PUBLIC HEALTH TRUST FINANCIAL RECOVERY BOARD

PUBLIC HEALTH TRUST FINANCIAL RECOVERY BOARD COMMITTEE MEETINGS AGENDAS June 14, 2012 Ira C. Clark Diagnostic Treatment Center 1080 N. W. 19 th Street Miami, Florida 33128

PUBLIC HEALTH TRUST FINANCIAL RECOVERY BOARD COMMITTEE MEETINGS SCHEDULE (June 2012) LOCATION SITE Ira C. Clark Diagnostic Treatment Center (DTC) 1080 N. W. 19 th Street Miami, Florida 33128 The Purchasing Subcommittee meeting is scheduled to begin at 7:15 a.m. and the Facilities Subcommittee meeting is scheduled to begin at 7:45 a.m. on Thursday, June 14, 2012. The Audit and Compliance Subcommittee meeting shall immediately follow the Facilities Subcommittee in the Diagnostic Treatment Center, Conference Room 259, which will then be followed by the standing committee meetings. A special PHT Financial Recovery Board meeting is scheduled to immediately following the Joint Conference & Efficiencies Committee meeting located in DTC 259. Thursday, June 14, 2012 Subcommittees Time Conference Room Purchasing Subcommittee 7:15 a.m. to adjournment DTC 270 Facilities Subcommittee 7:45 a.m. to adjournment DTC 259 Audit and Compliance Subcommittee Immediately following the DTC 259 Facilities Subcommittee meeting Standing Committees Fiscal Committee Immediately following the DTC 259 Audit & Compliance Subcommittee meeting Strategy & Growth Committee Immediately following the Fiscal DTC 259 Committee meeting Joint Conference Immediately following the Strategy DTC 259 & Efficiencies Committee and Growth Committee meeting PHT Financial Recovery Board Time Conference Room Special PHT Financial Immediately following the Joint DTC 259 Recovery Board Conference & Efficiencies Committee meeting As of June 11, 2012

PURCHASING SUBCOMMITTEE

PUBLIC HEALTH TRUST FINANCIAL RECOVERY BOARD Purchasing Subcommittee Joaquin del Cueto, Chairperson Stephen S. Nuell, Vice Chairperson Michael Bileca Date, Time and Place June 14, 2012 7:15 a.m. to adjournment Ira C. Clark Diagnostic Treatment Center Conference Room 270 AGENDA Action Items: 1. Approval of the Previous Meeting Minutes (Joaquin del Cueto, Chairperson, Purchasing Subcommittee) (a) * Meeting Minutes as of May 17, 2012 2. Review and Recommend Approval of the Purchasing Report (Rosa Costanzo, Vice President and Chief Procurement Officer, Strategic Sourcing and Supply Chain Management Division, Jackson Health System) (a) * Purchasing Report as of June 2012 3. *Resolution authorizing (1) approval of an amendment for the continuation of Microsoft Products provided by SHI International Corporation under the State of Florida, State and Local volume licensing agreements in the amount of $2,734,356.39 for a three year period, from April 1, 2012 through March 31, 2015 and (2) approval of true-up from the previous contract term in the amount of $1,380,817.17 and (3) payment in the amount of $1,537,109.83 to be made by June 16, 2012 (Michael Garcia, Interim Chief Information Officer, Jackson Health System) Informational Items: 4. *Monthly Report of Competitive Contracts Awarded or Renewed Over the Chief Procurement Officer Authority in Accordance to Procurement Regulations May 1, 2012 through May 31, 2012 (Fidel Alvarez, Manager, Procurement Management Department, Jackson Memorial Hospital) 5. *Monthly Report of Non-Competitive Contracts Awarded or Renewed Under $100,000 May 1, 2012 through May 31, 2012 (Fidel Alvarez, Manager, Procurement Management Department, Jackson Memorial Hospital) 6. Key Performance Indicators (KPI) for Procurement Update (Rosa Costanzo, Vice President and Chief Procurement Officer, Strategic Sourcing and Supply Chain Management Division, Jackson Health System) 7. Procurement Regulation Update (Rosa Costanzo, Vice President and Chief Procurement Officer, Strategic Sourcing and Supply Chain Management Division, Jackson Health System) Support document(s) will be distributed at the meeting for Informational Items 6 and 7. Agenda items noted with an asterisk (*) indicates that the supporting documents are attached.

1. Approval of the Previous Meeting Minutes

PUBLIC HEALTH TRUST FINANCIAL RECOVERY BOARD Purchasing Subcommittee Joaquin del Cueto, Chairperson Stephen S. Nuell, Vice Chairperson Michael Bileca Date, Time and Place May 17, 2012 7:15 a.m. to adjournment Ira C. Clark Diagnostic Treatment Center Conference Room 270 ATTENDANCE Purchasing Subcommittee Michael Bileca Joaquin del Cueto Stephen S. Nuell Financial Recovery Board Mojdeh L. Khaghan Marcos Jose Lapciuc Jackson Health System Rosa Costanzo Mark T. Knight Carlos A. Migoya Miami-Dade County Attorney s Christopher Kokoruda Jeffrey Poppel Eugene Shy, Jr.

Purchasing Subcommittee Meeting May 17, 2012 Page 2 CALL TO ORDER With a quorum being present, the Purchasing Subcommittee meeting was called to order by Joaquin del Cueto, Chairperson at 7:24 a.m. ACTION ITEMS: 1. Approval of the Previous Meeting Minutes April 19, 2012 Mr. del Cueto requested a motion approving the meeting minutes of April 19, 2012. Mr. Nuell moved approval; seconded by Mr. Bileca, and carried without dissent. 2. Review and Recommend Approval May 2012 Purchasing Report Rosa Costanzo, Vice President & Chief Procurement Officer, Strategic Sourcing and Supply Chain Management Division, Jackson Health System presented for review and approval the May 2012 Purchasing Report. A detailed copy of the report was included in the agenda packet. 3. Resolution Recommended to be Approved Resolution authorizing an amendment to Section I.F.3. of the Procurement Policy/Regulation approved on January 30, 2012 regarding Financial Recovery Board review of certain PHT/JMH Health Plan Managed Plan Managed Care Contracts Following the review of agenda items 2 (May 2012 Purchasing Report), and 3 (Resolution Recommended to be Approved). Mr. del Cueto requested a motion. Mr. Nuell moved approval for agenda items 2 and 3; seconded by Mr. Bileca, and carried without dissent.

Purchasing Subcommittee Meeting May 17, 2012 Page 3 INFORMATIONAL ITEMS: 4. Monthly Report of Competitive Contracts Awarded or Renewed Under the Chief Procurement Officer Authority in Accordance to Procurement Regulations April 1, 2012 through April 30, 2012 There was no significant activity to report. A copy of the report was included in the agenda packet. 5. Monthly Report of Non-Competitive Contracts Under $100,000 April 1, 2012 through April 30, 2012 There was no significant activity to report. A copy of the report was included in the agenda packet. 6. Key Performance Indicators (KPI) for Procurement Update Ms. Costanzo presented the monthly update of the Procurement/Strategic Sourcing KPI s. The report outlined completed contracts that included the average completion time of approximately forty-three (43) days with one sole source outlier agreement under Pharmacy for Central Admixture Pharmacy Services, Inc. (CAPS). It is anticipated that a resolution regarding CAPS will be presented for approval at the next meeting. OTHER DISCUSSION RFP-Two Envelope System Mr. Lapciuc expressed concern regarding the pricing process for the RFP-Two Envelope System. With regards to the item and the pricing process, Mr. Lapciuc want to be assured that the Procurement Team have adequate pricing tools and questioned what could be done to ensure that the pricing is made for the first envelope without moving forward with pricing the second envelope. He suggested that the Procurement Policy or the Bylaws be reviewed for a possible change to the pricing process. Ms. Costanzo stated that a process is in place using qualitative criteria then a short list, along with shared pricing which is weighed prior to final selection of a vendor. Mr. Knight stated that whether under a two envelope system or use of the prior system, the use of qualitative factors and review of written responses are conducted to determine who would be the highest ranked vendor(s). Once short listed, pricing is scored along with the qualitative factors to determine how the vendors are ranked. Mr. Lapciuc reiterated concern and preference for pricing to be on the first envelope as to which vendor(s) makes the cut. Ms. Costanzo stated that the matter will be reviewed with the County Attorney Office and presented back at the next Subcommittee meeting.

Purchasing Subcommittee Meeting May 17, 2012 Page 4 Adjournment The meeting of the Purchasing Subcommittee adjourned at 7:38 a.m. Transcribed by Terry D. Brown Executive Assistant Strategic Sourcing & Supply Chain Division

2. Review and Recommend Approval of the Purchasing Report

PUBLIC HEALTH TRUST FINANCIAL RECOVERY BOARD PURCHASING REPORT June 25, 2012 TO: FROM: PUBLIC HEALTH TRUST FINANCIAL RECOVERY BOARD 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 $1,000,000, waivers of formal competition over $100,000 and other categories for Board approval as prescribed by the Procurement Policy/Regulation. The entire report has been screened and assembled by the Procurement Management Department with the direct participation of the Administrator and staff, all subject to review by the Vice President, Strategic Sourcing Division, consultation with the President as needed, and review 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 $1,000,000. 1. (362348-LH) Jackson Memorial Long Term Care Center (JMLTCC) Administration requests a contract award to Pulmonary Health Network (PHN) resulting from a competitive Invitation to Bid (ITB 12-10248-LH) for the provision of Respiratory Services for a sixteen-bed Respiratory Care Unit to include eight ventilator units (New purchase). Background Pulmonary Health Network: $2,522,880 (for three years) Total approved funding: $2,522,880 This competitive procurement was solicited and administered by the Procurement Management Department through a competitive Invitation to Bid (ITB #12-10248-LH) process that was publicly advertised on April 25, 2012. A pre-proposal conference was conducted on May 1, 2012. Responses were received on May 7, 2012. The ITB document was distributed to four potential bidders. Responses were received from two of these firms: Respiratory Health Services and Pulmonary Health Network (PHN). June 2012 PHT Financial Recovery Board 1

SECTION I. (cont d.) The Bidder offering the lowest price was the incumbent vendor, Pulmonary Health Network. After verification of the licenses / certification of PHN s Registered Respiratory Therapists (RRTs), Certified Respiratory Therapists (CRTs) and Board Certified Pulmonary Physician and confirmation that the vendor had over 10 years experience in respiratory services in long term care centers, the results of the bid tabulation were provided to the JMLTCC. JMLTCC concurred with recommendation of Procurement to award the bid to the lowest bidder, PHN. The tabulation results are as follows: BIDDERS Item 1 - Respiratory Care Per Patient Day 3 Yr. Fixed Cost Item 2 - Ventilator Rental Cost Per Patient Day 3 Yr. Fixed Cost TOTAL THREE YEAR COST Pulmonary Health Network $140 $2,452,800 $8 $70,080 $2,522,880 Respiratory Health Services $266 $4,660,320 $32 $280,320 $4,940,640 JMLTCC in expanding the unit to a sixteen (16) bed unit, required bidders to provide eight (8) additional ventilators to include preventive maintenance at a per patient day rate. PHN offers respiratory services at $140.00 per patient day and ventilator rental at $8.00 per patient date. PHN currently provides respiratory services for an eight (8) Respiratory Care Unit at JMLTCC at the rate of $160.00 per patient day. In comparing the prior contract to this ITB quote, the difference for respiratory services cost is $20 less per patient day, thereby, providing cost reduction of $350,400 for the initial three-year term. The ventilator rental which includes maintenance at $8.00 per patient day, although not quantified, provides savings for capital purchase and maintenance/service cost. Recommendation The Administration Department at JMLTCC and Procurement request approval of a bid award to PHN for an initial term of three years plus two-one year options (OTRs) to renew. The Three-day bid protest filing period has passed and no protest to this award recommendation was presented. This contract has been approved by Risk as to Insurance and Liability and by the County Attorney s Office for Legal sufficiency. This contract can be terminated for convenience with a thirty (30) day notice and includes UAP and OIG provisions (K Andrews). June 2012 PHT Financial Recovery Board 2

SECTION II. AWARDS UNDER REQUESTS FOR PROPOSALS (RFP s) This section consists of awards under competitively solicited Requests for Proposals (RFP s) over $1,000,000. No items to report. SECTION III. AWARDS UNDER THE COMPETITIVELY SOLICITED CONTRACTS OF OTHER PUBLIC PROCUREMENT ENTITIES This section consists of awards over $1,000,000 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 $100,000 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 2. (381013-PE) The Department of Health Information Management (HIM) requests a contract award to PricewaterhouseCoopers, LLP (PwC) to continue utilizing the PwC SMART Inpatient service and for the addition of the PwC SMART Outpatient service for a period of one (1) year. June 2012 PHT Financial Recovery Board 3

SECTION V. (cont d.) Background PricewaterhouseCoopers, LLP (PwC): $312,000 (for one year) Total approved funding: $312,000 PwC has provided the SMART Inpatient solution to the Trust for a year at no cost through May 30, 2012 at a value of $156,000 ($13,000/month for 12 months). As a result of negotiations by Procurement Management, the vendor has agreed to continue providing this service for an additional month to June 30, 2012 (cost avoidance of $13,000) while approval is secured from FRB for this request to renew the service as well as add the Outpatient component system wide. The automated SMART Inpatient and Outpatient solution will assist in analyzing coding quality, correct coding errors before bills are submitted, identify documentation improvement opportunities to reduce reimbursement risks, and measure outcomes against key performance indicators. The tool has assisted and will continue to assist coding staff with appropriate coding consistent with American Hospital Association (AHA) coding guidelines, ensure that the department codes efficiently in areas that are focused on the Medicare Audit Recovery Contract project (RAC), other regulatory agency audits and is also vital in preparation for the International Classification of Diseases (ICD-10). The product was a component of the PwC Initiative to improve the overall quality of HIM coding. HIM would otherwise be unable to manually review all the records coded on a daily basis without the SMART system flagging potential errors for review. The system currently performs the audit three times per day. The HIM Department, in surveying the market, found that there is no other system currently available to perform the required task. Recommendation The HIM Department has stated that during the period that the PwC Smart Inpatient solution has been in place at no cost, the Trust has realized $1,394,872 in reimbursement changes. A total of 353 discharges of 38,592 were corrected prior to billing. The vendor has also agreed to waive its option of the customary 5% increase for entering this renewal. This translates to approximately $15,600 for the renewal period. According to MD Buyline, they are currently seeing annual increases in the 3-5% across the industry. Balance of page intentially left blank June 2012 PHT Financial Recovery Board 4

SECTION V. (cont d.) As a result of further negotiation by Procurement Management PwC has reduced its monthly Inpatient and Outpatient license fee for both Jackson North and Jackson South for cost savings of $4,000 per month or $48,000 for the one-year period and will provide these savings to any other sites the Trust may add. PwC has waived the installation fees for SMART Outpatient, providing cost avoidance to the Trust of $15,000. When PwC installed SMART Inpatient in 2011, the Trust realized cost avoidance of $15,000. Relative to the proposed renewal, the vendor has provided savings to the Trust totaling $91,600. The original contract was approved by Risk as to Insurance and Liability and by the County Attorney s Office for Legal Sufficiency. This contract can be terminated by either party with a ninety (90)-day notice and includes the UAP and OIG provisions. A Sole Source Justification has been provided by Vania Bredy and Mark Knight and Conflict of Interest Declarations signed by Vania Bredy, HIM Director, and Gerard Bielak, Partner, PwC. (M. Knight). 3. (373166-HT) The Revenue Cycle Division requests continued funding for the sole source ACCESS Florida Program services provided by the Florida Department of Children & Families (ongoing/replacement purchase). Background Florida Department of Children & Families: This request for funding: $484,704 (for two years) Total approved funding: $484,704 This Program helps JHS determine Medicaid Eligibility for all unfunded patients in order to ensure that JHS will be able to collect revenue for medical services rendered. The program is a joint effort by DCF and the Trust. The Trust funds 50% of the DCF employee s salary costs. Due to an increase in services, DCF will add three employees to the existing staff, there will now be eleven (11) onsite employees. The new contract also changes in structure; it will go from a funded position agreement to a fee for service agreement as mandated by the state. The requested funding will cover services for a two year period in the amount of $242,352 per year. These services can only be provided by the State of Florida and are not otherwise available. June 2012 PHT Financial Recovery Board 5

SECTION V. (cont d.) Recommendation The ACCESS Florida Program is strictly offered by the state of Florida under the Florida Department of Children and Families. Past performance of these FTE s has demonstrated the volume of classifying patients under the Medicaid program has far exceeded the cost paid for services. The relationship between the onsite offices of DCF and Potential Medicaid has made it seamless to work out denials and has allowed for timelier determinations enabling JHS to realize Medicaid dollars sooner than the 45-day waiting period for determinations. UAP and OIG fees do not apply to this contract since the contract is 50% funded by the state of Florida. This contract has a termination for non-appropriation of funds clause and is pending legal sufficiency by the County Attorney s Office. A sole source justification has been provided by Tellsa Lyons and Mark Knight (M. Knight). B. Physician s Preference Staff requests a waiver of formal competition for the contract items listed in this category because a physician or clinician has requested the particular item or service without which the physician or clinician cannot successfully and safely render patient care. No items to report. C. Standardization Items in this category have been established as the Trust standard. 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. Balance of page intentially left blank June 2012 PHT Financial Recovery Board 6

SECTION V. (cont d.) 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. 4. (366763, 388262-SH) JHS Construction Services and Jackson North Medical Center Engineering Services request ratification, under the Emergency Procurement provision of the Procurement Regulation for the rental of portable air conditioners for various areas due to failed air handler units (Emergency purchase). Background American Portable Air Conditioning, Inc.: $157,790 Total approved funding: $157,790 Requisition 388262 for $74,000 was submitted by JNMC on behalf of the JHS Construction Department for the rental of 37 portable air conditioning units from July 2011 to September 2011 as ordered by Abbey Spurgeon, former JHS employee, who authorized use of American Portable Air Conditioning during a capital project for the replacement of chillers that failed. The individuals involved in the authorization for the emergency procurement to meet the immediate emergency are no longer with JHS and did not complete the required paperwork before separating from the Hospital. The procurement regulation authorizes the utilization of an Emergency Procurement to meet the needs of an emergent situation that endangers the public health or safety or threatens to interrupt delivery of governmental service. There was no alternative source within the infrastructure of the hospital to cool the buildings. American Portable Air Conditioning was already in place providing service to JNMC, having been awarded a competitive contract, and was, therefore, the only practicable source under the circumstances that could satisfy the urgency of the situation. Emergency Procurement form K and Conflict of Interest Declarations were signed by Bill McKeon, Director of Operations, JNMC, and Alba Cheas, Manager, American Portable Air Conditioning, Inc., with no reported disclosures. Pricing was consistent with what was being charged by vendor via the competitive engagement, for service at Jackson North. The emergency procedure used was necessary to provide patient comfort, establish infection control and protect sensitive equipment. Balance of page intentially left blank June 2012 PHT Financial Recovery Board 7

SECTION V. (cont d.) Requisition 366763 was submitted by JNMC for $83,790 for the rental of portable air conditioning units on an as needed emergency basis from September 2011 through May 2012. This amount is owed to the vendor for service for that period. JNMC Plant Operations department had a prior purchase order which was competitively awarded in the amount of $50,000, but which funds had been exhausted due to utilization needs. Pricing is consistent with the pricing under this competitively awarded purchase order. A Bid Waiver Justification has been provided and Conflict of Interest Declarations signed by Bill McKeon, Director of Operations, JNMC, and Alba Cheas, Manager, American Portable Air Conditioning, Inc., with no reported disclosures. Although there has been a delay in the submission of this request, these emergency procurements are being submitted to the Board of Trustees for ratification in accordance with the procurement regulation requirements. (S. Sears/M. Valdez). 5. (377875, NSA) The Strategic Planning Department requests a contract award to the Praemon Group for a period of eight (8) weeks for the provision of consulting services needed to properly establish, organize, implement and operate a dedicated clinical research unit at Jackson (New purchase). Background The Praemon Partners, LLC: $120,000 Total approved funding: $ 120,000 This project has a two-fold purpose: to broaden the clinical trials effort at JHS and to utilize JHS empty beds to generate additional revenue. In order to deliver this, Praemon will assess JHS and assist in the establishment, organization, implementation and operation of a dedicated clinical research unit within JHS. During the market research, the user department found this vendor to be the only one that would outline a program which would involve the provision of program management, leadership, and provide documentation to allow JHS to set up a Clinical Trials Phase 1 unit embedded in the main hospital campus. Eve Sakran, Corporate Director for JHS Research and Grants, has found Praemon to be the only group that has built the only dedicated research unit embedded within a hospital. Balance of page intentially left blank June 2012 PHT Financial Recovery Board 8

SECTION V. (cont d.) The user department ( The Clinical Trials Department ) considers that an academic hospital-based research unit is preferable to a free standing or off-site research unit. The advantages, which could also result in increased revenue for JHS, include the following: Location in the hospital provides 24-hr access to code teams, Medical Emergency Teams, ICU physicians, and all of the support, diagnostic, therapeutic, administrative and safety elements. All costs associated with research can be captured in a hospital-based research unit by performing all procedures in the hospital (e.g. CT scan, MRI, etc). One of JHS most important assets is its diverse patient population, and with a hospital-based research unit the enrollment time of research patients is reduced because the patients are recruited in-house, thus reducing the lag between trials. Recruiting in-house reduces marketing costs and in turn saves the hospital money. A hospital-based research unit allows for the close relationship between physicians and the medical staff and eases referrals of patients for research. In light of the foregoing, the executive team finds that this project should also serve to attract sponsors and firmly implant JHS in the research community. Recommendation The vendor has successful experience in establishing a dedicated research unit. The Praemon Group is the compilation of the original staff that established and developed a clinically credible and revenue-producing research unit within the Saint Joseph s Hospital in Atlanta, Georgia. The Clinical Trials Department conducted market research to determine the availability of competition and found that the service being offered would be best fit for the Trust to accomplish its objective of broadening clinical trials efforts at JHS and generate additional revenue. Executive Management has approved a twenty-five percent (25%) initial upfront payment, $30,000. This contract has been approved by Risk as to Insurance and Liability and by the County Attorney s Office for Legal sufficiency. This contract can be terminated for convenience with a fifteen-day (15) notice and includes UAP and OIG provisions. A Bid Waiver Justification has been provided and approved by Eve Sakran and Jeff Crudelle. Conflict of Interest Declarations have been signed by Eve Sakran, Corporate Director of Research and Grants, and by Chris Hooper, Managing Partner at Praemon Partners LLC, with no reported disclosures (E. Sakran/J. Crudelle). June 2012 PHT Financial Recovery Board 9

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. 6. (381514 - CS) The Employee Benefits Department requests approval to exercise the first option to renew (OTR 1) of Competitive Contract ITB-11-10093-CS for Employee Group Life Insurance Programs with provider InsurancePoint LLC, aka Reliance Standard Life Insurance Company, and to add another service level to the existing contract which includes Life Insurance Programs for Residents (Ongoing purchase). Background InsurancePoint LLC: Employee Life Insurance Programs: $ 734,832 (initial one year) Option to Renew (OTR) 1: $ 734,832 (for one year) Residents Life Insurance Programs: $ 126,727 (for one year) Total approved funding: $ 1,596,392 On May 18, 2011, the competitive award of Bid No. ITB-11-10093-CS for Employee Group Life Insurance Programs was approved by the Trust s Chief Procurement Officer. The one-year contract was awarded to InsurancePoint LLC, aka Reliance Standard Life insurance Company. These programs include the Basic Life/Accidental Death & Dismemberment (AD&D) insurance plan, the Optional Life insurance plan, the Long Term Disability (LTD) and the Short Term Disability (STD). Since June 24, 1977, the Residents Life Insurance Programs have been provided by two different carriers through the services of a brokerage firm. This we found was an evergreen engagement that is automatically renewed on July 1 st of every year. However, there are no records of an established contract with JHS terms and conditions with the insurance carriers and the brokerage firm. June 2012 PHT Financial Recovery Board 10

SECTION VI. (cont d.) Section 8.B of the existing contract used for Employee Life Insurance Programs allows for additional terms and conditions within the scope and original intent. This clause states that: said terms and conditions may include additions of service levels, which in this case would be the Residents Life Insurance Programs that include Basic Life, Basic Accidental Death and Dismemberment (AD&D), Supplemental Life, and Long Term Disability (LTD) insurance. The department has identified the need to establish a contract for Residents Life Insurance programs. Annual savings of $34,708.10 will be realized by using contract ITB-11-10093-CS as opposed to the current engagement. The user department and PMD have determined it is in the Trust s best interest to add Residents Life Insurance programs to the terms and conditions of the contract at the OTR 1 level. Recommendation Prior to award of this current competitive contract, JHS spent $1,135,650 annually for Employee Life Insurance programs. During this first OTR, JHS will spend the fixed price of $734,832. The current annual expenditure for Residents Life Insurance is $161,435. The annual cost accessing this competitive contract will be $126,727. Therefore, the Trust will realize cost reduction of $34,707.99 by accessing this contract for the residents. This contract can be terminated for convenience by either party with a thirty (30)- day notice and includes the UAP and OIG provisions. Conflict of Interest Declarations have been provided by Tala Teymour, JHS Employee Benefits and by David Green, Sr. VP, Reliance Standard Life Insurance Company, with no reported disclosures. (M. Huot-Barrientos) 7. (389204 - CS) The Information Technology Department requests modification of the current purchase order issued to Terremark North America, Inc. through accessing (piggyback) the Broward College Competitive Contract #ITN-2010-001-BM for increased funding until expiration of the current contract term on July 31, 2012 as well as for a new 12-month term for the provision of Off-Site Data Center and Co-location Network Services. Balance of page intentionally left blank June 2012 PHT Financial Recovery Board 11

SECTION VI. (cont d.) Background Terremark North America, Inc.: Previously Approved Funding: (July 1, 2011 to July 31, 2012)) $ 961,295 (for thirteen months) This Request for Funding: Additional Funding For: (May July 2012) $ 180,000 OTR No. 1: $ 400,000 (for twelve months) Total approved funding: $1,541,295 In September 2011, JHS accessed (piggyback) Broward College competitive Contract No. ITN-2010-001-BM for a period of thirteen (13) months for collocation and network services. This Broward College contract had been awarded to Terremark in March 23, 2010 under Agenda Item # VII-F-4-Terremark. The request for additional funding will increase the contract value by $180,000 to cover the cost of services rendered during May, June and July 2012. The Broward College competitive contract will automatically renew on August 1, 2012. Therefore, JHS ITD will be accessing the contract for an additional year from August 1, 2012 to July 31, 2013 at an estimated cost of $400,000. This amount is less than the previous annual estimated cost of operation, because JHS IT continues system migration and evacuating IT resources from the Terremark collocation facilities. The modifications will take the total contract value to $1,541,295, thus requiring FRB approval. The increase in funding for the months of May, June and July 2012 is due to the delay in rehabilitating JHS IT Data Center at Park Plaza West. The evacuation of IT resources from the Terremark collocation facility has taken longer than anticipated. System migrations from Terremark to JHS IT Data Center cannot continue until Terremark receives permits from the City of Miami to approve electrical, mechanical, and physical construction activities. After permits are received, ITD will continue removing equipment from Terremark and the monthly invoices will decrease. The OIG and UAP provisions are included. June 2012 PHT Financial Recovery Board 12

SECTION VI. (cont d.) Conflict of Interest Declarations have been provided by Michael Garcia, Interim CIO, and by Cheryl Mahaffey, SVP Legal Affairs, Terremark North America, Inc., with no reported disclosures. (M. Garcia) 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. 8. (256026 P.E.) The Patient Placement Center, in collaboration with the Information Technology Division (ITD), requests a contract award to TeleTracking for the renewal of licensing and maintenance of the TeleTracking Solution and expansion of the solution to Jackson North and Jackson South (Ongoing purchase). Tele Tracking Technologies, Inc.: Year 1: Implementation/Training/ License/Maintenance $ 747,886 Year 2: License/Maintenance $ 326,892 Year 3: License/Maintenance $ 386,892 Year 4: License/Maintenance $ 386,892 Year 5: License/Maintenance $ 386,892 Total approved funding: $ 2,055,454 Background The Central Staffing and Patient Placement Center have been working to standardize processes and throughput systems. This initiative has included the consolidation of Central Staffing and Patient Placement Center (people and locations). The Tele Tracking System June 2012 PHT Financial Recovery Board 13

SECTION VII. (cont d.) is an integrated system for Bed Tracking, PreAdmit and TransportTracking that allows the hospital to efficiently plan, manage and expedite patient throughput. The system is proprietary to the vendor, Tele Tracking Technologies, and software upgrades, system support and maintenance are available only from this vendor. In August 2006 the Board approved a License Agreement for the upgrade and continued maintenance and support of the existing Bed, PreAdmit and Transport Tracking system at Jackson Main in the amount of $465,600. In June 2008 JHS signed an amendment with TeleTracking to provide services for the migration of Bed Tracking and PreAdmit Tracking to the SQL System and migration of TransportTracking to the XT platform. The current license agreement is set to expire on June 30, 2012 and a modification is being requested to expand this solution to both Jackson North and South and continue the required maintenance as well as add TransferCenter System, Custom Reporting Solution and Patient Flow Dashboard applications system-wide. The TransferCenter System provides effective and clear communication between clerical, clinical and physician personnel to ensure that incoming domestic transfers are being assessed accurately for admission. Proper assessment ensures that appropriate transfers are being admitted. This ensures cost effectiveness by eliminating inappropriate transfers due to mis-criteria and protection against the Federal Emergency Medical Treatment and Labor Act (EMTALA) which requires hospitals to provide an examination and stability treatment of a patient without consideration of insurance coverage or ability to pay when the patient reports to the emergency room. PreAdmit and BedTracking ensures patient throughput is efficiently managed. It works in conjunction with various departments within the hospital to properly and effectively move the patient from one area to another, from admission to discharge. By efficient throughput of a patient, the hospital is able to reduce length of stay of the patient, while simultaneously increasing patient volumes in ensuring that patients are properly placed, as well as decreasing patient LWOBS (Left Without Being Seen). The Custom Reporting Solution and Patient Flow Dashboard applications will assist in real-time access to reports. Recommendation This request for approval of a system-wide expansion will enable the JHS Transfer Center to command all the automated tools needed to transfer a patient in one single location and enable simultaneous communication between the referring and accepting facilities to verify bed availability as well as enable the sharing of data with the transport and emergency departments. This enterprise-wide expansion will also satisfy the Joint Commission, CMS, and AHCA requirements as well as JHS patient flow standards, while improving patient safety and reducing Emergency Department overcrowding. Information will be updated June 2012 PHT Financial Recovery Board 14

SECTION VII. (cont d.) and tracked effortlessly and shared with each person as well as groups critical to the successful care of the patient. The renewal requested will be for a period of Five (5) years and provides cancellation for convenience by the Trust after the third year. Implementation of a new solution requires years of training and could significantly affect patient flow if not done seamlessly. Key TransportTracking features can have tremendous financial impact within patient transport departments as well as throughout other areas of the hospital. TeleTracking s TransportTracking system will automatically assign jobs to transporters based on a complex dispatching logic that is configurable by the Hospital based on its demand and facility structure. When the transporter logs in for the day, the intelligent, Interactive Voice Response (IVR) system will give details of the first job and the IVR will be used continually throughout the day to update status and assign new jobs. TeleTracking s customizable dispatching logic has proven to reduce average transport trip times anywhere from 5 minutes to 15 minutes or more per trip. Benefits to be gained include: Ability to provide service for additional departments such as Radiology, ED, OR, etc; ability to transport patients to discharge, reducing the amount of time clinical staff has to spend transporting patients and providing more time for patient care; ability to transport patients to and from testing areas, freeing up technicians for more examinations. TransportTracking sends out a post dispatch page to the transporter after they receive their assignment through the IVR. This will include all the details of the job, two patient identifiers (a Joint Commission requirement), and whether that patient has an isolation status, thus eliminating the typical word of mouth or signs on doors to relay critical isolation information to patient transport personnel. The Patient Placement Center and ITD in researching the market found no other system as robust as the TeleTracking system or possessing the capabilities of this integrated solution. This system is the only one that offers a program that encompasses patient bed assignments, pre admitting services, transportation services for inpatients and Environmental services and tracks characteristics pertinent to each patient, such as infection type in determining cleaning status and time. Staff has also been trained on the earlier TeleTracking version that interfaces with the existing Electronic Medical Records (EMR) system. This solution was not available under the MedAssets contract. The following information conservatively illustrates Return On Investment (ROI) for TransportTracking based on average baseline patient transport data for approximately 400 beds and an assumption of: (1) 2 dispatchers with an average salary of $34,000 annually; (2) 300 trips per week with an average transport trip of 30 minutes; (3) 50 clinical transports per week with the average hourly Nursing rate of $32/hour, clinical transports taking 20 minutes; (4) an average cost of CT reimbursement estimated at $500;and, (5) average additional cost per patient of $15,272 for Hospital Acquired Infection, resulting in an ROI of $553,243: June 2012 PHT Financial Recovery Board 15

SECTION VII. (cont d.) (1) Fully Automated Dispatcherless Patient Transport System providing savings of $68,000 the equivalent of two salaries at $34,000 annually (2) Intelligent Dispatching Logic a. providing a reduction in average trip time by 5 minutes to generate $32,000 b. ability to provide service for multiple other departments without adding FTEs for a cost avoidance of $179,093 c. Efficiency improvements in diagnostic imaging for cost savings of $182,500 (3) Transporter notification of isolation information, thus preventing the spread of Hospital Acquired Infection resulting in savings of $91,650. Original contract was approved for legal sufficiency. This contract modification is pending legal review by the County Attorney s Office. This contract may be terminated by the Trust for convenience after the third year and contains OIG and UAP provisions A Sole Source Justification has been provided and Conflict of Interest Certifications signed by Michael Garcia, Interim CIO, JHS ITD, Alex Fernandez, Director of Central Staffing and Patient Placement Center, JHS, and Kirk Stephen, Executive VP, CPO and COO, Tele Tracking, with no reported disclosures. The vendor has provided in excess of 31% in total discount, which MD Buyline has reported to be far more competitive than other TeleTracking quotes they have reviewed in the last 12 months (R. Cuming/M. Garcia). 9. (388701-MR) The Human Relations Division requests a one year extension of the contract with Allen, Norton & Blue, PA for the continuation of expert consulting services. Allen, Norton & Blue, P.A.: Previously approved amount: $330,000 This request for funding: $150,000 (for one year) Total approved funding: $480,000 June 2012 PHT Financial Recovery Board 16

SECTION VII. (cont d.) Background In May 2011, the Financial Recovery Board approved a one year contract with Allen, Norton and Blue for labor negotiations consulting services in the amount of $275,000. Under the provisions of the agreement, the vendor provides services in connection with the negotiations of collective bargaining agreements between the Trust and the Trust s unionized employee organizations. During the initial term, the vendor assisted with the negotiations of the Trust s five bargaining units. Negotiations took longer than expected and a contract modification was required, under the Chief Procurement Officer s delegated authority, for a two-month period in the amount of $55,000. Four out of the five collective bargaining agreements have been finalized. Recommendation It is the intent of the Human Resources department to continue the relationship with Allen, Norton and Blue to allow for the finalization of the agreement with the Committee of Interns and Residents (CIR) and to allow for the Trust to address any reopeners for the finalized agreements with SEIU/Registered Nurses, SEIU/Professional, SEIU/Attending Physicians and AFSCME. The vendor s fees will remain at a blended hourly rate of $235 per attorney and $90 per paralegal. The original agreement was approved by Risk as to Insurance and Liability and by the County Attorney s Office for legal sufficiency. The contract can be terminated for convenience by either party with a thirty (30) day prior written notice and includes the UAP and OIG provisions. Conflict of Interest forms have been provided by Maria Huot-Barrientos, Sr. VP & Chief Human Resources Officer, JHS and by Robert Norton, President, Allen, Norton & Blue, P.A. with no reported disclosures. (M. Huot-Barrientos) 10. (391829) The Clinical Resource Management (CRM), Department of Quality and Patient Safety, requests a six-month extension of contract Bid Waiver 11-10286- NSA originally awarded to Infusion Technologies d/b/a CarePoint Partners Inc. under a waiver of formal completion for the provision of Home Infusion Services. (Ongoing purchase). Infusion Technologies d/b/a CarePoint Partners, Inc: OTR #2: $340,000 (for six months) Total approved funding: $340,000 June 2012 PHT Financial Recovery Board 17

SECTION VII. (cont d.) Background CRM assists the unfunded or homeless patients of Miami Dade County who would otherwise remain hospitalized for an extended period at a Jackson Health Systems (JHS) facility. CRM helps the patients, their family, and medical team identify the needs of the patient and targets appropriate resources for follow-up care which may include the need for Home Infusion services. Home infusion is a safe and effective alternative to inpatient care for many disease conditions and therapies. For many patients, receiving treatment at home is preferable to being in the hospital. On March 21, 2012, PMD issued RFP No. 12-10393-NSA for the provision of the services of a qualified contractor(s) to provide Home Infusion Services to adult and pediatric patients discharged from JHS. These Home Infusion services were to be provided as a turnkey project; inclusive of all medications, supplies, and personnel to administer the medications to the JHS clients and maintain the project. A pre-proposal conference was held on March 28, 2012. PMD received a number of questions from potential providers. These questions were submitted to the user department for review and disposition. However, after further evaluation, considering the questions and in conjunction with the increased need and costs, the user department ultimately decided that it would be in the best interest of the Trust to cancel the solicitation and reevaluate the requirements for Home Infusion Services in accordance with JHS strategic plan. On May 17, 2012, PMD cancelled RFP No. 12-10393-NSA for Home Infusion Services. Recommendation The continuation of the Home Infusion Services is a benefit to the Trust, as it is less costly to treat the qualifying patients in their home at a lower cost as opposed to extending their stay at JHS for a 2 to 6 weeks or longer. Contract Modification will extend the agreement for a period of six months. During this period, PMD will work with the user department to refine the solicitation to reflect the needs based on re-examination of the following areas: Weekly reconciliation of home visits and cost Cost of supplies and nursing The possibility that JHS may be able to provide medication for a reduced cost under 340B pricing The increase in the uninsured and underinsured ( benefits that include home health) The possibility of a bundled package to include the management of nursing services that are required outside of the infusion services ie; wound care, PT or OT. ( presently JHS contracts with 2 agencies and it may not be cost effective or well coordinated, which may increase cost) June 2012 PHT Financial Recovery Board 18

SECTION VII. (cont d.) The CRM Department, in collaboration with the Procurement Management Department, conducted market research to determine the availability of competition and found that it is still in the best interest of the Trust to contract with Infusion Technologies d/b/a CarePoint Partners Inc. during this interim period while a new strategy is being developed to allow PMD to issue a new competitive solicitation (K. Andrews). SECTION VIII. MISCELLANEOUS This section consists of procurement actions that require Board approval not included under any other section of the Purchasing Report. No items to report. A. Vendor Name Change This section refers to existing contracts requiring a vendor name change under any circumstance at any time after contract award and for the duration of contract performance. The Chief Procurement Officer is the approving authority when the original award of the subject contract was within the approval authority of the Chief Procurement Officer, and the Board of Trustees is the approving authority when the original award of the subject contract required the approval of the Board. The County Attorney s Office has been consulted and has provided a determination of legal sufficiency. No items to report. June 2012 PHT Financial Recovery Board 19

Agenda Item 3. Purchasing Subcommittee June 14, 2012 RESOLUTION NO. PHT 6/12 RESOLUTION AUTHORIZING (1) APPROVAL OF AN AMENDMENT FOR THE CONTINUATION OF MICROSOFT PRODUCTS PROVIDED BY SHI INTERNATIONAL CORPORATION UNDER THE STATE OF FLORIDA, STATE AND LOCAL VOLUME LICENSING AGREEMENTS IN THE AMOUNT OF $2,734,356.39 FOR A THREE YEAR PERIOD, FROM APRIL 1, 2012 THROUGH MARCH 31, 2015 AND (2) APPROVAL OF TRUE-UP FROM THE PREVIOUS CONTRACT TERM IN THE AMOUNT OF $1,380,817.17 AND (3) PAYMENT IN THE AMOUNT OF $1,537,109.83 TO BE MADE BY JUNE 16, 2012 (Michael Garcia, Interim Chief Information Officer, Jackson Health System) WHEREAS, the Public Health Trust ( PHT ) approved and entered into a three year Microsoft Enterprise Agreement ( EA ) pursuant to the State of Florida, State and Local Volume Licensing Agreement ( State Agreement ) through its reseller, SHI International Corporation ( SHI ), for JHS administrative and for clinical computer licenses expiring on March 31, 2012; and WHEREAS, accessing the State Agreement allows Jackson Health System ( JHS ) to take advantage of the highest level of discounts offered to participants and the most cost effective and efficient way to maintain JHS enterprise wide software standards; and WHEREAS, the agreements allow JHS to utilize additional licenses for any product covered under the Agreement with the understanding that at the end of each contract year, the additional licenses will be aligned with the number of licenses initially purchased; and WHEREAS, the EA accounted for 4,242 licenses for administrative computers, clinical computers, windows server licenses and other licenses as needed; and WHERAS, when the current inventory was reviewed, JHS has a total of 6,500 plus licenses; and WHEREAS, JHS Information Technology Division negotiated with SHI a reduction in the true up cost owed as well as a renewal of the Agreement commencing retrospectively on April 1, 2012 to maintain continuity of the current licenses JHS owns.

Agenda Item 3. Purchasing Subcommittee June 14, 2012 -Page 2- WHEREAS, a payment in the amount of $1,537,109.83 is required by SHI by June 16, 2012 in order to maintain the negotiated pricing for the true up and current contract custom pricing. WHEREAS, the PHT desires to accomplish the purposes outlined in this Resolution as further described in the memorandum attached hereto and made a part hereof; and WHEREAS, the PHT finds that the actions described herein are in the best interest of the PHT and the President and CEO recommend the actions described herein. NOW, THEREFORE, BE IT RESOLVED BY THE FINANCIAL RECOVERY BOARD OF THE PUBLIC HEALTH TRUST OF MIAMI-DADE COUNTY, FLORIDA, that this Board hereby authorizes (1) approval of an amendment for the continuation of Microsoft Products provided by SHI under the State of Florida, State and Local Volume Licensing Agreement in the amount of $2,578,874.52 for a three year period from April 1, 2012 through March 31, 2015, (2) approval of true-up from previous contract term in the amount of $1,380,817.17 and (3) Payment in the amount of $1,537,109.83 to be made by June 16, 2012.

TO: FROM: The Financial Recovery Board of the Public Health Trust of Miami Dade Michael Garcia, Interim Chief Information Officer DATE: June 14, 2012 SUBJECT: Microsoft Products Resolution Recommendation The President and CEO recommends that the Board hereby authorizes the following: (1) approval of an amendment for the continuation of Microsoft Products provided by SHI under the State of Florida, State and Local Volume Licensing Agreement in the amount of $2,578,874.52 for a three year period from April 1, 2012 through March 31, 2015, (2) approval of true-up from previous contract term in the amount of $1,380,817.17 and (3) Payment in the amount of $1,537,109.83 to be made by June 16, 2012. Background In April 2009, the Public Health Trust Board of Trustees approved a three year Enterprise License Agreement to access the State of Florida s Technology agreement for Microsoft License, Maintenance and Services from their Microsoft Enterprise Provider, Software House International. The agreements for administrative computers and clinical computers ran from April 1, 2009 through March 31, 2012. The first agreement (Enrollment number 6242474) is for JHS administrative computers which includes the Microsoft Office Suite and the second agreement (Enrollment number 7818130) is for the clinical computers which do not include the Microsoft Office Suite. The agreement enables JHS to use additional licenses for any product covered within it, with the understanding that once a year, the licenses purchased will be aligned with the number of licenses that were added during the previous 12 months. This is referred to as Microsoft s True- Up process. The agreements listed 2,325 administrative computers, 1,700 clinical computers, 217 Windows Server Enterprise Licenses, and other needed licenses. The current inventory is 3,250 administrative computers and 3,250 clinical computers in use at JHS across the enterprise. Additionally, there has been a need for additional SQL Server and CALs (Client Access Licenses) licenses. The initial cost of the true up was estimated at $2.4M. JHS has negotiated the amount of the true-up owed to $1.3M. In addition to the True-Up, JHS, Microsoft and SHI have been negotiating, in good faith, for the renewal of the agreement for a three year period. Microsoft has acted as a true partner to JHS in several ways through multiple concessions. Not only have they reduced the total cost of the agreement by $495,346.12, but they are also acting as a lender (0% financing) to JHS by means of allowing JHS to spread the payments over the three year renewal term. The payment schedule agreed is aligned with JHS fiscal year as follows: June 2012 = $1,537,109.83 April 2013 = $ 736,163.76 Dec 2013 = $ 553,273.50 April 2014 = $1,289,437.26 Total: $ 4,115,984.35

This amount includes the true up cost for the previous contract as well as the fees for the renewal term commencing on April 1, 2012 through March 31, 2015. The fee for the renewal period includes the current JHS infrastructure.

Monthly Report of Competitive Contracts Awarded or Renewed under the Chief Procurement Officer Authority in Accordance to Procurement Regulations May 1, 2012 May 31, 2012 For Information Only Vendor Name Professional Research Consultant MCT Express Inc Description Modification to contract for Continuation of Satisfaction Surveys Services as required by Joint Comission System Wide Medical Transportation Services Cost Center & Director/VP 71316 K Andrews 94003 K Andrews Contract Number Contract Date Contract Value Contract Term Procurement Method UAP 8105227 SERV 5/1/2012 $ 145,000.00 5 months RFP 05 5052 contract modification 8105283 SERV 5/15/2012 $ 992,566.60 One Year ITB 11 6078 A Y Y Central Admixture Pharmacy Preparation/Acquisition of Patient Specific Medication for the Pharmacy Departments 73005 A Contreras 8105307 SERV 5/18/2012 $ 483,000.00 Emergency One Time MedAssets MS01562 Y KCI USA Immixtechnology Inc System Wide Specialty Bed Rentals for Wound Care Kronos Hardware/Software Maintenance 63006 R Costanzo / M Knight 92816 Michael Garcia 83736 M Garcia 57060 S Sears 57160 S Sears Reference Lab Testing for Jackson North Quest Diagnostic Medical Center Reference Lab Testing for Jackson South Quest Diagnostic Community Hospital Radiopharmaceuticals for Jackson North Cardinal Health Medical Product Medical Center 1. "MedAssets" is the Trust's primary "Group Purchasing Organization" (GPO) 2. "State Contract" and "Miami Dade Contract" mean a contract competively awarded by the State or County as a "cooperative contract" 3. "US Communities" means a contract competively 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. Y 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 8105339 SERV 5/25/2012 $ 2,036,859.00 Three Years MedAssets MS01580 Y 8105344 SERV 5/29/2012 $ 358,670.63 One Year GSA Contract PB 12 10524 PE 8201004 SERV 5/21/2012 $ 240,000.00 Three Years MedAssets LB01066 Y 8301102 SERV 5/21/2012 $ 250,000.00 Three Years MedAssets LB01066 Y 8301107 SERV 5/23/2012 $ 108,206.50 One Year MedAssets MS02127 Y Y

Vendor Medical Information Technology Unity Mechanical Corp Morehead Consulting Akorn Inc Sap America Inc Joanne T Higbee Consulting Llc Meditech software Description Repairs for Utility Center Boilers Consulting services to evaluate physician productivity, compensation models and staffing levels Emergency order for medication to treat seizures insomnia, and to sedate patients (not available thru Cardinal) Annual maintenance and support for desktop intelligence, enterprise intelligence, web intelligence Acting controller for JHS Monthly Report of Non Competitive Contracts Under 100K May 1, 2012 May 31, 2012 For Information Only Cost Center & Director/VP 83900 M Garcia 100 A Contreras 99301 M knight 73005 A Behr 92826 M Garcia 90511 B Dean Contract Number Contract Date Contract Value Contract Term Procurement Method 8201003 SERV 05/21/2012 $82,000.00 One Time Sole Source N 4101344 CAPS 05/29/2012 $48,600.00 One Time Sole Source Y 8105327 SERV 05/24/2012 $40,000.00 1 Year Bidwaiver Y 8105298 SERV 05/17/2012 $42,593.40 One Time Sole Source N 8105312 SERV 05/22/2012 $13,236.24 1 Year Sole Source Y 8105341 SERV 05/25/2012 $80,000.00 6 Months Bidwaiver Y UAP Note: "Non competitive" procurement category includes: Sole Source, Physician's Preference, Standardization, Non Competitive Cooperate Purchasing, and Miscellaneous Bid Waiver. UAP User Access Program E Exclusion as per UAP program: i.e., Federal Grant, etc. Y 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 6/12/2012 9:07 AM 1 of 1

6. Key Performance Indicators (KPI) for Procurement Update (Supporting document will be distributed at the meeting.)

7. Procurement Regulation Update (Supporting document will be distributed at the meeting.)

FACILITIES SUBCOMMITTEE

PUBLIC HEALTH TRUST FINANCIAL RECOVERY BOARD Facilities Subcommittee Darryl K. Sharpton, Chairperson Mojdeh L. Khaghan, Vice Chairperson Joe Arriola Date, Time and Place June 14, 2012 7:45 a.m. to adjournment Ira C. Clark Diagnostic Treatment Center Conference Room 259 AGENDA 1. **Approval of the Previous Meeting Minutes (Darryl K. Sharpton, Chairperson, Facilities Subcommittee) (a) Meeting Minutes as of May 17, 2012 2. Chairperson s Report (Darryl K. Sharpton, Chairperson, Facilities Subcommittee) 3. Real Estate Update (Andrew Rachlin, Director, Real Estate, Jackson Health System) 4. * Financial & Budget Tracking Status Report April 2012 (Aurelio Gonzalez, Budget Director, Jackson Memorial Hospital) 5. *Capital Projects Construction Projects Update June 2012 (Madeline Valdes, Corporate Director, Property Management, Jackson Health System) The item(s) noted with an asterisk (*) indicates that the supporting documents are attached. The items noted with two asterisks (**) indicates that voting is required by the Subcommittee.

1. Approval of the Previous Meeting Minutes

PUBLIC HEALTH TRUST FINANCIAL RECOVERY BOARD Facilities Subcommittee Darryl K. Sharpton, Chairperson Mojdeh L. Khaghan Vice Chairperson Joe Arriola Date, Time and Place May 17, 2012 7:45 a.m. to adjournment Ira C. Clark Diagnostic Treatment Center Conference Room 259 ATTENDANCE Facilities Subcommittee Mojdeh L. Khaghan Marcos Jose Lapciuc Excused Darryl K. Sharpton Financial Recovery Board Joaquin Del Cueto Steven S. Nuell Michael Bileca Jackson Health System Carlos A. Migoya Mark T. Knight Don S. Steigman Aurelio Gonzalez Madeline Valdes David Clark Miami-Dade County Attorney s Jeffrey Poppel Eugene Shy, Jr.

Facilities Subcommittee Meeting May 17, 2012 Page 2 Call to Order With a quorum being present, the Facilities Subcommittee meeting was called to order at 7:45 a.m. by Mojdeh L. Khaghan, Vice Chairperson, Facilities Subcommittee. 1. Approval of the Previous Meeting Minutes (a) Meeting Minutes as of April 19, 2012 Ms. Khaghan requested a motion approving the meeting minutes of April 19, 2012. Mr. Lapciuc moved approval; seconded by Ms. Khaghan, and carried without dissent. 2. Chairperson s Report No report. 3. Real Estate and Retail Update No update report. 4. Resolution Recommended to be Approved (a) Resolution providing for the delegation of authority from the Financial Recovery Board of the Public Health Trust to the President or his designee to settle leasing disputes, including waiving interest and late charges; authorizing the President to consent to assignment of leases and to execute Subordination, Attornment and Non-Disturbance Agreements and Estoppel Certificates Ms. Khaghan requested a motion for the item. Mr. Lapciuc moved approval; seconded by Ms. Khaghan, and carried without dissent.

Facilities Subcommittee Meeting May 17, 2012 Page 3 5. Financial & Budget Tracking Status Report Aurelio Gonzalez, Corporate Director of Productivity, Jackson Memorial Hospital presented the Financial & Budget Tracking Status Report for the month of March 2012. A copy of the Financial & Budget Tracking report was included in the agenda packet. 6. Capital Projects Construction Projects Update May 2012 Adjournment Madeline Valdes, Corporate Director, Property Management Division, Jackson Health System, announced the appointment of David Clark as the Director of Construction Services for Jackson Health System. Mr. Clark will oversee the Capital Projects Department within the Property Management Division. Mr. Clark has been a Project Manager with Jackson Health System for approximately eighteen (18) months. Mr. Clark has years of experience in design/build management and AHCA/ICRA project management within the healthcare industry. Mr. Clark presented an update regarding new initiatives. With regards to the life safety projects, Mr. Clark stated that the Wide Fire Alarm and Campus Wide Sprinklers projects have been advertised and an Invitation to Bid has been issued. The life safety projects require regulatory compliance measures by the Centers for Medicare & Medicaid Services (CMS). The Ryder Trauma Center Exterior Hardening Project, which is a FEMA funded project, is currently out to bid and under the Cone of Silence. All other active projects are being tracked for completion. The Capital Projects Department Leadership Team met with Ms. Khaghan and agreed to implement new tile finishes to aesthetically modernize the bathroom renovations throughout the hospital. The meeting of the Facilities Subcommittee adjourned at 8:05 a.m. Transcribed by Monica Severiche Executive Assistant Property Management Division

2. Chairperson s Report

3. Real Estate Update

BUDGET TRACKING REPORT FY 2012 BY FUNDING SOURCE Original Total Total Projected Revised V.P. # of NEW Project Budget Project Start Compl. Compl. Fund. Project Project Exec. Actuals FY12 Total YTD Life to Date Amount left Proj. Proj.# Activity# Project Name Budget Changes Budget Date Date Date Source Manager Manager Spons. Apr.12 Apr.12 thru Apr.12 to Spend MULTIFUNDING SOURCE PROJECTS status 1 C P-00632 52005003 J.South Community Hptal 102,425,000 100,000 102,525,000 CO Aug-05 Dec.10 Apr.12 Multi Clark JMH Garcia (120,782) 4,019,384 101,104,666 1,420,334 2 J P-00949 51009046 WW-B Pharmacy Phase I 250,927 583,669 834,596 CN May-09 Mar.10 Jun.12 Multi Arnaldo JMH Contreras 8,402 139,915 580,084 254,512 3 K P-00952 51009047 SICU Reconfiguration 400,000 136,000 536,000 CL May-09 May.10 Sep.11 Multi Arnaldo JMH Contreras 6,962 20,514 532,757-4 L P-00836 51007017 Rehab Building Renovation 16,670,411 (59,620) 16,610,791 CN Sep-07 Aug.10 Sept.15 Multi Frank JMH Contreras - - 158,547 16,452,244 5 M P-00904 51008026 C-4 Cath Lab #6 2,833,500 196,500 3,030,000 D Jul-08 Oct.09 TBD Multi Alana JMH Contreras - 22,446 102,277 2,927,723 6 O P-00566 51001001 Elevator Modernization 3,000,000 70,700 3,070,700 CN May-01 Mar.08 Jun.13 Multi Alana JMH Armstrong - - 2,022,856 1,047,844 7 Q P-00696 51008007 Underground Storage Tank Rep 3,000,000 (1,689,852) 1,310,148 CL May-08 Dec.09 Dec.11 Multi Allen Heery Valdes - - 1,166,697-8 R P-00763 59007009 JMT Elevator Modern#141-146 1,057,183 243,574 1,300,757 CN Jul-07 Sept.10 Dec.12 Multi Frank JMH Valdes 37,394 427,245 967,314 333,443 9 S P-00827 53008015 Jack.No Elevators 1 & 2 490,050-490,050 DEF Feb-08 Jan.09 Oct.10 Multi TBD JMH Sears - - 58,980 431,070 10 T P-00834 51008016 ADA Compl.#Pkg1 Restrooms 991,763 692,000 1,683,763 CN Oct-07 Apr.08 Dec.12 Multi Arnaldo JMH Valdes 3,557 11,475 734,380 949,384 11 U P-00854 53008020 Jack.No. Window Replacement 2,057,220 1,088,750 3,145,970 CN Jan-08 Jan.09 Sep.12 Multi Arnaldo JMH Sears 5,000 453,157 2,567,156 578,814 12 V P-00606 59004002 JMT Elevators Moderniz. 931,591 (30,291) 901,300 D May-04 Feb.08 May.13 Multi Alana JMH Valdes - 26 23,739 877,561 13 W P-00655 56006004 JNCMHC Emerg. Generator 331,839-331,839 DEF Jul-06 Aug.07 Jun.11 Multi Camero JMH Valdes - - 17,470 314,369 14 X P-00724 51007008 Kitchen Equipment Modification 791,164-791,164 DEF Nov-06 Jun.07 TBD Multi Rob JMH Valdes - - 79,485 711,679 15 Y 51011105 Ryder Trauma Ext Hardening 8,589,588-8,589,588 D Dec-10 Aug.13 Multi Clark JMH Valdes - 472,495 478,480 8,111,108 16 Z P-00928 51008032 ET- 1 Ortho Suite & ERA 1,706,000 700,000 2,406,000 CN Sep-08 Sep.09 Mar.13 Multi Frank JMH Valdes - 163,766 880,602 1,525,398 17 AA 51011103 IT Infrastructure Renovat - 603,500 603,500 CL Dec-10 Mar.12 Sep.11 Multi Frank JMH Salgado - 13,657 589,704-18 AB PIP 31009002 Telecommunication 8,188,100 1,765,000 9,953,100 PIP Aug.09 Dec.11 Multi Niko JMH Salgado 4,633 2,073,003 8,377,799 1,575,301 19 AC P-00997 51009089 4160 Volt Oil Switch Repl 7,350,000 (2,565,000) 4,785,000 D Sep-09 Dec.12 Dec.13 Multi Douglas JMH Valdes 28,962 79,267 335,439 4,449,561 Total Mutifunding Source 161,064,336 1,834,930 162,899,266 (25,872) 7,896,350 120,778,433 41,960,344 CAPITAL CONTRIBUTION PROJECTS 1 O P-00566 51001001 Elevator Modernization 1,608,153-1,608,153 CN May-01 Mar.08 Jun.13 CC Alana JMH Armstrong - - 1,608,153 (0) 2 X P-00724 51007008 Kitchen Equipment Modification 79,485-79,485 DEF Nov-06 Jun.07 TBD CC TBD JMH Valdes - - 79,485 (0) 3 T P-00834 51008016 ADA Compliance Package#1 378,757-378,757 CN Oct-07 Apr.08 Dec.12 CC Arnaldo JMH Valdes - - 378,757-4 51011100 Highland Prof.Financ.Assessm 740,000-740,000 D Oct-10 Sep.11 Sep.12 CC Clark JMH Contreras - 118,878 178,645 561,355 5 51011104 WW-15 Nursing Unit Moder 2,588,568-2,588,568 D Dec-10 Aug.12 Dec.12 CC Clark JMH Contreras 2,350 6,642 170,993 2,417,575 6 Y 51011105 Ryder Trauma Ext Hardening 2,147,397-2,147,397 D Dec-10 Aug.13 CC Clark JMH Valdes - - - 2,147,397 7 51011106 Highland Prof. 6TH Floor 542,625-542,625 D Dec-10 Sep.11 Sep.12 CC Clark JMH Contreras - 2,725 42,117 500,508 8 51011107 ACC-W-1 Pharmacy Reno 1-1 D Dec-10 Dec.11 Jan.12 CC Arnaldo JMH Contreras - - - 1 9 C P-00632 52005003 J.South Community Hptal(661) 82,254-82,254 CO Aug-06 Dec.10 Apr.12 CC Clark JMH Garcia - - 82,254-10 S P-00827 53008015 Jack.No Elevators 1 & 2 52,317-52,317 DEF Feb-08 Jan.09 Jun.10 CC TBD JMH Sears - - 52,317-11 U P-00854 53008020 Jack.No. Window Replacement 85,608-85,608 CN Jan-08 Jan.09 Sep.12 CC Arnaldo JMH Sears - - 85,608-12 W P-00655 56006004 JNCMHC Emerg. Generator 17,470-17,470 DEF Jul-06 Aug.07 Jun.11 CC Camero JMH Valdes - - 17,470-13 V P-00606 59004002 JMT Elevators Moderniz. 23,713-23,713 D May-04 Feb.08 May.13 CC Alana JMH Valdes - - 23,713-14 R P-00763 59007009 JMT Elevator Modern#141-146 24,135-24,135 CN Jul-07 Sept.10 Dec.12 CC Frank JMH Valdes - - 24,135-15 51011112 DTC PET Scan 2,467,000 (343,000) 2,124,000 CN Jan-11 Jul.12 CC Abby JMH Contreras - 42,041 1,913,470 210,530 16 51011119 WW-105 Government Relat 95,875-95,875 CO Sep-11 TBD CC Abby JMH Valdes - 48,278 94,640 1,235 17 51012100 Human Resources Relocation 300,000-300,000 D Dec-11 Aug.12 CC Lourdes JMH Hout-Barrientos 150,029 150,029 149,971 18 AB PIP 31009002 Telecommunication 2,000,000-2,000,000 PIP Aug.09 Dec.11 CC Niko JMH Salgado 4,633 424,699 424,699 1,575,301 Page 1 of 6

BUDGET TRACKING REPORT FY 2012 BY FUNDING SOURCE Original Total Total Projected Revised V.P. # of NEW Project Budget Project Start Compl. Compl. Fund. Project Project Exec. Actuals FY12 Total YTD Life to Date Amount left status Proj. Proj.# Activity# Project Name Budget Changes Budget Date Date Date Source Manager Manager Spons. Apr.12 Apr.12 thru Apr.12 to Spend 19 AC P-00997 51009089 4160 Volt Oil Switch Repl - 1,000,000 1,000,000 D Sep-09 Dec.12 Dec.13 CC Douglas JMH Valdes - - - 1,000,000 Total Capital Contribution 13,233,358 657,000 13,890,358 6,983 793,291 5,326,488 8,563,871 CAPITAL CONTRIBUTION JACKSON NORTH Total Jackson North - - - - - - - CAPITAL CONTRIBUTION STRATEGIC INITIATIVE (PROJECTS CANCELLED) Total Strategic Initiative - - - - - - - CAPITAL CONTRIBUTION FINANCIAL SUSTAINABILITY Total Financial Sustainability - - - - - - - CAPITAL CONTRIBUTION CLOSED PROJECT FY 2011-2012 1 Q P-00696 51008007 Underground Storage Tank Rep 80,384-80,384 CL May-08 Dec.09 Dec.11 CC Allen Heery Valdes - - 80,384-2 51010102 Managed Care Relocation 952,906 952,906 CL Jul-10 Sep.11 Dec.11 CC Lourdes JMH Brady - 33,469 922,578-3 AA 51011103 IT Infrastructure Renovat - 368,500 368,500 CL Dec-10 Mar.12 Sep.11 CC Frank JMH Salgado - 13,657 354,704-4 51010093 Centralized Registration 362,005-362,005 CL Feb-10 Oct.10 Nov.11 FS Lourdes JMH Pla - 32,274 352,468-5 51011111 NW-3 Floor Phase 1 347,750 275,400 623,150 CL Jan-11 Oct.11 Dec.11 CC Frank JMH Contreras 185,996 430,698 623,004-6 58011110 Perdue Medical Center Reno 1,200,000 (1,200,000) - CAN Jan-11 May.12 Apr.12 CC Arnaldo JMH Andrews (35,174) (2,329) 0 - Total Closed Capital Contribution 1,990,139 396,806 2,386,945 150,822 507,770 2,333,137-23 SUB TOTAL CAPITAL CONTRIBUTION PROJECTS 15,223,497 1,053,806 16,277,303 157,805 1,301,061 7,659,625 8,563,871 Page 2 of 6

BUDGET TRACKING REPORT FY 2012 BY FUNDING SOURCE Original Total Total Projected Revised V.P. # of NEW Project Budget Project Start Compl. Compl. Fund. Project Project Exec. Actuals FY12 Total YTD Life to Date Amount left status Proj. Proj.# Activity# Project Name Budget Changes Budget Date Date Date Source Manager Manager Spons. Apr.12 Apr.12 thru Apr.12 to Spend FOUNDATION 1 P-00659 51006005 Holtz-2 Pathology Renovat 2,000,000-2,000,000 CN Jul-06 Jul.08 Jul.12 F Frank JMH Contreras - 564,371 1,848,191 151,809 2 51011117 DTC-1 Taylor Breast Ctr Reno 276,000-276,000 D Jul-11 Jul.12 Feb.13 F Alana JMH Contreras 5,670 5,670 6,370 269,630 3 51011118 C-5 NICU Intermed.Modern 100,000-100,000 D Aug-11 Apr.13 Jun.13 F Alana JMH Armstrong - - - 100,000 Total Foundation 2,376,000-2,376,000 5,670 570,041 1,854,561 521,439 GOB GENERAL OBLIGATION BONDS 1 L P-00836 51007017 Rehab Building Renovation 16,400,000 16,400,000 D Sep-07 Aug.10 Sept.15 GOB JS Frank JMH Contreras - - - 16,400,000 2 P-00867 51008024 Campus Wide Pneumatic Tube 3,629,400-3,629,400 CN Apr-08 Aug.10 Dec.13 GOB ED David JMH Valdes 48,035 607,523 1,470,647 2,158,753 3 P-00879 51008025 WW-4 CCU-B Expansion 1,855,000-1,855,000 CO Mar-08 Dec.08 Jul.11 GOB ED Arnaldo JMH Contreras 11,404 47,333 1,807,985 47,015 4 M P-00904 51008026 C-4 Cath Lab # 6 2,833,500 86,645 2,920,145 D Jul-08 Oct.09 TBD GOB ED Alana JMH Contreras - - - 2,920,145 5 Z P-00928 51008032 ET- 1 Ortho Suite & ERA 1,706,000 700,000 2,406,000 CN Sep-08 Sep.09 Mar.13 GOB ED Frank JMH Contreras - 163,766 880,602 1,525,398 Z P-00928 51008032 ET- 1 Ortho Suite & ERA - - - CN Sep-08 Sep.09 Mar.13 RB INTER Frank JMH Contreras - - - - C P-00632 52005003 J.South Community Hptal 52,000,000-52,000,000 CO Aug-05 Dec.10 Apr.12 GOB JS Clark JMH Garcia (120,782) 4,019,384 30,318,849 21,681,151 C P-00632 52005003 J.South Community Hptal (20,260,817) (20,260,817) CO Aug-05 Dec.10 Apr.12 GOB JS Clark JMH Garcia - - - (20,260,817) Total GOB Bonds 62,023,900 (3,074,172) 58,949,728 (61,343) 4,838,007 34,478,084 24,471,644 2005 REVENUE BOND L P-00836 51007017 Rehab Building Renovation 16,670,411 (59,620) 16,610,791 D Sep-07 Aug.10 Sept.15 RB REH Frank JMH Contreras - - 158,547 16,452,244 L P-00836 51007017 Rehab Building Renovation (16,400,000) (16,400,000) D Sep-07 Aug.10 Sept.15 RB REH Frank JMH Contreras - - - (16,400,000) M P-00904 51008026 C-4 Cath Lab # 6 109,855 109,855 D Jul-08 Oct.09 TBD IRB INTER Alana JMH Contreras - 22,446 102,277 7,578 1 P-00932 51009033 HCH ET-5 Intake, ET-7 BMT Ph. 1,758,649 (141,649) 1,617,000 CN Dec-08 May.10 May.12 RB PEDI Alana JMH Armstrong 65,367 391,798 1,360,971 256,029 2 P-00947 51009044 ET-5 Adolescen Unit 1,236,193 (200,000) 1,036,193 CN May-09 May.10 Sep.12 RB REH Alana JMH Armstrong - (11,810) 147,391 888,802 3 J P-00949 51009046 WW-B Pharmacy Phase I 250,927 470,000 720,927 CN May-09 Mar.10 Sep.12 RB ACU Arnaldo JMH Contreras 8,402 139,915 580,084 140,843 J P-00949 51009046 WW-B Pharmacy Phase I - 113,669 113,669 CN May-09 Mar.10 Sep.12 IRB INTER Arnaldo JMH Contreras - - - 113,669 4 P-00953 51009048 ET-4 Fetal Surgery Office 653,549-653,549 CO May-09 Feb.10 Jun.11 RB PEDI Abby JMH Armstrong 1,799 25,371 626,375 27,174 5 P-00959 51009054 ET-4 LDOR Fetal Surg.OR's 2,083,950-2,083,950 D May-09 Aug.10 Feb.13 RB PEDI Alana JMH Armstrong - 13,111 401,839 1,682,111 6 51010096 WW-2 Angio Suite 2,000,000 2,000,000 D May-10 Oct.10 Dec.12 RB PEDI Alana JMH Cuming - 1,212,063 1,273,018 726,982 7 51010097 DTC new MRI 2,500,000 2,500,000 D May-10 Oct.10 Oct.12 RB PEDI Alana JMH Cuming - 4,594 66,659 2,433,341 C P-00632 52005003 J.South Community Hptal 50,000,000-50,000,000 CO Aug-05 Dec.10 Apr.12 RB JS Clark JMH Garcia - - 50,000,000 (0) C P-00632 52005003 J.South Community Hptal 16,400,000 16,400,000 CO Aug-05 Dec.10 Apr.12 RB REH Clark JMH Garcia - - 16,400,000 (0) C P-00632 52005003 J.South Community Hptal 210,817 210,817 CO Aug-05 Dec.10 Apr.12 RB ACU Clark JMH Garcia - - 210,817 - C P-00632 52005003 J.South Community Hptal 3,650,000 3,650,000 CO Aug-05 Dec.10 Apr.12 RB INTER Clark JMH Garcia - - 3,650,000 0 Page 3 of 6

BUDGET TRACKING REPORT FY 2012 BY FUNDING SOURCE Original Total Total Projected Revised V.P. # of NEW Project Budget Project Start Compl. Compl. Fund. Project Project Exec. Actuals FY12 Total YTD Life to Date Amount left status Proj. Proj.# Activity# Project Name Budget Changes Budget Date Date Date Source Manager Manager Spons. Apr.12 Apr.12 thru Apr.12 to Spend C P-00632 52005003 J South Community Hptal 100,000 100,000 CO Aug-05 Dec.10 Apr.12 RB INTER Clark JMH Garcia - - 100,000-8 53010091 JN Pharmacy Clean Room - 361,000 361,000 CN Jan-10 Feb.11 May.12 RB INTER Arnaldo JMH Sears 141,852 241,987 280,023 80,977 9 51011116 C-4 Cath Lab #5 454,000-454,000 D Apr.11 Oct.11 Jun.12 RB INTER Alana JMH Contreras - 37,872 63,467 390,533 10 51012101 WW-6 Modernization 1,553,000-1,553,000 D Feb.12 TBD RB INTER Arnaldo JMH Contreras 1,415 1,415 1,415 1,551,585 11 51012102 SW-6 Modernization 482,320-482,320 D Feb.12 TBD RB INTER Alana JMH Contreras - - - 482,320 12 31012001 Xcelera Enterprise Solution 150,000-150,000 D Feb.12 TBD RB INTER Fuentes JMH Salgado - - - 150,000 Total 2005 Revenue Bond 75,292,999 9,114,072 84,407,071 218,836 2,078,762 75,422,882 8,984,189 2009 INFRASTRUCTURE BOND O P-00566 51001001 Elevator Modernization 1,391,847 70,700 1,462,547 CN May-01 Mar.08 Jun.13 IRB Alana JMH Armstrong - - 414,702 1,047,845 T P-00834 51008016 ADA Compliance Package#1 613,006 692,000 1,305,006 CN Oct-07 Apr.08 Dec.12 IRB Arnaldo JMH Valdes 3,557 11,475 355,622 949,384 1 P-00938 51009036 WW Fire Alarm 2,000,000 350,000 2,350,000 CN Apr-09 Sep.10 Sep.12 IRB David JMH Valdes 8,784 225,875 1,814,501 535,499 2 P-00958 51009053 ET A/C Repl177-180,181Inst 2,653,370 465,710 3,119,080 CN Sep-09 Nov.10 Apr.12 IRB Frank JMH Valdes - 514,626 2,756,197 362,883 3 P-00961 51009056 Replace Paralleling Gear 4,361,250 928,122 5,289,372 D Sep-09 Dec.12 Dec.13 IRB Douglas JMH Valdes 35,285 247,698 247,741 5,041,631 4 P-00962 51009057 Utility Ctr-2 Emerg.Generat 2,135,000 123,215 2,258,215 CN Sep-09 Jan.12 May.12 IRB David JMH Valdes 9,394 263,303 2,170,219 87,996 5 P-00967 51009062 Fire Alarm Upgrade Campus 4,815,000 (385,505) 4,429,495 D Sep-09 Dec.12 Mar.13 IRB Douglas JMH Valdes 48,711 217,289 256,801 4,172,694 6 P-00969 51009064 DTC,T,Rehab,WW&ACC-W AHU 6,541,500-6,541,500 CN Sep-09 Nov.12 Mar.14 IRB Frank JMH Valdes 57,316 666,260 2,596,393 3,945,107 7 P-00974 51009069 Campus Wide Roofing Repl. 1,500,000-1,500,000 D Sep-09 Dec.10 Feb.13 IRB Alana JMH Valdes 752 208,434 373,072 1,126,928 8 P-00978 51009072 Fire Sprinkler Upgrade Campus 2,000,000-2,000,000 D Sep-09 Dec.12 Mar.13 IRB David JMH Valdes 70,001 104,822 239,132 1,760,868 9 P-00982 51009076 UC Emerg.Well Boilers 2,331,000 286,350 2,617,350 CN Sep-09 Jun.11 May.12 IRB David JMH Valdes 116,151 819,879 2,365,064 252,286 10 P-00992 51009084 BackFl.&Byp.DomWater 250,000 117,000 367,000 CN Sep-09 Mar.10 Sep.13 IRB Frank JMH Valdes - (0) (0) 367,000 11 AC P-00997 51009089 4160 Volt Oil Switch Repl 7,350,000 (3,565,000) 3,785,000 D Sep-09 Dec.12 Dec.13 IRB Douglas JMH Valdes 28,962 79,267 335,439 3,449,561 12 51010098 Above Ground Tank Replacem - 369,580 369,580 D Jun-10 TBD IRB Camero JMH Valdes - - - 369,580 13 51010099 Concrete Struct Tank Farm - 100,000 100,000 D Jun-10 Mar-11 Aug.12 IRB Arnaldo JMH Valdes - 9,500 10,039 89,961 14 51010100 CampusW Underg Utilities - 3,200,000 3,200,000 CN Jul-10 Dec.11 Sep.12 IRB Allen Heery Valdes (20,856) 459,091 1,160,815 2,039,185 C P-00632 52005003 J.South Community Hptal (661) 342,746-342,746 CO Aug-06 Dec.10 Apr.12 IRB Clark JMH Garcia - - 342,746 - U P-00854 53008020 Jack.No. Window Replacement 1,971,612 1,088,750 3,060,362 CN Jan-08 Jan.09 Sep.12 IRB Arnaldo JMH Sears 5,000 453,157 2,481,548 578,814 15 P-00960 53009055 Main/JNMC-outside. lights 922,500 (141,820) 780,680 CN Sep-09 Sep.10 Dec.12 IRB Arnaldo JMH Valdes 2,193 32,403 142,824 637,856 16 P-00970 53009065 JNMC Hot Water/Boiler/Chiller 630,000 2,470,000 3,100,000 D Sep-09 Jun.11 Jul.13 IRB Arnaldo JMH Sears 18,750 748,866 1,468,469 1,631,531 17 P-00972 53009067 JNMC Remaining Roof 527,383 (427,071) 100,312 D Sep-09 Mar.10 TBD IRB Arnaldo JMH Sears - - - 100,312 18 P-00989 53009081 JNMC ICU Commode Rep 52,500 400,000 452,500 CN Sep-09 Mar.10 Jul.12 IRB Arnaldo JMH Sears 14,176 49,508 405,573 46,927 19 P-00996 53009088 JNMC Emer.Switchgear 1,650,000 95,000 1,745,000 D Sep-09 Dec.12 Dec.13 IRB Douglas JMH Sears 9,954 40,094 72,371 1,672,629 20 53010101 JNMC 40 Year Certification - 446,272 446,272 D Jul-10 Sep.12 IRB Arnaldo JMH Valdes - 70 65,330 380,942 V P-00606 59004002 JMT Elevators Moderniz. 907,878 (30,291) 877,587 D May-04 Feb.08 May.13 IRB Alana JMH Valdes - 26 26 877,561 R P-00763 59007009 JMT Elevator Modern#141-146 1,033,048 243,574 1,276,622 CN Jul-07 Sept.10 Dec.12 IRB Frank JMH Valdes 37,394 427,245 943,179 333,443 21 51011113 Reduction of NAP Utilization 300,000 569,824 869,824 D Apr-11 Sep.11 Sep.12 IRB Frank JMH Salgado 14 186,097 234,040 635,784 22 AB PIP 31009002 Telecommunication 6,000,000 1,765,000 7,765,000 PIP Aug.09 Dec.11 IRB Niko JMH Salgado - 1,648,304 7,765,000 - Page 4 of 6

BUDGET TRACKING REPORT FY 2012 BY FUNDING SOURCE Original Total Total Projected Revised V.P. # of NEW Project Budget Project Start Compl. Compl. Fund. Project Project Exec. Actuals FY12 Total YTD Life to Date Amount left status Proj. Proj.# Activity# Project Name Budget Changes Budget Date Date Date Source Manager Manager Spons. Apr.12 Apr.12 thru Apr.12 to Spend Total 2009 Infrastructure Rev.Bond 52,279,640 9,231,410 61,511,050 445,539 7,413,291 29,016,843 32,494,207 2009 INFRASTRUCTURE REVENUE BOND DEFERRED PROJECTS X P-00724 51007008 Kitchen Equipment Modification 711,679-711,679 DEF Nov-06 Jun.07 TBD IRB TBD JMH Valdes - - - 711,679 1 P-00964 51009059 Utility Ctr Chiller Replacem 2,810,370-2,810,370 DEF Sep-09 Dec.12 IRB TBD JMH Valdes - - - 2,810,370 2 P-00965 51009060 Chilled Water Loop Valves 315,000-315,000 DEF Sep-09 Dec.12 IRB TBD JMH Valdes - - - 315,000 3 P-00975 51009070 Heat Exchangers 420,000-420,000 DEF Sep-09 Mar.10 Oct.10 IRB Camero JMH Valdes - - - 420,000 4 P-00979 51009073 Public Area Bathrooms 210,000-210,000 DEF Sep-09 Oct.10 IRB TBD TBD Valdes - - - 210,000 5 P-00981 51009075 WW & C AHU Repl (14) 1,995,000-1,995,000 DEF Sep-09 Dec.12 IRB TBD JMH Valdes - - 95,926 1,899,074 6 P-00991 52009083 J.South Repl.2 Vacuum P 25,000-25,000 DEF Sep-09 Mar.10 Oct.10 IRB TBD JMH Garcia - - - 25,000 S P-00827 53008015 Jack.No Elevators 1 & 2 437,733-437,733 DEF Feb-08 Jan.09 Jun.10 IRB TBD JMH Sears - - 6,663 431,070 7 P-00968 53009063 JNMC AHU Replacement 2,908,500-2,908,500 DEF Sep-09 Dec.12 IRB TBD JMH Sears - - - 2,908,500 8 P-00971 53009066 JNMC Med. Air Compres 130,000-130,000 DEF Sep-09 Mar.10 Oct.10 IRB TBD JMH Sears - - - 130,000 9 P-00977 53009071 JNMC Repl.Conden.Coils 52,500-52,500 DEF Sep-09 Mar.11 IRB TBD JMH Sears - - - 52,500 10 P-00988 53009080 JNMC SICU Med Gas Colum 126,000-126,000 DEF Sep-09 Mar.10 Oct.10 IRB TBD JMH Sears - - - 126,000 11 P-00990 53009082 JNMC Vacuum System 78,750-78,750 DEF Sep-09 Mar.10 Oct.10 IRB TBD JMH Sears - - - 78,750 12 P-00993 53009085 JNMC Pat.R.Fan Coils 2,940,000-2,940,000 DEF Sep-09 Dec.12 IRB TBD JMH Sears - - - 2,940,000 W P-00655 56006004 JNCMHC Emerg. Generator 314,369-314,369 DEF Jul-06 Aug.07 Jun.11 IRB TBD JMH Valdes - - - 314,369 13 P-00994 56009086 Rose Lee W. Exp.Exam R 262,500-262,500 DEF Sep-09 Mar.10 Oct.10 IRB Camero JMH Contreras - - - 262,500 14 P-00995 56009087 Rose Lee W Med.Record 31,500-31,500 DEF Sep-09 Mar.10 Oct.10 IRB Camero JMH Contreras - - - 31,500 Total 2009 Infrastructure Rev.Bond DEFERRED 13,768,901-13,768,901 - - 102,589 13,666,312 TRUST FUND / GRANTS AB PIP 31009002 Telecommunication 188,100-188,100 PIP Aug.09 Dec.11 TF Niko JMH Salgado - - 188,100 - Total Trust Fund 188,100-188,100 - - 188,100 - FEMA Grants IN CONSTRUCTION Y 51011105 Ryder Trauma Ext Hardening 6,442,191-6,442,191 D Dec-10 Aug.13 FEMA Clark JMH Valdes - 472,495 478,480 5,963,711 1 56012103 Jefferson Reaves Wind Retro 601,281-601,281 D Mar.12 Sep.12 FEMA Arnaldo JMH Valdes 32 32 32 601,249 Total FEMA Grants 7,043,472-7,043,472 32 472,527 478,512 6,564,960 Page 5 of 6

BUDGET TRACKING REPORT FY 2012 BY FUNDING SOURCE Original Total Total Projected Revised V.P. # of NEW Project Budget Project Start Compl. Compl. Fund. Project Project Exec. Actuals FY12 Total YTD Life to Date Amount left status Proj. Proj.# Activity# Project Name Budget Changes Budget Date Date Date Source Manager Manager Spons. Apr.12 Apr.12 thru Apr.12 to Spend ALL OTHER FUNDING SOURCES Closed/Cancelled and Partially Capitalized FY 11-12 1 P-00941 51009038 Cooling Tower 4,100,000 150,000 4,250,000 CL Feb-09 Sep.10 Jan.12 IRB Camero JMH Valdes 140,783 4,238,534-2 53010095 JNMC Labor & Delivery 905,910 905,910 CL May-10 Oct.10 Oct.11 RB INTER Abby JMH Sears - 5,060 894,322 - Q P-00696 51008007 Underground Storage Tank Rep 2,919,616 (1,689,852) 1,229,764 CL May-08 Dec.09 Dec.11 IRB Allen Heery Valdes - - 1,086,314-3 51010092 Institute Annex 3rd Floor - 91,620 91,620 CL Jan-10 Sep.10 Dec.11 RB REH Abby JMH Contreras - 227 89,049 - AA 51011103 IT Infrastructure Renovat - 235,000 235,000 CL Dec-10 Mar.12 Oct.12 IRB TBD JMH Salgado - - 235,000-4 P-00957 51009052 PPW Cooling T.Chiller,AHU 1,496,790 (272,000) 1,224,790 CL Sep-09 Nov.11 Apr.11 IRB Frank JMH Valdes - - 1,155,719-5 K P-00952 51009047 SICU Reconfiguration 400,000-400,000 CL May-09 May.10 Sep.11 RB ACU Arnaldo JMH Contreras - - 400,000 - K P-00952 51009047 SICU Reconfiguration 136,000 136,000 CL May-09 May.10 Sep.11 RB PEDI Arnaldo JMH Contreras 6,962 20,514 132,757-6 51011102 Mainframe Retirement - - - CAN Dec-10 TBD IRB TBD JMH Salgado - (20,175) - - 7 P-00973 53009068 JNMC Roof No.So.ICU&ER 250,000 (250,000) - CAN Sep-09 Mar.10 TBD IRB Abby JMH Sears - - - - 8 P-00983 53009077 JNMC Med Line Isolation Panel 288,750 (288,750) - CAN Sep-09 Oct.11 TBD IRB Abby JMH Sears (734) (734) - - 9 51011120 ET-1 Admitting Renovation 258,000 (258,000) - CAN Sep-11 Aug.12 TBD RB&Inter Alana JMH Armstrong - - - - 10 PIP 31011014 Reduction of NAP Utilization 300,000 (300,000) - CAN Apr-11 Sep.11 IRB Niko JMH Salgado - - - - Total Closed Other Fundings 10,013,156 (1,540,072) 8,473,084 6,228 145,674 8,231,696-43 TOTAL FOR OTHER FUNDINGS 222,986,168 13,731,238 236,717,406 614,961 15,518,301 149,773,267 86,702,751 66 GRAND TOTAL 238,209,665 14,785,044 252,994,709 772,766 16,819,363 157,432,892 95,266,621 LETTERS Denotes Multi Funding Sources (The sum of all sources equals the Total Funded Commitment or Total Project Budget) New: Denotes a new project opened in the current month Hold: Projects placed on hold by Capital Projects Department Bold project numbers: Denotes changes in the project stages i.e.. From Design to Construction etc. Bold budget amount: Denotes a change in the Total Project Budget Bold date: Denotes changes in the projected completion/ revised completion date in the current month Status CAN CL CN CO D DEF PC Cancelled Project Closed Construction Close-Out Design Deferred Partial Capitalization Page 6 of 6

JACKSON MEMORIAL HOSPITAL MONTHLY STATUS REPORT JUNE 2012 JACKSON MEMORIAL HOSPITAL MASTER PLAN UPDATE Funding Source: JHS Capital Projects Total Project Budget: $264,500 Anticipated substantial completion date: December 30, 2011 Scope of the Work To collect and validate volume data, update facility assessment, update planning/programming/operational recommendations, update infrastructure recommendations, refine phasing and enabling recommendations and update capital cost study May 2012 June 2012 July 2012 On Hold Pending Validation of Strategic Plan On Hold Pending Validation of Strategic Plan Meet with Strategic Planning Group Begin Strategic Visioning Begin Design Concepts Preliminary Cost & cash Flow Analysis Begin Distillation of Strategic Direction Finalize Design Concepts Validate Cost & Cash Flow Analysis 51010100 CAMPUS WIDE UNDERGROUND UTILITY SITEWORK IMPROVEMENTS Funding Source: IRB Total Project Budget: $ 3,200,000 Anticipated substantial completion date: July 31, 2012 (Contractors revised completion date is now Sept. 4, 2012) Scope of the Work: To upgrade water and fire lines in and around the Alamo Plaza along with canopy replacement, improvements to hardscape, lighting and landscape. May 2012 June 2012 July 2012 Continue Construction Activities Continue Construction Activities Engage Phase 2 & 3 Contractor Continue Construction Activities Modify Fence Line Negotiate Phase 2&3 Pricing

JACKSON MEMORIAL HOSPITAL MONTHLY STATUS REPORT JUNE 2012 JACKSON MEMORIAL HOSPITAL 51008032 EAST TOWER FLOOR ER-RENOVATION Funding Source: GOB& 2005 RB Total Project Budget: $ 2,406,000 Anticipated substantial completion date Phase 3: March 31, 2013 PHASE 3 Scope of the Work To refurbish and upgrade the ER-B & ER-C Patient Units including all existing bathrooms within the Department, discharge/cashier s office and staff lounge. May 2012 Phase 1-B. entails the following areas: East Tower-Ryder Trauma Center Corridor Connection, East Tower-Central Building Corridor Connection, ER-Ward F (soil room, clean room, and patient bathrooms), ER-Staff Lounge, New ADA patient bathrooms June 2012 Phase 1-B Construction in progress July 2012 Phase 1-B Construction in progress 51006005 EAST TOWER 2 ND FLOOR PATHOLOGY LAB Funding Source: JMH Foundation Total Project Budget: $ 2,000,000 Anticipated substantial completion date: September 30, 2012 Scope of the Work: To upgrade and refurbish the existing Pathology Laboratory. Project Designed in Five (5) construction phases: 1.-UM Chairman Office/Bathroom, 2.-Conference Room, 3.-North Lab, 4.-South Lab/Grossing Stations 5.-Residencies Lab. May 2012 June 2012 July 2012 Pathology Residencies Lab (Phase 5) construction on hold FAT to increase total project budget for review and approval Pathology Residencies Lab (Phase 5) construction to be commenced

JACKSON MEMORIAL HOSPITAL MONTHLY STATUS REPORT JUNE 2012 51009033 ET-7 PEDIATRIC BMT Funding Source: 2005 RB Total Project Budget: $ 1,617,000 Projected Construction Completion Date: June 2012 JACKSON MEMORIAL HOSPITAL Scope of work The scope of work entails the disbursement of the CCIU unit on the East Tower 7 th floor in order to create a 7 bed Pediatric Bone Marrow Transplant Unit. The renovations will provide the modernization of 7 patient rooms and the addition of two (2) ADA Patient Restrooms, playroom and one (1) laundry facility. Upgrade of staff lounge, corridor and adjacent support areas. Total Square footage under this contract is approximately 3,382 sq. ft. May 2012 Issuance of PO issued for AHCA Comment, Neutral Retrofit Construction Continues Furniture to be delivered GE Monitors Installed June 2012 100% AHCA inspection in June July 2012 Training / Testing for GE Monitors Begin Project Close-out 51009044 HCH ADOLESCENT UNIT RELOCATION Funding Source: 2005 RB Total Project Budget: $ 1,036,193 Projected Construction Completion Date: June 2012 Scope of work Renovation of an existing area on the East Tower 5 th floor in the Infant Toddler Pediatric Patient Rooms for Adolescents. Remodel existing (6) six crib nursery and convert it into four (4) Private Patient rooms including the addition of four (4) new head walls and additional new ADA patient rest rooms by converting existing closets. Upgrade of existing Private and Semi-Private patient Rooms, staff lounge and corridor. May 2012 Confirmation of project scope with end users Lawson input of Bond, Asbestos Abatement, and Air Quality Test Notice to Proceed for Contractor to obtain Permit June 2012 Issuance of PO for Bond, Asbestos Abatement, Air quality test Notice to Proceed for Construction July 2012 Contractor Construction Mobilization

JACKSON MEMORIAL HOSPITAL MONTHLY STATUS REPORT JUNE 2012 JACKSON MEMORIAL HOSPITAL 51011117 TAYLOR BREAST CENTER RENOVATIONS Funding Source: JMH Foundation Total Project Budget: $276,000 Anticipated Construction Completion Date: February 2013 This scope of work entails the renovation of the Taylor Breast Center located in the Diagnostic Treatment Center 1st floor. The upgrade will include renovation of the entrance / Reception Room. The Patient Changing Rooms will be relocated and converted into 3 Patient Intake areas. The Radiologist and Reading rooms will be relocated to accommodate new equipment. The upgrade will also include new furniture, paint, and lighting. May 2012 Confirmation of Scope increase with end user and design team Ongoing Design Services June 2012 Design Team proceed with Construction Documents Ongoing Design Services 75% Construction Submittal to JMH July 2012 AHCA 51011118 NICU B, C AND INTERMEDIATE MODERNIZATION Funding Source: JMH Foundation Approved Project Budget: $100,000 (Design) Estimated Project Budget: $2,000,000 Anticipated Construction Completion Date: June 2013 The Scope of Work entails the modernization of the NICU B, C and Intermediate Units. This includes the complete renovation of the Nursing Stations, Refurbishment of Patient Bays and Replacement of flooring and Wall protection to match the existing NICU Unit A. May 2012 FAT approved by Budget Department June 2012 FAT approved by Executive Leadership Foundation Committed project funds confirmed with Budget / FAT funds into Project Lawson Input for PO issuance to A/E for Design Services July 2012 Issuance of PO to A/E for Design Services Notice to Proceed for Design

JACKSON MEMORIAL HOSPITAL MONTHLY STATUS REPORT JUNE 2012 JACKSON MEMORIAL HOSPITAL 51011116 CARDIAC CATH LAB #5 EQUIPMENT REPLACEMENT Funding Source: 2005 RB Total Project Budget: $454,000 Projected Construction Completion Date: August 2012 Construction to be performed by JOC Scope of work Replace Cardiac Cath Lab equipment for room 5 on Central 4 th floor. Existing equipment is 23 years old and has not functioned for almost two years. May 2012 RFI 1 regarding Air Filtration resolved by Design Team June 2012 JOC Contractor submit Price Proposal for review Lawson input for Contractor July 2012 PO issued to Contractor GE released to order equipment 51009054 ET-4 LABOR AND DELIVERY OPERATING ROOMS Funding Source: 2005 RB Total Project Budget: $2,083,950 Anticipated substantial completion date: TBD Scope of Work Remodeling and Renovation of 5 Labor and Delivery Operating Rooms and surrounding support areas at the East Tower 4 th Floor Holtz Children s Hospital. Four (4) Operating Rooms will maintain the same size and configuration. Operating Room Five (5) will be demolished and redesigned to higher standards. Total Square footage under this contract is approximately 5,450 Sq. Ft. May 2012 Re-engage the user staff and design team to re-familiarize all parties of the project-designed scope of work End user reapproved designed scope of work June 2012 Procurement Proposal review/ negotiations Contract review, approval, execution July 2012 Contractor Mobilization

JACKSON MEMORIAL HOSPITAL 51010096 WW-2 ANGIO SUITE Funding Source: 2005 RB Total Project Budget: $ 2,000,000 Anticipated substantial completion date: December 2012 Construction to be performed by JOC JACKSON MEMORIAL HOSPITAL MONTHLY STATUS REPORT JUNE 2012 Scope of work Removal of existing C-arm and replace with a new Siemens Zee in Interventional Radiology room #25. Renovation of abandoned Interventional Radiology area on WW2 to create a new recovery unit for Interventional Radiology. May 2012 Procurement ITB process continues June 2012 Procurement ITB process continues July 2012 CSBE Measures Established ITB issued 51008026 CARDIAC CATH LAB #6 Funding Source: GOB & 2005 RB Total Project Budget: $ 4,070,145 Projected Construction Completion Date: TBD Scope of work Construction of a new EP Cardiac Cath Lab on Central 4 th Floor. Includes the Relocation of the storage areas into the unit. May 2012 on hold - pending re-scoping from Alex Contreras and staff June 2012 on hold - pending re-scoping from Alex Contreras and staff July 2012 on hold - pending re-scoping from Alex Contreras and staff

JACKSON MEMORIAL HOSPITAL 51009053 EAST TOWER 2 FLOOR A/C REPLACEMENT Funding Source: IRB Total Project Budget: $ 3,119,080.00 Anticipated substantial completion date: August 31, 2012 JACKSON MEMORIAL HOSPITAL MONTHLY STATUS REPORT JUNE 2012 Scope of the Work: To furnish the Five (5) custom Air Handling Units at the East Tower 2nd Floor of Holtz Children s Hospital. May 2012 City of Miami Mechanical Final Approved (04/18/2012) June 2012 City of Miami Electrical Rough/Final Approved (05/15/2012) July 2012 AHCA 100% Survey Week July 16 51009072 FIRE SPRINKLER UPGRADE CAMPUS WIDE Funding Source: IRB Total Project Budget: $2,000,000 Anticipated substantial completion date: March 2013 Scope of the Work The campus-wide fire protection upgrades are to address all existing NFPA fire sprinkler codes in addition to installing new automatic sprinkler systems and other system components for each building as determined deficient by state and local authority having jurisdiction. These main campus building include Central, East Tower, North Wing, Rehabilitation, South Wing, West Wing, and Utility buildings. May 2012 June 2012 July 2012 JMH Procurement and Capital Projects to re-bid the fire sprinkler project in its entirety (all 6 patient buildings) for public solicitation Competitive proposal review for construction services (all 6 patient buildings) Proposal negotiations (all 6 patient buildings) Selection of Contractor (s) PHT Board Approval for construction services (construction cost estimated to be over $1M) Lawson Input for purchase order issuance (all 6 patient buildings)

JACKSON MEMORIAL HOSPITAL MONTHLY STATUS REPORT JUNE 2012 JACKSON MEMORIAL HOSPITAL 51011105 RYDER TRAUMA CENTER EXTERIOR HARDENING PROJECT Funding Source: FEMA (75%) / Capital Contribution (25%) Total Project Budget: $8,589,588 Anticipated substantial completion date: August 20, 2013 Scope of the Work The project scope of work is to structurally retrofit the building envelope. The project will be designed to install a wind abatement system of lightweight glass fiber reinforced concrete (GFRC) panels onto the Ryder Trauma Center. The components used for this wind retrofit project will meet the current Florida Building Code and Miami-Dade County specifications to withstand extreme hurricane conditions (Category IV storm conditions). May 2012 June 2012 July 2012 Solicit qualified construction managers / contractors through an ITB process Pre-Bid Conference Site Walk Thru Cone-of Silence (Extended) Bid Due date (Extended) Cone-of Silence Bid Due date 51011106 HIGHLAND PROFESSIONAL BUILDING TRANSPLANT RENOVATIONS Funding Source: Capital Contribution Total Project Budget: $542,625 Anticipated substantial completion date: September 2012(TBD due to project HOLD) Scope of the Work The scope of work is to renovate various areas of the 6 th floor transplant floor of the Highland Professional Building in order to add Patient Exams room and work station to support the 6 th Floor Transplant department. Additionally the scope of work includes interior renovations to the 1 st floor lobby area, elevator lighting upgrade, interior/exterior signage and renovations to an unoccupied area to support daily clerical activities. May 2012 June 2012 July 2012 Ongoing Construction Services ON HOLD Pending Executive Approval for procurement to release new/existing Purchase Orders Ongoing Construction Services ON HOLD Pending Executive Approval for procurement to release new/existing Purchase Orders Ongoing Construction Services ON HOLD Pending Executive Approval for procurement to release new/existing Purchase Orders

JACKSON MEMORIAL HOSPITAL MONTHLY STATUS REPORT JUNE 2012 JACKSON MEMORIAL HOSPITAL 51011100 HIGHLAND PROFESSIONAL BUILDING FINANCIAL ASSESSMENT Funding Source: Capital Contribution Total Project Budget: $740,000 Anticipated substantial completion date: September 2012(TBD due to project HOLD) Scope of the Work The scope of work is to renovate a portion of the first floor Highland Professional Building in order to relocate the Financial Assessment department into the renovated space. The proposed space is approximately 5,449 sq ft. The proposed renovation will provide six (6) offices, waiting/reception area, (1) copy room, (1) ADA Bathroom, and an open floor plan for cubicle work stations. May 2012 June 2012 July 2012 Ongoing Construction Services - ON HOLD Pending Executive Approval for procurement to release new/existing Purchase Orders Ongoing Construction Services - ON HOLD Pending Executive Approval for procurement to release new/existing Purchase Orders Ongoing Construction Services ON HOLD Pending Executive Approval for procurement to release new/existing Purchase Orders 51009046 WEST WING BASEMENT PHARMACY CLEANROOM PHASE I / CAROUSELS PHASE II Funding Source: 2005 RB Total Project Budget: $ 834,596 Projected Construction Completion Date: Phase I July 2011 / Phase II July 2012 Phase I Construction Status: 100% Phase II Construction Status: 0% Scope of Work: Phase I: Installation of a new USP 797 complaint pharmacy clean-room in the West Wing basement. Phase II: Demolition of the old cleanroom to create an open space within the pharmacy to receive (3) new pharmaceutical carousel. This includes new finishes throughout the basement pharmacy. May 2012 Procurement working on CSBE measures with Miami Dade County Procurement ITB process continues June 2012 CSBE Measures Established July 2012 Pre-bid Meeting Held Procurement ITB process continues

JACKSON MEMORIAL HOSPITAL 51010097 DTC NEW MRI Funding Source: 2005 RB Total Project Budget: $ 2,500,000 Anticipated substantial completion date: November 2012 Construction to be performed by JOC JACKSON MEMORIAL HOSPITAL MONTHLY STATUS REPORT Scope of the Work: Replacement of existing MRI in DTC 1 st floor. Includes expansion of room and new back up chiller. May 2012 Re- engage end user staff and contractor Contractor Mobilize for Construction June 2012 Construction Begins End user approve GE notice to manufacture July 2012 Trane 20-T Chiller installed Construction continues JUNE 2012 51009089/E10-JMH-01 MEDIUM VOLTAGE OIL SWITCHES REPLACEMENT AND ELECTRICAL SWITCHGEARS AT CENTRAL AND SOUTH WING REPLACEMENT: Funding Source: IRB Total project Budget: $3,785,000 Anticipated substantial completion date: Design March 2012 Construction October 2012 Scope of the Work Replace medium voltage oil switches in Central, South Wing, Institute, Rehabilitation and North Building. Central and South Wing: replace normal and emergency substations and main switchgears. May 2012 100% CD submittal for JMH staff review June 2012 Revised construction plans submitted for JMH staff approval Propose electrical rooms must be approved by administration July 2012 Submit construction plans to AHCA. PHT Board Approval for construction services (construction cost estimated to be over $5M Determine CSBE measures before we proceed with an ITB

JACKSON MEMORIAL HOSPITAL JACKSON MEMORIAL HOSPITAL MONTHLY STATUS REPORT JUNE 2012 51009056/E10-JMH-02 ENERGY CENTER REPLACE PARALLELING GEAR AND NEW EMERGENCY GENERATORS Funding Source: IRB Total project Budget: $ 5,289,372 Anticipated substantial completion date: Design May 2012 Construction May 2013 Scope of the Work Replace paralleling system and emergency distribution switchboard; provide new engines with the capability to operate in dual-fuel mode (natural gas component). Ryder Trauma Center emergency power system will be increased, with the intention of having the entire building on emergency power. May 2012 Continue with construction plans UC-Integration of the Portable unit with ASCO essential gear, plans submitted to PMD for solicitation June 2012 Procurement to proceed with the informal ITB for Campus wide Energy Monitoring and Control System (EMCS) phase project Determine CSBE measures before we proceed with an ITB July 2012 Bid Evaluation and award Energy Monitoring and Control System (EMCS) phase project Continue with construction plans for new generator at UC, emergency power upgrades at Energy Center and Ryder Trauma 59007009 JMT ELEVATOR MODERNIZATIONS #141 TO #146 Funding Source: Capital Contribution / IRB Total Project Budget: $1,300,757 Projected Completion Date: December 2012 Scope of Work Modernization and cab upgrade to Elevators #141-146 in Jackson Medical Towers May 2012 Simplex issued a proposal to upgrade fire alarm system June 2012 Schindler remobilize to the job site (06/04/2012) Continue Work on Car #141 July 2012 Start Work on Car #142

JACKSON MEMORIAL HOSPITAL JACKSON MEMORIAL HOSPITAL MONTHLY STATUS REPORT 51009062/E10-JMH-03 P-00967 FIRE ALARM UPGRADE AT JACKSON MEMORIAL HOSPITAL Funding Source: IRB Total project Budget: $ 4,429,495 Anticipated substantial completion date: March 2013 JUNE 2012 Scope of the Work Design and upgrade of existing hospital and business occupancy floor for: Rehabilitation, Trauma, Mental Health and Jackson Medical Towers buildings, replace all audio/visual devices provide new speakers, all older model addressable ceiling smoke detectors, heat sensors, manual pull station and duct detectors must be replaced, flow and tamper annunciation modules must be upgraded. Connect these building to the fire alarm loop/network. May 2012 June 2012 July 2012 Lawson Input and Purchase Order Issuance (Trauma, North Wing, and Rehab) Lawson Input and Purchase Order Issuance (East Tower, Mental Health, and Highland) Ongoing Design Services Track the completion of non-patient towers: Park Plaza East, park Plaza West, and Jackson Medical Towers PHT approved NTE amount of $1.3M to Simplex will be modified to reflect the negotiated prices above Engage Simplex Grinnell for construction services for patient s towers only. Commence construction Ongoing Design Services Track the completion of non-patient towers: Park Plaza East, park Plaza West, and Jackson Medical Towers Ongoing Construction at Patient Towers (e.g. ET, Highland, NW, MH, Trauma, & Rehab) Tracking ongoing design services for remaining buildings (PPW, PPE, and Jackson Medical Towers) 51009036 WEST WING AND CENTRAL FIRE ALARM UPGRADE PROJECT Funding Source: IRB Total Project Budget: $2,350,000 Projected Completion Date September 2012 Scope of Work Design and upgrade of existing patient occupancy towers for: West Wing and Central buildings, replace all audio/visual devices provide new speakers, all older model addressable ceiling smoke detectors, heat sensors, manual pull station and duct detectors must be replaced, flow and tamper annunciation modules must be upgraded. Connect these building to the fire alarm loop/network. May 2012 Ongoing City of Miami Fire Marshall inspections for the West Wing Tower Ongoing Fire Alarm installation, programming, trim-out for the Central Building June 2012 Ongoing City of Miami Fire Marshall inspections for the West Wing Tower Ongoing City of Miami Fire Marshall inspections for the Central Building Address the existing condition Central damper operations July 2012 Ongoing City of Miami Fire Marshall inspections for the West Wing Tower Ongoing Fire Alarm installation, programming, trim-out for the Central Building Tracking a 100% AHCA inspection the week of 7/16/12

JACKSON MEMORIAL HOSPITAL MONTHLY STATUS REPORT JUNE 2012 JACKSON MEMORIAL HOSPITAL 51011104 WEST WING 15 NURSING UNIT MODERNIZATION Funding Source: Capital Contribution Total Project Budget: $2,588,568 Projected Completion Date December 2012(TBD due to project on HOLD) Scope of Work The West Wing 15 Nursing Unit Modernization project has a vision towards creating a greater offering of singleoccupancy rooms at Jackson Health System. The projects interior renovation would create twenty-five (25) singleoccupancy rooms, one (1) VIP room, and other clinical support areas to current codes, hospital standards, and modernized finishes. May 2012 ON HOLD Pending executive approval Ongoing procurement process ITB for Qualified Contractor Pre-Bid meeting and site walk through Cone of Silence June 2012 ON HOLD Pending executive approval Received contractor proposals Proposal negotiations/reviews July 2012 ON HOLD Pending executive approval Construction Contract review by PHT, CAO, Legal Lawson Input and Purchase Order Issuance for construction services 53009055 MAIN CAMPUS / JNMC CAMPUS-WIDE LIGHTING UPGRADE Funding Source: IRB Total Project Budget: $ 780,680 Projected Construction Completion Date: August 2012 Percentage of Construction Completed: 0% Scope of Work: Campus wide outdoor lighting upgrade throughout the JMH main campus and the Jackson North Medical Center. The first phase of this project will cover the Alamo plaza and 16 th street portion of the project. May 2012 Canopy light fixture changed. Project phasing to be defined to continue with procurement process June 2012 Submit documentation to procurement to establish CSBE measures July 2012 Dade County CSBE measures established Procurement ITB process continues

JACKSON MEMORIAL HOSPITAL MONTHLY STATUS REPORT JUNE 2012 JACKSON MEMORIAL HOSPITAL 51009069 CAMPUS WIDE ROOFING REPLACEMENT EAST TOWER Funding Source: IRB Total Project Budget: $1,500,000 Projected Completion Date: TBD Scope of Work Replacement of East Tower Roof, approximately 90,000 SQFT May 2012 Specs Documents reviewed and revised by the Architect of Record to comply to MDC Sustainability Program June 2012 BID SET Documents issued to Procurement (05/31/2012). July 2012 ITB issued 51009064 REPLACEMENT OF 30 AIR HANDLING UNITS Funding Source: IRB Total Project Budget: $6,541,500 Anticipated substantial completion date: September 30, 2014 Scope of the Work: To furnish and install thirty one (31) custom Air Handling Units: May 2012 Emergency request to expedite Replacement of West Wing AHU #9 June 2012 AHCA DESK PLAN Review requested to expedite Replacement of AHU #9 BID SET Documents issue to procurement for AHU #9 July 2012 ITB issued

JACKSON NORTH MEDICAL CENTER 53008020 JACKSON NORTH WINDOW REPLACEMENT Funding Source: Capital Contribution & IRB Total Project Budget: $ 3,145,970 Anticipated substantial completion date: September 2012 JACKSON MEMORIAL HOSPITAL INFRASTRUCTURE REVENUE BOND MONTHLY STATUS REPORT JUNE 2012 Scope of Work: Replacement of all windows with new hurricane windows. Unforeseen conditions have been encountered and the wall systems on pavilion, pediatrics and Labor and delivery are being reconstructed and shored. May 2012 Construction continues on 2 nd Floor L & D /Pedi Areas Construction continues on Pavilion Replacement of the entrance doors completed. June 2012 Front entrance doors completed. Construction continues on 2 nd Floor L & D /Pedi Areas Construction continues on Pavilion July 2012 Construction continues on 2 nd Floor L & D /Pedi Areas Construction continues on Pavilion 53009065 JACKSON NORTH MEDICAL CENTER UTILITY PLANT REPLACEMENT Funding Source: IRB Total Project Budget: $3,100,000 Anticipated substantial completion date: July 2013 Scope of Work: Replacement of three chillers, two boilers and supporting systems, installation of a new cooling tower. Installation of new energy management system. May 2012 Design Continues June 2012 Emergency chiller work Submitted to AHCA for Construction Review Emergency chiller work substantially completed Steam boiler design is being revaluated by the consultant. Considering change to hot water boilers if within budget since this system would be more efficient July 2012 Design Continues Emergency chiller work City inspections

AUDIT AND COMPLIANCE SUBCOMMITTEE

PUBLIC HEALTH TRUST FINANCIAL RECOVERY BOARD Audit & Compliance Subcommittee Mojdeh L. Khaghan, Chairperson Darryl K. Sharpton, Vice Chairperson Michael Bileca Marcos Jose Lapciuc Date, Time and Place June 14, 2012 Immediately following the Facilities Subcommittee Meeting Ira C. Clark Diagnostic Treatment Center Conference Room 259 AGENDA 1. *Approval of the Previous Meeting Minutes (Mojdeh L. Khaghan, Chairperson, Audit & Compliance Subcommittee) (a) *Meeting Minutes as of May 17, 2012 2. *KPMG FY12 Audit Plan Discussion (Karen Mitchell, Partner, KPMG) 3. Corporate Compliance Program Department Update (Diana Salinas, Corporate Director and Chief Compliance Officer, Compliance Department, Jackson Health System) (a) *FY12 Audit Plan Update (b) *Review of Finalized Audit Reports Executive Summary (1) #42 Medicaid Payments for Therapy Services in Excess of State Limitations (2) #43 Recovery Audit Contractor (RAC) Review Medical Necessity (3) #38 Inpatient Point of Care Testing (POCT) Glucose (4) #36 Physician Signatures documented in Medical Records for Certified Nurse Midwife at Jackson Memorial OB Triage Services 4. Internal Audit Department Update (Stephen J. Weimer, Corporate Director, Internal Audit Department, Jackson Health System) (a) *FY12 Audit Plan Update (b) Review of Finalized Audit Reports (1) *Corporate Business Office Collections Audit (2) *Jackson Initiatives Audit (3) *Monthly Follow-up review Agenda items(s) noted with an asterisk (*) indicates that the supporting documents are attached.

1. Approval of the Previous Meeting Minutes

PUBLIC HEALTH TRUST FINANCIAL RECOVERY BOARD Audit & Compliance Subcommittee Mojdeh L. Khaghan, Chairperson Darryl K. Sharpton, Vice Chairperson Michael Bileca Marcos Jose Lapciuc Date, Time & Place May 17, 2012 Immediately followed the Facilities Subcommittee meeting Ira C. Clark Diagnostic Treatment Center Conference Room 259 ATTENDANCE Audit & Compliance Subcommittee Marcos Jose Lapciuc Michael Bileca Mojdeh L. Khaghan Excused Darryl K. Sharpton Financial Recovery Board Members Joaquin del Cueto Stephen S. Nuell Joe Arriola Jackson Health System Mark T. Knight Diana Salinas Stephen J. Weimer Don S. Steigman Carlos A. Migoya Miami-Dade County Attorney Valda Christian Laura Llorente Christopher Kokoruda KPMG Karen Mitchell

Audit & Compliance Subcommittee Meeting May 17, 2012 Page 2 Call to Order With a quorum being present, the Audit & Compliance Subcommittee meeting was called to order at 8:13 a.m. by Mojdeh L. Khaghan, Chairperson. Introduction of the New Miami-Dade County Assistant Attorney Laura Llorente, Assistant Miami-Dade County Attorney introduced Christopher Kokoruda, appointed as the newest member of the Legal Team representing Jackson Health System. 1. Approval of the Previous Meeting Minutes 2. Internal Audit Update (a) Meeting Minutes as of April 19, 2012 Ms. Khaghan requested a motion approving the meeting minutes of April 19, 2012 Mr. Bileca moved approval; seconded by Ms. Khaghan, and carried without dissent. (a) (b) FY 2012 Audit Plan Update Stephen J. Weimer, Corporate Director, Internal Audit Department, JHS presented an update regarding the fiscal year 2012 Audit Plan. Currently there are 3 internal audits under progress, approximately 46% near completion of the Audit Plan. It is anticipated that the Audit Plan will be completed by the end of the fiscal year. A copy of the 2012 Audit Plan was included in the agenda packet. Review of Finalized Audit Reports (1) JMH Emergency Room Admission Audit Update A review of the Emergency Department Admission process at Jackson Memorial Hospital was performed. The basis of the review had to do with the qualitative and quantitative analytical selection process with a focus on the outpatient admission process which generated total revenue of $130 million in fiscal year 2011. It was determined by ratings by area based on issues identified that Jackson Memorial Hospital Emergency Room Admissions needs improvement. The overall audit rating of needs improvement is based upon lack of controls relating to deleting Cerner access from terminated employees in a timely manner. Additionally, controls over scanned documents need improvement. Detailed observations, recommendations and management action plans were outlined in the audit report.

Audit & Compliance Subcommittee Meeting May 17, 2012 Page 3 3. Review of KPMG Management Letters With regards to the Cerner inappropriate access exits, Mr. Weimer stated that there continues to be a struggle with user access issues. A new automated tool has been implemented to better handle user access issues. Mr. Weimer further stated that he requested a meeting with Information Technology (IT) internal auditors along with the various business owners and representatives from the IT Department to address ways to assure that the user access issues are resolved in the next 30 to 60 days. (2) Audit Follow-up Report For the month of April 2012, the Audit Follow-up Report showed two audits were reviewed that included a Payment Posting audit and Charity Care audit. Original findings regarding Payment Posting were completed and there remain one audit finding from the Charity Care audit with a target date of December 2012 for completion. The Subcommittee will be kept informed regarding the remaining Charity Care audit finding. A copy of the report was included in the agenda packet. Mr. del Cueto requested as part of the Strategic Planning Retreat that there be some discussion regarding how to best manage unfunded and charity care patients through the JMH Health Plan. Mr. Lapciuc reminded the Subcommittee to submit there requests for discussion at the Strategic Planning Retreat to Jeffrey Crudele, Chief Strategy Officer, Jackson Health System. Karen Mitchell, Partner, KPMG opened the presentation regarding the JMH Health Plan Management Letter comments which the same comments were noted in the Public Health Trust Management Letter. She stated that that the focus of the presentation will be that of the Public Health Trust. With regards to the Public Health Trust, Ms. Mitchell pointed out that there were three comments reported in the Management Letter as of and for the year ended September 30, 2011 which had to do with one material weakness and two significant deficiencies. Highlights of the comments are as follows: 2011-01 Information Technology General Controls Material Weakness Based on evaluations performed by KPMG as well as the reports from internal audit the following important weaknesses were noted. Management does not perform a formal periodic review of the appropriateness of IT system access rights of active users; Management does not perform a periodic review of access rights focused on segregation of duties within system profiles or transactions; and Management does not have updated documented policies and procedures addressing security, change management or computer operations.

Audit & Compliance Subcommittee Meeting May 17, 2012 Page 4 KPMG recommend that Management perform a comprehensive review of the Trust s policies and procedures associated with the IT general controls environment to ensure that the critical risks associated with the weaknesses are well controlled. In response Management concurs with the findings and in response to the findings Management began cleaning up the access control issues, and implemented a policy for better controls. Ms. Khaghan state that there are audits currently pending regarding IT issues that are problematic that Mr. Weimer maybe requested to further report on at the next meeting. Ms. Khaghan impressed upon Management to resolve the IT issues and assure the same audits are not reported in next year s external audit results as material weaknesses. In an effort to prevent the matter from reoccurring, Mr. Migoya stated next month the Subcommittee will be presented with an update on what is being done to prevent IT issues being reported in the future as materials weaknesses. Also Mr. Migoya stated that a recruitment firm has been hired to assist with the search process of a Chief Information Officer for the Information Technology Division. The Subcommittee will be kept informed regarding the search process for a Chief Information Officer. 2011-02 Manual Accounting Processes Significant Deficiencies Management utilizes a number of excel spreadsheets to analyze, reconcile and report certain critical and significant financial accounting data. Such a process introduces the risk of material financial reporting errors. Specifically, this process requires attention and an in-depth and intricate knowledge and understanding of the Trust s complex and decentralized nature of its operations. During the course of the audit, the following was noted: Voluminous spreadsheets were used to analyze, reconcile, and report account balances such as allowances for doubtful accounts and contractual adjustments, patient refunds, unapplied cash, and accrued liabilities; Lack of policies and procedures related to the access and maintenance of the spreadsheets; and Occasions when the preparers demonstrated less than a thorough understanding of the underlying business transactions leading to several reiterations of reports and analysis to support recorded amounts. KPMG recommend that the Trust enhance its policies and procedures for analyzing, reconciling and reporting data that integrates the accounting systems within and across the different facilities. As spreadsheets continue to be utilized to analyze, reconcile and report data, Management is recommended to establish policies and procedures around the manual process in order to ensure that spreadsheets are properly reviewed by a Supervisor at a level above the preparer and that the spreadsheets, as part of the Trust s accounting records, are properly maintained with access physical ability to make changes limited to appropriate individuals in order to ensure the integrity of the accounting records.

Audit & Compliance Subcommittee Meeting May 17, 2012 Page 5 In Management s response, the Trust has made significant investments in IT financial systems which are being utilized to analyze, reconcile and report account balances such as contractual adjustments, patient funds, unapplied cash and accrued liability within and across the different facilities. The skilled nursing facilities, physician services and property management divisions are on highly specialized revenue cycle systems that are appropriate for their business cycles, but are disparate from the Trust s core financial information technology systems. Each of these divisions has appropriate operational and financial oversight on a monthly basis. Management agrees that there is an opportunity to migrate to a program based analysis for allowances for doubtful accounts and is currently in the final phases of user testing and acceptance. Mr. Knight stated that in response to the finding an automated rapid reserve system has been implemented which automatically contracturalize and create a bad debt calculation that will eliminate some of the spreadsheets and create more of an automated environment. However some of the products will remain in excel but will need to have better controls, limited access, limited editing capability, and a policy identifying a person(s) who will be responsible for reviewing the spreadsheets prior to forwarding to the external auditor. He further stated that there are system controls in place and are redesigning the way the schedules will be presented to KPMG for next year s audit. Ms. Khaghan questioned if the rapid reserve up and running. Mr. Knight stated that that the rapid reserve is running parallel to the current collection of tools that are used to drive valuation. 2011-03 Pension Trust Fund The financial reporting process related to the pension Trust fund did not appear to follow polices and procedures in place at PHT. It was noted that changes were made to the financial records that were not supported nor reviewed by anyone other than the preparer. This resulted in audit adjustments required to properly report the net assets available for pension benefits. KPMG recommenced that Management establish formal policies and procedures that specifically address the financial reporting process over the Pension Trust Fund. Such policies and procedures should include a review and reconciliation of the statements of net assets available for pension benefits reported to the underlying records received from the third party vendors. In response from Management, formal policies and procedures will be established that specifically address the financial reporting process over the Pension Trust Fund. With regards to the results of the audit, Ms. Mitchell stated that there has been a significant improvement over prior year. She further stated that one out of the two significant deficiencies does not relate to the Public Health Trust but relate to the Pension Plan which was included based on the reporting process used by the Public Health Trust. The Pension Plan audit process and information is a carry over from prior year.

Audit & Compliance Subcommittee Meeting May 17, 2012 Page 6 Following the presentation and discussion regarding the Management Letter, Ms. Khaghan requested a motion to accept the item as presented. Mr. Bileca moved approval to accept the Management Letter as presented; seconded by Mr. Lapciuc and carried without dissent. The Subcommittee agreed that the item will be presented to the full board for consideration and approval. Ms. Mitchell distributed information to members of the Subcommittee advising what is going on in the healthcare environment particularly as it relates to HER Implementation, Quality Assurance, Independent Verification and Validation, Meaningful Use Readiness Assessment, Healthcare Transformation, Medicaid Data Warehouse Benefits and Requirements, Health Information Technology and Health Information Exchanges, American Health Insurance Exchanges, Audits of Meaningful Use, Medicaid Program Impacts, and CMS Final Rule. Ms. Mitchell stated that she will return next month to present the Audit Plan for the next fiscal year and in August 2012 she will return to present a small industry presentation. Ms. Mitchell invited the PHT Financial Recovery Board to the KPMG s Spring 2012 Audit Committee Roundtable Series Is Governance Keeping Pace? on June 8, 2012. The purpose of the Spring Roundtable Series is to review the governance challenge from a number of perspectives and updates on legal/regulatory issues and audit/accounting developments. A flyer highlighting the event and topics was distributed during the meeting. Other Discussion Jackson Memorial Foundation Mr. Lapciuc spoke about the Jackson Memorial Foundation (Foundation) and issues surrounding capital commitments and not being clear regarding the nature of the commitments. He encouraged the Chairperson and Management to review the Foundation s capital commitments for better clarity and determine how it affects the JHS balance sheet. 4. Corporate Compliance Program Department Update (a) FY12 Audit Plan Update Diana Salinas, Corporate Director and Chief Compliance Officer, Corporate Compliance Department, JHS reported that for the month of April 2012 the Audit Plan is near 48% completed. A total of 2 audits have been completed, and 5 are in progress for the month of April 2012. Ms. Salinas is confident that that Audit Plan will be completed by the end of the fiscal year. A copy of the Audit Plan Report was included in the agenda.

Audit & Compliance Subcommittee Meeting May 17, 2012 Page 7 (b) Review of Finalized Audit Reports Ms. Salinas presented a summary report of the following audits. A detailed summary of the reports were included in the agenda packet. (1) #41 RAC Reassessment Short Stay Medical Necessity The scope and objective of the audit was to evaluate patients admitted and discharged the next day to determine if a stay in observation would have been the most appropriate setting for care. If appropriate, review that condition Code 44 was properly applied to Medicare claims per CMS guidelines. The conclusion of the audit review rendered a cost error rate of.06%. Compliance recommended continuation of the newly implemented Case Management Protocol, as well as training with the physicians as to the CMS regulation regarding an appropriate inpatient admission order. Compliance will continue to audit and monitor short stays on a monthly basis. (2) #22 Reassessment Clinical Trials The scope and objective of the audit was to determine if clinical trials research billing and modifier usage is in accordance with CMS regulations. In addition, to review that the informed consent is received in a timely manner from the principal investigators. The conclusion of the audit review rendered a cost error rate of 0%. The review rendered a JHS Policy compliance error rate of 83% due to principal investigators not submitting the informed consent form on a timely basis per policy. Compliance recommendations are as follows: Ensure that the signed patient informed consent forms are received from the Principal Investigator within the required 24-hour time frame by initiating a weekly protocol to ensure adherence to the policy; Ensure that the informed consent form is stamped with the date received by CTO; Update the Research Conversation and PM Office in Cerner with appropriate data and place a copy of the informed consent form in the CTO patient medical record within 48- hours of receipt; and Create an interface between UM and JHS to provide CTO real time knowledge of when patients have been enrolled in a clinical trial/research. (c) (d) Recovery Audit Contractor Update Ms. Salinas reported that one RAC report was received and will be reported on at the next Subcommittee meeting. National Ethics & Compliance Week Update Ms. Salinas reported that the National Ethics & Compliance Week was celebrated during the first week of May 2012. Activities were planned in honor of the week at the JHS sites and the Compliance Staff was positioned around the sites to bring awareness to compliance, ethics and the hotline.

Audit & Compliance Subcommittee Meeting May 17, 2012 Page 8 Adjournment The meeting of the Audit & Compliance Subcommittee adjourned at 9:02 a.m. Transcribed by Ivenette Cobb, Executive Assistant Public Health Trust Financial Recovery Board

Public Health Trust of Miami-Dade County, FL Audit Plan September 30, 2012 This presentation to the Audit Committee and management is intended solely for the information and use of Audit Committee and management and is not intended to be and should not be used by anyone other than these specified parties. This presentation is not intended for general use, circulation or publication and should not be published, circulated, reproduced or used for any purpose without our prior written permission in each specific instance. June 14, 2012

Agenda 1.0 Client Service Team 2.0 Objective of an Audit 3.0 Responsibilities 4.0 KPMG s Audit Approach and Methodology 5.0 Risk Assessment 6.0 Audit Plan Scope Materiality Deliverables Fraud risks Material weakness and significant deficiency Accounting policies and practices Auditing and accounting matters Involvement of others 2011 KPMG LLP, a Delaware limited liability partnership and the U.S. member firm of the KPMG network of independent member firms affiliated with KPMG International Cooperative ( KPMG International ), a Swiss entity. All rights reserved. Printed in the U.S.A. 23603NSS 1

1.0 Client Service Team

Client Service Team Audit Team Client Service Partner Jose Rodriguez Lead Engagement Audit Partner Karen Mitchell Engagement Quality Control Reviewing Partner David Rood Engagement Audit Managers Alex Lopez Monica Flaviani Reimbursement Advisory Services Director S. Kirk McNiel IT Advisory Managing Director Tom Pankey Actuarial Principal Steven Mahan 2011 KPMG LLP, a Delaware limited liability partnership and the U.S. member firm of the KPMG network of independent member firms affiliated with KPMG International Cooperative ( KPMG International ), a Swiss entity. All rights reserved. Printed in the U.S.A. 23603NSS 3

2.0 Objective of an Audit

Objective of an Audit The objective of an audit of financial statements is to enable the auditor to express an opinion about whether the financial statements that have been prepared by management with the oversight of the Audit Committee are presented fairly, in all material respects, in conformity with generally accepted accounting principles. We plan and perform the audit to provide reasonable, not absolute, assurance that the financial statements taken as a whole are free from material misstatement, whether from error or fraud. We design tests of controls to obtain sufficient evidence to support the auditor s control risk assessments for purposes of the audit of the financial statements. 2011 KPMG LLP, a Delaware limited liability partnership and the U.S. member firm of the KPMG network of independent member firms affiliated with KPMG International Cooperative ( KPMG International ), a Swiss entity. All rights reserved. Printed in the U.S.A. 23603NSS 5

3.0 Responsibilities

Responsibilities Management is responsible for: Adopting sound accounting policies Fairly presenting the financial statements in conformity with generally accepted accounting principles Establishing and maintaining effective ICFR Identifying and confirming that the Company complies with laws and regulations applicable to its activities Making all financial records and related information available to the auditor Providing the auditor with a letter confirming certain representations made during the audit that includes, but are not limited to management s: disclosure of all significant deficiencies, including material weaknesses, in the design or operation of internal controls that could adversely affect the Company s ability to record, process, summarize, and report financial data; and acknowledgement of their responsibility for the design and implementation of programs and controls to prevent and detect fraud 2011 KPMG LLP, a Delaware limited liability partnership and the U.S. member firm of the KPMG network of independent member firms affiliated with KPMG International Cooperative ( KPMG International ), a Swiss entity. All rights reserved. Printed in the U.S.A. 23603NSS 7

Responsibilities (continued) The Audit Committee is responsible for: Oversight of the financial reporting process and ICFR Management and the Audit Committee are responsible for: Establishing and maintaining internal controls to prevent, deter, and detect fraud Setting the proper tone and creating and maintaining a culture of honesty and high ethical standards The audit of the financial statements does not relieve management or the Audit Committee of their responsibilities. 2011 KPMG LLP, a Delaware limited liability partnership and the U.S. member firm of the KPMG network of independent member firms affiliated with KPMG International Cooperative ( KPMG International ), a Swiss entity. All rights reserved. Printed in the U.S.A. 23603NSS 8

Responsibilities (continued) KPMG is responsible for: Forming and expressing an opinion about whether the financial statements that have been prepared by management with the oversight of the Audit Committee are presented fairly, in all material respects, in conformity with generally accepted accounting principles Planning and performing the audit to obtain reasonable not absolute assurance about whether the financial statements are free of material misstatement, whether caused by fraud or error. Because of the nature of audit evidence and the characteristics of fraud, we are able to obtain reasonable, but not absolute, assurance that material misstatements will be detected. Evaluating: (a) whether the Company s controls sufficiently address identified risks of material misstatement due to fraud; and (b) controls intended to address the risk of management override of other controls Communicating to you in writing all significant deficiencies and material weaknesses in internal control identified in the audit and reporting to management all deficiencies noted during our audit that are of sufficient importance to merit management's attention Conducting our audit in accordance with professional standards Complying with the rules and regulations of the Code of Professional Conduct of the American Institute of Certified Public Accountants, and the ethical standards of relevant CPA societies and relevant state boards of accountancy Planning and performing our audit with an attitude of professional skepticism Communicating all required information, including significant matters, to management and the Audit Committee 2011 KPMG LLP, a Delaware limited liability partnership and the U.S. member firm of the KPMG network of independent member firms affiliated with KPMG International Cooperative ( KPMG International ), a Swiss entity. All rights reserved. Printed in the U.S.A. 23603NSS 9

4.0 KPMG s Audit Approach and Methodology

KPMG s Audit Approach and Methodology We have an experienced team Our team includes the following specialists: Information Risk Management (IRM) and Forensics In developing our Audit Plan for 2012, we have based our approach on our understanding of the Public Health Trust objectives and strategies and the challenges facing the business in 2012. KPMG has systems and processes in place to monitor compliance with professional standards. Compliance with applicable, professional standards Experienced team Tailored to (Entity Name) Business Strategies and Activities AUDIT QUALITY IS OUR TOP PRIORITY Top-down Risk-based approach We work closely with management to understand the business challenges and changes in the business during the year with respect to the impact on our audit approach. Our Audit Plan outlines our assessment of audit risk and highlights specific areas of focus for 2012. Consistent Audit Methodology and technology used by KPMG member firms worldwide. Consistent audit methodology worldwide Effective and efficient Audit Our audit approach involves interaction with all levels of management throughout the year to identify issues. Our audit approach is based on communication and coordination with management and Internal Audit. 2011 KPMG LLP, a Delaware limited liability partnership and the U.S. member firm of the KPMG network of independent member firms affiliated with KPMG International Cooperative ( KPMG International ), a Swiss entity. All rights reserved. Printed in the U.S.A. 23603NSS 11

KPMG s Audit Approach and Methodology (continued) Technology Enables Audit Workflow Risk Assessment Engagement Setup Tailor the eaudit workflow to your circumstances Access global knowledge specific to your industry Understand your business and financial processes Identify significant risks in your business Determine audit approach Evaluate design and implementation of your internal controls Completion Form and issue audit opinion on financial statements Issue management letter Debrief audit process Testing Test effectiveness of your internal controls Perform substantive tests Verify accuracy, completeness and appropriate presentation and disclosure of financial statements 2011 KPMG LLP, a Delaware limited liability partnership and the U.S. member firm of the KPMG network of independent member firms affiliated with KPMG International Cooperative ( KPMG International ), a Swiss entity. All rights reserved. Printed in the U.S.A. 23603NSS 12

5.0 Risk Assessment

Risk Assessment Based on our understanding of the entity s business, industry and environment (including internal controls), the following are risks that may result in a material misstatement (error) in the financial statements and our planned audit approach in response to such risks: Risk Financial Statement Impact Planned Audit Approach Liquidity and Capital Resources Change in the Trust s fund net assets (deficit ) Review management s financial improvement plan and compare the plan s actual results to date against the original plan. Net patient revenue and gains are not reported in the proper period using the accrual basis of accounting and are not classified properly by the type of service rendered. Net patient receivables are not reported in the financial statements at net realizable value. Completeness, existence, accuracy, and presentation of revenue and gains Valuation of patients receivables Test contractual adjustments, other adjustments, and bad debts to determine that they are accounted for both in accordance with the respective contracts and the entity's policy. Determine that specific and unallocated reserves appear reasonable and comparable to prior year. Review third-party payor contracts and methods of payment and test the entity's computation of estimated adjustments to revenue as required under such contracts. Review and test the method used to determine the allowances for uncollectible accounts. Test and analyze aged accounts receivable trial balances, collection trends, delinquent accounts, subsequent period write-offs and economic or other factors used to determine allowance for uncollectible accounts. 2011 KPMG LLP, a Delaware limited liability partnership and the U.S. member firm of the KPMG network of independent member firms affiliated with KPMG International Cooperative ( KPMG International ), a Swiss entity. All rights reserved. Printed in the U.S.A. 23603NSS 14

6.0 Audit Plan

Audit Plan Scope Scope of work Applicable financial reporting framework Applicable auditing standards Other terms of engagement Audit of the financial statements and Single Audit/Grant Compliance U.S. generally accepted accounting principles OMB Circular A-133 Compliance Supplement Standards of the AICPA Government Auditing Standards issued by the Comptroller General of the United States None Noted 2011 KPMG LLP, a Delaware limited liability partnership and the U.S. member firm of the KPMG network of independent member firms affiliated with KPMG International Cooperative ( KPMG International ), a Swiss entity. All rights reserved. Printed in the U.S.A. 23603NSS 16

Audit Plan Materiality Professional standards require that we exercise professional judgment when we consider materiality and its relationship with audit risk when determining the nature, timing, and extent of our audit procedures, and when evaluating the effect of misstatements. The assessment of materiality is a matter of our professional judgment. Information is material if its omission or misstatement could influence the economic decisions of users taken on the basis of the financial statements. Materiality depends on the size and nature of the item or error judged in the particular circumstances of its omission or misstatement. 2011 KPMG LLP, a Delaware limited liability partnership and the U.S. member firm of the KPMG network of independent member firms affiliated with KPMG International Cooperative ( KPMG International ), a Swiss entity. All rights reserved. Printed in the U.S.A. 23603NSS 17

Audit Plan Deliverables Audit Reports Auditors report on the financial statements of the Public Health Trust of Miami- Dade County as of and for the year ended September 31, 2012. Report on Internal Control Over Financial Reporting and on Compliance and Other Matters Based on an Audit of the Financial Statements Performed in Accordance With Government Auditing Standards Report on Compliance With Requirements That Could Have a Direct and Material Effect on Each Major Federal Program and State Financial Assistance Project and on Internal Control Over Compliance in Accordance with OMB Circular A-133, Section 215.97, Florida Statutes, and Chapter 10.550, Rules of the Florida Auditor General Report of the financial statements of JMH Health Plan as of and for the year ended December 31, 2012 Specific Audit of the Children s Trust Contract Other Deliverables Material written communications between KPMG and management 2011 KPMG LLP, a Delaware limited liability partnership and the U.S. member firm of the KPMG network of independent member firms affiliated with KPMG International Cooperative ( KPMG International ), a Swiss entity. All rights reserved. Printed in the U.S.A. 23603NSS 18

Audit Plan Fraud Risks Identification of fraud risks: Perform risk assessment procedures to identify fraud risks, both at the financial statement level and at the assertion level Discuss among the engagement team the susceptibility of the entity to fraud Perform fraud inquiries of management, the Audit Committee and others Evaluate the Company s broad programs/controls that prevent, deter, and detect fraud Response to identified fraud risks: Evaluate design and implementation of anti-fraud controls Test effectiveness of anti-fraud controls Address revenue recognition and risk of management override of controls Perform specific substantive audit procedures (incorporate elements of unpredictability) Evaluate audit evidence Communicate to management and the Audit Committee 2011 KPMG LLP, a Delaware limited liability partnership and the U.S. member firm of the KPMG network of independent member firms affiliated with KPMG International Cooperative ( KPMG International ), a Swiss entity. All rights reserved. Printed in the U.S.A. 23603NSS 19

Audit Plan Fraud Risks (continued) Fraud Risks Identified in Planning Risk of misstatement relating to revenue recognition Risk of management override of controls Journal entries and adjustments Significant accounting estimates Significant unusual transactions Impact on Financial Statements Completeness, existence, and accuracy of revenue. Misstatement/material weakness Erroneous entries Over/understatement of account balances Planned Audit Approach Proof of cash, substantive testwork, inspection of contracts and medical records Evaluate results substantive of procedures Utilize CAATs for journal entry testwork Evaluate management s methodology & assumptions 2011 KPMG LLP, a Delaware limited liability partnership and the U.S. member firm of the KPMG network of independent member firms affiliated with KPMG International Cooperative ( KPMG International ), a Swiss entity. All rights reserved. Printed in the U.S.A. 23603NSS 20

Audit Plan Material Weakness and Significant Deficiency Material Weakness A deficiency, or combination of deficiencies, in internal control over financial reporting, such that there is a reasonable possibility that a material misstatement of the Company s annual financial statements will not be prevented or detected on a timely basis. Significant Deficiency A deficiency, or combination of deficiencies, in internal control over financial reporting that is less severe than a material weakness, yet important enough to merit attention by those responsible for oversight of the Company s financial reporting. 2011 KPMG LLP, a Delaware limited liability partnership and the U.S. member firm of the KPMG network of independent member firms affiliated with KPMG International Cooperative ( KPMG International ), a Swiss entity. All rights reserved. Printed in the U.S.A. 23603NSS 21

Audit Plan Material Weakness and Significant Deficiency (continued) Additional Considerations Follow-up on remediation of prior year s comments Evaluation of the severity of a deficiency, individually or in combination, considers both qualitative and quantitative factors The severity of a deficiency does not depend on whether a misstatement has actually occurred, but rather on whether there is a reasonable possibility that the Company s controls will fail to prevent or detect a material misstatement on a timely basis More attention is given to the evaluation of deficiencies with the most potential to be material or important enough to merit the attention by those with oversight responsibility for the Company s financial reporting. 2011 KPMG LLP, a Delaware limited liability partnership and the U.S. member firm of the KPMG network of independent member firms affiliated with KPMG International Cooperative ( KPMG International ), a Swiss entity. All rights reserved. Printed in the U.S.A. 23603NSS 22

Audit Plan - Accounting Policies and Practices Critical Accounting Policies and Practices Significant Judgments and Estimates Comments Self-Insurance Provision for estimated self-insured programs medical malpractice claims and workers compensation The estimates for self-insured claims are continually reviewed and adjusted as necessary as experience develops or new information becomes known. Net Patient Service Revenue Unpaid Medical Claims Pension Plans Net patient service revenue is reported at the estimated net realizable amount from patients and/or payors. The accrual is based on a per diem rate for outstanding bed days for inpatient claims and on experience trends for outpatient & other medical claims Various actuarial assumptions Payment rates established by regulations or contractual agreements may be determined either prospectively or retrospectively. Postemployment Benefits Other Than Pensions Various actuarial assumptions 2011 KPMG LLP, a Delaware limited liability partnership and the U.S. member firm of the KPMG network of independent member firms affiliated with KPMG International Cooperative ( KPMG International ), a Swiss entity. All rights reserved. Printed in the U.S.A. 23603NSS 23

Audit Plan Auditing and Accounting Matters Significant Audit Areas Significant Estimates Significant Unusual Transactions/Other Items Information Technology Matters Revenue recognition Valuation of accounts receivable Pension and postretirement obligations Revenue recognition Allowance for doubtful accounts Allowance for third-party payor contractual adjustments Accrued third-party settlements (Medicare/Medicaid) Reserves for self-insured liabilities, including professional liability, workers compensation risks Commitments and contingencies SEC Investigation Health Care Industry regulation changes General information technology environment New systems implementation Existing systems upgrade Systems integration 2011 KPMG LLP, a Delaware limited liability partnership and the U.S. member firm of the KPMG network of independent member firms affiliated with KPMG International Cooperative ( KPMG International ), a Swiss entity. All rights reserved. Printed in the U.S.A. 23603NSS 24

Audit Plan Involvement of Others Internal Audit Significant account/disclosure Description of work/output Timing 1,000 hours Accounts and transactions identified as not having a significant inherent risk. Substantive testwork Interim and Final 2011 KPMG LLP, a Delaware limited liability partnership and the U.S. member firm of the KPMG network of independent member firms affiliated with KPMG International Cooperative ( KPMG International ), a Swiss entity. All rights reserved. Printed in the U.S.A. 23603NSS 25

2011 KPMG LLP, a Delaware limited liability partnership and the U.S. member firm of the KPMG network of independent member firms affiliated with KPMG International Cooperative ( KPMG International ), a Swiss entity. All rights reserved. Printed in the U.S.A. The KPMG name, logo and "cutting through complexity" are registered trademarks or trademarks of KPMG International Cooperative ( KPMG International ).

3. Corporate Compliance Program Department Update

Corporate Compliance Department - FY 2012 Annual Audit Plan In Progress Audit Summary Total 5 Risk Level Definition Total Audits Completed 25 High Audits that were identified through the CMS RAC Approved Issues, the OIG Work Plan or AHCA Moderate or High Reassessments and by Internal Risk Assessment Not Started Total Audits on Plan % of Plan Completed New audits added to Original Plan 15 45 56% 9 Audit # Audit Name Risk Scope & Objectives Assessm ent Status 1 Hospital to Hospital Transfer High RAC Approved Issue - To review if Inpatient hospital incorrectly reports the patient is discharged to home, when in fact they have been discharged to another facility (SNF, IRF, or home health) or left against medical advice (and was later admitted to another facility on same day of discharge), which the inpatient hospital claim from the transferring facility fall under the post-acute transfer policy. According to the Post Acute Transfer policy, the transferring facility should be reimbursed on per-diem basis (up to the DRG full payment), while the receiving facility receive the full DRG or respective PPS reimbursement. All DRG's being reviewed are available in the Post Acute Transfer Policy. Completion Date 2 Incorrect billing of J1642 - High Heparin, up to 10 units (Hep-Lock, Hep-Flush) Hospital RAC Approved Issue - To review if claims identified where J1642 (Heparin, up to 10 units (Hep-Lock), (Hep-Flush)) was billed for patients who receives Heparin for therapeutic infusion. The therapeutic infusion of Heparin should be J1644 (Heparin, up to 1000 units). Completed 11/20/2011 3 Duplicate Claims - Outpatient High AHCA - To determine if an issue may exist when duplicate services are billed and reimbursed under Medicare. 4 Inpatient Duplicate Payments High AHCA - To determine if two AHCA payments for inpatient services for the same date(s) of service were paid by Medicaid. In certain circumstances, part of each payment is correct but there is a payment for the same date(s) of service included in each. In that case, only the duplicate per diem amount for that date is identified for recovery. Completed 10/20/2011 Completed 2/1/2012 5 Service Exclusions High AHCA - To determine if JHS was paid for services that are excluded from Medicaid payments including procedure codes listed as not covered and services provided outside of the allowed place of service as listed the Medicaid Services Coverage and Limitations Handbooks and Medicaid Fee schedules. 6 Service Limitations High AHCA - To identify payments for claims that were paid for services that are in excess of the service limitations as listed the Medicaid Fee Schedules. This includes services that are limited to a maximum number of times per year ( calendar of fiscal), per number of days, or per lifetime, per recipient, and services that overlap with another service concomitantly for the same recipient. 7 BAA review with focus on Health Plan, Mental Health and International Program 8 Patient Medical Record Amendments Moderate Moderate HIPAA/Privacy Audit - To ensure that where a business associate agreement is required one would have been executed along with the underlying contract and that we are in compliance with JHS policies and procedures. HIPAA/Privacy Audit - To ensure that patient amendment requests are in compliance with JHS policies and procedures. 1 Completed 2/1/2012 In-Progress Not Started Not Started Not Started 9 Medical Director Agreements High Risk Assessment - Review timesheets to ensure they are in compliance with contract requirements. Not Started 10 ER On-Call High Risk Assessment - To review records of ER on-call Not Started 11 Clinical Agency Agreements High Risk Assessment - Review of agreements to verify that they are in compliance with Stark and Anti-Kickback statutes. Not Started 12 Child Health Services Moderate Reassessment - To ensure that JHS is providing appropriate Child Health Services to children who are beneficiaries of Medicaid as indicated by AHCA/CMS. In-Progress 13 ABN Review High Reassessment - To determine if Medicare beneficiaries are provided with timely ABN notices for non-covered Medicare services. In-Progress

Corporate Compliance Department - FY 2012 Annual Audit Plan In Progress Audit Summary Total 5 Risk Level Definition Total Audits Completed 25 High Audits that were identified through the CMS RAC Approved Issues, the OIG Work Plan or AHCA Moderate or High Reassessments and by Internal Risk Assessment Not Started Total Audits on Plan % of Plan Completed New audits added to Original Plan 15 45 56% 9 Audit # Audit Name Risk Assessm ent Scope & Objectives 14 Rehab Audit Outpatient Moderate Risk Assessment - As per CARF (Commission on Accreditation and Rehabilitation) requirements, an audit will be performed to evaluate outpatient rehabilitation services to ensure documentation supports billing appropriateness. The scope will focus on Prosthetics and Orthotics. Status Completion Date 15 In-Patient Rehabilitation Facilities High OIG - We will examine the appropriateness of admissions to IRFs. We will also examine the level of therapy being provided in IRFs and how much concurrent and group therapy IRFs are providing. IRFs provide rehabilitation for patients who require a hospital level of care, including a relatively intense rehabilitation program and a multidisciplinary, coordinated team approach to improve their ability to function. Patients must undergo preadmission screening and evaluation to ensure that they are appropriate candidates for IRF care. Completed 12/8/2011 16 MSP- Medicare Secondary Payer High Reassessment - To determine if the online Medicare Secondary Payer questionnaire utilized by the hospital is compliant with the rules and regulations set forth by CMS for the solicitation of MSP information from the beneficiary. Not Started 17 Monthly Short Stay Medical Necessity - #1 Main and Holtz 18 Bimonthly Short Stay Medical Necessity - #1 North 19 Bimonthly Short Stay Medical Necessity - #1 South High High High In-Progress RAC/Reassessment - To evaluate patients admitted and discharged the next day to determine if a stay in observation would have been the most appropriate setting for care. If appropriate, review that condition code 44 was properly applied to Medicare claims per CMS guidelines. Completed 10/14/2011 RAC/Reassessment - To evaluate patients admitted and discharged the next day to determine if a stay in observation would have been the most appropriate setting for care. If appropriate, review condition code 44 was properly applied to Medicare claims per CMS guidelines. Completed 10/20/2011 RAC/Reassessment - To evaluate patients admitted and discharged the next day to determine if a stay in observation would have been the most appropriate setting for care. If appropriate, review condition code 44 was properly applied to Medicare claims per CMS guidelines Completed 11/4/2011 20 Modifiers Moderate Risk Assessment - To ensure that Modifiers 73, 74, 91 and 51 are being utilized appropriately. The scope will focus on the Cardiology, Radiology and Lab. Not Started 21 Transplant (Outpatient Bone High Risk Assessment - To determine if bone marrow transplants at Holtz are billed according to CMS. Marrow) Not Started 22 Clinical Trials Moderate Reassessment - To review Clinical Trial Research billing and modifier used in accordance to CMS regulations and guidelines. In addition to review that consent forms are completed in a timely manner Completed 4/20/2012 23 Community Mental Health Center- Moderate Risk Assessment - To ensure that the billing meets all relevant regulations and internal policies PHP Completed 1/6/2012 24 Hospitalizations and Rehospitalizations of Nursing Home Residents (both facilities) High OIG - We will review the extent to which Medicare beneficiaries residing in nursing homes have been hospitalized and rehospitalized. We will also assess CMS s oversight of nursing homes whose residents have high rates of hospitalization. Hospitalizations and rehospitalizations of nursing home residents are costly to Medicare and may indicate quality-of-care problems at nursing homes. A 2007 OIG study found that 35 percent of hospitalizations during a SNF stay were caused by poor quality of care or unnecessary fragmentation of services. Not Started 2

Corporate Compliance Department - FY 2012 Annual Audit Plan In Progress Audit Summary Total 5 Risk Level Definition Total Audits Completed 25 High Audits that were identified through the CMS RAC Approved Issues, the OIG Work Plan or AHCA Moderate or High Reassessments and by Internal Risk Assessment Not Started Total Audits on Plan % of Plan Completed New audits added to Original Plan 15 45 56% 9 Audit # Audit Name Risk Scope & Objectives Assessm ent Status Completion Date 25 Referrals and Discharges Moderate Risk Assessment - To ensure upon discharge that all patients have a right to choose where they are discharged to according to all relevant regulations and internal policies. Completed 2/1/2012 26 Holtz Children's Hospital High Risk Assessment - To ensure that the respiratory billing meets all relevant regulations and internal policies 27 Hospice (Main & North) High OIG - To ensure Hospice billing and general meets all relevant regulations and internal policies 28 Ventilator Units Moderate Risk Assessment - To review the billing for the new Jackson North contracted unit to ensure compliance with all relevant regulations and internal policies 29 Omnicell in Inpatient Surgery - Main High Risk Assessment - To ensure that Omnicell dispensers are being used according to all relevant regulations and internal policies. The scope will focus on whether SurgiNet is reconciled correctly with Omnicell. 30 Pharmacy - Drug Diversion High Risk Assessment - To review the current policies and procedures related to narcotic counts and drug diversion to determine if there are any gaps or risk areas. The scope will include Holtz Oncology floor and Burn Center. 31 JMG Providers High Risk Assessment - To determine if professional billing is correct according to CMS guidelines for six providers. The scope will include the timeliness of charges being entered. 32 Breast Center - South Moderate Risk Assessment - Review compliance with the Susan B. Komen grant and possible compliance issues related to referrals to the Main campus. Completed 3/2/2012 Not Started Completed 3/7/2012 Not Started Not Started Not Started 33 Charity Care Application Moderate Risk Assessment - To ensure that the Patient Financial Assessment is being completed appropriately according to Federal Regulations and in a timely manner. 34 EMTALA Moderate Risk Assessment - To ensure the JHS is abiding by the EMTALA regulations Completed 4/3/2012 Completed 10/31/2011 35 Inpatient - Interrupted Inpatient Psychiatry Facilities (IPF) - Reassessment Moderate Reassessment - To review IPFs Emergency Department Mental Health claims for Medicare reimbursement in cases of transfers from IPFs to the same or other IPFs. To ensure that IPFs do not discharge and then readmit patients to obtain per diem payments with higher adjustments. Interrupted stays in which a patient is discharged and then readmitted to the same or another IPF within 3 days following the discharge will be treated as one continuous stay. Completed 3/30/2012 36 Physician Signatures documented in Medical Records for Certified Nurse Midwife encounters for Jackson Main Moderate Rollover: To ensure adherence to Florida Statutes and JHS policy: physicians are required to co-sign/attest to the care as provided by Certified Nurse Midwives. Not Started Completed 5/31/2012 3

Corporate Compliance Department - FY 2012 Annual Audit Plan In Progress Audit Summary Total 5 Risk Level Definition Total Audits Completed 25 High Audits that were identified through the CMS RAC Approved Issues, the OIG Work Plan or AHCA Moderate or High Reassessments and by Internal Risk Assessment Not Started Total Audits on Plan % of Plan Completed New audits added to Original Plan 15 45 56% 9 Audit # Audit Name Risk Assessm ent 37 Monthly Short Stay Medical Necessity - #2 Main and Holtz High Scope & Objectives RAC/Reassessment - To evaluate patients admitted and discharged the next day to determine if a stay in observation would have been the most appropriate setting for care. If appropriate, review that condition code 44 was properly applied to Medicare claims per CMS guidelines. Status Completion Date Completed 1/6/2012 38 Inpatient POCT Glucose Moderate Internal assessment: To assess the viability of clinical documentation at Jackson Memorial to begin charging for point of care testing for glucose services. Completed 5/31/2012 39 Community Mental Health Center - Moderate Risk Assessment - To ensure that billing meets all relevant regulations and internal policies Completed 1/6/2012 DTP 40 Monthly Short Stay - Medical High RAC/Reassessment - To evaluate patients admitted and discharged the next day to determine if a stay in Completed 3/26/2012 Necessity - Main, North and South #1 observation would have been the most appropriate setting for care. If appropriate, review that condition code 44 was properly applied to Medicare claims per CMS guidelines. 41 TEG (Thrombelastograph Moderate Internal assessment: To ensure that the current clinical documentation and billing is appropriate prior to beginning Completed 9/28/2011 hemostatist system) POC (point of care) services. 42 Monthly Short Stay - Medical High RAC/Reassessment - To evaluate patients admitted and discharged the next day to determine if a stay in Completed 5/9/2012 Necessity - Main, North and South #2 observation would have been the most appropriate setting for care. If appropriate, review that condition code 44 was properly applied to Medicare claims per CMS guidelines. 43 OIG Medicaid Payments for Therapy Services in Excess of State Limits High OIG Assessment - To determine if JHS is vulnerable to improper payments because: (1) plans of care were incomplete or missing; (2) documentation was missing, or providers failed to respond to our request for documentation; or (3) providers lacked proper qualifications, or we could not determine whether they had proper qualifications. Completed 5/9/2012 44 RAC Medical Necessity High RAC Review - To evaluate patients admitted and discharged the next day to determine if a stay in observation would Completed 5/11/2012 have been the most appropriate setting for care. 45 Monthly Short Stay - Medical Necessity - Main, North and South High RAC/Reassessment - To evaluate patients admitted and discharged the next day to determine if a stay in observation would have been the most appropriate setting for care. If appropriate, review that condition code 44 was #3 properly applied to Medicare claims per CMS guidelines. In-Progress 4

OFFICE OF COMPLIANCE Jackson Medical Towers 1500 NW 12 Ave, Suite 102 Miami, Florida 33136-1094 (305)585-2902 EXECUTIVE SUMMARY COMPLIANCE AUDIT SUMMARY REPORT June 2012 1. #42 OIG Medicaid Payments for Therapy Services in Excess of State Limitations Scope/Objective: To identify Medicaid payments for therapy services that exceeded State limits. To further ensure that JHS is not vulnerable to improper payments because (1) plans of care are incomplete or missing; (2) documentation is missing or providers fail to respond to requests for documentation; or (3) providers lack proper qualifications. Methodology: Reviewed 30 random encounters from all three campuses ranging from dates of service October 11, 2011 to February 28, 2012 with focus on CPT codes: 97001-97004; 92506; 97110; 97113; 97530; 97535 and 92506, which are evaluation and re-evaluation codes for therapy services. Results: The review rendered a cost error rate of 0% Recommendations: Jackson Health System should ensure that the requirements to receive Therapy services are met, such as Prescriptions and Orders are signed by physicians prior to providing services. They should also ensure that the Plan of Care is approved and signed by the physicians on a timely manner and filed in the medical records. Jackson Health System Therapy departments should be aware of Florida Medicaid exclusions and limitations as it relates to the Medicaid recipient(s). 2. # 43 RAC Review Medical Necessity Scope/Objective: To evaluate a portion of RAC initiated audits that were received for services paid for Medicare beneficiaries. The issue addressed for this review was patients admitted as inpatient into one of our facilities and may have not met the Milliman or InterQual criteria for admission. Methodology: A random sample of 30 encounters from the 156 that were chosen for medical necessity review by the RAC between the dates of service April 4, 2010 to January 10, 2012. Edited UB04, remittance notices, and detail bills were retrieved from Siemens EDM. Cerner was used to verify clinical documentation and notes. Billing and payment information was retrieved from Siemens Invision and MedAssets Contract Manager to validate payments and adjustments were processed according to the contract. Results: The review rendered a cost error rate of 4.9%. Out of the 30 encounters the results are: Jackson Memorial Jackson North 8.4% cost error rate 3.3% cost error rate

Jackson South 4.6 % cost error rate Recommendations: The function of this audit review is to anticipate the potential exposure to risk for the 224 encounters that JHS received from the RAC contractor (Connolly) on April 14, 2012. Ultimately the review of the medical records that are submitted to the RAC and the review by their chart auditors will be the defining measure as to whether the payment sent to JHS that were processed by Medicare will be recovered by the RAC. JHS has initiated several initiatives including, but not limited to a new Case Management Protocol, as well as training with the physicians and clinical staff regarding the Centers for Medicare and Medicaid Services regulation for an appropriate inpatient admission order and medical necessity. In our continuing effort to train our staff and improve our process, we have been able to bring awareness to the regulatory requirements to not only inpatient admissions, but also regarding patients in an observation status and improve the process for all of our facilities for all payers to reduce our potential to risk. 3. #38 Inpatient Point of Care Testing Glucose Scope/Objective: To evaluate the order, documentation and results process for inpatient point of care testing (POCT) for glucose services to patients, to be able to process charges for all patients who are admitted for POCT glucose services. Methodology: A sample of 30 encounters ranging from dates of service of April 30, 2012 thru May 15, 2012 were reviewed Results: The results rendered a 0% cost error rate Recommendations: Compliance recommends a periodic review to ensure adherence to the physician order, documentation and results are being followed according to the billing guidelines for point of care testing. While most payers do not reimburse separately for these services (included in the per diem or DRG allowable), the ability to provide and capture the additional revenue of the service and abiding by either the national or local coverage determination that Medicare provides is essential. In addition to the revenue implications, reporting charges for point of care tests through cost reporting is important for the charge profiles uses to determine DRG rates or cost data used to determine APC accurately. Separate reporting also allows JHS to track utilization of the tests for process improvement and patient care. 4. #36 Physician Signatures documented in Medical Records for Certified Midwife at Jackson Memorial OB triage services. Scope/Objective: To ensure adherence to Florida Statutes and JHS policy: physicians are required to cosign/attest to the care as provided by Certified Nurse Midwives. Recommendations: At the start of the audit meeting with the new Chief Administrative Officer of Holtz Hospital, it was communicated to Compliance that the regulations were not being adequately followed. It is noted by Compliance and the administrative staff at Holtz that a new process for OB triage services to be transitioned to the outpatient clinic patient type service and will now be governed by the regular policies and procedures as any other type of outpatient service.

4. Internal Audit Department Update

Internal Audit - FY12 Audit Plan as of 5/31/12 Risk Level Definition Audit Summary Total High Impact to company s financial statements is considered material; non-financial In Progress 3 risk, such as patient outcome and visibility, is considered high. Other considerations include significant change in associated management and/or process, and prior internal or external audit findings. Medium Process impact to company s financial statements may be material; other risk as Audits added to Original Plan 2 described above is considered less significant. Less: audits deleted from Plan (2) Total Audits Completed 17 Not Started 11 Total Audits on Plan 31 % of Plan Completed 55% Audit # Audit Name Risk Assessment Scope & Objectives Status Completion Date 1 Med Assets - GPO High Analyze results achieved from Med Asset GPO process. Fieldwork complete Audit Rating 2 Construction Projects Medium Review a sample of current construction projects to determine if procedures/processes are adequately controlled. Fieldwork underway 3 Potential Medicaid Medium Review and evaluate process to monitor potential Medicaid. Fieldwork underway 4 Accounts Payable High Evaluate controls over vendor on boarding, invoice approval Fieldwork underway and payment, general computer controls, non-po purchases. 5 Performance Reporting Medium Determine accuracy and appropriateness of performance reporting information provided to management. 6 AOA High Determine compliance with terms of AOA (UM and FIU). 7 Personal Leave Review Medium Perform analysis on capped PL (vacation and sick pay). Fieldwork complete 8 Financial Statement Close Medium Evaluate the adequacy of internal controls over initiation, authorization, processing, recording, and reporting of transactions; ascertain the existence and effectiveness of current policies and procedures, and evaluate financial statement close activities. 1

Audit # Audit Name Risk Assessment Scope & Objectives Status Completion Date 9 Fixed Assets High Determine effectiveness of fixed assets controls including buildings, reconcilement, addition/deletions, depreciation, etc. 10 Maxor Pharmacy Services High Evaluate physical receipt, and distribution controls over the pharmacy function (JMH). 11 Revenue Cycle Medium Audit of Denial Management, DNFB, and late charge processes and controls. 12 Rosie Lee Wesley Health Center, Palm Springs Middle School Low General controls review of offsite location. 13 Physical Inventory Observation Medium Observe FY12 physical inventory to determine the adequacy of physical inventory procedures. 14 Perdue Medical Center Low General controls review of offsite location Audit Rating 15 Patient Referrals Medium Perform quarterly review and analysis of patients referred from JHS to UM Hospital. 16 KPMG audit assistance n/a Provide 300 hours of audit assistance during Q4. 17 Inventory Control Jackson North/South High Assess internal controls related to OR and Pharmacy supplies. complete 10/30/2011 Needs Improvement 18 Sheraton Anesthesia Contract Medium Determine if physician payments are consistent with the terms of the contract and services provided. complete 12/31/2011 Good 19 Ward D/Corrections Health Services Medium Review CHS charge capture and billing processes to determine adequacy of controls, completeness and accuracy of charges and billings. 20 Follow Up Activities varied Perform follow-up review of prior audit findings to ensure corrective action is completed as stated and adequate. 21 HIPAA Security Rule High Assess compliance with required elements of the HIPAA Security Rule. complete 12/31/2011 Satisfactory Performed monthly n/a n/a complete 1/31/2012 Satisfactory 22 Physical Security High Evaluate physical security of hospital to ensure access is restricted to authorized individuals and proper security policies are in place to prevent theft of JHS assets and protect the safety of staff, patients and visitors. 23 Maintenance Contracts High Review contract management process to determine if contracts exist for services, proper procurement processes were followed, and effectiveness of payment controls. Hold considering consultant n/a n/a complete 2/29/2012 Needs Improvement 2

Audit Audit # Audit Name Risk Assessment Scope & Objectives Status Completion Date Rating 24 KPMG audit assistance n/a Provide 1,000 hours of audit assistance during Q1, Q2. complete 2/17/2012 n/a 25 Vendor Analysis High Evaluate data mining test results of vendor database, select various vendors and invoices for review to ensure proper on boarding, job performance, and payment approval. 26 Change Management High Review IT change management process to determine if changes to production systems are properly approved, tested, and controlled. 27 Admission/Registration and Insurance Verification High Verify accuracy of capturing patient information and insurance verification; also includes Siemens/Cerner IT controls review. 28 Initiatives High Determine adequacy of methodology to monitor strategic initiatives. complete 2/27/2012 Needs immediate Improvement Complete 3/31/12 Satisfactory complete 4/15/12 Needs Improvement Complete 5/31/12 Needs Improvement 29 Corporate Business Office High Added to FY12 plan review of collection process, employees, and charge off process. 30 Medicare Bad Debt Medium Review accuracy of Medicare bad debt submissions. Deferred to FY13 per management request Complete 5/31/12 Needs Immediate Improvement n/a n/a 31 Q3 Inventory Count Observation Medium Added to FY12 plan - Observe FY12 physical inventory to determine the adequacy of physical inventory procedures. Complete 5/31/12 Good 3

Process Life Cycle Audit # Audit Name Risk Assessment Status Completion Date 1 Periscope High Project on hold 2 Electronic Medical Records High Fieldwork underway 3 OR inventory, charge capture High Fieldwork underway 4 Axiom (Cost Accounting) High 5 Med Assets Revenue/Supply High Fieldwork underway 6 ICD-10 High 7 Denial Management Medium 8 Medicare Bad Debt Medium 9 Inpatient Financial Counseling Redesign Medium 10 Accounts Payable GHX/AP on demand Medium Fieldwork underway 11 Personal Leave System Low 12 QuickPay Medium Complete 4/30/12 13 Facilities Storeroom Medium Complete 4/30/12 14 Kronos upgrade Low Completed 3/31/12 15 MSS on boarding, off boarding Low completed 3/31/12 4

4 (b). Review of Finalized Audit Reports

Office of Internal Audit Jackson Medical Towers 1500 NW 12 th Avenue, #102 Miami, FL 33136 TO: CC: FROM: Carlos Migoya, President & Chief Executive Officer Don Steigman, Executive Vice President & Chief Operating Officer Mark Knight, Executive Vice President & Chief Financial Officer Steve Weimer, Corporate Director Internal Audit Janene Church, Corporate Business Office Director Melissa Melendez, Manager Internal Audit DATE: June 5, 2012 SUBJECT: CBO Collections Internal Audit Review Background, Scope and Objective In November, 2011, JHS management identified certain instances where patient account transactions were not processed in accordance with JHS internal policies, specifically, collection employees whose responsibilities included updating patient account information/documentation on provider rejected claims. Management s review disclosed eleven employees, who charged off transactions instead of working provider rejected claims and providing required information so that JHS may be reimbursed. Additionally, Management determined that these employees bypassed JHS policy requiring supervisory approval of charge off transactions exceeding $5,000 by dividing into multiple transactions less than $5,000 each. As a result of the review, all staff found to have performed 3 or more instances of writing off in excess of the policy was put on administrative leave for two months. One supervisor was terminated. In January, 2012, the Office of Internal Audit (IA) expanded management s review to include the remaining 55 department employees. The purpose of this audit was to determine if the above situation existed with employees other than the ones initially identified. Executive Summary Several significant issues were noted during the audit, including Fourteen additional employees and one supervisor were identified as processing transactions in an improper manner, charging off provider rejected claims without adequate due diligence and bypassing established JHS controls. Procedures to document daily collector activity were out of date and not enforced. Management review of collection activity was not performed on an ongoing basis and consistent basis. Automated management tools did not exist to detect this sort of improper activity. Key performance indicators had not been developed to track and manage collector activity on an ongoing basis. Detailed findings are noted below.

CBO Collections Internal Review Page 2 of 4 Detailed Observations, Recommendations and Management Action Plan 1. Adjustments processed by CBO employees were not in compliance with JHS policies. Review of an additional 55 CBO employees revealed 14 employees and one supervisor who bypassed established controls by splitting transactions and charging off without appropriate approval. Recommendation: A formalized process to review collector activity should be implemented. This process should be performed and documented on a daily basis. Management should create reports within Siemens which detail total transactions by account to ensure the Collector does not exceed policy approval limits. The Contractual, Administrative and Provider Liable Adjustment Approval Policy should be updated to include a statement that the approval limits are set by account level (not transaction level) to ensure balances are not improperly split into multiple transactions. Action taken by Management Two collectors and a supervisor were terminated. Additionally, the CBO updated the Contractual, Administrative and Provider Liable Adjustment Approval Policy with updated language detailing approval limits by account level. Management Response: During the course of each month, the supervisors are reviewing the prior month s adjustments for their employees to make sure that the write-offs are appropriate and no multiple write offs on one account (representing one adjustment) are done. When the review is complete, a copy of the review is scanned and held on the supervisor s directory. A copy of the review is also forwarded to the supervisor s Associate Administrator, who will review the report and save a copy as well. The Director or Assistant Director of the CBO will request copies of the reviews on a periodic basis to make sure the process flow is consistent. Action Plan Owner: Janene Church, CBO Director Implementation Date: Completed 2. Reporting tools in Siemens and management oversight of accounts are insufficient to detect and prevent inaccurate and/or fraudulent transactions. Currently, Siemens provides daily reports of each transaction processed by the Collector. These reports cannot be easily exported into a reporting tool for Management to analyze. Additionally, detailing work performed by Collectors on a daily, weekly, monthly or annual basis do not exist. As a result, management could not perform a sufficient review to detect unauthorized transactions. Collector KPI reports reviewed by management were not configured accurately in Siemens. These reports listed each transaction processed by the Collectors, however did not list the number of accounts worked on a daily basis. (Collector performance should be measured by number of accounts worked, not number of transactions processed.) The current KPIs for the CBO Collectors are not aligned to industry standards.

CBO Collections Internal Review Page 3 of 4 Recommendation: Reporting tools within Siemens should be customized to align with the strategic objectives of the Department relative to review of daily Collector activity. Specifically, the CBO should work with the IT Department in creating reports which details transactions by account level. These reports should include a daily overview of the activity by Collectors as well as include any promise to pay amounts and comments which would indicate that the Collector thoroughly worked the account. Additionally, key performance indicators should be updated in order to ensure alignment with industry standards. Management Response: CBO leadership has reviewed the productivity reports being produced with Information Technology and finds that there are some limitations to the system s reporting capabilities, in that there is no way for the system to determine more than the activity codes entered by each collector. This means that while the tool is useful to give an overall report, it is imperative that each supervisor review the staff s individual output to assess whether the employee is entering codes on accounts that do not qualify, e.g. zero balance accounts or entering multiple codes on individual accounts that inflate the total. By utilizing both for review, management feels confident that staff output will be accurately assessed. KPI indicators are based on national benchmarks from 2008 Strategic Advisory Council s Financial Leadership Council and are adequate for the measurement of staff activity at this time. Action Plan Owner: Janene Church, CBO Director Implementation Date: Completed 3. Updates are needed to the SSI edits and contractual adjustment configuration within MedAssets. Current SSI billing edits are configured for primarily one payer (Medicare) which can create errors requiring manual adjustments to be made by Collectors. Contractual adjustment terms are often not updated with accurate information which also creates additional manual adjustments. Additionally, a formal process to routinely alert Managed Care to issues related to contractual performance was not in place. Recommendation: Management should review the current SSI contract to determine whether additional payers can be included to prevent further billing errors and eliminate manual adjustments. Additionally, the CBO management team should work closely with the Managed Care Department to update and ensure the accuracy of MedAssets contractual adjustments. As part of these efforts, the CBO should ensure that a formal process is implemented to routinely notify MedAssets of any contractual errors noted.

CBO Collections Internal Review Page 4 of 4 Management Response: Management has reviewed current SSI contracts and identified where some programming improvements were required to have the system more accurately determine the net payments expected on accounts receivable. Leadership has worked with the Director of Managed Care as well as the MedAssets coordinator to correct some errors on the system and to add some programming not previously included in the system, e.g. include impact of IME payments on Medicare HMO accounts. Additionally, MedAssets recently had a trainer come to the CBO and met with leadership as well as key staff to train on nuances of the system, as well as to address current issues being experienced that caused the system not to tie to payors remittances. This is an ongoing process that requires vigilance on both the CBO and MedAssets. Action Plan Owner: Janene Church, CBO Director Implementation Date: Completed 4. Procedures to document activity performed by the Collectors needs improvement. Accounts often did not include a note in the comments section within Siemens detailing the reason for an adjustment. In 2011, the Collectors were provided training on the proper format for documenting notes on each account. These comments assist the CBO Management team in ensuring that adjustments were properly made and due diligence performed prior to the adjustment. Recommendation: The Contractual, Administrative and Provider Liable Adjustment Approval Policy should be updated to include that comments are required for each transaction performed on a patient account. Daily review of Collector activity should include ensuring comments were provided to each transaction performed. Management Response: Review of collectors activity will occur on a routine basis but daily checking of each collector for each transaction is not practicable. The Quality Assurance scorecard will be reintroduced to the supervisors and Associate Administrators, which provides for a routine check of the quality of work done, as well as the quantity. This translates into at least 10 (ten) accounts per month (selected on a random basis) are checked for each employee by the supervisors to ensure appropriate follow-up procedures are demonstrated. Action Plan Owner: Janene Church, CBO Director Implementation Date: Completed

Office of Internal Audit Jackson Medical Towers 1500 NW 12 th Avenue, #102 Miami, FL 33136 To: CC: From: Carlos A. Migoya, President and Chief Executive Officer Don S. Steigman, Chief Operating Officer Mark Knight, Executive VP and Chief Financial Officer Brian Dean, Vice President - Finance Michael Garcia, Corporate Director- Interim CIO Kevin Andrews, Vice President Quality Mehmet Akcin, Director Project Management Steve Weimer, Corporate Director Internal Audit Richard Kugler, IT Audit Manager Date: May 16, 2012 Subject: Final Report Jackson Initiatives Audit Background, Objective and Scope: As a part of the company s transformation process, numerous initiatives are underway and/or planned, with targeted savings exceeding $120M. As part of the FY12 Internal Audit Plan, we performed an audit of the initiatives process. The objective of the audit is to determine if the process to identify and analyze initiative opportunities is properly controlled, initiatives are approved, and ongoing tracking of initiative implementation and actual to targeted savings are managed. All initiatives currently in process were included in the scope of our audit. Audit Rating: Needs Improvement Executive Summary: Improvement was noted in the JHS initiatives tracking process, however, additional improvement is needed regarding overall ownership of the initiative tracking software and development of standards for accessing and updating initiatives. Our detailed findings are noted below. Page 1 of 2

Detailed Observations, Recommendations and Management Action Plans 1. Performance Logic System Ownership and Lack of Consistent Tracking Methodology Performance Logic has been designated and implemented as the system to track and manage all initiative projects. However, several issues were noted with the projects entered into the system 1. A system owner does not exist; and as a result, a lack of a standardized method of entering and updating information in the system did not exist making it difficult to determine the status of many of the ongoing projects via the system. 2. Project labor costs (labor expended outside normal job requirements) were not documented in the system; as a result, project expense was not completely captured or tracked. 3. The only Quality initiated projects tracked in the system are ones with IT components. 4. Numerous projects identified as Sustainable Jackson in the system project plans were not updated and/or closed. We recommended that management designate a Performance Logic system owner with responsibility for ensuring that all initiative projects are tracked via the system, developing standardized project input and update procedures, and developing/distributing standardized management reporting. Action Plan Owners: Michael Garcia, Corporate Director & Interim CIO Mehmet Akcin, Director - Project Management Kevin Andrews, Vice President - Quality Management Response: The PMO has been designated as Performance Logic system owner. As owner, we will develop standards for individuals accessing and using the system as well as a review process to ensure compliance by August 31, 2012. Additionally, we will review each FS project (project plan) and update the project plans to reflect the same status as the project charter. We will create a closed project folder and migrate all closed projects to the closed projects folder. Implementation Date: August 31, 2012 (Quality) We are in agreement and will implement all project plans into Performance Logic software. Implementation Date: August 1, 2012 Page 2 of 2

Jackson Health System Prior Audit Report Follow-Up 5/31/12 6/6/2012 Audit Audit Report Dated Original Number of Comments Follow-up Exceptions Noted Corrected during Audit? Exception Ratio Payroll FY11 1 1 n/a 100% Audit Finding Original Recommendation Original Target Date Follow-up Finding Revised Target Date Responsible Area PYR Management agrees: IT, HR and Payroll team will develop together. Payroll agreed to manage the team effort. Lack of Payroll Contingency and Disaster Plan: There is no defined, agreed and formal contingency and disaster recovery plan with the specific steps, actions, and responsibilities needed in order to process and pay the payroll under a crisis or under disaster circumstances. We recommend the following actions: Department needs to elaborate and document a formal Payroll Contingency and Disaster plan. IT department should validate and approve Payroll department Contingency and Disaster plan. IT: From an infrastructure and application hosting perspective, the Lawson Payroll application is remotely hosted and BCR/DR planning is part of the service agreement with the remote host vendor who provides an annual SAS70 type 2 Certification. From a payroll processing perspective, the payroll team will produce a contingency and disaster plan with IT input and approval. Implementation - 12/31/2011 Payroll Contingency Plan has not been developed. There are several reasons for plan implementation delay: Lawson, Kronos, Workforce analytics upgrades as well as Employee Self Service and Management Self Service implementations. Completing the eight other follow up items from the review. Processing other requested projects/reports related to Union agreement changes; Lawson and Kronos programming changes related to savings initiatives ; RIF processing. 10/31/2012 Implementation date has been moved to October 31, 2012. Review, vetting, and approvals will be complete by this date.

FISCAL COMMITTEE

PUBLIC HEALTH TRUST FINANCIAL RECOVERY BOARD Fiscal Committee Joe Arriola, Chairperson Darryl K. Sharpton, Vice Chairperson Michael Bileca Joaquin del Cueto Mojdeh L. Khaghan Marcos Jose Lapciuc Stephen S. Nuell Date, Time and Place June 14, 2012 Immediately following the Audit & Compliance Subcommittee meeting Ira C. Clark Diagnostic Treatment Conference Room 259 AGENDA 1. Approval of the Previous Meeting Minutes (Joe Arriola, Chairperson) (a) *Meeting Minutes as of May 17, 2012 2. Financial Statements Report, as of May 2012 (Mark T. Knight, Executive Vice President & Chief Financial Officer, Jackson Health System) 3. *Point of Service Collection Incentive Plan (Mark T. Knight, Executive Vice President & Chief Financial Officer, Jackson Health System) 4. Cost Accounting Timetable and Work Plan (Brian Dean, Vice President, Finance, Jackson Health System) 5. *Accounts Receivable Aging Report, as of May 2012 (Carmen Pla, Vice President, Patient Financial Services, Jackson Health System) 6. Contracts and Agreements There are no contracts or agreements to report. 7. Facilities Subcommittee Report (Darryl K. Sharpton, Chairperson)

Fiscal Committee Meeting Agenda June 14, 2012 Page 2 8. Purchasing Subcommittee Report (Joaquin del Cueto, Chairperson) (a) (b) *Review and Recommend Approval of the June 2012 Purchasing Report (Rosa Costanzo, Vice President and Chief Procurement Officer, Strategic Souring and Supply Chain Management Division) *Resolution authorizing (1) approval of an amendment for the continuation of Microsoft Products provided by SHI International Corporation under the State of Florida, State and Local volume licensing agreements in the amount of $2,734,356.39 for a three year period, from April 1, 2012 through March 31, 2015 and (2) approval of true-up from the previous contract term in the amount of $1,380,817.17 and (3) payment in the amount of $1,537,109.83 to be made by June 16, 2012 (Michael Garcia, Interim Chief Information Officer, Jackson Health System) Agenda items(s) noted with an asterisk (*) indicates that the supporting documents are attached.

1. Approval of the Previous Meeting Minutes

PUBLIC HEALTH TRUST FINANCIAL RECOVERY BOARD Fiscal Committee Joe Arriola, Chairperson Darryl K. Sharpton, Vice Chairperson Michael Bileca Joaquin del Cueto Mojdeh L. Khaghan Marcos Jose Lapciuc Stephen S. Nuell Date, Time and Place May 17, 2012 (Immediately followed the Audit & Compliance Subcommittee meeting) Ira C. Clark Diagnostic Treatment Center Conference Room 259 ATTENDANCE Fiscal Committee Joaquin del Cueto Marcos Jose Lapciuc Joe Arriola Stephen S. Nuell Mojdeh L. Khaghan Michael Bileca Excused Darryl K. Sharpton Jackson Health System Carlos A. Migoya Mark T. Knight Brian Dean Carmen Pla Donn S. Steigman Miami-Dade County Attorneys Eugene Shy, Jr. Jeffry Poppel Chris Kokoruda

Fiscal Committee Meeting May 17, 2012 Page 2 Call to Order With a quorum being present, the meeting of the Fiscal Committee was called to order at 9:20 a.m. by Joe Arriola, Chairperson, Fiscal Committee. 1. Approval of the Previous Meeting Minutes (a) Meeting Minutes as of April 19, 2012 Mr. Arriola requested a motion approving the meeting minutes of April 19, 2012. 2. Financial Statements Report, as of April 2012 Ms. Khaghan moved approval; seconded by Mr. del Cueto, and carried without dissent. Mark T. Knight, Chief Financial Officer, Jackson Health System reported that the month of April was the second consecutive month that Jackson Health System ended with a profit despite some negative indicators. Inpatient admissions were under budget and under year to date trend, patient days were approximately 31,000 which created 6.36 for length of stay which attributed to a positive impact on the financial statements for the month, continue to monitor inpatient utilization with a focus on generating more revenue, cash collections was strong, days in accounts receivable was reduced to 48, and approximately 10,200 FTE s was reported for the month which is a reduction of 900 FTE s from the prior year. As part of the key performance indicators, Mr. Knight pointed out that the sales tax income has been less than projected, net revenue for adjusted patient days is current for the month and exceeds budget on a year to date basis which is attributed to payor mix changes and strong cash collections, and days cash on hand was 16.5 for the month which is two and one-half days higher than projected. Mr. Knight briefly spoke about information that was included as part of the balance sheet which had to do with outcome of cash, net accounts receivable, and accounts payable and ongoing efforts to timely pay vendors. Also information having to do with the reduction in total operating expenses was highlighted from the P&L 12 month trend analysis report which showed better controls on salary and benefits, supply expenses on an adjusted volume basis and contract and services, and positive results from the new collective bargaining agreements. Information from the P&L business units showed that the three main hospitals continue to be profitable collectively, continued improvement regarding physician services, long term care facilities continues to improve, and primary care continues to trend which is better than previously anticipated and better than prior year. A copy of the Financial Statements report for the month ending April 30, 2012 was distributed at the meeting. 3. FY 2012 Projections Cash Flow Mr. Knight stated that in the prior month he reported the projected loss for fiscal year 2012 would be approximately $12 million. Since the time of the previous report it is projected that there will be a significant change in the cash deficit for the months of June and July which will be attributed to a projected stronger performance in cash collections. He stated that it is projected that JHS will complete the fiscal year with approximately 14 days cash-on-hand. Mr. Knight advised the Committee that the projected cash flow is modified on a continual basis and projected cash flow is based on the changes. A copy of the projected cash flow report was distributed at the meeting.

Fiscal Committee Meeting May 17, 2012 Page 3 JMH Health Plan Flash Report, April 2012 Brian Dean, Vice President, Finance Division, Jackson Health System reported that for the month the Commercial and Medicare lines of business showed a profit totaling $126,000.00 and year to date is $613,000.00. With regards to the Commercial line of business, a few lives remain as adjustments are being made to move to Av-Med. For the month the medical loss ratio for the Medicare line of business is 84.91% and year to date is 84.34% which are considered good targets. The current run rate is positive and it is anticipated that it will remain positive on a go forward basis. Additional information highlighted in the report was utilization trends having to do with Medicare admissions, length of stay, enrollment, and claim inventory. Mr. Dean reminded everyone regarding the ongoing discussions with the Office of Insurance Regulation (OIR) relevant to the $26 million that JHS contributed to the Health Plan last year, which $15 million was returned. Based on the balance sheet and the reserve requirements, Mr. Dean stated that the Health Plan is over reserved totaling approximately $7.1 million. OIR is aware of the overage in the reserve requirements and Mr. Dean anticipates a return to the OIR in July of this year requesting additional funds. Given the inconsistencies the Health Plan experienced last year OIR wanted to be sure that the Health Plan is stable before approving additional funds. A copy of the Health Plan Flash Report was distributed at the meeting. Mr. Bileca questioned the total amount of additional funds that the OIR has approved for the Health Plan including the request for additional funds. Mr. Dean replied $20 million which $15 million that was previously approved and $5 million additional funds that will be requested. 4. Cost Accounting Timetable and Work Plan Mr. Dean reported that relative to the implementation timelines a similar version of the report was presented in the prior month. At the request of Mr. Arriola an additional milestone was added to the Work Plan to hire one FTE for RVU Maintenance in the middle of October of this year. Mr. Dean spoke about the timelines having to do with building the environment within the Information Technology infrastructure and installation of software. A copy of the Cost Accounting Timetable and Work Plan was distributed at the meeting. 5. Pension Plan Investment Policy Statement Mr. Dean presented and recommended for approval the Pension Plan Investment Policy Statement. He stated that the document is a reflection of bringing current some of the investment policies including the asset allocations, and structure of the Pension Plan Committee. Review of the recommended changes includes the restructure of the Pension Plan Committee are as follows: Three (3) members of the Governing board One Labor Union Representative One Member at Large CEO/President Jackson Health System Executive Vice President/CFO Jackson Health System

Fiscal Committee Meeting May 17, 2012 Page 4 Further review of the changes to the Pension Plan Investment Policy Statement included investment return objectives and statements related to asset preservation as it relates to return on assets. The itemized changes are as follows: II. Investment Goals and Objectives B. Rate of Return Objectives (Achieved over a rolling 5-year period): 1. Meet or exceed a 5.0% premium, net of fees, over the rate of inflation as measured by the Consumer Price Index (CPI). 2. Meet or exceed an annualized rate of return, net of fees, in excess of the Plan s current actuarial return assumption, which is 8.00%. With regards to item II. B. 2. and the current actuarial return assumption, which is 8.00%, Mr. Dean pointed out that the Pension Plan Committee will be presented with a new study at its next meeting to potentially modify and approve the assumption which will be reflected in the Pension Plan Investment Policy Statement. Mr. Dean stated that based on the industry norms 8.00% is aggressive and will need to be adjusted to approximately 7.5%. 3. Outperform the return of a hypothetical portfolio composed of 50% S&P 500 Index, 20% MSCI All Country World Ex. U.S. Index and 30% Barclays Capital Aggregate Index. With regards to II. B. 3., Mr. Dean stated that the language support the ability to view similar portfolio for pension plans made up of a certain allocation and provide benchmark information for the pension plan as well as a review how JHS Pension Plan performs against of other institution pension plans. III. Plan Asset Allocation Guidelines A. Plan Structure Within the guidelines approved, the PPC is charged with the responsibility of recommending the structure of the Plan that offers the highest probability of achieving its investment objectives. Moreover, it must update and revise this structure as the financial needs of the Plan and/or the outlook for the capital markets change. With regards to item III. A., Mr. Dean explained that the language was modified to provide current asset allocation structure that is provided to the JHS money managers for latitude against certain constraints defined by the Pension Plan Committee to seek out the return objectives as defined in the Pension Plan Investment Policy Statement.

Fiscal Committee Meeting May 17, 2012 Page 5 After discussion regarding the history regarding the creation of the Pension Plan Committee, proposed structural change of the Pension Plan Committee, and a representative from both Labor Unions versus one representative for both Labor Unions, Mr. Arriola requested a motion to approve the Pension Plan Investment Policy Statement as amended. Resolution approving the Public Health Trust Defined Benefit Retirement Plan Investment Policy Statement (Mark T. Knight, Chief Financial Officer, Jackson Health System) Mr. del Cueto was the dissenting voter. Mr. Nuell moved approval; seconded by Mr. Khaghan, and carried with one dissent. With regards to item II B. 2., Mr. Migoya recommended that the language be modified to read as follows: 2. Meet or exceed an annualized rate of return, net of fees, in excess of the Plan s current actuarial return assumptions, which is 8.00%. Replacement language: Meet or exceed an annualized rate of return, net of fees, in excess of the Plan s actuarial return assumptions. Mr. Migoya recommended that the 8.00% be removed because it could change over a period time. After discussion, Arriola requested a motion accepting Mr. Migoya s recommendation to remove the 8.00% from the Plan Asset allocation Guidelines. Mr. del Cueto was the dissenting voter. 6. Accounts Receivable Aging Report Ms. Khaghan moved approval; seconded by Mr. Nuell, and carried with one dissent. Carmen Pla, Vice President, Patient Financial Services, Jackson Health System reported that overall the month of April was a great cash month and revenue cycle which is attributed to the entire organization. She pointed out that there is a focus around daily charge reconciliation. The goal for the month was $75.1 million and the actual was $85.9 million. Point of service exceeded the projected goal and was up from the prior month, DNFB days showed a decrease by 1.4 days which is equivalent to $29.5 million, potential Medicaid conversions continue to trend towards the goal and partnership continues with the Department of Children and Families Office located on the Medical Campus and are seeing an increased amount of accounts being converted, AR greater than 90 days because the total AR decreased by $37.4 million however the actual dollars decreased by $4.7 million, credit balances showed a decrease of $8.8 million during the month of April. 7. Contracts & Agreements There were no contracts or agreements to report.

Fiscal Committee Meeting May 17, 2012 Page 6 8. Facilities Subcommittee Report Mojdeh Khaghan, Vice Chairperson, Facilities Subcommittee reported that the Facilities Subcommittee met on May 17, 2012. The Subcommittee approved and forwarded a revised resolution to the Fiscal Committee requesting approval to delegate authority to the President or his designee to approve certain leases, modifications and lease renewals and to exercise terminations and cancellations as necessary. With the exception of the request to approve the resolution and regular monthly reporting there was no significant information to report. (a) Resolution Recommended to be Approved (1) REVISED Resolution providing for the delegation of authority from the Financial Recovery Board of the Public Health Trust to the President or his designee to settle leasing disputes, including waiving interest and late charges; authorizing the President to consent to assignment of leases and to execute Subordination, Attornment, Non-Disturbance Agreements and Estoppel Certificates (Madeline Valdes, Corporate Director, Property Management Division, Jackson Health System) Mr. Arriola requested a motion for the item as revised. 9. Purchasing Subcommittee Mr. Nuell moved approval; seconded by Ms. Khaghan, and carried without dissent. Joaquin del Cueto, Chairperson, Purchasing Subcommittee reported that the Purchasing Subcommittee met on May 17, 2012. With the exception of a recommendation to approve the resolution authorizing an amendment to Section I.F.3. of the Procurement Policy/Regulation having to do with the PHT/JMH Health Plan Managed Plan Managed Care Contracts, recommendation to approve of the May 2012 Purchasing Report and routine monthly reporting there was no significant information to report. (a) Resolution Recommended to be Approved (1) Resolution authorizing an amendment to Section I.F.3. of the Procurement Policy/Regulation approved on January 30, 2012 regarding Financial Recovery Board review of certain PHT/JMH Health Plan Managed Plan Managed Care contracts (Rosa Costanzo, Vice President and Chief Procurement Officer, Strategic sourcing Division) Mr. Arriola requested a motion for the item. Mr. Nuell moved approval; seconded by Ms. Khaghan, and carried without dissent.

Fiscal Committee Meeting May 17, 2012 Page 7 (b) Review and recommend approval of the May 2012 Purchasing Report Mr. del Cueto reviewed and recommended approval of the May 2012 Purchasing Report. Following the review and recommendation to approve, Mr. Arriola requested a motion for the May 2012 Purchasing Report. Mr. Nuell moved approval; seconded by Ms. Khaghan, and carried without dissent. Adjournment The meeting of the Fiscal Committee adjourned at 10:22 a.m. Transcribed by Ivenette Cobb Executive Assistant Public Health Trust Financial Recovery Board

2. Financial Statements Report, as of May 2012

Jackson Health System POS Cash Incentive Plan May September 2012 Patient Access Department

FY2012 Goal Maximize POS Cash Collections Tiered incentives Participation Requirements (Monthly) Individual QA score of 98% or higher No Unplanned leave outside PHT Policy No Disciplinary Action

Tiered Incentive Current Avg POS Monthly = $ 1.2m POS Incentive Cost Increase % $ 1.8m $ 75.00 $22,425 $ 600k 3.7% $ 2.0m $ 150.00 $44,850 $ 800k 5.6% $ 2.5m $ 225.00 $67,275 $ 1.3m 5.2% $ 3.0m $ 300.00 $89,700 $ 1.8m 4.9% $3.5m $ 350.00 $ 104,650 $ 2.3m 4.6% (299 FTE)

4. Cost Accounting Timetable and Work Plan

Jackson Health System Aged Trial Balance Accounts Receivables All Hospitals May 2012 1

AR KPI s Cash Collections Goal Actual May 2012 $78.7M $ 96.2M KPI Best Practice /Benchmark Goal Actual Prior Month POS 1% of net collections $750K $1.4M $1.9M DNFB Potential Medicaid Conversion AR Greater than 90 Days Target less than 5 days gross revenue (not including potential Medicaid) % of approvals compared to referrals for the prior 90 days. ** Less than 25% of discharged AR 5 8 8 80% 77% 75% 25% 35% 35% Credit Balances 3 days gross revenue 3 3 3 Benchmarks obtained by: HARA & Advisory Board ** Internal Target. No industry benchmark available Overall Revenue Cycle efforts continue to trend positively Reduction of Total AR by $33.8M Surpassed cash goal by $17.5M DNFB days remained flat, continued efforts are in place to reduce to target Potential Medicaid Conversion is trending upward JHS has increased number of applications submitted JHS has agreed (pending board approval) to reimburse DCF for additional staff May AR>90% remained flat. Although dollars decreased by $11M Total AR once again decreased by $33.8M for the second month. Decreased in Medicaid & Medicare by 23.7M Self Pay increased by $7.8M 2

JHS CBO Cash Collections Month FY 11 Cash FY 12 Cash October $74,311,292 $90,778,590 November $80,284,984 $85,907,276 December $93,776,571 $90,229,345 January $86,577,244 $77,375,312 February $81,296,613 $81,364,439 March $106,251,866 $98,406,469 April $88,670,750 $87,471,783 May $90,304,771 $96,207,257 June $92,269,050 July $79,590,189 August $93,698,857 September $97,026,774 Total $1,064,058,960 $707,740,741 Source: Dania Trasobares-Llópiz Director of Treasury Management 3

6. Contracts and Agreements (There are no contracts or agreements to report.)

7. Facilities Subcommittee Report

8. Purchasing Subcommittee Report

PUBLIC HEALTH TRUST FINANCIAL RECOVERY BOARD PURCHASING REPORT June 25, 2012 TO: FROM: PUBLIC HEALTH TRUST FINANCIAL RECOVERY BOARD 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 $1,000,000, waivers of formal competition over $100,000 and other categories for Board approval as prescribed by the Procurement Policy/Regulation. The entire report has been screened and assembled by the Procurement Management Department with the direct participation of the Administrator and staff, all subject to review by the Vice President, Strategic Sourcing Division, consultation with the President as needed, and review 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 $1,000,000. 1. (362348-LH) Jackson Memorial Long Term Care Center (JMLTCC) Administration requests a contract award to Pulmonary Health Network (PHN) resulting from a competitive Invitation to Bid (ITB 12-10248-LH) for the provision of Respiratory Services for a sixteen-bed Respiratory Care Unit to include eight ventilator units (New purchase). Background Pulmonary Health Network: $2,522,880 (for three years) Total approved funding: $2,522,880 This competitive procurement was solicited and administered by the Procurement Management Department through a competitive Invitation to Bid (ITB #12-10248-LH) process that was publicly advertised on April 25, 2012. A pre-proposal conference was conducted on May 1, 2012. Responses were received on May 7, 2012. The ITB document was distributed to four potential bidders. Responses were received from two of these firms: Respiratory Health Services and Pulmonary Health Network (PHN). June 2012 PHT Financial Recovery Board 1

SECTION I. (cont d.) The Bidder offering the lowest price was the incumbent vendor, Pulmonary Health Network. After verification of the licenses / certification of PHN s Registered Respiratory Therapists (RRTs), Certified Respiratory Therapists (CRTs) and Board Certified Pulmonary Physician and confirmation that the vendor had over 10 years experience in respiratory services in long term care centers, the results of the bid tabulation were provided to the JMLTCC. JMLTCC concurred with recommendation of Procurement to award the bid to the lowest bidder, PHN. The tabulation results are as follows: BIDDERS Item 1 - Respiratory Care Per Patient Day 3 Yr. Fixed Cost Item 2 - Ventilator Rental Cost Per Patient Day 3 Yr. Fixed Cost TOTAL THREE YEAR COST Pulmonary Health Network $140 $2,452,800 $8 $70,080 $2,522,880 Respiratory Health Services $266 $4,660,320 $32 $280,320 $4,940,640 JMLTCC in expanding the unit to a sixteen (16) bed unit, required bidders to provide eight (8) additional ventilators to include preventive maintenance at a per patient day rate. PHN offers respiratory services at $140.00 per patient day and ventilator rental at $8.00 per patient date. PHN currently provides respiratory services for an eight (8) Respiratory Care Unit at JMLTCC at the rate of $160.00 per patient day. In comparing the prior contract to this ITB quote, the difference for respiratory services cost is $20 less per patient day, thereby, providing cost reduction of $350,400 for the initial three-year term. The ventilator rental which includes maintenance at $8.00 per patient day, although not quantified, provides savings for capital purchase and maintenance/service cost. Recommendation The Administration Department at JMLTCC and Procurement request approval of a bid award to PHN for an initial term of three years plus two-one year options (OTRs) to renew. The Three-day bid protest filing period has passed and no protest to this award recommendation was presented. This contract has been approved by Risk as to Insurance and Liability and by the County Attorney s Office for Legal sufficiency. This contract can be terminated for convenience with a thirty (30) day notice and includes UAP and OIG provisions (K Andrews). June 2012 PHT Financial Recovery Board 2

SECTION II. AWARDS UNDER REQUESTS FOR PROPOSALS (RFP s) This section consists of awards under competitively solicited Requests for Proposals (RFP s) over $1,000,000. No items to report. SECTION III. AWARDS UNDER THE COMPETITIVELY SOLICITED CONTRACTS OF OTHER PUBLIC PROCUREMENT ENTITIES This section consists of awards over $1,000,000 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 $100,000 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 2. (381013-PE) The Department of Health Information Management (HIM) requests a contract award to PricewaterhouseCoopers, LLP (PwC) to continue utilizing the PwC SMART Inpatient service and for the addition of the PwC SMART Outpatient service for a period of one (1) year. June 2012 PHT Financial Recovery Board 3

SECTION V. (cont d.) Background PricewaterhouseCoopers, LLP (PwC): $312,000 (for one year) Total approved funding: $312,000 PwC has provided the SMART Inpatient solution to the Trust for a year at no cost through May 30, 2012 at a value of $156,000 ($13,000/month for 12 months). As a result of negotiations by Procurement Management, the vendor has agreed to continue providing this service for an additional month to June 30, 2012 (cost avoidance of $13,000) while approval is secured from FRB for this request to renew the service as well as add the Outpatient component system wide. The automated SMART Inpatient and Outpatient solution will assist in analyzing coding quality, correct coding errors before bills are submitted, identify documentation improvement opportunities to reduce reimbursement risks, and measure outcomes against key performance indicators. The tool has assisted and will continue to assist coding staff with appropriate coding consistent with American Hospital Association (AHA) coding guidelines, ensure that the department codes efficiently in areas that are focused on the Medicare Audit Recovery Contract project (RAC), other regulatory agency audits and is also vital in preparation for the International Classification of Diseases (ICD-10). The product was a component of the PwC Initiative to improve the overall quality of HIM coding. HIM would otherwise be unable to manually review all the records coded on a daily basis without the SMART system flagging potential errors for review. The system currently performs the audit three times per day. The HIM Department, in surveying the market, found that there is no other system currently available to perform the required task. Recommendation The HIM Department has stated that during the period that the PwC Smart Inpatient solution has been in place at no cost, the Trust has realized $1,394,872 in reimbursement changes. A total of 353 discharges of 38,592 were corrected prior to billing. The vendor has also agreed to waive its option of the customary 5% increase for entering this renewal. This translates to approximately $15,600 for the renewal period. According to MD Buyline, they are currently seeing annual increases in the 3-5% across the industry. Balance of page intentially left blank June 2012 PHT Financial Recovery Board 4

SECTION V. (cont d.) As a result of further negotiation by Procurement Management PwC has reduced its monthly Inpatient and Outpatient license fee for both Jackson North and Jackson South for cost savings of $4,000 per month or $48,000 for the one-year period and will provide these savings to any other sites the Trust may add. PwC has waived the installation fees for SMART Outpatient, providing cost avoidance to the Trust of $15,000. When PwC installed SMART Inpatient in 2011, the Trust realized cost avoidance of $15,000. Relative to the proposed renewal, the vendor has provided savings to the Trust totaling $91,600. The original contract was approved by Risk as to Insurance and Liability and by the County Attorney s Office for Legal Sufficiency. This contract can be terminated by either party with a ninety (90)-day notice and includes the UAP and OIG provisions. A Sole Source Justification has been provided by Vania Bredy and Mark Knight and Conflict of Interest Declarations signed by Vania Bredy, HIM Director, and Gerard Bielak, Partner, PwC. (M. Knight). 3. (373166-HT) The Revenue Cycle Division requests continued funding for the sole source ACCESS Florida Program services provided by the Florida Department of Children & Families (ongoing/replacement purchase). Background Florida Department of Children & Families: This request for funding: $484,704 (for two years) Total approved funding: $484,704 This Program helps JHS determine Medicaid Eligibility for all unfunded patients in order to ensure that JHS will be able to collect revenue for medical services rendered. The program is a joint effort by DCF and the Trust. The Trust funds 50% of the DCF employee s salary costs. Due to an increase in services, DCF will add three employees to the existing staff, there will now be eleven (11) onsite employees. The new contract also changes in structure; it will go from a funded position agreement to a fee for service agreement as mandated by the state. The requested funding will cover services for a two year period in the amount of $242,352 per year. These services can only be provided by the State of Florida and are not otherwise available. June 2012 PHT Financial Recovery Board 5

SECTION V. (cont d.) Recommendation The ACCESS Florida Program is strictly offered by the state of Florida under the Florida Department of Children and Families. Past performance of these FTE s has demonstrated the volume of classifying patients under the Medicaid program has far exceeded the cost paid for services. The relationship between the onsite offices of DCF and Potential Medicaid has made it seamless to work out denials and has allowed for timelier determinations enabling JHS to realize Medicaid dollars sooner than the 45-day waiting period for determinations. UAP and OIG fees do not apply to this contract since the contract is 50% funded by the state of Florida. This contract has a termination for non-appropriation of funds clause and is pending legal sufficiency by the County Attorney s Office. A sole source justification has been provided by Tellsa Lyons and Mark Knight (M. Knight). B. Physician s Preference Staff requests a waiver of formal competition for the contract items listed in this category because a physician or clinician has requested the particular item or service without which the physician or clinician cannot successfully and safely render patient care. No items to report. C. Standardization Items in this category have been established as the Trust standard. 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. Balance of page intentially left blank June 2012 PHT Financial Recovery Board 6

SECTION V. (cont d.) 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. 4. (366763, 388262-SH) JHS Construction Services and Jackson North Medical Center Engineering Services request ratification, under the Emergency Procurement provision of the Procurement Regulation for the rental of portable air conditioners for various areas due to failed air handler units (Emergency purchase). Background American Portable Air Conditioning, Inc.: $157,790 Total approved funding: $157,790 Requisition 388262 for $74,000 was submitted by JNMC on behalf of the JHS Construction Department for the rental of 37 portable air conditioning units from July 2011 to September 2011 as ordered by Abbey Spurgeon, former JHS employee, who authorized use of American Portable Air Conditioning during a capital project for the replacement of chillers that failed. The individuals involved in the authorization for the emergency procurement to meet the immediate emergency are no longer with JHS and did not complete the required paperwork before separating from the Hospital. The procurement regulation authorizes the utilization of an Emergency Procurement to meet the needs of an emergent situation that endangers the public health or safety or threatens to interrupt delivery of governmental service. There was no alternative source within the infrastructure of the hospital to cool the buildings. American Portable Air Conditioning was already in place providing service to JNMC, having been awarded a competitive contract, and was, therefore, the only practicable source under the circumstances that could satisfy the urgency of the situation. Emergency Procurement form K and Conflict of Interest Declarations were signed by Bill McKeon, Director of Operations, JNMC, and Alba Cheas, Manager, American Portable Air Conditioning, Inc., with no reported disclosures. Pricing was consistent with what was being charged by vendor via the competitive engagement, for service at Jackson North. The emergency procedure used was necessary to provide patient comfort, establish infection control and protect sensitive equipment. Balance of page intentially left blank June 2012 PHT Financial Recovery Board 7

SECTION V. (cont d.) Requisition 366763 was submitted by JNMC for $83,790 for the rental of portable air conditioning units on an as needed emergency basis from September 2011 through May 2012. This amount is owed to the vendor for service for that period. JNMC Plant Operations department had a prior purchase order which was competitively awarded in the amount of $50,000, but which funds had been exhausted due to utilization needs. Pricing is consistent with the pricing under this competitively awarded purchase order. A Bid Waiver Justification has been provided and Conflict of Interest Declarations signed by Bill McKeon, Director of Operations, JNMC, and Alba Cheas, Manager, American Portable Air Conditioning, Inc., with no reported disclosures. Although there has been a delay in the submission of this request, these emergency procurements are being submitted to the Board of Trustees for ratification in accordance with the procurement regulation requirements. (S. Sears/M. Valdez). 5. (377875, NSA) The Strategic Planning Department requests a contract award to the Praemon Group for a period of eight (8) weeks for the provision of consulting services needed to properly establish, organize, implement and operate a dedicated clinical research unit at Jackson (New purchase). Background The Praemon Partners, LLC: $120,000 Total approved funding: $ 120,000 This project has a two-fold purpose: to broaden the clinical trials effort at JHS and to utilize JHS empty beds to generate additional revenue. In order to deliver this, Praemon will assess JHS and assist in the establishment, organization, implementation and operation of a dedicated clinical research unit within JHS. During the market research, the user department found this vendor to be the only one that would outline a program which would involve the provision of program management, leadership, and provide documentation to allow JHS to set up a Clinical Trials Phase 1 unit embedded in the main hospital campus. Eve Sakran, Corporate Director for JHS Research and Grants, has found Praemon to be the only group that has built the only dedicated research unit embedded within a hospital. Balance of page intentially left blank June 2012 PHT Financial Recovery Board 8

SECTION V. (cont d.) The user department ( The Clinical Trials Department ) considers that an academic hospital-based research unit is preferable to a free standing or off-site research unit. The advantages, which could also result in increased revenue for JHS, include the following: Location in the hospital provides 24-hr access to code teams, Medical Emergency Teams, ICU physicians, and all of the support, diagnostic, therapeutic, administrative and safety elements. All costs associated with research can be captured in a hospital-based research unit by performing all procedures in the hospital (e.g. CT scan, MRI, etc). One of JHS most important assets is its diverse patient population, and with a hospital-based research unit the enrollment time of research patients is reduced because the patients are recruited in-house, thus reducing the lag between trials. Recruiting in-house reduces marketing costs and in turn saves the hospital money. A hospital-based research unit allows for the close relationship between physicians and the medical staff and eases referrals of patients for research. In light of the foregoing, the executive team finds that this project should also serve to attract sponsors and firmly implant JHS in the research community. Recommendation The vendor has successful experience in establishing a dedicated research unit. The Praemon Group is the compilation of the original staff that established and developed a clinically credible and revenue-producing research unit within the Saint Joseph s Hospital in Atlanta, Georgia. The Clinical Trials Department conducted market research to determine the availability of competition and found that the service being offered would be best fit for the Trust to accomplish its objective of broadening clinical trials efforts at JHS and generate additional revenue. Executive Management has approved a twenty-five percent (25%) initial upfront payment, $30,000. This contract has been approved by Risk as to Insurance and Liability and by the County Attorney s Office for Legal sufficiency. This contract can be terminated for convenience with a fifteen-day (15) notice and includes UAP and OIG provisions. A Bid Waiver Justification has been provided and approved by Eve Sakran and Jeff Crudelle. Conflict of Interest Declarations have been signed by Eve Sakran, Corporate Director of Research and Grants, and by Chris Hooper, Managing Partner at Praemon Partners LLC, with no reported disclosures (E. Sakran/J. Crudelle). June 2012 PHT Financial Recovery Board 9

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. 6. (381514 - CS) The Employee Benefits Department requests approval to exercise the first option to renew (OTR 1) of Competitive Contract ITB-11-10093-CS for Employee Group Life Insurance Programs with provider InsurancePoint LLC, aka Reliance Standard Life Insurance Company, and to add another service level to the existing contract which includes Life Insurance Programs for Residents (Ongoing purchase). Background InsurancePoint LLC: Employee Life Insurance Programs: $ 734,832 (initial one year) Option to Renew (OTR) 1: $ 734,832 (for one year) Residents Life Insurance Programs: $ 126,727 (for one year) Total approved funding: $ 1,596,392 On May 18, 2011, the competitive award of Bid No. ITB-11-10093-CS for Employee Group Life Insurance Programs was approved by the Trust s Chief Procurement Officer. The one-year contract was awarded to InsurancePoint LLC, aka Reliance Standard Life insurance Company. These programs include the Basic Life/Accidental Death & Dismemberment (AD&D) insurance plan, the Optional Life insurance plan, the Long Term Disability (LTD) and the Short Term Disability (STD). Since June 24, 1977, the Residents Life Insurance Programs have been provided by two different carriers through the services of a brokerage firm. This we found was an evergreen engagement that is automatically renewed on July 1 st of every year. However, there are no records of an established contract with JHS terms and conditions with the insurance carriers and the brokerage firm. June 2012 PHT Financial Recovery Board 10

SECTION VI. (cont d.) Section 8.B of the existing contract used for Employee Life Insurance Programs allows for additional terms and conditions within the scope and original intent. This clause states that: said terms and conditions may include additions of service levels, which in this case would be the Residents Life Insurance Programs that include Basic Life, Basic Accidental Death and Dismemberment (AD&D), Supplemental Life, and Long Term Disability (LTD) insurance. The department has identified the need to establish a contract for Residents Life Insurance programs. Annual savings of $34,708.10 will be realized by using contract ITB-11-10093-CS as opposed to the current engagement. The user department and PMD have determined it is in the Trust s best interest to add Residents Life Insurance programs to the terms and conditions of the contract at the OTR 1 level. Recommendation Prior to award of this current competitive contract, JHS spent $1,135,650 annually for Employee Life Insurance programs. During this first OTR, JHS will spend the fixed price of $734,832. The current annual expenditure for Residents Life Insurance is $161,435. The annual cost accessing this competitive contract will be $126,727. Therefore, the Trust will realize cost reduction of $34,707.99 by accessing this contract for the residents. This contract can be terminated for convenience by either party with a thirty (30)- day notice and includes the UAP and OIG provisions. Conflict of Interest Declarations have been provided by Tala Teymour, JHS Employee Benefits and by David Green, Sr. VP, Reliance Standard Life Insurance Company, with no reported disclosures. (M. Huot-Barrientos) 7. (389204 - CS) The Information Technology Department requests modification of the current purchase order issued to Terremark North America, Inc. through accessing (piggyback) the Broward College Competitive Contract #ITN-2010-001-BM for increased funding until expiration of the current contract term on July 31, 2012 as well as for a new 12-month term for the provision of Off-Site Data Center and Co-location Network Services. Balance of page intentionally left blank June 2012 PHT Financial Recovery Board 11

SECTION VI. (cont d.) Background Terremark North America, Inc.: Previously Approved Funding: (July 1, 2011 to July 31, 2012)) $ 961,295 (for thirteen months) This Request for Funding: Additional Funding For: (May July 2012) $ 180,000 OTR No. 1: $ 400,000 (for twelve months) Total approved funding: $1,541,295 In September 2011, JHS accessed (piggyback) Broward College competitive Contract No. ITN-2010-001-BM for a period of thirteen (13) months for collocation and network services. This Broward College contract had been awarded to Terremark in March 23, 2010 under Agenda Item # VII-F-4-Terremark. The request for additional funding will increase the contract value by $180,000 to cover the cost of services rendered during May, June and July 2012. The Broward College competitive contract will automatically renew on August 1, 2012. Therefore, JHS ITD will be accessing the contract for an additional year from August 1, 2012 to July 31, 2013 at an estimated cost of $400,000. This amount is less than the previous annual estimated cost of operation, because JHS IT continues system migration and evacuating IT resources from the Terremark collocation facilities. The modifications will take the total contract value to $1,541,295, thus requiring FRB approval. The increase in funding for the months of May, June and July 2012 is due to the delay in rehabilitating JHS IT Data Center at Park Plaza West. The evacuation of IT resources from the Terremark collocation facility has taken longer than anticipated. System migrations from Terremark to JHS IT Data Center cannot continue until Terremark receives permits from the City of Miami to approve electrical, mechanical, and physical construction activities. After permits are received, ITD will continue removing equipment from Terremark and the monthly invoices will decrease. The OIG and UAP provisions are included. June 2012 PHT Financial Recovery Board 12

SECTION VI. (cont d.) Conflict of Interest Declarations have been provided by Michael Garcia, Interim CIO, and by Cheryl Mahaffey, SVP Legal Affairs, Terremark North America, Inc., with no reported disclosures. (M. Garcia) 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. 8. (256026 P.E.) The Patient Placement Center, in collaboration with the Information Technology Division (ITD), requests a contract award to TeleTracking for the renewal of licensing and maintenance of the TeleTracking Solution and expansion of the solution to Jackson North and Jackson South (Ongoing purchase). Tele Tracking Technologies, Inc.: Year 1: Implementation/Training/ License/Maintenance $ 747,886 Year 2: License/Maintenance $ 326,892 Year 3: License/Maintenance $ 386,892 Year 4: License/Maintenance $ 386,892 Year 5: License/Maintenance $ 386,892 Total approved funding: $ 2,055,454 Background The Central Staffing and Patient Placement Center have been working to standardize processes and throughput systems. This initiative has included the consolidation of Central Staffing and Patient Placement Center (people and locations). The Tele Tracking System June 2012 PHT Financial Recovery Board 13

SECTION VII. (cont d.) is an integrated system for Bed Tracking, PreAdmit and TransportTracking that allows the hospital to efficiently plan, manage and expedite patient throughput. The system is proprietary to the vendor, Tele Tracking Technologies, and software upgrades, system support and maintenance are available only from this vendor. In August 2006 the Board approved a License Agreement for the upgrade and continued maintenance and support of the existing Bed, PreAdmit and Transport Tracking system at Jackson Main in the amount of $465,600. In June 2008 JHS signed an amendment with TeleTracking to provide services for the migration of Bed Tracking and PreAdmit Tracking to the SQL System and migration of TransportTracking to the XT platform. The current license agreement is set to expire on June 30, 2012 and a modification is being requested to expand this solution to both Jackson North and South and continue the required maintenance as well as add TransferCenter System, Custom Reporting Solution and Patient Flow Dashboard applications system-wide. The TransferCenter System provides effective and clear communication between clerical, clinical and physician personnel to ensure that incoming domestic transfers are being assessed accurately for admission. Proper assessment ensures that appropriate transfers are being admitted. This ensures cost effectiveness by eliminating inappropriate transfers due to mis-criteria and protection against the Federal Emergency Medical Treatment and Labor Act (EMTALA) which requires hospitals to provide an examination and stability treatment of a patient without consideration of insurance coverage or ability to pay when the patient reports to the emergency room. PreAdmit and BedTracking ensures patient throughput is efficiently managed. It works in conjunction with various departments within the hospital to properly and effectively move the patient from one area to another, from admission to discharge. By efficient throughput of a patient, the hospital is able to reduce length of stay of the patient, while simultaneously increasing patient volumes in ensuring that patients are properly placed, as well as decreasing patient LWOBS (Left Without Being Seen). The Custom Reporting Solution and Patient Flow Dashboard applications will assist in real-time access to reports. Recommendation This request for approval of a system-wide expansion will enable the JHS Transfer Center to command all the automated tools needed to transfer a patient in one single location and enable simultaneous communication between the referring and accepting facilities to verify bed availability as well as enable the sharing of data with the transport and emergency departments. This enterprise-wide expansion will also satisfy the Joint Commission, CMS, and AHCA requirements as well as JHS patient flow standards, while improving patient safety and reducing Emergency Department overcrowding. Information will be updated June 2012 PHT Financial Recovery Board 14

SECTION VII. (cont d.) and tracked effortlessly and shared with each person as well as groups critical to the successful care of the patient. The renewal requested will be for a period of Five (5) years and provides cancellation for convenience by the Trust after the third year. Implementation of a new solution requires years of training and could significantly affect patient flow if not done seamlessly. Key TransportTracking features can have tremendous financial impact within patient transport departments as well as throughout other areas of the hospital. TeleTracking s TransportTracking system will automatically assign jobs to transporters based on a complex dispatching logic that is configurable by the Hospital based on its demand and facility structure. When the transporter logs in for the day, the intelligent, Interactive Voice Response (IVR) system will give details of the first job and the IVR will be used continually throughout the day to update status and assign new jobs. TeleTracking s customizable dispatching logic has proven to reduce average transport trip times anywhere from 5 minutes to 15 minutes or more per trip. Benefits to be gained include: Ability to provide service for additional departments such as Radiology, ED, OR, etc; ability to transport patients to discharge, reducing the amount of time clinical staff has to spend transporting patients and providing more time for patient care; ability to transport patients to and from testing areas, freeing up technicians for more examinations. TransportTracking sends out a post dispatch page to the transporter after they receive their assignment through the IVR. This will include all the details of the job, two patient identifiers (a Joint Commission requirement), and whether that patient has an isolation status, thus eliminating the typical word of mouth or signs on doors to relay critical isolation information to patient transport personnel. The Patient Placement Center and ITD in researching the market found no other system as robust as the TeleTracking system or possessing the capabilities of this integrated solution. This system is the only one that offers a program that encompasses patient bed assignments, pre admitting services, transportation services for inpatients and Environmental services and tracks characteristics pertinent to each patient, such as infection type in determining cleaning status and time. Staff has also been trained on the earlier TeleTracking version that interfaces with the existing Electronic Medical Records (EMR) system. This solution was not available under the MedAssets contract. The following information conservatively illustrates Return On Investment (ROI) for TransportTracking based on average baseline patient transport data for approximately 400 beds and an assumption of: (1) 2 dispatchers with an average salary of $34,000 annually; (2) 300 trips per week with an average transport trip of 30 minutes; (3) 50 clinical transports per week with the average hourly Nursing rate of $32/hour, clinical transports taking 20 minutes; (4) an average cost of CT reimbursement estimated at $500;and, (5) average additional cost per patient of $15,272 for Hospital Acquired Infection, resulting in an ROI of $553,243: June 2012 PHT Financial Recovery Board 15

SECTION VII. (cont d.) (1) Fully Automated Dispatcherless Patient Transport System providing savings of $68,000 the equivalent of two salaries at $34,000 annually (2) Intelligent Dispatching Logic a. providing a reduction in average trip time by 5 minutes to generate $32,000 b. ability to provide service for multiple other departments without adding FTEs for a cost avoidance of $179,093 c. Efficiency improvements in diagnostic imaging for cost savings of $182,500 (3) Transporter notification of isolation information, thus preventing the spread of Hospital Acquired Infection resulting in savings of $91,650. Original contract was approved for legal sufficiency. This contract modification is pending legal review by the County Attorney s Office. This contract may be terminated by the Trust for convenience after the third year and contains OIG and UAP provisions A Sole Source Justification has been provided and Conflict of Interest Certifications signed by Michael Garcia, Interim CIO, JHS ITD, Alex Fernandez, Director of Central Staffing and Patient Placement Center, JHS, and Kirk Stephen, Executive VP, CPO and COO, Tele Tracking, with no reported disclosures. The vendor has provided in excess of 31% in total discount, which MD Buyline has reported to be far more competitive than other TeleTracking quotes they have reviewed in the last 12 months (R. Cuming/M. Garcia). 9. (388701-MR) The Human Relations Division requests a one year extension of the contract with Allen, Norton & Blue, PA for the continuation of expert consulting services. Allen, Norton & Blue, P.A.: Previously approved amount: $330,000 This request for funding: $150,000 (for one year) Total approved funding: $480,000 June 2012 PHT Financial Recovery Board 16

SECTION VII. (cont d.) Background In May 2011, the Financial Recovery Board approved a one year contract with Allen, Norton and Blue for labor negotiations consulting services in the amount of $275,000. Under the provisions of the agreement, the vendor provides services in connection with the negotiations of collective bargaining agreements between the Trust and the Trust s unionized employee organizations. During the initial term, the vendor assisted with the negotiations of the Trust s five bargaining units. Negotiations took longer than expected and a contract modification was required, under the Chief Procurement Officer s delegated authority, for a two-month period in the amount of $55,000. Four out of the five collective bargaining agreements have been finalized. Recommendation It is the intent of the Human Resources department to continue the relationship with Allen, Norton and Blue to allow for the finalization of the agreement with the Committee of Interns and Residents (CIR) and to allow for the Trust to address any reopeners for the finalized agreements with SEIU/Registered Nurses, SEIU/Professional, SEIU/Attending Physicians and AFSCME. The vendor s fees will remain at a blended hourly rate of $235 per attorney and $90 per paralegal. The original agreement was approved by Risk as to Insurance and Liability and by the County Attorney s Office for legal sufficiency. The contract can be terminated for convenience by either party with a thirty (30) day prior written notice and includes the UAP and OIG provisions. Conflict of Interest forms have been provided by Maria Huot-Barrientos, Sr. VP & Chief Human Resources Officer, JHS and by Robert Norton, President, Allen, Norton & Blue, P.A. with no reported disclosures. (M. Huot-Barrientos) 10. (391829) The Clinical Resource Management (CRM), Department of Quality and Patient Safety, requests a six-month extension of contract Bid Waiver 11-10286- NSA originally awarded to Infusion Technologies d/b/a CarePoint Partners Inc. under a waiver of formal completion for the provision of Home Infusion Services. (Ongoing purchase). Infusion Technologies d/b/a CarePoint Partners, Inc: OTR #2: $340,000 (for six months) Total approved funding: $340,000 June 2012 PHT Financial Recovery Board 17

SECTION VII. (cont d.) Background CRM assists the unfunded or homeless patients of Miami Dade County who would otherwise remain hospitalized for an extended period at a Jackson Health Systems (JHS) facility. CRM helps the patients, their family, and medical team identify the needs of the patient and targets appropriate resources for follow-up care which may include the need for Home Infusion services. Home infusion is a safe and effective alternative to inpatient care for many disease conditions and therapies. For many patients, receiving treatment at home is preferable to being in the hospital. On March 21, 2012, PMD issued RFP No. 12-10393-NSA for the provision of the services of a qualified contractor(s) to provide Home Infusion Services to adult and pediatric patients discharged from JHS. These Home Infusion services were to be provided as a turnkey project; inclusive of all medications, supplies, and personnel to administer the medications to the JHS clients and maintain the project. A pre-proposal conference was held on March 28, 2012. PMD received a number of questions from potential providers. These questions were submitted to the user department for review and disposition. However, after further evaluation, considering the questions and in conjunction with the increased need and costs, the user department ultimately decided that it would be in the best interest of the Trust to cancel the solicitation and reevaluate the requirements for Home Infusion Services in accordance with JHS strategic plan. On May 17, 2012, PMD cancelled RFP No. 12-10393-NSA for Home Infusion Services. Recommendation The continuation of the Home Infusion Services is a benefit to the Trust, as it is less costly to treat the qualifying patients in their home at a lower cost as opposed to extending their stay at JHS for a 2 to 6 weeks or longer. Contract Modification will extend the agreement for a period of six months. During this period, PMD will work with the user department to refine the solicitation to reflect the needs based on re-examination of the following areas: Weekly reconciliation of home visits and cost Cost of supplies and nursing The possibility that JHS may be able to provide medication for a reduced cost under 340B pricing The increase in the uninsured and underinsured ( benefits that include home health) The possibility of a bundled package to include the management of nursing services that are required outside of the infusion services ie; wound care, PT or OT. ( presently JHS contracts with 2 agencies and it may not be cost effective or well coordinated, which may increase cost) June 2012 PHT Financial Recovery Board 18

SECTION VII. (cont d.) The CRM Department, in collaboration with the Procurement Management Department, conducted market research to determine the availability of competition and found that it is still in the best interest of the Trust to contract with Infusion Technologies d/b/a CarePoint Partners Inc. during this interim period while a new strategy is being developed to allow PMD to issue a new competitive solicitation (K. Andrews). SECTION VIII. MISCELLANEOUS This section consists of procurement actions that require Board approval not included under any other section of the Purchasing Report. No items to report. A. Vendor Name Change This section refers to existing contracts requiring a vendor name change under any circumstance at any time after contract award and for the duration of contract performance. The Chief Procurement Officer is the approving authority when the original award of the subject contract was within the approval authority of the Chief Procurement Officer, and the Board of Trustees is the approving authority when the original award of the subject contract required the approval of the Board. The County Attorney s Office has been consulted and has provided a determination of legal sufficiency. No items to report. June 2012 PHT Financial Recovery Board 19

Agenda Item 8 (b) Fiscal Committee June 14, 2012 RESOLUTION NO. PHT 6/12 RESOLUTION AUTHORIZING (1) APPROVAL OF AN AMENDMENT FOR THE CONTINUATION OF MICROSOFT PRODUCTS PROVIDED BY SHI INTERNATIONAL CORPORATION UNDER THE STATE OF FLORIDA, STATE AND LOCAL VOLUME LICENSING AGREEMENTS IN THE AMOUNT OF $2,734,356.39 FOR A THREE YEAR PERIOD, FROM APRIL 1, 2012 THROUGH MARCH 31, 2015 AND (2) APPROVAL OF TRUE-UP FROM THE PREVIOUS CONTRACT TERM IN THE AMOUNT OF $1,380,817.17 AND (3) PAYMENT IN THE AMOUNT OF $1,537,109.83 TO BE MADE BY JUNE 16, 2012 (Michael Garcia, Interim Chief Information Officer, Jackson Health System) WHEREAS, the Public Health Trust ( PHT ) approved and entered into a three year Microsoft Enterprise Agreement ( EA ) pursuant to the State of Florida, State and Local Volume Licensing Agreement ( State Agreement ) through its reseller, SHI International Corporation ( SHI ), for JHS administrative and for clinical computer licenses expiring on March 31, 2012; and WHEREAS, accessing the State Agreement allows Jackson Health System ( JHS ) to take advantage of the highest level of discounts offered to participants and the most cost effective and efficient way to maintain JHS enterprise wide software standards; and WHEREAS, the agreements allow JHS to utilize additional licenses for any product covered under the Agreement with the understanding that at the end of each contract year, the additional licenses will be aligned with the number of licenses initially purchased; and WHEREAS, the EA accounted for 4,242 licenses for administrative computers, clinical computers, windows server licenses and other licenses as needed; and WHERAS, when the current inventory was reviewed, JHS has a total of 6,500 plus licenses; and WHEREAS, JHS Information Technology Division negotiated with SHI a reduction in the true up cost owed as well as a renewal of the Agreement commencing retrospectively on April 1, 2012 to maintain continuity of the current licenses JHS owns.

Agenda Item 8 (b) Fiscal Committee June 14, 2012 -Page 2- WHEREAS, a payment in the amount of $1,537,109.83 is required by SHI by June 16, 2012 in order to maintain the negotiated pricing for the true up and current contract custom pricing. WHEREAS, the PHT desires to accomplish the purposes outlined in this Resolution as further described in the memorandum attached hereto and made a part hereof; and WHEREAS, the PHT finds that the actions described herein are in the best interest of the PHT and the President and CEO recommend the actions described herein. NOW, THEREFORE, BE IT RESOLVED BY THE FINANCIAL RECOVERY BOARD OF THE PUBLIC HEALTH TRUST OF MIAMI-DADE COUNTY, FLORIDA, that this Board hereby authorizes (1) approval of an amendment for the continuation of Microsoft Products provided by SHI under the State of Florida, State and Local Volume Licensing Agreement in the amount of $2,578,874.52 for a three year period from April 1, 2012 through March 31, 2015, (2) approval of true-up from previous contract term in the amount of $1,380,817.17 and (3) Payment in the amount of $1,537,109.83 to be made by June 16, 2012.

TO: FROM: The Financial Recovery Board of the Public Health Trust of Miami Dade Michael Garcia, Interim Chief Information Officer DATE: June 14, 2012 SUBJECT: Microsoft Products Resolution Recommendation The President and CEO recommends that the Board hereby authorizes the following: (1) approval of an amendment for the continuation of Microsoft Products provided by SHI under the State of Florida, State and Local Volume Licensing Agreement in the amount of $2,578,874.52 for a three year period from April 1, 2012 through March 31, 2015, (2) approval of true-up from previous contract term in the amount of $1,380,817.17 and (3) Payment in the amount of $1,537,109.83 to be made by June 16, 2012. Background In April 2009, the Public Health Trust Board of Trustees approved a three year Enterprise License Agreement to access the State of Florida s Technology agreement for Microsoft License, Maintenance and Services from their Microsoft Enterprise Provider, Software House International. The agreements for administrative computers and clinical computers ran from April 1, 2009 through March 31, 2012. The first agreement (Enrollment number 6242474) is for JHS administrative computers which includes the Microsoft Office Suite and the second agreement (Enrollment number 7818130) is for the clinical computers which do not include the Microsoft Office Suite. The agreement enables JHS to use additional licenses for any product covered within it, with the understanding that once a year, the licenses purchased will be aligned with the number of licenses that were added during the previous 12 months. This is referred to as Microsoft s True- Up process. The agreements listed 2,325 administrative computers, 1,700 clinical computers, 217 Windows Server Enterprise Licenses, and other needed licenses. The current inventory is 3,250 administrative computers and 3,250 clinical computers in use at JHS across the enterprise. Additionally, there has been a need for additional SQL Server and CALs (Client Access Licenses) licenses. The initial cost of the true up was estimated at $2.4M. JHS has negotiated the amount of the true-up owed to $1.3M. In addition to the True-Up, JHS, Microsoft and SHI have been negotiating, in good faith, for the renewal of the agreement for a three year period. Microsoft has acted as a true partner to JHS in several ways through multiple concessions. Not only have they reduced the total cost of the agreement by $495,346.12, but they are also acting as a lender (0% financing) to JHS by means of allowing JHS to spread the payments over the three year renewal term. The payment schedule agreed is aligned with JHS fiscal year as follows: June 2012 = $1,537,109.83 April 2013 = $ 736,163.76 Dec 2013 = $ 553,273.50 April 2014 = $1,289,437.26 Total: $ 4,115,984.35

This amount includes the true up cost for the previous contract as well as the fees for the renewal term commencing on April 1, 2012 through March 31, 2015. The fee for the renewal period includes the current JHS infrastructure.

STRATEGY & GROWTH COMMITTEE

PUBLIC HEALTH TRUST FINANCIAL RECOVERY BOARD Strategy & Growth Committee Marcos Jose Lapciuc, Chairperson Michael Bileca, Vice Chairperson Joe Arriola Joaquin del Cueto Mojdeh L. Khaghan Stephen S. Nuell Darryl K. Sharpton Date, Time and Place June 14, 2012 Immediately following the Fiscal Committee meeting Ira C. Clark Diagnostic Treatment Center Conference Room 259 AGENDA 1. Approval of the Previous Meeting Minutes (Marcos Jose Lapciuc, Chairperson, Strategy and Growth Committee) (a) *Meeting Minutes as of May 17, 2012 2. Strategic Planning Retreat History and Context (Marcos Jose Lapciuc, Chairperson, Strategy and Growth Committee) 3. Governance and CEO Evaluation Process (Marcos Jose Lapciuc, Chairperson, Strategy and Growth Committee) The agenda item noted with an asterisk (*) indicates that the supporting documents is attached.

1. Approval of the Previous Meeting Minutes

2. Strategic Planning Retreat History and Context

3. Governance and CEO Evaluation Process

JOINT CONFERENCE AND EFFICIENCIES COMMITTEE

PUBLIC HEALTH TRUST FINANCIAL RECOVERY BOARD Joint Conference & Efficiencies Committee Stephen S. Nuell, Chairperson Joe Arriola, Vice Chairperson Michael Bileca Joaquin del Cueto Mojdeh L. Khaghan Marcos Jose Lapciuc Darryl K. Sharpton Date, Time and Place June 14, 2012 Immediately following the Strategy and Growth Committee meeting Ira C. Clark Diagnostic Treatment Center Conference Room 259 AGENDA 1. Approval of the Previous Meeting Minutes (Stephen S. Nuell, Chairperson) (a) *Meeting Minutes of May 17, 2012 2. President s Report (Carlos A. Migoya, President & Chief Executive Officer, Jackson Health System) 3. Chief Medical Officer Report (Michael Butler, MD, Executive Vice President, Chief Medical Officer and Sr. Associate Dean for Clinical Affairs) 4. President of the Medical Staff Report (Michael E. Barron, MD, University of Miami Health System) (a) *Approval of Policy No. 400.057 - Expired Patients 5. Review of Credentials Committee Decisions (Michael E. Barron, MD, University of Miami Health System) (a) Review and Recommend Approval of the June 2012 Credentials Activity Report (Michael E. Barron, MD, University of Miami Health System) (Support documents will be distributed at the meeting.) 6. Standing Reports (a) (b) ED and ACC Task Force Overview (Alejandro Contreras, Senior Vice President and Chief Administrative Officer and Gino Santorio, Corporate Director of Project Management, Jackson Health System) Scorecard and Bridges to Quality Report (Kevin Andrews, Vice President of Quality & Patient Safety Division, Jackson Health System) Agenda items noted with an asterisk (*) indicates that the supporting documents are attached.

1. Approval of the Previous Meeting Minutes

PUBLIC HEALTH TRUST FINANCIAL RECOVERY BOARD Joint Conference & Efficiencies Committee Stephen S. Nuell, Chairperson Joe Arriola, Vice Chairperson Michael Bileca Joaquin del Cueto Mojdeh L. Khaghan Marcos Jose Lapciuc Darryl K. Sharpton Date, Time and Place May 17, 2012 Immediately followed the Fiscal Committee meeting Ira C. Clark Diagnostic Treatment Center Conference Room 259 ATTENDANCE Joint Conference & Efficiencies Committee Stephen S. Nuell Joe Arriola Joaquin del Cueto Mojdeh L. Khaghan Marcos Jose Lapciuc Michael Bileca Excused Darryl K. Sharpton Jackson Health System Kevin Andrews Carlos A. Migoya Michael Butler, MD Michael Barron, MD Maria Huot-Barrientos Ric Cuming, RN Angela Burrafato, MD Miami-Dade County Attorneys Valda Christian Eugene Shy, Jr.

Joint Conference & Efficiencies Committee Meeting May 17, 2012 Page 2 of 4 CALL TO ORDER With a quorum being present, the Joint Conference & Efficiencies Committee meeting was called to order by Stephen S. Nuell, Chairperson at 10:36 a.m. 1. APPROVAL OF THE PREVIOUS MEETING MINUTES (a) Meeting Minutes as of April 19, 2012 2. PRESIDENT S REPORT No report. 3. CHIEF MEDICAL OFFICER REPORT Mr. Nuell requested a motion approving the meeting minutes of April 19, 2012. The meeting minutes of April 19, 2012, was approved as presented. Michael Butler, MD, Chief Medical Officer, Jackson Health System (JHS) reported the following: UM/JMH AOA Negotiations ACC project began two months ago and at the request of the Committee a status report will be provided at the June meeting of the Joint Conference & Efficiencies Committee. Also, the Task Force for the project will provide a monthly report to the Committee. 4. PRESIDENT OF THE MEDICAL STAFF REPORT Michael Barron, MD, reported the following: UM/JMH AOA Negotiations The Medical Staff approved the Designation and Delegation privileges for some of the Medical Provider Group members at Jackson North which will enable the Trauma Center Application process for Jackson North to move forward. It is the intent to continue the process at Jackson South. Preliminary approval for the Rules and Regulations is complete. The final approval will have been completed in time for the June meeting. 5. REVIEW OF THE CREDENTIALS COMMITTEE DECISIONS The Committee reviewed for approval the Credentials Committee Activity Report for the month of May 2012. (See attached summary report.) Mr. Nuell requested a motion for the item. Mr. Joaquin moved approval; seconded by Mr. Arriola and carried without dissent. The Committee was provided with a copy of the May 2012 Credentialing Report.

Joint Conference & Efficiencies Committee Meeting May 17, 2012 Page 3 of 4 6. STANDING REPORTS Kevin Andrews, Vice President of Quality and Patient Safety Division reported that in April he attended the HEN Project Conference with the Florida Hospital Association. He stated that JHS will participate in a national project to reduce harm in hospitals by 40% over two years. Mr. Andrews presented an overview of the cohorts that will be established in hospitals around the country. A. Quality Improvement Project Reports Mr. Andrews presented regarding the LIP projects for quality measures which are the core projects for the organization. A template will be developed to include the strategies, measures and teams for each project. The measures will be monitored on a monthly basis for the two year project. Expected outcomes, targets and timelines were provided for the following initiatives: Reduction of Readmission, Primary Care Capacity and Intervention to Reduce Central Line Associated Bloodstream Infections (CLABSIs). B. CDI Program Report. Mr. Andrews presented regarding the Clinical Documentation Improvement Program (CDI). One major obstacle toward financial sustainability in healthcare agencies is the accurate documentation and reporting of patient acuity. Using a metric known as Case Mix Index (CMI), institutions can track severity of illness and risk of mortality. Over the last two years, Jackson Health System has worked to improve the accuracy of medical record coding based upon the physician s documentation of the patient s clinical picture and treatment plan. This was accomplished through education and collaboration with physician champions to improve medical record documentation, including key phrases and terminology as governed by regulatory agencies. ADJOURNMENT Beginning in December 2011, JHS began measuring the impact of this effort with a standardized tool to compare the expected reimbursements based on initial diagnoses and final medical coding essentially gauging the financial impact of increased attention on proper coding. In just the first two months of study, accurate clinical documentation produced an additional $985,664 of reimbursement, for an estimated annual benefit of $5.9 million. The Joint Conference & Efficiencies Committee meeting adjourned at 11:17 a.m. Transcribed by Kimberly A. Calhoun, Executive Assistant Quality and Patient Safety Division

CREDENTIALS COMMITTEE MONTHLY ACTIVITY REPORT MAY 2012 Medical Staff Health Professional Affiliate Initial Applicant(s) ( 11 ) Community Physician(s) ( 3) Academic Physician(s) 15 2 Provisional Annual Evaluations 21 1 Reappointments(s) 40 4 Reappointments(s) Reinstatements 0 0 Termination 0 0 Modification(s) a. Extension of Clinical Privileges 5 0 b. Request for Additional Privileges 6 2 c. Change of Membership Category 2 0 d. Change Admit Priority 0 0 e. Additional/Change Sponsor 0 2 f. Additional Service 1 1 g. Request for Change of Service 0 0 h. Delete Sponsor/Privileges 0 0 i. Denial of Clinical Privileges Modified 0 0 j. Relinquish Clinical Privileges/Facility 4 0 k. Request for reduction of clinical privileges 0 0 l. Deceased 0 0 m. Request for Leave of Absence 0 0 Resignation(s) 6 2 BLS Waiver(s) 0 0 BLS Extension 0 0 Voluntary Withdrawal and Voluntary Relinquishment of Membership and Privileges: a. Incomplete Reappointment(s) 0 0 b. Incomplete Reappointment(s) No BLS 0 0 c. Voluntarily Resigned due to BLS Expiration 0 0 c. Reappointment Application Not Returned 0 0 d. Lack of Utilization 0 0

2. President s Report

3. Chief Medical Officer Report

4. President of the Medical Staff Report

SUPERSEDES: 12/15/11 CODE NO. 400.057 SECTION: 400 CARE OF THE PATIENT POLICY & PROCEDURE MANUAL SUBJECT: EXPIRED PATIENTS I. Purpose The purpose of this policy is to inform JHS personnel of their assignments and responsibilities following the expiration of a patient. II. Determination of Death A. The attending or resident physician pronounces a patient deceased. B. However, if a patient has a Do Not Resuscitate (DNR) order, the RN or ARNP may pronounce a patient deceased, and document and sign the progress record in the absence of an attending or resident physician. C. At Jackson South Community Hospital (JSCH) and Jackson North Medical Center (JNMC), if a patient death is unexpected and a DNR order has not been executed, the ED physician pronounces a patient deceased in the attending physician s absence. III. Notification of Family or Next of Kin Ideally, an attending or resident physician will notify the family or next of kin of a patient s demise. If a physician is unable to locate family, the physician will ask Social Work Services to assist in locating family or next of kin. If Social Work Services are unavailable, the Administrator in Charge will assist in locating family or next of kin. Contact Pastoral Care Office by beeper or phone to address any questions regarding religious practices. IV. Viewing of the Deceased Every effort is made to allow for compassionate viewing of the deceased on the nursing unit. If a bed space is needed, the deceased will be moved after one hour to the morgue/medical examiner s office. Keypoint: The Medical Examiner Department will only provide photographic viewing of the deceased. V. Completion of the Death Certificate The funeral home completes the death certificate and obtains the physician s signature. The death certificate serves family and public health needs. According to Florida Statute (s. 382.008(3), F.S.), only an attending physician can sign a death certificate. However, attending physicians cannot sign Death Certificates on deaths under Medical Examiner jurisdiction. Keypoint: A physician should record the cause of death based on his/her best medical opinion. Any delay in signing a death certificate will cause a delay in the burial of the body. In addition, families need death certificates for the following reasons: probating estates, insurance claims, social security benefits, Veterans benefits, retirement benefits. DATE: Revised 4/04/2012 PAGE 1 of 4

SUPERSEDES: 12/15/11 CODE NO. 400.057 SECTION: 400 CARE OF THE PATIENT POLICY & PROCEDURE MANUAL SUBJECT: EXPIRED PATIENTS Public Health needs death certificates for the following reasons: monitoring the leading causes of death, unintentional injury, suicide & homicide related deaths, infant deaths rate, occupational related deaths. Florida has recently begun an Electronic Death Registration System (EDRS). Funeral directors will be on-line users. Currently, a physician may choose to be an on-line user using EDRS or the physician can be an offline user and complete the medical certification via Fax Attestation. In order to become an online user, on line tutorials for physicians are available at http://www.doh.state.fl.us/planning_eval/vital_statistics/. The website also has an on-line tutorial for physicians on documenting the appropriate Cause of Death and who should sign the death certificate. VI. Documentation in the medical record The physician or nurse, if applicable, who pronounces the patient completes an electronic expiration notification order or Form C-691 Expiration Notification in the patient s medical record. The information in this document will be used to complete the death certificate. VII. Medical Examiner (ME) Cases Deaths falling within the categories outlined in Florida Statute 406.11 must be reported to the Medical Examiner at (305) 545-2400. The Medical Examiner may accept or deny the case. Violations of the reporting statute may result in disciplinary action by the Florida Board of Medicine and fines by the Miami-Dade County Board of County Commissioners. When in doubt, call the ME office. A trauma patient surviving more than 24 hours is an ME case and must be reported regardless how far distant was the injury. Referral to the Medical Examiner s Office does not require consent of the next of kin. Other cases that must be reported to the ME office by JHS staff includes: Falls resulting in a fatal injury, e.g., hip fracture, subdural hematoma Deaths from violence, acute or delayed Occupational related deaths Threat to public health Child abuse or abuse of the elderly All inmate deaths DOA (dead on arrival) and ED deaths OR and anesthesia deaths Therapeutic misadventure (e.g., wrong transfusion, surgery on wrong patient, etc.) Drug intoxication, acute or delayed Death under unusual or mysterious circumstances A body to be cremated, dissected or buried at sea A body brought into the state without medical certification A body brought into the state from sea or open waters DATE: Revised 4/04/2012 PAGE 2 of 4

SUPERSEDES: 12/15/11 CODE NO. 400.057 SECTION: 400 CARE OF THE PATIENT POLICY & PROCEDURE MANUAL SUBJECT: EXPIRED PATIENTS The following words may indicate that a case falls under the jurisdiction of the Medical Examiner.: Asbestosis Intoxication or Silicosis overdose Aspiration Injury, chemical or Subdural physical Cardiopulmonary Mesothelioma Sunstroke arrest Cervical or head Paraplegia or Tetanus trauma quadriplegia Coma Peritonitis Subarachnoid hemorrhage Encephalitis Pulmonary embolus Fracture Epidural Seizure Intracranial hemorrhage Gangrene Septicemia or Bronchopneumonia sepsis Hemothorax Shock Hepatic or renal failure Keypoint: Complete copies of the medical record must be sent to the Medical Examiner s office with the body. VIII. Autopsy of a Non-Medical Examiner Case The patient s family or physician team may request an autopsy. A licensed independent practitioner (LIP) may request an autopsy during the completion of the electronic expiration notification order. The LIP and the health care surrogate/next of kin must complete and sign the Autopsy Consent form C-639D which is linked to the electronic death notification. All autopsies for the Jackson Health System are completed at Jackson Memorial Hospital. IX. Organ Donation Form C-693 Organ Donation Record or its electronic equivalent must be initiated prior to and completed at the time of patient expiration. The Organ Procurement Organization (OPO) must be notified of all deaths, including brain death. Requirements are outlined in Policies 400.018 (Donation after Cardiac Death (Adult) and 400.018-1 (Non-Heart Beating Cadaver Organ Donation (Pediatric). X. Handling of Deceased Patient Property A. Nursing staff must separate valuables (jewelry, eyeglasses, and dentures) from nonvaluable property (clothing). DATE: Revised 4/04/2012 PAGE 3 of 4

SUPERSEDES: 12/15/11 CODE NO. 400.057 SECTION: 400 CARE OF THE PATIENT POLICY & PROCEDURE MANUAL SUBJECT: EXPIRED PATIENTS B. Non-valuables: Nursing is responsible to document the belongings on the Property List, Form C-633 or its electronic equivalent. If jewelry cannot be removed from the body, nursing documents the item on this form. Keypoint: In outpatient areas e.g., Emergency Department and Trauma Resuscitation, the documentation may also be completed by an Emergency Special Care Associate, Hospital Unit Secretary or a Support Associate. C. Valuables: A member of the unit staff will document valuable items on form A7026. At Jackson Memorial Hospital and Jackson North Medical Center, patient valuables will be held by the cashier. At Jackson South Community Hospital, patient valuables will be held in the safe in the Registration Department. D. Unless the deceased person s property is part of an ongoing criminal investigation, nonvaluable and valuable property is released to the patient s family or next of kin. See PHT Policy 400.081. Keypoint: If the deceased patient is part of a police investigation, property and/or valuables may be released to a law enforcement officer. The officer must sign for the property and/or valuables including his/her name, agency and badge number. A property/valuable receipt must be provided by the officer, which will be placed in the medical record. XI. Transportation and Release of the Body A. For autopsy and Medical Examiner (ME) cases, no tubes or dressings should be removed. Additionally, for Medical Examiner (ME) cases floor personnel must notify the appropriate law enforcement agency who will then notify the Medical Examiner s office to arrange for transportation. B. For non-medical Examiner cases, floor personnel or transport services will transport the body and medical record off the floor and to the morgue. Floor personnel will prepare the body per protocol. A unit staff member must use two methods of identification to identify the deceased, i.e., arm band, medical record number, and/or date of birth. Keypoint: If the Medical Examiner s office determines that autopsy by Medical Examiner is necessary that office arranges transportation. C. Form C-692, Release of the Expired Patient, is required to release the body to a funeral home. It can be completed by the family before sending the body to the morgue. Authorization Carlos A. Migoya, President and CEO of the Jackson Health System DATE: Revised 4/04/2012 PAGE 4 of 4

5. Review of Credentials Committee Decisions

5 (a) Review and Recommend Approval of the June 2012 Credentials Activity Report (Support documents will be distributed at the meeting)

6. Standing Reports

6 (a) ED and ACC Task Force Overview

6 (b) Scorecard and Bridges to Quality Report

SPECIAL PUBLIC HEALTH TRUST FINANCIAL RECOVERY BOARD

PUBLIC HEALTH TRUST FINANCIAL RECOVERY BOARD Ira C. Clark Diagnostic Treatment Center Conference Room 259 1080 N. W. 19th Street Miami, Florida 33128 SPECIAL MEETING June 14, 2012 Immediately following the Joint Conference & Efficiencies Committee Meeting AGENDA PUBLIC HEALTH TRUST FINANCIAL RECOVERY BOARD MEETING 1. Special Meeting Call To Order (Marcos Jose Lapciuc, Chairperson, PHT Financial Recovery Board) 2. Resolution Recommended to be Approved (a) *Resolution authorizing (1) approval of an amendment for the continuation of Microsoft Products provided by SHI International Corporation under the State of Florida, State and Local volume licensing agreements in the amount of $2,734,356.39 for a three year period, from April 1, 2012 through March 31, 2015 and (2) approval of true-up from the previous contract term in the amount of $1,380,817.17 and (3) payment in the amount of $1,537,109.83 to be made by June 16, 2012 (Michael Garcia, Interim Chief Information Officer, Jackson Health System) 3. Special Meeting Adjourned (Marcos Jose Lapciuc, Chairperson, PHT Financial Recovery Board) The item noted with an asterisk (*) indicate that the supporting document is attached.

1. Special Meeting Call To Order

2. Resolution Recommended to be Approved

Agenda Item 2 (a) Special PHT Financial Recovery Board June 14, 2012 RESOLUTION NO. PHT 6/12 RESOLUTION AUTHORIZING (1) APPROVAL OF AN AMENDMENT FOR THE CONTINUATION OF MICROSOFT PRODUCTS PROVIDED BY SHI INTERNATIONAL CORPORATION UNDER THE STATE OF FLORIDA, STATE AND LOCAL VOLUME LICENSING AGREEMENTS IN THE AMOUNT OF $2,734,356.39 FOR A THREE YEAR PERIOD, FROM APRIL 1, 2012 THROUGH MARCH 31, 2015 AND (2) APPROVAL OF TRUE-UP FROM THE PREVIOUS CONTRACT TERM IN THE AMOUNT OF $1,380,817.17 AND (3) PAYMENT IN THE AMOUNT OF $1,537,109.83 TO BE MADE BY JUNE 16, 2012 (Michael Garcia, Interim Chief Information Officer, Jackson Health System) WHEREAS, the Public Health Trust ( PHT ) approved and entered into a three year Microsoft Enterprise Agreement ( EA ) pursuant to the State of Florida, State and Local Volume Licensing Agreement ( State Agreement ) through its reseller, SHI International Corporation ( SHI ), for JHS administrative and for clinical computer licenses expiring on March 31, 2012; and WHEREAS, accessing the State Agreement allows Jackson Health System ( JHS ) to take advantage of the highest level of discounts offered to participants and the most cost effective and efficient way to maintain JHS enterprise wide software standards; and WHEREAS, the agreements allow JHS to utilize additional licenses for any product covered under the Agreement with the understanding that at the end of each contract year, the additional licenses will be aligned with the number of licenses initially purchased; and WHEREAS, the EA accounted for 4,242 licenses for administrative computers, clinical computers, windows server licenses and other licenses as needed; and WHERAS, when the current inventory was reviewed, JHS has a total of 6,500 plus licenses; and WHEREAS, JHS Information Technology Division negotiated with SHI a reduction in the true up cost owed as well as a renewal of the Agreement commencing retrospectively on April 1, 2012 to maintain continuity of the current licenses JHS owns.

Agenda Item 2 (a) Special PHT Financial Recovery Board June 14, 2012 -Page 2- WHEREAS, a payment in the amount of $1,537,109.83 is required by SHI by June 16, 2012 in order to maintain the negotiated pricing for the true up and current contract custom pricing. WHEREAS, the PHT desires to accomplish the purposes outlined in this Resolution as further described in the memorandum attached hereto and made a part hereof; and WHEREAS, the PHT finds that the actions described herein are in the best interest of the PHT and the President and CEO recommend the actions described herein. NOW, THEREFORE, BE IT RESOLVED BY THE FINANCIAL RECOVERY BOARD OF THE PUBLIC HEALTH TRUST OF MIAMI-DADE COUNTY, FLORIDA, that this Board hereby authorizes (1) approval of an amendment for the continuation of Microsoft Products provided by SHI under the State of Florida, State and Local Volume Licensing Agreement in the amount of $2,578,874.52 for a three year period from April 1, 2012 through March 31, 2015, (2) approval of true-up from previous contract term in the amount of $1,380,817.17 and (3) Payment in the amount of $1,537,109.83 to be made by June 16, 2012.

TO: FROM: The Financial Recovery Board of the Public Health Trust of Miami Dade Michael Garcia, Interim Chief Information Officer DATE: June 14, 2012 SUBJECT: Microsoft Products Resolution Recommendation The President and CEO recommends that the Board hereby authorizes the following: (1) approval of an amendment for the continuation of Microsoft Products provided by SHI under the State of Florida, State and Local Volume Licensing Agreement in the amount of $2,578,874.52 for a three year period from April 1, 2012 through March 31, 2015, (2) approval of true-up from previous contract term in the amount of $1,380,817.17 and (3) Payment in the amount of $1,537,109.83 to be made by June 16, 2012. Background In April 2009, the Public Health Trust Board of Trustees approved a three year Enterprise License Agreement to access the State of Florida s Technology agreement for Microsoft License, Maintenance and Services from their Microsoft Enterprise Provider, Software House International. The agreements for administrative computers and clinical computers ran from April 1, 2009 through March 31, 2012. The first agreement (Enrollment number 6242474) is for JHS administrative computers which includes the Microsoft Office Suite and the second agreement (Enrollment number 7818130) is for the clinical computers which do not include the Microsoft Office Suite. The agreement enables JHS to use additional licenses for any product covered within it, with the understanding that once a year, the licenses purchased will be aligned with the number of licenses that were added during the previous 12 months. This is referred to as Microsoft s True- Up process. The agreements listed 2,325 administrative computers, 1,700 clinical computers, 217 Windows Server Enterprise Licenses, and other needed licenses. The current inventory is 3,250 administrative computers and 3,250 clinical computers in use at JHS across the enterprise. Additionally, there has been a need for additional SQL Server and CALs (Client Access Licenses) licenses. The initial cost of the true up was estimated at $2.4M. JHS has negotiated the amount of the true-up owed to $1.3M. In addition to the True-Up, JHS, Microsoft and SHI have been negotiating, in good faith, for the renewal of the agreement for a three year period. Microsoft has acted as a true partner to JHS in several ways through multiple concessions. Not only have they reduced the total cost of the agreement by $495,346.12, but they are also acting as a lender (0% financing) to JHS by means of allowing JHS to spread the payments over the three year renewal term. The payment schedule agreed is aligned with JHS fiscal year as follows: June 2012 = $1,537,109.83 April 2013 = $ 736,163.76 Dec 2013 = $ 553,273.50 April 2014 = $1,289,437.26 Total: $ 4,115,984.35

This amount includes the true up cost for the previous contract as well as the fees for the renewal term commencing on April 1, 2012 through March 31, 2015. The fee for the renewal period includes the current JHS infrastructure.

3. Special Meeting Adjourned