NOTICE OF A REGULAR MEETING OF THE BOARD OF DIRECTORS MONTGOMERY COUNTY HOSPITAL DISTRICT

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1 NOTICE OF A REGULAR MEETING OF THE BOARD OF DIRECTORS MONTGOMERY COUNTY HOSPITAL DISTRICT Notice is hereby given to all interested members of the public that the Board of Directors of Montgomery County Hospital District will hold a regular meeting as follows: Date: October 24, 27 Time: Place: 4: P.M. MONTGOMERY COUNTY HOSPITAL DISTRICT ADMINISTRATIVE BUILDING 4 SOUTH LOOP 336 WEST CONROE, MONTGOMERY COUNTY, TEXAS 7734 Open to Public: The meeting will be open to the public at all times during which such subjects are discussed, considered, or formally acted upon as required by Texas Open Meetings Act, Chapter 55 of the Government Code. This Notice in detail was posted at least 72 hours prior to the beginning of said meeting with the County Clerk s Office and is on the Bulletin Board of the Courthouse and in the District s Administrative Office. Subject: The agenda for such meeting shall include the consideration of, and if deemed advisable, the taking of action upon:. Call to Order 2. Invocation 3. Pledge of Allegiance 4. Roll Call 5. Public Comment 6. Special Recognition Items Involving Visitors 7. Presentation on Hurricane Harvey. (Mr. Fawn, Chairman MCHD Board) District 8. CEO Report to include update on District operations, strategic plan, capital purchases, employee issues and benefits, transition plans and other healthcare matters, grants and any other related district matters. 9. Presentation of Quarterly Employee Turnover Report. (Ms. Whatley, Chair Personnel Committee). Consider and act on the November and December, 27 MCHD Regular Board of Directors meeting dates and times. (Mr. Fawn, Chairman MCHD Board) Emergency Medical Services. EMS Director Report to include updates on EMS staffing, performance measures, staff activities, patient concerns, transport destinations and fleet. 2. Consider and act on the purchase of one () ambulance. (Mr. Bagley, Chair EMS Committee) 3. Consider and act on staff s recommendation for purchase of oxygen cylinders. (Mr. Cole, Chair PADCOM Committee) NOTICE OF A REGULAR MEETING OF THE BOARD OF DIRECTORS MONTGOMERY COUNTY HOSPITAL DISTRICT - PAGE

2 4. Consider and act on the purchase of equipment for ambulances 5 and purchase of POWER-PRO XT cot only for ambulances 5 and 52. (Mr. Cole, Chair PADCOM Committee) 5. Consider and act on the purchase and installation of Opticoms. (Mr. Bagley, Chair EMS Committee) 6. Consider and act on purchase of one mobile column lift from JAM Equipment Sales (HGAC). (Mr. Cole, Chair PADCOM Committee) Operations and Health Care Services 7. COO Report to include updates on infrastructure, facilities, radio system, warehousing, staff activities, community paramedicine, emergency management, and purchasing. 8. Consider and act on the remodel of Station 34. (Mr. Cole, Chair PADCOM Committee) 9. Consider and act on the Interlocal agreement with Region 6 Education Service Center (RESC 6) Purchasing Cooperative. (Mr. Cole, Chair PADCOM Committee) 2. Consider and act on the reappointment of Mrs. Sandy Wagner to the Public Health District Board for (Mr. Fawn, Chairman MCHD Board) 2. Health Care Services Report to include regulatory update, outreach, eligibility, service, utilization, community education, clinical services, epidemiology, and emergency preparedness. 22. Consider and act on Healthcare Assistance Program claims from Non-Medicaid 5 Waiver providers processed by Boon-Chapman. (Mrs. Wagner, Chair - Indigent Care Committee) 23. Consider and act on ratification of voluntary contributions to the Medicaid 5 Waiver program of Healthcare Assistance Program claims processed by Boon Chapman. (Mrs. Wagner, Chair Indigent Care Committee) Finance 24. Presentation of preliminary Financial Report for twelve months ended September 3, 27 Brett Allen, CFO, report to include Financial Summary, Financial Statements, Supplemental EMS Billing Information, and Supplemental Schedules. 25. Presentation of Budget Report for FYE September 3, 27. (Mr. Grice, Treasurer - MCHD Board) 26. Presentation of Investment Report for the quarter ended September 3, Consider and act upon recommendation for amendment(s) to the budget for fiscal year ending September 3, 27. (Mr. Grice, Treasurer - MCHD Board) 28. Consider and act upon recommendation for amendment(s) to the budget for fiscal year ending September 3, 28. (Mr. Grice, Treasurer - MCHD Board) 29. Consider and act on ratification of payment of District invoices. (Mr. Grice, Treasurer MCHD Board) 3. Consider and act on salvage and surplus. (Mr. Grice, Treasurer MCHD Board) Other Items 3. Secretary s Report - Consider and act on minutes for the September 26, 27 Regular BOD meeting. (Mrs. Wagner, Secretary - MCHD Board) 32. Convene into executive session pursuant to section 55.7 of the Texas Government Code to discuss pending litigation matters, to wit: Raimer v. MCHD et al. Civil Action no. 4:7-cv-258 consolidated with Civil Action no. 4:7-cv-245 In the United States District Court for the Southern District of Texas, Houston Division. (Mr. Fawn, Chairman MCHD Board) 33. Reconvene from executive session and deliberate and take action on matters involving pending litigation, to wit: Raimer v. MCHD et al. Civil Action no. 4:7-cv-258 consolidated with Civil Action no. 4:7-cv-245 In the United States District Court for the Southern District of Texas, Houston Division. (Mr. Fawn, Chairman MCHD Board) NOTICE OF A REGULAR MEETING OF THE BOARD OF DIRECTORS MONTGOMERY COUNTY HOSPITAL DISTRICT - PAGE 2

3 34. Adjourn. Sandy Wagner, Secretary The Board will announce it will convene into Executive Session, if necessary, pursuant to Chapter 55 of the Texas Government Code, to receive advice from Legal Counsel, to discuss matters of land acquisition, litigation and personnel matters as specifically listed on this agenda. The Board of Directors may also announce it will go into Executive Session, if necessary, to receive advice from Legal Counsel regarding any item on this agenda. NOTICE OF A REGULAR MEETING OF THE BOARD OF DIRECTORS MONTGOMERY COUNTY HOSPITAL DISTRICT - PAGE 3

4 Agenda Item # 7 To: Board of Directors We Make a Difference! From: Randy Johnson, CEO Date: October 24, 27 Re: Hurricane Harvey Presentation Presentation on Hurricane Harvey. (Mr. Fawn, Chairman MCHD Board) Postponed until the November board meeting

5 Montgomery County Hospital District & Public Health District CEO Report October 24, 27

6 THE WAKE

7 Mission-Vision Mission Our mission is to care for the indigent and provide EMS services while protecting the interest of the taxpayers and insuring long-term stability through fund development. Vision Our vision is cost effective indigent care and taxpayer supplemented EMS with total professionalism administered through an elected Board of Directors.

8 Our Values Accountability ~ Being responsible for our thoughts, words, and deeds, and the resources entrusted to us. Compassion ~ To be understanding, caring, and nurturing. Excellence ~ We will strive to exceed all expectations and maintain the highest standards in our industry. Innovation ~ Providing superior and professional service to the citizens of Montgomery County utilizing professional development, state of the art technology, and sound practice. Integrity ~ Acting with the highest standards of honesty and ethics in every decision and action that we make as individuals or as an organization. Unity ~ A group of individuals striving toward shared goals and a vision of improving the quality of life for all.

9 MCHD BOARD CUTS TAX RATE and APPROVES 2% HOMESTEAD EXEMPTION

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11 MCHD 5-Year Plan Strategic Goals Maintain MCHD as the regional Employer of Choice Provide excellent service to MCHD co-workers, clients, taxpayers and the community Establish and maintain a structured process to measure and improve quality Provide for the financial stability of MCHD and protection for the taxpayer while meeting the needs of the community Proactively meet the growth needs of our community

12 Capital planned for FY 28 HUMAN RESOURCE INFORMATION SYSTEM (HRIS) HVAC Phase Time, Attendance, PTO through the new system beginning Clock-in and out via computer or cell phone st check 2//7 $, Install HVAC system in room 25 for additional classroom space Add roof-top A/C back-up for MDF room MICROWAVE TOWER PROJECT $,28, Microwave ring to connect all towers PHONE SYSTEM REPLACEMENT $25, Replace current phone system AMBULANCES new = $84,358 with a hybrid battery system vs generator 6 remounts = $76,48 STATION 34 EXPANSION $225, Extended apartment estimated to be complete June 28 TRANSFER SERVICE EXPANSION Station 9 George Strake Additional facility contracts

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14 More plans for FY 28 MERIT BASED RAISES Employees raise will be based on annual evaluation NEW PAY SCALE Effective //7 Pay grades have changed No employee s pay will be lowered due to a change in pay grade RANDOM DRUG SCREENS Increasing from 5% annually to 5% BACKGROUND CHECKS Will be done annually

15 Medicare Compliance October 27

16 Medicare Compliance Social Security Act False Claim Act Health Insurance Portability & Accountability Act Anti Kickback Act

17 Medicare Compliance Department of Justice Office Inspector General Office of Civil Rights Texas Department of State Health Services

18 Medicare Compliance- Fraud and Abuse Medically unnecessary trips Trips billed but not rendered False documentation Upcoding Payment of Kickbacks

19 Medicare Compliance Compliance Policies and Procedures Designation of a Compliance Officer Education & Training Internal Monitoring Developing Open Lines of Communication Enforcing Disciplinary Standards Evaluation and Risk Analysis

20 Report Suspected Fraud or Abuse to: Donna Daniel, MCHD Compliance Officer Phone: MCHD Ethics Hotline Phone: 844-MCHD-TX- ethicshotline.org/mchd OIG (Office of Inspector General) Phone: -8-HHS-TIPS Online:

21 MONTGOMERY COUNTY HOSPITAL DISTRICT BOARD REPORT Organizational Projects DATE: October 24, 27 Task/Project on Schedule Task/ Project in Danger of Not Meeting Task/Project Not Meeting Schedule Project Progress Evaluation Project: HCAP Eligibility Procedures Objective: Define and standardize current processes. Phase deadline: 2/3/25 complete Objective Phase 2: Analysis of KPI s and Action Plans Phase 2 deadline: 2/3/26 complete Objective Phase 3: Implement needed changes from Phase 2 Phase 3 deadline: 2/3/27 Budget: N/A Project Manager: Adeolu Moronkeji Project: Microwave Replacement Project- Objective: Redundant microwave connections to our dispatch center Initial Deadline: August 28 Final Deadline: Budget:$,26,. Project Manager: Justin Evans/Melissa Miller Project: Station Generator Purchase and Installation Objective: Provide back-up power at MCHD stations Installation Deadline: March, 28 Budget: $24, Station 3 Budget: $75,. tower Project Manager: Avery Belue /Justin Evans/Melissa Miller Sept Oct Nov Second level approval Project proposal was accepted by the Performance Improvement Committee. The next step is to meet with members of the committee and get guidance on the proper management of our process for sustained improvement. Sept Oct Nov Phase 3 began 9/9 with three respondents to the RFP. Phase 3 includes the evaluation of the respondents, contracting and installation of microwave ring. All three respondents attended individual 4 hour clarification interviews related to the project the week of Oct. 6. The RFP packets along with interview results are being evaluated and a recommendation will be made at the November Board meeting. Phase 3 is projected to take 9-2 months. Sept Oct Nov The Station 3 generator, which was part of the RFP but budgeted in FY 8, order is being processed and is estimated to be operational by March. The tower generator has been ordered and will be delivered in 4 6 weeks. Project: Air-conditioned for MDF Objective: Provide back-up air-conditioning to MDF room Initial Deadline for purchase: June 3, 27 Installation Deadline: Sept. 3, 27 Final Deadline: Feb. 28 Budget: $ Project Manager: Avery Belue /Melissa Miller Project: LaserFiche ( Multiyear Project) Objective: Fully Implement LaserFiche throughout the organization. Phase I Objective: Determine what the initial function and application needs to be for the HR Department. Set up new repository structure and move documents into new filing system. Phase I Deadline: August 3, 26 Budget: Project Manager: Sept Oct Nov The Interlocal with RESC 6, if approved at the October board meeting has vendors which can complete this project through job order contracting. We have three, bids that were not generated from the RFP process, ranging between $68,77 and $83,2 to help us gage appropriate pricing. Sept Oct Nov The Laserfiche Project is on hold pending decisions regarding HRIS. It will be removed from this project report for now and be reevaluated in January.

22 MONTGOMERY COUNTY HOSPITAL DISTRICT BOARD REPORT Organizational Projects DATE: October 24, 27 Task/Project on Schedule Task/ Project in Danger of Not Meeting Task/Project Not Meeting Schedule Project Progress Evaluation Project: EMS Deployment Objective: Evaluate current deployment program to determine the most effective and efficient deployment program. Initial Deadline: December 3, 26 Secondary Deadline: September 3, 27 Budget: Project Manager: Jared Cosper/ Matt Walkup Project: Effectiveness of Current EMS Shifts Objective: Review current shift structure to determine the appropriate shifts to fulfill our mission and minimize burnout/fatigue. Initial Deadline: December 3, 26 Secondary Deadline: September 3, 27 Budget: Project Manager: Jared Cosper/ Matt Walkup Project: EMS Transfer Service Objective: Provide quality transfer service. Initial Deadline: January, 28 Budget: Unbudgeted for FY7 Project Manager: Jared Cosper Project: Paycom Implementation Objective: Implement HRIS and Payroll System Phase I Objective: Implement Time Capture and Payroll Phase I Deadline: December Budget: $24,28 Project Manager: Brett Allen Sept Oct Nov The Business Analysis Unit is developing accurate and powerful reports that will allow the Deployment Committee to make informed decisions. The Deployment Committee met early October, and will meet one additional time to finalize deployment for CY 28. For the first time, MCHD used seasonalized demand analysis to more accurately staff on what are our historically busy days and busiest months of the year. Sept Oct Nov The data needed to fully evaluate the safety of our current deployment strategies is now live, which will give the deployment committee the ability to ensure shifts are safe and well thought out for 28. We have just gone live with the first phase of our fatigue monitoring system and are reworking the Field Operating Guideline related to consecutive hours worked to reflect our actual fatigue risk management system. Sept Oct Nov Currently Conroe Regional and Houston Methodist The Woodlands hospitals are using this service. Call volume continues to increase as does interest in the service. Sept Oct Nov New Project The project team has been defined, and the Phase I project timeline has been established. Data is being gathered for input into the Paycom software. Employee training is being planned for successful time capture. 2

23 Turnover Report //27 9/3/27 Human Resources October 27

24 / 9/3 TURNOVER REPORT Sum of Q Sum of Q2 Sum of Q3 2

25 / 9/3 TURNOVER BY DEPARTMENT Sum Of Q Sum Of Q2 Sum of Q ALARM FIELD OTHER

26 / - 9/3 Voluntary VS Involuntary Turnover Voluntary 5 Involuntary 3 4

27 Quarterly Turnover Sum of Q Sum of Q2 Sum of Q3 Sum of Q4 5

28 Agenda Item # To: Board of Directors We Make a Difference! From: Randy Johnson, CEO Date: October 24, 27 Re: November/December Board Meeting Dates Consider and act on the November and December, 27 MCHD Regular Board of Directors meeting dates and times. (Mr. Fawn, Chairman MCHD Board)

29 November 27 Sunday Monday Tuesday Wednesday Thursday Friday Saturday EMS Triple AAA Conference PUBLIC Health BOD Meeting 3 EMS Triple AAA Conference 4 EMS Triple AAA Conference Veterans Day MCHD Holiday EMS Conference 2 EMS Conference Thanksgiving MCHD Holiday 24 MCHD Holiday th Tuesday MCHD BOD 29 3

30 December 27 Sunday Monday Tuesday Wednesday Thursday Friday Saturday Staff s recommendation Combine November/December BOD Meeting MCHD Holiday Christmas MCHD Holiday 3 New Year s MCHD Holiday 26 MCHD Holiday 4 th Tuesday MCHD BOD MCHD Holiday 3

31 Agenda Item # To: Board of Directors From: Jared Cosper Date: October 24, 27 RE: EMS Report Executive Summary Final preparations are being made for 28 deployment and shift bid. The deployment committee used not only historical demand data, but also reviewed areas with the greatest opportunity for response time compliance. Additionally, historical demand was analyzed for seasonality trends which aided the group in making decisions that will likely have a very positive impact in response times and mitigate fatigue concerns on historically busy days. The last planned phase of new employee testing will take place in late October. We will also re-classify existing part-time staff as PRN. We hope to hire approximately ten part-time employees to help staff weekend shifts (Friday, Saturday, and Sunday). While we have made great strides in reducing the frequency of vacancies affecting operations, weekends remain challenging. System demand has remained high, the added resources budgeted for January will be a welcomed addition to handle the increased volume. Annual response data from 23 to current has been forecasted through 28. We expect to see over 67, responses for CY 28. ALARM Summary The Tritech CAD system redesign into a single system is complete. There are a few remaining improvements that are being made to ensure users are satisfied with the project. We will meet with FireCom next week to discuss next steps on the project. The recently hired staff are progressing well in their training. The staff have done a great job helping train their newest peers and we are pleased to have them in the organization. Business Analysis Unit Summary With the help of the BAU the first phase of field staff annual evaluations are complete. We will review the final product with the EMS Supervisors group before final approval. Feedback from the EMS Supervisors on this phase will be noted and improvements made before we begin the second phase of evaluations. The Fatigue Risk Management System has been live for some time, and has received favorable feedback from staff. BAU aided Accounting in completing required ICS forms for Hurricane Harvey reimbursement by linking historic hours worked from Crew Scheduler and generating automated reports that were user friendly for staff to sign remotely. This process saved countless hours over manual paper forms.

32 Working with the deployment committee to ensure the group is able to make the most informed decisions possible for 28 scheduling and deployment. Department of Clinical Services Summary Continuing Education will be held during the week of the October Board of Directors meeting along with annual compliance training. New SDO s will be presented including hyperkalemia and excited delirium, as well as a 27 Year in Review. Andy Adams has been selected to replace Coty Aiken as our Stroke and Trauma Coordinator. We welcome Andy and would like to recognize the fantastic work Coty Aiken did to improve the continuity of care between MCHD and our hospital partners. In addition to leading the region in stroke care initiatives, Coty developed an industry leading trauma case review that remains well attended by our EMS and first responder partners, as well as the emergency physicians, surgeons, and in some cases the medical examiners who cared for these patients. Coty will be returning to the field looking to advance his career in EMS Operations. As you may recall we transitioned from rapid sequence intubation to delayed sequence intubation some time ago, and are very proud of the patient safety improvements this has brought about. In summary, our first attempt success rate for intubation is now at 93% with delayed sequence intubation compared to 78% with rapid sequence intubation. Additionally, desaturation episodes where patient oxygen levels fall during the procedure fell from 8% to only 8% - both remarkable achievements for patient safety. Levophed (a medication used to treat low blood pressure), was added after last CE and has been administered safely to eight patients in the past quarter. The medication has worked very well as have the Alaris IV pumps we purchased. Of note, the previous IV pumps were just recalled again by the manufacturer. Staff reactions have been favorable, using the same devices as local hospital partners, which again improves patient safety with minimizing equipment variation in the local medical community. Two save reunions were held /8/27 and /2/27. EMS Director Capital Projects: Fleet: Annual remounts are scheduled throughout the year as budgeted. The exact duration of each remount depends on the complexity of the project but all will be completed during the 28 fiscal cycle. o The Projected dates for each remount are: Frazer Unit # Drop off Pick up X-99 /3/7 2/2/7 X-2 2/2/7 2/5/8 New Unit 2//8 4/5/8 X-22 4//8 6/4/8 X-23 6/2/8 8/23/8 X-24 9/4/8 /8/8 o

33 Fleet Capital Projects - Cont. New Ambulance Purchases one previously approved ambulance is under construction now, and will be complete by December, 27. A second new ambulance is being requested at the October meeting in lieu of remounting one of the used ambulance that was purchased. If approved, this unit will feature the hybrid battery system (no generator) and will be complete by May, 28. Mobile Column Lift to Board for approval /24/27. EMS Operations: Opticom in FY8 budget for October purchase, vendor will complete installs by April, 28. Business Analysis Unit: Mobile Data Computers RFP will be submitted by Dec. Contract Awarded /23/27, Installs completed by 6//28.

34 DispatchedIncidentReview -LastMonth (9//27to9/3/27) Dispatched Incidents 4,534 Responses 5,576 OnScene Incidents 4,38 Responses 4,559 UnitResponses HourUnits DispatchedOnly OnScene Non-24-HourUnits Transported Incidents 3,69 Responses 3,6 84 D D D3 D4 M M M2 M3 M4 M2 M2 M22 M23 M24 M25 M3 M3 M32 M33 M34 M4 M42 M43 M45 M92 SQ44 M M9 M39 M46 79 M49 M M9 M8 M82 M83 M84 M85 M86 M87 M88 M8 IncidentTypes Other/Unkn. Transfer MVC Fal SickPerson Diff.Breath. Unconscious ChestPain Psychiatric Seizures Abd.Pain Stroke Assault Overdose TraumaticI. Hemorrhage Diabetic CardiacArr. BackPain HeartProbl. AlergicRxn. Headache Choking Pregnancy Environme. Penetratin. AnimalBites Burns Hazmat Drowning EyeProble. Electrocuti. Inaccessibl ResponsesbyHourofDay : : District,454 2: 3: District2,58 4: 5: NumberofDistrictResponses 6: 84 7: District3,29 District4, : 9: : : Extra9-- SpecialEvent 48 2: Transfer 243 3: Avg.ElapsedSecAssignedEnrou. 4: : District : 7: District : District : AverageChuteTimes(seconds) : District : Extra : 5 23: Transfer 67.85

35 DispatchedIncidentReview Definitions Incident:Acalforservice. Response:Aperunitresponsetoanincident. AnMVAwith3unitswilbeincidentand3responses.Achestpaincalwithjustoneunitwilbeincidentandresponse. HourofDay:Hoursarethebeginningofthehour.I.e.:is::to:59:59.Thisisbasedonthetimethecalwasreceived.Thecolors onthischartmatchthedistrictcolorsonthechartsbelow it. SpecialDistricts Extra9--:Medicunitssetupasoverflow/specialcircumstances(Medic-9).Theseareusedforfielddays,stretchermaintenance,orvery busytimes. SpecialEvent:Medicunitsfordedicatedspecialeventcoverage(Medic8-89). Transfer:Medicunitsusedforthetransferservice(Medic9-M99) TheInterfacilityincidenttypeincludesBOTHtransfertrucksand9--trucks. 24-HourUnits Theseunitsprovidecoveragefor24-hoursaday.Thisincludespeaktrucksthatare2-hourshiftsbutprovide24-hourcoverage(Mand M2). Non-24-HourUnits M-M9:Thesearespecialtrucks(seeExtra9--inSpecialDistricts)thatareputupforashortperiodoftime(i.e.duringfielddayor maintenancedayswheremanytrucksmaybecaledintofortheevent,extratrucksarestaffedtohelpprovidecoverage). M9:.5hour/4hour:Mon-Thur-23,Fri-Sun- M39:2hour:-22 M46:2hour:2- M49:2hour:-22 M9:4hour:8-22 M9:8hour:Mon-Fri2-2(NocoverageSat/Sun) M99:Specialtransfertruckputupforshortperiodsoftimeduringtransferhighvolumetimes

36 Fleet Summary 26-7 Mileage Ambulance Supervisor/Squad Command Staff Other Monthly Total Weekly Total September 27 6,3 9,779 4,2 6,3 36,5 34,29 August 27 7,824,583 5,49 6,875 5,773 37,943 July 27,469 2,48 3,38 3,487 3,242 32,56 June 27 78,754 9,486,866,988,94 25,274 May 27 3,588 6,65 2,99 8,339 69,532 42,383 April 27 4,842 2,348 2,73 3,54 33,47 33,354 March 27 5,9 3,53 3,247 3,48 35,449 33,862 February 27,49 3,2 3,84 3,85 3,77 32,943 January 27 2,793 4,836 3,295 6,462 55,386 38,847 December 26 2,957,25 2,33 2,298 28,88 32,22 November 26 92,392,845 2,45 3,323 9, 29,753 October 26 5,7 3,97 3,384 8,689 5,997 37,749 Total,277,988 49,44 38,892 77,274,643,594 Average 6,499 2,453 3,24 4,773 36,966 34,242 Annualized Amounts,643,594 Accidents MCHD-Fault MCHD Non-Fault GRAND TOTAL Non-injury Injury Non-injury Injury September August 27 July June May April March February January December November October Total Per, Miles Service Interuptions Count Per K miles September August July June May April March February January December November October Total

37 Agenda Item # 2 To: Board of Directors We Make a Difference! From: Jared Cosper, EMS Director Date: October 24, 27 Re: Frazer Type 2 Hybrid Powered Ambulance Consider and act on purchase one additional ambulance with trade-in of used San Antonio ambulance (Mr. Bagley, Chair EMS Committee) Fiscal Impact: Nominal Yes No N/A X X Budgeted item? Within budget? X X Renewal contract? Special request?

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40 Agenda Item # 3 To: Board of Directors We Make a Difference! From: Eric Baldwin Date: October 24, 27 Re: Oxygen Cylinders Consider and act on staff s recommendation for purchase of oxygen cylinders. (Mr. Cole, Chair PADCOM Committee) Medical Oxygen Cylinders PRODUCT ID Price Qty. Total M22 Cylinders N/A $ $29,378. E Cylinders N/A $52.4 $5,24. Please see attachment for quote TOTAL $34,68. We would like to move forward with the purchase of the Medical Oxygen Cylinders, we received 4 RFQ s with Conroe Welding being the best value we will be able to purchase 85 M22 cylinders and E cylinders and come in under budget by $4.. This action will also save the District $25,. annually in rental fees. Fiscal Impact: Nominal Yes No N/A X X X Budgeted item? Within budget? Renewal contract? X Special request?

41 Conroe Welding Supply E CYLINDERS WILL BE 52.4 EA 22 CYLINDERS WILL BE 58.8 EA Stamped: MCHD CONROE TX Best Regards, -Ricky Morton (936) 788-4

42 Agenda Item # 4 To: Board of Directors We Make a Difference! From: Eric Baldwin Date: October 24, 27 Re: Equipment for ambulance 5 and purchase of One POWER- PRO XT cot only for ambulances 5 and 52 Consider and act on the purchase of equipment for ambulance 5 and purchase of POWER-PRO XT cot only for ambulances 5 and 52. (Mr. Cole, Chair PADCOM Committee) New ambulance purchased and will require the following $87, of equipment to stock the ambulances. ITEMS TO BE PURCHASED FOR SHOP 5 PRODUCT ID Price Qty. Total X SERIES MANUAL MONITOR/DEFIBRILLATOR $3,38.4 $3,38.4 SPO2 RAINBOW REUSABLE PATIENT CABLE 8-33 $22.25 $22.25 SPO2 LNCS ADULT REUSABLE SENSOR $22.25 $22.25 SIX HOUR RECHARGEABLE SMART BATTERY $ $8.8 POWER-PRO XT 656 $7,. $7,. POWER LOAD 639 $2,. $2,. STAIR-PRO MODEL $3,33.52 $3,33.52 NITRONOX KIT $3,75. $3,75. E7 TRANSPORT VENTILATOR 7687 $5,625. $5,625. E7 TRANSPORT VENTILATOR CASE CV739 $75. $75. MOUNTING BRACKET 7688 $277.5 $277.5 ALARIS 85 PCU $,2. $,2. GUARDRAILS SAFETY SOFTWARE LICENSE $95. $95. ALARIS 8 PUMP MODULE $7. 2 $,4. GUARDRAILS SAFETY SOFTWARE LICENSE $25. 2 $5. TOTAL $87, Purchasing two demo Power-PRO XT Cots for Shops 5 & 52 at the cost of $5,975. x 2 = $3,95., with a saving of $2,5. to the District. Fiscal Impact: Moderate Yes No N/A X X Budgeted item? Within budget? X Renewal contract? X Special request?

43 Agenda Item # 5 To: Board of Directors We Make a Difference! From: Jared Cosper, EMS Director Date: October 24, 27 Re: Opticoms Consider and act on the purchase and installation of Opticoms. (Mr. Bagley, Chair EMS Committee) Fiscal Impact: Nominal Yes No N/A X X Budgeted item? Within budget? X X Renewal contract? Special request?

44 /6/27 8:59 PM Page Name Jared Cosper MH73 Agency Montgomery Co. Hospital District /6/27 Address 4 S. Loop 336 West 8:58:4 PM City State Zip Conroe, TX 7734 Mike Hancock Phone Number(s) Address jcosper@mchd-tx.org mhancock@ctc-traffic.co CTC Part Number Description Qty Unit Price Total Price 6-MM Model 764 Multimode Phase Selector 5 $ 2,75. $ 4, MM Model 768 Auxiliary Panel 8 $ 32. $ 5, GPS Radio Unit (Mast Mount) 5 $ 2,695. $ 4, A GPS Cable 5 Ft Roll (Per Ft.) 4,5 $.77 $ 3,465. N/A Mast Arm Mount (GPS) 8 $ 8. $, Model 38 Card Rack 8 $ 68. $ 3,24. CTCINSTALL GPS Opticom Intersection 5 hours $23 per hour 8 $,5. $ 2,7. CTCINSTALL Driving Time One Man and Pickup Truck 8 $ 5. $ 2,7. CTCINSTALL Second Man (Include Both Drive and On Site time) 8 $ 75. $,35. CTCINSTALL Bucket Truck Upcharge (Include Both Drive and On Site Time) 8 $ 4. $ 72. Total Before Tax $ 2,237. Sales Tax (if applicable).% $ - Notes ADD (3) 764 Phase Selectors and (3) 3 Radio Units NO CHARGE GTT Buy 5 Get Free Promotion Shipping Grand Total $ 2,237. Consolidated Traffic Controls, Inc. 6 Enterprise Place Arlington Texas 76 Arlington Tx (87) Toll Free (8) Houston Tx (73) Prices Firm for 6 days FOB Destination, Payment Terms Net 3 Days

45 Agenda Item # 6 We Make a Difference! To: Board of Directors From: Wayde Sullivan, Fleet Manager Date: October 24, 27 Re: Purchase of mobile column lift 6. Consider and act on purchase of one mobile column lift from JAM Equipment Sales (HGAC) We made the decision a couple of years ago to use the Liquid Spring suspension in place of the Reyco-Granning air suspension. The Liquid Spring suspension uses hydraulics instead of air and is a much better system. Suspension issues/failures have been drastically reduced. The only issue with the Liquid Spring system is that the truck cannot be raised with a two-post lift, due to the position of the components. We currently have 8 trucks with the Liquid Spring system and will add seven more this fiscal year. Right now, that is two trucks shy of half the fleet. Currently, we have four, two-post lifts and two mobile column lifts. This last fiscal year we have had several instances in which we needed more of the column lifts to service the vehicles that were due. To clarify, the column lifts raise the vehicle by the wheels whereas the two-post lifts raise the vehicle by the frame. If we continue using the Liquid Spring system, which is currently the best solution available to us, we will need to replace two, two-post lifts with column lifts. Fiscal Impact: Yes No N/A X X X X Nominal Budgeted item? Within budget? Renewal contract? Special request?

46 7 Mykawa Houston Tx Main (73) Equipment Sales & Service Fax (73) Company Name: MONTGOMERY COUNTY HOSPITAL DISTRICT LUKE SNEED Address: 3 S LOOP City: CONROE Delivery Address State, Zip TX, 7734 MONTGOMERY COUNTY HOSPITAL DISTRICT Phone: S LOOP wsullivan@mchd-tx.org CONROE Submitted To: WAYDE SULLIVAN TX, 7734 Project: ADD MACH Date: 2/7/27 Page of # Manufacturer Part # Description Qty. Selling Price Extended ROTARY MCH43UA 3K 24V COLUMN LIFT WITH WIRELESS 4 $5, $23, ROTARY RS3YL 3K JACK STAND 4 $64.5 $2, ROTARY M424 WIRELESS KIT SOLD PER COLUMN 4 $,685.6 $6, LABOR REMOVE EXISTING 2 POST LIFT $25. $25. 5 TRADE-IN TRADE IN OF USED 2-POST LIFT ($,25.) ($,25.) Pricing does not include electrical or air hookup unless specifically stated Terms: Select Initial Special Notes: Product Total $3,76.62 Cash HGAC Contract #: FL3-7 Contract Period 2/3/9 Shipping & Handling $, Cashiers Check Sub-Total $33, Credit Card Tax 4 Check (requires prior approval) Total Quote $33, Net 3 (requires open account) Deposit Price Effective Until: /2/27 Or Until Manufacturer Price Increase Total Remaining $33,236.8 * Finance pricing is subject to credit approval/subject to change and is provided by a JAM approved third party. ** Taxes, if applicable, are included in the below rates. *** Below rates do not include a one time documenation fee of $99. Finance Options: Term 24 Month 36 Month 48 Month 6 Month Monthly Payment $,562.3 $,7.23 $ $7.96 Quotation Accepted: Title J.A.M. Equipment Accepted: Title

47 Agenda Item # 7 To: From: Board of Directors Melissa Miller, COO Date: October 24, 27 Re: COO Report FACILITIES: Station 34 s budgeted expansion is scheduled to begin by November and expected to be complete in June 28. The crews are being housed upstairs at Station 34 during the renovations and can be moved to Station 3 as needed. Station 32 s new water system is providing clean drinkable water to the station. On Saturday, Oct. 4 the float switch in the new tank became stuck causing water to be wasted and flooding due to tank overflow. I am so grateful to Mr. Grice for forwarding me the Mr. Bagley sent him at 7: pm after his visit to Station 32 from 2:3 pm :8 pm Saturday afternoon. I additionally thank Mr. Bagley for sending the to Mr. Grice which got the ball rolling. I received Mr. Grice s at 7:42 pm notifying me of the situation. Since no notification was made to facilities by phone, through alarm or resource ticket, this situation would have gone on indefinitely. Upon receiving Mr. Grice s , facilities was notified at 7:43 pm. Facilities was on site, had the problem resolved and began clean-up before 8:49 pm, shortly over an hour between notification and repair. This highlights the importance of notifying support services of issues in a timely manner because if they don t know, they can t fix it. Luckily the delay in notification did not cause extensive damage to the station. 2 Transfer crews will move into Station 9 this week. The Lawn RFP posted Oct. 3. A recommendation based on the results will be made at the December Board meeting. FY 8 Major Projects at a glance: o Air conditioner for the MDF and room 25 (the suite on second floor without ac) o Paint interiors at Admin, the Service Center and Stations as needed o Re-stripe parking lots o New fence between Admin and our neighbors in Rivershire o Redundant UPS or UPS bypass (UPS is a single point of failure to power at Admin) o Lawn RFP complete by Dec. 27 o Housekeeping RFP in January

48 RADIO AND TOWERS: The Microwave RFP produced 3 respondents which were interviewed last week. A recommendation for the selected vendor will be made to the board in November. Work has begun on the RFP for the budget Telephone System and is expected to post on November with proposals due December 8. A recommendation based on the results will be made at the January Board meeting. The planned project completion date is May, 28. FY 8 Major Projects at a glance: o Microwave Project with Redundant Control Point projected completion - August 28 o Telephone System to projected completion- May 28 o Hospital BDA s at St. Luke s, Tomball and Memorial North East July 28 MATERIALS MANAGEMENT: Diane Sandel found a savings of $2,5 by purchasing demo Powerload cots which carry the same equipment and warranty as a new cot. This is a separate agenda item for purchase. Eric Baldwin will present for approval the purchase of O2 tanks which will eliminate rental tanks providing a ROI in less than 2 years. o FY 8 Major Projects at a glance: Replace rental O2 tanks by Jan. 28 Supply RFP April through July 28 EMERGENCY MANAGEMENT: The Hurricane Harvey After-Action-Review was in progress as this report was written. An AAR summary will be presented to the board at the next meeting. COMMUNITY PARAMEDICINE: Average daily patient census (September): 9 Patient enrollments (on a target goal of 45): 74 Clinical encounters (to date): 3739 Resource contacts (non-medical contacts; rides, shelter, food, etc.) (to date): 2658 The program year for 5 Waiver activity ended September 3 th. The CP program will have achieved all expected metrics and milestones for the reporting year and is beginning to align anticipated operational requirements for the next two years of a waiver renewal.

49 Agenda Item # 8 To: Board of Directors From: Melissa Miller We Make a Difference! Date: October 24, 27 Re: Expanded Quarters at Station 34 Consider and act on the budgeted expansion of station 34 for $225,. with the first of two payments of $2,5 to be paid November, 27 and the final payment once the certificate of occupancy is obtained. Fiscal Impact: Yes No N/A X X X X Budgeted item? Within budget? Renewal contract? Special request?

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51 Agenda Item # 9 To: Board of Directors From: Melissa Miller We Make a Difference! Date: October 24, 27 Re: Interlocal with Region 6 Education Service Center Consider and act on the Interlocal Agreement with the Region 6 Education Service Center. We are seeking approval to enter into an Interlocal agreement with the Region 6 Education Service Center to provide cooperative purchasing services through EPIC 6 for MCHD. Region 6 currently has 2 Montgomery County based contractors, a General Contractor and a Mechanical HVAC contractor which can provide job order contracting. Fiscal Impact: Yes No N/A Budgeted item? Within budget? X X Renewal contract? Special request?

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58 Agenda Item # 2 To: Board of Directors We Make a Difference! From: Randy Johnson, CEO Date: October 24, 27 Re: Public Health Board Member Consider and act on the reappointment of Mrs. Sandy Wagner to the Public Health District Board for (Mr. Fawn, Chairman MCHD Board)

59 Agenda Item # 2 To: Board of Directors We Make a Difference! From: Ade Moronkeji, HCAP Manager Date: October 24, 27 Re: HCAP Report HCAP Updates HCAP hosted the annual IHS Basic Software Training in the MCHD boardroom from September 27 th -28 th 27. Representatives from the different County Indigent Health Care programs in Texas were in attendance. The training served as a refresher course for seasoned staff members and also gave our fairly new employees an opportunity to expand their knowledge on County Indigent Health Care Eligibility and navigating through the software for maximum efficiency. Ida Chapa and Ade Moronkeji attended the Homeless Coalition meeting at the Chamber of Commerce on September 2, 27. They were participants on a healthcare panel that was representative of various healthcare programs within Montgomery County. Attendees received information on the HCAP application process and requirements for program eligibility. HCAP Applications We have received and processed a total of 3225 applications fiscal year to date. For this reporting month, we have a 44% denial rate. Denials are based on a number of factors: Eligible for another payer source (Medicare, Medicaid, Market Place, etc.) Above 33% of FPIL Failure to complete application/provide information Month Apps. Received Apps. Approved Pending Apps Denials Sep % Aug % Jul % Jun % May % Apr % Mar % Feb % Jan % Dec % Nov % Oct % Sep %

60 HCAP Approvals and Denials FY6 and FY7 Comparison Sep-6 Oct-6 Nov-6 Dec-6 Jan-7 Feb-7 Mar-7 Apr-7 May-7 Jun-7 Jul-7 Aug-7 Sep-7 Approvals Average Denials Average Failure to Provide Denial Analysis For the month of September, we recorded a total of 3 cases that were denied due to failure to provide additional information. Some of these cases carried over from previous months. The table below represents the breakdown of the documents that clients were unable to provide for eligibility determination. Failure to Provide Information TWC-Registration Utility Bill Texas Drivers License Statement of Support Social Security Card for Household Social Security Award Letter Property Tax or Rent Receipt Proof of Birth, Citizenship, Immgration Status Police Report, MVA Information, Denial letter from VVC Medicare/Medicaid Eligibility Letter Income Verification Other Resources- Property, CD, Stocks Food Stamp Letter Final Divorce Decree/3 Domicile Letter Detail Injury Letter Death Certificate SSI Award Letter/SSI Pending Bank Accounts

61 Number of Hospital Applications Received Sep-6 Oct-6 Nov-6 Dec-6 Jan-7 Feb-7 Mar-7 Apr-7 May-7 Jun-7 Jul-7 Aug-7 Sep-7 CRMC Tomball Kingwood MHHS St. Luke's Status of Hospital Applications Approvals Denials Pending Cases Scheduled Appointments Sep % 53 64% 28 34% % Aug - 7 % 8 23% 26 74% 3% Jul - 7 % 52 57% 37 4% 2 2% Jun - 7 % 4 57% 28 4% % May - 7 % 49 62% 29 38% % Apr - 7 % 4 54% 34 45% % Mar - 7 % % % % Feb - 7 % % %.8% Jan - 7 % % % % Dec % % % % Nov % % % 2 7.4% Oct -6 % 25 58% 7 4% 2.3% Sep - 6 % 8 45% 22 55% %

62 Census Effective July, 2, new applicants are required to be <33% of FPIL to qualify for HCAP benefits HCAP Clients as of September 3, 27 = 433 versus September 3, 26 = 497 FPIL Range -2% 2-5% 5-% -33% Inmates FY % 54 2% 75 7% 5 3% 8 2% FY % 48 % 8 22% 9 4% 23 5% Clients who have reached the Maximum Annual Benefits of $6, or 3 inpatient days a. FY 6/7 = 9 b. FY 5/6 = c. FY 4/5 = Prescription Benefits Services: Month Applying Clients Total Applications Monthly Savings (AWP-6% + Dispensing Fee) Sep $,847.3 Aug $77,2.83 Jul $7,354. Jun $43,38.84 May $5, Apr $78, Mar $46,4. Feb $83,53. Jan $3, Dec $35, Nov $27,66.37 Oct $6,889.5 Sep $3,92.2 *Patient assistance programs are run by pharmaceutical companies to provide free medications to people who cannot afford to buy their medicine.

63 Coast2Coast Prescription Card Year-to-Date Royalty $7. $6. $5. $4. $3. $2. $. $. *We have not received the revenue for September Opioid Out of the opioid claims, 7 (69.3%) represented No Tramadol. Of these 7 only 2 (3%) were covered by MCHD. This is slightly higher than August for No Tramadol covered claims OPIOID UTILIZATION- NO TRAMADOL Total Claims MCHD covered Medicaid Reimbursement For FY 6-7 we have collected $66,63.26 in Medicaid reimbursement. In September 2 clients were found to eligible for Medicaid and $4,953.5 has been requested in reimbursement from the providers.

64 $45,. $4,. $35,. Medicaid Reimbursement by Fiscal Year First full fiscal year using IHS Power Search Sadler Bankrupcy $37,273 outstanding reimbursements not recoverable $3,. $25,. $2,. $5,. $,. $5,. $- FY 4-5 FY 5-6 FY 6-7 FY 7-8 FY 8-9 FY 9- FY - FY - 2 FY 2-3 FY 3-4 FY 4-5 FY 5-6 FY 6-7

65 September ended the fiscal year with desirable results. The Generic % of Total Paid Claims was favorably above average by.97%. The Avg Cost for Brand graph, while lower than last month, is slightly above average by.36%. All other graphs are well below average. This is attributed to the new pricing structure that was implemented in July.

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68 Top 25 Pharmacy Dispensing - by Dollar Amount From 9//27 to 9/3/27 25 Montgomery Co IHCP-Retail RETAIL Montgomery Co IHCP-Retail Brand RXs. Generic RXs. Brd Equiv. RXs. Total Rx Percent of Totals Rank Pharmacy Name NABP Cnt Amount Cnt Amount Cnt Amount Billed Count By RX By Amt WALMART PHARMACY $ $, Avg Day Supply 23.9 Report : RPT-57 Printed : /9/27 Page: Avg Cost DAW Per RX C-II Ovrd $ KROGER PHARMACY $ $ $ KROGER PHARMACY # $ $ $ CVS PHARMACY $ $ $ WALMART PHARMACY $ $ $ WALMART PHARMACY $ $ $ HEB PHARMACY $ $ $ WALMART PHARMACY $ $ $ KROGER PHARMACY $ $ $59.93 CVS PHARMACY $ $ $ WALMART PHARMACY $ $ $ PINECROFT PHARMACY 596 $ $ $ LONE STAR FAMILY HEALTH $ $ $ KROGER PHARMACY $ $ $ KROGER PHARMACY # $ $ $4.9 6 KROGER PHARMACY $ $ $3.7 7 CVS PHARMACY 455 $ $ $ CVS PHARMACY # $ $ $ WALMART PHARMACY $ $ $ Total Dollars: % Total By RX: %Total by Amt: Avg. Qty: Total calculated price for all RXs for Pharmacy (including copay) Percentage of RXs by Pharmacy vs. total RXs Percentage of dollars by Pharmacy vs. total dollars (including copay) Average quantity dispensed in each RX by Pharmacy Avg Day Supply: Avg. Cost Per Rx: C-II: DAW Ovrd: Average Number of days supply dispensed by Pharmacy for each RX Average total price for each RX by Pharmacy (including member copay) Total # of C-II Controlled RXs dispensed from Pharmacy Total # of DAW (Physician) and DAW 2 (Member) Overrides Note This report is based on Rx Dispensing Date. Totals could change if claims or reversals are subsequently submitted and the dispensing dates are within this range. Invoices are based on period close dates and may not balance to these amounts Top 25 Pharmacy Dispensing - by Dollar Amount From 9//27 to 9/3/27 Report : RPT-57 Printed : /9/27 Page: 2 Rank Pharmacy Name NABP Brand RXs. Cnt Amount Generic RXs. Cnt Amount Brd Equiv. RXs. Cnt Amount Total Billed Rx Count Percent of Totals By RX By Amt Avg Day Supply Avg Cost DAW Per RX C-II Ovrd 2 BROOKSHIRE BROTHERS $ $ $ KROGER PHARMACY 4574 $ $ $ HEB PHARMACY $ $ $ SAMS PHARMACY $ $ $ WALMART PHARMACY $ $ $ HEB PHARMACY 5982 $ $ $3.48 SUBTOTAL FOR TOP 25 : $9, $379.7 SUBTOTAL FOR ALL OTHER Pharmacies : $ $53.74 TOTAL FOR PLAN : $, ,52.92 $532.9 TOTAL FOR GROUP : $, ,52.92 $532.9

69 25 Montgomery Co IHCP-Retail RETAIL Montgomery Co IHCP-Retail Rank Physician Name ANUGWOM, CHINASA Top 25 Physician Dispensing - by Dollar Amount From 9//27 to 9/3/27 Brand RXs. Cnt Amount $36.7 Generic RXs. Cnt Amount Brd Equiv. RXs. Cnt Amount. Total Billed $78.6 Rx Count 59 Percent of Totals By RX By Amt Avg Day Supply 26.3 Report : RPT-56 Printed : /9/27 Page: Avg Cost DAW Per RX C-II Ovrd $ NGUYEN, CHANH $ $ $ ALI, SHAIKH $ $ $ MEMON, ILYAS 2 $ $ $ DESAI, ASHESH $ $ $ ADELEYE, VICTORIA $ $ $8.5 7 SLAUTER, ELIZABETH $ $ $ SPRINTZ, MICHAEL $ $ $ FARLEY, DANNY $ $ $6.94 WILLIS, BRANCH $ $ $9.7 CHERLO, SREENIVASULU $ $ $ THOMAS, CELESTE $ $ $ MORRISON, FRANCIS $ $ $3.5 4 AWASUM, SERGE-ALAIN $ $ $ DEJEAN, BAPTISTE $ $ $ PATRINELY, PATRICIA $ $ $ BOBADILLA, MARIBETH $ $ $.68 8 TRESVALLES, ANA $ $ $8.3 9 NGUYEN, LONG $ $ $56.8 Total Dollars: % Total By RX: %Total by Amt: Avg. Qty: Total calculated price for all RXs for Physician (including copay) Percentage of RXs by Physician vs. total RXs Percentage of dollars by Physician vs. total dollars (including copay) Average quantity dispensed in each RX by Physician Avg Day Supply: Avg. Cost Per Rx: C-II: DAW Ovrd: Average Number of days supply dispensed by Physician for each RX Average total price for each RX by Physician (including member copay) Total # of C-II Controlled RXs written by Physician Total # of DAW (Physician) and DAW 2 (Member) Overrides Note This report is based on Rx Dispensing Date. Totals could change if claims or reversals are subsequently submitted and the dispensing dates are within this range. Invoices are based on period close dates and may not balance to these amounts Top 25 Physician Dispensing - by Dollar Amount From 9//27 to 9/3/27 Report : RPT-56 Printed : /9/27 Page: 2 Rank Physician Name Brand RXs. Cnt Amount Generic RXs. Cnt Amount Brd Equiv. RXs. Cnt Amount Total Billed Rx Count Percent of Totals By RX By Amt Avg Day Supply Avg Cost DAW Per RX C-II Ovrd 2 CAO, PHU $ $ $ ZAIDI, SYED $ $ $ SANCHEZ, BENNY $ $ $ CHUA, EVELYN $ $ $ WILLIAMS, RENEE $ $ $ KARMOUT, CHRISTOPHER 2 $ $ $6.76 SUBTOTAL FOR TOP 25 : $7, $,536.7 SUBTOTAL FOR ALL OTHER PHYSICIANS : $2, , $,32.92 TOTAL FOR PLAN : $, ,52.96 $2, TOTAL FOR GROUP : $, ,52.96 $2,669.63

70 25 Montgomery Co IHCP-Retail RETAIL Montgomery Co IHCP-Retail *Insulin** *Tetracyclines** *Opioid Combinations** *Antimalarials** *Anticonvulsants - Misc.** *Nonsteroidal Anti-inflammatory Agents (NSAIDs)** *HMG CoA Reductase Inhibitors** *Opioid Agonists** *Thyroid Hormones** *Inflammatory Bowel Agents** *Steroid Inhalants** *Bronchodilators - Anticholinergics** *Beta Blockers Cardio-Selective** *Corticosteroids - Topical** *Anthelmintics** *Platelet Aggregation Inhibitors** *Fibric Acid Derivatives** *Amphetamines** *Calcium Channel Blockers** *Central Muscle Relaxants** *Otic Combinations** *Pyrimidine Synthesis Inhibitors** *Beta Blockers Non-Selective** *Analgesic Combinations** *Opioid Partial Agonists** Top 25 Therapy Classes by- Dollar Amount From 9//27 to 9/3/27 Rank Code Drug Class Retail Rxs Mail Rxs Avg Days Avg Rx Cost Rx Cnt Total Billed $ $77.48 $5.28 $53.49 $4.39 $9.2 $6.98 $3.73 $2.44 $72.74 $472.4 $ $8.26 $49.4 $373.2 $22.7 $2.96 $4.7 $8.66 $7.7 $3.7 $ $4.42 $8.47 $ Report: Printed: RPT-47 /9/27 Page: $, $ $ $ $75.9 $576.9 $565. $ $ $58.23 $472.4 $45.7 $44.84 $395.2 $373.2 $363.3 $356.4 $342.2 $33. $ $263.4 $ $ $ $235.9 Percent of Totals By Rx By Amt SUBTOTAL FOR TOP 25 : $2, SUBTOTAL FOR ALL OTHER CLASSES : 586 2, $,877.2 TOTAL FOR PLAN: 87 2,88.7 $4, $2,59.5 $5,336.2 $7, TOTAL FOR GROUP : 87 2,88.7 $4, $7, Code: Avg Rx Cost : Total Billed: Note Theraputic Classification for the drug class This report is based on Rx Dispensing Date. Totals could change if claims or reversals are subsequently Average amount per script for the drug cost and dispense fee only Total amount of the drug cost and dispense fee submitted and the dispensing dates are within this range. Invoices are based on period close dates and may not balance to these amounts

71 25 Type: ALL Montgomery Co IHCP-Retail Savings Summary Report From 9//27 to 9/3/27 Report: RPT-68 Date: /9/27 # of RXs %of All RXs Calculated Total Cost Average Cost/RX Avg Qty Avg Days ---- Savings vs Submitted Amounts Savings vs Full AWP Price Amt Amt Saved Pct Amt Saved Requested Saved per RX Saved Full AWP Saved Per RX Pct Saved Totals: New RXs: Refill RXs: Generic RXs: Brand Equiv RXs: Brand RXs: Maintenance RXs: Non-Maint RXs: 69 % $5,72 $ $6,593 $89 $ % $97,567 $8,866 $ % % $,557 $ $,338 $78 $ % $54,663 $44,6 $ % % $5,45 $ $5,255 $ $ % $42,95 $37,76 $ % % $2,32 $ $2,38 $248 $.24 2.% $92,649 $8,57 $ % 2.9% $67 $ $8 $3 $ % $8 $4 $ % 2.87% $3,52 $ $4,33 $63 $ % $4,837 $,335 $ % % $9,7 $ $,72 $46 $ % $73,599 $63,888 $ % % $5,99 $ $6,42 $43 $ % $23,968 $7,978 $ % Savings vs. Submitted Amounts Savings vs. Full AWP Price This section compares amounts requested by the pharmacy with amounts actually billed to the plan. This section compares the full AWP price of the drug against the amount billed to the plan Type indicate the network type of the pharmacy. Values are Retail, Mail, or All. All dollar amounts are based of Drug cost only. Brand Equiv RXs refers to brands drugs filled when a generic equivilant was available Note This report is based of invoice close dates.

72 AGENDA ITEM #22 Board Mtg: /24/27 Consider and act on Healthcare Assistance Program claims from Non-Medicaid 5 Waiver providers processed by Boon-Chapman (Mrs. Wagner, Chair-Indigent Care Committee) Montgomery County Hospital District Summary of Claims Processed Through (TPA) Boon-Chapman For the Period 9//7 through /26/7 Disbursement Date Board Reviewed Payments Made to All Other Vendors (Non-UPL) September September, 27 Yes $ 85,44.59 September 7, 27 Yes $ 6,452.8 September 4, 27 Yes $ 58, September 2, 27 No $ 37,88.67 September 28, 27 No $ 3, Total September Payments - MTD $ 229, Monthly Budget - September 27 $ 4,95. October October 5, 27 No $ 95,923.6 October 2, 27 No $ 82, October 9, 27 No $ 22,23.43 October 26, 27 No $ - Total October Payments - MTD $ 2, Monthly Budget - October 27 $ 256,335. Note: Payments made may differ from the amounts shown in the financial statements due to accruals and/or other adjustments.

73 AGENDA ITEM #23 Board Mtg: /24/7 Consider and act on ratification of voluntary contributions to the Medicaid 5 Waiver program of Healthcare Assistance Program claims processed by Boon Chapman. Montgomery County Hospital District Summary of Claims Processed Through (TPA) Boon-Chapman For the Period //27 through /3/27 Disbursement Date Value of Services Provided by CRMC and Affiliated Providers October Voluntary Contribution for Medicaid 5 Waiver Program $ 249,4. Budgeted Amount October 27 $ 249,4. Over / (Under) Budget $ -

74 AGENDA ITEM # 24 Board Mtg.: /24/7 Montgomery County Hospital District Financial Dashboard for September 27 (dollars expressed in 's) Sep 27 Sep 26 Var Var % Legend Cash and Investments 39,922 33,879 6,43 7.8% Green Favorable Variance Red Unfavorable Variance September 27 Year to Date Income Statement Act Bud Var Var % Act Bud Var Var % Revenue Tax Revenue (37) 38.5% 36,92 36,7 2.5% EMS Net Revenue, %,325,48 (93).8% Other Revenue 4,89 2,69, % 8,25 5,36 2, % Total Revenue 5,34 3,724, % 56,352 53,479 2, % Expenses Payroll 2,323 2,2 2 5.% 3,52 29, % Operating,392, % 3,278 5,256 (,979) 3.% Indigent Healthcare (82) 27.2% 4,939 8,2 (3,63) 38.3% Total Operating Expenses 4,2 4,9 2.7% 48,736 52,96 (4,7) 7.9% Capital 298,83 (886) 74.8% 2,8 3,928 (,848) 47.% Total Expenditures 4,497 5,273 (776) 4.7% 5,86 56,834 (6,8).6% Revenue Over / (Under) Expenses 844 (,55) 2, % 5,537 (3,355) 8, % Tax Revenue: Year to date, Tax Revenue has exceeded budget by $2k and is equal to.55% of the annual budget. EMS Net Revenue: Year to date, EMS Revenue is under budget on $93k. Billable trips are running 9.3% higher (7 per day compared to 97.9) than for the same period last year. Other Revenue: Year to date, Other Revenue is more than budget primarily due to investment income being more than expected, an increase in Tobacco Settlement Proceeds, the $9k Texas Mutual Dividend Payment, the Ambulance Supplemental Payment, and Employee Medical Premiums offset by 5 Waiver revenue for Community Paramedicine (CP). A new account, Employee Medical Premiums, was introduced in January due to making the change to a partially self funded health insurance plan. The Employee Medical Premiums account represents the employee portion of health insurance premiums. Payroll: Overall, Payroll Expenses are $87k over budget year to date mainly due to Disaster Pay and Bad Weather Days related to Hurricane Harvey. Health Benefits are $25k under budget primarily due to implementing a partially self funded employee health insurance program in January. The partially self funded plan versus the fully insured plan changes how Health & Benefits expense is recorded. Rather than record MCHD's portion of premiums as expense, the submitted medical claims are expensed. Operating Expenses: Generally, Operating Expenses are under budget year to date across the board. Indigent Care Expenses: In general, Indigent Healthcare Expenses are running less than budget due to fewer clients utilizing the HCAP program than anticipated. Capital Expenditures: Year to date, Capital Expenditures are $,848k less than budget mainly due to the purchase of equipment related to the microwave system reconfiguration being pushed to next year.

75 Montgomery County Hospital District Balance Sheet As of September 3, 27 Fund Fund 4 Total 9/3/27 9/3/27 9/3/27 ASSETS Cash and Equivalents -- Petty Cash-Adm.-BS $,95. $. $, Operating Account-WF-BS $3,7, $. $3,7, HCAP Disbursement-WF-BS $76,42.4 $. $76, Tax Revenue-WF-BS $, $. $, Texpool-District-BS $,898,39.53 $. $,898, Investments-WF Bank-BS $6,939,93.75 $. $6,939, TexStar Investment Pool-BS $,888, $. $,888, Investments-Raymond James, Inc.-BS $5,6,374.8 $. $5,6, Raymond James, Inc. - Cash-BS $,2,296.6 $. $,2,296.6 Total Cash and Equivalents $39,922,5.72 $. $39,922,5.72 Receivables --4 A/R-EMS Billings-BS $8,94, $. $8,94, Allowance for Bad Debts-BS ($3,983,633.72) $. ($3,983,633.72) --43 A/R-Other-BS $4,397,996.2 $. $4,397, A/R Employee-BS $28, $. $28, Receivable from Component Unit-BS $26, $. $26, Taxes Receivable-BS $,4,29.42 $. $,4, Allowance for bad debt-tax rev-bs ($356,277.) $. ($356,277.) Total Receivables $9,529,98.55 $. $9,529,98.55 Other Assets --48 Deposits-BS $95,258. $. $95, Prepaid Expenses-BS $45,43.7 $. $45, Inventory-BS $635,75. $. $635, Deferred Compensation-BS $. $53, $53, Total Other Assets $,35,836.7 $53, $,289,89.9 TOTAL ASSETS $5,587,4.97 $53, $5,74,23.36 LIABILITIES Current Liabilities --25 Accounts Payable-BS $886, $. $886, Accrued Expenditures-BS $,38, $. $,38, Accrued Payroll-BS $86,32.4 $. $86, P/R-United Way Deductions-BS $2, $. $2, P/R-Flexible Spending-BS-BS $6, $. $6, P/R-Health Savings-BS-BS $2. $. $ TCDRS Defined Benefit Plan-BS $385,947.2 $. $385, Due to Participants-BS $. $53, $53, Total Current Liabilities $3,479, $53, $3,633,96.4 Deferred Liabilities --23 Deferred Tax Revenue-BS $784, $. $784, Deferred Revenue-BS $599,39.69 $. $599,39.69 Total Deferred Liabilities $,384,252. $. $,384,252. TOTAL LIABILITIES $4,864, $53, $5,8,22.5

76 Montgomery County Hospital District Balance Sheet As of September 3, 27 CAPITAL Assigned - Open Purchase Orders-BS $,45,45.86 $. $,45, Nonspendable - Inventory-BS $635,75. $. $635, Nonspendable - Prepaids-BS $45,43.7 $. $45, Restricted - NACCHO Grant Funds Remaining-BS $,24.8 $. $, Committed - Uncompensated Care-BS $7,58,. $. $7,58, Committed - Capital Replacement-BS $,89,76. $. $,89, Committed - Capital Maintenance-BS $7,583. $. $7, Committed - Catastrophic Events-BS $5,,. $. $5,, Unassigned Fund Balance-MCHD-BS $28,994, $. $28,994, TOTAL CAPITAL $45,722,8.2 $. $45,722,8.2 TOTAL LIABILITIES AND CAPITAL $5,587,4.97 $53, $5,74,23.36

77 Montgomery County Hospital District Preliminary Income Statement - Actual vs. Budget For the Period Ended September 3, 27 Current Current Current Total % YTD Annual Month Month Month YTD YTD YTD Annual Annual Budget Actual Budget Variance Actual Budget Variance Budget Budget Remaining Revenue Tax Revenue 4 Tax Revenue 3, ,849. (4,594.9) 36,288, ,973,44. 35, ,973,44..88% (35,3.59) 4 Delinquent Tax Revenue 3, ,55. (2,777.96) 325, ,245. (78,293.9) 44, % 78, Penalties and Interest 3, ,76. (9,29.9) 28, ,28. (4,432.59) 323, % 4, Misc Tax Revenue VIT and BIT Funds... 5, , % (5,67.42) Total Tax Revenue 58, ,24. (36,58.24) 36,9, ,7,94. 2, ,7,94..55% (2,884.5) EMS Net Revenue 43 EMS - Advanced Life Support Revenue,783,574.34,37, , ,89, ,67,974. 3,47,56.7 6,67, % (3,47,56.7) 432 EMS - Basic Life Support Revenue 434, , , ,785, ,48,47. 35,2.25 4,48, % (35,2.25) 433 Transfer Service Fees 8, ,854., , , , , % (74,.64) 434 Non-Transport Fees 22, ,86. (,59.5) 46, , , , % (26,75.65) 435 Contractual Allowance (64,99.6) (549,365.) (9,544.6) (6,499,87.92) (6,683,94.) 84,752.8 (6,683,94.) 97.24% (84,752.8) 4352 Provision for Bad Debt (6,893.44) (366,243.) (234,65.44) (8,379,664.89) (4,455,956.) (3,923,78.89) (4,455,956.) 88.6% 3,923, Recovery of Bad Debt - EMS 4, ,77. (9,47.9) 27, ,24. (7,289.36) 278, % 7, Total EMS Net Revenue,93, , ,658.25,325,36.54,48,3. (92,669.46),48, % 92, Other Revenue 4 Investment Income - MCHD 34,6. 6, , ,28.2 8,4. 222,24.2 8, % (222,24.2) 425 Interest Income,29.86., ,74.,32. 4,42., % (4,42.) 43 Tobacco Settlement Proceeds , ,. 425, , % (425,35.48) 44 Weyland Bldg. Land Lease 8, ,266. (.49) 33, ,64. (.96) 33, % Miscellaneous Income, ,. 8, , ,. 293, ,. 297.% (293,528.4) 45 Rx Discount Card Royalties , ,8. 2,87.5 4, % (2,87.5) 46 Tenant Rent Income 7, ,75. (269.75) 89, ,2. (3,237.) 93, % 3, P.A. Processing Fees (4.) 3,495. 3, , % (255.) 437 Contract Revenue (Net) 5,3. 8,. (2,7.) 56, ,22. 27, , % (27,234.) Waiver - Paramedicine 3,5.,. 3,5.,2,7.,2,. (78,3.),2, % 78, Education/Training Revenue 2,435. 8,3. (5,865.) 66, ,8., , % (,436.4) 439 Stand-By Fees 2,2.. 2,2. 5,8. 28,. 22,8. 28,. 8.43% (22,8.) 4392 EMS - Trauma Fund Income... 2,88. 2,. 9,88. 2, % (9,88.) 4395 Ambulance Supplemental Payment Program 3,48, ,5,. 98, ,48, ,5,. 98, ,5, % (98,48.94) 44 Management Fee Revenue 8, , ,999.96,. (.4),..%.4 44 Employee Medical Premiums 75, , , , % (723,744.73) 45 Dispatch Fees 5,36. 7,. (,639.) 285,28. 29,. 66,28. 29,. 3.27% (66,28.) 455 MDC Revenue - First Responder 46, ,65. 53,65. 44,. 9,65. 44,. 2.93% (9,65.) 463 Inter Local 8 Mhz 98, , ,463.,. 98,463., % (98,463.) 465 VHF Project Revenue 2, ,868. (,96.2) 259, ,46. (4,789.53) 274, % 4, Sale of Assets 8,64.. 8,64. 49, ,. 25, , % (25,769.) Total Other Revenue 4,89,68.7 2,689,965.,399,3.7 8,25,7.95 5,359,876. 2,765, ,359, % (2,765,23.95) Total Revenue 5,34,55.8 3,723,875.,67,8.8 56,352, ,478,8. 2,873, ,478, % (2,873,447.) Expenses Payroll Expenses 5 Regular Pay,44,653.43,24,52. (69,848.57) 4,272, ,62,5. (339,6.8) 4,62, % 339, Overtime Pay 392, ,649. (6,98.84) 4,833, ,85,37. 8, ,85,37..39% (8,539.64) 53 Paid Time Off 32, ,899.32,563, ,.,457, , % (,457,36.55) 54 Stipend Pay 3, ,65. 3, , ,73. 59, , % (59,247.5) 55 Payroll Taxes 23, ,953. (274.59),498,97.38,49,643. 7,328.38,49, % (7,328.38) 565 TCDRS Plan 3, ,379. (2,866.) 4,343, ,469,295. (25,895.25) 4,469, % 25, Health & Dental 53, ,747. (257,679.7),28, ,83,983. (2,55,97.26) 3,83, % 2,55, Health Insurance Claims 224, ,375.27,86,37.69.,86, % (,86,37.69) 572 Health Insurance Admin Fees 7, , , , % (486,433.67) Total Payroll Expenses 2,322, ,2,88., ,59, ,648,99. 87, ,648, % (87,49.29)

78 Montgomery County Hospital District Preliminary Income Statement - Actual vs. Budget For the Period Ended September 3, 27 Current Current Current Total % YTD Annual Month Month Month YTD YTD YTD Annual Annual Budget Actual Budget Variance Actual Budget Variance Budget Budget Remaining Operating Expenses 52 Accident Repair 3, , , ,424. 4, , % (4,454.8) 52 Accounting/Auditing Fees,..,. 48,5. 5,. (,5.) 5,. 97.%, Advertising (426.57), ,26. (3,359.43) 5, % 3, Bank Charges 4,62.2,85. 2, , ,2., , % (,83.69) 5235 Credit Card Processing Fee 2, ,4. (754.6) 28, ,6. (,726.94) 39, %, Bio-Waste Removal 2, ,47. (947.39) 33,3.34 4,884. (7,572.66) 4, % 7, Books/Materials 7, ,745. 5, , ,2. (2,62.28) 55, % 2, Business Licenses (26.4) 9, ,354. (6,977.43) 36, % 6, Capital Lease Expense 68, ,482. (.3),29,687.52,29,688. (.48),29,688..% Collection Fees 3, ,. (8,34.2) 23, ,3. (37,856.78) 369, % 37, Community Education 39. 3,334. (3,25.) 9,6.9 8,35. (8,749.) 8, % 8, Computer Maintenance 88,569.,5. 87,69. 26, ,592. (36,433.42) 352, % 36, Computer Software 49, ,58. (2,62.57) 77, ,56. (74,675.65) 792, % 74, Computer Software - MDC First Responder 3, , , ,. 7, ,. 37.9% (7,88.6) 53 Computer Supplies/Non-Cap (76.6) 39, ,57.98 (5.37) 39, % Conferences-Fees, Travel, and Meals,5.92 2,36. (,245.8) 48, ,868. (46,36.8) 94, % 46, Contractual Obligations-County Appraisal 67,7.5 72,. (4,299.85) 37, ,. 29, ,..37% (29,873.5) 5332 Contractual Obligations-Tax Collector Assessor (296.7) 52, ,. 2, ,. 5.98% (2,989.52) 5333 Contractual Obligations- Other... 3,6. 6,72. (3,2.) 6, % 3, Customer Property Damage.. (.).,2. (,89.),2..92%, Customer Relations 3, , , ,3. 4, , % (4,887.4) 538 Disposable Linen, ,77. 2, , ,24. (4,543.39) 5, % 4, Disposable Medical Supplies 97, ,63. 7, ,757.9,2,39.58 (26,634.39),2, % 26, Drug Supplies 9,752.7,375. 8, , , , , % (43,887.45) 54 Dues/Subscriptions, , ,73. (4,825.57) 5, % 4, Durable Medical Equipment 9, , , ,94. (33,735.53) 793, % 33, Election Expenses... 25, ,. (59,49.) 275, % 59, Employee Health\Wellness 3,628.2,64., , ,7. (6,8.46) 29, % 6, Employee Recognition ,26. (6,59.26) 9, ,943.4 (48.5) 9, % Equipment Rental 57.22,6. (,442.78) 8, ,6. (5,737.5) 4,6. 6.7% 5, Fuel - Auto 48, ,227. 8, , ,26. (34,53.48) 447, % 34, Fuel - Non-Auto... 3,67. 6,. (2,33.) 6,. 6.7% 2, Hazardous Waste Removal (93.75) ,6. (2,32.) 2, % 2, Insurance 38, ,. (3,456.) 56, ,4. (3,963.34) 547, % 3, Interest Expense 3, , , ,64. (.84) 74,64..% Laundry Service & Purchase (8.5) 4,25.8 5,. (974.82) 5,. 8.5% Leases/Contracts 6,2.6 4,725., , , ,25..78% (523.36) 555 Legal Fees 7, ,84. 5, ,2.4 22,2. (3,79.6) 22, % 3, Maintenance & Repairs-Buildings 58, ,. 2, , , (24,46.39) 443, % 24, Maintenance-Contract Equipment 3,72. 4,875. (,83.) 228, ,277.8 (57,492.8) 386, % 57, Management Fees 32, ,79. (5,64.5) 423, ,48. (5,56.75) 574, % 5, Meals - Business and Travel. 26. (26.), ,854. (4,25.22) 5, % 4, Meeting Expenses ,65.6 2,26. (3,564.39) 2, % 3, Mileage Reimbursements 79.8,28. (427.82) 8, ,856. (6,788.45) 4, % 6, Office Supplies ,5. (2,457.42) 8, ,4.78 (,48.43) 3, %, Oil & Lubricants 6,263.64,84. 4, ,5. 22,8.,25. 22, % (,25.) 565 Other Services (546.79) 2,38. (2,854.79) 5, ,7. (2,24.9) 27, % 2, Other Services - DSRIP , ,589. (.68) 899,589..% Oxygen & Gases 5, ,25. (487.28) 73, ,626.8 (2,.37) 75, % 2, Paging System (.) 7, ,. 4, , % (4,43.77) 569 Postage 2, , ,9.6 3,. (,89.94) 3,. 93.7%, Printing Services ,225. (,235.52) 7, ,865. (,75.64) 8, %, Professional Fees 37, ,9. 5,768.,566,456.38,959, (393,8.55),959, % 393, Radio Repairs - Outsourced (Depot). 3,7. (3,7.) 8, ,475. (23,375.36) 4, % 23, Radio Repair - Parts (899.83) 3,525. (4,424.83) 37, , (3,496.8) 4, % 3, Radios. 5. (5.) 329, ,498. (,87.45) 34, %, Recruit/Investigate 3,66.,85., , ,2. 2, ,2. 9.9% (2,39.6) 575 Rent 6, ,575., ,3.7 39,9. (,786.83) 39, %,786.83

79 Montgomery County Hospital District Preliminary Income Statement - Actual vs. Budget For the Period Ended September 3, 27 Current Current Current Total % YTD Annual Month Month Month YTD YTD YTD Annual Annual Budget Actual Budget Variance Actual Budget Variance Budget Budget Remaining 5765 Repair-Equipment,292.5,572. (279.5) 9, ,564. (5,54.22) 34, % 5, Shop Tools,68.62,248. (79.38) 8, ,96. (,66.73) 8, %, Shop Supplies 4, ,86. (,2.84) 45, , (29,45.67) 74, % 29, Small Equipment & Furniture 63, , , , , (5,972.9) 454, % 5, Special Events Supplies. 5. (5.), ,65. (,23.37) 2, %, Station Supplies, ,556. 4, , , (7,927.53) 73, % 7, Supplemental Food 2,4.4. 2,4.4 2, ,. (2.32) 3, % Telephones-Cellular 7, ,443. (23.5) 82, ,545. (5,564.93) 88, % 5, Telephones-Service, ,87. (3,39.6) 65, ,452. (779.89) 66, % Telephones - Long Distance , ,4., ,4. 8.4% (,545.66) 585 Training/Related Expenses-CE 5,54.7 5,85. 9, , ,84. (42,95.2) 95, % 42, Tuition Reimbursement 6,5.76 4,583., , , , , % (23,89.4) 586 Travel Expenses (4.) 5,3.73 6,575. (,543.27) 6, %, Uniforms 6,844. 6, , ,86. (78,865.75) 253, % 78, Utilities 33, ,465. (2,8.34) 356, ,58. (69,335.77) 425, % 69, Vehicle-Batteries (835.7),74. (2,576.7) 5, ,9. (5,8.4) 2, % 5, Vehicle-Outside Services 746.,8. (,54.) 32, ,. (4,452.87) 37,. 88.% 4, Vehicle-Parts 37,32.4 2,833. 6, , ,3.68 2, , % (2,489.66) 59 Vehicle-Registration , ,496. (752.4) 2, % Vehicle-Tires (,454.47) 4,5. (5,954.47) 45, ,. (8,73.27) 54, % 8, Vehicle-Towing (275.),63. 3,3. (,669.9) 3, %, Unemployment Ins.,45.,45..,34.9 7,42. (7,277.8) 7, % 7, Worker's Compensation Insurance 44, ,922. (38.24) 445, ,223. (97,92.8) 543, % 97,92.8 Total Operating Expenses,39,58.66,22,98. 79, ,277,5.38 5,256,73.46 (,978,662.8) 5,256, %,978,662.8 Indigent Care Expenses Medicaid Waiver - Uncompensated Care 255, , ,47, ,7,62. (,22,72.42) 3,7, %,22, Specialty Healthcare Providers 229, ,95. (8,76.48) 2,89, ,93,42. (2,4,287.65) 4,93, % 2,4, Total Indigent Care Expenses 485, ,836. (8,76.48) 4,939, ,2,32. (3,63,9.7) 8,2, % 3,63,9.7 Total Operating, Payroll and Indigent Care Expenses 4,99,54.7 4,89,94. 9, ,736, ,96,34.46 (4,7,8.86) 52,96, % 4,7,8.86 Capital Expenditures Capital Purchases / Building Improvements (48,398.72). (48,398.72). 48, (48,398.74) 48, % 48, Capital Purchases / Equipment 293,892.82,3,454.4 (89,56.32) 949, ,723, (,773,832.53) 2,723, %,773, Capital Purchases - Vehicles 52, ,. (27,66.96),3,93.4,55,778. (25,684.96),55, % 25, Total Capital Expenditures 297,833.4,83,454.4 (885,62.) 2,79, ,927,55.3 (,847,96.23) 3,927, %,847,96.23 Total Expenditures 4,497, ,273,368.4 (776,3.3) 5,85, ,833,89.59 (6,8,97.9) 56,833, % 6,8,97.9 Revenue over Expenses 843,77.24 (,549,493.4) 2,393,2.38 5,536,534.5 (3,355,9.59) 8,89,544.9 (3,355,9.59) -65.2% (8,89,544.9)

80 AGENDA ITEM # 24 Board Mtg.: /24/27 Montgomery County Hospital District Payer Mix 2-Month Payer Oct-6 Nov-6 Dec-6 Jan-7 Feb-7 Mar-7 Apr-7 May-7 Jun-7 Jul-7 Aug-7 Sep-7 Total Medicare 86,573 93,27,4,559,4, ,467,,53 95,278,4,228 94,866,39,57,5,956,,45,875,598 Medicaid 2,25 86,97 23,846 29,44 88, ,52 223, , ,58 262,33 28, ,278 2,766,389 Insurance 38,35 367,33 38, , , , ,959 44,58 38,249 43, ,29 444,229 4,775,48 Facility Contract 24,75 2,822 5,854 8,85 8,928 9,986 9,553 8,95 9,479 9,57 4,539 32, ,4 Bill Patient 56,54 52,9 5,389 5,95 444,77 523, ,84 539,77 559,6 637, ,836 65,27 6,569,429 Total 2,37,33,992,223 2,35,477 2,59,43,95,5 2,2,76 2,98,87 2,233,8 2,28,92 2,37,869 2,465,354 2,445,588 26,23,236 2-Month Payer Oct-6 Nov-6 Dec-6 Jan-7 Feb-7 Mar-7 Apr-7 May-7 Jun-7 Jul-7 Aug-7 Sep-7 % Medicare 42.3% 45.3% 47.% 48.3% 47.4% 45.7% 43.6% 45.4% 44.2% 43.8% 44.9% 45.4% 45.3% Medicaid.3% 9.4%.9%.% 9.7%.2%.7%.5%.7%.%.4%.3%.5% Insurance 8.7% 8.4% 7.9% 7.6% 9.2% 9.4% 8.3% 8.% 7.9% 7.5% 7.6% 8.2% 8.2% Facility Contract.2%.%.7%.8%.%.9%.9%.8%.9%.8%.6%.3%.9% Bill Patient 27.5% 25.7% 23.5% 23.2% 22.8% 23.7% 26.5% 24.% 26.3% 26.9% 25.5% 24.7% 25.% Total.% 99.9%.%.%.% 99.9%.% 99.9%.%.%.% 99.9% 99.9%

81 AGENDA ITEM # 24 Board Mtg.: /24/27 Montgomery County Hospital District Accounts Receivable Analysis Days in Accounts Receivable Oct-6 Nov-6 Dec-6 Jan-7 Feb-7 Mar-7 Apr-7 May-7 Jun-7 Jul-7 Aug-7 Sep-7 A/R Balance 7,656,5 7,335,944 6,74,57 6,529,665 6,339,422 6,52,883 6,48,26 6,,392 5,995,34 6,2,88 6,365,77 6,694,754 Total 6-Mo Charges 3,56,962 2,79,662,982,934,265,64,423,82 9,78,739 9,77,26 9,92,74 9,969,594,83,665,397,7,522,74 Avg Charge / Day * 75,94 7,665 66,572 62,587 57,9 53,937 54,279 55,2 55,387 56,2 57,762 58,46 A/R Days * Beginning in August 25, A/R Balance excludes liens related to motor vehicle accidents. ** Avg Charge / Day is calculated using the most current six months' charges divided by 8 days. Accounts Receivable Aging by Dollars Days Month Current >8 Total > 9 Days > 2 Days Oct-6,534,929,62,5,289,3,37,78 75,52 2,646,634 8,944,46 4,499,24 3,362,36 Nov-6,552,3 882,923,388,49,94,727 92,253 2,75,994 8,644,257 4,82,974 3,626,247 Dec-6,6,539 96,978 73,335,34,49 898,865 2,786,539 8,68,665 4,89,83 3,685,44 Jan-7,676,385,52, ,6 684,2 85,72 2,88,959 7,879,95 4,45,7 3,73,679 Feb-7,622,49,8,855 79, ,45 74,28 2,978,73 7,73,768 4,353,236 3,79,83 Mar-7,62, , ,594 58,57 56,653 3,84,73 7,54,252 4,226,782 3,645,726 Apr-7,64, ,594 74,877 68,53 6,437 3,9,545 7,8,579 4,472,54 3,79,982 May-7,636,575 96, ,94 66,53 634,893 2,85,39 7,47,76 4,47,84 3,486,283 Jun-7,578, ,7 773,79 683, ,5 2,827,584 7,352,249 4,57,374 3,373,634 Jul-7,734,48 958,98 784,36 686,797 57,86 2,82,787 7,492,457 4,4,77 3,327,973 Aug-7,749,94,2, ,98 69, ,86 2,77,32 7,758,2 4,25,558 3,524,26 Sep-7,85,89,57,4 84,2 76,8 873,42 2,765,5 8,93,69 4,344,992 3,638,9 Accounts Receivable Aging by Percentage Days Month Current >8 Total > 9 Days > 2 Days Oct-6 7% 8% 4% 3% 8% 3% % 5% 38% Nov-6 8% % 6% 4% % 3% % 56% 42% Dec-6 2% % 9% 4% % 35% % 6% 46% Jan-7 2% 3% 9% 9% % 37% % 56% 47% Feb-7 2% 3% 9% 8% % 39% % 57% 48% Mar-7 2% 2% % 8% 7% 4% % 56% 48% Apr-7 2% 2% 9% 9% 8% 4% % 57% 49% May-7 22% 2% % 9% 8% 38% % 56% 47% Jun-7 2% 3% % 9% 7% 38% % 55% 46% Jul-7 23% 3% % 9% 7% 38% % 54% 44% Aug-7 23% 3% % 9% % 36% % 54% 45% Sep-7 23% 3% % 9% % 34% % 54% 45%

82 AGENDA ITEM # 24 Board Mtg.: /24/27 Montgomery County Hospital District Accounts Payable Analysis Accounts Payable Aging by Dollars Days $ Total Month Current > 9 Credits Total minus Credits Oct-6 758, (7) 758, ,43 Nov-6 49, (7) 49,48 758,889 Dec-6 783, (7) 783,979 49,425 Jan-7 455, (7) 455,39 783,995 Feb-7 347, (7) 348,52 455,336 Mar-7 4,846 4,42-2 (7) 45,25 348,69 Apr-7 445, (2) 445,8 45,268 May-7 28, (2) 28,78 445,83 Jun-7 458,483-2 (2) 458,494 28,79 Jul-7 5,32-2 (2) 5,33 458,495 Aug-7 36, (2) 36,284 5,333 Sep-7 886, (2) 886, ,566 Accounts Payable Aging by Percentage without Credits Days Month Current > 9 Oct-6 43% % % % Nov-6 7% % % % Dec-6 586% % % % Jan-7 58% % % % Feb-7 76% % % % Mar-7 4% % % % Apr-7 36% % % % May-7 63% % % % Jun-7 63% % % % Jul-7 9% % % % Aug-7 72% % % % Sep-7 % % % %

83 Agenda item 25 Montgomery County Hospital District FY 27 Budget Variance Analysis Revenue Tax Revenue Total Tax Revenue exceeded budget by $2,884 which represents.55% of the annual amount budgeted. EMS Net Revenue Total EMS Net Revenue was $92,669 or.8% less than budget. Effective on the first day of fiscal year 27, the EMS billing rate was reduced by approximately 47%. It was estimated that EMS Net Revenue would be reduced by approximately $3,5, for fiscal year 27; however, that reduction did not take into account bad debt write-offs resulting from ambulance runs billed at the original higher rate during the months prior to the change. These unbudgeted bad debt write-offs drove down EMS Net Revenue; however, billable runs for the year exceeded expectations, making up for most of the shortfall. Other Revenue Investment Income for the year was $32,28, which was $222,24 greater than budget. This variance is primarily due to increases in the interest rate and additional investments. Tobacco Settlement Proceeds were 825,35 versus the budgeted amount of $4,. The actual amount received for FY 24 through FY 26 averaged about $575, per year and was the basis of increasing the FY 28 budget to $55,. Miscellaneous Income surpassed budget due primarily to the following: Alarm received $, from the Montgomery County Emergency Communications District as part of the FY 27 PSAP Improvement Program. This was not budgeted revenue. Human Resources was credited with dividend checks from Texas Mutual totaling $235,78 compared to the budgeted amount of $27,5. The Fleet Department received $42,629 for insurance proceeds resulting from collisions. In the past, these payments have been credited to expense; however, upon advice from the auditors, they are now coded to revenue. The Records Department generated $25,36 more than budgeted for records requests due to requests from law firms increasing significantly. 5 Waiver Paramedicine revenue was $78,3 less than budget due to billable patient encounters being fewer than expected in FY 27.

84 The Ambulance Supplemental Payment Program yielded $98,48 more than budgeted in FY 27. On advice from the consultants who assist MCHD with submitting the cost report for this program, a 5% haircut to the reimbursable amount was applied; however, the actual haircut was only 34%. Employee Medical Premiums is a new account and is used to capture employees payroll deductions for their health insurance premiums. This new account is required because of MCHD s decision to change from a fully insured plan to a partially self-funded plan. Nothing was budgeted in this account, because the decision to move to a partially self-funded plan did not occur until after the FY 27 budget had been approved. Interlocal 8 Mhz revenue was $98,463 and exceeded the budget of $,. This revenue represents the reimbursement of MCHD by the City of Conroe for expenses related to the radio and tower system. This line item is under review and will likely need to be increased in future budgets. Expenses Payroll Expenses Payroll expenses are over budget mainly due to staffing demands associated with Hurricane Harvey. The health benefit related expenses are less than budget primarily due to the change from a fully insured plan to partially self-funded plan. In the past, these expenses represented insurance premiums; however, under the partially self-funded model, MCHD pays actual medical claims. Operating Expenses Collection Fees were under budget by $37,857 due to improvements initiated in the Billing department during this past year. These improvements have resulted in more payments being received in-house and fewer bills being sent to outside collections. Computer Maintenance expenses were $26,59 versus a budget of $369,3 mainly because department needs were less than expected during the budget process. Disposable Medical Supplies expense was $895,757 compared to the budgeted amount of $,2,392. There was a duplication error in the FY 27 budget, which incorrectly inflated the budget by $8,. In addition, there was a change in philosophy as to how much inventory is maintained. For most items, only a two week supply is now being stocked versus larger amounts of inventory being carried in the past. This results in increased inventory turns. Maintenance Contract Equipment is $57,492 under budget mainly due to not receiving an invoice for the Harris annual P-25 software agreement for $2,. This amount will be accrued pending receipt and payment of the invoice. Professional Fees are $393,8 less than budget primarily due to: The Radio department has approximately $36, of budgeted expense, which it has not incurred yet due to AT&T becoming a new tenant on two of the towers. Tower climbs, inspections, re-tensioning, etc. will occur once all of AT&T s equipment is installed. These services are purposely scheduled to occur on all of the towers at the same time to reduce cost.

85 Information Technology spent less money than anticipated on outside consulting for an interim manager due to an internal promotion to the manager position at the end of November 26. The amount saved in professional fees as a result of this change was $84,. Clinical Services budgeted for a contracted medical director for the entire year, but terminated that agreement at the end of June at which time Dr. Dickson became an MCHD employee. This created a favorable variance of $44,442. The Accounting department budgeted $5, to migrate fixed assets to different software; however, the project only required $3,. Indigent Care Expenses Indigent Care Expenses were $3,63,9 under budget due to fewer patients being on the role than expected. In addition, the cost of care for each patient has been reduced due to better case management. Capital Expenditures Capital Expenditures were $,847,96 under budget primarily due to the continuation of the Microwave Re-design project into fiscal year 28.

86 AGENDA ITEM #26 Board Mtg: /24/27 Presentation of Investment Report for the quarter ended September 3, 27. Montgomery County Hospital District Investment Report Quarter Ended September 3, 27 Market Market Percentage Yield Value Total Value Qtr Ended Fiscal Year Investment 6/3/27 Additions Withdrawals Interest Increase (Decrease) 9/3/27 9/3/27 To Date Woodforest Special Liquidity Fund - Capital Replacement Sinking Fund (33) $ 6,922,565. $ 2,52.43 $ (4,638.65) $ 9,4.97 $ 6, $ 6,939, %.8367% Woodforest Special Liquidity Fund - HCAP Catastrophic Fund (36) $,993.2 $ - $ (,993.42) $.2 $ (,993.2) $..3233%.65% Woodforest Securities - Certificate of Deposits ( ) $ 6,55, $ - $ (526,24.5) $ 9,6. $ (56,864.5) $ 6,8, %.85% Texas Local Government Investment Pool (3) $ 5,63,672.9 $ - $ (3,75,.) $ 34, $ (3,75,362.66) $,898, %.6962% TexSTAR Local Government Investment Pool (34) $ 5,63, $ - $ (3,75,.) $ 35,44.94 $ (3,74,585.6) $,888, %.723% Total $ 44,657,29.5 $ 2,52.43 $ (8,32,656.2) $ 8, $ (7,922,276.23) $ 36,734, This report and its attachments complies with the Investment Strategies and the Investment Policy of Montgomery County Hospital District, as well as Government Code Section 2256 ("Public Funds Investment Act") of the State of Texas. Randy Johnson D. Brett Allen, CPA Chris Grice Chief Executive Officer Chief Financial Officer Chris Grice, Treasurer, MCHD Board Investment Officer, Montgomery County Hospital District Investment Officer, Montgomery County Hospital District Investment Officer, Montgomery County Hospital District Page of 2

87 Investment Report Quarter Ended September 3, 27 BOOK VALUE MARKET VALUE Maturity Book Value Accrued Book Value Book Value Market Value Net Book Market Value Market Value Interest Investment Fnd Date 6/3/27 Additions Deletions Interest 9/3/27 6/3/27 Activity Change 9/3/27 YTD General Fund Money Market Accounts Woodforest Bank N/A $ 6,922,565. $ 2,52.43 $ (4,638.65) $ 9,4.97 $ 6,939,93.75 $ 6,922,565. $ 6, $ - $ 6,939,93.75 $ 4,68.68 Woodforest Special Liquidity N/A $,993.2 $ - $ (,993.42) $.2 $ (.) $,993.2 $ (,993.2) $ - $ (.) $ 7,94.8 Certificates of Deposit Woodforest Securities Various $ 6,52,65.76 $ - $ (524,988.3) $ 9,6. $ 6,5, $ 6,55, $ (55,828.3) $ (,35.92) $ 6,8,67.68 $ 38, Public Investment Pools Texpool N/A $ 5,63,672.9 $ - $ (3,75,.) $ 34, $,898,39.53 $ 5,63,672.9 $ (3,75,362.66) $ - $,898,39.53 $ 2,2.4 TexSTAR N/A $ 5,63, $ - $ (3,75,.) $ 35,44.94 $,888, $ 5,63, $ (3,74,585.6) $ - $,888, $ 2,926.9 Total General Fund $ 44,663,.8 $ 2,52.43 $ (8,3,62.2) $ 8, $ 36,74, $ 44,657,29.5 $ (7,92,24.3) $ (,35.92) $ 36,734, $ 3,389. Grand Total $ 44,663,.8 $ 2,52.43 $ (8,3,62.2) $ 8, $ 36,74, $ 44,657,29.5 $ (7,92,24.3) $ (,35.92) $ 36,734, $ 3,389. page 2 of 2

88 Market Value as of 9/3/27 Certificates of Deposit, $6,8,67, 6% Money Market Accounts, $6,939,94, 9% Public Investment Pools, $23,786,988, 65%

89 Fund Balance as of September 3, 27 Assigned Open Purchase Orders,,45,45.86, 2.29% Nonspendable Inventory, 635,75.,.39% Nonspendable Prepaids, 45,43.7,.89% Restricted NACCHO Grant Funds Remaining,,24.8,.% Committed Uncompensated Care, 7,58,., 6.58% Committed Capital Replacement,,89,76., 4.4% Unassigned Fund Balance, 28,994,278.84, 63.4% Committed Catastrophic Events, 5,,.,.94% Committed Capital Maintenance, 7,583.,.37%

90 Federal Reserve Bank of Dallas The Beige Book October 27 Summary of Economic Activity The Eleventh District economy continued to expand at a moderate pace over the past six weeks, and most contacts do not expect significant long-term disruption due to Hurricane Harvey. Manufacturing output strengthened, and activity in nonfinancial services increased. Retail sales growth continued to accelerate, with a surge in auto sales to replace vehicles damaged by the hurricane. Homes sales weakened during the reporting period and prices were flat. Growth in the financial services and energy sectors continued but at a slower pace, and crop conditions remained mostly favorable. Employment, wages and prices increased, particularly in manufacturing. Outlooks remained positive overall. Employment and Wages Overall employment rose, and upward wage pressure persisted. Hiring picked up in manufacturing, continued at about the same modest pace in services, and abated slightly in the energy sector. Reports of labor shortages persisted, spanning most industries. Some manufacturers said the difficulty finding workers was impeding their growth, and some services firms said it was driving up overtime costs. More than a quarter of firms expect that the impact of Hurricane Harvey will make finding and hiring workers more difficult over the next six months. In construction, builders were concerned that once posthurricane repair and rebuilding work begins, there likely will be skilled-worker shortages and increases in labor costs. Other contacts noted that they also pull from a labor pool that is likely to be in higher demand in the aftermath of the storm. Prices Selling prices increased at the same or faster pace over the past six weeks, and contacts noted upward pressure on input costs. Prices and costs rose at a faster clip in the manufacturing and energy sectors, while upward pressure was largely unchanged on the services side. New home prices were mostly flat, but there is continued pushback from buyers on pricing at the higher end. Some builders were offering discounts and/or incentives to entice buyers, particularly on inventory homes. Gasoline and diesel prices rose over the reporting period, as did oil prices. Manufacturing Robust expansion in the manufacturing sector continued, despite some disruption among Texas Gulf Coast producers in the wake of Hurricane Harvey. Output growth picked up further for durable goods in September, led by increases in computer and electronic product manufacturing. Fabricated metals production rebounded, and output among energy-related firms overall continued to exhibit strength. Meanwhile, nondurable goods production slowed. A majority of chemical producers noted production held steady or declined over the reporting period, with a number of executives saying Hurricane Harvey had a negative impact on logistics like transportation and availability of raw materials. Refinery capacity hampered by the storm was ramping back up quickly, with little damage to infrastructure. While it may take some time for supply chains to recover, the storm s impact on the refining and petrochemical industry are projected to be transitory. For Texas manufacturing overall, outlooks were positive and more optimistic than during the prior reporting period. K-