FRANKLIN COUNTY BOARD OF COUNTY COMMISSIONERS REGULAR MEETING FRANKLIN COUNTY COURTHOUSE ANNEX July 16, 2013 9:00

AM AGENDA
The Board of County Commissioners asks that all cell phones are turned off or placed on silent (vibrate) mode. If you would like to comment on any matter, when recognized by the Chairman, state your name, sign the speaker log, and please adhere to the 3 minute time limit. If you plan on distributing any handouts (information) to the Commission, please provide a copy to the Clerk for the official records.

9:00 AM

Call to Order Prayer and Pledge Approval of Minutes Payment of County Bills Department Supervisors Report Howard Nabors Superintendent of Public Works Fonda Davis Solid Waste Director Nikki Millender- Parks & Recreation Pam Brownell- Emergency Management Bill Mahan- County Extension Director Ray Brownsworth= Weems CEO- Hospital Update Gulf Coast Workforce Agreement Renewal Open Bids for Plumbing Repairs at the County Jail Open Sealed Quotes for Ballpark Lighting Open Bids for construction for Carrabelle Beach Multi-Use Path Open CIE Qualifications for Carrabelle Beach Multi-Use Path Planning & Zoning Consent Agenda BOA Consent Agenda Marcia M. Johnson- Clerk of Courts- Report Alan Pierce Director of Administrative Services Report Michael Shuler- County Attorney- Report Commissioners and Public Comments Adjourn for Lunch

9:15 AM

9:30 AM 9:45 AM 10:00 AM 10:05 AM 10:15 AM

10:30 AM 10:40 AM 10:45 AM 11:00 AM 11:15 AM 11:30 AM 12:00 PM

Franklin County Road Department Report to Board of County Commissioners July 16, 2013 Summary of Material Hauled and Work Performed by District District 1- Pink Jackel Material Hauled from withinMaterial Hauled to-

8 Cubic Yards of Debris 36 Cubic Yards of Ditch Dirt 9 Cubic Yards of #57 Shells 36 Cubic Yards of Black Dirt 144 Cubic Yards of Lime Rock 9 Cubic Yards of Milled Asphalt 34 Cubic Yards of Mixed Lime rock and Black Dirt

Work Performed- Box Drag, Checked county roads for safety of traveling for public, filled in pot holes, cleaned out culverts, installed culvert, cut and trimmed grass along county right of ways, mail boxes, signs and mouth of culverts, picked up litter, graded roads, shoulder work and sign maintenance. District 2- Cheryl Sanders Material Hauled to-

36 Cubic Yards of #57 Shells 18 Cubic Yards of Lime rock 54 Cubic Yards of Mixed Lime rock and Black Dirt 36 Cubic Yards of Sand 36 Cubic Yards of Yellow Lime Rock

Work Performed- Box Drag, Checked county roads for safety of traveling for public, sign maintenance, cut and trimmed grass along county right of ways, mail boxes, signs and mouth of culverts, picked up litter, graded roads, cut down and removed trees, filled in pot holes and installed Split Rail Fence for park on Alligator Point. District 3- Noah Lockley Material Hauled to-

31.5 Cubic Yards of #57 Shell 9 Cubic Yards of Black Dirt 9 Cubic Yards of Milled Asphalt

Work Performed- Checked county roads for safety of traveling for public, cut and trimmed grass along county right of ways, mail boxes, signs and mouth of culverts, graded roads, filled in pot holes and repaired driveways.

District 4- Joseph Parrish Material Hauled from withinMaterial Hauled to-

9 Cubic Yards of Debris 45 Cubic Yards of Trees 9 Cubic Yards of #57 Shells 22.5 Cubic Yards of Lime rock 9 Cubic Yards of Milled Asphalt

Work Performed- Box Drag, cut and trimmed grass along county right of ways, mail boxes, signs and mouth of culverts, Checked county roads for safety of traveling for public, repaired driveways, graded roads, picked up litter, filled in pot holes and trimmed trees. District 5- William Massey Material Hauled from withinMaterial Hauled to-

9 Cubic Yards of Trees 4.5 Cubic Yards of #57 Shells 22.5 Cubic Yards of Lime rock 144 Cubic Yards of Mixed Lime rock and Black Dirt

Work Performed- Box Drag, cleaned cemeteries, cut and trimmed grass along county right of ways, mail boxes, signs and mouth of culverts, Checked county roads for safety of traveling for public, repaired driveways, filled in pot holes, graded roads, sign maintenance, trim trees and cut bushes back from right of ways.

FRANKLIN COUNTY DEPARTMENT OF

Solid Waste & Recycling Animal Control
210 State Road 65 Eastpoint, Florida 32328 Tel.: 850-670-8167 Fax: 850-670-5716 Email: fcswd@fairpoint.net

DIRECTORS REPORT FOR: The Franklin County Board of County Commissioners DATE: July 16, 2013 TIME: 9:00 A.M. SUBJECT(S): Right-of-Way Debris Pickup / Recycle Material Hauled June 26th July 9th FOR BOARD INFORMATION: JUNE26th JULY 9th RIGHTOFWAY DEBRIS PICKUP Apalachicola Eastpoint St George Island Carrabelle Lanark Alligator Point
74.50 TONS 12.88 TONS 12.90 TONS 87.13 TONS 28.88 TONS 35.07 TONS

Apalachicola Cardboard Plastic,Paper, Glass, Aluminum

4.68 TONS 3.02 TONS

RECYCLE MATERIAL HAULED Eastpoint St George Carrabelle Lanark Island

7.18 TONS .45 TONS 8.66 TONS 6.74 TONS 1.12 TONS 2.15 TONS .22 TONS 1.42 TONS

Alligator Point
-0- TONS 1.57 TONS

St James
-0- TONS -0- TONS

REQUESTED ACTION: None

Franklin County Parks & Recreation

Nikki Millender, Director 66 4th Street Apalachicola, Fl 32320 Tel: 850-653-8277 Fax: 850-653-8279 Email: fcprd@yahoo.com

DIRECTORS REPORT FOR: The Franklin County Board of County Commissioners DATE: July 11, 2013 1. For Board Action: On Monday, July 8th I and Commissioner Sanders traveled to Brooksville Florida to support the Franklin County Debs and Belles Softball Teams which both had advanced on to play Monday for the Dixie Youth Softball Florida State Champs. The Belles got put out on Monday and brought home Second Place Trophy. The Debs swept through the tournament without a loss and are brought back home the title Florida Dixie Debs State Champions. Not only did the Debs bring home the title State Champs but they also captured the Sportsmanship Trophy. This is a Great accomplishment for this group of young ladies. The Debs are now headed to the World Series as Team Florida to compete in the World Series which is being held in Alexandria Louisiana starting August 2nd. They need to raise between $20.000 to $25,000 to cover the expenses of their trip. Anyone wishing to make a donation can do so at any Centennial Bank location. At this time I would like to ask the board for approval to contribute $5,000 to the Franklin County Dixie Debs. REQUESTED ACTION: Approval to contribute $5,000 to the Franklin County Dixie Debs

28 Airport Road Apalachicola, Florida 32320 (850) 653-8977, Fax (850) 653-3643 Em3frank@gtcom.net

Report to Board of County Commissioners

Date: July 11, 2013 Action Items: None Information Items: The Emergency Management office attended the Emergency Management assistance Compact (EMAC) webinars on July11, 15, 2013. The Emergency Management office met with Phil Worley to go over and finalize the county debris plan so he can submit it to the State and FEMA for review. Emergency Management attended the North Florida Domestic Security Task Force meeting held in Tallahassee on July12, 2013. There is a communications meeting scheduled at the Emergency Management Office for July 17, 2013 at 10:00am. There is a table top hospital shooter exercise scheduled for July 19, 2013 starting at 9:00am at Weems Memorial hospital. Pam Brownell will be attending the Midyear Florida Emergency Preparedness Association conference from July23-26, 2013 at Clearwater, Florida. This is part of the scope of work for our State and Federal grants. Sincerely,

Pamela Brownell
Pamela Brownell Director

Franklin UF/IFAS Extension 66- 4th Street, Apalachicola, FL 32320-1755 850-653-9337/ bmahan@ufl.edu MEMORANDUM: TO: FROM: SUBJECT: The Franklin County Board of County Commissioners Bill Mahan, Franklin/UF - IFAS Extension Director July 16, 2013, BCC Extension Update Report

Bill

Franklin - UF IFAS Updates 1) Board action/direction requested - FWC Sea Turtle Grant Proposal We received an email from Dr. Robbin Trindell with FWC reportig that our Deep Water Horizon Restoration Phase II Project, Restoring the Night Sky proposal was reviewed by FWC & DEP and well received. Our proposal has been approved for funding pending the completion of a few minor revisions/additions that FWC & DEP requested. As part of the proposal, the County was approved to hire a parttime, seasonal Code Enforcement employee. Direction from the Board. 2) Board action/direction requested - DACS Oyster Aquaculture Plans Last week during discussions with FL Department of Agriculture and Consumer Services about oyster aquaculture I was informed that they plan to take a request to the FL Board of Trustees of the Internal Improvement Trust Fund Sovereignty Submerged Lands to approve oyster aquaculture leases in Apalachicola Bay (the old Oyster Aquaculture Units Hwy 65, SGI Unit 4, Four Mile & Nine Mile). Please see attached map. 3) New Shellfish Harvester Education Program I have been working with Dr. Steve Otwell and others at UF to develop a Shellfish Harvester Education Program. The educational program is being developed to meet the mandated federal requirements for shellfish harvester education that go into effect in 2014. Tomorrow, Wednesday July 17th, the UF Harvester Education Team will be in Tallahassee to demonstrate the newest version of the program to DACS who is funding the program development. The next step is to demonstrate the new version of the program to SMARRT to get their comments. 4) UF Oyster Recovery Team Oyster Aquaculture Q & A Session The Franklin County SMARRT has requested that the UF Oyster Recovery Team have an Oyster Aquaculture Q&A Session to answer questions the members have about oyster aquaculture. The Oyster Aquaculture Q&A Session will be held on July 29th from 3:00 5:00 PM at the Apalachicola Community Center at 10-Foot Hole. The UF Oyster Recovery Team has asked the SMARRT to provide a list of questions ahead of time so the Recovery Team can research the questions if needed. If the Board has any questions, please give them to me and I will add them to the list. 5) Bridges to Circles Household Budgeting/Stretching Your Food $s Classes Im teaching a series of household budgeting, job exploration and stretching food $s to the graduates of the Franklin Bridges to Circles Program. Last night, July 15th, I taught Stretching Your Dollars: Controlling Your Grocery Bill. 6) 4-H Camp Counselor Training In another week, five of our 4H Campers will continue to develop their leadership skills at Camp while working as Cabin Counselors or Counselors-in-Training. To prepare our senior 4-Hers (14 years old or older) for what is expected of them and their duties at camp, I taught a Counselor/Counselor-in-Training class on July 10th. 7) 4-H County Camp Planning & Preparation We continue to receive requests for camp applications and information about this years 4-H County Camp at Camp Timpoochee. At this time we have 16 4Hers registered for camp. Our camp is the week of July 22nd 26th and we will be camping with Okaloosa, Walton and Covington County (AL). 8) UFs Natural Resource Leadership Institute UFs NRLI Program will be making another visit to Franklin County on August 8 10. This is a new class and the participants will be here to learn about local seafood and natural resource issues. They will be staying at the Buccaneer Inn on St. George Island. 9) Local 4-Her Attended 4H Legislature One of our County 4-Hers Ursula Countryman, attended this years FL 4-H State Legislature program in Tallahassee at the end of June. This was her second year participating; this year she was a State Legislator, and last year she was a lobbyist. As a result of her experiences at State Legislature, Ursula is interested in applying for the Senate Page Program for next years Legislative Session.

10) FDAs New Vibrio vulnificus Illness Reduction Calculation At the last Board Meeting I reported that I would supply the Board with additional information on FDAs new Vv illness reduction calculation method. Attached, please find a copy of FDAs Determination of Risk/Serving for Vibrio vulnificus in Raw Oysters document that was sent to the ISSC. If to meet NSSP risk/serving standards for the particular risk period(s) in which the standard was not met. 11) ISSC Committee Assignments For the upcoming ISSC Meeting the Chairman of the Executive Committee has appointed me to the following Committee assignments: Biotoxin, Communications, Education (now includes Vv Education), Foreign Relations, Pathogen Review, Post-Harvest Processing Review and Use of the Press 12) Biennial ISSC Meeting Scheduled The 2013 Biennial Meeting of the Interstate Shellfish Sanitation Conference (ISSC) will be held October 26 November 1, 2013, at the St. Anthony Hotel in San Antonio, Texas. The early registration fee (prior to September 15th) is $520. FL Department of Agriculture & Consumer Services (DACS) 13) FL Aquaculture Sales for 2012 Announced DACS announced on July 9th, that the 2012 Florida aquaculture survey showed $69 million of aquaculture sales in the state last year. Florida aquaculture sales were reported by 404 farms on a statewide survey completed by the Florida Agricultural Statistics Service and the DACS. Florida aquafarmers produced ornamental fish, shellfish, alligators, aquatic plants, and food, game and bait fish, among other aquatic animals. Ornamental sales totaled $35.5 million and consisted of freshwater and marine animals and plants, including freshwater fish, crayfish and marine fish, corals, live rock, snails and shrimp. Sales of aquaculture products for human consumption totaled $24.1 million and included freshwater and marine fish, clams, oysters, shrimp, prawns, alligators and turtles. All other aquaculture totaled about $10 million. There were 686 operations that reported being in business in 2012, of those, 404 reported sales during 2012. Many of the farms are small, family-owned and operated; 61 percent of the farms are less than 3 water acres in size. Total water acreage was 4,490. FL Fish & Wildlife Conservation Commission (FWC) 14) 2013 State Gulf of Mexico Recreational Red Snapper Season Closed July 15 The last day to harvest red

snapper in FL state waters was July 14th. This years state season was 44 days long. The Gulf federal season was 28 days long and ran from June 1 through June 28. State waters are from shore to 9 nautical miles in Gulf waters; federal waters extend beyond that line to 200 nautical miles. The Gulf of Mexico Fishery Management Council is
considering a supplemental recreational season for later this year in federal waters. If approved, the FWC will consider a supplemental season for Gulf state waters at a future Commission meeting. Gulf of Mexico Fishery Management Council (GMFMC) 15) Shrimp Fishery Re-Opened off Texas on July 15 Federal waters from 9 to 200 nautical miles off Texas opened to shrimp trawling at 30 minutes after official sunset, local time, on July 15, 2013. 16) Next GMFMC Meeting Scheduled The Gulf of Mexico Fishery Management Council will meet tomorrow Wednesday, July 17, 2013, from 7:00 a.m. to 5 p.m. at the Hilton Riverside Hotel, Two Poydras Street, New Orleans, Louisiana.

HOSPITAL CEO REPORT Board of County Commissioners July 2, 2013 1. Clinic renovation options Several companies were asked to assist Weems in developing budget figures. Adams Consulting Group which provided the hospital valuation for HB711 was the only firm which responded by figures. This was discussed at the June Hospital Board meeting. The original intent was to provide for additional exam rooms within nearby clinic space (Annex) and thus allow for additional providers. This unfortunately, would invoke upgrades within the building to comply with various regulations such as ADA due to the initiation of renovations. Instead, by using the existing space in its current configuration and by using providing like services from the prior occupancy, this can be avoided. Jim Bachrach will lead a work group to evaluate the necessary renovations to the Annex and work with me on getting a budget estimate and they soliciting bids. 2. Clinic Operations Ginny, Becky, and Nicole have been providing a detailed evaluation of how things are being done at the clinic resulting in a lot of discovery. Robb Moss and staff from TMH will have performed an operational assessment of the clinics providing us with insight into how to structure the clinics for both performance and quality care in the near future. With the assistance of these three as well as James Roberson, I am directing changes in policy, practice and processes. Part of this will be the expected productivity of both practitioners and staff as relates to staffing and productivity. Specific focus is being given to timeliness of chart completion and billing. The current clinic software system is cumbersome and will be replaced with the installation of the new hospital computer system. This will aide in charting, billing and revenue management. Recent reports from the current software have raised some concerns about open charts,billing and accounts receivable. Discussions with staff and further review question to usefulness of the data as it appears that the A/R and chart status needs to be cleaned up. Therefore, we are more current on billing that it would first appear. 3. Mammography Several informational emails have been distributed on the status of our mammography machine. In summary, the film processor for the current machine has gone out and will cost $8,000 to fix. Since October 2012, we have only done 20 mammos with numerous months having no procedures performed. This drop off is due to the advantage of digital imaging verses our analogy (film) imaging. Fixing the processor would not do anything to increase our volumes and would waste the money. Instead it makes sense to put the money toward a used digital unit. This has been discussed as a strategy in previous board meetings and I referenced seeking funding from a foundation or grant. Our foundation has chosen to continue raising funds for an ultrasound machine. I recommend that we continue to seek options related to the provision of digital mammography and pair it with our bone densitometry machine for womens services. Jeanne Sorrel is currently seeking pricing on a used machine and the availability of mobile services. If mobile services are available, it makes the most sense to begin with it to build volumes and then purchase a used machine later. 4. IT Contract Earlier this month, I provided BlueManta, our prior IT vendor, with 30 days notice of termination of the contract. This was due to concerns about their responsiveness to our requests and a failure to adequately provide for business continuity services. Based on BlueMantas response, I advised them that for the remainder of their contract their services

would not be required. After such a change, it is typical to reset system security controls and access. This has been performed related to this event. Concurrently, I have engaged Eagle Tree Technologies for an interim service agreement to provide IT services. Michael Schuler was consulted as part of the action with BlueManta and has reviewed a contract for month to month services with Eagle Tree Technologies. Input from the Board of Commissioners and Hospital Board of Directors will be sought related to a longer term agreement and the proper selection process. 5. CFO search I made a recommendation to the Hospital Board on the selection and hiring of a new hospital CFO. The recommendation was accepted and employment terms have been approved. At the time of writing this report, we were in process of making an offer and have not received a response from the candidate yet. It is my preference to wait until the offer has been accepted to announce the person selected. We were fortunate in that both of the final candidates were of exceptional quality, work history and had excellent references. 6. Recognitions See Below Hello All, I spoke with a customer today and he was very appreciative of how his family was assisted today with signing up for Kidcare and all of the other Medicaid services. He was raving at how wonderful the program is and the assistance that they received. I told him that I would thank the staff on his behalf. Please share with your staff. Thank you all!! Best of Health, David I would just like to reinforce the comments of our patient. I would like to extend to everyone at Weems my sincere thanks and gratitude to the excellent and fantastic care that I received at our hospital, I could not have received better care anywhere, and yes; the food was great. Thanks for saving my life! Doctor C 7. Pre-Construction Activities We continue to meet with the Adams Consulting Group and TRO Architecture on activities that must precede any USDA application. On June 27 and 28, 2013, I met with representatives from TRO Architectural firm and Adams Consulting Group to discuss and prepare information needed for the determine the scope of expected construction and renovations and for the USDA loan. They are developing three plan scenarios which tie into the dollar figures provided for in the Debt Capacity Study. To provide more context on this, we had a debt capacity study performed to make a high level evaluation of whether or not Weems would be able to fund construction for a replacement/renovated hospital based on our revenues and expenses. Due to the cost reimbursement aspect of critical access hospitals, it is possible for Weems to afford a larger capital investment that allow for by our current volumes and revenues. This is because we are reimbursed at cost for Medicare and Medicaid which represents about 50-60% of our volume. Having determined at a high level that it is feasible to build a new/renovated hospital, we now need to conduct a more detailed analysis. The Hospital Board has approved the authorization of a Feasibility Study with a cost of $50,000. This will be presented to the County Commission for consideration and action.

The study is required by the USDA which previously had been selected as our funding source. Due to the time since our original application, a new application along with the feasibility study and opinion letter will be required. The cost for this is $50,000 can be paid for from the Healthcare Trust Fund as pre-construction activities. 8. 800 Mhz Radios Earlier this year we were approved by the Board of Directors and the County Commissioners to upgrade our radios for narrow banding. The amount approved was approximately $69,000. At that that time, we noted this was merely to comply with federal requirements and that in the future it would be necessary to spend additional funds to minimize gaps in our coverage area, provide for a stronger clearer signal and to provide for cross agency communication. As a follow up to the approval and at the request of both boards, we have performed additional research into the 800 Mhz radios that various agencies use in the area and statewide. For an additional $20,000,we can meet federal guidelines for narrowbanding, maintain our existing capacity in the event of disaster and upgrade to 800 Mhz. The 800 Mhz units have been tested by our EMS staff and provide a clear and strong signal all the way to Tallahassee. There are some gaps remaining in our coverage area but they are less than the current system. Addition towers are scheduled to be added in our region to reduce the gaps even further. The units have the capability of being programmed in the future to allow communication with other agencies as they likewise upgrade their systems. We have tried to facilitate a meeting with other agencies to provide for agreement on equipment and purchasing but have been unsuccessful to date. It is therefore in our best interest and that of our patients to put in place a system that will take us 4-5 years into the future until such a collaborative approach can be realized and providing for equipment that could be easily programmed until such time. 9. Possible Grant Opportunity On June 25, 2013 I attended a dinner in Tallahassee with Dr. James Stockwell and several other physicians looking to develop a grant proposal to improve coordination of care between tertiary hospitals and rural hospital as well as the development of programs to improve clinical quality and reduce costs locally. This is part of the Affordable Care Act which is providing a billion dollars for these efforts. From this fund, 100 grants will be given. The collaborative is seeking 10-20 million dollars.

GEORGE E WEEMS MEMORIAL HOSP Income Statement April 30, 2013 Current Month
Hospital Operating Revenues Clinic Ambulance Total Hospital Clinic

Fiscal Year to Date

Ambulance Total

Inpatient Revenues Outpatient Revenues Emergency Depeartment Revenues

Total Patient Services Revenue

197,899.00 296,885.00 552,312.50 1,047,096.50

80,000.00 80,000.00

116,145.40 116,145.40

197,899.00 493,030.40 552,312.50 1,243,241.90

1,641,418.00 2,548,035.50 3,888,960.50 8,078,414.00

650,975.67 650,975.67

884,515.80 884,515.80

1,641,418.00 4,083,526.97 3,888,960.50 9,613,905.47

Less: Contractual Allowances Bad Debt and Charity LIP & DISH (393,588.08) (264,002.99) 86,842.00 (59,564.89) (48,643.99) (501,796.96) (264,002.99) 86,842.00 (3,349,689.06) (1,782,586.69) 338,534.00 (392,498.23) (578,262.08) (4,320,449.37) (1,782,586.69) 338,534.00

Net Patient Revenue

476,347.43

20,435.11

67,501.41

564,283.95

3,284,672.25

258,477.44

306,253.72

3,849,403.41

Operating Expenses Salaries and Wages Employee Benefits Professional Fees Purchased Services Clinical Supplies Non-Clinical Supplies Repairs & Maintenance Utilities Insurance Interest Expense Training & Development Marketing Other Depreciation Total Operating Expenses
Net Income or Loss from Operations Non-Operating Revenues & Expenses

202,125.12 37,285.97 80,208.20 28,680.77 33,007.83 24,928.47 11,383.27 14,317.91 5,901.00 1,008.82 10,679.94 5,729.24 29,497.72 23,008.74 507,763.00 (31,415.57)

45,599.92 7,825.12 616.75 1,635.14 2,364.95 2,518.64 1,169.06 2,171.72 42.00 1,160.18 65,103.48 (44,668.37)

55,835.88 12,554.45 5,186.62 1,139.44 100.22 7,583.10 1,226.11 5,695.42 89,321.24 (21,819.83)

303,560.92 57,665.54 86,011.57 30,315.91 36,512.22 27,547.33 20,135.43 17,715.74 5,901.00 1,008.82 10,679.94 5,771.24 36,353.32 23,008.74 662,187.72 (97,903.77)

1,591,552.21 284,951.41 683,010.14 285,185.28 259,772.30 138,330.43 84,066.45 99,073.15 47,208.00 10,975.46 79,273.23 41,385.64 181,852.69 184,587.37 3,971,223.76 (686,551.51)

329,178.88 58,087.49 5,390.33 13,197.06 13,954.11 26,025.94 2,488.67 15,768.47 978.88 1,660.28 21,548.74 488,278.85 (229,801.41)

425,533.21 105,735.46 33,913.81 498.78 7,828.42 1,869.11 27,081.01 10,842.15 2,967.32 45,361.87 661,631.14 (355,377.42)

2,346,264.30 448,774.36 722,314.28 298,881.12 281,554.83 166,225.48 113,636.13 125,683.77 50,175.32 10,975.46 80,252.11 43,045.92 248,763.30 184,587.37 5,121,133.75 (1,271,730.34)

County Sales Tax Subsidy Sales Tax Capital Sales Tax Reciepts Interest Income Grant Income Miscellaneous Income
Total Non-Operating Revenues & Expenses

79,855.00 151.85 4,604.78 827.17 85,438.80

10,000.00 10,000.00

42,137.67 42,137.67

42,137.67 89,855.00 151.85 4,604.78 827.17 137,576.47

44,590.47 448,019.23 1,276.22 107,004.83 15,264.67 616,155.42

80,000.00 80,000.00

337,066.36 337,066.36

337,066.36 44,590.47 528,019.23 1,276.22 107,004.83 15,264.67 1,033,221.78

Net Income or Loss from Operations

54,023.23

(34,668.37)

20,317.84

39,672.70

(70,396.09)

(149,801.41)

(18,311.06)

(238,508.56)

GEORGE E WEEMS MEMORIAL HOSPITAL BALANCE SHEET April 30, 2013

CURRENT FISCAL YEAR ASSETS CURRENT ASSETS CASH & CASH EQUIVALENTS RESTRICTED CASH PATIENT ACCOUNTS RECEIVABLE ALLOWANCE FOR UNCOLLECTABLE ACCOUNTS RECEIVABLE, NET SALES TAX RECEIVABLE DUE FROM OTHERS PREPAIDS TOTAL CURRENT ASSETS PLANT, PROPERTY & EQUIPMENT LAND BUILDINGS ACCUMULATED DEPRECIATION BUILDINGS, NET EQUIPMENT ACCUMULATED DEPRECIATION EQUIPMENT, NET TOTAL PLANT, PROPERTY, & EQUIP TOTAL ASSETS LIABILITIES CURRENT LIABILITES CURRENT LEASE OBLIGATIONS CURRENT NOTES PAYABLE ACCOUNTS PAYABLE ACCRUED SALARIES & PAYROLL ACCRUED PERSONAL & SICK LEAVE ACCRUED LIABILITIES DEFERRED REVENUE DUE TO TMH TOTAL CURRENT LIABILITIES LONG TERM LIABILITES LONG TERM LEASE OBLIGATIONS LONG TERM NOTES PAYABLE TOTAL LONG TERM LIABILITIES TOTAL LIABILITIES FUND BALANCE TOTAL LIABILITIES & FUND BAL $ 10,304.58 108,454.78 118,759.36 1,400,793.07 2,455,026.89 3,855,819.96 $ $ 35,156.12 $ 85,714.24 134,856.64 198,978.85 108,228.07 472,416.19 153,102.13 93,581.47 1,282,033.71 $ $ 381,990.64 $ 45,859.26 3,757,175.68 (2,642,723.04) 1,114,452.64 (161,318.00) 66,628.88 1,447,613.42

FISCAL YEAR ENDED SEPTEMBER 30, 2012

465,790.38 117,902.34 3,864,119.98 (2,647,168.15) 1,216,951.83 (151,175.75) (431,863.38) 107,511.03 1,325,116.45

13,400.00 1,929,308.41 (121,438.43) 1,807,869.98 1,696,748.55 (1,109,811.99) 586,936.56 2,408,206.54 3,855,819.96 $

13,400.00 1,929,308.41 (90,856.99) 1,838,451.42 1,567,447.91 (955,806.06) 611,641.85 2,463,493.27 3,788,609.72

32,247.59 85,714.24 143,456.84 115,221.75 98,258.87 49,153.89 213,863.06 154,090.71 892,006.95

32,693.75 170,373.57 203,067.32 1,095,074.27 2,693,535.45 3,788,609.72

Governing Board of Directors 2013

May 30, 2013
Members Present: Guests Present: Staff Present: Tammi Hardy, Chair; Jim Bachrach, Vice-Chair; Duffie Harrison, Secretary; Deborah Huckeba; Lauren Faison, TMH Liaison; Rachel Chesnut, WMH Foundation President Ginny Griner, HR/ Med Staff Coordinator; Heather Guidry, Administrative Assistant; Ray Brownsworth, CEO; Craig Gibson, Plant Operations Director; Becky Gibson, DON

TOPIC/ DISCUSSION Call to Order/ Approval of Minutes Tammi Hardy The meeting was called to order at 9:00 am. Minutes from the 4/25/2013 regular board meeting were presented for approval. Discussion was held regarding the ambulance service costs. Brownsworth informed the board that Hilda Pippin would be the new EMS Manager effective 6/1/2013. Harrison questioned the EMS overtime. Brownsworth stated that there was a tremendous amount of overtime in the EMS department on the last pay period. Harrison asked the overtime dollar amount. Brownsworth stated that the last pay period overtime was $15,000. Additional part-time and prn staff will be hired to decrease overtime needs. Griner pointed out the challenge of hiring locals due to a limited pool of licensed professionals. She stated that community members, high school students, etc. should be encouraged to attend the Gulf Coast State Colleges EMT or Paramedic program. Griner also stated that an EVOC and CPR certified person could assist with the BLS truck. Brownsworth and Hardy discussed increasing the hands on monitoring of the EMS department by the CEO versus delegation to the manager. Mr. Brownsworth assured BOD that he would be providing hands-on oversight of both Clinics and EMS until all were functioning properly. Brownsworth stated any overtime must be approved by him. County Report No report available.

ACTION

Motion made by Huckeba to approve minutes as presented, second by Bachrach. Motion carried unanimously.

Page 1 of 9

Governing Board of Directors 2013

May 30, 2013
TMH Report Lauren Faison TMH is moving forward to secure bond financing for the construction of a new surgical tower. The building cost is approximated at $75 million. The building will be designed to grow with the community and anticipated technology changes. The most recent Senate bill addressing payment for telemedicine services did not pass. Representative Marti Coley has agreed to be an advocate to assist with the next legislative process. Rep. Coley will be viewing a telemedicine demo at TMH on June 17th. Faison stated that under Nicole Sandovals leadership, the Weems East clinic has been a champion in the telemedicine expansion process. The clinic received training 2 weeks ago. Faison is meeting with Dr. Cognetta next week to talk about how he can increase his services to our area by performing virtual consults. Faison is continuing to reach out and educate various specialty physicians to build the infrastructure in preparation of the bill passing. Telemedicine will increase cost effective healthcare access, particularly in the rural areas. Emergency stroke intervention, neurology and mental health consultations will be among the popular uses for telemedicine. CEO Report Ray Brownsworth Financial Report Since January, several adjustments to the financial reports have been necessary. Some adjustments were due to an under anticipation of contractual write-offs as well as adjustments carried from the previous year. Additional adjustments will be necessary for the clinic as their financial system is rebuilt following the system crash on 4/5/2013. TMH has been assisting with the financial reports; beginning next month, Roberson and Associates will be taking over. Income Statement April 30, 2013 was presented and reviewed in detail. o YTD has a negative net profit of $278,181.26. This is an improvement of about $100,000 from last month. o End of month cash report shows a continued positive cash flow that is consistent

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with last year. o Harrison questioned the variation month to month with the end of month cash-onhand. Brownsworth responded that the balance fluctuates due to timing of tax subsidies and receipts of LIP /DSH payments. Brownsworth is trending to assist with tracking of accounts. o Brownsworth suggested presenting EBITA. Harrison agreed. Brownsworth stated that a strategy is needed for projections of write-offs. Contractual allowances, bad debt, charity, and LIP & DSH are approximations based on history. o Bachrach questioned where the hospitals CD went. Guidry advised that she thought it was cashed and placed it into the operating account. When the hospital began receiving the extra cent tax revenue, Drapal replaced the money by investing it into the money market account. Later clarification revealed that per the 1/26/12 BOD minutes, the money market fund amount transferred to the operating account in December (2011). The 2/23/12 BOD meeting minutes show that the hospitals CD was cashed. Drapals 2/23/12 Administrative report to the board reads OTTED Loans #1 & #2: 4 payments were paid from the certificate of deposit. The balance of the fund was placed into a money market account. HB711 The House Bill 711 public hearing was held yesterday. Brownsworth sent information to the board members yesterday for review. The attendees concerns were regarding unnecessary duplication of services. The attendee felt the hospital should collaborate with Sacred Heart to prevent duplication. Harrison pointed to collaborative efforts being made by bringing rotating specialists to Weems clinics. Market Value Review: After a number of evaluations and review of the hospital, the market worth value of the hospital was estimated to be approximately $3 million. The hospital is average on operational and financial indicators, but with a high percentage of uncompensated care. The following reports were reviewed in detail: o HB711 Comparison Worksheet

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o CAH Financial Indicators Report, Hospital Graphs by State and Peer Group Total margin (2010) showed value of WMH was greater than the national, state and peer group median. o Weems Hospital AHCA Analysis Cost per adjusted patient day shows WMH is market competitive compared to costs. Uncompensated care for WMH was $2.3 million in the year shown; the highest on the report. o CAH Financial Indicators 2012 Graph Having reviewed the reports provided, conducted a public meeting in accordance with the requirements of HB711, Brownsworths recommendation to the BOD as the hospital administrator is a recognition that WMH compared to peers (both for-profit and not-forprofit) is comparable, and there is no benefit to the communities served to sell or lease the hospital. Bachrach questioned uncompensated care. Brownsworth recommends addressing uncompensated care as part of the hospitals strategic plan. Current efforts are to assist patients with Medicaid enrollments, waiver programs, or enrollment in the hospitals charitable care program. Increased enrollees in the hospitals charitable care program will influence the hospitals participation in the DSH program. All are parts of the effort to maximize cash and recognize the needs of the community. Additionally, uncompensated care decreases when patients are seen at the clinics versus the ED. Motion made by Harrison to approve Brownsworths recommendation as stated, second by Bachrach. Motion carried unanimously.

Patient Satisfaction Becky Gibson In-Patient Surveys o 23 respondents; April 2013 was the first complete month following the change in distribution of the in-patient surveys o Overall, the comments were positive. Areas with the most comments were in regards to the age of building, the cleanliness of building, and the food. Food

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complaints were in regards to the temperature when served and explanation of restricted diets. Brownsworth questioned the strategy for addressing complaints. Gibson stated that plans were in place, including improving the method of insulating food until patient receipt. ER Surveys o 25 respondents o One area of dissatisfaction involved the respiratory department. There were only 2 or 3 patients who responded to questions regarding the respiratory department, so this slants the overall picture. o There was overall patient satisfaction in regards to the friendliness of staff and fast service. o Brownsworth questioned Gibsons strategy to prevent patients from feeling abandoned when they have to wait. Gibson stated that a policy/procedure is now in place. When a patient is waiting in an exam room or waiting after triage to be placed in an exam room, nurses will check patient vitals every hour. Every 15 minutes, a nurse checks in with the patient to provide reassurance. When an emergency presents, it takes the attention of the entire clinical staff; larger hospitals have larger employee resources. Gibson is considering using clerical staff to reassure patients in these situations. Huckeba shared that the complaints she has received involved patients hearing staff cutting up. o In regards to the overall pt satisfaction trended from November, low scores were related to months with low respondents. o Hardy questioned the dissatisfaction with ER respiratory and radiology. Brownsworth stated that when dissatisfaction is reported, the manager of the affected department must develop an action plan to address the problem. Risk Management Report Becky Gibson Gibson presented and reviewed the Risk Management and Regulatory Board Summary Report, 1st Quarter 2013. Discussion included the following: o Consistently only 1% of ER patients are leaving prior to triage and/or the medical screening exam. In response to Brownsworths question, Gibson stated that all the

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patients who left were non-emergent. o Hardy questioned the method of tracking and recording medication variances. Per Gibson, the variances are tracked via incident reports. Hardy questioned if callsbacks from pharmacies and outside healthcare providers regarding allergies, dosage, etc. are tracked. Gibson stated that these calls are noted in the patients medical record, but are not typically recorded with incident reports. CFO Applicants Ray Brownsworth Two CFO applicants have made it to the next step, which is an on-site interview. The applicant from Washington requested a salary beyond the offered range. Discussion was held regarding inviting this applicant for an interview. The board decided to inform the applicant that his requested salary range would not be considered. If he is flexible, then his application will be given further consideration. Discussion was held regarding the date to interview the applicant from Georgia. The board agreed on June 7th for the first interview. Harrison will be out of town for the first two weeks of June. EMS Communications Update Craig Gibson Gibson met with EOC a couple of weeks ago. He discussed 800 radios with Pam Brownell. Brownell and Gibson have made contact with state leaders and are attempting to bring all county agencies together to collaborate. Gibson anticipates the continued recommendation of 800 radios. The only concern is using the SLR system; law enforcement may take over in emergency situations and EMS would receive a busy signal. Clarification is desired to ensure that this will not happen. A new system (uni-system) is being developed that will combine UHF, VHF and SLR on one radio. Brownsworth was ready to make a recommendation, but will delay pending collaboration with other county agencies. Fire Alarm System Craig Gibson Computer components for the hospitals fire alarm system require replacement.

Motion made by Bachrach

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Brownsworth stated that replacement parts for the current system are antiquated, and that they cannot be purchased even from the after-market area. From a compliance and safety standpoint, the upgrades are necessary. Brownsworth requests approval from the board to purchase circuit upgrades for the fire alarm system for approximately $16,000. Hardy questioned the time frame given for required replacement. Gibson stated that Simplex Grinnells last quarterly inspection noted the need for the upgrades. AHCA reviews all fire alarm inspections. Brownsworth states that with board approval, he will take a request to the BOCC for the capital purchase in the amount of $16,000 from the healthcare trust fund. Strategic Planning Bachrach knows someone from Gulf State College who may assist with facilitating the strategic planning. Brownsworth expressed his desire to proceed with strategic planning within next 30 to 45 days. Items to address include possible construction, possible move of Weems West clinic next door, the clinic accountability systems and their performance, practitioners, and services inside the hospital. All this will fall under the strategic plan to paint a consistent picture of who we are, what we are, what the experience is going to be, and how we are going to perform. The strategic plan will address quality, service, growth, finance, community perception, and patient satisfaction. Bachrach expressed the necessity of obtaining a facilitator. If it takes longer to obtain a facilitator, Brownsworth recommended that the board meet prior and Brownsworth could walk the board through the process. Once the plan is established, then the action steps can be developed followed by tactics and deliverables. Hospital CEO Report to the Board of Directors Ray Brownsworth The CEO Report to BOD was reviewed. o EMS will stage a BLS truck on the islands on weekends and an ALS truck for the Memorial
Day, July 4th and Labor Day weekends.

to precede with necessary fire alarm system replacements, second by Huckeba. Motion carried unanimously.

o Hilda Pippin has been selected to assume the EMS Manager duties as part of an
administrative change.

o Brownsworth has requested clarification from Michael Shuler and Alan Pierce whether or

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not the fees associated with current and future activities for preconstruction services are payable as we go from the health care trust fund rather than being accumulated and paid during the project.

o Next step in the construction process will be a feasibility study. Brownsworth received a proposal from BKD to perform the study for a fee of $50,000. Brownsworth told BKD that approval would not be given until after the strategic planning. o Estimated cost to minimally renovate the building next door is $350,000. This estimate excludes equipment. Brownsworth expressed that additional providers are needed in the area to drive the hospital. Dr. Watson, TMH, CMO has suggested rounding TMH residents through the clinics. Their services would be provided at TMH cost. Any admissions by the residents could be covered by Weems ED physicians. Hardy suggested a professional evaluation of clinic operations and also consideration that patient census goals be met, before incurring additional physician expenditures. o The two final vendors for our EHR are Healthland and CSS. Site visits are scheduled. o A policy on weapons is being developed and will be brought before the board for
discussion.

o Jennifer Sockwell, Respiratory Manager is implementing a nebulizer machine giveaway to

patients with indigent status in the clinic.

o Craig Gibson is putting together a recommendation on how to provide for a visually more
attractive campus.

o Dr. Spurgeon requested to make presentation to the board today, though he did not show. The cost component must be deliberated before considering his engagement. Old/ New Business Harrison questioned if the hospital had a policy regarding employee reporting during the hurricane season. Griner stated that there was an established policy for the employees reporting responsibilities during disasters. Brownsworth stated that he would discuss the issue further at the administrative team meeting. Bachrach inquired about TMH assistance with grant writing. Per Faison, their Foundation

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handles grant writing for TMH. Brownsworth stated that administratively, action steps need to be set for grant writing. A Foundation update was given by Chesnut. The Butts and Clucks event rose between $4,000 to $5,000; the final number has not been determined yet. The next fundraiser will be held June 14th. Hardy questioned the Foundations goals. Chesnut stated that the Foundation has been promoting the purchase of an ultrasound in their fundraising efforts for the past three years. The Foundation would like to complete this goal, and then consider the purchase of a digital mammogram. Brownsworth suggested TMH Foundation guidance regarding best practices, promotions for fundraising, etc. Brownsworth stated his support of the Foundations goal of an ultrasound purchase. Previous estimates provided are significantly lower than present cost. Huckeba suggested that if the hospital were to purchase an ultrasound, the foundation funds could be applied to the cost of purchase.

Adjournment Meeting adjourned at 11:00 am.

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PLANNING & ZONING COMMISSION CONSENT AGENDA

*******Tuesday, July 16, 2013*******
PLEASE NOTE: PLANNING AND ZONING COMMISSION MAKES RECOMMENDATIONS TO THE FRANKLIN COUNTY BOARD OF COMMISSIONERS REGARDING YOUR APPLICATION. ALL APPLICANTS ARE NOTIFIED THAT IF YOUR APPLICATION IS DENIED, IT MAY NOT BE RESUBMITTED FOR ONE YEAR. ALSO, ANY PERSON WISHING TO APPEAL THE RECOMMENDATION OF THE PLANNING AND ZONING COMMISSION OR THE DECISION OF THE FRANKLIN COUNTY BOARD OF COUNTY COMMISSIONER BOARD ARE RESPONSIBLE TO ENSURE THAT A VERBATIM TRANSCRIPT OF THE PRCEEDINGS IS MADE.

The Planning & Zoning Commission met on Tuesday, July 9, 2013 with the following recommendations: CRITICAL SHORELINE REVIEW: 1RECOMMENDED APPROVAL (Unanimous) Consideration of a request to construct a Single Family Private Dock at 1705 East Gulf Beach Drive, Lot 7 Shell Harbor, St. George Island, Franklin County, Florida. The Dock will be 133x 3 with a 10 x 10 terminal platform. This application has all State and Federal Permits and meets all county requirements. Request submitted by Builders By the Sea, Inc., Gary Bartlett, agent for Thomas Dolan, applicant. (Has House) RECOMMENDED APPROVAL (Unanimous) Consideration of a request to construct a Single Family Private Dock at 16 Fiesta Drive, Lot 57, Holiday Beach, Unit 1, Alligator Point, Franklin County, Florida. The Dock will be 30x 6 parallel to the property. This application has State Exemption and meets all county requirements. Request submitted by Daniel Scheer, applicant. (Proposed House on Site Plan)

2-

REPORT: 3RECOMMENDED APPROVAL (Unanimous) Consideration of a request from the Franklin County Planning and Zoning Commission to hold a Workshop at the St. George Island Volunteer Fire Department in September to discuss the Commercial District on St. George Islands future zoning changes.

Franklin County Advisory Board of Adjustment July 16, 2013 The following recommendations were made to the Board of County Commissioners on July 10, 2013: 1Approve a request for a variance to construct a vertical seawall within the Critical Habitat Zone on property described as Lot 5, Block B, Magnolia Bluffs, 123 North Bayshore Drive, Eastpoint, Franklin County Florida. Request submitted by Michael L. Anderson, agent for Emerson C. Johns, Jr., owner.

Clerks Report to the Board 7-16-13 1. Board action is needed to set the dates for the 2 public hearings on the budget. Working around the Courts schedules, other governmental budget hearings, and advertising requirements, the finance office requests the Board set the first public hearing on Thursday, September 5, 2013 at 5:15 P.M. and the final public hearing on Monday, September 16, 2013 at 5:15 P.M.

Report to the Board of County Commissioners July 16, 2013 1- Inform the Board a pilot landed a plane at the airport Saturday night without putting the landing gear down. There were no injuries and no damage to the airport. The plane received significant damage but was able to be moved off the runway. Airport projects have been slow to get off the ground for a variety of reasons. I will be reporting in more detail at a later meeting. 2- Board action to accept a settlement with Capital City Bank on the acquisition of the 4 Secon Village lots. Mr. Shuler may be reporting on this, but on Friday Mr. Shuler and I met in court ordered mediation with Capital City Bank over the value of the land to be acquired in order to complete the relocation of Alligator Drive. The county had initially condemned just enough land for the road but in the settlement process we agreed to acquire all of the land included in the 4 lots. By agreeing to a settlement, the county can move forward with getting reimbursed from FEMA and we can begin road construction. Had we not agreed to a settlement the issue would have gone to court in late September. I have asked for an 8th time extension on this project, which has not yet been granted, and the current timeline on the FEMA funds expires on Nov. 30. The project was initially funded in 2005. Board action to accept settlement offer and to submit reimbursement request to FEMA once the judge signs the order. 3- Inform the Board that I am still working on the information requested from the last Board meeting regarding pay for interim directors. The Finance Office has been busy putting the budget together so I do not have numbers but at this time the 4 Board employees who have taken director positions without additional compensation are: Mark Curenton, June- Dec. 2004, as County Planner; Fonda Davis, April June, 2012 as Solid Waste Director; Dewitt Polous, Jan.- June, 2013 as Public Works Director; and Alan Pierce, Jan, 2013 to current as Airport Manager. 4- Board action to sign easement with Div. of State Lands for the easement to relocate Gulf Shore Blvd. I am still waiting for FEMA to authorize the changing of $450K of funds to rebuild Gulf Shore Blvd into a relocation project. 5- Inform the Board that bids will be opened for the repairs to the St. George Island Revetment at the Aug. 6 Board meeting. 6- Inform the Board that I have hired Angie Dean as the new courthouse janitor. She has been employed by the school system as a janitor for the last 15 years. There were many qualified applicants but Ms. Dean had the most experience directly related to working and cleaning public buildings. She will start Aug. 1. 7- The Gulf Coast Workforce Board has submitted two items for the Boards approval: A) The Workforce Board requests that Mr. Ted Mosteller be re-appointed to a 3 year term effective July 1, 2013. Mr. Mosteller has expressed an interest in continuing to serve on the Workforce.

B) The Workforce Board requests approval for the renewal of the Interlocal Agreement between Franklin County and the Gulf Coast Workforce Board. The Interlocal Agreement does not authorize any particular funding but it is the umbrella agreement that says the Franklin County agrees to let the Gulf Coast Work Force Board provide services in Franklin County. This is a renewal and without an agreement Franklin County would not be serviced by Gulf Coast Workforce. 8- Board will be opening sealed quotes for lights at Vrooman Park. Before a quote is awarded Mark Curenton will verify and consult with baseball officials that the new lights will provide the required illumination. We have received a call from one vendor that says LED lights have not been developed that are bright enough for lighting sports fields. 9- Inform the Board that the letter to FWC regarding Sunday oyster harvesting has been sent. The FWC has replied to the Boards previous letter about apparent commercial harvesters working on weekends. 10- At the beginning of July I received notice from DOT the county is eligible to submit one project for consideration of funding through the CIGP program. Currently in the CIGP pipeline is Oak St in Lanark Village, and a large loop in Eastpoint containing North and South Bayshore and Otter Slide to 6th St. The eligibility criterion is that a CIGP project must relieve congestion on the state highway system. The deadline for submitting is August 6. I recommend the submission of a project in Apalachicola which is essentially the repaving of a street known as Ellis Van Vleet, which runs from 17th St to 24 St and represents a by-pass for approximately 0.6 miles of US 98. Board action. 11- Inform Board that I attended a meeting in Panama City on Thursday, June 11, with representatives from the 8 impacted counties. Bay County Commissioner Mike Thomas chaired the meeting. The purpose of the meeting was to see if the 8 counties wanted to work together, with or without BP funding, to develop a plan for economic diversification of the region. Essentially this group would try to accomplish what Floridas Great Northwest was unable to accomplish, which was to promote and create jobs in NW Florida. I told the group that there was at least one thing we all had in common and that was aviation. There will be second meeting of the group sometime in August.