BOARD OF DIRECTORS - Lee Health · ELECTRONIC BOARD PACKET. BOARD OF DIRECTORS . Meetings: Lee Memorial Health System Board • Convene as Cape Coral Hospital • Convene as Lee Memorial

ELECTRONIC BOARD PACKET

BOARD OF DIRECTORS Meetings:

Lee Memorial Health System Board • Convene as Cape Coral Hospital

• Convene as Lee Memorial Hospital • Convene as Gulf Coast Medical Center

Governance Dinner Meeting

February 24, 2011, 4:00pm Lee Memorial Hospital Boardroom

2776 Cleveland Ave, Ft. Myers, FL 33901

ELECTRONIC BOARD PACKET

ALL MEETINGS ARE OPEN TO THE PUBLIC AND THE PUBLIC IS INVITED TO ATTEND Any Public Input pertaining to an agenda item is limited to three minutes and a

“Request to Address the Board of Directors” card must be completed and submitted to the Board Administrator prior to the meeting.

BOARD OF DIRECTORS OFFICE

239-343-3300 FAX: 239-343-3194

P.O. BOX 2218

FORT MYERS, FLORIDA 33902

CAPE CORAL HOSPITAL

GULF COAST MEDICAL CENTER

HEALTHPARK MEDICAL CENTER

LEE MEMORIAL HOSPITAL

THE CHILDREN’S HOSPITAL

THE REHABILITATION HOSPITAL

LEE PHYSICIAN GROUP

LEE CONVENIENT CARE

BOARD OF DIRECTORS

DISTRICT ONE

Stephen R. Brown, M.D.

Marilyn Stout

DISTRICT TWO

Richard B. Akin

Nancy M. McGovern, RN, MSM

DISTRICT THREE

Lois C. Barrett, MBA

Linda L. Brown, MSN, ARNP

DISTRICT FOUR

Diane Champion

Chris Hansen

DISTRICT FIVE

Donald A. Brown

James Green

Any Public input is limited to three minutes and a “Request to Address ‘ the Board of Directors” card must be completed and submitted to the

Board Administrator prior to meeting.

Lee Memorial Health System BOARD OF DIRECTORS FULL BOARD OF DIRECTORS’ MEETINGS

FOLLOWED BY GOVERNANCE BOARD OF DIRECTORS’ DINNER MEETING

Thursday, February 24, 2011, 4:00pm

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

Agenda

1. CALL TO ORDER: LEE MEMORIAL HEALTH SYSTEM BOARD OF DIRECTORS (Richard Akin, Board Chairman) {BLUE FOLDER}

2. Invocation and Pledge of Allegiance (Reverend Cynthia Brasher) 3. Public Input - Agenda Items: Any Public input is limited to three minutes and a

“Request to Address the Board of Directors” card must be completed and submitted to the Board Administrator prior to meeting.

4. RECOGNITION: Yemisi Oloruntola-Coates, Gulfshore Magazine FACE Award

5. Consent Agenda: (Approval)

A. System Risk Management Report, 1st Qtr, FY 2011 B. REDLINED Quality Outline (REVISED from approved version Feb 17)

6. System Financial Reports for Jan 31, 2011 (Mike German, CFO) (Accept) A. Moody’s Rating (Update)

7. Physician Leadership Council (PLC) Report (Accept) (Thomas Presbrey, M.D., PLC Chairman) 8. RECESS LEE MEMORIAL HEALTH SYSTEM Full Board of Directors Meeting 9. CALL TO ORDER: (Richard Akin, Board Chairman) A. Lee Memorial Hospital Board of Directors (Provider #10-0012) {{GGRREEEENN FFOOLLDDEERR}} BB.. Cape Coral Hospital Board of Directors (Provider #10-0244) {{YYEELLLLOOWW FFOOLLDDEERR}} C. Gulf Coast Medical Center Board of Directors (Provider #10-0220) {

022411 Governance Full Board FINAL Agenda Page 1 of 2

{OORRAANNGGEE FFOOLLDDEERR}} 10. RECONVENE LEE MEMORIAL HEALTH SYSTEM Full Board of Directors Meeting (Richard Akin, Board Chairman) {BLUE FOLDER}


239-343-3300 FAX: 239-343-3194

P.O. BOX 2218


CAPE CORAL HOSPITAL






LEE PHYSICIAN GROUP

LEE CONVENIENT CARE

BOARD OF DIRECTORS

DISTRICT ONE


Marilyn Stout

DISTRICT TWO

Richard B. Akin


DISTRICT THREE



DISTRICT FOUR

Diane Champion

Chris Hansen

DISTRICT FIVE

Donald A. Brown

James Green

022411 Governance Full Board FINAL Agenda Page 2 of 2

GOVERNANCE DINNER MEETING: (Donald Brown, Governance Chair)

11. Consent Agenda (All Directors) (Approval)

A. Board 1st Qtr, FY 2011 Budget B. Governance Committee Minutes of November 4, 2010

12. Board Bylaw IV: Committees (Jim Humphrey, Board Counsel) (Adoption)

13. Proposed Board Policies for Review/Adoption (Tabled from 9/23/10) (Steve Brown, MD, Director)

A. 10.11E: Board Member Attendance B. 20.13F: Compensation Benefits for Board Members

14. Board Retreat Final Follow-Up Topics A. Board Job Descriptions (Jim Humphrey, Board Counsel) B. Goal Card

15. Legal Services/Risk Management (Mary McGillicuddy, Chief Legal Officer) (Review) 16. Corporate Compliance Report, 1st Qtr, FY 2011 (Acceptance)

(Charles Swain, Chief Compliance Officer – 10 min)

LMHS SYSTEM BUSINESS (Richard Akin, Board Chairman)

17. Governance Conference Report (Review) (Diane Champion, Director and Donald Brown, Director)

18. Date of the Next Regular GOVERNANCE Full Board of Directors Meeting will be Thursday, October 27, 2011, 4:00pm, Lee Memorial Hospital – Boardroom 19. ADJOURN Governance Portion

20. Old Business 21. New Business 22. Board of Directors Reports (All Directors) 23. Board Administrator Report (Cathy Stephens, Board Administrator) A. Packet Preparation 24. Date of the Next Board of Directors’ Meetings Thurs, March 3, 2011, Lee Memorial Hospital - Boardroom 2:30 pm, Board Workshop, Healthcare: The Perfect Storm 4:00 pm, Board of Directors’ Meetings (PLANNING) 25. ADJOURN Lee Memorial Health System Board of Directors (Richard Akin, Board Chairman)

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

BBBOOOAAARRRDDD OOOFFF DDDIIIRRREEECCCTTTOOORRRSSS

PUBLIC INPUT – AGENDA ITEMS:

Any public input

pertaining to items on the Agenda is limited to three

minutes and a “Request to Address the Board of Directors”

card must be completed and submitted to

the Board Administrator prior to meeting.

Refer to Board Policy: 10:15E: Public Addressing the Board Non-Agenda Item: Individuals wishing to address the Board on an item NOT on the Agenda, the Board office must be notified of subject matter at least seven (7) days prior to the meeting to allow staff time to prepare and to insure the matter is within the jurisdiction of the Board.

RECOGNTION: Yemisi Oloruntola-Coates, Gulfshore Magazine FACE Award

Yemisi won the “Faces Awards” for the education category. She was recognized at an Awards Ceremony on January 20, 2011 and was featured in the January edition of the D'LATINOS & GULFSHORE BUSINESS MAGAZINES. Only six winners were selected out of all the nominations received. D’LATINOS AND GULFSHORE BUSINESS MAGAZINES TO PRESENT “FACE AWARDS" CELEBRATING DIVERSITY IN SW FLORIDA NAPLES, Florida (July 26, 2010)--In honor of unsung heroes in the local community who represent Southwest Florida’s diversity, D’Latinos and Gulfshore Business magazines proudly announce their inaugural FACE AWARDS 2011 was presented in print and at a gala on January 20th at the Hilton Hotel in Naples, Fl. The publications will recognize businesses and outstanding individuals who reflect and celebrate positive values and the ethnic and racial diversity within our community. Awards will recognize outstanding nominees in each of the following categories: Large Company, Small Business, Nonprofit/Philanthropy, Medical, Education, and Arts and Culture.

Congratulations Yemisi!

CONSENT AGENDA

Unless the information you submit with this form is significantly enhanced

in color (i.e. graphs), please submit in black & white,

maximum 2 slides per page.

LMHS BOARD OF DIRECTORS RECOMMENDED ACTION FOR BOARD APPROVAL

(Action includes Acceptance, Approval, Adoption, etc)

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

to L Drive Miscellaneous BOD Presentations by Noon the Friday before the week you’re

scheduled on agenda.

DATE: February 3, 2011 LEGAL SERVICE REVIEW? YES___ NO___

SUBJECT: Quarterly Risk Management Report

REQUESTOR & TITLE: Mary McGillicuddy, Chief Legal Officer

PREVIOUS BOARD ACTION ON THIS ITEM (IF ANY) (justification and/or background for recommendations – internal groups which support the recommendation i.e. SLC, Operating Councils, PMTs, etc.) Acceptance of Quarterly Risk Management Report for the previous quarter. SPECIFIC PROPOSED MOTION: Motion to Accept Quarterly Risk Management Report Q1FY11 PROS TO RECOMMENDATION Not Applicable

CONS TO RECOMMENDATION Not Applicable

LIST AND EXPLAIN ALTERNATIVES CONSIDERED Not Applicable FINANCIAL IMPLICATIONS Budgeted ____ Non-Budgeted ____ (including cash flow statement, projected cash flow, balance sheet and income statement) No financial implications OPERATIONAL IMPLICATIONS (including FTEs, facility needs, etc.) No operational implications SUMMARY Quarterly Risk Management Report including:

• Incident Reporting per 1,000 patient days • Injury Occurrences per 1,000 patient days • Categories of incident reports • Risk Management participation in LMHS System Committees and Education • Liability Claims • Recommendations

BOD/Forms/Board (Action) Reporting Form - revised 1/9/08/cs

1

QUARTERLY RISK MANAGEMENT REPORT TO THE BOARD

October - December 2010

The disclosure of this document and the contents herein does not constitute a waiver of any and all protections afforded Patient Safety Work Product under either Florida state or federal law including but not limited to those under the Patient Safety Quality Improvement Act of 2005 and implementing regulations.

2

REPORTING RATES

The graph below shows incident reporting rates for the system for the past 24 months. During this time range the reporting rate has increased.

The graphs on page 3 reflect the reporting rates for the four facilities individually. The four graphs also show the last 24 months of activity.

Lee Memorial Health System

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REPORTING RATES. . . continued

Cape Coral Hospital

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The trend as depicted in these graphs indicates a decided rate growth over the last 24 months. The increase may be attributed to recent patient safety initiatives.

Gulf Coast Medical Center

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4

INJURY

The first graph shows the reporting rate and the injury rate for the four facilities during the last quarter. The second graph shows the percentage of reports without injury. Reporting of no injury incidents are highly encouraged so that “near misses”

and potential areas of improvement can be identified. This information allows us to better understand where risks exist, and provides data used in our quality improvement activities throughout the system. More than 70% of the incident reports received involve no injury. During this quarter, there were four reports to AHCA, as required by Florida law.

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CCH HPMC LMH GCMC

Rate per 1000 Patient Days

Reporting Rate Injury Rate

Percent of Incidents Without Injury

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5

CATEGORIES

The graph to the right shows the rate for the categories of reported incidents from July through September 2010 at all four facilities. Rates are being utilized to be consistent with other system reporting. As indicated, the vast majority of these incidents did not involve any injury.

The top four categories are:•

Treatment & Testing category includes reports of IV infiltrates, Delays and Omissions, Patient Identification issues, etc

•

Other

category includes Exposures, Complaints, burns, skin breakdown, ER issues, AMAs, self-extubation, etc

•

Patient Falls •

Medication Errors70% of all reported occurrences fall within one of

these four categories

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Transport Issues

Assault

Sedation for Proc

NonPt Fall

Equipment

Adverse Drug Rx

Inf/Mat/OB

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Rate per 1000 Patient Days

6

EDUCATION

Risk Management Educational Activities included:

• Risk Management Orientation for new hires

• Risk Management for Nursing Interns• Facilitated numerous Patient Safety

Classes• Department Inservices• Defensive Documentation Workshop• ASHRM• ISO / NIAHO Training

7

LIABILITY

Malpractice ClaimsThe number of professional liability claims pending against Lee Memorial Health System at the end of the quarter was one more than

was open at the end of Fiscal Year 2010, for a total of 61 open files. The situation remains relatively stable, although the amount of litigation is greater than in several years. This may, of course, be

accounted for by the growth in size of the System, which includes a greater number of employed physicians, including specialists. This is consistent with predictions made for several years.

The first fiscal quarter (October - December) began with 60 open claims, up from 58 the previous quarter.During the quarter, 8 claims were opened, and 7 closed.No definitive reason for the increased litigation climate is easy to determine, although there may be a connection with increased

unemployment and a difficult economic situation.As with prior reports, the bases for professional liability claims remains quite diverse, making it difficult to determine that a particular

type of event or a particular location is involved. As usual, the terms under which malpractice claims against the System are closed continues to be very favorable to the Health System.

The increase in the caps under sovereign immunity is slated for 2012, after which it should be anticipated that the cost of adjusting claims against the System will increase.

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FY08Q4 FY09Q1 FY09Q2 FY09Q3 FY09Q4 FY10Q1 FY10Q2 FY10Q3 FY10Q4 FY11Q1

8

RISK MANAGEMENT ACTIVITIES

Continued participation in system committees including: •

Campus Specific ADE Work Groups•

Employee Safety and Wellness•

Ethics Committee•

Standards and Compliance•

Patient Care Service P&P Committee•

GCMC Patient Safety Committee•

Medication Safety Committee•

Psychiatric Consultation Services Council•

Patient Safety Evaluation System (LPSES) Steering Committee•

Tobacco Free Lee Steering Committee• Quality Safety Management Council• Patient Safety Transformation Committee• Fair & Just Culture: Appropriate Accountability Project Team• Hardwiring Leadership Safety Behavior Team• DNV Patient Rights Co-chair• DNV Informed consent Action Team• Suicide Prevention Team•

Participated in various Intense Analysis Teams/ Common Cause Analysis Teams•

Policy & Procedure Committee•

Quality PI Committee•

LMHS Standards and Compliance –

Handling Lab Specimens Committee

9

RECOMMENDATIONS

• Monitor the implementation of the SoftMed Risk Management Module.

• Continue to track and trend incidents, provide summary data and work closely with various departments and committees engaged in performance improvement and patient safety activities.

• Continue to work with Education and Organizational Development and management staff to assure that all employees are meeting the annual education requirement for risk management and to provide a module for the Competency activities.

• Continue to utilize pre-litigation procedures to resolve legitimate claims as quickly as the interests of the System and claimants allow.

• Continue development of specialized training materials for risk.• Collaborate with HPI with regard to patient safety initiatives.• Initiate use of ProLaw System for enhanced integration of Legal

Department activities.

______________

L E E M E M O R I A L HEALTH SYSTEM BBBOOOAAARRRDDD OOOFFF DDDIIIRRREEECCCTTTOOORRRSSS

RECOMMENDED ACTION FOR BOARD APPROVAL (Action includes Acceptance, Approval, Adoption, etc)

Keep form to one page, SUBMIT (thru SLC Member) ELECTRONICALLY to L Drive – Miscellaneous - BOD Presentations by Noon the Friday before you’re scheduled on agenda.

DATE: 17 February 2011 Feb 24, 2011 LEGAL REVIEW: Yes _X_ No _x__

SUBJECT: Quality Outline REVISED

REQUESTOR & TITLE: Chuck Krivenko MD, Chief Medical Officer; Chris Crawford RN, Vice President Quality

PREVIOUS BOARD ACTION ON THIS ITEM (IF ANY) (justification and/or background for recommendations – internal groups which support the recommendation i.e. SLC, Operating Councils, PMTs, etc.)

In preparation for becoming ISO 9001 compliant, a group of leaders participated in a workshop which focused upon revising the Quality Outline of the system. The outline is the system guide which describes our methods for addressing how quality and performance are measured and analyzed for the continued improvement of healthcare outcomes. The outline incorporates much of the previous LMHS Quality Manual with additions for compliance with ISO 9001 standards

SPECIFIC PROPOSED MOTION:

Board approval of the REVISED Quality Outline.

PROS TO RECOMMENDATION

The adoption of the quality outline as a system document is important to gain ISO 9001 compliance and eventually certification

CONS TO RECOMMENDATION

Adoption is important to gain ISO 9001 compliance for the upcoming DNV/ISO survey.

LIST AND EXPLAIN ALTERNATIVES CONSIDERED N/A

FINANCIAL IMPLICATIONS Budgeted ____ Non-Budgeted ____ (including cash flow statement, projected cash flow, balance sheet and income statement) N/A OPERATIONAL IMPLICATIONS (including FTEs, facility needs, etc.) N/A SUMMARY Changes were necessary as shown. The Quality Outline for the system requires adoption by the Board of Directors prior to the Spring DNV/ISO 9001 Survey. It is the guide to our quality and performance improvement methods, and our organizational structure which supports a continuous cycle of planning, designing, measuring, assessing and improving.

The disclosure of this document and the contents herein does not constitute a waiver of any and all protections afforded Patient Safety Work Product under the Patient Safety Quality Improvement

Act of 2005 and implementing regulations.

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

i

The disclosure of this document and the contents herein does not constitute a waiver of any and all protections afforded Patient Safety Work Product under the Patient Safety Quality Improvement Act of 2005 and implementing regulations.

QUALITY OUTLINE

S15 00 719

The Quality Outline is a resource for leaders, staff, and performance improvement teams. This guide outlines our methodology for addressing how quality and performance are measured and analyzed for continually improving our healthcare outcomes and reducing risks for patients.

Purpose Our Quality Outline provides the framework for a strategically planned, systematic, organization-wide approach to improving organizational performance. The Quality Outline is created with corporate input from Lee Memorial Health System (LMHS). The outline shows the organizational and functional processes to be used in the review and evaluation of patient care and support services. The structure is based on a continuous cycle of planning, designing, measuring, assessing and improving. LMHS strives towards a culture which promotes patient safety and high quality of care through a continued performance improvement process. The Quality Outline at LMHS defines the Quality Management System and the integral components that allow LMHS to provide consistent service to our patients, enhance their satisfaction and continually improve our performance. With efforts to continually promote a culture of patient safety, LMHS is a provider member of Medical Peer Review Resources, LLC (MPRR) a federally-listed patient safety organization (PSO) with the Agency for Healthcare Research and Quality (AHRQ), a division of the Department of Health and Human Services (DHHS). LMHS is committed to complying with the Patient Safety and Quality Improvement Act of 2005 (PSQIA) and to ensuring the privilege and confidential nature of all patient safety work product (PSWP). To comply with the PSQIA, LMHS has developed a patient safety evaluation system entitled Lee Memorial Health System Patient Safety Evaluation System (LPSES) for purpose of collecting, analyzing, and reporting PSWP to the PSO. The PSO protection applies to all LMHS employees, volunteers, students, medical staff members, and others working on behalf of LMHS. All PSWP within LPSES must be collected stored, analyzed and reported to the PSO in accordance with LMHS policies.

Deleted: ¶¶¶¶

Deleted: the

ii

QUALITY OUTLINE

LEE MEMORIAL HEALTH SYSTEM

Table of Contents

Glossary of Terms I. Mission, Vision, and Strategic Goals ......................................................................... II. Scope and Exclusions……………………………………………………………… III. Procedures in the Quality Management System…………………………………….. IV. Prioritizing Quality Objectives………………………………………………………. V. Quality and Patient Safety Strategic Plan……………………………………………. VI. Governance of Performance Improvement Activities……….………………………..

Board of Directors…………………………………………………………………….. System Quality Safety Management Council…………………………………………. System Quality and Conformance Committee………………………………….…… Multidisciplinary Performance Improvement Teams………………………………… Facility Quality Committees………………………………………………………….. Medical Staff Quality Committees…………………………………………………....

Patient Care Services…………………………………………………………………. Organization of Performance Improvement within Patient Care Services…………… Senior Nursing Leadership Council………………………………………………… Operations Councils…………………………………………………………………. VII. Measurement………………………………………………………………………….

System Strategic Goals………………………………………………………………. System Board Report………………………………………………………………… Management Review………………………………………………………………… Unit Level Indicators…………………………………………………………………

VIII. Performance Improvement Methodologies………………………………………. Appendix A: ISO Interaction Matrix Appendix B: NIAHO™ Interaction Matrix Appendix C: LMHS Process Interaction Sequence Map

4 4 5 5 6 6 6 6 6 6 7 7 8 8 8 9 9 10 10 12 12 12 12 12 13 13 14 14 14 14 14 14

Deleted: The Quality Outline at LMHS defines the Quality Management System and the integral components that allow LMHS to provide consistent service to our patients, enhance their satisfaction and continually improve our performance.

Deleted: ¶¶¶¶¶¶¶

iii

Glossary of Terms

AHRQ – Agency for Healthcare Research and Quality

ALOS – Average Length of Stay

AR – Accounts Receivable

BOD – Board of Directors

CAO – Chief Administrative Officer

CCH – Cape Coral Hospital

CCN – Claim Control Number

CMI AA – Case Mix Index per Adjusted Admission

CMS – Centers for Medicare/Medicaid Services

CoP – Conditions of Participation

DHHS – Department of Health and Human Services

ED- Emergency Department

EOC – Environment of Care

FQC – Facility Quality Committee

GCMC – Gulf Coast Medical Center

HCAHPS – Hospital Consumer Assessment of Healthcare Providers and Systems

HIM – Health Information Management

HPMC – Health Park Medical Center

HVA – Hazard Vulnerability Analysis

IC – Infection Control

ICU – Intensive Care Unit

ISO – International Standardization Organization

IRB- Institutional Review Board

LMH – Lee Memorial Hospital

LMHS – Lee Memorial Health System

LPSES – Lee Memorial Health System Patient Safety Evaluation System

MPRR – Medical Peer Review Resources

NIAHO – National Integrated Accreditation for Healthcare Organizations

OB - Obstetrics

OP - Outpatient

Formatted: Centered

Formatted: Justified

iv

OSHA – Occupational Safety and Health Administration

PDCA – Plan, Do, Check & Act

PI – Performance Improvement

PICU – Pediatric Intensive Care Unit

PSO – Patient Safety Organization

PSWP – Patient Safety Work Product

QM – Quality Management

QMS – Quality Management System

Rx - Pharmacy

S&P – Standard & Poor

SQCC – System Quality and Conformance Committee

SQSMC – System Quality Safety Management Council

SR – Standard Requirement

TCH – The Children’s Hospital

TRH - The Rehabilitation Hospital

VP – Vice President

5

QUALITY OUTLINE LEE MEMORIAL HEALTH SYSTEM

I. MISSION, VISION AND STRATEGIC GOALS

The Mission of the Lee Memorial Health System is to continue to meet the healthcare needs and improve the health status of the people of Southwest Florida. With advances in technology, healthcare is continuously changing. “Continuing to meet the healthcare needs” of the community means we must continue to change. That’s what Performance Improvement is all about. The Vision of the Lee Memorial Health System is to be the best patient-centered healthcare delivery system in the State of Florida, by balancing quality, access and cost. This balance is fundamental to achieving our Mission. By continuously improving the quality of our processes and outcomes, providing convenient services, and maintaining our financial stability, we will achieve our vision of being the best in Florida – and a leader in the nation. Continuous improvement is critical to that success. The Strategic Goals of Lee Memorial Health System are those of achieving excellence:

Quality – Excellent patient outcomes Community – Excellent community health system Service – Excellent patient experience People – Excellent health care employer Finance – Financial excellence

The Board of Directors, Medical Staff, Administration and Leadership of Lee Memorial have cooperatively developed the Mission, Vision and Strategic Goals of the organization, and express at every level the shared commitment to quality and performance improvement.

II. Scope and Exclusions

Geographically located in southwest Florida, LMHS serves a vital role in the community as a provider of primary, secondary, and tertiary health care services. Medical and surgical continuum of services is provided for all ages. LMHS provides the health care needs of the citizens of Lee County with a population of 615,124. As a public, not-for-profit special unit of government, Lee Memorial Health System is not governed by OSHA regulations. In accordance with federal and state regulations, professional practice standards and codes, LMHS provides the community and surrounding communities with a full range of services including, but not limited to:

Clinical Care Services

Diagnostic/Treatment and Wellness Services

Clinical Support Services

Non-Clinical Support Services

Deleted: The Lee Memorial Health System is a public, not-for-profit healthcare delivery system, created as a special unit of government by the Florida Legislature. Although a public institution, Lee Memorial Health System does not have taxing authority. Thus, it is even more important that processes are improved in a systematic fashion to ensure the safety, efficiency, and effectiveness of operations.

6

Below are the scope and exclusions of the LMHS hospitals as separated by the CMS CCN designation:

Cape Coral Hospital (CCH) is a 291-bed facility. Services include: General Medicine

General Surgery

Neurology

Neuroscience Unit

Obstetrics

Gynecology

Orthopedics

Pediatrics

Special Care Nursery

Diagnostic Cardiac Catheterization Neurosurgery and Spine Surgery

Exclusion 7.3: CCH has determined an exclusion from the requirements defined within ISO9001 Clause 7.3 for Product Design and Development based upon CCH using only proven methods, treatments, equipment, and medications. Cape Coral Hospital does not participate in development new methods, treatment, and medications. Exclusion 7.5.2: CCH has determined an exclusion from the requirements defined within ISO 9001 Clause 7.5.2 for Validation of Processes for Production for service provision. Lee Memorial Hospital (LMH) is a 355-bed facility, services include.

All-Star Joint Center (orthopedics)

Bariatrics

Senior Behavioral Health

General Medicine

General Surgery

Inpatient Oncology

Certified Primary Stroke Center

Level II Trauma Center

Neurosurgery and Spine Surgery

The Rehabilitation Hospital (TRH) is a 60 bed hospital located within Lee Memorial Hospital. Services include:

Neuropsychology

Occupational Therapy, Physical Therapy and Speech/Language Pathology

Therapeutic Recreation

7

Health Park Medical Center (HPMC) is a 368 bed facility. Services include: Cardiovascular Services

Cardiac Rehabilitation

Interventional Cardiology

General Medicine

Chest Pain Center

Cardiac Electrophysiology

Endovascular Surgery Suites

General Surgery

Heart and Vascular Institute

Cardiac Surgery

The Children’s Hospital (TCH) of SWFL is a 124 bed children’s hospital located with Health Park Medical Center. Services include:

Child Life and Social Services

Children's Rehabilitation Center

Early Intervention Program

Emergency Services Neonatal and Pediatric Transportation

General and High-Risk Obstetrics

General Pediatric Beds

Level III Neonatal ICU

Pediatric ICU

Pediatric Oncology/Hematology

Regional Perinatal Intensive Care Center

Exclusion 7.3: LMH, HPMC, TRH, TCH has determined an exclusion from the requirements defined within ISO9001 Clause 7.3 for Product Design and Development based upon LMH, HPMC, TRH, TCH using only proven methods, treatments, equipment, and medications. LMH, HPMC, TRH, TCH does not participate in development of new methods, treatment, and medications. Exclusion 7.5.1: TRH is located within LMH campus. This facility is included with a basis for the Physical Environment and Life Safety requirements. Exclusion 7.5.2: TRH, TCH, HPMC has determined an exclusion from the requirements defined within ISO 9001 Clause 7.5.2 for Validation of Processes for Production for service provision. Gulf Coast Medical Center (GCMC) is a 349 bed facility. Services include:

Interventional Cardiology

Cardiac Surgery

Kidney Transplantation

8

Orthopedic Surgery

Neurosurgery & Spine Surgery

Certified Primary Stroke Center

Obstetrics and Gynecological Care

General and Vascular Surgery

General Medicine

Exclusion 7.3: GCMC has determined an exclusion from the requirements defined within ISO9001 7.3 for Product Design and Development based upon GCMC using only proven methods, treatments, equipment, and medications. GCMC does not participate in development of new methods, treatment, and medications.

III. PROCEDURES IN THE QUALITY MANAGEMENT SYSTEM

Document Type Document Name

ISO9001 4.2.3 Control of Documents ISO9001 4.2.4 Control of Records ISO9001 8.2.2 Internal Audit ISO9001 8.3 Control of nonconforming product ISO9001 8.5.2 Corrective Action

Quality Procedures

ISO9001 8.5.3 Preventive Action Integrated Service Manual of Procedures Performance Improvement Plan Board Policy and Bylaws Medical Staff Bylaws

NIAHO℠ Documents

Scope(s) of Service Organizational Chart(s) Other Standards for Blood Banks and Transfusion Services

IV. PRIORITIZING QUALITY OBJECTIVES

Performance Improvement opportunities are identified in several ways: Review of performance indicators Feedback from patient, physician and employee satisfaction surveys, including customer comments Comparisons to industry trends Evidence based practice Evaluation of serious safety and precursor safety events

Criteria used in prioritizing projects include

Impact or potential impact on patient and staff safety Identification of high risk, high volume and problem prone processes Performance against strategic goals.

9

Projects are prioritized at the appropriate level of the organization. For instance, the Board of Directors, or Quality and Safety Management Council may prioritize projects of system wide impact. The unit Quality Council or leadership team may prioritize projects at a unit level.

V. QUALITY AND PATIENT SAFETY STRATEGIC PLAN

As part of the Quality Strategic Goal, LMHS has developed the Quality and Patient Safety Strategic Plan. The purpose of the plan is to ensure the health and safety of our patients by setting the highest standards of safety, quality and outcomes. The mission of the plan is to improve patient outcomes by:

Improving Medication Safety Implementing Information Systems to Improve Safety Instituting Clinical Safety Processes Educating on Safety Developing Methods to Monitor and Assure Safety Providing a Safe Environment Improving Customer Service Providing Information to Improve Quality Obtaining Distinction in Quality Reducing Inpatient Mortality Developing Methods to Monitor and Assure Quality Enhancing Flow and Redesign Work in the Inpatient Setting Educating to Improve Quality

VI. GOVERNANCE OF PERFORMANCE IMPROVEMENT ACTIVITIES

The Lee Memorial Health System is a public, not-for-profit healthcare delivery system, created as a special unit of government by the Florida Legislature. Although a public institution, Lee Memorial does not have taxing authority. Thus, it is even more important that processes are improved in a systematic fashion to ensure the safety, efficiency, and effectiveness of operations.

The following organizational chart outlines the authority and flow of information for the hospital based quality.

Hospital Based QualityOrganizational Chart Board of Director

LMHSPhysician

Leadership Council

System QualitySafety

ManagementCouncil*

Medical Staff Oversight

QualityCommittee

Medical Staff System

Credentials Committee

Medical Staff System CME Committee

Facility MedicalStaff Quality Committees

System Quality and

Conformance Committee

System Policy and Procedure

Committee

Facility Quality

Committee’s

PI Teams• Gap Analysis

Service Councils• ED• Critical Care• Surgical Services

Senior Nursing Leadership Council

*Acts as interdisciplinary group to oversee QMS (QM.6.SR.1) with an ISO 5.6.2 agenda

Revised – 10/27/10

Facility Medical

Executive Committee

Physician Safety

Committee

PI and Safety chartered

Teams

Patient Safety Organization and

LPSES Formatted: Font: Verdana

Formatted: Font: Verdana

10

Board of Directors – A ten-member publicly elected Board of Directors governs the Lee Memorial Health System and has ultimate authority and responsibility for the operations of the system. The Board receives a quarterly report of key operating indicators, which reflect the quality of service delivery and outcomes. This report shows the measures that meet, do not meet, or exceed targets, and tells what actions for improvement have been taken. The Board also participates in setting annual goals, and periodically identifies improvement opportunities. In addition, individual members of the Board sit on key operating councils and committees, providing them with an opportunity to view at closer range the improvement activities of the organization.

The System Quality Safety Management Council (SQSMC) - The SQSMC is assigned the responsibility by the LMHS Board of Directors to ensure that the organization implements and maintains an effective quality management system. It insures that corrective and preventive actions taken by the organization are implemented, measured and monitored. To meet this responsibility, the SQSMC integrates, analyzes and reviews quality and safety information for organization decision-making and performance improvement. The information includes the understanding of patient indicators of service and quality, operational performance, safety, organizational capabilities, and benchmark information. The SQSMC advises the Board, Medical Staff, and Senior Leadership Council on opportunities for improvement, consistent with business needs and priorities of the organization. It recommends the chartering of system-wide performance improvement teams and is responsible for oversight of those teams through the Quality and Conformance Committee. The interdisciplinary group that oversees the Quality Management System consists of the CEO, COO, Nurse Executive , Pharmacy, Risk Management, Safety Management, Privacy Office, Quality Management Representatives and two members of the medical staff who must be MD or DO’s. Annually, there is a management review of the 5.6.2 ISO clause. Members of the SQSMC include BOD Liaison; Community Representative, Chief Medical Director/Clinical & Quality Services; Chief Patient Safety Officer, Chief Patient Care Officer; Chief Legal Officer; Chief Operating Officer, Chief Information Officer, Corporate Compliance Officer, Vice President of Quality; System Medical Directors, System Director of Pharmacy, System Director of Care Management, System Director of Medical Staff Quality; System Director of Decision Support, System Director of Environmental Safety and Risk Management. The following groups report to the System Quality Safety and Management Council:

System Quality and Conformance Committee (SQCC) – The SQCC is assigned responsibility for

continuous review in a self-assessment perspective to determine the Quality Management System has been effectively implemented and maintained. This committee is responsible for evaluating NIAHO standards, ISO9001 clauses, CMS and other regulations validating conformance through existing monitors or initiation of monitors where current conformance is unknown or not recently documented. To assure the QMS has been effectively implemented and maintained by assessing accreditation survey readiness, conformance to regulatory standards, corrections and corrective action plans, preventative actions such as HVA, Failure Mode Effects Analysis, ISO internal surveys, performance improvement teams and initiatives, regulatory complaints and complaint investigations.

Members includes Vice Presidents of Patient Care, Vice President of Quality, Functional Leaders from Spiritual Services, Care Management, Clinical Learning, Decision Support, Infection Control, Organizational Effectiveness, Environmental Safety, Dietary, HIM, Medical Staff Quality, Radiology, Respiratory Care, Laboratory; Risk Management; Lee Physician Services; Staff Development; Clinical Information Systems; Human Resources; BOD; Pharmacy and the Program Managers for Standards and Quality.

11

Multidisciplinary Improvement Teams – The SQCC forms and charters multidisciplinary improvement teams as needed. Membership should include leaders and staff who are closest and most aware of the process in question, and the needs associated with the patient. PI teams maybe registered in the PI Project Data Base to improve communication and integration of PI projects.

Facility Quality Committees (FQC) – The FQC is assigned responsibility for continuous review in a self-assessment perspective to determine the Quality Management System has been effectively implemented and maintained at the facility. The FQC is responsible for measurement, monitoring and analysis of NIAHO standards QM.7, SR.1 – SR.18 and other regulatory findings validating conformance through existing monitors or initiation of monitors where current conformance is unknown or not recently documented.

Members include the facility CAO, VP of Patient Care Services, Nursing Directors, Directors/Managers of Respiratory Care, Pharmacy, Rehabilitation, Surgical Services, Laboratory, Care Management, Radiology, Food Services, Housekeeping, Physical Environment, Infection Control, HIM, Guest Services, Transportation; the Program Managers from Quality and Standards or Medical Staff Quality and others based on facility specializations and additional agenda items.

The FQCs may also form and charter multidisciplinary improvement teams for issues that are specific to several departments within the facility.

Medical Staff Quality Committees – Performance improvement activities in the Medical Staff are

coordinated through the System Medical Director of Medical Staff Services. Each medical staff has a Medical Staff Quality Committee that reviews key quality of care indicators including those defined in the NIAHO standards. Activities include Peer Review, Ongoing Monitoring and Analysis. The Medical Staff is also pivotal in the implementation of ongoing professional practice evaluations and focused professional practice evaluations. All documents created by the Medical Staff Quality Committees are considered patient safety work products and are part of the Lee Memorial Health System’s patient safety evaluation system and are privileged and confidential.

Patient Care Services – The mission of the Patient Care Services division is to support the vision and

values of the Lee Memorial Health System. This is achieved by providing compassionate and comprehensive patient care that meets and seeks to exceed the highest standard for quality care for all members of our community. The Patient Care Services Vision is to become the best patient care centered health system in the State of Florida. This vision will be accomplished through recognition of nursing as a “Focus of Excellence” while supporting an environment that fosters interdisciplinary collaboration with all members of the health care team.

Through its Performance Improvement Plan, Patient Care Services provides a framework directed at improving care delivery, organizational performance and patient outcomes across all patient care settings.

This purpose is achieved through

Objective, systematic monitoring and evaluation of patient care Identification of opportunities for improved outcomes Pursuit of creativity and innovation in the provision of patient care services and by creating an

organizational culture that is committed to excellence.

Organization of Performance Improvement Within Patient Care Services The organization structure is described in further detail in the aforementioned Performance Improvement Plan: Patient Care Services, (S15 00 717).

12

Senior Nursing Leadership Council - The Senior Nursing Leadership Council serves as a forum to provide effective and coordinated leadership to decentralized nursing services across the health system. The council facilitates operational planning and performance improvement related to patient safety assuring patients with comparable needs receive the same standard of care, treatment and services throughout the system

Unit Quality Councils - PI activities at the unit level are coordinated through unit Quality Councils, or

at staff meetings with the assistance of the unit PI Representative. Unit level opportunities for improvement are identified both in the Quality Council and in unit Staff Meetings.

The Nursing Research Council – Exists to foster the spirit of inquiry around nursing practice by

providing a forum for strategic planning, guidance and oversight of nursing research and evidence based practice. They review data related to nursing practice and patient outcomes and initiates studies or changes in practice that will improve organizational performance. Members include staff Registered Nurses, Clinical Nurse Specialists, Clinical Educators, Nursing Leaders, Decision Support, IRB Liaison, Senior Nursing Leaders and local university faculty.

The Clinical Practice Council – The Council Provides a forum for planning and evaluating

performance improvement activities across the system that are related to patient care, nursing practice and the delivery of nursing services. They receive and review system-wide performance improvement reports related to patient care and nursing practice and establish priorities for performance improvement. They receive reports on significant safety events and the root cause analysis of those events. The receive reports on accreditation compliance and the results of accreditation surveys. They make recommendations to improve the outcomes of patient care and nursing practice and identify opportunities for evidence-based research related to performance improvement. They participate in the implementation of actions to improve patient care, and serves on nursing and multidisciplinary performance improvement teams. Membership includes Staff Registered Nurses representing each campus in Critical Care, Surgical Services, Emergency Services, Medicine /Surgery, Staff Registered Nurses representing Pediatrics, PICU, Oncology, Obstetrics, one Licensed Practical Nurse representing each campus, Clinical Nurse Specialists, Clinical Nurse Educators, Nursing Director and Chairperson of the Nursing Research Council, and a representative of the Clinical Education Council.

Patient Safety Organization – All patient safety work product (PSWP) within the Lee Memorial Health

System Patient Safety Evaluation System (LPSES) is collected stored, analyzed, and reported to the patient safety organization (PSO) in order to ensure and preserve the federal privilege and confidentiality protections of PSWP and maintain such PSWP in accordance with LMHS’s record retention policies and state and federal retention requirements.

VII. MEASUREMENT

Measurement of processes is essential for Performance Improvement. Both process and outcomes measures are monitored at all levels of the organization to ensure quality performance. System Strategic Goals – Each System Strategic Goal has one or more measurements that are monitored on an on-going basis to ensure that annual goals are met. The System Strategic Goal measures are incorporated into the leadership performance standards and are a factor in calculating adjustments to the leadership pay plan. The System Strategic Goals and their associated measures are displayed below:

Formatted: Indent: Left: 36 pt

Formatted: Bullets and Numbering

Deleted:

Deleted: privilege and confidentiality

13

Each of the strategic goals has been assigned to a Senior Leadership Council member who acts as champion by monitoring performance and recommending course corrections. Performance improvement teams are created to address performance issues and opportunities for improvement.

System Board Report – Administration presents a quarterly Performance Indicator report to the Board of Directors on key performance indicators. As illustrated in the first page below, these are organized in categories of Clinical Outcomes, Safety Outcomes, Effectiveness, Efficiency, Timeliness and Patient Satisfaction. Outcomes of the current quarter, prior quarter, fiscal year to date and target are presented. A star performance grid indicates better than expected ***, as expected plus or minus 5 % variance **, and worse than expected* are rates each of the indicators.

Strategic ScorecardFY 2010

P EOP LE Q UALITY SERVICE COM MUNITY FINANCE

Vacancy Rate

Total Turnover

Year 1 Turnover

RN Turnover

M ortal ity Rate –Acute

ALOS – Acute Care

M edication Errors(Level 1 1)

Surgical InfectionRate - Acute

PatientSatisfaction –

S ystem

HCAHPSLikelihood

to Recom mend

Qu ality Care

Pu blic Im age

Philanthropy

M edical StaffSatisfaction

Operating M argin

Cash/De bt Rat io

Da ys in AR

W ages % ofNet Revenue

Bond Rati ngMoody’s/S&F

Net Revenueper CM I AA

Cost per CMI AA

Strategic ScorecardFY 2010


Vacancy Rate

Total Turnover

Year 1 Turnover

RN Turnover


ALOS – Acute Care




S ystem

HCAHPSLikelihood

to Recom mend

Qu ality Care

Pu blic Im age

Philanthropy


Operating M argin

Cash/De bt Rat io

Da ys in AR




Cost per CMI AA


Vacancy Rate

Total Turnover

Year 1 Turnover

RN Turnover


ALOS – Acute Care




S ystem

HCAHPSLikelihood

to Recom mend

Qu ality Care

Pu blic Im age

Philanthropy


Operating M argin

Cash/De bt Rat io

Da ys in AR




Cost per CMI AA

14

PATIENT SAFETY WORK PRODUCT

Performance MeasuresFirst Quarter Fiscal Year 2010

KEY: Stars assigned on Current Quarter values * Worse than Expected ** As Expected +/- 5% variance *** Better than Expected

Particular attention is paid to indicators performing worse than expected. Prior to the report to the board, analysis is conducted on poor performing indictors as requested, in order to provide the board with a corrective action plan with an improvement team. All of the performance indicators are present with the trends displayed on a Statistical Process Control Chart to reduce interventions for random variations in measurements. Management Review – Any variation, deficiency or non-conformity identified by the organization is addressed by the organization. This review can be initiated at the System Quality and Conformance Committee or the Senior Nursing Leadership Council. Appropriate corrective or preventative action plans will be determined, applied and documented. This documentation is part of the Management Review and will be performed at regular intervals at the System Quality Safety Management Council and at a minimum of once annually.

Unit Level Indicators – At the nursing unit level, key indicators are measured and tracked, such as falls, use of restraints, decubitis ulcers, and nosocomial infections. The Unit Quality Council reviews these, and opportunities for improvement are identified. Teams or work groups may be formed to study the issues and make recommendations for improvement. Department Level Indicators - Each department on the LMHS’ Process Sequence and Interaction Map has developed a performance improvement measure. On a quarterly basis data, the departmental performance improvement is evaluated by the System Quality and Conformance Committee where any nonconformities are reported to the System Quality Safety Management Council.

15

VIII. Performance Improvement Methodologies

The model for Performance Improvement at the Lee Memorial Health System is the PDCA Cycle. Plan – Identify the problem, analyzed the problem, diagnose the cause and develop potential solutions Do – Implement the changes Check – Measure the effectiveness of the changes Act – Take further action for improvement, as necessary. If the change was successful, incorporate

findings on a wider scale. If not successful, begin again with Planning. In the complex world of healthcare process improvement, experience has taught that “one size does not fit all.” Lee Memorial Health System has adopted several different approaches to quality improvement, all built around the Performance Improvement Mindset model shown below.

Plan-Do-Check-Act Cycle

2. We implement the plan. As we implement, we measure & evaluate process performance.

Plan

DoCheck

Act

1. We design the project, setting goals and expectations, and deciding what steps we have to do.

3. We reflect on our outcomes, & compare to our expectations. Were our assumptions correct? What did we learn?

4. What further action is necessary? Accept & standardize changes? Abandon? Consider further changes? Begin again with Plan.

Related Policies: S09 06 134 Confidentiality M10 10 719 Physician Profile Data Confidentiality References: National Integrated Accreditation for Healthcare Organization Standards QM.3 ISO 9001 American National Standard Quality Management System Requirements 4.2.2

16

Appendix A: ISO 9001 Interaction Matrix An ISO / Process Interaction Matrix identify the interaction of processes with the ISO9001 procedures. This diagram is considered when planning internal audits to ensure that process auditing is properly planned.

Process Category Step 1&2

Step 3 Step 4 S‐1 S‐2 S‐3 S‐4 S‐5 QP

S‐6 S‐7 S‐8 S‐9 B1 B2 QP

B3 QP

B4 QP

B5 B6 B7 QP2

ISO Clause

CLAUSE DESCRIPTION

Entry Process

Clinical Serv

ices

Di

schar g

e Process

Patient Focus

Diagnostic

Supply Chain

Facilities Support

Treatment

Hum

an Resources

Contracted Serv

ices

Nursing

Calibration

Scorecards

Preventive action

Corrective Action

Internal Surveys

Managem

ent Com

mittee

Governing Bo

ard

Quality Managem

ent System

4.1 General Requirements M

4.2 Documentation Req. X X X X X X X X X X X X X X X X X X M

5.1 Management Commitment M X X

5.2 Patient Focus M X X

5.3 Quality Policy X X X X X X M

5.4 Planning X M

5.5 Responsibility, Authority & Communication

M X

5.6 Management Review X X X X M X X

6.1 Provision of Resources X M X

6.2 Human Resources X X X X X X X X M X X X X X X X X X

6.3 Infrastructure X X X X X X M X X X X X X

6.4 Work Environment M

7.1 Planning of Service Realization

X X X X X X X M X X

7.2 Patient‐Related Processes M X X X X X

7.3 Design & Development

7.4 Purchasing X M X

7.5 Production & Service Provision

M X X

7.6 Control, Analysis & Improvement

X M

8.1 Measurement, Analysis & Improvement

M X X

8.2 Monitoring & Measurement X X X X X X X X X X M M X X X

8.3 Control of Non‐Conforming Product

X X X M X

8.4 Analysis of Data X M X X

17

8.5 Improvement X X X X X X X X X X X X X M M X X M X

M = Main Responsibility X = Some Interaction with the Process or Requirement Appendix B: NIAHO Interaction Matrix A NIAHO / Process Interaction Matrix identifies the interaction of processes with the applicable Conditions of Participation. This matrix identifies which processes fulfill the NIAHO requirements.

Process Category Step 1&2

Step 3

Step 4 S‐1 S‐2 S‐3 S‐4

S‐5 QP S‐6 S‐7 S‐8 S‐9 B1

B2 QP

B3 QP

B4 QP B5 B6

B7 QP2

NIAHO IDEN

TIFIER

NIAHO REQUIREMENT

Entry Process

Clinical Serv

ices

Disch

arge Process

Patient Focus

Diagnostic

Supply Chain

Facilities Support

Treatment

Hum

an Resources

Contracted Serv

ices

Nursing

Calibration

Scorecards

Preventive action

Corrective Action

Internal Surveys

Managem

ent Com

mittee

Governing Bo

ard

Quality Managem

ent System

QM Quality Management X X X X X X X X X X X X X X X X X X M

GB Governing Body X X X M X

CE Chief Executive Officer X X M X

MS Medical Staff M X X X X

NS Nursing Services X X X X X X X M S

SM Staffing Management X M X X X MM Medication Management X X X X X M X X

SS Surgical Services M X X X X X X X X X

AS Anesthesia Services X X X X M X X X

LS Laboratory Services X M X X X X X X X X

RC Respiratory Care Services X X X M X X X

MI Medical Imaging X X M X X X

NM Nuclear Medicine Services X M X X X

RS Rehabilitation Services X X X M X X

OB Obstetrical Services M X X X X X

ED Emergency Department X M X X X X X X X X X

OS Outpatient Services X X X X X M X X X

DS Dietary Services X M X X X X

PR Patient Rights M X X X X X

IC Infection Control X X X X X M X X X X X X

MR Medical Records X X X X X M M

DC Discharge Planning X X M X X

UR Utilization Review X X M X X X X

PE Physical Environment X X M X X X X X

TO Organ, Eye and Tissue Procur. X M X X X X

18

M = Main Responsibility X = Some Interaction with the Process or Requirement

19

Appendix C: LMHS Process Sequence Interaction Map

7.2.1 (b) & 7.2.2 Input – Patient w/Doctor Order

(If not specified applies to all locations)

OP Clinics: - Family Practice Direct Admit Transfer Patients

7.2.1 (c) - Scheduled Entry

Register complete Demographics (PR.1, PR.2, PR.3, PR.5)

7.2.1 (c) - Pre Admission Nursing Assessment

7.2.1 Un-Scheduled Entry

Check-in ED/OB Triage

7.2.1 (a, d) 7.2.2, 7.5.1 & 7.5.5

Emergency Department

7.2.1 (a, d) 7.2.2, 7.5.1 & 7.5.5

Clinical Services & Nursing Surgical Services OB: (Cape, GC, HP) ICU/PCU Internal Medicine Med/Surg Allergy/Immunology Ambulatory Services Oncology Cath Lab/EP: (Cape, GC, HP) Neurosurgery Gen/Vas Surgery Cardiology Pulmonary Endoscopy Senior Behavioral Health (LMH) Neurology Orthopedics Rheumatology Renal Transplant: (GC) Pediatrics: (Cape, HP) NICU/PICU: (HP) Special Care Nursery: (Cape, HP) Pediatric Oncology: (HP) Primary Stroke: (GC, LMH) Sub Acute Nursing Facility

7.4.1 – Contracted Treatment Services

Dialysis Radiation Oncology Organ Procurement Behavioral Health

MAIN

7.2.1 (a) & 8.2.1 Patient Discharge

Home w/o Services Home w/Services Home w/OP Services Assisted Living Long Term Care Acute Rehab Tertiary Care Facility The Rehab Hospital

7.2.1 (b) & 7.2.2 © Input – Patient w/o Doctor

Order

ED

5.2 – Patient Focus Spiritual Services Language Services Dietary Utilization Review Customer Service

7.2.1 (b) Diagnostic Imaging Laboratory (S-9) Neurodiagnostics Cardiovascular

6.1, 7.4.1, 7.6.1 & 8.3

Supply Chain Ordering Supplier Develop Product Receipt Donor Centers

6.1, 6.3 & 6.4 Facility Support

Utilities/Bio Medical Central Sterilization Security & Safety Housekeeping Infection Control Information Technology Linen Services HIM

7.5.2 & 8.3 TreatmentPharmacy Occupational, Physical

and Speech Therapy Respiratory, Asthma

Management and Pulmonary Rehab

Wound Care Cardiac Rehab IV Infusion Sleep Lab Breast Center Spine Center Pain Center Palliative Care

6.2.2 – Human Resources Orientation Annual Evaluation 6.2.2 Education DepartmentContinuing Education Competency Evaluation

6.2.2 Credentialing & Privileging

Credentials Committee

6.1 & 7.4.1 - Contracted Staff

Radiologists Pathologists Hospitalists Anesthesia Providers ED Physicians

7.4.1 Contracted Support

Services LeeSar/CSF

SUPPORT PROCESSES

8.2.3 Objective Framework Scorecard Clinical Outcomes Safety Outcomes Effectiveness Efficiency Timeliness Patient Satisfaction

8.5.2 HVA & FMEA 8.5.3 Risk Mgmt. &

Serious and Precursor Safety

Events

8.2.2 Tracers/ EOC / IC / Rx Rounds / Gap

Analysis

5.6 Quality Safety, Management

Council

(See Attached Committee Structure)

NIAHO-CMS CoPs

5.4.1 & 8.5.1 – Governing Board

(B-6)

4.1 Quality Management System (B-7)

Document Control Record Control Quality Manual

BUSINESS PROCESSES 1/11

7.1 & 7.2.1 (a) 7.5.1 (e) & 8.2.4. Nursing

8.5.1, 8.5.2, 8.5.3, 8.2.2, 4.2.3

Management Analysis Risk Management Infection Control Accreditation Clinical Outcomes Performance Improvement Compliance Facility Engineering

Lee Memorial Health System Operating Highlights

For the month ended January 31, 2011 Actual adjusted admits (overall inpatient & outpatient volume indicator) for the month ended January 31, 2011 are 10,776 which is 2.6% greater than budget. Actual inpatient admits for the month are 7,020 or 4.5% greater than budget and actual patient days are 37,611 or 7.3% greater than budget which resulted in a 5.4 day length of stay. Emergency room visits are 8.9% greater than budget while outpatient surgeries are 8.2% greater than budget. Net patient revenue for January 2011 reflects a $2.9 million or a 2.9% favorable variance to budget. This favorable variance in net patient revenue is primarily the result of the 2.6% increase in adjusted admits along with a slight increase in payor reimbursement during the month. Total operating expenses before depreciation and interest expense are $3.3 million greater than budget. All operating expense categories except fringe benefits and other services reflect unfavorable variances. Salaries & Wages have a $1.6 million unfavorable variance due to the increased volumes and the merit/market adjustments that occur in January. Purchased services have a $1.4 million unfavorable variance due to physician stipends and facility repairs. Actual total operating costs per case mix adjusted admit is 1.4% less than budget (6,611 act, 6,701 budget). Productivity as measured by FTEs/AOB increased by 2.3% (4.82 actual, 4.94 budget) for the four months ended January 31, 2011. For January 2011, the gain from operations is $2.3 million versus a budgeted gain of $2.9 million. Excess revenue over expenses is a gain of $7.5 million versus a budgeted gain of $5.8 million. Investments were budgeted to return $2.9 million for the month but the actual investment return was $5.2 million. For the month, Cash & Investments increased by $21.9 million to $506.0 million. Operations increased cash by $12.2 million while working capital increased cash by $24.6 million. Cash was reduced by $3.9 million for routine equipment. Days in Accounts Receivable are 56.2 days and resulted in a $10.9 million decrease in cash. Total Notes & Bonds payable on January 31, 2011 is $701.0 million resulting in a Cash to Debt ratio of 72.2%. Net Patient Revenue per adjusted admit CMI for the month ended January 31, 2011 is $6,773 while the Operating Expense per adjusted admit CMI is $6,611. The difference which represents the gain from operations per adjusted admit is $162.00 while the budgeted gain from operations is $202.00. Wages & Benefits as a percent of Net Operating Revenue is 52.7% for January 2011 versus a budget of 53.1%. The actual hourly pay rate is $32.18 which is $1.35 greater than budget due to merit/market adjustments. YTD, the average hourly rate is $29.52 which is 34 cents greater than budget. Post Acute entities provided the following YTD contributions to Acute Care by allowing charity care patients into their respective programs: Lee Memorial Home Health $226,000; HealthPark Care Center $135,000; The Rehabilitation Hospital $97,000; Access Medical South (DME joint venture) $53,000. The Lee Physician Group YTD loss per physician is $9,991. This includes practice revenue and expenses along with ancillary revenue referred to LMHS. This YTD loss is $26,959 per physician less than budget due to lower operating cost and better collections per visit than budget.

LEE MEMORIAL HEALTH SYSTEMCONSOLIDATED EXECUTIVE SUMMARYFOR THE PERIOD ENDING JANUARY 31, 2011

Current period Year-to-DateBudget Actual Prior Year Var % Budget Actual Prior Year Var %

ACT TO BUD ACT TO BUDInpatient Volumes: Admits - Adults & Peds 6,718 7,020 6,469 4.5% 24,757 26,224 24,107 5.9% Patient Days - Adults & Peds 35,064 37,611 34,366 7.3% 128,418 136,716 126,650 6.5%

Length of Stay (LOS) 5.2 5.4 5.3 3.8% 5.2 5.2 5.3 0.0%

Inpatient Surgeries 1,717 1,885 1,733 9.8% 6,612 6,838 6,673 3.4%

Outpatient Volumes: Emergency Room Visits 13,746 14,967 13,325 8.9% 55,649 55,663 53,923 0.0% OutPatient Surgeries 1,492 1,614 1,596 8.2% 5,825 6,275 6,390 7.7%

Adjusted Admits 10,501 10,776 10,060 2.6% 39,304 40,978 38,483 4.3% (overall in/outpat volume indicator)

Operating Ratios: Net Revenue/Adj Adm CMI 6,903 6,773 6,319 -1.9% 6,890 6,799 6,565 -1.3% Operating Exp/Adj Adm CMI 6,701 6,611 6,160 1.4% 6,717 6,604 6,384 1.7%

Wages/Ben - % of Net Oper Rev 53.1% 52.7% 54.6% 0.8% 52.1% 51.7% 51.5% 0.8% Supplies as a % of Net Oper Rev 20.9% 20.8% 21.7% 0.3% 20.8% 20.8% 21.6% -0.2%

Charity/Bad Debt - % of Gross Rev 6.9% 6.4% 6.4% 8.4% 6.9% 6.8% 6.6% 1.6% FTEs/AOB 4.76 4.48 4.45 6.2% 4.94 4.82 4.74 2.5%

Financial Ratios: Operating Margin (%) 2.9% 2.4% 2.5% -17.9% 2.5% 2.9% 2.8% 14.1% Excess Margin (%) 5.8% 6.3% -0.2% 9.8% 5.5% 1.4% 5.0% -74.9%

Liquidity Ratios: Cash to Debt (%) 83.7% 72.2% 64.6% Days Cash on Hand (net of VRDB) 138.5 129.9 80.0 Days In Acct Receivable 60.0 56.2 54.7

Income Statement Summary (In Thousands):Total Net Operating Revenue 100,760$ 103,647$ 90,268$ 2.9% 376,436$ 387,278$ 353,702$ 2.9%Total Operating Expenses 97,879 101,352 87,992 -3.4% 367,246 376,751 343,956 -2.5% Consolidated Gain(Loss) from Oper 2,881 2,296 2,276 20.3% $9,190 10,526 $9,746 -14.5%

Investment Earnings/Non Op Income 2,874 5,164 (2,455) 79.7% 11,296 (2,821) 8,044 -125.0%

Consolidated Excess Rev over Exp 5,755$ 7,460$ (179)$ 29.6% 20,486$ 7,705$ 17,790$ -62.4%

Trauma District Gain(Loss) from Oper (517)$ (456)$ (507)$ 11.8% (1,475)$ (1,773)$ (1,380)$ -20.2%

Balance Sheet Highlights (In Thousands): Cash & Investments 526,649$ 506,012$ 440,772$ Bonds & Notes Payable 650,660$ 700,967$ 682,268$

VRDB = variable rate demand bondsCMI = case mix index

Page 1

LEE MEMORIAL HEALTH SYSTEMCONSOLIDATED STATISTICAL SUMMARYFOR THE PERIOD ENDING JANUARY 31, 2011

Current period Year-to-DateBudget Actual Prior Year Variance Var % Budget Actual Prior Year Variance Var %

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

Admissions ADULTS 6,136 6,383 5,903 247 4.0% 22,396 23,773 21,755 1,377 6.1% PEDIATRICS 366 414 363 48 13.1% 1,525 1,649 1,513 124 8.1% NICU 48 53 41 5 9.9% 207 218 226 11 5.5% POST ACUTE 168 170 162 2 1.2% 630 584 613 (46) -7.3%Total Adult & Peds 6,718 7,020 6,469 302 4.5% 24,757 26,224 24,107 1,467 5.9% NEWBORNS 512 489 474 (23) -4.5% 2,186 2,040 2,064 (146) -6.7%Total Admissions 7,231 7,509 6,943 278 3.8% 26,943 28,264 26,171 1,321 4.9%

Patient Days ADULTS 28,171 30,668 27,726 2,497 8.9% 100,722 108,975 99,726 8,253 8.2% PEDIATRICS 1,302 1,354 1,091 52 4.0% 5,461 5,221 4,951 (240) -4.4% NICU 1,084 1,191 1,108 107 9.8% 4,684 5,314 5,062 630 13.5% POST ACUTE 4,507 4,398 4,441 (109) -2.4% 17,552 17,206 16,911 (346) -2.0%Total Adult & Peds 35,064 37,611 34,366 2,547 7.3% 128,418 136,716 126,650 8,298 6.5% NEWBORNS 1,181 1,249 1,168 68 5.8% 5,003 5,097 5,025 94 1.9%Total Patient Days 36,245 38,860 35,534 2,615 7.2% 133,421 141,813 131,675 8,392 6.3%

Average Length of Stay ADULTS 4.6 4.8 4.7 0.2 4.7% 4.5 4.6 4.6 0.1 1.9% PEDIATRICS 3.6 3.3 3.0 (0.3) -8.1% 3.6 3.2 3.3 (0.4) -11.6% NICU 22.5 22.5 27.0 (0.0) 0.0% 22.7 24.4 22.4 1.7 7.6% POST ACUTE 26.8 25.9 27.4 (1.0) -3.6% 27.9 29.5 27.6 1.6 5.8%Total Adult & Peds 5.2 5.4 5.3 0.1 2.7% 5.2 5.2 5.3 0.0 0.5% NEWBORNS 2.3 2.6 2.5 0.2 10.8% 2.3 2.5 2.4 0.2 9.2%Total Patient Days 5.0 5.2 5.1 0.2 3.2% 5.0 5.0 5.0 0.1 1.3%

OP Registrations EMERGENCY ROOM 13,746 14,967 13,325 1,221 8.9% 55,649 55,663 53,923 14 0.0% OP SURGERY CASES 1,492 1,614 1,596 122 8.2% 5,825 6,275 6,390 450 7.7%SUBTOTAL 15,238 16,581 14,921 1,343 8.8% 61,474 61,938 60,313 464 0.8%

Visits / Encounters HOME HEALTH ADMISSIONS 333 356 280 23 6.8% 1,271 1,372 1,082 101 7.9% HOSP BASED PHY ENCOUNTERS 14,857 15,912 13,821 1,055 7.1% 60,752 64,209 57,634 3,457 5.7% PHYSICIAN ENCOUNTERS 45,878 52,376 40,769 6,498 14.2% 179,336 191,277 160,249 11,941 6.7% TRAUMA SERVICES DISTRICT 684 784 664 100 14.6% 2,668 2,702 2,598 34 1.3%SUBTOTAL 61,753 69,428 55,534 7,675 12.4% 244,027 259,560 221,563 15,533 6.4%

TOTAL OP 76,991 86,009 70,455 9,018 11.7% 305,501 321,498 281,876 15,997 5.2%

Page A.3

LEE MEMORIAL HEALTH SYSTEMCONSOLIDATED STATEMENT OF OPERATIONSFOR THE PERIOD ENDING: JANUARY 31, 2011( IN THOUSANDS )

BUDGET ACTUAL PRIOR YEAR VAR VAR % VAR % BUDGET ACTUAL PRIOR YEAR VAR VAR % VAR %ACT TO BUD ACT TO BUD PR YR ACT TO BUD ACT TO BUD PR YR

INPATIENT REVENUE 233,896 248,986 215,341 15,090 6.5% 15.6% 864,023 914,774 803,300 50,750 5.9% 13.9%OUTPATIENT REVENUE 131,695 133,230 119,533 1,535 1.2% 11.5% 507,656 514,652 479,049 6,996 1.4% 7.4%TOTAL PATIENT REVENUE 365,592 382,216 334,874 16,625 4.5% 14.1% 1,371,679 1,429,426 1,282,349 57,746 4.2% 11.5%

DED FROM REV-MEDICARE 147,851 149,476 136,498 (1,626) -1.1% -9.5% 512,462 528,015 468,735 (15,552) -3.0% -12.6%DED FROM REV-MEDICAID 36,291 38,914 29,966 (2,622) -7.2% -29.9% 149,674 149,616 137,901 59 0.0% -8.5%DED FROM REV-CHARITY 12,029 11,069 10,206 960 8.0% -8.5% 45,111 46,206 40,532 (1,095) -2.4% -14.0%DED FROM REV-HMO/PPO 30,103 30,704 31,760 (601) -2.0% 3.3% 120,816 130,759 130,136 (9,943) -8.2% -0.5%DED FROM REV-OTHER 27,029 36,926 26,359 (9,897) -36.6% -40.1% 123,755 142,603 112,380 (18,847) -15.2% -26.9%DED FROM REV-BAD DEBT 13,145 13,219 11,149 (74) -0.6% -18.6% 49,766 51,126 44,381 (1,361) -2.7% -15.2%TOTAL DED FROM REV 266,449 280,308 245,938 (13,860) -5.2% -14.0% 1,001,584 1,048,325 934,065 (46,741) -4.7% -12.2%

NET PATIENT REVENUE 99,143 101,908 88,936 2,765 2.8% 14.6% 370,095 381,101 348,284 11,006 3.0% 9.4%OTHER OPER REV 1,617 1,739 1,332 122 7.5% 30.5% 6,341 6,177 5,418 (164) -2.6% 14.0%

TOTAL OPERATING REV 100,760 103,647 90,268 2,887 2.9% 14.8% 376,436 387,278 353,702 10,842 2.9% 9.5%

OPERATING EXPENSES PROD SALARIES 36,620 39,206 34,354 (2,586) -7.1% -14.1% 141,768 148,242 132,897 (6,475) -4.6% -11.5% PROD OVERTIME 2,313 1,545 1,225 768 33.2% -26.1% 5,801 6,032 4,962 (231) -4.0% -21.6% CONTRACT LABOR 664 319 386 345 51.9% 17.3% 711 474 550 237 33.3% 13.8% NON-PROD SALARIES 6,337 6,478 5,478 (141) -2.2% -18.3% 19,474 18,841 17,188 633 3.3% -9.6%TOTAL SALARIES & WAGES 45,934 47,548 41,442 (1,614) -3.5% -14.7% 167,753 173,589 155,597 (5,836) -3.5% -11.6%

FRINGE BENEFITS 7,570 7,077 7,818 493 6.5% 9.5% 28,374 26,631 26,595 1,743 6.1% -0.1%HEALTH CARE ACCESS 1,219 1,413 1,200 (194) -15.9% -17.8% 4,523 4,826 4,768 (303) -6.7% -1.2%SUPPLIES 21,068 21,597 19,608 (529) -2.5% -10.1% 78,310 80,744 76,506 (2,434) -3.1% -5.5%OTHER SERVICES 5,395 5,370 4,309 25 0.5% -24.6% 21,755 22,013 20,190 (257) -1.2% -9.0%PURCHASED SERVICES 9,219 10,627 7,307 (1,408) -15.3% -45.4% 37,004 37,963 33,838 (959) -2.6% -12.2%

TOTAL OPER EXPENSES 90,404 93,633 81,684 (3,229) -3.6% -14.6% 337,719 345,765 317,495 (8,046) -2.4% -8.9%

EBITDA 10,356 10,014 8,584 (342) -3.3% 16.7% 38,717 41,513 36,207 2,795 7.2% 14.7%

DEPRECIATION/AMORT 5,165 5,443 4,336 (278) -5.4% -25.5% 20,312 21,173 17,220 (861) -4.2% -23.0%INTEREST EXPENSE 2,310 2,275 1,971 35 1.5% -15.4% 9,215 9,813 9,241 (598) -6.5% -6.2%GAIN(LOSS) FROM OPER 2,881 2,296 2,276 (585) -20.3% 0.9% 9,190 10,526 9,746 1,337 14.5% 8.0%

CURRENT MONTH YEAR TO DATE

Page A.4

Lee Memorial Health SystemConsolidated Balance Sheet

As of JANUARY 31, 2011 in Thousands (000's)

ASSETS: Current Prior Month Prior Year LIABILITIES: Current Prior Month Prior Year

Current Assets: Current Liabilities:Cash And Cash Equivalents * 16,483 7,065 16,087 Accounts Payable 36,595 25,209 34,520Operating Fund Investments * 461,595 449,864 432,318 Wages and Benefits Payable 42,658 36,766 31,795Accrued Interest Receivable 353 336 371 Notes Payable - Short Term 6,680 6,889 4,349Accounts Receivable (net) 172,163 161,046 141,351 Current Portion Bonds Payable 10,350 10,350 14,871Accounts Receivable - Phys (Net) 7,260 7,495 10,626 Due to State of Florida 11,569 11,227 13,312Inventories 29,116 29,099 29,117 Malpractice Liability - Short Term 5,936 5,936 5,936Third Party Settlements 0 0 0 Accrued Bond Costs 7,610 5,913 12,282Other Current Assets 12,421 9,537 11,599 Due to LMHS 0 0 0

Other Current Liabilities 38,251 30,863 32,151

Total Current Assets: 699,390 664,443 641,468 Total Current Liabilities 159,649 133,153 149,216

Other Assets Other Liabilities and Fund BalanceLimited or Restricted Use Assets * 6,709 6,708 17,675 Benefits Payable - Long Term 0 0 0Bond Issuance Costs 5,247 5,277 5,685 Notes Payable - Long Term 156,548 156,709 104,040Trustee Held Funds * 0 0 0 Due to State of Florida - Long Term 6,894 5,856 3,494Directors/Officers Indemnity Fund * 100 100 100 Malpractice Liability - Long Term 9,842 9,642 9,242Long Term Operating Fund Investments * 21,126 20,304 20,304 Bonds Payable 527,389 527,352 553,410Other Assets 99,280 98,854 100,082 Other Long Term Liabilities 45,192 44,688 39,054

UnRestricted Fund Balance 601,728 595,019 596,992Restricted Fund Balance 25,807 25,057 22,838

Total Other Assets 132,462 131,243 143,846 Total Other Liabilities & Fund Balance 1,373,401 1,364,324 1,329,070

Property and Equipment:Plant In Use 1,222,991 1,221,283 1,203,696Construction in Process 28,193 29,221 26,866Accumulated Depreciation (571,220) (569,344) (555,419)

Total Property & Equipment (Net) 679,965 681,160 675,142

Restricted Assets 21,233 20,631 17,829

TOTAL ASSETS 1,533,050 1,497,477 1,478,286 TOTAL LIABILITIES AND EQUITY 1,533,050 1,497,477 1,478,286

* Cash and InvestmentsAbove Balance Sheet has been adjusted to eliminate intercompany receivables, payables and investments in subsidiaries

Page A.7


LEE COUNTY, FLORIDA CONSOLIDATED FINANCIAL STATEMENTS AND STATISTICAL REPORTS

JANUARY 31, 2011

LEE MEMORIAL HEALTH SYSTEM CONSOLIDATED FINANCIAL STATEMENTS & STATISTICAL REPORTS TABLE OF CONTENTS SECTION A PAGE CONSOLIDATED SCHEDULES HIGHLIGHTS A.1 CONSOLIDATED STATISTICAL REPORT A.3 CONSOLIDATED INCOME STATEMENT A.4 SOURCES & APPLICATIONS OF FUNDS A.6 CONSOLIDATED BALANCE SHEET A.7 CONSOLIDATED FINANCIAL RATIOS A.8 CONSOLIDATED PAYOR MIX A.10 CAPITAL STATUS REPORT A.11 INVESTMENT PERFORMANCE SUMMARY A.12


For the month ended January 31, 2011 Actual adjusted admits (overall inpatient & outpatient volume indicator) for the month ended January 31, 2011 are 10,776 which is 2.6% greater than budget. Actual inpatient admits for the month are 7,020 or 4.5% greater than budget and actual patient days are 37,611 or 7.3% greater than budget which resulted in a 5.4 day length of stay. Emergency room visits are 8.9% greater than budget while outpatient surgeries are 8.2% greater than budget. Net patient revenue for January 2011 reflects a $2.9 million or a 2.9% favorable variance to budget. This favorable variance in net patient revenue is primarily the result of the 2.6% increase in adjusted admits along with a slight increase in payor reimbursement during the month. Total operating expenses before depreciation and interest expense are $3.3 million greater than budget. All operating expense categories except fringe benefits and other services reflect unfavorable variances. Salaries & Wages have a $1.6 million unfavorable variance due to the increased volumes and the merit/market adjustments that occur in January. Purchased services have a $1.4 million unfavorable variance due to physician stipends and facility repairs. Actual total operating costs per case mix adjusted admit is 1.4% less than budget (6,611 act, 6,701 budget). Productivity as measured by FTEs/AOB increased by 2.3% (4.82 actual, 4.94 budget) for the four months ended January 31, 2011. For January 2011, the gain from operations is $2.3 million versus a budgeted gain of $2.9 million. Excess revenue over expenses is a gain of $7.5 million versus a budgeted gain of $5.8 million. Investments were budgeted to return $2.9 million for the month but the actual investment return was $5.2 million.

Page A.1


For the month ended January 31, 2011 For the month, Cash & Investments increased by $21.9 million to $506.0 million. Operations increased cash by $12.2 million while working capital increased cash by $24.6 million. Cash was reduced by $3.9 million for routine equipment. Days in Accounts Receivable are 56.2 days and resulted in a $10.9 million decrease in cash. Total Notes & Bonds payable on January 31, 2011 is $701.0 million resulting in a Cash to Debt ratio of 72.2%. Net Patient Revenue per adjusted admit CMI for the month ended January 31, 2011 is $6,773 while the Operating Expense per adjusted admit CMI is $6,611. The difference which represents the gain from operations per adjusted admit is $162.00 while the budgeted gain from operations is $202.00. Wages & Benefits as a percent of Net Operating Revenue is 52.7% for January 2011 versus a budget of 53.1%. The actual hourly pay rate is $32.18 which is $1.35 greater than budget due to merit/market adjustments. YTD, the average hourly rate is $29.52 which is 34 cents greater than budget. Post Acute entities provided the following YTD contributions to Acute Care by allowing charity care patients into their respective programs: Lee Memorial Home Health $226,000; HealthPark Care Center $135,000; The Rehabilitation Hospital $97,000; Access Medical South (DME joint venture) $53,000. The Lee Physician Group YTD loss per physician is $9,991. This includes practice revenue and expenses along with ancillary revenue referred to LMHS. This YTD loss is $26,959 per physician less than budget due to lower operating cost and better collections per visit than budget.

Page A.2

LEE MEMORIAL HEALTH SYSTEMCONSOLIDATED STATISTICAL SUMMARYFOR THE PERIOD ENDING JANUARY 31, 2011

Current period Year-to-DateBudget Actual Prior Year Variance Var % Budget Actual Prior Year Variance Var %

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

Admissions ADULTS 6,136 6,383 5,903 247 4.0% 22,396 23,773 21,755 1,377 6.1% PEDIATRICS 366 414 363 48 13.1% 1,525 1,649 1,513 124 8.1% NICU 48 53 41 5 9.9% 207 218 226 11 5.5% POST ACUTE 168 170 162 2 1.2% 630 584 613 (46) -7.3%Total Adult & Peds 6,718 7,020 6,469 302 4.5% 24,757 26,224 24,107 1,467 5.9% NEWBORNS 512 489 474 (23) -4.5% 2,186 2,040 2,064 (146) -6.7%Total Admissions 7,231 7,509 6,943 278 3.8% 26,943 28,264 26,171 1,321 4.9%

Patient Days ADULTS 28,171 30,668 27,726 2,497 8.9% 100,722 108,975 99,726 8,253 8.2% PEDIATRICS 1,302 1,354 1,091 52 4.0% 5,461 5,221 4,951 (240) -4.4% NICU 1,084 1,191 1,108 107 9.8% 4,684 5,314 5,062 630 13.5% POST ACUTE 4,507 4,398 4,441 (109) -2.4% 17,552 17,206 16,911 (346) -2.0%Total Adult & Peds 35,064 37,611 34,366 2,547 7.3% 128,418 136,716 126,650 8,298 6.5% NEWBORNS 1,181 1,249 1,168 68 5.8% 5,003 5,097 5,025 94 1.9%Total Patient Days 36,245 38,860 35,534 2,615 7.2% 133,421 141,813 131,675 8,392 6.3%

Average Length of Stay ADULTS 4.6 4.8 4.7 0.2 4.7% 4.5 4.6 4.6 0.1 1.9% PEDIATRICS 3.6 3.3 3.0 (0.3) -8.1% 3.6 3.2 3.3 (0.4) -11.6% NICU 22.5 22.5 27.0 (0.0) 0.0% 22.7 24.4 22.4 1.7 7.6% POST ACUTE 26.8 25.9 27.4 (1.0) -3.6% 27.9 29.5 27.6 1.6 5.8%Total Adult & Peds 5.2 5.4 5.3 0.1 2.7% 5.2 5.2 5.3 0.0 0.5% NEWBORNS 2.3 2.6 2.5 0.2 10.8% 2.3 2.5 2.4 0.2 9.2%Total Patient Days 5.0 5.2 5.1 0.2 3.2% 5.0 5.0 5.0 0.1 1.3%

OP Registrations EMERGENCY ROOM 13,746 14,967 13,325 1,221 8.9% 55,649 55,663 53,923 14 0.0% OP SURGERY CASES 1,492 1,614 1,596 122 8.2% 5,825 6,275 6,390 450 7.7%SUBTOTAL 15,238 16,581 14,921 1,343 8.8% 61,474 61,938 60,313 464 0.8%

Visits / Encounters HOME HEALTH ADMISSIONS 333 356 280 23 6.8% 1,271 1,372 1,082 101 7.9% HOSP BASED PHY ENCOUNTERS 14,857 15,912 13,821 1,055 7.1% 60,752 64,209 57,634 3,457 5.7% PHYSICIAN ENCOUNTERS 45,878 52,376 40,769 6,498 14.2% 179,336 191,277 160,249 11,941 6.7% TRAUMA SERVICES DISTRICT 684 784 664 100 14.6% 2,668 2,702 2,598 34 1.3%SUBTOTAL 61,753 69,428 55,534 7,675 12.4% 244,027 259,560 221,563 15,533 6.4%

TOTAL OP 76,991 86,009 70,455 9,018 11.7% 305,501 321,498 281,876 15,997 5.2%

Page A.3

LEE MEMORIAL HEALTH SYSTEMCONSOLIDATED STATEMENT OF OPERATIONSFOR THE PERIOD ENDING: JANUARY 31, 2011( IN THOUSANDS )

BUDGET ACTUAL PRIOR YEAR VAR VAR % VAR % BUDGET ACTUAL PRIOR YEAR VAR VAR % VAR %ACT TO BUD ACT TO BUD PR YR ACT TO BUD ACT TO BUD PR YR

INPATIENT REVENUE 233,896 248,986 215,341 15,090 6.5% 15.6% 864,023 914,774 803,300 50,750 5.9% 13.9%OUTPATIENT REVENUE 131,695 133,230 119,533 1,535 1.2% 11.5% 507,656 514,652 479,049 6,996 1.4% 7.4%TOTAL PATIENT REVENUE 365,592 382,216 334,874 16,625 4.5% 14.1% 1,371,679 1,429,426 1,282,349 57,746 4.2% 11.5%

DED FROM REV-MEDICARE 147,851 149,476 136,498 (1,626) -1.1% -9.5% 512,462 528,015 468,735 (15,552) -3.0% -12.6%DED FROM REV-MEDICAID 36,291 38,914 29,966 (2,622) -7.2% -29.9% 149,674 149,616 137,901 59 0.0% -8.5%DED FROM REV-CHARITY 12,029 11,069 10,206 960 8.0% -8.5% 45,111 46,206 40,532 (1,095) -2.4% -14.0%DED FROM REV-HMO/PPO 30,103 30,704 31,760 (601) -2.0% 3.3% 120,816 130,759 130,136 (9,943) -8.2% -0.5%DED FROM REV-OTHER 27,029 36,926 26,359 (9,897) -36.6% -40.1% 123,755 142,603 112,380 (18,847) -15.2% -26.9%DED FROM REV-BAD DEBT 13,145 13,219 11,149 (74) -0.6% -18.6% 49,766 51,126 44,381 (1,361) -2.7% -15.2%TOTAL DED FROM REV 266,449 280,308 245,938 (13,860) -5.2% -14.0% 1,001,584 1,048,325 934,065 (46,741) -4.7% -12.2%

NET PATIENT REVENUE 99,143 101,908 88,936 2,765 2.8% 14.6% 370,095 381,101 348,284 11,006 3.0% 9.4%OTHER OPER REV 1,617 1,739 1,332 122 7.5% 30.5% 6,341 6,177 5,418 (164) -2.6% 14.0%

TOTAL OPERATING REV 100,760 103,647 90,268 2,887 2.9% 14.8% 376,436 387,278 353,702 10,842 2.9% 9.5%

OPERATING EXPENSES PROD SALARIES 36,620 39,206 34,354 (2,586) -7.1% -14.1% 141,768 148,242 132,897 (6,475) -4.6% -11.5% PROD OVERTIME 2,313 1,545 1,225 768 33.2% -26.1% 5,801 6,032 4,962 (231) -4.0% -21.6% CONTRACT LABOR 664 319 386 345 51.9% 17.3% 711 474 550 237 33.3% 13.8% NON-PROD SALARIES 6,337 6,478 5,478 (141) -2.2% -18.3% 19,474 18,841 17,188 633 3.3% -9.6%TOTAL SALARIES & WAGES 45,934 47,548 41,442 (1,614) -3.5% -14.7% 167,753 173,589 155,597 (5,836) -3.5% -11.6%

FRINGE BENEFITS 7,570 7,077 7,818 493 6.5% 9.5% 28,374 26,631 26,595 1,743 6.1% -0.1%HEALTH CARE ACCESS 1,219 1,413 1,200 (194) -15.9% -17.8% 4,523 4,826 4,768 (303) -6.7% -1.2%SUPPLIES 21,068 21,597 19,608 (529) -2.5% -10.1% 78,310 80,744 76,506 (2,434) -3.1% -5.5%OTHER SERVICES 5,395 5,370 4,309 25 0.5% -24.6% 21,755 22,013 20,190 (257) -1.2% -9.0%PURCHASED SERVICES 9,219 10,627 7,307 (1,408) -15.3% -45.4% 37,004 37,963 33,838 (959) -2.6% -12.2%

TOTAL OPER EXPENSES 90,404 93,633 81,684 (3,229) -3.6% -14.6% 337,719 345,765 317,495 (8,046) -2.4% -8.9%

EBITDA 10,356 10,014 8,584 (342) -3.3% 16.7% 38,717 41,513 36,207 2,795 7.2% 14.7%

DEPRECIATION/AMORT 5,165 5,443 4,336 (278) -5.4% -25.5% 20,312 21,173 17,220 (861) -4.2% -23.0%INTEREST EXPENSE 2,310 2,275 1,971 35 1.5% -15.4% 9,215 9,813 9,241 (598) -6.5% -6.2%GAIN(LOSS) FROM OPER 2,881 2,296 2,276 (585) -20.3% 0.9% 9,190 10,526 9,746 1,337 14.5% 8.0%


Page A.4

LEE MEMORIAL HEALTH SYSTEMCONSOLIDATED INCOME STATEMENT BY ENTITYFOR THE MONTH ENDED JANUARY 31, 2011(IN THOUSANDS)

ENTITY BUDGET ACTUALVARIANCE PRIOR YR BUDGET ACTUALVARIANCE PRIOR YR

LEE MEMORIAL HOSPITAL 3,664 4,486 821 3,291 13,778 16,594 2,815 11,393HEALTHPARK MEDICAL CTR 6,555 6,891 337 4,580 25,064 27,334 2,270 23,853CAPE CORAL HOSPITAL 4,217 3,867 (351) 2,895 15,558 13,722 (1,836) 13,636GULF COAST MEDICAL CENTER 3,734 3,520 (214) 2,600 11,166 11,091 (75) 8,513TRAUMA SERVICES DIST (517) (456) 61 (507) (1,475) (1,773) (298) (1,380)OUTPATIENT CENTERS 243 593 350 1,402 817 1,937 1,120 4,557HEALTHPARK CARE CTR 151 103 (49) 132 591 591 (0) 371HOME HEALTH AGENCIES 76 (109) (186) (88) 302 (62) (364) 4FOUNDATION (58) 15 73 7 (207) 118 325 82REHAB HOSPITAL 525 564 39 401 1,989 1,974 (15) 1,538PHYSICIANS (LPG-MSO-HBP) (5,232) (5,457) (225) (4,487) (18,848) (18,974) (127) (14,701)CORPORATE SERVICES (10,438) (11,702) (1,264) (7,919) (39,284) (41,778) (2,494) (37,897)AUXILIARY (5) (5) 0 (4) (13) (20) (7) (16)CHILD DEVELOP/PPEC (34) (14) 20 (26) (247) (225) 22 (207)PHO (2) (0) 2 (0) (0) (0) 0 (0)

TOTAL GAIN FROM OPS 2,881 2,296 (585) 2,276 9,190 10,526 1,337 9,746

INT EARN & REALIZED GAIN 1,570 (387) (1,958) 101 6,175 3,987 (2,189) 3,382UNREALIZED GAIN (LOSS) 954 4,665 3,711 (2,574) 3,723 14,425 10,701 3,803UNREALIZED GAIN (LOSS) ON SWAP 0 0 0 0 0 905 905 229OTHER NON OPERATING 268 136 (132) 75 1,070 (25,107) (26,177) 579RESTRICTED GIFTS 82 750 668 (58) 328 2,969 2,641 51

TOTAL NON OPERATING 2,874 5,164 2,290 (2,455) 11,296 (2,821) (14,118) 8,044

EXCESS OF REV/EXPS 5,755 7,460 1,704 (179) 20,486 7,705 (12,781) 17,790


Page A.5

MONTH YTDSources of Funds:

Excess Revenue Over Expenses 7,460 7,705 Depreciation/Amortization Expense 5,443 21,173 Restricted Gifts (750) (2,969) SWFRMC Land Value Adjustment 0 29,549 Total Sources 12,153 55,458

Uses of Funds:

Dec(Inc) in Accts Receivable (24,100) (78,572) Provision for Bad Debts 13,219 51,126 Dec(Inc) in Net Accts Receivable (10,880) (27,445)

Net borrowings (333) (1,842) Dec(Inc) in Other Assets (3,763) (4,206) Inc(Dec) in Liabilities 28,688 23,473 Capital Expenditures, net (3,892) (25,910) Total Uses 9,819 (35,931)

Net Increase(Decrease) In Funds 21,972 19,528

Cash & Investments at beginning of period 484,042 486,485

Cash & Investments at end of period 506,012 506,012

Total Bonds & Notes Payable-end of period 700,967

Cash to Debt Ratio 72.2%

In Thousands (000's)

SOURCES & APPLICATIONS OF FUNDSLEE MEMORIAL HEALTH SYSTEM

FOR THE PERIOD ENDING JANUARY 31, 2011

Page A.6

Lee Memorial Health SystemConsolidated Balance Sheet

As of JANUARY 31, 2011 in Thousands (000's)

ASSETS: Current Prior Month Prior Year LIABILITIES: Current Prior Month Prior Year

Current Assets: Current Liabilities:Cash And Cash Equivalents * 16,483 7,065 16,087 Accounts Payable 36,595 25,209 34,520Operating Fund Investments * 461,595 449,864 432,318 Wages and Benefits Payable 42,658 36,766 31,795Accrued Interest Receivable 353 336 371 Notes Payable - Short Term 6,680 6,889 4,349Accounts Receivable (net) 172,163 161,046 141,351 Current Portion Bonds Payable 10,350 10,350 14,871Accounts Receivable - Phys (Net) 7,260 7,495 10,626 Due to State of Florida 11,569 11,227 13,312Inventories 29,116 29,099 29,117 Malpractice Liability - Short Term 5,936 5,936 5,936Third Party Settlements 0 0 0 Accrued Bond Costs 7,610 5,913 12,282Other Current Assets 12,421 9,537 11,599 Due to LMHS 0 0 0

Other Current Liabilities 38,251 30,863 32,151

Total Current Assets: 699,390 664,443 641,468 Total Current Liabilities 159,649 133,153 149,216

Other Assets Other Liabilities and Fund BalanceLimited or Restricted Use Assets * 6,709 6,708 17,675 Benefits Payable - Long Term 0 0 0Bond Issuance Costs 5,247 5,277 5,685 Notes Payable - Long Term 156,548 156,709 104,040Trustee Held Funds * 0 0 0 Due to State of Florida - Long Term 6,894 5,856 3,494Directors/Officers Indemnity Fund * 100 100 100 Malpractice Liability - Long Term 9,842 9,642 9,242Long Term Operating Fund Investments * 21,126 20,304 20,304 Bonds Payable 527,389 527,352 553,410Other Assets 99,280 98,854 100,082 Other Long Term Liabilities 45,192 44,688 39,054

UnRestricted Fund Balance 601,728 595,019 596,992Restricted Fund Balance 25,807 25,057 22,838

Total Other Assets 132,462 131,243 143,846 Total Other Liabilities & Fund Balance 1,373,401 1,364,324 1,329,070

Property and Equipment:Plant In Use 1,222,991 1,221,283 1,203,696Construction in Process 28,193 29,221 26,866Accumulated Depreciation (571,220) (569,344) (555,419)

Total Property & Equipment (Net) 679,965 681,160 675,142

Restricted Assets 21,233 20,631 17,829

TOTAL ASSETS 1,533,050 1,497,477 1,478,286 TOTAL LIABILITIES AND EQUITY 1,533,050 1,497,477 1,478,286

* Cash and InvestmentsAbove Balance Sheet has been adjusted to eliminate intercompany receivables, payables and investments in subsidiaries

Page A.7

LEE MEMORIAL HEALTH SYSTEMFINANCIAL RATIOSFOR THE 4 MONTHS ENDED JANUARY 31, 2011

2009 2011Moody's Financial FYE YTDMedian Goals 2010 1/31/2011

PROFITABILITY RATIOS:Operating Margin (%) - Total 3.0% 2.2% 3.4% 2.7% +Excess Margin (%) 5.1% 4.8% 6.2% 1.2% +Operating CashFlow Margin (%) 9.9% 10.0% 11.6% 10.7% +

LIQUIDITY RATIOS:Days Cash on Hand (net of Callable Debt) 169.5 138.5 130.5 129.9 +Cushion Ratio (x) 15.3 13.7 10.6 11.0 +Cash-to-Debt (%) 117.6% 83.7% 71.9% 72.2% +

CAPITALIZATION RATIOS:Debt to Capitalization(%) - (net of Callable Debt) 38.9% 41.5% 47.8% 48.5% (-)Annual Debt Service Coverage (x) 4.7 3.5 3.3 3.5 +Debt to Cashflow (net of Callable Debt) 3.3 3.7 4.8 5.0 (-)

NOTE: + = Ratios that should be above the Moody's median(-) = Ratios that should be lower than the Moody's median

Page A.8

LEE MEMORIAL HEALTH SYSTEMCONSOLIDATED OPERATING RATIOSFOR THE PERIOD ENDING JANUARY 31, 2011

YEAR TO DATESAME MO SAME MO

BUDGET ACTUAL PRIOR YR ACT-BUD ACT-PRIOR BUDGET ACTUAL PRIOR YR ACT-BUD ACT-PRIOR

AS % NET OPER REV

WAGES & BENEFITS 53.1% 52.7% 54.6% 0.8% 3.4% 52.1% 51.7% 51.5% 0.8% -0.4%SUPPLIES 20.9% 20.8% 21.7% 0.3% 4.1% 20.8% 20.8% 21.6% -0.2% 3.6%ALL OTHER OPER EXPENSES 15.7% 16.8% 14.2% -6.5% -18.3% 16.8% 16.7% 16.6% 0.5% -0.6%CAPITAL COSTS 7.4% 7.3% 7.0% 1.3% -3.9% 7.8% 7.9% 7.5% -1.1% -5.0%EBITDA MARGIN 10.3% 9.7% 9.5% -6.0% 1.6% 10.3% 10.7% 10.2% 4.3% 4.5%OPERATING MARGIN 2.9% 2.4% 2.5% -17.9% -4.9% 2.5% 2.9% 2.8% 14.1% 3.9%EXCESS MARGIN 5.8% 6.3% -0.2% 9.8% 103.1% 5.5% 1.4% 5.0% -74.9% -264.1%

PER CMI ADJ ADMIT / VISIT

NET OPER REV 6,903 6,773 6,319 -1.9% 6.7% 6,890 6,799 6,565 -1.3% 3.4%TOTAL EXPENSES 6,701 6,611 6,160 1.4% -7.3% 6,717 6,604 6,384 1.7% -3.4%WAGES & BENEFITS 3,665 3,570 3,448 2.7% -3.5% 3,590 3,515 3,382 2.1% -3.9%SUPPLIES 1,443 1,411 1,373 2.3% -2.8% 1,433 1,418 1,420 1.1% 0.1%ALL OTHER OPER EXPENSES 1,085 1,138 897 -4.7% -26.9% 1,158 1,137 1,091 1.8% -4.2%CAPITAL COSTS 507 492 442 3.0% -11.3% 536 534 491 0.4% -8.8%OPERATING MARGIN 202 163 159 -19.3% 2.5% 173 195 181 12.7% 7.2%EXCESS MARGIN 399 500 (13) 25.3% 102.6% 380 145 330 -61.8% -127.6%

LABOR

PROD FTEs/ADJ DAILY ADMIT 22.5 21.8 21.4 3.2% -2.0% 23.1 22.8 22.6 1.5% -0.9%NON PROD AS % PAID 9.2% 9.0% 9.3% 2.6% 3.3% 9.6% 9.2% 9.3% 4.3% 0.8%AVG HOURLY RATE 30.8 32.2 30.5 -4.2% -5.4% 29.2 29.5 28.4 -1.2% -4.0%

OP REV % OF TOTAL REVENUE 36.0% 34.9% 35.7% -3.3% -2.3% 37.0% 36.0% 37.4% -2.8% -3.6%

Page A.9

CURRENT MONTH % VARIANCE% VARIANCE

LEE MEMORIAL HEALTH SYSTEMCONSOLIDATED - PAYOR MIXJanuary 31, 2011

Budget Actual Same Mo Budget Actual Same MoPrior Year Prior Year

MEDICARE 55.4% 54.4% 55.1% 51.2% 51.4% 50.4%MEDICAID 10.5% 10.7% 10.2% 11.7% 10.8% 11.3%MEDICAID HMO 3.3% 3.8% 3.2% 3.4% 3.9% 3.4%HMO/PPO 18.8% 17.8% 20.0% 20.7% 20.4% 21.7%COMMERCIAL 3.0% 2.7% 2.8% 3.3% 3.0% 3.4%OTHER 9.2% 10.6% 8.7% 9.8% 10.6% 9.7%

100.0% 100.0% 100.0% 100.0% 100.0% 100.0%

Budget Actual % Variance Budget Actual % VarianceMEDICARE CASE MIX INDEX 1.56 1.55 -0.6% 1.56 1.51 -3.2%SYSTEM CASE MIX INDEX 1.39 1.42 2.2% 1.39 1.39 0.0%

09/30/10 01/31/11 VarianceGross Accounts Receivable 324,983 373,553 48,570 Net Accounts Receivable 152,139 179,423 27,284 Net Days in Accounts Receivable 52.1 56.2 4.1

CURRENT MONTH YEAR-TO-DATE

Page A.10

CAPITAL BUDGET POOL

$ CERF $'s

APPROVEDCERF $'s SPENT

CERF's PENDING

APPROVALCAPITAL BALANCE

ROUTINE CAPITALROUTINE 15,677,860 11,587,929 3,209,053 0 4,089,931SURGICAL 4,186,198 1,897,808 777,136 0 2,288,390RADIOLOGY 6,715,398 3,337,935 41,000 0 3,377,463

INFORMATION SYSTEMS 9,452,110 582,424 178,591 0 8,869,686EPIC 10,894,925 5,447,463 5,447,463

MAJOR FACILITIES/PLANT OPS 13,828,293 4,860,836 473,897 0 8,967,457

TACTICAL PLANS 8,645,216 8,640,466 5,449,387 0 4,750

CONTINGENCY 600,000 177,085 108,313 0 422,915

TOTAL FY 2010 70,000,000 36,531,946 10,237,378 0 33,468,054

Unbudgeted- Board Approved 0 0 0 0

Outside Funding 246,148 42,135 0 204,013

Total Approved Prior Yrs SpentEPIC 15,447,463 7,967,441 2,859,441 4,620,582

THE CHILDREN'S HOSPITAL 335,496 205,562 130,958 (1,024)

10-1-10 BalFY10 & PRIOR YRS CERF'S- OPEN 24,921,689 5,188,600 19,733,089

18,458,511

58,024,713

TOTAL CASH OUTLAY FOR CAPITAL IN FY'11

LEE MEMORIAL HEALTH SYSTEMFY 2011

CAPITAL STATUS REPORTJanuary 31, 2011

Page A.11

INTEREST REALIZED BOOK UNREALIZED MARKET MONTHLY %INCOME GAINS/(LOSSES) VALUE GAINS/(LOSSES) VALUE RETURN

CASH MANAGERSGENERAL OPERATING ACCOUNTS 11,819 0 16,483,099 0 16,483,099LIMITED/RESTRICTED ASSET ACCTS 119 0 3,384,325 0 3,384,325 0.00%NORTHERN TRUST 12,303 0 3,448,793 (11,158) 3,437,635 0.03%COMPASS BANK MONEY MARKET 3,274 0 4,554,108 0 4,554,108 0.07%COMPASS BANK 7 MONTH CD 3,144 0 7,574,900 0 7,574,900 0.04% ML Treasury 91 Day 0.00%

SEI CASH & EQUIVALENTSSEI DAILY INCOME TREAS II FUND #37 (45) 0 0 0 0 0.00% ML Treasury 91 Day 0.00%

SEI PRIME OBLIGATION FUND 2,280 0 43,435,429 0 43,435,429 0.01% ML Treasury 91 Day 0.00%

TOTAL CASH & CASH EQUIVALENT 32,894 0 78,880,654 (11,158) 78,869,496

FIXED INCOME COMPOSITEMFO SEI INSTL INVTS TR CORE FIXED INCOME 0.353 185,406 0 59,976,472 117,711 60,094,183 0.50% Lehman US Aggregate Index 0.10%

MFO SEI DAILY INCOME TR ULTRA SHORT BOND 0.093 102,866 0 77,553,899 166,326 77,720,225 0.40% Lehman 9-12 Month US Treasury 0.10%

MFO SEI INSTL INVTS TR ENHANCED INCOME 0.257 0 0 38,730,827 345,804 39,076,631 0.90% Merrill Lynch 3 mo Cons-Ma 0.00%

LOGAN CIRCLE FUND 0.257 43,017 512 26,241,145 (11,995) 26,229,150 0.20% ML Treasury 91 Day 0.00%

TOTAL FIXED INCOME COMPOSITE 331,289 512 202,502,343 617,846 203,120,189

EQUITY COMPOSITE DOMESTIC EQUITY

MFO SEI INSTL INVTS TR LARGECAP 23.4% 0 (410,746) 68,343,477 2,250,498 70,593,975 2.70% S&P 500 2.40%

MFO SEI SIIT SMALL/MID CAP 6.5% 0 0 13,832,672 166,389 13,999,060 1.20% Russell 2500 1.30%

SEI CORE PROPERTY FUND LP 0 0 15,000,000 0 15,000,000 NA NCREIF Property Index NA

INTERNATIONAL EQUITYWORLD EQUITY EX-US 0 0 26,503,513 168,347 26,671,860 0.70% MSCI ACWI EX-US 1.00%

TOTAL EQUITY COMPOSITE 0 (410,746) 123,679,662 2,585,233 126,264,895

ALTERNATIVE INVESTMENTSSEI OFFSHORE OPPORTUNITY FUND LI, LTD 0 0 75,964,775 588,574 76,553,349 0.80%SEI SPECIAL SITUATIONS FUND 0 0 20,304,325 821,716 21,126,042 0.00% ML Treasury 91 Day 0.00%

REAL ESTATE INVESTMENT TRUSTREIT FUND 0 (32,728) (37,545) 37,545 0 NA DJ WILSHIRE RESI NA

TOTAL OTHER COMPOSITE 0 (32,728) 96,231,555 1,447,836 97,679,391

FOUNDATION 4,901 (3,982) 25,082 MISCELLANEOUS OTHER INCOME 29,857 VARIABLE RATE INTEREST EXPENSE OFFSET (52,373) INVESTMENT MANAGER FEES (294,987)

GRAND TOTAL 51,581 (446,943) 501,294,214 4,664,839 505,933,971 0.80%PORTFOLIO INDEX 0.60%

FOR THE MONTH ENDING JANUARY 31, 2011DETAILED PERFORMANCE HISTORY

LEE MEMORIAL HEALTH SYSTEM INVESTMENT PORTFOLIO

Page A.12

INTEREST REALIZED BOOK UNREALIZED MARKET %INCOME GAINS/(LOSSES) VALUE GAINS/(LOSSES) VALUE RETURN*

CASH MANAGERSGENERAL OPERATING ACCOUNTS 21,911 0 16,483,099 0 16,483,099LIMITED/RESTRICTED ASSET ACCTS 270 0 3,384,325 0 3,384,325 0.01%NORTHERN TRUST 48,227 0 3,482,480 (44,845) 3,437,635 0.10%COMPASS BANK MONEY MARKET 12,976 0 4,554,108 0 4,554,108 0.28%COMPASS BANK 7 MONTH CD (2,321) 0 7,574,900 0 7,574,900 -0.03% ML Treasury 91 Day 0.10%

SEI CASH & EQUIVALENTSSEI DAILY INCOME TREAS II FUND #37 0 0 0 0 0 0.00% ML Treasury 91 Day 0.10%

SEI PRIME OBLIGATION FUND 9,657 0 43,435,429 0 43,435,429 0.02% ML Treasury 91 Day 0.10%

TOTAL CASH & CASH EQUIVALENT 90,718 0 78,914,341 (44,845) 78,869,496

FIXED INCOME COMPOSITEMFO SEI INSTL INVTS TR CORE FIXED INCOME 2,856,356 0 63,038,109 (2,943,926) 60,094,183 -0.10% Lehman US Aggregate Index -1.20%

MFO SEI DAILY INCOME TR ULTRA SHORT BOND 408,195 0 77,633,704 86,521 77,720,225 0.80% Lehman 9-12 Month US Treasury 0.10%

SIIT REAL RETURN 33,871 425,539 300,089 (300,089) 0 0.60% Lehman 1-5 YR US Treasury NA

MFO SEI INSTL INVTS TR ENHANCED INCOME 495,890 0 38,588,869 487,761 39,076,631 2.80% Merrill Lynch 3 mo Cons-Ma 0.10%

LOGAN CIRCLE FUND 77,225 (800) 26,277,793 (48,643) 26,229,150 NA ML Treasury 91 Day 0.10%

TOTAL FIXED INCOME COMPOSITE 3,871,538 424,739 205,838,564 (2,718,375) 203,120,189

EQUITY COMPOSITE DOMESTIC EQUITY

MFO SEI INSTL INVTS TR LARGECAP 1,149,748 (410,746) 62,166,038 8,427,937 70,593,975 13.90% S&P 500 13.40%

MFO SEI SIIT SMALL/MID CAP 24,576 0 12,080,436 1,918,624 13,999,060 16.30% Russell 2500 16.40%

SEI CORE PROPERTY FUND LP 0 0 15,000,000 0 15,000,000 NA NCREIF Property Index NA

INTERNATIONAL EQUITYWORLD EQUITY EX-US 461,237 0 24,917,850 1,754,010 26,671,860 9.20% MSCI ACWI EX-US 8.30%

TOTAL EQUITY COMPOSITE 1,635,561 (410,746) 114,164,323 12,100,572 126,264,895

ALTERNATIVE INVESTMENTSSEI OFFSHORE OPPORTUNITY FUND LI, LTD 0 0 74,729,198 1,824,151 76,553,349 4.20%SEI SPECIAL SITUATIONS FUND 0 0 20,304,325 821,716 21,126,042 4.10% ML Treasury 91 Day 0.10%

REAL ESTATE INVESTMENT TRUSTREIT FUND 249,105 (1,311,857) (2,348,362) 2,348,362 0 9.80% DJ WILSHIRE RESI 0.00%

TOTAL OTHER COMPOSITE 249,105 (1,311,857) 92,685,161 4,994,230 97,679,391

FOUNDATION 44,115 (33,869) 93,030 MISCELLANEOUS OTHER INCOME 1,492,266 VARIABLE RATE INTEREST EXPENSE OFFSET (59,336) INVESTMENT MANAGER FEES (1,108,070)

GRAND TOTAL 6,215,898 (1,331,732) 491,602,389 14,424,611 505,933,971 4.60%PORTFOLIO INDEX 4.00%

*Net of reallocations between funds

FOR THE FOUR MONTHS ENDING JANUARY 31, 2011DETAILED PERFORMANCE HISTORY

LEE MEMORIAL HEALTH SYSTEM INVESTMENT PORTFOLIO

Page A.13

LEE MEMORIAL HEALTH SYSTEM CONSOLIDATED FINANCIAL STATEMENTS & STATISTICAL REPORTS TABLE OF CONTENTS SECTION B PAGE CONSOLIDATING SCHEDULES CONSOLIDATING STATISTICAL REPORT B.1 CONSOLIDATING INCOME STATEMENT – MONTH B.7 YTD B.10 CONSOLIDATING FINANCIAL RATIOS B.13 STAFFING SUMMARY B.17 SUMMARY OF ACCOUNTS RECEIVABLE B.18

LEE MEMORIAL HEALTH SYSTEMSTATISTICAL SUMMARYCONSOLIDATING ACTUALFOR THE MONTH ENDING JANUARY 31, 2011

OP HOMESYSTEM LEE HPMC CCH GCMC CENTERS HPCC HEALTH REHAB

Admissions ADULTS 6,383 1,321 1,643 1,374 2,045 0 0 0 0 PEDIATRICS 414 0 399 15 0 0 0 0 0 NICU 53 0 53 0 0 0 0 0 0 POST ACUTE 170 0 0 0 0 0 77 0 93Total Adult & Peds 7,020 1,321 2,095 1,389 2,045 0 77 0 93 NEWBORNS 489 0 221 124 144 0 0 0 0Total Admissions 7,509 1,321 2,316 1,513 2,189 0 77 0 93

Patient DaysADULTS 30,668 7,288 7,542 6,332 9,506 0 0 0 0 PEDIATRICS 1,354 0 1,324 30 0 0 0 0 0 NICU 1,191 0 1,191 0 0 0 0 0 0 POST ACUTE 4,398 0 0 0 0 0 3,286 0 1,112Total Adult & Peds 37,611 7,288 10,057 6,362 9,506 0 3,286 0 1,112 NEWBORNS 1,249 0 471 450 328 0 0 0 0Total Patient Days 38,860 7,288 10,528 6,812 9,834 0 3,286 0 1,112

Average Length of Stay ADULTS 19.4 5.5 4.6 4.6 4.6 0.0 0.0 0.0 0.0 PEDIATRICS 5.3 0.0 3.3 2.0 0.0 0.0 0.0 0.0 0.0 NICU 22.5 0.0 22.5 0.0 0.0 0.0 0.0 0.0 0.0 POST ACUTE 54.6 0.0 0.0 0.0 0.0 0.0 42.7 0.0 12.0 Total Adult & Peds 5.4 5.5 4.8 4.6 4.6 0.0 42.7 0.0 12.0 NEWBORNS 8.0 0.0 2.1 3.6 2.3 0.0 0.0 0.0 0.0Total Patient Days 5.2 5.5 4.5 4.5 4.5 0.0 42.7 0.0 12.0

OP Registrations EMERGENCY ROOM 14,967 3,718 4,058 4,284 2,907 0 0 0 0 OP SURGERY CASES 1,614 346 506 334 378 50 0 0 0SUBTOTAL 16,581 4,064 4,564 4,618 3,285 50 0 0 0

Visits / Encounters HOME HEALTH ADMISSIONS 356 0 0 0 0 0 0 356 0 HOSP BASED PHY ENCOUNTERS 15,912 0 0 0 0 0 0 0 0 PHYSICIAN ENCOUNTERS 52,376 0 0 0 0 0 0 0 0 TRAUMA 784 784 0 0 0 0 0 0 0SUBTOTAL 69,428 784 0 0 0 0 0 356 0

TOTAL OP 86,009 4,848 4,564 4,618 3,285 50 0 356 0

Page B.1

LEE MEMORIAL HEALTH SYSTEMCONSOLIDATING STATISTICALACTUAL TO BUDGET VARIANCEFOR THE MONTH ENDED JANUARY 31, 2011

OP ALLSYSTEM LEE HP CCH GCMC CENTERS HPCC HH REHAB PHYSICIANS

Admissions ADULTS 247 109 84 (16) 70 0 0 0 0 0 PEDIATRICS 48 0 33 15 0 0 0 0 0 0 NICU 5 0 5 0 0 0 0 0 0 0 POST ACUTE 2 0 0 0 0 0 6 0 (4) 0Total Adult & Peds 302 109 122 (1) 70 0 6 0 (4) 0 NEWBORNS (23) 0 (8) (4) (11) 0 0 0 0 0Total Admissions 278 109 113 (5) 59 0 6 0 (4) 0

Patient Days ADULTS 2,497 833 642 355 667 0 0 0 0 0 PEDIATRICS 52 0 22 30 0 0 0 0 0 0 NICU 107 0 107 0 0 0 0 0 0 0 POST ACUTE (109) 0 0 0 0 0 (112) 0 3 0Total Adult & Peds 2,547 833 771 385 667 0 (112) 0 3 0 NEWBORNS 68 0 (36) 95 8 0 0 0 0 0Total Patient Days 2,615 833 736 480 675 0 (112) 0 3 0

Average Length of Stay ADULTS 0.8 0.2 0.2 0.3 0.2 0.0 0.0 0.0 0.0 0.0 PEDIATRICS (0.2) 0.0 (0.2) 0.0 0.0 0.0 0.0 0.0 0.0 0.0 NICU (0.0) 0.0 (0.0) 0.0 0.0 0.0 0.0 0.0 0.0 0.0 POST ACUTE (1.0) 0.0 0.0 0.0 0.0 0.0 (5.2) 0.0 0.5 0.0Total Adult & Peds 0.1 0.2 (0.1) 0.3 0.2 0.0 (5.2) 0.0 0.5 0.0 NEWBORNS 0.2 0.0 (0.1) 0.9 0.2 0.0 0.0 0.0 0.0 0.0Total Patient Days 0.2 0.2 (0.2) 1.2 0.4 0.0 (5.2) 0.0 0.5 0.0

OP Registrations EMERGENCY ROOM 1,221 264 345 478 135 0 0 0 0 0 OP SURGERY CASES 122 80 60 (6) 14 (25) 0 0 0 0SUBTOTAL 1,343 344 405 472 148 (25) 0 0 0 0

Visits / Encounters HOME HEALTH ADMISSIONS 23 0 0 0 0 0 0 23 0 0 HOSP BASED PHY ENCOUNT 1,055 0 0 0 0 0 0 0 0 1,055 PHYSICIAN ENCOUNTERS 6,498 0 0 0 0 0 0 0 0 6,498 TRAUMA 100 100 0 0 0 0 0 0 0 0SUBTOTAL 7,675 100 0 0 0 0 0 23 0 7,553

TOTAL OP 9,018 444 405 472 148 (25) 0 23 0 7,553

Page B.2

LEE MEMORIAL HEALTH SYSTEMCONSOLIDATING STATISTICALACTUAL TO PRIOR MONTH VARIANCEFOR THE MONTH ENDED JANUARY 31, 2011


Admissions ADULTS 480 149 131 24 176 0 0 0 0 0 PEDIATRICS 51 0 66 (15) 0 0 0 0 0 0 NICU 12 0 12 0 0 0 0 0 0 0 POST ACUTE 8 0 0 0 0 0 7 0 1 0Total Adult & Peds 551 149 209 9 176 0 7 0 1 0 NEWBORNS 15 0 0 2 13 0 0 0 0 0Total Admissions 566 149 209 11 189 0 7 0 1 0

Patient Days ADULTS 2,942 1,024 880 245 793 0 0 0 0 0 PEDIATRICS 263 0 325 (62) 0 0 0 0 0 0 NICU 83 0 83 0 0 0 0 0 0 0 POST ACUTE (43) 0 0 0 0 0 (56) 0 13 0Total Adult & Peds 3,245 1,024 1,288 183 793 0 (56) 0 13 0 NEWBORNS 81 0 (16) 70 27 0 0 0 0 0Total Patient Days 3,326 1,024 1,272 253 820 0 (56) 0 13 0

Average Length of Stay ADULTS 0.4 0.2 0.2 0.1 (0.0) 0.0 0.0 0.0 0.0 0.0 PEDIATRICS (4.7) 0.0 0.3 (5.1) 0.0 0.0 0.0 0.0 0.0 0.0 NICU (4.6) 0.0 (4.6) 0.0 0.0 0.0 0.0 0.0 0.0 0.0 POST ACUTE (5.1) 0.0 0.0 0.0 0.0 0.0 (5.1) 0.0 0.0 0.0Total Adult & Peds 0.0 0.2 (4.1) (5.0) (0.0) 0.0 (5.1) 0.0 0.0 0.0 NEWBORNS 0.1 0.0 (0.1) 0.5 2.3 0.0 0.0 0.0 0.0 0.0Total Patient Days 0.1 0.2 (4.1) (4.5) 2.3 0.0 (5.1) 0.0 0.0 0.0

OP Registrations EMERGENCY ROOM 1,642 419 396 624 203 0 0 0 0 0 OP SURGERY CASES 18 5 7 (21) (23) 50 0 0 0 0SUBTOTAL 1,660 424 403 603 180 50 0 0 0 0

Visits / Encounters HOME HEALTH ADMISSIONS 76 0 0 0 0 0 0 76 0 0 HOSP BASED PHY ENCOUNTE 2,091 0 0 0 0 0 0 0 0 2,091 PHYSICIAN ENCOUNTERS 11,607 0 0 0 0 0 0 0 0 11,607 TRAUMA 120 120 0 0 0 0 0 0 0 0SUBTOTAL 13,894 120 0 0 0 0 0 76 0 13,698

TOTAL OP 15,554 544 403 603 180 50 0 76 0 13,698

Page B.3

LEE MEMORIAL HEALTH SYSTEMSTATISTICAL SUMMARYCONSOLIDATING ACTUALFOR THE 4 MONTHS ENDING JANUARY 31, 2011

OP HOMESYSTEM LEE HPMC CCH GCMC CENTERS HPCC HEALTH REHAB

Admissions ADULTS 23,773 4,806 6,284 5,151 7,532 0 0 0 0 PEDIATRICS 1,649 0 1,591 58 0 0 0 0 0 NICU 218 0 218 0 0 0 0 0 0 POST ACUTE 584 0 0 0 0 0 246 0 338Total Adult & Peds 26,224 4,806 8,093 5,209 7,532 0 246 0 338 NEWBORNS 2,040 0 967 478 595 0 0 0 0Total Admissions 28,264 4,806 9,060 5,687 8,127 0 246 0 338

Patient Days ADULTS 108,975 25,060 27,296 22,492 34,127 0 0 0 0 PEDIATRICS 5,221 0 5,106 115 0 0 0 0 0 NICU 5,314 0 5,314 0 0 0 0 0 0 POST ACUTE 17,206 0 0 0 0 0 13,161 0 4,045Total Adult & Peds 136,716 25,060 37,716 22,607 34,127 0 13,161 0 4,045 NEWBORNS 5,097 0 2,113 1,604 1,380 0 0 0 0Total Patient Days 141,813 25,060 39,829 24,211 35,507 0 13,161 0 4,045

Average Length of Stay ADULTS 4.6 5.2 4.3 4.4 4.5 0.0 0.0 0.0 0.0 PEDIATRICS 3.2 0.0 3.2 2.0 0.0 0.0 0.0 0.0 0.0 NICU 24.4 0.0 24.4 0.0 0.0 0.0 0.0 0.0 0.0 POST ACUTE 29.5 0.0 0.0 0.0 0.0 0.0 53.5 0.0 12.0 Total Adult & Peds 5.2 5.2 4.7 4.3 4.5 0.0 53.5 0.0 12.0 NEWBORNS 2.5 0.0 2.2 3.4 2.3 0.0 0.0 0.0 0.0Total Patient Days 5.0 5.2 4.4 4.3 4.4 0.0 53.5 0.0 12.0

OP Registrations EMERGENCY ROOM 55,663 13,795 15,540 15,545 10,783 0 0 0 0 OP SURGERY CASES 6,275 1,326 2,114 1,295 1,436 104 0 0 0SUBTOTAL 61,938 15,121 17,654 16,840 12,219 104 0 0 0

Visits / Encounters HOME HEALTH ADMISSIONS 1,372 0 0 0 0 0 0 1,372 0 HOSP BASED PHY ENCOUNTERS 64,209 0 0 0 0 0 0 0 0 PHYSICIAN ENCOUNTERS 191,277 0 0 0 0 0 0 0 0 TRAUMA 2,702 2,702 0 0 0 0 0 0 0SUBTOTAL 259,560 2,702 0 0 0 0 0 1,372 0

TOTAL OP 321,498 17,823 17,654 16,840 12,219 104 0 1,372 0

Page B.4

LEE MEMORIAL HEALTH SYSTEMCONSOLIDATING STATISTICALACTUAL TO BUDGET VARIANCEFOR THE 4 MONTHS ENDED JANUARY 31, 2011

OPC ALLSYSTEM LEE HP CCH GCMC CENTERS HPCC HH REHAB PHYSICIANS

Admissions ADULTS 1,377 417 503 (103) 560 0 0 0 0 0 PEDIATRICS 124 0 66 58 0 0 0 0 0 0 NICU 11 0 11 0 0 0 0 0 0 0 POST ACUTE (46) 0 0 0 0 0 (22) 0 (24) 0Total Adult & Peds 1,467 417 581 (45) 560 0 (22) 0 (24) 0 NEWBORNS (146) 0 (73) (18) (56) 0 0 0 0 0Total Admissions 1,321 417 508 (63) 505 0 (22) 0 (24) 0

Patient DaysADULTS 8,253 2,245 1,920 1,270 2,818 0 0 0 0 0 PEDIATRICS (240) 0 (355) 115 0 0 0 0 0 0 NICU 630 0 630 0 0 0 0 0 0 0 POST ACUTE (346) 0 0 0 0 0 11 0 (357) 0Total Adult & Peds 8,298 2,245 2,195 1,385 2,818 0 11 0 (357) 0 NEWBORNS 94 0 (162) 216 40 0 0 0 0 0Total Patient Days 8,392 2,245 2,034 1,602 2,858 0 11 0 (357) 0

Average Length of Stay ADULTS 0.3 0.0 (0.0) 0.3 0.0 0.0 0.0 0.0 0.0 0.0 PEDIATRICS (0.4) 0.0 (0.4) 0.0 0.0 0.0 0.0 0.0 0.0 0.0 NICU 1.7 0.0 1.7 0.0 0.0 0.0 0.0 0.0 0.0 0.0 POST ACUTE 4.2 0.0 0.0 0.0 0.0 0.0 4.4 0.0 (0.2) 0.0Total Adult & Peds (0.1) 0.0 (0.1) 0.0 0.0 0.0 4.4 0.0 (0.2) 0.0 NEWBORNS 0.2 0.0 (0.0) 0.6 0.3 0.0 0.0 0.0 0.0 0.0Total Patient Days (0.1) 0.0 (0.1) 0.6 0.3 0.0 4.4 0.0 (0.2) 0.0

OP Registrations EMERGENCY ROOM 14 133 681 (205) (596) 0 0 0 0 0 OP SURGERY CASES 450 290 361 (68) (68) (64) 0 0 0 0SUBTOTAL 464 423 1,042 (273) (664) (64) 0 0 0 0

Visits / Encounters HOME HEALTH ADMISSIONS 101 0 0 0 0 0 0 101 0 0 HOSP BASED PHY ENCOUNTE 3,457 0 0 0 0 0 0 0 0 3,457 PHYSICIAN ENCOUNTERS 11,941 0 0 0 0 0 0 0 0 11,941 TRAUMA 34 34 0 0 0 0 0 0 0 0SUBTOTAL 15,533 34 0 0 0 0 0 101 0 15,398

TOTAL OP 15,997 457 1,042 (273) (664) (64) 0 101 0 15,398

Page B.5

LEE MEMORIAL HEALTH SYSTEMCONSOLIDATING STATISTICALACTUAL TO PRIOR YEAR VARIANCEFOR THE 4 MONTHS ENDED JANUARY 31, 2011


Admissions ADULTS 2,018 559 619 49 791 0 0 0 0 0 PEDIATRICS 136 0 207 (71) 0 0 0 0 0 0 NICU (8) 0 (8) 0 0 0 0 0 0 0 POST ACUTE (29) 0 0 0 0 0 (22) 0 (7) 0Total Adult & Peds 2,117 559 818 (22) 791 0 (22) 0 (7) 0 NEWBORNS (24) 0 (21) (3) 0 0 0 0 0 0Total Admissions 2,093 559 797 (25) 791 0 (22) 0 (7) 0

Patient Days ADULTS 9,249 2,087 3,247 785 3,130 0 0 0 0 0 PEDIATRICS 270 0 500 (230) 0 0 0 0 0 0 NICU 252 0 252 0 0 0 0 0 0 0 POST ACUTE 295 0 0 0 0 0 116 0 179 0Total Adult & Peds 10,066 2,087 3,999 555 3,130 0 116 0 179 0 NEWBORNS 72 0 (53) 110 15 0 0 0 0 0Total Patient Days 10,138 2,087 3,946 665 3,145 0 116 0 179 0

Average Length of Stay ADULTS (0.1) (0.2) 0.1 0.1 (0.1) 0.0 0.0 0.0 0.0 0.0 PEDIATRICS (4.8) 0.0 (0.1) (4.7) 0.0 0.0 0.0 0.0 0.0 0.0 NICU 2.0 0.0 2.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 POST ACUTE 5.6 0.0 0.0 0.0 0.0 0.0 4.8 0.0 0.8 0.0Total Adult & Peds (0.0) (0.2) 2.0 (4.5) (0.1) 0.0 4.8 0.0 0.8 0.0 NEWBORNS 0.1 0.0 (0.0) 0.2 0.0 0.0 0.0 0.0 0.0 0.0Total Patient Days (0.0) (0.2) 2.0 (4.3) (0.1) 0.0 4.8 0.0 0.8 0.0

OP Registrations EMERGENCY ROOM 1,740 748 885 401 (294) 0 0 0 0 0 OP SURGERY CASES (115) (7) 158 (128) (242) 104 0 0 0 0SUBTOTAL 1,625 741 1,043 273 (536) 104 0 0 0 0

Visits / Encounters HOME HEALTH ADMISSIONS 290 0 0 0 0 0 0 290 0 0 HOSP BASED PHY ENCOUNTERS 6,575 0 0 0 0 0 0 0 0 6,575 PHYSICIAN ENCOUNTERS 31,028 0 0 0 0 0 0 0 0 31,028 TRAUMA 104 104 0 0 0 0 0 0 0 0SUBTOTAL 37,997 104 0 0 0 0 0 290 0 37,603

TOTAL OP 39,622 845 1,043 273 (536) 104 0 290 0 37,603

Page B.6

LEE MEMORIAL HEALTH SYSTEMCONSOLIDATING INCOME STATEMENTACTUAL DOLLARS - IN THOUSANDSFOR THE MONTH ENDED JANUARY 31, 2011

OP HOME ALL CORP ALL SYSTEM LMH HPMC CCH GCMC TRAUMA CENTERS HPCC HEALTH REHAB PHYSICIANS FOUND SVS OTHERS

INPATIENT REVENUE 248,986 52,478 71,456 43,244 78,434 0 153 1,314 0 1,909 0 0 0 0OUTPATIENT REVENUE 133,230 20,108 23,996 22,768 19,941 555 17,207 0 863 21 27,763 0 9 0TOTAL PATIENT REVENUE 382,216 72,585 95,451 66,012 98,374 555 17,360 1,314 863 1,930 27,763 0 9 0

DED FROM REV-MEDICARE 149,476 28,311 36,272 29,332 47,138 0 7,690 102 39 591 0 0 0 0DED FROM REV-MEDICAID 38,914 5,983 15,730 6,935 8,881 0 1,355 14 16 0 0 0 0 0DED FROM REV-CHARITY 11,069 4,361 2,423 1,974 2,177 0 109 12 13 0 0 0 0 0DED FROM REV-HMO/PPO 30,704 4,987 9,353 5,839 8,723 0 1,706 0 34 63 0 0 0 0DED FROM REV-OTHER 36,926 6,862 4,386 3,577 4,062 261 1,495 60 0 0 16,223 0 0 0DED FROM REV-BAD DEBT 13,219 3,381 1,552 2,199 3,087 194 292 14 5 22 2,474 0 0 0TOTAL DED FROM REV 280,308 53,885 69,717 49,856 74,067 455 12,647 201 107 677 18,697 0 0 0

NET PATIENT REVENUE 101,908 18,700 25,735 16,156 24,307 100 4,713 1,113 756 1,254 9,066 0 9 0OTHER OPER REV 1,739 75 115 126 96 1 88 6 44 0 50 229 418 491

0TOTAL OPERATING REV 103,647 18,775 25,850 16,282 24,403 101 4,801 1,119 800 1,254 9,116 229 427 491

OPERATING EXPENSES PROD SALARIES 39,206 5,009 7,377 4,785 6,675 263 1,588 555 619 466 7,149 99 4,380 241 PROD OVERTIME 1,545 375 390 204 459 0 14 33 2 4 18 (0) 44 2 CONTRACT LABOR 319 14 61 95 123 0 1 11 4 11 0 0 0 0 NON-PROD SALARIES 6,478 681 1,034 596 776 120 166 62 79 62 1,473 13 1,377 39TOTAL SALARIES & WAGES 47,548 6,079 8,862 5,681 8,033 383 1,769 661 705 542 8,640 112 5,800 281

FRINGE BENEFITS 7,077 1,150 1,198 779 1,184 47 266 90 103 85 1,324 17 781 53HEALTH CARE ACCESS 1,413 350 364 269 333 0 53 37 0 7 0 0 0 0SUPPLIES 21,597 5,014 5,393 3,434 5,841 1 905 72 11 31 326 1 443 127OTHER SERVICES 5,370 496 538 475 506 6 484 17 57 6 752 62 1,937 35PURCHASED SERVICES 10,627 421 1,202 968 1,784 118 79 108 25 8 3,337 22 2,547 8

TOTAL OPER EXPENSES 93,633 13,509 17,557 11,605 17,681 554 3,556 985 901 679 14,379 214 11,509 504

EBITDA 10,014 5,266 8,294 4,677 6,722 (453) 1,245 133 (100) 574 (5,263) 15 (11,082) (12)

DEPRECIATION/AMORT 5,443 670 1,192 547 1,832 3 364 23 9 10 136 0 649 7INTEREST EXPENSE 2,275 109 210 263 1,370 0 288 7 0 0 58 0 (30) 0GAIN(LOSS) FROM OPER 2,296 4,486 6,891 3,867 3,520 (456) 593 103 (109) 564 (5,457) 15 (11,702) (19)

NON OPERATING REV INT EARN & REALIZED GAIN (387) (362) (50) 2 14 0 0 0 0 0 0 4 0 5 UNREALIZED GAIN (LOSS) 4,665 4,640 0 0 0 0 0 0 0 0 0 25 0 0 UNREALIZED GAIN (LOSS) ON SWAP 0 0 0 0 0 0 0 0 0 0 0 0 0 0 OTHER NON OPER REV 136 95 0 0 (67) 0 0 28 75 34 0 (29) 0 0 RESTRICTED GIFTS 750 0 0 0 0 0 0 0 0 0 0 750 0 0TOTAL NON OPER REV 5,164 4,373 (50) 2 (54) 0 0 28 75 34 0 750 0 5

EXCESS REV/EXPS 7,460 8,858 6,842 3,868 3,467 (456) 593 131 (34) 598 (5,457) 765 (11,702) (14)

Page B.7

LEE MEMORIAL HEALTH SYSTEMCONSOLIDATING INCOME STATEMENTACTUAL TO BUDGET DOLLAR VARIANCE - IN THOUSFOR THE MONTH ENDED JANUARY 31, 2011

OP HOME ALL CORP ALLSYSTEM LMH HPMC CCH GCMC TRAUMA CENTERS HPCC HEALTH REHAB PHYSICIANS FOUND SVCS OTHERS

INPATIENT REVENUE 15,090 3,945 1,787 2,537 6,994 0 72 (0) 0 (245) 0 0 0 0OUTPATIENT REVENUE 1,535 1,921 (1,482) (291) (1,958) (54) 927 0 (85) 14 2,533 0 9 0TOTAL PATIENT REVENUE 16,625 5,866 305 2,246 5,037 (54) 999 (0) (85) (231) 2,533 0 9 0

DED FROM REV-MEDICARE (1,626) (2,388) 2,419 1,325 (1,931) 0 (1,160) 71 (10) 49 0 0 0 0DED FROM REV-MEDICAID (2,622) (131) (754) (1,369) (815) 0 442 (2) 6 0 0 0 0 0DED FROM REV-CHARITY 960 638 455 530 (822) 0 137 3 19 0 0 0 0 0DED FROM REV-HMO/PPO (601) 975 649 (1,334) (1,356) 0 321 0 13 132 0 0 0 0DED FROM REV-OTHER (9,897) (3,296) (3,040) (1,264) 5 (133) (217) (23) 3 0 (1,931) 0 0 0DED FROM REV-BAD DEBT (74) (220) 7 (72) (287) 129 47 (0) 0 16 306 0 0 0TOTAL DED FROM REV (13,860) (4,422) (265) (2,185) (5,206) (5) (430) 49 31 197 (1,624) 0 0 0

NET PATIENT REVENUE 2,765 1,444 40 61 (169) (58) 568 49 (54) (34) 909 0 9 0OTHER OPER REV 122 5 20 16 (3) (12) 17 0 (7) 0 (34) 29 52 38TOTAL OPERATING REV 2,887 1,449 60 77 (172) (70) 585 49 (60) (34) 875 29 61 38

OPERATING EXPENSES PROD SALARIES (2,586) (558) (512) (322) (381) (19) (202) (79) (89) (13) (200) 9 (221) 2 PROD OVERTIME 768 60 289 149 308 17 (9) 1 (2) 12 (15) 0 (40) (2) CONTRACT LABOR 345 89 97 16 121 0 (1) (11) 4 31 0 0 0 0 NON-PROD SALARIES (141) (6) (108) 6 28 127 32 (6) (11) 21 (76) 7 (153) (2)TOTAL SALARIES & WAGES (1,614) (415) (233) (150) 75 125 (180) (96) (99) 50 (292) 16 (414) (2)

FRINGE BENEFITS 493 293 278 187 167 (47) 8 (4) (13) 19 (416) 2 26 (8)HEALTH CARE ACCESS (194) (119) (9) (57) 5 0 (12) (4) 0 1 0 0 0 0SUPPLIES (529) (533) 479 (41) (171) 0 (134) 3 2 (2) (22) 2 (93) (20)OTHER SERVICES 25 35 79 28 143 1 102 10 (12) (2) 3 28 (399) 9PURCHASED SERVICES (1,408) 75 (405) (322) (168) 49 26 (3) 1 6 (411) (5) (257) 5

TOTAL OPER EXPENSES (3,229) (664) 190 (355) 51 130 (190) (95) (121) 73 (1,138) 44 (1,138) (16)

EBITDA (342) 785 250 (278) (122) 60 395 (45) (181) 39 (263) 73 (1,076) 22

DEPRECIATION/AMORT (278) 94 6 (43) (44) 1 (61) 0 (4) 0 45 0 (274) (0)INTEREST EXPENSE 35 (58) 80 (30) (49) 0 16 (4) 0 0 (7) 0 86 0GAIN(LOSS) FROM OPER (585) 821 337 (351) (214) 61 350 (49) (186) 39 (225) 73 (1,264) 22

NON OPERATING REV INT EARN & REALIZED GAIN (1,958) (1,944) (26) 2 14 0 0 0 0 0 0 (6) 0 2 UNREALIZED GAIN(LOSS) 3,711 3,686 0 0 0 0 0 0 0 0 0 25 0 0 UNREALIZED GAIN(LOSS) ON SWAP 0 0 0 0 0 0 0 0 0 0 0 0 0 0 OTHER NON OPER REV (132) (180) 0 0 (72) 0 0 28 70 34 0 (12) 0 0 RESTRICTED GIFTS 668 1 0 0 0 0 0 0 0 0 0 667 0 0TOTAL NON OPER REV 2,290 1,563 (26) 2 (58) 0 0 28 70 34 0 674 0 2

EXCESS OF REV / EXPS 1,704 2,385 311 (349) (272) 61 350 (20) (115) 73 (225) 747 (1,264) 24

Page B.8

LEE MEMORIAL HEALTH SYSTEMCONSOLIDATING INCOME STATEMENTACTUAL TO PRIOR MONTH DOLLAR VARIANCE - IN THOUSFOR THE MONTH ENDED JANUARY 31, 2011

OP HOME ALL CORP ALLSYSTEM LMH HP CCH GCMC TRAUMA CENTERS HPCC HEALTH REHAB PHYSICIANS FOUND SVCS OTHERS

INPATIENT REVENUE 33,645 9,875 10,085 3,061 10,371 0 82 8 0 163 0 0 0 0OUTPATIENT REVENUE 13,697 2,091 (704) 1,492 (3,349) 138 7,904 0 154 9 5,953 0 9 0TOTAL PATIENT REVENUE 47,342 11,966 9,381 4,553 7,022 138 7,986 8 154 172 5,953 0 9 0

DED FROM REV-MEDICARE (12,978) (5,386) (95) (134) (3,359) 0 (3,998) 92 (35) (63) 0 0 0 0DED FROM REV-MEDICAID (8,948) (1,393) (3,990) (2,118) (824) 0 (632) 5 4 0 0 0 0 0DED FROM REV-CHARITY (863) 57 (187) 182 (878) 0 (48) 8 4 0 0 0 0 0DED FROM REV-HMO/PPO 1,056 866 807 (403) 397 0 (666) 0 15 39 0 0 0 0DED FROM REV-OTHER (10,567) (2,784) (2,849) (393) 966 (34) (1,008) (39) 2 0 (4,428) 0 0 0DED FROM REV-BAD DEBT (2,070) (636) (171) (108) (1,114) (44) (140) 14 (0) 1 127 0 0 0TOTAL DED FROM REV (34,370) (9,276) (6,485) (2,973) (4,812) (78) (6,492) 80 (10) (23) (4,300) 0 0 0

NET PATIENT REVENUE 12,972 2,690 2,896 1,580 2,209 60 1,494 88 144 149 1,652 0 9 0OTHER OPER REV 407 11 22 38 4 (60) 42 1 (1) 0 25 37 261 27TOTAL OPERATING REV 13,379 2,701 2,918 1,618 2,213 0 1,536 89 143 149 1,677 37 270 27

OPERATING EXPENSES PROD SALARIES (4,852) (473) (482) (288) (360) (12) (684) (71) (152) 11 (1,311) (25) (982) (23) PROD OVERTIME (320) (155) (121) (17) (2) 0 (6) 2 (1) 5 (4) 0 (22) (0) CONTRACT LABOR 67 13 14 (31) 40 0 (1) (11) 43 (1) 0 0 0 0 NON-PROD SALARIES (1,001) (71) (116) (37) 21 3 (24) (13) (28) (4) (224) 56 (558) (4)TOTAL SALARIES & WAGES (6,106) (686) (705) (373) (301) (9) (715) (93) (138) 11 (1,539) 31 (1,562) (26)

FRINGE BENEFITS 741 33 312 204 184 2 (54) 16 (5) 21 (44) 4 50 15HEALTH CARE ACCESS (213) (92) (23) (6) (33) 0 (53) (5) 0 (1) 0 0 0 0SUPPLIES (1,989) (824) (66) (134) (388) 0 (456) (3) (3) (6) (58) (0) (31) (20)OTHER SERVICES (1,061) (25) 69 (36) 153 (2) (315) (43) (4) (3) (164) (44) (663) 17PURCHASED SERVICES (3,320) 154 (373) (272) (302) 59 (104) 7 (6) (8) (736) (20) (1,717) (2)

TOTAL OPER EXPENSES (11,949) (1,440) (786) (617) (687) 51 (1,697) (120) (157) 14 (2,542) (28) (3,923) (17)

EBITDA 1,431 1,261 2,132 1,001 1,526 51 (161) (31) (13) 163 (865) 9 (3,653) 10

DEPRECIATION/AMORT (923) (78) (1) (36) (465) (0) (262) (0) (8) 0 92 0 (166) 0INTEREST EXPENSE (279) 12 180 6 (142) 0 (386) 2 0 0 12 0 36 0GAIN(LOSS) FROM OPER 20 1,195 2,311 972 920 51 (809) (29) (22) 163 (970) 9 (3,782) 10

NON OPERATING REV INT EARN & REALIZED GAIN (489) (434) (60) 0 10 0 0 0 0 0 0 (6) 0 1 UNREALIZED GAIN(LOSS) 7,239 7,205 0 0 0 0 0 0 0 0 0 34 0 0 UNREALIZED GAIN(LOSS) ON SWAP 0 0 0 0 0 0 0 0 0 0 0 0 0 0 OTHER NON OPER REV 62 197 0 0 1 0 0 (16) (42) (59) 0 (19) 0 0 RESTRICTED GIFTS 808 1 0 0 0 0 0 0 0 0 0 807 0 0TOTAL NON OPER REV 7,619 6,968 (60) 0 11 0 0 (16) (42) (59) 0 815 0 1

EXCESS OF REV / EXPS 7,639 8,163 2,252 972 931 51 (809) (45) (64) 104 (970) 824 (3,782) 12

Page B.9

LEE MEMORIAL HEALTH SYSTEMCONSOLIDATING INCOME STATEMENTACTUAL DOLLARS - IN THOUSANDSFOR THE 4 MONTHS ENDED JANUARY 31, 2011

OP HOME ALL CORP ALL SYSTEM LMH HPMC CCH GCMC TRAUMA CENTERS HPCC HEALTH REHAB PHYSICIANS FOUND SVS OTHERS

INPATIENT REVENUE 914,774 188,392 265,401 162,952 285,817 0 370 4,974 0 6,868 0 0 0 0OUTPATIENT REVENUE 514,652 74,808 98,979 89,809 78,894 2,440 61,152 0 3,557 88 104,915 0 10 0TOTAL PATIENT REVENUE 1,429,426 263,200 364,380 252,761 364,711 2,440 61,523 4,974 3,557 6,956 104,915 0 10 0

DED FROM REV-MEDICARE 528,015 94,502 127,591 110,661 167,177 0 25,560 336 149 2,039 0 0 0 0DED FROM REV-MEDICAID 149,616 24,281 63,522 25,017 31,523 0 5,150 57 66 0 0 0 0 0DED FROM REV-CHARITY 46,206 19,168 10,574 9,845 5,998 0 460 61 101 0 0 0 0 0DED FROM REV-HMO/PPO 130,759 21,306 39,172 25,199 37,406 0 7,162 0 142 371 0 0 0 0DED FROM REV-OTHER 142,603 22,415 18,865 13,345 20,192 1,358 4,830 203 0 (0) 61,394 0 0 0DED FROM REV-BAD DEBT 51,126 12,388 5,958 8,420 12,070 810 1,140 31 19 79 10,212 0 0 0TOTAL DED FROM REV 1,048,325 194,060 265,681 192,488 274,365 2,168 44,302 688 477 2,489 71,606 0 0 0

NET PATIENT REVENUE 381,101 69,140 98,699 60,272 90,345 272 17,221 4,286 3,080 4,467 33,309 0 10 0OTHER OPER REV 6,177 261 402 411 362 120 255 29 172 0 259 946 1,281 1,679

TOTAL OPERATING REV 387,278 69,401 99,101 60,684 90,708 392 17,475 4,315 3,252 4,467 33,568 946 1,291 1,679

OPERATING EXPENSES PROD SALARIES 148,242 18,541 27,769 17,792 24,898 1,019 5,557 1,962 2,279 1,697 28,422 382 17,012 913 PROD OVERTIME 6,032 1,182 1,641 821 1,793 0 74 150 9 31 116 0 209 4 CONTRACT LABOR 474 27 97 140 129 0 1 48 4 21 0 0 5 0 NON-PROD SALARIES 18,841 2,209 3,321 2,005 2,619 438 595 195 242 197 3,702 32 3,163 122TOTAL SALARIES & WAGES 173,589 21,960 32,828 20,759 29,439 1,458 6,227 2,355 2,535 1,947 32,240 414 20,389 1,039

FRINGE BENEFITS 26,631 4,643 5,080 3,280 4,543 116 1,013 366 385 328 3,351 62 3,249 215HEALTH CARE ACCESS 4,826 1,028 1,300 873 1,248 0 195 156 0 26 0 0 0 0SUPPLIES 80,744 18,031 20,484 13,907 22,681 3 3,005 287 49 107 1,159 8 578 445OTHER SERVICES 22,013 2,101 2,261 2,013 2,413 19 2,106 95 209 15 3,126 284 7,214 156PURCHASED SERVICES 37,963 2,217 3,595 2,998 6,671 556 271 344 100 28 11,783 61 9,297 43

TOTAL OPER EXPENSES 345,765 49,980 65,548 43,830 66,995 2,151 12,817 3,603 3,278 2,452 51,659 828 40,727 1,897

EBITDA 41,513 19,421 33,553 16,854 23,712 (1,760) 4,659 712 (26) 2,015 (18,091) 118 (39,436) (218)

DEPRECIATION/AMORT 21,173 2,404 4,757 2,088 7,179 14 1,551 93 36 41 666 0 2,319 27INTEREST EXPENSE 9,813 424 1,463 1,044 5,442 0 1,171 28 0 0 218 0 23 0GAIN(LOSS) FROM OPER 10,526 16,594 27,334 13,722 11,091 (1,773) 1,937 591 (62) 1,974 (18,974) 118 (41,778) (246)

NON OPERATING REV INT EARN & REALIZED GAIN 3,987 3,902 (46) 7 47 0 0 0 0 0 0 56 0 20 UNREALIZED GAIN (LOSS) 14,425 14,332 0 0 0 0 0 0 0 0 0 93 0 0 UNREALIZED GAIN (LOSS) ON SWAP 905 905 0 0 0 0 0 0 0 0 0 0 0 0 OTHER NON OPER REV (25,107) (738) 0 0 (24,786) 0 (33) 135 269 97 0 (51) 0 0 RESTRICTED GIFTS 2,969 0 0 0 0 0 0 0 0 0 0 2,969 0 0TOTAL NON OPER REV (2,821) 18,402 (46) 8 (24,739) 0 (33) 135 269 97 0 3,067 0 20

EXCESS REV/EXPS 7,705 34,995 27,288 13,730 (13,648) (1,773) 1,903 725 207 2,070 (18,974) 3,185 (41,778) (225)

Page B.10

LEE MEMORIAL HEALTH SYSTEMCONSOLIDATING INCOME STATEMENTACTUAL TO BUDGET DOLLAR VARIANCE - IN THOUSFOR THE 4 MONTH ENDED JANUARY 31, 2011


INPATIENT REVENUE 50,750 8,831 3,821 9,908 29,607 0 52 (110) 0 (1,358) 0 0 0 0OUTPATIENT REVENUE 6,996 4,875 (130) 664 (8,063) 65 3,893 0 (84) 62 5,704 0 10 0TOTAL PATIENT REVENUE 57,746 13,706 3,691 10,572 21,544 65 3,945 (110) (84) (1,296) 5,704 0 10 0

DED FROM REV-MEDICARE (15,552) (2,483) 2,584 (4,258) (8,291) 0 (3,947) 336 (40) 549 0 0 0 0DED FROM REV-MEDICAID 59 (1,420) 1,666 (1,495) 472 0 826 (12) 20 0 0 0 0 0DED FROM REV-CHARITY (1,095) (442) 340 (335) (1,030) 0 351 (2) 24 0 0 0 0 0DED FROM REV-HMO/PPO (9,943) (1,138) (1,655) (2,808) (5,237) 0 515 0 36 343 0 0 0 0DED FROM REV-OTHER (18,847) (2,575) (4,832) (1,247) (3,560) (859) (483) (62) 11 0 (5,240) 0 0 0DED FROM REV-BAD DEBT (1,361) (565) (49) (342) (1,775) 448 176 20 3 67 656 0 0 0TOTAL DED FROM REV (46,741) (8,624) (1,946) (10,485) (19,421) (411) (2,562) 279 54 959 (4,584) 0 0 0

NET PATIENT REVENUE 11,006 5,082 1,744 87 2,122 (346) 1,383 169 (30) (337) 1,121 0 10 0OTHER OPER REV (164) (18) 21 (28) (34) 68 (31) 7 (31) 0 (76) 148 (181) (10)TOTAL OPERATING REV 10,842 5,065 1,765 59 2,088 (277) 1,352 176 (61) (337) 1,045 148 (172) (10)

OPERATING EXPENSES PROD SALARIES (6,475) (1,382) (769) (769) (962) (84) (207) (138) (207) 114 (1,490) 34 (644) 29 PROD OVERTIME (231) (153) 112 18 121 68 (54) (17) (9) (11) (105) (0) (196) (4) CONTRACT LABOR 237 75 79 (2) 114 0 (1) (48) 4 20 0 0 (5) 0 NON-PROD SALARIES 633 52 (175) 56 170 (15) 96 (0) (24) 95 67 45 268 (2)TOTAL SALARIES & WAGES (5,836) (1,407) (754) (698) (557) (31) (165) (203) (237) 219 (1,527) 78 (576) 22

FRINGE BENEFITS 1,743 646 557 320 353 (116) 45 (31) (36) 61 203 14 (238) (34)HEALTH CARE ACCESS (303) (175) 34 (87) (36) 0 (24) (24) 0 8 0 0 0 0SUPPLIES (2,434) (1,429) 1,190 (770) (1,877) 1 35 7 1 6 90 5 326 (19)OTHER SERVICES (257) 27 195 (15) 162 9 253 14 (18) (1) 60 71 (1,065) 50PURCHASED SERVICES (959) (277) (439) (464) 5 111 149 76 4 29 (34) 8 (133) 5

TOTAL OPER EXPENSES (8,046) (2,616) 783 (1,712) (1,950) (25) 294 (162) (286) 323 (1,209) 177 (1,686) 24

EBITDA 2,795 2,449 2,547 (1,653) 139 (302) 1,646 14 (346) (14) (164) 325 (1,858) 15

DEPRECIATION/AMORT (861) 584 24 (71) (28) 5 (570) 0 (17) (1) 50 0 (836) (0)INTEREST EXPENSE (598) (217) (301) (112) (185) 0 44 (14) 0 0 (13) 0 201 0GAIN(LOSS) FROM OPER 1,337 2,815 2,270 (1,836) (75) (298) 1,120 (0) (364) (15) (127) 325 (2,494) 15

NON OPERATING REV INT EARN & REALIZED GAIN (2,189) (2,279) 12 7 46 0 0 0 0 0 0 18 0 7 UNREALIZED GAIN(LOSS) 10,701 10,609 0 0 0 0 0 0 0 0 0 92 0 0 UNREALIZED GAIN(LOSS) ON SWAP 905 905 0 0 0 0 0 0 0 0 0 0 0 0 OTHER NON OPER REV (26,177) (1,839) 0 0 (24,803) 0 (33) 135 251 97 0 16 0 0 RESTRICTED GIFTS 2,641 2 0 0 0 0 0 0 0 0 0 2,639 0 0TOTAL NON OPER REV (14,118) 7,399 12 8 (24,757) 0 (33) 135 251 97 0 2,764 0 7

EXCESS OF REV / EXPS (12,781) 10,215 2,282 (1,828) (24,832) (298) 1,087 135 (113) 82 (127) 3,089 (2,494) 22

Page B.11

LEE MEMORIAL HEALTH SYSTEMCONSOLIDATING INCOME STATEMENTACTUAL TO PRIOR YEAR DOLLAR VARIANCE - IN THOUSFOR THE 4 MONTHS ENDED JANUARY 31, 2011


INPATIENT REVENUE 111,473 20,462 35,492 14,450 40,436 0 155 142 0 338 0 0 0 0OUTPATIENT REVENUE 35,603 6,400 380 3,339 (13,411) 202 22,089 0 534 36 16,024 0 10 0TOTAL PATIENT REVENUE 147,077 26,862 35,872 17,788 27,024 202 22,244 142 534 375 16,024 0 10 0

DED FROM REV-MEDICARE (59,280) (9,615) (13,701) (10,904) (14,159) 0 (11,098) 299 (146) 45 0 0 0 0DED FROM REV-MEDICAID (11,715) (499) (6,264) (3,104) 453 0 (2,317) 2 14 0 0 0 0 0DED FROM REV-CHARITY (5,674) (1,537) (1,433) (1,281) (1,321) 0 (106) 0 5 0 0 0 0 0DED FROM REV-HMO/PPO (623) 1,177 (503) 484 903 0 (2,651) 0 33 (67) 0 0 0 0DED FROM REV-OTHER (30,222) (6,055) (7,185) (234) (3,470) (101) (2,156) (87) 8 0 (10,942) 0 0 0DED FROM REV-BAD DEBT (6,746) (333) (686) (625) (2,841) (385) (477) (4) (5) 11 (1,400) 0 0 0TOTAL DED FROM REV (114,260) (16,863) (29,773) (15,664) (20,434) (486) (18,805) 210 (91) (12) (12,341) 0 0 0

NET PATIENT REVENUE 32,817 9,999 6,099 2,124 6,590 (284) 3,438 352 443 363 3,682 0 10 0OTHER OPER REV 759 (1) 34 27 3 (6) (9) 9 (6) 0 21 195 504 (13)TOTAL OPERATING REV 33,575 9,998 6,133 2,152 6,593 (290) 3,429 361 438 363 3,704 195 514 (13)

OPERATING EXPENSES PROD SALARIES (15,345) (1,341) (1,347) (920) (805) (28) (1,916) (89) (457) 28 (4,996) (85) (3,387) (2) PROD OVERTIME (1,069) (224) (495) (103) (53) 0 (30) (5) (4) 4 (47) 0 (113) 1 CONTRACT LABOR 76 (0) 26 (49) 61 0 (1) (48) 100 (11) 4 0 (5) 0 NON-PROD SALARIES (1,653) (215) (367) (74) 11 (94) (105) (24) (43) 14 (128) 59 (678) (8)TOTAL SALARIES & WAGES (17,992) (1,779) (2,183) (1,146) (786) (122) (2,052) (166) (405) 34 (5,168) (25) (4,183) (10)

FRINGE BENEFITS (36) (459) 359 232 402 (4) (342) 32 (37) 44 (146) (0) (145) 28HEALTH CARE ACCESS (57) 39 87 164 (124) 0 (195) (27) 0 (2) 0 0 0 0SUPPLIES (4,238) (2,099) (313) (464) (1,211) (0) (1,245) 4 (10) (1) (130) 0 1,292 (61)OTHER SERVICES (1,782) (226) (196) (217) 675 2 (97) (42) (21) (10) (412) (96) (1,190) 47PURCHASED SERVICES (4,125) (227) (487) (540) (654) 21 (396) 49 3 5 (2,048) (38) 201 (15)

TOTAL OPER EXPENSES (28,230) (4,751) (2,733) (1,972) (1,697) (103) (4,327) (150) (471) 72 (7,904) (159) (4,025) (10)

EBITDA 5,346 5,247 3,400 180 4,896 (393) (898) 210 (33) 435 (4,200) 36 (3,511) (23)

DEPRECIATION/AMORT (2,777) (95) (3) (104) (1,674) (0) (539) 2 (33) 0 34 0 (366) 0INTEREST EXPENSE (494) 49 84 10 (644) 0 (36) 8 0 0 39 0 (4) 0GAIN(LOSS) FROM OPER 1,928 5,201 3,481 86 2,578 (393) (1,473) 220 (66) 435 (4,273) 36 (3,881) (23)

NON OPERATING REV INT EARN & REALIZED GAIN 604 620 (63) (3) 32 0 0 0 0 0 0 15 0 4 UNREALIZED GAIN(LOSS) 10,622 10,531 0 0 0 0 0 0 0 0 0 91 0 0 UNREALIZED GAIN(LOSS) ON SWAP 677 677 0 0 0 0 0 0 0 0 0 0 0 0 OTHER NON OPER REV (25,686) (674) 0 0 (24,718) 0 (33) (39) (41) (172) 0 (9) 0 0 RESTRICTED GIFTS 2,918 5 0 0 0 0 0 0 0 0 0 2,913 0 0TOTAL NON OPER REV (13,783) 11,153 (63) (3) (24,686) 0 (33) (39) (41) (172) 0 96 0 4

EXCESS OF REV / EXPS (11,855) 16,354 3,418 83 (22,108) (393) (1,506) 181 (107) 263 (4,273) 132 (3,881) (19)

Page B.12

LEE MEMORIAL HEALTH SYSTEMOPERATING RATIOSFOR THE MONTH ENDED JANUARY 31, 2011

OP HOME ALL ALL SYSTEM LMH HPMC CCH GCMC CENTERS HPCC HEALTH REHAB PHYSICIANS FOUND OTHERS

AS % NET OPER REVWAGES & BENEFITS ACTUAL 52.7% 40.6% 38.9% 39.7% 37.8% 42.4% 67.2% 100.9% 50.1% 109.3% 56.2% 68.0% BUDGET 53.1% 43.5% 39.2% 40.1% 38.5% 44.2% 60.9% 80.8% 54.1% 112.3% 73.8% 71.6% PRIOR YR 54.6% 43.3% 42.2% 42.9% 41.0% 38.8% 65.6% 101.0% 59.7% 112.7% 85.6% 69.7%

SUPPLIES ACTUAL 20.8% 26.6% 20.9% 21.1% 23.9% 18.9% 6.4% 1.4% 2.5% 3.6% 0.6% 25.9% BUDGET 20.9% 25.6% 22.8% 20.9% 23.1% 18.3% 6.9% 1.5% 2.2% 3.7% 1.6% 23.7% PRIOR YR 21.7% 25.9% 23.2% 22.5% 24.6% 13.8% 6.7% 1.3% 2.2% 3.6% 0.6% 23.1%

ALL OTHER OPER EXPENSES ACTUAL 16.8% 7.4% 8.1% 10.5% 10.7% 12.8% 14.5% 10.3% 1.7% 44.9% 36.5% 8.6% BUDGET 15.7% 8.2% 6.9% 8.4% 10.6% 17.4% 15.4% 8.3% 2.1% 44.7% 53.5% 12.3% PRIOR YR 14.2% 9.2% 7.8% 9.5% 11.0% 4.4% 11.7% 10.9% 0.8% 42.9% 10.4% 12.1%

CAPITAL COSTS ACTUAL 7.3% 4.1% 5.4% 5.0% 13.1% 9.5% 2.7% 1.1% 0.8% 2.1% 0.0% 1.4% BUDGET 7.4% 4.7% 5.8% 4.6% 12.7% 12.8% 2.5% 0.5% 0.8% 2.8% 0.0% 1.5% PRIOR YR 7.0% 4.4% 6.9% 5.3% 11.7% 0.1% 3.1% 0.1% 0.9% 1.2% 0.0% 1.5%

EBITDA MARGIN ACTUAL 9.7% 25.5% 32.1% 28.7% 27.5% 25.9% 11.9% -12.5% 45.8% -57.7% 6.7% -2.5% BUDGET 10.3% 22.7% 31.2% 30.6% 27.8% 20.2% 16.7% 9.4% 41.6% -60.7% -29.0% -7.6% PRIOR YR 9.5% 21.6% 26.9% 25.1% 23.4% 43.1% 15.9% -13.2% 37.2% -59.1% 3.4% -4.9%

OPERATING MARGIN ACTUAL 2.4% 21.3% 26.7% 23.7% 14.4% 16.4% 9.2% -13.7% 45.0% -59.9% 6.7% -3.9% BUDGET 2.9% 18.0% 25.4% 26.0% 15.2% 7.4% 14.2% 8.8% 40.8% -63.5% -29.0% -9.1% PRIOR YR 2.5% 17.2% 20.0% 19.7% 11.7% 42.9% 12.8% -13.3% 36.3% -60.3% 3.4% -6.4%

EXCESS MARGIN ACTUAL 6.3% 36.1% 26.5% 23.8% 14.2% 16.4% 11.4% -3.9% 46.5% -59.9% 1.6% -2.9% BUDGET 5.8% 34.0% 25.3% 26.0% 15.2% 7.4% 14.2% 9.4% 40.8% -63.5% 9.0% -8.5% PRIOR YR -0.2% 1.2% 20.0% 19.8% 11.4% 42.9% 17.1% 4.5% 44.7% -60.3% -30.4% -5.5%

PER CMI ADJ ADMIT / VISITNET OPER REV ACTUAL 6,773 6,449 6,742 5,953 6,516 950 14,527 2,248 11,826 174 15 32 BUDGET 6,903 6,714 7,140 5,906 6,613 851 15,060 2,581 10,643 180 14 31 PRIOR YR 6,319 6,214 6,375 5,427 5,858 749 11,830 2,348 9,604 182 13 33

TOTAL EXPENSES ACTUAL 6,611 5,072 4,945 4,539 5,576 794 13,189 2,556 6,504 278 14 33 BUDGET 6,701 5,507 5,325 4,369 5,608 788 12,927 2,353 6,300 294 18 34 PRIOR YR 6,160 5,145 5,102 4,355 5,171 428 10,312 2,661 6,120 293 13 35

WAGES & BENEFITS ACTUAL 3,570 2,617 2,624 2,362 2,461 403 9,758 2,268 5,919 190 8 22 BUDGET 3,665 2,923 2,797 2,368 2,545 376 9,175 2,086 5,760 202 10 22 PRIOR YR 3,448 2,689 2,687 2,328 2,402 291 7,762 2,372 5,736 206 11 23

Page B.13

LEE MEMORIAL HEALTH SYSTEMOPERATING RATIOSFOR THE MONTH ENDED JANUARY 31, 2011

OP HOME ALL ALL SYSTEM LMH HPMC CCH GCMC CENTERS HPCC HEALTH REHAB PHYSICIANS FOUND OTHERS

SUPPLIES ACTUAL 1,411 1,713 1,407 1,255 1,560 179 932 31 290 6 0 8 BUDGET 1,443 1,720 1,626 1,236 1,526 156 1,046 38 235 7 0 7 PRIOR YR 1,373 1,610 1,481 1,221 1,440 103 796 30 214 7 0 8

ALL OTHER OPER EXPENSES ACTUAL 1,138 475 549 626 700 122 2,107 232 199 78 5 3 BUDGET 1,085 549 490 496 700 148 2,326 215 220 80 7 4 PRIOR YR 897 570 494 517 644 33 1,387 257 80 78 1 4

CAPITAL COSTS ACTUAL 492 268 366 296 855 91 392 25 95 4 0 0 BUDGET 507 315 412 269 837 109 379 14 84 5 0 0 PRIOR YR 442 275 440 289 685 1 368 3 90 2 0 0

OPERATING MARGIN ACTUAL 163 1,377 1,797 1,414 940 156 1,337 (308) 5,321 (104) 1 (1) BUDGET 202 1,208 1,815 1,537 1,005 63 2,133 228 4,343 (114) (4) (3) PRIOR YR 159 1,069 1,273 1,071 686 322 1,518 (313) 3,484 (110) 0 (2)

EXCESS MARGIN ACTUAL 500 2,871 1,785 1,414 926 156 1,702 (96) 5,643 (104) 50 (1) BUDGET 399 2,286 1,808 1,537 1,006 63 2,133 244 4,343 (114) 1 (3) PRIOR YR (13) 72 1,276 1,072 669 322 2,021 107 4,294 (110) (4) (2)

LABORPROD FTEs/ADJ DAILY ADMIT ACTUAL 21.84 19.52 17.52 15.73 18.56 2.09 60.56 8.86 32.13 0.42 0.04 0.22 BUDGET 22.54 20.28 18.10 15.07 18.43 2.02 61.30 9.50 33.15 0.53 0.05 0.24 PRIOR YR 21.42 19.66 17.43 14.95 18.22 1.51 62.91 9.65 35.08 0.49 0.04 0.22

NON PROD AS % PAID ACTUAL 9.01% 9.02% 9.62% 9.07% 8.50% 7.98% 8.23% 9.97% 9.63% 8.32% 7.96% 10.47% BUDGET 9.24% 9.41% 9.34% 9.30% 8.59% 9.98% 9.90% 10.29% 12.94% 7.76% 10.22% 9.71% PRIOR YR 9.32% 10.07% 9.87% 9.33% 8.67% 6.50% 8.57% 8.59% 10.05% 8.27% 5.80% 10.52%

AVG HOURLY RATE ACTUAL 32.18 28.64 28.59 27.11 27.02 27.02 22.78 35.23 28.39 62.88 41.01 18.91 BUDGET 30.82 28.70 28.06 26.74 27.28 24.98 20.49 30.04 28.00 55.03 37.03 17.63 PRIOR YR 30.52 27.49 27.91 26.70 27.04 26.20 20.67 33.53 26.80 56.53 65.14 18.39

OP REV % OF TOTAL REVENUE ACTUAL 34.9% 28.3% 25.1% 34.5% 20.3% 99.1% N/A 100.0% 1.1% 100.0% N/A N/A BUDGET 36.0% 27.9% 26.8% 36.2% 23.5% 99.5% N/A 100.0% 0.3% 100.0% N/A N/A PRIOR YR 35.7% 30.2% 28.7% 34.6% 25.5% 99.2% N/A 100.0% 0.7% 100.0% N/A N/A

Page B.14

LEE MEMORIAL HEALTH SYSTEMOPERATING RATIOSFOR THE 4 MONTHS ENDED JANUARY 31, 2011

OP HOME ALL ALLSYSTEM LMH HPMC CCH GCMC CENTERS HPCC HEALTH REHAB PHYSICIANS FOUND OTHERS

AS % NET OPER REVWAGES & BENEFITS ACTUAL 51.7% 40.4% 38.3% 39.6% 37.5% 41.4% 63.1% 89.8% 50.9% 106.0% 50.3% 74.7% BUDGET 52.1% 41.9% 38.7% 39.0% 38.1% 44.2% 60.1% 79.9% 53.2% 105.4% 71.2% 73.5% PRIOR YR 51.5% 43.0% 38.8% 39.5% 39.9% 34.5% 65.4% 88.1% 57.4% 101.4% 59.9% 75.2%

SUPPLIES ACTUAL 20.8% 25.8% 20.7% 22.9% 25.0% 17.2% 6.7% 1.5% 2.4% 3.5% 0.8% 26.5% BUDGET 20.8% 25.5% 22.3% 21.7% 23.5% 18.9% 7.1% 1.5% 2.3% 3.8% 1.6% 25.2% PRIOR YR 21.6% 26.5% 21.7% 23.0% 25.5% 12.5% 7.4% 1.4% 2.6% 3.4% 1.0% 22.7%

ALL OTHER OPER EXPENSES ACTUAL 16.7% 8.5% 7.2% 9.7% 11.4% 14.6% 13.8% 9.5% 1.6% 44.4% 36.5% 11.8% BUDGET 16.8% 8.6% 7.1% 8.8% 11.8% 18.3% 15.9% 8.9% 2.2% 45.9% 53.2% 15.1% PRIOR YR 16.6% 9.2% 7.1% 9.0% 12.2% 13.1% 14.5% 10.3% 1.6% 41.7% 28.1% 13.7%

CAPITAL COSTS ACTUAL 7.9% 4.1% 6.3% 5.2% 13.9% 12.4% 2.8% 1.1% 0.9% 2.6% 0.0% 1.6% BUDGET 7.8% 4.9% 6.1% 4.9% 14.0% 11.9% 2.6% 0.6% 0.8% 2.8% 0.0% 1.6% PRIOR YR 7.5% 4.7% 6.8% 5.2% 12.2% 7.4% 3.3% 0.1% 1.0% 2.7% 0.0% 1.6%

EBITDA MARGIN ACTUAL 10.7% 25.3% 33.9% 27.8% 26.1% 26.8% 16.5% -0.8% 45.1% -53.9% 12.4% -13.0% BUDGET 10.3% 23.9% 31.9% 30.5% 26.6% 18.7% 16.9% 9.7% 42.2% -55.1% -26.0% -13.8% PRIOR YR 10.2% 21.3% 32.4% 28.5% 22.4% 39.8% 12.7% 0.3% 38.5% -46.5% 10.9% -11.5%

OPERATING MARGIN ACTUAL 2.9% 21.2% 27.6% 22.6% 12.2% 14.4% 13.7% -1.9% 44.2% -56.5% 12.4% -14.6% BUDGET 2.5% 18.9% 25.8% 25.7% 12.6% 6.7% 14.3% 9.1% 41.4% -58.0% -26.0% -15.4% PRIOR YR 2.8% 16.7% 25.7% 23.3% 10.1% 32.4% 9.4% 0.1% 37.5% -49.2% 10.9% -13.2%

EXCESS MARGIN ACTUAL 1.4% 37.7% 27.5% 22.6% -20.7% 14.2% 16.3% 5.9% 45.4% -56.5% 5.4% -13.3% BUDGET 5.5% 35.9% 25.7% 25.7% 12.6% 6.7% 14.3% 9.7% 41.4% -58.0% 12.0% -14.6% PRIOR YR 5.0% 28.7% 25.7% 23.3% 10.1% 32.4% 13.8% 11.2% 44.0% -49.2% 18.6% -12.2%

PER CMI ADJ ADMIT / VISITNET OPER REV ACTUAL 6,799 6,688 6,808 5,822 6,554 931 17,540 2,370 10,536 175 17 29 BUDGET 6,890 6,812 7,012 5,787 6,590 850 15,445 2,606 10,676 181 15 31 PRIOR YR 6,565 6,303 6,725 5,657 6,210 817 14,754 2,601 9,522 186 14 31

TOTAL EXPENSES ACTUAL 6,604 5,268 4,930 4,506 5,753 797 15,138 2,415 5,881 275 15 34 BUDGET 6,717 5,523 5,207 4,302 5,760 793 13,240 2,368 6,257 286 18 36 PRIOR YR 6,384 5,253 4,999 4,339 5,582 552 13,371 2,597 5,953 278 12 36

WAGES & BENEFITS ACTUAL 3,515 2,700 2,604 2,306 2,455 386 11,061 2,128 5,366 186 8 22 BUDGET 3,590 2,857 2,717 2,259 2,512 375 9,280 2,082 5,679 191 10 23 PRIOR YR 3,382 2,708 2,610 2,235 2,481 282 9,652 2,290 5,461 189 8 24

Page B.15

LEE MEMORIAL HEALTH SYSTEMOPERATING RATIOSFOR THE 4 MONTHS ENDED JANUARY 31, 2011

OP ALL CORPSYSTEM LMH HPMC CCH GCMC CENTERS HPCC HH REHAB PHYSICIANS FOUND SVC

SUPPLIES ACTUAL 1,418 1,728 1,407 1,334 1,639 160 1,168 36 253 6 0 8 BUDGET 1,433 1,740 1,561 1,254 1,547 160 1,099 39 250 7 0 8 PRIOR YR 1,420 1,672 1,459 1,299 1,585 102 1,088 36 247 6 0 7

ALL OTHER OPER EXPENSES ACTUAL 1,137 567 492 564 747 136 2,417 225 165 78 6 3 BUDGET 1,158 589 500 508 778 156 2,462 232 237 83 8 5 PRIOR YR 1,091 580 475 511 755 107 2,144 268 149 78 4 4

CAPITAL COSTS ACTUAL 534 272 427 300 912 115 492 26 97 5 0 0 BUDGET 536 337 428 281 923 102 399 15 90 5 0 0 PRIOR YR 491 293 456 294 761 60 488 3 96 5 0 1

OPERATING MARGIN ACTUAL 195 1,420 1,878 1,317 801 134 2,401 (45) 4,655 (99) 2 (4) BUDGET 173 1,289 1,806 1,485 830 57 2,205 237 4,419 (105) (4) (5) PRIOR YR 181 1,050 1,725 1,318 629 265 1,384 4 3,569 (92) 2 (4)

EXCESS MARGIN ACTUAL 145 3,183 1,875 1,317 (986) 132 2,949 151 4,883 (99) 56 (4) BUDGET 380 2,442 1,801 1,485 832 57 2,205 252 4,419 (105) 2 (5) PRIOR YR 330 1,810 1,727 1,319 625 265 2,030 291 4,192 (92) 3 (4)

LABORPROD FTEs/ADJ DAILY ADMIT ACTUAL 22.80 20.51 17.45 16.05 19.22 2.18 75.34 9.22 34.93 1.91 0.05 0.23 BUDGET 23.15 21.02 18.26 14.93 18.99 2.08 63.31 9.84 34.65 2.14 0.05 0.25 PRIOR YR 22.61 21.76 17.89 14.95 19.69 1.57 66.88 10.02 35.32 2.11 0.04 0.25

NON PROD AS % PAID ACTUAL 9.20% 9.47% 9.65% 9.45% 8.74% 9.10% 8.35% 10.04% 10.20% 7.98% 7.67% 10.85% BUDGET 9.59% 9.79% 9.67% 9.80% 9.13% 10.11% 10.18% 10.45% 13.23% 7.86% 10.34% 9.86% PRIOR YR 9.27% 9.36% 9.52% 9.53% 8.75% 10.34% 8.33% 9.54% 10.48% 8.27% 7.32% 10.12%

AVG HOURLY RATE ACTUAL 29.52 26.69 26.77 25.37 25.46 24.15 20.38 31.54 25.59 56.23 36.10 17.24 BUDGET 29.18 26.81 26.81 25.51 25.90 24.18 19.94 28.79 26.14 51.27 35.91 16.91 PRIOR YR 28.40 26.00 26.09 25.10 25.05 24.26 19.59 31.09 25.27 51.02 41.02 16.85

OP REV % OF TOTAL REVENUE ACTUAL 36.0% 29.1% 27.2% 35.5% 21.6% 99.4% 0.0% 100.0% 1.3% 100.0% N/A 100.0% BUDGET 37.0% 28.7% 27.5% 36.8% 25.3% 99.4% 0.0% 100.0% 0.3% 100.0% N/A N/A PRIOR YR 37.4% 29.6% 30.0% 36.8% 27.3% 99.5% 0.0% 100.0% 0.8% 100.0% N/A N/A

Page B.16

LEE MEMORIAL HEALTH SYSTEMFOR THE PERIOD ENDING: JANUARY 31, 2011CONSOLIDATED STAFFING SUMMARY

OP ALL ALLSYSTEM LMH HP CCH GCMC TRAUMA CENTERS HPCC HH REHAB PHYSICIANS FOUND CORP OTHERS

MONTH TO DATE

BUDGET 8,413.23 1,194.80 1,735.59 1,167.53 1,677.90 19.14 359.08 155.83 113.90 119.50 856.39 19.50 904.64 89.44

ACTUAL 8,342.38 1,254.03 1,749.89 1,183.16 1,678.25 19.89 369.57 163.92 112.95 107.84 775.70 15.36 827.97 83.84

DIFFERENCE 70.85 (59.23) (14.30) (15.63) (0.35) (0.75) (10.49) (8.09) 0.95 11.66 80.69 4.14 76.67 5.60

YEAR TO DATE

BUDGET 8,180.08 1,147.27 1,702.37 1,118.69 1,586.51 19.14 356.64 153.56 113.58 117.89 852.35 19.50 903.35 89.23

ACTUAL 8,366.26 1,228.29 1,744.88 1,164.02 1,645.35 20.08 366.82 164.40 114.36 108.24 815.70 16.31 892.10 85.70

DIFFERENCE (186.18) (81.02) (42.51) (45.33) (58.85) (0.94) (10.19) (10.84) (0.78) 9.65 36.66 3.19 11.25 3.53

Page B.17

LMH/HP CCH GCMC HPCC HHA HBP/LPG TOTALGross A/R 161,948 48,930 120,098 1,674 1,269 39,633 373,553Allowances 64,618 24,709 72,157 240 32 32,374 194,130Net A/R 97,330 24,220 47,941 1,434 1,237 7,260 179,423

Net Revenue Per Day 1,591 504 752 35 25 286 3,193

Net Days in A/R Current Month 61.2 48.1 63.8 40.5 49.1 25.4 56.2 Net Days in A/R Same Month Prior Yr 59.4 48.4 55.4 45.9 72.1 39.0 54.7 % Change 3.8% 2.2% -7.1% 3.1% 31.5% 12.6%

In Thousands (000)January 31, 2011

Summary of Accounts ReceivableLEE MEMORIAL HEALTH SYSTEM

Page B.18


LEE COUNTY, FLORIDA

UNCONSOLIDATED

FINANCIAL STATEMENTS AND

STATISTICAL REPORTS

JANUARY 31, 2011


UNCONSOLIDATED

TABLE OF CONTENTS

SECTION C

PAGE LEESAR REGIONAL SERVICE CENTER C.1 ACCESS MEDICAL SOUTH, LC C.2 BONITA COMMUNITY HEALTH CENTER, INC. C.3

VAR VAR % VAR % VAR VAR % VAR %BUDGET ACTUAL PRIOR YR ACT TO BUD ACT TO BUD PR YR BUDGET ACTUAL PRIOR YR ACT TO BUD ACT TO BUD PR YR

TOTAL SALES 14,158,922 13,863,473 11,617,300 (295,449) -2.1% 19.3% 53,502,228 52,932,128 43,514,629 (570,100) -1.1% 21.6%

COST OF GOODS SOLD 12,959,370 12,642,398 10,660,781 316,972 2.4% -18.6% 48,825,557 48,216,149 39,674,229 609,408 1.2% -21.5% GROSS PROFIT 1,199,552 1,221,075 956,519 21,523 1.8% 27.7% 4,676,671 4,715,979 3,840,400 39,308 0.8% 22.8%

OTHER OPERATING REVENUE 1,336 379 30,392 (957) -71.6% -98.8% 5,344 1,171 32,389 (4,173) -78.1% -96.4%

TOTAL OPERATING REVENUE 1,200,888 1,221,454 986,911 20,566 1.7% 23.8% 4,682,015 4,717,150 3,872,789 35,135 0.8% 21.8%

OPERATING EXPENSES SALARIES/WAGES 417,170 380,833 381,858 36,337 8.7% 0.3% 1,704,225 1,605,202 1,522,624 99,023 5.8% -5.4% BENEFITS 137,657 167,506 128,996 (29,849) -21.7% -29.9% 548,035 549,027 518,356 (992) -0.2% -5.9% OTHER SUPPLIES 48,566 50,832 32,140 (2,266) -4.7% -58.2% 188,149 202,758 157,930 (14,609) -7.8% -28.4% OTHER SERVICES 164,239 157,569 152,271 6,670 4.1% -3.5% 657,381 596,076 592,346 61,305 9.3% -0.6% PURCHASED SERVICES 51,741 36,182 54,748 15,559 30.1% 33.9% 206,964 176,813 185,632 30,151 14.6% 4.8% DEPRECIATION/AMORTIZATION 65,501 62,549 65,630 2,952 4.5% 4.7% 262,004 249,079 256,203 12,925 4.9% 2.8%

TOTAL OPERATING EXPENSES 884,874 855,471 815,643 29,403 3.3% -4.7% 3,566,758 3,378,955 3,233,091 187,803 5.3% -4.5%

GAIN(LOSS) FROM OPERATIONS 316,014 365,983 171,268 49,969 15.8% 113.7% 1,115,257 1,338,195 639,698 222,938 20.0% 109.2%

INTEREST EARNINGS 1,750 2,048 1,649 298 17.0% 24.2% 7,000 9,018 4,824 2,018 28.8% 86.9% GAIN(LOSS) ON DISPOSITION 0 0 0 0 0.0% 0.0% 0 0 0 0 0.0% 0.0%

EXCESS OF REV OVER EXPENSES 317,764 368,031 172,917 50,267 15.8% 112.8% 1,122,257 1,347,213 644,522 224,956 20.0% 109.0%

Page C.1

LEESAR REGIONAL SERVICE CENTERCOMPARATIVE INCOME STATEMENT (UNAUDITED)


CURRENT MONTH YEAR TO DATE FISCAL 2011


NET PRODUCT REVENUE 205,446 244,827 196,377 39,381 19.2% 24.7% 819,117 906,647 794,171 87,530 10.7% 14.2%

COST OF PRODUCTS SOLD 43,985 57,518 40,767 (13,533) -30.8% -41.1% 175,315 228,705 167,708 (53,390) -30.5% -36.4%

GROSS PROFIT 161,461 187,309 155,610 25,848 16.0% 20.4% 643,802 677,942 626,463 34,140 5.3% 8.2%

OPERATING EXPENSES SALARIES/WAGES 68,109 71,609 67,759 (3,500) -5.1% -5.7% 280,769 275,615 265,517 5,154 1.8% -3.8% BENEFITS 18,097 18,159 15,420 (62) -0.3% -17.8% 69,503 71,165 65,795 (1,662) -2.4% -8.2% OTHER SERVICES 26,537 36,021 28,380 (9,484) -35.7% -26.9% 106,148 134,431 119,341 (28,283) -26.6% -12.6% BAD DEBT 16,433 21,974 15,310 (5,541) -33.7% -43.5% 65,497 71,113 70,037 (5,616) -8.6% -1.5% DEPREC, INTEREST, & AMORT 17,505 17,959 16,074 (454) -2.6% -11.7% 69,037 72,759 63,278 (3,722) -5.4% -15.0%

TOTAL OPERATING EXPENSES 146,681 165,722 142,943 (19,041) -13.0% -15.9% 590,954 625,083 583,968 (34,129) -5.8% -7.0%

GAIN(LOSS) FROM OPERATIONS 14,780 21,587 12,667 6,807 46.1% -70.4% 52,848 52,859 42,495 11 0.0% 24.4%

NON OPERATING REVENUE 0 0 0 0 #DIV/0! #DIV/0! 0 0 53 0 #DIV/0! -100.0%

EXCESS OF REV OVER EXPENSES 14,780 21,587 12,667 6,807 46.1% 70.4% 52,848 52,859 42,548 11 0.0% 24.2%

MINORITY INTEREST 7,390 10,794 6,334 3,404 46.1% 70.4% 26,424 26,430 21,274 6 0.0% 24.2% NET INCOME (LOSS) 7,390 10,794 6,334 3,404 46.1% 70.4% 26,424 26,430 21,274 6 0.0% 24.2%

Page C.2

ACCESS MEDICAL SOUTH, LCCOMPARATIVE INCOME STATEMENT (UNAUDITED)




GROSS PATIENT REVENUE 1,680,583 1,278,637 1,417,376 (401,946) -23.9% -9.8% 5,632,936 4,829,530 5,015,236 (803,406) -14.3% -3.7%

DEDUCTIONS FROM REVENUE 1,098,433 742,790 892,864 355,643 32.4% 16.8% 3,717,083 2,974,865 3,243,423 742,218 20.0% 8.3% NET PATIENT REVENUE 582,150 535,847 524,512 (46,303) -8.0% 2.2% 1,915,853 1,854,665 1,771,813 (61,188) -3.2% 4.7%

OTHER OPERATING REVENUE 96,000 87,383 86,589 (8,617) -9.0% 0.9% 366,000 358,022 349,173 (7,978) -2.2% 2.5%

TOTAL OPERATING REVENUE 678,150 623,230 611,101 (54,920) -8.1% 2.0% 2,281,853 2,212,687 2,120,986 (69,166) -3.0% 4.3%

OPERATING EXPENSES SALARIES/WAGES/BENEFITS 318,434 289,503 279,471 28,931 9.1% -3.6% 1,181,425 1,112,564 1,061,606 68,861 5.8% -4.8% OTHER SUPPLIES 177,611 202,204 174,779 (24,593) -13.8% -15.7% 686,046 753,960 658,865 (67,914) -9.9% -14.4% PURCHASED SERVICES 100,237 66,331 99,805 33,906 33.8% 33.5% 387,571 279,690 369,237 107,881 27.8% 24.3% DEPRECIATION/AMORTIZATION 69,662 65,145 70,026 4,517 6.5% 7.0% 278,648 250,466 279,764 28,182 10.1% 10.5% BAD DEBT EXPENSE 14,554 10,713 14,230 3,841 26.4% 24.7% 47,897 46,806 48,268 1,091 2.3% 3.0% INTEREST 116,012 105,973 109,538 10,039 8.7% 3.3% 466,196 448,528 514,527 17,668 3.8% 12.8%

TOTAL OPERATING EXPENSES 796,510 739,869 747,849 56,641 7.1% 1.1% 3,047,783 2,892,014 2,932,267 155,769 5.1% 1.4%

GAIN(LOSS) FROM OPERATIONS (118,360) (116,639) (136,748) 1,721 -1.5% -14.7% (765,930) (679,327) (811,281) 86,603 -11.3% -16.3%

INTEREST EARNINGS 0 11 10 11 0.0% 10.0% 0 119 85 119 0.0% 40.0% GAIN ON SALE OF EQUIPMENT 0 0 0 0 0.0% 0.0% 0 4,000 0 4,000 0.0% 0.0% REFINANCE EXP-OPER LEASE 0 (34,538) 0 (34,538) 0.0% 0.0% 0 (34,538) 0 (34,538) 0.0% 0.0% INCRS(REDUCT) FV INT RATE SWAPS 0 0 (125,463) 0 0.0% 0.0% 0 267,999 64,513 267,999 0.0% -315.4%

EXCESS OF REV OVER EXPENSES (118,360) (151,166) (262,201) (32,806) -27.7% 42.3% (765,930) (441,747) (746,683) 324,183 42.3% 40.8%

Page C.3

BONITA COMMUNITY HEALTH CENTER, INC.COMPARATIVE INCOME STATEMENT (UNAUDITED)



Board of Directors Meeting February 24, 2011

Physician Leadership Council (PLC) Report

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

(ACCEPT)

PLC Chairman Report to the Board 2/24/2011

Recent Meetings

TCH MEC – 1/18 and 2/15, 2011 GCMC MEC – 1/10 and 2/17, 2011

HPMC MEC – 1/11 and 2/8, 2011 LMH MEC – 1/12, 2011

CCH MEC – 1/17 and 2/21, 2011 PLC – January 19th, 2011

Multiple Campus MEC Items

A formal impaired practitioner policy has been develop for System wide use. It gives

specific actions to be taken and procedures to be followed. It provides for confidentiality

and mandatory testing if necessary.

Patient safety video reviewed by everyone and to eventually include all the Medical Staff.

Out of County residency waiver being further developed to include a 25 mile limit on the

distance from facility to home or office. A Task Force activity.

Board Certification requirement for all members of the Medical Staff to include a seven

year limit after formal training.

Standardized stroke order sets have been implemented System wide.

PLC structural and meeting requirement changes were discussed.

Discussions concerning issues with holding patients in the emergency room, difficulties

with admissions due to high volumes, and the surge plans. Many physicians are

concerned about these items.

PLC

System representatives gave a presentation on Provider Sponsored Network

Opportunities. Physicians were asked to participate in exploring these options to meet

community needs. The possibility of this expanding to include more than Medicaid patients to

achieve financial success was discussed.

Thank you for your attention.

Tom Presbrey, MD PLC Chairman

RECESS Board Chairman

Richard Akin


Board of Directors

CALL TO ORDER: (Richard Akin, Board Chairman) A. Lee Memorial Hospital Board of Directors (Provider #10-0012) {{GGRREEEENN FFOOLLDDEERR}} BB.. Cape Coral Hospital Board of Directors (Provider #10-0244) {{YYEELLLLOOWW FFOOLLDDEERR}} C. Gulf Coast Medical Center Board of Directors (Provider #10-0220) {{OORRAANNGGEE FFOOLLDDEERR}}

CONVENE {{GGRREEEENN FFOOLLDDEERR}}

(Provider # 10-0012)

Lee Memorial Hospital

HHeeaalltthhPPaarrkk MMeeddiiccaall CCeenntteerr

TThhee CChhiillddrreenn’’ss HHoossppiittaall ooff SSWW FFlloorriiddaa


239-343-3300 FAX: 239-343-3194

P.O. BOX 2218


CAPE CORAL HOSPITAL






LEE PHYSICIAN GROUP

LEE CONVENIENT CARE

BOARD OF DIRECTORS

DISTRICT ONE


Marilyn Stout

DISTRICT TWO

Richard B. Akin


DISTRICT THREE



DISTRICT FOUR

Diane Champion

Chris Hansen

DISTRICT FIVE

Donald A. Brown

James Green

Public Input - Agenda Items: Any Public input is limited to three minutes and a “Request to Address the Board of Directors” card must be completed and submitted to

the Board Administrator prior to meeting

{{GGRREEEENN FFOOLLDDEERR}}

Convening as the Lee Memorial Hospital Board of Directors


Thursday, February 24, 2011, 4:00 p.m. Lee Memorial Hospital-Boardroom

2776 Cleveland Avenue, Ft. Myers, FL 33901

AGENDA

1. Call to Order LEE MEMORIAL HOSPITAL BOARD OF DIRECTORS (Richard Akin, Board Chairman) {{GGRREEEENN FFOOLLDDEERR}}

2. Public Input - Agenda Items: Any Public input is limited to three minutes and a “Request to Address the Board of Directors” card must be completed and submitted to the Board Administrator prior to meeting.

3. Jan 20, 2011 Lee Memorial Hospital Board Minutes (Approval) (Nancy McGovern, RN, MSM, Board Secretary)

4. Operations Report (Lisa Sgarlata, CAO) (Accept)

5. Medical Staff Business for LMH, HPMC, TCH (Approval) A. Medical Staff Recommendations of Feb 22, 2011 B. Medical Staff Policies

I. Medical Staff Conduct Policy II. Medical Staff Residence Policy

III. Preceptorship IV. Behave in a Professional and Civil Manner V. Credentialing practitioners who have not been

providing inpatient care and are now requesting membership and privileges to provide acute inpatient care (competency criteria)

6. Old Business

7. New Business

8. Date of the next meeting – Thursday, March 24, 2011, 4:00pm Lee Memorial Hospital – Boardroom

9. Adjournment (Richard Akin, Board Chairman)

FINAL Agenda - 022411 LMH




Any public input






LEE MEMORIAL HOSPITAL BOARD OF DIRECTORS (PROVIDER # 10-0012) LEE MEMORIAL HEALTH SYSTEM

Thursday, January 20, 2011 LOCATION: Lee Memorial Hospital Boardroom, 2776 Cleveland Avenue, Fort Myers, FL 33901 MEMBERS PRESENT: Richard Akin, Board Chairman; Marilyn Stout, Board Treasurer; Nancy McGovern, RN, MSM, Board Secretary; Steve Brown, M.D., Director; Chris Hansen, Director; Donald Brown, Director; Diane Champion, Director MEMBERS ABSENT: James Green, Director; Lois Barrett, MBA, Director; Linda Brown, MSN, ARNP, Board Vice Chairman OTHERS PRESENT: Cathy Stephens, Board Administrator; Jim Humphrey, Board Counsel; Mary McGillicuddy, Chief Legal Officer; Larry Antonucci, M.D., Chief Operating Officer/Hospital & Physician

Services; John Wiest, Chief Operating Officer/Business & Strategic Services; Scott Nygaard, M.D., Chief Medical Officer Physician Services; Lisa Sgarlata, R.N., Chief Administrative Officer/LMH; Bill Silverman, M.D., Quality & Education Community Representative; Ben Spence, Controller Acute Care & Reimbursement; Alex Greenwood, System Director CCH/GCMC; Dan Delatorre, Chair Department Med LMH; Holly Muller, Vice President Patient Care Services/GCMC; Karen Krieger, System Director of Public Affairs; Guest, Frank Gluck, News Press/Reporter; Laurie Gretten, Executive Secretary/Board of Directors

NOTE: Documents referred to in these minutes are on file by reference to this meeting date in the Office of the Board of Directors and on the Board of Directors website at www.lememorial.org/boardofdirectors, for public inspection.

SUBJECT DISCUSSION ACTION FOLLOW-UP

MEETING CALLED TO ORDER

LEE MEMORIAL HOSPITAL BOARD OF DIRECTORS (Provider #10-0012), LEE MEMORIAL HEALTH SYSTEM Meeting

was CALLED TO ORDER at 5:44 p.m. by Richard Akin, Board Chairman.

PUBLIC INPUT None at this time.

LEE MEMORIAL

HOSPITAL OPERATIONS

REPORT

Lisa Sgarlata presented the Operations Report for Lee Memorial Hospital (Exhibit 1) which consisted of a review of quality indicators, patient experience ratings, operational statistics comparing year to date to budget, management focus areas and financial reporting. Discussion ensued regarding capacity and growth issues.

A motion was made by Steve Brown to approve the Operations Report for Lee Memorial Hospital (Exhibit 1). The motion was seconded by Donald Brown and it carried with no opposition.

MEDICAL

STAFF RECOMMENDATIONS

Richard Akin asked for approval of the Lee Memorial Hospital Medical Staff Recommendations of January 19, 2011 (Exhibits 2, 3 and 4).

A motion was made by Nancy McGovern to approve the Medical Staff Recommendations for Lee Memorial Hospital, HealthPark Medical Center, and the Children’s Hospital (Exhibits 2, 3 and 4). The motion was seconded by Marilyn Stout and it carried with no opposition.

OLD BUSINESS

None at this time.

NEW BUSINESS

None at this time.

NEXT REGULAR

MEETING The next Full Board meeting of the LEE MEMORIAL HOSPITAL (Provider #10-

0012) BOARD OF DIRECTORS IS: February 24, 2011, 4:00 p.m. in the Lee Memorial Hospital, Boardroom

2776 Cleveland Avenue, Fort Myers, FL 33901

http://www.lememorial.org/boardofdirectors

LEE MEMORIAL HOSPITAL (Provider #10-0012) BOARD OF DIRECTORS MEETING LEE MEMORIAL HEALTH SYSTEM

Thursday, January 20, 2011 Page 2 of 2


ADJOURNMENT The Lee Memorial Hospital (Provider #10-0012) Board of Directors Meeting was ADJOURNED at 6:08 p.m. by Richard Akin, Board Chairman.

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

__________________________________________________ Nancy McGovern, RN, MSM

Board Secretary

Lee Memorial Hospital Provider Reports

Presented to Board of Directors February 24, 2011

Financial Report for LMH Providers

As of January 31, 2011 FISCAL YEAR TO DATE

Lee Memorial Hospital Provider 10-0012 (Consolidated: LMH/HP/OPCTR/REHAB) Budget Actual Prior

Act v Bud Var %

Act v PY Var %

(in thousands)

Net Revenue 182,601 190,445 170,522 7,845 4.3% 19,923 11.7%

Labor 73,228 74,026 67,648 798 1.1% 6,377 9.4%

Gain from Operations 41,917 48,412 41,341 6,495 15.5% 7,070 17.1%

Quality Report for LMH Providers

• LMH Providers – Patient Experience (top box)• HCAHPS: Rate this Hospital – 64.0%• Press Ganey: Likelihood to Recommend – 67.5%

• Emergency Services – Patient Experience (top box)• Press Ganey – Likelihood to Recommend – 62.7%

Operations Report for LMH ProvidersAs of January 31, 2011 FISCAL YEAR TO DATE

Lee Memorial Hospital Provider 10-0012 (Consolidated: LMH/HP/OPCTR/REHAB) Budget Actual Prior

Act v Bud Var %

Act v PY Var %

Admissions 12,264 13,237 11,867 973 7.9% 1,370 11.5%

ED Visits 37,602 38,931 36,490 1,329 3.5% 2,441 6.7%

ED Admits 9,081 9,597 8,788 516 5.7% 809 9.2%

Deliveries 1,188 1,159 1,160 (29) -2.4% (1) -0.1%

Surgical Cases 5,741 6,614 6,313 873 15.2% 301 4.8%

Lee Memorial Hospital Campus Report


Financial Report for LMH Campus

• Net Revenue• Net Patient Revenue exceeded budget by 5.1 million. The volume variance

related to greater than budgeted adjusted admissions equates to a favorable variance of 6.4 million, slightly offset by an unfavorable rate variance of -1.3 million.

• Labor• FTEs per AOB was 4.32 vs budget of 4.45 for a favorable improvement of 3.1%.

FTEs were over budget by 81. • Salaries were over budget $1.4 million due to adjusted admissions greater than

budget by 10.1%. Average hourly rate was less than budget by 0.2%.• Gain from Operations • Gain from Operations was 2.8 million over budget at 16.6 million vs. a budget of

13.8 and prior year of 11.4. The robust volumes combined with improvements in productivity, labor rates and improvement in supply cost per case are the main contributors to the favorable variance.

Quality Report for LMH Campus

LMH – Patient Experience (top box)

HCAHPS: Rate this Hospital – 57.0%

Press Ganey: Likelihood to Recommend – 60.4%

Emergency Services – Patient Experience (top box)

Press Ganey: Likelihood to Recommend – 56.4%

Operations Report for LMH Campus

As of January 31, 2011Fiscal Year Total

Lee Memorial Hospital (Acute Care Hospital) Budget '2011 FY'2011 FY'2010 Act v Bud Var % Act v PY Var %

Admissions 4,389 4,806 4,247 417 9.5% 559 13.2%

ED Visits 17,437 17,696 16,602 259 1.5% 1,094 6.6%

ED Admits 3,775 3,901 3,555 126 3.3% 346 9.7%

Deliveries

Surgical Cases 2,776 3,290 3,139 514 18.5% 151 4.8%



Donna Giannuzzi, RN, MBA, CNAA, BCCAO, HPMC


Quality Report for HPMC


Patient Experience Year to Date ‘FY 11Press Ganey Inpatient

Likelihood to Recommend 73.8%Press Ganey ED

Likelihood to Recommend 64.6%HCAHPS Top Box Score

Rating this Hospital 68%


Financial Report for HPMCNet RevenueNet Revenue per adjusted admission was below budget by -5.1%, with a negative rate variance of $4.9M offset by a positive volume variance of $6.7M

Labor

FTEs per AOB were 4.14 vs. budget of 4.28 for a productivity gain of 3.1% or 63 FTEs. Salaries were over budget $800k, all of which was attributable to the volume increase for the period.

Gain from OperationsThe Gain from Operations of $27.3M exceeded budget by $2.3M or 9.1% and PY by $3.5M or 14.6%. Operating Expense per adjusted admit was below budget by 7.9% and below PY by 2.9%. Supply expense per adjusted admission was below budget by 11.9% largely due to implant costs being down because procedures performed in the Cath Lab and EVL are down YTD.


Operations Report for HPMCYear to Date Budget Actual Prior Var Bud Var PYAdmissions 7512 8093 7275 7.7% 11.2%ER Visits 20165 21235 19888 5.3% 6.8%ER Admits 5306 5696 5233 7.4% 8.8%Deliveries 1188 1159 1160 -2.4% -0.1%Surgical Cases 3275 3596 3455 9.8% 4.1%

Admit Breakdown:Adult Admits 5781 6284 5665 8.7% 10.9%Pediatric Admits 1525 1591 1384 4.3% 15.0%NICU Admits 207 218 226 5.5% -3.5%


HP Children’s Hospital Performance Measures Fourth Quarter Fiscal Year 2010 (Jul – Sept 2010)


HP Children’s Hospital Performance Measures Fourth Quarter Fiscal Year 2010 (Jul – Sept 2010)

HOW MANY HP NICU PATIENTS ACQUIREDVENTILATOR ASSOCIATED PNEUMONIA?

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 01

0

2

4

6

8

10

12

14

Apr

-08

May

-08

Jun-

08

Jul-0

8

Aug

-08

Sep-

08

Oct

-08

Nov

-08

Dec

-08

Jan-

09

Feb-

09

Mar

-09

Apr

-09

May

-09

Jun-

09

Jul-0

9

Aug

-09

Sep-

09

Oct

-09

Nov

-09

Dec

-09

Jan-

10

Feb-

10

Mar

-10

Apr

-10

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-10

Jun-

10

Jul-10

Aug

-10

Sep

-10

VAP IN

FECT

ION CASE

S

HOW MANY HP PICU PATIENTS ACQUIREDVENTILATOR ASSOCIATED PNEUMONIA?

0 01

0 01

0 0 0 0 0 0 01 1

0 0 0 01

0 0 0 0 0 0 0 0 0 0 0 0 0 0 01

0

2

4

6

8

10

12

14

Oct

-07

Nov

-07

Dec

-07

Jan-

08

Feb-

08

Mar

-08

Apr

-08

May

-08

Jun-

08

Jul-0

8

Aug

-08

Sep-

08

Oct

-08

Nov

-08

Dec

-08

Jan-

09

Feb-

09

Mar

-09

Apr

-09

May

-09

Jun-

09

Jul-0

9

Aug

-09

Sep-

09

Oct

-09

Nov

-09

Dec

-09

Jan-

10

Feb-

10

Mar

-10

Apr

-10

May

-10

Jun-

10

Jul-1

0

Aug

-10

Sep-

10

VAP IN

FECT

ION CASE

S

HOW MANY HP NICU PATIENTSACQUIRED CENTRAL LINE INFECTION?

1

0

4

0 0 0 0 0

1

0 0 0

1 1 1

3

1

0

1

0 0 0 0 0

1 1

0

1

2

00

1

2

3

4

5

Apr

-08

May

-08

Jun-

08

Jul-0

8

Aug

-08

Sep-

08

Oct

-08

Nov

-08

Dec

-08

Jan-

09

Feb-

09

Mar

-09

Apr

-09

May

-09

Jun-

09

Jul-0

9

Aug

-09

Sep-

09

Oct

-09

Nov

-09

Dec

-09

Jan-

10

Feb-

10

Mar

-10

Apr

-10

May

-10

Jun-

10

Jul-1

0

Aug

-10

Sep-

10

CENTR

AL LINE IN

FECT

ION CASE

S

HP Children’s Hospital Acute Care – Elective Surgery

Surgical Site Infections Indicator Pending

HOW MANY HP PICU PATIENTSACQUIRED CENTRAL LINE INFECTION?

0 0 0 0 0 0 0 0 0 0

1

0 0 0

1

0 0 0 0

2

0 0 0 0 0 0

1 1 1

0

1

0 00

1

2

3

4

5

Jan-

08

Feb-

08

Mar

-08

Apr

-08

May

-08

Jun-

08

Jul-0

8

Aug

-08

Sep-

08

Oct

-08

Nov

-08

Dec

-08

Jan-

09

Feb-

09

Mar

-09

Apr

-09

May

-09

Jun-

09

Jul-0

9

Aug

-09

Sep-

09

Oct

-09

Nov

-09

Dec

-09

Jan-

10

Feb-

10

Mar

-10

Apr

-10

May

-10

Jun-

10

Jul-1

0

Aug

-10

Sep-

10

CENTR

AL LINE IN

FECT

ION CASE

SHOW MANY HP PICU FOLEY CATHETER PATIENTS

ACQUIRED URINARY TRACT INFECTION?

0 0 0

1

0 0 0 0 0 0 0 0 0 0

1

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00

2

4

6

8

10Ja

n-08

Feb-

08

Mar

-08

Apr

-08

May

-08

Jun-

08

Jul-0

8

Aug

-08

Sep-

08

Oct

-08

Nov

-08

Dec

-08

Jan-

09

Feb-

09

Mar

-09

Apr

-09

May

-09

Jun-

09

Jul-0

9

Aug

-09

Sep-

09

Oct

-09

Nov

-09

Dec

-09

Jan-

10

Feb-

10

Mar

-10

Apr

-10

May

-10

Jun-

10

Jul-1

0

Aug

-10

Sep-

10

URINARY

TRA

CT INFE

CTIO

N CASE

S


BBBOOOAAARRRDDD OOOFFF DDDIIIRRREEECCCTTTOOORRRSSS MEETING

MEDICAL STAFF

BUSINESS

LEE MEMORIAL HEALTH SYSTEM Lee County, Florida

#1 M E M O R A N D U M

To: Board of Directors From: Sandra L. Wharton, CPMSM, CPCS System Director, Medical Staff Services Date: February 22, 2011 Subject: Lee Memorial Hospital Medical Staff Recommendations The Facility Medical Executive Committee of the Medical Staff recommends the following physicians and allied health practitioners and certifies they have met the requirements set forth in the bylaws:

1. Associate Staff Appointments: a. Andrew M. Gross, M.D. – Pain Management b. Jeffrey A. Neale, M.D. – Colon & Rectal Surgery c. Anuradha Satyavolu, M.D. – Family Practice d. Deborah C. Silver, Psy.D. – Psychology

2. First Year Completion – Active Staff Appointments:

a. Robert W. Pollack, M.D. – Psychiatry b. Gregory M. Romaniuk, M.D. – Family Practice

3. First Year Completion – Associate Staff Appointments:

a. Christopher Calcagni, D.P.M. – Podiatry b. Leonard D. Cutler, M.D. – Dermatology c. A. Catherine David, D.P.M. – Podiatry d. Sheeja Kanacheril, D.O. – Family Practice e. Victor M. Luna, M.D. – Endocrinology f. Tatiana S. Reynolds, M.D. – Family Practice g. Kim D. Schurman, M.D. – Internal Medicine

4. Intrasystem Application:

a. S.V. Nagarathinam, M.D. – Internal Medicine 5. Privilege Request:

a. Karen Calkins, M.D. – Emergency Medicine (refer and follow) 6. Resignations:

a. Fred C. Beckett, III, M.D. – Pulmonary Medicine b. Ganesh Shenoy, M.D. – Nephrology

Memorandum to Board of Directors - LMH February 22, 2011 Page 2 of 2 7. Temporary Privileges:

a. Marcia Caldwell, CRNA – 02-16-11 – 03-17-11 b. Michelle Hartman, CRNA – 03-10-11 – 04-09-11

8. Allied Health Practitioners:

a. Alisa Santiago, PA – SW FL Neurosurgical Associates b. Kerry Shuffelbottom, PA – SW FL Neurosurgical Associates c. Christina Smith, ARNP – Employee Health

9. Allied Health Practitioner – Sponsor Change:

a. Kathryn Knutson, PA – Associates In General & Vascular Surgery 10. Allied Health Practitioner – Additional Sponsor:

a. Christina Flint-Lowe, ARNP – Inpatient Consultants b. Nelson Guzman, PA – Florida Medical Affiliates

Approved by the Board of Directors – February 24, 2011

__________________________________________ Richard B. Akin, Chairman - Board of Directors


Lee County, Florida #4

M E M O R A N D U M To: Board of Directors From: Sandra L. Wharton, CPMSM, CPCS System Director, Medical Staff Services Date: February 22, 2011 Subject: HealthPark Medical Center Medical Staff Recommendations The Facility Medical Executive Committee of the Medical Staff recommends the following physicians and allied health practitioners and certifies they have met the requirements set forth in the bylaws:

1. Associate Staff Appointments: a. Jeffrey A. Neale, M.D. – Colon & Rectal Surgery b. Anuradha Satyavolu, M.D. – Family Practice c. Deborah C. Silver, Psy.D. – Psychology


a. Victor M. Luna, M.D. – Endocrinology b. Tatiana S. Reynolds, M.D. – Family Practice c. Gregory M. Romaniuk, M.D. – Family Practice


a. Christopher Calcagni, D.P.M. – Podiatry b. Leonard D. Cutler, M.D. – Dermatology c. A. Catherine David, D.P.M. – Podiatry d. Sheeja Kanacheril, D.O. – Family Practice e. Robert W. Pollack, M.D. - Psychiatry f. Kim D. Schurman, M.D. – Internal Medicine

4. Intrasystem Application:

a. S.V. Nagarathinam, M.D. – Internal Medicine 5. Privilege Request:

a. Karen Calkins, M.D. – Emergency Medicine (refer and follow) 6. Resignations:

a. Fred C. Beckett, III, M.D. – Pulmonary Medicine

Memorandum to Board of Directors - HPMC February 22, 2011 Page 2 of 2 7. Temporary Privileges:



a. Mandy Parfitt, ARNP – MacKoul Pediatrics b. Alisa Santiago, PA – SW FL Neurosurgical Associates c. Kerry Shuffelbottom, PA – SW FL Neurosurgical Associates d. Christina Smith, ARNP – Employee Health


a. Kathryn Knutson, PA – Associates In General & Vascular Surgery b. April McCann, ARNP – Advanced Heart Center

10. Allied Health Practitioner – Additional Sponsor:

a. Christina Flint-Lowe, ARNP – Inpatient Consultants b. Nelson Guzman, PA – Florida Medical Affiliates





To: Board of Directors From: Sandra L. Wharton, CPMSM, CPCS System Director, Medical Staff Services Date: February 22, 2011 Subject: The Children’s Hospital Medical Staff Recommendations The Facility Medical Executive Committee of the Medical Staff recommends the following physicians and allied health practitioners and certifies they have met the requirements set forth in the bylaws:

1. Associate Staff Appointment: a. Deborah C. Silver, Psy.D. – Psychology



Page 1 of 2


Medical Staff POLICY & PROCEDURE MANUAL

Medical Staff Professional Conduct Policy LOCATOR NUMBER

T Y P E

CCH Medical Staff – policy that applies to all members of the Medical Staff.

GCMC Medical Staff – policy that applies to all members of the Medical Staff. HPMC Medical Staff – policy that applies to all members of the Medical Staff.

LMH Medical Staff – policy that applies to all members of the Medical Staff. TCH Medical Staff – policy that applies to all members of the Medical Staff.

CHAPTER:

TAB: POLICY #:

Date Originated: 6/24/10

Reviewed / No Revision:

Dates Revised:

Next Review Date:

Author(s): Mark A. Greenberg, M.D., System Medical Director of Medical Staff Services

Approved by: CCH FMEC GCMC FMEC HPMC FMEC LMH FMEC TCH FMEC

David Reardon, M.D. Charles Bisbee, M.D. Ralph Gregg, M.D. Razak Dosani, M.D. Emad Salman, M.D.

Date: Date: Date: Date: Date:

11-11-10 11-08-10 11-09-10 11-10-10 11-04-10

Approved by Board of Directors Date:

PURPOSE:

To establish a code of conduct for all Medical Staff Members to promote teamwork; a

positive patient care environment; a culture of safe, compassionate patient care; and

a reliable approach to addressing disruptive behavior in the patient care environment.

PROCEDURE:

All Medical Staff Members conduct themselves in a professional, collaborative, and cooperative manner consistent with Medical Staff Credo behaviors and in accordance with applicable Medical Staff policies and procedures. Medical staff Members shall treat all patients, visitors, students, and each other with courtesy, respect, and dignity. The Medical Staff and health

system fosters a just and safe culture by addressing unprofessional, inappropriate,

intimidating, disruptive, threatening, and violent behavior (hereinafter “disruptive

behavior”) within the workplace, including maintaining “zero tolerance” for confirmed

instances of the “most egregious behaviors, i.e. the most ethically serious behaviors.

Page 2 of 2

Specific Information:

A. The Medical Staff supports a culture of collegiality and excellence. Disruptive

behavior can undermine teamwork and our culture. The Medical Staff

recognizes that disruptive behavior may take aggressive, passive, or passive-

aggressive forms. Disruptive behavior includes, but is not limited to, words or

actions that:

1. Prevent or interfere with an individual’s or group’s work, academic

performance, or ability to achieve intended outcomes. Examples include

intentionally ignoring questions or not returning phone calls or pages related

to matters involving patient care.

2. Create an unsafe, intimidating, hostile or offensive work or academic

environment. Examples include verbal abuse, sexual or other harassment,

threatening or intimidating words, or words reasonably interpreted as

threatening or intimidating;

3. Threaten personal or group safety, such as aggressive or violent physical

actions; or

4. Violate Medical Staff policies, including those related to conflicts of interest

and compliance requirements.

B. All Medical staff Members share responsibility for promoting professional

conduct. This includes consistently responding to disruptive behavior they

witness or of which they become aware. Appropriate responses depend on the

specific behavior and circumstances, including the comfort level of the observer.

1. Medical Staff Members are encouraged to have “cup of coffee”

conversations with each other to provide quick feedback (“I saw,” “I

observed,” “I heard”) concerning non-Credo behaviors.

a. “Cup of coffee” conversations are non-directive

b. One should expressly distinguish whether the discussion is a “cup of

coffee” conversation or an authority-based clarification of expectations.

2. Medical Staff Members report single serious incidents or repeated incidents

“most egregious behaviors” as per the Medical Staff unprofessional and

disruptive behavior policy and procedure.

Page 1 of 4


POLICY & PROCEDURE MANUAL

TITLE OF POLICY: Medical Staff Residence Policy LOCATOR NUMBER

T Y P E




CHAPTER:

TAB: POLICY #:

Date Originated: 01-10-11


Dates Revised:

Next Review Date:

Author(s): Legal Counsel

Reviewed by:

Mary McGillicuddy Chief Legal Officer Date: 01-10-11

Approved by: CCH FMEC HPMC FMEC LMH FMEC GCMC FMEC TCH FMEC

David Reardon, M.D. Ralph Gregg, M.D. Razak Dosani, M.D. Charles Bisbee, M.D. Rodrigo Mon, M.D.


01-17-11 01-11-11 01-12-11 01-10-11 01-18-11

Approved by: Board of Directors

Date:

TITLE: Lee County Residence & Medical Office Requirements for Active and Associate Categories: FMEC waiver guidelines for practitioners who reside and/or maintain a practice outside of Lee County.

PURPOSE:

To create a process through which the FMEC will uniformly and consistently grant waivers to the Lee County residence / medical office requirements contained in Part I, subsection 4.1.1

Page 2 of 4

and Part III, subsection 2.1.1 of the Medical Staff Bylaws in accordance with the Medical Staff Bylaws and the “Pre-Application/Minimum Criteria for Appointment: Circumstances under which an application will be provided to a requesting provider” policy (“Pre-Application Policy”).

POLICY: The Medical Staff Bylaws require all applicants for appointment and reappointment for active or associate membership to the Medical Staff to maintain (1) an active, full-time medical practice, and (2) a full-time residence within Lee County, unless a waiver is granted by the FMEC. It is presumed that all practitioners who maintain (1) an active, full-time medical practice, and (2) a full-time residence within Lee County will be able to meet patient care requirements, provide emergency call, and attend to hospitalized patients. The Medical Staff Bylaws provide that the FMEC may grant a practitioner a waiver of the residence / medical office requirements so long as the practitioner can show, in writing, that the quality of patient care is not likely to be affected by his/her not residing and/or having a medical office in Lee County and that the practitioner’s obligation to provide emergency room call and to attend to hospitalized patients can be met. This policy seeks to set standards and provide guidance to the FMEC as to what criteria practitioners may use to demonstrate that the practitioner can provide quality patient care, emergency room call, and medical care to hospitalized patients if the practitioner does not reside and/or have a medical office in Lee County. It is the policy of the Medical Staff and FMEC to grant waivers of the Residence / medical office requirements contained in Part I, subsection 4.1.1 and Part III, subsection 2.1.1 of the Medical Staff Bylaws in accordance with this policy.

PROCEDURE:

1. General Rule. All active and associate Medical Staff members must maintain (1) an

active, full-time medical practice, and (2) a full-time residence within Lee County, unless the FMEC waives the residence / medical office requirement, consistent with this policy. A practitioner will not be provided an application for Medical Staff membership or be eligible for reappointment unless the practitioner (a) meets both of the residence / medical office requirements, or (2) is granted a waiver by the FMEC. If the practitioner does not meet one of the Residence / medical office requirements, the practitioner must request a waiver of that residence / medical office requirement from the FMEC. If the practitioner does not meet both residence / medical office requirements, the practitioner must request a waiver of both residence / medical office requirements from the FMEC.

2. FMEC May Grant Waiver. Pursuant to Part I, subsection 4.1.3.3 of the Medical Staff Bylaws and the Pre-Application Policy, the FMEC may waive one or both of the residence / medical office requirements, as applicable, if the practitioner can demonstrate that the quality of patient care is not likely to be affected by his/her not living and/or having an office in Lee County and that the practitioner’s obligation to provide emergency call and to attend hospitalized patients can be met.

3. Waiver Request by Practitioner. If the practitioner does not meet one or both of the residence / medical office requirements, the practitioner must request a waiver from the

Page 3 of 4

FMEC, in writing, that demonstrates that he/she meets one of the criteria in Section 5 below for both his/her personal residence and medical office practice.

4. Presentation at FMEC Meeting. Written requests for waivers must be presented at a

FMEC meeting. Requests relating to shift work will be presented to the FMEC in accordance with the Pre-Application Policy.

5. Waiver Guidelines. In order to demonstrate that the applicant can provide quality patient

care, emergency room call, and medical care to hospitalized patients, the practitioner must meet one of the following criteria for both his/her personal residence and medical office practice:

a. Shift Work Criteria:

i. Out-of-County Residence: If the practitioner resides outside of Lee County and the practitioner will provide hospital-based services solely on a shift basis, it is presumed that the practitioner will be able to meet patient care requirements, provide emergency call, and attend to hospitalized patients and the practitioner should be provided an application in accordance with the Pre-Application Policy.

ii. Out-of-County Medical Office Practice: Likewise, if the practitioner maintains a full-time medical practice outside of Lee County and the practitioner will provide hospital-based services solely on a shift basis, it is presumed that the practitioner will be able to meet patient care requirements, provide emergency call, and attend to hospitalized patients and the practitioner should be provided an application in accordance with the Pre-Application Policy.

b. Distance Criteria: If the practitioner will not provide hospital-based services solely on a shift basis, the practitioner may demonstrate that he/she will be able to meet patient care requirements, provide emergency call, and attend to hospitalized patients pursuant to the following criteria.

i. Written Explanation: The practitioner must provide a written detailed explanation of how he/she will provide patient care to ensure that the practitioner can provide quality patient care, emergency room call, and medical care to hospitalized patients; and ii. Out-of-County Residence: If the practitioner resides outside Lee County, but the practitioner lives no more than 25 miles driving distance from the hospital and the FMEC finds the practitioner submitted an acceptable written detailed explanation as required above in subsection 5 (b)(i), it is presumed that the practitioner will be able to meet patient care requirements, provide emergency call, and attend to hospitalized patients and the practitioner should be provided an application in accordance with the Pre-Application Policy; and/or

iii. Out-of-County Medical Office Practice: Likewise, if the practitioner

maintains a full-time medical office practice outside of Lee County, but the practitioner maintains a full-time medical office practice no more than 25 miles driving distance from the hospital and the FMEC finds the practitioner

Page 4 of 4

submitted an acceptable written detailed explanation as required above in subsection 5 (b)(i), it is presumed that the practitioner will be able to meet patient care requirements, provide emergency call, and attend to hospitalized patients and the practitioner should be provided an application in accordance with the Pre-Application Policy; and

iv. Map: PLEASE NOTE that this is 25 mile driving distance from the hospital, not a 25 mile radius from the hospital. The practitioner must submit a map (MapQuest, Google Maps) in order to evidence that the practitioner maintains an active, full-time medical office practice and/or full-time residence within 25 miles driving distance from the hospital.

c. Department or Clinical Section Criteria: In order to ensure patient safety and quality of care, these guidelines are subject to more stringent residence / medical office requirements and waiver guidelines which may be promulgated by any Department or Clinical Section of the Medical Staff and approved by the FMEC. The FMEC and/or the System Credentialing/Privileging Committee may set more stringent residence / medical office requirements and waiver guidelines for particular specialties if the applicable Department or Clinical Section declines to address the issue.

d. Institutional Needs Criteria: If the practitioner resides outside Lee County and/or maintains a full-time medical office practice outside of Lee County and cannot meet the criteria set forth in subsections 5 (a) (Shift Work), 5 (b) (Distance) or 5 (c) (Department or Clinical Section) above for one or both of the residence / medical office requirements, the FMEC may grant a waiver, upon recommendation of the System Credentialing/Privileging Committee Co-Chairs and the Board of Directors representative made pursuant to the Pre-application Policy, that there is an “institutional need” for the practitioner and that patient care will not be compromised by the wavier. Conflicting opinions between the FMEC, Co-Chairs and/or the Board of Directors representative will be resolved in accordance with the Pre-application Policy and the Medical Staff Bylaws, Part I, Section 9.

.

DEFINITION: “Hospital-based services provided solely on a shift basis” includes, but is not limited to, emergency medicine services, pathology services, radiology services, anesthesiology services, and hospitalist services provided by practitioners who will be providing care to hospitalized patients only. See also the Pre-Application Policy. “Institutional need” means those matters (social, organization, operational, or financial) which may have a significant influence on the ability of the Medical Staff and the Board to fulfill the mission and strategic objectives of the facility and the responsibilities set forth in the health system Enabling Act. The term “institutional needs” does not include economic criteria related to the volume of referrals or procedures beyond volumes necessary to maintain clinical proficiency. See also the Pre-Application Policy.

Page 1 of 2



TITLE OF POLICY: Preceptorship LOCATOR NUMBER

T Y P E




CHAPTER:

TAB: POLICY #:



Dates Revised:

Next Review Date:

Author(s): Sandra L. Wharton, CPMSM, CPCS

Reviewed by:

System Medical Director Mark Greenberg, M.D. Date: 09-02-09

CCH, HPMC, LMH, & TCH Cred. Comm. Emad Salman, M.D. and John Churchill, M.D. Date: 09-02-09 GCMC Cred. Comm. Douglas Savage, M.D. Date: 09-02-09

Approved by: CCH Exec. Comm. LMHS Exec. Comm. GCMC Exec. Comm.

David Reardon, M.D. F. Brett Shannon, D.O. Gary Correnti, M.D.

Date: Date: Date:

10-08-09 10-14-09 10-12-09


PURPOSE:

Establishes minimum criteria for practitioners requiring preceptorship in accordance with policy for practitioners who have not been providing inpatient care between two and five years and/or other practitioners as identified and recommended for preceptorship by the Credentials Committee. Certain specialties, i.e., surgical or procedural specialties, may require individualized preceptorship program with more rigorous criteria based upon their specialty and/or as identified by the Credentials Committee and Section Chief/Department Chairman.

Page 2 of 2

PROCEDURE: In accordance with the Medical Staff Bylaws, Section 8, burden will be

placed upon the practitioner to complete a preceptorship as outlined below (as well as any modifications recommended by the Credentials Committee) to demonstrate current competency for requested privileges.

Criteria to be followed in this order:

1. 80 hours of continuing medical education (specialty specific) within the last two years. Documentation to be submitted to Medical Staff Services (M.S.S.) prior to moving to next step.

2. 80 hours of shadowing – practitioner to “observe only” with preceptor for at least two

weeks. Letter to be submitted to M.S.S. by preceptor when shadowing completed prior to moving to next step.

3. Practitioner to co-manage 25 patients (admission to discharge) with preceptor.

Preceptor to complete preceptor’s reports of 25 co-managed cases and submit to M.S.S. prior to moving forward to next step.

4. Practitioner to manage care of 25 additional patients with retrospective case review by

Section Chief or Department Chairman. Completed retrospective case review reports to be submitted to M.S.S.

5. Completed documentation of preceptorship will be submitted to Credentials Committee

for review; Department Chairman for recommendation; and FMEC for approval that practitioner has met preceptorship requirements.

Page 1 of 6



TITLE OF POLICY: LMHS M.S. and A.H.P. “Behave in a Professional and Civil Manner”

LOCATOR NUMBER

T Y P E




CHAPTER:

TAB: POLICY #:



Dates Revised:

Next Review Date:

Authors:

Reviewed by:

Chief Medical Officer System Medical Director

Chuck Krivenko, M.D. Mark Greenberg, M.D. Date:




11-11-10 11-08-10 11-09-10 11-10-10 11-04-10

As needed:

Board of Directors: Date:

PURPOSE: To provide guidance in the enforcement of the Medical Staff

Bylaws PART I, subsection 2.7.18 relating to professional conduct.

POLICY: Medical Staff Bylaws provisions requiring that practitioners granted Medical Staff

membership or privileges and Allied Health Practitioners (collectively referred to herein as practitioners) behave in a professional and civil manner conducive to excellent patient care will be enforced in accordance with this Policy and Procedure, unless the circumstances reasonably demonstrate the existence of an immediate threat to a patient, another practitioner, an employee or the public in general, requiring Emergency Corrective Action/Precautionary Suspension be taken immediately pursuant to PART II, Section 2, of the Medical Staff Bylaws.

Page 2 of 6

If the conduct of a practitioner employed by Lee Memorial Health System (LMHS) demonstrates the inability to interact on a professional basis, the matter may be addressed in accordance with hospital employment policies and/or in accordance with the practitioner’s employment contract, in addition to being addressed in accordance with this policy. PROCEDURE: 1. Paramount Objective. To ensure a fair process for practitioners in addressing allegations of unprofessional behavior, protection of patients, employees, practitioners, volunteers, visitors, and others in the hospital and the orderly operation of the hospital are a paramount concern. 2. Documentation. Documentation of unprofessional behavior is critical since it is ordinarily not one incident that justifies disciplinary action, but rather a pattern of conduct. Physicians, nurses, and other LMHS employees who observe, or who have reported to them by patients, visitors, or volunteers, any behavior by a practitioner, which appears to constitute unprofessional behavior as defined in the Medical Staff Bylaws, and that jeopardizes patient care or interferes with LMHS operations or its ability to deliver services shall document the incident in writing. That documentation shall include:

a. The name of the offending practitioner; b. The date, time and location of the questionable behavior; c. The name(s) of any persons, including patients and staff, affected by the behavior; d. A factual description of the event involving unprofessional behavior, as defined in Medical

Staff Bylaws, PART I, subsection 2.7.18, to include:

(1) A description of the questionable behavior, including actual quotes of any words or language used, and any gestures or physical actions taken by the offending practitioner and others involved:

(2) An assessment of the consequences, if any of the behavior as it relates to patient

care or LMHS operations; and (3) A description of any intervention taken to abate the effect of the behavior, including

date, time, place, action, and name(s) of those intervening. All such reports of such behavior shall be made using the form attached to this policy as Addendum A or in a similar manner. 3. Submission of Reports. Reports should be submitted directly to the President of the Medical Staff in care of the System Director, Medical Staff Services. The System Director, Medical Staff Services will provide a copy to the System Medical Director for the acute care facility. Reports submitted by employees should be submitted through their supervisors. Management personnel receiving such reports should make sure that all necessary documentation is included prior to submitting the report to the President of the Medical Staff. Management personnel receiving such reports shall undertake reasonable efforts to forward such reports to the President of the Medical Staff in care of the System Director, Medical Staff Services, as soon as is reasonable under the circumstances. 4. Acknowledgement of Report. The President of the Medical Staff will acknowledge to the individual submitting the report that the report has been received and that it will be addressed by the Medical Staff. Reports submitted by the public (patients or visitors) will be acknowledged in accordance with the LMHS patient complaint process.

Page 3 of 6

5. Effect and Applicability of Medical Staff Bylaws. All reports, documentation, meetings and actions taken pursuant to this Policy shall be considered methods of reducing and eliminating unprofessional behavior, supplementing the Medical Staff Bylaws. Procedures set forth herein shall not be required to strictly comply with the procedural requirements set forth in the Medical Staff Bylaws, unless specifically provided herein. 6. Reports of First Incident.

a. A report regarding a practitioner which is the first such incident of unprofessional behavior regarding the practitioner shall be submitted and acknowledged as set forth above for review by the Department Chairman. The Department Chairman may:

(1) Determine the report does not meet the definition of unprofessional behavior,

document such a finding, close the matter and forward such documentation to the System Director, Medical Staff Services for filing. The System Medical Director of the acute care facility will be informed of the finding.

(2) Contact the offending practitioner directly, discussing the content of the report, and

suggesting and obtaining a commitment from the practitioner accepting voluntary corrective action, including appropriate apologies, and avoidance of similar future behaviors, or

(3) The Department Chairman may refer the offending practitioner to the Practitioner

Resource Committee under PART I, subsection 7.6.2.3 of the Medical Staff bylaws.

(4) If the Department Chairman is unable to obtain the offending practitioner’s commitment to voluntary corrective action, he or she shall advise and warn the offending practitioner that further future offenses have the potential to result in more severe action by the Medical Staff and/or Board of Directors, including revocation of Medical Staff privileges and membership, or denial of Medical Staff reappointment. The Department Chairman shall confirm such advice and warning in writing to the offending practitioner. The Department Chairman may, at his/her discretion, refer the complaint directly to the Facility Medical Executive Committee for additional review and possible action.

(5) All discussions with the offending practitioner by the Department Chairman and all

other individuals, formal and informal, shall be documented by written memorandum prepared by them and forwarded to the System Director, Medical Staff Services, for filing in the offending practitioner’s Medical Staff file.

b. In the event that the Department Chairman is unavailable, or was involved in the incident,

or is the practitioner whose behavior is at issue, the President of the Medical Staff will assume the responsibilities of report review and handling as noted in paragraph 6a.

7. Reports of Second Incident.

a. A Second Incident of unprofessional behavior committed by the same offending practitioner shall be reported using the documentation procedure set forth in Section 2 above.

b. If the Second Incident occurred more than 24 months after the First Incident, the procedure

regarding the handling of First Incidents shall be followed.

c. If the Second Incident occurs less than 24 months after the First Incident, the President of the Medical Staff shall appoint an ad hoc committee.

Page 4 of 6

(1) The ad hoc committee will be composed of:

a. The President of the Medical Staff, b. The System Medical Director of the acute care facility, c. The offending practitioner’s Department Chairman, d. Chief Administrative Officer or his/her designee, and e. The Past President or President-Elect of the Medical Staff.

(2) The ad hoc committee shall require the offending practitioner to meet with it within 15 days after appointment of the members of the committee. If the committee determines it to be appropriate, further investigation may be undertaken. All actions, findings and recommendations of the ad hoc committee shall be documented in writing and a copy filed in the offending practitioner’s Medical Staff file.

(3) No later than 45 days after meeting with the offending practitioner, the ad hoc

committee shall make a written report to the Facility Medical Executive Committee of the Medical Staff, and if the ad hoc committee finds that the offending practitioner engaged in unprofessional behavior, the ad hoc committee shall recommend action to be taken by the Facility Medical Executive Committee that may include:

a. Imposition of Emergency Corrective Action pursuant to PART II, section 2, of

the Medical Staff Bylaws, including a recommendation regarding the level of limitation or revocation of the offending practitioner’s privileges that should result;

b. Mandated participation in the Practitioner Resource Committee under PART I, subsection 7.6.2.3, of the Medical Staff Bylaws, refusal of which shall result in imposition of Emergency Corrective Action/Precautionary Suspension under PART II, section 2 of the Medical Staff Bylaws; or

c. Such other action as the ad hoc committee determines will mitigate the effects of the unprofessional behavior and prevent its recurrence in the future, including, but not limited to, referral to the System Practitioner Resource Committee.

(4) If the ad hoc committee’s report to the Facility Medical Executive Committee finds

that no unprofessional behavior occurred, no corrective action shall be recommended, and a statement shall be included in the report that the incident is not to be considered a Second Incident under this policy.

(5) The Facility Medical Executive Committee of the Medical Staff shall review the report

of the ad hoc committee at its next regular meeting and either accept or reject the ad hoc committee’s recommendations. Acceptance of a recommendation of Emergency Correction Action or referral to the Practitioner Resource Committee shall be implemented and proceed as outlined in the Medical Staff Bylaws. If the Facility Medical Executive Committee rejects the recommendation of the ad hoc committee, the Facility Medical Executive Committee may elect to take no action or whatever action it deems advisable, including, but not limited to:

a. Issuing a letter of warning or reprimand; b. Requiring the offending practitioner successfully complete additional

education or counseling; and/or c. Requiring monitoring of the offending practitioner’s behavior and performance

by other designated members of the Active Medical Staff.

(6) A finding by the ad hoc committee that the offending practitioner engaged in unprofessional behavior shall not be affected by the Facility Medical Executive Committee’s rejection of the recommendation of the ad hoc committee, even if the

Page 5 of 6

Facility Medical Executive Committee elects to take no action against the offending practitioner, and such finding shall constitute a Second Incident under this policy, and the documentation concerning the incident shall remain in the offending practitioner’s confidential Medical Staff file for a period of 24 months.

8. Reports of Third Incident.

a. A Third Incident of unprofessional behavior by the same offending practitioner shall be reported using the documentation procedure set forth in Section 2 above.

b. If the Third Incident occurred more than 24 months after the Second Incident, the procedure


c. If the Third Incident occurs less than 24 months after the Second Incident, upon receiving the written report of the alleged unprofessional behavior, the President of the Medical Staff shall meet with:

(1) The Chief Administrative Officer; (2) The offending practitioner’s Department Chairman or his or her designee; (3) The System Medical Director for the acute care facility; (4) Any other individual or individuals designated by the President of the Medical Staff.

d. Based on the available documentation and interviews, if necessary, of witnesses, the four

individuals shall determine whether the offending practitioner engaged in unprofessional behavior. They will also review all prior documentation regarding incidents of unprofessional behavior involving the offending practitioner. They will also meet with the offending practitioner.

e. If there is a finding that the offending practitioner did engage in unprofessional behavior, a

written report will be forwarded to the Facility Medical Executive Committee of the Medical Staff, along with all prior documentation, reports and recommendations for actions. Such finding shall require an automatic recommendation to the Facility Medical Executive Committee for Emergency Corrective Action/Precautionary Suspension pursuant to PART II, section 2, of the Medical Staff Bylaws, or mandated referral to the Practitioner Resource Committee, under PART I, subsection 7.6.2.3 of the Medical Staff Bylaws.

f. If the President of the Medical Staff, the Chief Administrative Officer (or designate), the

System Medical Director, Department Chairman (or designate) or other individual appointed to review this matter, find that no unprofessional behavior occurred, this finding shall be recorded in the report and it shall not be considered a Third Incident.

g. The Facility Medical Executive Committee of the Medical Staff shall review the report of the

individuals named above, and may:

(1) Accept the recommendation of Emergency Corrective Action or referral to the Practitioner Resource Committee, and impose same on the offending practitioner in accordance with the procedures set forth in applicable provisions of Medical Staff Bylaws; or

(2) Initiate Routine Corrective Action against the offending practitioner under PART II

section 1, of the Medical Staff Bylaws, in accordance with the procedures set forth herein.

Page 6 of 6

ADDENDUM A


Medical Staffs

REPORT OF UNPROFESSIONAL BEHAVIOR

(Please print legibly)

Name of Offending Practitioner:_____________________________________________________

Name of person reporting incident:___________________________________________________

[ ] Medical Staff Member [ ] Nurse or Other Hospital Employee [ ] Patient, Family or Visitor

Reporter’s workplace:_____________ Phone:_____________ Date of report: _________________

Alleged unprofessional incident: Date:__________ Time:___________ Location:______________

Describe alleged incident, what lead up to it, and consequences of alleged incident. Include names of patients, staff,

or other who were involved or who witnessed the incident.

Names of all persons involved and/or witnesses to incident: _________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

What happened? ___________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

Attach additional pages if needed.

Action, if any, taken immediately in response to alleged incident:

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

Date Received by: Medical Staff Services___________________ Medical Director______________________

Page 1 of 2



TITLE OF POLICY: Credentialing practitioners who have not been providing inpatient care and are now requesting membership and privileges to provide acute inpatient care (competency criteria)

LOCATOR NUMBER

T Y P E




CHAPTER:

TAB: POLICY #:



Dates Revised: May, 2010

Next Review Date:

Author(s): Mark Greenberg, M.D. and Sandra L. Wharton, CPMSM, CPCS

Reviewed by:

Chief Medical Officer Chuck Krivenko, M.D. Date: 03-04-09

LMHS Cred. Comm. Emad Salman, M.D. and John Churchill, M.D. Date: 03-04-09 GCMC Cred. Comm. David Reardon, M.D. and Douglas Savage, M.D. Date: 04-06-09


Timothy Dougherty, M.D. F. Brett Shannon, D.O. Gary Correnti, M.D.

Date: Date: Date:

03-12-09 03-11-09 04-13-09


PURPOSE:

Establish criteria for demonstrating competency to credential practitioners providing outpatient care and now requesting appointment and privileges to provide acute inpatient care.

POLICY: Credentialing practitioners who have not been providing inpatient care and are now requesting membership and privileges to provide acute inpatient care (competency criteria).

Page 2 of 2

DEFINITION:

1. Practitioner who has not provided acute inpatient care within the past twenty-four (24) months.

2. Practitioner who has not provided acute inpatient care between two (2) and five (5)

years. 3. Practitioner who has not provided acute inpatient care for more than five (5) years.

PROCEDURE: Burden will be placed upon the practitioner to provide information to

support the demonstration of current competency for requested privileges.

1. 0 to 24 months:

• No preceptorship requirement (as outlined in Section 8 – M.S. Bylaws).

2. 2 to 5 years:

• Requires preceptorship, office patient volume documentation and relevant CME as specified by the Credentials Committee and subsequently approved by the MEC.

3. More than 5 years:

• Requires additional post-graduate training with a letter from a residency director attesting to current competency, preceptorship, office patient volume documentation and relevant CME as specified by the Credentials Committee and subsequently approved by the MEC.

This procedure may be modified by the Credentials Committee with the approval of the MEC based upon a high intensity of outpatient practice demonstrating competence in caring for reasonably complex patients and/or successful completion of a clinical competency assessment program (defined as a recognized collaborative program with the National Board of Medical Examiners and Federation of State Medical Boards using the Post Licensure Assessment System).



OLD BUSINESS



NEW BUSINESS

ADJOURN Lee Memorial Hospital

GGOO TTOO

{{YYEELLLLOOWW FFOOLLDDEERR}} CCAAPPEE CCOORRAALL HHOOSSPPIITTAALL BBOOAARRDD OOFF DDIIRREECCTTOORRSS

((PPrroovviiddeerr ##1100--00224444))

CONVENE

{{YYEELLLLOOWW FFOOLLDDEERR}}


CAPE CORAL

HOSPITAL

Public Input - Agenda Items: Any Public input is limited to three minutes and a


239-343-3300 FAX: 239-343-3194

P.O. BOX 2218


CAPE CORAL HOSPITAL






LEE PHYSICIAN GROUP

LEE CONVENIENT CARE

BOARD OF DIRECTORS

DISTRICT ONE


Marilyn Stout

DISTRICT TWO

Richard B. Akin


DISTRICT THREE


Linda L. B rown, MSN, ARNP

DISTRICT FOUR

Diane Champion

Chris Hansen

DISTRICT FIVE

Donald A. Brown

James Green


239-343-3300 FAX: 239-343-3194

P.O. BOX 2218


CAPE CORAL HOSPITAL






LEE PHYSICIAN GROUP

LEE CONVENIENT CARE

BOARD OF DIRECTORS

DISTRICT ONE


Marilyn Stout

DISTRICT TWO

Richard B. Akin


DISTRICT THREE



DISTRICT FOUR

Diane Champion

Chris Hansen

DISTRICT FIVE

Donald A. Brown

James Green

“Request to Address the Board of Directors” card must be completed and submitted to the Board Administrator prior to meeting

{{YYEELLLLOOWW FFOOLLDDEERR}}

Convening as the Cape Coral Hospital Board of Directors


Thursday, February 24, 2011, 4:00 p.m. Lee Memorial Hospital – Boardroom


AGENDA

1. Call to Order CAPE CORAL HOSPITAL BOARD OF DIRECTORS (Richard Akin, Board Chairman) {{YYEELLLLOOWW FFOOLLDDEERR}}


3. Jan 20, 2011 Cape Coral Hospital Board Minutes (Approval) (Nancy McGovern, RN, MSM, Board Secretary)

4. Operations Report (Wendy Piascik, VP Patient Care) (Accept)

5. Medical Staff Business (All Directors) (Approval) A. Medical Staff Recommendations of Feb 22, 2011 B. Medical Staff Policies

i. Medical Staff Conduct Policy ii. Medical Staff Residence Policy iii. Preceptorship iv. Behave in a Professional and Civil Manner v. Credentialing practitioners who have not been


6. Old Business

7. New Business

8. Date of the next meeting – Thurs, March 24, 2011, 4:00pm Lee Memorial Hospital – Boardroom


FINAL Agenda - 022411 CCH




Any public input






CAPE CORAL HOSPITAL BOARD OF DIRECTORS (PROVIDER # 10-0244) LEE MEMORIAL HEALTH SYSTEM

Thursday, January 20, 2011 LOCATION: Lee Memorial Hospital Boardroom, 2776 Cleveland Avenue, Fort Myers, FL 33901 MEMBERS PRESENT: Richard Akin, Board Chairman; Marilyn Stout, Board Treasurer; Nancy McGovern, RN, MSM, Board Secretary; Steve Brown, M.D., Director; Chris Hansen, Director; Donald Brown, Director; Diane Champion, Director MEMBERS ABSENT: James Green, Director; Lois Barrett, MBA, Director; Linda Brown, MSN, ARNP, Board Vice Chairman OTHERS PRESENT: Cathy Stephens, Board Administrator; Jim Humphrey, Board Counsel; Mary McGillicuddy, Chief Legal Officer; Larry Antonucci, M.D., Chief Operating Officer/Hospital & Physician

Services; John Wiest, Chief Operating Officer/Business & Strategic Services; Scott Nygaard, M.D., Chief Medical Officer Physician Services; Lisa Sgarlata, R.N., Chief Administrative Officer/LMH; Bill Silverman, M.D., Quality & Education Community Representative; Ben Spence, Controller Acute Care & Reimbursement; Alex Greenwood, System Director CCH/GCMC; Dan Delatorre, Chair Department Med LMH; Wendy Piasek, Vice President Patient Care; Holly Muller, Vice President Patient Care Services/GCMC; Karen Krieger, System Director of Public Affairs; Guest, Frank Gluck, News Press/Reporter; Laurie Gretten, Executive Secretary/Board of Directors




The Cape Coral Hospital Board of Directors (Provider #10-0244) Lee Memorial Health System Meeting was CALLED TO ORDER at 5:34

p.m. by Richard Akin, Board Chairman.


CAPE CORAL OPERATIONS

REPORT

Wendy Piasak presented the Operations Report for Cape Coral Hospital (Exhibit 1) which consisted of a review of quality indicators, patient experience ratings, operational statistics comparing year to date to budget, management focus areas and financial reporting. Discussion ensued regarding capacity issues and how busy the emergency room is.

A motion was made by Marilyn Stout to approve the Operations Report for Cape Coral Hospital (Exhibit 1). The motion was seconded by Nancy McGovern and it carried with no opposition.

MEDICAL


Richard Akin asked for approval of the Cape Coral Hospital Medical Staff Recommendations of January 19, 2011 (Exhibit 2).

A motion was made by Nancy McGovern to approve the Medical Staff Recommendations for Cape Coral Hospital (Exhibit 2). The motion was seconded by Marilyn Stout and it carried with no opposition.

CAPE CORAL

HOSPITAL AUXILIARY

QUARTERLY REPORT

The report was submitted by Mary Pat Roleke, Cape Coral Hospital Auxiliary President, who was unable to attend; however, her report was submitted for approval.

A motion was made by Marilyn Stout to accept the Cape Coral Hospital Auxiliary Quarterly Report. The motion was seconded by Nancy McGovern and it carried with no opposition.

OLD BUSINESS None at this time.


CAPE CORAL HOSPITAL (Provider # 10-0244) BOARD OF DIRECTORS MEETING LEE MEMORIAL HEALTH SYSTEM


SUBJECT DISCUSSION ACTION FOLLOW-

UP NEW BUSINESS None at this time.

NEXT REGULAR

MEETING The next Full Board meeting of the CAPE CORAL HOSPITAL (Provider #10-

0244) BOARD OF DIRECTORS IS: February 24, 2011, 4:00 p.m. in the Lee Memorial Hospital, Boardroom


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

Meeting was ADJOURNED at 5:44pm by Richard Akin, Board Chairman.



Board Secretary

Cape Coral Hospital


Wendy Piascik, MSN, RN, CCRN, NEA, BC,FACHE Vice President, Patient Care Services

CAPE CORAL HOSPITAL

Quality Report

CAPE CORAL HOSPITAL

Patient Experience January 2011Press Ganey Inpatient

Likelihood to Recommend 58.4 %Press Ganey ED

Likelihood to Recommend 57.7%HCAHPS Top Box Score

Rate this Hospital 61%Percentile Ranking 21st

CAPE CORAL HOSPITAL

Financial Report YTD ending 1/31/11Net Revenue•Net Rev/Adj. Admit Budget 7239 Actual 7460 3.1%•Net Revenue per adjusted admission exceeded budget by 3.1%, with a positive rate variance of $1.84M offset by a negative volume variance of $1.75M.

Labor•FTEs per AOB were 4.02 vs. budget of 4.10 for a favorable improvement of 1.9% or 21FTEs.

•Salaries were over budget $753K, of which $477K was attributable to the 0.9% decreasein volume and $276K due to an increase in hourly rate..

Gain from Operations •Gain from Operations Budget 15558 Actual 13722 -11.8%•The Gain from Operations was under budget by $1.8M or -11.8% but favorable to PY by 86K.•Operating Expense per adjusted admit exceeded budget by 7.1% and PY by 7.3%.•Salary/Wage/Benefit expense per adjusted admit exceeded budget by 4.5% and PY by 6.5%.•Supply expense per adjusted admission exceeded budget by 8.9% and PY by 6.0%.

CAPE CORAL HOSPITAL

Operations Report YTD ending 1/31/11

Year to Date Budget Actual var Bud Admissions 5254 5209 -0.9%ER Visits 20115 20075 -0.2%ER Admits 4365 4531 3.8%Deliveries 484 473 -2.3%Surgical Cases 2680 2618 -2.3%

Seasonal Overflow Unit – 2 EastOpen with current capacity of 24



MEDICAL STAFF

BUSINESS


Lee County, Florida #2

M E M O R A N D U M To: Board of Directors From: Sandra L. Wharton, CPMSM, CPCS System Director, Medical Staff Services Subject: Cape Coral Hospital Medical Staff Recommendations Date: February 22, 2011 The Facility Medical Executive Committee of the Medical Staff recommends the following physicians and allied health practitioners and certifies they have met the requirements set forth in the bylaws:

1. Associate Staff Appointments: a. Jeffrey A. Neale, M.D. – Colon & Rectal Surgery b. Justin J. Polga, M.D. – Internal Medicine c. Anuradha Satyavolu, M.D. – Family Practice

2. First Year Completion – Active Staff Appointment:

a. Gregory M. Romaniuk, M.D. – Family Practice

3. First Year Completion – Associate Staff Appointments: a. Christopher Calcagni, D.P.M. – Podiatry b. A. Catherine David, D.P.M. – Podiatry c. Victor M. Luna, M.D. – Endocrinology d. Robert W. Pollack, M.D. - Psychiatry e. Kim D. Schurman, M.D. – Internal Medicine f. Anna D. Shuster, D.O. – Family Practice

4. Resignations:

a. Fred C. Beckett, III, M.D. – Pulmonary Medicine 5. Leave of Absence:

a. George Kovacevic, M.D. – Obstetrics & Gynecology, 02-22-11 to 04-21-11 6. Temporary Privileges:



a. Mandy Parfitt, ARNP – MacKoul Pediatrics b. Alisa Santiago, PA – SW FL Neurosurgical Associates c. Kerry Shuffelbottom, PA – SW FL Neurosurgical Associates d. Christina Smith, ARNP – Employee Health

Memorandum to Board of Directors - CCH February 22, 2011 Page 2 of 2 8. Allied Health Practitioner – Sponsor Change:



a. Christina Flint-Lowe, ARNP – Inpatient Consultants b. Nelson Guzman, PA – Florida Medical Affiliates c. Patrick Mora, PA – SW FL Neurosurgical Associates


__________________________________________ Richard B. Akin, Chairman – Board of Directors

Page 1 of 2




T Y P E




CHAPTER:

TAB: POLICY #:



Dates Revised:

Next Review Date:





11-11-10 11-08-10 11-09-10 11-10-10 11-04-10


PURPOSE:




PROCEDURE:






Page 2 of 2






actions that:










actions; or
















Page 1 of 4




T Y P E




CHAPTER:

TAB: POLICY #:



Dates Revised:

Next Review Date:


Reviewed by:





01-17-11 01-11-11 01-12-11 01-10-11 01-18-11


Date:


PURPOSE:


Page 2 of 4



PROCEDURE:





Page 3 of 4













Page 4 of 4





.


Page 1 of 2




T Y P E




CHAPTER:

TAB: POLICY #:



Dates Revised:

Next Review Date:


Reviewed by:





Date: Date: Date:

10-08-09 10-14-09 10-12-09


PURPOSE:


Page 2 of 2













Page 1 of 6




LOCATOR NUMBER

T Y P E




CHAPTER:

TAB: POLICY #:



Dates Revised:

Next Review Date:

Authors:

Reviewed by:






11-11-10 11-08-10 11-09-10 11-10-10 11-04-10

As needed:






Page 2 of 6








Page 3 of 6



















Page 4 of 6


















Page 5 of 6



















Page 6 of 6

ADDENDUM A


Medical Staffs











_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

What happened? ___________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________



_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________


Page 1 of 2




LOCATOR NUMBER

T Y P E




CHAPTER:

TAB: POLICY #:




Next Review Date:


Reviewed by:





Date: Date: Date:

03-12-09 03-11-09 04-13-09


PURPOSE:



Page 2 of 2

DEFINITION:






1. 0 to 24 months:


2. 2 to 5 years:







OLD BUSINESS



NEW BUSINESS

ADJOURN Cape Coral Hospital

GGOO TTOO

{{YYEELLLLOOWW FFOOLLDDEERR}} GGUULLFF CCOOAASSTT

MMEEDDIICCAALL CCEENNTTEERR BBOOAARRDD OOFF DDIIRREECCTTOORRSS

((PPrroovviiddeerr ##1100--00224444))

CONVENE

{{OORRAANNGGEE FFOOLLDDEERR}} (Provider # 10-0220)

GULF COAST

MEDICAL CENTER

ARD OF DIRECTORS BOOFFICE

239-343-3300 X: 239-343-3194 FA

P.O. BOX 2218

RT MYERS, FLORIDA 33902 FO

PE CORAL HOSPITAL CA






LEE PHYSICIAN GROUP

LEE CONVENIENT CARE

BOARD OF DIRECTORS

TRICT ONE DIS


Marilyn Stout

DISTRICT TWO

Richard B. Akin


DISTRICT THREE



DISTRICT FOUR

Diane Champion

Chris Hansen

DISTRICT FIVE

Donald A. Brown

James Green

Public Input - Agenda Items: Any Public input is limited to three minutes and a


239-343-3300 FAX: 239-343-3194

P.O. BOX 2218


CAPE CORAL HOSPITAL






LEE PHYSICIAN GROUP

LEE CONVENIENT CARE

BOARD OF DIRECTORS

DISTRICT ONE


Marilyn Stout

DISTRICT TWO

Richard B. Akin


DISTRICT THREE



DISTRICT FOUR

Diane Champion

Chris Hansen

DISTRICT FIVE

Donald A. Brown

James Green

“Request to Address the Board of Directors” card must be completed and submitted to the Board Administrator prior to meeting

{{OORRAANNGGEE FFOOLLDDEERR}}

Convening as the Gulf Coast Medical Center Board of Directors


Thursday, February 24, 2011, 4:00 p.m. Lee Memorial Hospital-Boardroom


AGENDA

1.Call to Order GULF COAST MEDICAL CENTER BOARD OF DIRECTORS

(Richard Akin, Board Chairman) {{OORRAANNGGEE FFOOLLDDEERR}}


3. Jan 20, 2011 Gulf Coast Medical Center Board Minutes (Approval) (Nancy McGovern, RN, MSM, Board Secretary)

4. Operations Report (Holly Mueller, VP Patient Care) (Accept)

5. Medical Staff Business (All Directors) (Approval) A. Medical Staff Recommendations of Feb 22, 2011 B. Medical Staff Policies

i. Medical Staff Conduct Policy ii. Medical Staff Residence Policy iii. Preceptorship iv. Behave in a Professional and Civil Manner v. Credentialing practitioners who have not been


6. Old Business

7. New Business

8. Date of the next meeting – Thursday, March 24, 2011, 4:00pm Lee Memorial Hospital – Boardroom


FINAL Agenda - 022411 GCMC Agenda




Any public input






GULF COAST MEDICAL CENTER BOARD OF DIRECTORS (PROVIDER # 10-0220) LEE MEMORIAL HEALTH SYSTEM

Thursday, January 20, 2011 LOCATION: Lee Memorial Hospital, Boardroom, 2776 Cleveland Avenue, Fort Myers, FL 33901 MEMBERS PRESENT: Richard Akin, Board Chairman; Marilyn Stout, Board Treasurer; Nancy McGovern, RN, MSM, Board Secretary; Steve Brown, M.D., Director; Chris Hansen, Director; Donald Brown, Director; Diane Champion, Director MEMBERS ABSENT: James Green, Director; Lois Barrett, MBA, Director; Linda Brown, MSN, ARNP, Board Vice Chairman OTHERS PRESENT: Cathy Stephens, Board Administrator; Jim Humphrey, Board Counsel; Mary McGillicuddy, Chief Legal Officer; Larry Antonucci, M.D., Chief Operating Officer/Hospital & Physician

Services; John Wiest, Chief Operating Officer/Business & Strategic Services; Scott Nygaard, M.D., Chief Medical Officer Physician Services; Lisa Sgarlata, R.N., Chief Administrative Officer/LMH; Bill Silverman, M.D, Quality & Education Community Representative; Ben Spence, Controller Acute Care & Reimbursement; Alex Greenwood, System Director CCH/GCMC; Dan Delatorre, Chair Department Med LMH; Holly Muller, Vice President Patient Care Services/GCMC; Karen Krieger, System Director of Public Affairs; Guest, Frank Gluck, News Press/Reporter; Laurie Gretten, Executive Secretary/Board of Directors




GULF COAST MEDICAL CENTER BOARD OF DIRECTORS (Provider #10-0220), LEE MEMORIAL HEALTH SYSTEM

Meeting was CALLED TO ORDER at 6:08 p.m. by Richard Akin, Board Chairman.


GULF COAST

MEDICAL CENTER OPERATIONS

REPORT

Holly Muller presented the Operations Report for Gulf Coast Medical Center (Exhibit 1) which consisted of a review of quality indicators, patient experience ratings, operational statistics comparing year to date to budget, management focus areas and financial reporting. Discussion ensued regarding comparing statistics of each facility; a patient experience including over 70 contacts which one encounter can make or break us.

A motion was made by Nancy McGovern to approve the Operations Report for Gulf Coast Medical Center (Exhibit 1). The motion was seconded by Marilyn Stout and it carried with no opposition.

MEDICAL


Richard Akin asked for approval of the Gulf Coast Medical Center Medical Staff Recommendations of January 19, 2011 (Exhibit 2).

A motion was made by Nancy McGovern to approve the Medical Staff Recommendations for Gulf Coast Medical Center (Exhibit 2). The motion was seconded by Chris Hansen and it carried with no opposition.

OLD BUSINESS

None at this time.

NEW BUSINESS None at this time.


GULF COAST MEDICAL CENTER (Provider # 10-0220) BOARD OF DIRECTORS MEETING LEE MEMORIAL HEALTH SYSTEM


SUBJECT DISCUSSION ACTION FOLLOW-

UP NEXT REGULAR

MEETING The next Full Board meeting of the GULF COAST MEDICAL CENTER

(Provider # 10-0220) BOARD OF DIRECTORS IS: February 24, 2011, 4:00 p.m. in the Lee Memorial Hospital, Boardroom


ADJOURNMENT The Gulf Coast Medical Center (Provider #10-0220)

Board of Directors Meeting was ADJOURNED at 6:20 p.m. by Richard Akin, Board Chairman.



Board Secretary

Gulf Coast MEDICAL CENTER

Presented to Board of DirectorsFebruary 24, 2011

Holly Muller, RN, MSN, MHA, CRRNVice President, Patient Care Services

The disclosure of this document and the contents herein does not constitute a waiver of any and all protections afforded Patient Safety Work Product under the Patient Safety Quality Improvement Act of 2005 and implementing regulations.

Quality Report ~ Gulf Coast MEDICAL CENTER

Patient Experience 1st. Quarter FY 11 January 2011

Press Ganey Inpatient:

Likelihood to Recommend 66.4% 60.3%

Press Ganey ED

Likelihood to Recommend 54.3% 46.7%

HCAHPS Top Box Score

Rate this Hospital 63.0% 63.0%

Operations Report ~ Gulf Coast MEDICAL CENTER

Year to Date Budget Actual var Bud

Admissions 6972 7532 8.04%ER Visits 16468 16370 -0.60%ER Admits 5089 5587 9.78%Deliveries 651 593 -8.84%Surgical Cases 3538 3505 -0.93%Gain from Operations 11166 11091 -0.67%Net Rev/Adj Admit 9448 9400 -0.50%

Capacity Management Focus:• Operations Improvement ~ ED• Discharge Execution Initiative

Financial Report ~ Gulf Coast MEDICAL CENTER

Net Revenue • Net Revenue per adjusted admission was below budget by -0.50%, with a

negative rate variance of $444K offset by a positive volume variance of $2.6M.

Labor• FTEs per AOB was 4.64 vs budget of 4.65 for a productivity improvement of

0.13% or 2 FTEs. • Salaries were over budget $557K, of which $1.1M was attributable to the

8.1% volume increase offset by a favorable average hourly rate decrease of $515K.

Gain from Operations • The Gain from Operations fell short by $75K or -0.67% due in part to the

variable interest rate being higher than expected for the beginning of the year and the 11% increase in Bad Debt and Charity as a % of Gross Revenue.

• Operating Expense per adjusted admit exceeded budget by -0.07% and below PY by -0.97%.

• Salary/Wage/Benefit expense per adjusted admit was below budget by - 2.3% and below PY by -2.4%.

• Supply expense per adjusted admission was above budget by 5.93% and above PY by 1.96%. The majority of the increase per AA is in Stents, AICD’s, and Drug-Eluting Stents.



MEDICAL STAFF

BUSINESS



To: Board of Directors From: Sandra L. Wharton, CPMSM, CPCS System Director, Medical Staff Services Subject: Gulf Coast Medical Center Medical Staff Recommendations Date: February 22, 2011 The Facility Medical Executive Committee of the Medical Staff recommends the following physicians and allied health practitioners and certifies they have met the requirements set forth in the bylaws:

1. Associate Staff Appointments: a. Andrew M. Gross, M.D. – Pain Management b. Jeffrey A. Neale, M.D. – Colon & Rectal Surgery c. Justin J. Polga, M.D. – Internal Medicine d. Anuradha Satyavolu, M.D. – Family Practice e. Deborah C. Silver, Psy.D. – Psychology


a. Tatiana S. Reynolds, M.D. – Family Practice b. Gregory M. Romaniuk, M.D. – Family Practice c. Margaret Taha, M.D. – Diagnostic Radiology


a. Christopher Calcagni, D.P.M. – Podiatry b. A. Catherine David, D.P.M. – Podiatry c. Victor M. Luna, M.D. – Endocrinology d. Robert W. Pollack, M.D. - Psychiatry e. Kim D. Schurman, M.D. – Internal Medicine

4. Privilege Request:

a. Michael R. Black, D.P.M. – Podiatry – Implant arthroplasty of the ankle 5. Resignations:

a. Fred C. Beckett, III, M.D. – Pulmonary Medicine b. Kirk Brown, M.D. – Teleradiology c. Paul M. Gardner, M.D. – Plastic Surgery d. Gregg Guffrey, M.D. – Emergency Medicine

Memorandum to Board of Directors - GCMC February 22, 2011 Page 2 of 2 6. Allied Health Practitioners:

a. Alisa Santiago, PA – SW FL Neurosurgical Associates b. Kerry Shuffelbottom, PA – SW FL Neurosurgical Associates c. Christina Smith, ARNP – Employee Health




a. Christina Flint-Lowe, ARNP – Inpatient Consultants b. Nelson Guzman, PA – Florida Medical Affiliates c. Patrick Mora, PA – SW FL Neurosurgical Associates


_________________________________________ Richard B. Akin, Chairman, Board of Directors

Page 1 of 2




T Y P E




CHAPTER:

TAB: POLICY #:



Dates Revised:

Next Review Date:





11-11-10 11-08-10 11-09-10 11-10-10 11-04-10


PURPOSE:




PROCEDURE:






Page 2 of 2






actions that:










actions; or
















Page 1 of 4




T Y P E




CHAPTER:

TAB: POLICY #:



Dates Revised:

Next Review Date:


Reviewed by:





01-17-11 01-11-11 01-12-11 01-10-11 01-18-11


Date:


PURPOSE:


Page 2 of 4



PROCEDURE:





Page 3 of 4













Page 4 of 4





.


Page 1 of 2




T Y P E




CHAPTER:

TAB: POLICY #:



Dates Revised:

Next Review Date:


Reviewed by:





Date: Date: Date:

10-08-09 10-14-09 10-12-09


PURPOSE:


Page 2 of 2













Page 1 of 6




LOCATOR NUMBER

T Y P E




CHAPTER:

TAB: POLICY #:



Dates Revised:

Next Review Date:

Authors:

Reviewed by:






11-11-10 11-08-10 11-09-10 11-10-10 11-04-10

As needed:






Page 2 of 6








Page 3 of 6



















Page 4 of 6


















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Page 6 of 6

ADDENDUM A


Medical Staffs











_________________________________________________________________________________

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What happened? ___________________________________________________________________

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Page 1 of 2




LOCATOR NUMBER

T Y P E




CHAPTER:

TAB: POLICY #:




Next Review Date:


Reviewed by:





Date: Date: Date:

03-12-09 03-11-09 04-13-09


PURPOSE:



Page 2 of 2

DEFINITION:






1. 0 to 24 months:


2. 2 to 5 years:







OLD BUSINESS



NEW BUSINESS

ADJOURN GULF COAST

MEDICAL CENTER

GGOO TTOO

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LLEEEE MMEEMMOORRIIAALL HHEEAALLTTHH SSYYSSTTEEMM

BBOOAARRDD OOFF DDIIRREECCTTOORRSS MMEEEETTIINNGG

GOVERNANCE BOARD OF DIRECTORS

MEETING Thursday, February 24, 2011

GOVERANANCE CHAIRMAN: Donald Brown

CONSENT AGENDA

BOARD OF DIRECTORS QUARTERLY BUDGET REPORTFY 2011 1st Quarter Oct - Dec, 2011 Manager: Stephens

Expenses YTD ACTUAL 2011 BUDGET SalaryProductive Salary 42,502 136,655NonProductive Salary (Benefits & Vacation) 50,523 166,983

Total Salaries 93,025 303,638Supplies (Variable)

840000 Office/Copy/Photo 1,511 4,250850000 Raw Food Costs - Catering Charge 2,045 4,444

Total Supplies (Variable) 3,556 8,694Other (Fixed)

822000 Legal Exp-Non Professional - Legal Fees 334 500825000 Legal Exp - Professional Attorney Fees 9,414 40,000858000 Special Events-Doc Coggins 10,237 17,400859000 Other Expenses (General Expenses other than office supplies) 2,881 4,250863000 Dues & Memberships (New 2011 - Governance Institute Membership) 7,811 15,622864000 Subscriptions 76 225865000 Scholarships/Donations 100 15,000868100 Cellular Phone 216 660880000 Education & Travel 7,435 49,500880100 Mileage Reimbursement 817 4,000881200 Business Meeting & Expense 1,023 10,000960000 Postage Expense 112 560

Total Other (Fixed) 40,456 144,217Purchased Services (Fixed)

845700 Purchased Svs - Printing 273 600845950 Purchased Svs - Courier 1,575 6,300

Total Purchased Services (Fixed) 1,848 6,900

Total Expenses 138,885 463,449

Budget/2011 Presentation Board Budget YTD/1st Qtr Presented to Governance 2/24/11

LEE MEMORIAL HEALTH SYSTEM BOARD OF DIRECTORS GOVERNANCE COMMITTEE OF THE WHOLE MEETING MINUTES

Thursday, November 4, 2010 LOCATION: Lee Memorial Hospital Boardroom, 2776 Cleveland Avenue, Fort Myers, FL 33901 MEMBERS PRESENT: Frank La Rosa, Governance Chairman; Richard Akin, Board Chairman; Marilyn Stout, Board Vice Chairman; Dawson McDaniel, Board Treasurer; Linda Brown, MSN, ARNP, Board

Secretary; Steve Brown, M.D., Director; Nancy McGovern, RN, MSN, Director MEMBERS ABSENT: James Green, Director; Lois Barrett, MBA, Director OTHERS PRESENT: Jim Nathan, President/CEO; Cathy Stephens, Board Administrator; Jim Humphrey, Board Counsel/Fowler & White; Jon Cecil, Chief Human Resources Officer, Charles Swain, Chief

Compliance Officer & Internal Audit Officer; Karen Krieger, System Director/Public Affairs; Nina Norman, Compliance Specialist; Jack Eikenberg, Community Representative/Planning Committee, David Berger, M.D., Community Representative/Quality & Education Committee, Bill Silverman, M.D., Guest, Don Brown, Board-Elect; Chris Hansen, Board-Elect, Laurie Gretten, Executive Secretary/Board of Directors, Sandy Carpenter; Executive Secretary/Board of Directors

NOTE: Documents referred to in these minutes are on file by reference to this meeting date in the Office of the Board of Directors and on the Board of Directors website at www.leememorial.org/boardofdirectors, for public inspection.

SUBJECT DISCUSSION ACTION FOLLOW-UP MEETING

CALLED TO ORDER

The GOVERNANCE COMMITTEE OF THE WHOLE meeting was CALLED TO ORDER at 11:41 a.m.

by Frank La Rosa, Governance Chairman.

The meeting of the Governance Committee of the Whole of the Lee Memorial Health System Health Board of Directors will be called to order. Matters concerning the business of Lee Memorial System

consisting of Gulf Coast Medical Center & Lee Memorial Hospital/HealthPark Medical Center and its subsidiaries (HealthPark Care Center, Inc., Lee Memorial Home Health, Inc., Cape Memorial

Hospital, Inc. doing business as Cape Coral Hospital, and Lee Memorial Medical Management, Inc.) may be reported,

discussed and recommended by the Committee of the Whole, then referred to the full Board of Directors for final action.


CONSENT AGENDA

Frank La Rosa asked if anyone wished to pull any of the items listed on the Consent Agenda consisting of the following: A. Governance Committee Meeting Minutes of May 6, 2010 B. Board of Directors FY 2010 Budget Report (Exhibit 1)

A motion was made by Marilyn Stout to approve the Consent Agenda consisting of: A. Governance Committee Meeting Minutes of May 6, 2010 B. Board of Directors FY 2010 Budget Report (Exhibit 1). The motion was seconded by Linda Brown and it carried with no opposition.

CORPORATE QUARTERLY

COMPLIANCE REPORT 4TH QTR FY2010

Charles Swain presented the Corporate Quarterly Compliance Report 4th Qtr FY 2010 (Exhibit 2). He reviewed the breakdown by category of hotline calls received. He mentioned calls have increased in various categories especially in the areas of human resources and patient care for FY 2010 vs. FY 2009.

A motion was made by Nancy McGovern to accept the Corporate Compliance Report, 4th Qtr FY 2010 (Exhibit 2). The motion was seconded by Linda Brown and it carried with no opposition.

DOC COGGINS AWARD-

PROPOSED ENHANCEMENT

Cathy Stephens presented the proposed Doc Coggins Award program modification (Exhibit 3). She explained the changes to the current program, allowing a “top finalist” award recognition which would consist of eighteen individuals, six from each division. She stated that this recognition is just adding another tier to the program and would not detract from the top twelve winners. The recognition would include a breakfast/brunch, recognition by the Board/Administration, $100 award check and a framed finalist certificate. Cathy noted the cost would be an additional $2,500.00 and she requests this change

http://www.leememorial.org/boardofdirectors


Thursday, November 4, 2010 Page 2 of 4

SUBJECT DISCUSSION ACTION FOLLOW-UP start this year. Jim Nathan spoke about the number of twelve winners and not watering it down. But because of the size of the organization, he reinforced that more individuals need to be recognized for their hard work. Discussion ensued regarding the criteria for the determination of the six finalists in each division, and most commented this extra tier for recognition is a good idea.

A motion was made by Marilyn Stout to approve the Doc Coggins award proposed enhancement (Exhibit 3). The motion was seconded by Nancy McGovern and it carried no opposition.

BOARD COUNSEL

EVALUATION RESULTS Cathy Stephens reviewed the Board Counsel Evaluation Results for Jim Humphrey (Exhibit 4). Jim Humphrey expressed great appreciation for the confidence. He enjoys this responsibility and he looks forward to another year.

A motion was made by Steve Brown to accept the Board Counsel Evaluation Results (Exhibit 4). The motion was seconded by Dawson McDaniel and it carried with no opposition.

.

BOARD POLICIES

/BYLAWS

Board Policy 10.52D: Community

Representatives

Board Policy 40.09A: President and Chief

Executive Officer (CEO) Unplanned Succession Process and Selection

and Replacement Process

Cathy Stephens reviewed the proposed changes to Board Policy 10.52 D: Community Representatives-Appointed (Exhibit 5). Cathy stated that at the last Board meeting, the Board made a decision to change from committee meetings to full board meetings starting in 2011. With that said, Board Policy 10.52 D, specifically item no. 5, Mary McGillicuddy recommends additional verbiage whereby community members would be appointed to serve in an advisory capacity role as opposed to having a vote at a committee level. Cathy noted this was discussed at length back in May whereby the Board did not want to loose the benefit of community members and their expertise. It was indicated the Board would survey the community members regarding their input and opinion before a formal vote was taken. Jim Humphrey clarified for the record that this Board Policy is named 10.52D version B: (Community Representatives – Advisory Appointments)(Exhibit 6) not the version as provided in the packet. Discussion ensued with concern about taking away a vote from members is a mistake; the important valuable expertise provided by the community members; their role would be diminished and it is possible they will not contribute in the meetings as well as attend. Discussion ensured. Jim Nathan reviewed Board Policy 40.09A: President and Chief Executive Office (CEO) Unplanned Succession Process and Selection and Replacement Process (Exhibit 7): He said this policy needed to be revised because there is no longer a rotating senior leadership team in place. Jim proposed a six-month – six-month rotation between the two chief operating officers, who would step into action immediately until the Board gathers and decides how they wish to proceed. Discussion ensued regarding how the six month assignment would work. Jim Humphrey recommended an additional change to the policy, Section Policy: #2, adding verbiage stating majority vote of the total Board of Directors to the final selection of the President and CEO should be added to the language in this policy. Therefore Section Policy, #2: to read: The final selection of the

A motion was made by Marilyn Stout to adopt Board Policy 10.52D: Community Representatives – Advisory Appointments (Exhibit 6). The motion was seconded by Steve Brown and it carried with no opposition. A motion was made by Marilyn Stout to adopt Board Policy 40.09A (Exhibit 6). The motion was seconded by Linda Brown and it carried with no opposition.




Board Bylaws Proposed Changes

to Article II: Meetings

& Article IV: Committees

President and CEO shall be by a simple majority vote of the total membership of the Board of Directors. Jim Nathan mentioned it is healthy and in the best interest for Lee Memorial Health System to go out for a national search regarding a replacement candidate whether there are internal candidates or not. Discussion ensued. Jim Humphrey & Cathy Stephens reviewed the Board Bylaws for proposed revisions due to the Board’s changing from Committee of the Whole to Full Board of Directors’ meetings for 2011 meeting schedule. Board Bylaw Article II: Meetings was distributed in the packet (Exhibit 8), whereas Jim Humphrey carried in revised Board Bylaw Article IV: Committees (Exhibit 9). Both Bylaw revisions were reviewed and discussed. Jim Humphrey reminded the Board that the changes from Committee of the Whole to Full Board of Directors meetings is scheduled to sunset in October 2011, therefore the wording has been carefully revised to include all meetings of the Board. Jim Humphrey also mentioned that any changes to the Board Bylaws requires approval by 2/3rds of the Board. Discussion.

The motion was amended by motion maker Marilyn Stout and seconded by Linda Brown to revise Section Policy, #2: to read: The final selection of the President and CEO shall be by a majority vote of the total membership of the Board of Directors. A motion was made by Nancy McGovern to adopt revised Board Bylaw Article II: Meetings and Board Bylaw Article IV: Committees (Exhibit 8 & 9). The motion was seconded by Marilyn Stout and it carried with no opposition.

OTHER ITEMS

Teleconference

Participation – Draft Policy 10.46B

Roll Call Voting

Procedure

Cathy Stephens introduced proposed changes Board Policy 10.46B: Teleconference Participation (Exhibit 10). Discussion ensued regarding the reason for drafting language for current policy was specifically due to the distraction it causes. Board members discussed teleconferencing should only be used on an emergency basis. Jim Humphrey stated from the Attorney General’s standpoint, teleconference should have a written policy on election of member call in vote only on an emergency basis at an emergency meeting. Jim stated a board member by teleconference cannot be counted in as quorum. It was agreed that teleconferencing should only be allowed for emergency purposes as approved by the Chairman. Cathy Stephens introduced the current practices used in roll call voting. She said she had a request for this topic to be added to the agenda, based on the current process gives unfair advantage, she reviewed the Board Member Roll Call Sheet (Exhibit 11): Jim Humphrey suggested a procedure of casting handwritten ballots. Jim Humphrey stated that according to the Attorney General’s office, the handwritten ballot is named, read and maintained for public inspection. Jim recommended preprinted slips for casting handwritten ballots for roll call voting procedure for the future.

A motion was made by Marilyn Stout to adopt Board Policy 10.46B: Attendance and Voting at Meetings by Teleconference (Exhibit 10). The motion was seconded by Dawson McDaniel and it carried with no opposition. A motion was made by Steve Brown to adopt handwritten roll call ballots. The motion was seconded by Nancy McGovern and it carried with no opposition.



SUBJECT DISCUSSION ACTION FOLLOW-UP NEXT REGULAR

MEETING Date of the next Governance Meeting will be a Governance Full Board Meeting: Thursday, February 10, 2011, (Follows Finance Meeting 4:00 P.M.) Held in the Lee Memorial Hospital Boardroom.

SUBJECT DISCUSSION ACTION FOLLOW-UP ADJOURNMENT The Governance Committee of the Whole meeting

was ADJOURNED at 12:58 p.m. by Frank La Rosa, Governance Chairman.

Minutes were recorded by Sandy Carpenter, Executive Secretary/Board of Directors Office

________________________________________________________________________ Nancy McGovern, RN, MSM

Board Secretary

Approved by Governance COMMITTEE ONLY 11/4/10 - Proposed for Adoption 2/24/11

ARTICLE IV

COMMITTEES

Section 1 Standing and Special Committees a. Standing committees shall include members of the Board and such other persons as the Board

may approve or as otherwise may be designated. The Chairman and Vice Chairman of Standing

committees shall be appointed by the Chairman of the Board and confirmed by the Board at the

first meeting following the appointment. Committee liaison assignments may be accomplished

when necessary or desirable, and such changes approved at any regular Board meeting.

Members of the Health System administration or medical staffs may be named as consultants to

the committees.

b. All Board members will be provided notice of any Board Committee meeting and invited to

participate.

c. The Board may meet as the Committee of the Whole, and may investigate and report on matters

within its jurisdiction, either at the request of the Board, the Chairman, or by any three (3) members

except for those matters which are referred to another committee by the Chairman of the Board or

as restricted by the Committee. The Committee of the Whole shall have no power to act other than

to make recommendations to the Board. Special committees may be established and

appointments made by the Chairman of the Board.

GB-4.2

(Revised 08/28/08) Approved by Governance COMMITTEE ONLY 11/4/10 - Proposed for Adoption 2/24/11

10.11E REVISED - Attendance of Directors of the Board for approval 022411 Page 1 of 1

LEE MEMORIAL HEALTH SYSTEM BOARD OF DIRECTORS

POLICY MANUAL ****REVISED**** no. 10.11 E D supersedes no. 10.11 D C --------------------------------------------------------------------------------------------------------------------------------------- category: General Operations

title: Board Member Attendance of Directors of the Board --------------------------------------------------------------------------------------------------------------------------------------- original adoption: 1/08/91 review date:5/27/10, 6/24/10, 8/26/10, 9/23/10, 02/24/11

revision date: 7/31/98, 7/26/02, 6/30/05, 5/31/07, 2/24/11 --------------------------------------------------------------------------------------------------------------------------------------- PURPOSE: The needs of the Health System are best served when all Board Members Directors are present at Board meetings. --------------------------------------------------------------------------------------------------------------------------------------- POLICY: As publicly elected officials, Board Members Directors must exercise diligence in the discharge of their public duties. When taking office each Board Member Director took an oath which included the statement, “I will well and faithfully perform the duties of a Director of the Board of Directors.” By adoption of this policy, the Board of Directors finds that attendance at regular meetings of the Board is necessary to meet the fiduciary duties to the public health care system and the health interests of the citizens served by the health system.

The Lee Memorial Health System Board of Directors is authorized and empowered by its enabling act to approve annual compensation of up to $10,000 for services as members of the Board, as increased on the first day of each fiscal year by an amount equal to the increase in the Consumer Price Index for the prior fiscal year. ------------------------------------------------------------------------------------------------------------------------------------- PROCEDURE:

1. Board Members Directors are requested to notify the Board office when unable to attend a Board meeting as far in advance of said meeting as possible. Board Members Directors are requested to notify the Board office of dates they will be out of town and unavailable for meetings.

2. The minutes shall reflect Board Members Directors who are present at meetings and shall reflect when a Board Member Director arrives if a Board Member Director arrives after a meeting is called to order and shall reflect when a Board Member Director departs if a Board Member Director departs prior to the end of the meeting. For purposes of this attendance at a meeting, a Board Member must be present for 75% of any published monthly meeting.

3. Board Members will be required to attend a minimum of 60% (rounded up to the nearest whole number) of all published monthly meetings in order to receive compensation (stipend) for the month.

4. The Board Secretary shall notify in writing any Board Member who will not be receiving said compensation based on the attendance requirements as stated above. See Board Policy 20.13: Compensation and Benefits for Board Members. If a Board Member receives compensation in part or in whole for a month in which he or she did not meet the attendance requirements as stated above, such amount will be deducted from the next scheduled compensation payment(s).

20.13 F REVISED -Compensation and Benefits for Board Members for approval 022411 Page 1 of 1

LEE MEMORIAL HEALTH SYSTEM BOARD OF DIRECTORS POLICY MANUAL ****REVISED**** no. 20.13 F E supersedes no. 20.13E D ------------------------------------------------------------------------------------------------------------------------------------- category: Financial Operations title: Compensation and Benefits for Board Members ------------------------------------------------------------------------------------------------------------------------------------- original adoption: 6/28/91 review date: 6/24/10, 8/26/10, 9/23/10, 2/24/11

revision date: 5/31/91, 7/31/98, 8/25/00, 3/01/02, 5/27/10, 2/24/11 ------------------------------------------------------------------------------------------------------------------------------------- PURPOSE: To adopt policies and procedures deemed appropriate regarding the granting of benefits and allowances for Board Members. ------------------------------------------------------------------------------------------------------------------------------------- POLICY: The Lee Memorial Health System Board is authorized to adopt policies, procedures, guidelines, and rules that it deems appropriate pertaining to privileges, benefits, and allowances for Board Members. After a careful review and discussion regarding the granting of meal privileges for Board Members the following policy and procedure is hereby adopted.

• Board Members will not be eligible nor accept free meals at any of the System cafeterias.

• The Board Administrator shall notify the Director of Food Services of this policy and have

the Director inform his/her staff members at all the cafeterias to enforce this policy.

Each member of the Lee Memorial Health System Board of Directors may shall receive the maximum total annualized compensation rate authorized by its enabling law, if approved by the Board and subject to requirements established by Board Policy. Board Member compensation may shall be amortized over a twelve month period and paid in equal biweekly (once every two weeks)

installments, or such other installments as determined by administration and the Board. Upon verification of a Board Member’s failure to meet the attendance requirement for a particular month in accordance with Board Policy 10.11, a Board Member shall not receive compensation for said month. If a Board Member has already received compensation in part or in full for a month in which he or she failed to meet the attendance requirements set forth in Board Policy 10.11, such amount will be deducted from the next scheduled compensation payment(s). Members may shall be authorized to receive all privileges, benefits, and allowance authorized by law subject to Board Policy. Members electing to receive health benefits will be charged the same amount established for full time Ssystem employees as set from time to time and payment shall be made in the same manner as established for Ssystem employees.

Memorandum

TO: Cathy Stephens, Board Administrator

FROM: James T. Humphrey

DATE: February 17, 2011

RE: Board Officers Job Descriptions

In preparing “job descriptions” for the Board Officers, it is important to begin with the

fact that the Lee Memorial Health System Board of Directors are elected public officials. As publically elected Directors of an Independent Special District, each Board Member is subject to the Florida Constitution, Florida Statutory requirements and Chapter 2000-439, Laws of Florida. Each Director has taken an oath to support, protect and defend the Constitution of the United States and the State of Florida, and to well and faithfully perform the duties as a Board Member. As an elected official and not an employee, individual Board Members do not actually have “job descriptions.”

The Special Act does provide for the election of officers at the annual organizational meeting of the Board. Officers are given additional duties and responsibilities associated with the particular office the member holds.

The CHAIRMAN is responsible for presiding at all meetings of the Board, except when the Board is considering and acting on financial matters at which time the Treasurer should act as the Chairperson. The Chairman is to exercise all the power and duties imposed on the position by the Enabling Act, the Florida Statutes, Federal Rules and Regulations, Board Bylaws, written Board Policies and Robert Rules of Order. As the Chairperson of a public body, there are occasions where Federal and State laws provide for the Chairman, who is deemed head of the public district, to take action such as during declared emergencies. State law provides for the Chair to first approve travel and reimbursement of travel for Board members. Under State laws and regulations, the Chair is often defined as the “Head of the Public Independent Special District.”

The Chairman, in his discretion, may appoint an Assistant Treasurer and Assistant Secretary. This power is important as it pertains to real estate, bonds, and other documents requiring the signature of the Treasures and/or the Secretary as well as the Chairman.

The Chairman is to appoint the Chairman and Vice Chairman of all Board committees which appointments are to be confirmed by the Board.

Special committees may be appointed by the Chairman when he determines it to be necessary and such appointments are to be confirmed by the Board.

2

The Chairman should communicate regularly with the President of the Health System and should insure the President has a clear understanding of the policies and directives of the Board. The Chairman is responsible for communicating with the Board Administrator regarding the agenda as well as insuring compliance with Board policies and procedures.

The Chairman should insure Board meetings are conducted in an orderly, efficient manner and that Directors conduct themselves in an honorable and orderly manner.

The Chairman makes liaison assignments and makes modifications as necessary.

The VICE CHAIRMAN is to act as Chairman in the absence of the Chairman and, when so acting, shall have all the powers, authority and responsibilities of the Chairman.

SECRETARY (and Assistant Secretary if appointed by the Chairman) is the custodian of the official seal, all records and reports of Board proceedings; is responsible for issuing the notices of all meetings, and keeping minutes of all such meetings. The Secretary is the custodian of the public records under Florida Law. The Secretary may delegate the responsibilities to the staff to assist with such duties under the supervision of the Secretary.

TREASURER (and Assistant Treasurer if appointed by the Chairman) is responsible for all duties specifically imposed on the office by the Enabling Act, written Board policies and the Bylaws as it pertains to financial matters affecting the System. When the Board is focused on such financial matters where staff members make presentations, the Board Treasurer should chair that part of the Board or Committee meeting.

Again, as elected officials being subject to the Florida Constitution and the laws of Florida, their powers, duties and responsibilities can change especially as it pertains to the Chairman of the Board.

Thanks.

Our Goals: • Deliver safe, highly reliable and exceptional patient centered care• Continue development of a clinically integrated community

oriented delivery system • Develop a culturally and strategically aligned multispecialty group• Ensure an optimal supply of quality physicians and workforce • Develop and implement system wide master facility plan• Assure ongoing financial viability of Lee Memorial Health System

1610.02 Financial Goals card 3.375x2.125.indd 1 2/21/11 10:45:25 AM

2009 2011 Moody’s Median Financial Target

Profitability Ratios:Operating Margin (%) - Total 3.0% 2.2%Excess Margin (%) 5.1% 4.8%Operating Cash Flow Margin (%) 9.9% 10.0%

Liquidity Ratios:Days Cash on Hand (net of Callable Debt) 169.5 138.5Cushion Ratio (x) 15.3 13.7Cash-to-Debt (%) 117.6% 83.7%

Capitalization Ratios:Debt to Capitalization (%) - (net of Callable Debt) 38.9% 41.5%Annual Debt Service Coverage (x) 4.7 3.5Debt to Cash Flow (net of Callable Debt) 3.3 3.7

Financial Ratios:

1610.02 Financial Goals card 3.375x2.125.indd 2 2/21/11 10:45:25 AM

Our Vision:

To become the best patient- and family-centered health care system by working collaboratively to deliver excellence in quality, safety, efficiency and compassion.

System Facts:• Over 9,500 employees, 1,200

physicians and 4,300 volunteers• $1B annual budget; $.5B local

employment• Seventh largest public (governmental)

health system in nation• Largest public health system in

Florida operating without benefit of local tax support

• One of Florida’s most significant safety net health systems; $75 million cost of charity care

• Over 1.2 million patient encounters annually

Our

Cre

do:

Carin

g Pe

ople

, Car

ing

for P

eopl

e.

Our Goals: • Deliver safe, highly reliable and

exceptional patient centered care• Continue development of a clinically

integrated community oriented delivery system

• Develop a culturally and strategically aligned multispecialty group

• Ensure an optimal supply of quality physicians and workforce

• Develop and implement system wide master facility plan

• Assure ongoing financial viability of Lee Memorial Health System

1610.02 Vision Credo Goals card 7.25x3.5.indd 1 2/21/11 10:50:09 AM

SAFETY CULTURE MEASURES MEETS ExCEEDSOverall Perception of Safety 63% - 69% positive response >69% positive response Management Support for Patient Safety 70% - 77% positive response >77% positive response Handoffs and Transitions 44% - 51% positive response >51% positive response

QUALITY MEASURES MEETS ExCEEDSCore Measures 20% - 25% improvement in a blended indicator >25% improvement in a blended indicatorPatient Experience (HCAHPS) 69.8% - 72.3% top box 72.4% or greater top boxIn-Patient Mortality 1.70% - 1.87% <1.7%

PHYSICIAN COLLABORATION MEASURES MEETS ExCEEDS

Multi-Specialty Group Practice Management structurePhysician governance structure Develop physician strategic plan

Develop physician partnershipsOrthopedic co-management agreementOutpatient Surgery Center at the SanctuaryACR Breast Center of Excellence

Heart and Vascular Institute Advanced Stroke Center

Medical Staff Satisfaction (PRC Survey) • Hospitalists % top box • Patient Safety % top box

30.8% - 35.2% top box22.7% - 28.1% top box

>35.2% top box>28.1% top box

OPERATIONS IMPROVEMENT MEASURES MEETS ExCEEDS

EPIC Implementation GCMC is complete on Epic Phase I in FY 2011 On track to complete Epic Phase I in all hospitals by the 12/31/11

Patient Flow • Discharge Execution Cycle time is 130 minutes or less, 85% of the time Cycle time is 120 minutes or less, 85% of the time. • Discharge Planning Develop plan to improve discharge planning process Implement plan to improve discharge planning processClinical Documentation Initiative $1,000,000 - $2,499,000 >$2,499,000

FINANCE MEASURES MEETS ExCEEDSOperating Margin FY 2011 Budget 2.2% -2.5% > 2.5%Increase Freestanding Outpatient Revenue 5% - 7.5% > 7.5%Cash-to-Debt Ratio FY 2011 Budget 83.7% - 85% > 85%Moody’s Upgrade A2 A1Philanthropy $15,000,000 - $17,500,000 >$17,500,000

1610.02 Vision Credo Goals card 7.25x3.5.indd 2 2/21/11 10:50:09 AM

Lee Memorial Health System Legal Services / Risk Management

Board Orientation

Mary McGillicuddyChief Legal Officer / General Counsel

Location and Contact Information

Location: Lee Memorial Hospital /MOC2780 Cleveland Avenue, Suite 459Fort Myers, Florida 33901

Telephone: 343-2382

E-mail: [email protected]

mailto:[email protected]

Legal Staff

Attorneys

Paralegals

Risk Managers

Legal Assistants

Major Areas of Responsibility

Legal Analysis and Counsel

Professional Liability Program

Risk Management Program

Litigation Defense

Funds Recovery

Education


Patient SafetyAdministrative / Regulatory Consents, Patient Rights, Patient CareContract Review and DraftingCompliance Issues / Compliance OfficerDocument and Forms Review and DraftingEmployment Law Legal Research Legislative and Regulatory ReviewPublic RecordsPrivacy / HIPAA Compliance


Medical Staff

Credentialing and Privileging

Medical Staff Quality review process within the Patient Safety Organization (PSO)

Investigation, Corrective Action and Fair Hearing

Board Ultimately Responsible / Medical Staff Self-Governance (Bylaws, Rules, and Policies and Procedures)

Administration of Professional Liability Program

LMHS Fully Self-Funded Professional Liability Coverage Program

Since 1985 - No Insurance for Professional Liability

All Losses, Costs and Expenses Borne Directly by LMHS

Claims Investigation and Response

Coordination and Monitoring of Outside Defense Counsel

Reporting Closed Claims to Florida Department of Financial Services

Litigation Defense

Investigation, Evaluation and Response

Representation in Judicial and Administrative Proceedings – Licensure Boards

Coordination and Monitoring of Outside Counsel if Case Referred for Defense

Funds Recovery

Initiation of Lawsuits to Recover Amounts Due LMHS – Liens, Refunds and Unpaid Accounts

Insurance CompaniesIndividualsContractors and Suppliers

Filing of Claims in Bankruptcy / Probate

Administration of Risk Management Program

Legal Support and Direction Provided by System Counsel

Program Administered Primarily by Licensed Healthcare Risk Managers

Incident Reporting and Analysis• Routine Incident Reports• Serious Incident Reports to State of Florida

Investigation of Incidents and Complaints

Preparation of Reports to Board, Leadership, Quality Review

Primary Contact with Florida AHCA Surveyors

Provide Orientation and Education for Staff

Provide Support in Claims Administration

Patient Safety Organization (PSO)

Number One Core Value

Cultural Transformation

Shared Learning

Amendment 7

PSO Federal Law ProtectionPatient Safety Evaluation SystemPatient Safety Work Product

BBBOOOAAARRRDDD OOOFFF DDDIIIRRREEECCCTTTOOORRRSSS RECOMMENDED ACTION FOR BOARD APPROVAL

(Action includes Acceptance, Approval, Adoption, etc)

Keep form to one page, SUBMIT (thru SLC Member) ELECTRONICALLY to L Drive – Miscellaneous - BOD Presentations by Noon the Friday before you’re scheduled on agenda.

DATE: February 17, 2011 LEGAL SERVICE REVIEW? YES__ NO__ SUBJECT: Quarterly Compliance Report REQUESTOR & TITLE: Charles Swain, Chief Compliance and Internal Audit Officer PREVIOUS BOARD ACTION ON THIS ITEM (IF ANY) (justification and/or background for recommendations – internal groups which support the recommendation i.e. SLC, Operating Councils, PMTs, etc.)

The Compliance Program Board Policy 10.47A requires quarterly updates summarizing compliance activities. SPECIFIC PROPOSED MOTION: Acceptance of the Quarterly Compliance Report for period 10-01-10 to 12-31-10. PROS TO RECOMMENDATION

CONS TO RECOMMENDATION

LIST AND EXPLAIN ALTERNATIVES CONSIDERED N/A FINANCIAL IMPLICATIONS Budgeted ____ Non-Budgeted ____ (including cash flow statement, projected cash flow, balance sheet and income statement)

N/A OPERATIONAL IMPLICATIONS (including FTEs, facility needs, etc.) N/A SUMMARY This report highlights the Compliance Department activities for the quarter. There were no significant compliance issues or concerns that needed to be brought specifically to the attention of the LMHS Board. The compliance activities are organized under the seven elements of a compliance program as contained in the guidelines issued by the Department of Health and Human Services, Office of Inspector General.

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

Compliance Report

Reporting Period: October 1, 2010 – December 31, 2010

Status of the Seven Compliance Elements Element # 1: Written Policies and Procedures.

• No system-wide Compliance policies were due for revision during the quarter. The

departmental policy describing the screening process for LMHS employees, physicians, and vendor/contractors was updated.

Element # 2: Compliance Officer and Compliance Committee.

• Compliance Officer’s activities and accomplishments are contained in other compliance elements that follow.

Element # 3: Education.

• Compliance training including the LMHS Standards of Conduct continues to be part of new employee On-Boarding Orientation and is part of the orientation offered to volunteers and by Medical Staff Services to new physicians.

Element # 4: Communication.

• Articles concerning reporting to the Compliance Hotline and introducing the Compliance

Website were included in the Have You Heard weekly publication. A total of 97 issues came to the Compliance Department during the quarter. • Twenty-eight of the 97 issues were calls to the Compliance Hotline. The allegations

involved four HIPAA matters, 13 Human Resource matters, nine Patient Care matters, and two matters classified as Other. Nine of the twenty-eight Hotline calls were substantiated.

1

• Sixty-nine of the 97 issues came directly to the Compliance Department.

o Fifty-two issues categorized as Guidance were inquiries from employees who

wanted to verify that they were doing the right thing before proceeding with an action. Nineteen of these inquiries involved questions regarding the Employee Conflict of Interest Questionnaire.

o Seventeen matters that came to the Compliance Department potentially

involved compliance violations. A breakdown of the 17 issues received during the quarter October 1, 2010 – December 31, 2010 is as follows: Issue Category

Brought Forward

Received

Resolved

Carried Forward

Billing, Documentation and Coding 1 4 3 2 Conflict of Interest/Inducements 0 2 1 1 HIPAA/Patient Confidentiality 0 1 1 0 Human Resources/Benefits/Miscellaneous 0 4 3 1 Human Resources/Employee Relations 0 0 0 0 Legal Interpretations/Risk and Safety 1 1 1 1 Other 0 4 3 1 Patient Care 0 1 1 0 Payroll/Timekeeping 0 0 0 0 Physician Matters 0 0 0 0

TOTAL 2 17 13 6

Appendix I contains a summary, by category, of the issues received directly by Compliance during the quarter.

Element # 5: Enforcement/Disciplinary Actions.

• Excluded Party Search System (EPSS) – The Compliance department screened all new

employees against the Office of Inspector General and the U.S. General Services Administration databases to be certain they are eligible for participation in Federal healthcare programs. Medical Staff Services performed a bi-monthly screen of physicians. Compliance performed the annual screening of vendors and contractors against the List of Excluded Individuals and Entities (LEIE) and GSA List of Parties Excluded from Federal Procurement and Non Procurement Programs.

2

3

Element # 6: Auditing and Monitoring. • Items on the Compliance Work Plan are in progress.

Element # 7: Pending Actions/Initiatives and Corrective Actions. Corrective Actions

• Corrective action on seven employee matters included coaching and inservice training. Opportunities for improvement were identified; departmental guidelines were developed and new processes implemented.

4

APPENDIX I Summary of 17 Cases Received by Category: Billing, Coding and Documentation 4 issues included topics such as readmission criteria, bariatric coding, wound care patient billing, and charging a facility fee. The matter regarding the facility fee was substantiated. A matter brought forward from the previous quarter was unsubstantiated. 2 issues remain open. Conflict of Interest/Inducements 2 matters involved provision of meals by vendors and potential nepotism. The matter regarding nepotism was substantiated.

1 issue remains open. Health Insurance Portability and Accountability Act (HIPAA) - Patient Confidentiality 1 matter involving protected health information was substantiated. HIPAA issues reported directly to the Patient Information Privacy Officer are not included in this report. Human Resources/Benefits/Miscellaneous 4 issues included telecommuting, an allegation regarding hostile work environment, gift shop charges prior to termination, and travel expenses. The issues regarding telecommuting and travel expenses were substantiated.

1 issue remains open. Human Resources/Employee Relations There were no reported issues. Legal Interpretations, Risk Management and Safety 1 matter involving the provision of Medicare’s Important Message to Emergency Room patients was substantiated. A matter brought forward regarding payroll deductions remains open and will be closed this quarter. Other 4 matters involved use of System resources, a vendor incident, donations, and notification from a vendor regarding a potential exclusion. The matters involving the System resources and vendor exclusion were substantiated. 1 issue remains open. Patient Care 1 matter regarding quality of care was reported to Risk Management and Compliance. This matter was referred to Medical Audit for review. Payroll/Timekeeping There were no reported issues. Physician Matters There were no reported issues.

BdRpt 1001110 to 123110.doc

Governance Conference Review

(Diane Champion, Director and Donald Brown, Director)

VERBAL REPORT



DATE OF THE NEXT REGULARLY SCHEDULED

MEETING

GOVERNANCE DINNER MEETING

THURSDAY, October 27, 2011

(Following 4pm Finance Meeting)

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

Lee Memorial Health System BOARD OF DIRECTORS

MEETING Thursday, February 24, 2011

BOARD CHAIRMAN: Richard Akin



OLD BUSINESS



NEW BUSINESS



BOARD OF

DIRECTORS’REPORTS



BOARD ADMINISTRATOR

REPORT

(Cathy Stephens)

LLEEEE MMEEMMOORRIIAALL HHEEAALLTTHH SSYYSSTTEEMM && LLEEEE CCOOUUNNTTYY TTRRAAUUMMAA SSEERRVVIICCEESS DDIISSTTRRIICCTT

BBOOAARRDD OOFF DDIIRREECCTTOORRSS MMEEEETTIINNGG CCAALLEENNDDAARR

Questions about this schedule: Contact the LMHS Board of Directors office at (239) 343-3300

MMAARRCCHH 22001111 Sunday Monday Tuesday Wednesday Thursday Friday Saturday

1

2

3

Nancy McGovern --------------------

4:00 pm PLANNING

FULL BOARD MEETING

4 Foundation

Event Bonita Bay

Celebrity Tennis March 4-5

5 Foundation Event The 2nd Annual

"Piper 5K" to benefit the Piper Buckley NICU fund at

The Children's Hospital

6

Foundation Event: Hooter to Hooters

Half Marathon

7

Foundation Event:

14th Annual Diamond Dinner

City of Palms Park

8

Anniversary Celebration- Annually

Gulf Coast Medical Center

9

10

11

12

13

14 FHA

“Hospital Days” Tallahassee 14th – 15th

++++++++++++

15 FHA

“Hospital Days” Tallahassee 14th – 15th

+++++++++++++

16

17 Happy St. Patrick’s Day!

18

19 American Red Cross STARSTRUCK 2011

Dancing Competition (The Hyatt Regency)

20 Foundation Event:

Sanibel Cares: 11th Anniversary

Island Celebration for The Children’s

Hospital

21

Rev. Israel

Suarez

22

23

24

4:00 pm FULL BOARD OF

DIRECTORS MEETING (LMH Boardroom)

25

26

2011 LMHS Service Award Dinner

Broadway Palm Dinner Theatre

27

Linda Brown

28

29 30 “Doctor’s Day”

31

Key: LMH – Lee Memorial Hospital HPMC – Health Park Medical Center CCH – Cape Coral Hospital GCMC- Gulf Coast Medical Center

DDAATTEESS TTOO RREEMMEEMMBBEERR: • April 10th-13th – American Hospital Association Annual Meeting, Washington, D.C.

FOUNDATION EVENTS: For additional information, please contact the Foundation Office at 239-343-6950 or visit www.leememorial.org/foundation

http://www.leememorial.org/foundation

Please join Jim Nathan, President of Lee Memorial Health System

for a special presentation to our community: “Lee Memorial Health System’s Next Legacy to

You and the Families of Southwest Florida” Cocktails and Hors d’oeuvres

Wednesday, March 9, 2011 • 5:30pm – 7:30pm Audi Jaguar Land Rover Fort Myers, A John Marazzi Dealership

15875 South Tamiami Trail Fort Myers 33908 Complimentary valet parking is available

Please RSVP to Christin Collins at 239-343-6062 or via email at [email protected]

� Space is limited �

ADJOURNMENT ___________________

L E E M E M O R I A L HEALTH SYSTEM BBBOOOAAARRRDDD OOOFFF DDDIIIRRREEECCCTTTOOORRRSSS

DATE OF THE NEXT REGULARLY SCHEDULED

BOARD OF DIRECTORS Meetings:

March 3, 2011 2:30pm Board Workshop “Healthcare: The Perfect Storm” 4:00pm Lee Memorial Health System Board PLANNING

March 24, 2011, 4:00pm Lee Memorial Health System Board • Convene as Cape Coral Hospital

• Convene as Lee Memorial Hospital • Convene as Gulf Coast Medical Center

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