be able to stop by North Oaks and get that into our trip down to Orange Beach since it is on the route. We have tried to do it and talked about doing it, we might can. David Jones said he was going to give Mary that one way or the other. She has been trying for twelve years. Helen Godfrey-Smith stated they also talked yesterday about our Strategic Planning Session, while we are talking about travel. She said our CEO talked about maybe two Strategic sessions this year – one in April where we can get together in a retreat environment and really begin to work on this true strategic thinking and vision. Then six months down the road as we begin to put together the plan to come back together and maybe not do a retreat at that time; maybe just go down to Willis Knighton’s meeting room or something, to review what we talked about and to review what the next steps were going to be so that we can, with some professional help, begin to really put together a viable plan and probably looking at a 12 month plan and then a 36 month plan and then ultimately probably over the next 24 months, we will have a good 5 year strategic plan.        4) Possible Effects to NCMC – Proposed State Budget Cuts:  David Jones stated as you know that State Budget is under a windfall of short givings.  He thinks the budget that the Governor put out was somewhere around a billion and one half underfunded. – $900,000,000 came straight from healthcare. There are some things in place to help protect rural hospitals, but we will certainly not be without some feeling of that. They changed the way our UCC (Uncompensated Care) was funded about four years ago. Somewhere around those lines to where it comes in a grant form now, through two different hospital at first and now it comes through one hospital. It all funnels through them. It is very convoluted – he would have to have John Wells, CPA with Lester, Miller and Wells, here to really tell you exactly how that money came about, but they did that to prevent things like this from gutting it. That was always, those of you that have been on the board for quite some time, that was the first thing that they would do, the Uncompensated Care for the hospital, they would drain immediately from that $900,000,000. Now only a portion comes from that so there will be cuts to that funding but it will not be total or half, along those lines. Now that’s to say they still have some things that they can do to help fill those budget holes where they would need to cut those things. This is certainly at a crisis level event and actually the Governor is going to speak at the Louisiana Hospital Winter Symposium, which is next week. Either he, David Jones, or somebody from the hospital will hopefully attend that just to see what the Governor has to say. Helen Godfrey-Smith asked where that will be. David Jones replied that it will be in Baton Rouge on the 30th and 31st. So if any of the Board members would like to attend, he thinks that is certainly something that could be worthwhile. Allyson Allums told Helen Godfrey-Smith that she could email that information. David Jones asked Allyson to send the information to all the Board members that have an email address. There was a copy of all Board member information included in the back of their Board binder. Mary Irvin asked for the members to review the information. There were some hand writing issues and would you make sure it is correct and if it is not correct, please let Ms. Lanell know so it can be corrected and we will have the right information. That is something that everyone might like to have a copy to take home. Thank you.           David Jones continued saying there will be more information forth coming from this because there are things that the State can do –there are some taxes, from his knowledge, that have expired that created part of this. Things that he believes that the State Legislature can do something about. That remains to be seen what they are willing to do. Healthcare and education – the two largest expenditures in the nation and they are certainly the two largest in our State budget. They are unprotected and they cut them every time. They are on the chopping block yet again. Hopefully they will do the right thing and help protect some of these things but, honestly you never know. Most Critical Access Hospitals – of the twenty-five patients that are in the hospital, he believes 21 of them are Medicare and 3 are Medicaid and there is one Blue Cross patient in the hospital. This is where our funding comes from – Federal and State government.         X.   Medical Staff Report – 1)   Recommendations – Allyson Allums:  Allyson Allums presented the Medical Staff recommendations for the Governing Board approval:   MEDICAL STAFF APPOINTMENTS: 1) Jaime Salvatore, M.D.  – Requests consulting privileges in the field of Radiology for the period of January 1, 2018 through January 31, 2019.   2) Heather Bracey, M.D.  – Requests Provisional Privileges in the field of Radiology for the period of January 1, 2018 through January 31, 2019.      MEDICAL STAFF REAPPOINTMENTS:  1) Donald Majeste , M.D.  – Requests Courtesy Privileges in the field of Radiology for the period of January 1, 2018 through January 31, 2019.  2) Travis Henley, M.D.  – Requests Courtesy Privileges in the field of Radiology for the period of January 1, 2018 through January 31, 2020.  3)  Adam Sciuk, M.D. –  Requests Courtesy Privileges in the field of Radiology for the period of January 1, 2018 through March 31, 2020.  ADVANCE PRACTICE PROFESSIONALS  – APPOINTMENTS/REAPPOINTMENT:  None.        EXTENSION REQUEST:  1)  Mark Banks, M.D. – Requests extension pending completion of credential application.  2) Thomas Siskron, M.D. – Requests extension pending completion of credential application. Physician will need “PAPA” (Physician Assessment) Per By-Laws. 3)  Brian Cornelius CRNA – Requests extension pending completion of credentialing application.        4) Kevin Nesbit, M.D. – Requests extension pending completion of Performance evaluation. 5) Kayci Wilson FNP. –  Requests extension pending completion of Performance evaluation.       VOLUNTARY RESIGNATIONS:  None      Allyson Allums noted that all of the files have been reviewed by the Chief of Staff, Dr. John Woods and she has a sign off sheet if anyone needs to review this.        Brenda Smith made a motion to accept the Medical Staff Appointments, Medical Staff Reappointments and Extension Requests as presented. David Norman seconded the motion. The vote: Yeas: Robert T. Green, Jr., Mary Irvin, Kenneth Clay, Ronnie Festavan, David Norman, Brenda Smith, Helen Godfrey-Smith, Bruce Walker, Pat White. Nays: None. Absent: None. Abstained: None. The motion passed.         2)   Chief of Staff Comments:  David Jones noted that the Chief of Staff texted him a little earlier and wanted him to express his apologies but he is a little bit busy right now and will not be able to come to the meeting to give comments. David Jones did text Dr. Woods back to ask him if he needed him to say anything for him and he has not responded yet. He is probably too busy to come back. David Jones said he apologized for him and he is sure Dr. Woods will make every effort to be at the next Board meeting.         Ronnie Festavan addressed the Chairman stating that he had a couple of things if it is appropriate at this time to bring it up. The next item is Executive Session. Perhaps we can bring it up while we have staff here. Robert Green recognized him to speak.         Ronnie Festavan stated the first item is pertaining to a standing documentation on our Board agenda. If we could, he would like to see a standing agenda item put on here – Board Member Requests, to come somewhere – we used this in the School Board very effectively. If he might discuss it a little bit; if someone is comfortable with it. Rather than hash out all types of things, it is sometimes easier if we just ask for a document from Mr. Jones and he can get that to us through his staff and have it in our hands. It saves a lot of time, saves having to bring it up in Board meeting – that sort of thing. It is a pretty easy thing. He would want your blessing on it, Mr. Jones, because obviously it falls in your lap. There are certain documents and things that he might be interested in that no one else is interested in and he just makes a Board member request. You make a note of it, if you want to put it in the mail to him or something like that. It answers my questions and it puts that to rest. Very effective, like he said, in the school system.  It was a standing agenda item every Board meeting – it was Board member requests at the end of the meeting. Mr. Chairman, he thinks that is probably one of your decisions, along with Mr. Jones, as being the Chair and Secretary. Robert Green said he sees no problem with it. Robert Green addressed David Jones. David Jones stated you will have no problem obtaining anything that Board would require from that standpoint. Helen Godfrey-Smith asked Mary Irvin if that was anything similar to her “parking lot”? Mary had been talking about something for Board members to be able to write a question down or request and leave a note on the table. Mary Irvin stated they were going to have some post-it notes.  Robert Green said he thinks that would take care of that, too. Ronnie Festavan stated we have mentioned several things here tonight that different Board members said I would like to see. Just hold that to the end and each Board member has something and you can jot it down. He thinks it speeds up the process. David Jones said honestly it may help him because sometimes when someone says something in the middle of the debate it may go – Ronnie Festavan said it is a heads up for Mr. Jones. He always liked it when he was Superintendent because he got it and did some research then if it came up in subsequent Board meetings – he had done something on it and he could say that he gave it to the Board member. It helps everybody all the way around. Robert Green said that is an easy fix. Ronnie Festavan said in light of that, may he make a request. He addressed David Jones. He said he would like a copy of the staff’s policy for holidays, staffing of the hospital during holidays, persons that are off during the holidays; surely there is some policy during the week or weekends. He said they had one – an example, he goes back to his experience in the school system – as Superintendent, if he left the building his secretary knew where he was. If he was going to be gone longer than one work day, eight hours, she emailed every Board member that he would be out of the building, where he was, his cell phone number, who was in charge of the building for that day, that person’s cell phone number. That was just in a policy, a set policy. That way there was never any question. If he called and you are out sick, then, he would know who to get in touch with and that sort of thing. He yielded to Robert Green. Robert Green said he thinks those are two easy simple ones to take care of. David Jones said actually he could speak on it later. Mary Irvin stated since we are going into Executive Session for Strategic Planning, maybe that would be a better time to discuss that. Ronnie Festavan said there is no discussion of any personnel or anything; nobody’s name has been used. It is just a policy. He is sure they probably already had one. Robert Green stated, like he said, those are two easy things to be handled. He does not see any difficulty in that whatsoever.         XI.   Executive Session:  Robert Green stated we are at the point to enter into Executive Session for Strategic Planning.  He will need a motion to enter into Executive Session for the purpose of strategic planning.        Helen Godfrey-Smith made a motion to enter into Executive Session for the purpose of strategic planning. Ronnie Festavan seconded the motion. The vote: Yeas: Robert T. Green, Jr., Pat White, Kenneth Clay, Ronnie Festavan, Mary Irvin, David Norman, Brenda Smith, Helen-Godfrey-Smith, Bruce Walker. Nays: None. Absent: None. Abstained: None. The motion carried.          The Executive Session was entered into. No action was taken during the Executive Session.         Ronnie Festavan made a motion to enter back into regular session.     Bruce Walker seconded the motion. The vote: Yeas: Robert T. Green, Jr., Pat White, Kenneth Clay, Ronnie Festavan, Mary Irvin, David Norman, Brenda Smith, Helen-Godfrey-Smith, Bruce Walker. Nays: None. Absent: None. Abstained: None. The motion carried.      XII. Adjourn:         There being no further business Kenneth Clay made a motion to adjourn. Brenda Smith seconded the motion. The vote: Yeas: Robert T. Green, Jr., Pat White, Kenneth Clay, Ronnie Festavan, Mary Irvin, David Norman, Brenda Smith, Helen-Godfrey-Smith, Bruce Walker. Nays: None. Absent: None. Abstained: None. The motion carried.          The meeting adjourned at 8:02 p.m.




North Caddo Medical Center

Vivian, Louisiana




David C. Jones, Secretary


Approved by the Board of Directors at the regular meeting held February 27, 2018