BOARD OF DIRECTORS FINANCE - Lee Memorial Health System

ELECTRONIC BOARD PACKET 

BOARD OF DIRECTORS 

FINANCE 

Full Board Meeting 

June 23, 2011, 4:00 pm 

Lee Memorial Hospital Boardroom 

2776 Cleveland Ave, Ft. Myers, FL 33901 

ELECTRONIC BOARD PACKET 

ALL MEETINGS ARE OPEN TO THE PUBLIC AND THE PUBLIC IS INVITED TO ATTEND 

Any Public Input pertaining to an agenda item is limited to three minutes and a 

“Request to Address the Board of Directors” card must be completed 

and submitted to the Board Administrator prior to the meeting.


OFFICE 

239-343-3300 

FAX: 239-343-3194 

P.O. BOX 2218 

FORT MYERS, FLORIDA 

33902 

CAPE CORAL HOSPITAL 

GULF COAST MEDICAL CENTER 

HEALTHPARK MEDICAL CENTER 

LEE MEMORIAL HOSPITAL 

THE CHILDREN’S HOSPITAL 

THE REHABILITATION HOSPITAL 

LEE PHYSICIAN GROUP 

LEE CONVENIENT CARE 


DISTRICT ONE 

Stephen R. Brown, M.D. 

Marilyn Stout 

DISTRICT TWO 

Richard B. Akin 

Nancy M. McGovern, RN, MSM 

DISTRICT THREE 

Lois C. Barrett, MBA 

Linda L. Brown, MSN, ARNP 

DISTRICT FOUR 

Diane Champion 

Chris Hansen 

DISTRICT FIVE 

Donald A. Brown 

James Green 

AGENDA 

FINANCE & FULL BOARD OF DIRECTORS’ MEETINGS 

June 23, 2011 - 4:00 p.m. 

Lee Memorial Hospital – Boardroom, 2776 Cleveland Ave, Ft. Myers, FL 33901 

1. CALL TO ORDER (Richard Akin, Board Chairman) 

Lee Memorial Health System Board of Directors Meeting 

2. INVOCATION & PLEDGE OF ALLEGIANCE (Chaplain Susan Crowley, MA) 

3. PUBLIC INPUT – Agenda Items: Any Public Input is limited to three minutes and a 

“Request to Address the Board of Directors” card must be submitted 

to the Board Administrator prior to meeting. 

4. RECOGNITION: 8 th Annual SW HOG Harley Easter Bunny Toy Run 

FINANCE CHAIRMAN: MARILYN STOUT, BOARD TREASURER 

5. CONSENT AGENDA (Approve) 

A. Finance Board Minutes of April 28, 2011; Full Board Minutes of May 26, 2011 

B. Entity Reports: Access Medical South; Home Health; HealthPark Care/Rehabilitation 

6. SEI Investment Performance Report-1 st & 2 nd Qtr, FY 2011 (Accept) 

(Peter Glennon, Terry Gerlich, Chris La Marca & Joe Hondros/SEI Representatives) 

7. Lease Terms & Capital (Dave Cato, VP Outpatient Operations) (Approvals) 

A. Lease Riverwalk Outpatient Radiology & Lab Lease Renewal/Renegotiation 

B. Capital for Bass Commons Expansion & Women’s Health Professionals Build Out 

C. Capital for MRI at HealthPark Commons 

8. Community Pharmacy at Lee Memorial Hospital (Approve) 

(Mark Collum,Pharm.D., Rph/Director Ambulatory Pharmacy Services) 

9. FY 2012 Capital & Operating Budget (Verbal Update) 

(Mike German, Chief Financial Officer) 

10. Financial & Statistical Reports of 5/31/11 (Accept) 


11. OTHER ITEMS/ Date of the next FINANCE BOARD OF DIRECTORS MEETINGS 

Thursday, September 22, 2011- 4:00 p.m. 

LMHS SYSTEM BUSINESS BOARD CHAIRMAN: RICHARD AKIN 

12. RECESS/RECONVENE LMHS Full Board Meeting to Call to ORDER: 

A. Cape Coral Hospital Board of Directors (Provider #10-0244) 

B. Lee Memorial Hospital Board of Directors (Provider #10-0012) 

C. Gulf Coast Medical Center Board of Directors (Provider #10-0220) 

13. Physician Leadership Council (PLC) Report (Accept) 

(Thomas Presbrey, M.D., PLC Chairman) 

14. Behavioral Health-Property Lease Agreement (Approve) 

(Lisa Sgarlata, Chief Administrative Officer/Lee Memorial Hospital) 

15. Old Business/New Business 

A. Board Scorecard & Proposed Board Policy 10.13D: Board Evaluation/Scorecard (Adopt) 

B. iPad Project – Community Representatives (Approve) 

C. Board Office Relocation Request (Approve) 

16. Board of Directors’ Reports & Board Administrator Report 

17. Date of the next FULL BOARD OF DIRECTORS MEETINGS 

Thursday, August 11, 2011- 4:00 p.m.: Trauma Board Meeting followed by Planning 

Lee Memorial Hospital – Boardroom, 2776 Cleveland Avenue, Fort Myers 

18. ADJOURN (Richard Akin, Board Chairman)

___________________ 

L E E M E M O R I A L HEALTH SYSTEM 


PUBLIC INPUT – 

AGENDA ITEMS: 

Any public input 

pertaining to items on the 

Agenda is limited to three 

minutes and a 

“Request to Address the Board of Directors” 

card must be completed 

and submitted to 

the Board Administrator 

prior to meeting. 

Refer to Board Policy: 10:15E: Public Addressing the Board 

Non-Agenda Item: 

Individuals wishing to address the Board on an item NOT on the Agenda, the Board office must be 

notified of subject matter at least seven (7) days prior to the meeting to allow staff time to prepare and 

to insure the matter is within the jurisdiction of the Board.

CHAIRMAN CHANGE: 



MEETING 

Thurs, June 23, 2011 4:00pm 

FINANCE CHAIRMAN: 

Marilyn Stout, 

Board Treasurer

LEE MEMORIAL HEALTH SYSTEM 

FULL BOARD OF DIRECTORS’ & FINANCE MEETING MINUTES 

Thursday, April 28, 2011 

LOCATION: Lee Memorial Hospital Boardroom, 2776 Cleveland Avenue, Fort Myers, FL 33901 

MEMBERS PRESENT: Richard Akin, Board Chairman; Linda Brown, MSN, ARNP, Board Vice Chairman; Nancy McGovern, RN, MSM, Board Secretary; Marilyn Stout, Board Treasurer; Steve Brown, M.D., 

Director; Chris Hansen, Director; Donald Brown, Director; Diane Champion, Director; James Green, Director 

MEMBERS ABSENT: Lois Barrett, MBA, Director 

OTHERS PRESENT: James Nathan, President/CEO; Cathy Stephens, Board Administrator; Jim Humphrey, Board Counsel; Mary McGillicuddy, Chief Legal Officer; Larry Antonucci, M.D., Chief Operating 

Officer/Hospital & Physician Services; Jon Cecil, Chief Human Resource Officer; Chuck Krivenko, M.D., Chief Medical Officer/Clinical and Quality Services; Mike German, Chief Financial Officer; Lisa 

Sgarlata, R.N., Chief Administrative Officer/LMH; Mike Smith, Chief Information Officer; Wendy Piascik, Vice President/Patient Care Services/CCH; Kathy Bridge-Liles, Vice President/Women’s and 

Children’s Services; Thomas Presbrey, M.D., Chairman/Physician Leadership Council; Karen Washburn, Director/Palliative Care; Donna Bradish, Director/Volunteer Resources; Regina Eberwein Acting 

Director/Planning & Strategy; Evan Rosenbaum, Senior Business System Analyst; Pam Scardina, Manager/Finance; Brian Church, Controller Physical & Outpatient; Mary Pat Roleke, President/Cape 

Coral Auxiliary; Bill Silverman, M.D., Quality & Education Community Representative; Marliese Mooney, Physician Leadership Council Consultant/Planning Community Representative; Mary Briggs, 

Interim Public Information Officer; Ben Keller, Reverend; Samira Beckwith, CEO/President Hope Healthcare Services; John Noland, Lee Healthcare Resources; Neil LeClair, Foundation Board Member; 

Gayle Reynolds, Chief Fiscal Officer/LeeSar; Pat Smith, Goodwill/Director of Business Development/Guest; Tom Feurig, Goodwill/Guest; Rick Evanchyk, Goodwill/Senior Vice President/Guest; Burt 

Saunders, Guest; George Knott, Knott/Ebelini Law Firm/Guest; Gregory Greene, Guest; Stephanie Miller, Guest; Gerald Means, Guest; Bob Koenig, Guest; Frank Gluck, News Press/Reporter; Lisa 

Porter, Executive Secretary/Board of Directors; Laurie Gretten, Executive Secretary/Board of Directors 

NOTE: Documents referred to in these minutes are on file by reference to this meeting date in the Office of the Board of Directors and 

on the Board of Directors website at www.lememorial.org/boardofdirectors, for public inspection. 

SUBJECT DISCUSSION ACTION FOLLOW- 

UP 

MEETING 

CALLED TO ORDER 

INVOCATION AND 

PLEDGE OF 

ALLEGIANCE 

PUBLIC INPUT None at this time. 

RECOGNITION 

RECYCLING 

PROGRAM 

LEESAR REGIONAL 

SERVICE CENTER 

STATUS REPORT 

HOPE HOSPICE: 

ARRAY OF 

SERVICES 

Reverend Ben Keller gave the Invocation and Pledge of Allegiance. 

Lee Memorial Health System Recycling & Shredding Program was recognized by 

Goodwill Industries with a certificate for recycling and shredding program. 

Jim Humphrey provided the Board with verbal update on the LeeSar Regional 

Service Center. He stated that he will provide a memorandum to the Board to keep 

the Board members informed of LeeSar’s building status. 

Samira Beckwith gave the Hope Hospice array of services presentation (Exhibit 1). 

She provided detail regarding Hope Healthcare Services which include Hope Kids 

Care, Hope Parkinson Program, Hope Connection, Hope Choices, Hope Hospice, 

Hope Healing Hearts, Hope PACE, and Hope Comfort Care. Hospice and PACE 

are managed care. Hope Hospice is about quality of life. She distributed a 

pamphlet that emphasized the programs in detail (Exhibit 2). She said Lee County 

has four hospice houses and soon to have a fifth house on land purchased on Six 

Mile Cypress. She said Hope provides pain control and management without 

The LEE MEMORIAL HEALTH SYSTEM FULL BOARD OF DIRECTORS 

(FINANCE) MEETING 

was CALLED TO ORDER at 4:06 p.m. 

by Richard Akin, Board Chairman. 

(James Green arrived at 4:25 p.m.)


FULL BOARD OF DIRECTORS FINANCE MEETING MINUTES 

Thursday, April 28, 2011 Page 2 of 7 


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having to bring people to the hospital for their final days. She stated she wanted to 

convey her appreciation of our work and how we help meet the community needs. 

She wanted to make sure that everyone is aware of what Hope Hospice does and 

how they help to reduce hospital admissions. Marilyn wanted to share that she was 

amazed how much Hope Hospice does for Lee County. Jim Nathan commended 

Samira and the job she does. He stated this is a great partnership and this program 

is still in its infancy, and what this program has done for the community is 

honorable. Richard Akin commended Samira and the work of Hope Hospice on 

behalf of the Board. 

RECESS FULL 

BOARD MEETING 

RECONVENE FULL 

BOARD MEETING 

CHAIRMAN 

CHANGE 

Recess to Call to Order the following Meetings: 

Lee Memorial Hospital Board of Directors (Provider #10-0012) 

Cape Coral Hospital Board of Directors (Provider #10-0244) 

Gulf Coast Medical Center Board of Directors (Provider #10-0220) 

CONSENT AGENDA Marilyn Stout asked for approval of the Consent Agenda consisting of the following: 

A. Board of Directors 2 nd QTR, YTD 2011 Budget (Exhibit 3) 

B. Full Board of Directors & Finance Meeting Minutes of January 20, 2011 with 

website correction. 

C. Full Board Meeting Minutes of March 24, 2011 

FY 2012 BUDGET 

FINANCIAL GOAL 

POLICY 20.17M 

BUDGET PLANNING 

CALENDAR 

2012 VOLUME 

PROJECTIONS 

A. Financial Goal Policy 20.17 (Exhibit 4) Mike German reviewed the policy for 

adoption. This policy helps us gear up for the future for healthcare and budget 

preparation. 

B. Budget Planning Calendar FY 2012 (Exhibit 5) 

Brian Church reviewed the calendar and key important budget dates. 

He stated that we are trying to bring in new tools and upgrade our software 

for upcoming projects. To date we have created 641 budget books. 

The Finance Department will come and present in late September the final budget 

approval. Discussion ensued. 

C. 2012 Volume Projections (Exhibit 6) 

Regina Eberwine presented for Kevin Newingham. She is requesting approval for 

the 2012 volume projections. She reviewed the Lee County population growth, use 

rate, and the LMHS admissions growth rate. We are predicting an increase in FY 

2011. Regina reviewed the Lee County population age distribution and stated the 

county is getting older. She reviewed Lee County use rates and admissions; the 

The LEE MEMORIAL HEALTH SYSTEM 

FULL BOARD OF DIRECTORS MEETING was RECESSED 4:25 p.m. 

by Richard Akin, Board Chairman, to conduct Hospital 

Provider Number portion of meeting. 

The LEE MEMORIAL HEALTH SYSTEM FULL BOARD OF DIRECTORS 

MEETING was reconvened at 4:43 p.m. by Richard 

Akin, Board Chairman 

The gavel was turned over to FINANCE Chairman, Marilyn Stout, to 

CONVENE the Finance portion of the meeting. 

A motion was made by Linda Brown to accept the Consent Agenda 

consisting of: 

A. Board of Directors 2 nd QTR, YTD 2011 Budget (Exhibit 3) 

B. Full Board of Directors & Finance Meeting Minutes of January 20, 

2011 with website correction. 

C. Full Board Meeting Minutes of March 24, 2011. 

The motion was seconded by Jack Eikenberg and it carried with no 

opposition. 

A motion was made by James Green to adopt Financial Goal Policy 

Board Policy 20.17M: (Exhibit 4). The motion was seconded by Linda 

Brown and it carried with no opposition.





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older population is increasing our admissions. Jack Eikenberg inquired if you 

should you see an increase in the length of stay due to the increase in older 

population. Regina stated that yes, this is true. Steve Brown wanted to share a 

thought that Alzheimer’s is going to increase the admissions. The big demand is 

FINANCIAL 

REPORTING 

LETTER OF CREDIT 

SUBSITUTION 

RESOLUTION 

FINANCIAL & 

STATISICAL 

REPORTS FOR 

MARCH 31, 2011 

QUARTERLY 

CAPITAL REPORT 

QUARTERLY 

SUPPLY REPORT 

going to be with Hope Hospice. Linda Brown stated that the PACE programs for 

Hope Hospice handles all sorts of dementia. 

Mike German reviewed the Letter of Credit Resolution (Exhibit 7). On March 24, 

2011 a resolution was approved by the Board to substitute the letter of credit for the 

outstanding variable rate hospital revenue bonds 2009 C; authorize the appropriate 

officers of the Lee Memorial Health System to proceed to draft the necessary 

documents in connection therewith; and providing an effective date. Jim Humphrey 

stated for the record he has reviewed the document for signing. 

Mike German presented the Financial and Statistical Reports for March 31, 2011 

(Exhibits 8, 9, 10). He reviewed the growth on the System adjusted admits and 

conversions of Inpatient and Outpatient admits. He reviewed the supply expense, 

and the total operating revenue. He reviewed the comparison of new revenue per 

case mix adjust admits, Gain/Loss from operations, financial statements, new 

patient revenue, total salaries and wages, productive salary and wages, contract 

labor, non productive salaries, other supplies, other services, purchased services, 

and bad debt expense. 

Marilyn stated that while in Washington she was asked about how we could 

operate at 47%. Jim Nathan stated that if our payor mix was at the median, we 

would be one of the top organizations; however, we have what we have. Jack 

Eikenberg asked about the projections in the year. Mike stated that the fixed cost 

don’t generate a lot of money in the last six fiscal months of the year. As we 

brought in more staff it created different staff ratios which made a big difference. 

We have the staffing we need to handle the volumes which will trim the profit 

margin. Chris Hansen inquired about season to non season and do you stay the 

same in the projected use due to vacation time. Jon Cecil stated that vacations are 

not typically used during season. Mike stated that as we come out of season we 

will see more overtime this season versus last season and different staff ratios due 

to the Epic project. We will do the best we can, but want to make sure the EPIC 

project is successful. James Green asked if legal fees are included in other 

services. 

Mike German reviewed the Quarterly Capital Report (Exhibit 11). 

Mike German reviewed the Quarterly Supply Report (Exhibit 12). 

A motion was made by James Green to approve the 2012 Volume 

Projections (Exhibit 6). The motion was seconded by Diane 

Champion and it carried with no opposition. 

A motion was made by Nancy McGovern to adopt the Letter of Credit 

Resolution: On March 24, 2011 a resolution was approved by the 

Board to substitute the letter of credit for the outstanding variable 

rate hospital revenue bonds 2009 C; authorize the appropriate 

officers of the Lee Memorial Health System to proceed to draft the 

necessary documents in connection therewith; and providing an 

effective date. (Exhibit 7). The motion was seconded by James 

Green and it carried with no opposition. 

A motion was made by Chris Hansen to accept the Financial and 

Statistical Reports for March 31, 2011 (Exhibits 8, 9, 10). The motion 

was seconded by Linda Brown and it carried with no opposition. 

A motion was made by James Green to accept the Quarterly Capital 

Report (Exhibit 11). The motion was seconded by Donald Brown 

and it carried with no opposition.





UP 

OTHER ITEMS: 

CAPE CORAL 

HOSPITAL- 2-EAST 

RENOVATIONS 

DATE OF THE NEXT 

FINANCE Board of 

Directors Meeting 

ADJOURNMENT OF 

FINANCE portion 

CHAIRMAN 

CHANGE 

PHYSICIAN 

LEADERSHIP 

COUNCIL (PLC) 

REPORT 

OLD BUSINESS 

Wendy Piascik reviewed the Unbudgeted capital requests for Cape Coral Hospital 

2 East Renovations (Exhibit 13). She stated a need for a motion to approve $1.9 

million in unbudgeted capital for 2011 fiscal year to complete the necessary 

upgrade of forty-two adult acute care rooms on 2 East at Cape Coral Hospital and 

to provide additional telemetry capability. She said the 2 East area is critical in 

managing excess volumes, especially in season, but also into the future.. 

The next Lee Memorial Health System Full Board (Finance) Meeting is: 

June 23, 2011, 4:00 p.m. in the Lee Memorial Hospital, Boardroom 

2776 Cleveland Avenue, Fort Myers, FL 33901 

Tom Presbrey reviewed the Physician Leadership Council Report (PLC) report 

(Exhibit 14) which included the safety committee update. He stated the medical 

staff will be ecstatic with the new beds at the Cape Coral Hospital. He said hand 

washing is always reviewed, and the Children’s Hospital is looking for a Chief 

Administrative Officer. May 4 th is the next PLC meeting. 

A. Attendance Policies- 10.11E & 20.13F (Exhibit 15) 

Board Counsel Jim Humphrey reviewed these policies. 

The Board approved these policies on March 24, 2011 and it pertained to the fact 

that you attend75% of the meeting, or attend another hospital function. Board 

Member Steve Brown met with Counsel and expressed his concern and that we 

should allow some excused absences, due to illness or other important factors that 

require you to not be present. On March 7 th Counsel Humphrey prepared and 

worked with Chris Hansen and then came before the Board with an attendance 

policy. Since that time we have learned of a Board members absence due to 

illness. Dr. Brown wanted this represented to the Board for allowing for 

other certain absences due to illness of themselves or due to illness of a family memb 

and If they are required to travel out of the country or state. Steve Brown has had the 

chance to reconsider and due to the recent illness of a Board member would like this 

reconsidered. If you are going to miss a meeting you should have a valid reason. 

Marilyn Stout said when you add up all our salaries it does not cover one county 

commissioner. The Budget we handle, the decisions we make all have come to be 

thought about. (She stated she made a trip arrangement with the current calendar 

at that time, and now the calendar has changed.) 

A motion was made by Donald Brown to approve $1.9 million in 

unbudgeted capital for 2011 fiscal year to complete the necessary 

upgrade of the adult acute care rooms (42) on 2 East at Cape Coral 

Hospital and to provide additional telemetry capability in order to 

accommodate, at this time, seasonal volumes. (Exhibit 13). The 

motion was seconded by Nancy McGovern and it carried with no 

opposition. 

The Lee Memorial Health System Finance Full Board Meeting was 

ADJOURNED at 5:42 p.m. by Marilyn Stout, Board Treasurer. The 

gavel was turned back to Richard Akin, Board Chairman, to 

RECONVENE at 5:42 p.m. 

the LMHS Full Board portion of the meeting. 

A motion was made by Nancy McGovern to accept the Physician 

Leadership Council Report (Exhibit 14). The motion was seconded by 

Linda Brown and it carried with no opposition. 

A motion was made by Steve Brown to motion to require 75% 

attendance at the meeting and if there is an absence the Chairman





UP 

Jim Humphrey stated that the point that was made that if you are going to say 75% 

or let the Chairman make the decisions; you need some criteria under a legal 

standpoint. James inquired about the workshop and is this considered part of the 

meeting pay. Jim Humphrey stated; no, workshops do not count. James also 

asked if for the month of July if there are no meetings, that means no pay. Jim 

Humphrey stated that is correct for the month of July there will be no pay. Donald 

Brown stated that we took an oath to attend all the meetings and do the best 

possible job for the system. Small conflicts that come about should be able to be 

handled by the Board. The objective is to have 100% attendance, and the policy 

should state that series illness, death of immediate family should be taken into 

consideration. To say we only need to attend 

75% of a meeting does not sound very good. 

Nancy agreed with Don’s comments and even though we should attend every 

meeting; she agrees on the 75%. Steve Brown stated that 75% is a figure he took 

from the last meeting. Linda Brown wanted to remind the Board that we are 

compensated and this is a position of honor, and it’s not about money; it’s about 

service. To be excused or punished is inexcusable terms to be used; we are here 

to be of service. It’s not about how much you get paid if your colleges are going to 

excuse your behavior. Chris stated that being a rookie, I did not have any 

vindictive bone when taking office; we have the duty and obligation to the health 

system we have to be above and beyond and be at the highest standard. Seventy- 

five percent was set for everyday conflicts we encounter daily; traffic, things that 

may happen. It is a standard and we have an obligation and a commitment of 

excellence; as the originator it would be remissible if we did not hold to the highest 

standard. Nancy stated we are elected officials, and we are to carry out our duty. 

Marilyn stated that the appropriate decision is to come up with a list of excused 

absences. Steve stated that 75% time period he does not feel strongly about a 

number of attendance. As that rule stands as of right now, Lois is not excused. 

Jim Humphrey concurred that is true that Lois is not exempt right at this current 

time. If there are extenuating circumstances there should be absences. Richard 

Akin asked the Board if they want the Board to revisit the policy and readdress 

this. Steve Brown asked that the Chairman, Jim Humphrey and Cathy Stephens 

meet and review this policy due to the current policy does not constitute 

fairness. James stated that everyone realities are not the same; what the 

compensation should be and this hypocrisy should stop. Chris Hansen stated 

that it was not intentional and he appreciates Steve’s comments. Richard Akin 

stated that we will never be able to accommodate everyone. Jim Humphrey 

said it is important to have defined standards, like a serious illness. Nancy 

McGovern asked to put a retro date on this so that a current ill Board Member 

can get paid. 

B. Request for Meeting Date Change (Exhibit 16) 

Marilyn asked the Board to approve change to the Finance meeting from 

November 17 th to the 10 th . Steve Brown asked the Board to approve change to 

the October Planning Meeting scheduled October 6, 2011 to October 20, 2011. 

From both Marilyn Stout and Steve Brown explained then requests for meeting 

date changes. The Board agreed. 

C. iPad Update 

Don Brown said the Board should go electronic and he is requesting for all the 

makes the decision of the excuse. The motion was seconded by 

Marilyn Stout and it carried with no opposition. 

(James Green left at 6:15 p.m.) 

The motions were withdrawn by Steve Brown rescind and Marilyn 

Stout to withdraw her second to the motion to require 75% 

attendance at the meeting and if there is an absence the Chairman 

makes the decision of the excuse. 

A motion was made by Steve Brown to have the Chairman, Jim 

Humphrey, and Cathy Stephens bring any necessary 

recommendations to this Board. The motion was seconded by 

Donald Brown and it carried with no opposition. 

A motion was made by Nancy McGovern to approve change to the 

Finance Meeting from November 17, 2011 to November 10, 2011 

(Exhibit 16). The motion was seconded by Chris Hansen and it 

carried with no opposition. 

Richard Akin, 

Jim 

Humphrey, 

and Cathy 

Stephens to 

bring back 

suggested 

excused





UP 

NEW BUSINESS 

BOARD OF 

DIRECTORS’ 

REPORT 

AHA CONFERENCE 

DISNEY INSTITUTE 

EVENT PROTOCOL 

Board members to get iPads. He stated that staff labor is #1 and to put this 

agenda together by the Board Staff is tremendous task that utilizes a large amount 

of paper, courier cost as well as toner/ink costs. If there is a Board member who 

does not want an iPad, the Board office could Fed Ex a packet to that particular 

Board member. He said the iPad is light, portable, and you could simply download 

the packet on your iPad and review whenever you want. Wi fi and connectivity will 

be used, and the support will be from our own IT department and Apple support as 

well as we can all help each other. Don stated that the manager at Apple has 

offered to do private training for us. 

Questions arose about putting personal email on it, and it was determined it will be 

in a separate mailbox not subject to Sunshine Laws. Don Brown said currently, the 

iPads are used by Sarasota Hospital, Dartmouth Hitchcock in New Hampshire, The 

Sanibel City Council. Edison, and several private banking companies. Don 

proposed to use 16g pad. Apple stated that they will give a 2% discount. A cover 

will be needed to keep it safe and secure. We will need a few applications to 

underline and circle words. Chris Hansen asked about Apple Care for the safety of 

the iPad. Mike Smith reviewed the software and will make sure it works for the 

Board. The bigger issue is receiving information about patients and we need to 

make sure the device is secure. It must have password protection to secure 

anything on patient information. Don asked for approval of the iPad project to 

include eleven iPads for Board Members and Cathy Stephens, Board 

Administrator. 

None at this time 

A. AHA Conference (Exhibit 17) 

Marilyn gave an update on the recent AHA conference and shared information 

about the false claims act and what the attorneys discussed about Medicare 

payments as it was an interesting session. They talked about the 

speakers that would be coming for 2012. Chris Hansen stated that we heard 

presentations about how the federal government is relying heavily upon filing 

false claims in hopes that hospitals will negotiate to pay settlements to avoid a 

more costly legal defense. there is a heavy reliance laying on false claims. Steve 

Brown stated that he found the conference amazing and interesting. 

B. Disney Institute 

Marilyn attended the Disney Leadership Institute conference and she will leave the 

book at the Board office for anyone who would like to review it. 

Marilyn stated that the Board is not always following a protocol as to be invited to 

events and she talked to Cathy Stephens about this and she agreed. 

Jim Nathan stated that through the years there have been various events where 

Elected officials need to be present; such as LMHS Board. Richard Akin asked 

for a resolution for Cathy Stephens to be included in all the event planning. 

Richard Akin asked if we passed this resolution that Cathy can be officially 

included so that the Board can be considered to attend events. Jim Nathan said 

that between Sally Jackson and her assistant, Toni Wengel, that there are many 

community events and we can get communications out to make it workable with 

A motion was made by Chris Hansen to approve the change to the 

Planning Meeting from October 6, 2011 October 20, 2011 (Exhibit 

16). The motion was seconded by Diane Champion and it carried 

with no opposition. 

A motion was made by Donald Brown to approve the iPad project 

purchasing eleven iPads. The motion was seconded by Nancy 

McGovern and it carried with no opposition. 

(Nancy McGovern left at 6:45 p.m.) 

A motion was made by Marilyn Stout as a Board directive to establish 

notifying the Board Office of any LMHS or community events, so that 

absence 

recommends 

to next 

meeting.





UP 

BOARD 

ADMINISTRATOR 

REPORT 

NEXT REGULAR 

MEETING 

Cathy. 

Richard asked the Board Administrator, Cathy Stephens to give an update on 

recent changes to the Board Office. Discussion ensued regarding establishing 

proper system procedures in the event of any unusual circumstances. 

Cathy Stephens announced the American Lung Association’s Fight for Air Climb 

event (Exhibit 18) and reviewed the Board Calendar for the month of May (Exhibit 

19). 

The next LEE MEMORIAL HEALTH SYSTEM FULL BOARD MEETING is 

PLANNING on May 12, 2011, 4:00 p.m. 

in the Lee Memorial Hospital, Boardroom 


proper protocol of including the Board of Directors first is followed if 

applicable. The motion was seconded by Steve Brown and it carried 


ADJOURNMENT The LEE MEMORIAL HEALTH SYSTEM FULL BOARD MEETING 

was ADJOURNED at 7:20 p.m. 


Minutes were recorded by Laurie Gretten, Executive Secretary/Board of Directors Office 

__________________________________________________ 

Nancy McGovern, RN, MSM 

Board Secretary

LEE MEMORIAL HEALTH SYSTEM BOARD OF DIRECTORS 

FULL BOARD MEETING MINUTES 

Thursday, May 26, 2011 

LOCATION: Lee Memorial Hospital, Boardroom, 2776 Cleveland Avenue, Fort Myers, FL 33901 

MEMBERS PRESENT: Richard Akin, Board Chairman; Linda Brown, MSN, ARNP, Board Vice Chairman; Nancy McGovern, RN, MSM, Board Secretary; Marilyn Stout, Board Treasurer; Steve Brown, M.D., Director; 

Chris Hansen, Director; Donald Brown, Director; Diane Champion, Director; James Green, Director 


OTHERS PRESENT: Cathy Stephens, Board Administrator; Jim Humphrey, Board Counsel; Mary McGillicuddy, Chief Legal Officer; John Wiest, Chief Operating Officer/Business and Strategic Services; Larry 

Antonucci, M.D., Chief Operating Officer/Hospital & Physician Services; Mike German, Chief Financial Officer; Jon Cecil, Chief Human Resource Officer; Charles Swain, Chief Compliance and Internal Audit 

Officer; Scott Nygaard, M.D., Chief Medical Officer Physician Services; Wendy Piascik, Vice President/Patient Care Services/CCH; Kathy Bridge-Liles, Vice President/Women’s and Children’s Services; Thomas 

Presbrey, M.D., Chairman/Physician Leadership Council; Andrea Snyder, Director/Transfer Center; Susan Crowe, Director/Volunteer Services; Diana Sutton, System Director/Nursing; Donna Bradish, 

Director/Volunteer Resources; Mary Lorah, Risk Manager II; David Berger, M.D., Community Representative/Quality & Education; Bill Silverman, M.D., Quality & Education Community Representative; Marliese 

Mooney, Physician Leadership Council Consultant/Planning Community Representative; Cynthia Brasher, System Director Spiritual Services; Mary Briggs, Interim Public Information Officer; Erica McDermott, 

Medical Social Worker/GCMC; Kim Gaide, Ambulatory Operations Manager; Nora Harmon, LMH/HP Auxiliary; Sandy Hiese, Auxiliary; Nancy Stanfield, Auxiliary/GCMC President; Jean Moren, Auxiliary; Bob 

Simpson, LeeSar; Gayle Reynolds, LeeSar; Andy Lynch, LeeSar; Sanford Cohen, M.D./Guest; Frank Gluck, News Press/Reporter; Paul Gesgler, NBC2/Reporter; Daniel Morency, Fort Myers Police Department; 

Todd Gates, Guest; Jean Perkins, Guest; Laurie Gretten, Executive Secretary/Board of Directors 

NOTE: Documents referred to in these minutes are on file by reference to this meeting date in the Office of the Board of Directors 

and on the Board of Directors website at www.leememorial.org/Boardofdirectors, for public inspection. 

SUBJECT DISCUSSION ACTION FOLLOW-UP 

MEETING 


INVOCATION AND 

PLEDGE OF ALLEGIANCE 

PUBLIC INPUT 

RECOGNITIONS 

The Invocation was given by Reverend Cynthia Brasher and was followed by the Pledge of 

Allegiance. 

None at this time 

Jon Cecil recognized Kim Gaide for her leadership of the LMHS Military Support Program in 

its eighth year. Kim gave an update of the support that has been provided in the 8 years, and 

until wartime is over. Several recipients were present also. 

CONSENT AGENDA Richard Akin asked for approval of the Consent Agenda containing the following items: 

A. Risk Management Quarterly Report (Exhibit 2) 

B. Corporate Compliance Quarterly Report (Exhibit 3) 

C. Interlocal Agreements with Lee County EMS (Exhibit 4 ) 

FINANICIAL AND 

STATISICAL REPORT FOR 

APRIL 30, 2011 

Mike German presented the Financial and Statistical Reports for April 30, 2011 (Exhibits 5 & 

6). He gave highlights from April and our current standing. He reviewed the admits, lengths of 

stay, emergency room, surgical volumes, net revenue, adjusting admits. He stated that as we 

head out of season in April our volumes go down. He reviewed total operating expenses and 

next week we will be turning on EPIC at Gulf Coast Medical Center. He stated April has been 

a good month overall, and the month of May you will see some variations with the training of 

EPIC. Chris Hansen thanked Mike for the comparison of all Facilities. 

The LEE MEMORIAL HEALTH SYSTEM 

BOARD OF DIRECTORS FULL BOARD MEETING WAS 

CALLED TO ORDER at 4:08 p.m. 


(James Green arrived at 4:21 p.m.) 

A motion was made by Nancy McGovern to accept the 

Proclamation presented to the Military Support Program 

(Exhibit 1). The motion was seconded by Linda Brown 

and it carried with no opposition. 

A motion was made by Donald Brown to approve the 

Consent Agenda consisting of the following items: 

A. Risk Management Quarterly Report (Exhibit 2) 

B, Corporate Compliance Quarterly Report (Exhibit 3) 

C. Interlocal Agreements with Lee County EMS 

(Exhibit 4 ) 

The motion was seconded by Diane Champion and it 

carried with no opposition. 

A motion was made by Nancy McGovern to accept the 

Financial and Statistical Reports for April 30, 2011 

(Exhibits 5 & 6). The motion was seconded by Diane



BOARD OF DIRECTORS FULL BOARD MEETING MINUTES 

Thursday, May 26, 2011 Page 2 of 3 

SUBJECT DISCUSSION ACTION 

Champion and it carried with no opposition. 

FOLLOW-UP 

GRADUATE MEDICAL Dr. Scott Nygaard presented an update on the Graduate Medical Education Initiative (Exhibit 

EDUCATION 7). He started with acknowledgement of Ben Spence’s work on this program and stated that 

the program will begin on July 1, 2013. He reviewed the key assumptions of this program. He 

said we have grant monies from AHCA for the start up fees. He reviewed the financial 

projections with the revenues, expenses, net contribution, capital, and net cash flow. Linda 

Brown inquired about if our residents be seeing patients in the hospital as well as the 

outpatient setting. Scott replied yes, and they would have elective. Nancy McGovern inquired 

as to physicians they will be working with; will it be physicians in the community or faculty. 

Scott stated it could be either/or; our goal is to announce the program and identify a solicited 

approach. Richard Akin asked for an approval of Scott’s report. Richard Akin acknowledged 

Scott for all the hard work on this program along with Dr. Berger and Dr. Sandy Cohen for 

serving as consultants and keeping this program on track. Dr. Berger also acknowledged 

Scott’s work on this program. 

A motion was made by Linda Brown to approve the 

Graduate Medical Education Program Report (Exhibit 7). 

The motion was seconded by Nancy McGovern and it 

carried with no opposition 

PHYSICIANS 

LEADERSHIP COUNCIL 

(PLC) REPORT 

Tom Presby reviewed the Physicians Leadership Council (PLC) report (Exhibit 8). He 

reviewed the TEVAR (Thoracic Endovascular Aorta Repair) criteria, the requirements of EPIC 

to obtain and maintain Medical Staff appointments. At Gulf Coast Medical Center physician 

orientation for EPIC was reviewed; as well as the HealthPark ICU Physicians assisting in 

coverage. He stated that collegial relationships conference was recently held at the Tarpon 

Point and was well attended. 

RECESS RECESS to Call to Order the following Meetings: 

Lee Memorial Hospital Board of Directors (Provider #10-0012) 

Cape Coral Hospital Board of Directors (Provider #10-0244) 

Gulf Coast Medical Center Board of Directors (Provider #10-0220) 

A motion was made by Chris Hansen to accept the 

Physicians Leadership Council Report (Exhibit 8). The 

motion was seconded by Donald Brown and it carried 


The LEE MEMORIAL HEALTH SYSTEM FULL BOARD OF 

DIRECTORS MEETING was RECESSED at 4:45 p.m. 


RECONVENE The LEE MEMORIAL HEALTH SYSTEM FULL BOARD OF 

DIRECTORS MEETING was RECONVENED at 5:00 p.m. 

by Richard Akin, Board Chairman 

NEW BUSINESS 

FPL EASEMENT 

OLD BUSINESS 

LeeSar Regional 

Service Center 

Board Policy: Proposed 

10.11F: Board Member 

Attendance & 

Compensation 

Jim Humphrey reviewed the FPL Easement at HealthPark Request (Exhibit 9). He stated he 

needed a motion to authorize the Chairman or President to execute an easement in favor of 

FPL over existing utility lines located on the System’s property at 9981 South HealthPark 

Drive. 

Jim Humphrey presented the LeeSar Regional Service Center (Exhibit 10). He said this is an 

update only adding that LMHS will pay for their share of Cook Chill and the cost has 

increased from previous quote. No official action of the Board is required. The last report was 

39 million and it is now up to 41 million. Time is of the essence and we are fortunate that 

there are no delays in appeals or requests for proposals. Bob Simpson said with the 

subcontractors we have seen a lot of hang up with HVAC and electrical. Nancy McGovern 

inquired what information the estimator felt he did not have. Bob stated that he took it as a 

general construction job and not a healthcare construction job. 

Jim Humphrey reviewed the proposed Board Policy 10.11F: Board Member Attendance and 

Compensation (Exhibit 11). He stated that this pertained to the Board member under hospital 

care. He came up with absences such as acute medical care, required to attend a meeting, 

and jury duty. He reviewed the word acute versus chronic illness. He said that with approval 

of these amendments which include hospitalization, it would include compensating Lois, 

retroactively. Nancy McGovern questioned the absence due to death in the family. Jim 

A motion was made by James Green to approve 

authorizing the Chairman or President to execute an 

easement in favor of FPL over existing utility lines 

located on the System’s property at 9981 South 

HealthPark Drive (Exhibit 9). The motion was seconded 

by Linda Brown and it carried with no opposition.



BOARD OF DIRECTORS FULL BOARD MEETING MINUTES 

Thursday, May 26, 2011 Page 3 of 3 

SUBJECT DISCUSSION ACTION FOLLOW-UP 

Humphrey stated that he could add this; but the next steps would be to define “family”. He 

suggested referring to Code of Ethics of Conduct definition. Marilyn Stout stated that she 

feels this policy incorporates what the Board wanted. Steve Brown requested a process be 

developed in the case of an excuse not listed here. Jim Humphrey said if something occurs 


REPORT 

BOARD ADMINISTRATOR 

REPORT 

NEXT REGULAR 

MEETING 

that is not the policy, you could bring it to the Board. Richard Akin asked if there could be 

something included in the policy; if something out of ordinary would seek Board approval. 

Chris Hansen restated the policy and that the Board Secretary should notify the Board 

member not receiving pay. Mr. Humphrey thanked Chris Hansen for his great work on this 

policy. 

Linda Brown attended the Encouraging Collegial Relationships Conference. She 

stated that the majority attending this conference were physicians. She felt truly 

privileged to attend this conference. This is part of Safe Lee safety initiative. It was 

a conference on dealing with colleges who express. It showed you how to deal 

with these behaviors in a professional matter. The participation was wonderful with 

an open discussion involving everyone. There were two speakers that stated we 

were above and beyond what they expected. Linda stated that she was pleased to 

hear this and this was very productive and positive conference. 

Board Scorecard Workshop follow-up was presented by Chris Hansen. He stated 

that Cathy Stephens will be sending out the template. Cathy Stephens gave the 

timeline for the assignment. The homework will give us a chance to review our 

ideas, and then present it to the public. Discussion ensued regarding whether a 

September workshop would be needed to complete this project, response was if 

it’s finished by June 23 rd , no September workshop would be needed. 

Chris Hansen stated he attended the Trauma Survivor Second Chance Award 

Luncheon; where survivors, physicians and medics were recognized. 

Nancy McGovern stated that she apologized missing the meeting on Monday. She 

attended the nurses meeting regarding collegial relationships. She hopes she gets 

to return next year as the nursing liaison. 

Marilyn stated she attended the Quality meeting for Steve Brown. She stated that 

it was a good meeting and she wanted to let everyone know that Disney 

Leadership will be returning in October. 

Cathy Stephens reviewed the June 2011 Calendar (Exhibit 12). Cathy stated that the iPads 

are being put together and she is getting a training session scheduled with Apple and our IT 

department. She stated there was some question to the community members regarding 

packets. Donald Brown stated that they could have them Fed ex, or get them online. Steve 

Brown asked if the community members could get the iPads. Richard Akin stated that the 

Board members should try them first on a trial run and then they can be approved for the 

community members down the road. Donald Brown stated that Chris Hansen, John Wiest, 

and he can assist with training for members. 

The date of the next Lee Memorial Health System Board of Directors Meeting 

QUALITY/EDUCATION is Thurs, June 16, 4:00 pm in the Lee Memorial Hospital Boardroom 

A motion was made by Marilyn Stout to adopt the Board 

Policy 10.11F: Board Member Attendance and 

Compensation as revised (Exhibit 11). The motion was 

seconded by Donald Brown and it carried with no 

opposition. 

ADJOURNMENT The Lee Memorial Health System Board of Directors 

Meeting was ADJOURNED at 5:40 p.m. 



_________________________________________________________________ 


Board Secretary

______________ 


BOARD OF D DI IRECTORS 

ENTITY REPORTING EXECUTIVE SUMMARY 

Please complete with targeted information only, maximum 2 pages. Submit (thru SLC Member) ELECTRONICALLY to 

L Drive Miscellaneous “BOD Presentations” by Noon the Friday before the week you’re scheduled on agenda. 

ENTITY/BUSINESS NAME: ACCESS MEDICAL SOUTH 

DIRECTOR & TITLE: MARJORY MAY REPORT DATE: MAY, 2011 

BUSINESS DESCRIPTION: Durable Medical Equipment 

(DME) provider of wheelchairs, walkers, bedside commodes and hospital 

beds. We specialize in Respiratory Care such as home oxygen and sleep 

therapy and supply replenishment. Equipment is delivered to patients’ 

homes, hospitals and to other healthcare facilities. All patients receive 

education of equipment, safety and a patient and a home assessment is 

performed at every delivery. 

SYSTEM GOAL: Financial Performance 

• Major Accomplishments 

• Scorecard Performance 

o Revenue 

o Profit/Loss 

o Explanation of major variances 

• Key Utilization Trends 

SYSTEM GOAL: Quality 



o LOS Trends 

o Outcome Data 

SYSTEM GOAL: Service 



o Inpatient Satisfaction 

o Outpatient Satisfaction 

SYSTEM GOAL: People 



o Employee Satisfaction 

o Vacancy Rates 

o Personnel Turnover 

Page 1 of 2 

MISSION STATEMENT: Access Medical South is 

committed to assisting individuals in maintaining a high standard of 

health by providing the best quality home medical equipment and 

respiratory services with above standard professionalism, confidentiality 

and assistance to our customers and our community. 

April 2011 YTD 

Budget Actual Prev Yr 

Net Rev $1,657,721 $1,792,941 $1,608,059 

Profit/Loss 117,015 109,870 82,370 

Minority Int 58,507 54,935 41,185 

Charity 48,000 79,469 64,197 

• Net Revenue is above budget by 8.2%. 

• Volumes are up by 10% currently with a census of 500 

oxygen patients. 

• Charity is above budget by 66%. Some non pay patients 

continue on our services for months -- not always just a one- 

time cost or one month service. i.e. oxygen therapy. 

• Bad debt continues to be our priority focus for improvement. 

We should receive payment from the LIP program (Low 

Income Payment) which will help lower our charity costs. 

• Decreased A/R > 115K to 82K. A 29% reduction. 

• Operational costs completely streamlined. 

• Increasing cost of fuel and cost of goods. 

The Joint Commission survey resulted in a “0” RFI 

(requirements for improvement). This is the third survey with 

a perfect score. 

As reported by Press Ganey Patient Perception of Care 

Survey: Overall score is 95%; Likeliness to recommend is 

92% 

Clean claim submissions to Medicare is 99% 

Sleep replenishment program now at 76% compliance. This 

continues to grow with increases to revenue and 

patient/physician satisfaction. 

Soon to be on an automated communication program called 

MedSage to call customers after hours when they are home. 

Access Medical is in its 12 th year! 

50% of Employees at 5 years or more 

20 Full Time Employees 

3 Part Time Employees 

Turnover of 5%. 

2- unexpected resignations due to family circumstances. 

1-termination.

SYSTEM GOAL: Community 



o Market Share 

o Community Preference 

Key Challenges & Opportunities 

• Market Overview 

o Key Competitive Developments 

o Key Legislative or Political Developments 

o Key Technology Developments 

o Potential New Ventures and/or Businesses 

BOD/Forms/Entity Reporting Executive Summary Form revised 6/16/08/cs 

Page 2 of 2 

ECIN reports Access Medical with 85% of DME referrals 

from the LMHS. 

Charity Care at 79K YTD. 

Continue to provide value added services such as no charge 

use of portable concentrators. 

Opportunities in procurement of new contractual 

relationships. 

Possible termination of BC/BS as they unite with Care 

Centrix. 

Competitive Bidding initiating Round 2 includes Ft. Myers 

and Cape Coral for 2012.



ENTITY/BUSINESS NAME: ____Home Heath___ Fiscal Year 2010___________ 

DIRECTOR & TITLE: Cindy Christman, System Director REPORT DATE: May 2011 

BUSINESS DESCRIPTION: Lee Memorial Home Health 

is a non-profit home health agency. The Agency provides nursing 

services as well as physical therapy, speech, occupational therapy, 

medical social work and home health aide services to residents of 

the community. In addition, we also provide Telehealth, Lifeline 

emergency response system and Choices Geriatric Case 

Management Programs 




o Revenue 

o Profit/Loss 






o LOS Trends 








Major Accomplishments - Scorecard Performance 





Major Accomplishments 

Scorecard Performance 

Market Share 

Community Preference 







BOD/Forms/Entity Reporting Executive Summary Form updated 090209/cs 

MISSION STATEMENT: Lee Memorial Home Health 

provides a comprehensive range of innovative, outcomeoriented, 

quality home health care services to residents of the 

community. 

FISCAL YEAR 2010 

Actual Budget Prior Year 

Admissions 3,660 3,820 3,859 

Operating Revenue 9,221,887 9,801,854 9,729,508 

Profit/Loss * 1,054,790 1,187,679 1,400,988 

* Includes charitable care and unbudgeted telehealth expenses 

not covered by Medicare, yet. 

Improved 4 of 12 publicly reported clinical outcomes. One 

outcome is in the top national 20%. Implemented telemonitor- 

ing program decreasing home health’s re-admission rate from 

26% to 22% . Four nursing staff received Certification in 

Telehealth. Ten RN staff received National Wound Care 

Certification. 

Patient Satisfaction annual score was 93.3% for 

Likelihood to Recommend. 

Jonathan Hollander, RN Clinical Manager awarded greatest 

improvement for employee satisfaction. Cindy Vaccarino, DPT, 

Rehab Manager and Laurie Champion, RN, Clinical Manager, 

recognized for President’s Circle Honor. RN Clinical Excellence 

was awarded to Carol Rothman, RN. 

Exceeded volumes to include recertifications from 4% to 12% 

(Medicare episodes). 

Increased referrals over the previous year with the following: 

LPG-4%; Ortho-7%; Surgical-8%; GI-20%; Neurology-15% 

Charitable care increased by 50% over previous year. 

Challenges/Opportunities 

Recruit and retain top performing staff was our biggest 

challenge. Our vacancy rate ran 16.67% for nursing. Continue 

to reduce readmission rate to acute care. Optimize our financial 

performance through business develop opportunities. Continue 

to improve clinical outcomes as well as employee and patient 

satisfaction scores.



Please complete with targeted information only, maximum 2 pages. Submit (thru SLC Member) ELECTRONCIALLY 

to L Drive Miscellaneous “BOD Presentations” by Noon the Friday before the week you’re scheduled on agenda. 

Please limit any necessary applicable attachments to maximum 5 pages 

ENTITY/BUSINESS NAME: Health Park Care & Rehabilitation Center 

DIRECTOR & TITLE: Nancy Zant, Administrator REPORT DATE: June 2011 

BUSINESS DESCRIPTION: 

Health Park Care & Rehabilitation Center is a 112 bed 

skilled nursing facility licensed by both Medicare and 

Medicaid. HPCRC provides rehabilitative, short-term 

as well as long term care services. We provide skilled 

nursing care to both geriatric, as well as younger 

patients who require our rehab services. 




o Revenue 

o Profit/Loss 






o LOS Trends 







Page 1 of 2 

MISSION STATEMENT: Our mission is to be 

the best skilled nursing facility in SW Florida by: 

Ensuring financial viability of HPCRC and updating 

facility to meet the needs of the community. 

Attracting, developing, and retaining highly qualified 

staff to deliver exceptional clinical care and service. 

Developing profitable specialty programs and 

building strong brand loyalty to HPCRC internally 

and externally. 

Net Revenue 

Profit/Loss 

April 2011 YTD 

Budget Actual Prior Year 

$7,267,098 

$1,040,351 

$7,742,776 

$1,299,022 

$6,975,329 

$837,218 

• Actual and prior year profits do not include post 

acute credit. 

• Medicare daily rate increased from $450 prior 

YTD to $514 YTD in 2011. 

• Total net revenue favorable $767,447 as 

compared to prior year. 

• Outstanding financial performance compared to 

prior years and 2011 budget. 

• Bad debt expense 65% under current year 

budget. 

• 5 Star rating AHCA 

• 4 Star rating CMS 

• Person Centered Care Program 

• Dramatic reduction in hospital readmissions 

• No nursing agency in past four years 

• Excellent annual AHCA survey (3 Citations) 

• No citations due to complaint survey action 

• Top Box scores continue to be a challenge, ytd 

57/goal 68.2 

• Increase in System referrals resulting in Market 

Share above other SNF competitors







* 




o Market Share 

o Community Preference 







Page 2 of 2 

• Trifecta Scores 2010 ESS improved over 

prior year 

• Total YTD Turnover 12% 

• Sub Acute/Rehab Unit with outstanding 

reputation 

• RN’s, LPN, C.N.A. students being trained on 

site from Edison, FGCU and Lee VoTech. 

• Hospital readmissions reduced from 15.3% ytd 

2010 to 7.4% 2011 

• Medicaid rate reduction 7/11 approximately 

$13.00 per patient per day 

• IS Capital Projects needed to automate 

medication pass, medical record and capture 

ADL’s for reimbursement (EMar/Sigma) 

• Medicare reimbursement reductions anticipated 

10/11 

• Recruiting timeline for therapists 

• Open up CON to remove Medicaid requirement 

• Facility refurbish project approved/ 4 year plan

Board Meeting 

June 23, 2011 SEI Global Institutional Group 

Peter Glennon 

610.676.3406 

PGlennon@seic.com 

1

Agenda 

Executive Summary 

Market & Economic Review 

- Market Review 

- Portfolio and fund performance 

- Outlook 

Fixed Income Market 

Asset Allocation 

Appendix 

2

Executive Summary 

As of 3/31/2011 

• The portfolio returned 2.2% for calendar year Q1 and 6.0% for Fiscal YTD, ending market value was 

$485,016,922. 

Q1 Market Review 

• Markets ended in positive territory after rebounding from impact of external shocks. 

• All asset classes posted positive returns. Equities outperformed bonds. 

Q1 Strategy Review 

• Most strategies outperformed benchmark for Q1 2011. 

• Most strategies outperformed benchmark for the past year. 

• There were 2 manager changes within LMHS’s portfolio. 

Q2 Market/Economic Outlook 

• Despite recent pullback, we think global equities will continue to work their way higher. 

• We have adopted a more neutral view toward emerging markets—both debt and equity—as inflation 

pressures push governments to tighten. 

SEI provided LMHS with fee reductions in Q1 2011 resulting in annual savings of $320,000. Additionally SEI has agreed to 

contribute $45,000 per year to LMHS Foundation. To date, SEI has contributed a total of $190,000 to LMHS Foundation since 2008. 

3

FOR INTERNAL USE ONLY 

Market & Economic Review 

4

Global Market Review 

External Shocks Temporarily Test Markets 

• 2011 outlook unchanged: 

• Moderate expansion with upside 

surprises is likely. 

• Inflation will be benign near term in 

developed markets. 

• Headwinds remain from 

deleveraging, sovereign debt 

concerns, employment, housing, 

emerging markets inflation and oil 

prices. 

• External events in February and March 

tested the markets; most markets rose for 

the quarter. 

• Shocks from Japan and Middle 

East/North Africa (MENA) created a 

temporary flight to safety. 

• After encouraging economic and 

company data in Q1, recent economic 

reports have shown some weakness due 

to transitory factors (supply chain 

disruption and impact of higher energy 

prices on confidence). 

U.S. Large Cap 

U.S. Small Cap 

International Equity 

Emerging Mkts Equity 

U.S. Inv Grade Bonds 

High Yield 

Emerging Markets Debt 

Treasury 

Inflation Linked 

Financial Markets Performance 

Selected Markets Q1, Q2 QTD and One Year 1 

Real Estate 

‐5 0 5 10 15 20 25 30 

1 Year as of 3/31 Q1 2011 Q2 QTD as of 5/31 

U.S. Large Cap = Russell 1000, U.S. Small Cap = Russell 2000, Real Estate = Wilshire RESI Index, International Equity = MSCI EAFE, Emerging Markets Equity = MSCI EME, U.S. 

Investment Grade Bonds = Barclays Capital U.S. Aggregate, High Yield = BofA ML Master II HY Constrained, Emerging Markets Debt = JP Morgan EMBI Global Diversified, Treasury = 

Treasury component of the Barclays U.S. Aggregate, Inflation Linked = Barclays 1-10 Year TIPS 

1 Source: SEI, Factset 

5

Asset Allocation & Performance Summary as of 3/31/2011 


US Equity 

Int Equity 

Fixed Income 

Cash & Equivalents 

Hedge Funds 

Real Estate 

TOTAL 

TOTAL PORTFOLIO RETURNS 

Enhanced Libor 

8.1% 

Sep FI Acct 

5.5% 

Core Fixed Income 

12.5% 

Cash 

10.5% 

1 Month 

0.4% 

Target Allocation 

17% 

5% 

43% 

11% 

21% 

3% 

100% 

3 Month 

2.2% 

Disciplined Equity 

7.6% 

Ultra Short 

16.1% 

Actual Allocation 

18% 

6% 

42% 

11% 

21% 

3% 

100% 

FYTD 

6.0% 

S&P Index 

7.5% 

Special Sits 

4.4% 

$ 

$ 

$ 

$ 

$ 

$ 

$ 

1 Year 

8.0% 

Small-Mid Cap 

3.1% 

Hedge 

16.0% 

Value 

87,910,837 

27,489,573 

203,889,937 

51,420,593 

99,305,982 

15,000,000 

485,016,922 

2 Year 

12.6% 

World Eq exU 

5.7% 

Core Prop 

3.1% 

ITD* 

-1.2% 

*Inception date 9/30/2007 

6

Debt Covenant Requirement Pool Composite 

Assets Bond Characteristics as of 3/31/2011 

Fund Returns 

Asset 

3/31/11 

Mkt Value 

Pct Credit Quality Duration Current Yield 

Yield to 

Maturity 

LMHS FYE 10 - 

3/31/11 

2011 YTD (3/31/11) 

Prime Obligation $38,937,813 18.0% AAA 0.11 0.09 0.09 0.05 0.02 

Core Fixed $60,396,983 28.0% AA 4.40 4.65 3.56 0.39 1.05 

Logan Circle $26,658,207 12.3% AA- 0.38 1.97 0.61 

Ultra Short $77,928,300 36.1% AA 0.66 2.42 1.62 1.07 0.69 

Compass Assets * $12,135,246 5.6% 0.34 0.08 

Total $216,056,549 100.0% AA+ 1.63 2.58 1.77 0.60 0.63 

* Compass Returns reflect holding period returns 

Scale 

AAA 5.0 

AA 4.0 

A 3.0 

BBB 2.0 

BIG 1.0 

Prime Obligation 1.0 AAA 

Core Fixed 1.2 AA 

Logan Circle 0.5 AA 

Ultra Short 1.5 AA 

Weighted Rating 4.2 AA+ 

AAA 19.1% 

AA 80.9% 

Total 100.0% 

Ultra Short 

36.1% 

Compass 

Assets 

5.6% 

Logan 

Circle 

12.3% 

Prime 

Obligation 

18.0% 

Core Fixed 

28.0% 

AA 

80.9% 

AAA 

19.1% 

7

Debt Covenant Requirement Pool 

Debt Covenant Summary March 31, 2011 

Prime Obligation 18% 38,937,813 

Compass Bank 6% 12,135,246 

Ultra Short 36% 77,928,300 

Core Fixed Income 28% 60,396,983 

Logan Circle 12% 26,658,207 

Total 100% 216,056,549 

Target (Required Covenant) 200,000,000 

Surplus/(Deficit) 16,056,549 

Current Target Ratio 108.0% 

Range Levels 

Maximum Target 110.0% 220,000,000 

Minimum Target 90.0% 180,000,000 

8

Fund Performance 

First Quarter 2011 

Fund SEI (%) Index (%) Reason 

Disciplined Equity 6.34 5.92 Benefited from Libor Plus and security selection within Energy 

S&P 500 Index 

Logan Circle FI Account 

-1.18 

0.3 

-1.13 

Small / Mid Cap 7.81 8.70 Poor security selection within Industrials, Energy and Financials 

World Equity ex-US 3.82 3.41 

Core Fixed Income 1.05 0.42 

Enhanced LIBOR 

Opportunities 

Ultra Short Bond 

Offshore Opportunity II* 

Special Situations* 

1.45 0.08 

0.69 

1.74 

1.87 

0.15 

0.1 

0.05 

0.05 

* Hedge fund returns are shown net of all fees. Special Situations returns assume 1.15% mgmt fee. 

Strong security selection within IT, Materials and Health Care; 

underweight Japan 

Benefited from overweight to non-agency MBS and security selection in 

corporate bonds 

Tightening spreads for non-agency MBS and allocations to Bank Loans 

were additive 

Allocations to ABS and Credit contributed to relative performance 

All four strategies contributed positively; led by Event-Driven 

Event-Driven and Relative Value were main contributors to performance 

Performance data quoted is past performance. Past performance is no guarantee of future results. The principal value and investment return of an 

investment will fluctuate so that shares, when redeemed, may be worth more or less than their original value. Current performance may be higher or lower. 

For performance data current to the most recent month end, please call 1-800-DIAL-SEI. 

9

Fund Performance 

One-Year Period Ending March 31, 2011 

Fund SEI (%) Index (%) Difference 

Disciplined Equity 15.44 15.65 -0.21 

Small / Mid Cap 24.34 26.12 -1.78 

World Equity ex-US 15.41 13.15 2.26 

Core Fixed Income 7.77 5.12 2.65 

Enhanced Libor Opportunities 6.10 0.36 5.74 

Ultra Short Duration Bond 

Offshore Opportunity II Fund* 

Special Situations* 

2.62 

4.88 

6.65 

* Hedge fund returns are shown net of all fees. Special Situations returns assume 1.15% mgmt fee. 

Performance data quoted is past performance. Past performance is no guarantee of future results. The principal value and investment return of an investment will 

fluctuate so that shares, when redeemed, may be worth more or less than their original value. Current performance may be higher or lower. For performance 

data current to the most recent month end, please call 1-800-DIAL-SEI. 

0.60 

0.16 

0.16 

2.02 

4.72 

6.49 

10

Asset Allocation & Performance Summary as of 5/31/2011 


Target Allocation Actual Allocation 

Value 

US Equity 

18% 

19% $ 

91,400,121 

Int Equity 

5% 

6% $ 

28,754,908 

Fixed Income 

46% 

44% $ 

208,625,863 

Cash & Equivalents* 

5% 

6% $ 

26,755,365 

Hedge Funds 

23% 

21% $ 

100,384,740 

Real Estate 

3% 

3% $ 

15,307,800 

TOTAL 

100% 

100% $ 

471,228,797 

* SEI no longer holds a large money market position for LMHS. In mid-May, $32,000,000 of money market was transferred from SEI. 

TOTAL PORTFOLIO RETURNS 

Enhanced Libor 

8.6% 

Sep FI Acct 

5.7% 


13.1% 

1 Month 

0.0% 

Cash 

5.6% 

Ultra Short 

17.0% 

3 Month 

1.6% 

Disciplined Equity 

8.1% 

FYTD 

7.2% 

S&P Index 

8.0% 

Special Sits 

4.6% 

1 Year 

10.0% 

Small-Mid Cap 

3.3% 

Hedge 

16.7% 

2 Year 

10.1% 

World Eq exUS 

6.1% 

Core Prop 

3.3% 

ITD* 

-0.8% 

*Inception date 9/30/2007 

11

Manager Changes 

First Quarter 2011 

Fund Manager Addition and Rationale Manager Termination and Rationale 

World Equity 

ex-US 

Small/Mid 

Cap 

Principal Global (Q1) – Primarily for portfolio 

restructuring purposes, termination will remove 

overlapping alpha sources and reduce correlations 

among investment managers. 

Wells Capital (Q1) – Primarily due to concerns with 

the manager's key personnel, as majority of growth 

team has resigned to start their own firm. Assets 

redistributed in Fund among existing managers in a 

fashion that will maintain our intended risk/return 

characteristics. 

12

SEI’s representative investment strategies 

Domestic Equity 

• S&P 500 Index Strategy 

State Street Global Advisors – Passive 

• US Managed Volatility Strategy 

Aronson Johnson Ortiz 

Analytic Investors 

LSV Asset Management* 

• US Large Cap Strategy 

Aronson Johnson Ortiz – Relative Value 

Brown Investment Advisory, Inc. - Growth 

Delaware Investments – Emerging Growth 

LSV Asset Management* – Contrarian Value 

Neuberger Berman – Quality Growth 

Legg Mason – Growth 

Legg Mason – Core 

Quantitative Management Associates – Quantitative Core 

WestEnd Advisors – Core 

• US Large Cap Disciplined Equity Strategy 

Analytic Investors – Dynamic Positioning 

INTECH – Volatility Capture 

Lazard Asset Management – Large Cap Value 

Quantitative Mgt Associates – Bias Exploitation 

Declaration Management & Research – Enhanced Cash 

Hyperion Brookfield Asset Management – Enhanced Cash 

GE Asset Management – Core Growth 

• US Small/Mid Cap Equity Strategy 

Allianz Global Investors Capital, LLC – Growth 

Century Capital Management - Growth 

Integrity Asset Management – Opportunistic Value 

Janus Capital Management – Quality Growth 

LA Capital Mgmt - Factor Rotation 

Lee Munder Capital Group – Relative Value 


Robeco Investment Management– Value 

Security Capital – REIT 

Wellington Management Company LLP – GARP 

Wellington Management Company LLP – Growth 

William Blair and Company, LLC – Relative Value 

• Cash Management Strategies 

Money Market Funds 

Custom Separate Accounts 

• US Small Cap Strategy 

AQR Capital Mgmt. – Quantitative 

Artisan Partners – Deep Value 

JP Morgan Investment Management - Growth 

Janus Capital Management – Quality Growth 

Lee Munder Capital Group – Relative Value 

LA Capital Management – Factor Rotation 


Allianz Global Invetors Capital, LLC – Relative Growth 

Security Capital – REIT 

Robeco Investment Management – Emerging Value 

Wellington Management Company LLP – GARP 

William Blair and Company, LLC – Relative Value 

• Real Estate Strategy 

Security Capital Management – REIT 

Wellington Management Company – REIT 

International Equity 

• World Equity ex US Strategy 

Acadian Asset Management – Quantitative 

Artisan Partners – Emerging 

JO Hambro Capital Management – International Growth 

McKinley Capital Management – Growth 

NFJ Investment Group - Contrarian 

Quantitative Mgt Associates – Quantitative Core 

Thornburg Investment Management – Value 

• Emerging Markets Equity Strategy 

Artisan Partners – Emerging 

The Boston Company Asset Management – Emerging Value 

Delaware Investments - Emerging 

JO Hambro Capital Management – International Growth 

Lazard Asset Management – Value 

Neuberger Berman - GARP 

PanAgora Asset Mgt. Company – Emerging 

• Dynamic Asset Allocation Strategy 

Goldman Sachs 

Credit Suisse 

Fixed Income 

Sub-Adviser Diversification as of April 2011. 

*SEI Investments has a 42% minority ownership interest in LSV Asset Management as of December 31, 2010. 

• GNMA Strategy 

Wellington Management Company LLP 

• Stable Value Strategy 

Dwight Asset Management 

• Real Return Strategy 


• US Core Fixed Income Strategy 

JP Morgan Asset Management – Value 

Jennison Associates - Core Fixed Income 

Western Asset Management – Sector Rotator 

Metropolitan West Asset Management – Value 

Wells Capital Management – Strategic Value 

• US Core Fixed Income Plus Strategy 

80% US Core Fixed Income Strategy 

10% High Yield Strategy 

10% Emerging Debt Strategy 

• Long Duration Bond Strategy 

Metropolitan West Asset Management – Opportunistic 

Jennison Associates – Long Duration 

Income Research & Management – Long Duration 

• High Yield Fixed Income Strategy 

Ares Management LLC – Opportunistic 

Brigade Capital Management, LLC – Opportunistic 

Delaware Investments – Fundamental 

Guggenheim Investment Management, LLC – Relative Value 

JP Morgan Asset Management – Relative Value 

• Emerging Markets Debt Strategy 

Ashmore Inv Mgmt. Ltd – Emerging Mkts Debt 

ING Investment Management – Opportunistic Emerging Debt 

Stone Harbor Investment Partners – EMBI Global 

• Short and Intermediate-Term Gov’t Strategies 


• Alternative Investments 

Hedge Fund Strategies 

Private Equity Strategies 

Structured Credit Strategies 

13

Inflation 

Benign in the Near Term 

Core Inflation Below Target… 

While Labor Costs still Depressed 1 

• Core inflation is up modestly off of historic lows. 

• Food and energy inflation is a relatively small component in core inflation. 

• Unit labor costs are much more important to generalized inflation and remain very depressed. 

• Broad money supply is still expanding slowly as commercial and industrial loan growth is muted. 

1 Source: Datastream, SEI 

14

SEI Outlook 

Sustainable Economic Expansion; Inflation Not a Near-Term Threat 

• GDP continues to grow in a 

sustainable expansion 

• Employment growth has been 

trending upward, and there is 

substantial room for additional 

growth. 

• Investor inflation expectations 

revert to “normal” levels (2.0 – 

2.5%). 

– Recent uptick from oil price 

volatility 

1 

Source: Datastream, SEI 

2 

Source: Ned Davis Research, SEI 

15

SEI Outlook and Positioning 

Asset Allocation as of May 31, 2011* 

Asset Class Outlook 

• We maintain a favorable outlook for equities 

versus fixed income. 

• Despite recent pullback, we believe the drivers 

to be transitory and that equity market 

fundamentals remain intact. 

• Total-return opportunity for bonds is limited 

given the low level of interest rates and 

normalization of spreads. 

• Interest rates will continue to be range-bound in 

the near term. 

• High-yield bonds remain a preferred asset 

class due to strong fundamentals and receptive 

capital markets. 

• We hold a more neutral view toward emerging 

markets—both debt and equity—as inflation pressures 

push governments to tighten. 

• Inflation is not a short-term threat in the developed 

world, but remains a tail risk in the longer-term. 

• Valuation of Treasury Inflation-Protected Securities is 

still not compelling. 

Asset Class Action 

• Overweight equities versus U.S. Treasuries and core 

fixed income. 

• Remain overweight to high-yield bonds relative to 

core fixed income. 

• Reduced overweight to neutral in emerging market 

debt. 

• Maintain no allocation to TIPS. 

*12-month timeframe for outlook 

16


Equities and Fixed Income as of March 31, 2011* 

Equity Outlook 

• Continued economic expansion combined with 

attractive valuations and the low inflationary 

environment should support equity markets. 

• Emerging markets remain a favored region long 

term, but a short-term risk as economies slow. 

• Alpha-source leadership should rotate to security 

selection. Macro should also be an important 

contributor. 

Fixed-Income Outlook 

• Total-return opportunity is limited given the 

potential for rising rates and low income levels. 

• Excess return will be driven primarily by yield, 

along with modest spread compression. 

Equity Action 

• Added to Japan exposure on weakness, but 

remain underweight. 

• Portfolios are generally positioned for a procyclical 

environment. 

• Portfolios remain positioned for better bottom-up 

security selection environment as stock 

correlations have begun to recede. 

Fixed Income Action 

• We are maintaining an overweight to spread 

sectors (particularly non-agency mortgagebacked 

securities). We modestly reduced 

overweight to corporates as spreads tightened. 

• We reduced allocations to opportunistic, highertracking-error 

managers. 

*12-month timeframe for outlook 

17


Hedge Funds as of March 31, 2011* 

Hedge Fund Outlook 

• Declining dispersion in equity space continues to 

challenge Equity Hedge strategies. 

• Levels of economic fundamentals’ dispersion has 

decreased modestly across countries and 

regions. We expect that focus on inflationary 

dynamics will create increasing directional and 

relative value opportunities in fixed income and 

currencies 

• Opportunities in equity-focused, event-driven 

strategies remain fertile, particularly in North 

America, where companies are in need to 

maximize shareholder value in a low growth 

environment, and Asia, with confirmation of 

growth prospects and transformation of 

ownership structures. 

Hedge Fund Action 

• While we have reduced the overall portfolio 

allocation to the Equity Hedge strategy space, we 

have upgraded the existing manager lineup by 

replacing long-term, fundamentally-oriented 

equity long/short strategies with managers that 

rely on a wider range of alpha sources. 

• We remain favorable to discretionary global 

macro strategies and relative value-oriented 

managers, especially in debt and currency 

markets. 

• We continue to increase exposure to eventdriven 

strategies in both corporate 

transformational and capital structure arbitrage 

strategies globally, with a particular emphasis on 

North America and Asian specialists. 

*12 month timeframe for outlook 

18


Fixed Income Market 

Review & Outlook 

19

The Bond Investor’s Dilemma 

Historically Low Yields 

4.5% 

4.0% 

3.5% 

3.0% 

2.5% 

2.0% 

1.5% 

1.0% 

0.5% 

0.0% 

Source: Bloomberg 

0.12% 

0.05% 

0.26% 

0.16% 

Treasury Yield Curve 

0.59% 

0.47% 

0.99% 

0.78% 

2.01% 

1.70% 

3.29% 

3.06% 

3 Month 1 Year 2 Year 3 Year 5 Year 10 Year 30 Year 

9/30/2010 12/31/2010 5/31/2011 

• Rates fall as recent weak economic data calls the modest recovery into question. 

• The Japanese Earthquake caused supply chain disruptions while Middle East unrest 

helped trigger higher gasoline prices. 

• Disentangling these effects on economic growth has been problematic for market 

participants, resulting in increased uncertainty and a flight to quality. 


4.33% 

4.22% 

20

4.00 

3.75 

3.50 

3.25 

3.00 

2.75 

2.50 

2.25 

Treasury Market Offering Less Value 

Financial regulation 

uncertainty 

Dec‐09 Jan‐10 Mar‐10 Apr‐10 May‐10 Jun‐10 Jul‐10 Aug‐10 Sep‐10 Oct‐10 Nov‐10 Dec‐10 Jan‐11 Feb‐11 Mar‐11 Apr‐11 May‐11 Jun‐11 


European sovereign 

debt concerns 

10-year Treasury yield 

US economic 

momentum and 

deflation concerns 

Jackson Hole 

QE2 

Announced 

Improving 

economic 

data 

N. Africa and 

Middle East crisis 

Earthquake/tsunami in 

Japan 

21

Interest Rate View 

• Our view has been and continues to be that this interest rate cycle will take longer to play out then those in the 

past. 

• The Fed’s exit strategy is more complex , so a focus on the Fed Funds Rate is not as meaningful this cycle. 

• 2 Trillion dollar balance sheet needs to be managed. 

• When the Fed acts, their first move is likely to be a suspension of their reinvestment of mortgage pay-downs 

and coupon interest. 

• This could be followed by either a rate hike or asset sales into the market. 

• Likely outcome is a rate hike sometime in 2012. Street predictions on timing vary widely. 

• The Fed is biased to keep rates low longer, rather then remove accommodation too soon. 

Economic headwinds persists: 

High Unemployment 

Low Capacity Utilization 

Housing 

Deleveraging 

Gasoline prices 

State/Local and eventual Federal Austerity 

2009 Fiscal stimulus has run its course 

Extraneous shocks (MENA, Europe) 

• Balancing Fiscal Austerity with eventual Fed tightening is a challenging position prone to accidents. 

• Recent data has called into question the timing of the Fed’s next move and even raised the possibility of more 

accommodation, either via fiscal or monetary policy. 

22

U.S. Fixed-Income Sector Performance vs. Treasuries 

2.5 

2.0 

1.5 

1.0 

0.5 

0.0 

-0.5 

Barclays 

Agg 

Agencies Agency 

MBS 

Excess Return Relative to Treasuries(%) 

Corporates Corp - 

Financials 

ABS Credit 

Card 

Q1 2011 Q2 2011 (QTD) 

ABS Auto CMBS 

Source: Barclays Capital 

23

700 

600 

500 

400 

300 

200 

100 

0 

Spread Levels Are Normalizing but Volatility has increased in Q2 

42 

34 

47 

57 

146 

135 

132 95 

Yield Spread Levels (in Basis Points) 

88 

66 57 85 68 58 

65 67 

* Agency MBS spreads tightened 45 bps in Q4 2010 due primarily to the Barclays Capital prepayment mortgage model change. 

** ABS Home Equity Loan data is from Barclays through November, 2009 and is the OAS of the non-Agency MBS holdings in the SIIT Core Fund for March 31, 

2010 and June 30, 2010. 

*** 20 Year Median OAS calculated based on monthly data beginning 12/31/1991 for ABS -Auto and ABS- Credit Card . CMBS OAS data begins 6/30/1999. 

686 

549 

519 

Agency MBS* Corporate ABS Credit Card ABS Auto Loan ABS HEL 

(FRN)** 

Dec-10 Mar-11 May-11 20 Year Median OAS 

254 

219 

216 

CMBS 

111 

Sources: Barclays Capital, BlackRock Solutions 

24

Financials: Smaller Overweight but still Constructive 

800 

600 

400 

200 

0 

Barclays Index Corporate Bond Spreads (in bps) 

Invest. Grade: Utility ‐ OAS Invest. Grade: Industrial ‐ OAS Invest. Grade: Financial Institutions ‐OAS 

Source: Barclays Capital 

• Historical valuations are attractive. 

• Regulatory reform means less levered balance sheets and better transparency. 

• “Too Big To Fail” regime has not yet arrived, which favors large institutions. 

• Business model requires tighter spread levels. 

25

Residential Housing Price Expectations 

2Q-2012 1Q-2011 1Q-2012 2H-2011 3Q-2011 4Q-2012 3Q-2012 4Q-2012 

• Many economists and managers expect continued housing price declines. 

• Non-agency mortgage-backed securities (MBS) offer value even under these stress scenarios. 

Sources: SEI, BofA, CITI, CS, Barclays, DB, GS, BIM 

26

SEI Adapts Portfolios to the Changing Market Environment 


100% 

80% 

60% 

40% 

20% 

0% 

Jun‐09 

Jul‐09 

Aug‐09 

Sep‐09 

Oct‐09 

Nov‐09 

Dec‐09 

Manager weights in SIIT Core Fixed Income 

Jan‐10 

Feb‐10 

Mar‐10 

Apr‐10 

Jennison (14%) JP Morgan (17%) Wells (25%) MetWest (22%) Western (22%) 

• The active SEI decision following the fixed-income market recovery in 2009 was to increase 

exposure to lower-volatility managers that emphasize security selection. 

• SEI diversified the manager lineup by adding JP Morgan and Jennison, focusing on selection 

managers with a high-quality bias. 

• SEI reduced risk within the Fund by decreasing the allocation to high tracking-error managers 

(e.g., Western, MetWest), and managers further reduced risk by reducing allocations at the 

margin to non-Treasury sectors (e.g., corporates). 

May‐10 

Jun‐10 

Jul‐10 

Aug‐10 

Sep‐10 

Oct‐10 

Nov‐10 

Dec‐10 

Jan‐11 

Feb‐11 

Mar‐11 

Sources: SEI, BlackRock 

27

Fixed Income Fund Scenario Analysis 

Performance Sensitivity to Changes in Interest Rates 

As of 3/31/2011 

Duration 

• Rising rate scenarios assume parallel yield curve shifts. 

• Returns assume no changes in yield spreads 

• Real Return scenarios assume 2.50% CPI 

SEI Est. 

Return* 0 +50 bps +100 bps +200 bps 

Core Fixed Income 4.40 years 2.0% - 3.0% 3.56% 1.36% -0.84% -5.24% 

Enhanced Libor Opportunities 0.37 years 4.0% - 5.0% 3.37% 3.44% 3.52% 3.79% 

Ultra Short Bond 0.66 years 2.0% - 2.5% 1.62% 1.29% 0.96% 0.30% 

Short Duration Government 1.77 years 1.0% - 1.5% 1.21% 0.33% -0.56% -2.33% 

Real Return 2.91 years 1.5% - 2.0% 2.75% 1.30% -0.16% -3.07% 

* SEI Estimated Absolute Returns: These are estimates based on the SEI fixed income team’s expectations for 2011 and are by no means certain forecasts 

of returns. The team assumed that the Fed would not raise the Fed Funds rate, but that Intermediate Treasury yields may rise by roughly 50 bps. Spread 

contraction is expected in the corporates, asset-backed, and non-agency sectors and agency mortgage spreads would be little changed. 

28



29

Portfolio Allocation and Statistics 

Asset Class Total Portfolio 

Debt Covenant 

Pool 

LMHS w/out Debt 

Covenant Pool 

Disciplined Equity 7.3% 0.0% 13.1% 

Small/Mid Cap Equity 2.5% 0.0% 4.5% 

World Equity Ex US 5.0% 0.0% 8.9% 

US Core Fixed 12.8% 28.0% 0.0% 

Special Situations Fund 4.6% 0.0% 8.2% 

Hedge Fund of Funds 17.4% 0.0% 31.2% 

US Ultra Short Bond Fund 17.0% 36.1% 0.0% 

Core Property Fund 3.0% 0.0% 5.4% 

Enhanced Income 8.7% 0.0% 15.6% 

S&P 500 Index Fund 7.3% 0.0% 13.1% 

Cash (Libor 3mo) 8.3% 23.6% 0.0% 

Logan Circle Partners 6.0% 12.3% 0.0% 

Total 100% 100% 100% 

Total Equity Exposure 22.1% 0.0% 31.2% 

Standard Deviation 5.0% 2.6% 8.2% 

Expected 1 Year Return 

Risk of Loss (5th percentile or 2 Standard 

6.2% 3.4% 7.9% 

Deviations) 1 Year -1.8% -0.8% -4.7% 

Sharpe Ratio 0.31 0.34 0.42 

30

Return Distributions and balances over time 

6.2% 

31

Distributions of Fund Value and actual balances over time 

32


Appendix 

33

The Current Environment for Healthcare Organizations 

As the healthcare sector continues to change, accessing capital will become increasingly difficult due to a 

variety of reasons including uncertainty stemming from healthcare reform, reduced availability of financing 

options, and the uncertainty around the municipal market created by state and federal deficits. 

Healthcare providers could face any of the following revenue impacts: 

• Intense funding pressure could weigh on Medicare and Medicaid in light of state and federal deficits, 

program funding reductions and newly passed healthcare reform. 

• Higher unemployment could continue to be a drag on hospitals putting pressure on bad debt expense 

with growing levels of uncompensated care and flat volume trends. 

• Healthcare reform will put added pressure over the next few years to reduce Medicare rates coupled 

with lower rate increases from commercial payers. 

• At its core, healthcare reform offers the promise of health insurance coverage for a vast number of the 

currently uninsured population – estimated at 32 million new Medicaid enrollees by 2014. 

In addition, healthcare providers will likely also face any of the following impacts related to accessing 

the capital markets: 

• Reduced availability of financing options relating to available supply of letters of credit for variable rate 

deals, auction rate market failure and widening credit spreads. 

• Fewer deals that are based on underlying credit as a result of the collapse of the bond insurance 

market. 

• Banks need for higher capitalization and overall risk reduction. 

• Competition with the overall bond market supply while also carrying the perception of being the riskiest 

sector of the market. 

34

2011 Priorities for Healthcare Finance Executives 

With the above pressures as a backdrop, healthcare finance executives identified their top ten 

organizational priorities in 2011: 

1. Evaluate local healthcare environment 

2. Attempt to decrease volatility by increasing portfolio diversification via new asset classes 

3. Increase spending on health information technology (IT) 

4. Address risks associated with new payment models 

5. Increase cash reserves to strengthen the balance sheet 

6. Find ways to best make asset allocation decisions in conjunction with organizational finance 

decisions 

7. Make asset allocation changes focused on downside risk protection 

8. Add or Increase allocation to inflation protection strategies 

9. Implement an asset allocation process aimed at exploiting shorter term market inefficiencies to add 

return and/or mitigate risk 

10. Define investment management fiduciary responsibilities for trustees and investment consultants 

SEI Financial Management Research Panel; Quick Poll February 2011 

35

Historical and current Healthcare yields 

AHERF 

Peak of credit crisis 

Correlations to MMD 

A 98.4% 89.4% 76.7% 

BBB 96.6% 89.1% 57.0% 

36

Historical Medical care and Consumer Price Index 

Source: Bureau of Labor and Statistics 

37

Healthcare CPI Summary 

38

Medical care and Consumer Price Index Components 

Medical care Index - Medical care commodities and 

medical care services. 

Medical care commodities 

•Medicinal drugs 

•Prescription drugs 

•Nonprescription drugs 

•Medical equipment and supplies 

Medical care services 

Professional services 

•Physicians' services 

•Dental services 

•Eyeglasses and eye care 

•Services by other medical professionals 

Hospital and related services 

Hospital services 

•Inpatient hospital services 

•Outpatient hospital services 

•Nursing home and adult day care services 

•In home care 

Health Insurance 

Medical Care 

Services Index 

Total Medical 

Care Index 

Consumer Price Index – Major expenditure categories 

with relative weights based on 2009 data 

Expenditure Weight (%) 

•Food and beverages 14.8 

•Housing 42.0 

•Apparel 3.7 

•Transportation 16.7 

•Medical care 6.5 

•Recreation 6.4 

•Education and communication 6.4 

•Other goods and services 3.5 

Total 100.0 

Source: Bureau of Labor and Statistics 

39

______________ 


BOARD OFF DIIREECTTORS 

RECOMMENDED ACTION FOR BOARD APPROVAL 

(Action includes Acceptance, Approval, Adoption, etc) 

Keep form to one page, SUBMIT (thru SLC Member) ELECTRONICALLY to 

L Drive – Miscellaneous - BOD Presentations by Noon the Friday before you’re scheduled on agenda. 

DATE: 6/23/11 LEGAL REVIEW: Yes _x__ No ___ 

SUBJECT: Riverwalk OP Radiology & Lab Lease Renewal/Renegotiation 

REQUESTOR & TITLE: David Cato, Vice President Outpatient Operations 

PREVIOUS BOARD ACTION ON THIS ITEM (IF ANY) 

(justification and/or background for recommendations – internal groups which support the recommendation i.e. SLC, Operating Councils, PMTs, etc.) 

Currently leasing space at Riverwalk Professional Center located at 12600 Creekside Lane, Fort 

Myers, FL under a Board approved lease that expires 8/31/11 for Radiology with a 5 year renewal 

option and for Lab that expires 12/31/11 with a 1 year renewal option. 

SPECIFIC PROPOSED MOTION: 

Approval for LMHS Outpatient Radiology and Lab to enter into a new lease with Jacobs Properties 

Limited Partnership based upon following terms and as set forth in the attached term sheet. Lease 

approval for existing 13,565 SF at a base rent of $14.50/SF, CAM at 5.60/SF, $130,000 tenant 

improvement allowance, and a 7 year term with renewal options. Lease will be contingent upon 

final LMHS legal counsel review. 

PROS TO RECOMMENDATION 

Opportunity to decrease base rent approximately 

$5/SF 

Results in approximately $70,000 in Annual 

Savings 

Central location for Outpatient Services 

New lease term assures LMHS ability to retain 

space longer term given investment of diagnostic 

equipment at this site. 

CONS TO RECOMMENDATION 

Locked into 7 year lease (However, we need long term 

commitment given the capital investment we have in 

placing diagnostic equipment at this location) 

LIST AND EXPLAIN ALTERNATIVES CONSIDERED 

Explored alternative properties in the immediate area. Based on options available this location and 

lease rate is the most cost effective approach that maintains a good strategic location 

FINANCIAL IMPLICATIONS Budgeted __x__ Non-Budgeted ____ 

(including cash flow statement, projected cash flow, balance sheet and income statement) 

We will see a savings of approximately $70,000 per year on our lease expense compared to the 

current lease terms. 

OPERATIONAL IMPLICATIONS (including FTEs, facility needs, etc.) 

None 

SUMMARY 

This is an opportunity to renegotiate existing leases to match current Fair Market Value and 

decrease lease expense at this location. LMHS is currently paying 19.60/SF for the Radiology suite 

and 19.36/SF for the Lab suite. Additionally, this project and location is strategically located in the 

market and will enable LMHS to provide OP diagnostic services. This location provided over $1.2 

Million in net contribution margin to LMHS in FY 2010 and is on pace to exceed this contribution 

margin in FY 2011. This location will continue to provide significant contribution to the LMHS 

revenue stream moving forward. 

BOD/Forms/Board (Action) Reporting Form – updated 9/2/09 cs

JACOBS PROPERTIES LIMITED PARTNERSHIP 

Proposed Lease Terms for Lee Memorial Health System – Suite 1 and 4 

Tenant: Lee Memorial Health System 

Square Footage: 13,565 Rentable Square Feet 

Renewal Term: 9/1/11 to 8/31/18 (7 years) *(Current Lease expires 8/31/11 (has 5 

year renewal option) 

Rental Rate: $14.50 per square foot *(Currently, we pay 19.60/SF for Radiology 

suite and 19.36/SF for Lab suite) 

CAM: $5.60 per square foot 

Annual Increase: CPI not to exceed 3% per annum 

Tenant Improvements: JPLP will pay 50% of tenant improvements for Suite 1, not to 

exceed $130,000. LMHS will cover remaining cost. 

Air Conditioner Replacement: JPLP will replace units 1,6,7 and 14 at lease signing and 

units 2,3,8, 11 and 13 in a timely manner as they fail. The Leibert Unit which services MRI 

equipment is the responsibility of LMHS 

Security Deposit: $5,000 currently on deposit to be transferred to lease renewal. 

Renewal Option: 2 renewal options of 5 years (rent to be negotiated based on market 

rate). Tenant shall give Landlord 90 days prior written notice of its 

intent to renew. 

Parking: Tenant’s current parking spaces shall be retained at no charge 

throughout the new term. 

Environmental 

Issues: Landlord will provide Tenant right to conduct its own phase I 

environmental assessment. 

Signage: Tenant wishes to retain building signage subject to applicable codes 

and architectural approvals. Landlord agrees to pay for the 

maintenance of said sign(s). 

Sublease and 

Assignment Right: Tenant will be given the right to assign the lease or sublet all or any 

portion of the premises at any time during the primary term or 

extensions thereof with Landlord’s consent not being unreasonably 

Page 1 of 2

withheld and/or delayed. If approved, any excess rents will be paid 

to Landlord. 

Fixtures: All affixed appurtenances including, but not limited to fixtures, wallmounted 

cabinets, computer and/or electronic equipment, may be 

removed by Tenant upon vacating the premises provided that any 

damage caused to premises by said removal be repaired to its original 

condition with reasonable wear and tear excepted. 

Riverwalk OP Radiology & Lab 

Lease Renegotiation 

Current Lease New Lease 

Terms 

Terms 

Total SF 

Base 

13565 13565 

Rent/SF $19.60 $14.50 

CAM/SF $5.60 $5.60 

Total/SF $25.20 $20.10 

Page 2 of 2 

Annual 

Savings 

Annual Rent $341,838.00 $272,656.50 $69,181.50

______________ 







DATE: 6/23/11 LEGAL REVIEW: Yes ___ No _x__ 

SUBJECT: Women’s Health Professionals Build Out & Bass Commons Expansion 


Mark Atkins, System Director Primary Care Services LPG 



On June 17, 2010 Board Finance Committee and on June 24, 2010 Full Board of Director’s approval 

to purchase Bass Commons and begin construction on approximately 17,000 SF of interior build out 

for Peds Specialist, PPEC, and Children’s Rehab. New Capital request reviewed by the System 

Planning Group on 5.25.11 and approved to move forward for Board of Director’s for approval. 


Approval of FY 2011 unbudgeted capital dollars in the amount of $5,712,242 to build out the 

Women’s Health Professionals office and complete the 13,000 SF building expansion at the OP Bass 

Commons building. 


Enabling project to facilitate Children’s 

Hospital Tower expansion and Cardiology 

services expansion needs at HP. 

Efficient location for physicians that provide 

both IP and OP care (WHP) 

Financial advantage of utilizing owned 

property for leased property over life of 

building (50 year +) 


Unbudgeted capital expense for FY 2011 


We need to move physician offices and other non acute based clinical function out of the HP 

campus. The other alternative considered is leasing space for these entities as close to the HP 

campus as feasible. Our risk to delaying this project will be slowing downing the Children’s Hospital 

Tower expansion project. 

FINANCIAL IMPLICATIONS Budgeted ____ Non-Budgeted __X__ 


Free up valuable acute care based spaced for expansion 


None 

SUMMARY 

The Bass Commons property was original purchased October 1, 2010 for the intent to expand 

Outpatient Pediatric services such as PPEC, Children’s Rehab, and Pediatric Physician Specialist. In 

addition, the building was also purchased to enable physician offices and other non acute care 

based departments to vacate the HP campus to prepare for expansion needs of both the Children’s 

Hospital Tower and Cardiology Services expansion needs. This funding will be a continuation of that 

strategy. 


Bass Commons Expansion & WHP Buildout

Strategic Overview: Enabling Project 

for Children’s Hospital Project 

• Demand exists for this space: 

– Free up space at HP for future expansion of the Children’s 

Hospital Tower 

– Growth of Pediatric Physician Clinics near the Children’s Hospital 

• Allows Physicians that provide both IP and OP care to stay 

close to campus 

• “Effective Cost of Ownership” - Long Term Financial Advantage 

to utilize owned property versus leased property 

• Part of the original Bass Commons building purchase strategy 

• Risk of not proceeding will slow down overall facility plan 

timeline on the HP Campus (WHP is 1 st clinic that needs to 

move) 

2

Overview 

• Ties into current project build out approved 6/17/10 by BOD 

of existing project 

• Build out remaining 7,800 SF of existing building shell to 

move WHP from HP 

• Provides enhanced access to Women’s Health Professionals 

patients 

• Build additional 13,000 SF to house other physician’s or 

offices that need to move out of HP 

• Contiguous with existing building which will provide a 

combined total of 41,000 SF 

• Infrastructure such as parking and utilities already exists for 

this project 

3

Previous Board Approval 

6/17/10 Board Approval: 

• Building Purchase (10/1/10) $5,300,000 

• Build out of PPEC/CRC $2,763,216 

• Original Deferred FY’11 $ 500,000 

Original Capital Approved $8,563,216 

4

Overview 

5

New Capital Overview 

• Construction $4,169,925 

• Design/A&E/Permit $ 417,500 

• Equipment $ 360,954 

• Furniture $ 201,942 

• Signage/Landscape $ 85,000 

• IT $ 476,921 

• Total $5,712,242 

6

Breakdown of Capital Request 

Capital Cost for WHP 

• WHP Project $1,272,418 

• Original Deferred FY’11 $ 500,000 

Capital Cost for 13,000 SF Expansion 

• Expansion Cost $3,939,824 

Total Project Cost $5,712,242 

7

Timeline Bass Commons 

• Original BOD Approval 6/1/10 

• Building Purchase 10/1/10 

• BOD Approval to fund expansion 6/23/11 

• Begin Construction on original 27,000 SF 7/1/11 

• Includes: PPEC, CRC, Specialist, & WHP 

• Complete Phase 1 (27,000 SF) 2/1/12 

• Begin Expansion Construction (13,000 SF) 3/1/12 

• Complete Expansion 3/1/13 

8

Board Approval Request 

• Approval of FY 2011 unbudgeted capital 

dollars in the amount of $5,712,242 to 

build out the Women’s Health 

Professionals office and complete the 

13,000 SF building expansion at the OP 

Bass Commons building. 

Questions? 

9

______________ 







DATE: 6/23/11 LEGAL REVIEW: Yes ___ No _x__ 

SUBJECT: MRI HP Commons Outpatient Center 


Mark Williams, Director OP Imaging 

Rendy Petrin, System Director Radiology 



Capital Project reviewed and approved by the System Planning Group to move forward for Board of 

Director approval. 


Approval of FY 2011 unbudgeted capital dollars in the amount of $2,276,761 to install a MRI at HP 

Commons Outpatient Center. Approval to work with CFO to either purchase the MRI system or 

enter into a lease for the MRI system based on which opportunity provides the highest financial 

benefit to LMHS. 


Opportunity to increase profitable OP MRI business 

Provides increased capacity for HP MRI to serve 

Pediatric sedation patient, inpatients, and ER 

patients 

Funding now will allow for completion by January 

for high seasonal volumes 

5 year ROI at 62% 



Unbudgeted capital expense for FY 2011 

Explored trying to shift business from HP Hospital to other OP sites and other Hospital campuses. 

Based on the planning data and geographic proximity of both patients and physician offices to HP 

Commons we risk losing existing volume and potential new OP volume by not utilizing this location. 



5 year ROI of 62 %, Year 1 margin $437,637, Year 5 margin $555,171 


We will have to hire 1.0 FTE OP MRI tech (56,000 annual salary included in proforma) 

SUMMARY 

The existing HP campus MRI is at capacity to meet the demands of outpatient adults, pediatrics, 

inpatients, and ER patients. Currently, we are only able to provide a limited schedule for both adult 

outpatients and pediatric patients due to capacity constraints. We have an OP Radiology center in 

HP Commons OP Center with a room that has previously been designed to house a MRI system. 

Installing a MRI in this room will allow for increased capacity to meet the demand of pediatric cases 

at HP and allow for growth of profitable OP revenue at HP Commons. Our planning data and patient 

satisfaction data support that this location provides the best opportunity to capture both the 

existing business that HP captures and future business that we don’t currently capture. 


Health Park 

Commons MRI 

Presented by: David Cato 

Mark Williams 

Rendy Petrin

Current Dilemma: MRI at Health Park 

The MRI at HPMC is at limited capacity for adult outpatients. This is 

due the increasing demand of pediatric sedation cases and that has 

attending physicians, radiologists and hospital leaders very concerned. 

Capacity will be an increased issue as the services at this campus continue 

to grow (Children’s Hospital/Cardiac) 

As a result, adult outpatient cases are frequently cancelled or rescheduled 

to accommodate inpatients, ED patients and pediatric outpatients. 

Long backlogs and the canceling of appointments is a major dissastisfier for 

patients and their referring physicians. It is logical to assume that a portion 

of this business is lost to competing MRI providers. 

While plans include a new MRI scanner in the Children’s Tower project, 

demand for MRI services does not allow us to wait 5 years until this system 

becomes operational. 

Due to the magnitude of this need, this project should be put in motion 

immediately for a target completion date before next season.

The HP Commons MRI Solution 

The Radiology department at HP Commons was originally designed 

to accommodate a future MRI system including magnet and 

equipment rooms, as well as a shared control area with CT. It is an 

ideal layout. 

With HP Commons located directly across from the Health Park 

acute care campus, there is no risk of losing the adult outpatient 

business to competing MRI providers. 

In fact, it is far more likely that Lee Memorial Health System would 

retain a greater percentage of it’s current market share with the 

customer dissatisfier eliminated from the equation. 

Moreover, HP Commons offers all the attributes of an outpatient 

facility such as easy access, parking and a staff that has 

consistently enjoyed very high customer satisfaction scores. 

With no other competing MRI providers in the Health Park market, 

we are very confident that we can grow the adult outpatient business 

rather than risking further loss of revenues. 

Moving adult outpatients to HP Commons will allow additional 

pediatric sedation slots at HPMC without the resultant decrease in 

overall appointment availability.

HP Commons FY 2011 

Patient Satisfaction 

Patient Facility Influence Data

The HP Commons MRI Solution 

No competing MRI’s within 5 miles

Justification 

Free up needed capacity for Peds and IP 

Drive true OP volume to OP Center to increase OP 

volume (current capacity at HP 3 MRI/day, HP 

Commons capacity will be 18 MRI/day) 

Average Net Revenue in system is $950 to $1,050 per 

MRI 

Increase patient satisfaction and access 

Relatively low investment since we are adding the 

service line to an existing location 

Able to generate positive cash flow on conservative daily 

volume projections (Yr 1 at 4.5, yr 2 at 5.5, yr 3 at 6) 

Average Annual ROI at 12%, 5 year ROI 62%

Capital Summary 

MRI System $1,925,386 

Minor Equipment $20,000 

Design & Planning $30,000 

Permitting $15,000 

Construction $263,875 

Furniture/Artwork $20,000 

Signage $2,500 

Grand Total $2,276,761 

*Potential to lease actual MRI system with operating lease to defer equipment 

expense*

Lee Memorial Health System 

ASSUMPTIONS: 

New MRI at Health Park Commons 

• Purchase MRI for Health Park Commons in order to use Health Park MRI only for 

Peds and inpatient needs 

•Volumes based on total ‘adult’ procedures performed at Health Park which will be 

backfilled by Peds procedures 

•Inpatients routinely held on 24hr hold since the Health Park MRI is over capacity 

on many days 

Initial Investment (Capital) $ 2,276,761 

2012 2013 2014 2015 2016 Total 

Contribution Margin* (incremental 

cash flow) $ 836,843 $ 809,456 $ 739,866 $ 826,442 $ 954,377 $ 4,166,984 

Depreciation Expense $ 399,206 $ 399,206 $ 399,206 $ 399,206 $ 399,206 $ 1,996,030 

Net Profit/(Loss) $ 437,637 $ 410,250 $ 340,660 $ 427,236 $ 555,171 $ 2,170,954 

5 Year Discounted Cash Flow $ 3,691,943 

Initial Investement $ (2,276,761) 

5 Year Cash Return in excess of Initial Investment $ 1,415,182 

Return on Investment (ROI) = 5 Year Discounted Cash Flow less Initial Investment $ 1,415,182 

Initial Investment 

$ 2,276,761 

5 Year ROI = 62.2%

Board Approval Request 

Approval of FY 2011 unbudgeted capital 

dollars in the amount of $2,276,761 to 

install a MRI at HP Commons Outpatient 

Center. Approval to work with CFO to 

either purchase the MRI system or enter 

into a lease for the MRI system based on 

which opportunity provides the highest 

financial benefit to LMHS. 

Questions?

______________ 







DATE: 6/23/11 LEGAL REVIEW: Yes ___ No _X__ 

SUBJECT: LMH Ambulatory/Community Pharmacy 

REQUESTOR & TITLE: John Armitstead, System Director Pharmacy 

& Mark Collum, Director Ambulatory Pharmacy Services 



No previous Board Action. This proposal comes with the support of the System Planning Group 

meeting on May 11, 2011. 


Motion to Approve $275,000 capital expense to create a Ambulatory/Community Pharmacy within 

Lee Memorial Hospital. 


1.) Increase medication safety by comparing 

discharge meds to actual prescriptions 

filled. 

2.) Increase access to pharmaceuticals to ED 

visitors and discharged patients of the 

hospital. 

3.) Facilitate transition of care from inpatient 

to home environment with Care 

Management. 

4.) Capture 340B savings for insured patients. 


1.) Unbudgeted expense in this fiscal year. 

2.) Continue to allow patients to use competitors 

rather than capturing business for ourselves. 

3.) No consideration for future bundled payments 

including outpatient medications. 


Without opening this pharmacy, we are continuing current business practice. One alternative is to 

consider alliance with community pharmacies. However, the community pharmacies want us to pay 

them to help care for our patients. In addition, they do not have the advantage of 340B that LMH 

and HPMC enjoy. 


(including cash flow statement, projected cash flow, balance sheet and income statement) See attachment 


Four (4.0) FTEs are needed to open and staff initially. 

SUMMARY 

• Ideal way to ensure patient safety for post-discharge prescriptions 

• Bedside delivery is successful everywhere it has been implemented 

• Medication reconciliation occurs thus ensuring patients get the medications they need and do 

not get duplicates in therapy 

• Increase access to medications that are hard to find and for patients who need financial 

assistance 

• Reduce Health Plan costs for acute prescriptions 

• Employees can more easily get prescriptions they need 

• Why allow others to have this business when we can do it ourselves with an opportunity to 

be profitable?


Community 

Pharmacy Proposal LMH 

Mark Collum, Pharm.D., CPh 

Director Ambulatory 

Pharmacy Services 

June 23, 2011


Community 


Why do we need it? 

• Increase patient safety with direct access to patient’s entire 

medical record through Epic 

• Decrease the potential for unpaid patient re-admission after 

discharge—future Medicare rules 

• Increase patient satisfaction and convenience upon 

discharge 

--Positive impact on HCAHPS 

--Bedside delivery allows for better patient education 

• Facilitate medication reconciliation by ensuring patients 

get the medications they need and do not get duplicates or 

miss a medication that is needed


Community 


Why do we need it? 

• Increase access to medications for patients who are 

uninsured and/or underinsured 

--This includes working with Care Management and 

the Dunbar Clinic 

• Capture acute employee prescription needs conveniently 

• Reduce Health Plan costs for acute employee prescriptions 

Why pay others when we can pay ourselves? 

• Stock hard to find medications for specialists 

• 340B pharmaceutical prices provides great profitability


ASSUMPTIONS: 

Community Pharmacy Proposal LMH 

• Create a Community Pharamcy 

in the current Pre-Op Testing area of the Lobby at LMH 

• Obtain 340 B discount drug prices on all patients of the hospital 

• Net revenue is $92 per script, drug expense is $67.16 per script 

Initial Investment (Capital) $ 267,023 

2012 2013 2014 2015 2016 Total 

Contribution Margin* 

(incremental cash flow) $ 369,816 $ 483,495 $ 586,153 $ 472,102 $ 346,848 $ 2,258,413 

Depreciation Expense $ 25,999 $ 25,999 $ 25,999 $ 14,803 $ 14,803 $ 107,603 

Net Profit/(Loss) $ 343,816 $ 457,495 $ 560,154 $ 457,299 $ 332,046 $ 2,150,810 

5 Year Discounted Cash Flow $ 2,009,846 

5 Year Cash Return in excess of Initial Investment $ 1,742,823 

5 Year ROI = 652.7% 

*Contribution Margin = Incremental revenues less incremental operating expenses related to tactic (source: detailed proforma)


Community 


Conclusions: 

• Ideal way to ensure patient safety for post-discharge prescriptions 

• Bedside delivery is successful everywhere it has been implemented 

• Medication reconciliation occurs thus ensuring patients get the 

medications they need and do not get duplicates in therapy 

• Increase access to medications that are hard to find and for patients 

who need financial assistance 

• Reduce Health Plan costs for acute prescriptions 

• Employees can more easily get prescriptions they need 

• Why allow others to have this business when we can do it ourselves 

with an opportunity to be profitable?

Board of Directors Meeting 

June 23, 2011 

FY 2012 Capital & Operating 

Budget 


(Verbal Update)


Board of Directors 

Financial Update 

For the Month Ending 5/31/11 

Presented 6/23/11

System Adjusted Admits

Percent of Total Operating Revenue for the month ended 5/31/11

Percent of Total Operating Revenue for the 8 months ended 5/31/11

Comparison of Net Revenue per CMAA 

for the 8 month period ended 5/31/11

Gain (Loss) From Operations ( in 000’s )

Financial Statements for the month ended 5/31/11 

May, 2011 

BUDGET PR YR 

BUDGET ACTUAL PR YR VAR % % 

VOLUME: 

ADJUSTED ADMISSIONS 9,618 9,692 9,453 74 1% 3% 

REVENUES: (000's) 

INPATIENT $207,808 $ 217,591 $ 198,148 $ 9,783 5% 10% 

OUTPATIENT 133,446 129,779 112,199 (3,667) -3% 16% 

TOTAL OPERATING REV 341,254 347,370 310,347 6,117 2% 12% 

DEDUCTIONS 247,925 248,944 220,195 (1,019) 0% -12% 

TOTAL OPERATING REVENUES 93,329 98,427 90,152 5,098 5% 9% 

OPERATING EXPENSES: (000's) 

OPERATING 84,428 89,165 79,588 (4,737) -6% -11% 

CAPITAL 7,499 7,918 8,283 (419) -6% 5% 

TOTAL OPERATING EXP 91,927 97,083 87,871 (5,156) -6% -9% 

OPERATING GAIN: $1,402 $1,344 $2,281 $ (58) -4% -41% 

INVESTMENT INCOME 3,019 

211 (8,532) (2,808) -93% 102% 

EXCESS OF REVENUES 

OVER EXPENSES $4,421 $1,555 ($6,252) $ (2,867) -65% 125%

Consolidated Income Statement Analysis of Variance 

for the month ended 5/31/11 

Net Patient Revenue 

SUMMARY OF VARIANCE: 

(In Thousands) 

EXPLANATION: 

VOLUME VARIANCE RATE VARIANCE 

BUDGET $ 91,764 

Actual Adj Admits-System 9,692 Actual Net Rev/Adj Admit $ 9,939 

Budget Adj Adm-System 9,618 Budget Net Rev/Adj Admit $ 9,541 

ACTUAL $ 96,327 

Variance 74 Variance $ 398 

VARIANCE $ 4,563 

Budget Net Rev/Adj Admit $ 9,541 Actual Adj Admits 9,692 

Total Volume Variance $ 707,433 Total Rate Variance $ 3,855,232 

Net Revenue - Rate & Volume Variance $ 4,562,665 

Net Patient Revenue - Rate Variance 

Medicare Medicaid 

Commmercial, 

HMO/PPO, 

Other TOTAL 

Budgeted Payor Mix 50.9% 15.1% 33.9% 100% 

Actual Payor Mix 50.9% 14.7% 34.4% 100% 

Budget Gross Rev/Adj Adm 42,221 26,384 29,290 

35,318 

Actual Gross Rev/Adj Adm 38,871 27,883 33,768 

35,624 

Budget Net Rev/Adj Admit 8,740 

5,687 12,538 

9,541 

Actual Net Rev/Adj Admit 8,461 

6,151 13,668 

9,939 

Reimbursement % 22% 22% 40% 28% 

Payor Mix Variance - 

237,011 546,819 783,830 

Rate/Adj Admit Variance (1,366,391) 656,467 3,781,326 3,071,402 

Total Rate Variance $ (1,366,391) $ 893,478 $ 4,328,145 $ 3,855,232



Total Salaries & Wages 



EXPLANATION: 


BUDGET $ 42,767 

Actual Total FTEs 8,650 Actual Rate/FTE $ 29.49 

Budget Total FTEs 8,253 Budget Rate/FTE $ 29.28 

ACTUAL $ 45,151 

Prod FTE Variance (397) Rate Variance $ (0.21) 

VARIANCE $ (2,384) 

Budget Rate/FTE 29.28 

Hours/FTE 177 

Actual Total FTEs 8,650 

Hours/FTE 177 

Total Volume Variance (2,057,214) Total Rate Variance (326,706) 

Rate & Volume Var $ (2,383,920) 

Description: 

Total FTE Volume Variance: 

FTEs Amount 

FTE's Earned Budget 

(based on Adj Adm & 50% flex) 

8,286 

Budget Prod FTEs 8,253 

Var due to Volume (33) $ (170,104) 

Actual FTEs 8,650 

FTE's Earned Budget 8,286 

Productivity Inc(Dec) (364) 

Total FTE-Volume Var (397) 

$ 

(1,887,110) 

(2,057,214)



Productive Salaries & Wages 



EXPLANATION: 


BUDGET $ 38,387 

Actual Prod FTEs 7,818 Actual Rate/FTE $ 29.15 

Budget Prod FTEs 7,342 Budget Rate/FTE $ 29.54 

ACTUAL $ 40,340 

Prod FTE Variance (476) Rate Variance $ 0.39 


Budget Rate/FTE $ 29.54 Actual Prod FTEs 7,818 

Hours/FTE 177 

Hours/FTE 177 

Total Volume Variance (2,490,452) Total Rate Variance 537,593 


Description: 

Prod FTE Volume Variance: 

FTEs Amount 

FTE's Earned Budget 

(based on Adj Adm & 50% flex) 

7,371 

Budget Prod FTEs 7,342 

Var due to Volume (29) $ (152,781) 

Actual FTEs 7,818 

FTE's Earned Budget 7,371 

Productivity Inc(Dec) (447) 

Prod FTE-Volume Var (476) 

$ 

(2,337,671) 

(2,490,452)



Contract Labor 



EXPLANATION: 


BUDGET $ 40 

Actual Contract FTEs 15 Actual Rate/FTE $ 51.26 

Budget Contract FTEs 5 Budget Rate/FTE $ 48.57 

ACTUAL $ 133 

Contract FTE Var (10) Rate Variance $ (2.70) 

VARIANCE $ (92) 

Budget Rate/FTE $ 48.57 Actual Contract FTEs 15 

Hours/FTE 177 

Hours/FTE 177 

Total Volume Variance $ (85,235) Total Rate Variance $ (6,976) 

Rate & Volume Var $ (92,211) 

Phys 

Contract Labor Volume/Rate Variance 

$ (1,000) 

Home Health (2,000) 

Rehab (9,000) 

HPCC - 

OP Centers - 

Corporate (2,000) 

Acute Care - 

Volume Related - 

Other Staffing Changes (78,211) 

Total Labor Rate & Volume Var $ (92,211)



Non-Productive Salaries 

SUMMARY OF VARIANCE: EXPLANATION: 


BUDGET $ 4,339 

PTO (16,000) 

Incentive Pay 65,000 

ACTUAL $ 4,678 

Leave & Other Adjustments (388,000) 


Total Variance $ 

(339,000)



Other Supplies 



EXPLANATION: 


BUDGET $ 18,989 

Actual Adj Admissions 9,692 Actual Supplies/Adj Adm $ 2,117 

Budget Adj Admissions 9,618 Budget Supplies/Adj Adm $ 1,974 

ACTUAL 20,519 

Variance (74) Rate Variance $ (143) 


Budget Supplies/Adj Adm $ 1,974 Actual Adj Admissions 9,692 

Total Volume Variance (146,391) Total Rate Variance (1,383,968) 


Rate Variance 

Budget/AA Actual/AA Variance 

(Inc) Dec in Drug Expense $ 430 $ 447 $ (163,094) 

(Inc) Dec in Implant Costs $ 636 $ 691 (533,633) 

(Inc) Dec in Med/Surg Supplies $ 604 $ 629 (238,959) 

(Inc) Dec in Other Supplies (448,282) 

Total Variance 1,066 

1,138 

(1,383,968)



Other Services 




ACTUAL 5,849 


Legal Fees (425,000) 

Recruiting (61,000) 

Total $ 

(486,000)



Purchased Services 




Reference Work (172,000) 

Transcripton/Coding (141,000) 

ACTUAL 9,675 

Trauma/ER Support (70,000) 

Dialysis (52,000) 


Maintenance (72,000) 

Total $ 

(507,000)



Bad Debt Expense 



EXPLANATION: 

Budget Bad Debt Percent 3.6% 

BUDGET $ 12,217 

Actual Gross Revenue $ 345,270,951 

ACTUAL 13,322 

Bad Debt Expense-Vol Adj $ 12,360,700 


Over (Under) Budget 961,000 

Actual Bad Debt Expense $ 

13,321,700


Operating Highlights 

For the month ended May 31, 2011 

Actual adjusted admits (overall inpatient & outpatient volume indicator) for the month ended May 31, 

2011 are 9,692 which is 0.8% greater than budget. Actual inpatient admits for the month are 6,108 or 

3.8% greater than budget while actual patient days are 32,914 or 4.9% greater than budget which resulted 

in a 5.4 day length of stay. Emergency room visits are 0.7% less than budget while outpatient surgeries 

are 19.5% greater than budget. 

Net patient revenue for May 2011 reflects a $4.6 million or a 5.0% favorable variance to budget. This 

favorable variance in net patient revenue is primarily the result of the 0.8% increase in adjusted admits 

along with a 4.2% increase in reimbursement during the month. 

Total operating expenses before depreciation and interest expense are $4.7 million greater than budget. 

All operating expense categories except fringe benefits reflect unfavorable variances. Salaries & Wages 

reflect a $2.4 million unfavorable variance due to increased overtime, non-productive salaries and fewer 

vacant positions. Supplies are $1.5 million over budget primarily due to additional implant costs from 

increased surgical volumes. Other services reflect a $0.5 million unfavorable variance due to legal fees 

and recruiting costs. Actual total operating costs per case mix adjusted admit is 1.1% greater than budget 

(6,947 actual, 6,871 budget). 

Productivity as measured by FTEs/AOB decreased by 2.8% (5.13 actual, 4.99 budget) for May 2011. 

For May 2011, the gain from operations is $1.3 million versus a budgeted gain of $1.4 million. Excess 

revenue over expenses is a gain of $1.6 million versus a budgeted gain of $4.4 million. Investments were 

budgeted to return $3.0 million for the month but the actual investment return was $0.2 million. 

For the month, Cash & Investments increased by $17.4 million to $527.6 million. Operations increased 

cash by $7.1 million while working capital increased cash by $6.1 million. Cash was reduced by $1.8 

million for routine equipment and debt principal payments reduced cash by $0.3 million. Days in 

Accounts Receivable are 49.2 days and resulted in a $6.3 million increase in cash. Total Notes & Bonds 

payable on May 31, 2011 is $688.9 million resulting in a Cash to Debt ratio of 76.6%. 

Net Patient Revenue per adjusted admit CMI for the month ended May 31, 2011 is $7,052 while the 

Operating Expense per adjusted admit CMI is $6,947. The difference which represents the gain from 

operations per adjusted admit is $105.00 while the budgeted gain from operations is $110.00. 

Wages & Benefits as a percent of Net Operating Revenue is 52.7% for May 2011 versus a budget of 

53.3%. The actual hourly pay rate is $29.49 which is $0.21 greater than budget due to overtime and nonproductive 

wages. YTD, the average hourly rate is $29.73 which is 30 cents greater than budget. 

Post Acute entities provided the following YTD contributions to Acute Care by allowing charity care 

patients into their respective programs: Lee Memorial Home Health $501,000; HealthPark Care Center 

$243,000; The Rehabilitation Hospital $368,000; Access Medical South (DME joint venture) $71,000. 

The Lee Physician Group YTD loss per physician is $15,958. This includes practice revenue and 

expenses along with ancillary revenue referred to LMHS. This YTD loss is $34,712 per physician less 

than budget due to lower operating cost and better collections per visit than budget.


CONSOLIDATED EXECUTIVE SUMMARY 

FOR THE PERIOD ENDING MAY 31, 2011 

Current period Year-to-Date 

Budget Actual Prior Year Var % Budget Actual Prior Year Var % 

ACT TO BUD ACT TO BUD 

Inpatient Volumes: 

Admits - Adults & Peds 5,884 6,108 6,065 3.8% 50,523 52,239 50,349 3.4% 

Patient Days - Adults & Peds 31,368 32,914 32,076 4.9% 261,963 274,183 261,973 4.7% 

Length of Stay (LOS) 5.3 

Inpatient Surgeries 1,620 

5.4 

1,678 

5.3 

1,586 

1.9% 5.2 

3.6% 13,647 

Outpatient Volumes: 

Emergency Room Visits 13,845 13,749 13,738 -0.7% 111,250 111,548 108,813 0.3% 

OutPatient Surgeries 1,578 1,885 1,519 19.5% 12,738 14,123 12,896 10.9% 

Adjusted Admits 9,618 9,692 9,453 0.8% 80,875 82,143 79,369 1.6% 

(overall in/outpat volume indicator) 

Operating Ratios: 

Net Revenue/Adj Adm CMI 6,981 7,052 6,861 1.0% 6,814 6,817 6,612 0.0% 

Operating Exp/Adj Adm CMI 6,871 6,947 6,687 -1.1% 6,616 6,620 6,379 -0.1% 

5.2 

13,887 

5.2 

13,578 

Wages/Ben - % of Net Oper Rev 53.3% 52.7% 51.5% 1.1% 52.1% 51.6% 50.5% 0.9% 

Supplies as a % of Net Oper Rev 20.3% 20.8% 20.6% -2.4% 20.9% 21.0% 21.7% -0.7% 

Charity/Bad Debt - % of Gross Rev 6.9% 7.3% 7.1% -5.3% 6.8% 6.8% 6.7% 0.8% 

FTEs/AOB 4.99 5.13 4.95 -2.8% 4.84 4.81 4.68 0.5% 

Financial Ratios: 

Operating Margin (%) 1.6% 1.5% 2.5% -5.6% 2.9% 2.9% 3.5% -0.7% 

Excess Margin (%) 4.8% 1.6% -6.9% -66.6% 5.9% 3.8% 5.7% -35.6% 

Liquidity Ratios: 

Cash to Debt (%) 83.7% 76.6% 66.8% 

Days Cash on Hand (net of VRDB) 138.5 133.7 80.3 

Days In Acct Receivable 60.0 49.2 50.5 

Income Statement Summary (In Thousands): 

Total Net Operating Revenue $ 93,329 $ 98,427 $ 90,152 5.5% $ 766,026 $ 789,601 $ 729,502 3.1% 

Total Operating Expenses 91,927 97,083 87,871 -5.3% 744,272 767,831 703,796 -3.1% 

Consolidated Gain(Loss) from Oper 1,402 1,344 2,281 4.2% $21,753 21,770 $25,706 -0.1% 

Investment Earnings/Non Op Income 3,019 

211 

(8,532) 

-93.0% 22,857 

13,671 

15,904 

0.0% 

1.8% 

-40.2% 

Consolidated Excess Rev over Exp $ 4,421 $ 1,555 $ (6,252) -64.8% $ 44,611 $ 35,441 $ 41,610 -20.6% 

Trauma District Gain(Loss) from Oper $ (268) $ (283) $ (104) -5.6% $ (2,746) $ (2,949) $ (2,606) -7.4% 

Balance Sheet Highlights (In Thousands): 

Cash & Investments $ 526,649 $ 527,596 $ 447,762 

Bonds & Notes Payable $ 650,660 $ 688,920 $ 670,758 

VRDB = variable rate demand bonds 

CMI = case mix index


CONSOLIDATED STATISTICAL SUMMARY 



Budget Actual Prior Year Variance Var % Budget Actual Prior Year Variance Var % 

ACT TO BUD ACT TO BUD ACT TO BUD ACT TO BUD 

Admissions 

ADULTS 5,330 5,581 5,464 251 4.7% 45,881 47,465 45,626 1,584 3.5% 

PEDIATRICS 351 341 395 (10) -2.8% 2,992 3,189 3,062 197 6.6% 

NICU 63 52 59 (11) -16.8% 416 429 445 13 3.2% 

POST ACUTE 140 134 147 (6) -4.3% 1,234 1,156 1,216 (78) -6.3% 

Total Adult & Peds 5,884 6,108 6,065 224 3.8% 50,523 52,239 50,349 1,716 3.4% 

NEWBORNS 534 435 481 (99) -18.6% 4,244 3,802 3,981 (442) -10.4% 

Total Admissions 6,418 6,543 6,546 125 1.9% 54,767 56,041 54,330 1,274 2.3% 

Patient Days 

ADULTS 24,417 26,048 24,990 1,631 6.7% 206,910 219,429 207,720 12,519 6.1% 

PEDIATRICS 1,194 1,214 1,360 20 1.6% 10,744 10,512 10,149 (232) -2.2% 

NICU 1,293 1,278 1,454 (15) -1.2% 9,332 9,882 10,164 550 5.9% 

POST ACUTE 4,463 4,374 4,272 (89) -2.0% 34,978 34,360 33,940 (618) -1.8% 

Total Adult & Peds 31,368 32,914 32,076 1,546 4.9% 261,963 274,183 261,973 12,220 4.7% 

NEWBORNS 1,224 1,059 1,170 (165) -13.5% 9,664 9,332 9,682 (332) -3.4% 

Total Patient Days y 

32,593 33,973 33,246 1,380 4.2% 271,626 283,515 271,655 11,889 4.4% 

Average Length of Stay 

ADULTS 4.6 4.7 4.6 0.1 1.9% 4.5 4.6 4.6 0.1 2.5% 

PEDIATRICS 3.4 3.6 3.4 0.2 4.6% 3.6 3.3 3.3 (0.3) -8.2% 

NICU 20.7 24.6 24.6 3.9 18.8% 22.4 23.0 22.8 0.6 2.7% 

POST ACUTE 31.9 32.6 29.1 0.8 2.4% 28.3 29.7 27.9 1.4 4.9% 

Total Adult & Peds 5.3 5.4 5.3 0.1 1.1% 5.2 5.2 5.2 0.1 1.2% 

NEWBORNS 2.3 2.4 2.4 0.1 6.3% 2.3 2.5 2.4 0.2 7.8% 

Total Patient Days 5.1 5.2 5.1 0.1 2.2% 5.0 5.1 5.0 0.1 2.0% 

OP Registrations 

EMERGENCY ROOM 13,845 13,749 13,738 (96) -0.7% 111,250 111,548 108,813 298 0.3% 

OP SURGERY CASES 1,578 1,885 1,519 307 19.5% 12,738 14,123 12,896 1,385 10.9% 

SUBTOTAL 15,423 15,634 15,257 211 1.4% 123,987 125,671 121,709 1,684 1.4% 

Visits / Encounters 

HOME HEALTH ADMISSIONS 350 283 323 (67) -19.2% 2,716 2,732 2,412 16 0.6% 

HOSP BASED PHY ENCOUNTERS 14,798 14,636 13,384 (162) -1.1% 124,298 125,684 115,183 1,386 1.1% 

PHYSICIAN ENCOUNTERS 47,578 43,336 38,047 (4,242) -8.9% 394,792 386,495 333,960 (8,297) -2.1% 

TRAUMA SERVICES DISTRICT 816 902 681 86 10.5% 5,454 5,803 5,174 349 6.4% 

SUBTOTAL 63,542 59,157 52,435 (4,385) -6.9% 527,260 520,714 456,729 (6,546) -1.2% 

TOTAL OP 78,966 74,791 67,692 (4,175) -5.3% 651,247 646,385 578,438 (4,862) -0.7%


CONSOLIDATED STATEMENT OF OPERATIONS 

FOR THE PERIOD ENDING: MAY 31, 2011 

( IN THOUSANDS ) 

CURRENT MONTH YEAR TO DATE 

BUDGET ACTUAL PRIOR YEAR VAR VAR % VAR % BUDGET ACTUAL PRIOR YEAR VAR VAR % VAR % 

ACT TO BUD ACT TO BUD PR YR ACT TO BUD ACT TO BUD PR YR 

INPATIENT REVENUE 207,808 217,591 198,148 9,783 4.7% 9.8% 1,759,782 1,840,652 1,665,557 80,870 4.6% 10.5% 

OUTPATIENT REVENUE 131,882 127,680 110,685 (4,202) -3.2% 15.4% 1,057,209 1,053,668 959,981 (3,541) -0.3% 9.8% 

TOTAL PATIENT REVENUE 339,690 345,271 308,833 5,581 1.6% 11.8% 2,816,992 2,894,321 2,625,538 77,329 2.7% 10.2% 

DED FROM REV-MEDICARE 123,925 123,773 109,280 153 0.1% -13.3% 1,063,340 1,089,660 975,247 (26,320) -2.5% -11.7% 

DED FROM REV-MEDICAID 36,423 35,554 32,156 870 2.4% -10.6% 292,669 294,871 269,052 (2,202) -0.8% -9.6% 

DED FROM REV-CHARITY 11,129 11,740 10,581 (612) -5.5% -11.0% 92,034 93,880 83,650 (1,845) -2.0% -12.2% 

DED FROM REV-HMO/PPO 32,949 31,253 29,798 1,696 5.1% -4.9% 241,221 252,568 254,579 (11,347) -4.7% 0.8% 

DED FROM REV-OTHER 31,281 33,303 26,934 (2,021) -6.5% -23.6% 273,444 284,110 232,658 (10,666) -3.9% -22.1% 

DED FROM REV-BAD DEBT 12,217 13,322 11,446 (1,104) -9.0% -16.4% 100,863 102,830 92,182 (1,967) -2.0% -11.6% 

TOTAL DED FROM REV 247,925 248,944 220,195 (1,019) -0.4% -13.1% 2,063,571 2,117,918 1,907,368 (54,347) -2.6% -11.0% 

NET PATIENT REVENUE 91,764 96,327 88,638 4,563 5.0% 8.7% 753,421 776,402 718,170 22,981 3.1% 8.1% 

OTHER OPER REV 1,564 2,100 1,514 535 34.2% 38.7% 12,605 13,199 11,332 594 4.7% 16.5% 

TOTAL OPERATING REV 93,329 98,427 90,152 5,098 5.5% 9.2% 766,026 789,601 729,502 23,575 3.1% 8.2% 

OPERATING EXPENSES 

PROD SALARIES 37,454 38,869 34,691 (1,415) -3.8% -12.0% 292,377 301,175 269,054 (8,799) -3.0% -11.9% 

PROD OVERTIME 933 1,471 1,175 (537) -57.6% -25.1% 10,572 11,924 10,183 (1,352) -12.8% -17.1% 

CONTRACT LABOR 40 133 31 (92) -227.9% -333.9% 2,185 1,810 1,797 375 17.2% -0.7% 

NON-PROD SALARIES 4,339 4,678 4,098 (339) -7.8% -14.1% 37,194 38,831 33,799 (1,637) -4.4% -14.9% 

TOTAL SALARIES & WAGES 42,767 45,151 39,996 (2,384) -5.6% -12.9% 342,327 353,741 314,832 (11,414) -3.3% -12.4% 

FRINGE BENEFITS 7,017 6,757 6,475 260 3.7% -4.3% 56,683 54,076 53,251 2,608 4.6% -1.5% 

HEALTH CARE ACCESS 1,103 1,214 1,198 (111) -10.0% -1.3% 9,122 9,934 9,805 (812) -8.9% -1.3% 

SUPPLIES 18,989 20,519 18,534 (1,530) -8.1% -10.7% 159,934 165,972 158,587 (6,038) -3.8% -4.7% 

OTHER SERVICES 5,396 5,849 4,833 (453) -8.4% -21.0% 42,909 44,903 40,228 (1,995) -4.6% -11.6% 

PURCHASED SERVICES 9,155 9,675 8,552 (520) -5.7% -13.1% 73,859 77,021 71,076 (3,162) -4.3% -8.4% 

TOTAL OPER EXPENSES 84,428 89,165 79,588 (4,737) -5.6% -12.0% 684,834 705,646 647,779 (20,812) -3.0% -8.9% 

EBITDA 8,901 9,262 10,564 361 4.1% -12.3% 81,192 83,955 81,723 2,763 3.4% 2.7% 

DEPRECIATION/AMORT 5,169 5,538 5,884 (369) -7.1% 5.9% 40,964 43,021 37,818 (2,057) -5.0% -13.8% 

INTEREST EXPENSE 2,330 2,380 2,399 (50) -2.2% 0.8% 18,474 19,165 18,199 (690) -3.7% -5.3% 

GAIN(LOSS) FROM OPER 1,402 1,344 2,281 (58) -4.2% -41.1% 21,753 21,770 25,706 16 0.1% -15.3%


Consolidated Balance Sheet 

As of MAY 31, 2011 

in Thousands (000's) 

ASSETS: Current Prior Month Prior Year LIABILITIES: Current Prior Month Prior Year 

Current Assets: Current Liabilities: 

Cash And Cash Equivalents * 49,924 1,268 16,087 Accounts Payable 26,910 25,916 34,520 

Operating Fund Investments * 449,373 480,634 432,318 Wages and Benefits Payable 38,263 33,883 31,795 

Accrued Interest Receivable 289 308 371 Notes Payable - Short Term 7,639 7,852 4,349 

Accounts Receivable (net) 156,966 162,058 141,351 Current Portion Bonds Payable 10,580 10,580 14,871 

Accounts Receivable - Phys (Net) 3,878 5,109 10,626 Due to State of Florida 9,877 9,596 13,312 

Inventories 29,201 29,198 29,117 Malpractice Liability - Short Term 5,936 5,936 5,936 

Third Party Settlements 0 0 0 Accrued Bond Costs 3,991 1,995 12,282 

Other Current Assets 11,843 13,138 11,599 Due to LMHS 0 0 0 

Other Current Liabilities 36,178 38,049 32,151 

Total Current Assets: 701,474 691,713 641,468 Total Current Liabilities 139,373 133,807 149,216 

Other Assets Other Liabilities and Fund Balance 

Limited or Restricted Use Assets * 6,678 6,692 17,675 Benefits Payable - Long Term 0 0 0 

Bond Issuance Costs 5,132 5,161 5,685 Notes Payable - Long Term 151,321 151,466 104,040 

Trustee Held Funds * 0 0 0 Due to State of Florida - Long Term 10,432 9,562 3,494 

Directors/Officers Indemnity Fund * 100 100 100 Malpractice Liability - Long Term 10,437 10,202 9,242 

Long Term Operating Fund Investments * 21,521 21,521 20,304 Bonds Payable 519,380 519,359 553,410 

Other Assets 101,087 100,819 100,082 Other Long Term Liabilities 46,159 45,814 39,054 

UnRestricted Fund Balance 626,436 624,971 596,992 

Restricted Fund Balance 28,835 28,746 22,838 

Total Other Assets 134,518 134,293 143,846 Total Other Liabilities & Fund Balance 1,393,001 1,390,119 1,329,070 

Property and Equipment: 

Plant In Use 1,229,650 1,228,446 1,203,696 

Construction in Process 33,284 33,381 26,866 

Accumulated Depreciation (587,734) (584,994) (555,419) 

Total Property & Equipment (Net) 675,200 676,833 675,142 

Restricted Assets 21,182 21,088 17,829 

TOTAL ASSETS 1,532,374 1,523,927 1,478,286 TOTAL LIABILITIES AND EQUITY 1,532,374 1,523,927 1,478,286 

* Cash and Investments 

Above Balance Sheet has been adjusted to eliminate intercompany receivables, payables and investments in subsidiaries


LEE COUNTY, FLORIDA 

CONSOLIDATED FINANCIAL STATEMENTS 

AND 

STATISTICAL REPORTS 

MAY 31, 2011


CONSOLIDATED FINANCIAL STATEMENTS & STATISTICAL REPORTS 

CONSOLIDATED SCHEDULES 

TABLE OF CONTENTS 

SECTION A 

HIGHLIGHTS A.1 

CONSOLIDATED STATISTICAL REPORT A.3 

CONSOLIDATED INCOME STATEMENT A.4 

SOURCES & APPLICATIONS OF FUNDS A.6 

CONSOLIDATED BALANCE SHEET A.7 

CONSOLIDATED FINANCIAL RATIOS A.8 

PAGE 

CONSOLIDATED PAYOR MIX A.10 

CAPITAL STATUS REPORT A.11 

INVESTMENT PERFORMANCE SUMMARY A.12




Actual adjusted admits (overall inpatient & outpatient volume indicator) for the month ended May 31, 2011 are 9,692 which is 0.8% 

greater than budget. Actual inpatient admits for the month are 6,108 or 3.8% greater than budget while actual patient days are 32,914 or 

4.9% greater than budget which resulted in a 5.4 day length of stay. Emergency room visits are 0.7% less than budget while outpatient 

surgeries are 19.5% greater than budget. 

Net patient revenue for May 2011 reflects a $4.6 million or a 5.0% favorable variance to budget. This favorable variance in net patient 

revenue is primarily the result of the 0.8% increase in adjusted admits along with a 4.2% increase in reimbursement during the month. 

Total operating expenses before depreciation and interest expense are $4.7 million greater than budget. All operating expense 

categories except fringe benefits reflect unfavorable variances. Salaries & Wages reflect a $2.4 million unfavorable variance due to 

increased overtime, non-productive salaries and fewer vacant positions. Supplies are $1.5 million over budget primarily due to 

additional implant costs from increased surgical volumes. Other services reflect a $0.5 million unfavorable variance due to legal fees 

and recruiting costs. Actual total operating costs per case mix adjusted admit is 1.1% greater than budget (6,947 actual, 6,871 budget). 

Productivity as measured by FTEs/AOB decreased by 2.8% (5.13 actual, 4.99 budget) for May 2011. 

For May 2011, the gain from operations is $1.3 million versus a budgeted gain of $1.4 million. Excess revenue over expenses is a gain 

of $1.6 million versus a budgeted gain of $4.4 million. Investments were budgeted to return $3.0 million for the month but the actual 

investment return was $0.2 million. 

Page A.1




For the month, Cash & Investments increased by $17.4 million to $527.6 million. Operations increased cash by $7.1 million while 

working capital increased cash by $6.1 million. Cash was reduced by $1.8 million for routine equipment and debt principal payments 

reduced cash by $0.3 million. Days in Accounts Receivable are 49.2 days and resulted in a $6.3 million increase in cash. Total Notes 

& Bonds payable on May 31, 2011 is $688.9 million resulting in a Cash to Debt ratio of 76.6%. 

Net Patient Revenue per adjusted admit CMI for the month ended May 31, 2011 is $7,052 while the Operating Expense per adjusted 

admit CMI is $6,947. The difference which represents the gain from operations per adjusted admit is $105.00 while the budgeted gain 

from operations is $110.00. 

Wages & Benefits as a percent of Net Operating Revenue is 52.7% for May 2011 versus a budget of 53.3%. The actual hourly pay rate 

is $29.49 which is $0.21 greater than budget due to overtime and non-productive wages. YTD, the average hourly rate is $29.73 which 

is 30 cents greater than budget. 

Post Acute entities provided the following YTD contributions to Acute Care by allowing charity care patients into their respective 

programs: Lee Memorial Home Health $501,000; HealthPark Care Center $243,000; The Rehabilitation Hospital $368,000; Access 

Medical South (DME joint venture) $71,000. 

The Lee Physician Group YTD loss per physician is $15,958. This includes practice revenue and expenses along with ancillary revenue 

referred to LMHS. This YTD loss is $34,712 per physician less than budget due to lower operating cost and better collections per visit 

than budget. 

Page A.2


CONSOLIDATED STATISTICAL SUMMARY 



Budget Actual Prior Year Variance Var % Budget Actual Prior Year Variance Var % 

ACT TO BUD ACT TO BUD ACT TO BUD ACT TO BUD 

Admissions 

ADULTS 5,330 5,581 5,464 251 4.7% 45,881 47,465 45,626 1,584 3.5% 

PEDIATRICS 351 341 395 (10) -2.8% 2,992 3,189 3,062 197 6.6% 

NICU 63 52 59 (11) -16.8% 416 429 445 13 3.2% 

POST ACUTE 140 134 147 (6) -4.3% 1,234 1,156 1,216 (78) -6.3% 

Total Adult & Peds 5,884 6,108 6,065 224 3.8% 50,523 52,239 50,349 1,716 3.4% 

NEWBORNS 534 435 481 (99) -18.6% 4,244 3,802 3,981 (442) -10.4% 

Total Admissions 6,418 6,543 6,546 125 1.9% 54,767 56,041 54,330 1,274 2.3% 

Patient Days 

ADULTS 24,417 26,048 24,990 1,631 6.7% 206,910 219,429 207,720 12,519 6.1% 

PEDIATRICS 1,194 1,214 1,360 20 1.6% 10,744 10,512 10,149 (232) -2.2% 

NICU 1,293 1,278 1,454 (15) -1.2% 9,332 9,882 10,164 550 5.9% 

POST ACUTE 4,463 4,374 4,272 (89) -2.0% 34,978 34,360 33,940 (618) -1.8% 

Total Adult & Peds 31,368 32,914 32,076 1,546 4.9% 261,963 274,183 261,973 12,220 4.7% 

NEWBORNS 1,224 1,059 1,170 (165) -13.5% 9,664 9,332 9,682 (332) -3.4% 

Total Patient Days 32,593 33,973 33,246 1,380 4.2% 271,626 283,515 271,655 11,889 4.4% 


ADULTS 4.6 4.7 4.6 0.1 1.9% 4.5 4.6 4.6 0.1 2.5% 

PEDIATRICS 3.4 3.6 3.4 0.2 4.6% 3.6 3.3 3.3 (0.3) -8.2% 

NICU 20.7 24.6 24.6 3.9 18.8% 22.4 23.0 22.8 0.6 2.7% 

POST ACUTE 31.9 32.6 29.1 0.8 2.4% 28.3 29.7 27.9 1.4 4.9% 

Total Adult & Peds 5.3 5.4 5.3 0.1 1.1% 5.2 5.2 5.2 0.1 1.2% 

NEWBORNS 2.3 2.4 2.4 0.1 6.3% 2.3 2.5 2.4 0.2 7.8% 

Total Patient Days 5.1 5.2 5.1 0.1 2.2% 5.0 5.1 5.0 0.1 2.0% 


EMERGENCY ROOM 13,845 13,749 13,738 (96) -0.7% 111,250 111,548 108,813 298 0.3% 

OP SURGERY CASES 1,578 1,885 1,519 307 19.5% 12,738 14,123 12,896 1,385 10.9% 

SUBTOTAL 15,423 15,634 15,257 211 1.4% 123,987 125,671 121,709 1,684 1.4% 


HOME HEALTH ADMISSIONS 350 283 323 (67) -19.2% 2,716 2,732 2,412 16 0.6% 

HOSP BASED PHY ENCOUNTERS 14,798 14,636 13,384 (162) -1.1% 124,298 125,684 115,183 1,386 1.1% 

PHYSICIAN ENCOUNTERS 47,578 43,336 38,047 (4,242) -8.9% 394,792 386,495 333,960 (8,297) -2.1% 

TRAUMA SERVICES DISTRICT 816 902 681 86 10.5% 5,454 5,803 5,174 349 6.4% 

SUBTOTAL 63,542 59,157 52,435 (4,385) -6.9% 527,260 520,714 456,729 (6,546) -1.2% 

TOTAL OP 78,966 74,791 67,692 (4,175) -5.3% 651,247 646,385 578,438 (4,862) -0.7% 

Page A.3


CONSOLIDATED STATEMENT OF OPERATIONS 


( IN THOUSANDS ) 


BUDGET ACTUAL PRIOR YEAR VAR VAR % VAR % BUDGET ACTUAL PRIOR YEAR VAR VAR % VAR % 

ACT TO BUD ACT TO BUD PR YR ACT TO BUD ACT TO BUD PR YR 

INPATIENT REVENUE 207,808 217,591 198,148 9,783 4.7% 9.8% 1,759,782 1,840,652 1,665,557 80,870 4.6% 10.5% 

OUTPATIENT REVENUE 131,882 127,680 110,685 (4,202) -3.2% 15.4% 1,057,209 1,053,668 959,981 (3,541) -0.3% 9.8% 

TOTAL PATIENT REVENUE 339,690 345,271 308,833 5,581 1.6% 11.8% 2,816,992 2,894,321 2,625,538 77,329 2.7% 10.2% 

DED FROM REV-MEDICARE 123,925 123,773 109,280 153 0.1% -13.3% 1,063,340 1,089,660 975,247 (26,320) -2.5% -11.7% 

DED FROM REV-MEDICAID 36,423 35,554 32,156 870 2.4% -10.6% 292,669 294,871 269,052 (2,202) -0.8% -9.6% 

DED FROM REV-CHARITY 11,129 11,740 10,581 (612) -5.5% -11.0% 92,034 93,880 83,650 (1,845) -2.0% -12.2% 

DED FROM REV-HMO/PPO 32,949 31,253 29,798 1,696 5.1% -4.9% 241,221 252,568 254,579 (11,347) -4.7% 0.8% 

DED FROM REV-OTHER 31,281 33,303 26,934 (2,021) -6.5% -23.6% 273,444 284,110 232,658 (10,666) -3.9% -22.1% 

DED FROM REV-BAD DEBT 12,217 13,322 11,446 (1,104) -9.0% -16.4% 100,863 102,830 92,182 (1,967) -2.0% -11.6% 

TOTAL DED FROM REV 247,925 248,944 220,195 (1,019) -0.4% -13.1% 2,063,571 2,117,918 1,907,368 (54,347) -2.6% -11.0% 

NET PATIENT REVENUE 91,764 96,327 88,638 4,563 5.0% 8.7% 753,421 776,402 718,170 22,981 3.1% 8.1% 

OTHER OPER REV 1,564 2,100 1,514 535 34.2% 38.7% 12,605 13,199 11,332 594 4.7% 16.5% 

TOTAL OPERATING REV 93,329 98,427 90,152 5,098 5.5% 9.2% 766,026 789,601 729,502 23,575 3.1% 8.2% 


PROD SALARIES 37,454 38,869 34,691 (1,415) -3.8% -12.0% 292,377 301,175 269,054 (8,799) -3.0% -11.9% 

PROD OVERTIME 933 1,471 1,175 (537) -57.6% -25.1% 10,572 11,924 10,183 (1,352) -12.8% -17.1% 

CONTRACT LABOR 40 133 31 (92) -227.9% -333.9% 2,185 1,810 1,797 375 17.2% -0.7% 

NON-PROD SALARIES 4,339 4,678 4,098 (339) -7.8% -14.1% 37,194 38,831 33,799 (1,637) -4.4% -14.9% 

TOTAL SALARIES & WAGES 42,767 45,151 39,996 (2,384) -5.6% -12.9% 342,327 353,741 314,832 (11,414) -3.3% -12.4% 

FRINGE BENEFITS 7,017 6,757 6,475 260 3.7% -4.3% 56,683 54,076 53,251 2,608 4.6% -1.5% 

HEALTH CARE ACCESS 1,103 1,214 1,198 (111) -10.0% -1.3% 9,122 9,934 9,805 (812) -8.9% -1.3% 

SUPPLIES 18,989 20,519 18,534 (1,530) -8.1% -10.7% 159,934 165,972 158,587 (6,038) -3.8% -4.7% 

OTHER SERVICES 5,396 5,849 4,833 (453) -8.4% -21.0% 42,909 44,903 40,228 (1,995) -4.6% -11.6% 

PURCHASED SERVICES 9,155 9,675 8,552 (520) -5.7% -13.1% 73,859 77,021 71,076 (3,162) -4.3% -8.4% 

TOTAL OPER EXPENSES 84,428 89,165 79,588 (4,737) -5.6% -12.0% 684,834 705,646 647,779 (20,812) -3.0% -8.9% 

EBITDA 8,901 9,262 10,564 361 4.1% -12.3% 81,192 83,955 81,723 2,763 3.4% 2.7% 

DEPRECIATION/AMORT 5,169 5,538 5,884 (369) -7.1% 5.9% 40,964 43,021 37,818 (2,057) -5.0% -13.8% 

INTEREST EXPENSE 2,330 2,380 2,399 (50) -2.2% 0.8% 18,474 19,165 18,199 (690) -3.7% -5.3% 

GAIN(LOSS) FROM OPER 1,402 1,344 2,281 (58) -4.2% -41.1% 21,753 21,770 25,706 16 0.1% -15.3% 

Page A.4


CONSOLIDATED INCOME STATEMENT BY ENTITY 

FOR THE MONTH ENDED MAY 31, 2011 

(IN THOUSANDS) 


ENTITY BUDGET ACTUALVARIANCE PRIOR YR BUDGET ACTUALVARIANCE PRIOR YR 

LEE MEMORIAL HOSPITAL 3,122 3,208 86 4,638 25,691 29,202 3,511 23,818 

HEALTHPARK MEDICAL CTR 6,630 7,165 536 5,625 49,710 55,145 5,435 48,424 

CAPE CORAL HOSPITAL 3,454 4,563 1,109 2,609 28,718 28,336 (382) 27,359 

GULF COAST MEDICAL CENTER 2,433 1,887 (545) 2,414 26,171 25,368 (802) 22,159 

TRAUMA SERVICES DIST (268) (283) (15) (104) (2,746) (2,949) (203) (2,606) 

OUTPATIENT CENTERS 707 501 (206) 114 4,209 5,613 1,404 7,112 

HEALTHPARK CARE CTR 155 143 (12) 147 1,195 1,372 177 985 

HOME HEALTH AGENCIES 125 (37) (162) 54 964 67 (896) 442 

FOUNDATION (56) 4 60 (9) (402) 132 534 159 

REHAB HOSPITAL 426 468 42 371 3,769 3,840 70 3,481 

PHYSICIANS (LPG-MSO-HBP) (4,840) (4,269) 571 (3,503) (35,834) (35,400) 435 (27,359) 

CORPORATE SERVICES (10,397) (11,941) (1,543) (9,996) (79,142) (88,426) (9,284) (77,783) 

AUXILIARY (3) (5) (2) (4) (25) (40) (15) (32) 

CHILD DEVELOP/PPEC (84) (61) 23 (75) (525) (492) 33 (452) 

PHO (0) (0) (0) (0) (1) (1) 0 (1) 

TOTAL GAIN FROM OPS 1,402 1,344 (58) 2,281 21,753 21,770 16 25,706 

INT EARN & REALIZED GAIN 1,655 253 (1,402) (35) 12,474 5,316 (7,158) 5,937 

UNREALIZED GAIN (LOSS) 1,015 (353) (1,368) (8,772) 7,583 24,851 17,268 7,228 

UNREALIZED GAIN (LOSS) ON SWAP 0 0 0 0 0 1,280 1,280 (162) 

OTHER NON OPERATING 268 221 (46) 267 2,145 (23,773) (25,917) 2,632 

RESTRICTED GIFTS 82 89 7 8 656 5,997 5,341 269 

TOTAL NON OPERATING 3,019 211 (2,808) (8,532) 22,857 13,671 (9,186) 15,904 

EXCESS OF REV/EXPS 4,421 1,555 (2,867) (6,252) 44,611 35,441 (9,170) 41,610 

Page A.5

Sources of Funds: 

MONTH YTD 

Excess Revenue Over Expenses 1,555 35,441 

Depreciation/Amortization Expense 5,538 43,021 

Restricted Gifts (89) (5,997) 

SWFRMC Land Value Adjustment 0 24,766 

Total Sources 7,003 97,231 

Uses of Funds: 


SOURCES & APPLICATIONS OF FUNDS 


In Thousands (000's) 

Dec(Inc) in Accts Receivable (6,999) (111,697) 

Provision for Bad Debts 13,322 102,830 

Dec(Inc) in Net Accts Receivable 6,323 (8,867) 

NNet t borrowings b i (337) (13 (13,889) 889) 

Dec(Inc) in Other Assets 621 (5,657) 

Inc(Dec) in Liabilities 5,458 2,292 

Capital Expenditures, net (1,687) (29,998) 

Total Uses 10,379 (56,120) 

Net Increase(Decrease) In Funds 17,382 41,111 

Cash & Investments at beginning of period 510,216 486,485 

Cash & Investments at end of period 527,596 527,596 

Total Bonds & Notes Payable-end of period 688,920 

Cash to Debt Ratio 76.6% 

Page A.6


Consolidated Balance Sheet 

As of MAY 31, 2011 

in Thousands (000's) 

ASSETS: Current Prior Month Prior Year LIABILITIES: Current Prior Month Prior Year 

Current Assets: Current Liabilities: 

Cash And Cash Equivalents * 49,924 1,268 16,087 Accounts Payable 26,910 25,916 34,520 

Operating Fund Investments * 449,373 480,634 432,318 Wages and Benefits Payable 38,263 33,883 31,795 

Accrued Interest Receivable 289 308 371 Notes Payable - Short Term 7,639 7,852 4,349 

Accounts Receivable (net) 156,966 162,058 141,351 Current Portion Bonds Payable 10,580 10,580 14,871 

Accounts Receivable - Phys (Net) 3,878 5,109 10,626 Due to State of Florida 9,877 9,596 13,312 

Inventories 29,201 29,198 29,117 Malpractice Liability - Short Term 5,936 5,936 5,936 

Third Party Settlements 0 0 0 Accrued Bond Costs 3,991 1,995 12,282 

Other Current Assets 11,843 13,138 11,599 Due to LMHS 0 0 0 

Other Current Liabilities 36,178 38,049 32,151 

Total Current Assets: 701,474 691,713 641,468 Total Current Liabilities 139,373 133,807 149,216 

Other Assets Other Liabilities and Fund Balance 

Limited or Restricted Use Assets * 6,678 6,692 17,675 Benefits Payable - Long Term 0 0 0 

Bond Issuance Costs 5,132 5,161 5,685 Notes Payable - Long Term 151,321 151,466 104,040 

Trustee Held Funds * 0 0 0 Due to State of Florida - Long Term 10,432 9,562 3,494 

Directors/Officers Indemnity Fund * 100 100 100 Malpractice Liability - Long Term 10,437 10,202 9,242 

Long Term Operating Fund Investments * 21,521 21,521 20,304 Bonds Payable 519,380 519,359 553,410 

Other Assets 101,087 100,819 100,082 Other Long Term Liabilities 46,159 45,814 39,054 

UnRestricted Fund Balance 626,436 624,971 596,992 

Restricted Fund Balance 28,835 28,746 22,838 

Total Other Assets 134,518 134,293 143,846 Total Other Liabilities & Fund Balance 1,393,001 1,390,119 1,329,070 

Property and Equipment: 

Plant In Use 1,229,650 1,228,446 1,203,696 

Construction in Process 33,284 33,381 26,866 

Accumulated Depreciation (587,734) (584,994) (555,419) 

Total Property & Equipment (Net) 675,200 676,833 675,142 

Restricted Assets 21,182 21,088 17,829 

TOTAL ASSETS 1,532,374 1,523,927 1,478,286 TOTAL LIABILITIES AND EQUITY 1,532,374 1,523,927 1,478,286 

* Cash and Investments 

Above Balance Sheet has been adjusted to eliminate intercompany receivables, payables and investments in subsidiaries 

Page A.7


FINANCIAL RATIOS 

FOR THE 8 MONTHS ENDED MAY 31, 2011 

2009 2011 

Moody's Financial FYE YTD 

Median Goals 2010 5/31/2011 

PROFITABILITY RATIOS: 

Operating Margin (%) - Total 3.0% 2.2% 3.4% 2.8% + 

Excess Margin (%) 5.1% 4.8% 6.2% 3.7% + 

Operating CashFlow Margin (%) 9.9% 10.0% 11.6% 10.6% + 

LIQUIDITY RATIOS: 

Days Cash on Hand (net of Callable Debt) 169.5 138.5 130.5 133.6 + 

Cushion Ratio (x) 15.3 13.7 10.6 11.5 + 

Cash-to-Debt (%) 117.6% 83.7% 71.9% 76.6% + 

CAPITALIZATION RATIOS: 

Debt to Capitalization(%) - (net of Callable Debt) 38 38.9% 9% 41 41.5% 5% 47 47.8% 8% 47 47.0% 0% () (-) 

Annual Debt Service Coverage (x) 4.7 3.5 3.3 3.6 + 

Debt to Cashflow (net of Callable Debt) 3.3 3.7 4.8 4.8 (-) 

NOTE: + = Ratios that should be above the Moody's median 

(-) = Ratios that should be lower than the Moody's median 

Page A.8


CONSOLIDATED OPERATING RATIOS 


AS % NET OPER REV 

CURRENT MONTH 

YEAR TO DATE 

SAME MO % VARIANCE 

SAME MO 

% VARIANCE 

BUDGET ACTUAL PRIOR YR ACT-BUD ACT-PRIOR BUDGET ACTUAL PRIOR YR ACT-BUD ACT-PRIOR 

WAGES & BENEFITS 53.3% 52.7% 51.5% 1.1% -2.3% 52.1% 51.6% 50.5% 0.9% -2.4% 

SUPPLIES 20.3% 20.8% 20.6% -2.4% -1.4% 20.9% 21.0% 21.7% -0.7% 3.3% 

ALL OTHER OPER EXPENSES 16.8% 17.0% 16.2% -1.4% 1.4% -5.1% 5.1% 16.4% 16.7% 16.6% -1.6% 1.6% -0.6% 0.6% 

CAPITAL COSTS 8.0% 7.9% 9.2% 0.5% 13.8% 7.7% 7.7% 7.7% -0.7% -0.9% 

EBITDA MARGIN 9.5% 9.4% 11.7% -1.3% -24.5% 10.6% 10.6% 11.2% 0.3% -5.3% 

OPERATING MARGIN 1.6% 1.5% 2.5% -5.6% -70.1% 2.9% 2.9% 3.5% -0.7% -21.9% 

EXCESS MARGIN 4.8% 1.6% -6.9% -66.6% 531.5% 5.9% 3.8% 5.7% -35.6% -50.2% 

PER CMI ADJ ADMIT / VISIT 

NET OPER REV 6,981 7,052 6,861 1.0% 2.7% 6,814 6,817 6,612 0.0% 3.0% 

TOTAL EXPENSES 6,871 6,947 6,687 -1.1% -3.9% 6,616 6,620 6,379 -0.1% -3.8% 

WAGES & BENEFITS 3,724 3,719 3,537 0.1% -5.1% 3,549 3,521 3,336 0.8% -5.5% 

SUPPLIES 1,420 1,470 1,410 -3.4% -4.3% 1,423 1,433 1,437 -0.7% 0.3% 

ALL OTHER OPER EXPENSES 1,171 1,199 1,110 -2.3% -8.0% 1,120 1,138 1,098 -1.6% -3.6% 

CAPITAL COSTS 556 559 630 -0.5% 11.3% 524 528 508 -0.8% -3.9% 

OPERATING MARGIN 110 105 174 -4.5% -65.7% 198 197 233 -0.5% -18.3% 

EXCESS MARGIN 336 120 (476) -64.3% 496.7% 402 315 377 -21.6% -19.7% 

LABOR 

PROD FTEs/ADJ DAILY ADMIT 24.1 25.0 23.7 -3.8% -5.8% 22.7 22.9 22.1 -0.9% -3.7% 

NON PROD AS % PAID 9.5% 9.5% 9.6% -0.2% 0.4% 9.5% 9.3% 9.3% 2.5% 0.1% 

AVG HOURLY RATE 29.3 29.5 28.3 -0.7% -4.2% 29.4 29.7 28.5 -1.0% -4.3% 

OP REV % OF TOTAL REVENUE 38.8% 37.0% 35.8% -5.0% 3.2% 37.5% 36.4% 36.6% -3.1% -0.4% 

Page A.9


CONSOLIDATED - PAYOR MIX 

May 31, 2011 

Budget Actual Same Mo Budget Actual Same Mo 

Prior Year Prior Year 

MEDICARE 50.9% 50.9% 49.4% 53.0% 53.1% 52.2% 

MEDICAID 11.4% 10.5% 11.3% 11.1% 10.5% 10.8% 

MEDICAID HMO 3.7% 4.2% 4.1% 3.5% 4.0% 3.5% 

HMO/PPO 21.5% 20.5% 21.4% 20.4% 19.9% 21.4% 

COMMERCIAL 3.2% 3.3% 3.1% 3.2% 3.1% 3.3% 

OTHER 9.3% 10.6% 10.7% 8.7% 9.4% 8.8% 

100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 

Budget Actual % Variance Budget Actual % Variance 

MEDICARE CASE MIX INDEX 1.56 1.52 -2.6% 1.56 1.53 -1.9% 

SYSTEM CASE MIX INDEX 1.39 1.44 3.6% 1.39 1.41 1.4% 

09/30/10 05/31/11 Variance 

Gross Accounts Receivable 324,983 355,333 30,350 

Net Accounts Receivable 152,139 160,844 8,705 

Net Days in Accounts Receivable 52.1 49.2 

(2.9) 

CURRENT MONTH YEAR-TO-DATE 

Page A.10


FY 2011 

CAPITAL STATUS REPORT 

May 31, 2011 

CAPITAL 

BUDGET POOL 

$ 

CERF $'s 

APPROVED 

CERF $'s 

SPENT 

CERF's 

PENDING 

APPROVAL 

CAPITAL 

BALANCE 

ROUTINE CAPITAL 

ROUTINE 15,677,860 13,020,691 7,052,922 0 2,657,169 

SURGICAL 4,186,198 2,910,651 1,830,387 0 1,275,547 

RADIOLOGY 6,715,398 4,425,153 90,479 0 2,290,245 

INFORMATION SYSTEMS 9,452,110 2,609,623 1,376,692 0 6,842,487 

EPIC 10,894,925 8,171,194 2,723,731 

MAJOR FACILITIES/PLANT OPS 13,828,293 10,630,684 1,453,996 0 3,197,609 

TACTICAL PLANS 8,645,216 8,640,466 5,468,706 0 4,750 

CONTINGENCY 600,000 200,395 175,125 0 399,605 

TOTAL FY 2011 70,000,000 50,608,858 17,448,307 0 19,391,143 

Unbudgeted- Board Approved 1,928,717 843 0 1,927,874 

Outside Funding 875,300 427,644 0 447,656 

Total Approved Prior Yrs Spent 

EPIC 18,171,194 7,967,441 9,131,477 1,072,276 

THE CHILDREN'S HOSPITAL 335,496 205,562 130,958 (1,024) 

10-1-10 Bal 

FY10 & PRIOR YRS CERF'S- OPEN 29,708,804 8,990,349 20,718,455 

TOTAL FY 2011 CASH OUTLAY FOR CAPITAL 

Page A.11 

36,129,578 

43,556,381

LEE MEMORIAL HEALTH SYSTEM INVESTMENT PORTFOLIO 

DETAILED PERFORMANCE HISTORY 

FOR THE MONTH ENDING MAY 31, 2011 

INTEREST REALIZED BOOK UNREALIZED MARKET MONTHLY % 

INCOME GAINS/(LOSSES) VALUE GAINS/(LOSSES) VALUE RETURN 

CASH MANAGERS 

GENERAL OPERATING ACCOUNTS 0 0 49,923,903 0 49,923,903 

LIMITED/RESTRICTED ASSET ACCTS 114 0 3,398,675 0 3,398,675 0.00% 

NORTHERN TRUST 12,303 0 3,451,464 (11,813) 3,439,651 0.01% 

COMPASS BANK MONEY MARKET 3,389 0 4,566,803 0 4,566,803 0.07% 

COMPASS BANK 7 MONTH CD 3,144 0 7,574,900 0 7,574,900 0.04% 

ML Treasury 91 Day 0.00% 

SEI CASH & EQUIVALENTS 

SEI PRIME OBLIGATION FUND 1,313 0 14,000,000 0 14,000,000 0.01% 


TOTAL CASH & CASH EQUIVALENT 20,263 0 82,915,745 (11,813) 82,903,932 

FIXED INCOME COMPOSITE 

MFO SEI INSTL INVTS TR CORE FIXED INCOME 0.353 179,587 151 61,359,861 536,018 61,895,879 1.20% 

Lehman US Aggregate Index 1.30% 

MFO SEI DAILY INCOME TR ULTRA SHORT BOND 0.093 106,397 (4) 80,159,108 (78,214) 80,080,895 0.10% 

Lehman 9-12 Month US Treasury 0.10% 

MFO SEI INSTL INVTS TR ENHANCED INCOME 0.257 0 (397) 40,349,645 (856) 40,348,790 0.00% 

Merrill Lynch 3 mo Cons-Ma 0.00% 

LOGAN CIRCLE FUND 0.257 39,738 (13,086) 26,500,747 (10,033) 26,490,714 0.10% 


TOTAL FIXED INCOME COMPOSITE 325,722 (13,335) 208,369,361 446,916 208,816,277 

EQUITY COMPOSITE 

DOMESTIC EQUITY 

S&P 500 INDEX EQUITY FUND 0 20 38,208,495 (418,500) 37,789,995 -1.10% 

MFO SEI INSTL INVTS TR LARGECAP 23.4% 0 12 38,652,462 (468,269) 38,184,193 -1.20% 

S&P 500 -1.10% 

MFO SEI SIIT SMALL/MID CAP 6.5% 0 8 15,651,593 (225,660) 15,425,933 -1.40% 

Russell 2500 -1.20% 

SEI CORE PROPERTY FUND LP 0 0 15,307,800 0 15,307,800 0.00% 

NCREIF Property Index 0.00% 

INTERNATIONAL EQUITY 

WORLD EQUITY EX-US 0 (68) 29,413,567 (658,659) 28,754,908 -2.20% 

MSCI ACWI EX-US -2.90% 

TOTAL EQUITY COMPOSITE 0 (27) 137,233,917 (1,771,088) 135,462,829 

ALTERNATIVE INVESTMENTS 

SEI OFFSHORE OPPORTUNITY FUND LI, LTD 0 0 77,876,568 988,118 78,864,685 1.30% 

SEI SPECIAL SITUATIONS FUND 0 0 21,520,510 0 21,520,510 0.00% 


TOTAL OTHER COMPOSITE 0 0 99,397,078 988,118 100,385,195 

FOUNDATION 4,612 (7,134) 

(4,968) 

MISCELLANEOUS OTHER INCOME 214,052 

VARIABLE RATE INTEREST EXPENSE OFFSET (2,154) 

INVESTMENT MANAGER FEES (289,102) 

GRAND TOTAL 273,394 (20,497) 527,916,101 (352,835) 527,568,234 0.00% 

PORTFOLIO INDEX -0.20% 

Page A.12

LEE MEMORIAL HEALTH SYSTEM INVESTMENT PORTFOLIO 

DETAILED PERFORMANCE HISTORY 

FOR THE EIGHTS MONTHS ENDING MAY 31, 2011 

INTEREST REALIZED BOOK UNREALIZED MARKET % 

INCOME GAINS/(LOSSES) VALUE GAINS/(LOSSES) VALUE RETURN* 

CASH MANAGERS 

GENERAL OPERATING ACCOUNTS 33,325 0 49,923,903 0 49,923,903 

LIMITED/RESTRICTED ASSET ACCTS 473 0 3,398,675 0 3,398,675 0.01% 

NORTHERN TRUST 95,852 0 3,530,105 (90,454) 3,439,651 0.15% 

COMPASS BANK MONEY MARKET 25,670 0 4,566,803 0 4,566,803 0.56% 

COMPASS BANK 7 MONTH CD 10,253 0 7,574,900 0 7,574,900 0.14% 


SEI CASH & EQUIVALENTS 

SEI DAILY INCOME TREAS II FUND #37 0 0 0 0 0 0.00% 


SEI PRIME OBLIGATION FUND 19,104 0 14,000,000 0 14,000,000 0.14% 


TOTAL CASH & CASH EQUIVALENT 184,678 0 82,994,386 (90,454) 82,903,932 

FIXED INCOME COMPOSITE 

MFO SEI INSTL INVTS TR CORE FIXED INCOME 3,582,767 151 63,769,198 (1,873,319) 61,895,879 2.90% 

Lehman US Aggregate Index 1.70% 

MFO SEI DAILY INCOME TR ULTRA SHORT BOND 717,449 133,783 80,122,852 (41,957) 80,080,895 1.40% 

Lehman 9-12 Month US Treasury 0.40% 

SIIT REAL RETURN 33,871 425,539 300,089 (300,089) 0 0.60% 

Lehman 1-5 YR US Treasury NA 

MFO SEI INSTL INVTS TR ENHANCED INCOME 574,439 (397) 39,664,080 684,710 40,348,790 3.70% 

Merrill Lynch 3 mo Cons-Ma 0.20% 

LOGAN CIRCLE FUND 246,116 (41,632) 26,565,951 (75,236) 26,490,714 0.49% 


TOTAL FIXED INCOME COMPOSITE 5,154,642 517,444 210,422,169 (1,605,892) 208,816,277 

EQUITY COMPOSITE 

DOMESTIC EQUITY 

S&P 500 INDEX EQUITY FUND 65,076 20 37,189,748 600,247 37,789,995 1.79% 

MFO SEI INSTL INVTS TR LARGECAP 1,272,290 (548,582) 26,705,334 11,478,859 38,184,193 20.10% 

S&P 500 19.40% 

MFO SEI SIIT SMALL/MID CAP 45,541 8 12,390,024 3,035,909 15,425,933 26.00% 

Russell 2500 26.90% 

SEI CORE PROPERTY FUND LP 0 0 15,000,000 307,800 15,307,800 2.05% 

NCREIF Property Index NA 

INTERNATIONAL EQUITY 

WORLD EQUITY EX-US 461,237 (68) 25,495,023 3,259,885 28,754,908 15.50% 

MSCI ACWI EX-US 12.90% 

TOTAL EQUITY COMPOSITE 1,844,144 (548,621) 116,780,129 18,682,700 135,462,829 

ALTERNATIVE INVESTMENTS 

SEI OFFSHORE OPPORTUNITY FUND LI, LTD 0 0 74,729,198 4,135,488 78,864,685 7.40% 

SEI SPECIAL SITUATIONS FUND 0 0 20,304,325 1,216,185 21,520,510 6.00% 


REAL ESTATE INVESTMENT TRUST 

REIT FUND 249,105 (1,311,857) (2,348,362) 2,348,362 0 9.80% 

DJ WILSHIRE RESI NA 

TOTAL OTHER COMPOSITE 249,105 (1,311,857) 92,685,161 7,700,035 100,385,195 

FOUNDATION 64,954 (43,175) 

164,417 

MISCELLANEOUS OTHER INCOME 2,817,378 

VARIABLE RATE INTEREST EXPENSE OFFSET (90,209) 

INVESTMENT MANAGER FEES (2,250,244) 

GRAND TOTAL 7,974,449 (1,386,208) 502,881,845 24,850,806 527,568,234 7.20% 

PORTFOLIO INDEX 4.70% 

*Net of reallocations between funds 

Page A.13


CONSOLIDATED FINANCIAL STATEMENTS & STATISTICAL REPORTS 

CONSOLIDATING SCHEDULES 


SECTION B 

CONSOLIDATING STATISTICAL REPORT B.1 

PAGE 

CONSOLIDATING INCOME STATEMENT – MONTH B.7 

YTD B.10 

CONSOLIDATING FINANCIAL RATIOS B.13 

STAFFING SUMMARY B.17 

SUMMARY OF ACCOUNTS RECEIVABLE B.18


STATISTICAL SUMMARY 

CONSOLIDATING ACTUAL 

FOR THE MONTH ENDING MAY 31, 2011 

OP HOME 

SYSTEM LEE HPMC CCH GCMC CENTERS HPCC HEALTH REHAB 

Admissions 

ADULTS 5,581 1,180 1,432 1,227 1,742 0 0 0 0 

PEDIATRICS 341 0 341 0 0 0 0 0 0 

NICU 52 0 52 0 0 0 0 0 0 

POST ACUTE 134 0 0 0 0 0 67 0 67 

Total Adult & Peds 6,108 1,180 1,825 1,227 1,742 0 67 0 67 

NEWBORNS 435 0 208 115 112 0 0 0 0 

Total Admissions 6,543 1,180 2,033 1,342 1,854 0 67 0 67 

Patient Days 

ADULTS 26,048 6,390 6,102 5,422 8,134 0 0 0 0 

PEDIATRICS 1,214 0 1,214 0 0 0 0 0 0 

NICU 1,278 0 1,278 0 0 0 0 0 0 

POST ACUTE 4,374 0 0 0 0 0 3,346 0 1,028 

Total Adult & Peds 32,914 6,390 8,594 5,422 8,134 0 3,346 0 1,028 

NEWBORNS 1,059 0 444 360 255 0 0 0 0 

Total Patient Days 33,973 6,390 9,038 5,782 8,389 0 3,346 0 1,028 


ADULTS 4.7 

PEDIATRICS 3.6 

NICU 24.6 

POST ACUTE 32.6 

Total Adult & Peds 5.4 

NEWBORNS 2.4 

Total Patient Days 5.2 

5.4 

4.3 

4.4 

4.7 

0.0 0.0 0.0 0.0 

0.0 3.6 

0.0 0.0 0.0 0.0 0.0 0.0 

0.0 24.6 

0.0 0.0 0.0 0.0 0.0 0.0 

0.0 0.0 0.0 0.0 0.0 49.9 

0.0 15.3 

5.4 

4.7 

4.4 

4.7 

0.0 49.9 

0.0 15.3 

0.0 2.1 

3.1 

2.3 

0.0 0.0 0.0 0.0 

5.4 

4.4 

4.3 

4.5 

0.0 49.9 

0.0 15.3 


EMERGENCY ROOM 13,749 3,463 3,642 3,917 2,727 0 0 0 0 

OP SURGERY CASES 1,885 316 472 318 355 424 0 0 0 

SUBTOTAL 15,634 3,779 4,114 4,235 3,082 424 0 0 0 


HOME HEALTH ADMISSIONS 283 0 0 0 0 0 0 283 0 

HOSP BASED PHY ENCOUNTERS 14,636 0 0 0 0 0 0 0 0 

PHYSICIAN ENCOUNTERS 43,336 0 0 0 0 0 0 0 0 

TRAUMA 902 902 0 0 0 0 0 0 0 

SUBTOTAL 59,157 902 0 0 0 0 0 283 0 

TOTAL OP 74,791 4,681 4,114 4,235 3,082 424 0 283 0 

Page B.1


CONSOLIDATING STATISTICAL 

ACTUAL TO BUDGET VARIANCE 


OP ALL 

SYSTEM LEE HP CCH GCMC CENTERS HPCC HH REHAB PHYSICIANS 

Admissions 

ADULTS 251 153 10 20 68 0 0 0 0 0 

PEDIATRICS (10) 0 (10) 0 0 0 0 0 0 0 

NICU (11) 0 (11) 0 0 0 0 0 0 0 

POST ACUTE (6) 0 0 0 0 0 7 0 (13) 0 

Total Adult & Peds 224 153 (10) 20 68 0 7 0 (13) 0 

NEWBORNS (99) 0 (41) (17) (42) 0 0 0 0 0 

Total Admissions 125 153 (51) 3 26 0 7 0 (13) 0 

Patient Days 

ADULTS 1,631 604 296 264 467 0 0 0 0 0 

PEDIATRICS 20 0 20 0 0 0 0 0 0 0 

NICU (15) 0 (15) 0 0 0 0 0 0 0 

POST ACUTE (89) 0 0 0 0 0 (8) 0 (81) 0 

Total Adult & Peds 1,546 604 301 264 467 0 (8) 0 (81) 0 

NEWBORNS (165) 0 (103) (0) (62) 0 0 0 0 0 

Total Patient Days 1,380 604 197 263 405 0 (8) 0 (81) 0 


ADULTS 0.1 (0.2) 0.2 0.1 0.1 0.0 0.0 0.0 0.0 0.0 

PEDIATRICS 0.2 0.0 0.2 0.0 0.0 0.0 0.0 0.0 0.0 0.0 

NICU 3.9 0.0 3.9 0.0 0.0 0.0 0.0 0.0 0.0 0.0 

POST ACUTE 0.8 0.0 0.0 0.0 0.0 0.0 (6.0) 0.0 1.5 0.0 

Total Adult & Peds 0.1 (0.2) 4.2 0.1 0.1 0.0 (6.0) 0.0 1.5 0.0 

NEWBORNS 0.1 0.0 (0.1) 0.4 0.2 0.0 0.0 0.0 0.0 0.0 

Total Patient Days 0.1 (0.2) 4.2 0.5 0.3 0.0 (6.0) 0.0 1.5 0.0 


EMERGENCY ROOM (96) 35 30 (131) (31) 0 0 0 0 0 

OP SURGERY CASES 307 55 104 (43) (44) 235 0 0 0 0 

SUBTOTAL 211 90 134 (174) (75) 235 0 0 0 0 


HOME HEALTH ADMISSIONS (67) 0 0 0 0 0 0 (67) 0 0 

HOSP BASED PHY ENCOUNT (162) 0 0 0 0 0 0 0 0 (162) 

PHYSICIAN ENCOUNTERS (4,242) 0 0 0 0 0 0 0 0 (4,242) 

TRAUMA 86 86 0 0 0 0 0 0 0 0 

SUBTOTAL (4,385) 86 0 0 0 0 0 (67) 0 (4,404) 

TOTAL OP (4,175) 176 134 (174) (75) 235 0 (67) 0 (4,404) 

Page B.2



ACTUAL TO PRIOR MONTH VARIANCE 


OP ALL 


Admissions 

ADULTS 117 72 (4) 0 49 0 0 0 0 0 

PEDIATRICS (54) 0 (24) (30) 0 0 0 0 0 0 

NICU (7) 0 (7) 0 0 0 0 0 0 0 

POST ACUTE (13) 0 0 0 0 0 0 0 (13) 0 

Total Adult & Peds 43 72 (35) (30) 49 0 0 0 (13) 0 

NEWBORNS (46) 0 (37) 10 (19) 0 0 0 0 0 

Total Admissions (3) 72 (72) (20) 30 0 0 0 (13) 0 

Patient Days 

ADULTS 1,058 375 347 (65) 401 0 0 0 0 0 

PEDIATRICS (146) 0 (75) (71) 0 0 0 0 0 0 

NICU (176) 0 (176) 0 0 0 0 0 0 0 

POST ACUTE 102 0 0 0 0 0 27 0 75 0 

Total Adult & Peds 838 375 96 (136) 401 0 27 0 75 0 

NEWBORNS (111) 0 (73) (7) (31) 0 0 0 0 0 

Total Patient Days 727 375 23 (143) 370 0 27 0 75 0 


ADULTS 0.1 (0.0) 0.3 (0.1) 0.1 0.0 0.0 0.0 0.0 0.0 

PEDIATRICS 0.1 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 

NICU (0.1) 0.0 (0.1) 0.0 0.0 0.0 0.0 0.0 0.0 0.0 

POST ACUTE 3.6 0.0 0.0 0.0 0.0 0.0 0.4 0.0 3.4 0.0 

Total Adult & Peds 0.1 (0.0) 0.2 (0.1) 0.1 0.0 0.4 0.0 3.4 0.0 

NEWBORNS 0.0 0.0 0.0 (0.4) 2.3 0.0 0.0 0.0 0.0 0.0 

Total Patient Days 0.1 (0.0) 0.2 (0.4) 2.4 0.0 0.4 0.0 3.4 0.0 


EMERGENCY ROOM 11 (55) (47) 25 88 0 0 0 0 0 

OP SURGERY CASES 366 (25) (14) 7 (26) 424 0 0 0 0 

SUBTOTAL 377 (80) (61) 32 62 424 0 0 0 0 


HOME HEALTH ADMISSIONS (40) 0 0 0 0 0 0 (40) 0 0 

HOSP BASED PHY ENCOUNTE 1,252 0 0 0 0 0 0 0 0 1,252 

PHYSICIAN ENCOUNTERS 5,289 0 0 0 0 0 0 0 0 5,289 

TRAUMA 221 221 0 0 0 0 0 0 0 0 

SUBTOTAL 6,722 221 0 0 0 0 0 (40) 0 6,541 

TOTAL OP 7,099 141 (61) 32 62 424 0 (40) 0 6,541 

Page B.3


STATISTICAL SUMMARY 

CONSOLIDATING ACTUAL 

FOR THE 8 MONTHS ENDING MAY 31, 2011 

OP HOME 

SYSTEM LEE HPMC CCH GCMC CENTERS HPCC HEALTH REHAB 

Admissions 

ADULTS 47,465 9,680 12,472 10,231 15,082 0 0 0 0 

PEDIATRICS 3,189 0 3,120 69 0 0 0 0 0 

NICU 429 0 429 0 0 0 0 0 0 

POST ACUTE 1,156 0 0 0 0 0 511 0 645 

Total Adult & Peds 52,239 9,680 16,021 10,300 15,082 0 511 0 645 

NEWBORNS 3,802 0 1,800 895 1,107 0 0 0 0 

Total Admissions 56,041 9,680 17,821 11,195 16,189 0 511 0 645 

Patient Days 

ADULTS 219,429 51,706 53,947 45,166 68,610 0 0 0 0 

PEDIATRICS 10,512 0 10,378 134 0 0 0 0 0 

NICU 9,882 0 9,882 0 0 0 0 0 0 

POST ACUTE 34,360 0 0 0 0 0 26,164 0 8,196 

Total Adult & Peds 274,183 51,706 74,207 45,300 68,610 0 26,164 0 8,196 

NEWBORNS 9,332 0 3,894 2,827 2,611 0 0 0 0 

Total Patient Days 283,515 51,706 78,101 48,127 71,221 0 26,164 0 8,196 


ADULTS 4.6 

PEDIATRICS 3.3 

NICU 23.0 

POST ACUTE 29.7 

Total Adult & Peds 5.2 

NEWBORNS 2.5 

Total Patient Days 5.1 

5.3 

4.3 

4.4 

4.5 

0.0 0.0 0.0 0.0 

0.0 3.3 

1.9 

0.0 0.0 0.0 0.0 0.0 

0.0 23.0 

0.0 0.0 0.0 0.0 0.0 0.0 

0.0 0.0 0.0 0.0 0.0 51.2 

0.0 12.7 

5.3 

4.6 

4.4 

4.5 

0.0 51.2 

0.0 12.7 

0.0 2.2 

3.2 

2.4 

0.0 0.0 0.0 0.0 

5.3 

4.4 

4.3 

4.4 

0.0 51.2 

0.0 12.7 


EMERGENCY ROOM 111,548 27,756 30,933 30,863 21,996 0 0 0 0 

OP SURGERY CASES 14,123 2,751 4,076 2,593 2,966 1,737 0 0 0 

SUBTOTAL 125,671 30,507 35,009 33,456 24,962 1,737 0 0 0 


HOME HEALTH ADMISSIONS 2,732 0 0 0 0 0 0 2,732 0 

HOSP BASED PHY ENCOUNTERS 125,684 0 0 0 0 0 0 0 0 

PHYSICIAN ENCOUNTERS 386,495 0 0 0 0 0 0 0 0 

TRAUMA 5,803 5,803 0 0 0 0 0 0 0 

SUBTOTAL 520,714 5,803 0 0 0 0 0 2,732 0 

TOTAL OP 646,385 36,310 35,009 33,456 24,962 1,737 0 2,732 0 

Page B.4



ACTUAL TO BUDGET VARIANCE 


OPC ALL 


Admissions 

ADULTS 1,584 731 486 (257) 623 0 0 0 0 0 

PEDIATRICS 197 0 128 69 0 0 0 0 0 0 

NICU 13 0 13 0 0 0 0 0 0 0 

POST ACUTE (78) 0 0 0 0 0 (11) 0 (67) 0 

Total Adult & Peds 1,716 731 627 (188) 623 0 (11) 0 (67) 0 

NEWBORNS (442) 0 (204) (76) (162) 0 0 0 0 0 

Total Admissions 1,274 731 423 (264) 462 0 (11) 0 (67) 0 

Patient Days 

ADULTS 12,519 4,434 2,797 1,546 3,742 0 0 0 0 0 

PEDIATRICS (232) 0 (366) 134 0 0 0 0 0 0 

NICU 550 0 550 0 0 0 0 0 0 0 

POST ACUTE (618) 0 0 0 0 0 (117) 0 (501) 0 

Total Adult & Peds 12,220 4,434 2,982 1,680 3,742 0 (117) 0 (501) 0 

NEWBORNS (332) 0 (457) 129 (3) 0 0 0 0 0 

Total Patient Days 11,889 4,434 2,525 1,809 3,739 0 (117) 0 (501) 0 


ADULTS 0.0 0.1 0.1 0.3 0.1 0.0 0.0 0.0 0.0 0.0 

PEDIATRICS (0.3) 0.0 (0.3) 0.0 0.0 0.0 0.0 0.0 0.0 0.0 

NICU 0.6 0.0 0.6 0.0 0.0 0.0 0.0 0.0 0.0 0.0 

POST ACUTE 1.4 0.0 0.0 0.0 0.0 0.0 0.9 0.0 0.5 0.0 

Total Adult & Peds (0.0) 0.0 (0.0) 0.0 0.0 0.0 0.9 0.0 0.5 0.0 

NEWBORNS 0.2 0.0 (0.0) 0.4 0.3 0.0 0.0 0.0 0.0 0.0 

Total Patient Days (0.0) 0.0 (0.0) 0.4 0.3 0.0 0.9 0.0 0.5 0.0 


EMERGENCY ROOM 298 674 688 (552) (511) 0 0 0 0 0 

OP SURGERY CASES 1,385 579 544 (319) (124) 705 0 0 0 0 

SUBTOTAL 1,684 1,253 1,232 (871) (636) 705 0 0 0 0 


HOME HEALTH ADMISSIONS 16 0 0 0 0 0 0 16 0 0 

HOSP BASED PHY ENCOUNTE 1,386 0 0 0 0 0 0 0 0 1,386 

PHYSICIAN ENCOUNTERS (8,297) 0 0 0 0 0 0 0 0 (8,297) 

TRAUMA 349 349 0 0 0 0 0 0 0 0 

SUBTOTAL (6,546) 349 0 0 0 0 0 16 0 (6,911) 

TOTAL OP (4,862) 1,602 1,232 (871) (636) 705 0 16 0 (6,911) 

Page B.5



ACTUAL TO PRIOR YEAR VARIANCE 


OP ALL 


Admissions 

ADULTS 1,839 729 523 (138) 725 0 0 0 0 0 

PEDIATRICS 127 0 334 (207) 0 0 0 0 0 0 

NICU (16) 0 (16) 0 0 0 0 0 0 0 

POST ACUTE (60) 0 0 0 0 0 (20) 0 (40) 0 

Total Adult & Peds 1,890 729 841 (345) 725 0 (20) 0 (40) 0 

NEWBORNS (179) 0 (129) 4 (54) 0 0 0 0 0 

Total Admissions 1,711 729 712 (341) 671 0 (20) 0 (40) 0 

Patient Days 

ADULTS 11,709 3,640 3,683 507 3,879 0 0 0 0 0 

PEDIATRICS 363 0 924 (561) 0 0 0 0 0 0 

NICU (282) 0 (282) 0 0 0 0 0 0 0 

POST ACUTE 420 0 0 0 0 0 205 0 215 0 

Total Adult & Peds 12,210 3,640 4,325 (54) 3,879 0 205 0 215 0 

NEWBORNS (350) 0 (255) (38) (57) 0 0 0 0 0 

Total Patient Days 11,860 3,640 4,070 (92) 3,822 0 205 0 215 0 


ADULTS 0.1 (0.0) 0.1 0.1 0.0 0.0 0.0 0.0 0.0 0.0 

PEDIATRICS (0.0) 0.0 (0.1) (4.5) 0.0 0.0 0.0 0.0 0.0 0.0 

NICU 0.2 0.0 0.2 0.0 0.0 0.0 0.0 0.0 0.0 0.0 

POST ACUTE 1.8 0.0 0.0 0.0 0.0 0.0 2.3 0.0 1.1 0.0 

Total Adult & Peds 0.0 (0.0) 0.2 (4.4) 0.0 0.0 2.3 0.0 1.1 0.0 

NEWBORNS 0.0 0.0 0.0 (0.1) 1.1 0.0 0.0 0.0 0.0 0.0 

Total Patient Days 0.1 (0.0) 0.3 (4.4) 1.1 0.0 2.3 0.0 1.1 0.0 


EMERGENCY ROOM 2,735 1,107 772 656 200 0 0 0 0 0 

OP SURGERY CASES 1,227 4 86 (223) (377) 1,737 0 0 0 0 

SUBTOTAL 3,962 1,111 858 433 (177) 1,737 0 0 0 0 


HOME HEALTH ADMISSIONS 320 0 0 0 0 0 0 320 0 0 

HOSP BASED PHY ENCOUNTERS 10,501 0 0 0 0 0 0 0 0 10,501 

PHYSICIAN ENCOUNTERS 52,535 0 0 0 0 0 0 0 0 52,535 

TRAUMA 629 629 0 0 0 0 0 0 0 0 

SUBTOTAL 63,985 629 0 0 0 0 0 320 0 63,036 

TOTAL OP 67,947 1,740 858 433 (177) 1,737 0 320 0 63,036 

Page B.6


CONSOLIDATING INCOME STATEMENT 

ACTUAL DOLLARS - IN THOUSANDS 


OP HOME ALL CORP ALL 

SYSTEM LMH HPMC CCH GCMC TRAUMA CENTERS HPCC HEALTH REHAB PHYSICIANS FOUND SVS OTHERS 

INPATIENT REVENUE 217,591 48,687 62,047 37,493 65,928 0 78 1,588 0 1,770 0 0 0 0 

OUTPATIENT REVENUE 127,680 20,124 22,275 21,621 20,221 765 16,351 0 849 33 25,447 0 (5) 0 

TOTAL PATIENT REVENUE 345,271 68,811 84,322 59,114 86,149 765 16,428 1,588 849 1,803 25,447 0 (5) 0 

DED FROM REV-MEDICARE 123,773 23,573 27,891 25,647 38,705 0 6,930 368 32 627 0 0 0 0 

DED FROM REV-MEDICAID 35,554 7,313 14,708 5,572 6,561 0 1,358 27 14 0 0 0 0 0 

DED FROM REV-CHARITY 11,740 4,690 2,652 2,698 1,533 0 124 21 22 0 0 0 0 0 

DED FROM REV-HMO/PPO 31,253 5,882 10,294 5,578 7,918 0 1,520 0 34 27 0 0 0 0 

DED FROM REV-OTHER 33,303 7,161 2,284 1,648 6,484 270 1,483 73 0 24 13,876 0 0 0 

DED FROM REV-BAD DEBT 13,322 3,294 1,381 1,970 3,411 194 364 0 4 20 2,683 0 0 0 

TOTAL DED FROM REV 248,944 51,914 59,210 43,113 64,612 464 11,779 489 107 697 16,560 0 0 0 

NET PATIENT REVENUE 96,327 16,897 25,112 16,001 21,537 301 4,650 1,099 742 1,106 8,888 0 (5) 0 

OTHER OPER REV 2,100 70 118 112 95 2 91 8 42 0 164 224 774 399 

0 

TOTAL OPERATING REV 98,427 16,968 25,230 16,113 21,632 302 4,741 1,107 784 1,106 9,052 224 770 399 


PROD SALARIES 38,869 4,880 7,081 4,523 6,274 267 1,518 514 562 425 7,297 102 5,185 242 

PROD OVERTIME 1,471 278 286 198 449 0 18 38 1 13 30 (0) 160 0 

CONTRACT LABOR 133 5 26 20 57 0 0 0 11 9 1 0 2 0 

NON-PROD SALARIES 4,678 540 814 529 761 33 175 52 58 53 894 8 732 29 

TOTAL SALARIES & WAGES 45,151 5,703 8,208 5,270 7,541 299 1,712 604 632 499 8,221 110 6,080 271 

FRINGE BENEFITS 6,757 1,197 1,276 834 1,123 22 249 93 92 80 780 16 944 50 

HEALTH CARE ACCESS 1,214 278 341 215 301 0 35 37 0 7 0 0 0 0 

SUPPLIES 20,519 4,990 4,920 3,308 5,374 2 874 78 10 24 384 2 456 98 

OTHER SERVICES 5,849 503 669 504 669 6 515 28 46 4 739 65 2,073 27 

PURCHASED SERVICES 9,675 551 866 612 1,597 254 152 93 30 14 2,991 26 2,479 11 

TOTAL OPER EXPENSES 89,165 13,221 16,280 10,743 16,606 582 3,537 932 811 628 13,115 220 12,031 458 

EBITDA 9,262 3,747 8,949 5,370 5,026 (279) 1,204 175 (27) 478 (4,063) 4 (11,262) (60) 

DEPRECIATION/AMORT 5,538 444 1,490 544 1,784 3 390 24 10 10 149 0 684 7 

INTEREST EXPENSE 2,380 94 294 263 1,355 0 313 8 0 0 57 0 (5) 0 

GAIN(LOSS) FROM OPER 1,344 3,208 7,165 4,563 1,887 (283) 501 143 (37) 468 (4,269) 4 (11,941) (66) 

NON OPERATING REV 

INT EARN & REALIZED GAIN 253 244 (4) 1 12 0 0 0 0 0 0 (5) 0 5 

UNREALIZED GAIN (LOSS) (353) (348) 0 0 0 0 0 0 0 0 0 (5) 0 0 

UNREALIZED GAIN (LOSS) ON SWAP 0 0 0 0 0 0 0 0 0 0 0 0 0 0 

OTHER NON OPER REV 221 136 0 (0) (65) 0 0 33 67 51 0 0 0 0 

RESTRICTED GIFTS 89 0 0 0 0 0 0 0 0 0 0 89 0 0 

TOTAL NON OPER REV 211 32 (4) 1 (53) 0 0 33 67 51 0 79 0 5 

EXCESS REV/EXPS 1,555 3,241 7,161 4,564 1,834 (283) 501 176 30 519 (4,269) 83 (11,941) (61) 

Page B.7



ACTUAL TO BUDGET DOLLAR VARIANCE - IN THOUS 



SYSTEM LMH HPMC CCH GCMC TRAUMA CENTERS HPCC HEALTH REHAB PHYSICIANS FOUND SVCS OTHERS 

INPATIENT REVENUE 9,783 4,883 621 945 3,189 0 (0) 291 0 (145) 0 0 0 0 

OUTPATIENT REVENUE (4,202) 2,104 (2,093) (1,459) (1,182) 38 (1,554) 0 (143) 26 66 0 (5) 0 

TOTAL PATIENT REVENUE 5,581 6,986 (1,471) (514) 2,007 38 (1,555) 291 (143) (119) 66 0 (5) 0 

DED FROM REV-MEDICARE 153 (748) 2,534 369 (652) 0 (1,123) (197) (2) (29) 0 0 0 0 

DED FROM REV-MEDICAID 870 (1,851) 593 268 1,321 0 544 (15) 10 0 0 0 0 0 

DED FROM REV-CHARITY (612) (38) (54) (358) (315) 0 148 (6) 12 0 0 0 0 0 

DED FROM REV-HMO/PPO 1,696 28 (271) (4) 781 0 995 0 15 153 0 0 0 0 

DED FROM REV-OTHER (2,021) (2,702) (132) 1,726 (2,186) (117) 880 (37) 3 (24) 567 0 0 0 

DED FROM REV-BAD DEBT (1,104) (364) 24 19 (887) 191 (28) 13 2 14 (88) 0 0 0 

TOTAL DED FROM REV (1,019) (5,675) 2,694 2,020 (1,939) 73 1,418 (243) 39 114 480 0 0 0 

NET PATIENT REVENUE 4,563 1,312 1,223 1,505 68 112 (137) 49 (104) (5) 546 0 (5) 0 

OTHER OPER REV 535 1 23 2 (4) (11) 20 2 (9) 0 81 25 409 (2) 

TOTAL OPERATING REV 5,098 1,312 1,245 1,507 64 101 (117) 51 (113) (5) 626 25 404 (2) 


PROD SALARIES (1,415) (440) (277) (128) (124) (22) 63 (45) (27) 37 105 5 (568) 5 

PROD OVERTIME (537) (75) (64) (66) (158) 17 (3) (4) (1) 1 (27) 0 (157) (0) 

CONTRACT LABOR (92) 23 (26) (17) (57) 0 (0) 0 (2) (9) (1) 0 (2) 0 

NON-PROD SALARIES (339) (5) (66) (37) (93) (4) 5 (5) (7) (4) (141) 11 9 (2) 

TOTAL SALARIES & WAGES (2,384) (497) (434) (247) (432) (9) 64 (54) (38) 25 (63) 16 (719) 3 

FRINGE BENEFITS 260 124 82 60 85 (22) 24 (8) (2) 15 98 3 (193) (5) 

HEALTH CARE ACCESS (111) (71) (13) (26) (7) 0 9 (4) 0 2 0 0 0 0 

SUPPLIES (1,530) (987) 101 (119) (252) (0) (115) (3) 3 4 (66) 1 (106) 10 

OTHER SERVICES (453) 13 (67) (7) 6 1 71 (0) (1) (1) 15 24 (523) 16 

PURCHASED SERVICES (520) (70) (84) 17 2 (87) (47) 12 (5) 1 (65) (9) (184) (1) 

TOTAL OPER EXPENSES (4,737) (1,487) (416) (323) (598) (117) 6 (58) (44) 47 (81) 35 (1,726) 23 

EBITDA 361 (175) 830 1,184 (534) (16) (111) (7) (157) 42 545 60 (1,322) 21 

DEPRECIATION/AMORT (369) 305 (290) (49) 6 1 (85) (0) (5) 0 32 0 (283) (0) 

INTEREST EXPENSE (50) (43) (4) (27) (18) 0 (10) (5) 0 0 (6) 0 62 0 

GAIN(LOSS) FROM OPER (58) 86 536 1,109 (545) (15) (206) (12) (162) 42 571 60 (1,543) 21 


INT EARN & REALIZED GAIN (1,402) (1,434) 32 1 12 0 0 0 0 0 0 (15) 0 2 

UNREALIZED GAIN(LOSS) (1,368) (1,362) 0 0 0 0 0 0 0 0 0 (5) 0 0 

UNREALIZED GAIN(LOSS) ON SWAP 0 0 0 0 0 0 0 0 0 0 0 0 0 0 

OTHER NON OPER REV (46) (139) 0 (0) (69) 0 0 33 62 51 0 17 0 0 


TOTAL NON OPER REV (2,808) (2,935) 32 1 (58) 0 0 33 62 51 0 4 0 2 

EXCESS OF REV / EXPS (2,867) (2,849) 567 1,110 (603) (15) (206) 21 (100) 93 571 64 (1,543) 23 

Page B.8



ACTUAL TO PRIOR MONTH DOLLAR VARIANCE - IN THOUS 



SYSTEM LMH HP CCH GCMC TRAUMA CENTERS HPCC HEALTH REHAB PHYSICIANS FOUND SVCS OTHERS 

INPATIENT REVENUE 19,443 6,756 5,375 1,687 5,133 0 27 336 0 130 0 0 0 0 

OUTPATIENT REVENUE 16,995 3,813 572 2,424 (781) 186 6,905 0 (11) 17 3,874 0 (5) 0 

TOTAL PATIENT REVENUE 36,438 10,570 5,946 4,111 4,352 186 6,932 336 (11) 148 3,874 0 (5) 0 

DED FROM REV-MEDICARE (14,493) (3,715) (2,689) (2,262) (2,201) 0 (3,249) (226) (7) (143) 0 0 0 0 

DED FROM REV-MEDICAID (3,398) (1,240) (577) (884) (299) 0 (391) (15) 7 0 0 0 0 0 

DED FROM REV-CHARITY (1,159) (764) (301) (495) 452 0 (40) (7) (3) 0 0 0 0 0 

DED FROM REV-HMO/PPO (1,455) (1,226) (1,034) 433 616 0 (327) 0 4 80 0 0 0 0 

DED FROM REV-OTHER (6,368) (3,368) 1,140 981 (2,247) 5 (745) (27) 4 52 (2,162) 0 0 0 

DED FROM REV-BAD DEBT (1,876) (652) (123) (97) (747) 11 (199) 0 (1) 3 (69) 0 0 0 

TOTAL DED FROM REV (28,749) (10,965) (3,585) (2,325) (4,427) 16 (4,951) (276) 4 (8) (2,231) 0 0 0 

NET PATIENT REVENUE 7,689 (395) 2,362 1,786 (76) 202 1,981 60 (7) 140 1,643 0 (5) 0 

OTHER OPER REV 586 11 37 23 12 0 25 2 (2) (0) 65 (95) 545 (38) 

TOTAL OPERATING REV 8,275 (384) 2,398 1,808 (63) 203 2,006 62 (9) 140 1,708 (95) 540 (38) 


PROD SALARIES (4,178) (355) (354) (76) (181) (76) (571) (39) (71) (18) (1,138) 0 (1,301) 1 

PROD OVERTIME (295) (60) 4 (52) (41) 0 (6) (2) (0) (7) (5) 0 (128) 2 

CONTRACT LABOR (102) (5) (28) (24) (46) 0 (0) 0 15 (9) (1) 0 (2) 0 

NON-PROD SALARIES (580) (38) (104) (34) (111) 97 (61) (9) (7) (1) (266) 3 (46) (2) 

TOTAL SALARIES & WAGES (5,155) (458) (482) (185) (379) 20 (638) (49) (64) (35) (1,411) 4 (1,477) 0 

FRINGE BENEFITS (281) 82 (27) (16) 3 1 (81) (2) (8) 1 (16) (0) (222) 5 

HEALTH CARE ACCESS (16) 28 (17) 17 (5) 0 (35) (3) 0 (0) 0 0 0 0 

SUPPLIES (1,986) (1,148) 121 (265) (193) (1) (402) (7) (1) 4 (104) (0) (13) 22 

OTHER SERVICES (1,016) (100) (96) (73) (30) (2) (162) 1 (4) (0) (49) 97 (626) 27 

PURCHASED SERVICES (1,123) 320 (212) 215 113 (400) (160) (4) (8) (12) (946) 7 (31) (4) 

TOTAL OPER EXPENSES (9,577) (1,276) (713) (308) (492) (381) (1,477) (64) (85) (43) (2,526) 108 (2,370) 51 

EBITDA (1,302) (1,660) 1,685 1,501 (555) (179) 529 (2) (94) 96 (818) 12 (1,830) 13 

DEPRECIATION/AMORT 229 217 (213) 576 (64) 0 (125) (1) 3 1 (58) 0 (106) 0 

INTEREST EXPENSE 32 14 68 (122) 92 0 (17) (1) 0 0 6 0 (8) 0 

GAIN(LOSS) FROM OPER (937) (1,429) 1,540 1,954 (526) (179) 386 (4) (91) 97 (766) 12 (1,944) 13 


INT EARN & REALIZED GAIN 288 375 (7) (2) (60) 0 0 0 0 0 0 (20) 0 1 

UNREALIZED GAIN(LOSS) 8,419 8,381 0 0 0 0 0 0 0 0 0 38 0 0 

UNREALIZED GAIN(LOSS) ON SWAP 0 0 0 0 0 0 0 0 0 0 0 0 0 0 

OTHER NON OPER REV (45) (36) 0 (0) (76) 0 0 6 16 46 0 0 0 0 


TOTAL NON OPER REV 8,743 8,721 (7) (2) (136) 0 0 6 16 46 0 99 0 1 

EXCESS OF REV / EXPS 7,806 7,292 1,533 1,952 (662) (179) 386 1 (76) 143 (766) 111 (1,944) 14 

Page B.9



ACTUAL DOLLARS - IN THOUSANDS 



SYSTEM LMH HPMC CCH GCMC TRAUMA CENTERS HPCC HEALTH REHAB PHYSICIANS FOUND SVS OTHERS 

INPATIENT REVENUE 1,840,652 392,309 529,643 320,076 572,494 0 836 11,150 0 14,145 0 0 0 0 

OUTPATIENT REVENUE 1,053,668 156,569 194,598 181,541 161,768 4,816 133,561 0 7,316 181 213,324 0 (6) 0 

TOTAL PATIENT REVENUE 2,894,321 548,878 724,241 501,617 734,262 4,816 134,396 11,150 7,316 14,326 213,324 0 (6) 0 

DED FROM REV-MEDICARE 1,089,660 200,645 257,967 223,514 343,353 0 57,797 1,598 316 4,470 0 0 0 0 

DED FROM REV-MEDICAID 294,871 52,063 125,686 46,932 58,876 0 11,063 148 103 0 0 0 0 0 

DED FROM REV-CHARITY 93,880 37,564 23,149 20,213 11,711 0 900 119 223 0 0 0 0 0 

DED FROM REV-HMO/PPO 252,568 43,982 76,276 47,543 69,394 0 14,432 0 302 638 0 0 0 0 

DED FROM REV-OTHER 284,110 51,003 30,182 25,094 41,341 2,384 10,463 442 0 111 123,091 0 0 0 

DED FROM REV-BAD DEBT 102,830 25,975 11,853 16,711 23,677 1,537 2,513 31 39 160 20,333 0 0 0 

TOTAL DED FROM REV 2,117,918 411,232 525,112 380,007 548,353 3,921 97,169 2,339 983 5,379 143,423 0 0 0 

NET PATIENT REVENUE 776,402 137,646 199,129 121,610 185,909 895 37,228 8,811 6,332 8,947 69,901 0 (6) 0 

OTHER OPER REV 13,199 560 878 929 739 353 629 61 343 0 677 1,909 2,788 3,331 

TOTAL OPERATING REV 789,601 138,206 200,007 122,539 186,648 1,249 37,857 8,872 6,675 8,947 70,579 1,909 2,782 3,331 


PROD SALARIES 301,175 37,907 56,128 36,060 50,223 1,995 11,450 3,945 4,549 3,442 56,759 792 36,079 1,846 

PROD OVERTIME 11,924 2,449 3,035 1,561 3,562 0 156 287 18 77 235 1 531 12 

CONTRACT LABOR 1,810 171 455 361 618 0 4 59 50 79 8 0 4 0 

NON-PROD SALARIES 38,831 4,387 6,548 4,069 5,541 644 1,330 398 461 397 8,343 61 6,419 231 

TOTAL SALARIES & WAGES 353,741 44,915 66,167 42,052 59,944 2,638 12,941 4,689 5,079 3,995 65,344 854 43,033 2,089 

FRINGE BENEFITS 54,076 9,434 10,176 6,577 9,084 230 1,983 728 752 642 6,902 128 7,028 411 

HEALTH CARE ACCESS 9,934 2,174 2,748 1,704 2,586 0 373 296 0 53 0 0 0 0 

SUPPLIES 165,972 38,030 41,640 27,446 46,193 7 6,601 572 95 211 2,562 22 1,686 905 

OTHER SERVICES 44,903 4,075 4,574 4,014 4,731 43 4,084 205 406 32 6,138 634 15,655 312 

PURCHASED SERVICES 77,021 4,867 7,069 5,990 13,647 1,252 748 765 201 92 23,283 139 18,876 91 

TOTAL OPER EXPENSES 705,646 103,495 132,373 87,782 136,186 4,171 26,731 7,255 6,532 5,027 104,230 1,777 86,279 3,808 

EBITDA 83,955 34,711 67,634 34,757 50,462 (2,922) 11,126 1,617 143 3,921 (33,651) 132 (83,496) (478) 

DEPRECIATION/AMORT 43,021 4,691 9,803 4,348 14,384 27 3,095 186 76 81 1,308 0 4,967 54 

INTEREST EXPENSE 19,165 817 2,685 2,073 10,710 0 2,418 58 0 0 440 0 (37) 0 

GAIN(LOSS) FROM OPER 21,770 29,202 55,145 28,336 25,368 (2,949) 5,613 1,372 67 3,840 (35,400) 132 (88,426) (532) 


INT EARN & REALIZED GAIN 5,316 5,149 (73) 15 94 0 0 0 0 0 0 90 0 40 

UNREALIZED GAIN (LOSS) 24,851 24,686 0 0 0 0 0 0 0 0 0 164 0 0 

UNREALIZED GAIN (LOSS) ON SWAP 1,280 1,280 0 0 0 0 0 0 0 0 0 0 0 0 

OTHER NON OPER REV (23,773) 42 2 11 (24,851) 0 (33) 243 556 368 0 (110) 0 0 

RESTRICTED GIFTS 5,997 0 0 0 0 0 0 0 0 0 0 5,997 0 0 

TOTAL NON OPER REV 13,671 31,158 (71) 26 (24,757) 0 (33) 243 556 368 0 6,141 0 40 

EXCESS REV/EXPS 35,441 60,360 55,075 28,362 611 (2,949) 5,580 1,615 624 4,208 (35,400) 6,273 (88,426) (492) 

Page B.10



ACTUAL TO BUDGET DOLLAR VARIANCE - IN THOUS 

FOR THE 8 MONTH ENDED MAY 31, 2011 



INPATIENT REVENUE 80,870 25,203 1,919 11,278 43,340 0 202 989 0 (2,062) 0 0 0 0 

OUTPATIENT REVENUE (3,541) 14,449 (7,613) (333) (12,477) (38) (1,031) 0 (407) 130 3,785 0 (6) 0 

TOTAL PATIENT REVENUE 77,329 39,652 (5,694) 10,946 30,864 (38) (829) 989 (407) (1,932) 3,785 0 (6) 0 

DED FROM REV-MEDICARE (26,320) (9,929) 11,562 (2,364) (14,469) 0 (11,382) (258) (83) 602 0 0 0 0 

DED FROM REV-MEDICAID (2,202) (6,834) (306) (374) 2,750 0 2,539 (57) 80 0 0 0 0 0 

DED FROM REV-CHARITY (1,845) 644 (1,059) (950) (1,520) 0 1,000 (3) 42 0 0 0 0 0 

DED FROM REV-HMO/PPO (11,347) (3,061) (3,277) (4,707) (4,285) 0 3,041 0 77 864 0 0 0 0 

DED FROM REV-OTHER (10,666) (8,636) 3,592 481 (7,336) (1,365) 6,766 (160) 23 (111) (3,920) 0 0 0 

DED FROM REV-BAD DEBT (1,967) (1,845) 104 (345) (2,577) 1,036 166 70 8 128 1,287 0 0 0 

TOTAL DED FROM REV (54,347) (29,660) 10,615 (8,259) (27,436) (329) 2,131 (407) 147 1,483 (2,633) 0 0 0 

NET PATIENT REVENUE 22,981 9,993 4,921 2,686 3,428 (367) 1,302 582 (260) (449) 1,152 0 (6) 0 

OTHER OPER REV 594 2 115 51 (54) 250 57 17 (58) 0 8 314 (136) 26 

TOTAL OPERATING REV 23,575 9,995 5,036 2,738 3,374 (117) 1,359 599 (317) (449) 1,160 314 (142) 26 


PROD SALARIES (8,799) (3,006) (1,317) (1,356) (1,254) (119) 708 (288) (395) 252 397 38 (2,508) 48 

PROD OVERTIME (1,352) (428) (79) (69) (36) 135 (100) (22) (18) (3) (213) (1) (506) (12) 

CONTRACT LABOR 375 202 43 (20) 150 0 (4) (59) (9) 83 (8) 0 (4) 0 

NON-PROD SALARIES (1,637) (55) (503) (104) (161) 22 104 (21) (47) 2 (1,158) 90 198 (4) 

TOTAL SALARIES & WAGES (11,414) (3,286) (1,855) (1,549) (1,301) 38 707 (391) (470) 334 (982) 128 (2,819) 32 

FRINGE BENEFITS 2,608 1,240 1,087 661 858 (230) 148 (63) (52) 138 (63) 22 (1,085) (52) 

HEALTH CARE ACCESS (812) (475) (78) (147) (75) 0 (21) (32) 0 16 0 0 0 0 

SUPPLIES (6,038) (3,945) 2,382 (545) (3,468) 3 (545) 10 6 11 29 4 76 (56) 

OTHER SERVICES (1,995) 43 194 (93) 573 12 550 10 (30) (4) 21 68 (3,403) 65 

PURCHASED SERVICES (3,162) (957) (741) (901) (544) 82 91 74 5 23 171 (2) (467) 3 

TOTAL OPER EXPENSES (20,812) (7,381) 990 (2,574) (3,957) (95) 930 (392) (541) 519 (825) 220 (7,698) (8) 

EBITDA 2,763 2,614 6,026 163 (583) (212) 2,289 207 (858) 71 335 534 (7,839) 18 

DEPRECIATION/AMORT (2,057) 1,304 (227) (339) (75) 9 (898) 0 (38) (0) 131 0 (1,924) (0) 

INTEREST EXPENSE (690) (407) (364) (206) (144) 0 12 (30) 0 0 (32) 0 480 0 

GAIN(LOSS) FROM OPER 16 3,511 5,435 (382) (802) (203) 1,404 177 (896) 70 435 534 (9,284) 18 


INT EARN & REALIZED GAIN (7,158) (7,401) 107 15 92 0 0 0 0 0 0 14 0 15 


UNREALIZED GAIN(LOSS) ON SWAP 1,280 1,280 0 0 0 0 0 0 0 0 0 0 0 0 

OTHER NON OPER REV (25,917) (2,160) 2 11 (24,885) 0 (33) 243 514 368 0 23 0 0 


TOTAL NON OPER REV (9,186) 8,830 109 26 (24,793) 0 (33) 243 514 368 0 5,535 0 15 

EXCESS OF REV / EXPS (9,170) 12,341 5,544 (356) (25,595) (202) 1,370 420 (383) 438 435 6,069 (9,284) 33 

Page B.11



ACTUAL TO PRIOR YEAR DOLLAR VARIANCE - IN THOUS 




INPATIENT REVENUE 175,095 43,681 45,233 20,270 63,925 0 296 1,332 0 358 0 0 0 0 

OUTPATIENT REVENUE 93,687 19,670 598 10,725 (18,624) 324 51,670 0 645 74 28,611 0 (6) 0 

TOTAL PATIENT REVENUE 268,782 63,351 45,830 30,996 45,301 324 51,966 1,332 645 432 28,611 0 (6) 0 

DED FROM REV-MEDICARE (114,413) (25,232) (15,863) (19,092) (27,875) 0 (25,665) (253) (256) (177) 0 0 0 0 

DED FROM REV-MEDICAID (25,819) (4,061) (12,961) (4,955) 632 0 (4,489) (47) 61 0 0 0 0 0 

DED FROM REV-CHARITY (10,230) (1,906) (4,113) (1,923) (2,097) 0 (185) (2) (3) 0 0 0 0 0 

DED FROM REV-HMO/PPO 2,011 (216) 2,043 1,324 3,938 0 (5,205) 0 53 75 0 0 0 0 

DED FROM REV-OTHER (51,453) (15,442) (3,939) (1,216) (6,642) (27) (5,312) (203) 18 (35) (18,654) 0 0 0 

DED FROM REV-BAD DEBT (10,648) (2,619) (968) (1,158) (2,420) (482) (777) (4) (10) 30 (2,240) 0 0 0 

TOTAL DED FROM REV (210,551) (49,476) (35,802) (27,020) (34,464) (509) (41,634) (508) (136) (107) (20,893) 0 0 0 

NET PATIENT REVENUE 58,232 13,875 10,029 3,976 10,836 (185) 10,332 824 509 325 7,717 0 (6) 0 

OTHER OPER REV 1,867 13 106 153 (15) 160 73 19 (20) (0) 139 193 1,104 (57) 

TOTAL OPERATING REV 60,099 13,887 10,134 4,130 10,822 (25) 10,405 842 489 325 7,856 193 1,098 (57) 


PROD SALARIES (32,121) (2,829) (2,807) (1,781) (2,016) (87) (4,064) (273) (748) 18 (9,712) (122) (7,682) (19) 

PROD OVERTIME (1,742) (516) (546) (175) (22) 0 (56) (5) (10) (4) (74) 0 (331) (1) 

CONTRACT LABOR (13) (71) (168) (41) 174 0 (4) (59) 177 (22) 5 0 (4) 0 

NON-PROD SALARIES (5,033) (396) (694) (238) (415) (114) (398) (57) (70) 2 (1,699) 33 (976) (12) 

TOTAL SALARIES & WAGES (38,909) (3,812) (4,215) (2,234) (2,279) (201) (4,522) (394) (651) (6) (11,481) (89) (8,993) (32) 

FRINGE BENEFITS (825) 94 308 254 298 (8) (686) (1) (93) 49 (505) (10) (554) 28 

HEALTH CARE ACCESS (129) 125 65 283 (189) 0 (373) (38) 0 (2) 0 0 0 0 

SUPPLIES (7,384) (4,035) 1,173 (498) (2,193) 1 (2,569) (7) (14) 8 (371) 1 1,203 (84) 

OTHER SERVICES (4,675) (543) (541) (392) 1,013 (2) (645) (53) (40) (9) (665) (54) (2,845) 101 

PURCHASED SERVICES (5,945) (368) (508) (659) (903) (107) (815) 27 (9) (9) (2,923) (67) 402 (7) 

TOTAL OPER EXPENSES (57,867) (8,540) (3,718) (3,247) (4,254) (318) (9,608) (466) (806) 33 (15,944) (220) (10,787) 7 

EBITDA 2,232 5,347 6,417 883 6,567 (343) 798 377 (317) 357 (8,088) (27) (9,689) (50) 

DEPRECIATION/AMORT (5,203) (46) (30) 244 (2,309) (0) (2,154) 0 (57) 2 113 0 (967) 2 

INTEREST EXPENSE (966) 83 335 (150) (1,049) 0 (143) 11 0 0 (66) 0 13 0 

GAIN(LOSS) FROM OPER (3,937) 5,384 6,722 977 3,209 (343) (1,499) 387 (375) 359 (8,041) (27) (10,643) (48) 


INT EARN & REALIZED GAIN (621) (536) (103) (2) (3) 0 0 0 0 0 0 15 0 8 


UNREALIZED GAIN(LOSS) ON SWAP 1,442 1,442 0 0 0 0 0 0 0 0 0 0 0 0 

OTHER NON OPER REV (26,405) (1,272) 2 10 (24,972) 0 (33) (64) (116) (81) 0 123 0 0 


TOTAL NON OPER REV (7,961) 17,098 (102) 8 (24,975) 0 (33) (64) (116) (81) 0 298 0 8 

EXCESS OF REV / EXPS (11,897) 22,482 6,620 985 (21,766) (343) (1,533) 323 (491) 277 (8,041) 271 (10,643) (40) 

Page B.12


OPERATING RATIOS 


OP HOME ALL ALL 

SYSTEM LMH HPMC CCH GCMC CENTERS HPCC HEALTH REHAB PHYSICIANS FOUND OTHERS 


WAGES & BENEFITS 

ACTUAL 52.7% 41.8% 37.6% 37.9% 40.1% 41.4% 62.9% 92.4% 52.4% 99.4% 56.4% 80.6% 

BUDGET 53.3% 43.0% 38.1% 40.5% 38.6% 42.2% 60.1% 76.3% 55.8% 107.2% 73.1% 79.8% 

PRIOR YR 51.5% 39.3% 39.3% 41.3% 38.2% 45.4% 61.7% 82.3% 56.4% 103.1% 40.7% 74.8% 

SUPPLIES 

ACTUAL 20.8% 28.9% 19.5% 20.5% 24.8% 18.4% 7.0% 1.3% 2.2% 4.2% 1.0% 24.6% 

BUDGET 20.3% 25.2% 20.9% 21.8% 23.8% 15.6% 7.0% 1.5% 2.5% 3.8% 1.6% 26.9% 

PRIOR YR 20.6% 22.0% 22.1% 21.3% 23.9% 17.3% 6.8% 1.1% 2.8% 3.8% 0.6% 27.6% 

ALL OTHER OPER EXPENSES 

ACTUAL 17.0% 9.2% 7.4% 8.3% 11.9% 14.8% 14.2% 9.7% 2.3% 41.2% 40.9% 9.8% 

BUDGET 16.8% 8.7% 7.1% 9.0% 11.9% 15.1% 15.7% 7.8% 2.4% 43.7% 53.5% 13.4% 

PRIOR YR 16.2% 8.2% 6.8% 10.4% 12.2% 12.6% 14.5% 8.2% 1.2% 37.2% 61.3% 14.2% 

CAPITAL COSTS 

ACTUAL 7.9% 3.1% 7.1% 5.0% 14.5% 12.3% 2.9% 1.3% 0.9% 2.3% 0.0% 1.7% 

BUDGET 8.0% 5.1% 6.2% 5.0% 14.5% 11.1% 2.5% 0.5% 0.9% 2.8% 0.0% 1.7% 

PRIOR YR 9.2% 4.4% 7.2% 8.8% 14.6% 20.5% 2.9% 1.6% 1.1% 3.5% 0.0% 1.6% 

EBITDA MARGIN 

ACTUAL 9.4% 20.1% 35.5% 33.3% 23.2% 25.4% 15.8% -3.5% 43.2% -44.9% 1.8% -15.0% 

BUDGET 9.5% 23.1% 33.9% 28.7% 25.8% 27.1% 17.2% 14.5% 39.3% -54.7% -28.3% -20.1% 

PRIOR YR 11 11.7% 7% 30 30.4% 4% 31 31.8% 8% 27 27.1% 1% 25 25.7% 7% 24 24.7% 7% 17 17.0% 0% 84% 8.4% 39 39.5% 5% -44.2% 44 2% -2.7% 27% -16.6% 16 6% 

OPERATING MARGIN 

ACTUAL 1.5% 16.9% 28.4% 28.3% 8.7% 13.1% 12.9% -4.7% 42.3% -47.2% 1.8% -16.7% 

BUDGET 1.6% 18.0% 27.6% 23.6% 11.3% 15.9% 14.7% 13.9% 38.3% -57.4% -28.3% -21.8% 

PRIOR YR 2.5% 26.0% 24.6% 18.2% 11.1% 4.2% 14.1% 6.8% 38.4% -47.7% -2.7% -18.2% 

EXCESS MARGIN 

ACTUAL 1.6% 17.1% 28.4% 28.3% 8.5% 13.1% 15.4% 3.5% 44.9% -47.2% -2.0% -15.2% 

BUDGET 4.8% 36.7% 27.5% 23.6% 11.3% 15.9% 14.7% 14.5% 38.3% -57.4% 9.7% -21.0% 

PRIOR YR -6.9% -23.8% 24.6% 18.3% 11.5% 4.2% 16.7% 13.3% 39.0% -47.7% -8.8% -17.2% 


NET OPER REV 

ACTUAL 7,052 6,208 7,319 6,455 6,553 1,143 16,525 2,770 14,360 209 

16 

29 

BUDGET 6,981 6,973 6,982 5,887 6,671 1,098 17,604 2,562 11,106 177 15 30 

PRIOR YR 6,861 7,290 6,828 5,612 6,614 698 12,592 2,455 9,661 193 24 33 

TOTAL EXPENSES 

ACTUAL 6,947 5,156 5,241 4,627 5,981 994 14,390 2,901 8,282 307 16 33 

BUDGET 6,871 5,718 5,052 4,495 5,919 923 15,021 2,205 6,847 279 19 36 

PRIOR YR 6,687 5,396 5,145 4,588 5,879 668 10,815 2,288 5,950 285 25 39 


ACTUAL 3,719 2,596 2,751 2,445 2,625 473 10,400 2,559 7,521 208 9 23 

BUDGET 3,724 2,998 2,659 2,384 2,573 463 10,580 1,955 6,196 190 11 24 

PRIOR YR 3,537 2,868 2,684 2,316 2,527 317 7,770 2,020 5,451 199 10 25 

Page B.13






SUPPLIES 

ACTUAL 11,470 470 11,794 794 11,427 427 11,325 325 11,628 628 211 11,159 159 37 309 9 0 7 

BUDGET 1,420 1,761 1,462 1,285 1,584 172 1,238 37 283 7 0 8 

PRIOR YR 1,410 1,605 1,507 1,194 1,580 121 854 28 275 7 0 9 


ACTUAL 1,199 572 544 534 778 169 2,352 269 323 86 7 3 

BUDGET 1,171 606 498 530 794 166 2,755 200 267 77 8 4 

PRIOR YR 1,110 600 464 585 807 88 1,831 200 120 72 15 5 

CAPITAL COSTS 

ACTUAL 559 195 518 323 951 141 479 36 128 5 0 0 

BUDGET 556 354 434 295 967 122 449 13 101 5 0 1 

PRIOR YR 630 323 490 494 966 143 361 40 104 7 0 1 


ACTUAL 105 1,052 2,079 1,828 572 150 2,135 (131) 6,078 (99) 0 (5) 

BUDGET 110 1,255 1,930 1,392 752 175 2,582 357 4,259 (102) (4) (7) 

PRIOR YR 174 1,894 1,682 1,024 736 29 1,776 167 3,711 (92) (1) (6) 

EXCESS MARGIN 

ACTUAL 120 1,063 2,077 1,829 556 150 2,622 105 6,743 (99) 6 (4) 

BUDGET 336 2,560 1,920 1,392 754 175 2,582 371 4,259 (102) 1 (6) 

PRIOR YR (476) (1,736) 1,683 1,025 761 29 2,099 326 3,765 (92) (2) (6) 

LABOR 

PROD FTEs/ADJ DAILY ADMIT 

ACTUAL 25.03 21.29 19.51 16.92 20.40 21.64 70.08 11.40 43.84 0.56 0.05 0.25 

BUDGET 24.07 22.34 17.91 15.80 19.60 19.80 71.49 9.13 39.39 0.52 0.06 0.26 

PRIOR YR 23.67 21.87 18.12 16.58 19.86 14.13 67.90 8.96 35.75 0.59 0.05 0.27 

NON PROD AS % PAID 

ACTUAL 9.53% 9.21% 9.84% 9.92% 9.67% 10.03% 9.10% 10.14% 10.87% 8.08% 8.32% 10.33% 

BUDGET 9.51% 9.84% 9.97% 9.85% 9.29% 9.84% 10.13% 10.30% 10.13% 7.78% 10.32% 9.72% 

PRIOR YR 9.57% 9.76% 9.95% 9.87% 8.95% 9.88% 8.56% 9.55% 11.46% 8.26% 6.54% 9.82% 

AVG HOURLY RATE 

ACTUAL 29.47 26.56 26.77 25.38 25.68 23.55 20.45 30.83 26.03 54.96 36.68 17.25 

BUDGET 29.25 26.46 26.68 25.47 25.65 25.06 20.17 29.18 26.09 53.39 36.62 17.14 

PRIOR YR 28.29 25.85 26.13 25.05 25.22 24.08 19.49 31.09 24.92 48.67 39.92 16.75 

OP REV % OF TOTAL REVENUE 

ACTUAL 37.0% 30.0% 26.4% 36.6% 23.5% 99.5% N/A 100.0% 1.8% 100.0% N/A N/A 

BUDGET 38.8% 30.0% 28.4% 38.7% 25.4% 99.6% N/A 100.0% 0.3% 100.0% N/A N/A 

PRIOR YR 35.8% 28.7% 27.7% 34.9% 25.7% 99.5% N/A 100.0% 0.9% 100.0% N/A N/A 

Page B.14








ACTUAL 51.6% 41.0% 38.2% 39.7% 37.0% 39.4% 61.1% 87.3% 51.8% 102.4% 51.4% 75.1% 

BUDGET 52.1% 42.4% 38.8% 39.8% 37.4% 43.2% 60.0% 75.9% 54.4% 102.6% 71.0% 75.1% 

PRIOR YR 50.5% 42.4% 38.1% 39.4% 38.1% 35.4% 62.5% 82.2% 54.3% 96.1% 51.4% 73.7% 

SUPPLIES 

ACTUAL 21.0% 27.3% 20.8% 22.4% 24.7% 17.4% 6.5% 1.4% 2.4% 3.6% 1.1% 27.2% 

BUDGET 20.9% 26.3% 22.6% 22.5% 23.3% 16.6% 7.0% 1.5% 2.4% 3.7% 1.6% 25.7% 

PRIOR YR 21.7% 27.1% 22.5% 22.8% 25.0% 14.7% 7.0% 1.3% 2.5% 3.5% 1.3% 24.3% 


ACTUAL 16.7% 8.9% 7.2% 9.6% 11.2% 13.7% 14.3% 9.1% 2.0% 41.7% 40.5% 12.1% 

BUDGET 16.4% 8.6% 7.1% 8.8% 11.4% 16.0% 15.9% 8.3% 2.3% 42.7% 52.6% 14.2% 

PRIOR YR 16.6% 9.2% 7.1% 9.2% 11.9% 12.3% 15.0% 9.0% 1.8% 41.2% 38.0% 14.7% 

CAPITAL COSTS 

ACTUAL 7.7% 4.0% 6.2% 5.2% 13.4% 11.8% 2.8% 1.1% 0.9% 2.5% 0.0% 1.6% 

BUDGET 7.7% 5.0% 6.1% 4.9% 13.6% 11.2% 2.6% 0.5% 0.9% 2.7% 0.0% 1.6% 

PRIOR YR 7.7% 4.4% 6.7% 5.5% 12.4% 11.7% 3.2% 0.3% 1.0% 2.9% 0.0% 1.7% 

EBITDA MARGIN 

ACTUAL 10.6% 22.8% 33.8% 28.4% 27.0% 29.4% 18.2% 2.1% 43.8% -47.7% 6.9% -14.3% 

BUDGET 10.6% 22.7% 31.6% 28.9% 27.9% 24.2% 17.0% 14.3% 41.0% -49.0% -25.2% -15.0% 

PRIOR YR 11 11.2% 2% 21 21.3% 3% 32 32.2% 2% 28 28.6% 6% 25 25.0% 0% 37 37.6% 6% 15 15.4% 4% 74% 7.4% 41 41.3% 3% -40.8% 40 8% 92% 9.2% -12.6% 12 6% 


ACTUAL 2.9% 18.8% 27.6% 23.1% 13.6% 17.6% 15.5% 1.0% 42.9% -50.2% 6.9% -16.0% 

BUDGET 2.9% 17.7% 25.5% 24.0% 14.3% 13.0% 14.4% 13.8% 40.1% -51.6% -25.2% -16.6% 

PRIOR YR 3.5% 16.9% 25.5% 23.1% 12.6% 25.9% 12.3% 7.1% 40.4% -43.6% 9.2% -14.3% 

EXCESS MARGIN 

ACTUAL 3.8% 33.7% 27.5% 23.1% 0.4% 17.5% 17.7% 8.6% 45.2% -50.2% 3.4% -14.6% 

BUDGET 5.9% 34.9% 25.4% 24.0% 14.3% 13.0% 14.4% 14.4% 40.1% -51.6% 12.8% -15.9% 

PRIOR YR 5.7% 28.1% 25.5% 23.1% 12.7% 25.9% 16.1% 18.0% 45.6% -43.6% 16.5% -13.3% 


NET OPER REV 

ACTUAL 6,817 6,460 6,864 5,795 6,701 996 17,362 2,443 11,046 183 16 29 

BUDGET 6,814 6,671 6,834 5,705 6,622 958 15,850 2,575 10,605 176 14 29 

PRIOR YR 6,612 6,440 6,665 5,624 6,278 781 15,122 2,565 10,073 188 16 31 

TOTAL EXPENSES 

ACTUAL 6,620 5,244 4,972 4,455 5,790 821 14,677 2,419 6,306 274 15 33 

BUDGET 6,616 5,490 5,091 4,338 5,677 834 13,560 2,220 6,351 267 18 34 

PRIOR YR 6,379 5,353 4,965 4,324 5,487 579 13,268 2,382 6,007 270 14 35 


ACTUAL 3,521 2,651 2,620 2,300 2,478 393 10,601 2,134 5,726 187 8 22 

BUDGET 3,549 2,830 2,649 2,274 2,478 414 9,508 1,955 5,768 180 10 22 

PRIOR YR 3,336 2,733 2,543 2,216 2,394 276 9,459 2,109 5,469 180 8 23 

Page B.15




OP ALL CORP 

SYSTEM LMH HPMC CCH GCMC CENTERS HPCC HH REHAB PHYSICIANS FOUND SVC 

SUPPLIES 

ACTUAL 11,433 433 11,762 762 11,429 429 11,298 298 11,658 658 174 11,120 120 35 261 7 0 8 

BUDGET 1,423 1,755 1,543 1,281 1,544 159 1,115 37 251 7 0 8 

PRIOR YR 1,437 1,744 1,503 1,280 1,571 115 1,065 34 256 7 0 7 


ACTUAL 1,138 575 494 554 753 136 2,478 222 219 76 7 3 

BUDGET 1,120 572 482 503 756 153 2,525 214 240 75 7 4 

PRIOR YR 1,098 591 471 520 746 96 2,263 231 185 77 6 5 

CAPITAL COSTS 

ACTUAL 528 256 429 304 901 118 479 28 100 5 0 0 

BUDGET 524 332 417 280 899 107 411 14 91 5 0 0 

PRIOR YR 508 286 449 309 776 91 481 8 97 5 0 1 


ACTUAL 197 1,216 1,893 1,340 911 175 2,685 25 4,740 (92) 1 (5) 

BUDGET 198 1,181 1,742 1,368 946 125 2,290 355 4,254 (91) (4) (5) 

PRIOR YR 233 1,088 1,700 1,299 791 202 1,854 183 4,066 (82) 1 (4) 

EXCESS MARGIN 

ACTUAL 315 2,660 1,890 1,341 22 175 3,161 228 5,194 (92) 54 (4) 

BUDGET 402 2,331 1,736 1,368 947 125 2,290 371 4,254 (91) 2 (5) 

PRIOR YR 377 1,808 1,701 1,300 799 202 2,433 462 4,591 (82) 3 (4) 

LABOR 

PROD FTEs/ADJ DAILY ADMIT 

ACTUAL 22.91 20.56 17.64 16.12 19.11 2.25 71.33 9.18 37.04 3.76 0.05 0.23 

BUDGET 22.69 20.78 17.74 14.96 18.63 2.28 64.31 9.14 35.80 3.82 0.05 0.24 

PRIOR YR 22.09 21.11 17.55 14.96 18.72 1.56 66.54 9.12 35.80 4.05 0.04 0.24 

NON PROD AS % PAID 

ACTUAL 9.27% 9.29% 9.55% 9.46% 8.90% 9.83% 8.81% 9.97% 10.14% 8.02% 7.60% 10.51% 

BUDGET 9.49% 9.76% 9.67% 9.75% 9.05% 9.91% 10.25% 10.50% 10.00% 7.90% 10.48% 9.92% 

PRIOR YR 9.28% 9.36% 9.52% 9.54% 8.65% 10.07% 8.50% 9.66% 10.46% 8.21% 7.22% 10.23% 

AVG HOURLY RATE 

ACTUAL 29.73 26.77 26.98 25.50 25.74 23.91 20.45 31.79 25.86 56.70 36.59 17.17 

BUDGET 29.43 26.76 26.81 25.55 25.96 24.76 20.03 28.98 26.56 53.86 36.26 17.01 

PRIOR YR 28.50 26.00 26.30 25.22 25.32 24.23 19.47 31.80 25.29 50.19 37.42 16.77 

OP REV % OF TOTAL REVENUE 

ACTUAL 36.4% 29.1% 26.9% 36.2% 22.0% 99.4% 0.0% 100.0% 1.3% 100.0% N/A 100.0% 

BUDGET 37.5% 28.6% 27.7% 37.1% 24.8% 99.5% 0.0% 100.0% 0.3% 100.0% N/A N/A 

PRIOR YR 36.6% 28.9% 28.6% 36.3% 26.2% 99.3% 0.0% 100.0% 0.8% 100.0% N/A N/A 

Page B.16



CONSOLIDATED STAFFING SUMMARY 

MONTH TO DATE 

OP ALL ALL 

SYSTEM LMH HP CCH GCMC TRAUMA CENTERS HPCC HH REHAB PHYSICIANS FOUND CORP OTHERS 

BUDGET 8,253.17 1,153.67 1,644.76 1,113.28 1,564.73 19.16 400.00 153.95 114.97 113.51 862.58 19.50 1,002.77 90.29 

ACTUAL 8,650.18 1,254.45 1,730.95 1,172.32 1,657.97 21.44 410.43 166.62 115.78 108.30 844.44 17.00 1,061.73 88.75 

DIFFERENCE (397.00) (100.79) (86.19) (59.04) (93.24) (2.28) (10.43) (12.67) (0.81) 5.22 18.14 2.50 (58.96) 1.53 

YEAR TO DATE 

BUDGET 8,377.90 1,173.37 1,727.53 1,141.76 1,626.93 19.15 396.89 154.54 114.56 117.40 860.58 19.50 935.87 89.82 

ACTUAL 8,569.23 1,259.16 1,765.95 1,187.61 1,676.92 20.17 389.75 165.17 115.07 111.25 829.99 16.81 943.76 87.64 

DIFFERENCE (191.33) (85.79) (38.42) (45.84) (49.98) (1.02) 7.14 (10.63) (0.51) 6.14 30.60 2.69 (7.89) 2.19 

Page B.17

LMH/HP CCH GCMC HPCC HHA HBP/LPG TOTAL 

Gross A/R 159,710 41,397 113,101 1,645 1,374 38,105 355,333 

Allowances 71,954 21,463 66,620 199 26 34,227 194,489 

Net A/R 87,756 19,934 46,481 1,447 1,348 3,878 160,844 

Net Revenue Per Day 1,601 


Summary of Accounts Receivable 

May 31, 2011 

In Thousands (000) 

514 

Net Days in A/R Current Month 54.8 38.7 

59.3 38.9 50.5 

12.7 

49.2 

Net Days in A/R Same Month Prior Yr 57.2 44.0 

47.9 38.4 64.0 

33.4 

50.5 

% Change 3.8% 2.2% -7.1% 3.1% 31.5% 12.6% 

Page B.18 

784 

37 

27 

305 

3,268


LEE COUNTY, FLORIDA 

UNCONSOLIDATED 

FINANCIAL STATEMENTS 

AND 

STATISTICAL REPORTS 

MAY 31, 2011


UNCONSOLIDATED 


SECTION C 

LEESAR REGIONAL SERVICE CENTER C.1 

ACCESS MEDICAL SOUTH, LC C.2 

PAGE 

BONITA COMMUNITY HEALTH CENTER, INC. C.3

LEESAR REGIONAL SERVICE CENTER 

COMPARATIVE INCOME STATEMENT (UNAUDITED) 


CURRENT MONTH YEAR TO DATE FISCAL 2011 

VAR VAR % VAR % VAR VAR % VAR % 

BUDGET ACTUAL PRIOR YR ACT TO BUD ACT TO BUD PR YR BUDGET ACTUAL PRIOR YR ACT TO BUD ACT TO BUD PR YR 

TOTAL SALES 14,747,252 13,888,250 13,267,042 (859,002) -5.8% 4.7% 113,525,124 109,741,325 94,445,118 (3,783,799) -3.3% 16.2% 

COST OF GOODS SOLD 13,492,923 12,480,780 12,035,276 1,012,143 7.5% -3.7% 103,783,431 99,150,224 86,221,802 4,633,207 4.5% -15.0% 

GROSS PROFIT 1,254,329 1,407,470 1,231,766 153,141 12.2% 14.3% 9,741,693 10,591,101 8,223,316 849,408 8.7% 28.8% 

OTHER OPERATING REVENUE 1,336 1,364 469 28 2.1% 190.8% 10,688 55,722 37,178 45,034 421.4% 49.9% 

TOTAL OPERATING REVENUE 1,255,665 1,408,834 1,232,235 153,169 12.2% 14.3% 9,752,381 10,646,823 8,260,494 894,442 9.2% 28.9% 


SALARIES/WAGES 439,199 409,235 356,395 29,964 6.8% -14.8% 3,436,693 3,224,611 3,022,280 212,082 6.2% -6.7% 

BENEFITS 160,254 125,599 117,422 34,655 21.6% -7.0% 1,145,670 1,021,949 1,027,658 123,721 10.8% 0.6% 

OTHER SUPPLIES 45,576 70,769 34,846 (25,193) -55.3% -103.1% 380,242 413,427 320,895 (33,185) -8.7% -28.8% 

OTHER SERVICES 160,026 187,225 153,847 (27,199) -17.0% -21.7% 1,297,796 1,252,822 1,180,394 44,974 3.5% -6.1% 

PURCHASED SERVICES 51,741 66,149 42,651 (14,408) -27.8% -55.1% 413,928 425,674 419,847 (11,746) -2.8% -1.4% 

DEPRECIATION/AMORTIZATION 65,501 60,760 63,541 4,741 7.2% 4.4% 524,008 487,676 510,589 36,332 6.9% 4.5% 

TOTAL OPERATING EXPENSES 922,297 919,737 768,702 2,560 0.3% -16.4% 7,198,337 6,826,159 6,481,663 372,178 5.2% -5.3% 

GAIN(LOSS) FROM OPERATIONS 333,368 489,097 463,533 155,729 46.7% 5.5% 2,554,044 3,820,664 1,778,831 1,266,620 49.6% 114.8% 

INTEREST EARNINGS 1,750 2,115 1,552 365 20.9% 36.3% 14,000 16,721 10,268 2,721 19.4% 62.8% 

GAIN(LOSS) ON DISPOSITION 0 0 0 0 0.0% 0.0% 0 0 0 0 0.0% 0.0% 

EXCESS OF REV OVER EXPENSES 335,118 491,212 465,085 156,094 46.6% 5.6% 2,568,044 3,837,385 1,789,099 1,269,341 49.4% 114.5% 

Page C.1

ACCESS MEDICAL SOUTH, LC 


FOR THE PERIOD ENDING May 31, 2011 




NET PRODUCT REVENUE 210,325 184,913 190,991 (25,412) -12.1% -3.2% 1,666,757 1,782,544 1,605,870 115,787 6.9% 11.0% 

COST OF PRODUCTS SOLD 45,006 27,161 40,862 17,845 39.7% 33.5% 356,750 407,635 348,460 (50,885) -14.3% -17.0% 

GROSS PROFIT 165,319 157,752 150,129 (7,567) -4.6% 5.1% 1,310,007 1,374,909 1,257,410 64,902 5.0% 9.3% 


SALARIES/WAGES 70,888 68,627 65,783 2,261 3.2% -4.3% 558,761 548,665 528,908 10,096 1.8% -3.7% 

BENEFITS 19,205 15,245 16,374 3,960 20.6% 6.9% 144,590 143,612 136,706 978 0.7% -5.1% 

OTHER SERVICES 26,537 30,251 26,305 (3,714) -14.0% -15.0% 212,296 264,640 231,947 (52,344) -24.7% -14.1% 

BAD DEBT 16,817 18,652 18,267 (1,835) -10.9% -2.1% 133,294 160,012 154,547 (26,718) -20.0% -3.5% 

DEPREC, INTEREST, & AMORT 17,795 18,627 16,889 (832) -4.7% -10.3% 140,946 147,338 129,262 (6,392) -4.5% -14.0% 

TOTAL OPERATING EXPENSES 151,242 151,402 143,618 (160) -0.1% -5.4% 1,189,887 1,264,267 1,181,370 (74,380) -6.3% -7.0% 

GAIN(LOSS) FROM OPERATIONS 14,077 6,350 6,511 (7,727) -54.9% 2.5% 120,120 110,642 76,040 (9,478) -7.9% 45.5% 

NON OPERATING REVENUE 0 0 0 0 #DIV/0! #DIV/0! 0 0 553 0 #DIV/0! -100.0% 

EXCESS OF REV OVER EXPENSES 14,077 6,350 6,511 (7,727) -54.9% -2.5% 120,120 110,642 76,593 (9,478) -7.9% 44.5% 

MINORITY INTEREST 7,039 3,175 3,256 (3,864) -54.9% -2.5% 60,060 55,321 38,297 (4,739) -7.9% 44.5% 

NET INCOME (LOSS) 7,039 3,175 3,256 (3,864) -54.9% -2.5% 60,060 55,321 38,297 (4,739) -7.9% 44.5% 

Page C.2

BONITA COMMUNITY HEALTH CENTER, INC. 






GROSS PATIENT REVENUE 1,117,451 1,135,888 1,081,052 18,437 1.6% 5.1% 12,001,418 10,420,708 10,542,312 (1,580,710) -13.2% -1.2% 

DEDUCTIONS FROM REVENUE 748,066 687,486 688,696 60,580 8.1% 0.2% 7,845,142 6,272,892 6,807,357 1,572,250 20.0% 7.9% 

NET PATIENT REVENUE 369,385 448,402 392,356 79,017 21.4% 14.3% 4,156,276 4,147,816 3,734,955 (8,460) -0.2% 11.1% 

OTHER OPERATING REVENUE 96,000 93,725 86,511 (2,275) -2.4% 8.3% 750,000 730,442 694,429 (19,558) -2.6% 5.2% 

TOTAL OPERATING REVENUE 465,385 542,127 478,867 76,742 16.5% 13.2% 4,906,276 4,878,258 4,429,384 (28,018) -0.6% 10.1% 


SALARIES/WAGES/BENEFITS 286,710 259,182 248,691 27,528 9.6% -4.2% 2,444,257 2,309,726 2,156,754 134,531 5.5% -7.1% 

OTHER SUPPLIES 156,079 179,559 148,588 (23,480) -15.0% -20.8% 1,393,342 1,478,219 1,369,075 (84,877) -6.1% -8.0% 

PURCHASED SERVICES 94,010 82,597 89,809 11,413 12.1% 8.0% 786,801 642,763 732,383 144,038 18.3% 12.2% 

DEPRECIATION/AMORTIZATION 69,662 65,905 70,046 3,757 5.4% 5.9% 557,296 512,626 556,913 44,670 8.0% 8.0% 

BAD DEBT EXPENSE 9,235 15,410 12,011 (6,175) -66.9% -28.3% 103,908 108,090 98,053 (4,182) -4.0% -10.2% 

INTEREST 116,012 103,081 101,584 12,931 11.1% -1.5% 917,817 872,967 940,985 44,850 4.9% 7.2% 

TOTAL OPERATING EXPENSES 731,708 705,734 670,729 25,974 3.5% -5.2% 6,203,421 5,924,391 5,854,163 279,030 4.5% -1.2% 

GAIN(LOSS) FROM OPERATIONS (266,323) (163,607) (191,862) 102,716 -38.6% -14.7% (1,297,145) (1,046,133) (1,424,779) 251,012 -19.4% -26.6% 

INTEREST EARNINGS 0 0 11 0 0.0% -100.0% 0 119 120 119 0.0% -0.8% 

GAIN ON SALE OF EQUIPMENT 0 50 0 50 0.0% 0.0% 0 4,750 0 4,750 0.0% 0.0% 

REFINANCE EXP-OPER LEASE 0 (34,538) 0 (34,538) 0.0% 0.0% 0 (172,690) 0 (172,690) 0.0% 0.0% 

INCRS(REDUCT) FV INT RATE SWAPS 0 0 0 0 0.0% 0.0% 0 490,223 153,109 490,223 0.0% 220.2% 

EXCESS OF REV OVER EXPENSES (266,323) (198,095) (191,851) 68,228 25.6% -3.3% (1,297,145) (723,731) (1,271,550) 573,414 44.2% 43.1% 

Page C.3

___________________ 



OTHER ITEMS

ADJOURNMENT 

___________________ 




REGULARLY SCHEDULED 

MEETING 


FULL BOARD MEETING 

THURSDAY, 

September 22, 2011 

4:00pm 

Lee Memorial Hospital - Boardroom 

2776 Cleveland Ave, Ft. Myers, FL 33901



MEETING 

Thurs, June 23, 2011 

BOARD CHAIRMAN: 

Richard Akin

RECESS 

Board Chairman 

Richard Akin 



CALL TO ORDER: (Richard Akin, Board Chairman) 

A. Cape Coral Hospital Board of Directors 

(Provider #10-0244) {YELLOW FOLDER} 

B. Lee Memorial Hospital Board of Directors 

(Provider #10-0012) {GREEN FOLDER} 

C. Gulf Coast Medical Center Board of Directors 

(Provider #10-0220) {ORANGE FOLDER}

CONVENE 

{YELLOW FOLDER} 

(Provider # 10-0244) 

CAPE 

CORAL 

HOSPITAL



239-343-3300 

FAX: 239-343-3194 

P.O. BOX 2218 


33902 










DISTRICT ONE 


Marilyn Stout 

DISTRICT TWO 






DISTRICT FOUR 


Chris Hansen 

DISTRICT FIVE 


James Green 

AGENDA 


BOARD OF DIRECTORS MEETING 

(Provider # 10-0244) 

June 23, 2011 4:00 p.m. 

Lee Memorial Hospital – Boardroom 

2776 Cleveland Ave 

Ft. Myers, FL 33901 


Cape Coral Hospital Board of Directors 

2. PUBLIC INPUT – Agenda Items: Any Public Input is limited to three minutes 

and a “Request to Address the Board of Directors” card must be 

completed and submitted to the Board Administrator prior to meeting. 

3. MEETING MINUTES OF MAY 26, 2011 (Approval) 

(Nancy McGovern, RN, MSM, Board Secretary) 

4. OPERATIONS REPORT (Wendy Piascik, VP Patient Care) (Approval) 

5. MEDICAL STAFF RECOMMENDATIONS OF 06/23/11 (Approval) 

(All Directors) 

6. OLD BUSINESS 

7. NEW BUSINESS 

8. DATE OF THE NEXT MEETING 

Thursday, August 25, 2011, 4:00 pm, Lee Memorial Hospital – Boardroom 

9. ADJOURN (Richard Akin, Board Chairman) 

062311 FINAL AGENDA - CAPE CORAL HOSPITAL

___________________ 




AGENDA ITEMS: 




minutes and a 











CAPE CORAL HOSPITAL BOARD OF DIRECTORS (PROVIDER # 10-0244) 




MEMBERS PRESENT: Richard Akin, Board Chairman; Linda Brown, MSN, ARNP, Board Vice Chairman; Nancy McGovern, RN, MSM, Board Secretary; Marilyn Stout, Board Treasurer; 

Steve Brown, M.D., Director; Chris Hansen, Director; Donald Brown, Director; Diane Champion, Director; James Green, Director 


OTHERS PRESENT: Cathy Stephens, Board Administrator; Jim Humphrey, Board Counsel; Mary McGillicuddy, Chief Legal Officer; John Wiest, Chief Operating Officer/Business and Strategic 

Services; Larry Antonucci, M.D., Chief Operating Officer/Hospital & Physician Services; Mike German, Chief Financial Officer; Jon Cecil, Chief Human Resource Officer; Charles Swain, Chief 

Compliance and Internal Audit Officer; Scott Nygaard, M.D., Chief Medical Officer/Physician Services; Wendy Piascik, Vice President/Patient Care Services/CCH; Kathy Bridge-Liles, Vice 

President/Women’s and Children’s Services; Thomas Presbrey, M.D., Chairman/Physician Leadership Council; Andrea Snyder, Director/Transfer Center; Susan Crowe, Director/Volunteer 

Services; Diana Sutton, System Director/Nursing; Donna Bradish, Director/Volunteer Resources; Cynthia Brasher, System Director Spiritual Services; Mary Lorah, Risk Manager II; Bill Silverman, 

M.D., Quality & Education Community Representative; Marliese Mooney, Physician Leadership Council Consultant/Planning Community Representative; David Berger, M.D., Community 

Representative/Quality & Education; Erica McDermott, Medical Social Worker/GCMC; Nora Harmon, LMH/HP Auxiliary President; Sandy Hiese, Auxiliary Volunteer; Nancy Stanfield, 

Auxiliary/GCMC President; Jean Moren, Auxiliary Volunteer; Bob Simpson, LeeSar; Andy Lynch, LeeSar; Gayle Reynolds, LeeSar; Sanford Cohen, M.D./Guest; Mary Briggs, Interim Public 

Information Officer; Frank Gluck, News Press/Reporter; Paul Gesgler, NBC2/Reporter; Daniel Morency, Fort Myers Police Department; Todd Gates, Guest; Jean Perkins, Guest; Laurie Gretten, 

Executive Secretary/Board of Directors 


and on the Board of Directors website at www.leememorial.org/boardofdirectors, for public inspection. 


UP 

MEETING 



CAPE CORAL 

HOSPITAL BOARD 

MINUTES 

CAPE CORAL 

HOSPITAL 

OPERATIONS 

REPORT 

Nancy McGovern asked for approval of the Cape Coral Hospital Meeting 

minutes of April 28, 2011. 

Wendy Piascik presented the Operations Report for Cape Coral Hospital (Exhibit 

1) which consisted of a review of quality indicators, patient experience ratings, 

operational statistics comparing year to date to budget, management focus 

areas and financial reporting. 

Bill Silverman inquired about the pediatric admits. Wendy Piascik stated that we 

did see a drop in the pediatric admits. Kathy Bridge-Liles stated that the Cape 

Coral Hospital pediatric unit is used as an over flow of the unit. When we open 

the unit at Cape Coral Hospital; we use the same staff at HealthPark Medical 

Center. If we didn’t have this we would have to send patients to Tampa and 

Miami, and we won’t need the beds until season. 

The Cape Coral Hospital Board of Directors (Provider #10-0244) 

Meeting was CALLED TO ORDER at p.m. 4:51 p.m. 


A motion was made by Nancy McGovern to approve the Cape Coral 

Hospital Board Meeting minutes of April 28, 2011. The motion was 

seconded by Linda Brown and it carried with no opposition. 

A motion was made by Donald Brown to accept the Operations 

Report for Cape Coral Hospital (Exhibit 1). The motion was 

seconded by Marilyn Stout and it carried with no opposition.

CAPE CORAL HOSPITAL (Provider # 10-0244) BOARD OF DIRECTORS MEETING 



Page 2 of 2 


UP 

MEDICAL 

STAFF 

RECOMMENDATIONS 

OLD BUSINESS None at this time. 

NEW BUSINESS None at this time. 

NEXT REGULAR 

MEETING 

Richard Akin asked for approval of the Medical Staff Recommendations for 

Cape Coral Hospital of May 19, 2011 (Exhibit 2). 

The next Full Board meeting of the CAPE CORAL HOSPITAL 

(Provider #10-0244) BOARD OF DIRECTORS IS: 

June 23, 2011, 4:00 p.m. in the Lee Memorial Hospital Boardroom 


A motion was made by Chris Hansen to approve the Medical Staff 

Recommendations for Cape Coral Hospital of May 19, 2011 (Exhibit 

2). The motion was seconded by Marilyn Stout and it carried with no 

opposition. 

ADJOURNMENT The Cape Coral Hospital (Provider #10-0244) Board of Directors 

Meeting was ADJOURNED at 4:55 p.m. 




Board Secretary

Net Revenue 

Labor 

Operations Report: Cape Coral Hospital - Provider # 10-0244 

Presented to Board of Directors, June 23, 2011 

Financial Report YTD ending 5/31/11 

• Net Rev/Adj. Admit for May: Budget $7,363, Actual $8,271, Var. 12.3% 

• Net Revenue per adjusted admission FYTD, actual: $7,534 

• Patient Revenue FYTD, actual $121,610K. 

• FTEs per AOB for May: Budget 4.10, Actual 4.25, Var. 3.5% 

• FTEs per AOB FYTD, actual: 4.02 

• Productive salaries FYTD, actual: $37,982,133. 

Gain from Operations 

• Gain from Operations for May: Budget $3,454K, Actual $4,563K, Var. 32.1% 

• Gain from Operations FYTD: Budget $28,718K, Actual $28,336K, Var. -1.3% 

• Fiscal Year to Date, actual: 

• Operating Expense per adjusted admit $5,438 

• Salary/Wage/Benefit expense per adjusted admit by $3,013 

• Supply expense per adjusted admission was $1,700 

Operations Report YTD ending 5/31/11 

May 2011 PY actual FYTD 

Budget Actual Var% May 2010 Budget Actual Var% PY actual 

Admissions 1,207 1,227 1.7% 1,257 10,488 10,300 -1.8% 10,645 

ER Visits 5,143 5,004 -2.7% 4,945 40,402 39,935 -1.2% 38,848 

ER Admits 1,095 1,087 -0.7% 1,053 8,987 9,072 0.9% 8,641 

Deliveries 125 116 -7.3% 103 951 887 -6.8% 895 

Surgical Cases 672 620 -7.7% 614 5,596 5,174 -7.5% 5,489 

Seasonal Overflow Unit – 2-East rooms being used for 3-West renovations until November 2011 

Quality Report 

Patient Experience 5/2010 5/2011 YTD 

Press Ganey Inpatient 

Likelihood to Recommend 57% 57% 58% 

Press Ganey ED 

Likelihood to Recommend 47% 56% 51% 

HCAHPS Top Box Score 

Rate this Hospital 53% 56% 59%

To: Board of Directors 


Lee County, Florida 

M E M O R A N D U M 

From: Sandra L. Wharton, CPMSM, CPCS 

System Director, Medical Staff Services 

Subject: Cape Coral Hospital Medical Staff Recommendations 

Date: June 22, 2011 

The Facility Medical Executive Committee of the Medical Staff recommends the following 

physicians and allied health practitioners and certifies they have met the requirements set forth in 

the bylaws: 

1. Associate Staff Appointments: 

a. Maria L. Becka-Fitzpatrick, D.O. – Internal Medicine 

b. Juan J. Hernandez, M.D. – Family Practice 

c. Shiyama V. Mudali, M.D. – Pathology 

d. Oscar H. Rodriguez Siguenas, M.D. – Internal Medicine 

e. Anila Veerani, M.D. – Cardiology 

f. Miriam C. Zolfoghary, M.D. – General Surgery 

2. Telemedicine Appointment – Privileges Only: 

a. Tore Detlie, M.D. – Teleradiology 

b. Nasir Iqbal, M.D. – Teleradiology 

3. Intrasystem Applications – Associate Staff: 

a. Iman Fares, M.D. – Pediatrics/Neonatology 

b. Allen Tafel, M.D. – Physical Medicine & Rehabilitation 

4. First Year Completion – Active Staff Appointment: 

a. Charina C. Yango, M.D. – Family Practice 

5. M.S. and A.H.P. Reappointments – 07-01-11 to 06-30-13 (list attached) 

6. Leave of Absence Extension: 

a. Charles Boggs, M.D. – General Surgery, 07-04-11 – 07-31-11 

7. Change of Status: 

a. Richard N. DeIorio, M.D. – Orthopedic Surgery, Active to Honorary 

8. Resignations: 

a. William R. Cook, M.D. – Cardiology, effective 06-03-11 

b. Michael B. Evans, M.D. – Neurology, effective 12-31-10 

c. Eric F. Martin, M.D. – Internal Medicine, effective 06-01-11 

#2

Memorandum to Board of Directors - CCH 

June 22, 2011 

Page 2 of 2 

9. Allied Health Practitioners: 

a. Jason Balt, CRNA – Medical Anesthesia 

b. William Byer, CRNA – Medical Anesthesia 

c. Emily Day, PA – Dr. Marilyn Kole 

d. Katrina Giraldez, PA – A. Kagan & Associates 

e. Karen Lash, ARNP – Specialists in Urology 

f. Helen Michele Robbins, PA – Gastroenterology Associates of SW FL 

10. Allied Health Practitioners – Intrasystem Application: 

a. Debra Harwood-Warndahl, ARNP – Pediatrix Group 

b. Janice Romito, ARNP – Pediatrix Group 

11. Allied Health Practitioners – Additional Privileges: 

a. Ira Saunders, PA – Dr. Marilyn Kole, Central venous catheter and Arterial line 

placement 

b. Marilyn Farley, ARNP – Pediatrix Group, privileges listed below 

c. April Felton, ARNP – Pediatrix Group, privileges listed below 

d. Lorna Forchin, ARNP – Pediatrix Group, privileges listed below 

e. Elaine Pao, ARNP – Pediatrix Group, privileges listed below 

Endotracheal tube placement, Lumbar puncture, Needle aspiration of the chest, 

Thoracostomy tube placement, Umbilical catheter placement 

12. Practitioners–in-Training: 

a. Kansas City COM Medical Students – 08-01-11 to 05-31-13 (list attached) 

b. NOVA SE COM Medical Students – 07-01-11 to 05-31-13 (list attached) 

c. NOVA SE PA Students – 08-22-11 to 08-23-12 (list attached) 

Approved by the Board of Directors – June 23, 2011 

__________________________________________ 

Richard B. Akin, Chairman – Board of Directors


CCH REAPPOINTMENTS 

07/01/11 - 06/30/13 

Name Suffix Specialty Type 

MEDICAL STAFF 

Agress, Jo Ann R. Ph.D. Psychology Associate 

Anthony, Nicholas C. Ph.D. Psychology Associate 

Assad, Charles Ph.D. Psychology Associate 

Bernas, Rebecca J. Psy.D. Psychology Associate 

Castillo, Lazaro L. M.D. Allergy & Immunology Associate 

Dunbar, Scott D. M.D. Oncology/Hematology Associate 

Dwyer, Brendan M. D.D.S. General Dentistry Associate 

Geiser, David S. Ph.D. Psychology Associate 

Hart, Lowell L. M.D. Oncology/Hematology Active 

Harwin, William N. M.D. Oncology/Hematology Associate 

Hogan, Timothy D. D.M.D. Oral/Maxillofacial Surgery Active 

Kazakos, George M. D.M.D. General Dentistry Associate 

Kim, Brian K. M.D. Oncology/Hematology Active 

Klucka, Charles V. D.O. Allergy & Immunology Associate 

Koneru, Bhanuprasad M.D. Oncology/Hematology Associate 

Krouk, Marianne G. D.O. Psychiatry Associate 

Laboda, Michele B. D.M.D. Orthodontics Associate 

Lopez, Mabel Ph.D. Psychology Associate 

Mazzorana, Ivan L. Jr. M.D. Psychiatry Associate 

McCleod, Michael J. D.O. Oncology/Hematology Active 

McGinnis, John Christopher Ph.D. Psychology Associate 

McMillan, Michael H. D.M.D. General Dentistry Associate 

Outlan, Kristin E. D.M.D. General Dentistry Associate 

Pollack, Robert W. M.D. Psychiatry Associate 

Rana, Vanrajsinh G. M.D. Oncology/Hematology Active 

Raymond, Michael G. M.D. Oncology/Hematology Active 

Reeves, James A. M.D. Oncology/Hematology Active 

Richards, John M. D.D.S. Orthodontics Associate 

Rieche, Omar M.D. Psychiatry Associate 

Rodriguez, Francisco A. M.D. Oncology/Hematology Active 

Romero, Silvia A. M.D. Oncology/Hematology Active 

Schurman, Seth S. M.D. Allergy & Immunology Associate 

Streater, Mark R. D.M.D. Oral/Maxillofacial Surgery Active 

Tejera, Tinerfe J. DMD, MD Oral/Maxillofacial Surgery Associate 

Teufel, Thomas E. M.D. Oncology/Hematology Active 

Zeterberg, Joseph M. M.D. Allergy & Immunology Honorary 

06/01/11 - 09/30/12 

Cumberbatch, Duane F. D.P.M. Podiatry Associate 

07/01/11 - 08/31/11 

Kosloff, Rebecca A. M.D. Oncology/Hematology Associate 

Lipman, Andrew J. M.D. Oncology/Hematology Associate 

Rubin, Mark S. M.D. Oncology/Hematology Associate 

ALLIED HEALTH 

Barden, Pamela A. CRNA Cert. Reg. Nurse Anesthetist AHP 

Biddison, Ann C. ARNP Adv. Reg. Nurse Practitioner AHP 

Bredar, Patrick J. P.A. Physician Assistant AHP 

Byrd, S. Diane C.N.M. Cert. Nurse Midwife AHP


CCH REAPPOINTMENTS 

07/01/11 - 06/30/13 


Calhoun, Joanne C. P.A. Physician Assistant AHP 

Carpenter, Christine D. ARNP Adv. Reg. Nurse Practitioner AHP 

Clyatt, Caryle Lyne ARNP Adv. Reg. Nurse Practitioner AHP 

Cohen, Michael J. P.A. Physician Assistant AHP 

Cuderman, Peggy I. CRNA Cert. Reg. Nurse Anesthetist AHP 

Edmiston, Karen M. ARNP Adv. Reg. Nurse Practitioner AHP 

Fee, Sandra Sue ARNP Adv. Reg. Nurse Practitioner AHP 

Gilliam, Melissa A. P.A. Physician Assistant AHP 

Govender, Shirley ARNP Adv. Reg. Nurse Practitioner AHP 

Kelly, Margaret M. ARNP Adv. Reg. Nurse Practitioner AHP 

Klein, Candace D. CRNA Cert. Reg. Nurse Anesthetist AHP 

Kmetz, John P. P.A. Physician Assistant AHP 

Lee, David E. P.A. Physician Assistant AHP 

Mallari, Christopher A. P.A. Physician Assistant AHP 

McKelvie, Jessica ARNP Adv. Reg. Nurse Practitioner AHP 

Melhado, Lolita Winifred ARNP Adv. Reg. Nurse Practitioner AHP 

Milligan, Jaine E. ARNP Adv. Reg. Nurse Practitioner AHP 

Nunley, Jennifer N. CRNA Cert. Reg. Nurse Anesthetist AHP 

Pitt, Judith A. ARNP Adv. Reg. Nurse Practitioner AHP 

Riley, Candice L. CRNA Cert. Reg. Nurse Anesthetist AHP 

Saunders, Ira P.A. Physician Assistant AHP 

Simms, Linda L. ARNP Adv. Reg. Nurse Practitioner AHP

PA Students, NOVA SE University –08/22/11-08/23/12 Medical Students, Kansas City University 

• Crista Anderson College of Osteopathic Medicine 8/1/11 to 05/31/13: 

• Danielle Bakalar Kyle Bruns 

• Andreea Barcan Austin Dennard 

• Kelly Baumgartner Andrew Gordon 

• Christopher Blanchet Amanda Goss 

• Nicole Bryant Rachel High 

• Sharon Cam Jessica Kim 

• Shannon Carie Paulina Olszewska 

• Michael Cook Drew Scribner 

• Audrey Cornelius Adam Streit 

• Scott Davis Cattie Williams 

• Jamison Dicus 

• Julie Dobritt 

• Ersan Erol 

• William Fazio Medical Students, Nova Southeastern University 

• Stephanie Featherstone College of Osteopathic Medicine 7/01/11 to 05/31/13: 

• Justin Fink Derrick Goubeaux 

• Erika Fonseca-Liddell Joseph Leaman 

• Danielle Gumina Chelsey Swaiko 

• Serena Haffner Andrew Whipple 

• Christopher Hatwell 

• Heidi Hindsley 

• Megan Horn 

• Jason Jaffe 

• Derek Johnson 

• Margo Klingensmith 

• Lynn Lakoma 

• Melinda Long 

• Angelica Martinez 

• Brett Mattei 

• Furva Merchant 

• Megan Michael 

• Amelia Miller 

• Erin Monahan 

• Curt Mullendore 

• Kaitlin Mullins 

• Toni Muto 

• Laura Nutter 

• Stuart Paasche 

• Timothy Pancio 

• Allison Petrak 

• Alicia Provenzano 

• Ashley Reid 

• Lisa Reidy 

• Nicole Reynolds 

• Alexandra Sanborn 

• Vincent Schaum 

• Michelle Simmons 

• Heather Slayton 

• Amanda Smith 

• Meredith Taylor 

• James Torrico 

• Ryan Upham 

• Sarah Watson 

• Justin West 

PA Students, NOVA SE University –08/22/11-12/31/11 

• Amanda Dutton 

• Becky Opper 

• Jordan Ritchie

___________________ 



OLD 

BUSINESS

___________________ 



NEW BUSINESS

ADJOURN 

Cape Coral Hospital 

GO TO 

{GREEN FOLDER} 

LEE MEMORIAL 

HOSPITAL 


(Provider #10-0012)

CONVENE 

{GREEN FOLDER} 

(Provider # 10-0012) 

Lee Memorial Hospital 

HealthPark Medical Center 

The Children’s Hospital of 

SW Florida



239-343-3300 

FAX: 239-343-3194 

P.O. BOX 2218 


33902 










DISTRICT ONE 


Marilyn Stout 

DISTRICT TWO 






DISTRICT FOUR 


Chris Hansen 

DISTRICT FIVE 


James Green 

AGENDA 



(Provider # 10-0012) 

June 23, 2011 4:00 p.m. 





Lee Memorial Hospital Board of Directors Meeting 




3. MEETING MINUTES OF MAY 26, 2011 (Approval) 


4. OPERATIONS REPORT (Approval) 

(Lisa Sgarlata, RN, MSN, Chief Administrative Officer/LMH) 



A. Lee Memorial Hospital 

B. HealthPark Medical Center 

C. The Children’s Hospital 






062311 FINAL AGENDA - LEE MEMORIAL HOSPITAL

___________________ 




AGENDA ITEMS: 




minutes and a 











LEE MEMORIAL HOSPITAL BOARD OF DIRECTORS (PROVIDER # 10-0012) 







OTHERS PRESENT: Cathy Stephens, Board Administrator; Jim Humphrey, Board Counsel; Mary McGillicuddy, Chief Legal Officer; John Wiest, Chief Operating Officer/Business and Strategic Services; 

Larry Antonucci, M.D., Chief Operating Officer/Hospital & Physician Services; Mike German, Chief Financial Officer; Jon Cecil, Chief Human Resource Officer; Charles Swain, Chief Compliance and 

Internal Audit Officer; Scott Nygaard, M.D., Chief Medical Officer/Physician Services; Wendy Piascik, Vice President/Patient Care Services/CCH; Kathy Bridge-Liles, Vice President/Women’s and 

Children’s Services; Thomas Presbrey, M.D., Chairman/Physician Leadership Council; Andrea Snyder, Director/Transfer Center; Susan Crowe, Director/Volunteer Services; Diana Sutton, System 

Director/Nursing; Donna Bradish, Director/Volunteer Resources; Cynthia Brasher, System Director Spiritual Services; Mary Lorah, Risk Manager II; Bill Silverman, M.D., Quality & Education Community 

Representative; Marliese Mooney, Physician Leadership Council Consultant/Planning Community Representative; David Berger, M.D., Community Representative/Quality & Education; Erica 

McDermott, Medical Social Worker/GCMC; Nora Harmon, LMH/HP Auxiliary President; Sandy Hiese, Auxiliary Volunteer; Nancy Stanfield, Auxiliary/GCMC President; Jean Moren, Auxiliary Volunteer; 

Bob Simpson, LeeSar; Andy Lynch, LeeSar; Gayle Reynolds, LeeSar; Sanford Cohen, M.D./Guest; Mary Briggs, Interim Public Information Officer; Frank Gluck, News Press/Reporter; Paul Gesgler, 

NBC2/Reporter; Daniel Morency, Fort Myers Police Department; Todd Gates, Guest; Jean Perkins, Guest; Laurie Gretten, Executive Secretary/Board of Directors 




UP 

MEETING 



LEE MEMORIAL 

HOSPITAL BOARD 

MINUTES 

LEE MEMORIAL 

HOSPITAL 

OPERATIONS 

REPORT 

MEDICAL 

STAFF 

BUSINESS 

Nancy McGovern asked for approval of the Lee Memorial Hospital Board minutes 

of April 28, 2011. 

The Operations Report for Lee Memorial Hospital Providers was submitted for 

acceptance (Exhibit 1) which consisted of a review of quality indicators, patient 

experience ratings, operational statistics comparing year to date to budget, 

management focus areas and financial reporting. 

Richard Akin asked for approval of the Medical Staff Recommendations for Lee 

Memorial Hospital (Exhibit 2), and HealthPark Medical Center of May 19, 2011 

(Exhibit 3). 

AUXILIARY Recognition was given by Lee Memorial Hospital Auxiliary President, Al Kinkle to 

LEE MEMORIAL HOSPITAL BOARD OF DIRECTORS 

(Provider #10-0012) Meeting was CALLED TO ORDER at 4:55 p.m. 


A motion was made by Nancy McGovern to approve the Lee Memorial 

Hospital April 28, 2011 Board Minutes. The motion was seconded by 

Donald Brown and it carried with no opposition. 

A motion was made by Chris Hansen to accept the Operations 

Reports for Lee Memorial Hospital (Provider #10-0012 (Exhibit 1). 

The motion was seconded by Marilyn Stout and it carried with no 

opposition. 

A motion was made by Chris Hansen to approve the Medical Staff 

Recommendations of for Lee Memorial Hospital (Exhibit 2), 

HealthPark Medical Center of May 19, 2011 (Exhibit 3). The motion 

was seconded by Marilyn Stout and it carried with no opposition.

LEE MEMORIAL HOSPITAL (Provider #10-0012) BOARD OF DIRECTORS MEETING 


Thursday, May 26 2011 

Page 2 of 2 


UP 

BUSINESS Sandy Heise, Treasurer of the Association of FL Healthcare Auxiliaries/Volunteers. 

Applause ensued. Mr. Akin thanked her and all the volunteers for all their work on 

behalf of the Board of Directors. 


NEW BUSINESS 

NEXT REGULAR 

MEETING 

None at this time. 

The next Full Board meeting of the LEE MEMORIAL HOSPITAL 

(Provider #10-0012) BOARD OF DIRECTORS IS: 



ADJOURNMENT The Lee Memorial Hospital (Provider #10-0012) 

Board of Directors Meeting was ADJOURNED 

at 4:59 p.m. by Richard Akin, Board Chairman. 



Board Secretary

Operations Report: Lee Memorial Hospital Provider # 10-0012 

(Combined Reports which include HealthPark Medical Center & The Children’s Hospital of SW FL) 

Presented to Board of Directors, June 23, 2011 

Net Revenue 

Labor 

Financial Report 5/31/2011 

• Net Rev/Adj. Admit Budget 9,832 Actual 10,147 

• Net Revenue per adjusted admission over budget by 3.2% 

• Net Patient Revenue positive rate variance of $1,449,760 due to strong surgical 

volumes. 

• FTEs per AOB were 4.59 vs. budget of 4.48 or 2.5% 

• Average hourly rate of $25.97 lower than budget by $.08 or 0.3% 

• OT was over by 32% from budget 

• Productive salaries were over budget $655K 


• Gain from Operations 11.0M Actual 

• The Gain from Operations was over budget by $468K or 4.4% and over PY by $617K 

or 5.9%. 

• Supply expense per adjusted admission over budget by 8%. 

• The main contributor to the favorable variance in the Gain from Operations was the 

strong volume growth. 

Operations Report 5/31/2011 

May’11 Budget Actual Prior var Bud varPY 

Admissions 2,863 3,005 2,968 5.0% 1.2% 

ER Visits 9,101 9,324 9,237 2.5% 0.9% 

ER Admits 2,061 2,219 2,030 7.7% 9.3% 

Surgical Cases 1,424 1,668 1,655 17.1% 0.8% 

Gain/Oper 10,526 10,994 10,377 4.4% 5.9% 

Net Rev/Adj 

Adm 9,832 10,147 9,717 3.2% 4.4%

Lee Memorial Hospital (Individual Report) 

Presented by Lisa Sgarlata, RN, MS, MSN, CEN, Chief Administrative Officer 


Patient Experience 5/10 5/11 YTD 


Likelihood to Recommend 57% 48.3% 58.7% 


Likelihood to Recommend 59.3% 52.8% 54% 


Rate this Hospital 57% 57% 57.2% 

Net Revenue 

Labor 

Financial Report 5/31/2011 

• Net Rev/Adj. Admit Budget 10,748 Actual 10,132 

• Net Revenue per adjusted admission lower than budget by 5.7% and 9.8% lower PY. 

• Net Patient Revenue positive rate variance exceeded budget by $1.3M due to strong 

surgical volumes. 

• FTEs per AOB were 4.31 vs. budget of 4.38 lower by 1.6% 

• Average hourly rate of $25.66 exceeded budget by $.18 or 0.7% 

• OT was over by 37% from budget. 

• Productive salaries were over budget $440K 


• Gain from Operations Budget $3.1M Actual $3.2M 

• The Gain from Operations was over budget by $87K or 2.8% and down from PY by 

$1.4M or 31%. 

• Supply expense per adjusted admission over budget by 8.4%. 

• The main contributor to the favorable variance in the Gain from Operations was the 

strong volume growth and improvements in productivity. 


May FY11 Budget Actual var Bud 

Admissions 1,027 1,180 14.9% 

ER Visits 4,311 4,451 3.2% 

ER Admits 883 988 11.9% 

Surgical Cases 698 817 17.0%

HealthPark Medical Center & The Children’s Hospital of SW Florida 

Presented by Donna Giannuzzi, RN, MBA, CNAA, BC, Chief Administrative Officer 

June 23, 2011 

Financial Report 

Net Revenue 

Net Revenue per adjusted admission exceeded budget by 8.6%, with a positive rate variance of $2,065K and a negative 

volume variance of ($843K). Positively impacted by a higher volume and better than expected reimbursement from 

Managed Care. HP admissions were down from budget by .6%, all of which was in the pediatrics and NICU. 

Labor 

FTEs per AOB were 4.59 vs. budget of 4.40 for a productivity decline of 4.4% or 73 FTEs. 

The decline in Outpatient Revenue caused 48 of the FTE overage, with remaining 25 FTEs being a decline in productivity 

for the month. Salary expense was over budget $434K, of which $25K was a negative rate variance and $409K negative 

volume variance. 


The EBDITA came in above budget by $830K or 10.2%. The Gain from Operations also came in above budget by $536K 

or 8.1%. YTD the Gain from Operations is $55.1mm vs. a budget of $49.7mm, a 8.1% positive variance. 


Volumes 

Month to Date Budget Actual Prior var Bud var PY 

Admissions 1835 1825 1860 -.6% -1.9% 

Adjusted Admits 2563 2480 2572 -3.2% -3.6% 

ER Visits 4789 4873 4826 1.7% 1.0% 

ER Admits 1178 1231 1137 4.5% 8.3% 

Deliveries 293 245 284 -16.3% -13.7% 

Surgical Cases 727 851 881 17.1% -3.5% 

Gain from Operations 6630 7165 5625 8.1% 27.4% 

Net Rev/Adj Admit 9319 10125 8844 8.6% 14.5% 


Patient Experience 5/10 5/11 Avg. Last 12 Mo 


Likelihood to Recommend 74.9% 72.5% 74.1% 




Rate this Hospital 67% 63.% 69.4% 

Highlights 

The Children’s Hospital 

The Pediatric/PICU Transport Team is going live July 5, 2011 utilizing one transport “hotline” number for The Children’s 

Hospital. All transports from other facilities will be coordinated through the LMHS Transfer Center and Lee County 

EMS.








Subject: Lee Memorial Hospital Medical Staff Recommendations 



the bylaws: 



b. Juan J. Hernandez, M.D. – Family Practice 

c. Shiyama V. Mudali, M.D. – Pathology 

d. Oscar H. Rodriguez Siguenas, M.D. – Internal Medicine 

e. Anila Veerani, M.D. – Cardiology 




3. First Year Completion – Associate Staff Appointment: 

a. Claudio A. Ferreira, M.D. – Ophthalmology 







a. Jeffrey R. Comer, M.D. – Otolaryngology, effective 07-01-11 

b. William R. Cook, M.D. – Cardiology, effective 06-03-11 

c. Michael B. Evans, M.D. – Neurology, effective 12-31-10 

d. James Johnson, M.D. – Pediatric Neurology, effective 06-30-11 

e. Eric F. Martin, M.D. – Internal Medicine, effective 06-01-11 

#1

Memorandum to Board of Directors - LMH 

June 22, 2011 

Page 2 of 2 






e. Helen Michele Robbins, PA – Gastroenterology Associates of SW FL 

f. Steven Mitnick, ARNP – LPG Dunbar Clinic 

9. Allied Health Practitioner – Additional Sponsor: 

a. Mary Raulerson, PA – Suncoast Surgical Associates 

10. Allied Health Practitioner – Additional Privileges: 


placement 






__________________________________________ 

Richard B. Akin, Chairman - Board of Directors


LMH REAPPOINTMENTS 

07/01/11 - 06/30/13 

Name 

MEDICAL STAFF 

Suffix Specialty Type 


Ahmadi, Anissa D.M.D. Ped. Dentistry Associate 

Alcalde, Rafael E. D.D.S. Oral/Maxillofacial Surgery Active 

Anderson, Stephen F. D.D.S. Oral/Maxillofacial Surgery Associate 


Bernas, Rebecca J. Psy.D. Psychology Active 

Cagata, Jay C. D.M.D. Oral/Maxillofacial Surgery Active 

Calkins, Cori J. Psy.D. Psychology Associate 

Casey, Gregory M. D.D.S. Oral/Maxillofacial Surgery Active 


Chrovian, Sharon L. Psy.D. Psychology Associate 

Dubin, Wayne M. D.D.S. Endodontics Associate 

Dunbar, Scott D. M.D. Oncology/Hematology Active 

Favalli, Oliver P. D.M.D. Orthodontics Associate 

Gear, Robert D. Jr. DMD, MD Oral/Maxillofacial Surgery Active 


Grumbach, Paul G. D.D.S. General Dentistry Associate 


Harwin, William N. M.D. Oncology/Hematology Active 

Hendry, Robert E. D.D.S. General Dentistry Honorary 

Hoek, Christopher B. D.D.S. Oral/Maxillofacial Surgery Honorary 

Hogan, Timothy D. D.M.D. Oral/Maxillofacial Surgery Active 

Johnson, Raymond A. M.D. Psychiatry Associate 

Kasprzak, Cheryl J. Psy.D. Psychology Associate 




Koneru, Bhanuprasad M.D. Oncology/Hematology Active 


Laboda, Gerald D.M.D. Oral/Maxillofacial Surgery Honorary 


Larned, Catherine M.D. Psychiatry Associate 

Lopez, Mabel Ph.D. Psychology Active 

Machlin, Steven R. M.D. Psychiatry Associate 

Mani, Tanja M. Ph.D. Psychology Associate 

Mazzorana, Ivan L. Jr. M.D. Psychiatry Active 


McDowell, Hope E. D.M.D. Ped. Dentistry Associate 


Minsky, Susan H. Ph.D. Psychology Associate 

Mulholland, Amy M. Ph.D. Psychology Associate 


Pauker, Neil E. M.D. Psychiatry Associate 

Pollack, Robert W. M.D. Psychiatry Active 





Richardson, Randolph M. D.M.D. Oral/Maxillofacial Surgery Active 


Robbins, Jonathan D. Psy.D. Psychology Associate



07/01/11 - 06/30/13 




Sangiacomo, Roxann M.D. Psychiatry Associate 


Schwartz, Donald P. M.D. Allergy & Immunology Associate 

Schwartz, Scott C. D.D.S. Ped. Dentistry Associate 

Shimoda, Kim C. Ph.D. Psychology Associate 

Sicilia, Judy Psy.D. Psychology Associate 

Silver, Robert B. Ph.D. Psychology Active 

Spellman, Michael B. Ph.D. Psychology Active 

Streater, Mark R. D.M.D. Oral/Maxillofacial Surgery Active 

Swanson, Gary E. D.D.S. General Dentistry Associate 

Tejera, Tinerfe J. DMD, MD Oral/Maxillofacial Surgery Active 


Turnier, Charles Gaston M.D. Allergy & Immunology Associate 

Verwest, Tim M. D.M.D. Ped. Dentistry Associate 

Wells, Anne M. Ph.D. Psychology Associate 


07/01/11 - 12/30/12 

O'Mailia, James J. M.D. Gastroenterology Active 

06/01/11 - 12/30/12 

Cruz-Gonzalez, Irma M.D. Gastroenterology Active 

06/01/11 - 09/30/12 

Cumberbatch, Duane F. D.P.M. Podiatry Active 

07/01/11 - 08/31/11 



Nicolau, Martin F. M.D. Oncology/Hematology Associate 

O'Neal, Shaun K. Psy.D. Psychology Associate 

Ramirez, Michele L. M.D. Oncology/Hematology Associate 


Satz, Harvey S. D.M.D. Oral/Maxillofacial Surgery Associate 

Talbott, Jody E. Ph.D. Psychology Associate 

ALLIED HEALTH 



Byrd, S. Diane C.N.M. Cert. Nurse Midwife AHP 


Campbell, Sheresa K. ARNP Adv. Reg. Nurse Practitioner AHP 





Fee, Sandra Sue ARNP Adv. Reg. Nurse Practitioner AHP



07/01/11 - 06/30/13 




Green, Kwee E. C.N.M. Cert. Nurse Midwife AHP 

Hall, Frederick J. P.A. Physician Assistant AHP 













Simms, Linda L. ARNP Adv. Reg. Nurse Practitioner AHP 

Stewart, Cynthia C.N.M. Cert. Nurse Midwife AHP 

VandeVeer, Calee A. ARNP Adv. Reg. Nurse Practitioner AHP 

07/01/11 - 12/30/11 

Pacheco, Naomi C.N.M. Cert. Nurse Midwife AHP






































• Toni Muto 






















• Jordan Ritchie








Subject: HealthPark Medical Center Medical Staff Recommendations 

The Facility Medical Executive Committee of the Medical Staff recommends the following physicians 

and allied health practitioners and certifies they have met the requirements set forth in the bylaws: 



b. Frank T. Grassi, M.D. – Pulmonary Medicine 

c. Juan J. Hernandez, M.D. – Family Practice 

d. Shiyama V. Mudali, M.D. – Pathology 

e. Oscar H. Rodriguez Siguenas, M.D. – Internal Medicine 

f. Anila Veerani, M.D. – Cardiology 

g. Miriam C. Zolfoghary, M.D. – General Surgery 




3. Intrasystem Application – Associate Staff: 

a. Iman Fares, M.D. – Pediatrics/Neonatology 






7. Privilege Request: 

a. Thomas Kowalsky, M.D. – General/Vascular Surgery, Brachytherapy seeds 

8. Leave of Absence Extension: 

a. Charles Boggs, M.D. – General Surgery, 07-04-11 – 07-31-11 

#4

Memorandum to Board of Directors - HPMC 

June 22, 2011 

Page 2 of 2 




a. Jeffrey R. Comer, M.D. – Otolaryngology, effective 07-01-11 

b. William R. Cook, M.D. – Cardiology, effective 06-03-11 

c. Michael B. Evans, M.D. – Neurology, effective 12-31-10 

d. James Johnson, M.D. – Pediatric Neurology, effective 06-30-11 

e. Eric F. Martin, M.D. – Internal Medicine, effective 06-01-11 






e. Karen Lash, ARNP – Specialists in Urology 

f. Helen Michele Robbins, PA – Gastroenterology Associates of SW FL 

g. Steven Mitnick, ARNP – LPG Dunbar Clinic 

h. Amanda Volberg, ARNP – LPG The Sanctuary 

12. Allied Health Practitioner – Additional Sponsor: 

a. Mary Raulerson, PA – Suncoast Surgical Associates 



placement 

b. Marilyn Farley, ARNP – Pediatrix Group, privileges listed below 

c. April Felton, ARNP – Pediatrix Group, privileges listed below 

d. Lorna Forchin, ARNP – Pediatrix Group, privileges listed below 

e. Debra Harwood-Warndahl, ARNP – Pediatrix Group, privileges listed below 

f. Elaine Pao, ARNP – Pediatrix Group, privileges listed below 

g. Janice Romito, ARNP – Pediatrix Group, privileges listed below 


Thoracostomy tube placement, Umbilical catheter placement, Percutaneous 

insertion of arterial catheter and central catheter, Single and double volume 

exchange transfusion (under neonatologist supervision) 






__________________________________________ 

Richard B. Akin, Chairman - Board of Directors


HPMC REAPPOINTMENTS 

07/01/11 - 06/30/13 


MEDICAL STAFF 


Ahmadi, Anissa D.M.D. Ped. Dentistry Active 

Anderson, Stephen F. D.D.S. Oral/Maxillofacial Surgery Associate 



Calkins, Cori J. Psy.D. Psychology Associate 

Casey, Gregory M. D.D.S. Oral/Maxillofacial Surgery Associate 


Chrovian, Sharon L. Psy.D. Psychology Associate 

Dubin, Wayne M. D.D.S. Endodontics Associate 


Favalli, Oliver P. D.M.D. Orthodontics Active 

Gear, Robert D. Jr. DMD, MD Oral/Maxillofacial Surgery Active 


Grumbach, Paul G. D.D.S. General Dentistry Associate 


Harwin, William N. M.D. Oncology/Hematology Active 

Hendry, Robert E. D.D.S. General Dentistry Honorary 

Hoek, Christopher B. D.D.S. Oral/Maxillofacial Surgery Honorary 

Johnson, Raymond A. M.D. Psychiatry Associate 

Kasprzak, Cheryl J. Psy.D. Psychology Associate 




Koneru, Bhanuprasad M.D. Oncology/Hematology Associate 

Krouk, Marianne G. D.O. Psychiatry Active 

Laboda, Gerald D.M.D. Oral/Maxillofacial Surgery Honorary 


Larned, Catherine M.D. Psychiatry Associate 


Machlin, Steven R. M.D. Psychiatry Associate 

Mani, Tanja M. Ph.D. Psychology Associate 

Mazzorana, Ivan L. Jr. M.D. Psychiatry Associate 


McDowell, Hope E. D.M.D. Ped. Dentistry Active 


Minsky, Susan H. Ph.D. Psychology Associate 

Mulholland, Amy M. Ph.D. Psychology Associate 


Pauker, Neil E. M.D. Psychiatry Associate 






Richardson, Randolph M. D.M.D. Oral/Maxillofacial Surgery Associate 


Robbins, Jonathan D. Psy.D. Psychology Associate 


Romero, Silvia A. M.D. Oncology/Hematology Associate 

Sangiacomo, Roxann M.D. Psychiatry Associate 


Schwartz, Donald P. M.D. Allergy & Immunology Associate



07/01/11 - 06/30/13 



Shimoda, Kim C. Ph.D. Psychology Associate 

Sicilia, Judy Psy.D. Psychology Associate 

Silver, Robert B. Ph.D. Psychology Associate 

Spellman, Michael B. Ph.D. Psychology Associate 

Swanson, Gary E. D.D.S. General Dentistry Associate 


Turnier, Charles Gaston M.D. Allergy & Immunology Associate 

Verwest, Tim M. D.M.D. Ped. Dentistry Active 



07/01/11 - 12/30/12 


06/01/11 - 12/30/12 

Cruz-Gonzalez, Irma M.D. Gastroenterology Active 

06/01/11 - 09/30/12 


06/01/11 - 09/30/12 

Palank, Edward A. M.D. Cardiology Associate 

07/01/11 - 08/31/11 

Governale, Lauren M. D.M.D. Ped. Dentistry Active 


Lettner, Harald W. Ph.D. Psychology Associate 



O'Neal, Shaun K. Psy.D. Psychology Associate 



Satz, Harvey S. D.M.D. Oral/Maxillofacial Surgery Associate 

Talbott, Jody E. Ph.D. Psychology Associate 

ALLIED HEALTH 



Byrd, S. Diane C.N.M. Cert. Nurse Midwife AHP 










Green, Kwee E. C.N.M. Cert. Nurse Midwife AHP 


Kelly, Margaret M. ARNP Adv. Reg. Nurse Practitioner AHP



07/01/11 - 06/30/13 














Stewart, Cynthia C.N.M. Cert. Nurse Midwife AHP 

VandeVeer, Calee A. ARNP Adv. Reg. Nurse Practitioner AHP 

07/01/11 - 12/30/11 

Pacheco, Naomi C.N.M. Cert. Nurse Midwife AHP






































• Toni Muto 






















• Jordan Ritchie








Subject: The Children’s Hospital Medical Staff Recommendations 



the bylaws: 


2. Resignation: 

a. James Johnson, M.D. – Pediatric Neurology, effective 06-30-11 






__________________________________________ 

Richard B. Akin, Chairman - Board of Directors 

#5


TCH REAPPOINTMENTS 

07/01/11 - 06/30/13 


MEDICAL STAFF 

Ahmadi, Anissa D.M.D. Ped. Dentistry Active 

Favalli, Oliver P. D.M.D. Orthodontics Active 

McDowell, Hope E. D.M.D. Ped. Dentistry Active 


Verwest, Tim M. D.M.D. Ped. Dentistry Active 

07/01/11 - 08/31/11 

Governale, Lauren M. D.M.D. Ped. Dentistry Active 

ALLIED HEALTH 



VandeVeer, Calee A. ARNP Adv. Reg. Nurse Practitioner AHP






































• Toni Muto 






















• Jordan Ritchie

___________________ 



OLD 

BUSINESS

___________________ 



NEW BUSINESS

ADJOURN 

Lee Memorial Hospital 

GO TO 

{ORANGE FOLDER} 

GULF COAST 

MEDICAL CENTER 


(Provider #10-0244)

CONVENE 

{ORANGE FOLDER} 

(Provider # 10-0220) 

GULF 

COAST 

MEDICAL 

CENTER



239-343-3300 

FAX: 239-343-3194 

P.O. BOX 2218 


33902 










DISTRICT ONE 


Marilyn Stout 

DISTRICT TWO 






DISTRICT FOUR 


Chris Hansen 

DISTRICT FIVE 


James Green 

AGENDA 



(Provider # 10-0220) 

June 23, 2011 4:00 p.m. 





Gulf Coast Medical Center Board of Directors 




3. MEETING MINUTES OF May 26, 2011 (Approval) 


4. OPERATIONS REPORT (Holly Mueller, VP Patient Care) (Approval) 








062311 FINAL AGENDA - GULF COAST MEDICAL CENTER

___________________ 




AGENDA ITEMS: 




minutes and a 











GULF COAST MEDICAL CENTER BOARD OF DIRECTORS (PROVIDER # 10-0220) 



LOCATION: Lee Memorial Hospital, Boardroom, 2776 Cleveland Avenue, Fort Myers, FL 33901 




OTHERS PRESENT: Cathy Stephens, Board Administrator; Jim Humphrey, Board Counsel; Mary McGillicuddy, Chief Legal Officer; John Wiest, Chief Operating Officer/Business and Strategic 

Services; Larry Antonucci, M.D., Chief Operating Officer/Hospital & Physician Services; Mike German, Chief Financial Officer; Jon Cecil, Chief Human Resource Officer; Charles Swain, Chief 

Compliance and Internal Audit Officer; Scott Nygaard, M.D., Chief Medical Officer/Physician Services; Wendy Piascik, Vice President/Patient Care Services/CCH; Kathy Bridge-Liles, Vice 

President/Women’s and Children’s Services; Thomas Presbrey, M.D., Chairman/Physician Leadership Council; Andrea Snyder, Director/Transfer Center; Susan Crowe, Director/Volunteer 

Services; Diana Sutton, System Director/Nursing; Donna Bradish, Director/Volunteer Resources; Cynthia Brasher, System Director Spiritual Services; Mary Lorah, Risk Manager II; Bill Silverman, 

M.D., Quality & Education Community Representative; Marliese Mooney, Physician Leadership Council Consultant/Planning Community Representative; David Berger, M.D., Community 

Representative/Quality & Education; Erica McDermott, Medical Social Worker/GCMC; Nora Harmon, LMH/HP Auxiliary President; Sandy Hiese, Auxiliary Volunteer; Nancy Stanfield, 

Auxiliary/GCMC President; Jean Moren, Auxiliary Volunteer; Bob Simpson, LeeSar; Andy Lynch, LeeSar; Gayle Reynolds, LeeSar; Sanford Cohen, M.D./Guest; Mary Briggs, Interim Public 

Information Officer; Frank Gluck, News Press/Reporter; Paul Gesgler, NBC2/Reporter; Daniel Morency, Fort Myers Police Department; Todd Gates, Guest; Jean Perkins, Guest; Laurie Gretten, 

Executive Secretary/Board of Directors 




UP 

MEETING 



GULF COAST 


BOARD MINUTES 

GULF COAST 


OPERATIONS 

REPORT 

MEDICAL 

STAFF 

RECOMMENDATIONS 

Chairman asked for approval of the Gulf Coast Medical Center Board minutes of 

April 28, 2011. 

The Operations Report for Gulf Coast Medical Center was submitted for 

acceptance (Exhibit 1) which consisted of a review of quality indicators, patient 

experience ratings, operational statistics comparing year to date to budget, 

management focus areas and financial reporting. 

Discussion ensued concerning format of report and information provided. 

Richard Akin asked for approval of the Gulf Coast Medical Center Medical Staff 

Recommendations of May 19, 2011 (Exhibit 2). 

AUXILIARY Nancy Stanfield presented the Auxiliary Quarterly report (Exhibit 3). She said 

THE GULF COAST MEDICAL CENTER BOARD OF DIRECTORS 

(Provider #10-0220) Meeting was CALLED TO ORDER at 4:59 p.m. 


(Nancy McGovern out of the room for vote) 

A motion was made by Linda Brown to approve the Gulf Coast 

Medical Center April 28, 2011 Board Minutes. The motion was 

seconded by Chris Hansen and it carried with no opposition. 

A motion was made by Chris Hansen to accept the Operations Report 

for Gulf Coast Medical Center (Exhibit 1). The motion was seconded 

by Diane Champion and it carried with no opposition. 

A motion was made by James Green to approve the Medical Staff 

Recommendations for Gulf Coast Medical Center of May 19, 2011 

(Exhibit 2). The motion was seconded by Chris Hansen and it carried 

with no opposition.

GULF COAST MEDICAL CENTER (Provider # 10-0220) BOARD OF DIRECTORS MEETING 



Page 2 of 2 


UP 

QUARTERLY 

REPORT 


NEW BUSINESS None at this time. 

NEXT REGULAR 

MEETING 

that the Auxiliary has had good years. She stated they revamped their Gift Shop, 

and remodeled the uniform store, as well as added some new fundraisers to the 

calendar for this year. 

The next Full Board meeting of the GULF COAST MEDICAL CENTER 

(Provider # 10-0220) BOARD OF DIRECTORS IS: 



A motion was made by Nancy McGovern to accept the Auxiliary 

Quarterly Report for Gulf Coast Medical Center (Exhibit 3). The 

motion was seconded by Linda Brown and it carried with no 

opposition. 

ADJOURNMENT The Gulf Coast Medical Center (Provider #10-0220) 

Board of Directors Meeting was ADJOURNED 

At 5:05 p.m. by Richard Akin, Board Chairman. 



Board Secretary

Operations Report: Gulf Coast Medical Center Provider # 10-0220 

Presented to the Board June 23, 2011 by 

Holly Muller, RN, MSN, MHA, CRRN, VP Patient Care Services 

Financial Report 

Net Revenue 

Net Revenue per adjusted admission fell below budget by 1%, with a negative rate variance of $224K and a 

positive volume variance of $291K. Negatively impacted by the increase in Bad Debt and Charity as a % of 

Gross Revenue, 29% increase over budget and 1% increase over prior year. 

Labor 

FTEs per AOB were 4.84 vs budget of 4.72 for a productivity decline of 2.51%. 

This was primarily the result of declining Outpatient Revenue. Salary expense was over budget $432K, of 

which $9K was a negative rate variance and $424K negative volume variance. 


The EBDITA fell below budget by $534K or -9.6%. 

The Gain from Operations fell below budget by $545K or -22.0%. 

Gain from Ops May Actual 1887 vs. Budget 2433 var -545 // YTD 25368 vs. Budget 26171 var -802 


Volumes 

Month to Date Budget Actual Prior var Bud var PY 

Admissions 1674 1742 1693 4.04% 2.89% 

Adjusted Adm 2245 2276 2278 1.37% -0.07% 

ER Visits 3980 4074 3910 2.36% 4.19% 

ER Admits 1222 1347 1271 10.23% 5.98% 

Deliveries 154 110 134 -28.40% -17.91% 

Surgical Cases 913 851 827 -6.76% 2.90% 

Gain from Operations 2433 1887 2414 -22.42% -21.80% 

Net Rev/Adj Admit 9561 9461 9488 -1.04% -0.28% 


Patient Experience 5/10 5/11 AVG last 12 months 


Likelihood to Recommend 61.3% 59.4% 62% 




Rate This Hospital 65% 59% 58.8% 

Highlights 

• Established HCAHPS Domain Champions; to duplicate PI process for the Discharge Information 

Domain that exceeds all comparison groups. 

• ED performance continues to demonstrate substantial recovery "on all fronts" based on current scores 

• Safety Champions established throughout GCMC; HPI training provided May 2011 

• EPIC Implemented 6/1/11 as scheduled







Subject: Gulf Coast Medical Center 

Medical Staff Recommendations 




the bylaws: 



b. Frank T. Grassi, M.D. – Pulmonary Medicine 

c. Juan J. Hernandez, M.D. – Family Practice 

d. Shiyama V. Mudali, M.D. – Pathology 

e. Oscar H. Rodriguez Siguenas, M.D. – Internal Medicine 

f. Chad M. Stine, M.D. – Anesthesiology 

g. Anila Veerani, M.D. – Cardiology 




3. Intrasystem Application – Associate Staff: 

a. Bruce M. Nakfoor, M.D. – Radiation Oncology 








#3

Memorandum to Board of Directors - GCMC 

June 22, 2011 

Page 2 of 2 


a. William R. Cook, M.D. – Cardiology, effective 06-03-11 

b. Michael B. Evans, M.D. – Neurology, effective 12-31-10 

c. Eric F. Martin, M.D. – Internal Medicine, effective 06-01-11 

d. Stephen Schroering, M.D. – Orthopedic Surgery, effective 06-23-11 


a. Emily Day, PA – Dr. Marilyn Kole 

b. Katrina Giraldez, PA – A. Kagan & Associates 

c. Karen Lash, ARNP – Specialists in Urology 

d. Helen Michele Robbins, PA – Gastroenterology Associates of SW FL 

10. Allied Health Practitioners – Intrasystem Application: 

a. Marilyn Farley, ARNP – Pediatrix Group 

b. Lorna Forchin, ARNP – Pediatrix Group 

c. Debra Harwood-Warndahl, ARNP – Pediatrix Group 

d. Elaine Pao, ARNP – Pediatrix Group 

e. Janice Romito, ARNP – Pediatrix Group 



placement 

b. April Felton, ARNP – Pediatrix Group, privileges listed below 


Thoracostomy tube placement, Umbilical catheter placement 






_________________________________________ 

Richard B. Akin, Chairman, Board of Directors


GCMC REAPPOINTMENTS 

07/01/11 - 06/30/13 


MEDICAL STAFF 


Assad, Charles Ph.D. Psychology Associate 





Grumbach, Paul G. D.D.S. General Dentistry Active 


Harwin, William N. M.D. Oncology/Hematology Associate 




Koneru, Bhanuprasad M.D. Oncology/Hematology Active 




Mazzorana, Ivan L. Jr. M.D. Psychiatry Active 











Schwartz, Donald P. M.D. Allergy & Immunology Associate 


Spellman, Michael B. Ph.D. Psychology Associate 

Teufel, Thomas E. M.D. Oncology/Hematology Associate 


07/01/11 - 12/30/12 


06/01/11 - 12/30/12 

Cruz-Gonzalez, Irma M.D. Gastroenterology Associate 

06/01/11 - 09/30/12 


07/01/11 - 08/31/11 




Pollard, Steven W. Ph.D. Psychology Associate 


Rawlings, David B. Ph.D. Psychology Associate 


Satz, Harvey S. D.M.D. Oral/Maxillofacial Surgery Associate


GCMC REAPPOINTMENTS 

07/01/11 - 06/30/13 


ALLIED HEALTH 

Bladen, Sarah J. CRNA Cert. Reg. Nurse Anesthetist AHP 







Gemme, Gerard L. CRNA Cert. Reg. Nurse Anesthetist AHP 






Laraway, Carol H. CRNA Cert. Reg. Nurse Anesthetist AHP 






O'Halloran, Margaret P. CRNA Cert. Reg. Nurse Anesthetist AHP 




Suckow, Wendy P.A. Physician Assistant AHP 

VandeVeer, Calee A. ARNP Adv. Reg. Nurse Practitioner AHP






































• Toni Muto 






















• Jordan Ritchie

___________________ 



OLD 

BUSINESS

___________________ 



NEW BUSINESS

ADJOURN 

GULF COAST 


GO TO 

{BLUE FOLDER} 

RECONVENE 

LEE MEMORIAL HEALTH 

SYSTEM 


MEETING

CONTINUE to 



{BLUE FOLDER} 

Board Chairman 

Richard Akin

Recent Meetings 

PLC Chairman Report to the Board 6/23/2011 

TCH MEC – 6/21, 2011 GCMC MEC – 6/13, 2011 

HPMC MEC – 6/14, 2011 LMH MEC – 6/8, 2011 

CCH MEC – 6/20, 2011 PLC June None 

Multiple Campus MEC Items 

Financial Clearance Policy--This policy was reviewed. If the ordering physician 

determines within a reasonable degree of medical certainty that rescheduling the 

service would endanger the health of the patient, the service may proceed. 

SafeLee Progress Report given at all campuses. Continuation of the Safety Committee 

again discussed. 

Medical Staff Quality and Peer Review Policy revisions were approved to bring them 

under the PSO umbrella. 

Individual Campus MEC Items 

At Lee Memorial, the issue of obtaining mandatory consultations for uninsured patients 

was raised and referred to the PLC August 17 th , 2011 meeting. 

At Gulf Coast, the issue concerning Gynecology call coverage has been referred to the 

PLC 

PLC August meeting to begin a system-wide resolution. 

Next meeting August 17, 2011. 

Thank you for your attention. 

Tom Presbrey, MD 

PLC Chairman

______________ 





DATE: 6/15/2011 LEGAL REVIEW: Yes _x__ No ___ 

SUBJECT: Behavioral Health Partial Hospitalization Program-Property Lease Agreement 

REQUESTOR & TITLE: Lisa Sgarlata, Chief Administrative Officer/Lee Memorial Hospital 



Approved by System Planning Group 


Approval to lease Behavioral Health PHP clinic space at 12550 New Brittany Blvd. Suite 200 & 201 

from Winfield Partners III, LLC, based upon following terms and set forth in the attached lease. 

Approve assignment of lease from JBH Behavioral Health systems to LMHS for approximately 7,000 

SF at a flat monthly all inclusive rate of $8,000 per month or approx $14 per sq. ft., term through 

September 30, 2013. 


Projected Positive Return on Investment from 

established business with excellent reputation and 

convenient location in Ft. Myers. Continues to 

provide much needed outpatient mental health 

services to all regardless of ability to pay. 


2 year lease will restrict movement of the program from 

this location. 


Currently, Jennings Behavioral Health operates at this location. Exploration of alternatives reviewed 

current available space to move the program without success do to the amount of space needed for the 

program. 

FINANCIAL IMPLICATIONS Budgeted ____ Non-Budgeted ___X___ 


Operating revenues from business will provide a positive cash flow over all expenses including lease and 

will enable LMHS to offset cost of outpatient mental health treatment currently paid to JBH for charity 

referrals with revenues from commercially insured. No capital dollars for 2011 required. 


Employment of current JBH staff as LMHS employees to provide continuity of care. 

SUMMARY 

LMHS will be expanding its offering of behavioral health services effective July 1, 2011 by providing 

partial hospitalization, outpatient intensive therapy and medication management at the location 

previously operated by JBH Behavioral Health Systems, LLC. LMHS has had a contractual relationship 

with JBH for the past 2 ½ years to provide placement of inpatients and ER patients in need of outpatient 

mental health services. The historic agreement with JBH has reduced the total cost by shifting from the 

inpatient and ER setting to the less expensive and more effective outpatient setting. LMHS has paid JBH 

at a contractually agreed upon rate to care for its charity patients in need of these services as a more 

appropriate care setting and more effective means to improve community mental health than utilization 

of ER. This has provided LMHS with a way to increase bed capacity and enhance the continuity of care 

for its patients through its relationship with JBH to provide PHP and outpatient treatment. JBH will no 

longer be in operations and has asked LMHS to continue this service under LMHS ownership. This will 

allow LMHS to continue this exceptional service and immediately be able to serve a larger patient 

population due to broader contracting capabilities by LMHS and the ability to take Medicaid/Medicare 

patients. This will improve both the access to care for Behavioral Health patients and the quality of care 

to those patients. This project makes sense from several aspects including appropriate patient care, 

financial gain, and increased capacity.

LMHS 

LMHS 

Behavioral Health Center 

Presented to Board of Directors 

June 23, 2011 

Lisa Sgarlata, RN, MS, MSN, CEN 

Chief Administrative Officer

LMHS 

LMHS: 

Opportunity to Expand Behavioral Health Services 

Currently contracted with Jennings 

Behavioral Health as a resource for our BA 

patients who were occupying our acute care 

beds.

LMHS 

LMHS: Behavioral Health Center 

As of July 1, 2011, LMHS will be 

expanding its offering of behavioral health 

services by providing partial hospitalization, 

outpatient, intensive therapy and medication 

management.

LMHS 

Behavioral Health Center 

• To date: #132 referrals 

• Providing (2.5) additional beds/day 

• Provided appropriate care in the appropriate 

setting. 

What’s best for the patient?

LMHS 

LMHS: Behavioral Health Services 

Request the Board’s approval to lease 

Behavioral Health PHP clinic space. 

*Board (Action) Reporting Form attached

LMHS 

LMHS: Behavioral Health Services 

Thank you.

___________________ 



OLD 

BUSINESS

ATTENDANCE 

EDUCATION 

DRAFT LMHS BOARD OF DIRECTORS SCORECARD 

Submitted for Approval June 23, 2011 Comments 

Area of Focus 

Goal Statement 

Meets Exceeds 

Board Meeting Attendance (Attends all meetings), 

(90% per year) (75%) 

Participation in System 

Events ‐ when offered = 

attendance 

100% per year, 

100% 

50% a year, 5 events 60% a year, 10 

events 

1. Be an active participant in discussion; 2. research areas to 

increase knowledge of subjects introduced, 3. ask questions. I 

think this should be both individual and corporate. By that I mean 

if we operate at peak efficiency (everyone there, missed meetings 

due to lack of quorum, not just how does one Board member 

compares to another board member for example. 

1. Show interest in system employees by attending events, 2. 

show up unless given excuse in advance, when you agreed to 

Interaction in Liaison 

Role/Liaison Involvement 

Attend 4 Meetings Attend 5 Meetings 

Volunteering 5 hours a year 10 hours a year Other General Comments: 1. Interpersonal skills/relationship 

with fellow Board members, 2. Adding extra meetings is 

inconsiderate to system staff, 3. Board members need to come to 

the meetings 'armed' ‐ meaning fully prepared wth knowledge of 

topics, to do their research prior to the meeting as opposed to 

"in" the meeting, if they have questions/concerns, 4. Some type 

of score points for extracurricular activities such as liaison 

meetings; volunteer obligations; community events 

Medical Staff 

Luncheons/Meetings 

Attend 4 Meetings Attend 5 Meetings 

Retreat 75% 100% 

BOD Education 

Healthcare Education: (to 

include reading FHA and 

LMHS articles) 

Level of Understanding of 

current and emerging 

healthcare issues 

Onsite presence/Familiar 

LMHS Facilities 

Example: Disney Institute 

Leadership Conference 

Reading Outside Related 

Materials 

Attend 2 of 4 offerings from 

VHA, FHA, AHA, Government 

Institute or The National 

Association of Health Services 

Executives (NAHSE); 2 of 3; 

percent of annually approved 

Board classes, conferences, or 

workshops completed 

Attend 2 of 4 offerings 

from VHA, FHA, AHA, 

Government Institute or 

The National 

Association of Health 

Services Executives 

(NAHSE) ; 3 of 3 

100 Hours completed 200 Hours 

completed 

4 Visits 5 Visits 

1 Event ! Event 

3 Readings 4 Readings 

1. Attend meetings & seminars at educational trips (do not use 

trip as vacation excuse) 2. written report in brief as to what was 

learned; there are only 3 conventions 

1. Research, research, research, 2. If needed CEUs/CMEs ‐ attend 

system events allowing for some 

V:\PRESENTATIONS\2011\062311 FINANCE ‐ Full Board\Full Board\Draft Board Scorecard V2 1OF 2

PHILANTHROPY POLITICAL ADVOCACY 

COMMUNITY INVOLVEMENT 

Area of Focus 

Goal Statement 

Meets Exceeds 

Civic Involvement: Volunteer 

pertaining to health care 

News Press Articles Written 

(No PR Department should 

do) 

Service club 

presence/participation 

Volunteer in other 

Organizations 

20 hours per year; 40 

hours 

Number articles per year 

(0) (1) 

4 Events 5 Events 

25 hours per year: 

80 hours 

Number of articles 

per year (1) (3) 

4 Organizations 5 Organizations 

1. attend outside events as representative of BOD, 2. be a good 

representative of the BOD, 3. inform BOD office of outside 

involvement, 4. let Board know of events in community of 

interest; Highly variable as to what counts civic versus politial; 

FOR health system related initiatives, not for political 

campaigning 

Authored or letters to editor?; Bring attention to Board articles 

beyond the News Press of health care interest 

Presentations Made: Not Delivered (0) 

Delivered (1) If attending an outside event, tive update to Board 

required 

presentations; (1) presentations; (2) 

Board members who 

attended a presentation 

update BOD members who 

1 update 2 updates 

Interaction with Citizens, less than 10 contacts per more than 10 

Patients, Employees, 

Volunteers regarding their 

experiences 

month 

contacts per month 

Involvement in non‐ less than 2 events per more than 2 events 

foundational events year 

per year 

Other Align community involvement with healthcare issues (i.e., 

American Cancer, American Lung Assoc., etc.) 

Hospital Lobby Days 

2 days; in addition to Lobby 3 days Same as Board education; 1. participate actively, 2. network with 

Days, local lobbying for health 

system initiatives. Instead of 

days maybe by issue or event. 

other systems, 3. workwith legislators as necessary ; one event so 

attendance is maybe exceeds 

Briefings by Legislators: 2 days; 3 3 Days, 5 1. attend and ask questions, 2. follow‐up with calls or letters re: 

Hospital Days in Tallahassee 

Initiated Efforts 

special interest subjects 

Involvement in local elected 

officials 

3 events 3 events 

Involvement in community 

advocate groups 

3 events 3 events 

Other Attend other plitical events of legislators sthat suport 

LMHS/healthcare. Educate legilsators on healthcare issues as 

necessary 

Money Raised No No Auxiliary participation for fund raisers; 1. support system fund 

raising efforts, 2. attend events when necessary beyond being 

offered tickets to events, 3. promote events in community ; 

wouldn't work for most of us so don't know 

Money Contributed: payroll 

deduction each pay 

Participation in System 

Fundraising Events 

No, $100 per year, $50 peNo, > $50 per year 1. support giving program (Mission in Motion) etc., 2. Monies 

given to a %, is tas deductable, so give what you can 

Attend 1 of 2 Fund 

Raising Events; 3 events 

Attend 2 of 3 Fund 

Raising Events; 5 

events 

Volunteering same as money Mission in Motion; Individual brings 

community members to contribute dollars. Does the Board 

member make an annual pledge to Mission in Motion (the act, 

not the amount); 1. attend as many as possible regardless of 

free/compensated with regard to time and affordability 

Other Promote system fund raising by requesting Foundation members 

to attend events in community ( Rotary) for networking or 

speaking engagements; I seem to recall concern over amount 

given. I would suggest we couch that as "funds raised." 

V:\PRESENTATIONS\2011\062311 FINANCE ‐ Full Board\Full Board\Draft Board Scorecard V2 2OF 2


POLICY MANUAL DRAFT no. 10.13C D 

Supersedes no. 10.13C 

------------------------------------------------------------------------------------------------------------------------- 

category: General Operations 

title: Board Evaluation/Board Scorecard Review of Performance 

------------------------------------------------------------------------------------------------------------------------- 

original adoption: 01/08/91 review: 06/23/11 

revision dates: 06/25/93, 07/31/98, 07/26/02, 06/23/11 

------------------------------------------------------------------------------------------------------------------------- 

PURPOSE: 

To provide a mechanism for self evaluation of the performance of the Board of Directors. 

------------------------------------------------------------------------------------------------------------------------- 

POLICY: 

A Board scorecard self evaluation will be created completed by the Board and reviewed 

annually to assist in measuring the effectiveness of the Board of Directors. Based on the 

results of the evaluation, annual goals will be derived and evaluated for completion quarterly. 

In addition, each director shall sign a conflict of interest statement which will be filed in 

accordance with Policy 20.02b and as required by law. 

The annual Board scorecard results evaluation and proposed goals will be accepted by the 

Board at a regular meeting. 

V:\PRESENTATIONS\2011\062311 FINANCE - Full Board\Full Board\10.13D Board Evaluation for 062311 approval.doc 

Page 1 of 1

___________________ 



NEW BUSINESS

iPad Project 

(Cathy Stephens, Board Administrator) 

(Verbal) 

Board of Directors Meeting 

June 23, 2011

______________ 







DATE: June 23, 2011 LEGAL REVIEW: Yes ___ No ___ 

SUBJECT: Board Office Relocation Request 

REQUESTOR & TITLE: Cathy Stephens, Board Administrator 



N/A 


Approve relocation of Board office to Gulf Coast Medical Center, Medical Office Building, Suite 190 

(draft design attached). 


• Frees up ‘prime’ patient care space in 

the acute care facility, removing our 

office from residing on the main corridor 

of a hospital 

• Provides central location significant to 5 

Lee County Board districts 

• Provides a updated somewhat enlarged 

‘stationery’ boardroom 

• Provides additional meeting space and 

storage 

• Benefits of being attached to an acute 

care facility without AHCA requirements 


Several locations in the vicinity of Daniels Pkwy. 


• Will require construction costs 

FINANCIAL IMPLICATIONS Budgeted ____ Non-Budgeted _XX___ 


Costs associated with move are still being tallied. Details to be presented at meeting. 


SUMMARY 

With our Facilities Dept, we have been exploring options of relocating the Board of Directors office 

and this particular property seems to be the best option. It is most desirable by being attached to 

Gulf Coast Medical Center to still have advantage of hospital services (food services, maintenance, 

etc). Daniels Parkway is considered one of the most central corridors in Lee County. Relocating to a 

central location would provide consideration for all members of the elected Board, along with 

appointed community members and staff. With the current drawing attached, the Boardroom is 

limited to 750 sq ft, based on fire wall ratings. The fire wall ratings are being determined. If it is 

determined the fire walls are rated for 2 hours, we can extend the boardroom to nearly 900 sq ft. 


___________________ 




OF 

DIRECTORS’ 

REPORTS

___________________ 




ADMINISTRATOR 

REPORT 

(Cathy Stephens)

& Lee County Trauma Services District 


2011 SUMMER SCHEDULE 

JULY (NO BOARD MEETINGS IN JULY) 

Mon, 4 th 

Independence Day Holiday- Board Office Closed 

Sat, 9th FOUNDATION EVENT: David Root Fishing Tournament for Trauma Center 

AUGUST 

Thurs, 11 th 4:00pm Trauma District & Planning & Full Board of Directors Meetings 

Wed, 17th FOUNDATION EVENT: Rumrunners Celebrity Chef Night 

Thurs, 25 th 4:00pm LMHS Full Board of Directors Meeting 

Tues, 30 th 8:30am “Doc Coggins” Award Selection Breakfast 

(Lee Memorial Hospital Auditorium) 

SEPTEMBER 

Mon, 5 th Labor Day Holiday (Board Office Closed) 

Thurs, 8th 4:00pm Quality/Education & Full Board of Directors Meetings 

Thurs, 22 nd 4:00pm Finance & Full Board of Directors Meetings 

FUTURE SAVE THE DATES: 

Weds – Fri Oct 5 th – 7 th VHA Southeast Annual Conference, Key Biscayne 

Weds - Fri Oct 12 th -14 th FHA Conference, Orlando 

Saturday Oct 22 nd “Doc Coggins” Gala Award Dinner

ADJOURNMENT 

__________________ 




REGULARLY SCHEDULED 

MEETING 

Trauma District 

Followed by a 

Planning 

FULL BOARD MEETING 

THURSDAY, 

August 11, 2011 

4:00pm 

Lee Memorial Hospital - Boardroom 

2776 Cleveland Ave, Ft. Myers, FL 33901

BOARD OF DIRECTORS FINANCE - Lee Memorial Health System

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