1-510-338-9438 Meeting Number (Access Code): 126 501 8815 Meeting Password: 74836697

GRAND TRAVERSE COUNTY DEPARTMENT OF HEALTH AND HUMAN SERVICES BOARD

9:00 AM Conference Call Phone: 1-510-338-9438 Meeting number (access code): 126 501 8815 Meeting Password: 74836697

On November 18, 2020 Robert Gordon, MDHHS Director, signed into effect an Emergency Order MCL 333.2253 to reduce the spread of COVID-19 by limiting the number of people at public indoor gatherings.

The Board Chair will announce when it is time for public comment and will give all call-in numbers the opportunity to speak during this time. This meeting will be recorded and saved on the Grand Traverse Pavilions website.

November 23, 2020 AGENDA

1. CALL TO ORDER – 9:00 a.m. Grand Traverse Pavilions – John Rizzo, Chair, Grand Traverse County Department of Health and Human Services Board

2. FIRST PUBLIC COMMENT Any person shall be permitted to address a meeting of the Grand Traverse County Department of Health and Human Services Board which is required to be open to the public under the provisions of the Michigan Open Meetings Act, as amended. (MCLA 15.261, et.seq.) Public comment shall be carried out in accordance with the following Board Rules and Procedures: 1. Any person wishing to address the Board shall state his or her name and address. 2. Persons may address the Board on matters which are relevant to Grand Traverse Pavilions issues. 3. No person shall be allowed to speak more than once on the same matter, excluding time needed to answer Board Members questions. The Chairperson shall control the amount of time each person shall be allowed to speak, which shall not exceed three (3) minutes. (1) Chairperson may, at his or her discretion, extend the amount of time any person is allowed to speak. (2) Whenever a group wishes to address the Board, the Chairperson may require that the group designate a spokesperson; the Chairperson shall control the amount of time the spokesperson shall be allowed to speak, which shall not exceed fifteen (15) minutes.

3. COUNTY LIAISON REPORT

4. APPROVAL OF AGENDA

5. CONSENT CALENDAR The purpose of the consent calendar is to expedite business by grouping items to be dealt with by one Board motion without discussion. Any member of the Board, or staff may ask that any item on the consent calendar be removed and placed elsewhere on the agenda for discussion. Such requests will be automatically respected.

Page 1 of 65 If any item is not removed from the consent calendar, the item on the agenda is approved by a single Board action adopting the consent calendar.

A. Review and File HANDOUT#

(1) Minutes of the 10/30/20 Board Meeting 1 (2) Closed Minutes of 10/30/20 Board Meeting (mailed to Board only) (3) Colby Thank You 2 (4) Provencher Thank You 3 (5) Opie Thank You 4 (6) P.E.P. Talk Employee Newsletter – November 5 (7) Media Report – October 6

6. ITEMS REMOVED FROM CONSENT CALENDAR (1)

7. GRAND TRAVERSE MEDICAL CARE -- Korvyn R. Hansen

A. General Information (1) COVID-19 Update 7 (2) U.S. News World Report Best Nursing Homes 8

B. Chief Executive Officer Board Report 9

C. Business (1) Financial Report 10 (2) Cash Reserve Policy 11 (3) Pension Bond Resolution/Proposal 12 (4) Proposed 5-Year Capital Budget (2021-2025) 13 (5) Proposed 2021 Non-union Wage Recommendation 14

D. Medical Staff (1)

G.T.P. Announcements (1) October Service Excellence Award 15

8. SECOND PUBLIC COMMENT Refer to Rules under First Public Comment/Input above.

9. CLOSED SESSION (1)

10. ADJOURNMENT

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GRAND TRAVERSE COUNTY DEPARTMENT OF HEALTH AND HUMAN SERVICES BOARD 1000 Pavilions Circle, Traverse City, MI 49684

MINUTES OF THE OCTOBER 30, 2020 MEETING

PRESENT: John Rizzo, Cecil McNally, Ralph Soffredine Board Kory Hansen, Rose Coleman, Robert Barnes, Lindsey Dood, Darcey Gratton Staff Gordie LaPointe Commission ABSENT: GUESTS: Steve Burke, Warren Creamer, Roger Swets, Jon Lanczak

The regular meeting of the Grand Traverse County Department of Health and Human Services Board was called to order at 9:09 am by Board Chair John Rizzo in the Dayclub Room at the West Bay Beach, a Delamar Resort.

On October 9, 2020 Robert Gordon, MDHHS Director, signed in to effect an Emergency Order MCL 333.2253 to reduce the spread of COVID-19 by limiting the number of people at public indoor gatherings. Grand Traverse Pavilions provided a link on its website for public participation. This meeting was recorded and saved on upnorthmedia.com and also shown on Charter cable channel 189.

First Public Comment

Andi Gerring

Claudia Bruce

County Liaison Report – LaPointe shared discussions of the most recent county board of commissioner meetings.

Approval of Agenda – Chair Rizzo asked if there were additions, changes or corrections to the agenda. Motion was made by Soffredine to approve the Agenda as presented, seconded by McNally and carried unanimously.

The purpose of the Consent Calendar is to expedite business by grouping items to be dealt with by one Board motion without discussion. Any member of the Board or staff may ask that any item on the Consent Calendar be removed and placed elsewhere on the agenda for discussion. Such requests will be automatically respected.

REVIEW AND FILE

(1) Minutes of the 9/25/20 Board Meeting (2) Roberts Thank You

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(3) Watson Thank You (4) Minicucci Thank You (5) Bowling Thank You (6) P.E.P. Talk Employee Newsletter – October (7) Media Report – September (8) AAANM Adult Day Caregiver Respite Grant

Motion was made by Soffredine to approve the Consent Calendar as presented. Motion seconded by McNally and carried unanimously.

Items Removed From Consent Calendar – none

Pension Bond Resolution – Hansen reviewed his memo to the board regarding the Grand Traverse County Board of Commissioners (GTBOC) not taking action to approve the Pavilions pension bonds at their October 6, 2020 board meeting. The GTBOC instead referred the item back to the DHHS board for further review. The Professional Service Team of Steven Burke, President of MFCI, Warren Creamer III, Managing Director of Public Finance at Baird, Roger Swets, municipal bond attorney for Dickinson Wright and Jon Lanczak, Senior Manager of Senior Care & Living Strategy and Operations at Plante Moran participated via conference phone to answer questions. After extensive discussion and evaluation the Board agreed to continue the discussion of the bonds at the next meeting in November including a related topic of the cash reserves fund balance policy.

COVID-19 Update – Coleman provided an update on the on-going status of COVID-related topics that affect the operation of the Pavilions. Coleman shared that she was alerted on October 28 that three staff members tested positive from the October 26 testing. Coleman stated the county COVID Level was upgraded to Level E which prohibits indoor visitations for nursing facilities. This mandate will be in force until there is a decrease in the number of confirmed positive cases reported on a county-wide basis regardless of the facility’s COVID status in the coming weeks. However, staff have prepared a formal visitation policy for full indoor visitation and will be shared with families as soon as visitation is allowed. Coleman shared that communal dining and activities of small groups will begin the first part of November. McNally suggested adding the social worker’s contact phone numbers on the bottom of the newsletter to help families call for updates.

Third Quarter Overtime Report – Hansen reviewed the report and answered board member’s questions.

Third Quarter Annual Plan 2020 Update – Hansen reviewed the written report for third quarter and answered board member’s questions.

Financial Report – Dood reviewed the financial operations report for September 2020. Dood outlined revenue and expenses compared to budget for each of the Pavilions’ programs that include the Medical Care Facility (skilled nursing), The Cottages (Assisted and Independent Living) and Adult Day Services. Additional information was provided on respective census and accounts receivable along with the total cash ending balance. Dood summarized the review of vouchers for the month that were in order without exception. The Social Accountability Summary was reviewed indicating the amount of uncompensated care provided and volunteer hours for the month. Motion made by Soffredine to accept the financial operations report as presented. Motion seconded by McNally and carried unanimously.

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Chief Executive Officer Report – Hansen reviewed his monthly report for September and answered board member’s questions.

Medical Staff

Donald Willman, DO - Attending Privileges - Hansen reviewed the request of Donald Willman, DO, to have attending privileges as recommended by Medical Director Dr. April Kurkowski, D.O. Donald is joining Sound Physicians, to serve nursing homes and assisted living facilities.

Jane Smallwood, NP - Attending Privileges - Hansen reviewed the request of Jane Smallwood, NP, to have attending privileges as recommended by Medical Director Dr. April Kurkowski, D.O. Jane is employed by PACE North which contracts with Grand Traverse Pavilions for skilled nursing short-term rehab services.

Mark Byland, MD - Attending Privileges - Hansen reviewed the request of Mark Byland, MD, to have attending privileges as recommended by Medical Director Dr. April Kurkowski, D.O. Mark is employed by PACE North which contracts with Grand Traverse Pavilions for skilled nursing short-term rehab services.

Motion was made by McNally to approve Donald Willman, DO, Jane Smallwood, NP and Mark Byland, MD for attending privileges, seconded by Soffredine and carried unanimously

Grand Traverse Pavilions Announcements - (1) September Service Excellence Award - Hansen reviewed weekly winners (2) Legacy

Second Public Comment

Andi Gerring

Claudia Bruce

Board Member Comment

Ralph Soffredine shared his appreciation for Coleman’s hard work and excellent leadership during the pandemic with keeping the residents and staff safe. Both Rizzo and McNally agreed.

Motion was made by McNally, seconded by Soffredine to go into Closed Session at 11:36 am for the purpose of discussing QAPI Quarterly Update and Resident Quarterly Incidents which all include discussion of Protected Health Information and for the purpose of conducting the annual personnel evaluation of the Administrator/CEO and employment contract negotiation at his request.

11:36 am LaPointe and Barnes out

Roll Call - McNally - yes, Rizzo – yes, Soffredine - yes

Motion was made by Rizzo to come out of Closed Session at 12:00 pm, seconded by McNally and carried unanimously.

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Administrator/CEO Annual Performance Evaluation – Due to the lateness of time, the annual evaluation of the Administrator/CEO was postponed to a future meeting.

McNally moved to approve the extension of the Administrator/CEO employment contract for an additional calendar year, to December 31, 2021. Soffredine seconded and carried unanimously.

Meeting adjourned at 12:02 pm

Signatures:

John Rizzo – Chair Grand Traverse County Department of Health and Human Services Board

Korvyn R. Hansen, Assistant-Secretary

Date: November 23, 2020 Approved Corrected and Approved

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Page 7 of 65 Page 8 of 65 Page 9 of 65 Page 10 of 65 VOLUME 8, ISSUE 11, NOVEMBER 2020 P E P T A L K

AN ATTITUDE OF GRATITUDE NOVEMBER 2020 IN-SERVICES Due November 30, 2020 As we ride out this pandemic, there are things we can do to im-  Relias: Mandatory – All STAFF: prove our outcomes and maintain health. One of the most pow- Implicit Bias erful tools for staying healthy is gratitude. What better to con-  Relias: Mandatory – All STAFF: Electrical Safety sider at this time of year?  Relias: Mandatory – ALL STAFF: Corporate Compliance There are always things to be grateful for (even now), and grati- and Ethics tude reminds us how special, beautiful and fortunate our lives  Relias: Mandatory – ALL are, even under stressful or hazardous conditions. STAFF: Trauma Informed Care  Relias: Mandatory – ALL STAFF: All Page and Code Sta- As we navigate this quarantine and epidemic, why not try to tus think of 3 things you are grateful for upon waking and going to  Relias: Mandatory – CERTIFIED sleep every day. At first it may be difficult to think of things that NURSE AIDES: Activities: An you can appreciate as everything may seem dire, but practicing interdisciplinary Approach  Relias: Mandatory – LICENSED gratitude makes gratitude a way of life! NURSES: Pneumonia and Bronchitis Management Gratitude practice is not only important for making you feel better psychologically during this crisis, it can also help your physi- Relias Link: https:// gtp.training.reliaslearning.com cal health in response to respiratory infection and in general (especially in older adults who are in a higher risk category for COVID-19). GRATITUDE Keep Calm and Carry On. During World War II (a different ex- TURNS istential threat to our wellbeing) the English people were told to "Keep Calm and Carry On." Though this is now a meme and WHAT WE HAVE fodder for kitschy t-shirts, the wisdom behind this statement INTO is as true as it ever was. ENOUGH Keep calm and carry on. We will get through this. Life will re- turn to normal. It may be a new kind of normal, but this will all be a memory one day.

Finally, it is important to focus on the silver lining of this situation. Crisis brings out the best in people. Crisis reminds us why it is important to celebrate every day and share our love with family, neighbors, and friends. Crisis reminds us of how lucky we are and how important it is to take care of ourselves, our communities, and our planet.

As we weather this crisis, let us be fortunate enough to remember the lessons that it has to teach Pageus so 11 that of we65 can continue to strive towards a better tomorrow. P E P T A L K VOLUME 8, ISSUE 11, NOVEMBER 2020 P A G E 2 5 HEALTHY EATING TIPS FOR THE HOLIDAYS

‘Tis the season for family, festivity, and food—lots of food. Temptations are everywhere, and parties and travel disrupt daily routines. What’s more, it all goes on for weeks. How do you stick to your guns when everyone around you seems to be splurging? Here are 5 tips that can help: 1. Holiday-Proof Your Plan You may not be able to control what food you’re served, and you’re going to see other people eating tempting treats. Meet the challenges armed with a plan:  Eat close to your usual times to keep your blood sugar steady. If your meal is served later than normal, eat a small snack at your usual mealtime and eat a little less when dinner is served.  Invited to a party? Offer to bring a healthy dish along.  If you have a sweet treat, cut back on other carbs (like potatoes and bread) during the meal.  Don’t skip meals to save up for a feast. It will be harder to manage your hunger...you’ll be really hungry and more likely to overeat.  If you slip up, get right back to healthy eating with your next meal. 2. Outsmart the Buffet When you face a spread of delicious holiday food, make healthy choices easier:  Have a small plate of the foods you like best and then move away from the buffet table.  Start with vegetables to take the edge off your appetite.  Eat slowly. It takes at least 20 minutes for your brain to realize you’re full.  Avoid or limit alcohol. If you do have an alcoholic drink, have it with food. Alcohol can lower blood sugar and interact with diabetes medicines. 3. Fit in Favorites No food is on the naughty list. Choose the dishes you really love and can’t get any other time of year, like Aunt Edna’s pumpkin pie. Slow down and savor a small serving, 4. Keep Moving You’ve got a lot on your plate this time of year, and physical activity can get crowded out. But being active is your secret holiday weapon; it can help make up for eating more than usual and reduce stress during this most stressful time of year. Get moving with friends and family, such as taking a walk after a holiday meal. 5. Get Your Zzz’s Going out more and staying out later often means cutting back on sleep. When you’re sleep deprived you’ll tend to eat more and prefer high-fat, high-sugar food. Aim for 7 to 8 hours per night to guard against mindless eating. Most of all, remember what the season is about—celebrating and connecting with the people you care about. When you focus more on the fun, it’s easier to focus less on the food.

CONGRATULATIONS and GOOD LUCK

The following employees have achieved success after hard work. We applaud your efforts and determination to “git ‘er done”!!

Naomi Rode—RN to BSN Kayla Tillman—LPN to RN Patricia Farrington—UW to CNA

The following employees have been approved for free tuition through the Futures for Frontlin- ers program. Good luck to you as you embark on your journey!!

Bethany Sherwin—CNA Danielle Recker—CNA Drew Spencley—CNA

Page 12 of 65 P E P T A L K VOLUME 8, ISSUE 11, NOVEMBER 2020 P A G E 3

MILESTONE ANNIVERSARY Amanda Prance : 20 Years Amanda is a puzzle extraordinaire! As a Scheduler, Amanda receives many, many email and phone calls every day. She does a great job caring for the residents and staff by ensuring the schedule is complete and creatively fits everyone’s needs. In addition to scheduling, Amanda assists in setting up transportation, communicating with ES and ADONs and pay- roll. Thank you, Amanda for all you do.

MILESTONE ANNIVERSARY April March : 5 Years April has been employed at GTP for five years and just recently passed her RN boards! April is well-known for her excellent nursing judgement and care, her hard work ethic, and her unfailing teamwork. She’s a quick learner, a great critical thinker, and never backs down from a challenge. She remains calm in stressful situations which is comforting to residents and other staff. She is a great supervisor and ensures quality care is given to our residents. April has a positive attitude and even under the mask, you can tell she is smiling. Nurses, CNAs, and most importantly the residents all love when she is working. We all love and appreciate April so much! MILESTONE ANNIVERSARY Ame Palacpac : 5 Years Ame has been a valued member of the Wellness Center team for five years! She is a per diem Physical Therapist that is skilled and dependable. She is invaluable in helping deliver excellent patient care on the weekends. Thank you, Ame, for your service to the Wellness Center and GTP!

MILESTONE ANNIVERSARY Kim Silvas : 5 Years Her smile lights up the room. The residents respond so well to Kim’s smile, soft approach and kindness. Kim is hardworking and dependable. Kim will go out of her way to help any- one, whether it be residents, staff, or families. The residents, families and staff at the Grand Traverse Pavilions, especially on Elm, are lucky to have you looking out for them and providing great care. Thank you for your 5 years of dedicated service.

LET’S TALK TURKEY � The average number of calories consumed on Thanksgiving is 4,500. � Butterball answers more than 100,000 turkey-cooking questions via their Butterball Turkey Hotline each November and December. � The tradition of football on Thanksgiving began in 1876 with a game between Yale and Princeton. The first NFL games were played on Thanksgiving in 1920. � AAA Travel estimates less than 50 million Americans will hit the road for the holiday this year. The figure marks the most dramatic one-year drop since the Great Recession in 2008.

Page 13 of 65 VOLUME 8, ISSUE 11, NOVEMBER 2020 P A G E 4

Laura Bilbrey Halaina Bufford Erin Ducker Jenn Gallagher RN RN Sodexo—Registered Dietician CNA The EXPERT in anything was once a BEGINNER Taylor Haslip Tayler McCaughna Jessica Thrasher Universal Worker Housekeeper Universal Worker

P E C A N T A S S I E S

CRUST: FILLING: 1/2 cup butter, softened 1 large egg, room temperature 3 ounces cream cheese, softened 3/4 cup packed brown sugar 1 cup all-purpose flour 1 teaspoon vanilla extract 2/3 cup finely chopped pecans, divided

 In a small bowl, beat butter and cream cheese until smooth; gradually beat in flour. Refrigerate, covered, 1 hour or until firm enough to roll.  Preheat oven to 375°. Shape dough into 1-in. balls; press evenly onto bottoms and up sides of greased mini muffin cups.  For filling, in a small bowl, mix egg, brown sugar, butter, vanilla and salt until blended. Stir in 1/3 cup pecans; spoon into pastries. Sprinkle with remaining pecans.  Bake 15-20 minutes or until edges are golden and filling is puffed. Cool in pans 2 minutes. Remove to wire racks to cool.Freeze option: Freeze cooled cookies, layered between waxed paper, in freezer containers. To use, thaw in covered containers. Page 14 of 65 October, 2020 Media Report

Broadcast Report:

WTCM-FM: Recruitment/Join the Team Broadcast advertising ran from October 1-11, 2020. On-Site Dialysis Services Broadcast advertising ran from October 3-31, 2020.

WTCM-AM: Recruitment/Join the Team Broadcast advertising ran from October 2, 2020. Recruitment/Join the Team Broadcast advertising ran from October 6, 2020. Adult Day Broadcast advertising ran from October 13, 2020. Adult Day Broadcast advertising ran from October 22, 2020.

WKLT-FM/WBCM-FM: Recruitment/Join the Team Broadcast advertising ran from October 1-11, 2020. On-Site Dialysis Services Broadcast advertising ran from October 3-31, 2020.

PRINT:

Record Eagle: Grand Mission October 1, 2020. A Career that Loves you Back.. October 4, 2020. On-Site Dialysis Services October 11, 2020.

NorthCoast: On-Site Dialysis Services October 10, 2020. A Career that Loves you Back.. October 24, 2020.

Record Eagle/Young at Heart: Young at Heart October, 21 – Wellness – Our Team Has Your Back

DIGITAL:

TC Ticker-Classifieds A Career that Loves you Back.. Monday, October 12, 2020 A Career that Loves you Back.. Tuesday, October 13, 2020 A Career that Loves you Back.. Wednesday, October 14, 2020 A Career that Loves you Back.. Thursday, October 15, 2020 A Career that Loves you Back.. Friday, October 16, 2020 A Career that Loves you Back.. Saturday, October 17, 2020 A Career that Loves you Back.. Sunday, October 18, 2020

Record Eagle: Digital Career Advertisement –October 20, 2020

Michigan 4 Hire: Digital Career Advertisement – October 1 - 31

Page 15 of 65

Digital Campaign Results Record Eagle:

 84,053 impressions in October from people in Northern MI who have interests/behaviors relating to job seeking, job searches, nursing jobs, etc. with 97 clicks.  Top Geographic Areas: Traverse City, Boyne City, Charlevoix, Cadillac, and Mesick.  Garnered 53 branding actions in October. This includes: 1. 50 view-through other actions: this is when someone sees your ad, doesn’t click on it, but then later goes to your website (either organically through Google or by the direct URL) for more information. 2. 3 click-through other actions: this is when someone clicks on your ad to the careers page and then later comes back to your website (either organically through Google or direct URL)

Ticker Classifieds:

 For the week of October 12 – 18 total job views totaled 422.  Experienced a 64$% increase from the previous week’s page views to our employment website (October 5-11).

Obituary Ad online Results:

522,986 views in the exclusive Obituary Sponsorship position in less than five months (started 5/15)…reaching the assisted living demographic of 50+ totaling 116,947

Page 16 of 65 COVID 19 Report – November 2020

Testing Results We are still receiving our COVID results within 48 hours of receipt. During the testing period of 10/26, there were three new positive cases of COVID. One staff member works the midnight shift on the Rehab unit without symptoms, the second, a direct care worker on Aspen with symptoms and the third was a direct care worker at Willow Cottage without symptoms. Testing for the week of 11/2 did not have any new positive COVID cases. Testing the week of 11/9 had one staff member on the Rehab unit test positive, without symptoms. We completed testing on 11/16 for all staff, SNF and cottage residents and are awaiting results.

Staff Screening Staff are required to enter the building through the employee tunnel wearing their mask. Employees have their temperature and photo taken via the thermal camera. If a temperature is outside of the acceptable range of 94-100 degrees, the nursing supervisor and administration are instantly alerted. An assessment is conducted by nursing at this time. If the temperature is acceptable, the screen on the thermal camera flashes green and staff proceed to the questionnaire kiosk to complete the screening. Should staff check yes to any symptoms, the system prevents them from completing the screening process and a nursing assessment is completed at this time.

Visitation We continue with a large volume of electronic visits between the residents and their families. Window visits continue weekly and we will be moving indoor visits in the front lobby vestibule. The family member will still make an appointment as usual however will be able to be in the warm vestibule while the resident remains in the lobby. We have not been able to facilitate any in-person visits due to several factors including 14 days without a new COVID positive case and our county being at level E on the MI Start map for county risk levels. Additionally MDHHS issued new orders on November 16, 2020 regarding gatherings. Although these orders do not affect the residents particularly, the department is asking people to stay home and socially distance from one another.

Communication In addition to phone conferences between families and staff, COVID information and facility happenings can be found on our website under the Weekly Family Update tab, the Neighborhood News and the Legacy publication. In the event that families need to be notified of a positive COVID case, a ROBO call is sent out with information needed and direction to review the facility update page. Staff receive a facility text notifying them of a positive COVID. Our residents are notified verbally with reassurances and questions answered.

Infection Control Employee and any resident illness is tracked through our infection control processes to ensure that staff and residents are not exposing otherwise healthy individuals to potential germs. Staff and residents practice strict hand hygiene. Facility surfaces are disinfected several times daily and as needed. Staff are continually provided education on infection control practices within the workplace, in the community and at home. Staff are also required to wear eye protection while in

Page 17 of 65 the resident areas. We continue to administer the influenza vaccine to staff and residents. Although we do not know when a COVID vaccine will be available, both the Pavilions and the Cottages are signed up with a pharmacy for its administration.

As interpreted by MDHHS, all new admissions, readmissions and those residents who leave the facility for appointments must be quarantined (preferably on the same unit) for 14 days regardless of a resident’s COVID status. The Rehab unit is being utilized for this purpose and has been divided into three sections – new and readmissions, those who go out for an appointment and those who may become COVID positive. Staff on this unit are required to wear KN95’s along will full PPE including face shields when entering any isolation room.

Personal Protection Equipment (PPE) Currently we have an adequate supply of gowns, face shields and masks. There is a shortage of gloves in all sizes nationwide. We order continually and sometimes the order is received and others times we are placed on a wait list. We have managed a healthy supply of PPE to last us through the winter and flu season. We continue to search out legitimate suppliers of approved PPE.

COVID Surveys We have not had any further COVID-focused surveys however we are working with the Quality Improvement Organization as required by CMS on two separate projects. The first project is regarding antibiotic usage and the second is environmental disinfection practices. These projects are in their early stages with no data yet to report.

COVID Funding Relief The State of Michigan, in its FY2021 budget provided a $20 million allocation for nursing homes for PPE based on $439 per bed. This funding, distributed in November, netted the Pavilions $105,379. The Pavilions continued to receive reimbursement for COVID-related costs, including $45,602 from the MDHHS towards the $2/hour wage premium for direct-care staff; and $53,917 from MDHHS towards weekly COVID testing administration of residents and staff. Additionally, the grant of $18,500 funded through the Michigan Department of Health and Human Services (MDHHS) for infection prevention and control equipment was received in October.

Page 18 of 65 FOR IMMEDIATE RELEASE November 1, 2020

CONTACT: Deborah Allen Grand Traverse Pavilions Chief Development/Community Engagement Officer (231) 932-3020 [email protected]

U.S. News and World Report Names Grand Traverse Pavilions A 2020-21 Best Nursing Home X2

November 1, 2020 – Traverse City. Grand Traverse Pavilions is among the top 5% of U.S. skilled nursing facilities that have been recognized as a Best Nursing Home for 2020-21 by U.S. News & World Report by achieving the highest possible rating of “High Performing,” for both Short-Term Rehabilitation and Long-Term Care. The Pavilions was one of only 32 nursing homes in Michigan to earn a top rating in both categories and the only “very large” facility, defined as 200 or more beds. U.S. News gives the designation of Best Nursing Home only to those homes that satisfy U.S. News’s assessment of the appropriate use of key services and consistent performance in a variety of quality measures.

“We are very proud and honored to be recognized by U.S. News as being one of the Best Nursing Homes in the country,” said Kory Hansen, Administrator/CEO for Grand Traverse Pavilions, “all of our team works very hard to achieve quality outcomes and this designation is a testament to their efforts.”

Now in its 11th year, the U.S. News Best Nursing Homes ratings and profiles offer comprehensive information about care, safety, health inspections, staffing and more for nearly all of the nation’s 15,000-plus nursing homes. The Best Nursing Homes ratings reflect U.S. News’ exclusive analysis of publicly available data using a methodology

Page 19 of 65 defined by U.S. News that evaluates factors that it has determined most greatly impact patient and resident care, safety, and outcomes. This year, to accompany the new ratings, nursing home profile pages were updated to include a patient safety summary that reflects COVID-19 data alongside other measurements of safety and related advice on choosing a home or facility amidst the pandemic.

“U.S. News strives to provide access to information that allows consumers to make educated decisions on all types of care,” said Ben Harder, managing editor and chief of health analysis at U.S. News. “Updating the profiles to include a patient safety summary that highlights COVID-19 data paired with other measures of care arms families, caregivers and patients with the information needed to make a decision that keeps safety at the highest priority.”

The Best Nursing Home finder features ratings on both long-term and short-term care. The Long-Term Care Rating aims to provide prospective residents who need help with daily activities, and their families, with analysis and information regarding the quality of care provided by nursing homes. The rating includes data on staffing, success in preventing ER visits and pneumonia vaccination rates, among other metrics. The short- term rating incorporates measures of quality including consistency of registered nurse staffing, use of antipsychotic drugs and success in preventing falls. For more information behind both U.S. News ratings please visit USNews.com.

### About Grand Traverse Pavilions Grand Traverse Pavilions is the region’s first and only nonprofit Continuum of Care. Initiated by Grand Traverse County Department of Health and Human Services in response to the Social Welfare Act 280 of 1939 to care for the states most vulnerable citizens. Current the Pavilions provides services for more than 300 on-site residents and 100 daily program participants. Grand Traverse Pavilions is a community of caring and innovation primarily for our region’s low-income seniors, with Wellness Center programs for the entire community. Grand Traverse Pavilions has received Nursing Care Center accreditation by the Joint Commission along with Post-Acute Care and Memory Care certifications. A recipient of the Governor’s Quality Care Award, The Pavilions is owned by Grand Traverse County and governed by the Grand Traverse County Department of Health and Human Services Board. Learn more about Grand Traverse Pavilions by visiting www.gtpavilions.org.

Page 20 of 65 About U.S. News & World Report U.S. News & World Report is the global leader in quality rankings that empower people to make better, more informed decisions about important issues affecting their lives. A digital news and information company focused on Education, Health, Money, Travel, Cars and News USNews.com provides consumer advice, rankings and analysis to serve people making complex decisions throughout all stages of life. More than 40 million people visit USNews.com each month for research and guidance. Founded in 1933, U.S. News is headquartered in Washington, D.C.

Support Criteria: U.S. News Best Nursing Homes Nursing Home Compare

Page 21 of 65 Page 22 of 65 Page 23 of 65 Page 24 of 65 Page 25 of 65 Page 26 of 65 Page 27 of 65 Page 28 of 65 Page 29 of 65 Page 30 of 65 Page 31 of 65 Page 32 of 65 Page 33 of 65 Page 34 of 65 Page 35 of 65 Page 36 of 65 Page 37 of 65 Page 38 of 65 Page 39 of 65 Page 40 of 65 Page 41 of 65 Page 42 of 65 Page 43 of 65 Page 44 of 65 Page 45 of 65 Page 46 of 65 Page 47 of 65 Page 48 of 65 Page 49 of 65 Page 50 of 65 GRAND TRAVERSE COUNTY DEPARTMENT OF HEALTH AND HUMAN SERVICES BOARD (Grand Traverse County, Michigan)

RESOLUTION NO. ______

RESOLUTION TO AUTHORIZE ACTIONS WITH RESPECT TO PENSION BONDS

Minutes of a regular meeting of the Grand Traverse County Department of Health and Human Services Board, Grand Traverse County, Michigan, held on November ____, 2020, at _____ p.m., local time.

PRESENT: Members:

ABSENT: Members:

The following resolution was offered by Member ______and supported by Member ______:

WHEREAS, the Grand Traverse County Department of Health and Human Services Board (the “Board”) deems it to be in the best in interest of the Grand Traverse Pavilions (the “Pavilions”) for the County of Grand Traverse (the “County”) to issue its limited tax general obligation bonds (the "Bonds") to finance part of the cost of the Pavilions’ unfunded pension liability for its defined benefit plan retirement program as authorized by Section 518 of Act 34, Public Acts of Michigan, 2001, as amended (“Act 34”);

WHEREAS, the issuance of the Bonds would significantly fund Division 41 and Division 43 of the defined benefit retirement plan, providing assurance to the participants in such divisions of their pension benefits thereunder;

WHEREAS, Act 34 requires the preparation of a comprehensive financial plan and other actions and certain certifications prior to filing an application with the Department of Treasury for approval for the issuance of Bonds;

WHEREAS, a comprehensive financial plan has been prepared pursuant to Section 518(5) of Act 34 (the “Comprehensive Financial Plan”) and presented to the Board; and

WHEREAS, the Board has reviewed the Comprehensive Financial Plan and desires to approve and recommend the Comprehensive Financial Plan to the County, along with a request that the County consider issuance of the Bonds for the benefit of the Pavilions.

4834-6357-6523 v1 [90129-4] Page 51 of 65 NOW, THEREFORE, BE IT RESOLVED that:

1. The Board finds that the issuance of the Bonds would be in the best interests of the Pavilions, hereby approves the form of the Comprehensive Financial Plan as presented to the Board, with such additions, completions and changes as may be approved by any officer of the Pavilions and recommends it to the County Board of Commissioners for consideration.

2. The Board requests that the County consider undertaking the issuance of the Bonds for the purpose of providing funding to Division 41 and Division 43 of the defined benefit retirement plan and proceed with such actions as are required for that purpose.

3. The officers of the Pavilions are authorized and directed to take all necessary procedures required to assist in the issuance of the Bonds, should the County determine to proceed. Such officers, or any one or more of them, are authorized to execute any documents or certificates necessary to effectuate such issuance.

4. All resolutions and parts of resolutions insofar as they conflict with the provisions of this resolution be and the same are hereby rescinded.

YEAS:

NAYS: ABSTAIN: RESOLUTION DECLARED ADOPTED.

CERTIFICATION

I hereby certify that the foregoing is a true and complete copy of a Resolution adopted by the Grand Traverse County Department of Health and Human Services Board at a regular meeting held on September ___, 2020 and that the public notice of the meeting was given pursuant to Act 267, Public Acts of Michigan, 1976, as amended.

Dated: November ___, 2020

4834-6357-6523 v1 [90129-4] Page 52 of 65 Page 53 of 65 Grand Traverse Pavilions Grand Traverse Medical Care

FUND BALANCE POLICY Financial Management POLICY Grand Traverse Pavilions’ unassigned fund balance is a measure of its financial resources. The accumulation of unassigned fund balance during favorable economic times is a resource to sustain an organization in times of economic duress. Assigned fund balances are also an important indicator of board commitment to ensuring the long-term sustainability of the organization as they are intended to be used for specific purposes. Establishing this policy will assist the Pavilions in adhering to a widely recognized, prudent fiscal management tool appropriate for protecting the Organization’s overall financial condition. This policy establishes: 1. Acceptable level for unassigned fund balance; 2. Mechanism for using excess unassigned fund balance; 3. Mechanism for utilizing fund balance below the target; 4. Mechanism for replenishing fund balance below the target; 5. Assigned fund balance for Capital Improvements; 6. Assigned fund balance for Pension Stabilization; 7. Reporting and monitoring framework; 8. Process for review and updating the policy POLICY ON UNASSIGNED FUND BALANCE LEVELS The Grand Traverse County Department of Human Services Board sets the following policies on general fund unassigned fund balance levels. 1. Target. The Organization will strive to maintain an unassigned fund balance at each fiscal year end of 20% of actual year-end general fund revenues. This level is the Pavilions “Target” for unassigned fund balance. 2. Draw Down of Funds in Excess of the Target. Any funds in excess of the target may be designated in the Pavilions budget for any of the following: a. Fund current capital projects including large capital items; b. Reduce future debt service or any other long term liabilities; c. Add to the Assigned Fund Balances for PACE North, Capital Improvements or Pension Stabilization or to establish a new Assigned Fund Balance.

Page 54 of 65 3. Use of Funds Below the Target. Utilizing the unassigned fund balance below the target will only be budgeted with unanimous approval of the entire Department of Human Services Board and is intended for emergency situations or in times of economic duress. 4. Replenishing the Target Shortfall. If the unassigned fund balance at the end of a fiscal year is less than the target, the Pavilions will strive to increase the unassigned fund balance with adjustments to the current or future budgets until the unassigned fund balance is at or above the target level. 5. Assigned fund balance for Capital Improvements. Ensuring adequate fund balances for replacing key physical infrastructure and making any necessary improvements to the facility is critical to providing excellent resident care. To evidence that commitment, the Board assigns $1M of the Pavilions Fund Balance to the Capital Improvements Fund to be used to supplement capital expenditures that are substantially higher in a particular year. 6. Assigned Fund Balance for Pension Stabilization. Ensuring adequate fund balances to pay pension liabilities is critical to maintaining an engaged and committed workforce. To evidence that commitment, the Board assigns $1M of the Pavilions unassigned fund balance to the Pension Stabilization Fund to supplement pension funding during periods of higher annual required payments. 7. Reporting and Monitoring. Information on the status of all fund balances will be reported as part of the operational budget recommendation from the Administrator/CEO in the fall of each year and in conjunction with the issuance of the annual audited financial statements. 8. Review and Updating the Policy. This policy will be reviewed at least every three years by the Grand Traverse County Department of Human Services Board based on the recommendations of the Administrator/CEO for any changes that may be appropriate for the current situation at that time.

Page 55 of 65 Page 56 of 65 Page 57 of 65 Page 58 of 65 Page 59 of 65 Page 60 of 65 Page 61 of 65 Page 62 of 65 Page 63 of 65 Page 64 of 65 GRAND TRAVERSE PAVILIONS Service Excellence Award Program October 2020

Date: 10/07/2020 Employee: Gabi Walton Suggesting beneficial ideas to enrich the lives of the residents at the Cottages. Your Awarded for: continued efforts are much appreciated!” Position: UW Nominated by: Jeff Valentine

Date: 10/14/2020 Employee: Stefan Gray Always going the extra mile to assist the residents, thanks for always cleaning my cats, Awarded for: kitty litter. Always appreciated. Position: UW Nominated by: Virginia Ritondale (Resident)

Date: 10/21/2020 Employee: Chelsea Schroeter Chelsea went the extra mile to obtain needed supplies for me (a resident). God bless Awarded for: you, Chelsea Position: RN Nominated by: Ann (Resident)

Date: 10/28/2020 Employee: Amy Stallman Awarded for: being an incredibly hard worker that never hesitates to help out a resident or a coworker Position: CNA Nominated by: Emily Rice

Date: Employee: Awarded for: Position: Nominated by:

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