BOARD OF DIRECTORS FULL BOARD MEETING - Lee … · BOARD OF DIRECTORS FULL BOARD MEETING Thursday, March 24, 2011, 4:00pm Lee Memorial Hospital Boardroom 2776 Cleveland Ave, Ft. Myers,

BOARD OF DIRECTORS

FULL BOARD MEETING

Thursday, March 24, 2011, 4:00pm Lee Memorial Hospital Boardroom

2776 Cleveland Ave, Ft. Myers, FL 33901

ELECTRONIC BOARD PACKET

ALL MEETINGS ARE OPEN TO THE PUBLIC AND THE PUBLIC IS INVITED TO ATTEND Any Public Input pertaining to an agenda item is limited to three minutes and a

“Request to Address the Board of Directors” card must be completed and submitted to the Board Assistant prior to the meeting.

BOARD OF DIRECTORS OFFICE

239-343-3300 FAX: 239-343-3194

P.O. BOX 2218

FOR 339 T MYERS, FLORIDA

ORAL HCAPE C OSPITAL

GULF COAST MEDICAL CENTER

HEALTHPARK MEDICAL CENTER

LEE MEMORIAL HOSPITAL

THE CHILDREN’S HOSPITAL

THE REHABILITATION HOSPITAL

LEE PHYSICIAN GROUP

LEE CONVENIENT CARE

BOARD OF DIRECTORS

DISTR CT ONE I

Stephen R. Brown, M.D.

Marilyn Stout

DISTRICT TWO

Richard B. Akin

Nancy M. McGovern, RN, MSM

DISTRICT THREE

Lois C. Barrett, MBA

Linda L. Brown, MSN, ARNP

DISTRICT FOUR

Diane Champion

Chris Hansen

DISTRICT FIVE

Donald A. Brown

James Green

BOARD OF DIRECTORS OFFICE

239-343-3300 FAX: 239-343-3194

P.O. BOX 2218

FORT MYERS, FLORIDA 33902

CAPE CORAL HOSPITAL GULF COAST MEDICAL CENTER



THE CHILDREN’S HOSPITAL THE REHABILITATION HOSPITAL

LEE PHYSICIAN GROUP

LEE CONVENIENT CARE

BOARD OF DIRECTORS

DISTRICT ONE


Marilyn Stout

DISTRICT TWO

Richard B. Akin


DISTRICT THREE



DISTRICT FOUR

Diane Champion

Chris Hansen

DISTRICT FIVE

Donald A. Brown

James Green

Any Public input is limited to three minutes and a “Request to Address the Board of Directors” card must be completed and submitted to the Board Administrator prior to meeting.

LEE MEMORIAL HEALTH SYSTEM BOARD OF DIRECTORS Thursday, March 24, 2011, 4:00 pm

At Lee Memorial Hospital – Board Room, 2776 Cleveland Avenue, Fort Myers, FL 33901

AGENDA

1. 4:00 pm - CALL TO ORDER (Richard Akin, Board Chairman) LEE MEMORIAL HEALTH SYSTEM BOARD OF DIRECTORS

2. Public Input - Agenda Items: Any Public input is limited to three minutes and a “Request to Address the Board of Directors” card must be completed and submitted to the Board Administrator prior to meeting.

3. Invocation and Pledge of Allegiance (Chaplain Susan Crowley, MA)

4. Recognitions: Board Of Directors

5. RECESS LEE MEMORIAL HEALTH SYSTEM Full Board of Directors Meeting

6. CALL TO ORDER: (Richard Akin, Board Chairman) A. Lee Memorial Hospital Board of Directors (Provider #10-0012) {{GGRREEEENN FFOOLLDDEERR}} B. Cape Coral Hospital Board of Directors (Provider #10-0244) {{YYEELLLLOOWW FFOOLLDDEERR}} CC.. Gulf Coast Medical Center Board of Directors (Provider #10-0220) {{OORRAANNGGEE FFOOLLDDEERR}}

7. RECONVENE LEE MEMORIAL HEALTH SYSTEM Full Board of Directors Meeting (Richard Akin, Board Chairman) {BLUE FOLDER}

8. Consent Agenda A. 2010 Environment of Care Report B. Lee Memorial Health System Organizational Chart March 2011

9. Physician Leadership Council (PLC) Report (Accept) (Thomas Presbrey, M.D., PLC Chairman)

10. Graduate Medical Education (Update) (Dr. Scott Nygaard, Chief Medical Officer Physician Services, Dr. David Berger, Quality & Education Community Representative, Dr. Sanford Cohen, GME Committee Representative)

11. Financial Business (Mike German, Chief Financial Officer) A. 2009 Series C Bond Resolution – Letter of Credit Substitution (Adoption) B. Financial & Statistical Reports for February 28, 2011 (Acceptance)

12. Old Business A. Board Policies (Jim Humphrey, Board Counsel) (Discussion/Action) B. Board Scorecard (Chris Hansen, Board Member)

13. New Business (Approvals) A. Pediatric Therapy Space Lease (Dave Cato, VP Outpatient Operations) B. Pediatric Collier Clinic: Sub-Leases (Dave Cato, VP Outpatient Operations) C. Fiddlesticks Therapy Space Lease (Ray Cyr, Director of Rehab Services)

14. Board of Director’s Report

15. Board Administrator Report (Cathy Stephens, Board Administrator)

16. DATE OF THE NEXT FULL BOARD OF DIRECTORS’ MEETINGS (TRAUMA DISTRICT & QUALITY/EDUCATION) Thursday, April 21, 2011, 4:00 pm, Lee Memorial Hospital - Boardroom

17. ADJOURN (Richard Akin, Board Chairman)

v:/Agenda/2011/032411 Full Board Tentative Agenda

___________________ L E E M E M O R I A L HEALTH SYSTEM

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PUBLIC INPUT – AGENDA ITEMS:

Any public input

pertaining to items on the Agenda is limited to three

minutes and a “Request to Address the Board of Directors”

card must be completed and submitted to

the Board Administrator prior to meeting.

Refer to Board Policy: 10:15E: Public Addressing the Board Non-Agenda Item: Individuals wishing to address the Board on an item NOT on the Agenda, the Board office must be notified of subject matter at least seven (7) days prior to the meeting to allow staff time to prepare and to insure the matter is within the jurisdiction of the Board.

_________________________________________________________________________

L E E M E M O R I A L HEALTH SYSTEM BBBOOOAAARRRDDD OOOFFF DDDIIIRRREEECCCTTTOOORRRSSS

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Recognizes with Sincere Appreciation

Linda Brown, MSN, ARNP 10 YEARS of Service

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_________________________________________________________________________


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Recognizes with Sincere Appreciation

Marilyn Stout 10 YEARS of Service

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cstephens

Sticky Note

CONGRATULATIONS NANCY! You represented Lee Memorial Health System Board of Directors VERY well - great dancer too! ...and raised over $10,000 for American Red Cross, CONGRATS!

RECESS Board Chairman

Richard Akin

Lee Memorial Health System

Board of Directors

CALL TO ORDER: (Richard Akin, Board Chairman) A. Lee Memorial Hospital Board of Directors (Provider #10-0012) {{GGRREEEENN FFOOLLDDEERR}} BB.. Cape Coral Hospital Board of Directors (Provider #10-0244) {{YYEELLLLOOWW FFOOLLDDEERR}} C. Gulf Coast Medical Center Board of Directors (Provider #10-0220) {{OORRAANNGGEE FFOOLLDDEERR}}

CONVENE {{GGRREEEENN FFOOLLDDEERR}}

(Provider # 10-0012)

Lee Memorial Hospital

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TThhee CChhiillddrreenn’’ss HHoossppiittaall ooff SSWW FFlloorriiddaa

BOARD OF DIRECTORS OFFICE 239-343-3300

FAX: 239-343-3194

P.O. BOX 2218 FORT MYERS, FLORIDA 33902

CAPE CORAL HOSPITAL






LEE PHYSICIAN GROUP

LEE CONVENIENT CARE

BOARD OF DIRECTORS

DISTRICT ONE


Marilyn Stout

DISTRICT TWO

Richard B. Akin


DISTRICT THREE



DISTRICT FOUR

Diane Champion

Chris Hansen

DISTRICT FIVE

Donald A. Brown

James Green

Public Input - Agenda Items: Any Public input is limited to three minutes and a “Request to Address the Board of Directors” card must be

completed and submitted to the Board Administrator prior to meeting.

{{GGRREEEENN FFOOLLDDEERR}}

Convening as the Lee Memorial Hospital Board of Directors


Thursday, March 24, 2011 4:00 p.m.

Lee Memorial Hospital-Boardroom 2776 Cleveland Avenue, Ft. Myers, FL 33901

AGENDA

1. Call to Order LEE MEMORIAL HOSPITAL BOARD OF DIRECTORS (Richard Akin, Board Chairman) {{GGRREEEENN FFOOLLDDEERR}}

2. Public Input - Agenda Items: Any Public input is limited to three minutes and a “Request to Address the Board of Directors” card must be completed and submitted to the Board Administrator prior to meeting.

3. Meeting Minutes of February 24, 2011 (Approval) (Nancy McGovern, RN, MSM, Board Secretary)

4. Operations Reports (Accept) (Lisa Sgarlata, RN, MSN, Chief Admin Officer/LMH & Donna Giannuzzi, RN, MBA, Chief Patient Care Officer/Chief Admin Officer/HP)

5. Medical Staff Business (Approvals) A. Lee Memorial Hospital i. Medical Staff Recommendations of March 22, 2011 ii. Impaired Practitioner Oversight Policy & Procedure B. HealthPark Medical Center i. Medical Staff Recommendations of March 22, 2011 ii. Impaired Practitioner Oversight Policy & Procedure C. The Children’s Hospital i. Medical Staff Recommendations of March 22, 2011 ii. Impaired Practitioner Oversight Policy & Procedure

6. Old Business

7. New Business

8. Date of the next meeting – Thursday, April 28, 2011 4:00 pm, Lee Memorial Hospital – Boardroom




Any public input






LEE MEMORIAL HOSPITAL BOARD OF DIRECTORS (PROVIDER # 10-0012) LEE MEMORIAL HEALTH SYSTEM

Thursday, February 24, 2011 LOCATION: Lee Memorial Hospital Boardroom, 2776 Cleveland Avenue, Fort Myers, FL 33901 MEMBERS PRESENT: Richard Akin, Board Chairman; Linda Brown, MSN, ARNP, Board Vice Chairman; Nancy McGovern, RN, MSM, Board Secretary; Marilyn Stout, Board Treasurer; Steve Brown, M.D.,

Director; Chris Hansen, Director; Donald Brown, Director; Diane Champion, Director; James Green, Director MEMBERS ABSENT: Lois Barrett, MBA, Director OTHERS PRESENT: James Nathan, President/CEO; Cathy Stephens, Board Administrator; Jim Humphrey, Board Counsel; Mary McGillicuddy, Chief Legal Officer; Mike German, Chief Financial Officer;

Jon Cecil, Chief Human Resource Officer; Larry Antonucci, M.D., Chief Operating Officer/Hospital & Physician Services; Chuck Krivenko, M.D., Chief Medical Officer/Clinical and Quality Services; Emad Salman, MD; Medical Staff President/TCH; Scott Nygaard, M.D., Chief Medical Officer/Physician Services; Lisa Sgarlata, R.N., Chief Administrative Officer/LMH; Donna Giannuzzi, R.N., Chief Patient Care Officer/Chief Administrative Officer/HP; Kristy Rigot, System Director of Recruitment and Retention; Bill Brown, Allied Health Recruiter; Mary Lorah, Risk Manager II; Sally Jackson, System Director of Community Projects; Bill Silverman, M.D., Quality & Education Community Representative; Bob Fischer, Financial Community Representative; Mary Briggs, Interim Media Relations; Guest, Frank Gluck, News Press/Reporter; Laurie Gretten, Executive Secretary/Board of Directors; Lisa Porter, Executive Secretary/Board of Directors

NOTE: Documents referred to in these minutes are on file by reference to this meeting date in the Office of the Board of Directors and on the Board of Directors website at www.lememorial.org/boardofdirectors, for public inspection.

SUBJECT DISCUSSION ACTION FOLLOW-UP

MEETING CALLED TO ORDER

The LEE MEMORIAL HOSPITAL (Provider #10-0012) BOARD OF DIRECTORS Meeting was CALLED TO ORDER at 4:56 p.m.

by Richard Akin, Board Chairman.

PUBLIC INPUT None at this time.

LEE MEMORIAL

HOSPITAL BOARD MINUTES

Nancy McGovern asked if there were any corrections or additions to the January 20, 2011 Lee Memorial Hospital (Provider #10-0012) Board of Directors Minutes.

A motion was made by Nancy McGovern to approve the January 20, 2011 Lee Memorial Hospital (Provider #10-0012) Board of Directors Minutes. The motion was seconded by Donald Brown and it carried with no opposition.

LEE MEMORIAL

HOSPITAL OPERATIONS

REPORTS

Emad Salman reviewed the Operations/Performance Measures Report for The Children’s Hospital (Exhibit 1). Lisa Sgarlata presented the Operations Report for Lee Memorial Hospital (Exhibit 2) which consisted of a review of quality indicators, patient experience ratings, operational statistics comparing year to date to budget, management focus areas and financial reporting. Discussion ensued regarding capacity and growth issues. Donna Giannuzzi presented the Operations Report for HealthPark Medical Center (Exhibit 3). Discussion ensued regarding the report format and the reduction of babies being delivered due to the migration, economy and people postponing having children.

A motion was made by Linda Brown to accept the Operations Report for Lee Memorial Hospital (Provider #10-0012) containing HealthPark Medical Center and The Children’s Hospital (Exhibit 3). The motion was seconded by Nancy McGovern and it carried with no opposition.

MEDICAL STAFF

BUSINESS

MEDICAL STAFF RECOMMENDATIONS

OF FEBRUARY 22,

Richard Akin asked for approval of the Medical Staff Recommendations of February 22, 2011 for The Children’s Hospital (Exhibit 4), Lee Memorial Hospital (Exhibit 5), and HealthPark Medical Center (Exhibit 6).

A motion was made by Marilyn Stout to approve the Medical Staff

http://www.lememorial.org/boardofdirectors

LEE MEMORIAL HOSPITAL (Provider #10-0012) BOARD OF DIRECTORS MEETING LEE MEMORIAL HEALTH SYSTEM

Thursday, February 24, 2011 Page 2 of 2


2011

MEDICAL STAFF POLICIES

Chuck Krivenko reviewed the Medical Staff policies provided for Board approval:

I. Medical Staff Professional Conduct Policy (Exhibit 7) II. Medical Staff Residence Policy (Exhibit 8) III. Preceptorship Policy (Exhibit 9) IV. “Behave in a Professional and Civil Manner” Policy (Exhibit 10) V. Credentialing practitioners who have not been providing inpatient care

and are now requesting membership and privileges to provide acute inpatient care (competency criteria) Policy (Exhibit 11)

Discussion ensued.

Recommendations of February 22, 2011 for The Children’s Hospital (Exhibit 4), Lee Memorial Hospital (Exhibit 5), and HealthPark Medical Center (Exhibit 6). The motion was seconded by Nancy McGovern and it carried with no opposition. A motion was made by [name] to approve the following Medical Staff Policies:

I. Medical Staff Professional Conduct Policy (Exhibit 7) II. Medical Staff Residence Policy (Exhibit 8) III. Preceptorship Policy (Exhibit 9) IV. “Behave in a Professional and Civil Manner” Policy

(Exhibit 10) V. Credentialing practitioners who have not been providing

inpatient care and are now requesting membership and privileges to provide acute inpatient care (competency criteria) Policy (Exhibit 11)

The motion was seconded by [name] and it carried with no opposition.

OLD BUSINESS

None at this time.

NEW BUSINESS

None at this time.

NEXT REGULAR

MEETING The next LEE MEMORIAL HOSPITAL (Provider #10-0012) BOARD OF

DIRECTORS MEETING IS: March 24, 2011, 4:00 p.m. in the Lee Memorial Hospital Boardroom

2776 Cleveland Avenue, Fort Myers, FL 33901

ADJOURNMENT The Lee Memorial Hospital (Provider #10-0012)

Board of Directors Meeting was ADJOURNED at 6:08 p.m. by Richard Akin, Board Chairman.

Minutes were recorded by Lisa Porter, Executive Secretary/Board of Directors Office

Nancy McGovern, RN, MSM Board Secretary

Lee Memorial Hospital

Presented to Board of Directors March 24, 2011

Lisa Sgarlata, RN, MS, MSN, CENChief Administrative Officer


Quality Report


Patient Experience 2/10 2/11 YTD

Press Ganey InpatientLikelihood to Recommend 54% 56.6% 59.8%

Press Ganey EDLikelihood to Recommend 58.5% 46.9% 56.4%

HCAHPS Top Box Score Rate this Hospital 46% 55% 62.3%


Financial Report 2/28/11Net Revenue•Net Rev/Adj. Admit Budget 9,076 Actual 9,537 5.1%•Net Revenue per adjusted admission over budget by 5.1%•Net Patient Revenue positive rate variance of $770K offset by a negative volume variance of $73K.

Labor•FTEs per AOB were 4.03 vs. budget of 4.31 for a favorable improvement of 6.5% •FTEs were over budget by 84 •Productive salaries were over budget $445K

Gain from Operations •Gain from Operations Budget 2,516 Actual 2,745 9.1%•The Gain from Operations was over budget by $229K or 9.1% and over PY by 425K.•Operating Expense per adjusted admit over budget by 5.4% and PY by 5.9%.•Salary/Wage/Benefit expense per adjusted admit over budget by 5.6% and PY by 7.9%.•Supply expense per adjusted admission over budget by 5.4% and up 6.8% from PY.


Operations Report 2/28/11

Feb’11 Budget Actual var Bud Admissions 1,226 1,218 -0.7%ER Visits 4,304 4,790 11.3%ER Admits 1,005 963 -8.7%Surgical Cases 753 862 14.5%

LMHS Provider


Lisa Sgarlata, RN, MS, MSN, CENChief Administrative Officer

LMHS Provider


Financial Report 2/28/11Net Revenue•Net Rev/Adj. Admit Budget 8,896 Actual 9,072 2.0%•Net Revenue per adjusted admission over budget by 2.0%•Net Patient Revenue positive rate variance of $869K and a positive volume variance of $726K

Labor•FTEs per AOB were 4.16 vs. budget of 4.32 for a favorable improvement of 3.7% •FTEs were over budget by 161•Productive salaries were over budget $710K

Gain from Operations •Gain from Operations Budget 9,198 Actual 10,489 14.0%•The Gain from Operations was over budget by $1.3M or 14% and over PY by 777K.•Operating Expense per adjusted admit lower than budget by 0.6% and up from PY by 1.6%.•Salary/Wage/Benefit expense per adjusted admit over budget by 1.4% and PY by 5.4%.•Supply expense per adjusted admission lower than budget by 3.1 and PY by 4.3%.


Operations Report 2/28/11

Feb’11 Budget Actual var Bud Admissions 3,217 3,272 1.7%ER Visits 9,394 9,809 4.4%ER Admits 2,453 2,341 -4.6%Surgical Cases 1,625 1,689 3.9%

HealthPark Medical Center


Donna Giannuzzi RN, MBA, CNAA, BCCAO, HPMC


Quality Report


Patient Experience February FY YTD

Press Ganey Inpatient Likelihood to Recommend 71.4% 74.1%

Press Ganey ED

Likelihood to Recommend 58.2% 64.1%

HCAHPS Top Box Score

Rate this Hospital 69% 68.8%

Highlights

Cindy Brown, Vice President HPMC and Nikki Willis, MSN have been selected for participation at Nursing 2011

Symposium in April for the poster presentation entitled “Transfer of Care Bundle: Standardizing Nurse to Nurse

Communication”.

Nikki Willis, MSN has been selected to present at the 41st

Biennial Sigma Theta Tau International – Honor Society of Nursing oral presentation title: “Transfer of Care Bundle:

Standardizing Nurse to Nurse Communication”.


Financial Report – February 2011

Net Revenue Net Patient Revenue exceeded budget by $705k for the month. The volume variance was a positive $600k due to adjusted admits being above budget by 2.5%. HPMC also experienced a positive $104k rate variance as net revenue/adjusted admission was $8,722 vs. a budget of $8,683. LaborFTEs per AOB were 4.10 vs. budget of 4.24 for a productivity gain of 3.3%. Salaries were over budget $244k, or 3.1%, the majority of which was attributable to the volume increase for the month.

Gain from Operations The Gain from Operations of $6.9M exceeded budget by $1.1M or 19.1% and PY by $328k or 5.0%. The increase in volume coupled with the improvements in productivity and supply cost per adjusted admission were the main contributors to the favorable variance in the Gain from Operations.



Operations Report – February 2011

Year to Date Budget Actual Prior Var Bud Var PYAdmissions 1991 2054 2021 3.2% 1.6%ER Visits 5090 5019 5020 -1.4 % 0.0%ER Admits 1398 1378 1379 -1.4 % -0.1%Deliveries 275 259 266 -5.8% -2.6%Surgical Cases 872 827 889 -5.2% -7.0%Gain from Operations 5819 6932 6604 19.1% 5.0%Net Rev/Adj Admit 8683 8722 8759 0.4% -0.4%Admit Breakdown:Adult Admits 1584 1624 1650 2.5% -1.6%Pediatric Admits 363 373 321 3.9% 17.4%NICU Admits 44 53 50 20.8% 6.0%

LEE MEMORIAL HEALTH SYSTEM Lee County, Florida

#1 M E M O R A N D U M

To: Board of Directors From: Sandra L. Wharton, CPMSM, CPCS System Director, Medical Staff Services Date: March 22, 2011 Subject: Lee Memorial Hospital Medical Staff Recommendations The Facility Medical Executive Committee of the Medical Staff recommends the following physicians and allied health practitioners and certifies they have met the requirements set forth in the bylaws:

1. Associate Staff Appointments: a. Maria F. Badami, D.O. – Family Practice b. Keri L. Mason, D.O. – Internal Medicine c. Luis F. Rodriguez, M.D. – Pediatric Neurosurgery d. James A. Stith, M.D. – Pathology e. Anayet U. Thakur, M.D. – Internal Medicine

2. First Year Completion – Associate Staff Appointment:

a. Snehal R. Patel, M.D. – Internal Medicine 3. M.S. and A.H.P. Reappointments – 04-01-11 to 03-30-13 (list attached)

4. Leave of Absence:

a. Charles C. Boggs, M.D. – General Surgery, LOA from 02-28-11 to 07-04-11 b. Nelayda Fonte, D.O. – Trauma Surgery, LOA from 02-07-11 to 03-31-11 c. Kathleen Shimp, M.D. – OB/Gyn, LOA from 06-09-11 to 08-07-11 d. Jerry V. Thomas, M.D. – Family Practice, LOA from 03-27-11 to 06-30-11

5. Leave of Absence Extension:

a. Vincent Belcastro, M.D. – General Surgery, LOA from 03-01-11 to 02-28-12 b. Lea Blackwell, M.D. – General Surgery, LOA from 03-01-11 to 02-28-12 c. Charles Boggs, M.D. – General Surgery, LOA from 03-01-11 to 02-28-12 d. Thomas Carrasquillo, M.D. – General Surgery, LOA from 03-01-11 to 02-28-12 e. Thad Kammerlocher, M.D. – General Surgery, LOA from 03-01-11 to 02-28-12 f. Thomas Kowalsky, M.D. – General Surgery, LOA from 03-01-11 to 02-28-12 g. Michelle Mon, M.D. – General Surgery, LOA from 03-01-11 to 02-28-12

6. Change of Status:

a. Christopher B. Hoek, D.D.S. – Oral & Maxillofacial Surgery, Honorary Staff b. Richard H. Wingert, M.D. – Otolaryngology, Honorary Staff

Memorandum to Board of Directors - LMH March 22, 2011 Page 2 of 2 7. Privilege Request:

a. Jeffrey A. Neale, M.D. – Colorectal Surgery, Class II moderate sedation 8. Resignations:

a. Eric Eskioglu, M.D. – Neurosurgery, effective 03-18-11 b. Brian Mason, M.D. – Diagnostic Radiology, effective 03-18-11 c. Madhava T. Pally, M.D. – Cardiology, effective 02-15-11

9. Temporary Privileges:

a. Marcia Caldwell, CRNA – 03-18-11 – 04-17-11 b. Michelle Hartman, CRNA – 04-10-11 – 05-09-11

10. Allied Health Practitioners:

a. Christopher Bourn, CRNA – Medical Anesthesia b. Dawn Bradley, ARNP – Neurology Consulting Services c. Tanya Bryndzia, ARNP – ICU Practitioners d. Heather Ferrer, CRNA – Medical Anesthesia e. NancyAnn Harrod, ARNP – Dr. Jon Burdzy f. S. Todd Little, CRNA – Medical Anesthesia g. R. Craig Merrifield, CRNA – Medical Anesthesia h. Shannon Murphy, PA – LMHS Emergency Physicians i. Lahoma Nachtrab, CRNA – Medical Anesthesia j. Susan Nolan, PA – LMHS Emergency Physicians k. John Rafacz, CRNA – Medical Anesthesia l. Yvonne Whittle-Brown, ARNP – Neurology Consulting Services

11. Allied Health Practitioner – Sponsor Change:

a. Michael Sempsrott, ARNP – Neurology Consulting Services

Approved by the Board of Directors – March 24, 2011

__________________________________________ Richard B. Akin, Chairman - Board of Directors

LEE MEMORIAL HEALTH SYSTEM

Lee County, Florida #4

M E M O R A N D U M To: Board of Directors From: Sandra L. Wharton, CPMSM, CPCS System Director, Medical Staff Services Date: March 22, 2011 Subject: HealthPark Medical Center Medical Staff Recommendations The Facility Medical Executive Committee of the Medical Staff recommends the following physicians and allied health practitioners and certifies they have met the requirements set forth in the bylaws:

1. Associate Staff Appointments: a. Maria F. Badami, D.O. – Family Practice b. Keri L. Mason, D.O. – Internal Medicine c. Luis F. Rodriguez, M.D. – Pediatric Neurosurgery d. James A. Stith, M.D. – Pathology e. Anayet U. Thakur, M.D. – Internal Medicine


a. Snehal R. Patel, M.D. – Internal Medicine 3. M.S. and A.H.P. Reappointments – 04-01-11 to 03-30-13 (list attached)


a. Charles C. Boggs, M.D. – General Surgery, LOA from 02-28-11 to 07-04-11 b. Nelayda Fonte, D.O. – Trauma Surgery, LOA from 02-07-11 to 03-31-11 c. Kathleen Shimp, M.D. – OB/Gyn, LOA from 06-09-11 to 08-07-11 d. Jerry V. Thomas, M.D. – Family Practice, LOA from 03-27-11 to 06-30-11

5. Change of Status:

a. Christopher B. Hoek, D.D.S. – Oral & Maxillofacial Surgery, Honorary Staff b. Richard H. Wingert, M.D. – Otolaryngology, Honorary Staff

6. Privilege Request:


a. Eric Eskioglu, M.D. – Neurosurgery, effective 03-18-11 b. Brian Mason, M.D. – Diagnostic Radiology, effective 03-18-11

Memorandum to Board of Directors - HPMC March 22, 2011 Page 2 of 2 8. Temporary Privileges:



a. Christopher Bourn, CRNA – Medical Anesthesia b. Dawn Bradley, ARNP – Neurology Consulting Services c. Tanya Bryndzia, ARNP – ICU Practitioners d. Heather Ferrer, CRNA – Medical Anesthesia e. NancyAnn Harrod, ARNP – Dr. Jon Burdzy f. S. Todd Little, CRNA – Medical Anesthesia g. R. Craig Merrifield, CRNA – Medical Anesthesia h. Shannon Murphy, PA – LMHS Emergency Physicians i. Lahoma Nachtrab, CRNA – Medical Anesthesia j. Susan Nolan, PA – LMHS Emergency Physicians k. John Rafacz, CRNA – Medical Anesthesia l. Yvonne Whittle-Brown, ARNP – Neurology Consulting Services


a. Michael Sempsrott, ARNP – Neurology Consulting Services 11. Practitioner-in Training:

a. Kimberly A. Scott, ARNP student – HP Emergency Dept., 04-01-11 – 06-30-11





To: Board of Directors From: Sandra L. Wharton, CPMSM, CPCS System Director, Medical Staff Services Date: March 22, 2011 Subject: The Children’s Hospital Medical Staff Recommendations The Facility Medical Executive Committee of the Medical Staff recommends the following physicians and allied health practitioners and certifies they have met the requirements set forth in the bylaws:

1. Associate Staff Appointments: a. Luis F. Rodriguez, M.D. – Pediatric Neurosurgery b. Stephanie H. Stovall, M.D. – Pediatric Infectious Disease

2. M.S. and A.H.P. Reappointments – 04-01-11 to 03-30-13 (list attached)




POLICY & PROCEDURE MANUAL

PURPOSE:

This policy and procedure is intended to provide guidance and direction on how to proceed at Lee Memorial Health System (“LMHS”) facilities when confronted with a potentially impaired physician or other practitioner who possesses clinical privileges at LMHS facilities (generically referred to as a "practitioner").

DEFINITION:

Impairment is defined as the condition of being unable to perform one’s professional duties and responsibilities in a reasonable manner and consistent with professional standards. Cognitive function, judgment, reaction time, and ability to handle stress are increasingly affected. As impairment progresses the potential for compromised patient care increases. Impairment may result from dependence or use of mind or mood altering substances; distorted thought processes resulting from mental illness or physical condition; or disruptive social tendencies.

LOCATOR NUMBER TITLE OF POLICY: Impaired Practitioner Oversight P & P

CCH Medical Staff – policy that applies to all members of the Medical Staff. GCMC Medical Staff – policy that applies to all members of the Medical Staff. HPMC Medical Staff – policy that applies to all members of the Medical Staff. LMH Medical Staff – policy that applies to all members of the Medical Staff.

T Y P E

CHAPTER: TAB: POLICY #:

TCH Medical Staff – policy that applies to all members of the Medical Staff.

Reviewed / No Revision: Next Review Date: Date Originated: 110910 Dates Revised: 011811

Author(s): Legal Services

Reviewed by: Ralph Gregg, M.D. HPMC M.S. President Approved by: HPMC FMEC LMH FMEC GCMC FMEC CCH FMEC TCH FMEC Ralph Gregg, M.D. Razak Dosani, M.D. Charles Bisbee, M.D. David Reardon, M.D. Rodrigo Mon, M.D. As Needed: Board of Directors

Date: 011811 Date: Date: Date: Date: Date: 020811 020911 021411 022111 03-1511 Date:

PROCEDURE:

Any person having a reasonable suspicion or concern that a practitioner is impaired should immediately take the following steps:

1) Report:

Contact the President of the Medical Staff, any member of the Facility Medical Executive Committee (“FMEC”), a Department Chairperson, the Chief Medical Officer of Clinical and Quality Services or his/her designee (“hospital representative”) and inform them of their concerns and observations. The contacted Medical Staff or hospital representative should meet, or make arrangements for a designee to meet, with the practitioner and assess the situation. This contact should be made in all situations where it appears that the practitioner cannot safely and competently carry out patient carerelated activities at the time observed. (e.g., the practitioner smells of alcohol; exhibits difficulty walking, slurred speech, or clumsiness, or erratic, inappropriate or unusual behavior). The person initiating the contact should ask the practitioner to cease patient care and await the arrival of the Medical Staff or hospital representative, if appropriate. Legal Services/Risk Management may be contacted for assistance and guidance. The Medical Staff or hospital representative should counsel the person(s) initiating the contact as to the confidential nature of the matter.

2) Confidentiality: All information and documents created pursuant to this policy are strictly confidential. The Medical Staff or hospital representative must counsel the person(s) initiating the contact and others involved in the review as to the strict confidential nature of the matter. Improper disclosures of confidential information or documents will result in review and disciplinary action in accordance with the Medical Staff Bylaws and/or health system policies, as applicable.

3) Initial Assessment:

If, after careful assessment, the Medical Staff or hospital representative assessing the situation believes there is a question of impairment due to intoxication/substance abuse, a urine sample and serum blood sample should be obtained immediately (or as soon as practical under the circumstances) under direct supervision through the procedures established in Article II, B of the LMHS’s Drug Free Workplace Policy (Policy S0906189).

An appropriate chain of custody procedure will be followed. Such specimens shall be evaluated for the presence of alcohol and drugs as provided for in the Drug Free Workplace Policy.

If a nonsubstance abuse impairment problem is felt to be present, then appropriate evaluation may be recommended or requested by the FMEC.

In each case, the Medical Staff or hospital representative shall direct the collection and maintenance of all specimens, test results, evaluations and other information including treatment information regarding the practitioner in a confidential and secure manner.

If in the opinion of the Medical Staff or hospital representative precautionary suspension is needed to protect the health and/or safety of any individual, the representative should contact the President of the Medical Staff or the Chief Medical Officer and system legal counsel to impose emergency corrective action in accordance with Part II, Section 1 of the Medical Staff Bylaws.

4) Posttest Review: Should the urine and blood screens test positive, or if such tests are negative and the Medical Staff or hospital representative determines that the practitioner appears to be otherwise psychiatrically or physically impaired, the practitioner in question will be reported in a timely manner to the FMEC for followup consistent with Part II of the Medical Staff Bylaws. If warranted, the practitioner’s clinical privileges may be subject to a precautionary suspension pursuant to Part II, Section 2.1 of the Medical Staff Bylaws.

5) Refusal to Submit to a Reasonable Suspicion Drug Test: The clinical privileges of any practitioner who refuses a proper request to provide blood or urine samples may subject to emergency corrective action / precautionary suspension under Part II, Section 2 of the Medical Staff Bylaws, or subject to disciplinary action pursuant to routine corrective action under Part II, Section 1 of the Medical Staff Bylaws.

6) FMEC Action: Depending on the nature of the impairment and the severity of the problem, the FMEC may address the matter under its authority within the Medical Staff Bylaws or refer the practitioner to the System Practitioner Resource Committee ("SPRC"). In addition to other recommendations under the Medical Staff Bylaws, the FMEC may take any of the following actions:

Require the practitioner to undergo chemical dependency evaluation; Refer the practitioner to the Impaired Practitioner Program of Florida or otherwise participate in a rehabilitation program approved by LMHS as a condition of continued Medical Staff membership and clinical privileges. This may include suspending the practitioner’s clinical privileges, if appropriate, until rehabilitation has been accomplished unless he/she voluntarily agrees to refrain from exercising his/her clinical privileges; Recommend appropriate restrictions on the practitioner’s Medical Staff membership or clinical privileges; or Recommend appropriate counseling/treatment.

7) Bylaws/Policy Conflict: in the event of an apparent or actual conflict between this policy and procedure and Medical Staff Bylaws and rules and regulations, the Medical Staff Bylaws and rules and regulations shall supersede this policy and procedure. Efforts have been made to assure that this policy and procedure is consistent with the Medical Staff Bylaws and rules and regulations.



OLD BUSINESS



NEW BUSINESS

ADJOURN Lee Memorial Hospital

GGOO TTOO

{{YYEELLLLOOWW FFOOLLDDEERR}} CCAAPPEE CCOORRAALL HHOOSSPPIITTAALL BBOOAARRDD OOFF DDIIRREECCTTOORRSS

((PPrroovviiddeerr ##1100--00224444))

CONVENE

{{YYEELLLLOOWW FFOOLLDDEERR}}


CAPE CORAL

HOSPITAL


FAX: 239-343-3194


CAPE CORAL HOSPITAL






LEE PHYSICIAN GROUP

LEE CONVENIENT CARE

BOARD OF DIRECTORS

DISTRICT ONE


Marilyn Stout

DISTRICT TWO

Richard B. Akin


DISTRICT THREE



DISTRICT FOUR

Diane Champion

Chris Hansen

DISTRICT FIVE

Donald A. Brown

James Green

Public Input - Agenda Items: Any Public input is limited to three minutes

and a “Request to Address the Board of Directors” card must be completed and submitted to the Board Administrator prior to meeting.

{{YYEELLLLOOWW FFOOLLDDEERR}}

Convening as the Cape Coral Hospital Board of Directors



Lee Memorial Hospital – Boardroom 2776 Cleveland Avenue, Ft. Myers, FL 33901

AGENDA

1. Call to Order CAPE CORAL HOSPITAL BOARD OF DIRECTORS (Richard Akin, Board Chairman) {{YYEELLLLOOWW FFOOLLDDEERR}}

2. Public Input - Agenda Items: Any Public input is limited to three

minutes and a “Request to Address the Board of Directors” card must be completed and submitted to the Board Administrator prior to meeting.

3. Meeting Minutes of February 24, 2011 (Approval)

(Nancy McGovern, RN, MSM, Board Secretary)

4. Operations Report (Wendy Piascik, VP Patient Care) (Accept)

5. Medical Staff Business (Approval)

A. Medical Staff Recommendations of March 22, 2011 B. Impaired Practitioner Oversight Policy & Procedure

6. Old Business

7. New Business

8. Date of the next meeting – Thursday, April 28, 2011

4:00 pm, Lee Memorial Hospital – Boardroom

9. Adjournment (Richard Akin, Board Chairman)




Any public input






CAPE CORAL HOSPITAL BOARD OF DIRECTORS (PROVIDER # 10-0244) LEE MEMORIAL HEALTH SYSTEM

Thursday, February 24, 2011 LOCATION: Lee Memorial Hospital Boardroom, 2776 Cleveland Avenue, Fort Myers, FL 33901 MEMBERS PRESENT: Richard Akin, Board Chairman; Linda Brown, MSN, ARNP, Board Vice Chairman; Nancy McGovern, RN, MSM, Board Secretary; Marilyn Stout, Board Treasurer; Steve Brown,

M.D., Director; Chris Hansen, Director; Donald Brown, Director; Diane Champion, Director; James Green, Director MEMBERS ABSENT: Lois Barrett, MBA, Director OTHERS PRESENT: James Nathan, President/CEO; Cathy Stephens, Board Administrator; Jim Humphrey, Board Counsel; Mary McGillicuddy, Chief Legal Officer; Mike German, Chief Financial

Officer; Jon Cecil, Chief Human Resource Officer; Larry Antonucci, M.D., Chief Operating Officer/Hospital & Physician Services; Chuck Krivenko, M.D., Chief Medical Officer/Clinical and Quality Services; Emad Salman, MD; Medical Staff President/TCH; Scott Nygaard, M.D., Chief Medical Officer/Physician Services; Lisa Sgarlata, R.N., Chief Administrative Officer/LMH; Donna Giannuzzi, R.N., Chief Patient Care Officer/Chief Administrative Officer/HP; Kristy Rigot, System Director of Recruitment and Retention; Bill Brown, Allied Health Recruiter; Mary Lorah, Risk Manager II; Sally Jackson, System Director of Community Projects; Bill Silverman, M.D., Quality & Education Community Representative; Bob Fischer, Financial Community Representative; Mary Briggs, Interim Public Relations; Guest, Frank Gluck, News Press/Reporter; Laurie Gretten, Executive Secretary/Board of Directors; Lisa Porter, Executive Secretary/Board of Directors




The CAPE CORAL HOSPITAL (Provider #10-0244) BOARD OF DIRECTORS Meeting was CALLED TO ORDER at 5:34

p.m. by Richard Akin, Board Chairman.


CAPE CORAL

HOSPITAL BOARD MINUTES

Nancy McGovern asked if there were any corrections or additions to the January 20, 2011 Cape Coral Hospital (Provider #10-0244) Board of Directors Minutes. It was pointed out that Wendy Piascik’s name was misspelled in the minutes. The minutes were corrected.

A motion was made by Chris Hansen to approve the January 20, 2011, Cape Coral Hospital (Provider #10-0244) Board of Directors Minutes, as corrected. The motion was seconded by Diane Champion and it carried with no opposition.

CAPE CORAL

HOSPITAL OPERATIONS

REPORT

Wendy Piascik presented the Operations Report for Cape Coral Hospital (Exhibit 1) which consisted of a review of quality indicators, patient experience ratings, operational statistics comparing year to date to budget, management focus areas and financial reporting. Discussion ensued regarding capacity issues, how busy the emergency room had been, and formats for quality statistical comparisons.

A motion was made by Donald Brown to accept the Operations Report for Cape Coral Hospital (Provider #10-0244) (Exhibit 1). The motion was seconded by Chris Hansen and it carried with no opposition.

MEDICAL STAFF

BUSINESS


OF FEBRUARY 22, 2011

Richard Akin asked for approval of the Medical Staff Recommendations of February 22, 2011, for Cape Coral Hospital (Exhibit 2).

A motion was made by Linda Brown to approve the Medical Staff Recommendations of February 22, 2011, for Cape Coral Hospital (Exhibit 2). The motion was seconded by Nancy McGovern and it carried with no opposition.


CAPE CORAL HOSPITAL (Provider # 10-0244) BOARD OF DIRECTORS MEETING LEE MEMORIAL HEALTH SYSTEM

Thursday, February 24, 2011 Page 2 of 2


MEDICAL STAFF POLICIES

Chuck Krivenko reviewed the Medical Staff policies provided for Board approval: I. Medical Staff Professional Conduct Policy (Exhibit 3) II. Medical Staff Residence Policy (Exhibit 4) III. Preceptorship Policy (Exhibit 5) IV. “Behave in a Professional and Civil Manner” Policy (Exhibit 6) V. Credentialing practitioners who have not been providing inpatient care


Discussion ensued.

A motion was made by [name] to approve the following Medical Staff Policies:





OLD BUSINESS None at this time.

NEW BUSINESS None at this time.

NEXT REGULAR

MEETING The next CAPE CORAL HOSPITAL (Provider #10-0244) BOARD OF

DIRECTORS MEETING IS: March 24, 2011, 4:00 p.m. in the Lee Memorial Hospital Boardroom


ADJOURNMENT The Cape Coral Hospital (Provider #10-0244) Board of Directors

Meeting was ADJOURNED at 5:44 p.m. by Richard Akin, Board Chairman.



Cape Coral Hospital


Wendy Piascik, MSN, RN, CCRN, NEA, BC,FACHE Vice President, Patient Care Services

CAPE CORAL HOSPITAL

Quality Report

CAPE CORAL HOSPITAL

Patient Experience 2/11 FY YTDPress Ganey Inpatient

Likelihood to Recommend 58.6% 59.4%Press Ganey ED

Likelihood to Recommend 44.3% 51.4%HCAHPS Top Box Score

Rate this Hospital 59% 58.4%

CAPE CORAL HOSPITAL

Financial Report YTD ending 2/28/11Net Revenue•Net Rev/Adj. Admit Budget 7123 Actual 7453 4.4%•Net Revenue per adjusted admission exceeded budget by 4.4%, however the Net Patient Revenue positive rate variance of $3.25M offset by a negative volume variance of $3.42M.

Labor•FTEs per AOB were 3.98 vs. budget of 4.01 for a favorable improvement of 0.8% or 26FTEs.

•Productive salaries were over budget $848K, of which $616K was attributable to the -2.8 decrease in volume and $233K due to an increase in average hourly rate..

Gain from Operations •Gain from Operations Budget 18,627 Actual 16452 -11.7%•The Gain from Operations was under budget by $2.2M or -11% but and off PY by 132K.•Operating Expense per adjusted admit exceeded budget by 8.1% and PY by 9..3%.•Salary/Wage/Benefit expense per adjusted admit exceeded budget by 6.1% and PY by 8.6%.•Supply expense per adjusted admission exceeded budget by 9.8% and PY by 9.3%.

CAPE CORAL HOSPITAL

Operations Report YTD ending 2/28/11

Year to Date Budget Actual var Bud Admissions 6611 6426 -2.8%ER Visits 24960 24734 -0.9%ER Admits 5544 5665 2.2%Deliveries 588 565 -2.9%Surgical Cases 3345 3247 -2.9%

Seasonal Overflow Unit – 2 EastContinues to be open with current capacity of 24

Telephone conversion to Cisco wireless 3/21-3/28/11


Lee County, Florida #2

M E M O R A N D U M To: Board of Directors From: Sandra L. Wharton, CPMSM, CPCS System Director, Medical Staff Services Subject: Cape Coral Hospital Medical Staff Recommendations Date: March 22, 2011 The Facility Medical Executive Committee of the Medical Staff recommends the following physicians and allied health practitioners and certifies they have met the requirements set forth in the bylaws:

1. Associate Staff Appointments: a. Maria F. Badami, D.O. – Family Practice b. Keri L. Mason, D.O. – Internal Medicine c. James A. Stith, M.D. – Pathology d. Anayet U. Thakur, M.D. – Internal Medicine

2. Intrasystem Appointment:

a. Joseph Mazza, M.D. – Plastic Surgery

3. First Year Completion – Active Staff Appointments: a. Pamela M. Falcigno, M.D. – Emergency Medicine b. Snehal R. Patel, M.D. – Internal Medicine

4. M.S. and A.H.P. Reappointments – 04-01-11 to 03-30-13 (list attached)


a. Charles C. Boggs, M.D. – General Surgery, LOA from 02-28-11 to 07-04-11 b. Aparna Eligeti, M.D. – OB/Gyn, LOA from 05-23-11 to 07-17-11 c. Jerry V. Thomas, M.D. – Family Practice, LOA from 03-27-11 to 06-30-11



a. Eric Eskioglu, M.D. – Neurosurgery, effective 03-18-11 b. Brian Mason, M.D. – Diagnostic Radiology, effective 03-18-11

8. Temporary Privileges:


Memorandum to Board of Directors - CCH March 22, 2011 Page 2 of 2 9. Allied Health Practitioners:

a. Christopher Bourn, CRNA – Medical Anesthesia b. Dawn Bradley, ARNP – Neurology Consulting Services c. Tanya Bryndzia, ARNP – ICU Practitioners d. Heather Ferrer, CRNA – Medical Anesthesia e. S. Todd Little, CRNA – Medical Anesthesia f. R. Craig Merrifield, CRNA – Medical Anesthesia g. Lahoma Nachtrab, CRNA – Medical Anesthesia h. John Rafacz, CRNA – Medical Anesthesia i. Yvonne Whittle-Brown, ARNP – Neurology Consulting Services


a. Michael Sempsrott, ARNP – Neurology Consulting Services


__________________________________________ Richard B. Akin, Chairman – Board of Directors



PURPOSE:


DEFINITION:




T Y P E







PROCEDURE:


1) Report:
















OLD BUSINESS



NEW BUSINESS

ADJOURN Cape Coral Hospital

GGOO TTOO

{{OORRAANNGGEE FFOOLLDDEERR}} GGUULLFF CCOOAASSTT

MMEEDDIICCAALL CCEENNTTEERR BBOOAARRDD OOFF DDIIRREECCTTOORRSS

((PPrroovviiddeerr ##1100--00224444))

CONVENE

{{OORRAANNGGEE FFOOLLDDEERR}} (Provider # 10-0220)

GULF COAST

MEDICAL CENTER


FAX: 239-343-3194


CAPE CORAL HOSPITAL






LEE PHYSICIAN GROUP

LEE CONVENIENT CARE

BOARD OF DIRECTORS

DISTRICT ONE


Marilyn Stout

DISTRICT TWO

Richard B. Akin


DISTRICT THREE



DISTRICT FOUR

Diane Champion

Chris Hansen

DISTRICT FIVE

Donald A. Brown

James Green

Public Input - Agenda Items: Any Public input is limited to three minutes and a “Request to Address the Board of Directors” card must be

completed and submitted to the Board Administrator prior to meeting.

{{OORRAANNGGEE FFOOLLDDEERR}}

Convening as the

Gulf Coast Medical Center Board of Directors (Provider # 10-0220)


Lee Memorial Hospital-Boardroom 2776 Cleveland Avenue, Ft. Myers, FL 33901

AGENDA

1. Call to Order GULF COAST MEDICAL CENTER BOARD OF DIRECTORS

(Richard Akin, Board Chairman) {{OORRAANNGGEE FFOOLLDDEERR}} 2. Public Input - Agenda Items: Any Public input is limited to three minutes

and a “Request to Address the Board of Directors” card must be completed and submitted to the Board Administrator prior to meeting.

3. Meeting Minutes of February 24, 2011 (Approval)

(Nancy McGovern, RN, MSM, Board Secretary)

4. Operations Report (Holly Mueller, VP Patient Care) (Accept) 5. Medical Staff Business (Approval)

A. Medical Staff Recommendations of March 22, 2011 B. Impaired Practitioner Oversight Policy & Procedure

6. Old Business 7. New Business 8. Date of the next meeting – Thursday, April 28, 2011

4:00 pm, Lee Memorial Hospital – Boardroom

9. Adjournment (Richard Akin, Board Chairman)




Any public input






GULF COAST MEDICAL CENTER BOARD OF DIRECTORS (PROVIDER # 10-0220) LEE MEMORIAL HEALTH SYSTEM

Thursday, February 24, 2011 LOCATION: Lee Memorial Hospital, Boardroom, 2776 Cleveland Avenue, Fort Myers, FL 33901 MEMBERS PRESENT: Richard Akin, Board Chairman; Linda Brown, MSN, ARNP, Board Vice Chairman; Nancy McGovern, RN, MSM, Board Secretary; Marilyn Stout, Board Treasurer; Steve Brown,

M.D., Director; Chris Hansen, Director; Donald Brown, Director; Diane Champion, Director; James Green, Director MEMBERS ABSENT: Lois Barrett, MBA, Director OTHERS PRESENT: James Nathan, President/CEO; Cathy Stephens, Board Administrator; Jim Humphrey, Board Counsel; Mary McGillicuddy, Chief Legal Officer; Mike German, Chief Financial

Officer; Jon Cecil, Chief Human Resource Officer; Larry Antonucci, M.D., Chief Operating Officer/Hospital & Physician Services; Chuck Krivenko, M.D., Chief Medical Officer/Clinical and Quality Services; Emad Salman, MD; Medical Staff President/TCH; Scott Nygaard, M.D., Chief Medical Officer/Physician Services; Lisa Sgarlata, R.N., Chief Administrative Officer/LMH; Donna Giannuzzi, R.N., Chief Patient Care Officer/Chief Administrative Officer/HP; Kristy Rigot, System Director of Recruitment and Retention; Bill Brown, Allied Health Recruiter; Mary Lorah, Risk Manager II; Sally Jackson, System Director of Community Projects; Bill Silverman, M.D., Quality & Education Community Representative; Bob Fischer, Financial Community Representative; Mary Briggs, Interim Media Relations; Guest, Frank Gluck, News Press/Reporter; Laurie Gretten, Executive Secretary/Board of Directors; Lisa Porter, Executive Secretary/Board of Directors




The GULF COAST MEDICAL CENTER (Provider #10-0220) BOARD OF DIRECTORS Meeting was CALLED TO ORDER at 6:08 p.m.

by Richard Akin, Board Chairman.


GULF COAST

MEDICAL CENTER BOARD MINUTES

Nancy McGovern asked if there were any corrections or additions to the January 20, 2011, Gulf Coast Medical Center (Provider #10-0220) Board of Directors Minutes.

A motion was made by Nancy McGovern to approve the January 20, 2011 Gulf Coast Medical Center (Provider #10-0220) Board of Directors Minutes. The motion was seconded by Marilyn Stout and it carried with no opposition.

GULF COAST

MEDICAL CENTER OPERATIONS

REPORT

Holly Muller presented the Operations Report for Gulf Coast Medical Center (Exhibit 1) which consisted of a review of quality indicators, patient experience ratings, operational statistics comparing year to date to budget, management focus areas and financial reporting. Discussion ensued regarding an increase in bad debt from charities.

A motion was made by Steve Brown to accept the Operations Report for Gulf Coast Medical Center (Exhibit 1). The motion was seconded by Chris Hansen and it carried with no opposition.

MEDICAL STAFF

BUSINESS


OF FEBRUARY 22, 2011

MEDICAL STAFF

POLICIES

Richard Akin asked for approval of the Medical Staff Recommendations of February 22, 2011 for Gulf Coast Medical Center (Exhibit 2). Chuck Krivenko reviewed the Medical Staff policies provided for Board approval:

I. Medical Staff Professional Conduct Policy (Exhibit 3) II. Medical Staff Residence Policy (Exhibit 4) III. Preceptorship Policy (Exhibit 5)

A motion was made by Chris Hansen to approve the Medical Staff Recommendations of February 22, 2011 for Gulf Coast Medical Center (Exhibit 2). The motion was seconded by Diane Champion and it carried with no opposition.


GULF COAST MEDICAL CENTER (Provider # 10-0220) BOARD OF DIRECTORS MEETING LEE MEMORIAL HEALTH SYSTEM

Thursday, February 24, 2011 of 2

Page 2


IV. “Behave in a Professional and Civil Manner” Policy (Exhibit 6) V. Credentialing practitioners who have not been providing inpatient care


Discussion ensued.

A motion was made by Maryiln Stout to approve the Medical Staff Policies:





OLD BUSINESS

None at this time.

NEW BUSINESS None at this time.

NEXT REGULAR

MEETING The next GULF COAST MEDICAL CENTER (Provider # 10-0220)

BOARD OF DIRECTORS MEETING IS: March 24, 2011, 4:00 p.m. in the Lee Memorial Hospital Boardroom


ADJOURNMENT The Gulf Coast Medical Center (Provider #10-0220)

Board of Directors Meeting was ADJOURNED at 6:20 p.m. by Richard Akin, Board Chairman.



Gulf Coast MEDICAL CENTER

Presented to Board of DirectorsMarch 24, 2011

Holly Muller, RN, MSN, MHA, CRRNVice President, Patient Care Services

Quality Report ~ Gulf Coast Medical Center

Patient Experience 1st. Quarter FY 11 YTD

Press Ganey Inpatient:


Press Ganey ED


HCAHPS Top Box Score

Rate this Hospital 63.0% 64.0%

Operations Report ~ Gulf Coast Hospital

Year to Date Budget Actual var Bud

Admissions 1940 1900 -2.05%ER Visits 4067 4125 1.42%ER Admits 1416 1412 -0.31%Deliveries 155 135 -12.96%Surgical Cases 842 900 6.84%

Capacity Management Focus:• Surge beds remain part of strategy for managing capacity• Operations Improvement ~ ED• Discharge Execution Initiative

Financial Report YTD ending 02/28/11 ~ Gulf Coast Medical Center ~

Net Revenue • Net Revenue per AA (Budget $9,302 Actual $9,755 var 5.0%• Actual exceeded budget by 5.0%, with a positive rate variance of

$1.15M offset by a negative volume variance of $1.19M. The rate variance was positively impacted by the increase in GCMC Medicaid rate effective 1/1/11 from $1660 to $2065 per day and the Kidney Receivable Adjustment of $120K.

Labor• FTEs per AOB was 4.49 vs budget of 4.43 for a productivity decline

of 1.4% or 23 FTEs. This was primarily the result of declining Outpatient Revenue.

• Salary expense was under budget $48K, of which $24K was attributable to the 0.3% volume decrease and a favorable average hourly rate decrease of $24K.

Gain from Operations • Gain from Operations: Actual $3,647M Budget $4,011 Var -364K• The Gain from Operations fell short of Budget by $364K or -9.1%

and EBDITA fell short of budget by $421K or 5.9%. Supply expense and Purchased Service misses were the primary reason for both EBDITA and Gain from Operations shortfall for February.



To: Board of Directors From: Sandra L. Wharton, CPMSM, CPCS System Director, Medical Staff Services Subject: Gulf Coast Medical Center Medical Staff Recommendations Date: March 22, 2011 The Facility Medical Executive Committee of the Medical Staff recommends the following physicians and allied health practitioners and certifies they have met the requirements set forth in the bylaws:

1. Associate Staff Appointments: a. Maria F. Badami, D.O. – Family Practice b. Keri L. Mason, D.O. – Internal Medicine c. James A. Stith, M.D. – Pathology d. Anayet U. Thakur, M.D. – Internal Medicine


a. Snehal R. Patel, M.D. – Internal Medicine 3. First Year Completion – Active Staff Appointment:

a. Steven F. Woodring, D.O. – Anesthesiology 4. M.S. and A.H.P. Reappointments – 04-01-11 to 03-30-13 (list attached)



a. Bruce Gerber, M.D. – Diagnostic Radiology, effective 03-30-11 b. Eric Eskioglu, M.D. – Neurosurgery, effective 03-18-11


a. Dawn Bradley, ARNP – Neurology Consulting Services b. Tanya Bryndzia, ARNP – ICU Practitioners c. W. Glen Sorokoty, CRNA – Anesthesia & Pain Consultants d. Yvonne Whittle-Brown, ARNP – Neurology Consulting Services

Memorandum to Board of Directors - GCMC March 22, 2011 Page 2 of 2 8. Allied Health Practitioner – Sponsor Change:

a. Michael Sempsrott, ARNP – Neurology Consulting Services 9. Allied Health Practitioner – Additional Sponsor:

a. Justin Fitz, PA – Southwest Florida Emergency Physicians


_________________________________________ Richard B. Akin, Chairman, Board of Directors



PURPOSE:


DEFINITION:




T Y P E







PROCEDURE:


1) Report:
















OLD BUSINESS



NEW BUSINESS

ADJOURN GULF COAST

MEDICAL CENTER

GGOO TTOO

{{BBLLUUEE FFOOLLDDEERR}} RREECCOONNVVEENNEE

LLEEEE MMEEMMOORRIIAALL HHEEAALLTTHH SSYYSSTTEEMM

BBOOAARRDD OOFF DDIIRREECCTTOORRSS MMEEEETTIINNGG

CONTINUE to Lee Memorial Health System

Board of Directors {BLUE FOLDER}

Board Chairman

Richard Akin

BBBOOOAAARRRDDD OOOFFF DDDIIIRRREEECCCTTTOOORRRSSS RECOMMENDED ACTION FOR BOARD APPROVAL

(Action includes Acceptance, Approval, Adoption, etc)

Keep form to one page, SUBMIT (thru SLC Member) ELECTRONICALLY to L Drive – Miscellaneous - BOD Presentations by Noon the Friday before you’re scheduled on agenda.

DATE: March 24, 2011 LEGAL SERVICE REVIEW? YES__ NO_X_ SUBJECT: 2010 Annual Evaluation of the Environment of Care Programs for Lee Memorial Health System REQUESTOR & TITLE: Rocky Rhoads, System Director of Environmental Safety / Safety Officer PREVIOUS BOARD ACTION ON THIS ITEM (IF ANY) (justification and/or background for recommendations – internal groups which support the recommendation i.e. SLC, Operating Councils, PMTs, etc.)

SPECIFIC PROPOSED MOTION: Acceptance of the 2010 Annual Evaluation of the Environment of Care Programs for Lee Memorial Health System. PROS TO RECOMMENDATION

CONS TO RECOMMENDATION

LIST AND EXPLAIN ALTERNATIVES CONSIDERED

FINANCIAL IMPLICATIONS Budgeted ____ Non-Budgeted ____ (including cash flow statement, projected cash flow, balance sheet and income statement)

OPERATIONAL IMPLICATIONS (including FTEs, facility needs, etc.) SUMMARY This annual evaluation of effectiveness for the Physical Environment and Safety Management Programs is prepared for leadership and Board of Directors in compliance with Det Norske Veritas National Integrated Accreditation for Healthcare Organizations. Effectiveness is evaluated by comparing the programs’ scope to the current needs of the organization and comparing the programs’ stated objectives with the measurements made related to stated performance measures. All seven programs were found to be effective.

BOD/Forms/Board (Action) Reporting Form – updated 9/2/09 cs

AAnnnnuuaall EEvvaalluuaattiioonn OOff tthhee PPhhyyssiiccaall EEnnvviirroonnmmeenntt

22001100 LLeeee MMeemmoorriiaall HHeeaalltthh SSyysstteemm

Lee Memorial Health System 2010 Annual Evaluation Report to Leadership and Board

This document has been created as part of the Lee Memorial Health System Patient Safety Evaluation System.

3

Table of Contents

Summary of Overall Effectiveness of Physical Environment Programs 4

Safety Management System Evaluation Graphs 5 Security Management System Evaluation Graphs 8 Hazardous Material Management System Graph 9 Emergency Management System Evaluation Graph 11 Life (Fire) Safety Management System Evaluation Graph 11 Medical Equipment Management System Evaluation Graph 13 Utility Management System Evaluation Graph 13 Safety Management System Evaluation Report 14 Security Management System Evaluation Report 20 Hazardous Material Management System Evaluation Report 24 Emergency Management System Evaluation Report 28 Life (Fire) Safety Management System Evaluation Report 31 Medical Equipment Management System Evaluation Report 35 Utilities Management System Evaluation Report 39 LPG/LCC/MSO Physical Environment Compliance Records 43

Safety Management System Evaluation Summary:

Comparison of Staff Knowledge 2006 to 2010 (Goal: > 90 %)

Staff Knowledge of Safety Management

60

80

100

How tocontact the

Safety Officer

Meaning ofthe term

"Enviroment ofCare"

What to do ifthey discover

a safetyhazard

How to reporta patient

injury

% o

f Sta

ff A

nsw

erin

g Co

rrec

tly 2006

2007

2008

2009

2010

Comparison of Inpatient Fall Rates from 2008 to 2010

Patient Fall Rates by Quarter Q1CY08-Q4CY10

0.0

1.0

2.0

3.0

4.0

5.0

6.0

7.0

8.0

9.0

08Q1 08Q2 08Q3 08Q4 09Q1 09Q2 09Q3 09Q4 10Q1 10Q2 10Q3 10Q4

Fall

Rat

e pe

r 100

0 Pa

tient

Day

s

CCH HPMC LMH GCH/GCMC


5


Comparison of Non-Patient Falls from 2007 to 2010 (Goal: < 5 Per Month, Per Campus)

Falls due to Environmental Conditions

02468

101214161820

2007 Env-Con

2008 Env-Con

2009 Env-Con

2010 Env-Con

CCHHPMCLMHSWGC

Note: There were no non-patient falls reported at SW & GC during 2008.

Comparison of Needlestick rates from 2006-2010 Goal rate < 0.30 (Number of Needlestick Incidents Per 100 FTEs)

Rate Of Needlesticks 2006-2010

0.000.050.100.150.200.250.30

2006 2007 2008 2009 2010

This document has been created as part of the Lee Memorial Health System Patient Safety Evaluation System. 6


Comparison of Staff Injuries Jan. 2009 to Dec. 2010 Goal rate < 0.30 (Number of Injuries Per 100 FTEs)

0.00

0.50

1.00

1.50

2.00

2.50

3.00

3.50

Jan-0

9

Mar-09

May-09

Jul-0

9

Sep-0

9

Nov-0

9

Jan-1

0

Mar-10

May-10

Jul-1

0

Sep-1

0

Nov-1

0

CCHHPMCLMHGC

Comparison of Department Environmental Safety Tours Completed from 2008 to 2010

Goal: > 90 %

0

20

40

60

80

100

Feb-08 Aug-08 Apr-09 Aug-09 Feb-10 Aug-10

CCHHPMCLMHSWGC


7

Security Management System Evaluation Summary:

Comparison of Staff Knowledge from 2006 to 2010 Goal: > 90 %

Staff Knowledge of Security Management

80

100

Number for non-emergencyincidents

Code for infantabduction

Code for a bombthreat

What to do aboutsuspicious

persons

% o

f Sta

ff A

nsw

erin

g Co

rrec

tly

2006

2007

2008

2009

2010

Comparison of Thefts, Vandalism and Assaults from 2006 to 2010


8

Hazardous Material Management Evaluation:

Comparison of Staff Knowledge from 2006 to 2010

Security Management Report of Thefts/Vandalism/Assualts

68

9

74

32

6

92

41

11

78

27

11

58

2113

0102030405060708090

100

Thefts andalism Assaults

2006 2007 2008 2009 2010

6

V

Hazardous Material Management System Evaluation Summary:

Comparison of staff knowledge from 2006 to 2010 Goal: > 90 %

Staff Knowledge of Hazardous Materials Management

60

80

100

What MSDSmeans

EmergencyCode for aHazMat spill

Location ofdepartment

HazMatmanual

Hazardousmaterials intheir area

% o

f Sta

ff A

nsw

erin

g C

orre

ctly 2006

2007

2008

2009

2010

Bio Medical Waste 2010 Pounds Per Month

0

2000

4000

6000

8000

10000

12000

Jan-10 Feb-10 Mar-10 Apr-10 May-10 Jun-10 Jul-10 Aug-10 Sep-10 Oct-10 Nov-10 Dec-10

Last 12 months

Poun

ds

LMH

HPMC

CCH

GC


9

Hazardous Material Management System Evaluation Summary:

Comparison Bio Medical Waste 2008 – 2010 Pounds Per Patient Per Day

Biohazardous Patient Waste

0.00

0.50

1.00

1.50

2.00

2.50

3.00

3.50

4.00

LMH HPMC CCH GC

Campus

Poun

ds P

er P

atie

nt P

er D

ay

Total 2008Total 2009Total 2010

Carbon Footprint Estimator Comparison of 2009 – 2010

Carbon Footprints from 2009-2010

05000

1000015000200002500030000350004000045000

CO2-09

Plastic

-09

Cardboard

-09

CO2-10

Plastic

-10

Cardboard

-10

Poun

ds D

iver

ted

LMHHPMCCCHGC


Emergency Management System Evaluation Summary:


Staff Knowledge of Emergency Management

020406080

100120

Location ofDisasterManual

How toreport a fire

WhatRACE

stands for

EmergencyCode for

firePerc

enta

ge o

f Sta

ff A

nsw

erin

g C

orre

ctly

20062007200820092010

Life (Fire) Safety Management System Evaluation Summary:


Staff Knowledge of Fire/Life Safety Management

80

100

Meaning ofPASS

Location ofnearest pull

station

Location ofnearest

extinguisher

Location ofsmoke

compartments

% o

f Sta

ff A

nsw

erin

g C

orre

ctly

2006

2007

2008

2009

2010


11

Life (Fire) Safety Management System Evaluation Summary:

Life Safety Management System 2010 Fire Drills

Hospital Staff Participation

and Performance Goal JAN

FEB

MA

R

APR

MA

Y

JUN

JUL

AU

G

SEP

OC

T

NO

V

DE

C

SUM

Fire drills are conducted at

least once per shift per quarter in hospitals (list

shift)

100% ALL 100%

ALL 100%

ALL 100%

ALL 100%

ALL 100%

ALL 100%

ALL 100%

ALL 100%

ALL 100%

ALL 100%

ALL 100%

ALL 100% 100%

Critique sheets are returned from all affected

departments 80% 100% 99% 98% 98% 98% 98% 98% 100% 99% 99% 98% 99% 99%

# of times staff failed to initiate alarms properly in

actual fires 0 0 0 0 0 0 0 0 0 0 0 0 0 0%

Life Safety Management System Fire Alarm System Activations

Performance of the automatic fire

systems Goal JA

N

FEB

MA

R

APR

MA

Y

JUN

JUL

AU

G

SEP

OC

T

NO

V

DE

C

SUMMATION

Number of unplanned

activations of the fire alarm systems

< 5/month Per

Campus 4 8 11 9 5 7 10 10 4 6 9 5 Goal Met

Number of actual fire situations

(system activated appropriately)

0 2 1 4 4 1 2 1 2 3 4 2 1 27

Number of activations due to

system malfunction (false alarms)

< 2/month Per

Campus 1 2 1 1 3 0 2 1 0 2 2 0 Goal Met


12

Medical Equipment Management System Evaluation Summary:


Staff Knowledge of Equipment Management

0

20

40

60

80

100

120

What mustoccur before

you use apiece of

equipment

How to identifythat equipmentis safe to use

What to do w ithmalfunctioning

equipment

Number toreport

equipmentfailures

% o

f Sta

ff A

nsw

erin

g C

orre

ctly

2007

2008

2009

2010

Utility Management System Evaluation Summary:

Comparison of Staff Knowledge from 2006 to 2010

Staff Knowledge of Utilities Management

0

20

40

60

80

100

Signif icance ofthe red outlets

Who isauthorized to

shut off amedical gas

valve

Utility systems intheir area

Emergencyprocedures forutility failures

% o

f Sta

ff A

nsw

erin

g C

orre

ctly

2006

2007

2008

2009

2010



14

2010 ANNUAL SAFETY MANAGEMENT

SYSTEM PROGRAM EVALUATION REPORT

SCOPE: The scope of the 2010 Safety Management System Plan was reviewed and found to be appropriate and effective. The Lee Memorial Health System (LMHS) safety program provides patients, staff, and visitors with an environment free from recognized safety and health hazards both by promoting staff activities that reduce the risk of injuries and illnesses and by fostering an accident and injury preventive culture. OBJECTIVES: A review of the Safety Management System Program shows that the objectives listed in the Plan were appropriate and in line with the needs of the organization. The existing objectives cover all aspects of safety that are applicable to the facilities listed in the scope of the Safety Management System Plan. It has been determined that these objectives form the foundation for providing an environment free from hazards and reducing the risk of injury to patients, visitors, staff and physicians. PERFORMANCE: A review of data collected for the Safety Management System Program clearly indicates that the performance of the program is at an acceptable level. The Safety Program as well as all the other Physical Environment (PE) Programs is an integral part of the hospital’s orientation and annual review process. In addition to the seven physical environment programs that report to the Environmental Safety Committee, other reports presented to the Environmental Safety Committee include the Employee Health Safety Report, the Infection Control Report, and Workers Compensation Reports. When issues, incidents or concerns involve the physical environment, they are presented to the Environmental Safety Committee from Standards and Quality, Risk Management, Patient Safety and from health care alerts and other regulatory agency publications. All these programs and related functions work with the Environmental Safety Committee to provide a safe physical environment that is free from hazards. The first annual DNV-Healthcare (DNV-HC) survey occurred in May 2010 utilizing the National Integrated Accreditation for Healthcare Organizations (NIAHO) standards. During the survey there were no Physical Environment (PE) non-conforming category one (NC-1) findings and six (6) PE non-conforming category two (2) (NC-2) findings: one in PE.1 Facility, one in PE.2 Life Safety Management System, one in the PE.3 Safety Management System, two in the PE.7 Medical Equipment Management System and one in the PE.8 Utility Management System. The DNV-HC PE surveyors were very complementary indicating that six (6) PE NC-2 findings was an excellent score compared to similar health care organizations’ first DNV-HC surveys. LMHS corrective action plans were submitted and approved by DNV-HC. Next DNV-HC survey is expected 60-days prior to or 60-days after May 2011.


15

During the year 2010, some of the major areas of focus for the Safety Management System Program included:

• Environmental safety tours, hazard surveillance and departmental safety inspections conducted by facility physical environment teams, environmental safety department and department leaders to ensure a safe and effective PE

• Continued emphasis on elimination of needle sticks and other sharp object injuries • Participation in pre-construction risk assessments and alternative life safety measures on

construction, renovations and additions throughout the system • Provided data and reports to departments and committees for performance improvement

activities • Implemented an expired hazardous chemical removal program for Laboratory, Pathology

and Pharmacy effective at all campuses • Completed a spill kit assessment and installation for all campuses including the

Outpatient Surgery Center • Conducted education training sessions relating to Formalin • Currently conducting PPE assessments with Environmental Services to ensure the safety

of their staff while using hazardous chemicals • Improving our ability to respond to issues of disasters • Reducing potential exposures to hazardous material • Responding to indoor air quality issues remains a strong focus

EFFECTIVENESS: A review of the performance standards data related to the Safety Management System Program shows that the program has been effective. Staff Knowledge of the Safety Management System Program: The Environmental Safety Department, hospital Physical Environment Teams and the Security Department throughout the year conduct random staff knowledge surveys. The Environmental Safety Committee reviews and evaluates the hospital and offsite-clinics ICES matrix data. The committee has approved a goal of ninety percent (90%) for correctly answered safety management staff knowledge questions. The percentage of staff randomly questioned if they had their “gold cards” improved from ninety-eight percent (98%) in 2009 to ninety-nine percent (99%) in 2010. The “gold cards” are physical environment quick reference cards containing important emergency information for staff to reference during emergencies. Ninety-six (96%) of staff questioned knew how to contact the Safety Officer, an improvement of two percent (2%) from ninety-four percent (94%) in 2009. Ninety-seven percent (97%) of staff knew the meaning of the term "Environment of Care" in 2010. This remains unchanged from 2009. Also in 2010, an average of one-hundred percent (100%) of randomly questioned staff knew the correct procedure to report a wet floor, which replicates last years figure. Staff knowledge held steady at ninety-eight percent (98%) in articulating the procedure to report a patient injury.


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Monitoring of Patient Falls: The system has set a goal for the rate of patient falls per one thousand patient days at 4.0 for general medical/surgical units and 6.0 for Neuro and Rehabilitation units. The 2010 average System patient fall rate for medical/surgical units, calculated per 1000 patient days, was 3.64 and 4.68 for the Neuro and Rehabilitation units. There was an increase in the rate over 2009 by 0.59 for the medical/surgical units and an improvement of 0.44 for the Neuro and Rehabilitation units. The patient fall rate for Cape Coral Hospital improved in 2010 to 3.28 from 3.75 in 2009, for a 0.47 improved rate. The patient fall rate at HealthPark Medical Center decreased from 2.33 in 2009 to 2.29 in 2010. That is a 0.04 decrease in patient falls. The following are the rate fluctuations for the hospitals with Neuro and Rehabilitation units. The rates at Lee Memorial Hospital Neuro and Rehabilitation unit improved from 6.88 in 2009 to 6.38 in 2010, for a 0.50 improved rate. The rate at Gulf Coast Medical Center improved in 2010 to 3.19 from 3.36 in 2009, for a 0.17 improved rate. Monitoring of Non-Patient Falls: Other fall indicators for monitoring purposes include visitor falls also known as non-patient falls. There are two categories of non-patient falls, those caused by environmental conditions or not caused by environmental conditions. Both indicators have the same goal of less than 5-falls per month at each facility. The total number of visitor falls increased from 106 in 2009 to 132 for 2010. The reported non-patient falls caused by environmental conditions increased from 15 in 2009 to 42 in 2010. Both indicators for 2010 are well below the goal maximum of 5-visitor falls per campus per month. Needle Stick Monitoring Results: The System goal of keeping needle stick injuries to less than 0.3 injuries per 100 FTE’s was met as well as our overall goal of keeping the rate of all employee injuries below 3.0 injuries per 100 FTE’s. The System-wide Employee Needle stick and Sharps Injuries Rate, calculated per 100 FTE’s (full time equivalent), increased from .13 in 2009 to .16 for 2010. Employee Injuries, calculated per 100 FTE, increased from 1.52 for 2009 to 1.76 for 2010. Staff Injuries and Workers Compensation: The year-end FY 10 Worker’s Compensation claims costs were $1,647,967. LMHS claims costs for FY 09 were $2,021,694. The results are almost an 18% savings, which is amazing. Worker’s Compensation (WC) is administered by Human Resources. The primary focus of the WC Department was on closing claims. Department’s injury rates are continuously monitored and if a trend is identified, training and education are delivered. Our focus is on the following five injury categories:

• Strains and sprains


17

• Fractures • Contusions • Punctures

Surveillance and Continuous Cycles: As part of the surveillance and continuous compliance cycle (CCC) process and data collection, department directors/managers or their designees conduct departmental environmental safety tours. Departments where patients are-served are required to conduct at least two environmental safety tours per year approximately six-months apart. Patient care departmental safety tours are conducted in February and August of each year. Non-clinical departments are required to conduct at least one environmental safety tour per year, in February. Ninety percent is the goal for both patient care and non-patient care area departmental safety inspections completed and sent to the Environmental Safety office February 27th for the first round and August 31st for the second clinical round. 2010 Departmental Safety inspections data:

Facility

Due February 27th

Due August 31st

Cape Coral Hospital 100% 100% Gulf Coast Medical Center 100% 94% HealthPark Medical Center 100% 96% Lee Memorial Hospital 99% 100% To ensure quality and safety management compliance the Environmental Safety Department also conducts environmental safety tours of all 4-hospitals. Environmental Safety Committee reviews the results of the environmental safety tours and other committees as necessary. Each hospital campus also has a Physical Environment Team with two co-captains. Environmental Safety assigns the teams bimonthly environmental safety tours for specific areas and tracks collected data. Physical Environment Teams meet at least every other month for education, in-services and to discuss and review environmental safety tour identified opportunities for improvements. Identified opportunities for improvement are brought to the attention of the department director/manager in a written memo for correction and follow up activities. The results of our performance monitoring indicate that the current Safety Management System Program is stable, sustainable, and acceptable in providing a safe physical environment that is free from hazards. CUSTOMER SATISFACTION Environmental Safety department conducted the first annual customer satisfaction survey in 2010. The survey asks customers to rate the level of satisfaction with Environmental Safety in five (5) key areas on a scale of 1 to 5 with the following goals: > 4.0 = exceeds standard, 3.9 to


18

3.0 meets the standard and below 3.0 does not meet the standard. The 2010 Environmental Safety Department customer satisfaction score was 4.2, exceeds the standard.

Environmental Safety Department Customer Satisfaction Score

QUESTIONS SCORE How satisfied are you with the response time upon requesting assistance from Environmental Safety?

4.5

How satisfied are you with the support you receive for drills and exercises? 4.2 How satisfied are you with the support you receive on hazardous material inquiries and needs?

4.0 How satisfied are you with Environment of Care, Physical Environment and DNV-HC / ISO-9001 education and support?

4.2

How satisfied are you with inquires regarding local, state and federal regulatory codes? 4.2 AVERAGE SCORE OF FIVE QUESTIONS 4.2

PERFORMANCE GOALS FOR 2011: Based on the results of surveillance, continuous compliance cycle assessments, performance monitoring and safety risk assessments, the Environmental Safety Committee selected the following goals for 2011:

• Maintain staff response to random physical environment staff knowledge question surveys equal to or above the corresponding information collection and evaluation system (ICES) designated goal of ninety or ninety-five percent (90% or 95%) for all hospitals and offsite clinics

• Complete at least ninety percent (90%) of the safety related facility tour Plant Operations work orders generated from identified opportunities for improvement during environmental safety tours and safety surveillance

• Provide a physical environment free of hazards, reduce the risks of human injuries and loss of system resources

• Continue to implement appropriate measures for meeting the physical environment objectives of FL-Agency for Healthcare Administration, Centers for Medicaid and Medicare Services, and Det Norske Veritas National Integrated Accreditation for Healthcare Organizations

• Continue the risk assessment process including the biannual departmental safety tour inspection and self-assessment component for individual departments and business entities in order to engage and increase the management team participation in the compliance monitoring process and to increase the System’s survey readiness on a day-to-day basis

• Achieve compliance with all applicable standards and regulations • Monitor the effectiveness of the safety management program and identify opportunities

for improving safety performance • Environmental Safety department participated in a complete workforce productivity

review conducted by Delta Healthcare Productivity Group. The productivity review recommendation was to add one environmental safety coordinator for extended coverage


19

of hospital and offsite clinic patient and staff safety, compliance surveillance and safety in-services

• Continue to assist Employee Health Services, Risk Management, Standards and Quality Management and Workers Compensation with identification, development of recommendations and implementation of action plans designed to reduce the frequency and severity of losses attributable to opportunities for improvement within the physical environment

• Communicate identified trends and opportunities for improvement with recommendations and/or solutions to the Environmental Safety Committee, Facility Quality Committees, System Quality and Conformance Committee, System Quality and Safety Management Council, Board of Directors and appropriate departments and facilities

• Facilitate the continued development of staff training pertaining to the Safety Management System process within LMHS

• Support the continued integration of staff representing the entire system into the PE management process, and

• Support the continued streamlining of the physical environment management process throughout the system for efficiency, consistency, and compliance purposes

The annual evaluation of the Safety Management System Program has determined the program to be effective in regards to its objectives, scope and performance.


20

2010 ANNUAL SECURITY MANAGEMENT SYSTEM PROGRAM EVALUATION REPORT

SCOPE: At the end of 2010, the scope of the Security Management System Program was reviewed and found to be appropriate. The program is applied to all facilities, property and buildings of Lee Memorial Health System. OBJECTIVES: In January 2010, the Security Management System plan for Lee Memorial Health System was reviewed. The purpose of the plan was to provide a secure environment for the employees, patients, and visitors to LMHS. Results of the plan were compared to local statistics on crime for the surrounding area and Security’s statistics from previous years. In addition to the current Security method’s, which have been effective in the past, the Security leadership was challenged to seek innovative ways to provide a more secure environment. Areas of improvement are the consistent need for training/education of employees and combating crime. While all employees are trained during initial orientation along with on going monthly and annual education, we will continue alerting security trends and issues to employees via all our internal notification methods (i.e. email, Have You Heard, monthly management meetings, in-service training, etc). In addition, we discovered a significant upsurge in reports of Vandalism Incidents in 2003 (33 reports as opposed to only 13 reports in 2002). This led to a review of our methods to combat this type of crime. As a result of our efforts we were able reduce the number of Vandalism Incidents each year since down to only 6 reported in 2006. However, this category began an upswing again with 32 reports in 2007 and increased to 41 reports in 2008. Due to increased efforts by LMHS Security, there were only 27 reports for 2009 and down to 21 reports for 2010. Combating this category of crime will remain a major initiative for 2011. PERFORMANCE: A review of data collected for the Security Management System Program indicates that the overall performance of the program remains at a high level. LMHS Security conducted 2,788 reports/investigations plus responded to 227,814 Activity Report functions (68 separate categories). During the year 2010, there was an increase in performance in two key areas. The Security Management System Program as well as all the other Physical Environment Programs are an integral part of the System’s new employee orientation and annual review process. When issues, incidents, or concerns involve security in the physical environment, the following reports are presented to the System Director of Environmental Safety and the LMHS Environmental Safety Committee: copies of the Security Department’s statistical data and reports collected from the Incident Reporting Information Management System (IRIMS), the STATS activity reporting systems, plus monthly updates to the ICES grid reporting program. All these programs and related functions work with the System Director of Environmental Safety and the Environmental Safety Committee to strive for a safe and secure physical environment that is free from hazards. Some areas specifically evaluated for performance are Thefts, Assaults, Vandalism and other selected topics.


21

EFFECTIVENESS: Of the goals that were set out in the last Annual Evaluation all were met in 2010. One of the key indicators of effectiveness is number of Reported Thefts. A total of 52 Thefts (all categories) were reported in 2005 but increased to 68 reported in 2006 and 74 in 2007. This figure increased to 92 reports in 2008 but decreased in 2009 with 62 reports and only 58 in 2010. This decrease may be due our increased Mobile Patrols (on average 14.1% of total man-hours per each campus). Most of these were purses left in plain view in offices, unsecured employee lockers, and “Smash and Grab” thefts from employee vehicles. Warnings and education of all LMHS employees as to how they can easily avoid these crimes of opportunity is an ongoing initiative. Fortunately, theft of Patient Property and Auto Thefts continue to remain level (6 to 8 for each category per year). Another indicator is Assaults. In 2005, LMHS reported only 5 Assaults but with an increase of 9 reported in 2006 (the increase was assaults on Security Officers, not others) but only 6 in 2007. However, this increased to 11 reported Assaults in 2008 and 11 in 2009 with 13 in 2010 (again the increase was to Security Officers). As indicated, our rate of Vandalism decreased to 21 reports in 2010 from 27 in 2009. Vandalism reports showed a significant increase to 41 in 2008, 2007 with 32 reports, in 2006 with a total of 6 reports, 2005 with a total of 16 reports as opposed to 33 for 2003. Statistics from our physical environment surveys of randomly selected employees determined that 100% knew how to report a suspicious incident and 99% knew the phone number to report a non-emergency Security incident. In addition, 97% of the employees surveyed knew the Emergency Code for Infant Abduction. We conclude from these statistics that our employee knowledge and education efforts are appropriate. For over the past 27 years, LMHS Security has sent out an Annual Customer Satisfaction Survey to all LMHS department heads and supervisors. This survey asks the respondent to rate the level of satisfaction with Security in 3 key areas: Speed of Security response to a call, satisfaction with the response or actions taken, and overall level of satisfaction with Security at their respective facility. A benchmark of 4.7 was established in 2003 (using a score of 1 for Very Dissatisfied to 5 for Very Satisfied). LMHS Security scored an Overall Satisfaction Score at 4.81 (same score as in 2009 but up from a score of 4.80 in 2008). These figures lead us to conclude that even though crime levels are up in some categories, LMHS employees retain a high level of confidence and overall satisfaction with the Security Management Program. Much of the increase of crime is attributed to the continued economic decline of Lee County and Florida as a whole over the past two years. With a 12.7% unemployment rate in Lee County alone, it will be a challenge to reverse these numbers. We are fortunate to have strong support from the System Leadership, department heads, and employees in general. We continue to maintain a high average percentage amount of time spent on Mobile Patrols (14%) while still responding to all other duties and responsibilities. In 2009, all officers attended a mandatory 8-hour basic certification course conducted by the Lee County Sheriff’s Department to increase officer safety and operational effectiveness. In addition, in 2010 all officers attended a 3 hour Patient Safety Course. We were able to obtain funding plus use internal resources to perform


22

major maintenance of our CCTV equipment on all four campuses. In addition, there has been a major emphasis on expansion of the DSX Access Control System. It is hoped all these efforts combined with continued employee education will hold the line or decrease the trends we experienced in 2010. Reductions in state funding for basic mental healthcare has created a statewide crisis. We have experienced an increase of patients in our Emergency Departments and acute care facilities with severe altered mental states or Emotionally Disturbed Persons (EDPs). To complicate matters there is a general movement toward decreasing physical restraints of patients. This had resulted in an increase in the demand for Security Officers to “Stand-by” with patients to relieve hard-pressed nursing personnel and curb Patient Elopements. We began comparing the trend in these statistics to 2000 (824 Standing-by incidents requiring 1,495 man hours to 834 incidents with only 238 man hours in 2006, 614 incidents with 182 man hours in 2007, and 780 incidents with 334 hours in 2008, and 837 incidents with 482 hours in 2009, and 814 incidents with 247 hours 2010) to determine what resources are needed to respond to patient and nursing needs appropriately. At this point, it appears our resources are adequate to meet the challenge but we shall continue to examine the trends in 2011 as well. The Security Management System Program is effective in providing a safe and secure physical environment for our patients, visitors, and staff. GOALS FOR 2011: • A prime goal for 2011 will be to keep the theft rate in all reported categories at the same

level or below that of 2010. With the increase of unemployment, street crime, and auto thefts in Lee County, this will be a major challenge for all System locations.

• Our personal safety training of all officers seems to be rewarded with holding officer injuries in confrontations but we have noticed a continued increase of injuries suffered during the restraint of combative patients (9 Officer injuries with 572 restraints in 2010, 18 Officer injuries with 594 restraints in 2009, 17 Officer injuries with 596 restraints in 2008, 23 Officer injuries for 895 restraints in 2007 as opposed to only 17 for 937 restraints in 2006). We shall continue in this training with special emphasis on restraint, officer safety, and de-escalation techniques.

• LMHS Security completed a special, in-depth Workplace Violence Risk Assessment, which covered numerous areas from physical security to trend tracking and basic employee education in responding to such incidents. Results of this assessment will be reported out to the LMHS Environmental Safety Committee, System Quality and Conformance Committee and System Quality and Safety Management Council. One of the prime recommendations coming from this review will be the adoption of an active shooter response plan for 2011.

• We also participated in a complete workforce productivity review from the Delta Healthcare Productivity Group. The end result of this extensive study was to revamp the LMHS Security staffing model to provide for a minimum of 3 officers on duty at all times plus a supervisor. This is an increase of the previous staffing model, which called for only 2 officers. It is expected this will assist in increasing officer, patient, and staff safety. Implementing this new staffing model will be a goal for 2011.

• Maintain or, if possible, reduce the numbers of vandalisms as reported in 2010 despite rise in rate of vandalism in neighborhoods surrounding each of the four campuses.


23

• Security responded to 9,089 requests for Key Runs for a total of 869 man-hours. This has the potential to become a significant cost to the System for a non-value added service at the expense of high priority duties (i.e. Mobile Patrols). We shall attempt to reduce key runs where feasible even with major construction projects at all acute care locations.

• Continue to monitor and reduce the number of false and accidental alarms caused by staff of our Infant Protection System at HealthPark Medical Center, Cape Coral Hospital, and at Gulf Coast Medical Center.

• Continue specific training for all our officers to respond in an efficient and appropriate manner to these threats. Continue training all officers in basic Decontamination Set Up Operations and Perimeter Control and we hope to participate in one major WMD or Haz-Mat related drill to exercise our capabilities.

• Continue to monitor and reduce the number of unlocked doors found by officers on routine patrol after business hours.

• Revise, as needed the Program Plan to reflect any changes made in 2010-2011 and the full scope of the program and continue with the transition to DNV standards and nomenclature.

The Annual Evaluation of the Security Management System Program has determined the program to be effective in regards to its objectives, scope and performance.


24

2010 ANNUAL HAZARDOUS MATERIAL MANAGEMENT SYSTEM PROGRAM EVALUATION REPORT

SCOPE: The scope of the Hazardous Material (HazMat) Management System program was reviewed and determined by the Environmental Safety Committee to be appropriate for 2010. HazMat Management System program refers to a variety of sites where patients are treated. These include both inpatient settings such as the acute hospitals and skilled nursing units as well as outpatient settings such as rehabilitation centers, ambulatory surgery centers and diagnostic centers. Such environments are made up of three basic components: buildings, equipment and people. Effective physical environment management includes processes and activities to reduce and control environmental hazards and risks; prevent accidents and injuries; and maintain safe conditions for patients. OBJECTIVES: A review of the Hazardous Material (HazMat) Management System program indicates the objectives listed in the plan were appropriate and in line with the needs of the organization. It has been determined that under existing conditions, these objectives cover all the necessary aspects of hazardous material and waste within the System’s facilities. The objective of the HazMat Management System program is to provide a functional, effective and safe environment for patients, staff members and guests of the hospital. Achieving and maintaining this goal depends on strategic planning by System leaders for the space, equipment and resources needed to safely and effectively support the services provided. To accomplish this goal, staff is encouraged to promote a sound and safe patient centered environment, leaders continuously monitor best practices and measure outcomes of the hospitals and offsite facilities’ performance improvements. The HazMat Management System program as a process is assisting the system in improving environmental performance and compliance, reducing costs, fewer accidents and increased efficiency. The HazMat Management System program also utilizes internal and external consultants to help us manage water resources and recycling. Where applicable, the System has installed extremely efficient equipment to insure the minimum usage of water required to support efficient operation. We have established alternate water sources for irrigation. At all hospital campuses, there are separate dumpsters for paper-products recycling to reduce our waste stream costs significantly and assist the recycle effort. The System continues to provide an education program for the departments that are the largest medical waste producers. This is a constant effort to educate and train staff in the proper use, cost and most efficient handling the medical waste stream. The in-services stress the importance of placing the right waste items in the correct bag for disposal. Points of disposal have been added throughout the system to increase disposal convenience for staff where possible.


25

PERFORMANCE: HazMat Management System program monitoring of the physical environment is specifically designed to monitor best safety practices throughout the hospitals and all off-site facilities. The IntraLee online material safety data sheet (MSDS) system continues to enhance the management and performance of the “right to know” and chemical inventory programs. The IntraLee MSDS system gives immediate access to the LMHS MSDS library and is user-friendly for staff to utilize. The IntraLee MSDS system also provides on-demand staff training, container labeling and acts as a safety information resource center. The System continues to improve the Universal Pharmaceutical Waste program that assists in identification and regulating pharmaceutical waste in all our waste streams. The program has added increased effectiveness with the Florida Department of Environmental Protection waste regulations compliance. Our Mass casualty decontamination processes continues to be improved and refined with the acquisition of specialized equipment funded by federal and state grants in conjunction with our Emergency Management program. EFFECTIVENESS: The HazMat Management System programs for 2010 have been deemed effective by the Environmental Safety Committee. Opportunities for improvement were noted and are reflected in the goals listed at the end of this evaluation. A review of the performance data collected for the Hazardous Material Management System program increased in relationship with the annual 2010 numbers. However, staff education continues to be a high priority focus for improvement in 2011. The 2010 training stats are as follows: Staff knows what MSDS means 96% Staff knows the emergency code for a HazMat incident 99% Staff know the location of the Hazmat Manual in their area 97% Staff are able to identify hazardous material in their area 100% In review of the 2010 percentages in comparison to 2009 percentages, knowledge of what MSDS means increased from ninety-three percent (93%) to ninety-six percent (96%) for 2010. Staff who knew the code for a HazMat incident increased from ninety-six percent (96%) in 2009 to ninety-nine percent (99%) in 2010. The location of the HazMat Manual responses remained the same for 2009 and 2010 at ninety-seven percent (97%). The ability to identify hazardous material in their area increased from ninety-eight percent (98%) in 2009 to one-hundred percent (100%) in 2010. Waste Anesthesia Gases and Hazardous Chemicals: Waste anesthesia gases and other hazardous chemicals such as Formaldehyde, Gluteraldehyde, Par acetic Acid and Xylene levels were monitored and results exhibited safe levels well below the American Conference of Governmental Industrial Hygienists, National Occupational Safety


26

and Health Institute and Occupational Safety and Health Administration action, ceiling, threshold or permissible exposure levels. Laboratory and Pharmacy Chemical Hood Maintenance: All Laboratory and Pharmacy chemical hood preventative maintenance schedules are current with documented maintenance visits for verification. Negative air pressure and air exchange rates were tested in the Histology and Microbiology laboratory and the results were within acceptable levels. Medical/Infectious Waste: Medical waste poundage is monitored and divided by the patient days for a pounds/patient day’s rate. The rate is utilized to benchmark medical waste at each campus and for the System’s total. Rate changes are directly linked and proportional to disposal cost fluctuations so continuous monitoring is essential to keeping costs low. In 2008, LMHS implemented a sharps management proactive process to improve employee safety and further reduce the disposal costs while protecting and preserving the environment. Re-useable sharps containers are a key component that provides a significant reduction in the pounds of plastic and cardboard from the sharps waste stream. The LMHS sharps management vendor provides the following annual Carbon Dioxide or carbon footprint reduction estimate for each of the hospitals in the program. The following carbon footprint reduction estimate was based on the number of plastic containers and shipping cardboard that would have been sent to landfills if the sharps containers were not re-used.

INDICATOR CCH GCMC HPMC LMH

Pounds of CO2 emissions prevented: 18,618 24,536 24,824 18,794 Pounds of plastics kept out of landfills: 31,727 42,018 42,513 32,189 Pounds of cardboard kept out of landfills: 1,765 1,937 1,955 1,478 CO2 emissions prevented equal to not burning this many gallons of gasoline:

959

1,263

1,278

968

CO2 emissions prevented equal to not using this many tanks of propane gas for barbeques:

352

464

470

355

The sharps management program diverted an estimated total of 86,772 pounds of Carbon Dioxide from entering the atmosphere in 2010 and an estimated 72,587 pounds in 2009. In just two (2) years, LMHS effectively diverted approximately 159,359 pounds of Carbon Dioxide from entering the atmosphere with this program.


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GOALS FOR 2011:

• Monitor hazardous waste costs for the System and add results to the HazMat Management System program information collection and evaluation system matrix

• Recruit new HazMat team members on board this year to evaluate all current policies and reporting mechanisms for accuracy, relevancy, and manageability

• HazMat Subcommittee meets at least biannually • Improve criteria for identifying hazardous material and update departmental inventories

accordingly • Evaluate current response plans for chemical spills and exposures • Continue staff education of automated IntraLee MSDS system for user-friendly access

throughout the health system • Improve, update and monitor staff in-services system-wide to meet continuously

changing Florida Department of Environmental Protection guidelines and Universal Pharmaceutical Waste Program

• Educate and train staff regarding segregation of Biomedical/Infectious waste and Chemotherapy waste

• Review and update MSDS database to ensure inventory is accurate and current • Investigate and consider safer chemical alternatives • Continue monitoring program performance and compliance with applicable laws and

regulations • Maintain required records and documentation • Provide reports to the Environmental Safety Committee, Facility Quality Committees,

System Quality and Conformance Committee, System Quality and Safety Management Council, Board of Directors and appropriate departments and facilities

• Provide more substance specific information resources and training opportunities for staff The annual evaluation of the Hazardous Material Management System Program has determined the program to be effective in regards to its objectives, scope, and perform


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2010 ANNUAL EMERGENCY MANAGMENT SYSTEM PROGRAM EVALUATION REPORT

SCOPE: At the end of 2010, the scope of the Emergency Management System Program was reviewed and determined to be appropriate. The program is applied to all facilities, property and buildings of Lee Memorial Health System. OBJECTIVES: A review of the Emergency Management System Program shows that the objectives listed in the Emergency Management System Plan were appropriate and in line with the needs of the organization. The existing objectives cover all aspects (Mitigation, Preparedness, Response and Recovery) of Emergency Management that are applicable to the facilities listed in the scope of the Emergency Management System Plan to include an all hazards approach. There are no suggested changes to the program objectives at this time. PERFORMANCE: A review of data collected for the Emergency Management System Program clearly indicates that the performance of the program is at a high level. During the year 2010, there was an improvement in performance in nearly every area monitored. The Emergency Management System Program is an integral part of LMHS orientation and annual review process. During the year 2010, major accomplishments included participation in county, state, and regional drills in addition to drills internal to LMHS. EFFECTIVENESS: A review of the performance standards data related to the Emergency Management System Program shows that the program has been very effective. The data indicates that 100% of the required drills were completed. A Hazardous Vulnerability Analysis was re-conducted and was shared with Lee County Emergency Management and State agencies. We documented a total of 360 disaster situations/incidents/drills for all four acute care campuses and offsite locations for 2010. These included drills, training, alarms, and actual incidents. LMHS started the year off with a total loss of power at Health Park Medical Center on January 1, 2010 at 5:20 AM for a period of 27 minutes. Subsequent investigation determined the cause of the incident was a combination of hardware, procedural, and human error. There no negative outcomes to any patient. Corrective actions were implemented and as a result, our emergency power loss response plans and contingencies are stronger for all LMHS hospitals. On January 12, 2010 a strong earthquake struck Haiti with over 1 million homeless and thousands injured. Over the next several weeks, all LMHS facilities were placed on ready standby to receive victims. A core team monitored events, maintained liaison with the Florida Hospital Association, Florida Department of Health, plus Agency for Health Care Administration and briefed LMHS administration for the duration of relief effort.


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From August 10 thru 16, 2010 the Care Center at Health Park along with Health Park Medical Center exercised major portions of the Hurricane Response Plan during “Hurricane Zant”. This drill tested our ability to totally evacuate 119 patients from the Care Center to HPMC. The Senior Leadership of LMHS developed a widespread, multi-disciplinary Disaster Preparedness Committee, which first met on June 19, 2006. After several general and numerous sub committee meetings LMHS now has a Pan Flu Epidemic Response Plan plus has appointed a physician to serve as the Hospital Disaster Preparedness Committee Medical Director. The monitoring phase of this plan was implemented effective April 27, 2009 with the outbreak of the H1N1 virus in Mexico, which spread to the US and other nations creating a pandemic situation. These efforts continued on thru all 2010 as well. The response phases of the plan were refined with the formal development of Alternate Medical Treatment Sites at each acute care facility plus mass inoculation of a large percentage of LMHS employees. On November 11, 2010 a construction accident led to a natural gas failure for over 7,000 commercial and private users in Lee County. This included all four acute care hospitals, Care Center at Health Park, and offsite facilities. Contingency measures were put in place until full restoration 4 days later. LMHS continued the initiative for HazMat/WMD preparedness and training throughout 2010. A total of 21 additional employees completed an 8-hour HazMat Operations level training class plus the LMHS Disaster Preparedness Coordinator and her assistant completed a 24 hour DECON Train-the-Trainer Course. Education of all LMHS supervisors and above continued through 2010 in the NIMS ICS100 and ICS200 courses along with the required ICS 700 and ICS 800 courses with our Senior Leadership. 100% (150) of the ED registration personnel, 100% (61) of Security personnel, 100%, (84) of Plant Operations, plus 100 of Emergency Dept. personnel completed an online HazMat awareness level course. This training is based on the required training for the roles in which they are expected to perform in. 106 local Respiratory Therapists completed 2 hrs of Hospital HazMat Awareness and Hurricane Preparedness. Finally, our Disaster Preparedness Coordinator was able to secure over $204,000.00 in funds for training, equipment, and supplies from the State of Florida Hospital Preparedness Program (ASPR Funds). LMHS is fully NIMS compliant. All four acute care hospitals conducted HazMat decontamination set up drills in 2010. Each session included staff from Plant Operations, Emergency Department, Safety, and Security plus teams from Ft. Myers, South Trail, Iona-McGregor, and Cape Coral Fire Departments and HazMat Teams. Each session was conducted over a period of one to three days and included set up of all mass decontamination equipment located at each facility. Interviews conducted during physical environment surveys determined that 95% of randomly selected employees could show the location or how to access their departments’ System Disaster Manual. A combined total of 95.5% of the employees surveyed knew the emergency code word for a Bomb Threat and 98.75% for Infant Abduction. Finally, all 30 of the offsite medical practices of our Lee Physician Group plus 19 of the MSO offices achieved nearly 100% compliance in their Emergency Drills and Education initiatives. The annual evaluation of the Emergency Management Program has determined the program to be effective as to its objectives, scope and performance.


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GOALS FOR 2011: • Continue with the transition of the Emergency Operations and Management Plan to

comply with DNV standards and nomenclature. • Continue to work with all four acute care facilities in assessing their patient surge

capacity in the event of a mass or catastrophic incident. • Submit the revised LMHS System Disaster Manual for the Annual CEMP review to Lee

County Emergency Management prior to December 2011. • Update policies in the System Disaster Manual as needed and post on the LMHS intranet. • Introduce and exercise a new Active Shooter Response Plan (Code Silver). • Continue to refine the Pan Epidemic Flu Response Plan and extend into other areas of

disaster preparedness. • Attend the Annual DASH Coordination meeting and update the Emergency Response

Team Manual as needed. • Participate in the Annual Statewide Hurricane Drill. • Participate in all local/regional/or state sponsored WMD drills and make

recommendations for changes to respond to a terrorist incident involving mass causalities or other WMD incident.

• Continue to train and develop our Decon Response Teams utilizing the mobile mass decontamination equipment located at all four acute care facilities.

• Conduct a Lock Down drill on all 4 acute care campuses and work with local law enforcement to refine perimeter control plans.

• Continue the initiative to prevent surgical fires at our acute care facilities by conducting annual staff education and conducting special evacuation fire drills.

• Continue to refine our information collection and evaluation system. • Periodically test the effectiveness of our Emergency Management System Program

through actual implementation of planned drills. The Annual Evaluation of the Emergency Management System Program has determined the program to be effective in regards to its objectives, scope and performance.


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2010 LIFE (FIRE) SAFETY MANAGEMENT SYSTEM PROGRAM EVALUATION REPORT

SCOPE: At the end of 2010, the scope of the Life (Fire) Safety Management System Program was reviewed by the Environmental Safety Committee and determined to be appropriate. Southwest Florida Regional Medical Center has been demolished; LeeSar has purchased property to build a new distribution center. They should start breaking ground in 6 months. In February, the Circuit City Employment center leased expired. The Employment Center moved to owned building at 1555 Matthew Drive. In June, the Heart Group, Med Plaza I, Suites 300-320, added 8785 square feet. The Heart Group Bonita Community Health Center Suite 2300-2330 added 3399 square feet. The Children’s Hospital Pediatric Specialty Group opened its second office. Pink Bazaar lease expired at 12135 S. Cleveland Avenue Fort Myers, Florida. Lee Wound Care added 10,000 square feet at 13778 Plantation Road, and moved its location from Lee Memorial Hospital to Plantation Road. Access Infusion partnership dissolved, LMHS took full possession of 11220 Metro Parkway consisting of 4000 square feet. In October, Coastal Cardiology was added at 16261 Bass Road Suite’s 300 & 401, consisting of 7719 square feet leased space. Dennis Lynch building 15901 Bass Road was purchased. In November the Advanced Heart Center 14051 Metropolis Avenue, consisting of 7300 square leased space. On November 15, 2010, the brand new Outpatient Surgery Center at 8970 Colonial Center Drive in Fort Myers opened. The facility features four operating rooms, two procedure rooms and brand new equipment. Outpatient procedures that will be done at the surgery center include: breast surgeries, needle biopsies, lumpectomies, gynecological surgeries, urology procedures, bariatric surgeries, pain management procedures, plastic surgeries and general surgeries. The new E.R. addition at Cape Coral Hospital was opened and Phase III has been completed. Phase IV will continue in 2011. Healthpark Medical Center, Phase 3 was completed for the Clinical Lab, Histology expansion. Project completed. Transcription moved from Santa Barbara to Cape Coral Hospital.


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The following goals and projects were completed in 2010: Lee Memorial: Replaced line isolation monitors in Operating Rooms Replacement overhead paging system Fire Line Replacement Replacement of Cooling System for Data System Cape Coral Hospital: Chiller Unit Circulation pump replacement for MRI HealthPark Medical Center: 2 New Cooling Towers were installed HealthPark Care Center: Fire Alarm System Upgrade Fire Doors were replaced Gulf Coast Medical Center:

• Facilities – ADA Accessibility Upgrades – GCMC • A new state-of-the-art telephone system by Cisco was installed.

. OBJECTIVES: A review of the Life Safety Management System Program revealed that the objectives listed in the Life Safety Management System Plan were appropriate, and in line with the needs of the organization. The existing objectives provide the framework to establish and maintain a fire safe physical environment. These objectives cover all the practical aspects of fire safety program therefore there are no recommendations for any changes to the program objectives at this time. PERFORMANCE: A review of the data collected for the Life Safety Management System Program shows continued high scores in nearly every area and the program has an overall excellent performance rating. During the year 2010, performance of the staff and fire protection equipment and systems was at a very high level. There were 27 actual fires during the year (compared to only 15 fires in 2010). All of these were minor electrical or microwave/toaster type incidents or smoking related external to the facility and of nominal consequences. Responses to all alarm activations were very good to excellent overall. No injuries related to fires occurred during the year and none required evacuation of any patients. All system and equipment tests and inspections were conducted on schedule and alternative life safety measures were activated whenever needed. Florida Agency for Health Care Administration Florida Agency for Health Care Administration conducted 2010 annual Re-Licensure Life Safety surveys at Cape Coral Hospital, September 6th through the 9th, Gulf Coast Medical Center, November 1st through the 4th, HealthPark Medical Center and Lee Memorial Hospital, June 1st


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through 3rd. All plans of corrections submitted were approved and subsequent follow up visits confirmed the previously cited deficiencies were found corrected on the day of the revisit. Centers for Medicaid and Medicare Centers for Medicaid and Medicare conducted a Federal Validation survey of HealthPark Medical Center and Lee Memorial Hospital, June 1st through the 3rd, due to the DNV-Health Care National Integrated Accreditation for Healthcare Organizations survey, May 17th through the 20th. All plans of corrections submitted were approved and subsequent Life Safety follow up visit on August 10th confirmed the previously cited deficiencies were found corrected on the day of the revisit or cleared by a September 29th “desk review”. EFFECTIVENESS: A review of the performance standards related to the Life Safety Management System Program reveals an effective program. The performance indicators that monitor staff knowledge during fire drills and safety tours determined that a combined average 99% of employees know the RACE procedure and recognized their responsibilities. During fire drills, an annual average of 98% of staff closed all doors in response to a fire alarm. During fire drills, 99% of staff made the correct responses and knew the procedures to protect and transfer their patients. During safety tours, 100% of staff knew the emergency code word for fire. The announcement of a fire was clear and audible 97% of the time. The flashing lights worked properly 99% of the time. Results of fire drill critiques that were received identified 41 issues requiring improvements. Most of these were reports of doors not closing properly, minor obstructions found in the hallways (gurneys, beds, etc.), lowered volume on the house P.A. systems, extinguisher/hose cabinets blocked, etc. The vast majority of the physical issues were either resolved on the spot or submitted for action and corrected by Plant Operations. A total of 21 “employee performance” issues were discovered during fire drills. Most of these centered around employees who failed to implement the response plan in proper sequence (Rescue, Alarm, Contain, Extinguish). Some responders felt the need to extinguish the “fire” before implementing proper alarm, rescue, or evacuation of patients, visitors, or others. Next highest issue was failure of some employees to manually close doors to patient rooms, work areas etc. Next highest issue was the failure to use the closest portable fire extinguisher. In each of these instances, the responder could have used an extinguisher closer at hand. These scores support the statement that the Life Safety Management System Program is effective in providing a fire safe physical environment. Offsite physicians’ offices (Lee Physicians Group or LPG) conducted separate drills using the some basic criteria and observations sheets as acute care facilities. All offsite offices (total of 30 locations) were to conduct 1 fire drill for the year but hospital based offices still conduct an average of 4 per year. The goal of 100% compliance was met. Statement of Conditions and Plan for Improvement Management In 2010, Facilities Management and Support Services contracted with Smith Seickman Reid, Inc. to conduct a Statement of Conditions assessment at all four hospitals between March and October.


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GOALS FOR 2011

• Work in cooperation with Surgery, Plant Operations, Risk Management, Environmental Safety, Standards and Compliance, Quality Management, Security, plus local fire departments for all four of our acute care facilities in the development of fire safety plans, education, and response specific to prevention of surgical fires.

• Continue to work with fire departments in all four jurisdictions of our acute care facilities for live, hands-on fire extinguisher demonstrations.

• Revise and upgrade our portable Fire Extinguisher Monthly checklist forms on all four acute care campuses and attempt to place in some form of computerized database.

• Continue to cooperate with Facility Planning and Design for review and revision of pre-construction Hazard Risk Assessment for fire prevention, basic Alternative Life Safety Measures, plus other related Fire Safety/Security issues.

• Review and revise fire safety/prevention indicators in our ICES grid evaluation process as needed.

• Continue to offer basic fire response education for construction personnel on all campuses.

• Conduct at least one live evacuation drill with LMHS Security and nursing personnel at each campus.

• Upgrade Fire Alarm System at HealthPark Care Center. The annual evaluation of the Fire Safety Management Program has determined the program to be effective as to its objectives, scope, and performance.


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2010 MEDICAL EQUIPMENT MANAGEMENT SYSTEM PROGRAM EVALUTION REPORT

SCOPE: In 2010, Biomedical Engineering (Biomed) managed the scope of the Medical Equipment Management System Program. The scope of the Biomedical Engineering services includes all activities related to the Medical Equipment Management System Program for Lee Memorial Hospital (LMH), Health Park Medical Center (HPMC), Cape Coral Hospital (CCH), Health Park Care Center (HPCC), Gulf Coast Medical Center (GCMC), Outpatient Imaging Centers, Lee Physician Group (LPG), Medical Specialty Office (MSO), and other Offsite Locations. In 2010, Lee Memorial Health System (LMHS) changed its accreditation process from The Joint Commission (TJC) to Det Norske Veritas Health Care (DNV-HC) and National Integrated Accreditation for Healthcare Organizations (NIAHO) standards. DNV conducted the first inspection of LMHS in May of 2010. The inspections conducted by DNV, the Agency for Health Care Administration (AHCA), Centers for Medicare and Medicaid (CMS), Lee County Agencies, and In-House Readiness Teams in 2010 determined the Medical Equipment Management System Program had a well-defined plan. They also determined that the process and tasks necessary to meet the intent of the program were properly executed and managed. DNV recommended that Biomedical Engineering implement two (2) changes to the Medical Equipment Management System Program. First, implement a process to track test equipment utilized to check medical equipment for accuracy or calibration and the second improve “Preventive Maintenance” tracking of all Rental, Loaner, and Trial / Demonstration (Demo) Medical Equipment. To meet the recommendation made by DNV, in 2010 Biomedical Engineering revised System Policies M08 10 428 “Inspecting and Labeling Medical Equipment” and M08 10 766 “Rental, Loaner, Demo, and Patient Owned Medical Equipment”. Biomedical Engineering also implemented the processes and changes reflected on the revisions of these policies. After implementing the DNV recommended changes, inspections conducted by AHCA, DNV Readiness and other inspectors determined that the LMHS Medical Equipment Management System Program met or exceeded the requirements or expectations. Future concerns and tasks include:

a) In 2010, LMHS expanded its services and added new outpatient practices. The addition of these locations includes imaging and general medical equipment technologies that require additional Biomedical Engineering resources, staff, and planning. Biomedical Engineering acknowledged that to support these practices it imposes additional labor and budget constraints. We are planning appropriately to meet the needs of these new customers.

b) The addition of these services will require additional Biomedical Engineering staff to

provide timely and quality support to these newly acquired areas.


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c) Biomedical Engineering is actively working with many areas and leaders to coordinate and manage all events and activities related to the Medical Equipment Management System Program. In FY2011 Biomedical Engineering requested an FTE and additional operating funds to support new areas like the Heart Group, Coastal Cardiology, Advance Heart Center, The Sanctuary, and the Ambulatory Surgery Center. Both requests were denied during the budget process. LMHS took the approach of approving the FY2011 budget based on past history only.

d) Biomedical Engineering continues to experience some challenges to complete 100%

Preventive Maintenance (PM) on time for Life Support Medical Equipment and 95% PM completion for General Medical Equipment. The major challenge for Biomedical Engineering staff is to locate the equipment within the facilities to perform the PM. This challenge will continue and may not be resolved until LMHS deploys Radio Frequency Identification Technology (RFID) in the hospitals to facilitate locating the equipment.

e) Biomed will continue to work in cooperation with Supply Chain Management (CSM) to

improve the process to assure that in the future LMHS meets the 95% PM completion requirements for general rental medical equipment. We established a tagging system to assist us in locating this equipment for SCM to return to the vendor before the PM required date expires. This is a very challenging area because in many instances the number of rented devices for a specific hospital can be relatively small.

f) To meet the 95% we must be able to locate at least 19 of every 20 items rented. For

example, the total items rented in a month for a specific hospital can be less than 20. Therefore, under these circumstances, if one (1) item is not located we are not able to meet the 95% requirement.

OBJECTIVES: The Medical Equipment Management System Program was reviewed and indicated that the objectives were appropriate and in line with the needs of the organizational objectives. These objectives covered every major aspect of the Medical Equipment Management System Program. It was determined as appropriate that these objectives should remain in place for the year 2011. Biomedical Engineering objectives are to complete medical equipment preventive maintenance on time at an average of 100% for life support medical equipment and at least 95% for general medical equipment. Although the TJC changed their requirements to 90% average timely preventive maintenance (PM) completion for general medical equipment, it is our plan to maintain a goal of 95% for LMHS. Based on our experience, we understand that a 95% goal contributes to sustain a more stable physical environment for LMHS. If in the future we discover that the 95% goal is unsustainable we will revise it as appropriate while operating and maintaining the DNV-HC NIAHO standards. As in previous years, it is our goal and intent to accomplish our objectives while maintaining a professional atmosphere and supporting, cooperating, and responding to the needs of the patients, the staff, the community, and LMHS Administration.


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PERFORMANCE:

A review of the data collected for the Medical Equipment Management System Program indicates that we met the monthly performance standards of an average of 100% for life support and 95% for general medical equipment. Biomed consistently met or exceeded the preventive maintenance requirement. In the past 12 months Biomed consistently met or exceeded the scheduled preventative maintenance requirements for all LMHS owned, leased, or in consignment medical equipment tracked by an asset number in the medical database. In August 2010, we started tracking the PM status of rented medical equipment. We met the preventive maintenance requirements of 100% completion on time for all rented life support medical equipment. We are not able to meet the 95% requirement for rented general medical equipment due to the inability of SCM and Biomed, in cooperation of some of the end user, to locate the equipment and return it to vendor before the PM expires. The majority of this rental equipment is infusion devices, which once deployed are very difficult to find since they move between multiple locations including other departments and other hospitals. To maintain technical competence and to minimize the cost of medical equipment services by external sources, in 2010 the Biomedical Engineering staff attended twenty one (21) technical training schools. Biomedical Engineering also achieved a system wide average of 100% for life support and 98% average PM completion for general medical equipment in the last 12 months. Biomed processed 12,396 repair work orders equal to a monthly average of 5.68% of the 18,191 pieces of equipment inventory included in the medical equipment database as December 31, 2010. Biomed also processed at total 235 work orders for medical equipment recalls. In 2010, Biomed made changes and adjustment in the Medical Equipment Database and the tagging process. The changes in the database were made to capture and document the test equipment used to calibrate and check medical equipment for accuracy during the preventive maintenance or repairs, as applicable. The change made to the tagging process was to identify Rental with a rental green tag and Loaner / Demo medical equipment with an orange tag prior to its deployment. EFFECTIVENESS: A review of the data collected for the Medical Equipment Management System Program indicates a high level of effectiveness. The medical equipment database history shows that Biomedical Engineering has consistently met or exceeded the on time PM completion of 100% for life support equipment and 95% for general medical equipment in the last 10 years.


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GOALS FOR 2011: Biomedical Engineering will continue to work in cooperation with the LMHS Administration, Facility Management, Information Technology, and other departments to improve our environment and technologies. We will adjust our resources as necessary to meet the medical equipment support needs for Lee Memorial Health System. LMHS is working on a system wide plan to replace the present inventory of large volume infusion and syringe pumps. Biomedical Engineering is an active participant of this process. The new technologies found on these new infusion devices will require cooperation between many areas like Supply Chain Management, Nursing, Pharmacy, Information Technology and others. Biomedical Engineering’s goal is to work closely with everyone involved to make the selection and trial processes a success. The deployment of these new devices is projected to take place in 2012. The annual evaluation of the Medical Equipment Management System Program has determined the program to be effective in regards to its objectives, scope, and performance.


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2010 UTILITY MANAGEMENT SYSTEM PROGRAM EVALUATION REPORT

SCOPE: LMHS 2010 Utility Management System Program, the following changes occurred to our scope. Southwest Florida Regional Medical Center has been demolished; LeeSar has purchased property to build a new distribution center. They should start breaking ground in 6 months. In February, the Circuit City Employment center leased expired. The Employment Center moved to a LMHS owned building at 1555 Matthew Drive. In June, the Heart Group, Med Plaza I, Suites 300-320, added 8785 square feet. The Heart Group Bonita Community Health Center Suite 2300-2330 added 3399 square feet. The Children’s Hospital Pediatric Specialty Group opened its second office. Pink Bazaar lease expired at 12135 S. Cleveland Avenue Fort Myers, Florida. Lee Wound Care added 10,000 square feet at 13778 Plantation Road, and moved its location from Lee Memorial Hospital to Plantation Road. Access Infusion partnership dissolved, LMHS took full possession of 11220 Metro Parkway consisting of 4000 square feet. In October Coastal Cardiology was added at 16261 Bass Road Suite’s 300 & 401, consisting of 7719 square feet leased space. Dennis Lynch building 15901 Bass Road was purchased. In November the Advanced Heart Center 14051 Metropolis Avenue, consisting of 7300 square leased space. On November 15, 2010, the brand new Outpatient Surgery Center at 8970 Colonial Center Drive in Fort Myers opened. The facility features four operating rooms, two procedure rooms and brand new equipment. Outpatient procedures that will be done at the surgery center include: breast surgeries, needle biopsies, lumpectomies, gynecological surgeries, urology procedures, bariatric surgeries, pain management procedures, plastic surgeries and general surgeries. The new E.R. addition at Cape Coral Hospital was opened and Phase III has been completed. Phase IV will continue in 2011. HealthPark Medical Center, Phase 3 was completed for the Clinical Lab, Histology expansion. Project completed. Transcription moved from Santa Barbara to Cape Coral Hospital Based on the above changes, our Utility Management System Total Maintenance System (TMS) program was updated accordingly.


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Goals and projects were completed in 2010: Lee Memorial:

• Phase II, Sanitary, Chilled, and domestic Water Piping Replacement • Replaced overhead paging system • Replace line isolation monitors in OR’s • Parking lot sealed and restriped • Gas station was demolished and tank closure • Fire Line Replacement • Replacement of Cooling System for Data System • A new state-of-the-art telephone system by Cisco was installed.

Cape Coral Hospital:

• Started installation of the Duel Fuel System for the Emergency Generators so generators can run on 50/50 mixture of gas and diesel, this will double our existing run time.

• Energy Management Controls (project will continue into 2011) • Parking lot sealed and restriped • Chiller Unit Circulation pump replacement for MRI • At Cape Coral Hospital in the Women’s Breast Center, a Digital Mammogram was

installed at Cape Coral Hospital. HealthPark Medical Center:

• 2 new Cooling Towers were installed • Physical Plant / Building Automation System project will continue into 2011 • Parking lot sealed and restriped • A new state-of-the-art telephone system by Cisco was installed.

HealthPark Care & Rehabilitation Center:

• Fire Alarm System Upgrade • Fire Doors were replaced

Gulf Coast Medical Center:

• Facilities – ADA Accessibility Upgrades – GCMC • A new state-of-the-art telephone system by Cisco was installed.

OBJECTIVES: A review of the data collected for the Utility Management System Program showed that the objectives listed in the Utilities Management System Plan were appropriate and in line with the needs of the organization. The current objectives have been determined to be broad enough to encompass all pertinent aspects of Utilities Management System Program in the system’s facilities. At this time, there are no further recommendations to change any of the program’s objectives.


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PERFORMANCE: The Utility Management System Code required PM’S have maintained an average completion rate of 100% for 2010. The average for the Life Support Equipment portion of the Utilities Management System Plan was at 100% for 2010. During the year, there were 25 utility failures reported: 5-failures reported at Cape Coral Hospital, 4-failures at Lee Memorial Hospital, 8-failures at HealthPark Medical Center, 1-failure at HPCRC, and 7-failures at Gulf Coast Medical Center. All failures were investigated for causable factors and reported to the Environmental Safety Committee. No further education or change in the PM scope was found to be necessary. EFFECTIVENESS: A review of the data collected for the performance monitoring of the Utility Management System Program shows that this program is effective in providing a safe and reliable physical environment for the patients, visitors and staff in Lee Memorial Health System facilities. During 2010, the preventive maintenance rate for on time completions averaged 100%. For the indicator that monitor’s employee knowledge of the significance of the red electrical outlets was 99%. The indicator for employee knowledge of staff authorized to turn off medical gas control valves was 94%. The indicator for employees who were able to identify utility systems in their work area was 100% and the indicator for employee knowledge of the emergency procedures in case of a utility system failure in their area was 90%. In 2010 the Plant Operations Customer Survey resulted in 204 surveys received and had average score of 4.72, which indicates customers are very satisfied with our services provided. GOALS FOR 2011: Lee Memorial Hospital Continue following projects:

• Replacement of the chilled water & sanitary piping to ensure proper cooling and waste disposal for the facility

• Replacement of the nurse calls system on the seventh floor and Ortho. • Upgrade of the Liebert A/C system for the Data Center

New (goals) projects:

• Visitor Elevator Cab Upgrades for Elevators 1, 2, 3, 4, 5, & 6. • Replace Fire/Smoke Doors. • Piping Project Replacement • Replacement of Medical Air Pumps • Replacement of the existing DI Water Tank System with RO System. • Replacement of several Air Handler replacements 332, 340, 341, 342 & 350.

HealthPark Medical Center New (goals) projects

• Installation of security access doors with a combination code on four (4) pneumatic tube delivery stations for increased security for medication delivery from the Pharmacy.

• Chilled Water & Sanitary Piping Replacement • Atrium LED Lighting Retrofit • Replacement of light poles in parking lot


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HealthPark Care & Rehabilitation Center New (goals) projects

• Replacement A/C Units in patient’s rooms • Replacement of faucets in patient’s rooms.

Cape Coral Hospital Continue following projects:

• ER expansion New (goals) projects

• Installation of security access doors with a combination code on four (4) pneumatic tube delivery stations for increased security for medication delivery from the Pharmacy.

• Replacement of Chiller #3 • Replacement of Plant Operations Shop A/C • Installation of a new state-of-the-art telephone system by Cisco.

Gulf Coast Medical Center New (goals) projects

• Nurse Call System Replacement for Existing Building • Replacement of the DI Water System Tank with RO System • Replacement, of several AHU, 1, 2, 4 and 6 • HVAC Equipment Integration.

All Campus Goals

• Increase knowledge of staff in emergency procedures in case of a utility failure. The annual evaluation of the Utility Systems Management Program has determined the program to be effective in regards to its objectives, scope, and performance.


43

2010 ANNUAL LPG/ LCC/MSO/PAIN CENTERS SUMMARY REPORT

A review of the data collected for the physical environment drills for physician offices to include Lee Physician Group (LPG), Lee Convenient Care (LCC), Medical Specialty Offices (MSO), and Pain Centers at Bass Road & Cape Coral Hospital continue to show high scores for overall completion. 2010 LPG, LCC, MSO and Pain Center compliance was very good. (See spreadsheet on next page.)


44

ENVIRONMENT OF CARE COMPLIANCE RECORDS

DUE DATE

STANDARDS Met

Crit

eria

Late

Did

Not

Mee

t

Met

Crit

eria

Late

Did

Not

Mee

t

Met

Crit

eria

Late

Did

Not

Mee

t

Met

Crit

eria

Late

Did

Not

Mee

t

Met

Crit

eria

Late

Did

Not

Mee

t

Met

Crit

eria

Late

Did

Not

Mee

t

Met

Crit

eria

Late

Did

Not

Mee

t

Met

Crit

eria

Late

Did

Not

Mee

t

Met

Crit

eria

Late

Did

Not

Mee

t

Met

Crit

eria

Late

Did

Not

Mee

t

Met

Crit

eria

Late

Did

Not

Mee

t

Met

Crit

eria

Late

Did

Not

Mee

t

Met

Crit

eria

Late

Did

Not

Mee

t

Met

Crit

eria

Late

Did

Not

Mee

t

Met

Crit

eria

Late

Did

Not

Mee

t

Administration 1 1 1 1 1 1Assoc Int Med-Bass Road 1 1 1 1 1 1 1 1 1 1 1 1Assoc In Med -Matthews 1 1 1 1 1 1 1 1 1 1 1 1Assoc Peds - Cape 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1Assoc Peds - Estero 1 1 1 1 1 1 1 1 1 1 1 1Assoc Peds - Lehigh 1 1 1 1 1 1 1 1 1 1 1 1Assoc Peds - Page 1 1 1 1 1 1 1 1 1 1 1 1Bonita GYN Assoc*LPG Bonita 1 1 1 1 1 1 1 1 1 1 1 1Bonita Primary Care*LPG Bonita 1 1 1 1 1 1 1 1 1 1 1 1(WHP-Estero)*LPG Bonita 1 1 1 1 * 1 1 1 1 1 1 1David & Saludo 1 1 1 1 1 1 1 1 1 1 1 1FP Clayton Ct 1 1 1 1 1 1 1 1 1 1 1 1LCC PI Rd * 1 1 1 1 1 1 1 1 1 1 1 1LCC North 1 1 1 1 1 1 1 1 1 1 1 1LCC Page Field 1 1 1 1 1 1 1 1 1 1 1 1Lee Memory Care Suite 814 1 1 1 1 1 1 1 1 1 1 1 1Lee OB/GYN Associates 1 1 1 1 1 1 1 1 1 1 1 1Lee Professional Billing 1 1 1 1 1 1 1 1 1 1 1LPG Bass Rd 1 1 1 1 1 1 1 1 1 1 1 1LPG/College Pt 1 1 1 1 1 1 1 1 1 1 1 1LPG IM Labelle 1 1 1 1 1 1 1 1 1 1 1 1LPG Pine Island Rd * 1 1 1 1 1 1 1 1 1 1 1 1LPG PC Page 1 1 1 1 1 1 1 1 1 1 1 1LPG @ Sanctuary 1 1 1 1 1 1 1 1 1 1 1 1Pain Center-Bass Rd 1 1 1 1 1 1 1 1 1 1 1 1Pain Center-CCH 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1Pain Center @ Sanctuary 1 1 1 1 1 1 1 1 1 1 1 1Property Mgmt-CCH 1 1 1 1 1 1 1 1 1South Cape Physicians 1 1 1 1 1 1 1 1 1 1 1 1WHP-HP Ste 283 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1WHP-Page 1 1 1 1 1 1 1 1 1 1 1 1

Total Number of Offices# Met Criteria# Late# Did Not Meet% Met Criteria% Late% Did Not Meet

29%0%0%0%

0%0%0%

62%38%0%

0

0%

1811

100%0%

00

3

0%

0

30

100%0%

28

071%

25

0100%

LPG/LCCENVIRONMENT OF CARECOMPLIANCE RECORDS

2010

28208

303005

0 0100%

0%

0100%0%0% 0%

0%

0100%0%0%

29 30 31 30

07/30/10

30 31 3 293

0%83%17%

30

90%10%

00

100%

01/30/10 02/26/10 03/31/10 04/30/10

29 30 31 30

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313100

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ENVIRONMENT OF CARE COMPLIANCE RECORDS

DUE DATE

STANDARDS Met

Crit

eria

Late

Did

Not

Mee

t

Met

Crit

eria

Late

Did

Not

Mee

t

Met

Crit

eria

Late

Did

Not

Mee

t

Met

Crit

eria

Late

Did

Not

Mee

t

Met

Crit

eria

Late

Did

Not

Mee

t

Met

Crit

eria

Late

Did

Not

Mee

t

Met

Crit

eria

Late

Did

Not

Mee

t

Met

Crit

eria

Late

Did

Not

Mee

t

Met

Crit

eria

Late

Did

Not

Mee

t

Met

Crit

eria

Late

Did

Not

Mee

t

Met

Crit

eria

Late

Did

Not

Mee

t

Met

Crit

eria

Late

Did

Not

Mee

t

Met

Crit

eria

Late

Did

Not

Mee

t

Met

Crit

eria

Late

Did

Not

Mee

t

Met

Crit

eria

Late

Did

Not

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t

AICC/AICC Cape/GC Pulm- Sanctuary 1 1 1 1 1 1 1 1 1 1 1AICC/AICC Cape/GC Pulm- Pine Island 1 1 1 1 1 1 1 1 1 1 1AICC/AICC Cape/GC Pulm-Plantation 1 1 1 1 1 1 1 1 1 1 1Cape Gen/Vascular -PI Road 1 1 1 1 1 1 1 1 1 1 1Heart Group Bonita CH Ctr - Suite 2330 1 1 1 1 1 1 1Heart Group - MPO Suite 320 1 1 1 1 1 1 1 1HP Pulmonary Specialist 1 1 1 1 1 1 1 1 1 1Infectious Disease Specialists - HP 1 1 1 1 1 1 1 1 1 1 1 1 1 1Infectious Disease Specialists - LMH 1 1 1 1 1 1 1 1 1 1 1 1 1 1Kreegel Aesthetic Surgery Ctr. 1 1 1 1 1 1 1 1 1 1 1Lee Neurosurgery - LMH 1 1 1 1 1 1 1 1 1 1 1 1 1 1Lee Neurosurgery - CCH 1 1 1 1 1 1 1 1 1 1 1 1 1 1Lee Neurosurgery - Cancer Center 1 1 1 1 1 1 1 1 1 1 1Pediatric Specialties - Bass Rd. Suite 100 1 1 1 1 1 1 1 1 1 1 1Pediatric Specialties - MPO - Suite 140 1 1 1 1 1 1 1 1 1 1 1Pediatric Endo@Clayton Court (NEW) 1 1 1 1 1 1Spine Center @ Sanctuary 1 1 1 1 1 1 1 1 1 1Suncoast - Bariatric Center**MOC808 1 1 1 1 1 1 1 1 1 1 1 1 1 1Suncoast Surgical Associates** 1 1 1 1 1 1 1 1 1 1 1

Total Number of Offices# Met Criteria# Late# Did Not Meet% Met Criteria% Late% Did Not Meet 0% 0% 0% 0%0% 0% 0% 0%

0% 0% 0%0% 0% 0% 0% 0% 0% 0%

11% 0% 0% 21%0% 0% 0% 18%0% 7% 0% 0%79% 100% 100% 100%82% 89% 100% 100%

0 0 0100% 93% 100% 100% 0% 100% 100%

0 0 0 00 0

0 0 0 0 0 0 0 00 0 4 0

200 1 0 0 0 0 0 3 2

20 20 2014 17 19 5 15 20 20

19 19 5 1917 18 5 1716 15 5 16

07/30/10 10/31/10 11/30/10 12/31/1006/30/10 09/30/10 08/31/10 08/31/10

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MSO ENVIRONMENT OF CARE 2010

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51416 518016


45


46

This is the end of the Annual Evaluation.

Board of Directors

PresidentJim Nathan

CHIEF OPERATING OFFICERHospital & Physician ServicesLarry Antonucci, M.D.

Chief Medical OfficerClinical & Quality Services.

Chief Pt. Safety OfficerChuck Krivenko, M.D.

Vice PresidentStandards & QualityChristine Crawford

System DirectorClinical Decision Support

Becky Watt

System DirectorSpiritual ServicesCynthia Brasher

System Medical DirectorMedical Staff ServicesMark Greenberg, M.D.

System DirectorCare Management

Chris Nesheim

REMOVEDSystem Director

Medical Staff QualityMary Kirkwood

System DirectorMedical Staff Services

Sandy Wharton

System DirectorEpidemiology/

Infection ControlSteven Streed

Chief Medical OfficerPhysician Services

Scott Nygaard, M.D.

Chief Nursing Officer &Chief Admin. Officer

HealthPark Med. CenterDonna Giannuzzi

Chief Admin. OfficerGulf Coast Med. Center

VACANT

Chief Admin. OfficerCape Coral Hospital

VACANT

Chief Admin. OfficerLee Memorial Hospital

Lisa Sgarlata

Vice PresidentRehab HospitalWalt Ittenbach

System DirectorPharmacy Services

John Armitstead

System DirectorOperations Improvement

Steve Oreolt

Medical DirectorThe Children’s Hospital &LPG Pediactric Specialty

Emad Salman, MD

System DirectorLPG Primary Care Services

Mark Atkins

Medical DirectorTrauma Services

Drew Mikulaschek, M.D.

Medical DirectorNeurosurgery

Bijan Bakhtian, M.D.

Medical Directors – ER PhysLarry Hobbs (GCMC)

Roger Howell (LMH/HPTimothy Dougherty (CCH)

Medical Directors Anesthesia ServicesRalph Gregg, M.D.

Charlie Bisbee, M.D.

Medical DirectorsRadiology Services

Tom Presbrey, M.D. Mike Carron, M.D.

Medical DirectorLaboratory Contract Services

David Reardon, M.D.

Medical DirectorInfection Control

Mary Beth Saunders, D.O.

Intensive Care ServicesMedical Directors

Steve Hannan, M.D. Jeff Scott D.O.–Ken Tolep, M.D.

System DirectorHospital Based Physicians

Chip Carroll

System Medical DirectorSpecialty Care Services

Marilyn Kole, M.D.

System DirectorSpecialty Care Services

David Rybicki

VP Patient CareWomen & ChildrenKathy Bridge-Liles

VP of NursingHPMC

Cindy Brown

Medical DirectorHPMC

Chuck Krivenko, M.D.

ControllerHPMC

Patty Duquette

System DirectorCardiovascularPatty Johnson

System DirectorCardiac Rehab

Sandy Childress

System DirectorInvasive Cardiovascular

Beth Moss

System DirectorResource Mgmt

Nursing & Pt. Care SvcsKristie Huff

System DirectorClinical Learning

Jamie Tyrna

System DirectorGCMC

Alex Greenwood

VP of NursingGCMC

Holly Muller

Administrative DirectorNursing Services

GCMCJulia Liebscher

Administrative DirectorNursing Services

GCMCClaude Houle

ControllerGCMC

Barb Melby

System DirectorRenal Transplant & Acute Hemodialysis

Dave Mainous

Medical DirectorGCMC

Mark Greenberg, M.D.

VP of NursingCCH

Wendy Piascik

Medical DirectorCCH


ControllerCCH

TJ Pennsy

VP of NursingLMH

VACANT

Medical DirectorLMH


ControllerLMH

Ben Spence

Board of Directors

PresidentJim Nathan

Chief Compliance OfficerInternal Audit Officer

Charles Swain

System DirectorInternal Audit Angela D’Anna

Chief Legal OfficerLegal Services

Mary McGillicuddy

Chief Foundation OfficerLMHS FoundationSharon MacDonald

System DirectorCCH

Alex Greenwood

Medical Executive Committees

CCH, GCMC, HPMC, LMH, TCH

Physician Leadership Council

System Leadership Council

Board AdministratorCathy Stephens

Board Legal CounselJim Humphrey

System DirectorPediatrics

Diana Sutton

System DirectorRadiology Services

Rendy Petrin

System DirectorLaboratory Services

Susan Lawless

System DirectorRespiratory Services

Alan Cunningham

Carlisle BaySystem Director

Heart Central

March, 2011

Business Partner Physician Services

Brian Owens

System Medical DirectorPrimary Care Services

Avra Carpoussis-Bowers, M.D.

Medical DirectorInformatics

Leah Lynch, M.D.

Medical DirectorEducation

Eric Goldsmith, D.O.

Medical DirectorPractice Transformation

Rick Waks, M.D.

Dotted lines to Controller’s Cao’s

All Medical Directors added anddisplayed more clearly with correct titles under Dr. Nygaard

Steven Streed now reportsdirectly to Dr. Greenburg andno long to Dr. Kole

Board of Directors

CHIEF OPERATING OFFICERBusiness & Strategic Services

John Wiest

Chief Financial OfficerMike German

Vice President Revenue Cycle / PHO

Anne Rose

Chief Information OfficerMike Smith

Vice PresidentStrategic ServicesKevin Newingham

Vice PresidentFacilities & Support Services

Dave Kistel

Chief Human Resources Officer

Jon Cecil

Vice PresidentPost Acute Care

Marjory May

System DirectorSurgery Business

OperationsDenise Adema

ControllerReimbursement

Ben Spence

ControllerCorporate

Patty Duquette

ControllerPhysician/ Outpatient

Brian Church

ControllerGCMC

Barb Melby

ControllerCCH / Post Acute

T J Pennsy

PresidentLeeSar & CSFBob Simpson

System DirectorBusiness Operations

Neal Sword

System DirectorBusiness Services

Billie Jo Debolt

System DirectorCentral Business Office

Vicki Di Tomaso

System DirectorPBS RegistrationColleen Edwards

System DirectorBusiness Development

& ContractingMarlon Tyson

System DirectorCentralizedSchedulingSylvia Smith

Interim System DirectorHealth Information

Management, Privacy Officer, Lisa Whitacre

System DirectorSystems Programming

/ OperationsLoraine Martelli

System DirectorClinical Information

SystemsJoyce Campbell

System DirectorBiomedical Engineering/ Telecommunications

Pablo Mora

(removed “Acting””System Director

Bill ObermanMarketing

System DirectorCommunity Projects

Sally Jackson

System DirectorMedia Relations

VACANT

System DirectorPlant Operations

Rod Allen

System DirectorPlanning & Design

Kent Ley

System DirectorEnvironmental Safety

Rocky Rhoads

System DirectorConstruction

Dirk Frink

System DirectorSecurity

Doug Wade

System DirectorFood & Nutrition

Larry Altier

System DirectorComp & Benefits

Alison Thurau

System Director HRRecruitment &

RetentionKristy Rigot

Business Partner-HRAmbulatory ServicesPost-Acute-Corporate

Randy Toscano

Sr. Business PartnerAcute/OutpatientSupport Services

Mel King

Business Partner – HRGCMC

Mike Polito

System DirectorOrganizational EffectivenessBrad Pollins

System DirectorLeadership

DevelopmentCarol Simonds

System DirectorChild Development

CentersJoanne Fuciu

System DirectorHome Health

Cindy Christman

System DirectorHealthPark Care Ctr

Nancy Zant

System DirectorWellness Centers

Greg Camp

System DirectorGerontologySue Maxwell

System DirectorOperations Improvement

Steve Oreolt

Vice PresidentOutpatient Services

David Cato

System DirectorAmbulatory Services / Outpatient Operations

Fern Dennis

System DirectorSpecial Projects

Suzanne Bradach

Vice PresidentOncology ServicesSharon MacDonald

Board of DirectorsBoard of Directors

PresidentJim Nathan

Chief Compliance OfficerInternal Audit Officer

Charles Swain

System DirectorInternal Audit Angela D’Anna

Chief Legal OfficerLegal Services

Mary McGillicuddy

Chief Foundation OfficerLMHS FoundationSharon MacDonald

Medical Executive Committees

CCH, GCMC, HPMC, LMH, TCH

Physician Leadership Council

System Leadership Council

Board AdministratorCathy Stephens

Board Legal CounselJim Humphrey

System DirectorEmployee HealthBarbara Evans

Vice PresidentHealth & Wellness

Sal Lacagnina D.O.

March 2011

System DirectorAmbulatory/Outpatient

SystemsCindy Kinney

Medical Director Informatics

William Carracino, MD

System DirectorSales

Mike Moss

Joan Carroll WasRemoved from thischart – new title “Director of Transition of Care Program”

StanPadfieldremoved

PLC Chairman Report to the Board 3/24/2011

Recent Meetings

TCH MEC – 3/15, 2011 GCMC MEC – 3/14, 2011

HPMC MEC – 3/8, 2011 LMH MEC – 3/9, 2011

CCH MEC – 3/21, 2011 PLC – January 19th, 2011

Multiple Campus MEC Items

Two new policies were reviewed at each of the MECs as part of DNV certification.

Corrective Action Policy--Will define methods to eliminate the cause of an existing

nonconformity in order to prevent recurrence and will serve as a distinction between

“correction” and “corrective action”.

Preventative Action Policy--Will define methods to eliminate the causes of potential

nonconformities in order to prevent their occurrence.

A shortage of Levophed is occurring nationally and locally.

Hand washing and safety are always reviewed.

Individual Campus MEC Items

At the Cape the new phone system is up and running.

At Gulf Coast the hunt for a new CAO is starting.

TCH reported that live plants will be removed from the Atrium due to water intrusion

problems.

PLC

Next meeting will be held April 20th, 2011. The March meeting was cancelled and instead a

meeting of the Administration and Medical Staff Presidents was held.

Thank you for your attention.

Tom Presbrey, MD

PLC Chairman

Lee Memorial Health SystemGME Partnership with FSU

Scott D. Nygaard, MD MBACMO Physician Services

March 23, 2011

Objectives

Provide an update and background information on current GME strategyProgress to dateDescribe next steps

FSU College of MedicineFSU College of Medicine

Established in 2000 by Florida LegislatureThe first new allopathic medical school in 25 yearsClass of 2005 started in 2001, 30 studentsClass size anticipated 120 / classDistributed modelSix Regional Campuses

Florida State University College of MedicineFlorida State University College of MedicineRegional and Rural CampusesRegional and Rural Campuses

58 state legislative districts58 state legislative districts154 ZIP codes154 ZIP codes

Mission Statement FSUMission Statement FSU

The Florida State University College of Medicine will educate and develop exemplary physicians

who practice patient-centered health care, discover and advance knowledge, and are responsive to community needs, especially

through service to elder, rural, minority, and underserved populations.

Mission LMHS

To continue to meet the health careneeds and improve the health statusof the people of Southwest Florida

Unique Medical SchoolUnique Medical School

An educational program with a community based modelA commitment to a patient centered care for underserved communitiesA clear focus on teaching medical studentsDesigned to produce the physicians that Florida needs most

RuralRural ElderlyElderly MinorityMinority Medically UnderservedMedically Underserved

CommunityCommunity--based Trainingbased Training-- Medical Medical StudentsStudents

At the regional campuses, third- and fourth-year medical students train one-on-one with practicing physicians in private practices, hospitals,

and other medical facilities.

GME Impact on Our CommunityGME Impact on Our Community

Brings medical community togetherModel team practice and systems of careAdvance information technology / linkages to the medical schoolFocus on the underserved / physician shortage areasLink future physicians to these communitiesImprove quality of care

Residency Impact on CommunitiesResidency Impact on Communities

Enhances community image by academic presenceStimulates attendings to improve careDifferentiates hospital/community in market and service areaProvides a pipeline for future workforceEnhances physician / specialty recruitment Prolongs career of physician workforce

What Program?What Program?-- Start with Family PracticeStart with Family Practice

Community needs (present and future)Leadership and supportVolumes and QualityNational needs (primary care residency has grown in terms of applicants by about 10%)Can meet the majority of requirements locallyDevelopment / endowment

How to Pay for it?How to Pay for it?

Federal GME Support (TBD)State Support (AHCA monies $533,000 x 2)Endowment / giftsConsider “cost avoidance” analysis

HospitalistRecruitment / retention costsQuality / safety

Value Added Analysis (Intangible)Medical staff imageMarket position in communityRecruitment opportunities

Residency 101Residency 101-- Clear ApproachClear Approach

General Requirements – ACGMEInstitutional accreditationSponsorship and responsibility

Program RequirementsProgram specific by specialty

I – Institutional SupportII – Program Personnel and ResourcesIII – Resident appointmentsIV – Educational ProgramV – EvaluationVI – Duty hours and resident environment

Institutional Requirements Institutional Requirements

1. Institutional Organization for Residency 2. Institutional Responsibility for residents3. Graduate Medical Education Committee

(GMEC) 4. Internal Review 5. Require some medical staff bylaw

changes to accommodate residents

Why Affiliate with a University?Why Affiliate with a University?

Support / expertise in application processSupport in recruitment

Program DirectorFacultyResidents

Academic imagePartnership with AdvocacyResearch opportunitiesDevelopment support

Progress to DateAppointed a Director of Medical Education

Eric Goldsmith, DOCampus of Lee Memorial Hospital/Health Park selected for program developmentCompleting negotiations on an agreement with FSU for a 6 FTE Family Practice ResidencyTargeted start date of residency 2013

Next Steps

Complete and get agreement signed in April 2011Begin recruitment of program directorSecure and design space for residency program within LMH-MOB campusFinalize budget for 2012 submissionPerforma update and revise

FSU College of MedicineFSU College of Medicine at Lee Memorial Health Systemat Lee Memorial Health System

Medical Education for the 21Medical Education for the 21stst CenturyCentury

BBBOOOAAARRRDDD OOOFFF DDDIIIRRREEECCCTTTOOORRRSSS RECOMMENDED ACTION FOR BOARD APPROVAL

(Action includes Acceptance, Approval, Adoption, etc)


DATE: March 24, 2011 LEGAL SERVICE REVIEW? YES_X_ NO__

SUBJECT: Authorizing Resolution for the substitution of the Letter of Credit provider for the outstanding variable rate hospital revenue bonds 2009 Series C.

REQUESTOR & TITLE: Mike German, CFO PREVIOUS BOARD ACTION ON THIS ITEM (IF ANY) (justification and/or background for recommendations – internal groups which support the recommendation i.e. SLC, Operating Councils, PMTs, etc.) None SPECIFIC PROPOSED MOTION: Approve the resolution to substitute the Letter of Credit for the outstanding Variable Rate Hospital Revenue Bonds 2009 C; authorizing the appropriate officers of the Lee Memorial Health System to proceed to draft the necessary documents in connection therewith; and providing an effective date. PROS TO RECOMMENDATION

Partnership with a large bank.

CONS TO RECOMMENDATION

LIST AND EXPLAIN ALTERNATIVES CONSIDERED

Leave letter of credit as is. FINANCIAL IMPLICATIONS Budgeted ____ Non-Budgeted ____ (including cash flow statement, projected cash flow, balance sheet and income statement)

OPERATIONAL IMPLICATIONS (including FTEs, facility needs, etc.) SUMMARY

Management is seeking approval of the attached resolution, which will allow management to substitute the Letter of Credit provider on the Series 2009 C Bonds.

1 BOD/Forms/Board (Action) Reporting Form – updated 9/2/09 cs

A RESOLUTION OF THE LEE MEMORIAL HEALTH SYSTEM BOARD OF DIRECTORS; APPROVING THE SUBSTITUTION OF THE LETTER OF CREDIT FOR THE OUTSTANDING VARIABLE RATE HOSPITAL REVENUE BONDS 2009 SERIES C; AUTHORIZING THE APPROPRIATE OFFICERS OF THE LEE MEMORIAL HEALTH SYSTEM TO PROCEED TO DRAFT THE NECESSARY DOCUMENTS IN CONNECTION THEREWITH; AND PROVIDING AN EFFECTIVE DATE.

WHEREAS, the Lee Memorial Health System (the “System”) is a body politic and corporate establish pursuant to Chapter 2000-439 Laws of Florida, as amended (the “Act”); and WHEREAS, the System, acting through its Board of Directors (the “Board”) is authorized under the Act, among other things, to issue from time to time revenue bonds of the System to finance or refinance the cost of acquisition and construction of extensions and additions to any hospital buildings and facilities of the System, together with equipment required in connection therewith; and WHEREAS, the Board has previously issued and there remain outstanding the System’s Variable Rate Hospital Revenue Bonds 2009 Series C (the “Series 2009C Bonds”), which Series 2009C Bonds were issued under a Trust Agreement dated as of February 1, 2009 between the System and Regions Bank, as Bond Trustee (the “Trustee” and the “Trust Agreement”) ; and WHEREAS, capitalized terms used but not defined in this Resolution shall have the meanings ascribed to such terms in the Trust Agreement; and WHEREAS, the Series 2009C Bonds are secured by, among other security therefor, a letter of credit issued pursuant to a Letter of Credit and Reimbursement Agreement dated as of February 1, 2009 between the System and The Northern Trust Company (the “Existing Letter of Credit” and the “Existing Reimbursement Agreement,” respectively); and WHEREAS, Section 1502 of the Trust Agreement permits the Board to arrange for the replacement of an existing Letter of Credit with an Alternate Letter of Credit provided certain conditions are met and the Board has determined to obtain an Alternate Letter of Credit for the Series 2009C Bonds; and

WHEREAS, there have been obtained and reviewed proposals from several financial institutions for the extension of the Existing Letter of Credit and the provision of an Alternate Letter of Credit and the Board has determined that the proposal of JP Morgan Chase Bank, N.A. (the “Bank”) to provide an Alternate Letter of Credit is the most favorable to the Board in terms of, among other things, providing diversity of bank credit exposure for the System; and

WHEREAS, it is necessary at this time to authorize the appropriate officers of the Board and the System and the Board’s and System's Counsel, Financial Advisor, Bond Counsel to proceed to draft or negotiate, as applicable, the necessary documents for the substitution of the Existing Letter of Credit.

TAMPA/172401.2

NOW, THEREFORE, THE LEE MEMORIAL HEALTH SYSTEM Board of Directors does hereby resolve as follows:

Section 1. The Board hereby approves and ratifies the acceptance of the Bank’s proposal for the provision of an Alternate Letter of Credit to secure the Series 2009C Bonds.

Section 2. The appropriate officers of the Board and the System, together with Fowler, White, Boggs, Banker P.A., Counsel to the Board, Ponder & Co., as Financial Advisor, and Squire, Sanders & Dempsey (US) LLP, as Bond Counsel, are authorized and directed to proceed to develop the necessary documentation associated with the letter of credit substitution and to obtain confirmation from the appropriate rating agencies of the rating on the Series 2009C Bonds. The transaction shall not be completed, however, without the further approval of this Board.

Section 3. This Resolution shall take effect immediately upon its passage.

Passed and adopted this 24th day of March, 2011.

LEE MEMORIAL HEALTH SYSTEM BOARD OF DIRECTORS By: __________________________________

Richard B. Akin Board Chairman

(SEAL) ATTEST: By: _______________________________ Nancy M. McGovern, RN, MSM

Board Secretary

TAMPA/172401.2


LEE COUNTY, FLORIDA CONSOLIDATED FINANCIAL STATEMENTS AND STATISTICAL REPORTS

FEBRUARY 28, 2011

LEE MEMORIAL HEALTH SYSTEM CONSOLIDATED FINANCIAL STATEMENTS & STATISTICAL REPORTS TABLE OF CONTENTS SECTION A PAGE CONSOLIDATED SCHEDULES HIGHLIGHTS A.1 CONSOLIDATED STATISTICAL REPORT A.3 CONSOLIDATED INCOME STATEMENT A.4 SOURCES & APPLICATIONS OF FUNDS A.6 CONSOLIDATED BALANCE SHEET A.7 CONSOLIDATED FINANCIAL RATIOS A.8 CONSOLIDATED PAYOR MIX A.10 CAPITAL STATUS REPORT A.11 INVESTMENT PERFORMANCE SUMMARY A.12

Lee Memorial Health System Operating Highlights

For the month ended February 28, 2011 Actual adjusted admits (overall inpatient & outpatient volume indicator) for the month ended February 28, 2011 are 10,172 which is 2.6% less than budget. Actual inpatient admits for the month are 6,529 or 2.1% less than budget while actual patient days are 34,060 or 4.1% greater than budget which resulted in a 5.2 day length of stay. Emergency room visits are 3.4% greater than budget while outpatient surgeries are 12.2% greater than budget. Net patient revenue for February 2011 reflects a $2.2 million or a 2.4% favorable variance to budget. This favorable variance in net patient revenue is primarily the result of the 2.6% decrease in adjusted admits which is offset by the 5.0% increase in reimbursement during the month. Total operating expenses before depreciation and interest expense are $2.6 million greater than budget. All operating expense categories except fringe benefits and purchased services reflect unfavorable variances. Salaries & Wages reflect a $2.2 million unfavorable variance due to increased overtime and the market adjustments that have increased the average hourly rate. Supply costs reflect a $0.6 million unfavorable variance but is equal to budget when expressed as a percent of net patient revenue. Actual total operating costs per case mix adjusted admit is 2.8% greater than budget (6,400 act, 6,223 budget). Productivity as measured by FTEs/AOB increased by 1.3% (4.66 actual, 4.72 budget) for February 2011. For February 2011, the gain from operations is $2.5 million versus a budgeted gain of $3.1 million. Excess revenue over expenses is a gain of $7.4 million versus a budgeted gain of $5.8 million. Investments were budgeted to return $2.7 million for the month but the actual investment return was $4.8 million.

Page A.1


For the month ended February 28, 2011 For the month, Cash & Investments increased by $7.4 million to $513.4 million. Operations increased cash by $12.6 million while working capital decreased cash by $6.2 million. Cash was reduced by $4.6 million for routine equipment. Days in Accounts Receivable are 53.0 days and resulted in a $5.6 million increase in cash. Total Notes & Bonds payable on February 28, 2011 is $700.7 million resulting in a Cash to Debt ratio of 73.3%. Net Patient Revenue per adjusted admit CMI for the month ended February 28, 2011 is $6,584 while the Operating Expense per adjusted admit CMI is $6,400. The difference which represents the gain from operations per adjusted admit is $184.00 while the budgeted gain from operations is $222.00. Wages & Benefits as a percent of Net Operating Revenue is 51.4% for February 2011 versus a budget of 50.5%. The actual hourly pay rate is $30.20 which is $0.97 greater than budget due to market adjustments and overtime. YTD, the average hourly rate is $29.65 which is 46 cents greater than budget. Post Acute entities provided the following YTD contributions to Acute Care by allowing charity care patients into their respective programs: Lee Memorial Home Health $308,000; HealthPark Care Center $161,000; The Rehabilitation Hospital $187,000; Access Medical South (DME joint venture) $53,000. The Lee Physician Group YTD loss per physician is $12,308. This includes practice revenue and expenses along with ancillary revenue referred to LMHS. This YTD loss is $25,783 per physician less than budget due to lower operating cost and better collections per visit than budget.

Page A.2

LEE MEMORIAL HEALTH SYSTEMCONSOLIDATED STATISTICAL SUMMARYFOR THE PERIOD ENDING FEBRUARY 28, 2011

Current period Year-to-DateBudget Actual Prior Year Variance Var % Budget Actual Prior Year Variance Var %

ACT TO BUD ACT TO BUD ACT TO BUD ACT TO BUD

Admissions ADULTS 6,107 5,956 6,043 (151) -2.5% 28,503 29,729 27,798 1,226 4.3% PEDIATRICS 363 380 360 17 4.7% 1,888 2,029 1,873 141 7.5% NICU 44 53 50 9 20.8% 251 271 276 20 8.1% POST ACUTE 153 140 144 (13) -8.5% 783 724 757 (59) -7.5%Total Adult & Peds 6,667 6,529 6,597 (138) -2.1% 31,424 32,753 30,704 1,329 4.2% NEWBORNS 505 443 476 (62) -12.3% 2,691 2,483 2,540 (208) -7.7%Total Admissions 7,172 6,972 7,073 (200) -2.8% 34,115 35,236 33,244 1,121 3.3%

Patient Days ADULTS 26,365 27,601 26,753 1,236 4.7% 127,087 136,576 126,479 9,489 7.5% PEDIATRICS 1,286 1,285 1,123 (1) -0.1% 6,747 6,506 6,074 (241) -3.6% NICU 986 1,096 1,131 110 11.1% 5,670 6,410 6,193 740 13.1% POST ACUTE 4,069 4,078 4,103 9 0.2% 21,621 21,284 21,014 (337) -1.6%Total Adult & Peds 32,706 34,060 33,110 1,354 4.1% 161,125 170,776 159,760 9,651 6.0% NEWBORNS 1,146 1,018 1,136 (128) -11.2% 6,149 6,115 6,161 (34) -0.6%Total Patient Days 33,853 35,078 34,246 1,225 3.6% 167,274 176,891 165,921 9,617 5.7%

Average Length of Stay ADULTS 4.3 4.6 4.4 0.3 7.3% 4.5 4.6 4.5 0.1 3.0% PEDIATRICS 3.5 3.4 3.1 (0.2) -4.6% 3.6 3.2 3.2 (0.4) -10.3% NICU 22.5 20.7 22.6 (1.8) -8.0% 22.6 23.7 22.4 1.0 4.5% POST ACUTE 26.6 29.1 28.5 2.5 9.5% 27.6 29.4 27.8 1.8 6.5%Total Adult & Peds 4.9 5.2 5.0 0.3 6.3% 5.1 5.2 5.2 0.1 1.7% NEWBORNS 2.3 2.3 2.4 0.0 1.2% 2.3 2.5 2.4 0.2 7.8%Total Patient Days 4.7 5.0 4.8 0.3 6.6% 4.9 5.0 5.0 0.1 2.4%

OP Registrations EMERGENCY ROOM 13,257 13,706 12,828 449 3.4% 68,907 69,367 66,751 460 0.7% OP SURGERY CASES 1,490 1,672 1,533 182 12.2% 7,315 7,947 7,923 632 8.6%SUBTOTAL 14,747 15,378 14,361 631 4.3% 76,221 77,314 74,674 1,093 1.4%

Visits / Encounters HOME HEALTH ADMISSIONS 353 352 312 (1) -0.4% 1,625 1,724 1,394 99 6.1% HOSP BASED PHY ENCOUNTERS 14,065 14,889 13,283 824 5.9% 74,817 79,098 70,917 4,281 5.7% PHYSICIAN ENCOUNTERS 46,369 49,648 41,703 3,279 7.1% 225,705 239,943 201,952 14,238 6.3% TRAUMA SERVICES DISTRICT 455 637 435 182 40.0% 3,123 3,339 3,033 216 6.9%SUBTOTAL 61,242 65,526 55,733 4,284 7.0% 305,269 324,104 277,296 18,835 6.2%

TOTAL OP 75,990 80,904 70,094 4,914 6.5% 381,491 401,418 351,970 19,927 5.2%

Page A.3

LEE MEMORIAL HEALTH SYSTEMCONSOLIDATED STATEMENT OF OPERATIONSFOR THE PERIOD ENDING: FEBRUARY 28, 2011( IN THOUSANDS )

BUDGET ACTUAL PRIOR YEAR VAR VAR % VAR % BUDGET ACTUAL PRIOR YEAR VAR VAR % VAR %ACT TO BUD ACT TO BUD PR YR ACT TO BUD ACT TO BUD PR YR

INPATIENT REVENUE 224,249 229,359 209,561 5,110 2.3% 9.4% 1,088,272 1,144,133 1,012,861 55,861 5.1% 13.0%OUTPATIENT REVENUE 126,897 127,972 115,679 1,075 0.8% 10.6% 634,553 642,624 594,727 8,071 1.3% 8.1%TOTAL PATIENT REVENUE 351,146 357,332 325,240 6,185 1.8% 9.9% 1,722,825 1,786,757 1,607,589 63,932 3.7% 11.1%

DED FROM REV-MEDICARE 139,573 143,142 128,054 (3,569) -2.6% -11.8% 652,035 671,156 596,789 (19,122) -2.9% -12.5%DED FROM REV-MEDICAID 32,877 33,317 30,484 (439) -1.3% -9.3% 182,552 182,932 168,385 (381) -0.2% -8.6%DED FROM REV-CHARITY 11,596 11,988 10,634 (393) -3.4% -12.7% 56,707 58,195 51,166 (1,488) -2.6% -13.7%DED FROM REV-HMO/PPO 26,227 29,880 29,083 (3,653) -13.9% -2.7% 147,043 160,639 159,218 (13,596) -9.2% -0.9%DED FROM REV-OTHER 36,408 32,250 27,796 4,158 11.4% -16.0% 160,163 174,853 140,177 (14,690) -9.2% -24.7%DED FROM REV-BAD DEBT 12,492 12,362 11,482 130 1.0% -7.7% 62,257 63,488 55,863 (1,231) -2.0% -13.6%TOTAL DED FROM REV 259,171 262,938 237,533 (3,767) -1.5% -10.7% 1,260,756 1,311,263 1,171,598 (50,507) -4.0% -11.9%

NET PATIENT REVENUE 91,975 94,393 87,707 2,419 2.6% 7.6% 462,070 475,494 435,990 13,424 2.9% 9.1%OTHER OPER REV 1,545 1,374 1,305 (171) -11.0% 5.3% 7,886 7,551 6,724 (335) -4.2% 12.3%

TOTAL OPERATING REV 93,520 95,768 89,012 2,248 2.4% 7.6% 469,956 483,045 442,714 13,090 2.8% 9.1%

OPERATING EXPENSES PROD SALARIES 34,488 36,178 32,165 (1,690) -4.9% -12.5% 176,340 184,420 165,062 (8,080) -4.6% -11.7% PROD OVERTIME 1,228 1,434 1,307 (205) -16.7% -9.7% 7,029 7,465 6,269 (436) -6.2% -19.1% CONTRACT LABOR 560 464 513 96 17.2% 9.7% 1,271 938 1,063 333 26.2% 11.8% NON-PROD SALARIES 4,136 4,568 3,645 (432) -10.4% -25.3% 23,526 23,409 20,833 117 0.5% -12.4%TOTAL SALARIES & WAGES 40,412 42,643 37,630 (2,231) -5.5% -13.3% 208,166 216,232 193,227 (8,067) -3.9% -11.9%

FRINGE BENEFITS 6,845 6,563 6,619 281 4.1% 0.8% 35,219 33,195 33,214 2,025 5.7% 0.1%HEALTH CARE ACCESS 1,126 1,209 1,214 (83) -7.3% 0.4% 5,649 6,035 5,983 (386) -6.8% -0.9%SUPPLIES 20,343 20,921 19,559 (578) -2.8% -7.0% 98,652 101,665 96,065 (3,012) -3.1% -5.8%OTHER SERVICES 5,004 5,345 5,109 (341) -6.8% -4.6% 26,759 27,357 25,299 (598) -2.2% -8.1%PURCHASED SERVICES 9,192 8,845 7,938 348 3.8% -11.4% 46,196 46,808 41,776 (611) -1.3% -12.0%

TOTAL OPER EXPENSES 82,922 85,526 78,070 (2,604) -3.1% -9.6% 420,641 431,291 395,565 (10,650) -2.5% -9.0%

EBITDA 10,597 10,242 10,942 (356) -3.4% -6.4% 49,315 51,754 47,149 2,440 4.9% 9.8%

DEPRECIATION/AMORT 5,151 5,403 4,635 (252) -4.9% -16.6% 25,463 26,576 21,855 (1,113) -4.4% -21.6%INTEREST EXPENSE 2,295 2,292 2,061 4 0.2% -11.2% 11,510 12,104 11,302 (594) -5.2% -7.1%GAIN(LOSS) FROM OPER 3,151 2,547 4,246 (604) -19.2% -40.0% 12,341 13,074 13,992 733 5.9% -6.6%

CURRENT MONTH YEAR TO DATE

Page A.4

LEE MEMORIAL HEALTH SYSTEMCONSOLIDATED INCOME STATEMENT BY ENTITYFOR THE MONTH ENDED FEBRUARY 28, 2011(IN THOUSANDS)

ENTITY BUDGET ACTUALVARIANCE PRIOR YR BUDGET ACTUALVARIANCE PRIOR YR

LEE MEMORIAL HOSPITAL 2,516 2,745 229 2,320 16,294 19,338 3,044 13,713HEALTHPARK MEDICAL CTR 5,807 6,932 1,125 6,604 30,871 34,266 3,395 30,457CAPE CORAL HOSPITAL 3,069 2,852 (216) 2,948 18,627 16,575 (2,052) 16,584GULF COAST MEDICAL CENTER 4,035 3,647 (388) 2,971 15,201 14,738 (463) 11,484TRAUMA SERVICES DIST (341) (230) 111 (363) (1,816) (2,003) (187) (1,743)OUTPATIENT CENTERS 787 693 (95) 788 1,604 2,629 1,025 5,345HEALTHPARK CARE CTR 125 225 99 191 716 815 99 562HOME HEALTH AGENCIES 192 47 (145) 121 494 (15) (509) 125FOUNDATION (34) 2 36 1 (241) 120 361 83REHAB HOSPITAL 415 550 135 447 2,404 2,524 119 1,985PHYSICIANS (LPG-MSO-HBP) (3,976) (3,840) 136 (2,038) (22,823) (22,814) 9 (16,740)CORPORATE SERVICES (9,383) (11,015) (1,632) (9,702) (48,668) (52,793) (4,125) (47,599)AUXILIARY (3) (5) (2) (4) (16) (25) (9) (20)CHILD DEVELOP/PPEC (59) (56) 3 (37) (306) (282) 24 (243)PHO (0) (0) 0 (0) (0) (0) 0 (0)

TOTAL GAIN FROM OPS 3,151 2,547 (604) 4,246 12,341 13,074 733 13,992

INT EARN & REALIZED GAIN 1,434 91 (1,343) 803 7,610 4,078 (3,532) 4,186UNREALIZED GAIN (LOSS) 883 4,272 3,389 1,018 4,606 18,696 14,090 4,820UNREALIZED GAIN (LOSS) ON SWAP 0 0 0 0 0 905 905 229OTHER NON OPERATING 269 257 (12) 1,296 1,339 (24,850) (26,189) 1,876RESTRICTED GIFTS 82 223 141 (808) 410 3,192 2,782 (757)

TOTAL NON OPERATING 2,668 4,844 2,175 2,309 13,965 2,022 (11,942) 10,353

EXCESS OF REV/EXPS 5,819 7,391 1,571 6,554 26,306 15,096 (11,210) 24,345


Page A.5

MONTH YTDSources of Funds:

Excess Revenue Over Expenses 7,391 15,096 Depreciation/Amortization Expense 5,403 26,576 Restricted Gifts (223) (3,192) SWFRMC Land Value Adjustment 0 29,549 Total Sources 12,570 68,029

Uses of Funds:

Dec(Inc) in Accts Receivable (6,758) (85,331) Provision for Bad Debts 12,362 63,488 Dec(Inc) in Net Accts Receivable 5,604 (21,843)

Net borrowings (299) (2,141) Dec(Inc) in Other Assets (687) (4,893) Inc(Dec) in Liabilities (5,249) 18,224 Capital Expenditures, net (4,589) (30,499) Total Uses (5,221) (41,151)

Net Increase(Decrease) In Funds 7,350 26,877

Cash & Investments at beginning of period 506,013 486,485

Cash & Investments at end of period 513,362 513,362

Total Bonds & Notes Payable-end of period 700,668

Cash to Debt Ratio 73.3%

In Thousands (000's)

SOURCES & APPLICATIONS OF FUNDSLEE MEMORIAL HEALTH SYSTEM

FOR THE PERIOD ENDING FEBRUARY 28, 2011

Page A.6

Lee Memorial Health SystemConsolidated Balance Sheet As of FEBRUARY 28, 2011

in Thousands (000's)

ASSETS: Current Prior Month Prior Year LIABILITIES: Current Prior Month Prior Year

Current Assets: Current Liabilities:Cash And Cash Equivalents * 11,561 16,483 16,087 Accounts Payable 30,181 36,595 34,520Operating Fund Investments * 473,871 461,595 432,318 Wages and Benefits Payable 44,301 42,658 31,795Accrued Interest Receivable 361 353 371 Notes Payable - Short Term 7,545 6,680 4,349Accounts Receivable (net) 166,160 172,163 141,351 Current Portion Bonds Payable 10,350 10,350 14,871Accounts Receivable - Phys (Net) 7,660 7,260 10,626 Due to State of Florida 11,904 11,569 13,312Inventories 29,159 29,116 29,117 Malpractice Liability - Short Term 5,936 5,936 5,936Third Party Settlements 0 0 0 Accrued Bond Costs 9,531 7,610 12,282Other Current Assets 12,511 12,421 11,599 Due to LMHS 0 0 0

Other Current Liabilities 33,016 38,251 32,151

Total Current Assets: 701,282 699,390 641,468 Total Current Liabilities 152,765 159,649 149,216

Other Assets Other Liabilities and Fund BalanceLimited or Restricted Use Assets * 6,706 6,709 17,675 Benefits Payable - Long Term 0 0 0Bond Issuance Costs 5,218 5,247 5,685 Notes Payable - Long Term 155,343 156,548 104,040Trustee Held Funds * 0 0 0 Due to State of Florida - Long Term 7,736 6,894 3,494Directors/Officers Indemnity Fund * 100 100 100 Malpractice Liability - Long Term 9,942 9,842 9,242Long Term Operating Fund Investments * 21,126 21,126 20,304 Bonds Payable 527,430 527,389 553,410Other Assets 99,413 99,280 100,082 Other Long Term Liabilities 45,546 45,192 39,054

UnRestricted Fund Balance 608,896 601,728 596,992Restricted Fund Balance 26,030 25,807 22,838

Total Other Assets 132,562 132,462 143,846 Total Other Liabilities & Fund Balance 1,380,924 1,373,401 1,329,070

Property and Equipment:Plant In Use 1,224,090 1,222,991 1,203,696Construction in Process 29,729 28,193 26,866Accumulated Depreciation (575,322) (571,220) (555,419)

Total Property & Equipment (Net) 678,497 679,965 675,142

Restricted Assets 21,348 21,233 17,829

TOTAL ASSETS 1,533,688 1,533,050 1,478,286 TOTAL LIABILITIES AND EQUITY 1,533,689 1,533,050 1,478,286

* Cash and InvestmentsAbove Balance Sheet has been adjusted to eliminate intercompany receivables, payables and investments in subsidiaries

Page A.7

LEE MEMORIAL HEALTH SYSTEMFINANCIAL RATIOSFOR THE 5 MONTHS ENDED FEBRUARY 28, 2011

2009 2011Moody's Financial FYE YTDMedian Goals 2010 2/28/2011

PROFITABILITY RATIOS:Operating Margin (%) - Total 3.0% 2.2% 3.4% 2.7% +Excess Margin (%) 5.1% 4.8% 6.2% 2.5% +Operating CashFlow Margin (%) 9.9% 10.0% 11.6% 10.7% +

LIQUIDITY RATIOS:Days Cash on Hand (net of Callable Debt) 169.5 138.5 130.5 130.4 +Cushion Ratio (x) 15.3 13.7 10.6 11.2 +Cash-to-Debt (%) 117.6% 83.7% 71.9% 73.3% +

CAPITALIZATION RATIOS:Debt to Capitalization(%) - (net of Callable Debt) 38.9% 41.5% 47.8% 48.2% (-)Annual Debt Service Coverage (x) 4.7 3.5 3.3 3.7 +Debt to Cashflow (net of Callable Debt) 3.3 3.7 4.8 5.0 (-)

NOTE: + = Ratios that should be above the Moody's median(-) = Ratios that should be lower than the Moody's median

Page A.8

LEE MEMORIAL HEALTH SYSTEMCONSOLIDATED OPERATING RATIOSFOR THE PERIOD ENDING FEBRUARY 28, 2011

YEAR TO DATESAME MO SAME MO

BUDGET ACTUAL PRIOR YR ACT-BUD ACT-PRIOR BUDGET ACTUAL PRIOR YR ACT-BUD ACT-PRIOR

AS % NET OPER REV

WAGES & BENEFITS 50.5% 51.4% 49.7% -1.7% -3.4% 51.8% 51.6% 51.1% 0.3% -1.0%SUPPLIES 21.8% 21.8% 22.0% -0.4% 0.6% 21.0% 21.0% 21.7% -0.3% 3.0%ALL OTHER OPER EXPENSES 16.4% 16.1% 16.0% 1.9% -0.4% 16.7% 16.6% 16.5% 0.8% -0.6%CAPITAL COSTS 7.9% 7.9% 7.5% -0.2% -5.1% 7.8% 7.9% 7.5% -0.9% -5.1%EBITDA MARGIN 11.3% 10.7% 12.3% -5.6% -14.9% 10.5% 10.7% 10.7% 2.1% 0.6%OPERATING MARGIN 3.4% 2.8% 4.8% -19.1% -71.3% 2.7% 2.9% 3.2% 5.7% -10.9%EXCESS MARGIN 6.3% 7.2% 7.4% 15.1% -1.7% 5.7% 2.6% 5.5% -54.2% -111.7%

PER CMI ADJ ADMIT / VISIT

NET OPER REV 6,445 6,584 6,254 2.2% 5.0% 6,796 6,794 6,536 0.0% 3.8%TOTAL EXPENSES 6,223 6,400 5,956 -2.8% -7.5% 6,613 6,600 6,329 0.2% -4.3%WAGES & BENEFITS 3,257 3,383 3,109 -3.7% -8.8% 3,520 3,508 3,343 0.3% -4.9%SUPPLIES 1,402 1,438 1,374 -2.5% -4.7% 1,427 1,430 1,418 -0.2% -0.8%ALL OTHER OPER EXPENSES 1,056 1,059 1,002 -0.3% -5.7% 1,137 1,128 1,079 0.8% -4.5%CAPITAL COSTS 509 521 470 -2.3% -10.9% 530 535 489 -0.9% -9.4%OPERATING MARGIN 222 183 298 -17.6% -62.8% 183 194 207 6.0% -6.7%EXCESS MARGIN 406 516 461 27.1% 10.7% 385 222 359 -42.3% -61.7%

LABOR

PROD FTEs/ADJ DAILY ADMIT 20.3 21.3 20.5 -4.8% -3.8% 22.5 22.5 22.2 0.2% -1.6%NON PROD AS % PAID 9.5% 9.3% 9.2% 2.4% -1.2% 9.5% 9.2% 9.3% 3.5% 0.4%AVG HOURLY RATE 29.2 30.2 28.5 -3.2% -6.0% 29.2 29.7 28.4 -1.6% -4.3%

OP REV % OF TOTAL REVENUE 36.1% 35.8% 35.6% -0.9% 0.7% 36.8% 36.0% 37.0% -2.4% -2.8%

Page A.9

CURRENT MONTH % VARIANCE% VARIANCE

LEE MEMORIAL HEALTH SYSTEMCONSOLIDATED - PAYOR MIXFebruary 28, 2011

Budget Actual Same Mo Budget Actual Same MoPrior Year Prior Year

MEDICARE 55.3% 55.7% 55.4% 52.0% 52.2% 51.4%MEDICAID 10.1% 9.5% 9.7% 11.3% 10.5% 11.0%MEDICAID HMO 3.1% 3.8% 3.0% 3.4% 3.9% 3.3%HMO/PPO 19.0% 18.3% 19.8% 20.3% 20.0% 21.3%COMMERCIAL 2.9% 2.8% 2.9% 3.2% 3.0% 3.3%OTHER 9.6% 10.0% 9.3% 9.7% 10.5% 9.6%

100.0% 100.0% 100.0% 100.0% 100.0% 100.0%

Budget Actual % Variance Budget Actual % VarianceMEDICARE CASE MIX INDEX 1.57 1.56 -0.6% 1.56 1.53 -1.9%SYSTEM CASE MIX INDEX 1.39 1.43 2.9% 1.39 1.39 0.0%

09/30/10 02/28/11 VarianceGross Accounts Receivable 324,983 369,983 45,000 Net Accounts Receivable 152,139 173,820 21,681 Net Days in Accounts Receivable 52.1 53.0 0.9

CURRENT MONTH YEAR-TO-DATE

Page A.10

CAPITAL BUDGET POOL

$ CERF $'s

APPROVEDCERF $'s SPENT

CERF's PENDING

APPROVALCAPITAL BALANCE

ROUTINE CAPITALROUTINE 15,677,860 11,979,497 3,766,850 0 3,698,363SURGICAL 4,186,198 2,034,142 871,515 0 2,152,056RADIOLOGY 6,715,398 4,408,535 62,644 0 2,306,863

INFORMATION SYSTEMS 9,452,110 1,836,459 256,106 0 7,615,651EPIC 10,894,925 5,447,463 5,447,463

MAJOR FACILITIES/PLANT OPS 13,828,293 6,864,247 559,419 0 6,964,046

TACTICAL PLANS 8,645,216 8,640,466 5,454,271 0 4,750

CONTINGENCY 600,000 177,085 143,193 0 422,915

TOTAL FY 2010 70,000,000 41,387,894 11,113,997 0 28,612,106

Unbudgeted- Board Approved 0 0 0 0

Outside Funding 373,292 48,006 0 325,286

Total Approved Prior Yrs SpentEPIC 15,447,463 7,967,441 4,346,110 3,133,913

THE CHILDREN'S HOSPITAL 335,496 205,562 130,958 (1,024)

10-1-10 BalFY10 & PRIOR YRS CERF'S- OPEN 24,921,689 5,985,429 18,936,260

21,624,500

51,006,540

TOTAL CASH OUTLAY FOR CAPITAL IN FY'11

LEE MEMORIAL HEALTH SYSTEMFY 2011

CAPITAL STATUS REPORTFebruary 28, 2011

Page A.11

INTEREST REALIZED BOOK UNREALIZED MARKET MONTHLY %INCOME GAINS/(LOSSES) VALUE GAINS/(LOSSES) VALUE RETURN

CASH MANAGERSGENERAL OPERATING ACCOUNTS 0 0 11,356,398 0 11,356,398LIMITED/RESTRICTED ASSET ACCTS 48 0 3,390,731 0 3,390,731 0.00%NORTHERN TRUST 11,113 0 3,448,747 (10,391) 3,438,357 0.02%COMPASS BANK MONEY MARKET 2,959 0 4,557,067 0 4,557,067 0.06%COMPASS BANK 7 MONTH CD 3,144 0 7,574,900 0 7,574,900 0.04% ML Treasury 91 Day 0.00%

SEI CASH & EQUIVALENTSSEI DAILY INCOME TREAS II FUND #37 0 0 0 0 0 0.00% ML Treasury 91 Day 0.00%

SEI PRIME OBLIGATION FUND 2,354 0 51,063,523 0 51,063,523 0.00% ML Treasury 91 Day 0.00%

TOTAL CASH & CASH EQUIVALENT 19,617 0 81,391,366 (10,391) 81,380,975

FIXED INCOME COMPOSITEMFO SEI INSTL INVTS TR CORE FIXED INCOME 0.353 175,275 0 60,279,532 59,040 60,338,571 0.40% Lehman US Aggregate Index 0.20%

MFO SEI DAILY INCOME TR ULTRA SHORT BOND 0.093 98,196 0 77,828,087 83,417 77,911,504 0.23% Lehman 9-12 Month US Treasury NA

MFO SEI INSTL INVTS TR ENHANCED INCOME 0.257 0 0 39,076,631 98,803 39,175,434 0.30% Merrill Lynch 3 mo Cons-Ma 0.00%

LOGAN CIRCLE FUND 0.257 44,666 763 26,332,993 (19,385) 26,313,609 0.10% ML Treasury 91 Day 0.00%

TOTAL FIXED INCOME COMPOSITE 318,137 763 203,517,243 221,875 203,739,118

EQUITY COMPOSITE DOMESTIC EQUITY

MFO SEI INSTL INVTS TR LARGECAP 23.4% 0 0 70,593,975 2,316,791 72,910,766 3.40% S&P 500 3.40%

MFO SEI SIIT SMALL/MID CAP 6.5% 0 0 13,999,060 554,638 14,553,698 4.00% Russell 2500 4.90%

SEI CORE PROPERTY FUND LP 0 0 15,000,000 0 15,000,000 0.00% NCREIF Property Index 0.00%

INTERNATIONAL EQUITYWORLD EQUITY EX-US 0 0 26,671,860 673,410 27,345,270 2.60% MSCI ACWI EX-US 2.60%

TOTAL EQUITY COMPOSITE 0 0 126,264,895 3,544,839 129,809,734

ALTERNATIVE INVESTMENTSSEI OFFSHORE OPPORTUNITY FUND LI, LTD 0 0 76,553,349 481,170 77,034,519 0.60%SEI SPECIAL SITUATIONS FUND 0 0 21,126,042 0 21,126,042 0.00% ML Treasury 91 Day 0.00%

TOTAL OTHER COMPOSITE 0 0 97,679,391 481,170 98,160,561

FOUNDATION 4,543 (2,468) 34,215 MISCELLANEOUS OTHER INCOME 53,914 VARIABLE RATE INTEREST EXPENSE OFFSET (12,851) INVESTMENT MANAGER FEES (293,277)

GRAND TOTAL 90,083 (1,705) 508,852,895 4,271,709 513,090,389 1.00%PORTFOLIO INDEX 0.90%

FOR THE MONTH ENDING FEBRUARY 28, 2011DETAILED PERFORMANCE HISTORY

LEE MEMORIAL HEALTH SYSTEM INVESTMENT PORTFOLIO

Page A.12

INTEREST REALIZED BOOK UNREALIZED MARKET %INCOME GAINS/(LOSSES) VALUE GAINS/(LOSSES) VALUE RETURN*

CASH MANAGERSGENERAL OPERATING ACCOUNTS 21,911 0 11,356,398 0 11,356,398LIMITED/RESTRICTED ASSET ACCTS 318 0 3,390,731 0 3,390,731 0.01%NORTHERN TRUST 59,339 0 3,493,592 (55,236) 3,438,357 0.12%COMPASS BANK MONEY MARKET 15,935 0 4,557,067 0 4,557,067 0.35%COMPASS BANK 7 MONTH CD 822 0 7,574,900 0 7,574,900 0.01% ML Treasury 91 Day 0.10%

SEI CASH & EQUIVALENTSSEI DAILY INCOME TREAS II FUND #37 0 0 0 0 0 0.00% ML Treasury 91 Day 0.10%

SEI PRIME OBLIGATION FUND 12,010 0 51,063,523 0 51,063,523 0.02% ML Treasury 91 Day 0.10%

TOTAL CASH & CASH EQUIVALENT 110,335 0 81,436,211 (55,236) 81,380,975

FIXED INCOME COMPOSITEMFO SEI INSTL INVTS TR CORE FIXED INCOME 3,031,631 0 63,223,457 (2,884,886) 60,338,571 0.30% Lehman US Aggregate Index -0.90%

MFO SEI DAILY INCOME TR ULTRA SHORT BOND 506,392 0 77,741,566 169,938 77,911,504 0.80% Lehman 9-12 Month US Treasury NA

SIIT REAL RETURN 33,871 425,539 300,089 (300,089) 0 0.60% Lehman 1-5 YR US Treasury NA

MFO SEI INSTL INVTS TR ENHANCED INCOME 495,890 0 38,588,869 586,565 39,175,434 3.10% Merrill Lynch 3 mo Cons-Ma 0.10%

LOGAN CIRCLE FUND 121,891 (37) 26,381,636 (68,028) 26,313,609 NA ML Treasury 91 Day 0.10%

TOTAL FIXED INCOME COMPOSITE 4,189,675 425,503 206,235,618 (2,496,500) 203,739,118

EQUITY COMPOSITE DOMESTIC EQUITY

MFO SEI INSTL INVTS TR LARGECAP 1,149,748 (410,746) 62,166,038 10,744,728 72,910,766 17.70% S&P 500 17.30%

MFO SEI SIIT SMALL/MID CAP 24,576 0 12,080,436 2,473,262 14,553,698 20.90% Russell 2500 22.10%

SEI CORE PROPERTY FUND LP 0 0 15,000,000 0 15,000,000 NA NCREIF Property Index NA

INTERNATIONAL EQUITYWORLD EQUITY EX-US 461,237 0 24,917,850 2,427,421 27,345,270 12.00% MSCI ACWI EX-US 11.10%

TOTAL EQUITY COMPOSITE 1,635,561 (410,746) 114,164,323 15,645,411 129,809,734

ALTERNATIVE INVESTMENTSSEI OFFSHORE OPPORTUNITY FUND LI, LTD 0 0 74,729,198 2,305,322 77,034,519 4.90%SEI SPECIAL SITUATIONS FUND 0 0 20,304,325 821,716 21,126,042 4.10% ML Treasury 91 Day 0.10%

REAL ESTATE INVESTMENT TRUSTREIT FUND 249,105 (1,311,857) (2,348,362) 2,348,362 0 9.80% DJ WILSHIRE RESI 0.00%

TOTAL OTHER COMPOSITE 249,105 (1,311,857) 92,685,161 5,475,400 98,160,561

FOUNDATION 48,658 (36,337) 127,245 MISCELLANEOUS OTHER INCOME 1,546,180 VARIABLE RATE INTEREST EXPENSE OFFSET (72,187) INVESTMENT MANAGER FEES (1,401,347)

GRAND TOTAL 6,305,981 (1,333,437) 494,521,313 18,696,320 513,090,389 5.60%PORTFOLIO INDEX 4.90%

*Net of reallocations between funds

FOR THE FIVE MONTHS ENDING FEBRUARY 28, 2011DETAILED PERFORMANCE HISTORY

LEE MEMORIAL HEALTH SYSTEM INVESTMENT PORTFOLIO

Page A.13

LEE MEMORIAL HEALTH SYSTEM CONSOLIDATED FINANCIAL STATEMENTS & STATISTICAL REPORTS TABLE OF CONTENTS SECTION B PAGE CONSOLIDATING SCHEDULES CONSOLIDATING STATISTICAL REPORT B.1 CONSOLIDATING INCOME STATEMENT – MONTH B.7 YTD B.10 CONSOLIDATING FINANCIAL RATIOS B.13 STAFFING SUMMARY B.17 SUMMARY OF ACCOUNTS RECEIVABLE B.18

LEE MEMORIAL HEALTH SYSTEMSTATISTICAL SUMMARYCONSOLIDATING ACTUALFOR THE MONTH ENDING FEBRUARY 28, 2011

OP HOMESYSTEM LEE HPMC CCH GCMC CENTERS HPCC HEALTH REHAB

Admissions ADULTS 5,956 1,218 1,624 1,214 1,900 0 0 0 0 PEDIATRICS 380 0 377 3 0 0 0 0 0 NICU 53 0 53 0 0 0 0 0 0 POST ACUTE 140 0 0 0 0 0 62 0 78Total Adult & Peds 6,529 1,218 2,054 1,217 1,900 0 62 0 78 NEWBORNS 443 0 209 96 138 0 0 0 0Total Admissions 6,972 1,218 2,263 1,313 2,038 0 62 0 78

Patient DaysADULTS 27,601 6,625 6,815 5,610 8,551 0 0 0 0 PEDIATRICS 1,285 0 1,282 3 0 0 0 0 0 NICU 1,096 0 1,096 0 0 0 0 0 0 POST ACUTE 4,078 0 0 0 0 0 3,038 0 1,040Total Adult & Peds 34,060 6,625 9,193 5,613 8,551 0 3,038 0 1,040 NEWBORNS 1,018 0 450 248 320 0 0 0 0Total Patient Days 35,078 6,625 9,643 5,861 8,871 0 3,038 0 1,040

Average Length of Stay ADULTS 18.8 5.4 4.2 4.6 4.5 0.0 0.0 0.0 0.0 PEDIATRICS 4.4 0.0 3.4 1.0 0.0 0.0 0.0 0.0 0.0 NICU 20.7 0.0 20.7 0.0 0.0 0.0 0.0 0.0 0.0 POST ACUTE 62.3 0.0 0.0 0.0 0.0 0.0 49.0 0.0 13.3 Total Adult & Peds 5.2 5.4 4.5 4.6 4.5 0.0 49.0 0.0 13.3 NEWBORNS 7.1 0.0 2.2 2.6 2.3 0.0 0.0 0.0 0.0Total Patient Days 5.0 5.4 4.3 4.5 4.4 0.0 49.0 0.0 13.3

OP Registrations EMERGENCY ROOM 13,706 3,827 3,641 3,525 2,713 0 0 0 0 OP SURGERY CASES 1,672 335 464 313 398 162 0 0 0SUBTOTAL 15,378 4,162 4,105 3,838 3,111 162 0 0 0

Visits / Encounters HOME HEALTH ADMISSIONS 352 0 0 0 0 0 0 352 0 HOSP BASED PHY ENCOUNTERS 14,889 0 0 0 0 0 0 0 0 PHYSICIAN ENCOUNTERS 49,648 0 0 0 0 0 0 0 0 TRAUMA 637 637 0 0 0 0 0 0 0SUBTOTAL 65,526 637 0 0 0 0 0 352 0

TOTAL OP 80,904 4,799 4,105 3,838 3,111 162 0 352 0

Page B.1

LEE MEMORIAL HEALTH SYSTEMCONSOLIDATING STATISTICALACTUAL TO BUDGET VARIANCEFOR THE MONTH ENDED FEBRUARY 28, 2011

OP ALLSYSTEM LEE HP CCH GCMC CENTERS HPCC HH REHAB PHYSICIANS

Admissions ADULTS (151) (8) 40 (143) (40) 0 0 0 0 0 PEDIATRICS 17 0 14 3 0 0 0 0 0 0 NICU 9 0 9 0 0 0 0 0 0 0 POST ACUTE (13) 0 0 0 0 0 (3) 0 (10) 0Total Adult & Peds (138) (8) 63 (140) (40) 0 (3) 0 (10) 0 NEWBORNS (62) 0 (35) (10) (17) 0 0 0 0 0Total Admissions (200) (8) 28 (150) (57) 0 (3) 0 (10) 0

Patient Days ADULTS 1,236 824 351 (39) 100 0 0 0 0 0 PEDIATRICS (1) 0 (4) 3 0 0 0 0 0 0 NICU 110 0 110 0 0 0 0 0 0 0 POST ACUTE 9 0 0 0 0 0 (29) 0 38 0Total Adult & Peds 1,354 824 457 (36) 100 0 (29) 0 38 0 NEWBORNS (128) 0 (81) (47) 0 0 0 0 0 0Total Patient Days 1,225 824 376 (84) 100 0 (29) 0 38 0

Average Length of Stay ADULTS 1.4 0.7 0.1 0.5 0.1 0.0 0.0 0.0 0.0 0.0 PEDIATRICS (0.1) 0.0 (0.1) 0.0 0.0 0.0 0.0 0.0 0.0 0.0 NICU (1.8) 0.0 (1.8) 0.0 0.0 0.0 0.0 0.0 0.0 0.0 POST ACUTE 2.5 0.0 0.0 0.0 0.0 0.0 1.8 0.0 1.9 0.0Total Adult & Peds 0.3 0.7 (1.8) 0.5 0.1 0.0 1.8 0.0 1.9 0.0 NEWBORNS 0.0 0.0 (0.0) (0.2) 0.3 0.0 0.0 0.0 0.0 0.0Total Patient Days 0.3 0.7 (1.8) 0.2 0.4 0.0 1.8 0.0 1.9 0.0

OP Registrations EMERGENCY ROOM 449 578 (51) (141) 62 0 0 0 0 0 OP SURGERY CASES 182 54 32 (39) 48 87 0 0 0 0SUBTOTAL 631 632 (19) (180) 111 87 0 0 0 0

Visits / Encounters HOME HEALTH ADMISSIONS (1) 0 0 0 0 0 0 (1) 0 0 HOSP BASED PHY ENCOUNT 824 0 0 0 0 0 0 0 0 824 PHYSICIAN ENCOUNTERS 3,279 0 0 0 0 0 0 0 0 3,279 TRAUMA 182 182 0 0 0 0 0 0 0 0SUBTOTAL 4,284 182 0 0 0 0 0 (1) 0 4,103

TOTAL OP 4,914 814 (19) (180) 111 87 0 (1) 0 4,103

Page B.2

LEE MEMORIAL HEALTH SYSTEMCONSOLIDATING STATISTICALACTUAL TO PRIOR MONTH VARIANCEFOR THE MONTH ENDED FEBRUARY 28, 2011


Admissions ADULTS (87) 31 (26) (104) 12 0 0 0 0 0 PEDIATRICS 20 0 56 (36) 0 0 0 0 0 0 NICU 3 0 3 0 0 0 0 0 0 0 POST ACUTE (4) 0 0 0 0 0 1 0 (5) 0Total Adult & Peds (68) 31 33 (140) 12 0 1 0 (5) 0 NEWBORNS (33) 0 (12) (7) (14) 0 0 0 0 0Total Admissions (101) 31 21 (147) (2) 0 1 0 (5) 0

Patient Days ADULTS 848 540 76 (75) 307 0 0 0 0 0 PEDIATRICS 162 0 248 (86) 0 0 0 0 0 0 NICU (35) 0 (35) 0 0 0 0 0 0 0 POST ACUTE (25) 0 0 0 0 0 (51) 0 26 0Total Adult & Peds 950 540 289 (161) 307 0 (51) 0 26 0 NEWBORNS (118) 0 (28) (30) (60) 0 0 0 0 0Total Patient Days 832 540 261 (191) 247 0 (51) 0 26 0

Average Length of Stay ADULTS 0.9 0.3 0.1 0.3 0.1 0.0 0.0 0.0 0.0 0.0 PEDIATRICS (3.1) 0.0 0.2 (3.3) 0.0 0.0 0.0 0.0 0.0 0.0 NICU (1.9) 0.0 (1.9) 0.0 0.0 0.0 0.0 0.0 0.0 0.0 POST ACUTE (0.5) 0.0 0.0 0.0 0.0 0.0 (1.6) 0.0 1.1 0.0Total Adult & Peds 0.2 0.3 (1.6) (3.0) 0.1 0.0 (1.6) 0.0 1.1 0.0 NEWBORNS (0.1) 0.0 (0.0) (0.1) 2.3 0.0 0.0 0.0 0.0 0.0Total Patient Days 0.2 0.3 (1.7) (3.1) 2.5 0.0 (1.6) 0.0 1.1 0.0

OP Registrations EMERGENCY ROOM 878 724 0 0 154 0 0 0 0 0 OP SURGERY CASES 139 9 9 (54) 13 162 0 0 0 0SUBTOTAL 1,017 733 9 (54) 167 162 0 0 0 0

Visits / Encounters HOME HEALTH ADMISSIONS 40 0 0 0 0 0 0 40 0 0 HOSP BASED PHY ENCOUNTE 1,606 0 0 0 0 0 0 0 0 1,606 PHYSICIAN ENCOUNTERS 7,945 0 0 0 0 0 0 0 0 7,945 TRAUMA 202 202 0 0 0 0 0 0 0 0SUBTOTAL 9,793 202 0 0 0 0 0 40 0 9,551

TOTAL OP 10,810 935 9 (54) 167 162 0 40 0 9,551

Page B.3

LEE MEMORIAL HEALTH SYSTEMSTATISTICAL SUMMARYCONSOLIDATING ACTUALFOR THE 5 MONTHS ENDING FEBRUARY 28, 2011

OP HOMESYSTEM LEE HPMC CCH GCMC CENTERS HPCC HEALTH REHAB

Admissions ADULTS 29,729 6,024 7,908 6,365 9,432 0 0 0 0 PEDIATRICS 2,029 0 1,968 61 0 0 0 0 0 NICU 271 0 271 0 0 0 0 0 0 POST ACUTE 724 0 0 0 0 0 308 0 416Total Adult & Peds 32,753 6,024 10,147 6,426 9,432 0 308 0 416 NEWBORNS 2,483 0 1,176 574 733 0 0 0 0Total Admissions 35,236 6,024 11,323 7,000 10,165 0 308 0 416

Patient Days ADULTS 136,576 31,685 34,111 28,102 42,678 0 0 0 0 PEDIATRICS 6,506 0 6,388 118 0 0 0 0 0 NICU 6,410 0 6,410 0 0 0 0 0 0 POST ACUTE 21,284 0 0 0 0 0 16,199 0 5,085Total Adult & Peds 170,776 31,685 46,909 28,220 42,678 0 16,199 0 5,085 NEWBORNS 6,115 0 2,563 1,852 1,700 0 0 0 0Total Patient Days 176,891 31,685 49,472 30,072 44,378 0 16,199 0 5,085

Average Length of Stay ADULTS 4.6 5.3 4.3 4.4 4.5 0.0 0.0 0.0 0.0 PEDIATRICS 3.2 0.0 3.2 1.9 0.0 0.0 0.0 0.0 0.0 NICU 23.7 0.0 23.7 0.0 0.0 0.0 0.0 0.0 0.0 POST ACUTE 29.4 0.0 0.0 0.0 0.0 0.0 52.6 0.0 12.2 Total Adult & Peds 5.2 5.3 4.6 4.4 4.5 0.0 52.6 0.0 12.2 NEWBORNS 2.5 0.0 2.2 3.2 2.3 0.0 0.0 0.0 0.0Total Patient Days 5.0 5.3 4.4 4.3 4.4 0.0 52.6 0.0 12.2

OP Registrations EMERGENCY ROOM 69,367 17,621 19,181 19,069 13,496 0 0 0 0 OP SURGERY CASES 7,947 1,661 2,578 1,608 1,834 266 0 0 0SUBTOTAL 77,314 19,282 21,759 20,677 15,330 266 0 0 0

Visits / Encounters HOME HEALTH ADMISSIONS 1,724 0 0 0 0 0 0 1,724 0 HOSP BASED PHY ENCOUNTERS 79,098 0 0 0 0 0 0 0 0 PHYSICIAN ENCOUNTERS 239,943 0 0 0 0 0 0 0 0 TRAUMA 3,339 3,339 0 0 0 0 0 0 0SUBTOTAL 324,104 3,339 0 0 0 0 0 1,724 0

TOTAL OP 401,418 22,621 21,759 20,677 15,330 266 0 1,724 0

Page B.4

LEE MEMORIAL HEALTH SYSTEMCONSOLIDATING STATISTICALACTUAL TO BUDGET VARIANCEFOR THE 5 MONTHS ENDED FEBRUARY 28, 2011

OPC ALLSYSTEM LEE HP CCH GCMC CENTERS HPCC HH REHAB PHYSICIANS

Admissions ADULTS 1,226 409 543 (246) 520 0 0 0 0 0 PEDIATRICS 141 0 80 61 0 0 0 0 0 0 NICU 20 0 20 0 0 0 0 0 0 0 POST ACUTE (59) 0 0 0 0 0 (25) 0 (34) 0Total Adult & Peds 1,329 409 644 (185) 520 0 (25) 0 (34) 0 NEWBORNS (208) 0 (108) (27) (73) 0 0 0 0 0Total Admissions 1,121 409 536 (212) 448 0 (25) 0 (34) 0

Patient DaysADULTS 9,489 3,069 2,271 1,231 2,918 0 0 0 0 0 PEDIATRICS (241) 0 (359) 118 0 0 0 0 0 0 NICU 740 0 740 0 0 0 0 0 0 0 POST ACUTE (337) 0 0 0 0 0 (18) 0 (319) 0Total Adult & Peds 9,651 3,069 2,652 1,349 2,918 0 (18) 0 (319) 0 NEWBORNS (34) 0 (243) 169 40 0 0 0 0 0Total Patient Days 9,617 3,069 2,409 1,518 2,958 0 (18) 0 (319) 0

Average Length of Stay ADULTS 0.6 0.2 (0.0) 0.4 0.1 0.0 0.0 0.0 0.0 0.0 PEDIATRICS (0.3) 0.0 (0.3) 0.0 0.0 0.0 0.0 0.0 0.0 0.0 NICU 1.0 0.0 1.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 POST ACUTE 4.1 0.0 0.0 0.0 0.0 0.0 3.9 0.0 0.2 0.0Total Adult & Peds (0.0) 0.0 (0.0) 0.0 0.0 0.0 3.9 0.0 0.2 0.0 NEWBORNS 0.2 0.0 (0.0) 0.4 0.3 0.0 0.0 0.0 0.0 0.0Total Patient Days (0.0) 0.0 (0.1) 0.4 0.3 0.0 3.9 0.0 0.2 0.0

OP Registrations EMERGENCY ROOM 460 710 630 (347) (533) 0 0 0 0 0 OP SURGERY CASES 632 344 393 (107) (20) 23 0 0 0 0SUBTOTAL 1,093 1,054 1,023 (454) (554) 23 0 0 0 0

Visits / Encounters HOME HEALTH ADMISSIONS 99 0 0 0 0 0 0 99 0 0 HOSP BASED PHY ENCOUNTE 4,281 0 0 0 0 0 0 0 0 4,281 PHYSICIAN ENCOUNTERS 14,238 0 0 0 0 0 0 0 0 14,238 TRAUMA 216 216 0 0 0 0 0 0 0 0SUBTOTAL 18,835 216 0 0 0 0 0 99 0 18,519

TOTAL OP 19,927 1,270 1,023 (454) (554) 23 0 99 0 18,519

Page B.5

LEE MEMORIAL HEALTH SYSTEMCONSOLIDATING STATISTICALACTUAL TO PRIOR YEAR VARIANCEFOR THE 5 MONTHS ENDED FEBRUARY 28, 2011


Admissions ADULTS 1,931 590 593 (55) 803 0 0 0 0 0 PEDIATRICS 156 0 263 (107) 0 0 0 0 0 0 NICU (5) 0 (5) 0 0 0 0 0 0 0 POST ACUTE (33) 0 0 0 0 0 (21) 0 (12) 0Total Adult & Peds 2,049 590 851 (162) 803 0 (21) 0 (12) 0 NEWBORNS (57) 0 (33) (10) (14) 0 0 0 0 0Total Admissions 1,992 590 818 (172) 789 0 (21) 0 (12) 0

Patient Days ADULTS 10,097 2,627 3,323 710 3,437 0 0 0 0 0 PEDIATRICS 432 0 748 (316) 0 0 0 0 0 0 NICU 217 0 217 0 0 0 0 0 0 0 POST ACUTE 270 0 0 0 0 0 65 0 205 0Total Adult & Peds 11,016 2,627 4,288 394 3,437 0 65 0 205 0 NEWBORNS (46) 0 (81) 80 (45) 0 0 0 0 0Total Patient Days 10,970 2,627 4,207 474 3,392 0 65 0 205 0

Average Length of Stay ADULTS 0.1 (0.1) 0.1 0.1 (0.0) 0.0 0.0 0.0 0.0 0.0 PEDIATRICS (4.6) 0.0 (0.1) (4.5) 0.0 0.0 0.0 0.0 0.0 0.0 NICU 1.2 0.0 1.2 0.0 0.0 0.0 0.0 0.0 0.0 0.0 POST ACUTE 4.4 0.0 0.0 0.0 0.0 0.0 3.6 0.0 0.8 0.0Total Adult & Peds 0.0 (0.1) 1.3 (4.4) (0.0) 0.0 3.6 0.0 0.8 0.0 NEWBORNS 0.0 0.0 (0.0) 0.2 3.2 0.0 0.0 0.0 0.0 0.0Total Patient Days 0.0 (0.1) 1.2 (4.2) 3.2 0.0 3.6 0.0 0.8 0.0

OP Registrations EMERGENCY ROOM 2,616 1,471 885 400 (140) 0 0 0 0 0 OP SURGERY CASES 24 2 167 (182) (229) 266 0 0 0 0SUBTOTAL 2,640 1,473 1,052 218 (369) 266 0 0 0 0

Visits / Encounters HOME HEALTH ADMISSIONS 330 0 0 0 0 0 0 330 0 0 HOSP BASED PHY ENCOUNTERS 8,181 0 0 0 0 0 0 0 0 8,181 PHYSICIAN ENCOUNTERS 37,991 0 0 0 0 0 0 0 0 37,991 TRAUMA 306 306 0 0 0 0 0 0 0 0SUBTOTAL 46,808 306 0 0 0 0 0 330 0 46,172

TOTAL OP 49,448 1,779 1,052 218 (369) 266 0 330 0 46,172

Page B.6

LEE MEMORIAL HEALTH SYSTEMCONSOLIDATING INCOME STATEMENTACTUAL DOLLARS - IN THOUSANDSFOR THE MONTH ENDED FEBRUARY 28, 2011

OP HOME ALL CORP ALL SYSTEM LMH HPMC CCH GCMC TRAUMA CENTERS HPCC HEALTH REHAB PHYSICIANS FOUND SVS OTHERS

INPATIENT REVENUE 229,359 49,350 66,149 38,718 71,887 0 180 1,219 0 1,856 0 0 0 0OUTPATIENT REVENUE 127,972 18,360 23,989 21,410 19,114 473 17,147 0 917 21 26,550 0 (9) 0TOTAL PATIENT REVENUE 357,332 67,710 90,138 60,128 91,001 473 17,326 1,219 917 1,877 26,550 0 (9) 0

DED FROM REV-MEDICARE 143,142 26,354 34,514 27,657 45,938 0 8,050 75 35 519 0 0 0 0DED FROM REV-MEDICAID 33,317 6,070 14,493 5,159 6,036 0 1,535 16 7 0 0 0 0 0DED FROM REV-CHARITY 11,988 4,660 3,264 2,754 1,268 0 9 7 25 0 0 0 0 0DED FROM REV-HMO/PPO 29,880 5,367 9,069 5,413 8,165 0 1,676 0 46 145 0 0 0 0DED FROM REV-OTHER 32,250 6,138 2,910 3,136 3,352 223 1,162 19 0 0 15,309 0 0 0DED FROM REV-BAD DEBT 12,362 3,184 1,477 2,002 2,779 153 294 0 5 21 2,447 0 0 0TOTAL DED FROM REV 262,938 51,772 65,727 46,122 67,538 376 12,726 118 118 685 17,755 0 0 0

NET PATIENT REVENUE 94,393 15,938 24,411 14,006 23,463 97 4,600 1,101 800 1,191 8,795 0 (9) 0OTHER OPER REV 1,374 72 110 106 94 106 83 9 44 0 77 204 59 411

0TOTAL OPERATING REV 95,768 16,009 24,521 14,111 23,557 204 4,683 1,110 843 1,191 8,873 204 50 411

OPERATING EXPENSES PROD SALARIES 36,178 4,603 6,836 4,340 6,058 221 1,360 462 546 420 6,824 101 4,192 216 PROD OVERTIME 1,434 329 367 182 419 0 19 28 3 18 32 0 37 1 CONTRACT LABOR 464 71 116 82 160 0 1 5 11 17 0 0 0 0 NON-PROD SALARIES 4,568 505 755 484 649 22 207 48 56 46 1,058 7 706 25TOTAL SALARIES & WAGES 42,643 5,507 8,074 5,089 7,287 243 1,586 544 616 501 7,913 108 4,934 242

FRINGE BENEFITS 6,563 1,138 1,217 776 1,086 30 223 85 88 74 947 16 837 46HEALTH CARE ACCESS 1,209 255 392 150 327 0 46 32 0 7 0 0 0 0SUPPLIES 20,921 4,719 5,187 3,368 5,988 1 762 58 12 28 379 4 282 130OTHER SERVICES 5,345 426 506 432 486 8 541 26 48 5 731 56 2,043 36PURCHASED SERVICES 8,845 538 672 667 1,689 148 117 111 23 16 2,518 18 2,317 11

TOTAL OPER EXPENSES 85,526 12,583 16,048 10,482 16,864 430 3,276 856 787 631 12,489 202 10,415 465

EBITDA 10,242 3,426 8,473 3,630 6,694 (227) 1,407 254 56 560 (3,616) 2 (10,365) (54)

DEPRECIATION/AMORT 5,403 583 1,171 537 1,816 3 403 23 9 10 169 0 673 7INTEREST EXPENSE 2,292 99 370 241 1,231 0 311 6 0 0 55 0 (22) 0GAIN(LOSS) FROM OPER 2,547 2,745 6,932 2,852 3,647 (230) 693 225 47 550 (3,840) 2 (11,015) (61)

NON OPERATING REV INT EARN & REALIZED GAIN 91 51 (6) 3 10 0 0 0 0 0 0 28 0 5 UNREALIZED GAIN (LOSS) 4,272 4,237 0 0 0 0 0 0 0 0 0 34 0 0 UNREALIZED GAIN (LOSS) ON SWAP 0 0 0 0 0 0 0 0 0 0 0 0 0 0 OTHER NON OPER REV 257 72 0 0 0 0 0 26 69 91 0 0 0 0 RESTRICTED GIFTS 223 0 0 0 0 0 0 0 0 0 0 223 0 0TOTAL NON OPER REV 4,844 4,360 (6) 3 10 0 0 26 69 91 0 285 0 5

EXCESS REV/EXPS 7,391 7,105 6,926 2,855 3,658 (230) 693 251 116 641 (3,840) 288 (11,015) (56)

Page B.7

LEE MEMORIAL HEALTH SYSTEMCONSOLIDATING INCOME STATEMENTACTUAL TO BUDGET DOLLAR VARIANCE - IN THOUSFOR THE MONTH ENDED FEBRUARY 28, 2011

OP HOME ALL CORP ALLSYSTEM LMH HPMC CCH GCMC TRAUMA CENTERS HPCC HEALTH REHAB PHYSICIANS FOUND SVCS OTHERS

INPATIENT REVENUE 5,110 1,743 (218) (178) 3,720 0 105 34 0 (95) 0 0 0 0OUTPATIENT REVENUE 1,075 765 (642) (305) (1,510) 69 661 0 (82) 15 2,114 0 (9) 0TOTAL PATIENT REVENUE 6,185 2,509 (860) (484) 2,211 69 765 34 (82) (81) 2,114 0 (9) 0

DED FROM REV-MEDICARE (3,569) (713) 1,154 1,059 (3,449) 0 (1,726) 82 (5) 28 0 0 0 0DED FROM REV-MEDICAID (439) (1,176) (503) (244) 1,184 0 288 (6) 17 0 0 0 0 0DED FROM REV-CHARITY (393) 222 (512) (374) 21 0 235 6 9 0 0 0 0 0DED FROM REV-HMO/PPO (3,653) (207) (2,842) (503) (761) 0 520 0 3 136 0 0 0 0DED FROM REV-OTHER 4,158 156 4,253 426 871 (138) 64 13 3 0 (1,491) 0 0 0DED FROM REV-BAD DEBT 130 (94) 14 19 (115) 62 47 12 1 14 171 0 0 0TOTAL DED FROM REV (3,767) (1,811) 1,564 384 (2,249) (76) (572) 108 29 178 (1,320) 0 0 0

NET PATIENT REVENUE 2,419 697 705 (100) (39) (8) 194 141 (54) 98 794 0 (9) 0OTHER OPER REV (171) 2 15 (4) (5) 93 12 3 (3) 0 (6) 5 (306) 24TOTAL OPERATING REV 2,248 699 720 (104) (44) 85 205 145 (57) 98 787 5 (315) 24

OPERATING EXPENSES PROD SALARIES (1,690) (389) (125) (110) 34 (3) (85) (30) (57) 7 (550) (4) (383) 7 PROD OVERTIME (205) (78) (58) (16) 13 16 (12) 3 (3) (6) (29) (0) (33) (1) CONTRACT LABOR 96 23 16 2 44 0 (1) (5) (3) 21 0 0 (0) 0 NON-PROD SALARIES (432) (19) (77) (39) (43) 25 (55) (6) (10) (1) (299) 11 81 (0)TOTAL SALARIES & WAGES (2,231) (464) (244) (163) 49 37 (154) (38) (73) 21 (878) 7 (335) 5

FRINGE BENEFITS 281 142 153 103 156 (30) 29 (7) (6) 21 (126) 1 (151) (2)HEALTH CARE ACCESS (83) (51) (65) 36 (2) 0 (3) 1 0 2 0 0 0 0SUPPLIES (578) (220) 431 (50) (634) (1) (44) 9 0 (2) (57) (1) 20 (29)OTHER SERVICES (341) 60 63 31 106 (2) (8) (2) (7) (2) (7) 25 (604) 4PURCHASED SERVICES 348 (57) 122 (26) (75) 19 (12) (6) 2 (2) 408 (1) (25) (1)

TOTAL OPER EXPENSES (2,604) (590) 459 (68) (401) 24 (192) (43) (84) 37 (659) 32 (1,094) (22)

EBITDA (356) 109 1,179 (172) (445) 109 13 102 (141) 135 128 36 (1,409) 1

DEPRECIATION/AMORT (252) 167 27 (33) (26) 1 (100) 0 (4) 0 12 0 (296) (0)INTEREST EXPENSE 4 (47) (80) (11) 83 0 (8) (3) 0 0 (4) 0 73 0GAIN(LOSS) FROM OPER (604) 229 1,125 (216) (388) 111 (95) 99 (145) 135 136 36 (1,632) 1

NON OPERATING REV INT EARN & REALIZED GAIN (1,343) (1,394) 18 3 10 0 0 0 0 0 0 18 0 2 UNREALIZED GAIN(LOSS) 3,389 3,355 0 0 0 0 0 0 0 0 0 34 0 0 UNREALIZED GAIN(LOSS) ON SWAP 0 0 0 0 0 0 0 0 0 0 0 0 0 0 OTHER NON OPER REV (12) (203) 0 0 (4) 0 0 26 62 91 0 17 0 0 RESTRICTED GIFTS 141 1 0 0 0 0 0 0 0 0 0 141 0 0TOTAL NON OPER REV 2,175 1,758 18 3 6 0 0 26 62 91 0 210 0 2

EXCESS OF REV / EXPS 1,571 1,987 1,144 (214) (382) 111 (95) 125 (83) 225 136 246 (1,632) 3

Page B.8

LEE MEMORIAL HEALTH SYSTEMCONSOLIDATING INCOME STATEMENTACTUAL TO PRIOR MONTH DOLLAR VARIANCE - IN THOUSFOR THE MONTH ENDED FEBRUARY 28, 2011

OP HOME ALL CORP ALLSYSTEM LMH HP CCH GCMC TRAUMA CENTERS HPCC HEALTH REHAB PHYSICIANS FOUND SVCS OTHERS

INPATIENT REVENUE 19,798 6,276 1,671 2,946 8,714 0 114 (5) 0 83 0 0 0 0OUTPATIENT REVENUE 12,293 1,957 37 845 (1,553) 118 6,956 0 81 8 3,852 0 (9) 0TOTAL PATIENT REVENUE 32,092 8,233 1,708 3,791 7,161 118 7,070 (5) 81 91 3,852 0 (9) 0

DED FROM REV-MEDICARE (15,088) (3,757) 494 (1,979) (6,384) 0 (3,521) 109 (35) (14) 0 0 0 0DED FROM REV-MEDICAID (2,832) (864) (1,836) (496) 980 0 (627) (2) 12 0 0 0 0 0DED FROM REV-CHARITY (1,355) (496) (372) 215 (667) 0 (45) 9 2 0 0 0 0 0DED FROM REV-HMO/PPO (797) (328) 121 373 (311) 0 (664) 0 (7) 19 0 0 0 0DED FROM REV-OTHER (4,453) (1,018) 78 (1,474) 1,207 (98) (643) (3) 3 0 (2,505) 0 0 0DED FROM REV-BAD DEBT (880) (489) (59) (86) 448 (53) (117) 0 (2) 2 (524) 0 0 0TOTAL DED FROM REV (25,405) (6,953) (1,574) (3,447) (4,727) (151) (5,617) 113 (26) 7 (3,030) 0 0 0

NET PATIENT REVENUE 6,687 1,280 133 344 2,434 (33) 1,453 108 55 98 823 0 (9) 0OTHER OPER REV 69 (4) 21 (13) (3) 104 14 3 (8) 0 (4) 101 (139) (3)TOTAL OPERATING REV 6,756 1,276 154 331 2,431 71 1,467 111 47 98 819 101 (148) (3)

OPERATING EXPENSES PROD SALARIES (4,013) (354) (389) (218) (302) 7 (463) (39) (97) 10 (1,367) (24) (776) (2) PROD OVERTIME (126) (90) (2) (7) 8 0 (4) 7 (2) (7) (12) (0) (16) 0 CONTRACT LABOR 50 (31) (35) 7 78 0 (1) (5) 34 2 1 0 (0) 0 NON-PROD SALARIES (923) (31) (46) (37) (71) (3) (89) (8) (16) (0) (662) (39) 80 (0)TOTAL SALARIES & WAGES (5,013) (505) (472) (255) (288) 5 (557) (46) (82) 4 (2,040) (64) (712) (2)

FRINGE BENEFITS 56 (100) (8) (4) 6 (1) (77) (9) (18) 4 (120) (4) 389 (1)HEALTH CARE ACCESS 5 38 (41) 79 (20) 0 (46) (3) 0 (1) 0 0 0 0SUPPLIES (1,362) (385) 614 (298) (773) 0 (291) 5 (2) (4) (180) 3 (24) (27)OTHER SERVICES (236) 116 18 57 234 (4) (194) (0) (10) (6) (142) (20) (293) 10PURCHASED SERVICES (906) (93) 52 (51) (267) 62 (76) (27) 0 7 (139) (15) (362) 3

TOTAL OPER EXPENSES (7,456) (929) 161 (474) (1,108) 62 (1,242) (79) (112) 5 (2,621) (99) (1,002) (18)

EBITDA (700) 347 315 (143) 1,323 133 225 32 (65) 103 (1,802) 2 (1,150) (21)

DEPRECIATION/AMORT (792) 69 28 (0) (441) 0 (261) (0) (8) 0 (12) 0 (167) 0INTEREST EXPENSE (209) 8 (15) 47 (206) 0 (59) 2 0 0 11 0 4 0GAIN(LOSS) FROM OPER (1,699) 425 328 (96) 676 133 (95) 33 (73) 103 (1,801) 2 (1,313) (20)

NON OPERATING REV INT EARN & REALIZED GAIN (712) (733) (11) 2 7 0 0 0 0 0 0 23 0 1 UNREALIZED GAIN(LOSS) 3,254 3,224 0 0 0 0 0 0 0 0 0 30 0 0 UNREALIZED GAIN(LOSS) ON SWAP 0 0 0 0 0 0 0 0 0 0 0 0 0 0 OTHER NON OPER REV (1,039) (1,057) 0 (0) (137) 0 0 (19) (74) 70 0 178 0 0 RESTRICTED GIFTS 1,032 1 0 0 0 0 0 0 0 0 0 1,031 0 0TOTAL NON OPER REV 2,535 1,435 (11) 2 (131) 0 0 (19) (74) 70 0 1,261 0 1

EXCESS OF REV / EXPS 836 1,860 317 (94) 546 133 (95) 15 (147) 174 (1,801) 1,262 (1,313) (19)

Page B.9

LEE MEMORIAL HEALTH SYSTEMCONSOLIDATING INCOME STATEMENTACTUAL DOLLARS - IN THOUSANDSFOR THE 5 MONTHS ENDED FEBRUARY 28, 2011

OP HOME ALL CORP ALL SYSTEM LMH HPMC CCH GCMC TRAUMA CENTERS HPCC HEALTH REHAB PHYSICIANS FOUND SVS OTHERS

INPATIENT REVENUE 1,144,133 237,742 331,550 201,670 357,704 0 550 6,194 0 8,724 0 0 0 0OUTPATIENT REVENUE 642,624 93,168 122,968 111,219 98,008 2,913 78,299 0 4,475 109 131,466 0 1 0TOTAL PATIENT REVENUE 1,786,757 330,910 454,518 312,889 455,712 2,913 78,849 6,194 4,475 8,832 131,466 0 1 0

DED FROM REV-MEDICARE 671,156 120,856 162,105 138,318 213,115 0 33,610 411 184 2,558 0 0 0 0DED FROM REV-MEDICAID 182,932 30,352 78,015 30,176 37,559 0 6,685 74 73 0 0 0 0 0DED FROM REV-CHARITY 58,195 23,827 13,838 12,600 7,266 0 470 68 126 0 0 0 0 0DED FROM REV-HMO/PPO 160,639 26,673 48,241 30,613 45,571 0 8,838 0 188 516 0 0 0 0DED FROM REV-OTHER 174,853 28,553 21,775 16,482 23,544 1,581 5,992 223 0 (0) 76,703 0 0 0DED FROM REV-BAD DEBT 63,488 15,572 7,434 10,423 14,849 963 1,434 31 24 100 12,658 0 0 0TOTAL DED FROM REV 1,311,263 245,833 331,408 238,611 341,903 2,544 57,028 806 595 3,174 89,361 0 0 0

NET PATIENT REVENUE 475,494 85,077 123,110 74,278 113,808 369 21,821 5,387 3,880 5,659 42,104 0 1 0OTHER OPER REV 7,551 333 513 517 456 226 338 37 215 0 336 1,150 1,340 2,089

TOTAL OPERATING REV 483,045 85,410 123,622 74,795 114,265 595 22,159 5,425 4,095 5,659 42,441 1,150 1,341 2,089

OPERATING EXPENSES PROD SALARIES 184,420 23,144 34,605 22,133 30,955 1,241 6,917 2,424 2,825 2,117 35,245 482 21,203 1,128 PROD OVERTIME 7,465 1,511 2,007 1,003 2,213 0 92 178 12 50 148 0 245 5 CONTRACT LABOR 938 98 214 223 290 0 2 53 15 38 0 0 5 0 NON-PROD SALARIES 23,409 2,713 4,076 2,489 3,268 460 802 244 298 244 4,760 39 3,869 147TOTAL SALARIES & WAGES 216,232 27,466 40,902 25,847 36,726 1,701 7,813 2,899 3,151 2,448 40,153 522 25,323 1,281

FRINGE BENEFITS 33,195 5,781 6,297 4,057 5,629 146 1,236 451 474 402 4,298 78 4,087 260HEALTH CARE ACCESS 6,035 1,283 1,692 1,022 1,575 0 241 188 0 33 0 0 0 0SUPPLIES 101,665 22,750 25,671 17,275 28,669 5 3,767 346 61 135 1,538 11 860 576OTHER SERVICES 27,357 2,528 2,767 2,445 2,899 27 2,648 121 256 20 3,858 340 9,257 192PURCHASED SERVICES 46,808 2,755 4,267 3,665 8,360 703 388 455 123 45 14,301 79 11,614 54

TOTAL OPER EXPENSES 431,291 62,563 81,596 54,311 83,859 2,582 16,093 4,459 4,064 3,084 64,148 1,030 51,141 2,362

EBITDA 51,754 22,847 42,027 20,484 30,406 (1,986) 6,066 966 31 2,575 (21,707) 120 (49,801) (273)

DEPRECIATION/AMORT 26,576 2,987 5,928 2,625 8,994 17 1,954 116 45 51 834 0 2,991 34INTEREST EXPENSE 12,104 522 1,833 1,284 6,673 0 1,483 35 0 0 273 0 1 0GAIN(LOSS) FROM OPER 13,074 19,338 34,266 16,575 14,738 (2,003) 2,629 815 (15) 2,524 (22,814) 120 (52,793) (307)

NON OPERATING REV INT EARN & REALIZED GAIN 4,078 3,954 (52) 10 58 0 0 0 0 0 0 84 0 25 UNREALIZED GAIN (LOSS) 18,696 18,569 0 0 0 0 0 0 0 0 0 127 0 0 UNREALIZED GAIN (LOSS) ON SWAP 905 905 0 0 0 0 0 0 0 0 0 0 0 0 OTHER NON OPER REV (24,850) (666) 0 0 (24,786) 0 (33) 161 338 187 0 (51) 0 0 RESTRICTED GIFTS 3,192 0 0 0 0 0 0 0 0 0 0 3,192 0 0TOTAL NON OPER REV 2,022 22,762 (52) 10 (24,729) 0 (33) 161 338 187 0 3,353 0 25

EXCESS REV/EXPS 15,096 42,101 34,214 16,585 (9,991) (2,003) 2,596 976 323 2,711 (22,814) 3,473 (52,793) (282)

Page B.10

LEE MEMORIAL HEALTH SYSTEMCONSOLIDATING INCOME STATEMENTACTUAL TO BUDGET DOLLAR VARIANCE - IN THOUSFOR THE 5 MONTH ENDED FEBRUARY 28, 2011


INPATIENT REVENUE 55,861 10,574 3,603 9,730 33,327 0 156 (76) 0 (1,454) 0 0 0 0OUTPATIENT REVENUE 8,071 5,641 (772) 358 (9,573) 134 4,554 0 (166) 77 7,818 0 1 0TOTAL PATIENT REVENUE 63,932 16,215 2,831 10,089 23,754 134 4,710 (76) (166) (1,377) 7,818 0 1 0

DED FROM REV-MEDICARE (19,122) (3,197) 3,738 (3,199) (11,741) 0 (5,673) 417 (45) 577 0 0 0 0DED FROM REV-MEDICAID (381) (2,596) 1,163 (1,739) 1,657 0 1,114 (17) 37 0 0 0 0 0DED FROM REV-CHARITY (1,488) (220) (172) (709) (1,009) 0 585 4 34 0 0 0 0 0DED FROM REV-HMO/PPO (13,596) (1,345) (4,496) (3,311) (5,998) 0 1,035 0 39 479 0 0 0 0DED FROM REV-OTHER (14,690) (2,419) (579) (820) (2,689) (997) (419) (49) 14 0 (6,731) 0 0 0DED FROM REV-BAD DEBT (1,231) (659) (36) (323) (1,891) 510 223 32 4 81 827 0 0 0TOTAL DED FROM REV (50,507) (10,435) (382) (10,102) (21,670) (487) (3,133) 387 83 1,138 (5,904) 0 0 0

NET PATIENT REVENUE 13,424 5,780 2,449 (13) 2,084 (353) 1,577 310 (84) (239) 1,914 0 1 0OTHER OPER REV (335) (16) 36 (32) (39) 162 (19) 10 (34) 0 (82) 153 (487) 14TOTAL OPERATING REV 13,090 5,764 2,484 (45) 2,045 (192) 1,558 320 (117) (239) 1,832 153 (487) 14

OPERATING EXPENSES PROD SALARIES (8,080) (1,772) (894) (879) (928) (87) (292) (168) (264) 205 (2,040) 30 (1,027) 36 PROD OVERTIME (436) (231) 53 1 134 83 (66) (14) (12) (16) (134) (0) (229) (5) CONTRACT LABOR 333 98 95 (1) 158 0 (2) (53) 1 41 0 0 (5) 0 NON-PROD SALARIES 117 32 (252) 18 127 10 41 (6) (34) 10 (231) 56 350 (3)TOTAL SALARIES & WAGES (8,067) (1,872) (998) (861) (508) 6 (318) (241) (310) 240 (2,406) 85 (912) 27

FRINGE BENEFITS 2,025 787 710 423 509 (146) 73 (38) (42) 82 77 15 (389) (37)HEALTH CARE ACCESS (386) (226) (31) (50) (39) 0 (27) (23) 0 10 0 0 0 0SUPPLIES (3,012) (1,649) 1,620 (819) (2,512) 1 (9) 16 1 3 33 5 347 (48)OTHER SERVICES (598) 86 258 16 268 8 246 12 (24) (3) 53 96 (1,669) 55PURCHASED SERVICES (611) (333) (318) (489) (70) 130 137 70 6 28 375 7 (158) 5

TOTAL OPER EXPENSES (10,650) (3,206) 1,242 (1,781) (2,351) (1) 102 (204) (370) 360 (1,868) 208 (2,781) 2

EBITDA 2,440 2,557 3,726 (1,825) (307) (193) 1,659 116 (487) 120 (36) 361 (3,267) 16

DEPRECIATION/AMORT (1,113) 751 50 (104) (55) 6 (670) 0 (22) (1) 63 0 (1,132) (0)INTEREST EXPENSE (594) (265) (381) (123) (101) 0 36 (17) 0 0 (17) 0 274 0GAIN(LOSS) FROM OPER 733 3,044 3,395 (2,052) (463) (187) 1,025 99 (509) 119 9 361 (4,125) 16

NON OPERATING REV INT EARN & REALIZED GAIN (3,532) (3,673) 30 10 56 0 0 0 0 0 0 36 0 9 UNREALIZED GAIN(LOSS) 14,090 13,964 0 0 0 0 0 0 0 0 0 126 0 0 UNREALIZED GAIN(LOSS) ON SWAP 905 905 0 0 0 0 0 0 0 0 0 0 0 0 OTHER NON OPER REV (26,189) (2,042) 0 0 (24,807) 0 (33) 161 313 187 0 33 0 0 RESTRICTED GIFTS 2,782 3 0 0 0 0 0 0 0 0 0 2,779 0 0TOTAL NON OPER REV (11,942) 9,157 31 10 (24,751) 0 (33) 161 313 187 0 2,974 0 9

EXCESS OF REV / EXPS (11,210) 12,201 3,426 (2,042) (25,214) (187) 992 260 (196) 307 9 3,335 (4,125) 25

Page B.11

LEE MEMORIAL HEALTH SYSTEMCONSOLIDATING INCOME STATEMENTACTUAL TO PRIOR YEAR DOLLAR VARIANCE - IN THOUSFOR THE 5 MONTHS ENDED FEBRUARY 28, 2011


INPATIENT REVENUE 131,272 26,738 37,163 17,396 49,150 0 268 136 0 421 0 0 0 0OUTPATIENT REVENUE 47,897 8,358 417 4,184 (14,964) 320 29,045 0 615 45 19,876 0 1 0TOTAL PATIENT REVENUE 179,168 35,096 37,580 21,579 34,186 320 29,314 136 615 466 19,876 0 1 0

DED FROM REV-MEDICARE (74,367) (13,373) (13,207) (12,883) (20,543) 0 (14,619) 408 (181) 31 0 0 0 0DED FROM REV-MEDICAID (14,548) (1,364) (8,100) (3,600) 1,434 0 (2,944) 1 26 0 0 0 0 0DED FROM REV-CHARITY (7,029) (2,034) (1,805) (1,066) (1,988) 0 (151) 9 7 0 0 0 0 0DED FROM REV-HMO/PPO (1,420) 849 (382) 857 592 0 (3,314) 0 27 (48) 0 0 0 0DED FROM REV-OTHER (34,676) (7,074) (7,107) (1,709) (2,262) (199) (2,799) (91) 12 0 (13,447) 0 0 0DED FROM REV-BAD DEBT (7,625) (822) (745) (711) (2,394) (438) (594) (4) (7) 13 (1,924) 0 0 0TOTAL DED FROM REV (139,665) (23,817) (31,347) (19,111) (25,161) (637) (24,422) 324 (117) (5) (15,371) 0 0 0

NET PATIENT REVENUE 39,504 11,279 6,233 2,468 9,024 (317) 4,891 460 498 461 4,505 0 1 0OTHER OPER REV 828 (5) 54 15 (1) 99 6 11 (14) 0 17 296 365 (16)TOTAL OPERATING REV 40,331 11,274 6,287 2,483 9,024 (218) 4,897 471 484 461 4,522 296 366 (16)

OPERATING EXPENSES PROD SALARIES (19,358) (1,694) (1,736) (1,138) (1,107) (21) (2,380) (128) (555) 38 (6,363) (108) (4,163) (4) PROD OVERTIME (1,196) (313) (497) (110) (46) 0 (34) 2 (7) (4) (59) 0 (129) 1 CONTRACT LABOR 125 (31) (9) (42) 139 0 (2) (53) 134 (10) 4 0 (5) 0 NON-PROD SALARIES (2,576) (246) (414) (112) (60) (96) (194) (32) (59) 14 (790) 20 (598) (9)TOTAL SALARIES & WAGES (23,005) (2,284) (2,655) (1,401) (1,073) (117) (2,609) (212) (486) 39 (7,208) (89) (4,895) (12)

FRINGE BENEFITS 20 (559) 351 228 408 (5) (419) 23 (55) 48 (266) (4) 244 27HEALTH CARE ACCESS (52) 78 46 242 (144) 0 (241) (30) 0 (2) 0 0 0 0SUPPLIES (5,600) (2,484) 301 (763) (1,983) 0 (1,536) 10 (12) (4) (310) 3 1,268 (88)OTHER SERVICES (2,018) (110) (178) (161) 909 (2) (290) (42) (32) (16) (554) (116) (1,483) 57PURCHASED SERVICES (5,031) (320) (435) (591) (921) 83 (473) 23 3 12 (2,187) (53) (161) (12)

TOTAL OPER EXPENSES (35,686) (5,680) (2,572) (2,446) (2,805) (41) (5,569) (229) (582) 77 (10,525) (259) (5,027) (28)

EBITDA 4,645 5,594 3,715 37 6,219 (260) (672) 242 (98) 538 (6,003) 37 (4,661) (44)

DEPRECIATION/AMORT (3,329) (26) 25 (104) (2,115) (0) (560) 2 (41) 0 23 0 (533) 1INTEREST EXPENSE (703) 57 69 58 (850) 0 (96) 9 0 0 50 0 0 0GAIN(LOSS) FROM OPER 470 5,625 3,809 (10) 3,254 (260) (1,328) 253 (140) 538 (6,075) 37 (5,194) (43)

NON OPERATING REV INT EARN & REALIZED GAIN (108) (113) (74) (1) 39 0 0 0 0 0 0 37 0 5 UNREALIZED GAIN(LOSS) 13,876 13,755 0 0 0 0 0 0 0 0 0 121 0 0 UNREALIZED GAIN(LOSS) ON SWAP 677 677 0 0 0 0 0 0 0 0 0 0 0 0 OTHER NON OPER REV (26,725) (1,731) 0 0 (24,856) 0 (33) (57) (115) (101) 0 168 0 0 RESTRICTED GIFTS 3,950 6 0 0 0 0 0 0 0 0 0 3,943 0 0TOTAL NON OPER REV (12,280) 12,587 (74) (1) (24,817) 0 (33) (57) (115) (101) 0 327 0 5

EXCESS OF REV / EXPS (11,811) 18,213 3,735 (10) (21,563) (260) (1,361) 196 (255) 437 (6,075) 364 (5,194) (38)

Page B.12

LEE MEMORIAL HEALTH SYSTEMOPERATING RATIOSFOR THE MONTH ENDED FEBRUARY 28, 2011

OP HOME ALL ALL SYSTEM LMH HPMC CCH GCMC CENTERS HPCC HEALTH REHAB PHYSICIANS FOUND OTHERS

AS % NET OPER REVWAGES & BENEFITS ACTUAL 51.4% 42.7% 37.9% 41.6% 35.5% 38.6% 56.6% 83.5% 48.3% 99.9% 60.8% 70.1% BUDGET 50.5% 42.8% 38.7% 40.8% 36.3% 37.6% 60.4% 69.4% 56.3% 97.2% 66.3% 75.1% PRIOR YR 49.7% 42.5% 36.2% 40.7% 38.3% 36.5% 57.4% 75.9% 53.3% 83.2% 55.0% 68.7%

SUPPLIES ACTUAL 21.8% 29.1% 21.2% 23.9% 25.4% 16.3% 5.3% 1.5% 2.3% 4.3% 1.8% 31.8% BUDGET 21.8% 29.2% 23.6% 23.3% 22.7% 16.0% 7.0% 1.4% 2.4% 4.0% 1.5% 26.2% PRIOR YR 22.0% 29.2% 23.8% 22.3% 24.7% 14.6% 6.4% 1.3% 2.2% 2.5% 6.1% 25.0%

ALL OTHER OPER EXPENSES ACTUAL 16.1% 8.5% 6.4% 8.8% 10.6% 15.0% 15.2% 8.3% 2.4% 36.6% 36.2% 11.4% BUDGET 16.4% 8.7% 7.1% 9.1% 10.7% 15.2% 16.8% 7.3% 2.4% 45.2% 49.2% 13.0% PRIOR YR 16.0% 10.0% 6.6% 9.7% 11.6% 12.1% 13.9% 7.6% 2.6% 36.8% 38.2% 14.4%

CAPITAL COSTS ACTUAL 7.9% 4.2% 6.3% 5.5% 12.9% 12.7% 2.7% 1.1% 0.8% 2.5% 0.0% 1.7% BUDGET 7.9% 5.2% 6.3% 5.2% 13.1% 12.1% 2.8% 0.5% 0.9% 2.9% 0.0% 1.8% PRIOR YR 7.5% 5.1% 6.4% 6.0% 11.4% 12.3% 3.1% 0.1% 0.9% 2.8% 0.0% 1.7%

EBITDA MARGIN ACTUAL 10.7% 19.7% 34.6% 25.7% 28.4% 30.1% 22.9% 6.7% 47.0% -40.8% 1.2% -13.3% BUDGET 11.3% 19.3% 30.6% 26.7% 30.2% 31.1% 15.8% 21.9% 38.9% -46.3% -17.0% -14.4% PRIOR YR 12.3% 18.3% 33.5% 27.4% 25.4% 36.8% 22.2% 15.2% 41.8% -22.5% 0.7% -8.2%

OPERATING MARGIN ACTUAL 2.8% 15.5% 28.3% 20.2% 15.5% 17.4% 20.2% 5.6% 46.2% -43.3% 1.2% -15.0% BUDGET 3.4% 14.1% 24.4% 21.6% 17.1% 19.1% 13.0% 21.4% 38.0% -49.2% -17.0% -16.1% PRIOR YR 4.8% 13.2% 27.1% 21.4% 14.1% 24.5% 19.1% 15.1% 40.9% -25.3% 0.7% -9.9%

EXCESS MARGIN ACTUAL 7.2% 33.4% 28.3% 20.2% 15.5% 17.4% 22.1% 12.7% 50.0% -43.3% 13.2% -13.5% BUDGET 6.3% 31.0% 24.3% 21.6% 17.1% 19.1% 13.0% 22.1% 38.0% -49.2% 21.0% -15.3% PRIOR YR 7.4% 32.8% 27.1% 21.4% 14.7% 24.5% 23.6% 33.1% 42.7% -25.3% -944.1% -8.9%

PER CMI ADJ ADMIT / VISITNET OPER REV ACTUAL 6,584 5,985 6,586 5,491 6,754 934 17,905 2,395 13,386 179 14 28 BUDGET 6,445 5,891 6,507 5,334 6,487 947 14,855 2,546 10,034 174 14 27 PRIOR YR 6,254 6,011 6,324 5,329 5,855 724 13,148 2,553 10,512 193 7 29

TOTAL EXPENSES ACTUAL 6,400 5,056 4,724 4,381 5,708 772 14,282 2,261 7,206 256 14 32 BUDGET 6,223 5,060 4,919 4,183 5,378 766 12,927 2,002 6,223 260 16 31 PRIOR YR 5,956 5,220 4,610 4,189 5,032 547 10,633 2,166 6,217 242 7 32

WAGES & BENEFITS ACTUAL 3,383 2,554 2,495 2,282 2,400 361 10,140 2,000 6,460 178 9 20 BUDGET 3,257 2,521 2,515 2,178 2,358 356 8,979 1,767 5,653 169 9 20 PRIOR YR 3,109 2,554 2,286 2,168 2,243 265 7,550 1,938 5,608 161 4 20

Page B.13

LEE MEMORIAL HEALTH SYSTEMOPERATING RATIOSFOR THE MONTH ENDED FEBRUARY 28, 2011

OP HOME ALL ALL SYSTEM LMH HPMC CCH GCMC CENTERS HPCC HEALTH REHAB PHYSICIANS FOUND OTHERS

SUPPLIES ACTUAL 1,438 1,743 1,393 1,311 1,717 152 942 35 314 8 0 9 BUDGET 1,402 1,718 1,536 1,245 1,472 152 1,033 35 236 7 0 7 PRIOR YR 1,374 1,753 1,506 1,187 1,446 106 840 33 235 5 0 7

ALL OTHER OPER EXPENSES ACTUAL 1,059 508 422 486 717 141 2,724 200 319 65 5 3 BUDGET 1,056 513 462 484 696 144 2,500 186 242 79 7 3 PRIOR YR 1,002 604 415 515 679 87 1,833 193 276 71 3 4

CAPITAL COSTS ACTUAL 521 253 414 302 873 119 476 26 113 5 0 0 BUDGET 509 308 407 275 853 114 414 13 93 5 0 0 PRIOR YR 470 308 403 319 665 89 410 2 99 5 0 1

OPERATING MARGIN ACTUAL 183 928 1,862 1,110 1,046 162 3,623 134 6,180 (77) 0 (4) BUDGET 222 831 1,587 1,152 1,109 181 1,928 544 3,811 (86) (2) (4) PRIOR YR 298 791 1,714 1,140 823 177 2,515 387 4,295 (49) 0 (3)

EXCESS MARGIN ACTUAL 516 2,538 1,860 1,111 1,049 162 4,041 330 7,197 (77) 20 (4) BUDGET 406 1,824 1,581 1,152 1,110 181 1,928 563 3,811 (86) 3 (4) PRIOR YR 461 1,974 1,715 1,140 863 177 3,103 844 4,488 (49) (68) (3)

LABORPROD FTEs/ADJ DAILY ADMIT ACTUAL 21.28 19.36 16.10 15.95 17.81 10.71 65.59 8.23 36.97 0.43 0.05 0.21 BUDGET 20.25 17.94 16.24 13.82 17.00 10.11 58.32 7.92 32.80 0.46 0.05 0.21 PRIOR YR 20.50 19.33 16.24 14.08 17.41 8.08 67.09 8.30 37.26 0.47 0.04 0.22

NON PROD AS % PAID ACTUAL 9.26% 9.18% 9.07% 9.28% 8.72% 12.83% 9.63% 10.32% 9.05% 7.82% 7.26% 10.50% BUDGET 9.48% 9.72% 9.52% 9.61% 8.75% 10.38% 10.43% 10.70% 10.11% 8.21% 10.81% 10.16% PRIOR YR 9.15% 9.42% 9.42% 9.32% 8.41% 10.20% 8.51% 9.37% 9.88% 8.23% 7.60% 10.48%

AVG HOURLY RATE ACTUAL 30.20 27.08 27.53 25.88 26.24 23.48 20.41 32.18 26.41 58.07 36.22 17.09 BUDGET 29.23 26.79 27.00 25.74 26.33 24.47 20.19 29.24 27.37 51.41 36.79 17.09 PRIOR YR 28.50 26.10 26.78 25.49 25.71 24.49 19.48 32.70 25.59 46.21 17.97 16.79

OP REV % OF TOTAL REVENUE ACTUAL 35.8% 27.6% 26.6% 35.6% 21.0% 99.0% N/A 100.0% 1.1% 100.0% N/A N/A BUDGET 36.1% 27.4% 27.1% 35.8% 23.2% 99.5% N/A 100.0% 0.3% 100.0% N/A N/A PRIOR YR 35.6% 28.0% 27.1% 36.5% 24.7% 99.4% N/A 100.0% 0.7% 100.0% N/A N/A

Page B.14

LEE MEMORIAL HEALTH SYSTEMOPERATING RATIOSFOR THE 5 MONTHS ENDED FEBRUARY 28, 2011

OP HOME ALL ALLSYSTEM LMH HPMC CCH GCMC CENTERS HPCC HEALTH REHAB PHYSICIANS FOUND OTHERS

AS % NET OPER REVWAGES & BENEFITS ACTUAL 51.6% 40.8% 38.2% 40.0% 37.1% 40.8% 61.7% 88.5% 50.4% 104.7% 52.1% 73.8% BUDGET 51.8% 42.1% 38.7% 39.4% 37.7% 42.7% 60.2% 77.7% 53.8% 103.7% 70.2% 73.8% PRIOR YR 51.1% 42.9% 38.3% 39.7% 39.6% 34.9% 63.8% 85.4% 56.5% 97.5% 59.3% 73.9%

SUPPLIES ACTUAL 21.0% 26.5% 20.8% 23.1% 25.1% 17.0% 6.4% 1.5% 2.4% 3.6% 1.0% 27.5% BUDGET 21.0% 26.2% 22.5% 22.0% 23.3% 18.2% 7.1% 1.5% 2.3% 3.9% 1.6% 25.4% PRIOR YR 21.7% 27.0% 22.1% 22.8% 25.4% 12.9% 7.2% 1.4% 2.5% 3.2% 1.7% 23.2%

ALL OTHER OPER EXPENSES ACTUAL 16.6% 8.5% 7.1% 9.5% 11.2% 14.7% 14.1% 9.3% 1.7% 42.8% 36.4% 11.8% BUDGET 16.7% 8.7% 7.1% 8.8% 11.6% 17.6% 16.1% 8.6% 2.3% 45.8% 52.4% 14.7% PRIOR YR 16.5% 9.4% 7.0% 9.2% 12.0% 12.9% 14.4% 9.7% 1.8% 40.7% 29.4% 13.8%

CAPITAL COSTS ACTUAL 7.9% 4.1% 6.3% 5.2% 13.7% 12.5% 2.8% 1.1% 0.9% 2.6% 0.0% 1.6% BUDGET 7.8% 5.0% 6.1% 4.9% 13.8% 12.0% 2.6% 0.6% 0.9% 2.8% 0.0% 1.6% PRIOR YR 7.5% 4.7% 6.7% 5.3% 12.1% 8.3% 3.3% 0.1% 1.0% 2.7% 0.0% 1.7%

EBITDA MARGIN ACTUAL 10.7% 24.3% 34.0% 27.4% 26.6% 27.5% 17.8% 0.7% 45.5% -51.1% 10.4% -13.1% BUDGET 10.5% 23.0% 31.6% 29.8% 27.4% 21.4% 16.7% 12.3% 41.6% -53.4% -24.2% -13.9% PRIOR YR 10.7% 20.7% 32.7% 28.3% 23.0% 39.3% 14.6% 3.6% 39.2% -41.4% 9.7% -10.9%

OPERATING MARGIN ACTUAL 2.9% 20.2% 27.7% 22.2% 12.9% 15.0% 15.0% -0.4% 44.6% -53.8% 10.4% -14.7% BUDGET 2.7% 18.0% 25.5% 24.9% 13.5% 9.4% 14.0% 11.7% 40.8% -56.2% -24.2% -15.5% PRIOR YR 3.2% 16.0% 26.0% 22.9% 10.9% 31.0% 11.3% 3.5% 38.2% -44.1% 9.7% -12.5%

EXCESS MARGIN ACTUAL 2.6% 36.9% 27.7% 22.2% -11.2% 14.9% 17.5% 7.3% 46.4% -53.8% 6.2% -13.3% BUDGET 5.7% 34.9% 25.4% 24.9% 13.6% 9.4% 14.0% 12.3% 40.8% -56.2% 13.8% -14.8% PRIOR YR 5.5% 29.5% 26.0% 22.9% 11.0% 31.0% 15.7% 16.0% 43.7% -44.1% -97.7% -11.6%

PER CMI ADJ ADMIT / VISITNET OPER REV ACTUAL 6,794 6,560 6,784 5,727 6,604 931 17,613 2,375 10,840 177 16 29 BUDGET 6,796 6,612 6,906 5,695 6,567 869 15,330 2,593 10,532 180 14 30 PRIOR YR 6,536 6,252 6,651 5,600 6,115 798 15,056 2,590 9,715 188 13 31

TOTAL EXPENSES ACTUAL 6,600 5,238 4,903 4,458 5,752 792 14,966 2,384 6,006 272 14 34 BUDGET 6,613 5,422 5,146 4,278 5,677 787 13,179 2,288 6,239 281 18 35 PRIOR YR 6,329 5,254 4,925 4,315 5,448 551 13,348 2,501 6,004 271 11 35

WAGES & BENEFITS ACTUAL 3,508 2,677 2,590 2,290 2,448 380 10,876 2,102 5,460 185 8 22 BUDGET 3,520 2,784 2,675 2,242 2,479 372 9,221 2,014 5,664 187 10 22 PRIOR YR 3,343 2,680 2,545 2,225 2,422 278 9,606 2,211 5,490 183 7 23

Page B.15

LEE MEMORIAL HEALTH SYSTEMOPERATING RATIOSFOR THE 5 MONTHS ENDED FEBRUARY 28, 2011

OP ALL CORPSYSTEM LMH HPMC CCH GCMC CENTERS HPCC HH REHAB PHYSICIANS FOUND SVC

SUPPLIES ACTUAL 1,430 1,736 1,409 1,323 1,657 158 1,122 35 259 6 0 8 BUDGET 1,427 1,735 1,556 1,252 1,531 159 1,086 38 247 7 0 8 PRIOR YR 1,418 1,691 1,472 1,279 1,551 103 1,080 35 244 6 0 7

ALL OTHER OPER EXPENSES ACTUAL 1,128 556 479 546 742 137 2,479 220 189 76 6 3 BUDGET 1,137 572 492 503 760 153 2,469 222 237 82 8 4 PRIOR YR 1,079 586 462 513 737 103 2,170 251 173 76 4 4

CAPITAL COSTS ACTUAL 535 269 426 299 905 116 489 26 98 5 0 0 BUDGET 530 330 424 280 908 104 402 15 90 5 0 0 PRIOR YR 489 297 445 299 738 66 492 3 97 5 0 1

OPERATING MARGIN ACTUAL 194 1,322 1,880 1,269 852 140 2,647 (9) 4,834 (95) 2 (4) BUDGET 183 1,190 1,760 1,417 890 82 2,151 304 4,293 (101) (3) (5) PRIOR YR 207 998 1,726 1,284 667 247 1,708 90 3,711 (83) 1 (4)

EXCESS MARGIN ACTUAL 222 3,058 1,878 1,270 (577) 138 3,169 187 5,193 (95) 49 (4) BUDGET 385 2,309 1,755 1,417 891 82 2,151 320 4,293 (101) 2 (4) PRIOR YR 359 1,847 1,728 1,285 672 247 2,371 414 4,250 (83) (12) (4)

LABORPROD FTEs/ADJ DAILY ADMIT ACTUAL 22.50 20.29 17.18 16.03 18.94 2.16 73.36 9.02 35.32 2.48 0.05 0.23 BUDGET 22.55 20.36 17.84 14.71 18.57 2.05 62.33 9.42 35.36 2.74 0.05 0.24 PRIOR YR 22.16 21.23 17.54 14.77 19.19 1.55 66.92 9.64 35.70 2.72 0.04 0.24

NON PROD AS % PAID ACTUAL 9.21% 9.41% 9.54% 9.41% 8.73% 9.87% 8.59% 10.09% 9.97% 7.95% 7.59% 10.78% BUDGET 9.53% 9.77% 9.64% 9.76% 9.06% 10.16% 10.22% 10.49% 9.91% 7.93% 10.43% 9.92% PRIOR YR 9.25% 9.37% 9.50% 9.49% 8.69% 10.31% 8.37% 9.51% 10.36% 8.26% 7.38% 10.19%

AVG HOURLY RATE ACTUAL 29.65 26.77 26.91 25.47 25.61 24.01 20.39 31.66 25.76 56.59 36.12 17.21 BUDGET 29.19 26.80 26.84 25.56 25.99 24.24 19.99 28.87 26.37 51.29 36.08 16.95 PRIOR YR 28.42 26.02 26.22 25.18 25.18 24.31 19.57 31.40 25.34 50.09 36.24 16.84

OP REV % OF TOTAL REVENUE ACTUAL 36.0% 28.8% 27.1% 35.5% 21.5% 99.3% 0.0% 100.0% 1.2% 100.0% N/A 100.0% BUDGET 36.8% 28.4% 27.4% 36.6% 24.9% 99.5% 0.0% 100.0% 0.3% 100.0% N/A N/A PRIOR YR 37.0% 29.3% 29.4% 36.7% 26.8% 99.4% 0.0% 100.0% 0.8% 100.0% N/A N/A

Page B.16

LEE MEMORIAL HEALTH SYSTEMFOR THE PERIOD ENDING: FEBRUARY 28, 2011CONSOLIDATED STAFFING SUMMARY

OP ALL ALLSYSTEM LMH HP CCH GCMC TRAUMA CENTERS HPCC HH REHAB PHYSICIANS FOUND CORP OTHERS

MONTH TO DATE

BUDGET 8,640.53 1,222.82 1,812.42 1,195.93 1,741.51 19.12 365.89 156.54 115.91 119.14 855.30 19.50 925.97 90.48

ACTUAL 8,824.96 1,306.67 1,832.95 1,228.81 1,735.74 20.23 422.20 166.45 119.55 118.59 851.70 18.66 914.87 88.56

DIFFERENCE (184.43) (83.85) (20.53) (32.88) 5.76 (1.10) (56.31) (9.91) (3.64) 0.54 3.60 0.84 11.11 1.92

YEAR TO DATE

BUDGET 8,265.46 1,161.28 1,722.78 1,133.01 1,615.25 19.14 358.35 154.11 114.01 118.12 852.90 19.50 907.55 89.46

ACTUAL 8,451.31 1,242.83 1,761.21 1,176.03 1,662.11 20.11 377.09 164.78 115.32 110.16 822.37 16.74 896.32 86.23

DIFFERENCE (185.85) (81.55) (38.44) (43.02) (46.86) (0.97) (18.74) (10.67) (1.31) 7.96 30.53 2.76 11.23 3.23

Page B.17

LMH/HP CCH GCMC HPCC HHA HBP/LPG TOTALGross A/R 160,583 47,028 118,980 1,664 1,266 40,462 369,983Allowances 66,394 24,905 71,841 212 8 32,802 196,163Net A/R 94,189 22,122 47,139 1,452 1,258 7,660 173,820

Net Revenue Per Day 1,624 510 779 37 26 303 3,278

Net Days in A/R Current Month 58.0 43.4 60.5 39.4 48.4 25.3 53.0 Net Days in A/R Same Month Prior Yr 57.7 46.5 53.7 52.1 72.1 37.8 53.2 % Change 3.8% 2.2% -7.1% 3.1% 31.5% 12.6%

In Thousands (000)February 28, 2011

Summary of Accounts ReceivableLEE MEMORIAL HEALTH SYSTEM

Page B.18


LEE COUNTY, FLORIDA

UNCONSOLIDATED

FINANCIAL STATEMENTS AND

STATISTICAL REPORTS

FEBRUARY 28, 2011


UNCONSOLIDATED

TABLE OF CONTENTS

SECTION C

PAGE LEESAR REGIONAL SERVICE CENTER C.1 ACCESS MEDICAL SOUTH, LC C.2 BONITA COMMUNITY HEALTH CENTER, INC. C.3

VAR VAR % VAR % VAR VAR % VAR %BUDGET ACTUAL PRIOR YR ACT TO BUD ACT TO BUD PR YR BUDGET ACTUAL PRIOR YR ACT TO BUD ACT TO BUD PR YR

TOTAL SALES 14,419,742 13,793,420 11,853,318 (626,322) -4.3% 16.4% 67,921,968 66,725,549 55,367,947 (1,196,419) -1.8% 20.5%

COST OF GOODS SOLD 13,208,200 12,448,451 10,991,531 759,749 5.8% -13.3% 62,033,755 60,664,598 50,665,760 1,369,157 2.2% -19.7% GROSS PROFIT 1,211,542 1,344,969 861,787 133,427 11.0% 56.1% 5,888,213 6,060,951 4,702,187 172,738 2.9% 28.9%

OTHER OPERATING REVENUE 1,336 52 2,262 (1,284) -96.1% -97.7% 6,680 1,222 34,651 (5,458) -81.7% -96.5%

TOTAL OPERATING REVENUE 1,212,878 1,345,021 864,049 132,143 10.9% 55.7% 5,894,893 6,062,173 4,736,838 167,280 2.8% 28.0%

OPERATING EXPENSES SALARIES/WAGES 399,914 372,180 349,812 27,734 6.9% -6.4% 2,104,139 1,977,383 1,872,436 126,756 6.0% -5.6% BENEFITS 138,349 125,059 124,123 13,290 9.6% -0.8% 686,375 674,085 642,479 12,290 1.8% -4.9% OTHER SUPPLIES 48,566 58,490 29,748 (9,924) -20.4% -96.6% 236,719 261,246 187,678 (24,527) -10.4% -39.2% OTHER SERVICES 160,253 144,806 146,962 15,447 9.6% 1.5% 817,632 740,883 739,308 76,749 9.4% -0.2% PURCHASED SERVICES 51,741 39,354 50,413 12,387 23.9% 21.9% 258,705 216,167 236,045 42,538 16.4% 8.4% DEPRECIATION/AMORTIZATION 65,501 56,712 64,585 8,789 13.4% 12.2% 327,505 305,791 320,788 21,714 6.6% 4.7%

TOTAL OPERATING EXPENSES 864,324 796,601 765,643 67,723 7.8% -3.9% 4,431,075 4,175,555 3,998,734 255,520 5.8% -4.4%

GAIN(LOSS) FROM OPERATIONS 348,554 548,420 98,406 199,866 57.3% 457.3% 1,463,818 1,886,618 738,104 422,800 28.9% 155.6%

INTEREST EARNINGS 1,750 1,698 1,104 (52) -3.0% 53.8% 8,750 10,716 5,928 1,966 22.5% 80.8% GAIN(LOSS) ON DISPOSITION 0 0 0 0 0.0% 0.0% 0 0 0 0 0.0% 0.0%

EXCESS OF REV OVER EXPENSES 350,304 550,118 99,510 199,814 57.0% 452.8% 1,472,568 1,897,334 744,032 424,766 28.8% 155.0%

Page C.1

LEESAR REGIONAL SERVICE CENTERCOMPARATIVE INCOME STATEMENT (UNAUDITED)


CURRENT MONTH YEAR TO DATE FISCAL 2011


NET PRODUCT REVENUE 208,842 230,601 204,150 21,759 10.4% 13.0% 1,027,959 1,137,248 998,321 109,289 10.6% 13.9%

COST OF PRODUCTS SOLD 44,690 49,522 40,938 (4,832) -10.8% -21.0% 220,005 278,227 208,646 (58,222) -26.5% -33.3%

GROSS PROFIT 164,152 181,079 163,212 16,927 10.3% 10.9% 807,954 859,021 789,675 51,067 6.3% 8.8%

OPERATING EXPENSES SALARIES/WAGES 65,331 63,885 63,058 1,446 2.2% -1.3% 346,100 339,500 328,575 6,600 1.9% -3.3% BENEFITS 19,239 24,127 19,387 (4,888) -25.4% -24.4% 88,742 95,292 85,182 (6,550) -7.4% -11.9% OTHER SERVICES 26,537 30,832 26,583 (4,295) -16.2% -16.0% 132,685 165,263 145,924 (32,578) -24.6% -13.3% BAD DEBT 16,698 37,083 24,318 (20,385) -122.1% -52.5% 82,195 108,196 94,355 (26,001) -31.6% -14.7% DEPREC, INTEREST, & AMORT 17,790 18,172 16,297 (382) -2.1% -11.5% 86,827 90,931 79,575 (4,104) -4.7% -14.3%

TOTAL OPERATING EXPENSES 145,595 174,099 149,643 (28,504) -19.6% -16.3% 736,549 799,182 733,611 (62,633) -8.5% -8.9%

GAIN(LOSS) FROM OPERATIONS 18,557 6,980 13,569 (11,577) -62.4% 48.6% 71,405 59,839 56,064 (11,566) -16.2% 6.7%

NON OPERATING REVENUE 0 0 500 0 #DIV/0! -100.0% 0 0 553 0 #DIV/0! -100.0%

EXCESS OF REV OVER EXPENSES 18,557 6,980 14,069 (11,577) -62.4% -50.4% 71,405 59,839 56,617 (11,566) -16.2% 5.7%

MINORITY INTEREST 9,279 3,490 7,035 (5,789) -62.4% -50.4% 35,703 29,920 28,309 (5,783) -16.2% 5.7% NET INCOME (LOSS) 9,279 3,490 7,035 (5,789) -62.4% -50.4% 35,703 29,920 28,309 (5,783) -16.2% 5.7%

Page C.2

ACCESS MEDICAL SOUTH, LCCOMPARATIVE INCOME STATEMENT (UNAUDITED)




GROSS PATIENT REVENUE 1,694,183 1,337,864 1,383,509 (356,319) -21.0% -3.3% 7,327,119 6,167,394 6,398,745 (1,159,725) -15.8% -3.6%

DEDUCTIONS FROM REVENUE 1,088,463 776,385 915,932 312,078 28.7% 15.2% 4,805,546 3,751,250 4,159,355 1,054,296 21.9% 9.8% NET PATIENT REVENUE 605,720 561,479 467,577 (44,241) -7.3% 20.1% 2,521,573 2,416,144 2,239,390 (105,429) -4.2% 7.9%

OTHER OPERATING REVENUE 96,000 90,573 85,009 (5,427) -5.7% 6.5% 462,000 448,595 434,182 (13,405) -2.9% 3.3%

TOTAL OPERATING REVENUE 701,720 652,052 552,586 (49,668) -7.1% 18.0% 2,983,573 2,864,739 2,673,572 (118,834) -4.0% 7.2%

OPERATING EXPENSES SALARIES/WAGES/BENEFITS 323,664 292,953 275,976 30,711 9.5% -6.2% 1,505,089 1,405,517 1,337,582 99,572 6.6% -5.1% OTHER SUPPLIES 178,310 160,667 173,997 17,643 9.9% 7.7% 864,356 914,627 832,862 (50,271) -5.8% -9.8% PURCHASED SERVICES 101,102 90,705 107,074 10,397 10.3% 15.3% 488,673 370,395 476,311 118,278 24.2% 22.2% DEPRECIATION/AMORTIZATION 69,662 65,238 70,028 4,424 6.4% 6.8% 348,310 315,704 349,792 32,606 9.4% 9.7% BAD DEBT EXPENSE 15,143 15,744 9,202 (601) -4.0% -71.1% 63,040 62,550 57,470 490 0.8% -8.8% INTEREST 106,692 98,056 100,554 8,636 8.1% 2.5% 572,888 546,584 615,081 26,304 4.6% 11.1%

TOTAL OPERATING EXPENSES 794,573 723,363 736,831 71,210 9.0% 1.8% 3,842,356 3,615,377 3,669,098 226,979 5.9% 1.5%

GAIN(LOSS) FROM OPERATIONS (92,853) (71,311) (184,245) 21,542 -23.2% -61.3% (858,783) (750,638) (995,526) 108,145 -12.6% -24.6%

INTEREST EARNINGS 0 0 10 0 0.0% -100.0% 0 119 95 119 0.0% 25.3% GAIN ON SALE OF EQUIPMENT 0 0 0 0 0.0% 0.0% 0 4,000 0 4,000 0.0% 0.0% REFINANCE EXP-OPER LEASE 0 (34,538) 0 (34,538) 0.0% 0.0% 0 (69,076) 0 (69,076) 0.0% 0.0% INCRS(REDUCT) FV INT RATE SWAPS 0 0 (9,364) 0 0.0% 0.0% 0 267,999 55,149 267,999 0.0% -386.0%

EXCESS OF REV OVER EXPENSES (92,853) (105,849) (193,599) (12,996) -14.0% 45.3% (858,783) (547,596) (940,282) 311,187 36.2% 41.8%

Page C.3

BONITA COMMUNITY HEALTH CENTER, INC.COMPARATIVE INCOME STATEMENT (UNAUDITED)



Lee Memorial Health SystemBoard of Directors

Committee of the WholeFinancial Update

For the Month Ending 2/28/11Presented 4/28/11

System Adjusted Admits

Percent of Total Operating Revenue for the month ended 2/28/11

Percent of Total Operating Revenue for the 5 months ended 2/28/11

Comparison of Net Revenue per CMAAfor 5 month period ended 2/28/11

Gain (Loss) From Operations ( in 000’s )

Financial Statements for the month ended 2/28/11

February, 2011

VOLUME:ADJUSTED ADMISSIONS 10,440 10,172 10,239 -268 -3% -1%

REVENUES: (000's)INPATIENT $224,249 229,359$ 209,561$ 5,110$ 2% 9%OUTPATIENT 128,442 129,347 116,984 905 1% 11% TOTAL OPERATING REV 352,691 358,706 326,545 6,015 2% 10%

DEDUCTIONS 259,171 262,938 237,533 (3,767) -1% -10%

TOTAL OPERATING REVENUES 93,520 95,768 89,012 2,248 2% 8%

OPERATING EXPENSES: (000's)OPERATING 82,923 85,526 78,070 (2,603) -3% -9%CAPITAL 7,446 7,695 6,696 (249) -3% -13%TOTAL OPERATING EXP 90,369 93,221 84,766 (2,852) -3% -9%

OPERATING GAIN: $3,151 $2,547 $4,246 (604)$ -19% -40%

INVESTMENT INCOME 2,668 4,844 2,308 2,176 82% 110%

EXCESS OF REVENUES OVER EXPENSES $5,819 $7,391 $6,554 1,572$ 27% 13%

Net Patient Revenue

Consolidated Income Statement Analysis of Variancefor the month ended 2/28/11

SUMMARY OF VARIANCE: EXPLANATION: (In Thousands)

VOLUME VARIANCE RATE VARIANCEBUDGET 91,975$ Actual Adj Admits-System 10,172 Actual Net Rev/Adj Admit 9,280$

Budget Adj Adm-System 10,440 Budget Net Rev/Adj Admit 8,810$ ACTUAL 94,393$ Variance (268) Variance 470$

VARIANCE 2,418$ Budget Net Rev/Adj Admit 8,810$ Actual Adj Admits 10,172

Total Volume Variance (2,359,381)$ Total Rate Variance 4,777,381$

Net Revenue - Rate & Volume Variance 2,418,000$

Medicare Medicaid

Commmercial, HMO/PPO,

Other TOTAL Budgeted Payor Mix 55.3% 13.2% 31.5% 100%Actual Payor Mix 55.7% 13.3% 31.0% 100%Budget Gross Rev/Adj Adm 37,969 28,995 27,974 33,636Actual Gross Rev/Adj Adm 39,500 24,970 31,635 35,129Budget Net Rev/Adj Admit 8,376 6,623 10,489 8,810Actual Net Rev/Adj Admit 8,488 5,792 12,199 9,280Reimbursement % 21% 23% 39% 26%

Payor Mix Variance 340,799 67,368 (533,453) (125,286) Rate/Adj Admit Variance 646,593 (1,145,151) 5,401,225 4,902,667 Total Rate Variance 987,392$ (1,077,783)$ 4,867,772$ 4,777,381$

Net Patient Revenue - Rate Variance

Total Salaries & Wages



VOLUME VARIANCE RATE VARIANCEBUDGET 40,412$ Actual Total FTEs 8,825 Actual Rate/FTE 30.20$

Budget Total FTEs 8,641 Budget Rate/FTE 29.23$ ACTUAL 42,643$ Prod FTE Variance (184) Rate Variance (0.97)$

VARIANCE (2,231)$ Budget Rate/FTE 29.23 Actual Total FTEs 8,825 Hours/FTE 160 Hours/FTE 160

Total Volume Variance (862,584) Total Rate Variance (1,368,416)

Rate & Volume Var (2,231,000)$

Description: FTEs Amount FTE's Earned Budget 8,528 (based on Adj Adm & 50% flex) Budget Prod FTEs 8,641 Var due to Volume 113 526,306$

Actual FTEs 8,825 FTE's Earned Budget 8,528 Productivity Inc(Dec) (297) (1,388,890) Total FTE-Volume Var (184) (862,584)$

Total FTE Volume Variance:


Productive Salaries & WagesSUMMARY OF VARIANCE: EXPLANATION: (In Thousands)

VOLUME VARIANCE RATE VARIANCEBUDGET 35,716$ Actual Prod FTEs 7,956 Actual Rate/FTE 29.55$

Budget Prod FTEs 7,613 Budget Rate/FTE 29.32$ ACTUAL 37,612$ Prod FTE Variance (343) Rate Variance (0.22)$

VARIANCE (1,896)$ Budget Rate/FTE 29.32$ Actual Prod FTEs 7,956 Hours/FTE 160 Hours/FTE 160

Total Volume Variance (1,610,301) Total Rate Variance (285,699)

Rate & Volume Var (1,896,000)$

Description: FTEs Amount FTE's Earned Budget 7,514 (based on Adj Adm & 50% flex) Budget Prod FTEs 7,613 Var due to Volume 99 462,746$

Actual FTEs 7,956 FTE's Earned Budget 7,514 Productivity Inc(Dec) (442) (2,073,046) Prod FTE-Volume Var (343) (1,610,300)$

Prod FTE Volume Variance:


Contract LaborSUMMARY OF VARIANCE: EXPLANATION: (In Thousands)

VOLUME VARIANCE RATE VARIANCEBUDGET 560$ Actual Contract FTEs 52 Actual Rate/FTE 56.30$

Budget Contract FTEs 67 Budget Rate/FTE 52.31$ ACTUAL 464$ Contract FTE Var 15 Rate Variance (3.99)$

VARIANCE 96$ Budget Rate/FTE 52.31$ Actual Contract FTEs 52 Hours/FTE 160 Hours/FTE 160

Total Volume Variance 128,844$ Total Rate Variance (32,844)$

Rate & Volume Var 96,000$

Phys -$ Home Health (3,000) Rehab 21,000 HPCC (5,000) Corporate - Acute Care - Volume Related (15,000) Other Staffing Changes 98,000

Total Labor Rate & Volume Var 96,000$

Contract Labor Volume/Rate Variance


Non-Productive Salaries


BUDGET 4,136$ PTO (275,000) Incentive/Performance Based Pay (5,000)

ACTUAL 4,567$ Leave & Other Adjustments (151,000)

VARIANCE (431)$ Total Variance (431,000)$


Other Supplies


VOLUME VARIANCE RATE VARIANCEBUDGET 20,343$ Actual Adj Admissions 10,172 Actual Supplies/Adj Adm 2,057$

Budget Adj Admissions 10,440 Budget Supplies/Adj Adm 1,949$ ACTUAL 20,921 Variance 268 Rate Variance (108)$

VARIANCE (578)$ Budget Supplies/Adj Adm 1,949$ Actual Adj Admissions 10,172

Total Volume Variance 521,847 Total Rate Variance (1,099,847)

Rate & Volume Var (578,000)$

Budget/AA Actual/AA Variance

(Inc) Dec in Drug Expense 436$ 450$ (139,863)$ (Inc) Dec in Implant Costs 650$ 703$ (538,424) (Inc) Dec in Med/Surg Supplies 547$ 575$ (279,496) (Inc) Dec in Other Supplies (142,064)

Total Variance 1,086 1,153 (1,099,847)

Rate Variance

Consolidated Income Statement Analysis of Variancefor the month ended2/28/11

Other Services


Recruiting Costs (229,000) BUDGET 5,004$ Legal Fees (153,000)

Repairs (84,000) ACTUAL 5,345 Other Expenses 115,000

VARIANCE (341)$

Total (351,000)$


Purchased Services


ER/Trauma Stipends 286,000 BUDGET 9,193$ E.H.R Fees 151,000

Non Annual Repairs 157,000 ACTUAL 8,845 Information Systems 102,000

Dialysis (173,000) VARIANCE 348$ Transcription/Coding Fees (159,000)

Total 364,000$


Bad Debt Expense


Budget Bad Debt Percent 3.6%BUDGET 12,492$

Actual Gross Revenue 1,786,757,000$ ACTUAL 12,361

Bad Debt Expense-Vol Adj 63,429,874$ VARIANCE 131$

Over (Under) Budget (51,069,000)

Actual Bad Debt Expense 12,360,874$


For the month ended February 28, 2011 Actual adjusted admits (overall inpatient & outpatient volume indicator) for the month ended February 28, 2011 are 10,172 which is 2.6% less than budget. Actual inpatient admits for the month are 6,529 or 2.1% less than budget while actual patient days are 34,060 or 4.1% greater than budget which resulted in a 5.2 day length of stay. Emergency room visits are 3.4% greater than budget while outpatient surgeries are 12.2% greater than budget. Net patient revenue for February 2011 reflects a $2.2 million or a 2.4% favorable variance to budget. This favorable variance in net patient revenue is primarily the result of the 2.6% decrease in adjusted admits which is offset by the 5.0% increase in reimbursement during the month. Total operating expenses before depreciation and interest expense are $2.6 million greater than budget. All operating expense categories except fringe benefits and purchased services reflect unfavorable variances. Salaries & Wages reflect a $2.2 million unfavorable variance due to increased overtime and the market adjustments that have increased the average hourly rate. Supply costs reflect a $0.6 million unfavorable variance but is equal to budget when expressed as a percent of net patient revenue. Actual total operating costs per case mix adjusted admit is 2.8% greater than budget (6,400 act, 6,223 budget). Productivity as measured by FTEs/AOB increased by 1.3% (4.66 actual, 4.72 budget) for February 2011. For February 2011, the gain from operations is $2.5 million versus a budgeted gain of $3.1 million. Excess revenue over expenses is a gain of $7.4 million versus a budgeted gain of $5.8 million. Investments were budgeted to return $2.7 million for the month but the actual investment return was $4.8 million. For the month, Cash & Investments increased by $7.4 million to $513.4 million. Operations increased cash by $12.6 million while working capital decreased cash by $6.2 million. Cash was reduced by $4.6 million for routine equipment. Days in Accounts Receivable are 53.0 days and resulted in a $5.6 million increase in cash. Total Notes & Bonds payable on February 28, 2011 is $700.7 million resulting in a Cash to Debt ratio of 73.3%. Net Patient Revenue per adjusted admit CMI for the month ended February 28, 2011 is $6,584 while the Operating Expense per adjusted admit CMI is $6,400. The difference which represents the gain from operations per adjusted admit is $184.00 while the budgeted gain from operations is $222.00. Wages & Benefits as a percent of Net Operating Revenue is 51.4% for February 2011 versus a budget of 50.5%. The actual hourly pay rate is $30.20 which is $0.97 greater than budget due to market adjustments and overtime. YTD, the average hourly rate is $29.65 which is 46 cents greater than budget. Post Acute entities provided the following YTD contributions to Acute Care by allowing charity care patients into their respective programs: Lee Memorial Home Health $308,000; HealthPark Care Center $161,000; The Rehabilitation Hospital $187,000; Access Medical South (DME joint venture) $53,000. The Lee Physician Group YTD loss per physician is $12,308. This includes practice revenue and expenses along with ancillary revenue referred to LMHS. This YTD loss is $25,783 per physician less than budget due to lower operating cost and better collections per visit than budget.

LEE MEMORIAL HEALTH SYSTEMCONSOLIDATED EXECUTIVE SUMMARYFOR THE PERIOD ENDING FEBRUARY 28, 2011

Current period Year-to-DateBudget Actual Prior Year Var % Budget Actual Prior Year Var %

ACT TO BUD ACT TO BUDInpatient Volumes: Admits - Adults & Peds 6,667 6,529 6,597 -2.1% 31,424 32,753 30,704 4.2% Patient Days - Adults & Peds 32,706 34,060 33,110 4.1% 161,125 170,776 159,760 6.0%

Length of Stay (LOS) 4.9 5.2 5.0 6.1% 5.1 5.2 5.2 2.0%

Inpatient Surgeries 1,717 1,708 1,678 -0.5% 8,329 8,546 8,351 2.6%

Outpatient Volumes: Emergency Room Visits 13,257 13,706 12,828 3.4% 68,906 69,367 66,751 0.7% OutPatient Surgeries 1,490 1,672 1,533 12.2% 7,315 7,947 7,923 8.6%

Adjusted Admits 10,440 10,172 10,239 -2.6% 49,747 51,149 48,733 2.8% (overall in/outpat volume indicator)

Operating Ratios: Net Revenue/Adj Adm CMI 6,445 6,584 6,254 2.2% 6,796 6,794 6,536 0.0% Operating Exp/Adj Adm CMI 6,223 6,400 5,956 -2.8% 6,613 6,600 6,326 0.2%

Wages/Ben - % of Net Oper Rev 50.5% 51.4% 49.7% -1.8% 51.8% 51.6% 51.1% 0.4% Supplies as a % of Net Oper Rev 21.8% 21.8% 22.0% 0.0% 21.0% 21.0% 21.7% 0.0%

Charity/Bad Debt - % of Gross Rev 6.9% 6.8% 6.8% 0.7% 6.9% 6.8% 6.7% 1.4%

Financial Ratios: Operating Margin (%) 3.4% 2.8% 4.8% 0.0% 2.7% 2.9% 3.2% 7.4% Excess Margin (%) 6.3% 7.2% 7.4% 14.3% 5.7% 2.6% 5.5% -54.4%

Liquidity Ratios: Cash to Debt (%) 83.7% 73.3% 66.3% Days Cash on Hand (net of VRDB) 138.5 130.4 83.0 Days In Acct Receivable 60.0 53.0 53.2

Income Statement Summary (In Thousands):Total Net Operating Revenue 93,520$ 95,768$ 89,012$ 2.4% 469,956$ 483,045$ 442,714$ 2.8%Total Operating Expenses 90,369 93,221 84,766 -3.1% 457,615 469,971 428,722 -2.6% Consolidated Gain(Loss) from Oper 3,151 2,547 4,246 19.2% $12,341 13,074 $13,992 -5.9%

Investment Earnings/Non Op Income 2,668 4,844 2,308 81.6% 13,965 2,022 10,353 -85.5%

Consolidated Excess Rev over Exp 5,819$ 7,391$ 6,554$ 27.0% 26,306$ 15,096$ 24,345$ -42.6%

Trauma District Gain(Loss) from Oper (341)$ (230)$ (363)$ 32.6% (1,816)$ (2,003)$ (1,743)$ -10.3%

Balance Sheet Highlights (In Thousands): Cash & Investments 549,475$ 513,362$ 451,897$ Bonds & Notes Payable 656,480$ 700,668$ 681,915$

VRDB = variable rate demand bondsCMI = case mix index

Page 1

LEE MEMORIAL HEALTH SYSTEMCONSOLIDATED STATISTICAL SUMMARYFOR THE PERIOD ENDING FEBRUARY 28, 2011

Current period Year-to-DateBudget Actual Prior Year Variance Var % Budget Actual Prior Year Variance Var %

ACT TO BUD ACT TO BUD ACT TO BUD ACT TO BUD

Admissions ADULTS 6,107 5,956 6,043 (151) -2.5% 28,503 29,729 27,798 1,226 4.3% PEDIATRICS 363 380 360 17 4.7% 1,888 2,029 1,873 141 7.5% NICU 44 53 50 9 20.8% 251 271 276 20 8.1% POST ACUTE 153 140 144 (13) -8.5% 783 724 757 (59) -7.5%Total Adult & Peds 6,667 6,529 6,597 (138) -2.1% 31,424 32,753 30,704 1,329 4.2% NEWBORNS 505 443 476 (62) -12.3% 2,691 2,483 2,540 (208) -7.7%Total Admissions 7,172 6,972 7,073 (200) -2.8% 34,115 35,236 33,244 1,121 3.3%

Patient Days ADULTS 26,365 27,601 26,753 1,236 4.7% 127,087 136,576 126,479 9,489 7.5% PEDIATRICS 1,286 1,285 1,123 (1) -0.1% 6,747 6,506 6,074 (241) -3.6% NICU 986 1,096 1,131 110 11.1% 5,670 6,410 6,193 740 13.1% POST ACUTE 4,069 4,078 4,103 9 0.2% 21,621 21,284 21,014 (337) -1.6%Total Adult & Peds 32,706 34,060 33,110 1,354 4.1% 161,125 170,776 159,760 9,651 6.0% NEWBORNS 1,146 1,018 1,136 (128) -11.2% 6,149 6,115 6,161 (34) -0.6%Total Patient Days 33,853 35,078 34,246 1,225 3.6% 167,274 176,891 165,921 9,617 5.7%

Average Length of Stay ADULTS 4.3 4.6 4.4 0.3 7.3% 4.5 4.6 4.5 0.1 3.0% PEDIATRICS 3.5 3.4 3.1 (0.2) -4.6% 3.6 3.2 3.2 (0.4) -10.3% NICU 22.5 20.7 22.6 (1.8) -8.0% 22.6 23.7 22.4 1.0 4.5% POST ACUTE 26.6 29.1 28.5 2.5 9.5% 27.6 29.4 27.8 1.8 6.5%Total Adult & Peds 4.9 5.2 5.0 0.3 6.3% 5.1 5.2 5.2 0.1 1.7% NEWBORNS 2.3 2.3 2.4 0.0 1.2% 2.3 2.5 2.4 0.2 7.8%Total Patient Days 4.7 5.0 4.8 0.3 6.6% 4.9 5.0 5.0 0.1 2.4%

OP Registrations EMERGENCY ROOM 13,257 13,706 12,828 449 3.4% 68,907 69,367 66,751 460 0.7% OP SURGERY CASES 1,490 1,672 1,533 182 12.2% 7,315 7,947 7,923 632 8.6%SUBTOTAL 14,747 15,378 14,361 631 4.3% 76,221 77,314 74,674 1,093 1.4%

Visits / Encounters HOME HEALTH ADMISSIONS 353 352 312 (1) -0.4% 1,625 1,724 1,394 99 6.1% HOSP BASED PHY ENCOUNTERS 14,065 14,889 13,283 824 5.9% 74,817 79,098 70,917 4,281 5.7% PHYSICIAN ENCOUNTERS 46,369 49,648 41,703 3,279 7.1% 225,705 239,943 201,952 14,238 6.3% TRAUMA SERVICES DISTRICT 455 637 435 182 40.0% 3,123 3,339 3,033 216 6.9%SUBTOTAL 61,242 65,526 55,733 4,284 7.0% 305,269 324,104 277,296 18,835 6.2%

TOTAL OP 75,990 80,904 70,094 4,914 6.5% 381,491 401,418 351,970 19,927 5.2%

Page A.3

LEE MEMORIAL HEALTH SYSTEMCONSOLIDATED STATEMENT OF OPERATIONSFOR THE PERIOD ENDING: FEBRUARY 28, 2011( IN THOUSANDS )

BUDGET ACTUAL PRIOR YEAR VAR VAR % VAR % BUDGET ACTUAL PRIOR YEAR VAR VAR % VAR %ACT TO BUD ACT TO BUD PR YR ACT TO BUD ACT TO BUD PR YR

INPATIENT REVENUE 224,249 229,359 209,561 5,110 2.3% 9.4% 1,088,272 1,144,133 1,012,861 55,861 5.1% 13.0%OUTPATIENT REVENUE 126,897 127,972 115,679 1,075 0.8% 10.6% 634,553 642,624 594,727 8,071 1.3% 8.1%TOTAL PATIENT REVENUE 351,146 357,332 325,240 6,185 1.8% 9.9% 1,722,825 1,786,757 1,607,589 63,932 3.7% 11.1%

DED FROM REV-MEDICARE 139,573 143,142 128,054 (3,569) -2.6% -11.8% 652,035 671,156 596,789 (19,122) -2.9% -12.5%DED FROM REV-MEDICAID 32,877 33,317 30,484 (439) -1.3% -9.3% 182,552 182,932 168,385 (381) -0.2% -8.6%DED FROM REV-CHARITY 11,596 11,988 10,634 (393) -3.4% -12.7% 56,707 58,195 51,166 (1,488) -2.6% -13.7%DED FROM REV-HMO/PPO 26,227 29,880 29,083 (3,653) -13.9% -2.7% 147,043 160,639 159,218 (13,596) -9.2% -0.9%DED FROM REV-OTHER 36,408 32,250 27,796 4,158 11.4% -16.0% 160,163 174,853 140,177 (14,690) -9.2% -24.7%DED FROM REV-BAD DEBT 12,492 12,362 11,482 130 1.0% -7.7% 62,257 63,488 55,863 (1,231) -2.0% -13.6%TOTAL DED FROM REV 259,171 262,938 237,533 (3,767) -1.5% -10.7% 1,260,756 1,311,263 1,171,598 (50,507) -4.0% -11.9%

NET PATIENT REVENUE 91,975 94,393 87,707 2,419 2.6% 7.6% 462,070 475,494 435,990 13,424 2.9% 9.1%OTHER OPER REV 1,545 1,374 1,305 (171) -11.0% 5.3% 7,886 7,551 6,724 (335) -4.2% 12.3%

TOTAL OPERATING REV 93,520 95,768 89,012 2,248 2.4% 7.6% 469,956 483,045 442,714 13,090 2.8% 9.1%

OPERATING EXPENSES PROD SALARIES 34,488 36,178 32,165 (1,690) -4.9% -12.5% 176,340 184,420 165,062 (8,080) -4.6% -11.7% PROD OVERTIME 1,228 1,434 1,307 (205) -16.7% -9.7% 7,029 7,465 6,269 (436) -6.2% -19.1% CONTRACT LABOR 560 464 513 96 17.2% 9.7% 1,271 938 1,063 333 26.2% 11.8% NON-PROD SALARIES 4,136 4,568 3,645 (432) -10.4% -25.3% 23,526 23,409 20,833 117 0.5% -12.4%TOTAL SALARIES & WAGES 40,412 42,643 37,630 (2,231) -5.5% -13.3% 208,166 216,232 193,227 (8,067) -3.9% -11.9%

FRINGE BENEFITS 6,845 6,563 6,619 281 4.1% 0.8% 35,219 33,195 33,214 2,025 5.7% 0.1%HEALTH CARE ACCESS 1,126 1,209 1,214 (83) -7.3% 0.4% 5,649 6,035 5,983 (386) -6.8% -0.9%SUPPLIES 20,343 20,921 19,559 (578) -2.8% -7.0% 98,652 101,665 96,065 (3,012) -3.1% -5.8%OTHER SERVICES 5,004 5,345 5,109 (341) -6.8% -4.6% 26,759 27,357 25,299 (598) -2.2% -8.1%PURCHASED SERVICES 9,192 8,845 7,938 348 3.8% -11.4% 46,196 46,808 41,776 (611) -1.3% -12.0%

TOTAL OPER EXPENSES 82,922 85,526 78,070 (2,604) -3.1% -9.6% 420,641 431,291 395,565 (10,650) -2.5% -9.0%

EBITDA 10,597 10,242 10,942 (356) -3.4% -6.4% 49,315 51,754 47,149 2,440 4.9% 9.8%

DEPRECIATION/AMORT 5,151 5,403 4,635 (252) -4.9% -16.6% 25,463 26,576 21,855 (1,113) -4.4% -21.6%INTEREST EXPENSE 2,295 2,292 2,061 4 0.2% -11.2% 11,510 12,104 11,302 (594) -5.2% -7.1%GAIN(LOSS) FROM OPER 3,151 2,547 4,246 (604) -19.2% -40.0% 12,341 13,074 13,992 733 5.9% -6.6%


Page A.4

Lee Memorial Health SystemConsolidated Balance Sheet As of FEBRUARY 28, 2011

in Thousands (000's)

ASSETS: Current Prior Month Prior Year LIABILITIES: Current Prior Month Prior Year

Current Assets: Current Liabilities:Cash And Cash Equivalents * 11,561 16,483 16,087 Accounts Payable 30,181 36,595 34,520Operating Fund Investments * 473,871 461,595 432,318 Wages and Benefits Payable 44,301 42,658 31,795Accrued Interest Receivable 361 353 371 Notes Payable - Short Term 7,545 6,680 4,349Accounts Receivable (net) 166,160 172,163 141,351 Current Portion Bonds Payable 10,350 10,350 14,871Accounts Receivable - Phys (Net) 7,660 7,260 10,626 Due to State of Florida 11,904 11,569 13,312Inventories 29,159 29,116 29,117 Malpractice Liability - Short Term 5,936 5,936 5,936Third Party Settlements 0 0 0 Accrued Bond Costs 9,531 7,610 12,282Other Current Assets 12,511 12,421 11,599 Due to LMHS 0 0 0

Other Current Liabilities 33,016 38,251 32,151

Total Current Assets: 701,282 699,390 641,468 Total Current Liabilities 152,765 159,649 149,216

Other Assets Other Liabilities and Fund BalanceLimited or Restricted Use Assets * 6,706 6,709 17,675 Benefits Payable - Long Term 0 0 0Bond Issuance Costs 5,218 5,247 5,685 Notes Payable - Long Term 155,343 156,548 104,040Trustee Held Funds * 0 0 0 Due to State of Florida - Long Term 7,736 6,894 3,494Directors/Officers Indemnity Fund * 100 100 100 Malpractice Liability - Long Term 9,942 9,842 9,242Long Term Operating Fund Investments * 21,126 21,126 20,304 Bonds Payable 527,430 527,389 553,410Other Assets 99,413 99,280 100,082 Other Long Term Liabilities 45,546 45,192 39,054

UnRestricted Fund Balance 608,896 601,728 596,992Restricted Fund Balance 26,030 25,807 22,838

Total Other Assets 132,562 132,462 143,846 Total Other Liabilities & Fund Balance 1,380,924 1,373,401 1,329,070

Property and Equipment:Plant In Use 1,224,090 1,222,991 1,203,696Construction in Process 29,729 28,193 26,866Accumulated Depreciation (575,322) (571,220) (555,419)

Total Property & Equipment (Net) 678,497 679,965 675,142

Restricted Assets 21,348 21,233 17,829

TOTAL ASSETS 1,533,688 1,533,050 1,478,286 TOTAL LIABILITIES AND EQUITY 1,533,689 1,533,050 1,478,286

* Cash and InvestmentsAbove Balance Sheet has been adjusted to eliminate intercompany receivables, payables and investments in subsidiaries

Page A.7



OLD BUSINESS

Memorandum

TO: LMHS Board of Directors

FROM: James T. Humphrey

DATE: March 7, 2011

RE: LMHS Board Policies

As you continue to consider revising Policies No. 10.11 and 20.13, I thought it important

to again review your authority as it pertains to Directors Compensation.

Directors compensation is governed by Section 8 of the Special Act which provides that Directors shall receive an annual compensation of up to $13,055.39 for services as members of such board if such compensation is approved by the Board. The governing words are “up to,” “services” and “if” such compensation is approved by the Board. This means the Board has the authority to approve a lesser amount and the compensation should be for “services” as members of the Board.

The primary service performed by board members is to participate in board meetings where decisions are to be made regarding the operations and maintenance of the public health system.

It is the system board, not individual members, who has the authority and the responsibility to take action and make decisions which can be made only at publicly advertised meetings. Any additional time and effort expended by board members are over and above their primary responsibility of attending meetings and making decisions collectively.

The board may address the approval of its annual compensation through adopted policies which may include:

• Dividing the annual compensation by weeks or months or by meeting attended by the members. For example, you have the authority to divide the total annual compensation into the number of meetings and pay each member for attending the meetings. Banks often follow this procedure for their directors who are only paid if they attend the meeting.

• The board may allow for a certain number of excused absences and define what constitutes an excused absence. The board’s Bylaws states that board members are expected to attend all meetings unless attendance is not possible.

Should the board desire to allow for excused absences, valid reasons could include:

• Illness of the member or his or her family member.

2

• Required travel out of the County on the date of the meeting.

• Conflicting commitments required by the members official position.

If not able to attend, the member should notify board staff prior to the meeting and explain the reason for his or her absence. The date and time the member contacted staff should be noted and this information, together with the reason, should be made a part of the official minutes of the meeting.

10.11D POLICY - Attendance of Directors of the Board approved 5-31-07 Page 1 of 1

“Original” policy LEE MEMORIAL HEALTH SYSTEM BOARD OF DIRECTORS

POLICY MANUAL no. 10.11D supersedes no. 10.11C ------------------------------------------------------------------------------------------------------------------------------------- category: General Operations

title: Attendance of Directors of the Board ------------------------------------------------------------------------------------------------------------------------------------- original adoption: 01/08/91 review date: 2/1/07, 5/10/07

revision date: 07/31/98, 07/26/02, 06/30/05, 5/31/07 ------------------------------------------------------------------------------------------------------------------------------------- PURPOSE: The needs of the Health System are best served when all Directors are present at Board meetings. ------------------------------------------------------------------------------------------------------------------------------------- POLICY: As publicly elected officials, Directors must exercise diligence in the discharge of their public duties. When taking office each Director took an oath which included the statement, “I will well and faithfully perform the duties of a Director of the Board of Directors.” By adoption of this policy, the Board of Directors finds that attendance at regular meetings of the Board is necessary to meet the fiduciary duties to the public health care system and the health interests of the citizens served by the health system. The Lee Memorial Health System Board of Directors is authorized and empowered by its enabling act to approve annual compensation of up to $10,000 for services as members of the Board, as increased on the first day of each fiscal year by an amount equal to the increase in the Consumer Price Index for the prior fiscal year. ------------------------------------------------------------------------------------------------------------------------------------- PROCEDURE:

1. Directors are requested to notify the Board office when unable to attend a Board meeting as far in advance of said meeting as possible. Directors are requested to notify the Board office of dates they will be out of town and unavailable for meetings.

2. The minutes shall reflect Directors who are present at meetings and shall reflect when

a Director arrives if a Director arrives after a meeting is called to order and shall reflect when a Director departs if a Director departs prior to the end of the meeting.

10.11E TABLED - REVISED - Attendance of Directors of the Board for approval 022411 Page 1 of 1

TABLED from 2/24/11 LEE MEMORIAL HEALTH SYSTEM BOARD OF DIRECTORS

POLICY MANUAL ****REVISED**** no. 10.11 E D supersedes no. 10.11 D C --------------------------------------------------------------------------------------------------------------------------------------- category: General Operations

title: Board Member Attendance of Directors of the Board --------------------------------------------------------------------------------------------------------------------------------------- original adoption: 1/08/91 review date:5/27/10, 6/24/10, 8/26/10, 9/23/10, 02/24/11,3/24/11

revision date: 7/31/98, 7/26/02, 6/30/05, 5/31/07 --------------------------------------------------------------------------------------------------------------------------------------- PURPOSE: The needs of the Health System are best served when all Board Members Directors are present at Board meetings. --------------------------------------------------------------------------------------------------------------------------------------- POLICY: As publicly elected officials, Board Members Directors must exercise diligence in the discharge of their public duties. When taking office each Board Member Director took an oath which included the statement, “I will well and faithfully perform the duties of a Director of the Board of Directors.” By adoption of this policy, the Board of Directors finds that attendance at regular meetings of the Board is necessary to meet the fiduciary duties to the public health care system and the health interests of the citizens served by the health system.

The Lee Memorial Health System Board of Directors is authorized and empowered by its enabling act to approve annual compensation of up to $10,000 for services as members of the Board, as increased on the first day of each fiscal year by an amount equal to the increase in the Consumer Price Index for the prior fiscal year. ------------------------------------------------------------------------------------------------------------------------------------- PROCEDURE:

1. Board Members Directors are requested to notify the Board office when unable to attend a Board meeting as far in advance of said meeting as possible. Board Members Directors are requested to notify the Board office of dates they will be out of town and unavailable for meetings.

2. The minutes shall reflect Board Members Directors who are present at meetings and shall reflect when a Board Member Director arrives if a Board Member Director arrives after a meeting is called to order and shall reflect when a Board Member Director departs if a Board Member Director departs prior to the end of the meeting. For purposes of this attendance at a meeting, a Board Member must be present for 75% of any published monthly meeting.

3. Board Members will be required to attend a minimum of 60% (rounded up to the nearest whole number) of all published monthly meetings in order to receive compensation (stipend) for the month.

4. The Board Secretary shall notify in writing any Board Member who will not be receiving said compensation based on the attendance requirements as stated above. See Board Policy 20.13: Compensation and Benefits for Board Members. If a Board Member receives compensation in part or in whole for a month in which he or she did not meet the attendance requirements as stated above, such amount will be deducted from the next scheduled compensation payment(s).

“Original” policy LEE MEMORIAL HEALTH SYSTEM BOARD OF DIRECTORS POLICY MANUAL no. 20.13 E supersedes no. 20.13D --------------------------------------------------------------------------------------------------------------------------------- category: Financial Operations title: Compensation and Benefits for Board Members --------------------------------------------------------------------------------------------------------------------------------- original adoption: 6/28/91 review date: 5/27/10

revision date: 5/31/91, 7/31/98, 8/25/00, 3/01/02, 5/27/10 --------------------------------------------------------------------------------------------------------------------------------- PURPOSE: To adopt policies and procedures deemed appropriate regarding the granting of benefits and allowances for Board Members. --------------------------------------------------------------------------------------------------------------------------------- POLICY: The Lee Memorial Health System Board is authorized to adopt policies, procedures, guidelines, and rules that it deems appropriate pertaining to privileges, benefits, and allowances for Board Members. After a careful review and discussion regarding the granting of meal privileges for Board Members the following policy and procedure is hereby adopted.

• Board Members will not be eligible nor accept free meals at any of the System

cafeterias.

• The Board Administrator shall notify the Director of Food Services of this policy and have the Director inform his/her staff members at all the cafeterias to enforce this policy.

Each member of the Lee Memorial Health System Board of Directors shall receive the maximum total annualized rate authorized by law. Board Member compensation shall be paid in equal bi-weekly installments. Members shall be authorized to receive all privileges, benefits, and allowance authorized by law. Members electing to receive health benefits will be charged the same amount established for full time system employees as set from time to time and payment shall be made in the same manner as established for system employees.

20.13E-Compensation and Benefits for Board Members Approved 052710 Page 1 of 1

20.13 F TABLED - REVISED -Compensation and Benefits for Board Members for approval 022411 Page 1 of 1

TABLED from 2/24/11 LEE MEMORIAL HEALTH SYSTEM BOARD OF DIRECTORS POLICY MANUAL no. 20.13 F E ***REVISED*** supersedes no. 20.13E D ------------------------------------------------------------------------------------------------------------------------------------- category: Financial Operations title: Compensation and Benefits for Board Members ------------------------------------------------------------------------------------------------------------------------------------- original adoption: 6/28/91 review date: 6/24/10, 8/26/10, 9/23/10, 2/24/11, 3/24/11

revision date: 5/31/91, 7/31/98, 8/25/00, 3/01/02, 5/27/10 ------------------------------------------------------------------------------------------------------------------------------------- PURPOSE: To adopt policies and procedures deemed appropriate regarding the granting of benefits and allowances for Board Members. ------------------------------------------------------------------------------------------------------------------------------------- POLICY: The Lee Memorial Health System Board is authorized to adopt policies, procedures, guidelines, and rules that it deems appropriate pertaining to privileges, benefits, and allowances for Board Members. After a careful review and discussion regarding the granting of meal privileges for Board Members the following policy and procedure is hereby adopted.

• Board Members will not be eligible nor accept free meals at any of the System cafeterias.

• The Board Administrator shall notify the Director of Food Services of this policy and have

the Director inform his/her staff members at all the cafeterias to enforce this policy.

Each member of the Lee Memorial Health System Board of Directors may shall receive the maximum total annualized compensation rate authorized by its enabling law, if approved by the Board and subject to requirements established by Board Policy. Board Member compensation may shall be amortized over a twelve month period and paid in equal biweekly (once every two weeks)

installments, or such other installments as determined by administration and the Board. Upon verification of a Board Member’s failure to meet the attendance requirement for a particular month in accordance with Board Policy 10.11, a Board Member shall not receive compensation for said month. If a Board Member has already received compensation in part or in full for a month in which he or she failed to meet the attendance requirements set forth in Board Policy 10.11, such amount will be deducted from the next scheduled compensation payment(s). Members may shall be authorized to receive all privileges, benefits, and allowance authorized by law subject to Board Policy. Members electing to receive health benefits will be charged the same amount established for full time Ssystem employees as set from time to time and payment shall be made in the same manner as established for Ssystem employees.



NEW BUSINESS

______________


RECOMMENDED ACTION FOR BOARD APPROVAL (Action includes Acceptance, Approval, Adoption, etc)


DATE: 3/24/11 LEGAL REVIEW: Yes _x__ No ___

SUBJECT: Pediatric Therapy Lease

REQUESTOR & TITLE: David Cato, Vice President Outpatient Operations PREVIOUS BOARD ACTION ON THIS ITEM (IF ANY) (justification and/or background for recommendations – internal groups which support the recommendation i.e. SLC, Operating Councils, PMTs, etc.)

Approved by System Planning Group. SPECIFIC PROPOSED MOTION: Approval to lease Physical Therapy clinic space from Pediatric Orthopedics of SW Florida based upon following terms and set forth in the attached lease. Lease approval for approximately 3,000 SF at a base rent of $18/SF plus CAM for a 2 year term. Lease will be contingent upon final LMHS legal counsel review. PROS TO RECOMMENDATION Opportunity to collaborate with Peds Ortho physicians working with therapy patients Projected Positive Return on Investment

CONS TO RECOMMENDATION Additional Expense

LIST AND EXPLAIN ALTERNATIVES CONSIDERED Currently, the Peds Ortho group owns and operates the therapy clinic at this location. If we do not lease this space we will not be able to operate this location as a department of the Lee Memorial due to Provider based rules and regulations. This would decrease our ability to provide comprehensive and coordinated pediatric specialty clinic services to these patients. FINANCIAL IMPLICATIONS Budgeted __x__ Non-Budgeted ____ (including cash flow statement, projected cash flow, balance sheet and income statement) No additional capital dollars will be required to fund the project. We will lease the existing equipment from Pediatric Orthopedics. OPERATIONAL IMPLICATIONS (including FTEs, facility needs, etc.) We will hire 1.5 FTE Physical Therapist and 1.0 FTE Customer Service Rep for daily operations. Costs of these positions are covered by Revenue projections for the project.

SUMMARY By partnering with Pediatric Orthopedics of SW Florida we now have the opportunity to provide specific pediatric orthopedic therapy care at this location. LMHS will immediately be able to serve a larger patient population due to broader contracting capabilities by LMHS and the ability to take Medicaid patients. This will improve both the access to care for pediatric patients and the quality of care to pediatric patients. This project makes sense from several aspects including patient care, financial gain, and partnering with physicians.


Request Board Approval

Lease Pediatric Therapy Clinic Space

Overview• Peds Ortho currently owns and operates it’s own Pediatric

Therapy clinic next to Physician clinic near HP campus• Opportunity to Engage and Partner with Peds Ortho by

leasing this therapy space and operating therapy clinic• Provide increased access to care for Pediatric Therapy

patients• Peds Ortho currently limited in number of patients they can

provide service to (Medicaid, contracts)• LMHS in better position to provide staffing, billing,

scheduling, contracting, etc. specific to therapy• Win, win scenario for patients, physicians, and LMHS

Overview• LMHS take over therapy practice• No capital outlay required• Projected Margin $117,000 (31% Return)• Hire 1.5 Therapist, 1.0 Front Desk• Operate as a Hospital Based Clinic

Lease Terms• Full lease in Board Packet• 2 year term• $18/SF base rent plus CAM• Approximately $55,000 Annually• Approximately 3,000 SF• Lease contingent upon final LMHS legal

counsel review

Request Board Approval

Approval to lease Physical Therapy clinic space from Pediatric Orthopedics of SW Florida based upon following terms and set forth in the attached lease. Lease approval for approximately 3,000 SF at a base rent of $18/SF plus CAM for a 2 year term. Lease will be contingent upon final LMHS legal counsel review.

Questions?

______________





SUBJECT: Fulltime Sublease X-ray Space Pediatric Collier Specialty Clinic


Original lease terms approved by LMHS Board Finance Committee 1/21/10, lease signed 3/29/10. Approved FY 2010 tactic project. 11/11/10 received approval from Board Finance Committee to exercise lease option for additional space. SPECIFIC PROPOSED MOTION: Approval of Fulltime sublease between LMHS and Pediatric Specialist of SW Florida, LLC to sublease approximately 179 square feet of space at our Pediatric Specialty clinic in Collier County to operate an x-ray room per the terms in the attached lease. Fulltime sublease will be contingent upon final LMHS legal counsel review. PROS TO RECOMMENDATION Enable Peds Ortho specialty group to provide essential diagnostic services for patients Provides increased access to physician specialist for the Collier community Synergy between existing peds specialist, ortho, pediatricians, and therapies

CONS TO RECOMMENDATION Potential inefficient space utilization due to regulatory requirements that stipulate the need for a full time sublease.

LIST AND EXPLAIN ALTERNATIVES CONSIDERED Potential alternative would have Peds ortho find space in a separate location. This would decrease our ability to provide comprehensive and coordinated pediatric specialty clinic services to patients in Collier County. FINANCIAL IMPLICATIONS Budgeted __x__ Non-Budgeted ____ (including cash flow statement, projected cash flow, balance sheet and income statement) Pediatric Orthopedics of SW Florida will be furnishing the equipment and leasehold improvements specific to putting x-ray equipment in this space. OPERATIONAL IMPLICATIONS (including FTEs, facility needs, etc.) None

SUMMARY The Children’s Hospital Pediatric Specialty Clinic is a part of the overall mission of the Children’s Hospital to serve the children of SW Florida. This clinic opened March 1, 2011 and we currently provide multi-specialty physician services, lab draw services, physical therapy, occupational therapy, speech therapy, and audiology services. This clinic enables the Children’s Hospital to reach out into Collier County to provide much needed pediatric specific care to the community. By partnering with Pediatric Orthopedics of SW Florida we now have the opportunity to provide specific pediatric orthopedic care at this location.


Pediatric Specialty Clinic Collier County

Request Approval: Timeshare Sublease Template

and Fulltime Sublease X-ray space

Overview• Multi-specialty clinic opened March 1st• Integrate both Employed and

Independent Pediatric specialist • Dedicated pediatric PT, OT, Speech, and

audiology services• Extension of the Children’s Hospital of

SW Florida

Opportunity• Opportunity to Engage and Partner with

Independent Specialist in clinic• Provide much needed specialties to

community• Synergy with existing employed specialist and

Creekside Pediatrics (Collier Health Services)• Downstream Referrals to OP Therapy• Potential referrals/admissions back to the

Children’s Hospital

Lease Terms – Timeshare Sublease• Use attached template to sublease space to a variety of

independent physicians • Sublease time frames will range from 1 day/month to

several days/week based on specialty (ortho, pulmonary, cardiology)

• Seeking approval for CEO and/or COO’s to sign subleases moving forward at this location

• Full day blocks will be $250/day• Half day blocks will be $125/day• FMV based on pass through of LMHS cost

Lease Terms – Fulltime Sublease• Full terms in attached Fulltime sublease with Peds Ortho

group• This is specific to a x-ray room to be operated by Peds

Ortho group• Required to lease this space 24/7 since Peds Ortho will be

operating and billing for this service• 2 year term• Base rent is pass through of rent charged to LMHS: Year 1

= starting at 17.50 and escalating as LMHS rent escalates• Pass through CAM (Additional Rent)• 179 Rentable Square Feet

Request Board ApprovalTimeshare Sublease Template

Approval of Timeshare sublease template for LMHS to sublease space to independent physicians at our Pediatric Specialty clinic in Collier County per the terms in the attached lease. Approval for Chief Executive Officer and Chief Operating Officers of Lee Memorial Health System to sign all future timeshare subleases that we execute with physicians at our Pediatric Specialty Clinic in Collier County. Timeshare sublease template will be contingent upon final LMHS legal counsel review.

Fulltime Sublease X-ray SpaceApproval of Fulltime sublease between LMHS and Pediatric Specialist of SW Florida, LLC to sublease approximately 179 square feet of space at our Pediatric Specialty clinic in Collier County to operate an x-ray room per the terms in the attached lease. Fulltime sublease will be contingent upon final LMHS legal counsel review.

MEDICAL OFFICE SUBLEASE AGREEMENT

(Full-Time)

THIS SUBLEASE AGREEMENT (this “Agreement”) is made and entered into this ______ day of March, 2011, by and between Lee Memorial Health System, a special purpose unit of local government created by Special Act of the Florida Legislature (hereinafter referred to as "Sublandlord") and Pediatric Orthopedics of Southwest Florida, LLC, a Florida limited liability company (hereinafter referred to as "Subtenant").

1. Sublease of Space. On the terms and conditions set forth below, Sublandlord hereby subleases to

Subtenant and Subtenant hereby subleases from Sublandlord, approximately 179 rentable square feet of office space designated as Suite 203 (the “Office Space”) in the medical office building located at 1265 Creekside Parkway, Naples, Florida (the "Building"), as such space is shown generally on the drawing attached hereto as Exhibit A, which is a portion of the space currently being leased by Sublandlord in the Building. Sublandlord also grants Subtenant the non-exclusive right to use that hallway described on Exhibit A for purposes of accessing the Office Space.

2. Term. The term of this Agreement shall commence (the "Commencement Date") on the earlier of

(a) the date that a certificate of occupancy has been issued for the Office Space, or (b) the date that Subtenant begins occupying the Office Space, and continuing thereafter for a period of two (2) years (the "Term").

3. Preparation of Office Space. Subtenant acknowledges and agrees that the Office Space is

unfinished and is not complete or ready for Subtenant's use and occupancy. Sublandlord will work with the Prime Landlord (defined below) and its contractor to complete the installation of the demising walls, painted drywall, flooring or carpeting, and the door to the Office Space ("White Box Finish"), at Sublandlord's expense. Within fifteen (15) days from the date that this Agreement is fully executed, Sublandlord and Subtenant shall determine the nature and extent of any additional improvements beyond the White Box Finish, including, but not limited to the installation of special power sources, additional electrical components, and wall shielding, the cost of which shall not exceed Thirty Three Thousand Five Hundred and 00/100 Dollars ($33,500.00) so that Subtenant may use the Office Space as an imaging suite (the "Leasehold Improvements"). Sublandlord will be responsible for working with the Prime Landlord and its contractor to construct the Leasehold Improvements. The cost of the Leasehold Improvements, including the cost of architectural, engineering and space planning services will initially be paid by Sublandlord, but such amounts will be reimbursed by Subtenant after the Commencement Date and within fifteen (15) days following the submission of an invoice by Sublandlord, Prime Landlord or its contractor, as the case may be, to Subtenant for the total cost of the Leasehold Improvements. Other than Sublandlord's obligation to work with the Prime Landlord to deliver the Office Space with a White Box Finish, Sublandlord nor its agents or employees make any representations or warranties as to the quality of the White Box Finish, the Leasehold Improvements or the suitability or fitness of the Office Space for the conduct of Subtenant's use or for any other purpose, nor has Sublandlord or its agents or employees agreed to undertake any alterations or construct any improvements to the Office Space except as expressly set forth herein. Subtenant will be responsible for purchasing and installing, at its expense, the imaging equipment, trade fixtures, fixtures or other items necessary for its use of the Office Space.

4. Base Rent, Additional Rent and Payment. Subtenant agrees to pay rent during the Term of this

Agreement directly to Sublandlord at Sublandlord's address specified in Section 16 of this Agreement as follows:

(a) Base Rent. "Base Rent," as such term is used in the Prime Lease (defined below), throughout the Term of the Agreement, in the amounts set forth in the table below. Base Rent shall be paid in monthly installments, in advance, on the first day of each calendar month during the Term, without demand therefor, set off or abatement, in the amounts set forth in the table below. The Base Rent shall be prorated in the event that the Term results in a period of time that is less than a complete calendar year. Base Rent set forth below is subject to increases as a result of increases in the Base Rent paid by the Sublandlord under the Prime Lease (as defined herein) during the Term of this Agreement. Subtenant shall pay and be liable for all rental, sales and use taxes or other similar taxes, if any, levied or imposed on the Rent and any other sums payable hereunder, by any city, county, state or other governmental body having authority, such payments to be in addition to all other payments required to be paid to Sublandlord by Subtenant under the terms of this Agreement. Any such payment shall be paid to Sublandlord concurrently with the payment of the Rent or other payment upon which such tax is based.

Period

Base Rent per

Rentable Square Foot

Annual Base Rent

Monthly Base Rent

Commencement Date – 12/23/2011

$ 17.50 $ 3,132.50 $ 261.04

12/24/2011 – 12/23/2012 $ 18.00 $ 3,222.00 $ 268.50 12/24/2012 – 12/23/2013 $ 18.50 $ 3,311.50 $ 275.96

12/24/2013 – Expiration Date $ 20.50 $ 3,669.50 $ 305.79

(b) Additional Rent. In addition to any other amounts of additional rent attributable to Subtenant, throughout the Term, Subtenant shall pay an amount equal to Subtenant's Proportionate Share of Operating Expenses for the Office Space ("Additional Rent"). The term "Operating Expenses" shall mean all expenses and costs of every kind and nature which Sublandlord shall pay or become obligated to pay in connection with all of the space that Sublandlord currently leases in the Building by virtue of its status as a tenant under the Prime Lease, including but not limited to the following: repair and maintenance expenses, utility charges, real estate taxes, insurance, condominium association dues, HVAC use and maintenance costs, cable television service fees, and internet and janitorial expenses. It is hereby agreed that "Subtenant's Proportionate Share" of Operating Expenses constitutes one and seven tenths percent (1.7%) of all Operating Expenses incurred or paid by Sublandlord. Such share is arrived at by dividing the square feet of the Office Space (179 rentable square feet) by the square feet of space being set aside for the exclusive use by Sublandlord within the Building (10,534 rentable square feet). Subtenant acknowledges that Sublandlord may bill for Subtenant's Proportionate Share of Operating Expenses on a monthly (or other periodic) basis. Subtenant shall be responsible for (and shall pay Sublandlord on demand) any such pro-rated amount of Subtenant's Proportionate Share of Operating Expenses which are paid by Sublandlord, but which are attributable to the Term. Additional Rent shall be prorated in the event that the Term results in a period of time that is less than a complete calendar year. Base Rent and Additional Rent may hereinafter be referred to as "Rent" or "Rental".

(c) The rentable area in the Office Space has been calculated in accordance with the definition of “rentable area” in the BOMA Standard Method for Measuring Floor Area in Office Buildings, ANSI/BOMA Z65.1 - 1996 (the “BOMA Standard”). The rentable area in the Office Space as set forth on Page 1 of this Agreement is hereby stipulated to be the rentable area of the Office Space for all purposes under this Agreement, whether the same should be more or less as a result of minor variations resulting from actual construction and completion of the Office Space and for actual occupancy; provided, however, in the event Sublandlord re-measures the Office Space in accordance with commercially reasonable procedures in conformity with the BOMA Standard and if the rentable area of the Office Space is different than above stated, Sublandlord may give Subtenant written notice of the change and the new number of square feet shall become the rentable area of the Office Space for all purposes effective as of the date of such notice. In the event of any such adjustment in the rentable area of the Office Space, the portion of the Rent calculated on the basis of the fair market rental rate for the Office Space shall be adjusted in accordance with the change in the Office Space square footage calculation.

(d) If any monthly Rent is not received by the 10th day of the month, Subtenant shall, upon demand,

pay Sublandlord a late charge of 5% of the amount of such installment. In addition, if any such past due installment of the Rent is not paid by the 10th day of the next month or by the 10th day of any subsequent month, such past due installment shall be subject to an additional late charge in the same amount for each such month until paid. Such late charge is to defray the administrative costs and inconvenience and other expenses which Sublandlord will incur on account of such delinquency. The right to recover such late charges shall be in addition to any other remedies available as a matter of law or as otherwise provided in this Agreement.

5. Maintenance. Sublandlord shall maintain the Office Space in good repair and condition. Subtenant

shall repair, in a good and workmanlike manner, any damage to the Office Space or the Equipment, if any, caused by any breach of this Agreement or by any willful or negligent act or omission of Subtenant, or of any employee, agent or invitee of Subtenant; provided that if any such damaged Equipment cannot be restored to operable condition, Subtenant shall replace the same at its sole cost and expense.

6. Compliance with Laws. In its use and occupancy of the Office Space, Subtenant shall comply with

all applicable laws and other governmental rules, regulations and orders and with the Rules and Regulations attached hereto as Exhibit B and made a part hereof, and with such other reasonable rules and regulations which Sublandlord may adopt from time to time for the Office Space. Subtenant and Subtenant's employees and agents shall comply with all federal, state or local laws, ordinances and regulations concerning the generation, storage and/or removal of infectious, biohazardous and hazardous waste from the Office Space.

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7. Fire and Other Casualty. If the Office Space or the Building shall be damaged by fire or other casualty and the Office Space is thereby rendered wholly or partly unsuitable for its intended use, then Sublandlord may terminate this Agreement. If Sublandlord desires to terminate this Agreement, it shall give Subtenant written notice of termination within 30 days of the occurrence of such damage, and upon the giving of such notice, this Agreement shall terminate as of the date of the casualty, and any prepaid Rent shall be refunded to Subtenant, and both parties shall be released of all liabilities and obligations under this Agreement arising or accruing after the effective date of termination.

8. Services, Equipment and Utilities.

(a) Sublandlord shall provide such services for Subtenant's use of the Office Space as Sublandlord deems necessary in its sole reasonable discretion.

(b) Subtenant shall be solely responsible for providing and maintaining his or her own medical records system, which shall include, but not be limited to patient charts, consent forms, and all other documentation necessary to comply with all applicable laws, rules, regulations and standards governing his or her specific medical practice.

(c) Subtenant shall pay and be solely responsible for (i) all costs of postage and private overnight or

express delivery service incurred in connection with the medical practice conducted by Subtenant in the Office Space; (ii) any customized printed or engraved stationery or business cards used by Subtenant in connection with his or her medical practice in the Office Space; and (iii) all costs associated with any answering service used by Subtenant in connection with his or her medical practice in the Office Space.

(d) Sublandlord assumes no responsibility for any money in any form or other valuables or any other

personal property or equipment brought into or left in the Office Space by Subtenant, all of which shall be at Subtenant's sole risk. Subtenant assumes sole responsibility for the collection of all fees for services rendered by Subtenant during each day he or she practices medicine in the Office Space.

(e) Subtenant shall provide at his or her sole expense an accounts receivable billing service adequate

for Subtenant's practice of medicine within the Office Space. (f) Sublandlord shall pay for all electricity consumed within the Office Space as normally and

reasonably required for medical office use; provided, however, that Sublandlord shall not be responsible for any interruption or cessation of electrical services to the Office Space or for any damage to Subtenant's business or property caused by any such interruption or cessation.

(g) Sublandlord shall furnish for Subtenant’s use the furniture, fixtures, equipment and other personal

property located within the Office Space listed on Exhibit C attached hereto (collectively, the “Equipment”), if any. Sublandlord shall be obligated to furnish furniture, fixtures, equipment and other personal property only to the extent listed on Exhibit C, and if Exhibit C is blank or if there is no Exhibit C, then Sublandlord shall have no such obligation. If any Equipment is listed on Exhibit C, then Subtenant’s use of such Equipment shall be subject to the terms set forth on Exhibit C and the terms of Exhibit C are and shall be incorporated herein as if set forth in full herein.

(h) Sublandlord shall furnish for Subtenant’s the services listed on Exhibit D attached hereto, if any

(collectively, the “Services”). If Exhibit D is blank or if there is no Exhibit D, then Sublandlord shall have no such obligation.

9. Use. The Office Space shall continuously and at all times during the Term be used and occupied

by Subtenant only as medical offices for licensed physicians (“Physicians”) to engage in the private practice of pediatric medicine and other related activities incidental thereto, and for no other purpose.

9.1 Prohibited Uses.

(a) Notwithstanding anything to the contrary in paragraph 9 above, the provision or operation of any of the following services or facilities shall not be permitted in the Office Space:

(i) a health care facility that has facilities for overnight accommodations of patients;

(ii) the provision of any medical or related service to or for any person that is in addition to the examination and diagnosis of patients performed directly by a Physician or by other health care professionals either independently licensed or under the direct supervision of a Physician, or a facility operated for the provision of any such service(s);

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(iii) outpatient or inpatient surgery services;

(iv) a birthing center;

(v) an oncology treatment facility;

(vi) physical therapy services;

(vii) respiratory therapy services;

(viii) a laboratory (including, without limitation, a pathology laboratory or a clinical laboratory); and

(ix) a facility providing diagnostic or therapeutic testing services, including without limitation, all diagnostic imaging services, including without limitation:

A. fluoroscopy; B. x-ray; C. plane film radiography; D. computerized tomography (CT); E. ultrasound; F. radiation therapy; G. mammography and breath diagnostics; H. nuclear medicine testing; and I. magnetic resonance imaging.

(b) Notwithstanding the foregoing, nothing herein shall prevent Physicians who conduct a medical practice in the Office Space from performing outpatient surgeries that do not require general anesthesia or intravenous sedation or from rendering pathological laboratory or x-ray services for which Subtenant has obtained Sublandlord’s consent pursuant to paragraph 9(c); provided that such surgery services, pathological laboratory or x-ray services are the kind usually and customarily provided in a physician’s office, are provided to such Physician’s own patients who are not referred to such Physician for the sole purpose of receiving the same, and are merely ancillary and incidental to such Physician’s primary medical practice and do not constitute such Physician’s primary medical practice or specialty or constitute the predominant services rendered by such Physician to Physician’s patients.

(c) Prior to providing pathological laboratory or x-ray services, Subtenant shall have submitted to Sublandlord a detailed description of the laboratory or x-ray services Subtenant desires to provide or perform and Sublandlord shall have consented in writing to the provision or performance of such services, which consent may be denied in Sublandlord’s sole and absolute discretion (the provision of such services and procedures shall be strictly limited to those services and procedures to which Sublandlord has expressly consented in writing and the terms of this paragraph shall be strictly construed to prohibit any expansion or addition to such services or procedures without Sublandlord’s written consent). Subtenant shall not dispense any drugs or medicines to persons other than Subtenant’s own patients. Prior to the installation of any diagnostic, laboratory or radiology equipment for services permitted hereunder, Subtenant shall provide Sublandlord with a list of such equipment; a list of any hazardous substances, wastes or materials, as hereinafter defined, which will be used or generated in connection with the use of such diagnostic, laboratory or radiology equipment; and Subtenant’s proposed procedures for the use, storage and disposal of any hazardous substances, wastes or materials, including but not limited to the procedure for silver recovery for any radiology equipment.

9.2 Physician Qualifications. All Physicians who conduct a medical practice and related activities in the Office Space must be and remain appropriately licensed and in good standing with the state licensing board and any applicable federal, state or local certification or licensing agency or office, without restriction, not subject to any sanction, exclusion order, or other disciplinary order with respect to his or her participation in any federal or state healthcare program. Further, all such Physicians must be qualified to be a member of the active medical staff of Lee Memorial Health System (the “Hospital”); provided, however, that nothing in this paragraph 9.2 shall require any Physician actually to be a member of the Hospital’s active medical staff.

9.3 Supervision and Management. The medical practice conducted in the Office Space shall at all times be conducted under the supervision and authority of a Physician and, except with Sublandlord’s prior written consent, which may be withheld in Sublandlord’s sole and absolute discretion, Subtenant shall not (1) allow any other person or entity to purchase, manage or operate his or her medical practice or (2) conduct the medical practice while serving as an agent or employee of any other person or entity.

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9.4 Compliance with Legal Requirements. Subtenant shall act in accordance with and not violate any restrictions or covenants of record affecting the Office Space or the Building. Subtenant shall not use or occupy the Office Space in violation of law or of the Certificate of Use or Occupancy issued for the Building of which the Office Space is a part, and shall immediately discontinue any use of the Office Space which is declared by either any governmental authority having jurisdiction or the Sublandlord to be a violation of any law, code, regulation or a violation of said Certificate of Use or Occupancy. Subtenant shall comply with any direction of any governmental authority having jurisdiction which shall, by reason of the nature of Subtenant’s use or occupancy of the Office Space, impose any duty upon Subtenant or Sublandlord with respect to the Office Space or with respect to the use or occupancy thereof.

9.5 Hazardous Acts; Waste; Nuisance. Subtenant shall not do nor permit to be done anything which will invalidate or increase the cost of any casualty and extended coverage insurance policy covering the Building and/or property located therein, and shall comply with all rules, orders, regulations and requirements of the appropriate Fire Rating Bureau or any other organization performing a similar function. Subtenant shall promptly upon demand reimburse Sublandlord for any additional premium charged for such policy by reason of Subtenant’s failure to comply with the provisions of this paragraph. Subtenant shall not do nor permit anything to be done in, on or about the Office Space which would in any way obstruct or interfere with the rights of other tenants or occupants of the Building, or use or allow the Office Space to be used for any immoral, unlawful or objectionable purpose, nor shall Subtenant maintain or permit any nuisance or commit or suffer to be committed any waste in, on or about the Office Space.

10. Indemnification. Subtenant shall indemnify and hold Sublandlord and Prime Landlord (defined

below) harmless against and from any and all claims, demands, actions, losses, damages, orders, judgments and any and all costs and expenses (including without limitation reasonable attorneys' fees, court costs, and costs of litigation), resulting from or incurred by Sublandlord or Prime Landlord arising out of (i) Subtenant's use of the Office Space, (ii) any medical procedure performed in the Office Space, or (iii) from any default by Subtenant under this Agreement.

11. Insurance. Subtenant will procure and maintain during the Term a policy or policies of insurance,

written by an insurance company or companies licensed to do business in the State of Florida with an A.M.Best rating of A-,8 or equivalent, insuring Subtenant against any and all losses, claims, demands or actions whatsoever for injury to or death of any one or more persons in any one occurrence to the limit of not less than One Million Dollars ($1,000,000) and for damage to property in an amount not less than One Million Dollars ($1,000,000), which insurance will cover accidents occurring in the Office Space or arising from Subtenant's conduct and operation of Subtenant's business in the Office Space. The policy of insurance required to be carried by Subtenant hereunder, or a certificate thereof, shall be delivered to Sublandlord and Prime Landlord at least ten (10) days prior to the Commencement Date. Said policy shall expressly provide that Sublandlord and Prime Landlord are additional insureds and that the policy shall not be canceled or altered in such a manner as to adversely affect the coverage afforded thereby without thirty (30) days prior written notice to Sublandlord and Prime Landlord.

12. Waiver of Subrogation. Sublandlord and Subtenant on behalf of themselves and all others claiming

under them, including any insurer, waive all claims against each other, including all rights of subrogation, for loss or damage to their respective property (including, but not limited to, the Office Space) arising from fire, smoke damage, windstorm, hail, vandalism, theft, malicious mischief and any of the other perils normally insured against in an "all risk" of physical loss insurance policy, regardless of whether insurance against those perils is in effect with respect to such party's property and regardless of the negligence of either party. If either party so requests, the other party shall obtain from its insurer a written waiver of all rights of subrogation that it may have against the other party so long as such waiver is commercially available.

13. Default. If Subtenant fails to pay the Rent or other sum payable by Subtenant hereunder and fails

to cure such default within five (5) days after notice thereof, or if Subtenant defaults in the prompt or full performance of any other provision of this Agreement and fails to cure such default within thirty (30) days after notice thereof, Sublandlord shall have the right to terminate this Agreement and deny Subtenant access to the Office Space by any lawful means. In the event of such termination by Sublandlord, all of Subtenant's rights and privileges hereunder shall terminate and Sublandlord shall have no further obligation to Subtenant under this Agreement.

14. Assignment or Transfer The rights granted by Sublandlord to Subtenant under this Agreement are

considered a personal privilege and may not be assigned or transferred, in part or in whole, without the written consent of Sublandlord, which consent may be withheld in Sublandlord’s sole and absolute discretion.

15. Events of Holdover. In the event Subtenant should remain in possession of the Office Space after

expiration of the Term of this Agreement without execution by Sublandlord and Subtenant of a new Agreement or extension of the Term of this Agreement, then Subtenant shall be deemed to be occupying the Office Space as a

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tenant at sufferance subject to all of the covenants and obligations of this Agreement and at a daily Rent of one hundred fifty percent (150%) of the per diem rate of Rent provided hereunder until such time as Subtenant vacates the Office Space. Sublandlord shall have the right to deem the continuing occupancy of Subtenant to constitute the creation of a month-to-month tenancy at one hundred percent (100%) of the Rent provided hereunder, provided Sublandlord gives Subtenant notice of such election, which month-to-month tenancy shall continue thereafter until either party shall have given the other one (1) full calendar month's notice of its intention to terminate such month-to-month tenancy.

16. Notice. All notices to be given hereunder by either party shall be in writing and may be sent by

United States certified mail, postage prepaid, addressed to:

Sublandlord: Lee Memorial Health System Attn: Property Management 636 Del Prado Blvd Cape Coral, FL 33990

Subtenant: Pediatric Orthopedics of Southwest Florida, LLC

15880 Summerlin Rd #300 PMB #322, Fort Myers, Florida 33908 Attention: ____________________________

or to such other address as either party may have furnished to the other. Any notice shall be deemed given when deposited in the mail in the foregoing manner.

17. Subordination to Prime Lease. (a) The Office Space is leased to Sublandlord pursuant to that certain Commercial Lease, dated March

29, 2010, as amended by that First Amendment To Commercial Lease dated June 17, 2010, and as further amended by that Second Amendment To Commercial Lease dated March ________, 2011 (said lease as amended shall hereinafter be referred to as the “Prime Lease”), between Creekwood of Naples, LLC, a Florida limited liability company (the “Prime Landlord”), as landlord, and Sublandlord, as tenant, and unless renewed or extended, the Prime Lease will expire on December 23, 2017. Accordingly, this Agreement (including, without limitation, Subtenant’s occupancy and use rights with respect to the Office Space) is subject and subordinate to the Prime Lease and to all of the matters to which the Prime Lease is or shall be subordinate. Subtenant acknowledges that the Office Space may only be used to provide pediatric health care. Notwithstanding anything to contrary provided elsewhere in this Agreement, if the term of the Prime Lease is not extended, this Agreement will expire and terminate on the date of expiration of the term of the Prime Lease unless Prime Landlord assumes this Agreement as provided below. Subtenant acknowledges that Sublandlord shall have no obligation to renew or extend the term of the Prime Lease. In the event of termination or expiration of the Prime Lease prior to the expiration or earlier termination of this Agreement, Prime Landlord may, at its option, take over and assume the rights and interests of Sublandlord under this Agreement (but Prime Landlord shall have no obligation to do so), and in such event, Subtenant shall attorn to the Prime Landlord pursuant to the provisions of this Agreement; provided that, Prime Landlord shall not (i) be liable for any previous act or omission of Sublandlord under this Agreement, (ii) be subject to any offset, not expressly provided in this Agreement, which theretofore accrued to Subtenant against Sublandlord, or (iii) be bound by any previous prepayment of more than one month's rent. This paragraph 17 shall not apply if the name of the Prime Landlord is not inserted above.

(b) Insofar as Prime Landlord is or may be obligated to furnish any services to the Office Space, to

repair or rebuild the same, to perform any other act whatsoever with respect to the or the Building or to perform any obligation or satisfy any condition under the Prime Lease, Subtenant expressly acknowledges that notwithstanding anything to the contrary provided in this Agreement, Sublandlord does not undertake the performance or observance of such obligations, but is only obligated to use reasonable efforts to obtain Prime Landlord’s performance for Subtenant’s benefit and without obligating itself to institute legal action or incur any out of pocket expense.

18. Radon Gas. (Applicable in Florida only) Radon is a naturally occurring radioactive gas that, when it has accumulated in a building in sufficient quantities, may present health risks to persons who are exposed to it over time. Levels of radon that exceed federal and state guidelines have been found in buildings in Florida. Additional information regarding radon and radon testing may be obtained from the local county public health unit.

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19. Regulatory Matters. (a) Sublandlord and Subtenant enter into this Agreement with the intent of conducting their relationship and implementing the agreements contained herein in full compliance with applicable federal, state and local law, including without limitation, the Medicare/Medicaid Anti-Kickback statute (the “Anti-Kickback Law”) and Section 1877 of the Social Security Act (the “Stark Law”), as amended. Notwithstanding any unanticipated effect of any of the provisions of this Agreement, neither party will intentionally conduct itself under the terms of this Agreement in a manner that would constitute a violation of the Anti-Kickback Law or the Stark Law. Without limiting the generality of the foregoing, Sublandlord and Subtenant expressly agree that nothing contained in this Agreement shall require either party to refer any patients to the other, or to any affiliate or subsidiary of the other. If any legislation, regulation or government policy is passed or adopted, the effect of which would cause either party to be in violation of such laws due to the existence of any provision of this Agreement, then Sublandlord and Subtenant agree to negotiate in good faith for a period of 90 days to modify the terms of this Agreement to comply with applicable law. Should the parties hereto fail to agree upon modified terms to this Agreement within this time, either Sublandlord or Subtenant may immediately terminate this Agreement by giving written notice to the other party.

(b) Subtenant represents and warrants to Sublandlord that Subtenant (i) is not currently excluded,

debarred or otherwise ineligible to participate in Medicare or any federal health care program under section 1128 and 1128A of the Social Security Act or as defined in 42 U.S.C. § 1320a-7b(f) (the “Federal Health Care Programs”); (ii) has not been convicted of a criminal offense related to the provision of healthcare items or services but has not yet been excluded, debarred, or otherwise declared ineligible to participate in any Federal Health Care Program; and (iii) is not under investigation or otherwise aware of any circumstances which may result in Subtenant being excluded from participation in any Federal Health Care Program. The foregoing representation shall be an ongoing representation and warranty during the term of this Agreement and Subtenant shall immediately notify Sublandlord of any change in the status of the representation and warranty set forth in this paragraph, at which time Sublandlord will have the right to immediately terminate this Agreement.

(c) For purposes of this paragraph of this Agreement, “protected health information”, or PHI, shall have the meaning defined by the Standards for Privacy of Individually Identifiable Health Information, 45 C.F.R. Part 160 and Subparts A and E of Part 164 (the “Privacy Standards”), as promulgated by the Department of Health and Human Services (“HHS”) pursuant to the Administrative Simplification provisions of the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”). Subtenant agrees to reasonably safeguard PHI from any intentional or unintentional disclosure in violation of the Privacy Standards by implementing appropriate administrative, technical and physical safeguards to protect the privacy of PHI. Subtenant further agrees to implement appropriate administrative, technical and physical safeguards to limit incidental disclosures of PHI, including disclosures to Sublandlord, its subcontractors and agents. The parties agree that neither the Sublandlord nor its contractors, subcontractors or agents shall need access to, nor shall they use or disclose, any PHI of Subtenant. However, in the event PHI is disclosed by Subtenant or its agents to Sublandlord, its, contractors, subcontractors or agents, regardless as to whether the disclosure is inadvertent or otherwise, Sublandlord agrees to take reasonable steps to maintain, and to require its contractors, subcontractors and agents to maintain, the privacy and confidentiality of such PHI. The parties agree that the foregoing does not create, and is not intended to create, a “business associate” relationship between the parties as that term is defined by the Privacy Standards.

20. Personal Items. The limited storage by Subtenant of items of personal property (“Personal Items”)

in the Office Space is permissible if (a) the presence of such items will not interfere with the use of the Office Space by others and (b) Sublandlord in its sole discretion does not object to such storage. Subtenant agrees not to use any Personal Items left or stored in the Office Space by any other subtenant, occupant or user of the Office Space without the consent of such other subtenant, occupant or user. Subtenant acknowledges and agrees that (i) any Personal Items brought into, left or stored in the Office Space will be unsecured, (ii) Sublandlord shall have no duty or obligation to provide security for or otherwise safeguard any Personal Items brought into, left or stored in the Office Space, (iii) Sublandlord assumes no responsibility for any Personal Items brought into, left or stored in the Office Space by Subtenant or any agent or employee of Subtenant, all of which shall be at Subtenant's sole risk, (iv) Subtenant assumes all risk of damage to, destruction of or loss from any cause whatsoever of any Personal Items brought into, left or stored in the Office Space by Subtenant or any agent or employee of Subtenant, and (v) Subtenant waives any and all claims against Sublandlord for any damage to, destruction of or loss of any such Personal Items brought into, left or stored in the Office Space. Furthermore, Subtenant hereby assumes all risk of injury to persons or damage to property resulting from the presence of or use by any person of any Personal Items brought into, left or stored in the Office Space by Subtenant or any agent or employee Subtenant (whether or not such person had permission to use such Personal Items). Subtenant shall indemnify and hold harmless Sublandlord and its affiliates against and from any and all claims, demands, actions, losses, damages, orders, judgments and any and all costs and expenses (including without limitation reasonable attorneys' fees and costs of litigation), resulting from or incurred by Sublandlord or any affiliate of Sublandlord arising out of (A) the presence of any Personal Items brought into, left or stored in the Office Space by Subtenant or any agent or employee of Subtenant, (B) any injury to persons or damage to property resulting from the presence of or use by any person of any Personal Items brought into, left or stored in the Office Space by Subtenant or any agent or employee of Subtenant (whether or not such person had

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permission to use such Personal Items), (C) any damage or loss caused by Subtenant or by any agent or employee of Subtenant to any Personal Items left or stored in the Office Space by any other subtenant, occupant or user of the Office Space and/or (D) the disposition of any Personal Items left or stored in the Office Space by Subtenant or any agent or employee of Subtenant. At any time Sublandlord may notify Subtenant of Sublandlord's objection to the storage of Personal Items by Subtenant or any agent or employee of Subtenant, and Subtenant shall promptly remove such Personal Items from the Office Space. If Subtenant does not remove such Personal Items in accordance with this provision, then Subtenant hereby authorizes Sublandlord to remove such Personal Items, at Subtenant's expense, and to make any disposition of such Personal Items as Sublandlord may determine appropriate in its discretion.

IN WITNESS WHEREOF, the parties hereto have executed this Agreement on the date first above written. Witnesses: Witness Signature Witness Printed Name Witness Signature Witness Printed Name

SUBLANDLORD: LEE MEMORIAL HEALTH SYSTEM By: Print Name: Print Title: Date:

Witnesses: Witness Signature Witness Printed Name Witness Signature Witness Printed Name

SUBTENANT: PEDIATRIC ORTHOPEDICS OF SOUTHWEST FLORIDA, LLC By: Print Name: Print Title: Date:

1037000v7

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ACKNOWLEDGMENT AND CONSENT BY PRIME LANDLORD

Creekwood of Naples, LLC, a Florida limited liability company ("Prime Landlord") hereby acknowledges and consents to the foregoing Medical Office Sublease Agreement ("Agreement") between Lee Memorial Health System, as Sublandlord, and Pediatric Orthopedics of Southwest Florida, LLC, a Florida limited liability company, the proposed Subtenant under the Agreement. Prime Landlord acknowledges that the "Office Space" being subleased under the Agreement is space that is currently being leased by Prime Landlord to Sublandlord pursuant to the terms of that certain Commercial Lease, dated March 29, 2010, as amended by that First Amendment To Commercial Lease dated June 17, 2010, and as further amended by that Second Amendment To Commercial Lease dated March ______, 2011 (said lease as amended shall hereinafter be referred to as the “Prime Lease”). As of the date set forth below, the Prime Lease remains in full force and effect.

IN WITNESS WHEREOF, Prime Landlord has executed and delivered this Acknowledge and Consent as of the _____ day of March, 2011.

PRIME LANDLORD: CREEKWOOD OF NAPLES, LLC By:_______________________________________ Printed: ___________________________________ Title: _____________________________________

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EXHIBIT A

Diagram of Office Space

Access Hallway

Office Space

A-1

EXHIBIT B

Rules and Regulations

1. Tobacco use is strictly prohibited in the Office Space, the Building, the parking areas and surrounding grounds and Subtenant, its employees, agents, customers, contractors, subtenants, assignees, patients, invitees, or licensees shall comply with the Lee Memorial Health System tobacco free policy.

2. No animals shall be kept in or about the Office Space.

3. Subtenant shall not use the water closets and other plumbing fixtures for any purposes other than those for which they were constructed, and shall not place any debris, rubbish, rags or other substances therein. All damage resulting from any misuse of the fixtures shall be borne by the Subtenant whose servants, employees, agents, customers, contractors, subtenants, assignees, patients, invitees, or licensees shall have caused the same.

4. Subtenant shall not place any furniture, equipment, records, trash or other objectionable material in the common areas of the Building other than in an appropriate refuse container.

5. The Subtenant or his employees shall not make or commit any indecent or improper acts while on the property or make any unseemly or disturbing noises or disturb or interfere with neighboring occupants of the Building or those having business with them, whether by use of any musical instrument, radio, loud speaker, singing, or in any other way. Subtenant or his employees shall not throw anything out of the doors or windows of the Office Space.

6. The Office Space shall not be used for the sale of merchandise in the ordinary course of business, or for the sale at auction of merchandise, goods or property of any kind.

7. Sublandlord does not assume any responsibility, and shall not be held liable, for any damage or loss to any automobile or personal property in the parking lot or for any injury sustained by any person in the parking lot.

8. The entry, corridors, and stairways shall not be obstructed by the Subtenant, nor used by the Subtenant for any purpose other than ingress or egress to and from the Office Space, nor shall employees of the Subtenant loiter or congregate therein. The floors and windows that reflect or admit light into passageways in common areas shall not be covered or obstructed by the Subtenant.

9. The Sublandlord reserves the right to make such other and further rules and regulations as Sublandlord shall deem necessary.

10. Subtenant shall not, without the written consent of Sublandlord, place a load upon any floor of the Building exceeding 80 pounds per square foot. Additional air conditioning, electrical or other facilities required in connection with the installation and operation of any computers or other large business equipment shall be made at Subtenant's expense and only after obtaining Sublandlord's written consent. Subtenant shall pay for the cost of electrical current required to operate computers and other large business equipment and for the cost of additional air conditioning necessitated by such equipment.

11. Subtenant will not permit or suffer any signs, advertisement or notices to be displayed, inscribed upon or affixed on any part of the outside of the Office Space or on windows or doors or on the adjacent street, except that directory boards and Office Space identification signs shall be provided by the Sublandlord. Signage on entry doors to the Office Space will be provided by Sublandlord consistent with signage standards within the Building.

B-1

EXHIBIT C

Equipment None

C-1

EXHIBIT D

Services List services to be provided by Sublandlord: The following shall be provided within the Office Space:

• Water as required for normal and customary medical office use; • Elevator service on a continuous basis, if applicable; • Central heat and air-conditioning; • Electrical power as required for normal and customary medical office use; • Lamps, bulbs, tubes and ballasts for building standard lighting fixtures used in the Office Space; • Sanitary sewer services; • television with cable service (in waiting room); • basic disposable medical supplies (e.g., band-aids, gauze, paper for the exam tables, otoscope

tips, hand hygiene supplies, alcohol preps); • miscellaneous office supplies; • non-infectious waste disposal; • infectious waste disposal; • "sharps" disposal; • recycling services; • telecommunication services (including basic telephone services, desk-top computers, and wireless

network access) • janitorial and trash removal services three (3) days during a regular work week; and • repair, maintenance and replacement (as needed) of the Office Space and all HVAC, mechanical;

electrical and plumbing systems.

D-1

______________





SUBJECT: Timeshare Sublease Template Pediatric Collier Specialty Clinic


Original lease terms approved by LMHS Board Finance Committee 1/21/10, lease signed 3/29/10. Approved FY 2010 tactic project. 11/11/10 received approval from Board Finance Committee to exercise lease option for additional space. SPECIFIC PROPOSED MOTION: Approval of Timeshare sublease template for LMHS to sublease space to independent physicians at our Pediatric Specialty clinic in Collier County per the terms in the attached lease. Approval for Chief Executive Officer and Chief Operating Officers of Lee Memorial Health System to sign all future timeshare subleases that we execute with physicians at our Pediatric Specialty Clinic in Collier County. Timeshare sublease template will be contingent upon final LMHS legal counsel review. PROS TO RECOMMENDATION Enable Peds Specialty clinic to engage independent specialty physicians to participate in this multi-disciplinary clinic. Provides increased access to physician specialist for the Collier community Synergy between existing peds specialist, ortho, pediatricians, and therapies

CONS TO RECOMMENDATION Potential inefficient space utilization

LIST AND EXPLAIN ALTERNATIVES CONSIDERED Independent physicians would have to find space in a separate location from our clinic. Since the demand for these services varies from 1 day/month to 3 days per week depending on specialty most physicians would not be able to find a part-time lease arrangement else where. This would decrease our ability to provide comprehensive and coordinated pediatric specialty clinic services to patients in Collier County. FINANCIAL IMPLICATIONS Budgeted __x__ Non-Budgeted ____ (including cash flow statement, projected cash flow, balance sheet and income statement) No additional capital dollars will be required to fund the project. We are simply passing through the cost of our lease on a daily rate or partial daily rate basis. OPERATIONAL IMPLICATIONS (including FTEs, facility needs, etc.) None

SUMMARY The Children’s Hospital Pediatric Specialty Clinic is a part of the overall mission of the Children’s Hospital to serve the children of SW Florida. This clinic opened March 1, 2011 and we are currently providing multi-specialty physician services (employed only), lab draw services, physical therapy, occupational therapy, speech therapy, and audiology services. This clinic enables the Children’s Hospital to reach out into Collier County to provide much needed pediatric specific care to the community. By partnering with independent physician specialists we now have the opportunity to provide a larger spectrum of specialty care at this location.


MEDICAL OFFICE SUBLEASE AGREEMENT

(Timeshare)

THIS SUBLEASE AGREEMENT (this “Agreement”) is made and entered into this ______ day of ____________________, 2010, by and between Lee Memorial Health System (hereinafter referred to as "Sublandlord") and ___________________, an ____________________ (hereinafter referred to as "Subtenant").

1. Sublease of Space. On the terms and conditions set forth below, Sublandlord hereby subleases to

Subtenant and Subtenant hereby subleases from Sublandlord, approximately ___________ square feet of office space designated as Suite 203 (the “Office Space”) in the medical office building located at 1265 Creekside Parkway, Naples, Florida (the "Building"), as such space is shown generally on the drawing attached hereto as Exhibit A. Sublandlord also grants Subtenant permission to use the “Equipment” (as defined and described in Paragraph 7), if any, during the term of this Agreement.

2. Term. (a) The commencement date of the term of this Agreement shall be __________________, 2011, (the

“Commencement Date”), and shall continue thereafter for ______year and ________ months and shall expire at 11:59 p.m. on _________________________________, 20____ .

(b) During the Term of this Agreement, Subtenant shall have the right to occupy and use the Office

Space on ______________[day or week] from the hours of ________________[time of use in increments] (the “Use Period”). The Use Period shall not include New Years Day, The Fourth of July, Labor Day, Thanksgiving, and Christmas, or any other holiday day recognized by the Sublandlord (a “Holiday”). Any additions, cancellations, or changes to a Use Period proposed by Subtenant shall be communicated to Sublandlord at least thirty (30) days in advance ("Notice Period"). In the event that Subtenant fails to (i) cancel a Use Period before the Notice Period, or (ii) to utilize the Office Space during a Use Period, Subtenant will be responsible for Rent for the Office Space during the applicable Use Period. The parties acknowledge and agree that Subtenant will have exclusive possession of the Office Space during Use Periods only. Subtenant recognizes that the Office Space may be used or subleased by Sublandlord prior to or immediately after the Use Period, and therefore Subtenant must vacate and leave the Office Space on a timely basis, leaving the same in a clean and orderly condition at the end of each Use Period. Failure to do so may result in the Subtenant having to pay damages as set forth below.

3. Rent, Adjustments and Payment. (a) Rent. Subtenant agrees to pay Sublandlord a rent for use of the Office Space in the amounts set

forth in the attached Exhibit B during the Term of this Agreement (the “Rent”). The Rent shall be payable monthly and shall be due and payable in advance on the first day of each calendar month. Such Rent shall be paid, without demand or deduction, in lawful money of the United States of America to Sublandlord, at the address listed in Section 15, or at such other address as Sublandlord may designate. Subtenant shall pay and be liable for all rental, sales and use taxes or other similar taxes, if any, levied or imposed on the Rent and any other sums payable hereunder, by any city, county, state or other governmental body having authority, such payments to be in addition to all other payments required to be paid to Sublandlord by Subtenant under the terms of this Agreement. Any such payment shall be paid to Sublandlord concurrently with the payment of the Rent or other payment upon which such tax is based. The Rent shall be prorated for any partial calendar month at the beginning or end of the Term of this Agreement.

(b) Annual Adjustments. The Rent set forth in paragraph 3(a) is subject to increases as a result of increases in the rent or operating costs paid by the Sublandlord under the Prime Lease (as defined herein) during the Term of this Agreement. On the first anniversary of the Commencement Date (each an “Adjustment Date”), and each year thereafter, the Rent shall be adjusted to reflect any increase in rent or operating costs payable by Sublandlord under the Prime Lease.

(c) The rentable area in the Office Space has been calculated in accordance with the definition of “rentable area” in the BOMA Standard Method for Measuring Floor Area in Office Buildings, ANSI/BOMA Z65.1 - 1996 (the “BOMA Standard”). The rentable area in the Office Space as set forth on Page 1 of this Agreement is hereby stipulated to be the rentable area of the Office Space for all purposes under this Agreement, whether the same should be more or less as a result of minor variations resulting from actual construction and completion of the Office Space and for actual occupancy; provided, however, in the event Sublandlord re-measures the Office Space in accordance with commercially reasonable procedures in conformity with the BOMA Standard and if the rentable area of the Office Space is different than above stated, Sublandlord may give Subtenant written notice of the change and the new number of square feet shall become the rentable area of the Office Space for all purposes effective as of the date of such notice. In the event of any such adjustment in the rentable area of the Office Space, the portion of the Rent calculated on the basis of the fair market rental rate for the Office Space shall be adjusted in accordance with the change in the Office Space square footage calculation.

(d) If any monthly Rent is not received by the 10th day of the month, Subtenant shall, upon demand,

pay Sublandlord a late charge of 5% of the amount of such installment. In addition, if any such past due installment of the Rent is not paid by the 10th day of the next month or by the 10th day of any subsequent month, such past due installment shall be subject to an additional late charge in the same amount for each such month until paid. Such late charge is to defray the administrative costs and inconvenience and other expenses which Sublandlord will incur on account of such delinquency. The right to recover such late charges shall be in addition to any other remedies available as a matter of law or as otherwise provided in this Agreement.

4. Maintenance. Sublandlord shall maintain the Office Space in good repair and condition. Subtenant

shall repair, in a good and workmanlike manner, any damage to the Office Space or the Equipment, if any, caused by any breach of this Agreement or by any willful or negligent act or omission of Subtenant, or of any employee, agent or invitee of Subtenant; provided that if any such damaged Equipment cannot be restored to operable condition, Subtenant shall replace the same at its sole cost and expense.

5. Compliance with Laws. In its use and occupancy of the Office Space, Subtenant shall comply with

all applicable laws and other governmental rules, regulations and orders and with the Rules and Regulations attached hereto as Exhibit C and made a part hereof, and with such other reasonable rules and regulations which Sublandlord

may adopt from time to time for the Office Space. Subtenant and Subtenant's employees and agents shall comply with all federal, state or local laws, ordinances and regulations concerning the generation, storage and/or removal of infectious, biohazardous and hazardous waste from the Office Space.

6. Fire and Other Casualty. If the Office Space or the Building shall be damaged by fire or other

casualty and the Office Space is thereby rendered wholly or partly unsuitable for its intended use, then Sublandlord may terminate this Agreement. If Sublandlord desires to terminate this Agreement, it shall give Subtenant written notice of termination within 30 days of the occurrence of such damage, and upon the giving of such notice, this Agreement shall terminate as of the date of the casualty, and any prepaid Rent shall be refunded to Subtenant, and both parties shall be released of all liabilities and obligations under this Agreement arising or accruing after the effective date of termination.


(a) Sublandlord shall provide such services for Subtenant's use of the Office Space as Sublandlord deems necessary in its sole reasonable discretion.

(b) Subtenant shall be solely responsible for providing and maintaining his or her own medical records

system, which shall include, but not be limited to patient charts, consent forms, and all other documentation necessary to comply with all applicable laws, rules, regulations and standards governing his or her specific medical practice.

(c) Subtenant shall pay and be solely responsible for (i) all costs of postage and private overnight or

express delivery service incurred in connection with the medical practice conducted by Subtenant in the Office Space; (ii) any customized printed or engraved stationery or business cards used by Subtenant in connection with his or her medical practice in the Office Space; and (iii) all costs associated with any answering service used by Subtenant in connection with his or her medical practice in the Office Space.

(d) Sublandlord assumes no responsibility for any money in any form or other valuables or any other

personal property or equipment brought into or left in the Office Space by Subtenant, all of which shall be at Subtenant's sole risk. Subtenant assumes sole responsibility for the collection of all fees for services rendered by Subtenant during each day he or she practices medicine in the Office Space.

(e) Subtenant shall provide at his or her sole expense an accounts receivable billing service adequate

for Subtenant's practice of medicine within the Office Space. (f) Sublandlord shall pay for all electricity consumed within the Office Space as normally and

reasonably required for medical office use; provided, however, that Sublandlord shall not be responsible for any interruption or cessation of electrical services to the Office Space or for any damage to Subtenant's business or property caused by any such interruption or cessation.

(g) Sublandlord shall furnish for Subtenant’s use the furniture, fixtures, equipment and other personal

property located within the Office Space listed on Exhibit D attached hereto (collectively, the “Equipment”), if any. Sublandlord shall be obligated to furnish furniture, fixtures, equipment and other personal property only to the extent listed on Exhibit D, and if Exhibit D is blank or if there is no Exhibit D, then Sublandlord shall have no such obligation. If any Equipment is listed on Exhibit D, then Subtenant’s use of such Equipment shall be subject to the terms set forth on Exhibit D and the terms of Exhibit D are and shall be incorporated herein as if set forth in full herein.

(h) Sublandlord shall furnish for Subtenant’s the services listed on Exhibit E attached hereto, if any

(collectively, the “Services”). If Exhibit E is blank or if there is no Exhibit E, then Sublandlord shall have no such obligation.

8. Use. The Office Space shall continuously and at all times during the Term be used and occupied

by Subtenant only as medical offices for licensed physicians (“Physicians”) to engage in the private practice of pediatric medicine and other related activities incidental thereto, and for no other purpose.

8.1 Prohibited Uses.

(a) Notwithstanding anything to the contrary in paragraph 8 above, the provision or operation of any of the following services or facilities shall not be permitted in the Office Space:

(i) a health care facility that has facilities for overnight accommodations of patients;

(ii) the provision of any medical or related service to or for any person that is in addition to the examination and diagnosis of patients performed directly by a Physician or by other health care professionals either independently licensed or under the direct supervision of a Physician, or a facility operated for the provision of any such service(s);

(iii) outpatient or inpatient surgery services;

(iv) a birthing center;

(v) an oncology treatment facility;

(vi) physical therapy services;

(vii) respiratory therapy services;

(viii) a laboratory (including, without limitation, a pathology laboratory or a clinical laboratory); and

(ix) a facility providing diagnostic or therapeutic testing services, including without limitation, all diagnostic imaging services, including without limitation:

A. fluoroscopy; B. x-ray; C. plane film radiography;

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D. computerized tomography (CT); E. ultrasound; F. radiation therapy; G. mammography and breath diagnostics; H. nuclear medicine testing; and I. magnetic resonance imaging.

(b) Notwithstanding the foregoing, nothing herein shall prevent Physicians who conduct a medical practice in the Office Space from performing outpatient surgeries that do not require general anesthesia or intravenous sedation or from rendering pathological laboratory or x-ray services for which Subtenant has obtained Sublandlord’s consent pursuant to paragraph 8(c); provided that such surgery services, pathological laboratory or x-ray services are the kind usually and customarily provided in a physician’s office, are provided to such Physician’s own patients who are not referred to such Physician for the sole purpose of receiving the same, and are merely ancillary and incidental to such Physician’s primary medical practice and do not constitute such Physician’s primary medical practice or specialty or constitute the predominant services rendered by such Physician to Physician’s patients.

(c) Prior to providing pathological laboratory or x-ray services, Subtenant shall have submitted to Sublandlord a detailed description of the laboratory or x-ray services Subtenant desires to provide or perform and Sublandlord shall have consented in writing to the provision or performance of such services, which consent may be denied in Sublandlord’s sole and absolute discretion (the provision of such services and procedures shall be strictly limited to those services and procedures to which Sublandlord has expressly consented in writing and the terms of this paragraph shall be strictly construed to prohibit any expansion or addition to such services or procedures without Sublandlord’s written consent). Subtenant shall not dispense any drugs or medicines to persons other than Subtenant’s own patients. Prior to the installation of any diagnostic, laboratory or radiology equipment for services permitted hereunder, Subtenant shall provide Sublandlord with a list of such equipment; a list of any hazardous substances, wastes or materials, as hereinafter defined, which will be used or generated in connection with the use of such diagnostic, laboratory or radiology equipment; and Subtenant’s proposed procedures for the use, storage and disposal of any hazardous substances, wastes or materials, including but not limited to the procedure for silver recovery for any radiology equipment.

8.2 Physician Qualifications. All Physicians who conduct a medical practice and related activities in the Office Space during Subtenant’s Use Periods must be and remain appropriately licensed and in good standing with the state licensing board and any applicable federal, state or local certification or licensing agency or office, without restriction, not subject to any sanction, exclusion order, or other disciplinary order with respect to his or her participation in any federal or state healthcare program. Further, all such Physicians must be qualified to be a member of the active medical staff of Lee Memorial Health System (the “Hospital”); provided, however, that nothing in this paragraph 4.2 shall require any Physician actually to be a member of the Hospital’s active medical staff.

8.3 Supervision and Management. The medical practice conducted in the Office Space shall at all times be conducted under the supervision and authority of a Physician and, except with Sublandlord’s prior written consent, which may be withheld in Sublandlord’s sole and absolute discretion, Subtenant shall not (1) allow any other person or entity to purchase, manage or operate his or her medical practice or (2) conduct the medical practice while serving as an agent or employee of any other person or entity.

8.4 Compliance with Legal Requirements. Subtenant shall act in accordance with and not violate any restrictions or covenants of record affecting the Office Space or the Building. Subtenant shall not use or occupy the Office Space in violation of law or of the Certificate of Use or Occupancy issued for the Building of which the Office Space is a part, and shall immediately discontinue any use of the Office Space which is declared by either any governmental authority having jurisdiction or the Sublandlord to be a violation of any law, code, regulation or a violation of said Certificate of Use or Occupancy. Subtenant shall comply with any direction of any governmental authority having jurisdiction which shall, by reason of the nature of Subtenant’s use or occupancy of the Office Space, impose any duty upon Subtenant or Sublandlord with respect to the Office Space or with respect to the use or occupancy thereof.

8.5 Hazardous Acts; Waste; Nuisance. Subtenant shall not do nor permit to be done anything which will invalidate or increase the cost of any casualty and extended coverage insurance policy covering the Building and/or property located therein, and shall comply with all rules, orders, regulations and requirements of the appropriate Fire Rating Bureau or any other organization performing a similar function. Subtenant shall promptly upon demand reimburse Sublandlord for any additional premium charged for such policy by reason of Subtenant’s failure to comply with the provisions of this paragraph. Subtenant shall not do nor permit anything to be done in, on or about the Office Space which would in any way obstruct or interfere with the rights of other tenants or occupants of the Building, or use or allow the Office Space to be used for any immoral, unlawful or objectionable purpose, nor shall Subtenant maintain or permit any nuisance or commit or suffer to be committed any waste in, on or about the Office Space.

9. Indemnification. Subtenant shall indemnify and hold harmless Sublandlord and its affiliates against

and from any and all claims, demands, actions, losses, damages, orders, judgments and any and all costs and expenses (including without limitation reasonable attorneys' fees and costs of litigation), resulting from or incurred by Sublandlord or any affiliate of Sublandlord on account of any of the foregoing (i) arising from Subtenant's use of the Office Space, the conduct of the practice or Subtenant's profession or from any other activity permitted or suffered by Subtenant in the Office Space, or (ii) arising from any breach by Subtenant of this Agreement.

10. Insurance. Subtenant will procure and maintain during the Term a policy or policies of insurance,

written by an insurance company or companies licensed to do business in the State of Florida with a current rating by AM Best of A-, 8 or S&P equivalent, insuring Subtenant against any and all losses, claims, demands or actions whatsoever for injury to or death of any one or more persons in any one occurrence to the limit of not less than One Million Dollars ($1,000,000) and for damage to property in an amount not less than One Million Dollars ($1,000,000), which insurance will cover accidents occurring in the Office Space or arising from Subtenant's conduct and operation of Subtenant's business in the Office Space during Use Periods. The policy of insurance required to be carried by Subtenant hereunder, or a certificate thereof, shall be delivered to Sublandlord and Prime Landlord at least ten (10) days prior to the Commencement Date. Said policy shall expressly provide that Sublandlord and Prime Landlord are

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additional insureds and that the policy shall not be canceled or altered in such a manner as to adversely affect the coverage afforded thereby without thirty (30) days prior written notice to Sublandlord and Prime Landlord.

11. Waiver of Subrogation. Sublandlord and Subtenant on behalf of themselves and all others claiming

under them, including any insurer, waive all claims against each other, including all rights of subrogation, for loss or damage to their respective property (including, but not limited to, the Office Space) arising from fire, smoke damage, windstorm, hail, vandalism, theft, malicious mischief and any of the other perils normally insured against in an "all risk" of physical loss insurance policy, regardless of whether insurance against those perils is in effect with respect to such party's property and regardless of the negligence of either party. If either party so requests, the other party shall obtain from its insurer a written waiver of all rights of subrogation that it may have against the other party.

12. Default. If Subtenant fails to pay the Rent or other sum payable by Subtenant hereunder and fails

to cure such default within five (5) days after notice thereof, or if Subtenant defaults in the prompt or full performance of any other provision of this Agreement and fails to cure such default within thirty (30) days after notice thereof, Sublandlord shall have the right to terminate this Agreement and deny Subtenant access to the Office Space by any lawful means. In the event of such termination by Sublandlord, all of Subtenant's rights and privileges hereunder shall terminate and Sublandlord shall have no further obligation to Subtenant under this Agreement.

13. Assignment or Transfer The rights granted by Sublandlord to Subtenant under this Agreement are

considered a personal privilege and may not be assigned or transferred, in part or in whole, without the written consent of Sublandlord, which consent may be withheld in Sublandlord’s sole and absolute discretion.

14. Events of Holdover:

(a) Subtenant acknowledges that while this Agreement is in effect, the Sublandlord has or may have granted other third parties the right to use the Office Space at times immediately after the Subtenant’s Use Period, and therefore, if Subtenant does not vacate the Office Space promptly upon the expiration of his Use Period the Sublandlord shall suffer the loss of rent from such third parties as a result of not being able to give such third parties use of the Office Space. Subtenant agrees to promptly vacate the Office Space upon expiration of the Use Period. Subtenant also agrees to leave the Office Space in a neat, clean and orderly condition, without damage, and acceptable for use by the next physician for medical office use. If the Subtenant fails to leave the Office Space in a neat, clean and orderly condition, and without damage, upon the expiration of his Use Period, then the Subtenant, upon demand from the Sublandlord, shall pay the Sublandlord a $50.00 cleaning fee. Furthermore, if the Subtenant fails to vacate the Office Space promptly upon the expiration of his Use Period, then the Subtenant, in addition to other fees and sums payable hereunder, shall pay to the Sublandlord promptly under demand the greater of: (i) $100.00 or (ii) the amount of any lost rent suffered by the Sublandlord as a result of Subtenant’s failure to timely vacate the Office Space.

(b) Subtenant acknowledges that while the Agreement is in effect, the Sublandlord has or may have

granted other third parties the right to use the Office Space at times immediately prior to the Subtenant’s Use Period. Sublandlord shall attempt in good faith to see that any such third party vacates the Office Space in a timely fashion so that the Subtenant may use the Office Space upon commencement of the Subtenant’s Use Period. However, if any such third party does not vacate the Office Space promptly upon expiration of his Use Period and the Subtenant is therefore delayed in his occupancy of the Use Area, then Subtenant’s Rent shall be abated, on an hourly basis, for that portion of Subtenant’s Use Period during which the Subtenant is unable to use the Office Space. This shall be the Subtenant’s sole remedy in the event Subtenant is delayed or prevented from occupying the Office Space as a result of another party holding over under the terms of its agreement.

15. Notice. All notices to be given hereunder by either party shall be in writing and may be sent by United States certified mail, postage prepaid, addressed to:

Sublandlord: Lee Memorial Health System Attn: Property Management 636 Del Prado Blvd Cape Coral, FL 33990

Subtenant: Attention:

or to such other address as either party may have furnished to the other. Any notice shall be deemed given when deposited in the mail in the foregoing manner.

16. Subordination to Prime Lease. (a) The Building or the Office Space is leased to Sublandlord pursuant to that certain Commercial

Lease, dated March 29, 2010, as amended by that First Amendment To Commercial Lease dated June 17, 2010, and as further amended by that Second Amendment To Commercial Lease dated March ___, 2011 (said lease as amended shall hereinafter be referred to as the “Prime Lease”), between Creekwood of Naples, LLC, a Florida limited liability company (the “Prime Landlord”), as landlord, and Sublandlord, as tenant, and unless renewed or extended, the Prime Lease will expire on December 23, 2017. Accordingly, this Agreement (including, without limitation, Subtenant’s occupancy and use rights with respect to the Office Space) is subject and subordinate to the Prime Lease and to all of the matters to which the Prime Lease is or shall be subordinate. Subtenant acknowledges that the Office Space may only be used to provide pediatric health care. Notwithstanding anything to contrary provided elsewhere in this Agreement, if the term of the Prime Lease is not extended, this Agreement will expire and terminate on the date of expiration of the term of the Prime Lease unless Prime Landlord assumes this Agreement as provided below. Subtenant acknowledges that Sublandlord shall have no obligation to renew or extend the term of the Prime Lease. In the event of termination or expiration of the Prime Lease prior to the expiration or earlier termination of this Agreement, Prime Landlord may, at its option, take over and assume the rights and interests of Sublandlord under this Agreement (but Prime Landlord shall have no obligation to do so), and in such event, Subtenant shall attorn to the Prime Landlord pursuant to the provisions of this Agreement; provided that, Prime Landlord shall not (i) be liable for any previous act or omission of Sublandlord under this Agreement, (ii) be subject to any offset, not expressly provided in this Agreement, which theretofore accrued to Subtenant against Sublandlord, or (iii) be bound

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by any previous prepayment of more than one month's rent. This paragraph 16 shall not apply if the name of the Prime Landlord is not inserted above.

(b) Insofar as Prime Landlord is or may be obligated to furnish any services to the Office Space, to

repair or rebuild the same, to perform any other act whatsoever with respect to the or the Building or to perform any obligation or satisfy any condition under the Prime Lease, Subtenant expressly acknowledges that notwithstanding anything to the contrary provided in this Agreement, Sublandlord does not undertake the performance or observance of such obligations, but is only obligated to use reasonable efforts to obtain Prime Landlord’s performance for Subtenant’s benefit and without obligating itself to institute legal action or incur any out of pocket expense.

17. Radon Gas. (Applicable in Florida only) Radon is a naturally occurring radioactive gas that, when it has accumulated in a building in sufficient quantities, may present health risks to persons who are exposed to it over time. Levels of radon that exceed federal and state guidelines have been found in buildings in Florida. Additional information regarding radon and radon testing may be obtained from the local county public health unit.

18. Regulatory Matters. (a) Sublandlord and Subtenant enter into this Agreement with the intent of

conducting their relationship and implementing the agreements contained herein in full compliance with applicable federal, state and local law, including without limitation, the Medicare/Medicaid Anti-Kickback statute (the “Anti-Kickback Law”) and Section 1877 of the Social Security Act (the “Stark Law”), as amended. Notwithstanding any unanticipated effect of any of the provisions of this Agreement, neither party will intentionally conduct itself under the terms of this Agreement in a manner that would constitute a violation of the Anti-Kickback Law or the Stark Law. Without limiting the generality of the foregoing, Sublandlord and Subtenant expressly agree that nothing contained in this Agreement shall require either party to refer any patients to the other, or to any affiliate or subsidiary of the other. If any legislation, regulation or government policy is passed or adopted, the effect of which would cause either party to be in violation of such laws due to the existence of any provision of this Agreement, then Sublandlord and Subtenant agree to negotiate in good faith for a period of 90 days to modify the terms of this Agreement to comply with applicable law. Should the parties hereto fail to agree upon modified terms to this Agreement within this time, either Sublandlord or Subtenant may immediately terminate this Agreement by giving written notice to the other party.

(b) Subtenant represents and warrants to Sublandlord that Subtenant (i) is not currently excluded,

debarred or otherwise ineligible to participate in Medicare or any federal health care program under section 1128 and 1128A of the Social Security Act or as defined in 42 U.S.C. § 1320a-7b(f) (the “Federal Health Care Programs”); (ii) has not been convicted of a criminal offense related to the provision of healthcare items or services but has not yet been excluded, debarred, or otherwise declared ineligible to participate in any Federal Health Care Program; and (iii) is not under investigation or otherwise aware of any circumstances which may result in Subtenant being excluded from participation in any Federal Health Care Program. The foregoing representation shall be an ongoing representation and warranty during the term of this Agreement and Subtenant shall immediately notify Sublandlord of any change in the status of the representation and warranty set forth in this paragraph, at which time Sublandlord will have the right to immediately terminate this Agreement.

(c) For purposes of this paragraph of this Agreement, “protected health information”, or PHI, shall have the meaning defined by the Standards for Privacy of Individually Identifiable Health Information, 45 C.F.R. Part 160 and Subparts A and E of Part 164 (the “Privacy Standards”), as promulgated by the Department of Health and Human Services (“HHS”) pursuant to the Administrative Simplification provisions of the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”). Subtenant agrees to reasonably safeguard PHI from any intentional or unintentional disclosure in violation of the Privacy Standards by implementing appropriate administrative, technical and physical safeguards to protect the privacy of PHI. Subtenant further agrees to implement appropriate administrative, technical and physical safeguards to limit incidental disclosures of PHI, including disclosures to Sublandlord, its subcontractors and agents. The parties agree that neither the Sublandlord nor its contractors, subcontractors or agents shall need access to, nor shall they use or disclose, any PHI of Subtenant. However, in the event PHI is disclosed by Subtenant or its agents to Sublandlord, its, contractors, subcontractors or agents, regardless as to whether the disclosure is inadvertent or otherwise, Sublandlord agrees to take reasonable steps to maintain, and to require its contractors, subcontractors and agents to maintain, the privacy and confidentiality of such PHI. The parties agree that the foregoing does not create, and is not intended to create, a “business associate” relationship between the parties as that term is defined by the Privacy Standards.

19. Personal Items. The limited storage by Subtenant of items of personal property (“Personal Items”)

in the Office Space from Use Period to Use Period is permissible if (a) the presence of such items will not interfere with the use of the Office Space by others and (b) Sublandlord in its sole discretion does not object to such storage. Subtenant acknowledges and agrees that any Personal Items of Subtenant or any agent or employee of Subtenant left or stored in the Office Space between Use Periods may be used by any other tenant, occupant or user of the Office Space and that Subtenant shall not be entitled to any compensation or other payment for any such use. Subtenant acknowledges and agrees that the availability of such Personal Items for use by other subtenants, occupants or users of the Office Space is not provided by Subtenant as a service to Sublandlord or to any such other subtenant, occupant or user for which Subtenant is entitled to compensation, but instead is agreed upon by Subtenant as a condition to the limited storage of such Personal Items. Subtenant, however, agrees not to use any Personal Items left or stored in the Office Space by any other subtenant, occupant or user of the Office Space without the consent of such other subtenant, occupant or user. Subtenant acknowledges and agrees that (i) any Personal Items brought into, left or stored in the Office Space will be unsecured, (ii) Sublandlord shall have no duty or obligation to provide security for or otherwise safeguard any Personal Items brought into, left or stored in the Office Space, (iii) Sublandlord assumes no responsibility for any Personal Items brought into, left or stored in the Office Space by Subtenant or any agent or employee of Subtenant, all of which shall be at Subtenant's sole risk, (iv) Subtenant assumes all risk of damage to, destruction of or loss from any cause whatsoever of any Personal Items brought into, left or stored in the Office Space by Subtenant or any agent or employee of Subtenant, and (v) Subtenant waives any and all claims against Sublandlord for any damage to, destruction of or loss of any such Personal Items brought into, left or stored in the Office Space. Furthermore, Subtenant hereby assumes all risk of injury to persons or damage to property resulting from the presence of or use by any person of any Personal Items brought into, left or stored in the Office Space by Subtenant or any agent or employee Subtenant (whether or not such person had permission to use such Personal Items). Subtenant shall indemnify and hold harmless Sublandlord and its affiliates against and from any and all claims, demands, actions, losses, damages, orders, judgments and any and all costs and expenses (including without limitation reasonable attorneys' fees and costs of litigation), resulting from or incurred by Sublandlord or any affiliate of Sublandlord arising out of (A) the presence of any Personal Items brought into, left or stored in the Office Space by Subtenant or any agent or employee of Subtenant, (B) any injury to persons

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or damage to property resulting from the presence of or use by any person of any Personal Items brought into, left or stored in the Office Space by Subtenant or any agent or employee of Subtenant (whether or not such person had permission to use such Personal Items), (C) any damage or loss caused by Subtenant or by any agent or employee of Subtenant to any Personal Items left or stored in the Office Space by any other subtenant, occupant or user of the Office Space and/or (D) the disposition of any Personal Items left or stored in the Office Space by Subtenant or any agent or employee of Subtenant. At any time Sublandlord may notify Subtenant of Sublandlord's objection to the storage of Personal Items by Subtenant or any agent or employee of Subtenant, and Subtenant shall remove such Personal Items from the Office Space by the end of Subtenant’s next scheduled Use Period, or sooner if so requested by Sublandlord. If Subtenant does not remove such Personal Items in accordance with this provision, then Subtenant hereby authorizes Sublandlord to remove such Personal Items, at Subtenant's expense, and to make any disposition of such Personal Items as Sublandlord may determine appropriate in its discretion.

IN WITNESS WHEREOF, the parties hereto have executed this Agreement on the date first above written. Witnesses: Witness Signature Witness Printed Name Witness Signature Witness Printed Name

SUBLANDLORD: LEE MEMORIAL HEALTH SYSTEM By: Print Name: Print Title: Date:

Witnesses: Witness Signature Witness Printed Name Witness Signature Witness Printed Name

SUBTENANT: [Enter Subtenant's name] By: Print Name: Print Title: Date:

1061825v2

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EXHIBIT A

Diagram of Office Space [A floor plan of the Office Space is attached hereto.]

A-1

EXHIBIT B

Rent Payment Grid

PACKAGE OF SPACE & EQUIPMENT

RENT

DESCRIPTION

Medical Office Space $250.00 per eight (8) hour block or $125 per four (4) hour block

(i) the Office Space, (ii) common use of the fax, copier, and phone, (iii) such miscellaneous minor medical supplies (e.g., exam gloves, alcohol wipes, tape, etc.) as may be provided by Sublandlord, and (iv) other services set forth in this Sublease

B-1

EXHIBIT C

Rules and Regulations

1. Tobacco use is strictly prohibited in the Office Space, the Building, the parking areas and surrounding grounds and Subtenant, its employees, agents, customers, contractors, subtenants, assignees, patients, invitees, or licensees shall comply with the Lee Memorial Health System tobacco free policy.

2. No animals shall be kept in or about the Office Space.

3. Subtenant shall not use the water closets and other plumbing fixtures for any purposes other than those for which they were constructed, and shall not place any debris, rubbish, rags or other substances therein. All damage resulting from any misuse of the fixtures shall be borne by the Subtenant whose servants, employees, agents, customers, contractors, subtenants, assignees, patients, invitees, or licensees shall have caused the same.

4. Subtenant shall not place any furniture, equipment, records, trash or other objectionable material in the common areas of the Building other than in an appropriate refuse container.

5. The Subtenant or his employees shall not make or commit any indecent or improper acts while on the property or make any unseemly or disturbing noises or disturb or interfere with neighboring occupants of the Building or those having business with them, whether by use of any musical instrument, radio, loud speaker, singing, or in any other way. Subtenant or his employees shall not throw anything out of the doors or windows of the Office Space.

6. The Office Space shall not be used for the sale of merchandise in the ordinary course of business, or for the sale at auction of merchandise, goods or property of any kind.

7. Sublandlord does not assume any responsibility, and shall not be held liable, for any damage or loss to any automobile or personal property in the parking lot or for any injury sustained by any person in the parking lot.

8. The entry, corridors, and stairways shall not be obstructed by the Subtenant, nor used by the Subtenant for any purpose other than ingress or egress to and from the Office Space, nor shall employees of the Subtenant loiter or congregate therein. The floors and windows that reflect or admit light into passageways in common areas shall not be covered or obstructed by the Subtenant.

9. The Sublandlord reserves the right to make such other and further rules and regulations as Sublandlord shall deem necessary.

10. Subtenant shall not, without the written consent of Sublandlord, place a load upon any floor of the Building exceeding 80 pounds per square foot. Additional air conditioning, electrical or other facilities required in connection with the installation and operation of any computers or other large business equipment shall be made at Subtenant's expense and only after obtaining Sublandlord's written consent. Subtenant shall pay for the cost of electrical current required to operate computers and other large business equipment and for the cost of additional air conditioning necessitated by such equipment.

11. Subtenant will not permit or suffer any signs, advertisement or notices to be displayed, inscribed upon or affixed on any part of the outside of the Office Space or on windows or doors or on the adjacent street, except that directory boards and Office Space identification signs shall be provided by the Sublandlord. Signage on entry doors to the Office Space will be provided by Sublandlord consistent with signage standards within the Building.

C-1

Exhibit D

Equipment List furniture, fixtures and equipment provided by Sublandlord:

• examination room medical equipment (e.g. exam tables, exam lights, wall-mounted diagnostic sets, weight scale with height measurement, x-ray view box);

• all rooms will have furniture and fixtures as depicted generally on Exhibit A; and • basic office equipment (e.g., photocopier, fax machine and printer);

Subtenant’s use of the Equipment shall be subject to the following terms and conditions:

1. The Equipment shall at all times be the sole and exclusive property of Sublandlord. Subtenant shall have no rights or property interest in the Equipment, except for the right to use it in the normal operation of the Office Space during Subtenant's Use Period.

2. The Equipment is and shall remain the personal property of Sublandlord even if installed in or attached to real property. Sublandlord shall be permitted to display notice of its ownership on each item of Equipment by means of a suitable stencil, label or plate affixed thereto or other marking thereon.

3. Subtenant shall not assign, transfer, pledge, lend, create a security interest in, or sublet the Equipment or any part thereof, attempt in any other manner to dispose of the Equipment, or remove the Equipment or any part thereof from the Office Space.

4. Subtenant shall use the Equipment in a careful and proper manner and shall comply with and conform to all federal, state, local and other laws, ordinances and regulations, any insurance policies and any warranties of the manufacturer in any way relating to the possession, use or maintenance of the Equipment.

5. Subtenant shall use the Equipment only in the Office Space and at no other location and only during Subtenant’s Use Periods.

D-1

EXHIBIT E

Services List services to be provided by Sublandlord: The following shall be provided within the Office Space:

• Water as required for normal and customary medical office use; • Elevator service on a continuous basis, if applicable; • Central heat and air-conditioning; • Electrical power as required for normal and customary medical office use; • Lamps, bulbs, tubes and ballasts for building standard lighting fixtures used in the Office Space; • Sanitary sewer services; • Television with cable service (in waiting room); • basic disposable medical supplies (e.g., band-aids, gauze, paper for the exam tables, otoscope

tips, hand hygiene supplies, alcohol preps); • miscellaneous office supplies; • non-infectious waste disposal; • infectious waste disposal; • "sharps" disposal; • recycling services; • telecommunication services (including basic telephone services, desk-top computers, and wireless

network access) • janitorial and trash removal services three (3) days during a regular work week; and • repair, maintenance and replacement (as needed) of the Office Space and all HVAC, mechanical;

electrical and plumbing systems.

E-1

______________





SUBJECT: Outpatient Physical Therapy Lease

REQUESTOR & TITLE: Ray Cyr, Director of Rehabilitation Services PREVIOUS BOARD ACTION ON THIS ITEM (IF ANY) (justification and/or background for recommendations – internal groups which support the recommendation i.e. SLC, Operating Councils, PMTs, etc.) No previous board action on this item. SPECIFIC PROPOSED MOTION: Approval to lease space at Fiddlesticks Fitness Center to provide onsite physical therapy services based upon terms set forth in the attached lease. Specific terms include: total of 90 square feet leased at $20 per square foot. Terms are for one year to commence at a time agreed by both parties within LMHS fiscal year 2011. This lease will be contingent upon final LMHS legal counsel review. PROS TO RECOMMENDATION Provide our community improved access to physical therapy services On time, convenient services to limit healthcare cost Serve as an potential entry point to other LMHS therapy centers Projected positive return on investment

CONS TO RECOMMENDATION Additional lease expense

LIST AND EXPLAIN ALTERNATIVES CONSIDERED Continuing to provide therapy services just within existing outpatient therapy locations is an alternative option. This lease agreement however will provide more convenient quick access to the community for therapy services and serves as a pilot endeavor for a potential future therapy services model. To provide services at this location as a department of the Lee Memorial a lease is required due to Provider-based rules and regulations. FINANCIAL IMPLICATIONS Budgeted ____ Non-Budgeted _x___ (including cash flow statement, projected cash flow, balance sheet and income statement) No additional capital dollars will be required to fund the project. Salary, small equipment and other associated expense are offset by additional revenue generated. OPERATIONAL IMPLICATIONS (including FTEs, facility needs, etc.) 0.25 FTE Physical Therapist as well as billing and scheduling function for will be provided out of an existing therapy center. Facility space is only a single small room. No upgrades or modifications are needed. SUMMARY This project is an exploration of an alternate model of providing therapy care to the community, providing closer to home, low cost healthcare. Limited therapy services will be provided in a small 90 square foot space within the existing Fiddlesticks Fitness Center in South Lee County. Total lease expense will be only $1,800 annually. Additional revenue generated will more than offset this and other expense added.


LMHS Outpatient Physical Therapy Services

@Fiddlesticks Country Club

Recommendation for Lease Agreement

Overview• Provide basic outpatient physical therapy services on site at the

Fiddlesticks Fitness Center in South Lee County• Convenient, close to home patient access to rehabilitative care• Opportunity to provide “on time” education, care and prevention• Serve as an access point to other therapy centers• Lease agreement is required to provide services as an

outpatient department of LMH on this site • Small (90 sqft) leased area/room to provide care• Total annual lease expense $1,800• Additional expenses more than offset by additional revenue

generated• Potential alternative model option of future therapy care delivery

Lease Terms• 90 sq ft exam/treatment room within Fiddlesticks

Fitness Center• $20/sq ft• No additional build/ capital required• One year• Commence in LMHS fiscal year 2011• Lease contingent upon final LMHS legal counsel

review

Request Board ApprovalApproval to lease space from Fiddlesticks Country Club to provide onsite physical therapy services based upon terms set forth in the attached lease. Specific terms include: total of 90 square feet leased at $20 per square foot. Terms are for one year to commence at a time agreed by both parties within LMHS fiscal year 2011. This lease will be contingent upon final LMHS legal counsel review.

Questions?

LEASE AGREEMENT

THIS LEASE AGREEMENT (this “Agreement”) is made and entered into this ______ day of____________________, 20__, by and between Fiddlesticks Golf and Country Club (hereinafter referred to as"Landlord") and Lee Memorial Health System d/b/a Lee Memorial Hospital, a special purpose unit of localgovernment created by Special Act of the Florida Legislature (hereinafter referred to as "Tenant").

1. Lease of Space. On the terms and conditions set forth below, Landlord hereby leases to Tenantand approximately 90 rentable square feet of space designated as Suite _______ (the “Space”) in the medicaloffice building located at ___________________________, Fort Myers, Florida (the "Building"), during the term ofthis Agreement.

2. Term. The term of this Agreement shall commence on __________________, 20___, (the“Commencement Date”), and shall expire on 11:59 p.m. on _________________________________, 20____ (the"Expiration Date"). The "Term" shall mean the period of time between the Commencement Date and ExpirationDate.

3. Base Rent, Additional Rent and Payment. Tenant agrees to pay rent during the Term of thisAgreement directly to Landlord’s address specified in Section 15 of this Agreement as follows:

(a) Base Rent. Tenant shall pay ___________ dollars ($___.00) per square foot of space which shallequate to annual rent of $_______________. The annual rent shall be paid in equal monthly payments of$_______________ ("Rent") on the first day of each calendar month during the Term, without demand therefore,set off or abatement.(b)

(c) If any monthly Rent is not received by the 10th day of the month, Tenant shall, upon demand, payLandlord a late charge of 5% of the amount of such installment. In addition, if any such past due installment of theRent is not paid by the 10th day of the next month or by the 10th day of any subsequent month, such past dueinstallment shall be subject to an additional late charge in the same amount for each such month until paid. Suchlate charge is to defray the administrative costs and inconvenience and other expenses which Landlord will incur onaccount of such delinquency. The right to recover such late charges shall be in addition to any other remediesavailable as a matter of law or as otherwise provided in this Agreement.

4. Maintenance. Landlord shall maintain the Space in good repair and condition. Tenant shallrepair, in a good and workmanlike manner, any damage to the Space, if any, caused by any breach of thisAgreement or by any willful or negligent act or omission of Tenant, or of any employee, agent or invitee of Tenant;provided that if any such damage cannot be restored, Tenant shall replace the same at its sole cost and expense.

5. Compliance with Laws. In its use and occupancy of the Office Space, Tenant shall comply withall applicable laws and other governmental rules, regulations. Tenant and Tenant's employees and agents shallcomply with all federal, state or local laws, ordinances and regulations concerning the generation, storage and/orremoval of infectious, biohazardous and hazardous waste from the Space.

6. Fire and Other Casualty. If the Space or the Building shall be damaged by fire or other casualtyand the Space is thereby rendered wholly or partly unsuitable for its intended use, then Landlord may terminate thisAgreement. If Landlord desires to terminate this Agreement, it shall give Tenant written notice of termination within30 days of the occurrence of such damage, and upon the giving of such notice, this Agreement shall terminate as ofthe date of the casualty, and any prepaid Rent shall be refunded to Tenant, and both parties shall be released of allliabilities and obligations under this Agreement arising or accruing after the effective date of termination.


(a) Landlord shall pay for all electricity consumed within the Space as normally and reasonablyrequired for physical therapy office use; provided, however, that Landlord shall not be responsible for anyinterruption or cessation of electrical services to the Space or for any damage to Tenant's business or propertycaused by any such interruption or cessation.

(b) Landlord shall furnish for Tenant’s use the furniture, fixtures, equipment and other personalproperty located within the Space listed on Exhibit B attached hereto (collectively, the “Equipment”), if any.Landlord shall be obligated to furnish furniture, fixtures, equipment and other personal property only to the extentlisted on Exhibit B. Tenant’s use of such Equipment shall be subject to the terms set forth on Exhibit B and theterms of Exhibit B are and shall be incorporated herein as if set forth in full herein.

8. Use. The Space shall continuously and at all times during the Term be used and occupied byTenant only as an out patient physical therapy department of Lee Memorial Hospital for Tenant to engage in theprovision of pediatric physical therapy and other related activities incidental thereto, and for no other purpose.Tenant shall not do nor permit to be done anything which will invalidate or increase the cost of any casualty andextended coverage insurance policy covering the Building and/or property located therein, and shall comply with allrules, orders, regulations and requirements of the appropriate Fire Rating Bureau or any other organizationperforming a similar function. Tenant shall promptly upon demand reimburse Landlord for any additional premiumcharged for such policy by reason of Tenant’s failure to comply with the provisions of this paragraph.

9. Indemnification. Tenant and Landlord shall indemnify and hold each other harmless against andfrom any and all claims, demands, actions, losses, damages, orders, judgments and any and all costs andexpenses (including without limitation reasonable attorneys' fees, court costs, and costs of litigation), resulting fromor incurred by the other arising out of the negligence of the other party to the extent permitted by Florida law.

10. Insurance. Tenant will procure and maintain during the Term a policy or policies of insurance,satisfactory to the Landlord and consistent with Tenant’s current insurance policies.

11. Waiver of Subrogation. Landlord and Tenant on behalf of themselves and all others claimingunder them, including any insurer, waive all claims against each other, including all rights of subrogation, for loss ordamage to their respective property (including, but not limited to, the Space) arising from fire, smoke damage,windstorm, hail, vandalism, theft, malicious mischief and any of the other perils normally insured against in an "allrisk" of physical loss insurance policy, regardless of whether insurance against those perils is in effect with respectto such party's property and regardless of the negligence of either party. If either party so requests, the other partyshall obtain from its insurer a written waiver of all rights of subrogation that it may have against the other party solong as such waiver is commercially available.

12. Default. If Tenant fails to pay the Rent or other sum payable by Tenant hereunder and fails tocure such default within five (5) days after notice thereof, or if Tenant defaults in the prompt or full performance ofany other provision of this Agreement and fails to cure such default within thirty (30) days after notice thereof,Landlord shall have the right to terminate this Agreement and deny Tenant access to the Space by any lawfulmeans. In the event of such termination by Landlord, all of Tenant's rights and privileges hereunder shall terminateand Landlord shall have no further obligation to Tenant under this Agreement.

13. Assignment or Transfer The rights granted by Landlord to Tenant under this Agreement areconsidered a personal privilege and may not be assigned or transferred, in part or in whole, without the writtenconsent of Landlord, which consent may be withheld in Landlord’s sole and absolute discretion.

14. Events of Holdover. In the event Tenant should remain in possession of the Space afterexpiration of the Term of this Agreement without execution by Landlord and Tenant of a new Agreement orextension of the Term of this Agreement, then Tenant shall be deemed to be occupying the Space as a tenant atsufferance subject to all of the covenants and obligations of this Agreement and at a daily Rent of one hundred fiftypercent (150%) of the per diem rate of Rent provided hereunder until such time as Tenant vacates the Office Space.Landlord shall have the right to deem the continuing occupancy of Tenant to constitute the creation of a month-to-month tenancy at one hundred percent (100%) of the Rent provided hereunder, provided Landlord gives Tenantnotice of such election, which month-to-month tenancy shall continue thereafter until either party shall have giventhe other one (1) full calendar month's notice of its intention to terminate such month-to-month tenancy.

15. Notice. All notices to be given hereunder by either party shall be in writing and may be sent byUnited States certified mail, postage prepaid, addressed to:

Landlord: __________________________________________________________________

Attention: ____________________________

Tenant: Lee Memorial Health SystemAttn: Property Management636 Del Prado BlvdCape Coral, FL 33990

or to such other address as either party may have furnished to the other. Any notice shall be deemed given whendeposited in the mail in the foregoing manner.

17. Radon Gas. (Applicable in Florida only) Radon is a naturally occurring radioactive gas that,when it has accumulated in a building in sufficient quantities, may present health risks to persons who are exposedto it over time. Levels of radon that exceed federal and state guidelines have been found in buildings in Florida.Additional information regarding radon and radon testing may be obtained from the local county public health unit.

18. Regulatory Matters. (a) Landlord and Tenant enter into this Agreement with the intent ofconducting their relationship and implementing the agreements contained herein in full compliance with applicablefederal, state and local law, including without limitation, the Medicare/Medicaid Anti-Kickback statute (the “Anti-Kickback Law”) and Section 1877 of the Social Security Act (the “Stark Law”), as amended. Notwithstanding anyunanticipated effect of any of the provisions of this Agreement, neither party will intentionally conduct itself underthe terms of this Agreement in a manner that would constitute a violation of the Anti-Kickback Law or the StarkLaw. Without limiting the generality of the foregoing, Landlord and Tenant expressly agree that nothing containedin this Agreement shall require either party to refer any patients to the other, or to any affiliate or subsidiary of theother. If any legislation, regulation or government policy is passed or adopted, the effect of which would causeeither party to be in violation of such laws due to the existence of any provision of this Agreement, then Landlordand Tenant agree to negotiate in good faith for a period of 90 days to modify the terms of this Agreement to complywith applicable law. Should the parties hereto fail to agree upon modified terms to this Agreement within this time,either Landlord or Tenant may immediately terminate this Agreement by giving written notice to the other party.

(b) Tenant represents and warrants to Landlord that Tenant (i) is not currently excluded, debarred orotherwise ineligible to participate in Medicare or any federal health care program under section 1128 and 1128A ofthe Social Security Act or as defined in 42 U.S.C. § 1320a-7b(f) (the “Federal Health Care Programs”); (ii) has notbeen convicted of a criminal offense related to the provision of healthcare items or services but has not yet beenexcluded, debarred, or otherwise declared ineligible to participate in any Federal Health Care Program; and (iii) isnot under investigation or otherwise aware of any circumstances which may result in Tenant being excluded fromparticipation in any Federal Health Care Program. The foregoing representation shall be an ongoing representationand warranty during the term of this Agreement and Tenant shall immediately notify Landlord of any change in thestatus of the representation and warranty set forth in this paragraph, at which time Landlord will have the right toimmediately terminate this Agreement.

(c) For purposes of this paragraph of this Agreement, “protected health information”, or PHI, shall havethe meaning defined by the Standards for Privacy of Individually Identifiable Health Information, 45 C.F.R. Part 160

and Subparts A and E of Part 164 (the “Privacy Standards”), as promulgated by the Department of Health andHuman Services (“HHS”) pursuant to the Administrative Simplification provisions of the Health Insurance Portabilityand Accountability Act of 1996 (“HIPAA”). Tenant agrees to reasonably safeguard PHI from any intentional orunintentional disclosure in violation of the Privacy Standards by implementing appropriate administrative, technicaland physical safeguards to protect the privacy of PHI. Tenant further agrees to implement appropriateadministrative, technical and physical safeguards to limit incidental disclosures of PHI, including disclosures toLandlord, its subcontractors and agents. The parties agree that neither the Landlord nor its contractors,subcontractors or agents shall need access to, nor shall they use or disclose, any PHI of Tenant. However, in theevent PHI is disclosed by Tenant or its agents to Landlord, its, contractors, subcontractors or agents, regardless asto whether the disclosure is inadvertent or otherwise, Landlord agrees to take reasonable steps to maintain, and torequire its contractors, subcontractors and agents to maintain, the privacy and confidentiality of such PHI. Theparties agree that the foregoing does not create, and is not intended to create, a “business associate” relationshipbetween the parties as that term is defined by the Privacy Standards.

IN WITNESS WHEREOF, the parties hereto have executed this Agreement on the date first above written.

Witnesses:

Witness Signature

Witness Printed Name

Witness Signature


LANDLORD:

FIDDLESTICKS GOLF AND COUNTRY CLUB

By:

Print Name:

Print Title:

Date:

Witnesses:

Witness Signature


Witness Signature


TENANT:


By:

Print Name:

Print Title:

Date:

EXHIBIT A

Diagram of Office Space

EXHIBIT B

Equipment

EXHIBIT C

Services

List services to be provided by Landlord:

The following shall be provided within the Office Space:

Water as required for normal and customary physical therapy office use; Central heat and air-conditioning; Electrical power as required for normal and customary physical therapy office use; Lamps, bulbs, tubes and ballasts for building standard lighting fixtures used in the Space; Sanitary sewer services; non-infectious waste disposal; infectious waste disposal; "sharps" disposal; recycling services; telecommunication services (including basic telephone services, desk-top computers, and

wireless network access) daily janitorial and trash removal services; repair, maintenance and replacement (as needed) of the Spaceand all HVAC, mechanical;

electrical and plumbing systems; and shredding service.



BOARD OF

DIRECTORS’ REPORTS



BOARD ADMINISTRATOR

REPORT

(Cathy Stephens)

BBOOAARRDD OOFF DDIRREECCTTOORRSS I

Welcomes You and a Guest to Attend a Special Evening Honoring our

“Pioneer Physicians 1916 – 1979”

DATE: Thursday, April 7, 2011

TIME: 4:30pm – 5:30pm Medical Museum Tour & Reception Program & Dinner to Follow

LOCATION: Edison State College, School of Nursing Building

8099 College Parkway, Ft. Myers, FL 33919

Please R.S.V.P. by April 1, 2011 LMHS Board of Directors Office (239) 343-3300

(Transportation is available upon request)

2011 Outstanding Administrative Professional Award OFFICIAL NOMINATION FORM

I am pleased to nominate the following individual for the 2011 Outstanding Administrative Professional Award: Nominee: Position: Department: Agency Address: Phone: Immediate Supervisor: * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * Submitted by: Position: Department: Email: Phone: * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * Please check the criterion on which your nomination is based: ___ Implemented a new idea or program to benefit the staff and clients of the agency. ___ Improved the quality of programs and/or services of the agency. ___ Showed an outstanding commitment to the agency by their voluntary involvement in community activities ___ Provided excellent customer service. ___ Demonstrated exemplary commitment to the core values of the agency. Return this nomination form along with a one-page, double-spaced narrative to: Nida Eluna Dr. Piper Center for Social Services, Inc. 2607 Dr. Ella Piper Way Fort Myers, FL 33916 [email protected] Deadline for nominations: Friday, April 22, 2011. Awards will be presented at the 8th Annual Administrative Professional Luncheon, Fashion Show and Auction at the Broadway Palm Dinner Theatre on April 29, 2011 from 10:30-1:00PM. Nomination form also available at www.drpipercenter.org

LLEEEE MMEEMMOORRIIAALL HHEEAALLTTHH SSYYSSTTEEMM && LLEEEE CCOOUUNNTTYY TTRRAAUUMMAA SSEERRVVIICCEESS DDIISSTTRRIICCTT BBOOAARRDD OOFF DDIIRREECCTTOORRSS MMEEEETTIINNGG CCAALLEENNDDAARR

APRIL 2011

Sunday Monday Tuesday Wednesday Thursday Friday Saturday

1 APRIL FOOLS

DAY

2 Foundation Event

Madisen’s Match Tennis Tournament

3

4

5 12 pm - 2 pm

Regional Advisory on

Trauma Services Meeting

(LMH Boardroom)

6

7

4:30 pm Pioneer Physician Dinner

(Edison State College)

8

Cape Coral Service Award Luncheons, CCH New Café

Auxiliary Room 11:30 am & 1:30 pm

9 Ronald McDonald Storybook Ball

6 pm (Hyatt Regency) By RSVP only

++++++++++++++++++++++++ 6 pm

Nations Assoc. Gala (Harborside Event Center)

By RSVP only

10 AHA

Annual Meeting Washington

10th – 13th

++++++++++++++++++ National Volunteer

Week April 10-16

11 AHA


10th – 13th

++++++++++++++++++ Foundation Event

Children’s Hospital Golf Classic at the Colony Golf & Bay

Club

12 AHA


10th – 13th

13 AHA


10th – 13th

14 HealthPark Service Award Luncheon

HP H201-204 (LPG Onl ) y11:30 am - 12:30 pm

15 Tax Day! HealthPark Service Award

Luncheons, HealthPark H201-204

11:30 am & 1:30 pm +++++++++++++++++++++

5:30 pm - 9:00 pm Golden Apple Teacher

Award Dinner (Harborside Event Center)

By RSVP only

16

17

18

19

Gulf Coast Medical Center Service Award

Luncheons GCMC Community Room

11:30 am & 1:30 pm

20

21 Annual Lee Memorial Service Award Luncheon, LMH Auditorium

11:30 am & 1:30 pm +++++++++++++++++++++++

4:00pm Trauma District Board

Then Quality/Education Board of Directors (LMH Boardroom)

22 Good Friday

23 8th Annual Harley Easter

Bunny Toy Run

24 HAPPY

EASTER

25

26

27 Administrative Professionals Day

28 4:00PM

Finance & Full Board Meetings

(LMH Boardroom)

29 Dr. Piper Administrative Professional Luncheon

10:30 am-1:00 pm (Broadway Palm)

30 American

Heart Association Heart Ball

Hyatt Regency By RSVP only

Key: LMH – Lee Memorial Hospital HPMC – Health Park Medical Center CCH – Cape Coral Hospital GCMC- Gulf Coast Medical Center

FOUNDATION EVENTS: For additional information, please contact the Foundation Office at 239-343-6950 or visit www.leememorial.org/foundation. Questions regarding this schedule: Please contact the Board of Directors Office at 239-343-3300.

http://www.leememorial.org/foundation

LEE MEMORIAL HEALTH SYSTEM BOARD OF DIRECTORS

Recognizes and Awards

??? ??? Nomination Period May 1 Nomination Period May 1 –– June 30June 302011 “DOC” COGGINS

COMMITMENT TO EXCELLENCE AWARDBOARD OF DIRECTORS

District 1 – Stephen Brown, MD • Marilyn StoutDistrict 2 – Richard Akin • Nancy McGovern, RN, MSM

District 3 – Lois Barrett, MBA • Linda L. Brown, MSN, ARNPDistrict 4 – Diane Champion • Chris Hansen

District 5 – Don Brown • James Green

ADJOURNMENT __________________


DATE OF THE NEXT REGULARLY SCHEDULED

MEETING

Trauma District then Quality & Education

FULL BOARD MEETING

THURSDAY, April 21, 2011

4:00pm

Lee Memorial Hospital - Boardroom 2776 Cleveland Ave, Ft. Myers, FL 33901