BOARD MEETING:  Regular Meeting   DATE:  July 31, 2018    MEMBERS PRESENT:  Robert T. Green, Jr. , Mary Irvin, Kenneth Cochran, Ronnie Festavan, David Norman, , Patricia White.      MEMBERS ABSENT: Kenneth Clay (arrived at 5:56 p.m.)   Brenda Smith,   Helen Godfrey-Smith (arrived at 5:41 p.m.).   TIME CALLED TO ORDER:  5:30 p.m.   OTHERS PRESENT:  David Jones, CEO, Pam Hughes, COO, Dakota Robinson, Interim CFO, Walter D. (Doug) White, Hospital Attorney, Mary Coil, Foundation Executive Director/Marketing Director, Jessica Teer, IT / LPN, Lanell Audirsch, Admin. Asst.,     LOCATION:  NCMC Events Center     BOARD CHAIR: Robert T. Green, Jr.     SECRETARY:  David Jones     I. CALLED TO ORDER – Robert T. Green, Jr., Chairman, called the meeting to order.   II. Invocation and Pledge of Allegiance – Robert T. Green, Jr. offered the Invocation and Mary Irvin led the group in the Pledge of Allegiance.     Robert Green, Chairman of the Board, stated that before we go any further into our meeting he wanted the Board to extend a welcome to Mr. Kenneth Cochran as part of our Board. He has already been appointed by the Caddo Commission and is part of the Board. We will give him an official greeting, thanking him for being here and we are glad to have you. We believe in our heart that you will make our Board even better. Robert Green asked Mr. Kenneth Cochran if he would like to speak at this time.  Kenneth Cochran stated he has connections with many here. He appreciates the opportunity. He is looking forward to learning a lot of things about what is going on and hopefully being a part of it.  III. Approval / Amend Agenda – Pat White made a motion to approve the agenda. David Norman seconded the motion. Robert Green inquired if there were any questions. There were none. The vote: Yeas: Robert T. Green, Jr., Mary Irvin, Kenneth Cochran, Ronnie Festavan, David Norman, Pat White.  Nays: None.  Absent: Kenneth Clay, Brenda Smith, Helen Godfrey-Smith.   Abstained: None.   The motion passed by unanimous vote.   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 June 26, 2018 –    The minutes of the June 26, 2018 Regular Board meeting were mailed prior to today’s meeting for review.  Mary Irvin made a motion to approve the minutes of the Regular Meeting held on June 26, 2018 as mailed.      Pat White seconded the motion.   The vote: Yeas: Robert T. Green, Jr., Mary Irvin, Kenneth Cochran, Ronnie Festavan, David Norman, Pat White.  Nays: None.  Absent: Kenneth Clay, Brenda Smith, Helen Godfrey-Smith.   Abstained: None.   The motion passed by unanimous vote.   VI. Presentation of HCAHPS  –  David Jones stated that he invited Ms. Jessica Teer. She has been working with our IT Department and she is an LPN here at the hospital. She has worked here for five years. At the Board Retreat we heard HCAHPS and he felt that it would probably be good to have her to come and explain what they are and go over some results and give a quick presentation. She graciously said she would.   Jessica greeted the Board. Ms. Teer presented our current HCAHPS results. (Helen Godfrey-Smith arrived at 5:41 p.m.) We stand above the Louisiana average and the National average in everything except one measure that we don’t. When we get these numbers back they are sent to Mr. Jones in Administration and Mary Coil in Marketing.    VII. Old Business – 1) Radiology and ER Expansion Update:  David Jones stated we have some exciting news on the Radiology and ER Expansion. We had our pre-bid meeting last Thursday. Mrs. Hughes was in attendance. We had seven general contractors and six sub-contractors show up to the meeting to get all the information. There were a few questions asked. They did a tour of the existing facility. The bids will be opened on August 16th so we will know what our budget will be looking like by the next Board meeting. He asked Doug White, hospital attorney, if he was available on the 16th. That is the date set to open the bids. Ronnie Festavan asked when you say that the hard figure as to what the budget will look like, we are going to open the bids. Help him with the process. You open the bids and then you make the budget to fit the bids.  David Jones said they will tell us what it will cost to build the building and then we can review the existing funds that we still have with the USDA and then the Board can make the decision whether to go forward with the project or scale the project down or kill the project, one or the other. Ronnie Festavan asked if the bid will somewhat drive that process.  David Jones replied yes Sir. Ronnie Festavan thanked David Jones.  USDA reviews them, our architect reviews them also, and there are regulations that they can, if there is a legitimate reason, exclude a contractor.  Pam Hughes said there are certain specifications for everything in there and they have to follow those specifications when they are bidding and then there is criteria to be met.  Mary Irvin asked if she could add a little something. Robert Green said yes, please.  Mary Irvin said just a little bragging right while we are talking about the architects. Our architects were at the conference and our hospital was featured on their brochure. We were on their power point presentation that rolled throughout the entire conference. He mentioned to her that people have commented “that is North Caddo Medical Center?” He replied it sure is. Helen Godfrey-Smith said they had an ad in the brochure and North Caddo Hospital was right there featured. Mary Irvin said there was a lot of chatter about North Caddo Medical Center. We have a lot to be proud of.     2) Ultrasound Equipment Purchase Update:  David Jones stated that the Ultrasound Equipment has been put in line. He said Mrs. Hughes got an email the last few days that August 20th will be the delivery date. We tried to get a loaner unit brought in but they are waiting on a couple of other units to go out of service wherever they are. It does not look like we are probably going to get one until the new unit arrives. That will allow us to do the 4D ultrasounds. He believes it is going to be a pretty big hit the day it goes in. That is the one that gives the total picture of the baby – what the face looks like.  Robert Green asked if there were any comments or questions about the Ultrasound. There were none.    VIII. 1) Review June 2018 Statistics  –  Dakota Robinson:    Dakota asked the Board to turn to the handout with the Statistical slides in it. Dakota noted that this month as you look at the Statistics it is one of those June months where your numbers are typically down. The good thing about June we get to have an overview of the last twelve months. Through this slide he will throw in a few things and highlight some good things which hopefully this entire presentation will highlight all of those; just give you an overview of the yearly financial as well as the June financials.  For the month of June we had 55 admissions; newborns – we had five. We did see a reduction in newborns for the total year, but that fluctuates greatly from year to year.  We didn’t lose any services, if anything we are adding them; it is not alarming on that. In-patient days in June was 152, but over the twelve month period we saw almost an 11% increase. (Kenneth Clay arrived at 5:56 p.m.) Ronnie Festavan was not able to find his copy. He said he has not had any for the last two meetings. He thought that Dakota didn’t want him looking at it anymore. He found his copy and there was a moment of joshing and laughter.  Ronnie Festavan stated he was good and apologized for the interruption.  Dakota Robinson continue stating the in-patient days of 152 were down in June but for the 12 month period there was an 11% increase which is strong in that area. He noted the slide had changed a little bit. He wanted to make it easier to look at the hospital as a whole. The average daily census – used to be broken up between acute patients and swing patients. On this slide you are only looking at the acute patient average daily census. He combined those so you have all of your patients that are swing and acute on one report. This is actually anybody that is on the floor – whether they are swing or an acute. This will be a better representation than you looking at acute and swing being somewhere off in the statistics. Hopefully everybody will enjoy looking at that slide knowing that is the hospital total for the floor. Endoscopies – we had 7; Surgeries – this is a bright area.  It did go down to 8 in June, but for the year, in and out-patient we had 109 surgeries this year compared to 60 in the previous year – about an 82% increase. The changes that were made in the surgery department, the addition of Dr. Banda, you can see that in the numbers. Emergency Room visits down in the month of June to 420, but over a 12 month period there was a 4% increase. We are still seeing an increase in that ER and goes hand in hand with that expansion. Mammography – the same as the previous month of 44. The Vivian Clinic saw 1,573 patients and they had a loss of $51,698.00. You will see that they had a year in the black when we review the financials.  David Jones noted that something that Dakota didn’t hit on but these are the year-end statistics and financials. These are the unaudited financials and statistics. This will be our fiscal year end. We go from July 1 to June 30, Mr. Cochran, for our fiscal year.  Dakota noted that Plain Dealing Clinic saw 567 patients and they had a profit of $87,229. You have to remember in the month of June there are a lot of entries that are made in the financial statements to true them up and get the expenses allocated where they need to be for the cost report. A portion of this is moving a physician’s pay from one clinic to clinics that they saw the patient in. We have one physician that does that – Dr. McCommon in Plain Dealing. She splits some of her time. We moved from the home department and allocated to the Vivian Clinic and the Benton Clinic. You will see that in the next slide.  The Benton Clinic saw 328 patients with a loss of $37,718.82.  Helen Godfey-Smith asked him to repeat what he said about the allocation and why he is doing it. Dakota replied absolutely.  At the end of June we took the report that we get year after year of the adjustments that the auditor was making after the June financials. We made a big push this year to get those work papers from the auditors so we could get those booked in June so we can present those to you. It is as close as we can get until they have completed all of their audit work and give their adjustments. The push was to have less adjustment after these financials were presented and that is why we had some of these changes. Does anyone have any questions on that? He knows that it is confusing.  Ronnie Festavan said he has a question – he doesn’t think it is on that. Are you on the Benton Clinic yet. Dakota said yes. He asked Mrs. Hughes, where are we on our Medicaid number for the Benton Clinic? Pam Hughes stated that CMS asked for some information from her. She entered all that and now she got something from Department of Health and Hospitals asking for more information. She sent all that in. She is still in the holding pattern – waiting. Ronnie Festavan asked if she would say that this is somewhat usual. Pam Hughes replied yes Sir. He said he is tracking it. Each month we talk about it. We say within a few weeks a few days. It is out of your hands he understands that. Pam Hughes said on the Vivian clinic we waited a while. He said he will keep asking. He thanked Pam Hughes.  Dakota said hopefully we will get a better answer.  Dakota continued with Days Cash on Hand – dropped to 56. This is directly related to the Interim Cost Report repayment. We made a payment back to Novatos – which is the Medicare contractor for about $600,000 last month. That was that estimate that we had booked in the previous months’ financials as a contractual expense. We actually made the expense which reduced the cash on hand. That is the large chunk of that is the repayment. You will see that rebound hopefully this next period. We had our Finance Committee meeting and were looking at about 60 days cash on hand so it had rebounded a little bit after we made that payment. It was a timing issue. If you start seeing a trend down instead of just one month, we have to say what is the concern and cause of this. No alarm there. Profit/Loss – there was a loss of $79,340. AR days went to 50. He did a calculation because it might be one of those questions that got brought up – anytime you have a month with a higher revenue month – a higher revenue in May than we did in June. It affects your numerator and denominator in this equation. We had less revenue come in the door in June but AR stayed about the same. If we don’t see this correct a little bit next month, that could mean that we have a little bit of a billing problem. We do recognize that we do have a small billing problem right now. Medicare notified us that there are some outpatient claims that aren’t paying out of the ER and that could take until the end of October to correct itself. That is directly related to an increase AR days. We could see that climb a little bit. We are tracking that; we have a good estimate. The Finance Committee was aware of that. We’ve got our eyes on all the codes that it is affecting.  David Jones, just to reiterate what he just said and over-emphasize, and this is something that is fairly unique in healthcare. These are services that we have already given to patients that we are billing correctly and timely that Medicare just says – oh I have a glitch in my system so I’m not going to pay you that for the next six months. Now, I probably will be fixing that sometime in October so I probably will now pay your claims sometime after October – and deal with it. That is basically what they told us. It is not just us, it is every hospital. That is what just one of the fun things we have to deal with in healthcare. Helen Godfrey-Smith asked if that has to do with the coding. David Jones said it is something with their system that is wrong. They don’t have to give you an explanation. You can throw a fit and stomp around but that is the way it is.  Kenneth Cochran asked if they have any oversight. David Jones said somewhere in Congress he guesses. That is one of the fun things we have to deal with – it is crazy but that is the way it is.  He apologized to Dakota. Dakota said he was glad for the explanation. Dakota continued stating that the Fitness Center membership increased slightly to 428. He invited any comments or concerns regarding the Statistics.  There were none.     2) Review June 2018 Financials – Dakota Robinson – Dakota began with page 1, the Balance Sheet. He noted there is $3.48 million in unrestricted cash. That gets us our Days Cash on Hand that you see. The biggest highlights on here are the assets who’s use is limited. That is where you see your biggest change from last year to this year. You see that the sales tax fund is strong. He will report that this year has been the highest income from sales tax in the past three years. There are a lot of changes sales taxes wise in the State with online sales tax remits. They are collecting a lot more of those. The Federal Government passed down a law now where you are able to collect sales taxes from vendors that are out of state and don’t have a presence in your state, so hopefully we will continue to see that number go up. It is good for the hospital and it keeps the sales tax revenue coming in to pay off the bonds.  You will see the NCMC reserve. Remember that is a reserve account that the Board established. We will talk about that in a second. That is the $500,000 that was set by you several months ago. If you will go to page two of the Balance Sheet, three of the largest things you will see on here  – Notes Payable; the $22 million dollars that is directly related to the issuance of bonds for constructions for the new facility. Then under that, you will see Deferred Inflows – Pension and GASB 68 Pension Liability – those two line items are a significant portion of the Balance Sheet but they are directly related to the retirement plan for the hospital and the auditors are the ones that adjust those. That is why you see that number exactly the same for 2017 and 2018. Those will change when the final audit comes in.  He asked if there were any questions on the Balance Sheet. There were none.  He asked them to turn to the Income Statement on page three.  He is going to go over the 12 months ended June 30th column which is the last three on the report. He wants to point out that revenues for 2018 topped $42 million dollars which is a 13% increase from the previous year and then total operating revenues after contractuals are broken out and other operating revenues are added back in – $19.8 million dollars which is a 6% increase from 2017.  Salaries and Wages – we pushed for that half million dollar total; we were at $454,000 the previous year. If you combine that with the employee benefits, payroll taxes and everything that goes with hiring an employee and keeping them employed, he would say we reached that and exceeded it. If you go down the line, line by line, you will see that each and every category, for the most part, the expenses were less than the previous year which he has to commend the Department Heads, Administration and the Board because all the decisions came into those numbers. The largest ones Depreciation and Interest Expense, he is talking largest as far as increase from the previous years, we have no control over those two. We can budget for those, but no control as far as what that number finally turns out. Those are actual numbers from the depreciation and interest expense related to a hospital.  Ronnie Festavan said those are good numbers, but the $65,273 under Other Expenses. He knows that is not a significant amount of money when you are talking about millions but Other Expenses. Dakota replied nothing that really jumped out. He said they did talk in the Finance Committee about building another schedule for this to give the Board a little bit more information, because when you pull that account it is a conglomerate of about fifty GL accounts and they could range anything from G & A travel to advertising; a large list. It is his goal within the next few months, if it is the Finance Committee’s wishes, to get something built and in place to where you can see a little bit more detail of what that is.  Ronnie Festavan said he is not interested in working you all to death because he understands what Dakota says that can be broken down into dollars and cents and he doesn’t want to do that, but anytime you see things called Other or Miscellaneous or Loose Cash, or whatever you want to call it, those are terms that trigger people to wonder.  Helen Godfrey-Smith noted from the Finance Committee’s stand point, they have encouraged Dakota in the accounting department, because when you have a $3 million dollar expense and you are spending $23 million and $3 million of it is Other, that is too much, that is not miscellaneous, that can be identified. He is working on that to get that broken down in a schedule so that we will be able to compare from a budget standpoint, these expense line items. Right now we are saying Other, but Other – we could spend $200,000 over on Board travel and not even know it. She said we would not but she is just saying. Ronnie Festavan said he understands and she has made his point exactly. Once again, the Finance Committee is ahead of him and that is good. Like he said, those are words that when the public sees words like Other or Miscellaneous, he is always concerned about the public perception of what we are doing with our money. Helen Godfrey-Smith said we are too. He likes to see those as well defined; he doesn’t want it broken down in dollar and cents. Dakota showed them a rough draft of a schedule. You can see it is very similar to the other schedules that have been presented and it basically lumps in like items; software expense – we might have five or six different software expense GL’s, he will lump those in as well as he can. Then if there is cause for concerns or questions about it, he can always go back and drill into that and at least get you some more information but it would at least give you a starting point. Ronnie Festavan thanked Dakota.  Dakota said there was a decrease in Total Operating Expense by about 4%. He wants to point out a big take away of this is below the line Income. These are grants, sales tax revenue, 340B revenue, non-operating money that is brought into the facility.  We saw 104% increase from the previous year. The majority of it is lumped into the UCC dollars that we received – we received $1.9 million dollars in UCC funding the then the 340B program. Then if you look at our bottom line of $1.8 Million dollars and you look at those two items, it makes or breaks you. Even with the good numbers that the hospital saw, that area makes or breaks you. That is why it is very important.  Dakota asked the Board to turn to page four. This is the Direct Departmental Expense. You will see for the month of June that there departments that are down in revenue. That is expected. He would lead you to look at page number five at the whole twelve months for each one of those departments and look at how many of them are in a better place than the previous year. There are only four departments out of the entire list that weren’t where they were at.  He asked if there were any questions on the Departments. Helen Godfrey-Smith asked, under the grants report, how many of those dollars are Federal dollars versus State or Foundations. Are they all primarily all government grants. Dakota asked if she was referring to the $1.9 million. She replied yes. Dakota stated that is mainly the UCC dollars so it is all government grants. She was not referring to our Foundation, only outside Foundation grants that you might apply for a grant. Dakota said we do get very minute amount of grant money, but we do get some that are in that same line item. Dakota again inquired if there were any questions Departmental wise. There were none. Dakota asked the Board to turn to the Budget page on page seven. We brought in more revenue than we budgeted. Net Patient revenue was higher than we expected and we did a very good job of estimating the contractual adjustments. This number could change based on the final cost report, whether we are overpaid or under paid. As of right now it is less than a 1% difference. If you will look at the Employee Benefit and Payroll Taxes it is $129,000 over budget. This number does include a significant estimate for the self-funded insurance plan. We are self-funded on our Employee Insurance Plan. We have to record what is called an IBNR, Incurred But Not Reported; basically, the claims that the employees have already sustained at a doctor’s office, at a hospital, any kind of medical claim, but they haven’t been billed out. We have to make an estimate, so we use the previous year’s number and try to make that estimate and it is an estimate of $150,000 dollars. That could come in and it could be $300,000. If we had a catastrophic claim come in at the end of the month, which he doesn’t believe that we had, or it could $50,000. We are trying to get it as close as possible. The reductions in professional services, that is another one of the big changes. Helen Godfrey-Smith asked Dakota if he could make the point for the Employee Benefits that we are down almost $500,000 under 2017. Because when you look at the budget it looks a little skewed.   Dakota replied correct. We were expecting to reduce those budget numbers so we put our budget where we were trying to reach and since we did reach it, if we would not have this would have been skewed greatly. The $170,000 difference in Professional Services, the reduction in that, was from reducing the number of shifts covered in the Emergency Room by our contract company and hiring an extra physician to cover those shifts in the Emergency Room. We did add an employee into the employee mix and saved some money on the contract side. The 340B Revenue – $103,000 – we budgeted for $750,000 and it hit a little over a million.  If you go to page eight, this is the Vivian Clinic. For twelve months they were in the black. We strive for them to be in the black. They provide a lot to this facility – a lot of life. They were in the black $325,000. On page number nine, this is the Plain Dealing Clinic. They had a profit of $205,000 over twelve months. Then we get to Benton – I know we don’t like to see it, however, but they incurred a twelve month loss of $65,740. Hopefully we get the rate changes in for them pretty soon and we can get that number turned around. The patient volume more than doubled this past year so there is a lot of upside in that. On the statistics, go through it and look at all the categories and you can see where we were at this year compared to last year.  Helen Godfrey-Smith said she had one question. She knows he said this before, but she hopes he will be merciful and know that they have to take in a lot of information. Explain one more time; she knows we are going to get an increased rate because that clinic has come under our rural hospital designation. Will they effective date those payments back to the date of the actual designation or will we just pick up once they say yes? Dakota said they will just pick up.  Ronnie Festavan asked if we have any statistics on the Benton Clinic as far as private pay versus Medicare / Medicaid. If that is what is holding us, we must not have a lot of private pay there. Is that correct? David Jones stated it is not the majority, no. There is some, but not majority.  Helen Godfrey-Smith asked do you know if it is maybe higher there. Ronnie Festavan said he would have thought it would is the reason he asked the question. David Jones said it is a little bit higher there than the Plain Dealing Clinic is; probably close to what we have here in Vivian. Pam Hughes said actually the private pay is not going to pay as much as Medicaid will when we get it. We do have $500,000 dollars sitting currently in a checking account that’s a Board Reserve. It was discussed in the Finance Committee. We have been shopping rates for a CD for that $500,000. Rates have increased at the bank for CD’s. It was his suggestion to the Finance Committee that we move that $500,000 dollars into a CD.  Helen Godfrey-Smith said from a risk standpoint we are in a very healthy cash position right now. But, we know that can change rather rapidly, so we don’t want to tie our money up for long periods of time. The CD’s have a penalty of a six month loss of income for early withdrawal. We figure, if our cash position can hold steady for six months, we won’t lose any earnings and it would be worth it to us to do the extended time – up to five years. Dakota said currently all of our checking accounts are a half percent interest. He did some negotiating with Citizen National and the other one and those rates have revised to what is on your paper. The rates are increasing and that is great as far as the checking accounts. For something that is sitting there, he suggests that we make a move and invest in one of these CD’s.  We know we want to do the $500,000 reserve, because that is a long term account, so to invest it for five years at the best rate we can get.  Dakota said he and Mr. Jones talked it over and it might behoove the Board and everybody to see where the cost report numbers come in. We might owe money back. He doesn’t expect that due to February through June’s numbers, but at that point it might be a better option to stay on top of the $500,000 what we want to do. Helen Godfrey-Smith asked when we will know about the cost report.  David Jones said he was hoping by October. Oddly enough October is only three months away.  Ronnie Festavan said you may have already addressed this, he apologizes because he does not know what you have addressed. Is there any wisdom in a laddered CD where you spread that out and different maturity dates – is that financially sound? He finds that sometimes then if you need to go and reach and get $200,000 you don’t affect your other $300,000 or $150,000 increments and they come at different times. Dakota said he thinks that is what Helen Godfrey-Smith was alluding to as far as breaking them into some smaller chunks. Helen Godfrey-Smith asked him would it be o.k. to make a motion to resolve to do that and then prepare the resolution and have it properly signed. Doug White said sure. Mary Irvin asked if we would do that at the August meeting. Helen Godfrey-Smith replied no, we can do it now because we want this 3.5% rate. Helen Godfrey-Smith said with the indulgence of the Board, Mr. Chairman, can she make, as Chairman of the Finance Committee, make a motion. Robert Green asked if she was referring to the CD’s. Helen Godfrey-Smith replied yes.    He said why don’t we take care of the Statistics and Financials. Dakota Robison stated he was done with the Statistics and Financials. He was leading into the discussion of the CD’s. He apologized. Robert Green stated he would like to entertain a motion concerning the Statistics and Financials that have been reported at this time. Ronnie Festavan asked Mr. Chairman, if we could, before we go into, could we have our Finance Chairman go through it and have a little discussion, you are the maker of the motion, you have the privilege of the first discussion on the motion for the record, talk about for the minutes, what we are about to do. Robert Green said, Mr. Festavan,  what he was doing is taking care of the Statistics and Financials then he was going back to that and allow her to do that separate. We have already had the Statistics and Financials and while it is fresh on our minds let’s take care of that then we will go back to the CD’s and then we will let her do what is necessary.  Kenneth Cochran said he just wanted to comment that Dakota said he got some of the information yesterday. Is there any more information coming? Dakota replied no. That was it. Kenneth Cochran said he wanted to be sure.         Pat White made a motion to accept the Statistical and Financial Reports as presented subject to audit.  Ronnie Festavan seconded the motion.    Robert Green inquired if there were any questions or discussion regarding the Statistical and Financial Reports.  There were none. The vote: Yeas: Robert T. Green, Jr., Mary Irvin, Kenneth Clay, Kenneth Cochran, Ronnie Festavan, David Norman, Helen Godfrey-Smith, Pat White.  Nays: None.  Absent: Brenda Smith.  Abstained: None. The motion passed by unanimous vote.       Robert Green stated we can now visit about the CD’s.   Helen Godfrey-Smith said in a nutshell what we would be proposing what we would resolve to do as a Board is to invest the $500,000 dollars reserve account that we approved several months ago to be set aside and we know that is our cushion for our loan that we have here on our building to make sure we can make our payments.   Helen Godfrey-Smith made a motion to purchase a Certificate of Deposit for five years at 3.5% with monies removed from the NCMC Reserve Fund at Citizen Bank and Trust of Vivian breaking it into two Certificates of Deposit at $250,000 dollars each from First Guaranty Bank of Vivian. The motion was seconded by Pat White.   Robert Green inquired if there was any further discussion on the matter of creating the resolution to take care of the moving the money for the checking account to be placed in CD’s at First Guaranty. There is no more shopping to be done. Dakota noted currently the only account that we have at Citizens National is the Benton Clinic which is a flush account. Dakota said that First Guaranty is a local bank and it will be spreading it out more through the community.      The vote: Yeas: Robert T. Green, Jr., Mary Irvin, Kenneth Clay, Kenneth A. Cochran, Ronnie Festavan, David L. Norman, Helen Godfrey-Smith, Patricia White. Nays: None.  Absent: Brenda Smith.  Abstained: None.   The motion passed by unanimous vote.      Helen Godfrey-Smith made a motion to purchase a Certificate of Deposit from the Reserve Account for five years at 3.5% breaking it up into two CD’s of $250,000 each moving it from Citizens Bank to First Guaranty Bank.   Doug White said it needs to be done right away because you may not get 3.5%.  Dakota said it will be drafted tomorrow morning. Mary Irvin made a second on the motion.     Robert Green asked if there was any further discussion.   There was none.  The vote:   Yeas: Kenneth Clay, Kenneth A. Cochran, Ronnie Festavan, Robert T. Green, Jr., Mary E. Irvin, David L. Norman, Helen Godfrey-Smith, Patricia White. Nays: None.  Absent: Brenda Smith.  Abstained: None.   The motion passed by unanimous vote.   Robert Green stated the motion has carried that we will move these finances from one place to another and create a resolution to reflect what we just approved.  Doug White said the resolution is where you pull out a certain thing rather than handing somebody the whole minutes with all the discussion, we resolve to do X. This is proof of it. Dakota make it happen. (Robert Green left at 6:53 p.m.)      IX.  New Business  –  1) Ratify Phone Poll of Board Members Regarding Approval of the Nominating Committee’s Recommendation of Ken Cochran as Board member to Fill Current Vacancy:  David Jones state the only new business we have on the agenda is to ratify the phone poll the Board members took in the approval process of the Nominating Committee’s recommendation of Mr. Ken Cochran as the Broad member to fill the current vacancy just for record keeping purposes.  Mary Irvin stated we are asking for a motion to approve the recommendation of Ken Cochran as our Board member to fill the vacancy.  Ronnie Festavan made a motion to approve the Nominating Committee’s recommendation of Mr. Ken Cochran as the Broad member to fill the current vacancy. Kenneth Clay seconded the motion. The vote: Yeas: Kenneth Clay, Ronnie Festavan, Jr., Mary E. Irvin, David L. Norman, Helen Godfrey-Smith, Patricia White. Nays: None.  Absent: Robert T. Green, Brenda Smith.  Abstained: Kenneth A. Cochran.   The motion passed by unanimous vote.     X. Administrative Reports:  – 1) NCMC – Current Activity:  David Jones stated he wanted to give the Board an update from the Board Retreat. One of the things that we wanted to present at the July Board meeting was an Employee Recognition Program to get started. We talked about Customer Satisfaction and Employee Satisfaction that we are moving forward with. Employee Satisfaction is certainly something I know the Board was interested in and that we have been interested in period ever since he has been here. The Committee met today. We called it an Employee Enhancement Committee, not just a recognition committee because what we’ve found by firsthand experience, if you just set a program and run with. He said it was talked about at the retreat by January 1st to have a budget lined out and have a program in place and come to the Board in December for approval and then go forward with it from there.  Mary Irvin said if she could reiterate from the Board Retreat we had said this month we would have a committee established then in September we would have the shell of the program and then like you just reiterated December approval and then roll it out in January was a decision made at the retreat by the Board. It is exciting. At the kick off date, if we could have certainly all the Board members that can make it, throw a spotlight on the event, he thinks it would push us in the right direction. Helen Godfrey-Smith asked are we in hopes of doing a December event this year similar to what we did last year. David Jones said that would very timely thing if the year continues on the way it has been, he would see that would be a very doable time frame.   David Jones said just brainstorming through they have decided that every twelve months the committee will roll off and new committee members will come on. The focus is to keep this going. A ten year, twenty year type thing. A cultural change is what we are trying to invest in. They had some great ideas today. They even went into community involvement; like a three prong thing, employee recognition and employee enhancement as far as different certifications in different clinical departments and celebrating degrees achieved and those kinds of things and then a community involvement level; a volunteer program.      2) Board Review of LHA Conference:  Helen Godfrey-Smith said they spent the Sunday, July 22, 2018 through Wednesday, July 25, 2018 at the Louisiana Hospital Association Summer Conference. It was an education experience to remember. It truly was. For those of us who were there, you see them with the Governor of Utah, Michael Leavitt. He is former White House U.S. Secretary, Health and Human Services (2005-2009) and several other titles. He was an excellent speaker. The presentations can be found on the website We are members and would like for you to show us how to get access to the members only section and we can go in and look at all of those presentations. She did not bother to print them out or bring them to you. If there is any interest it is just such good information. Mr. Governor, talked about the state of the healthcare eco system; the system where we have to function within overall nationally. He did his from the perspective from 25 years into a 40 year transition. It was really exciting. The future of rural healthcare, the presenter was Eric Shell, CPA, MBA. The four things that he really pushed was aligning providers, improving quality, increasing organization efficiencies and the healthcare industry’s migration from volume based payment. Ken Kaufman did a great presentation. The top priority moving forward is looking at all facets of cost. It is time now when we really have to pick our cost; we have to know what our costs are.  Mary Irvin said she will add one thing for the Board members, if you are interested in talking to your Legislature, you could give them a call and talk to them about the 340B Plan. What we were told by one of the speakers is that it is under attack by a representative from New York.  Ronnie Festavan asked Dakota to get him the Senate Bill and House Bill numbers on that that way when you call you can address specific bills rather than talk about what is in them. He would be glad to call Johnson and Cassidy.  Mary Irvin said to tag on she loved one of the things that one of the speakers said coming from the Board’s perspective – what’s now, what’s near and what’s far. Mary Irvin reviewed their trip to North Oaks with the Board and is looking forward to returning and working with such a great organization.  There was a lot of vision and a futuristic way of thinking.     3) Foundation:   Mary Coil reported that we had our Gala on the 21st and it was a great success. We have heard great things about the food and the band. That is always two of the strongest opinions is about the food and the band. We had an excellent silent auction which was donated by different people in the community. We really appreciated their support. We are looking at good numbers. It was an exciting event. We look forward to the next one. We have a committee that helps her with this. The Foundation Board, of course, is very instrumental in the whole process. We also have a committee that is not on the Board. She is so thankful for them to helping us. They will get sponsors, silent auction items, it is just a great way to be involved. We really appreciate those ladies that stepped up and served with us. We had Crystal Wooldridge, Patricia Wooldridge, Edie Festavan, Patsy Hartzo, Shawn Gibson, and Stacy Farguson.  We had a great group of ladies who joined in and helped the Board members who also attended all those meetings. It is a great way to involve other people and they were truly instrumental in making this such a success. We were thankful for it and we look forward to it next time. Mary Irvin said you could tell that the people at North Oaks were all amazed at our Gala and its success.  Ronnie Festavan said he will tell you personally that he thought it was outstanding. He has been to all of them that you have had even before he moved back here. This was the best one. The food was outstanding and the entertainment was outstanding. We can’t wait until the next one.  Mary Irvin said it truly does become an ambassador of our hospital. It truly is part of what is changing the perception of our facility. People who come to the Gala may never have a reason to come here, but they know we are here and they know that we are awesome.     XI. Medical Staff Report  –  1) Recommendations – Dakota Robinson:  MEDICAL STAFF APPOINTMENTS:  1.)  Sanjeevi Tivakaran, M.D. Request Provisional Privileges in the field of Sleep Medicine for the period of July 24, 2018 through July 31, 2019.   MEDICAL STAFF REAPPOINTMENT: 1.)  John Woods, M.D. –  Request Active Privileges in the field of Emergency      Medicine for the period of July 24, 2018 through March 31, 2020.   2.)  Jeffrey Goorland, M.D. –  Request Active Privileges in the field of Emergency Medicine for the period of July 24, 2018 through July 31, 2019.    3).  William Wesche, M.D. –  Request Courtesy Privileges in the field of Pathology for the period of July 24, 2018 through July 31, 2020.     4.)  Kirtesh Patel, M.D. – Request Courtesy Privileges in the field of Pathology   for the period of July 24, 2018 through January 31, 2019.     5.)  Anisha Turner, M.D. –  Request Courtesy Privileges in the field of Emergency Medicine for the period of July 24, 2018 through December 31, 2019.  6.)  Alison Robinette, M.D. – Request Courtesy Privileges in the field of Radiology for the period of July 24, 2018 through December 31, 2019.      ADVANCE PRACTICE PROFESSIONALS REAPPOINTMENT:   1.)  Kevin McElhaney, CRNA – Request Courtesy Privileges in the field of Anesthesia for the period of July 24, 2018 through February 28, 2019.     EXTENSION REQUEST:  1.)  William Liles, M.D. – Request extension pending completion of credential application.  2.)  James Thomson, M.D. – Request extension pending completion of credential application.     VOLUNTARY RESIGNATIONS:   1.) Kevin Nesbit, M.D. – Request voluntary resignation in Emergency Medicine  effective 06/30/2018.    2.)  Luis Soto, M.D. – Request voluntary resignation in Radiology effective 06/19/2018.         Kenneth Clay made a motion to accept the Medical Staff Appointments, Reappointments, Advance Practice Professionals Reappointment, Extension Requests and Voluntary Resignations.    David Norman seconded the motion. The vote:  Yeas:  Mary Irvin, Kenneth Clay, Kenneth Cochran, Ronnie Festavan, David Norman, Helen Godfrey-Smith, Pat White.  Nays: None. Absent: Robert T. Green, Jr.,  Brenda Smith.   Abstained: None.   The motion passed by unanimous vote.  2) Chief of Staff Comments:  David Jones noted that our Chief of Staff is serving his annual National Guard three weeks in southwest Louisiana.   XII. Executive Session:  Mary Irvin noted that we needed a motion to enter into Executive Session for Strategic Planning.    Ronnie Festavan made a motion to enter into Executive Session for Strategic Planning with a short break before entering into the session.   Helen Godfrey-Smith seconded the motion.  The vote: Yeas:  Mary Irvin, Kenneth Clay, Kenneth Cochran, Ronnie Festavan, David Norman, Helen Godfrey-Smith, Pat White.  Nays: None. Absent: Robert T. Green, Jr.,  Brenda Smith.   Abstained: None.   The motion passed by unanimous vote.  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.    Pat White seconded the motion.   The vote:   Yeas:  Mary Irvin, Kenneth Clay, Kenneth Cochran, Ronnie Festavan, David Norman, Helen Godfrey-Smith, Pat White.  Nays: None. Absent: Robert T. Green, Jr., Brenda Smith.  Abstained: None.   The motion carried.      XII. Adjourn:    There being no further business Kenneth Clay made a motion to adjourn.   Pat White seconded the motion.   The vote:    Yeas: Mary Irvin, Kenneth Clay, Kenneth Cochran, Ronnie Festavan, David Norman, Helen Godfrey-Smith, Pat White.  Nays: None. Absent: Robert T. Green, Jr., Brenda Smith.   Abstained: None.  The motion carried.      Meeting adjourned at 9:00 p.m.




North Caddo Medical Center

Vivian, Louisiana





David C. Jones, Secretary


Approved by the Board of Directors at the regular Board meeting held August 28, 2018