Board of Directors Agenda Packet

BOARD OF DIRECTORS AGENDA PACKET

March 12, 2018

BOARD OF DIRECTORS

Joy Gorzeman, RN, MSN, MBA, Chair Dara Czerwonka, MSW, Vice Chair Raymond McCune, RN, Secretary Jerry Kaufman, PTMA, Treasurer Jeffrey D. Griffith, EMT-P, Director Hans Christian M. Sison, LVN, Director Douglas Moir, MD, Director

Diane Hansen, Interim President and CEO

Regular meetings of the Board of Directors are usually held on the second Monday of each month at 6:30 p.m., unless indicated otherwise. For an agenda, locations or further information call (760) 740-6375, or visit our website at www.palomarhealth.org

MISSION STATEMENT

The Mission of Palomar Health is to: Heal, comfort, and promote health in the communities we serve

VISION STATEMENT

Palomar Health will be the health system of choice for patients, physicians and employees, recognized nationally for the highest quality of clinical care and access to comprehensive services

VALUES

Compassion - Providing comfort and care Excellence - Aspiring to be the best Integrity - Doing the right thing for the right reason Service - Serving others and our community Teamwork - Working together toward shared goals Trust - Delivering on promises

Affiliated Entities

*Palomar Medical Center Escondido * Palomar Medical Center Downtown Escondido * Palomar Medical Center Poway *Palomar Health Foundation * Palomar Home Care * Arch Health Partners *Palomar Health Development, Inc.* North San Diego County Health Facilities Financing Authority* *San Marcos Ambulatory Care Center * Villa Pomerado * Palomar Health Source*

POSTED THURSDAY, ` MARCH 8, 2018 BOARD OF DIRECTOR'S MEETING Monday, March 12, 2018 AGENDA Palomar Medical Center Poway 6:30 p.m. Conference Room E 15615 Pomerado Road Poway, CA 92064

PLEASE TURN OFF CELL PHONE OR SET TO SILENT MODE UPON ENTERING MEETING ROOM Form A Time Page Target I. CALL TO ORDER 6:30 II. ESTABLISHMENT OF QUORUM 2 6:32

III. OPENING CEREMONY 3 6:35 A. Pledge of Allegiance IV. PUBLIC COMMENTS1 15 6:50 V. * MINUTES (ADD A) 3 6:53 A. Special Executive Session Board of Director's Meeting - February 12, 2018 (Pp8-9) 1 B. Regular Board of Director's Meeting - February 12, 2018 (Pp10-17) 2 VI. * APPROVAL OF AGENDA to accept the Consent Items as listed (ADD B) 3 6:56 A. Approval of Revolving, Patient Refund & Payroll Fund Disbursements – January 2018 (P19) 1. Accounts Payable Invoices $55,047,999.00 2. Net Payroll $16,045,668.00 Total $71,093,667.00 B. Summary of Executed Budgeted Routine Physician Agreements (Pp20-39) 3 C. January 2018 and YTD FY2018 Financial Report (Pp40-61) 4 VII. QUALITY AND SAFETY (verbal) 5 7:01 Chief Quality Officer Dr. Jerry Kolins, District Director of Quality, Patient Safety and Infection Control Valerie Martinez VIII. PRESENTATIONS A. Joint Conference Update (verbal) 5 7:06 Board Chair Joy Gorzeman, Board Member Dr. Doug Moir, Board Member Jerry Kaufman * B. Parking Structure (ADD C Pp63-69) 10 7:16 Vice President Hospitality & Facilities Dan Farrow, Chief Financial Officer Hugh King IX. REPORTS (ADD D) A. Medical Staffs *1. Palomar Medical Center Escondido - Franklin Martin, M.D. 5 5 7:21 i. Credentialing and Reappointments (Pp71-88) *2. Palomar Medical Center Poway - Charles Callery, M.D. 5 6 7:26 i. Credentialing and Reappointments (Pp89-90) B. Administrative 1. Chair of the Palomar Health Foundation - Ginger Larson (Pp91-92) 5 7:31 2. Chair of the Board - Joy Gorzeman 5 7:36 3. Interim President and CEO - Diane Hansen 5 7:41 X. INFORMATION ITEMS A. ACHD Update Report for February 2018 (to be forwarded under separate cover) 1 7:42 Form A Time Page Target XI. * APPROVAL OF BYLAWS, CHARTERS, POLICIES, RESOLUTIONS 5 7:47 (ADD E) (Discussion by exception) Item Board Action Committee A. Conflict of Interest Code - Lucidoc Policy 21800 Governance Review/Approval (Redline version Pp94-97) (Clean Version Pp98-101) B. Resolution No. 03.12.18(06)-01 Resolution of the Board of Directors of Palomar Health Establishing Board Audit & Compliance Committee Meetings for Calendar Year 2018 (P102) Audit & Compliance Review/Approval C. Resolution No. 03.12.18(07)-02 Resolution of the Board of Directors of Palomar Health Authorizing Management to Take the Actions Necessary to Negotiative and Execute the Documents Necessary for a Parking Structure to be Constructed and Operated on Property Owned by the District Within the Escondido Regional Technology Center (Pp103-104) Finance Review/Approval XII. COMMITTEE REPORTS (ADD F) 5 7:52 A. Audit & Compliance Committee - Ray McCune, Committee Chair (Pp106-107) 1. Standing Agenda Items for Calendar Year 2018 (informational Pp108-109) 2. Notable Accomplishments for Calendar Year 2017 (informational Pp110-111) B. Community Relations Committee - Dara Czerwonka, Committee Chair (P112 ) C. Finance Committee - Jerry Kaufman, Committee Chair (Pp113-119) 1. PRIME - Public Hospital Redesign and Incentives in Medi-Cal (Informational Pp120-154) Public HospitalD. Governance Redesign Committee and Incentives - Jeff Griffith,in Medi-Cal Committee Chair (no meeting in February) E. Human Resources Committee - Hans Sison, Committee Chair (Pp155-156) F. Quality Review Committee - Joy Gorzeman, Committee Chair (no meeting in February) G. Strategic & Facilities Planning Committee - Doug Moir, Committee Chair (no meeting in February) XIII. BOARD DISCUSSION A. Board Severance Procedure 10 8:02 XIV. ADJOURNMENT TO EXECUTIVE SESSION A. Pursuant to California Government Code §54957(b) - Public Employee Performance 30 8:32 Evaluation - President and CEO B. Conference with legal Counsel Concerning Potential Litigation per Government 30 9:02 Code 54956.9(d)(2) – one case XV. RE-ADJOURNMENT TO OPEN SESSION 1 9:03 XVI. ACTION RESULTING FROM EXECUTIVE SESSION DISCUSSION-IF ANY 3 9:06 XVII. BOARD MEMBER COMMENTS / AGENDA ITEMS FOR NEXT MONTH 3 9:09 1 XVIII.PUBLIC COMMENTS 15 9:24 XIX. FINAL ADJOURNMENT 2 9:26

1 5 minutes allowed per speaker with a cumulative total of 15 minutes per group. For further details & policy, see Request for Public Comment notices available in meeting room.

"In accordance with the ADA (Americans with Disabilities Act) please notify us at 760-740-6375 48 hours prior to the meeting so we may provide reasonable accommodations" ______* Asterisks indicate anticipated action. Action is not limited to those designated items.

Minutes

Special Executive Session Board of Director’s Meeting

Monday, February 12, 2018

TO: Board of Directors

MEETING DATE: Monday, March 12, 2018

FROM: Debbie Hollick, Board Assistant

Background: The minutes from the Monday, February 12, 2018 Special Executive Session Board of Director’s meeting are respectfully submitted for approval.

Budget Impact: N/A

Staff Recommendation: Recommendation to approve the Monday, February 12, 2018 Special Executive Session Board of Director’s meeting minutes.

Committee Questions:

COMMITTEE RECOMMENDATION: N/A

Motion:

Individual Action:

Information:

Required Time:

Minutes

Board of Director’s Meeting

Monday, February 12, 2018

TO: Board of Directors

MEETING DATE: Monday, March 12, 2018

FROM: Debbie Hollick, Board Assistant

Background: The minutes from the Monday, February 12, 2018 Board of Director’s meeting are respectfully submitted for approval.

Budget Impact: N/A

Staff Recommendation: Recommendation to approve the Monday, February 12, 2018 Board of Director’s meeting minutes.

Committee Questions:

COMMITTEE RECOMMENDATION: N/A

Motion:

Individual Action:

Information:

Required Time:

2 Executed, Budgeted, Routine Physician Agreement Board Summary Report TO: Board of Directors MEETING DATE: Monday, March 12, 2018 FROM: Board Finance Committee Wednesday, February 28, 2018 BY: Jerry Kaufman, PT MA, Chair, Board Finance Committee

Background: The following Executed, Budgeted, Routine Physician Agreements became effective as noted below: PHYSICIAN/GROUP TYPE OF AGREEMENT October 2017  Department Chair Agreement –  Southern California Permanente Medical Group for the services of Orthopaedic Surgery Rehabilitation Michael G. Ryan, MD Department – PMC Escondido January 2018  Department Chair Agreement – Radiology  Michael Scott Burke, MD Department – PMC Escondido  Department Chair Agreement – Pediatrics  Nabil Fatayerji, MD Department – PMC Escondido  Department Chair Agreement – Pathology  Lachlan Macleay, MD Department – PMC Escondido  Department Chair Agreement – Pathology  Lachlan Macleay, MD Department – PMC Poway  Medical Staff Secretary Treasurer  Lachlan Macleay, MD Agreement – PMC Escondido  Department Chair Agreement – Radiology  Charles McGraw, MD Department – PMC Poway  Department Chair Agreement – Trauma  John Steele, MD Department – PMC Escondido  Department Chair Agreement – Surgery  Ashish Wadhwa, MD Department – PMC Poway  Department Chair Agreement – Medicine  Adnan M. Zahid, MD Department – PMC Escondido The standard Form A and Abstract Table for each are attached. Staff Recommendation: Approval

COMMITTEE RECOMMENDATION: The Board Finance Committee recommends approval of the Executed, Budgeted, Routine Physician Agreements as presented. Approval recommended 6 to 0 by the Committee; Board members 3 to 0; Absent: 0.

Motion: X

Individual Action:

Information:

Required Time:

3 January 2018 & YTD FY2018 Financial Report

TO: Board of Directors

MEETING DATE: Monday, March 12, 2018

FROM: Board Finance Committee Wednesday, February 28, 2018

BY: Jerry Kaufman, PT MA, Chair, Board Finance Committee

Background: The Board Financial Report (unaudited) for January 2018 and YTD FY2018 (per pages 40 to 61) is submitted for the Board’s approval.

Budget Impact: N/A

Staff Recommendation: Approval

Committee Questions:

COMMITTEE RECOMMENDATION: The Board Finance Committee recommends approval of the Board Financial Report (unaudited) for January 2018 and YTD FY2018. Approval recommended 4 to 0 by the Committee; Board members 3 to 0; Absent: 2.

Motion: X

Individual Action:

Information:

Required Time:

Form A - Financial Report 4

Palomar Medical Center Escondido Medical Staff Credentialing Recommendations

TO: Board of Directors

MEETING DATE: March 12, 2018

FROM: Franklin Martin, M.D., Chief of Staff, Palomar Medical Center Escondido

Background: Credentialing Recommendations from the Medical Executive Committee of Palomar Medical Center Escondido.

Budget Impact: None

Staff Recommendation:

Committee Questions:

COMMITTEE RECOMMENDATION: Approval

Motion: X

Individual Action:

Information:

Required Time:

Form A 5 6

ADDENDUM A

SPECIAL EXECUTIVE SESSION BOARD OF DIRECTOR’S MEETING MINUTES – MONDAY, FEBRUARY 12, 2018

AGENDA ITEM CONCLUSION / ACTION

 DISCUSSION

I. CALL TO ORDER

 The meeting – held in the Graybill Auditorium at Palomar Medical Center Downtown Escondido, 555 E. Valley Parkway, Escondido, CA 92025 was called to order at 5:30 p.m. by Palomar Health Board Chair Joy Gorzeman

II. ESTABLISHMENT OF QUORUM

Quorum comprised of Directors Czerwonka, Gorzeman, Kaufman, Griffith, Moir, Sison Excused Absences: Director McCune

NOTICE OF MEETING Notice of Meeting was posted at Palomar Health’s Administrative office as well as to the Palomar Health website on Friday, February 9, 2018, which is consistent with legal requirements

III. PUBLIC COMMENTS There were no public comments

IV. ADJOURNMENT TO EXECUTIVE SESSION A. Pursuant to Health & Safety Code 32106 – Report Involving Trade Secret Concerns Potential New Program or Service (estimated disclosure date: TBD)

V. RE-ADJOURNMENT TO OPEN SESSION

VI. ACTION RESULTING FROM EXECUTIVE SESSION DISCUSSION, IF ANY

In Closed Session the Board directed staff to survey recruitment firms and draft a Request for Proposal for executive search services

VII. PUBLIC COMMENTS

There were no public comments

VIII. FINAL ADJOURNMENT

1 021218 Special Executive Session BoD Meeting 8 SPECIAL EXECUTIVE SESSION BOARD OF DIRECTOR’S MEETING MINUTES – MONDAY, FEBRUARY 12, 2018

AGENDA ITEM CONCLUSION / ACTION

 DISCUSSION

The meeting was adjourned at 6:27 p.m. by Chair Gorzeman

SIGNATURES: BOARD SECRETARY Raymond McCune, R.N.

BOARD ASSISTANT Debbie Hollick

2 021218 Special Executive Session BoD Meeting 9

Board of Directors Meeting Minutes – Monday, February 12, 2018

Agenda Item

 Discussion Conclusion/Action/Follow Up

I. CALL TO ORDER The meeting, held in the Graybill Auditorium of the Palomar Medical Center Downtown Escondido, 555 E. Valley Parkway, Escondido, CA 92025, was called to order at 6:30 p.m. by Palomar Health Board Chair Joy Gorzeman

II. ESTABLISHMENT OF QUORUM Quorum comprised of Directors Czerwonka, Gorzeman, Kaufman, Griffith, Moir, Sison Excused Absence: Director McCune

III. OPENING CEREMONY – Pledge of Allegiance

The Pledge of Allegiance was recited in unison

MISSION AND VISION STATEMENTS

The Palomar Health mission and vision statements are as follows:

 The mission of Palomar Health is to heal, comfort and promote health in the communities we serve

 The vision of Palomar Health is to be the health system of choice for patients, physicians and employees, recognized nationally for the highest quality of clinical care and access to comprehensive services

NOTICE OF MEETING

Notice of Meeting was posted at the Palomar Health Administrative Office; also posted with full agenda packet to the Palomar Health website on Tuesday, February 6, 2018 which is consistent with legal requirements

IV. PUBLIC COMMENTS

 Pacita Balcom spoke about the CEO search

 Corinne Wilson spoke about the Palomar Health budget and CEO search

021218 BOD MEETING MINUTES 10 1

Board of Directors Meeting Minutes – Monday, February 12, 2018

Agenda Item

 Discussion Conclusion/Action/Follow Up

V. APPROVAL OF MINUTES

nd A. Special Board of Director's Meeting – January 8, 2018 A. MOTION: By Director Kaufman, 2 by Director Griffith and carried to approve the January 8, 2018 Special Board of Director's meeting minutes as written. All B. Board of Director's Meeting - January 8, 2018 in favor. None opposed. No abstentions

B MOTION: By Director Kaufman, 2nd by Director Moir and carried to approve the January 8, 2018 Board of Director's meeting minutes as written. All in favor. None opposed. No abstentions

There was no discussion

VI . *APPROVAL OF AGENDA to accept the Consent Items as listed including – MOTION: By Director Moir, 2nd by Director Kaufman and carried to approve

Consent Agenda items A. – D. as presented. All in favor. None opposed. No A. Approval of Revolving, Patient Refund & Payroll Fund Disbursements – November 2017 abstentions. 1. Accounts Payable Invoices $47,606,309.00 $15,435,628.00 2. Net Payroll

Total $63,041,937.00

B. Approval of Revolving, Patient Refund & Payroll Fund Disbursements – December 2017

1. Accounts Payable Invoices $42,938,071.00

2. Net Payroll $23,725,280.00

Total $66,663,351.00

C. Summary of Executed Budgeted Routine Physician Agreements

D. December 2017 and YTD FY2018 Financial Report

Information Only VII. PATIENT FIRST There was no presentation

VI II. PRESENTATIONS Information Only

A. Association of California Healthcare Districts (ACHD) 2018 Leadership Academy Update

021218 BOD MEETING MINUTES 11 2

Board of Directors Meeting Minutes – Monday, February 12, 2018

Agenda Item

 Discussion Conclusion/Action/Follow Up

Directors Czerwonka and Moir provided an update on their recent attendance at the (ACHD) 2018 Leadership Academy; Director Czerwonka serves as a board member on ACHD

 Director Czerwonka provided background on ACHD, noting that there are 79 other healthcare districts in the state of California. ACHD represents the district’s interests in the state legislature, and does a lot of work around non-reimbursement issues affecting healthcare districts

 Director Moir reported that this was his first year attending the training. It was interesting to see the breadth and scope of activities in the other districts, some of which are more community-health related i.e. clinics and nursing homes; provided many valuable ideas. Attended interesting presentations re: the Brown Act, organizational aspects of board function, networking opportunities. Learned more about the clout of the many districts presence as a whole in Sacramento rather than individually. Gleaned a deeper understanding of the sense of potential value of Palomar Health’s participation in ACHD

B. Mayo Quality Project Update

Chief Quality Officer Dr. Jerry Kolins provided an update on the Mayo Quality Project

 Noted that Palomar Health became a member of the Mayo Clinical Care Network two years ago. Network benefits include consultations with members of Mayo Clinic when physicians so seek, review and input on processes in which the organization is engaged

o Mayo provided an evaluation of the organizational Quality Assurance Performance Improvement (QAPI) Plan. Due to the spate of recent surveys Palomar Health has received, intent was to look into the reason why this was occurring; realized that the objective eyes and reputation of quality that Mayo brings would make this a high value process. Mayo’s review results reported that we are solid on our QAPI Plan and should be proud of this. Opportunity exists for increased collaboration between the Quality office and the operations team who implement the plan; Mayo offered to come onsite to review this process as well. Opportunity to think globally of quality, safety, risk management and reduction

o Director Gorzeman asked if there will be an additional cost for the Mayo visit; Dr. Kolins replied that there should not be any additional expense to the health system

 Noted that new Vice President Risk Hala Helm will be joining the organization in early March. Looking forward to working with her on this and myriad other projects

 Expressed that working with new Chief Operations Officer Sheila Brown and new Chief Medical Officer Dr. Omar Khawaja has been extremely refreshing. Feels a sense of esprit de corps that we need to move forward organizationally

 Director Czerwonka asked when the trip to Mayo would take place; Dr. Kolins replied anticipation is for this to occur in March, so that Ms. Helm may participate

IX. REPORTS A. Medical Staff

021218 BOD MEETING MINUTES 12 3

Board of Directors Meeting Minutes – Monday, February 12, 2018

Agenda Item

 Discussion Conclusion/Action/Follow Up

1. Palomar Medical Center Escondido i. MOTION: by Director Czerwonka, 2nd by Director Griffith and carried to approve the Palomar Medical Center Escondido Medical Staff Credentialing i. Credentialing and Reappointments Recommendations as presented. All in favor. None opposed. No abstentions ii. Modification to the Physician Assistant Clinical Privileges Orthopaedic Surgery – Palomar Medical Center Escondido / Palomar Medical Center Poway nd ii. MOTION: by Director Moir, 2 by Director Kaufman and carried to approve iii. Modification to the Hematology / Oncology Privilege Checklist - Palomar Medical Center the Modification to the Physician Assistant Clinical Privileges Orthopaedic Escondido / Palomar Medical Center Poway Surgery – Palomar Medical Center Escondido / Palomar Medical Center Poway as presented. All in favor. None opposed. No abstentions

iii. MOTION: by Director Moir, 2nd by Director Griffith and carried to approve the Modification to the Hematology / Oncology Privilege Checklist - Palomar Medical Center Escondido / Palomar Medical Center Poway as presented. All in favor. None opposed. No abstentions

 Palomar Medical Center Escondido (PMCE) Chief of Staff Dr. Franklin Martin presented the Palomar Medical Center Escondido Medical Staff Executive Committee reports for review and approval

There was no discussion

2. Palomar Medical Center Poway i. MOTION: by Director Czerwonka, 2nd by Director Moir and carried to approve the Palomar Medical Center Poway Medical Staff Credentialing i. Palomar Medical Center Poway Hospital Medical Staff Credentialing Recommendations Recommendations as presented. All in favor. None opposed. No abstentions

 In Palomar Medical Center Poway (PMCP) Chief of Staff Dr. Charles Callery’s absence, PMCP Chief-elect Dr. Edward Gurrola presented the Palmar Medical Center Poway Medical Staff Credentialing Recommendations for review and approval

There was no discussion B. Administrative

1. Palomar Health Foundation Information only

 Palomar Health Foundation Board President Ginger Larson noted that the board had received the Foundation report electronically in advance of the meeting. Wished to turn the remainder of her time over to Chief Human Resource Officer Pam Sime, who would discuss the Foundation’s number one priority at this time o Ms. Sime reported that a search is under way for the interim Foundation leadership positon, with interviews beginning this week. Once the interim position has been filled, will commence with search for permanent leader. Utilizing the search firm Paschal Murray, who Mrs. Larson noted come highly recommended

2. Chair of the Board

021218 BOD MEETING MINUTES 13 4

Board of Directors Meeting Minutes – Monday, February 12, 2018

Agenda Item

 Discussion Conclusion/Action/Follow Up

Palomar Health Board Chair Joy Gorzeman provided the following update:

 Noted anticipation was for California Department of Public Health (CDPH) to be onsite today on behalf of Centers for Medicare and Medicaid Services (CMS). Everyone is ready and a little excited as well as a little nervous as this survey is very important to the organization’s reimbursement status going forward. Awareness that many great things have been done to move Palomar Health forward in our Quality and Safety processes and our commitment to excellence and ongoing quality improvement Pleased with our progress and plans going forward; sustainability will be the challenge and opportunity. Believes we have good leadership and collaboration going forward. Thanked everyone for their hard and diligent work

 Acknowledge the organizational changes that have occurred since the last Board of Director’s meeting. As stated in her memo to all employees, the board is appreciative of the past and all that people who are no longer here have done, noting that we are moving into the future with a restructure and downsizing to help us move to the next level. It is evident that we are in a rapidly changing environment and pretty uncertain time in healthcare; the Palomar Health Board of Directors endeavor to serve our community and organization in the best way possible. Our primary focus is to improve communication flow, focus on quality care, financial stewardship and a culture of collaboration, respect, and accountability. Change can be difficult and also motivating – our focus is on integrating the operationalization of the strategy into the daily work; the board is working closely with management and physician leaders to support this

o Attended recent Leadership Development Institute session where this conversation was discussed; leadership called out the importance of valuing our employees so they can facilitate the best experience for our consumers/community. Appreciated the information exchange and Q & A session

 For Board colleagues – the above changes will also result in changes in staff supporting our committees in some circumstances, and a few committees have had to be flexible in regard to meetings dates and times; appreciate the support. Will meet with interim CEO this Friday and have talked and will talk with those of you affected; anticipate changes to be finalized and documented by early next week

 Completed online certification education for board members (Best on Board); found it to be helpful and informational. Also attended Governance Institute webinar: “Healthcare Forecast 2018: 10 trends board leaders need to know”. Will forward presentation to board members

3. President and CEO Palomar Health Interim President and CEO Diane Hansen provided the following update:

 Echoed Director Gorzeman’s comments re: the changes and restructure, noting that none of these decisions were made lightly. Understands that any time we are impacting our employees we are impacting people that are close and near and dear to us that we have worked with for along time. It was difficult to make those decisions, but appreciated the board’s support as worked through this with the teams. These changes will afford the organization the opportunity to positon itself in the future and move forward with some of the things that we have not been afforded the ability to do in the past. Understands that while the future is exciting, change is difficult for all of us

 Excited about being in escrow for the sale of the Palomar Health Downtown Campus. Agreements have been signed; due diligence to take approximately 12 – 15 months. The only foreseeable hold up to closing escrow may come from our side as we continue to move services off the campus and into other locations – goal is to accomplish this on or before the 15 month timeline. Information has been made public via media outlets. Exciting times ahead and ready to move forward

 Had anticipated survey visit that Director Gorzeman referenced this week; so far not onsite but we are well prepared and ready thanks to the significant work that has been done by District Director of Quality, Patient Safety and Infection Control Valerie Martinez and the teams

 Noted to be glad to be moving forward with filling the interim Foundation leadership position

Board of Directors Meeting Minutes – Monday, February 12, 2018

Agenda Item

 Discussion Conclusion/Action/Follow Up

X. INFORMATION ITEMS The January 2018 ACHD Update Report was forwarded electronically to the board members when received on 2/09/2018 – link is provided below http://campaign.r20.constantcontact.com/render?m=1102296513759&ca=c24a259a-ed46-46e7-969d-3d9366edd5ee

XI. *APPROVAL OF BYLAWS, CHARTERS, POLICIES

A. Resolution No. 02.12.18(04)-01 - Resolution of the Board of A. MOTION: by Director Kaufman, 2nd by Director Moir and carried to approve Directors of Palomar Health Establishing the Date, Time and Resolution No. 02.12.18(04)-01 - Resolution of the Board of Directors of Location for the Regular Meetings of the Board Finance Palomar Health Establishing the Date, Time and Location for the Regular Committee and for the Board Budget Meeting for Calendar Meetings of the Board Finance Committee and for the Board Budget Meeting for Year 2018 Calendar Year 2018. All in favor. None opposed. No abstentions. Director McCune - absent B. Resolution No. 02.12.18(05)-02 - Resolution of the Board of Directors of Palomar Health Designating Subordinate Officers B. MOTION: by Director Kaufman, 2nd by Director Moir and carried to approve of the District Resolution No. 02.12.18(05)-02 - Resolution of the Board of Directors of Palomar Health Designating Subordinate Officers of the District. Roll call voting was utilized:

Director Gorzeman - aye Director Kaufman - aye Director Griffith - aye Director Sison - aye Director Czerwonka - aye Director Moir – aye Director McCune - absent All in favor. None opposed. No abstentions

th  A. Director Czerwonka noted a conflict with the April 25 Board Finance Committee meeting date as all of the board members will be at a conference during that time. Board Finance committee Chair Kaufman replied that an alternate date will be selected for that meeting

II. COMMITTEE REPORTS A. Audit and Compliance Committee Information only

 In Director McCune’s absence, Director Gorzeman noted the committee did not meet in January, however the agenda for the February meeting is currently being drafted

B. Community Relations Committee Information only

 Committee Chair Czerwonka shared highlights from the meeting and attached summary

 The main focus of the meeting was to bring all stakeholders together to formulate a Population Health strategy that will be brought to the full board as a recommendation

C. Finance Committee Information only

021218 BOD MEETING MINUTES 15 6

Board of Directors Meeting Minutes – Monday, February 12, 2018

Agenda Item

 Discussion Conclusion/Action/Follow Up

 Committee Chair Jerry Kaufman noted the committee meeting summary was included in the board meeting packet

 Committee reviewed an Emergency department report re: the acuity level patients presenting in the ED, which illustrated that over the past two years a significant number of patients could have been treated in an Urgent Care setting. This is an issue the organization will be working on in the coming year as we focus on the continuum of care and getting patients the services they need where they need them. Triage can play an important role in the improvement process

D. Governance Committee Information only

 Committee Chair Griffith noted that there was no meeting in January  Elvira Simmons to be the new secretary for this committee; looking forward to working with her to get things rolling. Major committee focus for 2018 will be the refreshing of Palomar Health Bylaws

E. Human Resources Committee Information only

 Committee Chair Sison noted there was no meeting in January

F. Quality Review Committee Information only

 Committee Chair Gorzeman shared highlights from the meeting and attached summary  Committee will be dark in February as meeting date conflicts with President’s Day holiday

G. Strategic & Facilities Planning Committee Information only

 Committee Chair Moir shared highlights from the meeting and attached summary  Committee will be dark in February as meeting date conflicts with President’s Day holiday

XIII. ADJOURNMENT TO EXECUTIVE SESSION C. Pursuant to California Government Code §54957(b) - Public Employee Performance Evaluation - President and CEO

XIV. RE-ADJOURNMENT TO OPEN SESSION

XV. ACTION RESULTING FROM EXECUTIVE SESSION DISCUSSION - IF ANY No action taken

XVI. BOARD MEMBER COMMENTS/AGENDA ITEMS FOR NEXT MONTH There were no comments/agenda items

021218 BOD MEETING MINUTES 16 7

Board of Directors Meeting Minutes – Monday, February 12, 2018

Agenda Item

 Discussion Conclusion/Action/Follow Up

XVII. PUBLIC COMMENTS1 There were no public comments

XVIII. FINAL ADJOURNMENT

The meeting was adjourned at 8:30 p.m.by Chair Gorzeman

Board Secretary Raymond McCune, R.N. Signatures:

Debbie Hollick Board Assistant

021218 BOD MEETING MINUTES 17 8

ADDENDUM B

18 19

Palomar Medical Center Escondido Medical Staff Department Chair Agreement Orthopaedic Surgery/Rehabilitation

TO: Board Finance Committee

MEETING DATE: Wednesday, February 28, 2018

FROM: Omar Khawaja, MD, Chief Medical Officer

Background: Palomar Medical Center Escondido Medical Staff Department and Committee Chairs are provided a stipend for services performed as required by the Medical Staff Bylaws. This agreement serves to document the relationship of the Medical Staff Department and Committee Chairs to Palomar Health, and the duties to be performed as consideration for the stipend to assure compliance with Federal regulations. Presented is the Contract for the following Department Chair: Chair, Department of Orthopaedic Surgery/Rehabilitation – SCPMG for the Services of Michael G. Ryan, M.D.

Budget Impact: None.

Staff Recommendation: Approval

Committee Questions:

COMMITTEE RECOMMENDATION:

Motion: X

Individual Action:

Information:

Required Time:

2016 Form A – Department Chair Contract 20 PALOMAR HEALTH – AGREEMENT ABSTRACT Section Reference Term/Condition Term/Condition Criteria TITLE Department Chair Agreement AGREEMENT DATE 10/01/2017

PARTIES Orthopaedic Surgery/Rehabilitation Department Chair –SCPMG for the services of Michael G. Ryan, M.D, Palomar Medical Center Escondido Medical Staff, and Palomar Health

PURPOSE To provide administrative services on behalf of the Palomar Medical Center Escondido Medical Staff in accordance with Medical Staff Bylaws, Plans and Policies.

SCOPE OF SERVICES As per duties defined in the Palomar Medical Center Escondido Medical Staff Bylaws and Policies.

PROCUREMENT  Request For Proposal Discretionary METHOD TERM October 1, 2017 – December 31, 2020

RENEWAL None.

TERMINATION As described under §10

COMPENSATION Monthly METHODOLOGY FAIR MARKET  Yes  No – Date Completed: 10/02/2017 VALUATION BUDGETED  YES  NO – IMPACT:

EXCLUSIVITY  NO  YES – EXPLAIN:

JUSTIFICATION Position elected by the Medical Staff in accordance with Medical Staff Bylaws.

AGREEMENT NOTICED  YES  NO Methodology & Response: Elected by the Palomar Medical Center Escondido Medical Staff

ALTERNATIVES/IMPACT N/A

Duties  Provision for Staff Education  Provision for Medical Staff Education  Provision for participation in Quality Improvement  Provision for participation in budget process development  Defined in the Palomar Medical Center Escondido Medical Staff Bylaws COMMENTS

APPROVALS REQUIRED  VP  CFO  CEO  BOD Committee ______ BOD

Palomar Medical Center Escondido Medical Staff Department Chair Agreement Radiology

TO: Board Finance Committee

MEETING DATE: Wednesday, February 28, 2018

FROM: Omar Khawaja, MD, Chief Medical Officer

Budget Impact: None.

Staff Recommendation: Approval

Committee Questions:

COMMITTEE RECOMMENDATION:

Motion:

Individual Action:

Information:

Required Time:

2016 Form A – Department Chair Contract 22 PALOMAR HEALTH – AGREEMENT ABSTRACT Section Reference Term/Condition Term/Condition Criteria TITLE Department Chair Agreement AGREEMENT DATE 01/01/2018

PARTIES Radiology Department Chair – Michael Scott Burke, M.D, Palomar Medical Center Escondido Medical Staff, and Palomar Health

PURPOSE To provide administrative services on behalf of the Palomar Medical Center Escondido Medical Staff in accordance with Medical Staff Bylaws, Plans and Policies.

SCOPE OF SERVICES As per duties defined in the Palomar Medical Center Escondido Medical Staff Bylaws and Policies.

PROCUREMENT  Request For Proposal Discretionary METHOD TERM January 1, 2018 – December 31, 2019

RENEWAL None.

TERMINATION As described under §10

COMPENSATION Monthly METHODOLOGY FAIR MARKET  Yes  No – Date Completed: 11/28/2017 VALUATION BUDGETED  YES  NO – IMPACT:

EXCLUSIVITY  NO  YES – EXPLAIN:

JUSTIFICATION Position elected by the Medical Staff in accordance with Medical Staff Bylaws.

AGREEMENT NOTICED  YES  NO Methodology & Response: Elected by the Palomar Medical Center Escondido Medical Staff

ALTERNATIVES/IMPACT N/A

APPROVALS REQUIRED  VP  CFO  CEO  BOD Committee ______ BOD

Palomar Medical Center Poway Medical Staff Department Chair Agreement Pediatrics

TO: Board Finance Committee

MEETING DATE: Wednesday, February 28, 2018

FROM: Omar Khawaja, MD, Chief Medical Officer

Background: Palomar Medical Center Poway Medical Staff Department and Committee Chairs are provided a stipend for services performed as required by the Medical Staff Bylaws. This agreement serves to document the relationship of the Medical Staff Department and Committee Chairs to Palomar Health, and the duties to be performed as consideration for the stipend to assure compliance with Federal regulations. Presented is the Contract for the following Department Chair: Chair, Department of Pediatrics – Nabil Fatayerji, M.D.

Budget Impact: None.

Staff Recommendation: Approval

Committee Questions:

COMMITTEE RECOMMENDATION:

Motion: X

Individual Action:

Information:

Required Time:

2016 Form A – Department Chair Contract 24 PALOMAR HEALTH – AGREEMENT ABSTRACT Section Reference Term/Condition Term/Condition Criteria TITLE Department Chair Agreement AGREEMENT DATE 01/01/2018

PARTIES Pediatrics Department Chair – Nabil Fatayerji, M.D, Palomar Medical Center Poway Medical Staff, and Palomar Health

PURPOSE To provide administrative services on behalf of the Palomar Medical Center Poway Medical Staff in accordance with Medical Staff Bylaws, Plans and Policies.

SCOPE OF SERVICES As per duties defined in the Palomar Medical Center Poway Medical Staff Bylaws and Policies.

PROCUREMENT  Request For Proposal Discretionary METHOD TERM January 1, 2018 – December 31, 2019

RENEWAL None.

TERMINATION As described under §10

COMPENSATION Monthly METHODOLOGY FAIR MARKET  Yes  No – Date Completed: 11/8/2017 VALUATION BUDGETED  YES  NO – IMPACT:

EXCLUSIVITY  NO  YES – EXPLAIN:

JUSTIFICATION Position elected by the Medical Staff in accordance with Medical Staff Bylaws.

AGREEMENT NOTICED  YES  NO Methodology & Response: Elected by the Palomar Medical Center Poway Medical Staff

ALTERNATIVES/IMPACT N/A

APPROVALS REQUIRED  VP  CFO  CEO  BOD Committee ______ BOD

Palomar Medical Center Escondido Medical Staff Department Chair Agreement Pathology

TO: Board Finance Committee

MEETING DATE: Wednesday, February 28, 2018

FROM: Omar Khawaja, MD, Chief Medical Officer

Budget Impact: None.

Staff Recommendation: Approval

Committee Questions:

COMMITTEE RECOMMENDATION:

Motion:

Individual Action:

Information:

Required Time:

2016 Form A – Department Chair Contract 26 PALOMAR HEALTH – AGREEMENT ABSTRACT Section Reference Term/Condition Term/Condition Criteria TITLE Department Chair Agreement AGREEMENT DATE 01/01/2018

PARTIES Pathology Department Chair – Lachlan Macleay, M.D, Palomar Medical Center Escondido Medical Staff, and Palomar Health

PURPOSE To provide administrative services on behalf of the Palomar Medical Center Escondido Medical Staff in accordance with Medical Staff Bylaws, Plans and Policies.

SCOPE OF SERVICES As per duties defined in the Palomar Medical Center Escondido Medical Staff Bylaws and Policies.

PROCUREMENT  Request For Proposal Discretionary METHOD TERM January 1, 2018 – December 31, 2019

RENEWAL None.

TERMINATION As described under §10

COMPENSATION Monthly METHODOLOGY FAIR MARKET  Yes  No – Date Completed: 11/07/2017 VALUATION BUDGETED  YES  NO – IMPACT:

EXCLUSIVITY  NO  YES – EXPLAIN:

JUSTIFICATION Position elected by the Medical Staff in accordance with Medical Staff Bylaws.

AGREEMENT NOTICED  YES  NO Methodology & Response: Elected by the Palomar Medical Center Escondido Medical Staff

ALTERNATIVES/IMPACT N/A

APPROVALS REQUIRED  VP  CFO  CEO  BOD Committee ______ BOD

Palomar Medical Center Poway Medical Staff Department Chair Pathology

TO: Board Finance Committee

MEETING DATE: Wednesday, February 28, 2018

FROM: Omar Khawaja, MD, Chief Medical Officer

Budget Impact: None.

Staff Recommendation: Approval

Committee Questions:

COMMITTEE RECOMMENDATION:

Motion: X

Individual Action:

Information:

Required Time:

2016 Form A – Department Chair Contract 28 PALOMAR HEALTH – AGREEMENT ABSTRACT Section Reference Term/Condition Term/Condition Criteria TITLE Department Chair Agreement AGREEMENT DATE 01/01/2018

PARTIES Pathology Department Chair – Lachlan Macleay, M.D, Palomar Medical Center Poway Medical Staff, and Palomar Health

PURPOSE To provide administrative services on behalf of the Palomar Medical Center Poway Medical Staff in accordance with Medical Staff Bylaws, Plans and Policies.

SCOPE OF SERVICES As per duties defined in the Palomar Medical Center Poway Medical Staff Bylaws and Policies.

PROCUREMENT  Request For Proposal Discretionary METHOD TERM January 1, 2018 – December 31, 2019

RENEWAL None.

TERMINATION As described under §10

COMPENSATION Monthly METHODOLOGY FAIR MARKET  Yes  No – Date Completed: 11/8/2017 VALUATION BUDGETED  YES  NO – IMPACT:

EXCLUSIVITY  NO  YES – EXPLAIN:

JUSTIFICATION Position elected by the Medical Staff in accordance with Medical Staff Bylaws.

AGREEMENT NOTICED  YES  NO Methodology & Response: Elected by the Palomar Medical Center Poway Medical Staff

ALTERNATIVES/IMPACT N/A

APPROVALS REQUIRED  VP  CFO  CEO  BOD Committee ______ BOD

Palomar Medical Center Escondido Medical Staff Secretary Treasurer Agreement

TO: Board Finance Committee

MEETING DATE: Wednesday, February 28, 2018

FROM: Omar Khawaja, MD, Chief Medical Officer

Background: Palomar Medical Center Escondido Medical Staff Officers, Department and Committee Chairs are provided a stipend for services performed as required by the Medical Staff Bylaws. This agreement serves to document the relationship of the Medical Staff Officer, Department and Committee Chairs to Palomar Health, and the duties to be performed as consideration for the stipend to assure compliance with Federal regulations. Presented is the Contract for the following Officer: Secretary Treasurer – Lachlan Macleay, M.D.

Budget Impact: None.

Staff Recommendation: Approval

Committee Questions:

COMMITTEE RECOMMENDATION:

Motion: X

Individual Action:

Information:

Required Time:

2016 Form A – Department Chair Contract 30 PALOMAR HEALTH – AGREEMENT ABSTRACT Section Reference Term/Condition Term/Condition Criteria TITLE Medical Staff Secretary Treasurer Agreement AGREEMENT DATE 01/01/2018

PARTIES Secretary Treasurer – Lachlan Macleay, M.D, Palomar Medical Center Escondido Medical Staff, and Palomar Health

PURPOSE To provide administrative services on behalf of the Palomar Medical Center Escondido Medical Staff in accordance with Medical Staff Bylaws, Plans and Policies.

SCOPE OF SERVICES As per duties defined in the Palomar Medical Center Escondido Medical Staff Bylaws and Policies.

PROCUREMENT  Request For Proposal Discretionary METHOD TERM January 1, 2018 – December 31, 2019

RENEWAL None.

TERMINATION As described under §10

COMPENSATION Monthly METHODOLOGY FAIR MARKET  Yes  No – Date Completed: 12/18/2015 VALUATION BUDGETED  YES  NO – IMPACT:

EXCLUSIVITY  NO  YES – EXPLAIN:

JUSTIFICATION Position elected by the Medical Staff in accordance with Medical Staff Bylaws.

AGREEMENT NOTICED  YES  NO Methodology & Response: Elected by the Palomar Medical Center Escondido Medical Staff

ALTERNATIVES/IMPACT N/A

APPROVALS REQUIRED  VP  CFO  CEO  BOD Committee ______ BOD

Palomar Medical Center Poway Administrative Services Agreement Medical Staff Department Chair

TO: Board Finance Committee

MEETING DATE: Wednesday, February 28, 2018

FROM: Omar Khawaja, MD, Chief Medical Officer

Budget Impact: None.

Staff Recommendation: Approval

Committee Questions:

COMMITTEE RECOMMENDATION:

Motion: X

Individual Action:

Information:

Required Time:

2016 Form A – Department Chair Contract 32 PALOMAR HEALTH – AGREEMENT ABSTRACT Section Reference Term/Condition Term/Condition Criteria TITLE Department Chair Agreement AGREEMENT DATE 01/01/2018

PARTIES Radiology Department Chair – Charles McGraw, M.D, Palomar Medical Center Poway Medical Staff, and Palomar Health

PURPOSE To provide administrative services on behalf of the Palomar Medical Center Poway Medical Staff in accordance with Medical Staff Bylaws, Plans and Policies.

SCOPE OF SERVICES As per duties defined in the Palomar Medical Center Poway Medical Staff Bylaws and Policies.

PROCUREMENT  Request For Proposal Discretionary METHOD TERM January 1, 2018 – December 31, 2019

RENEWAL None.

TERMINATION As described under §10

COMPENSATION Monthly METHODOLOGY FAIR MARKET  Yes  No – Date Completed: 11/8/2017 VALUATION BUDGETED  YES  NO – IMPACT:

EXCLUSIVITY  NO  YES – EXPLAIN:

JUSTIFICATION Position elected by the Medical Staff in accordance with Medical Staff Bylaws.

AGREEMENT NOTICED  YES  NO Methodology & Response: Elected by the Palomar Medical Center Poway Medical Staff

ALTERNATIVES/IMPACT N/A

APPROVALS REQUIRED  VP  CFO  CEO  BOD Committee ______ BOD

Palomar Medical Center Escondido Medical Staff Department Chair Agreement Trauma

TO: Board Finance Committee

MEETING DATE: Wednesday, February 28, 2018

FROM: Omar Khawaja, MD, Chief Medical Officer

Budget Impact: None.

Staff Recommendation: Approval

Committee Questions:

COMMITTEE RECOMMENDATION:

Motion: X

Individual Action:

Information:

Required Time:

2016 Form A – Department Chair Contract 34 PALOMAR HEALTH – AGREEMENT ABSTRACT Section Reference Term/Condition Term/Condition Criteria TITLE Department Chair Agreement AGREEMENT DATE 01/01/2018

PARTIES Trauma Department Chair – John Steele, M.D, Palomar Medical Center Escondido Medical Staff, and Palomar Health

PURPOSE To provide administrative services on behalf of the Palomar Medical Center Escondido Medical Staff in accordance with Medical Staff Bylaws, Plans and Policies.

SCOPE OF SERVICES As per duties defined in the Palomar Medical Center Escondido Medical Staff Bylaws and Policies.

PROCUREMENT  Request For Proposal Discretionary METHOD TERM January 1, 2018 – December 31, 2019

RENEWAL None.

TERMINATION As described under §10

COMPENSATION Monthly METHODOLOGY FAIR MARKET  Yes  No – Date Completed: 11/17/2017 VALUATION BUDGETED  YES  NO – IMPACT:

EXCLUSIVITY  NO  YES – EXPLAIN:

JUSTIFICATION Position elected by the Medical Staff in accordance with Medical Staff Bylaws.

AGREEMENT NOTICED  YES  NO Methodology & Response: Elected by the Palomar Medical Center Escondido Medical Staff

ALTERNATIVES/IMPACT N/A

APPROVALS REQUIRED  VP  CFO  CEO  BOD Committee ______ BOD

Palomar Medical Center Poway Medical Staff Department Chair Agreement Surgery

TO: Board Finance Committee

MEETING DATE: Wednesday, February 28, 2018

FROM: Omar Khawaja, MD, Chief Medical Officer

Budget Impact: None.

Staff Recommendation: Approval

Committee Questions:

COMMITTEE RECOMMENDATION:

Motion: X

Individual Action:

Information:

Required Time:

2016 Form A – Department Chair Contract 36 PALOMAR HEALTH – AGREEMENT ABSTRACT Section Reference Term/Condition Term/Condition Criteria TITLE Department Chair Agreement AGREEMENT DATE 01/01/2018

PARTIES Surgery Department Chair – Ashish Wadhwa, M.D, Palomar Medical Center Poway Medical Staff, and Palomar Health

PURPOSE To provide administrative services on behalf of the Palomar Medical Center Poway Medical Staff in accordance with Medical Staff Bylaws, Plans and Policies.

SCOPE OF SERVICES As per duties defined in the Palomar Medical Center Poway Medical Staff Bylaws and Policies.

PROCUREMENT  Request For Proposal Discretionary METHOD TERM January 1, 2018 – December 31, 2019

RENEWAL None.

TERMINATION As described under §10

COMPENSATION Monthly METHODOLOGY FAIR MARKET  Yes  No – Date Completed: 11/8/2017 VALUATION BUDGETED  YES  NO – IMPACT:

EXCLUSIVITY  NO  YES – EXPLAIN:

JUSTIFICATION Position elected by the Medical Staff in accordance with Medical Staff Bylaws.

AGREEMENT NOTICED  YES  NO Methodology & Response: Elected by the Palomar Medical Center Poway Medical Staff

ALTERNATIVES/IMPACT N/A

APPROVALS REQUIRED  VP  CFO  CEO  BOD Committee ______ BOD

Palomar Medical Center Escondido Medical Staff Department Chair Agreement Medicine

TO: Board Finance Committee

MEETING DATE: Wednesday, February 28, 2018

FROM: Omar Khawaja, MD, Chief Medical Officer

Budget Impact: None.

Staff Recommendation: Approval

Committee Questions:

COMMITTEE RECOMMENDATION:

Motion: X

Individual Action:

Information:

Required Time:

2016 Form A – Department Chair Contract 38 PALOMAR HEALTH – AGREEMENT ABSTRACT Section Reference Term/Condition Term/Condition Criteria TITLE Department Chair Agreement AGREEMENT DATE 01/01/2018

PARTIES Medicine Department Chair – Adnan M. Zahid, M.D, Palomar Medical Center Escondido Medical Staff, and Palomar Health

PURPOSE To provide administrative services on behalf of the Palomar Medical Center Escondido Medical Staff in accordance with Medical Staff Bylaws, Plans and Policies.

SCOPE OF SERVICES As per duties defined in the Palomar Medical Center Escondido Medical Staff Bylaws and Policies.

PROCUREMENT  Request For Proposal Discretionary METHOD TERM January 1, 2018 – December 31, 2019

RENEWAL None.

TERMINATION As described under §10

COMPENSATION Monthly METHODOLOGY FAIR MARKET  Yes  No – Date Completed: 11/14/2017 VALUATION BUDGETED  YES  NO – IMPACT:

EXCLUSIVITY  NO  YES – EXPLAIN:

JUSTIFICATION Position elected by the Medical Staff in accordance with Medical Staff Bylaws.

AGREEMENT NOTICED  YES  NO Methodology & Response: Elected by the Palomar Medical Center Escondido Medical Staff

ALTERNATIVES/IMPACT N/A

APPROVALS REQUIRED  VP  CFO  CEO  BOD Committee ______ BOD

39 Passion. People. Purpose.TM

Fiscal Year 2018 Financial Performance *Supplemental Section includes Arch Health Partners and Consolidating Schedule January 2018

40 Title Table Executive Management Supplemental

Text Balance Income Cash Budget Condensed Condensed

Monthly Current Year Case Month Includes Payor Excludes Statistical of

Year

Flow ER

Comparison Statements ‐

Discussion

Sheets Information to ‐ Mix

Mix to Payor ‐

‐ to Statement Contents

Date vs.

Combining Combining

‐ Trend

G.O. Date ‐

G.O. Index

Date Indicators

...... Prior

Mix

...... Bonds Financial

Bonds ......

......

and

...... Year Statistical ......

......

Statement Statement

......

Analysis

...... ‐ ...... to ......

‐ Performance Date ......

Indicators ......

...... of of ......

Net Revenue, ......

...... Position ...... Title

Expenses ...... 41 Text ......

...... & ......

...... Changes ......

...... in ......

Net ......

Position ...... 8 ...... 21 ...... 22 ...... 14 ...... 9 ...... 10 ...... 3 ...... 16 ...... 15 ...... 19 ...... 18 ...... 12 ......

17 11 7 2 Title Management positive and January is primarily December, Inpatient from year Summary Patient were of Hospital For CFO Palomar Outpatient For surgeries $4.5M, budget. previous 0.9% Outpatient and the

presented this

the the 12‐

orthopedic

a Monthly

respectively.

FY18 increase

below decrease

monthly

month

respectively.

Period Utilization

Operating

budget Similarly, admissions

Health of month; Services of

Results

budget

surgeries and however;

Text increased

budget 15 in

Management

compared

average

of Ended the

Ancillary

cases. increase of of

January

and

of 12.3% ADC and

Total $4.0M following Expenses/Adjusted $9.8M,

for

Operations

increased

remained January salaries,

YTD

prior 1.81% for of

both Emergency

was Services

a compared

to 2018, 3.89 from

both year and delivery

the year Discussion

sections.

campuses relat and

31, wages,

days

‐

by the

campuses operations a previous to

4.1%

respectively.

decrease

$7.9M, ‐ 2018 16 date Discussion

same to Department largely volume

to or

and contract

the

Discharges

and

were basis, the 3.2%

riod

6 pe

respectively.

increased ‐

3.5% previous

resulted month due

Analysis continued remained

up compared

Operating

$14.1M

ER labor

behind in visits 67

Admissions average incr

were

the

in month. or

and

eased

increased 2.7%

flu from at or

prior

FY18

below Expenses/Adjusted supplies,

overall

13.3% 2,494 season.

of previous

over

At prior flu

year. t

sed

budge 1.71. increa

and the ‐

budget

related from loss 1,674 or

the

ume

high year. Year

The District 7.1%

The Title month;

of previous

and December,

42 or

vol ‐ January $2.0M,

to cases hospital’s in

Text

The

14.1% less ‐

prior

Analysis

January date 21.04%. level,

however, Discharges

annual

and than

month;

compared

case year net from

the

yet flu

average higher

EBIDA by

FY18 income

‐

mix related respectively. YTD highest

decline

December,

149 remained however,

low were

index

ADC budget. CMI. to

length

margin

from

cases 49.2% monthly in

be budgeted remained

(CMI), Deliveries

monthly

5.7% YTD

while

operations

and Inpatient

Poway and from

budget stay admissions

and excluding increases

YTD

EBIDA

positive at decline

and prior

(ALOS)

were 5.6%

saw 7.9%

volume

surgeries

was annual

month

were

12.65%. the

down behind

deliveries, were

below

in net was remained

surgical

greatest loss was

operating

below

4.27,

operating

seen at 1

FY18 were

FY18

of up the EBIDA

0.3% cases. which

$3.6M,

was at in by

budget

budget. Poway increase budget up

9.6% cardiology,

1.6% income

margin

1.72, income lower 28 Further

was

compared

less

campus. by

and and

The

which

higher

than of 7.37% 4.1%

and

than

consisted

3.6% Inpatient prior

majority $2.21M,

vascular analysis

EBIDA in

was

from FY18

than

and the

a a

3 Title Management increased Operating and monthly Salaries period sourcing effective budget. Other daily productivity budget severances, organizational Year Total January Net Outpatient $3.5M. the budgeted. registrations Operating Financial

increase patient coordinating ‐

to census operating

Operating

last ‐

Acute

by & date saw

On and initiative

annual Performance

volume Wages Gross

Expenses Revenues

3.4%.

year. registrations

Text

service annual

and

(ADC)

a a in declined net yearly

YTD slight

hierarchy patient

the

expenses

A Year

rate efficiency

Revenue

patient were staffing revenue

with with

was

merit basis, improved revenue concerted

variances

increase increase,

‐ by

higher to the days CAP/SART 351,

increased

revenue

‐

3,956, increases, and

models.

date

Salaries for had

Group improvements

for an (NPR)

than January are

in NPR. support

effort an

pricing operating increase

the or other

was

discussed Purchasing increase services.

& by 4.3%, budget ed Adjust Discussion for

month union

is Wages 1,831,

$427.6M, were changes

the operating services being

compared expenses

step is

month of 41 were

in $67.4M, or ongoing,

were

Organization, $3 $33.5M pursued

discharges from

further

16.2%,

ccurred increases, in o

.5M,

10,887,

revenues

payor

of $6.8M,

$13.3M

were December to

January or

from over detail

the to

$2.5M

13%,

contracts are

an $437.6M, for

stabilize premium in or same

the of Captis, prior

higher

active

increase

below. January

1.6%, for January was

$37.7K,

ove increase,

and previous and

January

period month;

$64.6M, and

the

searches previously

increase than

.6% pay

Title

providing of were $19.9M,

or positive workforce

43 ab

and

last

1,264 month

recorded primarily however,

4.6% Text

Analysis an 3.9%,

4,137,

an year. over for

known

budget. increase

days

or inc

from results

but reductions savings

the from by 4.8% rease

due an

was remained from

December.

integrating

same as increase the

from

increase,

of in offset Upper opportunities

previous the

same $4.2M FTEs.

to period

patient

reduction

or 3.8%

with Midwest of

This

deferral January time the month,

from from

last month

behind

$27.7M throughput

New from

the

positive

year. prior for

the in Consolidated

year and of

force

and Grad

previous December; FY18 future

costs.

in year. This

‐ an

contractual 4.0% trend

severance

program,

budget. ‐ initiative. increase

date

increase The

months. An

year.

ahead

month;

aggressive

labor Service

however, contributors primarily

of controlling

accrual

was Review adjustments This of

productivity

a $7.1M and

budget. Center YTD

primarily is

7.8% restructure due $3.3M

of primarily basis,

to from

of approximately

(UMCSC), premium The to

behind

the

operational

resulting

outpatient more the was due

the

negative

average

due

supply below to to

same

FY18 than

and pay the the

to in

4 Title Management Professional Purchased including Crofab, unfavorable increase Supplies Fees for abandoned Net Benefits Net Contract Other expenditures Depreciation unforeseen the due and due prior in

high‐ surveys

union Non Non food to to

were year’s

Direct

annual positive

cost the

‐ ‐

were were

Operating Operating Labor in Director Th supplies.

negotiations

$2.4M,

Services

snakebite and Capital EKG Text repairs interest

cardiothoracic,

to Fees

Expenses

was for

greater merit higher

budget. was variances

additional reads,

this

were

below of or

Improvement and

Revenue/Expenses

for

above increases,

were

expense,

Surgery, 9.6%, fiscal

than anti ere than

were

the

and did above maintenance This

budget on

‐

was

budget over venom.

budget year. not

costs budget month greater consulting cardiac

below property unfavorable

Director

budget

also namely severance materialize

Actual budget

for by

Projects

was by

Discussion a budget On rhythm than

$322K,

Rapid

significant

$1.1M,

$1.3M, for $917K

by and

services of

from a a

capital

year budget.

negative

$641K,

both Women’s variance payment

liability at

and by Response

management $332K,

cost or

or both ‐ or

$6K,

campuses.

8.2%

for subsequently

expenditures 12.8% 131.9% 16.0%, increase

‐

or date

This

$2.1M,

insurance, campuses.

billing

and or 18% ater Services, or

primarily for issuance

travel

5%,

0.2%, basis, unfavorable greater

for PEP

greater, gre

the

and and an

the

bonuses for Supplies labor

month

increase Director

through e affected building for

orthopedic cash

attributable expenses month than purchases and

the

than

than the

collection

variance

month FY18 of

Title

which

assist were

FY18

FY18 of month

of of January rent

th January. 44

January. This Case $1.4M related

Text surgical budget

Group

Analysis budget

$3.8M, and of to budget. with affected

provements,

flu

im of January the Management,

YT primarily ventory

‐

from

related the January.

D to This

Health for cases continued

for or

were

the On

the flu

the

the 6.5%,

favorable and unfavorable the

and

season.

FICA new attributable products insurance $4.6M

month year prior

adjustments.

month $602K

This

greater

volume

nursing CHRO

survey and bond ‐

to month.

compared unfavorable variance of ‐

or of Work date and

variance

negatively

and January.

than ‐ issues addition,

January. 2.7%

related readiness shortage, to

pharmaceuticals,

basis,

The CFO Comp the

FY18

is below

and to

new unfavorable is primarily Emergency are

The Contract variance

the several On

primarily by

insurance.

budget.

mandatory and resumption

included

budget

CEP

$700K. a unfavorable annual

year patient

contract, interim attributable

Labor

is ‐ attributable

Department,

for as

change

capital in primarily Anticipated

‐ training,

throughput date well

year Contract of

was

leadership

variance Arch efforts

budget basis, ‐ is

to $5.3M,

to attributed a

‐

additional

attributable

to date, settlement high

Labor.

Home lower

savings

Professional the

initiative.

is of

positions,

or spend primarily primarily write

increase $15M

87.8%, capital Health

from staf

for of on an

f f

5 Title Management Managed $5 been the revenue and Payor Self Cash Balance credit Bond improve compared previous 2.7, ‐

construction, to Pay

and requested

debt

balances

Mix, or assist

Sheet

and bonds collections.

month.

5.0%, Equivalents

Care

increased Days Text

with

Medi prior

Medicare, will in from from

Improving in

improvement, revenue January. ‐

Cal year AR not

In e the

by th increased

financial and

be addition,

monthly $60.1M

Bond

Medi included

collection Cash

collections

Fund. ‐

classes

in Cal renovation

Collections

due the

average

month January Discussion

in and

District efforts

the

increases

the from Managed

and of DCOH

and

recent for proved recently $56.6M.

payors were $4.3M

equipping ratio

Care

issuance

$7.9M a

continues

over engaged

until percentage Days

Medi

cash

the

of less released

in of

the ‐

Cal

Huron previous

Net flow. and

the than to campuses

totaled of

be AR 2017

Title

from prior Gross

Healthcare

the increased 45

month.

Text Certificates

escrow. most year. Analysis 57%

Patient and

Days Collections of

critical related

to from

Management Gross

Service provide

Cash 70.9

operating

Participation. healthcare Patient

Revenue

days revenue on

Hand

service

is to year challenge.

continuing

facilities. 73.1

(DCOH) cycle in

‐ to

Intended January.

Revenue. ‐ days date

process Cash

As decreased

due basis, to

uses

On pursue

January, and from to Cash

a averaged

for

combined operational

clean

5.3

the

strategies collections the

no days issuance ‐ funds

bond $55.9M

to effort basis,

improvements

with are

94.2 proceeds decreased

per to Medicare, nt of

payors th from

finance

patie month 2017

had the

to to

6 EBIDA EBIDA Oper. Operating Financial Labor Case Average Net Deliveries Days ER Note: Average Key Adjusted Key Acute

Surgeries Average Inpatient Outpatient Executive

Visits Title

Income Statistics

Volumes Financial

Mix Cash

Productivity Expenses/Adj. Patient Margin

LOS LOS Daily

Performance Discharges

on Income

Performance ‐

by Observation Hand

Days Census

Days Text

Dschg

excludes

by Dashboard

r 27.00 Hrs GO

Bonds

(1,999,558) (4,055,496) 2,418,986 Jan culBde ainePrior Variance Budget Actual 15,429 13,547 10,887 ‐ 4,137 1,235 .0 10%(.7)1.2 .6 .7 18% 10.74% (1.81%) 8.77% 6.96% 12.82% (7.37%) 11.07% 3.70% 8Jan 18 1.72 4.27 354 724 351 511

6,875,979 2,209,297

458,520 January – 12,749 11,893 10,469 ‐ Month 4,391 1,334 18 1.65 3.85 387 784 550 349 ‐ to

‐ aeYear Date (4,456,993) (4,514,016) (4,208,855) 2.4)12,567 (21.04%) 1.1)3.80 (10.91%) 39%12,390 13.91% 85% 389 (8.53%) 57% 4,455 (5.78%) 74% 1,645 (7.42%) 76% 902 (7.65%) 70% 743 (7.09%) Title .4 1.65 4.24% .7 338 10,480 0.57% 3.99%

46 Text

2018 7,976,026 1,996,532 Jan 716,930

‐ erAta ugtVrac Prior Variance Budget Actual Year 7Jan 17

(12,529,048) 30,199,988 (3,571,696) 14,670 84,336 28,091 66,864 66 0.%(.% 97.9% (3.4%) 100.0% 96.6% ‐ 26.00 2,494 8,875 5,278 3,597 8Jan 18 1.71 94.2 3.95 311

38,056,464 (6,867,409) 9,798,354 13,023 82,974 30,455 72,607 ‐ 131.0

2,685 9,252 5,438 3,814 18 1.66 3.85 338 ‐ to

‐ (13,370,050) Date (7,856,476) (5,661,639) 1.5)13,171 (12.65%) 2.% 112.7 (28.1%) 26% 3.88 (2.60%) 56% 5,221 (5.69%) 71% 2,502 (7.11%) 40% 11,553 (4.07%) 77% 29,522 (7.76%) 29% 6,332 (2.94%) 79% 328 (7.99%) 79% 70,564 (7.91%) .1 1.66 3.01% .4 81,395 1.64%

45,988,148 10,545,394 (2,358,533) Jan

‐ Year 17 7 1 EBIDA Margin EBIDA Income Net Nonoperating revenues, net Nonoperating Property tax revenues tax Property Income fromoperations Income Total expenses Total 2= Non-Operating G.O. Interest Income Bonds excludes (Expense) G.O. Levy Bonds 1= Tax Revenue Property excludes Deductions from revenue Deductions revenue Gross Revenue Operating s rge Discha d Adjuste Net patient revenue patient Net Total net revenue net Total revenue operating Other Benefits Other Depreciation svcs purch & fees Prof aais ae otatlbr32,414,036 Supplies labor contract & wages Salaries, Expenses Operating Income Title Consolidated

Text Statement: 1

(290,599,760) 355,188,918 Month‐toDate Actual Jan-18 67,438,573 64,589,158 65,439,015 10,501,716 (4,055,496) (3,480,938) (1,999,558) 1,425,000 3,607,815 8,109,473 3,236,197 9,569,336 849,857 .0 10%(7.37%) 11.07% 3.70% 4,137

(271,537,708) 332,789,490 ugtVariance Budget Jan-18 59,909,134 61,251,782 62,118,431 27,770,267 (3,175,777) 1,425,000 2,209,297 3,241,977 9,528,430 7,192,137 3,930,304 8,246,019 458,520 866,649 4,391

(19,062,052)

22,399,428 Title a-8Vlm aeEfAta ugtVariance Budget Actual Rate/Eff Volume Jan-18 (4,514,016) (4,208,855) (7,529,439) (4,643,769) (1,323,317) 3,337,376 3,320,584 (305,161) (973,286) (917,336) 47 322,489 (16,792) Text 5,780 (254) -

(19,250,405) 15,707,260 (3,543,146) (3,593,277) 3,465,479 1,606,388 (127,798) 187,534 551,178 476,996 416,033 227,351 (50,132) Variance

(10,994,918) (34,769,312) 41,649,833 (4,081,057) (6,250,157) (1,524,464) (1,800,313) (1,333,369) 6,880,522 6,913,861 (181,754) 33,340 95,138

(70,244.08) 16,301.32 85,856.64 15,612.56 15,817.99 7,835.15 2,538.49 2,313.11 1,960.23 (483.34) Dollars/Adjusted Discharges 782.26 205.43 872.08

(61,839.61) 13,643.62 75,789.00 13,949.39 14,146.76 6,324.36 2,169.99 1,877.94 1,637.93 503.14 738.32 197.37 895.08

10,067.64 (2,657.70) (8,404.47) (1,510.79) 1,663.17 1,671.23 (986.48) (368.49) (435.17) (322.30) (43.93) 23.00 8.06 8 Property tax revenues tax Property from operations Income Net Income Net net revenues, Nonoperating Total expenses Total EBIDA Margin EBIDA 2= Non-Operating G.O. Income Interest Bonds excludes (Expense) G.O.1= Levy Tax Property Revenue Bonds excludes Gross revenue Gross Operating Revenue Discharges Adjusted Other operating revenue operating Other revenue patient Net from revenue Deductions aais ae otatlbr200,634,428 Benefits labor contract & wages Salaries, Expenses Operating revenue net Total Supplies Other svcs purch & fees Prof Depreciation Consolidated Income Title

Text Statement: 111

(1,868,032,818) 2,295,656,484 437,601,237 427,623,666 434,029,541

(18,932,352) (12,529,048) Actual Jan-18 62,170,239 50,933,870 22,246,757 76,122,643 25,493,300 Year (3,571,696) 9,975,000 6,405,875 28,091 6.96% ‐toDate

(1,873,800,850) 2,301,556,921 424,121,887 ugtVariance Budget 190,916,289 433,920,241 427,756,071 (26,640,763) Jan-18 50,912,549 58,360,826 22,848,292 73,571,842 27,512,089 (6,867,409) 9,798,354 9,975,000 6,164,170 30,455 8.77%

(13,370,050) (13,479,350) Jan-18 (5,661,639) (5,900,437) (9,718,139) (3,809,413) (2,550,801) Title 7,708,411 5,768,032 2,018,789 (132,405) 241,705 109,300 601,535 (21,321) (1.81%) 48 (2,364) Text -

(178,653,113) 145,449,523 oueRt/f culBde Variance Budget Actual Rate/Eff Volume (33,203,591) (33,682,070) 32,921,495 14,819,442 1,773,547 4,530,126 3,951,971 2,135,563 5,710,847 (760,575) (478,480) Variance

(139,681,491) 172,752,676 (12,609,475) (46,400,845) (24,537,581) 33,071,186 33,791,370 (1,172,012) (3,973,292) (8,339,539) (8,261,648) (116,774) 720,185

(66,499.33) 15,577.99 15,222.80 81,722.13 15,450.84 7,142.30 1,813.17 2,213.17 2,709.86 (127.15) 791.95 228.04 907.53 Dollars/Adjusted Discharges Dollars/Adjusted

(61,526.87) 13,926.18 14,045.51 75,572.38 14,247.91 6,268.80 1,671.73 1,916.30 2,415.76 321.73 750.23 202.40 903.37

(1,651.80) (4,972.46) 1,177.29 6,149.75 1,202.93 (448.88) (873.50) (141.44) (296.88) (294.10) (41.72) 25.64 (4.16) 9 Nonoperating revenues, net Nonoperating revenues tax Property EBIDA Margin EBIDA Net Income Net Income fromoperations Income Total expenses Total 2= Non-Operating Income (Expense) excludes G.O. Interest Bonds 2= Non-Operating Income excludes (Expense) G.O. Levy Bonds Tax Revenue excludes 1= Property Adjusted Discharges Adjusted te 22,246,757 25,493,300 62,170,239 50,933,870 76,122,643 Other Depreciation 434,029,541 200,634,428 svcs purch & Prof fees Supplies 6,405,875 427,623,666 Benefits labor 2,295,656,484 contract & wages Salaries, Expenses Operating (1,868,032,818) revenue net Total revenue operating Other revenue patient Net from revenue Deductions revenue Gross Revenue Operating Title Current Consolidated

Text

1111 vs. 2

Prior

29,522 23,543,531 28,847,318 72,730,258 58,458,368 49,299,702 184,799,959 428,224,530 7,373,604 420,850,926 (1,735,027,723) 2,155,878,649 urn erPrior Year Current Year

Year a-8Jn1 hneVlm aeEfAta ugtVariance Budget Actual Rate/Eff Volume Change Jan-17 Jan-18 437,601,237 (18,932,352) (12,529,048) (3,571,696) 9,975,000 28,091 6.96% ‐toDate

(1,431) 3,354,018 (3,392,385) (3,711,871) (1,634,168) (15,834,469) 5,805,011 (967,729) 6,772,740 (133,005,095) 139,777,835

417,679,136 (22,120,594) 10,545,394 (2,358,533) 9,216,667 10.74%

1,398,297 3,525,405 2,833,613 2,389,671 8,957,684 (20,757,039) (357,416) 84,100,829 (20,399,623) (104,500,452)

(10,170,515) (14,117,090) (19,922,101) 3,188,242 1,296,774 758,333

(3.78%) Title

49 Text

1,955,721 (6,917,790) (6,545,484) (4,023,839) (24,792,153) 26,562,050 (610,313) 27,172,363 (217,105,924) 244,278,287.09 20,245,879 1,141,210 (511,160) Variance

907.53 2,709.86 2,213.17 1,813.17 7,142.30 15,450.84 228.04 15,222.80 (66,499.33) 81,722.13 (13,605,930) (40,167,980) 155,564

977.15 2,463.60 1,980.16 1,669.93 6,259.74 14,505.27 249.77 14,255.50 (58,770.67) 73,026.17 15,577.99 (127.15) 791.95 Dollars/Adjusted Discharges

69.62 (246.26) (233.01) (143.24) (882.57) 945.57 (21.73) 967.30 (7,728.66) 8,695.96 14,148.06 357.20 797.49

(1,429.92) (484.35) 5.54 10 Net Nonoperating Adjusted Total EBIDA 1= xpenses Salaries, Operating Net Property Income Prof Deductions Gross 2= Supplies Other Depreciation Benefits Other Total Operating

Property Non

income

patient fees

‐ xess59,808,843 expenses

net Operating

eeu 317,273,636 revenue operating Margin Title

from Income

Consolidated

wages

Tax

tax eeu 59,822,446 revenue Discharges &

Revenue E

purch from Revenue eeu 59,044,801 revenue

eeus1,425,000 revenues

prtos13,603 operations

Income

revenues,

eeu 777,645 revenue

eeu (258,228,835) revenue

svcs contract

excludes

(Expense) 1

net

G.O. ao 27,037,247 labor

excludes

Bonds Text

Statement:

G.O. Levy

Bonds Jul-17 10,619,923 (1,132,198) (2,570,801) 8,106,059 3,645,579 7,282,912 3,117,123

Interest

3,865 .9 .6 .8 .8 .6 .4 3.70% 2.64% 8.96% 8.38% 8.48% 8.56% 8.19%

(269,421,052) 331,797,115 Aug-17 62,793,124 11,615,531 27,790,703 62,376,063 63,352,570 (2,748,103) 1,425,000

9,530,476 2,955,333 7,222,947 3,678,134 (763,657) 559,446 976,507 4,086

Monthly

(255,094,069) 315,065,088 Sep-17 60,352,295 11,207,387 26,428,463 59,971,019 60,921,931 (2,851,813) 1,425,000 3,320,596 8,882,011 6,869,231 3,644,607 (857,177) 569,636 950,912 3,960

(277,555,739) 338,655,391 Oct-17 61,882,519 10,870,139 28,062,628 61,099,652 62,174,001 (2,250,927) 1,425,000 2,787,740 9,347,983 7,194,619 3,619,410 1,074,349

(534,445) 291,482 Trend 4,046

(255,896,415) 316,011,001 Nov-17 60,479,938 10,472,853 27,660,125 60,114,586 61,079,005 (2,936,921) 1,425,000 3,470,839 8,174,303 7,043,641 3,658,177 ( 912,854) 599,067 964,419 3,908

Title (261,236,949) 321,665,335 Dec-17 50 64,845,946 10,835,095 31,241,228 60,428,386 61,240,571 (2,092,849) (4,273,224) (3,605,375) 1,425,000 3,358,929 8,560,070 7,211,047 3,639,577

812,185 Text 4,089

(290,599,760) 355,188,918 Jan-18 67,438,573 10,501,716 32,414,036 64,589,158 65,439,015 (3,480,938) (4,055,496) (1,999,558) 1,425,000 3,236,197 9,569,336 8,109,473 3,607,815 849,857 4,137 Feb-18 Mar-18 Apr-18 May-18 Jun-18

(1,868,032,818) 2,295,656,484 Fiscal 437,601,237 200,634,428 427,623,666 434,029,541 (18,932,352) (12,529,048) 22,246,757 62,170,239 50,933,870 25,493,300 76,122,643 (3,571,696) 2018 9,975,000 6,405,875

Year 28,091 11 6.96% North ot 2,982 North Surgeries North Average Adjusted Consolidated North South ot 898 South Kaiser North Consolidated Average Consolidated Consolidated Observation South C osldtd3,865 Consolidated South South South Consolidated South North South Patient Consolidated North Average Consolidated Consolidated To N Consolidated Surgeries South North Surgeries onsolidated orth tal Title

Surgeries

Average Statistical

Days

Length Daily Length

Inpatient ‐ Outpatient ‐ CVS ‐ Discharges

Acute ‐ Discharges

Census

Daily Cases

of of

Stay Stay

Consolidated ‐

Text Only Census Acute ‐

Only Observation ‐ Acute ‐

Indicators

Hours

Jul ‐

7Aug 17 78.26 9,359 1,224 1,408 7,951 3.95 3.30 4.08 603 871 249 256 676 124 353 229 302 727 478 ‐ 45 19 19

‐ 7Sep 17 58.32 3,199 1,407 9,421 4,086 8,014 1,325 3.85 3.26 3.98 606 934 315 883 259 150 694 391 241 304 756 556 ‐ 45 13 13

‐ 7Oct 17 63.00 3,011 1,541 9,122 3,960 7,581 1,335 Title 3.84 3.15 4.02 652 970 299 951 253 142 647 365 223 304 794 522 ‐ 51 19 19 51 Text

‐ 7Nov 17 54.32 3,140 1,808 9,790 4,046 7,982 1,313 4.00 3.79 4.06 614 936 300 895 257 164 705 377 213 316 778 513 ‐ 58 22 22

‐ 7Dec 17 66.10 2,930 1,554 8,662 3,908 7,108 1,251 3.78 3.16 3.96 554 865 294 977 237 158 717 386 228 289 712 522 ‐ 52 17 17

‐ 17 72.84 25.00 23.00 25.00 3,137 1,744 9,623 4,089 7,879 1,192 3.85 3.42 3.96 559 883 308 944 254 122 724 309 187 310 681 495 ‐ 56 16 16

Jan ‐ 10,887 821 2018 2018 18 64.68 27.00 29.00 27.00 3,112 2,244 1,007 4,137 8,643 1,235 4.27 3.94 4.37 572 915 328 279 137 698 320 183 351 709 511 ‐ 72 15 15 Fiscal

‐

21,512 11,706 66,864 28,091 55,158 65.37 26.00 26.00 26.00 4,160 6,556 6,374 2,093 4,861 2,501 1,504 8,875 5,157 3,597

3.95 3.54 4.06 erBudget Year 257 997 311 121 121 ‐ 54

23,129 16,272 72,607 30,455 56,334

87.40 4,360 7,327 6,593 2,170 1,015 4,680 2,659 1,644 9,252 5,375 3,814 3.85 4.02 3.80 262 338 12 76 63 63 Nor Deliveries Consolidated South North Trauma Consolidated South Consolidated Consolidated South Consolidated South Consolidated ER Total South North ER Consolidated ER South North South North Outpatient ot 8,624 North Trauma Consolidated South North North

Visits Admissions Conversion Title th Statistical

ses

Visits Admissions

Ca (includes

Registrations

(includes (ER (includes

Admission Trauma) Text Trauma

Trauma) (includes Outpatient ‐

as Indicators

& % Inpatient ‐ Admissions) Lab) ‐ age of

Only

Only Visits) Jul ‐ 12,579 11,262 7Aug 17 1,435 9,827 27 23 24 20 23 26 13.4% 12.6% 12.3% 12.0% 12.4% 12.3% 12.7% 1,169 7,455 2,372 5,707 2,638 36 36 30 26 27 32 13.5% 13.2% 12.7% 12.6% 13.0% 13.6% 13.6% 6,872 01 .%1.%1.%1.%1.%13.0% 10.6% 11.2% 10.2% 10.1% 8.4% 10.1% 103 162 103 322 266 251 162 ‐ ‐ 71

‐ 12,957 11,037 12,582 7Sep 17 1,545 1,285 8,187 2,850 5,788 9,472 3,110 7,169 166 386 260 291 166 ‐ ‐ 95 95 95

‐ 12,577 11,204 7Oct 17 1,384 9,820 1,128 7,540 2,280 5,495 8,668 2,536 7,082 Title 139 387 256 288 139 ‐ ‐ 80 80 99 52 Text

‐ 13,251 10,822 12,295 7Nov 17 1,473 1,162 8,089 2,733 5,801 9,251 3,044 7,450 100 100 163 358 311 282 163 ‐ ‐ 76

11,808 10,146 11,573 ‐ 7Dec 17 1,427 1,107 7,604 2,542 5,362 8,711 2,862 6,446 149 332 320 267 149 ‐ ‐ 91 91 65

‐ 11,299 10,382 11,873 17 1,491 1,188 7,824 2,558 5,285

9,012 2,861 6,014 143 355 303 278 143 ‐ ‐ 88 88 77

Jan ‐ 13,130 11,734 13,547 10,070 821 2018 2018 18 1,361 3,025 6,024 1,813 8,709 3,477 7,106 109 173 109 354 452 276 173 ‐ ‐ 78 Fiscal

‐

18,360 39,462 87,601 10,568 55,408 73,768 20,528 84,336 48,139 63,808 25 12.7% 12.5% 06 10.5% 13.4% 10.6% 13.2% 1,095 2,494 2,168 1,933 1,095 8,400

erBudget Year 666 666 561 ‐ ‐

17,126 40,497 91,100 10,559 55,288 72,414 19,135 82,974 50,603 63,839 2,685 2,008 1,978 8,551 588 588 984 707 984 13 Title May ao Mix Payor Mar PY Nov Aug Dec Feb Sep Apr Oct Ju Jan Jul

n AVG ‐18 ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ 17 18 17 17 18 18 18 17 17 17 18 %1%2%3%4%5%6%7%8%9%100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% MEDICARE

Text

ALL 22% 23% 23% 23% 23% 23% 25% 25% MCAR

MGD

ALL MEDI 13% 15% 14% 13% 15% ‐ 14% CAL 14% 14%

ALL MCAL 7% 6% 7% 6% 7% 7% 5% 5%

MGD Title

ALL 53 Text 14% 15% 17% 17% 14% 15% 15% SELF 16%

PAY

ALL 2% 4% 3% 2% 1% 2% 1% 3% MGD

CARE 20%

22% 20% ALL 21% 21% 22% 21% 21% CAP

ALL COV ‐ 14% CA 14% 14% 14% 14% 13%

13% 14% ALL OTHER 2% 2% 2% 2% 1% 2% 2% 2% 4% 3% 2% 2% 2% 2% 2% 2%

ALL 14 May PY Mar Nov Aug Dec Feb Sep Title Apr Oct Ju Jan Jul ao Mix: Payor

n AVG ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ 17 18 18 17 17 18 18 18 17 17 17 18 %1%2%3%4%5%6%7%8%9%100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% MEDICARE

Text 15% 16% 16% 16% 16% 17% 17% 18% MCAR Emergency

MGD 12% 12% 12% 12% 12% 13% 13% 13% MEDI ‐ 8% CAL 8% 7% 10% 6% 9% 7% 6%

Department MCAL

MGD Title 22% 23% 24% 22% 24% 23% 21% 21% 54 Text SELF PAY 2% 6% 4% 4% 6% 6% 5% 6% MGD

CARE 24% 24% 25% 25% 23% CAP 24% 24% 24% COV ‐ CA 8% 7% 7% 8% 8% 7% 7% 7% 2% OTHER 2% 2% 1% 1% 2% 2% 1% 5% 4% 3% 3% 3% 3% 2% 2% 15 ot 1.56 1.69 Case Consolidated South ot 1.75 1.77 1.78 Consolidated South North Case Consolidated South North Case North Title Case Mix Mix Mix Index Index Index

‐

(excludes Text Medicare Mix Deliveries)

Only

Index

Jul ‐ 7Aug 17 1.56 1.41 1.60 1.72

‐ 7Sep 17 1.68 1.65 1.76 1.73 1.76 1.55 1.42 1.58 1.69

‐

7Oct 17 Title 1.71 1.52 1.78 1.53 1.89 1.56 1.33 1.62 1.76 55 Text

‐ 7Nov 17 1.73 1.64 1.76 1.68 1.79 1.60 1.49 1.62 1.75

‐ 7Dec 17 1.73 1.65 1.88 1.75 1.95 1.60 1.54 1.62 1.75

‐ 17 1.69 1.59 1.77 1.69 1.81 1.56 1.43 1.59 1.72

Jan ‐ 821 2018 2018 18 1.72 1.60 1.81 1.66 1.89 1.60 1.48 1.63 1.76 Fiscal

erBudget Year

1.71 1.60 1.79 1.68 1.84 1.58 1.44 1.61 1.74

1.67 1.66 1.59 1.76 1.68 1.79 1.45 1.32 1.49 16 Total Investment Assets Accumulated Property, Other Prepaid of Total Other Construction Prepaid Est. Allowance Current Net Inventories Net Total Total Cash Deferred Total Restricted Restricted Non loss Cash Board Total Patient Balance

resources

third property, accounts ‐ on

Current

on marketable restricted assets non current assets cash Title

non designated

refunding

Accounts Assets debt expenses hand

party ‐ outflow plant

‐ current

other assets on current

and cash

Assets in assets

insurance receivable depreciation

accounts plant

settlements

& assets process

deferred

securities bt

equivalents Receivable

qimn 1,549,135,200 equipment of assets of

assets

companies &

de resources Sheet:

Text qimn 1,052,435,578 equipment

costs

outflow

‐

Excludes

1,616,511,868 1,209,349,829 1,557,316,849 (533,072,585) (230,480,594) 134,913,074 144,938,722 347,967,020 116,617,022 124,315,409 160,686,996 375 59,195,019 Jan 10,856,538 11,754,764 36,372,963 10,961,250 16,942,683 36,371,587 17,947,821 7,123,566 2,682,606 4,021,073 ,419,316 348,231 ‐ 8Dec 18

1,550,636,891 1,610,684,937 1,200,608,237 1,054,768,574 1,551,427,346 (530,933,040) (215,911,792) 124,355,558 355,910,344 139,998,552 350,819,109 102,429,762 120,893,113 164,984,632 59,257,592 10,374,480 15,413,178 35,064,723 10,890,108 16,942,683 44,091,519 21,577,699 7,145,938 2,589,956 3,963,687 G.O. 348,098 ‐ 7Jun 17

1,545,122,079 1,644,873,964 1,220,859,306 1,068,812,554 1,604,686,070 Bonds (508,941,185) (228,299,821) 348,571,235 120,271,414 383,826,763 157,180,569 223,257,937 53,880,572 40,187,894 32,631,660 10,428,531 88,878,276 66,077,368 1 53,533,284 5,759,958 6,942,683 3,396,376 3,527,946 9,529,822 347,288 ‐ 17

‐ Title

56 Text Total Current Total Other Liabilities Net Long Bonds Unrestricted Est. Total Current Total Other Total Total Restricted Board Deferred Accounts Accrued Accrued Accrued of resources unearned

third Position

Term resources liabilities net liabilities, current long liabilities

LT current designated &

portion Liabilities

arl 19,327,471 payroll T 22,875,254 interest PTO contracts

liabilities

position party aal 33,302,780 payable inflow

term for Liabilities

and revenue liabilities

liabilities other

settlements

and

liabilities of deferred

aal 3,810,035 payable net

payable bonds

resources deferred

purpose

oiin1,616,511,868 position

inflow

‐ inflow

789,995,408 826,516,461 132,018,496 670,581,909 670,446,848 771,699,356 802,600,405 12,290,000 Jan 37,416,239 17,947,821 23,916,056 2,996,718 135,061 348,231 ‐ 8Dec 18

1,610,684,937 822,617,082 796,053,318 774,127,521 143,064,193 671,400,732 814,631,620 671,567,427

11,355,000 46,757,871 31,280,129 21,577,699 21,373,137 23,634,935 6,702,847 7, 1,960,275 985,462 166,696 348,098 ‐ 7Jun 17

1,644,873,964 749,993,585 902,921,245 902,573,957 135,891,355 606,055,086 606,061,364 741,952,719 13,515,000 40,690,444 33,808,502 16,670,225 23,754,402 8,040,866 3,896,344 3,556,438 347,288 ‐ 17 6,278 17 ‐ Total Assets Investment Accumulated Property, of Total Other Other Prepaid Construction Prepaid Est. Allowance Total Current Net Inventories Net Cash Total Non Deferred Total Restricted Restricted Cash loss Board Total Patient Balance

resources

third property, accounts ‐ on

Current

on marketable restricted assets current non assets cash Title

non designated

refunding

Accounts Assets debt expenses hand

party ‐ outflow plant

‐ current

other assets on current

and cash

Assets in assets

insurance receivable depreciation

accounts plant

settlements

& assets process

deferred

securities

equivalents Receivable

qimn 1,549,135,200 equipment of assets of

assets

companies &

de resources Sheet:

Text qimn 1,052,435,578 equipment bt

costs

outflow

‐

Includes

1,652,342,297 1,240,311,687 1,589,164,397 (533,072,585) (230,480,594) 163,467,288 348,852,710 144,938,722 145,171,236 124,315,409 160,686,996 375 63,177,900 Jan 13,264,182 12,640,453 36,372,963 10,961,250 16,942,683 36,371,587 17,947,821 7,123,566 2,682,606 4,021,073 ,419,316 348,231 ‐ 8Dec 18

1,550,636,891 1,644,732,784 1,227,270,523 1,054,768,574 1,581,492,313 (530,933,040) (215,911,792) 148,594,420 355,910,344 354,221,789 139,998,552 126,668,623 120,893,113 164,984,632 63,240,472 18,815,858 12,797,904 35,064,723 10,890,108 16,942,683 44,091,519 21,577,699 G.O. 7,145,938 2,589,956 3,963,687 348,098 ‐ 7Jun 17

Bonds 1,545,122,079 1,681,635,110 1,253,391,491 1,068,812,554 1,637,357,173 (508,941,185) (228,299,821) 348,571,235 383,965,682 120,271,414 157,180,569 223,257,937 83,884,294 44,277,937 32,631,660 10,428,531 88,878,276 66,077,368 1 83,537,006 6,942,683 5,759,958 3,396,376 9,668,741 6,056,409 347,288 ‐ 17

‐ Title

57 Text Total Current Other Liabilities Total Net Long Bonds Unrestricted Est. Total Current Total Total Other Total Restricted Board Accounts Deferred Accrued Accrued Accrued of resources unearned

third Position

Term resources liabilities net long liabilities, current liabilities

LT current designated &

portion Liabilities

arl 19,327,471 payroll T 22,875,254 interest PTO contracts

liabilities

position party aal 33,302,780 payable inflow

term for Liabilities

and revenue liabilities

liabilities other

settlements

and

liabilities of deferred

aal 9,358,745 payable net

payable bonds

resources deferred

purpose

oiin1,652,342,297 position

inflow

‐ inflow

1,467,267,320 1,300,549,576 1,300,414,516 1,443,351,264

185,074,977 142,801,687 166,778,925 17,524,480 Jan 37,416,239 17,947,821 23,916,056 2,996,718 135,061 348,231 ‐ 8Dec 18

1,452,659,467 1,299,570,172 1,299,736,868 1,644,732,784 1,444,674,004 192,073,317 170,147,521 144,937,137 16,589,480 38,772,409 21 31,280,129 21,373,137 23,634,935 7,985,462 6,702,847 6,584,200 ,577,699 166,696 348,098 ‐ 7Jun 17

1,377,015,420 1,228,736,069 1,228,742,347 1,681,635,110 1,368,974,554 304,619,690 304,272,402 140,232,207 20,622,127 32,649,578 33,808,502 16,670,225 23,754,402 8,040,866 3,896,344 8,831,029 347,288 ‐ 17 6,278 18 ‐ Cash Title

Flow

Text

Statement Accounts payable Accounts assets current andother expenses Prepaid Inventories receivables other and Tax Property receivable accounts Patient liab and assets operating in Changes debts bad for Provision Expense Depreciation activities: from operating provided cash net to assets net in change reconcile Adjustmentsto operations from (Loss) Income ACTIVITIES: OPERATING CASH FLOWS FROM CASH AND CASH EQUIVALENTS - End of period CASH period AND of CASH Beginning - EQUIVALENTS INCREASENET (DECREASE) IN CASH AND CASH EQUIVALENTS activities financing related and incapital used Net cash Debt Term Long of Payments paid Interest Bond Revenue paid Interest Bond G.O. debt of issuance from Net Proceeds Distributions Fund Trust Redevelopment andequipment plant property of Acquisition sale onasset Proceeds CASH FLOWS CAPITAL FROM AND RELATED FINANCING ACTIVITIES: activities financing non-capital from provided Net cash Taxes District of Receipt Taxes Bond G.O. of Receipt CASH FLOWS NON-CAPITAL FROM FINANCING ACTIVITIES: activities investing by) (used from provided Net cash inaffiliates Investment oninvestments (Loss) Income investments of sales Net (purchases) ACTIVITIES: INVESTING CASH FLOWS FROM activities operating by) (used from provided Net cash liabilities current Other payors duethird-party amounts settlement Estimated compensation Accrued ilities: Title

58 Text 6315736,371,587 66,077,368 36,371,587 44,091,519 Jan-18 19308 (12,354,131) (1,933,058) (10,049,261) (1,884,560) 1,778,098 (2,805,345) 87244 (53,899,988) (8,712,494) (3,571,696) (1,999,558) 49369 (41,081,772) (31,368,676) (4,973,629) (2,946,006) 77992 (29,705,781) (4,167,295) (7,719,932) (2,724,493) 17590 (15,948,256) (1,795,980) (3,706,129) 79721 (6,750,111) (7,937,211) ,7,2 29,232,675 3,772,324 ,0,1 25,493,300 3,607,815 ,1,7 1,018,079 1,018,079 2,022,651 ,1,7 10,556,836 3,615,077 ,1,0 22,293,396 11,736,560 7,915,401 4,300,324 (143,063) (70,278) 1,9)(36,573,934) (18,392) (71,142) 3,3)(20,636,763) (31,635) 33733,379,339 43,337 8111,010,361 18,101 (6,164,223) 0 48,907,638 0 YTD (649,838) (505,722) (532,719) (899,626) 336,165 19 Title

Text Supplemental

Title

59 Text

Information 20 Title

1- Includes GO Bonds GO 1- Includes AND POSITION RESOURCES NET INFLOW OF LIABILITIES, DEFERRED TOTAL RESOURCES TOTAL ASSETS AND DEFERRED OUTFLOW OF Total Net Position Net Total Unrestricted Restricted Invested in capital assets — net of related debt Deferred inflow of resources - deferred revenue liabilities Total Long-term Liabilities Current liabilities LIABILITIES AND NET POSITION Deferred outflow of resources Other receivables assets Noncurrent Capital assets -- net Current assets ASSETS AS OF JANUARY 2018 CONDENSED COMBINING STATEMENT OF NET POSITION Text Total liabilities and deferred inflow of resources Total Assets Total 1

Title 13,635,076 - - 13,635,076 39,389 9,140,775 2,537,861 2,537,861 11,041,054 675,895 - 11,097,215 11,097,215 56,161 13,635,076 3,779,017 60 1,652,342,297 1,652,342,297 Text 1,052,435,579 1,467,267,321 1,443,351,265 1,302,786,423 1,589,164,397 159,127,550 376,996,351 185,074,976 212,521,330 140,564,842 (57,127,516) 29,681,162 23,916,056 63,177,900 PH 604,917 - (4,251,848) - - (4,251,848) - (3,145,099) (3,145,099) (3,145,099) (1,106,749) (1,106,749) - (1,106,749) (1,106,749) - (4,251,848) - RHEiiain Total Eliminations ARCH -

1,661,725,525 23,916,056 63,177,900 1,661,725,525 156,021,840 386,137,126 184,467,738 211,914,092 150,499,147 - (57,127,516) 1,477,257,787 1,453,341,731 1,302,842,584 1,598,373,562 1,056,214,596

29,681,162 21 Title OPERATING REVENUE: ENDED THE MONTHS FOR SEVEN JANUARY 2018 POSITION NET IN AND CHANGES EXPENSES, REVENUE, OF STATEMENT COMBINING CONDENSED ERCAINADAOTZTO 25,493,300 AMORTIZATION AND DEPRECIATION PRTN XESS412,107,938 EXPENSES OPERATING NOE(OS RMOEAIN (3,571,694) (EXPENSE): INCOME NONOPERATING OPERATIONS FROM (LOSS) INCOME E OIIN-Bgnigo er304,619,689 NET POSITION - End of yea of year NET POSITION - Beginning te e oiinAjsmns(48,411) (100,346,355) (19,149,947) Adjustments Position Net Other Partners Health Interfund - Arch IN NETCHANGE POSITION 1- Includes GO Bonds GO Includes 1- hrdrs eeu 42,269,044 385,354,623 revenue risk Shared revenue service patient Net HPormrvne- 6,405,875 revenue Program PH revenue Other neteticm 336,164 income Investment te e (1,959,623) (36,413,125) 22,458,331 - net Other revenue tax Property expense Interest

Text oa prtn eeu 434,029,542 revenue operating Total oa prtn xess437,601,237 expenses operating Total oa ooeaigepne-nt(15,578,253) - net expense nonoperating Total r 1 1,133,454 2,537,861 701,167 23,466,484 (13,375,114) 36,841,598 1,947,282 352,529 3,272,000 (11,079,127) 2,295,987 6,314,534 104,013 - (3,824) 15,914,483 36,140,431 100,346,355 (90,001,367) 185,074,976 HAc lmntosTotal Eliminations Arch PH Title

61 Text (65,038) (1,133,454) (3,145,099) - (1,198,492) - (1,198,492) - - (1,945,099) (1,945,099) - - (1,198,492) (1,945,099) - - (1,200,000) - 48,583,578 6,444,850 - 184,467,738 447,049,877 26,194,467 338,347 456,297,534 22,458,331 (36,416,949) 473,244,343 (16,946,808) (1,607,094) (91,249,778) 307,891,689 - (32,174,173) (15,227,365) 401,269,106

ADDENDUM C

62 Passion. People. Purpose.TM

Proposed Parking Structure Dan Farrow, VP Hospitality & Facilities Hugh King, CFO Board of Directors Monday, March 12, 2018

1 63 StrategicInitiative Title Text • • • o o o o Parking issues will be escalated when Parking at PMC Critical Crisis Floors New New MOB is rehabilitationhospital is to expansionof at services PMC Stabilization Unit building Stabilization is 9, 9, 10 and 11 are opened – Escondido is currently inadequate completed

opened Title 64

opened Text : - Escondido Campus Escondido 2 Developer’s Rendering Title Text : Proposed Parking Structure

Title

65 Text 3 Issues to BeAddressed Issues • • Title Text o o o o o o o Timing Capital Requirements Floors Crisis Rehabilitation Medical Parkingstructure will which is already committed to other strategic Palomar Parkingstructure with1,900 . If Stabilization Unit Stabilization construction begins in Q2 in begins construction 9, 9, 10 and 11 Office Building #1 Health has approximatelyHealth $60 millionin available Hospital are expected take about take about 15 months to is expected is is expected is expectedis + spaces willcost over $27 millionto –

2018, Title to open in Q3 66 to open Q3 to open Q3 Text will be available for use in use for availablebe will to open projects Q3 – complete – – 2019 2019 2021 – 2018 capital, Q3 – 2019 build most of 4 Proposed PlanProposed • • Title Text o o o o o o o o o o o TIMING FINANCING Ground Ground Tax NHREFCO Contract If Estimated rent monthly Remaining provide Will Contract Monthly Operating building rental rental building Bargaining Collective necessary with completion the plan is approved isapproved plan the - exempt exempt lease from Palomar Health to NHREFCO NHREFCO to PalomarHealth from lease rent of approximately $117,000of approximately rent with ACE Parkingwith NHREFCO with isa revenues of $5.00 per slot per day would be needed to cover needed be day wouldslot per of$5.00per revenues Palomar NHREFCOto from lease Health 1,257 slots would need to generate an average of $3.10 of average an generate to need slots1,257would by Q3 bonds approximately 750 slots (reserved free parking for employees for employees parking free slots(reserved approximately 750 501(c)(3) and operating costs operating and projects which they cannot finance using their ownusing their financecannot they projects which – 2019 Agreement) in March,in corporation whose whose corporation to develop a 5 to develop Services to construction Title operate 67 -

story Text tax parking - could begin in Q2 in begin could fee exempt exempt - based based structure with 1,907 structure with mission toassist is parking programparking – 2018, credit per slotper to monthly with spaces hospitals per project cover 5 Benefits and Risks Benefitsand • • Title Text o o o o o o o RISKS BENEFITS Potential negative public relations impact (can be mitigated by signage, i.e., by signage, mitigatedbe (canimpactrelations publicPotential negative there of operations, the cost less than to be were revenues parking structureIf Provides Provides Assuming No Enables “This parking facility is owned by NHREFCO and operated by ACE Parking Services”) by operated and by NHREFCO “This facilityparking is owned cash flows on impacta negative be would Balance Sheet Health’s no impact impact on income from on income impact Palomar Health to meet its parking needs for the foreseeable future foreseeable Palomarfor themeet itsHealth toneeds parking for timelyof parkingfor completion of parking constructionfor parking on cash on structure fees fees structure positon operations cover costs of operations and lease lease operations and costscover of

structure withstructure Title

68 Text structurebefore no debt added to added no debt peak peak demand payments, Palomar 6 Recommendation • Title Text o o o Board To negotiate To negotiate To negotiate with NHREFCOwith Authorization Management for and execute an operating agreement with ACE Parking with agreement operating an execute and parking proposed the for lease operating an execute and withlease a ground execute and

Title

69 Text NHREFCO Services structure 7

ADDENDUM D

70 Palomar Medical Center Escondido 2185 Citracado Parkway Escondido, CA 92029 (442) 281-1005 (760) 233-7810 fax Medical Staff Services

February 27, 2018

To: Palomar Health Board of Directors

From: Franklin Martin, M.D., Chief of Staff Palomar Medical Center Escondido Medical Executive Committee

Board Meeting Date: March 12, 2018

Subject: Palomar Medical Center Escondido Credentialing Recommendations

I. Provisional Appointment (03/12/2018 – 02/29/2020) Ballas, Jerasimos, M.D., Maternal-Fetal Medicine Bayati, Nasser, M.D., Internal Medicine Esfahani, Fatemeh B., M.D., Internal Medicine Hardesty, Susan J., M.D., Psychiatry Knight, Amber N., M.D., Obstetrics and Gynecology Mazzarulli, Anthony A., M.D., Psychiatry Nguyen, Brian M., M.D., General Surgery Ramezani, Roshanak, M.D., Psychiatry Seigler, David R., M.D., Psychiatry Walker, Kolby R., D.O., Psychiatry Whitney, Janet, D.O., Wound Care & Hyperbaric Medicine

II. Advance from Provisional to Active Category Tavakoli, Sirpa A., M.D., Psychiatry (03/12/2018 – 05/31/2018)

III. Additional Privileges Panzer, Glenn M., M.D., Family Practice/Hospice & Palliative Medicine  Family Medicine Core Privileges (with Co-management plan) Zakko, Maram F., M.D., Gastroenterology  Moderate Sedation

IV. Leave of Absence Mulder, Nicole B., M.D., Ophthalmology (12/21/2017 – 11/30/2019)

V. Voluntary Resignations Clapper, Mark F., M.D., Orthopaedic Surgery (Effective 02/08/2018) Hekmat, Maryam J., M.D., Internal Medicine (Effective 02/28/2018) Page, Thomas E., M.D., Pediatrics (Change to Retired Category Effective 01/01/2018) Zupancic, Michael J., M.D., Neurology (Effective 03/01/2018)

71 VI. Allied Health Professional Appointment (03/12/2018 – 02/29/2020) Brown, Kaley M., P.A.-C., Physician Assistant (Sponsors: Drs. Cohen, Owsley, Stern) Chujutalli, Gissel S., P.A.-C., Physician Assistant (Sponsor: Dr. Anthony) Ortiz, Don J., P.A.-C., Physician Assistant (Sponsor: Dr. Bower) Periharos, Zachary, P.A.-C., Physician Assistant (Sponsors: Drs. Cohen, Owsley, Stern)

VII. Allied Health Professional Expiration of Membership Effective 03/31/2018 Forbes, Beth A., F.N.P., Family Nurse Practitioner (Sponsor: Dr. Gandhi) Gessin, Leah G., P.A.-C., Physician Assistant (Sponsor: Dr. Clapper for Kaiser Ortho) Montague, Marsha M., P.A.-C., Physician Assistant (Sponsor: Dr. Rivas for CEP) Sikich, Michael A., P.A.-C., Physician Assistant (Sponsor: Dr. Clapper for Kaiser Ortho) Watkins, John S., P.A.-C., Physician Assistant (Sponsor: Dr. Clapper for Kaiser Ortho)

VIII. Reappointment Effective 04/01/2018 – 06/20/2019 Kadesky, Yale M., M.D. Plastic Surgery Dept of Surgery Active

Reappointments Effective 04/01/2018 –03/31/2020 Bitar, Roger A., M.D. Infectious Disease Dept of Medicine Active Busby, Andrew J., M.D. Internal Medicine Dept of Medicine Active Canales, Jose J., M.D. Endocrinology Dept of Medicine Consulting Choudry, Bilal A., M.D. Neurology Dept of Medicine Active Chow, Byron C., M.D. Pediatrics Dept of Pediatrics Affiliate (Change from Active to Affiliate with No Clinical Privileges) Cizmar, Branislav, M.D. Obstetrics and Gynecology Dept of OB/GYN Active Cullen, Jennifer, M.D. Emergency Medicine Dept of Emergency Med Active Deree, Jessica A., M.D. General Surgery Dept of Surgery Courtesy Errecart, Keith C., M.D. Emergency Medicine Dept of Emergency Med Active Esmaeili, Keyvan, M.D. Physical Medicine and Rehab Dept of Ortho/Rehab Active Furubayashi, Jill K., M.D. Diagnostic Radiology Dept of Radiology Active Gonsalves, Gary D., M.D. Anesthesiology Dept of Anesthesia Active Hempton, Robert F., M.D. Orthopaedic Surgery Dept of Ortho/Rehab Active Hong, Raymond J., M.D. Diagnostic Radiology Dept of Radiology Active Isariyawongse, Brandon K., M.D. Urology Dept of Urology Active Khaleel, Maseeha S., M.D. Anesthesiology Dept of Anesthesia Active Lee, Emmet W., M.D. Internal Medicine Dept of Medicine Active Liu, Paul Y., M.D. Rheumatology Dept of Medicine Consulting Metsch, Daniel J., M.D. Pediatics Dept of Pediatrics Active Meyerhoff, Brian W., M.D. Internal Medicine Dept of Medicine Affiliate (Refer and Follow Privileges) Phan, Tuan A., M.D. Internal Medicine Dept of Medicine Active Posadas, Emerito D., M.D. Pediatrics Dept of Pediatrics Courtesy (Change from Active to Courtesy) Raiszadeh, Ramin, M.D. Orthopaedic Surgery Dept of Ortho/Rehab Courtesy (Change from Active to Courtesy) Reisman, Bruce K., M.D. Otolaryngology Dept of Surgery Courtesy Rodriguez, George J., M.D. Internal Medicine Dept of Medicine Active Sawhney, Navinder S., M.D. Cardiovascular Disease Dept of Medicine Active Smith, Joel J., M.D. Orthopaedic Surgery Dept of Ortho/Rehab Active (Change from Courtesy to Active)

72 Reappointments….Continued Stearns, Gregory S., M.D. Otolaryngology Dept of Surgery Active Stern, Mark S., M.D. Neurosurgery Dept of Surgery Active Soontornvachrin, Mark S., M.D. Ophthalmology Dept of Surgery Courtesy Weissman, Jeffrey S., M.D. Gastroenterology Dept of Medicine Active Wu, Fang, M.D. Internal Medicine Dept of Medicine Active Yee, Jonathan G., M.D. Internal Medicine Dept of Medicine Active Zentner, Phillip G., M.D. Radiation Oncology Dept of Radiology Courtesy

Certification by and Recommendation of Chief of Staff As Chief of Staff of Palomar Medical Center Escondido/Palomar Medical Center Escondido Downtown, I certify that the procedures described in the Medical Staff Bylaws for appointment, reappointment or alteration of staff membership or the granting of privileges and that the policy of Palomar Health’s Board of Directors regarding such practices have been properly followed. I recommend that the action requested in each case be taken by the Board of Directors.

73 Jerasimos Ballas, M.D. Page 1 of 1 PALOMAR HEALTH PROVISIONAL APPOINTMENT March 2018

PERSONAL INFORMATION

Provider Name & Title Jerasimos Ballas, M.D. Palomar Health Facilities Palomar Medical Center Escondido

SPECIALTIES/BOARD CERTIFICATION

Specialties Obstetrics and Gynecology – Certified 2014 Maternal-Fetal Medicine - Certified 2017

ORGANIZATIONAL NAME

Name UCSD Dept. of Reproductive Medicine

EDUCATION/AFFILIATION INFORMATION

Medical Education Information State University of New York, Downstate From: 09/01/2002 To: 05/31/2006 Doctor of Medicine Degree

Internship Information N/A Residency Information State University of New York at Stony Brook Obstetrics/Gynecology From: 07/01/2006 To: 06/30/2010

Fellowship Information University of California, San Diego Maternal-Fetal Medicine From: 07/01/2010 To: 06/30/2013

Current Affiliation Information University of California, San Diego Ben Taub General Hospital, Houston

74 Nasser Bayati, M.D. Page 1 of 1 PALOMAR HEALTH PROVISIONAL APPOINTMENT March 2018

PERSONAL INFORMATION

Provider Name & Title Nasser Bayati, M.D. Palomar Health Facilities Palomar Medical Center Escondido Palomar Medical Center Poway

SPECIALTIES/BOARD CERTIFICATION

Specialties Internal Medicine - Certified 2000, Recertified 2010

ORGANIZATIONAL NAME

Name CEP Hospitalists

EDUCATION/AFFILIATION INFORMATION

Medical Education Information Tebriz University of Medical Sciences, Iran From: 09/01/1983 To: 08/31/1990 Doctor of Medicine Degree

Internship Information N/A Residency Information William Beaumont Hospital - Michigan Internal Medicine From: 07/01/1997 To: 06/30/2000

Fellowship Information N/A Current Affiliation Information Sharp Memorial Hospital, San Diego Sharp Chula Vista Medical Center, Chula Vista

75 Fatemeh B. Esfahani, M.D. Page 1 of 1 PALOMAR HEALTH PROVISIONAL APPOINTMENT March 2018

PERSONAL INFORMATION

Provider Name & Title Fatemeh B. Esfahani, M.D. Palomar Health Facilities Palomar Medical Center Escondido Palomar Medical Center Poway

SPECIALTIES/BOARD CERTIFICATION

Specialties Internal Medicine - Certified 2014

ORGANIZATIONAL NAME

Name CEP Hospitalists

EDUCATION/AFFILIATION INFORMATION

Medical Education Information Isfahan University of Medical Sciences & Health Services, Iran From: 09/01/1989 To: 07/09/1996 Doctor of Medicine Degree

Internship Information N/A Residency Information Texas Tech University Health Sciences Center Internal Medicine From: 07/01/2011 To: 07/11/2014

Fellowship Information The Mount Sinai Medical Center Research From: 08/01/2009 To: 03/31/2010

University of Alabama - Birmingham Cardiac Imaging From: 08/01/2010 To: 12/31/2010 Visiting Scientist/International Fellow in Cardiovascular MRI

Current Affiliation Information Sharp Memorial Hospital, San Diego

76 Susan J. Hardesty, M.D. Page 1 of 1 PALOMAR HEALTH PROVISIONAL APPOINTMENT March 2018

PERSONAL INFORMATION

Provider Name & Title Susan J. Hardesty, M.D. Palomar Health Facilities Palomar Medical Center Escondido

SPECIALTIES/BOARD CERTIFICATION

Specialties Psychiatry – Certified 1995, Recertified 2015 Psychiatry, Forensic - Certified 1999, Recertified 2015

ORGANIZATIONAL NAME

Name JSA Health Telepsychiatry

EDUCATION/AFFILIATION INFORMATION

Medical Education Information University of North Carolina (Chapel Hill), MD From: 07/01/1986 To: 05/13/1990 Doctor of Medicine

Internship Information N/A Residency Information Medical University of South Carolina Psychiatry From: 07/01/1990 To: 06/30/1994

Fellowship Information N/A Current Affiliation Information St. David’s South Austin Medical Center, TX St. David’s Medical Center, TX St. David’s North Austin Medical Center, TX Methodist Hospital, Houston, TX Good Shephard, TX Seton Healthcare Family, TX

77 Amber N. Knight, M.D. Page 1 of 1 PALOMAR HEALTH PROVISIONAL APPOINTMENT March 2018

PERSONAL INFORMATION

Provider Name & Title Amber N. Knight, M.D. Palomar Health Facilities Palomar Medical Center Escondido

SPECIALTIES/BOARD CERTIFICATION

Specialties Obstetrics and Gynecology – Not Certified

ORGANIZATIONAL NAME

Name Kaiser Permanente

EDUCATION/AFFILIATION INFORMATION

Medical Education Information New York Medical College From: 08/01/2008 To: 05/31/2012 Doctor of Medicine Degree

Internship Information University of California, San Diego Obstetrics/Gynecology From: 07/01/2012 To: 06/30/2013

Residency Information University of California, San Diego Reproductive Endocrinology & Infertility From: 07/01/2013 To: 06/30/2016

Fellowship Information N/A

Current Affiliation Information Kaiser Permanente, San Diego

78 Anthony A. Mazzarulli, M.D. Page 1 of 1 PALOMAR HEALTH PROVISIONAL APPOINTMENT March 2018

PERSONAL INFORMATION

Provider Name & Title Anthony A. Mazzarulli, M.D. Palomar Health Facilities Palomar Medical Center Escondido

SPECIALTIES/BOARD CERTIFICATION

Specialties Psychiatry - Certified 2015

ORGANIZATIONAL NAME

Name CEP Psychiatry Program

EDUCATION/AFFILIATION INFORMATION

Medical Education Information UMDNJ-New Jersey Medical School Program From: 07/01/1999 To: 06/30/2004 Doctor of Medicine Degree

Internship Information N/A Residency Information Medical University of South Carolina Psychiatry – Drug Abuse From: 07/01/2004 To: 06/30/2006

Univ. of Texas Southwestern Medical Ctr., Dallas Psychiatry – Clinical Research From: 07/01/2006 To: 06/30/2008

Fellowship Information Univ. of Texas Southwestern Medical Ctr., Dallas Psychiatry - Addiction Medicine From: 07/01/2008 To: 06/30/2009

Current Affiliation Information Haywood Regional Medical Center, NC

79 Brian M. Nguyen, M.D. Page 1 of 1 PALOMAR HEALTH PROVISIONAL APPOINTMENT March 2018

PERSONAL INFORMATION

Provider Name & Title Brian M. Nguyen, M.D. Palomar Health Facilities Palomar Medical Center Escondido

SPECIALTIES/BOARD CERTIFICATION

Specialties Surgery, General - Certified 2016

ORGANIZATIONAL NAME

Name Kaiser Permanente

EDUCATION/AFFILIATION INFORMATION

Medical Education Information Virginia Commonwealth University From: 08/01/2006 To: 05/22/2010 Doctor of Medicine Degree

Internship Information N/A Residency Information Harbor/UCLA Medical Center General Surgery From: 06/24/2010 To: 06/30/2016

Fellowship Information Beth Israel Deaconess Medical Center Surgery, Complex & Minimally Invasive From: 08/01/2016 To: 07/31/2017

Current Affiliation Information Kaiser Permanente, San Diego

80 Roshanak Ramezani, M.D. Page 1 of 1 PALOMAR HEALTH PROVISIONAL APPOINTMENT March 2018

PERSONAL INFORMATION

Provider Name & Title Roshanak Ramezani, M.D. Palomar Health Facilities Palomar Medical Center Escondido

SPECIALTIES/BOARD CERTIFICATION

Specialties Psychiatry – Certified 2012 Geriatric Psychiatry - Certified 2014

ORGANIZATIONAL NAME

Name CEP Psychiatry Program

EDUCATION/AFFILIATION INFORMATION

Medical Education Information UCSD School of Medicine From: 09/01/2004 To: 06/01/2008 Doctor of Medicine Degree

Internship Information N/A Residency Information University of California, Davis Psychiatry From: 07/01/2008 To: 06/30/2010

Harbor/UCLA Medical Center Psychiatry From: 07/01/2010 To: 06/30/2012

Fellowship Information State University of New York Downstate Geriatric Psychiatry From: 07/01/2012 To: 06/30/2013

Current Affiliation Information Beverly Hospital (Montebello) Mercy Medical Center Saint Agnes Medical Center Providence Tarzana Regional Medical Center Kaiser Permanente, Bakersfield

81 David R. Seigler, M.D. Page 1 of 1 PALOMAR HEALTH PROVISIONAL APPOINTMENT March 2018

PERSONAL INFORMATION

Provider Name & Title David R. Seigler, M.D. Palomar Health Facilities Palomar Medical Center Escondido

SPECIALTIES/BOARD CERTIFICATION

Specialties Psychiatry - Certified 2015

ORGANIZATIONAL NAME

Name CEP Psychiatry Program

EDUCATION/AFFILIATION INFORMATION

Medical Education Information David Geffen School of Medicine at UCLA From: 08/01/2007 To: 06/03/2011 Doctor of Medicine Degree

Internship Information N/A Residency Information UCLA Department of Psychiatry Psychiatry From: 07/01/2011 To: 06/30/2015

Fellowship Information N/A Current Affiliation Information Riverside County Regional Medical Center

82 Kolby R. Walker, D.O. Page 1 of 1 PALOMAR HEALTH PROVISIONAL APPOINTMENT March 2018

PERSONAL INFORMATION

Provider Name & Title Kolby R. Walker, D.O. Palomar Health Facilities Palomar Medical Center Escondido

SPECIALTIES/BOARD CERTIFICATION

Specialties Psychiatry - Certified 2015

ORGANIZATIONAL NAME

Name CEP Psychiatry Program

EDUCATION/AFFILIATION INFORMATION

Medical Education Information Touro University College of Osteopathic Medicine, Vallejo, CA From: 08/01/2006 To: 06/21/2010 Doctor of Osteopathy Degree

Internship Information N/A Residency Information Good Samaritan Regional Medical Center Psychiatry From: 06/28/2010 To: 06/30/2014

Fellowship Information N/A Current Affiliation Information Beverly Hospital (Montebello) Saint Agnes Medical Center Mercy Medical Center Good Samaritan Regional Medical Center

83 Janet Whitney, D.O. Page 1 of 1 PALOMAR HEALTH PROVISIONAL APPOINTMENT March 2018

PERSONAL INFORMATION

Provider Name & Title Janet Whitney, D.O. Palomar Health Facilities Palomar Medical Center Escondido Palomar Medical Center Poway

SPECIALTIES/BOARD CERTIFICATION

Specialties Wound Care – Not Certified Preventive Medicine – Certified 2013 Hyperbaric Medicine – Certified 2013

ORGANIZATIONAL NAME

Name Restorative Healing Group

EDUCATION/AFFILIATION INFORMATION

Medical Education Information College Of Osteopathic Medicine of the Pacific From: 09/01/1991 To: 06/01/1996 Doctor of Osteopathic Medicine Degree

Internship Information Naval Medical Center, San Diego Transitional From: 07/01/1996 To: 06/30/1997

Residency Information University of California, San Diego Preventive Medicine From: 07/01/2003 To: 06/30/2005

Fellowship Information N/A Current Affiliation Information Enloe Medical Center Tri-City Medical Center

84 Kaley M. Brown, P.A.-C. Page 1 of 1 PALOMAR HEALTH ALLIED HEALTH PROFESSIONAL APPOINTMENT March 2018

PERSONAL INFORMATION

Provider Name & Title Kaley M. Brown, P.A.-C. Palomar Health Facilities Palomar Medical Center Escondido Palomar Medical Center Poway

SPECIALTIES/BOARD CERTIFICATION

Specialties Physician Assistant - Certified 2009

ORGANIZATIONAL NAME

Name Physician Assistant Surgical Services

EDUCATION/AFFILIATION INFORMATION

Education Information Touro University California From: 08/01/2006 To: 05/08/2009 Master of Science in Physician Assistant Studies

Employment On-Call, Inc/Physician Assistant Surgical Services Physician Assistant From: 06/01/2017 To: Present

Current Affiliation Information Rancho Springs Medical Center Inland Valley Medical Center Temecula Valley Hospital Loma Linda University Medical Center - Murrieta Temecula Valley Day Surgery Center SCA Golden Triangle SurgiCenter

85 Gissel S. Chujutalli, PA-C Page 1 of 1 PALOMAR HEALTH ALLIED HEALTH PROFESSIONAL APPOINTMENT March 2018

PERSONAL INFORMATION

Provider Name & Title Gissel S. Chujutalli, PA-C Palomar Health Facilities Palomar Medical Center Escondido Palomar Medical Center Poway

SPECIALTIES/BOARD CERTIFICATION

Specialties Physician Assistant - Certified 2017

ORGANIZATIONAL NAME

Name California Cancer Associates

EDUCATION/AFFILIATION INFORMATION

Education Information Kettering College of Medical Arts From: 05/11/2015 To: 07/11/2017 Master of Physician Assistant Studies

Employment California Cancer Associates Physician Assistant From: 01/01/2018 To: Present

Current Affiliation Information None

86 Don J. Ortiz, PA-C Page 1 of 1 PALOMAR HEALTH ALLIED HEALTH PROFESSIONAL APPOINTMENT March 2018

PERSONAL INFORMATION

Provider Name & Title Don J. Ortiz, PA-C Palomar Health Facilities Palomar Medical Center Escondido Palomar Medical Center Poway

SPECIALTIES/BOARD CERTIFICATION

Specialties Physician Assistant - Certified 2005

ORGANIZATIONAL NAME

Name Palomar Health Corporate Health Services

EDUCATION/AFFILIATION INFORMATION

Education Information Stanford University Medical Center From: 09/11/2001 To: 01/13/2003 Physician Assistant

Employment Otay Detention Center Physician Assistant From: 02/01/2016 To: Present

Palomar Health Corporate Health Physician Assistant From: 01/29/2018 To: Present

Current Affiliation Information None

87 Zachary Periharos, P.A.-C. Page 1 of 1 PALOMAR HEALTH ALLIED HEALTH PROFESSIONAL APPOINTMENT March 2018

PERSONAL INFORMATION

Provider Name & Title Zachary Periharos, P.A.-C. Palomar Health Facilities Palomar Medical Center Escondido Palomar Medical Center Poway

SPECIALTIES/BOARD CERTIFICATION

Specialties Physician Assistant - Certified 2016

ORGANIZATIONAL NAME

Name Physician Assistant Surgical Services

EDUCATION/AFFILIATION INFORMATION

Education Information Touro College - Barry Z. Levine School of Health Sciences From: 08/01/2013 To: 06/28/2016 Physician Assistant

Employment On Call, Inc./Physician Assistant Surgical Service Physician Assistant From: 04/18/2017 To: Present

Current Affiliation Information Scripps Mercy Hospital, San Diego Scripps Mercy Hospital, Chula Vista Sharp Memorial Hospital Mission Valley Heights Surgery Center Sharp Chula Vista Medical Center Coast Center for Orthopedic Arthroscopic Surgery Sharp Grossmont Hospital Paradise Valley Hospital Sharp Coronado Hospital SCA University Ambulatory Surgery Center Outpatient Surgery Center of La Jolla Otay Lakes Surgery Center

88 89 90

District Board Meeting Report March 12, 2018 6:00 – 8:00 p.m.

GINGER LARSON, CHAIR I would like to introduce Ron Mirenda, Interim Chief Philanthropy Officer. Ron has more than 40 years of executive leadership, fund-raising, strategic-planning, public relations and communications experience. In 1996 he founded Mirenda & Associates and served as a vice-president with national fund-raising firms providing consultative services to nationally recognized organizations. His areas of expertise include campaign design and management and developing leadership gift strategies. Ron has been a board member of the Greater Los Angeles Chapter of the Association of Fund Raising Professionals (AFP). He holds both a Master of Arts degree in Educational Administration and Bachelor of Arts degree in English from the University of St. Thomas, St. Paul, Minnesota.

On behalf of the Foundation Board and staff, I am pleased to provide the following report on recent activities and generosity of our Palomar Health donors and community-at-large.

January 2018 Production Report for the Palomar Health Foundation Production represents all outright gifts of cash (excluding pledge payments) and new gift commitments made in the reporting year. New gift commitments effectively combine all new pledges and letters of intent (including revocable gift commitments) and current market value of irrevocable planned gifts. Production is not GAAP reporting.

TYPE OF GIFT Count MONTH OF JAN Count FY18 YTD New Cash Gifts 45 43,522 608 365,741 New Pledge Gifts 13 111,033 291 421,118 154,555 786,859

Gifts in Kind 1 120 26 19,815 Planned Gifts Commitments 0 - 2 175,000 120 194,815

Total Production $ 154,675 $ 981,674

ANNUAL SUPPORT AND SPECIAL CAMPAIGNS UPDATE:  Employees: During the month of January we received a combined total of $11,462 from our dedicated employees including 1 pledge over $5,000, 2 pledges over $1,000, and 2 pledges over $500.  Grateful Patient: During the month of January, we received a $25,000 gift from a grateful patient family to purchase a portable EKG machine for the PMC Emergency Department and an ICU Patient Lift for the PMC Escondido Critical Care Unit. This family was overwhelmed by the lifesaving care their daughter received as a trauma patient.

B:\Board\Board - Foundation\Board Reports - District\2018\03.12.18 Foundation91 Report-2.docx 1 of 2

District Board Meeting Report March 12, 2018 6:00 – 8:00 p.m.

UPCOMING EVENTS:

 Richard Elliott Concert o Cost $115 per ticket, that is the face-value of the ticket x10 plus any o The VIP ticket allows for a pre-wine party with the donors and with the entertainer, who is a major donor of ours o March 23rd at Center for the Performing Arts

B:\Board\Board - Foundation\Board Reports - District\2018\03.12.18 Foundation Report-2.docx 2 of 2

ADDENDUM E

93 Conflict of Interest Code, 21800

TWELFTHTHIRTEENTH AMENDED AND RESTATED CONFLICT OF INTEREST CODE OF PALOMAR HEALTH I. PURPOSE:

The Political Reform Act (California Government Code, Sections 81000 et seq.) requires state and local government agencies to adopt and promulgate conflict of interest codes. Pursuant to the Political Reform Act of 1974 (California Government Code, Sections 81000 et seq.) and regulations of the Fair Political Practices Commission (California Code of Regulations, Title 2, Sections 18100, et seq.). Palomar Health hereby adopts the following Conflict of Interest Code.

II. DEFINITIONS:

The definitions contained in the Political Reform Act of 1974, regulations of the Fair Political Practices Commission, and any amendments to the Act or regulations, are incorporated by reference into this conflict of interest code.

III. STANDARDS OF PRACTICE:

A. INCORPORATION OF FPPC REGULATION §18730:

The Political Reform Act, requires state and local government agencies to adopt and promulgate Conflict of Interest Codes. The Fair Political Practices Commission has adopted a regulation, California Code of Regulations, Title 2, Section 18730, which contains the terms of a standard Conflict of Interest Code, which can be incorporated by reference in an agency’s code. After public notice and hearing, the standard code may be amended by the Fair Political Practices Commission to conform to amendments in the Political Reform Act. Therefore, the terms of California Code of Regulations, Title 2, Section 18730 and any amendments to it duly adopted by the Fair Political Practices Commission are hereby incorporated by reference. This regulation and the attached Appendix, designating positions and establishing disclosure categories, shall constitute the Conflict of Interest Code of Palomar Health.

B. STATEMENTS OF ECONOMIC INTERESTS: PLACE OF FILING:

Individuals in designated positions shall file their statements of economic interests (Form 700) with the Palomar Health Chief Executive Officer or designee. The Palomar Health Chief Executive Officer or designee shall make and retain a copy and forward the original to the San Diego County Board of Supervisors. The Palomar Health Chief Executive Officer or designee will make the statements available for public inspection and reproduction. (California Government Code, Section 81008).

IV. ADDENDIX:

OFFICIALS WHO MANAGE PUBLIC INVESTMENTS

94 Conflict of Interest Code, 21800

Palomar Health Officials who manage public investments, as defined by California Code of Regulations, Title 2, section 18701, subdivision (b), are not subject to Palomar Health’s Conflict of Interest Code, but are subject to the disclosure requirements of the Act. (Gov. Code § 87200 et seq.) These positions are listed here for informational purposes only, and are required to file a statement of economic interest.

It has been determined that the positions listed below are officials who manage public investments[1]:

 Members of the Board of Directors  Chief Executive Officer  Executive Vice President of Finance Chief Financial Officer

DESIGNATED EMPLOYEE POSITIONS

The persons holding positions listed below are designated employees. It has been determined that these persons make or participate in the making of decisions which may foreseeably have a material effect on economic interests.

Designated Employee Position Title Assigned Disclosure Category

1. General Counsel………………………………………………...... ……..…...All 1. Vice President, Risk, Compliance and Legal ………………………………………………..All 2. Compliance Officer…………………………………...... All 3. Audit Officer…………………………………………………...... …...... …...…..All 4. Executive Vice President of Strategy……………………...... ………...... …….All 5.3. Executive Vice President of Physician AlignmentChief Medical Officer...... ….….5 6.4. Executive Vice President of OperationsChief Operations Officer..……...... ….…..All 7.5. Executive Vice President of Chief Human Resources Officer...... ………...... …...... …6 8. Vice President of Patient Experience………………………...... ……..…...... …..1, 5 9. Vice President of Palomar Medical Center………………...... ………...... ….All 10. Vice President of Palomar Health Downtown Campus and Pomerado Hospital...... All 11.6. Vice President of Continuum Care…………………….……...... …...... …1, 2, 5 12.7. Vice President of Information Systems……………………...... …...….5 13.8. Vice President of Revenue Cycle………………………….……...... …..1, 2 14.9. Assistant Vice President of Hospitality & Facilities…..……….……...... ….5 15. Assistant Vice President of Clinical & Diagnostic Services………...... …..5 16.10. Chief Nursing Officer of Palomar Health Downtown Campus and Pomerado Hospital.....5,6 17.11. Chief Nursing Officer of Palomar Medical Center…………………...... …....5, 6 18.12. Director, Corporate Supply Chain Services…………...... 5 19.13. Consultant[2]

DISCLOSURE CATEGORIES

The disclosure categories set forth below specify which kinds of economic interests are reportable. Such a designated employee shall disclose in his or her statement of economic interests those economic interests he or she has which are of the kind described in the disclosure categories to which he or she is assigned. It has been determined that the economic interests set forth in a designated employee's disclosure categories are the kinds economic interests which he or she foreseeably can affect materially through the conduct of his or her office.

95 Conflict of Interest Code, 21800

Category 1.

All investments and business positions in business entities, and sources of income, including gifts, loans, and travel payments that are located in, do business in or own real property within the jurisdiction of Palomar Health.

Category 2.

All interests in real property which is located in whole or in part within, or not more than two (2) miles outside, the jurisdiction of Palomar Health.

Category 3.

All investments and business positions in, and sources of income from, business entities that are engaged in land development, construction or the acquisition or sale of real property within the jurisdiction of Palomar Health.

Category 4.

All investments and business positions in, and sources of income from, business entities that are banking, savings and loan, or other financial institutions.

Category 5.

All investments and business positions in, and sources of income from, business entities that provide services, supplies, materials, machinery, vehicles or equipment of a type purchased or leased by Palomar Health.

Category 6.

Category 7.

All financial interests in investment advisors and managers; financial services providers, actuaries, and those providing fiduciary services (including recordkeeping) to retirement plans.

[1] Individuals holding one of the above-listed positions may contact the FPPC for assistance or written advice regarding their filing obligations if they believe that their position has been categorized incorrectly. The FPPC makes the final determination whether a position is covered by Government Code section 87200.

96 Conflict of Interest Code, 21800

requirements. The Chairperson’s determination is a public record and shall be retained for public inspection in the same manner and location as this Conflict of Interest Code. Nothing herein excuses any such consultant from any other provision of this Conflict of interest Code.

V. PUBLICATION HISTORY:

Revision Effective Document Owner Version Notes Number Date

6 (this 06/11/2016 Mark Neu, Vice Pres Comp Audit and Incorporate BoD approved version) Legal revisions Jan, 2016[Owner changed from Barnes, Deborah to Neu, Mark by Barnes, Deborah on 13- OCT-2016] 7 (this 03/06/2018 Mark Neu, Vice Pres Comp Audit and Complete review and update version) Legal to include current leadership structure.

97 Conflict of Interest Code, 21800

THIRTEENTH AMENDED AND RESTATED CONFLICT OF INTEREST CODE OF PALOMAR HEALTH I. PURPOSE:

II. DEFINITIONS:

III. STANDARDS OF PRACTICE:

A. INCORPORATION OF FPPC REGULATION §18730:

B. STATEMENTS OF ECONOMIC INTERESTS: PLACE OF FILING:

IV. ADDENDIX:

OFFICIALS WHO MANAGE PUBLIC INVESTMENTS

98 Conflict of Interest Code, 21800

are subject to the disclosure requirements of the Act. (Gov. Code § 87200 et seq.) These positions are listed here for informational purposes only, and are required to file a statement of economic interest.

It has been determined that the positions listed below are officials who manage public investments[1]:

 Members of the Board of Directors  Chief Executive Officer  Chief Financial Officer

DESIGNATED EMPLOYEE POSITIONS

Designated Employee Position Title Assigned Disclosure Category

1. Vice President, Risk, Compliance and Legal..……………………………...... All 2. Compliance Officer…………………………………...... All 3. Chief Medical Officer...... ….……………………………………………………………………...5 4. Chief Operations Officer.……...... ….……………………………………..…………………….All 5. Chief Human Resource Officer...... ………...... …...... ……………………………...……………...6 6. Vice President of Continuum Care…………………….……...... …...... ………….. 1, 2, 5 7. Vice President of Information Systems……………………...... …...……………5 8. Vice President of Revenue Cycle………………………….……...... …………... 1, 2 9. Vice President of Hospitality & Facilities…..……….……...... ………….. 5 10. Chief Nursing Officer of Palomar Health Downtown Campus and Poway Campus…...... 5, 6 11. Chief Nursing Officer of Palomar Medical Center…………………...... …...... 5, 6 12. Director, Corporate Supply Chain Services …………...... 5 13. Consultant[2]

DISCLOSURE CATEGORIES

Category 1.

Category 2.

All interests in real property which is located in whole or in part within, or not more than two (2) miles outside, the jurisdiction of Palomar Health.

99 Conflict of Interest Code, 21800

Category 3.

Category 4.

All investments and business positions in, and sources of income from, business entities that are banking, savings and loan, or other financial institutions.

Category 5.

Category 6.

Category 7.

All financial interests in investment advisors and managers; financial services providers, actuaries, and those providing fiduciary services (including recordkeeping) to retirement plans.

[2] Consultants shall be included in the list of Designated Employees and shall disclose pursuant to the broadest disclosure category in this Code subject to the following limitation: The Chairperson of the Board may determine in writing that a particular consultant, although a "designated position," is hired to perform a range of duties that are limited in scope and thus is not required to fully comply with the disclosure requirements described in this section. Such written determination shall include a description of the consultant's duties and, based upon that description, a statement of the extent of disclosure requirements. The Chairperson’s determination is a public record and shall be retained for public inspection in the same manner and location as this Conflict of Interest Code. Nothing herein excuses any such consultant from any other provision of this Conflict of interest Code.

V. PUBLICATION HISTORY:

Revision Effective Document Owner Version Notes Number Date

100 Conflict of Interest Code, 21800

6 (this 06/11/2016 Mark Neu, Vice Pres Comp Audit and Incorporate Body approved version) Legal revisions Jan, 2016[Owner changed from Barnes, Deborah to Neu, Mark by Barnes, Deborah on 13- OCT-2016] 7 (this 03/06/2018 Mark Neu, Vice Pres Comp Audit and Complete review and update version) Legal to include current leadership structure.

101 RESOLUTION NO. 03.12.18(06)-01

RESOLUTION OF THE BOARD OF DIRECTORS OF PALOMAR HEALTH ESTABLISHING BOARD AUDIT & COMPLIANCE COMMITTEE MEETINGS FOR CALENDAR YEAR 2018

WHEREAS, Palomar Health is required, pursuant to Section 54954 of the California Government Code, Section 5.2.2 of the Palomar Health Bylaws, and Palomar Health Policy 21790 Establishing Board Meeting Dates, to pass a resolution adopting the time, place and location of the Board Audit & Compliance Committee meetings:

NOW, THEREFORE, BE IT RESOLVED by the Board of Directors of Palomar Health that the following schedule of Board Audit & Compliance Committee meetings will apply for calendar year 2018, beginning with the March 2018 meeting:

2018 BOARD COMMUNITY RELATIONS COMMITTEE MEETING SCHEDULE

February 7 August 21 March 20 September 18 April 17 October 16 May 15 November 20 June 19 December 18 July 17

Each meeting will be held at 5:30 p.m. in the 1st Floor Conference Room of the Palomar Health Administration Office, 456 E. Grand Ave., Escondido CA, 92025.

PASSED AND ADOPTED at a regular meeting of the Board of Directors of Palomar Health held on March 12, 2018, by the following vote:

AYES:

NO’S:

ABSENT:

ABSTAINING:

DATED: March 12, 2018

APPROVED: ATTESTED:

______Joy Gorzeman, Chair Raymond McCune, Secretary Palomar Health Board of Directors Palomar Health Board of Directors

102

RESOLUTION NO. 03.12.18(07)-02

RESOLUTION OF THE BOARD OF DIRECTORS OF PALOMAR HEALTH AUTHORIZING MANAGEMENT TO TAKE THE ACTIONS NECESSARY TO NEGOTIATE AND EXECUTE THE DOCUMENTS NECESSARY FOR A PARKING STRUCTURE TO BE CONSTRUCTED AND OPERATED ON PROPERTY OWNED BY THE DISTRICT WITHIN THE ESCONDIDO REGIONAL TECHNOLOGY CENTER

WHEREAS, Palomar Health (the "District") is a local health care district duly organized and existing under The Local Health Care District Law, constituting Division 23 of the Health and Safety Code of the State of California (the "Healthcare District Law");

WHEREAS, the Board has determined that Palomar Medical Center-Escondido (“PMC-E”) has a current need for Convenient and adjacent parking for patients, visitors and staff;

WHEREAS, the need for parking at the PMC-E campus will likely increase substantially with the pending completion of the on campus Medical Office Building, Rehabilitation Hospital, and Crisis Stabilization Unit facility, and the buildout of PMC-E floors 9, 10, and 11 are completed within the next four (4) years;

WHEREAS, the District has identified a parcel of undeveloped land which is a part of the PMC-E campus (“the Subject Property”) which is suitable for the construction of a five-level, 1,907-space parking structure (“the parking structure”);

WHEREAS, the cost of constructing a parking structure on the Subject property is currently estimated to be approximately $25,000,000 to $27,000,000;

WHEREAS, Administration has identified a funding mechanism which would allow for construction of a multi-level parking facility on the Subject Property, which would be the subject of a long term Ground Lease to the National Healthcare Research and Education Finance Corporation a 501(c)(3) nonprofit corporation and financier/developer (“NHREFCO”) of healthcare facilities for nonprofit healthcare organizations like the District;

WHEREAS, NHREFCO would, at its expense and risk, design and construct the parking structure (with a targeted starting date in the early summer of 2018), and, when completed (with a targeted completion date of late summer of 2019), lease the parking structure to the District for a period of 300 months (25 years);

WHEREAS, the District would make payments on the structure lease of the completed parking structure through the revenues generated by parking fees in the Structure;

WHEREAS, the ground lease/parking structure lease arrangement would provide, inter alia, the District with a fair market value purchase option at the end of the term of the lease; and,

103

WHEREAS, the Ground Lease/Structure Lease funding arrangement would provide benefit to the residents of the District by enabling the District to address the current and increasing parking need at PMC-E without encumbering available District funds for capital expenditures.

NOW THEREFORE, BE IT RESOLVED AS FOLLOWS:

1. The Board of Directors hereby authorizes its President and Chief Executive Officer to negotiate with and develop a Ground Lease and Structure Lease Arrangement to be executed by and between the District and NHREFCO, to include a District ground lease of the Subject Property, and an agreement by NHREFCO to design and construct the Parking Structure on the Subject Property, on terms which are favorable to the residents of the District;

2. The Board of Directors also authorizes the President and Chief Executive Officer to negotiate and execute a Structure Lease Agreement with NHREFCO for the completed parking structure, for use by PMC-E patients, visitors, and staff, at an approximate monthly lease payment of $117,000.00, on terms which are favorable to the residents of the District;

3. The Board of Directors also authorizes the President and Chief Executive Officer to negotiate and execute an operating/management agreement with Ace Parking, for the latter to operate and manage the parking structure once it is completed, on terms which are favorable to the residents of the District.

PASSED AND ADOPTED at a meeting of the Board of Directors of Palomar Health held on March 12, 2018, by the following vote:

AYES: NOES: ABSTAINING: ABSENT:

Dated: March 12, 2018 BY: Joy Gorzeman, RN Chair, Board of Directors ATTESTED:

Ray McCune, RN Secretary, Board of Directors

104

ADDENDUM F

105

TO: Board of Directors FROM: Ray McCune, RN – Chair, Board Audit & Compliance Committee DATE: Monday, March 12, 2018 RE: Board Audit & Compliance Committee – February 20, 2018 Meeting Summary

BOARD MEMBER ATTENDANCE: Chair Ray McCune, Director Jeff Griffith, Director Hans Sison.

ACTION ITEMS:

Minutes - Tuesday, February 20, 2018: The minutes from the January 17, 2018 Board Audit & Compliance Committee meeting were unanimously approved as written.

2018 Board Audit and Committee Schedule: The 2018 Board Audit and Committee Schedule was approved with a change in the start time from 12:30 p.m. to 5:30 p.m. Board Secretary to prepare a resolution for the March 12, 2018 Board of Director’s meeting.

Audit and Compliance Charter: The Audit and Compliance Charter was reviewed by the Committee. Compliance Officer Mark Neu noted that this charter is restating what we do and is duplicative. After discussion the committee approved eliminating the charter.

Audit and Compliance Duties and Bylaws: The Audit and Compliance Duties & Bylaws were reviewed by the committee. Additional duties approved by the committee will be added under section 6.2.2 (C) and include “Approve the Compliance Work Plan” and “Receive regular updates on the Compliance Work Plan”.

Audit and Compliance Standing Agenda Items for 2018: Audit and Compliance Standing Agenda Items for 2018 were reviewed and approved by the committee.

Notable Accomplishments for Calendar Year 2017: The summary of Notable Accomplishments for the Calendar year 2017 was reviewed and approved by the committee.

INFORMATION ITEMS:

Audit and Compliance Education: Mr. Neu presented the Practical Guidance for Healthcare Boards and Compliance Oversight. Will also provide the committee with a summary of the Health Care Compliance Association Conference (HCAA) and a list of upcoming HCAA meetings

106

Ethics and Compliance Committee (ECC) January and February Meeting Reports:

January 4, 2018: The meeting agenda items discussed were: review of prior action items, Culture of Safety Committee, 2018 Compliance Work Plan – Draft, 2017 Annual Report, subcommittee reports from Revenue Integrity, Policy and Procedure, and Privacy and Information Security, and a review of educational articles and recent enforcements.

February 1, 2018: The meeting agenda items discussed were: ECC, What, How, Who, Quality Update, 2017 Annual Report, 2018 Compliance Workplan, subcommittee reports from Revenue Integrity, Policy and Procedure, and Privacy and Information Security, Section 1557 Notice of Nondiscrimination, OCR Conscience and Religious Freedom Division and a review of educational articles and recent enforcements.

107 108 109 110 111

Memorandum

To: Palomar Health Board of Directors From: Dara Czerwonka, MSW, Chair Palomar Health Board of Directors Community Relations Committee Date: February 23, 2018 Subject: Committee Meeting Summary – February 23, 2018

BOARD MEMBER ATTENDANCE: Directors Czerwonka and Sison Excused: Director Kaufman

INFORMATIONAL ITEMS: Review of Committee Bylaws Committee Chair Czerwonka suggested any changes be discussed/reviewed next month, then submitted to full board in March or April.

Foundation Update Kirk Effinger, Foundation Board Member provided update. Currently interviewing for interim executive; expectation is to have someone in place in near future.

Marketing Update Community classes being provided and attendees. Evidence of growth in cardiovascular program. Digital improvements to optimize “find a doc pages”, adding videos, bios. Will start with cardiovascular physicians, then Orthopedics, and continue from there. Optimizing “click to call” function. Will increase patient experience and decrease cost of using our 800 number. Flu season has provided Palomar Health a great deal of positive coverage with the use of tent. CBS News featured story about flu that included Palomar Health. Cardiovascular advertising campaign launched and has played during Olympics. Cardiovascular ad will run for six months, and Orthopedics ad is planned to begin around July. Discussion around New Movers campaign.

Discussion: New Attendees/Who is Missing Discussion around who may be missing from group. Committee in agreement to add Jeremy Lee, Director Pharmacy Services to the discussion. Jeremy Lee, Director of Pharmacy Services will be invited to March 7th meeting.

Population Health Strategy Development Overview Director Czerwonka provided background on the Population Health Strategy Discussion about what Palomar Health currently does in the community and what other outreach opportunities can be identified. Potential to address this topic at the Board Community Relations Committee level. Hospital Association of San Diego and Imperial Counties (HASD&IC) publishes a community needs assessment every few years; core health issues are obesity, diabetes, heart disease and behavioral health. Palomar Health offers programs in all of these areas; goal is to have clear sense of what we do, and opportunities for the future

Brainstorming: All the Ways Palomar Health Touches the Community Group provided input as to Palomar Health’s current outreach programs within the community, what social determinants can affect outcome and what opportunities there are for the future. Committee to reconvene on March 7 to finish discussion.

ACTION ITEMS:  Minutes – Wednesday, January 3, 2018: The Board Community Relations Committee approved the minutes as written.

112

To: Board of Directors From: Jerry Kaufman, PT MA, Chair, Board Finance Committee Date: March 12, 2018 Re: Board Finance Committee – February 28, 2018, Meeting Summary

BOARD MEMBER ATTENDANCE: Directors Gorzeman, Kaufman and Moir

INFORMATION ITEMS

 Effect of the Federal Tax Reform Bill on Palomar Health: In response to a request by Committee Chair Jerry Kaufman, CFO Hugh King prepared the attached document—based on an article written by the law firm of McDermott, Will and Emery—which outlines whether there are any potential impacts to the District and, if so, what they might be.

 Board Finance Committee Follow‐up – The Impact of Medicare’s Approval of Total Knee Replacements as Outpatient Surgeries: In response to this inquiry from a previous meeting, Mr. King provided the following loss estimates. The estimates were based on:

o Total knee replacement cases for Medicare patients over the past year; and,

o The assumption that—with Medicare’s shift to paying for total knee replacement surgeries at outpatient venues—the number of patients having their procedures done at ambulatory surgery centers would increase:

Estimated Cases Estimated Loss PMC Escondido 67 ($227K) PMC Poway 63 ($223K) TOTALS 130 ($450K))

Mr. King further noted that these numbers might be understated, as Medicare Advantage plans haven’t yet determined if they will follow Medicare’s new protocol. Also,

 The Public Hospital Redesign & Incentives in Medi‐Cal Program (PRIME): Dr. Jerry Kolins and the project leads for each of the 7 PRIME projects in which Palomar Health is participating presented information on the projects that had been chosen, the metrics to which the funding for each of those projects is tied, and the current status of each of the projects (the entire presentation may be reviewed elsewhere in the agenda packet).

 Balanced Scorecard Results – Finance Pillar: Information on the December 2017 scores as compared to the June 2018 goals and the action items required to reach those goals was presented in the agenda packet but not discussed (documentation is attached).

113 Board Finance Committee Meeting Summary February 28, 2018, Meeting Page 2

ACTION ITEMS

 Minutes, Wednesday, January 24, 2018, Board Finance Committee Meeting: Reviewed and approved the draft minutes from the Wednesday, January 24, 2018, Board Finance Committee meeting.

 Executed, Budgeted, Routine Physician Agreements: Reviewed and recommended approval of the Executed, Budgeted, Routine Physician Agreements that had been administratively approved, signed and became effective in the months listed in the Summary Form A Narrative (that Narrative and other background materials may be reviewed elsewhere in the agenda packet).

 January 2018 and YTD FY2018 Financial Report: Reviewed an updated Financial Reporting Packet that now includes a summary titled “Management Discussion and Analysis”, and recommended approval of the January 2018 and YTD FY2018 financial performance, which reflected a YTD operating income that was $13.4M unfavorable to budget. YTD net income was $5.7M unfavorable to budget.

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The Effect of the Federal Tax Reform Bill on Palomar Health The Chair of the Finance Committee, Jerry Kaufman, requested an analysis of the impact of the recently enacted Federal Tax Reform Bill on Palomar Health, specifically addressing issues raised by attorneys from the firm of McDermott, Will & Emory (MWE) in December of 2017. The MWE article is focused on healthcare organizations exempt from federal income taxes under Internal Revenue Code Section 501(c)(3). Organizations exempt under Section 501(c)(3) are required to file a 990T tax return. Palomar Health, a California healthcare district, is exempt from federal income taxes as a body politic of the State of California under the 10th and 16th amendments to the U. S. Constitution and, therefore, is not required to file any type of income tax return. Accordingly, some of the issues raised by the MWE article do not apply to Palomar Health. 1. The country’s largest tax‐exempt organizations will now find it more costly to recruit and retain their top talent. For tax years beginning after December 31, 2017, an organization tax‐exempt under IRC Section 501(c)(3 will now be required to pay an annual excise tax on compensation exceeding $1 million paid to any of its “covered employees”. This tax is 21 percent of the amount exceeding $1 million (21 percent is the corporate tax rate under the new law). For example, to provide $2 million of reasonable compensation to a covered employee in 2018, an exempt organization would pay $210,000 in tax. Comments: This tax will not apply to Palmar Health employees. However, Palomar Health’s subsidiaries that are exempt under Section 501(c)(3)—such as Arch Health Medical Group—will be subject to the tax. 2. Advance refunding bonds have been repealed, but tax‐free bond financing otherwise remains available for Section 501(c)(3) organizations. Comments: This provision of the bill eliminates the federal income tax exemption on interest paid to bondholders for “Advance Refunding Bonds”. The provision is applicable to Palomar Health because it affects bondholders, i.e., if there is not a tax exemption, the bondholders will not purchase the bonds. This provision of thee Bill is th reason Palomar Health issued advance‐refunding bonds on December 28, 2017, before the Bill became effective on January 1, 2018. Palomar Health can issue tax exempt bonds for other purposes. 3. Private colleges and universities with substantial endowments will be subject to a new excise tax. Comments: No impact on Palomar Health. 4. Tax‐exempt organizations with unrelated businesses may owe additional tax. Comments: This provision of the Bill could affect corporate subsidiaries of Palomar Health to the extent they might have unrelated business income.

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5. Exempt organizations’ leadership should be prepared with proactive defenses of their exempt operations. Comments: California state law clearly defines the permitted activities of healthcare districts. The Board and leadership of healthcare districts must adhere to the state regulations and, in doing so, ensure continued exemption from federal income tax as a body politic of the State of California. The Boards and management of Palomar Health’s subsidiaries that are exempt under Section 501(c)(3)— such as Arch Health Medical Group—must be alert to and compliant with the federal regulations that govern tax‐exempt corporations. The Bigger Picture The recently passed Tax Reform Bill had one significant provision affecting Palomar Health: The elimination of the tax exemption for advance refunding bonds. However, Palomar Health has two subsidiaries that are exempt under Section 501(c)(3), and those subsidiaries have an increased compliance risk under the new bill.

116 2 Finance Pillar ‐ Consolidated December 2017

Status Summary

Target 3.00 Average Financial Score still maintaining just above an average of 3.0, though there is still significant opportunity for improvement compared to budget Actual 3.03

Risk Areas

• Productivity Labor Dollars

• Cost per Department Unit of Service

• Inefficiencies due to Patient Holds

• Premium Pay Dollars

• Pressure on Reimbursement Dollars

117 Finance Status Report – Organization Level November 2017

Operating Margin Days Cash on Hand Cost per Adjusted Discharge

Target – 2.84% Target – 100% Target – 100%

Actual – (0.43%) Actual – 79% Actual – 89%

Action Items • Identify short term opportunities • Monitor cash projections • Identification of budgeted to correct financial performance • Manage cash expenditures and expenses that can be to budget activity delayed/eliminated • Begin focus on identifying cost • Continue temporary hold on • Ramp up the position control efficiencies for the next fiscal capital spend process year through the upcoming • Identify opportunities in cash • Implement ad‐hoc work team to budget process collections with new vendor in manage premium pay place • Manage cost per UOS

118 Finance Status Report –Leader Level November YTD 2017

Productivity* Cost per UOS*

Target – 3.00 Target – 3.00

Actual –3.16 Actual –3.00

Action Items • Determine structure for productivity reporting and • Implement monthly departmental business accountability within new organization structure reporting and reviews • Increase compliance with data entry so results are reflective of entire district

• *Based on entered metrics

119 Passion. People. Purpose.TM

PRIME Public Hospital Redesign and Incentives in Medi-Cal

Jerry Kolins, MD Board Finance Committee Wednesday, February 28, 2018

1 120 • • • • PRIME Selection Project Title Text District/Municipal Public Hospitals (DMPHs) were (DMPHs) Hospitals Public District/Municipal projects of 18 a menufrom choose could Hospitals legislation2015 30,enacted December on based are participating HospitalsDistrict Public Distribution of selections is presented below is presented of selections Distribution projectrequiredto selectleast1 at – – 5 DMPHs selected 5 to 8 projects to 8 selected5 DMPHs5 projects to 4 1 selected DMPHs 31 • Palomar Health selected 7 projects 7 selectedHealth Palomar

Title 121 Text 2 Palomar Health’sPRIME Projects 2.3 2.2 1.7 2.7 Title Text Comprehensive Advanced Illness Planning & Planning Illness Advanced Comprehensive for High Management Care Complex Post of Integration Transitions: Care Foods Healthier & Prevention Obesity Populations – – – – – – – – Physician Partner: Sabiha Pasha,MD Leads: Rachel Ricchio/Samar Hireish Physician Partner: Singh, Teja MD Leads: Joe Parker/Rachel Ricchio/Patrice Gadd Physician Partner: Bret Ginther, MD Leads: Dan Farrow/Kathryn Physician Partner: Sabiha Pasha, MD Leads: Samar Hireish /Rachel /Rachel

Title 122 Text Vasaeli Ricchio - - Acute Risk Initiative Medical Medical Care Care 3 Palomar Health’sPRIME Projects 3.2 3.1 3.3 Title Text High Cost High Antibiotic – – – – – – Physician Partners: Patrick MD/James Schultz, Tellez, MD Leads: Lee/Michael Kruse Jeremy Physician Partners: Gregory Nicpon, MD/David Lee,MD Lead: DonnaRolin Committee Physician Partners: MD/Antimicrobial Lee, David Stewardship Leads: Lee/Michael Kruse Jeremy Cost Pharmaceuticals Cost Imaging Stewardship

Title 123 Text (cont’d) 4 PRIME Dollars ontheline… Title Text • • • • Funding Funding $47M 5 over DY12 DY11 DY13 in beginning – Demonstration = Fiscal Year     • $6M Baseline Data Submission $4M Process Measures completion of andmodification report to $7.5M for achieving targeted process measures, $ i .e. DY11 =Fiscal 16 2.5M for application submission is tied to the of success EACH metric each for Demonstration Years (DY)

Title 124 Text plan project, project, 5 DY11 Title Text 2015: 2015: Jul – DY 11 11 DY (FY16) - Dec 13 Timeline 2016: 2016: Jan Infrastructure Building Process Measures (DY 11 – 5 Jun Approved - Year Plan 2016: 2016: Jul Process Measure (Aug (Aug 26, 2016) (Sept 30, 2016) Template Template DY Annual11 Report Due Performance Metrics (DY 12) Baseline Data Period for – DY 12 12 DY (FY17) Dec Title 125 Text 2017: 2017: Jan (March 31, 2017) DY Mid 12 - 12) Report – - Jun Year 2017: 2017: Jul (Sept 30, 2017) DY Annual12 Performance Metrics (DY 13 {Similar Reporting Cycle for DY14 for Cycle Reporting {Similar Report – DY 13 13 DY (FY18) Dec 2018: ( DY Mid 13 March 31, Report Jan – 15) – - 2018) Year Jun – 15} 6 Passion. People. Purpose.TM

Project 1.7

Obesity Prevention & Healthier Foods Initiative

Leads: Dan Farrow/Kathryn Vasaeli Physician Partner: Bret Ginther, MD

7 126 Project Project 1.7:Objectives/Goals • • • Title Text 1.7.1 Adult Obesity PreventionObesityAdult 1.7.1 1.7.3 Child Obesity PreventionChildObesity 1.7.3 (PHA) HealthierAmericafor a Partnership 1.7.2 – – – 2 Encounters: ED and out and ED Encounters:2 9 2 • • E Initiatives: menus, beverages, snacks & marketing snacks beverages,Initiatives: menus, ncounters: referral/counseling percentiles,3 BMI g + old,yrs. , ≥18 >25 or <18.5 BMI and HealthyBMI uidance planuidance Obesity Prevention & Healthier Foods Initiative w ound - c

17 yrs. old, PCP/OBGYN visit PCP/OBGYNold, yrs. 17 Title are & behavioralare & 127 Text - patient counseling patient h ealth + 8 Project Project 1.7:Status Title Text Adult Obesity Prevention ObesityAdult Child Child Prevention Obesity Obesity Prevention & Healthier Foods Initiative Metric 1.7.3 1.7.2 1.7.1 PHA

Title 128 Text Risk LevelRisk High LowRisk LowRisk Risk 9 Project Project 1.7:Expectations If • • • for performing100 of maximum Title Text values are achieved BUT BUT valuesare achieved 1.7.2: Beverages: 57.20/63.6% Beverages: 57.20/63.6% 1.7.2: 42.49% = 25% ~2, Baseline = 1.7.1: 1.7.3: Baseline= 0, 25 Baseline=0, 1.7.3: 1.7.1/1.7.3. Obesity Prevention & Healthier Foods Initiative 50 % overmetric target inDY14 inanother or % % funding in funding% th % = 54.5, 51.84, 45.09% 51.84, 54.5, % =

below the 25 belowthe Title 129 DY13 can be achieved if over achievedbe can DY13 Text  65% Target Target 65%  th full$ %  Onlya   full$ full $ full - 10 Passion. People. Purpose.TM

Project 2.2

Care Transitions: Integration of Post-Acute Care

Leads: Joe Parker/Rachel Ricchio/Patrice Gadd Physician Partner: Teja Singh, MD

11 130 Project Project 1.7:Objectives/Goals Title Text • • • • • 2.2.3 2.2.2 2.2.1 2.2.5 2.2.4 Timely Transmission of Transition Record Record of Transition TimelyTransmission ReceivedMedicationList by Reconciled Reconciliation Medication H ReadmissionsAllCause Obesity Prevention & Healthier Foods Initiative - CAHPS Discharged Patients Discharged – Care Transitions

Title 131 Text – 30 Days 30 12 Project Project 1.7:Status Title Text 2.2.4 Reconciled2.2.4 Med List Received Discharged by Patients 2.2.5 Transmission of TransitionTransmission of Care2.2.5 Document(TOC) 2.2.2 HCAHPS CareHCAHPS Transition2.2.2 Questions 2.2.3 Medication2.2.3 Reconciliation 2.2.1 All-Cause 2.2.1 Readmissions Obesity Prevention & Healthier Foods Initiative Metric

Title 132 Text RiskLevel Moderate Moderate Moderate High Low 13 Project Project 1.7:Expectations Title Text • • • • • reported for broader patient broader population for reported 2.2.2 see to 2.2.1 record transfer timing of andmodify transfer documentfor secure network create 2.2.5 m 2.2.4 2.2.3 edication Continue to work with Palomar Health IT and to local FQHCs Palomar Health IT with work to Continue receivepatients ensure to staff CRM with Work hardwire to withdata FQHCs work Continue to sharing process metrics HCAHPS evaluate Routinely Specialist and hireTransition metricsNurse evaluate Routinely PRIME patients.PRIME Obesity Prevention & Healthier Foods Initiative l ist prior to discharge ist priorto

Title 133 Text - Challenge that HCAHPS is that HCAHPS r econciled 14 Passion. People. Purpose.TM

Project 2.3

Complex Care Management for High-Risk Medical Populations

Leads: Rachel Ricchio/Samar Hireish Physician Partner: Sabiha Pasha, MD

15 134 Project Project 1.7:Objectives/Goals Title Text • • • • 2.3.2 2.3.2 2.3.1 2.3.4 2.3.4 2.3.3 Timely Transmission of Transition Record Record of Transition TimelyTransmission PreventionQualityOverall Composite #90 Reconciliation Medication State byRetired Obesity Prevention & Healthier Foods Initiative –

no reportingno Title 135 Text – 30 Days 30 16 Project Project 1.7:Status Title Text 2.3.4 Transmission of Transmission Transition 2.3.4 of Care Document(TOC) 2.3.3 Prevention2.3.3 Quality Composite #90 2.3.2 Medication2.3.2 Reconciliation Obesity Prevention & Healthier Foods Initiative Metric

Title 136 Text Risk Level Moderate High Low 17 Project Project 1.7:Expectations Title Text • • • • sharing 2.3.2 2.3.1 transfer and modifyof recordtransfertimingtransfer and for document network secure to create local FQHCs 2.3.4 2.3.3 Routinely evaluate metricsRoutinely Continue to work with Palomar Health IT andIT Health with Palomar to work Continue to hardwiredata with FQHCs to work Continue State byRetired Obesity Prevention & Healthier Foods Initiative process –

no further reporting requiredreportingfurtherno Title 137 Text 18 Passion. People. Purpose.TM

Project 2.7

Comprehensive Advanced Illness Planning & Care

Leads: Samar Hireish/Rachel Ricchio Physician Partner: Sabiha Pasha

19 138 Project Project 1.7:Objectives/Goals • • • • • • Title Text 2.7.3 2.7.2 2.7.1 2.7.6 2.7.5 2.7.4 Ambulatory Palliative Team Established Care Plan Advanced Proportion Admitted to Hospice for3 LessThanDays Palliative at Care Services Time ofDiagnosis Offered of Outpatient Preferences Treatment Inpatient Preferences Treatment Advanced Illness Obesity Prevention & Healthier Foods

Title 139 Text Initi 20 Project Project 1.7:Status Title Text Obesity Prevention & Healthier Foods Initiative

Title 140 Text 21 Project Project 1.7:Expectations • • • • • • Title Text 2.7.3 2.7.2 regarding documentation needed 2.7.1 Elizabeth/Lightbridge 2.7.6 Medi referrals for 2.7.5 Elizabeth/Lightbridge 2.7.4 staff to improve EHR documentation Ambulatory Palliative Team Established Expect improvement with continued education staff Continue to hardwire data sharing process with Expect improvement with Continue to hardwire data sharing process with Expect improvement with education of physician/clinical Obesity Prevention & Healthier Foods - Cal Cal patients

Title 141 Text increase increase in palliative care Initi - Metric complete 22 Passion. People. Purpose.TM

Project 3.1

Antibiotic Stewardship

Leads: Jeremy Lee/Michael Kruse Physician Partners: David Lee, MD/Antimicrobial Stewardship Committee

23 142 Project Project 1.7:Objectives/Goals • • • • • Title Text *Innovative measures: paid for reporting rather than performance than rather for reporting paid measures: *Innovative inpatients 3.1.3* 3.1.2 emergencythe department 3.1.1 3.1.5 3.1.4* – – – – – Reduce Clostridium difficileClostridiuminfection Reduce Retiredbystate in for bronchitis prescriptionsantibioticReduce Obesity Prevention & Healthier Foods Initiative Stop using antibiotics after antibioticsusingsurgicalclosureStop Report and benchmark antibiotic use for use antibiotic benchmark and

Title 143 Text 24 Project Project 1.7:Status Title Text Antibiotics after surgical closure surgical after Antibiotics Clostridium difficile infection difficile Clostridium Antibiotic use for inpatients for Antibiotic use Obesity Prevention & Healthier Foods Initiative Antibiotics Metric for bronchitis for

Title 144 Text Risk LevelRisk No risk No risk No risk No risk 25 Project Project 1.7:Expectations • • • • Title Text *Innovative measures: paid for reporting rather than performance than rather for reporting paid measures: *Innovative 3.1.4* time(similarto surgical hours at 72 antibiotictimeantibioticexpandingan prescribing; 3.1.3* 3.1.1 performer 3.1.5 colon) and (orthopedics – – – – Further improvementFurther above 90 Staying Obesity Prevention & Healthier Foods Initiative Changing order protocols for two surgeriesfor two protocols orderChanging to fine orderingChangingprotocols

th Title 145 percentile Text – likely to be near top likelyto benear - out) - tune - out 26 Passion. People. Purpose.TM

Project 3.2 High Cost Imaging

Lead: Donna Rolin Physician Partners: Gregory Nicpon, MD/David Lee, MD

27 146 Project Project 1.7:Objectives/Goals • • Title Text management of 3 specific indications: of 3specific management imaging utilizationon and focuses 3.2 project PRIME expected. is education patient and Physiciangained. are also access efficienciesand Imaging department patients. radiationto unnecessary helpreduce to order in (AUC) Use CriteriaAppropriateon imagingbased studies All – – – – 3.2.4 3.2.3 Embolism 3.2.2 3.2.1 four of the initiativesof the requirefour Obesity Prevention & Healthier Foods Initiative – – – – Imaging for Low Back Pain, Variation Pain,Back Imaging forLow Imaging Pain for LowBack for PulmonaryAngiography CT Use of Imaging Headaches for Routine

Title 147 Text referring MDs to order referring MDs 28 Project Project 1.7:Status Title Text 3.2.1 Imaging for Routine Headaches Routine for Imaging 3.2.1 3.2.4 3.2.3 Low Back Pain Back Low 3.2.3 Obesity Prevention & Healthier Foods Initiative Low Back Pain Variable Pain Back Low 3.2.2 CTA for PE for CTA3.2.2 Metric

Title 148 Text Risk LevelRisk Moderate High High High 29 Project Project 1.7:Expectations • • • • Title Text ionizing radiation to patients and gainimaging 3.2.2 infrastructure. Minimal to no improvement expected with current ionizing radiation to patients and gainimaging efficiency. 3.2.1 infrastructure. Minimal to no improvement expected with current ionizing radiation to patients and gain imaging efficiency. 3.2.4 infrastructure. Minimal to no improvement expected with current ionizing radiation to patients and gainimaging efficiency. 3.2.3 probability of PE will be better at documented reporting time. – – – – Software solution will to realize in be needed reduction Software solution will tobe needed realize reduction in Software solution will to realize in be needed reduction Software solution to will realize be needed reduction in Obesity Prevention & Healthier Foods Initiative

Title 149 Text efficiency. efficiency. Clinical 30 Passion. People. Purpose.TM

Project 3.3

High Cost Pharmaceuticals

Leads: Jeremy Lee/Michael Kruse Physician Partners: Patrick Tellez, MD/James Schultz, MD

31 150 Project Project 1.7:Objectives/Goals • • • • Title Text enough to be taking at least 80% of intended number of number of intended taking atleast80% to be enough filledfrequentlyServices)Healththeir medications CountyNorthand Health(Neighborhood health centers communitypartnering two our in pharmaceuticals” 3.3.1* medication reconciliationevery visit?with medication primarycare 3.3.4* lowerthat prefersalternative cost protocolused first? anorderingwas how often pharmaceuticals, cost 3.3.3* 3.3.2 covered (PDC)]” of days“percentage [calleddays *Innovative measures: paid for reporting rather than performance than rather for reporting paid measures: *Innovative – – – – Retired by state; replaced with 3.3.4 with replaced state; byRetired Obesity Prevention & Healthier Foods Initiative For the above patients, how many had how many above patients, For the highfor the prescriptionsnew with For patients cost “high taking Calculatemany patients how

Title 151 Text 32 Project Project 1.7:Status Title Text Obesity Prevention & Healthier Foods Initiative Percentage of DaysCovered of Percentage Medication Reconciliation Medication High cost medications High cost medications High cost medications High cost Protocol Metric Use

Title 152 Text Moderate Risk LevelRisk No risk No risk risk 33 Project Project 1.7:Expectations • • • Title Text 3.3.3* clinicthe other from last yearclinic; from onestillthan patients very few many more preliminaryshowingdata of PRIME); end 3.3.1* 3.3.4* clinic at each implementedto be need year; protocols this *Innovative measures: paid for reporting rather than performance than rather for reporting paid measures: *Innovative – – – Obesity Prevention & Healthier Foods Initiative Data still pending on medicationreconciliationon stillData pending of months first6 in of protocols zero use Expect by drugs per year (goal of15 drugs3 Adding

Title 153 Text 34 Title Text Questions?

Title 154 Text 35

Memorandum

TO: Board of Directors FROM: Hans C. Sison, LVN; Chair, Board Human Resources Committee DATE: Monday, March 12, 2018 RE: Board Human Resources Committee – February 20, 2018, Meeting Summary

BOARD MEMBER ATTENDANCE: Directors Sison, Griffith EXCUSED ABSENCES: Director McCune

INFORMATION ITEMS:

Highlights of Labor Contracts Status / Leadership Training: Chief Human Resources Officer Pam Sime gave an overview of the status of the labor contracts and leadership training. Highlights include the following:

 Final contracts for CNA and CHEU will be done tomorrow  Leadership training will begin at the February 27 Leadership Council Meeting  The HR Team is in the process of restructuring Labor Relations to improve responsiveness

Annual Market Compensation Survey: Chief Human Resources Officer Pam Sime notified the group that we have now contracted with Gallagher Integrated, a national firm, for data studies. Every position in the organization will be tied to a benchmark. The goal is to move quickly to have everything in place for budgets.

Severance Procedure: Committee Chair Sison stated that this item was with the Governance Committee and a discussion was had around where this item belongs. It was suggested that it be brought back to the HR Committee as the most appropriate place for it.

Chief Human Resources Officer Pam Sime provided updates and changes according to market standards. This mostly affects Leadership; changes to be announced at a future Leadership meeting.

Emergency Loan Fund: Chief Human Resources Officer Pam Sime informed the committee that there has been a spike in applications since we raised the loan to $850. In looking at cost management, this is something that has escalated. Committee suggested to update the policy for stricter guidelines and Pam will come back with changes at the next meeting.

Benefit Open Enrollment May 2018: Chief Human Resources Office Pam Sime notifies the group that there will be another open enrollment due to new union contracts in place.

Committee Responsibilities: Chief Human Resources Officer Pam Sime and Committee Chair Sison requested input re: future meeting agenda items to keep this meeting meaningful.

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ACTION ITEMS:

Minutes from the Tuesday, November 21, 2017 Board Human Resources Committee: The minutes from this meeting were unanimously approved as written.

156