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HomeMy WebLinkAbout1987 - 1991 i HENDERSON BRYANT & WOLFE ATTORNEYS& COVNSELOH9 123 NORTH CROCKETT STREET JAMES E HENOERSON -tTAroi P O BOX 340 NILLIAM R bRYANT OpIg.,9 )BI 9TAP 5. JOHN90N JOSEPH W WOLFE SHERMAN, TEXAS 7801P1-O.S40 JAMES COPLEY HT VOERSON CJnRYH YOOELSANO DEBORAH 5. 9URLESON RICHARD C 4APPISON 19031 093.9.421 DEBORAH L McORCOORY RONALO H CLARK FAX 19031 892.2391 JAMES C. TIOWELL f SCOTT SMITH NANCY 0 WY.LIAMS October 11, 1991 Debra Drayovitoh City Attorney City of Denton 216 East McKinney Denton, Texas 762o1 REs Denton V. Flow Regional Medical Center Dear Me, Drayovitchi Enclosed please find copy of Flow Regional N dical Center, Points of Agreement for Escrow of Funds. If you have any questions or comments, please do not hesitates to call. Your vary truly, HENDERSON BRYANT WOLFE Mt'go /erY, JSeory to T. Cott 9mi'th encl. RO CT 1 1991 O~T 1'i I Q1'~ FLOW REGIONAL MEDICAL CENTER Points of A&mmn nt for Escrow of Finrte Citv's Po itlon 1_Iow Po UM Who should serve First State Bunk First State Bank as escrow agent? of Denton of Denton What should be (1) $370,000 (1) $370,000 placed In escrow? (2) Note and payments (2) Note and payments based upon agreed based upon agreed amortized schedule amortized schedule Who should receive Flow Flow the Interest imputed from the Flow note payments? Who should pay the City of Denton City of Denton escrow fees? Have the parties yes • (w/madiflcation yes - (w/modification agreed to a form to Impute interest and to Impute Interest and of escrow agreement? Increase cash payment) Increase cash payment) (Original agreement (Original agreement prepared by City) prepared by City) Should Flow use a No Yes • It was a art of the portion of some of its funds (nonescrowed) for agreement with the health care scholarships? hospital facility Purchaser, a sale approved by the City. Who should direct the City Flow . It's Flow's function selection of the private and purpose as a private, agencies to be recipients not•forprofI4 foundation of Flow's funds (non•escrowed) available to meet the health care needs of Denton County? i i 1. ah ❑oaf 2 OCT I r'C) i,7 . LL4i~~f.::. . r r:[ i.,L'_~ - S.1'i OF G'f7J1'Ofl 'E lv'ril c.... _F.h1 3Q, t~4, hl ~:C iJ r,r i I . C LN7 !..i1=i ILL 1 23 f!FT:E:Nr AI:I:Ot1NT5 F'AYAPLE r:, i?"1,!PiL alTHHOLUIING A r!LI IU l m rEREST PAYASLE PAYABLE rC,L4A1 CURRENT LIAHIL.ii'Ir..~ ,}I 5J•u,; ;E;?hl LIr4L4ILITIE'S :,LNUS a•OALILE UiCFf F. RE rrdCOhiE I::ITY L',:PJi3 TERM .:;)u<rl_'TI~:~:: Jr:r~.irjr'r,}r~ r.., t a t L. e b i I 1 1; I o s r'Ur~fU I:IALr1Nl:~rr al ,ia Dlr. 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JE f .,c! ~?.'30/31 ]0,3G• 31 ii! ~1 18535- 1£ I ';3 3J :9130131 78"l- 138,10- 271,13- :F a :21 9: :;31CO131 :E 1 222 i. 3;,or31 IF I 21 273 3; ^7,":^..3i 1,550, 1n. !E 1274 3d 10131 360,00• RtarRta J;,rnal 4J E841,73 7,80),84• 0 115 0 A;.AWNCE FOR OCUBfrUL ACi:I9 356,362,90 421, 525, B4 JE 1714 OJ 0940/91 4,963b1 RE4ER8E BD 9Rli£OFr J 113 0 ACCTS RECEIVABLE •NON PATIENT 416,56E 23- 112,213,84 Roca;r!I:uurnai Rd 510,;10- „1,'B9,o4 , J 113•a STOCK CERTIFICATE • HTNLEO .."80.00 0 f20 1 91JRPLU3 CERTIFICATE • 1HIE 11.'BO d4 °;,091,00 0 12T0 iNT£REBT RECEIVAPLE • T-NOTES 53,001,00 1,198,:1 0 172 1 LNTEREBT RECEI'JAPLE NOTE 1,138 11 6,141,32 • I Aa a~ FLOW RE310NAL NEOML C£NIEP ierera! :e:ger it Susnafy Page s wi: A!:iU~15 SIL Petiad rii~dl 'rear ?I '~ila r:~i0 ~Sf Ydf7 ref:?fJ 'v!alce 3ererel .nw ,:9seot :"veil s GVL! _.^Al rr 3313&r'3 160 a :~'~:'L'RE S EOtIPN£N' 2,7:3.V°a9. ?4- JE I 3 NOS ".O PJ E~ ?26 OB• 7 202 0 :'JkkENi A"1:01"NTS 6',?:nc'.5 n •.n 4aucher lcurnel dJ ;,5'3.41• CaO Oisboseaents CD 1,676.41 000 i .JS 0 rEOSRAL ,1":aOtOl4G 'r,GB .aac.lar :curnal 11 366.00 Casd Olab~faeaaats CO 3b6,00- O,UO 9.V0 0.00 9ousNar Jnureal PJ 156.68 Cash Otsburaeaants CD 156.66• O' 00 b 201 fi BOND INTEREST PAYABLE 0 OU 22,435.44• Uouchar Journal 4J 362.50 22, 072, 34 0 210 0 BOOS PAYABLE 900000,00- 0.321_0 rLND BALANCE 90, 000. 00- 1,560,285.52• I 560.265.52• C-326.0 WN LOSS CURRENT 'TEAR 370,426.6E• ' Nat 1a40e11 ;Loss; NI 2,351.35 313, 218.01 J•40i•0 1NT£RESIIN+;OAE 31.L 19, 321 , 34- 13, 321, 54• 4;•401.1 INTEREST IYCOME T NOTES t,I1S.6I• 1 Aa FLOW PEW % MED1:At CEN1Ek .:;191;01 lea.+r a: ;ed4er SL~~arr 8i1 At<aunts ";Oa . ill ?er~ad :i F;;ral Year 3[ Balam:r ^ 0 ya1 Foli; ')r.ar7 :aeent sa anca ie^aral +d r 9e ' "F FC .1 - • e .-V1±1 •I I1Y111 JI c4,+1 ; X~1111 `1.1` IUN-1, hl'I.~UAL 1,-442 . :rC Of.B' 9 )1.;463 •LA~Y 1 402 ' Dec DEBT 30,3101;5• •443 '7 ;'°r1; CPITGENOS BETHLEHEM :337013B '6190• yesai~ts :aerral , 1..x,0• 0 404 0 XINERAL Ri,'3HrS ARCHER i:0 48100- ;3139- 0.406.0 MISCEILANE4U::'ICOME 19139• r 103, 000100- 0 S11 o SAD DES"ABITE•JFF03,000100 !E 1 .:6 Wo 31 0130111 361'tS 1- JE 1 215 61, i3r>01'31 :551?5 :E4:3 1 d1, v7/JD/31 i51 i5 ' :E 1 2b) v' u+:36131 136140 e 61, )3r1P1,91 212133 1f' 1 6i,',D/91 2,110113 JE 4 :21, 31, 09/,30191 I,SS01l0 :E t 234 0, 09!3P/91 360I00 JE ;2S 31, J?13019; 4,963161• REVERSE BD aRTTEOFF 0100 0 511 0 1;ONFP,ACTUAL ADJUSTMENTS 0100 I,SSI1 B5 4M:NIS19-ATIVE ADJUSTMENTS 1,851185 :8,429,1] 0.601.0 SALARY ERPENSE 28,41117 46, 2621b9 Ca1h Diourseaerlts Ct 2,648100 e 0.616.0 PAYROLL TAXES 48, 310169 3,53?112 4ourher Journal PJ 156168 ?•618.0 EMPLOYEE BENEFITi 3,695160 1,422123 t I ar ;EGfOh'% MEOi:~± :ENTER ~ " ie~Pla! '.alger ;r 3naaary e 7 ?ar„d a: f?ar 1D ~f34Q t:'i l') 'ae3'7 ='P!I:4 33 iani5 19 era dg Pr '.::LPllt ?f~ .....PAPS... . EEE ;C .•.•i .E~iAI LFER61;h'u c3 X03,:5 L i51 J Jl'.E:EXPENSE Receipts Journal of 9 ?4" ~ ~.9V Jcucher Journal 4J 54:.^0 ~329J 31, 605, 81 0.668-0 DEPRECIATION EXPE43E'S C3?. :4 JE l 2.5 GJ C'r,',O!?l t?6,14 3 MOE °:NPUIER 67~ 0 REPAIR EXPENSE 729,08 '37,00 ,)•614-0 INTEREST EXP£.NSE IB0,00 53, 365, 4P 53,566 40 5 635 v 1NSURANCE EXPENSE 1, 34 6, 00 ~i•698•u :;9MiJNIiAT;CN3 1,390,58 l~~~re! Journal 'JJ 94,35 1485,23 0 6'i4 0 POSTPiiE EXPENSE 723 ~ 3b 723.36 9.399.9 Insole iranaler 35,392.9 H!! Insole Ilola) N! ,,951 35 38,:43.54 r Tor,l Balance Forvard 7:'al Aetivlty 0,00 total Balance 0,00 essess a aru eau utu uaa uessetas usralr a es - i ( SEPTEMBER PATIENT '-'ASH REPORT 'itk ~ l7 • I I =!711 _ I;- •r _ y.. ! t 1 '..'I, '•i ..aill'cl.. ~...r.,. :10 1 6!':11 i{Pif li L',_t I', 4(. II ' (.~Jir; 5._.'.7(,1 'Ji 1.r•J/'.~1 p{=r ,i "Ilfl. 010 t!'. F', :t,' iCd i•t L 61(7.Iac+ $/31:7/'31 `J\\L Cdl ;i1yI;C1c: ?F; 0 1) L%tl i'.. , !.'•1 : 11 III (,71;) n •~0 5',r'1.{7il 5/91 .l(L 'r, S': f]~/li4 Q''1l_I(_I(1 4:2:;7i~iJ 5..11.[7(',! '1iJi'~1 /:)"1 r 1 -.'1 Lll it l':II ;i ) 1 LE:HIv, LC:'.I ICI (;i ' '(j t_I'J I 1 J, (Jf:7 J/ ..1 j. 17' r)`'. i 74L~j ~S il.), (Jfj Cl /'71 l^": NICL)DY 5 7 .'I i'G';IV: N1:7 1 V.: 060 51!1,11.1 ai [.I."~i JOANNE Sit iv i~ 3 li 1 "31 ;LIdDE:7, E 3q ~~-I -t1, f (It .33i 1 .11.1 r Ll E:kI.' > 1• 3 3~i1 6,~I;t, 7(:1 9 .w _..1 F't t!-It '1i1 IJ i!: i'.U (',•,i 11;11;7(111 JI`i rl 7!;7 J/W%'.•11 I~,ILL.I.IIf,L'. L'+L1'~''r' 31:7 ::E'er(>3l3 ~Slii r'u;l ,.w, ;i:DU1;N, D 111P1p '3 1''!'1;17'W $t;l ,I;u) 9i`"sl31 .1I'AMME I't TE F ESA 3p 1.U(:13~' bl ,'1ra 3/ S/'32 r11,'1-1061, 3E 1.1:1144, I5 vI,1 L/!!6u Se;fl Ilfl r I~.0ERr 1'.IFTIIE.' r,171;1(;n;ua !1149 531;7,Q S 5/91 183''i 131;1, 17(:1 >3i'3 RAi:I IEL t I _I54 r,25. 17 r,, 3/F,/'!11 i~'Ag4+ 1 r f t 1 r , ' IIr3 .q } " l 1 III 7 JIGH t .5. - 9!5! lE N'I HAUL ISaF'b!='I r;1 1'.G`) 1 ~ t.l.l.,(•1 7,'S;'+t hiUl rt_r c tLilE :l% 1;'31 `fI J Li .-.jBL~'':T r4} .L., ri1 S', iw C3UC:'j P'IrF'5CtN, t: F:`r'S'fAL u7i"I Sri C?rtl(I?!5r EILi.'. C Irn(t,l(i lagry "J EA!,.AS, IIGF'TGNST:'r MAY 'A I-W BN' J3:367.: W.1h1r LilJMlgj ttul:7i1 3E33Y,1! t:~,!it:. iAX,G, JAE_ C X1,7 Imo,. s, l.. !bait, rj(j y!1,-l!.`I. F11 JClft, dU ± ,I It.11.a.J ; n' I• i1 J~1-: i yi.l~1'i3.. 1, 4 ~.'I'I l lyf I J1111t,11.1 -'7 `6 I PJ(,I, ylll ~ 11 3'r'I N: f: }'r IaE UF'UE (,MANATFIA 3 1'ic:!3'3G #~t 1f1 Sl.ri; iUUJFV, JAI },7h 31 y t5 (I J_dl it tr r(,Io 30 .3W5~13 b i l;.. •I J%:i r ral c r ,,rF; i_L L.E J 1 1+4 3:3 Gift , t;)t5 9i : ,`.i r'3 ; LL7MF'''JN1 I)TANA t:Itat;1',1t1Q 144r:IG1 tWt:l,l:r(;r :f!'S;'~S i{,;v,C,oLr,i3. 0L+LF:T ciilrir;l(;IC:1 'iG~7 00 a)UN ~I:Ir 1L, J C13; • 55C , i0 al_ ble:r'ND V)'C7 'flHi. A 1 f f7 tt I~ . J 1raML I~{ t 1 II I r r'egp i EI { HENDERSON BRYANT 6 WOLFE ATTORNEYS 6 COUNSELORS 200 NORTH TRAVIS STREET, FIFTH FLOOR JAMES E, HENDERSON:n[art.D, P O, BOX 239 STACI S. JOHNSON WILLIAM R. BRYANT 11919.19791 gHERMAN, TEXAS 76061.0230 T. SCOTT SMITH JOSEPH W. WOLFS NANCY O. WILLIAMS CURRY H, VOGELSANG 19631 893.9421 JAMES CORLEY HENDERSON W. ROBERT ESSIN OE90RAH S. BURLE90N RICHA40 E. HARRISON FAX (903) 892.2397 DEBORAH L. MCOHEOORY RONALD H. CLARK February 4, 1991 IJ;j FEB 61991 VIA FACSIMILE (817) $66. 236 ~ C114 11 ICf~ .11 1,I I E: , Mr. Lloyd Harrell City Manager Municipal Building 215 E. McKinney Denton, Texas 76201 Re: Denton County v, City of Denton Cause No. 87-4366-367 Dear Lloyds This is to confirm that your deposition has been set for February 8, 1991, at the offices of the City Attorney in Denton. This deposition will be noticed by counael for Plaintiff, and T will contact you later this week regarding the time of your deposition. Thank you for your attention to this matter. Sincerely, Deborah S. Burleson DSB/lee Enclopures cc; Ms. Debra Drayovitch City Attorney .Municipal, Building 1 215 E. McKinney Denton, Texas 76201 1 i N Deloitte Haskinv-Sells 1400 Lincoln Plata LB ##4 Datlas, Texas 75201.3302 12141 954.4500 Tatox: 732848 Mr, John F. McGrane, February 20, 1987 r~ Director of Finance City of Denton Municipal Building 215 East McKinney Street Denton, Texas 76201 Dear Mr, McGrane: We are pleased to respond to your request for a proposal to assist the City of Denton in evaluating the future financial a viability of Flow Memorial Hospital. We have developed a program of assistance that is designed to meet the needs ci the City of Denton in this critical and sensitive project. Our approach is based upon conversations with you, and our experience on similar engagements. We are highly qualified to assist the City in this endeavor. Our project ream meets the critical factors related to the engagement Confi,ontiali5y - As your auditing firm we are well aware oE"EIe rner E6 maintain strict confidentiality of the data gati,oret! and our findings and re,,ommendations. Technical Experience - as evidenced by the project team resumes, c as Tie needed, proven skills in the key areas of financial feasibility studies and strategic planning for health care providers. Industry ~~Expertise - Ttie references provided describe our extenaiva ac ground in working ith similar hospitals. Coupled with our knowledge of Tewxas municipal financial operations, and the City of Denton in particular, we have an unequaled depth of industry expertise. Timeliness - Our track record in working with the City reporting o and rbudgetary commitment to meeting your ' This combination of capabilities makes us the overwhelming choice to meet your needs, w I In the remaining sections of this proposal, after a brief statement on the background of the project, we describe the project background scope of work, estimate of timing and costs, and our qualifications, We appreciate this opportunity to further serve our valued audit client, and look forward with enthusiasm to working closely with you, the City's management team, and the City Council, If you have any questions, or any need for additional information, please feel free to call me at (214) 954-4535 or Ken Staples at (817) 336-2531. Sincerely, Mark E. Delano Managing Director of Consulting Services i i l ti.y i I t v; 'i CITY OF DENTON PROPOSAL TO ASSIST WITH A FINANCIAL EVALUATION OF FLOW MEMORIAL HOSPITAL TABLE OF CONTENTS SECTION PROJECT BACKGROUND, OBJECTIVES AND APPROACH,,,,,,,,,,,,,,,,, I PROJECT ORGANIZATION AND STAFFING II PROFESSIONAL FEES............ III REFERENCES, QUALIFICATIONS AND RELATED EXPERIENCE........... IV RESUMES V i I i F i i r 1 i r ~a t, i fiW i "'Al@ l s PROJECT BACKGROUND OBJECTIVES AND APPROACH i j 1 Y I I - 1 E~ PROJECT BACKGROUND, OBJECTIVES AND APPROACH Bac,~round_and Ob.iectives Flow Memorial Hospital (the "Hospital"), like many public hospitals across the country, has recently encountered considerable difficulty in meeting its financial obligations. information for the three months ended December d31,n1986areflect an operating loss of over $878 000. This represents a deterioration of over 2671 from the same period last year. The administration of the Hospital has requested substantial financial assistance from the City in order to meet its obligations. City Management ie appropriately and justifiably concerned as to the financial viability of the Hospital, and desires a study which would project the relative financial health of the institution over the next five years, Such a study is to be based upon projections of operating revenue and expenses and assumptions relating to the future environment in the health care marketplace. The results of the study would serve to inform City and County officials as to the potential amount of financial assistance the Hospital may require during the next five years, AM, oach A project of this magnitude will require an analysis of many factors, including; The growing demand for indigent care. Shrinking debt capacity and access to additional working capital due to current and proposed reductions in Medicare reimbursement. A national trend in the shifting of admissions to an outpatient basis, The Hospital's ability to handle this shifting of admissions in light of the Hospital's physical plant restraints. k Competition in the service area, The influx of alternative delivery systems into the Hospital's service area and the pressure to discount Hospital charges. The impact of community awareness and anticipated health card industry changes upon the Hospital's utilization. The deteriorating economic condition of the overall Texas economy, l I~ t' I lr2 Our approach to serving the City would resemble a pr©liminary feasibility/debt capacity study, While our report would not suitable for financing purposes, many of the same steps and be procedures employed in a formal feasibility study would be utilized. Accordingly the primary objectives of our participation in this projent wiii be to identify the facts that can be used by the City and/oL the Hospital to assess; The Hospital's financial outlook over the next five years assuming current utilization trends and methods of operation. The future cash needs of the Hospital based upon this scenario. The "critical success factors" that must be present in order to improve the Hospital's financial outlook, In addition, a secondary objective of our participation will be to provide information useful in future strategic planning for the Hospital. To do this we will; Meet with the City and Hospital management and others, as necessary, to discuss risk areas, from a financial feasibility reimbursementufactors, anditheefuture rfinancial pviayy Hospital, y biliC of the Prepare selected alternative utilization levels and/or methods of operation to identify and assess the financial impact that mix' staffing' etc, has onttheafutureecash flowsiofztheoHospital, Be available to attend critical City and/or Hospital planning meetings to review the study. goal g p potential y outcome analysis of is alto inrm ternative the City ma os so that scenarios knowledgable decisions can be made. ~a k I/ ~q SCOPL OF SERVICES TO HE PROVIDED In pprepaying a study where we provide a compilation of projections, it is our policy to base these compilations on assumptions provided by management concerning future events and circumstances. As such, the underlying assumptions are the responsibility of Hospital or City management and we will assess the reasonableness of those assumptions. A general description of the scope of services, procedures performed and information analyzed during our involvement is included below, Data Gathering And Analysis We would begin by analyzing historical data provided by the City and Hospital. The historical data analyzed would include, Patient charges and other operating and non-operating revenue, 'third-party reimbursement data such as cost reports, admissions by payor type, and alternative delivery contracts, Operating expenses by key expense categories such as medical supplies, purchased services, professional fees, utilities, insurance and other expenses, Historical staffing patterns and employee benefits. Analysis of historical balance sheets and working capital requirements. Historical utilization and workloads, both inpatient and outpatient, Service area statistics and competitive factors if readily available, The historical data obtained will serve as the basis of our utilization and financial analyses. The data collection and review phase will also enable us to gain a good understanding of the Hospital s operations and management staff. r 1 - 4 Utilization Analysis We will then make an initial assessment of the future demand for the Hospital's programs taking Our into approach consideration to would include consideration of: Historic admitting patterns. r Service area definition and demographics. Historic and alternative projected use rates, An overview of attitude and age characteristics of the medical staff. The Hospital's future plans as to services and/or program changes. One task in this phase would be to meet with management to review our findings and obtain an understanding of management's expectations of future utilization. We would then prepare the utilization projections that will be the driving factor behind the financial analysis. Financial Anal vsis And Protections This phase will combine all information gathered during previous tasks, examine the information for reasonableness, develop assumptions, and prepare the financial projections that will be summarized and included in our final report. Our approach includes; An assessment of the Hospital's historical and projected patient charges in terms of a competitive position. Identification of fixed and variable expenses of the Hospital, An analysis of projected staffing patterns and employee benefits, Assessment of working capital needs as to any future capital additions and improvements, An analysis of reimbursement from third-party payors. _a i PIP 1 E <n I. M k , .a ,tY 1 - 5 The conduct of sensitivity and other feasibility determinant tests including: The potential impact of alternative operating levels, Calculati.,A of key ratios used by financial rating agencies to assist in identifying strengths and weaknesses of the Hospital. Use of our microcomputer-based, "utilization-driven" financial model to incorporate all assumptions and project the current and alternative operating levels of the Hospital. We will meet with Hospital management to review our findings and obtain an understanding of their expectations of future financial results This phase of our work is designed to finalize all assumptions pertaining to the projections and our final report, The final phase of our work will include preparation of our report to the City. Final Report Our final report will be designed to incorporate the results of our analysis, It will be a comprehensive document and serve as a basis for the City, County and the Hospital, to evaluate the institution's future direction, in support of this, the final report will encompass, at a minimum, the following discussion supported by exhibits, as necessary: . Executive summary Comparative analysis of projections under existing conditions to projections under alternative operating levels, Identifloation and discussion of the "critical success factors" of the Hospital. Summary assessment of factors affecting future utilization: 1 Service area Medical staff to Trends in medical treatment patterns kf A I'. I - 6 A summary of the projection r.hsumptions used in the financial projections, and a discussion of the alternative operating levels evaluated, Projected financial information, along with various reimbursement assumptions. Summary of conclusions, Financial projections: in addition, all of the supplemental and supporting detail information used in preparing the alternative financial projections can be included as an Appendix to our Study. Although stated previously, we would reiterate that the scope of our work on this engagement would be considerably less than that of a full financial feasibility study which would be used for financing purposes. We believe the focus and scope of a full feasibility , study would not be relevant to the needs of the City at this point, and would also be more costly. We would also point out that much of the information gathered and analyses to be performed would lend itself to a full scope feasibility should oue be needed in the near future. Timing Due to the critical nature of this engagement, we are prepared to begin our work w.'.thin ten working days of being notified that our proposal has been accepted. Assuming the full cooperation of Hospital and City management in data gathering and interviews, we anticipate rendering our report within thirty days of our start date, During the course of our work, we would suggest that periodic interim meetings be held with representatives of the City to review progress on the engagement. Such meetings will help to assure that our efforts are well-focused, and will serve to keep City officials apprised of our progress. l.) low it ua'r M1fiNiM 14 1 5E.TION II PROJECT ORGANIZATION AND STAFFING k r r J i 1 zI-l TI PROJECT ORGANIZATION AND STAFFING We have assembled for this important project a multi-disciplined team of professionals with the critical blend of skills and experience to provide financial consulting services to the City of Denton, The consulting team has had significant experience in the following areas: Financial feasibility studies Computerized financial modeling Strategic planning Market analysis Tax-exempt financing and related bond documents Knowledge of the specific market and third-party reimbursement systems, Strategic business planning studies including joint ventures, mergers and acquisitions and debt capacity analysis Corporate reorganization Multi-hospital organizations Design Structure Implementation Case mix management Additionally, our project team has experience in a broad range of consulting services including operations reviews, productivity studies, reimbursement, and automated systems, The organizational chart on the following page depicts how we propose to staff this project. ' i 9q..ep4'4 1 II - 2 CITY OP' AENTON PROJECT TEAM CITY OF DENTON DIRECTOR OF FINANCE CLIENT SERVICES PARTNER KENNETH E. STAPLES ENGAGEMENT PARTNER CONSULTING PARTNER MARK E. DELANE STEPHEN G. WEST PROJECT MANAGER RANDALL W. LUECKE LEAD CONSULTANT CHARLES D. CHRISTY OTHER CONSULTANTS AS NEELED ~d II - 3 Kenneth E. Staples, Partner in the Fort Worth office and Audit Partner on the City of Denton audit, will serve as the client services partner. He will ensure that the project deliverables are appropriate for the City's needs. Mr. Staples has worked with numerous governmental and corporate organizations to dovelop successful and viable financial strategies. Technical advisor to this engagement will be Stephen G. Wuest, our Firm's Great Lakes Region Director for Healthcare Services, He brings to the project extensive experience in health care strategic business planning and financial feasibility studies. Randall W, Luecke is a Senior Manager in our Great Lakes Health Care Consulting Group, and one of our Firm's lead specialists in health care planning and operational analysis. He has over ten years of health care consulting experience. Until recently, Mr. Luecke served as National Health Care Director for another international public accounting firm. He will be the Project Manager on this engagement and be responsible for the day to day engagement activities. Charles D, Christy, a Manager in our Great Lakes Health Care Consulting Group, will serve as the lead consultant for this project. Mr, Christy is the regional financial feasibility specialist and brings to this engagement the experience of successful management of many such studies. Mr. Christy has had experience in health care feasibility studies and financial modeling. Staff level activities will be provided as needed by a variety of consultants. These consultants will bring to the engagement both the clinical and financial backgrounds necessary to ensure a successful project. All of the consultants utilized will have varying experience in the areas of reimbursement financial modeling, systems, operations, financial feasibility studies, corporate reorganization and case mix management. Resumes for each of the identified members of the project team are included as Section V of this proposal, Mark E, Delano, Consulting Managing Director of the Enorgy Region headquartered in Dallas will be the engagement partner. He will have overall responsibility for the quality of the engagement, Mr. Delano has extensive experience in consulting engagements to similar financial institutions. M tFTPW'A Ii:,iNeW(~ I 4ECTIOH II7 PROFESSIONAL FEES .J 1 I .l 1N,W eD dVtit e, IIT - 1 PROFESSIONAL FEES Our professional fees for this engagement will be 125,000 plus out of pocket expenses of travel, subsistence and clerical support. Our reimbursable expenses are customarily billed at actual, each month they are incurred. It is not practical to predict with any degree of precision how many special meetings you may require or the particular situations we may encounter at Flow Memorial both of which affect our out-of-pocket expenses. However, we will establish a ceiling for reimbursable expenses of $6,000. In no event would we exceed our estimate without your prior approval. Should any unforeseen factors change the scope of our work, we would confer with you immediately before proceeding. We follow the practice of submitting progress billings at the end of each calendar month during the course of our work, with a final billing at the completion of the engagement, I .I I a/9f xy.V h 1 I rl,~ REFERENCES, QUALIFICATIONS AND RELATED EXPERIENCE ~a I IV - 1 ~ECT~I ON~IV REi'FRENCES, QUALIFICATIONS AND RELATED EXPERIENCE In an effort to demonstrate our qualifications to assist the City of Denton a list this very listing w of a financial pleased planningide of references important and Project ' both clients we have served in the past few years. References As evidence of the experience of members of the project team to be and people offer that t would following be of inselect terest references to e you. assigned to the appropriate contact City, Southwest General Hospital Middleburg Heights Ohio Mr. L. Kenneth Tayior Executive Vice President 216-826-8000 ProJec": Strategic Planning/Service Review and Analysis Riverside Hospital Mr. Scott E. Shook Senior Vice President and Chief Operating Officer 1600 Superior Street Toledo, Ohio 43604 (419) 729-6000 Project: Formal Financial Feasibility Study Baptist Hospital of Miami, Inc. Mr. Richard C, Marx Director of Financial and Lang-Range Planning 8900 North Kendall Drive Miami, Florida 33176 (305) 596.6503 Project: Formal Financial Feasibility Study San Pedro Peninsula Hospital San Pedro, California Mr. Andrew P. Marincovich Chairman Board of Directors 213-514-f233 Project: Management Audit Business Office Review A listing of financial planning clients is included at the end of this section, on pages IV-19 and IV-20, i 1 'i i 1 IV -2 The remainder of this section discusses the services we have rendered to our health care clients. 7 Auditing Services Early in our history we began serving health care institutions - first as accountants and auditors and then, as the needs of the ! industry became more complex, we began the continuous development of specialized consulting skills. Today, the Firm serves voluntary health and welfare agencies; mental. health centers; physicians and dentists, both individual and group practices; large teaching hospitals; community hospitals; major hospital and nursing home management companies, We take a constructive approach in serving our clients, blending technical knowledge with business insight, and providing timely communication of financial and accounting developments to client executives. One partner is assigned the responsibility for all services to each client and is supported by all of the Firm's resources. Audit work is planned around the concept of continuous year-round contact. An audit team frequently performs a substantial portion of the audit during periods prior to year end. The use of a relatively small team at planned intervals during the year, rather than a large audit crew at year-end closing, fosters a more efficient working relationship with client personnel and minimizes any disruptive effect on the client's normal operations. It also affords the opportunity to identify and resolve questions as they arise and to help the client better plan for the year-end closing. In making an examination, we use many advanced auditing techniques that we have developed through the years. These techniques are designed to achieve audit economy and efficiency while maintaining strict quality controls. We also make many of these techniques available to our clients for use in internal auditing, special analyses, and other applications. During the audit, we coordinate our work with client personnel, so that we can operate most efficiently and avoid duplication of work. We make maximum use of the financial statements, schedules, and ' special analyses that the client prepares, We also perform as much of our work as feasible at those times when the client's personnel, and computers, are least burdened with periodic work loads and special projects, 1 IV - 3 While carrying out our normal auditing procedures, we often raise questions and develop suggestions for improving the orianization's system of internal accounting controls and administratve procedures. We also make recommendations from time to time for improving the organization's financial structure achieving maximum reimbursement benefits, increasing the profitability of operations, and strengthening the overall management process, ~r1 Financial Feasibility Studies and Capital Planning I A ma or area of service to our health care clients relates to feas bility studies and related analyses (such as debt capacity studies and Certificates of Heed) performed in connection with planning and financing for expansion and/or modernization programs, mergers and acquisitions, reorganizations, and budgeting and strategic planning, In addition to studies prepared for public financings, we have also had experience in studies for inclusion in various loan applicatiionsngsuchsasiFarmers Home Administration applications and FHA-242 loan guaranty ? programs), private placements and limited partner syndications. The clients that we have serviced include hospitals, life care and continuing care centers and other types of extended care facilities. Our health care consulting group utilizes sophisticated computer modeling in conjunction with our capital planning and budgeting services, and can tailor our microcomputer models for in-house use. As evidence of our experience, our staff has assisted more than ninety hospitals in the capital financing process, The combined project size for the health care organizations they have assisted, or are assisting, exceeds $1,500,000,000. Accounts Receivable Management In the past two years many changes in the health care environment have resulted in hospItal accounts receivable levels climbing higher than ever before. Those changes include: Medicare implementation of Prospective Payment System (PPS) which included additional billing requirements. Implementation of UB-82, a uniform bill for all payors. ' Increased use of negotiated contracts for HMOs, PPOs and others, Hospital diversification into home health care and skilled nursing homes which requires specific billing, We have been actively involved in interpreting these changes and helping hospitals respond appropriately. 4 y r IV -4 Targeting Accounts Receivable A significant contribution to the effort of meeting today's health care environment challenge can be made by improving cash flow through effective management of patient accounts receivable. We help hospitals effectively manage their receivables by; Determining an appropriate level of patient accounts receivable for each individual hospital. Implementing a reporting system which enables management to identify troublesome areas. Business Office Reviews The objectives of our Business Office Reviews are; To identify ineffective policies and procedures. To identify bill processing delays. To review stsffing - organization structure and number of employees. To meet cost justified recommendations. Our approach to Business Office Reviews includes; . Interviews with managers) supervisors, and staff members, Reviewing patient account documentation. . Reviewing third-party documentation. . Compliancy testing to policies and procedures. 1 Reviewing file systems, automated and hard copy. RL lewing interdepartmental interfaces including Medical Records, Data Processing, and ancillary departments responsible for processing charges. k !,eviewing batch control procedures to ensure timely and accurate submission of charges. y jI F 1 a I IV - S Operations Reviews and Productivity Analyses Our health care consulting group has extensive experience in performing productivity studiea designed to ensure that hospital services are provided effectively and efficiently. In approaching these projects, we take the position that client participation is vital to the success of such programs, Accordingly, our consultants work closely with client personnel in all phases of a project, scheduling frequent reviews of engagement progress with management officials and user groups throughout the course of our work, Through this approach, client personnel beco-ne i sufficiently proficient to carry on the programs developed once our consultants have completed their work, Our Executive Office considers productivity measurement and monitoring in health care to be paramount to the services we offer. To ensure that, as a Firm, internal resources are fully utilized. We have created an ad hoc committee of senior consulting personnel to continually evaluate and, when necessary, enhance our Firm-wide productivity monitoring product. To supplement this, we employ on a regional basis an experienced staff of management engineering, clinical and electronic data processing specialists with the operations experience to establish effective productivity analysis and monitoring systems, and to train clients in their use. Furthermore, we utilize IBM microcomputers and compatible software to perform our initial analysis at the department level, which remains with our clients for ongoing use once our field work is complete. As evidence of our experience, our health care consulting group has performed staffing and productivity studies in almost every area of a hospital, including the design and implementation of productivity monitoring systems. Our staff has vast experience in performing operational reviews which focus on the administrative, professional, and support service sections of hospitals. Examples of the range of productivity and operational review studies performed in non-nursing areas include: Reviewing the effectiveness and efficiency of selected operating components in numerous clinical and support departments. Evaluating staffing levels in key support departments by implementing time and workload studies, while considering interdepartmental relationships. IV - 6 In addition to services in the non-nursing areas, we have developed and implemented a patient acuity/nurse staffing system. The system is flexible, simple to maintain and involves detailed observations of nursing activities, In connection with services in the nursing area, our staff has recently; Co,n leted an audit of an existing patient acuity system to I~ - evaluate its effect on short and long-term staffing needs, As a result of this work, a redistribution of skill mix and decentralization of nursing management was imp''Limented. Implemented a patient acuity system, utilizing a work sample of nursing activities to ensure proper staff acuity ratios. Performed a detailed staffing evaluation of operating room, recovery room, emergency department and nursing services, This study included direct observation of :cursing activities and evaluation of scheduling methodology, resulting in a redistribution and reduction of full-time equivalents. Performed operational reviews of nurse management functions, leading to the reorganization of nursing services to increase management effectiveness and productivity. As a result, techniques were implemented to increase span of control, reducing nursing management full-time equivalents, Finally, with the increased emphasis on health care costs, we have begun to apply management engineering techniques to the area of cost accounting where detailed work standard development becomes an integral part of determining the standard costs of revenue producing procedures, Our consultants have assisted hospitals in the development of detailed cost standards by; , Guiding the process of work standard development through meetings with senior management and coat analysts, auditing results as produced. Playing a lead role in developing standards for major revenue producing ancillary procedures and nursing units, ntegrating acuity rating, labor, and non-labor standards. Assisting in the development of a "cost" performance report. This report includes variance analysis and is tailored to management's needs. .rrnw~w~ Y C k I IV - 7 Staffing Studies The Business Office's organizational structure and staffing plan should facilitate response to their volatile environment. Unfortunately, tasks in the Business Office have been historically assigned to individuals who had insufficient time to complete new tasks, This often results in inefficient processing and illogical r flows of tasks, 4 Staffing study objectives include: Review of adequate manager and supervisor support. Identification of tasks being completed by the wrong level of personnel. Management reporting to identify activity levels to determine appropriate staffing. Initial review of existing staffing levels. Policies and Procedures Never underestimate the power of good policies and procedures! ror training, retraining and informing hospital personnel physicians and the public, hospitals should have documented polic es and procedures. Key areas of concern in the Business Office are: Admitting and outpatient registration. Pile maintenance. Credit and collection, Bad debt referrals. To assist hospital;;, we will: Evaluate established policies and procedures for appropriateness and compliancy to those procedures, Revise policies and procedures to improve Business Office effectiveness within the guidelines of hospital philosophies and mission statements, Document policies and procedures, r Monitor implementation of new and/or revised policies and procedures to ensure successful implementation. s IV -8 Materials Management Improvement Our Materials Management Improvement Program is designed to assist hospitals in obtaining quality materials at the best possible prices and in the most efficient manner. Specifically, this program helps reduce inventory levels and purchasing costs and improve productivity and service levels from f~1 vendors to users. Modularly organized, this program can be applied I to all supply, processing and distribution activities and any of the elements thereof (e. requisitioning, purchasing, receiving, inventory management . Medical Records In this increasingly restrictive health care environment, it is imperative that hospitals and physicians fully understand the changes that are occurring in financial incentives, and the impact of these processes on their organizations, One of the major changes in the third-party payor system is the hospital's direct dependence , on the quality and accuracy of documentation contained in the medical record and the conversion of narrative diagnoses and procedures to numeric codes. Because the Medical Record Department in the hospital is responsible for providing the appropriate coded information which ultimately determines the level of hospital reimbursement, we include among our consultants Registered Record Administrators who are prepared to address the specialized information and medical record data needs required in the current health care environment. Services performed by the medical record consultants focusing on operations and optimum reimbursement include: Data quality reviews which assess medical record data to assure that it is complete, valid, consistent, and measuring what it is intended to measure. These reviews evaluate the sequencing of diagnoses and procedures, the accuracy of ICD-9-CM codes, and the timely availability of this data to maximize reimbursement and improve cash flow. Operational analyses, which assess the efficiency of overall departmentsl operations, work flow, staffing levels, and information systems. Recommendations are In made, as needed, to improve quality control, productivity, interdepartmental reporting procedures, and work flow. I I:,r Mrf r e dL1 S { IV - 9 Data analysis activities, which examine and interpret data generated from the medical record abstracting system, case mix management system or in-house information system. These activities can assist the hospital in helpingg achieve the most effective use of the data in strategic planning, corporate restructuring, marketing, research, and in evaluations of -,outpatient care alternatives. Educational programs, which address the s ecific information { needs of trustees, administration, medical staff, financial managers, medical record professionals, and other hospital disciplines. Depending on the audience, the programs may focus on peer review organization activities, coding and sequencing, medical record documentation, or other related topics. In response to the current activities of Peer Review Or anizations (PROs) the medical record consultants of Deloitte Haskins & Sells have also been active in assessing hospitals' Utilization Review Plans and Procedures in order to assimilate the preadmission and retrospective reviews of the PRO. Specifically, consulting services focused in the Utilization Review area include: Assistance in the formulation or review of Utilization Review Plan elements concentrating on the procedures for preadmission, concurrent and respective review. A review of the physician peer review activities including the process of physician advisor reviews, criteria and guideline approvals and the methodology for physician profile analyses. An assessment of the documentation requirements of the Utilization Review Plan and Procedures and statistics maintained for analyses of profiles. In addition to these services provided to hospitals, we offer a variety of similar services tailored to the individual requirements of outpatient facilities, physicians' offices and long-term care facilities. These services include record management systems, risk management, transcription services microfilming options, and assistance with accreditation and licensing compliance. a Iv - 10 Cost Accounting Our health care personnel have had extensive experience in the design, development and implementation of standard and other cost accounting systems within both health care and other industries. As evidence, we; ! Are presently assisting detailed des several hospitals in conceptual and design and implementation of standard cost accounting s will ystems. At the completion of these engagements, the systems patient services, detailed costs stafor ndards and report pre-established variances by department and DRG. Have and are presently assisting hospitals to develop procedure level standards for use in conjunction with standard coat and productivity monitoring systems. Have assisted numerous hospitals in implementing revised manual and automated systems to comply with uniform reporting requirements, Have developed sophisticated planning models and analysis techniques aimed at evaluating the feasibility of expanding, contracting or closin services. Included within these models have been the identifleation of costs as variable, semi-variable and fixed as related to changes in volume. Developed a cost-benefit based overhead cost allocation methodology for a major university with over 100 indirect cost centers and eight different auxiliaries, including two hospitals. Participated in the cost accounting design of integrated financial management systems fot iumerous organizations in the industrial sector - both large and small. Evaluated and recoiamended order processing, inventory control, bill of material and general ledger systems for several companies, Case Mx_ Management In 1976, Deloitte Haskins & Sells was among the first to consult with a state developing diagnosis-related groupings when the State of New Jersey engaged us to provide technical expertise as they implemented this prospective payment system. To this day, we still consult on this important project. h IV - 11 It was through this experience, in which we assisted New J,arsey in establishing DRG rates for approximately 100 hospitals, that the DH&S approach to case mix management was developed. Our approach recognizes that hospital needs vary. Furthermore, we know that there are large variations, from provider to provider, in the content and flow of patient bills/abstracts, volumes, desired costing methods and the availability of data processing hardware, For these reasons, we have developed our Case Mix Management (CMM) System to operate in a number of varying configurations including: . A COBOL version for the IBM PC microcomputer. A COBOL version for mainframe computers. . An in-house Statistical Analysis System (SAS). Our health care consulting group has been involved in the installation of this system at eight major teaching hospitals, including those with large IBM mainframe computers. Certain salient , points incorporated in these installations are: Integration of a costing system which produces standards for approximately 80% of the hospital's operating revenues. . Integration of a nurse acuity rating system which provides for the costing of ten act!ty classifications within each DRG, coupled with disease staging analysis. Full integration of Medicare's outlier logic. Development of a concurrent system which tracks patient costa and length•of-stay on a daily basis and compares these with HCFA standards and DRG rates of reimbursement. Information Systems and Office Automation Within the area of information systema, we have performed a wide variety of services for a large number of industries, including health care. Services rendered have included long-range EDP planning, comprehensive effectiveness and control reviews of large installations, identification and prioritization of information requirements, and assistance in the selection and installation of both mainframe and minicomputers as well as telephone systems. Representative health care systems projects performed by our health care consulting group, include: Performance of a comprehensive review of a shared data processing service providing services to numerous hospitals, This review, performed in two major phases, addressed: y IV - 12 Long-range planning and future role Modifications to existing applications Communications Documentation ( Contractual arrangements Competitive position III Development of a long-range data processing plan for all sizes of acute care hospitals, Selection of cost accounting software for an acute care hospital. Project management for the installation of a minicomputer system in a medical clinic. Assistance in the development of a atravagic data processing plan for several specialty children's hospitals. Assistance with the selection of a comprehensive management information system for many large urban hospitals. Assistance with the development of Request for Proposals (RFP) and the selection of financial systems for many community hospitals. Office automation (OA) is a field that has experienced tremendous growth in recent years. With the benefits of faster/easier information storage retrieval and data manipulation, coupled with potential labor savings, we expect this growth to continue. In connection with this, we have provided our health care clients a broad range of services in this area, including; Assistance in defining OA objectives and needs, Assistance in linking various components (n.g,, word processing, telephone, etc.), plus defining future system direction. System design and vendor selection (including telephone system selections). Ir .7 F N IV - 13 Reimbursement and Rate Setting We strongly believe effective third-party reimbursement services are critical to serving our clients. As a result, we have developed an effective working relationship with Medicare intermediaries, Blue Cross plans, and various state regulatory bodies. We regularly; Participate in projects designed to maximize Medicare reimbursement and analyze the reimbursement effects of operational changes. Prepare Medicare, Medicaid, and when applicable, Blue Cross cost reports for our clients. Consult with clients on the applicability and interpretation of reimbursement regulations, including dealing with the Provider Reimbursement Review Board (PRRB) and the Health Care Financing Administration (HCFA). During recent years, our health care consulting group has; Completed third-party maximization projects for numerous hospitals. In connection with these projects, we have successfully proposed numerous adjustments to prior ,years' cost reports and, in all completed projects, have found the additional reimbursement received by our clients through our participation greatly exceeded the professional fees charged. Consulted with numerous hospitals on a variety of reimbursement matters, including those associated with state sponsored rate setting agencies, Successfully settled several controversial reimbursement issues administratively with the Blue Cross Association, and have assisted numerous clients in the preparation and presentation of t appeals to the PRRB. Assisted numerous hospitals in developing reimbursement strategies as they relate to operational and regulatory matters, i clients on ncluding TEFRA and PPS. In addition, we continually update our potential incorporation impact of of specifically capital changes costs p into g DRG t rates and establishment of fee-for-service payment rates for outpatient ' services. :i I~ Y IV - 14 Strategic Planning Our health care consulting group has extensive experience in performing strategic planning consulting services from both an entire institution perspective and a specific service perspective, teamfirmly Web staff these denby a gagements ewith personnel experienced in he areas of not only strategic planning but also operations, corporate restructure pproductivity, accounting and finance, organizational design, and reimbursement and rate setting, The competitive environment in which health care providers n more ow function causes the financial implications of decisions to be of complemented ebycourhaccounting 0andhfinance askills, help nassure that we assist clients in establishing strategiea that are realistic and pragmatic. In addition to the more traditional approaches to assessing markets, demographics and needs for service, we utilize our advanced techniques in financial modeling and case mix management to test the validity of alternative strategies. Internal/External Smith Assossu:enC Our Internal/External Strength Assessment for multi-hospital systems facilitates the sharing of resources by individual hospitals within a system, making the system and each member hospital stronger and better able to compete. The first phase, data collection, provides our health care consultants with information about the system. We interview key personnel to determine: The mix of programs and services offered by each hospital and their relative success Each hospital's strengths and weaknesses in market position and ability to compete . The best demonstrated practices and "expert" managers within the system . Each hospital's priorities and expectations of system membership a.: a guide for system goals. This information experiences, match aneeds twNhs resourcesti..nternally, and share lsson the dependency on external advisors. Additionally, the goal setting process is simplified. rfIV - 15 in the second phase, our health care conFultants or a system task force, analyze the data and develop recommendations for sharing capabilities and resources. Opportunities for operational improvements are developed by a task force of line managers. The results of the assessments are summarized in two reports: a summary report with comparative statistics and market penetration information and an optional hospital specific report. If the multi-hospital system is not making the most of its potential, the Internal/External Strength Assessment can provide the techniques and expertise to bring about a new degree of cooperation and mutually berieficial sharing of the strengths and capabilities the system already possesses. Corporate Restructuring External forces which affect the health care industry have become much more severe. As a result, many hospitals have determined that their present corporate structure must be evaluated as part of an E overall strategy to meet the challenges of the future. Our health care consulting group has assisted numerous hospitals with these important projects. In connection with these studies, we have: Assisted in the development of short and long-range business planning goals, resulting in the design of proposed corporate models for hospital management and board of trustee working group sessions. Performed studies of the legal ( erformed in cooperation with hospital legal counsel), tax, reimbursement, governance, and operational aspects of various corporate structures. Assisted in the implementation of revised corporate structures, including: Requesting the necessary revenue rulings. Gaining the acceptance of third-party regulatory agencies. Presenting revised corporate structures to appropriate parties. Developing implementation plans and procedures. Performed financial impact reviews for selected diversification service plans such as dome health, ambulatory surgery, rc;.l estate ventures, child care centers, rehabilitation units, etc, r IV - 16 Telecommunications Recognizing the growing importance of both voice and data communications planning in the health care industry, we offer a wide range of consulting services to address the issues within the telecommunications area. Typical services include: r Inds endent Telecommunications Technolo AssessmenC ITTA - We I ent y opportun t es to en ante t e e c ency an effectiveness of the telecommunications function within an organization. Telecommunications Feasibilit Stud - We perform a detailed nanc a ana ys s to a use as t e basis for objectively evaluating telecommunication options, Communications Network Anal sis and Design - We deli n a voice an or ata networrk that is econom ca , provides optimum performance, and is capable of expanding to accommodate unknown or undefined future communications requirements. Telecommunications System Selection - We select the optimum ar ware an software so ut on C rough an unbiased and competitive process. SOFTWARE PRODUCTS Deloitte Haskins & Sells is committed to developing and maintaining microcomputer software to assist clients in responding to today's competitive health care environment. Examples of software currently available are described below: NURSEPRO NURSEPRO, our patient acuity system, is designed to help hospitals minimize nursing labor costs through increased efficiency. Specifically, the software provides management with a staffing plan based on actual patient acuity levels. The plan details the appropriate skill mix of nursing personnel based on standards custom-developed for the hospital. ' Additionally, NURSEPRO monitors the efficiency of the nursing labor component and produces reports which highlight the areas needing improvement. The data is maintained at the level of detail required for costing nursing services and may be utilized in the development of cost accounting standards. is fi IV - 17 NURSRPRO also serves as a planning tool which tracks trends in patient acuity levels and provides comparisons of budgeted, actual and required personnel resources, Productivity Analyzer Productivity Analyzer is a high level productivity analysis system designed to provide hospital management with the information necessary to operate more efficiently. This product measures past and present productivity levels and provides an ongoing monitoring system. Target hours per unit of service are developed for each department giving e.=siderration to the department's methods of operation and productivity improvement potential based on historical performance, Productivity Analyzer is a microcomputer-based product featuring menu-driven software, on-demand reporting capability and fully integrated graphics. Case Mix Management System CaMMS, our case mix management system, is designed to provide hospital management with the information necessary to better manage under PPS. The system which operates on IBM, mainframes and the IBM PC-XT, features a flexible data base design, both otandard and ad hop, reporting, simple processing options and easy access :o information. The PC version interfaced with LOTUS 1-2-3. CaMMS includes reports by DRG, physician, payor clinical service, ancillary department and patient, The system also assists the user in developing hospital-specific standards for comparative reporting purposes. Through the LOTUS interface, summary level data may be formatted for graphic presentation. A grouper program is part of the system. Grouper Grouper is a software product that assists the user in tracking DRG-based third-party payor information. In addition to Medicare, the system can handle three DRG-baaod payor groups. Grouper has both tutorial and interactive options, providing efficient modes of operation for both new and experienced users. Requiring an IBM-PC or compatible equipment, the software is generally used by medical records and utilization review personnel. f ~k l n "r Y lV - 18 Plus Plan Plus Plan performs financial projections and Consolidates financial , statements from varl.ous entities to produce actual or pro forma financial statements. We also have available software designed to assist in preparing financial projections, developing standards for cost accounting systems, analyzing physician admitting patterns, etc. 1 i ;J r r. M g Iv-19 SELECTED HOSPITAL CAPITAL PLANNING AND/OK MLASISILITY STUDY ~~.N'fS •1' 1'H~ J+i'aLTkl rC xe 'UNSULTIN~f. CHUUP DLBT CAPACITY/ FLNANCINO ?KLLIHINAXY CLKT'IFICATE FINAL LNVESTLIENT BANKEK(8) r 0Ep TAL WMIII N SAY BTULY Ntto LTUU' (IF ALLECTEU) Salomon brothers Franciscan Healthcare Corporation Colorado Sprlnie, Colorado X108:345,000 X X X Merrill Lynch Gcod Samaritan Hospital Cincinnati, Oh o X Dillon Road Cain Bros„ Shattuck, 100,000,000 Merritt Lynch and Bankers Trust 86,500,000 X ongood 6 Meyer and Merrill Lynch f ; Seeeongood 6 Meyer end Merrill Lynch Jewish Hospital Cincinnati, Ohio lab,500 000 X X % Seee % Hiller 6 Schroeder I Foothill Preabyyterlen Hospital Glendora, California 80,00,000 X E. F, Hutton L Co. ueen'a MedLeal Conter Honolulu, HAWAII 65,000,000 X Drexel, Burnham 6 Lambert, Inc. E Forum Group, Inc. lndianapolLe, India $0 G3,000,000 % Goldean, Sachs L Co., Merrill Lynch Bethaeda hospital Clnclnnetl, Uhlo X and Seasongood L Cog i 58,500,000 X Herk'a Hosplte! Salt Lake City, Utah 39,000,000 % X % R. P. Hutton L Co. and Seasongood L f Port Hamilton- iughea Hospital Hamilton, Ohio 31,3UU,000 % Meyer ` Port Thomas, Kentucky 32 000,000 % X X Seasongood 6 114yer and Merrill Lynch St. Luke Hospital X % Seeeongood L Mayor and Merrill Lynch Albert B, Chandler Medical Canter Lexington Kentucky s3,5O0,OV0 X X X Merrill Lynch and Seasongood L Mayer St, prancle-St, George Hospital Clnclnnntt, Uhlo 3L,SUU,OUO % X X Seasongood L Mayer 4,75U,UUU X Lehmann Bros. Children's Hospital Columbus, Ohio 29,310,000 g Harrill Lynch Poseack valley floeppitol 4eetwuod, New Jersey 29,100,000 Youvllle Chronic Diseaso and 20000,000 X X Goldman, Sachs 6 Cc. kehabilltation Hoepltal Boston, Massachusetts 20 , 000 000 k Dillon, Read 6 Co. and Roney 6 Co. Klvoralde Hospital Toledo, Lori 25, COD 000 X S. C. 'Lei lav baptist Hospital hisml, poride X % X tlaas;rl L Mayer and Connors 6 Co. Our Lady of Mercy Hospital Cincinnati, Ohio 25,000,UOU goo Southern California Prsabytevian ale dale California 25,000,000 X S. P. Hutton 6 Cu. Homes 23 550,000 X X X E, F. Hutton 6 Co. and Govd Samaritan Medical Cantor 2anoaville, Ohio McDonald 6 Co. X E, F. Hutton 6 Co, j Oranade Hills Community Hospital Grenade Hills, California 20,0coo 000 9 00,004 X parkvlew L iacopaL Hospital Puabio, Colorado 20,000,000 X X Community Hospital Sprlnyyheld tlpringiield, Ohio % Hollywood preabyterlan Ned Cal Cantor Los Angeles, California 19,000,000 X X 8aaeonqcod 6 Mayor Piqua Middletown Rational Hospital Middletown, , 0Ohio 1312,,300150,,000 000 % X McDonald 6 Co. St. j Hasplte Piqua, Ohio % Nuveen tlt Joseph lloepital Ft. Wayne, Indiana 12,692,000 X X Paine Lieber Southern Nevada Memorial Hospital Las Vegas, Nevada 12,000,000 X X Patna Nicolas St. Elizabeth Hospital Chicago, llinots 11,250,000 X X X SWoods tin 4 Company St. Cetharino'A Hospital TChicago, roy Ohio Indiana 10,500,000 X Seasongood 6 Mayer Stouder Hcapitl Troy, Uh 10,000,000 X X Brown County General Hospital Georgetown, Ohio I i ~S i IV-20 SELKCTED HOSPITAL CAPITAL PLANNING AND/UK FEASIBILITY STUDY ~•NT9 Q+~'~{F: CLNCINNATI HEALTH L'AHE CONHUL',~( CROllP DEBT CAPACITY/ MINANCtNO I'HELININAHY CEKTIPICATE P1HA4 INVESTMENT BANKER(S) HOSPITAL CIU AT101+ STUDY UPS T$ DY (1P SELECTED) Union Hospital New York, New York $ 10,000,000 X pleasant valley Hospital Cam8rill 0, California 8,520,000 % x Hiller 6 Schroeder Selby Gonoral Hospital Mar Letts Ohio 6,330,000 x x Haarner, Wilkins and Company Morris Hospital Morrie, Illinois 6,200,000 X Kidder, Peabody McCullough-Hyde Memorial Hoaryryitsl, Inc. Oxford, Ohio 6,1OU,0UD x Otto C. Eppp Memorial Iloepital Cincinnati, Ohio 5,000,000 k Wayne Nnepitel Coml1any Greenville, Ohio 4,215,000 % X Ohio Company provldonce Hoaplta Cincinnati, Ohio 4:000,OUO x Schrooder Manor 4,000,OUO % X Clifton Springs Hospital and CiLnic Clifton Springs, New York 3,500,000 X X Community Health Center of Branch County Coldwater, Michigan 3,500,000 x Cushing memorial Hospital Leavonworth, Kansas 3,500,000 X Paine Webber and Housomen Securities I{ St. Sosoph Hospital Hishewake, Indiana 3,260,000 X x Heche, Heleey, Stuart, Shields, Inc. Choctaw County Hpmorial Hospital Hugo Oklahoma 3,000,000 X 11ousOman Securities Memorial Ilonos Poundation Cincinnati, Ohio 3,000,000 x Tillman County Nosppitel Frederick, Oklahoma 3,000,000 x Houseman Securities Huron Road Ilosppltai Cleveland, Ohio 310001000 x McDonald 6 Co. Muscle Shoals Peraonal Care FdatiLty Tuscaloosa, Alabama 3,000,000 % x f Pushmetaha Cmmty Hoepltal Antler:, Oklahoma 2,800,000 X Houseman Securities SequoyAh Memorial Hospital Sall isaW, Oklahoma 2,600,000 x Housuman Securities Sellevue Iloeppital bellovua, Ohio 2,100,000 X x % McDonald h Co. He loserling Foundation Columbua, Ohio 1,960,000 x Horath, Orr W Jones, Inc. i Wstumke General Iloepital Wetumka, Oklahoma 1175,00 % Houseman Securities Total 1 I 1 1 i~ U" 5211J~1 1. RESUMES r ~J f V - 1 SECTION V RESUMES The success of any consulting engagement depends on the technical competence: and human resources of the firm conducting the study. We can provide both the technical expertise and the capacities required to conduct the engagement outlined in this proposal. Key requisites for conducting an engagement of this type include defining required skills and selecting qualified professionals with related experience and capabilities in specialized disciplines. The professional backgrounds of those individuals specifically selected for this engagement are shown on the followin& pages, V - 2 MARK E. DELANE Consulting Managing Partner Role in F.ngaxement: Engagement Partner Experience: Ten years of diversified data processing experience in both the public and private sectors. Examples of HEALTH CARE: Clients Served: UCSD Medical Center UCLA Medical Center Sharp HealthCare University of Washington Hospitals Providence Hospitals Children's Hospital and Health Center Scripps Clinic and Research Foundation GOVERNMENT: County of San Diego City of Orange County of Orange - LIS SweetwAter Author'.ty San Diego County Registrar of Voters EDUCATION: Department of Education, San Diego County San Diego Community College District San Diego Unified School District California Western School of Law FINANCIAL MANAGEMENT: Salk Institute INFORMATION SYSTEMS: } Signal. Companies San Diego Office Supply Southwest Marina Big Bear Supermarkets Wavetek Corporation Equitable Life Leasing a I ;F V - 3 Mark F. Delane In addition Mr. Delane has over eight years experience In health care sys"ems consulting. Particular engagements include: Project manager and team member for vendor evaluation of patient care systems for a major Southern California teaching ( hospital. Areas evaluated include ADT census, order espiratory andn occupationall therapy, and { r outpatient clinics. Pro ect manager for the evaluation and design of all financial policies and procedures for a San Diego hospital and health center. Managed an evaluation of the accounts receivable system for a significant San Diego hospital and clinic. Designed and implemented hospital-wide patient charge procedures for a large Alaskan acute care hospital. Developed and implemented revised patient scheduling and control procedures for two Pacific Northwest teaching hospitals. Installed an automated budgeting system in three Pacific Northwest hospitals. Co-authored a budgeting systems manual used state-wide, Financial Management Managed the development of complete accounting procedures for a major hospital. Cash management studies. y „J Financial system installations. . . 1 !t if Iti V' v-4 Mark E. Delane Special Expertise: Mr, Delane has been with the Firm since 1979. Throughout his career he has been consistently involved in EDP system selection projects in a variety of client environments. These engagements have typically included re uirements analysis, Request for Proposal ?RFP) preparation, vendor evaluation, contract negotiation, and system installation, Education: M.B.A., University of Southern California B.A., University of California, Los Angelea Professional Activities: Association for Systems Management Center for Data Processing Professional Development M I V - 5 STEPHEN G. WEST SIGNIFICANT CAREER EXPERIENCE Deloitte Haskins & Sells, Partner - Management Advisory Services (Cincinnati) EDUCATIONAL BACKGROUND f B.S.I.M. - Purdue University M.B.A. - University of Chicago Mr. Wuest is a partner in the Health Care Consulting Group of the Cincinnati office. His experience with Deloitte Haskins & Sells has included consulting assignments as well as varying assignments as a member of our audit staff. He has been with Deloitte Haskins & Sells for nine years and has substantial health care and data processing planning experience. He has participated in and managed r numerous financial feasibility and debt capacity studies for hospitals as wall as nursing homes. During the last two years, he has managed approximately ten financial feasibility studies. Mr. Wuest has also performed debt capacity, data processing, and procedures efficiency studies for numerous Ohio hospitals and health care organizations. His financial feasibility clients have included; St. Francis-St. George Hospital, Cincinnati Medishare, Dayton Piqua Memorial Hospital, Piqua Stouder Memorial Hospital, Troy Health Care Industries, Dayton Millsr's Merry Manor, Plymouth, IndianP Mr. Wuest also has extensive health care data processing experience. He is currently supervising projects for four hospitals who are evaluating total hospital information systems. He is also responsible for an engagement in which DH&S is developing a strategic business plan for a hosppital service bureau which ~.4 pprovides Application systems to 22 hospitals. In addition, , Mr. Wuest has provided data processing services to physician groups, nursing homes, and community mental health organizations. His health care date processing cliaitcs include: Providence Hospital, Cincinnati a Doctor's Hospital, Columbus Otto C. Epp Memorial Hospital, Cincinnati Montgomery County Board of Mental Retardation, Dayton Southwest General Hospital, Cleveland Children's Hospital, Pittsburgh 4a.Fi'-u V 6 PROFESSIONAL ASSOCIATIONS Healthcare Financial Management Association ! American Institute of Certified Public Accountants ( Ohio Society of Certified Public Accountants i . i i v V - 7 RANDALL W. LUECKE SIGNIFICANT CAREER EXPERIENCE Deloitte Haskins & Sells - Senior Manager, Management Advisory Services (Cleveland) KMG Main Hurdman - National Healthcare Director (Washington) Ernst & Whinney - Senior Consultant (Cleveland) EDUCATION MBA - Lehigh University BA - McMaster University PROFESSION DESIGNATIONS Certified Management Accountant Certified Purchasing Manager Mr. Luecke has over tan years experience in the health care area. He has participated in numerous hospital audits, rel and final financial feasibility studies and debt capacity,mIon$ range lanning, corporate restructuring, and nurse staffing studies. He has prepared and reviewod Medicare Coat Reports and assisted hospitals in optimizing their reimbursement tinder Federal and State government programs. He has participated in operational reviews and cost containment studies, and has prepared and assisted with Certificate of need applications. Mr. Luecke has worked with hospital architects, program planners, bond underwriters and attorneys, comprehensive health planO ng agencies, third-party reimbursors, bond rating firms, county commissioners, hospital financing authorities, state health } departments, and other agencies concerned with the health care delivery system, s y V-8 PROFESSIONAL ASSOCIATIONS Healthcare Financial Management Association American Hospital Association American Ansociation of Hospital Consultants . Institute of Management Accounting ARTICLES "Pension Plans: More Than a Savings Accounts for the Hospital", Healthcare Financial Management, December, 1986. "Diversifying Revenue Sources: A Key to Hospital Survival", Corporate Accounting, Spring, 1986. "The Implications of SFAS No. 81: Disclosing Certain Postretirement Benefits", Management Accounting, October, 1985. "Corporate Healthcare Costs: A Strategy for Containment", Corporate Accounting, Fall, 1984. "Updating the Controversial Social Security Option", Healthcare Financial Management, November, 1982. "Feasibility Study Offers Guidance", Contemporary Administrator, June, 1982. "Corporate Restructuring: Positioning for Future Viability", Osteopathic Hospitals, February, 1982. "How to Work With the New Rules for Compensated Absences"t The Practical Accountant, October, 1981. - "The New Accounting for Compensated Absences", Healthcare Financial Management, July, 1981. "The New Economicsi of PSRO Review: An Uncertain Future:, Hospital Financial Management, April, 1981. "The Economics of Delegated vs, Undelegated PSRO Review'", Hospital ' Financial Management, July, 1980. f' z Y V-9 CHARLES D. CHRISTY SIGNIFICANT CAREER EXPERIENCE Deloitte Haskins & Sells - Manager, Management Advisory Services Klosterman's Baking Company - Controller EDUCATIONAL BACKGROUND B.H.A. - Ohio University Since joining Deloitte Haskins & Sells, Mr. Christy has been involved with the financial segment of financial feasibility and debt capacity studies. Mr. Christy has also assisted in the preparation of a microcomputer health care financial model which is primarily designod to forecast the financial statements required in a formal feasibility study, Mr. Christy also has experience in working with large investment banking and bond counsel firms. His experience includes the assistance in the analysis of advance refunding of bond issues for hospitals and municipalities, Prior to joining Deloitte Haskins & Sells, Mr. Christy had a broad range of experience in accounting, personnel, cost and financial management. His experience includes taxes, financial statement preparation, analysis and design, profit sharing plans, manufacturing feasibility studies, budgeting and strategic planning, unit cost and pricing, and administrative management. Mr. Christy has also negotiated and obtained structured pricing agreements with major customers in order to ensure adequate returns on investment and has experience in the private placement of Industrial Revenue Bond issues. Mr. Christy is presently a member of the National Assoc'ation of Accountants. He has previously served as a director on the board of the Cincinnati Chapter. a tir I C/TYolDENTON,TEXAS MUNICIPAL BUILDING / DENTON, TEXAS76201 i TELEPHONE (817) 5668200 Office of City Attorney July 1, 1986 Frank S. Davila, Jr. Roger D, Nunn, M.D. 2408 Fowler 2621 Woodhaven Denton, Texas 76201 Denton, Texas 76201 J. Raymond David Genevieve Scott 705 Newberry Route 1, Box 30A Pilot Point, Texas 76258 Argyle, Texas 76226 David W. Finch Michael J. Whitten, President P.O. Box 2606 218 North Elm Denton, Texas 76202 Denton, Texas 76101 Harry M. McClendon, M.D. Ken Newman 521 Bryan Street 3100 Carmel Denton, Texas 76201 Denton, Texas 76205 James R. Killingsworth, Jr. Ph.D. 908 Kings Row Denton, Texas 76201 Dear Board Members; On June 19, we, the City Council, voted to approve the Flow Asset 'transfer Agreement with the stipulation that a letter be forwarded to all Board Members of Flow Regional Medical Center conveying our concern about the conflict of interest guidelines under which the Board will conduct business. These were of major concern to many of us throughout the negotiatiing process and we sincerely hope that you, as members, can appreciate our concerns, which may be summarized as two principles; k (1) No Board member abuse the public trust, and (2) That. No Board member should profit from his service on the Board As members of the City Council, we hold positions of trust and are prohibited from having any financial interest, direct or indirect, in the sale of any goods or property, to or from the Flow Regional Medical Center Board of Directors Ju y 1, 1986 Page 2 City, or in any contact with the City. For some of us, this has resulted in substantial personal sacrifice, While the new corporation is a private entity, it was created to insure that the public purposes of H.G. Flow's trust be maintained and that Flow Hospital would not become a for-profit institution. As the general public will not be privy to your decisions, and, as the laws which apply to public officials will not be applicable to your acts, the contract provision is the only mechanism to insure the continued public trust, For a board member to achieve personal financial gain as a result of his service on the Board would denigrate the very purposes sought to be achieved in the transfer. Therefore, it is our strongest recommendation that you voluntarily adopt and incorporate into your bylaws a conflict of interest provision which is similar to the one contained in our City Charter. Although such a provision is more stringent than that mandated in the recent contract, it would be in keeping with the goals sought to be achieved, Sincerely, Ray Stephens, Mayor City of Denton, Texas Mayor Pro Tempore Joe G. Alford Councilmember Mark R.Chew Councilmember Jim R. Alexander Councilmember Linnie McAdams Councilmember Jim Riddlesperger Councilmember Jane Hopkins 1 Flow Regional Medical Center board of Directors July 1, 1986 Page 3 m Judge Buddy Cole Commissioner Ruth Tansey Commissioner Bill Switzer Commissioner Sandy Jacobs Frank S. Davila, Jr, 2408 Fowler Denton, Texas 76201 J. Raymond David 705 Newberry Pilot Poillt, Texas 762SS David IV. Finch P.D. Box 2606 Denton, Texas 76202 Harry M. MCCIendon, %I, D, S21 Bryan Street r Denton, Texas 76201 James R. Killingsworth, Jr, Ph,D, 908 Kings Row Denton, Texas 76201 Judge Buddy Cole Carroll Courts Building 401 West Hickory, Room 612 Denton, Texas 76201 Commissioner Ruth Tansey 212 West Sycamore Street Denton, Texas 76201 Commissioner Hill Switzer 212 West Sycamore Street Denton, Texas 76201 Commissioner Sandy Jacobs 212 West Sycamore Street Denton, Texas 76201 Roger D. Nunn, M.D. 2621 Woodhaven Denton, Texas 76201 Genevieve Scott Route 1, Box 30A Argyle, Texas 76226 Michael J. Whitten, President 218 North Elm Denton, Texas 76201 Ken Newman 3100 Carme! Denton, Texas 76205 EMERGENCY AGENDA ADDENDUM CITY OF DENTON CITY COUNCIL July 30, 1985 Special Called Meeting of the Tuesd City of Denton City Council on ay, July 30, 1985, at 5130 p.m. in the Civil Defense Room of the Aunicipal Building at which the following item will be considered= 5130 p,m. 1, Consider approval of a Resolution accepting the Final Report of the Flow Memorial Hospital Task Force and the Flow Memorial Hospital Board and endorsing the concepts as set forth therein, 1 C E R T I F I C A T E I certify that the above notice of meeting was posted on the bulletin board at the City Hall of the City of Denton, Texas, on the day of 1885 at o'clock . 18600 F , r ~ 1159E 1 I R e 5 0 L U T I 0 N WHEREAS, in April, 1985, the Task Force on Flow Memorial Hospital convened and met regularly for several months to consider the issues confronting Flow Memorial Hospital, and to develop recommendations on how beat to feasibly address those iseuos; and WHEREAS, on July 16, 1985, the Task force on Flow Memorial Hospital and the Flow Memorial Hospital Board presented their Report and Recommendations to the city Council of the City of I Denton, Texas; and WHEREAS, the Flow Memorial Hospital Board has endorsed the Report of the Task Force; and WHEREAS, the City Council is desirous of accepting said Report; IVOW, THEREFORE, BE IT RESOLVED BY THE COUNCIL OF THE CITY OF DENIAON, TEXAS: SECTION I. That the City Council hereby accepts the Final Report of the Flow Memorial Hospital Task Force and the Flow Memorial Hospital board and endorses the concepts as set forth therein. SECTION II. That the creation of a Blue Ribbon Committee to oversee the negotiation of a lease agreement for the non-profit Section 501 (c)(3) Corporation is hereby authorized. The members of said Committee will be as finally determined by the City Council and the Commissioners Court of Denton County, based upon recommendations received by the Task Force. The number and qualifications of said members shall be as set forth in the Task Force Report. The duties of the Committee shall be to oversee the negotiation of the terms of a lease agreement between the City, County and the non-profit corporation and make recommendations to the City Council and County Commissioners in this regard with respece to the following issuesI (1) farm of the lease ('l) Protection of the aseeLS of the City and County (3) Obligations of the City and County under the terms of the lease (4) Consideration (5) Hospital and future indebtedneaj of Flaw Memorial (6) The degreo of authority to be rested in the non-profit, +§501 (c)(3) Corporation. Further, the Committee is hereby authorized to make recommen- dations, after careful stu.;y and subcommittee analysis, with regard to the issues of capital formation, admissions policies and manage- ment enhancement of the hospital under the non-profit corporation; provided that said recommendations shall be submitted on or before larch 1, 1986. Additionally, the City and County, by resolution, may charge the Committee with additional duties. The Committee is hereby authorized to act in the performance of their duties until such time as the City Council and the County Commissionere have approved the creation of said non-profit corporation and a lease document has been prepared. PAGE l 1 SECTION III. The City Council hereby endorses the following timetable for creating the non-profit 9501 (c)(3) Corporation: Activity Time Frame (1) Organize and incorporate pursuant to Immediately Tex. Rev. Civ. Stat., Art. 1396 (Vernon Supp. 1985). ('l) Obtain non-profit Texas Corporation 1-3 months exempt status according to Tax. Tax Code Ann. sec. 171.063 (Vernon 1982) and 9501~c)(3) of the internal Revenue Code. (3) Obtain Federal Employer Identification Concurrent Number and Medicare Provider Number. (4) Structure and Appointment of Governing L month Boards (5) Prepare management/lease agreement be- 4-6 months tween non-profit corporation, the City of Denton, and the County of Denton. (6) Select Chief Executive Officer 2 months SECTION 1V. The City Council authorizes the attorney for the Flow Memorial Hospital Board to initiate the procedures necessary to incorporate the non-profit corporation upon coordination with the City and the County. SECTION V. The Council hereby expresses its appreciation to the members of the Task Force for the dedication and tireless efforts they have shown in addressing concerns vital to the community and the County. SECTION VI. That this resolution shall become effective immediately upon its passage and approval. PASSED AND APPROVED this the day of r, 1985. RlCMM 0. , CITY OF DENTON, TEXAS ATUM CWLOTTE MEN CITY SERU CITY OF DENTON,,TEXAS M APPROVED AS TO LEGAL FORM; ' DEBRA ADAMI DRAYOVITCE, CITY ATTORNEY CITY /O~F, DENTON, TEXAS A PAGE 2 E 1 h ` FLOW MEMORIAL HOSPITAL f Balance Sheet March 31, 1988 ASSETS Audited September CURRENT 1988 1987 Operating Cash $ 367,960644 $ 176'942 Reserve Funds investments 176,434 75,191 Total Cash & Investments $ 5450002 $ 252,984 Patient Receivables $ 2,772,421 $ 31316,49? Leas Allowances (739,646) Total Patient Receivables $ 2,032,775 $ 21419,256 Other Receivables $ 188,339 $ 204,913 Inventory 918,249 427,926 Prepaid Expenses 305,804 138,084 Total Current Assets $ 3,490,169 $ 30043,163 PROPERTY, PLANT & EQUIPMENT Land $ 37,547 $ 37,547 Building/Improvements 31887,593 31887,593 Equipment 7 244 24A 7 UL32,9 $ 21, 69,388 $ 711078t469 Less Accumulated Depr (6,340.2.41) _.,(5,9588070 Net Property/Plant/Equip 41828,647 5,120,398 Total unrestricted Funds $ 8,31_.81616 Ljaj 6 . ,t,_ ..-gym ...e.. c.wr...~i Balance Sheet Page 2 LIABILITIES & FUND BALANCE Audited September CURRENTt 1988 1987 Current Notes Payable $ 438,238 $ 470,567 Current Bonds Payable 30,000 30,000 Accounts Payable 11132,858 .1,0381926 Fees Payable Accrued Payroll & Taxes 262,489 343,400 Accrued Bond Interest Payable 17,404 16,266 Reimbursement Due Medicare 411_,699 558,295 Total Current Liabilities $ 2r 292,688 $ 2,4571454 Long Term Debt i Deferred Income $ 46,218 $ 40,574 Long Term Debt 1,423,498 11423,892 Bonds Payable 330,000 330,000 Total Liabilities $ 40092,404 $ 41251,920 FUND BALANCE Donated Capital $ 41455,779 $ 41455,779 Pledgers & Gifts 10360,414 11229,420 Fund Balance Beg of Yr (21041,959) (42,491) Inc. & exp. Balance 452f.178 1 73.1 _06.7) Total Fund Balance 4,2N, 12 -1`6111641 Total Unrestricted Funds $ 81318,816 $ 81163,561 FLOW MEMORIAL HOSPITAL Statistical Statement March 31, 1988 Current Month Year-to-Date Prior Prior PATIENT UTILIZATION Actual Budget Year Actual Year Adult Patient Days 938 806 1795 5851 10333 Average Per Day 30.3 26 57.9 32.0 56.8 Average Stay 6.0 6.5 5.9 5.7 5.6 l Discharges 181 124 29.8 101.9 1848 ICU Patient Days 63 47 71 332 485 Average Per Day 2.0 1.5 2.3 1.8 2.7 Psychiatric Pat Days 283 217 354 1744 1600 Average Per Day 9.1 7.0 11.4 9.5 8.8 of Occupancy 332 288 458 358 449 OTHER UTILIZATION Operating Procedures 110 60 119 539 684 "mergency Visits 557 5~0 747 4042 5010 La,cratory Tests 5161 2800 8417 30565 53620 PER ADULT PATIENT DAY Gross Pat Revenue $1175 $1020 $812 $1030 $868 Net Oper Revenue 858 735 549 704 454 Operating Expense 827 839 574 749 634 Income From Operations (3) (104) (25) (72) (137) LABOR COST MANAGEMENT FTE Employees 160.1 135 244.0 159.2 276.8 FTE Per Adult Patient Days 5.3 5.2 4.2 5.0 4.9 FTEu Per Adjusted Patient Days* 3.9 4.0 3.1 3.8 3.7 Payroll as a 8 of Total Expenses 39.7% 39672 43.18 38.98 42.8 *Total FTC - Patient Days - (Inpatient Revenue - Total Revenue) FLOW MEMORIAL HOSPITAL Comparative Analysis - Accounts Receivable March 31, 1988 Aging by Discharge Current 8 of Prior of Date Month Total Month Total 0- 30 $ 11071,671 38.5 8 $ 1,130,971 41.2 8 31- 60 678x340 24.4 4870060 17.7 61- 90 257x765 9.3 268,380 9.8 (r-~ 91-120 140,011 5.0 207e748 7.5 121-150 133,798 4.8 161,074 5.9 151 t 502,6.0.4, ]Q~9... 492,546 _17.9_ $ _ 2y784,191 100.0$ $ 2,747,779 100.0% Revenue by Financial Current Class Month 3/88 2/88 1/88 12/87 11/87 10/87 Medicare $ 547,825 49.78 49.7% 51,7% 48.38 52.68 40.0% Medicaid 57,876 5.3 515 4.7 2.4 6.6 7.0 Blue Cross 29,652 2.7 3.5 4.7 5.1 2.3 3.6 Com Insurance 296,502 26.9 19.7 2211 28.0 19.2 26,3 Self-Pay 123,712 11.2 18.7 12.4 16.2 19.3 23.1 County _A.4. $ 1,102,005 100 % 100 % 100 % 100 % 100 8 100 % nays of Revenue in Current Accounts Receivable Month 2/88 1/88 12/87 11/87 10/87 Gross 74 82 102 102 104 91 Net 80 85 95 95 84 71 WRITEOFF9 & RECOVERIES Current Month Year-to-Date Charity Bad Debt $ 18,928 $ 31017A2 $ 161,683 $ 1,023,913 Bad Debt Recoveries $ 31,009 $ 221,312 DRG OUTLIERS Current Month Year-to-Date Number of Discharges over $18,000 3 17 FLOW MEMORIAL HOSPITAL Statement of Revenue & Expenses March 31, 1988 ACTUAL BUDGET PRIOR YEAR Inpatient Revenue Routine Services $ 221,900 $ 170,745 $ 438,578 Ancillary Services 95 8,462 461,643. Q03,338 Total Inpatient Revenue $820,362 $ 632,388 $ 1,241,915 Outpatient Revenue $ 281,643 $ 189,71-6 216,42 Total Patient Revenue $1,102,005 $ 822,104 $ 1,458,390 1 Deduction From Revenue Contractual Adjustments $ 119,195 $ 115,671 $ 264,000 Charity 71391 - - 21,500 Other 39,267 61892 - - Bad Debts 130,248 155,916 2:,3 500 Total Revenue Deductions 96;-8-1 $ 27 ,787 ; 9 Total Net Patient Revenue $ 805,203 $ 550,317 $ 93214,48 Other Operating Revenue $ 38,322 $ 42,500 $ 53,543 Operating Expenses Salaries & Wages $ 336,756 $ 268,555 $ 444,576 Benefits 53,334 48,612 81,909 Supplies 114,151 83,018 132,957 Fees-Physician 27,302 27,302 37,969 Fees-Other 86,514 70,224 96,592 Utilities 28,787 24,000 16,662 Repairs & Maintenance 18,226 14,400 161422 Leases & Rentals 18,236 16F400 11,805 Insurance 28,110 24,000 25,898 Interest Expense 17,018 111040 13,641 Other Expenses ..47_,_612Q• ---•-~1~`i~ Total Operating Expenses $ _7761451 ~_,61 291 962F976 Operating Inoome (loss) $ 67,474 $ (18,474) $ 23,015 Depreciation Expense $ (720016) $ (65,640) $ (68,046) Non•Oper Inoome/Expense $ _ . $ 580 Contributions $ ' Interest Income General 21242 2,800 531680 Other income Total Non-Operating $ 2t2 42 21800 $ 57 810 Excess of Rev over Exp $ 20) 12 9 FLOW MEMORIAL HOSPITAL Statement of Revenue & Expenses YTD Through March 31, 1988 Actual Prior Year Inpatient Revenue Routine Services Ancillary Services $ 1,379,859 $ 2,522,175 Total Inpatient Revenue $ q199 _5,238 995 - Outpatient Revenue $ 7,7-6 Outpatient Patient Revenue $498a O Deductions From Revenue $__e,g73,300 Contractual Adjustments Charity $ 1,031,494 Other 71391 $ 11880,000 Bad Debts 154,303 3831510 ) Total Revenue Deductions 7LZJ07 77,119 I $.119051995 - $ 4' 28y441.,~- - ,1........J_ . Total Net Patient Revenue ~-2Q`'U_4 ~4., X9.1.5 5 4 Other Operating Revenue $ 261,642 $ 449,315 Operating Expenses Salaries & Wages Benefits $ 11859,256 $ 2,803,640 Supplies 353,649 419,433 P008-physician 593,804 794,745 Fees-Other 163,812 276,309 Utilities 588'212 892,683 Repairs & Maintenance 186'758 198,384 Lease & Rentals 97,339 101,850 Insurance 99,174 89,390 Interest Expense 112,993 93,390 Other Expenses 78,133 88,256 Total Operating Expenses $`-2A~'b1S 8 6`1 U,. 5, 7.6- Operating , 74 5 Operating Income (loss) $ 4 3 r~""~" Depreciation Expense $ 2'891 $(1,033,147) 426, 785 ) Non- (370,538) 0 er Income/Expenses Contributions Interest Income-Qaneral $ 100 $ 590 Other Income 7'571 32,955 ' Total Non-Operating ~ -000-- ---JU4151- Excess Of Rev over Exp $ 1' 83` 777 ' -,---r $(1,324,55990 M COPY WY ofDENTON,rOXAS MUNICIPAL BUILDING/ DENTON, TEXAS 76201 / r LEPHONE(817)?82.9601 January 81 1987 Mr. Slake Fortenberry Plant Engineer Flow Memorial Hospital 1310 Scripture Denton, 'texas 76201 Dear Mr. Fortenberry: With ti," transfer of Flow Hospital the City of Denton Electric Department plans to either put all security lights as shown on enclosed drawing on security light contracts or transfer lights to Flow, The two lights at the mein entrance cannot be put on a security light contract since they are connected behind the meter and to connect them on the utility side would be extremely difficult and expensive. If Flow wishes to maintain its own security lighting, all existing Scriptur.: facilities would 16, 18ft& 21), In three lights on three security lights on Scripture, there is also three street lights and the Electric Department does not wish to be involved with split ownership. The electric service to the lights would be disconnected and it would be Flow's responsibility to reconnect the service, At this point, all ownership and responsibility would be transferred to Flow, If Flow should oh sign seourit ht contracts, the curre ost is 1 3 r light, f 24 1 ghts, for a total 0 247,20 per ma zac I would aotu recommend that some li a e a on down as being unnecessary, The lights that I would recommend be numbers 16, 180 210 31, 28, h 9. By these six lights the monthly bill would be roduced t 185.4 ease note, if you should decide you want them ey would be reinstalled at no additional charge beyond the monthly fee. The security light contract does include a rider which will make Flow responsible for Flow Page 2 paying for replacement of poles, For these charges electricity to the security light would be provided by The City of Denton, and the Electric Department would be responsible for maintenance, Regards, tr/' v /I 5~~~ ~ Donald L, McLaughlin Senior Electrical Engineer FLOWLTtvw oot Ernie Tullos Director Electric Utilities , rM1 12-Ai'1'RONE M MU U OF NO Mfr 160 1987 C°rr o - er tem 21A, New FSsployees, Kenneth Scott Irick, Crewman for R&D Pct..l, di ion ecobs was absent due to a computer seminar in Austin, Motion by Comm. Tansay, second by Comm, Jacobs to approve the minutes of November 16 as emended. Motion carried 3.0, I'M #22-Mme AOF1i]1 rnm No action. rM #23~0 BUSDUS ~ REPORTS & nw0r#0.TWN Judge Burgess presented a flag donated by Senator Glasgow, state of ',Vexes, and a Certificate of Presentation. Comm, Jacobs stated that she will make a statement after Executive Session regarding Flow Hospital, COMM, Jacobs also questioned where we Stand on cleaning for the CHOS, 17M #21-MMMMW Motion by Comm.T ay, send by Umm Jacobs to adjourn into Executive Session pursuant to Article 6252-170 Sec, 2 rat Litigation (a) for Items A & B Notion carried 3.0, A) PROW LMGATTON - Denton County vs, The City of Denton, at al, Judge Burgess read for the record the order to transfer assets to Flow Memorial Hosppital to the Non-Profit Corporation, Motion by Comm. Hill, second by Comm, Tansey to approve the Resolution to order the transfer of assets to Flow Under discussion, Comm, Jacobs read Memorial This recthe ordnherostateemmentrasifollowae many Payers uincluding tohe pep tAl been difficult and arduous process, the County Commissioners Court have worn different membershats and City ed uncfl end individual roles, Now we are facing a contract that in principal may look good on the outside but after a throe I am concerned that in our hate ttoi eiithe causes ve Flloowi HHoospitalingot out of the hospital business altogether= or find the best solution to this problem for the majority of cur taxpayers (dep"ing on which roll we as individuals play), we may inadvartantly make an irresppoonnsible decision by approving this coniraot Y of these same players believe Flow Hospital would go under year and that this contract is the only savi by the lot of the accepting the fact that neither the City of Daantomn or tja Flow HospittaaldBoarrdd would consent, in writing, to obtain proposals to sell the hospital, Now can we honestly. say we have depleted all our alternatives when two our of three participating parties would not even Secondly' I am eonoarned that tt ere to nose nfliet of f~erest clause in this contract, This creates the awkward possibility of any new volunteer non. profit 'hospital pital board membar suspect of making personal gains, I wonder who will part of this issueey~s watchdog after their elected officials are no iongnr a Last and most important, I'm concerned about the Count Ta he or she gains frw this contract. This contract says the County will give or transfar all of Flow Hospital assets to the now non y y~ and whet Payment in return, Flow Hospital a profit organization with no e aisar last year that has estimsted t~value t ofithhee hospit 1 ibetweeennasixdand eleven million dollars. What troubles me most is that we are transferring the taxpayers asset while keeping possible future liability in outside debts that cou drr~ into the thousands, new hospital non-prof t board me mbeer makis no es any direct or iindirect l hope not one the It pera fran their position, I hope the majority of the County Taxpeyare feel theygggot deal we could offer them. No one has a crystal ball, Only time will tall ionlyoahistory 3.111 JJidge Burgan jssvoting in favor, Comm, Jacobs voting o", (Documentation follows) PACE 5 OF 6 • DECEtW 70 1987 218) L14T=CN - Mellon Stuart vs. Denton County - Case 0-87-271-CA Attorney Jim Allison reported that this law suit pertains to the construction of the Denton County Law Enforcement Center and Jail. This action has been filed by Mellon Stuart (contractors) against the County. This fili g alledgea numerous actions by both contractors, Willow Products (Architectural) and Mellon Stuart. Mellon Stuart can only sue the County because they are the only party that the County has entered into a contract with. The County has absolutely not failed any duty that the County is required to perform in regard to the construction of this project. We have filed, on behalf of the County) an answer to the law suit absoluteey denying that the County has failed any duty. The County has also suffered losses and damages. The County has retained sane portion on the contracts prices of both contractors. We have been unable to negotiate a settlement at this time with both parties. Mr. Allison recommends that the County, in addition to filing the denial to Mellon Stuart, file a counterclaim against Mellon Stuart f0r the damages that the County has suffered regarding this project. We will also file a cross-claim against Willow Products for damages to the County that they have caused. And further file a cross-claim against Willow Products and the Architectural Joint Venture for indamnity and segregation, which is an action to require those parties go forward and defend their actions. And they respond in damages as a result of their actions. Motion by Comm, Jacobs, second by Comm. Tansey to authorise Attorney Jim Allison to respond to take these actionst file counterclaim against Mellon Stuart, file cross-claim against Willow Products, and file a cross-claim against the Architectural Joint Venture. Motion carried 3.0. Motion by Comm. Tense y, second by Comm. Jacobs to adjourn until Monday, December 14, 1987, at gam, Motion carried 3-0. PAM 6 OF 6 ~ DECOM= 7, 1907 MIN #4-BUOCEr AKEMLWr/JP PCr, 1 Fl.. 1 Comm. Tansey requested to pull this item because there was no back up material for the reasons why they needed a cash register or why it was caning Ho,)-Departmental Unappropriated Contingency, gg doer rotes'IbisspurChasw uild impr ve register, and in his budget. Cann. Tansey suggested to find funds anywhere but in Unappropriated Contingency, and pit back on agenda next week. Motion by Comm, Tansey, second by Come. Walker to table one reek, Motion carried 3-0, Irm OiNDiGEm CARE wmA7~ PROmm & ALmryr C pR0mu&s 'attorney Jim Allison came back. to the court with a report requested by Comm. Jacobs, Mr. Allison reportedi no preparation for the Indigent Health Care Program are such that Denton County can assign them to inhouse staff. Mr, Allison dos not anticipate that the county will need much services from outside council or outside experts in order to get the matter underway. The court can count on inhouse, and call for council as needed, (3) Three things the county will need to do by January 8 in order that the transfer of Flow Hospital will get accomplished in order to be prepared to undertake the Indigent Health Care Program as a county rovided 1, complete contract negotiations with the mandated pprovidersgr i 2, designate and train staff for eligibility and claim review (this will became the county's responsibility) (a) receive applications and refer them eligibility, making recom- mendatione for review on eligibility of individual programs, (b) review claims from hospital, making sure they are appropriate services, and that they are at the appropriate hospital resident (as designated by the Department of Human Services), There are training programs, coordinated through the Dept. of Human Services. 3, specify procedures for verifying eligibiity and notify public, Mr. Allison suggggests to publish a notice, at least once, that eligibilty applications for. Indlgent Health Care Program may be obtained and filed In whatever office you will place it in as of January 81 1988, impiemeenttitsaresteps above sponsibilitieslund a theprograammpas accomplished trab the nsfer count on January order , 1988. Ire contract calls for payment after rates are designated by the Department of Hunan Services; The Act suggests this rate, it does not mandate it, If in the futuro, Denton County is entitled to state assistance (IM counties), you can not pay more than the state mardated rate. will have hospital Is rates thatS' OHS h saapproved. The Act pro deshfospi orr (3) options to the countiesi I Can 2, Can selectsole a nuummbber of provider providers 3, Can have no mandated providers Jim Allison stated that the Act says the public enrfty (public hospital) closes, transfer, is sold, or leases that public hospital, the entity shall provide services tlat the public hospital was required to provide at the tlme it was sold, leased, etc, regarding Arhatsservicesethe~countysiskto provide, through the attorney general Comm, Walker suggested to have the employee(s) that will be screening applicants should be placed under the County Judge, Mr, Allison stated that the determination of eligibility for Indigent Health Care services or for any other programs such as Medicaid, WIC, etc,, should be determined by the scroeningg employee(s), if the applicant is approved for indigent care, the county will need employee(s) to review the claims, requesttofnComn,CJacobs, and'for second b Rob Morris Lo rev ew to contract. The motion includes for Judge Burgess and Rob Morris to coordinate with hospital representatives. Under discussion, Jim Allison stated under section 5,01, the rates era set for each individual hospital. There will be soma slight differences in races. Motion carried 3.0, (Doormentation follows) PACE 2 Of 6 • OECE fM 14, 1987 Be it remembered the Commissioners Court of Denton County, Texas met on this 14~n day of December, 1987 at the Courthouse on the Square with Judge P, rgess presiding. Comm, Jacobs waa absent due to illness, Comp, Tansey, Walker, Hill, and Deputy Clerk Jeryl Barton were present when the following proceedings were had to wit; IM 42-APPROVE MCNVlM OF NOYEMBE'R 2,1 & DECEMBER 71 1967 Motion by Comm Tanseyy, second by Comm, Walker to approve the minutes for November 23, and December 7, as written, Motion carried 3-0. r1FM i3-APPROVE BU IS Auditor James Wells presented the court with five (5) additions to the bill report as followsm -Out of General Fund to- 1) Jackie Prater Contract labor in voter registration for $520,00. 2 Marilyn Kesseler, Contract labor in voter registration for $520,00, -Out of Water Study Fund to- t) Espey, Huston and Assoc,, October linter Study Services for $10,319.75 ) -Out of Courthouse Renovation Fund to- 2) Window Fashion Schneiderraetpssco,j Installation delet edmmf rom the bill requested rt, ill Th s9 bill isofor cchamber d esr ofComm,eTansey E felt that chamber dues shorld not be paid by the county, they are a per =al expense. The bill amount is for $50, Motion by Com. Tansey, second by Comm, Walker to approve the bills as amended, Motion carried 2-1, Comm, Hill voting "no", Comm, Hill's reason for voting "no" is that he objects to the payment of the additional bill under Courthouse Renovation Fund to Monroe Schneider & Assoc, for the floor covering contract. (Documentation follows) rITM A-17- CONSDIT AGCNllA Motion b Comm. Tansey, second by Comp. Walker to pull Item i41 and approve the balance of the Consent Agenda as followst 5 approve budget amendment from Non-Departmental Unappropviated Contingency to Commissioners Court for Contract Labor for $2,000, 6) tha rove specs & Denton County Probation t& Juvenile oDefor tenti Detention Facility-Bid 011.87.130for 0. 7) approve Preliminary Plat of Hlghpoint Varms Subdivision in Rd8 Pct. 1, 8 Approve Preliminary & Final Plat of Sturat Decote's Subdivision in R&B Pct, 1. Ibis is not in the ECJ of any city/town, NO ROADS, 9) approve Preliminary Plat of High rndustrial Perk in R&B Pct, 3, 'this is not in the ETJ of any city/town. Road & Road name approval needed fora Mesa Butte Ct. 10) approve appointment to the Board of Trustees for the Denton County Mental Health/Mental Retardation Canter, 11) approve request from the Denton County Republican Executive Committee to use the Colony Government Canter (Court Roan) as polling locations for the March 8, 1988 primary election, 12) approve request to formally record the Historic Ceremony for the Court- house on the Square, Saturday, November 21, 1987; this will include a video recording of the entire ceremony, copies of the Prayer of Dedication, program, Invitation, spaechs, coam norative coin, snap shots, ther to mark 13A) a prove ICA withptherCity of Pilot PointtAmb lancerServiceeion, 138) approve ICA with the Town of Trophy Club AaiLulance Service. 14A) approve ICA with the City of Hickory Creek for road work. 15) approve allocation of temporary space on the 6th floor of the Carroll Courts Building, 401 W. Hickory, Denton Texas, for exhibit storage- District Clerk's Office, 16) approve request from Mr. Roger N. Wilkinson, ROW Agent for the City of Denton, to begin street paving plans and ROW survey for Woodrow Lane adjacent to property lwned by Denton County-R&B Pot, 1, 17) approve request from the Southwestern Bell Telephone Company to born Motion ncarriArvin Hill ed 3.0, (RDocumein R&A ntation Pet. follows for all items above) PALL 1 OF 6 . DM MM 14, 1987 t I March 6, 1987 VIA HAND DELIVERY Honorable Vic Burgess County Judge Honorable Ruth Tansey commissioner Precinct one Honorable Sandy Jacobs Commissioner Precinct Two Honorable Lee Walker Commissioner Precinct Three Honorable Don Hill Commissioner Preoinct Four Honorable Ray Stephens Mayor of the City of Denton Honorable Jim Riddlesberger City councilman Honorable Mark Chew City Councilman Honorable Jim Alexander City Councilman Honorable Joe Alford City Councilman Honorable Jane Hopkins J City Councilwoman Honorable Linnie McAdams City Councilwoman Re: Flow Memorial Hospital Ladies and 0entlemeni We, members of the Board of Directors of Flow Regional Medical Center, Inc., a non profit corporation, believe that it March 6, 1987 Page 2 is in the best co interest of Flow Memorial Hospital, of the new rporation, and of the City and County, as the hospital's owners, to address urgent and fundamental questions concerning Flow Memorial Hospital. As you all know, Flow has reached a crisis of great proportions. Unless action is taken immediately to adequately fund Flow Hospital, to reorganize its operations, and to restore to Flow the confidence of the physician and citizen community, Flow Hospital will fail. It is not necessary that Flow Hospital fail, and it is within our judgment both financially and politically feasible to save the hospital. The purpose of this letter is to reiterate why we believe Flow Hospital should be saved, emphasize the circumstances which make Flow's salvation feasible, explain to the best of our ability the immediate consequences to the City and County of Flow's failure, and set forth those steps which we believe to be absolutely essential to give us, and `low, a fighting chance to succeed, Why Keep F~ o ~1 It would take a treaties rather than a letter to explain in depth the reasons to keep Flow Hospital operating as a non-profit corporation. We list the most importanti 11 It is a first class facility with modern up-to-date Mast physicians a withtwhomdweghaand ve talkedt agree othatfthe employees. of health care received b quality at at Flo Hosital is outstanding. Moreover, therepi sian tremend usw reservoir of community support for the hospital. most of its Flow has an employeesn will have $6,693#000 outside closes of seek employment If the City of Denton and probably outside of Denton County, Neither the City nor the County can easily afford the loss of a business of this size without feeling its effects on the local economy and ultimately upon tax revenue. 31 Nationally non-profit hospitals charge rates that are twenty-five percent (25$) less than for profit hospitals. Flow's rates are seventeen (17%) to twenty percent (20$) lower than its for-profit competitors. The cost of health care in Denton County will rise significantly if Flow closes. A healthy Flow Hospital with lower rates for its services is a plus in recruiting industry to Denton. March 6, 1987 Page 3 4. Without Flow the continued development of low cost health care plans in the County is in great jeopardy. The Denton Independent School District Preferred Provider organization (PPO), for instance, benefits greatly from 'the existence of a non-profit hospital. The existing physicians PPO could not even gat the for-profit hospitals in Denton to negotiate until Flow came forward with an offer. 5. Flow Hospital is the logical place to provide much of the indigent care in Denton County. Flowle lower rates and substantial discount for indigent patients meano that feeder tax dollars will have to be spent on indigent care. 6. Decisions concerning Flow Hospital will be made by local citizen board members not absentee owners, and will be based upon the health planning needs of the community, not the investment needs of a for-profit corporation. 7. Flow will help maintain a community where physicians can practice without conflicts of interest. 8. A healthy Flow Hospital will enable the community to avoid dependence upon the ailing hospital chain industry. Any profits generated through operating Flow Hospital will be plowed back into the hospital for the community's benefit, and will not be sent out of state to support troubled chain hospitals, to finance hospital chain acqu!sdtions, or to-line the pockets of hospital chain owners. Can Flow Succeed? Some have expressed doubt that the base of support exists for Flow to succeed, even if appropriate assistance is given by the owners of the hospital. We believe Flow is viable for the following.reasons. 1. The physicians of the City and County will support Flow Hospital if the political turmoil of the past can be laid to rest once and for all. The most critical factor in assuring the success of Flow, or any hospital, is physician support. The physician rather than the patient determines which hospital a person is admitted to in nearly all circumstances. Physician support for Flow Hog &I has eroded over the years, and in recent months the erosion has grown to an avalanche of physicians who will not admit paying patients to Flow Hospital. Two principal reasons contribute to the loss of physician support. I i March 6, 1987 Page 4 First, physicians perceive, not entirely incorrectly, that if they remain on the staff at Flow Hospital they will have to take c re of an unacceptable number of indigent or otherwise non- 1- ying patients, second, the for-profit hospitals are playing hardball with the physician community and insisting that physicians admit virtually one hundred percent (100%) of their I paying patients to the for-profits. Since man exclusively on referrals from other physicians for nstheir business, physicians fear that if they use Flow Hospital the for- profits will out off their referrals, if Flow were the physicians as viable, and thus as a resource forrreferrals through its medical staff, the latter would not be a problem, We believe that once the physicians understand that Flow is viable and is going to survive many will come back. successfulurapr s nt manage tment not team highly professional and nationwide basis. We are impressed with theiroexpertise and comjudpgment the are well able environment that exists guide Flow in the 3. With virtually no exceptions not-for-profit hospitals are the only hospitals in the nation to achieve excellence, The City and County of Denton desire excellence. They will never achieve it if the only remaining hospitals are solely for-profit operations whose principal function is to make money for absentee shareholders, 4. We believe that if the owners choose to con-cinue Flow Hospital under the circumstances outlined in this letter, Flow will be able to borrow sufficient capital for future growth, ~onseuuences of ~~os~nA Flow Before turning to the conditions which we believe must be met for Flow to remain viable, we think that you should be aware of the consequences if Flow should close, 1, The City and county will be obligated to immediately pay approximately $3,174,000 (current accounts payable $1,7 million, contractual obligations $638,000, bonded indebtedness $3900000, accrued expenses $416,0000 minimum salaries due to close down financial operations $31,000). Additionally, the hospital has long term debt in the nature of leases for major equipment in the amount of $10 million, bringing the total indebtedness to $8,074,000. On the current asset side of the March 6, 1987 Page 5 ledger the $ hospital has approximately $2,575,000 475,000, net accounts receivable $1.8 million, (Current cash other assets $300,000). Dash value of 2. The responsible or bodies would have to arrange for indigent health care political body through existing for-profit facilities at higher rates than or with charged by plow. hospital buildowners nd wsensitiface the business medik ep on the until it could be sold or otherwise disposed of, equipment profit hospitals W uthe ld likelytraise rategplow, the existing for. S. 350 the community, fobs and a payroll of $6,693,000 will be lost to 6. Virtually all health care dollars in the county will go to outside banks and outside vendors, immediate Hosnir~i use While it is difficult, to quantify the economic loss to the community from the closing of Flow Hos ita2 that its closing will cost the County and Citwe sincerely believe dollars over the next decade, A prellmina y $20 to $40 million these economic consequences is attached as Exhibit itAn, Moreover, an existing facility with highly analysis outlining employees providing top notch health care willllabefforever willing What will it take for Flow Regional Medical Center, Inc. to take over the operation of the Hospital and at the same time represent to the owners and the have a fighting chance for survival?liWetbelieve thepfollowing are absolute minimum requirementst 1. An immediate infusion from the owners of the hospital of $1.5 million dollars in cash. relieving Flow ion of the obligations Proposed lease agreement by revenues for indigent health care for ra vide a percentage of its eriod of hteen (10) months from the date the lease is implemented, eiDuring this period Flow would provide indigent health care for 80t of its standard ohargrts paid on a monthly basis. M March 6, 1987 Page 6 3. Provision by the City of Denton of free city utilities to the hospital for a period of eighteen (18) months from implementation of the lease. 4. Funding of the nurse-midwifery other than the hospital or, alternatively, c los ng the program. 5. Agreement by the owners to retire the existing bonded indebtedness, or, if legally permitted the hospital will pay the indebtedness as it becomes payable according to its original terms. We recognize that this analysis will require the owners to pay a great deal more money than was anticipated a few short months ago. The failure of the owners to fund the hospital from October of 1986 to the preseni has greatly exacerbated an already critical economic situation. We, or any other proposed owner or lessor of the hospital cannot continue operations without an immediate infusion of capital of at least $1.5 million dollars, An attempt to operate Flow without such an infusion of capital simply will not succeed, and will only prolong the economic agony of this institution. As originally contemplated the nonprofit corporation was to purchase the assets of Flow Hospital out right. As part of the negotiation process and in conformity with~the requirements of the Texas Constitution that public property not be sold for less than adequate consideration, the non-profit corporation agreed to pay off the $390,000 bonded indebtedness. When the Attorney General of Texas made clear that that proposed transfer would face a long and expensive court fight, the contract was renegotiated into a long term lease arrangement. During negotiations the owners of the hospital insisted that the new corporation agree to pay the bonded indebtedness. Although we did not think that to be a fair arrangement in a lease situation, we nevertheless agreed to do so some six months ago. The financial condition of the hospital has deteriorated to such a point, however, that It is no longer economically feasible that the hospital pay off these bonds. We simply do not have the resources and do not feel that we can represent to the owners that the hospital can succeed if it must pay this indebtedness upon assuming responsibility for the hospital. requirem ntu to provideeighteen oars moratorium indigent she lth month upon nciour ty March 6, 1487 Page 7 utilities to permit us a window of opportunity to get the hospital rejuvenated, increase its census, build physician support, and do the other things that are for the long term survival of the insti u ion,to be necessary talking about an 80 year lease arrangement that willsince stillwbeain effect after we are dead and gone, this eighteen (18) month moratorium seems to us both reasonable and necessary. Finally, the nurse-midwifery program must be funded by other sources, governmental or private. The hospital sustains a $28,000 per month loss to fund this program, We simply cannot afford it given our present economic circumstances, we all b one elieve the nurse midwifery program to be an extremely valuable whi cannot in should be preserved for the community. However, we can fund tgood conscience represent to you, the owners, that we program under our present circumstances. If the program cannot be funded from other sources we, as directors, would be compelled to terminate that program in the interest of saving the hospital as a whole. We have no about that respective bodiesi1lFlow Hospital tin an Basset of extreme valueto the City and County. As citizens and tax payers we cannot afford to close it. Unless the above conditions are met, however, we cannot in good faith represent to you that Flow Regional Medical Center, inc,, a non-profit corporation with no resources other than the dedication of its board members, can take control and manage the hospital with any hope of success. We feel time is of the essence in this matter. if something is not done promptly the hospital will have to close, For this reason we suggest to each of the owners that a joint session of the City Council and the Commissioner's Court be convened to discuss the matter, invite public comment and act upon our proposal., Unless the matter is resolved and we are able to take the dcontr ays we see no pointpin a thirty our forty-five (48) positions. We know that the burdens of your office are great and that you must make difficult decisions concerning allocations of scarce tax funds among many deserving needs. This letter is our effort, as persons selected by you to serve on the board of a non-profit corporation, to give you in unvarnished form our best assessment of this situation, We stand ready to assist you in every way in reaching this diffioult decision. r March 6, 1987 Page 8 Sincerely yours, Michael J7tt4nj Carman en Newman, V/ce C a rman v a -Ties R. K $lin sworth, retary - Treasurer RogA D. Nunn, M.D., Director 0e11MV eve Scott, D rector F nk Davila, D Moto r" J. Raymon David, Director Dav W, Finch, D M or Frt 4 , EXHIBIT "A" Page I of 3 MAJOR COMMUNITY COSTS OF LOSING FLOW HOSPITAL The loss of Flow Hospital poses profound economic and social costs for Denton county, This preliminary analysis shows only the readily available economic impacts of shutting the hospital, But even these direct estimates show a loss of enormous magnitude, rrrrrrrrrrrrrrrrrrr rrrr rrr rrrrrrrr rrrrwrrrrsrrrrrrrrrrrrrrrrrn,r rrrrrrr F' ~t IClosure natG The closure of Flow would incur major- costs or Payments, Contracts, Bonds) and has been conservatively estimated at $3,174,000, A One-Time Closure Expenditure of 12,174,0Q0,00 FI, &712i=&Dl Flow Hospital currently employes about 350 persons with about S10% residing in Denton, If these 315 local residents Join the 3200 now unemployed in Denton, the unemployment rate rises from 9,596 to 10,4%, A. TWU estimates of the effect of institutional salaries upon the local economy used a multiplier of 3 to deter- mine the effect of salary loss upon the community, If current annual wages are $ 6,693,429 and 90% of the employees livo in Denton, then wages amount to approximately $ 6,024,086 per year. Annual Wages $ 6,693,429,00 Estimated 90% in Denton 6,024,086,00 Times Multiplier of 3 $18,072,258,00 Direct loss of wages (at current 118,072 258 00 per year inflation and outlay levels) B. Other basic expenditures for the hospital are projected at and annual level of $ 6,276,423,00, If 90% of these other expenditures are spent in Denton, then approximately $5,648,781,00 remains in town in the form of "other expen- ditures, Using the TWO multiplier for other expenditures fixes the impact of this expenditure at $16,946,342. If only 60% stayed in Denton, the other expenditure figure would be less (see below), t 90%tayi in Penton At 60°a stayin in Denton $6,276,423,00 x .90 r $6,276,423,00 x ,60 - and $5,648,781,00 x 3 r $3,765,6and 54,00 x 3 r Tot Impact al Other Expenditure r $16,946,342,00 gB_X11,297 5~ 61,00 per year EXHIBIT "Arl -Page 2 of 3 Page 2, III, hospital e1they spend into the As persons accompany visitors of Flow patients are from economy, If evenel0~ of the average of $30,00 per day om out of town diture Impact is as followson gas, food, etc tho total ViasitoreExpen~~ ; Flow Patients Per Day; Multiplied by 365 days 63 per day, Assuming 10% Out of Town 22,995 At $30.00 2,300 Per day Times Multiplier of 3 $69,000,00 per Year $207 000 00 p-9Y YA,~ EY TO TN i S pn r ~r,• ' Qne Time Clo rr these costs can be offs~r $3 174,000,00 cannot be avoided although liquidation of hospital eventually by whateve assets, r i3 recovered from the Employment, Other amount to $9,858, 940~ppenditure, and Visitor Expenditures Live of the before the multiplier using the foegone r rises to $29,576,820.00~ns above, After the muItiplier~srhis cons much of the $29 576 820,00 might simply migrate to figure in the Denton area and hence stay in the loc other hospitals al economy? If a rising consus at por-Profit hospitals led to a rising level of employment, perhaps as much as 1/2 of the Flow reduce on the books of other hospitals (a conservative estimate). This would reduce the lass of local institutional payroll would show up addition all but institutional of the al Payroll to about If, in by For-profit Expenditures$wereBAbso~bed area hosp $14,602,110,00 itals, then the actual loss would be $3,174,000,00, per year in addition to the about one-time COSt of One-lima n L $3,17Q, Allnuel ros s imatA 000,00 $19,502,,000.00 NbCe EXHIBIT "A" Page 3 of 3 ' UN-r L~ PA; 1EA^'cTHE AnGSr DD~1Cy4~w V ~ Jos P: Tn, away. The Problem al Cggj§ " Un-funded patient care will not simply go away. The m will merely migrate from Flow Hosptiai to the neigh- :Poart: oinc For-Profs hospitals, When funded indigents (S,B.1) and No-Pay ients (i,e , the total Flow Bad Debt) begin to make use of the area -Profit hospitals in Denton, insured patients and paying patients at those facilities will pick up most of the tab. The For-Profits would have to pick-up the costs for those not covered f ^ by the indigent care obligation imposed under S,B. 1 and not meeting other tests for governmental programs--just as Flow hospital has paid for un-funded Patients in the past, Not only 'are the rates at the For-Profit hospitals purported to be higher than those at Flow at the present, these hospitals would also have to raise their rates to accommodate the new direct costs brought by unfunded patients formerly going to Flow, If current charge structures and patient mixes are accepted as given and coupled with reasonable For-Profit profit margins, the impact of the approximately 1100 Un-Funded patients on local For-Profit hospitals would lead to a rate increase in the neighborhood of 29%. It is unreaslistic to assume that this price hike would be handled by reductions in staff or service cuts at the for-Profit hospitals in the area, Employers AfP~ctPd The effect of a price hike at local For-Profits to off-set the impact of No-Pays formerly handled at Flow is considerable, Not only would it directly affect the health care costs of patients, it would also lead to a ripple effect on Denton employers, As their premiums rise, either they would have to up prices to deal with the effect of rising health care costs or they would have to scale-back the benefits they can offer to their employees. Not only does this affect the ability of area employers to compete, it would lead them to send patients to less expensive health care providers in the Metroplex--hence putting a still greater cost squeeze on the local health care economy. Conc- 1---usi.on , Finally, since the rates at For-Profit hospitals initially were above those at Flow, the effect upon the cost of indigent care (S,B, 1) will be intensified by the new rate increases at the For-Profit hospitals to off-set the impact of the 1100 Un-Funded Flow patients, To the extent that the assumptions above are valid, it might be expected that For-Profit starting prices, rate increases and additional indigent care costs (S,B,1) would add perhaps an ad- ditional X1,204 000 00* on to the cost of Un-Funded Patients in Denton annually, *Without using the TWU multiplier for Denton, rM #7-0ONr'D Comm Walker stated we are trying to establish services for people in the South part of the County for Animal Control becasue they pay taxes too, Come, Hill commends Judge Burgess for taking on the responsibility for the budget. I as a County Commissioner do feel it is some responsibility of mine havingeno taxoInca vote reases tastfarlasa1987-88, fhave made my recommendations. Even though the Judge has already cut $2 million dollars from Elected Officials requests, ),feel there is more do be done, I will stand by my position, and vote "no" for the adoption of this budget, Comm. Tansey commends the Judge and Staff on the budget, It was done in a business like manner, We all expressed through budget hearings our likes and dislikes. We all worked to get a goad document for the whole County. I do not think that $500k is going to cover our portion of responsibility for indigent care. I will vote for this budget because it is a fair budget. Motion carried 4-1. Comm. Hill votes "no", f/-\ Judge Burgess stated this his recommendation for an Increase to Elected Officials is partially based on the fact that there has been no increases in the past three years for Elected Officials, I! 1711N /8-ADOPT TAR RATE Motion by Comm, Jacobs, second by Como. Walker to adopt the tax rate based on the ..$100 evaluation for Denton County for the tax year 1981-88 as follows: $,20331 for the purposes of maintenance & operation, .$,02210 for the payment of principle and interest on the debt of this county, for a total tax rate of $,22541. Motion carried 4.1, Coma, Hill votes "no", Judge Burgos votes in favor, Comm, Tansey stated this percentage includes the $50k deduction for over 65 exemption, ITEM /9-WARTT1tLY REPORT reports, statistics) and a npopennh use, he activity accepted, and case total inquiries for the end of the calendar year June 30, Ms. Wiley stated the small sliding scale fees have increased. There are three types of cases which the Center cannot collect fee on such as employee- employer Center has haddonedcourtnrefe al which will address SB 1436 which pich gives divorce. he Judges the right to refer cases particularly in custody and visitation issues. SB 386 was Introduced for small counties to help fund their pprograms, All the small programs in the State of Texas has already initiated the $10 filing fee, Motion by Comm, Jacobs, second by Cann, Tansey to accept the presentation. Carried 4-0. rr>N 110-DISPUM RESOLUTION WhU Motion by Comm, Tasney, second by Comm, Jacobs to approve resolution in reoo 1987flnition of Dispute Resolution Week In Texas, September 27 - October 3, Motion carried 4-0, ITM Y12-EXEXxTTIVE SESSION Fbtion by Comm. Jacobs second by Corm, [Jill to ad ourn into Executive Session pursuant to Article 6152-17, Sac, 2 re: Litigation (el, Carried 4-0, MH !12(A)- T9_~10M dRXVI 'MIN A) PF]~Ifk?'1"CCATION•Denton Co, vs, The City of Denton Jim Allison reported that he has received' Correepondenca from the City concerning possible settlement on certain issues but the proposal is unclear. The proposal involves some type of transfer to a kl(c)(3) tax exempt corporation. The proposal clearly incorporates a provision that the new corporation, with whatever is transfered to it, will not assume any obligations for present liabilities to Flow. There is no indication in this proposal that the Flow Board of Directors has, or will consent to this transfer, The City and the County agree that sane change is necessary, The Flow Board of, Directors does not agree. We have not received any correspondence from the Board of Directors indicating any willingness to cooperate in the change of rid ownersh County,eandaFlow Board ip structure n the Directors to engage{~ ini any chnngew of will sttrucuture• Cl Tna only way, to %make this change without the consent of all three bodies is litigation, QONT'D PAGE 4 OF 7 - SErEPBFR 21, 1987 ITEM 112(A)-MAD Mr. Allison stated if this was done without the Hospital Boards consent, there would still be some problemsu (1) If the proposal is to make a transfer of assets only from Flow to n new Corporation Board without any liabilities, this would constitute an ' unconstitutional transfer of assets by both the City and the County, both would be barred by the Courts and the Attorney General. (2) If you transfered all the assets and held all the liabilities, this Would be an unconstitutional act between both the County and the City, (3) If you did this without an unconditional agreement to assume responsibility for these liabilities, you would prompt litigation from present creditors of Flow. Judge, Burgess reported that he has contacted the President of tho Foundation to see if they could meet, but the President did not see any urpose in meeting, Come, Jacobs motioned to respond to the City in writping stating all the legal concerns that Mr. Allison mentioned about their latest proposal and request any necessary clarifications about their offer. We will continue to persue obtaining information about the Flow Soundation including the bylaws and the charter to aid in the crisis that we now have at Flow Hospital today, A letter will be sent to the Flow Board as Judge Burgess suggested, Corm. Walker seconded the motion, Jim Allison stated that the Flow Board of Directors is responsible for initiating effort to resolve this problem. We cannot directly meet with the Board, we can only meet through their counsel or a negotiating team. Motion carried 3-2. Comets, Tansey and Hill voting "no", Judge Burgess voting in favor. 11V #118-Ci10S Ward Bogard reported the CHOS subcommittee met and discussed a number of things such as the cornerstone to be put on south side of CHOS. The Mr. Bogard also discussed wf.oia date a for should put He suggested cornerstone. to have the opening before everyone moves in. The Commissioners agreed. The Commissioners discussed to have the approximate date on November 14th or 21st. The entire opening will be coordinated by the subcommitte. The commemorative coins, which will be for sell, will be $2560 for 1500 coins with a 50'2 upfront deposit. Motion by Comm. Walker, second by Comm, Jacobs to approve ordering coins from Kearley and Company for $2560 for the CHOS opening, Motion carried 4-0. Mr. Bogard reported they are in the process of drawing tip specs for furniture for the areas that are not covered with TDC furniture that we already have, 11IN 111B(1)-+Ifl.F.!' "W SY51'F]d end bid to cour oeAmeri anumComnuunications Ebids xchangeeforr altotalapricrec e of § 59022.09 installed with SMDR for billing, This bid has a one year warranty and is lowest and best bid. Motion by Corm. Walker, second by Comm, Jacobs to approve Purchasings recommendation and award bid to American Communications Exchange for $25,022,09 being the lowest and best bid. Motion carried 4.0. 1'f FM 1113-pcr. I IN S 01M1l'CI£ MIErm See separate paper on the Committee rwating. "M #3.OUMT'B APPRM BnU Motion by Comm, Tansey to pay at least 50% as documented and accepted by the Auditor as payment to Flow Hospital for Indigent Care, Comm. Hill secorxiad the motion. Comm, Jacobs stated we do not have documentation in front of us, We have the Auditor that goys it has been checked. The summary sheet that we do have only includes the $781k of recent indigent care requests and does not include the original,;200k,which we do not have documentation for that area. Motion carried 3..2. Comets. Jacobs and Walker voting "no", Judge Burgess voting in favor, PAGE 5 OF 7 - SEP'I' MER 21, 1987 Sept. 28, 1987 OCT ^ 61987 CITV~YN E,- c irsc~wcg Denton County Commissioners 212 W. Sycamore St, Denton, TX 78201 h Dear Commissioner, The Denton County Commissioners Court ruprosents over 200,000 Individuals In Denton County. 1 wish to address our current crisis with health care in Denton County and Flow Hospital from a perspective different from the usual, "Flow - Yes or No?" question. A.L1 attention has focused around the indigent care fiscal responsibility of the political entities Involved, but l am asking you to broaden your focus at this time. We have a desperate need to asseso the health care needs of all the people in Denton County - insured and uninsured - and unite to meet those needs. It is said that we have too many gouts care in-patient beds In Denton County. T agree, but a hospital - if allowed to - can provide more than just in-patient care. The resources are here at Flow Hospital, and should be channeled to provide what is necessary for our citizens. However the question remains, "Flow do we know what to do, if we don't even know what we need?" To the beet of my knowledge, there has never been a thorough assessment of the health care needs of our county. We are blessed with two universities that are filled with highly qualified people. Let's use those resources and assess the overall health care needs of the entire county and work towards the goal of meeting those needs. Money could be spent to subsidize a graduate study at one, or both, of the universities, This certainly would cost lose that simply closing Flow Hospital! The students could work to most their degree requirements and contribute to the growth oe the county. We, in essence, would integrate our resources and achieve a goal for the common good, U r ~z- I recognize that this in a commitment to innovation, but why can't Denton County be innovative and be firut to qjr tte rather than one of that last to comply? AFter• all, aren't we one of the Fastest growing counties In 'texas? Ono of our problems is the entire population of medically Indigent, not Just the Indigent defined by federal guidelines. The entire indigent population is not a Fiscal responsibility by the letter of the law, but we in Denton County are facing this problem, and it must be addressed. However, the health care noeds of all citizens of Denton County - both North and South - must be addressed, not Just the indigent population. We all 3 have health Caro needs. 3 ! Perhaps the public hospital can be tailored to moot the needs identlflod by the Assessment. Our community health experts tell us that we nand an extended care Pnollity In our county. This would necensitate some initial expense, but It in as necessary a function as repaving roads. Some Individuals In the south part of the County say that they don't use Flow as an acute care facility, That may be true, but what dAQ they require in health care services - a clinic, health screenings, health education programs? Why couldn't Flow's resources and personnel work to meet those needs? Obviously, this would not pimply be a proJect of the hospital. It would require a ocunty-wide effort, To summarize - I am asking that, as an elected body representing the whole of Denton County, you make every effort to assess the health care needs of the eltizens, and systematically work to meet those needs rather than simply acting and reacting to the trines we face dally. Sincerely, Linda Ashmore 2018 WontQood Denton, TX 76206 co: U.S. Sen. Phil Gramm i U.S. Sen, Lloyd Bentecsn t U. S, Nap, Dick Armey State Son, Bob Glasgow State Rep. Jim Horn State Rep, Ben Campbell Lewisville City Council Flower Mound Councll llghland Village Council w7v~1 C/r'Y COUN0C, l 1 t'. 1 I i HOW 1310 Scrl lure Slrec P 1 MEN ORIAL 1400 'ITAL Donlon, TX 76201 (817) 3875861 August 31, 1987 The Honorable A. Ray Stephens Mayor of Denton 619 Ridgecreat Denton, Texas 76205 Dear Mayor Stephensr I am writing to remind you of the expiring terms of three city appointees to the Flow Memorial Hospital Hoard of Directors. On October 1, 1987) the terms of Don F. Holt, J. Stanley Monroe, and Mary Henderson Williams will expire. Please notify me or Mike Whitten of the appointees' names when they have been selected. Thank you for your attention. Sincerely, Chard e Linton Chief Executive Officer ktp cc: Michael J. Whitten, Chairman Board of Directors t i~ FRDW 13 10 Scripture blrect MEMORIAL HOSPITAL Denton, Tx 76201 (817) 387.5861 September 1, 1987 HAND DELIVERED TOt The Honorable A, Ray Stephens Mayor of Denton The Honorable City Council City of Denton 215 East McKinney Denton, Texas 76201 Dear Mayor and City Council Members: As you are aware, the nurse-midwifery service and obstetrics and nursery departments at Flow Memorial Hospital will close as of midnight on Thursday, September 3, 1987, Duo to this change, the City/county appropriations requested in the Flow Memorial Hospital budget for the fiscal year 19871988 (submitted to you earlier this year) will decrease from $2,039,474 Co $1,859,474, Sincerely, Charles Linton Chief'Executive Officer CBL/ktp i cc: Board of Directors Flow Memorial Hospital OE04111~N~ CITY of WNTON OKWON, TEXAS 70201 MEMORANDUM DATEt August 19, 1987 TOt Lloyd Harrell, City Manager FROM$ R. E. Nelson, Executive Director of Utilities REt Meeting of the Flow Hospital Medical Staff-August 18, 1987 At the Flow Hospital Medical Staff Meeting, Mr. Litton -advised the medical staff that the hospital had made $37,000 in July which is in contrast to the losses that had been experienced in previous months. He advised that he was not certain that this profit could continue since two additional doctors had moved their obstetrics practice to Westgate, He reported that this would only leave the midwife program at the nursery in the hospital, and therefore, it probably would not pay to keep the nursery open. Stanley Monroe advised that there would be a Hospital Board meeting Thursday, at which they would review the profitability of the various services being provided at the hospital. Litton expressed that it appeared that the County would not be willing to participate in any efforts to support Plow Hospital other than indigent cared therefore, any support for Flow Hospital would have to be from the City of Denton. Litton and several doctors expressed that it was imperative, if Flow is to remain open and viable, that someone would have to provide some financial backing to assure the stability of the hospital. Several of the doctors expressed that Flow should remain open, but that unprofitable services should be terminated and that the hospital provide only those services that are self-supporting, thereby reducing or eliminating the need for any financial support other than indigent care. Litton and others expressed a concern about the medical support staff such as nurses and lab personnel were actively seeking positions elsewhere, and that if some decision about the support of the hospital was not reached fairly soon, many of the support staff would be leaving Plow. Many expressed the concern that some resolve needed to be finalized within two weeks or the support staff may be gone. Z-'~ R. E. Nelson, Executive Director Department of Utilities gar 501OUt10 CITY of VENTGN,7EXAS MUNICIPAL BUILDING / DENTON, TEXAS 76201 / TELEPHONE (817) 6888307 0!1109 of the city manager M E M 0 R A N D U M T0: Roy Appleton, Jr, FROM: Lloyd V. Harrell DATE: July 200 1987 SUBJECT: Proposed Brochure for Neighbors United for Health Roy, generally I think the brochure is very well done, it should be a big help. I do have three specific suggestions which you can use as you see fit, First, I think the paragraph at the top of page two is a little weak once you get past the first point. I would suggest wording which would be similar to the following: On August 8, you will be asked to decide the fate of the Denton County Hospital District, It is an important decision. You must ask yourself, "Is it worth nickels a day to care for our less fortunate? Nickels a day to guarantee the continuation of important programs such as Meals on Wheels and the respected midwife program? Nickels a day to insure the existence of a public hospital and thus keep down the rates of other Denton County 'for profit' hospitals? Nickels a day to control our own system of health care and to show that we care and take care of our own?" i Secondly, under the myth/fact section, I would suggest the following wording for the first fact answer, Fact: State law requires the ballot to read "up to seventy-five cents per hundred dollar valuation", However, a proposed budget has been offered which will require four cents per hundred dollars, about a nickel a day for the owner of a $50,000 home. Proposed Brochure July 20, 1987 Page two Finally under the final fact answer, 1 would change the phrase "left the City and County failing" to read "left the City and County unable". Please use these comments as you see fit. Hopefully, they will provide some help. oy arre City Manager sj 3SS2M R 201 THOW 1310 Scrlpture 6Street Dc(817I387 5861 (l MEMORIAL tiosPITAL t, r ? I - a ~sas t May 26, 1986 Mr. Lloyd Harrell city manager CITY OF DENTON 215 East McKinney Denton, Texas 76201 Dear Mr, Harrell: I am forwarding to you herewith the Fiscal Year '986•ag Management Plan (Budget) for Flow Memorial Hospital, approved by the Board 1 of Directors at: their regular meeting on Thursday, May This budget Court s and being County delivered Auditor. the Denton County C Should you wish to discuss any aspect of the budget, please feel free to contact me at 817-383-6400. Sincerely, David D. Yode~ Acting Administrator ktp enclosure cct Mary Henderson Williams Chairman, Board of Directors Certified Mail OP 555 811 896 s FLOW 1910 Scripture Street MEMORIAL HOSPITAL Denton, TX 76201 (817) 3878861 1cm1 N7 ell May 8, 1987 iiu Mr, Lloyd Harrell City Manager CITY OF DENTON 215 Bast McKinney Denton, Texas 76201 Dear Mr, Harrelli We appreciated the opportunity to meet with you and Mr. McGrane to review the financial status of the hospital, As a result of our discussion, we wish to propose the following repayment schedule for the hospital's utility bills which currently total $170,599,30 (October 1986 through April 1987)t 1) Beginning with the May water reading (June invoice), slid all. monthly billings thereafter, we will pay such monthly state- ments by their respective due date, 2) In August 1987, we will begin repayment of the past due $170099,30 in seven installments, each of which will represent one of the seven months' services. We regret that this re- payment cannot begin until this date, but due to-our current commitment to fund our malpractice insurance expense of $62,500 in June and a $30,000 payment on the Bill-Burton bonds in July, this is the soonest that our cash flow will permit. However, this proposal is contingent upon the Council's approval of interim funding, If any questions arise, do not hesitate to contact me. Sincerely, G:_t ~ t David As Nowiski Chief Financial Officer DAN/ ktp cel Mr, Charles Linton .S `t I ' r ITEMIZATION SUMMARY FOR FLOW MEMORIAL 1986 BILLED PAYMENT BAL. DUE October 0271248.73 $25,149,31 $ 69,121.19 I` November 26,755.89 33,793.51 62,083.57 ~ ( I December 25,039.19 -0- 67,122.76 i 1987 January 24,726.23 189,36 111,659.63 February 25,232.81 -0- 136,692.44 March 8,287.18 -0- 145,179.62 April 33,482.01 -0- 178,661.63 May 21,941,48 -0- 200,603,11 June 21,877.73 -0- 222,480.84 July 26,711.52 21,980.73 227,211,63 August 251726.33 26,708.15 226,229.81 September 25,902,45 25,738,25 2260394,01 2844F 10/06/87 i I CITY of VENroN, rexAB MUNICIPAL BUILDING / DENTON, TEXAS 76201 / TELEPHONE (817) 5668100 MEMORANDUM ( DATEt October 30, 1987 TOt Debra A. Drayovitch, City Attorney FROMt John F. McGrana, Executive Director of Finance SUBJECTS FLOW HOSPITAL As you are aware, there has been significant activity in the past week regarding the Flow Hospital situation. As of today, I am aware of two offers for resolution of the situation, One, from the current management group, Hospital Management Professionals, and the other from the State Attorney General's Office. Both offers require that Lite hospital remain open. After reviewing the offers to the extent possible, I believe that the City has several options which are as followst OPTION 1 Pay a share of $1.2 million ($40U,000 for indigent care and $b00,000 for cash flow) to K.M.P. and transfer the assets of the hospital to a 501(c)3 Corporation. 1 am assuming tnat the most the City will be liable for if this option is exercised would be a maximum of $b00,000. This could be funded by utilizing the $250,000 previously budgeted in the 19b7-bb budget, plus $350,000 from the unappropriated balance of the Ueneral Fund. This would reduce the General Fund Balance to a little over 1.1 million dollars. If this option is exercised it still does not address the issue of indigent care. Memo to Debra Drayovitch October 30, 1987 Page 2 OPTION II The second offer of resolution was proposed by the State Attorney General's I~ office. It is my understanding essentially that their proposal is to keep the hospital open, and that the City and County must make a financial commitment to keep it open or else they will file suit. The suit would request that a transfer of the assets of the hospital to a 5U1(c)3 Corporation and would also request a judgment against the City and the County for $1.5 million to pay off outstanding liabilities. It is my understanding that if a judgment if rendered then the $1.5 million could be financed through judgment bonds. If the pay back period was between lU and 2U years for those bonds, the debt service requirements would range from approximately $75,0UU to $11U,000 per annum depending upon the length of those bonds. Once again, this option does not address the issue of indigent care, UPTION III (Uity to pick up portion of the hospital's long term liabilitie3.) A. The City would refinance the current outstanding debt that was issued by thik hospital in 1975. It is my understanding that there is $360,000 of outstanding debts still due on the 1975 issue. The maturity dates of those isaues vary from 1991 through the year 2UOO. It is also my understanding after discussions with frank Medanich at first Southwest Corporation, that both aeries bonds became callable after July 1, 190. IT R l Memo to Debra Drayovitch October 30, 1987 Page 3 My suggestion would be to re-finance those bonds with a twenty (2U) year maturity at an eight (8%) per cent interest rate. If they were sold at that time and rate, the annual debt service requirement would be approximately $36,000. The advantage to this option would be to spread out the payments over a longer period of time and to consolidate the debt which has a heavy principle repayment schedule at the tail end of the bonds. B. The City would also commitment itself to the payment of some of the long term lease payable obligations that the hospital board has entered into. It would be my suggestion that the City would either re-finance through Certificate of Obligations these lease agreements, or to make payments on the current leases. I would suggest that the City be responsible for the following leases: total Outstanding Current Lease Balance Monthly Payment IBM System 38 $242,064 $5,463 Inter-Mountain Software 1 127,081 30211 Inter-Mountain Software it 14U,8hO 30211 Decision Data E 133 U1.2. 21911 TUTAL 5643 b '2 These lease purchase agreement mature at various times in 1991, If it could be worked out by our bond counsel so that the City could refinance this, we would possibly be able to issue Certificates of Obligations. If not, the City could then make the annual lease payments would amount to $177,792 on an annual basis. It would also be my suggestion that at the expiration of the lease/purchase agreements that they hospital, if it is in a financial position at that period of time, purchase back from the City, these capital items at their salvage value, Memo to Debra Drayovitch October 3U, 1987 page 4 C. Defer payment balance of current outstanding utility bills to July of 1988 and then begin pay back based on a contractual agreement. Currently, the outstanding utility bills for Flow Hospital are approximately $252,000. Under the cash flow projection that the hospital has submitted to us, it appears that in July of 1988, the cash flow situation for the Hospital Improves. It would be my suggestion, then, to have the hospital and City entered into a contract whereby beginning in July of 1988, that the Hospital pay $361000 per month for a seven (7) month period of time to extinguish the outstanding utility bills. It would also be part of the contract that current utility bills would be kept up during that period of time and thereafter. RECOMMENDATION It is my recommendation that the City explore the possibilities of option Number Three. This would have several advantages not only to the City but also to the County and to the Hospital. However, the City is making a substantial up front commitment bytakinghey over $360,000 worth of outstanding debt liabilities, $643,000 worth of longterm lease liabilities, and delaying payment on $252,000 on past due utility bills, for a totnl of $1025U,000. Since this is a substantial commitment from the City and thereby, before a commitment to exercise this option, I would propose that the County make a commitment to be responsible for indigent care for a period of five (5) years. In addition, 1 would also expect the Hospital to explore the possibility of the Foundation either acquiring the additional assets that are under lease purchase and the current Items that have notes payable on them. Memo to Debra Drayovitch October 30, 1987 Page 5 This recommendation has the advantages of relieving the hospital of a substantial amount of their current liabilities and portions of their long-term liabilities, It establishes a commitment from the County for indigent payment for a set period of time. It allows the transfer of the assets to a 501(c)3 Corporation and keeps the hospital open. If I can be of any further assistance in this matter, or if see any problems with these options, please advise. i ~if~ ~ % /rte' ~y/ C✓''''L•,J~ n F. McCrane Jr'McGtaf 2925E ya Dear r'riend of F`.oH i,,,spitII Because of your interest in Flan, you art, no doul,t alaitV,irr of thn iuiai,t flow's financial difficulties ~tiav h1WO on the NIII'Sr -MidwIfrri Srrviie,, tain Iy no one oil the flow Board wants to closo tlir tlurSo-IIIWOI'r tu•akl)"Im hul in order to decrease Flow's riontIII deficit, tluy liavt~ found it met)ss,irv to find other sources of fundiml to keep ,I1d pri±klr,nu open. A group of interested citizens has respUn(if. d to tito sired the hoard ns;+rrsr<<i for funding alternatives, toriq-tei~n answers heino t x\omined itiv Poundol ion funding and affiliation with tfie developing Penton Countti, Clinic projetA scheduled to open in the fall, in the short term, this coirniitttte h,is Slit up ii dumber of opportunities for Denton CountianS to contribute to tha tVuiso~MidwIrt+ fund; many churches have made their congr gotions awaro of the niod ii huoth at Golden Triangle Mall is giving out information aboul. Iho prosIvelm find poss- ing out envelopes for donations to be made; contributionq are hero.) rerr!ived at a special account set up at first State Bank. The $28,000 presently needed to subsidize the program each mouth Is ii challollilt, that can only be met if all of those who believe. in How and in sevvicus Ilk) the Nurse-Midwife program give their support, Nvaso givu as goiufrnusly ai: ynu can to this project, Tell your friends, neighbors, and colloniinoti at work about the need. If you belong to groups than. would allow ii spodor to Como to make a presentation on the need (from 5 minutes to a full progrnm, dopundintt nn available time) and pass out proaddressed cavelopos, ploaso cell ono of OuI persons below, Thank you for your help and for al T the support you have givon to flow Ilo';; l l,nl through the years. Elinor Hughes Dorothy Danilco 'idril Ciiroy 387-2867 382-;1327 i,66.i161`17 I a; 4Vr April 16, 1987 11 ' r1 APR 2 lg97 i i Dear Friend of Flow Hospital: Because of your interest in Flow, you are no doubt already aware of the impact Flow's financial difficulties may have on the Nurse-Midwifery Services, Cer- tainly no one on the Flow Board wants to close the nurse-midwife program, but in order to decrease Flow's monthly deficit, they have found it necessary to find other sources of funding to keep the program open. A group of interested citizens has responded to the need the Board expressed for funding alternatives. Long-term answers being examined are foundation funding and affiliation with the developing Denton County Clinic project scheduled to open in the fall, In the short term, the committee has set up a Number of opportunities for Denton Countians to contribute to the Nurse-Midwife fund; many churches have made their congregations aware of the need; a booth at Golden Triangle Mall is giving out information about the program and pass- ing out envelopes for Jonations to be made, contributions are being received at a special account set up at First State Bank, The $28,000 presently needed to subsidize the program each month is a challenge that can only be met if all of those who believe in Flow and in services like the Nurse-Midwife program give their support. Please give as generously as you can to this project. Tell your friends, neighbors, and colleagues at work about the need. If you belong to groups that would allow a speaker to come to make a presentation on the need (from 5 minutes to a full program, depending on available time) and pass out proaddressed envelopes, please call one of the persons below. Thank you for your help and for all the support you have given to Flow Hospital through the years. Elinor Hughes Dorothy Damico Sara Carey 387-2867 382-3327 566-8682 THE FLOW HOSPITAL NURSE-MIDWIFE PROGRAM-- What It Means To You WHY THE NURSE-MIDWIFE PROGRAM FOR DENTON COUNTY? To provide professional prenatal care and hospital deliveries for those who cannot afford to pay the full cost of health care. At present they deliver about 60 women per month. OUR TAXES TAKE CARE OF THAT, DON'T THEY? Not really. A person making $448.33 a month or less--or a couple making $603.33 a month or less--may be eligible for some form of government help, but what about all the others. What about those whose incomes are a little higher, but they have no money in the bank and can't afford health insurance? What about the people who have been laid off and lost their insurance? Flow's patients without insurance jumped from 17.48 in 1984 to 32.58 in 1986. The Nurse-Midwives charge according to a sliding scale. JUST HOW IMPORTANT IS PRENATAL CARE? Very. Prenatal care eliminates problems by catching them early. Prenatal care gives babies the best opportunity to grow up healthy and productive. And for the rest of our community this care transl- atrs into many tax dollars saved in medical costs, custodial care, special education, institutionalization, even law enforcement and prisons. WHAT' ARE THE ALTERNATIVES? Without the Flow Nurse-Midwives many women will receive no prenatal care. They will have to "drop-in" during labor at one of Denton's hospitals and hope there is a doctor there willing to care for them. These deliveries will be much riskier. More babies will need cost- ly intensive care. The county, state, and federal governments will pay only what they are required to pay. The uncovered costs will be a burden to Denton's hospitals. And this burden will certainly be reflected in the rising charges for all hospital patients. All of, us can expect rising insurance premiums as well. WHERE ARE WE NOW? Because of Flow's serious financial problems, the hospital's Board of Directors has said it will close the Nurse-Midwife program unless the community can give $28,000 by April 23, You can help save this cost-efficient and much needed program, by sending a contribution today tot Flow Memorial Hospital Nurse-Midwife Program First State Bank Box 100 Denton, TX 76202 r; C-• ROW `131 6i ripuu~ Snrr~ MEMORIAL HOSPITAL DI'llt n,• TN 7mz 01 (8 17) 383-0,127 NOTICE OF AVAILABILITY OF CHARITY CARE Under its Hill-Burton obligation, this Hospital will make avail- able a reasonable amount of Uncompensated Services to a person eligible under the applicable Poverty Income Guidelines as issued by the Department of Health and Human Services. M-11-Burton charity care will be available for all hospital services on a first request basis to an eligible person needing care who are unable to pay for such services until the facility's annual compliance level is met. In order to qualify for Hill- Burton charity care, your family income cannot be more than that indicated for your family size. Size of Family Family Unit Income 1 $5,360 2 $7,240 3 $9,120 4 $11,000 5 $12,880 6 $14,760 7 $16,640 8 $18,520 *Vor family units with more than 8 members, add $1,880 for each additional member. To make a request for Uncompensated Services, please contact the Ilill-Burton Representative (first floor Fospital Business Office) or call 383-6427, A written determination of your eligibility will be made within two (2) working day's of your request. FM N 147 pg. 2 1 c. i FLOW MEMORIAL HOSPITAL PATIENTS APPROVED AS COUNTY INDIGENTS JANUARY 21, 1987 THROUGH MARCH 11, 1987 Admission Discharge Name Date Date Service Charges Moreno, Sergio 01/28/87 01/29/87 OB $ 1,964.81 Moreno, Infant 01/28/87 01/29/87 Newborn 290.95 Venable, Tammy 02/02/87 02/08/87 OB 4,424.72 Venable, Infant 02/02/87 02/02/87 Newborn 2,208.00 Escamilla, Raul 02/23/87 02/28/87 Surgical 5,745.21 Solis, Rosalva 02/17/87 02120187 OB 21151.03 Solis, Infant 02/17/87 02/25/87 Newborn 11970.41 Adams, Linda 03/04/87 03/05/87 OB 952.87 Adams, Infant 03/04/87 03/06/87 Newborn 184.20 Goortz, William 02/13/87 02/13/87 ER 111.10 Zimmerman, Shells 02/04/87 02/08/87 OB 3,924.76 Zimmerman, Infant 02/04/87 02/08/87 Newborn 561.20 Deeds, Jimmy 02111187 02121187 Surgical 7,329.51 Henderson, Arlene 01/21/87 01/29/87 Medical 8,941.93 Henderson, Arlene 02/03/87 02/03/87 ER 336.25 Henderson, Arlene 01/31/87 01/31/87 ER 321.75 Henderson, Arlene 02/05/87 02/10/87 Medical 8,289.47 Nabors, Nannette 02/18/87 02/18/87 Outpatient 476.25 Nabors, Nannette 01/23/87 01/23/87 ER 234.65 Nabors, Nannette 01.121187 01/21/87 ER 171.25 X50,590.32 1 kw D , Ur INIL 81LL DATE ADMITTED OATS DISCHARGED PAGE NO, r IFC) PATIENT NUMBER %1 WL PATIENT NAME I D--.. OCT- OA _ DIAGNOSIS 1 INSURANCE CARMER BILL GROUP NUMBER POLICY NUMBER T0: LJl.'... , Y NOTICE: TO AVOID PAYMENT OF % LSTATEMENT PAYMENT PATMTNr MAM AFiFfl , FEES % ANNUAL PEACENTAOE RATE), YNT MUST TNLS BATE WU BE MADE IN FULL WITHIN DAYS ODATE. APHARONNIX? STATEMENT .&Qig;;3rd!`a,Sl+Or,W1~'Sx7R1~I~M''~~1 1 IRS N0. , DATE AOMIT7Ep _ DATE DISCHAROED PAGE No. ._r_~_ 'V`ir•~.I I IFCI PATIENT NUMBER ~un.v ~l i PATIENT NAME DOCTOR 7 DIAGNOSIS INSURANCE CARRIER BILL 1) ti I OROUPNUMBER POLICY NUMBER ' I IJ 3 J0 4' i v t l I„ j I I I I I r:av~ r~raLS ~i~ cuD ~•II;;~;_W I pAyMENT j U: AYED FEETICE: TO AVOID ANNUAL ERCENTAOE RATE). ~YOuRLPAYMENT M I I' 111, UST iw9pilMµml' w . , IRE MADE IN FULL WITHIN DAYS OF STATEMENT DATE. APPS 0NNEfRBtAttm(Nt ~ .I,~,y Fil{etrilH?~i•D, ru .'•hilr r.... b, . , •,vr f w • ..:i~)..4.IYIMW.III.K~y~ll/~11~yA/n'R~iOVV~t~MMTIR~~ UETAIL BILL J SAS NO . DATE ADMITTED DATE DISCHARGE PACE NO, (FC) _ PATIENT NUMBER - +'•~\r\, air PATIENT NAME • ! ! - / , DOCTO._._•--._R DIAGNOSIS y INSURANCE CARRIER BILL GROUP NUMBER POLICY NUMBER 7 1 l ru J + t I I' ' I 7 T ~ 4 V ~ ) ~ r M1 1. J ~ ~ . ~ 4 S ~ . ' l A ' i r• ~ a TC FEET)CE, TO°b AAVOID PAYMENt OF NNUAL PERCENTAGE RATE), ppAY DELAYED A PAYMENT MUST AYYAMENT MA Ar1EA HE MADE IN FULL WITHIN DAYS OF STATEMENT DATE. APTDATEWKI PFAB0NNjXr8rAr(MtBr i ;Mll- !LL ? 1 f V f Z ? : DATE AOMITTLO DIVE 06CNARCCO I PACE N0. !FC) PATIENTNU M RER PATIEAT NAME DOCTOR DIAGNOSIS :Z11 )<_I` :ji? ~~l j y INSURANCE CARRIER L CROUP NUMCIER POLICY NUM RER BILL TC: :1"%jr14 JI +11AItY " I-""~' I I r r ~ i i I I wI. ~ »~;rJ Ir''~ }.JO1~ v_ 7Yr,1 .h 7 327 141r3 Jyr•;•I I 71.a 511%tJ2r tia~r P3~ tirar:: f j I I t1 4 T)1A6S JF) 9747. I~ 1~JJ'std%qI'S .v: ~~ra:JrS .:il r _ I `(OTICE: TO AVOID PAYMENT OF ^o DELAYED PAYMENT PAYMEMMANAIRR ?EE I b ANNUAL PERCENTAGE RATE{, YOUR PAYMENT MUST IHI Olt WI xT SIAI6NEN1 E MADE IN FULL WITHIN DAYS OF STATEMENT DATE. T~ r ~ iDILL . IRS NO UATE aD1411TTE-_D - - OAIE DISCHARGED I PAGE N0. iFCI IIATIENi NUMBER PA71EN7 NAME 1 -~----~Y aaONosls I 1 I BILL - ? 1 J ; ,I ChOUP NUMBh INSURANCE CARRIER LoLVCY NUMBER ~a TO: 1 1 ~ I 1) ..I I i 1 _ 1 1 r I 1 I ,1i is t .J}~'_r Iflllf 11 j ;11 {~71r1~( I I 1 'i 'IYJa r'•I}-~It 1- I: / 1 I I I V Tl~d, f) - J , vr. 'Ifis'Jf', IJ~ NOTICE; TO AVOID PAYMENT OF IEE ( A ANNUAL PERCENTAGE RATE 1. YoUpLPAYMENt MUST iNl9 MADf TEA 7E MADE IN FULL WITMN A DAYS OF STATEMENT DATE A...PHAA . BYNEXrSfAtlMENI~ is ;,FIJI: i- ui: I~ DATE ADMITTED F. t P DATE DlSCHAHOED AAOE NO ' ' I / > + . u I r (F C) PATIENT NUMBER + r. ` 1WrlVV pq } 700 CIO_.. N DLAONOSIS r 19.',IJ I f INSURANCE CARRIEq 1 B1~L ~ ~ ; ; ! •I ,I + I ,f 1 f ~ROUPN UMbCR TO: t ? : - - J L N V :1 c / ;I POUCY NUMBER ~_rraJ, 'c r>~ti - - - - - - - - - - - - . ' I ' i.1gJ,~J 2 i'r > Ili1f,:Y :J r 1 I I r ~t I +i 3 ~f a}JJ".i I:VrS fTJCE; TO AVOID PAYMENT GF E PERCENTAGE % DELAYED PAYMENT PATM(Nt MADE AFUR .+MADE IN IN FULL LL WITHIN ANNUAL THIN f7ATE), Youth PAYME/ 11 MUST Ims bAtt gill ~ % • 1'-" DAYS OP STATEMENT WE. APPtAA tWNENt SiATIM[NT ' t. u..o r+!AVi~~k t4.•°a'~Rri 'r!d~bll' y~ I / J I ; „ u 'rAlL n;LL WS No .1 . 1 DATE ADMITIFO DAIS UISC}IAROFO ~Z-- - I PAGE NO. } " ! I i n I CI PATIENT NumBER i DOCTOR t : cnourNUMdER INSURANCE CAl FR 61LL + r 1' ' ; + POLICY NUMOE-._. R mull [01~-, S / .1 l r ,i f+ 1 ~ 4 1 i I 1 I ~f .Il i 1~5 i 1 i i t ii. .,iJt'slJ~f l'll~ 1 ; 1 . I 1 ~ I f: 1 1 M1. . I J ,)IJirli:ar> NOTICE: TO AVOID NN PAYMENT qF 'Ib DELAYED PAYMENT PA.,., M...AfIFA 1 ; lEEMAbE IM FUrLLA WITHINCN1A0EDAYS OF4USTAE1vM1EN7 U4iEr APIA449hfXiSTAliylnT c Y~1f •'4'.v;lrJi',1i13 (+,a 411A1{~YrM1M~D~MI.~I 1✓'rl+o-,l~ i ~~1rnu lrrirn ~ I~ nAtEnt~rli~rt,) _ paTff , - - -I_ MRER ~ _ BILL J iNSUanvc`ECA ENR n TQ, CgOUP_kUl IREfl - ~_y I i S. 1 f I~ III + I I I jl' ' ill I I 1 I 1 ~ 1 j f f ' f NOTIM TO AVOIb PAYMENT OF }co ( 5o ANNU AL a bRA FY PAYM dE MADE IN FULL WITHIN THIN TAOE RAtEI, YOUR PAY' AY ENT PAYMMI MAbr All(n 1 bAYS OF STArEMLNT DN-1051 ii(IS ATE HMARnINIXTS1A11MI'N~f''' 1 J~ a~YAL ;a1StCTAI 75 ~,002?5A _ D PAGE VO ;'t0 v-,jj ru:kE SHEET TE APMITIE Il I)l11E t)13(;1 R( EO u r62o1 ,..uTav ~rf~taT_1a.1 2t13tAT Ia.l. - -v. n 2/IAlAT n 1„flf3EtICYAIL_ 01000 O30T62446 1 22_/Y3/ST 14 NRlt 10 39•T3,__ /E E r p - ntron natils f AWN T NANO „ __.-J--.- {3A5HIUD• _)ENISE-L 33 iNsunANCE CARMILF1 (MoUP NUMIiEn POLICY NU.'~FlEfl BILL 30ERTZ% JILLIAH TO: 1150 Fk ME 94 ...ViTOYr Tk 7£x201 ~fItPA7 ~kT j97_~aiA t tij, VIM I 2Xa, E~Lie~AL ~;,1?PLY 2 f b.85 I I ' ~ ' y ~ A}rT5 I ' 3aa a&aaATOar ' a~a ~xues>sxcY .~oar~ ; 9ftk Eft PHYSICIaNr >r 35.Oa 1 I I i, i I I I i i 1'4AYS TOTAf S Y/OI IRM FWD CHARGES 111.1a I ~ ADJusINENTS .00 PAVItENTS .oQ "OT(CC: TO AVOip pAVMtNT (II' "CLAYGU pAYMGNT iusoAitNi wii ~11A ivo Et I o; ANNUAL POICCNIAM SAM). YOUf1 fAYMCNt MUST ,aAR0.4 ILL SIaIIAUNi lllj~ L' MADE IN IULL WIIIiIN DAYS OF SIAICMCNI bATE, MXI I i uctNilOAL :313 3:2I~Tfi= iT1. T NO YJ-!>J02"O j I U t 1 V T'( T 521 1 DATE nUMITifO UATE DISCH'ANCi-D ee NO i ~_/o4/IEi l~.u zTc,iTsl l,.u i LF0C) PATIENT NUMUER E 1Q10.15 2 1 /U4/1S7T2/i0/67 ~ PATIENT NAME Y 4 T 1 -IT = T A 1 L~ ! _ 1- uncton u u i(AnSls FJSU4h4-ll30L_EMJA4 JOHN c it' ( ru 4 iL CT \1 US -)F INSURANCE CARRIER OROUP NUMUER ^POLICY 1!;'dRCR BILL 1taMwi~aNl c~tthY j 10: 235 TJ2VEi AJ"_ t!]20 _ r_. f i)A\)t:s iK 7652 Jim 120 71C StII-'7IVATE h 740.00 250 !)4414ACY 53 212073 'til tJ SOLUTIOVS 10 274.00 27) 'Z TMAL O'JPPLY 33 365071 330 LA35RATDRY 7 141is 2O 313 LA3-aATHOLJGICAL 3 104020 I 30 JPEW*A102 7,00.4 2 247050 i70 ANE-S `SAT U.NLY 1 407075 j 432 JLTIASOJV) 1 113673 413 1E301AATOtY THCRAPY 4 01600 113 RE:DVERY 3004 1 !32.50 1 121 311N ING »_V ER 2 1050.00 733 E,t3 1 2".2.00 E jI 1 f i T7aVS TOTALS A/) .F1'IL F'AD CHAR3_S 3#92400 A]JUSTNENTS +00 PAYMENTS .00 NOTICE, TO AVOID PAYMENT OF eo DELAYED PAYMENT PATME11 MARE 0114 ~wI 1~ PEE ( °h ANNUAL PERCENTAGE HATEIr YOUR PAYMENT MUST ERISOA1EWll RE MADE TN PULL WITHIN DAYS QF STATEMENT DAEE, APPEAR ONNfAESIATEMENI ' '+J~ldr . .il ru' . -u . fL~L ,.aYvA •?...IIM't:,. r r1• .lu ..zr~TJ~ rz ~r ui 1,trL uiLL ~~VI~V r~ 7u2JI snn l'-X002"'r',iA Dg1f UISL IlAR pf U PAGE NO. ikcl VaAIl:__e_TrAIj 9/ PAilENT NAME NAME fjT ~Lr<9;i_1I~I_._I_fl Z ~q1 - N4 `oocron _ VIAUKO`SrS 11, ;,-YB ISZHULMc,~[~` irP~lC'! 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Isl s I a, IMP 1 t:J 'J~: s'AI«,2lfai- iJ l~~~rJ2 > tVi1A:r ).+J a:«J., .%l I.IJr_i 7J .'1lia, 17J,'1 1'I !7,22 .>7r1 i 1. ) I 1 J ~ I b tii'IIwJ rs) :c~ I f:r~t I r rt`.'15 rlf1.; yu1'IiVI:, .J5 +luriCE; TO AVOID PAYMENT OF °a DELAYED PAYMENT PAYMlkTMADEAFTER FEE ( ANNUAL TAOE RATE). YOUR PAYMENT MUST INO DAR W4L 9E MADE IN FULL WITHIN THIN DAYS OF STATEMENT DATE. APPEAR DN NE%t STATINJINt ~W. r 4i !.r r r.. Ulb- ~.l.~i.?..o a~i.~..L'Hi ujp..au+Ad~v,h.w«aArr'T`/.M1Mw T~IYI M.Y _ DATE ADMITTE D_ E-DATE UISCHAROW - PAGE Np. iECI PATIENTNUMRCR PATIENT NAME UDCTUII V UiAtiNUSIS INSURANCE CARRIER ' GROUP NUMRfR POLfCY NompER J BILL j TO: r I ~1 I 1 i 1 I 1 , ~i I a I ! I ' I 1 1 ~ 1 t ' 7 .I I. J I 1 NOTICE: TO AVOID PAYMENT OF % DELAYED PAYMENT PAYMtNt MAOt At1tA FEE I % ANNUAL PERCENTAGE RATE), YOUR PAYMENT MUST floe Dart Wit aE MADE IN FULI, WITHIN DAYS OF STATEMENT DATE, APPIAA ON NI%t SIAHMtNT ,a .:.d.•1; .:Mra!.y,•r,q.+sla..iNk.H;a.,ck~rttAaN:.Mw~ttrrQ~,'~!, I uc 4L I 1115 rJC) UATf AUMIrTCD U,VC DISCHARGED I RATIENi NUNIbEH OldGN( PATIENT NAME ,)OCroR, ` _ - - 'USIS _ INSUhANCECARRNIER 811L GROUP NUMBER POGCY NUNRER TO; NMI J , I , i I i~ I I i I I ~ I J - 1 VOTICEr TO AVOID "I""' OF °o DELAYED PAYMENT PAYM[NI'MAO[A;T(A fEE ( % ANNUALEACENTAOE RATE), YOUR PAYMENT MUST rxq IIAtt WAI 3E MADE IN FULL WITFIIN DAYS OF STATEMENT DATE. APPtARn.4N[xI3?AI[WENT f ",..a,...~n.:tis:J,eir.a<.,,:~a91`{,m~6#i.B'1Y,4~r:1 t41tl}~YIKVA~#T~VN~YNF . T llc ill Ill , cps r~~,-~-~ DATE ADMITTED f_ pgTC OISCffAliQfp PAGE NO - fFCI _ PAIIENT NUNIREN PATIENT NAME - _ `~.y .r I DOCTOR - DIAGNOSIS INSURANCE CARR IER~ BIL Cn06PNUMRffl POLICY TO NUMDER : I , l r . t~ I a 1. '1 r r Y ..r i L/..i I I I I I ' fcavs rjr:, r ~ J IJ NOTICE. TO AVOID PAYMENT OF 46 BELAYED PAYMENT ParMIHf MADE AF1EA FEE 1 °6 ANNUAi PERCENTAOE RATEI. YOUN PAYMENT MUST I1113 DAFF WNI EE MAbE IN FULI WITHfN DAYS OF SEATEMENT DATE. APPEAR ONNENT STAfIMINf _ uET/IIL DILL _ _ iuti yn _ ..i)niE nulvuTTeD DATE DIS0MRGEI) PAGE NO ITC) PARENT NUMBER i. -^PATIENT NAME DOCTOR j - - vlACrrosls` INSUI#ANCE CARRIER GIIOUP NUMNEB~ POLICY NUMBER BILL . TO: VIP" ' 1 1 f NOTICE, TO AVOID PAYMENT OF o6 DELAYED PAYMENT PAYMENT MADE AiEEA R PAYMENT ML THIS BEE MADE IN FUtLAW THEINENTAOE ~AY31 OP uSTATEMENT OATS AFPEAgEORNEKESiAEEMENE W'` I - <<4,rta•~+r,~r,4ti'i,+°n ~'r <,SiA~'~«~rH".CiJp((fAl 0.11 tAL { lilt :%3~I~TJti~ ,'T2;°T ..a.l;all.I.ILL )~VIr3 _ T% 76201 - - NSryq 75-6002`15H DATE Amidf fret) -,r- RAfF UISCNAN-- ! PAGE NO. ~itil7rs7 z~ia%H7:u; _IPCI L PA7ICNT NUNIHER _i~2_ i -'e -'133 l02UG4N8= 7!0 OJfPAT1eNT ~EtAiL o000 Y - AA1YENrNAM- J-- t-~- c,11 s 7 i~~ I "~?S 8-78 LtC-' _.•__."F `:202-6-37 C~00X.c~* oocroR _ t----- JAI/iD r1 3f~iA1:N-V:OP[A INSURANCE CARRIER BILL IZVAJDt 4L3ERT GnouPNUMOER Po~ICVNUN1aER j T0: 3:13 A 33A11 St f~ 3L:UJAL--r CA 33203 lU 2'0 CZVTRAL SJ;)PLY 1 3.75 351 Ct SCAN•Hr40 1 472.50 I I 1 I r I I 1 I I I T9aVS MALS JI 3AL Fda CHARGES AMSI'MENTS 4x6.25 PA!'MENt5 •00 .bb wnT(M TO AVOC PAYMENT OP _ rEE t S ANNUAL POICENTAOE HATE), YObgLPAYMENT MUST MYSDAt MAD( Amn A7 t Wit ~ 4E MAb6 fN FUI.I. WITHIN GAYS OF STATEMENT OAM ArwC oNpIXTStAIFMENr~~ i _ ti Io DATE 0MIT I C D narc olsc4tAR,,ED ~ r 'PAGK. NO. I IECI I A71ENi Ntf ,lRER 1 PatlENT NAME 1 v _ ---r _DOC10R ~ DIAGNOSIS -II I,VSUItA NCHCARRIER (jlLL GIIOUP NUMBER % " < ! n i ,1 ? . ~ ; - POUCV NUMBER TO: - v 1.0 I I r Jill i ! J. '..i2 u J " i :11; 1 .I i i f J 7 1 .•i Y t 1-f r11 JI )LU.^,Y I 1 r .J U I I! I 1 i i I I ` tit vl, r rr.~:~ ~~r L V VIl i. li ~1 !.J 1. ~l ♦IS VOFICE: TO AVOID PAYMENT OP % DFl AYED PAYMENT PAVMINF MARE AF IM ~ r J;1 4'EF I ro ANNUAL PERCFNTAtlE RATE}, YOUR PAYMENT MU8i tYRSDAEI Wkl 9E MADE IN FULL WITHIN DAYS OF STATEMENT BATE. APPEARI>FINERT8IATEMENI ~W& i 1. I - I.~I;aIL ~iLL 1 j 0'; No ' ' - 3 , CIIARG J l DATE ADM, FTfP GAIL OIS EP PAGE N0. IFC) VATII NT NUMktC Ii ~--,~roFi-" = PATIENT NAME DOCTOR Ub- NOSIS INSURANCE CARRIER GROUP NUMBER POLICY NUMBER RILL ~!4j323F 4 T'1u_I". T0: S/ 5 ,l = S T C i: S T l , own u:JC L.a-1l)gf.T0R J.1L ~Wt C:L'1IV I it4'11 1 JTAL.y 1/ 0L P,d'J CHARG_; 171.^.i A)JU';1'4:.,Vy . f ;l l PP,Y'4wIJT3 IIOTICE: TO AVOID PAYMENT OF b DELAYED PAYMENT PAIM(NI MAR WIR ; 71 ' tF..E I % ANNUAL PERCENTAGE W8), YOUR PAYMENT MUST N4 OAR WRI 3E MADE IN FULL WITHIN DAYS OF STATEMENT DAfE. APHAA ON NIXT SfAIEIAENT . :..r. w 4a> „t,'. ..a'ii... :;y...Jt,r•'4uirtk9terNk~.dl/ktJi+li~~ it FfOW 61.~~s1 1310 Scrlplure 5(reel MEMORIAL HOSPITAL f I.:{ Denton, TX 78201 {817} 3878861 March 25, 1987 Th- Honorable A. Ray Stephens Mayor of Denton 215 East McKinney Denton, Texas 76201 Dear Mayor S~ephenat Per your eaquest made to Mr. Linton, I have enclosed the following t information regarding services provided to Denton County residents by Flow Memorial Hospital who moot the Indigent Health Care Ouidel.inast 1) From October 1, 1986 through January 20, 1987, the hospital provided .$372,964 in serv.tcas under our Hill-Burton Charity Care program. This amount fulfilled our annual obligation and notice was published that on January 21, 1987, the hospital had closed the program for this fiscal year (09/30/87), 2) All services provided to patients after this date that met the 11111-Burton Income Guidelines (copy enclosed) would be paid for under the Indigent Health Care program, 3) Itemized billings totaling ,$50,590.32 for patients approved for Indigent Health Care for the period January 21, 1986 through March 11, 1981, The supporting documentation for each of these- claims is available at the hospital foc your review, 4) I prograin within the next t is not anticipated that the hospital will reopen the Hill-Burton eus yearal obligations which t have a resulted t in o funds exceeding available for future periods, Therefore, all patients meeting the Hill-Burton ' Income Ouidelines will be approved far payment under the provisions of Senate Bill No, 1. The Honorable A, Ray Stephens March 25, 1987 page 2 of 2 If any questions arise, please do not hesitate to contact me, Sincerely, David A. Nowiski Chief Financial Officer DAN/ktp enclosures cc: Lloyd V. Harrell, City Manager, i 3 j i I ;d j I P HOW 131 U Srrlln i,rr 5u rri 'lopp, 76,201 MCMOR1AL HOSPITAL f)i„ A TX ` ix171 383-6,127 f NOTICE OF AVAILABILITY OF CHARITY CARL Under its Hill-Burton obligation, this Hospital will make avail- able a reasonable amount of Uncompensated Services to a person eligible under the applicable Poverty Income Guidelines as issued by the Department of Health and. Human Services. Ili.ll-Burton charity care will be available for all hospital services on a first request basis to as eligible person needJng care who are unable to pay for such services until the facility's annual compliance level is met. In order to qualify for Hill- Burton charity care, your family income cannot be more than that indicated for your family size. Size of Family Family Unit Income $5,360 $7,240 $9,120 5 $11,000 5 $12,880 7 $14,760 8 $16,640 $18,520 *Por family units with more than 8 members, add $1,880 for each Laddltional member. To make a request for Uncompensated Services, please contact tho hill-Burton Representative (first floor Hospital susiness Office) or call 383-6427, A written determination of your eligibility will bo made within two (2) working days of your request. FM 0 147 pg. 2 a 71 FLOW MEMORIAL HOSPITAL PATIENTS APPROVED AS COUNTY INDIGENTS JANUARY 21, 1987 THROUGH MARCH 11, 1987 Admission Discharge Name Date - Date Service Charges Moreno, Sergio 01/28/87 01/29/87 OB $ 1,964.81 Moreno, infant 01/28/87 01/29/87 Newborn 290.95 Venable, Tammy 02/02/87 02/08/87 O8 +,424,72 Venable, Infant, 02/02/87 02/02/87 Newborn 2,208,00 Escamilla, Raul 02/23/87 02/28/87 Surgical 51145.21 Solis, Rosalva 02/17/87 02/20/87 OB 2,151.03 Solis, Infant 02117187 02/25/87 Newborn 1070.41 Adams, Linda 03/04/87 03/05/87 OB 952.81 Adams, Infant 03/04/87 03/06/87 Newborn 184.20 Goertz, William 02/13/87 02/13/87 ER 112.10 Zimmerman, Sheila 02/04/87 02/08/87 08 3,924.76 Zimmerman, Infant 02/04/87 02/08/87 Newborn 561.20 Deeds, Jimmy 02/1.1/87 02/21/87 Surgical 7,329.51 Henderson, Arlene 01/21/87 01/29/87 Medical 8,941.93 Handerson, Arlene 02/03/87 02/03/87 ER 336,25 Henderson, Arlone 01/31/87 01131187 ER 721.15 Henderson, Arlene 02/05/87 02/10/87 Medical 8,289.47 Nabors, Nannette 02/18/87 02/18/87 Outpatient 476.25 Nabors, Nannette 01/23/87 01/23/87 ER 234.65 Nabors, Nannette 01/21/87 01/21/87 ER 171.25 1.502590. 32 , r Ut IAIL BILL IRS DATE ADMITTED OATE DISCHARGED ppgE IFCI PATIENT NUMBER 1 PATIENT NAME DOCTOR DUWNOSIS INSURANCE CARRIER GRO P NUMBER POLICY NUMBER BILL ,.~Ila~cr L J✓;yI ! \ I • 1 I a u 1 . r 1 V ~ J r 1 li ~1 • 1 ~u .1 •i r r NOTICE; TO AVOID PAYMENT or :DS ELAYED PAYMENT tw OA I MAEE li ilA FEE ANNUAL PEACENTAOE RATEI, UR PAYMENT MUST iW BAIE Wall EE MAOf IN FULL WITHIN DAY5 TATEMENT DAif. APPEARWNEZfSfAnMlBi~'` ..,.:.A{~9.Mt 'N•~If/dlrii r{~1"i,. l•aw, r~+'.r ; 'j ' DETAIL -81[L- DATE ADMITTED DALE WSCHAROED pAOE N0. • ' = ! r / s (FE) PATIENT NUMBER w PATIENT NAME DOCTOR DIAGNOSIS INSURANCE CARRIER Blll GAOUP NUMBER _t POUCY NUMBER TO: fad, rX e'$ ')1 17) ~HJ 'Id`,S.il + I.~•Gtl 7J T7;L»~. Tt44Pi 1J1'4Ly l/.' .;SL FIIO '•l i.i';. ::+5•'i~ JVL.' II " T J I y J Y IV NOTICE; 10 AVOID PAYMENT OF % DELAYED PAYMENT POMINI MADE NRR FEE ( % ANNUAL PERCENTAGE RATE). YOUR PAYMENT MUST IHl4WE WN{ 88 MAOA IN FULL WITHIN DAYS OF STATEMENT DAIS, MIUAONNlNf31ATEMINf WMM& . ......•awY,t!n~k/PdhiM~vdllrl~AMw41'~i'IMAa:♦~ ' DETAIL BILL • IRS NO ' DATE ADMITTED DATE DISCNAAOED PAGE N0. ~ J IFCf PATIENT NUMRER ' a PATIENT NAME DOCTOR DIAGNOSIS INSURANCE CARRIER GROUP NUMBER I POLICY NUMBER BILL r I Tt4VS 13YALJ 4/ iJ~ .•~{1'1 f~•. iluvlll,3 ~i ti)JUST'1:'ll; P.TY:aTC .JJ NOTICE: TO AVOID PAYMENT OF % DELAYED PAYMENT PAYMINt MAN AMA ` PEE ( 9b ANNUAL PEACENTAGE RATE), YOUR PAYMENT MUST two oAtt w t HE MADE IN FULL WITHIN DAYS OF 8TATEMUNT OATS, MPEAA ONN 11181AtIMENt e•1 . ...LIr1:5rCV.r~L~1~...,r.r, .vf f • :,,,d.Ji1Mw11.tY~AXWhthi'aYAd riA0N4Ui I~Nf ~PMILI~ a~WN~i"4 .~/:f~~1 , `.11 1 zz'4f tit: _AL DATE ADMITTED OAfE DISCHARGED PAGE NO, • 4 d : Air , I !FC) PAT ENT NUMBER , o n PATIENT NAME 4 1 DOCTOR _S.ttJ i '.1_ ~i:11:i ~t~2V:Yr =iy,,JC_I` ~ nwaJosls I J 3 1 J . NSURANCE CARRIER + BILL '1 rr-. r J - 1 U i 1 GROUP NUMBER 'NUMBER Ydt 33 { I' { f - I L>) 77I ~.or•~221tirs Jzs, J z~J1 iyz;.3a =`f 287.~Jj _1iJ2htJ7r ' t , L C 'I L .4 3i.J7 i YI1 t:~~r7ar~~r rii71~Y r *LJ 2::}l:tr 2)J4 14 V . Y f ' I I 4 '1Yd:JfS ►:~I OTICEI TO AVOID PAYMENT OF % DELAYED PAYMENT OATMINf MADL p11lA EE t S ANNUAL PERCENTAOE RATE), YOUR FAME IN t MU97 Nil DAtt WNL E MADE IN FULL WITHIN DAYS OF STATEMENT DATE. APHAB DRN(xi srAtIMLNT ~ v + r w. w l k w' w x px, ~ 'i • IAI~ ~1L~ - - Liz: -F$iN 1 DATE ADMITTEp} f • DATE DISCNAgOEb PAGE NO IPCf PATIENT NUMaon PA4ENY NAME r, DOCTOR .OWON0Si~3 I L~ N1 J j iNSURAMCE CARRIER BILL + I j op { GROUP NUMBER POLICY NUMBER r r . r r 1 1 . l ..r j :7. irtiL :J7j~; If i'c, I~ i 7rr:. looo, i i 'I o., I llJ~.l~:~ra QOTfCEI TO AVOID PAYMENT OF EP I 4 ANNUAL PEACENTAOE AATE1, YODEL AYME PAYMENT PAymINr AD MICR ~B MADE IN FULL WITHIN DAYS OF STATEMENT DATE. APPEAR ON NUTSIAttMENT -o, I r, trri.r.virs'~tWlalm• .l dIM~yMYgnN .rqr Ab1Y41{~ r` • 1 ' L;t (AlL 3iLL IRS NO.' l 11;: .'ti:' ) r C ( t) y ; GATE AOMITTED OATE DISCHARGED PAGE NO. (FC) PATIENT NUMBER i i r i 1• 1 i l~)~ r 1 ~I i - I i r L f .I a ) 1 i r1 f .1 r PATIENT NAME DOCTOR DIAGNOSIS INSURANCE CARRIER GROUP NUMBER POLICY NUMBER TO, L1112 :r_04) r--~~ lfl J1i3=~1 ~ l,t7J/J~ 11141 f i s 1 ,`.1 !+}I)_?}Y 131' ){'r,: Y )TICEI TO AVOID PYMENT Op 96 DELAYED PAYMENT PATMEk1 MADE AF1EA ' E I % ANNUAL PERCENTAGE RATE i, YOUR PAYMENT MUST tlg9 DAtE Wlll MADE IN PULL WITHIN QAYS OP STATEMENT DATE. APPEARd)NEMf 81ATIMENI E~ j'. DATE ADMITTED OATS DISCHARGED PACE NO, J .I ,I IFCI PA7IENT NUMEEA wrr ,r DOCTOR ' L OIAONOSIS INSURANCE CARRIER 1} 1 'I p i 3/ I GROUP NUbIBER TO: 13 7 : i 1 J 1 t 1 1 1 J. 1 1 POUCYNUh}SER.y- i. 1 t5' r X1124):! ,l ` I f k .}JJ, NOTICE: TO AIOID PAYMENT OF % DELAYED PAYMENT PAYMENT MADE AETER tee f N ANNUAL PERCENTAtlE RATE), YOUR PAYMENT MUST EHd DATE 1Mll 1E MADE IN FULL WITHIN DAYS OF STATEMENT DATE, APPEAR ORRIxiSTA1EMERE 4»:. + JA1tl~.w~M lY'R a';'~~fy ~.MK. l i3 r i II ~a:irill OIL. f IPS NO - E)ATE AON117TE0 OATE OfSCNARGED PAGE , f0. ~_.IFCI PA71ENiNUMBER°.~,r PAt1ENTNAME OOCfOH._ DIAGNOSIS INSURANCE CASAIEA MIL GROUP NUMBER POUCY NUM1 FR TO: I l f I I I i ' f I I ~ i l~ I ~ f r r NOTICE; TO AVOID pAYMENi OF °o DELAYED PAYMENT PrIYMIN MANE utER FEE I % ANNUAL PERCENTAGE RATE I t , YOUA PAYMEMT MUST IRS Bnrr 2 3E 41ADE IN FULL MTIiIN DAYS OF STATEMENT DATE AFPTARQNHEMTSIFtlMINi pi -I kS{R.er~# Yffi h' =330 SC.11nult 5rlur 75-6002958 JEYT~V :}i 75201 %re:~i7NUrreo '1 unTEO-"-iyHnaGep PAGE N'o.~ ~/231F~7-1,4.1 f 2/l3APBT 14.1 2 I PATIENT NUMBER =~Z-~~4_~`~•1!~ E!E E'SERpE`♦CY OETaIL ',-)0 0-6 :01Ob24~-G I 2,123k87 2/~ 2AlB) PATIENT NAMB _ UUGTGq UInGNO91S 70 3I~Y- xL~ 0.K M Oa?.a BA5KIU ♦ DENISE L ~UfSURANCC CARRIER GROUP NUMBER POUCYNUMBfR SILL 30ERT2s JILLIAM TD: 1100 FtA!tt A4 I :E7T0Yv Ik T61201 r~~ 81 q17 M-44-34 i Zia ZIT&AL WPLY 2 j b.85 j 3h0 Adr3RRTOR,r ! I 41.75 'I 434 ENEARE,YC1! 4009 S I 2T.5D f I 1 i i 9P11 E4t PHTSICjk.% I L 35.00 i i I I , I I f I + I 1 1 i i I TAAYS TDTALS 4I3190.L Fw0 CHAABES 132010 1 ADJUSTMENTS 600 I I PAVHENTS .OQ R OTtCE: TO AVOID PAYMENT OF DELAYED PAYMENT rAYMthtNANAFEER I1f.IQ~I 18( a ANNUAL PE'RCENIAOE RATES. YOUR PAYMENr MUST fR,S OAft Will 'C MADE IN FULL WIMIN DAYS OF STATEMENT DArE,-PPEARONNERISEAImm _ s f "L?J ~i'1)itA_ IOL'"'ITR;, Ui:IHI~.IOI~L ID I,. TJiz 3r3.LT MgNO, 75-6J025'9H V f O U T l( 76201 DATE hDMITTEO DATE DISCHARGED PAQE NO :/04/87 12,u 2/08%87 11.E 5 I IFC) PARENT NUMBER )3S 441 13-I -4S III IVATUVT OXTAIL 0000 16103332-1 2/04-37; 2/10167 PATIENT NAME DOCTOR U:AONDSIS I ?Yi411NAU :3 F 464 3JLE%43A JOHN I= PREV C-SLCT VUS-3E I` INSURANCE CARRIER GROUP NUMBER POLICY NUMBER BILL 1144-414,V, C*9RY TO: 239 TJ2VEZ AJr #123 ~ ~)a~l)c~~ r>< 7E,~sa 123 11C 37-11-DU VATE 4 140.00 I 259 14414ACY 55 292*93 2S3 tV SOLUTIOVS 10 274600 273 ~`MAL SJPPLY 33 365.71 330 1.4303ATORY 7 141.20 ' 315 LA3-DATHOL3GICAL ° 1G4.20 I353 5p:.iAT:V3 130,9 2 247050 I 373 AV:.S 4Ar OVLY 1 409.73 I 112 JLt2ASOJ.V) 1 113473 I 413 l_a-laAr02Y THERAoY rr 01600 71) R_COVERY 1304 1 42.50 771 3Ttr!tlu3 C:.VTER 2 lUriO.DO ' i i 733 :.t3 1 22.00 f I I i • I i tlAVS T)TALS V/) 9AL FWD CHAROrt '024#75 A3JJSTNENTS .00 PAYACNTS .00 `tOTICE: TO AVOID PAYMENT OF °o DELAYED PAYMENT LA"HWA4 MENr MAp( AFTER 1 FE8 f °b ANNUAL pERCENIAOE RATE}, YOUR PAYMENT MUST 9 BAII.1 LAW RE MADE IN FULL WITHIN DAYS OF STATEMENT OATS, ONN(kr SFAtUdifT f .j 1j f I wrlo ,."tt~r13E 3r2EEr RsNrr 73-5002958 u r V r 7 6 i' S 1 DATE ADM_IrTED DATE DISCHAROE~ ;'AGE N0. i ?34/ti 17.2 ?/09/87 11.J1 2 1 IFC) PATIENT NUMOEA^' r _t .J A;y t ~.a5 t/' IaAIIF' •r TAIL 0 05111. L 2/04,&871 2/09/87 PATIENT NAME DOCTOR DWMN(ISIS _:SwA i4iU• ] JI] 2AV1A _ _ In-U17 SCMVL ~PEE:V SINGLE LIVEfiOAW-IN INSURANCE CARRIER OROUPNUMBER _I POUCY NUMBER BILL LI~M:t44Y~ <--RRr TO: 200 TJAVFR AVr H123 i)AVO<E,f 15252 110 )HC VJRS£iM 4 500.00 I 23) 11%44AC/ 5 2?.50 211 C:--MAL SJyPLY 15„ 0 530 LA33U.?ORf ' 23.5tl 44 ~ I i M YS r)TALS .411 39L F,+Q CHARG:S 5b1.20 a)JUST.NENTS .00 PAYMENT S O DO NOTICE: TO AVOID PAYMENT OF DELAYED PAYMENT PAYMI_ N_t M_ADI APIIA 3 bI . 2 0 cat I S ANNUAL PEACENTAOE RATE}, YOUR PAYMENT MUST INIS OATS YAtt ,E MADE IN FULL WITHIN DAYS OF STATEMENT DATE. APPEAR ON NEM SIAIEMINI :•.t....l. NfoaaiAFi~~KMa.JNJ+4{~%1W6+'~'If~t. •.yti%;iaI~ f t DATEADMVEO WE OISCHAROED Pp 1 i ; f f r 1 fFC} f PATIENT NUMBER s,rnel PATIENT NAME / r.. , DOCTOR OfA0N0515 IJl :t1 ..;.L Z, J' INSURANCE CARRIER ' r 911 1,_ 1 j. f; ; 1 r OROUPNUTA8En TO: POLICY NUMBER { f 4:j_1,a~1 I - lz ~ld 1~J9,J~ ~Ilit4~i ~J) 11 )irli/J~'' J ! I L '/i iftly ';1>>L 55u.4J ; 3i1J, l a 1 .i 7l) i:)l i( i)Jt ur; r1rL1,J' . J. ~Li fdiJf ; .JJ 107fCE; TO AVO;O PAYMENT OF a~ DELAYED PAYMENT PArM(HTMAf)EI11tR , iT FEE f ANNUAL 9E MAOE IN PERCENTAOE RATE), YOUR PAYMENT MUST tNq 04 YAII FULL W€THIN DAYS OF STATEMENT DATE• AFPtARfN OTSFAR6gNT J I, L . a. 1.A6.Ywta~Glt hT/J,(aa!'/~i1iM(r,l '~N ,.ly s.1+IntR I I'. 4 r;c UiL ALL IASN t ! DATE ADMITTED DATEOISCHAROED YAOENO. ' tm PATIENT NUMBER PATIENT NAME DOCTOR DIAONOSIS ! r INSURANCE CARRIER OROUPNUMBER POLICY NUMBER BILL t 1. TO: I. I ` 1 I I ! J p i a 7 'I I I. 1~ l f I IJ I r I r I , ! I r r r 1 4 I 1 i r I I ~ I r 1 ' r I l r I, I NIOTICC TO AVOID PAYMENT Of , DELAYED PAYMENT FATHMAR ENt MADE MUR FEE { ?b ANNUAL PERCENTAGE RATE, YOUR PAYMENT MUST OATE WAL 3 E MADE IN PULL VATHIN DAYS OP STATEMENT DATEONNP%iSTATLMENT ~t d.Lr,r '+r. a.J r.tit'/44..NMI{I'b'(yJA:il db)TNi11WWfrwG'µfYrM ~.i1[W{a~ 1 t1 n I I uc (*AIL SILL IRS N - DATE ADMITTED DATE DISCHARGED PAGE 140. (FC) PARENT NUMBER PATIENT NAME DOCTOR OLLGNOSIS INSURANCE CARRIER GROUP NUMBER TDUCY NUMBER BILL . , TO, f , I rla:: NOTICE: TO AVOID PAYMENT OF "o DELAYED PAYMENT PAYI Nf MADE AE((A FEE I % ANNUAL PERCENTAGE RATEI, YOUR PAYMENT MUST TMIMIONR %1 L(A!(MINT 3E MADE IN FULL WITHIN DAYS OF S(ATEMENT DATE, ~ • i .i,~at'• ~.w:~c:...l;>Hwxiu+,~r~A:.~.KwikA~~+A~tdwnY~ 1 I} d . ut IAIL d1Ll. fRS N~ ^ GATE ADMITTED DATE DISCHARGED PADE NO. (XCI PATIENT NUMBER ~u PATIENT NAME ' DOCTOR DIAGNOSIS INSURANCE CARRIER B'll 4ROUPNUM9ER POLICY NUMBER To, 1 ME= ~ . 11, I y 1 Jv i I / i / / JIJi1 '`Ic1') .J i J.1Y'l `.yn r~U NOTICE: TO AVOID PAYMENT 8 OF DELAYED PAYM8N1 P4YMtRTAIABtAtttR 1 48AAADE N FULL AWPTpNENiAOEDAYS OF SWEMENI DATEr tIffsoArlm PPEARoAr OBNEATSIATIMEMA . .':1N♦Kh..~N!AI~IVV.I~~.K!{~I~{MWw1~hyA2~AtMil1 c; W uETA1L OU 1 DATE ADMITTED GATE OISCHAROE0 PAGE NO, I I (FC) PATIENT NUMBER w taylwlr PATIENT NAME • OOCTOOR DWGNOSIS I INSURANCE CARRIER BILL GROUP NUMBER POLICY NUMBER . r 1 , r r , r I J 4 l~ '1 Y! 1 ~ , y 1 ' Y~E1,l.1 NOTICE, 10 AVOID PAYMENT OF % DELAYED PAYMENT P6YMENTMApEAETIR FEE ( 6► ANNUAL PERCENTAGE RATE). YOUR PAYMENT MUST tws BATE BE MADE IN FULL WITHIN DAYS OF STATEMENT DATE. APPEARdEtVNXEEXtStAtEMENt~ r,..4,*v4* rn„uA--nn,r /6C~lt4+MN1~ f y e °e lita'•s~7rir;J.i. ~rz~:r uc`i~a~L ~ii:i `_.~_____1 V r,311 r~ r6201 1 '-`-^-~-..!gy NG 7 5 "b O O 2 7 J d t GATE ADNIITTED F--^-----.~_. PAG DATE OISCitAROED E N0. 2/1!3/R7 3.0 2 19/x7 7dili - ~'b IFCi PATIENT NUMBER a ,u 0 OUTPATIENT OErAIL 0000 20206449-3 PATIENT NAME 2 / 19 r fS~'r~'i 114 i l~'' Z iY V E T r COMA OWGN09lS 220253 C7Ottr )AVID N 3R IM V 0 Q33` INSURANCE CAggIER'""-- BILL q"VAJJ1 AL3ERT GROUP NUMBER I TQ' 353 A )31,\( ST POUCY)qUMBER 1 31EVJALf :A 41203 1~~~ " P-8000 I 2r0 C~VTRAL SJPPLY t 3.%5 331 Cr SCAN-MEAD ' 1 472.50 Ii j I TZ4VS 6TALS it 341 ND CHARGe'a^ 476.25 A)JUSTHENTS 00 PAYNENTS . 600 boo VOTIM TO Aftb PAYMENT OF 39LAYED PAYMENT PATMtkf Mhpt Afftrt TEE f IN 46 FULL ANNUAL VVITHIM AE MADE IN PEaCENTADE AATEI. YOUR PAYMENT MUST rx~4CAq ymt pAY3 OF STA1EbIENT DATE. AMA ON NJ XTSTATIMENr /1 r ~I i' y - 4c inlL till. ' 't l DATE ADMITTED DATE DISCHARGED PAGE NO, ITC) PATIENT NUMBER °Iw au : I I y ' 1 PATIENT NAME l 1 ~ • ~ i •,J 1. I• r. ! r l / ::1 / f DOCTOR OUIGNOSIS INSURANCE CARRIER i ' BILL GROUP NUMBER POLICY NUMBER I T0. L1 '.1111:> >ai l 1' 'A' ?'_ul A e 11 -1 11 1 J ~ )iIZ ~'irrY , f i l i ^ 4\ I 10 V..' it„= ' 7~T t I,l .+r l; I i J1 )LU"Y y :IrT'I I .I "J I { r ) I f I I N, Vol ]JI151 ~'I . I1~1 ♦f e' . J I; VOTICE: TO AVOID PAYMENT OF 16 DELAYED 1''I'V t PATMIkfMAOtAItER FEE ( °d ANNUAL PERCENtAOE RATE), YOUR PAYMENT MUST fHl9 pAetE WRt - 8E MACE IN FULL WITHIN DAYS OF STATEMENT OATS. APPEAR TYIht AI StATIMINf~ . ..I.,,...o::.:~\wwk+.n.:,.r."~xa-+Igiscx'l1e~AfJgFr~IEIq,.E11dnJ>~ A 4• L~lAi Li J 1'. '•J r ,r wS ND DATE ADMITTED UAtE OISCHAROEU : PAGE NO PATIENT NUMBER . . ~ - 77 i3 ' I.. PAAENTNAMF i y ` . A S n J r T + UOCTORJl DIAONOSIS INSURANCE CARRIER BILL V 4 j D Z r } V V E l T GROUP NUMBER POLICY NUMBER T0. i1r:5 I iI:,7 1 r~ ur0JT E'+( 73 t - 1 t MEMO" I I I i t i iiS+1S JrAL;i n'/ 144 F'd'J CYw.R n• 4)JU'iT •4i VT" 171, L'U PAY14E+1TG .UJ +IOTICE: TO AV010 PAYMENT OF % DELAYED PAYME EE I IT PAYMERT MA($ urER I ANNUAL PERCENTAGE RATE). YOUR PAYMENT MUST 11tlS BATE WAl 7E MADE IN PULL WHIN DAYS Of STATEMENT OAfE APHARGYHExTSTAIEMINE gk911G4~NS~ t C'ry Of DRNrON, 1"6XA8 MUNICIPAL BUILDING t DENT ON, TEXAS 76201 1 TELEPHONE (817) 568.8309 D1Rce 0/ the mayor March 18, 1987 Mr, Mark E, Delane Managing Director of Consulting Services Deloitte, Haskins and sells 1400 Lincoln Plaza L13#4 Dallas, Texas 75201 Dear Mr. Delanes I appreciated the opportunity of talking with Mr. Randall Luecke on his preliminary meeting with Flow Honpital personnel. I feel that he is heading in the right direction with hid approach to the feasibility study. I have received from the county commissioners, court i list of additional questions they would like your firm to address in the study. These are very pertinent questions that the City would also like to see addressed. However, the City would also like you to address the followings 1, in your estimat,:, will the hospital (within the next five years) operate without a deficit? If not, how extensive will those deficits be? 2, Are there any creative revenue-generating ideas that the hospital will be able to incorporate (t,e., room rentals for non-patients, computer time rental, etc.)? 3. Would an H,M.O. or PaP,o. (with the City, Bounty, and/or other agencies participating) be a viable option for plow? 4. Are there any immediate cost-cutting measurea that could ' take place which would not drastically affect services? 5. As you proceed with your study, would you please provide us a detailed listing rf all outstanding leases? "s r' Mr, Mark 8, Delane March 18, 1987 Page 2 of 2 Are there any services the City and/or the county could be r~---~ providing to help Flow (i,e., purchasing, data processing, personnel, billing, collection, etc.)l I am looking forward to receiving your rsport and recommendations, If I or any member of the City staff can be of any assistance, please feel free to contact me, Sincerely, Ray Stephens Mayor RS:JMrsfn 2351F i f CITY of DENTON, TEXAS MUNICIPAL BUILDING / DEN TON, TEXAS 76201 / TELEPHONE {817) 566.8204 M E M O R A N D U M a s■ a a a a a a a DATE: March 9, 1987 T0: Lloyd V, Harrel], City Manager FROM: John F. McGrarne, Director of Finance SUBJECT: FLOW MEMORIAL HOSPITAL SERVICES Attached is a listing of the current services provided by FLow Hospital. We obtained a hand written copy of this from the Flow Hospital Administration Office and have retyped it. We are now submitting it for your review. If you have any questions regarding these services, please advise, rn crane JFMcG:a£ Attachment 2345F i I niy YN'(.~I }I SERVICES PROVIDED BY FLOW MEMORIAL 80SPITAL I. GENERAL HOSPITAL SERVICES Dietary Service Environmental Service Maintenance Medical Records Records Auditing Pre-Admission Screening Quality Assurance Utilization Review Infection Control Social Service Administration Medical Staff Coordination Volunteer Services Central Supply Fiscal Service Data Processing Admissions Credit/Collections/insurance Materials Management Biomedical Engineering Personnel Pharmacy Nursing Administration Marketing/Public Relations II. DIRECT PATIENT CARE SERVICES ('Associated Community/ Education Services) A. Nursing *Labor/Delivery *Midwifery *Birthing Room *Post-Partum *Newborn Nursery *NICU Medical Surgical Pediatrics Coronary-Intensive Care Progressive Care Emergency Dept, Behavioral Medicine *Chemical Dependency Operating Room Recovery Room Outpatient Services Anesthesia II. DIRECT PATIENT CAkE SERVICES (cont'd): B. Respiratory Care C. Cardiopulmonary D. Radiology, Ultra Sound Nuclear Medicine CT Scanning E, Laboratory Pathology III, COMMUNITY SERVICES & EDUCA'rION PROGRAMS Meals on Wheels Lifeline Telmed TOTS CPk (Adult, Child, Infant) $ Instructor Classes Home Alone „ .Safely Health Pairs (Flow's, TWU, NTSU) Children's Health Fair Physician Referral Service Love IN Care Osteoporosis Screening Breast Self-Exam Mammography Service Pre-Operative Education visits pre-Natal Classes Barly Pregnancy Classes Birthing Room Orientation Lamaze Classes New Brother/New Sister Program NICU Support Group Gastroplasty Support Group Smoke Stoppers Be Trim Childsaver Classes First Aid Courses Hirst Aid Courses Diabetes Education Business Health Screenings Safety Programs (Child Safety, Holiday Safety) Monthly TV Health Program Booth at Spring Fling Nursing Student/Faculty b Educational Clinical Resource Health Information Library Hospital Tours Speaker's Bureau Babysitter's Course Blood Drive fr 4 F IV, HOSPITAL EDUCATION SERVICES A. Patient-family Infant CPR Breastfeeding Newborn Care Diabetes Ostomy Care Pre-Operative Teaching Discharge Planning/Preparation Breast Care/Mastectomy Teaching Asthma Anticoagulant Therapy Teaching Home Tube feedings Home Tracheostomy Care Post MI Teaching Spinal Care Audiovisual Health Programs for CCTV B. Staff Education/Services CPR Recertification $ Instructor Certification Sakety Classes Body Mechanics Mock Code 99 Assertiveness Professionalism Medical Terminology New Employee Orientation IV Therapy Documentation IV. STAFF EDUCATION/SERVICES (cont'd); Physical Assessment Pediatric Care EKG Classes Dysrhythmi, Interpretation Hemodynamic Monitoring New Equipment Insorvices Changes in Personnel Policies & Tax Laws Infection Control Heart at Work Community Relations Blood Drive Patient Education Programs C 2344F 03/06/87 1 %Z1T y of DENrON, TEXAS MUNICIPAL BUILDING / DENTON, TEXAS 76201 / TELEPHONE (817)56618200 M E M O R A N D U M r r r r r r r r r r UATEi March 41 1987 Tot Lloyd V. Harrell, City Manager FROMs John F. McGrane, Director of Finance SUSJEM FUNDING OF FLOW HOSPITAL As you are aware, the request for funding of Flow Hospital comes at a time when the General Fund budget is already experiencing difficulties, The decrease in revenue associated with the short fall of sales tax collections has already %ad an adverse effect on the fund, Actual sales tax collections for the first five (5) months of fiscal year 1986-87 have been under collected in an amount of $2400000 over the amount budgeted based on the experience of collections for the same time period of the previous year. If this trend continues through the end of the fiscal year there will be additional problems in the fund. It is projected that the yearend revenue shortfall from sales tax collections will be approximately 441,000. Another area of concern is with the building permit revenue since It appears that building activity in our area may be slowing, we will be monitoring this source of revenue over the next few months, This is the peak permit season and therefore, we will be able to know if any further revenue problems are in store, On the expenditure side of the fund, departments have already "tightened their belts' to produce a reduced current service level budget in the amount of 05200000 $532,000 from proposed budget and 4120,000 from a two (2%) per cent reduction in February, This has already put a strain on those departments since their expected levels of services have not been reduced accordingly. Therefore, in order to produce an appropriation for the funding of Flow Hospital, a shifting of priorities will be necessary in the General Fund. Following is a Itst of alternatives for the offset of the decrease In revenue and the potential funding of the hospital, Memo to Lloyd V. Harrell March 4, 1987 Page Two i Alternatives 1. Eliminate the hiring within the last six (6) months of the year of three (3) additional police officers. This would produce a savings of 42,500. This would have an effect upon the efficient and effective utilization of our current police officers. 2. The average personal service cost per euployee is approximately 422,000 on an annual basis. In order to produce the 0200,000 funding for Flow Hospital, it would be necessary to lay off approximately eighteen (18) people for the last six months of the fiscal year. Thin would have a severe Impact upon the service levels of all the departments within the General Fund. This would include police, fire, general government, municipal court, and all the other staff functions. 3. Reduce the unreserved fund balance by the appropriate amount, The unreserved fund balance in the General Fund as of September 30, 1986, was 11515,000. This amount ;;apresents seven (7R) percent of the total 19864 7 General Fund. Althou-1h there is no set percentage, the general rule of thumb is that a props reserve level should be between 8-10 per cent. It was recognized earlier in the 1986-87 budget process and, eventually became one of the goals approved by Council to increase the unreserved fund balance to the 8-30 per cent range. The use of funds from the unreserved fund balance could have two adverse effects. One, this is one of the elements used in analyzing the fiscal responsibility of an entity by the New York bond rating agencies. We have stated to the rating agencies that we were striving for the 8-10 percent reserve level. The City will be issuing bonds within the next couple of months and, therefore, this reduction on the unreserved fund balance may have an effect upon the City's overall general obligation bond ratings. Once again, there is no telling what exact effect a down grading of our bond rating would have. However, it's thought that the difference between rating grades can cause anywhere from .25 to .50 per cent difference in the interest rate depending on the factors relating to that particular bond sale. At current interest rates, a .25 per cent interest rate increase over the twenty (20) year life of the 11.7 million dollar bonds would mean approximately $750100 worth of additional costs. The second effect would be that this would further reduce available funds for any future potential claims against the General Fund, including pending law suits or any other unexpected claims. 4. The fourth potential area would be to initiate an across the board out of all the departments in the General Fund of approximately four (49) per cent. This would produce 240,000 worth of expenditure reduction and would be in areas other than personal services. As mentioned earlier, the various departments have already tightened their belt and an additional four (4!1 per cent cut may have a drastic effect especially upon the smaller departments. i . Memo to Lloyd V. Harrell March 4, 1981 Page Three 5, Eliminate the fire station reserve of $75,000 that was incorporated into the 1986-87 budget. The adverse effect of this would be to delay the opening of the fire station from which the capital portions are funded in the current capital improvements program. 6. Reduce the City Manager's Contingency by $75,000. This would have the effect of eliminating any potential funding of any other unexpected needs that may arise between now and the year end. 7. Reduce the amount of appropriation for the City/County Health Department. There is a balance within this appropriation of approximately 76,300 that could be utilized for other priority items. 8, Eliminate the appropriation for a Revenue study update. Savings will be $20,000 and delay the funding until next fiscal year. The impact of not doing the study will have an effect on the ability to charge for the actual cost of services and could have a long term effect. Staff will look at various fees on a limited basis and will attempt to revise 't some of the user fees for the 1987-88 budget. However, the total revenue cost of the study will need to be reappropriated and conducted in the 1987-e8 fiscal year. 9. Transfer from the Recreation Fund 50,000 to the General Fund. This would limit the future capabilities of funding various Parke & Recreations programs. 10. Reduce the street program budget by General Fund 4140,000 for street9Sresurfacinge and buaealedcoating programs, we have currently used and/or obligated 451000 of the total, If the balance of funds were utilized the following streets would not be donee - Kingston Trace - Linwood - Foxoroft - Bernard - Fulton - scripture 114 eliminate $24,100 for youth sports contract. This amount pays for the officiating of the various sports leagues, The elimination of these funds would put a burden on the various leagues to provide their own umpires, eta, i 12. The last item would be to issue some notes in order to funding for Flow Hospital, After discussing this ma tterivlthnoour Financials, First Southwest Corporation, the only way that this could be accomplished at all this year would be to present to the State Legislature a bill that would give the City the authority to issue notes so that we could fund en operating deficit of the hospital. Memo to Lloyd V. Harrell March 4, 1987 Page Four Staff Recommendations, (1) Sales Tax Shortfall - If the current trend for sales tax 0012ections continues through the rest of the year, the projected revenue shortfall for the year will be 941,000. Some initial action has already been - taken to offset the revenue shortfall. The steps are as followas (a) Initiate a hiring freeze In vacant positions $100,000 (b) Implement a two (29) per cent non-personal service budget reductions - all General Fund Departments 1.20,000 TOTAL 220,000 The additional recommended actions are, (a) Reduce amount allocated for the Contingency Fund (b) Reduce over-appropriation for County Health Department 75i000 (c) Transfer fron, the Recreation Fund 7 0 (d) Delay Revenue Study 50,400 00 2_- 0.,000 TOTAL $221,000 (2) Punding for Flow Hospital it is the staff recommendation that Plow Hospital that a study be done byranroutside consultant thatnwould look at the feasibility of continuation of the current short term problems that the hospital is experiencing in order to identify whether it is a cash flow problem or is a bovere funding client mix that is occurring, The study would alsootake as 1 okpat the long term prospects of tho hospital in order to determine whether the deficit funding of Flow Hospital will be an annual occurrence and, therefore, severely affect the General Fund operations, The second recommendation is for the 0225,000 necessary for the funding of Flow and the study, The reductions are as follower (1) Reduce the street program budget (2) Eliminate the funding of three (3) new 95,000 police officers 42,500 (3) Cut all General Fund non-personal service budgets by an additional 1.59 87,500 TOTAL ,2251000 s t' Memo to Lloyd V. Harrell March 4, 1987 Page Five It should be noted that with the additional 4200rooo funding for Flow there still remains a severe problem with the for the hospital. The outstanding utilit payment of the utility bills current time is approximate) Y bill for the hospital at the Article XII, Sec. 12,02 of the Charter provides that the util$ties0sh Z1~ pide no free sevi Flow has refused to pay for this service, somevaction will berece, Since collect payment or terminate service. In addition necessary to noted that the recommendations for reduction will should also be further ability of the staff also to adjust the General Fund budget i,mi This may be a concern if other unanticipated expenses or revenue shortfalls occur later in the year, ahn F. MCarane JPMcOia£ 2341P r h y: S FLOW MEMORIAL HOSPITAL FINANCIAL ANALYSIS PROJECT g PROJECT STATUS STATEMENT In accordance with the contract, the Coordination Committee has received an oral report outlining preliminary findings related to the Hospital's fiscal year's projected deficit. The project is on schedule and a draft of the final report will be delivered to the Committee the week of April 13, 1987, Based on current operating practices, the preliminary findings indicate a projected income deficit in the range of $200,000 per month. The final report will address this projection in greater detail and present the financial implications over a longer term. Ic: 3404M 1 1 1 ail I L:'~ ~ :~91?M1IUItl~11, I I0S'ITM ~ In tii~rynurl tie, , r i l 71 387.")8(j I Ducunlber 4, 1986 NAND DrLiVh'RED Thu llonorablo A, Ray Stephens Mayor of Denton 2l5 Bast McKinney Dunton, Taxas 76201 Dear Mayor Staphuns; The Hoard of Directors of Flow Memorial Hospital, at it., meeting on November 19, 1986, aekud that 1 write to you rd outing V4161burp Mont for the financial logs of plow Manloriel Hosp;%1,t8, ENi mono of October 1986 in the atAount of ;267,638. As you are aware, Denton County provided funds to Flow A!umorial H^spital for our fiscal year ended September 30, 1986, In the amount of $450,000, and the ! City of Denton allocated funds in the amount of $225,000 for our fiscal year undud Septembur 30, 1986, of which we have received $200,000, Flow Hospital's audit report for the year ended Suptember 30, 1986, will show n loss of 4518,036. Flow also had a not deirease in working capital for this same period of $1,080,442 which was dcu to the hood to raplaeu obsolatu equipment and make repairs and renovations to the building requirud to maintain licensure by the Texts Deportment of Health and accreditation by the Joint Commission on Accreditation of Nuupit,lls, Viuse two factors have placed the hospital In an extremely negative cast, flow position. Since we cannot borrow funds as a city/county hospital, we need Immudiuto nsstatance in order to operate the hospital urt a flnunclall.y rusponsible basis, As of December 2, 1986 the hoepitnl had 4602,196,02 in cash and cortificaten of deposit, and had accounts paynble equalling .$1,016,703,46, of which $606,158.91 worn past due. 7ho hospital has taken a nurber of steps in recant months to reduce uxptnsus, includlny, a stbntficant reduction in payroll, We have alao duveluped procedures to control the number of bad debts at the hospital; i 110CUmher 4, 1986 PuhL! ul 2 There stupS should begin to reduce tl•u d,;:lclt beginning In January 1987. In the muontlme, we nuud your assistance in hnlpinl with our operationnI losses and our urgent cash Llow problums, 1 nm available to answer any questions you might have rugarding this totter. Sincerely, Chnrlu's B, 1.1 nton Chlof Exucutlve Offlcor CBL/ktp oai The Honorable R, L, rule Denton County Judge Michael J. Whitten Chairman, Board of Directors i I I' 1. ,NItA'10RIAL 110Sn('j"%j' I!) to 5i ril,lurr Srrrrl Drill ort. 'I'X 7H2O1 IN 1 71 387 5Nr I January 23, 1987 HAND DELIVERED The Honorable A. Ray Stephens Mayor of Denton 215 East McKinney Denton, Texas 76201 Dear Mayor Stephens, In order to update our ro I Of Memorial n Directors of plow questHosr financial assistance you with financ The hospital's ial information througgh the requested thattlo Board and of the Deeemberpr1986 leas in December was $386,587, month loss now totals x87$ i , 1986, that the cit The Board of Directors is requestingcte y and county reimburse the hospital for this loss, As of January 15, 1987, the hospital had $ certiPicetea of deposit, and had accounts of which $93812.10 worn peat due Payable e qustlinoin and , g $1,175,352, The Board of Directors would a matter, ,prociate your consideration of this Sincerely, ChaYieB B, Linton ; Chief Executive officer CBL/ktp ccl The Honorable Vic Burgess, Michael J, Whitten, Count Chairman y Judge Board of Directors lli ~ i i FLOW MEMORIAL HOSPITAL INCOME STATEMENT December 31, 1986 MONTH YEAR TO DATE 9, PRIOR X PRIOR PATIENT ItP:VENI'E, ACTUAL BUDGET VAR YEAR ACTUAL BUDGET VAR Y-T-D r-~ Inpatient Revenue $ 1,572,941 $ 1,670,165 (:i.8) $ 1,675,830 $ 4,164,176 $ 4,956,616 (16.0) $ 4,853,665 Outpatient Revenue 2170040 255,258 (15,0) 201,576 645,464 __751,536 14,8) 603,392 'total Patient Revenue $ 1,789081 $ 1,925,423 (7.0) $ 1,877,406 $ 41809,640 $ 5,714,154 (15.8) $ 5,457,057 DEDUCTIONS FROM REVENUE Contractual Adjuats $ 475,935 $ 268,118 77,5 $ 198,409 $ 1,028,133 $ 795,705 29.2 $ 551,400 Bad Debt 450,000 221,586 103.1 310,489 1,117072 657,610 70.0 736,342 Other Deductions 159,890 66,833 139.2 100,561 327,692 198,343 65.2 3090040 Total. Deductions $ 1,085,824 $ 556,537 95.1 $ 609,459 $ 2,473,597 $ 1,651,658 49,8 $ 1096,782 Not Patient Revenue $ 704,157 $ 1,368,886 (48.6) $ 1,267,947 $ 2,336,043 $ 4,062,496 (42.5) $ 3,860,275 Other Revenue S0p645 660357 23.7) 45,452 218,784 196,930 11.1 _ 180,510 Total Net Revenues $ 754,801 $ 1,435,243 (47.4) $ 1013099 $ 2,554,827 $ 4,259,426 (40.0) $ 4,040,785 OPERATING EXPENSES Salaries & Wages $ 490,945 $ 607026 (19.2) $ 552,835 $ 1,491,160 $ 1,803,573 (17.3) $ 1,616,259 Employee Benefits 65033 949308 (30.5) 66055 185,132 219,883 (33.9) 231,284 Professional Fees 220,684 185092 19.0 162,099 679062 550,195 23.5 532,550 Operating Supplies 138,921 186,867 (25.7) 197,026 402,548 554,579 (27.4) 523x625 Other 167,701 _ 218,951 23.4) _ 194006 519,_620 649,185 20,0) 619,662 Total Operating Expenses $ 1,083,7A3 $ 1,293444 (16.2) $ 1,173,421 $ 3,277,821 $ 3,838415 (14.6) $ 3,523,380 Income (Loss) Before Depreciation $ (328,982) $ 141,999 (331.7) $ 1399978 $ (122)994) $ 421,411 271.6 $ 511,405 Depreciation (61,557) (80,685) (23.7) (42,672) (1739982) (239,453) (27.3) (123,305) Non-Upt+rating Revenue 3,952 24,630 83.9) _853 182 18,173 _ 73,095 ,(75.1) 113,327 Total Income (Loss) 1(386,587) 85,944 (549.8) 182,488 $ (8181803) 255,053 (444.6) $ 527,427 1 • 1 i VLOW MEMORIAL HOSPITAL BALANCE SHEET December 31, 1986 ASSETS LIABILITIES b FUND BALANCE CURRENT; 1986 1985 CURRENT; 1986 _ 1985 Cash & Investments $ 577,182 $ 1,658,616 Current Notes Payable $ 468,31.4 $ 225j J.07 Accounts Payable 1,6500940 100119509 Patient Receivables 4,655,773 4,835,603 Accrued Expenses 389,469 421,955 Less Allowance (2,345,366) (1969097) Due Government Agencies 322,400 281,751 Net Patient Receivnbles $ 2010,407 $ 2,865,706 Total Current Liabilities $ 2,931,123 $ 1,940052 i Other Current Assets 848,927 1,160,700 Long Term Debt 971,073 1,143,699 Total Current Assets $ 3,736,516 $ 5,685,022 Total Liabilities $ 4,802,196 $ 3,084,051 i 1 3 Property, Plant & Equipment Land $ 37,548 $ 37,548 Fund Balancer Building 3,792,858 3,130,541 Donated Capital $ 4,455,779 $ 4,455,779 I Equipment 7,202,443 5,834,325 Pledges & Gifts 1,039,337 701,177 $ 11,032,849 9,002,413 Beginning Fund Balance (42,491) 475050 Lesst Accumulated Deprec, (5,393,347) (5,443,451) Income & Expense Balance (818,803) _527,427 Nut Property/Plant/Equip. E 5,6391502 _ 3,558,962 Total Fund Balance $ 4,573,822 $ 6,159,933 Total Unrestricted Funds $ 9,376,018 $ 9,243,984 Total Unrestricted Funds $ 9,376,018 $ 90243,984 -2- 16 . ~r FLOW MEMORIAL HOSPITAL COMPARATIVE ANALYSIS - ACCOUNTS RECEIVABLE December 31, 1986 AGING BY DISCHARGE DATE CURRENT % OF PRIOR % OF DAYS MONTH TOTAL MONTH TOTAL 0- 30 $ 2,117,122 46,4 % $ 2,199,486 47.4 % 31- 60 866,389 19.0 708,166 15.3 61- 90 543,468 1119 471,210 10.2 91-120 304,450 6.7 286,708 6.2 121-150 145,104 3.2 255,852 5.5 150+ 583,692 12.8 719,140 1515 $ 4,560,425 $ 4,640,562 REVENUE BY FINANCIAL CLASS _ Current Month 12/86 11/86 10/86 X19/86 08/86 !18 Medicare $ 606,804 33.9 % 25.6 % 30.8 % 29.1 % 26.0 % 26.2 % Medicaid 166,468 9.3 10.6 14.7 915 1018 10.8 Blue Cross 39,380 2.2 1.7 3.0 3.1 3.3 3.3 Commercint Insurance 4991405 27.9 29.9 29.8 29.8 37.6 31.6 Self-Pay 477,924 26.7 32.1 21.7 21.1 22.1 22.1 X1,789,981 DAYS OF REVENUE IN A/R CURRENT MONTH 10/86 09/86 08186 07/86 - Gross 86 97 88 74 78 71 Net 45 55 57 52 49 49 I4Ri'1'EOFF8 h RECOVERIES CURRENT MONTH YEAR-TO-DATE DRG OUTLIERS CURRENT MONTH YEAR-TO-DATE Charity/11111-Burton $ 134,571 $ 387,744 Number of Bad Debt 554,669 1,345,395 Discharges it 5 Bad Dcht Recoveries 42,730 115,772 Over $18000 E F FLOW MEMORIAL HOSPITAL STATISTICAL STATEMENT December 31, 1986 CURRENT MONTH YEAR-TO-DATE PATLENT U'I'ILIXATIONI ACTUAL BUDGET VAR PRIOR YEAR ACTUAL BUDGET % VAR ~PKIUK YEAK Adult Patient Days 1,837 2,170 (15.4) W 2,284 5,151 6,440 (20,0) 6,799 Average Per Day 59.3 70.0 (15.4) 73,7 56,0 70.0 (20.0) 73.9 Average Length of Stay 5.5 4.4 25.0 4.6 5,2 4.4 18.2 5.1 Discharges 334 490 (31.8) 460 998 1,454 (31,4) 1,392 Newborn Patient Days 271 375 (27.7) 387 627 1,113 (43 7) 1,083 Average Per Day 8.7 12.1 (28.1) 12.5 6.8 12.1 (43,7) 1118 N1CO Patient Days 65 65 - 92 183 184 - 264 Average Per Day 2.1 2,1 - 3.0 2,0 2.0 2.9 ICU Patient Days 106 93 14,0 88 294 276 6.5 277 Average Per Day 3.4 3.0 14.0 2.8 3.2 310 6.7 310 Psychiatric Unit Patient Days 218 484 (55.0) 516 651 1,435 (54.6) 1,473 Average Per Day 7.0 15.6 (55.0) 16.6 7,1 15.6 (54.4) 16.0 Percent of Occupancy 42.9 50,7 (15.4) 53.4 40.6 5011 (19.9) .53.6 OTHER U111.1ZATION: Operating Room Procedures 120 143 (16.1) 146 366 424 (13,7) 470 Emergency Room Visits 835 1,224 (31.8) 11115 2,661 3,633 (26.8) 3,347 C'I' Scans 34 59 (42.4) 47 66 175 (62.3) 103 Cert. Nurse-Midwife Deliveries 55 34 61.8 32 137 101 35.6 85 'T'otal Deliveries 94 62 51,6 149 264 .184 43,5 409 Nome Health Visits 220 264 (16,7) 169 643 783 (17,9) 1020 Laboratory Visits 9,227 7,719 1915 81959 28061 22,908 25.6 26,557 PER ADULT PATIENT DAY Cross Patient Revenue 974.40 887.29 9.8 821,98 933.73 887,29 (5.2) 802.63 Not Operating Revenue 410,89 630.82 (34.9) 555,14 495,99 661,40 (25,0) 567.77 Operating Expense. 623,48 633.15 (1.5) 532.44 670,12 633,15 518 536.36 lucome From Operations (212,60) 28.26 - 61,29 (174.14) 28.25 - 76.10 LABOR COST MANAGEMENTi FT'E Employees 291.3 290.8 2 325,2 295.4 29018 1,6 326,5 F'TEs Per Adult Patient Day 4.9 4.1 19.5 4,4 513 4.1 29,3 4.4 FTis Per Adjusted Patient Day* 4,3 3.1 38.7 3.4 4.5 3.1 45.2 314 Payroll as a % of Total Expense 42,9 44.2 (2.9) 145,5 43.2 44.2 (2,3) 44,3 1?'otal f'1'E + ((Patient Days .H Newborn Days) + (Inpatient Revenue + Total Revenue)( r -4- i i l~ i i c9-f, FLOW 1310 Scripture Street MEMORIAL HOSPITAL Denton, TX 76201 (817) 387.8862 January 23, 1987 HAND DELIVERED The Honorable A. Ray Stephens Mayor of Denton 215 East McKinney Denton, Texas 76201 Dear Mayor Stephenet In order to update our request for financial assistance, the Board of Dirwiecthtors of Flow Memorial Hospital has requested that I provide you financial information through the month of December, 1986. The hospital's lose in December was $386,587, and the year-to-date loss now totals $878,803 The Board of Directors is requesting that the city and county reimburse the hospital for this loss. As of January 15, 1987, the hospital had $552,020 in cash and certificates of deposit, and had accounts payable equaling $1,175,352, of which 9938,210 were pant due, The Board of Directors would appreciate your consideration of this matter, Sincerely, ~4 V*j Chatlea B, Linton Chief Executive Officer CBL/ktp act The Honorable Vic Burgasa, County Judge Michael J. Whitton, Chairman, Board of Directors r (a 1Y L~ .1 i FLOW MEMORIAL HOSPITAL INCOME STAThMENT December 31, 1986 MONTH YEAR TO DATE % PRIOR PRIOR M j 1 PATIENT REVENUE: ACTUAL BUDGET VAR YEAR ACTUAL BUDGET VAR Y-T-D ' Inpatient Revenue $ 1,572,941 $ 1,6709165 (5.8) $ 1,675,830 $ 4,164,176 $ 4,956,616 (16,0) $ 4,853,665 Outpatient Revenue 217,040 __255,258 15.0) 201,576 645,464 757,538 14.8) 603,392 Total Patient Revenue $ 1,789,981 $ 1,925,423 (7,0) $ 1077,406 $ 4,809,640 $ 5,714,154 (15.8) $ 5,457,057 DEDUCTIONS FROM REVENUE Contractual Adjusts $ 475035 $ 268,118 77.5 $ 198,409 $ 1,028,133 $ 795,705 29.2 $ 551,400 Bad Debt 450,000 221,586 103.1 310,489 1,117,772 657,610 70.0 736,542 Other Deductions 159,890 66,833 139.2 100,561 327,692 _148,34) 65.2 309,040 Total Deductions $ 1,085,824 $ 556,537 95.1 $ 609,459 $ 2,473,597 $ 1,651,658 49.8 $ 1,596,782 Net Patient Revenue $ 704,157 $ 1068086 (48.6) $ 1,267,947 $ 2,336,043 $ 4,062,496 (42.5) $ 3,860,275 Other Revenue 50,645 G6, 357 23,7) 45,452 218,784 196,930 11,1 1800510 Total Net Revenues $ 754,801 $ 1,435,243 (47.4) $ 1,313,399 $ 21554,827 $ 49259,426 (40.0) $ 4,040,785 OPERATING EXPENSESI Salaries & Wages $ 490,945 $ 607026 (19.2) $ 552,835 $ 11491,160 $ 1,803,573 (17.3) $ 1,6169259 Employee Benefits 65033 94008 (30.5) 66,555 18511,32 279,883 (33.9) 231,284 Professional Pees 220,684 185,392 1910 162,099 679062 550,195 23.5 532,550 Operating Supplies 138,921 186,867 (25.7) 197,026 402,548 554,579 (27,4) 523,625 Other 167,701 218,951 23,4) 194,906 519,620 649,785 20.0) 619,662 Total Operating Expenses $ 1,083,783 $ 1,2939244 (16.2) $ 1,1739421 $ 3,277,821 $ 3,838,015 (14,6) $ 3,523,380 Income (Loss) Before Depreciation $ (328)982) $ 141099 (331.7) $ 139,978 $ (722,994) $ 421,411 271.6 $ 517,405 Depreciation (61057) (80,685) (23,7) (42,672) (173,982) (239,453) (27.3) (123,305) Non-Operating Revenue 31952 24,630 83.9) 850182 18,113 73,095 75,1) _13.3,321 Total Income (Loss,) $ (386,387) 3 85,944 (549.8) $ 182,488 78802) -$__2 5..5 053 (444.6) $ 527,427 _1_ .,4a FLOW MEMORIAL HOSPITAL BALANCE SHEET December 31, 1986 ASSETS LIABILITIES & FUND BALANCE CURREN'rr 1986 1985 CURRENTi 1986 1985 Cash & Investments $ 577,182 $ 1,658,616 Current Notes Payable $ 468,314 $ 225,107 Accounts Payable 1,650,940 11011,509 Patient Receivables 4,655,773 4,835,603 Accrued Expenses 389,469 421,985 Leas Allowance (2,345,366) (1,969,897) Due Government Agencies 322,400 281,751 Net Patient Receivables $ 21310,407 $ 2,865,106 Total. Current Liabilities $ 2,831,123 $ 11940,352 Other Current Assets 848,927 11160,700 Long Term Debt 1,971,073, 1,143,699 Total Current Assets $ 3,736,516 $ 5,685,022 Total Liabilities $ 4,802,196 $ 3,0849051 , Property, Plant & Equipment Land $ 37,548 t 37,548 Fund Balancer Building 3,792,858 3,130041 Donated Capital $ 41455079 4,455,779 r Equipme:t 7,202,443 5,834,325 Pledges & Gifts 1,039037 701,177 $ 11,032,849 $ 9,002,413 Beginning Fund Balance (42,491) 475,550 Lessr Accumulated Oeprec, (5093047) (5,443,851) Iucome & Expense Balance _ (878,803) 527,427 Net Property/Plant/Equip, $ 5,639,502 $ 3,558,962 Total Fund Balance $ 4,573,822 $ 6,159,933 Total'Unrestricted Funds $ 9,316,018 $ 9,243,984 Total Unrestricted Funds $ 9,3761018 $ 9,243,984 -2~ r ti s FLOW MEMORIAL HOSPITAL COMPARATIVE ANALYSIS - ACCOUNTS RECEIVABLE December 31, 1986 AGING EY DISCHARGE DATE CURRENT % OF PRIOR % OF DAYS MONTH TOTAL MONTH TOTAL, 0- 30 $ 2,117022 46.4 % $ 21199,486 47.4 31- 60 8660389 19.0 708,166 15.3 61- 90 543,468 11.9 471;210 10.2 91-120 304,450 6.7 286,708 6.2 121-150 145,104 3.2 255,852 5.5 150+ 583,692 12,8 719,140 15.5 $ 4,560,425 $ 4,640,562 REVENUE BY FINANCIAL. CLASS Current Month 12/86 11/86 10/86 09/86 08/86~Y 117/86 Dledicare' $ 606,804 33.9 % 25.6 % 30.8 % 2911 % 26.0 7. 20.2 7 Medicaid 166,468 9.3 10.6 14.7 9.5 10.8 10.8 Blue Cross 39,380 2.2 1.7 3.0 3.1 3.3 3.3 Commercial Insurance 499,405 27.9 29.9 29.8 29.8 37.6 37.6 Self-Pay 4779924 26.7 32.1 21.7 21.7 22.1 22.1 $ 1,789,981 DAYS OF REVENUE IN A/R CURRENT MONTH 11 86 10/86 09/86 OS 86 07/8 6 Gross 86 97 88 74 78 71 Net 45 55 57 52 49 48 WRITEOFFS & RECOVERIES CURRENT MONTH YEAR-TO-DA'Z'E DR(; OUTLIERS CURRENT MONTH YEAR-TO-DATE Charity/Hill-Burton $ 134,571 $ 387,744 Number of - Bad Debt 554,669 .19345095 Discharges 4 5 Bad Debt Recoveries 42,730 115,772 Over $18000 ti Y. FLOW MEMORIAL HOSPI'T'AL STATI S'I'1CAT, STATEMENT December 31, 1986 CURRENT MONTH YEAR-TO-DATE PATIENT UTILIZATION: ACTUAL BUDGET Z Vi,H PR10R YEAR ACTUAL BUDGET 7 VAR PRIOR YEAH - Adult Patient Days 1,837 2,170 (15,4) 2,284 5,151 6,440 (20.0) 6,799 Average Per Day 59.3 70.0 (15.4) 73.7 5610 70.0 (20,0) 73.9 Average Length of Stay 5.5 4.4 25.0 4.6 5.2 4.4 18.2 5.1 Discharges 334 490 (31.8) 460 998 1,454 (31.4) L,392 Newborn Patient Days 271 375 (27.7) 387 627 1,113 (43.7) 1,083 Average Per Day 8.7 12.1 (28.1) 12.5 6.8 12.1 (43.7) 11.8 NICU Patient Days 65 65 - 92 183 184 264 Average Per Day 2.1 2.1. - 3.0 2.0 2.0 - 2.9 ICU Patient Days 106 93 14.0 88 294 276 6.5 277 Average Per Day 3.4 3.0 14.0 2,8 3 ? 3.0 6.7 3.0 Psychiatric Unit Patient Days 218 484 (5510) 516 6'1 19435 (5(1,6) 10473 Average Per Day 7,0 15.6 (55.0) 16.6 7.1 15.6 (54.4) 16.0 Percent of occupancy 42.9 50.7 (15.4) 53.4 40.6 50.7 (19.9) 53.6 OTHER UTILIZATION: Operating Room Procedures 120 143 (16.1) 146 3,,6 424 (13.7) 470 Emergency Room Visits 835 1,224 (3118) 10115 2,661 3,633 (26.8) 3,347 CT Scans 34 59 (42.4) 41 66 175 (62.3) 103 Cert. Nursc-tdidwlfe Deliveries 55 34 61.8 32 131 101 35.6 85 Total Deliveries 94 62 51.6 149 264 184 43.5 409 Home Health Visits 220 264 (16.7) 169 643 783 (17.9) 1,020 Laboratory Visits 9,227 7,719 19.5 81959 28,761 22,908 25.6 26,557 PER ADULT PATIENT DAYa Gross Patient Revenue 974.40 887.29 9.8 8>L 98 933.73 887.29 (5,2) 802.63 Net Operating Revenue 410.89 630.82 (34.9) 555.14 495.99 661.40 (25.0) 367.77 Operating Expense 623.48 633.15 (1,5) 532.44 670.12 633.15 5.8 536.36 Incoma From Operations (212.60) 28.26 - 61,29 (174.14) 28.25 76.10 LABOR COST MANAGEMENT: FTL Employees 291.3 290.8 .2 325.2 295.4 290.8 1.6 326.5 xT89 pet Adult Patient Day 4.9 4.1 19.5 4.4 5.3 4.1 29.3 4.4 FTBs Per Ad'Jested Patient Day+f 413 M. 38.7 5,4 4.5 311 45.2 3.4 Payroll as a y of Total Expense 42.9 44.2 (2.9) 45,5 43.2 44.2 (2.3) 44.3 PRESS RELEASE MARCH 7, 19870 1:00 P.M. Late yesterday afternoon, each City Council Member receivec a communication from the Board of Directors of Flow Regional Medical Center, the new board formed to operate and manage Flow Memorial Hospital under the 501-(C)(3) structure. Those board members submitted "absolute minimum requirements" for them to assume operations of Flow under the terms of the proposed lease. These minimum requirements are; 1. an immediate infusion of 91.5 million in cash; 2. modification of the proposed lease agreement by relieving Flow of its obligation to provide a percentage of its revenues for indigent health care for a period of eighteen months; 3. free City utilities for a period of eighteen months; 4. funding of the nurse ,'midwifery program from sources other than the hospital or alternatively closing the program; and 5. agreement by the City and County to retire the existing indebtedness which was to have been assumed by the hospital under the proposed lease agreement. . PRESS RELEASE March 7, 1987 Page two These demands constitute a request of more than $3.7 million of City/County funds as a minimum for the Board to assume operations. I have conferred by telephone with members of tme city Council and would like to provide the Council's response to this document. The Implications of the Board that the current financial difficulty of the Hospital has occurred because the City and County have not taken prompt "action" in facilitating the transfer and supporting Flow is in error. In fact, on numerous occasions during this last very difficult year, the City has waited for weeks and months for needed responses from the attorney representing the Hospital n oard so that the legal structure could be put In place to permit the operrition of the SCI-(C)(3). The city was perplexed by several delays caused by the Board's attorney throughout these deliberations and was continually frustrated by the lack of the speedy resolution of outstanding issues. In fact, several times during the discussions, the Council "gave in" to 5oard demands in order to keep the process moving. The financial demands now being placed upon the City during the r last hour of this lengthly process are completely unrealistic And impossible for the City to meet. The 'City has no recourse other than to reject the absolute minimum demands as presented by the Board. PRESS RELEASE March 7, 1987 Page three First, the dollars are simply not available to meet the type of financial demands being made by the Board. As our citizens are aware, approximately one week ago we instructed our City i Manager to present alternatives to the City council for raising money that could be forwarded to Flow Hospital to help the current situation, Those alternatives were being prepared and were scheduled for Council discussion Tuesday evening. However, because of a shortfall in City sales tax dollars and other financial constraints, the City finds itself in an extremely tight budget situation. In fact, the City Manager has shared with us that alternatives were being prepared which would have raised approximately $200,000 for Flow Hospital, Raising even that amount, however, would have been impossible without pain and would have required, among other things, the elimination of the street resurfacing program for this summer, the foregoing of hiring three additional police officers which is scheduled for April 1, and several other reductions which would have an impact on services provided to our citizens. The consequences of providing more than ten times that amount in the middle of a budget year is hard to comprehend, In order to raise that type of money, massive layoffs of current City employees would be required resulting in the elimination and reduction of numerous City programs of almost every description. PRESS RELEASE March 7, 1987 Page four The Board's letter contends that we should be willing to make this payment since the City and County would be obligated to assume Flow's current indebtedness of $5 million if the Hospital closes, This contention is subject to legal disagreement and would likely be the subjecb• or litigation before the issue was finalized. In addition to the unrealistic dollars which have been requested, certain legal matters, such as giving free utility services, Is prohibited by the City Charter and St could not be done by this or any City Council. Therefore, since the monetary demands from the new board cannot either legally or practically to met, the City Council is of one mind that the negotiations to form a lease with the present members of the 501_(C)(3) corporation have come to an end and the members have, in effect resignations, The City Council appreciates the work done by these members on an individual basis. It is with the deepest regret we conclude that the efforts to lease the hospital have not succeeded because of these last hour demands which are impossible for the City to meet, ` While concluding that the current negotiations have ended, all of the members of the Clty Council desire that Flow Hospital continues to operate. Therefore, during the coming days, we { PRESS RELEASE March 7, 2987 Page five will be taking several actions to determine if Flow Hospital can continue to operate in some form within our community. In this regard, the City, hopefully to be joined by the County, will at our meeting Tuesday night consider the hiring of the auditing firm of Deloitte, Haskins, and Sells-,to assess the possibility of both short and long term continuation of Flow Hospital and to make appropriate recommendations accordingly. In addition, the City has already begun to explore, in cooperation with Denton County officials, other structural arrangements which would allow for the continuation of Flow Memorial Hospital, Also, in an effort to allow time for the City and County to discover a workable solution to this perplexing community problem, we have asked the City administration to allow the Flow Hospital utility account of 9137,000 to remain in a delinquent status for a short period of time. In conclusion, we must be honest and acknowledge to the community that these latest efforts to save Flow may be in vain and it is possible that Flow Hospital will close. However, the City Council members to a person pledge our best efforts to find a workable alternative to such unfortunate action if such is available. We call upon the physicians and all Penton citizens to join us in making the continuation of Flow a community effort. I jY ,i e PRESS RELEASE March 7t 1987 Page six The other Council members and I would be happy to respond to any questions any member of the press might hove concerning this critical issue. i 2588C I~I March 11, 1987 We, the undersigned members of the Denton Ministers' Association, call upon the Denton Community to join in a concerted effort to save Flow Hospital. We do this because we see no other viable means for providing hospital care to those whose need exceeds their ability to pay. Should Flow close, it is extremely doubtful that our "for profit" hospitals would be able to fund adequate health care for those unable to pay. They would have to add too much to the bills of those who can. It seems much more fair that the coat of indigent health care should come out of the taxes of all rather than out of the pockets of the already hard- pressed patients. We therefore ask: l.. That a hospital district be established with power to tax; 2. That both city and county be urged to provide emergency funds to Flow Hospital to keep it functioning until such a hospital district can be established, 3. That the hospital boards organize a fund drive asking that everyone able purchase one or more shares at $100, each in a apecial "Save Plow Hospital ^ n.';" 4. That, when appropirate and in accord with good medical practice, insured and other patients able to pay, consider helping Flow Hospital by using it for their care; 5. And that this in no way be considered as critical of our community's "for profit" hospitals, but rather, as coming out of the conviction that our community needs both private and pisblic hospital care. I\ 1` t E'G ~~Cr,~N? of . fZa t