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Lake Emergency Medical Services, Inc.

Board of Directors Meeting June 21, 2016

2:30 p.m. Lake County BOCC Chambers

Comm. Welton Cadwell, Lake EMS Board Chairman

I. Call to Order

II. Public Comment

III. Employee Recognition

IV. Departmental Business

Tab 1 Review & Approve Minutes of April 12, 2016 Board Meeting – Action Item Tab 2 Financial Report – Action Item Tab 3 Finance Committee Report – Comm. Sullivan, Chairman

A. Consent Agenda – Action Item B. Proposed FY 2016-2017 Budget – Action Item

Tab 4 EMS Operations Committee Report – Mayor Michael Holland, Chairman

A. RFP for High Fidelity Patient Simulation Mannequins — Action Item B. Waiver of Conflict of Interest Agreement — Action Item C. First Watch — Action Item

Tab 5 Employee Issues Committee Report – Comm. Campione, Chairman

A. Dayforce Contract Termination — Action Item

Tab 6 Staff Reports A. Patient Financial Services Report B. Human Resources Report C. Operations Report

Tab 7 Director’s Report

V. Adjourn

Tab 1

MINUTES

04.12.16 Lake EMS Board Minutes – Page 1

Lake Emergency Medical Services, Inc. Board of Directors Budget Workshop

April 12, 2016 MINUTES

I . Call to Order The Lake EMS, Inc. Board of Directors Meeting was held on April 12, 2016 in the Lake County Board of County Commissioners Chambers in Tavares, Florida. A quorum was established. Chairman Welton Cadwell called the meeting to order at 9:30 a.m.

II . Public Comment

Chairman Cadwell announced an opportunity for public comment. There was no public comment.

I II . Promotions/ Presentations

Chief Communications Officer Kimberly Stephens announced the following promotions of Communications Center staff: Margaret Albandor and Nicolle Gardner were promoted to Communications Supervisor positions; Catherine McNew was promoted to CAD Administrator; Dustin Sheckler was promoted to Chief Training Officer for Communications; and Angie Lucas has been promoted to Lead Dispatcher. Chief Operations Officer John Simpson recognized the following Paramedics who had recently been through comprehensive training and testing to achieve the rank of Lieutenant/Field Training Officer: Jacob Greenwell, Jason White, Lorena Guastella, and Gary Rice. County Attorney Melanie Marsh introduced newly hired Assistant County Attorney Luis Guzman. Mr. Guzman will be working with Lake EMS when Ms. Marsh is not available.

IV. Departmental Business Tab 1 – Approval of M inutes Action: Mayor Holland moved for approval of the January 25, 2016 Lake EMS Board of Directors meeting minutes. Comm. Sullivan seconded the motion w hich carried unanimously.

Tab 2 – Financial Report Ms. JoAnne Drury reviewed the Lake EMS financial reports for the months ending January 31, 2016. Ms. Drury reported that Lake EMS is on track with its budget for the current fiscal year with total revenues at $6.2 million and expenditures at $5.7 million resulting in an excess of

Board Members Present: Comm. Welton Cadwell, Chairman Comm. Jimmy Conner, Vice Chairman Comm. Sean Parks Comm. Tim Sullivan

Mayor Chris Bell Mayor Michael Holland City Commissioner Keith Mullins


revenue over expenditures of $489,000. She stated that the ending funding balance is expected to be $2.9 million.

Action: Comm. Sullivan moved, and Mayor Holland seconded, to approve the Financial Report as presented. The motion carried unanimously. Tab 3 – Finance Committee Comm. Sullivan reported that the Finance Committee met on April 5, 2016 and had the following agenda items which it recommended for Board approval:

A. Consent Agenda

1. Budget Resolution – Recognition of Unanticipated Revenue

The Finance Committee is recommending approval of a Budget Resolution that would recognize unanticipated revenue from the following sources: EMS Grant reimbursement for EMS training program, Target Solutions $32,329; 911 Public Safety funds reimbursement for Dispatch Training and Headsets $6,090.20; Insurance proceeds from stolen trailer $1,295.00; Special Detail Revenue $2,009.14; P-Card rebate 4,941.91; Insurance proceeds for repairs $3,536.03; ZOLL speaker fee reimbursement $1,000; Miscellaneous revenues $193.37. (See Attachment 1.)

2. Purchasing Card Agreement

The Finance Committee is recommending approval of the updated Purchasing Card Agreement through the State of Florida. (See Attachment 2.)

3. Approval to Seek Sponsorships

The Finance Committee is recommending approval to seek corporate sponsorships for special events such as National Telecommunicators Week and National EMS Week as well as training events and classes presented by the Lake EMS Quality Development Department (QDD). QDD sponsors an average of four multi-agency, multi-disciplinary training events each fiscal year. The training is open to any EMT or Paramedic working in Lake County. Corporate sponsorships would cover the cost of food and beverages for participants as well as staff and speaker appreciation items. Experts in various aspects of the medical field donate their time and expertise at these events. Training event examples include the Lake EMS’ Spring and Fall Symposiums as well as Lunch and Learns held in conjunction with Shift Meetings twice a year. Entities having a current contract with Lake EMS shall not be solicited.

4. Approval to Sponsor Events

Historically, Lake EMS has co-sponsored and/or supported community events with other agencies whose missions include community safety, health, wellness, and fitness. The Finance Committee is recommending approval to sponsor such events in Lake County. A maximum sponsorship of $2500 would be given and is contingent on available funding.

5. Transfer of Capital Assets

The Finance Committee is recommending approval to transfer HP Servers to Lake County Board of County Commissioners Department of Public Safety Communications Technologies Division. Lake EMS has transitioned all services from these servers to recently updated computing infrastructures. These servers will be re-purposed for use with the Public Safety 800MHz Radio System providing continued value from them.


Asset# Serial Number

Description

EMS00821 2UX74600LF DL380G5 Dual Quad Core Xeon 2.33Ghz 32GB RAM 8-146GB

EMS00975 SZUX838011K DL380G5 Dual Quad Core Xeon 3.16Ghz 32GB RAM 8-146GB

6. Trade-In of Assets

The Finance Committee is recommending approval for the trade-in of five (5) LifePak-12 units at a value of $5,500 each. The LifePak-12 units were traded in for LifePak-15 units.

7. Reserve Capital Replacement

The Finance Committee is recommending a dedicated line item to replace capital items that are required operationally. This action is a fiscally responsible measure to plan capital items that impact the budget.

Action: Comm. Sull ivan moved to approve the Consent Agenda. Comm. Conner seconded the motion which carried unanimously.

B. Mid-Year Adjustment The Finance Committee is recommending approval of a Mid-Year Adjustment to the budget in the amount of $1,619,984 available from the remaining fund balance from the FY 2014-2015 budget. After a minor reduction of $300,000 of the County subsidy, the remainder will be allocated to the Lake EMS budget areas outlined in the Budget Change Amendment:

$468,604 – Professional Services, Contractual Services, IT Repair/Maintenance and Office Supplies. $691,998 -- Capital Expenditures $159,382 – Capital Reserves

This action funds necessary capital equipment for ambulances, quality training for Operations staff, necessary work stations for Dispatch staff, Payroll software, equipment for a secure and efficient IT process, capital purchase planning and the Finance Committee request for a consultant. Action: Comm. Sull ivan moved to approve the Mid-Year Adjustment as presented. Comm. Conner seconded the motion which carried unanimously.

C. Update on RFP for Operational Analysis Comm. Sullivan explained that the Selection Committee for RFP 16-0211 met on March 7, 2016 and reviewed the six (6) proposals received. The Selection Committee recommended three (3) vendors for further consideration. All three vendors gave presentations to the committee on March 16, 2016. The Selection Committee Meeting Summary is attached. It was the unanimous decision of the committee to select Fitch & Associates to conduct the analysis. It is anticipated that the contractual amount will be


$145,600. The Finance Committee voted unanimously to recommend Fitch & Associates be awarded the contract.

Action: Comm. Sull ivan moved to recommend Fitch & Associates be awarded the contract for the Operational Analysis. Comm. Campione seconded the motion which carried unanimously.

Tab 4 – EMS Operations Committee Report Chairman Michael Holland stated that the EMS Operations Committee had met on April 5, 2016 and voted unanimously to recommend full Board approval of the following agenda item:

A. Agreement with University of Florida Fellowes The University of Florida, School of Medicine has requested that Lake EMS enter into a Program Letter of Agreement for Rotation of Medicine Residents and/or Fellows. Lake EMS would serve as a training site where residents may participate in medical education, research, and/or patient care. Action: Mayor Holland moved, and Comm. Parks seconded, to approve the Agreement w ith University of Florida Fellowes as presented. The motion carried unanimously.

Tab 5 – Employee Issues Committee Report Chairman Leslie Campione reported that the Employee Issues Committee had met on April 6, 2016 and recommends approval of two agenda items as follows:

A. Risk Management & Employee Benefits Interlocal Agreement

This Interlocal Agreement formalizes the existing arrangements between Lake County and Lake EMS regarding provision of Health Care Benefits for employees.

Action: Comm. Campione moved, and City Councilmember Mullins seconded, to approve the R isk Management & Employee Benefits Interlocal Agreement. The motion carried unanimously.

B. Human Resources Manager

On April 6, 2016, the Employee Committee voted unanimously to recommend discontinuing the agreement with Lake County for a Human Resources Manager. If approved, the Human Resources Manager will become a Lake EMS employee effective immediately. Any annual leave and sick leave will be converted to Lake EMS PDO.

Action: Comm. Campione moved, and Mayor Bell seconded, to approve discontinuing the agreement w ith Lake County for a Human Resources Manager and transition the Manager to be a Lake EMS employee. The motion carried unanimously.

Tab 6 – FY2016-2017 Budget Discussion Mr. Smith explained that the FY 2017 proposed budget is being developed keeping the priorities set by the Board of Directors as the focus. He noted that FY 2017 is being viewed as a transition year because funding from the Penny Sales Tax will not be available for capital equipment and the results of the study being conducted by the consultant group Fitch and Associates will not be available until the first quarter of FY 2017. It is anticipated the projected allocation of Penny Sales Tax funding to Lake EMS in FY 18 for capital replacement will allow for some FY 2017 proposed funding levels to be redirected to fulfill potential recommendations from the consultant’s study. It was agreed that the proposed budget will maintain the current staffing model, provide staff salary adjustments, cover the increased cost to provide health insurance and address the need to


continue capital equipment replacement. It is expected that user fees will cover the budget enhancements.

Tab 7 – Staff Reports Mr. Smith commented that staff reports from Patient Financial Services, Human Resources, and Operations had been reviewed at the appropriate committees and were included in the Board books. There were no questions on the written reports.

Tab 8 – Directors Report Mr. Smith reported on issues and accomplishments since the January 25, 2016 Lake EMS Board Meeting including:

• The Astor ambulance is now operational. • The new truck put into service in February has been busy - running 7-8 calls a shift. • Telecommunicators Week is being held the week of April 12 with activities honoring our

Communications Center staff in conjunction with the Lake County Sheriff’s Office. • EMS Week will be held the week of May 15th with staff recognition in the form of a BBQ

lunch and RTIC cups for all staff. • Staff is prepping for the County Fair and Bikefest. • Mr. Smith and Mr. Simpson will be participating in the Lake Health Partnership.

Adjournment The meeting was adjourned at 10:20 a.m.

Tab 2

FINANCIAL

REPORT

Lake EMS, Inc. Agenda Item Summary Sheet

DATE: June 13, 2016 MEETING DATE: June 21, 2016 SUBJECT: Financial Report ACTION REQUESTED: Approval BACKGROUND SUMMARY: A representative of the Lake County Clerk’s Finance Office will review the Lake EMS Financial Statements for the month ending March 31, 2016 at the Board Meeting FISCAL IMPACT: Not applicable ATTACHMENTS: Financial Statements for Month Ending March 31, 2016

Tab 3

Finance

Committee

Report


____ ___ DATE: June 14, 2016 MEETING DATE: June 21, 2016 SUBJECT: Finance Committee Report ACTION REQUESTED: See Tab 3A-B BACKGROUND SUMMARY: The Finance Committee, chaired by Comm. Tim Sullivan, met on June 7, 2016. The committee’s recommendations are presented in Tabs 3A-B. FISCAL IMPACT: As Presented ATTACHMENTS: See Tab 3A-B.

Tab 3A

Consent

Agenda


DATE: June 13, 2016 MEETING DATE: June 21, 2016

SUBJECT: Consent Agenda

ACTION REQUESTED: Request Board Approval

BACKGROUND SUMMARY:

The Finance Committee recommends Board approval of the following Consent Agenda items as outlined below:

1. Budget Resolution – Recognition of Unanticipated Revenue- Staff is requesting approval of a Budget Resolution that would recognize unanticipated revenue from the following sources:

• Insurance proceeds for repairs to Unit 621: $4,495 • New Unit 648: $189,316 • Unit 675: $29,840 • Unit 617: $22,821 • LC Motorola Radio $4,122 • Special Detail Revenue $3,331 • Interest Revenue $1,312 • Miscellaneous revenue $356. • (Budget Resolution attached.)

2. Authority to Use Insurance Proceeds – Staff is requesting approval to purchase a

replacement for Ambulance Unit 648 with insurance proceeds of $189,316, which includes a stair chair, a Power Pro XT Stretcher, and Power Load device. Additionally, staff requests to repair Unit 675 with insurance proceeds of $29,840.

3. Authority to Purchase – Staff is requesting approval of Purchasing Card utilization for: A. Our P-Card rebate percentage is 1.1%; Vendors that charge no more than 0.5% B. Additional P-Card Vendors:

1) Arrow International: $80,000 2) McKesson Medical Surgical: $70,000 3) ZOLL Data Systems: $107,000

C. To increase the maximum amounts for previously authorized Vendors: 1) MMS: $97,000 to $160,000 2) Moore Medical: $153,000 to $200,000 3) Verizon Wireless: $35,000 to $45,000

4. Trade-In of Assets

Staff is requesting approval for the trade-in of fifteen (15) Power Pro Stretchers at a value of $2,500 each. The Power Pro Stretchers will be traded in for eleven (11) Power Pro XT Stretchers with the power load upgrade. (Asset Change Forms attached.)

5. Termination of Tower Leases

Staff is requesting approval to terminate Pinnacle Tower Lease and City of Leesburg Tower Lease at the end of the lease term, September 30, 2016, due to the consolidation of communication resources with the County.

FISCAL IMPACT: As outlined in each Consent Agenda item. ATTACHMENTS: Budget Resolution and Asset Change Forms

FISCAL YEAR: 2016

DATE: 5/31/2016 BUDGET CHANGE#:DEPARTMENT NAME: Lake EMS NEW CAP. REF CODE:Prepared By:

WHAT IS NEEDED:Additional funds: More funds needed for major object code

X New Item: Item NOT in this year's budgetCapital Substitution: Any changes of authorized CAPITAL item CAP. REF. CODE*

JUSTIFICATION FOR REQUEST: Describe item and show calculations of all associated cost of item.Part I. Explain why item is needed (if equipment is to be replaced, include description, model, year, inventory #,)Part II. Identify source of funds and why these funds are no longer needed for the budget intent. For savings on

capital item give account #, budget item, amount budgeted, purchase order #, and actual purchase cost.

Part I. Record unanticipated revenue for Insurance ProceedsRecord unanticipated revenue for InterestRecord unanticipated revene for Special Detail invoicing

Part II. Increase line item in 290 IT Capital-County radio replacementIncrease line item in 240 Field Operations Regular SalariesIncrease line item in 220 Admin 465 Employee Recog.Increase line item in 242 Support 461 Auto Supplies/Repairs

FILL IN THIS SECTION IF A TRANSFER OF MONIES IS NEEDED:Account Number Account Title Amount

Transfer From:Revenue

9720.9797290.364420 Misc Rev-Ins Proceeds 4,122 9720.9797220.369900 Misc Rev- Spec. Detail9720.9090972.361110 Interest9720.9797242.364420 Misc Rev-Ins. Proceeds 356 9720.9797242.364420 Ins. Proceeds-Unit 621 4,495 9720.9797242.364420 Ins. Proceeds-Unit 648 189,316 9720.9797242.364420 Ins. Proceeds-Unit 675 29,840 9720.9797242.364420 Ins. Proceeds-Unit 617 22,821

TOTAL 255,593 Transfer To:Expenditures

9720.9797290.860640 Motorola Radio Rplcmnt. 4,122 (EMS-16023)9720.9797240.810120 Regular Salaries 3,3319720.9797220.830465 Employee Recog. 1,3129720.9797242.830461 Auto Supplies/Repairs 356 9720.9797242.830461 Auto Supplies/Repairs 4,495

Capital-Repmnt. Ambulance 189,316 (EMS-16024)9720 9797242.830461 Auto Supplies/Repairs 29,840 9720.9797242.830461 Auto Supplies/Repairs 22,821

Total 255,593

FUNDS AVAILABILITY: YES X NO

APPROVING AUTHORITY:Department/Office Signature Date

Major Object/Capital Welton G. Cadwell

Gerald L Smith IILine Item/Non Capital

FINANCE:

Signature: Date:

9720.9797240.860640

3,331

LAKE EMERGENCY MEDICAL SERVICES BUDGET RESOLUTION

1,312

Tab 3B

Proposed

FY 2016-2017

Budget

Lake EMS, Inc. Agenda Item Summary

DATE: June 14, 2016 MEETING DATE: June 21, 2016 SUBJECT: Proposed Lake EMS Budget for FY 2016-2017 ACTION REQUESTED: Recommend approval of Board of Directors. BACKGROUND SUMMARY: The Proposed Lake EMS FY 2016-2017 Budget will be reviewed including a current Lake EMS Organizational Chart and the following five summary sheets:

1. 2017 Proposed Budgeted Statement of Operations 2. 2017 Proposed Personnel Services – Operating Expenses 3. 2017 Proposed Capital Outlay Justification 4. 2017 Proposed Five Year Capital 5. 2017 Proposed Ambulance Deployment

Complete Proposed Lake EMS FY 2016-2017 Budget Books will prepared and provided to Board members for the September 27, 2016 Board of Directors Meeting for full adoption. FISCAL IMPACT: As presented ATTACHMENTS:

A. Lake EMS Budget Highlights Memorandum B. 2017 Proposed Budgeted Statement of Operations C. 2017 Proposed Personnel Services – Operating Expenses D. 2017 Proposed Capital Outlay Justification E. 2017 Proposed Five Year Capital F. 2017 Proposed Organizational Chart G. 2017 Proposed Ambulance Deployment

MEMORANDUM

Lake Emergency Medical Services, Inc. 2761 W. Old US Highway 441 – Mount Dora, FL 32757

Voice: 352-383-4554 – FAX: 352-735-4475 – www.lakeems.org

To: Lake EMS Board of Directors

From:

Gerald “Jerry” Smith II Executive Director

Date: May 31, 2016

Subject: Proposed Lake EMS Budget for Fiscal Year 2017

__________________________________________________________________________________

During the April 12th Lake EMS Board of Directors meeting Lake EMS staff explained the estimated revenue projections for Fiscal Year (FY) 2017. The proposed budget revenues include nearly $13.7 million from user fees, $6 million in County Subsidy, and a balance carried forward of $700,000 for a proposed total revenue of nearly $20.4 million. In the meeting Lake EMS staff presented information regarding maintaining the current staffing model, providing staff salary adjustments, increase cost to provide health insurance and the need to continue capital equipment replacement. It was agreed by the Board of Directors to make Staffing, Benefits and Capital Replacement the priorities for the FY 2017 proposed budget. The Lake EMS staff has developed the FY 2017 proposed budget keeping the priorities set by the Board of Directors as the focus. However, it should be recognized that FY 2017 is a transition year because funding from the Penny Sales Tax will not be available for capital equipment and the results of the study being conducted by the consultant group Fitch and Associates will not be available until the first quarter of FY 2017. It is anticipated the projected allocation of Penny Sales Tax funding to Lake EMS in FY 18 for capital replacement will allow for some FY 2017 proposed funding levels to be redirected to fulfill potential recommendations from the consultant’s study. The attached FY 2017 proposed budget summary documents provide specific revenue and expenditure information, as well as the proposed organizational chart and the proposed ambulance deployment model. These proposed budget summary documents are for the June 21, 2016 Board of Directors meeting when staff will request approval of the proposed budget summary. Complete Proposed Budget Books will be prepared for the September 27, 2016 Board of Directors meeting when staff will request final adoption. The same Proposed Budget Summary documents will be sent to the County Manager and staff for their use in development of the budget for the Lake County Board of County Commissioners. I look forward to answering any questions you may have and the approval of the Proposed 2017 Lake EMS Budget. Attachments:

• 2017 Proposed Budget Statement of Operations • 2017 Proposed Personnel Services – Operating Expenses • 2017 Proposed Capital Outlay Justification • 2017 Proposed Five Year Capital • 2017 Proposed Organizational Chart • 2017 Proposed Ambulance Deployment

http://www.lakeems.org/

2014 2015 2016 2017 2017 Budget Budget Amended Budget Proposed Budget Baseline%REVENUES:

Private Pay Fees 3,669,355 2,739,588 3,201,906 3,522,053 10.0%Medicare Fees 11,526,790 11,679,931 13,650,970 15,015,881 10.0%Medicaid Fees 2,071,301 1,879,593 2,196,782 2,416,430 10.0%Contract Fees 205,050 189,142 221,061 243,164 10.0%Commercial & HMO Fees 2,429,352 2,506,933 2,929,989 3,222,948 10.0% Less Bad Debt Expense (4,046,481) (3,266,238) (3,958,698) (4,563,760) 15.3% Less Contractual Allowances (4,908,323) (5,020,006) (5,582,526) (6,181,624) 10.7%

Net Charges for Services 10,947,044 10,708,943 12,659,484 13,675,092 8.0%

Public Safety (Local) - 35,000 32,329 100%Urban Areas Security Initiative Grant - - 100%Motor Fuel Tax Rebate (State) - - 100%Other Miscellaneous Revenues 51,317 24,000 6,000 6,000 0.00%P-card Rebate - - 18,000 35,000 94.44%Other Dispatch Fees - - 100%Surplus Furn/Fix/Eq 12,185 - 100%Ins Proc/Loss Furn/Fix/Equip 134,285 - 0.00%Other Charges for Services 500 500 -100.00%Reimbursements 658 - 100%Interest - - 100%Donations 100 100 100 100 0.00%Other Public Safety - - 100%Highway Safety Grant - - 100%Lake County Subsidy 5,300,000 6,000,000 6,000,000 6,000,000 0.00%

Total Miscellaneous Revenues 5,498,545 6,059,600 6,024,600 6,073,429 0.8%

Balance Carried Forward 300,000 789,512 700,000 -11.3%159,382

Total Revenues 16,445,589 17,068,543 19,473,596 20,607,903 5.8%

EXPENDITURES:

Personal Services 12,313,406$ 13,007,274$ 13,922,076$ 14,523,795 4.3%Operating Expenses 3,802,209 3,432,630 4,208,546 4,330,093 2.89%Capital Outlay 169,974 406,928 1,182,974 1,434,633 21.3%Administration Costs 160,000 160,000 160,000 160,000 0.0%

Total Expenditures 16,445,589 17,006,832 19,473,596 20,448,521 5.0%

Reserve for Contingencies - 159,382

Total Expenditures Plus Reserve 16,445,589 17,006,832 19,473,596 20,607,903 5.8%

Excess of Revenues OverExpenditures - 61,711 - (0) -

Lake Emergency Medical Services, Inc. Budgeted Statement of Operations

Proposed Budget 2017

Capital Reserve

Reserve for Capital Replacement

2014 2015 2016 2016 2017 2017

Actual Budget Actual Budget Adopted Budget Amended Budget Proposed Budget Baseline %

PERSONAL SERVICES

Executive Salaries 111,667 117,280 116,699 116,699 120,200 3.00%

- -

Regular Salaries 8,403,183 8,940,025 9,465,755 9,253,575 9,490,638 2.56%

- -

Overtime 764,654 844,259 746,800 746,800 880,500 17.90%

- -

Special Pay - - - - - 0.00%

- -

Social Security Matching 679,575 725,479 790,187 790,187 802,588 1.57%

- -

Retirement Contributions 634,519 661,682 760,930 760,930 771,612 1.40%

- -

Life and Health Insurance 1,475,560 1,480,715 1,923,309 1,923,309 2,078,938 8.09%

- -

Workers Compensation 238,011 236,773 321,576 321,576 370,319 15.16%

- -

Unemployment Compensation 6,237 1,060 9,000 9,000 9,000 0.00%

- -

Total Personal Services 12,313,406 13,007,274 14,134,256 13,922,076 14,523,795 4.32%

- -

OPERATING EXPENDITURES - -

Professional Services 86,117 89,965 140,221 140,221 118,841 -15.25%

- -

Contractual Services 139,586 169,056 269,895 482,075 439,555 -8.82%

- -

70027 Contractual Services 4,482 4,481 5,141 4,481 4,261 -4.91%

- -

Collection Fees 56,749 66,427 65,000 65,000 75,000 15.38%

- -

Travel and Per Diem 6,385 28,371 45,750 45,810 57,410 25.32%

- -

Communications 73,133 62,195 73,365 73,365 67,500 -7.99%

- -

Telephone 73,813 66,803 71,397 71,397 47,400 -33.61%

- -

Cellular Telephone 24,271 28,831 49,590 49,590 40,845 -17.63%

- -

Paging Service 395 395 395 395 395 0.00%

- -

Freight & Postage 25,389 27,853 28,375 28,375 28,375 0.00%

- -

Utility Services 84,708 83,357 87,275 87,275 92,350 5.81%

- -

70027 Utility Services 9,303 8,821 10,547 10,547 10,651 0.99%

- -

Rental Leases - - 110 110 - -100.00%

- -

Property Leases 275,552 269,180 299,649 299,649 277,800 -7.29%

- -

Equipment Leases 23,375 33,296 36,130 36,130 22,359 -38.12%

- -

Insurance 240,597 124,152 132,000 132,000 135,000 2.27%

- -

Repair and Maintenance 265,860 211,188 303,844 303,844 312,140 2.73%

- -

70027 Repair and Maintenance 6,327 6,188 8,329 8,329 12,855 54.34%

- -

Auto Repairs/Supplies 216,746 251,598 240,000 240,000 283,600 18.17%

- -

IT Repair and Maintenance - 188,067 237,402 237,402 308,520 29.96%

- -

Printing and Binding 6,871 11,156 6,200 6,200 6,900 11.29%

- -

Reprographic Charge 1,947 71 1,000 1,000 1,000 0.00%


Personal Services and Operations Expenses

Proposed Budget 2017

- -

Promotional Activities - 902 1,000 1,000 3,000 200.00%

- -

Employee Recognition 7,804 13,778 10,000 10,000 14,000 40.00%

- -

Other Current Charges/Obligations 12,700 11,557 11,764 11,764 12,450 5.83%

- -

Office Supplies 247,161 54,208 40,400 40,400 39,750 -1.61%

- -

IT Supplies - 140,419 83,660 83,660 97,300 16.30%

- -

Operating Supplies 17,405 32,378 82,252 82,252 66,174 -19.55%

- -

97006 Operating Supplies 2,283 - - - - 0.00%

- -

Motor Fuel/Oil 462,673 333,105 500,000 500,000 400,000 -20.00%

- -

Linen Supplies 42,741 48,396 64,000 64,000 64,000 0.00%

- -

Cleaning Supplies 19,697 20,901 22,000 22,000 22,000 0.00%

- -

Uniforms 72,058 90,298 100,823 100,823 130,691 29.62%

- -

*Medical Supplies 575,571 661,562 637,771 637,771 696,140 9.15%

- -

Oxygen 58,920 64,137 80,000 80,000 90,000 12.50%

- -

*Pharmacy Supplies 130,512 169,888 145,000 145,000 196,602 35.59%

- -

Books, Publications & Dues 21,490 25,800 47,867 47,867 62,762 31.12%

- -

Tuition Reimbursement - - - 0.00%

- -

*Training 16,445 33,851 58,814 58,814 92,467 57.22%

- -

Total Expenditures 3,309,066 3,432,630 3,996,966 4,208,546 4,330,093 2.89%

* Current market conditions and statutory mandates associated with these line items require an increase.

PROPOSED CAPITAL OUTLAY JUSTIFICATION - BUDGET YEAR 2017

FY-'17

Dept Equipment Price/Unit Qty Total Replacement Useful Life

Operations

Autovent Replacements w/ E500 combo 3,249 8 25,992 Replace older ventilators and CPAP's (Continuous Positive Airway Pressure

Devices) with a single device. Replaces two pieces of hard equipment with one

Battery Support System replacement-LP-15 1,638 8 13,102 Replace older units reaching life expectancy

Stryker Stretcher replacements 15,404 8 123,231 Replace 2007 model year stretchers beyond their life expectancy

Stryker Powerload Device 20,800 8 166,400 Implementation of required ambulance specifications for patient restraint system

Life Pak 15 Cardiac Monitor Replacements 32,988 7 230,916 Replace monitors at their life expectancy

MTP IV Pump Replacements 3,244 6 19,464 Replace older units reaching life expectancy

Ambulances- Replacement 158,995 5 794,976 Replacement of high mileage ambulances with pt. compartments beyond

rechassis

Stair Chairs 1,638 4 6,551 Replace older units reaching life expectancy

Subtotal Operations 1,380,633

Information Services Nutanix Converged System 31,000 1 31,000 Replaces 1 aged virtualization host servers

Mobile Tablets (EPCR) 3,200 5 16,000 Replaces end-of-cycle field tablets

Spectracom SecureSync 7,000 1 7,000 Replaces EOL GPS Modular Time Synchronization System

Subtotal Information Services 54,000

Total CAPITAL 1,434,633

2017 Proposed Five-Year Capital

FY '17 FY '18 FY '19 FY '20 FY '21 5 Year

Dept Equipment Qty Total QTY Total QTY Total QTY Total QTY Total Totals

Field Operations

Autovent Replacements (with E500 Combo) 8 25,992 6 20,082 3 10,041 3 10,095 3 10,398 76,608

Battery Support System replacement-LP-15 8 13,102 8 13,504 8 13,920 8 14,360 8 14,792 69,678

Stryker Stretcher replacements 8 123,232 7 111,062 7 114,394 8 134,656 7 121,359 604,703

Stryker Powerload Device Additional 8 166,400 8 171,392 8 176,534 8 181,830 8 187,285 883,440

Life Pak 15 Cardiac monitor Replacements 7 230,916 8 271,821 5 174,985 8 288,375 7 259,898 1,225,995

MTP IV Pump Replacements 6 19,464 6 20,048 3 10,325 3 10,634 3 10,953 71,424

Ambulance Replacements 5 794,975 4 605,788 4 630,020 3 491,415 3 511,071 3,033,269

Ambulance Re-Chassis 0 2 219,400 2 226,000 2 240,800 2 248,000 934,200

AED 1 3,510 3,510

QRV- Replacement 2 108,000 2 114,480 1 58,957 281,437

Special Event Vehicle

Stair Chairs 4 6,552 4 6,749 4 6,951 3 5,370 3 5,531 31,152

Tank Boss replacement

Administrative Vehicles 1 36,846 36,846

Subtotal Field Operations 1,380,633 1,547,846 1,363,169 1,532,371 1,428,244 7,252,263

Information Services

Laptops -

Servers - - - - -

Nutanix Converged System 1 31,000 - 31,000 Network Equipment 3 30,000 - - - - - - 30,000

CAD/Billing Workstations 0 - - - - - - - - - -

Ambulance Radio Replacements 1,500,000 -

Portables 800MHz 0 - - -

Mobiles 800MHz 0 - - -

Mobile Tablets EPCR/MDT 5 16,000 10 32,000 10 33,280 10 34,610 10 36,000 151,890

MSC2000 Radios - -

Network Switches - -

Firewall VPN Appliance - -

Tower Site Generator - -

Netclock-NTP (Master PSAP Clock) 1 7,000 - 7,000

CAD Workstations - -

System Management Appliance - -

Core Network Switch - -

Field Data Reporting Server - -

Security Equipment - -

COOP Server - -

AVL/MDT Server - -

Mapping Server - -

PC Blade Chassis - -

Fax Server - -

Office Computers - -

Dispatch Computers - -

Station Computers - -

Printers - Networked 1 1,700 1 1,800 1 1,800 1 2,000 7,300

Plotter - -

Network Infrastructure Equip. - -

Raid Server Arrays - -

Subtotal Information Services 54,000 63,700 35,080 1,536,410 38,000 227,190

Total 1,434,633 1,611,546 1,398,249 3,068,781 - 1,466,244 7,479,453


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Proposed Fiscal Year 2017Ambulance Deployment

0 5 102.5Miles

This map product was prepared from a Geographic InformationSystem establised by the Lake County Board of County Commissioners.Its employees, agents and personnel, make no warranty as to its accuracy,and in particular its accuracy as to labelling, dimensions, contours,property boundaries, or placement or location of any map features thereon.The Lake County Board of County Commissioners, its employees, agents andpersonnel MAKE NO WARRANTY OF MERCHANTABILITY OR WARRANTY FORFITNESS OF USE FOR A PARTICULAR PURPOSE EXPRESS OR IMPLIEDWITH RESPECT TO THIS MAP PRODUCT. Independent verification of all datacontained on this map product should be obtained by any user of this map.

DATE: May 31 2016

DATA SOURCES: Lake EMS/Lake County GIS

Produced by Lake EMS

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Lake EMSLake Emergency Medical Services

"C&"C$

24 Hour EMS Station

13 Hour EMS Station

Tab 4

EMS Operations Committee Report


DATE: June 14, 2016 MEETING DATE: June 21, 2016 SUBJECT: EMS Operations Committee Report ACTION REQUESTED: As presented in Tab 4A-C BACKGROUND SUMMARY: The EMS Operations Committee met on June 7, 2016 and their recommendations are presented in Tab 4A-C. FISCAL IMPACT: Budgeted ATTACHMENTS: Tab 4A-C

Tab 4A

RFP for

High Fidelity Patient

Simulation Mannequins


DATE: June 14, 2016 MEETING DATE: June 21, 2016 SUBJECT: RFP for High Fidelity Patient Simulation Mannequins ACTION REQUESTED: Recommend Board Approval BACKGROUND SUMMARY: RFP 16-0220 for High Fidelity Patient Simulation Mannequins was issued on April 18, 2016 with a deadline of May 9, 2016. Responses were received from: Gaumard; Laerdal; and CAE Healthcare. The Selection Committee met on May 11, 2016 to review the proposals received. All three vendors were invited to an on-site interview and demonstration of their Patient Simulation Mannequins on May 19, 2016. After discussion of the individual proposals, the Selection Committee ranked the vendors and unanimously voted to recommend approval of the proposal submitted by CAE Healthcare. It is anticipated that the contractual amount will be $115,133.

FISCAL IMPACT: Budgeted ATTACHMENTS: RFP Selection Committee Summary for RFP 16-0220 Evaluation Summary

LAKE EMERGENCY MEDICAL SERVICES, INC.

2761 West US Old Highway 441, Mount Dora, FL 32757-3500

RFP Selection Committee Summary RFP 16-0220

High Fidelity Patient Simulation Mannequins May 19, 2016

Selection Committee Members: Dr. Desmond Fitzpatrick, Medical Director, Lake EMS Bryan Andrews, Chief Administration Officer, Lake EMS Patrick Stephens, Operations Support Manager, Lake EMS Sheryl Drew, Clinical Training Officer, Lake EMS Observers: Keith Blanchard, Field Training Officer, Lake EMS Lorena Guastella, Field Training Officer, Lake EMS Wm. Stewart Brown, District Chief, Lake EMS Dr. Jason Jones, Associate Medical Director, Lake EMS The purpose of this memo is to document the selection process for RFP 16-0220. The RFP was issued on April 18, 2016 with a deadline of May 9, 2016 at 3:00 p.m. On Wednesday April 27, 2016 at 2:00 p.m. Lake EMS held a pre-proposal conference call to answer any of the vendors questions and only CAE Healthcare called. This call was recorded via Lake EMS and documented via FreeConfrenceCall.Com. At 3:00 p.m. on May 9, 2016 the proposals were opened and recorded. A total of three (3) responses were received as outlined below:

Vendor City and State Mannequins Price for 2 Each Additional Year S/W

Gaumard Miami, Florida

Option 1 $76,990.00 $7305.90

Option 2 $71,990.00 $7305.90

Laerdal Wappinger Falls, NY $75,728.53 $5690.00

CAE Healthcare Sarasota, Florida $115,133.00 includes 1st year S/W

$7999.00

The initial Selection Committee meeting was advertised and occurred on Wednesday, May 11, 2016 from 10:30 a.m. – 12:00 p.m. The meeting was recorded. The committee discussed the merits of each proposal and recommended to bring all three vendors to interview and demonstration. The committee did ask for a couple of questions to be clarified through legal:

1. Is a vendor able to submit a higher fidelity mannequin with new pricing for the interview and demo?

• Legal: No they must demo what they proposed. 2. Is the vendor only allowed to submit a single gender mannequin?

• Legal: The RFP said should and not shall. Single gender mannequins are ok. 3. Is a previous employee considered a conflict of interest? (CAE and Laerdal.)

• Legal: No it is not a conflict of interest. The vendors were contacted to set up interviews. The Selection Committee meeting was advertised as required and the meeting date was set for Thursday, May 19, 2016 from 10:30 a.m. -5:00 p.m. The agenda for the meeting was as follows:

EMS RFP 16-0220 High Fidelity Patient Simulation Mannequins

Name Time Location CAE Healthcare 1030 to 1200 Lake EMS Classroom B Gaumard 1230 to 1400 Lake EMS Classroom B Laerdal 1430 to 1600 Lake EMS Classroom B Committee Meeting 1600 to 1700 Lake EMS Conference Room A It is important to note vendors were placed in alphabetical order for demonstration and that the vendors were video recorded during their demonstration. CAE Healthcare was the first vendor to be interviewed and demonstrate their product. CAE Healthcare had two representatives on site, a Corporate Accounts Manager and a Regional Sales Manager, they discussed how CAE Healthcare is a community partner and that they are 2 ½ hours away for support. They demonstrated how their male and female mannequins had physiological responses, medications reactions, and included the half-life of the medication. They also demonstrated the CPR monitor, neurological capability, IO capability (humerus and tibia), and conducted a dynamic patient scenario of an ACS patient to a cardiac arrest patient for the Lake EMS Field Training staff to go through without incident. The Field Training staff talked about how realistic the simulation and scenario was. Gaumard was the second vendor to be interviewed and demonstrate their product. Gaumard had one representative on site, a Senior Territory Sales Manager. This demonstration showed the 12 lead design capabilities, but also showed the female mannequin was not capable of having 12 leads. In addition the mannequins did not have humeral head IO capability but did have tibial IO capability. During the demonstration we viewed CPR monitor prior to conducting a dynamic patient scenario of an ACS patient to a cardiac arrest patient for the Lake EMS Field Training staff to go through. During this scenario the training staff placed the hands free pads on the chest and defibrillated the mannequin at 360 joules causing an arc. This arc short circuited the mannequins EKG, and CPR monitor. After further review it was discovered that the hands free pads were placed on a 12 lead stud. The studs were not anatomically correct and the vendor was aware of this fact. Option 2 was shown but not demonstrated due to not meeting all of the aspects of the RFP without adding additional money and upgrades. The Field Training staff discussed that the features were not anatomically correct with this mannequin and they were not able to get a realistic airway seal with a supraglottic airway that our system uses. Laerdal was the last vendor to be interviewed. They had two representatives on site for the

demonstration, an EMS Sales Manager and an Executive Territory Manager. The two demonstrated one mannequin, SimMan ALS. This mannequin is available in a female form by changing body parts and adding a wig on the mannequin. This mannequin was a dry system and did not have an IV capable arm and the lower extremity could not be articulated unless the skin was unzipped. The mannequin did have a capability of adding an IV arm for additional cost. The SimMan had an option of a SimPad but was not included in the original RFP quote and would cost additional money. The SimPad is small handheld device that the scenario controller can use to run the scenarios through. The Laerdal software did have a nice debriefing component to it. The demonstration also showed the CPR tracking prior to conducting a dynamic patient scenario of an ACS patient to a cardiac arrest patient for the Lake EMS Field Training staff to go through. Field staff could not get compliance with the CPR monitor with depth when chest compressions were hitting stop plate. After the interviews and demonstration were complete the committee moved to Conference Room A for discussion. At this time the committee discussed the interviews and demonstrations. Each one of the committee members read through their notes discussing the positives and negatives of each vendor. During this meeting Sheryl Drew provided emails from two colleges that use the products and their recommendation of what product had a higher fidelity and better service. Dr. Fitzpatrick brought up that the simulators we looked at today were not an apple to apple comparison. He was interested in asking Laerdal to present a higher fidelity mannequin such as the SimMan 3G. Bryan informed Dr. Fitzpatrick that he had talked to the Inside Sales Representative about the 3G and that this product was roughly $85,000.00 per mannequin. Bryan then informed Dr. Fitzpatrick Lake EMS would not have enough money budgeted for this mannequin. After the discussion was complete, the committee ranked the vendors from 1 to 3. The following represents the unanimous rankings:

Vendor Voting Scores Rank CAE Healthcare 4 1st Laerdal 9 2nd Gaumard 11 3rd

Based on the process as outlined above, the selection committee unanimously recommends CAE Healthcare be awarded the bid to provide High Fidelity Mannequins as outlined in RFP 16-0220. Respectfully Submitted by: Wm. Stewart Brown District Chief Lake EMS

RFP EVALUATION SUMMARY

CAE mannequins

These mannequins are realistic high fidelity patient simulators that have life like physiology responses to conditions, medication, and treatment. This mannequin can determine if the practitioner has an appropriate seal with a BVM and reacts accordantly. These mannequins are male and female gender to make for a more realistic environment and as long as the mannequins are under service and warranty agreements all education is free at their office in Sarasota.

Laerdal’s mannequins

The mannequin demonstrated in the RFP has less fidelity than the CAE’s models demonstrated. The mannequin platform was male gender but could be converted to a female gender by changing a body part and adding a wig. This mannequin’s lower extremities did not articulate without un-zipping the skin and the mannequin did not have an IV arm on it. On could be purchased for additional money. Laerdal has a higher fidelity mannequin that cost roughly $85,000.00 per mannequin but still only available on a male gender platform. For us to consider the SimMan 3G it would cost Lake EMS $170,000.00

Gaumard Mannequins

These mannequins demonstrated in the RFP have less fidelity than CAE’s model. The Female mannequin did not have 12 lead capabilities but the male mannequin did have 12 lead capabilities. The male 12 lead placement was not anatomically correct and the airway was not realistic to patient airways thus making it easier to intubate and unable to get a correct seal with the I-gel supraglottic airway that the Lake EMS system uses. During the scenario the training staff placed the hands free pads on the chest to defibrillate a lethal rhythm the mannequin was in at 360 joules causing an arc. This arc short circuited the mannequins EKG, and CPR monitor. After further review it was discovered that the hands free pads were placed on a 12 lead stud. The studs were not anatomically correct and the vendor was aware of this fact.

Tab 4B

Waiver of

Conflict of Interest

Agreement


DATE: June 14, 2016 MEETING DATE: June 21, 2016 SUBJECT: Waiver of Conflict of Interest Agreement ACTION REQUESTED: Recommend Board Approval BACKGROUND SUMMARY: The County Attorney is requesting Lake EMS enter into a Waiver of Conflict of Interest for Legal Services Agreement. This is a requirement under the Florida Bar Ethics Rules. FISCAL IMPACT: None ATTACHMENTS: Waiver of Conflict of Interest Agreement

AGREEMENT BETWEEN

LAKE COUNTY, FLORIDA AND


WAIVER OF CONFLICT OF INTEREST

THIS AGREEMENT is by and between Lake County, Florida, a political subdivision of the

State of Florida, hereinafter the “COUNTY,” and Lake Emergency Medical Services, Inc., hereinafter

“LEMS.”

WHEREAS, LEMS desires that the Lake County Office of the County Attorney provide legal

services to LEMS and the County Attorney is willing and able to provide such services; and

WHEREAS, pursuant to Section 2-106, Lake County Code, the Office of the County Attorney

may render any other legal services as may be required by the Lake County Board of County

Commissioners; and

WHEREAS, the COUNTY and LEMS agree and acknowledge that although the interests of each

party are generally consistent, it is recognized and understood that differences may exist or become

evident during the course of the legal representation; and

WHEREAS, notwithstanding these possibilities, both parties have determined that it is in their

individual and mutual best interests to have a single legal office represent them; and

WHEREAS, Rule 4-1.7 of the Rules Regulating the Florida Bar provides than an attorney must

not represent a client in the same or similar matter if such representation could be directly adverse to

another client or there is risk that representation of one client will be materially limited by attorney’s

responsibilities to another client, unless a waiver is obtained.

NOW, THEREFORE, IN CONSIDERATION of the mutual understandings, terms, and

conditions set forth, the parties agree as follows:

1. Recitals. The foregoing recitals are true and correct and incorporated herein.

2. Waiver. Despite any potential or actual conflict of interest which may exist now or in

the future, LEMS consents to the Lake County Office of the County Attorney simultaneously representing

both the COUNTY and LEMS. The COUNTY and LEMS hereby agree to waive any conflict of interest

that may arise, including any conflict that may have arisen in the drafting of this Agreement. The parties

agree that such services do not include advising or representing the employees of LEMS in their

individual capacities. It is further understood and agreed that the County Attorney and his/her Assistant

County Attorneys may freely convey necessary information provided by the LEMS to the COUNTY.

3. Withdraw. Nothing herein shall prohibit LEMS from employing separate legal counsel

for specific needs when deemed necessary and appropriate by LEMS. The parties hereby agree that in the

event of a dispute between the COUNTY and LEMS, or where provision of such services would be in

Agreement btwn Lake County and LEMS for Waiver of Conflict of Interest

2 S:\DOCUMENT\2016\COUNTY ATTORNEY\Attorney Representation Conflict Waiver\WAIVER OF CONFLICT_LEMS_5.20.16.docx

violation of the Rules Regulating the Florida Bar, the Lake County Office of the County Attorney shall

withdraw from representing LEMS.

4. Termination. In the event LEMS no longer wants to obtain the services of the Lake

County Office of County Attorney, LEMS will provide written notice to the County Attorney. Upon the

date of receipt of such notice, this Agreement will be considered terminated and the Lake County Office

of the County Attorney will be relieved from representation of LEMS.

IN WITNESS WHEREOF, the parties hereto have made and executed this Agreement on the

respective dates under each signature: COUNTY through its Board of County Commissioners, signing by

and through its Chair, and by LEMS through its duly authorized representative.


ATTEST: _____________________________________________ _____________________________ Welton G. Cadwell, Chairman Jerry Smith, Executive Director This day of , 2016. Approved as to form and legality: _____________________________ Melanie Marsh, Attorney for LEMS BOARD OF COUNTY COMMISSIONERS

ATTEST: OF LAKE COUNTY, FLORIDA

________________________ ____________________________________ Neil Kelly, Clerk of the Sean M. Parks, Chairman Board of County Commissioners of Lake County, Florida This _____ day of ______________, 2016. Approved as to form and legality: _____________________________ Melanie Marsh, County Attorney

Tab 4C

First Watch


DATE: June 14, 2016 MEETING DATE: June 21, 2016 SUBJECT: Purchase of First Watch Software ACTION REQUESTED: Recommend Board Approval BACKGROUND SUMMARY: Staff is requesting approval for the sole source purchase of FirstWatch Software. (Quote attached) FirstWatch is a fully customizable clinical and business analytics software package. Connecting to multiple disparate data sources, this product provides call taking, dispatching and field operational analytics, comprehensive clinical quality improvement review, hospital offload monitoring, bio-surveillance, data visualizations, and automated alerting. Of particular interest to Lake EMS, FirstWatch monitors incidents by determinants, or dispatch levels associated with key metrics in terms of case entry performance. In depth analysis can be done on demand to monitor aspects of dispatch or field performance by individual or shift to improve call processing times and patient care. The total first year cost including support and maintenance is $184,800. The estimated annual support and maintenance beyond the first year (including a 3% annual increase) will be $29,419. The pricing is fair and reasonable given the software value is based upon incident volume and population, data sources accessed and triggers/reports required which is the standard for pricing this type of software for public safety agencies. Additionally, this pricing structure allows for the future capability to connect to new data sources and the development of new triggers/reports for specific areas identified needing evaluation for improvement. Lake EMS is officially recognized as an Accredited Center of Excellence (ACE) by the International Academies of Emergency Dispatch. The National Academies of Emergency Dispatch, through its College of Fellows, has established a high standard of excellence for emergency dispatching, providing the tools to achieve this high standard at both the dispatcher level through Certification, and at the communication center level through the Accreditation Program. The three tools Lake EMS uses to maintain this critical accreditation are Priority Dispatch's Pro-QA Paramount for Emergency Medical Dispatching and Emergency Fire Dispatching and Priority Dispatch's AQUA Evolution. The International Academies of Emergency Dispatch provided Lake EMS a notification letter from the Director of Software Development for Priority Dispatch indicating that FirstWatch is the only available monitoring and analysis program in the world to interface directly with their Priority Dispatch software. Since FirstWatch is the only real-time monitoring & data analysis program approved to interface directly with Priority Dispatch's software and databases, staff is requesting the sole source approval of this purchase and implementation, upon legal approval, of the Master Software Agreement terms and conditions. FirstWatch is deployed across the United States and Canada utilizing highly developed statistical measuring processes to provide real-time analysis and feedback. Fitch and Associates have noted the positive results obtained by their customers using the real-time monitoring and data analysis capabilities in FirstWatch. By connecting to all of the Lake EMS databases, real-time information can provide continuous improvement in clinical care, operational oversight, and public health integration. While data analysis is in-depth and comprehensive, the dashboard style outputs provide intuitive views for frontline supervisory staff to manage assets and resources, while providing management staff with a range of tools for improvement of services. The data analysis obtained through FirstWatch will also be available to our Fire Services partners which will greatly enhance each agency’s ability to contribute to the success of the EMS System of Lake County. FISCAL IMPACT: $184,800 (Budgeted) ATTACHMENTS: First Watch New System Quote and Priority Dispatch Letter 05.05.16

FirstWatch Solutions, Inc.

322 Encinitas Blvd., Suite 100

Encinitas, California 92024 USA

Phone: 760-943-9123 Fax: 760-942-8329

Atten: Phil Davis, Regional Manager (Ph Ext 267)

Customer Information: Quote Information:

Name: Jim Root, CTO Date: 6/1/2016Organization: Lake EMS Expiration Date: 11/28/2016

Address: 2761 West Old U.S. Highway 441City, ST Zip: Mount Dora, FL 32757-3500 Call Volume: 57,000

Phone: (352) 383-4554 Population: 303,186Email: [email protected]

Qty Description Unit Price Item TotalFirstWatch System (FW) w/ Primary Data Source 1 (DS1) - ZOLL CommCAD (LEMS & 12 FDs)

1 (DS1) System License $40,140 $40,1401 (DS1) Annual Support & Maintenance $8,831 $8,8311 (DS1) Data Source Integration $7,500 $7,5001 Installation / Configuration $2,500 $2,5001 Training / Trigger Consultation / Project Mgmt. $6,500 $6,500

Sub-total $65,471Data Source 2 (DS2) - ProQA

1 (DS2) System License $4,500 $4,5001 ProQA Dashboard Report Included Included1 (DS2) Annual Support & Maintenance $990 $9901 (DS2) Data Source Integration $7500 $7,500

Sub-total $12,990Data Source 3 (DS3) - ZOLL RescueNet ePCR

1 (DS3) System License $28,098 $28,0981 (DS3) Annual Support & Maintenance $6,182 $6,1821 (DS2) Data Source Integration $7500 $7,500

Sub-total $41,780Data Source 4 (DS4) - ZOLL RescueNet Billing Regular Price Discounted Price Honored

1 (DS4) System License - 5/5/14 Licensing discount pricing honored * $28,098 $7,5001 (DS4) Annual Support & Maintenance - 5/5/14 ASM discount pricing honored * $6,182 $1,6501 (DS2) Data Source Integration - Single source RescueNet database discount applied $7500 $0

Sub-total $9,150FirstWatch Triggers / Reports

20 Included Standard FirstWatch Triggers Included Included10 Standard FirstWatch Triggers $400 $4,00010 Standard FirstWatch Triggers Annual Support & Maintenance $200 $2,00020 Customized FirstWatch Reports Development (hours) $150 $3,0001 Customized FirstWatch Reports Annual Support & Maintenance $660 $660

Sub-total $9,660Performance Plus Module (PP)

2 Performance Plus Module $2,500 $5,0002 Performance Plus Annual Support & Maintenance $550 $1,100

Sub-total $6,100FirstPASS Module (FP)

1 FirstPASS Module w/Protocol & Reporting Bundle (Requires ePCR data source) $30,000 $30,000

1 FirstPASS Annual Support & Maintenance $6,600 $6,6000 Additional FirstPass Add-on Agency $5,000 $00 Additional FirstPass Add-on Agency Annual Support & Maintenance $1,100 $00 Additional Custom Protocols (beyond the basic bundle) $1,500 $00 Additional Custom Protocols Annual Support & Maintenance $330 $00 Additional FirstPASS Report Development (hours - beyond the basic bundle

offering) $150 $00 Additional FirstPASS Reports Annual Support & Maintenance $33 $0

Sub-total $36,600EMS Transport / Hospital Status Dashboard (EMST/HS)

1 EMS Transport / Hospital Status Dashboard $2,500 $2,5001 EMS Transport / Hosp Status Dashboard Annual Support & Maintenance $550 $550

Sub-total $3,050Total of Items Above $184,800

$184,800

$29,419

Accepted:

Title:

Date:

New SystemQuote

New System (Payment of All Year One Fees) - Total: Payment of All Year One Fees

FirstWatch offers the following payment option for your consideration

Estimated Annual Support & Maintenance beyond Year 1 (included in Software as a Service payments above)Estimated Annual Support & Maintenance for Year 2 (based on a 3% annual increase):

The discounts associated with the ZOLL RescueNet Billing data source are provided with a mutual agreement that Lake EMS staff will assist FirstWatch staff with the continued betterment of our offering with a focus being related to monitoring data specific to the billing and business office.

In addition to the number of Triggers shown on the quote above: A total of 13 'All Calls' Triggers will be provided at "No Cost". 1 for LEMS and 12 (1 each) for the dispatched Fire Departments. Also, a total of 13 ' All Responses' Triggers will be provided at "No Cost". 1 for LEMS and 12 (1 each) for the dispatched Fire Departments.

To authorize FirstWatch to proceed with proposed enhancements, please fax signed copy (all pages) back to:FirstWatch @ (760) 942-8329 or email executed PDF to: [email protected]

Thank you for the opportunity to present this quote.

Please see Page 2 for Additional Information

Lake EMS'New System Quote' - 06/01/2016 - Additional Information

General Project Information

FirstWatch has worked diligently to keep pricing 'fair and reasonable' as well as in developing a REMOTE approach to FirstWatch software sales, presentation, deployment, installation, data interface, system configuration and training; as such we have NOT included any fees for travel associated with this project. If travel is requested / required by customer, customer will be asked to pay for all travel-related expenses (e.g., transportation, accommodations, food) incurred by FirstWatch at the request of customer and approved by customer, for Software-related services such as on-site installation, training, customization, integration, support and maintenance.

This quotation expires on the date noted on the top right section of page 1. For additional information or questions please contact the FirstWatch Representative also noted on the top of page 1.

FirstWatch - Primary Data Source #1 (ZOLL CommCAD (LEMS & 12 FDs))

Preliminary project pricing (in US Dollars, which does not include taxes or externally imposed fees), as outlined on page 1, is for a single FirstWatch remote-client system installed on client provided PC / Server (configured to FirstWatch specifications and integrated with Data Source's outlined on page 1) using ODBC or client provided data push configuration to move data to the FirstWatch Data Centers. Preliminary pricing is based on customer provided annual call volume / annual patient encounters noted on page 1 (plus/minus 20%).

Primary FirstWatch System Data Source (DS1) is the first data source integration/interface to be made, regardless of type (CAD, ePCR, RMS, etc.). All Data Source Interfaces proposed on page 1 (DS1, DS2, DS3, etc.) are priced based on data availability via the same network and using the standard FirstWatch approach. Configurations outside standard FirstWatch approach (as outlined above) may require additional costs and may not include all functionality. All Data Analysis (including GIS mapping) is done within the FirstWatch Data Centers and is based on analyzing a subset of data elements present within client's database and will likely not contain every available data element. Interface will commonly include information related to location, times, symptoms, treatment and responses, but may include other available elements.

Unless quoted differently, this FirstWatch thin-client deployment includes: Twenty (20) Regular FirstWatch Triggers. Default FirstWatch thin-client deployment also includes access for (50) Simultaneous users. Additional Triggers or Simultaneous User accounts may be purchased at anytime. Trigger and Simultaneous User account fees recur annually and will be billed as separate line item on Annual Maintenance and Support invoice.

FirstWatch Training & Trigger Consultation includes up to 10 hours of Remote (online) FirstWatch Training & Trigger Configuration / System Orientation sessions.

FirstWatch Enhancement Modules are NOT included with Standard FirstWatch and instead are priced separately (if needed) based upon customer request. FirstWatch Enhancement Modules require Standard FirstWatch deployment be in place first. FirstWatch Enhancement Modules may require additional Triggers (like Online Compliance Utility - OCU) and Triggers for FirstWatch Enhancement Modules will appear as a separate line item in the Additional Options & Enhancement Modules Section of Worksheet on Page 1, or elsewhere on FirstWatch System Enhancement Quotes. At this time, the following FirstWatch Enhancement Modules are offered as System Enhancements / Upgrades (and require additional fees initially and annually recurring support fees): Performance PLUS, FW FTP Data Mover, Online Compliance Utility (OCU), FirstPASS (FP), Demand Analysis, EMS Transport / Hospital Status Dashboard tool, Patient Transfer of Care (TOC) tool and Upgraded SQL Reporting Services tools, features, assistance or automated report distribution functionality.

FirstWatch - Data Source #2 (ProQA)

This Data Source has a minimum prerequisite of a base FirstWatch system that includes Data Source #1. Should additional Triggers or customized Reports be needed for this Data Source or you need additional information, please notify the FirstWatch representative shown at the top of page 1.

Interface with ProQA requires ProQA Software Version 3.4.1.41 or later. The 'ProQA Dashboard Report' is being included as a 'Value Added No Cost' addition to this purchase.

FirstWatch - Data Source #3 (ZOLL RescueNet ePCR)


This product shares a common database with other installed or quoted ZOLL RescueNet products. FirstWatch has removed the $7,500 Data Integration cost from this data source.

FirstWatch - Data Source #4 (ZOLL RescueNet Billing)


This product shares a common database with other installed or quoted ZOLL RescueNet products. FirstWatch has removed the $7,500 Data Integration cost from this data source.

FirstWatch - Standard Triggers

Standard FirstWatch triggers are defined as: existing (commercially available) FirstWatch trigger technology that does not require any custom programming. Regular triggers are based on existing functionality, related to existing data sources and data structures. Triggers requiring custom programming are considered non-standard or custom triggers and may have additional cost associated, which will be based on the estimated development efforts. Regular triggers are generally based on Syndromic Surveillance, Operational/Performance, or Situational Awareness monitoring. Details available upon request...or see Regular Trigger definition document for more details.

FirstWatch - Customized Report Development

FirstWatch has used it best effort in estimating the number of Customized Report Development hours required for this project. Depending upon complexity of actually developing & testing the aforementioned customized report development, additional report development hours may be required (at additional cost). Customer may cancel customized report development project at any time. If cancellation occurs after customer's authorization to begin (by signing and returning this quote sheet or issuing a P.O. to FirstWatch), customer will be responsible for all costs associated with actual work completed prior to cancellation notification to FirstWatch.

Performance PLUS

Performance PLUS is a FirstWatch System Enhancement Module and therefore requires a standard FirstWatch System deployment be in place first. Performance PLUS offers a more granular view of FirstWatch Trigger criteria; for example performance measures by individual; crew, unit, station, zone, response area, beat or hospital. Each Performance PLUS module offers 100 data points; granular detail views of primary Trigger criteria. Alternately, some customers think of Performance PLUS approach as a "primary / sub" Trigger approach.

FirstPASS - w/ Standard Protocol, Clinical Triggers and Reports Bundle

FirstWatch System Enhancement: ADDING FirstPass (FP) enhancement module to existing FirstWatch Base System. Please NOTE: the FirstPass enhancement module requires a data source interface into ePCR data system. FirstPass is a smart queue based QA/QI tool which includes a Recommended Base Bundle of (6) Standardized FirstPass Protocols (included with enhancement module) for: STEMI, Stroke, Cardiac, Trauma, Airway and Universal. These protocols are designed to provide measures against predefined, evidence based quality metrics. While the initial 6 protocols included in the bundle are preconfigured, the customer agency will also have the ability to add or vary unique metrics specific to their locality. Report Development Hours for Standardized/Base FirstPass Reports are included in the Bundle pricing; and will be based upon the above Standardized/Base FirstPass Protocols. Future Reports may offer simple overviews on; Protocol Deviation within the context of overall system (or individual) performance, Benchmarking and Paramedic Scorecards – all developed against the Standardized Protocols in the Bundle. Additional FirstPass Protocols, Reports and Clinical Triggers can be added (at additional cost initially/annually) and will be priced upon request. Please see Regional Manager for additional information.

EMS Transport / Hospital Status Dashboard

EMS Transport / Hospital Status Dashboard (EMSTHS) is a FirstWatch System Enhancement Module and therefore requires a standard FirstWatch System deployment be in place first. Each EMSTHS module offers real-time views of EMS Units enroute & arrived at up to 100 area hospitals.

Annual Support & Maintenance (ASM)

Annual Support recurs annually and includes: system enhancements, updates and patches, 24/7 urgent technical support, business hour support for routine issues and guidance with configuration of your FirstWatch System. Support fees increase annually. Annual Support fee increase is projected (for budget purposes) at 3% per year.

Tab 5

Employee Issues

Committee Report


DATE: June 14, 2016 MEETING DATE: June 21, 2016 SUBJECT: Employee Issues Committee Report ACTION REQUESTED: Approval of Tab 5A BACKGROUND SUMMARY: The Employee Issues Committee, chaired by Comm. Leslie Campione, met on June 8, 2016. They voted unanimously to recommend full Lake EMS Board approval of the item presented in Tab 5A. FISCAL IMPACT: N/A ATTACHMENTS: Tabs 5A

Tab 5A

Dayforce Contract

Termination


DATE: June 14, 2016 MEETING DATE: June 21, 2016 SUBJECT: Ceridian Dayforce Contract Termination ACTION REQUESTED: Recommend Board Approval BACKGROUND SUMMARY: UltiPro Software has been successfully launched as the new HRIS system. As a result, staff is requesting approval to terminate the previous contract with Ceridian Dayforce.

FISCAL IMPACT: $15,789.38 (Budgeted) ATTACHMENTS: Amendment to Agreement between Lake EMS and Ceridian HCM

AMENDMENT TO AGREEMENT BETWEEN


AND

CERIDIAN HCM, INC. This is an Amendment, by and between Lake Emergency Medical Services, Inc., a Florida not for

profit corporation, herein referred to as “Lake EMS,” and Ceridian HCM, Inc., a Delaware for profit

corporation authorized to do business in the State of Florida, herein referred to as “Ceridian,” collectively

referred to as the “Parties”, to the Master Services Agreement between the Parties dated December 19,

2013, whereby the Parties agreed Ceridian would provide certain services to Lake EMS, herein referred to

as the “Agreement”.

WHEREAS, the Agreement is for a 36 month term, ending on December 19, 2016, and pursuant

to Section 10.2 of the Agreement the parties agreed that if Lake EMS should terminate the Services prior

to the expiration of the term of the Agreement, Lake EMS shall pay Ceridian an Early Termination Fee;

and

WHEREAS, Lake EMS has terminated the Services effective June 30th, 2016; and

WHEREAS, Lake EMS is of the view that Ceridian has failed to perform one or more of its

material obligations under the Agreement but Ceridian disagrees with such assertion; and

WHEREAS, the Parties wish to set forth herein the terms of their agreement regarding the

termination of the Services, and any Services to be provided by Ceridian to Lake EMS following the

termination, and do so freely and voluntarily, after having received the benefit of independent legal advice;

and

WHEREAS, any terms not defined herein shall have the meaning ascribed to them in the

Agreement;

NOW THEREFORE, IN CONSIDERATION of the mutual terms, understandings, conditions,

promises, covenants and payment hereinafter set forth, and intending to be legally bound, the parties hereby

agree as follows:

1. Recitals. The foregoing recitals are true and correct and are incorporated herein.

2. Early Termination Fee. The Parties agree that Lake EMS shall pay Ceridian an Early

Termination Fee for this termination pursuant to the Agreement in the amount of $15,789.38.

3. Extended Access. While the Services were discontinued effective March 31, 2016,

Ceridian agrees to provided Lake EMS with access to Lake EMS’s data for the Services in the hosted

database, and will continue to do so, at no cost to Lake EMS, until March 31, 2017 (the “Data Access

Services”), provided that Lake EMS pays the Early Termination Fee by July 15, 2016, and otherwise

complies with the terms of the Agreement, including all billing obligations, past, present, and future.

2

C:\Users\bandrews\Desktop\Term of Agr_Lake EMS_6 1 16.docx

4. Additional Post-Termination Services. In addition, Lake EMS agrees to pay associated

Fees relating to any other post-termination Services requested, including an archival copy of the database.

5. Release. The Parties, on behalf of themselves, their successors, affiliates and assigns,

hereby agree to release and forever discharge the other party of and from all charges, claims, demands,

actions, causes of action, suits, debts, dues, sums of money, judgments, executions, damages, and rights

whatsoever, in law or in equity, which it may have against the other party resulting the facts, circumstances,

agreement, occurrences, and any other matter between the Parties, whether known or unknown, suspected

or unsuspected, existing or having occurred as of the date hereof, including, but not limited to all facts and

allegations set forth or which may have been set forth in connection with the execution of this Amendment.

It is understood that this is a full and final settlement and release of all claims.

6. Agreement. Except as modified by this Amendment, all terms and conditions of the

Agreement will remain in full force and effect. The terms and conditions of the Agreement shall apply to

the Data Access Services.

7. No admission of Liability. Neither the payment or waiver of payment of any sums, nor the

execution of this Agreement, shall be construed as an admission of liability or fault by any Party.

8. Enurement. This Amendment shall enure to the benefit of and be binding on the Parties

and their respective successors and assigns.

9. Construction. This Agreement shall be construed as if the Parties jointly prepared it, and

any uncertainty or ambiguity shall not be interpreted against any one Party.

10. Further Assurances. The Parties agreed to do everything (including executing and

delivering any document) necessary to give full effect to this agreement and the transactions contemplated

by it.

11. This Amendment may be executed in counterparts, including by way of .pdf transmission,

each of which shall be considered an original and all of which when taken together form one single

document.

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C:\Users\bandrews\Desktop\Term of Agr_Lake EMS_6 1 16.docx

AMENDMENT TO AGREEMENT BETWEEN LAKE EMS AND CERIDIAN HCM, INC.

IN WITNESS WHEREOF, the parties hereto have made and executed this Amendment on the

respective dates under each signature: Lake EMS, by and through its Chairman and Ceridian, through its

duly authorized representative.

CERIDIAN HCM, INC. _______________________________________

Lois M. Martin, Director This _____ day of ____________, 2016.


_______________________________________ Welton G. Cadwell, Chairman This _____ day of ___________, 2016. Approved as to form and legality: _____________________________ Melanie Marsh, County Attorney

Tab 6

Staff

Reports


DATE: June 14, 2016 MEETING DATE: June 21, 2016 SUBJECT: Staff Reports ACTION REQUESTED: Information Only BACKGROUND SUMMARY: Lake EMS staff has provided the following written reports:

A. Patient Financial Services Bryan Andrews, Chief Administrative Officer

B. Human Resources

Deo Persaud, Human Resources Manager

C. Operations John Simpson, Chief Operations Officer

FISCAL IMPACT: N/A ATTACHMENTS: Reports in Tabs A, B, C

Tab 6A

Patient Financial

Services Report


DATE: June 14, 2016 MEETING DATE: June 21, 2016 SUBJECT: Patient Financial Services Report ACTION REQUESTED: Information Only BACKGROUND SUMMARY:

• Attached is the Month Ending A/R Summary for ME 03/31/16. FISCAL IMPACT: As described ATTACHMENTS: Accounts Receivable Summary and Reports for ME 03/31/16

6/2/2016 12:08 PM

LAKE EMSFY 2016 A/R Summary

Jun-15 Jul-15 Aug-15 Sep-15 Oct-15 Nov-15 Dec-15 Jan-16 Feb-16 Mar-16 FY 2015 FY 2016

BEGINNING AR: 3,685,780 3,285,947 3,801,046 3,782,071 3,742,529 3,543,227 3,261,712 3,452,287 3,505,158 3,719,581 3,146,569 3,742,529

Total Invoices Posted 2,940 2,975 2,991 2,933 3,097 2,983 3,162 3,223 3,457 3,621 36,408 19,543.00Gross Charges

Self Pay 377,723 354,261 360,835 322,938 339,162 325,099 309,542 296,432 289,147 383,187 3,634,790 1,942,569Medicare 988,464 959,166 967,784 1,007,279 1,026,301 1,011,723 1,133,624 1,161,816 1,259,754 1,276,557 12,921,600 6,869,774Medicaid 174,554 190,927 196,114 177,066 202,119 191,677 180,165 181,187 204,773 216,530 2,160,770 1,176,452Contracts 18,357 18,679 16,610 12,759 19,478 14,031 17,998 20,191 30,803 35,620 234,559 138,121

Commercial 214,369 265,160 236,271 235,376 261,357 246,601 262,005 269,012 280,457 268,214 2,946,345 1,587,6451,773,466 1,788,193 1,777,614 1,755,417 1,848,418 1,789,130 1,903,335 1,928,637 2,064,934 2,180,108 21,898,064 11,714,561

Average Fee per Invoice 603 601 594 599 597 600 602 598 597 602 601 599

Gross CollectionsSelf Pay 85,764 74,659 86,290 83,064 77,071 74,755 74,735 92,870 85,425 94,664 966,107 499,520

Medicare 417,452 411,268 482,228 457,260 568,190 353,897 398,271 403,002 364,541 441,141 5,503,215 2,529,041Medicaid 28,217 32,636 14,420 31,277 27,632 19,709 16,759 14,619 18,871 15,928 342,987 113,519Contracts 4,749 7,299 12,831 9,022 9,537 6,594 12,517 9,927 16,678 8,266 131,783 63,518

Commercial 505,920 459,076 482,529 553,505 600,835 458,303 420,089 478,710 422,115 424,945 5,743,054 2,804,997Subtotal Cash 1,042,102 984,938 1,078,298 1,134,129 1,283,265 913,258 922,371 999,128 907,630 984,943 12,687,147 6,010,595

Interest Payments 81 48 32 21 274 125 39 70 28 6 1,073 543Total Cash $1,042,183 $984,986 $1,078,330 $1,134,150 $1,283,539 $913,384 $922,410 $999,198 $907,658 $984,949 12,688,220 6,011,138

AllowancesSelf Pay 0 0.00 0 0 0 0 0 0 0 0 0 0

Medicare 252,328 252,165 248,392 256,783 272,398 263,305 279,483 303,761 334,726 333,356 3,318,363 1,787,029Medicaid 132,050 139,004 143,861 130,343 157,403 142,191 128,727 137,802 159,496 154,591 1,599,613 880,210Contracts 17,142 21,968 24,145 17,849 18,492 20,942 15,314 4,195 28,252 27,797 222,116 114,992

Commercial 3,962 3,941 1,461 4,245 10,891 2,904 4,731 20,579 6,050 2,638 56,683 47,794405,482 417,078 417,858 409,220 459,184 429,341 428,256 466,336 528,524 518,383 5,196,774 2,830,025

Bad Debt W/O's 0 300 450 668 0 470 39,159 298 96 0 2,157 40,023Collection W/O 1,277 (118) 3,730,162 338,648 (13,853) (3,371) (9,749) (2,390) (7,530) 2,236 4,050,570 (34,658)Collection Fees 0 0 (193) (5) (75) 0 0 0 0 (18) -262 -93

Admin W/O'sSelf Pay 0 296 638 0 0 1,206 1,939 (630) (299) 1,730 2,802 3,946

Medicare 0 0 0 0 4,429 0 0 0 47 285 446 4,761Medicaid 0 0 0 0 0 0 0 0 0 0 0 0Contracts 0 0 0 0 0 0 0 0 0 0 0 0

Commercial 0 0 0 0 0 0 0 0 0 0 0 00 296 638 0 4,429 1,206 1,939 (630) (252) 2,015 3,248 8,707

Charity W/O'sSelf Pay 1,662 4,578 87 4,228 2,440 3,134 855 1,655 1,579 2,768 24,357 12,431

Medicare 3,987 4,282 2,484 3,908 1,792 3,990 1,475 3,699 3,071 1,740 35,766 15,767Medicaid 0 0 0 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0 0Contracts 0 0 0 0 0 0 0 0 0 0 0 0

Commercial 0 0 0 0 0 0 0 0 0 0 0 05,649 8,860 2,570 8,137 4,232 7,125 2,330 5,354 4,650 4,508 60,122 28,197

Small Balance (81) (26) (50) (28) (282) (129) (29) (68) (5) 56 -990 (455)Refunds 1,554 6,933 1,379 15,575 14,532 0 5,339 162 3,733 7,041 118,180 30,807

Total Misc. 1,474 6,906 1,329 15,547 14,250 (129) 5,310 95 3,729 7,098 117,190 30,352

ACTIVE A/RSelf Pay 768,427 1,180,463 1,313,353 1,362,604 1,379,699 1,064,211 1,085,710 980,444 879,025 916,588 1,362,604 916,588

Medicare 1,565,156 1,579,760 1,509,717 1,459,951 1,279,801 1,324,481 1,489,596 1,601,091 1,837,429 2,009,828 1,459,951 2,009,828Medicaid 229,111 238,529 177,633 149,241 145,797 154,859 126,028 144,393 170,896 197,706 149,241 197,706Contracts 54,215 53,259 53,002 49,899 53,849 50,178 57,290 53,637 58,355 77,213 49,899 77,213

Commercial/Mgd Care 669,038 749,034 728,367 720,834 684,082 667,983 693,663 725,593 773,876 803,647 720,834 803,647Total 3,285,947 3,801,046 3,782,071 3,742,529 3,543,227 3,261,712 3,452,287 3,505,158 3,719,581 4,004,981 3,742,529 4,004,981

Days on Books(3 Mth Roll)Self Pay 64.87 98.71 109.66 119.78 123.07 98.36 101.73 96.08 89.60 86.33 106 99

Medicare 44.18 47.46 47.25 45.40 38.91 39.68 42.85 44.17 47.16 49.59 39 42Medicaid 39.06 40.23 28.86 24.14 23.12 24.75 20.04 23.82 27.54 29.94 33 24Contracts 66.89 72.23 90.15 94.76 100.59 98.96 101.49 93.72 77.18 81.34 71 77

Commercial/Mgd Care 85.14 95.51 92.85 89.27 85.16 82.00 82.20 85.14 87.02 89.68 95 83Total 53.17 63.61 64.63 64.17 60.08 55.19 56.85 56.90 57.55 59.19 58 56

3 Month Cash CollectionsNet 77% 77% 76% 78% 85% 81% 74% 66% 63% 62% 76% 68%

Gross 59% 59% 58% 60% 65% 62% 56% 50% 48% 47% 58% 51%

% Bad Debt 0% 0% 0% 0% 0% 0% 2% 0% 0% 0% 0 0% Charity 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0 0

Self Pay 17%

Medicare 59%

Medicaid 10%

Contracts 1%

Commercial 13%

FYTD Charges by Payer for Month-Ending 3/31/16

1,042,102 984,938

1,078,298 1,134,129

1,283,265

913,258 922,371

999,128

907,630

984,943

0

200,000

400,000

600,000

800,000

1,000,000

1,200,000

1,400,000

Jun-15 Jul-15 Aug-15 Sep-15 Oct-15 Nov-15 Dec-15 Jan-16 Feb-16 Mar-16

Total Cash

Month

Historical Cash Receipts b y Month Through Month-Ending 3/31/16

0

500,000

1,000,000

1,500,000

2,000,000

2,500,000


Cha

rges

Month

Historical Charges by Month Through ME 3/31/16

Charges

53.17

63.61 64.63 64.17

60.08

55.19 56.85 56.90 57.55

59.19

30

40

50

60

70


DAYS

MO

NTH

S

HISTORICAL DAYS IN A/R Through Month-Ending 3/31/16

Days in A/R

Linear (Daysin A/R)

0

500,000

1,000,000

1,500,000

2,000,000

2,500,000

3,000,000

3,500,000

4,000,000

4,500,000


Endi

ng A

/R

Month

Ending A/R by Month for ME 3/31/16

Tab 6B

Human Resources

Report


DATE: June 14, 2016 MEETING DATE: June 21, 2016 SUBJECT: Human Resources Staff Report ACTION REQUESTED: None BACKGROUND SUMMARY: The Human Resources Department has compiled a written report of activities and accomplishments for the period April 1, 2016 through June 1, 2016 which will be reviewed at the Employee Issues Committee meeting. FISCAL IMPACT: None ATTACHMENTS: Human Resources Report

1

Human Resources Report Accomplishments & Goals

April 1st through June 1st, 2016

Major Accomplishments:

The following are highlights and or major accomplishments by the Human Resources Department during the period, from April 1st, 2016 through June 1st, 2016:

RECRUITMENT & COMPENSATION New Employee Orientation (NEO): Orientation’s were done on April 25th and May 23rd, 2016

respectively.

23 – (15 FT EMT’s, 2 Flex EMT’s, 1 FT Paramedic, 2 Flex Paramedic, 1 Tele communicator I, 1 Payroll/Accounts Payable Specialist and 1 Flex Patient Accounts Representative were hired during this period.

o Promotions: 4 EMT’s were promoted to Provisional Paramedic (Bitner, Jennifer, Garrison, Cory, Haardt, Tristan & Rodriguez, Austin.

o Demotions: 3 Paramedics were demoted to EMT’s (Cote, Richard, Cline, Tyler & Kocielko, Colton).

Compensation & Turnover – The turnover rate during this period was 2.62%. RISK & BENEFITS MANAGEMENT, HRIS ACA - Setup, implementation and rollout of Affordable Care Act reporting in Ultipro HRIS.

Generation of 1095’s for tax filing purposes. 3 Month build of ACA Data for January, February and March 2016.

HRIS- Implementation of Ultimate HR software. Go live was on 4/1/2016. Manual HR build of 7 years historical job data, scheduled implementation completed on 5/31/16.

Completed rollout of recruitment module in Ultimate Software, live date was 5/15/16.

UPCOMING HR GOALS:

Recruitment: 8 job openings: EMT’s, Paramedic’s, and Tele-communicator’s. New Employee Orientation – August, 2016 Implementation and setup of Life module for open enrollment. Setup Affordable Care Act reporting in Ultimate Software. Develop and implement a formal Performance evaluation system and employee retention plan.

2

HR Statistics:

Recruitment: - New Hire

- Applications processed - Average time to fill

23 – (15 FT EMT’s, 2 Flex EMT’s, 1 FT Paramedic, 2 Flex Paramedic, 1 Tele communicator I, 1 Payroll/Accounts Payable Specialist and 1 Flex Patient Accounts Representative). 90 days- (Time includes start of posting, screening, panel interviews, clinical theory testing, fitness testing, final selection, up to offer and NEO presentation.) Both Internal and external postings.

Promotions:

Promotions: 4 EMT’s were promoted to Provisional Paramedic (Bitner, Jennifer, Garrison, Cory, Haardt, Tristan & Rodriguez, Austin.

Terminations:

- Turnover Rate: 6 total (based on 193 FTE):

- 6 FT (2.62) - 0 Flex

FMLA

13 Employees

Corrective action (ROC and above)

21 incidents (from attendance to carelessness)

Ride Along Program Internships

3 Participants 0

Tab 6C

Operations

Report


DATE: June 14, 2016 MEETING DATE: June 21, 2016 SUBJECT: Operations Staff Report ACTION REQUESTED: Information Only BACKGROUND SUMMARY: Staff has provided operational data for the second quarter – January 1, 2016 through March 31, 2016. Graphs presented include: Annual Trending; Total Response Components; Overall Total Response; Hospital Offload Measures; Cardiac Arrest Measures; and MOI Report. FISCAL IMPACT: Not applicable ATTACHMENTS: Operations Staff Report

Incident and Patient Trends

0

500

1000

1500

2000

2500

3000

3500

4000

4500

5000

Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep

Total Incidents and Patients

FY 2016

Incidents

Patients

0.00%

1.00%

2.00%

3.00%

4.00%

5.00%

6.00%

7.00%

8.00%

9.00%

Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep

Percentage Change YTD by Month

As Compared to FY 2015

Incidents

Patients

Note: Medic 411 & 412 are placed in service with Float personnel when staffing is full on all other units

Workload Trends

Unit Hours and Locations

District 1 District 2 District 3

0.00

0.05

0.10

0.15

0.20

0.25

0.30

0.35

0.40

0.45

0.50

10

1

11

1

12

1

13

1

14

1

14

2

15

1

16

1

17

1

20

1

21

1

22

1

22

2

23

1

24

1

25

1

26

1

27

1

31

1

32

1

33

1

34

1

35

1

36

1

41

1

41

2

YTD Comparisons of UHU Aggregate by Unit

October - April

UHU YTD FY 2012

UHU YTD FY 2013

UHU YTD FY 2014

UHU YTD FY 2015

UHU YTD FY 2016

0.40 UHU

0.35 UHU

0.30 UHU

101 | 24 hr | 0700-0700 | Umatilla

111 | 13 hr | 1000-2300 | Astor

121 | 13 hr | 0900-2200 | Mount Dora

131 | 13 hr | 1130-0030 | 46 and 46A

141 | 13 hr | 0700-2000 | Eustis (Day)

142 | 13 hr | 1800-0700 | Eustis (Night)

151 | 24 hr | 0700-0700 | Mount Dora

161 | 24 hr | 0700-0700 | Tavares

201 | 13 hr | 0900-2200 | Grand Island

211 | 13 hr | 0900-2200 | The Villages

221 | 13 hr | 0700-2000 | Leesburg (Day)

222 | 13 hr | 1800-0700 | Leesburg (Night)

231 | 24 hr | 0700-0700 | Okahumpka

241 | 24 hr | 0700-0700 | Leesburg Airport

251 | 13 hr | 0700-2000 | Leesburg

261 | 24 hr | 0700-0700 | Lady Lake

311 | 24 hr | 0700-0700 | Mascotte

321 | 24 hr | 0700-0700 | Clermont

331 | 13 hr | 1000-2300 | Four Corners

341 | 13 hr | 0900-2200 | Clermont

351 | 24 hr | 0700-0700 | Minneola

361 | 24 hr | 0700-0700 | Clermont

Note: Medic 411 & 412 are placed in service with Float personnel when staffing is full on all other units

Workload Trends

Unit Hours and Locations

District 1 District 2 District 3

0

500

1000

1500

2000

2500

10

1

11

1

12

1

13

1

14

1

14

2

15

1

16

1

17

1

20

1

21

1

22

1

22

2

23

1

24

1

25

1

26

1

27

1

31

1

32

1

33

1

34

1

35

1

36

1

41

1

41

2

YTD Total incidents by Unit

October - April

FY 2012

FY 2013

FY 2014

FY 2015

FY 2016

101 | 24 hr | 0700-0700 | Umatilla

111 | 13 hr | 1000-2300 | Astor

121 | 13 hr | 0900-2200 | Mount Dora

131 | 13 hr | 1130-0030 | 46 and 46A

141 | 13 hr | 0700-2000 | Eustis (Day)

142 | 13 hr | 1800-0700 | Eustis (Night)

151 | 24 hr | 0700-0700 | Mount Dora

161 | 24 hr | 0700-0700 | Tavares

201 | 13 hr | 0900-2200 | Grand Island

211 | 13 hr | 0900-2200 | The Villages

221 | 13 hr | 0700-2000 | Leesburg (Day)

222 | 13 hr | 1800-0700 | Leesburg (Night)

231 | 24 hr | 0700-0700 | Okahumpka

241 | 24 hr | 0700-0700 | Leesburg Airport

251 | 13 hr | 0700-2000 | Leesburg

261 | 24 hr | 0700-0700 | Lady Lake

311 | 24 hr | 0700-0700 | Mascotte

321 | 24 hr | 0700-0700 | Clermont

331 | 13 hr | 1000-2300 | Four Corners

341 | 13 hr | 0900-2200 | Clermont

351 | 24 hr | 0700-0700 | Minneola

361 | 24 hr | 0700-0700 | Clermont

Lost Time Trends

Summary and Aggregate Measures

60%27%

13%

Total Incidents by Zone Type

FY 2015-2016

Urban

Suburban

Rural

0

200

400

600

800

1000

1200

1400

Open Shift Call Off/Left

Shift

Staff from

other

location

FMLA / AL /

WC

Move for

coverage

Mechanical Other Coverage Tardy Injury Unit Swap

YTD Lost Unit Hour Comparison by Cause

October - April

FY 13

FY 14

FY 15

FY 16

66.54%

19.17%

14.20%

0.09%

Incident Comparison by Priority

FY 2015-2016

Emergency

Non-emergency

Downgrade

Mutual Aid

EMS System of Lake County Total Response Components for1/1/2016 12:00:00 AM to 3/31/2016 11:59:59 PM

00:00:0000:02:53 00:05:46 00:08:38Ring Time

95th% 00:00:08

NFPA 95% 00:00:15

System Answer Time

00:01:2600:02:5300:04:1900:05:4600:07:1200:08:38Call Processing

90th% 00:02:37

NFPA 90th% 00:01:30

System Call Processing

Start Date1/1/2016 12:00:00 AM

End Date3/31/2016 11:59:59 PM

00:07:1200:14:2400:21:3600:28:4800:36:00Reaction

90th% 00:01:02

NFPA 90th% 00:01:00

System Reaction

ZoneValue

00:00:00 00:14:24 00:28:48 00:43:12 00:57:36Travel Time

R

S

U

90th% 00:11:56

90th% 00:09:28

90th% 00:06:56

NFPA 90th% 00:08:00

System TravelZoneValue

00:00:00 00:14:24 00:28:48 00:43:12 00:57:36 01:12:00

Total Response

R

S

U

90th% 00:14:30

90th% 00:12:08

90th% 00:09:35

NFPA 90th% 00:10:45

System Total Response

00:00:00 00:02:53 00:05:46 00:08:38Ring Time

95th% 00:00:08

NFPA 95% 00:00:15

LEMS Answer Time

00:00:00 00:07:12 00:14:24 00:21:36

Call Processing

90th% 00:02:37

NFPA 90th% 00:01:30

LEMS Call Processing

00:00:00 00:01:26 00:02:53 00:04:1900:05:46Reaction

90th% 00:01:10

NFPA 90th% 00:01:00

LEMS Reaction

ZoneValue

00:00:00 00:14:24 00:28:48 00:43:12 00:57:36Travel Time

R

S

U

90th% 00:22:33

90th% 00:14:09

90th% 00:10:50

NFPA 90th% 00:08:00

LEMS Travel

ZoneValue

00:00:00 00:14:24 00:28:48 00:43:12 00:57:3601:12:00Total Response

R

S

U

90th% 00:24:58

90th% 00:16:51

90th% 00:13:34

NFPA 90th% 00:10:45

LEMS Total Response

NOTE: System equals Lake EMS and all fire services in Lake County.Measurements are in accordance with definitions in NFPA Chapter 3.

ZoneValueR

S

U

Grand Total 100.00%

58.72%

28.39%

12.89%

System Count

ZoneValueR

S

U 58.79%

28.45%

12.76%

LEMS Count

Overall Total Response (System vs. EMS only) for1/1/2016 12:00:00 AM to 3/31/2016 11:59:59 PM

00:07:12 00:14:24 00:21:36 00:28:48 00:36:00 00:43:12 00:50:24 00:57:36 01:04:48 01:12:00Total Response

90th% 00:16:48NFPA 90th% 00:10:45

LEMS Overall Response

Total Response = Ring time to 1st On-Scene

Emergency Calls Only. EMS Related calls only

00:07:12 00:14:24 00:21:36 00:28:48 00:36:00 00:43:12 00:50:24 00:57:36 01:04:48 01:12:00

Total Response

90th% 00:11:09NFPA 90th% 00:10:45

System Overall Response

Start Date1/1/2016 12:00:00 AM

End Date3/31/2016 11:59:59 PM

00:07:12 00:14:24 00:21:36 00:28:48 00:36:00 00:43:12 00:50:24 00:57:36 01:04:48 01:12:00

Total Response

90th% 00:11:36NFPA 90th% 00:10:45

System Overall Reponse w/o EMS

Offload Times by Hospital (Summary)

For service dates from: 2016-01-01 through: 2016-03-31

Lake EMS

Maximum Average Median 90th%Count

00:17:4001:23:111-FL HOSP WATERMAN/TAVARES 00:29:4800:15:37

1,5030-15 Min: 16-30 Min: Over 120 Min: 1,366 0 47.23% 42.93% 0.00%

3,182

31-60 Min: 299 9.40% 61-120 Min: 14 0.44%


00:22:3001:50:461-LEESBURG REGIONAL MEDICAL CTR 00:42:2200:18:02

8530-15 Min: 16-30 Min: Over 120 Min: 1,024 0 35.77% 42.94% 0.00%

2,385

31-60 Min: 441 18.49% 61-120 Min: 67 2.81%


00:16:1401:22:071-SOUTH LAKE HOSPITAL 00:27:5900:13:51

1,0920-15 Min: 16-30 Min: Over 120 Min: 674 0 57.08% 35.23% 0.00%

1,913

31-60 Min: 137 7.16% 61-120 Min: 10 0.52%


00:31:1102:04:241-THE VILLAGES REGIONAL HOSPITAL 00:55:4200:26:12

1450-15 Min: 16-30 Min: Over 120 Min: 436 1 14.84% 44.63% 0.10%

977

31-60 Min: 318 32.55% 61-120 Min: 77 7.88%

90th% Clearing Times for Hospitals : 00:36:38

Average Hospital Clearing Time : 00:20:16 Total Count: 8,457

\\EPCR2\RESCUENET\REPORTS32\BILLING CUSTOM\TRANSFER OF CARE\HOSPITAL OFFLOAD SUMMARY.RPT

RescueNet™

Reporting

Page 1Printed on 5/31/2016, 4:24:59PM

Trauma = 1

N= 230 Medical = 5

Trauma Other

N= 37 15 22 N= 193

Cardiac = 90 Cardiac = 30

Non-Cardiac = 18 Cardiac = 75 Non-Cardiac = 6

Non-Cardiac = 11

Cardiac = 56 Total Pts: 0 Cardiac = 137

Non-Cardiac = 3 Total ROSC: 0 Non-Cardiac = 34

% ROSC: #DIV/0!

Total Pts: 229

Total ROSC: 77 Cardiac = 36

Cardiac = 30 % ROSC: 33.6% Non-Cardiac = 11

Non-Cardiac = 1

Total Pts: 1

Total ROSC: 1

% ROSC: 100.0%


Non-Cardiac = 0 Non-Cardiac = 0


Non-Cardiac = 0 Non-Cardiac = 0

Total Arrests: 230 Total VFib Non-Vfib

Cardiac: 193 83.9% Overall: 33.9% 52.5% 27.5%

Non-Cardiac: 37 16.1% Cardiac: 34.2% 53.6% 26.3%

% presenting in VF: Non-Cardiac: 32.4% 33.3% 32.4%

Overall: 59 25.7% Overall: 0.0% 0.0% 0.0%

Cardiac: 56 94.9% Cardiac: 0.0% 0.0% 0.0%

Non-Cardiac: 3 5.1% Non-Cardiac: 0.0% 0.0% 0.0%

% presenting in Non-VF: Overall: 0.0% 0.0% 0.0%

Overall: 171 74.3% Cardiac: 0.0% 0.0% 0.0%

Cardiac: 137 80.1% Non-Cardiac: 0.0% 0.0% 0.0%

Non-Cardiac: 34 19.9%

ROSC:

Resuscitation:

Save:

Discharged Alive

(Save)

Summary of Data

(Save)

AutoPulse OnlyVentricular Fibrillation / VT

Discharged Alive

CPR Only

Other Rhythms

Non-Vfib ROSCReturn of Spontaneous

Circulation (ROSC)

Admitted to Hospital

(Resuscitation)

Admitted to Hospital

(Resuscitation)

Combined Tx

Cardiac Arrests Measures

FY 2016

Arrests Not Witnessed Arrests Witnessed by

Bystanders

Arrests Witnessed by EMS

Confirmed Cardiac Arrests

Resuscitation Attempted

Non-Cardiac Etiology Cardiac Etiology

Pediatric

Mechanism of Injury 1st Qtr 2nd Qtr FYTD 1st Qtr 2nd Qtr FYTD 1st Qtr 2nd Qtr FYTD

Aircraft Related Accident 4 4 8 5 7 12 3 3 6

Animal Bite 11 11 22 11 13 24 15 15 30

Barotrauma(Scuba) 0 0 0 1 0 1 1 1 2

Bicycle Accident 25 21 46 20 24 44 27 19 46

Bites 2 0 2 0 1 1 4 1 5

Burn/Scald 14 5 19 10 8 18 14 8 22

Chemical Poisoning 0 1 1 2 1 3 0 3 3

Diving Related Accident 0 1 1 0 1 1 0 2 2

Drowning 2 2 4 1 1 2 1 6 7

Drug Poisoning 6 10 16 4 6 10 12 10 22

Electrocution(Non-Lightning) 1 5 6 1 1 2 3 1 4

Excessive Cold 3 2 5 2 4 6 3 2 5

Excessive Heat 2 1 3 3 1 4 2 1 3

Falls 973 1020 1993 1190 1259 2449 1405 1510 2915

Fight or Brawl 71 64 135 69 98 167 100 95 195

Fire or Flames 1 0 1 1 1 2 0 4 4

Firearm Injury(Accidental) 4 4 8 2 3 5 3 2 5

Firearm Self Inflicted 4 4 8 2 2 4 4 0 4

Inhalation 0 2 2 0 1 1 11 0 11

Machinery Accidents 9 9 18 7 10 17 9 7 16

Mechanical Suffocation 0 1 1 1 2 3 0 0 0

Motor Vehicle Non-Traffic 11 12 23 6 10 16 16 18 34

Motor Vehicle to Bicycle 3 8 11 4 3 7 6 2 8

Motor Vehicle to Fixed Object 44 47 91 47 43 90 58 52 110

Motor Vehicle to Motor Vehicle 279 263 542 333 364 697 479 554 1033

Motor Vehicle to Motorcycle 9 13 22 18 8 26 15 12 27

Motor Vehicle to Other 27 17 44 30 22 52 31 39 70

Motor Vehicle to Pedestrian 17 16 33 26 18 44 26 24 50

Motorcycle 24 26 50 18 26 44 52 39 91

Not Applicable 4960 5396 10356 6212 6481 12693 6318 7039 13357

Not Available 65 83 148 43 37 80 61 52 113

Not Known 548 565 1113 601 693 1294 631 736 1367

Other Injury NOS 100 94 194 125 127 252 168 144 312

Overexertion/Strain 13 13 26 6 10 16 18 14 32

Rape 0 2 2 0 2 2 4 3 7

Smoke Inhalation 1 0 1 0 0 0 1 0 1

Stabbing Assault 7 7 14 5 5 10 11 17 28

Strike by Blunt Object/Thrown Object 14 17 31 6 13 19 19 21 40

Venomous Stings(Plants, Animals) 2 1 3 3 1 4 7 0 7

Water Transport Accident 0 2 2 0 2 2 0 0 0

FY 2014 FY 2015 FY 2016

Mechanism of Injury Report


DATE: June 13, 2016 MEETING DATE: June 21, 2016 SUBJECT: Director’s Report ACTION REQUESTED: None BACKGROUND SUMMARY: The Executive Director will give a verbal report on pertinent issues since the last Board meeting. FISCAL IMPACT: NA ATTACHMENTS: None

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