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Indian River Memorial Hospital, Inc. d/b/a
Indian River Medical Center
Dec 10, 2015 at 04:30 PM - 05:30 PM
IRMC Boardroom
1000 36th Street
Vero Beach, FL
This meeting may be recorded
a. Approval of Minutes
1. William Baxt, M.D.
1. Class of 2018
b. Nominating Committee
1. Minutes Dated October 28, 2015
II. Consent AgendaWayne T. Hockmeyer, Ph. D.
For Action
1. Residency Requirement
2. Compliance Committee Membership
1. Residency Requirement
a. Bylaw Revisions
III. Chairman's ReportWayne T. Hockmeyer, Ph. D.
For Action
a. Presentation of Employee CampaignCommittee
IV. Foundation Chairman's ReportAnthony Woodruff
For Information
a. Human Resource Annual Report For Information
V. President's ReportJeffrey L. Susi
I. Call to OrderWayne T. Hockmeyer, Ph. D.
For Information
2. Juliette Lomax-Homier, M.D.
1. Compliance Committee Membership
b. November/December Report
Meeting Book - Board of Directors
Board of Directors
Page 4
Page 8
Page 17
Page 19
Page 21
Page 22
Karen Mitchell
b. November/December Report
1. Annual Human Resources Report
a. October 2015 Consolidated, Hospital, Physician& Imaging
b. IRMA Physician Practice Update
1. Pension Plan
c. Pension Plan Risk Management Tactics
1. October 2015 Consolidated Financials
1. FY 2015 IRMA Financials
VI. Finance CommitteeJack Weisbaum
1. William Kelley, M.D.
2. Fran Ross, Esq.
a. Recognition of Outgoing Board Members
VII. Other BusinessWayne T. Hockmeyer, Ph.D.
For Information
1. November/December Report
2. Towers Watson Presentation
3. Charles Celano, M.D.
VIII. Public Comment
IX. Adjoun to the Private Session
Page 25
Page 51
Page 56
Page 60
Page 73
Page 76
INDIAN RIVER MEMORIAL HOSPITAL, INC. D/B/A
INDIAN RIVER MEDICAL CENTER BOARD OF DIRECTORS
MINUTES
The regular meeting of the Indian River Medical Center Board of Directors was convened by Chairman Wayne Hockmeyer, Ph.D. on October 28, 2015 at 5:40 p.m. in the Hospital Boardroom. MEMBERS PRESENTS: Wayne Hockmeyer, Ph.D., Chairman
Charles Celano, M.D. Michael Hammes Kathy Hendrix John Lindenthal, M.D. Hugh McCrystal, M.D. Keith Morgan Jack Pastor Matthew Reiser Gerri Smith Jeffrey L. Susi Jack Weisbaum Anthony Woodruff
MEMBERS EXCUSED: William Kelley, M.D. Donald Laurie Pranay Ramdev, M.D. Fran Ross, Esq.
OTHERS PRSENT: Jan Donlan
Warren Fuller Greg Gardner Barbara Grimaldi Lisa Hedenstrom, Ph.D., R.N. Allen Jones Valerie Larcombe, Esq. Lisa Licitra Charles Mackett, M.D. Ann Marie McCrystal, R.N. Nate McCollum Karen Mitchell William Neil Steven Salyer Grace Simonson Cary Stowe, M.D. Richard Van Lith, Pharm. D.
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CONSENT AGENDA The following items were previously discussed at respective committees and distributed for review to the Board of Directors as Consent Agenda:
1. Approval of Minutes
a. IRMC Board of Directors Minutes dated August 26, 2015
2. Governance Committee
a. 2016 Proposed Slate of Officers
Wayne T. Hockmeyer, Ph.D.
Jeffrey L. Susi, President/Chief Executive Officer
Jack Pastor, Vice Chairman
Gerri Smith, Secretary
Jack Weisbaum, Treasurer
3. Nominating Committee
a. Class of 2018 Reappointment
Jack Weisbaum – Three year term
4. Joint Conference Committee
a. Medical Staff Privilege Forms Revisions
Gastroenterology
Family Medicine
b. Medical Staff Chief of Staff and Vice Chief of Staff Elections – Two Year Term
Hal Brown, M.D. – Chief of Staff
John Lindenthal, M.D. – Vice Chief of Staff
5. Finance Committee
a. FY 2016 Operating and Capital Budget Dr. Hockmeyer asked the Board Members if anyone wished to remove any item under the Consent Agenda for further discussion. There were no requests. Dr. Hockmeyer asked for a Motion to accept the Consent Agenda. Upon MOTION made by Dr. McCrystal, duly seconded by Mr. Pastor and unanimously carried, the Board of Directors approved the Consent Agenda as presented.
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FOUNDATION CHAIRMAN’S REPORT Mr. Woodruff reported on the beginning of the new season for the Foundation. November 4th is a orientation for six new Foundation Board members. On November 18th there will be a soft opening of the Scully Welsh Cancer Center. The Grand Opening will be held in January. Mr. Woodruff referred to the most recent Foundation mailing that includes a timeline of fundraising efforts since 1998. It is incredible how much has been accomplished in this timeframe. The Cancer Campaign still needs $8 million to reach its goal. The Foundation has also committed $4.5 million for EP. A donor has also given $1million to start the funding of an endowment. PRESIDENT’S REPORT Mr. Susi explained that the Medical Center has been working collaboratively on several project with the District. The Partners Collaborative, led by Allen Jones for the District and Kathy Hendrix for the Medical Center, have been working on a quality metrics for the Partners Program. Ms. Hendrix explain the Collaborative Group has worked on defining the needs of women in the community and developed solutions to help monitor and provide services for the high risk pregnancies. The work of the Collaborative is being developed into an agreement between the Medical Center and the District. The Collaborative will continue to meet quarterly. Discussion ensued. Mr. Susi explained that he is authorized to sign the agreement on behalf of the organization but suggested that given the importance of this issue, the Chairman be authorized to execute this agreement. Upon MOTION made by Ms. Hendrix, duly seconded by Mr. Weisbaum and unanimously carried, the Board of Directors authorizes Dr. Hockmeyer to execute the Partners agreement between the Medical Center and the District. Recently a review of the Emergency Department has been completed by Dr. William Baxt and Ms. AnnMaire Papa who are affiliated with the University of Pennsylvania. Dr. Baxt is an Emergency Physician and Ms. Papa is a nurse. They had very positive things to say about Dr. Giasi and felt IRMC had the right leadership in place. They also complemented the organization for the performance excellence hour which takes place each day. During the performance hour, all of the leadership meets to address the real time issues. Dr. Baxt did have some recommendation regarding the electronic medical record and suggested the nursing director of the Emergency Department report directly to the Chief Nursing Officer. This change has already been implemented. Mr. Susi noted the invitations to the annual employee awards banquet, the Medical Staff Holiday Party and the IRMA Quarterly Business Meeting. Governance Committee The Bylaw Revision discussion was deferred until next month. Joint Conference Committee Dr. Celano explained the proposed Medical Staff Leadership criteria which will be going to the Medical Staff for ratification. The criterion includes committee attendance obligations.
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Investment Committee The Investment Committee received the quarterly report of the investments as of September 30, 2015. The Frozen Pension Plan liability is projected based on a snapshot on September 30, 2015. The liability was approximately $18 million on that date but today the gap would be about $5 million less. The Plan is 80% funded similar to the majority of other institutions. Finance Committee The Finance Committee met for more than two hours yesterday and reviewed the consolidated results. The financial impact from the HAVAC event will be approximately $1 million, but we are still evaluating insurance coverage. The Committee also reviewed in depth review of the imaging business which was recently acquired. The meeting adjourned to the private session at 5:36 p.m. Respectfully submitted, Wayne T. Hockmeyer, Ph.D. Chairman
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Section 4.2. QUALIFICATIONS, TENURE AND ELECTION.
APPOINTMENT PROCEDURES.
4.2-1 Number and Voting. There shall be seventeen members ofDirectors
on the Board. Each member, except the President, shall have a vote.
4.2-2 Composition, Qualifications and Terms.
4.2-2.1 Composition. The Board shall be composed of twelve
Independent Directors, three of whom shall be designated by the District;
one elected Medical Staff Representative; and four ex-officio Directors; the
President; the Chairman of Indian River Medical Center Foundation (or
designee nominated by the Chairman of the Indian River Medical Center
Foundation and approved by the Board of Directors); the Chief of the
Medical Staff; and the Vice Chief of the Medical Staff.
4.2-2.2 Qualifications. Any adult Florida resident is eligible to serve
as an Independent Director other than: (1) a Public Official; (2) a member
of the Medical Staff with current clinical privileges; or (3) an employee of
Indian River Memorial Hospital, Inc. or any of its subsidiaries. and
affiliates. The Nominating Committee or the District, as the case may be,
shall find one or more of the following characteristics in prospective
Independent Directors: demonstrated management or professional acumen,
prior experience in health care delivery, a history of voluntary service, or a
particular attribute or skill considered desirable.distinctive competency
considered desirable. All Directors should possess universal competencies
as assessed by the Board in accordance with its Guidelines for Developing
Board Competency Based Standards.
4.2-2.3 Terms. Independent Directors shall be divided into three
equally-sized annual classes. Each class shall be elected for a term of three
years. The Medical Staff Representative shall serve two-year terms.
4.2-3 Election Procedures.
A. 4.2-3.1 Elected Directors. A Nominating CommitteeSubcommittee
shall be appointed annually in accordance with Section 6.1-1. The
Nominating CommitteeSubcommittee shall present its nominees for
Independent Director to the Board no later than the regular Board meeting
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preceding the Annual Meeting. The number of nominees presented shall
equal the number of Independent Directors to be elected by the Board at
such meeting. Nominees for re-appointment to the Board shall require a
majority vote of the Nominating CommitteeSubcommittee. Nominees to be
newly appointed to the Board shall require the unanimous vote of the
Nominating CommitteeSubcommittee. The Board shall elect Independent
Directors from among those persons nominated by the Nominating
CommitteeSubcommittee at or before its regular monthly meeting
immediately preceding the Annual Meeting. A newly-elected Independent
Director shall assume his or her position at the start of the Annual Meeting.
Section 4.2-4. TENURE. After completing three consecutive three-year
terms, no Independent Director shall be eligible for either election or
designation as an Independent Director until the next Annual Meeting,
provided, however, the Chairman of the Board may continue to serve for an
additional one (1) year term if the Governance Committee recommends and
the Nominating Committee and the Board approves an exception for the
Chairman to continue to serve as Chairman.
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6.1-6 COMPLIANCE COMMITTEE.
6.1-6.1 Composition and Appointment. The Compliance Committee
shall consist of the Committee’s Chairman, the Corporation’s Treasurer and
six (6) Independent Directors as assessed by the Board in accordance with its
policy on the Independence of Directors. It is intended that the Compliance
Committee shall be solely comprised of Independent Directors.
6.1-6.2 Authority and Function. The Compliance Committee assists
the Board of Directors consistent with the Compliance Committee Charter in
fulfilling the Board’s corporate governance and oversight fiduciary duties in
relation to corporate compliance, executive compensation, enterprise risk
management and internal control systems including the internal and external
audit function of the Corporation and its affiliates. The Compliance
Committee shall operate in accordance with its Charter then in effect or as
amended from time to time. To fulfill its Compliance function, the
Compliance Committee oversees three (3) Subcommittees (Audit, Physician
Compensation and Executive Compensation) each of which is further
described in Subsections 6.1-6-2, 6.1-6-3 and 6.1-6-4 of this Section 6.1-6.
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Indian River Medical Center Foundation Report
Indian River Medical Center
Board of Directors
October/November 2015
Campaign for Excellence in Cancer Care
The recent announcement of Dr. James Grichnik as Director of the Scully-Welsh Cancer Center
generated widespread and enthusiastic response in the community. Dr. Grichnik’s international
reputation, impressive resume and Duke connection resonated with donors and prospective
donors to the Campaign for Excellence in Cancer Care.
On the heels of Dr. Grichnik’s appointment, the completion of the Scully-Welsh Cancer Center
in mid-November amplified the progress in cancer care. Attendance at the November 18
preview reception numbered 185, all anxious to meet the new director and tour the state-of-the-
art center. Prior to the event, a timely Foundation mailing provided donors and prospects with
a draft of the donor recognition list resulting in a wave of interest. Many were motivated to
support the campaign via naming opportunities and additional gifts arrive daily. To date, total
funds raised for Excellence in Cancer Care tally $42 million. Additional verbal commitments have
been received further narrowing the gap to our $48-million campaign goal. Naming options
remain available on both the first and second floors of the center and tours continue to
showcase the center and these opportunities to give.
Continuing to exceed expectations, the Foundation’s November 19 season kick-off event
presented an all-star cast to members of the Foundation Board, Honorary Board, Advisory
Council, Community Leadership Committees and James B. Malloy Society. Led by Foundation
Chairman Tony Woodruff, IRMC CEO Jeff Susi and Foundation President Jan Donlan, the
program featured visionaries in both the clinical and philanthropic arenas. Addressing future
medical advancements were Dr. James Grichnik, Dr. Linda Sutton, Director Duke Oncology
Network, Dr. James Daubert, Cardiology and Clinical Cardiac Electrophysiology at Duke, and
IRMC’s Chief Nursing Officer/Vice President of Patient Safety Lisa Hedenstrom. Passionately
illustrating the continuing importance of philanthropic vision were donors Carol Welsh,
Marlynn Scully and the initiator of our new Endowment for Excellence in Patient Care, Al
Martinelli.
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Within days of the kickoff, Community Leadership Committees began to focus on prospects
and activities to complete Excellence in Cancer Care. Volunteers will also help to introduce the
new $5-million initiative to support development of IRMC’s electrophysiology program and
specialized cardiac catheterization lab, as well as the endowment effort introduced by Al
Martinelli.
Beginning its volunteer efforts even before the kick-off event, Grand Harbor Leadership
Committee hosted the first Eagle Society event of the season for 118 dinner guests. On
November 11, radiologist Dr. Heather Nagel shared a “grateful physician’s” view of the
importance of philanthropy to the delivery of outstanding healthcare for our community. Dr.
Nagel’s heartfelt progress report highlighted the cancer care program and the incomparable
benefits philanthropy offers to patients throughout IRMC.
Also prior to kickoff, new members of the Foundation Board of Directors and Advisory Council
joined Foundation President Jan Donlan and IRMC CEO Jeff Susi for an informative orientation
and tour. New Board members include: Jim Balog, Kay Brown, Chris Clifford, Dick Sameth and
Buzz Wurzer. Returning to the Board are Jack Rohrbach and Dr. Richard Milsten. Joining the
Honorary Board are Bernadette Emerick, Allen Jones and Barry Reardon. New to the Advisory
Council are Nancy Cruce, Ted Herget, France Kenyon, Ellen Kowalyk, Brian Kroh, Diana Stark
and Dr. Ted von Zielinski.
Planned Giving
Members of the Foundation’s Professional Circle gathered for their annual luncheon and
update on IRMC advancements and Foundation initiatives. Capping an enlightening program,
Al Martinelli shared his views on the importance of endowment giving. Best known as founder
of Buckeye Partners and a former chairman of the board at Philadelphia’s Hahnemann
University Hospital, Al and his wife Aline committed $1 million to start the general endowment
for Excellence in Patient Care at IRMC. With their son and daughter pledging an additional
$500,000, the family is encouraging others to help build an endowment that will enable medical
center leaders latitude to day-to-day challenges and opportunities associated with delivering
quality healthcare. To support Al’s dream of a $60-million endowment, the Foundation will
seek immediate outright commitments and, with the help of the Planned Giving Committee and
Professional Circle, promote deferred gifts to the endowment.
FY16 Annual Fund
Each fiscal year, Annual Fund contributions largely are generated by direct mail appeals in
October and December. Typically, two appeals are sent to members of The Eagle Society and to
non-Eagles throughout the IRMC community. With the Campaign for Excellence in Cancer Care
in its final phase, our direct mail strategy was modified to capitalize on year-end giving.
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In October of FY16, the non-Eagles across the community were solicited, as usual, for
contributions to the Annual Fund. However, members of The Eagle Society instead received a
draft of the Campaign for Excellence in Cancer Care donor recognition display, along with an
opportunity to make their first or an additional gift to the campaign before December 31,
thereby earning or enhancing their position on the recognition wall.
Also mailed in October to more than 15,000 community households, was the Foundation’s
Philanthropy at Work Timeline, an illustration of IRMC advancements made possible by The Eagle
Society since the mid-1990s. Though not a solicitation, the timeline resulted in $255,679 in
unrestricted gifts to the Annual Fund.
As of November 30, 2015, a total of $314,813 in unrestricted gifts and pledges had been received
for the Annual Fund. Included are contributions resulting from direct mail appeals, the Annual
Fund includes honor/memorial gifts, estate distributions, unsolicited gifts, unrestricted online
gifts, and those generated by special mailings such as the timeline.
Also as of November 30, 2015, the Foundation had received $1,449,121 in gifts and pledges to
the Cancer Campaign, prompted by the October mailing to The Eagle Society. During the same
period last year, Annual Fund mailings to Eagles and non-Eagles netted $539,079. While the
FY16 results represent a decrease of $224,266 in Annual Fund gifts, the net gain is $1,224,855 in
combined support of the Annual Fund and cancer care.
As in years past, there will be two direct mail appeals in early December. Featured in the
mailing will be the impressive compilation of ten awards for excellence received by IRMC in
just six months. One mailing will be sent to non-Eagles who did not respond to the October
Annual Fund appeal. The other mailing will reach Eagles who did not respond to their October
appeal and will offer the option to support either the Annual Fund or Excellence in Cancer Care.
May Pops
Mark your calendars for the 27th annual May Pops: Sunday, May 1, 2016 at Windsor.
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Human Resources Highlighted Results
July 2014 to Present
Presented December 10, 2015 by Karen Mitchell, VP/CHRO
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Broad HR Functional Areas
• Recruitment
• Employee and Labor Relations
• Benefits
• Compensation
• Occupational Health
• HRIS
• Organizational Development & Training
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Recruitment Process
Application
Submitted
Inclusive of
Behavioral
Assessment
Tool
HR Screens
for Minimum
Qualifications
and Selects
Candidates(s)
for Initial
Interview
HR Conducts
Behavior
Based
Interview to
Confirm
Minimum
Qualifications
Met and
Screen for
Cultural Fit
Applicant is
Hired and
Begins Work
HR Begins
Pre-
Employment
and
OnBoarding
Activities
Candidates
Who are
Successful
in HR
Interview are
Referred to
Hiring
Leader(s)
Hiring
Leader
Conducts
Behavior
Based
Interview
Using Guide
Hiring
Leader
Makes
Selection
Decision
and Advises
HR
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Selection Tools &
Interview Guides
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OnBoarding & Orientation
• IRMC’s OnBoarding & Orientation
programs provide a sense of community
for new employees; inspiring
engagement and commitment;
integrating new employees into the
culture; and promoting knowledge, and
excellence throughout the organization.
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OnBoarding & Orientation Design
Prepare
Day 1 –New
Employee Orientation
First 90 Days
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Prepare Phase Components
• Consistent welcoming practices
– Work station/locker ready
– New Employee profile posted
– Work orders submitted
– OnBoarding Champion assigned
– Announcement in huddle
– Training plan prepared
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Day 1 –
Initial Orientation Changes
• Welcome table & greeter
• Branded folder for handouts
• PowerPoint updates
• Badge photo in HR
• Audience participation/raffle
• Lunch ticket (managers)
• Online feedback survey
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Day 1 –
Recent Orientation Changes
• Slogan - “It starts with me”
• New agenda grouped by theme - Handout
• Executive Presentation of Mission/Vision/Values
• Presenting HCAHPS & Core Measures
• Icebreakers & stretch breaks
• Same PPT template for all presenters
– Include master slide set for ease of transition
• Add group work & role play
• OnBoarding program explained in NEO
• Room setup semi-banquet style
– Promotes getting to know others in orientation
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First 90 Days
• Onboarding Champion AssignedIntroduce to peers Build Social Ties Hospital Tour
Lunch Do’s & Don’ts
• Manager 1 week check-in 30/60 day meetingGauge how new hire is adjusting Surface retention concerns
Surface performance/training concerns
• 90 day new employee online surveyAcculturation Pre-Employment Manager and Coworker Interaction
OnBoarding Champion Interaction
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OnBoarding Badge Reel
• Purpose –recognize
new employees
– Smile & speak
– Offer help
– Return to HR after 90
days
• Replace w 90+ badge reel
• Staff meeting info
sessions
• Explain in NEO35 of 103
Employee Engagement
At the time - 2014 Survey
• Reduction in Force
• Projected financial losses
At the time - 2015 Survey
• Grassroots efforts
• Internal Engagement
Champions
• Developed Action Plans
by Department
• Implemented huddles and
rounding programs
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Employee Survey Results
13
IRMC’s national percentile rank across all employee
survey items—IRMC went from performing better than
10 percent of healthcare organizations in the national
database to outperforming 40 percent!
10th 40th
2014 2015
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14
2015
Employee
Engagement
Score
A Focus on Employee
Engagement at IRMC
IRMC
Overall
4.92
Diff. from
Prev
+.50
Diff. from
Nat’l.
Avg.
-.06
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Personal Appearance Policy
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Benefits
• Contracted and transitioned to Florida
Blue as ASO Provider effective
1/1/2015
• Redesigned health plan to increase
domestic steerage
• Kept employee contributions same for
three plan years
• Spousal exclusion effective 1/1/201640 of 103
Benefits
• RFP for supplemental life and disability,
resulting in savings
• Implemented with vendor for ACA
tracking and compliance
• Auto Enrollment in the 403(b) retirement
plan effective 1/1/2016
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Incentive Compensation
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Occupational Health –
Flu Vaccination Compliance
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Employees Medical Staff Allied Staff Volunteers
2014/15
2015/16
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Workers Compensation
0
500
1000
1500
2000
2500
Lost Days
2012/13
2013/14
2014/15
120
130
140
150
160
Total Incidents
2012/13
2013/14
2014/15
0
500
1,000
1,500
2,000
2,500
Modified Days
2012/13
2013/14
2014/15
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Occupational
Health Visits
0
1000
2000
3000
4000
5000
6000
7000
8000
Total Visits
2013/14
2014/15
• New Hire Physicals
• Return to Work
Clearance
• Injuries
• TB Screening
• Fit-Tests
• Vaccinations
• Blood Pressure
• Workstation
assessments
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HRIS
• Evaluated current systems:
– HR & Payroll – Infinium
– Time & Attendance – Kronos
– Learning Management – Healthstream
– Staffing & Scheduling – ESP
– Benefits Enrollment - ADP
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Developing Our Leaders –
Leadership Institute
Mission: The IRMC Leadership Institute supports the
mission of IRMC by delivering engaging development
activities to facilitate excellence in leadership and
cultivate organizational learning, knowledge, and
wisdom.
Goals & Objectives: – Align development actions with organizational mission, vision,
values, and strategic goals
– Ensure a pipeline of future leaders are prepared for executive
positions
– Deliver development activities appropriate to leadership level in the
organization
– Develop and strengthen IRMC’s key leadership competencies and
behaviors in all leaders
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New Manager
Orientation
Co
ach
ing
Lea
de
r
Nurse Manager
Development
Fundamental
Management
Skills
Mid Level –
Advanced
Management
Skills
Me
nto
r L
ea
de
r
Successor
Development
Continuing
Education &
Development
Mentoring HIPOs & Successors
Tra
nsfo
rma
tio
na
l Lea
de
r
Advanced
Facilitation
HIPO
Development
Coaching &
Developing Leaders
Su
pe
rvis
or/
Lead
Ma
na
ge
rD
ire
cto
r/
AV
PE
xec
uti
ve
Developing Leadership
Institute Programs
Priority for 10/1 launch
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Manager Development Program Courses & Schedule
FALL 2015 Topic Time Location Facilitator Executive
9/15/15
Tue
Introduction & Role of the Manager 4 hours
10a-2:30p
MED A&B Rosalie Hakker Jeff Susi
9/16/15
Wed
Budgeting and Finance for Non-
Financial Managers
3 hours
10a-1:30p
MED C Warren Fuller Warren Fuller
9/22/15
Tue
Employment Law & Diversity 4 hours
10a-2:30p
MED A&B Susan Eisenberg &
Rosalie Hakker
Valerie Larcombe
9/29/15
Tue
Personality Plus (MBTI) &
Interpersonal Communication Skills
6 hours
10a-4p
MED A&B Rosalie Hakker Lisa Hedenstrom
10/1/15
Thu
Managing Multiple Priorities 4 hours
10a-2:30p
MED A&B Rosalie Hakker Bill Neil
10/6/15
Tue
Interview & Selection Practices 6 hours
10a-4p
MED A&B Rosalie Hakker Dr. Mackett
10/13/15
Tue
Coach to Lead 4 hours
10a-2:30p
MED A&B Rosalie Hakker Steven Salyer
10/20/15
Tue
Corrective Actions 4 hours
10a-2:30p
MED A&B Rosalie Hakker Karen Mitchell
10/21/15
Wed
Conflict Resolution 4 hours
10a-2:30p
MED A&B Rosalie Hakker Lisa Hedenstrom
10/27/15
Tue
Teambuilding & Collaboration 4 hours
10a-2:30p
BHC Café & Gym Rosalie Hakker &
Chris Ellison
Jan Donlan
11/3/15
Tue
Leadership in Action 4 hours
10a-2:30p
MED A&B Rosalie Hakker Lewis Clark
11/10/15
Tue
Performance Appraisals 4 hours
10a-2:30p
MED A&B Rosalie Hakker Karen Mitchell
11/17/15
Tue
Managing Change 4 hours
10a-2:30p
MED A&B Rosalie Hakker Richard Vanlith
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What’s Next
• Continuous improvement of employee engagement,
including a mid-year pulse survey
• Reduction in turnover rate, including exit interview
research
• Compensation program and structure audit and
redesign
• Implementation of core HR/Payroll, Time &
Attendance and Staffing & Scheduling Technologies
• Continued focus on people development, for both
leaders and staff
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PRESIDENT’S REPORT
November/December 2015
Scully-Welsh Cancer Program - Medical Director Dr. James Grichnik, an international expert on the diagnosis and treatment of melanoma, has been named Medical Director of the Scully-Welsh Cancer Center at Indian River Medical Center. Dr. Grichnik brings extensive knowledge in cancer research and the use of innovative technologies to detect and treat cancer at the earliest, most curable stages. He has directed melanoma programs at the University of Miami (UM) and Duke University Medical Center in Durham, N.C. Dr. Grichnik earned his medical degree from Harvard Medical School in Boston and has a Ph.D. in cell biology from Baylor College of Medicine in Houston. Dr. Grichnik’s experience is critical in Indian River County, where cancer is the leading cause of death and melanoma is one of the fastest growing cancers according to the American Cancer Society. Grichnik will relocate in January 2016, when he assumes his new role on January 4. The Scully-Welsh Cancer Center was built through the generosity of donors to Indian River Medical Center Foundation’s Campaign for Excellence in Cancer Care. Affiliated with Duke Cancer Institute, the Cancer Center brings world-class resources and a full continuum of cancer care to IRMC. The facility gives patients access to the latest technology, research and treatment options for a seamless journey from diagnosis through treatment.
Campaign for Excellence in Cancer Care The recent announcement of Dr. James Grichnik as Director of the Scully-Welsh Cancer Center generated widespread and enthusiastic response in the community. Dr. Grichnik’s international reputation, impressive resume and Duke connection resonated with donors and prospective donors to the Campaign for Excellence in Cancer Care.
On the heels of Dr. Grichnik’s appointment, the completion of the Scully-Welsh Cancer Center in mid-November amplified the progress in cancer care. Attendance at the November 18 preview reception numbered 185, all anxious to meet the new director and tour the state-of-the-art center.
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Prior to the event, a timely Foundation mailing provided donors and prospects with a draft of the donor recognition list resulting in a wave of interest. Many were motivated to support the campaign via naming opportunities and additional gifts arrive daily. To date, total funds raised for Excellence in Cancer Care tally $42 million. Additional verbal commitments have been received further narrowing the gap to our $48-million campaign goal. Naming options remain available on both the first and second floors of the center and tours continue to showcase the center and these opportunities to give.
IRMC Earns “A” Grade in Fall 2015 Leapfrog Hospital Safety Score Indian River Medical Center earned an “A” in patient safety—the top grade in the latest Leapfrog Hospital Safety Score. This study rates how well hospitals protect patients from accidents, errors, injuries and infections. This is IRMC’s second consecutive “A” rating, also receiving the honor this spring. The Hospital Safety Score is compiled under the guidance of the nation’s leading experts on patient safety and is administered by The Leapfrog Group, an independent industry watchdog. The first and only hospital safety rating to be peer-reviewed in the Journal of Patient Safety, the Hospital Safety Score is free to the public and designed to give consumers information they can use to protect themselves and their families when facing a hospital stay. More than 2,500 U.S. general hospitals were assigned scores in April 2015 with less than 31 percent—or 733 nationwide—receiving an “A” grade. Calculated under the guidance of Leapfrog’s Blue Ribbon Expert Panel, the Hospital Safety Score uses 28 measures of publicly available hospital safety data to produce a single “A,” “B,” “C,” “D,” or “F” score representing a hospital’s overall capacity to keep patients safe from preventable harm. The Hospital Safety Score is fully transparent, and its website offers a full analysis of the data and methodology used in determining grades. To see how IRMC’s score compares locally and nationally, and to access safety tips for patients and their loved ones, visit the Hospital Safety Score website at www.hospitalsafetyscore.org.
Mission Lifeline STEMI Receiving Center Gold Award From American Heart Association Indian River Medical Center is proud to receive the prestigious Mission: Lifeline STEMI Receiving Center Gold Award for the second year in a row. The award, presented by the American Heart Association, recognizes the medical center’s success in implementing the highest standard of care for heart attack patients. ST-segment elevation myocardial infarction, or STEMI, is the deadliest form of heart attack during which one of the heart’s major arteries (one of the arteries that supplies oxygen and nutrient-rich blood to the heart muscle itself) is blocked. To prevent death, it’s critical to restore blood flow as quickly as possible, either by surgically opening the blocked vessel or by giving clot-busting medication. Hospitals participating in Mission: Lifeline are referred to as STEMI Receiving Centers and are evaluated on eight performance achievement measures, including the percentage of STEMI patients who received percutaneous coronary
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intervention (PCI) within 90 minutes of first medical contact, a metric that involves collaboration with the EMS agencies that deliver patients to the medical center. To receive an award, IRMC must achieve 85 percent or higher composite adherence on these measures, with no single measure below 75 percent over a number of consecutive months. IRMC exceeded these benchmarks. Gold is the highest award level, recognizing two consecutive years of achieving these standards. Every year, more than 250,000 people experience a STEMI, the deadliest form of heart attack. IRMC stands ready as an award-winning STEMI Receiving Center to deliver the best cardiac care.
New OnBoarding Program IRMC recently announced a new OnBoarding Program for new employees. There are two key components of the program designed to help other employees recognize new employees. Karen Mitchell, VP and Chief Human Resources Officer will be giving an update on Human Resources at the Board meeting this month.
New Employee Profile: Posters/profiles will be created with a new employee’s photo
and hung in the new employee’s department. This will give everyone some basic information about their new coworker. It is posted only in the department where the person will be assigned and is intended to encourage everyone to be friendly. Studies show that the faster a new employee has friends in their department, the more likely they are to remain employed there.
Yellow Star Badge Reel: All new employees will be asked to wear the yellow star badge reel (pictured below), so everyone will be able to recognize our new coworkers across all departments. When you see someone wearing this reel, please take a moment to say, “Hello” and welcome them to IRMC.
Health & Wellness Center
Can we get a picture?
Health and Wellness construction is well underway and ahead of schedule for
completion late in 2016. Progress can be seen from the Scully-Welsh Cancer Center or
from the exit ramp of the Emergency Department.
Information Services Update The older MUSE ECG system was replaced with the McKesson ECG system.
This included replacing all of our older ECG carts with new Mortara carts. The new ECG replacement system with new Mortara carts went live November 30th.
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McKesson is in the process of performing a strategic assessment of the Surgical Services Department for the purpose of identifying opportunities to target for system optimization efforts. Initial findings are showing opportunities in surgical case scheduling, case card rebuild and the education of staff.
The Emergency Department optimization and rebuild of the Paragon ED system is progressing. Information and material content received from other Paragon ED healthcare organizations is being evaluated and built into our system based on our workflows. The IT Clinical Informatics staff is working closely with Dr. Paul Giasi, ED Medical Director, and Stephanie Kerensky, Director of Emergency Services.
Compliance Point is currently performing our annual HIPAA / HITECH Security Risk assessment for both the hospital and our IRMA practices. They are focusing on Security Standards, Administrative Safeguards, Physical Safeguards, Technical Safeguards, Organizational Requirements and Policy & Procedures.
Clinical Research The oncology clinical research program at IRMC is working collaboratively with Duke Cancer Network (DCN) on the following: Studies
A new venous thrombo-embolism study will be reviewed December 15, 2015 by the Indian River Medical Center (IRMC) Clinical Research Review Committee (CRRC). The objective for this study is to assess the efficacy and safety of rivaroxaban compared with placebo in the prevention of symptomatic venous thromboembolism in high-risk, medically ill patients, to include patients with a history of cancer. IRMC will have a study initiation visit by Janssen Pharmaceuticals on January 13 and enrollment at IRMC is expected to begin late-January 2016. IRMC research staff will be working in collaboration with Dr. Suen on this study.
Working with Duke’s Institutional Review Board (IRB), it is anticipated that the ALLIANCE A011104 study will be presented and reviewed at the January 2016 CRRC meeting. This study will compare the rates of local-regional recurrence following attempted breast conserving therapy in women with triple negative or HER-2 amplified breast cancer. Patients qualifying for this study will be randomized to preoperative staging with mammography or mammography plus breast MRI. We will be collaborating with VRA and local community general surgeons.
CIRB (National Cancer Institute Central Institutional Review Board Initiative)
Membership
The application for membership to CIRB was submitted in October (must have ALLIACE membership approval first, for which we obtained September 28, 2015) and we are waiting for membership approval. IRMC is on the list, along with multiple other sites, to be reviewed. It is not known yet if the NCI will hold a review meeting in December.
May Pops Mark your calendars for the 27th annual May Pops to be held on Sunday, May 1, 2016 at Windsor.
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Florence Booms’ Celebration of Lights The Auxiliary held the 25th annual Tree of Lights ceremony on Thursday, December 03, 2015. At the ceremony, it was announced that the program is being renamed the Florence Booms’ Celebration of Lights. It was Florence’s dream and persistence that initiated the celebration 25 years ago. Funds raised from this program are used to purchase unbudgeted items for women’s and children’s programs in various areas of the hospital. To date, over $295,250 has been donated. In 2015, funds raised by the Tree of Lights program, (over $17,000), was used for the purchase of new hearing test equipment for newborns. In conjunction with the renaming of the celebration, lighting of the tree outside of the Ambulatory Services Center and the star on the roof of the hospital was expanded to include the lighting of a menorah. Rabbi Michael Birnholz and Reverend Robert Bremer shared in the Invocation and lighting ceremony. Kristi Beckett (daughter of Dr. Clarke Beckett) and Cantor Dannah Rubinstein provided vocal entertainment. Florence volunteered at the hospital from January 1987 to October 2011 and served in various positions. She was the Auxiliary President from 1997 to 2000, and the Tree of Lights Chairperson from 1991 to 2006. She also served as a second vice president, corresponding secretary, and was a Life Member of the Auxiliary. She also served as a Director on the IRMC Board from 1999 to 2004 and served as Board Secretary.
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Act / Bud Act / PY
Volume Actual Budget Prior Year % Var % Var
Admissions 1,238 1,249 1,277 -0.9% -3.1%
Observation Discharges 341 311 302 9.6% 12.9%
Total Admissions & Observation 1,579 1,560 1,579 1.2% 0.0%
Adjusted Admissions 2,141 2,098 2,130 2.0% 0.5%
Patient Days 4,867 5,025 5,220 -3.1% -6.8%
Adjusted Patient Days 8,416 8,442 8,706 -0.3% -3.3%
Average Daily Census 157 162 168 -3.1% -6.8%
Urgent Care Visits 1,299 1,341 1,341 -3.1% -3.1%
ER Visits 4,953 5,265 5,012 -5.9% -1.2%
Surgeries 644 668 627 -3.6% 2.7%
FTE's - Overall 1,515.5 1,479.3 1,386.2 2.4% 9.3%
AR Days 41.5 41.0 42.0 1.3% -1.0%
Days Cash on Hand 75.1 76.0 70.1 -1.1% 7.2%
Case Mix Index 1.54 1.56 1.56 -1.0% -1.2%
Income Statement Act / Bud Act / PY
(in thousands) Actual Budget Prior Year % Var % Var
Patient Revenue 17,513 19,203 17,599 -8.8% -0.5%
DSH / UPL 264 277 302 -4.9% -12.5%
Medicaid / UPL 50 54 63 -7.7% -20.8%
Other Revenue 1,328 1,340 1,342 -0.9% -1.0%
Bad Debt (814) (1,197) (1,390) -32.0% -41.5%
Net Revenue 18,342 19,677 17,915 -6.8% 2.4%
Total Personnel Cost 10,796 10,845 9,711 -0.5% 11.2%
Contracted and Other Services 3,942 3,959 3,627 -0.4% 8.7%
Supplies 3,624 3,751 3,530 -3.4% 2.7%
Depreciation 1,065 1,087 984 -2.1% 8.2%
Interest Expense 27 27 31
Total Operating Exp 19,453 19,669 17,883 -1.1% 8.8%
Excess (Deficit) Revenue Over Expenses (1,111) 9 32
Indian River Medical Center
Consolidated Financial InformationOctober 2015
Month to Date
Month to Date
1,800
2,000
2,200
2,400
2,600
Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep
Adjusted Admissions
Actual Budget
(2,500)
(1,000)
500
2,000
3,500
Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep
Excess (Deficit) Revenue Over Expenses to Budget (In Thousands)
Actual Budget
7,500
8,500
9,500
10,500
Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep
Operating Expense Per Adjusted Admission
Actual Budget
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Act / Bud Act / PY
Volume Actual Budget Prior Year % Var % Var
Admissions 1,238 1,249 1,277 -0.9% -3.1%
Observation Discharges 341 311 302 9.6% 12.9%
Total Admissions & Observation 1,579 1,560 1,579 1.2% 0.0%
Adjusted Admissions 2,141 2,098 2,130 2.0% 0.5%
Patient Days 4,867 5,025 5,220 -3.1% -6.8%
Adjusted Patient Days 8,416 8,442 8,706 -0.3% -3.3%
Average Daily Census 157 162 168 -3.1% -6.8%
ER Visits 4,953 5,265 5,012 -5.9% -1.2%
Surgeries 644 668 627 -3.6% 2.7%
FTE's - Overall 1,282.2 1,241.2 1,182.4 3.3% 8.4%
AR Days 43.4 42.0 43.4 3.3% 0.0%
Days Cash on Hand 75.1 76.0 70.1 -1.1% 7.2%
Case Mix Index 1.54 1.56 1.56 -1.0% -1.2%
Income Statement Act / Bud Act / PY
(in thousands) Actual Budget Prior Year % Var % Var
Patient Revenue 13,996 15,219 14,692 -8.0% -4.7%
DSH / UPL 264 277 302 -4.9% -12.5%
Medicaid / UPL 50 54 63 -7.7% -20.8%
Other Revenue 1,118 1,134 1,175 -1.4% -4.8%
Bad Debt (814) (1,197) (1,390) -32.0% -41.5%
Net Revenue 14,615 15,488 14,841 -5.6% -1.5%
Total Personnel Cost 7,821 7,651 7,304 2.2% 7.1%
Contracted and Other Services 3,175 3,164 2,716 0.4% 16.9%
Supplies 3,419 3,545 3,319 -3.6% 3.0%
Depreciation 943 959 869 -1.7% 8.5%
Interest Expense - - -
Total Operating Exp 15,358 15,319 14,208 0.3% 8.1%
Excess (Deficit) Revenue Over Expenses (743) 169 633
Indian River Medical Center
Hospital Only Financial InformationOctober 2015
Month to Date
Month to Date
1,800
2,000
2,200
2,400
2,600
Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep
Adjusted Admissions
Actual Budget
5,500
6,500
7,500
8,500
Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep
Operating Expense Per Adjusted Admission
Actual Budget
(2,500)
(1,000)
500
2,000
3,500
Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep
Excess (Deficit) Revenue Over Expenses to Budget (In Thousands)
Actual Budget
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Act / Bud Act / PY
Volume Actual Budget Prior Year % Var % Var
Patient Visits 13,038 13,842 12,234 -5.8% 6.6%
Urgent Care Visits 1,299 1,341 1,341 -3.1% -3.1%
Hospital Outpatient Surgeries 154 - 124 24.2%
FTE's - Overall 233.3 238.1 203.8 -2.0% 14.5%
Income Statement Act / Bud Act / PY
(in thousands) Actual Budget Prior Year % Var % Var
Patient Revenue 2,534 3,022 1,959 -16.2% 29.3%
DSH / UPL
Medicaid / UPL
Other Revenue 205 201 162 2.3% 26.5%
Bad Debt - - -
Net Revenue 2,739 3,222 2,122 -15.0% 29.1%
Total Personnel Cost 2,660 2,901 2,149 -8.3% 23.8%
Contracted and Other Services 482 487 623 -1.2% -22.7%
Supplies 91 121 122 -25.1% -25.7%
Depreciation 62 65 59 -4.4% 5.3%
Interest Expense - - -
Total Operating Exp 3,295 3,575 2,954 -7.8% 11.5%
Excess (Deficit) Revenue Over Expenses (556) (352) (832)
Indian River Medical Center
Physician Financial InformationOctober 2015
Month to Date
Month to Date
-
5,000
10,000
15,000
20,000
Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep
Total Patient and Urgent Care Visits
Actual Budget
(2,000)
(1,000)
0
1,000
2,000
Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep
Excess (Deficit) Revenue Over Expenses to Budget (In Thousands)
Actual Budget
-
1,000
2,000
3,000
4,000
Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep
Operating Expense
Actual Budget
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Income Statement Act / Bud Act / PY
(in thousands) Actual Budget Prior Year % Var % Var
Patient Revenue 983 962 947 2.2% 3.8%
DSH / UPL 0 0 0
Medicaid / UPL 0 0 0
Other Revenue 5 5 5
Bad Debt - - -
Net Revenue 988 967 952 2.2% 3.8%
Total Personnel Cost 315 293 258 7.4% 22.2%
Contracted and Other Services 285 308 289 -7.4% -1.3%
Supplies 114 84 88 34.7% 29.0%
Depreciation 60 63 56 -5.8% 6.6%
Interest Expense 27 27 31 1.5% -13.1%
Total Operating Exp 800 775 721 3.2% 10.9%
Excess (Deficit) Revenue Over Expenses 188 192 231 -2.0% -18.4%
Indian River Medical Center
Outpatient Imaging Services Financial InformationOctober 2015
Month to Date
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Indian River Medical Center
Physician Services Division
FY 2015 Financial Performance
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Indian River Medical Center
Physician Services Division
FY 2015 Financial Performance
The Physician Services Division includes the results of
employed physicians, excluding OBGYN’s and Psychiatrists.
The financial results of the 5 OBGYN physicians practicing
at the Partner’s Program and the 3 Psychiatrist practicing at
BHC are consolidated in Hospital operating performance.
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• As of September 30, 2015, includes 36 physician who
practice at 16 distinct leased office sites
• 23 of these physicians who practice at 8 of the office sites
will be relocating into the Health and Wellness Center in the
fall of 2016
• 11 Primary Care Physicians will continue to practice at 6
office sites, while 2 cardiologist will practice solo at offsite
offices
Office Based Practices
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Office Based Practices
• In aggregate, the office based physician practices generated
$26.5 million of net revenue during FY 2015. For these 36
physicians, the average per physician net revenue is
approximately $736,000
• After allocation of IRMA overhead costs (coding, billing
and collections and management) the combined income for
FY 2015 was $138,000
• The losses sustained at the Surgical Specialist are offset by
income generated at most Primary Care and Medical
Specialty sites 63 of 103
Hospital Based Practices
• As of September 30, 2015, includes 22 of the 58 physicians
accounted for in the Physician Services Division. These 22
physicians practice exclusively within the Hospital, serving
primarily inpatients
• In aggregate, the Hospital based practices generated $6.7
million of net revenue during FY 2015. For these 22
physicians, the average per physician net revenue is
approximately $306,000, less than one-half of the average
of office based physicians
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Hospital Based Practices
• The losses at the Hospital based practices who serve
inpatients, account for all the losses within the Physician
Services Division
• From a financial reporting perspective, consideration
should be give to consolidating the results of the Hospital
based practices with the Hospital, while leaving the office
based physician practices in the Physician Services
Division
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• As of September 30, 2015 there was $6.2M of
capital in the office based practices, which
included $2.8M of accounts receivable and $3.4M
book value of FF&E
• As of September 30, 2015 there was $1.3M of
capital invested in the Hospital based practices,
which included $1.2M of accounts receivable and
$100K value of FF&E
Hospital Based Practices
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Indian River Medical Center
Physician Services
Statement of Revenue and Expenses (000's)
FY 2015
6093 Hospital Based Office Based Total
Number of Employees:
Physicians 22 36 58
ARNP's 9 10 19
Staff 18 123 141
Total FTE's 49 169 218
Net Revenues $ 6,744 $ 26,498 $ 33,242
Operating Expenses:
Salaries and Wages 6,588 19,218 25,806
Employee Benefits 322 827 1,148
Contracted Services 4,374 287 4,661
Professional Fees - 0 0
Medical Supplies 20 1,039 1,059
Other Supplies 19 301 320
Bad Debts - 0 0
Interest - 0 0
Depreciation and Amortization 45 665 710
Other Expenses 296 320 616
Utilities 10 212 222
Purchased Services 17 1,721 1,737
Insurance - 292 292
Total Operating Expenses 11,690 24,882 36,571
Operating Income (Loss) $ (4,946) $ 1,616 $ (3,329)
IRMA Adinistartion 376 1,478 1,854
Adj. Operating Income (Loss) $ (5,322) $ 138 $ (5,183)
after overhead
Budget Operating Income (Loss) (3,146) (604) (3,750)
Variance $ (2,176) $ 742 $ (1,433) 67 of 103
Indian River Medical Center
Physician Services
Statement of Revenue and Expenses (000's)
FY 2015
6093 Hospital Based Primary Care Medical Specialties
Surgical
Specialties IRMA Admin Total
Number of Employees:
Physicians 22 17 14 5 0 58
ARNP's 9 1 9 0 0 19
Staff 11 43 43 11 33 141
Total FTE's 42 61 66 16 33 218
Net Revenues $ 6,744 $ 8,564 $ 14,535 $ 3,399 $ 351 $ 33,594
Operating Expenses:
Salaries and Wages 6,588 5,514 9,918 3,786 1,322 27,128
Employee Benefits 322 282 426 119 94 1,242
Contracted Services 4,374 33 229 25 38 4,699
Professional Fees - 0 0 0 94 94
Medical Supplies 20 293 655 91 9 1,068
Other Supplies 19 123 137 41 41 361
Bad Debts - 0 0 0 - 0
Interest - 0 0 0 - 0
Depreciation and Amortization 45 192 456 17 5 714
Other Expenses 296 96 176 48 393 1,009
Utilities 10 81 101 30 8 230
Purchased Services 17 719 698 304 202 1,939
Insurance - 0 145 147 - 292
Total Operating Expenses 11,690 7,333 12,940 4,608 2,205 38,777
Operating Income (Loss) $ (4,946) $ 1,230 $ 1,595 $ (1,209) $ (1,854) $ (5,183)
Budget Operating Income (Loss) (2,791) 544 1,264 (1,060) (1,707) (3,750)
Variance $ (2,154) $ 686 $ 331 $ (149) $ (147) $ (1,433)68 of 103
Indian River Medical Center
Hospital Based Physician Services
Statement of Revenue and Expenses (000's)
FY 2015
6093
6096
Hospitalists
6094
Intensivists 6099 Intervent
6093
Pediatrics
6207
Pathology
6102 Infectious
Disease
Hospital
Based
Number of Employees:
Physicians 13 3 2 0 2 2 22
ARNP's 6 2 0 0 0 1 9
Staff 1 4 1 0 1 4 11
Total FTE's 20 9 3 0 3 7 42
Net Revenues $ 3,929 $ 663 $ 37 $ 1,124 $ 990 $ 6,744
Operating Expenses:
Salaries and Wages 3,318 1,504 41 62 761 901 6,588
Employee Benefits 177 61 3 2 31 48 322
Contracted Services 3,537 - 621 117 98 - 4,374
Professional Fees - - - - - - 0
Medical Supplies 3 2 - - - 15 20
Other Supplies 9 2 - - 1 7 19
Bad Debts - - - - - - 0
Interest - - - - - - 0
Depreciation and Amortization - - - - - 45 45
Other Expenses 202 20 9 1 58 6 296
Utilities 10 - - - - - 10
Purchased Services 0 0 - - - 16 17
Insurance - - - - - - 0
Total Operating Expenses 7,257 1,590 673 182 950 1,038 11,690
Operating Income (Loss) $ (3,329) $ (927) $ (673) $ (144) $ 175 $ (48) $ (4,946)
Budget Operating Income (Loss) (1,834) (672) (657) (103) 512 (37) (2,791)
Variance $ (1,495) $ (255) $ (16) $ (41) $ (338) $ (10) $ (2,154)
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Indian River Medical Center
Primary Care Physician Services
Statement of Revenue and Expenses (000's)
FY 2015
6093
6200 Sebastian
Urgent Care
6201 Pointe
West Urgent
Care
6106 Family
Practice North
6107 Family
Practice South
6104 PW
Family
Practice
6204 Concierge
Practice
6095 Vero
Internal Med
6203 Barefoot
Bay Primary Care
Number of Employees:
Physicians 2 2 3 1 2 2 4 1 17
ARNP's 0 0 0 0 0 0 1 0 1
Staff 7 7 7 3 5 3 8 3 43
Total FTE's 9 9 10 4 7 5 13 4 61
Net Revenues $ 1,171 $ 1,130 $ 719 $ 463 $ 932 $ 2,179 $ 1,665 $ 304 $ 8,564
Operating Expenses:
Salaries and Wages 670 689 525 278 567 1,602 869 315 5,514
Employee Benefits 38 45 35 16 32 48 49 17 282
Contracted Services 19 13 - - 0 - 0 1 33
Professional Fees - - - - - - - - 0
Medical Supplies 34 26 70 16 82 35 24 7 293
Other Supplies 11 15 28 2 25 4 31 6 123
Bad Debts - - - - - - - - 0
Interest - - - - - - - - 0
Depreciation and Amortization 51 47 17 19 22 18 10 8 192
Other Expenses 6 24 44 1 8 1 10 1 96
Utilities 12 9 6 12 11 4 15 12 81
Purchased Services 124 216 46 57 37 37 187 15 719
Insurance - - - - - - - - 0
Total Operating Expenses 965 1,085 771 402 783 1,750 1,194 382 7,333
Operating Income (Loss) $ 206 $ 45 $ (52) $ 62 $ 149 $ 428 $ 470 $ (78) $ 1,230
Budget Operating Income (Loss) 62 (44) (102) (17) 74 291 321 (40) 544
Variance $ 144 $ 90 $ 50 $ 79 $ 76 $ 138 $ 150 $ (39) $ 686
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Indian River Medical Center
Medical Specialties Physician Services
Statement of Revenue and Expenses (000's)
FY 2015
6093 Cardiology 6205 Vero GI
6209
Endocrinology Medical Specialties
Number of Employees:
Physicians 8 5 1 14
ARNP's 6 3 0 9
Staff 32 8 3 43
Total FTE's 46 16 4 66
Net Revenues $ 9,289 $ 5,139 $ 108 $ 14,535
Operating Expenses:
Salaries and Wages 6,588 3,121 210 9,918
Employee Benefits 256 156 14 426
Contracted Services 6 223 - 229
Professional Fees 0 0 - 0
Medical Supplies 285 369 1 655
Other Supplies 92 29 16 137
Bad Debts 0 0 - 0
Interest 0 0 - 0
Depreciation and Amortization 258 195 3 456
Other Expenses 93 80 3 176
Utilities 71 24 5 101
Purchased Services 526 134 37 698
Insurance 86 59 - 145
Total Operating Expenses 8,261 4,391 288 12,940
Operating Income (Loss) $ 1,028 $ 748 $ (181) $ 1,595
Budget Operating Income (Loss) 703 662 (100) 1,264
Variance $ 325 $ 86 $ (81) $ 331 71 of 103
Indian River Medical Center
Surgical Specialties Physician Services
Statement of Revenue and Expenses (000's)
FY 2015
6093
6098
Cardiovascular 6097 Urologists 6100 Neurosurgery
6105 General
Surgery
Surgical
Specialties
Number of Employees:
Physicians 2 1 1 1 5
ARNP's 0 0 0 0 0
Staff 3 3 1 4 11
Total FTE's 5 4 2 5 16
Net Revenues $ 1,248 $ 1,034 $ 772 $ 346 $ 3,399
Operating Expenses:
Salaries and Wages 1,508 726 1,040 511 3,786
Employee Benefits 44 24 29 24 119
Contracted Services - - 25 - 25
Professional Fees - - - - 0
Medical Supplies 1 81 1 8 91
Other Supplies 14 14 9 4 41
Bad Debts - - - - 0
Interest - - - - 0
Depreciation and Amortization - 10 5 3 17
Other Expenses 13 9 14 12 48
Utilities 7 12 8 3 30
Purchased Services 115 70 87 31 304
Insurance 128 19 - - 147
Total Operating Expenses 1,831 965 1,217 595 4,608
Operating Income (Loss) $ (583) $ 69 $ (445) $ (249) $ (1,209)
Budget Operating Income (Loss) (712) 153 (204) (297) (1,060)
Variance $ 129 $ (84) $ (241) $ 47 $ (149)72 of 103
Pension Plan Review
December 8, 2015
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Pension Plan Review
• Towers Watson will provide the Finance Committee
with a review of the pension plan and update
assessment of pension plan risk transfer strategies.
The table that follows shows the history of the
balance of Pension Benefit Obligation and Plan
Assets and the resulting funding statuses, over the 13
year period subsequent to the plan being frozen on
December 31, 2002
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Indian River Memorial CenterPension Plan Review
Bob BruechertFinance Committee Meeting
December 8, 2015
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Today’s Agenda
Overview Mortality Update Pension Accounting under GAAP Funding Results Forecasts Appendix
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Overview – Fundamental Concepts
The costs and liabilities of the Pension Plan are determined using actuarial assumptions and methods related to future demographic events (such as employee turnover, retirements and mortality) and economic events (such as investment returns and interest rates)
Required cash contributions to the Plan, and the pension expense on the financial statement, are different calculations using different methods
IRS rules and assumptions are used to determine required cash contributions. GAAP rules and assumptions are used to determine pension expense on the Income Statement and liability for the Balance Sheet. Both values are determined only once each year, as of September 30 IRS cash funding rules allow use of an average interest rate and the
smoothing of investment returns in the valuation of assets GAAP results are based on a spot interest rate and market value of
assets However, the ultimate cost of the Pension Plan = benefits paid to
participants Less net investment income
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Overview
Economic Environment Corporate bond rates remained level during 2015 (unchanged at 4.5%) Returns on Market Value of Assets for fiscal year 2015 were lower than expected (2.7%
loss versus 7.25% expected return) GAAP Results
PBO funded ratio decreased from 87% to 78%– New mortality table was adopted for FYE 2015 and contributed to the decline in funded ratio
Expense for FY 2016 expected to be $500K, up from $(700K), in FY 2015 PPA Funding Results
Higher effective interest rates due to HATFA legislation bring funded status to over 100% as of 10/1/2014 (legislation allows use of 6.4% discount rate and smoothed asset value)
Regulatory Update – Bipartisan Budget Act of 2015 Continued support of higher interest rates for funding purposes beyond 2017 Significant increases in PBGC premiums
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Overview Capital Market Update as of September 30, 2015
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Bond rates have remained constant during 2015 Discount rate for expense is based on corporate
bond rates as of the measurement date
Towers Watson Pension Index tracks the performance of a hypothetical pension plan The benchmark plan discount rate increased 6
basis points since 9/30/2014
IRMC plan discount rate did not change
Benchmark portfolio return for a 60% / 40% allocation was lower than expected for FYE 2015
Pension Index Results
Bond YieldsSeptember
2015September
2014
- Benchmark Plan Discount Rate 4.36% 4.30% +6bp
- ML 10+ HQ 4.30% 4.29% +1bp
- Citigroup HG Credit 4.24% 4.26% -2bp
- IRMC Discount rate 4.50% 4.50% 0bp
Benchmark Portfolio ReturnsSeptember
2015Last 12 Months
- 40% Stocks/ 60% Fixed Income -0.9% 1.0%
- 60% Stocks/ 40% Fixed Income -1.7% 0.1%
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OverviewPlan Asset Experience ($000)
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2011 2012 2013 2014 2015Values at 9/30
- Fair Market Value1 $ 58,279 $ 67,630 $72,240 $75,037 $69,566
- Return 0.14% 16.49% 9.03% 9.12% (2.70%)
- Actuarial Value (Funding Only) $61,788 $66,022 $69,150 $74,240 TBD
- Return 3.67% 8.60% 10.33% 11.82% TBD1 Market value shown does not include any contributions receivable.
The (2.70)% return on market value of assets generated an asset loss of about $7.3M relative to the 7.25% expected return
Actuarial value of assets (using 2-year smoothing) as of 10/1/2015 will be determined with the 10/1/2015 valuation – for purposes of pension funding
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OverviewSummary of Plan Participant Data
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10/1/2012 10/1/2013 10/1/2014Participating Employees
Frozen Active Participants 349 307 282
- Average Attained Age 53.7 years 54.3 years 54.8 years
Grandfathered Active Participants 3 1 n/a
- Average Attained Age 71.3 years 72.8 years n/a
Participants with Deferred Benefits- Number 562 562 540
- Average Age 54.4 years 55.1 years 55.9 years
- Average Annual Benefits $3,872 $3,772 $3,749
Participants Receiving Benefits- Number 663 679 722
- Average Age 70.4 years 70.3 years 70.6 years
- Average Annual Benefits $6,031 $6,214 $6,127
Total Participants 1,577 1,549 1,544
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Mortality Update
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Mortality Tables and Improvement Scale The Society of Actuaries issued new mortality tables in late October 2014, based on
industry experience through 2006 The auditors require that these be considered for corporate financial statements at
9/30/2015 IRMC elected to use a modification the new tables, reflecting a largely hourly workforce
and more current mortality experience Net impact of the selected table is to increase PBO liability of about 4.2%, or $3.6 The new tables have not yet been mandated by the IRS for either pension funding
calculations or Lump Sum payouts, but are expected to be mandated for 2017
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Pension Accounting
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Pension Accounting under GAAPYear-End Accounting Balance Sheet Impact ($000)
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FYE 2014 Actual FYE 2015 Actual
Balance Sheet
Projected Benefit Obligation (PBO) $ (85,830) $ (89,270)
Fair Value of Assets 75,037 69,566
Net Balance Sheet (Liability)/ Asset $ (10,793) $ (19,704)
Funded Status 87.4% 77.9%
Unrestricted Net Assets
Net Prior Service Cost $ 0 $ 0
Net (Gain)/Loss 28,218 38,803
Total Unrestricted Net Assets $ 28,218 $ 38,803
- Change from Prior Year $ 2,130 $ 10,585Assumptions:- Discount Rate- Expected Return on Assets- Census Date- Measurement Date (Assets and Liabilities)- Mortality Table
4.50%7.50%
10/01/201309/30/2014
RP 2000, projected to 2020 with scale AA
4.50%7.25%
10/01/201409/30/2015
RP 2014 (blue collar), with MP-2015 scale
The PBO funded status decreased by $9M primarily due to negative asset performance and the change in the mortality table
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Pension Accounting under GAAPAnnual Expense ($000)
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FYE 2014 Actual
FYE 2015 Actual
FYE 2016 Preliminary
Expense
Service Cost $ 0 $ 0 $ 0
Interest Cost 3,988 3,757 3,906
Expected Asset Return (5,270) (5,340) (4,697)
Amortization of Net Prior Service Cost - - -
Amortization of Net (Gain)/Loss 798 889 1,319
Total Expense $ (484) $ (694) $ 528Assumptions:- Discount Rate- Expected Return on Assets- Census Date- Measurement Date (Assets and Liabilities)- Mortality
5.00%7.50%
10/01/201209/30/2013
RP 2000, projected to 2020 with scale AA
4.50%7.25%
10/01/201309/30/2014
RP 2000, projected to 2020 with scale AA
4.50%7.00%
10/01/201409/30/2015
RP 2014 (blue collar), with MP-2015 scale
FYE 2016 expense increased due to the following: Higher amortization of net (gain)/loss (due to the change in mortality table and asset return)
Lower expected return on assets (due to lower fair value of assets and lower expected return assumption)
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Pension Accounting under GAAPPlan History: Annual Expense & Employer Contributions by Fiscal Year ($000)
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13
FYE2007
FYE2008
FYE2009
FYE2010
FYE2011
FYE2012
FYE2013
FYE2014
FYE2015
FYE2016*
Pension Expense $24 $(1,249) $(150) $2,353 $2,222 $2,635 $(269) $(484) $(694) $528Cash Contribution $1,415 $0 $0 $0 $7,000 $3,569 $2,603 $653 $980 $0Discount Rate 6.25% 6.75% 6.25% 5.50% 5.40% 5.00% 4.00% 5.00% 4.50% 4.50%
($2,000)
($1,000)
$0
$1,000
$2,000
$3,000
$4,000
$5,000
$6,000
$7,000
$8,000
Pension Expense in FYE 2013 and later is based on the amortization of gains and losses over the average life expectancy of plan participants.
* FYE 16 cash contribution is to be determined; preliminary estimated minimum requirement is $0.
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Pension Accounting under GAAPPlan History: Funded Status
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9/30/07 9/30/08 9/30/09 9/30/10 9/30/11 9/30/12 9/30/13 9/30/14 9/30/15Market Value of Assets $68.3 $62.5 $54.1 $54.9 $58.3 $67.6 $72.2 $75.0 $69.6PBO $67.3 $64.6 $74.7 $76.6 $80.9 $91.5 $82.0 $85.8 $89.3Funded Status % 101.5% 96.7% 72.4% 71.7% 72.1% 73.9% 88.0% 87.4% 77.9%Funded Status $ $1.0 $(2.1) $(20.6) $(21.7) $(22.6) $(23.9) $(9.8) $(10.8) $(19.7)Interest Rate 6.25% 6.75% 5.50% 5.40% 5.00% 4.00% 5.00% 4.50% 4.50%
101.5%96.7%
72.4% 71.7% 72.1%
73.9% 88.0% 87.4% 77.9%
0.0%
20.0%
40.0%
60.0%
80.0%
100.0%
120.0%
$0
$20
$40
$60
$80
$100
$120
Perc
ent %
$ m
illio
ns
The plan’s funded status had been improving over the last several years due to favorable asset returns, disciplined cash funding, and an increase in interest rates; however at FYE 2015 the new mortality assumption, negative asset return, and a decrease in actual cash contributions all caused a decline in funded status.
PBO funded status as of 10/31/2015 estimated to be about 82%, based on 10/31 assets and a 4.50% discount rate
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Funding Results
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Funding Results
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16
Plan Year Beginning 10/110/1/2013
Actual 10/1/2014
Actual
Pension Funding
Target Liability $71,289 $70,814
Fair Value of Assets $72,240 $75,998
Actuarial Value of Assets $69,150 $74,240
Underfunded Amount (based on Actuarial Value) $2,351 $(3,194)
Adjusted Funding Target Attainment Percentage 96.7% 104.8%
Minimum Contribution $1,314 $0
Effective Interest Rate 6.27% 6.43%
Reflects post-HATFA effective interest rates Rates must be within a corridor around the 25 year average rate
The plan is less than $15 million underfunded; therefore, no PBGC 4010 filing is anticipated for the 2015 Plan Year The plan must either be less than $15 million underfunded on a post HATFA basis or over
80% funded on a pre MAP-21 basis*
The plan is currently 83% funded as of 10/1/2014 on a pre MAP-21 basis
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*PBGC issued proposed regulations to eliminate the $15 million underfunding exemption.
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Regulatory Update
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0.9%
1.4%
2.4%
3.0%3.4%
3.9%4.4%
$42$49 $57 $64 $69 $74 $…
0%
1%
2%
3%
4%
5%
6%
$0
$30
$60
$90
$120
$150
$180
2013 2015 2017 2019 2021 2023 2025
Variable Rate Prem
ium(%
of unfunded vested benefits)Per P
artic
ipan
t Pre
miu
m
Variable Rate Premium Flat Rate Premium
2013 Bipartisan Budget Act increased per-head premiums by 25% and variable premiums by 50%.
Bipartisan Budget Act of 2015 calls for further increases Flat-rate Premiums. Under the amendment, the statutory premiums will increase to $69 in 2017, then $74 in 2018 and $80 in 2019;
Premiums would index for inflation after 2019.
Variable Premium rate as a percentage of underfunding is increased to 3.4% in 2017, 3.9% in 2018 and 4.4% in 2019; Premiums would index for inflation after 2019. Continued $500 per participant cap (indexed) on variable rate premium.
Accelerated Due Date - Moves the premium due date to the 15th day of the ninth calendar month (i.e., a one-month acceleration) for plan years beginning in 2025
Pension Provisions in the Bipartisan Budget Act of 2015Ongoing PBGC Premium Increases
2015 Changes
Indexed with wage inflation
Future increases
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Forecasts
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Forecasts – Annual Expense & Minimum Required Contributions ($000 by fiscal year)
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FYE 2016 FYE 2017 FYE 2018 FYE 2019 FYE 2020 FYE 2021Pension Expense $528 $553 $533 $344 $66 $(148)Cash Contribution $0 $153 $2,600 $4,921 $3,813 $3,923Discount Rate 4.50% 4.50% 4.50% 4.50% 4.50% 4.50%
($500)
$500
$1,500
$2,500
$3,500
$4,500
$5,500
The estimated 10/1/2015 results reflect data as of 10/1/2014, rolled forward and adjusted for the changes in assumptions; these results will change based on the actual 10/1/2015 valuation results
Assumes an actual return on assets equal to expected for all fiscal years (7.00%)
Reflects the RP-2014 blue collar mortality table with MP-2015 projection scale as of 9/30/2015
Reflects contributions of $0 for FYE 2016; minimum thereaftertowerswatson.com
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Forecasts – Funding Ratios
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10/1/14 10/1/15 10/1/16 10/1/17 10/1/18 10/1/19Target Liability $70.8 $72.6 $73.8 $82.3 $83.7 $84.7Actuarial Value of Assets $74.2 $73.4 $70.9 $68.8 $70.8 $73.0Funding Target Attainment Percentage 104.8% 101.1% 95.0% 83.6% 84.6% 86.2%Plan Year Minimum Contribution $0.0 $0.1 $1.4 $3.3 $3.5 $3.7Effective Interest Rate 6.43% 6.23% 6.04% 5.85% 5.67% 5.51%
104.8% 101.1%95.0%
83.6% 84.6% 86.2%
0.0%
20.0%
40.0%
60.0%
80.0%
100.0%
120.0%
$0
$20
$40
$60
$80
$100
$120
Perc
ent %
$ m
illio
ns
The estimated 10/1/2015 results reflect data as of 10/1/2014, rolled forward and adjusted for the changes in assumptions; these results will change based on the actual 10/1/2015 valuation results
Reflects post-MAP-21, post HATFA, post Bipartisan Budget Act of 2015 effective interest rates, projected using current rates
Assumes an actual return on assets equal to expected for all fiscal years (7.00%)
Reflects the RP-2014 mortality table with MP-2014 projection scale as of 10/1/2017
Reflects contributions of $0 for FYE 2016; minimum thereafter
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Pension De-risking
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PBGC Premiums Mortality Update Society of Actuaries released new base
tables and improvement factors based on broad experience
Increased average PBOs by approximately 5%, still to be reflected in funding
Estimated to increase cost of lump sums and funding target by 5% - 8% if/when adopted by IRS
Regulatory Interest
Increased interest from GAO, DOL, and IRS may lead to regulatory changes or negative publicity for de-risking actions
2013 Bipartisan Budget Act increased per-head premiums by 25% and variable premiums by 50%
Additional increases in the 2015 Budget Act Premiums will continue to increase with
inflation
De-Risking MarketplaceRegulatory Forces Continue to Impact Activity
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Potential Advantages and Disadvantages of Lump Sum Offer- Assessment of 2016 vs Delayed Window
Lock-in cost to provide benefits at corporate bonds rates
• 2016: lump sum values already known leading to more certainty of financial impact
Significant long-term savings from PBGC/ administration fees• 2016: Saves an additional $64/head in
PBGC premiums plus administrative costs plus $515/head beginning in 2017
Advantages+Expected to increase ongoing pension cost (about $100k) due to loss of EROA arbitrage and required one-time charge (dependent on design & take-rates)
Reduction in volatility means upside potential not as significant
Disadvantages-
• 2016: Regret risk if rates rise in near-term
Cost-effectively reduce plan size and transfer mortality and demographic risk
• 2016: mortality basis already known and expected to be more favorable than 2017+ basis
Increased regulatory / media scrutiny of lump sum windows• 2016: Potential additional disclosuresAccelerated administrative effort required to implement• 2016: Process must start soon in order to
complete by September 30, 2016
• 2016: Non-cash acceleration of unamortized losses
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Appendix
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Overview - Actuarial Assumptions
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10/1/2013 - 9/30/2014Valuation
10/1/2014 - 9/30/2015Valuation
10/1/2015 - 9/30/2016Valuation
IRS Funding: 10/1/2013 10/1/2014 10/1/2015
- Effective Interest Rate 6.27% 6.43% TBD
- Mortality PPA Static PPA Static PPA Static
ASC 715-30 Expense: FY 2014 FY 2015 FY 2016
- Discount Rate 5.00% 4.50% 4.50%
- Expected Asset Return 7.50% 7.25% 7.00%
- Mortality RP 2000, projected to 2020 with scale AA
RP 2000, projected to 2020 with scale AA
RP 2014 with blue collar adjustment, back to
2006, and generational projection using Scale
MP-2015
Both Funding & Expense:
Assumed Retirement Age 55-65 graded 55-65 graded 55-65 graded
Employee Turnover Rates by age Rates by age Rates by age
The September 30, 2015 mortality for GAAP purposes which generated a liability increase of about $3.6 million
Expected return on assets assumption was decreased another 25 basis points for FY 2016
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Forecasts – Minimum required contributions ($000)
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27
While $0 is required for FYE 2016-FYE2017, IRMC may want to consider making additional contributions to smooth out longer-term funding
2013-2014 Plan Year
Preliminary 2014-2015
Plan Year
Estimated 2015-2016 Plan Year
Estimated 2016-2017 Plan Year
Estimated 2017-2018 Plan Year
Estimated 2018-2019 Plan Year
Estimated 2019-2020 Plan Year
Estimated 2020-2021 Plan Year
FYE Total FYE Due Date9/30/2015 980.9$ 10/15/2014 $217.5
1/15/2015 $381.7 $0.04/15/2015 $381.7 $0.06/15/20157/15/2015 $0.0
9/30/2016 $0.0 10/15/2015 $0.01/15/2016 $0.04/15/2016 $0.06/15/2016 $0.07/15/2016 $0.0
9/30/2017 $153.1 10/15/2016 $0.01/15/2017 $0.04/15/2017 $0.06/15/2017 $153.17/15/2017 $0.0
9/30/2018 2,599.7$ 10/15/2017 $0.01/15/2018 $350.34/15/2018 $350.36/15/2018 $1,548.77/15/2018 $350.3
9/30/2019 4,921.4$ 10/15/2018 $350.31/15/2019 $796.94/15/2019 $796.96/15/2019 $2,180.47/15/2019 $796.9
9/30/2020 3,813.4$ 10/15/2019 $796.91/15/2020 $833.94/15/2020 $833.96/15/2020 $514.77/15/2020 $833.9
9/30/2021 3,922.9$ 10/15/2020 $833.91/15/2021 $851.84/15/2021 $851.86/15/2021 $533.77/15/2021 $851.8
9/30/2022 4,201.6$ 10/15/2021 $851.81/15/20224/15/20226/15/2022 $541.37/15/2022
Total Plan Year Contributions $980.9 $0.0 $153.1 $1,548.7 $3,581.7 $3,702.4 $3,869.4 $3,948.3
Estimated Minimum Contribution Schedule
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Actuarial Certification
In preparing the information detailed in this presentation, we have relied upon information regarding plan provisions and plan participants provided by IRMC and other persons or organizations designated by IRMC which is documented in our fiscal year 2015 Disclosure provided in November 2015. Therefore, such information including the reliances and limitations of the reports use should be considered part of this report.
The information contained in this presentation was prepared for the internal use of IRMC only. It is not intended for and may not be used for other purposes, and we accept no responsibility or liability in this regard. IRMC may distribute this presentation to the appropriate authorities who have the legal right to require IRMC to provide them this presentation, in which case IRMC will use best efforts to notify Towers Watson in advance of this distribution, and will include the non-reliance notice included at the end of the upcoming valuation report. Further distribution to, or use by, other parties of all or part of this presentation is expressly prohibited without Towers Watson’s prior written consent. In the absence of such consent and an express assumption of responsibility, we accept no responsibility whatsoever for any consequences arising from any third party relying on this report or any advice relating to its contents. There are no intended third-party beneficiaries of this report or the work underlying it.
The undersigned consulting actuaries are members of the Society of Actuaries and meet the “Qualification Standards for Actuaries Issuing Statements of Actuarial Opinion in the United States” relating to pension plans. Our objectivity is not impaired by any relationship between IRMC and our employer, Towers Watson Pennsylvania Inc.
28
Note: This presentation was developed for the internal use of IRMC in connection with its analysis of its plans. It is not intended nor necessarily suitable for other purposes. Further distribution or use of all or part of this material is prohibited without prior written consent.
Robert W. Bruechert, F.C.A., A.S.A., E.A. Senior Consulting Actuary
Lori Wolfersberger, F.S.A., E.A. Consulting Actuary
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