El Camino Hospital Board of Directors and Invited Hospital Staff Only

EL CAMINO HOSPITAL BOARD AMENDED AGENDA AND SPECIAL MEETING OF THE BOARD Wednesday, September 11, 2013 5:30 p.m. Location: El Camino Hospital, Conference Rooms, E, F & G, ground floor 2500 Grant Road Mountain View, California

and via teleconference: 4100 Lake Tahoe Blvd. South Lake Tahoe, CA 96150

MISSION: To be an innovative, publicly accountable and locally controlled comprehensive healthcare organization which cares for the sick, relieves suffering, and provides quality, cost competitive services to improve the health and well-being of our community. A copy of the amended agenda for the Special Meeting will be posted and distributed at least twenty-four (24) hours prior to the meeting. In observance of the Americans with Disabilities Act, please notify us at 650-988-7504 twenty-four (24) hours prior to the meeting so that we may provide the agenda in alternative formats or to make disability related modifications and accommodations PRESENTED BY I. CALL TO ORDER/ROLL CALL Neal Cohen, MD 5:30 p.m. Board Chair

II. POTENTIAL CONFLICT OF Neal Cohen, MD 5:31-5:32 INTEREST DISCLOSURES Board Chair

III. BOARD RECOGNITION Resolution 2013-7 Pat Wolfram, VP, public motion The Board will recognize individual(s) who ECH, Los Gatos comment required enhance the experience of the Hospital’s patients and the community. 5:32-5:37 ATTACHMENT 1

IV. PUBLIC COMMUNICATION Neal Cohen, MD 5:37-5:42 A. Oral Comments Board Chair This opportunity is provided for persons in the audience to make a brief statement, not to exceed 3 minutes on issues or concerns not covered by the agenda. B. Written Correspondence

V. ACTION Neal Cohen, MD public motion A. Consent Calendar Board Chair comment required All items listed on the Consent Calendar are 5:42-5:44 considered to be routine matters or are considered formal documents covering previous Board instructions. One motion, a second and a vote may enact all of the items listed on the Consent Calendar. There will be no separate discussion of Consent Calendar items unless members of the Hospital Board, Hospital staff or the public request discussion Page 1/534 El Camino Hospital Board Regular Board Meeting September 11, 2013 Page 2

on a specific item at the beginning of the consideration of the Consent Calendar. Approval:  Minutes of the Board Meetings: a. Regular Meeting of the Board – July 10, 2013

 b. FY 2013 Community Benefit Report  Committee Updates: c. Quality, Patient Care, and Patient Experience (David Reeder, Chair)  Reviewed and Recommended for Approval by the Finance Committee d. May and June 2013 Financials e. Simplee Agreement f. Travel Policy g. Medical Director, Digestive Health h. Medical Director, Geriatric Psychiatry i. Medical Director, Wellness and Associated On-Call Panel j. Medical Director, Information Technology k. On-Call Panel, Plastic Surgery l. Medical Director, Transcatheter Aortic Valve Replacement m. Surgical Robot Purchase  Reviewed and Recommended for Approval by the Investment Committee n. Revised Cash Balance Investment Policy o. Revised Surplus Cash Investment Policy  Reviewed and Recommended for Approval by the Medical Staff p. Medical Staff Report (open)  Information: q. LG IT Post Activation Review r. July 2013 Financials  Acceptance: Committee Minutes (open): s. Finance Committee (May 28, 2013) t. Governance Committee (July 2, 2013) u. Investment Committee (May 13, 2013) v. Quality Committee (June 17, 2013) w. Auxiliary Report x. Foundation Report ATTACHMENT 2

VI. DISCUSSION ITEMS (for possible action):

A. Quality Update: Preventable Harm Eric Pifer, MD, Chief Medical information – Infection Control and Antimicrobial Officer 5:44-5:54 Stewardship Dan Shin, MD, Medical ATTACHMENT 3 Director, Antimicrobial PageStewardship 2/534 El Camino Hospital Board Regular Board Meeting September 11, 2013 Page 3

B. Governance Committee Report: Julia Miller, Chair public possible  Chair and Vice Chair in Governance Committee comment motion(s) Committees; 5:54-6:04  Revised Agenda Format;  Considerations for Closed Session Minutes;  Considerations for Executive Sessions in Committee; and  Appointment of Ad Hoc Committee ATTACHMENT 4

C. Annual Board Meeting Schedule – Patricia A. Einarson, MD public possible Dark Months Secretary/Treasurer comment motion ATTACHMENT 5 6:04-6:09

D. CEO Report Tomi Ryba information ATTACHMENT 6 President and CEO 6:09-6:14

E. Board Comments Neal Cohen, MD information Board Chair 6:14-6:24

VII. ADJOURN TO CLOSED SESSION 1. Conflict of Interest disclosures relating to Items 2-11 on the Closed Session agenda pursuant to the code provisions listed below. 2. Approval of: - Minutes of the closed session of the Special Meetings of the Board (July 30, 2013), motion required Govt. Code Section 54957.2; Acceptance of: - Minutes of the closed session of the Finance Committee (May 28, 2013), Governance motion required Committee (July 2, 2013), Investment Committee (May 13, 2013), and Quality Committee (June 17, 2013), Govt. Code Section 54957.2. 3. Report of Medical Staff Quality Assurance Committee, Health and Safety Code Section 32155. - Deliberations concerning reports on Medical Staff quality assurance matters motion required - Medical Staff Report 4. Health and Safety Code Section 32106(b) for a report involving health care facility trade secrets. - IT Case for Change information 5. Health and Safety Code Section 32106(b) for a report involving health care facility trade secrets. - FY 2013 Organizational Goal Achievement information 6. Report involving Govt. Code Sections 54957 and 54957.6 for discussion and report on personnel matters. - FY 2014 Foundation President Base Pay information 7. Report involving Govt. Code Sections 54957 and 54957.6 for discussion and report on personnel matters. - Employee Recognition Bonus information 8. Conference with Legal Counsel – pending or threatened litigation, Govt. Code Section 54956.9(d)(1) - Tamara vs. El Camino Hospital, et al. information 9. Health and Safety Code Section 32106(b) for a report involving health care facility trade secrets - Development of New Services and Programs – Continuum of Care Update. information 10. Health and Safety Code Section 32106(b)Page for a report3/534 involving health care facility trade secrets; El Camino Hospital Board Regular Board Meeting September 11, 2013 Page 4

report involving Govt. Code Section 54957 for discussion and report on personnel performance matters; and report of Medical Staff Quality Assurance Committee, Health and Safety Code Section 32155. - CEO Report information 11. Report involving Govt. Code Section 54957 for discussion and report on personnel performance matters. - Executive Session possible motion 12. Adjourn to Open Session ATTACHMENTS 7-16

VIII. RECONVENE OPEN SESSION Neal Cohen, MD 8:33-8:34 To report any required disclosure regarding Board Chair permissible actions taken during Closed Session.

IX. FY 2014 Foundation President Base Pay Tomi Ryba, public possible President and CEO comment motion Julie Johnston, Director, 8:34-8:37 Compensation and Benefits

X. Service Animal Policy Sheetal Shah, Manager, Risk public possible ATTACHMENT 17 Management and Patient Safety comment motion 8:37-8:40

XI. IT Case for Change Tomi Ryba, public possible President and CEO comment motion Eric Pifer, MD, CMO 8:40-8:45 Greg Walton, CIO

XII. ADJOURNMENT Neal Cohen, MD 8:46 p.m. Board Chair

PLEASE NOTE: The CLOSED SESSION is limited to the El Camino Hospital Board of Directors and invited Hospital staff only. Page 4/534 Separator Page

Att 1 - Resolution 2013-7.pdf

Page 7/534 RESOLUTION 2013 - 7 RESOLUTION OF THE BOARD OF DIRECTORS OF EL CAMINO HOSPITAL REGARDING RECOGNITION OF SERVICE TO THE COMMUNITY

WHEREAS, the Board of Directors of El Camino Hospital values and wishes to recognize on an ongoing basis the contribution of individuals who enhance the experience of the Hospital’s patients, their families, the community and staff, as well as individuals who in their efforts exemplify El Camino Hospital’s mission and values. WHEREAS, the Board wishes to honor and express heartfelt gratitude to the Los Gatos multi- disciplinary team that worked diligently to become the youngest Primary Certified Stroke Center in Santa Clara County. Achieving Primary Stroke Center Certification signifies an organization’s dedication to fostering better outcomes for stroke patients when every second counts. Because of the persistence and innovation of this team, El Camino Hospital has demonstrated that our Los Gatos campus now meets these critical elements of performance to treat patients suffering from stroke who need immediate assessment and treatment. WHEREAS, the Board would like to recognize these employees who showed unwavering dedication to patient care by working together in a concerted effort to achieve a common goal. This ambitious task took more than a year to complete. Tomi Ryba, Eric Pifer, Michelle McGowFn, Pat Wolfram, and Martin Lesica provided incredible leadership, commitment, and support for the project. Five members of the stroke neurology team graciously monitored the 24 hour coverage, collaborating with other units across campus. The eagerness from nurses throughout the hospital to learn about stroke care was impressive. One Joint Commission Certification reviewer lauded staff for their engagement, describing the level of stroke education they received as phenomenal. Your diligence and attention to detail in your work is commendable.

WHEREAS, the Board acknowledges the service of this special group, whose work resulted in elevating our standard of care to the community we serve. A full and comprehensive survey yielded a great enterprise accomplishment of Joint Commission Stroke Certification for El Camino Hospital Los Gatos. NOW THEREFORE BE IT RESOLVED that the Board does formally and unanimously pay tribute to:

Alyshia Abraham Peter Fung, MD Tamara Mains Poopak Barirani Pepe Greenlee Karen Pike, MD Judith Bolker Sherril Hopper Patty Smith Pat Erbst David Jordan Michael WolfF, MD Brandi Fitzsimmons Martin Lesica Pat Wolfram Alida Lorenz IN WITNESS THEREOF, I have here unto set my hand this 11TH DAY OF SEPTEMBER, 2013. EL CAMINO HOSPITAL BOARD OF DIRECTORS: Dennis Chiu, JD Jeffrey Davis, MD Nandini Tandon, PhD Neal Cohen, MD Julia Miller Tomi Ryba Patricia Einarson, MD David Reeder John Zoglin

PATRICIA "EINARSON, MD SECRETARY/TREASURER, EL CAMINO HOSPITAL BOARD OF DIRECTORS

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Att 2a - Regular Board Minutes - July 10, 2013.pdf

Page 9/534 DRAFT for Consideration of the Board

EL CAMINO HOSPITAL BOARD OF DIRECTORS Regular Meeting – July 10, 2013

MINUTES

The Regular Meeting of the Board of Directors of El Camino Hospital (the “Hospital”) was called to order by Neal Cohen MD, Chairman, at 5:30 p.m. on Wednesday, July 10, 2013 in Conference Rooms E, F, & G, ground floor, El Camino Hospital, 2500 Grant Road, Mountain View, California and via videoconference at Anenska 13, Prague 01, Praha 1 11000 Czech Republic.

I. ROLL CALL:

The Directors present were John Zoglin; Dennis Chiu; Neal Cohen, MD; Jeffrey Davis, MD; Patricia Einarson, MD (via video conference call); Julia Miller; David Reeder; Tomi Ryba; and Nandini Tandon Ph.D.

II. POTENTIAL CONFLICT OF INTEREST DISCLOSURES:

Director Cohen asked if any of the Board members or anyone in the audience knew of any conflicts that any of the Board members might have with any of the items on the agenda.

No Conflict was stated.

III. BOARD RECOGNITION: Resolution 2013-6

Action: A motion to approve Resolution 2013-5 was made by Director Reeder, seconded by Director Zoglin, and the motion was approved by a vote of nine Directors in favor.

The Board recognized the Knowledge Based Medication Administration team members for their efforts and success in implementing this important program that greatly enhances patient safety.

Director Ryba acknowledged Director Zoglin for his service as Board Chairman for the last two years and presented him with a commemorative statue on behalf of the Hospital and certificates signed by State Assemblyman Rich Gordon and State Senator Jerry Hill.

IV. PUBLIC COMMUNICATION:

Mr. Geoffrey Mangers spoke of his concerns regarding Behavioral Health Services and lithotripsy billing.

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V. CONSENT CALENDAR:

Director Cohen stated that all items listed on the consent calendar are considered to be routine matters. One motion, a second and a vote may adopt all of the items listed on the Consent Calendar with no discussion unless requested by a Board Member, staff, or a member of the audience. Director Cohen asked if anyone had any items they wanted removed from the consent calendar.

Director Miller requested that item “e” “Board Advisory Committee Goals” be removed from the consent calendar and indicated that she specifically wanted to address the Governance Committee Draft Goals for FY2014. Director Zoglin requested that item “g” “Patient Centered Transformation (PaCT)” be removed.

Action: Upon motion made by Director Miller, seconded by Director Chiu, the remaining items on the Consent Calendar were approved or accepted as follows by a vote of nine Directors in favor: Approved: Health Information Management ICD-10 Computer Assisted Coder (AutoCoder), Corporate Compliance and Audit Committee Update, Minutes of the Special Meeting of the Board of May 28, 2013, Minutes of the Special Meeting of the Board of June 12, 2013, and Corporate Compliance and Audit Committee Charter Revisions; Accepted: Minutes of the Governance Committee meeting of June 4, 2013, Minutes of the Corporate Compliance and Audit Committee of April 9, 2013, Minutes of the Quality, Patient Care and Patient Experience Committee Meeting of May 20, 2013, Auxiliary Report and Foundation Report.

Consent Calendar Item e. Board Advisory Committee Goals:

Director Miller commented that the Governance Committee had developed 11 Goals, 5 “above the line” and six “below the line”, with the intention of not losing sight of those below line that could be reconsidered as goals for FY 2015. She then asked the Board to consider discussing whether the Governance Committee’s Draft Goal #2 should be a Governance Committee goal, or whether that should be addressed at the Board level only.

Director Chiu requested clarification regarding the process for approving the Advisory Committee Goals and Director Reeder asked Director Zoglin for clarification regarding the Governance Committee’s recommendations. Director Cohen and Director Zoglin explained that the Committees develop their goals, the Governance Committee provides feedback, and ultimately the Board approves them.

Director Reeder requested that staff communicate each of the Governance Committee’s recommendations so that the committees can address them at their upcoming meetings. Director Cohen noted that it was a good suggestion and staff agreed to do so.

Director Chiu commented that, with respect to Governance Committee Draft Goal #2, he would prefer that be addressed at the Board level, and not at the Governance Committee. Director Zoglin and Director Einarson commented that while it would ultimately be a discussion for the full Board, there is expertise at the Governance Committee level and the initial work and

Page 11/534 Minutes: Regular ECH Board of Directors Meeting DRAFT for Consideration of the Board July 10, 2013 Page 3 research should be done there. Director Cohen commented that having the Governance Committee do some research and bring information to the Board, but perhaps not at first bring recommendations to the Board, would be useful. Director Chui stated his objection to taking up a discussion that might ultimately result in removing the District Board members from the Corporation’s Board because that would be in conflict with the voters’ expectations. Director Reeder commented that the Hospital Board does not have authority to appoint its own members so it is something of a moot point. The Board members then discussed how the Governance Committee might redraft its Draft Goal #2.

Action: Director Reeder made a motion, seconded by Director Tandon and approved by a vote of nine Directors in favor, to approve the Board Advisory Committee Draft Goals for FY 2014, with 2 modifications: (1) each committee should consider the recommendations made by the Governance Committee and (2) the Governance Committee should rewrite and expand its Draft Goal #2 to reflect that the Committee will conduct research into the governance structures of other hospitals in order to ensure that, with respect to all of its members, the ECH Board includes members with relevant expertise and bring the results of its initial research to the Board.

Consent Calendar Item g. Patient Centered Transformation (“PaCT”):

Director Zoglin commented that the PaCT plan is an important, high quality piece of work and suggested it might warrant some discussion at the Board level either at this meeting or in the future. Director Cohen commented that it is a critically important piece of work that warrants additional work at the Quality Committee, particularly around defining what is meant by “Quality.” Directors Cohen and Einarson suggested that the Board approve the plan, but refer it back to the Quality Committee for some additional work, then bring it back to the Board for a broader discussion at a later date.

Action: Upon motion made by Director Miller, seconded by Director Tandon and approved by a vote of nine Directors in favor, the PaCT plan was approved, and referred back to the Quality Committee for additional work with the understanding there would be a broad discussion at the Board level to follow at a future meeting.

VI. INFORMATIONAL AND POSSIBLE MOTION ITEMS:

A. Quality Update: Hospital Acquired Pressure Ulcers:

Michaella Cavarlez-Sarinas, RN and Marissa Szyslowski, RN, ECH wound care and ostomy nurses, presented the Hospital’s hospital acquired pressure ulcer (“HAPU”) prevention program and successes. They reported that the Hospital is meeting its goals for stage 3 and 4 pressure ulcers – down from 25 in FY 2011 to 10 in FY 2013. They reported the specific types of ulcers that have occurred and the counter measures employed including proactive application of silicon dressing, use of Dolphin beds for hip fracture patients and a trial of chair cushions for ischial tuberosity ulcers. The Directors commented on the great work done by the team to decrease the incidence of HAPU’s. Director Davis suggested that once the Hospital reaches its goal of zero HAPU’s, it should set a metric for tracking how long the incidence remains at zero.

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B. CEO Report:

Director Ryba reported that the data for FY 2013 Organization Goals is not yet complete, but will be provided to the Board in September. She commented that the Hospital submitted its Nursing Magnet Designation Application and expects an onsite survey in about a year. The Hospital held 6 focus groups for women who had birthing experiences here, especially looking at the experiences of South Asian women to ensure we have the cultural competencies necessary to support the communities served by the Hospital. Dr. Zummaraga presented the Aspire program to the Mountain View Los Altos High School District Board and was very well received. El Camino Hospital was chosen by the California Special District Association as a Model Special District Hospital. Director Reeder requested information regarding the Leap-Frog program and breast feeding statistics. Director Ryba indicated that staff would get the information to him.

C. Medical Staff Report:

Karen Pike, MD, Chief of Staff, Los Gatos, reported that the Medical Staff revised the Restraint Policy making improvements to improve the amount of restrictiveness while still keeping patients safe and she requested that the Board approve the policy. Dr. Pike also reported that the Los Gatos site had its Joint Commission visit and is now certified as a Primary Stroke Center. The Directors thanked her for stepping in as the new Chief of Staff for the Los Gatos site.

Action: Upon motion made by Director Ryba, seconded by Director Cohen and approved by a vote of nine Directors in favor, the Revised Patient Care Services Policy 09.02 “Restraints Policy” was approved.

D. Board Comments:

Director Miller recognized Alicia Podinski, a recent graduate of the City of Sunnyvale Leadership Program, who was instrumental in involving the Hospital in her project to raise money for "Our Daily Bread” a nonprofit that feeds the poor and the homeless.

Director Miller also asked staff to make sure the Website is updated regularly and for a status update regarding when Board meetings could be Webcast. Director Ryba stated that staff would provide that information before the September Board meeting.

Director Reeder acknowledged that the issue of ‘Reordering the Board Meeting Agenda’ would be placed on the September Agenda, and he also requested that the discussion include Auxiliary and Foundation interaction with the Board. In addition, he requested information regarding what the Hospital is doing about providing a bill to patients that is understandable and that the Board be given information about how the Hospital answers patients’ questions about pricing.

VII. ADJOURN TO CLOSED SESSION:

Upon motion made by Director Tandon, seconded by Director Chiu, and approved by a vote of nine Directors in favor; the Open Session of the meeting was adjourned to Closed Session at 6:30

Page 13/534 Minutes: Regular ECH Board of Directors Meeting DRAFT for Consideration of the Board July 10, 2013 Page 5 p.m. pursuant to Gov’t Code Section 54957.2 to approve the Minutes of the Closed Session of the Special Board Meeting of May 28, 2013 and the Special Board Meeting of June 12, 2013; pursuant to Health and Safety Code Section 32155, to approve the Minutes of the Executive Session of the Medical Staff Executive Committee Meetings of April 25, 2013 and May 23, 2013 and the Credentials and Privileges Reports of May 23, 2013 and June 27, 2013; pursuant to Gov’t Code Section 54957.2 to accept the Minutes of the Closed Sessions of the Corporate Compliance Committee Meeting of April 9, 2013, the Governance Committee Meeting of June 4, 2013 and the Quality Committee Meeting of May 20, 2013; pursuant to Gov’t Code Section 54956.9(d)(4) for a conference with legal counsel regarding pending or threatened litigation (Measure M Update); pursuant to Gov’t Code Sections 54957 and 54957.6 and Health and Safety Code Section 32106(b) for a discussion and report on personnel matters (Individual Executive Goals for FY 2014); pursuant to Gov’t Code Sections 54957 and 54957.6 for a discussion and report on personnel matters (Executive Base Salaries FY 2014); pursuant to Gov’t Code Sections 54957 and 54957.6 for a discussion and report on personnel matters (CEO Compensation FY 2014); pursuant to Health and Safety Code Section 32106(b) for a report involving health care trade secrets: Development of New Services and Programs (Behavioral Health Services Pro forma and Plan); pursuant to Health and Safety Code Section 32106(b) for a report involving health care trade secrets: Development of New Services and Programs (Appointment of Board Advisory Committee Chairs and of Board Members to the Board Advisory Committees); pursuant to Health and Safety Code Section 32106(b) for a report involving health care trade secrets: Development of New Services and Programs (Reappointment of External Members – Non- Directors – to the Board Advisory Committees); pursuant to Health and Safety Code Section 32106(b) for a report involving health care trade secrets: Development of New Services and Programs (CEO Report); and pursuant to Gov’t Code Section 54957 for a discussion involving personnel performance matters (Executive Session).

VIII. RECONVENE OPEN SESSION:

The Board reconvened Open Session at 9:40 pm. Director Cohen reported on the following actions taken in Closed Session:

The Board approved the Minutes of the Closed Sessions of the Special Board Meetings of May 28, 2013 and June 12, 2013, the Minutes of the Executive Sessions of the Medical Staff Executive Committee Meetings of April 25, 2013 and May 23, 2013, the Credentials and Privileges Reports of May 23, 2013 and June 27, 2013, the Individual Executive Goals for FY 2014 and accepted the Minutes of the Closed Sessions of the Corporate Compliance Committee Meeting of April 9, 2013, the Governance Committee Meeting of June 4, 2013 and the Quality Committee Meeting of May 20, 2013.

As the next order of business, the Board considered item XII on its Agenda.

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XII. REAPPOINTMENT OF EXTERNAL MEMBERS (NON DIRECTORS) TO THE BOARD ADVISORY COMMITTEES:

Action: Director Reeder made a motion to appoint the external (non-directors) to the Board Advisory Committees as that information appears on Appendix 1 to these Minutes. Director Zoglin seconded the motion.

Directors Chiu and Miller commented that it is extremely important for the Board to develop a process by which committee members can address Board members’ concerns about reappointments.

Action: Following this discussion the motion was approved by a vote of five Directors in favor (Cohen, Einarson, Reeder, Ryba and Zoglin) and four Directors opposed (Chiu, Davis, Miller and Tandon).

Director Einarson discontinued participation in the meeting.

As the next order of business, the Board considered item XI on its Agenda.

XI. APPOINTMENT OF BOARD ADVISORY COMMITTEE CHAIRS AND OF BOARD MEMBERS TO THE BOARD ADVISORY COMMITTEES.

Action: Director Reeder made a motion, seconded by Director Tandon and approved by a vote of eight directors in favor, Director Einarson absent, to appoint the Board Advisory Committee Chairs and Board Members to the Board Advisory Committees as that information appears on Appendix 2 to these Minutes.

IX. EXECUTIVE BASE SALARIES FOR FY2014:

Action: Director Tandon made a motion, seconded by Director Cohen to defer action on the Executive Base Salaries for FY 2014 at least until there is a judicial decision on the Hospital’s Application for Default Judgment currently scheduled for hearing on July 15, 201. The motion was approved by a vote of seven Directors in favor (Chiu, Cohen, Davis, Miller, Ryba, Tandon and Zoglin), one opposed (Reeder) and Director Einarson absent.

X. CEO COMPENSATION FY 2014:

Action: Director Tandon made a motion, seconded by Director Cohen to defer action on the CEO Compensation for FY 2014 at least until there is a judicial decision on the Hospital’s Application for Default Judgment currently scheduled for hearing on July 15, 2013. The motion was approved by a vote of six Directors in favor (Chiu, Cohen, Davis, Miller, Tandon and Zoglin), one opposed (Reeder), one abstaining (Ryba) and Director Einarson absent.

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XIII. ADJOURNMENT:

There being no further business to come before the Board, the meeting was adjourned at 10:20pm.

______Neal Cohen, MD (date) Patricia Einarson, MD (date) Chairman of the Board Secretary/Treasurer John Zoglin ECH Board Chairman ECH Board Secretary

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Att 2a.1 - Appendix 1 to Minutes 7.10.13.doc

Page 17/534

Appendix 1 to July 10, 2013 Minutes Board Member Appointments to Advisory Committees Effective July 10, 2013 Corporate Compliance/Privacy and Audit Committee

John Zoglin, Chair Dennis Chiu, Member

Investment Committee

John Zoglin, Chair Jeffrey Davis, MD, Member

Governance Committee

Julia Miller, Chair David Reeder, Member Nandini Tandon, PhD, Member

Executive Compensation Committee

Nandini Tandon, PhD, Chair Julia Miller, Member David Reeder, Member

Finance Committee

Dennis Chiu, Chair Nandini Tandon, PhD, Member John Zoglin, Member

Quality, Patient Experience and Service

David Reeder, Chair Jeffrey Davis, MD Patricia Einarson, MD, Member

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Att 2a.2 - Appendix 2 to Minutes 7.10.13.doc

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Appendix 2 to July 10, 2013 Minutes External (Non-Director) Appointments to Advisory Committees Effective July 10, 2013 Corporate Compliance/Privacy and Audit Committee

Sharon Anolik Ramy Houssaini Wes Alles Christine Sublett

Investment Committee

Nicola Boone Ethan Cohen-Cole Brooks Nelson

Governance Committee

Gary Kalbach Pete Moran

Executive Compensation Committee

Teri Eyre Jing Liao Bob Miller Prasad Setty

Finance Committee

Bill Hobbs Richard Juelis

Quality, Patient Experience and Service

Katherine Anderson Elizabeth Joyce Freeman R. Cary Hill, MD Robert Pinsker, MD, JD

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Att 2b - FY 2013 Community Benefits Report.pdf

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Community Benefit

Date: August 28, 2013 To: El Camino Hospital Board of Directors From: Cecile Currier and Barbara Avery Re: El Camino Hospital Community Benefit Grant Metric Results FY 13

We are pleased to present the 2013 El Camino Hospital Community Benefit Dashboard. The dashboard includes results of what the Hospital's 20 partners have achieved. Please note that there is also a dashboard for the El Camino Healthcare District which includes all the grantees from Mountain View, Sunnyvale and Los Altos. This dashboard will be presented at the October District Board meeting.

In FY 2013, El Camino Hospital invested $1,555,449 in grants and sponsorships.

 14,358 people were served through the community benefit grants o Healthcare Access - 6,945 people o Mental Health Access - 2,741 people o Healthy Eating and Physical Activity - 2,041 people o Community Health Education and Health Literacy - 2,631 people

We are very pleased with the performance of our partners. The staff worked closely with each partner throughout the year, understanding their challenges and helping them to overcome obstacles and meet their goals. The majority did an excellent job in achieving their goals and reaching aggressive targets. Three struggled to meet metrics and two of those will not be funded in FY 14.

Our partners tell us that El Camino Hospital has a strong and rigorous grant making process. They appreciate the fact that they are encouraged to constantly improve and to evaluate the real impact of their work.

We are impressed with their dedication to serve students, patients and families, all year long in a caring and committed way.

El Camino Hospital can be proud of its generous commitment to improve the health of the community. These grants provide an essential resource to many people who have no access to healthcare and truly count on El Camino Hospital! Thank you for your continued support of our community partners.

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Att 2b.2 - ECH_40355_Benefits_Dash_Hospital_v6.pdf

Page 23/534 EL CAMINO HOSPITAL Community Beneﬁt Fiscal Year 13 Grant Metric Results

Commitment

Page 24/534 Priority 1 HEALTHCARE ACCESS

El Camino Hospital Community Benefit Fiscal Year 13 Grant Metric Results * Healthcare Access * (Primary, Oral, and Healthcare Access (Primary,Chronic ConditionsOral, and Chronic Care) Conditions Care) * Pilot metric, expected improvement in FY14. * Metric outcome within 10% of target receives green designation continued

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El Camino Hospital Confidential 1 06.30.13

El Camino Hospital Confidential 2 06.30.13 El Camino Hospital Community Benefit Fiscal Year 13 Grant Metric Results Priority 1 HEALTHCARE ACCESS This is the final year of funding for Healthy Kids as replacement support is secured with Santa Clara County Measure A. Missed target on primary care visits, agency assessing this setback. Missed dental target underscores difficulty in getting older children seen for preventive care. Data for young children was much stronger. Healthcare Access (Primary, Oral, and Chronic Conditions Care) Healthcare Access (Primary, Oral, and Chronic Conditions Care) Off cycle grant that had logistical complications with the Social Services Agency resulting in a late start in service provision. Issues resolved with strong likelihood of reaching target for next granting cycle. * Metric outcome within 10% of target receives green designation

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El Camino Hospital Confidential 2 06.30.13

El Camino Hospital Confidential 2 06.30.13 Priority 2 MENTAL HEALTH

El Camino Hospital Community Benefit Fiscal Year 13 Grant Metric Results Mental Health Access Mental Health Access While this grant addressed a need in the community, there were a number of implementation problems that resulted in a poor performance. The program will not be funded in FY14. Page 27/534 * Metric outcome within 10% of target receives green designation

El Camino Hospital Confidential 3 06.30.13

El Camino Hospital Confidential 2 06.30.13 El Camino Hospital Community Benefit Fiscal Year 13 Grant Metric Results

H E A L T H Y E A T I N G A N D Priority 3 PHYSICAL ACTIVITY * Healthy Eating and Physical Activity Healthy Eating, and Physical Activity * Metric outcome within 10% of target receives green designation

El Camino Hospital Confidential 2 06.30.13

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El Camino Hospital Confidential 4 06.30.13 El Camino Hospital Community Benefit Fiscal Year 13 Grant Metric Results

C O M M U N I T Y Priority 4 HEALTH EDUCATION * Community Health Education Community Health Education and Health Literacy * Metric outcome within 10% of target receives green designation

Page 29/534El Camino Hospital Confidential 2 06.30.13

El Camino Hospital Confidential 5 06.30.13 Separator Page

Att 2c- Board Presentation Template Quality Committee Update.ppt

Page 30/534 Quality, Patient Care and Patient Experience Committee Update to the ECH Hospital Board David Reeder, Chair September 11, 2013

Page 31/534 Summary of Key Activities Date of last update to Board May 8, 2013

Date of last committee meeting July 22, 2013

Date of next committee meeting September 16, 2013 Progress against Goals:

Goal #1: Review Hospital Organizational Goals: This was done in June 2013, and the Committee will review final goals with Targets on September 16th. Goal # 3: The Committee has reviewed patient stories at each of its meetings.

Goal # 5: We will work toward this goal by reviewing presentations on readmissions and C. Difficile Infections at the September meeting as part of our program-template approach. Other key accomplishments:

The June and July meetings as well as the September meeting are all very focused on specific metrics and performance

Important future activities:

The committee’s future agendas will include review of a patient story, drill down on 1-2 key metrics, and updates on the service lines. The committee will also receive information regarding the IT Case for Change, and Review both the Safety Report for the Environment of Care and the FY 2014 Organizational Goals with Metrics

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Att 2d - May and June 2013 Financials.pdf

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Summary of Financial Operations

Fiscal Year 2013 – Period 11 7/1/2012 to 5/31/2013

Page 34/534 Page 35/534 2 (1) Hospital entity only, excludes controlled affiliates Management Commentary (1)

Budget is represented by solid lines; Bars represent actual results

Net Days in AR At 45.6, Net days in A/R decreased to the lowest point in the past year in May, driven primarily by strong collections that provided a $4.8 million (5%) decrease in the amount of outstanding receivables.

CMI Adjusted Discharges Driven primarily by strong levels of outpatient activity, May’s CMI adjusted discharges were 7% above budget and were just slightly (0.4%) below the FYTD average. Of particular note are higher than expected activity levels in surgery and obstetrics. Surgical volume is 1% below budget fiscal YTD but was 6.5% favorable in May. Deliveries, which are 14.7% favorable fiscal YTD, were 19.7% favorable in May. Unadjusted Discharges were also 2% higher than budget in May.

Operating Margin Operating margin remained favorable in May, exceeding budget by $3 million or 79%. Although inpatient gross charges were $3.2m unfavorable to budget, this was more than offset by high outpatient activity levels and total gross charges were $7m or 3.3% ahead of budget. May’s net revenues were $6m favorable to budget, including the effect of $2m in settlements and due to the higher than normal collections on older accounts. Overall, operating expenses were $2.5m or 4.9% unfavorable to budget. The largest drivers of this variance were labor costs ($2.9m unfavorable) and supplies ($0.8m unfavorable), partially offset by purchased services ($1.1m favorable). The unbudgeted transition of the Allscripts employees to ECH payroll accounts for the swing between purchased services and labor.

Page 36/534 3 (1) Hospital entity only, excludes controlled affiliates Page 37/534 4 (1) Hospital entity only, excludes controlled affiliates El Camino Hospital Financial Metrics Trend (1)

2.2% P Favorable to Budget YTD r o f I t _ L o s s

56 Days Favorable to B Budget A L Represents _ cash of $556 million S H E E T

Page 38/534 5 (1) Hospital entity only, excludes controlled affiliates (1) ECH Operating Margin

Run rate is booked operating income adjusted for material non-recurring transactions

Page 39/534 6 (1) Hospital entity only, excludes controlled affiliates ECH Volume Statistics (1)

Page 40/534 7 (1) Hospital entity only, excludes controlled affiliates APPENDIX

Page 41/534 8 Summary of Financial Results (1) $ in Thousands

1 Page 42/534 9 (1) Hospital entity only, excludes controlled affiliates Worked Hours per CMI Adjusted Discharge(1)

P11 YTD: 6.8 below budget

Page 43/534 10 (1) Hospital entity only, excludes controlled affiliates Supply Cost per CMI Adjusted Discharges (1)

YTD P11 : 3.5% above budget YTD P11: 6.9% above budget Mountain View Los Gatos

Page 44/534 11 (1) Hospital entity only, excludes controlled affiliates (1) Mountain View LOS & CMI Trend

• Medicare: Due to DRG reimbursement, financial results usually improve with decreased LOS and increased CMI • Non-Medicare: Reimbursement varies; financial results usually improve when both LOS & CMI increase

Payor Mix YTD P11 Prior Yr $ in millions Gross Chg Mix % Gross Chg Mix % Government $865.0 46.8% $804.4 46.3% Commercial 897.2 48.6% $850.5 48.9% Other 85.0 4.6% $83.3 4.8% $1,847.2 $1,738.2

Page 45/534 12 (1) Hospital entity only, excludes controlled affiliates Los Gatos LOS & CMI Trend (1)

Payor Mix YTD P11 Prior Yr $ in millions Gross Chg Mix % Gross Chg Mix % Government $172.3 41.4% $179.7 43.1% Commercial 205.0 49.3% 200.3 48.1%

Other 38.6 9.3% 36.6 8.8% 1 $415.9 $416.5

Page 46/534 13 (1) Hospital entity only, excludes controlled affiliates El Camino Hospital (1) Preliminary Results from Operations vs. Prior Year 11 months ending 5/31/2013

Page 47/534 14 (1) Hospital entity only, excludes controlled affiliates El Camino Hospital – Mountain View(1) Preliminary Results from Operations vs. Prior Year 11 months ending 5/31/2013

Page 48/534 15 (1) Hospital entity only, excludes controlled affiliates El Camino Hospital – Los Gatos1 (1) Preliminary Results from Operations vs. Prior Year 11 months ending 5/31/2013

Page 49/534 16 (1) Hospital entity only, excludes controlled affiliates (1) El Camino Hospital Preliminary Results from Operations vs. Budget 11 months ending 5/31/2013

Page 50/534 17 (1) Hospital entity only, excludes controlled affiliates El Camino Hospital – Mountain View(1) Preliminary Results from Operations vs. Budget 11 months ending 5/31/2013

Page 51/534 18 (1) Hospital entity only, excludes controlled affiliates El Camino Hospital – Los Gatos (1) Preliminary Results from Operations vs. Budget 11 months ending 5/31/2013

Page 52/534 19 (1) Hospital entity only, excludes controlled affiliates El Camino Hospital (1) Balance Sheet ($ Thousands)

Page 53/534 20 (1) Hospital entity only, excludes controlled affiliates El Camino Hospital (1) Capital Spending for the 11 months ended 5/31/2013

Page 54/534 21 (1) Hospital entity only, excludes controlled affiliates (1) (1) Corporate Scorecard, FY 13(1)

Page 55/534 22 (1) Hospital entity only, excludes controlled affiliates Corporate Scorecard, FY 13(1) (1)

Page 56/534 23 (1) Hospital entity only, excludes controlled affiliates Separator Page

Att 2d.2 - June 2013 Financials.pptx

Page 57/534

Summary of Financial Operations

Fiscal Year 2013 – Period 12 7/1/2012 to 6/30/2013

Page 58/534 Page 59/534 2 (1) Hospital entity only, excludes controlled affiliates (1) Management Commentary

Budget is represented by solid lines; Bars represent actual results

Net Days in AR At 47.8, net days in A/R rebounded from its lowest point of the fiscal year of 45.6 in May. Outstanding receivables increased $5.2 million in June. For the 12-month period, A/R days averaged 49.1 or 0.9 days favorable to the 50-day target.

CMI Adjusted Discharges During June, outpatient activity continued to be strong, case mix was slightly higher than the YTD average, and discharges were 4% ahead of budget. Combined, these factors resulted in CMI Adjusted Discharges which are 5% favorable to budget. For the year, CMI adjusted discharges were 9% favorable to budget.

Operating Margin While June’s gross charges were $5.2 million favorable to budget, a favorable payer mix resulted in total revenues which were $6.6 million favorable. Expense overages, primarily in labor and benefits, consumed most of the favorable revenues resulting in operating income which was $1.2 million favorable to budget in June. For the year, hospital operations were $23.7 million or 52.2% favorable to budget. Primarily as a result of market changes impacting our investments, the hospital recorded a $7.4 million loss on non-operating items during June. For the year, non-operating items were $9.7 million or 98% favorable to budget.

Page 60/534 3 (1) Hospital entity only, excludes controlled affiliates Page 61/534 4 (1) Hospital entity only, excludes controlled affiliates El Camino Hospital Financial Metrics Trend (1)

1.9% P Favorable to Budget YTD r o f I t _ L o s s

56 Days Favorable to B Budget A L Represents _ cash of $560 million S H E E T

Page 62/534 5 (1) Hospital entity only, excludes controlled affiliates (1) ECH Operating Margin

Run rate is booked operating income adjusted for material non-recurring transactions

Page 63/534 6 (1) Hospital entity only, excludes controlled affiliates ECH Volume Statistics (1)

Page 64/534 7 (1) Hospital entity only, excludes controlled affiliates APPENDIX

Page 65/534 8 Summary of Financial Results (1) $ in Thousands

1 Page 66/534 9 (1) Hospital entity only, excludes controlled affiliates PRELIMINARY PRELIMINARY Worked Hours per CMI Adjusted Discharge (1)

P14 YTD: 4.3 below budget

Page 67/534 10 (1) Hospital entity only, excludes controlled affiliates PRELIMINARY PRELIMINARY

Supply Cost per CMI Adjusted Discharges (1)

YTD P14 : 1.3% above budget YTD P14: 7.4% above budget Mountain View Los Gatos

Page 68/534 11 (1) Hospital entity only, excludes controlled affiliates (1) Mountain View LOS & CMI Trend

Payor Mix YTD P12 Prior Yr $ in millions Gross Chg Mix % Gross Chg Mix % Government $933.5 46.4% $878.5 46.3% Commercial 980.6 48.8% $928.0 48.9% Other 96.2 4.8% $92.3 4.8% $2,010.3 $1,898.8

Page 69/534 12 (1) Hospital entity only, excludes controlled affiliates Los Gatos LOS & CMI Trend (1)

Payor Mix YTD P12 Prior Yr $ in millions Gross Chg Mix % Gross Chg Mix % Government $187.2 41.4% $198.1 42.9% Commercial 222.9 49.3% 222.1 48.1% Other 42.2 9.3% 41.4 9.0% 1 $452.3 $461.6

Page 70/534 13 (1) Hospital entity only, excludes controlled affiliates El Camino Hospital (1) Preliminary Results from Operations vs. Prior Year 12 months ending 6/30/2013

Page 71/534 14 (1) Hospital entity only, excludes controlled affiliates El Camino Hospital – Mountain View (1) Preliminary Results from Operations vs. Prior Year 12 months ending 6/30/2013

Page 72/534 15 (1) Hospital entity only, excludes controlled affiliates El Camino Hospital – Los Gatos1 (1) Preliminary Results from Operations vs. Prior Year 12 months ending 6/30/2013

Page 73/534 16 (1) Hospital entity only, excludes controlled affiliates El Camino Hospital (1) Preliminary Results from Operations vs. Budget 12 months ending 6/30/2013

Page 74/534 17 (1) Hospital entity only, excludes controlled affiliates El Camino Hospital – Mountain View (1) Preliminary Results from Operations vs. Budget 12 months ending 6/30/2013

Page 75/534 18 (1) Hospital entity only, excludes controlled affiliates El Camino Hospital – Los Gatos (1) Preliminary Results from Operations vs. Budget 12 months ending 6/30/2013

Page 76/534 19 (1) Hospital entity only, excludes controlled affiliates El Camino Hospital (1) Balance Sheet ($ Thousands)

Page 77/534 20 (1) Hospital entity only, excludes controlled affiliates El Camino Hospital (1) Capital Spending for the 12 months ended 6/30/2013

Page 78/534 21 (1) Hospital entity only, excludes controlled affiliates Separator Page

Att 2e - Simplee Ten Step.docx

Page 79/534

Date: September 11, 2013

To: El Camino Hospital Board of Directors

From: Michael King, CFO

Subject: Simplee Contract

1. Recommendation: Authorize management to negotiate and execute a two-year agreement with Simplee for web pay tool, eligibility tool, cost estimator tool and patient bill pay portal at a total cost not to exceed $720,000 for the two-year duration of the agreement.

2. Problem Definition: For the last year, El Camino Hospital has been in an agreement with Simplee for web pay, eligibility, and cost estimator. Recently, management executed a short-term amendment to extend that agreement and to expand their services to include management of web based payments for patients who elect to pay their bills online (the “patient bill pay portal”). This latter service has historically been provided by a different vendor, but at a higher cost than will be incurred with Simplee, and with a less satisfactory customer experience than the one provided by Simplee. Due to the limits within the Signature Authority Policy, management is unable to execute a longer term agreement without Board approval.

3. Authority: The Signature Authority Policy states that agreements with a value in excess of $500 thousand must be approved by the Board. Due to the fees resulting from the acceptance of consumer credit card transactions, this agreement is expected to exceed that threshold.

4. Process Description: Management will finalize negotiations for a two-year agreement and obtain the necessary reviews and approvals from legal and compliance, and execute a two-year the agreement for Simplee to provide our web pay tool, eligibility tool, cost estimator tool and patient bill pay portal.

5. Alternative Solution: Returning to our prior vendor was considered and rejected as the recommended solution is less costly and also provides patients with a superior service.

6. Concurrence for Recommendation: This action is recommended by the PFS Director and CFO. The new agreement will not be executed prior to receiving concurrence from counsel and compliance.

7. Outcome Measures/Deadlines: Simplee’s results will be measured against goals and against prior performance on a monthly basis by the PFS Director. Page 80/534

8. Legal Review: Reviewed and approved existing agreement; will review and approve final agreement prior to execution.

9. Compliance Review: Reviewed and approved existing agreement; will review and approve final agreement prior to execution.

10. Financial Review: Use of Simplee for these additional services will reduce costs by approximately $31 thousand annually.

Page 81/534 Separator Page

Att 2f - Travel Policy.pdf

Page 82/534

DATE: September 11, 2013

TO: El Camino Hospital Board of Directors

FROM: Michael King, CFO

SUBJECT: Proposed Revision to Reimbursement of Business, Education and Travel Expenses – Administrative Policy 5.00

BOARD ACTION: Motion Required

Executive Summary

 Purpose of the Request – to update and/or for clarifications to the current policy.  Proposed revision has been revised by Executive Management and the Finance Committee.  Changes/clarifications have been highlighted in yellow.  Primary update is in mileage reimbursement when the travel departs or returns to the employee’s home (Item D.1).  Clarification on gifts and appreciation event gifts to employees ((Item D.3; professional memberships (Item 4.i).  Added a process for handling Exceptions (Item H).

For Consideration:

 None

Next Steps:

 None

Page 83/534 Separator Page

Att 2f.2 - PROPOSED Business Education Travel Policy 5 00 -.docx

Page 84/534

EL CAMINO HOSPITAL ADMINISTRATIVE POLICIES AND PROCEDURES

5.00 REIMBURSEMENT OF BUSINESS, EDUCATION AND TRAVEL EXPENSES

A. Coverage

All El Camino Hospital and related entities employees, auxilians, board members, and contracted medical directors for expenses incurred as part of their contracted duties. (For expenses involving physicians other than contract medical directors engaged in their contracted duties, whether submitted by physicians or non- physician staff, refer to Policy 37.00).

B. Reviewed/Revised

6/97, 5/01, 6/02, 05/03, 03/05, 11/06, 06/09, 07/09, draft 07/13

C. Policy Summary

It is the policy of El Camino Hospital (the “Hospital”) to reimburse employees, auxilians, and board members from operational funds for business, educational and associated travel expenses. [Note: For ease of writing within this document, employees, auxilians and board members are included in the term “employee”.] The employee must submit a completed request (form #2085) for educational seminars and conferences, or necessary off-site business expenses incurred on behalf of the Hospital.

Employees are expected to use prudent judgment in selecting their travel accommodations and otherwise incurring expenses which will be reimbursed by the Hospital.

D. Eligibility for Reimbursement

1. Use of Personal Vehicle for approved Hospital Business.

a) The Hospital will pay the current IRS mileage rate for miles traveled in excess of the employee’s normal mileage to and from work. This is illustrated by the following four examples, all of which are based on an employee who has a 10 mile drive to arrive at her “primary” work site:

Approved: 07/13 C:\utilities\distiller\temp\1DODD_QVDV6F- EBBAA3CFC0A80BAC4D75650EF2FA29BB.docx\\san01\users\michael_ki\WP\2013\Policy\PROPOSED Business Education Travel Policy 5 00 - Jul2013v3.docx  El Camino Hospital Rev. 07/13

Page 85/534 Administrative Policies and Procedures 5.00 Reimbursement of Business, Education and Travel Expenses Page 2 of 7

i) The employee travels from home to an offsite work location, and then come to his/her primary work site to finish the day. Starting at home, the trip to the offsite location and then to work is 40 miles. Because this employee normally travels 10 miles to work, he/she should request reimbursement for 30 miles (40-10). [This same logic would apply to a person traveling to an offsite location at the end of the day, and then home. They should claim only mileage in excess of the drive home from their primary work site, if any.]

ii) The employee is asked to attend an all-day meeting in Sacramento and does not come to his/her normal work site. The round trip mileage is 242 miles. Since the employee would normally travel 20 miles to and from work, he/she should request reimbursement for 222 miles (242-20).

iii) The employee travels to his/her primary work site and then travels 8 miles to a secondary site. He/she then travels 8 miles back to the primary site, before heading home for the day. Because the employee still had a full commute to and from the primary site, he/she should claim 16 miles (8+8).

Note: Employees who use their personal vehicles in performing Hospital business are responsible for maintaining a current California driver’s license and proof of automobile collision/liability insurance. The Hospital does not provide insurance coverage for the use of any personal vehicles.

b) Mileage between some sites has been standardized, as follows:

Mountain View/Los Gatos 13 miles Mountain View/Evergreen 18 miles Mountain View/Rose Garden 14 miles

c) To be reimbursed, the employee should complete the Mileage Reimbursement form (form # 54.00a). Instructions for completing this form are on the back of the form. Note: If the reimbursement is for any of the predetermined mileages in D.1.b, no odometer readings need to be completed.

The form must be signed by the employee’s supervisor or manager and forwarded to Payroll (OAK200) for processing with an upcoming payroll. This is a non-reportable W-2 transaction, and will be itemized on the paystub.

Page 86/534 Administrative Policies and Procedures 5.00 Reimbursement of Business, Education and Travel Expenses Page 3 of 7

2. Approved educational seminars, conferences, events, etc. attended for the benefit of the Hospital.

a. Seminar/conference fees will be reimbursed in full or at a pro- rated amount, as approved by the employee’s Director or VP.

b. Air travel will be reimbursed at “coach” airfare rates. No reimbursement should be claimed for personal convenience fees such as those associated with priority boarding or seating upgrades.

c. Ground travel to a seminar or a meeting using the employee's personal vehicle will be reimbursed as noted in item D.1., at the current IRS mileage rate per mile. Employees should consider use of a rental car in cases where the expenses are expected to be less than the reimbursement for a personal vehicle.

d. Taxi, bus, rail, limo or rental car service, if required at the destination, may be reimbursed by the Hospital if necessary for business purposes, as follows: i) Reimbursement for car rental expenses incurred by the employee will be limited to the amount charged for a standard “intermediate” car unless there is a business need for a larger vehicle (multiple travelers with luggage, for example). If the requester requests a larger automobile than is necessary to meet the business need, he/she is to have the rental agency document what the price would have been for a standard “intermediate” vehicle and seek reimbursement for only the lower amount. If a larger vehicle is required to meet a business need, this need must be documented on the "Business-Education-Travel Reimbursement Authorization" form.

ii) Limousine service is permitted if it is no more expensive than available alternatives.

iii) Employees should choose the least expensive available alternative suitable for the purpose and situation.

e. Lodging will be reimbursed at the standard private room rate at the selected motel/hotel.

f. Meals will be reimbursed at actual cost plus tip (normally 15%). The maximum reimbursement per day is $95.00. It is the Approved: 07/13 C:\utilities\distiller\temp\1DODD_QVDV6F- EBBAA3CFC0A80BAC4D75650EF2FA29BB.docx\\san01\users\michael_ki\WP\2013\Policy\PROPOSED Business Education Travel Policy 5 00 - Jul2013v3.docx  El Camino Hospital Rev. 07/13

Page 87/534 Administrative Policies and Procedures 5.00 Reimbursement of Business, Education and Travel Expenses Page 4 of 7

responsibility of the employee to decide how he/she spends the per day maximum allowable amount for meals. Detailed receipts indicating the items purchased must be submitted.

[Note: Other than contracted medical directors, this policy shall not apply to reimbursement for meals involving physicians, regardless of whether submitted by a physician or a non-physician employee. Refer to Policy 37.00 for expenses involving physicians.]

g. Alcohol will not be reimbursed unless approved by the CEO or CFO. Because approval will only be granted in unusual circumstances, it is recommended that employees request approval in advance of the expenditure. The maximum reimbursement of $95.00 per day includes any approved expenses for alcohol.

h. Telephone calls and Internet Service required for necessary Hospital business will be reimbursed at cost. These expenses should be itemized on the statement. The Hospital will also reimburse expenses for a personal telephone call home each day while on Hospital business. The conversation should be kept to a reasonable length and will be reimbursed at cost.

3. Gifts and appreciation event expenses.

Due to state and federal tax regulations, the Hospital will generally not provide reimbursement for expenses associated with gifts to employees. However, with advance approval of the Vice President of Human Resources or the CFO, the Hospital may provide reimbursement for gifts that have minimal value for employees of a department for “a job well done” or other occasion (for example, pizza in celebration of heavy workload that went well).

As a result of the complexities of imputing gifts to employees as reportable income, the preferred method of rewarding an employee for exceptional performance is a monetary award processed via the payroll system (refer to Employee Cash Award –HR Policy 2.08).

4. The Hospital will not advance or reimburse for the following:

a. Any expenses of a spouse or other individual who accompanies the employee on travel.

Page 88/534 Administrative Policies and Procedures 5.00 Reimbursement of Business, Education and Travel Expenses Page 5 of 7

b. Any additional expenses for travel by business or first class, or any charges for special boarding privileges or seats.

c. Lodging amenities such as subscription television, valet service, cleaning/pressing of clothes (if the function is greater than one week, this service is allowed), concierge, etc. In-room meal service is subject to the normal meal reimbursement rates detailed in D.2.f above.

d. If an offsite event is within a reasonable radius of the employee’s “home site” and the function is starting after 7:30 a.m. and/or will be ending before 5:30 p.m., the Hospital will not pay for overnight accommodations, as it is expected that the employee will commute that distance to and from the function within that business day.

e. Car rental fees on an individual basis where there is the opportunity to share a rental car for a group of participants.

f. Additional per mileage charge or gasoline expense by a car rental agency for personal pleasure driving.

g. Any entertainment such as theater, tours, nightclubs, etc.

h. Discretionary expenses for another employee, such as a birthday, holiday (e.g. Christmas), weddings, child birth, special days (i.e. Administrative Day, or some life event.

i. Professional memberships are generally not reimbursable.

E. Travel Reservations

When booking accommodations and/or air travel, the following points should be noted:

1. If a deposit is required to be made by the Hospital, prior approval of the travel request must be received in sufficient time for Accounting to process the request and ensure that the payment reaches its destination by the required date.

2. When booking air travel utilizing a travel agency, the Hospital's current travel agency must be used. Employees may book airfares over the

Page 89/534 Administrative Policies and Procedures 5.00 Reimbursement of Business, Education and Travel Expenses Page 6 of 7

Internet using the employee’s personal credit card. The employee must then seek reimbursement from the Hospital.

3. In most cases, air travel should be booked as a non-refundable fare. The much-lower cost of these non-refundable fares is normally so great that the extra cost, should a trip be re-scheduled, is still much less than paying a full-price fare.

F. Expense Account Reporting

Expense account reporting must be in conformity with minimum IRS standards and all expenses of $25.00 or greater must be supported by detailed receipts. Expense reports must indicate as a minimum all of the following:

 Business purpose  Date and location  Name and position of employee

Noncompliance with the above requirements could cause the reimbursement to be considered as additional compensation to the employee and thus would become taxable (via a W-2 or Form 1099). To avoid this potential problem, the employee must complete the "Business-Education-Travel Reimbursement Authorization" form and attach all supporting documentation.

G. Procedure for Completing Form

1. All employees must complete the "Business-Education-Travel Reimbursement Authorization" form (Form 2085). Local business mileage reimbursement may be requested via the use of the Mileage Reimbursement form (form #54.00a).

2. Form #2085 is self-explanatory, but listed below are key points to remember.

All supporting documents must be attached to the request form. Examples of supporting documents include:  Copy of registration form  Lodging receipts  Detailed meal receipts  Car rental receipts  Parking fee receipts  Canceled personal checks for the expense Approved: 07/13 C:\utilities\distiller\temp\1DODD_QVDV6F- EBBAA3CFC0A80BAC4D75650EF2FA29BB.docx\\san01\users\michael_ki\WP\2013\Policy\PROPOSED Business Education Travel Policy 5 00 - Jul2013v3.docx  El Camino Hospital Rev. 07/13

Page 90/534 Administrative Policies and Procedures 5.00 Reimbursement of Business, Education and Travel Expenses Page 7 of 7

a. In circumstances where a receipt is not obtainable (or lost), the employee must attach a statement detailing the expense as to date, place, reason for expense, and amount. All reports with missing receipts require approval by the CFO or CEO.

b. Where receipts are given that include non-reimbursable expenses, these expenses must be marked in some fashion and deducted from the total so that only eligible expenses are reimbursed.

c. If reimbursement is for a business meeting, the employee must detail the nature of the meeting, its purpose, and identity of the participants.

d. Where the expenses of multiple employees are included on a single report, that report should be filed by the employee with the highest position on the Hospital organization chart.

3. When travel advances are provided, the recipient must submit a final accounting of his/her expenses on the Business, Education, and Travel Expense form and return any excess advance, no later than 120 days from the date of the event. If this is not done, disciplinary action may be taken. In addition, any undocumented advance will be considered additional income to the recipient and reported as a W-2 or Form 1099 transaction.

4. Signature Authority (approval) for the completed form, as well as travel agency invoices, is as follows:

 Department Manager/Director - up to $5,000.00 per activity.  Department Line Vice President - up to $50,000.00 per activity.  CEO - amounts greater than $50,000.00 per activity.

An employee cannot approve her/his own reimbursement of funds.

H. Exceptions

Because it is impossible to foresee every possible situation, it is recognized that exceptions may sometimes be appropriate. As a result, expenses which are not generally reimbursed under this policy may be reimbursed by the Hospital upon determination of the appropriateness and reasonableness of the expenses by the CEO or CFO. Any such exception, including the justification for the exception, shall be attached to the request for reimbursement.

Page 91/534 Administrative Policies and Procedures 5.00 Reimbursement of Business, Education and Travel Expenses Page 8 of 8

Page 92/534 Separator Page

Att 2g - 10 Step Digestive Health MDir.docx

Page 93/534

Date: September 11, 2013

To: El Camino Hospital Board of Directors

Subject: New Medical Director of Digestive Health

1. Recommendation: We request that the Board approve delegating the authority to negotiate this medical director agreement to the CEO. At its July 30, 2013 meeting, the Finance Committee reviewed this proposal and voted to recommend that the Board approve it.

2. Problem/Opportunity Definition: This proposal is to add a medical leader who can direct the development and implementation of the Digestive Health clinical program and promote physician alignment with EL Camino Hospital and PAMF physicians. At El Camino Hospital, our team of specialists that treat digestive problems are working together to establish a collaborative and integrated clinical service for patients that experience a multitude of gastrointestinal disturbances. To put the health problem into perspective, an estimated 35 million Americans experience abdominal pain, gas, and diarrhea or constipation associated with irritable bowel syndrome. Four million Americans have ulcers and 4 million Americans are infected with hepatitis C virus. Cancer of the colon and rectum is second to lung cancer as the leading cause of cancer-related deaths in American. 50,000 people die of this disease annually. In addition, more than 40,000 Americans are diagnosed with pancreatic cancer every year. Because people who may have pancreatic cancer do not often display symptoms during the early stages, it is typically diagnosed at a very late stage when it is more challenging to treat. At El Camino Hospital, we are known for our aggressive approach to treating pancreatic cancer. While our cancer program was recently accredited by the American College of Surgeon’s Commission on Cancer and our oncologists and surgical oncologists are renowned for the passion, resolve, and expertise they bring to the treatment of pancreatic cancer, we need to further expand our program to become more inclusive of digestive disorders.

3. Authority: According to Administrative Policies and Procedures 51.00, Board approval is required for all new physician agreements.

4. Process Description: This position will provide 1 day per week of committed time for a qualified physician leader to handle the numerous and complex tasks required. He will report to the Chief Medical Officer. The duties required are as follows:

Page 94/534 a. Chair the bimonthly Digestive Health Task force with PAMF and ECH team members b. Direct and approve web content for the various diseases c. Establish a dashboard for evaluation of the metrics and quality of the program d. Serve as medical staff liaison on the Steering Committee and other committees as requested e. Determine the quality indicators and data to be evaluated and its frequency f. Oversee clinical trial participation in Digestive Health protocols and contribute to the workflow for trials g. Promote alignment with PAMF and independent MDs by compiling a panel of physicians for patient referrals

5. Alternative Solution which Includes Cost Benefit/SWOT Analysis: The hospital has lived with the alternative of having no physician leadership of this disease- specific program, and the result has been growth that is lower than the opportunity offers. The future success of the project is contingent on collaboration among surgeons, oncologists, intervention radiologists and departments, and collaboration requires leadership. A medical specialist who understands the medical conditions and has experience with setting up a similar model will be invaluable to reaching a successful goal. This proposal serves to align ECH and PAMF MDs as oppose to competing factors.

6. Concurrence for Recommendation: The new position is supported by the CEO who provided leadership and direction in establishing the scope and breath of the project.

7. Outcome Measures and Deadlines: The outcome will be the implementation of a visible web presence, an increase in the number of analytic cases reported in the cancer registry using 2012 as the baseline number. Also an increase in the discharges by DRG for GI cases and procedures using 2013 data.

8. Legal Review: Legal counsel will review the final agreement prior to execution.

9. Compliance Review: Compliance will review and approve the proposed agreement and compensation. A compensation of $150/hour is proposed as being within fair market limits for similar services.

10. Financial Review: The total number of hours per month is estimated to be 32. The amount not to exceed is $57,600.

Page 95/534 Separator Page

Att 2h - Medical Director, Geriatric Psychiatry.pdf

Page 96/534 Date: September 11, 2013

To: El Camino Hospital Board of Directors

Subject: New Medical Director for Geriatric Psychiatry

1. Recommendation: We recommend that the Board authorize the ECH administration to complete the negotiations and the agreement required according to the terms described below. At its July 30, 2013 meeting the Finance Committee reviewed this proposal and voted to recommend that the Hospital Board approve it.

2. Problem/Opportunity Definition: Because of poor reimbursement from Medicare for psychiatric services, there has been an inability to retain a geropsychiatrist for the Older Adult Transition Services (OATS) mental health program, for the senior health center, or for consultation/liaison for our seniors with behavioral health conditions.

OATS has operated on a “rotation basis” for many years, with psychiatrists who are not specialists in gero-psychiatry rotating through these programs as a condition of their associate medical director status. This has been a dis-satisfier for the MDs, and not provided optimal staffing for the program due to clinical variation, interest level, cultural adaptations on treatment approaches, etc.

A change is proposed to transition the medical directorship to a gero-psychiatrist, who would be based in the MV Senior Health Center, to see OATS patients as well as provide consults to patients referred from SHC. This psychiatrist would further help develop senior mental health services in the community and be available to receive referrals from primary care physicians both PAMF and independent, via the enrolling of the patient for a visit at the SHC. Further, the psychiatrist would supervise a consultation team (registered nursing) at ECH for gero-psychiatric and cognitive disorders, when such patients are in medical services, and be a resource for psychiatrists on-call for these services.

3. Authority: According to Administrative Policies and Procedures 51.00, Board approval is required for all new physician agreements.

4. Process Description: Approval is requested for negotiation and execution of an agreement with a geropsychiatrist for the filling of this position.

5. Alternative Solution which Includes Cost Benefit/SWOT Analysis: The status quo of rotation physicians has been unsuccessful in applying best practices for the care of

Page 97/534 seniors with mental health needs. The expansion of services and the desire to provide best care is through the hire of a gero-psychiatrist.

6. Concurrence for Recommendation: The Chief Medical Officer is requesting this change in structure and the associated contracting modifications. The Chief Medical Officer is in alignment with Behavioral Health physicians and staff and leadership who are supportive of this new position.

7. Outcome Measures and Deadlines: This step allows for the reduction in clinical variation in the provision of older adult (geriatric) mental health services at El Camino Hospital. The addition of a gero-psychiatrist (board certified is the hiring requirement) will provide improvement in quality, direction, and consistency of care. Further, the position will strengthen alignment with primary care providers including PAMF and independent physicians, so that patients will receive improved services for mental health conditions.

a. Provide direct services and oversight of OATS programs in MV and LG. Fully on-boarded with gero-psychiatric consults by 10/13. b. Improve staff satisfaction with MD services at both campuses. c. Establish referral structure from physician groups to SHC for psychiatric consultation services.

8. Legal Review: The contract with physician will be subject to legal review as applicable.

9. Compliance Review: The position is a hire position at the SHC, reporting to Eric Pifer, MD. The contract position will be subject to compliance review as indicated.

10. Financial Review: The position has been vetted for financial feasibility and the pro forma is attached for review.

2 Page 98/534 Separator Page

Att 2h.2 - Copy of Pro Forma - Grace Nadolny Geriatric Psychiatry Doc 3.xlsx

Page 99/534 Physician Specialty: Geriatric Psychiatry Date: 6-11-2013 Year 1 Proforma YEAR 1 Total Month 1 Month 2 Month 3 Month 4 Month 5 Month 6 Month 7 Month 8 Month 9 Month 10 Month 11 Month 12 Year 1 Statistics

Office Visits / Month - OATS 160 160 160 160 160 160 160 160 160 160 160 160 1920 Office Visits / Month - PCMH 20 20 25 25 30 30 35 35 40 40 45 40 385 Office Visits / Month - Other 10 20 30 40 50 60 60 70 70 80 90 100 680 Revenue Net Revenue/Office Visit - OATS 116 116 116 116 116 116 116 116 116 116 116 116 Based on 99213 Net Revenue/Office Visit - PCMH 180 180 180 180 180 180 180 180 180 180 180 180 Based on 99214 Net Revenue/Office Visit - Other 116 116 116 116 116 116 116 116 116 116 116 116 Based on 99213, inpatient visits would be higher Medical Director Fees OATS - MV & LG 6,000 6,000 6,000 6,000 6,000 6,000 6,000 6,000 6,000 6,000 6,000 6,000

Receipts/Office Visit - OATS 18,560 18,560 18,560 18,560 18,560 18,560 18,560 18,560 18,560 18,560 185,600 Receipts/Office Visit - PCMH 3,600 3,600 4,500 4,500 5,400 5,400 6,300 6,300 7,200 7,200 54,000 Receipts/Office Visit - Other 1,160 2,320 3,480 4,640 5,800 6,960 6,960 8,120 8,120 9,280 56,840 Revenue collections 23,320 24,480 26,540 27,700 29,760 30,920 31,820 32,980 33,880 35,040 Medical Director Fees OATS - MV & LG 5,000 5,000 5,000 5,000 5,000 5,000 5,000 5,000 5,000 5,000 5,000 5,000 60,000 Total Revenue 5,000 5,000 28,320 29,480 31,540 32,700 34,760 35,920 36,820 37,980 38,880 40,040 356,440

Expenses Physician Compensation 22,500 22,500 22,500 22,500 22,500 22,500 22,500 22,500 22,500 22,500 22,500 22,500 270,000 Malpractice Insurance 2,000 2,000 2,000 2,000 8,000 Rent 0 0 0 0 0 0 0 0 0 0 0 0 0 Billing Fees at 10% of collections 2,332 2,448 2,654 2,770 2,976 3,092 3,182 3,298 3,388 3,504 29,644 Cell Phone, Pager, Answering Svc 300 300 300 300 300 300 300 300 300 300 300 300 3,600 Office/Medical Supplies 100 100 100 100 100 100 100 100 100 100 100 100 1,200 Dues 300 300 300 300 300 300 300 300 300 300 300 300 3,600 Transcription 100 100 100 200 200 200 200 200 200 200 200 200 2,100 Marketing 3,000 3,000 6,000 Staff (CMA) 5,000 5,000 5,000 5,000 5,000 5,000 5,000 5,000 5,000 5,000 5,000 5,000 60,000 Employee taxes (30% of salary) 1,500 1,500 1,500 1,500 1,500 1,500 1,500 1,500 1,500 1,500 1,500 1,500 18,000 MD Benefits 4,000 4,000 4,000 4,000 4,000 4,000 4,000 4,000 4,000 4,000 4,000 4,000 48,000 Miscellaneous 150 150 150 150 150 150 150 150 150 150 150 150 1,800 CME 400 400 400 400 400 400 400 400 400 400 400 400 4,800 Relocation 0 Total Expenses 39,350 37,350 36,682 38,898 37,104 37,220 39,426 37,542 37,632 39,748 37,838 37,954 456,744

Estimated Net Expense to ECH $34,350 $32,350 $8,362 $9,418 $5,564 $4,520 $4,666 $1,622 $812 $1,768 ($1,042) ($2,086) $100,304

Page 100/534 Separator Page

Att 2h.3 - Nadolny Term Sheet Geriatric Psychiatry Doc 2.docx

Page 101/534

Thomas Havel, M.D. Medical Director Behavioral Health Services

July 8, 2013 Grace Nadolny, M.D.

Term Sheet regarding Geriatric Psychiatry Position at El Camino Hospital with Silicon Valley Primary Care, P.C.

Dear Grace,

As you know, El Camino Hospital (“ECH”) desires to develop a Geriatric Psychiatry program in the Mountain View /Los Gatos area and is eager to have you lead these efforts. To formalize our agreement I am sending you this Term Sheet outlining our proposal for your consideration. The proposed terms are as follows:  You will serve as the OATS medical director for both LG & MV  You will serve as the research medical director for dementia  You will provide outpatient Geriatric Psychiatry services at our current PCMH in Mountain View  You will provide consulting psychiatry services for geriatric medical floor patients with dementia/delirium and other behavioral health conditions  You will partner with Palliative Care and Pain Management for geriatric patients  You would become a full time employed physician with SVPC, PC and receive their standard benefits package equal to other employed physicians  Your total compensation for year one would be $250,000  Your start date would be on or before January 1, 2014

By signing below, we assert that we intend to work together to finalize our agreement including the anticipated implementation schedule, conditioned on execution of a physician employment agreement with Silicon Valley Primary Care, P.C. and contingent on approval by the El Camino Hospital Board of Directors. This is a non-binding term sheet.

We look forward to your reply and working with you on this exciting endeavor.

Sincerely,

______Thomas Havel, M. D.

______Grace Nadolny, M.D. Date:______

Page 102/534 Separator Page

Att 2i - 10 Step Wellness meddir.docx

Page 103/534

Date: September 11, 2013

To: El Camino Hospital Board of Directors

Subject: Expanded Medical Directorship for Medical Director Wellness and Associated On- Call Panel – ECH Mountain View Campus -

1. Recommendation: We request that the Board approve delegating the authority to negotiate this medical director agreement to the CEO. At its July 30, 2013 meeting the Finance Committee reviewed this proposal and voted to recommend that the Board approve it.

2. Problem Definition: Cardiac rehabilitation after cardiac surgery, catheter interventions, and myocardial infarction is increasingly recognized as critical to patient recovery, and El Camino Hospital has an excellent program on its Mountain View campus. Patients in this program are carefully evaluated initially and during the course of the program. Graded exercise is a significant part of the program, but occasional chest pain, electrocardiographic abnormalities and impending or recurrent infarction are possible occurrences.

In recent years, heart disease has been increasingly recognized as a major unaddressed problem in women. The Women’s Hospital service line is adding a focus on heart disease to the excellent program on breast disease that it has featured for a number of years, and the leadership for this new service is being added to this medical directorship. Duties related to continuity of care generally will also be included as new responsibilities, including some oversight of employee health.

3. Authority: According to Administrative Policies and Procedures 51.00, Board approval is required for all new physician agreements.

4. Process Description: Approval is requested for negotiation and execution of creation of two new agreements involving these services. The Medical Director of Wellness will oversee programs of cardiac rehabilitation, women’s health and employee health. The agreement has not been negotiated yet but will take the form of an hourly compensation based on the fair market value for this service. An associated on-call panel of cardiologists will also be created to provide multiple cardiologists to provide emergency availability and direct patient care services to

Page 104/534 these cardiac patients during exercise The attached Exhibit A, in the format of a 10 Step, provides more details about the associated on-call panel.

5. Alternative Solution which Includes Cost Benefit/SWOT Analysis: This position is best served by a cardiologist who not only understands at a personal level the health issues that are unique to women but who can excel with educational programs directed to women in our patient community.

6. Concurrence for Recommendation: The Chief Medical Officer, the Heart and Vascular Institute and the executive director of the Women’s Hospital are requesting these changes to this directorship.

7. Outcome Measures and Deadlines: A metric for performance as to the cardiac rehabilitation program will continue to be the rate of physician referral of patients to the program. Specific educational and screening programs related to heart disease in women have not yet been identified, but when they are metrics will be identified and followed. The Heart and Vascular Institute will also monitor the use of these programs as to utilization and value.

8. Legal Review: Legal counsel will review the final agreement prior to execution.

9. Compliance Review: Compliance will review and approve the proposed agreement and compensation prior to execution.

10. Financial Review: Compensation will be constrained to fair market value limits. The 2013 survey of fair market value employed by the hospital shows a 50-75th percentile range of $170 - $190 per hour rate. With up to 30 hours per month allowed for the director, the amount not to exceed is $68,400 per year.

Page 105/534

EXHIBIT A

Date: July 30, 2013

To: El Camino Hospital Finance Committee

Subject: New On-Call Panel for Cardiac Rehabilitation – ECH Mountain View Campus

1. Recommendation: We request that the Board approve delegating the authority to negotiate this on-call panel medical director agreement to the CEO. At its July 30, 2013 meeting, the Finance Committee reviewed this proposal and voted to recommend that the Board approve it.

All new patients are required by Medicare to have an initial evaluation by a cardiologist to assess the appropriate scope of the exercise prescription and review it with the patient and family. It is also critical for patient safety that a cardiologist be available for quick consultation either by phone or in person in the department, which is located on the ground floor in the old hospital building. The medical director who provides administrative oversight to the program currently provides this availability. However, her duties are being upgraded to include numerous duties in other programs, and she can no longer be sufficiently available to provide comprehensive coverage. Therefore, a new panel of cardiologists must be created to provide initial evaluations and be available for emergency coverage for eight hours per day Monday through Friday.

3. Authority: According to Administrative Policies and Procedures 51.00, Board approval is required for all new physician agreements.

Page 106/534 4. Process Description: Approval is requested for negotiation and execution of an agreement with a number of local cardiologists to provide coverage of the cardiac rehabilitation program on a business-day, business-hour basis. The agreement has not been negotiated yet but will take the form of a daily stipend equivalent to the fair market value for this service.

5. Alternative Solution which Includes Cost Benefit/SWOT Analysis: There is no clear alternative to meeting these essential services other than compensating physicians to provide the professional, clinical oversight required by law.

6. Concurrence for Recommendation: The Chief Medical Officer and the Heart and Vascular Institute are requesting this physician service.

7. Outcome Measures and Deadlines: The use of this service will be monitored by the Heart and Vascular Institute as to utilization and value.

8. Legal Review: Legal counsel will review the final agreement prior to execution.

9. Compliance Review: Compliance will review and approve the proposed agreement and compensation prior to execution.

10. Financial Review: Compensation will be constrained to fair market value limits. The 2013 survey of fair market value employed by the hospital shows a 50th percentile range of $480 for 24 hours of availability, which equates to $160 for eight hours. The amount not to exceed is $41,600 per year.

Page 107/534 Separator Page

Att 2j - 10 Step IT meddir.docx

Page 108/534

Date: September 11, 2013

To: El Camino Hospital Board of Directors

Subject: New Medical Director of Information Technology

2. Problem/Opportunity Definition: The hospital is very engaged with a thorough assessment of its current information systems, focusing on the very information intensive future ahead. While many features of a comprehensive information system support the business requirements of the hospital, the clinical electronic medical record supporting the patient care environment must support not only the hospital’s nursing staff but must also provide an accurate, user-friendly and responsive user interface for the hospital’s medical staff physicians.

Practicing physicians have little time away from their patient care responsibilities that can be used to contribute productively to the decision making process that is so essential to securing the optimum system, and communications between practicing physicians and IT experts are always challenging. Hospitals have discovered that a critical step in facilitating communications and information exchange is having a single physician, knowledgeable in both clinical medicine and information technology, who can enhance the needed communications between the IT department and the medical staff.

3. Authority: According to Administrative Policies and Procedures 51.00, Board approval is required for all new physician agreements.

4. Process Description: This position will provide 1½ days per week of committed time for a qualified physician leader to handle the numerous and complex tasks required. He will report to the Chief Medical Officer. The duties required are as follows:

Page 109/534 1. Co-chair the MSIT Committee (Medical Staff IT), which is currently chaired by a volunteer physician. 2. Advise CMO, CIO and hospital administration on matters related to health information technology 3. Create, in conjunction with the CIO and the senior executive team, a vision & strategy for physician components of: a. Electronic data warehouse b. Health information exchange (HIE) c. Electronic medical record (EMR) 4. Work with Lean team on physician related IT matters 5. Serve as medical staff liaison for order set development and other physician order entry issues 6. Serve as medical staff liaison to and co-lead the hospital ICD-10 committee Champion and organize efforts to build physician documentation expertise and to create a fully integrated inpatient EMR

5. Alternative Solution which Includes Cost Benefit/SWOT Analysis: Some hospitals create a more expansive role with a full time Chief Medical Information Officer position. The executive leadership believes that with the extensive IT knowledge base available from our Chief Medical Officer, this smaller investment is all that is needed at the current time. Further, it is likely that the proposed position can be filled with a qualified physician that can remain very clinically active and very familiar with the EMR environment of the hospital.

6. Concurrence for Recommendation: The new position is supported by the Chief Information Officer and the Chief Medical Officer.

7. Outcome Measures and Deadlines: The anticipated outcome will be an acceleration of the processes needed to create an optimum clinical IT roadmap supportive of our physicians.

8. Legal Review: Legal counsel will review the final agreement prior to execution.

9. Compliance Review: Compliance will review and approve the proposed agreement and compensation. A compensation of $150/hour is proposed as being within fair market limits for similar services.

10. Financial Review: The total number of hours per month is estimated to be 52. The amount not to exceed is $93,600.

Page 110/534 Separator Page

Att 2k - 10 Step Plastics on-call.docx

Page 111/534

Date: September 11, 2013

To: El Camino Hospital Board of Directors

Subject: New ED On-Call Panel for Plastic Surgery – ECH Mountain View Campus

1. Recommendation: We request that the Board approve delegating the authority to negotiate this on-call agreement to the CEO. At its July 30, 2013 meeting, the Finance Committee reviewed this proposal and voted to recommend that the Board approve it.

2. Problem/Opportunity Definition: To date, ECH Mountain View has not had an Emergency Department on-call panel for coverage of emergency patients that require the services of a plastic surgeon. The occasional patient has facial lacerations that are extensive enough that the patient requests that a plastic surgeon rather than the ED physician or physician assistant provide the repair. Hand injuries occasionally require repairs that can only be provided by a surgeon qualified in hand surgery, which most of the ECH plastic surgeons are. Thus far, plastic surgeons have voluntarily been willing to respond to telephone requests from ED physicians to come to the ED to provide expert evaluations and repairs and have maintained a call panel of surgeons managed by one willing surgeon.

However, the ECH ED is very popular with the local ECH community, and there appears to be an increasing demand for plastic surgery repairs from community patients. Recently a patient with significant lacerations to the hand had to wait five hours to obtain the expertise required. The imposition on the time of busy surgeons is such that the hospital can no longer expect plastic surgeons to interrupt their visits with patients in their offices in order to respond to telephone inquiries for guidance from ED physicians or requests to abandon those office patients in order to come to the ED to evaluate and treat emergencies.

The EMTALA (Emergency Medical Treatment and Active Labor Act) requires hospital emergency departments to receive all patients presenting at the ED and stabilize them and to only transfer them to other facilities if they do not normally provide the needed services to any patients. Plastic surgery is an important service at ECH Mountain View, and transfer is not a viable option in the majority of cases.

Page 112/534 3. Authority: According to Administrative Policies and Procedures 51.00, Board approval is required for all new physician agreements.

4. Process Description: Approval is requested for negotiation and execution of an agreement with a number of local plastic surgeons to provide on-call coverage of the emergency department on a 24/7 basis. The agreement has not been negotiated yet but will most likely take the form of an appearance fee equivalent to the fair market value for this community and possibly some compensation for uninsured and Medi-Cal patients.

5. Alternative Solution which Includes Cost Benefit/SWOT Analysis: Since medical staff bylaws do not force physicians to provide 24/7 coverage of the ED without compensation, these services are needed to assure quality care to emergency patients and to avoid potential violations under EMTALA. An alternative to the proposed methodology that avoids the cost uncertainties would be a fixed daily stipend. The MD Ranger 2013 survey indicates that the 50th – 75th percentile range is $400 to $1100. This would provide a not to exceed cost of $401,500 at the higher level.

6. Concurrence for Recommendation: The Chief Medical Officer, the Medical Director of the Emergency Department and medical staff plastic surgeons are requesting this arrangement.

7. Outcome Measures and Deadlines: The use of this service will be monitored by the Emergency Department as to utilization and value. If it does not address an important need over time, it can be discontinued.

8. Legal Review: Legal counsel will review the final agreement prior to execution.

9. Compliance Review: Compliance will review and approve the proposed agreement and compensation.

10. Financial Review: Compensation will be constrained to fair market value limits as determined by an independent survey of such physician agreements that is published annually. Following a fairly common approach for lower volume surgical cases, the compensation is expected to be a fixed payment of $1000 for coming to the ED to consult on the patient and a fixed payment of $3000 if a surgical procedure is also required. The issue of providing post-operative care for uninsured or Medi-Cal patients may be addressed by payment of Medicare rates for such care. The annual cost can only be estimated, but patient volume is estimated to be in the range of up to ten patients per month. Assuming that one- fourth require operative intervention, the annual cost would be $210,000. But they

Page 113/534 could be higher or lower. The alternative of the fixed stipend described above in Item #5 is the only way to provide an absolute cap for costs.

Page 114/534 Separator Page

Att 2l - 10 Step MedDir TAVR.docx

Page 115/534

Date: September 11, 2013

To: El Camino Hospital Board of Directors

Subject: New Medical Director of Transcatheter Aortic Valve Replacement (TAVR)

2. Problem/Opportunity Definition: This will be a transition of the Heart & Vascular Institute Medical Director of Research and Education to a more focused role that will operationalize the current experimental program for aortic valve replacement.

Transcatheter aortic valve replacement is a procedure for select patients with severe symptomatic aortic stenosis (narrowing of the aortic valve opening) who are not candidates for traditional open chest surgery or are high-risk operable candidates. TAVR is performed on a beating heart and does not require cardio-pulmonary bypass. The TAVR valve is made of bovine (cow) pericardium and is supported with a metal stent.

Use of the TAVR involves the placement of multiple large bore catheters into the major vessels and ultimately into the aortic valve itself. After a balloon on the catheter expands the defective heart valve, the replacement valve is inserted into the aortic valve space and expanded to replace the old valve. When the catheters are removed, the valve immediately begins operating with a resulting normal blood flow from the heart. Patients normally leave the hospital after five to eight days, and most recover very well. However, the procedure remains costly, and much work will be required to optimize facilities, supplies and personnel resources.

3. Authority: According to Administrative Policies and Procedures 51.00, Board approval is required for all new physician agreements.

Page 116/534 4. Process Description: This position will provide six to eight hours per week of time for a qualified cardiologist. He will report through the Heart and Vascular Institute medical director to the Chief Medical Officer. The duties required are as follows:

Administrative:  Identify variations in care and participate in developing protocols or practice guidelines to reduce those variations.  In collaboration with the HVI Executive Director, OR Director and Cath Lab Manager identify areas to reduce overutilization or inappropriate care in the TAVR Program.  Promote a cooperative and collaborative working environment among the clinical disciplines involved in TAVR care.  Assist Executive Director of Heart and Vascular Institute and Cardiac and Vascular Surgery Clinical Nurse Specialist in developing and meeting the TAVR budgetary goals through process improvement measures.  Demonstrate consistent, efficient, cost effective and quality care at all times.  Performance Improvement  Determine and implement PI activities appropriate to the TAVR program  Oversee the TAVR Performance Improvement program.  Review and investigate all TAVR Performance Improvement inquiries and refer to appropriate committees.  Identify areas to improve patient care and correct deficiencies in policies, guidelines and protocols.

TAVR Goals and Objectives for FY 2014 include:

Demonstrate evidence in the following areas:  Review the care of TAVR patients to identify areas of overutilization or inappropriate care by end of 1st quarter FY 14  Implement two TAVR process improvement activities by end of 2nd quarter FY 14  Implement an additional two TAVR process improvement activities by end of 3rd quarter FY 14.  Reduce total cost per case for the TAVR population by 20%. (Measurement last quarter compared to previous FY or last 6 months………?)  Manage the volume and cost of the program to be within the ECH established $3M strategic investment in the research and clinical trial efforts. This $3M investment is intended to cover the cost of managing the clinical trials (Fogarty) and the uncovered direct hospital costs resulting from the trials.

Page 117/534 5. Alternative Solution which Includes Cost Benefit/SWOT Analysis: Management considered and finds unappealing the option of maintaining the program in its current state. That option is not recommended because the procedure is currently performed in compliance with very extensive protocols that are necessary and appropriate for a research project but are not necessary outside of the research environment. While it is not yet possible to quantify with precision the future savings which will be obtained, management believes they will offset the costs associated with this directorship many times over.

6. Concurrence for Recommendation: The new position is supported by the Chief Medical Officer, the Heart and Vascular Institute medical director and the Executive Director of the Heart and Vascular Institute.

7. Outcome Measures and Deadlines: The anticipated outcome will be an acceleration of the processes needed to create an optimum clinical IT roadmap supportive of our physicians.

8. Legal Review: Legal counsel will review the final agreement prior to execution.

9. Compliance Review: Compliance will review and approve the proposed agreement and compensation. A compensation of $263/hour, an amount that is unchanged from the prior directorship, is proposed as being within fair market limits for similar services.

10. Financial Review: The total number of hours per month is estimated to be 35. The amount not to exceed is $110,460.

Page 118/534 Separator Page

Att 2m - Surgical Robot Purchase.pdf

Page 119/534

Administration

Date: September 11, 2013 To: El Camino Hospital Board of Directors From: Mick Zdeblick, COO Cheryl Reinking, Interim CNO Re: Unbudgeted Capital Purchase Request - Surgical Robot System

Recommendation: It is recommended that Board approve the purchase of a fourth surgical robot system at a cost not to exceed $2 million. The Finance Committee reviewed this proposal at its July 30, 2013 meeting and voted to recommend that the Board approve it.

Authority: As the COO and CNO, with support from several surgeons and the Surgical Services Department, we are requesting your approval to purchase a surgical robotic system that will allow us to increase the volume of minimally invasive robotic surgeries.

Problem / Opportunity Definition: Our current minimally invasive robotic program is growing and profitable. In addition to the continued growth of robotic surgeries by currently trained PAMF and independent physicians, we have recently been approached by a group of PAMF affiliated surgeons who perform the majority of their surgeries at other hospitals indicating their desire to perform more surgeries at El Camino Hospital. This opportunity for increasing surgical volume is dependent upon our ability to equip a third operating room in Mountain View with a surgical robot system. We currently have two rooms in Mountain View and one in Los Gatos with surgical robot system capability.

Process Description: In researching the possibility of seizing this opportunity, a team of individuals evaluated the cost benefit of our current surgical robotic program at both sites of service to determine if a fourth system was justified. The evaluation indicated that the dual campus robotics program is meeting its quality and outcome goals and is highly profitable. The growth of robotic surgical cases and the increase in the number of robotic qualified physicians supports the addition of a fourth surgical robotic system.

Page 120/534

Alternative Solutions: One alternative considered was to relocate the robotic system from Los Gatos to Mountain View due to the lower volume of robotic cases in Los Gatos. This was ruled out for two reasons. One is that even with the lower volume the profitability of the cases cover direct costs and contributes to covering indirect costs, and two there continues to be demand and growth opportunities in the Los Gatos market.

Concurrence for Recommendation: This request is supported by the Surgical Services Department, the Executive Leadership Team and the physicians who utilize the surgical robotic systems.

Outcome Measures / Deadlines: Upon approval of the Finance Committee and the Board of Directors in September the system will be delivered and the room made ready for operations by early October.

Legal Review: The purchase agreement has been reviewed by in house legal counsel and is consistent with our policies for procurement.

Compliance Review: Not Required.

Financial Review: Based on projections provided by the planning department indicating expectations of 240 additional cases annually, the pro forma indicates that the system would provide payback within twelve months, generate an IRR of 100%, and provide an NPV of $5.9 million over a five-year life. Break-even analysis indicates that the system will pay for itself (generate an NPV of $0) at volumes which are less than 1/3 of the expected volumes.

The demand and growth of this program has been monitored by the Surgical Service department. Back in the spring of 2013 we did not anticipate the expected surgical demand from these additional surgeons (see attachment); therefore, this purchase was not placed in the FY14 capital planning process. It is management recommendation that we offset this unapproved budgeted amount with a commensurate reduction from within the approved FY14 capital budget.

Page 121/534 Separator Page

Att 2m.2 - Surgical Robot Purchase Attach 1 to 10 step.pdf

Page 122/534 Five Year Forecast of Additional Robot at Mountain View ($ In Thousands)

FY2014 FY2015 FY2016 FY2017 FY2018 Volume 240 240 240 240 240

Net Revenue $5,894 $6,011 $6,132 $6,254 $6,379

Total Cost $4,060 $4,430 $4,662 $4,909 $5,171

Net Income $1,834 $1,582 $1,469 $1,345 $1,209 Cash Flow $234 $1,982 $1,869 $1,745 $1,609

NPV @ 5% $5,939 IRR 100% Payback Years 1

Assumptions (1) Volumes forecasted for the next 5 years at 20 cases per month from General Surgery. (2) Net revenue inflation at 2% per year (compounded) (3) Expense inflation at 6% per year (compounded) (4) Total cost is comprised of direct + indirect cost per case + new robot at $2M depreciated over 5 years + $150K for maintenance starting FY2015 (5) Assumes same payor mix & IP/OP mix as FY2013

Page 123/534 Separator Page

Att 2m.3 - Surgical Robot Purchase Attach 2 behind 10- Step.pptx

Page 124/534 ROBOTICS

Page 125/534 1 Robotic Program Economics

ECH’s “dual campus” robotics program is meetings its quality and outcome goals, and is highly profitable

Profitability has been driven by: • Higher surgery reimbursement rates from commercial payers • Improved service mix (GYN) • More outpatient

Page 126/534 2 Robotic Program Economics

Based on the last 3 months, FY 2014 volume in Los Gatos will be 20% less than this fiscal year

Based on the last 3 months, FY 2014 volumes are 25% above FY 2013 (861 cases)

Potential new volume at Los Gatos of 10-15 a month (½ GYN and ½ General Surg) Gyn: 10 cases a month. Drs Graven, Kilkinney. additional training needed on single site surgery. General Surgery: 5 cases a month. Advanced Surgical Associates currently perform 300-400 cases a year and are expanding. Remaining question on payer mix for incremental cases.

Potential new volume at Mountain View of 20 a month (General Surg), but requires additional machine General Surgery: 20 cases a month Requires new machine & OR process improvements Thoracic: Replacement physician at 3 cases a month (matches Dunnington)

Page 127/534 3 Projections & Discussion • Evaluation of Los Gatos new volume & payer mix • Evaluation of Mountain View new volume & payer mix (note some also bring non robotic volume) • Benefit of 2-campus program as we move into West Valley • Ability to lease to test volumes and operational issues at Mountain View • Ability to improve OR process to allow use of another machine/minor building changes • Other comments / questions

USES 50% INDIRECTS AS FIXED FY 2013 Projection Scenario 1 Scenario 2 Scenario 3 Net Income Net Income Net Income Net Income Volume ($ Millions) Volume ($ Millions) Volume ($ Millions) Volume ($ Millions) Total Program 763 8 1,040 11 1,100 12 1,280 13 Los Gatos Campus 76 1 180 2 - - 180 2 Mountain View Campus 686 7 860 9 1,100 12 1,100 11 Scenario 1 assumes programs continue as currently configured, but Los Gatos successfully adds new practices Scenario 2 assumes Los Gatos program moved to Mountain View, Mountain View opens to new practices Scenario 3 assumes both programs remain, new robot added at depreciation cost of $0.32m a year Contribution per case by product type less 10% income erosion (cost/revenue) New Robot for Scenario 3 shown at a cost of $1.6 million with 5 year depreciation

Page 128/534 Separator Page

Att 2m.4 - Surgical Robot Purchase Attach 3 Behind 10 Step.pptx

Page 129/534 da Vinci Utilization Procedures Trained Surgeons Volume Projection

• Prostatectomy • • Lai 5 • Pyeloplasty Urology • Angell • 5 • Partial Nephrectomy • 2 • Cystectomy • Phonsombat • Sacracolpopexy • Aigen • 4

• • 16 • Hysterectomy Chen GYN • Myomectomy • Pisani • 20 • Sacracolpopexy • Burrs • 3 • Cancer Procedures • Patel • 3 • Krishnan • 4 • White • 2 • Medina • 2 • Phelps-Sandall • 3 • Sutherland • 3 • Khoo • 2 • Sarda-Madura • 4

Volume based on per month calculation Page 130/534 Names in red represent incremental volume gain da Vinci Utilization Procedures Trained Surgeons Volume Projection

• Nissen • See-tho • 5 • LAR • Tran • 5 GEN • Colectomy • Whang • 5 • Chole • Bariatric • Khalil • 5 • Feng • 4 • Kiterakis • ? • Lega • ?

• TORS • Shah • ? ENT/CV • Lung Thoracic • Heart

Summary: 100 cases per month projected

Page 131/534 Separator Page

Att 2n - Revised Cash Balance Investment Policy.pdf

Page 132/534

Administration

Date: Aug 29, 2013 To: El Camino Hospital Board of Directors From: Michael King, Chief Financial Officer Re: Ten-Step for Cash Balance Policy and Cash Surplus Policy Changes

Recommendation: Management recommends that the Board approve revisions to the cash balance policy and to the surplus cash policy. The recommended revisions (black-line copies attached) correctly identify the Investment Committee instead of referencing it as a sub- committee of the Finance Committee. In addition, language is added to each policy expressing the intent that El Camino not hold direct investments in companies involved with weapons whose sale is illegal in the state of California. We currently hold no such investments. Problem / Opportunity Definition: The existing policies incorrectly refer to the Investment Committee as a sub-committee, which needs to be corrected. In addition, current hospital policies restrict investments in companies involved with tobacco products but include no restrictions on investments in companies involved with weapons. Authority: The Board approves all facility-wide policies. Process Description: Shortly after a widely publicized mass shooting at an elementary school, a hospital staff member proposed that similar to the existing restriction on investments in companies involved with tobacco products, it might be appropriate that El Camino also adopt a policy restricting investments in companies producing certain classes of weapons. The issue was discussed at the next Investment Committee meeting and members asked our investment advisors to provide information on what other investors were doing, as well as information on whether our current portfolio contained any such investments. At the next meeting, the committee members received the report from the investment advisors and agreed that the policies should be presented to the Board for consideration. Management drafted proposed policies incorporating both the technical changes and the investment restrictions, which were reviewed and approved by the Investment Committee for Board consideration. Alternative Solutions: Leaving the policies as is was considered and rejected. It is recognized that the Board may wish to adopt the technical corrections and avoid creating additional investment restrictions, but that was not believed to be the best outcome.

Concurrence for Recommendation: The Investment Committee members, the CFO, and the investment advisors recommend approval of the proposed policies.

Page 133/534 Page 2 of 2 Ten-Step for investment policy changes Aug 29, 2013

Outcome Measures / Deadlines: As defined in the policies, the investment advisors will monitor our investments and make reports to the Investment Committee on an annual basis. Legal Review: None Compliance Review: None Financial Review: The Chief Financial Officer is initiating this request and believes, based on input from our investment advisors, that this will have no material impact on our financial results.

Page 134/534 Separator Page

Att 2n.2 - DRAFT Cash Balance Investment Policy_33- Aug2013.docx

Page 135/534

EL CAMINO HOSPITAL ADMINISTRATIVE POLICIES AND PROCEDURES

33.00 CASH BALANCE PENSION INVESTMENT AND ADMINISTRATION POLICY

A. Coverage:

All El Camino Hospital

B. Reviewed/Revised

5/90, 5/03, 03/05, 11/06, 5/07, 5/12, 6/13

C. Policy Summary This policy has been developed to provide a prudent framework for the management and oversight of the assets of the Cash Balance Pension plan (the "Plan"). The overall goal of the Plan's investment program is to achieve the highest possible investment return, and the resulting positive impact on asset values, funded status, contributions and benefits, without exceeding a prudent level of risk. The structure of the Plan's investment program was developed after evaluating the implications of increased investment return versus increased variability of return for a number of potential asset allocations with varying commitments to equity, fixed income, alternative and cash equivalent investments.

D. Policy

1. Objectives and Purpose

a. The policy will be to invest Plan assets in a diversified investment portfolio that targets capital appreciation without assuming undue risk to principal. The primary objectives of the retirement Plan shall be:

(1) The preservation of capital in real terms with a focus on meeting future benefit payments.

(2) Obtaining the maximum return within reasonable and acceptable levels of risk.

2. Delegation of Responsibility

a. Within the financial activities of the organization, it is necessary to provide a prudent framework for the regular supervision of the management of invested funds. A hospital board Investment Sub- CommitteeSubcommitteeCommittee (the “Committee”) of the Finance Committee has been established to review and monitor investment Approved: 06/09 C:\utilities\distiller\temp\1DODD_QVDV6F-EF13F82DC0A80BA456200470ED3452F7.docxC:\Documents and Settings\marina_ki\Desktop\Att 2n.2 - DRAFT Cash Balance Investment Policy_33-Aug2013[[0DODD_QVDV6F- EBBAB424C0A80BAC4D75650E11C6AD97]].docxG:\CLIENT\E-412\Policy\2012\Cash Balance Investment Policy_33 00 - Final Draft.docx\\san01\users\ned_b\word\Cash Balance Investment Policy_33 00 - 032912.docx  El Camino Hospital Rev: 03/12

Page 136/534 Administrative Policies and Procedures 33.00 Cash Balance Investment Policy Page 2 of 14 performance of the Cash Balance Plan. The Committee bears primary responsibility as detailed in section 2.e. below for oversight of the independent Investment Consultant and the overall Plan investment program. In addition, a Retirement Plan Administrative Committee (the “RPAC”) administers the Hospital's pension plan including employee communication and education, eligibility, and distributions.

b. The members of the Investment Sub-CommitteeSubcommitteeCommittee are appointed by the hospital board of directors. The RPAC shall be composed of the Chief Financial Officer, Controller, Chief Human Resources Officer, Benefits Manager, and others appointed by the Chief Executive Officer,

c. Management (“Management”) shall be defined as the Chief Executive Officer, Chief Financial Officer and Controller. The Plan Administrator (“Plan Administrator”) shall be defined as any one of the following: Chief Executive Officer, Chief Financial Officer, Chief Human Resources Officer, Controller or Benefits Manager.

d. Those authorized to execute investment and financial transactions include the Chief Executive Officer, Chief Financial Officer, Controller, and investment advisor(s) approved by the Committee.

e. Responsibilities of the board Investment Sub- CommitteeSubcommitteeCommittee

(1) Establish and recommend revisions to the investment policy, as appropriate.

(2) Review compliance with policy.

(3) Determine allocations across investment styles and investment managers that are consistent with this investment policy.

(4) Assure that implementation of each investment program is consistent with its overall investment objectives and risk tolerances.

(5) Monitor and evaluate the performance of investment managers through reports provided by the Investment Consultant no less frequently than annually.

f. Responsibilities of Management

(1) Select, contract with, and when appropriate, terminate investment Approved: 06/09 C:\utilities\distiller\temp\1DODD_QVDV6F-EF13F82DC0A80BA456200470ED3452F7.docxC:\Documents and Settings\marina_ki\Desktop\Att 2n.2 - DRAFT Cash Balance Investment Policy_33-Aug2013[[0DODD_QVDV6F- EBBAB424C0A80BAC4D75650E11C6AD97]].docxG:\CLIENT\E-412\Policy\2012\Cash Balance Investment Policy_33 00 - Final Draft.docx\\san01\users\ned_b\word\Cash Balance Investment Policy_33 00 - 032912.docx  El Camino Hospital Rev: 04/12

Page 137/534 Administrative Policies and Procedures 33.00 Cash Balance Investment Policy Page 3 of 14 managers who manage the investment programs’ assets.

(2) Select, contract with, and when appropriate, terminate custodian banks/brokers that are responsible for the custody of the Plan's assets.

(3) Select, contract with, and when appropriate, terminate an investment consultant.

(4) Evaluate on a regular basis the investment performance objectives of each of the investment programs’ investment managers.

(5) Provide each investment manager with specific investment objectives and guidelines consistent with overall objectives.

(6) Implement allocations across investment styles and investment managers that are consistent with this investment policy.

(7) Oversee the operational investment activities of the funds subject to this investment policy.

(8) Work with the independent, external Investment Consultant in developing and/or reviewing investment recommendations for presentation to the Committee and Board.

(9) Review the projected cash flow requirements of the Plan at least annually.

g. Responsibilities of the Retirement Plan Administrative Committee

(1) Review compliance testing. Receive annual compliance update from plan consultants. Engage and select legal advisers and consultants.

(2) Oversee processes used to determine employee eligibility, vesting, and benefits. Receive annual contribution report.

(3) Review annual budget regarding plan administrative and benefit costs. Review 403(b) fee policy annually. Recommend changes to policy. Ensure Hospital complies with Fee Disclosure regulations to participants.

(4) Purchase and maintain appropriate fidelity bond. Ensure that RPAC members sign fiduciary acknowledgment and conflict of interest forms annually.

(5) Review annual budgets including projected funding. Ensure that annual

Approved: 06/09 C:\utilities\distiller\temp\1DODD_QVDV6F-EF13F82DC0A80BA456200470ED3452F7.docxC:\Documents and Settings\marina_ki\Desktop\Att 2n.2 - DRAFT Cash Balance Investment Policy_33-Aug2013[[0DODD_QVDV6F- EBBAB424C0A80BAC4D75650E11C6AD97]].docxG:\CLIENT\E-412\Policy\2012\Cash Balance Investment Policy_33 00 - Final Draft.docx\\san01\users\ned_b\word\Cash Balance Investment Policy_33 00 - 032912.docx  El Camino Hospital Rev: 04/12

Page 138/534 Administrative Policies and Procedures 33.00 Cash Balance Investment Policy Page 4 of 14 funding notices are sent to participants.

(6) Retain, evaluate, and remove record-keepers, non-investment advisers and consultants.

(7) Approve non-material plan changes related to administrative and regulatory changes. Review draft resolutions. Ensure implementation of plan document changes.

(8) Review human resources and administrative policies on retirement annually. Update and recommend policy changes based on input from investment committee, plan consultants, and regulatory changes.

(9) Each management member of the RPAC will be authorized to act as a plan administrator to effectively administrate the plan. Such authority will be documented in writing by at least two members of the RPAC.

h. Responsibilities of the independent Investment Consultant

(1) Review the Plan’s investment policies and objectives and suggest appropriate changes.

(2) Monitor long-term capital market trends and recommend appropriate asset allocation strategies to the Committee.

(3) Provide Management and the Committee with ongoing asset allocation, investment manager allocation recommendations, and total portfolio context.

(4) Provide assistance concerning the allocation of new contributions as well as periodic asset allocation rebalancing.

(4)(5) On an annual basis, provide to the Plan’s Investment Managers a list of securities that are prohibited by the Plan’s investment policy under section 10.b.

(5)(6) Recommend which investment management firms should receive increased or decreased allocations and, when warranted, recommend firms that should be dismissed.

(6)(7) Research and recommend investment management firms and custodian(s) appropriate to implement the Plan’s investment policies and objectives.

(7)(8) Measure, evaluate, and report each investment manager’s Approved: 06/09 C:\utilities\distiller\temp\1DODD_QVDV6F-EF13F82DC0A80BA456200470ED3452F7.docxC:\Documents and Settings\marina_ki\Desktop\Att 2n.2 - DRAFT Cash Balance Investment Policy_33-Aug2013[[0DODD_QVDV6F- EBBAB424C0A80BAC4D75650E11C6AD97]].docxG:\CLIENT\E-412\Policy\2012\Cash Balance Investment Policy_33 00 - Final Draft.docx\\san01\users\ned_b\word\Cash Balance Investment Policy_33 00 - 032912.docx  El Camino Hospital Rev: 04/12

Page 139/534 Administrative Policies and Procedures 33.00 Cash Balance Investment Policy Page 5 of 14 performance on a quarterly basis.

(8)(9) Monitor adherence of each investment manager to its stated investment philosophy and style.

(9)(10) Monitor each investment manager's adherence to the guidelines and investment policies contained in this Investment Policy and specific manager guidelines, if applicable.

(10)(11) Maintain contact with and report to Management and the Committee on changes within each investment manager’s organization including but not limited to investment professional turnover and ownership changes.

(11)(12) Communicate promptly with Management and the Committee regarding significant changes in the Investment Consultant’s ownership, organizational structure, and professional staffing.

(12)(13) Communicate promptly to the Committee any financial arrangements between the Investment Consultant and money management firms.

i. Responsibilities of the Custodian Bank as directed by a Plan Administrator

(1) Provide complete and accurate accounting records and prompt monthly reports to reflect all transactions, cash flows, and assets held.

(2) Disburse and receive cash flows and investments as directed by investment managers to the extent of their authority or authorized by a Plan Administrator.

(3) Issue monthly reports of holdings and transactions priced in accordance with industry standards.

(4) Provide monthly reports showing individual asset holdings with sufficient descriptive detail to include units, unit price cost, market value, CUSIP number (where available) and any other information requested by the direction of a Plan Administrator . Principal cash transactions, including dividends, interest and principal payments received, deposits and withdrawals, securities purchased, sold, and matured, and fee payments will also be listed.

(5) Expeditiously transfer funds into and out of specified accounts.

Page 140/534 Administrative Policies and Procedures 33.00 Cash Balance Investment Policy Page 6 of 14 (6) Promptly forward all proxy materials received to the appropriate investment manager or a Plan Administrator.

j. Responsibilities of the Investment Managers

(1) Manage the portfolio’s assets with full discretion, in accordance with the investment objectives and guidelines stated in this Investment Policy and specific investment manager guidelines.

(2) Communicate promptly with Management and the Investment Consultant regarding all significant matters such as:

-- major changes in the investment manager’s investment outlook and strategy, -- shifts in portfolio construction (asset mix, sector emphasis, etc.), -- changes in the investment manager’s ownership, organizational structure, or professional staffing (additions and departures), and -- other changes of a substantive nature.

(3) Comply with all laws and regulations that involve the Plan as they pertain to the investment manager’s duties, functions, and responsibilities as a fiduciary.

(4) Vote the proxies on the securities held in the investment manager’s portfolio in accordance with the manager’s fiduciary duties and professional judgment.

(5) Provide Management and the Investment Consultant with monthly performance and organizational updates and other information as requested.

(6) Provide periodic presentations to the Committee and RPAC as requested.

3. Reporting and Evaluation Process:

a. The achievement of investment objectives will be reviewed by the Committee annually and recommended to the Board of Directors for approval. This review will focus on the continued feasibility of achieving the objectives and the continued appropriateness of the investment policy.

b. The Investment Consultant will be responsible for reporting the status of investments to the Committee and Management no less frequently than annually.

Page 141/534 Administrative Policies and Procedures 33.00 Cash Balance Investment Policy Page 7 of 14 c. On a quarterly basis, the Investment Consultant will provide a summary of the Plan's investment performance to the Committee and CFO. The following will be reviewed:

(1) The Plan's asset allocation relative to the target asset allocation.

(2) The total fund, segment and investment manager returns relative to the stated investment objectives.

(3) Other items pertaining to the Plan.

d. All major liability assumptions regarding workforce, benefit levels and actuarial assumptions will be subject to, at a minimum, an annual review by the RPAC. This review will focus on an analysis of major differences between the Plan's assumptions and actual experience.

e. Management will report the Plan's projected cash flow requirements to the Committee on an annual basis.

4. Review and/or Modification of Policy:

The Committee as assisted by Management and the Investment Consultant will be responsible for reviewing and modifying investment guidelines as conditions warrant, subject to approval by the Board of Directors.

5. Return and Risk Parameters:

The Committee has established the following return and risk parameters that will guide the investment of the Plan assets.

a. The Committee will review the risk tolerance and asset allocation of the Plan within the context of the expected cash flow needs and benefit obligations of the Plan.

b. The Plan will be actively invested to achieve growth of capital through appreciation of securities held and through the accumulation and reinvestment of dividend and interest income.

c. The Plan will be strategically allocated among asset classes and investment styles in order to enhance investment returns and diversify correlating risk factors. This strategic allocation must at all times be within investment policy allocation ranges.

d. The Plan is to be sufficiently diversified in order to reduce volatility.

Page 142/534 Administrative Policies and Procedures 33.00 Cash Balance Investment Policy Page 8 of 14

e. Diversification of assets may be achieved by:

-- allocating assets to multiple asset classes, -- allocating assets among various investment styles, and -- retaining multiple investment management firms with complementary investment philosophies, styles, and approaches.

f. The time horizon for evaluating total fund investment performance shall be long-term, which is understood generally to be ten-year periods. The time frame for evaluating the performance of investment managers generally will be rolling five-year periods.

6. Target Asset Allocation

a. The Target Asset Allocation represents the Plan's normal risk/reward orientation. This orientation has been determined by the Plan's ability to assume risk, the Plan's expected cash needs and the Committee’s risk preferences.

b. The Target Asset Allocation and individual asset class allocation ranges are outlined in the following table:

ASSET ALLOCATION Rebalancing ASSET CLASS Neutral Range Domestic Equities 32% 27% to 37% International Equities 18% 15% to 21% Alternatives 20% 17% to 23% Broad Fixed Income 25% 20% to 30% Cash 5% 0% to 8% Total Fund 100% ---

c. The Plan's allocations may be allowed to be outside of the Rebalancing Ranges specified above until the plan is rebalanced, which will take place at least quarterly, if necessary, and in the following circumstances on a temporary basis:

Page 143/534 Administrative Policies and Procedures 33.00 Cash Balance Investment Policy Page 9 of 14 (1) The Plan is in the process of implementing new investments within asset classes specified above to which asset classes the Plan does not currently have exposure.

(2) The Plan experiences significant inflows or outflows over a short time frame or is expected to experience significant inflows or outflows over a specified time frame.

d. Investments within "Alternatives" may include the following investments:

(1) Open-ended and closed-ended real estate investment vehicles and core, value-added and opportunistic real estate investments.

(2) Hedge fund of funds strategies that are of institutional quality and are managed by highly skilled investment professionals with robust risk management and operational due diligence processes in place. The following contractual terms are required for hedge fund of funds investments:

A. Maximum lockup – 2 years

B. Minimum liquidity/redemption period – annually after initial lockup

C. Frequency of valuation – monthly

7. Rebalancing Procedure

a. Plan assets will be monitored by Management to keep the asset allocation in line with the target asset allocations outlined in Section 6.

b. The Investment Consultant will provide rebalancing recommendations to Management and the Committee on a quarterly basis, at minimum.

c. In circumstances specified under section D.6.c. where Management and the Investment Consultant believe it to be necessary for the Plan's allocations to be temporarily outside of the Rebalancing Ranges, Management will provide a written recommendation to the Investment Sub- CommitteeSubcommitteeCommittee detailing the requested deviation from the Rebalancing Ranges and the reasons for the deviation.

8. Investment Manager Selection

a. As stated under Delegation of Responsibilities, Management appoints investment managers who will manage, acquire or dispose of the Plan Approved: 06/09 C:\utilities\distiller\temp\1DODD_QVDV6F-EF13F82DC0A80BA456200470ED3452F7.docxC:\Documents and Settings\marina_ki\Desktop\Att 2n.2 - DRAFT Cash Balance Investment Policy_33-Aug2013[[0DODD_QVDV6F- EBBAB424C0A80BAC4D75650E11C6AD97]].docxG:\CLIENT\E-412\Policy\2012\Cash Balance Investment Policy_33 00 - Final Draft.docx\\san01\users\ned_b\word\Cash Balance Investment Policy_33 00 - 032912.docx  El Camino Hospital Rev: 04/12

Page 144/534 Administrative Policies and Procedures 33.00 Cash Balance Investment Policy Page 10 of 14 assets. In selecting an investment manager, Management will use appropriate methods to exercise due diligence and to evaluate the appropriateness and merits of the investment manager. The Committee has delegated to the Investment Consultant the task of researching and recommending investment managers.

b. In investigating potential managers, the Investment Consultant must, at a minimum, use the following procedures:

(1) Identify a range of possible investment manager candidates.

(2) Obtain relevant information about the investment manager’s experience, qualifications and investment approach.

(3) Evaluate experience, qualifications and investment approach. Included in this evaluation will be an analysis of past performance, risk characteristics, and investment management fees.

(4) Document the selection process.

9. Investment Objectives

Investment objectives are necessary to properly measure and evaluate the success of the Plan's investment program.

Total return for the Plan's assets and the investment managers, is defined as interest and/or dividends plus (or minus) realized and unrealized capital gains (or losses) minus investment management fees.

a. The investment objectives of the Total Plan are as follows:

(1) Outperform the Composite Benchmark over rolling five-year periods.

A. The Composite Benchmark shall be composed of relevant indices combined in a proportion reflective of the underlying target asset allocation.

(2) Outperform the median of a composite fund manager universe over five- year periods.

b. The investment objectives of the Investment Managers are as follows:

(1) Outperform a passive, style-specific index over rolling five-year periods.

(2) Outperform the median of a style-specific peer group over rolling five-

Page 145/534 Administrative Policies and Procedures 33.00 Cash Balance Investment Policy Page 11 of 14 year periods if available.

(3) Assume a level of risk no greater than is appropriate for the investment manager's specific investment mandate.

10. Investment Restrictions

a. This section details the investment restrictions for separate account investment managers. In the case of pooled investment vehicles (mutual funds, commingled funds and limited partnerships), the investment guidelines and restrictions defined and detailed by the vehicle will apply. Management and the Investment Consultant are responsible for the review of such guidelines and restrictions prior to investment.

b. The purchase of the securities of companies described below is prohibited; however, as specified in section 10.a., this prohibition is waived in the case of pooled investment vehicles. For the purposes of this section, Investment Managers are expected to rely upon a list of companies engaged in such activities as provided by the Investment Consultant, who will provide such a list on a best efforts basis. In instances where companies that engage in the activities below are inadvertently purchased or held by an Investment Manager, the Investment Manager will divest of the security within 90 days of being made aware of the violation unless the Investment Manager receives a written exception to this section of the investment policy from the Investment SubcommitteeCommittee.

(1) Companies whose major product is tobacco (greater than 50% of company revenues). is prohibited; however, as specified in section 10.a., this prohibition is waived in the case of pooled investment vehicles.

(1)(2) Companies who engage in the manufacture of firearms that are illegal for sale to or possession by civilians in the state of California.

b.c. Equity Manager Guidelines

(1) The domestic and international equity segments may be diversified across a spectrum of market capitalizations by allowing investments in small-, medium-, and large-capitalization stocks.

(2) Unless specified otherwise in writing, equity holdings should be readily marketable and diversified by issuer, industry, and sector.

(3) An individual security position may not exceed 10% of an equity manager's portfolio market value.

Page 146/534 Administrative Policies and Procedures 33.00 Cash Balance Investment Policy Page 12 of 14 (4) Investments in money market instruments and bonds, as a surrogate for cash reserves, are allowed subject to a maximum of 10% of total allocation.

(5) Investments in options, futures and other derivatives are allowed only for hedging purposes or as a substitute for actual securities in cases where the derivative instrument is a more efficient means of gaining exposure to the underlying securities. Derivatives may not be used in a speculative manner or to leverage the portfolios.

c.d. Fixed Income Manager Guidelines

(1) Fixed income holdings should be readily marketable and diversified by issuer, sector, coupon and quality.

(2) No more than 5% of the Investment Manager's bond portfolio at the time of purchase shall be invested in the securities of any one issuer. There shall, however, be no such limit on U.S. Government securities, U.S. Agency securities, or government sponsored entities, U.S Agency mortgage backed securities, or other sovereign issues rated “AAA” or “Aaa”.

(3) For managers benchmarked against the Barclays Capital U.S. Aggregate Bond Index, up to 20% of the portfolio’s market value at the time of purchase may be invested in high yield debt. For split-rated securities, the higher rating will be used in determining compliance with these guidelines.

(4) For managers benchmarked against the Barclays Capital U.S. Aggregate Bond Index, emerging markets debt shall be limited to no more than 15% of the portfolio's market value at the time of purchase.

(5) For managers benchmarked against the Barclays Capital U.S. Aggregate Bond Index, exposure to non-U.S. dollar assets shall be limited to no more than 20% of the portfolio's market value at the time of purchase.

(6) The portfolio’s weighted average effective duration determines a bond portfolio’s sensitivity to interest rate changes. A manager’s market value weighted effective duration, adjusted for expected life and call provision, cannot be more than +/- 30% of the benchmark’s effective duration.

(7) Permissible Holdings include the following:

A. Debt securities issued or guaranteed by the United States or U.S.

Page 147/534 Administrative Policies and Procedures 33.00 Cash Balance Investment Policy Page 13 of 14 government sponsored entities (including U.S. Government sponsored Agency mortgage backed securities, and inflation linked bonds).

B. Non-agency and commercial mortgage-backed securities, including collateralized mortgage obligations and whole loans.

C. Corporate bonds, debentures and other forms of corporate debt obligations, including equipment trust certificates, Eurobonds, Insurance Surplus Notes, and Capital Securities.

D. Municipal securities (up to 20% of the portfolio).

E. Asset-backed securities.

F. Indexed notes, floaters, and other variable rate obligations.

G. 144A securities without registration rights (up to 20% of the portfolio).

H. Bank collective funds.

I. Certificates of deposit (“CD’s”) and other money market instruments from banks also issuing bankers acceptances and with current commercial paper ratings of at least A 1 (by Standard & Poor's) or P 1 (by Moody's Investors Service).

J. Mutual funds or commingled pools.

K. U.S. dollar-denominated sovereign, supranational, provincial, and municipal securities issued by foreign entities.

L. Non-U.S. dollar-denominated sovereign securities.

M. On a temporary basis, securities received in exchange offers or other similar situations (subject to approval by the Committee after notification by the investment manager of the receipt of such securities).

N. Hedging with futures contracts and options on futures contracts are permitted to offset price risks (which include interest rates, currency fluctuations and the general price level of certain financial markets) incidental to the portfolio’s principal mandate. Transactions in futures contracts and options on futures contracts are restricted to those contracts that are substitutes for assets that the portfolio could

Page 148/534 Administrative Policies and Procedures 33.00 Cash Balance Investment Policy Page 14 of 14 own, and that are economically appropriate to the reduction of risks in the conduct/management of the portfolio. In no way will futures or options on futures be used to leverage the portfolio.

d.e. Exceptions to these restrictions may only be made upon prior approval of the Committee.

Page 149/534 Separator Page

Att 2o - DRAFT Surplus Cash Investment Policy_16- Aug2013.docx

Page 150/534

EL CAMINO HOSPITAL ADMINISTRATIVE POLICIES AND PROCEDURES

16.00 SURPLUS CASH INVESTMENT POLICY

A. Coverage:

El Camino Hospital Surplus Cash

B. Reviewed/Revised

6/98, 11/00, 6/01, 9/02, 1/04, 3/05, 5/06, 06/09, 05/12, 06/13

C. Policy Summary

It is the policy of the El Camino Hospital Board of Directors that cash funds of El Camino Hospital, El Camino Hospital Foundation, CONCERN:EAP, and other affiliates be prudently invested with a focus on preserving the liquidity and principal necessary to meet known and reasonably unforeseen operational and capital needs. Funds will be invested in a diversified portfolio that balances the need for liquidity with a long-term investment focus in order to improve investment returns and the organization's financial strength.

D. Policy

1. Objectives and Purpose

a. The policy will be to invest the Surplus Cash assets in a diversified investment portfolio that targets capital appreciation without assuming undue risk to principal. The primary objectives of the overall Surplus Cash pool shall be (1) preservation of capital, (2) capital growth, (3) maintenance of liquidity, and (4) avoidance of inappropriate concentration of investments.

b. The assets subject to this Investment Policy include the commingled funds of the Hospital, Foundation, CONCERN, and the El Camino Hospital Foundation Gift Annuity Fund.

c. The El Camino Hospital Foundation Gift Annuity Fund is also managed according to the following restrictions: investments shall be managed in a diversified and prudent manner and in compliance with and subject to the criteria set forth under California Insurance Code Section (CICS) 1192.9, including Section 11521.2 to 11521.3.

Approved: 06/09 C:\utilities\distiller\temp\1DODD_QVDV6F-EF196A19C0A80BA456200470A2D48793.docxC:\Documents and Settings\marina_ki\Desktop\Att 2o - DRAFT Surplus Cash Investment Policy_16-Aug2013[[0DODD_QVDV6F- EBBAB502C0A80BAC4D75650EFA443332]].docxG:\CLIENT\E-412\Policy\2012\Surplus Cash Investment Policy_16 00 - Final Draft.docxC:\Users\Antonio.DiCosola\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\F3S311TR\Surplus Cash Investment Policy_16 00 - 030212 V3.docx  El Camino Hospital Rev: 03/12

Page 151/534 Administrative Policies and Procedures 16.00 Surplus Cash Investment Policy Page 2 of 13

2. Delegation of Responsibility

a. Within the financial activities of the organization, it is necessary to provide a prudent framework for the regular supervision of the management of invested funds. The Board of Directors ("the Board") has the overall fiduciary responsibility for the Surplus Cash assets. The Board shall appoint an Investment SubcommitteeCommittee of the Finance Committee ("the Committee") that bears primary responsibility as detailed in section 2.d. below for oversight of El Camino Hospital management ("Management"), the independent Investment Consultant, and the overall Surplus Cash investment program. The Board shall delegate the specific management of the Surplus Cash pool's investments to Management as detailed in section 2.e. below.

b. Management shall be defined as the Chief Executive Officer, the Chief Financial Officer, Controller, and Finance Director.

c. Those authorized to execute transactions include the Chief Executive Officer, Chief Financial Officer, Controller, and investment advisor(s) approved by Management.

d. Responsibilities of the Investment SubcommitteeCommittee of the Finance Committee e.d. (1) Establish and recommend revisions to the investment policy, as appropriate.

(2) Review compliance with policy.

(3) Approve allocations across investment styles and investment managers that are consistent with this investment policy.

(4) Assure that implementation of each investment program is consistent with its overall investment objectives and risk tolerances.

(5) Monitor performance of investment managers through reports provided by the Investment Consultant.

f.e. Responsibilities of Management

(1) Select, contract with, and when appropriate, terminate investment managers who manage the investment programs’ assets.

Page 152/534 Administrative Policies and Procedures 16.00 Surplus Cash Investment Policy Page 3 of 13 (2) Evaluate the investment performance objectives of each of the investment programs’ investment managers.

(3) Select, contract with, and when appropriate, terminate custodian banks/brokers that are responsible for the custody of the investment programs’ assets.

(4) Select, contract with, and when appropriate, terminate an investment consultant.

(5) Provide each investment manager with specific investment objectives and guidelines consistent with overall objectives.

(6) Determine and implement allocations across investment styles and investment managers that are consistent with this investment policy.

(7) Oversee the operational investment activities of the funds subject to this investment policy and other operating procedures and policies of El Camino Hospital.

(8) Work with the independent, external Investment Consultant in developing and/or reviewing investment recommendations for presentation to the Committee and Board.

g.f. Responsibilities of the independent Investment Consultant

(1) Review the Surplus Cash pool’s investment policies and objectives and suggest appropriate changes.

(2) Monitor long-term capital market trends and recommend appropriate asset allocation strategies to Management and the Committee.

(3) Provide Management and the Committee with ongoing asset allocation, investment manager allocation recommendations, and total portfolio context.

(4) Provide assistance concerning the allocation of new contributions as well as periodic asset allocation rebalancing.

(4)(5) On an annual basis, provide to the Surplus Cash pool’s Investment Managers a list of securities that are prohibited by the Surplus Cash pool’s investment policy under section 10.b.

(5)(6) Recommend which investment management firms should receive

Page 153/534 Administrative Policies and Procedures 16.00 Surplus Cash Investment Policy Page 4 of 13 increased or decreased allocations and, when warranted, recommend firms that should be dismissed.

(6)(7) Research and recommend investment management firms and custodian(s) appropriate to implement the Surplus Cash pool’s investment policies and objectives.

(7)(8) Measure, evaluate, and report each investment manager’s performance on a quarterly basis.

(8)(9) Monitor adherence of each investment manager to its stated investment philosophy and style.

(9)(10) Monitor each investment manager's adherence to the guidelines and investment policies contained in this Investment Policy and specific manager guidelines, if applicable.

(11)(12) Communicate promptly with the Management and the Committee regarding significant changes in the Investment Consultant’s ownership, organizational structure, and professional staffing.

(12)(13) Communicate promptly to the Committee any financial arrangements between the Investment Consultant and money management firms.

h.g. Responsibilities of the Custodian Bank as directed by Management

(1) Provide complete and accurate accounting records and prompt monthly reports to reflect all transactions, cash flows, and assets held.

(2) Disburse and receive cash flows and investments as directed by investment managers to the extent of their authority or by authorized Management.

(3) Issue monthly reports of holdings and transactions priced in accordance with industry standards.

(4) Provide monthly reports showing individual asset holdings with Approved: 06/09 C:\utilities\distiller\temp\1DODD_QVDV6F-EF196A19C0A80BA456200470A2D48793.docxC:\Documents and Settings\marina_ki\Desktop\Att 2o - DRAFT Surplus Cash Investment Policy_16-Aug2013[[0DODD_QVDV6F- EBBAB502C0A80BAC4D75650EFA443332]].docxG:\CLIENT\E-412\Policy\2012\Surplus Cash Investment Policy_16 00 - Final Draft.docxC:\Users\Antonio.DiCosola\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\F3S311TR\Surplus Cash Investment Policy_16 00 - 030212 V3.docx  El Camino Hospital Rev: 03/12

Page 154/534 Administrative Policies and Procedures 16.00 Surplus Cash Investment Policy Page 5 of 13 sufficient descriptive detail to include units, unit price cost, market value, CUSIP number (where available) and any other information requested by the direction of Management. Principal cash transactions, including dividends, interest and principal payments received, deposits and withdrawals, securities purchased, sold, and matured, and fee payments will also be listed.

(5) Expeditiously transfer funds into and out of specified accounts.

(6) Promptly forward all proxy materials received to the appropriate investment manager or Management.

i.h. Responsibilities of the Investment Managers

(1) Manage the portfolio’s assets with full discretion, in accordance with the investment objectives and guidelines stated in this Investment Policy and specific investment manager guidelines.

(2) Communicate promptly with Management and the Investment Consultant regarding all significant matters such as: -- major changes in the investment manager’s investment outlook and strategy, -- shifts in portfolio construction (asset mix, sector emphasis, etc.), -- changes in the investment manager’s ownership, organizational structure, or professional staffing (additions and departures), and -- other changes of a substantive nature.

(3) Comply with all laws and regulations that involve the Surplus Cash pool as they pertain to the investment manager’s duties, functions, and responsibilities as a fiduciary.

(4) Vote the proxies on the securities held in the investment manager’s portfolio in accordance with the manager’s fiduciary duties and professional judgment.

(5) Provide Management and the Investment Consultant with monthly performance and organizational updates and other information as requested.

(6) Provide periodic presentations to the Investment SubcommitteeCommittee of the Finance Committee as requested.

3. Reporting and Evaluation Process:

Page 155/534 Administrative Policies and Procedures 16.00 Surplus Cash Investment Policy Page 6 of 13 a. Management and the Investment Consultant will be responsible for reporting the status of investments to the Committee on a regular basis.

b. Annual reports by Management should include a complete listing of securities held and must be verified (audited) by the District’s auditors.

c. On a quarterly basis, the Committee will evaluate investment performance. The following will be reviewed:

(1) The Surplus Cash pool's asset allocation relative to the target asset allocation.

(2) The total fund, segment and investment manager returns relative to the stated investment objectives.

(3) Other items pertaining to Surplus Cash pool.

(4) Management will provide minutes of each meeting to the Committee.

4. Review and/or Modification of Policy:

a. The Committee as assisted by Management and the Investment Consultant will be responsible for reviewing and modifying investment guidelines as conditions warrant, subject to approval by the Board of Directors.

b. A copy of this policy will be rendered to the Board of Directors annually.

5. Return and Risk Parameters:

The Committee has established the following return and risk parameters that will guide the investment of the Surplus Cash assets.

a. The Committee will review the risk tolerance of the Surplus Cash pool’s assets within the context of El Camino’s long-term financial plan.

b. The Surplus Cash pool will be actively invested to achieve growth of capital through appreciation of securities held and through the accumulation and reinvestment of dividend and interest income.

c. The Surplus Cash pool will be strategically allocated among asset classes and investment styles in order to enhance investment returns and diversify correlating risk factors. This strategic allocation must at all times be within investment policy allocation ranges.

Page 156/534 Administrative Policies and Procedures 16.00 Surplus Cash Investment Policy Page 7 of 13 d. The Surplus Cash pool is to be sufficiently diversified in order to reduce volatility.

e. Diversification of assets may be achieved by:

f. The time horizon for evaluating total fund investment performance shall be long-term. The time frame for evaluating the performance of investment managers generally will be rolling five-year periods.

6. Target Asset Allocation

a. The Target Asset Allocation represents the Surplus Cash pool's normal risk/reward orientation. This orientation has been determined by the Surplus Cash pool's ability to assume risk and the Committee’s risk preferences.

b. The Target Asset Allocation and individual asset class allocation ranges are outlined in the following table:

ASSET ALLOCATION ASSET CLASS Neutral Range

Domestic Equities 20% 17% to 23%

International Equities 10% 8% to 12% Alternatives 20% 17% to 23%

Broad Fixed Income 40% 35% to 45%

Short Term Fixed Income 10% 8% to 12% Total Fund 100% ---

Page 157/534 Administrative Policies and Procedures 16.00 Surplus Cash Investment Policy Page 8 of 13 c. The Plan's allocations may be allowed to be outside of the Rebalancing Ranges specified above until the Plan is rebalanced, which will take place at least quarterly, if necessary, and in the following circumstances on a temporary basis:

(1) The Plan is in the process of implementing new investments within asset classes specified above to which asset classes the Plan does not currently have exposure.

(2) The Plan experiences significant inflows or outflows over a short time frame or is expected to experience significant inflows or outflows over a specified time frame.

d. Investments within "Alternatives" may include the following investments:

(1) Open-ended and closed-ended real estate investment vehicles and core, value-added and opportunistic real estate investments.

A. Maximum lockup – 2 years

B. Minimum liquidity/redemption period – annually after initial lockup

C. Frequency of valuation – monthly

7. Rebalancing Procedure

a. Surplus Cash pool assets will be monitored by Management to keep the asset allocation in line with the target asset allocations outlined in Section 6.

b. The Investment Consultant will provide rebalancing recommendations to Management and the Committee on a quarterly basis, at minimum.

Page 158/534 Administrative Policies and Procedures 16.00 Surplus Cash Investment Policy Page 9 of 13 detailing the requested deviation from the Rebalancing Ranges and the reasons for the deviation.

8. Investment Manager Selection

a. As stated under Delegation of Responsibilities, Management appoints investment managers who will manage, acquire or dispose of the Surplus Cash assets. In selecting an investment manager, Management will use appropriate methods to exercise due diligence and to evaluate the appropriateness and merits of the investment manager. Management has delegated to the Investment Consultant the task of researching and recommending investment managers.

b. In investigating potential managers, the Investment Consultant must, at a minimum, use the following procedures:

(1) Identify a range of possible investment manager candidates.

(2) Obtain relevant information about the investment manager’s experience, qualifications and investment approach.

(3) Evaluate experience, qualifications and investment approach. Included in this evaluation will be an analysis of past performance, risk characteristics, and investment management fees.

(4) Document the selection process.

9. Investment Objectives

Investment objectives are necessary to properly measure and evaluate the success of the Surplus Cash pool's investment program.

Total return for the Surplus Cash pool's assets and the investment managers, is defined as interest and/or dividends plus (or minus) realized and unrealized capital gains (or losses) minus investment management fees.

a. The investment objectives of the Total Surplus Cash Pool are as follows:

(1) Outperform the Composite Benchmark over rolling five-year periods.

A. The Composite Benchmark shall be composed of relevant indices combined in a proportion reflective of the underlying target asset allocation.

Page 159/534 Administrative Policies and Procedures 16.00 Surplus Cash Investment Policy Page 10 of 13 (2) Outperform the median of a composite fund manager universe over five- year periods.

b. The investment objectives of the Investment Managers are as follows:

(1) Outperform a passive, style-specific index over rolling five-year periods.

(2) Outperform the median of a style-specific peer group over rolling five- year periods if available.

(3) Assume a level of risk no greater than is appropriate for the investment manager's specific investment mandate.

10. Investment Restrictions

(1) Companies whose major product is tobacco (greater than 50% of company revenues).

(2) Companies who engage in the manufacture of firearms that are illegal for sale to or possession by civilians in the state of California. b. The purchase of securities whose major product is tobacco (greater than 50% of company revenues) is prohibited; when the fund is a mutual fund or pooled vehicle, such prohibition is waived.

c. Equity Manager Guidelines

Page 160/534 Administrative Policies and Procedures 16.00 Surplus Cash Investment Policy Page 11 of 13

(1) The domestic and international equity segments may be diversified across a spectrum of market capitalizations by allowing investments in small-, medium-, and large-capitalization stocks.

(2) Unless specified otherwise in writing, equity holdings should be readily marketable and diversified by issuer, industry, and sector.

(3) An individual security position may not exceed 10% of an equity manager's portfolio market value.

(4) Investments in money market instruments and bonds, as a surrogate for cash reserves, are allowed subject to a maximum of 10% of total allocation.

d. Fixed Income Manager Guidelines

(1) Fixed income holdings should be readily marketable and diversified by issuer, sector, coupon and quality.

(3) For managers benchmarked against the Barclays Capital U.S. Aggregate Bond Index, the average credit quality of the fixed income portfolio shall be “A-” or higher. Up to 15% of the portfolio’s market value at the time of purchase may be invested in high yield debt. For split-rated securities, the higher rating will be used in determining compliance with these guidelines.

Page 161/534 Administrative Policies and Procedures 16.00 Surplus Cash Investment Policy Page 12 of 13 (5) For managers benchmarked against the Barclays Capital U.S. Aggregate Bond Index, exposure to non-U.S. dollar assets shall be limited to no more than 20% of the portfolio's market value at the time of purchase.

(7) Permissible Holdings include the following:

A. Debt securities issued or guaranteed by the United States or U.S. government sponsored entities (including U.S. Government sponsored Agency mortgage backed securities, and inflation linked bonds).

B. Non-agency and commercial mortgage-backed securities, including collateralized mortgage obligations and whole loans.

C. Corporate bonds, debentures and other forms of corporate debt obligations, including equipment trust certificates, Eurobonds, Insurance Surplus Notes, and Capital Securities.

D. Municipal securities (up to 20% of the portfolio).

E. Asset-backed securities.

F. Indexed notes, floaters, and other variable rate obligations.

G. 144A securities without registration rights (up to 20% of the portfolio).

H. Bank collective funds.

J. Mutual funds or commingled pools.

K. U.S. dollar-denominated sovereign, supranational, provincial, and municipal securities issued by foreign entities.

Page 162/534 Administrative Policies and Procedures 16.00 Surplus Cash Investment Policy Page 13 of 13 L. Non-U.S. dollar-denominated sovereign securities.

M. Hedging with futures contracts and options on futures contracts are permitted to offset price risks (which include interest rates, currency fluctuations and the general price level of certain financial markets) incidental to the portfolio’s principal mandate. Transactions in futures contracts and options on futures contracts are restricted to those contracts that are substitutes for assets that the portfolio could own, and that are economically appropriate to the reduction of risks in the conduct/management of the portfolio. In no way will futures or options on futures be used to leverage the portfolio.

(8) Exceptions to these restrictions may only be made upon prior approval of the Committee.

Page 163/534 Separator Page

Att 2p - Board Open Session 09-11-13.pdf

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Att 2q - LG IT Post Activation Review.pdf

Page 202/534

Date: September 11, 2013

To: EL Camino Hospital Board of Directors

From: Greg Walton, CIO

Subject: Post Activation Summary- Los Gatos Voice over Internet Protocol Implementation

Attached is an IT Project Post Activation Review for the Los Gatos VoIP Implementation which was initiated in FY 2013.

Items of note include:

* Generally the goal was to replace an unsupported, isolated phone switch with a Voice over Internet solution fully integrated into the ECH enterprise solution. This was accomplished.

* The project was budgeted at $1,079,640 and spending to date is approximately $100,000 below budget. We do not anticipate exceeding the original budget as the project is now closed.

*The expected timing for several milestones was exceeded by one to four months due to unexpected complexities and vendor staff changes.

* 13 of 14 deliverables are completed. One was cancelled.

Overall, Information Services management is satisfied with the products and outcome and we have also confirmed Los Gatos executive leadership and staff satisfaction.

Page 203/534 Separator Page

Att 2q.2 - ECH Post-Activation Summary Doc 2.DOCX

Page 204/534

IT Project Post Activation Review Los Gatos VoIP (Voice over Internet Protocol) Implementation

April 26, 2013

Board Authorization Date: 5/9/2012 Vendor: Bear Data Solutions; Amcom Software; Vocera

Requesting Department: IS Technical Services Budget Amount: $1,079,640 Project Sponsor: Greg Walton, CIO Capital ID#: 12-0206, 12-0138, 12-0050

Project Team:

ROLE NAME TITLE Executive Sponsor Greg Walton Chief Information Officer Executive Sponsor Pat Wolfram Vice President ECH-Los Gatos IT Sponsor Kristy Ikerd Former Director of Information Services Technical Manager James Brummett Director of IS Technical Services Telecom / Project Lead Qing Liu Telecom Engineer III

Problem/Opportunity Definition: (Problem statement, business case)

El Camino Hospital Los Gatos used a legacy Nortel phone and voicemail system that had reached end-of-life and was no longer under manufacturer support. Replacement phones, modules, and other components were becoming scarce and more costly in the marketplace. Functionality with the existing solution was limited and did not provide common features such as call center or reporting to support the needs of departments and tenants. In addition, there was no Vocera integration as it was not supported by the legacy phone system. This project replaced the Nortel Option 81C system by utilizing the LG data network and leveraged the existing voice infrastructure in Mountain View. It included utilizing the existing E911 Emergency Responder solution implemented for MV in 2011. By leveraging the MV infrastructure, total cost was reduced over a completely standalone phone system and additional redundancy was provided over the wide area network to both campuses.

Outcomes, Deliverables, and Milestones: (project goals, achievement/accomplishment status)

DELIVERABLE OUTCOME STATUS MV - Upgrade the Unified Upgraded UCM and UCCX to the latest versions to support Mountain Completed Communications Manager View. Added new nodes for LG to leverage the existing MV voice (UCM) cluster and Unified infrastructure and provided additional redundancy over the wide area Contact Center Express network to both campuses. (UCCX) cluster MV - Upgrade Amcom Intellidesk server and all operators’ consoles were upgraded. Completed Intellidesk system & Operator Consoles 1DODD_QVDV6F-EBBABD89C0A80BAC4D75650E8F648274.DocxECH Post-Activation Review - LG VoIP Implementation.Docx Page 1 of 4 Page 205/534

IT Project Post Activation Review Los Gatos VoIP (Voice over Internet Protocol) Implementation

April 26, 2013

MV - Replace the Unity Replaced previous Unity voicemail system in MV with Unity Connection Completed Voicemail system with Unity and expanded to provide new voicemail service in LG. Connection MV - Vocera SIP telephony Vocera SIP telephony integration was implemented which provides Completed conversion better performance and scalability. MV – Dial plan adjustments Overlapping extensions are allowed between the two campuses. All Completed existing LG phone numbers and extensions were maintained to lessen the amount of change for the users. LG – Facility: power and Power improvements and cabling needs were met by an outside Completed cabling updates contractor with assistance provided by Facilities. LG – Equipment staging, LG users, directories, auto attendants, a new operator call center, Completed provisioning and testing E911(enhanced 911) locations and both internal and external call routing were created and tested. LG – New phone installation Parallel phone installation provided users the ability to become familiar Completed with the new handsets and set up their voicemail accounts before having to switch over and have their old phone removed. LG – End user training Partnered with the Education Department to provided end user Completed instructions, education, and communication. LG – Install Intellidesk Amcom provided on-site installation of new Intellidesk consoles to Completed consoles & operator training replace the Nortel solution, and added LG directories to the database. LG – Vocera SIP telephony Implemented Vocera SIP telephone integration in LG to allow badge-to- Completed Integration phone as well as phone-to-badge calling. LG – Remove and recycle all Cleaned up the MPOE closet that previously housed the Nortel PBX. Completed existing Nortel components

Exceptions, Exclusions, and Mitigations: (incomplete items, plans to address)

DELIVERABLE OUTCOME STATUS Amcom Intellidesk operator Due to the change in the caller ID fields (Cisco Unified Communications Work In Progress console pop-up for answering Manager software) and the lack of Cisco certification and testing on the services Intellidesk console software, some answering services calls are not showing pop-up windows for the operators. Amcom remains committed to resolve the issue. Extension Mobility for the Amcom Intellidesk does not support Extension Mobility when Cancelled operators to simplify login interoperating with Cisco telephony systems. Researching additional process and track individual options to potentially pursue at a later date to provide this feature. performance

1DODD_QVDV6F-EBBABD89C0A80BAC4D75650E8F648274.DocxECH Post-Activation Review - LG VoIP Implementation.Docx Page 2 of 4 Page 206/534

IT Project Post Activation Review Los Gatos VoIP (Voice over Internet Protocol) Implementation

April 26, 2013

Project Schedule: (Planned Vs. Actual)

SCHEDULED GO ACTUAL GO LIVE COMMENTS MILESTONE/MODULES LIVE MV: UCM , UCCX and Original date was adjusted due to complexity of Amcom Intellidesk June 2012 July 2012 the changes being made to these systems and the upgrade change of project managers Original date was adjusted due to complexity of LG: Facilities build July 2012 August 2012 completion the changes and OSHPD approval Activation date was adjusted due to the schedule MV: Vocera SIP July 2012 September 2012 upgrade change in pre-requisite activities MV: Voicemail Activation date was adjusted due to vendor staff July 2012 November 2012 platform migration to changes Unity Connections Activation date was adjusted due to vendor staff MV: Dial plan August 2011 December 2012 adjustment changes and the complexity of the change Original date was adjusted due to the schedule LG: Staging & other July 2012 December 2012 preparations changes in MV Activation date was adjusted due to the schedule LG: Installation, user September January 2013 changes in the pre-requisite activities and holiday training, Cutover and 2013 Vocera integration change freeze

Financial Review: (overall budget vs. actual, explanations of differences)

APPROVED DESCRIPTION ACTUAL VARIANCE BUDGET Capital Budget 12-0206: “Telecom – Los Gatos VoIP $ 710,125.00 $ 666,658.61 $ 43,466.40 Implementation” Capital Budget 12-0138: “Software – Existing Software Upgrades & $ 220,537.00 $ 188,337.98 $ 32,199.02 Replacements” Capital Budget 12-0050: “Telecom – Baseline $ 148,978.00 $ 128,694.92 $ 24,283.08 Replacements” Totals $ 1,079,640.00 $ 979,691.51 $ 99,948.49

1DODD_QVDV6F-EBBABD89C0A80BAC4D75650E8F648274.DocxECH Post-Activation Review - LG VoIP Implementation.Docx Page 3 of 4 Page 207/534

IT Project Post Activation Review Los Gatos VoIP (Voice over Internet Protocol) Implementation

April 26, 2013

Future Plans: (anticipated future activities, projects; timeline if known)

DELIVERABLE EXPECTED OUTCOME TARGET Add LG directory Call reporting and billing will be available for LG departments and tenants. July 2013 numbers to ISI database Amcom Intellidesk pop- Address the pop-up issues July 2013 up fixes

1DODD_QVDV6F-EBBABD89C0A80BAC4D75650E8F648274.DocxECH Post-Activation Review - LG VoIP Implementation.Docx Page 4 of 4 Page 208/534 Separator Page

Att 2r - MRK_Board and Finance Committee FY14 Period 1 for distribution.pptx

Page 209/534

Summary of Financial Operations

Fiscal Year 2014 – Period 1 7/1/2013 to 7/31/2013

Page 210/534 Page 211/534 2 (1) Hospital entity only, excludes controlled affiliates (1) Management Commentary

Budget is represented by solid lines; Bars represent actual results

Net Days in AR Net days in A/R, while still favorable to goal, increased for the third straight month, coming in at 47.7 days for the first period of the new fiscal year. Net outstanding receivables increased $1.6 million in July. For the most recent 12-month period, A/R days averaged 49.0 or 1 day favorable to the 50-day target.

CMI Adjusted Discharges Although Case Mix was 1% below budget in July and discharges were 0.4% short, outpatient activity that was 8% above budget more than offset the shortfall resulting in CMI Adjusted Discharges which were 3% favorable to budget.

Operating Margin Although July’s gross charges were $3.2 million favorable to budget, an unfavorable payer mix provided a $2.8 million unfavorable variance in revenue deductions. In addition, other operating revenues $146 thousand unfavorable to budget. Expenses were well-controlled, coming in 1.5% favorable to budget, in spite of the increased gross charges. Consequently, hospital operations were $927 thousand 17% favorable to budget. Very strong investment performance in July provided a $9.3m favorable budget variance in non-operating income and total income which was $10.3 million favorable to budget.

Page 212/534 3 (1) Hospital entity only, excludes controlled affiliates Key Hospital Indicators(1)

Statistic FYE 2011 FYE 2012 FYE 2013 FYTD 2014 Target (2) +/- Operating Margin 7.9% 10.5% 9.9% 10.4% 8.9%

EBITDA Margin 16.6% 19.4% 17.8% 18.2% 17.1%

Days of Cash 250 321 350 361 278

Debt Service Coverage Ratio (MADS) 7.5 7.2 7.9 8.4 5.1

Debt to Capitalization 17.1% 15.8% 14.0% 13.7% 26.8%

Net AR Days 48.6 48.1 48.3 47.7 49.7

(1) Hospital Only - Excludes Affiliates (2) Target source: FYTD Budget for Operating Margin and EBITDA Margin Target source: S&P 2012 A+ Rated Hospital Medians for all others *Prior Year numbers represent full year

Page 213/534 4 (1) Hospital entity only, excludes controlled affiliates El Camino Hospital Financial Metrics Trend (1)

1.1% P Favorable to Budget r o f I t _ L o s s

8 Days Favorable to B Budget A L Represents _ cash of $580 million S H E E T

Page 214/534 5 (1) Hospital entity only, excludes controlled affiliates (1) ECH Operating Margin

Run rate is booked operating income adjusted for material non-recurring transactions

Page 215/534 6 (1) Hospital entity only, excludes controlled affiliates ECH Volume Statistics (1)

MOUNTAIN VIEW Month of Jul, 2013 Year to Date Prior Year Act Bud Var% Act Bud Var% Act Var% Discharges (2) 1,234 1,270 -2.8% 1,234 1,270 -2.8% 1,265 -2.5% ADC (2) 173 179 -3.4% 173 179 -3.4% 173 -0.2% Deliveries 386 343 12.4% 386 343 12.4% 423 -8.7% ED Visits 3,787 3,545 6.8% 3,787 3,545 6.8% 3,460 9.5% Surgical Cases 556 536 3.7% 556 536 3.7% 482 15.4%

LOS GATOS Month of Jul, 2013 Year to Date Prior Year Act Bud Var Act Bud Var Act Var% Discharges (2) 302 272 11.2% 302 272 11.2% 301 0.3% ADC (2) 48 39 23.3% 48 39 23.3% 41 18.5% Deliveries 64 61 4.4% 64 61 4.4% 64 0.0% ED Visits 1,121 924 21.3% 1,121 924 21.3% 983 14.0% Surgical Cases 364 316 15.2% 364 316 15.2% 367 -0.8% ECH Month of Jul, 2013 Year to Date Prior Year Act Bud Var Act Bud Var Act Var% Discharges (2) 1,536 1,541 -0.4% 1,536 1,541 -0.4% 1,566 -1.9% ADC (2) 221 218 1.4% 221 218 1.4% 214 3.4% Deliveries 450 405 11.2% 450 405 11.2% 487 -7.6% ED Visits 4,908 4,469 9.8% 4,908 4,469 9.8% 4,443 10.5% Surgical Cases 920 852 7.9% 920 852 7.9% 849 8.4%

(1) Hospital entity only, excludes controlled affiliates Page 216/534 (2) Excludes normal newborns (MS-DRG 795) 7 El Camino Hospital Volume Trends Prior and Current Fiscal Years

Page 217/534 8 APPENDIX

Page 218/534 9 Summary of Financial Results (1) $ in Thousands

Period 1 - Month Period 1 - FYTD Actual Budget Variance Actual Budget Variance El Camino Hospital Income(Loss) from Operations Mountain View (1) 4,450 4,482 (33) 4,450 4,482 (33) Los Gatos (1) 1,808 848 960 1,808 848 960 Sub Total - El Camino Hospital (1) 6,257 5,330 927 6,257 5,330 927 Operating Margin % 10.4% 8.9% 10.4% 8.9% El Camino Hospital Non Operating Income Investments ** 10,815 2,012 8,803 10,815 2,012 8,803 Swap Adjustments 499 0 499 499 0 499 Community Benefit (180) 0 (180) (180) 0 (180) Other (141) (351) 211 (141) (351) 211 Sub Total - Non Operating Income 10,994 1,660 9,333 10,994 1,660 9,333 El Camino Hospital Net Income (Loss) 17,251 6,990 10,261 17,251 6,990 10,261 ECH Net Margin % 28.7% 11.6% 28.7% 11.6% Net Income All Other Hospital Affiliates 1,744 1,153 591 1,744 1,153 591

Total Net Income Hospital & Affiliates 18,995 8,143 10,851 18,995 8,143 10,851

1 Page 219/534 10 (1) Hospital entity only, excludes controlled affiliates Worked Hours per CMI Adjusted Discharge (1)

Page 220/534 11 (1) Hospital entity only, excludes controlled affiliates Supply Cost per CMI Adjusted Discharges (1)

YTD: 11.1% under budget YTD: 7.4% under budget Mountain View Los Gatos

Page 221/534 12 (1) Hospital entity only, excludes controlled affiliates (1) Mountain View LOS & CMI Trend

(1) Hospital entity only, excludes controlled affiliates Page 222/534 All data excludes normal newborns (MS-DRG=795), Medicare data excludes Medicare HMOs and PPOs 13 (1) Los Gatos LOS & CMI Trend

(1) Hospital entity only, excludes controlled affiliates Page 223/534 All data excludes normal newborns (MS-DRG=795), Medicare data excludes Medicare HMOs and PPOs 14 El Camino Hospital (1) Results from Operations vs. Prior Year 1 month ending 7/31/2013

Variance $000s FY 2014 FY 2013 Fav (Unfav) Var% OPERATING REVENUE: Gross Revenue 201,253 198,881 2,372 1.2% Deductions (142,382) (143,288) 906 0.6% Net Patient Revenue 58,871 55,593 3,278 5.9% Other Operating Revenue 1,225 1,398 (173) -12.4% Total Operating Revenue 60,096 56,991 3,105 5.4%

OPERATING EXPENSE: Salaries & Wages 31,898 28,302 (3,596) -12.7% Supplies 7,933 9,412 1,479 15.7% Fees & Purchased Services 6,670 7,034 364 5.2% Other Operating Expense 7,339 6,356 (983) -15.5% Total Operating Expense 53,839 51,104 (2,736) -5.4% Net Operating Income/(Loss) 6,257 5,888 369 6.3% Non Operating Income 10,994 3,430 7,564 220.5% Net Income(Loss) 17,251 9,318 7,933 85.1%

Collection Rate 29.3% 28.0% 1.3% Operating Margin 10.4% 10.3% 0.1% Net Margin 28.7% 16.3% 12.4%

Page 224/534 15 (1) Hospital entity only, excludes controlled affiliates El Camino Hospital – Mountain View (1) Results from Operations vs. Prior Year 1 month ending 7/31/2013

Variance $000s FY 2014 FY 2013 Fav (Unfav) Var% OPERATING REVENUE: Gross Revenue 159,794 154,859 4,934 3.2% Deductions (112,547) (110,865) (1,682) -1.5% Net Patient Revenue 47,246 43,994 3,252 7.4% Other Operating Revenue 1,189 1,327 (138) -10.4% Total Operating Revenue 48,435 45,320 3,115 6.9%

OPERATING EXPENSE: Salaries & Wages 26,504 23,429 (3,075) -13.1% Supplies 6,289 6,744 455 6.7% Fees & Purchased Services 5,404 5,911 506 8.6% Other Operating Expense 5,788 4,800 (988) -20.6% Total Operating Expense 43,985 40,884 (3,101) -7.6% Net Operating Income/(Loss) 4,450 4,436 13 0.3% Non Operating Income 10,994 3,430 7,564 220.5% Net Income(Loss) 15,443 7,866 7,577 96.3%

Collection Rate 29.6% 28.4% 1.2% Operating Margin 9.2% 9.8% -0.6% Net Margin 31.9% 17.4% 14.5%

Page 225/534 16 (1) Hospital entity only, excludes controlled affiliates El Camino Hospital – Los Gatos1 (1) Results from Operations vs. Prior Year 1 months ending 7/31/2013

Variance $000s FY 2014 FY 2013 Fav (Unfav) Var% OPERATING REVENUE: Gross Revenue 41,460 44,022 (2,563) -5.8% Deductions (29,835) (32,423) 2,588 -8.0% Net Patient Revenue 11,625 11,599 26 0.2% Other Operating Revenue 37 72 (35) -49.1% Total Operating Revenue 11,661 11,671 (10) -0.1%

OPERATING EXPENSE: Salaries & Wages 5,394 4,873 (521) -10.7% Supplies 1,644 2,668 1,024 38.4% Fees & Purchased Services 1,265 1,123 (142) -12.7% Other Operating Expense 1,551 1,556 5 0.3% Total Operating Expense 9,854 10,220 366 3.6% Net Operating Income/(Loss) 1,808 1,452 356 24.5% Non Operating Income 0 0 0 0.0% Net Income(Loss) 1,808 1,452 356 24.5%

Collection Rate 28.0% 26.3% 1.7% Operating Margin 15.5% 12.4% 3.1% Net Margin 15.5% 12.4% 3.1%

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Variance $000s FY 2014 Budget 2014 Fav (Unfav) Var% OPERATING REVENUE: Gross Revenue 201,253 198,229 3,024 1.5% Deductions (142,382) (139,585) (2,797) -2.0% Net Patient Revenue 58,871 58,644 227 0.4% Other Operating Revenue 1,225 1,372 (146) -10.7% Total Operating Revenue 60,096 60,016 81 0.1%

OPERATING EXPENSE: Salaries & Wages 31,898 31,875 (23) -0.1% Supplies 7,933 8,594 661 7.7% Fees & Purchased Services 6,670 6,419 (251) -3.9% Other Operating Expense 7,339 7,799 460 5.9% Total Operating Expense 53,839 54,686 847 1.5% Net Operating Income/(Loss) 6,257 5,330 927 17.4% Non Operating Income 10,994 1,660 9,333 562.1% Net Income(Loss) 17,251 6,990 10,261 146.8%

Collection Rate 29.3% 29.6% -0.3% Operating Margin 10.4% 8.9% 1.5% Net Margin 28.7% 11.6% 17.1% 1

Page 227/534 18 (1) Hospital entity only, excludes controlled affiliates El Camino Hospital – Los Gatos (1) Results from Operations vs. Budget 1 month ending 7/31/2013

Variance $000s FY 2014 Budget 2014 Fav (Unfav) Var% OPERATING REVENUE: Gross Revenue 41,460 36,612 4,847 13.2% Deductions (29,835) (26,217) (3,617) -13.8% Net Patient Revenue 11,625 10,395 1,230 11.8% Other Operating Revenue 37 45 (8) -18.4% Total Operating Revenue 11,661 10,440 1,221 11.7%

OPERATING EXPENSE: Salaries & Wages 5,394 5,013 (381) -7.6% Supplies 1,644 1,787 143 8.0% Fees & Purchased Services 1,265 1,246 (19) -1.5% Other Operating Expense 1,551 1,547 (4) -0.3% Total Operating Expense 9,854 9,592 (261) -2.7% Net Operating Income/(Loss) 1,808 848 960 113.3% Non Operating Income 0 0 0 n/a Net Income(Loss) 1,808 848 960 113.3%

Collection Rate 28.0% 28.4% -0.4% Operating Margin 15.5% 8.1% 7.4% Net Margin 15.5% 8.1% 7.4%

Page 228/534 19 (1) Hospital entity only, excludes controlled affiliates El Camino Hospital (1) Balance Sheet ($ Thousands)

ASSETS LIABILITIES AND FUND BALANCE Period Ending Jul 31 Period Ending Jul 31 CURRENT ASSETS FY 2014 FY 2013 CURRENT LIABILITIES FY 2014 FY 2013 Cash 59,687 43,885 Accounts Payable 21,595 16,948 Short Term Investments 134,016 156,393 Salaries and Related Liabilities 16,461 17,270 Patient Accounts Receivable, NET 87,235 89,267 Accrued PTO 18,609 16,437 Other Accounts and Notes Receivable 3,294 3,344 Worker's Comp Reserve 2,383 2,300 Intercompany Receivables 996 1,281 Third Party Settlements 21,117 19,682 Inventories and Prepaids 53,142 42,231 Intercompany Payables 235 236 Total Current Assets 338,370 336,401 Malpractice Reserves 2,002 2,318 Bonds Payable - Current 3,000 2,850 BOARD DESIGNATED ASSETS Bond Interest Payable 4,387 4,501 Plant & Equipment Fund 83,689 59,511 Other Liabilities 5,814 7,337 Operational Reserve Fund 100,196 100,989 Total Current Liabilities 95,603 89,878 Community Benefit Fund - 4,926 Workers Compensation Reserve Fund 26,221 20,585 Postretirement Health/Life Reserve Fund 15,629 14,927 LONG TERM LIABILITIES PTO Liability Fund 18,609 16,437 Post Retirement Benefits 15,629 14,927 Malpractice Reserve Fund 2,002 2,318 Worker's Comp Reserve 23,838 18,285 Catastrophic Reserves Fund 15,246 12,101 Other L/T Obligation (Asbestos) 3,320 3,216 Total Board Designated Assets 261,592 231,795 Other L/T Liabilities (IT/Medl Leases) - 2,806 Bond Payable 187,629 196,008 FUNDS HELD BY TRUSTEE 9,385 9,385 Total Long Term Liabilities 230,416 235,242

LONG TERM INVESTMENTS 124,737 38,108 FUND BALANCE/CAPITAL ACCOUNTS INVESTMENTS IN AFFILIATES 22,837 23,274 Unrestricted 804,760 741,595 Board Designated 261,592 231,795 PROPERTY AND EQUIPMENT Restricted 34 4 Fixed Assets at Cost 1,011,754 1,003,166 Total Fund Bal & Capital Accts 1,066,386 973,394 Less: Accumulated Depreciation (391,533) (353,520) Construction in Progress 10,611 5,073 TOTAL LIABILITIES AND FUND BALANCE 1,392,406 1,298,514 Property, Plant & Equipment - Net 630,831 654,719

DEFERRED COSTS/BOND ISSUE COSTS 4,647 4,828 RESTRICTED ASSETS - CASH 7 4 1 TOTAL ASSETS 1,392,406 1,298,514

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Att 2s- Approved 5-28-13 OPEN MINS FINANCE COMM.docx

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EL CAMINO HOSPITAL FINANCE COMMITTEE OF THE BOARD Tuesday, May 28, 2013

MINUTES

The combined session of the Finance Committee of the Board of Directors of El Camino Hospital (the “Hospital”) and the Board of Directors of El Camino Hospital was called to order by David Reeder, Chairman, at 5:30 pm on Tuesday, May 28, 2013 in Conference Room G, Ground Floor, El Camino Hospital, Mountain View. In attendance were David Reeder, Tomi Ryba, Michael King, Eric Pifer, Diana Russell, Mick Zdeblick, Greg Walton, Cecile Currier, Nandini Tandon, Neal Cohen, Dennis Chiu, Julia Miller, Bill Hobbs, Jeff Davis, Judi Ashline, Ken King, Pat Wolfram, Richard Juelis, and Cindy Murphy.

OPEN SESSION

There was a discussion about how the special Board meeting to conduct a study session was noticed and how the agenda was handled.

CONFLICT OF INTEREST DISCLOSURES: Mr. Reeder asked if any Committee member may have a conflict of interest on any of the items on the agenda. No conflict was stated.

2014 BUDGET PRESENTATION:

STRATEGY: Tomi Ryba, CEO shared assumptions of building the budget for 2014, gave historical information and shared how we map carefully our strategy towards decision making, directionally correct strategically and investing in the right things. Ms. Ryba briefly reviewed FY2013-2015 goals centered around Quality, Affordability, Physician Partnerships and Community Alliances. Our goal is to stay true to our core business by achieving the Triple Aim (Quality, Service & Affordability) but moving towards Continuum of Care. Ms. Ryba presented the Three Year Strategic Plan, summarizing the Operations Plan including the strategic goals and tactical focus. It was suggested that in addition to existing metrics, there should be additional outcomes measures included as part of the Quality tactics as well as expanded discussion around patient safety programs, including falls, medication errors, bar coding, and preventable harm.

During discussion of affordability tactics, it was noted that our pricing philosophy was an important element of overall affordability and it was suggested that home monitoring capabilities be included in continuum of care tactics. A concierge program was also suggested to be available to patients.

The future of Health Exchange was discussed. Ms. Ryba suggests having a future conversation with the Board on whether we want to redirect some of our Community Benefit efforts to providing financial support for the uninsured through subsidizing Federally Qualified Health Care Centers. It was suggested that we have someone lead an innovation effort, responsible for quantitative goals, and to scan the environment for business development opportunities and nontraditional businesses. Other suggestions provided for further developing revenue opportunities included developing a more robust employee suggestion program and focusing on fostering innovation by working with Silicon Valley companies.

Ms. Ryba reviewed key accomplishments for FY2013 and stated that we are on track with respect to program development, accreditation and progress against goals.

Ms. Ryba reviewed the FY2014 Priority Goals which include Triple Aim (Quality, Service & Affordability), Continuum of Care and Innovative Partnerships.

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Ms. Ryba reviewed FY2014 Draft Shared Executive Goals, noting that the shared goals were developed with the input from the Board: goals are equitable, everyone has similar weighting, goals are complex, and there is shared accountability and evidence of teamwork. She demonstrated that the goals are in alignment with the strategy and priorities around Physician Partnership, Triple Aim, Clinical Integration, Business Development, Community Health & Wellness, and People.

Ms. Ryba reviewed the FY 2014 Draft Corporate Scorecard which includes Patient Safety Indicators and other performance indicators of a well-run organization. The scorecard has been presented to the Quality Committee, who would like to learn more about what the service lines are doing and how they are influencing the indicators.

Ms. Ryba reviewed the FY 2014 Draft Organizational Goals which has also been presented to the Quality Committee. The priority is to remain focused and be as constant as possible in achieving consistently high performance. She noted that in the Continuum of Care category a revised metric is the switch from tracking 7 day unplanned readmission to 30 day all cause readmission, which is tracked by many other hospitals and will provide an external benchmark.

OPERATING BUDGET FY2014: Michael King, CFO, began the presentation by reviewing the assumptions that are driving the budget. It was suggested that alignment of hospital and physician relationships, particularly in service line level, should be explored. A suggestion was also made that at a future Board meeting to have a discussion about the partnership with physicians in relation to cost so that both physicians and Board members are aware about the need to decrease cost. It was suggested that the Board may find it interesting and useful to receive a briefing on our inventory management system.

There was a discussion on the 2014 operating margin and FYTD 2013 run rate, the consolidating revenue and expense budget, and the operating margin. Mr. King reviewed the margin for the hospital and demonstrated the impact of the affiliates’ operations on the consolidated margin, and then also discussed the specific changes that are expected to result in the 2014 margin being changed from the 2013 margin.

Mr. King next reviewed the expected FY13 capital spending and provided a comparison of this to the amounts included in the FY2014 capital budget, providing diagrams that categorized the spending request by “facility”, “information technology”, and “equipment”. He noted that the capital request for next year is less than this year’s expected commitment level. He then discussed the process for developing the capital budget, noting that a group of physicians served on the Capital Committee and assisted management in finalizing the request. It was stated that one challenge is to look long term and determine the capital needs in the next year and following year, etc. Mr. King stated that although ECH produces a multi-year capital plan, it might be useful to engage the capital committee in assisting with that part of the process as well. In response to a request to differentiate recurring and nonrecurring items of capital spending, it was noted that by their nature, the facility items were generally non-recurring – at least in the short term – and the IT and equipment items were generally recurring.

Mr. King then reviewed a graphic illustrating that the majority of spending is focused on quality and service projects, which includes most of the facilities work. Other categories of spending included Continuum of Care initiatives, Affordability, and Regulatory items. Mr. King also reviewed the Capital Equipment Spending Trend, noting that the hospital’s experience is consistent with what is typically seen when a new facility is constructed. Mr. King closed his presentation by noting that the proposed budget was developed with operational tactics which are tied to the organization’s strategic objectives.

PUBLIC COMMENTS: There were no public comments.

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ADJOURN TO CLOSED SESSION: Upon motion duly made by Dennis Chiu, seconded by Bill Hobbs, and approved by the members of the Finance Committee, the Open Session of the combined meeting was adjourned to Closed Session at 6:43 pm. pursuant to Gov’t Code Section 54957.6.

Upon motion duly made by Neal Cohen, seconded by Nandini Tandon, and approved by the members of the Board of Directors, the Open Session of the combined meeting was adjourned to Closed Session at 6:43 pm. pursuant to Gov’t Code Section 54957.6.

CLOSED SESSION

The Committee completed its business of the Closed Session at 8:15pm.

RECONVENE OPEN SESSION:

The Committee reconvened Open Session at 8:15pm.

CLOSED SESSION REPORTS: Mr. Reeder reported that no action was taken in Closed Session.

2014 BUDGET ACTION: After discussion, a motion was made by Bill Hobbs, seconded by Richard Juelis, and approved by a vote of five members in favor, none opposed, to recommend that the Board approve the FY 2014 Budget with emphasis on capital spend rate, cost metrics and venture capital fund.

CONSENT CALENDAR: A motion was made by Nandini Tandon, seconded by Bill Hobbs, and approved by five members in favor, none opposed, to accept the items on the consent calendar. Dennis Chiu abstained from accepting the March 26, 2013 minutes as he was not present at that meeting.

NEURO INTERVENTIONAL CONTRACT - MEDICAL DIRECTOR: A motion was made by Nandini Tandon, seconded by Dennis Chiu, and approved by five members in favor, none opposed, to recommend that the Board of Directors authorize the CEO to approve the Medical Director Agreement.

NEURO INTERVENTIONAL CONTRACT - ON CALL SERVICES: A motion was made by Nandini Tandon, seconded by Dennis Chiu, and approved by five members in favor, none opposed, that the Board of Directors authorize the CEO to approve the On Call Neuro Interventional Agreement.

CO MANAGEMENT SERVICES AGREEMENT: A motion was made by Nandini Tandon, seconded by Dennis Chiu, and approved by five members in favor, none opposed, that the Board of Directors authorize the CEO to approve the Co Management Services Agreement.

PRIMARY STROKE CENTER – MEDICAL DIRECTOR AGREEMENT: A motion was made by Nandini Tandon, seconded by Dennis Chiu, and approved by five members in favor, none opposed, that the Board of Directors authorize the CEO to approve the Medical Director Agreement.

STEMI MYOCARDIAL INFARCTION: A motion was made by Nandini Tandon, seconded by Bill Hobbs, and approved by five members in favor, none opposed, to authorize the CEO to execute the On Call Agreements required.

SUMMARY OF FINANCIAL OPERATIONS: Mike King presented the April Financials stating that it was a very strong month with an unusually favorable percentage of commercially insured patients. It was noted that the YTD operating margin increased slightly and that in April the patient financial services area collected the most cash they’ve ever collected. As a result, Days in Accounts Receivable were reduced, and Days Cash On Hand were increased. A motion was made by Nandini Tandon, seconded by Richard Juelis, and approved by five members in favor, none opposed to approve the April financials.

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SELF ASSESSMENT REPORT – No further discussion regarding the Self Assessment report was necessary as Mr. Reeder had reviewed the report in Closed Session.

MEETING EVALUATIONS AND ASSESSMENT: Committee members received evaluation forms and were asked to complete them for today’s meeting. It was suggested that a review of the original committee goals be placed on the next Agenda.

PUBLIC COMMENT: As no member of the public chose to attend, there was no public comment.

ADJOURNMENT: There being no further business, the meeting adjourned at 8:43pm.

NEXT MEETING: July 30, 2013, Ground Floor Meeting Room A.

Dennis Chiu Patricia A. Einarson, MD, Secretary Chair, Finance Committee El Camino Hospital Board of Directors

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EL CAMINO HOSPITAL GOVERNANCE COMMITTEE OF THE BOARD SPECIAL MEETING Tuesday July 2, 2013

MINUTES

1. CALL TO ORDER/ROLL CALL

The Special Meeting of the Governance Committee of the Board of El Camino Hospital (the “Hospital”) was called to order by John Zoglin at 5:30 pm on Tuesday, July 2, 2013 in Conference Room A, El Camino Hospital, 2500 Grant Road, Mountain View, California.

Roll call was taken. The Committee members present were John Zoglin, Julia Miller, Gary Kalbach, and Mark Sickles. Cindy Murphy, Board Liaison, of El Camino Hospital was also present. Pete Moran arrived at 5:45 pm. Patricia Einarson, MD was absent. Executive Sponsor Tomi Ryba, CEO joined by telephone conference call at 6:00pm, but was disconnected shortly after due to interrupted cellular phone service.

2. CONFLICT OF INTEREST DISCLOSURES:

Mr. Zoglin asked if any Committee member had a conflict of interest regarding any of the items on the agenda. No conflict was stated.

3. PUBLIC COMMENT:

There was no public comment.

4. CONSENT CALENDAR:

Action: A motion was made by Mr. Kalbach, seconded by Ms. Miller, and approved by a vote of four committee members in favor, Mr. Moran and Dr. Einarson absent, to approve the minutes of the June 4, 2013 Governance Committee meeting.

5. FY 2014 ALL COMMITTEE GOALS:

The committee members reviewed and discussed the FY 2014 Draft Goals submitted by the Board Advisory committees. The members considered the committees’ stated purposes, the specificity of the Draft Goals, the specificity of the metrics and the timing of completion. The committee members also considered the status of completion of the committees’ FY 2013 Goals and assessed whether or not the committees’ Draft goals reflected a realistic volume of work. Finally, the committee considered whether the Draft Goals reflected any gaps in coverage of oversight or unnecessary overlaps between the committees.

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Action: A motion was made by Mr. Kalbach seconded by Ms. Miller and approved by a vote of five committee members in favor, Dr. Einarson absent, to recommend the Board approve the Draft goals as submitted by the Board Advisory Committees with the following recommendations for the committees and the Board to consider:

1. Corporate Compliance and Audit Committee – Further specificity for the metrics. 2. Executive Compensation Committee – Further depth and development for Draft Goals #5 and #7. 3. Finance Committee – In general, concern with timing as no goal is paced to be completed until Q3. a. Draft Goal #1 – Goal should be more specific. b. Draft Goal #2 – Change to “Review and monitor financial implications (profitability) of new business proposals.” c. Draft Goal #4 – Change to “Educate the Board re the Budget development process.” Also, consider completing earlier - maybe in Q2. 4. Investment Committee – Draft Goal #5 - Change metric to: “Provide executive summary/dashboard that includes performance against budget and benchmarks.” 6. Quality, Patient Care, and Patient Experience Committee – a. Draft Goal #1 – Seems unintentionally broad. The Committee might consider adding a phrase (noted in bold) to the end of the sentence: “Review the hospital’s organizational goals and scorecard and ensure that those metrics and goals are consistent with the strategic plan and set at an appropriate level as they apply to the Quality, Patient Care, and Patient Experience Committee.” b. While important to the functioning of the committee, Draft Goals #3 and #6 seem more like committee management than committee goals and should be recorded as important, but probably removed as overall goals. 7. The major IT project is not currently assigned to any specific committee. The Board might consider discussing how this project should be addressed in 2014, e.g. Board level only, Board ad hoc Committee, or one or two committees take the lead as we did last year around the continuum of care discussions.

6. DRAFT REVISIONS TO THE CORPORATE COMPLIANCE COMMITEEE (“CCAC”) CHARTER

The committee members discussed the draft revisions to the CCAC charter, noting that the revisions were related to IT security, risk management, and policy oversight.

Action: A motion was made by Mr. Moran, seconded by Mr. Kalbach and approved by a vote of five members in favor, Dr. Einarson absent, to recommend that the Board approve the Draft Charter Revisions for FY 2014 as submitted by the CCAC.

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7. BOARD AND COMMITTEE EDUCATIONAL GATHERINGS

The committee reviewed the results of the Estes Park Conference Survey included in the packet and discussed the proposed agenda items and format for the gatherings. The committee also discussed the value of bringing in expert speakers vs. attending a seminar as well as the associated costs. The committee members also commented that there is great value in hosting off site gatherings with a combined educational and social purpose as a positive way to enhance interpersonal relationships and thereby improve board and committee effectiveness. Many of the committee members noted that, of the proposed expert speaker topics listed in the committee packet, the two most important are continuum of care and payment reform.

Action: A motion was made by Ms. Miller and seconded by Mr. Kalbach and approved by a vote of five members in favor, Dr. Einarson absent, to recommend to the Board that it host two joint Board and Committee Educational Gatherings, the first on October 23, 2013 and the second on April 23, 2014.

8. POTENTIAL ROLE AND APPOINTMENT OF COMMITTEE VICE CHAIR:

The committee members discussed the role of a Vice Chair, and whether there was any reason not to appoint Vice Chairs. The members commented that a Vice Chair would be useful to chair meetings, in the absence of the Chair, or when the Chair participates via telephone conference call. The members also discussed how the Vice Chair would be selected.

Action: A motion was made by Ms. Miller, seconded by Mr. Kalbach, and approved by a vote of five members in favor, Dr, Einarson absent, to recommend that the Board approve the appointment of a Vice Chair (to be selected by each Committee Chair) to each of the Board Advisory Committees.

9. OVERLAP OF DIRECTORS BETWEEN HOSPITAL AND DISTRICT BOARDS:

The committee members discussed some of the issues related to the overlap of directors between the El Camino Healthcare District Board and the El Camino Hospital Board. Mr. Kalbach commented that the committee does not have enough data to engage in a full discussion on the topic and the members suggested that, after the Board approves the Committee’s goals, staff begin some research into how the Boards overlap in other Districts that own hospitals. There was also some discussion regarding who the appropriate persons (Board members, committee members, or hospital staff) might be to contact other Districts or other District owned hospitals.

No action was taken.

Page 238/534 Minutes of Special Meeting of the Governance Committee DRAFT July 2, 2013 Pending Committee Page 4 Consideration 10. ADJOURN TO CLOSED SESSION:

Upon motion duly made by Mr. Moran, seconded by Mr. Sickles, and approved by a vote of 5 members in favor, Dr. Einarson absent, the open session of the meeting was adjourned to closed session at 6:50 pm pursuant to Gov’t Code Section 54957.2 for approval of the minutes of the closed session (June 4, 2013) and pursuant to Health and Safety Code Section 32106 (b) for a report on health care facility trade secrets- development of new services and programs- committee chair slate review; and pursuant to Health and Safety Code Section 32106 (b) for a report on health care facility trade secrets – development of new services and programs – pacing plan.

CLOSED SESSION

The Committee completed its business of the Closed Session at 7:15pm.

11. RECONVENE OPEN SESSION:

The Committee reconvened open session at 7:16pm.

CLOSED SESSION REPORT:

John Zoglin reported on the following action taken in closed session, which is required to be reported in open session:

Consent Calendar

The Committee reviewed and approved the Consent Calendar Closed Session items as follows: Approval of the minutes of the Closed Session of the Regular Committee Meeting (June 4, 2013) by a vote of five members in favor, Dr. Einarson absent.

12. ADVISORY BOARD COMMITTEE CHAIR SLATE REVIEW:

The committee discussed the proposed slate of committee chairs. They also discussed the propriety of one Board member chairing more than committee in view of the heavy workload involved. The members also discussed whether the Board should consider formalizing the obligations of Board members to participate in leadership positions.

Action: A motion was made by Mr. Kalbach, seconded by Ms. Miller, and approved by a vote of five members in favor, Dr, Einarson absent, to advise the Board that the committee reviewed the proposed slate and has no additional specific input regarding the slate.

Action: A motion was made by Mr. Kalbach, seconded by Mr. Sickles, and approved by a vote of five members in favor, Dr, Einarson absent, to recommend that the Board agendize a discussion with the goal of working towards guidelines that formalize the obligations for Board members to participate in Board or Committee leadership positions.

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13. ADJOURNMENT

Action: Upon motion duly made by Mr. Moran, seconded by Mr. Kalbach the meeting was adjourned at 7:32pm, by a vote of five members in favor, Dr. Einarson absent.

______Julia Miller Patricia Einarson, MD Chair, ECH Governance Committee Secretary, ECH Board of Directors

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EL CAMINO HOSPITAL INVESTMENT COMMITTEE OF THE BOARD Monday, May 13, 2013

MINUTES

The Investment Committee of the Board of Directors of El Camino Hospital was called to order by Mr. John Zoglin, Chairperson, at 5:29 p.m. on Monday, May 13, 2013 in Conference Room A, ground floor, El Camino Hospital, Mountain View.

Committee members present were Mr. John Zoglin, Ms. Nicki Boone, and Dr. Jeffrey Davis. Also in attendance were Mr. Michael King, Chief Financial Officer, Mr. Antonio DiCosola, Mr. Lucas Mansberger, and Mr. Tom Dodd of Pavilion Advisory Group. Absent were Committee members Mr. Brooks Nelson and Mr. Ethan Cohen-Cole.

OPEN SESSION

CONFLICT OF INTEREST DISCLOSURES: Mr. Zoglin asked if there was any person who believes a committee member may have a conflict of interest on any of the items on the agenda. No conflict was stated.

CONSENT CALENDAR: Upon motion duly made by Dr. Davis, and motion seconded by Ms. Boone, the minutes of the February 11, 2013 meeting was unanimously approved by those members in attendance.

INVESTMENT ADVISOR PRESENTATION:

Direct Hedge Fund Program: Mr. Antonio DiCosola, Mr. Lucas Mansberger and Mr. Tom Dodd from Pavilion Advisory Group discussed the composition of the proposed direct hedge fund portfolio. They presented a snapshot of the portfolio and summarized the liquidity profile of the portfolio. Mr. Dodd summarized the four strategies which included Equity, Credit, Macro and Relative Value. He stated they believe they can add value by over-weighting the equity strategy to 40% and underweighting the other three strategies at 20% each. The Committee was concerned with the amount of exposure to non-U.S. and European equity long/short managers and how these managers would help provide protection versus long-only U.S. equities. Non-U.S. equity long/short managers tend to have lower net long exposures than U.S. based managers, which provides protection in poor equity markets. Additionally, they stated that European Equities is a good area to have exposure and to take advantage of at this time as they are seeing lots of areas of opportunity. Mr. DiCosola stated that Pavilion will be preparing a draft of funds that they will recommend for the next quarter and will add our suggestions so that they can create a separate performance book for the direct hedge fund program to include key exposures and key statistics.

Performance for 1st Quarter of calendar year 2013: Pavilion stated overall it has been a good quarter performance wise and in line with the benchmark for operating assets for surplus cash and slightly under the benchmark for the pension assets. They went over manager specific issues such as personnel changes, organizational changes, etc. Pavilion is continuing to monitor changes with the firms to be sure there is no adverse impact on performance.

Surplus Cash: Pavilion reviewed the performance summary and asset class diversification for Surplus Cash. The Surplus Cash portfolio performed in line with its benchmark. Two additional hedge funds will be funded for $5 million each in the near future. An asset allocation study will be conducted once updated financial projections are available. Ms. Boone had requested that Capital App/(Dep) Net of Expenses on the Surplus Cash and Cash Balance Plan Executive Summaries be separated to show income/cash flow, and unrealized and

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realized gains/(losses). The Committee also requested that the time periods read from oldest to newest from left to right as they do on the line chart on the bottom of the page. Pavilion has agreed to do this for the next quarter.

Cash Balance Plan: Pavilion reviewed the performance summary and the asset class diversification for the Cash Balance Plan. Both market duration fixed income managers, Dodge & Cox and MetWest, outperformed their benchmark and ranked in the top quartile of their peer group.

The Committee asked that Pavilion change the Dashboard exhibits for both the Surplus Cash and Cash Balance Plan to replace the Performance: Since Inception chart with an exhibit that captures performance trends such as rolling 3-year performance.

SOCIAL INVESTING: At the previous meeting, Pavilion was requested to evaluate El Camino Hospital’s exposure to civilian firearms and provide background on the practice of portfolio screening for social investing. Pavilion reviewed the background on the integration of environmental, social and governance factors into investment allocations and provided an analysis of the exposure of the overall market and the Hospital’s specific exposure. In aggregate, the hospital’s Surplus Cash equity portfolio has exposure that amounts to 0.23% of the total portfolio’s assets and the Cash Balance Plan’s equity portfolio has exposure that amounts to 0.42% of the total portfolio’s assets to companies that have any tie to the production or sale of civilian firearms or related supplies. The Surplus Cash and Cash Balance Plan portfolios have 0.09% and 0.17% equity exposure, respectively in the narrower category of those who manufacture firearms or small arms ammunitions for civilian markets, and includes no direct investment in any company that manufactures weapons that are illegal in California.

Pavilion also discussed the actions that other large institutional investors have taken in response to the renewed public debate on gun control. Institutional investors that have either announced their intention to divest of certain firearms-related companies, have begun a comprehensive portfolio review related to firearms, or have taken other actions related to addressing firearms exposure in their portfolio include the Illinois Teachers’ Retirement System, Maryland Retirement and Pension System, Massachusetts Pension Reserve Investment Management Board and the New York State Common Retirement Fund. In California, the California State Teachers Retirement System and the California Public Employees Retirement System have both elected to divest from manufacturers of firearms that are illegal for sale or possession in California.

Following discussion, a motion was made by Mr. Zoglin, seconded by Ms. Boone, and approved by three members in favor, none opposed, to recommend to the Board that El Camino Hospital not hold any direct investment in companies that manufacture guns which are illegal for sale or possession in California.

It was suggested that in the future, the Pavilion team should participate via video conferencing unless there was a specific reason for their personal presence. Staff was asked to arrange for video conferencing to be available for future meetings.

COMMITTEE CHARTER: The Committee requested that Mr. King review the wording of the Charter to ensure that the Committee’s responsibilities for the organization’s defined contribution plans were clearly stated.

COMMITTEE GOALS: A motion was made by Ms. Boone and seconded by Dr. Davis, and approved by three members in favor, none opposed, to approve the following 2014 Investment Committee Goals: 1) Review manager performance of making recommendations for changes quarterly, 2) Review Investment Advisor’s Page 243/534 Investment Committee of the Board Page | 3 May 13, 2013

performance in 3rd quarter, 3) Review Investment Policy and recommend any appropriate changes in 2nd quarter, and 4) Review Investment Committee Charter in 4th quarter, and 5) Produce an Executive Summary/Dashboard in 4th quarter.

COMMITTEE DATES: Investment Committee meeting dates are scheduled for the 2nd Monday of the 2nd month following the end of each fiscal quarter, which is August 12, 2013; November 11, 2013; February 10, 2014; and May 12, 2014. Members were asked to advise the chair of any conflicts as soon as possible.

COMMITTEE ASSESSMENT: Mr. Zoglin briefly reviewed the Investment Committee Self-Assessment Summary Report, stating that one of the goals for the yearly assessment is to identify opportunities for improvement which could also be used to develop goals for the following year.

ADJOURNMENT: There being no further business, the meeting adjourned at 7:56 p.m.

John Zoglin, Chair Patricia A. Einarson, MD, Secretary Investment Committee El Camino Hospital Board of Directors

Page 244/534 Separator Page

Att 2v - Open QBC Minutes 6-17-13 FINAL.docx

Page 245/534

Minutes of the Open Session Quality, Patient Care and Patient Experience Committee of El Camino Hospital June 17, 2013

The Open Session meeting of the Quality, Patient Care and Patient Experience Committee of El Camino Hospital (the “Committee”) was called to order by Chair Patricia Einarson, M.D., at 5:30 p.m. on Monday, June 17, 2013, Conference Room E & F, at El Camino Hospital, 2500 Grant Road, Mountain View, California.

I. Call to Order. Roll call was taken. Committee members present were Patricia Einarson, M.D., Neal Cohen, M.D., M.P.H., Katie Anderson, M.P.H., Lisa Freeman, and Jeffrey Davis, M.D.

II. Potential Conflict of Interests Disclosures. Dr. Einarson asked if any Committee member or anyone in the audience believes that a Committee member may have a conflict of interest on any of the items on the agenda. No conflict of interest was reported.

III. Consent Calendar. The Committee reviewed the minutes from the May 20, 2013 meeting, as well as the Quality Summary.

Action: A motion was made by Neal Cohen, M.D., M.P.H., and seconded by Jeffrey Davis, M.D. and approved by Committee members present to approve the minutes from the May 20, 2013 meeting. Eric Pifer, M.D., will present on the patient who died in restraints, if the final report from CMS is complete and he will also report on the update on ICD-10 training at the July 22, 2013 meeting.

IV. Informational and Possible Motion Items.

A. Patient Video. Dr. Pifer highlighted a patient video with the Committee and related elements of this patient video to continuum of care.

Action: No action taken.

B. Final Recommendations of FY14 Organizational Goals and Final Recommendations of FY 14 Corporate Scorecard. Dr. Pifer mentioned that the targets are not completed for FY 14, but that they will be by the end of FY13. Mick Zdeblick briefly went over the both documents and a discussion ensued on whether there are too many metrics listed on the corporate scorecard. There was also discussion on specific metrics and whether they would they would stay on the final copy as some variables are too difficult to measure, such as “30 day post-acute Total Cost of Care.”

Action: Mick Zdeblick will present the final corporate scorecard and organizational goals at the September 16, 2013 meeting.

Page 246/534 Open Minutes: Quality, Patient Care and Patient Experience Committee June 17, 2013 Page 2 C. Spotlight on Continuum of Care. Dr. Pifer briefly discussed his PowerPoint presentation. A discussion ensued on the definition of continuum of care, what El Camino Hospital is trying to solve, what the future of El Camino Hospital looks like and what the gaps are.

Action: Dr. Pifer will discuss at a future meeting in regards to the progress on the continuum of care on 4 items: 1. Focus on fragmentation and to recognize that information technology is a big part of fragmentation. 2. Carefully define the problem we are trying to solve and to run experiments to test whether you are solving the problem. 3. Recognize that building a continuum of care organization is very complicated and to think carefully in regards to packing and over commitment. 4. Carefully define the hospital vision of the future and to work with the Board on how many elements of continuum of care we need to focus on.

D. Value Based Purchasing Dr. Pifer briefly discussed the questions that he wanted to discuss at the meeting.

Action: Value Based Purchasing will be discussed in depth at a future meeting.

V. Adjourn to Closed Session. A motion was made, seconded and approved by Committee members present, to adjourn the Open Session to Closed Session at 6:51 p.m. pursuant to Gov’t Code Section 54957.2 and pursuant to Health and Safety Code Section 32106 (b) for report involving Health Care Facility Trade Secrets.

VI. Closed Session Report. Dr. Einarson reported on the following action taken in Closed Session:

VII. Consent Calendar. The Committee reviewed and approved the minutes of the regular Committee meeting on May 20, 2013

VIII. Closing Comments and Summary Call out of Deliverables. Dr. Pifer announced the summary call out of deliverables. All call outs are listed as actions under the appropriate section of the minutes.

There being no further business, the meeting was adjourned at 8:15 p.m.

Attest as to the approval of the foregoing minutes by the Board of Directors of El Camino Hospital:

______

David Reeder, Chair Patricia A. Einarson, M.D, Secretary ECH Quality, Patient Care and El Camino Hospital Board of Directors Patient Experience Committee El Camino Hospital Board of Directors

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Att 2w - Auxiliary Report.pdf

Page 248/534 El Camino Hospital Auxiliary

Activity Report to the Hospital Board Meeting of August 14, 2013

The New Fiscal Year Begins

The 14 member Auxiliary Board began the new year with a mix of 6 new members, 6 members from last year, and two positions still in the nominations process. This year the Board focuses on putting into action the Auxiliary Strategic Plan prepared last year. The key initiatives strive to better align their objectives and activities with the Q-S-A goals of the hospital.

At its July 9 meeting the Board heard a report by Anne Kusian (Immediate Past President and Parliamentarian) summarizing the progress in strengthening the partnership between auxiliary and hospital executives, particularly one-on-one meetings between top executives, Auxiliary participation in the hospital Central Partnership Council, Unit Partnership Councils, and the like. In August and September the Board will center on the strategic plans for auxiliary leadership development and training and on enhanced volunteer training, which will focus a growing number of auxiliary initiatives with its members during summer and fall. For example, four more workshops on “Exceeding Customer Expectations” trained 66 auxiliary volunteers in July.

Respectfully submitted by Charles Hebel

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Att 2w.2 - ECHA membership report to ECH BOD - August 2013.pdf

Page 250/534 El Camino Hospital Auxiliary Membership Report to the Hospital Board Meeting of August 14, 2013

Combined Data as of June 30, 2013 for Mountain View and Los Gatos Campuses

Membership Data: Senior Members Active Members 518 Dues Paid Inactive 129 (Includes Associates & Patrons) Leave of Absence 23 Subtotal 670

------Resigned in Month 9 Deceased in Month 0

------

Junior Members Active Members 203 Dues Paid Inactive 2 Leave of Absence 1 Subtotal 206

------

Total Active Members 721

Total Membership 876

COMBINED AUXILIARY HOURS FROM INCEPTION (to June 30, 2013): 5,307,768

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Att 2w.3 - ECHA Activity Report to ECH BOD - Sept 2013.pdf

Page 252/534 El Camino Hospital Auxiliary

Activity Report to the Hospital Board Meeting of September 11, 2013

Auxiliary Board Focuses on Volunteer Training and Leadership Development At its meeting of August 13, 2013 the Auxiliary Board focused on the many issues involved in putting into action two key parts of the Auxiliary Strategic Plan. 1. Volunteer Training: The need and options for additional workshops to go beyond the “Exceeding Customer Expectations” workshops already underway since January. 2. Leadership Development: The need for and issues with identifying and developing future Auxiliary leaders, e.g., workshops for current Chairpersons and other leaders. The discussion of policy issues (such as “required” topics) will continue at our September 10 Board meeting, looking ahead to an October 17 meeting with the Chairpersons of our various services. These and other aspects of the Strategic Plan support the evolutionary development of a more “professional” cadre of dedicated volunteers.

Strategic Partnership with the Hospital Staff The August edition of the Auxiliary News Flash newsletter begins a series of articles to educate our members about the Auxiliary’s strategic partnership with hospital staff to help improve the patient and visitor experience, and to help the hospital attain their Triple-Aim Goals for Quality, Service and Affordability. Successive issues of the News Flash will highlight stories of volunteers and staff working together to help achieve such goals. In addition, the August edition highlights Auxilian Jane Seaman, our first celebrant of 50 years of volunteer service to El Camino Hospital.

Respectfully submitted by Charles Hebel

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Att 2w.4 - ECHA membership report to ECH BOD - Sept 2013.pdf

Page 254/534 El Camino Hospital Auxiliary Membership Report to the Hospital Board Meeting of September 11 2013

Combined Data as of July 31, 2013 for Mountain View and Los Gatos Campuses

Membership Data: Senior Members Active Members 526 Dues Paid Inactive 128 (Includes Associates & Patrons) Leave of Absence 15 Subtotal 669

------Resigned in Month 18 Deceased in Month 4

------

Junior Members Active Members 230 Dues Paid Inactive 2 Leave of Absence 1 Subtotal 233

------

Total Active Members 756

Total Membership 902

COMBINED AUXILIARY HOURS FROM INCEPTION (to July 31, 2013): 5,317,942

Page 255/534 Separator Page

Att 2x - September 2013 Foundation Report to Hospital Board.docx

Page 256/534

Date: August 28, 2013 To: El Camino Hospital Board of Directors From: Claudia Coleman, Chair, El Camino Hospital Foundation Board of Directors Ron Mirenda, Interim President, El Camino Hospital Foundation Re: Report on Foundation Activities

FY 2013 a Fundraising Success

El Camino Hospital Foundation exceeded its goals for fiscal year 2013 for both total number of donors and revenue raised. We closed the year with 2,738 contributors (the goal was 2,700) and received $7,958,430 for El Camino Hospital (nearly $1 million more than the goal of $7 million).

FY 2014 off to a Promising Start

Through July 31, the Foundation has already received $658,000, a wonderful start to the new fiscal year. Included in that amount is an estate gift of $212,000, a $25,000 sponsorship to underwrite Norma’s Literary Luncheon, which will be held in February, and several other gifts described below.

Major Gift to Behavioral Health Services

In July El Camino Hospital Foundation received a $50,000 gift from Donna and John Shoemaker to benefit the MOMS program. This is the Shoemakers’ second such gift to the program in two years.

Sapphire Soirée 2014 Kicked Off with $250,000 Challenge

Sapphire Soirée 2014 will be held on May 31st at the Menlo Circus Club in Atherton. Katie and Greg Morganroth, MD and Sandra and Doug Bergeron have once again agreed to chair the signature event and Pamela and Edward Taft will reprise their roles as honorary chairs. Save the date cards were mailed in July.

The Foundation is pleased to announce that the Tafts have agreed to donate a $250,000 challenge gift. This is the fourth year they have contributed to the challenge, the third time at this level. In order to generate excitement and ensure the appeal’s success on May 31, the Foundation is forming an honorary committee, chaired by the Tafts, of

Page 257/534 individuals and couples who commit to donating $25,000 toward the challenge in advance of the event. Their names will be listed on the invitation and other gala collateral materials.

The Foundation is hosting a private stewardship reception at the home of Katie and Dr. Greg Morganroth on September 10 for guests who contributed matching gifts to the challenge at the gala over the past three years. The Taft challenge will be announced that night. Cancer Center doctors will speak about how these donations have been used to improve care for cancer patients.

El Camino Heritage Golf Tournament

Planning for the 18th annual El Camino Heritage Golf Tournament is now in full swing. The event will be held at a new location, Ruby Hill golf course in Pleasanton, on Monday, October 21, 2013. It will be a streamlined, one-day tournament. In addition to golf there will be activities for non-golfers including an afternoon bocce ball tournament and a wine tasting tour and luncheon at Wente Winery. Fidere Anesthesia has renewed their lead sponsorship at the $40,000 level and other sponsorships are coming in. Sponsorship packets were mailed in July and registration is now available online at https://echf.cvent.com/golf13 Forty three golfers have already signed up.

Allocations

At their quarterly meeting on August 1, 2013, the Foundation Allocations Committee made the following grants:  Advanced Genome Analysis Training – will allow the hospital to evaluate the feasibility, challenges and benefits of offering a full genome sequencing service at El Camino Hospital - $10,000  Cancer Center Casa ECHO Project – a pilot project to provide free hotel stays for all oncology patients who travel from outside a designated distance from El Camino Hospital - $30,000  Cancer Center Survivor Day – a one-day event open to all cancer survivors in the community and their families that will feature lectures, activities, games, food and music - $5,000  Care Coordination – Funds for indigent patients at discharge to cover medical equipment, medication and housing, which will help to prevent readmissions - $20,000  Behavioral Health Services MOMS program enhancements – Video equipment to provide reflective learning and validation to mothers who experience feelings of inadequacy in the care of their newborns and home visits - $19,000

At the same meeting, the Allocations Committee approved the following larger grants, which will be submitted to the full Foundation board for final approval at the September 19 board meeting:  Healing Arts Program - $101,000 to cover the remaining costs for FY 2014  Maternal Child Health – 54 new sleep chairs - $141,000

Page 258/534  Pharmacy Technician for Medication Reconciliation in the emergency department - $88,000  Men’s Health Center – Morcellator device for benign prostatic hyperplasia  Prostate Imaging – 3 Tesla high field strength MRI for the accurate diagnosis of early prostate cancers - $187,500

Board of Ambassadors

The Foundation hosted its second Board of Ambassadors reception on Wednesday, June 26 at Fremont Hills Country Club. The emeritus Foundation leaders who attended heard a hospital update from Tomi Ryba and learned about plans for the Behavioral Health Services expansion from Executive Director Michael Fitzgerald. Invited guests who were unable to come received a follow-up letter summarizing the program and were encouraged to attend the next event, which is scheduled for December 4. Chaired by former Foundation Board Chair Bob Adams, the mission of the Board of Ambassadors is to actively engage or re-engage former Foundation leaders.

Behavioral Health Services Campaign

In July, the Foundation began a search for a consulting firm to conduct a feasibility study for a behavioral health services campaign. Three firms will be interviewed in early September. Interviews of community leaders, foundations, hospital and foundation leadership will commence in October with a final report due to the Foundation board by the end of the year. A Foundation campaign planning committee is being formed to oversee the feasibility study process.

Foundation Staff Update

The Foundation welcomed three new employees: Director of Annual Giving John Baldwin, who will oversee, among other things, direct mail, database, employee giving, and all donor acquisition efforts; Steve Yeater, executive assistant, who comes to us from the ECH emergency department; and Laura Cowan, administrative assistant for special events. We bid farewell to Madeline Chaleff, director of gift planning, and a search is currently underway for her replacement.

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Att 3 - Quality Update: Preventable Harm.pdf

Page 260/534 Preventable Harm

Eric Pifer M.D. Chief Medical Officer

Page 261/534 El Camino Hospital Patient Safety Goal

• PaCT plan calls for increased vigilance and “zero defects” related to patient harm.

• PaCT plan describes our Patient Safety Target: - “Within 3 years, harm will occur only by random or unpreventable circumstances and we will build safety and preventable harm targets into all of the work that we do.” January, 2013 (PaCT Plan)

Page 262/534 Definitions of Preventable Harm • Medication Errors : (reviewed by Medication Safety Committee) all medication errors that cause harm which necessitates drug intervention or transfer to a higher level of care.

• Falls with Harm (reviewed by Falls Committee)all falls in which the patient suffers injury that requires diagnostic intervention (xrays) and occurred as a result of not following policy. Examples include not using bed and chair alarms, leaving high risk patients unattended while toileting.

• Hospital Acquired Pressure Ulcers Stage III & IV (reviewed by Pressure Ulcers Committee) all Stage III & IV HAPU except where preexisting conditions impact the patient’s ability to heal and we have followed all hospital policies for skin care.

• Hospital Onset Infections (reviewed by Infection Control Committee)

-Surgical Site Infections which meet NHSN criteria for deep/organ space - CAUTI based on NHSN guidelines - CLABSI based on NHSN guidelines - Hospital Acquired Ventilator Associated Pneumonia Sentinel Events: Any sentinel event that results in patient harm and meets criteria for Never 28 reportable event.

Page 263/534 PRIVILEGED AND CONFIDENTIAL UNDER 9/4/2013 EVIDENCE CODE 1157 Separator Page

Att 3.2 - Antibiotic Stewardship Program Report BOD Sept 2013 Final Copy.pptx

Page 264/534 Antibiotic Stewardship Report to Board of Directors

Daniel Shin, MD

SeptemberPage 265/534 11, 2013 Antibiotic Stewardship Program

1. Fifty percent of antibiotic use is unnecessary or inappropriate. 2. The most common risk factor for Clostridium difficile infection (CDI) is use of antibiotics. 3. CDI incidence is increasing and associated with mortality, morbidity, increased length of stay and costs. 4. Two large factors in CDI: hand washing and antibiotic use. 5. ECH antibiotic stewardship started July 1, 2009.

Page 266/534 Enterprise Ciprofloxacin Days of Therapy / 1000 Patient Days

-50%

Antibiotic Stewardship July 1, 2009

Page 267/534 3 Enterprise Levofloxacin Days of Therapy / 1000 Patient Days

-29%

Antibiotic Stewardship July 1, 2009

Page 268/534 4 Enterprise Zosyn Days of Therapy / 1000 Patient Days

-40%

Antibiotic Stewardship July 1, 2009

Page 269/534 5 Enterprise Vancomycin Days of Therapy / 1000 Patient Days

-8%

Antibiotic Stewardship July 1, 2009

Page 270/534 6 Clostridium difficile Hospital Onset Rate

Page 271/534 Antibiotic Stewardship Program New Initiatives 2013-2014

1. Hired a full-time antibiotic pharmacist (Nan Hong, PharmD). 2. Daily CCU rounds on antibiotic usage. 3. Move the clinical pharmacists to center of nursing stations. 4. Update peri-operative antibiotic cards. 5. Probiotics. 6. Fecal Microbiota Transplantation (Stool Transplants) for recurrent CDI patients. 7. Screen all nursing home admissions for C. difficile colonization with peri-rectal swabs. 8. Maintain CDI standardized infection ratio (SIR) <1.0. 9. Maintain current usage rates for Cipro, Levaquin, Zosyn. 10.Consider restricting the IV carbapenems. 11.Prolonged IV Zosyn infusions over 4 hours. 12.CDS for UTI. 13.Review HO-CDI cases.

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Separator Page

Att 4.1 - Board Cover Memo - Committee Chair and Vice Chair (V1).doc

Page 273/534

DATE: ECH Board Meeting – September 11, 2013

TO: El Camino Hospital Board of Directors

FROM: Julia Miller, Chair, Governance Committee

SUBJECT: Appointment of Chairs and Vice Chairs for Board Advisory Committees

BOARD ACTION: For Possible Motion(s)

(1) Vice Chair - That the Board Approve the Governance Committee’s recommendation that the Board Advisory Committee Charters be amended to provide that the Chair of each Board Advisory Committee may appoint a Vice Chair from among the Board Members serving on the committee (2) Committee Chair - That the Board Approve the Governance Committee’s recommendation that the Board Advisory Committee Charters should continue to require that only Board members are eligible to serve as Committee Chairs.

Summary:

At its July 2, 2013 meeting, the Governance Committee voted to recommend that the Board approve the appointment of Vice Chairs to each of the Board Advisory Committees. At its September 3, 2013 meeting, the newly constituted Governance Committee affirmed that recommendation and further voted to recommend to the Board that the Committee Chairs appoint Vice Chairs to their committees from among the Board members who serve on their committees and that only Board members be eligible to serve as Committee Chairs.

Next Steps:

. All Committee Charters will need to be revised in accordance with the Board’s decision.

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Att 4.2 - Revised Agenda Format.pdf

Page 275/534

DATE: ECH Board Meeting – September 11, 2013

TO: El Camino Hospital Board of Directors

FROM: Julia Miller, Chair, Governance Committee

SUBJECT: Board and Committee Agenda Format

BOARD ACTION: For Possible Motion(s)

(1) That the Board Approve the Governance Committee’s recommendation that the Board adopt the attached format (with possible changes to the attachment labeling at staff discretion) for Board and Board Committee Agendas.

1. Summary It was brought to the attention of the Governance Committee that some Board and Committee members find the current agenda format confusing and difficult to navigate. Specifically, changes to the identification of the attachments and the references to the open and closed sessions were desired. The attached Sample Agenda reflects the proposal that was presented to the Governance Committee.

2. Proposed Changes . Notation on the agenda that the Board Liaison takes the roll call. . Notation on the agenda that Legal Counsel, if present, calls for conflicts of interest. . Change from Roman numerals and letters to Arabic numbers only to identify agenda items. . Reduce words describing the consent calendar to “Any (Board/Committee) member may pull an item for discussion before a motion is made.” . Additional Item “Action” Descriptors; Motion; Possible Motion; Information; Information/Discussion; and Discussion. . Attachment numbering references the agenda item number. For example, Agenda item 5 has Attachments 5.1, 5.2, 5.3 etc. Note that this requires staff to create custom tabs for each new agenda for paper copies distributed to members. The committee indicated that staff should pursue alternative labeling that does not require creating custom tabs. . Numbering of open session agenda items flows directly into closed session agenda and then back into open session. Separate agendas for open and closed sessions are not required. Staff can easily manage removing closed session items from publicly distributed agenda. . Dates for upcoming meetings noted at the conclusion of the agenda.

1 Page 276/534 Separator Page

Att 4.2.2 - AGENDA - Governance Committee Agenda 9.3.13.docx

Page 277/534

AGENDA Governance Committee Meeting of the El Camino Hospital Board Tuesday, September 3, 2013, 5:30 p.m. El Camino Hospital, Conference Room A, ground floor 2500 Grant Road Mountain View, California

MISSION: To advise and assist the El Camino Hospital (ECH) Board of Directors (“Board”) in matters related to governance, board development, board effectiveness, and board composition, i.e., the nomination and appointment/reappointment process. The Governance Committee ensures the Board and Committees are functioning at the highest level of governance standards.

AGENDA ITEM PRESENTED BY

1. CALL TO ORDER Julia Miller, Chair 5:30 – 5:31 p.m.

2. ROLL CALL Cindy Murphy, 5:31 – 5:32 Board Liaison

3. POTENTIAL CONFLICT OF Mohammed Hill, 5:32 – 5:34 INTEREST DISCLOSURES Legal Counsel

4. PUBLIC COMMUNICATION Julia Miller, Chair 5:34 – 5:35

5. CONSENT CALENDAR ITEMS: Julia Miller, Chair public Motion Any Committee Member may pull an item comment 5:35 – 5:38 for discussion before a motion is made.

Approval: . Minutes of Governance Committee Meeting, dated July 2, 2013 ATTACHMENT 5.1 – Draft Minutes Information: . On-Boarding of New Board Members ATTACHMENT 5.2 – On-Boarding Summary

6. DISCUSSION REGARDING THE USE Julia Miller, Chair public Discussion/Motion OF FULL COMMITTEE VS. AD HOC comment 5:38 – 6:03 WORK ON COMMITTEE GOAL #3 Goal #3: Develop succession plan for the community members of the Board and Committees ATTACHMENT 6.1 – Hospital Board Advisory Committee Member Nomination and Selection Policy ATTACHMENT 6.2 – Hospital Board Advisory Committee Member Nomination and Selection Procedures ATTACHMENT 6.3 – Research Survey A copy of the agenda for the Regular Committee Meeting will be posted and distributed at least seventy-two (72) hours prior to the meeting. In observance of the Americans with Disabilities Act, please notify us at 650-988-7504 prior to the meeting so that we may provide the agenda in alternative formats or makePage disability 278/534-related modifications and accommodations.

Agenda: El Camino Hospital Board Governance Committee Meeting September 3, 2013 Page 2

AGENDA ITEM PRESENTED BY 7. LAST YEAR’S GOALS/PACING PLAN Julia Miller, Chair Information 6:03 – 6:08

8. STANDARDIZATION OF FORMAT Julia Miller, Chair public Discussion/Motion . Agenda Format Cindy Murphy, comment 6:08 – 6:18 Board Liaison

9. DISCUSSION ON “GOVERNANCE IN Julia Miller, Chair Information/Discussion LARGE NONPROFIT HEALTH Tomi Ryba, 6:18 – 6:43 SYSTEMS” REPORT (2012) President and CEO ATTACHMENT 9.1 – Commonwealth Center Article

10. COMMITTEE CHAIR REPORT Julia Miller, Chair public Possible Motion(s) . Eligibility (Board vs. Community comment 6:43-7:03 Member) to Serve as Advisory Committee Chair or Vice Chair . Advisory Committee Authority (Advisory vs. Delegated Authority)

11. CEO REPORT/CONCERNS Tomi Ryba, Discussion Communication flow between CEO and President and CEO 7:03 – 7:08 Board

12. ADJOURN TO CLOSED SESSION 7:08

13. POTENTIAL CONFLICT OF Mohammed Hill, 7:08 – 7:13 INTEREST DISCLOSURES Legal Counsel

14. CONSENT CALENDAR Any Committee Member may pull an item for discussion before a motion is made.

Approval of Meeting Minutes of the Closed Julia Miller, Chair Motion Session (July 2, 2013) Gov’t Code Section 7:13 – 7:15 54957.2.

Approval: . Minutes of the Governance Committee Meeting, Closed Session, dated July 2, 2013 ATTACHMENT 14.1 – Draft Minutes

Page 279/534 Agenda: El Camino Hospital Board Governance Committee Meeting September 3, 2013 Page 3

AGENDA ITEM PRESENTED BY 15. Gov’t Code Section 54957.2 for report Mitchell J. Olejko, Information/Recommendation involving consideration for recording closed Legal Counsel 7:15 – 7:30 session minutes for Board and Committee meetings. TO CONSIDER THE RECORDING OF CLOSED SESSION MINUTES FOR BOARD AND COMMITTEE MEETINGS ATTACHMENT 15.1 – Legal Memorandum

16. Report involving Gov’t Code Section 54957 Mitchell J. Olejko, Information for discussion and report on personnel Legal Counsel 7:30 – 7:40 performance matters: . Consideration for Using Executive Session in Committee Meetings TO CONSIDER THE USE OF EXECUTIVE SESSION IN COMMITTEE MEETINGS ATTACHMENT 16.1 – Legal Memorandum

17. RECONVENE OPEN SESSION Julia Miller, Chair 7:40 – 7:45

To report any required disclosures regarding permissible actions taken during Closed Session.

18. CONSIDERATION FOR RECORDING Mitchell J. Olejko, public Motion CLOSED SESSION MINUTES FOR Legal Counsel comment 7:45 – 7:50 BOARD AND COMMITTEE MEETINGS

19. CONSIDERATION FOR USING Mitchell J. Olejko, public Motion EXECUTIVE SESSION IN Legal Counsel comment 7:50 – 8:00 COMMITTEE MEETINGS

20. ROUNDTABLE DISCUSSION Julia Miller, Chair All 8:00 – 8:10

21. ADJOURNMENT Julia Miller, Chair 8:10 p.m.

Upcoming Governance Committee Meetings in 2013:

. October 8, 2013 . November 5, 2013 . December 3, 2013

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Att 4.3 - Board Cover Memo - Closed Session Minutes (V2).doc

Page 281/534

DATE: ECH Board Meeting – September 11, 2013

TO: El Camino Hospital Board of Directors

FROM: Julia Miller, Chair, Governance Committee

SUBJECT: Use of Closed Session Minutes in Board and Committee Meetings

BOARD ACTION: For Possible Motion(s): That the Board approve the Governance Committee’s recommendation that the Board and Board Advisory Committees continue with the current practice of keeping abbreviated closed session minutes.

Summary:

At its September 3, 2013 meeting, the Governance Committee voted to recommend that the Board and Committees keep with current practice of keeping abbreviated closed session minutes. The committee arrived at this recommendation by a vote in open session following a report by legal counsel (provided separately to the Board) and a discussion in closed session.

Next Steps:

None required.

1 Page 282/534 Separator Page

Att 4.4 - Board Cover Memo - Executive Session in Committee (V2).doc

Page 283/534

DATE: ECH Board Meeting – September 11, 2013

TO: El Camino Hospital Board of Directors

FROM: Julia Miller, Chair, Governance Committee

SUBJECT: Executive Sessions in Board Advisory Committee Meetings

BOARD ACTION: For Possible Motion(s): That the Board approve the Governance Committee’s recommendation that the Board Advisory Committees may place executive sessions on their agendas at the discretion of the Chair of the Committee.

Summary:

At its September 3, 2013 meeting, the Governance Committee voted to recommend that the Board Advisory Committees may place executive sessions on their agendas at the discretion of the Chair of the Committee. The committee arrived at this recommendation by a vote in open session following a report by legal counsel (provided separately to the Board) and a discussion in closed session.

Next Steps:

None required.

1 Page 284/534 Separator Page

Att 4.5 - Draft Board Cover Memo - Ad Hoc Committee (V1).doc

Page 285/534

DATE: ECH Board Meeting – September 11, 2013

TO: El Camino Hospital Board of Directors

FROM: Julia Miller, Chair, Governance Committee

SUBJECT: Appointment of Ad Hoc Committee

BOARD ACTION: For Possible Motion(s): That the Board approves the Governance Committee’s recommendation that the Board appoint an ad hoc advisory committee to the Governance Committee to convene for the following temporary purposes:

1. To Review the Hospital Board and Advisory Committee Member Nomination and Selection Policy and Procedure for the purpose of adding a process to develop a succession plan for the replacement of Community Members of the Board and Committees; and to include a debriefing process for Board and committee members who elect to leave a committee;

2. To review alternate lists for community members of the Board and advisory committees who had expressed interest in serving and prepare a summary, by name, by expertise, and relevant committee; and

3. To identify potential candidates for the Governance Committee vacancy for discussion at the October committee meeting.

The Governance Committee recommends Director Dave Reeder and community member Pete Moran to serve on this ad hoc committee which requires two members of the Board of Directors to serve as members. Chair Julia Miller seeks an additional member of the Board to serve.

1 Page 286/534 Separator Page

Att 5 - Board Cover Memo - Annual Meeting Calendar (V4).doc

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DATE: ECH Board Meeting – September 11, 2013

TO: El Camino Hospital Board of Directors

FROM: Patricia Einarson, MD

SUBJECT: Annual Board Calendar – Dark Months

BOARD ACTION: For Possible Motion

Possible Motion: Motion to Approve that the Board’s Regular Meeting Schedule for Board and Committee meetings be modified beginning in December 2013 to provide that Board and Advisory Committee Meetings be held only in January, February, March, April, May, June, August, September, October and November.

Summary:

It has been the practice of the ECH Board of Directors since August of 2012 to keep the months of August and January mostly “dark” meaning that neither the Board nor its Advisory Committees meet during those months. There has never been a discussion by the full Board regarding this practice. The Board members may want to consider changing that practice to accommodate for Board and Committee Members’ busy personal and family calendars during July and December.

General Considerations:

 The Board’s Master Calendar for FY 2014 provides for the following: o July – . Three committee meetings (approx. 6 hours) . One Hospital Board meeting (approx. 5 hours) o August – . One committee meeting mid – month (approx. 2 hours) o December – . Three committee meetings (approx. 6 hours) . One Hospital Board meeting (approx. 5 hours) . One El Camino Healthcare District Board meeting (approx. 3 hours)

1 Page 288/534

o January – . One committee meeting end of month (approx. 3 hours)

 This modification would result in a total savings of 11 hours of evening meeting time in July, and 14 hours of meeting time in December for Board Members, Committee Members, Executive Sponsors and Staff who attend these meetings.

 Since most local schools start in August, families with school age children are likely to vacation during July. The Board may want to consider how holding July meetings might impact the ability of Board Members, Committee Members and Executive Staff to attend meetings.

 Due to the Holiday season, December may also be a busy personal month for many.

 It will be necessary for Board Chairs, Committee Chairs, Executive Sponsors and Staff involved in planning and preparing materials for January meetings to participate in that effort during December. Similarly, planning and preparations for August meetings will take place in July.

Considerations Specific to FY 2013

 Master Calendar for FY 2013 was published in July. A change at this time may pose a hardship to Board and Committee members who have calendared meetings for December and planned January 2014 to be dark.*  Impact of moving December 11, 2013 Board meeting to January 14, 2013 o November Board meeting agenda is primarily dedicated to Effective Governance Session leaving little time for business discussions and decisions. o Deferral of Strategy Discussions to January 2014.  Impact of moving committee meetings from December to January o Governance Committee meets the first Tuesday of the month. The proposed change would move a meeting from December 2, 2013 to January 7, 2014. o Quality Committee meets the third Monday of the month – The proposed change would move a meeting from December 16, 2013 to January 20, 2014 (Martin Luther King Holiday). o Corporate Compliance and Audit Committee has a slightly irregular 3rd Thursday of the month meeting schedule. The proposed change would move a meeting from December 19, 2013 to January 16, 2014.

*Board members may also want to consider certain members’ commitment to El Camino Healthcare District Board meetings. There is currentlyPage 289/534a meeting scheduled for December 17, 2013. Separator Page

Att 6 - CEO Report 9-11-13 OPEN (V2).doc

Page 290/534

Date: September 11, 2013 To: El Camino Hospital Board of Directors

From: Tomi Ryba, CEO

Re: CEO Report - Open Session

1 Page 291/534 Quality

 All medical director agreements were renewed by July 1, with new quality goals in place (with two delayed while the directorship is restructured – e.g. those of Dr. Joye and Dr. Collings), the highest priority activity for the months of July and August has been reconciliation of actual performance of the medical directors against stated goals. With a huge effort by Shawn Jacob and Vicky Lawson and vital assistance from Anne Pauselius, we are making progress assessing that performance and moving toward payment of directors.

Service

 The Patient Advisory Committee had its first meeting in July and will rotate between the Mountain View and Los Gatos for its every other month meetings. The group is a nice mix of patients and family members who have had care experiences at either Mountain View or Los Gatos within the last year. Additionally, the group has representation of most of the clinical service lines across the enterprise (Mom Baby, Cardiac, Orthopedics, etc.) All of the members were referred by staff members and have undergone an application and screening/interview process before being selected. This group provided valuable feedback to the organization regarding key aspects of care - notably in the realm of service and patient experience as well as overall quality and safety. The next meeting is slated for September and the group will be prioritizing the service standards and helping to refresh and also provide examples of these key behaviors in action based off of their experiences. This input will be critical to the service culture training for the organization.

Independent Physician Strategies

 IPECH (Independent Physicians of El Camino Hospital) general membership met in July and voted on a new slate of board members. They are: o Shyamali Singhal M.D. o George Ting M.D. o Hya Rubin M.D. o Inna Yaskin M.D. o Ramptin Agah M.D. o Stuart Weissman M.D. o Mathew Gillette M.D. o Earnest Thomas M.D.

The new board is enthusiastic and engaged and they want to discuss the hire of an executive director either full or part time to help with the work plan which will involve clinical integration and information technologies, exploration of ACO development and managed care work, work with transitions for independent physicians and registries and disease management work.

2 Page 292/534 Operations

 ECH’s Senior Health Center received Level 3 designation — the top designation — under the Patient Centered Medical Home voluntary accreditation program with the National Commission for Quality Assurance (NCQA), a Washington, D.C.-based nonprofit organization that seeks to improve health care quality by managing voluntary accreditation programs for physicians and health plans. Additionally, the team is finalizing the SHC/PCMH Dashboard which will be available September. We are working on finalizing a physician partnership of independent doctors in Campbell to launch a second center in CY2014.

 I am pleased to announce that El Camino Hospital, in partnership with the Taft Center for Clinical Research and the Fogarty Clinical Research Institute, recently enrolled its first patient into the Medtronic CoreValve Surgical Replacement and Transcatheter Aortic Valve Implantation (SURTAVI) Trial, a global clinical trial comparing the Medtronic CoreValve® System with surgical aortic valve replacement in patients with severe aortic stenosis who are at intermediate risk for open-heart surgery. El Camino Hospital is one of only 75 clinical sites globally that together will enroll a total of approximately 2,500 patients. El Camino Hospital's team is led by co-investigators Dr. James Joye, an interventional cardiologist, and Dr. Vincent Gaudiani, a senior cardiothoracic surgeon.

 El Camino Hospital is the only Bay Area Hospital participating in a clinical trial of a new treatment for severe emphysema. I am equally pleased to share that Dr. Ganesh Krishna, an interventional pulmonologist at El Camino Hospital and the Palo Alto Medical Foundation, is also partnering with the Fogarty Clinical Research Institute in the national FDA-approved RENEW clinical trial of the RePneu® (pronounced 'RENEW') Lung Volume Reduction Coil (LVRC), a medical implant designed to treat the symptoms of emphysema. El Camino Hospital is the only hospital in the Bay Area to participate in this multicenter, randomized trial that will investigate the safety and effectiveness of the RePneu LVRC based on exercise capacity, improved lung function and quality of life. The trial expects to enroll 315 patients in approximately 30 medical centers across North America and Europe.

 Received an average score of 95% excellent and very good from an independent survey of CONCERN’s top tier employer groups in the categories of: overall rating of services, value to their organization and likelihood of recommending CONCERN to other organizations.

 Completed the Rehab accreditation survey (CARF) August 15-16 for both the General Certification and Neuro Specialty Certification. Actual accreditation results will come in a report in 4-6 weeks; however, they complimented the team as having done a good job and saw no red flags. The recommendations are sent to CARF for analysis and we will be notified of the final results.

 Received certification as a Primary Stroke Center for TJC at Los Gatos.

3 Page 293/534

 Cheryl Reinking has transitioned to the Interim CNO position over the enterprise. Cheryl spends two days a week at LG to interact and meet with the nurse and clinical leaders as well as the staff of LG. Cheryl is establishing her new direct reports team which includes members of pharmacy and lab along with all the nursing directors. The nursing strategic plan is underway for FY 2014 and we foresee its adoption at the Central Partnership Council in September. This is a requirement for Magnet Designation. We are ramping up for Magnet designation now because re designation is due to occur in mid-2014.

 The Evergreen Dialysis Unit treated its last patient on August 5, 2013. All patients were safely and efficiently transferred to other units. All staff that wished to bid on an open position were placed in a position are going through several different training programs including 10 RN’s.

Affordability/Efficiency

 The RPIW (Rapid Performance Improvement Work) to reduce patient door to floor wait time continues to sustain improvements. Target goals for 286 minutes were met by fiscal year end. In order to achieve the results, RN’s have changed the way nursing hand off report is given between the ER nurses and the floor RN’s.

 Major cost savings initiatives that were implemented in August are: o Spine - $400k (Phase II pricing for implant components and biologics effective 8- 5-13. SpineWare, NuVasive, Zimmer and DePuy Spine o Ortho total joints - $940k (new pricing implemented 8-5 and 8-19 with 4 major suppliers. Biomet, DePuy, Zimmer and Stryker)

Community Benefit

 Received annual reports from all 43 El Camino Healthcare District and El Camino Hospital grantees. FY 13 grantee highlights include: 85% of all volume and quality metrics achieved; 93% of top tier partners met their metrics; over 96,000 community members served with grant funding in FY 2013.

Community and Government Affairs

 Board Director Dave Reeder and staff met with LAFCo staff and Commissioners to discuss our service review response in advance of the August 7 public hearing. A great team effort led to ECHD being awarded a “Certificate of Transparency Excellence” from the Special District Leadership Foundation, making ECHD the first special district in Santa Clara County and only the 12th in the state to receive that distinction. LAFCo accepted our report and is requiring that when we send our budget to the County each year, that we also send it to LAFCo staff.

4 Page 294/534  On July 8th, the Superior Court of the State of California, County of Santa Clara, declared Measure M unconstitutional, and elected leaders were informed.

 During July the website had 432k views. In July, the post popular Facebook post was “Sun Safety Tips” with 2.6K reached. The top three videos viewed on the hospital’s YouTube page were Maternity Care, Knee Replacement and Anterior Hip Surgery. In August Facebook fans increased to 6,358 and our top performing Facebook post was for related to oncology and Dr. Dormady.

5 Page 295/534 Separator Page

Att 17 - FINAL Service Animal (CO).doc

Page 296/534 Administrative Policies and Page 1 of 5

EL CAMINO HOSPITAL ADMINISTRATIVE POLICIES AND PROCEDURES 34.0 SERVICE ANIMALS FOR DISABLED PATIENTS OR VISITORS

I. Coverage This policy applies to all inpatients, outpatients and visitors of El Camino Hospital using a service animal.

II. Reviewed/Revised Dates 9/09, 10/12, 8/13

III. Policy Summary

It is the policy of El Camino Hospital to comply with the requirements of the Americans with Disability Act and other state and federal regulations to provide access to individuals with disabilities who present with service animals unless it has been determined that the animal poses a direct threat to the health or safety of others. Except as specified below, a person using a service animal shall generally be afforded the same access to the Hospital as that afforded the public in general. Care of the service animal is the obligation of the person with the disability. Any questions about this policy should be directed to the Manager of Risk Management.

IV. DEFINITIONS

A. Disability:

A disability is defined as a physical or mental impairment that substantially limits one or more of the major life activities of an individual, including but not limited to walking, talking, breathing, hearing or caring for oneself.

B. Service Animal A service animal is defined as a dog trained to work or perform tasks for the benefit of an individual with a disability. For sight impaired patients who are allergic to dogs, a miniature horse (usually not more than 26 inches in height or more than 100 pounds) may be used as a service animal. However, the miniature horse must be trained to provide assistance to the individual with a disability and must be house broken. The work or tasks performed by a service animal must be directly related to the individual´s disability. This includes but is not limited to the following: guiding individuals with impaired vision, alerting individuals with impaired hearing to sounds, providing minimal protection. C. Direct Threat. A direct threat is defined as a significant risk to the health or safety of others that cannot be eliminated or mitigated by a modification of policies and procedures or by the provision of auxiliary aids/services. The Hospital shall make an individual assessment based on reasonable judgment that relies on current medical knowledge or on the best available objective evidence to ascertain the nature, duration, and severity of the

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risk, the probability that the potential injury will actually occur, and whether reasonable modifications of policies, practices or procedures will mitigate the risk.

V. Responsibility

A. Patient.

1. The patient is responsible for arranging for the care of the service animal, including food, water, toileting and cleaning up after the service animal.

2. If the patient is unable to take care of the service animal or needs to be separated from the service animal for a period of time, the patient is responsible for arranging the care of the animal through family members, friends or other accompanying person (not including staff). The patient’s physician may be involved with assessing whether the patient is able to care for the service animal due to his/her condition or whether the patient needs to be in a restricted access area.

3. The service animal shall be well groomed, clean and housebroken. If the service animal does not appear to be well groomed, the patient may be asked to remove the service animal due to the direct threat it poses to the health and safety of patients and visitors.

4. If the service animal becomes out of control and not able to be managed by the patient or designated handler within a reasonable amount of time, the patient/designated handler will be asked to immediately remove the animal from the Hospital. The patient/designated handler shall be responsible for any damage caused by the service animal.

B. Healthcare Provider/Staff

1. Any service animal in attendance of a patient or visitor will be recognized as an animal trained to assist a disabled person and will not be viewed as a “pet”.

2. If any El Camino Hospital employee has a concern that an animal is a “pet” rather than a service animal, the employee may ask the following questions and consult with Risk Management.

a) If the animal is a service animal required because of a disability b) What work/task has the service animal been trained to perform

3. If the person answers “No” to either of the questions above, then the animal is not considered a service animal and the staff member should refer to the Animal Visitation Policy for further guidance about allowing the animal to visit with the patient. The staff

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member should document this interaction in the patient’s medical record. If the patient answers yes to the questions, the service must be allowed unless it is in a restricted area.

4. Staff must not ask for information about the person’s disability, require medical documentation regarding the service animal, or request to see a special identification card or training documentation for the service animal.

VI. Procedure

A. In general, a service animal shall be permitted in any area of the Hospital that is unrestricted to inpatients, outpatients or visitors such as lobbies, cafeterias and patient rooms provided that the service animal does not pose a Direct Threat to the health and safety of others and would not require a fundamental alteration in the Hospital’s policies and procedures.

1. Upon identification that a patient has a service animal, staff shall notify the clinical manager of the area and the Hospital Supervisor if the patient requires admission.

2. For inpatients, the patient should be placed in a private room if at all possible.

3. The manager of the unit and/or Hospital Supervisor should aid patients or staff with known or suspected allergies to a service animal by making reasonable accommodations such as arranging for different staff members, arranging for physical separation whenever possible.

B. Restricted Access Areas. Areas that are considered restricted where service animals will not be allowed include areas where the general public is not permitted. Additional areas may be identified on a case-by-case basis to protect the health and safety of patients, visitors and employees of El Camino Hospital. These areas include but are not limited to: a. Procedural and interventional areas including the operating room, cath labs, endoscopy and the PACU. b. Patient units where a patient is immunocompromised c. Patients who are placed in isolation for respiratory, enteric or infectious precautions. d. Areas where the hospital determines that the service animal presents a direct threat and that the presence of the service animal would not require a fundamental alteration in the unit/department’s policies, practices, or procedures. Prior to excluding the service animal, hospital staff must make an individualized assessment, based on reasonable judgment that relies on current medical knowledge or on the best available objective evidence, to ascertain: the nature, duration, and severity of the risk; the probability that the potential injury will actually occur; and whether reasonable modifications of policies, practices, or procedures will mitigate the risk.

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C. If a patient with a service animal is located in an area with restricted access, efforts must be made to accommodate the patient’s disability.

D. Risk Management/Clinical Effectiveness shall be notified before a patient is denied access to an area with his/her service animal.

E. The patient will be informed about the decision to allow/deny the service animal, the reasons why, and what accommodations will be made for his/her disability and documentation will be in the medical record.

Page 300/534 Administrative Policies and Procedures 34.0 Services Animals for Disabled Patients or Visitors Page 5 of 5

VI. CROSS REFERENCE DOCUMENTS

A. Americans with Disabilities Act of 1990 B. Chang H. Miller, H. Watkins, N., Arduino, M., Midgley, G., Aguero, S. Pinto- Powel, R., von Reyn, C.F., Edwards, W., McNeil, M., Jarvis, W., Pruitt, R. “An Epidemic of Malassezia pachydermatis in an Intensive Care Nursing Associated with the Colonization of Health Care Workers’ Pet Animals,” New England Journal of Medicine, March 12, 1998, vol. 338, no. 11, pp. 796-711. C. Hardy, Glenna: “The seeing-eye animal: an infection risk in hospital?” Canadian Medical Association Journal, March 15, 1981, vol. 124, pp. 698-700. D. Houghtalen, R., Doody, J.I., “After the ADA: Service Animals on Inpatient Psychiatric Units,” Bull American Academy Psychiatry Law, vol. 23, no. 2, 1995. E. Mayhall, C.G.., Epidemiology and Prevention of Nosocomial Infection Associated with Animals in the Hospital, Hospital Epidemiology and Infection Control, 1996 Williams & Wilkins, chapter 85. F. Olmsted, R., APIC Infection Control and Applied Epidemiology, Principles and Practice, 1996, Mosby, chapter 97. G. Reuter, “Pet Study Warns of Many Diseases Transfer to Humans,” The Washington Post, September 22, 1997

VII. Approvals Patient Care Management Council, 8/12 (MV and LG) Medical Executive Committee, 9/12 Board of Directors: 11/12

Page 301/534 Pages and are closed session materials not publicly available.