2007 Board Minutes

SHERIDAN MEMORIAL HOSPITAL BOARD OF TRUSTEES (December 2007 meeting re-scheduled)
January 9, 2008 5:00 P.M.

MEMBERS PRESENT: Michael Strahan, M.D., Harlan Rasmussen, Ron Mischke, Dixie See, Ron Mischke, Gary Miller and Mike McCafferty

APPROVAL OF MINUTES
The meeting minutes of November 28, 2007 were reviewed. After review, Harlan Rasmussen made a motion to approve the minutes, Dixie See seconded the motion and motion carried.

PUBLIC COMMENTS
There were no public comments.

QUALITY COMMITTEE REPORT
It was noted that Ron Mischke will be the new Chairman of the Quality Council.

Lajune Bacon reviewed the scorecard for November, 2007. Lajune reported that a PI Project is in process to improve hyperglycemia control for inpatients with elevated blood glucose and Dr. Ian Hunter is helping with the study. Anthony Spiegelberg asked that Lajune communicate this with Dr. Scott Nickerson as this was his suggestion.

MEDICAL STAFF REPORT
Anthony Spiegelberg welcomed Dr. Brad Hanebrink as the new Chief of Staff. Dr. Hanebrink said he is looking forward to his role and stated that Dr. Barry Wohl has done a terrific job as Chief of Staff for the past four years.

Dr. Hanebrink presented one medical staff application request for reappointment.

Stephanie Sanders, PA - Stephanie Sanders, Physician Assistant, is requesting renewal of her privileges as a Limited Health Care Practitioner in the Department of Medicine. Dr. Hugh Batty is her supervising physician.

Harlan Rasmussen asked Dr. Hanebrink if he personally reviewed the file. Dr. Hanebrink said that he did and Ms. Sanders’ application was reviewed and approved by the Medicine Committee as well as the Medical Executive Committee.

Ron Mischke made a motion to approve the renewal application of Stephanie Sanders, PA, Bill Huppert seconded the motion and motion carried.

ADMINISTRATION REPORT
IT Update - Mike McCafferty asked Ed Johlman to give a report on Information Systems. Mr. Johlman noted that several projects have been completed as outlined in the Hayes Report, for example, new phones, Microsoft exchange server, etc. The hospital’s IT Task Force prioritized the projects and in what order they should be completed. Mr. Johlman explained that the hospital is looking at an electronic medical record and physician integration and will hear presentations from other systems in the near future as to what they can offer that the hospital’s current system cannot. Mr. Johlman stated that the hospital’s current system, Keane, may have more capabilities that have not been activated, noting that it is very expensive if we change vendors.   A hospital group will travel to a Michigan hospital who use the Keane System to see of we can actually receive what we need from Keane.

Gary Miller expressed concern with regard to Keane not sharing information with the hospital regarding the systems capabilities. Mr. Johlman said that some of this has to do with information not being passed on to new staff.

Anthony Spiegelberg asked if a new computer system would be of benefit to the community. Mr. Johlman said that some systems do have a patient portal, but that the hospital would need to have an electronic medical record. Mr. Spiegelberg asked about medical staff input and Dr. Hanebrink stated that he will encourage physicians to help in any way they can.

IT Manager - Ed Johlman reported that the hospital initially advertised for an IT Manager, but did not receive the quality of resumes needed. The hospital is now seeking a Chief Information Officer and have received several good resumes. Mr. Johlman will begin prescreening phone calls this week.

Medical Oncologist - Mike McCafferty reported that a Medical Oncologist will be relocating to Sheridan and will be employed by Hematology-Oncology of the Northern Rockies in Billings, Montana. Mr. McCafferty said that the recruitment of a Medical Oncologist ties together the hospital’s efforts to bring a full compliment of cancer care to our patients.

Quality Training - Mike McCafferty explained that the American College of Healthcare Executives (ACHE) have board development opportunities as healthcare becomes more complex. Online training for Board participation is available and Mr. McCafferty will work with Anthony Spiegelberg and Joanne Redder to set up this training. There is also quality training that will be helpful for Ron Mischke as the Quality Council Chairman.

Sheridan Surgical Center - As negotiations continue, Mike McCafferty reported that the hospital has received financial information from the Sheridan Surgical Center, and a Letter of Nondisclosure has been signed. A valuation is being completed, should the hospital decide to make an offer. Mr. McCafferty asked Anthony Spiegelberg if he would appoint a subcommittee to meet with him in the decision making process. Mr. Spiegelberg asked the Board’s Long Range Planning Committee to work with Mike.

Home Care & Hospice Report - Lee Ingalls, Home Care & Hospice Manger, reviewed the Home Care & Hospice Annual Reports. Mr. Ingalls noted that Home Care visits were down 600 last year, but these numbers are rising and he continues to receive very positive comments regarding the staff.

Mr. Ingalls noted that Home Care & Hospice have received awards from Mountain-Pacific Quality Health for quality outcomes and national benchmarks.

Mr. Ingalls reported that Hospice served 31 families in the last fiscal year and, in addition to the staff, praised the volunteers for their many hours working with patients and for their commitment. Mr. Ingalls said there is a training process for the volunteers.

After review, Harlan Rasmussen acknowledged receipt of the report from Home Care and Hospice. Dixie See seconded the motion and motion carried.

Mike McCafferty introduced Shannon Boint, new Med/Surg Manager and welcomed her to the hospital. Anthony Spiegelberg welcomed Mrs. Boint and noted that she was recipient of one of the first Foundation scholarships.

Marketing Report - Danae Brandjord, Marketing Manager, reported that the hospital’s marketing video is in the final stages and will be reproduced within the next few weeks. The department is also narrowing down vendors for redesign of the hospital’s website.

FINANCE COMMITTEE REPORT
Financial Statements - Gary Miller reported that the Finance Committee met prior to the meeting and reviewed the vouchers. The financial statements were reviewed and Ed Johlman stated that November was a busy month with inpatient revenue higher than budgeted and outpatient was strong. The rise in patient volume was felt to be a result of increased confidence from the community and physicians. Dr. Hanebrink attributed the rise in surgical visits to the addition of two new excellent surgeons.

Ed Johlman reported that the hospital had to repay $435,000 to Medicare to settle a recently completed audit on the hospital’s ’06 Medicare cost report. $350,000 of that settlement was due to the hospital’s new cost report auditors, Noridian of Fargo, S.D., removing our Disproportionate Share Hospital reimbursement. Noridian would not accept the information that the hospital’s previous auditors, Blue Cross/Blue Shield of Cheyenne, had accepted and instead based their adjustment on a faulty log from the WY Medicaid office. Ed will be working with the hospital’s cost report preparer and with WY Medicaid to resolve this issue. The hospital should be able to get the DSH money back in the next 6 months or so.

Ed Johlman presented two capital equipment request items:

Laparoscopic Cameras - A request has been submitted from surgeons Corey Jost, M.D. and Barry Mangus, M.D. for the purchase of two additional laparoscopic cameras at a cost of $16,000 for each camera. This is an unbudgeted request.

Anthony asked if this request was approved by the appropriate Medical Staff Committee. It was noted that it was not submitted to the Surgery Committee for approval. This will be done and the request will be re-submitted for approval at the January 30^th Board Meeting.

Interface - A request was presented for purchase of an interface between Soft Script medical transcription and the hospital’s Keane information system to help with the transcription services. The hospital is currently down from four to two transcriptionists. This is an unbudgeted item at a cost of $17,000. There was concern expressed with regard to confidentiality. Mr. Johlman said that confidentiality will be carefully planned out. Soft Script provides total transcription coverage for several major hospitals in the US and the hospital will have the same security that is functioning in those major hospital systems. Also, home transcription is becoming an industry standard. This will be safe.

Harlan Rasmussen made a motion to approve the purchase of the interface, Bill Huppert seconded the motion and motion carried.

FOUNDATION REPORT
Ada Kirven, Foundation Assistant, gave a report in Tom Ringley’s absence, noting that the membership drive is going well and there are currently 318 employee partners.

Mr. McCafferty added that the employee partners voted on a needed project for the hospital and the ICU remodel was the project chosen at a cost of approximately $23,000. Mr. McCafferty said that approximately $70,000 has been given from hospital employees to the Foundation.

BUILDING COMMITTEE REPORT
Dixie See reported that the hospital is awaiting the building permit for the Transitional Care Unit and the Pharmacy Project has moved up to number two for state approval.

There being no further business, the open meeting adjourned at 6:25 p.m. The Board then went into executive session. No action will be taken.

Recorder, Joanne Redder
Dixie See, Secretary

MEMBERS PRESENT: Michael Strahan, M.D., Harlan Rasmussen, Ron Mischke, Dixie See, Ron Mischke, Gary Miller and Mike McCafferty

Harlan Rasmussen, Vice Chairman, called the meeting to order at 5:00 p.m. Mr. Rasmussen announced a change in the agenda with an executive session to be held at the end of the meeting. The closed session will be for discussion of personnel, with no action to be taken after the executive session.

The previous meeting minutes of October 24, 2007 were reviewed. Two corrections were noted. On page 4, the cost of the breast coil should be $45,000 and also on page 4, the total current Foundation hospital partners is 312. Dixie See made a motion to approve the minutes as corrected, Dr. Strahan seconded the motion and motion carried.

ADMINISTRATION REPORT
Surgery Center Update - Mike McCafferty reported that negotiations continue with the Sheridan Surgical Center owners and a letter of nondisclosure has been signed.

Psychiatry - Mike McCafferty reported that the hospital is monitoring the Psychiatry Program which continues to grow. Numbers are being reviewed to determine if further psychiatry recruitment is needed, and pro forma information will be shared with the Board.

Gainsharing - Mr. McCafferty noted that a multitude of thank you letters has been received regarding the recent gainsharing award and thanked the Board on behalf of the hospital and staff.

VHA - Mike McCafferty reported that hospital leadership is working with the VHA Executive Improvement Academy whose aim is to help the executive teams lead substantial measured improvements in performance in clinical quality and patient safety. Also, Mr. McCafferty recommended to the Board that the Quality Committee Report be moved to the first part of the agenda. It was agreed that the Quality Report will be placed on the agenda after Public Comments.

MEDICAL STAFF REPORT
Dr. Wohl presented one new Medical Staff application for approval and several Limited Healthcare Practitioners’ applications for reappointment.

Martin Kirk Lucas, M.D. Dr. Lucas is requesting privileges as a Courtesy Medical Staff member in the Department of Medicine, specializing in Hematology/Oncology. Dr. Wohl stated that the application has been reviewed and approved by the appropriate department. After review, Ron Mischke made a motion to approve Dr. Lucas for privileges as requested, Bill Huppert seconded the motion and motion carried.

Gary Miller asked if the Medical Oncologist who visited Sheridan several weeks ago will be relocating here. Mr. McCafferty reported that the hospital does have a verbal commitment from this physician.

Recredentialing - Dr. Wohl presented a list of 28 mid-levels who have re-applied for privileges for a two year period. He explained that physicians and mid-level practitioners are re-credentialed in opposite years. This year is recredentialing for mid-level practitioners. Dr. Wohl stated that all applications have been reviewed by their appropriate department(s), as well as the Medical Executive Committee and recommended their approval. It was noted that all mid-levels are under the supervision of a member of the Active Medical Staff.

Dr. Strahan made a motion to approve all 28 Limited Health Care Practitioners for privileges for the period January 1, 2008 through December 31, 2009. Dixie See seconded the motion and motion carried.

Medical Staff Policy - Dr. Wohl presented changes to Medical Staff Policy #250 at the October Board Meeting. Harlan Rasmussen stated that the Board Bylaw Committee met after the meeting, acknowledged receipt of the policy changes and concurred. No action necessary.

FINANCE COMMITTEE REPORT
Gary Miler reviewed the financial statements, noting a very high volume month, but a very high bad debt expense. Harlan Rasmussen asked how the hospital distinguishes between charity and bad debt. Mr. Miller explained that with charity care expense, the patient is unable to pay, and with bad debt expense, the patient is unwilling to pay. It was noted that in the first four months of the fiscal year, charity care has totaled $480,000 and bad debt $3.2 million.

Dr. Wohl asked if the hospital has any idea how this compares with the national trend. It was noted that cost of providing medical care has gone up and so much of what the hospital gets paid is fixed payment. Mike McCafferty said that the hospital’s Utilization Review staff and Social Services do an excellent job of working with the physicians so patients can be discharged as soon as possible, helping keep the length of stay numbers down.

Outsourcing - Ed Johlman explained that two of the hospital’s billing staff will soon be taking extended leaves and the hospital has engaged a company in Rawlins, Wyoming to help move older 3^rd party insurance denials and claims.

Sheridan Radiology Resolution - Ed Johlman stated that a check signature resolution is needed for Sheridan Radiology, for payment of bills. Dan Alzheimer, M.D. Roxanne Alzheimer, Mike McCafferty, and Ed Johlman will be authorized to sign checks. It was moved, seconded and passed to approve the pre-signature account for Sheridan Radiology.

FOUNDATION REPORT
Tom Ringley reported that employee partners will be able to vote on how they want their money spent at the December 19^th Employee Partner Breakfast. Mr. Ringley also reported that the Membership Drive is in process and has received good response.

BUILDING COMMITTEE REPORT
Dixie See reported that Rob Forister is working on obtaining the building permit for the cafeteria expansion and the project will then go to bid.

The Pharmacy Project is still at the state level.

One action item was presented. A request was submitted from the Building Committee to spend $19,210 for road improvement and an additional 14 parking spots behind the Medical Arts Complex. Facilities Manager, Rob Forister, reviewed the design drawing, noting that the city has no problem with hospital staff using this road and a stop sign has been installed where the road exits into Highland Avenue.

QUALITY COMMITTEE REPORT
Quality Services Manager, Lajune Bacon, reported that Home Care developed a patient satisfaction survey that followed the HCAHPS format, bringing it more in line with other hospital departments. The survey was reviewed by Mr. Ingalls.

Mike McCafferty pointed out an article in the Board’s Packet which explains what HCAHPS means. Lajune Bacon reviewed the HCAHPS trend report for this fiscal year, noting that the overall rating has gone up every month

The Service Excellence Scorecard was reviewed with the Board and Human Resources Manager, Len Gross, reviewed the breakout on staff turnover. Mr. Gross explained that a big part of the reason staff has left the hospital is due to relocation.

OTHER BUSINESS
Marketing Manager, Danae Brandjord, invited the Board to the hospital’s December holiday events.

Nursing Director, Peggy Callantine, introduced Shannon Boint who recently joined the hospital as the new Med/Surg and TCU Manager. Shannon came to the hospital from the VA Medical Center. Mrs. Boint said that she is committed to the hospital and happy to be part of the team.

The Board then adjourned and entered into executive session at 6:10 p.m. Gary Miller will serve as temporary chairman for the executive session.

MEMBERS PRESENT: Michael Strahan, M.D., Harlan Rasmussen, Anthony Spielberg, Ron Mischke, Dixie See, Ron Mischke, Gary Miller and Mike McCafferty

APPROVAL OF PREVIOUS MINUTES -- The previous meeting minutes of September 26, 2007 were reviewed. After review, Dr. Strahan made a motion to approve the minutes, Harlan Rasmussen seconded the motion and motion carried.

Anthony Spiegelberg explained that there will need to be a modification to the agenda to include an executive session. Harlan Rasmussen made a motion that the Board adjourn into executive session for a personnel matter, Dixie See seconded the motion and motion carried.

The Board adjourned into executive session at 5:05 p.m.
The meeting reconvened at 5:20 p.m.

MEDICAL STAFF REPORT
Dr. Wohl presented three medical staff applications to the Board for review and approval. All applications have been reviewed and approved by their appropriate department, as well as the Medical Executive Committee.

James Burke, M.D. - Dr. Burke is requesting privileges on the Courtesy Medical Staff in the Department of Medicine, specializing in Hematology/Oncology. Dr. Burke practices in Billings, Montana.

After review of his credentials, Dr. Strahan made a motion to approve Dr. Burke for privileges as requested. Ron Mischke seconded the motion and motion carried.

Rae Marie McReynolds, PhD, LPC - Ms. McReynolds is requesting privileges as an Independent Limited Health Care Practitioner in the Department of Medicine as a Licensed Professional Counselor.

After review of her credentials, Bill Huppert made a motion to approve Ms. McReynolds for privileges as requested. Dixie See seconded the motion and motion carried.

Ivy Larson, CST, CFA - Mrs. Larson is requesting privileges as a Dependent Limited Health Care Practitioner as a Certified Surgical Technician and Certified First Assistant in the Department of Surgery.

Dr. Wohl explained that there are two parts to his recommendation to approve Ivy Larson’s application for privileges.

The first part is, as specified in the Medical Staff Bylaws, approval of the establishment of a category for Certified Surgical Technician and First Assistant in the Department of Surgery as a Dependent Limited Health Care Practitioner. This category has been approved by the Department of Surgery and the Medical Executive Committee.

Ron Mischke made a motion to recommend approval of the establishment of a category for Certified Surgical Technician and First Assistant in the Department of Surgery as a Dependent Limited Health Care Practitioner. Dixie See seconded the motion and motion carried.

Dr. Strahan expressed concern that a new category is being established that has not gone before the full Medical Staff. Dr. Wohl explained that the Bylaws are being followed and anything that Mrs. Larson does in the hospital is under the direct supervision of her sponsoring physicians, Drs. Ferries, Gill, Holst, Milner, Quinn, Ritterbusch, Scott, Jost, Mangus and Bateman.

There was discussion with regard to Mrs. Larson being self-employed and questions regarding billing, etc. Dr. Wohl stated that Mrs. Larson’s financial arrangements are not under the purview of the Medical Staff. Mike McCafferty explained that Mrs. Larson’s sponsoring physicians are members of the hospital’s Surgery Department and they will utilize her services as they feel is appropriate, as a Dependent Practitioner.

The second part of Ivy Larson’s application is the request for privileges as a Dependent Limited Health Care Practitioner, as approved by the Department of Surgery and the Medical Executive Committee. Dr. Strahan made a motion to approve Ivy Larson for privileges as requested, Dixie See seconded the motion and motion carried.

Dr. Wohl passed out copies of Medical Staff Policy #250, noting the following changes as per the October 18^th Medical Executive Committee Meeting:

· Page 5 of 8 – switch the order of letter C. and D. to read the following with the appropriate (bolded) revisions:

o C. “The Chief of Staff, (in consultation with the Department Chair (addition)), may dismiss any unfounded report and will notify the Quality

o Services Manager who initiated the report of his or her decision. Unsubstantiated reports will not be kept.”

o D. “Once a report of unprofessional conduct is received, the Chief of Staff, in consultation with the Medical Executive Committee, will investigate the report unless the report has been dismissed.”

Dr. Wohl said he was bringing this before the Board as information. Anthony Spiegelberg asked that that Board Bylaw Committee Review and make recommendation to the full Board.

ADMINISTRATION REPORT
Mike McCafferty reviewed the new Strategic Plan & Physician Directory and thanked Danae Brandjord, Marketing Manager, and all staff who helped in the development.

VHA - Mike McCafferty gave a report on the VHA Executive Improvement Academy which is targeted to hospital senior leadership teams to lead substantial measured improvements in performance in clinical quality and safety for entire hospitals and health systems. Mr. McCafferty explained that Superior Performance Improvement (SPI) helps our hospital benchmark with other hospitals.

Dr. Strahan stated that he recently attended a VHA Clinical Leadership Conference, noting the benefit of networking to improve SMH performance, as well as all hospitals in the Mountain States region.

Sheridan Surgical Center - Mike McCafferty reported that he met with SCC’s accountant and there will be some financial data sharing, with information expected next week.

FINANCE REPORT
Audit Report - Ed Johlman introduced Jerrel Tucker from TCA Partners. Mr. Tucker reviewed the Year-End Audit for 2007, noting that it was previously reviewed in Finance Committee. Mr. Tucker said he was very pleased with how well the audit went, stating that during a transition to a new CFO there are sometimes some bumps in the auditing process. Mr. Tucker said everything went very smoothly and the hospital received an unqualified opinion.

Anthony Spiegelberg asked questions regarding any future accounting changes. Mr. Tucker said that revenue management is the crux of healthcare and the hospital needs to keep the business office functioning properly. In answer to a question from Mr. Spiegelberg, Mr. Tucker said he cannot consult the hospital on this because he does the audit report, but stated that there are staff in his firm who do this type of work. Mr. Tucker added that Sheridan Memorial Hospital is used as a model hospital when TCA puts their reports together for other hospitals. The Board thanked Mr. Tucker for his report.

Gary Miller made a motion to accept the audit report, Dr. Strahan seconded the motion and motion carried.

Financial Statements - Gary Miller reported that the vouchers were reviewed in the Finance Committee, noting that the month of September was uneventful.

Capital Equipment Request - Ed Johlman explained that the hospital has an opportunity to purchase a breast coil that will attach to the MRI. This will be used as follow-up for women who have had breast cancer, instead of having a mammogram. Mr. McCafferty said that purchase of the coil has been discussed for some time and it is better for the hospital financially to have their own. Cost of the coil is $45,000.

Gary Miller made a motion to approve the purchase of a breast coil, Ron Mischke seconded the motion and motion carried.

Gainsharing - Ed Johlman passed out a memo on the fiscal year 2007 Gainsharing award and Mr. McCafferty explained the process. The Gainsharing Program was designed to award a portion of the hospital’s net operating income to employees based on the hospital’s overall Avatar score. Each full time, part time and PRN employees of the hospital who are still actively employed as of the distribution date will receive a share of the Gainshare award based on the number of hours worked during the previous fiscal year.

Gary Miller made a motion to accept the recommendation from Mr. McCafferty and the Finance Committee for the FY 2007 Gainsharing Award. The motion was seconded and passed.

Anthony Spiegelberg stated that this program pays for itself and the Board is glad the hospital can continue with this program to thank their employees

FOUNDATION REPORT
Tom Ringley reminded the Board of the Foundation’s Physician Recognition Reception scheduled for November 2^nd. Mr. Ringley noted that the Foundation Partner Christmas Party is coming up in December with 312 current hospital partners.

BUILDING COMMITTEE REPORT
Dixie See asked Rob Forister to review the upcoming projects recommended by the Building Committee.

Cafeteria Expansion - Rob Forister explained that the outdoor eating area needs to be enclosed due to a design problem in the last remodel. This project is included in this year’s fiscal budget at $150,000.

Dixie See made a motion to approve the Cafeteria Expansion Project. Harlan Rasmussen seconded the motion and motion carried.

Transitional Care Unit Remodel - Rob Forister explained that the project will create space for TCU patients to rehabilitate in comfort, with a dining and activity area, family area, area for rehab activities, etc. This is not a budgeted project, but $65,000 in donated funds are available from the Foundation and total cost of approximately $100,000 for the project is expected by the Foundation when the project is completed. Mr. Forister asked for approval not to exceed a total expense of $100,000.

Harlan Rasmussen made a motion to approve up to $100,000 for the TCU remodel. Dixie See seconded the motion and motion carried.

Lab Project - Rob Forister explained that an area under the current Emergency Department (next to the area designated for Dialysis) is the best location for the Laboratory, allowing for future growth. Funding for the Laboratory project is in the current budget.

Mr. Forister requested approval of the footprint for Dialysis and approval for the Laboratory to be located next to the Dialysis Unit.

Dr. Strahan made a motion to approve the footprint and proceed with the Laboratory as requested. Ron Mischke seconded the motion and motion carried.

QUALITY COMMITTEE REPORT
Dr. Strahan passed out Superior Performance numbers to the Board for review. There was no Quality Council Meeting held in October - several members were attending the VHA Conference. The next meeting will be held on November 21^st.

There being no further business, the meeting adjourned at 7:10 p.m.

Recorder, Joanne Redder

Dixie See, Secretary

MEMBERS PRESENT: Michael Strahan, M.D., Harlan Rasmussen, Anthony Spielberg, Ron Mischke, Dixie See, Ron Mischke, Gary Miller and Mike McCafferty.

Mr. Spiegelberg called the meeting to order at 4:30 p.m. The Board then adjourned into executive session at 4:35 p.m. The meeting re-convened at 5:10 p.m.

APPROVAL OF MINUTES
The previous meeting minutes of August 22, 2007 were reviewed. After review, Harlan Rasmussen made a motion to approve the minutes; Dixie See seconded the motion and motion carried.

MEDICAL STAFF REPORT
Dr. Wohl reported that new Medical Staff Officers were elected for next year. Brad Hanebrink, D.O. will replace Barry Wohl, M.D. as Chief of Staff on January 1, 2008. Dr. Wohl will remain on the Medical Executive Committee. Hugh Batty, M.D. will be Vice Chief of Staff and Ian Hunter, M.D. was elected Secretary/Treasurer. Dr. Wohl noted that the September Quarterly Staff Meeting had the largest turnout in more than two years. Discussion at the meeting included strengthening the leadership of physicians, supporting the tobacco policy, and information on the Drug-Free work place. It was suggested that the information on the Drug-Free work place be gathered from the hospital and WYSTAR and taken to physician practices. Anthony Spiegelberg asked Dr. Wohl to invite Dr. Hanebrink to attend a Board Meeting in the near future.

ADMINISTRATION REPORT
Mike McCafferty announced that the SMH Foundation Directors are sponsoring a Physician Recognition Reception on Friday, November 2, 2007 from 6-8 p.m. at the Powder Horn Club House. Invitations will be mailed out to SMH Board Members and Physicians. The Foundation is hosting the reception for the purpose of recognition and to build relationships between the two boards and physicians. It was reported that currently 80% of SMH employees are Foundation partners and 27 members are physicians.

Mr. McCafferty explained that Danae Brandjord will be providing marketing information, updates and an operational overview monthly in the board packets.

Mike McCafferty stated that he has been in contact with the Sheridan Surgical Center to request volumes, case mix, and financial information to continue the process of discussion to be a potential partner. Mr. McCafferty stated that he feels the process is positive and moving forward and that he will notify the board when the requested financial information has been received. Dr. Strahan reiterated the Boards sincere desire to partner with Sheridan Surgical Center.

Quality Presentation - Dee Neavill and Len Gross reported on a Drug Free Workplace project. Dee presented the information with statistics and stated that SMH will soon implement the policy. The program is recommended by Workers Compensation and SMH will receive a total 15% discount on hospital premium if implemented. Requirements for the discount include staff participation in education opportunities and training provided by SMH. Each staff person has received a copy of the policy and after December 1, 2007 random drug testing will be done in the facility. Discussion was held on SMH being the leader in healthcare and that we may be of assistance to other organizations and Anthony Spielberg suggested that we contact the Chamber to help facilitate their program. Mike McCafferty explained that SMH has done new hire drug testing and for-cause drug testing and that the random drug testing will be another layer. Ron Mischke asked if the Hospital had a policy to handle positive drug tests and it was explained that, depending on the circumstance, SMH has many avenues to follow to provide resources as needed.

Mike McCafferty discussed the difficulty that SMH has experienced in hiring and retaining staff and utilization of travelers and locums to meet our staffing needs. Hiring is difficult due to several factors, including real estate. Len Gross and Peggy Callantine were asked to come up with some possible solutions. Newly hired Marketing Manager, Danae Brandjord presented a rough draft of a recently developed marketing DVD for the Board members. Mr. McCafferty explained that it will be used as a recruiting tool featuring the Sheridan Community and Sheridan Memorial Hospital information. The concept was well received and Anthony Spiegelberg encouraged Danae Brandjord and Len Gross to share the production with Sheridan Travel and Tourism, Forward Sheridan and the Chamber.

FINANCE COMMITTEE REPORT
Financial Statements - Gary Miller reported that the committee met and reviewed and approved August vouchers. It was reported that August was a very-high volume month and a great month financially with $7.5 million in patient revenue, more than $915,000 over budget. Ed Johlman stated that, overall, 1,038 patient-days made August the highest number in SMH history. Record inpatient volume led to a $401,566 profit. Several departments saw an increase in activity during the month compared to their budget. Expenses are in line with the increased activity. Mr. Johlman reported that the billing department currently has all positions filled. The hospital is currently using a collection agency to help with 3^rd party billing and follow-up with insurance company to collect accounts over 180 days old. This is a temporary relationship with the Collection Center out of Rawlins and Ed Johlman said he expects to see 40% of those accounts collected. Dr. Strahan noted that it was good to see the numbers are doing better than the Superior Performance Improvement goals set.

Capital Equipment Request for a non-budgeted item for this year. Ed Johlman and Dr. Dan Alzheimer presented information and the request to upgrade the 32-slice scanner to a 64-slice CT scanner. Mr. Johlman noted that the expense is in the 3-year budget plan but based on physician and radiology requests, the upgrade is needed now, and with the start-of-year financials strong, financially it makes great sense to do it. Gary Miller explained the upgrade involves software and memory upgrade to the existing 32-slice machine and would cost $188,000. Discussion was held on the benefits of the upgrade and that it would provide the highest image quality available and is the standard for most health care facilities. Dr. Strahan explained the functions were important from a physician standpoint and that the upgrade would be safer, more efficient, and better for patient confidence level. Dr. Wohl explained that this can also be used as a referral tool to assist physicians sort out which patients need referred to a cardiac center and who we can treat. Anthony Spiegelberg stated that this upgrade was expected and is in step with what was expected to come when the current scanner was installed a year and half ago. Mike McCafferty noted that this procedure is part of SMH strategic plan for expanding the hospitals cardiology services. It also is another step in the process to stay at the front edge of medical technology in providing care for patients in the community. Dr. Wohl affirmed that this request has been through Executive Committee and approved. Gary Miller made a motion to approve the upgrade to a 64-slice CT scanner and the motion was seconded by Mike Strahan, M.D. Motion carried.

Dr. Alzheimer discussed a request from the Sheridan Radiology and Big Horn Surgical to look at purchasing a Breast MRI Coil. The American Cancer Association recommends that women with cancer have MRI follow-up instead of yearly mammograms. The cost for the MRI Coil and software would be $48,000 from GE. These physicians would like to proceed by presenting this recommendation at the next Medical Executive Committee meeting. With the number of cancer patients that would benefit from this procedure, the equipment would pay for itself in the first year. This is a service that is currently being offered in the community. A PET scanner was also discussed as we currently receive requests and patients are referred to Billings for procedure. Ed Johlman and Chris Bilyeu will continue discussion on charges, and will continue to research purchasing used equipment or leasing a mobile unit. Mike McCafferty noted that both the MRI Breast Coil and PET scanner will be important to Oncologists and asked that Dr. Alzheimer continue to pursue these requests.

FOUNDATION REPORT
Tom Ringley reported that currently there are 300 employee Foundation Partners. The Board members were invited to attend the upcoming physician recognition reception to be held on November 2, 2007 and invitations will be mailed. Nursing program is alive and well with six nursing scholarship students currently in hospital and soon to graduate. Anthony Spiegelberg asked Tom if there were opportunities to expand the program and Mr. Ringley explained that there is the potential and they will continue to work with the college.

BUILDING COMMITTEE REPORT
Dixie See asked Rob Forister to discuss the Medical Arts Complex parking lot problems. Mr. Forister explained that the MAC entrance was created with the boulevard for traffic coming and going in and out of the complex. The boulevard entrance has caused problems with motorists accidentally entering or exiting the parking lot the wrong way, driving over curbs, grass, and sprinkler systems. Snow removal on the south parking lot is also difficult to remove and is piled on the grass and as it melts it creates ice and also takes valuable parking spaces. Rob Forister stated that it would cost $32,000 to remove some roadway islands in the Medical Arts Center parking lot that would help with the traffic setup, create 2 extra parking spaces and facilitate snow removal. Discussion was held on the Building Committee recommendation for changes and Gary Miller asked what we are paying for and Mr. Forister stated that the hospital would be doing the work and the cost is to cover concrete and labor. Harlan Rasmussen moved to approve $32,000 to remove 2 islands and 2 peninsulas. Dixie See seconded the motion and it was approved. Mr. Rasmussen noted he doesn’t understand why people can’t maneuver in the parking lot as it is, and it’s really too bad that we have to do this but voted to accept for snow removal purposes. Signage was also discussed and Rob Forister stated that this has been addressed. Mike McCafferty said this is an on-going issue and they will continue to address concerns as they arise. The hospital is limited by City sign regulations and at some point may have to request a special exemption rule for signage needs. Mike Strahan, M.D. asked that when construction occurs they also address the back parking lot and draining needs for both areas.

Rob Forister presented a concept for the Dialysis Center for discussion at this time. A floor plan was developed and defined with dialysis staff. After review of several options, it was proposed to the Building Committee that the Dialysis Center be located in the basement of Emergency Department. This location decision was based on optimal accessibility for patients versus remodel of current second floor space. Parking availability and wheel chair access provide improved accessibility. Rob Forister noted that currently there are no plans for the 1000 square feet vacated on second floor but many opportunities

exist. Anthony Spiegelberg asked about the cost for the project and Mr. Forister stated that it is projected at $600,000 and $500,000 has been donated from Foundation.

The Building Committee has reviewed the proposed location and floor plan, however, Harlan Rasmussen and Dixie See requested discussion by the entire Board before making a recommendation. Therefore, discussion was held on the valuable space located below the ED as well as other available hospital space for potential future use. Effects on parking availability continued to be discussed. Out of all outpatient services to be considered for that location, the Dialysis Center would need the least amount of parking. Mike McCafferty stated that the area under the Emergency Department does fit for Dialysis with only a few reoccurring patients, more than a high profile service such as cardiac cath lab or rehab services that would require significant parking usage for longer durations. Anthony Spiegelberg stated that there is a responsibility to physicians and outpatient services currently located at the Medical Arts Complex and to avoid creating a parking space burden, planning should continue to be addressed when considering expansion plans. Dixie See made a motion to go forward with the plan of Dialysis Center being relocated in the basement under the Emergency Department with the stipulation to look at increased parking. The motion was seconded by Harlan Rasmussen. Current space plans allot 4,000 square feet to the dialysis area, therefore the Board requested Rob Forister present the entire space schematic at the next Board meeting and discuss how it impacts other space and then discussion will commence upon Board review of the presentation. With the Board approval of this location, Rob Forister reported the next phase will be to get the engineer design for dialysis center completed. The cost for the design is $50,000 which has already been approved. After much discussion the Board agreed to pursue plans for Dialysis in this space along with parking issues and will hold future discussion on remaining space. Motion on the floor carried.

QUALITY COMMITTEE REPORT
Mike Strahan, M.D. asked Lajune Bacon to review the Service Excellence Scorecard for August, noting that some areas will be reported quarterly in September. Discussion was held on Core Measures and that they are also presented to Medicine Committee. Dr. Strahan discussed coding and how to identify patient’s diagnosis. This can be a difficult problem and Lajune Bacon clarified that this is a data collection problem, not a treatment issue and that it is an industry wide issue. PI report submission is down this month and Lajune Bacon will ask managers to make mandatory appointments with her to assist in meeting operational plans and deadlines. Accounts Receivable goal to bill was 0 which was not appropriate for us and has been set for 7 calendar days. Anthony Spiegelberg thanked the Quality Committee for their hard work. Mike McCafferty recently presented to the legislature on public reporting of hospitals and he would like to make the presentation to the Board which explains how difficult it is for hospitals to gather accurate information. Several hospital employees, as well as Mike McCafferty, Ron Mischke and Dr. Strahan will be attending the VHA conference in October.

OTHER BUSINESS
There being no further business, the meeting was adjourned at 7:10 p.m.

MEMBERS PRESENT: Anthony Spiegelberg, Dixie See, Harlan Rasmussen, Ron Mischke, Evelyn Ebzery, Gary Miller, Michael Strahan, M.D., and Bill Huppert

Mr. Spiegelberg called the meeting to order at 4:30 p.m. Mr. Spiegelberg welcomed Mr. Bill Huppert as the newly appointed member to the Board of Trustees.

APPROVAL OF MINUTES - July 25, 2007
The previous meeting minutes of July 25, 2007 were reviewed. After review, it was asked that the terms President and Vice President on page 5 be changed to Chairman and Vice Chairman. It was then moved seconded and passed to approve the minutes with the one noted change.

Mike McCafferty introduced LaNora Dixon, the hospitals new Program Development Manager. Mrs. Dixon will serve as a liaison between physician offices and the hospital as well as exploring and developing strategic priorities.

Mr. McCafferty shared the following with the Board:

Ø A hospital get-together will be held from 11 a.m. - 1 p.m. on Wednesday, August 29^th for outgoing Board of Trustee member, Evelyn Ebzery.

Ø The Wyoming Hospital Association annual meeting will be held in Sheridan on October 3^rd and 4^th. The Board was encouraged to attend and Joanne Redder will send out the conference material.

Ø An annual calendar for the hospital’s internal education sessions was given to each Board member.

Ø Mr. McCafferty will be traveling to Casper tomorrow & Friday to present to the Legislative subcommittee information on patient safety, public reporting, and health initiatives

Ø Sheridan Memorial Hospital was recognized in the Thomson 100 Top Hospitals for performance improvement. Of more than 2,800 hospitals in the U.S., SMH was recognized under the small community hospital category and compared with data from over 1,000 hospitals in this category. The criteria included patient outcomes, safety, financial stability, and growth.

Mr. Spiegelberg said that the staff, physicians and hospital can be proud of this accomplishment.

Quality Presentation - Lajune Bacon introduced Linda Benth, Women & Children’s Services Manager. Mrs. Benth explained the department’s PI Project Board and said that the staff used key results data to formulate a plan to improve their customer service and track their progress.

Smoking Policy for Hospital Campus - Mike McCafferty reported that the administrative policy has been drafted and will be put into effect on November 15, 2007 to coincide with the Great American Smoke-out. Mr. McCafferty explained that the hospital will offer smoking cessation classes and will reimburse staff up to $200 for costs involved. The Board supports the policy and Dr. Wohl stated that the Medical Staff is solidly behind the effort.

MEDICAL STAFF REPORT
Dr. Wohl reported that the Medical Executive Committee meets on August 23^rd and are addressing the physician behavior policy. The next Quarterly Medical Staff meeting will be held on Tuesday, September 11^th and Dr. Wohl encouraged the Board’s attendance.

FINANCE COMMITTEE REPORT
Financial Statements - Gary Miller reported that July was a good volume month. The committee is looking at building the hospital’s reserves for major anticipated and unanticipated projects. Reserves are down after completion of the Emergency Department and Medical Arts Complex Projects. Accounts receivable is a concern and Ed Johlman noted that the hospital has hired additional staff. It was noted that the hospital needs to be financially sound to provide services to patients and all patients are accepted, regardless of their ability to pay.

Capital Request - Mike McCafferty noted that at the May Board Meeting, $72,000 was approved for a Microsoft exchange server from 150 to 475 licenses. During the process, some holes in the platform were found and Mr. McCafferty recommended an additional cost of $32,000. Bridgette Wiley, Information Systems, explained that the problem is with the main infrastructure and this will prevent future problems.

After discussion, Harlan Rasmussen made a motion to approve the recommended additional cost of $32,000, Ron Mischke seconded the motion and motion carried.

FOUNDATION REPORT
Tom Ringley reviewed an historical activity analysis for the past 20 years for the Hospital Foundation. This was also presented to the Foundation Board. Mr. Ringley explained that income from the endowment fund is used to support the Foundation.

BUILDING COMMITTEE REPORT
Dixie See reported that OR two is complete and in use. Work on OR one will be put on hold as the hospital continues discussions for potentially sharing in the surgical center. Mr. McCafferty noted that a Letter of Intent with Sheridan Surgical Center was signed on Monday.

Work on the Pharmacy is awaiting state approval and the Dialysis and Laboratory projects are in the planning and design stages.

QUALITY COMMITTEE REPORT
Lajune Bacon reviewed the Service Excellence Scorecard for July, noting that this follows the Quality Plan. Dr. Wohl stated that nursing morale is up considerably and thanked Mike McCafferty for his leadership the past year. Dr. Strahan echoed Dr.Wohl’s statement.

OTHER BUSINESS
Committee Assignments - Anthony Spiegelberg presented the Board Committee Assignments for 2007/2008.

Blood Draws - Mr. Spiegelberg noted that blood draws for the Health Fair are averaging approximately 300 per day and complimented the staff for their work in this important effort.

Information Systems - Mr. Spiegelberg asked about the next step after the report from Hayes Consulting regarding the hospital’s IT System. Mr. McCafferty explained that the hospital is extensively reviewing the recommendations and are awaiting the addition of a new IT Manager for additional input. Mr. Spiegelberg offered the Board’s assistance, if needed.

There being no further business, the meeting adjourned at 6:30 p.m.

Recorder, Joanne Redder
Dixie See, Secretary

MEMBERS PRESENT: Anthony Spiegelberg, Dixie See, Harlan Rasmussen, Ron Mischke, Evelyn Ebzery, Gary Miller, Michael Strahan, M.D.

Mr. Spiegelberg called the meeting to order at 4:30 p.m. The Board then adjourned into executive session.
The meeting re-convened at 4:50 p.m.

APPROVAL OF MINUTES - June 27, 2007
The previous meeting minutes of June 27, 2007 were reviewed. After review, Mr. Spiegelberg requested one change should be made to the Building Committee Report, regarding the Dialysis remodel. The statement that the total project cost was not to exceed $500,000 was excluded from the minutes. Dixie See made a motion to approve the minutes as corrected; Gary Miller seconded the motion and motion carried.

PUBLIC COMMENTS
There were no public comments.

MEDICAL STAFF REPORT
Dr. Barry Wohl presented one application for medical staff privileges. Dr. James Miller’s application has been approved by the appropriate departments and by the Medical Executive Committee.

James Miller, M.D. - Dr. Miller, Psychiatrist, is requesting Active Staff privileges in the Department of Medicine and OB/Peds for Adult and Pediatric Psychiatry. Dr. Wohl felt after review that he was satisfied with Dr. Miller’s training and experience and recommended him for privileges. Dr. Strahan made a motion to approve James Miller, M.D. for privileges as requested. Harlan Rasmussen seconded the motion and motion carried. Dr. Wohl commented that after a 13 year search he was pleased to have a Psychiatrist on staff for much needed patient care.

Strategic Planning - Dr. Wohl stated that the physicians will be working with Mike McCafferty to help develop a long range plan for medical staff. More experience with credentials, privileges, and peer review is a need for all physicians. Mr. Spiegelberg asked Dr. Wohl how the Board could help with this and he stated that the Board may be asked to revise their By-Laws to include a special credentials committee with the Executive Committee being the lead. Dr. Wohl would also ask for a commitment from the Board to continue providing training to the Executive Committee and the Quality Services Department staff.

ADMINISTRATION REPORT
Strategic Planning - A power point presentation was given to the Board by Mike McCafferty as a global look at the organizational direction for the future. Anthony Spiegelberg asked the Board to provide feedback to Mike McCafferty within a short period of time as the goal is to have the strategic plan available to the public by the end of August. Mr. McCafferty stated that the planning process started in September, 2006 by getting input from employees, Medical Staff, Board and community members, with over 400 people involved in the development of the direction of community health care. Mike McCafferty mentioned that he serves as a member of Forward Sheridan and that they have also identified the need to have strong health care for the community. Discussion on the presentation was as follows:

Mission - To lead in providing and supporting quality healthcare. We have a supportive role in the community with a lot of collaboration with physicians as part of delivering healthcare with patients at the center.
Vision - is what we aspire to become “When people think of excellent healthcare, they think of Sheridan.” The vision was developed from a compiled list of Strengths, Weaknesses, Opportunities, and Threats (SWOT). SMH needs to be the leader for providing healthcare and someone that the community has great confidence in. Sheridan includes all providers to be utilized; a collaboration.
Strategic Plan - A 4-year plan which begins July 1, 2007 (30,000 foot perspective) includes Mission, Vision, Values, and Strategic Priorities which set the direction for all planning activities.
Operational Plan - A 2-year plan (1,000 foot perspective) which hovers over the Organization. The plan is framed by the 5 Pillars and Driven by Superior Performance Initiative. The pillars frame the direction of Organization by Departments and each pillar has specific measures of benchmarks and how they will be reported to the Board:

People - SPI Workforce Benchmark

Service - AVATAR Results

Quality - Core Measures - SPI know monthly where we are at for each clinical benchmark

Finance - SPI Benchmarks

Growth - Tied to Strategic Priorities

These measures will be tied to a Score Card that the Board will receive monthly.

Each Pillar of Excellence has a goal:

People - SMH will be the Employer of Choice (VHA recognized)

Service - SMH will pursue excellence in ALL we do

Quality - SMH will achieve leading results in healthcare and service quality

Finance - SMH will manage our financial resources to support our Mission, Vision and Values

Growth - SMH will pursue fiscally responsible and collaborative growth to meet the service needs of our community

Strategic priorities have been identified as follows:

1. Information Systems - Assess and develop technology plans for both physicians and patients.

2. Primary Care - Plan for the future delivery of Primary Care (i.e. Family Practitioner, Internist, Pediatrician, and Obstetrician). (Collaborative strategies developed, with Primary Care physicians, in upcoming year.

3. Psychiatry - Develop and implement effective Psychiatric Services.

4. Outpatient Surgery - Develop collaborative partnership for Outpatient Surgery.

5. Culture of Service Excellence - Develop a culture of service, (i.e. physician/nurse; nurse/nurse; patient/physician; patient/nurse, etc.) the feel of the organization drives quality.

6. Explore Growth - Explore program and service areas of growth opportunities for Sheridan. Some areas to consider are Cardiology and Cardiovascular Program. Gastroenterology and ENT services will be developed depending on what track we take with Surgery Center.

Operational Plan Scorecard - Areas outlined within the Operational Plan will have pillars with target benchmarks and monthly actual percentages will be provided based on experience. Finance will include both an operating margin and net income margin. Growth pillar will give a status report or provide a way of monitoring priorities. This is a great marketing tool that will give us a big look at the next four years. A Physician Directory with photos and information will also be put together and distributed by 8/31/07.

Anthony Spiegelberg asked if the Board would receive the scorecard with all target percentages on a monthly basis and Mike McCafferty reported that Quality Council agreed that those measures would be reported monthly. While more information is submitted monthly to the Quality Council, those key indicators will be reported to the Board on a quarterly basis.

Dr. Wohl commented that with new projects there are many expense reduction opportunities in supply costs, salaries, as well as revenue growth opportunities with new programs all creating a culture of excellence. Discussion was held on the recommendations from Hayes Consultants regarding Information Systems. Mike McCafferty stated that we are continuing to recruit an IT Manager. The IT Department recently completed their strategic plan recommendations and Ed Johlman stated that additional steps are being taken with the IT Task Force in prioritizing recommendations. Bridget Wiley, Interim IT Manager, reported that four of the five following identified projects have been completed or are near completion (OPTIO is not a priority at this time), iVantage, HEAT, VoIP phone system is well over half way completed. MS Exchange, when completed, will allow staff/physicians/Board Members to have e-mail addresses (425 accounts) and the implementation is estimated to be completed by the end of October. In addition, the department has established in-house monitoring of the network which resulted in a $63,000 savings annually to the hospital. Patient scheduling/EMR with NEXTGEN will start in September for Big Horn Surgical. Also in process is the PAC’s upgrade which will allow us to use the same procedure as Billings and the implementation of new software for the Blood Bank is in progress. Dixie See thanked Bridget Wiley for the report and good to see that the IT Department is on task with realistic goals and keeping to them. Ed Johlman requested that Joanne Redder e-mail the full Hayes Strategic IT Plan to the entire Board and Dr. Wohl.

FINANCE COMMITTEE REPORT
Gary Miller reported that the Finance Committee met and expenditures were reviewed. June was a high revenue month and very busy for inpatients with an $875,995 variance in revenue. There is a net result of 1.5 million, above budget, for the first time in history. Every department was busy with a very positive result. Ed Johlman distributed a revised income page due to a change in the balance sheet regarding a second adjustment for gain sharing accrual. Net income result was $279,955 for June.

Anthony Spiegelberg asked Mr. Johlman if the capital replacement is getting built back up. Ed reported that we are doing well with about $800,000 cash to put back into reserves which will be done over the next couple of months.

Gary Miller stated that Accounts Receivable is a significant issue with close to16 million and growing (not due to lack of effort) but because of higher volume. Mr. Johlman explained that the Billing Department currently has two open positions and the volume of statements is significantly higher. While they are making head way, we have a local agency lending us a full time person to help follow up on aged accounts (over 180 days). The hospital is currently looking at collection firms, to contract with, to work aged accounts and follow-up calls to insurance companies regarding old accounts. Anthony Spielberg asked what our collection rate is on accounts that are 180 days old. Ed Johlman explained that 100% is written off and an average of 10-15% has been his experience for recovery. Gary Miller asked how staff was doing with such an increase volume of inpatients and Mr. McCafferty stated that we have been able to maintain staff to meet the volume.

Mr. Miller noted that Ed Johlman, CFO, is busy working on the year-end adjustments and audit preparations. Mr. Johlman said that typically adjustments are done in August and September but it is near completion. Discussion was held on the increase in Pediatrics this month and five new positions were approved, this department has seen a large growth with an increase in deliveries. Surgery volume has also increased but still not what it was prior to the Surgery Center. Mike McCafferty feels the change in delivery system contributes to the increase in radiology. Outpatient services offered at the imaging center has increased our ability to provide competitive services with at good turn around time resulting in the increased business. The need for an outpatient surgery center, similar to radiology, is an opportunity for us. Dr. Strahan and Dr. Wohl both agreed that the PAC system for radiology is amazing and is outstanding for physician/patient satisfaction.

Gary Miller stated that while the new fiscal year budget was approved last month, the hurdle is increased volume while our price increase remains lower than national average.

FOUNDATION REPORT
Tom Ringley reported that the Foundation featured the Craft Brothers, in conjunction with the Wyo Theater, during the Rodeo Week and $9,000 was raised. Recently they had four nursing student applicants and all four where chosen; to date three have accepted to work at SMH. The nursing scholarship program is working well and Peggy Callantine stated that we have good quality people and currently have eight nurses doing internship for the next six months.

BUILDING COMMITTEE REPORT
Dixie See announced that the Lab expansion and Dialysis study is ongoing. Welch Cancer Center and Operating Room #2 renovations are near completion. The parking lot project at the Welch Cancer Center is complete.

QUALITY COMMITTEE REPORT
Dr. Strahan reported that our hospital was asked by VHA to be part of a conference call to discuss with other hospitals in the Mountain States Region, our success on maintaining a low infection rate in ICU. The call included Iris Hehn, Lajune Bacon, Dee Neavill, and Lorean Newbrough. Lajune Bacon reported that under the People Pillar; Human Resources are working on three ongoing projects which include a smoke free campus, new employee handbook and the benefits committee.

Under the Service Pillar; the AVATAR overall score for the hospital, during the month of May, was 88.5. SMH recently received an award for exceeding patient expectations in 2006 and a press release was sent to The Sheridan Press. For Quality Pillar; the Core Measure data and patient safety data were reviewed. For the Finance Pillar; it was announced that the Length of Stay (LOS) for June was 3.62 and below the national average. Days from discharge to bill were 8.6. Future projects under the Growth Pillar; include the MRSA reduction project. Medicine Committee approved the MRSA prevention policy and it will be taken to Surgery for approval and we will be starting a stroke data base soon. An operational report card (score card) will be given to the Board on a monthly basis starting in August.

Gary Miller asked what the benchmark for LOS is now and Lajune Bacon stated that it is per diagnosis and that the national benchmark average is 4 days. A question was raised on days to bill regarding the score cared target for VHA as 0, however, based on our technology that is not an achievable target for us and will look at changing that number.

NOMINATING COMMITTEE RECOMMENDATIONS
Anthony Spiegelberg asked that the Board of Trustee Nominating Committee to present their recommendations. Dixie See reported that the committee would like to present the following members for office and that all members had agreed to accept the office:

Anthony Spiegelberg - Chairman Harlan Rasmussen - Vice Chairman

Dixie See - Secretary Gary Miller - Treasurer

Ron Mischke moved to accept the nominations and it was seconded by Harlan Rasmussen. Discussion was held regarding the appointments and everyone stated their excitement and that it is a good opportunity and a great time for the hospital. Motion carried.

OTHER BUSINESS
Anthony Spiegelberg asked Gary Miller to give a presentation on the recent Leadership Conference that he attended in Nashville. He would like Joanne Redder to schedule a meeting for this presentation within the next 30 days and to notify all Board Members of the date and time.

Committee Assignments - Mr. Spiegelberg announced that the County Commissioners would be conducting three interviews for the vacant seat on the Hospital Board. As soon as a selection is made, Anthony Spiegelberg will make committee assignments. He asked if any member wished any changes to please contact him.

Dr. Strahan stated that he would be attending the VHA Conference in October. Mike McCafferty stated that he would like to see other Board Members plan to attend. This annual leadership training is a fantastic orientation to both Service Excellence and great access with 38 other hospitals. Joanne Redder was asked to send information to all Board Members regarding conference registration.

There being no further business, the meeting was adjourned at 6:00 p.m.

MEMBERS PRESENT: Anthony Spiegelberg, Dixie See, Harlan Rasmussen, Ron Mischke, Evelyn Ebzery, Gary Miller

Mr. Spiegelberg called the meeting to order at 4:30 p.m. The Board then adjourned into executive session.

The meeting re-convened at 4:55 p.m.

APPROVAL OF MINUTES - May 30, 2007 & June 12, 2007
The previous meeting minutes of May 30, 2007 were reviewed. After review, Harlan made a motion to approve the minutes, Dixie See seconded the motion and motion carried.

The June 12, 2007 budget meeting minutes were reviewed. One change was requested under Summary Income Statements, 3rd paragraph, 1^st sentence (Ed would have preferred to see a 60% of revenue growth come from new activity). Evelyn Ebzery made a motion to approve the minutes as corrected, Gary Miller seconded the motion and motion carried.

MEDICAL STAFF REPORT
Dr. Barry Wohl presented two applications for medical staff privileges. Both applications have been approved by the appropriate departments and by the Medical Executive Committee.

Barry Mangus, M.D. - Dr. Mangus, General Surgeon, is requesting Active Staff privileges in the Department of Surgery. He will be in practice with Dr. Corey Jost. After review, Evelyn Ebzery made a motion to approve Barry Mangus, M.D. for privileges as requested. Dixie See seconded the motion and motion carried.

Scott Morey, PA-C - Mr. Morey is requesting privileges as a Dependent Limited Health Care Practitioner as a Physician Assistant and Non-physician Surgical Assistant in the Department of Surgery. He will be working with Sheridan Orthopaedics who will be his supervising physicians. After review, Dixie See made a motion to approve Scott Morey, PA-C for privileges as requested. Ron Mischke seconded the motion and motion carried.

Amendment to the Medical Staff Rules & Regulations - Dr. Wohl reviewed an amendment to the Medical Staff Rules & Regulations discussed at the April 4, 2007 Board of Trustees meeting and approved at the June 12^th Quarterly Staff meeting. The amendment is with regard to qualified medical personnel, page 1, #8, line 3 - omit the words early or. Evelyn Ebzery made a motion to approve the amendment to the Medical Staff Rules & Regulations as recommended, Ron Mischke seconded the motion and motion carried.

Chief of Staff Nomination - Dr.Wohl reported that at the June 12^th Quarterly Staff meeting, current Vice Chief of Staff, Bradley Hanebrink, D.O. was nominated for Chief of Staff in 2008. Election of officers will take place at the September Quarterly Staff meeting. Dr. Wohl stated that the physicians also held a discussion regarding long range planning and where they look to be in five years. The Medical Staff will be working with Mike McCafferty to develop a plan to present to the Board.

Recognition -Evelyn Ebzery - Anthony Spiegelberg announced that this is Evelyn Ebzery’s last meeting as Board of Trustee member after serving two full five year terms, 1997-2007. Mr. Spiegelberg noted that Evelyn Ebzery was Board Chair from 2000-2005 and gave praise for her participation in the many accomplishments during her 10 year tenure.

Ø Placement of a new LINAC System at the Welch Cancer Center in 2000

Ø Instrumental in securing AML (Abandon Mine Land) grant funds for the new Patient Wing (May, 2000 completion)

Ø Instrumental in securing funds from SLIB (State Land & Investment Board) for the new Emergency Department (June, 2006 completion)

Mr. Speigelberg thanked Mrs. Ebzery for her time and commitment to the hospital. Mike McCafferty thanked Mrs. Ebzery for her leadership and support over the years, stating that he is not certain the community understands the unwavering commitment to the hospital. County Commissioner, Steve Meier, gave Mrs. Ebzery a personal thank you from the Commissioners and presented her with the first County Commissioners service medal. Dr. Wohl, on behalf of the Medical Staff, thanked Mrs. Ebzery for her commitment and part in assuring the hospital remains here for the community and the physicians.

Evelyn Ebzery said she has enjoyed her time on the Board of Trustees and feels she is leaving the hospital in very capable hands.

ADMINISTRATION REPORT
Marketing Manager - Mike McCafferty introduced Danae Birch as the hospital’s new Marketing Manager. Danae comes to the hospital from Cody, Wyoming and earned her Bachelor and Master degrees from the University of Wyoming.

Customer Service Training - Mr. McCafferty noted that approximately two months ago the hospital started customer service training for staff with Sheridan College through I-tech and have completed the fourth training session. Mr. McCafferty said this is an important piece of health care and additional training will be offered. The hospital will also begin training offers to physician office staff on coding, running effective offices, etc. and physicians are very supportive of this training.

Psychiatrist - Mr. McCafferty informed the Board tha