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Home My WebLink About1967 I yap a~~1; GaQdl~. `fn~o~Pe 1310 SCRIPTURE O~NT TEXAS FLOW HOSPITAL 08PYTAL 3825411 11 382.5437 June 27, 1967 ut', Ali Mr, Tack Reynolds, City Manager n. City of Denton j Denton, Texas Dear Jack; At the meeting of the Board of Managers of Flow Memorial ~y Hospital on June 161 the Board unanimously approved your request to remove the trees on the proposed areas to be converted to parking lots. Now that they have assumed this responsibility, feel free to remove the trees that are necessary for the construotion of parking facilities. Thank you for your assistance and cooperation. i S _~incerely, Robert M Dickson Administrator RMD; jb J r.xh• u r Ay~eYN4y/+~`MPMvxitMla v..... p f Rf Y y N 1 k 1310 SCRIPTURE H O S P I T'AIL t)ENrON, Texas FLOW 389.5411 389.5437 November 29, 1967 Yrt Mr, Jack Reynolds, City Manager city council city Nall Denton, Texas dentlement E In an attempt to keep our construction cost at the lowest possible point to save Denton County residents additiuhttl expenditures on their hospital, the Board of Managers and Administrator omitted the parking lot from the contract and arranged for the City to build it with the cooperation of the County. When the City and County agreed to build the perking lot, all curbing and paving were omitted from the contract. This i inadvertently cancelled the walk from the parking lot, the emergency .wive and some repair work on the existing park- inglot, In the interest of conserving future expenditures to save the residents of Denton County as -much as possible, we are ask- c ing that the City and County build the emergency drive, the walk from the parking lot and the repair work in the existing parking lots, Sincerely, { L, Huffiness, Chairman c Board of Managers JLH11b ' •JiWI y~ • "(i(Atl~`HKV('.4R.a'.~AI§Ir15J1w.f4M:=avuK,.«!'N•l ,Y.cLLMKlwlu (tMKN.11b1{MI~ ;'010 1 6 100 .r ~MIO,Ifd r 717 4~t~¢ ~DQ~1M. ~u~~ 1310 SCRIPTURE a DENTON, TEXAS FLOW HOSPITAL 382.5411 382.5437 December 12, 1967 w+ City Council i City of Denton Denton Municipal Building Denton, Texas Attentions Mr, jack Reynolds, City Manager ~r 0. entlemen: We are nearing the final stages of completion of the rr hospital project and it appearb that we will need the $100,000,00 pledged by the City approximately Febru- ary 1, 1968, F ~ f Sincerely, Tarr - M, Smith f Ad inistrator i JMSt Jb j e r ; ,~!)M„*........ .,.....+,~~y,py~~r,~~~~pyXp/KMwa rw.wu... w..•.,..,...»... 't'.'• ti'. .1 .it MOW" I nfp e..ww ~wx+rwr...,, n 1 MEMORANDUM N, Dates February 12, 1968 ~i p; TO; Jack Reynolds aFROMt Jack Owen SUBJECTS EXPENDITURES ON FLAW HOSPITAL PARKING TATS The following expenditures for materials have been made by the City on the parking lots at Flow Hospitals E Curb and Gutter $3,816.25 Base Material 8,346.91 Mc-1 Asphalt Oil 163.65 Asphalt Topping 1,976.50 French Drain 481.40 Gasoline & Diesel Fuel 148,95 Total Cash Expenditures to Date $14,933.69 I F The South parking lot is complete. All base material for the North parking lot is in place but is not ready for topping. Below is an estimated cost of the materials needed to completes Mc-1 Asphalt Oil. $ 188.00 Additional French Drain 192.00 Asphalt Topping -500,00 Total estimated additional material coat $20880.00 i Signed JOtkk E i i I r•' ~„M~a.'••.... ."•w11Yry~~q'an^MMf~~iNAIFTP,N^°'utl.nux...u:aiMaMi.l+tb.s~.1WWW4di +W(oYl'YWOfWFNY'MWMCI. r r ' 1.. , HILLTOP FLOW MEMORIAL HOVIITAL l OtI001,11us HAPPENING-8 MICATFo ro 1101NO Fxr HJUR NfM"HNW cot*" /ubll,ME MenMIY for Wr FmploYOU IM htpyy VOL, 61 140, 3 FLOW MSMOR1AL HOSPITAL ~APRn, IM 1968 "PINK" P04LIES NIP-4 6 000 "Mropwb At the April Executive Board Dr, King Added To meeting of the Auxiliary to Flow Sfaff Plow Hospital, . Mrs. Scott William roxwoAh King, M ,D., Haggard, Treasurer, reported currently residing In Denver, a net receipt of $6,200 deposit. Colorado, will join the staff of ed as a result of the April 6.9 Plow Memorial Hospital In the "paint the Town Pink" Follies, ! early summer, Dr, King's appll• Not only wan the production Option was approved at the a tremendous nucceas financial. April mooting of the Board of ly but a real winner so far as Managers, community relations were con. A" a local boy, Dr. King ro• corned. Never in the history of celved his elementary and high Hospital Fund Raising has so i school education in tho Denton much cooperation been given. Public Schools and hie B,A, de. From the advertising In the ,tree from North Texas State program to tha participation in Univaralty, Ito attended North. the production, everyone wan western University Medical eager to help,, School in Chicago, DlirrOls, The production started with where he received his M,D, in Committee meetings back in June of 1866, Hie Internship December cnd ended with only WAN served at Jefferson Davis a two hour business session to Hospital In Houston, Texas clear all records of finances, 1 Immediately following ids grad. This short business meeting In. uatlon, In 1057 he entered the dicates that a 'tremendous I V S. Army as Medical Officer Amount of organisatlon went and spent two years of active Into the planning and exeouting duty. Residencies wore served of all pho"es of the operation, Ulf, WILLIAM FOXWORTN KING in General Praotlce and Crtho• TO be able to arrive at a com• Pedle WYSTH LABORATORIES MAKES 1901 5861, Surgery from 1668 until plate acnou eceiof all expends, , tuna and receipts of such a In 1661 In Pueblo, Colorado, large production In such a short j CONTRIBUTION he eniorod into General prac• time Is a near impossibility, Mr, JIM Moltun netrlot Matta or for Wyeth Labor. ties. in July of 1866 he went to "a costume Committee Also atorlon Presented Kin Jerry M. PIntth, Adtnin)etrator the United States Veterans functioned at a record speed, with a cheok for $500 to be used for any pu1r'ppoo00 deemed Hospital In Denver, Colorado, to according to Mr. Rd. Horner, i most necessary by the 110~0~0ptal AdminlAtrator, He was serve a residency In Radiology, Within an hour after the pro. aaoompanted by Maynard H. Timmons, 10001 reproaenta• This he will complete in July, duation, all costume$ w e r e 1 tive, of the flan, 1868, counted and packed, ready' for In returning to Denton Dr, transportation to the Airport, , } King will be usoolated with The Cast was very rooeptlva ,i Doctors Lockwood and lavnlay to the entertainment following l! In the praotico of Radiology, the show, Approximately two Dr, and Mrs, King have three hundred people were aervod in children, He Is the son of Mrs the Band 'room of the Senior and Mtn, W. W. tcing of Don. High School foltow,ing•tho Ahow, ton, Texas, Music ,by the Poanut Gallory, the young combo who played in n 1 the production, added listening I r~ Soya~ Book Consp@}@ enjoyment as well as music for ITOr (hefloth oon"ecutha yepr, dancing. Sandwiches, cookies Flow Memorial Hospital will and punch were served by the enter a public relations sorAp Auxiliary, Now the show is over - book In competitlon at the however it is not forgotten, for Texaa Hospltai Association Con. ventlon In may 20.", does soldersu , doss a day pave, that The book this year carritaWhen do they t arrive day plan to do the theme "Picture of the year,,, Another Pbltfes9" It steno >cach page introducing a cote. Pfatlit0d Ora jiff, 6u1fth, Tlaimona, Mamid 01ac1, Nure Aelmldiftf• gory such psi Board Relations, Show 91a just get" most people or an the heart "tang" and won't d Notion (Conunaod on Pare let go, I A ~l ' PAGF. 2 FLOW MEMORIAL 110SPITAL APRIL, 19% SCRAYl300K - from page 1 Denton To Host From the Wployee Relations, otC. le con- Auxiliary Meet f tared by n large cut out In r An w,p ~p~C represent movie film with fair Mrs. L. A. Whitfield, Proal. Addin6a1A windows showing colored plc dont of the Auxiliary to now ~ l~ lureaof portions mpreaenting Mamorial Hoapltal has been N that particular category, named Councilwoman for. Dil• The book cover rf blue loath trtet V, Area Il of the Texas er with acconls of green is Assoriation of Hospital AuxII• striking In appearance and IN larloa, a monument of beauty to show Mrs, Robert Manson, Inoom• PROGRESS the combined efforts of those Ing president, accepted the interested volunteers whose responsibilltles of oo•counoil• An acquaintance asked me the other day if Flow combined efforts have made woman. Memorial Hospital would over complete their building the book possible. It Is Indeed The %ppolntmont was made program, My first Inclination was to shrug and comment a task to preserve the efforts by Mrs, George J, Ritter, pres. that it looked as If wo would never be finished, He and of all at Flow from, April 1, Ident-10leot of the T,A H,A. I were thinking in terms of physical construction, 1967 to March 91, 1088 but It Donton will he the host city As I reflected on his question, I hope(1 that Flow has been done. When the book for the district mooting In would never complete a building grogram, We have to Id returned from the TAHA early fall The local meeting move to progress and every day that we stand still will convention, it is hoped that It place will be announced at a take two days of harder work in order to catch up, We can be an display in the lobby later date. cannot remain changeless when the world is phan&X, for all to sift. (Continued on Page e) If we are doing a job the some way it was done ten - ycare ago, that Is enough to make us think there must e a batter, a faster, or a more modern way to do the SUB DEBS GIVE TO rrMAXrr same task, The Sub Dabs; a local high school sororityy, recently If we prefer the safe road the road with no bends presented the hospital with a check for $50 to be used and no curves and plenty of s6a and lights, we must on the purchase of the Max Cart, Thule your ~r)s, one content ourselves with mediocrity, a Candystriper.and one the daughter of a local pp'i slelan, Along with progress, we must expect some mistakes, eaprossed deep concern for the health needs oP, the hos• In looking for the new and better methods, we will have pital, They are pictured looking at the life saving device to one our Initiative and imagination, This eliminates and havingg some of the features of the cart pointed out fullowing the sore and proven laths and we will make by Jerry l3mith, Administrator, some miistakes. We will learn from these mistakes and therefore move, rather than stagnate, Janie Stedman, Leslie Kinard, Jerry $mith a►o dandy Simpson ADMINISTRATOR TO j I' SPEAK Mr. sorry At. Smith, Admin... Istrator a l plow Mamorial Hospital, has boon asked to i lead u panel discussion at the P , P, Texas Association Staff Dimat• are of Hospital volunteer + services May 10, at the 9tatler Hilton Hotel, "The Art of Sharing and Receiving" to the subject an- 'signed Mr, Smith, He will be r Introduced by Mrs, Micky / copo, Director of Volunteer Servloea at Flow. , DOCTORS AND NURSES COFFEE SCHEDULED The Medical and Nursing Staff at Flow will be honored with n coffee Tuesday, May if, from 8;0040:80 a.m. In the private dining room, During National Hospital Week, may 19 - 18, It is hoped that each employee at Flow !i.; will bo more mindful of their privileges and responsibilities as members of the greatest team on earth the team of giving and ireaerving the health of the nation. I", l p i , i x ii APR.iI,, 1988 /LOW Y$MORIAL HOSPITAL PAGE 3 " ;7w pwWpIlepeople caring f o r I N S ERW I C E DIRECTOR NAMED Yow Hosplw Pte* Cming uldn't you hke to be a Volunteer at now? It to the P beat way ' to spend your free New ideas, new devices, now time T Cartag for people, Call techniques are all helping to 8 7-Udl, exto lon 884 ano make the modern hospital even Volunteer your Samoa; better, Advances in sclance and technology have made avallable, elaborate and sophis• tioatsd equipment which the haepital utilises in carrying out its basic function patient k Oral's,. But in the bcspital, un• v.. like many .induttrief,, the sna• ohlge can I and does'support tim Although our',pelnt the Town g S work done 'by people, but it does not supplant people. Pink". ' P hoc No, 8 is history A machine does; not care - now, I don't think we will 0604 in the hosp1tAl;1Wple care for forget it or, our',}mp and sin. people, cars gratitude to Mae of you a lover 'present on the hospital who have gtven'so much of yourselves, Yeur time, your assns are the doctors, prgtes• money and your interest, sfonal nurser, practical nurses. aides, orderlies and.th'e volun•'. toots, all of whom provide inspeoially to Anne Schulze direct • service to the patient, goes our admiration and thanka contributing for, one of the moat magnia• 4► But there are many rare people their oklnle and cent jobs of organbsation we ' z serviool to patient care, have even seen Her,conque t V I R 01 N I A M O O P R R Always present but not' at, of almost Impossible obataeloa l` Ways assn are other hospital at times, her,ability to gather Virginta Hooper, RX, B.S., All personnel will be included le who can the labors. the town and. country together has joined the Flow Memorial in the planning of the programs and X-ray technologist, the to make this th9 outstanding •'Voopital nursing staff as Di• for the ialtial orientation and y+ taohnioian and big helpers who, project that It was , r her to- rector of Inaervioe Moatton, the continuing growth of all with palfisteking akUl,ald in 'lusal t0 even pane When she Virginia 10 a native of Donton personnel, Special emphasis will had to tako to oeutohas with a and a graduate of the TWV be placed on planning and diagnalsl the medical record b4y sprained ankle for all tiollega of Nursing, She lives working with nursing personnel fI librarian who charts the course this and so muoh'more; our near BartonvWs with her hus• to Improve communications and of patient oars and the pharma• special Thanks, Anne, bead 'Hoop' Who is owner of w o r k In g rekttionshipa with sistl the ehapwn, the social worker and welfare worker 'Hoop's Machine acid Welding ether departments of the ha• Of course, space 400 not ow. pitall. whole warmth and concern are dlreoted to the needs of the Permit, but T wish we could list White on the alaif she plan It is only through such plan. and thank each and everyone to organize and prepaty a our. ning, working` togvtliar and fol. pal Then, thane ire the general Of you chairmen, DMMWee rlotaum outlino for eaoh oats. low-up that our ultimate goal membim, pgtrons, out and gory of personnel at Mow. This of bo ter patient oars and gibs ! NrWoes porscnnoi of, ,the has. everyone who has had a Part, will enable each employos to personnel m and ot'ale can be obtain- ad With their eligineen Choir large or , small In this event 'Iss"me well versed in the W. , • ea laundry works* their To you sit - Thank you. oeophy and objectives u well - r-- housekeepers and malittenanoe as the polialef of the' hosplW. meta the dietary team of awls Now It to time to turn, our and kitchen helpers, attention to the next project of The administrative team the year - our,'otfiw. Drapes which keeps all of -the hospital and carpets have been selected services operating smoothly and ordered by the .eominlttee Riv" and handles per e, personnel headed kay, g od wlth'a tittle National Hoset toI programs, and d the accounting Alf redda Par andbuQineae functions, ' time and much effok, the Vol. These hospital people Pepro• untesr•Department will llnally eltnr 1~1 E sent more than 800 job clasw• move lntc a new office, if you f~ (t yi tloations and in the avarage in called upim to lend a help- eommuflity hospital, 261 such M8 hand, do tryl squeeze in people are needed. to proWdn oJust Ak bvious little were growing and6pretty wo care for each 100 patients, need your help to ai , this May 12018 This year and. the Years ~y~, 1d• sure to to fin, your t follow will bring more sophle• spot In the hospital at your F tlaated equipment to support appointed time, patient, Dare in the hoepitsl, but chi of these scientific aid E technological UWar►eea Will fall (Con ffeal p4o g) short of the warm, human and 11 yet intangible expreabn of Mrs. Whitfield will attend a Support Your ,Llatptial pom,W interest that Is the workshop for 0otmoltwomen on T' dlattngulahing f sA to r e, the may 20 in the North Room, ROM Of the Hotel Adolphus, unlquenefs of a hoepltel. >cseentially, a hospital to f. 6 I n } z I: I SCHMITZJ.D. FLOYD r OWNER cRemembeh the Sled wtfh Mawelta YOUR ity~6?al a o~lte CA FO FAVPROMPTODELIVERRITE I i HAML.ETT JOE ALFORD FLOR.`".'i 882.0684 382-2214 JACK BAKER FLORIST 882.4014 , 24 HOUR AMBULANCE LINWOOD ROBERSON FLORIST 882.2081 or TINIVF.RSITY FLOWER SHOP 882.5471 SERVICE SELBY FLOWER SHOP, INC. 887.8101 120 CENTER 387-6300 CAMPBELL'S FLOWER GARDEN 882.8812 FIRST STATE CHECK•A•LOAN CABS ACCOUNT A CONVENIENT WAY TO BORROW c ING -DIAL- woe 382-2544 STATE BANK, 0. PAIINEII MGR. i l I4 f0 M, tf 41 NW cus IN DENTON "DID 0WRCLUD IIN ~A111H0 382.5421 D1 101 W. McKINNEY RENTAL tmCENTER Hospital Equipment Camping Power Tools Pllanbiu Coldr r aoto P ~ s alts Needs ' Babbi( Furnishings mraotars garden and Yard r' ANto Tools Moving Sanding Moohines C}prrN7+ YOU NAME IT WE RENT IT DIAL 387-3NOw IN OUA 70TH DENTON, TEXAS YKA I Y I CLAYTON HOUSE More a 000. HALFWAY HOUSE RESTAURANT 4; f I I I I University Drive West Ph, 382.9626 < fAY130LVLaAN A{{OQIAilONl6N AT IN IN I wt No* 011w c4s Iuuliows ! I AI~f1Al0 Ww°r"w CITY-WIN EDIIWRY A4M*W "K OYAAN aif♦sM~uA/s DRUG $TORE 222 W. Imory 382.2565 Your Shoppinq Heedqualers For PHARMACY #1.21403 Sotln 382.2563 WHITE SWAN & SANDRA LOU UNIFORMS DOYLE•CALMLS DRUGS HANES SEAMLESS WHITE NYLONS I W 514 L lo1Yu D1aI 382.9116 ~ 'NORTH rexAs fl N O { r FAM04'./S FAR 91D Ydr,4R9 { YOUR SAVINOe IN/UIIRD TO Of/,000 MY AN AOANOY C+V%AKG006L OM THIR 11140111AL 00911NMlNT, I M;4 I5 YOURS FROM THE AlOVI ADVIRYISfAS C r L i 'tKml t~; 4 tiyM1 r r , 1 k j October 31, 1968 I The attached is being mailed to each member of flow Memorial Hospital Board of Managers, glow Memorial Hospital Administrator, each member of the Denton City Council, Denton City Manager, F each member of the Denton County Court, and the Denton County I Auditor. 1 I. A. Bnil,*istri rman i tal tudy Committee f Attachment i ~~'~~gar~A11..we.Inv{n k hN hWlNb:asfw+wF TMw!ncMU a~-N,rw r x u 41K 14114 I J~ 1 xMi.YA, October 29, 1968 MEM4R~4NDUM QOMMITTEE REPORT RE I~OSPITAL DISTRICT FOR DENTON CQUNTY STUDY The study group of Messrs, Loren Tisdell, L. A, Nelson and I. A. Bailey, appointed respectively by the Denton County Commissioners Court, the Dwiton City Council, and the Flow Memorial Hospital Board of Managers, unanimously recommend, . , (a) That enabling legislation to form a Denton County Hospital District be instigated as soon as possible whether or not ! recommendation (b) is accepted now or later, (b) That the proposition that a hospital district be set up with a tentative starting tax rate of 25 to 304 per $100.00 assessment be put before the Denton County voters at the first opportunity, This would be partially offset by a 104 reduction in the county rate, giving a not of 15 to 204, In arriving at these recommendations, your committee considered the following as f i major points , 1 , All residents of Denton County are entitled to professionally required hospital care, 2. The practice of medicine increasingly uses hospital facilities and this trend will continue, In providing the above, it is our opinion that major capital improvements such as buildings and related equipment should be financed as lei the pest with a county- wide property tax and Federal funds. (We are not recommending major municipal participation) We feel that indigent costs should be a charge on the county as a whole rather than stood by those who pay theirlbtlls as now practiced. Isi elaborating on this, the attached schedule estimates the indigent costs involvael and interprep them in terms of tax, At tho same time, it should be pointed'ouC that at present no hospital provision is offered those indigent cases which have to be treated out- side the county, In that no body exists with the funds available to enter into reciprocal agreements With other counties. Also, we consider it highly probable 1 that other hospital facilities will be bunt in the county, but that as now indigent cases will still go to Flow, i.e., the estimated dollars of cost as shown on the attaohad schedule would not change with additional hospital facilities. By definition, indigent cases would include in addition to those who cannot pay in full, the partial amounts that patients in better financial circumstances cannot a ~ 1 MEMORANDUM_ v. Page 2 STUDY COMMITTEE REPORT RE HOSPITAL DISTRICT FOR DENTON COUNTY pay. There are no definite statistics available in respact to either group. At this point, it is our feeling that only tho above two factors bq recognized in any hospital district tax structure, i,e„ all o~:her costs suoh ate rpji 'o annual capital outlays would be paid by the hospital and conEidered part of its' porating costs, l s The forming of a Hospital District would give the opportunity to increase the num- 1 bar and manner of selectirsg the Board of Managers, As it is now, under State law I the Board of Managers is restricted to seven and are appointed, On numerous coca- l signs, the Board has felt that seven is too small a number in that the committee type of structuring needed in a hospital of this size is difficult with only seven members, Also, with a Hospital District the members may be elected rather than appointed, introducing this as a further safeguard for the county, I Attached is a timetable as to the earliest that stops can be taken, should it be de- i sired to form the Hospital District, Respectfully submitted, HOSPITAL DISTRICT STUDY COMMITTEE I, A. Bailey,ha r E. L, Tisdell L. A, Ne son Attachments r f r C f . ,,•.a.tifiigw u; 'All V-11;W J 1 1 ~1LMN i wwnr~ } } i EARLIEST POSSIBLE TIMETABLE TO FORM A HOSPITAL D STR T _ _ _ I IG Texas Legislabire meets January 7, 1969, Lorial bills introduction starts January 13., 1969. Thirty (3G) days notice has to be given general public, l Three (3) days for Governor to sign, Minimum of thirty (,10) days before election after it is called by ~ ! County Commissioners, I i Co__ mme_nts i i I 1, There would be no revenue until late in 1969 at earliest, " I i,e„ the next oounty tax year, ! 2. Legislators want clear-cut majority in view before introduction, If there is substantial opposition, then there would be hearings in the Legislature, ! i I ~ ` II I i j Ootober; 1968 i i t } i PLOW MEMORIAL HOSPITAL r ESTIMATED NET REVENUE FROM HOSPITAL PXSTRICT (A) 1970,F1 RE' T, 1969 1970 1971 :972 2973 1971 { atual Est MIU Estimated Estimated stimated Estimated Est 9 a (8 Denton County assessment 78,832,000 83,800,000 88,800,000 93,800,000 98,300,000 103,300,000 108/3 Available for hospital ex f district at, 104 per $100 assessment 78,832 83,800 88,800 93,800 98,300 103,300 10 Less hospital bond prin, and interest, 761469 79 954 73 439 76 79 79 9-1A 77 994 Available to hospital 21363 56 I,t 81846 15,361 17,004 18,361 25,306 51 Estimated indigent cost (0) `596 of total billings 147,500 154,875 162,620 170,750 179,287 188,250 19 Leaving to be borne by paying patients 145,137 146,029 147,259 1531746 160,926 162,944 14 giving per, $100 at assessment 18,4 ote, 17,4 ats, 16,6 ots, 16,5 ets, 16,4 ots, 35,8 at$. ` Note., This would be the net f` tax increase r 1 f Total tax needed per' $100 assess, to meet bonds and indwent'cost 28.4 ate, 27.4 ate. 26,6 ota, 26,5 ots, 26,4 ots. 25,6 at$, 7 (A) Hospital fiscal year 1970 starts October 11 1969 to September 30, 19700 R (8) Mr, 0, H. Balley, County Auditor, reports County assessments increase from 4,500,000 to 5, 000,00{),,s (C) Indigent costs based on proportion of 5% to total revenues leaving 3% for bad debts, Mr Smith feel's, t (D) Growth in hospital useage of 6% annually. >rIY R phi{: 00 4 FLOW MEMORIAL HOSPITAL VENUE FROM HOSPITAL DISTRICT (A) 1970 FISCAL YEAR TO 1979 RELATED TO mr) IC~ENT O9$TS 1978 1979 972 1973 1979 1975 1976 1977 Eat m ted stimated a~w ed Estimated Estimated Fps ,tmated Estimated l;stt^ mate_d "Owl 800,040 98,304,000 103,300j000 W 1 300,000 113,300,600 118,300,000 123,304,400 128,300,000 123,300 128,300 93,800 96,300 103,300 108,340 113,300 118,300 76, 796i 79,939 77,994 56,409 60,096 5 696 7 296 60 809 17,004 18,361 2$,c+06 51,891 53,204 59,004 66,004 67,491 170,750 179,287 188,250 1970662 207,545 217,922 228,820 240,260 Ik63,746 160,926 162,944 145,771 154,341 158,918 162,816 172,769 16,8 eta. 16,4 eta, 15,8 eta, 13.5 cts, 13,6 ots, 13,4 ots. 13.2 cts, 13.5 ots, E "S ots, 2F.,4 eta, 25.8 eta, 23,5 cts, 23,6 ots, 23,4 ots, 23,2 eta, 2315 ots, ;r r ! jl; Jr • o i jy1~+ r 30, 1874, lAt;A knorease from 4,600,000 to 5,000,000 annually, S+rs~~}r:„„' ! ' jbwinq 396 for bAd debts , Mr`, Smith feels the total may be 10% In future rather than 8%, 4r Y i October 1968 f , t4 11,11, s:111 N "I I 1,rt ,Etr i ~ , + f 1 ~~~~y1~,!~,r 'r ..w 6 I , '21 Mzit rjw'gF' MON,TNXA676901 yr' ' FLOW A&"AA HOSPITAL 17L Y October 24, 1969 I City Council Municipal Building Denton, Texas Attention: Mr, Jim White City Manager t Gentlemen: The contractors are nearing completion of the addition to Flow Memorial Hospital, As you are aware, additions were made to the building program and additional equipment was purchased to insure residents of Denton County of having the facilities to offer proper hospital YL,t~ Cara, The additions can be measured in the number of lives saved as well as additional coats, The cost of the building is $2,466,922 , 75, and the cost of the equipment to furnish 156 beds in the building is $423,076,23, for a total of $2,478,99$,98, There is a need for additional equipment, After using all available funds of 02942,180 the hospital is shout $89,066,80, This amount is dU6 t6 be paid the contractors on completion of an expdp- tion list of work liefioienoLes oompiLed by the architeots and hospi- tal Staff, Car,pletion of this work will probably take place in 30 taM3 a to 60 days, ;i If you have any suggestions for solving our situation or can help in any way, all of the residents of Denton County will be grateful. sinoerely, A John M, Brooks, Chairman Board of Managers fi j t'S JMBf jb ccs Mr, Zeke Martin, Mayor fir''a? Dr, A, M. Finlay Mr♦ J. To Jones =n~,r Mr, La A. Nelson ~ar s .t, a Mr, Marvin Loveleas 4 a~ fyn! v Wit t~ , M b i ~ v faVi/,!Fy YN'W-OFFUR MEMO ~a TO FROM ~ I..~. i suBJEcx: , nAT1& r 1 i / qi 7 -o 19G7-/9F8 ~ r ! 967• / gG~ ( i t Y , 1 1, ~~IF14f: .rte ~A( / ~ ~ 1 I~ 1 ~ b w - 41 r yM (r V r ~ t j A n... i.. t 1 r t~ z 1 hj: N'ILV yI 1 II mar" ISM l"I E 1'Ot Qewaty Judge fN Todd *ad City wasayer Jim white W~atioouot $lose I satyr to »eatoo last Jwly, I hvi sat is eo all US" of "Olows ooaeeraiMr /'low, *ad rseotvo+l ism" eeafidoatial. iwfonation mad opialoss oN the hespjt~ to lwot as yew bwo• AA yew have weth boo mad onewpb ts' 14opw { of epistaso asd iafonnmtiea to the paatf I felt I bto write you this letter. As yew both Wwwt I ape" a faw awe i is Plew I&" sweMor for minor ewryery.'' I, bravo' $00 ep"t d 10 dwo tboro after oa$or swrgery• oN>s'otiea was eo INsioy, Maotilh 1, NIw,140,nape i fort olomovwogliom of Moto "All the 1UowAsy w0mohfl: I Mall } be etoraal,,►;y aratofol to W pMyaleias tit w#'s #V teas *4 ` ~ a il►rtlq►. JLAet Mewsobro after wlMor swr"# I 'r wll &a aide offered to bathe rre• rfeotly obloAo 46•Ws AW"Al• AA the *w r' ""s ~070 ,""1A" piss" a I" ♦f { wator awl w obft so a bodotdo robes aN Aootrw s" '*i to both* massif. I weakly u1sow to wN IV to"# aw! ow: help" sot late °a Rrwib Nirhtpoo. the MA dos OtW'" psu both are awAreq the third Obw is w"Aly the w *140 a paw of wtor war plaeed so a sbir to tre bathrOm am, I was oAAto 1041"404 to bAthoo I strMpiod era a" Reif "*4 Am a obar while or Mori war mdo• wfav AN't fool will" me ~ of tM bi'ahoop>rs ealAr aoi I o#wA. hrtwrAteyf lherpalt•r I war ewpsble of taldar a shower. The other shop I ob"mo&• bofore the w"kend•« two the Roed. Met Moveobors it was porfooly filwa "to po/hr ! it W" lwediblo. As yea both WOwr frM oWVorrriore, w rot lea sbeows aN diowro, I o" A" do w►t womomtp/ to sight. i t say food tM torriky►, At is• . rusel~+cYww4~dw+l~tnt,ArKSwrnr~ru«.e....,.•,....,,..._._ i f Yw.!OP~A Pap 24. ,P V r r • Os PWAW, the lay is Or room bad major owr8erys Satardy mor"Nev bar p1watelan ease by and said she ooold have water$ lrroM 6 aoro rhon the dsotsr Mss prOSemto Until 13 nwn Vb* her bW*&W "tit to the versos station 110 hie Vitoos pitokoro this lay Sot '?f me water, slshousk several 44118 wo rants That gars 4114nrdwo x sot red up with wassmag the sMMriso over Damson$ The oonrtkov" lodes level$ in the, pink 11ewo bM! sm"O } is *%*Nebo WM*o as §0014lo the orderly anakenod *WM so 41 8090 some to ask in it 1 had &Oak OW01me sinso 10 MON,, the "Ibs botoreo Y Sold his0o ,tors that wery 0i810t 4444F 1 Mailed MY 10 tons aisspiNO p" rill, 1 sat 0p all night MatsuAl tolovisiomo &10 1" "Am"BM and sating olives and oavi4r4 w roommatofs Owal4iam is an asoo"mo of two whom, 10 4400 fir that ov$ r told kin am$ She orderly bad tole m"w it Y ""It want to be 4w ke"do Bet ant order Crow or dsotsr (skis we told am ;4* a triow4w sad soMtidestial na4wr) o "Nolp. M4," 1 said. IM rant to the myraos atatieM nod' o400 bnek amd told r4-,sbat as MOVb f S 'AW donor bad lots i04trV~OlAs10s 1 didi0os have t~ We the ! 11091 46010 qnO *j*dlyo Yell 0s11MS WO this a"i and of she Inhere b" eoo 4w Now* SOWN /o X a" ou sk"Od Alain at 8091 s►eM iN she seven . enter head and sold ibr ON-se or order ! tot Mb dlNeeal donor bad eaiVi Y ar001d stMM. "rode a0ro to havv0 a pill 4ve0rf sin boors," 11 a" told MA 1 am 40o/ber W# 10tor tbst day, of deat.r 4414114 " did Mi My I Ow to 64" M pill woryr sire boars. On Tooft*# *"6 So bromwast to" Ouwod as 0 aoM. ~ 3 AS l had to appO #!o O'ity 0r sw in n4M, 1 40044 mild bat t t to ONTO ouwr third flog w sis4l patients OW be" M4N b pag rro All waste were served at irrogslar trims dnrie8 W mWe On !hO am Woolard in geostiomo she 4400 MbOrtMo 0 was told 044 "six No N the tl"r") Wait sppow" As tb! ; tro+at00owt .t patients at Mrs yMebaltovs f do not mew "lot bind at spos"Ust ho is$ and hops F" 4000 ! i 1 ' i 1 i.' ~1,kiGPP.•e..v ..+.M17iR!dSr»Sd4k~4f'a'~~~14#f~f~~~itlHlk6AbkPYrrvn•f i I, pogo so no savor sttrgery be "*No it widestly regsiros the potiest be wslkod sr eeved abe0t# to keep flood Mttetisirarlatisg or somethlogo Not ono of bid patiosts was gotten so that wodtoadw• I "a told *us by *so who said lfro ftrkbaltor was farlotw. This is sosooduad Y; letformatiems of oerrooo IMt I was told the same story by the wlto of awethor of Wo Do to patlootso She was a smwll wemaos.but she 044 she had mamagtd to trrr her btsbosd is the be4o Y rosall her joy ono doW shortly before I loft whoa ohs, told as that for the first $Ono "me" had "oasts to kelp we got hie Mpal roforriao to her husbaodo i leitring W November visito I ioade some friemde OwW the staff. I WAS lwtppy to see them adalso. and mob of the Later"Uss ' *Mob follows ewe from Uses Natsrallrp I would set Mast to disoloso their mamoso 5 An ordorly told as he boo worked a year without a mimeo A wlrseoI aide told me oho called is aiak either that Wo or $as sod woe showed art tborougblys although alts said site didnst take •f$ work volesa she me olsko "I shorldh't be here as* ore-is thou patlostes" As eaido hod it Was Ariors eks had a ooldo ` ON Nafto a to ease by at so" with the 0411eo of this i i times I was so 0644 to them. I tools them Withers 0006ioso hr's I bappe"d $0 lone dews and saido "It's rellsws. Isre serer had a rolltw pill before." as, abook"I "A maids "Ar $ rat Nrso 7 MrAt" hoes Y satdo Are rtes *No 460160" t No, X 0440 Obt $aid ~ she world be bask Wars She saw book lator ate! 4ored of it I ~ muss Nrar SWO"wor«ethero Sol I saide a%4 by this ties I was dotoreised was mat to toll k w~IC her +deo I Mae. "sAke pw ra qr► II woo 000+00 (IV Awsisiasos RWW pot I said0 frt that is doetoro At lasts we had the right pills I had "s filet iUgS ~ what sight haw reoslted if X had takes the relief piYl•• ors rw ' both knows X harp a. merit dial of lawsatiomb This 14* later told as sho bad rely was*" two Modw at now and was werkiog her ttb straiMht gar; I Th. setet fts the seine to 4eh04 se mopes egoists ba"43r it I wa Not Ws. O"WO (the oast of mr "GOO X tone the P411 and didetot "Met bee. ' i ~r 1 ' j ~MiV _.,-.o•wtxTiG;+l:dl gY1ib„'sa,~t,..•. _ y a,,.,. ` ~j~r~hM!~ 'd~'*und7M{f~58t`r+~f'+~y~6"n~r,'1~M$k l ' q -10 ~M fl14T11f` - MMM Page 4• Y do get know ar physiola0 personally, bat to .pwteot UO 4" 044 ether Notes 4Nt0rs' fr00 6140der0 1 saestieM this. It raftrs of bigmW aid Tonging ares0d" beriw to elreselate abest 1Nste0 OW4Ao1a"$ X beliove it will be attributablo to au#h wjX%p4•w Not a wave of wise 00006 the 0041041 seas Shortly befero t left Plow* I eat the lather of 'a patie0t who was sy now roowate (the other, fortunately sot~dylMg of tM M4 bad bee% released.) No was as oxeoutfvo its a SpIlas firm which supplies hospital lisoase Is told so that a year age plaw had plased mob a large order for lines that he questioned We It was wow, he said, tb40 ftyler aced its a year. to Meted that plow had ' f Balled his airs that morning aeklag far towels. Me gentlesra0 aaid either **mono wasnOt washing the, lamgdry or sewee40 0aM elf with sole lis"s• On the bater4ay my MOM440 kAd Ne water, the girl Who shade my bed told me she had sAght to do than 6,y►.,« 14asspo ebe had ether 6t1es besides UA*4dM8. I world like to weirs it Plain that this letter is not A0tea4ed to 44pdw the staff eat the ""Asal flosrr• What troate"o, I { was 60400 wool oxselleMte As i have worked Ior 0ewop4"rg,fer yearm, I rooogalne overwork when 1 000 it• I rs"ll a Noofibev 4046106 04 the hospital when a pbsisum sold he was worried bosmoo he wrs sfr0id the bad pabUsity, plow was { ro"Avw +would oft" owpos"t va'sen001 60 seek jobs olsewhoro', ! Qoatl"W49 it As olwi4mo eithor this has happW40 or ~t wvo Ms6 bmw a &"%if 00004k its OMM Y do mat boli`vo the latter is tats 1W to sense the besotal's pr^oblawo aril took of ps"461. 44"0 bad ft oh 4600 oats espy bray sore bad pablirity so stories " as mom, Not AbOM4, ~ f The ether thing I would law to say is that this lottor { is " WOW of 3004,00 phrdei+ye0 At 1►4rie o mieeti0ys, i ba" heard it MM"Mod that %be MOters" abwd do *oat" to snw: ~ 1 ylew-• oostribste tisaselaily0 M to hays p4tiaMs tiwrej etc♦ ; At eso Mok 0006406, a ply►siedas said "hat dsoters kww botsir thaw 4%Wo0e WwA the sitanuos is at now and aw ses 89W to 0600ibrte rile POW "sit the 0000 is atmight90od "60" , P' pass ha t?l *A eat as awtharitr oe hwspitals* s wore +u a newspaperwaaas, he have does i,storrlews le, sad sossereisr$ MW* I harts 4140 is OHIO w d sang physisiass. I will sane see Zia statoreet at spi"Os• Flow Momrial mospital to the first n hays over "ON where the pbraisias ban so intlosaeo• when n 06wooetod is a Beater that this is how thawds appeared to **-a that the plyrsistae had little isxlweseo+o be replied, "'Bore." w I have sssa hospitals whers, it as happoood to the patient who dida$$ rsseir* inter, her dseter wovI4 hays wooled the paint Ott the walla is the seises station is Mao Vr" I What X observed dwrind W 10 dqa at Plow, tt 8"" pigrS,{etars a tool aarrplaimps would do little pods it 1 were a Nstom J*sisia», I wrwld amts with the 4664e00 statewsst. x would set 0iw "0 pow to help, ~ either, wtil the cross is straixhtso" wt• I ar~o t wrlti to * wer V1018 r hseaMSe Pbraieiaa, and 1l cram" h• As swArw of 4111 t>~<~i 4 Xx jo also aesomius mob of thin bear acre to reer attestiou hstarx, ! l *W6 thoMiht 1 00010 ysrbaws verity asro of taws dis~wttielt I that Me rea"od rims + hi itool# Mwewsr the hospital is roe raMaisN, a pMl►sisi46 r. shwld be repro"Oud Mw *n o$ reproffau law-- sr tho "Jon1,l WAVO I do Mt dM it this lottor io shm any sltr eeweilres ar esuetr eserirsieesr• I hcsow taker all *M believe thrpr kmu w N, X*tsrallyo Z waMld'ratbwr'this letter iwt 6e cads fabliro h.wevel• It wood boo Y "a wppir "We omm addrrrasa st Mtwr pa6toots Otto wore .i~ two es the sarw tlewr ar >I aa0 whte witio I bolims verity wegrthisw is this 11e410r0 aliaorolr ~r * , r ,I Ness Pat Stwa i 4100 daittwsN !rail ' ~ NAtN, ~ i f I F ' i, ley" ` TH STATE OP' TEXAS X FLOW MG,MORIAL IIOSPITAL ACRBINMT COUNTY OF DENTON X ` WE, the undersigned throe parties, beinq the Commissioners' i court of the County of Denton, Texas, the City of Denton, Texas, r and the Board of Directors of Flow Memorial Hospital, all of Denton County, Texas, pursuant to mutual Resolutions heretofore passed by the Commissioners' Court of the County of Denton and the City of Denton,,hereby dissolve the organization of said Hospital under Revised Civil statute Article 44941 and hereby re-organize said { Hospital under, the provisions of Texas Revised Civil Statutes, Article 49941-1., which Article is incorporated into this contract, with and subject to the following conditions, terms, and covenants to which all parties hereto, and their successors in office, shall J be mutually bound, to-wits ' f The City of Denton, hereinafter :referred to as CITY, and the 1 County of,benton, hereinafter referred ,to as COUNTY, shall retain title to all hospital lands, physical assets and facilities,.except as may be hereafter granted by resolution of the reapootive,govern- { ing bodies. Any matter requiring a vote on the part of both the E City and County other than the expenditure or transfer of funds shall be passed upon the affirmative vote of any six (G) members of a said combined governing bodies at a joint meeting, and any eight (8) mombers of the combined. Commissioners' Court and City Council I shall constitute a quorum to act on any hospital matter requiring approval of-City and County other than the transfer of City or E ! County funds, the pledging of any City or County asset, or the term- ination'of this eontre~ot as provided below, Any decision on the y ' part of either Of said bodies to authorite the transfer of funds, or Pledge assets, to Flow Memorial mospi'tal, haiainaftor referred to as ; HOAPXTAL, shall be decided under existing law pertinent to the ran- f } , r f ; 7, The City and County shall exercise all authority over the r, hoard of Diroctors of Flow Memorial Hospital, hereinafter referred to as BOARD, consistent with the intent of said Article 44941-1. The bisector of Finance of the City, and the Auditor of the, County, N shall each have the authority as authorized under the laws of the State of Texas to examine all hospital books and records at any x reasonable time, either separately or together. A11 donations and grants for the benefit of the Hospital, in- eluding benefits of trust funds, may be made directly to the Board 1 of Directors of the Hospital but shall. be subject to approval by City and County if any condition, obligation or limitation is con- netted with any such donation or benefit. All funds transferred by the City and County to, or for the .f benefit"of, the Hospital shall be based upon a written detailed budget, as described below, and no special transfer of City or i t County funds within a budge?; year may be made without the submiss- ion and Approval of a budget amendment or supplement prior to any such transfer. The said City and County agree to provide all funds necessary to balance said budget after said budget is examined, accept-. ,y} ed`ahd approved by the said City and County. 1 ' ly° The City and County shall transfer funds to the hospital in the following proportions: . 7t`' For each dollar, 'transferred, the City shall commit 50 per..aent and the County shall commit 50 er cent, after the amount of each tra fer has been authorized by both, This percentage Of fu#ldinq is vale only for the year October 1,ry 1971, through September 30,19720 to be re-negotiated thereafter. J.L. The Initial Board shall consist OR the following seven appoint- ments, three of which were appointed by the City, and four of which 3+ were appointed by the County, with the terms of office es set out by each name, The terms shall begin on the execution date of this ~t contract, and it is spebifi'oally provided that the terms shall ax- .2- , r r+wrw pire on the first and second anniversary of the last day of the next complete fiscal year of said hospital, depending on the 1 initial term, then each new appointment or reappointment shall be { for a term of two years beginning with the expiration date of the initial term, as provided in said Article 44941-1.. No member shall carry over into a new term unless properly reappointed, as all terms automatically expire as indioatod. The initial appointees and thair terms are as followss COUNTY APPOINTERS TrRM nXPIRATION DATE 1. Mrs. Paul N. Simpson ~0 1 2. Mr. Walter Ray C~Iv 3. Mr. Carl Degan, Jr. 4. Mr. Al Testa / » 7~ CITY APPOINTEES TEEN EXPIRATION DATE 1. Dr.. Charles Saunders «ti /O• 2. Dr. John Carter 3. Mr. Dorcell Young i f !J - County appoints two members for two_ye , arm and t140, for one yeor term. ne .Y_. 9._. ear term and na, r l:Y,-.appt2~.bts tiro nlpl2@rs for t4 e aLrt ..._r.- $or o shall be the' duty of the Board to appoint Hospital Ad- i I "yrrr,:'~ ministrator having the qualifications established in the BY-Laws, and to confirm the appointment of the Assistant Administrator and f the Comptroller (or Controller). The Board shall oxecutw a written 9 11 4„ contract with the Adminintrator for his services with such provis- ions as may be agreed upon, but no-.ouch employment oontraot shall exoeada term of four (4) years, and shall provide for removal for f , cause. The Board shall concur in nno approve any written contract the Administrator ma'y negotiate for the employment of the Assistant I Administrator and the Comptroller (Controller) prior to any such employment. Vie Board shall have final authority in all matters of has a pitAl policy) including management policies, in tho gpvornment And t operation of the Hospital, The maters of quorum and voting are ► I , as govarned by jaid ArLiclu d494i-.1 and tho ay-Laws. All Offiaii(l " acts of the Board affecting the management or oporati.on of the v NI"' Y n. I hospital shall be by written .resolution, All said resolutions duly passed upon during an official Board meeting shall be reflect- i ad in the minutes of the Board. All. expenditures of hospital funds in excess of the total bud- get allocation shall be approved by the Board, the City and the s County prior to any such expenditure. i ~AA .It shall be the duty and responsibility of the Board during 1 1 each fiscal year to engage an independent auditing firm to make i an audit of that fiscal year. Such engagement contract, or letter, shall be approved jointly by the City and County, as to its terms, and it shall provide that true copies of all audit reports and mat- erial, including the auditors management letter and confidential information, shall be furnished simultaneously to the Board, the City and the County. The Board may appoint advisory committees, to serve without compensation, under terms and for purposes which said Board dooms proper,' All committees other than advisory shall be as provided in the,By-Laws . All meetings of the Board and its Executive Committee shall be open to the public according to the provisions of the Open Session•Aot, Texas Revised Civil Statutes, Article 6252-17, as amended. xrr. The Hospital Administrator shall have the authority and res- ponsibility to do any and all acts necessary and appropriate in the administration and operation of Flow Memorial Hospital with in the framework of the policies set by the Board in its fjy-La and by Resolution. The line of authority from all employees ahd personnel of the Hospital shall be to and from said Administrator, who shall appoint: and discharge all hospital' salaried personnel w and ©mployaos, provided that the Board must approve the appointW ii ntont of the iWaistant ridminisatrator and the Corr+ptrollor (Conl roller) , t oil who shall Bach or both be entitled to a hearing before the Board prior to dismissal by the Administrator, as set forth in the By-saws. The Administrator shall each month provide the Board, the City and the County with a summary of accounts and expenditures, and with a list of all accounts to be designated uncollectible. IV. The annual budget for, each fiscal year of the hospital shall be prepared by the Administrator and presented to the Board no later. than the first day of May proceeding that fiscal year, and the Board shall present same to the County and the City within thirty (30) days of its receipt: thereof, or no latter than the first day of June pre- ceedi•ng that fiscal year, The hospital budget: shall be considered a public record and be readily available at all times. The budget shall get out estimated i indigent care and bad debt loss in one account, to be separate acc ounte when determinable by the County Medical Services Consultant. The budget shall be compatible with the organizational chart, E which shall divide the hospital, organization into departments and I sub-departmenta. I • The hospital, budget shall be conaia;4nt with the form of accounts and method suggested by the Xwrican Hospital Association, and sufficient in detail to show all income, revenues, losses, ex- penditures of funds, and salaries of all hospital personnel, The fiscal year of the hospitaI shall begin the first day of October and j I, end' ie 30th day of 6eptemk.,.r. V. ' The By-Laws of the hospital, and all amondments thereto, shall be prepared by the Board and approved by the City and the County prior to adoption ; 8uph By-Laws shall be-made pursuant tn'the terms and conditions of this contract, and gailurall,y follow guidelines established there,,- 4 for by the American Hospital Association, 5., M$ ' I i1r1WVy pl • Ip51N 'jf A copy of such By-Laws and amendments shall be furnished to the City, the County, and the Administrator. By-Laws are superior, ! to any resolution of the Board, and no resolution or other act of the Board shall be cantrary tho veto. VI. The transfer of the funds approved by the City and the County, upon acceptance of the regular annual hospital budget, shall be made to the Board in one of the following manners in cash on or be- fore r'ebruary' of the approved budget years or, not less than 1/12 f of said sum o,~, or before the lst day of each month during such bud- get year; or, in three (3) equal payments of 1/3 each, beginning pebruary 1 of such approved budget year. The payment option shall be made by City and County, respectively, at the time the budget is finally approved, The Board shall require bonds of the Administrator, the Assist- ant Administrator, the Comptroller (or Controller), and of all other hospital employees who receive or pay out any monies of the hospital,. The amount of such bonds shall be determined by the Board, and the cost thereof shall be borne by the hospital. No such bonds, however., shall be for less than Ten Thousand ($10,000.00) Dollars. j VIII. This contract shall remain in full. farce and effact until amend- ed or terminated by a majority vote of all of the three parties here- I to, separately, unless sooner terminated by the dissolution of the organization under Article 44991-1 by joint act of the City and County. I Such dissolving of the organization shall automatically terminate this 1, aontraa~~ , I j IXr This contract to become effective on October t, 1971, when approved '~y all parties hereto. 1 1 i, h 1 E Al "nov, ,J Yr r M 4.7 \J 1f tJ rR V \ 1 / / ✓'I r . c OX X. ...1tr ArrIll"ST coillti i Y CT., it:^; t: -0i %'a C n L~ J` ~ • , ~i OF "PE"5, 1 ' R' ..1 C} } •!l1'~1 ` f COURT lJ J.'i i1 V; .Vr V, ♦ 1 / rl .~A 1.Q .1 a4y' tit J• Y ~'4l ~ , ~ .1 e4z ~Ir . IA ell, s• ] ~ Mry . uI 1 r M ; .I.rr Y. ~I .l 4 .I u M i IE • h~449 V n bV V irV 1 ~ r ]rA7Z. ~ gpp1:OVT D thin °'c1gV 1 i CIO` _'bF t3L11T0 11 .~CL19' fl-" w«. A 1:X t31 VI11Ln~tt, +Jtd~~i" ~ 1 IIUC~St •7\ c;it, `Cour,ct.l' n f DR. ftOrrn!C `rJ~ Cti~tI:,U1hfi~ CoUnailsnan~ ILLf~tt, ht'. , Cnunaih~An f thROLU~'s 1971. ~ L.~.r......--,~w- ArhR~Vt;D thin day of 1 ~o~rsri bk tst~rc'raiso q r,c~u ~ir~~tyt;xnr, WAVIT tin, un~./~roliN r.;n~rrt;fe, 1 4 ~ w ~ i 4 'lI ' WAIT 1'Ik •R~•`r • w,w wr ~Y`rrr r. ' l1R8. PAUL !l. FiYbS118UN RT, 3'C,A ' j F 1 ; APPROVED { E xx Q. BARTON OM AIYORNEY, f I % tM J II r 1 ~ggyyypd ...w. . t 3 r AT A REMULAH MEE' T NO OF THE CITY COUNCIL op THE CITY 01" DEMTON, TH.M", 1119LD TN IPJJE MUNICIPAL 13U LDTNO OIL' SAID CI'T'Y ON THE 26TH j DAY OV JANUARY, A. D, 1.971, 1 s S 0 T, U T :f O N i 1 j WI REAS, it is deemed beneficial and advisable to re,- organizo Flow Memorial Hospital under Article 411911i.-.l of the I Civil Statutes of the State of Texas M A.T.S,) and dissolve i the entity heretofore created under Artlole 449jii, ,jointly with the County of Denton; now thereforo, BE IT RESOLVED, that, the following; three (3) residents of ~ the City of Denton are hereby named as Direotors of Flow Mem- orial Hospital, to-wit; Qj?~-SftTillioT,`i_ , Dorce l l Young an and si~i. D' rectors s all, as soon as po~5ib~le, me©L with he four (11) Directors who shall be appointed by the Commissioners Court of the County of Denton, and shall elect from their group a Chairman and upon electing one of their members as Chairman j of said Board, the Board shall have authority,, on behalf of if Flow Memorial. Hospital, to enter into a contractual agreement 1 among and between themselves, the City of' Denton, and the County M ' I of Denton, which contract shall spell out the obligations, duties, I' r ? and responsibilities of the parties to the contract; and that when said contract shall be signed by all of the above named par- ties, the operation of Flow Memorial T•loopital shall be,guided in whole by said Article 411941-10 V.A.T.S. It is t;,tie Intention oI thin Ror~olution that the operation of Plow Memor.la.l Hospital bball continuo to be governed by Article 1111941, V.A.T.S., until that t time when the newly appointed board, whether composed in whole or in part by others than present members, and the City of Denton and County of Denton shall enter into and oign the aforesaid con- tract of agreement between said parties, The newly appointed Board shall have no other authority than that outlined in this Rosol.ution unless and until the above named parties shall enter into said contract, Upon final execution of said dontvact, the entity existing under said Article 411941 shall cease to exist,; and the entity shall be that provided by Articlo 44501i•-l, as do.. fined and limited by said contract. PASSED AND APPROV1,,D this the 26th clay of Ianuary, A. D. , 1971, AL X DM 1 I IRLAYJ ' ✓ ~1? CITY OF DENTON, TEXAS ' ATTEST4 t. 01:TY Oh DEN'T'ON) TEXAS APP1 ED AS O WIMAL FORM; ' 51~C" ci y''sni erg, cr.. u IY C.' . OF MINTON, TEXAS r i THE BY-LAWS OF THE BOARD Or! DIRECTORS OF PLOW MEMORIAL HOSPITAL DEN'TON, TEXAS ARTICLE I Name and Purposes The governing body of flow Memorial Hospital shall be known as the Board of Directors of Flow Memorial Hospital, referr.od to { herein as Board. They shall be appointed and hold office in j accordance with Article 44941.1, Texas Revised Civil ,Statutes, as ~ amended, under which Flow Memorial Hospital is now organized, The f Board of Directors shall be responsible for the management of the finances of the hospital, for the appointment of a competent medi- cal staff, for the making and enforcement of such regulations as tire necessary to ensure proper care of patients, and for all other duties provided by said Article 44941.1 and puvbiA4nt to the terms and intent of the contract brand between the Board, the County of LJ Denton, Texas, and the City of Denton, Texas, dated even with the initial adoption of these By--Laws. BOARD GUIDELINCS t For carrying out its duties under the By-Laws the Board policies 1 shall include the followings i I PAGE ONE 't . _ u~wRU~~.;wwwa+NS~+sn+4~FU1CK1'~WeeiHgputS6Afi~?',~4iY~'j~4i"i~a1r~~Fr-'. ......„~~~,w~.~ i~;_,; ~y~gp~ld;f~lw~+~ : it r. "M1 1 j 1 t Derc,r.mine hoapi.tal policy in regarcl to procuring finances A. for growth. B. Determine hospital policy concerning borrowiAig and other methods of major financing. t C, Determine guidelines for major areas of cash utilization. D. Approve board rata policies, and any room rate change. X. Approve financial and other major reports that aro directed 'to the public and other interested parties. F. Approve ma jov short-term loans and all long-term loans, JJ G. Review and/or approve major Contracts such as those for., i! acquisition or sale of real estate. H. Authorize officers to sign various written legal documents and to take final action 1. Approve major pordonnel and labor.. relations policies And progrn,ths that shape the pssontial character of personnel and l.ak`gr relations. This inolufts any controot to bra ; nogotiat.)d with a union or any major contract such as A k total hospital omployee retirement plan, j a. Approve all merger or acquisition activities. H. Approve, rojedt and modify hospital budgets (operating and capital) submitted by the Administrator. L. the By-Laws retain or in any contract entered into with any egovern- ing bodies, m. Approve actions that dispose of any substantial asset. N. Review and approve all donations and oontributions made to 1 the hospital with or witl•iout restrictions, except minor gifts of $1,000.00 or ,long. PAGE TWO ~ih;-; 4 T f.5 ■eA y }t ARTXCLr 11 i Meetings ~ t Section 1. The Board members shall hold regular meetings on F the third Thursday of each month. The regular meeting in October 4? shall be known as the annual meeting. Special meetings may be hold f at the o411 of the chairman or, in his absence, at the call of the Vice-Chairman, or at the call of any three members. Section 2. Tour (4) members shall constitute a quorum, t Section 3, The order of the business at all meetings of the Hoard shall include the follo%4ingt 1. Meeting called to order E 2. Roll Call, f 3. Reading of minutes of previous meeting. 4. Correction and approval of minutes, by motion, j 5. Treading of communications, 6. Reports of Committees and Officers. 7, Reading of report of Administrator. 8. Reacting of professional analysis report of medical staff. j 9. Unfinished Business# 10, New BusinesA. 11. Adjournment, PAGF: ~'H~2hH E o.w.,i,n.-..wxw.T.,w.ru(.Yxd Wdti.uW.rlkllkiMdfiY`Y1v4Mf1a')Ik~!. e....r.... j ~ j I f I'll r rWAMM a r i f F Section 9. The general parliamentary procedure established E by Robert's Rules of Order shall be followed. ARTICLE III Annual Reports The - Board will have prepared an annual report setting forth in sufficient scope and detail the more important facts concerning the business management and professional work of the hospital, and { , I such report shall be presented to the County of Denton 'and the-City h of Denton. ARTICLE IV Budget; and Expenditures The Board shall be responsible for submitting the annul bud- gat of the hospital to the city Manager of the city n'P Denton, and to the County Auditor., in the form, and within the time, prescribed in the aforesaid joint contract. The Board shall approve all expenditures of 'hospital funds in excess of $5,000,00, except for perishables and emergency needs. Such expenditures for perishables, and for emergency needs, shall be at the discretion of the Administrator provided that funds are 1 available within the total allocation of the budget. Such expondir turas will be reported at the next rregular mooting of the Board. The fiscal year of the hospital shall begin the first day of 00tober and end the 30th day of September. r PAOV POUR R7P9° ••HOr.rwnaKnk16'dlW7hS~'l~EhSA'`1MAYli~114AdW"•••. "+1 .~i~~p~~ -."L r r 4fliill{MNi'OM'r.. L ~ y J 4NNTM ; ~ L a y ARTICLB V 1. x Nepotism ~ No person may be paid from hospital funds if such person is related to any Board member, or to the Administrator, within the third degree of affinity,or consanguinity except bolow the third level of management and only then with the consent of the Board. 1 ARTICLE VI I Officers and Committees At the first regular meeting after adoption of these By-Laws I ; and at each annual meeting' thereafter, the mcambers shall elect a i ~ Chairman, Vice-Chairman and a Secretary. These officers shall' constitute the Executive Committee of the Board, The Executive k Committee in addition to its 'other duties hereinafter referred to, shall represent the Board on the Joint Conference Committee, The Board shall appoint a Vinance Advisory Committee, Medical Advisory Committee, and other Advisory Committees as needed, Such advisory ` committees shall limit their Aotivi.ties to the purpose for which they were appointed and they shall have no power to act for tha Board, The officers and standing committee members shall serves un•• til the following annual meeting of the Board or 'until their suo. cessorEs have been named, rwgwr..«,,..,_.w.,.»::..exwtu.r,r~riNfitN'FIIYtiNl~flllekt,rt.•H".","•... I A i'S 71 1 ARTICL1: VT.T. Duties Of Officers and Committees ' Shall preside at all meetings of the k Section l.. The Chairman member. of all. Standing comai.ttees. The , and be an ex officio Board ss vela at meetings of the Hoard, but shall have no vote a chairman may i committee. as ex officio member of any the duties of the Section 2. The Vice-Chairman shall perform .s absence, and in the event of his resignation, death j, Chairman in hl office of the Chairman or inability to act, shall suoceod tO the . r section 3. The Secretary shall, keep the minutes of the meet- II j ings of the Board and i.ts standing oommittoaSi record the namuS of k notify all members of commit- I tall mem!>ers present at each meet'ingr standing toes of their app ~ ointments, and not~ifl all members of thn w etings committees of regular or spacial, me at least three days be 1 l tore the appointed time for the meating, except in case of emer- uch notification gency as provided, herein and by law, and in S state the nature of the business for which the meeting is called. notice of each meeting shall. be doliver.ed to the County Reasonable ,h ujitor and the City Manager prior to such mnating• s to trans- act 4, The Executive Committee shall have power .Act all regular buuiness of the Board during the interim between the meetings of the Doard, provided that any action which it may PAG1s SIX ~ I WOW ..r-ca;dirLNHrK0.WYZi:6"~'~'M•.:•x, i i :i b - r ; take shall not conflict with the policies and expresse3d crishos of } the Board, and be subject to ratification, modification or repeal 1 by the Board, and that it shall refer all matters of major import- ance to the Hoard. Should any matter of oxtreme urgency arise be- tween the regular meetings of the Board, is shall be the duty of the executive committee to request th., Chairman to call a special meet- ✓~yr. ing of the Board as provided in the By-Laws. i section 5. Where shall be a Finance committee compoeed of ran„ three membaxu of the Board; appointed by the Chairman, with the a` Chairman and-\dministrator ex officio members, it shall devise ways and mean•j of securing funds for the slip port of the hospital. .get , ' It shall supervise and assure its preparation of the annual buCt 4r ! #i,hmission to the Board as provided in the contract by and between i the Poard, the City of Denton, and the County of Denton, referred ;w-- to above. ' It shall be the further duty of the Finance Committee to exa- mine the monthly :Financial reports and to regtiaixe an explanation F~, r ur.` from the administrator of any variation 1rom the current budget 1 when deemed necessary, and make r.oconunendations to the board on ¢ti any financial matter. This con'nittee shall examine the•financial' reports of the hospital monthly and report its findings and row commendations' to the Board. The accounts of tho hospital shall be ! ;t i! • r~c~, srv>;ro ~~.r. •~rir' 1 4w; ~i~i~?,1~ ~.~Pa 4 ~ rY. V,p a` 1 Owl w • 1 1 P50.1}y , 1 f L j` examined annually by a compatent auditing iyrm as engaged accord- outxact, • ing to the above mentioned o Section G. Tile finance Advi"Or Committee shall consist of no less than three nor more than nine county or city residents who E j' are not members of tttie Board and who shall have expar~ enco in the i fields of finance and busin®s$• ry Committee shall review the rates, fees The Finttneo Adviso hares of the hospital for the services it renders, and, from and c g ~ • os, recommendations to the and make time to time, review these aharg to oard for any ad;iustments thereto. rt shall also investiga and ' i Et funds for support of Plow reoomm©nd ways and means of securing , Memorl,al•Hospital. The Finance Advisory Committee shall report f e Board, but may advise the Finance Committee on all direct to th financial matters. section 1. Tile Joint Conference Committee shall consist of president and Vice-President of the Active medical Staff, the i tile • Fxocittf,vo committee of the Board,-and the Administrator. The j medical staff ropreeentativos will be spokesmen for the medical staff on this committee. This committee shall be a medical- committee and tite Official point of contact eon alive liaison administr between thtl,Medical Staff, the Board and the Administrator. It i k DAM MG1IT i ck I. shall meet monthly and keep proper minutes of said meoi:ing: for reporting to both the Medical Staff and the Board. Section a, The Medical Advisory Committee shall be appointed by the Board and shall be constituted of not less than four nor more than nine residents of Denison County who are licensed to practice medicine in Denton county and the State of Texas. The Board may use whatever means at its disposal for making these appointments which may include consultation with the President of the Medical Staff( I' ✓ the Executive Committee and/or the Joint Conference Committee if deemed advisable. The Medical Advisory Committee shall act on and, in behalf of the Board of directors only in an advisory capacity and e as directed` by said Board Thg Medical Advisory committee shall be responsible to the. Board of Directors to carry out the duti''es'as delegated by the Hoard. The activities of the Medical Advisory Committed shall in- clude the following: 1, It shall be responsible for assisting the Board in deter- mining long-range objectives and achieving long-range stability and growth. 2, it shall act an an advisory body to assist in planning t° and designing mayor hospital programs to achieve short and long d. ~ rAOr~; NrNra 1 E Q7~' PlN~ plOki~. 1 R w. i I f R range goals. These plans should bo baHOd on and consistent with hospital objectives. 1 M 3. Plane should also pzojeot the ho:tpitaL s present am sr o- j +s health needs. jected role in meeting the community 4. The Committee shall act in advisory capacity to the Board in evaluating issues that involve measuring the quality of medical care to be rendered. 5. it shall assist the Board in providing a long-range plan faoility needs, in written foam concerning 6. Appraise the community's health needs and the hospital's objectives and plans in terms of their campatibility,, the Board in coordinating the hospital's long-range y, Assist plan with the capital requirement plan. B. Assist the board when so requested by furnishing guidelines. for equipment needs, measurement of patient care being rendered, and other functions as otherwise requested to do. The Medical Advisory Committee shall meet with the Board at least quarterly and as otherwise doomed advisable or requested by said board. ARTICLE VIII .a Duties of the Administrator a Section 1. The hoard of bireat'ors shall select and employ a PAG8 TCN ~H 000 i . qq~, reruns' { t 1 i i i I competent and experienced administrator who shall be its direct representative in the management of the hospital.. Such administrator shall be given the necessary authority and held responsible for the administration of the hospital in all its departments, subject only to the policies enacted by the Board. The authority and duties of the administrator shall include the following: i ` 1.' To complete and submit to the Board for approval, a scheme of and for organization of the personnel and others concerned with the operation of the hospital', including an organizational chart. tai 2. To prepare a budget showing the expected receipts, expendi- tures and accounts as required by the aforesaid contract. 3. To select, eruploy, control and discharge all employees I authorized by the budget, provided that the employment and discharge of the Assistant Administrator and the Comptroller (Control lor)shalI be subject to approval by the Board. I 4, To see that the building and grounds are kept in a good 'i state of repair, conferring with the Board in major, matters bu+s carrying on routine repairs And maintenance without such consul- tation. 3, To supervise and manage all business affairs, such as the records of financial transactions, collections of accounts, pur y . PAM 9MV N to r ~ a. R i r 9 l l chase and issue of supplies, and to be certain that all funds are collected and expended to the best possible advantage and are with- in the accounts of the budget allocation. 1 6. To cooperate with the Medical Staff and to secure like I cooperation on the part of all those concerned with rendering professional service to the end that the patient may receive the best possible care. He shall attend all meetings of the Executive Committee of the Medical Staff, and be an ex o'ffieio member there- of. 7. To submit regularly to the Board, the City,. and the County, or their authorized representatives, periodic reports showing the professional service, and the; other reports that may be required by I the Board, the City, or the County.. 8. To attend all meetings of the Board and its committees, 1 and shall be an ex officio ma-mber of all committees appointed by the Board, except the Executive Committee, and shall' have no vote. 9. In all cases of disputed authority, or uncertainty as to the meaning of the By-Laws and Rules and Regulations of the hospital, t the decision of the Administrator shall be operative until a con- ' I trary ruling shall have been made by the Board or the P xecutive y, l committee. i r PALL TWrr,vr r i 1., a i i r e F 10, To be resporinible for posting an agenda of each regular- ly scheduled meeting of the Board at least three (3) days in ad- vance on the hospital bulletin board, and, on the same day of post- ing, shall mail copies of such agenda to the County Auditor and I City Manager. r 11, on called meetings, reasonable notice as possible will f be given to the County Auditor and City Manager in advance of said f ~ 1 meeting. 12. To serve as the hospital administrative head and to per- I form any other duty that may be in the best interest'o> the hospital. { j ARTICLE IX Medical Staff' Acting on. the best edical advice available the Board shall it appoint d medical staff of physicians and shall see that they are organized in such a manner as to secure the desired results. The medical staff organization must provide the framework in which the duties and the fwictions of the medical staff, can be carried out, t' In the professional care of patients, the attending physician c appointed to the me .cal staff shall have full authorit subjeat f i` only to the policies stated by the Board, There must be such t 'f PAGE j 01 A 811. a: q.N IJAO.. .:hK ~lN~Hd } x MUM ti 7 i i ~ 1 I, j k E j officers of the mec?ical staff organization as will provide ©ffQC- I tivo governance of its affairs and as will insure proper acceptance I and discharge of the overall responsibilities for the quality of j medical care delegated to the medical staff by the Board. The I duties of each officer, and the qualifications of Aoh incumbent, as well as the method of selection, shall be delineated in the By-Laws, k r'O Rules and Regulations of the medical Staff. Each officrer must be a member of the active medical staff and must be elected by the vot- ing members of the medical staff. The medical staff shall develop its own organizational structure as well as its own By-Laws sub'jeot ' i only to final approval by the Board. Such Ay-Lava should be in keeping with the guidelines of the Joint Commission on Accreditation of Hospitals. The key position in the medical staff shall be the President whose duties will include the followings A. Serve as presiding o°fioer at all medical staff meetings. B. Serve, as the Chairman of the Medical Staff Executive Committee and as an Hex Officio member of all Medical Staff Committees. C. Appoint MedioaL Staff: Committoo members (exoe t.Wlion membership is otherwise specified in the medical Staff . BY-Laws) D. Enforce' Medical Staff By-)Laws, Rules and Requlations. Y`{ E, Presont the views, policies, needs and grievances of I the Medical Staff to the Administrator and to the Board. t j , i PAGE t'Ot]RR'F,rN .:.i+,.navvsyV`,k~<{~ASi`,'+~!41hS~lKA1~.4~OM,~11lD.YfN~`N.6 T'bf~k~FIN'~!V`~TM+'~~hlY4wri'~'^.. y ~{(bs i f V r 'I I A i 4!.WAN 1 ,j At.t~nd all Board meetings 88 spokesman in and for the Medical Staff. I G, the responsible representative of the Medical serve as { Staff. policies from the board and report Receive and interpret rovid~ prove stBoard aff s tresponsibility for on and interpr eaical the tennnce of the go ing ng good medical care. Y. Act as Medical Staff spokesman for the Staff's external professional and public relations. , LT, To receive and act upon the reports of the Medical Staff Committees R. Consider and recommend action to the Administrator on all matters of medical administrative nature. t L, implement and approve policies of the modical Staff. M. Take all. reasonable steps to insure professional ethical conduct the such prescribed cooperativeeMeasuresa and to sni nits an f ~ are indicated to fd1fi11 the m©dical care rendered to the . patient in the hospital. N, Insure that ~lprogrmaandtintormodao£ tl~egacaroditation w accreditation hos ital. ~ status' of the p , Confere tee alon L ith p, Serve o tdantoasto tlinednabove intthe activicties ofothe Vic~ewPresi, re Committee. 30int Ccnf orun ARTICLL X Hospital Auxiliary ;r t The board shall assist in the,organizing of an effective PAGE FICTS13N . ...q.,..4rlb U.j,.p 'ro' vdw YPrww... e+ ~y~[ 4a .iYV+ ,,aa ~j~F J~w) 1 i which shall be under the supervision of the t` hospital aux3,liaryf the same as a regular employee of the hos administrator pital. ARTICLE XT I Amendments These By-taws may be changed by a majority vote of the mem- j held for that purpogo, notice of bers of the Board at a meeting the sooretary to each member which has been given in writing by E E two weeks in advance Of the meeting, but shall not be at least County of Benton and the City effective until approved by the , I of Denton, as Proviclcad in said joint contraot. of Tu A. D. 1971. ADOPTED this the cay CH TA RMAN OF THE BOARD APPROVED, 1 APPROVED' r~ C~a~-c-`-` 11YaI2 t f~ c:' 1>nGC 9rXT1;T;N l i v; i , STATE' OP TEXAS X r LOW MCMORLAL 110M)ITAL 7kGRl;tM M'r COUNTY OF DENTON WL, the undersigned three partioy, being the COmmigSi.Oners' 1 Court of the County of Denton, Texas, the City of ur.nton, Toxar,, and the Board of Wroctors of Flow Memorial Nospital, all of Dantan County, Texas, pursuant to mutual Resolutions heretofore passed by the Commissioners' Court of the County of Denton and the Clty of. j Denton, hereby dissolve tlse organization of said Hospital under Revised Civil Statute Article 44941 and hereby ro-organize said Hospital under the provisions of Texas Rovisod Civil Statutes, s Article 44941-1, which Article is incorporated into this contract, with and subject to the following conditions, terms, and covenants to which all }parties heroto, and their successors in offiea, shah be. mutually bound, to-wits 1. i „ The City of Benton, hereinafter referred to as'C.tTY', and the County of. Denton, hereinafter referred to as COUNTY, shn71 retain title to all hospital lands, physical assets and facilities, except as may be hereafter granted by reso,tution of the rearictive govern- ing bodies. Any matter requiring a vote on the part; of both the City and county other than the expenditure or txansfa: of. 'tun( shall be palmed upon the affirmative vote of any six {6) mombers of said combined governing bodies at a joint meeting, and any eight (n) _members of the Combined Commiseionorss' Court and City Council shall constitute a quorum to act on any hospital matter requiring approval of City and County other than the transfer of, City or County funds, the sledging of any City or County assaot, of the tdrm ination of this contract as provided below. Any decision on the part of either, of said bodies to authorize the Let"Isfer of funds, or { pledge assets, to Vlow Mc-imori.al Hospital., hereinafter reforred to as HOSPITAL, shall bo drsAJOd under existing law pertinent to the res- pective bodies, } s; Fe A f , t i The City and County shall exercise all. authority over tho Board of Directors of flow memorial Hospital, hereinafter referred to as BOARD, consistent with the intent of said Article 44941•-1, i The biroctor of Finan:>e of the City, and the Auditor of the County, a shall each have the aut:Ilority as authorized under the laws of the St to of Texas to examine all hospital books and records at any reasonable time, either separately or together. s <.4 All donations and tyrants for the benefit of the ttospite in- -Al , cluding benefits of trust funds, may be made directly to the Board of Directors of the Hospital but shall be suhject to approve] by ;x City and County if any condition, obligation or limitation is cone i; nected with any such donation or benefit. All funds transferred by the city and county to, or for the benefit of, the, Hospital shall be based on a written detailed r 3 t ti+ budget, as described below, and no special transfer of City or J County funds withi;: a budget year may be made without the submiss- ion and approval of a budget amendment or supplement prior to any such transfer, The said City and County agree to provide all funds necousarY , to balAnoe said budget after, said budget in examine d, accept- ed 'a'nd approved by the said City and County. The City and County shall transfer funds to the Hospital in 1+`t1',;~ the following proportionss ' Tor each dollar transferred, the city shall commit qr c6 and the County shall eommtt 50 per cent, after the amount of each LO transfer haF, been authorized by both,' Thin peroentage of fundinq in valid only for the year October 11 1971, through aeptttImber 30,19"2, to be re~negotiaied It oroaftor. r The initial Board shall consist of the following woven apprint- r 7 ~ Monts, three of which were appointed by the Ct.ty, and f f which our o were appointed by the County, with the torms of office as Set: out t, by each newer The Corms shall begin on the execution date of this contract, and it is sporifically provided that the t,rms shall ex- ,tit -2« f LAW* i N ~,ar rlro on the firm and second anniversary of the lftst day of t.lu J 1 ?r next complete fiscal year of said hospital, dnpendi3ig on the initial term, thou each new a1)15ointment ()r reappointment shall. bo j s with the expiration' Fate of the for a term of two years beginning initial term, as provided in said Article 44941-11 No membor shall carzY over into a new term unless properly reappointed, as all terms automatically expire as indicated. The initial appointees and 'che.ir terms are as follows. DATE ~ COUNTY APPOINTEES mER~M E~XPLP.ATION._~---/y-.~ i` 1. Mz's. lsaIai 11. 5lmpaon / / /p« ~3 2. Mx. Walter Ray VV r y 3. Mr. Carl began, jr. /40 4. Mr. Al Testa Z I ~ CITY APPOINTEES S 'PERM EXPIRATION DATE 1. Dr. Charles Saunders ;/r/// /O ~.2•• 2. De. Cohn Carter ~p , i 73 3. Mr. Doroell Young for two year term and two for r at' <<I County appoints two members 1 ' one year term. A ,,l di'6k City appoi;its two members for two year term and,one for one f IN Year term) a W 1 Ad Dint a 110spita it mha.il be the duty of 'the 06ard to app fx3 bushed in the 6y-Laws, ministrator having the qualifications ostr. and to confirm the appointment of the Assistaoa- ~ *clministratpr and ' 11t`l1 at;~ execute a written ~rrya~! the comptroller (or Controller) A. The lida?^cl shall , contract with the Administrator for his gorvtoes with such provis•• 1 n, but no , such employment contract shall ,,~i, as may be agreed uLx> ions far removal for o r ,tiff ,.4 *FyA'"1~~ exceed a form of four (4) Years, and shrall provide „ f written contract { ppravo any cause. The Poard shall concur, in ano a 4;; t negotiato,for the employment : of the Assistant the Adminifatrl tor May a nd the Cnmpt:rollar. (Controller) prior to any such Administrator A shall. havo final authority in all matl•nrs of 110aw The Board management 15ol.ici.ess, in the government and i r,cl.uding pit:E,1 policy, • , ital. The matters of quorum and voting are Operation of t;ho 1to.~t'. itaf;wr` jaws. All official as governed by slid Article 44941.1 and the fty•I operation of the the noarrd affnctiAcl the management er ants of t, dom...,., hospital shall be by wriL•ton resolution. All said resolutions duly passod upon during an official Board meeting shall be roflect- ,.x. ed in the minutes of the Hoard, 1! All axpandituros of 1(ospi.tal funds in excess of the total bud- get allocation shall be approved by the Board, the City and the , County prior to any such expenditure. i It shall be the duty and responsibility of the Board during it. each fiscal year to engage an independent auditing firm to make an audit of :hat fiscal year Such engagement contract, or letter, shall be approved jointly by the City and County, as to its terms, and it shall provide that true copies of all audit reports and mat oriel, including the auditors management letter and confidential 111 information, shall be furnished simultaneously to the Board, the r City and the County. The Board bray appoint advisory commitroes, to soave without , compensation,, under terms and for purposes which said Board deems 'k,CN' Kl v;,>>r proper. All committees other than advisory shall be as provided , t in the ly-Laws. All meetings of thu Board and its Executive Committee shall' be open to the public, ac=?ding to the provisions of the Open Sesoioo Act, 'texas Revised Civil Statutes, Article 6252-17, as amended IZY. The Hospital Administrator shall have the authority and res- ponsibility to do any and all acts necessary and appropriate in the administration and operation of Plow Memorial hospital with in the framework of the policies set by the Board in its By-Laws ` and by nesoluti.on. The line of authority from all, employees and n1ti personnel of the hospital shall be to and from said Administrator, r . who shall appoint and discharge All hospital salaried personnel t, t e)t' and Omployoosr provided that the Hoard mua+; approve tho"appoint- meat of the Assistant Administrator and the Comptrollat (Controller), 1 dr•i ..Q.. jf t~ 6 , t b, Mlgwyp"., I ii c }z who shall each or both be ontitlud to a hearing before the Hoard prior to dismissal by the Administrator, as sut forth in the By-.Laws, i Tho Administrator shall each month provide the Board, the City and the County with a summary of accounts and oxponditures, a•nd with a list of all accounts to be dosignated uncolloctible. IV. The annual budget for each fiscal year, of the hospital shall be prepared by the Administrator and presented to the Board no later than the first day of; May proceeding that fiscal year, and the J3oard shall present same to the Couitty and the City within thirty (30) days of its receipt thereof, or no later than the'first day of ~7une pre- f I ceeding that fiscal year. 4 I The hospital budget shall be considered a public record and be readily available at all times.' The budget shall set out estimated indigent care and bad debt logs in one account, to beyseparate aca- ounts when determinable by the County Medical Services Consultant. ':ne budget shall be compatible with the organizational chart, which shall divide the hospital organization into departments and sub-departments. The hospital budget shall be consistent with the form of accounts and method suggested by the American Hospital ilssociation, and Miffiuidnt in detail to show all incomo, revenu(s, leases, ex- penditures of funds, and salaries of all hospital ner,ve)nnal. The fiscal year of the hospital shall begin the first day of October and end the 30th day of September. V. The By-Laws of the hospital, and all amendments thereto, shall ~F be prepared by the Board and•aPproved by the City and the County prior to adoption, Such ny-trawa shall be made pursuant to the terms and conditions of this contract, and generally follow guidelines notabliahud thero- for,by the American Hospital Askoeiati.on. k~r(6 Ci;, p A copy of such By-LAWS and ameridmontss shall bo furnished to the City, the County, and the Administrator. by-taws are superior enwwr rr and no resolution cr. other act of to any resolution of the 6oa)Mf f the Board shall be contrary',=thereto. Vx. The transfer of the funds approved by the City and the County, i i upon acceptance of the regular annual hospital budget, shall be made to the Board in one of the following manners in cash on or be- fore February I of the approved budget year; or, not less than 1/12 E of said sum on or before the 1st day of each month during such bud- 1 `~<< get yearn or, in three (3) equal payments of 1/3 each, beginning February 1 of such approved budget year. The payment option shall ,f be made by City and County, respectively, at the time the budget is t finally approved. VSS. The Board shall require bonds of, the Administrator, the Assist- ant . Administrator, the Comptroller (or Controller), and of all other y hospital employees who receive or pay out any monie's of the hospital. 1. 1 The amount of such bonds shall be determined by the Board, and tha ~ 1 ' post thereofshall be borne by the hospital. No such bonds, however,' 'I shall be for less than Ton Thousand (¢10,000.00) Dollars. Vill, This contract shall remain in full force and effect until amand- od or terminated by a majority vote of all of the three partied here- I to, separately, unless sooner terminated by the dissolution of the organization under Article 4494-1 by Joint not of the City and County. , Such dissolving of the organization shall automatically terminate this y# contract. SX. This contract to become effective on October 1, 1971, when approved by all parties hereto. 1 1 nr\ Na~W1sw..r. ~ r, ~f i~ II''~Seh ~w'.~.FfI J'KS./ •~M=-%+'•.I~~ •1 ~r~.• '4 / ' CL`si(- V."1 Pl^ia ti \V`:•i:i Ytl /V^!„~!r I .r6;r" ',y~ J, COi;H1 r~ 1J.:~. \•~.y /.1~ ~/rf,[ ,p „J ffy ~f7~; r. . / \T"i ~yri'L,~Cf'T'~i"~,,. / I,.7.4 ~,(b'R,w•I~,.,• ' ~ r~/ I / ~ ° ~ `fi't \71++ " ...._IT.r. ~ w... I r~CJ4 wi. ~iV No. rr r ) !lllITTTT~~/ rf r~~} ' ~ • Ll r•'fJ.r .J~ ♦I ii„ji...,. ~IIi1N r/4A Y.•~\lV ~ , jiC LaY: :CY WIROV"D thin ^%'day of _ r 1 71. i at, f A h. FX LAY, `J it , t•1 y z ;ir;011 •r. E'It, Cotu:nilq~n DR, ROB""RT '14 Cnvls'll o t Coutiailla 1LL~, t;i;.1, Counaiktaan / • .rW+/:L •.-r ~ rw w✓t.4MnlrW w.r.M• Ilmlor,n Cor~ lMan . Arrravl;n tlrio ..s:... Clay oe ...w.5~?~.~ 1072 l BOAhi) Or nsn o,olu; nr' PLOW P'I;IInN2AL NAP2'.`n 7 s ~ i Litt. Cimm..vi ;i, .;k u,; , l>Y I IStlun4 1f\/~f``t I~~ {(///fir 1( w....I..y /,LI.».~w\'AYi{ +wY+•r w.w.w...«:r 1114 CAtITER o. HEifl, hAUT 11, .5 11'1 0 WkA APPROVED jar C a JACK Q. BARTON CItY ATTORNEY co, ,w ` r. .I 3 k , r5 A,~AIfN, ~tri5^Y k ii ' a FROM MEETING OF FEBRUARY 5, 1971, NOON FLOW HOSPITAL SUMMARY OF TERMS; 1. Resolution - passed i 2. Statute - Terms (4494i-l) include pertinent ones in contract. 3. Appointees designated terms. 4. Duties of Administrator and authority of all. parties. 5. Finances of hospital) finance budget (content' forme method of presentation). b. Indigent funding- guidelines of determination, use of Social tl Worker, i 7, Handling of trust funds and donations, 6. Open sections. Medically indigent; contracts for outside ser- vices; fluid by-laws; sub-oommittees. a' ualifioations of Board Members: 9~ Doctors c,. Board? None? One? All? € fi General requirements for all appointees. 10. Outside audit, type of engagement, firm, ete,. f JIM WHITE: To Creation of City-County Hospital Board (Joint Resolution), IT. The appointment of the Board and their terms, .IIIj Powers, duties and responsibility of the boards IV, Power, duties and responsibility of administrator, V, Finances of the Hospital 10 P'inanoial Reportingt (a) Monthly Reports. (b) Year End Report. s(o) Audit. ' 2, Sudgetingt i (a) The manner and time of the Budget. f (b) Joint Approval of Budgets Cityf County, Board.' 3, Contributions; (a) Tax Revenues Prom City and County. (b) Indigent Funding (separate budgot Item) (o) Trust P'unde 1 F 4. Long; Term Debt (Revenue Bonds) eta.). VII. Changing Sections of Agreements: S., { 1. Definition of 'Medioal Indigents, 2. Joint Approval of Contract and arrangement with outside services. j; 3. Joint Adoption of Bylaws for the operation of the Hospital Board. BILL SWITzER: 9 Two Ex-Officio members of Board - one from City, one from kv County r „s , ri . 1 4~, 1 r4 'r JACK Q, BARTON: 11 A sub-oommittee composed of three: one from Hospital Board;. one .trom City; and one from County . 'r. JULIAN WELLS, COMMUNICATIONS: Communications should include the following data to all parties involved. 1`1 Copy of detailed budget (manner, format, oontent of , budget), The annual detailed budget should include antieipated funds needed for indigent care as well as yy funds for capital improvements to be budgeted and fund- i `A ed by the City and County. o. Copy of monthly financial statements, ti COPY of charge off list. 4. Analysis of accounts that are medically indigent. S ~f 1 Joint meeting to approve budget, ; ' ANNUAL AUDIT: The annual audit is to be financed by the City z and County with combined agreement upon detail of data to be P included in 'the audit to be useful as a management tool as well as a confirmation of operation, i } k DE' r "01NO INDIGSNT CARE: City and County to provide a social worker to assist i in determining indigency, 2. To combine information on patients through utility records, tax records, etc, to assist in determining i financial status of applicant for indigent care. ' 3. To expedite the mechanism for projecting funds to be budgeted by the City and County to assist the hospital to use 4% of hospil,al's budget as anticipated indigent care and another 2% to be set up as a reserve fonds for capital improvements, To make monthly payments to the hospital based on 1/12 of the anticipated indigent care needs with adjustments at the end of the year based on the amount of indigeney actually cared for. ' tl NOTSS: } V'Lyty ' y} ~d+!t st t ~i l , r t hers ,e rig, I t I ,III} f { All awl q 1 11m A RECULAR MENTINC Or TIi;3 CITY COUNCIL OF THE CITY Or DEN'PON, 4'EXAS, HELD IN THE MUNICIPAL BUILDING OF SAID CITY ON THE 23RD f DAY 0;~' 1)E0h113BR, A. D. 1974. RIBS 0 L U T 1 0 N k t WIIEREAS, flow Memorial Hospital, a City-County Hospital, the city being Donton, Texas, and the County being the County of Denton, State of Texas, is operating under Article 44941-1 Of Vernon's Civil Statutes of the State of Texas; and WHEREAS, said Hospital is pursuing an application for a I grant and loan for hospital improvement; and 1 WHEREAS, said Article 44941-1, Section 51 authorizes a resolution on the part of said City and County relative to the pursuit of said purpose. NOW, THEREFORB, BE IT RESOLVED BY THE CI'T'Y COUNCIL OF THE CITY OF DENTON, 'T'EXAS; .a That Flow Memorial Hospital be and it is hereby authorized and designated as the lawful agency to apply for, receive, and expend any available funds from the Federal or State Government for County and City Hospital purposes; and, not by limitation, a f but specifically', to apply for a Federal grant through the Depart ! mant of Health, education and'Welfare in the sum of $367,212.00 1 and for a loan from the Federal Government through the Department of Health, Education and Welfare in the sum of $2930770.00. PASSED and APPAOVED this the 23rd day of December, A. D. 1974. / I N , , MAYOR s, CITY OF DENTON, THXAS r ATTEST J 13F 0 Ka 130L'T' i CITY 3LCRE AAR7 CITY Or DENTON, TEXAS Ap'pROVED rT LrNIAL FORMS l LP AN C I1 r' L ~ i CITY ore DENT~N, TEXAS f~ I •4 „(r BOARD Or DIRECTORS BUSINESS MINUTES oats February 20, 1975--=- _ 1l m. on Thurs- 0 The Board of Directors of f'''low ltilemorial Hospital met at 7,00 p Charles Saundra presiding. Also present were Mr, Joh day, February 20 with Dr. Carter, Mrs. Geraldine Crawford, Mrs. Pant Simpson, Mr. A. J. Testa.M~1 bon t` present ware Dr, J. W. Holland, Mr. Wallace Duvall, Mr. Don Provost, Richey, and Mrs, Gloria Made well, Mrs, Crawford 'requested that the -minutes of the previous meeting be changed to read in the first paragraph Thursday, January 23, 1076. Mrs. Crawford moved that they be approved as corrected. This motion was seconded by Mr, Carter and % Y passed by voice vote. Mr. Vesta presented the report from the Finance Committee and announced that the Excess of Revenue over Vxpense for the month of January is $24,,874 and year-to-data is $18, 995. He discussed the letter to management from Coopers and t ' Lybrand concerning the 1974 audit and said that copies of this letter have been 6 f 111 d^~' : tired to City and County officials, A letter in response to the comments made He noted that 't'`, by Coopers and Lybrand will be sent to the City and County tomorrow. {=:'a steps have already been taker to clear up the tw.o deficiencies having to do with f, internal controls, - The management letter, he said, shows what a fine job the ' Accounting Department is doing. Mr. Carter moved thi the report be approved, Crawford and passed by voice vote. Mr. Carter moved ~ This was seconded by Mrs. i that the Bad Debt Charge-Off amount of $25, 871. 08, the Charity Charge-Off amount ! Y of $8, 727, 72, and the hill--Burton Charge-Off amount of $10 511, 70 be approved. This motion was seconded by Mrs. Crawford and passed by voice vote. Mr. Testa moved that the financial report as a whole be accepted; this was seconded by 3 Mrs. Simpson and passed by voice vote. { Mr. Duvall presentod the Joint Conference Committee's report and noted that- the problem concerning the role of Emergency Room phystclane and staff physicians enrolled in the Emrergencyounty being worked out. A formal ld pro agreement Junior College which would provide ob ex erienc Medical Teehniciai program to rotate through the hospital to get on-the-j p Flo said that the proposed presidential reeission of Hill-Burton funds has been lifted, Mr. Testa moved that the report be accepted; this was seconded by Mrs. Crawford and passed by voice vote. `Y Dr, Saunders said that letters have been written to all persons who had written ' to Congressmen on behalf of lifting the`reefssion. , Mr, Duvall presented the Administrator's report. He said that liability insurance for the hospital. will be going up $40, 000; this increase will likely offset the favorable current excess of revenue over expenses. He suggested that.the Board al of perhaps 10% of excess of revenue over expense each month in orde to deal with the fluctuations of revenue during the whole year as well moved that the or unanticipated expenses and Ainding of improvements. Mr. report be approved, This was seconded by Mrs. Crawford and passed by voice veto. 'A discussion of liability insurance followed, Dr. Saunders stated that the insurance companies can charge whatever they want and can raise the malpractice ` rates Kt anytime, Mr, Testa, however, questioned wl+ather or not the insurance I101R V•1 a `Y BUSINESS MINUTES o.i, ~ February 20, 1975 P n@. 2 _ 2 Commissioner regulates this, Mrs. Simpson said that she believed the Commission is not over hospital liability insurance. Dr. Holland said that the liability insurance for physicians is also exorbitant. ' Mr, Duvall reviewed the steps remaining in the renovation project. Ile said that Phase III is next and will be the submission from the architects of the final drawings and specifications. At that time, Mr. Duvall will ask for a special .t; meeting of the Board and some members of the medical staff for review of ;ne final 11 specifications and drawings. The drawings and specifications can then be sent to t the Stato Health Department for final approval. When approval is received, we can i then advertise for bids-bidding to last for 30 days. We will have 45 days in which to evaluate the bids and negotiate a contract. He believes that we will meet the June 30 deadline for beginning the renovation project. } ' Dr. Holland gave the Medical Staff Report. He noted that Dr. J',_ H. Miller has been appointed to the Executive Committee to represent the OB/G1Y'N Department. rs He discussed the physician recruitment activities, Mr, Carter moved that this ~f report be accepted, Tills was seconded by Mrs. Simpson and passed by voice vote. r,hu Mrs. Simpson asked what financing would be used for the nuclear medicine unit and if the ultra sound system has been purchased. Mr. Duvall explained that financ- ing has not been completed for the nuclear medicine unit which is expected to be ` .delivered about March 1 and that the ultra sound system will be purchased as a part x''l of the renovation project. ,af'P Mr, Duvall presented the Utilization Review Report and noted that 19 cases had been favorably reviewed. A utilization review plan which does not provide for f~ the lrebruar i deadline regulations has been a y approved by the medical staff, ~t Mrs. Simpson moved that the report be approved; this was seconded by Mrs. Crawfor t and passed by voice vote, ! jwd5 Mr, Duvall presented the Nursing Audit Report. Ten gastroenteritis charts had been favorably reviewed, There were some minor deficiencies= but, generally, the charts were thought to be in good shape. Mr. Testa moved that the report be aceeptedl this was seconded by Mrs. Simpson and passed by voice vote. lttj { Mrs. Simpson preset ted the Legislative Report and noted that Govenor l3riscoe had called for a provision of HMO's in Texas to be Introduced in the House and Senate, } She reviewed an analysis which appeared in the Dallas Mornin News concerning +F ~ Y national health Insurance legislation.' ' According 'to is:a analysis, he legislation will probably not be sent to the Senate until 1976, She diroussed'the rising costs of mai- 'LS practice liability Insurance and cited an increasing number of out-of-jury settlements for malpractice suits, She briefly discussed state health planning legislation, and flu`" Dr, Saunders suggested cotitaoting the County Commissioners to give them' opinions 5k; is concerning this legislation, Mrs, Crawford moved that the Legislative Report be accepted, this was seconded by Mrt Carter and passed by 'voice vote, lry~;~'1. y Mr. Duvall presented a proposed resolution which would prohibit the use of j inflammable anesthetics in the hospital, He said that the resolution 'bad already been ! Z clear ed with Dr, Love, Mr. Carter movcq for approval of the resolutlnni this was seconded by Mrs, Crawford and passed by voice vote. The resolution was then dlstrlbuted far' signatures, 4•ac- ins-.i. nur-.mrrat rca:.-_~acros ams~ez _-,ramr 1. ,.6816 ,.t 11(11M .11..0 to" In. I I. It U.,i1 IU.Itt L N.4 . ' k'OV:1N w....... . ....~f.a ,,,~,,y~ IKSN', W+lan. .::.y it ?X ts i r 1d,~r1 A i r ell p11'MW.e 7ilp■~ CT017°~ BOARD OF DIRE Page 3 BUSINESS MINUTES Dale February 20 1975 ~ Mr, Duvall distributed copies of the "Plan for the Organization and P'uncttonin of the Utilization Review Committee of the Medical Staff, II which had been approved and the Executive Committee of the Medical by the Utilizatior Review Committee this was seconded by Staff, Mrs. Simpson moved that the Board accept was noted that Medicare officials will Mrs. Crawford and passed by voice votes l provide guidelines to use in revising the uti' ization review plan to comply with the requirements to be effective about April 1, Dr, Saunders announced that Miss Lillian Dstes will be retiring in April and suggested that the Board pass a resolution at the next meeting commending her for y her dedicated and loyal service.to Flow Memorial Hospital. Mr. Testa asked what effect the case of Dr. EdeLin, the Boston physiclan who had been sued for allegedly killing a fetus after performing a legal abortion on one f; of his patients. Dr. Holland discussed some of the problems with abortions. Mr. Duvall reviewed the Supreme C'ourt's decision concerning abortions and agreed to check into Fiowls policies concerning abortions. Mrs. Crawford moved that the Board. be adjourned. This was seconded by j Mr. Carter and passed by voice vote. The meeting was adjourned at 8;48 p. m. lit Respectfully submitted, r 1 A. J. Testa Secretary f f f 1 gm i P 1 I F 1' , 1 _.-.-fir. yY 1 5i~ IRIII(IRrI AI<OIP ~Iu ~I Rif Ri l1ME11 lau II 016 ....y[ ~ ,.-w.. . t S y~ < !Y P~tS". fir, t 1 Y I I ' I fil ~~l Wl mute. FL04J MM11ORIAL HOSPITAL ~ 140YTULY STATISTICAL REPORT FEBRUARY, 1975 Patients remainin This This Ho. This Yr. Last Yr. g last report: 104` Month Last Yr, To Date To pare Admitted: Adult , , 267 293 1367 Pediatric... 45 59 208 1934 1 Obstetrical..., 74 90 350 464 63 N wb Sub Total 2 59 2747 eorn........................... 65 82 394 404 Total 456 524 24,53 3151 Medicare (Included in Adult)........,.. 72 101 404 Mediceid (included in all Categories).. 23 22 568 116 128 Total patients treated.- 560 { ~5a Dincharged, Adult 291 < 282 1405 a Pediatric 1940 46 59 202 948 Obstetrical.. 73 87 460 4 Sub Total 410 " 428 2067 2748 Mewborn........ 61 79 392 404 3 Total 471 507 2459. 3152 Medicare (Included in Adult)...'........ 80 93 415 Medicaid (Included in all categories),, 21 25 5b2 .110 133 Total Patients remaining.- 89 Discharge- Days.- Adult,,,, 2096 2108 10,503 15 161 Pediatric 273 251 ' 944 1,230 Obstetrical....., 251 276 1 511. 1 *396 Sub Total `°"262D' 5 i 2635 c: Newborn 309 284 1,585 1633 TOTAL , ' Nadica rb (included in Adult),,.,,,,,,,, 869 888 4,229 5,886 f k Medicaid (Included in all categories)., 155 138 609 742 F`± Average. Length of Stays l Adult.... 7.2 7 7,4 8 Pediatrics., 5.9 14.6 Obstetrical 3.4 3 3.2 4 i { 3.2 3 Total 6 ,9 6 A.. Medicare (Included in Adult)............ 10.8 110 10.1 4'9 lie d i c aid (Included in all categories).,, 7.3 6 5.5 16 1 f. I i{U 1 a iiu" inu i oi~tila iiuxc. Y a$C L ThLS Thia uo. Census Patient Day TOLD Yr. Last Yr, Adult,,, a' Flonth Last Yr. To Date To Date Pediatric. • • • • . ' • . • • • • • 1,822 2,178 91780) 13,939 Obstetrica1 277 323 977 1,491 218 288 1.473 1 451 11ewborn.. , , Sub Total 2,317 2,789 12,230 16,881 4 283 289 1.5,81 11628 Total 21600 3,078 13,821 18,509 Medicare (Included in Adult)........... 636 1,063 4,013 50976 Medicaid (Included in all categories),. 138 113 621 713 Average Daily Census: Adult. . . . . . . . . . ................65 78 65 Pediatric...... 10 92 12 6 10 Obstetrical 8 lp g10 ~ ' Sub Total 83 100 81 112 Newborn........... r, 10 10 lp 11 Total 11~1~ 91 12 I # Medicare (Included in Adult)........... 23 38 27 40 { Medicaid (Included in all categories),, 5 4 4 5 Percentage of Occupancy: I j Adult (94.Hes1v.1...... 75% 48% 75% 56i Pediatric ..(.6.B.ell61....., 166% 1099 100% 91% Obstetrical..... , ....05 .0.60PI , 32% 421. 362 42% ' (117 Bads) Sub Total , Newborn............(26.@aar@tia~.... 38% 38% 38% 42% + ,:,;JJ~ (143 Beds & Bassinets) ..2_657, . *198 Bade Total . , Medicare (Included in Adult)(8G AP 27% 31Y. *25% x z~ 23% 41a63digad d (Inclucc~ aa in 11 cate orie 37 2% 3% **2Z {~43 Beta & Baas nata~ 1 < < ~A ~t','}4 Dat;''€~r Beds 6 bassinets Over 48 hoursi ~rrz 8 35 43 Pediatric.. U p 0 0 Obstetrical............'......., 0 0 0 0 Et; r' Sub Total - 8 8 35 43 Newborn, . 0 0 0 1 'ay Total 8 35 Medicare (included in Adult)........ 6 6 29 33 raj Medicaid (Included in all categories) 0 0 l 1 ,r y, Under 48 houres r Adult 2 4 lU 22 Pediatric 0 0 p l 0 0 0 Ubstetrical 0 E Sub Total -"-2 tdewhora 1 2 2 4 Total i t <<' Hadicare (Included is Adult)..,,... 1 4 g lg ' Medicaid (Includedin all categories} 0 O 0 1 i elutopsies.,........ 1 0 5 5 Not Autopgy Rato 9, 1% 0"/, 10.6% y% VvV 'y t ` k rfP _f FEDRUAP,Y, 1975 MONTHLY STATISTICAL REPORT a.µXwa Page 3 This This p10, This Yr, r Intensive Care Unit: Month Last Yr. r Last Yr. (Figures of this category are included other categoies) Patients Admitted.,,,,------ To Date Patients Discharged...... 0660 27 k5 20 35 171 228 Patients Expired., 4 154 202 Census Days .....6 13 ff Average Dally Census 72 122 22 Average length of gCa 3 4 511 660 y 3 Pdreentage of Occupancy „ 43% 3 3 4 Medicares(Included 57% 43x 3 Admissions in above totals),. 57% i 9 Discharges", 4 22 81 113 Expired 3 15 69 99 Census Days 26 5 12 14 Medicaid t(included in above totals) 69 246 366 Admissions......,. 2 Discha 2 10 J rges 1 4 I E Expired 0 2 9 3 f 4 .Census bs....... O C y 3 5 0 25 7 Operational Major ........r.......r..,...,. 63 I Minor 118 67 322 525 Tots 85 651 844 {I{ Electrocardiogr~my,..Ja~ ry1 O 11 1 , , , , ..Totrrl 183 In-Patients: 201 10028 180 1,271 ' Out-Patients 3 985 43 Laboratory Testat....... .............TOtal xn-PaCienCSt 129305 12,305 14,957 54,596 9,412 80,353 Out-Patients;,,,183 .440611 Emergency Room Patients:...... 258 896 Physical Therapy Treatments 1,569 In-i'aeiente:.........0..4T~tal 11210 I o034 7,347, 8,878 Out-Petleatat 176 6,157 1.190 ; DietarY (Meals 8erved).........Cafoteria 2,743 Patient 6 903 13'7G7 i5, 743 20,0&5 Other 1 933 2,3055 46 36,681• 49,301 Total 11,579 141168 9,901 11,808 62,325 ,1 4 i Laundry lbss 38,747 Pat Patient Day 14.9 38,130 216,175 241,721 12 15.6 13 1 - Emergency Roost visits:.. 667 711 21943 41355 ; 4 Respiratory Therapy Treatments: Total 1,362 1,564 7,652 7,550 In-Patienta: 1)359 ~1f OuC-Pati©nCS:..........:...... 3 7,618 34 44 X-Ray 1,172 Ia-Patients: 623 6,015 7,033 2079 ,.Out-Patients: 536 3,o36 Pharmacy: (Proscriptions Trilled).,,,.Total Yn-•Patiente: 10,345 8,656 50,595 9,393 &2,971 ; OutwPntierttes 912 46,654 f 3p941 r µi .r N N q N N A A N n Q~j~ N pwp~~ tfpp 41 pw~ H d W W Oyl N ~I+ A y OD N rpp ~o r;~ " " "Mg " ~y Ay an ~p~1 N b o~87" ~n .1LLON y1 yyg~ f~~t ~y y ((~~j~+ o . 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M; ~rN ` ,'y„ ~ ~ N,y0 V -4 b.-5 J0'y.j.sH r'-4 OVO 9.V O.,JO O.rO Oily `1y f^ 'i ~f' g't 0, J1, ly F.a F brr a-4. tr Ml4tYr at or,a wONaF t..tY.t at, 0'r ,n C~ d'' CAP fp1' w ~w' V AO \or\+~rNID Ir NNr~ INPw N r NN 2 N 1 I N w t O ,V d, b b\\ •tl' lY rM1 0 \ I~ w\' " ' ` N lnti,. ~ rW V V O V . V ~ V i N C N V fir, ..J I. V '.rl V ~1 ,,yy ~ i~ F . .F F '.t d t ' F. F ` F ~ F ' t t ' t 'r.. K It +t a rg +^~'jf W it 1., 1 ~p~Jp I F 7:. W N M pp~~ I llJ A~ ,N .1A : ~~f, N N W M m t O000dEEE • • • a ♦ • • „ • ♦ • ~ ♦ - • • • ~ • • • to 6 p~ N r1 R 14 1. ' , S, w ~ p c ; I I'd (p 'm. G.! a Ito 11 J ~+i 'few! °_t N v b 4 E ; W [~O} RfNR~JJ m tl y•yy(( `~Q •(p! ♦N ' 4; N 00 4ryp1 1 +~,ly, 1 r 'iN ' i tl~ •D. ~ C2 iQ Q, rVI ~ d Ig f. R~ ,O 4r0 I 1\.. O, ~N _ r ~w i:i 12 J~1 O ' "it w A r ~ 12 • nm J, lr Alterations to i'LGW bU:NSOlt1AL 110SPITAL Construction Cost lstimate,5ummary, 1-23-75 1. Propramnod'Chongos (Rofor to Appendix I) • 4-19»73 10-10»74 1-23»7S A, SITE WORK ; l• Covered entrance and ramp for ;f Doctors and Outpntionts 531,500 $37,000 $ 2,000 2. New controlled access parking ±4 of lloctors and Outpntionts " 28100 340025 ww 3/• Remove Personnel Sidewalk 500 46 Refinish older buildings concrete, and limestone trim ..w 5,400 »w S• Walk paving allowance «w wr q50 8• FIRST FLOOR A 1, Relocate Autopsy and Employee , Locker Rooms 310500 400500 35,500 2.' Expand Administration and add , Board Room 100065 17,G00 8,600 13• RofurBish Private Dining Room, ; 2 S80 moo Z 4. Now Resilient Floor and Base 20 100 »w Si New Quarry Tile Floor and, + Base in Kitchen 100300 100300 6. Relocate Dir, of Volunteors 16600 16 s`t Co SECOND FLOOR is 1• ,outpatient Services Area r l8, 000 17790 146670 24 Library 11,440 S00 -f';•;36 Bspgenby Physicians OnwC012 (loom .w X20 E L 4• Mdielogy 6 31 140 ~l9 G2A 14 980 E l S• General ,Spaces.) -Blood-Donor-Room, Classroom, LVN, Storage) Future . Occupational Tharnpys oto. 7 480 6: Respiratory Therapy 96000 10,500 7. BKOUG 2,400 7$500 / 8. Physical Therapy 110500 12,600 2,200 w« : 9. l?quipraent Storage 10. Now Resilient F100r.and'089e 6,200 ww !Ml 11• New Door in.atair near outpatient Entrance 400 400 p. 171IRD FLOOR 8zpand Surgery Waiting 40000 l1~885 ~.300900 5uito and e x. Reno~ate~ Surgerj xpsnd ' . at itoctorso Lounge and Control 370600 39,180 19470 3. Ronovnto and expand Nationt li'in$ to 17 beds • . -60,320 511 j220 »y' 44 fiosiliont floor and base ' ..M 2#688 5. Expand l•C•Uo 17,500 . rrt~td~; rW IM rconstruction'Cost estimate Summary, 1«23-75 Continued raga 2 4.19-73 10-10-74 1••23-75 s, COM.YING 9QUIPrAlNT t ~ '34,000 X36,000 bed sized elevator .'i P, MECHANICAL, PLUMDING A'D ELECTRICAL , 1, Surgery Suite, now Air Conditioning 84,000 1090200 1081100 • 2, Surgery Suite, new electrical 60300 80190 100390 ; 30 Central Air Condition parts of 69,500 846750 920400 original building 4. Revise Main Eloctxical Service 10 000 156000 170750 5, Provide Compressed Air Outlets 9,000 in each patient room $,000 5,500 60 Provide exhaust air in Boiler Room 7. bloctrica: power to new radio- $,500 graphic equipment G, PROGRAMMED CHANGE TOTALS ' r iOTAL 434,485 629,178 420,420 E contingency 0 10% 430485 62,918 426042 _ 01 .,._r,.r~., ►~+1450 I "Contractors 7% profit and 5'k Overhead 52,181 75 5 50 TOTAL PROGRAMED CANSTRUCTION COST 5306511 7670597 $12,912 11. Corroction of Deficiencies to egqualxcurrent reinimum standards (Rofer to App , Corroct listed 1deficiencies • 112;435 204,700 178,925 11,232 200470 17,803 r v Contingency g Contractors 74 Profit and 5% Overhead 133 496 24056 4 21j47 TOTAL CORRECTIVE WORK 137,347 249,734 2186'269 1J. Movable Equipment (Rofer to Appendix 111) proposed equipment 708075 12,876 IV., Additional requiroments from join; z Ststo/rejoral Plan aoviow, 9 October 1971; g~900 96for Appondix IV for disposition) : r ' , `~14 ~ ~ ydr~ IW4pSUMptYa.w.+•e 1 r AI ga;, %no f" i res• Taft , 03istruction Cost Estimate Summary, 1-23-75 Continued ~rr age 3 r 4-19-73 10-10-74 1-23-75 TOTALS, A, Total Construction and r1 quipment V Costs (1, 11, 111 & 1V) .887, 658, 10 0960 306 7749076 13. Professional Design pees (at 10% of Construction and Equipment) 68, 786 1090631 74o408 Co Total Project Costs 734, 424 102060 937 818, 484 D.' Bill-Burton Grant 50% 367v212 i Hospital I+und 10%O WS, 442 440.864 ~ V'° , • ~.g~l/+~ "7D 3770 830 Z' Mquipmont requirementsi Urology X-ray System 20$500' j Radiographic & Fluor- "epcopy System 140; 000 MaMmorex System 30,000 1 1964500 i ~ 5?4,880 J ~f wSiYj>rnww~ r • M m OIA" i• Air 1 i ur All Altorati,ons to FLOW MMORIAL HOSPITAL Agri-NUIX I Programmed Changes ' As S ITWORK,. 40 1. Outpationt nn'trnnce ,a. Ramp and handrail Z 2000 .b. Delete Canopy 2. Delete Parking Area work from Contract. 3'. Delete romoval of Porsonnol Sidewalk. 4. Deloto cleaning, exterior stone $ concrete. ; * S. Add allowance for sidewalk from ramp to 750 parking area. Ss FIRST VLOOR: 1. Autopsy; relocate autopsy and employed 3 lockar rooms, y~5p0 a. Plumbing 5 000 b. Mechanical 21500' c. Electrical f d. Demolition 0 Architoatural 20 506 i f 2. Administration Area. I a. Deloto Board/Conference Rooms Iill 9a b. Now toilet room{ delete 1,500 rl,, conference service area, c. Now Administrator's Office; y1 S40 512 9 $I5.00/5P 5,100 Expand and refurbish Administrative ! t Socrotary 4 Hoooption area; 2 000 1ls '200 SP 0 t10400/5P N ?`I S. Delete rofurbishing Private Dining Room. 4. Deloto now resilient flooring and base In Lobbyj Corridors# Central Supply. kk • , wpns.^-" .,.,«.~d+cwiNa'' ' ~ - i~illdf1~k11t11fAYeWAwtarwra....,.4 . rc ,i L Ids x. s?? APPENDIX I Continued w' page 2 B. FIRST P600R (continuod)t S. Now Quarry Tilo floor and base in Yitcl}on, g 100 as Iloort 20600 SP 0 $3,50/SP , b. Bases 300 SI: 0 $4100/SP 10200 C$ SRC0I4,OARt 10 Outpationt Services as Delete entrance door and sign, b. Rocoption Aron; 240 SP 0 $10400/SF "2,400 + C, Waiting Room-, 610 SF 0 $ 7.00/SF 40270 d. Rostrooms 3 200 (1) plumbing 16200 (2) Mechanical j200 ; (3) Electrical 10 • (4) Demolition g Architectural 2j400 670 2. Delete Library/Reading Room 3., Delete On-Call Room. 4, Radiology as Dressing.Roomsl 80 SF a $10.00/SF 800 .b, Viewing Room,, refurbish and add countors, 1$2 8P 0 $10.00/SP 1 $20 0. Doloto Staff 'toilet, d, Doloto new corridor and two I dross"" rooms, as Delete new drain at Process X-Ray, f. Offices for Radiologist G Chief ?i' To4niciant 340 SP 0 $5,001SF 10700 g, Mammography Room; 272 SP 0 $10,001SP 21720 h. Nuclear Medicine Space and Isotope r ' Lab; 420 $P 0 $12,00/SF, $1,500 Exhaust 60540 alt; it Add Ultrasonic Spate; f 120 SF .0 $15,00/SF 14800 f• Add Special Procedures refurbishing (Soo also Electrical - P) 1) If load shiolding, allows $9,000 h ~2) if now finishes for clinical rocedures$ allows $30000 . . i 4 1 1 1 5~. I 1wo1W. , ' • `Jr,:w.,... .....e RiKiN.,r1Y#+~~1'~tiyi~~'..-, ' ' " 'Wrt*'^.u`1xc,.u...... ~ 1., , rsuane 1 APPENDIX 1, Continued I 77. Pago.3 " ` . CO SECOND 1'r.001t (Continued): S, Dol"O fill General spaces, 66 Doloto Rospj ratory 7horapy, 74 Doloto UKG/I',L?G. Doloto physi,caI'Therapy, .as 04 Deleto Lquihmont Storago,; 10, Delete xasilient floors and bases in other aroas, 116 Provide Door in Stair W4 to allow to qualify as exit from first floor. $ 400 i Do THIRD PJ,OOR: Surgery Waiting Areas, a. Main waiting., 300 SP.0 $10100/SP 3,000' f + b, Moditation/Consultation; 170 SP 0 $7100/SP 1 190 c, Public Restrooms, (1) plumbing 2,600 (2) !Jechanical 1,200 (3) Electrical 1,200 , f (4) Demolition G Architectural 1 800 2, . surgery suite A, Expand Cystoscopy; add'new floor and wall finishes and refurbish; 388 SP 0 $15,00/sP 40x20 b. Pxovida Shower in Orderlies, Dressing Area. 1;500 c. Provido aluminum and glass parti. tion for recovery Isolation area, 10300 d, Do16ta revising Equipment Storage, . ' e, Delete conversion at old Anesthosia Workroom to Storage. ' P. Expand old O, R., into Doetorst Li 1 1 Dressing; add now floors, walls 4 %F ceilings; 320 SP 0 $10,00/SP • 84 ROViSO control area G corridor to 30200 now Control, stretcher holding F, O,R, Supervisor Areas; 350 SP 0 ~f r ,h, Revise Doctors' Lounge to Doctors Dressing $ add pnssage to Surgery Corridors 265 91) 0 $104001SP 2,650 + Convort existing Patiunt Room to nootors Lounge; 200 SP 0 $56001SP 11000 f, Moto resilient floor and baso in + • , . other area, 41 JlT'I,.W wnK, ' .r t • OJNiC'NM'FW aYkei ' I "I'll 4`1 w„ APITNUIX 1 Continued rage 4 D. 2, Sur gory Suite (continued) { k1 D010to rofurbishing existing toraxxo floors and bases. polato now floors in Existing O,INs 13 and 064 r at1 Refinish and repair coiling work, *4'4 under now mochonical in O,It's ' 'i N1► 2 & 5 but dol.oto wall finishes 2,000 1 Doloto repainting other areas of ;y. Surgcvy Saito, o. Delete all now caso•work, e ► S. Patient Wi}gig " as Nurses Station 4 Unit Core Area (Dictation, Medication, Nourishmont► Lockors► gtorago),.with nll mechani• z cal plumbing, electrical 4 fixed equ pmonsj 1200 SF A ;154001SF 18,000 K'j b► . Convert existing space to six Semi- r" a private Rooms with complete toilets, (1) Rooms; 1122 SF 0 520,00/SF - 11,220 ( 2) Toiletst Y , (a) Plumbing 121000 (b)' 1•tochanical 2►000 {o) Electrical 30600 d) Demolition 4 Archit€ctural 11j400 (3) If plan changed to provide ' additional Isolation Rooass add c, Doloto refurbishing existing patient rooms, trAatmont 4 consultation. (By Owner), , •4.°~Deleto rosiliont floor and base at all other oroas, Y,. D► delete elevator and related work, ti, ty' p1 ' fmC1JANICAL PI.IlM0IN0 G ELECTRJCAL ' 1A ¢r { " 11 Surgery Suite; Air Conditioning with ventilation, temperature, humidity 4 °3a t. filtration controls, 99,000 Mechanical 9 100 b 8loctrical Power k , ,,y,y;,• „w,.,,.:~ak',n~Wyi~,O,MpJ' jrmypl`au;¢!,.'"r,~' '~~1SWM.4wtreMivst, 1 K??ENU1X X, Continued Y ?ago 5. FtRMANICAL, ht,WRINC & EI.GCTRTCAI4 (continued) I 2. Surgery Suito; Electrical Revisions a. lighting 8,190 s be Add 2 outlet§ in O,R's 010 20 1 200 ~~t 3 S 5; 6 0 $15U.OU ~ Add one outlet for portable x-rey E 3. unit at O.Ris kl, 20 3 $ i 000 f 44 $250,00.. j c' 3, Central Air Condition Original building (oxoept 2nd Ploor, West Wing) where none exists, (4 pipe plus fan coil units) ; a. Mechonical ~4~000 I be Condensate Drains (from Ian coil units) $ 000 c, Electrical (with 14 be above) d, New coilings under now piping and ducting 3 400 j .4. Revise Main Electrical Service Q. Electrical 15,600 be Ventilation 20000 I c4 Enclosure S. Nlete compressed air outlets in patient rooms, 15, b, Provide Exhaust air in Bailor Room# a. Mechanical 4,500 be Housings • l 00~n`"" + 7.. Add electrical power to now equipment in Y,.. Cystascopy, Mammography, Nuclear Madicino and Rs:diology SpeciAl procoduros Room, All to conform with equipment manufacturer's g 500 ,+,tt information. ' $•420,420 A?rttNnl X I To'rAl + Added since previous estimates. i I ro _ f etcaM,.,. ,,,I..I~w;Y~ ~Ikt1~P~`a'4mip+ iiY»ANv~,a•„iww.a.w.l.,.,.... x ~ 1 f + Alterations to PLOW bL ORIAL HOSPITAL APPLND1x 11 I Corrections of Doficiencios-noted on Joint State/Podcrnl Survoys, March G, 1973 6 and Juno 20, 1974, and noted in Plan Roviows, Juno 20, OcLobor 9 F, Docombor 3, 1974 ~s and ldiuimum Stnndnrds of.Construction and li~ui mont for Hospitals and'Medicnl ~S FaciA1.t eJ, liIV. U U, 19740 i.r Al Doors: 1. Delete replacing existing •1.1four doors ' with 1.1/2 Hour doors. a. State has waived replacement of stair doors. b. Other doors to be by Owner. 2. Delete door at Emergency Treatotent Room ' (By Owner), 3 E, 3, Doloto doors to dumbwaiter vestibules P.. I B 0 r Replace Uumbwaitor oponings with 1.1/2 f Hour rated doors and frames. I ! 94 flatorial: 450 cat x 3 1$350 975 b. Installation: 325 oat x 3 to o. Patch 4 Ropairs 150 eat x 3 p' 950; 6P t + + , B, Piro Separations= Provide 2-Hour rated partition as separation whore exit distances oxcoed 100 foot or where building abutts lesser. fire resistance -voting, #F`4` 1. Partitions: floor to structure, outside wall ' to outside wall; $0 LP 0$25,00/LP 24000 t 26 Doorst 1»1/2 Hour rated door at any ponotra- tion; self-closing or olectro-magnetic hold- open with closer. 50b/loaf x S "500 t ' ft n • 4ob C.. Smoke Col;ipnrtmentalixation; Provide 1-Hour rated j; partitions to :rake areas not to exceed 221500 SP r with no dimonsion over 150 feet. i 1. Partition-''floor to structure, outside wall }I to outside wall! 250-LP 0 335000/LF .3,750 26 Doorst 20 minuto+ratod or 1«3/4" solid core 'wood with visio:i panels, tsolf-iclosing or"oloctro» ,f, angnotle hold open with closers, pairs shell have each loaf swinging in opriosito directions pair Corridor Doors. 7 pairs 0 $750.001pair 50250 x v. 1-0 tq tqt ~ • APPENDIX 11 Continued " . Psoo 2 1 , Co Smoke Compartmontalization (continued): 2. Doors (continued) t b, Sini;lo doors and non-corridor doublo doorsl 10 s, $150/loaf. 1,500 c. Mlodi fY Stat'o.accoptod existing corridors to CIM 0 fusible link to oloct.ro-magnotic hold-opnn; 22 at $150/loaf. s, Soo 3, Mlodicaro/Mlodicaid interpretation in liou of Ilill-Burton interpretation would add approxi- eaately' $10,000. • . D. Plaster and Drywall Pire Protection and Corridor, Separations. 1. Repair and add 2••11our plaster ceilings pt j Miechsnical Equipment Room, Boiler Room arid.' I 100 Central.. Supply. 50000 2. Extend all corridor partitions to structure abovel 1-Flour rated, S 000 ' A, Delete removal mid replacement of combustible coiling tilo with non-combustible (9yOwnor),'. A. Delete removal and replacement of non-conforming plain glAss, gloss frames, doorsi louvers, and ' combustible finishes except Gift Shop noted in 11, below, (By Owner), w G. Delete work, on stair handrails, H, 40ireproofing of existing l-story steel 'frame structure at Main Sntranco, Lobby, Gift She , Chapel, POX, Information D'osk, existing Adli- strator's OMeo, and parts of Dining Room 1. Now 2-11our acoustical coiling at all except , Dining. Room; 30000 `SP ® $2,501SP y,500' 26 Add spray, fi'ropxooting to existing columns and repair finishos► , 36000 3. Modify fighting And mechanical systems to L • work with now ceilings; 3$0008V 0 54600/Sp " y 121000 t 4. !lake arcs in, repair said refinish Dining Room Ceiling; 10800 SPA $1,UU/SF 11800 S. Replnco plain glass in aluminum frames with wiro glass in,stool frames-at Gift Shop,., __14300 tk'~' i~, d AH•,~11~k tlrvkd• IQ 1 v Ai'f~'NU1X YY. Continued • . , Page 3 , f; 14 Provide extra lighted exit signs on omorgoncy circuits so that 2 signs aro visiblo from any ' point whon smoko doors closed. 1. Wlote work at t(Ik existing construction ' (By 0+,•nor), 2. Provido oxit lights at each side of now corridor smoko doors and firo doors; 9 x 2 a 18 x $200 30600 J, Uoloto omorgoncy oloctrical outlet in patient rooms (By Ownor). K. Roviso supply and return air ducting in Corridor 4,000 near Lmergoncy, 1 1+950 III 4. Roviso Nursery exhaust air, y, provide vacuum outlet at each new patient rood at 3rd Ploov « included in patient room costsi I( polete all' other outlets. I , Ni.:amoxgonoy Gonoratoxt 'i 1. Additional Generating Capacity, 150 lWA 2$,000 New trattsfor swi'tchos and controls. 90300 i ' 36 puel upk, vesit and piping. 30000 + 4, Additional !switching and wiring to Boilers, g 004 • land fan's to vAintain heat. in rewired areas, 1,000 0, 'Ale m and Detection Systems: 1, Revise existing alarm system to add pull . *•'~t..stptions`and detectors whore required. 25 000 E Roplaco monitor and control systbms, j 2, State Waives req'uiromont for detectors in corridors and waiting areas other than Main Lobby, r3• Add detectors at all air handling equipment throughout building. a, Moahanicn,ls X10 x $115/e8ch 4,600 b, Hleorricalt 40 x $100/each 4 000 0 ~ + Yontilate Surgary Anasthosia Storage. 2 500 * Q, Add fire and smoke dr,mpors throughout , hospital :or smoke 'find fire sorarations 20,OQ0 and at hazardous areas. 100 x $200/each ~s r ,44 a r 1-. NrpNU1X 11 Continued Paso 4. • a. Gift Shop storage area td have 2-11our partitions 20500 1«1/2 flour doors and sprinlclored, • S, Provide 1-11aur partition at Kitchon (1-Hour doors provided by Ownor).. 1,500 • 1'4 provide flow alarm and automatic fuel/power shut off for Kitchen flood extinguishment system. In -Alarm and llotection Systems cost (04 abovo)•, U. :ovido Bquipotontial grounding systems and isolated panels. i 1♦ 1444114 3'500 2.' Surgery A 000 1 :OP$Nazx 11 TOTAi, $ 178,925 i ' *.Added since previous estimate. : 1. ' ' 'r . I • 111 'i'. 1 \ l 10 , ~.~Ln M" W0.~t r ~ ~}"'~d+~F1k1k1ll~GYr81.ISM1/J4\Ja+w vw....:.. Fv r •~R.\4C P~l a. ~S~y 1 . Altorntions to ' FLOW bIEMORIAL HOSPITAL 'AMNOXX.III N proposed *vnbla Equipment List (Pixod i:quipmont is includud in Construction: Costs) Aa ''FIRST PLOOR-, is Autopsy TWO compartment, side opening refrigerator,' 5,000 f 2a Administrative Area. a. Reception; s Chairsi 2 0 $75 ISO End Table 100 Lamp 75 ba Administrator's Office Chairs; 2 0 $100 200 End Table ISO I►'' Lamp • , a 75 ca board Room/Conference. Room deleted, 3 br 5BCONU FLOOR; I 1a Outpatient lfaitin Chairs, '11 $75 025 : Couch, 3 8 $400 10200 Coffee Fable 150 End Table 100 Color TV 400 Lamps, 4 0 $75 •3Q......., 0........ t + ry~p 2a 'Delete Ronding Room/Library, 3a-.Deleto Outpatient Reception. • 46'1 Daloto Conned bressinpa 5a delete Radiologist Office, 6a Radiology Film Viewing Room. Chairs, 2 0 $50 100 Qa Nuclear Medicine r' a) Portable Xenon exhaust unit 250. ~b) puma klood changed to exhaust system and xddod to Conoral construction:. Soo Appendix 1a 9a Delete Classroom, loa Deloto LIM Ili Dolote Physical Therapy h , 4 , l • ..X~ ~y#LY"'4r'1i:VFtil~{'Vi~E~hry!P.''..,T'. ~RRM A~ItKYlsSfrNN PON'niil'.x.. r..._.,... J )v I+.1. V ! 10 } t I ai 2~ APONUIX II'I Continuod Pago 2 T111RU rr.oon: i if Surgory Waiting 400 Couch 720 Choirs, 12 0 $69 { End 9ablos 2'0 $65 130 ; Color TV 400 Lamps, 2 ®$50 100 24 Modi.tation/Consultation 400 Coach 450 Chairs, 2.0 $75 I50 Coffoo Tablo 50 t Lamp 5 , S# Doctors' Lounge ` 400 Couch # Chairs, 3 0 $100 $00 ; ~ I50 Coffeo Table , i Color TV 400 ! Lamp . 60 u t Delete Nurses Station. , medications Pixod oquipmont added to construction costs. APPhNU1X lII TOTAL S 12,876 y 'how *0v WOO I l 't r, AGENDA FOR JOINT MEETING FJ/OW HOSPITAL BOARD AND CITY COUNCIL pY April 28, 1975 f7100 p.m.i i 1. Review expansion plans of Flow McMor.iai Hospital Board F~ 2. Discuss ways and means of acting on financial assistance 3. Other matters that may come befAre the Board and City j t ~ ~1 ~¢uncil t NOTE: Meeting will be held in the,Civi1 nefebse Meeting Room t l06ated at 215 E. McKinney Street, Denton, Texas, f f' j ~I { Y #AVI V LO~N YIV v W tit lA 1310 ,SCRI EXAS HOSPITAL 1 ~ y~~ Q~~'S GEXAS 76201 1 S' T 0: Officers and Members of the City Council and County Commission f of Denton FROM; Julian Wells, Administrator, Flow Memorial Hospital { SUBJECT; Hospital News Memorandum s Gentlemen; We all recognize that the Board of Managers represents the direct body of the hospital and most of the policies and Internal problems lieewithin the responsibility of the Board and the Administrator. However, we feel that you, as the ultimate governing body and taxing agency representing the pub- 11o, would benefit from some general information concerning the hospital and the trends In health care In this country. I am, therefore a few comments with various attachments for your personal use, ing on to you I. HOSPITAL EXPENSES, The attached graph and statistical data report from { the American Hospital Association reflects exactly what we have all been say- Ing about the economics of the hospital in 1970. You will note that patient days fell, thereby reducing revenue and, particularly, that total expenses increased 18,1% over 1969. % 2, MEMORANDUM FROM ADMINISTRATOR CONCERNING ANNUAL AUDIT, This memo is self-explanatory and is further substantiated by the comments under.#l. 3. QUALIFICATIONS CONSIDERED IN CHOOSING MEMBERS OF HOSPITAL BOARD. Based on the research of considerable data furnished by the American Hospital Association, the Joint Commission on Accreditation of Hospitals, and the American College of Hospital Administrators, the above document was'pre- pared far your consideration. 4. LEOISLATION AND PROPOSALS FOR NEALTH CARE, Being in public office, all of you, no doubt, will be born bard6d with many questions concerning health ` Core legislation that will be pending within the next few years, particularly relative to national health insurance, It might be well for you to familiarize yourself with some of the panding proposals now being considered In Congress and to be Introduced In the near` future. These are (1) the Kizer Plan, (2) The Walter Ruther Plan, (3) National Health Insurance Act by United States Senator ti«yy'~~~1{~7,~KIL:56:AYk~t,ariW.lwfN.~fw.hi•...:wrv .v +W I' e} Hospital News Memorandum WSW - Page 2 Jacob Javitz, (4) The Ameriplan by the American Hospital Association, (5) the Medl Credit Plan by the American Medical Association, (6) The , H.I.A,A, Plan by the Health Insurance Association of America, (7) The { C,N,Ii,I, Plan sponsored by the A.F',L„ C.I.O. and the Independent United Auto Workers, and oo-sponsored by Senator Edward Kennedy, Any or all of these plans may very well remove the problem of financing indi- gent care on the local level and place It In the hands of the federal govern- ment. This could have considerable bearing on future budgeting to both the ' City and the County. I will be glad to prepare a memorandum defining all of these plans if there is Interest or need among you for this information. 5, HOSPITAL LITIGATION, i i T~ A. Along the lines as mentioned above, there Is pending at the present time, In federal court in New Orleans, a suit prepared by the Office . of roonomlo Opportunity on behalf of a group of b;aok people; The suit claims that they were denied care at a state supported hospital as well as several other hospitals, all of which had 'received Hill- Burton funds, which, therefore, made them liable for the care of,Indl- gent, This suit has not gone to trial but could have far-reaching effect on many hospitals, particularly the non-city county or govern- ment al hospitals. B, The Fifth U. S, Circuit Court recently reversed a case In Dallas in which one of our neighboring hospitals, Brookhaven, was ordered to pay $440000.00 In back wages to female employees because they were discriminated against for being paid less than the male orderlies, C, We are happy to note that a Baltimore Superior Court has refused to hold John Hopkins Flospltal liable for serum hepatitis contracted by a former patient from a blood transfusion, There was a previous suit a few months ago in Illinois which held that the administering of blood was an act of a contract of sale of a product and forced extreme liability on hospitals for this exposure, D. The Supreme Court, as well as other courts, both natlonally and in Texas, continue to affirm that doctors of osteopathic medicine must be allowed to practice In city-oounty and governmental hos pltals if they meet professional standards. That is to say the mere fact that they are an osteopath Is no basis for refusing them the right to practice medicine to these hospitals, E. Wage and Hour Law Litigation and Bnfov ,ement - Both In hospitals and private Industries, we are seeing a trend for rigid enforcement of the wage and hour law by the federal government, I would advise all who are involved with employees under this act to keep abreast of the requirements and have absolute strong documentation Concerning hours worked, i ,III WAM* Hospital News Memorandum Page 3 99 4 j It is hoped that the above information will afford you with some Insight to the currant trends and activities In the health care field. Through my direct con- t8at in the health field, as new Information and leglsltation develops in this area that will be of interest to all, I will forward a summary report, if Julian 'W'ells, Administralcr JEW; 1b • }aM1 E ' 4 r~+ . 1 11 W0101114111*4 41e•r'+. 'Ve low ADM IOSIONS E}:PLENSES A8 76 ~ 'i 1970 198@ 84 a 70 1070 f e2 tao9 414 TOTAL EXPENSES. x ao 60 PER ADJUSTED PATIENT DAY a 78 00 PAYROLL. EXPENSE'S 78 - 00 PER ADJUSTED PATIENT DAY 74 40 1970 ADMISSIONS PER DAY 40 J F M A M J J A S 0 N 0 J V M A M J J A 8 O N O TOTAL ADMISSIOI tS FOR MONTH TOTAL EXP1iNSMS (IN THOUSANDS) FOR MONTH Sept, Avg. $4 hod $lu Sop1, Avg, sept• q Sept. Aug. 9e01, 844 $Ito UPI. Avg. Sept. 1970 1070_1960 Cetcuory 1910 1970 1969 g 1970 1970 1969: If Cotegery 1970 19y0 1969 1 1561814 1671750 157,140 0.24 18466 .28,408- 261258 q$ 121,015$ 124,1611102013 6.24$ 1,1656 12,0485--4.248 493,810 450,748 46 . , 12{,4 99 69 004 70,910 62,671 60.748 419,042 26' 40 109587 174,39 l 161,110 2 310,05 315,W 3 387,800 343,977 353,604 60. 09 322,126 340,949 333,066 3 217,223 211,189 182,165 60. 09 301,982 281,619 1400144 f 4 467,490 400,864 401,077 100.190 617,670 604,313 600,40P 4 349,640 340,370 005,013 100.100 320,695 320.212 271,911 1 8 172,500 182.182 105,793 200.200 430,046 484,130 450,102 6 83,346 e3,783 71,101 90400 282,647 207,699 200,472 8 251,817 230.160 SD9.600 300.309 340,843 300,034 304;637 8 134,003 134,720 100,780 300.395 204,209 ° 214,066 209,151 7 237,014 272,774 241,022 400.499 229,630 288,120 218,421 1 120,281. 125,410 10,449 400.499 181,613 774,906 146,680 103,132 101,210 104,324 boo A. 386,120 3601214 324,079 8 63,102 811652 $1,311 So+ 416,311 411A80 031,439. 0 364,0{6 $30,012 202,978 0 241,614 264,24t 105,112 21478,978 2,600,111 2,303,740 _ 2,478,076 209111 2,303,740 $1,718,702$1,717,891441,442,610 $1,116,10251,711,661$1,442,610 f of 98.3 per cant during the eight-year period WAS Increased utilization and personnel, together with noted, „i rises in the cost of supp)ics, equipment, and fad!ttles, 1 As utilization lncrens4u4 over the elght-year period, have increased hospital expenses; Total expeusos have I so did the number of hospital employees, During tho reused 18.1 per cent In one year %y on ,e_11'r3 I period, full-lime equivalent personnel bwreased by quocter o • ' g com seed w t1 ftQ scone peeled ~gi 81.4 percent, Reflected In this figure are the oddl- 1BO~t is important to no(o t et nonpayroll expenses if tional personnel hired by hogpttaia to operato hospital 1ave ltlcressed at a faster We than h6vo pnyroll ex- i services which have increased in complexity and pauses. Even though hospitnl salaries and the number number, of employees hava incrensed, the proportion of pay- roll in the total exponso is dropping slightly, s 104 loo BIRTHS , 'F47AL BIRTHS FOR MONTH 98 Sept, Avg Sept bed size Sept. Aug. Sopl. 84 1864 1970 1970 1060 Cologeiy 1970 1970 1969 i' 4 1970 1 18,101 17:55 17,700 a- 24 905 0203,144 4l% 2 53,034 61,603 4000 25. 40 71,818 1101 14,774 90 44,227 44,623 41,000 Co. Do 35,112 38,319. 33.072 ` 3 4 69,907 69,40 606c3 10•16J co,9c9 42,342 e1,103 60 6 20,023 10002 24,200 200.259 60,116 69,151 68,212 iD OG 0 22,693 N,51.4 10,2:6 300.10J 44:40 43,118 0,803 6(RTHS PER DAY 1 27,165 KOH 24,N I 400.409 PAO 20.431 90,199 94 8 10,102 1411DR 10300 Sol. 60,023 60,048 41,329 9 41,SC0 41,090 he 15,217 257,910 ¢76020 J F M A M J J A 8 o N 0 30 HOSPITALS, J,A,H,A. «I , o 17 OCCUPANCY FiATE OUTPATIENT VISITS 64 {770 ^ 390 1970 1 A ' z 380 'i p 370 360 y n1989 ~ I a 70 y 360 - 1889 18 ? 340 2 t S 330 320 72 OCCUPANCY RATE c 310 OUT P riENT !SITS I ! i 70 p I 1 ! I I 300 , 0 J F M A M J J A 9 0 N 0 J F M A M J J A 9 0 N 0 NTH OCCUPANCY RATE FOR MONTH TOTAL OUTPATIENT VI5178 FOR MONTH t Sept, Aug. Sept, Sept, Aug, Sept. 1910 1970 1969 cod silo 1970 1970 19,69 Q$ Sep?, Aug. Sepl, god Sloe Sept. Aug. Sept. f9 y, ye e ye y e7 1970 1970 1969 I ColeAarY 1970 1970 t969_ I _ % Cob9nty 6A 84 I 78.6 77.2 78,8 8.94 4019 68,0 51.3 1 000,201 958,763 638,018 I, 6. 24 116,365 112,091 118,678 2,611 1 2 81.0 80.7 80.3 28. 49 6410 0311 66.4 2 2,136,630 2,781,819 2,610,617 40 712,872 872,231 620,231 k,141 3 79.8 77,8 78.8 60-0 86.4 61.6 0914 3 1,766,622 1,710,001 1,373,368 80. 00 1,320,018 1,287,001 937,810 1,111 1 76.9 77.6 802 100.109 75.8 73.4 75.7 4 11391,274 21330,437 2,180,161 too-100 1,120,100 2,058,661 `1,820,244 1 0'172 8 80.2 003 80.0 260.209 8015 763 79.0 5 674,871 535,638 640,389 200.299 2;421,017 8,080,758 1,906,121 P,161 6 10.4 09.2 74lB 300.300 78.1 NO 8017 0 851,800 807,258 1100,161 300.309 1,741,950 1,766900 1,018,100 !r 86l 7 14.4 73.8 74.6 400.100 81,6 8010 838 7 1,041,126 140,431 803,850 400.40D 1,116,101 1,92,790 802,844 14 6 71.3. 68.6 86.2 600 } 814 611 80.3 8 310,630 330,030 221,511 600 2,600,811 2,800,718 2,239,098 688 6111 708 0 1,886,080 1,244,303 5,422,863 .110 1A.D 0 18 76e 76,7 lea f2~ 18,A2RU,307,16a16,o73,laa 12,103.01o1s397,1865491a,143 i 6th les, eve TAB-LE-.EIGHT•YEAR SUMMARY OF THIRD QUARTER DATA FOR COMMUNITY H8§PITALS Ird Poe 64IIt Per cent tot dtrence difference S9s 1888 1064 1909 1960 1889 1868 1060 1010 1090.1910 1608.1970 ex. hods (tllousand3) 698 112 726 140 167 788 798 881 * 4,1 + 19,0 ber Bae,iinots (thousands) 99 99 08 00 04 93 02 03 + 1,1 W '6,1 AY. Adm16s1ons (thousan(14) 0,626 6,666 6,080 6,834 6,808 9,024 7,147 4,836 } 0,8 + 17,0 a Npntlant days (thousands) 47,616 48,027 40,466 62,203 63,601 66,860 65,868 67,986 8,8 21,8 { Births (thousands) 960 938 876 842 820 826' 847 906 * 0,8 - 4,7 Newborn drays (lh6usand5) 4,180 4,OOD 31804 3,870 3,696 3,680 3,632 8,780 x.4,1 9,6 0011stlont vielts (1housnnds) 20,082 22r031 23,378 26,168 27,061 28,630 30,668 36,411 }i6.6 } 78.3 Surgical peoeedules" Opt, # (thousands) 31127 3,170 3,211 a,888 3,343 8,421 8,606 3,688 } 6,2 + 17,9 969 Mull.tlmo personnel 8141 (11101130nd4)., 11140 1,181 1,234 1,801 1,420 1,600 1,610 1,608 -h 8,0 * 48.8 4,114 Port•time porsannel m2 (thousands) 208 271 202 323 362 400 428 480 8,9 •L 13,0 t.163 ll'uli•timo egnlvalenl 1 j p^raonncl (ihouantuls) 1,274 1,327 1,300', 1,402 1,601 1,700 1,184 1,020 £1 31,4 1'.lyroll 0spcnsu ~.1b,6 140,2 also 011111bus) 1,231 1,324 1,464 1r016 2,061 2,37g 2,050 8,008 + l,3ao `alpnyroll aspenaa (In11110113) 743 813 878 1,020 1,101 1,388 1,110 2,000 -p22,1 4.182,6 _ 1'0h11 esp:nae (11111110110 1,474 2,137 2,332 2,701 3,222 3,701 4,870 6,107 +18.1 {161.8 01'1 ~'neelnninp with J,rna ?r). 1970. the NnNount tlo.,pltid 7'nnrl .gWY1Y 6nr collouh.l 1be ni.rnber of eur,rlenl operattons tether than tur¢Ield yro o~lur-% I,A, oECIMHA 16, 1970, Y04, 44 31 1: 7rftvm UA 1' CA'f1o S_M CONS ~ IN cI-tCQSIN( MEIfLgj2 CAF AQ~ PITAL P-QMti). i' i i PERSONAL QUALIFICATIONS The board Is a deliberative body that must, in the best interests of the people ' ,r it serves, reach a consensus and make decisions on crucial matters. It is essential W for trustees to maintain a spirit of cooperation in working toward the achievement of legitimate goals, even though at-times they will have differing.views. Not all members It. possess the same qualifications or possess them In the same degree, It is the "mtx" 41 ` of various personalities and qualifications that produces a socially, as well as proles it sionally, dynamic group. Nevertheless, there are basic qualifications that should apply ~I generally to all board members or potential members, f i I Individual trustees should possess the baslo'qualities such as honesty, Integrity, a sense of justice, and a sound moral character. Recommendations and references can provide some basis for judging whether an Individual possesses these qualities, before he is . actually approached for board membership. A. COMMITMENT TO COMMUNITY HEALTH AND WELFARE, The Individual board member should be committed to serving the community, and his past activities and accomplish- meats should evidence this commitment. Although his previous accomplishments may have been In other fle)ds, they should indicate whether or not, he has a potential com- mitment to quality health care. Further indications of such commitment are the lndlvidUal's willingness and ability to devote the necessary time to board activities. Monthly board meetings are only part of the activities that board members must be involved In In order i~ G to function effectively. B ABILITY TO CONCEPTUALIZE. Issues concerning the delivery of health care are s not easily reduced to simple, concrgte terms. The individual board member needs they ability to think abstractly, both In terms of the present and future plans of the hospital, He must be able to visuailze possible outcomes and measure them against forecasts, IW ~Qt . ~4.. MfNMUi....a.iF4111 , !.{'9N6 I Mill Qualifications to Consider In Choosing D1embcrs of Hospital Board Page 2 Ff~ a9t be able to look beyond the present to the future. Co A BROAD PERSPECTIVE, A board member'must be able to view the entire hospital l'~• operation as a whole, He must realize that decisions made In one sector of the hospt- tal have an impact elsewhere. An individual who has had little experience in dealing with such broad concerns will need considerable orientation to the breadth of his new position, In other words, if an individual has had a somewhat limited social and pro- fessional background, it is doubtful whether he Is ready to function as a board member," i t D, TRANSLA'T'ABLE EXPERIENCE, An Individual brings to the board the sum of his j past accomplishments and activities. Although he need have no previous e:~perlence with a health facility, the experience he has had-be It managerlal, technical, profes- 'r sional, etc,-should be translatable to hospital operations. Obviously, past success is essential since there must be some evidence that the individual can carry out his i duties effectively. In addition, any past experience of serving on boards of other organizations Indicates that the Individual Is at least familiar with the board concept. E. OBJECTIVITY. Although objectivity Is difficult to measure or predict, it Is a quality that a boar(: member must possess. The individual board member must be open- minded about necessary Internal and external changes, His record of Innovation In his previous sphere of activity will give some Indication of his receptivity to change. As stated previously, the board member is prohibited by law from using his position to I seek personal gain, In addition, he must continually guard agalnst the consolous or unconscious attempts of others to "use"' him for their personal gain. This kind of prey- i sure may come from either Inside or outside the hospital, j P. AGE, When considering the criteria already suggested for selecting board members, 1 one might erruneously conclude that only those who are maturo in chronological age can qualify, A board needs members of different ages, just as It needs a diversity of back- x. 1 ~gi9y ■ i Qualifications to Consider In Choosing Members of'H`ospital board cage s grounds. Youthful courage and enthuslasin are needed to cope with the inevitable change, while, at the•same time, the experience and wisdom of those who have en- countered similar problems over the years is likewise essential. In short, the board ask must monitor Its own "age" In order to maintain new blood, new Ideas, and youthful It r~ vigor, all of which are necessary in meeting new demands for health care. G. CONFIDENTIALITY, A hospital is an Institution in which' indl'ilduals are asso- ciated In a very personal way,' Consequently, much information of a personal and con- members fldentlal nature must be interchanged, and, frequently, individual board become the recipients of such information. As a result, board members must be able to maintain confidentiality In these situations and avoid the tendency to carry such E ~ t information outside the hospital. Granted that a'quasi-public enterprise such as a hospital is obligated to give public accountability; nevertheless, there is much confl- j dential information concerning physlcla.ns, patients, and others which should remain within the confines of the board room, ~ i 2. PROFESSIONAL QUALIFICATIONS A number of factors can be grouped under this heading, Some are directly related to an indioldual board member's vocation or profession; others represent incidental by-products of that vocation or profession, Some of the professional qualifications that are necessary should be required of all board members, Others are required of only / some of the board members and contribute to the professional "mix, I~I ttI ~ 1 Different professions have varying degrees of status and prestige, Consequently, individuals representing different professions possess varying degrees of personal Influence and power, it Is Important that the board retain a balance of interests and ' personalities so that no one Individual or profession exerts an Inordinate amount of r. Influence. Such an Inbalance may not always be in the best interests of the hospital k t .,~9MF ' ".1. ?aaliflcations to Consider in Lhoosing Members of lo'spttal uoarc raye 4 t, or the patient, The professional qualifications listed below provide a broad base of potentially is useful talents to a hospital. It is not Intended that all of the professions listed must y} be present in order to have a well functioning board. The needs of each health care facility will dictate the need for the presence and degree of specific professional skills, s` r A. TECHNICAL COMPETENCY, Hospitals are complex institutlong "and they require a wide variety of technical competencies to achieve their objectives, Some of these competencies are directly related to the hospital's primary goal, while others represent d skills that only Indirectly support hospital goals. If a board is to be able to adequately 4 I ~ i review and evaluate hospital operations, some of Its members must have In-depth know i 'r lodge and competency In certal;1 areas, while the remaining members must possess II ~ I basic minimum knowledge and competency in these same areas, In some cases, board I members will have to acquire this basic minimum, knowledge through orientation and E Continuing education. I. HEALTH CARE COMPETENCY. Since health care Is a fundamental goal of the hospital and since the board is responsible for maintaining high quality healthcare, It follows that Individuals who represent health professions ran contribute greatly to such a function, At least minimal competency In health matters should be a general requirement for all board members , All should be familiar with the health issues of the day and the health needs of the Immunity. Thus, in-depth competency on the part of some members of the board, together with a basic knowledge of health Issues on the part of all board members, Is essential, a. MEDICAL COMPETENCY, The health care facility is an institution In which medical care is provided by practicing physlblans, The physiclan Is the key figure in the pro- vision of quality care In accordance with the objectives established by the hospital's , J~ ~Ud1R lCdllV (Iti lVVIIII:ilUtlt 111 VIIIJVuIIHJ av,l;,II1JCa ;f vt ia11'o NtlU .t iVUtu •r+vv ~ F j board, Because of the physician's Importance to the operation of the hospital and because of the board's responsibility for quality care, it seems Jr.sttfinble td include ~r a'physician(s) as a member of the board. His contribution as an active practitioner will help the board recognize the important role that medicine plays In a successful } health care facility, However, as with any other individual selected for board mem- bership, the physician should be chosen for v ;lat he can contribute to the`instltution, at this policy-making level. He should meet the same criteria for membership as any other individual being considered. The basic question that must he asked is. "What i 3 will this person contribute to the Institutional goals In addition, since the board chooses Its own members, it would be inappropriate to allow any group other than the r board to make the final decision In this regard. b, COMPETENCY IN OTHER HEALTH PROFESSIONS , health care Is no longer a one-man activity. It requires the services of a wide range of health professionals working cooperatively as a cohesive unit. Therefore, health professionals other than physicians could also be included on the board, They can make valuable contributions in many areas,, I Including such things as community need, evaluation of prolesslonal health care, and need for additional manpower. Other professionals that might be represented include those' involved In health planning, public health, home health agencies, or any of the related J health professions, It. EDUCATIONAL COMPETENCY, Most hospitals either participate in or conduct formal education programs or, at least, conduct Inservlce or continuing education pro- grams for employees and physicians, As a result, it is extremely valuable to Include an educator on the board, Not only can he assist the hospital in reviewing Its educa- tional programs, but he can also provide competency in ant area for which many, although i having been exposed to its benefits, may lack an appreciation of its continued tinpor- R Rk 1".RrJ.M MWY10?.1A:.rr... w)gy'.y.l p;u(y/rAf~nWlar~YMMwWi....nu r..... • q i r. NAM] r ' . sing Members of Hospital Board Page & Qualification: to Con~tdor in Choo H tance. In addition, the presence of an educator on the board is desirable because t fAanY 'ssuos in the field of education have parallels in the health field. i ITI, MANAGERIAL COMPETENCY, Managing a modern hospital Is a project of con- i aiderable magnitude, Even though the chief executive officer has management training 4 and experience, it Is desirable to have a board member(s) who Is skilled in management sciences, knowledgeable about organizational patterns and new developments in manage- ment sciences, and recognized as a management expert. Moreover, since there is a need to constantly develop executive management personnel in the hospital, a board member who is qualified in the broad areas of management and/or management consulting j1 could contribute greatly to the Improvement of the quality and practice of management; In the institution, f IV, FINANCIAL COMPETENCY, Because of the fiduciary responsibility of the board, I all board members should be minimally competent In the area of finance so that they can Intelligently consider such issues as the financial solvency of the hospital, invest- ment decisions, financial statement implications, budgeting, and capital fund require- ' F tnents, In addition, the board could Include member(s) who are competent In this area by virtue of their training and background, so that In-depth review of the hospital's , financial status can be achieved. Of course, the hospital shduid employ its own finan- elal experts, but the board should also possess the necessary financial expertise. Otherwise the necessary checks and balances will not function properly. V, LEGAL COMPETENCY, Hospitals r;ontlnually face new legal problems, both of a judicial and legislative nature, Even though the hospital retains Its own legal counsel, an attorney on the board can help to keep.the hospital abreast of existing and potential legal issues that could affect Its ability to reach its goals, It seems inappropriate for the same attorney who serves as legal counsel for the hospital to serve in the additional capacity of board member. The attorney who serves as a board member need not bn 1 h AIM quait tiCaftons to uoiisiaer to inoosincj yvieiiiuers oftjospitai unara rage i I y oriented to health matters initially, but he can be reasonably expected to increase this I. kind of orientation as time passes, VI, ENGINEERING COMPETENCY. Because a significant percentage of hospital k resources is Invested In the physical plant, an individual who is knowledgeable about? and skilled In engineering and maintenance problems is a necessary component of the board, Even though mayor construction is normally undertaken only periodically, there is a continuing need to assess the adequacy of the physical plant In the light of new services that are developed and new demands that are made, In addition, the need for t remodeling and renovation Is recurrent. Given these obligations and the added diman~- a 4 f sion of patient safety, an engineer could be inoludpd on the board. i VII, ADDITIONAL COMPETENCIES, As time passes, a hospital may require addi- i tional competencies of its board members, due to changed goals, new activities, f i f ehanged'community conditions, etc. A board should constantly wises these needs i r f and, as vaoanoies occur, supplement the competencies mentioned above by adding new members who possess these needed qualities, i E In some situations, the technical oompeteneies mentioned :.above may not be available outside the hospital environment. If such a situation prevails, key personnel who possess the competencies needed can either be asked to serve on board committees or asked to attend board meetings whenever an Issue requiring their particular expertise is being deliberated. In such a way, the board can obtain professional advice'on sub_ Jeots on which there Is Insufficient board expertise, In other cases, the board may wish to seek the advice of a professional consultant in regard to a particular problem, The wise board, although constantly seeking to obtain the necessary competencies by appointing board members who possess them, will realize Its own limitations and know when to seek outside counsel, f , • N ~yp?hlli8~11iY¢i1}KN' "*yy~rti~, •yp~~Ar+a}N. v►».aw+u"w'm` . . , n t rY'~ 1 MA"I I WualllLCdtwns LO t,,'b'n lUUt in ItuOgYn(j 1Vw1'1CUUiJ'u1"11ubNuu1 uvaiu iayd n I . ~t B, MANAGERIAL EXPI?fiIENGE, Strictly speaking, a board dons not manage, It hires a chief executive officer to perform the management function. In fact,'by inter- fering In internal management affairs, the board can disrupt authority patterns and create Internal chaos. The chief executive officer, whom tha board hires, employs, in turn, additional management personnel to assist him In managing the total operation, i ~ c a I,. . ~y it l}. 1 PN xa -d As the annual audit report financial statement reflects, the total operational loss for the year arrlountod to $183,566.00, This could very well be debated as a semantic or a technical deflnltlon concerning the operation, First, we began the year with a budget, In fact, an adjusted budget which still reflected a $249,000,00 deficit s~ to be anticipated. In view of the annual projection, we were some $66,000,00 under `I the projected loss. Further, it should be noted that the current assets increased by a ~ $200,OG0,00 and that equipment Increased by $42,000.00. P In the Source and Application of Funds Statement, there was a negative balance of $168,783,00 for 1970, as compared to a pos,Ittve balance of $215,919.00 for-1969. It is interesting to note that $101,132 , 00 of this $215, 919.00 balance was created ! by a bank loan and an additional amount of $19,279,00 which was from special con- trlbutlons, In 1970 $41 805. ' f~ l 00 was paid on the equipment debt of 19694 $15, 000.00 i~ E was paid as refunds on restricted contributions, $70,547,00 was paid on the $114000100 4 previous year's bank note. Also, the previous year did not reflect the reserve account° E for patient accounts held In escrow which was created and noted on the 1970 balance, This would reflect a positive adjustment of $172,060,00 in 1970, and a negative adjustment of $172,060,00 In the 1969 balance In 1yorkingE capital which would reflect a balance of $3,277,00 in 1970, as opposed to a $4,3,859,00 figure for 1969, E j Figures tell only part of the story, In an operation as complex as a hospital, E !!E We are not dealing with a negotiable commodity but'with the precious element of human EE life, The best evidence available, In fact a very obvious one, with which everyone will agree, reflects that the qu9llty of patlent care "was at an all time low in the letter part of 1969, 'there was a very marginal relationship of professional help available Oer patient to render care. Complaints concerning housekeeping and dietary were at ' y, gw `ypq„yy~yv ar:,„' ^'ab{ ~lwA.WN+,+M'M1rux.a w a a (1) 41U W11V IIUj11. 111 UU0 dIIU IUC't311.dI `u,.U,iyn uJi. iIIVS IILU~ W9 WN.It UL C IJl lL l1.Cl lUV4 level and were at the point of placing hunian life in jeopardy. Increasing these inventories, of course, required considerable funds, *The major problem ,'however, that reflects the operation, was the 1970 economy, ..which, no doubt, contributed to the 2700 less patient days In 1970 than In 1969. 1 This alone represented $216,000,00 unanticipated loss in revenue,' Along with this, the hospital faced losses from Indigent care and bad debts In the amount of $283,00000, I and an additional $76,000,00 in medicare losses. If foresight were as good as hindsight, perhaps some adjustments could have J fl been made more rapidly, but the culprit still remains as ever - that is, the age old t problem of lack of funds from the outside to support the indigent care. To the above, we m.lght add that while the economy was falling and the collection rate was dropping LF I from 921A to 85%, federal minimum wage laws fixed salary increases to at least X16%, I f and materials and supplies increased to an equal amount or more. I r What lies ahead 7 First, the hospital, we feel, has overcome most' of its internal problems, and particularly, we wruid put'emphaslls on thls;tn the Business Office, The trying and perplexing job of converting our flhhncial racords' onto the - computer has almost been completed, To us, this wi:1 mein absolute control of 511 ! II patient accounts, It will assure us that all billing will be accurate and timely and F that cross-checks on revenue and expenses will be available for quick analysis for any adjustment needed and will contribute to reduction In the overall operating expenses i I In due time, This coupled with the combined spirit and cooperation of both the City and the County entering Into underwriting the Indigent care as they have so Indicated for the future, should afford us with an optlmistlc outlook that Flow Hospital has never experienced or faced in the past. i , , ~YY~~~kW,vneNaetw'~+"°" ...•v'J.Mha,etle.,x~,}~11V~FtA'ildskr9elr~iie~,leslf~ , fl+~" i W OF I lk ADDITIONAL SUGGESTIONS RELATIVE TO CONTRACT In developing a contract for the operation of the hospital, we should bear in mind that this to a 3-'1/2 to 4 million dollar business which is requesting a minute portion of its budget from the City and County. Detailed study of the past six years, as reflected in previous financial reports, indicates that if the'pasi deficit created from lack of funding of Indigent care was removed the Institution could be self-sus- taining with a contribution of something in the neighborhood of 1/2 the charity and I bad debt write-off figure. Again, the attached copy of the analysis of the financial needs reflects that during the past six years SO% reimbursed to charity and bad debts would have amounted j to $886 o 01, 00. If this amount were in the bank today, there would be no financial 4 problem at Flow Hospital. Therefore, it would seem that the primary concern of the committee would be to instruct the governing bodies with the taxing ability to arrange a means of assisting in the removal of the current deficit plus fund the 4% needed for charity. ~i As Indicated In the legal requirements under Article 94941-1, the committee should make recommendations as to the appointment of the Board of Managers, In considering a board appointments, consideration must be given to the expertise and responsibility r involved in operating a complex organization such as a hospital. Such requirethents as a minimum of a college degree as well as a minimum and maximum age limit should be considered. Also of paramount necessity would be one who can devote the necessary time required to fulfill the responsibility of board membership, j a , • r y r 'i eri 'w 1 ~Y FLOW MEMORIAL HOSPITAL ANALYSIS OF FINANCIAL NEEDS i i According to our recap of the previous six year financial statistics the following f table shows cash which could be generated through a 50% reimbursement on charity and bad debts: i, YEAR CHARITY AND 50% REIMBURSEMENT d HAD DEBTS 1965 $105,542 $ 52,771 1966 117,213 $8,606 t "r 1967 214, 715 107o358 1968 2160014 108,007 1970 283,509 1410755 1~~•♦•i: <fl' },J{:♦.1 •C?'~~'~iil ' S! i ti 1 ~1.'J ~ Qeys. i7.1 a i 1 1t 1 1 .l NT~'`~1/1/~l,3VJ,l~r.4.<'~'.l l5i41~3'i11~(), .11,1~:+2Sf 'IrfJ, li.,l 1!'',rt~.4 f.,~'♦.l11 .~i'.d:aS ~.t~•~'J.1 SbA~',67~i 1 A 50% taimbursemen'L In the past would have elelminated the cash problem, t The current years statistical budget reflects an estlma`aad ch&rlty Wrtfe-off of approximately X300000. If funded at 50%, this would amqunt to $1,600; or $12,600.00 per month. 1 TIs ~rj kl /)1/ 40-: '.Lt`~/ f _ , 1. l/r , (nl, - ® • ~1 tus_ r Ct?, 2 0 r Of .~G?2tt7?2 ~1ftrr►zc2 gal B•ai,iltl-btg, Dento)j,, Texas' Office a/ Clfy bleutaper April S , 19 71 Wf. l:. judge Tom Todd Members of the Commissioner's Court i Dr, Alex M. Finlay, Jr„ Mayor Members of the City Council Dr, Cborles Saunders, Chairman of the Board Members of the Hospital Board of Managers, i. Flow Memorial Hospital Gentlemen; / Several weeks ago, at a joint meeting of the City Council and Commissloner's Court, County Judge Tom Todd appointed the u,idersigned to prepare a con- traotual draft re-organizing Plow Memorial Hospital, under Article 9999-1-1, of Vernon's Annotated Stag, Statutes, and a revision of the by-laws to coincide with the now contract I • Numerous man hours and several meetings were held regarding this assignment. It is with pleasure, this committee in its entirety, submita,the attadhed con- tract and by-laws for consideration of ratification by each of the respective bodies. Upon the submission of these documents we consider our assignment I I as complete, and the automatic disgolvament .,f this committee. We trust these documents meet with your approval and will be beneficial tb the success- ful operation of Flow Memorial Hospital; sincerely yours . j i Jack Q, Barton t Chairman ' County: Olt 00H. Bailey Ja Q, Barton i F r i iE Bill SWitz mes W. White 7its Jullan Wellq, Administrator I ' w• ~ i i I ~ ' 1 , f!' i f NA1{N34~rR~Cri'.nrts~~h1 Fir nu+r:7t~,Ssp j 1 l SM . 4ltAYNfX'1 NEW, THE SPATE OF TEXAS X FLOW MEMORIAL HOSPITAL ArRf:EMrNT COUNTY OF DENTON ~ WE, the undersigned three parties, being t2ie Commissioners' Court of the County of Denton, Texas, the City of Denton, Texas, and the Board of DiLectors of Flow Memorial Hospital, All of Denton County, Texas, pursuant to mutual Resolutions heretofore passed by the Commissioners! Court of the County of Denton and the City of Denton, hereby dissolve the organization of said Hospital under Revised Civil Statute Article 44941 and hereby re-organize said Hospital under the provisions of Texas revised Civil Statutes, Article 44941-1, which Article is incorporated into this contract, with and subject to the following oonditions, terms, and covenants to which all parties hereto, and their successors in office► shall be mutually bound, to-wits 1. The City of Denton, hereinafter referred to as CITY, and the County of Denton, hereinafter referred to as COUNTY, shall retain tittle to all hospital lands, physical assets and facilities, except r 1 as may be hereafter granted by rosolution of the respective govern I 1 1 E ing bodies. Any matter requiring a vote on the part of both the j I City and County other than the expenditure or transfer of funds shall be passed upon the affirmativervote of any six (8) members of j a said combined governing bodies at a joint meeting# and any eight i (8) members of the combined Commissioners' Court and City Council shall constitute a quorum to act on any hospital matter requiring approval of City and County other than the transfer of City or County funds► the pledging of any, City or County asset, or tho-term inaxion of this contract as provided,'bEalaw, Any decision on the j 1 part of either of said bodies to authorize the transfer of funds, or pledgo assets, to plow Memorial, Hospital, hereinafter r©fprrod to ae HOSPITAL, shall be decided under exiating Law pertinent to the reeve r i pectivo bodies. l F i i. ; rr wl r l `1 r•+l.Vr}F#1cA ' FYi"`'.Ni~vtltsv ♦ 4", t 1 y,{.'`ft y 'r! . ` r4n~el 'irt s,la , P M~,r, a~tr! '~;~3M.M, x The City and County shall exercise all authority over.the Board of Directors of plow memorial Hospital, hereinafter referred to as BOARD, consistent with the intent of said Article 44941-1. The Director of Finance of the City, and the Auditor of the County, shall each have the authority as authorized under the laws of the y State of Texas to examine all hospital books and records at any r reasonable time, either separately or together, f All donationu and grants for the benefit of the Hospital, in- eluding benefits of trust funds, may be made directly to the Board of Directors of the Hospital but shall be subject to approval by City and County if any condition, obligation or limitation is con- neoted with any such donation or benefits All funds transferred by the City and County to, or for the ~ 3 benefit of, the Hospital shall tie baset^ upon a written detailed budget, as described below, and no special transfer of City or f County funds within a budget year may be made without the submiss- ion and approval of a budget amendment or supplement prior to any f such transfers The said City and County agree to provide all 'funds, necessary to balance said budget after, said.'budget is examined► aooert= ed'ahd approved by the said City and County. The City and County shall transfer funds to the Hospital in the following proportions y I For each dollar transferred, the City shall commit ' and the County shall commit , After the amount of 'each f traW84 has been authorized by both, Z~' f The initial Board shall consist of the following seven appoint- { mentor three of which wore appointed by the City$ and, four of which were appoihted by the County, with the terms of office an set out j by each name. The terms shall begin on the execution date of this contract, and it is specifically provided that the terms 'shall ex- ,I. fi r2... j t i h f9 cite on the first and socond anniversary of the last day of the next r,om late fiscal ' p year of said hospital, depending on the ~ initial term, then each new appointment or reappointment shall be for a term of two year's beginning with the expiration date of the initial term, as provided in said Article 44941-14 No member shall carry over into a new term unless properly reappointed, as all r'd4 terms automatically expire as indicated. y. uj The initial a .r., ppolntees and their forms are as followsr COUNTY APPOINTEES TERii rXPIRATION DATE 1. Mrs. Paul N. Simpson 2. Mr. Walter Ray 3. Mr. Carl Degan, Jr. r 4. Mr. Al Testa r4 CITY APPOINTEtS TERM FoXPIRAT_ION DATE jj z+ 1. Dr. Charles Saunders ca 2. Dr, John Carter 3. Mr. Dorcell Young County appoints two members for two year term and two for one year term, City appoints two members for two year term and one for one 1 year term. It shall be the duty of the Board to appoint a hospital Ad- s i `Y ministrator having the qualifications established in the By-Laws, and to confirm the appointment of the Assistant Administrator and' the Comptroller (or Controllar). The Board shell execute a written 4 A contract with the Administrator for his services with ouch provie. ions as may be agreed upon, but no, such employment•contracr shall exceed a term of four (4) years, and shall provide for removal for " cause, The Board shall concur in and approve any written contract the Administrator may negotiate for the.employmont of the Assistant Administrator and the Comptroller (Controller) prior to any such employment, The Board,shall have final authority in all matter* of hoe- ` pital polioyr including management policies, in the government and operation of the Hospital, The matters of'quorum and voting are , as goverrnod by said Article 44941-1 and the By-Laws. All official cafe of the Board affecting the management or operation of the ~ er , . ~~%:a,lq . •,,•°rek'44 ndli{i~,. rr t ~,N ` ' HbEdi{ hospital shall be by written resolution All said resolutions duly passed upon during an official Hoard meeting shall be reflect- ed in the minutes of the Board. All expenditures of Hospital funds in excess of the total bud- get allocation shall be'kpproved by the Board, the City and the County prior to any such expenditures r It shall be the duty and responsibility of the Board during each fiscal year to engage an independent auditing firm to make r fi an audit of that fiscal year, Such engagement contract, or letter, Rs shall be approved jointly by the City and County, as to its germs, and it shall provide that true copies of all audit reports and mat- erial, including the auditors management lettei: and confidential information, shall be furnished simultaneously to the Board, the a"FJ$1 City and the County. The Board may appoint advisory commi-:tesoo to serve without A, compensation, under terms and for purposes which said Board deem. proper, All committees other than advisory shall be as provided in the By-Laws. i All meetings of the Board and its Exaoutive Committee shall be open to the public according to the provisions of the Open i 1 Session Aot, Texas Revised Civil Statutes, Article 6252-17~ as amended, ill, ti. The Apitial Administrator shall have the authority and- roe-"', ponsibility to do any and all acts necessary and appropriate in I the administration and operation of Flow Memorial Hospital with in the framework of the policies set by the Board in its By-haws IE and by R0061ationo The line of authority from all employees end 3 personnel 01 the Hospital shall be to and from said Administrator, who shall appoint and discharge all hospital salaried personnel and employees, provided that the Board must approve the appoint- Mont of the Assistant Administrator the Comptroller (Controlloe)~ } _q-' i u s 41 Oil who shall each or both be entitled to a hearing bofore the Board prior to dismissal by the Administrator, as set forth in the By-Laws.' The Administrator shall each month provide the Board, the City y and the County with a summary of accounts and expenditures, and with a list of all accounts to be designated uncollectible. e hospital shall The annual budget for each fiscal year of th 4R be prepared by the Administrator and presented to the Board no later. ` than the first day of. May proceeding that fiscal year, and the Board t~ 4 shall present same to the County and the City within thirty (30) days its receipt thereof, or no later than the first day of June pro- of f `°1 ceeding that fiscal year. wtr8 The hospital budget shall be considered a publia record and be Y, eft" readi~y available at all times. 'the budget shall set out estimated indigent oars and bad debt logs in one aaccunt, to be separate aca~ aunts when determinable by the County Medical Services Consultant. ' The budget shall be compatible with the organizational chart, 3 which shall divide the hospital organization into departments and k ~ sub-departments. , x' The hospital budget shall be consistent with the form of accounts and method suggested by the American Hospital Association, and sufficienthin detail to show all income, revanuesp losses, ex- { penditures of funds, and salaries of all hospital personnel. The 1 r of-the hospital shall begin the first day of. October and fiscal yea and the 30th day of September. j V.' r the Sy-Laws of the hospital, and all dmendmdnts thereto► shall be prepared by the Zoard and approved by the City and the County prior to adoption. Laws shall be made pursuant to the terms and conditions i 8 uch By- , of this contract, and generally follow guidelinas.eetablished thare- E the American Hospital Association, for by M 1 I .e. 1 \XIl~fffl• fJ , pp ,r , 1 r "I .-7 A copy of such Byr-Laws and amendments shall be furnished to , t}=e City, the County, and the Administrator, 13y-Laws are superior I to any resolution of the Board, and no resolution or other act of the Board shall be contrary-,-thereto. VT. The transfer of the funds approved by the City and the county, 4 upon acceptance of the regular annual hospital budget, shall be ZY1 made to the Board in one of the following manners in cash on or be. fore February l of the approved budget ayeart or, not less than 1/12 of said sum on or before the lst day of each month during such bud- get year) or, in three (3) equal payments of 1/3 each, beginning February 1 of such approved budget year. The payment option shall i be made by City and County, respectively, at the time the budget is h finally approved, VII ! The Board shall require bonds of the Administrator# the Assist- ant Administrator, the.Comptroller (or Controller), and of all other. t hospital employees who receive or pay out any monies of the hospital. i The amount of such bonds shall be deLokmined by the Board, and the cost thereof shall be borne by the hospital. No such bonds, however, shall be for lees than Ten Thousand (010,000,00) Dollars, i nlxx, This contract shall remain in full force and effect until amend- ed or terminated by 1a majority vote of all of the three parties here,. to, separately, unless sooner terminated by the dissolution of -the' i organization under Article 44941-1 by joint act of the City and County. ~ Such dissolving cf~ the organization shall automW tally terminate this contract. r R r i~„.f ~4p4.r51.ati.,Y,y.rt,lllE1J~~ r S~ %r,'Iti,r'rsltr tl:';Ytdtid Orr, g I s„.~ . THE STATE OF TEXAS X COUNTY OF DENTON X ` WE, the undersigned three parties, boing the Commissioners' Court Of the County of Denton, Texas, the City of Denton, Texas, and the Eoard of Dir.Cicttors.of Flow Memorial Hospital, pursuant to a mutual ResolUti.Otl heretofore passed by the Commissioners' Court of thO County of Denton and tho City of Denton, hereby dis- solve the organization of said Hospital under Revised Civil Stat- ute Article 44941 and hereby re-organize said Hospital under the provisions of Revised Civil Statute Article 94941-1 with and sub- sect to the following conditions, forms, and covenants to which ~ it ' rt? all parties hereto, and their suooessors in offics3, shall be mutes ually bound, to-wits The City of Denton, hereinafter referred to as CITY, and the a'>.1 County of Denton, hereinafter referred to as COUNTY► shall retain title to all. hospital lands, phynio4l assets and faoilities; except E as may be heroAftor granted by resolution of the respective govern- ing bodies, Any matter requiring a: vote on the part of both the E• i E City and County other than the expenditure or transfer of ~ttitnds, , a,. ttr shall be passed upon the affirmative vats of any six (6) members I ' of said combined governing bodies at a joint meeting, and any eight ` (a) members of the combined Commissioners' Court and City Counoil shall constitute a quorum to transact any and all hospital businegse Al 'Td other than the transfer of City or County funds, or the, pledging of t y g any city or County asset. Any decision on the part of either of said bodies to authorize the transfer of funds, or pledge assets, to the ' hospital, or for hospital, naeds, shall ue decided under existing law. by the respective bodisast provided, however, that the City and 4 s`{ County ohall transiEar funds to said hospital at the ratio as fallowsc ,j rs 4. 1 a xuti , t • , 1 f a :;r,. 1 For each dollar transferred, the City shall commit and the county shall commit after the amount of each _.,M._... transfer has been authorized by both* The City and county shall exercise all authority over the Board of Directors of Flow Memorial Hospital, hereinafter referred to as BOARD, consistent with the intent of said Article 44941••1. f Any mcimber of said Commissioners' Court and City Council shall be authorized to attend any and all Board meetings, but shall have no vote. The Director of Finance of City, and the Auditor of the . County, shall each have the authority as authorized under the laws of the State of Texas to examine all hospital books and records at any reasonable timer either separately or together. All donations and grants for the benefit of Flow Hospital, in eluding benefits oft, trust funde, may be made directly to the Directors of said Hospital but shall be subject to approval ~ board of by County and City if any condition, obligation or limitation is oon i nooted with any such donation or benefit. k All funds transferred by the City and County to, or for the i benefit of, the Hospital shall be based upon a written detailed budget, as deecribod below, and no special transfer within a budget year may be made without the submission and approval of a budget r amendment or supoloment prior to any such transfer, II. ~ The initial Board shall consist of the following seven appoint- Monts, three of which were appointed by the City, and four of which f were appointed by the County, with the terms of office as sot out by each names The terms shall begin on the execution date of this eon- tract, and it is specifically provided t1lat the terms shall expire on the first and second anniversary of the execution date hereof, f depending on the initial term, then each now appointment or re- appoi:ltm6ht shall be for a term of two years beginning with the ' a ~Z. i.rf. `..1 ~ 1fit4~th`~f. expiration date of the initial torm, all as provided in said J Article 4494i-l. No momber shall carry over into a now term 4 unless Properly re-appointed, as all terms automatically expire as indicated, Ite initial appointees and their terms are as follower COUNTY APPOINTED TERM Mrs. Paul N. Simpson a 2. Mr. Walter Ray ,ba 3. Mr. Carl Dagan, Jr.. 4. ny CITY APPOINTUS TERM 1,. Dr. Char] .3s Saunders 2. Dr. John Carter 3 County appoints two for two year terms two for one year term. City appoints two for two year term; one for one year term. It shall be the duty of the Board to appoint a Hospital Ad- ministrator having the qualifications established in the Hy-Laws, and to confirm the appointment of The Assistant Administrator and the Comptroller (or Controller). The Board shall execute a written ~I E contract with the Administrator for his services with such provis- ions as may be agreed upon, but no such employment contraot skull exceed a term of flour (4) years, and shall provide for removal for a cause. The hoard sh.nll concur in and approve any written contract the Administrator may negotiate for the employment of the Assistant Administrator and the Comptroller, No other employment contracts may be entered into unless approved by the Hoard, and the City and the County, including professional services. The Board shall have final authority in all matters of hos- pital policy, including management policies, in the government and { { operation of the said 11oapital. The matters of quorum and voting are as governod by said Article 44941.•1, All official acts of the Hoard affecting the management or operation op said hospital shall k, ..3- t ,t r -10 A MAI be by writton resolution. 'rho board shrill approve all budgeted purchases from hospital funds in excess Of $5000.00, All budget fund transfers in oxccso of $1,000,00 shall be approved by the Board prior to any suclz transfer. 1 W-1 expendituros of hospital funus in excess of the total W budgct allocation shall be submitted for approval by the Board, c such expenditure. the City and the County prior to any ' It shall be the duty and responsibility of the Board during each fiscal year to negotiate a written o~ntraet with an auditing firm selected by all parties h(.reto, to make an audit of the en- cuing fiscal year, and such contract shall be approved jointly by f the City and County, after consultation with the Admirt), °.tor. I Such contract shall provide that true copies of all audit reports and material, including the management letter and eonfidertial in- formation, shall be furnished to the Board, City and Countjy'At the i same time as furnished the Administrator. The Board may appoint advisory committaes, to serve without compensation,'M)dar terms and for purposes which said Board dooms proper, All committees other than advisory shall be as provided in the By-Laws. The Hospital Administrator shall have the authority and rea- f ponsibility to do any and all acts'neoessary and appropriate in'the administration and operation of Flow Memorial Honpital within the framework of the policies set by the Board in its Hy-Laws and by Resolution, The line of authority from all employees and personnel of the Hospital shall be to and from said Administrator,, ca;, w;so shall hire and fire all hospital' salaried personnel and am- ployaos, provided that the Board must approve the appointment of the Assistant Administrator and the Comptroller (Controller), who shall each or both be entitled to a hearing before the Board prior ~ to disminAal by the Administrator, are not forth in the By-Laws,, l 1 i "4u { 1 .4 ch ~kMMNA Tv I) A(l.lintat.r<stor. shall oaeb month l~rci~ide the board, City and County with a fsunnnary of accounts and expenditures, and with ~.1xRlJ,O a list of al.l accounts to be designated uncolleotiblo, or. to be turned ovor to a collection agency or attornoy, and such list .`I shall indicate the ojta the obligation incurred, amount due, amount ! paid thereon, last t;nuwn address, and whether considered indigent. TV. The annual budyFSL for each fiscal. year of the hospital shall be prepared by the Administrator and presented LG the Board no late?: than sixty days prior to the beginning of that fiscal year, and the Board shall present game to the County and the City within thirty days The budget shall be considered a public record and be readily I available at all times. The budget shall set out estimated in- ' digent care coot, and separately show monthly bad debt and indigent j f)}yy loss. The bmdstet shall be compatible with the organizational chart? ' which shall d?,vido the hospital organization into departments and f sub-departments. ; I The orgnniYational chart shall name the current department S } k head and nub-departrrrnt head along with the title thereof, as de- t:ermined by thG Adminiatrator. Each depar.v,ont head shall prepare and submit a budget for , his department to the Administrator at a time,and in the form, da- A signatod by said Administrator, , The hcapital budget shall be consistent with the form, mothod and detail of the current budget of the City, including detailed t expenditure of funds, and salaries of Administrator and Buparvisora. p V4 w The By-Laws of the hospital, ane all amendments thereof, shall be propa>;ed by the Board and approved by the City and County Prior tti , to adoption. a i p IA rp,iljNlll.~~ e ' (eJl 11 Y.. EMI' 11100 in 4 ~WA m Y W 1 4 $UCtI BY-Laws shall be made pursuant to the terms and conditions 'Arm aE this contract, and gonerally fallow guidelines established there- for by the America,, ttospital Association. A copy of such By-Las.os and amendments shall be furnished to the Cf.ty, County, Administrator, and each Department Read, and shall ' "'I considered a public record. By-Laws are superior to any resolution of the Aoardl and no resolution or other act of the Board shall' be 1 contrary thereto. I VT. ' This contract shall remain in full force and affect until amended t ,~1ar terminated by a majority vote of each of the three patties hereto, unless sooner terminated by the dissolution of the organization under Article 99941-1 by joint not of the City and County. $uoh disolving of the organisation shall automatically terminate this contract# #1 1 r# Gr:' f f Aw f n t I I 1 SJ 'I !M• t off . I ` I.v g1 ~ J A lr G ' n• i r s BRIEF STATEt4ENT OF FACTS The City and County of Denton, in 1948, Jointly established Flow Hospital pursuant to Article 44941 of Texas Civil Statutes, r. passed in 1943. Said Hospital, since that data, has been operat- ed jointly from appropriations by both the County and City, but a primarily by the County, which contributes approximately one per cent (1%) of the total valuation of the property subject to taxes within Denton County, However, almost all of that amount goes to- ward the service of the building bond issue. No regular contri- butions are being made toward the operation expenses or the cost f;~k { irk I t ,V of indigent or pauper medical care or support. y *rl'' iS;fYS=1 sv1 fg•1 r j~nf QUESTIONS fir;. 1. Is the City and County each limited to the assessment of ten cents on the hundred dollar valuation and limitad,by the same limitation to this amount in the financial support that the City and County can give to Flow Memorial Hospital, a City-County Hospi- tal created and operated by the authority of Article 44941 of Ver- { lion's Annotated Civil Statutes? Another way to ask the same ques- tion is to inquire as to wh-ither there are other existing laws that ~1 F would permit the County and/or the City to make contributions to r Flow Memorial Hospital in excess of the statutory limits prrasoribed in Article 44941 (such as payments to Flow Memorial Hospital by h City and/or County toward indigent care). . ,•Y 2, If it is possible for the City and/or County to earmark funds to such hospital for indigent care and in excess of said statutory limits, who has the responsibility of determining which E patients are indigent patients? xti ' 3. If the Denton City-County Hospital was reorganized under W ` Artiole 49941-1, would the increased powers given to the Board ter, ` . include the power to borrow money for immediate operational expenses? i pyJ 51, r Y 4,~ ~ r ortAmoftV f . CONCLUSIONS OF LAW ; " There are no legal limitations restricting the Commissioners' Court of Denton County from annually contributing whatever sum is necessary to ~ f adequately support said City-County Hospital, other than actual encumbrances (obligations) against the general fund, or any fund with surplus. r t TT. The Commissioners' Court of Denton County is authorized, and Obligated as a matter of law to pay the haspital bills of County residents for services rendered from the City-County Hospital {4b when such residents are determined to be indigents or paupers by s 5 the County nudge, any County Commissioner, or by act of the Com- missioners' ` Court. th The obligation to provide msdiaal care and support for in digent residents of the County is now affected in any way by the County's donation toward the support of the City-County Hospital s under the provisions of RC,'!. p,rt, 44991. a ~'a4 UI9(t~a6TA:V OF ISBUSS X . 4 Section l. of Article 44941, provides for the establishment t a i and operation of a City-County Hospital. It provides that' "such cities or towns and counties that have heretofore issued and sold r r bonds for the epeuific purpose Of jointly establi~#hing, erecting, t$rl.; ➢~r3 equipping, maintaining and operating such joint City-County Hoe- pital may finance such hospital or hospitals out of the yenexal revenues and. are each, respectively, hereby autharitpd to levy and collect a tax,.not to exceed ten cents (100) per One hundred eb i it 'jI 1 Y. I l dollar valuation on the property subject to taxes therein, for ewe ouch purposes°, The above, in effect, states that each Tidy may levy and i collect a tax for the specific purpose of erecting, equipping, y; maintaining and operating the Hospital, but such special tax levy may not exceed one (18) per cent of the valuation on the property' i } as} sUb3Qat to taxation. The County Tax Assessor uses approximately 20$ of Pair market value of property as its valuation, r`,E If either Cities or counties have issued bonds before enact- s ment of 44941, for specific purpose of a hospital, they may finance t' such hospital out of General Revenues, and are each authorized to ll r 4t} levy and collect a tax not to exceed one per cent (19) of the a, C{ valuation. it No mention is made regarding other contributions toward the j , maintenance or operation of such a hospital. The first section ` I is concerned primarily with authorizing the creation of a hospital } by the Commissioners' Court and City Council. There is a provision for Cities and Counties who have before the sot sold bonds for such } a hospital to tinanoe such hospital out of general revenues, and f grants h°,cities and counties the authority to levy and collect an addif nal tax as limited above. Section 6 is the authority for monotary contributions, and does not seem to impose a limitation in section 3 of said article is provided the roquirement that Y r, the Board of managers shall prepare and present to the Commisisi,oners' Court and the City Council a financial statement of the status of said hospital, and a budget anticipating financial needs, etas Further, we find the following statements "On the basis of such P„1 financial statement and budget the Commissionerf3' Court of such ,J County and the governing body of such City or Town shall appropriate ' , ` or set aside for the use of such toard of Managers in the operation i of such hospital or hospitals the amount of money which looms pro- i + at per and. ne~,ossar,Y for such purpose". hl r f J , a I t Other than the last sentence of Section 1, above, no limi- t\ tations whatsoever are stated on how much money might legally be appropriated to the hospital if the City and County reach an agree- ment, nor from what fund or source said money might be obtained. f, It appears obvious, from this wording that the Legislature in its wisdom intended that a City and County appropriate the amount of t money necessary for the operation and support of such hospital, p and gives them the authority to jointly determine what is necessary, based on full disclosure of hospital records, and the public needs in all other areas of the respective ;Jurisdictions within the frame- r, work of the available revenues, from all sources. { In Section 6 of Article 44941 V.C.S. the following is founds "The Commissioners' Court of such County and the governing body of such City or Town may contribute to the funds necessary for such hospital or hospitals in whatever proportion may be determined by them by Agreement". } surely, there can be no disagreement toward the meaning of this provision. it is apparent that the Legislature wants the r governing bodies of the City and County to contribute whatever is i necessary to support said hospital, in whatever proportion may be determined by them by agreements and grants that authority to both. Section 7 provides for the authority of the Board of ManAger , , r and states that the management and control of said hospital is i.n the hands of said Hoard, It further states that "Said Board of managers shall have the authority to determine the manner of ex- pending any funds that may have been provided by such County and such City or 'town for such purpose, whether by tha issuance of, " bonds or other obligations, or by appropriations from other fyndc of such County or City or 'own." In otherwords, tha legislature anticipated the funding of s such a hospital from various different sources of revenue and in- come of the County and City. ! : Irf 4. FR~h~ ~kfXl71'~ r r Therefore, there should be little disj.;te with the conq?1is- ion that the Legislature in providing for the establishment and erection of public hospitals pursuant to Article 44941 lid so with the knowledge that the operation and maintenance of same would re- quire, on a continuous basis, proper and adequate funding. This L ' intent was further expressed in the passage of Article 44941-1 in 1965, which Act removed many of the limitations of its 1943 pre { decessor, and it is noteworthy to mention here that no reference 1 I' to a tax limitation is made or suggested in the 1965 Act (Article 33 44941-1). 4 II. f At a very early date in the history of the State of 'texas, the indigent in Texas was primarily a problem for Churches or pri- vate oharitibi and relief was given to the poor by these organiza- tions largely in their own homes. 'With the sharp rise in indi- ;4 genenoy fo',lowing the Civil, Warr there was the growing recognition that in many cases private charity was insufficient, and with it grew the idea that some governmental unit should be responsible for the care of the poor. The most logical unit in an agrarian G, civilization was the County, and in 'Texas the County Poor Farm was l the first, and for many years the only, public charitable ihstitu- tion. Such Poor Parm has been greatly expanded, and this authori- zation remains today the basics through which the Legislature has k ' provided for the support of paupers and indigents within the State of Texas. Article 16, Para. 8, Constitution of Texas. Article 16, Section 8 of the Constitution of the State of CH r' ,r r { Texas provides for "the supplying of the wants of its indigent ,flI and poor inhabitants". Such constitutional provision further authorizes attendance to the wants and needs, "in such manner a$ , may be subscribed by law",' rk 1=,° in response to that directive, Article 2351 of Vexnon's a Annotated Civil statutes was enacted by the Legislature, which enumerates the specific powers entrusted to the Commissioners' f i r -4- S, k r tii:M1la y. Moo" t Court. Subdivision 11 of Article 2351 requires that the County Commissioners' provide for the support of parsers who are resi- dcnts'of the County and unable to support themselves. An early case defines the term resident to mean a person who has been a bona fide inhabitant of the County not less than six months and of the State not less than one year. And, the term # "support" used in Subdivision 11, means all that is necessary to x bodily health and comfort, and especially to include proper care, attention and treatment during sickness. (Monghon v. VanZandt County 3 App. C.C. Para. 198). The case furthor states that where s r adequate provisions had not been made by the Commissioners' Court ' I for this purpose, the County Judge or any other member of the { ` Court could, by contract, bind the County in any reasonable sum necessary for the support of the pauper, and such support included professional services rendered by a medical doctor. k I Although it is within the sound discretion of the Commission- j y{. ere' Court to determine where medical did and medicine will be j furnished to paupers and the manner in which such mediones and aid will be dispenssd, (opinion Attorney general 1941) there seems little doubt from early cage law that the Commissioners'/iauan t dowed . with the full responsibility and obligation for the support of resin deY,f indigents. further, 12.C 8o Article 4438 provides for the care of the in- digent sick. "If there is a regularly established public hospital in the County, the Commissioners' Court shall provide for sending }f. the indigent sick of the County to the Hospital, if more than one suoh hospital exists in the County, the indigent patient shall have the right to select which one of them he shall be sent to." } Quoting from the. case of W 11'0. CCou~ otv v, Valley Saptisti Hospit§kl, eti_a1_, 29 Swzd 456, (1930) the Court, in'diotum, plainly Nrk~. ,a k qtr f3 «g« , d'~ l„ A t YI t , implied that it is the duty and obligatt. n of the commissioners' Court to send the indigent sibk to public hospitals within the County, and to pay for their care and treatment. No limitation + f on the number of indigents a County may care for are to be found t c; in any statute or constitution. The only limitation seems to be availability of funds in the general funds of the County, k \ This case Indicates that the statutes above stated, obliga- ting the County to provide medical aid and support for indigent J.. i residents, are clear, and do obligate the County to provide such W; $ `I support. Further, the Attorney General, in Opinion No, V, 608 (1948), has stated that hospital aid to the indigent sick of the 41~ County Must be ~ Y paid out of general funds and no other. fund. The Aki term "general funds" is well defined, and will not be set out here, fa I 1 being not now in question, but.can briefly be stated, to include s every County fund not expressly oreated by Statute as a special t fund, such as a particular bond fund, ! y Y IL tj t~tl { { .1 <s' r ,y'ftdl J,r;., .Y • ' HE M-LAWS OP ME BOARD Cll MANAGERS CF' 2'11C FLOW M )"M OMAL 1105 PITAIr aSr,NroN Tl:xn ARTICLE I ~ f l Name and Purposes 11 The litnmbers shall he kno•r/n as the Board of Managers of the Flow Memol fail ]•los ital l f ;l They shall ba anl,olnted and hold office in accordanco with the state statute undr or which + k~ tho Flow h1e'lnertal 1losl l was established, The Board of Managers shall be resppnsl- 1 ble, not only fnr the management of the finances of the hospital, but also for the appoint- me;,t of a compotent medical utoff,' and the malting and enforcement of such regulations as are necessary to ensure proper care of patients. I i f1 , I ARTICLE II tJ I • ~ 'Y Fiscal Year f 1 The fiscal year of this Institution shall commence on the first db of v.., the 31st day of nLcamber, Y January, and end on 1 ARTICLE Ill g. Meetings ~t section 1. Tk members shell hold rogular tnectings on the third Wedneoday of eaoh II nionl.h, The regullhr meatlnlg In January shall be known a,y the annual meettnq. Specifal mootfngs may be held rat the call of the chairman or, In his absence, at the call of tho vloo-chalrman, or at the c4311 of any throe members, !Section 2, A rvalorfty of th&j members shall constitute a quorwn, J; ARTICLE IV f dffiaers pnd Committees > ' f ! At tho first regular mectltiu sifter Adoption of those by-laves, and at each ann 1al } 1 moetlttg tticreafter, the'lnenil>ors shall aleot a chafrrnan, vlcp-chaitrmnn'and a searotary and c 'I' w Aha]l appoint l7 finance commhiso, an nudlting aommJttclh and a Modica] 'gdvisory 666- s it,ittae, The offlcors'of the Board of Iviano ers sltifill constitute the exocutlve comnlittoa, ; r Oilior temporary commlttuen 11111, w ~I l bo tlnpointod by tho Board of Manavors frbm•tlme to llnia } as ocCaalon dt~ittands. 7hobe edsnmitteaH shall limit their activwaa to the,purpoee for t c r y ~ 1 If rl' ' .:Y,Sr1 '.'1.1'1L':iII;.M Li I TJI I"wYd' L.I.:i:•_1`,."1'. l~ ~ ~~~t~" (~'{(111tW. aMhkwer+nr iyr.N4k11.rvH N'~ ' i N 1 1.' iNiNiN r,. w ~h p, r,lflcally it Wlllcll 11tt::y 11plloh1L:!(1 on(l thL`Y r'h 141 bees I1Q i)OWCr CU -let 11t11ef,y r>tlGh 113 `confc'rrctd I,y action of llv: 13otuct of Naanagcr:l, Tim officers and standing committers shall vork,witil the following annual lne")ting, ar until lhr,ir successors have been ntlmecl, ~r ART1CIA" V t i 17t1tias of Officers and Committees I Section 1, The Chairman of the Board of n77nm7e1's shall exercise general supervlnlon ' II rosida at all meetings of the members, and be an L over all the affairs of the inl Itltutlon, i~ i !I ex offlclo mc.,nber of 4111 standing committees. I~ 9actlor, 2, 'J'he Vica-C:halrrnan shall perform the duties of the Chairman in his abconce, or In the event of his rr",signation, death or Inability to act, shall succeed to the office ~I I of Chairman. ll Section 3. The Secretary shall keep the minutec of the meetings of the Board of Managers p, present at each rnootingi , and its standinr commlttocs, record the gamaol4tmtlntge ncl notify all members of the stand f h b` notify all members of committees of irfolr app ' ` I II ing committees of regular or special mcatings of the Board and committees at least three days before the appointed time for meeting, and in such notification, if a special meeting, 41~ state the nature of the business for which the mooting is called. shall have power to transact all regular business of Section Tile ${ACtltlVC? Committee the hospital duping tite interim between the mcatings of the Board of Managorn, provided that any action which it may take shall not conflict with the policies and expressed wishes I ' of the Board of Managers$ and theit it shall refer all matters of maior importance to tho S ,4 ,l+ Board of M4uta Ars, Should any mottor of oxtrcme urgency aribe between the regular m>tet- ings of the I ot7rd of Managers, it shall be the duty of the executive committee to request ry 11 the Chnintitln'to calla •speotal rneetiug of the Board of Managers, ,t ~SAatlon b; 'J'ha C'inanoo Ca,nmitteA slyoll consist of thi'eA members olactACi by the ilca:d r t ~I of hiinnagers, with the C1hilrman ex offlclo, It shall dovlsa ways and met;ns of socuring + fundo for t,aw. Dttpport of tl'r0 hosplictl, It shell. also see th.lt a budget to prepared anti sulb- t mlttecl to tiit! llo;lrd of iw1e11zctgcr3 tit itn lslst nleetiu;t Deft>te the end of the flactll year of G tho hospital, this budget to Hhoty the expnotad receipts and r.xpondmirc;n fol' the nrasuinCl yonr, It shall then be t)cf(rther duty of the finance oomrtrlttge to pxalnlnethe monthly 11 flnunoiAl ropot'l:+ and to rrquire an er.pMnatlon for the od,ninistration'of any Varletion from r IN,, the buftot, " ,'section G, 'i'he Auditing Committee Mull consist of three members alaoted by the Board of Nlanovers, with the Chalrm4in ex offlclo, This. committee shall examine the accounts 6 a of ttto lnstltutlon .semi'-annually and cat~tlfy in the saute, if found correct, ond.oftanert if jI thuy see fit or lf'directe'ci,bs' the'membci-s of the board to do so, 'file aocoulito of thu hoip- pital shall bo cxw6ned i3eltti'•aunuallY by a oompctont aooountant as the 11otird of managers, ,r 1 may awhorUe or dirc:ot, r: Section 7, The Joint Advlsmry' Conforonoo Coriiptittao shall consist of an agpv) ntunbor of members uppointcd by'tln 11011rd of Managers nlid the Mt±dical Staff. The administrator 6 is . ' Lill ilia , ,..4b1: b. Y•: 1'•... Yr 14f li.r n'. fl '.••mr.I.UY~{11r1p~a1/1KY~J.NI1tl MrvglrrwMr44wn,u.L,._+f n,.e•.......... .......an,~1 - f•.~' +Tl k~t 1. 1, ",ate I , ~j shall bo t'.'( offlrly ei luerube!' of tills committee:, It shall ma c fltf> rc; ulirmr.e et lul.tilerly at a time prCCC 5! llrtq 4f Ilte fia.;rc! of M ana4rc;rE, Its (lutlc;r, Whit)! Ile to act as a Itc,is group bctwacn the: 13varQ of Mana~crs, th;r odmEnlslrrattoil and thcl f on M ,edi al7l Staff, Qiscu;ld-ln;t l snuf mntlar,i or u merlic:o-•ac9minlstr~tilvc n'ilru•r, that iun!' ho brought to its ttilenlEon and lrtaiclrt7 such reoornrnendatlon8 as it may doom In the best lntorestr, of the hospital, Awflun V1 Duties of the Administrator Section 1, The Boarcl of MS,jni i.gc:rv v.11,111 select and employ a competent and o.%perienced r JI 8dminlstratr,r who sits!.! be lis dlrecrt reprr+senteltSlve In the ntanagement of lhr, hospltl This adcnintstrl, -s ho 11 be gIt,cn tile. rt,cesn(~try'authorlty and held re8ponslbin for tho adrnin- t 4 Istrotlon of tho hospl in till its ftartjnents sub ect only rl ' ' Board of Mil or by any of its aormilitteea to which it hato tho policies cnntLy s dolegatcd pol,vtr tocact t • More apeelficolly, the authority and dutles of the administra r ~ tar shall be; j ~ 1. To perfect and subrtilt to the board of Managers for a 0 to IIA,: organization of the personnel and others concerned lthothra apernilan of the hospital. I 2. To prapare a budget showing the e)cpected reoelpis ;'hl and expenditures as rc- ,Wsyulred by the Plnrsnve Committee. r . , i I 3. To select, employ, control and discharge all employees ailthorized by the 'M budget, { 4. To see that the building and grounds are kept In n good state, of rapair, ern- ) I! ferrinq with the Board of ManaVers In ma/or matters but carrying on routine it repairs and mafiltonalice without subh conoulttatloll, 1+ S. To supervise tilt business affairs such as the records of ftrtanr.>rl transactions ~ 1 aollortiontt of. accounts and ptrrhal,c and issue af.,s;uppllos, end"to be cer- tali) that all funds arc coNvoted and expended to the best possible advantage, 6, To coonerate v.,Ith th, Modlcal Strt if and to Secureltkc r,oo;aeratlotti oil the j part of all thane canoerned with render V profen8lonal sorill to the end IjI that the patient may reoaivo tha best rln J! possible care, y, To sulymlt rcqulttrly to the Board of Managers or its euth4rized'pammlttoes y?~ porlodlo,rc+lil showlusl the profousional service and tho'spocial report that may be rcagulrod by the Board of Managors, I~ 6, To aneno all meetings of the Board of Managers and i' i is vonimlttcos, f i 9. in trll raae;q of cllaputacl authority, or Llhoortalltty as to the.meari t of the ~ r`s llyWT,uwsi anti liulcu and f;r,r~ulatlons of th^~haapltrtii,'iho deolsldu of ilia ,g Adnilnintrotor nhaIl ho op;:rt tlve until a ruling shall hav41 bil made by tho trr.l ~I Board of Marurgcrs or ilia }vc+outlve C omniftloc, ! f~i: rf 1 .I I'y 111 b•... Allf Iii I ,.,.m.0. , : 1111 u:n , icyx{\~,•, ~ ~rM~F~ ~.fti,b~ N a(r, To loerform any other duty tint way he in the I)r,:;t lntllrr;:,I. of the 1`0`111"11 i ARTICU;'VIf t,.• Medical Staff j r Acting on lh, I,>est nleclieol advice sivailable tha Boarcl of Managua shall Lippotlit a medical I+ sniff of physla(ons and shill see thet thoy ON organized In euccl a manner ns to sr.~;ure i the boot po£l;,W)14i•oriult.;;, In tilt profusatrn~,! Core of pttImits Oct nitendinrl phy:llnlast oppoilltod to the mcdtcal :ltlff. eht:ll havu+ full authority nublect only to tha polled.es stau'd by the Holyd of 1Vlanz;rrcral Ill adraIlllstrntlvc-~ maltong the medical staff, os nn orgtlntrod body, shall act In an advlrory cc:uflcity, this function br;litr~ cnrricd on through 0C., lolnt advihory colnmlttce, _ I , ~ u ^11< ! . { ARMLY, VIII rl I lioapltal Auxiliary !i !:Iho Board of Mniv.vr:1 ah711 ast;ist In the ortlurllring of nn offdctlve hospital attx111ary vJheit 111 th lr jl.lcltrutunt CanLSltimia far organlziny such an nuxlllary tiro favorable, It AR9'lOhE 1X r, ~a,14. i 1 • 5 Wi Tho ord'ir of l>uslness at all moetingn of the Board of Managers shall be as follows: ~0 ~I Meotlntj cnl.lod to ordrr. 11 Z, Roll call 3, Reading of mlltutela of l,,revioua mr•.cltlug. , 2 pp-Ovol. of llllmt: os, i S. Rl,i%Cllit;l of C'G~ilinitllliCttitl)y101 , fE ' - c, Roport>s of'coinlllitle,s nd offlc(+rs, l r 7, ltenrltnti of report of adminLitrator. 01 lteciQU,g of profusslonell antilysls report of Medical Staff, .~r, ; g, Ilntiill~ili,cl husln;:~s, Nc,` Iluri ill:! fl li r n Ad)ouerunotit l./J ARTICLE X ' r 1 1 }J n Annual Reports ti ' forth 1st sufftuihnt scope, , AttlnSl ' The 13o:lyd of A4nnugers will ItaVC prepatucl an annual roport a nhcl &r tntl tho more lulporloot facto concerning thc, business manngomoot and profesalonal WCA. Uf lllb 11UNI ltel, 1 rd` ~ ' I1 J fit. h , l r: a! ii ~ I 1 1 ~l)ll. ~ ~I. r l .rq I,A ~ 1 I ~ . 1 11 1 r •I. a f° 4( 12 diifil?1611tl94k~biMd.q~, ,.rY,..,vl,Mk{1r~~ ,..,i....; *owl ( r l F t' ! 1 J R NiA\ M' • AR'1'iCLI; X1 ~I, 1$a7 ,I I 4 hndowinent +:rid Gifts {E 'j'Ize Board of jvlanagGrt; shall accept cndowmants and rifts for the Ina Into nfllice of frect i beds, new construction and egr;lpr,ient, I !E AR'1'1CLT, X11 i ~ I} lun e ncht~ e nt s may be chmn d by a .,.:ijorlty vote of the momberF nt a mooting hold for E by that purposr, notice of %vhich has F~ecn given In v,1rltlnc~ b} I,he Secretary toe uch rnernber ! tit !oust ho vreeks in advance of. the meetln;f, ~ h f f I , E. i r . ~ I,r Ct. ilh .•.a . lv1.HU` R~n,r. f0 il9 r.l.dltiis., rgall I, r ' I M irk' 15 1 WAN t MM I CITY OF DENTON k MEMORANDUM } t, DATE: February 15, 1971 tt'.§ Tat Jim White S r.~r FROM: Bill Brya.,t SU$JECT: Construction Obligations L As pointed out in my memos on assessment #6 and Carroll Strout project we have a total obligation of $844,477.00, in addition, we have an obligation of $225,000.00 for purchase of Brisooe property off University Drive. The total funds required will exceed $1,069,477,00 in all prob- ability, ! The cash balance of Strest Bond Fund as of the 12th day of February, - s. 1971 is $364,437,63, Assumins *$229,000.00 as firm collectible assess- mewtta and $17,000,00 on deposit (Raynor payment) we will be short of funds in the neighborhood of $459,039,37, Just keeping you advised, + * University Drive $1250000.00 * Assessment #6 and Others 104,000.40 Collectible in immediate future. i 1 h J t (1 k • eRfR11M~ y g yy i AriTHUR ANDERSEN & CO. DALLA5,TmxAs To the Board of Managers, ' Flow Memorial Hospitals II 1 ~ ' }ave examined the balance shoot of Flow Memorial We Hospital (a Texas oity-county hospital) as of September 30, 1970, 1 and the related statements of operations, ohanges in fund capital and cures and application of raAds for the year then ended, Our examination was rondo in eooordanae with generally accepted auditing i etandarda, and accordingly inoludi,d ouoh testa of the acoounting records and such other auditing prooedures as we considered I necessary in the oirou'motances, 4(e have previously examined and reported on the financial statements for the preceding year. i In our opinion, subject to the effoot of possible losses on reoeivables in exosss of the reserve provided therefor as dia- ousged in Note 2 to the finanoi.al statements, and oubseot to the j effect of such adjug.tments, if any, as msy be required as a result of the final determination of amounts from.or finanoi4l refundable statements { --Hodioare for 1970 (See Note 3), , the %ocomp present fairly the financial position of Flow Memorial Hospital as f of September 30 1970y and the results of its operations and the I souroes and appiioation of funds for the year then ended, in eonformity with generally aooopted aooounting principles, applied on a basis oonsietent with that of the preoeding year after giving retroactive effect to the Medicare reoeivable discussed in Note 9 to 'the tinAnoial statements. r Dallas, Texas, # .November 16, 1970, f f 7 iN b A+..+( ! s t 7z 7, 7 ;1 W1.1 '0 1 1. 4 l v1 3, . I i 1!U 7 1 y FLOW MEMO~txA~i 1 AY AN CF MEm 1970 u--- 14,601 f3 ovxRM assExs: $ 112A6 $ 0asn 150000 31#774 Oerti€ioates of deposit s Reoeivables Patients less reserve inrl9Obandl 929,226 719)366 ti accounts of $148, 3 $115,000 in 1969 (Note 2) 501241 51017 139,093 1010477 f Medicare and other Inventories,at Preps cost 20,9ll 2x,97$ penaee .rrrrw«~~.. ««rr Prepaid ex W.Mwa 1,1x5,759 944,371 Total current asset rrrr rrrw~r rrr~«r «rrw HOSPITAL PLANT, at eedto partially I plebged (Note 4)! 37047' 37547 l 609 Land 3,324,925 3#324, Buildings and improvements 972,4$6 930,997 , Lquiptlent and furniturei I Lesar Adoumu],ated depreciation Qetaxmined on the straight ~Xine (1,229,566) (11046048 ' method ..rrrrw«rr .«rrr«rr.r t ~ 90105,371 3,244#305' r r .«r.r I+ rwwrrrrrrr r+w r. OASH, withdrawal controlled by bank{ '70$ /r r f held as collateral. for disotuntad 44 { patient accounts receivable (Note 5) rw..rr..,r rr..wwrrwr . $40295;839 $4*1~90$6+6 The aocompenying.notea'are'sn' 1 11{ i• } • wI~.IM1Vi.+W`HT/'1~✓f'MIMI F'rY}A~„yIt . Amy Yr.... `rNa+.MrM~FMMT~Yr~i`_• I.~M mow. ..~rww•° „1. ♦N e ti 4 ''A t i 1i03PITAL J % SEPTEMBER 30, 1970 AND 19.69 LIABILITIES AND FUND CAPITAL 1970 196 CURRENT LIABILITIES: $ 40,034 $ } 1 Bank overdrafts Notes payable- 4r1/2% unseoured bank notes ;OC,OOO - Due Owtober, 1970 (not paid or renewed) 45,250 E Due rune, 1971 i5 Nonintereat bearing note to supplier, 20~g39 due Deoembex, 1970 20 796 8,251 6 +7 Current maturities on long-'term notes ) g Aodounts payable (substantially past due 328,794 179y527 4 ai Sep~t9mbe'r 30, 1,970) 33 i1 Medicare finanoing advanoes 106 749 96 f y payroll taxes p ~7 Aoarued payroll and ;120 - rrrrrrrrrr rr.. r..rrrr 1Total ourrent Siabilities 660 462 292,,291 I 9 `.LON0-TrRM NOT S, less current 7 maturitiesNote 4) 24,723 95,270 E 48) OONTINOENT LIABILITIES (Note 5) i J FUND CAPITAL 3,610,654 3,e03,115 1 rrr rr r.rrr rrrrrr rrwr $40295,839 UoI100676 76 ~ ugrrmreorr .nr«.=..., 1 I I ~ nn $ntegral part of this etatemeht, 1 r '~r i. I 1 ~ rl MORIAL HOSPITAL s FLOW r STATEMENT or OPERATIONS FOR THE YEARS ENDED SEPTEMBER 0 1970 AND 1969 s: 1969, 1970 I INCOME: patients $3,543,577 $3,0970474 E" Gross revenues from care of pa Less- , i charity allowanoes and provision 2810493 234360 78 835 i for doubtful aooounts 76,758 W_ Mediocre siloaanasa patient yy 3,1859626 2,784,279 1 pare inoomo I.rW YYrY... ........1r i 1 OPERA'fXNO COSTt 2,o4o,006 1,676$24 professional sere of patients 162;677 296,725 i Dietary 362;906 243,475 ] Houanhold and property 539,928 ~,2R,125 Administration and general' 1$9,738 170,7817 Depreoiation 130,932 le>548• wrr rr rrrr rrrr ww- Mar/ 1 other 3,$02,187 2,830,984 rr r. irr WrY1 .r YYr Ar r»~ (316,561) (146,705) Net (loge) from patient oars rrrrwWrr». 1 f OTHER HOSPITAL INCOME' Contributions from- 350000 - City of Denton 120000 County of Denton 85 995 g00 476 Other. r«r-w YU-Y- ....M Yr MYY . 132,995 $00476 ' ~ p. rr rr rrrr lirrr«wrrM r , 33,771 NET INCOME (LOSS) $r(1~83r96*),rrrrrrr■ 'fhe aooompa tying a are at integral part of this rtatom6nt 1 1 V .IM/M`nn,4 .r.u♦. v. inn.:,.. a,.•fl u ~yt'` ~ et ~ M ey opt ~ ' S HM ~ it OO N D p "ii.. a a, N i q F' N p ~r. o ' bbl ~ ~ f ~y1 P i cYi o µ ~ j i) . ~~I V V V 1 CCC % r~` 1 N 1 C" 1 1 rr ! 1 , ' A 8 1 v . it ~r, w r H I•' . v. v y4l47rt k+ 'it. ~ W I ' ~ F... ! ' i l l{ ~14yF? ,1 f r r r pip) 41 Ott tYA1111 i { + FLOW 1u t,011IAL HOSPITAL i STATEMENT OF SOURCE AND APPLICATION OF FUNDS FOR THE YEARS ENDED S PTEM9ER-30, 1970 AND 1969 1270 i9 I ; ~r FUNDS PROVIDED BY; Operations- $(1$3,566} $ 33,771 Net income (loss) 180,73$ 170787 j Depreciation yr rYrryMW YYYY YYNw {20828) 204,558 Contributions and grants restricted g lO5 19,279 for plant and equipment ~ lOl~i32 Additions to longY term notes ....r..r_ 3$277 3x496 ..'total funds provided , 8 . N.MMr NTMN MM ryYr« , } FUNDS APPLIED TO: Additions to plant and equipment, net 410805 5I 914 Return of oc'tributed funds to donor 150000 f 700547 57236 i I Retirement of longrtarm notes, Restricted cash account related to 5} 706 sale of patient accounts receivable (Note rY~wwr Nrr.«r.N Total funds applied 172,060 109,050 rrrrwNrYr YrYr.rrrr 0 0' $215,919 INCREASE {DECREA9E} IN WORKING OAPTxAY ${168,78 f uaaarrra rarrrrpr 3 . ,I The aoocmpShYing notes are ab integral, part of this ststetaent. I , 1 1 i `6M FLOW MEMORIAL HOSPITAL is NOTES TO FINANCIAL STATEMENTS SEPTEMBER 30, 1970 AND 1969 (1) TYPE; OF OROANIZATION AND OPERATING RESTRICTIONS= 6 The Hospital is governed by a Board of Managers composed of seven, members; three of which are appointed by the Commissioners, Court of Denton County, three by the City Commission of the City of Denton, and one by the County and City acting jointly as one appointive body, e 1 Flow Memorial Hospital is a pity-county hospital organized and operating under the authority of Texas Civil Statute. Article No, ' 44941 which authorizes the 3aint,esthbl'ish" Mont of hospitals by counties and cities, The Hoepi;ta4i" haqb,e.en~ advised by its legal counsel that the Constitution.,~_' _ of Texas and the applicable state statutes under which the i Hospital is or anized and operating d"o not provide for the Hospital to (a mortgage or encumber any of its asaate; (b) borrow funds, unless'speoifia funds are identified for liqui• dation of the obligation within one year) (o) issue revenue bonds or levy a tax; or (d) deficit finance its operati'ons,. However, prior to receiving legal oounseli`e opinion, the Hospital ' borrowed $145,250 from a bank pledged equipment as collateral ; for notes payable (See Note 41, has a $40031, bank overdraft At September 30, 1970 and has incurred a net lose for the year then ended of $(183,5661, The Hospitals legal counsel has further advised that, in his opinion, the assets of the Hospital are not subject to levy under a writ of execution for judgments that may be rendered against the Hospital, (2) RESERVE FOR DOUBTFUL ACCOUNTS: At September 30, 19700 the Hospital had a significant amount of patient accounts receivable which.were past due. The aggregate amount poet due and degree, o£. dell Yuen ,these nacauntee readily'-determinable because an aaourate aging oft was not has riot boon prepared. This situation was partially caused by difficulties encountered in converting the patient aoa6unte receivable reoords to a computer system, Because of the past due Y I yC{{fjll'V.{RTA' yMR RHmvn.. u j MUM. i ' status of a significant amount of receivables and the absence z. of information to evaluate the possible loon from such delinquent accounts, the Hospital Is not able to evaluate the adequacy of the reserve for doubtful acoounte. (3? RESTATEMENT AND MEDICARE REIMBURSEMENT: In accordance with provisions of the Medicare statutes, the Hospital will be paid oust (determined in accordance with the Principles of Reimbursement) of services provided to Medicare beneficiaries. Interim payments for such services have been received from the fiscal intermediary. Statements of reimbursable costs have been filed for j each of the three years ended September 300 1969, During 1970, the additional amount due to the Hospital for the two years ended September 30, 1968, was determined by the intermediary's auditors to be $50,241.. Accordingly, the accompanying financial 1 statements have been retroactively restated to September 30, t 1967, The Hospital is in the process of preparing the statement of reimbursable costs for the year ended September 30, i 1970, The additional amounts due to or refundable by the Hospital resulting from the retroactive adjustment applicable to 1970 are not presently determinable. i j (4) LONG-TERM NOTES PAYABLE; f Long-term notes payable as of September 30► 1970 and 1969, consisted of the following-, i i 1910 1962- Equipment notes secured by certain a Hospital equipment, due in monthly installments of $10389 including interest to November, 1973 (several installments are past due) $ 360041 $ 36,682 4% unsecured note payable to a bank, duo August, 1972 Y 460000 Unsecured noninterest bearing note to s supplier, due December, 1970 Y 200839 Inouranos premium notes, due in installments including interest to May, 1972 6047$ r..Yrr Yn rr 4. M.r , a 42 9~9 $7,03, 921 Less." Current maturit#ea 17796 8129. YY Y,I IY~Y. M14'. Nt..4. Y. 24,.723 $ 99,270 , 00009"Oft MONSOON" ' !r r' :'4 sr ..8• I gyp' j~ h 41 (9) COUTIIMPIT LIABILITIES: ' At September 30, 1970, the Hospital was contingently l3aUlo for. patient accounts receivable aggregating to $66,355 ' sold with full xe4ouxa0 to a bank and a financing oompany, The N ` Hospital is contingently liable since it Iva agreed to repurchase acoow:ta reaching a prescribed past-due a'atua, In addition, tho agrcoment with the bank provides that the Hospital will main. tain a minimum bank balance of $50 000, as collateral for these rooaivablos. At September 300 1976, this balance totaled i' $44,'!08. , i 1 I { i a wow 5, IMF Ph y, r ty . 1. Y DEFINITIONS r j Indigent person - Any non-property owner whose entire income is spent on minimum existence requirements for food, shelter, and clothing. i 1•! Semi-indigent person - Any non-property owner who can pay a limited amount on his account (below $200 a year), but cannot pay anymore without strain- Ing the family income to the point where they cannot pay for minimum axis- tenca requirements. r `'a Charity patient - That person who survives totally on income provided by local, statei or government agencies. Paying patient - That person who can pay their total bill within six months' d' either by insurance, private pay or a combination of insurance and pri- vate pay. Uncollectable Account - Any person who can pay their hospital bill but will not for any number of reasons. This 'person usually will leave town without notice and/or will falsify-information to evade creditors. I a , Y y' Y r u4 , i S t i „ rd J r' t r ~1 S 5 ° Y~1 PROCEDURES FOR RESTRICTED ADMISSIONS • A new procedure in pre-a,:'missIons will become effective today, The Implementation of a restricted admission policy will became an intregal part of the admitting function. Before a patient is actually admitted to the hospital, certain financial statistics will be needed. If a patient cannot meet established guidelines, • he will be asked to sign a "paupers Oath" and sent to the County Judge for his endorsement. Then and only then will the indigent be admltbid to the xr hospital. The guidelines for admittance are as follows: 1, Federal, state, or acceptable private' insurance should pay at least 75% of the entire bill, or Ygi• 2. A cash deposit of $$0.00 per day for expected stay, or { r, F; 3. Existence of a medical emergency, or 4. Have o red book credit rating, ; i If a patient qualifies for one of the above guidelines he will automatically a patient qualifies for one of the above guidelines, he will automatically be admitted. If it is questionable that a medical emergency exists, the atten- ding physician should be contacted and asked if an emergency exists in this , 44 particular case. If the doctor says yes, admit the patient at once. If he re- pales negatively, the paupers oath should be completed and signed, and the patient sent to the County Judge's Office for his signature. When the patient returns with Mr. Todd's endorsement, the patient shoilld be admitted. t` a Y ltd All . , l 1 t{ . iy 1 ti tY` , Iv r , -10 CALCULATIONS ON INDIGENT CARE ramlly N umt er Monthly Net ramily Number Monthly Net ' lnrn~ me _ Income 1 $150,00 6 $265400 2 188100 7 285. Q0 3 205.00 8 305.j, 4 226400 9 325. 5 245.00 10 355.00 i Gross Income - that money received by an individual or family whether it be from pensions, survivors insurance, compensation, rental and/or i earnings. General Earnings Expense - that expense which is a deduction from Income due to the fact that it is an allowable cost to be employed. Example: Child care, uniforms, transportation (excluding automobile payments), tools, and other related working expenses, Meals are not a general earning expense. C E> Net Income - that money which Is left after General Earning Expenses are deducted from Gross Income. j Allowances: { Shelter - includes housing and utilities, Thirty percent of Gross Income i should be used for shelter with a minimum o+ $75,00 being spent, Food - if the applicant is on a food stamp plan or commodity plan he is automatically accepted as an indigent. If the shelter allowance is less than $75.00 (30% of Grose Income), subtract that number from the $75,00 minimum spent on shelter to get difference, Lower monthly net income figure by the difference to obtain true nei: income . Examplei Gross Income: $250':00 for family of three.' General earnings expense cost of $42.00 per month, Is this family 'indigent ? Caloulations: #1 $250 0,1. $208 N,I. $206 N.f, shelter % $62,40 shelter allowance $7640 minimum shelter requirement 62.4Q shelter allowance 12,60 difference t t i 1:' Lowered Net Income by difference to $195,40 Conclusion; Family of three will be eligible for indigent care because net Income is below specified level. Calculation #2 Grose income for family of 5 is $270,00. General earnings expense costa $30.00. Is family Indigent? I 280.00 G.I, - 250.00 N.I. f f 260.00 N,I. -shelter 96 7$.00 shelter allowance ' rl } Conoluslont Family of 5 whose net Income is $250.00 is not eligible for Indigent care, This is due to the shelter allowance meets the minimum shelter requirement. 'r ~CrM Calculation #3. { I Gross income for family of 4 is $265.00 a month. General earningrs expense is $35.00, Is family indigent? 266.00 G.I. 38.00 p.E.E, 230, 00 N.I. 230,00 N4I, shelter 9b 69,00 shelter allowance 75.00 minimum shelter requirement .6.2.00 shelter allowance 6600 difference Lower net Income by difference to $2244004 Conolusion., Family of 4 is eligble for indigent dare because adjusted net income is below standards by $1,000 =gs t t" F i WORKS HEET I Total Family income (Gross Income) General Earnings Expense: Child Care Uniforms E' Transportation Tools Others f Not Income T, Net Income Shelter 9b Shelter Allowance If shelter 41lowance is below $75.oo `fill i Minimum shelter requirement - $75,00, Shelter allowance ? niffere no e I Net Income Difference Net Income T T If net income meets or Is below indigent schedule patient is eligible for County funds. j' 7 t q; I 9 r' w..ryWbAl/4V.t0i4HJtnM>,w r S t , ' usw3 ' h ~ 1J44): v c ~ afro o as c d t." tit r Fj Mi ty b ~ C1 51 v og o~ ~o (p ~ vin v Q ~ W iA r~ 'i 61 a w O p~ r ►i A ~ . v. N w I ! kl N I ~ .~i V ~ ra m M ~ w Aim j CONTRACT BETWEEN THE CITY, COUNTY OF DENTON AND BOARD OF MANAGERS OF FLOW MEMORIAL HOSPITAL i ~~Jf1CCA Communications should Include the following data to all parties involved. t y (1) Copy of detailed budget, The annual detailed budget should include anticipated funds needed for indigent care as well as funds for capital improvements to be budgeted and funded by the City and County. i (2) Copy of monthly financial statements. i (3) Copy of charge off list, (4) Analysis of accounts that are medically Indigent. ANN>i;AL A rnrr. The annual audit is to be financed by the City and County combined agreement upon detail of data to be included in the audit to be Lsefulth as a management tool as well as a oonfirmation of operation. " ' 1~ETERMI~T~IN~TC~~ 4~' f (1) City and County to provide a social worker to assist in determini lndigency. ng (2) T,o comb'ins Information on patients through utility records, tax records, etc, to assist in determining financial status of applicant for dndigent care. i (3) To oxpedite the mechanism for projecting funds,to be budgeted by :the City and County to assist the hospital to use 4% of hospital's budget as anticipated Indigent care and another 2% to be s9t up as a reserve funds for capital Improvements, to make 'Monthly payments to the hospital based on 1/12 of the anticipated Indigent care nerds with' adjustments at the end of the year based on the amount of Indigenoy actually cared for. l E ~~~•Y ' , 11 C~j1 (i c'sli' ~ ..Y+..p4V.y~ 1 t 9 W r~ E. THE UNIVERSITY OF TEXAS MEDICAL BRANCH HOSPITALS CLASSIFICATION SCALE FOR PATIEN'T'S i EYFECTIVE FEBRUARY 1s 1970 t TOTAL i~ Y I COME NUMBER OF DEPENDENT£ HCN I, 1 2 6 8 { $f; $ .00. 23,06 4000» $0400-1199 0 0 0 0 0 0 0 0 i- } 23.07. 34.60 100.149 1200.1799 A' 0 0 0 0 0 0 0. " 34.61. 46.13 150»199 1800-2399 B A 0 0 0 0 0 0 } T,♦ 46.14. 57,67 200-249 2400.2999 C B A 0 0 0 0 0 57.68. 69,21 250299 3000-3599 D C B A` 0 0 0 0 Y f i. 69,22. 74,98 300324 3600.3899 8 D C B A 0 0 0 74.99- 80.75 325»349 3900»4199 F B D C B A 0 0 d 80,76. 56652 350-374 4200.4499 0! E D 0 B A 0 f 86,53« 92.29 375-399 45004799 9 0 F 6 D C B A rf k 92,30 98.06 400-424 4800»5099 1 R 0 F 8 D C d 98,07-103,83 425.449 5100.5399 J S H 0 F B D 0r { 103,84.109.60 450.474 3400.5699 r j Y a 0 V I D C 109.61-115,37 475.494 5700-5999 J J .I I N 0 F 8 115,38.1214'14 500524 60.6299 J J J' J I R 0 F ' i 121413.126,91 X25.549 6300.6599 p j J J J 1 0 0 126,92.132468 550474 6600.6899 p p 3 J J 3 1 R 132,69.138,45 575.599 4900»7199 p p p J J J J I 138,46.144,23 600.625 1200.7500 P P p p J J J J Ago. 10% .70 B.,, 20% 35.40 Cow 30% MID D-- 407. 70080 '.I Eau 30% 86130 Frr ,609. 106.20 0tl yd% ..123.90 Has 00% 141660 ' Ira 90% 159.30 Jm« 100% 260600 , P.M Private Patients v.ht%♦1FMkµyEL Ac ti, IM:r..AW,V" f~R Ate.. 7 9 1 r A ~MIM W" 5T, JOSEPH'$ HOc3PM'AL AND N>•,71ICAL CF\7'FR -tr OUT-MMk:N'I' 1Ik21CY CLINIC rINCoklt, BCREDULL - nXTIVI AT10S OF MEDICAL 1h,-;iIi1flN'CY h ANXIIAL MONTH INCOME, ~ I 1 2 3 4 K B 7 8 9 10 ur aorq.~,,,t 0-2400 200 ;1 5401-2700 226 b A 6 57o1-3ono 250 C B A 100l~~301) 276 D C B A I 5301-8400 300 D C A, M.1960 W5 B D r, a n 3901_1 So' a P, 5 D, C H A 3 4461-4500 976 it a F E D C B_ A 4401-0" 400 r 1I, a 5' ~ n C . 5 " 4db1-Sloo DStb J Y D a, lr E 11 C H A j 6101-5400 450 J I a a. F E 11 : C A I b/p1..K71M 475 J F H 0 F E, D, C 'rot.Wn Wln J I x r E L I 11 i F ` F ~ooi.aslx► 525 4301 *660n . 550 J I : Il F mot-I 575 J T i; u 001-72nn Mn 1 l 11 7506-7644 625 1 r 561-7ROO 660 t........J J ; al. i t, For every $506 In medical bills in lamt }year, redncr• n,lr Nrr>p, h - 2. For r'%tlltUatihA elfeUmMtnnfSP1l, rec111QP one NtPI>. E If patient bee uunelQerehlr, nrnpcrty he}nml II and ever I,honl!h !.ix irrc11roe I•~~ low, Ile Is Oun+I NIP ITl;iIll u or J-1nnv. 4, All pllente on public aaeiNtaoee (WellurO nre Lo he referrer! to Cmrl!y, l~ a.., ~fiHt. >Y.~i`C1sYi>l"91~5mS4aA~LP'If~y"f.•`1A`~»''' Fae. j >1 , I r OTHER HOSPITAL BILLS OWING VERBAL CREDIT REPORT DATA PAUPERS OATH; I HEREBY SWEAR AND AFFIRM THAT THE ABOVE STATEMENTS ARE TRUE UNDER PENALTY OF FRAUD. I DO HEREBY REQUEST CHARITY FROM THE ~ COUNTY OF DENTON BECAUSE I AM UNABLE TO PAY, a RESPONSIBLE PARTY DATE - WITMS: j - 4 THE ABOVE PERSON IS HEREBY APPROVED AS A CHARITY PATIENT, AND I ORDER FLOW MEMORIAL HOSPITAL, A CITY COUNTY HOSPITAL TO AbMIT AND CARE FOR THE PATIENT AT ONCE S f ' I COUNTY JUDGE, DENTON COUN'TY, TEXAS DATE f y ,It Y I"" r ~ y t MAIM REQUEST FOR CHARITY FROM DENTON COUNTY FOR HOSPITAL CARE DATE Interviewer , iGa PATIENT AGE s RESPONSIBLE PARTY RELATIONSHIP ADDRESS JOB SALARY ADDRESS SPOUSE'S IOB SALARY ADDRESS , NUMBER OF DEPENDENTS i ~ I OTHER FAMILY INCOME. EXPLAIN HOW MUCH AND WHAT FORt {Ifs ON COMMOISITY PROGRAM OR OB CLINIC PROGRAM? CAR MAKE HOW FINANCEll HOW bWED CIRCLE: HOMEt RENT LEAJE OWN CLEAR BUYING WITH RELATIVES MONTHLY PAYMENT FOR HOMt;. MONTHLY PAYMENT FOR UTILITIES OTHER PROPERTY IS PATIENT OR RrSPONSIBLE PARTY RECEIVING BENEFITS FROM STATE OF TEXAS? Vr I fVi. V IF YES,. LIST MEDICAID 1 COUNTY OF DENTON, . ,,.W. ,r, e 2 z q x n u y aa, o .hNW1►I i ~ n ~ K r r~ n >r' C q fu I I~~ m rm, sum, " i t " S 9 q r a too ' 1 i' ~ ~ ~ N f y1 b►fooh a" M411 to MA, P. O. @►t 013, Awlin, Yalu 78761 YYYn.,Y.YY.......... .........yy Yy.. ..Y~y Y.1 ..Y Y .IO...YYYYYY...Y....... {I' x• 71' W W W N N N N %0 C ro U b WO W v~i 'G ~ 0Q2. r+ COW W VI 'C.. t rt 5 . o a w ro m p (s, ro q N d I ro W F .Xc~:. • o sl , to 0 0 y : M C y A a1 t f; H H O H r+ y D{ p y p G W ? to t-4 n M C+ xA ro a ~n I~ "1n~ b EE .I i on, d r9 H y Il H ~I y All to ib y 46 W V " µ ~.7 }1 ~.N Wtl µ~b'I t-1 M}~~N M ~'I~~A~'tl r'S' PI t~~1e111 C old y I ' log OM At A vqy p~ ~ d H Y M Y ~ ~ Otl~f p A i:?; ~ ` R N ~ - GW1 L~ Fy ft ~ A S7 ~ W W A '~l d 4 N v W W r 4 jt;a F5 rA fly w y' X01, Y y At rq n O N > IL.'.' W. te Cl' 4~i d H c~t G. N dl tr. to N• Fy CL I N @. ;..i 1.w e4.ut:.u..Ad... . ayRy ~_:l1w.o:".w~,ua...wM.:+:a..ww.I,iuai..lr.•Xi+6:4w:4.~w.ask.wo.:.r7.d++Y+.w'w.:....i,+.s~.,w.......,,.__:,. ~.lnwvytp.++ `~"^P' ^.wn«sww..sKFMAY.BH#NAA R~'~'''_ 14fiM+SNpfilr.4Y:d`+K. 'N~%itiN~+u.w.e WNSkNx+H^. ,"~~f i r i U1S. DIPAR}yTIAINCcT OF LABOR ' 't wA0! AROOID %V" IC1R~tTa~ Q~MMTR TS DIVISICMS t Fort Worth) Texae 7 or 610022et } DATE 12/14/71 RCI+LV TO ATTW op, e, }.f ~ r,<~ evr♦lsctti lrioW Memorial ltepital Denton, Texas s. i{ Tol Larry Camp sr s1. Rt. 3, Box 215 t Denton, Texas t r, A recent investigation o[ the firm nomad In the above Subject under the Felt Labor Stand. aids Act indicates that you were not paid as required by that law. it Is. estimated the period from that for 6/13/69 in back wages. to. 4/4/70 you are due S„_47•pp _ , The firm was requested to pay the back; wages but did not agree to do to, .We have re. r viewed all the circumstances involved in this case and it has been decided that the De. fartment of Labor can take no further action to secure payment of this money to you, E_ The fact that we will take no further action on your behalf does not affect your Indepen• f, dent fight under the Act to bring suit to recover any back wages due. The Department of t Labor does not encourage or discourage such suits. The decision Is entirely up to you. z It you decide to bring an Independent action, keep In mind that recovery of bock wages under this low is subject to a two-year statute of limitations (three ears wh , ; y • Proved that the vloJeti y ere ona a can r are be willful), Generally, eJolm which was earned more than two years bore i suit is filed may no! be collectible, For your Information I am enclosing a Mandy Reference Guide to the Fair Labor Standards Act. L. C. Chandler Area Director , Enclosure: ' j, ' Mandy Reference Guide E 1! j P4M wit I* inw, pdq) r r..e 4 I U.S. DEPARTMENT OP LABOR r. :tin MAGI 9o"M*1Af?D,t WfArToTr IEr'e"VISIOMs port worth, Texas 76102 H 3 , RILPLV p 12/24/71 { ~~aaff 'Q,+ E v~1 ATTM o!h Al• lt: t,;r glow Memorial lbpikal 1^ Denton Texas yt ~ 1.F~ a to. Larry Cemp E` I Rr 3, Box 215 1'ur Denton, Texas f!(f}1\ 1 S' A recent investigation of the firm named In the above Subject under the Fair Labor Stand. R ards Act Indicates that you were not paid as required by that few. It Is-estimated that for d the period from 6115 6 to E In hack wages. 9/4/70 you are due,S- 241.00. 4`' The firm was requested to pay the back wages but did not agree to do so, We have re- f viewed all the circumstanes., i Involved In this cabs and it has been decided that the De• partment of Labor can take no further action to secure payment of this money to you. The fact that we will take no further action on your behalf does not affect your Indepen- dent right under the Act to bring suit to recover any back wages dual The Department of ' Labor does not encourage or discourage such suits. The declblon Is entirely up to your + If you decide to bring in Independent action, Leep in mind that recovery of back wages a under this law Is subject to a two-year statute of limitations (three years where It can be i proved that the violatious are willful). Generally, this means that any part of a back wage E ciaim which was earned more than two years before suit is filed may not be colfeotlbfs l For your Information I am enclosing a Hancy Reference Ouide to the Fair Labor Standards f Act. A L, Co Chwidleri 'i Area Direator Enclosure, Handy Reference aulde { j lam WN•130 10". 1/491 r t 'dulylCH,r..,....: _.a._ --`-•f'. ..•_-•VwRr hl:jM~IM1'x~~,~y e.r.. 1 .,....,.I fy,~~ r COMPARISON OF ARTICLE 44941 IVD ARTICLE 44941-1 (1943 ACT) (1965 ACT) City and county delegate to a City and county may create 4.prt Board of Managers full authority a public body politio, with to establish, erect, equip, main- out tax authority, by resolu- tain and operate the hospital, by Lion. No reference to tax or revolution or other appropriate tax limitations is made. t action. For some cities and coup- y ties, a limit W special tax is Seven (7) Hospital Board of authorized. Directors are appointed and con- stitute a Joint agent of county Board of Managers are appointed and city, and sha.l.l act solely 3, 3 and l joint. The seven (7) for the joint benefit of said members serve a six year term, county and city, although it is and appoint their own chairman. a separate entity which may sue or be sued separately, in its J' Board may contract and disburse own name, capacity and behalf. for hospital purposes any funds set aside for it by county and The Directors are appointed 4 dity, without approval by county by county, and 3 by city (no i. or city. joint) and serve two-year terms. { They elect own chairman Board may not pledge, lease, obli- gate or assign hospital property County and city expressly auth- or assets of any other kind, and orized (in Section 5) to exptlnd may not borrow money. money, and enter into contracts with Hospital board, and may Board to present financial state-( levy ad velorum taxes# without meat and budget once each year, lim tation. ✓gfrA2 from which county and city shall appropriate money for ensuing Board of Directors may borrow,, j-~ year, as they deem proper and ne money, through Revenue Bonds, cessary. but may not encu ber.property or hospital assets of which it (County and city may contribute to has title. County and city, the funds shown in the proposed both, must, approve the revenue budget in whatever proportion they bonds. When city or county trans agree upon, and no lam tation is fare title to the Board, it may stated. impose limitations upon the use of that pproperty as each deem The Board of. Managers have comp- reasonr,bZe) resipectively, late authority to manage and con- trol. The only authority ti;he city The Board of Directors holds and county have is to appoint mem- title same as corporate entity, bars to the Board (with no removal and may sue and be sued. It is for cause provision), to approve a separate body pQlitio, the annual budget, and appropriate money therefore. } ~y Only sources of revenues ares (1) , ,2 cityy and tlounty appropriated con- 1 dle ;,xr tributionni (2) private contribu- tions) and (3) income from opera- _e 4rl ';ya tion including patient cars. ✓ The Board of Managers cannot hold° title to property by more creation U r under this Article 44941. This Board is not a separato entity, or t a body politio. r a+~ i 1 C d _.i }4 ~w,J..Y t~r'a r< rr,V,rb~a(bMo.¢W~.uUU+.JU. <Ydti]p4,. tVs~. •.n .c,. ..n.wY.alrw,k`S ' cr I L ' Cnunty City flaw Result 1. 88,000 A. Hospital closes 2. 88,000 889000 300,000 a. Conduct drive b, Continue restricted admission policy c. Probable 'surplus to aid cash flow - d, Time to plan for restructuring hospital 3. 88,000 88,000 3001000 a, Conduct drive 60,600 b, Trial of graduated partial pay schedule far Indigent c, Hire social worker d, Possible surplus to 'aid In cash flow e. Time to plan for restructuring hospital I . } i` natitl,Y Cm t/A(cr /~tn1r .l. µt..M4~.V+-tylv{~ -.C!~JiQ~,./SfLG .{/Le.1Q?.F~«C./. Y!.,4Yt.vJ.'.' ..`Q.tl2tl,rFw.._kd!C.LU-QXl~4 ..I 2 ' ti :f i ; , 7•: ~i1y~. 1~........ _ ,::l:.I ///4'__~S. rlY _.gw~f.K ~"eci~' ~T~~~. ~~~~~i~~. ~a . r 7, ~ r~ A r 3~ 1{,j ~ .~r4~N""-_T. I Y/M(i .r r:.. GM.M_.~""(lY. "4!.:_... n...+,.. M'°"'^• ; , 2 ~~•((7.y,!~.~~~"' ..~s:G'/' , .~F~r . -.:.fit.-S:r~+/. ~ . il~l'l Ilk fez...-+'~" .ti s'• _.r M..._r.. r...rw. :.r. _..r_.u. bra i _ i r, r ry.:: ysicf4i%i..n,ua+rwwrr...,,r.a1~R45ir`,y~ „ ~~,~a,,. a,. vnir.•w..yeli!y.0'a~h~NA~'2n~6'N~c~i `h4TGS'sti~iE #l 1'I,CW MEholORIAL IIOSPITAT.i ANALYSIS 01' FINANCIAL NEM)S } According to our rocap of the previous six year financlal statistics', the 'ollrwtn9 table shows cash witch could be generated through a'50% reimbursement on charity and bad debts- YEAR CIMRITY AND 50% RI;IMBURSFMENT BAD DEBTS f 19G5 $105,542 $ 52,771 1956 117,213 58,6Q6 1967 211, 715 107,358 1960 216,014 108,007 r • . ^ . rj a rl l r ~li•: s.. gip, i1 r.. ,gyp ..r -~.A~ t. r. '~.'i ,.,F r. . 1 t. y. N;•; i'. ,rr.••, i.l ~ii~'~:, yr, en'.')f,5 t, l.rr ~ i,SN":C r,{'../H,r~1}1f,8'Sr 51.2 ../.:.rl -I+' r .r /'ii:~ r fir., .1.2 }f r,.+'.1~1,17~';3~3.•.• '$58;'67! A 50% reimbursement in the past would have elelminated the cash problem. The current years statistical budget reflects an estimated charity write off of approximately $300;000, If funded at 50%, this would amount to $1600000, or w ' $12 , 540.00 per m oath. 1 ;t E E 1 r 1 .lad'' 1 I 9'' R 1~ ~ I Y QUESTION: Can Citp buy, pledge, or otherwise use the accounts receivable of Flow Hospital, for the immediate or xAR direct benefit of the hospital, to raise needed cash? ANSWER: The Hospital Board of Managers has no authority to borrow money, therefore no loan could be made to it by City or by County no matter what the pledge or security. The same Board has no authority to sell, pledgof lease or onaumber any asset of the hospital, including its accounts receivable, as it does not have actual title to 5 same. Title remains with the City and, other than realty, jointly with the County. The only powers given the Board of Managers under 44941 (1943 Act) is to enter into contracts connected with the establishment, erection, equipping, maintaining, or operating the hospital, and for those same purposes, disburse and pay out funds set aside by the County and City for that purpose. This is a very serious contractual power limitation. it appears that the present Board can only manage funds act- ually received by it, or appropriated for it by City or F County. The City of Dentpri 's Charter limits City purohasing, and further limits th investment of its funds. The City may borrow money, without Apparent limitation as to source, but may lend mon~y, only As expressly provided by charter and statute. Thai City y not Iona its` credit to any person or entity, inol+~~ii±q` Flow Ro' v.pital. Taking the accounts receivable on their merits, deter- mining rate of aolleotioho percentage of oollection► oto,r and Assigning a value to name, may justigp their puraha"i but since the present'noard cannot lawfully soil, we can Act lawfully buy,. x Y 1 1 { 7 Gt~ RL r a f Y A. !4 NANFn i'(•).r~l•;Y iU .1,. a'Ii.L Y4.FAr.: ..u.r.•a....u i.. j ITf~1 ~di rel Jl F F-4, i, ,f ch. 6 COUNTY HOSPITAL Art. 44941 Art. 44941. Joint oslablishment and oporntlon of hospitals by counties and cities or towns i >wstnbllxluncnt- And 61MrAtlon nuthm,lzedl Ins to Inq bonds Section 1, Any county of the State and any incorporated city or town within such county, Acting through ilia Commissioners C60rt of such count`, and the governing body of such city or town, may joint. ( a 1y establish, erect, equip, innintnin rind opornte a hospital or hospitnia { for the care and trentment of the sick, Infirm, And/or 'injured; and for Ilia purposos of establishing, erecting, equipping, maintninIng and { operating such a hospital or hospitals, the Comlbisslollers Court of any i county and the govorning body of nny elt.v or town within such county rang, by resolution or other appropriate action, Confer upon, delegate' to and grant to a Bonrd of Managers, as horolnaftor provided, full and complato nuthorlts to stablish, erect, equip, maintain and operate such r hospital or hospitals, , >,ipl.; Cities or toayns.nnd gountfes that have here; btrt~o ~ f totore issued and sorc3 bonds for the speclfle purpose of joi(iily eathb, a i U§11114, erecting; equipping,, maintnining rand opornting such joint if ILt ' ;p1gty-city JiosllitaI Jnay finance sueh hospital or hospitals out,of gen- t1t,.7t; gitl rot nues and are caeh, respectively, horebv nuthorlr~ott.tO levy and 1 J" r'.. collect a tax, not to exceed Ten (20) Cont%per one hundred dollar ? } N-aluntlon on tide property subject to taxes therein, for such purposes to 44~ ~a { Ik`Ardot:ltnnngo+~tl nlemberehlpl tetntt .Yncnncies fA? , Sec. 2. The Montid of Managers shall be colnposed of seven (7) j members; throb (3) of this number shall be appointed by the Com• 1 . misslonera Court of sueld county, throe .ahnil be appointed by the governing body of such city or town, and one shall be nppointed by the i Conmtiasioners Court of such county and the governing body of Such 1 city or town noting jointly as ohe npidolntlve body. The. Commission, ers Court of such county MIMI appoint to the Board one member for a t 1 term of o£fieo expiring at the and of two (2) yoara from date of ap• ' pointment, one member for n term of office expiring four (4) years i from date of appointment, and one member for a term of office ex• t plying six (0) years from We of nppolutmetdt, In 111;o ndanner, the f govorning body of Much City or teen $11011 nlipoint to the )'Joard ono I member for a term of office expiring two (2) years from date of rip- i pointment, one member for a tarn of office expiring four (4) years ; from .irate of appointment, and one member. for n terln of office oxpir- ing six (0) years from dn(o of appointment; And similarly, ilia Com• i misAoners Court and ilia govorning body of such city or town, stating 't together as an nppointivo body, Shall appolat one member for a term of office expiring six (0) years from date of appolntment, There, nftkr, rat the expiration of each term of office of the inembers so ap• pointed to such Hoard, tide Commissioners Ceu1't And Elie govorning ; body of such city or town acting',joi11!?y AS nn nppointivo body, shall 5 485 ~ l ,1 l,,.p......o,w,,,,,,•.,f,,.~„P.e,,,,wr.~~,,,..,•,w,~;.,,r..,,,.•,,,q,.11N.c1Nh1*R' *.`M!e~►.nlcNw.Y'-+'nYA~W~1+wMM" , s W070" I , Art. 44941 HEALTH-PUBLIC Title sr each respectlvely make, and continue to make, similar appointment.; to such Board for a term of office of six (6) years each, Any vaoanev occurring dui-ing the torm of office of any mombcr, whether by roslt~. ; nation or death, shall be filled for the unexpired portion of such term by the particular appointive body previously making the appointment f `J of file resigning or deceased member Ih*vtding ofaoer4 quorum See, S. Such Board of Managers shall select a chairman or pre. i siding officer from among their number who slinll preside over u}I meetings of the said Board, and shall sign all contracts, agreements and other instruments made by said Board on behalf of such count- and such city or town. A majority of the members of the Board shall constitute a quorum with full authority and power to act, Powers of Mard f~ Seo, d. Such Board of Managers shall have full and compietn ge a t'4 authority to enter into any vontrggA connected with or incident to tilt t~ establishment, ereotlon, equipping, maintaining or operating such f ' -,n e s hospital or hospitals, and in this connection shall have authority Ill •dlsburse,and pay out all funds sat,nsldp N such county and such clt, y or town forWptuposQs,conntectetl with such hospital or hospitals, 1tn1l such action by such city or town ns though such action had been taken by the Commissioners Court of such county or governing bod,%, k of such city or town, A Soo, S. Once eadh year" such slatementl budget Board of a nw gers sht;11 prepare t+ f i and present to such Comuiissiotters Court and the governing both, of 11 such city or town h complete financial statement of the financial stntu alt,. of such hospital or hospitals, and shall submit th6rawltlrn propoar l f" ! budget of the Anticipated financial needs of such hospital or host>ilnl, "nt +1 `IS uuldgthe et the Commyear. tssion~s t~'notuasis of such financial ptntemont and I!, r' etT t of such county and the gotctnhw r body : of such city or town shall appropriate or sot aside for flto uar of such Board of Unnnget% In the oporntlon of such hospital be ho.glhai, the amount of money winloh seems prosper and necesgary for such lilt", pose. Contrtbntierut Sec, 6. The Commissioners Court of such county And Oho guv eraing body of such city or town may contnlbut6 to the funds nerei saty for such hospital or hospitals In whatever proportion may I,c dr. termined by them by agreement, 1 t..t68j t Hw,.,,,. _ ...,.w+.o,,..,enww.v.au;.,tewn'.ueNalr Wa., tB.heMdM,~,riNY+•xs..wr .4a.. 0V 1 S, slaur r ` rt, i•,MIrIJkI H.\Ya.. gyn. JJYn.... i. . Ch. G COUNTY HOSPITAL Art. 4494i Hmtngotuont find control Sec, 7. In connection n'ltli the orectfon and epltipping of suc11 , hospJlnl or liospfiah quilt ol?onrd of Itnnngerg shall hnvt~ the A tliorlty N!• ) to detetmllno the manner f exvending any funds that may hate been provided by such county And such ity or town for sucll purpose, whether by the issuance of bonds or oilier obligations, oe t1,r• appro• ? pi'fntfons front other funds of such county And olty ot• town it bein 1r 7 f Ilie Intention by this Act.to g C! t ih, to ninnnge And control tiilln mAttei~s~nfeetinghSuchtihospitals,lire- leaving to such counh f nn~l city pl town the rlgLtolil,v So. nppolnt .nlemboi-a to quell Board of lltanngcrs And to Approve (lie'Annital budget l f horelnnbove provided for, J Act cumulntlre I See, 8. This Act is ounittintive 'of all other Acts relating to elty and county hospitAls, Acts 1948; 48th Log, p, 6911 oil. 883, Historleal Note i 1'Ait of Atilt Il An Act prodding for counties and alike saidleBopard &11d g dcrtghmanner of; (haltiponmknl t 1 1 to )olntly eparme, and mnlntnfn hort,ttatp and dullee slifor c hatr ~ to provitI nff for n nonrd of mwmoors for till, Ilia Rinds of soldhean~t:iles providing foe a fqn rat Ion of such hospitals, and' further direct lox IfVY 1 i e Act n a t I-rovidlne for Ilia d le rl I mfit. Ore Act 1, Act• 1 amartlea to such f o pc nt l at such such has. and 111 1043, 0j a tilt nd Lep, p, drolnrh aPi, r1 1% emorpMloP Acts I 1oaW oro cl".. Otr. Cress 1R Ilnnnl of manpprs, i;N art, 4470.eerseloes l1110A (if 10.00 fir moro, joint hospitala, too net 4402, I'lly-volinly Lc0th units in o6inaloa containing lucorporilled CII;', em art, 443Qa--1, I Ilo><f,llnl 111109 hl Cities And 0ountlos, Em net, M. Notes of Deoldare tilde a Conttruatl6n sad applleallon 1 nnlro n Otero, And dottilled report of the oil. Liability cration of moat hospdnl front parties oMr- vurthssettand eoalra6U t sting ilia hospital tokother with suitable mesa 7 recomnlendafiens 41141 other matters as might to raqulred of thom• Up.A lly'.tlen, 19dP, So. 7T8, ,M1 LlararY n}annae N-ueetm county could Icgally.expand mom irtinp lara OW, IF Meratice 6,. eY for file conmitmetim of A storm rN'er ' of a - V.J.H. t4ospilais it 4 at eon., 0. (A line -c un%11hosidiA ven}thooffi the city I, Conetruauoa and appiltaliort oonarmMilllis too the plratosedealormepower - The InAUakcinan6 control and operntlon 110101.6f the ell 4010. hospital, Op,AI(y, f t'tts•county hospitals operated Johnny b}, a* 1044, Na. h-0610. "tx and count yy was voml0d la odunollud Board of niauapong of cllycounly hospl• n i.d lountY authorllloa Jointly, find. by olu. boil rinroomenl. WeY:could pro0da, for ilia lulled ngAlm loon of eounly ofunds !rune. nNrrmdlit, WIWI And 6"I'Allpn of such ferrerl to such Wahl, but Wiled. members I..." I-nn4 And lrescrpplGO Ilia 1116110 told Man• Ulm liable for Any mlmallpheatlon of funds ' bli4tuj b^rlnndit4l'alndhtafd,r4ndlprovItidfoes keop- feinting to l usa lnml onto lat pubild funds tt x bf reconN of nil lie proccedings and it. Op,AttyclonAplt, No, 1'-004, 457 r , s' n`swl~ihe'Y~W."e,vh~et7L11G,1'trIA9/ANtyi(4MaMM'tihisNgert«t,.»w , I rw i i II Art, 4494i HkALTH--PUBLIC Title 71 4. Purchases and contracts on $So0 valuation. Op.Ati Y.Oen.1019 \n. A board of nNnaYor6 of A olly'counly V-93 i. i, hospital, operattug pur.uant to lldlarllclo, ff1 did not havo to ady6tilte ter bids too pur• 4. LlAblllty 1 ehnro of tnatortuls and adppllQS in exceae of Incorporated city , and county Nitrify 1f $10, Arid Was not re'lulred to Advortiso for nattntatubtg and onaraang hospital un't- bids oil coutracts JA 6100.8 of $3,000, Op, MARKO u'oro not Itnblofor damagos (0^ pom. A11Y.Uon.1914, No, 0-053. sonat Injuries tudtalned hf Cntplu>o- s, The Cmnmlaaioners' Cmirt of Nolan n'hna porformiup duties In conwHen ein, 1 otf tr,ly,. ll Coutny Amy Iegutiy nliprovo and ratify a hospital, eauscd by ne11190ned Of provlat0 unaulhorleod oapondtlure of he sorvants, or emplel•e68, Op. AllyOen,t4.'.9, ti hoard of dinnagers of It ORY•counly 1163pl• Y6. P -148L - i; jai it they se6 fits op.Aily0on.1963, NO, t1'S5'-1339, 6, olds, if Tld pmvUlone of Avis: 100, 1651, and {f n. 7ax4s 43080. relating to bids for mate lnl and sup- lfaximuru tax rnle tehtoh could bo W-led pllas And to the "ClUlrorneuu governing Ad- by oommt.stonurs court of now county vortlsing for b1do by counties old cities, do for ho401141 purposes In C60"011en with not apply to n etly'aounty hospltal est:n,. 't joint oporatlon of mamorAl hospital with lished pursuant to this article, op..Np'. it>' Of Ann Antonio teas not to axoesd 100 0en.1003,. N0, Ayw'1339. 7 C~%;7 - Art. 4494i-I. Joint Bounty'-clty hospital boards ~i Itesolutions'crenUng bontdril designation l Section 1. T t' c L Winty, and a thg' v er bo of n i ch 3n 4C18.u1 ocated w 10 of Ali 1 Gsa u s tit ou hos board t tax- n 1' rs t c 1t o c a to j0. ~>'s pa a 19 " - ountyC ty o _ . -r a 08, { pf oar<, U[rcctota; n1iVoLlttneljtt boards As separato entities Sec, 2.' Said Ilospitol Board shall conslet of seven Director's, to r, be appointed and sol.vo as hereinafter provided, and said Hoavital Hoard shall constituto a joint agent of said county and city for hospi- tal purposes, and shall {tot solely for the Joint benefit at said eount+' and city, Although acting as such Joint agent, said hospital Donrd shalt eonatituto a separate entity in the oxerolso and pallormanco of the powers, duties, and fufietions authorized by this Act, and with ver• { Grande thereto Bald Hospital Board shall net and proceed independent' iy, and may suo (Ind be sued separately, In its own name, capacity, nod behalf, 1 ,I Ton" of ditootorsl' relttibursoment for expl'nsest chairtnnn And Wrefilryl ofGcora See, 9, In ilia resoigtlon of the commisslonors court oreatlivt sate hospital Board tour Dmetors of said MAN shalt Ise appohitk.d, w1F1i '.vo being designated to Born fo3' two-roar terms of offlea, i1 t1t1 Director the appointed by 1110 iext%vb pih~lon of f tile term of office of tiny 458 a w..n.n++r...«.~.+s,'^'•».+~,.y,.+ww..ew~WgnMq!..nww+......,e..-.. ,.rte' - 2 ,Y J 1 y( yo+ ..°.••.,,ro,rykf,r:4Ja4a116`~4A'~t1a Yr„tgilgpit~.y*~~,,,','j{j}i:'.NLFN,ya's N.sr.u.•e..... ^n„r r.r.. -1 t'h y COUNT flosptxnr. Art, 44841--11 1111104sioners court, said commissioners courtshnit appoint his sue- ,n• to serve for a two-year term of office. In the resolution of rrcrniug body of the city creating sold Hospital Board three DI- L-1or.; shall be Appointed, iwlth two being designated to servo, for terms of offico, and witlr one being designated to serve for 1"11.}•enr term of office. At the expiration of the term of office of Director appointed by the governing body of said city, said gov i -JIrt,• holy shall appoint his successor to serve for a two-year term t office, It is the intention of this Act that at all times raid Hospital r .wd shall consist of four Directors appointed by said commissioners f to irl wnl threo Directors appointed by the governing body of said All Directors shall servo until their suceessors are appointed, that in the case of any vacancy the unexpired term of office f I.;,ll be filled by the appointment of a Director by said commis- court or the governing body of said city*, as the caso may lw. which cppointed the Director whoso death or resignation has r,111~ed the vacancy, All Directors shall be ellftible to succeed them. trc8 ht office, Directors shall not roceivb any remuneration or ru: ,lament of office,' but they shall be entitled to reimbursement for +11611 actual expenses Incurred In performing their duties as Diree• to the extent authorized And permitted by the Hospital Board, The flfreotors slitdl elect one of their number as Chairman of the Hos. 1'11;d Board) And he shrill presido at nteotings of said Hoard And per. i -rill :nlch other duties And functions as tiro proscribed by thA Board. 'I he Chalrman of the Hospital Board'siiall have a voto the e,nlo as Iiw olhor Directors, The Directors shall elect a secretary of the Hos. )~O;d DoArd, who may or nroy not be a Director) and who shall lio ilia official custodian of rte minutes, boolts,'records, and seal of i ! 4;Iid Board, And who shall perform such other duties and fimctlons ns tiro prescribed by the Honed. The Directors shall be authorized to 1•1ect nliv other officers of said Hos; itni Honed As they deem necessary ar advlsablol and said Directors shall be authorized to appoint or employ such agents, employees, and officials as they deem neeessary "I, advisable to carry out any power, duty, or funetion of said Hospital 1:4011. Said Hospital Board shall act and proceed by And through rv~;olulIons adopted by tlio Directore, and the affirmative vote of four rirectors shall be required to adopt a resolution, \nl"IsItIOA of hotptlnl htOWILMl pnrebuo or We at propergy donatiotlr „a t >rn#t, and ,hall be authorized to pure Sec, 'L ) r .2a13e, Con , yljye, l t ra se ac"liMaI land iA61. 1 o furniah, a v ~ o In Aft calu e --Iilq pro t lug t onations ro n source. ' 1ggifts, ~......g3'flllYr& i s t f, ~ L 10" OF- Arta 44941•-•1 HEALTH-PUBLIC Title 71 TrArOfcr of 110apltnl fnenrtles to bnnrdo: contrrtets for enre and treninu tit of ucedy pntlentst federal And Mato funds Sec, G, The county And the_ojtJ; usptcti►p h f~ Sf1i<1' T[ospit ,Qp~,~h,~azed.to,douse,.or,.to.cunr~,t.ttud„f~a~sfel' i t t o or any other interest la. nil or env uat't of their hocnilnl fn. c 1t it~les_^-11 s a real and personal ro port ortAlnin thereto, to Said Hospital Board, upon suc t ernts anc Condit o s, naval l AA e (a erm Ifi fc TiTflso partles• It is providrd, however, that said Hospital •-shnll.atnt.J~& „author zec o o .I c nve onn pro per m ranee sn e, 1 lenso, t°"est,.l9Ltt1LC9.f3.p' p! of tot e'finAl cone •ITolt I i there sapoff v resn3 1~ A 4 mr~ s onel:q eourl o eounty and a~ Y e ~"`"t'ga r t overn 118 dv of said cit rMae ve'; s 1 ft. u)l ei' SShnTlfie e j~n into con rACts c ty thgh i Tine•p, Ital Maw for the caro need Atlents, orT an er to 5j44A, ant] gn nut or .-ti -exam -AV ypymofits o,JL, tat E 461utUs in 9'U frivia Cta and . Vt or A "d to led t n ads o untrilets, Sa < I if osp In 0AR shnyiqi 1101 li a iiufltorized o ap- ply fov, receive, and expend any AvallAblo funds front the federal or state government for hospital` purposes. Further, said county and E said oity, respeetlvely,'may, adopt resolutions Authorizing and donne f tinting such Hospital Bonrd as the lawful agency to apply foil receirc, f And expond any nvnilgbie funds from the federal or state government II for county or city hospital 1wrposesl; and to the. 'extent of such nu- tltorization the Hosplint Board may apply for, t ecelva. and a-Mend any such funds. Bond Issue l Seo. 6. o t o e of carr Lt o an other duty, or fuu t S ttil Sipp' If tor• ized to i, sue its proven I~t~gj~~~p~y.gpl~lo»frout„Anclaaer lTTe j, A OF oil an mtt of ti 0 14%1 zttitQJAIeranaa, sH T tt iTl~ati an k to tos ti itl fhcillttrv f A! boar'I; a c bolo e ac c tfbiuillJ"' sACti a,}"itloi'},}ril~ ljl}` out 4, 1'ts r~a1 of persondi pfepe! t, nniT s cu{lb'd~F7~1#YUakt~~ri_s_e_t~i_e ; ctp ar"Cc (MC-1 , oof trill rttl nt' 'os other forms~o oncanf -"~iY£ phi" s Gt ilfl °st> a , uttt'c s fit 1 nvc no ry p potvcr 1ta obi@r o le4y noes of an 1{at4ile aucriill"6onil9"~fsssiec y 5nid ~ Boar d ltltli c`""'tit q nn"t~i'1'tlio t"oT~ottlitk'-t hFtE7"""CItVt7chll- i el• to 00 a to never into le ! g "tlItllfi'iC'tJlnent of this obli- gatiort'from tuxes l6lod by said Hospital lloard," if qo provIdod is the ProfeodIngs Autltorizing tho lsstmnoo of the bonds, any reflull-ed pnl•t of the proceeds front tlto anlo thereof stay be used for paying Interest A!i tllo bonds during the period of the Construotion of tiny ; aao R~ ,is ^ n.n .,..vq ewswbl!., «.,..y„p.y.,,.. ....~~...•w+,.w.,.........ew~«ntY ~ r.~~e.,.a~l~rl~M~~r'... +,r.:. i i~ I II , r:,: w.tv{...r•e ~r.e ~.~?aH1lE84Y.i4ir.LSf{^Y3rA:rS'aiNf{~4 • . 1 low j' COUNTY ItosClr.►r. Art. 4494i-2 I ihospflnl fnellitles to be acquired through the lssuanco of sold bonds, it ;ild for the payment of operation And nnnintenmteo expenses of said hospitnt facilities to the extent, And for the period of time, specified in Enid proceedings, And also for the creation of reserves for the pay. ment of the pOncipal of and interest on the bonds; and such moneys may be invested, until needed, to the extent and in the in anner pro- vided in the Bond Itesolutlon or any trust indenture executed In con- nectlon therewith. Interest ratel additional portly bonds See. 7. Said bonds cony be issued to maturo serially or other- %vfse within not to exceed 40 years from their (hate, and may be Issued to bear interest at any rate or rates not to exceed 61,b per annum. In tho authorization of any such bonds, the Directors may provide for the subsequent issumico of additional parity bonds, or subordinnte lien bonds, under such terms or conditions As may be set forth in the proceedings authorizing the issuance of said bonds, all within the discretion of the Directors. Said bonds, and nny interest coupons S Apiertninfiig thereto, shall be negotiable Instruments (provided that such bonds may be mnde registrable As to principal Alone or As to both principal And interest), And they may be mnde redeemnble prior to maturity, find mAti' be issued in such form, denominations, and man. ner, and under such terms, conditions, mud details, and shall be ex- ecated, its provided by the Directors In the proceedings authorizing the issumnce of said bonds. Said bonds cony be sold at public or s private sale and At n price and under such terms as shnll be determined by the Directors, provided that the `interest cost to said Hospital board, including any discount on the bands, shall not exceed 8;~o per annum calculnted by the use of standard bond interest tables current- )y in use by insurance companies and investment banking companies, Approrat of twnd lseae See, 9. Notwithstanding the foregoing provisions of this Act, i I said hospital Board shnil not deliver any bonds unless the Issuance thereof is Approved by resolutions adopted by the commissioners court of said county and the governing body of said city, respectively. Clinrges for wrrlees and facllnles see, 9. All hospitril facilities of said Hospital Board shall be operated for tho tlse and benefit of the public, but It shall bo the duty of said Board to establish find collect sufficient charges for services and facilities, and to utilize all other available sources of revenues and Income, in order to pay all expenses In connection with tho owner- ship, operation, and mnintennneo of Its hosplwl facllities, to pay the A ; Pelnelpal of And interest on Its bonds, and to create and nnintain r reserves and any other funds as provided lit the proceedings author 1 l i ~ H•.wf,-'IMI4S~yb.~„'4~,+9N+IRIY}F,F.,ry~!"• 1 1 S~ c µq is 1 ' 1 41p 7 ' Art. 4494i-1 HEALTH-PUBLIC Title 71 Wag the issuance of its bonds. In the proceedings authorizing the issuance of Its bonds said Hospital Board may prescribe systems, methods, routines, and procedures wider which its hospital fncllities shall be operated and maintained. Wlito of land reeolutlonl petlllon for ereettanl ndolttlon of bond t resornt lon Sec. 10, (a) Before authorizing tile Issuance of any bonds, other than refunding bonds, (lie Directors shall cause a notice to be prepared stating that the Directors of said Hospital Board intend to adopt a resolution (heroin called the "Bond Resolution") nuthorizing the Issuance of bonds, on a named date, and stating the maximum amount and maximum maturity thereof. Such notice shall be pub. lished once each week for two consecutive weeks in a newspaper hnr• Ing genoral circulation in the county and tho ctts-, with the first pub. Notion thereof to bo made at least fourteen days prior to the irate act i for adopting the Bond Resolution; 1 (b) If, prior to the date set for the adoption of the Dond Dosow E Iution, there is presented to the secretary of said Hospital Boned it i petition signed by not less than ten per centun (10%) oe the qunlineil voters residing within tho county mud any part of the city which is not within tho county, praying that tine Directors order an election be held on the proposMon of the issuanco of tho bonds, such bonds shall not ti be Issued miles an election is held and such bonds are duly and favor- ably voted nt said election, Sitei% election shall be called by the Direc- tors, and hold within said count• and nny part of trio city which Is not within the county, substantially in accordance with the procedures lwc• scribed In Chapter 1, title 22, Revised Civil Statutes of Texas, 11125. as amonuul. If no sreh patitton is filed, the nontl Resolution was erry'° . - be adopted on the date set, unerefor, or within not to exceed thirty d;ts,,y thereafter, and the bonds may be issued and delivered without nay election in connection with tile issuanco thereon or the creation of my encumbrance portaining thereto, It Is provided, however,, Vint Ow Directors may call such election on their oven notion, if they deem it advisable, on the proposition of the Issuance of suelt bonds, witlOut the filing of any potation. Mtmination and approval of Wnddl registration See. 11. All bonds pmmmittod to be issued under this Act, a114 tho appropriate pi\occodings authorizing their issuance, shall bd ;tut]. mittod to tine Attorney General of tits State of Tuns for exnntinatbiff. If he finds that such bonds hnvo been authorized in accordance mill, title Act ho shall approve them, and thereupon they shall bo regi-Mal vo by the Comptroller of Public Accounts of the State of Tomas; AN4 after such approval m• 1 1 egistrat(on such bonds shall be \iconto-Aa Wo 462 ,~y;,,,, \rb.crit~xl'«atA..YYgnk,UCd,~.~BL^~itvwkYA`UN~tr+~Lta<i+ ,a: l0 4 yy; c Ch. 5 COUNTY HOSPITAL. Art. 449411-1 In any court, or other forum, for any renson, And shnl; be valid And binding obligations in necordance with their terms for all purposes. netunding Uonds Sec. 12. Any bonds Issued under this Act may be refunded by the Issuance of refunding bonds for such purpose, in such manner as may be determined by the birectori and any such refunding bonds shall be issued its provided herein for other bonds authorized under this Act, except that the refunding bonds may be Issued to be ex. clinnged for ilia bonds being refunded thereby. In such case, the Comptroller of Public Accounts shAll register the refunding bonds { and deliver the same to the holder or holders of the bonds being re- funded thereby, in accordance with the provisions of the proceedings Authorizing the refunding bonds, and any such exchange may be made 1 in one delivery, or in several installment deliveries. { i , prongs m legal and nwhorlxod tmeetment Sec. 19. All bonds issued under this Act sirnll be legal and Au- thorized investments for nil batiks, savings banks, trust companies, i building and loan assoclntions, savings and loan nssocintions, incur. ( $ 1111 anco companies of all kinds And types, fiduciaries, trustees And guard- 1 1 inns, And for all interest and sinking funds and other public funds of the State of Texas And all ugeneies, subdivisions, and instrumentalities thereof, including All counties, elties, towns, villages, school districts, 4 And all other kinds and types of districts, public ngencies and bodies 1 politic, Said bonds Also shall be eligible And lawful security for all de- posits of public funds of the State of Texan and all agencies, subdi- visions, and instrument cities thereof, including All counties, cities, towns, villages, school districts, and all other kinds and types of dis- tricts, public agencies, and bodies politic, to the extent of the value of said bonds, when Accompanied by any unmatured interest coupons ap- j purtenAnt thereto. 1 1rct~'gor1► l See, 14, Said Hospitnl Board may select a depository or deposl• tortes according to the procedures provided by law for ilia selection of county and city depositories, or It may enter into a depository con. tract with nny depository or depositories selected by the county or the city, And on the sane terms. i Memption of IddI let tram (Mation See, 1611. Recognizing the fact ilnt`all hospital facilities of said 110914141 Dear() u-111 be hold for public purposes only, and 11-141 bo do- Voted exclusively to the use And benefit of tho public, such hospital facilities shntl be exempt from taxation of every character. 408 - ..aa...•'v,c..r-r.wrhwwiedy:W.jtdl INK. . ! +mWkae'Ai.+V+zsnl uiY}gtirr.ws..w. ES *owl f Art. 44941-1 HEALTH-PUBLIC Title 71 F.atlnent domain See. 16, f•oi, the purpose of cArrying out Any power, duty, or function authorized by this Act, said Hospital Board shall have the right to acquire the fee simple titlo or any other interest In land anti any other property by condeninatlon In the manner provided by Title 62, Revised Civil Statutes of Texas, 1025, as amended, relating to eminent domain. Said Hospital Board shnil hAve the snme rights as t{ counties and cities under Article 8268, ns Amended, of said Title 52. The amount And character of Interest in land or other property thus to be Acquired shall) be determined by the Directors,r r Investment of funds l Sec. 17, Tho law As to the security* for, and the Investment of, ' funds of counties and eltfes shall be applicable to funds of said Tfospl- tal Board. The Bond Resolution, or any trust indenture executed in i 1 connection therewith, may further restrict the securing and Invest- ment of funds of said Hospital Board. Also, said Hospital Boned shall ' 4 have the power to Invest all or any part of tiro proceeds received from E the sale And delivery of its bonds, until such proceeds are needed, in direct obligations of the United States of America, to the extent nu• I thoriaed in the bond Resolution or any trust indenture executed in j connection therewith. Cumulative dfet:tl coaniciing laws see. 18. This Act shall be eumulative of All other larva on file subJect, but this Act shall be wholly sufficient authority within itself for tile issuance of the bonus and the performance of the other acts and procedures Authorized hereby, without reference to any other laws # or Any restrictions or llmitnttons contained therein, except as herein specifically provided; and when any bonds are being issued under } this Act, then to the extent of Any conflict or inconsistency between Any provisions of this Act and any provisions of any other law, tho provisions of this Act shall provall and control; provided, however. that any Hospi(al honed shall have the right to uAo the provisions of Any other lads, not in conflict with the provisions hereof, to the ex- tent convenient or necessary to carry out any power or authority, vx. press or Implied, granted by this Act. Acts 1965, 66th Leg,, p, 1011), l ch. 611. Xisteriest Note YAls of Aotr sell And deliver revenue bends, Prmhim'! A i Act authorletng the creation of joint for a referendum•b'pe aleolian an to t11e r.• } oounty•cny hospital boards. without tastnit seance of rareuuo Londe, Upda the Rune of It{ Powerst providing for tho powers and tile. ronuiedd bellitanl Providlog for till, i-• function of counties nud cities frith refer. 41uanc0 of rotundtnq bonds, provM11111 ihol 55 41446 to said joint hospital boardai all bonds lesued under thla Aet Will I... Prorldln,r for the control, operaUOn. pow gal Investulents and securlq, for fnj ',btr ore,. duties, And fundllona of sold Joint 1108• regulated fuada, provldidg that tai., Altai boards, Inclu,litis the Pan'er to 1011% clash to awuulalivo of all laws on the 461 Y t 51 .._.+w.~y,.'•~,~f1Ml+..~.tn.-....,. ...r.~w.wM+M~M+rr'°., 5 rl?1 l 1 r ' h a , ~y ~ Ra Churchill Way and Coventry Road DLllas, Texas March 22, 1951 a t ~ Far, R, M. Barnes, President Board of Managors~ now Memorial Hospital Denton, Texas Deer Mr, Barnes, 3 Transmitted herewith is the report of the survoq at the operation I ofprovePlowhelpfulN,emoriwlin, togetherfuturewithoperationscertain,reoommandatlorss which may your rn general, thL' „inanoisl an' service statistics are very similar to the experience of praotioally all small hr,pitals openad in,reoent s years. The first aix months period is always a modt difficult one because of inadequate workiup osppital to absorb the unavoidable costs associated with the opening months of operation until the patient census has reached a volume where it will carry the load, fool confident that it. the Board, Staff, and Administration show the rame attendance to duties and the same enthusiasm in the future as they hava shoun in the past, the hospital is well on its way toward being "out of the woods", Respectfully submitted, f . Albert N• Scheidt • ' l1W.i4.♦,.W~~YYYYY.Y.a w.Wiua..wl.W JaYY 9Y ~ ur..y.W WW ^f - .,.......♦+1.+NMMiWti I~ • esq. ..yw~.. _u.w..~ .g'• , o- SAk4 `„~'!1kfi,irl.,~.M'W~Uq~4M.1 fAlAY4~{~Yfl1iNA ~:ns..F CV a ~ CCC s~ REPORT ON FLOW MEt Q49AD }{MIA r' i CONCEPTIOA AND DEVELCPMNT While oonsidsrable thought had neon given to the development of a f boapital prior to the war, actual oryatellization of the program did not develop until the postwar period when funds became available from three sources to make the building of the hospital possible. these three funds as sot out on the hospital balance ehoet of Septem- ber 30, 1950 consisted of the following sources and amountst Flow Endowment Fund t255,173.42 City-County of Denton 302047Oo64 ;z Federal Grant ~11ZO , Total _ 813"2' r M1 Need for additional hospital bode in the City and County was eotab. lished by a atatowido survey financed under the Hospital Stu-voy and ! Construction Aot, which established a Grant-in-Aid program to assist JJ the stated to plan end build additional facilities whore they were most needed, This survey established Us fact that the total bad requirements of Denton County consist of approximately 135 adult bode E for general wdical, aurgicall and obstetrical care. With 35 beds already available in the oommtusity original plans for the Flow ~ Yezaoriai Hospital contcmpletea bui~ding 140 adult bode, However, increased building costs reduced the number actually built to 60 beds, although the service facilities in the hospital are large enough to aooommodate the addition of another 40 beds at some future time when ` the bao4 manifests iteelf, F I COHSIMUCTI ON Plana for the building war* prepared by Bennett and Crittenden, ArohEteots, who availed themselves of studies prepared by the hospital .t Construction Station of the U. S, Public Health Servige, as well as { other literature on hospital eonatruction. In addition and as a part of eacuring a federal Grant, the plane were revieved and suggestions were made by the fSospitel Section of the State Board of Health of Texas, The finished structure ie, in general, well laid out for the purposes for which the building was designed, CPZMTINO RJ'"~UTRDUNTS Plane for future opfrating requirements. were prepared by the presssrt Admin4strator and trsnamitted to the Board in A memorandum dated x NIM'L'~iM..ly~~.~uY111...Yh.J.AIdW~YY.Y W.~u.Lu lJi •••.w;x°.4flIXMNMV.V Vx9 tYV'...n.aN9}Ldl~y~V~SIVJV°^.''.~~~i?NnW'••r v.,. .t n•;j~ 00 i T ty All r 7 1 I ~ 1 Way 17, 1950, That memorandum indicated the necessity for an initial ~ working fund in the following tarmsr *It Is a foregone conclusion that the hospital will s' not be able i to carry its own load for perhaps two or three-nanths after it opens, For one thing, the expense will be extra heavy for this period, because it is irpoesible to anticipate all the expendi- tures for setting up operotions, Considerable backlog of accounts receivable moat be built up in order to build up the not income to the point where the hospital will be self-eustaining, For this reason, it will be neoesuary to obtain sufficient funds to carry the hospital for preferably two or three wonths, It is estimated that tho bnre opera Zing fund should be 0150000. " This memorandum likew,ian pointed out the need for establiahing some form of rsimburtioment for oharity oases handled in Flow Mencrial in order to avoid loading this coat on charges made to the individual pay patients as follower l E E "The above discussion of hospital rates and financing doeeu't consider the charity or non-paying patient, It is impossible to predict jnat how many ohority patients it will ba noco.4mory to care for. The moat equit4ble wny of hnndling this aituation i is to hove either the City or County, or both, take core of g the charity cases at cost, which will be easy to determine after the hospital has opureted for a time, then the rates set so that E the paying patients would pay cost, plus u omall amount to take are of replacement of equipment, depreciation, etc, Thin would serve as a basis for City and County participation, and place the burden of takir,- cero of the medically indigent patient on the local oommunity wne.:.. "longa, rather than ohnrging the t paying patient a.sufficient rate w take care of thoas vho cannot ; afford to pay for their hospital care," To date no provision has been made forlinonoing these charity asses, except for a part-pay arrangement with the Rivania Club from their Children'* Fund, and a few individualised cases wherein the Red Cross has sseumed responsibility on the costs incurred by wives of service ~ Mail6 ~e,~ i` DO= OF tAWOERS , The Board of Managers, consisting of uevan individuals from (city and County, is appointed on the following basiat three by the County { bamteissionerar Court three by the C I Cormaissioners, and one by ! .the joint action of the two groups aboas In order to provide some t,,;oont1nuity in office the first terms of sppointment of t1woe members Gars staggered over twro-year, four-year, sroG six year appoiattments, r . a 11bN::tu......~ J J,.c,:...,'HU.r.,e.N.w:.....a:.w..'..~u....il.awul~rLww..:w.~iLG,ariiJi/J.+b~..,arwdew~.....u:.u.L1iNw ~ /,f ,yp..w~. _ w.wv,-+ae, +.4rsa4d a.l+wi, 4A`u1Wi✓FJ.610nihl9GV4?,+4f Std VKbA41911 Wa. W'ga•;.n ••....7. I _.•-•.yl. r ,J Y , F Tho American Kos ital Association and the irmerican College of Koopital AdministratorsIssm?p the Code of Bthi.os approved r"1 adopted November,2% 19410 defined the duties of the governing board as followas s. Todetermi.ne the policioo of the institution with relation I to coomurzi ty ncoda# i b. To provide equipment and facilities consistent with community needs for the pationts entrusted to their hospital. ± o.' To see that proper professional standards ere maintained in the core a.C the nick. d. To coordinate profeasionol interests with administrative, I financial, ana community needs. I s. To provide adequate financing by securing sufficient income and by onforainf buoit,eee-like control of expenditures. + f. To provide for the We ndminiatration of funds given in l trust, e g. To keep accurate records of its finances end activities. { 3 h. To surround the pationt with every renponable protection, thereby fulfilling the morel and legal responsibility of the board, accordingly, I I ' (1) It is the responsibility of the governing board to j exercise proper care r.nd fudgment in the selection of I a qualified administrator and of the medical, nursing, technical and other porronneli (2) LppoinWonte should be made on a banis of ,rarit and not bvcatsoe of politioal'conncction.or' favoritiemf 13) No member of the buerd rhould expect to profit by his rr.; oonneotion with the hospital. t, {While the hospital has not been in operation for a sufficient length j of time to make eny specific long..tIme evaluation of tho hoc.rdla activities, there is every evidence that it is a very representative Li and enthusiastic group which has the confidence of the ooax=Ity. MICAL STOP f There is every evidence of close cooperation and solidarity on the part of the medical staffs npro is no tvidonce of individual sel- t a~. fiehosso to the detriment of any other physician's petiont, as is ' frequently manifest in amall oom miry hospitals elsewhere. Me r staff shows a definite willingness to care for tree oases where the ' individual is unable to pay either for his hospital Aare or for offiee care. At present no steps have boon taken to centralize this indigent care in one loontion, nor has the oommuaity bean made r cognitent of the fact that suoh a alzooble donation of free servioe 3 s is being, given to the community by the medical staff. There exists ~ ij + - at the present time a much closer eaordination and cooperation I between the medical staff and the administration than existed at the I outset, and there is every indication of willingness on the part of r both the staff and administration to perfeot an even greater degree yk, of ooardinatina. Y L t . ~ ..u...i.ir•.....w.y.nwiMw.r~fnrY:y....,.r...r.r.w,vL,awwuN rlj u.+4:Iti~Rfl,, ~ dr~ r t + yy .R lair ~ r a n.. r l 2~ I I ~ WOMaNQ "NDS i' This hospital, as is true of practically all now has halo under Public Low 74j, hoed its opening date now oopitauat opene in with flmda. The openirW of e spital Is no different than of any business, wherein p e-opening inourrod Opening li basic stocks and credit must supplies to open moat be pravidod, wherein extended } eduoated to the value of ofhthe lacrvioeand a avaerein the cutxau»ity must to i 2n this instanoe► $15,004 vea Provided estimated in by the City ood Count valued at over~0 LnginnQ~a memorandum, with which to put a plonts t less thsn $8o0,~ into operatic s half of the comaonly accepted fiBuireooPiSltOU per bed 4 opoasd, to take ears of the items a mentioned is the 000 per graphs while the Administratorle Mena P pnrn_ ~ opening period !From bond funds enlariep totolAnd during the pro- paid from working ends to ke ►eMPto 5066.32 Vero h prior to opening y yeas uhoos pxoaenaa was necessary { ' Purther, in order to hM the necessa d ' +uPpliea needed by the ~ toga, r~adioal anti surgical r Physicians and to stook the basic food eup,,iies i f necessary to the operation of the Dietary.b&part,;,cnt an w611 n, a, _ w ! g f~,ather opvning'tuhp2ies, uli'htl a y' o}€r f'h,C(0 4140 'upont to # { Sit0blish opening inventories in all the various and eundry delrn f x Thus it is apparent that obligetioas in and were incurred at £1040{)0 the ho i prior to opening, Iooving little With which to o state ap ten 033 the day of open . a , for an organizational e opening !moat hospitals make provision e aount to the are made, in order to a PArnteaopening ooetsctrom se o snip A compsrativo ats atateae ow p sting co . S ante. of operation is'aPPsnded of and is Ingo= cubjsadsat ext to th t)j for thO fil'ot six months o Pol2owing coI N ~ ,..j l0 The average oengue for the per 400th of 8ePtember being r patients dayr or leas than 30 oi. the 1802 bospitat, combined vith the the feat ,at pro vision for or8nniaational 0x000808 W496 made in a sep fund arate resulted in din average oust The average chat 90 to the per patient per day of 148.29 . was $21.10, lsa n Patient per dalyy during September ` s day uhioh vas not bsorbed, andepo ubatpn9tiA~r Patient per union repreaonted oPenihd a po t on of xpanses previously, mentioned,, x0 The Income. 1 gxpense stJtemeat for October'hmaiahce no information of shy value insomuch as such accounts as Anesthesiology and Radio ~o ,fir , ettributab]o, no Goubt ehoV n9gative operating figures j ;deptember items. ' to adjusting entries to correct "There ors three months in q j year in which meet hospitals inveriebly experiegoe financial ditficulties0 ` these is the month of November► in which thendu first .p f drops, due to a inverxnbly ,in the the taut that patients avoid elective surgery g 'Phnaksgiving Noiideyr, t i !'7 ~ t ~~..F.'.Ya4u:.u++.. eaMS . t' .~Lpy ~Ll! i 7 4° 1 x. ' x. ,!k' y o"r,ti t•' 7 to p ' S •T' 1t ' esa' 4' ~uembar is the second of the thre and the e months referred to Above snme situation prevails except in a more abundnnt l7o5#t, cocordingly the census dropped to en average of 17.5, the cost per patient increased to 029,061 while tile average charge the some to pnticnts per day retuned approximately . r , 5. January mnrked the firet month in which a true profit WAS realized without any subsidy from City end County, end the operation fo» this month de!nonstruted the fact that when an adalunte aenaus begins to cxiet, t'ze aunt per patient day } ern be%-Jn to be brought down to n reunonablo _le•101 consistent in aro•ar,t•with the coats of othsr ;':rf L ~insL :mspitals in f the surro-ziding communities. ` I 6. Yebru,.)ry to the third month in the fietin' Warily ehow.4 poor o e ysnr which ordi- r p atin 1 g result N. phi r t4 A { the e of la i fit attributable that at 6 for monthly, salaries, :nd attthe Samohtime,atho~hoapita2$ cat i income is limited to 8 E tact, and with a days of revenue. In spite of this oenue j cnpncity of the hospital, a profittof l only 61% of the rated Coat per patient day, in turn, was reduced to $14gb was epand . over all general fund deficit .G1, and the ''Schedule g s by phoxn pn the ottua4ed .6 hs'larscd" Ssrcrti tnlenHii~~ . k~ d rcducd tj:V"L 1463 It is firm belief that the hospital hers now come into itf, of nand its operating headaches, as they ralats to tan problems j opening, are pretty won oared. { One residual hendaohe remains for which basic provision to cure, or to oorreot,a major portion of the problem was votbd b City and Co i affioialo on the day of nV visit, by tY k f ! w'; ; As was indioatud previously, one of the workin iluida problems of nn ' hospital is to have Sufficient working g Y line of credit to pationto unable to payathe fro biltnatathenfthy x- , of disch.rec. As a result of an increasing oeumue through January time and xebruaryj accounts receivable had risen to ¢1gi42b.2g. According with this amount of money tied up in reoeivobles, and with, as- 1 a operation for the year to data still bein g ~S461 21 t ; r; t accounts payable totaling 22 in the Vision was evade on Monde ~1$99#13 had soottl,ted, pro.- f - o March 12, ror the City and County contribute $17,OM toward thews accumulated toooSta X110 was determined to be payable, which ` except current February sufficient to cover all 6000 aoaountS. untepayoble, s f contribution to the opereiti This makes the total Oit -County r~,t. t•" and bwgiue to approach the ootunda of the project total 3 000 ' be mmouly aoospted standard of IOdO per { 41 1 d in wee pa a yardstick for providing edoqu8te working oepital. i i,° 'Yu the eooounts receivable pleiturs, in enalyais of which is atteahed k ' there has been a ftrked YncrOelc each month as demand t ` the Wepital grow, and a aorresp°adin or sen►iose of i ' {5. of credit grew. g public need for extension ' s 6 k it ~ r ~ 1llWWiitkatW%YMrA:'r+ti+sW.Y a,M,.. K.+a.» :an.a+.,;,,.,:+»K+#V/euu~rnuw.n,.w.,.a.rw...-.. 4Y'~..,{J ~p «7711 4 1 h, `k ~tii',f ,.:.v.~~'. ~.4 1~'' • , r i~tl&' << b I SRI t Operation for the first ton days in March indicated that collections for these days were within 083 of charges mode to patients for the corresponding days, rn other words there is every reason to expect a, that the hospital osah inconn should oqunl the credit billing to patients in the future, and the amount of money tied up in aooounts receivable should stabilize itself from this time forward. The foregoing statement is predicated on the assumption that the census will remain relatively stable. Howover, the community must bear in rind that neither the Hospital Borrd nor the doctor can $ control the incidence of sickness or necessary surgery, and that it the oenaus drops, such a drop would create rdditionul hardahip to the hospital. But the community will have profited by a lesser incidence of sickness. I The comaunity must also realize that the hospital offers available facilities in case of neooeaity, and sa such, a:ftore a standby eer» # vice to, the aorrxunity in case of need Just as is true of the `ire Department, whoae efficiency is not moeeured in reintion to the number of fires that occurred in the oo=unity, but rather, on how Y well it attended to its duties in hendling -those fires whioh unfor- tunately ooourred. F 3n' aruOlyflhg a'46kSntb "o'' bly -io: A2 fi,oont. to, r4 to that , a. tWo-thirds of the bospital accounts roceivables are from bluo Crone " I end other hospital insurance 00a4panies. Collootfon from there com- t pebies always, involves some delay duo to the necessity for prooessing . the insurance pnpora, and it it my opinion that sufficient clerical help is not availablo to cope witb this problem. This matter Is i ooamanted on In, greater detail in the section on reoo m ondations, . I iE 1{i!i 44 I f 45. i . ' 1 k Z 1, + 'v a C, u . 1 F~ r1, ~ ~.,..u~;, .x~wv +zNiv,~<rra;r. H,I _ _ I ~ f ,r 11Pii?r ,1ru. i tS r3~~..,:1 ,t ra l.~.. } re ~1- v•y `i's' ° •'Fr. N~. t'rr{iR k 1 4, 'y REC0WSEi.ITIONS In reviewing the operation of the hospital. y,,oeraily, certain things come to my attention which 1 feel the adminiatrntors and the Da`rd f should consider. 2. g gf t e ndi ea-PW20 Some trrnngement ahould ba made, vheroin the burden of taking ore of tho medical indigent patient should be shored by the entire con-unity. The considerotion whether this be done through tnx sources or through same form of community drive t Is secondary to the principle involved, for under your present j arrangement the eick petionts in: your hospital who ore olrae:dy burdened with substantial expenrie will likewise have to cover .;t the cost of the indigent patient in the absence of any out- side support. i ~ 4 j 'r dome form of tabulating the vrlue of free care given to the ' Corrrun the medical str, itY by f'F should be developed as s lever x , ` j ~,.:r,', r•.,' -iq,pryp,, t.ose hu}dR.,~'orq J}~n othor•Np ivin' O a f .the •d 3 P 11 fl i 'S j'. O"r' x thousand's of do rira'ot refi ccz=a ' the' _co~ unitYy ' should in some way provide funds for hospital care end needs- _ sery medication. f t ffr ;z 24 ti ve -DUYbtisa } Nov that the hospital has been in oro%tion long enough to i determine the approximate quantitlac of verious supplies needed, thn quantities of supplies i.1 stock should be stan- dFrdized at some agreed upon level. quality of stocks rude availerle to the medical and nursing staff should be reviewed I and some consideration then given to the economies which can be effeatud through competitive bidding and long-time oontrno•j 34 QQOCQ_ rAton„Xitf~42 staff 4f There is every Evidence of a growing closer roUtionship E betwoen the Mcdianl St,;ff, lriministration, and goord. This should be enocuroged to the point whero a strong kedical Advisory Council or some sitdilar body takes an active pert j in Mmking recommendations on professional matters whether 1t - they have to do with direct care of the petiont, the tyyppes of euppliea and drugs purchased, and similar itema. Thia will develop staff interest, and it must be rooog•.ixe•i that t !+:,i the seedionl staff is the 'boat public relations depart,%nt that a hospital oan develop. t ~4 M~ Ad~i ti.onn Elmpi f Yn light of the profits shown in January And February, there u now seems to be sufficient capital to give consideration ` to ph~ioging n few holas in the organizations j 5~~~1~ , , ♦.1... ~.vLiyyf.tyy,o r .a ue. w.... .r r r w 4s.rr 1 1 v, ssu•-.. .•.•s•• air=iuan'N..Vrt +<4-t-1NN XN dFXlrrx f V~. . ~h9riif3JU' usMMtf1'Ye~4L'CI~nMV\glwa.~M•e......•. ♦+a •wy } `f `s 5~ d n's' t Z . .t • , i.t,V- t;;jtl E~A r~. Wan t, a. As mentioned previously, the raccoounta receivable backlog is the primary account in which working capital in tied up, Hospital experience shows that open accounts rapidly docreaes in value as they become older, ftrthermore, two-thirds of the accounts receivable ere tied up in insurpnoe orsos which require the filling out of a large . > number of forms. In addition to the slowness of collecting accounts receivable, the hospital hae no Medical Rccord Librr.rian, with the result that many of the medical records of patients are Accumulating in on incomplete fashion, and 1 In a manner which would preclude the hospital being approved t by the American College of Surggcons, It is reoovoonded, ;j LAM ' therefore, that a combined poaition At u salary of $175 to ~ E205 be created, with the principle duties of handling ~ accounts receivable dictation, and medical records work, b, It is further recommended thr,t a Nurse Supervisor, with duties in addition to auras supervision, be hired at ' approximately t265 to (300 to better correlate the nursing and medical service of tho hospital, I o. If the hospital ebovs continued successful operation over ...edeiK ,mough:or two.l, $t'is•..t10n'rgvot,z d thn"t;,aga; 1..,.., oIia Y draduote 'Nuirae to hired a t ~ setae , your prevailing , for night duties in the hospital. At present the coverage at night is poor qunntitntively, i d. As funds become available, it is recommended that conei.. doration be given to the hiring of a yard man, at a solnry of apprdxi.mo tely £150 par month to do Como thing n bout the groundo condition, which will erode if left undeveloped for ,too long a time. With these four positions as recommended it would seem that the hospital has adequate working staff consletent with its present rate of ooouponey, Obviously, with occupancy inoreasei additional help dill be needed in Nursing and is Dietnryt but the coat of these additional employees resulting from an increased census will be more than offset by revenue. If the financial picture of the hospital continues favorable to a point whore it becomes stabillmd , in its operation) consideration might t&n be given to soma reduo- t tion in rates to the public. I So Oreation cf a Womcnal A~ye1~n As the hospital dsvelo a$ I believe the ad"atsgos of establishing Womens Auxiliary wHl become more and more appardnt, Active ip!Eorest in the Auxiliary brie a more p olosa contact with both the ebeotiveaendl pr►blsms of thsi'hosi pital, and by proper plenning of Auxiliary programs much can be dodo ';r-; mplished to educate the community at large, a v, ~ ~.eww.Saw.wa ..ri Jy ~i.r.fu•.w.:..v...sA~«1i,.~\.Jti......a,auaw.uw.i.:. wJ.... ~ f1 ' K.d, a ~\✓1..:'.fr:M.rwu.W.y\{ya a i. i 1, E d i , r :1w' aVrM.OtinTVy\t r r 5 I 4 1..a•~ A NSY S:- t I j s J 6. Provision f4.j:. a Li--a l r4nanaia2 statements up until now hovo made no provision for # depreoifition of equipment. Unless Eomn other arrangement is i worked out with the City and County, whereby additional funds will be made available for equipment depreciation rind replace- } mentp this item should be considered as an operating expense, and if poaeible, tho amount set aside for deproointion should t 3.y . be "funded" so ns to insure availability when neododo f A {{mo~t l ( . e , { I t'1✓;' ) j~, it 1. 1. 3 .f: •al\4"~ ~nfly 'i I1~''.i t~. In.'. i .L• li li,~r ,'1 f\l jjj ' 5 \ w , b.r.l t'' t ;s I~ 10 ~ In I , rll (pi `J WW y 7ka4 _~.~..r.;. .,uw.., tL»N. 1.. s,wa...o.a~l.h ...,iu.'...1,,..~.um:4wr+..:.1:.wm,.n.•d iAJlw. a.wi. ru.Jai+.ilSr I I I l r . ~ 1r , r q. •w.'._ _.__...........•._....u~.rw~wxMbrwwhawaii~2+W1AAN~w'+n«w-~.,. ...-.\_....•..•e1M ( t1 2 L~; r' S4) ( J L 1 1 y,II IS' CY~ 4~.~ ii ~ ~ ✓.ti~ I I '~n'i(. rk 1 ..1 S S.~r ~ ' .1, i t, `d .,l,a~l ~a 1f j~, I~ I 1. ~ , d 7 1 M twow fo" 0 ,10 tuw ~ b MH M c- § I ? i is t.,,' ~ fur M r~. ~ y ,,,fffJJl ISTN I j `w N t? t , -'jq~ r ,F''.Ar 4"'... itN, J. y. , 1. y', , l .I ~.f 1',. t sS,~ 't.Aif 't! L~~;j] : 1„ e, P w ~d Y r rail L~ t, ~ v ,ON F:+ I~w V I , r y$ball$sj~jf~ • QbQr E a r ~y+r~ 1 f J G I~ ~ I l Y l~'r.!!^"^ I✓P fI,NMwwc.4w +..rr. ..a'.J . 1 ~ ~7 ~~~,Zf~'e F.a~. .I~ e. a~y .rye 1 .kt 1,`- px.'' .b r~~' .eK~ i . ~ CITY ttAt.t. 517 C'"5 Ah 11, 191,9 J Reru.lm• mrrL?n" : " the City Cotr,rtio,sion or ttte City of I)cuton, tc 1ta held Friday April 11, 1947 at 7100 F Prtarnntt Barrow, Russell , Caddol., Ball 4 Ab;act+t•t Yinq 1 y, Freuetctt ;:d J, rlilliams and R,L. Selby, Jr„ Cotmni r', r•.l ones -loaf. d 1, The tntnutea of the a;flQtirrrs from Xnreh 14t,h to and inoluiiinF April s were read and appt•oved, 90 Thn reEular nonthly accounts wore allowed and warrants ordorrd Orlltn arninst their respective funds in pr.;rtrent, i 3. The following ret•orte were reoeivrd and orderec+ filed, Health Orrk(lr t ; + k{uteherton, test „ Dairy 7nrtreotor Skilev, City ;SarshaI 5hepttc,rd, ,scot Su Sr- Intendont Coffey, Fire Yarahai Cook, City aeeretary Knight, City dnr+.nPhr and Mnyor Yarbrough, 44 The following resolution was preeenteds NFREAS, the City of Denton, Tpxas, a ,iunicipal Corroration, toNother with the County of Lienton, a folitloal subdivision of the state of Texoe, and 1 the Flow Nemorial ?iospital, a Trustee Fatate ,toting d T s hove agroed to join to pother and erect a hospital in thesa9deugh its rasters, { Texas, and City of Denton) i S i!EREn5, the sold two Polltioal auMivisiona and the Flow Memorial i Hospital Estate have agreed to employ Bennett and Crittenden, a firm of architects of Dallas, Texas, to draw plans and supervise the oonstructicn of i Flow Memorial Hospital, and t S!t1RRfAi, it was opreoii to enter into n contract In writing by and be- ' twaen the said three employing, agencies and said first of architects, and ` # 1,113EREAS, when said contract :ngs been fully and correctly expressed in } j writing; and is ready to be aimed by all rarties hereto, I x h' ! "lots, VMRrrO w; PF IT RESOMP nY VE t E rTY 00,•117381at1 n" T!iE CITY OF t DENTOh, Tt`%Aa1 That the Mayor of said City, J.L. Yarbrough, and its Sr.ori~+.aryj ; O.C, Knight be, And they are hereby appointed and instructed to expouto said r; contmot on behalf of said Ituniei.pality, the City of Denton, Texan, and this t' resolution shall be their full authority to so exeoute said onntraot, Attectt 04, Knight Signed, „ D. Barrow City Secretary Chairman, City Co-Alissicn A motion was made by Kuasell, seconded by Caddel, that the t ! resolution be Adopted. The motion carried, tft a The foiloving bids for construction of water towers were received, + Chicano Bridne 3c Iron Co, 7400,00 eraeh Tane.ed 5toe1 Conatruotion Co, , Fi ttaburg- 94Bp.3b , a Ueamoine -,'tool Co, 5500600 . tt cis !r ti A notion was made by Russell, secnndad by Cadlel, to refer the bfr+a to tho Vty Fnrineer for trbttlation to be oondlderhd at a later meWnr, hy 5rt , . I l t'te Comiasion, The notion carried, aids wore received for the Purchase of turbine and t+oostr,r ptulpa, iron t the rollowinn firma, f:riPei; -+,teavrtr; t,' t•;. F'icrce Company; Lone 8tn14 f amp do f l 7ehinaty Co.; A111 a Chalr^ero Company and ,Southern Ln ine Canr;tny, K A notion wAa made by Rustieil, seoondod by Cndrtul, to rc f} r the bids to the City i,neineer for tabulation and study to bo oonuiderwl ty the C"O tssion ItetAr, -141 . t +y `'t. . ` t,. t° i~.`~...! i } • ' '.I.. ♦ ~+aMaYMM11Mt1MY'~11(t , }1Jd/AYI~`~~_df~l.(Y4~SQi~lrt~,)~'k11R,Y~IiSLq][ti3~f . W i,. N ( } t i t F (rti, C__ tty Clerk-Records On Prow lbsnital October 17, 1946 x ';zr F Bond Hlection-Plow %t' I April s, 1947 County Ok'd Architect (City Ok's On ril I lo r 1, 1947- Attached) I October 10, 1947 4 *'a Appointed Board of Managers And Gave Them All ( , Authority Vested To f mdri Under _Revised ~iVi1 Statute$ of State of Texan 4494i-•194 Se tfsber 19, 1947 City of UDeenton Appointed Three t Members to Hospital Board , 5 ..«r,eTM+1Y.w.r.,'+N.rrWwtaevNwrM'I.wn...., , ~i 1 r1 1 p i R r Contributions To Flow Hospital 411, , 1948 Sold $150,000 in hospital bonds r 1953 Shared cost with County to repair parking lot c1t,~ 1954 $$5,000 contribution 1957 $70500 contribution 1958 70500 contribution { 1061 / $00 contribution ht 1966 500 contribution ; a 1968 114,085{30 ($100,000 cash-City completed parking lot and emergency drive at estimated cost of $180085.30) s r 1990 $35,000 plus $25,000 $600000 total i City installed lights on parking lots--$13,744,83 , (estimate) Ti~ City gave Flow a $60,000 emergency generator hs' Approximate contribution $442,000 { rV'nf" ie+t w.♦.~.._.. ._.....a.w.....,.4..aawu!wlw.w......... _ ..1.. cs„ti is V R h 'i f ~''u~:~M'r I{.~~[Jl'gn i-i e r Iv~ { { e 'J ~4• , r, f i Y a, . .ttj, . _ 1„'P .~,{dry I~~~~i aSa{, ~ldx i;!'w 34Y£ ~~}}i" ~'.r k 1,~~•, yi 'y fs. `D' ,k x a4,i tilwY.9 RK~ r f. 1 ~ ~ 1 r i I 4 1 j ~ IF t I' , i e I i xr r~ " ~ ~ i -,.S ,'T''. ~ :.I , , r(;,~'. Ai.sw+tab.:,ru-.. ..a!~a kMw!A SM ~ Wk',,• ~ t afl#~}~ , & yl,ZR~ lvoi» 'ilk Rk, tkr S Y a ,