PUBLIC HEALTH TRUST BOARD OF TRUSTEES

Transcription

1 PUBLIC HEALTH TRUST BOARD OF TRUSTEES ONE-DAY COMMITTEE MEETINGS AGENDAS Thursday, January 15, 2015 Following the Special PHT Board of Trustees Meeting (Closed Session) Jackson Memorial Hospital West Wing Board Room 1611 N. W. 12 th Avenue Miami, Florida 33136

2 PUBLIC HEALTH TRUST BOARD OF TRUSTEES ONE-DAY COMMITTEE MEETINGS SCHEDULE Thursday, January 15, :00 a.m. to adjournment Jackson Memorial Hospital West Wing Board Room 1611 N. W. 12 th Avenue Miami, Florida The One-Day Committee Meetings will commence at 10:00 a.m. with the Reasonable Opportunity for the Public to be Heard as required by Section , Fla. Stat. (Chapter , Laws of Florida), and then followed by the Chairperson s Remarks, Presentations and Discussion. A Closed Session of the Joint Conference and Efficiencies Committee meeting will follow the Chairperson s Remarks, Presentations and Discussion which will then be followed by a Special PHT Board of Trustees Meeting, then the monthly scheduled subcommittee and standing committee meetings. The meetings will be held in the West Wing Board Room. Reasonable Opportunity to be Heard 10:00 a.m. Please be advised that those members of the public wishing to speak on a proposition before the Board of Trustees or its committees will be called in the order in which they registered with the Secretary of the Board of Trustees. A speaker shall be limited to no more than two (2) minutes on a proposition before the Board of Trustees or its committees. Chairperson s Remarks, Presentations and Discussion Joint Conference and Efficiencies Committee Closed Session Special PHT Board of Trustees Meeting Closed Session Joint Conference and Efficiencies Committee Open Session Strategy and Growth Committee Audit and Compliance Subcommittee Purchasing and Facilities Subcommittee Fiscal Committee Following the Reasonable Opportunity to be Heard Following the Chairperson s Remarks, Presentations and Discussion Following the Joint Conference and Efficiencies Committee Following the Special PHT Board of Trustees meeting Following the Joint Conference and Efficiencies Committee meeting Open Session Following the Strategy and Growth Committee meeting Following the Audit and Compliance Subcommittee meeting Following the Purchasing and Facilities Subcommittee meeting January 14, 2015

3 JOINT CONFERENCE AND EFFICIENCIES COMMITTEE AGENDA (Open Session) January 15, 2015

4 PUBLIC HEALTH TRUST BOARD OF TRUSTEES JOINT CONFERENCE AND EFFICIENCES COMMITTEE AGENDA (Open Session) Thursday, January 15, 2015 Following the Special PHT Board of Trustees Meeting Jackson Memorial Hospital West Wing Board Room Joint Conference and Efficiencies Committee Marcos J. Lapciuc, Chairperson Irene Lipof, Vice Chairperson Joe Arriola Mojdeh L. Khaghan Ralph G. Patino Darryl K. Sharpton Carlos Trujillo Public Health Trust Rules Any person making impertinent or slanderous remarks or who becomes boisterous while addressing the committee, shall be barred from further audience before the committee, unless permission to continue or again address the committee be granted by the Chairperson. No clapping, applauding, heckling or verbal outbursts in support or opposition to a speaker or his or her remarks shall be permitted. No signs or placards shall be allowed in the Board Room. Persons exiting the Board Room shall do so quietly. The use of cell phones in the Board Room is not permitted. Ringers must be set to silent mode to avoid disruption of proceedings. Individuals, including those seated around the board table, must exit the Board Room to answer incoming cell phone calls. 1. Meeting Call To Order (a) Previous committee meeting minutes (December 11, 2014) Motion to approve the previous committee meeting minutes Marcos J. Lapciuc Chairperson Page 1 of 2

5 JOINT CONFERENCE AND EFFICIENCES COMMITTEE AGENDA January 15, Reports (a) Chief Medical Officer Presented by Peter Paige, M.D., Senior Vice President and Chief Medical Officer (b) Executive Medical Committee of the Medical Staff Presented by Joshua Lenchus, DO, RPh, FACP, SFHM, President, Executive Medical Committee of the Medical Staff (c) Credentials Committee Activity as of January 2015 Presented by Joshua Lenchus, DO, RPh, FACP, SFHM, President, Executive Medical Committee of the Medical Staff Motion to approve the Credentials Committee Activity as of January 2015 with a favorable recommendation to the PHT Board of Trustees Marcos J. Lapciuc, Chairperson (d) Crimson Data Overview 3. Adjournment Presented by Kevin Andrews, Vice President, Quality/Utilization Review Chief Quality Officer and Vice President of Nursing Homes Page 2 of 2

6 1. Meeting Call To Order

7 JOINT CONFERENCE AND EFFICIENCIES COMMITTEE MEETING MINUTES Thursday, December 11, 2014 Followed the Purchasing and Facilities Subcommittee Meeting Jackson Memorial Hospital West Wing Board Room First Floor 1611 N. W. 12 th Avenue Miami, FL Joint Conference and Efficiencies Committee Marcos J. Lapciuc, Chairperson Irene Lipof, Vice Chairperson Joe Arriola Mojdeh L. Khaghan Ralph G. Patino Darryl K. Sharpton Carlos Trujillo Members Present: Member(s) Excused: Irene Lipof, Vice Chairperson, Darryl K. Sharpton, Mojdeh L. Khaghan, Ralph G. Patino, and Carlos Trujillo Marcos J. Lapciuc and Joe Arriola In addition to the PHT Board of Trustees, the following staff members, University of Miami Miller School of Medicine (UMMSOM) Representatives and Assistant Miami-Dade County Attorneys were present: Carlos A. Migoya, Don S. Steigman, Peter Paige, M.D., Richard Klass, Matthew Pinzur, Rosa Costanzo, Lynn Barrett, and Isis Zambrana; Barry Gelman, M.D., and Steven Falcone, M.D., UMMSOM Representatives; and Eugene Shy, Jr., Laura Llorente, and Tania Carreno-Mederos, Assistant Miami- Dade County Attorneys 1. Meeting Call to Order Irene Lipof, Vice Chairperson at 10:30 a.m. (a) Previous committee meeting minutes (November 19, 2014) Motion to approve the previous committee meeting minutes Irene Lipof, Vice Chairperson Carlos Trujillo moved approval; seconded by Ralph G. Patino, and carried without dissent. Page 1 of 3

8 JOINT CONFERENCE AND EFFICIENCIES COMMITTEE MEETING MINUTES December 11, Reports (a) Executive Medical Committee of the Medical Staff In the absence of Joshua Lenchus, DO, PPh, FACP, SFHM, President, Executive Medical Committee of the Medical Staff, Barry Gelman, M.D., Associate Professor of Clinical Pediatrics, Chief Medical Officer, Holtz Children s Hospital at Jackson Memorial Hospital, and Vice President, Executive Medical Committee of the Medical Staff, reported that the Committee met on December 2, The Committee reviewed in detail the December 2014 Credentials Activity Report and forwarded the report with a favorable recommendation to the PHT Board of Trustees. Laura Llorente, Assistant Miami-Dade County Attorney stated for the record that the December 2014 Credentials Activity Report was presented and approved at the Special PHT Board of Trustees meeting which was conducted prior to the Joint Conference and Efficiencies Committee meeting. Due to a closed session Special PHT Board of Trustees (PHT BOT) the Joint Conference and Efficiencies Committee adjourned at 10:32 a.m. and will reconvene immediately following the closed session Special PHT BOT. INTRODUCTION Mr. Sharpton introduced Andre Boyd, the new Chief Administrative Officer, Jackson North Medical Center and is pleased and excited to have Mr. Boyd as a member of the Jackson Health System team. JOINT CONFERENCE AND EFFICIENCIES COMMITTEE MEETING The Joint Conference and Efficiencies Committee meeting reconvened at 11:53 a.m. 2. Reports cont (b) Chief Medical Officer Peter Paige, M. D., Senior Vice President and Chief Medical Officer reported that the Medical Director of Perioperative Services is scheduled to begin on December 15, With regards to safety, Dr. Paige reported that a lot of data and measures have been tracked that have to do with various performance standards as well as reporting requirements. The data reflects Jackson Health System (JHS) performance. With regards to JHS measures, Dr. Paige stated that Isis Zambrana, Corporate Director, Quality and Patient Safety was prepared to present an update regarding JHS measures, changes, and how some of the changes relate to value-based purchasing. Page 2 of 3

9 JOINT CONFERENCE AND EFFICIENCIES COMMITTEE MEETING MINUTES December 11, Reports cont (c) Quality and Patient Safety Year End Report Ms. Zambrana shared information having to do with Key Changes to Key Measures particularly as it relates to the upcoming changes to JHS Hospital Inpatient Quality Reporting and how the changes will impact the value-based purchasing program for 2015 calendar year performance. Highlights from the information shared showed how measures are reported to Joint Commission and CMS and published on HospitalCompare.gov and Joint Commission.org websites for public viewing as well as the process for administering and determining value-based purchasing. Ms. Zambrana spoke about the measure set changes for year 2015 which included an overview of the Retired Measures (Heart Failure, Pneumonia and Children s Asthma); Kept Measures (AMI, SCIP, VTE, Emergency Department, Immunization, Perinatal Care, Outpatient Measures, Inpatient Psychiatric, and Substance Abuse); and New Measure (Tobacco Treatment for the psychiatric population). Ms. Zambrana stated that not all of the required measures for reporting to Joint Commission and CMS will impact the valuebased purchasing program. As part of the information shared was the percentage based evolving changes for some of the clinical based measures and its impact on value-based purchasing. As it relates to value-based purchasing, Mr. Sharpton stated that over the coming months he considers it a priority. He further stated that he has met and expressed concerns to Rosa Costanzo, Chief Procurement Officer and Ms. Zambrana regarding the level of accountability; will hold Ms. Zambrana, Kevin Andrews, Vice President, Quality and Patient Safety and Peter Paige, M.D., Chief Medical Officer secondarily accountable; and Don S. Steigman, Chief Operating Officer primarily accountable until there is a change in the numbers. Mr. Sharpton stated that he appreciates the fantastic job that Ms. Zambrana is doing. 3. Adjournment Irene Lipof, Vice Chairperson at 12:04 a.m. Meeting Minutes Prepared by Ivenette Cobb-Black Executive Assistant Public Health Trust Board of Trustees Page 3 of 3

10 2. Reports

11 2 (a) Chief Medical Officer

12 2 (b) Executive Medical Committee of the Medical Staff

13 2 (c) Credentials Committee Activity as of January 2015

14 2 (d) Crimson Data Overview

15 3. Adjournment

16 STRATEGY AND GROWTH COMMITTEE AGENDA January 15, 2015

17 PUBLIC HEALTH TRUST BOARD OF TRUSTEES STRATEGY AND GROWTH COMMITTEE AGENDA Thursday, January 15, 2015 Following the Joint Conference and Efficiencies Committee Meeting (Open Session) Jackson Memorial Hospital West Wing Board Room Strategy and Growth Committee Joe Arriola, Chairperson Marcos J. Lapciuc, Vice Chairperson Mojdeh L. Khaghan Irene Lipof Ralph G. Patino Darryl K. Sharpton Carlos Trujillo Public Health Trust Rules Any person making impertinent or slanderous remarks or who becomes boisterous while addressing the committee, shall be barred from further audience before the committee, unless permission to continue or again address the committee be granted by the Chairperson. No clapping, applauding, heckling or verbal outbursts in support or opposition to a speaker or his or her remarks shall be permitted. No signs or placards shall be allowed in the Board Room. Persons exiting the Board Room shall do so quietly. The use of cell phones in the Board Room is not permitted. Ringers must be set to silent mode to avoid disruption of proceedings. Individuals, including those seated around the board table, must exit the Board Room to answer incoming cell phone calls. 1. Meeting Call To Order (a) Previous committee meeting minutes (December 11, 2014) Motion to approve the previous committee meeting minutes Joe Arriola, Chairperson 2. Reports (a) Strategic Plan and Process Update Presented by Richard Klass, Senior Vice President and Chief Strategy Officer (b) Cerner Update Presented by Michael Garcia, Chief Information Officer 3. Adjournment Page 1 of 1

18 1. Meeting Call To Order

19 STRATEGY AND GROWTH COMMITTEE MEETING MINUTES Thursday, December 11, 2014 Followed the Audit and Compliance Subcommittee Meeting Jackson Memorial Hospital West Wing Board Room First Floor 1611 N. W. 12 th Avenue Miami, FL Strategy and Growth Committee Joe Arriola, Chairperson Marcos J. Lapciuc, Vice Chairperson Mojdeh L. Khaghan Irene Lipof Ralph G. Patino Darryl K. Sharpton Carlos Trujillo Member(s) Present: Member(s) Excused: Mojdeh L. Khaghan, Irene Lipof, Darryl K. Sharpton, Ralph G. Patino, and Carlos Trujillo Joe Arriola and Marcos J. Lapciuc In addition to the Board of Trustees, the following staff members, and Assistant Miami-Dade County Attorneys were present: Carlos A. Migoya, Don S. Steigman, Richard Klass, Peter Paige, M.D., and Lynn Barrett; and Eugene Shy, Jr., and Tania Carreno- Mederos, Assistant Miami-Dade County Attorneys 1. Meeting Call To Order Darryl K. Sharpton, Chairperson, PHT Board of Trustees at 12:11 p.m. (a) Previous committee meeting minutes (November 19, 2014) Approval of the previous committee meeting minutes Darryl K. Sharpton, Chairperson, PHT Board of Trustees Ralph G. Patino moved approval; seconded by Mojdeh L. Khaghan, and carried without dissent. Page 1 of 2

20 STRATEGY AND GROWTH COMMITTEE MEETING MINUTES December 11, Report (a) Managed Care Contract Update As a follow up from the previous committee meeting, Don S. Steigman, Executive Vice President and Chief Operating Officer reported that Jackson Health System (JHS) is fully contracted with 8 (Aetna, Florida Blue, Cigna, Coventry Health Care, Molina Healthcare, Preferred Medical Plan, Sunshine Health, and UnitedHealthcare) out of the the 9 Affordable Care Act Plans. Humana is the remaining Affordable Care Act Plan that JHS is currently in negotiations with. With regards to the 10 Florida Medicaid Managed Care Standard Plans, (Amerigroup RealSolutions in Healthcare, WellCare, Coventry Health Care, Molina Healthcare, Preferred Medical Plan, Humana, Sunshine Health, UnitedHealthcare, Prestige Health Choice, and Simply Healthcare) JHS is fully contracted with 9 out of the 10. JHS has a short term Letter of Agreement with Sunshine Health and full contract negotiations are ongoing. Ongoing discussions continue with the University of Miami to insure that some of the specialties are covered. Also JHS is fully contracted with 4 Florida Medicaid Managed Care Special Needs Plans (Clear Health Alliance, Freedom Health, Magellan Health and Positive Healthcare). Mr. Steigman stated that the Committee will be kept informed on a monthly basis regarding all of the activities surrounding the Managed Care contracts which have a tremendous impact on the population that JHS serve. Mr. Sharpton questioned the reason why there was not a balanced score card update report. Mr. Steigman stated that the update information regarding the balanced score card was presented at the individual briefings with the PHT Board of Trustees prior to the committee meetings. 3. Adjournment Darryl K. Sharpton, Chairperson, PHT Board of Trustees at 12:16 p.m. Meeting Minutes Prepared by Ivenette Cobb-Black Executive Assistant Public Health Trust Board of Trustees Page 2 of 2

21 2. Reports

22 2 (a) Strategic Plan and Process Update

23 2 (b) Cerner Update

24 3. Adjournment

25 AUDIT AND COMPLIANCE SUBCOMMITTEE AGENDA January 15, 2015

26 PUBLIC HEALTH TRUST BOARD OF TRUSTEES AUDIT AND COMPLIANCE SUBCOMMITTEE AGENDA Thursday, January 15, 2015 Following the Strategy and Growth Committee Meeting Jackson Memorial Hospital West Wing Board Room Audit and Compliance Subcommittee Mojdeh L. Khaghan, Chairperson Marcos J. Lapciuc, Vice Chairperson Irene Lipof Carlos Trujillo Public Health Trust Rules Any person making impertinent or slanderous remarks or who becomes boisterous while addressing the committee, shall be barred from further audience before the committee, unless permission to continue or again address the committee be granted by the Chairperson. No clapping, applauding, heckling or verbal outbursts in support or opposition to a speaker or his or her remarks shall be permitted. No signs or placards shall be allowed in the Board Room. Persons exiting the Board Room shall do so quietly. The use of cell phones in the Board Room is not permitted. Ringers must be set to silent mode to avoid disruption of proceedings. Individuals, including those seated around the board table, must exit the Board Room to answer incoming cell phone calls. 1. Meeting Call To Order (a) Previous subcommittee meeting minutes (December 11, 2014) Motion to approve the previous subcommittee meeting minutes Mojdeh L. Khaghan, Chairperson Page 1 of 2

27 AUDIT AND COMPLIANCE SUBCOMMITTEE AGENDA January 15, Reports (a) Corporate Compliance Presented by Lynn M. Barrett, Vice President and Chief Compliance Officer, Corporate Compliance Department (1) Fiscal Year 2015 Work Plan Gantt Chart (2) Compliance Mandatories (b) Internal Audit 3. Adjournment Presented by Andre Reid, Corporate Director, Internal Audit Department (1) Fiscal Year 2015 Comprehensive Audit Work Plan Update (2) Review of Finalized Audit Reports (a) 2014 Logical Access Audit Report (3) Audit Follow-up Summary Page 2 of 2

28 1. Meeting Call To Order

29 AUDIT AND COMPLIANCE SUBCOMMITTEE MEETING MINUTES Thursday, December 11, 2014 Followed the Joint Conference and Efficiencies Committee Meeting Jackson Memorial Hospital West Wing Board Room First Floor 1611 N. W. 12 th Avenue Miami, FL Audit and Compliance Subcommittee Mojdeh L. Khaghan, Chairperson Marcos J. Lapciuc, Vice Chairperson Irene Lipof Carlos Trujillo Members Present: Member(s) Excused: Board of Trustees Member(s) Present: Mojdeh L. Khaghan, Chairperson, Irene Lipof, and Carlos Trujillo Marcos J. Lapciuc Darryl K. Sharpton and Ralph G. Patino In addition to the Board of Trustees, the following staff members, Foley & Gardner LLP Representatives, and Assistant Miami-Dade County Attorneys were present: Carlos A. Migoya, Peter Paige, M.D., Don S. Steigman, Richard Klass, and Lynn M. Barrett; Don Romano and Myla R. Reizen, Foley & Lardner LLP Representatives; and Eugene Shy, Jr., Laura Llorente, Jeffrey Poppel, and Tania Carreno-Mederos, Assistant Miami-Dade County Attorneys 1. Meeting Call to Order Mojdeh L. Khaghan, Chairperson, Audit and Compliance Subcommittee at 12:05 p.m. (a) Previous subcommittee meeting minutes (November 19, 2014) Motion to approve the previous subcommittee meeting minutes Mojdeh L. Khaghan, Chairperson Irene Lipof moved approval; seconded by Carlos Trujillo, and carried without dissent. Page 1 of 2

30 AUDIT AND COMPLIANCE SUBCOMMITTEE MEETING MINUTES December 11, Report (a) Corporate Compliance Lynn M. Barrett, Vice President and Chief Compliance Officer stated that working together with the County Attorneys Office the PHT Board of Trustees (PHT BOT) will be presented with a comprehensive Compliance Training session. Eugene Shy, Jr., Assistant Miami-Dade County Attorney introduced Donald H. Romano and Myla R. Reizen, Foley & Lardner LLP who conducted the Compliance Training session. Mr. Romano is of counsel and a practicing health care lawyer with Foley & Lardner LLP. Ms. Reizen is a partner and health care lawyer with Foley & Lardner, LLP. The Audit and Compliance Subcommittee entered into a brief recess at 12:11 p.m. The Audit and Compliance Subcommittee reconvened at 12:16 p.m. 3. Public Health Trust Board Compliance Training Mr. Romano and Ms. Reizen provided the PHT BOT with a comprehensive Compliance Training session having do with federal health programs (e.g., Medicare), state health programs (e.g., Medicaid), and other payors and funding sources; what payors expect from health care providers to comply with laws, regulations and funding requirements; and penalties for noncompliance. Highlights of the Compliance Training session included an overview of the current compliance environment for hospital systems; purpose and elements of an effective Compliance program; description of Miami-Dade County Office of Inspector General seven (7) elements of an effective Compliance plan (Designation of a Compliance Officer and Compliance Committee, Development of Compliance Policies and Procedures, including Standards of Conduct, Developing open lines of communication, Appropriate training and education, Internal monitoring and auditing, Response to detected deficiencies, and Enforcement of disciplinary standards); review of the Board of Directors fiduciary responsibility (duty of care, duty of loyalty, and duty of obedience and purpose); and identified hospital risk areas (fraud and abuse, quality, coding and billing, and privacy and security). Following the Compliance Training session Mr. Sharpton questioned if there is a checklist of what the PHT BOT need. Ms. Barrett explained that the purpose of the Compliance Training session was to review and provide information from a regulatory standpoint the current compliance environment for hospital systems. Ms. Khaghan thanked Ms. Barrett and the Miami-Dade County Attorney s for coordinating the training session. Mr. Migoya thanked Mr. Romano and Ms. Reizen and staff for an eye opening Compliance Training session. 4. Adjournment Mojdeh L. Khaghan, Chairperson, Audit and Compliance Subcommittee at 1:38 p.m. Meeting Minutes Prepared by Ivenette Cobb-Black Executive Assistant Public Health Trust Board of Trustees Page 2 of 2

31 2. Reports

32 2 (a) Corporate Compliance

33 * In collaboration with Internal Audit

34 CY 2014 Annual Compliance Required Training Overview * Compliance Course # Completed YTD % Complete Mandatory 2014 All Employees-General Compliance Mandatory 2014 All Employees HIPAA Mandatory 2014 All Employees Conflict of Interest 10,048 99% 9,075 98% 9,091 99% Miami-Dade County Ethics Training 8,905 97% * Data as of January 8, 2015

35 2 (b) Internal Audit

36 INTERNAL AUDIT - FY15 COMPREHENSIVE AUDIT WORK PLAN STATUS UPDATE as of 12/31/14 Risk Rating Definition Work Plan Progress Summary Total Impact to company's financial statements is considered material; non-financial risk, such as patient outcome, High visibility and reputation, is considered high. Other considerations include significant change in management Total Projects Completed 0 and/or process, and prior internal or external audit findings. Process impact to company's financial statements may be material; other risk as described above is considered Medium less significant. In Progress 13 Low Minimal risk to organization from either a financial or operational risk. Not Started 21 Total Projects 34 % of Plan Completed (% hours) 15% New projects added to Original Plan 0 Project # Project Name Risk Rating Objectives Scope Status Planned Hours Actual Hours % Capital Projects Rehab Process Evaluation and Design Operating Room ("OR") Inventory Management, Charge Capture, CDM, and Billing Cerner Upgrade project ICD-10 Accounts Payable Process Enhancements Corrections Health Service ("CHS") 340B Discount Program Denial Management high medium high high high medium high high medium Review existing/new process and control designs collaboratively with Construction Procurement, Capital Projects, and Finance for sufficiency and adequacy for all phases of the construction project process to detect, prevent, and correct errors. Collaborate with management to review existing/new Rehab process and control designs from the point of admission to discharge for effectiveness. Collaborate with the OR, Supply Chain, and Finance Administrative Team in reviewing the sufficiency of process and control designs currently in place or to be implemented to ensure they adequately and effectively address the operational, inventory, and charge capture deficiencies identified. Review the sufficiency of process designs and control effectiveness to prevent, detect, and correct errors in production, and adequate training/education provided to staff prior to the implementation for each phase of the Cerner Upgrade. Review the sufficiency of controls to prevent, detect, and correct coding errors in production, Ensure that the organization awareness, impact and adequate training/education provided to communication of ICD-10 implementation standard requirements physicians, and process efficiency exist to are met. appropriately drop inpatient claims prior to the implementation of the new ICD-10 codes. On-going collaboration with management to evaluate the Accounts Payable process design efficiency and control effectiveness for processing vendor payments. Advisory/Consulting Services - Process Life Cycle Proactive oversight and involvement with management from a control perspective in all phases of the construction project process to ensure adequate sourcing, contract language, contracting, scope of work ("SOW") performance, and accounting exist to provide assurance over the expenditure of the miracle bond funds. Active participation in JHS Rehab process evaluation of deficiencies and gaps for current state and assist management with root cause analysis/solution process mapping. Assist management with the redesign of existing and/or creation of new process to effectively address controls deficiencies and process inefficiencies identified from prior audits and management self-assessment for the Operating Room ("OR") inventory management and charge capture processes. On-going involvement from a control perspective in the Cerner upgrade to ensure efficient process designs, effective controls, and adequate training is provided to users. Assist management on an on-going basis in improving and enhancing the Accounts Payable process design efficiency and control effectiveness for processing vendor payments. Collaborate with CHS management in reviewing Ensure that Corrections Health Service deficiencies identified by the sufficiency of process and control designs the Department of Justice ("DOJ") review were adequately currently in place or to be implemented to addressed; if not, assist management from a control perspective ensure they adequately and effectively address in process design and self-testing for compliance with related the clinical deficiencies identified. In addition, laws and regulations. perform follow-up testing to ensure compliance with process design and effectiveness. Assist management from a control perspective to ensure compliance and optimization of the section 340B program requirements and restrictions of the Public Health Services Act. Active participation in JHS denial reduction committee to evaluate the life cycle of patient accounts for deficiencies and gaps for current state and assist management with root cause analysis/solution process mapping from a control perspective. Review process over the 340B program, including record maintenance and compliance with related regulations. In addition, perform data analysis for optimization and proper reporting (i.e. Cost Report). Subsequently, perform periodic self-analysis to validate patient and physician eligibility on dispensing, assess potential duplicate discounts, and price changes. Collaborate with management to review existing/new denial failure points and root cause analysis to develop control points of remediation. In Progress % In Progress % In Progress % In Progress % 200 0% In Progress % In Progress % In Progress % In Progress %

37 Project # Project Name Risk Rating Objectives Scope Status Planned Hours Actual Hours % 10 Assess and evaluate current processes and Ensure completeness and accuracy of the data used to develop Transplant medium controls and data capture related to organ 250 0% cost reports related to Transplant. acquisition in 2014 cost report Graduate Medical Education & Indirect Medical Education Payments Credentialing Surprise Cash Counts Emergency Procurement Rotation Process Review Purchase Orders Created After the Fact Analysis medium medium high medium medium Ensure completeness and accuracy of the data used to develop cost reports related to Graduate Medical Education & Indirect Medical Education Payments. Assess and evaluate current processes and controls and data capture related to Graduate Medical Education & Indirect Medical Education Payments in 2014 cost report. Review current process to ensure compliance Perform a comprehensive gap analysis with Compliance and with related regulatory and contractual Management to determine the effectiveness and efficiency of the requirements, design efficiency and operational credentialing process. effectiveness. Advisory/Consulting Services - Continuous Monitoring Determine if JHS established daily change fund and cash receipts are present and properly accounted for. In addition, identify cash receipts and cash handling internal control On a periodic basis, perform surprise cash counts to validate the accuracy of cash reported at various JHS locations. Perform a weekly review of all emergency Determine if JHS Engineering department is complying with the procurement to evaluate adherence to the established emergency procurement vendor rotational policy and established emergency procurement vendor guidelines. rotational policy and guidelines. Determine compliance to the JHS Procurement Regulation and identify opportunity for purchasing enhancement based on trend analysis. Perform a monthly analysis based on prior month's PO creation for invoice transaction activities to ensure purchasing compliance and address outliers based on trend analysis. Perform a periodic review of the following financial processes: 250 0% 250 0% % In Progress % In Progress % Financial Processes high Determine compliance with JHS financial process design and effectiveness based on trend analysis. A. Kronos and Lawson Comparison (Payroll Cycle Attribute testing) 1. Bank accounts should be unique to an employee 2. Footing information relating to the number of employees in the HR listing vs. number of employees in Payroll payout 3. Other attributes B. AP review for potential duplicate payments and exceeding P.O. amount C. Potential charge capture reconciliation (Outpatient/ Inpatient) D. Capital Requisition vs. Traditional Requisition financial criteria review In Progress % 17 Pharmacy Drug Override Process Review - ED/ER high Ensure there are compensating controls in place to address the override process for narcotics/schedule II drugs administered at JMH ED/ER facility. In collaboration with the Pharmacy department, develop periodic reports to review trend analysis and outliers for potential detection of drug diversion. Specifically, reviewing segregation of duties, proper approvals, and dispensing trend of controlled substance % 18 Grants Review medium Determine whether processes surrounding federal and state grants are appropriate and effective to meet federal and state regulations guidelines. Perform random reviews in conjunction with the Grants department of significant grants to ensure adherence to grant agreement, compliance, and regulatory guidelines % Balanced Scorecard Initiative Physician Billing and Collections high medium Advisory/Consulting Services - Strategic Initiatives Assist management with developing and compiling Periodically assist management with the metrics/criteria for new strategic initiatives, ensuring compilation and review of metrics/criteria completeness/accuracy of data and methodology used to ensuring that data and methodology for measure actual performance to target expectations. Enhance measurements are consistent with regulatory components based on strategic objective and goals from internal requirements, operational and strategic and external industry benchmarks. objectives. Assurance Services Determine the effectiveness and efficiency of JMG physician billing process design and controls. Review JMG physician billing process to ensure effectiveness, including the McKesson billing process, medical records, coding, collections process, and recording of transactions in G/L. In Progress % 300 0% 21 Charge Description Master (CDM) Maintenance high Ensure that adequate processes and controls are in place to update and maintain the CDM. Review controls related to the CDM update and maintenance process including use of generic/miscellaneous CDM numbers, creation of new CDM, and product markup calculations %

38 Project # Project Name Risk Rating Objectives Scope Status Planned Hours Actual Hours % Payroll Purchasing high high Review payroll process design and controls for effectiveness related to employee on-boarding, job change, terminations, overtime pay, payroll codes, payroll payment processing. Review compliance with established policies/procedures for the procurement and supply chain functions. Specific areas of focus include sourcing vendors, proper authorizations of requisitions and purchase orders, maintenance of purchase orders, purchase order coding, existence of supporting documentation, and proper segregation of duties % In Progress % To provide support to the external auditors in auditing JHS External Audit Assistance N/A Will be determined by the External Auditors In Progress % Financial Statements. Business Continuity/Disaster Recovery Assessment Privacy Impact Assessment Vulnerability Assessment Annual Physical Inventory Count Community Health Inc. ("CHI") high high high high low Review and validate current processes and P&P related plans, procedures, and capabilities to restore operations in the event of a disaster, natural or otherwise. Review current processes and P&P related to privacy program. Review current processes and P&P related vulnerability management and system patching processes. Review contract with third party inventory counting vendor to ensure that terms and conditions are adequate. In addition, provide oversight of third party counts by performing sample recounts of items counted by the third party. Review contract/mou criteria for dollar match requirements for services and programs for compliance with fund allocation % 200 0% 200 0% 150 0% 250 0% 30 Special Projects/Unplanned N/A TBD TBD In Progress % Audits/Investigations 31 Perform follow-up reviews of prior year's audit findings to ensure Audit Follow Up N/A TBD In Progress % adequate and corrective actions are completed as stated. 32 Annual Risk Assessment N/A Evaluate the adequacy of internal controls as well as the effectiveness and efficiency of the payroll process. Ensure that policies and procedures are adhered to established criteria for vendor selection, appropriate bidding process, document retention, contracting, and receiving. Ensure that the organization has adequate plans, procedures, and capabilities to restore operations in the event of a disaster, natural or otherwise. Determine whether JHS has an effective privacy program to properly safeguard the use and protection of personal information. Verify that vulnerability management and system patching processes are operating effectively. Ensure that externally exposed services are secured. Ensure completeness of year end physical inventory count. Determine compliance with existing contract/mou for services, proper financial allocation, and effectiveness of payment controls. Develop a methodical risk based approach annual audit work plan. Meet with various business unit management to obtain their concerns and perspective on operational, financial, and compliance risk in order to develop the annual audit work plan % Administrative/Other Services 33 Project Carryover from Prior Year N/A TBD TBD In Progress % 34 Public Records Request Review N/A TBD TBD In Progress % Process Life Cycle ("PLC) 4, % Continuous Monitoring 1, % Strategic Initiatives % Assurance Services 4, % Admin./Other Services % Total 11,740 1,762 15%

39 2 (b) (2) Review of Finalized Audit Reports

40 Office of Internal Audit 1500 N.W. 12th Avenue Suite 102 Miami, FL Audit Team on the Engagement: Carline Etienne, Internal Auditor JeanPaul Nathaniel, Senior Internal Auditor Andre Reid, Corporate Director of Internal Audit 2014 Logical Access Human Resources, Payroll, and Procurement Lawson Forms January 15, 2015

41 To: Rosa Costanzo, Vice President of Strategic Sourcing and Chief Procurement Officer Michael Garcia, Vice President and Chief Information Officer Maria Huot-Barrientos, Senior Vice President of Human Resources & Chief Human Resource Officer Date: November 18, 2014 Re: 2014 Logical Access Human Resources, Payroll, and Procurement Lawson Forms Background As part of Internal Audit fiscal year ( FY ) 2014 audit plan, we performed an audit of current Logical Access within the Jackson Health System ( JHS ) Lawson system forms for Human Resources ( HR ), Payroll and Procurement business processes. This review was conducted in accordance with the International Standards for the Professional Practice of Internal Auditing of the Institute of Internal Auditors. Objectives The objective of the audit was to determine the effectiveness of current logical access controls of JHS for Lawson financial software modules (HR, Payroll and Procurement). Scope This audit included a review of the logical access related to HR (job pay related data), Payroll and Procurement applications. The audit focused primarily on the processes and controls currently in place for onboarding, off boarding, and appropriate access based on job functions of employees and vendors/contractors within FY Summary of Findings The Logical Access audit revealed opportunities to further segregate certain access to Lawson HR, Payroll and Procurement forms based on employee job function. Our detailed observations are outlined below. Conclusion Based on our review, we conclude that the controls surrounding Logical Access to Lawson HR, Payroll, and Procurement forms present some opportunities for improvement by segregating duties with the creation of new roles and/or eliminating unnecessary access to employees. Prior to the completion of the audit, all observations were remediated. Internal Audit would like to extend our appreciation to JHS Human Resources/Capital Management, Payroll, Procurement and Information Technology ( IT ) personnel who assisted and cooperated with us during the audit Logical Access See Page 4 for Abbreviations 1

42 Cc: Carlos Migoya, President and Chief Executive Officer Fidel Alvarez, Procurement Manager Connie Barrera, Director of Information Assurance Lance Fuller, Human Resource System Manager Mark Knight, Executive Vice President and Chief Financial Officer Mahnaz Parsi, Director of Business Systems Kenneth Robertson, Director of Procurement Construction Services Michelle Romano, Director of Procurement Services Don Steigman, Executive Vice President and Chief Operating Officer Laura Scott, Payroll Manager 2014 Logical Access See Page 4 for Abbreviations 2

43 2014 Logical Access Audit Observations and Management Responses 1. Inappropriate segregation of duties identified for user access roles within Lawson HR and Procurement Forms A. According to the Information System Access Policy code number 961, department directors/managers must ensure that authorized access does not exceed the minimum necessary requirements for the job function. Based on the limited number of user roles created in Lawson, we identified that certain user roles lack segregation of duties for employee job function within the HR and Procurement forms noted below. While the current access levels have not resulted in any inappropriate transactions being performed, not having appropriate segregation of duties would allow for such transaction to occur. As such, there is an opportunity to further restrict access to the field level within the Lawson forms to ensure that employees only have access required for their job function. Human Resources: o Ten of 26 (38%) individuals have unnecessary access to change employee bank accounts (PR 12.1 and 12.2); Corrected during audit o Two of 41(5%) individuals have unnecessary access to terminate employees (PA 52.1); Corrected during audit o 1 of 41 (2%) individuals have unnecessary access to change compensation (PA 52.1); Corrected during audit Procurement: o Four of 71 (6%) individuals have unnecessary access to edit Purchase Orders (PO 20). Corrected during audit B. Based on a review of the June 2014 Quarterly Reports issued to management, we noted that HR and Procurement management approved user access roles associated with Lawson PA52 and PR12 forms, which were not required for the job functions. This was due to the role complexity of the different forms/fields associated with each Lawson user access roles. Recommendation We recommend that Human Resources Information System ( HR IS ), Payroll, Procurement, and IT departments collaborate to create user roles with associated fields within Lawson forms and ensure they are clearly defined. In addition, management should ensure access is assigned based on user job functions and adequate segregation of duties exists. Management Response: Management agreed with the Internal Audit recommendations. The following actions have taken place and are now complete: 1A. Remove any existing EDIT access to PR12.1 and PR12.2 for ALL HR users which currently have the access and change them to INQUIRY of those forms. Completed 1B. Remove access to ADD any SEPARATION actions from the HCMCompensationAdmin Role. Completed 1C. Remove Seth Eisinger from the HCMCompensationAdmin Role. Completed 2B. Create versions of MMPOBuyerRole and MMLeadUserRole with PO20.1 INQUIRY access and assign them to those four individuals. Completed Human Resources has granted access to some actions in the roles based on HR s staff responsibility to 2014 Logical Access See Page 4 for Abbreviations 3

44 provide direct customer service to employees who come in to request assistance. For example, the Service Center staff historically assist employees in the direct deposit screen, therefore required the access. All actions entered into PA52 are reviewed and audited by HRMS every pay period to ensure accuracy of data and appropriateness of activities. These audit reports are saved to an audit location (PA100) for future reference, if necessary. In addition, actions contain the username of the employee completing the action which allows for easy identification of staff making changes in the system. HR management reviews and signs-off on quarterly security audit reports. The quarterly report includes a list of all role assignments based on the employees duties and responsibilities. Lawson had limitations which could not restrict access at the field/action level, the role definitions were complex and no comprehensive report or format was available to indicate what specific access these roles provided. This was noted by HR on each sign-off. However, we have now been informed that this functionality is currently available (and has been implemented by IT). We will continue to work with IT to improve security reports based on Lawson s new functionality. Responsible Party: Completion Date: Rosa Ruiz, Director of Compensation Michelle Romano, Director of Procurement Services Laura Scott, Payroll Manager Mahnaz Parsi, Director - Business System DuringAudit Abbreviation Used Throughout the Report JHS HR IT HR IS PR 12 PA 52.1 PA 52.4 PO 20 Jackson Health System Human Resources Information Technology Human Resource Information System This is a form within Lawson which provides the ability to change employee bank account This is a form within Lawson which provides the ability to change compensation This is a field within form PA 52 in Lawson which provides the ability to set up new employees This is a form within Lawson which provides the ability to create and/or edit purchase order ( PO ) 2014 Logical Access See Page 4 for Abbreviations 4

45 Completed On-track of Concerns 2011 Charity Care Process Audit Accounting/Revenue Cycle/Quality JNCMHC General Controls Audit JNCMHC JNMC Radiology Inventory and Supply Control JNMC Interventional Radiology a/o 5/2/ OR - Patient Intake & Revenue Cycle Audit JMH OR JMH Outpatient Medical Oncology Ambulatory Pharmacy Administration/Ambulatory Care Care Center - East Outpatient Center/Patient Access Service JNMC Patient Intake & Revenue Cycle JNMC- Operating Room Operating Room Audit Cash Audit Finance/Patient Access Services JHS Accounts Payable and Accrual Process Audit Accounts Payable Revenue Cycle Write-off and Contractual Revenue Cycle Adjustments Audit Transplant Audit Transplant Malpractice & Claims Management Audit Risk Management Completed: On-track: of Concerns: Prior Audit Observation Status as of December 31, 2014 Fiscal Year Audit Report Name Area/Department Total # of Observations Status of Observations % 25% 58% 0% Management has completed action plans and Internal Audit is satisfied with the action(s) taken to address the risk identified. Management expects that the action plan(s) will be completed on time, or the due date has been extended for good reasons. Action plans are not expected to be completed on time, no other action was taken to mitigate the risk, or no extension of the due date was requested/discussed with Internal Audit. Total %

46 3. Adjournment

47 PURCHASING AND FACILITIES SUBCOMMITTEE AGENDA January 15, 2015

48 PUBLIC HEALTH TRUST BOARD OF TRUSTEES PURCHASING AND FACILITIES SUBCOMMITTEE AGENDA Thursday, January 15, 2015 Following the Audit and Compliance Subcommittee Meeting Jackson Memorial Hospital West Wing Board Room Purchasing and Facilities Subcommittee Marcos J. Lapciuc, Chairperson Joe Arriola, Vice Chairperson Mojdeh L. Khaghan Ralph G. Patino Carlos Trujillo Public Health Trust Rules Any person making impertinent or slanderous remarks or who becomes boisterous while addressing the committee, shall be barred from further audience before the committee, unless permission to continue or again address the committee be granted by the Chairperson. No clapping, applauding, heckling or verbal outbursts in support or opposition to a speaker or his or her remarks shall be permitted. No signs or placards shall be allowed in the Board Room. Persons exiting the Board Room shall do so quietly. The use of cell phones in the Board Room is not permitted. Ringers must be set to silent mode to avoid disruption of proceedings. Individuals, including those seated around the board table, must exit the Board Room to answer incoming cell phone calls. 1. Meeting Call To Order (a) Previous subcommittee meeting minutes (December 11, 2014) Motion to approve the previous subcommittee meeting minutes Marcos J. Lapciuc, Chairperson Page 1 of 4

49 PURCHASING AND FACILITIES SUBCOMMITTEE AGENDA January 15, Reports (a) Purchasing (1) Purchasing Report as of January 2015 Presented by Rosa Costanzo, Vice President and Chief Procurement Officer, Strategic Sourcing and Supply Chain Management Division (2) Competitive Contracts Awarded or Renewed Under the Chief Procurement Officer Authority as of December 2014 Presented by Rosa Costanzo, Vice President and Chief Procurement Officer, Strategic Sourcing and Supply Chain Management Division (3) Non-Competitive Contracts Awarded or Renewed Under $250,000 and Modifications Allowed Under the Chief Procurement Officer Authority as of December 2014 Presented by Rosa Costanzo, Vice President and Chief Procurement Officer, Strategic Sourcing and Supply Chain Management Division (4) Key Performance Indicators (KPI) for Procurement Presented by Rosa Costanzo, Vice President and Chief Procurement Officer, Strategic Sourcing and Supply Chain Management Division (1) Monthly KPI as of December 2014 (2) Procurement KPI Report Card (January 2014 to December 2014) (5) Direct Payments as of December 2014 Presented by Rosa Costanzo, Vice President and Chief Procurement Officer, Strategic Sourcing and Supply Chain Management Division (b) Facilities (1) Construction Projects Presentation Presented by Isa Nunez, Vice President, Facilities Design and Construction, and David Clark, Corporate Director, Capital Projects Page 2 of 4

50 PURCHASING AND FACILITIES SUBCOMMITTEE AGENDA January 15, 2015 (c) Property Management (1) Lease Agreement with IMCMV Holdings, Inc. for Park Plaza West, Suite E Presented by Madeline Valdes, Corporate Director, Property Management (2) Lease Agreement with Dade County Federal Credit Union at Miami Transplant Institute 3. Resolutions Recommended to be Accepted Presented by Madeline Valdes, Corporate Director, Property Management (a) Resolution authorizing and approving award of bids and proposals, waiver of bids, and other purchasing actions for January 2015, in accordance with the Public Health Trust s Procurement Policy, Resolution No. PHT 10/ Sponsored by Rosa Costanzo, Vice President and Chief Procurement Officer, Strategic Sourcing and Supply Chain Management Division. Motion to accept the resolution with a favorable recommendation to the Fiscal Committee Marcos J. Lapciuc, Chairperson (b) Resolution authorizing the President or his designee to enter into a Lease Agreement with IMCMV Holdings, Inc., a Florida corporation for the rental of five thousand five hundred forty (5,540) square feet of retail space and three hundred seventy-seven (377) square feet of outdoor license area situated at 1611 Northwest 12th Avenue, Park Plaza West Garage facility, Suite E, for a period of twelve (12) years commencing on the effective date of the Lease Agreement, with two (2) five year options to extend, for an annual rent payment of Three Hundred Twenty-Three Thousand Thirty-Seven Dollars ($323,037), with an operating charge in the amount of Nineteen Thousand Two Dollars ($19,002), with an annual increase of two percent (2%) or Consumer Price Index, with greater of annual base rent or eight percent (8%) of gross sales Sponsored by Madeline Valdes, Corporate Director, Property Management Motion to accept the resolution with a favorable recommendation to the Fiscal Committee Marcos J. Lapciuc, Chairperson Page 3 of 4

51 PURCHASING AND FACILITIES SUBCOMMITTEE AGENDA January 15, Resolutions Recommended to be Accepted cont 4. Adjournment (c) Resolution authorizing the President or his designee to enter into a Lease Agreement with Dade County Federal Credit Union, a Florida not-for-profit corporation for the rental of three thousand (3,000) square feet of retail space situated at 1801 Northwest 9th Avenue, Miami Transplant Building, Suite C, for a period of five (5) years commencing on the effective date of the Lease Agreement, with two (2) five year options to extend, for an annual rent payment of Ninety Thousand Dollars ($90,000), with an operating charge in the amount of Nine Thousand Nine Hundred Sixty Dollars ($9,960), with an annual increase of three percent (3%) or Consumer Price Index Sponsored by Madeline Valdes, Corporate Director, Property Management Motion to accept the resolution with a favorable recommendation to the Fiscal Committee Marcos J. Lapciuc, Chairperson Page 4 of 4

52 1. Meeting Call To Order

53 PURCHASING AND FACILITIES SUBCOMMITTEE MEETING MINUTES Thursday, December 11, 2014 Followed the Learning and Innovation Subcommittee Meeting Jackson Memorial Hospital West Wing Board Room First Floor 1611 N. W. 12 th Avenue Miami, FL Purchasing and Facilities Subcommittee Marcos J. Lapciuc, Chairperson Joe Arriola, Vice Chairperson Mojdeh L. Khaghan Ralph G. Patino Carlos Trujillo Members Present: Member(s) Excused: Mojdeh L. Khaghan, Ralph G. Patino, and Carlos Trujillo Marcos J. Lapciuc and Joe Arriola PHT Board of Trustees Present: Darryl K. Sharpton and Irene Lipof In addition to the Board of Trustees, the following staff members, University of Miami Miller School of Medicine (UMMSOM) Representative, and Assistant Miami-Dade County Attorneys were present: Carlos A. Migoya, Don S. Steigman, Rosa Costanzo, Richard Klass, Matthew Pinzur, Isa Nunez, and Peter Paige, M.D.; Steven Falcone, M.D., UMMSOM Representative; and Eugene Shy, Jr., Jeffrey Poppel, Laura Llorente, and Tania Carreno-Mederos, Assistant Miami-Dade County Attorneys 1. Meeting Call to Order Mojdeh L. Khaghan, Member of the Purchasing and Facilities Subcommittee at 10:20 a.m. (a) Previous subcommittee meeting minutes (November 19, 2014) Motion to approve the previous subcommittee meeting minutes Mojdeh L. Khaghan, Member, Purchasing and Facilities Subcommittee Ralph G. Patino moved approval; seconded by Carlos Trujillo, and carried without dissent. Page 1 of 2

54 PURCHASING AND FACILITIES SUBCOMMITTEE MEETING MINUTES December 11, Reports (a) Purchasing With regards to agenda items 2 (a) (1) to (5), Rosa Costanzo, Vice President and Chief Procurement Officer, Strategic Sourcing and Supply Chain Management Division reported that information regarding the items presented were discussed in detail at individual meetings with members of the PHT Board of Trustees. (1) Competitive Contracts Awarded or Renewed Under the Chief Procurement Officer Authority as of November 2014 A detailed copy of the report was included with the agenda. (2) Non-Competitive Contracts Awarded or Renewed Under $250,000 and Modifications Allowed Under Chief Procurement Officer Authority as of November 2014 A detailed copy of the report was included with the agenda. (3) Key Performance Indicators (KPI) for Procurement 1. Monthly KPI as of November Procurement KPI Report Card (December 2013 to November 2014) A detailed copy of the reports was included with the agenda. (4) Direct Payments as of November 2014 A detailed copy of the report was included with the agenda. (5) Vendor and Contract Performance Monitoring Report (b) Facilities 1. Contract Evaluation Performance Summary 2. Summary of Evaluation Received A detailed copy of the reports was included with the agenda. (1) Construction Projects Presentation Isa Nunez, Vice President, Facilities Design and Construction presented an update and shared illustrations regarding the interior and exterior hardening project at the Ryder Trauma Center. The project is currently on schedule with anticipated date of completion in September The Subcommittee will be kept informed as the project continues to move forward. Ms. Khaghan stated that the Subcommittee is looking forward to the new and improved Ryder Trauma Center. 3. Adjournment Mojdeh L. Khaghan, Member of the Purchasing and Facilities Subcommittee at 10:29 a.m. Meeting Minutes Prepared by Ivenette Cobb-Black Executive Assistant Public Health Trust Board of Trustees Page 2 of 2

55 2. Reports

56 2 (a) Purchasing

57 PUBLIC HEALTH TRUST BOARD OF TRUSTEES PURCHASING REPORT January 15, 2015 TO: FROM: PUBLIC HEALTH TRUST BOARD OF TRUSTEES PROCUREMENT MANAGEMENT DEPARTMENT The following recommendations are made in accordance with the Trust s Procurement Policy and it s implementing Procurement Regulation. This report includes competitively solicited contract awards over $3,000,000, waivers of formal competition over $250,000 and other categories for Board approval as prescribed by the Procurement Regulation. The entire report has been screened and assembled by the Procurement Management Department with the direct participation of the Directors and staff, all subject to review by the Chief Procurement Officer, consultation with the Executive Staff and the President, and reviewed for legal sufficiency by the County Attorney s Office. SECTION I. AWARDS UNDER INVITATIONS TO BID (ITB s) This section consists of awards under competitively solicited Invitations to Bid (ITB s) over $3,000,000. No items to report. SECTION II. AWARDS UNDER REQUESTS FOR PROPOSALS (RFP s) This section consists of awards under competitively solicited Requests for Proposals (RFP s) over $3,000,000. No items to report. SECTION III. AWARDS UNDER THE COMPETITIVELY SOLICITED CONTRACTS OF OTHER PUBLIC PROCUREMENT ENTITIES This section consists of awards over $3,000,000 under competitively solicited ( ITB, RFP or equivalent) contracts of other public and nonprofit entities. No items to report. SECTION IV. AWARDS UNDER GROUP PURCHASING ORGANIZATION ( GPO ) CONTRACTS This section consists of awards over $3,000,000 under Group Purchasing Organization ( GPO ) contracts. GPOs are organizations that aggregate the purchasing volume of their members consisting of hospitals and other health care providers to leverage discounts with manufacturers, distributors and other vendors to realize administrative savings and efficiencies. The Trust s GPO is MedAssets. No items to report. SECTION V. AWARDS UNDER A WAIVER OF FORMAL COMPETITION This section consists of awards over $250,000 without the formal solicitation of competitive bids or proposals. All award recommendations in this section have the approval of the President, are based on a finding that the waiver of competitive bidding is in the best interests of the Public Health Trust, and require a two-thirds affirmative vote of the Trustees present for approval. A. Sole Source No items to report. January 2015 PHT Board of Trustees 1

58 B. Physician s Preference Staff requests a waiver of formal competition for the contract items listed in this category because a physician and clinician have requested the particular item without which the physician and clinician cannot successfully and safely render patient care. 1. (783817, JFJ) The Perioperative Services Department requests contract awards to Depuy/Synthes Spine, a Division of Johnson & Johnson, Inc. ( Depuy/Synthes ) and Medtronic Sofamor Danek USA, Inc. ( Medtronic ) for a period of one year for the continued provision of spinal implant products and related accessories. (Ongoing purchase). Depuy/Synthes Spine: Medtronic Sofamor Danek USA, Inc.: $5,012,767 (For One Year) Total approved funding: $5,012,767 Background Depuy/Synthes and Medtronic will continue to provide to the Trust spinal implant products, generally used to fuse the spine in the neck and lower back. As part of a greater initiative to identify additional saving opportunities for the Trust without limiting product choices, procurement has conducted discussions with surgeons relative to their use of these products. The resulting feedback was that continued utilization of the spine products provided by Depuy/Synthes and Medtronic was preferred, as these products offer the physician better surgical choices. The Physicians utilize these vendors products to meet the specific needs of the patient, and this has resulted in different levels of spend between vendors. As a result, for the one year contract term, the projected spend with Depuy/Synthes is $3,030,178 and with Medtronic is $1,982,589. Some of the products offered by the two vendors are similar but not exactly alike. The Physicians make their choices based on different technology types (different types of instrumentation used with spinal implant products) suited to both physician s and patient s needs. The main focus of this initiative was to standardize on price in a given product category between the vendors. To this end, procurement entered into negotiations with these two current vendors, achieving reductions by line item across the majority of vendor products to realize standardized pricing. The negotiated price reduction is effective immediately after both contracts are executed. Depuy/Synthes pricing reflects an estimated $261,139 in savings. The pricing from Medtronic reflects approximately $143,769 in savings. The overall savings achieved through this process represents a combined 7.47 percent reduction in price based on prior paid price. Combined savings over the one-year period is estimated at $404,909. The dollars requested for each vendor have been capped and are stated as a maximum contract value in the individual agreements. ECRI and Broadjump reported that the new pricing provided by these vendors falls within the average competitive price point of the ECRI Price Guide and Broadjump Auto Price Checker databases. In providing an evaluation of the vendors performance during the current contract year, the Perioperative Services Division has reported the following: The overall service meets standard There have been no complaints from patients or employees regarding these supplies The vendor meets all requirements for the contracted service/supply Recommendation After review and discussion of the information presented, the Perioperative Services and Procurement Management Departments have determined that it would be in the best interest of the Trust to award physician preference contracts to Depuy/Synthes and Medtronic for the provision of spinal implant products and related accessories. The underlying contracts can be terminated for convenience with a thirty (30) day notice and include UAP and OIG Provisions. January 2015 PHT Board of Trustees 2

59 A bid waiver justification has been provided and Conflict of Interest Declarations signed by A. Panos, Professor of Surgery for JHS, Tomas A. Salerno M.D., Chief Division of Cardiothoracic Surgery, Handel Robinson, M.D., Assistant Clinical Professor, Vascular Surgery, Jorge Rey M.D., Assistant Clinical Professor, Vascular Surgery, Eliot Rosenkranz, M.D., Professor of Surgery, Pediatric Surgery, Silvia Scandar, Administrator, Medical Hospital Center, Perioperative Services, Jackson Memorial Hospital, and Alexander Raecke, Account Director, Depuy/Synthes, and Chip Lomel, Director of Contracts, Medtronic, with no reported disclosures. (M. Garcia). 2. ( JFJ) The Perioperative Services Department, Jackson Memorial Hospital, requests a contract award to Covidien Public Limited Company ( Covidien ) for a period of one year for the provisions of surgical mesh biomaterials specialized in the treatment of soft tissue procedures (Ongoing purchase). Covidien Public Limited Co.: $405,000 (For one year) Total approved funding: $405,000 Background Covidien provides the Trust with surgical mesh biomaterials, primarily used to assist in the treatment of open and laparoscopic hernia repair surgical procedures. These products are intended to repair protrusions in the abdominalcavity caused by a combination of pressure and opening or weakness of muscle or connective tissue. The pressure pushes an organ or tissue through the opening or weak spot. The main components of these products are designed to play a role similar to that of the body s extracellular matrix, and are inserted in the affected area to help support organized tissue growth and reinforcement. Covidien has established itself as a market leader in hernia repair, developing new products that reinforce established standards of care, while lowering supply cost to the Trust. It offers Permacol Surgical Implants, a porcine dermal collagen implant from which weakened tissue is removed so that a new, cellular collagen matrix is cross linked to establish dimensional stability through the body s wound healing process; Symbotext Composite Mesh, a nonabsorbable implant designed to minimize tissue attachment to the device in case of direct contact with the viscera, allowing for use in both open and laparoscopic ventral hernia repairs, and soft tissue deficiencies; and Pro Grip, a proprietary, bio-integrative synthetic tissue scaffold which is designed to play a role similar to that of the body's cellular matrix, supporting organized tissue reinforcement and long term healing. The device is designed for repair and reinforcement in a variety of soft tissue procedures. The requested amount of $405,000 reflects a cost avoidance of $68,850 for the cost of medical/surgical consumables. In providing an evaluation of Covidien performance during the current contract year, the Perioperative Services Department has reported the following: The overall service meets standard There have been no complaints from patients or employees regarding these supplies The vendor meets all requirements for the contracted service/supply In accordance with our Contractor Due Diligence Review, Covidien Public Limited Co has provided Sworn/ Notarized Statements to the Trust s Procurement Management Department that: (1) No Lawsuits have been filed against the Company within the five(5) years prior to submittal of a bid or proposal to the Trust; (2) The companies have not defaulted in the five (5) years prior to bid or proposal submittal to the Trust; (3) the companies have not been debarred not have the firms received formal notices of on-compliance or non-performance in the five (5) years prior to proposal submittals to the Trust. ECRI and Broadjump have reported that the new pricing provided by Covidien falls within the average and above average competitive price point for their respective databases for these products. January 2015 PHT Board of Trustees 3

60 Recommendation In the best interest of the Trust, the Perioperative Department recommends an award to Covidien for the provisions of surgical mesh biomaterials specialized in the treatment of soft tissue procedures. This contract can be terminated for convenience with a thirty (30) day notice and includes UAP and OIG provisions. A bid waiver justification has been provided and Conflict of Interest Declarations signed by A. Panos, Professor of Surgery for JHS, Tomas A. Salerno M.D., Chief Division of Cardiothoracic Surgery, Handel Robinson, M.D., Assistant Clinical Professor, Vascular Surgery, Jorge Rey M.D., Assistant Clinical Professor, Vascular Surgery, Eliot Rosenkranz, M.D., Professor of Surgery, Pediatric Surgery, Ana Victoria Sanchez, Administrator, Medical Hospital Center, Jackson Memorial Hospital, and, Mike Trovato, Director of Contracting, Covidien, with no reported disclosures. (M. Garcia). C. Standardization Items in this category have been established as the Trust standard. No items to report. D. Non-Competitive Cooperative Purchasing This subsection consists of awards under the contracts of other public entities that were not competitively solicited. No items to report. E. Miscellaneous Bid Waiver This subsection consists of awards not falling in the other categories of waiver of formal competition but where waiver is deemed to be in the best interests of the Trust. No items to report. SECTION VI. OPTIONS-TO-RENEW AND CONTRACT MODIFICATIONS FOR CONTRACTS THAT WERE COMPETITIVELY SOLICITED This section refers to existing contracts that were competitively bid ( ITB or RFP ) at their origin and consists of either (a) the exercise of established options to renew or (b) the execution of contract modifications for which the Procurement Policy requires prior Board approval. No items to report. SECTION VII. OPTIONS-TO-RENEW AND CONTRACT MODIFICATIONS FOR CONTRACTS THAT WERE AWARDED UNDER A WAIVER OF FORMAL COMPETITION This section refers to existing contracts that were not competitively bid at their origin and consists of either (a) the exercise of established options-to renew or (b) the execution of contract modifications for which the Procurement Policy requires prior Board approval. All contracts in this section are renewals not previously authorized by the Board have the written approval of the President, are based on a finding that the waiver of full and competitive bidding is in the best interest of the Public Health Trust, and require a two-thirds affirmative vote of the Trustees present for approval. No items to report. January 2015 PHT Board of Trustees 4

61 SECTION VIII. MISCELLANEOUS This section consists of procurement actions that require Board approval not included under any other section of the Purchasing Report. SECTION VIII. MISCELLANEOUS This section consists of procurement actions that require Board approval not included under any other section of the Purchasing Report. 3. ( TC) The Facilities Design and Construction and Procurement Management Departments request ratification of this one-time emergency procurement from HITT Contracting, Inc., under the "Emergency Procurement" provisions of the Procurement Regulation for required renovations needed to replace and install new cardiac catheterization lab equipment in Cath. Lab #2. HITT Contracting, Inc.: $481,145 (One-time) Total Funding Requested: $481,145 Background Due to a spontaneous sprinkler head burst in Cath. Lab #2, the cardiac catheterization lab equipment was permanently damaged and needed to be replaced immediately to avoid further interruption and compromising the delivery of services to Trust patient. This was deemed an emergency given that, of the three additional existing adult catheterization labs, only one could perform peripheral cases, which could have potentially caused scheduling inefficiencies and a delay in patient care. JMH Administration contacted HITT Contracting, Inc., to perform necessary mechanical, electrical, and plumbing renovations to meet code and AHCA regulations for the new catheterization lab equipment. The funding amount requested of $481,145 includes a $50,000 contingency allowance to address any unforeseen conditions or owner-requested changes that may arise during construction. Recommendation In accordance to the Procurement Regulation, the procurement was limited to services necessary to immediately address the interruption of services and minimize operational impact compromising the delivery of patient care services. An emergency request for the replacement and installation of cardiac catheterization lab equipment and associated renovations in Cath Lab #2 was approved by Martha Garcia, JMH Director of Operations; Isa Nuñez, Vice President, Facilities Design and Construction Division; Hamilton Clark, JMH Chief Financial Officer; Alex Contreras, Senior Vice President and JMH Chief Administrative Officer; Mark Knight, Executive Vice President and JHS Chief Financial Officer; Don Steigman, Executive Vice President and JHS Chief Operating Officer; and Carlos Migoya, President and JHS Chief Executive Officer; and submitted by the Facilities Design and Construction Department. The UAP and OIG provisions apply to this one-time emergency purchase. (M. Garcia). January 2015 PHT Board of Trustees 5

62 Baxter GE Vendor Name Johnson and Johnson, Inc. MGE Architects RC Construction and Investments Siemens Medical Solutions Steris Corporation Monthly Report of Competitive Contracts Awarded or Renewed under the Chief Procurement Officer Authority in Accordance to Procurement Regulations December 2014 For Information Only (Greater than $100K) Description Medication (Vancomycin and Azactam) for the Pharmacy Department Centricity System Project for Quality and Patient Safety Department and Cath Lab Upgrades Bedside Monitors for Radiology Nursing Services Sterrad 100NX Sterilizing Plasma Units for Sterile Processing Department Architectural and Engineering Services for the Interior Renovation of the East Tower 6B Hematology/Oncology Units Interior Renovations Project for Behavioral Health Uroskop Omnia Max Radiographic Fluoroscopic System for the Main Operating Room Replacement of Surgical Table in Main Operating Room Cost Center & Director/VP Deborah Tedder 100 Peter Paige/ Kevin Andrews Martha Garcia Martha Garcia Isa Nunez Isa Nunez Martha Garcia Martha Garcia Contract Number Contract Date Contract Value Contract Term Procurement Method UAP SERV 12/11/2014 $ 600,000 1 Year SERV CAP CAP 12/23/2014 $ 674,176 One Time CAP 12/19/2014 $ 137,295 One Time CAP 12/15/2014 $ 252,602 One Time CAPS 12/10/2014 $ 169,875 One Time CAPS 12/18/2014 $ 178,013 One Time CAP 12/04/2014 $ 375,315 One Time CAP 12/01/2914 $ 347,940 One Time MedAssets Contract# PH00278 MedAssets Contract# EG170/BM06077 MedAssets Contract # MS03482 MedAssets Contract# BM0992 Miami Dade County Equitable Distribution Program ITB JE Job Order Contract MedAssets Contract# MS03232 MedAssets Contract# BM01878 Yes Yes Yes Yes Yes Yes Yes Yes 1. "MedAssets" is the Trust's primary "Group Purchasing Organization" (GPO) 2. "State Contract" and "Miami-Dade Contract" mean a contract competitively awarded by the State or County as a "cooperative contract". 3. "US Communities" means a contract competitively awarded by the U.S. Communities governmental purchasing alliance as a "cooperative contract". 4. "OTR" means "Option to Renew". 5. "Contract Value" corresponds to the fixed "Contract Term" that has been awarded or rewarded (not to future OTR's). 6. "RFP" means competitive Request for Proposals (or Qualifications) procurement process performed by the JHS Procurement Management Department. 7. "ITB" means competitive Invitation to Bid (or Quote) procurement process performed by the JHS Procurement Management Department. 8. "UAP" means User Access Program E Exclusion as per UAP program: ie, Federal Grant, etc. Yes Incorporated into the purchase as either discount on invoice or discount upfront N/A No, did not apply to procurement. Either an emergency purchase or contract was executed or extended before UAP was implemented

63 Monthly Report of Non-Competitive Contracts Awarded Under 250K and Modifications Allowed Under CPO Authority December 2014 For Information Only Vendor Comp Air Service, Co. Kratos Public Safety Security Microtek Medical, Inc. Security 101 Description Replacement of a Vacuum Pump Service Agreement for Security Equipment for Jackson Main, North, and South Hush Slush Machine for Surgical Procedures Requiring Rapid Cooling of Tissue or Organs for the Main Operating Room Security Systems repair, maintenance and installation Cost Center & Director/VP Contract Number Contract Date Contract Value Contract Term Martha Garcia Mark Aprigliano 100 Martha Garcia Mark Aprigliano Procurement Method EMER 12/24/2014 $ 16,200 One Time Emergency Yes SERV 12/02/2014 $ 30,000 1 Year Bid Waiver Yes CAP 12/29/2014 $ 241,800 One Time Sole Source Bid Waiver SERV 12/02/2014 $ 30,000 1 Year Bid Waiver Yes UAP Yes Note: "Non-competitive" procurement category includes: Sole Source, Physician's Preference, Standardization, Non-Competitive Cooperate Purchasing, and Miscellaneous Bid Waiver. UAP - User Access Program: Exempt Exclusion as per UAP program: i.e., Federal Grant, etc. Yes Incorporated into the purchase as either discount on invoice or discount upfront N/A No, did not apply to procurement. Either an emergency purchase or contract was executed or extended before UAP was implemented Legacy System Legacy system means a system including, but not limited to computer software, computer hardware, and biomedical equipment that are fully integrated into the daily operations of one or more departments or are considered strategic in nature or are unique to the provider, manufacturer, distributor, and / or provider. The Purchase of support, maintenance, upgrades, and necessary expansions of legacy systems shall not be subject to the requirements of the Procurement Regulation relating to competitive process. Vendor Description Cost Center & Director/VP Contract Number Contract Date Contract Value Contract Term Procurement Method UAP Omnicell/Macquarie Equipment Finance MedAssets Lease of 5 Anesthesia Workstation (Omnicell) SERV $ 166,803 Contract # Deborah Tedder PH /29/ Years MedAssets Lease of 17 Anesthesia workstation (Omnicell) SERV $ 544,925 Contract # for Jackson North Medical Center Andre Boyd PH00390 Yes

64 2 (a) (4) Key Performance Indicators (KPI) for Procurement

65 I. Purchase Order Activity (Monthly) a) Optiflex & Omnicell Activity: Total Buyers & Omnicell: August September October November December Grand Total Procurement KPI 2014 PO's b) 2014 PO Lines Average August September October November December Grand Total PO's 5,407 5,650 6,112 5,390 6,003 28,562 5,712 91,661 99, ,212 89, , ,701 97,140 7,828 8,203 8,965 7,613 8,495 41,104 8, , , , , , , ,682 Monthly Average Number of PO's by FTE for December = 607 Monthly Average Number of PO's Lines by FTE for December = 8,207 II. Contracting Activity (Weekly) Current Activity as of 12/31/2014 # of Projects with Approved Documents*: 16 # of Projects Pending Procurement Documents: 58 # of Contracts in Process Average # of Weekdays in Process with Pending Documents *Approved Documents Average # of Weekdays III. Previous Activity in Process with # of Contracts Pending Documents *Approved Documents 31-Dec Nov Oct Sep Aug Jul Jul Administrative May Capital / Support Services May Clinical Support Services Apr Hospitals (JNMC/JSCH/Holtz) Feb Information Technology Jan Long Term Care / Quality / Safety Jan OR / Surgery / Anesthesia Nov Pharmacy Nov Revenue Cycle Oct Total: Aug Average Lines IV. December 2014 Contracts Completed: 73 *Average cycle time for completed projects: 11 days Savings Approximately: $ 4,086,896 *Procurement process begins upon receipt of fully completed / approved documents, per Procurement Regulation

66 Procurement KPI Report Card January December 2014 Completed Contracts Jan 2014 Feb 2014 Mar 2014 Apr 2014 May 2014 Jun 2014 Jul 2014 Aug 2014 Sep 2014 Oct 2014 Nov 2014 Dec 2014 Average Number of Completed Contracts: 81 Average cycle time for completed projects Procurement process begins upon receipt of fully completed / approved documents, per Procurement Regulation Jan 2014 Feb 2014 Mar 2014 Apr 2014 May 2014 Jun 2014 Jul 2014 Aug 2014 Sep 2014 Oct 2014 Nov 2014 Dec month average cycle time for completed projects: 14 days First six months average was 13 days Last six months average was 15 days Key: 30 Days Trendline 2013 FY Trendline was 45 Days 2014 FY Trendline improved to 30 Days $1,872,192 Dec 2014 $4,086,896 $930,760 Nov 2014 $1,052,626 Oct 2014 $4,486,572 $5,820,436 $2,943,574 Sep 2014 $4,440,326 $778,525 Aug 2014 $2,110,203 Jul 2014 $2,637,333 $2,653,835 Jun 2014 $3,110,929 $3,549,722 $6,390,333 May 2014 $2,060,293 Apr 2014 $3,858,790 $9,893,138 Mar 2014 $1,220,054 $1,376,775 $1,486,876 Feb 2014 $1,898,036 $767,984 Jan 2014 $793,833 $0M $2M $4M $6M $8M $10M Total Savings for the first year of the contract: (January December 2014) Savings Annual Savings Savings For The Entire Contract Term $ 28,685,425 Total Savings Approximately: $ 41,534,615

67 Direct Payment as Approved Pursuant to Resolution No. PHT 10/ December 2014 Vendor Allen Norton & Blue, PA American Medical Foundation Armstrong Creative Consulting, Inc. Baird Consulting, Inc. Ballard Partners, Inc. Complete Consulting Services Group DGA Partners, Inc. DGL and Associates GKM Productions, Inc. Gropper and Associates, Inc. Hathaway Resources, Inc. Healthcare Transformation, LLC Hooper Lundy and Bookman, PC I and B Medical Associates, Inc. JFC Consultation Services, LLC JL Media, Inc. Kforce Inc Description Professional services for collective bargaining negotiations Review of patient records for peer review and education Community Outreach & Marketing Services Consulting services for coaching for engagement and improved performance training Professional Services: State Lobbying Services Review and assessment of parking operations Fair market value Jackson North real estate analysis Jackson South SBE Vendor Fair Regulatory compliance and Trauma certification (ACS) Consulting services Consulting Services for Credentialing Specialist, Senior Case Management, and Quality Improvement AOA legal services Emergency on-call physician agreement Consultation on suicide prevention training Advertisement: Radio Media Cerner training/supplemental staffing Leadingstar Events and Media Meeting Management Services for Robotic Surgery Conference 2015 Meredith Beattie MFM Coding and Billing, LLC On Point Strategies, LLC Robert J. Greene Salvation Army The Weinbach Group, Inc. Technical support and writing to prepare JHS Medical Home Role for partnership with Early Learning Coalition and PDM Grant Submissions for Jackson North's Roof Retrofit Services for the Fetal Therapy Program Strategic direction and organization of Managed Care payor relationships Consulting services for the Trust s applications to Department of Health for new trauma center at JSCH Adult residential services Advertising and marketing services Cost Code VP Maria Huot-Barrientos Kevin Andrews Matt Pinzur Maria Huot-Barrientos Mark Knight Mark Aprigliano Mark Knight Mark Knight 95714, Matt Pinzur Deborah Tedder Kevin Andrews 69509, Kevin Andrews Mark Knight Alan Goldsmith Kevin Andrews Matt Pinzur 100, Mike Garcia Matt Pinzur Mark Knight Patricia Sechi Mark Knight Richard Klass Kevin Andrews Matt Pinzur Paid Amount $ 73, $ 23, $ 13, $ 69, $ 19, $ 7, $ 15, $ 10, $ 7, $ 13, $ 13, $ 55, $ 200, $ 4, $ 1, $ $ 53, $ 15, $ 1, $ 4, $ 24, $ 31, $ 7, $ 58,259.12

68 2 (b) Facilities

69 2 (b) (1) Construction Projects Presentation

70 2 (c) Property Management

71 2 (c) (1) Lease Agreement with IMCMV Holdings, Inc. for Park Plaza West Suite E

72 2 (c) (2) Lease Agreement with Dade County Federal Credit Union at Miami Transplant Institute

73 3. Resolutions Recommended To Be Accepted

74 TO: FROM: Marcos J. Lapciuc, Chairperson and Members, Purchasing and Facilities Subcommittee Rosa Costanzo Vice President, Strategic Sourcing and Supply Chain Management and Chief Procurement Officer DATE: January 15, 2015 RE: January 2015 Purchasing Report Recommendation The following recommendations are made in accordance with the Trust s Procurement Regulation. These items fully support our business operations and help the organization in its efforts to provide an excellent world class patient experience. Scope This report includes competitively solicited contract awards over $3,000,000, waivers of formal competition over $250,000 and other categories for Board approval as prescribed by the Procurement Regulation. Fiscal Impact/Funding Source The items included are part of the Trust s budget. Track Record/Monitor The Procurement Management Department along with the user departments and leadership support will track and monitor the responsibilities and obligations set forth in the contracts. Background The entire report has been vetted and assembled by the Procurement Management Department with the direct participation of the Director and staff, all subject to review by the Chief Procurement Officer, consultation with the Executive Staff and the President, and reviewed for legal sufficiency by the County Attorney s Office. Request is made for approval of the Purchasing Report, consisting of the following: Vendor Amount 1. Depuy/Synthes Spine & Medtronic Sofamor Danek Dual Contracts $5,012,767 USA, Inc. (For One Year) 2. Covidien Public Limited Co. $405,000 For One Year 3. HITT Contracting, Inc. $481,145 Emergency Ratification Procurement completed an orderly administrative process with each item to bring the best value (cost, quality, and outcome) with each project. January 2015 PHT Board of Trustees 1

75 Agenda Item 3 (a) Purchasing and Facilities Subcommittee January 15, 2015 RESOLUTION NO. PHT 1/15 RESOLUTION AUTHORIZING AND APPROVING AWARD OF BIDS AND PROPOSALS, WAIVER OF BIDS, AND OTHER PURCHASING ACTIONS FOR JANUARY 2015, IN ACCORDANCE WITH THE PUBLIC HEALTH TRUST S PROCUREMENT POLICY, RESOLUTION NO. PHT 10/ (Rosa Costanzo, Vice President Strategic Sourcing and Supply Chain Management Division and Chief Procurement Officer, Jackson Health System) WHEREAS, bids and proposals were solicited, received and reviewed by staff; and WHEREAS, the Purchasing and Facilities Subcommittee met on January 15, 2015 and reviewed staff s recommendations as submitted under the PHT s Procurement Policy, Resolution No. PHT 10/12-078; and WHEREAS, the Purchasing and Facilities Subcommittee forwarded the Purchasing Report to the Fiscal Committee with a recommendation for approval for each item under the report, which is attached hereto and hereby incorporated by reference; and WHEREAS, upon his written recommendation, the President recommends that the Public Health Trust Board of Trustees (Board of Trustees) waive competitive bidding for items under the heading of Bid Waiver and Waiver of Full and Competitive Bidding in the respective Purchasing Report, finding such action to be in the best interests of the Public Health Trust; and WHEREAS, the President and Fiscal Committee recommend various other purchasing actions, as indicated in the attached Purchasing Report. NOW, THEREFORE, BE IT RESOLVED BY THE BOARD OF TRUSTEES OF THE PUBLIC HEALTH TRUST OF MIAMI-DADE COUNTY, FLORIDA, that this Board hereby authorizes and approves the award of bids and proposals and all the purchasing actions as set forth in the attached Purchasing Report, under the Public Health Trust s Procurement Policy, Resolution No. PHT 10/12-078; and finds it in the best interest of the Public Health Trust to waive competitive bidding for those items listed under the heading Bid Waiver and Waiver of Full and Competitive Bidding in the respective report; and to take such action as is necessary and authorized to implement these awards and actions. January 2015 PHT Board of Trustees 2

76 PUBLIC HEALTH TRUST BOARD OF TRUSTEES PURCHASING REPORT January 15, 2015 TO: FROM: PUBLIC HEALTH TRUST BOARD OF TRUSTEES PROCUREMENT MANAGEMENT DEPARTMENT The following recommendations are made in accordance with the Trust s Procurement Policy and it s implementing Procurement Regulation. This report includes competitively solicited contract awards over $3,000,000, waivers of formal competition over $250,000 and other categories for Board approval as prescribed by the Procurement Regulation. The entire report has been screened and assembled by the Procurement Management Department with the direct participation of the Directors and staff, all subject to review by the Chief Procurement Officer, consultation with the Executive Staff and the President, and reviewed for legal sufficiency by the County Attorney s Office. SECTION I. AWARDS UNDER INVITATIONS TO BID (ITB s) This section consists of awards under competitively solicited Invitations to Bid (ITB s) over $3,000,000. No items to report. SECTION II. AWARDS UNDER REQUESTS FOR PROPOSALS (RFP s) This section consists of awards under competitively solicited Requests for Proposals (RFP s) over $3,000,000. No items to report. SECTION III. AWARDS UNDER THE COMPETITIVELY SOLICITED CONTRACTS OF OTHER PUBLIC PROCUREMENT ENTITIES This section consists of awards over $3,000,000 under competitively solicited ( ITB, RFP or equivalent) contracts of other public and nonprofit entities. No items to report. SECTION IV. AWARDS UNDER GROUP PURCHASING ORGANIZATION ( GPO ) CONTRACTS This section consists of awards over $3,000,000 under Group Purchasing Organization ( GPO ) contracts. GPOs are organizations that aggregate the purchasing volume of their members consisting of hospitals and other health care providers to leverage discounts with manufacturers, distributors and other vendors to realize administrative savings and efficiencies. The Trust s GPO is MedAssets. No items to report. SECTION V. AWARDS UNDER A WAIVER OF FORMAL COMPETITION This section consists of awards over $250,000 without the formal solicitation of competitive bids or proposals. All award recommendations in this section have the approval of the President, are based on a finding that the waiver of competitive bidding is in the best interests of the Public Health Trust, and require a two-thirds affirmative vote of the Trustees present for approval. A. Sole Source No items to report. January 2015 PHT Board of Trustees 3

77 B. Physician s Preference Staff requests a waiver of formal competition for the contract items listed in this category because a physician and clinician have requested the particular item without which the physician and clinician cannot successfully and safely render patient care. 1. (783817, JFJ) The Perioperative Services Department requests contract awards to Depuy/Synthes Spine, a Division of Johnson & Johnson, Inc. ( Depuy/Synthes ) and Medtronic Sofamor Danek USA, Inc. ( Medtronic ) for a period of one year for the continued provision of spinal implant products and related accessories. (Ongoing purchase). Depuy/Synthes Spine: Medtronic Sofamor Danek USA, Inc.: $5,012,767 (For One Year) Total approved funding: $5,012,767 Background Depuy/Synthes and Medtronic will continue to provide to the Trust spinal implant products, generally used to fuse the spine in the neck and lower back. As part of a greater initiative to identify additional saving opportunities for the Trust without limiting product choices, procurement has conducted discussions with surgeons relative to their use of these products. The resulting feedback was that continued utilization of the spine products provided by Depuy/Synthes and Medtronic was preferred, as these products offer the physician better surgical choices. The Physicians utilize these vendors products to meet the specific needs of the patient, and this has resulted in different levels of spend between vendors. As a result, for the one year contract term, the projected spend with Depuy/Synthes is $3,030,178 and with Medtronic is $1,982,589. Some of the products offered by the two vendors are similar but not exactly alike. The Physicians make their choices based on different technology types (different types of instrumentation used with spinal implant products) suited to both physician s and patient s needs. The main focus of this initiative was to standardize on price in a given product category between the vendors. To this end, procurement entered into negotiations with these two current vendors, achieving reductions by line item across the majority of vendor products to realize standardized pricing. The negotiated price reduction is effective immediately after both contracts are executed. Depuy/Synthes pricing reflects an estimated $261,139 in savings. The pricing from Medtronic reflects approximately $143,769 in savings. The overall savings achieved through this process represents a combined 7.47 percent reduction in price based on prior paid price. Combined savings over the one-year period is estimated at $404,909. The dollars requested for each vendor have been capped and are stated as a maximum contract value in the individual agreements. ECRI and Broadjump reported that the new pricing provided by these vendors falls within the average competitive price point of the ECRI Price Guide and Broadjump Auto Price Checker databases. In providing an evaluation of the vendors performance during the current contract year, the Perioperative Services Division has reported the following: The overall service meets standard There have been no complaints from patients or employees regarding these supplies The vendor meets all requirements for the contracted service/supply Recommendation After review and discussion of the information presented, the Perioperative Services and Procurement Management Departments have determined that it would be in the best interest of the Trust to award physician preference contracts to Depuy/Synthes and Medtronic for the provision of spinal implant products and related accessories. The underlying contracts can be terminated for convenience with a thirty (30) day notice and include UAP and OIG Provisions. January 2015 PHT Board of Trustees 4

78 A bid waiver justification has been provided and Conflict of Interest Declarations signed by A. Panos, Professor of Surgery for JHS, Tomas A. Salerno M.D., Chief Division of Cardiothoracic Surgery, Handel Robinson, M.D., Assistant Clinical Professor, Vascular Surgery, Jorge Rey M.D., Assistant Clinical Professor, Vascular Surgery, Eliot Rosenkranz, M.D., Professor of Surgery, Pediatric Surgery, Silvia Scandar, Administrator, Medical Hospital Center, Perioperative Services, Jackson Memorial Hospital, and Alexander Raecke, Account Director, Depuy/Synthes, and Chip Lomel, Director of Contracts, Medtronic, with no reported disclosures. (M. Garcia). 2. ( JFJ) The Perioperative Services Department, Jackson Memorial Hospital, requests a contract award to Covidien Public Limited Company ( Covidien ) for a period of one year for the provisions of surgical mesh biomaterials specialized in the treatment of soft tissue procedures (Ongoing purchase). Covidien Public Limited Co.: $405,000 (For one year) Total approved funding: $405,000 Background Covidien provides the Trust with surgical mesh biomaterials, primarily used to assist in the treatment of open and laparoscopic hernia repair surgical procedures. These products are intended to repair protrusions in the abdominalcavity caused by a combination of pressure and opening or weakness of muscle or connective tissue. The pressure pushes an organ or tissue through the opening or weak spot. The main components of these products are designed to play a role similar to that of the body s extracellular matrix, and are inserted in the affected area to help support organized tissue growth and reinforcement. Covidien has established itself as a market leader in hernia repair, developing new products that reinforce established standards of care, while lowering supply cost to the Trust. It offers Permacol Surgical Implants, a porcine dermal collagen implant from which weakened tissue is removed so that a new, cellular collagen matrix is cross linked to establish dimensional stability through the body s wound healing process; Symbotext Composite Mesh, a nonabsorbable implant designed to minimize tissue attachment to the device in case of direct contact with the viscera, allowing for use in both open and laparoscopic ventral hernia repairs, and soft tissue deficiencies; and Pro Grip, a proprietary, bio-integrative synthetic tissue scaffold which is designed to play a role similar to that of the body's cellular matrix, supporting organized tissue reinforcement and long term healing. The device is designed for repair and reinforcement in a variety of soft tissue procedures. The requested amount of $405,000 reflects a cost avoidance of $68,850 for the cost of medical/surgical consumables. In providing an evaluation of Covidien performance during the current contract year, the Perioperative Services Department has reported the following: The overall service meets standard There have been no complaints from patients or employees regarding these supplies The vendor meets all requirements for the contracted service/supply In accordance with our Contractor Due Diligence Review, Covidien Public Limited Co has provided Sworn/ Notarized Statements to the Trust s Procurement Management Department that: (1) No Lawsuits have been filed against the Company within the five(5) years prior to submittal of a bid or proposal to the Trust; (2) The companies have not defaulted in the five (5) years prior to bid or proposal submittal to the Trust; (3) the companies have not been debarred not have the firms received formal notices of on-compliance or non-performance in the five (5) years prior to proposal submittals to the Trust. ECRI and Broadjump have reported that the new pricing provided by Covidien falls within the average and above average competitive price point for their respective databases for these products. January 2015 PHT Board of Trustees 5

79 Recommendation In the best interest of the Trust, the Perioperative Department recommends an award to Covidien for the provisions of surgical mesh biomaterials specialized in the treatment of soft tissue procedures. This contract can be terminated for convenience with a thirty (30) day notice and includes UAP and OIG provisions. A bid waiver justification has been provided and Conflict of Interest Declarations signed by A. Panos, Professor of Surgery for JHS, Tomas A. Salerno M.D., Chief Division of Cardiothoracic Surgery, Handel Robinson, M.D., Assistant Clinical Professor, Vascular Surgery, Jorge Rey M.D., Assistant Clinical Professor, Vascular Surgery, Eliot Rosenkranz, M.D., Professor of Surgery, Pediatric Surgery, Ana Victoria Sanchez, Administrator, Medical Hospital Center, Jackson Memorial Hospital, and, Mike Trovato, Director of Contracting, Covidien, with no reported disclosures. (M. Garcia). C. Standardization Items in this category have been established as the Trust standard. No items to report. D. Non-Competitive Cooperative Purchasing This subsection consists of awards under the contracts of other public entities that were not competitively solicited. No items to report. E. Miscellaneous Bid Waiver This subsection consists of awards not falling in the other categories of waiver of formal competition but where waiver is deemed to be in the best interests of the Trust. No items to report. SECTION VI. OPTIONS-TO-RENEW AND CONTRACT MODIFICATIONS FOR CONTRACTS THAT WERE COMPETITIVELY SOLICITED This section refers to existing contracts that were competitively bid ( ITB or RFP ) at their origin and consists of either (a) the exercise of established options to renew or (b) the execution of contract modifications for which the Procurement Policy requires prior Board approval. No items to report. SECTION VII. OPTIONS-TO-RENEW AND CONTRACT MODIFICATIONS FOR CONTRACTS THAT WERE AWARDED UNDER A WAIVER OF FORMAL COMPETITION This section refers to existing contracts that were not competitively bid at their origin and consists of either (a) the exercise of established options-to renew or (b) the execution of contract modifications for which the Procurement Policy requires prior Board approval. All contracts in this section are renewals not previously authorized by the Board have the written approval of the President, are based on a finding that the waiver of full and competitive bidding is in the best interest of the Public Health Trust, and require a two-thirds affirmative vote of the Trustees present for approval. No items to report. January 2015 PHT Board of Trustees 6

80 SECTION VIII. MISCELLANEOUS This section consists of procurement actions that require Board approval not included under any other section of the Purchasing Report. SECTION VIII. MISCELLANEOUS This section consists of procurement actions that require Board approval not included under any other section of the Purchasing Report. 3. ( TC) The Facilities Design and Construction and Procurement Management Departments request ratification of this one-time emergency procurement from HITT Contracting, Inc., under the "Emergency Procurement" provisions of the Procurement Regulation for required renovations needed to replace and install new cardiac catheterization lab equipment in Cath. Lab #2. HITT Contracting, Inc.: $481,145 (One-time) Total Funding Requested: $481,145 Background Due to a spontaneous sprinkler head burst in Cath. Lab #2, the cardiac catheterization lab equipment was permanently damaged and needed to be replaced immediately to avoid further interruption and compromising the delivery of services to Trust patient. This was deemed an emergency given that, of the three additional existing adult catheterization labs, only one could perform peripheral cases, which could have potentially caused scheduling inefficiencies and a delay in patient care. JMH Administration contacted HITT Contracting, Inc., to perform necessary mechanical, electrical, and plumbing renovations to meet code and AHCA regulations for the new catheterization lab equipment. The funding amount requested of $481,145 includes a $50,000 contingency allowance to address any unforeseen conditions or owner-requested changes that may arise during construction. Recommendation In accordance to the Procurement Regulation, the procurement was limited to services necessary to immediately address the interruption of services and minimize operational impact compromising the delivery of patient care services. An emergency request for the replacement and installation of cardiac catheterization lab equipment and associated renovations in Cath Lab #2 was approved by Martha Garcia, JMH Director of Operations; Isa Nuñez, Vice President, Facilities Design and Construction Division; Hamilton Clark, JMH Chief Financial Officer; Alex Contreras, Senior Vice President and JMH Chief Administrative Officer; Mark Knight, Executive Vice President and JHS Chief Financial Officer; Don Steigman, Executive Vice President and JHS Chief Operating Officer; and Carlos Migoya, President and JHS Chief Executive Officer; and submitted by the Facilities Design and Construction Department. The UAP and OIG provisions apply to this one-time emergency purchase. (M. Garcia). January 2015 PHT Board of Trustees 7

81 TO: FROM: Marcos José Lapciuc, Chairperson and Members, Purchasing and Facilities Subcommittee Madeline Valdes Corporate Director, Property Management DATE: January 15, 2015 RE: Lease Agreement with IMCMV Holdings Inc. for Park Plaza West, Suite E Recommendation Staff recommends that the Public Health Trust Board of Trustees execute a lease agreement with IMCMV Holdings Inc., a Florida corporation, for the rental of 5,540 square feet of retail space and 377 square feet of outdoor license area at Suite E of the Park Plaza West Garage. The proposed agreement is a 12-year lease with two five-year options to extend. Fiscal Impact/Funding Source The proposed annual base payment is $323,037, plus eight percent (8%) of gross sales above annual base rent. The rental charge would increase annually by two percent (2%) or the Consumer Price Index, whichever is greater. Track Record/Monitor The Property Management Division will track and monitor the responsibilities and obligations set forth in the agreement, overseen by Madeline Valdes, Corporate Director for Property Management. Background Jackson Health System initiated an invitation to bid ITB PMD (P1) for Suite E at Park Plaza West parking garage on the UM/Jackson Memorial Medical Center campus. IMCMV Holdings, Inc., a Florida corporation, was deemed the responsive and responsible bidder. The company proposed to build Pollo Tropical and Viena Pizza multi-concept food court, with construction costs estimated at $1.5 million and an estimated timeframe of approximately 120 days for completion of renovations once final plans and permits are approved. All construction costs will be paid by IMCMV Holdings, Inc.

82 Agenda Item 3 (b) Purchasing and Facilities Subcommittee January 15, 2015 RESOLUTION NO. PHT 1/15 RESOLUTION AUTHORIZING THE PRESIDENT OR HIS DESIGNEE TO ENTER INTO A LEASE AGREEMENT WITH IMCMV HOLDINGS, INC., A FLORIDA CORPORATION FOR THE RENTAL OF FIVE THOUSAND FIVE HUNDRED FORTY (5,540) SQUARE FEET OF RETAIL SPACE AND THREE HUNDRED SEVENTY-SEVEN (377) SQUARE FEET OF OUTDOOR LICENSE AREA SITUATED AT 1611 NW 12 th AVENUE, MIAMI, FL., PARK PLAZA WEST, SUITE E, FOR A PERIOD OF TWELVE (12) YEARS COMMENCING ON THE EFFECTIVE DATE OF THE LEASE AGREEMENT, WITH TWO (2) FIVE-YEAR OPTIONS TO EXTEND, FOR AN ANNUAL RENT PAYMENT OF THREE HUNDRED TWENTY-THREE THOUSAND THIRTY- SEVEN DOLLARS ($323,037), WITH AN OPERATING CHARGE IN THE AMOUNT OF NINETEEN THOUSAND TWO DOLLARS ($19,002), WITH AN ANNUAL INCREASE OF TWO (2%) PERCENT OR THE CONSUMER PRICE INDEX, WITH THE GREATER OF ANNUAL BASE RENT OR EIGHT PERCENT (8%) OF GROSS SALES (Madeline Valdes, Corporate Director, Property Management Division, Jackson Health System) WHEREAS, this Board seeks to accomplish the purposes set forth in the attached memorandum; and WHEREAS, the President, Purchasing and Facilities Subcommittee and Fiscal Committee recommend approval. NOW, THEREFORE, BE IT RESOLVED BY THE BOARD OF TRUSTEES OF THE PUBLIC HEALTH TRUST OF MIAMI-DADE COUNTY, FLORIDA, that this Board hereby authorizes the President or his designee to enter into a Lease Agreement with IMCMV Holdings

83 Agenda Item 3 (b) Purchasing and Facilities Subcommittee January 15, Page 2- Inc., a Florida corporation for the rental of five thousand five hundred forty (5,540) square feet of retail space and three hundred seventy-seven (377) square feet of outdoor license area situated at 1611 Northwest 12th Avenue, Park Plaza West Garage facility, Suite E, for a period of twelve (12) years commencing on the effective date of the lease agreement, with two (2) fiveyear options to extend, for an annual rent payment of Three Hundred Twenty-Three Thousand Thirty-Seven Dollars ($323,037), with an operating charge in the amount of Nineteen Thousand Two Dollars ($19,002), with an annual increase of two percent (2%) or Consumer Price Index, with greater of annual base rent or eight percent (8%) of gross sales, in accordance with the recommendation set forth in the agenda item attached hereto and incorporated herein by reference.

84 TO: FROM: Marcos José Lapciuc, Chairperson and Members, Purchasing and Facilities Subcommittee Madeline Valdes Corporate Director, Property Management DATE: January 15, 2015 RE: Lease Agreement with Dade County Federal Credit Union at Miami Transplant Institute Recommendation Staff recommends that the Public Health Trust Board of Trustees execute a Lease Agreement with Dade County Federal Credit Union, a Florida not-for profit corporation for the rental of 3,000 square feet of retail space known as Suite C in the Miami Transplant Institute/Highland Professional Building. The proposed lease term is five years with two five-year options to extend. Fiscal Impact/Funding Source The proposed annual base payment to the Trust is $90,000, with an annual operating charge in the amount of $9,960. The annual base payment would increase annually by three percent (3%) or the Consumer Price Index, whichever is greater. Track Record/Monitor The Property Management Division will track and monitor the responsibilities and obligations set forth in the agreement, overseen by Madeline Valdes, Corporate Director for Property Management. Background Dade County Federal Credit Union has been operating at the Miami Transplant Institute/Highland Professional Building since As the credit union has a not-for-profit status, a formal request for proposals was not necessary. In addition, the credit union proposes to upgrade the facility, with construction costs estimated at approximately $1 million. All construction costs will be paid by Dade County Federal Credit Union.

85 Agenda Item 3 (c) Purchasing and Facilities Subcommittee January 15, 2015 RESOLUTION NO. PHT 1/15 RESOLUTION AUTHORIZING THE PRESIDENT OR HIS DESIGNEE TO ENTER INTO A LEASE AGREEMENT WITH DADE COUNTY FEDERAL CREDIT UNION, A FLORIDA NOT- FOR PROFIT CORPORATION FOR THE RENTAL OF THREE THOUSAND (3,000) SQUARE FEET OF RETAIL SPACE SITUATED AT 1801 NW 9 th AVENUE, SUITE C, MIAMI TRANSPLANT BUILDING, MIAMI, FLORIDA, FOR A PERIOD OF FIVE (5) YEARS COMMENCING ON THE EFFECTIVE DATE OF THE LEASE AGREEMENT, WITH TWO (2) FIVE-YEAR OPTIONS TO EXTEND, FOR AN ANNUAL RENT PAYMENT OF NINETY THOUSAND DOLLARS ($90,000), WITH AN OPERATING CHARGE IN THE AMOUNT OF NINE THOUSAND NINE HUNDRED SIXTY DOLLARS ($9,960), WITH AN ANNUAL INCREASE OF THREE PERCENT (3%) OR THE CONSUMER PRICE INDEX (Madeline Valdes, Corporate Director, Property Management Division, Jackson Health System) WHEREAS, this Board seeks to accomplish the purposes set forth in the attached memorandum; and WHEREAS, the President, Purchasing and Facilities Subcommittee and Fiscal Committee recommend approval. NOW, THEREFORE, BE IT RESOLVED BY THE BOARD OF TRUSTEES OF THE PUBLIC HEALTH TRUST OF MIAMI-DADE COUNTY, FLORIDA, that this Board hereby authorizes the President or his designee to enter into a Lease Agreement with Dade County Federal Credit Union, a Florida not-for profit corporation for the rental of Three Thousand (3,000) square feet of retail space situated at 1801 NW 9th Avenue, Suite C, Miami Transplant Building, for a period of five (5) years commencing on the effective date of the lease agreement, with two (2) five-year options to extend, for an annual rent payment of Ninety Thousand Dollars ($90,000), with an operating charge in the amount of Nine Thousand Nine Hundred Sixty Dollars ($9,960), with an annual increase of three percent (3%) or Consumer Price Index, in accordance with the recommendation set forth in the agenda item attached hereto and incorporated herein by reference.

86 4. Adjournment

87 FISCAL COMMITTEE AGENDA January 15, 2015

88 PUBLIC HEALTH TRUST BOARD OF TRUSTEES FISCAL COMMITTEE AGENDA Thursday, January 15, 2015 Following the Purchasing and Facilities Subcommittee Meeting Jackson Memorial Hospital West Wing Board Room Fiscal Committee Mojdeh L. Khaghan, Chairperson Joe Arriola, Vice Chairperson Marcos J. Lapciuc Irene Lipof Ralph G. Patino Darryl K. Sharpton Carlos Trujillo Public Health Trust Rules Any person making impertinent or slanderous remarks or who becomes boisterous while addressing the committee, shall be barred from further audience before the committee, unless permission to continue or again address the committee be granted by the Chairperson. No clapping, applauding, heckling or verbal outbursts in support or opposition to a speaker or his or her remarks shall be permitted. No signs or placards shall be allowed in the Board Room. Persons exiting the Board Room shall do so quietly. The use of cell phones in the Board Room is not permitted. Ringers must be set to silent mode to avoid disruption of proceedings. Individuals, including those seated around the board table, must exit the Board Room to answer incoming cell phone calls. 1. Meeting Call to Order 2. Reports (a) Previous committee meeting minutes (November 19, 2014) Motion to approve the previous committee meeting minutes Mojdeh L. Khaghan, Chairperson (a) Purchasing and Facilities Subcommittee (1) Purchasing Report as of January 2015 (forwarded to the Fiscal Committee) with a favorable recommendation from the Purchasing and Facilities Subcommittee Presented by Marcos J. Lapciuc, Chairperson, Purchasing and Facilities Committee Page 1 of 3

89 FISCAL COMMITTEE AGENDA January 15, Reports cont (b) Jackson Health System Financial Statements Presented by Mark T. Knight, Executive Vice President and Chief Financial Officer (1) Combined Financial Statements as of December 2014 (2) Accounts Receivable as of December 2014 (3) Financial and Budget Tracking Status Report as of November Resolutions Recommended To Be Accepted (a) Resolution authorizing and approving award of bids and proposals, waiver of bids, and other purchasing actions for January 2015, in accordance with the Public Health Trust s Procurement Policy, Resolution No. PHT 10/ Sponsored by Rosa Costanzo, Vice President and Chief Procurement Officer, Strategic Sourcing and Supply Chain Management Division, Jackson Health System Motion to accept the resolution with a favorable recommendation to the PHT Board of Trustees Mojdeh L. Khaghan, Chairperson (b) Resolution authorizing the President or his designee to enter into a Lease Agreement with IMCMV Holdings, Inc., a Florida corporation for the rental of five thousand five hundred forty (5,540) square feet of retail space and three hundred seventy-seven (377) square feet of outdoor license area situated at 1611 Northwest 12th Avenue, Park Plaza West Garage facility, Suite E, for a period of twelve (12) years commencing on the effective date of the Lease Agreement, with two (2) five year options to extend, for an annual rent payment of Three Hundred Twenty-Three Thousand Thirty-Seven Dollars ($323,037), with an operating charge in the amount of Nineteen Thousand Two Dollars ($19,002), with an annual increase of two percent (2%) or Consumer Price Index, with greater of annual base rent or eight percent (8%) of gross sales Sponsored by Madeline Valdes, Corporate Director, Property Management Motion to accept the resolution with a favorable recommendation to the PHT Board of Trustees Mojdeh L. Khaghan, Chairperson Page 2 of 3

90 FISCAL COMMITTEE AGENDA January 15, 2015 (c) Resolution authorizing the President or his designee to enter into a Lease Agreement with Dade County Federal Credit Union, a Florida not-for-profit corporation for the rental of three thousand (3,000) square feet of retail space situated at 1801 Northwest 9th Avenue, Miami Transplant Building, Suite C, for a period of five (5) years commencing on the effective date of the Lease Agreement, with two (2) five year options to extend, for an annual rent payment of Ninety Thousand Dollars ($90,000), with an operating charge in the amount of Nine Thousand Nine Hundred Sixty Dollars ($9,960), with an annual increase of three percent (3%) or Consumer Price Index 4. Adjournment Sponsored by Madeline Valdes, Corporate Director, Property Management Motion to accept the resolution with a favorable recommendation to the PHT Board of Trustees Mojdeh L. Khaghan, Chairperson Page 3 of 3

91 1. Meeting Call To Order

92 FISCAL COMMITTEE MEETING MINUTES Wednesday, November 19, 2014 Followed the Purchasing and Facilities Subcommittee Meeting Jackson Memorial Hospital West Wing Board Room First Floor 1611 N. W. 12 th Avenue Miami, FL Fiscal Committee Mojdeh L. Khaghan, Chairperson Joe Arriola, Vice Chairperson Irene Lipof Marcos J. Lapciuc Ralph G. Patino Darryl K. Sharpton Carlos Trujillo Members Present: Mojdeh L. Khaghan, Chairperson, Darryl K. Sharpton, Ralph G. Patino, and Marcos J. Lapciuc Member(s) Excused: Joe Arriola, Irene Lipof, and Carlos Trujillo In addition to the Board of Trustees, the following staff members, University of Miami Miller School of Medicine (UMMSOM) Representative; and Assistant Miami-Dade County Attorneys were present: Carlos A. Migoya, Don S. Steigman, Isa Nunez, Matthew Pinzur, Peter Paige, M.D, Mark T. Knight, and Richard Klass; Michael Barron, M.D., UMMSOM Representative; and Jeffrey Poppel, and Laura Llorente, Assistant Miami-Dade County Attorneys 1. Fiscal Committee Meeting Call to Order Mojdeh L. Khaghan, Chairperson at 11:29 a.m. (a) Previous committee meeting minutes (October 17, 2014) Motion to approve the previous committee meeting minutes Mojdeh L. Khaghan, Chairperson Darryl K. Sharpton moved approval; seconded by Ralph G. Patino, and carried without dissent. Page 1 of 3

93 FISCAL COMMITTEE MEETING MINUTES November 19, Reports (a) Jackson Health System Combined Financial Statements September 2014 and October 2014 (Preliminary) Mark T. Knight, Executive Vice President and Chief Financial Officer presented a summary of fiscal year 2014 financial results and fiscal year 2015 performance as of October Mr. Knight reminded everyone that KPMG, external auditors for Jackson Health System (JHS) have begun the 2014 fiscal year end field work. It is anticipated that a draft of the fiscal year 2014 audited financial statements will become available in January 2015, and presenting the final audited results to the PHT Board of Trustees (PHT BOT) in February Fiscal Year 2014 Financial Results Bottom line performance was $50.9 million versus a budget totaling $11.6 million. Net gain from operations was $31.4 million versus a budget totaling $11.6 million. It was pointed out in light of restoring the 5% employee contribution for health benefits, a decline in patient volumes, and increased utilization of premium pay net gain from operations was stronger than anticipated. Cash collections exceeded prior fiscal year approximately $40 million. Days cash-on-hand for the fiscal year ended approximately 41; and days in accounts receivable for the fiscal year end was approximately 29. Performance for both day s cash-on-hand and accounts receivable exceeded best practice and far exceeded performance over the last four fiscal years. It is anticipated that the external audit results will show no changes in the profit and loss statement. Fiscal Year 2015 Financial Performance (October 2014 First Month Results) While experiencing increased patient volumes at Jackson South Community Hospital there is a continuing trend in lower patient volumes within the remaining JHS hospitals. For the month of October 2014 there was a budget totaling $200,000. The budget was exceeded by approximately $6 million. Out of the $6 million, $1.8 million was sales tax proceeds which exceeded what was projected and the remainder was due to higher than expected net revenue. Despite lower patient volumes JHS continue to experience higher net revenue and higher utilization by some of the funded categories. Continue to experience solid volumes in the Transplant Department and higher margin product lines which has attributed to keeping the net revenue higher than projected. For the first time in 18-months labor is on budget. Since August 1, 2014 JHS has on boarded approximately 800 positions which has attributed to a lower reliance on premium pay dollars. As anticipated, the migration of Medicaid has resulted in a slowdown of cash from managed care payors. Because some patients have migrated into a managed care environment it is very possible that JHS will experience some erosion in days in accounts receivable and slowdown in cash. The migration of the Medicaid process will continue to be closely monitored. Current month projection on cash collections is approximately $80 million which is approximately 5% lower than the original target. Ms. Khaghan thanked Mr. Knight and the Management Team for exceptional financial results. Ms. Khaghan expressed concern regarding the continued decrease in patient volumes and hope that in a collaborative effort with the Strategy Team there will be a focus on reducing the length of stay and increasing patient volumes as the processes continue to move forward in fiscal year Page 2 of 3

94 FISCAL COMMITTEE MEETING MINUTES November 19, 2014 Mr. Patino congratulated Mr. Knight and the entire JHS family for exceptional financial results. Mr. Patino questioned what is being done from a marketing standpoint to increase patient volumes. Matthew Pinzur, Associate Vice President, Communication and Outreach Division stated that working together with Richard Klass, Chief Strategy Officer and Laura Hunter, Senior Vice President, Business Development are assuring that business plans for every service line is developed including some of the new programs. Mr. Pinzur further stated that JHS is approximately 40-days away from launching its television campaign for Urology Services, and also targeting some of the transplant marketing in year Mr. Patino questioned if there is a strategic plan to increase patient volumes. With regards to increasing patient volumes, Don S. Steigman, Executive Vice President and Chief Operating Officer stated that there are some strategies to increase patient volumes through managed Medicare and managed care companies as well as increasing the Transplant service line. Mr. Sharpton stated that the Strategy Team has very exciting strategies that are currently in the works and are being contemplated. He reminded everyone that it was discussed to schedule a strategic session on a tri-monthly basis. Mr. Sharpton requested that Mr. Migoya schedule a strategic session during the first part of the 2015 year. (b) Jackson Health System General Obligation Bond Project Listing For purposes of disclosure, Mr. Knight presented the Committee with a summary showing the projects scheduled as part of the General Obligation Bond (GOB) budget for fiscal year Mr. Knight stated that the proposed projects will be forwarded to the PHT BOT for approval prior to expenditure through the GOB. Ms. Khaghan suggested that Isa Nunez, Vice President, Facilities Design and Construction and members of the Jackson Health System General Obligation Bond Citizen s Advisory Committee develop timelines for each project and funding so that the PHT BOT can better track the process and funding for each project. Ms. Khaghan questioned the status of hiring a Program Manager. Kenneth Robertson, Director, Procurement Construction Services stated that selection process to hire a Program Manager is ongoing. The Committee will be kept informed as the selection process continues to move forward. 4. Adjournment Mojdeh L. Khaghan, Chairperson at 11:50 a.m. Meeting Minutes Prepared by Ivenette Cobb-Black Executive Assistant Public Health Trust Board of Trustees Page 3 of 3

95 2. Reports

96 2 (a) Purchasing and Facilities Subcommittee

97 PUBLIC HEALTH TRUST BOARD OF TRUSTEES PURCHASING REPORT January 15, 2015 TO: FROM: PUBLIC HEALTH TRUST BOARD OF TRUSTEES PROCUREMENT MANAGEMENT DEPARTMENT The following recommendations are made in accordance with the Trust s Procurement Policy and it s implementing Procurement Regulation. This report includes competitively solicited contract awards over $3,000,000, waivers of formal competition over $250,000 and other categories for Board approval as prescribed by the Procurement Regulation. The entire report has been screened and assembled by the Procurement Management Department with the direct participation of the Directors and staff, all subject to review by the Chief Procurement Officer, consultation with the Executive Staff and the President, and reviewed for legal sufficiency by the County Attorney s Office. SECTION I. AWARDS UNDER INVITATIONS TO BID (ITB s) This section consists of awards under competitively solicited Invitations to Bid (ITB s) over $3,000,000. No items to report. SECTION II. AWARDS UNDER REQUESTS FOR PROPOSALS (RFP s) This section consists of awards under competitively solicited Requests for Proposals (RFP s) over $3,000,000. No items to report. SECTION III. AWARDS UNDER THE COMPETITIVELY SOLICITED CONTRACTS OF OTHER PUBLIC PROCUREMENT ENTITIES This section consists of awards over $3,000,000 under competitively solicited ( ITB, RFP or equivalent) contracts of other public and nonprofit entities. No items to report. SECTION IV. AWARDS UNDER GROUP PURCHASING ORGANIZATION ( GPO ) CONTRACTS This section consists of awards over $3,000,000 under Group Purchasing Organization ( GPO ) contracts. GPOs are organizations that aggregate the purchasing volume of their members consisting of hospitals and other health care providers to leverage discounts with manufacturers, distributors and other vendors to realize administrative savings and efficiencies. The Trust s GPO is MedAssets. No items to report. SECTION V. AWARDS UNDER A WAIVER OF FORMAL COMPETITION This section consists of awards over $250,000 without the formal solicitation of competitive bids or proposals. All award recommendations in this section have the approval of the President, are based on a finding that the waiver of competitive bidding is in the best interests of the Public Health Trust, and require a two-thirds affirmative vote of the Trustees present for approval. A. Sole Source No items to report. January 2015 PHT Board of Trustees 1

98 B. Physician s Preference Staff requests a waiver of formal competition for the contract items listed in this category because a physician and clinician have requested the particular item without which the physician and clinician cannot successfully and safely render patient care. 1. (783817, JFJ) The Perioperative Services Department requests contract awards to Depuy/Synthes Spine, a Division of Johnson & Johnson, Inc. ( Depuy/Synthes ) and Medtronic Sofamor Danek USA, Inc. ( Medtronic ) for a period of one year for the continued provision of spinal implant products and related accessories. (Ongoing purchase). Depuy/Synthes Spine: Medtronic Sofamor Danek USA, Inc.: $5,012,767 (For One Year) Total approved funding: $5,012,767 Background Depuy/Synthes and Medtronic will continue to provide to the Trust spinal implant products, generally used to fuse the spine in the neck and lower back. As part of a greater initiative to identify additional saving opportunities for the Trust without limiting product choices, procurement has conducted discussions with surgeons relative to their use of these products. The resulting feedback was that continued utilization of the spine products provided by Depuy/Synthes and Medtronic was preferred, as these products offer the physician better surgical choices. The Physicians utilize these vendors products to meet the specific needs of the patient, and this has resulted in different levels of spend between vendors. As a result, for the one year contract term, the projected spend with Depuy/Synthes is $3,030,178 and with Medtronic is $1,982,589. Some of the products offered by the two vendors are similar but not exactly alike. The Physicians make their choices based on different technology types (different types of instrumentation used with spinal implant products) suited to both physician s and patient s needs. The main focus of this initiative was to standardize on price in a given product category between the vendors. To this end, procurement entered into negotiations with these two current vendors, achieving reductions by line item across the majority of vendor products to realize standardized pricing. The negotiated price reduction is effective immediately after both contracts are executed. Depuy/Synthes pricing reflects an estimated $261,139 in savings. The pricing from Medtronic reflects approximately $143,769 in savings. The overall savings achieved through this process represents a combined 7.47 percent reduction in price based on prior paid price. Combined savings over the one-year period is estimated at $404,909. The dollars requested for each vendor have been capped and are stated as a maximum contract value in the individual agreements. ECRI and Broadjump reported that the new pricing provided by these vendors falls within the average competitive price point of the ECRI Price Guide and Broadjump Auto Price Checker databases. In providing an evaluation of the vendors performance during the current contract year, the Perioperative Services Division has reported the following: The overall service meets standard There have been no complaints from patients or employees regarding these supplies The vendor meets all requirements for the contracted service/supply Recommendation After review and discussion of the information presented, the Perioperative Services and Procurement Management Departments have determined that it would be in the best interest of the Trust to award physician preference contracts to Depuy/Synthes and Medtronic for the provision of spinal implant products and related accessories. The underlying contracts can be terminated for convenience with a thirty (30) day notice and include UAP and OIG Provisions. January 2015 PHT Board of Trustees 2

99 A bid waiver justification has been provided and Conflict of Interest Declarations signed by A. Panos, Professor of Surgery for JHS, Tomas A. Salerno M.D., Chief Division of Cardiothoracic Surgery, Handel Robinson, M.D., Assistant Clinical Professor, Vascular Surgery, Jorge Rey M.D., Assistant Clinical Professor, Vascular Surgery, Eliot Rosenkranz, M.D., Professor of Surgery, Pediatric Surgery, Silvia Scandar, Administrator, Medical Hospital Center, Perioperative Services, Jackson Memorial Hospital, and Alexander Raecke, Account Director, Depuy/Synthes, and Chip Lomel, Director of Contracts, Medtronic, with no reported disclosures. (M. Garcia). 2. ( JFJ) The Perioperative Services Department, Jackson Memorial Hospital, requests a contract award to Covidien Public Limited Company ( Covidien ) for a period of one year for the provisions of surgical mesh biomaterials specialized in the treatment of soft tissue procedures (Ongoing purchase). Covidien Public Limited Co.: $405,000 (For one year) Total approved funding: $405,000 Background Covidien provides the Trust with surgical mesh biomaterials, primarily used to assist in the treatment of open and laparoscopic hernia repair surgical procedures. These products are intended to repair protrusions in the abdominalcavity caused by a combination of pressure and opening or weakness of muscle or connective tissue. The pressure pushes an organ or tissue through the opening or weak spot. The main components of these products are designed to play a role similar to that of the body s extracellular matrix, and are inserted in the affected area to help support organized tissue growth and reinforcement. Covidien has established itself as a market leader in hernia repair, developing new products that reinforce established standards of care, while lowering supply cost to the Trust. It offers Permacol Surgical Implants, a porcine dermal collagen implant from which weakened tissue is removed so that a new, cellular collagen matrix is cross linked to establish dimensional stability through the body s wound healing process; Symbotext Composite Mesh, a nonabsorbable implant designed to minimize tissue attachment to the device in case of direct contact with the viscera, allowing for use in both open and laparoscopic ventral hernia repairs, and soft tissue deficiencies; and Pro Grip, a proprietary, bio-integrative synthetic tissue scaffold which is designed to play a role similar to that of the body's cellular matrix, supporting organized tissue reinforcement and long term healing. The device is designed for repair and reinforcement in a variety of soft tissue procedures. The requested amount of $405,000 reflects a cost avoidance of $68,850 for the cost of medical/surgical consumables. In providing an evaluation of Covidien performance during the current contract year, the Perioperative Services Department has reported the following: The overall service meets standard There have been no complaints from patients or employees regarding these supplies The vendor meets all requirements for the contracted service/supply In accordance with our Contractor Due Diligence Review, Covidien Public Limited Co has provided Sworn/ Notarized Statements to the Trust s Procurement Management Department that: (1) No Lawsuits have been filed against the Company within the five(5) years prior to submittal of a bid or proposal to the Trust; (2) The companies have not defaulted in the five (5) years prior to bid or proposal submittal to the Trust; (3) the companies have not been debarred not have the firms received formal notices of on-compliance or non-performance in the five (5) years prior to proposal submittals to the Trust. ECRI and Broadjump have reported that the new pricing provided by Covidien falls within the average and above average competitive price point for their respective databases for these products. January 2015 PHT Board of Trustees 3

100 Recommendation In the best interest of the Trust, the Perioperative Department recommends an award to Covidien for the provisions of surgical mesh biomaterials specialized in the treatment of soft tissue procedures. This contract can be terminated for convenience with a thirty (30) day notice and includes UAP and OIG provisions. A bid waiver justification has been provided and Conflict of Interest Declarations signed by A. Panos, Professor of Surgery for JHS, Tomas A. Salerno M.D., Chief Division of Cardiothoracic Surgery, Handel Robinson, M.D., Assistant Clinical Professor, Vascular Surgery, Jorge Rey M.D., Assistant Clinical Professor, Vascular Surgery, Eliot Rosenkranz, M.D., Professor of Surgery, Pediatric Surgery, Ana Victoria Sanchez, Administrator, Medical Hospital Center, Jackson Memorial Hospital, and, Mike Trovato, Director of Contracting, Covidien, with no reported disclosures. (M. Garcia). C. Standardization Items in this category have been established as the Trust standard. No items to report. D. Non-Competitive Cooperative Purchasing This subsection consists of awards under the contracts of other public entities that were not competitively solicited. No items to report. E. Miscellaneous Bid Waiver This subsection consists of awards not falling in the other categories of waiver of formal competition but where waiver is deemed to be in the best interests of the Trust. No items to report. SECTION VI. OPTIONS-TO-RENEW AND CONTRACT MODIFICATIONS FOR CONTRACTS THAT WERE COMPETITIVELY SOLICITED This section refers to existing contracts that were competitively bid ( ITB or RFP ) at their origin and consists of either (a) the exercise of established options to renew or (b) the execution of contract modifications for which the Procurement Policy requires prior Board approval. No items to report. SECTION VII. OPTIONS-TO-RENEW AND CONTRACT MODIFICATIONS FOR CONTRACTS THAT WERE AWARDED UNDER A WAIVER OF FORMAL COMPETITION This section refers to existing contracts that were not competitively bid at their origin and consists of either (a) the exercise of established options-to renew or (b) the execution of contract modifications for which the Procurement Policy requires prior Board approval. All contracts in this section are renewals not previously authorized by the Board have the written approval of the President, are based on a finding that the waiver of full and competitive bidding is in the best interest of the Public Health Trust, and require a two-thirds affirmative vote of the Trustees present for approval. No items to report. January 2015 PHT Board of Trustees 4

101 SECTION VIII. MISCELLANEOUS This section consists of procurement actions that require Board approval not included under any other section of the Purchasing Report. SECTION VIII. MISCELLANEOUS This section consists of procurement actions that require Board approval not included under any other section of the Purchasing Report. 3. ( TC) The Facilities Design and Construction and Procurement Management Departments request ratification of this one-time emergency procurement from HITT Contracting, Inc., under the "Emergency Procurement" provisions of the Procurement Regulation for required renovations needed to replace and install new cardiac catheterization lab equipment in Cath. Lab #2. HITT Contracting, Inc.: $481,145 (One-time) Total Funding Requested: $481,145 Background Due to a spontaneous sprinkler head burst in Cath. Lab #2, the cardiac catheterization lab equipment was permanently damaged and needed to be replaced immediately to avoid further interruption and compromising the delivery of services to Trust patient. This was deemed an emergency given that, of the three additional existing adult catheterization labs, only one could perform peripheral cases, which could have potentially caused scheduling inefficiencies and a delay in patient care. JMH Administration contacted HITT Contracting, Inc., to perform necessary mechanical, electrical, and plumbing renovations to meet code and AHCA regulations for the new catheterization lab equipment. The funding amount requested of $481,145 includes a $50,000 contingency allowance to address any unforeseen conditions or owner-requested changes that may arise during construction. Recommendation In accordance to the Procurement Regulation, the procurement was limited to services necessary to immediately address the interruption of services and minimize operational impact compromising the delivery of patient care services. An emergency request for the replacement and installation of cardiac catheterization lab equipment and associated renovations in Cath Lab #2 was approved by Martha Garcia, JMH Director of Operations; Isa Nuñez, Vice President, Facilities Design and Construction Division; Hamilton Clark, JMH Chief Financial Officer; Alex Contreras, Senior Vice President and JMH Chief Administrative Officer; Mark Knight, Executive Vice President and JHS Chief Financial Officer; Don Steigman, Executive Vice President and JHS Chief Operating Officer; and Carlos Migoya, President and JHS Chief Executive Officer; and submitted by the Facilities Design and Construction Department. The UAP and OIG provisions apply to this one-time emergency purchase. (M. Garcia). January 2015 PHT Board of Trustees 5

102 2 (b) Jackson Health System Financial Statements as of December 2014

103 PUBLIC HEALTH TRUST JACKSON HEALTH SYSTEM COMBINED FINANCIAL STATEMENTS December 31, 2014

104 PUBLIC HEALTH TRUST JACKSON HEALTH SYSTEM COMBINED FINANCIAL STATEMENTS December 31, 2014 INDEX 1. Key Performance Indicators 2. Combined Balance Sheet 3. Combined Statement of Revenues, Expenses & Changes in Fund Net Assets 4. P &L 12 Month Trend Analysis 5. Combining Statement of Revenue & Expense Reflecting Allocated Corporate Overhead & Public Support Funding /Month 6. Combining Statement of Revenue & Expenses Reflecting Allocated Corporate Overhead & Public Support Funding /YTD 7. Combining Statement of Revenue & Expenses by Company 8. Combined Statement of Unrestricted/Restricted Cash Flow 9. Consolidated Portfolio Inventory Summary by Security /Account Type 10. Sales Tax Monthly Income Trend Analysis 11. Payor Mix Patient Days as % of Total Fiscal Year

105 (a) (b) (e) (f) (g) (h) (i) (j) (k) FS 1 NEW KEY PERFORMANCE INDICATORS Fiscal Year 2015 (Dollars in 000) (d) (e) (l) YTD Dec-14 Dec-14 Dec-13 $ Variance % Variance Nov-14 YTD YTD YTD $ YTD Variance % YTD Variance Benchmark Status Actual Budget Actual Budget Prior Budget Prior Actual Actual Budget 2014 Budget Prior Budget Prior JHS Financial (1) Net Patient Revenue 66,675 73,233 81,204 (6,558) (14,529) (9.0)% (17.9)% 65, , , ,400 (15,482) (39,295) (7.1)% (16.1)% (2) Other Operating Revenue 30,029 22,922 11,192 7,107 18, % 168.3% 27,784 86,796 66,918 34,958 19,878 51, % 148.3% (4) Total Operating Revenue 96,704 96,154 92, , % 4.7% 93, , , ,358 4,397 12, % 4.5% (6) Total Operating Expenses 128, , , (3,434) 0.4% 2.8% 123, , , ,767 1,247 (7,245) 0.3% (1.9)% (7) Gain and (Loss) from Operations (31,481) (32,523) (32,355) 1, (3.2)% 2.7% (30,187) (89,112) (94,755) (94,410) 5,643 5, % 5.6% (8) Total Net Non-operating Items (before GOB & Special Contributions) 32,540 32,536 30, , % 7.8% 32,542 97,648 95,559 92,063 2,089 5, % 6.1% (9) Excess of Revs Over (Under) Expenses before GOB & Special Contrib. 1, (2,165) 1,047 3,224 8,406.2% 148.9% 2,355 8, (2,347) 7,733 10, % 463.7% (10) GOB & Special Contributions 1,299 (0) 1,201 1, % 8.1% 1,143 3,747 (0) 3,046 3, % 23.0% (11) Excess of Revenues Over (Under) Expenses 2, (963) 2,345 3,321 18,835.9% 344.7% 3,497 12, ,480 11,585 1,428.5% 1,658.0% (12) Unrestricted Health Care Surtax 18,976 18,770 17, , % 8.3% 18,997 56,983 54,310 53,556 2,673 3, % 6.4% (13) Miami Dade County Unrestricted Funds 12,268 12,268 11, % 6.8% 12,268 36,805 36,805 34,475-2, % 6.8% (14) Discharged Not Final Billed (DNFB) HIM 47,330 21,000 21,049 26,330 26, % 124.9% 18,501 47,330 21,000 21,049 26,330 26, % 124.9% Financial Ratios (15) Net Patient Revenue per Adjusted Patient Day 1,508 1,638 1,769 (130) (262) (8.0)% (14.8)% 1,516 1,515 1,628 1,776 (113) (261) (7.0)% (14.7)% (16) Total Cost per Adjusted Patient Day 2,899 2,878 2,718 (20) (180) (0.7)% (6.6)% 2,849 2,821 2,827 2,719 7 (101) 0.2% (3.7)% Liquidity Indicators (17) Days Net in Receivable (2.64) (7.06) (6.9)% (15.5)% (2.64) (7.06) (6.9)% (15.5)% (18) Days (Unrestricted) Cash on Hand % 27.5% % 27.5% (19) Current Ratio % 8.3% % 8.3% (20) Cash (Unrestricted) to Debt Ratio % 31.0% % 31.0% Utilization (21) Admissions excl. Newborn 4,813 4,779 4, (54) 0.7% (1.1)% 4,434 14,133 14,473 14,175 (340) (42) (2.3)% (0.3)% (22) Observation Equivalent Days 1,447 1,342 1, % 18.0% 1,178 4,004 4,045 3,981 (41) 23 (1.0)% 0.6% Total equivalent admissions 6,260 6,121 6, % 2.7% 5,612 18,137 18,518 18,156 (381) (19) (2.1)% (0.1)% (22) Admissions % through ED 67.82% 67.88% 66.04% (0.1)% 1.8% (0.1)% 1.8% 66.49% 66.50% 67.02% 66.43% (0.5)% 0.1% (0.5)% 0.1% (23) Hospital Patient Census Days excl. Newborn 32,589 32,248 33, (681) 1.1% (2.0)% 31,809 98,118 97,139 97, % 0.2% (24) Average Length of Stay (0.02) 0.06 (0.3)% 0.9% (0.23) (0.04) (3.4)% (0.5)% (25) Outpatient Visits 24,383 24,937 23,213 (554) 1,170 (2.2)% 5.0% 23,556 78,836 77,911 75, , % 3.8% (26) JMH Number of O/R Cases 1,177 1,140 1, % 3.2% 1,102 3,479 3,538 3,535 (59) (56) (1.7)% (1.6)% (27) Overtime % of Productive Hours 3.25% 2.34% 3.63% (0.91)% 0.38% (39.1)% 10.6% 3.53% 3.73% 2.33% 3.48% (1.40)% (0.25)% (60.2)% (7.2)% FTE's (28) JHS FTE per Adjusted Occupied Bed (0.15) (0.45) (2.1)% (6.7)% (0.09) (0.33) (1.3)% (5.0)% (29) Jackson Health System FTE's 10,353 10,253 10,072 (100) (282) (1.0)% (2.8)% 10,312 10,349 10,221 10,031 (128) (317) (1.3)% (3.2)% Payor Mix Self Pay Patient Days as % of Total (30) Jackson Memorial Hospital 15.59% 15.67% 17.21% 0.08% 1.63% 0.5% 9.4% 15.41% 15.62% 15.72% 16.74% 0.10% 1.12% 0.6% 6.7% (31) Jackson North 9.01% 11.30% 10.82% 2.29% 1.81% 20.3% 16.7% 10.26% 9.49% 11.31% 11.11% 1.82% 1.62% 16.1% 14.6% (32) Jackson South 12.13% 16.62% 19.62% 4.49% 7.49% 27.0% 38.2% 13.56% 13.01% 16.63% 17.71% 3.62% 4.70% 21.8% 26.6% (33) Inpatient Charges as Percent of Total 73.69% 72.13% 72.50% -1.56% -1.19% (2.2)% (1.6)% 73.13% 72.83% 72.03% 71.40% 0.80% 1.42% 1.1% 2.0% (34) Realization Rate 18.21% 20.48% 23.54% 2.27% 5.33% 11.1% 22.6% 18.92% 18.65% 20.24% 23.26% -1.59% -4.61% (7.9)% (19.8)% Key: Positive variance or no major concerns Year-to-date numbers are ok or explained, but concern for future trend Negative variance or area of current concern Variance are Favorable (positive number) and Unfavorable (negative number)

106 Public Health Trust of Miami-Dade County (Consolidated) Combined Balance Sheet December 2014 (Amounts in thousands) Dec 14 Nov 14 Dollar Change Sep 14 Dollar Change ASSETS: Cash and Investments 141, ,994 1, ,462 (21,559) Cash and Investments Restricted 11,768 17,285 (5,517) 11, Cash and Investments Limited as to Use 83,032 31,985 51,047 3,005 80,027 Gross Patient Accounts Receivable 648, ,786 (17,662) 635,108 13,016 Allowances for Contractuals and Bad Debt (544,614) (554,347) 9,733 (535,031) (9,583) Net Accounts Receivable 103, ,439 (7,928) 100,078 3,433 Third Party Receivable 76, ,059 (108,580) 171,367 (94,888) Due From Miami-Dade County 39,631 38,007 1,625 39, Other Receivables - Restricted 4,355 4, , Inventories 25,885 25, , Prepaid Expenses and Other Current Assets 9,752 4,636 5,117 4,694 5,058 Total Current Assets 496, ,368 (62,052) 523,504 (27,187) Due From Restricted Funds (0) (0) 0 (0) (0) Cash and Investments Limited as to Use - LT 34,895 34, ,645 1,251 Cash and Investments Restricted - LT 51,628 52,498 (870) 53,226 (1,599) Capital Assets, Net 466, ,124 1, ,592 5,429 Other Assets 1,385 1,391 (6) 1,403 (18) Total Non-Current Assets 553, ,472 1, ,866 5,063 Total Assets $ 1,050,245 $ 1,110,840 $ (60,595) $ 1,072,370 $ (22,124) Current Portion of Long Term Debt 8,005 8, ,005 0 Accounts Payable and Accrued Expenses 110, ,923 (8,383) 112,225 (1,685) Accrued Salaries and Payroll Taxes Withheld 117, ,954 (974) 146,642 (28,661) Due to Other Third Party 173, ,872 (33,297) 179,898 (6,324) Due to Miami-Dade County 20,762 20, ,909 (147) Other Restricted 2,167 1, , Other Current Liabilities 34,474 55,681 (21,207) 34, Total Current Liabilities 467, ,005 (63,502) 503,429 (35,926) Long Term Debts, Excluding Current Portion 335, , , Other Liabilities 49,989 49, ,558 1,431 Total Liabilities 853, ,997 (62,953) 887,453 (34,408) NET ASSETS: Unrestricted Net Assets 14,328 5,518 8,810 2,887 11,441 Invested in Capital Assets 171, ,193 1, ,900 4,825 Restricted Net Assets 11,148 19,132 (7,985) 15,130 (3,982) Total Net Assets 197, ,843 2, ,917 12,284 Total Liabilities & Net Assets $ 1,050,245 $ 1,110,840 $ (60,595) $ 1,072,370 $ (22,124) Notes * Reserves for AR is comprised of $358.0 million in cont. adjustments, $36.0 million in charity care and $150.6 million in prov. for doubtful accounts. ** Amounts due to the University total $18 million reported in other current liab. FS-2

107 Combined Statement of Revenue, Expenses & Change in Fund Net Assets Public Health Trust of Miami-Dade County December 2014 (Amounts in thousands) Dec 14 Actual Dec 14 Budget Month of December 2014 Dec 13 Actual $ Variance Budget Prior % Variance Budget Prior Dec 14 Actual YTD Dec 14 Budget YTD 3 Months Ended December 31, 2014 Dec 13 Actual YTD Budget $ Variance Prior % Variance 64,453 71,101 78,805 (6,647) (14,351) (9)% (18)% Hospital and physician services 197, , ,519 (16,241) (39,506) (8)% (17)% (187) 0 % (100)% Community Medical Practices (681) 0 % (100)% % 14 % Primary Care Centers % 5 % 2,087 2,014 2, (7) 4 % 0 % Continuing Care (SNF) 6,670 5,925 5, % 15 % 66,675 73,233 81,204 (6,558) (14,529) (9)% (18)% Net Patient Service Revenue 204, , ,400 (15,482) (39,295) (7)% (16)% , (3,423) 0 % (100)% Division of Managed Care , (9,783) 0% (100)% 2,122 1,977 1, % 45 % Grants Revenue 5,881 5,884 5,788 (3) 93 0 % 2 % 27,897 20,945 6,294 6,952 21, % 343 % Other Operating Revenue 80,881 61,034 19,352 19,847 61, % 318 % 96,704 96,154 92, ,309 1 % 5 % Total Operating Revenue 290, , ,358 4,397 12,543 2 % 5 % 73,947 74,935 68, (5,708) 1 % (8)% Salaries & Related Costs 219, , , (14,089) 0 % (7)% 28,952 30,126 29,214 1, % 1 % Contractual and Purchased Serv. 87,977 90,919 88,016 2, % 0 % ,935 (101) 3,814 (504)% 97 % Division of Managed Care - Paid Claims ,055 (294) 9,701 (490)% 96 % 18,514 16,125 16,134 (2,389) (2,380) (15)% (15)% Supplies 52,101 47,825 47,714 (4,276) (4,387) (9)% (9)% 3,827 4,671 4, % 11 % Depreciation 11,530 13,805 12,777 2,275 1, % 10 % 1,364 1,349 1,421 (14) 57 (1)% 4 % Interest 4,100 4,048 4,230 (52) 130 (1)% 3 % 1,460 1,452 1,497 (8) 37 (1)% 2 % Other Operating Expenses 4,383 4,356 4,497 (28) 114 (1)% 3 % 128, , , (3,434) 0 % (3)% Total Operating Expenses 380, , ,767 1,247 (7,245) 0 % (2)% (31,481) (32,523) (32,355) 1, % 3 % Gain (Loss) From Operations (89,112) (94,755) (94,410) 5,643 5,298 6 % 6 % % 202 % Investment Income % 90 % 1,232 1,459 1,149 (227) 83 (16)% 7 % Other Income 3,694 4,330 3,944 (636) (250) (15)% (6)% 12,268 12,268 11, % 7 % Dade County Unrestricted Funds 36,805 36,805 34, ,330 0 % 7 % 18,976 18,770 17, ,448 1 % 8 % Unrestricted Health Care Surtax 56,983 54,310 53,556 2,673 3,427 5 % 6 % 32,540 32,536 30, ,350 0 % 8 % Total Non-Operating Gain Net 97,648 95,559 92,063 2,089 5,585 2 % 6 % 1, (2,165) 1,047 3, % (149)% Revenue & Gain in Excess of Exp. & Loss 8, (2,347) 7,733 10, % 464 % % 0 % Capital Contributions Grants and Other % 0 % (312) 0 % (71)% JM Foundation (312) 0 % (71)% 1, ,171 ( )% % Miami Dade County GOB 3, ,606 3,620 1,014 ( )% 39 % 2, (963) 2,345 3, % (345)% Revenue & Gain after Extraordinary Loss 12, ,480 11, % (1658)% Budget Prior FS-3

108 P & L 12 Month Trend Analysis Public Health Trust of Miami-Dade County December 2014 Dec 14 Nov 14 Oct 14 Sep 14 Aug 14 Jul 14 Jun 14 May 14 Apr 14 Mar 14 Feb 14 Jan 14 Inpatient Services 269, , , , , , , , , , , ,940 Ambulatory Services 96,315 93, , ,957 99,537 96,908 96, , , ,330 94,021 99,148 Gross Patient Service Revenue 366, , , , , , , , , , , ,088 Contractual Adjustments 220, , , , , , , , , , , ,870 Charity Care 26,103 24,877 30,416 27,815 28,192 24,380 24,702 26,637 29,077 29,200 28,357 29,605 Net Patient Revenue Adjustment Provision for Doubtful Accounts 52,847 46,912 48,194 18,050 46,564 39,152 35,916 36,132 37,540 42,107 38,151 44,812 Total Deductions From Revenue 299, , , , , , , , , , , ,287 Net Patient Service Revenue 66,675 65,956 71,474 (56,410) 94,671 82,939 82,234 87,326 86,056 87,558 78,712 80,801 Division of Managed Care (184) (76) (43) 1,607 2,126 2,140 3,160 2,994 3,451 Other Operating Revenue 27,897 25,792 27, ,568 6,325 9,681 6,650 6,756 7,188 5,696 6,045 6,386 Grants Revenue 2,122 1,992 1,767 4,360 1,797 2,730 2,346 1,952 1,459 2,367 1,830 1,725 Total Operating Revenue 96,704 93, , , ,717 95,306 92,837 98,160 96,843 98,781 89,580 92,362 Salaries & Related Costs 73,947 71,847 73,773 85,976 73,610 72,397 73,310 75,194 71,932 73,976 67,632 67,734 Contractual and Purchased Services 28,952 28,980 30,045 33,299 28,267 26,116 26,167 28,931 28,676 28,314 29,453 29,136 Supplies 18,514 16,218 17,369 26,841 16,879 17,441 16,034 16,158 16,038 18,697 16,339 15,413 Division of Managed Care Paid Claims (107) ,369 1,966 1,997 3,077 1,109 3,300 Interest 1,364 1,399 1, ,310 1,314 1,346 1,370 1,361 1,363 1,388 1,406 Provision for Self-Insured Claims (3,372) Public Med/Assist. Trust F. Assess Depreciation 3,827 3,911 3,792 4,910 3,952 3,981 3,860 3,959 3,917 4,095 4,123 4,242 Other Operating Expenses Total Operating Expenses 128, , , , , , , , , , , ,728 Gain (Loss) From Operations (31,481) (30,187) (27,444) (20,105) (22,873) (27,539) (30,749) (30,918) (28,566) (32,237) (31,967) (30,366) Med. Edu. and Tert. Care Fund 1,235 1,235 1,235 1,235 1,429 1,235 1,170 1,752 1,170 1,170 1,170 1,170 Interest Income - Non. Operating Unrealized Gains and Losses (1) (1) (1) 46 (1) (1) (1) (1) (1) (1) (1) (1) Other Non-Operating (3) (3) (4) (23) 7 (1,604) Dade County Unrestricted Funds 12,268 12,268 12,268 11,420 11,420 11,420 11,420 11,420 11,420 11,420 11,492 11,492 Unrestricted Health Care Surtax 18,976 18,997 19,010 18,804 18,547 18,341 19,279 20,961 18,667 18,568 22,412 18,906 TOTAL Non-Operating Gain Net 32,540 32,542 32,566 31,523 31,438 29,413 32,205 34,355 31,567 31,475 35,270 31,781 Revenue & Gain in Excess of Exp. & Loss 1,059 2,355 5,123 11,418 8,565 1,875 1,456 3,437 3,000 (762) 3,304 1,415 Capital Contributions Grants and Other JM Contributions , Miami Dade Cty. GOB 1,171 1,143 1,306 1,378 1,455 1,730 1,741 1,286 1,304 2, Revenue & Gain after Extraordinary Loss 2,358 3,497 6,429 12,796 10,020 6,266 3,622 4,723 4,304 1,776 3,951 2,394 FS-4

109 Jackson Health System Dec 2014 Actual Combining Statement of Revenue & Expense Reflecting Allocated Corporate Overhead & Public Support Funding Jackson Memorial Hospital Jackson South Jackson North Physician Services JHS Health Plan Nursing Homes Primary Care Corrections Health Services Jackson Medical Towers Total Total Gross Inpatient Revenue 206,748 22,028 38,013 3, ,796 Total Gross Outpatient Revenue 70,894 12,250 11, ,498 96,315 Total Gross Revenue 277,642 34,278 49,300 3,393 1, ,111 Total Deductions from Revenue -232,051-25,725-38,991-1,306-1, ,436 Total Net Patient Revenue 45,591 8,553 10,309 2, ,675 Other Operating Revenue 24, , ,897 Managed Care Revenue Grant Revenue 1, ,122 Total Other Operating Revenue 26, , ,029 Total Revenue 71,868 9,478 11, , ,704 Operating Expenses Salaries & Wages 46,611 3,975 4,706 1,194 1, , ,936 Benefits 10, ,012 Total Salaries & Benefits 56,639 4,812 5,674 1,376 2, , ,947 Purchased Services 14,065 1,440 2, ,322 Managed Care Paid Claims UM AOA Purchased Service 9, ,741 Total Purchased Service 23,730 1,448 2, ,073 Supplies 14,936 1,597 1, ,514 Total Direct Operating Cost 95,305 7,857 9,363 1, ,708 1,583 2, ,534 Depreciation 2, ,827 Interest 1, ,364 Self Insurance HCCB Assessment Other Operating Expense Total Other Operating Cost 5, ,651 Total Operating Expenses Before Allocations 100,410 8,807 9,838 1, ,748 1,595 2, ,185 Allocated Corporate Services: Clinical Trials Office Corporate Administration 2, ,248 Financial Services Human Resources Integrity Information Technology 3, ,698 Public Safety Revenue Cycle Management 2, ,648 Strategic Sourcing ,222 Total Allocated Corporate Services 11,203 1,347 1, ,968 Total Expenses Subject to Allocation -14,968-14,968 Total Operating Expenses Including Allocations 96,646 10,154 11,623 1, ,942 1,772 2, ,185 Excess of Operating Revenue over (under) Operating Expenses -24, ,399-2, ,481 Non Operating Revenue and Expenses Investment Income Unrestricted Health Care Surtax 18,976 18,976 Miami Dade County Unrestricted Funds 12,268 12,268 Other Income 1, ,231 JMH Foundation Total Non Operating Revenue 32, ,668 Redistribution of Revenue -5,171 2,346 2, Total Non Operating Revenue After Redistribution 27,498 2,345 2, ,668 Excess of Revenue over (under) Expenses before GOB and County Special Contributions 2,720 1,669 2, ,031-2, ,187 Miami Dade County GOB Contributions Miami Dade County Special Contributions 1,171 1,171 Total Miami Dade GOB and Special Contributions 1,171 1,171 Excess of Revenue over (under) Expenses 3,891 1,669 2, ,031-2, ,358 FS-5

110 Jackson Health System Dec 2014 YTD Actual Combining Statement of Revenue & Expense Reflecting Allocated Corporate Overhead & Public Support Funding Jackson Memorial Hospital Jackson South Jackson North Physician Services JHS Health Plan Nursing Homes Primary Care Corrections Health Services Jackson Medical Towers Total Total Gross Inpatient Revenue 618,969 64, ,901 9, ,027 Total Gross Outpatient Revenue 214,977 38,560 37,959 1,116 4, ,354 Total Gross Revenue 833, , ,860 10,465 4,742 1,094,381 Total Deductions from Revenue -690,875-78, ,347-3,796-4, ,276 Total Net Patient Revenue 143,071 24,429 29,513 6, ,105 Other Operating Revenue 70,803 2,571 3,187 2, ,445 80,881 Managed Care Revenue Grant Revenue 5, ,881 Total Other Operating Revenue 76,169 2,571 3,187 2, ,445 86,796 Total Revenue 219,240 27,000 32,699 2, ,706 1,074 1, ,900 Operating Expenses Salaries & Wages 138,454 11,678 13,395 3,680 4,652 2,148 5, ,878 Benefits 30,986 2,480 2, , , ,689 Total Salaries & Benefits 169,439 14,158 16,185 4,211 5,935 2,665 6, ,567 Purchased Services 42,809 4,055 7, ,051 2, ,990 Managed Care Paid Claims UM AOA Purchased Service 29, ,322 Total Purchased Service 71,903 4,080 7, ,069 2, ,331 Supplies 41,661 4,505 4, ,101 Total Direct Operating Cost 283,002 22,743 27,881 5, ,921 4,984 7, ,999 Depreciation 7,918 2, ,530 Interest 4, ,100 Self Insurance 1, ,660 HCCB Assessment 2, ,721 Other Operating Expense 2 2 Total Other Operating Cost 15,369 2,885 1, ,013 Total Operating Expenses Before Allocations 298,371 25,627 29,291 5, ,043 5,020 7, ,012 Allocated Corporate Services: Clinical Trials Office Corporate Administration 5, ,729 Financial Services ,197 Human Resources 2, ,808 Integrity Information Technology 10,252 1,275 1, ,436 Public Safety 1, ,162 Revenue Cycle Management 9,159 1,135 1, ,905 Strategic Sourcing 2, ,617 Total Allocated Corporate Services 33,657 3,932 5, ,558 Total Expenses Subject to Allocation -44,558-44,558 Total Operating Expenses Including Allocations 287,470 29,560 34,434 5, ,619 5,545 7, ,012 Excess of Operating Revenue over (under) Operating Expenses -68,230-2,560-1,734-2, ,914-4,471-7, ,112 Non Operating Revenue and Expenses Investment Income Unrestricted Health Care Surtax 56,983 56,983 Miami Dade County Unrestricted Funds 36,805 36,805 Other Income 3, ,692 JMH Foundation Total Non Operating Revenue 97, ,776 Redistribution of Revenue -17,358 7,437 7, ,141 Total Non Operating Revenue After Redistribution 80,411 7,434 7, ,141 97,776 Excess of Revenue over (under) Expenses before GOB and County Special Contributions 12,182 4,874 6,189-2, ,057-3,330-7, ,664 Miami Dade County GOB Contributions Miami Dade County Special Contributions 3,620 3,620 Total Miami Dade GOB and Special Contributions 3,620 3,620 Excess of Revenue over (under) Expenses 15,801 4,874 6,189-2, ,057-3,330-7, ,284 FS-6

111 Public Health Trust of Miami-Dade County Consolidated Combining Statement of Revenue & Expenses by Company Month of December 2014 (Amounts in thousands) Jackson Memorial Jackson South Jackson North Physician Services JHS Health Plan Primary Care Centers Corrections Health Services Skilled Nursing Facilities Jackson Property Management Revenue Inpatient Revenue 206,748 22,028 38, , , ,081 Outpatient Revenue 70,894 12,250 11, , ,315 94,869 Total Prior Year Actual Gross Patient Service Revenue 277,642 34,278 49, , , , ,950 Deductions From Revenue: Contractual Adjustments 166,693 20,420 32, , ,714 Provisions For Charity Care 22,751 1, ,103 25,886 Net Patient Revenue Adjustment Provision for Doubtful Accounts 42,607 4,155 6, ,847 47,147 Total Deductions From Revenue 232,051 25,725 38, , , , ,746 Net Patient Service Revenue 45,591 8,553 10, , ,675 81,204 Division of Managed Care ,433 Other Operating Revenue 24, , ,897 6,294 Grants Revenue 1, ,122 1,464 Total Operating Revenue 71,868 9,478 11, , ,704 92,395 Operating Expenses Salaries & Related Costs 56,639 4,812 5,674 1, ,435 2, ,947 68,239 Contractual and Purchased Services 23,730 1,448 2, ,073 33,148 Supplies 14,936 1,597 1, ,514 16,134 Interest 1, ,364 1,421 Depreciation 2, ,827 4,312 Other Operating Expenses 1, ,460 1,497 Total Operating Expenses 100,410 8,807 9,838 1, ,595 2,699 2, , ,751 Excess of operating revenue over (under) operating expenses (28,542) 671 1,635 (820) (116) (1,223) (2,699) (631) 244 (31,481) (32,355) Other Revenues (Expenses) Investment Income 64 (1) Unrestricted Health Care Surtax 18, ,976 17,529 Miami Dade County Unrestricted Funds 12, ,268 11,492 Other Income 1, ,232 1,149 Miami Dade County Special Contributions JM Foundation Miami Dade County GOB Contributions 1, , Total Other Revenues (expenses) 33,840 (1) ,839 31,392 Excess of revenues over (under) expenses 5, ,635 (820) (116) (1,223) (2,699) (631) 244 2,358 (963) FS-7

112 Public Health Trust Jackson Health System Combined Statement of Unrestricted / Restricted Cash Flow As of December 31, 2014 Unaudited Current Month Year to Date Year to Date December 31, 2014 December 31, 2014 September 30, 2014 Cash generated (used) by operations: Funds available for working capital/facilities improvements 2,358 $12,284 $50,662 Non cash expenses: Depreciation 3,827 11,530 49,816 Loss on disposal of capital assets (2) (4) (234) Total 6,183 23, ,244 Cash provided (used) for current assets: Decreases (increases) in: Patient Receivable and Other Third Party payor 114,885 91,243 40, Cash and Invst. Limited as to Use (51,047) (80,027) 6,080 Inventories, Prepaid Expenses and Other Receivables (5,391) (5,343) (2,370) Total 58,447 5,873 44,522 Cash provided (used) for current liabilities: Increases (decreases) in: Current Installment of Long Term Debt Accounts Payable and Accrued Expenses (9,358) (30,348) (14,121) Due to other third party (33,296) (6,470) 11,524 Other Liabilities (21,207) 154 (15,375) Other- Restricted (4,293) Total (63,503) (35,926) (21,905) Decreases (increases) in: Cash and Invst. Limited as to Use (436) (1,250) (6,321) Cash and Invst. Restricted 870 1,598 6,262 Long Term Investment Cash provided (used) for Other Assets Cash provided (used) for Long Term Liabilities: - Increases (decreases) in: - Long Term Debt (7,662) Other Liabilities 521 1,431 3,357 Total 547 1,517 (4,305) Cash provided (used) for Prop., Plant and Equipment: Purchases of Prop. Plant and Equipment (5,722) (16,955) (64,989) - - Total (5,722) (16,955) (64,989) Net Increase in Cash and Cash Equivalents (3,608) (21,315) 53,829 - Cash, beginning of period 157, , ,141 Cash, end of period 153, , ,970 FS-8

113 PUBLIC HEALTH TRUST CONSOLIDATED PORTFOLIO INVENTORY SUMMARY BY SECURITY/ACCOUNT TYPE December 31, 2014 # of Investments Description Par Value Avg. Interest Rate Market Value 1 Money Markets 612, % 612,313 1 Total Investments Portfolio 612,313 Wells Fargo interest bearing accts 0.250% 255,680,052 Wells Fargo Institutional Bank Deposit account 9,134, % 9,134,293 Bond Proceeds Invested at Miami-Dade County 0.476% 57,800,220 Total Cash and Investments $ 323,226,879 FS-9

114 PUBLIC HEALTH TRUST SALES TAX MONTHLY INCOME STATEMENT TREND ANALYSIS FISCAL YEAR 2013 Oct-12 Nov-12 Dec-12 Jan-13 Feb-13 Mar-13 Apr-13 May-13 Jun-13 Jul-13 Aug-13 Sep-13 monthly est 15,096,482 16,870,407 15,156,957 15,600,201 15,600,201 15,600,201 15,600,201 15,600,201 15,600,201 15,600,201 15,600,201 15,600,201 mo portion of qtly est: 1,207,668 1,273,109 1,273,109 1,273,109 1,273,109 1,273,109 1,273,109 1,273,109 1,273,109 1,273,109 1,273,109 1,273,109 State revision to Sales Tax Projection +/-est vs. actual rec'd; mo of (257,802) 981,343 3,665,869 1,457, ,194 2,964,808 1,053, , , ,814 +/-est vs. actual rec'd; qt of 338, , ,666 Monthly Revenue 16,304,150 18,143,516 16,172,264 17,854,653 20,877,588 18,331,229 17,574,504 20,369,247 17,926,959 17,365,758 17,575,066 17,177,124 FISCAL YEAR 2014 Oct-13 Nov-13 Dec-13 Jan-14 Feb-14 Mar-14 Apr-14 May-14 Jun-14 Jul-14 Aug-14 Sep-14 monthly est 15,600,201 16,597,159 16,597,159 16,597,159 16,597,159 16,597,159 16,597,159 16,597,159 16,597,159 16,597,159 16,597,159 16,597,159 mo portion of qtly est: 1,273,109 1,416,470 1,416,470 1,416,470 1,416,470 1,416,470 1,416,470 1,416,470 1,416,470 1,416,470 1,416,470 1,416,470 State revision to Sales Tax Projection 1,140,319 +/-est vs. actual rec'd; mo of (485,039) 892,399 3,943, , ,794 2,307,416 1,265, ,211 (5,798) (221,497) +/-est vs. actual rec'd; qt of 454, , ,276 Monthly Revenue 16,873,310 19,153,948 17,528,590 18,906,028 22,411,799 18,568,363 18,667,423 20,960,934 19,278,655 18,340,840 18,547,107 17,792,132 FISCAL YEAR 2015 Oct-14 Nov-14 Dec-14 Jan-15 Feb-15 Mar-15 Apr-15 May-15 Jun-15 Jul-15 Aug-15 Sep-15 monthly est 17,412,313 17,378,859 17,378,859 mo portion of qtly est: 1,597,585 1,624,581 1,624,581 State revision to Sales Tax Projection (6,458) (27,130) +/-est vs. actual rec'd; mo of +/-est vs. actual rec'd; qt of Monthly Revenue 19,009,898 18,996,983 18,976, Comments: Estimate was calculated based on same month prior year adjusted for percentage change of recent receipts vs. recent estimates. FS-10

115 Jackson Health System Hospitals Payor Mix Patient Days as % of Total Fiscal Year Actual Budget % Variance Actual Actual Budget % Variance FC Group Dec-14 Dec-14 Budget Nov-14 YTD YTD Budget Jackson Health System Combined percentages: Commercial 1.41% 1.11% 0.30% 1.20% 1.23% 1.11% 0.12% Medicaid 7.31% 19.18% 11.87% 9.31% 9.31% 19.13% 9.82% Medicare 15.81% 15.85% 0.04% 14.24% 14.99% 15.91% 0.92% Other 4.62% 4.79% 0.17% 3.79% 4.04% 4.80% 0.76% Managed Care 40.43% 26.92% 13.51% 39.86% 39.62% 26.92% 12.70% Self Pay 14.41% 15.15% 0.74% 14.64% 14.64% 15.18% 0.54% Potential Medicaid 16.01% 17.00% 0.99% 16.96% 16.17% 16.95% 0.78% Total % % 0.00% % % % 0.00% Jackson Memorial Hospital Combined percentages: Commercial 1.68% 1.30% 0.38% 1.35% 1.43% 1.30% 0.13% Medicaid 8.75% 21.07% 12.32% 10.85% 10.83% 21.00% 10.17% Medicare 12.80% 13.71% 0.91% 11.95% 12.48% 13.78% 1.30% Other 5.46% 5.56% 0.10% 4.45% 4.70% 5.57% 0.87% Managed Care 38.47% 24.42% 14.05% 38.06% 37.60% 24.42% 13.18% Self Pay 15.59% 15.67% 0.08% 15.41% 15.62% 15.71% 0.09% Potential Medicaid 17.25% 18.27% 1.02% 17.93% 17.34% 18.22% 0.88% Total % % 0.00% % % % 0.00% Jackson South Combined percentages: Commercial 0.56% 0.88% 0.32% 0.95% 0.66% 0.87% 0.21% Medicaid 3.02% 8.69% 5.67% 2.63% 3.24% 8.70% 5.46% Medicare 23.17% 22.64% 0.53% 20.37% 21.61% 22.67% 1.06% Other 2.81% 2.57% 0.24% 2.13% 2.78% 2.56% 0.22% Managed Care 49.59% 40.29% 9.30% 50.00% 49.87% 40.25% 9.62% Self Pay 12.13% 16.62% 4.49% 13.56% 13.01% 16.62% 3.61% Potential Medicaid 8.72% 8.31% 0.41% 10.36% 8.83% 8.33% 0.50% Total % % 0.00% % % % 0.00% Jackson North Combined percentages: Commercial 0.41% 0.18% 0.23% 0.39% 0.33% 0.16% 0.17% Medicaid 1.70% 14.68% 12.98% 3.80% 3.75% 14.67% 10.92% Medicare 28.54% 23.97% 4.57% 25.11% 26.47% 24.02% 2.45% Other 0.90% 1.73% 0.83% 0.57% 0.72% 1.73% 1.01% Managed Care 45.95% 33.24% 12.71% 44.74% 45.44% 33.22% 12.22% Self Pay 9.01% 11.30% 2.29% 10.26% 9.49% 11.31% 1.82% Potential Medicaid 13.49% 14.90% 1.41% 15.13% 13.80% 14.89% 1.09% Total % % 0.00% % % % 0.00% FS 11

116 Accounts Receivable All Hospitals December 2014 (FY15)

117 Revenue Cycle KPI s Cash Collections Goal Actual December 2014 (FY15) $79M $84M KPI Best Practice /Benchmark Goal Actual Prior Month POS Based on POS total cash collections $1.9M 1.8M $1.2M Potential Medicaid Conversion AR Greater than 90 Days Denial % of approvals compared to referrals for the prior 90 days. Less than 20% of discharged AR Reduce Net denial write-offs FYTD (less Benefit exhausted amounts) 90% 85% 77% 20% 18% 18% 5.5% 7.1% 6.6% Revenue Integrity Reduce late charge (# of charges) greater than 5 days 1.5% 2.5% 2.2% Benchmarks obtained by: HARA & Advisory Board ** Internal Target. No industry benchmark available

118 JHS CBO Cash Collections Month FY-14 Cash FY-15 Cash October $90,244,083 $76,350,606 November 78,392,708 $68,642,554 December 83,639,983 $84,192,529 January 83,299,949 February 82,690,658 March 90,563,137 April 85,904,675 May 97,521,847 June 80,747,235 July 87,097,474 August 119,988,431 September 103,573,871 Total $1,083,664,051 $229,185,690 Source: JHS Treasury Management & Revenue Control Dept.

119 Thank you,

120 FINANCIAL & BUDGET TRACKING STATUS REPORT NOVEMBER 2014 Capital Contribution (aka funded depreciation): The FY 2015 budget programmed $30 million of capital expenditures (both equipment and projects) to occur during the year funded with Capital Contribution dollars. For the current month end active capital projects funded with Capital Contribution dollars total $15.6 million. Of this amount, $6.0 million was spent in prior years leaving $9.6 million to be spent. Of that, $0.7 million has been spent Fiscal-Year-To-Date. The remaining $8.9 million is programmed to be spent in FY Foundation: Active Foundation funded projects continue this year totaling $4.7 million of prior and current year funding commitments. $1.6 million was spent in prior fiscal years leaving $3.1 million to be spent. Of this amount, $79 thousand has been spent Fiscal-Year-To-Date. An additional $3.0 million is programmed to be spent in FY Series 2005 Revenue Bonds: Active Series 2005 projects total $35.2 million of which $7.8 million was spent in prior years, leaving $27.4 million left to spend. Of this amount, $1.5 million has been spent Fiscal-Year-To- Date. An additional $25.5 and $0.4 million is programmed to be spent in FY 2015 and FY 2016 respectively. Series 2009 Revenue Bonds: Active Series 2009 projects total $37.8 million of which $21.4 million was spent in prior years leaving $16.4 million left to spend. Of this amount, $0.9 million has been spent Fiscal-Year-To- Date. An additional $13.4 and $2.1 million is programmed to be spent in FY 2015 and FY 2016 respectively. Trust Funds and Grants: The active projects funded by grants total $6.8 million, primarily FEMA dollars allocated to the ongoing Ryder Trauma Center Hardening project. Of this amount, $0.9 million was spent in prior years leaving $5.9 million left to spend. Of that, $721 thousand has been spent Fiscal- Year-To-Date. An additional $3.7 and $1.5 million is programmed to be spent in FY 2015 and FY 2016 respectively. Series 2015C GOB: Active Series 2015 projects total $9.8 million. $84 thousand has been spent Fiscal-Year-To- Date. The remaining $9.7 million is programmed to be spent in FY 2015.

121 3. Resolutions Recommended To Be Accepted

122 TO: FROM: Mojdeh L. Khaghan, Chairperson and Members, Fiscal Committee Rosa Costanzo Vice President, Strategic Sourcing and Supply Chain Management and Chief Procurement Officer DATE: January 15, 2015 RE: January 2015 Purchasing Report Recommendation The following recommendations are made in accordance with the Trust s Procurement Regulation. These items fully support our business operations and help the organization in its efforts to provide an excellent world class patient experience. Scope This report includes competitively solicited contract awards over $3,000,000, waivers of formal competition over $250,000 and other categories for Board approval as prescribed by the Procurement Regulation. Fiscal Impact/Funding Source The items included are part of the Trust s budget. Track Record/Monitor The Procurement Management Department along with the user departments and leadership support will track and monitor the responsibilities and obligations set forth in the contracts. Background The entire report has been vetted and assembled by the Procurement Management Department with the direct participation of the Director and staff, all subject to review by the Chief Procurement Officer, consultation with the Executive Staff and the President, and reviewed for legal sufficiency by the County Attorney s Office. Request is made for approval of the Purchasing Report, consisting of the following: Vendor Amount 1. Depuy/Synthes Spine & Medtronic Sofamor Danek Dual Contracts $5,012,767 USA, Inc. (For One Year) 2. Covidien Public Limited Co. $405,000 For One Year 3. HITT Contracting, Inc. $481,145 Emergency Ratification Procurement completed an orderly administrative process with each item to bring the best value (cost, quality, and outcome) with each project. January 2015 PHT Board of Trustees 1

123 Agenda Item 3 (a) Fiscal Committee January 15, 2015 RESOLUTION NO. PHT 1/15 RESOLUTION AUTHORIZING AND APPROVING AWARD OF BIDS AND PROPOSALS, WAIVER OF BIDS, AND OTHER PURCHASING ACTIONS FOR JANUARY 2015, IN ACCORDANCE WITH THE PUBLIC HEALTH TRUST S PROCUREMENT POLICY, RESOLUTION NO. PHT 10/ (Rosa Costanzo, Vice President Strategic Sourcing and Supply Chain Management Division and Chief Procurement Officer, Jackson Health System) WHEREAS, bids and proposals were solicited, received and reviewed by staff; and WHEREAS, the Purchasing and Facilities Subcommittee met on January 15, 2015 and reviewed staff s recommendations as submitted under the PHT s Procurement Policy, Resolution No. PHT 10/12-078; and WHEREAS, the Purchasing and Facilities Subcommittee forwarded the Purchasing Report to the Fiscal Committee with a recommendation for approval for each item under the report, which is attached hereto and hereby incorporated by reference; and WHEREAS, upon his written recommendation, the President recommends that the Public Health Trust Board of Trustees (Board of Trustees) waive competitive bidding for items under the heading of Bid Waiver and Waiver of Full and Competitive Bidding in the respective Purchasing Report, finding such action to be in the best interests of the Public Health Trust; and WHEREAS, the President and Fiscal Committee recommend various other purchasing actions, as indicated in the attached Purchasing Report. NOW, THEREFORE, BE IT RESOLVED BY THE BOARD OF TRUSTEES OF THE PUBLIC HEALTH TRUST OF MIAMI-DADE COUNTY, FLORIDA, that this Board hereby authorizes and approves the award of bids and proposals and all the purchasing actions as set forth in the attached Purchasing Report, under the Public Health Trust s Procurement Policy, Resolution No. PHT 10/12-078; and finds it in the best interest of the Public Health Trust to waive competitive bidding for those items listed under the heading Bid Waiver and Waiver of Full and Competitive Bidding in the respective report; and to take such action as is necessary and authorized to implement these awards and actions. January 2015 PHT Board of Trustees 2

124 PUBLIC HEALTH TRUST BOARD OF TRUSTEES PURCHASING REPORT January 15, 2015 TO: FROM: PUBLIC HEALTH TRUST BOARD OF TRUSTEES PROCUREMENT MANAGEMENT DEPARTMENT The following recommendations are made in accordance with the Trust s Procurement Policy and it s implementing Procurement Regulation. This report includes competitively solicited contract awards over $3,000,000, waivers of formal competition over $250,000 and other categories for Board approval as prescribed by the Procurement Regulation. The entire report has been screened and assembled by the Procurement Management Department with the direct participation of the Directors and staff, all subject to review by the Chief Procurement Officer, consultation with the Executive Staff and the President, and reviewed for legal sufficiency by the County Attorney s Office. SECTION I. AWARDS UNDER INVITATIONS TO BID (ITB s) This section consists of awards under competitively solicited Invitations to Bid (ITB s) over $3,000,000. No items to report. SECTION II. AWARDS UNDER REQUESTS FOR PROPOSALS (RFP s) This section consists of awards under competitively solicited Requests for Proposals (RFP s) over $3,000,000. No items to report. SECTION III. AWARDS UNDER THE COMPETITIVELY SOLICITED CONTRACTS OF OTHER PUBLIC PROCUREMENT ENTITIES This section consists of awards over $3,000,000 under competitively solicited ( ITB, RFP or equivalent) contracts of other public and nonprofit entities. No items to report. SECTION IV. AWARDS UNDER GROUP PURCHASING ORGANIZATION ( GPO ) CONTRACTS This section consists of awards over $3,000,000 under Group Purchasing Organization ( GPO ) contracts. GPOs are organizations that aggregate the purchasing volume of their members consisting of hospitals and other health care providers to leverage discounts with manufacturers, distributors and other vendors to realize administrative savings and efficiencies. The Trust s GPO is MedAssets. No items to report. SECTION V. AWARDS UNDER A WAIVER OF FORMAL COMPETITION This section consists of awards over $250,000 without the formal solicitation of competitive bids or proposals. All award recommendations in this section have the approval of the President, are based on a finding that the waiver of competitive bidding is in the best interests of the Public Health Trust, and require a two-thirds affirmative vote of the Trustees present for approval. A. Sole Source No items to report. January 2015 PHT Board of Trustees 3

125 B. Physician s Preference Staff requests a waiver of formal competition for the contract items listed in this category because a physician and clinician have requested the particular item without which the physician and clinician cannot successfully and safely render patient care. 1. (783817, JFJ) The Perioperative Services Department requests contract awards to Depuy/Synthes Spine, a Division of Johnson & Johnson, Inc. ( Depuy/Synthes ) and Medtronic Sofamor Danek USA, Inc. ( Medtronic ) for a period of one year for the continued provision of spinal implant products and related accessories. (Ongoing purchase). Depuy/Synthes Spine: Medtronic Sofamor Danek USA, Inc.: $5,012,767 (For One Year) Total approved funding: $5,012,767 Background Depuy/Synthes and Medtronic will continue to provide to the Trust spinal implant products, generally used to fuse the spine in the neck and lower back. As part of a greater initiative to identify additional saving opportunities for the Trust without limiting product choices, procurement has conducted discussions with surgeons relative to their use of these products. The resulting feedback was that continued utilization of the spine products provided by Depuy/Synthes and Medtronic was preferred, as these products offer the physician better surgical choices. The Physicians utilize these vendors products to meet the specific needs of the patient, and this has resulted in different levels of spend between vendors. As a result, for the one year contract term, the projected spend with Depuy/Synthes is $3,030,178 and with Medtronic is $1,982,589. Some of the products offered by the two vendors are similar but not exactly alike. The Physicians make their choices based on different technology types (different types of instrumentation used with spinal implant products) suited to both physician s and patient s needs. The main focus of this initiative was to standardize on price in a given product category between the vendors. To this end, procurement entered into negotiations with these two current vendors, achieving reductions by line item across the majority of vendor products to realize standardized pricing. The negotiated price reduction is effective immediately after both contracts are executed. Depuy/Synthes pricing reflects an estimated $261,139 in savings. The pricing from Medtronic reflects approximately $143,769 in savings. The overall savings achieved through this process represents a combined 7.47 percent reduction in price based on prior paid price. Combined savings over the one-year period is estimated at $404,909. The dollars requested for each vendor have been capped and are stated as a maximum contract value in the individual agreements. ECRI and Broadjump reported that the new pricing provided by these vendors falls within the average competitive price point of the ECRI Price Guide and Broadjump Auto Price Checker databases. In providing an evaluation of the vendors performance during the current contract year, the Perioperative Services Division has reported the following: The overall service meets standard There have been no complaints from patients or employees regarding these supplies The vendor meets all requirements for the contracted service/supply Recommendation After review and discussion of the information presented, the Perioperative Services and Procurement Management Departments have determined that it would be in the best interest of the Trust to award physician preference contracts to Depuy/Synthes and Medtronic for the provision of spinal implant products and related accessories. The underlying contracts can be terminated for convenience with a thirty (30) day notice and include UAP and OIG Provisions. January 2015 PHT Board of Trustees 4

126 A bid waiver justification has been provided and Conflict of Interest Declarations signed by A. Panos, Professor of Surgery for JHS, Tomas A. Salerno M.D., Chief Division of Cardiothoracic Surgery, Handel Robinson, M.D., Assistant Clinical Professor, Vascular Surgery, Jorge Rey M.D., Assistant Clinical Professor, Vascular Surgery, Eliot Rosenkranz, M.D., Professor of Surgery, Pediatric Surgery, Silvia Scandar, Administrator, Medical Hospital Center, Perioperative Services, Jackson Memorial Hospital, and Alexander Raecke, Account Director, Depuy/Synthes, and Chip Lomel, Director of Contracts, Medtronic, with no reported disclosures. (M. Garcia). 2. ( JFJ) The Perioperative Services Department, Jackson Memorial Hospital, requests a contract award to Covidien Public Limited Company ( Covidien ) for a period of one year for the provisions of surgical mesh biomaterials specialized in the treatment of soft tissue procedures (Ongoing purchase). Covidien Public Limited Co.: $405,000 (For one year) Total approved funding: $405,000 Background Covidien provides the Trust with surgical mesh biomaterials, primarily used to assist in the treatment of open and laparoscopic hernia repair surgical procedures. These products are intended to repair protrusions in the abdominalcavity caused by a combination of pressure and opening or weakness of muscle or connective tissue. The pressure pushes an organ or tissue through the opening or weak spot. The main components of these products are designed to play a role similar to that of the body s extracellular matrix, and are inserted in the affected area to help support organized tissue growth and reinforcement. Covidien has established itself as a market leader in hernia repair, developing new products that reinforce established standards of care, while lowering supply cost to the Trust. It offers Permacol Surgical Implants, a porcine dermal collagen implant from which weakened tissue is removed so that a new, cellular collagen matrix is cross linked to establish dimensional stability through the body s wound healing process; Symbotext Composite Mesh, a nonabsorbable implant designed to minimize tissue attachment to the device in case of direct contact with the viscera, allowing for use in both open and laparoscopic ventral hernia repairs, and soft tissue deficiencies; and Pro Grip, a proprietary, bio-integrative synthetic tissue scaffold which is designed to play a role similar to that of the body's cellular matrix, supporting organized tissue reinforcement and long term healing. The device is designed for repair and reinforcement in a variety of soft tissue procedures. The requested amount of $405,000 reflects a cost avoidance of $68,850 for the cost of medical/surgical consumables. In providing an evaluation of Covidien performance during the current contract year, the Perioperative Services Department has reported the following: The overall service meets standard There have been no complaints from patients or employees regarding these supplies The vendor meets all requirements for the contracted service/supply In accordance with our Contractor Due Diligence Review, Covidien Public Limited Co has provided Sworn/ Notarized Statements to the Trust s Procurement Management Department that: (1) No Lawsuits have been filed against the Company within the five(5) years prior to submittal of a bid or proposal to the Trust; (2) The companies have not defaulted in the five (5) years prior to bid or proposal submittal to the Trust; (3) the companies have not been debarred not have the firms received formal notices of on-compliance or non-performance in the five (5) years prior to proposal submittals to the Trust. ECRI and Broadjump have reported that the new pricing provided by Covidien falls within the average and above average competitive price point for their respective databases for these products. January 2015 PHT Board of Trustees 5

127 Recommendation In the best interest of the Trust, the Perioperative Department recommends an award to Covidien for the provisions of surgical mesh biomaterials specialized in the treatment of soft tissue procedures. This contract can be terminated for convenience with a thirty (30) day notice and includes UAP and OIG provisions. A bid waiver justification has been provided and Conflict of Interest Declarations signed by A. Panos, Professor of Surgery for JHS, Tomas A. Salerno M.D., Chief Division of Cardiothoracic Surgery, Handel Robinson, M.D., Assistant Clinical Professor, Vascular Surgery, Jorge Rey M.D., Assistant Clinical Professor, Vascular Surgery, Eliot Rosenkranz, M.D., Professor of Surgery, Pediatric Surgery, Ana Victoria Sanchez, Administrator, Medical Hospital Center, Jackson Memorial Hospital, and, Mike Trovato, Director of Contracting, Covidien, with no reported disclosures. (M. Garcia). C. Standardization Items in this category have been established as the Trust standard. No items to report. D. Non-Competitive Cooperative Purchasing This subsection consists of awards under the contracts of other public entities that were not competitively solicited. No items to report. E. Miscellaneous Bid Waiver This subsection consists of awards not falling in the other categories of waiver of formal competition but where waiver is deemed to be in the best interests of the Trust. No items to report. SECTION VI. OPTIONS-TO-RENEW AND CONTRACT MODIFICATIONS FOR CONTRACTS THAT WERE COMPETITIVELY SOLICITED This section refers to existing contracts that were competitively bid ( ITB or RFP ) at their origin and consists of either (a) the exercise of established options to renew or (b) the execution of contract modifications for which the Procurement Policy requires prior Board approval. No items to report. SECTION VII. OPTIONS-TO-RENEW AND CONTRACT MODIFICATIONS FOR CONTRACTS THAT WERE AWARDED UNDER A WAIVER OF FORMAL COMPETITION This section refers to existing contracts that were not competitively bid at their origin and consists of either (a) the exercise of established options-to renew or (b) the execution of contract modifications for which the Procurement Policy requires prior Board approval. All contracts in this section are renewals not previously authorized by the Board have the written approval of the President, are based on a finding that the waiver of full and competitive bidding is in the best interest of the Public Health Trust, and require a two-thirds affirmative vote of the Trustees present for approval. No items to report. January 2015 PHT Board of Trustees 6

128 SECTION VIII. MISCELLANEOUS This section consists of procurement actions that require Board approval not included under any other section of the Purchasing Report. SECTION VIII. MISCELLANEOUS This section consists of procurement actions that require Board approval not included under any other section of the Purchasing Report. 3. ( TC) The Facilities Design and Construction and Procurement Management Departments request ratification of this one-time emergency procurement from HITT Contracting, Inc., under the "Emergency Procurement" provisions of the Procurement Regulation for required renovations needed to replace and install new cardiac catheterization lab equipment in Cath. Lab #2. HITT Contracting, Inc.: $481,145 (One-time) Total Funding Requested: $481,145 Background Due to a spontaneous sprinkler head burst in Cath. Lab #2, the cardiac catheterization lab equipment was permanently damaged and needed to be replaced immediately to avoid further interruption and compromising the delivery of services to Trust patient. This was deemed an emergency given that, of the three additional existing adult catheterization labs, only one could perform peripheral cases, which could have potentially caused scheduling inefficiencies and a delay in patient care. JMH Administration contacted HITT Contracting, Inc., to perform necessary mechanical, electrical, and plumbing renovations to meet code and AHCA regulations for the new catheterization lab equipment. The funding amount requested of $481,145 includes a $50,000 contingency allowance to address any unforeseen conditions or owner-requested changes that may arise during construction. Recommendation In accordance to the Procurement Regulation, the procurement was limited to services necessary to immediately address the interruption of services and minimize operational impact compromising the delivery of patient care services. An emergency request for the replacement and installation of cardiac catheterization lab equipment and associated renovations in Cath Lab #2 was approved by Martha Garcia, JMH Director of Operations; Isa Nuñez, Vice President, Facilities Design and Construction Division; Hamilton Clark, JMH Chief Financial Officer; Alex Contreras, Senior Vice President and JMH Chief Administrative Officer; Mark Knight, Executive Vice President and JHS Chief Financial Officer; Don Steigman, Executive Vice President and JHS Chief Operating Officer; and Carlos Migoya, President and JHS Chief Executive Officer; and submitted by the Facilities Design and Construction Department. The UAP and OIG provisions apply to this one-time emergency purchase. (M. Garcia). January 2015 PHT Board of Trustees 7

129 TO: FROM: Mojdeh L. Khaghan, Chairperson and Members, Fiscal Committee Madeline Valdes Corporate Director, Property Management DATE: January 15, 2015 RE: Lease Agreement with IMCMV Holdings Inc. for Park Plaza West, Suite E Recommendation Staff recommends that the Public Health Trust Board of Trustees execute a lease agreement with IMCMV Holdings Inc., a Florida corporation, for the rental of 5,540 square feet of retail space and 377 square feet of outdoor license area at Suite E of the Park Plaza West Garage. The proposed agreement is a 12-year lease with two five-year options to extend. Fiscal Impact/Funding Source The proposed annual base payment is $323,037, plus eight percent (8%) of gross sales above annual base rent. The rental charge would increase annually by two percent (2%) or the Consumer Price Index, whichever is greater. Track Record/Monitor The Property Management Division will track and monitor the responsibilities and obligations set forth in the agreement, overseen by Madeline Valdes, Corporate Director for Property Management. Background Jackson Health System initiated an invitation to bid ITB PMD (P1) for Suite E at Park Plaza West parking garage on the UM/Jackson Memorial Medical Center campus. IMCMV Holdings, Inc., a Florida corporation, was deemed the responsive and responsible bidder. The company proposed to build Pollo Tropical and Viena Pizza multi-concept food court, with construction costs estimated at $1.5 million and an estimated timeframe of approximately 120 days for completion of renovations once final plans and permits are approved. All construction costs will be paid by IMCMV Holdings, Inc.

130 Agenda Item 3 (b) Fiscal Committee January 15, 2015 RESOLUTION NO. PHT 1/15 RESOLUTION AUTHORIZING THE PRESIDENT OR HIS DESIGNEE TO ENTER INTO A LEASE AGREEMENT WITH IMCMV HOLDINGS, INC., A FLORIDA CORPORATION FOR THE RENTAL OF FIVE THOUSAND FIVE HUNDRED FORTY (5,540) SQUARE FEET OF RETAIL SPACE AND THREE HUNDRED SEVENTY-SEVEN (377) SQUARE FEET OF OUTDOOR LICENSE AREA SITUATED AT 1611 NW 12 th AVENUE, MIAMI, FL., PARK PLAZA WEST, SUITE E, FOR A PERIOD OF TWELVE (12) YEARS COMMENCING ON THE EFFECTIVE DATE OF THE LEASE AGREEMENT, WITH TWO (2) FIVE-YEAR OPTIONS TO EXTEND, FOR AN ANNUAL RENT PAYMENT OF THREE HUNDRED TWENTY-THREE THOUSAND THIRTY- SEVEN DOLLARS ($323,037), WITH AN OPERATING CHARGE IN THE AMOUNT OF NINETEEN THOUSAND TWO DOLLARS ($19,002), WITH AN ANNUAL INCREASE OF TWO (2%) PERCENT OR THE CONSUMER PRICE INDEX, WITH THE GREATER OF ANNUAL BASE RENT OR EIGHT PERCENT (8%) OF GROSS SALES (Madeline Valdes, Corporate Director, Property Management Division, Jackson Health System) WHEREAS, this Board seeks to accomplish the purposes set forth in the attached memorandum; and WHEREAS, the President, Purchasing and Facilities Subcommittee and Fiscal Committee recommend approval. NOW, THEREFORE, BE IT RESOLVED BY THE BOARD OF TRUSTEES OF THE PUBLIC HEALTH TRUST OF MIAMI-DADE COUNTY, FLORIDA, that this Board hereby authorizes the President or his designee to enter into a Lease Agreement with IMCMV Holdings

131 Agenda Item 3 (b) Fiscal Committee January 15, Page 2- Inc., a Florida corporation for the rental of five thousand five hundred forty (5,540) square feet of retail space and three hundred seventy-seven (377) square feet of outdoor license area situated at 1611 Northwest 12th Avenue, Park Plaza West Garage facility, Suite E, for a period of twelve (12) years commencing on the effective date of the lease agreement, with two (2) fiveyear options to extend, for an annual rent payment of Three Hundred Twenty-Three Thousand Thirty-Seven Dollars ($323,037), with an operating charge in the amount of Nineteen Thousand Two Dollars ($19,002), with an annual increase of two percent (2%) or Consumer Price Index, with greater of annual base rent or eight percent (8%) of gross sales, in accordance with the recommendation set forth in the agenda item attached hereto and incorporated herein by reference.

132 TO: FROM: Mojdeh L. Khaghan, Chairperson and Members, Fiscal Committee Madeline Valdes Corporate Director, Property Management DATE: January 15, 2015 RE: Lease Agreement with Dade County Federal Credit Union at Miami Transplant Institute Recommendation Staff recommends that the Public Health Trust Board of Trustees execute a Lease Agreement with Dade County Federal Credit Union, a Florida not-for profit corporation for the rental of 3,000 square feet of retail space known as Suite C in the Miami Transplant Institute/Highland Professional Building. The proposed lease term is five years with two five-year options to extend. Fiscal Impact/Funding Source The proposed annual base payment to the Trust is $90,000, with an annual operating charge in the amount of $9,960. The annual base payment would increase annually by three percent (3%) or the Consumer Price Index, whichever is greater. Track Record/Monitor The Property Management Division will track and monitor the responsibilities and obligations set forth in the agreement, overseen by Madeline Valdes, Corporate Director for Property Management. Background Dade County Federal Credit Union has been operating at the Miami Transplant Institute/Highland Professional Building since As the credit union has a not-for-profit status, a formal request for proposals was not necessary. In addition, the credit union proposes to upgrade the facility, with construction costs estimated at approximately $1 million. All construction costs will be paid by Dade County Federal Credit Union.

133 Agenda Item 3 (c) Fiscal Committee January 15, 2015 RESOLUTION NO. PHT 1/15 RESOLUTION AUTHORIZING THE PRESIDENT OR HIS DESIGNEE TO ENTER INTO A LEASE AGREEMENT WITH DADE COUNTY FEDERAL CREDIT UNION, A FLORIDA NOT- FOR PROFIT CORPORATION FOR THE RENTAL OF THREE THOUSAND (3,000) SQUARE FEET OF RETAIL SPACE SITUATED AT 1801 NW 9 th AVENUE, SUITE C, MIAMI TRANSPLANT BUILDING, MIAMI, FLORIDA, FOR A PERIOD OF FIVE (5) YEARS COMMENCING ON THE EFFECTIVE DATE OF THE LEASE AGREEMENT, WITH TWO (2) FIVE-YEAR OPTIONS TO EXTEND, FOR AN ANNUAL RENT PAYMENT OF NINETY THOUSAND DOLLARS ($90,000), WITH AN OPERATING CHARGE IN THE AMOUNT OF NINE THOUSAND NINE HUNDRED SIXTY DOLLARS ($9,960), WITH AN ANNUAL INCREASE OF THREE PERCENT (3%) OR THE CONSUMER PRICE INDEX (Madeline Valdes, Corporate Director, Property Management Division, Jackson Health System) WHEREAS, this Board seeks to accomplish the purposes set forth in the attached memorandum; and WHEREAS, the President, Purchasing and Facilities Subcommittee and Fiscal Committee recommend approval. NOW, THEREFORE, BE IT RESOLVED BY THE BOARD OF TRUSTEES OF THE PUBLIC HEALTH TRUST OF MIAMI-DADE COUNTY, FLORIDA, that this Board hereby authorizes the President or his designee to enter into a Lease Agreement with Dade County Federal Credit Union, a Florida not-for profit corporation for the rental of Three Thousand (3,000) square feet of retail space situated at 1801 NW 9th Avenue, Suite C, Miami Transplant Building, for a period of five (5) years commencing on the effective date of the lease agreement, with two (2) five-year options to extend, for an annual rent payment of Ninety Thousand Dollars ($90,000), with an operating charge in the amount of Nine Thousand Nine Hundred Sixty Dollars ($9,960), with an annual increase of three percent (3%) or Consumer Price Index, in accordance with the recommendation set forth in the agenda item attached hereto and incorporated herein by reference.

134 4. Adjournment