Lee Memorial Health System Finance Board & Full Board of Directors Meetings Thursday, September 24, :00 p.m.

Transcription

1 Lee Memorial Health System Finance Board & Full Board of Directors Meetings Thursday, September 24, :00 p.m.

2 AGENDA BOARD OF DIRECTORS OFFICE FAX: DOCTORS WAY #190 FT MYERS, FLORIDA CAPE CORAL HOSPITAL GULF COAST MEDICAL CENTER HEALTHPARK MEDICAL CENTER LEE MEMORIAL HOSPITAL GOLISANO CHILDRENS HOSPITAL OF SOUTHWEST FLORIDA THE REHABILITATION HOSPITAL LEE PHYSICIAN GROUP LEE CONVENIENT CARE BOARD OF DIRECTORS DISTRICT ONE Stephen R. Brown, M.D. Therese Everly, BS, RRT DISTRICT TWO Donna Clarke Nancy M. McGovern, RN, MSM DISTRICT THREE Sanford N. Cohen, M.D. David Collins DISTRICT FOUR Diane Champion Chris Hansen DISTRICT FIVE Jessica Carter Stephanie Meyer, BSN, RN FINANCE BOARD & FULL BOARD OF DIRECTORS MEETINGS September 24, :00 p.m. Gulf Coast Medical Center Boardroom (Medical Office Building) Doctors Way, Ft. Myers, FL CALL TO ORDER (Sanford Cohen, M.D., Board Chairman) Lee Memorial Health System Board of Directors, sitting as the Lee Memorial Health System (LMHS) Board of Directors for Gulf Coast Medical Center & Lee Memorial Hospital/HealthPark Medical Center and the Board of Directors of its subsidiary corporations, including but not limited to Cape Memorial Hospital, Inc. doing business as Cape Coral Hospital; Lee Memorial Home Health, Inc.; and HealthPark Care Center, Inc. 2. INVOCATION & PLEDGE OF ALLEGIANCE (Rev. Cynthia Brasher, MDiv, BCC) 3. PUBLIC INPUT Agenda Items: Any Public Input is limited to three minutes and a Request to Address the Board of Directors card must be completed and submitted to the Board Staff prior to meeting. Individuals wishing to address the Board on a Non Agenda item must notify the Board Staff of the subject matter at least three (3) days prior to the meeting. 4. RECOGNITION: Jacqueline Shaffer, BA, CNMT-33 yrs. 5. PRESIDENT S REPORT (Jim Nathan, CEO/President) 6. EMPLOYEE ENGAGEMENT UPDATE (Kristy Rigot, System Director, Recruitment & Retention and James Jiloty, Advisor, Talent Development & Performance Improvement Success Profiles) 7. CONSENT AGENDA: (Approve) A. Home Health Reports B. Care Center Reports FINANCE PORTION: David Collins, FINANCE LIAISON 8. CONSENT AGENDA A. Finance Board and Full Board meeting minutes of 6/25/15 B. July Financials 9. SEI BOARD SURVEY RESULTS (Peter Glennon, Al Pierce, and Brian Bono, SEI) 10. FY2016 BUDGET (Ben Spence, Chief Financial Officer) A.FY2016 Operating Budget (Approve) B.FY2016 Capital Budget (Approve) C.FY2016 Room Rates (Approve) 11. FINANCIAL & STATISTICAL REPORTS OF AUGUST 2015(Approve) (Ben Spence, Chief Financial Officer) 12. OTHER ITEMS Date of the next FINANCE BOARD MEETING November 19, 2015, 1:00 p.m. Gulf Coast Medical Center Boardroom (Medical Office Building) Doctors Way, Fort Myers, FL LMHS SYSTEM BUSINESS SANFORD COHEN, M.D., BOARD CHAIRMAN FINANCE & FULL BOARD\AGENDA(FINAL).doc Page 1 of 2

3 AGENDA (Page 2 of 2) BOARD OF DIRECTORS OFFICE FAX: DOCTORS WAY #190 FT MYERS, FLORIDA CAPE CORAL HOSPITAL GULF COAST MEDICAL CENTER HEALTHPARK MEDICAL CENTER LEE MEMORIAL HOSPITAL GOLISANO CHILDRENS HOSPITAL OF SOUTHWEST FLORIDA THE REHABILITATION HOSPITAL LEE PHYSICIAN GROUP LEE CONVENIENT CARE FINANCE BOARD & FULL BOARD OF DIRECTORS MEETINGS September 24, :00 p.m. 13. MEDICAL STAFF RECOMMENDATIONS OF 9/22/2015 (Approve) A. Lee Memorial Hospital B. Cape Coral Hospital C. Gulf Coast Medical Center D. HealthPark Medical Center E. Golisano Children s Hospital of SW Florida 14. OLD BUSINESS 15. NEW BUSINESS 16. BOARD MEETING CRITIQUE 17. BOARD OF DIRECTORS REPORTS 18. Date of the next Meeting: Thursday, October 22, 2015: 1:00pm Planning Board & Governance Board & Full Board of Directors Meetings Gulf Coast Medical Center Boardroom Doctors Way, Ft. Myers, FL ADJOURN (Sanford Cohen, M.D., Board Chairman) BOARD OF DIRECTORS DISTRICT ONE Stephen R. Brown, M.D. Therese Everly, BS, RRT DISTRICT TWO Donna Clarke Nancy M. McGovern, RN, MSM DISTRICT THREE Sanford N. Cohen, M.D. David Collins DISTRICT FOUR Diane Champion Chris Hansen DISTRICT FIVE Jessica Carter Stephanie Meyer, BSN, RN FINANCE & FULL BOARD\AGENDA(FINAL).doc Page 2 of 2

4 BOARD OF DIRECTORS Invocation Prayer & Pledge of Allegiance

5 L E E M E M O R I A L HEALTH SYSTEM BOARD OF DIRECTORS PUBLIC INPUT AGENDA ITEMS: Any public input pertaining to items on the Agenda is limited to three minutes and a Request to Address the Board of Directors card must be completed and submitted to the Board Staff prior to meeting. Refer to Board Policy: 10:15F: Public Addressing the Board Non-Agenda Item: Individuals wishing to address the Board on an item NOT on the Agenda, the Board office must be notified of subject matter at least three (3) days prior to the meeting to allow staff time to prepare and to insure the matter is within the jurisdiction of the Board.

6 Proclamation L E E M E M O R I A L HEALTH SYSTEM BOARD OF DIRECTORS September 24,, 2015 would like to recognize with sincere appreciation Jacqueline Shaffer, BA, CNMT in her retirement of 33 dedicated service years to the Lee Memorial Health System. The entire system wishes you health & happiness, and all the best in your future endeavors. BOARD OF DIRECTORS District 1 Stephen R. Brown, MD Therese Everly, BS, RRT District 2 Donna Clarke Nancy M. McGovern, RN, MSM District 3 Sanford N. Cohen, M.D. David F. Collins District 4 Diane Champion Chris Hansen District 5 Jessica Carter Peer Stephanie L. Meyer, BSN, RN

7 L E E M E M O R I A L HEALTH SYSTEM BOARD OF DIRECTORS PRESIDENT S REPORT Jim Nathan CEO/President

8 LMHS Board of Directors President s Report September 24, 2015 Virginia Elections Could Signal Future of Medicaid Expansion Political analyst: Virginia a key swing state for 2016 presidential election o Democratic Governor Terry McAuliffe o Republicans control both House & Senate o Democrats only need net increase of one Senate seat to gain control o Republicans control 2/3 majority in House o Highly visible Senate campaign: Republican OB/GYN strongly opposed to expansion versus Democrat nurse, a staunch supporter o Major hospital campaign advocating for expansion; 400,000 in coverage gap o Expansion trails jobs and education in Virginia polls o Some observers indicate the Nov. 3 election could affect nation s momentum re. Medicaid expansion Kentucky Republican Governor candidate has vowed to roll back outgoing Democratic Governor Steve Beshear s expansion New governor will be elected in Louisiana to replace expansion foe Bobby Jindal o All four candidates have indicated an openness to some form of expansion Bean Says Mediciad Expansion Unlikely in 2016 Senate Health Policy Chair Aaron Bean o Not expecting focus on extending funding for uninsured patients this upcoming legislative session o Focus will be on bringing down health costs; planning for eventual loss of Low Income Pool (LIP) o Specific public comments: Expand telemedicine; allow patients to pay primary care doctors without involving insurance companies Nearly 9 Million People Gained Insurance in Health Marketplace s First Year Americans: 2013 >> 13.3% uninsured 2014 >> 0.4% uninsured Despite record gains (or drop in uninsured) 33 million Americans remain uninsured Largest gains: Medicaid up 2% to 62 million; individual purchases up 3.2% to 14.6 million Due to expanded Medicaid and making private insurance easier for individuals to purchase who do not have employer sponsored coverage Employer sponsored coverage remained steady at 55% Uninsured dropped for every age, income and ethnic group in every state 1

9 State 2013 Uninsured % 2014 Uninsured % Percent Change Kentucky 14.3% 8.5% -41% West Virginia 14.0% 8.6% 39% Rhode Island 11.6% 7.4% -36% Oregon 14.7% 9.7% -34% Vermont 7.2% 5.0% -31% Florida (15 th drop) 20.0% 16.6% -17% Number of Uninsured Drops to 16.6 percent in Florida Florida: 2013 >> 20% uninsured 2014 >> 16.6% uninsured Drop due to ACA s mandatory insurance coverage and Florida being the most successful with health exchange (not Medicaid expansion) plus increased Medicaid enrollment 21 of nation s largest cities improved insurance coverage through combination of private purchases and health exchanges (marketplace) Only Texas (19.9%) and Alaska (17.2%) remain higher Florida can celebrate and now call itself the 3 rd highest uninsured state in nation National average: 3013 >> 14.5% uninsured 2014 >> 11.7% uninsured Census: Miami-Dade, Broward Residents Gain Health Insurance Coverage, but Uninsured Rates Still High Miami-Dade: 2014 >> 22% uninsured Broward: 2014 >> 18% uninsured States with lowest uninsured o Massachusetts: 2014 >> 3.3% uninsured o Vermont: 2014 >> 5% uninsured o District of Columbia 2014 >> 5.3% uninsured Florida s Medicaid Rolls are About to Swell Florida projected to add 250,000 Medicaid next year to just over 4 million Would be 1/3 of state budget Florida chief economist Amy Baker: Due to increase in awareness of coverage, not more poor people; costs up due to prescription drug costs Legislators questioning whether statewide Medicaid Managed Care is working 10 year law suit still alive with pediatricians and parents fighting for higher Medicaid reimbursement o Recent ruling Florida s Medicaid in violation of federal law as it relates to physician reimbursement rates ; litigation and appeals ongoing 2

10 Hospitals Say They Aren t to Blame for Jump in Medicaid Costs Safety Net Hospital Alliance of Florida o Increases stem from more people entering Medicaid plus fallout from state s shift to Medicaid managed care o Hospital costs will experience one of the smallest percentage increases across most of the major Medicaid program categories. o State is required to pay actuarially sound rates to managed-care plans while previous direct reimbursement from state to hospitals were below actuarially sound rates Recall that LMHS pays into Medicaid twice the rate of the stat s coverage included in Ben s finance report today Obamacare Punishes Hospitals that See Poor Patients, Study Finds New Harvard study: ACA penalizes hospitals who see more vulnerable patients; such as less educated, more disabled, and more likely to suffer from depression Each year the penalties have grown and thus the risks are higher; could severely penalize hospitals caring for sicker, more complex, more vulnerable patients Readmission penalty does control for some factors beyond hospital s control such as age, gender and a few preexisting conditions Academics have raised issues in recent years that readmission penalties do not adjust for enough noncontrollable factors and thus would penalize hospitals serving low-income patients with weaker social system support Readmission program has potential to exacerbate disparities in care and create disincentives to providing care for patients who are particularly ill Study: o Hospitals with the worst readmission records had 50% greater patients with less than a high school education o If Medicare would control for all 29 factors in study the difference between the top and bottom performers in admission rate differentials would be cut in half Summary: o Half difference between really high and really low readmission rates had nothing to do with health care provided o American children 17.5% obese v Canadian 13% (both up about 1% in last half decade) o American adolescents v. Canadian (19.2% v. 11.8) o Next phase: Compare dietary and physical activity in children The Gupta Guide: Are CMS Penalties Failing Hospitals? ACA s focus on reducing hospital acquires infections and other conditions (HACs) by penalizing worst performers may be missing mark Surgical Outcomes and Quality Improvement Center at Northwestern University Feinberg School of Medicine o HAC reductions well intentioned 3

11 o Chasing wrong performance metrics o Accredited, large hospitals caring for the most complex patients penalized the most Non-accredited hospitals penalized less frequently Large teaching hospitals penalized more Safety net hospitals penalized more than non safety net Venous thromboembolism (VTE) rates higher for hospitals using imaging to monitor for VTEs Hospitals with failing grades in the mandated assessment actually did better when graded on outcomes such as deaths from heart attacks or pneumonia AHA Urges CMS to Redesign Hospital Star Rating System Relates to star system in HospitalCompare.com o Five-star scale o 12 different star ratings on website for each facility o 11 ratings are based on individual HCAHPS measures; 12th is a composite star rating AHA supports transparency of hospital quality measures but concerned that CMS is trying to retrofit the existing [quality] measures when many are not constructed in such a way that they can accurately depict the kind of distinctions in care CMS wants to depict." AHA recommendations: o Consider a system in which star ratings are only applied to specific measure topics, like cardiac care, rather than one overall rating for each hospital o Reconsider using readmission and mortality measures in the star rating system o Re-examine whether weighing [of various] measures is scientifically sound or justified o Move forward with the goal of creating a comprehensive assessment of hospital care, but do so over the next few years rather than all at once o Build the star rating system using HCAHPS metrics, and then add conditionspecific assessment measures that can provide important insights into overall performance Healthy Lee s Million Mile Movement Kick off presentation today Begins October 1 Help transform the lifestyle of our community one step at a time 4

12 Lee Memorial Health System 2015 Employee Engagement Survey Results Presenters Kristy Rigot, LMHS System Director Human Resources James Jiloty, Advisor, Talent Development & Performance Improvement Success Profiles

13 Approach to Annual Survey An engaged workforce helps assure Patients get safe care and have a positive patient-customer experience LMHS financial viability All employees have an opportunity to participate in annual Employee Engagement Survey. This feedback is extremely helpful to making LMHS an Exceptional Healthcare Employer and winner of the prestigious Employer of Choice award In addition, this type of data helps LMHS prioritize its Caring People strategic goals as well as ensure that employees are given the tools and support by their supervisors necessary to do their best work. Our motto for our survey is You Talk, We Listen, Things Change. Copyright Success Profiles Inc. Research, 1992 to 2013

14 Results Roll-out & Action Planning Process Each year, Senior Leaders communicate survey results and expectations for department leader action planning and follow-up: Share results of the survey with all employees Identify opportunities for improvement in the department Demonstrate a commitment to actions that will follow from identified areas needing improvement Created appropriate action plans with employee input Provide on-going communication with employees regarding action planning implementation Celebrate success as improvements occur. Copyright Success Profiles Inc. Research, 1992 to 2013

15 Recognition & Celebrations Leadership Recognition President Circle Honorees - To be recognized for the President s Circle, the department leader scored in the top 10% for Department Leader section of survey. Greatest Improvement Winners - To be recognized for the Greatest Improvement, the overall score for the Department Leader Section was significantly higher from previous year. Departments with at least 80% response rate get a pizza party LMHS S commitment to employee engagement is evident through our 97.1% National Percentile Rank Overall Grand Mean score for 2015 Survey. Leaders are focused on results and make it a top priority to be the best health care system for our employees, patients and the communities we serve. Copyright Success Profiles Inc. Research, 1992 to 2013

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17 Improving the Health of Healthcare One Organization at a time The Impact of Leadership and Employee Engagement on Overall Results 2015 Employee Engagement Survey Results James Jiloty Success Profiles, Inc. & Healthcare Performance Solutions (HPS) Copyright Success Profiles Inc. Research, 1992 to 2013

18 Setting the Stage: The Journey 24 Years of Performance Measurement experience by Success Profiles, Inc. (est. 1991) 13 Years of Focused Research Exclusively in Healthcare Industry 250 Organizations / 30,000+ Front-line department leaders evaluated = Most Comprehensive Database of Healthcare Leadership Effectiveness Assessments Copyright Success Profiles Inc. Research, 1992 to 2013

19 Effective Protocols and Business Analytics Evidence Based Medicine: The discipline of providing consistent protocols of care most appropriate for the specific ailments/symptoms and medical conditions people experience. Copyright Success Profiles Inc. Research, 1992 to 2013

20 Effective Protocols and Business Analytics Evidence Based Business Practices: The discipline of providing consistent leadership decisions and improvement interventions based upon objective performance criteria and demonstrated results. Copyright Success Profiles Inc. Research, 1992 to 2013

21 Mature and Sophisticated Measurement What s easy to measure usually doesn t count. Employee Turnover, FTE s, Labor costs - Traditional Accounting etc. And What really counts isn t easily measured. Leadership, Culture, Engagement, Productivity - ABC Accounting Albert Einstein Copyright Success Profiles Inc. Research, 1992 to 2013

22 GPS like Navigation (Business Intelligence) Odds of Success 90% 80% 70% 60% 50% 40% 30% 20% 10% High Success Zone = A & B + Talent Excellent Alignment Odds 3:1 Likely to Succeed Possible Success Zone Poor Alignment 25% 15% 5% 40% 30% 20% 75% 60% 45% 85% 75% 65% Most Frequent Mistake Unlikely Success Zone = C & D Talent Bad Alignment Odds 3:1 Likely to Fail D Level Talent C Level Talent B Level Talent A Level Talent Demonstrated Leadership Ability (Talent) Level 90% 80% 70% 60% 50% 40% 30% 20% 10% Executive Perspective of Leadership Talent 5 4 Behavioral Style Assessment 5 Behavioral Assessments 22 Data points (4,000) Hard Performance Metrics Financial results $$$ Productivity of FTE s Quality and safety Labor costs Cycle times/through-put 12 Data points Front-line Manager Leader Success Rates Considering Talent & Degree of Difficulty (DoD) 2 Talent Management Eye Chart Soft Performance Metrics Staff satisfaction & loyalty Culture and engagement Employee retention Performance review scores Customer satisfaction - loyalty 3 24 Data points (7,000) Department Window Transition Time Development Time 1 2 Position: CEO Vulnerability Candidate Pool Name Title Dev Time Potential Gary T. CFO None - Inter. A Name Ron R. Title COO Dev Time 6 months Potential A Name Title Dev Time Potential Joy H. COO 5 Years A - Name Cherie W. Name Bill B. Title COO Title COO Dev Time 3 Years Dev Time 5 Years Potential A - Potential A Leadership continuity/succession 16 Data points Staff Perspective of Manager Performance Copyright Success Profiles Inc. Research, 1992 to 2013 Performance Management Eye Chart 12 Data points (30,000)

23 Management Effectiveness Index PMEC Percentil Rank Management Effectiveness Index PMEC Percentile Rank Leadership Effectiveness and Employee Engagement Varying Levels of PMEC Percentile Rank Performance (15,086 Front-line leaders) 100% 100% 90% 90% 80% 80% 70% 70% 60% 60% 50% 50% 40% 40% 30% 30% 20% 20% 10% 10% Leadership Effectiveness and Likelihood of Employee Engagement (Individual Organizations) Leaders Leaders compared compared to all to those leaders within within their the respective database. organization. (15,086 (109 Leaders) Organizations) Leaders compared to those within their respective organization. (109 Organizations) 0% 0% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Overall Employee Overall Employee Engagement Engagement (% likely Based to have on above Quartile average Ranking scores) (%likely to have above average scores) Copyright Success Profiles Inc. Research, 1992 to 2013

24 Leadership Effectiveness and Employee Engagement Copyright Success Profiles Inc. Research, 1992 to 2013

25 Leadership Effectiveness and Employee Engagement Copyright Success Profiles Inc. Research, 1992 to 2013

26 Leadership Effectiveness and Employee Engagement Copyright Success Profiles Inc. Research, 1992 to 2013

27 Leadership Effectiveness and Employee Engagement Copyright Success Profiles Inc. Research, 1992 to 2013

28 Leadership Effectiveness and Employee Engagement Copyright Success Profiles Inc. Research, 1992 to 2013

29 Leadership Effectiveness and Employee Engagement Aggregate score Exceeds FY 15 Goal Copyright Success Profiles Inc. Research, 1992 to 2013

30 Top Key Factors Driving Employee Perception of Their Profession 97.1% Percentile Rank Copyright Success Profiles Inc. Research, 1992 to 2013

31 Top Key Factors Driving Employee Perception of Their Profession 97.1% Percentile Rank Based on Overall Grand Mean Raw Score

32 U.S. Job Satisfaction Trends 2010: All-time low of 42.6% 2014: Happier but still not happy <50% are very satisfied with their jobs (The Conference Board) Recession a factor in the low numbers SHRM: workload, communication channels, recognition contribute to gains SOURCE: Copyright Success Profiles Inc. Research, 1992 to 2013

33 Creating Business Intelligence with Eye Charts The Visual Display of Quantifiable Information Copyright Success Profiles Inc. Research, 1992 to 2013

34 When an organization has effective leadership and a healthy (engaged) culture, it is 66% to 75% more likely to achieve better than average overall outcomes (by virtually every measure). Copyright Success Profiles Inc. Research, 1992 to 2013

35 The Phases of Innovation Where are we today (in the Healthcare marketplace) with mature and sophisticated business practices? Leaders Laggards 2000 to to to to to 2030 Less than 15% of Hospital Systems have a formal structured approach to Performance Management, Talent Management and Succession Planning. Copyright Success Profiles Inc. Research, 1992 to 2013

36 Lee Memorial s Business Practices Assessment (employee satisfaction, loyalty and engagement scores) places them in approximately the 97th percentile as a system. This marks another year of outstanding levels of employee job satisfaction, organizational loyalty, and professional engagement. This pattern of consistent high-performance is a noteworthy accomplishment considering results are system-wide and overall employee engagement scores are mostly down across the board in multiple industries. Leader and manager effectiveness is the key contributing factor to this success. We have and still consider LMHS to be an industry leader with respect to their business practices, Human Resources practices and high performance culture. They truly serve as an Employer of Choice model for other Healthcare organizations to benchmark. Tom Olivo, President of Success Profiles and Healthcare Performance Solutions Copyright Success Profiles Inc. Research, 1992 to 2013

37 Questions or Comments Copyright Success Profiles Inc. Research, 1992 to 2013

38 L E E M E M O R I A L HEALTH SYSTEM BOARD OF DIRECTORS CONSENT AGENDA (Approve) A. Home Health Reports B. Care Center Reports

39 BOARD OF DIRECTORS ENTITY REPORTING EXECUTIVE SUMMARY to: by Noon eight (8) days PRIOR to presenting. ENTITY/BUSINESS NAME: Home Health Fiscal Year 2014 DIRECTOR & TITLE: Marjory May, Vice President Continuum of Care REPORT DATE: September 24, 2015 BUSINESS DESCRIPTION: Lee Memorial Home Health is a non-profit home health agency. The Agency provides nursing services as well as physical therapy, speech, occupational therapy, medical social work and home health aide services to residents of the community. In addition, we also provide Telehealth, Lifeline emergency response system and Choices Geriatric Case Management Programs. SYSTEM GOAL: Financial Performance Major Accomplishments Scorecard Performance o Revenue o Profit/Loss o Explanation of major variances Key Utilization Trends MISSION STATEMENT: To continue to meet the health care needs and improve the health status of the people of Southwest Florida FYE Actual Budget Prior Year Admissions 4,287 5,578 4,152 Operating Revenue 8,523,250 11,503,436 7,423,253 Profit/Loss (3,135,000) (2,278,000) (3,934,000) Agency admissions were 4% above prior year. This was primarily due to the anticipated increase from LMHS hospitals and physicians in the last 4 months of FY14. Operating Revenue increased 15% from prior year due above stated volume increase and a 19% reduction of Revenue Deductions from improved billing processes. Loss was significantly reduced from prior year by 20%. This was primarily due to of strong revenue improvement while controlling costs/admission at a slower rate. $525K in Charity Care provided in FY14. (Charity Credit not included above) NOTE: The Telehealth program ($623K cost included above) provided acute care cost avoidance to payers by preventing readmissions was $3.2 million for the year ($2.0, FY13). SYSTEM GOAL: Quality Major Accomplishments Scorecard Performance o LOS Trends o Outcome Data Medicare s publically reported quality of patient care measures for Medicare are better than the National and State average for 19 of the 22 measures for calendar year Medicare s publically reported 30 day re-hospitalization rate is 18.1%. This is 2% over the national average. SYSTEM GOAL: Service Major Accomplishments Scorecard Performance o Inpatient Satisfaction o Outpatient Satisfaction Lee Memorial Home Health Top Box target was 86.9%. The agency actual score was 86.2%. Telehealth Manager spoke at the Peak Summit in Washington, D.C. in March The topic was reducing readmission through the use of Telehealth monitoring. Agency collaborated with Honeywell Home Med and the National Association of Home Care to publish a case study in Telehealth and was published in Caring magazine.

40 SYSTEM GOAL: People Major Accomplishments Scorecard Performance o Employee Satisfaction o Vacancy Rates o Personnel Turnover Several areas in the agency scored very well in employee engagement. Employee Engagement Index Raw Score as follows: Telehealth/Lifeline Healthy Start/Choices Therapy Over All Agency Areas of focus for next year will be nursing and administration. Our vacancy rate for the agency was 13% (10%, FY13) SYSTEM GOAL: Community Major Accomplishments Scorecard Performance o Market Share o Community Preference Within Lee County, there are >50 Home Health agencies. During 2014, Lee Memorial Home Health s Hospital Market Share experienced a slight decrease of 3% over previous year. Medicare admissions increased by 3%, but remained steady at 39% of our payer mix. Medicare Replacements increased by 19% with admissions increasing from 27% of our payer mix in FY13 to of 31% of our payer mix in FY14. Medicare (traditional) is still the agency s best payer as opposed to replacements and commercial payers. Choices, our fee for service geriatric case management program, realized a 77% operating gain from prior year. Lifeline, LMHH s emergency response program posted a 20% operating loss primarily due drop in subscribers during the first half of the year. This was reversed due to the a vendor promotion. Healthy Start (Mom/Baby) support services received an additional $173K above FY13 due to the Nurse Family Partnership grant and the HOPE grant to provide community services. For a total that exceeded $800K. Key Challenges & Opportunities Market Overview o Key Competitive Developments o Key Legislative or Political Developments o Key Technology Developments o Potential New Ventures and/or Businesses Challenges/Opportunities 1. Regulatory requirements of timely physician encounters with patients and documentation referred to as the Face to Face mandate. 2. Continued Medicare cuts along with significant growth in Medicare replacement products that impact operating revenue. 3. Continued growth with internal referrals. 4. Continued growth with preferred providers. 5. Expand technology to maintain patient s independence in their homes and avoid unnecessary readmissions. 6. Opportunities to grow and develop top performing staff.

41 BOARD OF DIRECTORS ENTITY REPORTING EXECUTIVE SUMMARY to: by Noon eight (8) days PRIOR to presenting. ENTITY/BUSINESS NAME: HealthPark Care & Rehabilitation Center DIRECTOR & TITLE: Marjory May, Vice President Continuum of Care REPORT DATE: September 24, 2015 BUSINESS DESCRIPTION: Health Park Care and Rehabilitation Center was opened in 1992 as a 90 bed Skilled Nursing Facility named Health Park Care Center. A CON was obtained and 12 beds were added several years later. The facility was not built by LMHS but was purchased by the System prior to opening. SYSTEM GOAL: Financial Performance Major Accomplishments Scorecard Performance o Revenue o Profit/Loss o Explanation of major variances Key Utilization Trends SYSTEM GOAL: Quality Major Accomplishments Scorecard Performance o LOS Trends o Outcome Data SYSTEM GOAL: Service Major Accomplishments Scorecard Performance o Inpatient Satisfaction o Outpatient Satisfaction MISSION STATEMENT: To continue to meet the health care needs and improve the health status of the people of Southwest Florida. FY 2014 Actual Budget Prior Yr. Patient Days 39,007 39,420 38,203 OP Revenue 13,034,712 13,882,457 12,942,377 Profit/Loss (278,195) 1,130,722 (981,182) Admits *Operating revenue increase from PY *Actual profit does not include a charity care credit of $528,650 *Bad Debt Write-off from prior years totaled $670,000 Achievement of the CMS Five-Star Rating Zero health care citations from AHCA complaint surveys minimal citations on annual AHCA survey New Quality Assurance/ Performance Improvement program introduced Meeting or exceeding the national average in September 2014 on 14 of the 17 quality metrics on the MDS 3.0 Casper Report Press Ganey Top Box Scores for September 2014 at 60.5% Therapy Components still our highest driver for patient satisfaction on Press Ganey surveys. September 2014 Physical Therapy Top Box Scores at 73.3% and Occupational Therapy Top Box Scores at 74.4% Implemented Customer Service initiatives Electronic Health Record integration completed with Achieve MatrixCare product (Skilled Nursing Facility specific).

42 SYSTEM GOAL: People Major Accomplishments Scorecard Performance o Employee Satisfaction o Vacancy Rates o Personnel Turnover Employee Satisfaction Survey produced solid results in the response rate and the overall scores in the five major index rankings. Grand Mean score = Employee Engagement score = Trifecta score = Work Environment = Total Turnover rate 12.31% SYSTEM GOAL: Community Major Accomplishments Scorecard Performance o Market Share o Community Preference Major renovation in progress throughout the facility to attract a larger sub-acute population. Medicare payer mix rose from 62.4% in PY to 72.0% in FY14 Average daily census of sub-acute patients at which is 8% over PY. 30 day readmission rate of all diagnoses decreased from 19.1% for PY to 15.8% for FY 14. Key Challenges & Opportunities Market Overview o Key Competitive Developments o Key Legislative or Political Developments o Key Technology Developments o Potential New Ventures and/or Businesses Heavy Regulatory Action at the State Level Budget flexing needed for sub-acute population Exploring another Skilled Nursing Facility and/or Hospital Based Skilled Nursing Unit beds at one of LMHS campuses. Epic Research to begin for a Skilled Nursing Home component Continuing facility renovation of inpatient rooms and dining areas. BOD/Forms/Entity Reporting Executive Summary Form updated /lg

43 To Finance Liaison Change: FINANCE BOARD OF DIRECTORS MEETING Thursday, September 24, :00pm David Collins, Board Treasurer

44 L E E M E M O R I A L HEALTH SYSTEM BOARD OF DIRECTORS CONSENT AGENDA (Approve) A. Finance and Full Board Minutes of 06/25/15 B. July Financials

45 LEE MEMORIAL HEALTH SYSTEM FINANCE BOARD & FULL BOARD OF DIRECTORS MEETING MINUTES Thursday, June 25, 2015 LOCATION: Gulf Coast Medical Center, Boardroom, Medical Office Building, Doctors Way, Fort Myers, FL MEMBERS PRESENT: Sanford N. Cohen, M.D, Board Chairman; Chris Hansen, Board Vice Chairman; David Collins, Board Treasurer; Diane Champion, Board Secretary ;Steve Brown, M.D., Board Member; Therese Everly, Board Member; Nancy McGovern, RN, MSM, Donna Clarke, Board Member; Jessica Carter Peer, Board Member Stephanie Meyer, RN, BSN, Board Member NOTE: Documents referred to in these minutes are on file by reference to this meeting date in the Office of the Board of Directors and on the Board of Directors website at for public inspection. SUBJECT DISCUSSION ACTION FOLLOW- UP MEETING CALLED TO ORDER The LEE MEMORIAL HEALTH SYSTEM FINANCE BOARD & FULL BOARD OF DIRECTORS MEETINGS were CALLED TO ORDER at 1:00 p.m. by Sanford N. Cohen, M.D., Board Chairman. INVOCATION AND PLEDGE OF ALLEGIANCE Rev. Denise Sawyer gave the Invocation, followed by the Pledge of Allegiance. PUBLIC INPUT None at this time. PRESIDENT S REPORT Jim Nathan presented his President s report. CONSENT AGENDA SEI INVESTMENT PERFORMANCE REPORT FY2105 REFUNDING OF 2005 SERIES A BONDS David Collins asked for approval of the Consent Agenda consisting of: A. April 2015 Financials B. Finance Board and Full Board of Directors Meeting minutes of 4/23/15 The SEI Investment Performance report was presented. David Collins asked for approval. The 2015 Asset Allocation Survey was distributed for board member scoring. Surveys were collected and submitted. SEI will compile the results and bring back for discussion in September. Ben Spence presented the refunding of 2005 Series A Bonds. The meeting was turned over to David Collins, Board Treasurer to CONVENE the Finance portion of the meeting at 1:35 p.m. A motion was made by Dr. Cohen to approve the Consent Agenda consisting of: A. April 2015 Financials B. Finance Board and Full Board of Directors Meeting minutes of 4/23/15 The motion was seconded by Chris Hansen and it carried with no opposition. A motion was made by Nancy McGovern to approve the SEI Investment Performance Report FY The motion was seconded by Dr. Cohen and it carried with no opposition. A motion was made by Steve Brown to approve the resolution authorizing and approving the refunding and refinancing of the outstanding Lee Memorial Health System Hospital Revenue Refunding Bonds 2005 Series A; approving a direct loan in the principal amount of not to exceed $50,850,000 for the purpose of refunding and refinancing the 2005 Series A Bonds; approving a form of loan agreement; authorizing the execution and delivery of documents and the taking of all other necessary actions in connection with the loan; providing for severability; and providing an effective date and authorizing Jim Humphrey, as Board counsel to

46 LEE MEMORIAL HEALTH SYSTEM FINANCE BOARD & FULL BOARD OF DIRECTORS MEETING MINUTES Thursday, June 25, 2015 Page 2 of 4 SUBJECT DISCUSSION ACTION FOLLOW- UP approve immaterial alterations to the documents if necessary in order to accomplish the loan closing during July since timing is important. If material alterations are necessary, we will delay the closing until August in order to present them to the Board for its consideration. The motion was seconded by Therese Everly and it carried with no opposition. FINANCIAL & STATISTICAL BUSINESS FY 2016 BUDGET- COMPENSATION AND BENEFITS TOTAL REWARDS PACKAGE OTHER ITEMS NEXT FINANCE MEETING RETURN TO FULL BOARD PORTION Ben Spence presented the Financial & Statistical Business consisting of: A. Financial & Statistical Reports as of May 2015 (Accept) Alison Thurau presented the FY 2016 Compensation and Benefits Total Rewards Package. David Collins asked for approval. Discussion ensued regarding Outside Consultants and Governance Institute new dues rate. The next Lee Memorial Health System Full Board (Finance) Meeting is: Thursday, September 24, 2015, 1:00 p.m. Gulf Coast Medical Center, Medical Office Boardroom Doctors Way, Fort Myers, FL A motion was made by Therese Everly to accept the Financial & Statistical Reports as of March The motion was seconded by Jessica Carter Peer and it carried with no opposition. A motion was made by Dr. Cohen to approve the FY 2016 LMHS Compensation Program Recommendations pending the Board of Directors final approval of the FY 2016 LMHS Budget. The motion was seconded by Diane Champion and it carried with no opposition. A motion was made by Dr. Cohen to approve the FY 2016 LMHS Benefits Program Recommendations pending the Board of Directors final approval of the Fiscal Year 2016 LMHS Budget. The motion was seconded by Diane Champion and it carried with no opposition. Donna Clarke made a motion to include funds in the Board budget for outside consultants. The motion was seconded by Steve Brown and it carried with no opposition. Dr. Cohen made a motion to authorize the Governance Chair and Board Treasurer to explore all alternatives to membership of the Governance Institute that will provide all the educational and networking opportunities the Governance Institute has provided. The motion was seconded by Jessica Carter Peer and it carried with no opposition. Sanford N. Cohen, M.D., Board Chairman, resumed the LMHS Full Board portion of the meeting at 4:20pm. GCMC ADDITIONS AND RENOVATIONS Dave Kistel presented the Gulf Coast Medical Center Additions and Renovations Project consisting: A. Architectural Design Services and Construction manager at Risk selection for Gulf Coast Medical Center Additions and Renovation project B. Update on Capacity Renovation Project A motion was made by Therese Everly for 1) Approval of rankings as submitted for Architectural Design Services for Gulf Coast Medical Center Additions and Renovation Project: first ranked, HKS 1106 points; second ranked, HDR points; third ranked, Perkins & Will 979 points. Proceed with contract negotiations per Board Policy, starting with highest numerical ranked firm, HKS. 2) Approval of rankings as submitted for Construction Management at Risk for Gulf Coast Medical Center Additions and Renovation Project: first ranked, Skanska / Gates 989 points; second ranked, Deangelis Diamond / Yates Construction 876 points; third ranked, Robins

47 LEE MEMORIAL HEALTH SYSTEM FINANCE BOARD & FULL BOARD OF DIRECTORS MEETING MINUTES Thursday, June 25, 2015 Page 3 of 4 SUBJECT DISCUSSION ACTION FOLLOW- UP Morton points. Proceed with contract negotiations per Board Policy, starting with highest numerical ranked firm, Skanska / Gates. The motion was seconded by Nancy McGovern and it carried with no opposition. On 3/19/2015 the Board approved $7,289, for design, construction, furniture, equipment, and information technology to implement and operationalize patient care beds at Lee Memorial and observational beds at Gulf Coast Medical Center and HealthPark Medical Center. A motion was made by Jessica Carter Peer to approve in lieu of previously approved plan at Gulf Coast Medical Center, convert spaces on 2nd floor and 4th floor to 7 critical hospital beds for an additional cost of $200, over what was previously approved. The motion was seconded by Diane Champion on it carried with no opposition. CONSENT AGENDA MEDICAL STAFF RECOMMENDATIONS OF June 17, 2015 Dr. Cohen asked for approval of the Consent Agenda consisting of: A. Asthma Lease at Metro Medical Plaza B. Pediatric Specialty Clinic Lease Port Charlotte Dr. Cohen asked for a motion to approve the Medical Staff Recommendations as of 6/17/15: 1. Lee Memorial Hospital 2. Cape Coral Hospital 3. Gulf Coast Medical Center 4. HealthPark Medical Center 5. Golisano Children s Hospital of SWFL A motion was made by Chris Hansen to approve the consent agenda consisting of: A. Asthma Lease at Metro Medical Plaza B. Pediatric Specialty Clinic Lease Port Charlotte The motion was seconded by Therese Everly and it carried with no opposition. A motion was made by Chris Hansen to approve the Medical Staff Recommendations of June 17, Lee Memorial Hospital 2. Cape Coral Hospital 3. Gulf Coast Medical Center 4. HealthPark Medical Center 5. Golisano Children s Hospital of SWFL The motion was seconded by Therese Everly and it carried with no opposition. OLD BUSINESS None at this time. NEW BUSINESS The LeeSar expansion tour and workshop will be held at 1pm. on September 17 th. BOARD MEETING CRITIQUE BOARD OF DIRECTORS REPORTS All were in agreement that the meeting included good discussion and good material. Steve Brown spoke about children s behavioral health. Therese Everly spoke of her recent attendance at the Leadership Royale event. Chris Hansen stated Salus Care just added a new pediatric and adolescent Psychologist

48 LEE MEMORIAL HEALTH SYSTEM FINANCE BOARD & FULL BOARD OF DIRECTORS MEETING MINUTES Thursday, June 25, 2015 Page 4 of 4 SUBJECT DISCUSSION ACTION FOLLOW- UP Diane Champion reminded the Board members to encourage staff to nominate a deserving LMHS employee. Donna Clarke stated she has been handing out the LMHS Key Facts sheet to members of the community. She encouraged other Board members to do the same as it is a great way to educate the community. Nancy McGovern stated her friend s great granddaughter was born premature at HealthPark Medical Center and received great care. Dr. Cohen congratulated David Collins on his recent editorial Lee Memorial Health System disputes state's hospital data. He also mentioned he had lunch with Fred Schaerf regarding behavioral health research. NEXT REGULAR MEETING The next LEE MEMORIAL HEALTH SYSTEM MEETINGS PLANNING BOARD & FULL BOARD will be held on August 13, 2015, 1:00 p.m. in the Gulf Coast Medical Center, Medical Office Building, Boardroom Doctors Way, Fort Myers, FL ADJOURNMENT The LEE MEMORIAL HEALTH SYSTEM FINANCE BOARD & FULL BOARD OF DIRECTORS MEETINGS were ADJOURNED at 5:18 p.m. by Sanford N. Cohen, M.D., Board Chairman. Minutes were recorded by Katie Fournier, Board Assistant/Board of Directors Office Diane Champion Date approved Board Secretary

49 LEE MEMORIAL HEALTH SYSTEM LEE COUNTY, FLORIDA CONSOLIDATED FINANCIAL STATEMENTS AND STATISTICAL REPORTS July 31, 2015

50 LEE MEMORIAL HEALTH SYSTEM CONSOLIDATED FINANCIAL STATEMENTS & STATISTICAL REPORTS TABLE OF CONTENTS SECTION A CONSOLIDATED SCHEDULES HIGHLIGHTS EXECUTIVE SUMMARY CONSOLIDATED STATISTICAL REPORT CONSOLIDATED INCOME STATEMENT SOURCES & APPLICATIONS OF FUNDS CONSOLIDATED BALANCE SHEET CONSOLIDATED FINANCIAL RATIOS CONSOLIDATED PAYOR MIX PAGE A.1 A.2 A.3 A.4 A.6 A.7 A.8 A.10

51 Lee Memorial Health System Operating Highlights For the month ended July 31, 2015 Adjusted admits for the month ended July 31, 2015 are 11,028 which is 11.8% greater than budget. Actual inpatient admits for the month are 6,250 or 10.0% greater than budget and actual patient days are 31,728 or 7.2% greater than budget which resulted in a 5.08 day length of stay. Emergency room visits are 4.3% greater than budget at 19,973 and outpatient surgeries of 1,897 are above budget by 16.8%. Net patient revenue for July reflects a $13.6 million or 13.0% favorable variance to budget. This favorable variance in net patient revenue is the result of the 11.8% increase in adjusted admits and a positive variance of 1.2% in reimbursement. Net Patient Revenue per CMI adjusted admit for the month ended July 31, 2015 is $7,219 vs. budget of $7,255. Total operating expenses before depreciation and interest expense are 10.2% greater than budget. Salaries & Wages are 5.8% higher than budget, which continues to be the result of increased volumes and the need for additional staffing. Salaries, Wages & Benefits as a percent of Net Operating Revenue are 52.6% for July 2015 versus a budget of 56.2%. The actual hourly pay rate is $31.42 which is $.05 lower than budget. Supply Expense is higher than budget by 16.8%; on a case mix adjusted admission basis the variance is also unfavorable at $1,434 actual vs. $1,395 budget. The majority of the supply expense variance is in drug expense due to increased pricing. Total operating costs per case mix adjusted admit are below budget at $6,607 actual vs. $6,808, a 3.0% favorable variance. Productivity as measured by FTEs/AOB improved by 2.8% (5.44 actual vs budget) during July Productive FTE s per adjusted daily admission were 6.0% better than budget at vs. a budget of For July 2015, the gain from operations is $4.6 million or 3.8% versus a budgeted gain of $1.2 million or 1.1%. Excess revenue over expenses is $13.9 million versus a budget of $6.1 million. Other Non-Operating Revenue was budgeted at $4.9 million gain while the actual was $9.3 million, the majority of which was due to fund raising dollars received through the Foundation for the month of July. For the month, Cash & Investments decreased by $2.7 million to $952.8 million. Cash flow from Operations and working capital increased cash by $20.3 million and reduced cash by $23.1 million, respectively. Cash was reduced by $7.9 million for routine equipment replacement and $0.7 million for principal payments on the debt. Days in Accounts Receivable decreased from 42.1 days in June 42.0 days in July which resulted in a $7.0 million increase in cash. Total Notes & Bonds payable on July 31, 2015 is $657.1 million resulting in the Cash to Debt ratio of 145.0%. Page A.1

52 LEE MEMORIAL HEALTH SYSTEM CONSOLIDATED EXECUTIVE SUMMARY Current Month Year-to-Date For the Period Ending July 31, 2015 % Variance % Variance Budget Actual Prior Year Budget Actual Prior Year Act to Bud Act to PY Act to Bud Act to PY Inpatient Volumes: Admits - Adults & Peds 5,681 6,250 6, % 0.7% 64,670 70,118 65, % 7.4% Patient Days - Adults & Peds 29,592 31,728 30, % 2.4% 324, , , % 10.1% Length of Stay % -1.7% % -2.4% Inpatient Surgeries 1,691 1,746 1, % 6.4% 17,751 17,871 17, % 3.2% Outpatient Volumes: Emergency Room Visits 15,183 15,727 15, % 4.5% 162, , , % 4.7% Outpatient Surgeries 1,625 1,897 1, % 9.4% 18,135 18,712 17, % 4.9% Hospital Based Physician Visits 18,181 21,732 17, % 26.3% 194, , , % 20.6% Physician Visits 57,773 56,667 53, % 6.4% 570, , , % 7.3% Home Health Visits 4,958 5,835 4, % 28.0% 48,620 55,743 48, % 15.6% Adjusted Admits 9,861 11,028 10, % 4.3% 110, , , % 6.8% (overall in/outpat volume indicator) Total Case Mix Index % 3.1% % -0.6% Operating Ratios: Net Revenue/Adj Adm CMI 7,482 7,406 7, % -0.2% 7,074 7,281 6, % 4.1% Operating Exp/Adj Adm CMI 6,808 6,606 6, % -3.7% 6,290 6,242 6, % -2.9% Supply Exp/Adj Adm CMI 1,395 1,434 1, % -3.8% 1,336 1,381 1, % -7.2% Wages/Ben - % of Net Oper Rev 56.2% 52.6% 51.4% 6.4% -2.4% 54.4% 51.3% 51.7% 5.7% 0.8% Supplies as a % of Net Oper Rev 18.6% 19.4% 18.6% -3.9% -4.0% 18.9% 19.0% 18.4% -0.5% -3.0% Charity/Bad Debt - % of Gross Rev 6.7% 6.3% 5.9% 6.8% -5.8% 6.7% 6.2% 6.6% 7.7% 5.7% FTEs/AOB % -2.5% % 1.9% Productive Hours/Adjusted Admit % -4.7% % -0.7% Average Hourly Rate % -0.9% % -2.5% Financial Ratios: Operating Margin (%) 1.1% 3.8% 6.3% 257.9% -39.5% 3.9% 7.6% 5.9% 93.1% 28.4% Excess Margin (%) 5.4% 10.7% 1.5% 96.3% 625.2% 7.6% 10.8% 10.5% 43.0% 3.1% Liquidity Ratios: Days Cash on Hand (net of VRDB) Cash to Debt (%) 112.1% 145.0% 116.8% Days in Acct Receivable Income Statement Summary (in Thousands) Total Net Operating Revenue 107, , , % 7.4% 1,144,217 1,245,436 1,127, % 10.5% Total Operating Expenses 106, , , % -10.2% 1,099,160 1,150,714 1,060, % -8.5% Consolidated Gain(Loss) from Oper 1,145 4,609 7, % -35.1% 45,057 94,722 66, % 41.9% Investment Earnings/Non Op Income 4,974 9,295 (5,521) 86.9% % 44,708 44,544 57, % -22.3% Consolidated Excess Rev over Exp 6,119 13,904 1, % 781.8% 89, , , % 12.3% Balance Sheet Highlights (In Thousands): Cash & Investments 847, , ,164 Bonds & Notes Payable 755, , ,706 VRDB = variable rate demand bonds CMI = Case Mix Index Page A.2

53 LEE MEMORIAL HEALTH SYSTEM CONSOLIDATED STATISTICAL SUMMARY For the Period Ending July 31, 2015 Current Month Budget Actual Prior Year Year-to-Date % Variance % Variance Budget Actual Prior Year Act to Bud Act to PY Act to Bud Act to PY Admissions ADULTS 5,135 5,697 5, % -0.1% 58,734 63,819 59, % 7.3% PEDIATRICS % 5.5% 3,720 3,716 3, % 3.0% NICU % 51.2% % 15.4% POST ACUTE % 5.3% 1,622 1,895 1, % 19.6% Total Adult & Peds 5,681 6,250 6, % 0.7% 64,670 70,118 65, % 7.4% NEWBORNS % 13.8% 4,688 5,149 4, % 7.5% Total Admissions 6,137 6,795 6, % 1.6% 69,358 75,267 70, % 7.4% Patient Days ADULTS 22,566 24,999 24, % 2.1% 254, , , % 11.5% PEDIATRICS 1,089 1, % 10.0% 11,483 11,540 11, % 4.0% NICU 1,319 1,143 1, % -8.7% 13,092 13,356 13, % 2.1% POST ACUTE 4,618 4,572 4, % 5.5% 45,282 46,095 43, % 5.5% Total Adult & Peds 29,592 31,728 30, % 2.4% 324, , , % 10.1% NEWBORNS 1,031 1,127 1, % 2.4% 10,817 11,799 11, % 7.2% Total Patient Days 30,623 32,855 32, % 2.4% 335, , , % 10.0% Average Length of Stay ADULTS % -2.2% % -3.9% PEDIATRICS % -4.3% % -1.0% NICU % 39.6% % 11.5% POST ACUTE % -0.2% % 11.8% Total Adult & Peds % -1.7% % -2.4% NEWBORNS % 10.0% % 0.3% Total Length of Stay % -0.8% % -2.4% OP Registrations EMERGENCY ROOM 15,183 15,727 15, % 4.5% 162, , , % 4.7% OP SURGERY CASES 1,625 1,897 1, % 9.4% 18,135 18,712 17, % 4.9% SUBTOTAL 16,808 17,624 16, % 5.0% 180, , , % 4.7% Visits HOME HEALTH VISITS 4,958 5,835 4, % 28.0% 48,620 55,743 48, % 15.6% HOSP BASED PHY VISITS 18,181 21,732 17, % 26.3% 194, , , % 20.6% PHYSICIAN VISITS 57,773 56,667 53, % 6.4% 570, , , % 7.3% TRAUMA SERVICES DISTRICT % -2.7% 10,769 10,107 9, % 2.0% SUBTOTAL 81,667 85,152 75, % 12.1% 824, , , % 10.7% TOTAL OP 98, ,776 92, % 10.8% 1,004,836 1,076, , % 9.6% Page A.3

54 LEE MEMORIAL HEALTH SYSTEM CONSOLIDATED STATEMENT OF OPERATIONS For the Period Ending July 31, 2015 (in thousands) Current Month Budget Actual Prior Year Year-to-Date % Variance % Variance Budget Actual Prior Year Act to Bud Act to PY Act to Bud Act to PY INPATIENT REVENUE 261, , , % 7.4% 2,861,522 3,104,618 2,715, % 14.3% OUTPATIENT REVENUE 192, , , % 16.7% 2,036,248 2,137,399 1,898, % 12.6% TOTAL PATIENT REVENUE 453, , , % 11.3% 4,897,770 5,242,017 4,613, % 13.6% DED FROM REV-MEDICARE 177, , , % -8.4% 1,922,780 2,091,823 1,794, % -16.5% DED FROM REV-MEDICAID 52,988 57,561 49, % -15.5% 566, , , % -15.0% DED FROM REV-CHARITY 16,253 16,367 15, % -3.6% 176, , , % -0.4% DED FROM REV-HMO/PPO 41,538 49,836 44, % -12.8% 444, , , % -12.3% DED FROM REV-OTHER 47,476 54,246 45, % -19.6% 522, , , % -15.4% DED FROM REV-BAD DEBT 14,189 14,330 10, % -39.7% 152, , , % -15.0% TOTAL DED FROM REV 349, , , % -12.3% 3,784,045 4,046,673 3,523, % -14.8% NET PATIENT REVENUE 104, , , % 8.1% 1,113,725 1,195,344 1,090, % 9.7% OTHER OPER REV 3,268 3,060 3, % -14.7% 30,492 50,091 37, % 33.8% TOTAL OPERATING REV 107, , , % 7.4% 1,144,217 1,245,436 1,127, % 10.5% OPERATING EXPENSES PROD SALARIES 45,501 47,163 42, % -11.7% 467, , , % -9.3% PROD OVERTIME 1,251 1,734 1, % -33.6% 13,440 18,309 13, % -32.7% CONTRACT LABOR % % 2,694 2, % % NON-PROD SALARIES 4,878 5,685 6, % 9.4% 49,396 56,667 53, % -6.7% TOTAL SALARIES & WAGES 51,643 54,647 49, % -9.7% 532, , , % -9.9% FRINGE BENEFITS 8,725 8,905 8, % -11.1% 89,026 91,629 85, % -7.6% HEALTH CARE ACCESS 1,232 1,376 1, % -9.6% 13,781 14,383 13, % -3.6% SUPPLIES 20,025 23,393 20, % -11.6% 216, , , % -13.8% OTHER SERVICES 6,046 7,237 6, % -7.7% 62,384 67,428 61, % -8.8% PURCHASED SERVICES 10,064 12,175 9, % -23.9% 103, , , % 0.3% TOTAL OPER EXPENSES 97, ,733 96, % -11.5% 1,017,365 1,067, , % -9.2% EBITDA 9,675 13,057 15, % -18.0% 126, , , % 18.6% DEPRECIATION/AMORT 6,400 6,403 6, % 4.0% 61,548 62,730 60, % -3.5% INTEREST EXPENSE 2,129 2,044 2, % 5.1% 20,247 20,190 22, % 10.1% GAIN(LOSS) FROM OPER 1,146 4,610 7, % -35.1% 45,058 94,722 66, % 41.9% Page A.4

55 LEE MEMORIAL HEALTH SYSTEM CONSOLIDATED INCOME STATEMENT BY ENTITY For the Year-to-Date Period Ending July 31, 2015 (in thousands) CURRENT MONTH YEAR TO DATE ENTITY BUDGET ACTUAL PRIOR YR VARIANCE BUDGET ACTUAL PRIOR YR VARIANCE LEE MEMORIAL HOSPITAL 5,132 6,290 4,298 1,158 63,505 69,959 54,680 6,454 HEALTHPARK MEDICAL CTR 7,430 10,892 9,582 3,463 84, ,218 85,618 22,458 CAPE CORAL HOSPITAL 4,427 3,786 4,769 (641) 42,608 49,402 47,231 6,795 GULF COAST MEDICAL CENTER 4,197 4,538 6, ,057 61,280 55,173 10,223 TRAUMA SERVICES DIST (414) (380) (211) 34 (3,417) (3,602) (2,494) (184) OUTPATIENT CENTERS 1,202 4,201 1,914 3,000 16,155 23,453 17,859 7,299 HEALTHPARK CARE CTR (196) (11) HOME HEALTH AGENCIES (398) (380) (207) 18 (3,945) (2,029) (2,488) 1,916 FOUNDATION (4) (32) REHAB HOSPITAL ,196 4,612 3,271 1,416 ALL PHYSICIANS (5,683) (7,374) (6,111) (1,691) (55,501) (50,088) (44,991) 5,413 CORPORATE SERVICES (15,074) (16,899) (13,320) (1,826) (153,171) (165,278) (147,266) (12,107) ALL OTHERS (58) (464) (17) (407) (607) (751) (347) (145) TOTAL GAIN FROM OPS 1,146 4,610 7,098 3,464 45,058 94,722 66,770 49,665 INT EARN & REALIZED GAIN 1,089 1,626 1, ,261 21,720 8,063 12,459 UNREALIZED GAIN (LOSS) 2,581 1,415 (8,201) (1,167) 22,409 4,010 37,898 (18,399) UNREALIZED GAIN (LOSS) ON SWAP OTHER NON OPERATING 3, (2,577) 31,539 19,900 1,001 (11,638) RESTRICTED GIFTS (1,850) 5, ,527 (18,500) (1,086) 9,413 17,414 TOTAL NON OPERATING 4,974 9,295 (5,521) 4,321 44,708 44,544 57,295 (164) EXCESS OF REV/EXPS 6,120 13,905 1,577 7,785 89, , ,065 49,501 Page A.5

56 LEE MEMORIAL HEALTH SYSTEM SOURCES & APPLICATIONS OF FUNDS For the Year-to-Date Period Ending: July 31, 2015 (In thousands) Sources of Funds: MONTH YTD Excess Revenue Over Expenses 13, ,266 Depreciation/Amortization Expense 6,403 62,730 (Gain)/Loss on Sale of Assets Total Sources 20, ,586 Sources/(Uses) of Funds: Dec(Inc) in Accts Receivable 7,041 1,668 Net borrowings (746) (26,871) Dec(Inc) in Other Assets (6,527) 10,332 Inc(Dec) in Liabilities (14,911) 31,712 Capital Expenditures, net (7,943) (90,869) Total Sources/(Uses) (23,086) (74,027) Net Increase(Decrease) In Funds (2,743) 128,559 Cash & Investments at beginning of period 955, ,217 Cash & Investments at end of period 952, ,776 Total Bonds & Notes Payable-end of period 657,102 Cash to Debt Ratio 145.0% Page A.6

57 LEE MEMORIAL HEALTH SYSTEM CONSOLIDATED BALANCE SHEET For the Year-to-Date Period Ending July 31, 2015 (in thousands) ASSETS: Current Prior Month Prior Year LIABILITIES: Current Prior Month Prior Year Current Assets: Current Liabilities: Cash And Cash Equivalents * 71,635 77,677 55,895 Accounts Payable 41,053 41,204 56,002 Operating Fund Investments * 850, , ,815 Wages and Benefits Payable 20,925 39,552 23,506 Accrued Interest Receivable Notes Payable - Short Term 20,661 20,893 25,835 Accounts Receivable (net) 150, , ,004 Current Portion Bonds Payable 1,100 1,565 2,615 Accounts Receivable - Phys (Net) 7,926 8,174 9,431 Due to State of Florida 8,230 7,891 15,711 Inventories 32,055 32,033 31,902 Malpractice Liability - Short Term 3,378 3,378 3,378 Limited or Restricted Use Assets ,351 Accrued Bond Costs 5,557 4,970 9,751 Other Current Assets 17,160 16,041 30,294 Other Current Liabilities 76,966 75,821 31,291 Total Current Assets: 1,131,223 1,139,869 1,015,041 Total Current Liabilities 177, , ,090 Other Assets Other Liabilities and Fund Balance Limited or Restricted Use Assets * 30,319 30,284 41,507 Benefits Payable - Long Term Bond Issuance Costs Notes Payable - Long Term 327, , ,256 Trustee Held Funds * Due to State of Florida - Long Term 14,571 13,571 3,973 Directors/Officers Indemnity Fund * Malpractice Liability - Long Term 12,276 12,020 10,076 Long Term Operating Fund Investments * Bonds Payable 308, , ,266 Other Assets 113, , ,236 Other Long Term Liabilities 66,182 65,599 62,991 Unrestricted Fund Balance 1,047,494 1,039, ,142 Restricted Fund Balance 78,719 73,043 79,805 Total Other Assets 144, , ,379 Total Other Liabilities & Fund Balance 1,854,583 1,838,888 1,719,510 Property and Equipment: Plant In Use 1,473,289 1,472,291 1,461,420 Construction in Process 121, ,577 54,080 Accumulated Depreciation (852,082) (845,826) (801,221) Total Property & Equipment (Net) 742, , ,279 Restricted Assets 14,248 9,364 4,901 TOTAL ASSETS 2,032,453 2,034,162 1,887,600 TOTAL LIABILITIES AND EQUITY 2,032,453 2,034,162 1,887,600 * Cash and Investments Above Balance Sheet has been adjusted to eliminate intercompany receivables, payables and investments in subsidiaries Page A.7

58 FINANCIAL RATIOS For the Year-to-Date Period Ending July 31, Moody's Financial FYE YTD Median Goals /31/2015 PROFITABILITY RATIOS: Operating Margin (%) - Total 2.5% 3.2% 7.4% 7.6% + Excess Margin (%) 5.7% 6.5% 11.1% 10.8% + Operating CashFlow Margin (%) 9.9% 10.2% 14.7% 14.3% + LIQUIDITY RATIOS: Days Cash on Hand (net of Callable Debt) Cushion Ratio (x) Cash-to-Debt (%) 142.4% 101.6% 120.5% 145.0% + CAPITALIZATION RATIOS: Debt to Capitalization(%) - (net of Callable Debt) 34.0% 42.9% 42.3% 38.6% (-) Annual Debt Service Coverage (x) Debt to Cashflow (net of Callable Debt) (-) NOTE: + = Ratios that should be above the Moody's median (-) = Ratios that should be lower than the Moody's median Page A.8

59 LEE MEMORIAL HEALTH SYSTEM CONSOLIDATED OPERATING RATIOS For the Period Ending: July 31, 2015 (in thousands) Current Month Budget Actual Prior Year Year-to-Date % Variance % Variance Budget Actual Prior Year Act to Bud Act to PY Act to Bud Act to PY AS % NET OPERATING REVENUE Wages and Benefits 56.2% 52.6% 51.4% 6.4% -2.4% 54.4% 51.3% 51.7% 5.7% 0.8% Supplies 18.6% 19.4% 18.6% -3.9% -4.0% 18.9% 19.0% 18.4% -0.5% -3.0% All Other Operating Expenses 16.1% 17.2% 15.9% -6.6% -8.1% 15.7% 15.5% 16.6% 1.1% 6.7% Capital Costs 7.9% 7.0% 7.8% 11.9% 10.8% 7.1% 6.7% 7.4% 6.9% 9.6% EBDITA Margin 9.0% 10.8% 14.2% 20.0% -23.6% 11.1% 14.3% 13.3% 28.7% 7.3% Operating Margin 1.1% 3.8% 6.3% 257.7% -39.5% 3.9% 7.6% 5.9% 93.1% 28.4% Excess Margin 5.4% 10.7% 1.5% 96.3% 624.9% 7.6% 10.8% 10.5% 43.0% 3.1% Per CMI ADJ ADMIT / VISIT Net Operating Revenue 7,482 7,407 7, % -0.2% 7,074 7,281 6, % 4.1% Total Operating Expenses 6,808 6,607 6, % -3.7% 6,290 6,242 6, % -2.9% Wages and Benefits 4,205 3,897 3, % -2.2% 3,845 3,733 3, % -3.3% Supplies 1,395 1,435 1, % -3.8% 1,336 1,381 1, % -7.2% All Other Operating Expenses 1,208 1,275 1, % -8.6% 1,109 1,128 1, % 2.9% Capital Costs % 11.0% % 5.9% Operating Margin % -39.6% % 33.7% Excess Margin % 719.6% % 5.8% LABOR Productive FTEs/Adj Daily Admit % -4.7% % -0.7% Average Hourly Rate % -0.9% % -2.5% OP REV % of Total Revenue 42.4% 43.3% 41.3% 2.2% 4.9% 41.6% 40.8% 41.1% -1.9% -0.9% Page A.9

60 LEE MEMORIAL HEALTH SYSTEM CONSOLIDATED - PAYOR MIX For the Period Ending July 31, 2015 CURRENT MONTH YEAR-TO-DATE Budget Actual Prior Year Budget Actual Prior Year MEDICARE 37.5% 34.4% 35.2% 37.9% 37.5% 37.7% MEDICARE HMO 13.9% 14.3% 14.9% 14.0% 15.1% 14.1% MEDICAID 10.9% 4.2% 6.1% 11.1% 4.8% 10.7% MEDICAID HMO 4.7% 11.2% 9.4% 4.3% 10.4% 4.8% HMO/PPO 19.4% 21.2% 21.3% 19.0% 19.1% 19.1% COMMERCIAL 3.5% 4.6% 3.1% 3.6% 3.7% 3.5% OTHER 10.1% 10.1% 10.0% 10.1% 9.4% 10.1% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% Budget Actual % Variance Budget Actual % Variance MEDICARE CASE MIX INDEX % % SYSTEM CASE MIX INDEX % % 09/30/14 07/31/15 Variance Gross Accounts Receivable 367, ,109 8,295 Net Accounts Receivable 160, ,768 (1,668) Net Days in Accounts Receivable (1.8) Page A.10

61 Lee Memorial Health System Board of Directors Financial Update For Month Ending 7/31/15 Presented 8/27/15

62 System Adjusted Admits

63 Percent of Total Operating Revenue for month ending 07/31/15

64 Percent of Total Operating Revenue for 10 months ended 07/31/15

65 Net Revenue per CMAA for the month ending 07/31/15 FY 2015

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

67 Financial Statements for the month ending 07/31/15 July 2015 Current Month Budget Actual Prior Year % Variance Act to Bud Act to PY VOLUME: Admissions 5,681 6,250 6, % 0.7% Adjusted Admissiions 9,861 11,028 10, % 4.3% Patient Days 29,592 31,728 30, % 2.4% Average Length of Stay % -1.7% Case Mix Index % 3.1% Inpatient Surgery Cases 1,691 1,746 1, % 6.4% Outpatient Surgery Cases 1,625 1,897 1, % 9.4% ER Visits 15,183 15,727 15, % 4.5% Hospital Based Physician Visits 18,181 21,732 17, % 26.3% Physician Visits 57,773 56,667 53, % 6.4% Home Health Visits 4,958 5,835 4, % 28.0% Current Month % Variance Budget Actual Prior Year STATEMENT OF OPERATIONS: Act to Bud Act to PY Revenues: Net Patient Revenue 104, , , % 8.1% Other Operating Revenue 3,268 3,060 3, % -14.7% Total Net Operating Revenue 107, , , % 7.4% Expenses: Operating Expenses 97, ,733 96, % -11.5% Capital Expenses 8,529 8,447 8, % 4.3% Total Expenses 106, , , % -10.2% Operating Gain 1,146 4,610 7, % -35.1% Operating Margin % 1.1% 3.8% 6.3% 257.8% -39.5% Non Operating Revenue 4,974 9,295 (5,521) 86.9% % Excess Revenues Over Expenses 6,120 13,905 1, % 781.5%

68 Variance Analysis for the month ending 07/31/15 Net Patient Revenue SUMMARY OF VARIANCE: EXPLANATION: (In Thousands) VOLUME VARIANCE RATE VARIANCE ACTUAL 117,730 Actual Adj Admits-System 11,028 Actual Net Rev/Adj Admit 10,676 Budget Adj Adm-System 9,861 Budget Net Rev/Adj Admit 10,561 BUDGET 104,143 Variance 1,167 Variance 115 Variance % 11.8% Variance % 1.1% VARIANCE 13,587 VARIANCE % 13.0% Budget Net Rev/Adj Admit 10,561 Actual Adj Admits 11,028 Total Volume Variance 12,319,565 Total Rate Variance 1,267,728 Net Revenue - Rate & Volume Variance 13,587,293 Net Patient Revenue - Rate & Volume Variance Budget Actual Variance Variance % Net Patient Revenue/Adj Admit 10,561 $ 10, % Case Mix Index % Net Patient Revenue/CMI Adj Admit 7,255 7,219 (36) -0.5% Payer Mix Analysis Medicare Medicaid All Other Total Budgeted Payer Mix 47.7% 14.4% 38.0% 100.0% Actual Payer Mix 45.4% 14.2% 40.4% 100.0% Budgeted Reimbursement % 18.1% 18.7% 30.7% 23.0% Actual Reimbursement % 18.9% 17.5% 32.0% 24.0%

69 Variance Analysis for the month ending 07/31/15 Payor Mix CURRENT MONTH YEAR-TO-DATE Budget Actual Prior Year Budget Actual Prior Year MEDICARE 37.5% 34.4% 35.2% 37.9% 37.5% 37.7% MEDICARE HMO 13.9% 14.3% 14.9% 14.0% 15.1% 14.1% MEDICAID 10.9% 4.2% 6.1% 11.1% 4.8% 10.7% MEDICAID HMO 4.7% 11.2% 9.4% 4.3% 10.4% 4.8% HMO/PPO 19.4% 21.2% 21.3% 19.0% 19.1% 19.1% COMMERCIAL 3.5% 4.6% 3.1% 3.6% 3.7% 3.5% OTHER 10.1% 10.1% 10.0% 10.1% 9.4% 10.1% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% Budget Actual % Variance Budget Actual % Variance MEDICARE CASE MIX INDEX % % SYSTEM CASE MIX INDEX % % 09/30/14 07/31/15 Variance Gross Accounts Receivable 367, ,109 8,295 Net Accounts Receivable 160, ,768 (1,668) Net Days in Accounts Receivable (1.8)

70 Variance Analysis for the month ending 07/31/15 Total Salaries & Wages SUMMARY OF VARIANCE: EXPLANATION: (In Thousands) VOLUME VARIANCE RATE VARIANCE ACTUAL 54,647 Actual Total FTEs 9,820 Actual Rate/FTE $ Budget Total FTEs 9,266 Budget Rate/FTE $ BUDGET 51,643 FTE Variance (554) Rate Variance $ 0.05 Variance % -6.0% Variance % 0.2% VARIANCE (3,004) VARIANCE % -5.8% Budget Rate/FTE 31 Actual Total FTEs 9,820 Hours/FTE 177 Hours/FTE 177 Total Volume Variance (3,087,861) Total Rate Variance 84,121 Rate & Volume Var (3,003,740) Total FTE Volume Variance: Productivity Ratios FTEs Amount $ FTE's per AOB - Actual 5.44 FTE's Earned Budget 10,097 FTE's per AOB - Budget 5.59 Budget FTEs 9,266 Variance % 2.8% Variance due to Volume (832) (4,635,787) Salaries as % NOR - Actual 45.2% Actual FTEs 9,820 Salaries as % NOR - Budget 48.1% FTE's Earned Budget 10,097 Variance % 5.9% Productivity Inc(Dec) 278 1,547,925 Total FTE Variance (554) (3,087,861) Productive Hours per Adj Admit - Actual Productive Hours per Adj Admit - Budget Variance % 6.0%

71 Variance Analysis for the month ending 07/31/15 Premium Labor (OT & Contract Labor) SUMMARY OF VARIANCE: EXPLANATION: (In Thousands) VOLUME VARIANCE RATE VARIANCE ACTUAL 1,799 Actual Premium FTEs 274 Actual Rate/FTE $ Budget Premium FTEs 193 Budget Rate/FTE $ BUDGET 1,264 Premium FTE Var (81) Rate Variance $ (0.06) Variance % -42.1% Variance % -0.2% VARIANCE (535) VARIANCE % -42.3% Budget Rate/FTE Actual Premium FTEs 274 Hours/FTE 177 Hours/FTE 177 Total Volume Variance (532,038) Total Rate Variance (2,877) Rate & Volume Var (534,914) Premium Labor Variance Overtime Budget 1,250,515 Actual 1,734,491 Overtime Variance (483,975) Contract Labor Budget 13,123 Actual 64,062 Contract Labor Variance (50,939) Total Labor Rate & Volume Var (534,914)

72 Variance Analysis for the month ending 07/31/15 Other Supplies SUMMARY OF VARIANCE: EXPLANATION: (In Thousands) VOLUME VARIANCE RATE VARIANCE ACTUAL 23,393 Actual Adj Admissions 11,028 Actual Supplies/Adj Adm 2,121 Budget Adj Admissions 9,861 Budget Supplies/Adj Adm 2,031 BUDGET 20,025 Variance (1,167) Rate Variance (91) Variance % -11.8% Variance % -4.5% VARIANCE (3,368) VARIANCE % -16.8% Budget Supplies/Adj Adm 2,031 Actual Adj Admissions 11,028 Total Volume Variance (2,368,884) Total Rate Variance (999,276) Rate & Volume Var (3,368,161) Rate Variance Budget/AA Actual/AA Variance (Inc) Dec in Drug Expense (1,174,685) (Inc) Dec in Implant Costs ,465 (Inc) Dec in Med/Surg Supplies (404,529) (Inc) Dec in Other Supplies ,474 Total Rate Variance 2,031 2,121 (999,276)

73 Variance Analysis for the month ending 07/31/15 Other Services SUMMARY OF VARIANCE: (In Thousands) EXPLANATION: ACTUAL 7,237 Contract Labor Expense (397,000) Other Actuarial Accruals (300,000) BUDGET 6,046 Legal Fees (198,000) Recruiting (197,000) VARIANCE (1,191) VARIANCE % -19.7% Total (1,092,000)

74 Variance Analysis for the month ending 07/31/15 Purchased Services SUMMARY OF VARIANCE: EXPLANATION: (In Thousands) Consulting Contracts (1,000,000) ACTUAL 12,175 Medical (731,000) Culinary Solutions (275,000) BUDGET 10,064 Maintenance Contract (72,000) VARIANCE (2,111) Total (2,078,000) VARIANCE % -21.0%

75 Variance Analysis for the month ending 07/31/15 Bad Debt Expense SUMMARY OF VARIANCE: EXPLANATION: (In Thousands) VOLUME VARIANCE RATE VARIANCE ACTUAL 14,330 Actual Adj Admits-System 11,028 Actual Bad Debt Exp/Adj Admit 1,300 Budget Adj Adm-System 9,861 Budget Bad Debt Exp/Adj Admit 1,439 BUDGET 14,189 Variance (1,167) Variance 139 Variance % -11.8% Variance % 9.7% VARIANCE (141) VARIANCE % -1.0% Budget Bad Debt Exp/Adj Admit 1,439 Actual Adj Admits 11,028 Total Volume Variance (1,678,512) Total Rate Variance 1,537,349 Net Revenue - Rate & Volume Variance (141,163)

76 Lee Memorial Health System Board of Directors Meeting September 24, 2015 Footer 2015 SEI 1

77 Agenda FOR INSTITUTIONAL INVESTOR USE ONLY. NOT FOR PUBLIC DISTRIBUTION. 2

78 Agenda Portfolio and Economic Update 2015 Asset Allocation Survey Results Advisory Services Strategic Allocation Recommendation SEI Participants Peter Glennon, Senior Client Portfolio Manager Brian Bono, Client Investment Strategist, Advisory Team Al Pierce, Vice President and Managing Director, Advisory Team Dale K. Campbell, Client Service Director Footer 3

79 LMHS Client Experience and Economic Outlook Footer 4

80 Performance review as of August 31, 2015 (Fiscal Year to Date) Inception date: 9/30/07. Alternative Asset performance and valuations may be reported on a monthly or quarterly lag. The Portfolio Return numbers are calculated using Gross Fund Performance, using the Modified Dietz method of calculation, which considers the timing of cash flows during the periods. Gross Fund Performance reflects the effective performance of the underlying mutual funds that are selected or recommended by SIMC to implement an institutional client s investment strategy. Gross Fund Performance does not reflect the impact of fund level management fees, fund administration or shareholder servicing fees, all of which, if applicable are used to offset the account level investment management fees the client pays to SIMC. Gross Fund Performance does reflect certain operational expenses charged by the funds and the reinvestment of dividends and other earnings. The inclusion of the fund level expenses that the client incurs but that are offset against the client s account level investment management fees would reduce the Gross Fund Performance of the mutual funds. If applicable, Alternative, Property and Private Assets performance is calculated gross of investment management fees and net of administrative expenses and underlying fund/product expenses. FOR INSTITUTIONAL INVESTOR Footer USE ONLY. NOT FOR PUBLIC DISTRIBUTION. 5

81 Percent (%) Percent (%) SEI forward view and positioning: Equities as of August 31, 2015 Monthly Commentary Global equity markets performed poorly in August as concerns spread about the broad impact of China s selloff. All primary equity markets were strongly negative with emerging markets leading the charge lower. Within the U.S., defensive sectors such as Telecom and Utilities outperformed but were still unable to post positive returns. Losses were largest in sectors such as Financials and Health Care during the period. Forward View We expect continued financial-market volatility as global events, particularly in China, drive headline risk in the near-term. As we get closer to the start of a rising interest rate cycle driven by the Federal Reserve, the views of market participants can be expected to shift with changing economic conditions. We believe that the Fed will continue to remain more dovish than hawkish in this volatile environment. Despite this volatility, it is still our expectation the U.S. bull market will remain intact and any correction will be limited. Positioning Within SEI large cap mandates, general positioning will be to favor growth over value, with a modestly pro-cyclical stance (technology and consumer discretionary), but shying away from deeper cyclical names such as energy and industrials. Within SEI international mandates, general positioning favors growth over value, small caps over mega caps, and less levered (higher quality) over more levered businesses. Source: SEI, FactSet (5) (10) (15) (5) (10) (15) (20) Equity Markets Month YTD Japan U.S. Large Cap U.S. Small Cap Europe ex UK Developed Intl ACWI ex USA Emerging Markets MSCI BRIC S&P 500 Sectors Month YTD Telecom Utilities Energy Industrials Materials IT Cons. Stap. Cons. Disc. Financials Health Care FOR INSTITUTIONAL INVESTOR USE ONLY. NOT FOR PUBLIC DISTRIBUTION.

82 Yield (%) Percent (%) SEI forward view and positioning: Fixed Income as of August 31, 2015 Monthly Commentary Fixed-income markets were primarily negative during the month of August, with emerging-market and high-yield debt serving as notable underperformers. Though equity markets sold off strongly and investors saw a broad flight to higher-quality assets, U.S. Treasurys remained relatively flat during the period. Elsewhere, primary spread sectors, higher-yielding credits, and emerging markets saw strong volatility as concerns over China impacted investor behavior across all primary markets. Forward View We believe rate volatility in response to global growth concerns will continue in the short term. The market continues to price for a slower pace of rate hikes than what the Fed (FOMC) has projected. As these views merge, this could be an additional source of volatility. As we continue to see volatility in spreads and rates, security selection through active management is expected to play a larger role in performance. Positioning Within SEI core strategies, non-agency MBS (mortgage backed securities) remains an overweight on strong supply / demand technicals, housing recovery and attractive risk-adjusted yield. Within the corporate sector, SEI managers maintain overweights to financials on regulatory-driven fundamental improvements. Our core strategies maintain a curve-flattening bias in anticipation of shorter-term yields rising faster than longer-term yields. Fixed Income Sectors (0.5) (1.0) (1.5) (2.0) Month YTD U.S. Agg. Govt - Treasury U.S. Aggregate U.S Govt Inflation-Linked (1-5 Y) U.S. Agg. Corp Credit - Inv Grade Emerging Markets Debt U.S. High Yield U.S. Treasury Yield Curve /31/ /31/ M 2Y 3Y 5Y 7Y 10Y 30Y Source: Top Chart: SEI, FactSet Bottom Chart: SEI, Bloomberg FOR INSTITUTIONAL INVESTOR USE ONLY. NOT FOR PUBLIC DISTRIBUTION.

83 2015 Asset Allocation Survey Results Footer 8

84 Survey purpose and format This questionnaire is designed to collect information necessary to determine the desired investment portfolio for LMHS. Important factors such as return, time horizon, liquidity, market volatility and risk tolerance along with LMHS financial goals will have a material impact upon the design of the investment portfolio and the resulting investment return. Investment risk is simply the probability that the actual return on an investment will be different than the expected return. Higher risk investments may have the potential for higher returns, but they also have potential for greater losses, so there is greater volatility. A person s ability to accept the uncertainty associated with volatility and the possibility of incurring large losses is risk tolerance. The objective of this assessment tool is to develop an investment strategy and asset allocation that provides a sufficient return to meet the financial goals of LMHS while meeting the risk tolerances of the LMHS Board of Directors and its leadership. Format Two sections Investment Objectives; questions 1 6 Risk Tolerance; questions 7 12 FOR INSTITUTIONAL INVESTOR USE ONLY. NOT FOR PUBLIC DISTRIBUTION. 9

85 What we heard from LMHS Board of Directors LMHS Risk Tolerance The Board is comfortable with the risk of loss of 10.4% on the current investment portfolio (80% of Board) The Board identifies a risk as not meeting its organizational financial goals, as measured by key financial metrics, multiple times over a 10-year period LMHS Return Expectations Seeking return between 5%-7% (90% of Board) LMHS Portfolio Time Horizon for Evaluating Success The Board stated that a 3-5 year time horizon is appropriate for evaluating investment results versus return budget and recovering from any losses incurred (80% of Board) LMHS Inflation Goals Preserve purchasing power (70% of Board) LMHS Portfolio Allocation Allocation derived from weighted average of responses: 39% equity, 38% fixed income, 12% alternatives, 11% cash (see next slide) The Board is comfortable with 5%-10% in illiquid assets Responses from Community Consultants and Administration were consistent with the themes listed above. Source: 2015 Asset Allocation Survey (June, 2015) FOR INSTITUTIONAL INVESTOR Footer USE ONLY. NOT FOR PUBLIC DISTRIBUTION. 10

86 What we heard from LMHS Board of Directors Asset Class Range (median shown in blue bar, high and low ranges shown in orange) 80% 70% 60% 50% 40% 30% 39% 38% 20% 10% 12% 11% Equity Fixed Income Alternatives Cash Source: 2015 Asset Allocation Survey (June, 2015) FOR INSTITUTIONAL INVESTOR Footer USE ONLY. NOT FOR PUBLIC DISTRIBUTION. 11

87 What we heard from LMHS Board of Directors throughout time Thematic Survey Question Survey Year What would you expect the total return 4%-6% or of the LMHS portfolio to be over the long-term? "Moderate Growth" 6%-10% 5%-7% % of Respondants That Selected This Answer 71% 90% 90% What investment time horizon seems most appropriate when evaluating the overall success of LMHS 3+ Years 3-5 Years 3-5 Years investment portfolio strategy? % of Respondants That Selected This Answer 67% 90% 90% How long should it take to recover any losses in a particular investment? Concerned with shortterm variability within the portfolio; aim to eliminate short-term losses in the portfolio. 3 Years 3-5 Years % of Respondants That Selected This Answer 71% 90% 80% Which event represents the greatest long-term risk to LMHS? Not preserving capital while meeting applicable benchmarks. Possibility of not achieving a target rate of return coupled with portfolio volatility. Not meeting system goals multiple times in a 10 year period or being downgraded by Moody s. % of Respondants That Selected This Answer Comments from Board 50% 100% How much loss in total value can LMHS investment portfolio sustain before the investment becomes uncomfortable, understanding that this loss could lead to changes in operations and the strategic plan of LMHS? Unacceptable to allow the portfolio to fall below $200M. 15% 10.4% % of Respondants That Selected This Answer Comments from Board 60% 80% Portfolio Actions Increased equity allocation by 10%; added Managed Volatility and Multi-Asset Real Return; added Core Property in Increased equity allocation by 10%; added Emerging Markets Equity; reduced portfolio duration. Retain current equity target; add Global Managed Volatility; reduce World Equity Ex-US. Source: 2009 Asset Allocation Survey (April, 2009), 2013 Asset Allocation Survey (April, 2013), 2015 Asset Allocation Survey (June, 2015) FOR INSTITUTIONAL INVESTOR Footer USE ONLY. NOT FOR PUBLIC DISTRIBUTION. 12

88 Advisory Services Strategic Allocation Recommendation Footer 13

89 SEI s advice process promotes the alignment of investment strategy with the financial characteristics of LMHS Unrestricted Cash & Investments Operations & Capital Budgeting Unrestricted Cash & Investments LMHS Operations & Capital Budgeting Affordable Care Act impact on reimbursement model and payer mix; uncertainty of future operating environment Capital expenditure plans Capital Structure Ability to fund strategic initiatives Revenue and expense projections Impact of industry consolidation Ability to quickly adapt portfolio strategy during a changing market environment Cash / liquidity needs Portfolio expected return vs. expense growth and healthcare inflation Desire for capital preservation vs. the need for long-term growth; ability to withstand market volatility Portfolio sensitivity to interest rate movements Draw down / spending expectations Capital Structure Accessibility of capital markets Credit rating and cost of financing Financial ratio management Existing debt policy: fixed/floating/synthetic fixed Puttable debt levels Interest rate sensitivity to floating rate liabilities and swap contracts Restrictive financial debt covenants It is critical to understand how these various components interact and collectively influence the financial profile of LMHS FOR INSTITUTIONAL INVESTOR Footer USE ONLY. NOT FOR PUBLIC DISTRIBUTION. 14

90 LMHS Financial observations Source: Lee Memorial Health System Monthly Financial Information FOR INSTITUTIONAL INVESTOR USE ONLY. NOT FOR PUBLIC DISTRIBUTION. 15

91 LMHS Advisory update The financial profile of the health system is strong and continues to show improvement Year-to-date financial results are at or above the 2015 financial goal for the health system LMHS has attractive financial ratios when compared to similarly rated health systems (Moody s A1 A3) highlighted by good liquidity and strong cash flow Cash to debt and debt-to-capitalization are less attractive than the Moody s medians, however, pressures typically associated with high debt levels are offset by LMHS strong operational cash flows and high liquidity levels The level of market risk present within the Operating portfolio remains appropriate Meeting the future financial goals of the health system will require investment returns in the range of 6.0% - 7.0% The Operating fund as it is currently constructed carries an expected annual return of 6.0% (net) based on SEI s April 2015 capital market assumptions (CMA s) LMHS maintains an above-average ability to take investment risk when considering the organizations financial health and ongoing financial goals FOR INSTITUTIONAL INVESTOR USE ONLY. NOT FOR PUBLIC DISTRIBUTION. 16

92 $ Millions How we create probability distributions and what they mean The probability distribution graphs and tables that follow are meant to provide an overview of the range of possible outcomes for a given variable (e.g., returns, pension contributions, expense) for a given asset allocation. The graphs are generated using SEI s proprietary modeling tool and simulated capital market behavior. Capital market behavior is simulated for 1,000 possible scenarios based on expected performance of each asset class and reflecting current economic conditions. Capital market assumptions such as return, standard deviation and covariances are inputs into this process, combining with model parameters to create market scenarios. We use these 1,000 capital market scenarios to create 1,000 output scenarios for each variable being considered. A 90% confidence interval should be interpreted as 90% of the projected output variables, falling between the 5% and 95% results, based on SEI Capital Market Assumptions. This projection is hypothetical in nature, does not reflect actual investment results and is not a guarantee of future results. 95 th percentile: 95% of outcomes are less than or equal to this value 50 th percentile: 50% of outcomes are greater than this amount, and 50% are less 5 th percentile: 5% of outcomes are less than or equal to this value Distribution of Probable Outcomes 95 th Percentile 75 th Percentile Median (50 th Percentile) 25 th Percentile 5 th Percentile About Capital Market Assumptions SEI Investments Management Corporation develops forward-looking, long-term capital market assumptions for risk, return, and correlations for a variety of global asset classes, currencies, interest rates, and inflation. These assumptions are created using a combination of historical analysis, future market environment expectations and by applying our own judgment. In certain cases, alpha and tracking error estimates for a particular asset class are also factored into the assumptions. We believe this approach is less biased than using pure historical data, which may be affected by unsustainable trends or permanent material shifts in market conditions. FOR INSTITUTIONAL INVESTOR USE ONLY. NOT FOR PUBLIC DISTRIBUTION. 17

93 RETURN (%) LMHS investment portfolio Asset Class Current Target Efficient De-Risk S&P 500 Index % 1-Year Expected Returns Distribution US Small/Mid Cap Equity Index US Managed Volatility Equity % 25.9% 23.7% Global Managed Volatility Equity % World Equity ex-us Emerging Markets Equity % Total Return Enhancement Core Fixed Income % 13.8% 12.9% 14.1% Limited Duration Fixed Income Diversified Short Term Fixed Income Multi-Asset % 6.0% 6.0% 8.1% 4.2% Total Risk Management Moderate Volatility Hedge % -1.2% -0.6% 0.4% Private Real Estate Total Alternatives % -4.9% Expected Return 6.0% 6.0% 4.2% *Standard Deviation 11.2% 10.1% 5.8% -10% -10.7% -9.3% *Risk of Loss (5 th Percentile) -10.7% -9.3% -4.9% *Risk & Return assumptions are based on SEI s April 2015 Capital Market Assumptions -15% Current Efficient De-Risk FOR INSTITUTIONAL INVESTOR USE ONLY. NOT FOR PUBLIC DISTRIBUTION. 18

94 Stress test Long-term reserves Starting market value based on 8/31/15 fund value: $828.9 million ($ millions) $ millions 1% Rise in 10-Yr Treasury -$7.7 (-0.93%) $2.7 (0.33%) $5.8 (0.70%) Fed Taper Talks (2013) -$25.7 (-3.10%) -$40.5 (-4.89%) -$41.1 (-4.96%) Vix spike to 35 -$6.4 (-0.77%) -$17.8 (-2.15%) -$19.6 (-2.36%) 10% Drop S&P 500 -$34.1 (-4.11%) -$37.5 (-4.52%) -$12.2 (-1.47%) 2008 Crisis -$126.2 (-15.22%) -$127.1 (-15.34%) -$80.2 (-9.67%) -$140 -$120 -$100 -$80 -$60 -$40 -$20 $0 $20 De-Risk Efficient Current Source: Blackrock Portfolio Risk Tools; SEI Investment Management Unit FOR INSTITUTIONAL INVESTOR USE ONLY. NOT FOR PUBLIC DISTRIBUTION. 19

95 SEI Capital Market Assumptions - short term - April 2015 Compound Return Risk Arithmetic Return Emerging Markets Equity 8.54% 30.30% 13.13% Inflation: 2.00% World Equity ex-us 8.37% 22.10% 10.81% Core Fixed Income 3.52% 6.60% 3.74% Moderate Volatility Hedge 10.33% 12.50% 11.11% Diversified Short Term Fixed Income 3.48% 5.60% 3.64% US Managed Volatility Equity 7.49% 15.20% 8.65% Global Managed Volatility Equity 7.75% 13.10% 8.61% Russell 1000 Large Cap Index 6.98% 19.00% 8.79% Limited Duration Bonds 3.06% 2.60% 3.09% Multi-Asset 3.48% 8.90% 3.88% Private Real Estate 6.98% 19.30% 8.85% US Small/Mid Cap Equity Index 6.97% 21.90% 9.36% Please see important disclosures at the beginning of this section and at the back of the presentation. FOR INSTITUTIONAL INVESTOR USE ONLY. NOT FOR PUBLIC DISTRIBUTION. 20

96 SEI Capital Market Assumptions - short term - April 2015 Correlations Emerging Markets Equity World Equity ex- US Core Fixed Income Moderate Volatility Hedge Diversified Short Term Fixed Income US Managed Volatility Equity Global Managed Volatility Equity Russell 1000 Large Cap Index Limited Duration Bonds Multi-Asset Private Real Estate Emerging Markets Equity US Small/Mid Cap Equity Index World Equity ex-us Core Fixed Income Moderate Volatility Hedge Diversified Short Term Fixed Income US Managed Volatility Equity Global Managed Volatility Equity Russell 1000 Large Cap Index Limited Duration Bonds Multi-Asset Private Real Estate US Small/Mid Cap Equity Index Please see important disclosures at the beginning of this section and at the back of the presentation. FOR INSTITUTIONAL INVESTOR USE ONLY. NOT FOR PUBLIC DISTRIBUTION. 21

97 Disclosures Footer 22

98 Important information This presentation is provided by SEI Investments Management Corporation (SIMC), a registered investment adviser and wholly owned subsidiary of SEI Investments Company. The material included herein is based on the views of SIMC. Statements that are not factual in nature, including opinions, projections and estimates, assume certain economic conditions and industry developments and constitute only current opinions that are subject to change without notice. Nothing herein is intended to be a forecast of future events, or a guarantee of future results. This presentation should not be relied upon by the reader as research or investment advice (unless SIMC has otherwise separately entered into a written agreement for the provision of investment advice). There are risks involved with investing including loss of principal. There is no assurance that the objectives of any strategy or fund will be achieved or will be successful. No investment strategy, including diversification, can protect against market risk or loss. Current and future portfolio holdings are subject to risk. Past performance does not guarantee future results. For those SEI products which employ a multi-manager structure, SIMC is responsible for overseeing the sub-advisers and recommending their hiring, termination, and replacement. References to specific securities, if any, are provided solely to illustrate SIMC s investment advisory services and do not constitute an offer or recommendation to buy, sell or hold such securities. Certain economic and market information contained herein has been obtained from published sources prepared by other parties, which in certain cases have not been updated through the date hereof. While such sources are believed to be reliable, neither SEI nor its affiliates assumes any responsibility for the accuracy or completeness of such information and such information has not been independently verified by SEI. Index returns are for illustrative purposes only and do not represent actual portfolio performance. Index performance returns do not reflect any management fees, transaction costs, or expenses, which would reduce returns. Indexes are unmanaged and one cannot invest directly in an index. Annual performance is calculated based on monthly return streams, geometrically linked as of the end of the specified month end. Performance results do not reflect the effect of certain account level advisory fees. The inclusion of such fees would reduce account level performance, particularly when compounded over a period of years. The following hypothetical illustration shows the compound effect fees have on investment return: For an account charged 1% with a stated annual return of 10%, the net total return before taxes would be reduced from 10% to 9%. A ten year investment of $100,000 at 10% would grow to $259,374, and at 9%, to $236,736 before taxes. For a complete description of all fees and expenses, please refer to SIMC s Form ADV Part 2A, the investment management agreement between SIMC and each client, and quarterly client invoices. FOR INSTITUTIONAL INVESTOR USE ONLY. NOT FOR PUBLIC DISTRIBUTION. 23

99 Important information SIMC develops forward-looking, long-term capital market assumptions for risk, return, and correlations for a variety of global asset classes, interest rates, and inflation. These assumptions are created using a combination of historical analysis, current market environment assessment and by applying our own judgment. In certain cases, alpha and tracking error estimates for a particular asset class are also factored into the assumptions. We believe this approach is less biased than using pure historical data, which is often biased by a particular time period or event. The asset class assumptions are aggregated into a diversified portfolio, so that each portfolio can then be simulated through time using a montecarlo simulation approach. This approach enables us to develop scenarios across a wide variety of market environments so that we can educate our clients with regard to the potential impact of market variability over time. Ultimately, the value of these assumptions is not in their accuracy as point estimates, but in their ability to capture relevant relationships and changes in those relationships as a function of economic and market influences. The projections or other scenarios in this presentation are purely hypothetical and do not represent all possible outcomes. They do not reflect actual investment results and are not guarantees of future results. All opinions and estimates provided herein, including forecast of returns, reflect our judgment on the date of this report and are subject to change without notice. These opinions and analyses involve a number of assumptions which may not prove valid. The performance numbers are not necessarily indicative of the results you would obtain as a client of SIMC. We believe our approach enables our clients to make more informed decisions related to the selection of their investment strategies. For more information on how SIMC develops capital market assumptions, please refer to the SEI paper entitled Executive Summary: Developing Capital Market Assumptions for Asset Allocation Modeling. If you would like further information on the actual assumptions utilized, you may request them from your SEI representative. FOR INSTITUTIONAL INVESTOR USE ONLY. NOT FOR PUBLIC DISTRIBUTION. 24

100 Important information: definitions Standard Deviation: Statistical measure of historical volatility. A statistical measure of the distance a quantity is likely to lie from its average value. It is applied to the annual rate of return of an investment, to measure the investment's volatility (risk). Standard deviation is synonymous with volatility, in that the greater the standard deviation the more volatile an investment s return will be. A standard deviation of zero would mean an investment has a return rate that never varies. The MSCI Japan Index is designed to measure the performance of the large and mid cap segments of the Japan market. With 314 constituents, the index covers approximately 85% of the free float-adjusted market capitalization in Japan. The MSCI EAFE Index is an unmanaged, market-capitalization-weighted equity index that represents the developed world outside North America. The Russell 1000 Index includes 1000 of the largest U.S. equity securities based on market cap and current index membership; it is used to measure the activity of the U.S. large-cap equity market. The MSCI All Country World Index is a market-capitalization-weighted index composed of over 2,400 companies, and is representative of the market structure of 46 developed and emerging market countries. The index is calculated with net dividends reinvested in U.S. dollars. The Russell 2000 Index includes 2000 small-cap U.S. equity names and is used to measure the activity of the U.S. small-cap equity market. The MSCI Emerging Markets Index is a free float-adjusted market-capitalization-weighted index designed to measure the performance of global emerging market equities. The MSCI Europe ex UK Index captures large and mid cap representation across 14 Developed Markets (DM) countries in Europe*. With 331 constituents, the index covers approximately 85% of the free float-adjusted market capitalization across European Developed Markets excluding the UK. The MSCI BRIC Index is a free float-adjusted market capitalization weighted index that is designed to measure the equity market performance across the following 4 Emerging Markets country indexes: Brazil, Russia, India and China. With 302 constituents, the index covers approximately 85% of the free float-adjusted market capitalization in each country. FOR INSTITUTIONAL INVESTOR USE ONLY. NOT FOR PUBLIC DISTRIBUTION. 25

101 Important information: definitions The Barclays U.S. Aggregate Bond Index is an unmanaged benchmark index composed of U.S. securities in Treasury, Government-Related, Corporate, and Securitized sectors. It includes securities that are of investment-grade quality or better, have at least one year to maturity, and have an outstanding par value of at least $250 million. The Barclays U.S. TIPS Index is an unmanaged index composed of all U.S. Treasury Inflation- Protected Securities rated investment grade, have at least one year to final maturity, and at least $250 million par amount outstanding. The BofA Merrill Lynch US High Yield Constrained Index measures the performance of high yield bonds. The JP Morgan EMBI Global Diversified Index tracks the performance of external debt instruments (including U.S.-dollar-denominated and other external-currency-denominated Brady bonds, loans, Eurobonds and local market instruments) in the emerging markets. The JP Morgan GBI-EM Global Diversified Index tracks the performance of local-currency bonds issued by emerging market governments. FOR INSTITUTIONAL INVESTOR USE ONLY. NOT FOR PUBLIC DISTRIBUTION. 26

102

103 Lee Memorial Health System Operating and Capital Budget Fiscal Year Ending September 30, 2016 Ben Spence Chief Financial Officer Presented on: 9/24/2015 Copyright Lee Memorial Health System All rights reserved

104 TABLE OF CONTENTS 2) System Volume Summary 1) Operating Budget Assumptions 2) System Volume Summary 3) Payer Mix Summary 4) Medicare Reimbursement Impact Summary 5) Statement of Profit /Loss Summary 6) Financial Ratios 7) Capital Budget Summary 3

105 BUDGET ASSUMPTIONS: LEE MEMORIAL HEALTH SYSTEM OPERATING BUDGET 2016 REVENUE NET RATE INCREASE 1.3% SALARIES MERIT 3.0% STAFFING LEVEL FTE PER ADJUSTED OCCUPIED BED 5.27 SUPPLIES INFLATION 1.0% INVESTMENTS INVESTMENT RETURN 6.4% PROFITABILITY RATIOS OPERATING MARGIN 4.6% EXCESS MARGIN 8.7% CAPITAL EXPENDITURES CASHFLOW FOR CAPITAL % 80.0% CAPITAL BUDGET $ 93,000,000

106 LEE MEMORIAL HEALTH SYSTEM OPERATING BUDGET 2016 SYSTEM VOLUME SUMMARY FY 2014 FY 2015 FY 2016 % ACTUAL PROJECTED BUDGET VARIANCE Admissions ADULTS 71,147 75,650 76, % PEDIATRICS 4,275 4,320 4, % NICU % POST ACUTE 1,905 2,273 2, % Total Adult & Peds 78,068 83,026 84, % NEWBORNS 5,805 6,054 6, % Total Admissions 83,873 89,080 90, % Patient Days ADULTS 310, , , % PEDIATRICS 13,027 13,467 13, % NICU 15,656 15,622 16, % POST ACUTE 52,227 55,275 56, % Total Adult & Peds 391, , , % NEWBORNS 13,373 14,081 14, % Total Patient Days 405, , , % Average Length of Stay ADULTS % PEDIATRICS % NICU % POST ACUTE % Total Adult & Peds % NEWBORNS % Total Patient Days % OP Registrations EMERGENCY ROOM 191, , , % OP SURGERY CASES 17,606 17,808 17, % SUBTOTAL 209, , , % Visits / Encounters HOME HEALTH ADMISSIONS 57,880 76,959 80, % PHYSICIAN ENCOUNTERS 887, ,773 1,258, % TRAUMA SERVICES DISTRICT 11,584 11,931 12, % SUBTOTAL 956,518 1,063,663 1,351, % TOTAL OP 1,165,915 1,279,520 1,569, %

107 LEE MEMORIAL HEALTH SYSTEM OPERATING BUDGET 2016 PAYOR MIX Payer Mix ( Based on Gross Charges) ACTUAL PROJECTED BUDGET Medicare 51.5% 52.2% 53.4% Medicaid 15.4% 15.2% 15.3% Commercial Managed Care 22.8% 23.1% 23.3% Other 10.3% 9.5% 8.0% 100.0% 100.0% 100.0%

108 Medicare Reimbursement Impact Summary Rate Increase FY 15 Payments FY 16 Payments $ Impact % Change Medicare Inpatient $ 271,780,600 $ 272,956,300 $ 1,175, % Medicare Outpatient $ 76,643,200 $ 76,894,000 $ 250, % Medicare Rehab Hospital $ 9,107,400 $ 9,687,300 $ 579, % Medicare Skilled Nursing Facility $ 8,222,700 $ 8,438,300 $ 215, % Medicare Home Health $ 4,107,400 $ 4,158,500 $ 51, % Total Reimbursement $ 369,861,300 $ 372,134,400 $ 2,273, % ACA Incremental Cuts (2,592,100) Coding/Productivity/Lab Cuts (3,891,600) Uncompensated Care Pool Incremental Cuts (1,980,500) Quality Based Incremental Cuts* (831,000) Total Incremental Cuts FY 2016 $ (9,295,200) Sequestor Impact -2% ( continuation) $ (7,442,600) *Quality Based Cuts Detail

109 LEE MEMORIAL HEALTH SYSTEM OPERATING BUDGET INCOME STATEMENT SUMMARY FY 2014 FY 2015 FY 2016 VARIANCE FY16 BUD vs FY15 PROJ (in thousands) ACTUAL PROJECTED BUDGET $ % INPATIENT REVENUE 3,247,118 3,667,407 3,905, , % OUTPATIENT REVENUE 2,269,561 2,566,084 2,771, , % TOTAL PATIENT REVENUE 5,516,679 6,233,491 6,676, , % DED FROM REV-MEDICARE 2,130,960 2,447,459 2,688, , % DED FROM REV-MEDICAID 620, , ,793 32, % DED FROM REV-CHARITY 195, , ,045 10, % DED FROM REV-HMO/PPO 510, , ,330 51, % DED FROM REV-OTHER 567, , ,392 44, % DED FROM REV-BAD DEBT 172, , ,852 3, % TOTAL DED FROM REV 4,197,035 4,802,278 5,185, , % NET PATIENT REVENUE 1,319,645 1,431,213 1,491,320 60, % OTHER OPER REV 44,140 60,238 42,174 (18,064) -30.0% TOTAL OPERATING REV 1,363,784 1,491,451 1,533,495 42, % OPERATING EXPENSES PROD SALARIES 516, , ,283 67, % PROD OVERTIME 16,605 21,829 17,142 (4,687) -21.5% CONTRACT LABOR 887 2,380 2, % NON-PROD SALARIES 63,773 72,659 69,111 (3,548) -4.9% TOTAL SALARIES & WAGES 597, , ,124 59, % FRINGE BENEFITS 101, , ,096 7, % HEALTH CARE ACCESS 16,125 17,216 17, % SUPPLIES 248, , ,476 3, % OTHER SERVICES 72,435 77,066 76,081 (985) -1.3% PURCHASED SERVICES 127, , ,174 (2,414) -1.8% TOTAL OPER EXPENSES 1,162,924 1,290,849 1,358,527 67, % EBITDA 200, , ,968 (25,634) -12.8% DEPRECIATION/AMORT 73,810 75,753 81,187 5, % INTEREST EXPENSE 26,441 23,876 23,315 (561) -2.3% GAIN(LOSS) FROM OPER 100, ,973 70,465 (30,508) -30.2% OPERATING MARGIN % 7.4% 6.8% 4.6% NON OPERATING REV INT EARN & REALIZED GAIN 9,850 22,808 14,480 (8,328) -36.5% UNREALIZED GAIN(LOSS) 33,712 (24,967) 36,852 61, % OTHER NON OPER REV 13,523 18,673 17,813 (860) -4.6% TOTAL NON OPER REV 57,085 16,514 69,146 52, % EXCESS OF REV / EXPS 157, , ,611 22, %

110 LEE MEMORIAL HEALTH SYSTEM OPERATING BUDGET 2016 FINANCIAL RATIOS LMHS A MOODY'S AUDIT PROJ BUDGET GOALS MEDIANS PROFITABILITY RATIOS: OPERATING MARGIN 3.5% 3.1% 7.4% 6.8% 4.6% + EXCESS MARGIN 6.7% 6.3% 11.1% 7.8% 8.7% + OPERATING CASH FLOW MARGIN 10.7% 10.4% 16.7% 13.5% 11.4% + LIQUIDITY RATIOS: DAYS CASH ON HAND (NET OF VRDB) CUSHION RATIO CASH TO DEBT 139.0% 155.3% 119.2% 137.0% 140.7% + CAPITAL RATIOS: DEBT TO CAPITALIZATION(%)-(NET OF VRDB) 34.2% 32.5% 41.9% 40.6% 36.7% (-) ANNUAL DEBT SERVICE COVERAGE DEBT TO CASHFLOW NET OF VRDB (-)

111 CAPITAL BUDGET & CASHFLOW AVAILABLE FOR CAPITAL OPERATING BUDGET 2016 LEE MEMORIAL HEALTH SYSTEM (In Thousands) ACUTE CARE 11,599,440 SURGICAL SERVICES 7,316,583 RADIOLOGY 7,495,364 OUTPATIENT/LPG/MSO 2,773,515 POST ACUTE 457,365 SUBS & CORPORATE 1,156,678 CONTINGENCY 1,200,000 ROUTINE 31,998,945 FACILITIES 14,000,000 INFORMATION TECHNOLOGY 19,700,000 NEW GROWTH/PROGRAM DEVELOPMENT 27,301,055 TOTAL PROPOSED CAPITAL BUDGET ,000,000 CASHFLOW FROM OPERATIONS AVAILABLE FOR CAPITAL 116,225,000 80% EXCESS (DEFICIT) 23,225,000

112 BOARD OF DIRECTORS RECOMMENDED ACTION FOR BOARD APPROVAL (Action includes Acceptance, Approval, Adoption, etc) Keep form to one page, to: by Noon eight (8) days PRIOR to presenting. DATE: September 24, 2015 LEGAL SERVICE REVIEW? YES NO_X_ SUBJECT: FY 2016 Capital Budget REQUESTOR & TITLE: Ben Spence, CFO PREVIOUS BOARD ACTION ON THIS ITEM (IF ANY) (Justification and/or background for recommendations internal groups which support the recommendation i.e. SLC, Operating Councils, PMTs, etc.) On August 20 th, 2015, in accordance with the Board of Director s Policy #20.09J, a detailed list of the FY2016 capital requests was provided to the Board for a 30 day preliminary review. At the time, efforts were still being made to reduce the capital budget requests from approximately $93.5 million to $93 million. SPECIFIC PROPOSED MOTION: Requesting a motion to approve the FY 2016 Capital Budget of $93 million which is approximately 80% of the operating cash flow for Budget This request supports the following Strategic Initiative(s): PROS TO RECOMMENDATION None CONS TO RECOMMENDATION None LIST AND EXPLAIN ALTERNATIVES CONSIDERED FINANCIAL IMPLICATIONS Budgeted Non-Budgeted (including cash flow statement, projected cash flow, balance sheet and income statement) N/A OPERATIONAL IMPLICATIONS (including FTEs, facility needs, etc.) N/A SUMMARY Total capital submitted for the FY2016 capital budget is $93,000,000 to be funded by LMHS operating cashflow. Additionally, there are $2,687,578 in capital requests that will be considered for funding from philanthropic sources. BOD/Forms/Reporting Forms/Board (Action) Reporting Form revised 4/4/13 cs

113 LEE MEMORIAL HEALTH SYSTEM CAPITAL BUDGET 2016 CAPITAL BUDGET REQUESTS FY16 CAPITAL REQUESTED Acute 11,599,441 Subs & Corp 1,156,678 Post Acute 457,365 Outpatient 1,923,843 LPG/MSO 849,672 Surgical Services 7,316,583 Radiology 7,495,364 Contingency 1,200,000 ROUTINE 31,998,946 Facilities 14,000,000 Information Technology 19,700,000 New Growth/Program Development 27,301,054 TOTAL 93,000,000

114 FY16 Capital Budget Requests- Acute Care Unit Total Dept # Department Capital Request Description Quantity Cost Capital Cost C GCHSWF TRANSPORT / VASCULAR ACCESS NURSING Transport Portable Suction C OHICU Internal Paddles for R-Series Zoll Defibrillator C EMERGENCY SERVICES IV poles with electrical plugs for equipment C GENERAL MED/INFECTIOUS DISEASE 02 Meter C ORTHOPEDICS CENTER oximetry hand held C N3 PCU Oximeter Hand Held C NEURO PCU Pulse Oximeter Hand Held C PCU Pulse Ox C SOUTH - STEP DOWN UNIT New larger refrigerator for breakroom used by staf C CARDIAC DECISION UNIT Doppler C DIALYSIS Doppler-Vascular C DIALYSIS HAND HELD DOPPLER C CPCU Doppler-Vascular C MSPCU - 6W doppler C W - Cardiology PCU doppler C CARDIAC DECISION UNIT Doppler-Hand Held C DIALYSIS Doppler-Vascular C EMERGENCY SERVICES Doppler C MPCU 3W Doppler C MED/SURG 4W doppler C DIALYSIS HAND-HELD DOPPLER C OB TRIAGE Obstetrical Doppler C BIOMEDICAL ENGINEERING Bean Alignment Phanton C NURSING REDESIGN 5N oto/opthalmoscope with rechargeable handle C NEURO PCU Ophthalmoscope/Otoscope Diagnostic C CARDIAC DECISION UNIT Otoscope C HOUSEKEEPING copier C EMERGENCY SERVICES Copy Machine C HOUSEKEEPING Copier C EMERGENCY SERVICES Portable Oxygen holders 1 1,000 1,000 C INTENSIVE CARE UNIT Cart 1 1,030 1,030 C NEURO ICU Neuro Cart 1 1,030 1,030 C SPECIAL CARE NURSERY Transilluminator 1 1,037 1,037 C NURSING REDESIGN 5N pulse oximeter ,140 C NEURO Pulse Oximeter Hand Held ,140 C MED/SURG 7W pulse oximeters, hand held ,140 C MED/SURG 8W Pulse Oximeters ,140 C MEDICAL ONCOLOGY - L2W Thermometers ,160 C MED/SURG ONCOLOGY Thermometers ,160 C MED/SURG 4N DOPPLER ,250 C LAB - GENERAL Microscope compensator and polarizer package 1 1,350 1,350 C NURSING REDESIGN 5N Doppler Vascular ,360 C MPCU Doppler-Vascular ,360 C CARDIAC MED Doppler-Vascular ,360 C LAB - GENERAL Refrigerator 1 1,400 1,400 C HOUSEKEEPING Floor Burnisher 1 1,531 1,531 C WOMENS CARE CENTER Bili Meter 1 1,600 1,600 C RESPIRATORY CARE Blood Gas Data Management interface upgrade 1 1,640 1,640 C MSPCU - 6W Crash cart for unit 1 1,650 1,650 C NEWBORN NURSERY Neonatal Crash Cart 1 1,650 1,650 C NEURO Seizure Pads ,660 C STROKE UNIT Seizure Pads ,660 C SPCU Pulse Oximeter-Hand Held ,710 C MSPCU - 6W pulse oximeter hand held ,710 C EMERGENCY SERVICES Pulse Oximeter-Hand Held ,710 C PULMONARY DIAGNOSTIC LAB Bronchoscopy storage cabinet. 1 1,740 1,740 C TRANSPORTATION SVS High Speed Rotary Surface Cleaner 1 1,749 1,749 C BIOMEDICAL ENGINEERING Attenuator Kit 1 1,800 1,800 C EMERGENCY SERVICES Otoscope ,870 C HOUSEKEEPING small carpet extractor 1 1,900 1,900 C LAB - HISTOLOGY Waterbath 1 1,900 1,900 C GCHSWF TRANSPORT / VASCULAR ACCESS NURSING 4 pack Transport Child Restraint System ,956 C ANTEPARTUM Locked treatment cart 1 1,968 1,968 C GENERAL MED/INFECTIOUS DISEASE Medication cart 1 2,000 2,000 C PLANT OPS TABLE SAW 1 2,000 2,000 C TRANSPORTATION SVS stretcher mattress ,100 C BIOMEDICAL ENGINEERING Image Quality Phantom 1 2,100 2,100 C PULMONARY DIAGNOSTIC LAB Bedside spirometer 1 2,120 2,120 C W - Cardiology PCU pulse oximeter hand held ,280 C OHICU Portable Pulse Ox ,280 C MICU NURSING obtain a intraosseous vascular access system 1 2,300 2,300 C RESPIRATORY CARE Heliox / oxygen calibrate medical gas blender 1, ,425 C FAMILY EDUCATION/SUPPORT Breast pumps- rental 2 1,300 2,600 C SICU - HP MET Team carts that are covered and locked 2 1,300 2,600 C MEDICAL ONCOLOGY - L2W Patient Scale 1 2,800 2,800 C ANTEPARTUM 500lb Digital Scale 1 2,800 2,800 C MOM/BABY SCALE 1 2,800 2,800 C EMERGENCY SERVICES Chair Scale 1 2,900 2,900 C LAB - GENERAL Benchtop Centrifuge 1 2,900 2,900 C LAB - DONOR SVS Blood Collection Scales 1 2,920 2,920 C BIOMEDICAL ENGINEERING Ultrasound Phantom 1 3,000 3,000 C EMERGENCY SERVICES Chair Scale 2 1,500 3,000

115 FY16 Capital Budget Requests- Acute Care Unit Total Dept # Department Capital Request Description Quantity Cost Capital Cost C BIOMEDICAL ENGINEERING Ulttrsound Phantom 1 3,000 3,000 C EMERGENCY SERVICES icare Tonometer 1 3,000 3,000 C BIOMEDICAL ENGINEERING Ulstrasound Phantom 1 3,000 3,000 C HOUSEKEEPING upright vacuum cleaners ,000 C BIOMEDICAL ENGINEERING Ultrasound Phantom 1 3,000 3,000 C EMERGENCY SERVICES EMS Hand held radios 1 3,141 3,141 C CARDIAC CATH LAB Crash Cart 2 1,650 3,300 C LAB - GENERAL Centrifuge 1 3,450 3,450 C CENTRAL SUPPLY MIT Poly Cart 2 1,740 3,480 C CENTRAL SUPPLY Enclosed plastic supply cart 2 1,740 3,480 C EMERGENCY SERVICES Lead Apron ,500 C FOOD & NUTRITION SERVICES Patient Tray Delivery Carts 1 3,500 3,500 C BIOMEDICAL ENGINEERING Bladder Scanner Phantom 1 3,500 3,500 C BIOMEDICAL ENGINEERING Bladder Scanner Phantom 1 3,500 3,500 C HOUSEKEEPING Upright vacuum cleaners ,600 C DIALYSIS digital dialysate meter 2 1,807 3,614 C DIALYSIS dialysate meter 2 1,808 3,615 C DIALYSIS Dialysate Meter 2 1,808 3,615 C SPECIAL CARE NURSERY Bili Tx Phototherapy system 1 3,635 3,635 C BIOMEDICAL ENGINEERING Tool 1 3,658 3,658 C HOUSEKEEPING Floor Scrubber 17" ,683 C WOMENS CARE CENTER Bili Blanket 1 3,700 3,700 C MED SURG Copier Machine 1 3,739 3,739 C THORACIC ICU Overbed Table ,780 C HOUSEKEEPING high speed burnishers 2 1,900 3,800 C HOUSEKEEPING Hi-Speed Buffers 2 1,900 3,800 C HOUSEKEEPING Small Carpet Extractor 2 1,900 3,800 C BIOMEDICAL ENGINEERING CT DETECTOR UPGRADE 1 4,000 4,000 C HOUSEKEEPING Housekeeping Cart ,000 C MOM / BABY Vein finder 1 4,195 4,195 C WOMENS CARE CENTER Pulse Ox Machine 1 4,200 4,200 C LABOR & DELIVERY Vein Viewing System 1 4,200 4,200 C BIOMEDICAL ENGINEERING Radiology Phantom 1 4,200 4,200 C NEURO Vital Signs machine 1 4,300 4,300 C NEURO PCU Vital Signs Machine 1 4,300 4,300 C MS OVERFLOW UNIT Monitor-BP (VS4 w/temp) 1 4,300 4,300 C EMERGENCY SERVICES Scales 2 2,150 4,300 C CARDIOVASCULAR SERVICES Monitor-BP 1 4,300 4,300 C RESPIRATORY - NICU Oxygen blender ,318 C CARDIOVASCULAR SERVICES Tango blood pressure cuffs and microphones ,500 C W MED/SURG Blanket warmer 1 4,500 4,500 C LABOR & DELIVERY Baby Scale on rolling cart 1 4,700 4,700 C CARDIOVASCULAR SERVICES New tango BP and microphones ,800 C CARDIOVASCULAR SERVICES TEE probe storage cabinet 1 4,850 4,850 C CARDIAC OBSERVATION Carbon Dioxide Monitor 1 4,850 4,850 C CARDIOVASCULAR SERVICES TEE Probe Storage Cabinet 1 4,850 4,850 C CARDIAC OBSERVATION Carbon Dioxide Monitor 1 4,850 4,850 C CARDIOVASCULAR SERVICES TEE Probe Storage Cabinets 1 4,850 4,850 C CARDIOVASCULAR SERVICES TEE probe storage cabinet 1 4,850 4,850 C HOUSEKEEPING Patient Bed Mattress ,900 C EMERGENCY SERVICES Glucose Monitoring Machine 4 1,300 5,200 C LABOR & DELIVERY Portable Delivery lights w/mobile stand 2 2,610 5,220 C DIALYSIS Blanket Warmer 1 5,250 5,250 C PULMONARY DIAGNOSTIC LAB Ultrasonic Probe for Peripheral EBUS access 1 5,256 5,256 C ICU MMS Modules 1 5,265 5,265 C STROKE UNIT SPO2 Sensor for MP30s ,350 C LAB - DONOR SVS Tube Sealer 2 2,700 5,400 C DIALYSIS DIALYSATE METER 3 1,805 5,415 C LAB - TRANFUSION SVS Blood Bank Workstation 1 5,450 5,450 C LAB - TRANFUSION SVS Blood Bank Workstation 1 5,450 5,450 C LAB - TRANFUSION SVS Blood Bank Workstation 1 5,450 5,450 C EMERGENCY SERVICES Stand-on Scale 2 2,800 5,600 C TRANSPORTATION SVS Hot Water Pressure Washer 1 5,692 5,692 C PHARMACY Fluid transfer pump for pharmacy compounding 1 5,700 5,700 C EMERGENCY SERVICES Cart 4 1,428 5,710 C EMERGENCY SERVICES Wheelchair 2 3,000 6,000 C INTENSIVE CARE UNIT Vein Viewing System 1 6,000 6,000 C RESPIRATORY CARE MRI compatible Ventilator 1 6,020 6,020 C PULMONARY DIAGNOSTIC LAB Pulmonary Function Lab windows 7 upgrade 1 6,213 6,213 C PULMONARY DIAGNOSTIC LAB Upgrade to interface Pulmonary Function Lab with E 1 6,213 6,213 C PULMONARY DIAGNOSTIC LAB Windows 7 upgrade for the Pulmonary Lab interface 1 6,213 6,213 C NEWBORN NURSERY Draeger Jaundice Meter JM ,400 6,400 C PLANT OPS Light bulb Crusher 1 6,500 6,500 C LAB - GENERAL Centrifuge 2 3,400 6,800 C MICU - HP Overbed Table ,930 C SICU - HP New Overbed Tables for Each Patient Room ,930 C OHICU Overbed Table ,930 C LAB - TRANFUSION SVS Blood Bank Freezer 1 6,990 6,990 C RESPIRATORY CARE Aerogen Nebulizers ,000 C EMERGENCY SERVICES EMS radio 2 3,500 7,000 C PLANT OPERATIONS Bulb Crusher 1 7,000 7,000 C SICU NURSING Interface cable to attach to patient monitor to mo 6 1,181 7,086 C HOUSEKEEPING hard surface cleaner 1 7,100 7,100

116 FY16 Capital Budget Requests- Acute Care Unit Total Dept # Department Capital Request Description Quantity Cost Capital Cost C HOUSEKEEPING Hard Surface Floor Cleaner 1 7,100 7,100 C LAB - MICROBIOLOGY Microscope 1 7,100 7,100 C LAB - HISTOLOGY Digital camera 1 7,250 7,250 C NURSING REDESIGN 5N Diligent Sara 3000 with scale 1 7,300 7,300 C LAB - HISTOLOGY Digital Camera 1 7,300 7,300 C PLANT OPERATIONS Sewer Viewer camera 1 7,500 7,500 C LAB - TRANFUSION SVS Cell Washer 1 7,500 7,500 C MED/SURG 4N PHARMACY REFRIGERATOR 1 7,597 7,597 C MED TELE 3N Monitor-Patient (MP5) 1 7,600 7,600 C CARDIAC CATH LAB Temporary Pacemaker Box 1 8,000 8,000 C CARDIAC DECISION UNIT Monitor-BP (VS4 w/temp) 2 4,000 8,000 C DIALYSIS BLANKET WARMER 1 8,050 8,050 C MED TELE 3N Diligent Maxi Move 1 8,100 8,100 C EMERGENCY SERVICES IV carts 4 replacements 2 new for direct admit are 8 1,030 8,240 C EMERGENCY SERVICES Vein Viewing System 2 4,195 8,390 C SPCU Monitor-Patient (MP2) 1 8,500 8,500 C GENERAL MED/INFECTIOUS DISEASE Vital sign machine 2 4,300 8,600 C CARDIOVASCULAR SERVICES Monitor-BP (VS4 w/temp) 2 4,300 8,600 C CPCU Monitor-BP (VS4 w/temp) 2 4,300 8,600 C PED MED/SURG UNIT Phillips VS4 w/temp 2 4,300 8,600 C MED/SURG 7W Datascopes 2 4,300 8,600 C MED/SURG 8W Phillips Datascopes 2 4,300 8,600 C PEDIATRICS Phillips VS4 w/temperature 2 4,300 8,600 C MED/SURG 4N VITAL SIGNS MONITOR 2 4,300 8,600 C NEURO PCU Sure Signs VS4 2 4,300 8,600 C ORTHOPEDICS CENTER Bladder Scanner 1 8,800 8,800 C NURSING REDESIGN 5N Bladder Scanner 1 8,800 8,800 C NEURO Bladder scanners 1 8,800 8,800 C NEURO PCU Bladder scanner 1 8,800 8,800 C SPCU Bladder Scanner 1 8,800 8,800 C NEURO Bladder Scanner 1 8,800 8,800 C TH FLOOR OBSERVATION UNIT bladder scanner 1 8,800 8,800 C LAB - GENERAL Phlebotomy Carts 5 1,800 9,000 C LAB - GENERAL 3 Door Refrigerator 1 9,300 9,300 C CARDIAC CATH Carbon Dioxide Monitor 2 4,850 9,700 C RESPIRATORY CARE Metaneb 2 4,995 9,990 C EMERGENCY SERVICES Wheelchairs 1 10,000 10,000 C MOM/BABY EKG Machine 1 10,000 10,000 C CENTRAL SUPPLY electric cart puller 2 5,150 10,300 C CENTRAL SUPPLY electric cart puller 2 5,150 10,300 C LAB - GENERAL Ultra Low Freezer 1 10,325 10,325 C TRANSPORTATION SVS Wheelchair 6 1,750 10,500 C PULMONARY DIAGNOSTIC LAB PFT machine computer upgrade and VMAX window 7 pul 1 10,577 10,577 C CARDIAC DECISION UNIT ISTAT 1 10,730 10,730 C MOM / BABY defibrillator 1 10,750 10,750 C PLANT OPS EZ-GO GOLF CART 1 11,000 11,000 C LAB - GENERAL Microscope with co-observation 1 11,000 11,000 C LABOR & DELIVERY i-stat Analyzer 1 11,180 11,180 C HOUSEKEEPING Carpet Cleaning Equipment 1 11,936 11,936 C CARDIAC DECISION UNIT Wheelchair 4 3,000 12,000 C LAB - GENERAL Refrigerator 1 12,000 12,000 C LAB - TRANFUSION SVS Blood Bank Freezer 1 12,380 12,380 C PLANT OPS Digital Hand Held UHF Radios ,480 C EMERGENCY SERVICES EMS Radio unit 1 12,500 12,500 C MED/SURG 8W over-the-bed tables ,600 C ORTHOPEDICS CENTER Vital Sign Monitor 3 4,300 12,900 C MEDICAL ONCOLOGY - L2W Vital Signs machine 3 4,300 12,900 C EMERGENCY SERVICES Vital Signs Monitor 3 4,300 12,900 C CARDIOVASCULAR SERVICES Monitor-BP (VS4 w/temp) 3 4,300 12,900 C MED/SURG 4W VITAL SIGNS MONITOR 3 4,300 12,900 C LAB - GENERAL Refrigerated Centrifuge 2 6,750 13,500 C LAB - GENERAL Phlebotomy Cart 8 1,688 13,500 C LAB - GENERAL Refrigerator - 2 Door 1 14,000 14,000 C EMERGENCY SERVICES Video Laryngoscope system 1 14,026 14,026 C LAB - GENERAL Blood Gas Analzyer 1 14,340 14,340 C FOOD & NUTRITION SERVICES Steam Jacketed Kettles 1 14,392 14,392 C CARDIAC DECISION UNIT Telemetry Transmitter 3 4,800 14,400 C PHARMACY Main IV Room Pharmacy - Medication Refrigerators 2 7,288 14,576 C EMERGENCY SERVICES Blanket warmer 2 7,300 14,600 C ER HOLDING UNIT EKG Machine 1 15,000 15,000 C CENTRAL SUPPLY Supply Cart Kanban conversion 5 3,000 15,000 C EMERGENCY SERVICES EKG 1 15,000 15,000 C CARDIOVASCULAR SERVICES EKG cart 1 15,000 15,000 C HOUSEKEEPING Carpet Extractor / Vacuum Ride-On 1 15,000 15,000 C E MED/SURG EKG machine 1 15,000 15,000 C W MED/SURG EKG machine 1 15,000 15,000 C ICU EKG Machine 1 15,000 15,000 C CENTRAL SUPPLY Supply Cart Kanban Conversion 5 3,000 15,000 C PEDIATRIC IP CANCER CENTER Phillips MP2 portable monitor 2 7,600 15,200 C STROKE UNIT Monitor-Patient (MX400) 1 15,500 15,500 C ANGIO RECOVERY Monitor-Patient (MX400) 1 15,500 15,500 C CARDIAC CATH LAB Transport Monitor 2 7,750 15,500 C HOUSEKEEPING Cleaning Equipment 16 1,013 16,200

117 FY16 Capital Budget Requests- Acute Care Unit Total Dept # Department Capital Request Description Quantity Cost Capital Cost C GCHSWF TRANSPORT / VASCULAR ACCESS NURSING Phillips Transport Monitors 2 8,198 16,396 C DIALYSIS portable reverse osmosis machine 1 16,498 16,498 C DIALYSIS PORTABLE REVERSE OSMOSIS MACHINE 1 16,498 16,498 C LABOR & DELIVERY Birthing bed mattress 4 4,197 16,788 C RESPIRATORY CARE pulse oximeters 4 4,200 16,800 C CARDIAC DECISION UNIT Monitor-Patient (MX450) 1 17,000 17,000 C W - Cardiology PCU VS 4 with Temperature 4 4,300 17,200 C E MED/SURG data scope 4 4,300 17,200 C W MED/SURG datascope 4 4,300 17,200 C MED TELE 3N Monitor-Patient (VS4 w/temp) 4 4,300 17,200 C BIOMEDICAL ENGINEERING Radiation Meter 1 17,500 17,500 C MOM/BABY Overbed Tables ,640 C CENTRAL SUPPLY Electric Cart Puller 2 8,928 17,855 C CENTRAL SUPPLY Electric Cart Puller 2 8,928 17,855 C FOOD & NUTRITION SERVICES Direct Steam Tilting Kettles - 40 qt. 1 18,000 18,000 C EMERGENCY SERVICES Stackable wheelchairs 10 1,816 18,160 C BIOMEDICAL ENGINEERING Vehicle 1 18,500 18,500 C W - Cardiology PCU tele boxes 4 4,800 19,200 C CARDIAC CATH LAB Carbon Dioxide Monitor 4 4,850 19,400 C CARDIAC CATH Carbon Dioxide Monitor 4 4,850 19,400 C LAB - HISTOLOGY Microscope with Digital Camera 1 19,705 19,705 C LAB - HISTOLOGY Pathology Microscope with Camera 1 19,705 19,705 C LABOR & DELIVERY Giraffe Incubator on Wheels 1 20,000 20,000 C FOOD & NUTRITION SERVICES Main Kitchen Steamers 1 20,300 20,300 C MED/SURG 4W diligent equipment 4 5,100 20,400 C HOUSEKEEPING mattress ,000 C HOUSEKEEPING Mattress ,000 C VASCULAR ACCESS NURSING Handheld ultrasound for peripheral IV insertion in 2 11,000 22,000 C LABOR & DELIVERY FETAL MONITOR (MONICA) 2 11,500 23,000 C FOOD & NUTRITION SERVICES Double Stack Convection Oven 1 23,287 23,287 C RESPIRATORY CARE CPAP/Bipap system 10 2,395 23,950 C RESPIRATORY - NICU Blood gas analyzers 2 12,040 24,080 C CARDIOVASCULAR SERVICES Echo bed and Scan Chair 2 12,200 24,400 C EMERGENCY SERVICES Telemetry Transmitters 5 4,900 24,500 C HEART CENTRAL Telemetry Transmitter 5 4,900 24,500 C PULMONARY DIAGNOSTIC LAB Blood Gas Analyzer 2 12,690 25,380 C EMERGENCY SERVICES Ultrasound-Vascular Access 1 25,418 25,418 C MED/SURG ONCOLOGY Vital sign machines 6 4,300 25,800 C LABOR & DELIVERY Infant Warmer 1 26,000 26,000 C ANTEPARTUM panda warmer with neonatal resusitation module 1 26,000 26,000 C RESPIRATORY CARE V-60 BiPAP machine 2 13,000 26,000 C RESPIRATORY CARE V-60 BiPap ventilators 2 13,000 26,000 C LABOR & DELIVERY Giraffe Bedded Warmer 1 27,302 27,302 C RESPIRATORY CARE Storz Difficult Intubation Cart 1 28,145 28,145 C DIALYSIS DIALYSIS MACHINE 2 14,950 29,900 C CENTRAL SUPPLY Supply Cart Kanban Conversion 10 3,000 30,000 C VASCULAR ACCESS NURSING Ultrasound-Portable 1 30,000 30,000 C EMERGENCY SERVICES ED Heart Central Telemetry 1 30,000 30,000 C LAB - GENERAL Molecular Analyzer 1 30,000 30,000 C MPCU 3W Vital signs monitor 7 4,300 30,100 C MPCU Monitor-Patient (MX400) 2 15,500 31,000 C CARDIAC MED Monitor-Patient (MX400) 2 15,500 31,000 C CPCU Monitor-Patient (MX400) 2 15,500 31,000 C DIALYSIS Monitor-Patient (MX400) 2 15,500 31,000 C LABOR & DELIVERY Waste Mgmnt System (Neptune 2) 2 16,000 32,000 C DIALYSIS Monitor-Patient (MX400) 2 16,500 33,000 C RESPIRATORY - NICU pulse oximeters 8 4,200 33,600 C HOUSEKEEPING UV Disifecting light 1 34,275 34,275 C HOUSEKEEPING UV Disinfecting Light 1 34,275 34,275 C HEART CENTRAL Spare telemetry transmitters 7 4,900 34,300 C PHARMACY Pediatric Compounding Aseptic Containtment Isolato 1 35,000 35,000 C DIALYSIS WALL MOUNTED ECG MONITOR WITH PULSE OXIMETRY AND B 2 17,500 35,000 C LAB - MICROBIOLOGY Upgrade to Molecular Analyzers 2 17,500 35,000 C RESPIRATORY CARE LTV 1200 portable ventilators 2 17,621 35,243 C EMERGENCY SERVICES ED Bed Stretchers 5 7,100 35,500 C HOUSEKEEPING UV Light 1 36,904 36,904 C HOUSEKEEPING UV Disinfection Light 1 36,904 36,904 C EMERGENCY SERVICES istat 4 9,400 37,600 C RESPIRATORY CARE Blood Gas Analyzer 3 12,690 38,070 C RESPIRATORY CARE Servo-I Adult Ventilator with capnography 1 39,550 39,550 C EMERGENCY SERVICES allows ETCO2 to 8 more rooms in ER New standard of 8 5,060 40,480 C CARDIOVASCULAR SERVICES Vascular Lab Pressure Volume Recorder 1 40,533 40,533 C CARDIAC CATH Anesthesia Machine with Gas Analyzer 1 41,000 41,000 C EMERGENCY SERVICES Exam Lights 8 5,404 43,232 C EMERGENCY SERVICES stretchers 3 replacement and for direct admission 7 6,200 43,400 C RESPIRATORY CARE Servo-I adult ventilators with capnograhy and conf 1 44,909 44,909 C LABOR & DELIVERY Baby Cribs 20 2,345 46,900 C TRANSPORTATION SVS Transport Wheelchair 15 3,175 47,626 C EMERGENCY SERVICES tele boxes 10 4,800 48,000 C RESPIRATORY CARE Bronchoscopy equipment 1 48,000 48,000 C RESPIRATORY CARE Blood gas machines 4 12,040 48,160 C GCHSWF TRANSPORT / VASCULAR ACCESS NURSING ETCO2 Critical Care Monitor 4 12,200 48,800 C ED OUTTAKE telemetry boxes 10 4,900 49,000

118 FY16 Capital Budget Requests- Acute Care Unit Total Dept # Department Capital Request Description Quantity Cost Capital Cost C HOUSEKEEPING Floor Equipment 6 8,167 49,000 C ADMIN SVCS ACUTE Stackable wheelchairs 30 1,640 49,200 C HEART CENTRAL Additional bedside telemetry monitors for CCH 4 12,625 50,500 C CARDIOVASCULAR SERVICES Ergonomic Echo beds and Scanning Chairs 4 13,200 52,800 C CARDIOVASCULAR SERVICES Echo/Vascular Ergonomic Scanning Chairs and Stretc 4 13,200 52,800 C GCHSWF TRANSPORT / VASCULAR ACCESS NURSING Pediatric Transport Ventilator 2 26,671 53,342 C LAB - MICROBIOLOGY Molecular Analyzer 2 27,500 55,000 C FOOD & NUTRITION SERVICES Combi Oven 1 56,278 56,278 C PULMONARY DIAGNOSTIC LAB EVIS EXERAIII HIGH-DEFINITION VIDEO SCOPEs 2 28,246 56,492 C NEURO ICU Transport Monitor 6 9,667 58,000 C OHICU Portable bedside ultrasound machine 1 60,000 60,000 C CENTRAL SUPPLY Supply Cart Kanban Conversion 20 3,000 60,000 C CARDIAC CATH Intra-aortic Balloon Pump (IABP) 1 63,122 63,122 C DIALYSIS PORTABLE REVERSE OSMOSIS MACHINES 4 16,498 65,992 C MSPCU - 6W VS4 with temperature 16 4,300 68,800 C MICU - HP MRI Compatible IV Pumps (x3) 3 24,200 72,600 C LAB - DONOR SVS Apheresis System 1 75,800 75,800 C PULMONARY DIAGNOSTIC LAB Pulmonary Function Lab upgrade and EPIC interface. 1 79,000 79,000 C NEURO ICU Ultrasound for Central line placement 1 80,000 80,000 C EMERGENCY SERVICES I-Stat Lab machines 7 11,465 80,255 C RESPIRATORY CARE Ventilator 2 41,550 83,100 C RESPIRATORY CARE Maquet Servo i ventilators 2 41,550 83,100 C LABOR & DELIVERY Birthing beds 6 14,480 86,880 C EMERGENCY SERVICES I-STAT Analyzers 8 11,180 89,440 C EMERGENCY SERVICES istat 8 11,191 89,530 C HEART CENTRAL Additional client screens for 3N 3 33,167 99,501 C MICU NURSING Upgraded Sonosite machine to have one for each int 2 60, ,000 C EMERGENCY SERVICES Patient Monitoring 1 120, ,000 C LABORATORY Urinalysis Analyzer 1 124, ,500 C LAB - GENERAL Urinalysis analyzer 1 124, ,500 C CARDIAC CATH LAB Optical Coherence Tomography (OCT) 1 125, ,000 C LAB - HISTOLOGY IHC System 1 140, ,000 C SICU - HP Portable End-Tidal CO2 Monitor 3 51, ,550 C LABOR & DELIVERY Infant Warmer w/scale 6 26, ,000 C RESPIRATORY CARE EBUS bronchoscopy equipment 1 179, ,940 C MICU - HP Bedside Portable Ultrasound Unit with cardiac and 3 60, ,000 C CARDIAC CATH LAB Intra-aortic balloon pump (IABP) 3 63, ,366 C MICU - HP Maquet Intra-Aortic Balloon Pump with all required 3 63, ,366 C OHICU New Model Intra-Aortic Balloon Pumps with all supp 3 63, ,366 C CARDIAC CATH Inatra-Aortic Balloon Pump (IABP) 3 63, ,366 C RESPIRATORY CARE Ventilator (Servo-I) 5 39, ,489 C CARDIAC CATH Intracardiac Echocardiography (ICE) 2 100, ,000 C CARDIOVASCULAR SERVICES Echo machine for cardiac ultrasound 1 213, ,000 C CARDIOVASCULAR SERVICES Echo machine 1 213, ,000 C W MED/SURG Telemetry Units 24 8, ,000 C EMERGENCY SERVICES Patient Monitor 20 11, ,000 C CARDIOVASCULAR SERVICES Case stress system for stress testing 3 82, ,000 C LABOR & DELIVERY Birthing Bed (Affinity 4) 18 14, ,640 C CARDIAC CATH Cardiac Mapping System (CARTO) 1 285, ,000 C CARDIOVASCULAR SERVICES Holter monitor system replacement 1 300, ,000 C HEART CENTRAL replace HC older telemetry transmitters for GCMC 170 4, ,000 C SLEEP LAB ETCO2 Monitor 1 3,565 3,565 C CARDIOVASCULAR SERVICES Monitor-BP (VS4 w/temp) 1 4,300 4,300 C PULMONARY REHAB Recumbant bike 1 6,000 6,000 C PULMONARY REHAB Strength training equipment 1 6,553 6,553 C SLEEP LAB Equipment Dryer 1 6,565 6,565 C PEDIATRIC SEDATION CENTER Phillips MP2 Monitor 1 12,100 12,100 C PULMONARY REHAB LSI Software, standard Laptops, Altus Carts 2 6,988 13,976 C PULMONARY REHAB Upgrade LSI System 1 16,485 16,485 C SLEEP LAB Sleep Acquisition System 1 18,940 18,940 C PEDIATRIC SEDATION CENTER MRI Infusion Pump 1 20,017 20,017 C PULMONARY REHAB LSI Cardiac Telemetry System 1 22,000 22,000 C NEURO Ophthalmoscope/Otoscope Diagnostic Set C NEURO PCU Bed Tables ,260 C NEURO Cart, Medical 1 3,000 3,000 C NEURO PCU Cart, Medical 1 3,000 3,000 C NEURO Bed Tables ,150 C PHARMACY Copier 1 3,259 3,259 C INFUSION CENTER Vital Signs Monitor 2 4,300 8,600 C CARDIAC CATH Temporary Pacemaker Boxes 2 8,000 16,000 C PHARMACY Compounding Aseptic Containment Isolator (CACI) 2 30,000 60,000 C PHARMACY Smart autonomous mobile delivery robot and medicat 1 161, ,000 C SECURITY Olympus Voice Recorder 1 1,000 1,000 C PLANT OPERATIONS Drain cleaning snake 1 3,500 3,500 C SECURITY UHF Radios ,304 C SECURITY UHF Digial Radios ,304 C SECURITY UHF radios ,304 C SECURITY UHF Digital Radios ,304 C PLANT OPERATIONS Portable Radios ,380 C PLANT OPERATIONS Voltage recorder 1 28,000 28,000 C LABOR & DELIVERY ProNox Nitrous Oxide Delivery System 2 6,459 12,918 C TRANSPORTATION SVS transport chair 6 3,000 18,000 C TRANSPORTATION SVS Transport Chair 6 3,000 18,000

119 FY16 Capital Budget Requests- Acute Care Unit Total Dept # Department Capital Request Description Quantity Cost Capital Cost C TRANSPORTATION SVS stretchers 3 7,100 21,300 C NEONATAL ICU - HP Biliblanket light meter 1 1,546 1,546 C PLANT OPS Tig Welder 1 2,500 2,500 C PLANT OPS portable generator 1 3,200 3,200 C VASCULAR ACCESS NURSING Locked Carts for IV supplies 2 1,600 3,200 C CARDIAC DECISION UNIT IV cart 4 1,030 4,120 C NEONATAL ICU - HP Bili Tx Phototherapy system 2 3,635 7,269 C N3 PCU Vital Sign Machine 2 4,300 8,600 C OB ADMIN Manikin torso for simulation 1 9,553 9,553 C NEONATAL ICU - HP HeRO Solo Monitoring System 4 3,750 15,000 C NEONATAL ICU - HP SpO2 modules for MX700 cardiac monitors 10 5,265 52,650 Total $11,599,441

120 FY16 Capital Budget Requests- Subs & Corp Unit Total Dept # Department Capital Request Description Quantity Cost Capital Cost C EMPLOYEE HEALTH SVS Audiometer 1 1,940 1,940 C SYSTEM/CORP MAJOR FACILITIES Particle Counters 1 2,500 2,500 C PPEC Stander 1 4,058 4,058 C LAB - GENERAL CORPORATE i-stat Analyzer 1 11,180 11,180 C EMPLOYEE HEALTH SVS EKG 1 15,000 15,000 C HEALTH INFORMATION MANAGEMENT Dedicated courier car 1 17,000 17,000 C WELLNESS CENTER OF CAPE CORAL UV system for pool at the Wellness Center of Cape 1 20,000 20,000 C SUPPLY CHAIN MANAGEMENT 7-8 Passenger Van 1 35,000 35,000 C FACILITIES MANAGEMENT ADMINISTRATION Cargo Van - White 1 50,000 50,000 C PROPERTY MANAGEMENT Work Van 2 50, ,000 C SUPPLY CHAIN MANAGEMENT Phase II of 2 year ICU bed replacements 39 23, ,000 Total $1,156,678

121 FY16 Capital Budget Requests- Post Acute Unit Total Dept # Department Capital Request Description Quantity Cost Capital Cost C CASE MANAGEMENT-REHAB Bariatric Drop Arm 3:1 Commode C PHYSICAL THERAPY Omnicylce Printer C SPEECH THERAPY Estim unit C LEE MEMORIAL HOME INFUSION Medicus Health Medical Cart C LEE MEMORIAL HOME INFUSION Anthro Zido Phlebotomy Cart C HOUSEKEEPING Floor Burnisher 1 1,400 1,400 C LEE MEMORIAL HOME INFUSION Medicus Phlebotomy Chair 1 1,550 1,550 C HOUSEKEEPING Cart-Housekeeping 2 1,000 2,000 C REHAB HOSP - OT The Hand Facilitator 1 2,526 2,526 C CASE MANAGEMENT-REHAB Bariatric Wheelchair with removable arms and leg r 2 1,650 3,300 C REHAB HOSP - OT Mobile Arm Support Device 1 3,400 3,400 C NURSING- SNF Pulse Oximeters ,420 C PHYSICAL THERAPY Ultrasound/Electrical stimulation combo Unit 1 3,975 3,975 C LEE MEMORIAL HOME INFUSION Vital Signs Monitor 1 4,300 4,300 C HPCRC SPEECH THERAPY VitalStim Therapy Portable Kit 1 4,600 4,600 C PHYSICAL THERAPY Omnistem FX PRO 1 5,050 5,050 C HOUSEKEEPING Floor Scrubbber 1 5,600 5,600 C REHAB NURSING patient overbed table ,300 C HOUSEKEEPING Hard surface scrubber 1 6,300 6,300 C FOOD & NUTRITION SERVICES Meat Slicer 1 7,000 7,000 C PLANT OPERATIONS Resident Room TV's ,800 C ADMINISTRATION Digital handheld radios ,400 C REHAB NURSING Bladder Scanner 1 8,800 8,800 C REHAB NURSING Blanket Warmer 2 4,500 9,000 C NURSING- SNF Blanket Warmers 2 4,500 9,000 C REHAB HOSP - PT Tilt in Space wheelchair with headrest (specialty) 1 15,000 15,000 C REHAB NURSING VS Machines 4 4,300 17,200 C REHAB HOSP - PT Vital Signs Reader (blood pressure and pulse oxime 4 4,300 17,200 C REHAB HOSP - PT Adjustable Parallel Bars 2 8,790 17,580 C REHAB HOSP - OT Dynavision D2 1 18,890 18,890 C TELEHEALTH GPRS Devices ,450 C REHAB HOSP - PT Bariatric Mat Table with Parallel Bars 1 24,600 24,600 C REHAB HOSP - SP Swallow Evaluation Unit (FEES) 1 43,980 43,980 C TELEHEALTH Genesis 66 2, ,600 Total $457,365

122 FY16 Capital Budget Requests- Outpatient Unit Total Dept # Department Capital Request Description Quantity Cost Capital Cost C THE CHILDRENS REHAB CTR OF NORTH COLLIER Myotrac T4000P C THE CHILDRENS REHAB CTR OF NORTH COLLIER jamar Hand Evaluation Kit C REHABILITATION SERVICES Rolling mirror C REHAB SVCS PEDIATRIC ORTHOPEDIC Flowtron Hydroven Pump C REHABILITATION SERVICES-SANCTUARY ETPS point stimmulator C THE CHILDRENS REHAB CTR OF NORTH COLLIER Ramp and Table C REHABILITATION SERVICES-CCH OP ToeOff Gait Assessment Kit C REHABILITATION SERVICES-SANCTUARY dynamic ski machine C REHABILITATION SERVICES-CCH OP Walker-U Step (Neurological) C THE CHILDRENS REHAB CTR OF NORTH COLLIER Rainbow Split Donut C REHABILITATION SERVICES-SANCTUARY Elliptical exercise machine 1 1,150 1,150 C RADIOLOGY - CT SCAN Recliner for istat 1 1,300 1,300 C REHABILITATION SERVICES-SANCTUARY Splint Pan for splint fabrication 1 1,400 1,400 C THE CHILDRENS REHAB CTR OF NORTH COLLIER Pediatric Youth Vital Stim package 1 1,407 1,407 C ASTHMA/COPD MANAGEMENT Asthma Training Doll 1 1,423 1,423 C REHABILITATION SERVICES Splint pan 1 1,500 1,500 C BEHAVORIAL HEALTH CENTER AED (AUTOMATED EXTERNAL DIFIBRILLATOR) 1 1,567 1,567 C REHABILITATION SERVICES - CITY CENTER PEDIATRICS VitalStim 1 1,600 1,600 C LMH CARDIOLOGY - BASS RD Crash Cart 1 1,650 1,650 C SURGERY CENTER SANCTUARY Super Rapid Attest Readers 1 1,995 1,995 C SURGERY CENTER SANCTUARY Bioburden Tester 1 2,150 2,150 C REHABILITATION SERVICES-GCMC Armedica AM-300 Treatment Table 1 2,264 2,264 C REHABILITATION SERVICES - CITY CENTER PEDIATRICS Convertible Stairs 1 2,450 2,450 C REHABILITATION SERVICES-SANCTUARY Adjustable treatment table 1 2,580 2,580 C RIVERWALK SPORTS MED & REHAB Ultrasound/-Estim Combo 1 2,599 2,599 C REHABILITATION SERVICES Recliner-Joint Center 2 1,300 2,600 C REHABILITATION SERVICES-BASS RD Performa 3 section X w/power flex 1 2,626 2,626 C REHAB SVCS PEDIATRIC ORTHOPEDIC System for functional sport specific training 1 2,749 2,749 C REHABILITATION SERVICES-CCH OP SVI Expansion Software kits - Charts, Visual Motor 1 3,000 3,000 C REHABILITATION SERVICES-CARREL RD High/low treatment table 1 3,000 3,000 C REHABILITATION SERVICES-CARREL RD Bobath Mat Table 1 3,000 3,000 C LMH CARDIOLOGY - METRO PKWY Zoll AED Plus Defibrillator 1 3,200 3,200 C LAB - OUTREACH SERVICES Centrifuge 1 3,400 3,400 C LMH CARDIOLOGY - BASS RD Copier 1 4,009 4,009 C REHABILITATION SERVICES-SANCTUARY Hi-low mat table 1 4,040 4,040 C REHABILITATION SERVICES-BASS RD Pilates Trapeze Table 1 4,286 4,286 C LEE PAIN SERVICE Vital Signs Monitor 1 4,300 4,300 C LEE WOUND CARE CLINIC Exam stools ,400 C CARDIAC REHAB Exercise Equipment 1 4,435 4,435 C REHABILITATION SERVICES-CARREL RD Combo electrical stimulation/ultrasound unit 1 4,510 4,510 C RIVERWALK SPORTS MED & REHAB Biostep 2 Semi-Recumbent Elliptical 1 4,690 4,690 C RADIOLOGY - DIAGNOSTICS CR Cassettes 1 4,820 4,820 C REHABILITATION SERVICES - CITY CENTER PEDIATRICS Automatic door opener 1 4,944 4,944 C SLEEP LAB Apnea Link Plus devices 3 1,667 5,000 C REHABILITATION SERVICES-BASS RD Pilates Clinical Reformer 1 5,264 5,264 C REHABILITATION SERVICES-SANCTUARY Functional Trainer for multi-purpose exercise 1 6,000 6,000 C ASTHMA/COPD MANAGEMENT Spirometer 3 2,108 6,325 C LMH CARDIOLOGY - MED PLAZA 1 echo table 1 6,500 6,500 C REHABILITATION SERVICES-GCMC Motorized Height and Width Parallel Bars 1 7,100 7,100 C SURGERY CENTER SANCTUARY Arthroscope 2 3,637 7,274 C SURGERY CENTER SANCTUARY Extremity Tray 2 3,646 7,292 C LMH CARDIOLOGY - METRO PKWY Warming Cabinet 1 7,300 7,300 C REHABILITATION SERVICES - CITY CENTER PEDIATRICS Interactive Metronome 1 7,340 7,340 C THE CHILDRENS REHAB CTR OF NORTH COLLIER Interactive Metronome 1 7,340 7,340 C REHABILITATION SERVICES-CCH OP Stovehood w/installation 1 7,500 7,500 C SURGERY CENTER SANCTUARY C-Arm Wireless Upgrade 2 3,800 7,600 C SURGERY CENTER SANCTUARY Headlight with light source 1 7,792 7,792 C WOMENS BREAST CENTER Carts 3 2,700 8,100 C CARDIOVASCULAR SERVICES Philips Blood pressure monitor VS3 2 4,400 8,800 C REHABILITATION SERVICES-CARREL RD Video Motion Analysis System 1 9,145 9,145 C REHABILITATION SERVICES-GCMC Vectra Genisys Therapy System 2 4,596 9,192 C RADIOLOGY - ULTRASOUND Trophon US probe cleaning system 1 10,000 10,000 C RADIOLOGY - ULTRASOUND Ultrasound probe cleaning system 1 10,000 10,000 C RADIOLOGY - ULTRASOUND Ultrasound probe cleaning system 1 10,000 10,000 C RADIOLOGY - NUCLEAR MEDICINE Dose calibrator 1 10,000 10,000 C LMH CARDIOLOGY - BASS RD Defibrillator 1 10,750 10,750 C REHABILITATION SERVICES-SANCTUARY Balance machine for treating balance and gait diso 1 12,500 12,500 C PULMONARY DIAGNOSTIC LAB Blood Gas Analyzer 1 12,690 12,690 C REHABILITATION SERVICES-CCH OP Mat Table - Bobath Hi/Low electric 3 4,632 13,896 C REHABILITATION SERVICES - CITY CENTER PEDIATRICS Bioness 1 18,144 18,144 C REHABILITATION SERVICES-GCMC Bioness L ,375 18,375 C SURGERY CENTER SANCTUARY Long Ureteroscope 1 20,000 20,000 C SURGERY CENTER SANCTUARY Cystoscopy Tray 1 20,000 20,000 C SURGERY CENTER SANCTUARY Force Triad 1 20,000 20,000 C REHABILITATION SERVICES-CARREL RD Driving Evaluation Automobile 1 20,000 20,000 C REHABILITATION SERVICES-GCMC Bioness H ,791 21,791 C SURGERY CENTER SANCTUARY C-Arm Monitor Upgrade 2 11,995 23,990 C SURGERY CENTER SANCTUARY System 7 Ortho Power Equipment 1 24,000 24,000 C RADIOLOGY - MRI Software upgrade 1 24,000 24,000 C REHABILITATION SERVICES-CARREL RD Bioness Integrated Therapy System BITS 1 24,390 24,390 C SPINE CENTER Upgrades for C-Arm Equipment 1 33,595 33,595 C SURGERY CENTER SANCTUARY Camera/light cord 1 35,000 35,000

123 FY16 Capital Budget Requests- Outpatient Unit Total Dept # Department Capital Request Description Quantity Cost Capital Cost C SURGERY CENTER SANCTUARY Gastroscope 1 35,280 35,280 C LEE PAIN SERVICE C-Arm upgrades 1 35,800 35,800 C LEE PAIN SERVICE C-Arm Upgrade 1 35,800 35,800 C LAB - OUTREACH SERVICES Courier Vehicles 2 18,000 36,000 C REHABILITATION SERVICES-MED 1 TIMS DICOM system 1 40,100 40,100 C CARDIOVASCULAR SCREENING Vascular Pressure Volume recorder 1 40,533 40,533 C SURGERY CENTER SANCTUARY NeoProbe 1 44,000 44,000 C SURGERY CENTER SANCTUARY TPS Drill 1 44,000 44,000 C NEUROSCIENCE EEG amublatory monitors 2 22,500 45,000 C PHARMACY - CANCER Compounding Aseptic Containment Isolator (CACI) 2 30,000 60,000 C LMH CARDIOLOGY - METRO PKWY stress treadmill systems 2 30,000 60,000 C LAB - GENERAL Hematology Analzyer 1 67,500 67,500 C RADIOLOGY - MRI MRI Upgrade 1 81,000 81,000 C WOMENS BREAST CENTER Aixplorer Ultrasound Machine 1 110, ,000 C LMH CARDIOLOGY - BASS RD New Echocardiography Machine 1 213, ,000 C LMH CARDIOLOGY - MED PLAZA 1 nuclear camera 1 350, ,000 Total $1,923,843

124 FY16 Capital Budget Requests- LPG/MSO Unit Total Dept # Department Capital Request Description Quantity Cost Capital Cost C LPG GME PROGRAM Fetal Doppler C LPG CARDIOTHORACIC SURGERY Summit LifeDop 250 hand-held doppler with display, C LPG INTERNAL MEDICINE - LABELLE Digital Blood Pressure Monitor C GCHSWF PEDS SPECIALISTS - COLLIER CLINIC Headlight 1 1,000 1,000 C LPG CONENIENT CARE - PAGE FIELD REFRIGERATION 1 1,000 1,000 C LPG HOUSE CALLS New Provider Clinical Tools ,120 C LPG FAMILY-INTERNAL MEDICINE - BONITA Pulse Oximetry ,140 C LPG INTERNAL MEDICINE - MATTHEW DRIVE Wall Diagnostic Unit 1 1,190 1,190 C LPG OB BASS ROAD Microscope 1 1,294 1,294 C LPG PULMONOLOGY - HPMC - GCMC Spirometry software 1 1,500 1,500 C LPG FAMILY-INTERNAL MEDICINE - SOUTH CAPE Automatic External Defribrillator 1 1,567 1,567 C LPG PRIMARY CARE - SURFSIDE Defibrillator-AED Plus 1 1,567 1,567 C LPG INTERNAL MEDICINE - MATTHEW DRIVE Wheelchair 1 1,600 1,600 C LPG FAMILY-INTERNAL MEDICINE - COLLEGE POINT Urine Analyzer 1 1,650 1,650 C LPG FAMILY-INTERNAL MEDICINE - COLLEGE POINT Portable Pulse Oximeter ,710 C LPG PEDIATRICS - PAGE FIELD Defibrillator 1 2,000 2,000 C LPG PEDIATRICS - LEHIGH AED 1 2,000 2,000 C LPG CONENIENT CARE - PAGE FIELD Procedure Carts 2 1,030 2,060 C LPG SURGERY CAPE CORAL Brewer Featherlight medical light free standing un 1 2,600 2,600 C LPG GME PROGRAM Cryogenic system 1 2,600 2,600 C GCHSWF PEDIATRIC SURGERY SPECIALITIES Exam Light 1 2,610 2,610 C LPG CONENIENT CARE - PAGE FIELD Wall Diagnostic Unit ,805 C GCHSWF PEDIATRIC SPECIALISTS Ultralite Ambulatory Blood Pressure Monitor 1 3,000 3,000 C LPG OB BASS ROAD Exam light - Welch light ,052 C LPG PEDIATRICS - PAGE FIELD Infant Blood Pressure units 2 1,599 3,199 C GCHSWF PEDIATRIC NEUROLOGY Defibrillator-AED 1 3,200 3,200 C LPG INFECTIOUS DISEASE - HPMC Defibrillator-AED Plus 1 3,200 3,200 C LPG INFECTIOUS DISEASE - LMH Zoll AED Plus Defibrillator 1 3,200 3,200 C LPG FAMILY-INTERNAL MEDICINE - BONITA AED 1 3,200 3,200 C LPG FAMILY-INTERNAL MEDICINE - COLLEGE POINT Automated External Defibrillator (AED) 1 3,200 3,200 C LPG FAMILY-INTERNAL MEDICINE - OBGYN - BASS RD AED 1 3,200 3,200 C LPG INTERNAL MEDICINE - LABELLE Defibrillator-AED 1 3,200 3,200 C LPG PEDIATRICS - BONITA AED with housing 1 3,200 3,200 C LPG INTERNAL MEDICINE - MATTHEW DRIVE AED Defibrillator 1 3,200 3,200 C LEE COMMUNITY HEALTHCARE - N FT MYERS Zoll AED Plus Defibrillator 1 3,200 3,200 C LPG OB BASS ROAD AED Defibrillator 1 3,200 3,200 C LPG PEDIATRICS - CAPE AED with Housing 1 3,200 3,200 C LPG ALLERGY Emergenncy Medical Kit 2 1,788 3,576 C LPG ENDOCRINOLOGY COPIER/FAX COMBO 1 3,739 3,739 C LEE PROFESSIONAL BILLING Copier to support LPB expansion at SB 1 3,739 3,739 C BIOMEDICAL ENGINEERING Tool Kit 1 4,000 4,000 C LPG OBSTETRICS & GYNECOLOGY Ultrasound exam bed 1 4,480 4,480 C LPG OB BASS ROAD Ultrasound exam bed 1 4,480 4,480 C SNFIST PHYSICIAN PROGRAM New Provider/Expansion Equipment-Clinical ,480 C LPG WOUND CARE PHYSICIANS Exam Light ,525 C LPG OBSTETRICS & GYNECOLOGY Defibrillator-AED 2 3,200 6,400 C LPG ALLERGY AED 2 3,200 6,400 C LPG GME PROGRAM Camera to attach to Colposcope 1 6,995 6,995 C LPG CONVENIENT CARE - PINE ISLAND Stretcher for New Procedure Room 1 7,100 7,100 C LPG CONVENIENT CARE - PINE ISLAND New Storage ROOM set Up 1 7,864 7,864 C LPG FAMILY-INTERNAL MEDICINE - OBGYN - PINE ISLAND RD Green Series Exam Light 4 8 1,007 8,056 C LPG ALLERGY Rhino-laryngo fiber scope 1 8,550 8,550 C GCHSWF PEDIATRIC SPECIALISTS Installation of stretcher and/or infusion chairs i 1 9,000 9,000 C LPG CARDIOLOGY - SANCTUARY EKG MACHINE 1 10,000 10,000 C LPG FAMILY-INTERNAL MEDICINE - COLLEGE POINT EKG Machine 1 10,000 10,000 C LPG FAMILY-INTERNAL MEDICINE - OBGYN - PINE ISLAND RD EKG machine 1 10,000 10,000 C LPG FAMILY-INTERNAL MEDICINE - COLONIAL EKG machine 1 10,000 10,000 C BIOMEDICAL ENGINEERING Safety Analyzer 1 10,000 10,000 C TRAUMA SURGEONS Driving Simulator 1 10,755 10,755 C LPG CONENIENT CARE - PAGE FIELD Exam Table 3 3,606 10,818 C LPG WOUND CARE PHYSICIANS Monitor-Patient (MP5) 1 11,750 11,750 C GCHSWF PEDS SPECIALISTS - COLLIER CLINIC ENT Patient Chair 2 6,500 13,000 C LPG FAMILY-INTERNAL MEDICINE - COLLEGE POINT Otoscopes/Opthamaloscope Equipment ,090 C LPG OBSTETRICS & GYNECOLOGY Exam light - Welch Allyn ,734 C GCHSWF PEDS SPECIALISTS - COLLIER CLINIC ENT Cabinet/ Cart 2 7,000 14,000 C LPG OB BASS ROAD NST 1 17,797 17,797 C LPG PEDIATRICS - BONITA SPOT On vision screener 2 9,000 18,000 C LPG OBSTETRICS & GYNECOLOGY ultrasound probe cleaning system 2 9,297 18,594 C LPG OB BASS ROAD Trophon system - probe cleaning system GE 2 9,298 18,596 C GCHSWF PEDS SPECIALISTS - COLLIER CLINIC Microscope- rolling 1 20,000 20,000 C LPG FAMILY-INTERNAL MEDICINE - COLLEGE POINT Otoscopes/Opthamaloscope Equipment ,570 C TRAUMA SURGEONS Endoscope 1 28,115 28,115 C BIOMEDICAL ENGINEERING Vehicle 1 50,000 50,000 C TRAUMA SURGEONS Sonosite 1 65,000 65,000 C GCHSWF PEDIATRIC SURGERY SPECIALITIES Opthamology set-up - for FMV of acquisition items 1 129, ,300 C LPG FAMILY-INTERNAL MEDICINE - OBGYN - PINE ISLAND RD voluson E10 Console 2015 U/S Machine 1 150, ,075 Total $849,672

125 FY16 Capital Budget Requests- Surgical Services Unit Total Dept # Department Capital Request Description Quantity Cost Capital Cost C OPERATING ROOM T-handle probe C STERILE PROCESSING Peg Board C SURGERY ADMINISTRATION Peg Board C OPERATING ROOM CoolVest System C OPERATING ROOM Flex Bronch Sterilization Tray C ENDOSCOPY EndoFlush Pump C OPERATING ROOM Henly Popliteal Retractor C OPERATING ROOM Mini Doppler C OPERATING ROOM Transfer Board C OPERATING ROOM Vascular Tunneler C OPERATING ROOM Long Metz - Black Handle ,222 C ANESTHESIA MRI Blade and Handles 1 1,243 1,243 C OPERATING ROOM VATS Node Grasping Forcep 1 1,363 1,363 C ENDOSCOPY Scope Buddy 1 1,433 1,433 C OPERATING ROOM Lapara-Ty 1 1,449 1,449 C OPERATING ROOM Suture Racks 1 1,500 1,500 C OPERATING ROOM Laparoscopic Right Angle Dissector ,548 C OPERATING ROOM Custom Lead Aprons ,600 C STERILE PROCESSING Utility Carts ,769 C OPERATING ROOM Cervical Kerrisons - Gold ,923 C OPERATING ROOM Long Drill Attachments ,990 C STERILE PROCESSING Super Rapid Attest Readers 1 1,995 1,995 C SURGERY ADMINISTRATION Super Rapid Attest Readers 1 1,995 1,995 C CENTRAL STERILE PROCESSING Super Rapid Attest Readers 1 1,995 1,995 C STERILE PROCESSING Super Rapid Attest Readers 1 1,995 1,995 C STERILE PROCESSING Super Rapid Attest Readers 1 1,995 1,995 C OPERATING ROOM Wilson Frame Pad Replacement ,998 C OPERATING ROOM Single CoolVest System 1 1,999 1,999 C OPERATING ROOM Laparoscopic Turkey Foot Retractor 2 1,000 2,000 C OPERATING ROOM Muscle Set 1 2,000 2,000 C OPERATING ROOM Rigid Grasper ,064 C SURGERY ADMINISTRATION Instrument Insulation Tester 2 1,038 2,076 C OPERATING ROOM Double Action Sliding Grasper 2 1,069 2,138 C STERILE PROCESSING Bioburden Tester 1 2,150 2,150 C SURGERY ADMINISTRATION Bioburden Tester 1 2,150 2,150 C CENTRAL STERILE PROCESSING Bioburden Tester 1 2,150 2,150 C STERILE PROCESSING Bioburden Tester 1 2,150 2,150 C STERILE PROCESSING Bioburden Tester 1 2,150 2,150 C SURGERY ADMINISTRATION Washer Cart Wheels ,220 C OPERATING ROOM Low Anterior Tray - Kowalsky 1 2,300 2,300 C OPERATING ROOM NLDO Set 1 2,400 2,400 C OPERATING ROOM Cataract Set 1 2,500 2,500 C OPERATING ROOM Biopsy Forcep ,685 C OPERATING ROOM Ortho Instrument Carts ,749 C OPERATING ROOM Battery-Operated Headlight 1 2,995 2,995 C OPERATING ROOM Carpal Tunnel Instruments with Tray 1 3,000 3,000 C OPERATING ROOM Metal Arthroscopy Cannulas ,064 C OPERATING ROOM Laparoscopic Needle Drivers 1 3,132 3,132 C OPERATING ROOM Nerve Hooks ,220 C OPERATING ROOM Mini Doppler ,400 C PERI-ANESTHESIA CARE UNIT Mini Doppler ,400 C PERI-ANESTHESIA CARE UNIT Mini Doppler ,400 C OPERATING ROOM Fifer Innomed Hip Tray 1 3,500 3,500 C OPERATING ROOM Integrated Room Cable Kit Upgrade 2 1,860 3,720 C ENDOSCOPY C-Arm Wireless Upgrade 1 3,800 3,800 C OPERATING ROOM Suture Passer Handle ,876 C OPERATING ROOM Rolling Lead Wall 1 3,892 3,892 C ANESTHESIA EZ Stim II Nerve Stimulators ,250 C STERILE PROCESSING Utility Carts ,422 C OPERATING ROOM Bipolar Forceps 3 1,498 4,494 C OPERATING ROOM Kelly Wick - Short 6, 7, 8 1 4,500 4,500 C ENDOSCOPY Procedure Display 1 4,600 4,600 C OPERATING ROOM Arm Table with clamps 2 2,357 4,714 C OPERATING ROOM Ejector Kerrisons 1 5,000 5,000 C OPERATING ROOM Foraminotomy Kerrisons 3 1,730 5,190 C STERILE PROCESSING Eye Wash Stataion 1 5,500 5,500 C STERILE PROCESSING Hand Wash Sink 1 5,500 5,500 C STERILE PROCESSING Eye Wash Station 1 5,500 5,500 C PERI-ANESTHESIA CARE UNIT Hovermat Mattress 3 1,905 5,715 C ANESTHESIA Anesthesia Locking Carts 3 2,000 6,000 C OPERATING ROOM Mysoure Scope XL 1 6,500 6,500 C OPERATING ROOM Hovermats 2 3,258 6,516 C OPERATING ROOM Micro Spetzler Tray 1 6,817 6,817 C OPERATING ROOM Micro Spetzler Tray 1 6,817 6,817 C PERI-ANESTHESIA CARE UNIT Transport Monitors 1 7,000 7,000 C OPERATING ROOM Auxiliary Laparoscopic Monitor 1 7,023 7,023 C OPERATING ROOM Pacemaker External per Biomed 1 7,045 7,045 C OPERATING ROOM Pacemaker - External Temp per Biomed 1 7,045 7,045 C SURGERY ADMINISTRATION Cannulated Inspection Scope 2 3,640 7,279 C OPERATING ROOM Reducer and T-Handle 2 3,656 7,312 C OPERATING ROOM Hovermat Mattress 1 7,336 7,336 C ENDOSCOPY PillCam Upgrade 1 7,350 7,350

126 FY16 Capital Budget Requests- Surgical Services Unit Total Dept # Department Capital Request Description Quantity Cost Capital Cost C OPERATING ROOM Reciprocating saws 1 7,475 7,475 C OPERATING ROOM Tray - Universal Lap 1 7,500 7,500 C STERILE PROCESSING Workstation 1 8,703 8,703 C PERI-ANESTHESIA CARE UNIT Bladder Scanner 1 8,800 8,800 C ENDOSCOPY Rectal Biopsy Set 1 9,500 9,500 C STERILE PROCESSING Shelving Carts ,000 C ENDOSCOPY Endo Leak Tester 1 10,000 10,000 C ANESTHESIA Flexible Intubation Scope with Monitor - Refurbish 1 10,000 10,000 C ENDOSCOPY Procedure Carts 2 5,102 10,204 C ANESTHESIA MMS Cardules 1 10,530 10,530 C OPERATING ROOM Swiss Lithoclast Pneumatic Handpiece 2 5,450 10,900 C OPERATING ROOM Nephroscope 2 5,563 11,126 C OPERATING ROOM Neuro Equipment Cart 3 3,849 11,548 C OPERATING ROOM 9900 C-ARM Monitor Upgrade 1 11,885 11,885 C OPERATING ROOM Metrx Tubular Retractor Set 2 6,000 12,000 C OPERATING ROOM Laparoscopic Lenses 3 4,000 12,000 C OPERATING ROOM Small Bone Extras 2 6,000 12,000 C PERI-ANESTHESIA CARE UNIT Transport Monitors 1 12,500 12,500 C OPERATING ROOM MIS Dural Repair Set 1 12,526 12,526 C OPERATING ROOM Swiss Lithoclast Ultrasonic Handpiece 2 6,300 12,600 C OPERATING ROOM Biotenodeis Tray 2 6,499 12,998 C OPERATING ROOM Bolt Cutters 1 13,000 13,000 C OPERATING ROOM Synthes Screw Removal Tray 1 13,325 13,325 C OPERATING ROOM Aquiflex Pump 1 13,500 13,500 C OPERATING ROOM Novasure Unit 1 13,500 13,500 C OPERATING ROOM Aquiflex Pump 1 13,500 13,500 C OPERATING ROOM Novasure with stand 1 13,500 13,500 C PERI-ANESTHESIA CARE UNIT Cribs 2 7,553 15,106 C OPERATING ROOM Neptune 2 Ultra 1 16,000 16,000 C OPERATING ROOM Arthroscopy tray 2 8,003 16,006 C OPERATING ROOM Complete Thoracoscopy Tray 1 16,524 16,524 C OPERATING ROOM BioLabral Tray 1 17,340 17,340 C ENDOSCOPY C-Arm Monitor Upgrade 1 17,800 17,800 C OPERATING ROOM C-Arm SBC Computer Upgrade 1 18,000 18,000 C OPERATING ROOM Force Triad 1 19,000 19,000 C OPERATING ROOM BFW Headlight with video 1 19,000 19,000 C OPERATING ROOM ENT Microscope 1 20,000 20,000 C OPERATING ROOM Force Triad 1 20,000 20,000 C OPERATING ROOM Laparoscopic Infant Tray 1 20,000 20,000 C OPERATING ROOM Choledochoscope 1 20,000 20,000 C ANESTHESIA Syringe Pump per Biomed 4 5,000 20,000 C ENDOSCOPY Auto Lith 1 20,500 20,500 C OPERATING ROOM DORO Radiolucent Neurosurgical Equipment 1 20,725 20,725 C OPERATING ROOM Bankhart, Modified Tray 3 7,500 22,500 C OPERATING ROOM Pediatric FESS Tray 1 22,705 22,705 C OPERATING ROOM Pediatric Sinus Set 1 22,705 22,705 C OPERATING ROOM Continuous Flow/Gyrus Tray 2 11,377 22,754 C OPERATING ROOM IM Pressure Reamers 18-22mm 1 23,000 23,000 C OPERATING ROOM Myosure units with scopes 2 11,500 23,000 C OPERATING ROOM Plasma Kinetic Superpulse Generator 1 23,793 23,793 C OPERATING ROOM 9900 C-Arm Monitor Upgrade 2 11,995 23,990 C OPERATING ROOM C-arm Monitor Upgrade 2 11,995 23,990 C PERI-ANESTHESIA CARE UNIT Patient stretchers 4 6,200 24,800 C OPERATING ROOM RF Lesion Generator 1 24,900 24,900 C ANESTHESIA Infus O.R. Pump 5 5,000 25,000 C ENDOSCOPY Light Sources 2 12,600 25,200 C OPERATING ROOM Cystoscopy Trays 2 12,638 25,276 C OPERATING ROOM ESU per Biomed 2 13,000 26,000 C ENDOSCOPY ESU 2 13,700 27,400 C OPERATING ROOM Sonosite Ultrasound 1 27,500 27,500 C OPERATING ROOM Allen stirrups with cart 2 14,374 28,748 C ANESTHESIA Pediatric TTE Probes Upgrade 1 29,542 29,542 C OPERATING ROOM GYN/Onc LAVH Trays 1 30,000 30,000 C OPERATING ROOM Laparoscopic Toddler Tray 1 30,000 30,000 C ANESTHESIA Syringe Pump per Biomed 6 5,000 30,000 C OPERATING ROOM Cystoscopy Trays 2 15,000 30,000 C OPERATING ROOM Laparoscopic video tower WISE HDTV Transmitter 5 6,026 30,130 C OPERATING ROOM Crossfire 2 with footswitch 3 10,500 31,500 C ENDOSCOPY Nitrous Oxide Patient-Controlled Anesthesia System 4 8,000 32,000 C OPERATING ROOM Odontoid Screw Tray 1 33,000 33,000 C OPERATING ROOM Laparoscopic Lenses 1 34,224 34,224 C OPERATING ROOM Tourniquet per Biomed 3 11,509 34,526 C ENDOSCOPY Gastroscope 1 35,280 35,280 C OPERATING ROOM 9800 C-Arm Monitor Upgrade 2 17,800 35,600 C OPERATING ROOM C-Arm Monitor Upgrade 2 17,800 35,600 C ENDOSCOPY Duodenoscope 1 36,100 36,100 C ENDOSCOPY Flouro Table 1 36,347 36,347 C STERILE PROCESSING Decontam Sink/Sonic 1 38,544 38,544 C CENTRAL STERILE PROCESSING Decontam Sink/Sonic 1 38,544 38,544 C STERILE PROCESSING Decontam Sink/Sonic 1 38,544 38,544 C STERILE PROCESSING Decontam Sink/Sonic 1 38,544 38,544 C ENDOSCOPY Pedi Colonoscopes 1 38,640 38,640 C ANESTHESIA Propofol Pumps 8 5,000 40,000

127 FY16 Capital Budget Requests- Surgical Services Unit Total Dept # Department Capital Request Description Quantity Cost Capital Cost C OPERATING ROOM Lami B Kerrisons 9 4,512 40,609 C OPERATING ROOM Acufex Arthroscopy trays 2 21,000 42,000 C ENDOSCOPY Endoscopy Processors 2 21,840 43,680 C OPERATING ROOM Explant Osteotomes 1 47,000 47,000 C OPERATING ROOM ESU per Biomed 4 12,000 48,000 C OPERATING ROOM Neptune 2 Ultra 3 16,000 48,000 C OPERATING ROOM Rotating Endoscopic Camera Heads 3 16,100 48,300 C ENDOSCOPY Anorectal Manometry System Upgrade 1 49,350 49,350 C OPERATING ROOM NeoProbe 1 49,500 49,500 C ENDOSCOPY Esophageal Manometry Upgrade 1 51,695 51,695 C ANESTHESIA C-Mac Video System 1 52,469 52,469 C STERILE PROCESSING Sterrad NX 1 55,000 55,000 C STERILE PROCESSING Sterrad NX 1 55,000 55,000 C STERILE PROCESSING Sterrad NX 1 55,000 55,000 C OPERATING ROOM Tourniquets per Biomed 5 11,509 57,543 C PERI-ANESTHESIA CARE UNIT MMS Cardules 10 5,771 57,710 C OPERATING ROOM Cyn Frame 1 60,000 60,000 C OPERATING ROOM ENT Mobile Work Station 1 65,000 65,000 C ANESTHESIA Sonosite 1 70,000 70,000 C ANESTHESIA Sonosite EDGE 1 70,000 70,000 C ENDOSCOPY Gastroscope 2 35,280 70,560 C OPERATING ROOM Minimally Invasive Tray - Long and Short 2 35,340 70,680 C OPERATING ROOM ESUs Dept/Biomed 6 12,167 73,000 C OPERATING ROOM Surgical Light Upgrade 2 37,000 74,000 C ENDOSCOPY Colonscope 2 38,640 77,280 C OPERATING ROOM Tourniquets 7 11,509 80,563 C ANESTHESIA Ventialtor - iflow 1 95,000 95,000 C ENDOSCOPY Endoscopes 3 38, ,000 C OPERATING ROOM Holmium Laser 1 121, ,000 C OPERATING ROOM Intra-Aortic Balloon Pump 2 62, ,000 C ENDOSCOPY Barxx RFA Ablation System 1 131, ,000 C OPERATING ROOM Ceiling-Mounted Video Upgrade 1 137, ,489 C ENDOSCOPY Olympus Video Tower 3 45, ,848 C OPERATING ROOM Cordless 4 Driver 8 18, ,000 C OPERATING ROOM 1188 Stryker Laparoscopic Video Components 2 75, ,000 C SURGERY ADMINISTRATION Case Carts 1 167, ,750 C OPERATING ROOM Vitrector 1 170, ,000 C STERILE PROCESSING Washer 1 170, ,014 C OPERATING ROOM Laparoscopic Video Equipment 2 89, ,736 C OPERATING ROOM Alpha 7 Surgical US Console with Transducers 1 196, ,170 C OPERATING ROOM Camera and Cord Trays 6 34, ,000 C SURGERY ADMINISTRATION Instrument Container Upgrades 250 1, ,000 C ENDOSCOPY ESU/Argon/Water Flusher 3 84, ,000 C OPERATING ROOM OPMI Pentero , ,000 C PERI-ANESTHESIA CARE UNIT Central Monitoring Station 1 326, ,000 C OPERATING ROOM Olympus 3D Colonoscope System 1 360, ,000 Total $7,316,583

128 FY16 Capital Budget Requests- Radiology Unit Total Dept # Department Capital Request Description Quantity Cost Capital Cost C RADIOLOGY - ULTRASOUND Supply Cart 1 1,232 1,232 C RADIOLOGY - NUCLEAR MEDICINE Eye Shield 1 2,000 2,000 C RADIOLOGY - NUCLEAR MEDICINE Flood Source 1 2,300 2,300 C ENDOVASCULAR LAB Kyphoplasty Arm Rest 1 3,500 3,500 C RADIOLOGY - ULTRASOUND Trans Vag Probe 1 4,000 4,000 C RADIOLOGY - SPEC PROCEDURES Accuvein with Stand 1 4,200 4,200 C RADIOLOGY - DIAGNOSTICS Peds Immobilization Chair 1 4,500 4,500 C RADIOLOGY - DIAGNOSTICS Peds Immobilization Chair 1 4,500 4,500 C RADIOLOGY - DIAGNOSTICS DVD Recorder for X-ray R&F 2 1 5,000 5,000 C RADIOLOGY - MRI MRI Sound System 1 11,000 11,000 C RADIOLOGY - MRI MRI Sound System 1 11,000 11,000 C RADIOLOGY - MRI istat 1 11,180 11,180 C RADIOLOGY - DIAGNOSTICS DR Plate Protectors 6 2,100 12,600 C RADIOLOGY - DIAGNOSTICS DR Plate Protectors 6 2,100 12,600 C RADIOLOGY - DIAGNOSTICS DR Plate Protectors 6 2,100 12,600 C RADIOLOGY - DIAGNOSTICS DR Plate Protectors 6 2,100 12,600 C RADIOLOGY - NUCLEAR MEDICINE Thyroid Probe 1 25,000 25,000 C RADIOLOGY - NUCLEAR MEDICINE Thyroid Probe 1 25,000 25,000 C RADIOLOGY - SPEC PROCEDURES Patient Monitor 1 30,250 30,250 C RADIOLOGY - DIAGNOSTICS DR Detector 1 35,000 35,000 C RADIOLOGY - DIAGNOSTICS DR Detector 1 35,000 35,000 C RADIOLOGY - DIAGNOSTICS C-Arm Wireless Upgrade 10 3,800 38,000 C RADIOLOGY - NUCLEAR MEDICINE Neoprobe 1 42,000 42,000 C RADIOLOGY - MRI Med Rad Injector 1 55,000 55,000 C RADIOLOGY - MRI Med Rad Injector 1 55,000 55,000 C RADIOLOGY - MRI Med Rad Injector 1 55,000 55,000 C RADIOLOGY - DIAGNOSTICS LCD Monitors for model 9900 C-arms 5 12,000 60,000 C RADIOLOGY - MRI Door Ferromagnetic Detector 1 65,000 65,000 C RADIOLOGY - SPEC PROCEDURES Patient Monitor 2 36,900 73,800 C RADIOLOGY - SPEC PROCEDURES Ray Safe System for Angio Rooms 2 39,500 79,000 C ENDOVASCULAR LAB Sonosite 1 80,000 80,000 C RADIOLOGY - ULTRASOUND Sonosite 1 80,000 80,000 C RADIOLOGY - SPEC PROCEDURES Monitor-Patient 3 28,334 85,002 C RADIOLOGY - DIAGNOSTICS LCD Monitors for model 9800 C-arms 6 18, ,000 C RADIOLOGY - MRI Cinemavision 2 55, ,000 C RADIOLOGY - SPEC PROCEDURES Microwave Ablation 1 112, ,500 C RADIOLOGY - ULTRASOUND Ultrasound Unit 1 138, ,000 C RADIOLOGY - ULTRASOUND Ultrasound Unit 1 138, ,000 C RADIOLOGY - DIAGNOSTICS CCH Room 1 DR Upgrade 1 150, ,000 C RADIOLOGY - DIAGNOSTICS C-Arm 1 228, ,000 C RADIOLOGY - DIAGNOSTICS Small DR Detector 4 70, ,000 C RADIOLOGY - DIAGNOSTICS Canon DR Portables 2 150, ,000 C RADIOLOGY - MRI Ambient Lighting 2 151, ,000 C RADIOLOGY - DIAGNOSTICS HP ED Room , ,000 C RADIOLOGY - NUCLEAR MEDICINE Dual Head Nuclear Camera with extra physician work 2 397, ,000 C RADIOLOGY - NUCLEAR MEDICINE SPECT/CT 3 316, ,000 C RADIOLOGY - MRI 1.5 T MRI 1 2,300,000 2,300,000 Total $7,495,364

129 FY16 Capital Budget Requests- Contingency Unit Total Dept # Department Capital Request Description Quantity Cost Capital Cost C CAO CONTINGENCY-LMH CAO Contingency- LMH 1 50,000 50,000 C CAO CONTINGENCY-GCMC CAO Contingency-GCMC 1 50,000 50,000 C CAO CONTINGENCY-HPMC CAO Contingency-HPMC 1 50,000 50,000 C CAO CONTINGENCY-CCH CAO Contingency-CCH 1 50,000 50,000 C CAO CONTINGENCY-LPG CAO Contingency-LPG 1 50,000 50,000 C CAO CONTINGENCY-GCHSWF CAO Contingency-GCHSWF 1 50,000 50,000 C SYSTEM CONTINGENCY System Contingency 1 900, ,000 Total $1,200,000

130 FY16 Capital Budget Requests- Facilities Unit Total Dept # Department Capital Request Description Quantity Cost Capital Cost C CCH MAJOR FACILITIES MORGUE COOLER REFRIGERATION SYSTEM 1 5,900 5,900 C LPG/OP MAJOR FACILITIES MINI SPLIT FOR LPG CARDIO BASS 1 8,000 8,000 C LMH MAJOR FACILITIES GENERAL LAB FACILITIES MODIFICATIOND FOR NEW CHEMI 1 10,000 10,000 C GCMC MAJOR FACILITIES PHARMACY USP ,000 10,000 C GCMC MAJOR FACILITIES SOFTWARE UPGRADE FOR NURSE CALL 1 10,000 10,000 C GCMC MAJOR FACILITIES GENERAL LAB FACILITIES MODIFICATIONS FOR NEW CHEMI 1 10,000 10,000 C HPMC MAJOR FACILITIES GENERAL LAB FACILITY MODIFICATIONS FOR NEW CHEMIST 1 10,000 10,000 C CCH MAJOR FACILITIES 2 ICE MACHINES 4W 1 11,000 11,000 C CCH MAJOR FACILITIES 2 ICE MACHINES OB 1 11,000 11,000 C HPMC MAJOR FACILITIES REPLACE CHAIN AND NON RETURN VALVES FOR BOILERS 1& 1 12,000 12,000 C CCH MAJOR FACILITIES SUPPLY FAN ,000 14,000 C LPG/OP MAJOR FACILITIES EMPLOYMENT CENTER 2 UNITS 1 15,000 15,000 C GCMC MAJOR FACILITIES SOFTWARE UPGRADE FOR SWISS LOG 1 16,000 16,000 C CCH MAJOR FACILITIES CONDENSATE RETURN PUMPS AND TANK A ,000 18,000 C LMH MAJOR FACILITIES AHU ,000 20,000 C LMH MAJOR FACILITIES WEST WING AHU ,000 20,000 C LMH MAJOR FACILITIES AHU ,000 20,000 C LMH MAJOR FACILITIES MOC ELEVATOR AHU ,000 20,000 C LMH MAJOR FACILITIES RTU ,000 20,000 C GCMC MAJOR FACILITIES AHU 6&7 FAN WALL RETROFIT 1 20,000 20,000 C HPMC MAJOR FACILITIES AHU 23 PODS B&C 1 20,000 20,000 C HPMC MAJOR FACILITIES FCU 5 IS 1 20,000 20,000 C HPMC MAJOR FACILITIES AHU 25 4TH FL 1 20,000 20,000 C HPMC MAJOR FACILITIES AHU ,000 20,000 C HPMC MAJOR FACILITIES AHU ,000 20,000 C CCH MAJOR FACILITIES NITROGEN/NITROUS OXIDE CONTROL PANEL 1 22,000 22,000 C CCH MAJOR FACILITIES ED PHASE 5B & 5C MODULAR CASEWORK 1 25,000 25,000 C CCH MAJOR FACILITIES OR SWING DOORS 1 25,000 25,000 C LMH MAJOR FACILITIES BOILER FEED PUMPS/MOTORS 1 30,000 30,000 C LMH MAJOR FACILITIES ED AND TRIAGE NURSE CALL REPLACEMENT 1 30,000 30,000 C LMH MAJOR FACILITIES REPLACEMENT OF IT AIR CONDITIONING EQUIPMENT IN DA 1 30,000 30,000 C CCH MAJOR FACILITIES RADIATORS FOR GENERATORS 1&2 1 32,000 32,000 C CCH MAJOR FACILITIES BACK DOOR BY MORGUE 1 32,000 32,000 C HPMC MAJOR FACILITIES TOWER CONDENSER PUMP 1 40,000 40,000 C CCH MAJOR FACILITIES FIRE ALARM CRT REPLACEMENT 1 45,000 45,000 C LPG/OP MAJOR FACILITIES PROPERTY MANAGEMENT LIFE SAFETY UPDATES 1 45,000 45,000 C LMH MAJOR FACILITIES Pharmacy USP ,000 50,000 C GCMC MAJOR FACILITIES HIM RENOVATIONS 1 50,000 50,000 C GCMC MAJOR FACILITIES 5 NEW AIR CONDITIONER UNITS FOR MOB 1 50,000 50,000 C GCMC MAJOR FACILITIES EXPANSION JOINT REPLACEMENT 1 50,000 50,000 C HPMC MAJOR FACILITIES DINING AREA PUBLIC TOILETS 1 50,000 50,000 C HPMC MAJOR FACILITIES NURSE CALL REPLACEMENTS OLD ORS 1 50,000 50,000 C GCMC MAJOR FACILITIES SOUTH TOWER ELEVATORS 1 60,000 60,000 C LPG/OP MAJOR FACILITIES LPG CALL CENTER CENTER EXPANSION 1 67,300 67,300 C LMH MAJOR FACILITIES Diesel Fire Tank Fuel Tank R&R 1 80,000 80,000 C HPMC MAJOR FACILITIES 2 CHILLED WATER ZONE PUMPS 1 80,000 80,000 C HPMC MAJOR FACILITIES PHARMACY USP ,000 80,000 C CCH MAJOR FACILITIES PHARMACY USP ,000 80,000 C LMH MAJOR FACILITIES ELECTRICAL DESIGN FOR GEN SET 1&2 RUSSELL GEAR 1 100, ,000 C SYSTEM MAJOR FACILITIES FURNITURE FROM ROUTINE CAPITAL REQUESTS 1 107, ,386 C LMH MAJOR FACILITIES UTILITY PIPE REPLACEMENT 1 125, ,000 C LMH MAJOR FACILITIES NORTH TOWER 3RD 3 1/2 ROOF REPLACEMENT 1 125, ,000 C SYSTEM MAJOR FACILITIES DSX REQUESTS 1 125, ,000 C LMH MAJOR FACILITIES Radiology Angio Suite 1 150, ,000 C LMH MAJOR FACILITIES 8 SICU FCUS 1 150, ,000 C LMH MAJOR FACILITIES 3 N PATIENT ROOM FCU'S 1 150, ,000 C HPMC MAJOR FACILITIES VACUUM PUMP 1 150, ,000 C HPMC MAJOR FACILITIES MED AIR PUMP 1 150, ,000 C CCH MAJOR FACILITIES ADDITIONAL FULE TANK 1 150, ,000 C CCH MAJOR FACILITIES MOTOR CONTROL CENTERS 1,2, AND , ,000 C LMH MAJOR FACILITIES Surgery Services Endo Phase III 1 175, ,000 C HPMC MAJOR FACILITIES F&N NSA OFFICES 1 175, ,000 C GCMC MAJOR FACILITIES HEART CENTRAL EXPANSION ND COMMAND CENTER RELOCATI 1 196, ,414 C GCMC MAJOR FACILITIES COOLING TOWER RETROFIT TO GEAR BOX 1 200, ,000 C CCH MAJOR FACILITIES PLANT OPS AND FACILITIES BUILDING ROOF REPLACE 1 200, ,000 C CCH MAJOR FACILITIES CLINICAL LAB PHASE , ,000 C SYSTEM MAJOR FACILITIES ADA UPGRADES 1 250, ,000 C HPMC MAJOR FACILITIES PATHOLOGY RENOVATIONS 1 250, ,000 C CCH MAJOR FACILITIES FACILITIES RENOVATION 1 250, ,000 C WELLNESS CENTER OF CAPE CORAL Roof Replacement 1 285, ,000 C SYSTEM MAJOR FACILITIES SITE WORK IMPROVEMENTS 1 300, ,000 C SYSTEM MAJOR FACILITIES SYSTEM MOVES 1 300, ,000 C HPMC MAJOR FACILITIES NUCLEAR RADIOLOGY EXPANSION 1 300, ,000 C SYSTEM MAJOR FACILITIES EXTERNAL/INTERNAL SIGNAGE 1 377, ,000 C SYSTEM MAJOR FACILITIES CODE COMPLIANCE/LIFE SAFETY 1 400, ,000 C HPMC MAJOR FACILITIES CEP ROOF REPLACEMENT 1 425, ,000 C CCH MAJOR FACILITIES AHU 7 REHEAT AND FAN COIL CONTROLS TO DDC 1 450, ,000 C SYSTEM MAJOR FACILITIES ENERGY MANAGEMENT/BUILDING CONTROLS 1 500, ,000 C LMH MAJOR FACILITIES CHILLER , ,000 C HPMC MAJOR FACILITIES ELEVATOR 8 NEW 1 700, ,000 C SYSTEM MAJOR FACILITIES INFRASTRUCTURE 1 750, ,000 C HPMC MAJOR FACILITIES ELEVATOR MODERNIZATIN 7, 9, , ,000

131 FY16 Capital Budget Requests- Facilities Unit Total Dept # Department Capital Request Description Quantity Cost Capital Cost C LPG/OP MAJOR FACILITIES LPG/OUTPATIENT RENOVATIONS/MOVES 1 1,325,000 1,325,000 C HPMC MAJOR FACILITIES 4 WEST RENOVATION 1 1,400,000 1,400,000 Total $14,000,000

132 FY16 Capital Budget Requests- IT Unit Total Dept # Department Capital Request Description Quantity Cost Capital Cost C IT CAPITAL BUDGET Network/Power Installation for Pyxis Expansion 1 3,800 3,800 C IT CAPITAL BUDGET Chemistry Analyzer Interface 1 12,500 12,500 C IT CAPITAL BUDGET Enterprise Fax Server Solution 1 15,000 15,000 C IT CAPITAL BUDGET OBIX Upgrade to Support Patient ID Number 1 17,000 17,000 C IT CAPITAL BUDGET Telecommuting Thin Client 1 18,000 18,000 C IT CAPITAL BUDGET Implementation of Clinical Hub for Student Trackin 1 20,000 20,000 C IT CAPITAL BUDGET Expansion of New Video Conferencing to New Locatio 1 21,000 21,000 C IT CAPITAL BUDGET Backup Dictation System 1 50,000 50,000 C IT CAPITAL BUDGET FAST PASS Software Expansion-HPMC & CCH 1 51,706 51,706 C IT CAPITAL BUDGET Replace Trendstar Hardware/Software 1 55,000 55,000 C IT CAPITAL BUDGET OneStaff License Increase 1 56,194 56,194 C IT CAPITAL BUDGET Blood Bank Interface Engine Upgrade 1 65,000 65,000 C IT CAPITAL BUDGET E-Signature Forms/Consents 1 70,625 70,625 C IT CAPITAL BUDGET Cisco Agent Licenses/Subscriptions-LPG Call Center 1 71,145 71,145 C IT CAPITAL BUDGET Cisco Agent Licenses/Subscriptions-Central Schedul 1 71,145 71,145 C IT CAPITAL BUDGET Replace 1D Medication Bard Code Scanners- GCMC 1 75,000 75,000 C IT CAPITAL BUDGET Telephony Server Capacity 1 90,000 90,000 C IT CAPITAL BUDGET Credit Card Payment Gateway Integration w/ EPIC 1 100, ,000 C IT CAPITAL BUDGET Patient Safety Reporting System 1 100, ,000 C IT CAPITAL BUDGET Micros Cash Register- GCMC 1 112, ,000 C IT CAPITAL BUDGET Upgrade Diver Server Environment 1 122, ,000 C IT CAPITAL BUDGET New Workstations/Laptops 1 125, ,000 C IT CAPITAL BUDGET Handheld Devices for Positive Phlebotomy Patient I 1 150, ,000 C IT CAPITAL BUDGET Medicalis/ACR Select Implementation 1 150, ,000 C IT CAPITAL BUDGET Ebuilder Construction Mgmnt Software 1 150, ,000 C IT CAPITAL BUDGET GlucoStabilizer Implementation 1 158, ,620 C IT CAPITAL BUDGET Network Access Control 1 175, ,000 C IT CAPITAL BUDGET Webcam for Patient Photos for Registration Service 1 178, ,000 C IT CAPITAL BUDGET 3D Radiology Imaging Software Upgrade 1 179, ,000 C IT CAPITAL BUDGET PaceArt Software for Cardiology Svcs 1 200, ,000 C IT CAPITAL BUDGET Holter Monitor Replacement 1 200, ,000 C IT CAPITAL BUDGET PSO/Incident Reporting/Risk Mgmnt System Replaceme 1 250, ,000 C IT CAPITAL BUDGET Fair Warning Patient Privacy Software 1 255, ,398 C IT CAPITAL BUDGET Replace PolyCom Video Conferencing 1 275, ,000 C IT CAPITAL BUDGET Supply Chain Touch Screen Replacement/Upgrade 1 323, ,736 C IT CAPITAL BUDGET EPIC- Additional Cache License 1 340, ,560 C IT CAPITAL BUDGET Infection Control Data Mgmnt System 1 375, ,000 C IT CAPITAL BUDGET EPIC- Inpatient Licenses 1 404, ,200 C IT CAPITAL BUDGET General Requests for OA/Workstations 1 452, ,120 C IT CAPITAL BUDGET Population Health for Lee PHO 1 500, ,000 C IT CAPITAL BUDGET EPIC- Ambulatory Licenses 1 751, ,700 C IT CAPITAL BUDGET Add Dragon VM Licenses 1 1,000,000 1,000,000 C IT CAPITAL BUDGET OA Workstation Refresh 1 1,229,300 1,229,300 C IT CAPITAL BUDGET IT Infrastructure 1 4,180,251 4,180,251 C IT CAPITAL BUDGET GEAC Replacement- HR/Financial 1 6,500,000 6,500,000 Total $19,700,000

133 FY16 Capital Budget Requests- New Growth/Program Development Unit Total Dept # Department Capital Request Description Quantity Cost Capital Cost C NEW GROWTH/PROGRAM DEVELOPMENT LeeSar Culinary Solutions/SPD Expansion 1 3,000,000 3,000,000 C NEW GROWTH/PROGRAM DEVELOPMENT Strategic Projects and Programs- System wide 1 24,301,054 24,301,054 Total $27,301,054

134 FY16 Capital Budget Requests- Pending Philanthropic Funding Unit Total Dept # Department Capital Request Description Quantity Cost Capital Cost C RESPIRATORY CARE Transport Ventilator 1 27,943 27,943 C PERI-ANESTHESIA CARE UNIT Transport Monitors 1 11,250 11,250 C OPERATING ROOM Temporary Pacers 6 7,045 42,270 C LABOR & DELIVERY Infant Warmer 1 26,000 26,000 C SICU NURSING Flex intubation video endoscope system 1 28,115 28,115 C MOM / BABY Panda Warmer 2 26,000 52,000 C OPERATING ROOM DaVinci Surgical Robot 1 2,500,000 2,500,000 Total $2,687,578

135 BOARD OF DIRECTORS RECOMMENDED ACTION FOR BOARD APPROVAL (Action includes Acceptance, Approval, Adoption, etc) Keep form to one page, to: by Noon eight (8) days PRIOR to presenting. DATE: September 24, 2015 LEGAL SERVICE REVIEW? YES NO_X SUBJECT: FY 2016 Room Rates REQUESTOR & TITLE: Ben Spence, CFO PREVIOUS BOARD ACTION ON THIS ITEM (IF ANY) (justification and/or background for recommendations internal groups which support the recommendation i.e. SLC, Operating Councils, PMTs, etc.) None SPECIFIC PROPOSED MOTION: To approve the FY 2016 Acute Care Hospital room rates which provide for a 5% increase over current rates. This request supports the following Strategic Initiative(s): PROS TO RECOMMENDATION CONS TO RECOMMENDATION LIST AND EXPLAIN ALTERNATIVES CONSIDERED FINANCIAL IMPLICATIONS Budgeted Non-Budgeted (including cash flow statement, projected cash flow, balance sheet and income statement) OPERATIONAL IMPLICATIONS (including FTEs, facility needs, etc.) SUMMARY Attached you will find the FY 2016 Room Rate Schedule. BOD/Forms/Reporting Forms/Board (Action) Reporting Form revised 4/4/13 cs

136 LEE MEMORIAL HEALTH SYSTEM OPERATING BUDGET 2016 ACUTE CARE HOSPITALS ROOM RATE COMPARISON Current Proposed LMHS LEVEL OF CARE LMHS LMHS Increase ROUTINE PRIVATE $ 1,190 $ 1,250 5% ROUTINE SEMI PRIVATE $ 1,190 $ 1,250 5% PROGRESSIVE CARE - SURG $ 1,969 $ 2,067 5% PROGRESSIVE CARE - MED $ 1,969 $ 2,067 5% PROGRESSIVE CARE - NEURO $ 1,969 $ 2,067 5% INTENSIVE CARE - MEDICAL $ 2,997 $ 3,147 5% INTENSIVE CARE - SURGICAL $ 2,997 $ 3,147 5% INTENSIVE CARE - OPEN HEART $ 2,997 $ 3,147 5% OBSTETRICS $ 1,213 $ 1,274 5% NURSERY $ 1,008 $ 1,058 5% NICU $ 2,825 $ 2,966 5% PEDIATRICS ROUTINE $ 1,472 $ 1,546 5% PEDIATRICS PROGRESSIVE $ 1,969 $ 2,067 5% PEDIATRICS INTENSIVE $ 2,996 $ 3,146 5%

137 Lee Memorial Health System Board of Directors Financial Update For Month Ending 8/31/15 Presented 9/24/15

138 System Adjusted Admits

139 Percent of Total Operating Revenue for month ending 08/31/15

140 Percent of Total Operating Revenue for 11 months ended 08/31/15

141 Net Revenue per CMAA for the month ending 08/31/15 FY 2015

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