Chairman Estrada asked the Secretary to call upon the registered public speakers. The Secretary responded that there were none present.

Minutes of the meeting of the Finance Committee of the Board of Directors of the Cook County Health and Hospitals System held Friday, April 21, 2017 at the hour of 8:30 A.M., at 1900 W. Polk Street, in the Second Floor Conference Room, Chicago, Illinois. I. Attendance/Call to Order Chairman Estrada called the meeting to order. Present: Chairman Ric Estrada and Director Mary B. Richardson-Lowry (2) Directors Mary Driscoll, RN, MPH and Ada Mary Gugenheim Steven Scheer (non-director Member) Present Telephonically: Board Chairman M. Hill Hammock (ex-officio) Absent: Director Hon. Jerry Butler (1) Additional attendees and/or presenters were: Ekerete Akpan Chief Financial Officer Douglas Elwell Deputy Chief Executive Officer, Finance and Strategy Charles Jones Director of Strategic Sourcing and Supply Chain Management Jeff McCutchan Interim General Counsel Deborah Santana Secretary to the Board John Jay Shannon, MD Chief Executive Officer II. Public Speakers Chairman Estrada asked the Secretary to call upon the registered public speakers. The Secretary responded that there were none present. III. Action Items A. Minutes of the Finance Committee Meeting, February 17 March 24, 2017 Director Richardson-Lowry, seconded by Chairman Estrada, moved to accept the minutes of the Finance Committee Meeting of March 24, 2017. THE MOTION CARRIED UNANIMOUSLY. B. Contracts and Procurement Items (Attachment #1) Charles Jones, Director of Strategic Sourcing and Supply Chain Management, provided an overview of the requests presented for the Committee s consideration. The Committee reviewed and discussed the requests. With regard to request numbers 8 and 9, Director Richardson-Lowry inquired whether a physician team or technical consult was used to affirm the sole source award. Dr. John Jay Shannon, Chief Executive Officer, responded affirmatively; he stated that many of these types of matters come up through the Value Analysis process. That process is predominantly composed of a physician clinical team, those who are using the pieces, along with a Value Analysis person who lives within procurement and coordinates that team. Page 1 of 32

Minutes of the Meeting of the Finance Committee Friday, April 21, 2017 Page 2 III. Action Items B. Contracts and Procurement Items (continued) Mr. Scheer recused himself with regard to request number 5. Director Richardson-Lowry, seconded by Chairman Estrada, moved the approval of request numbers 1 through 11, subject to completion of review by Contract Compliance, where appropriate. THE MOTION CARRIED UNANIMOUSLY. C. Any items listed under Sections III and IV IV. Recommendations, Discussion / Information Items A. Report from Supply Chain Management Report of emergency purchases (Attachment #2) Mr. Jones presented information on two (2) emergency purchases recently made. Douglas Elwell, Deputy Chief Executive Officer of Finance and Strategy, provided additional information on the emergency purchase with Texture Health Systems for a care coordination system for CountyCare. He stated that this was not anticipated. CCHHS had an agreement with a prior vendor, but they changed direction and then could no longer meet the needs. The administration had a little time to evaluate some other potential vendors, but given the timeframe this was thought to be the best option. Director Richardson-Lowry inquired regarding the additional cost over what was originally contracted for with the prior vendor. Mr. Elwell stated that, by the end of the three (3) years, the additional cost would probably be about $250,000 to $1 million, for basically re-creating the system. Over time, it is expected to have the same cost efficiency as the previous system; it has more capabilities and will be used in a broader way. With regard to any recourses that CCHHS may have against the prior vendor, Mr. Elwell stated that the administration is focused on getting the final payment to them so the administration can get the last of CCHHS data back from them. Jeff McCutchan, Interim General Counsel, provided additional information. The prior vendor was customizing and developing software to meet CCHHS particular needs, so it was an ongoing collaboration; they did the services for which they were originally contracted, so CCHHS does owe them for the provision of those services. It was the development of new things to meet CCHHS particular needs and goals that the prior vendor thought they were going to do they eventually determined that they either could not do it or did not desire to put more money into creating it. Chairman Estrada inquired whether the work they did is useful to CCHHS going forward. Mr. Elwell responded in the negative; however, he noted that it served a purpose for the year it was used. With regard to the emergency purchase with Health Management Associates (HMA) for technical assistance and consultation, Director Richardson-Lowry commented that this is a high buy-in, and inquired regarding the emergency nature of the contract. Mr. Elwell responded that this contract is for assistance with writing the response to the State s Medicaid Managed Care Request for Proposals (RFP). The response will be more than 300 pages, will be highly technical, and writing it requires a particular skill set. As to the emergency nature of the contract, the administration did not initially believe that the State would require CCHHS to formally submit a response to the RFP, as state statute contains a provision that essentially automatically qualifies CCHHS; when it was determined that a formal response was going to be required, it had become a time-sensitive matter. Director Richardson-Lowry reiterated her initial comments she still thinks this is a high buy-in; she stated that there is a better way to do this - that conversation will need to be held at a different time. Page 2 of 32

Minutes of the Meeting of the Finance Committee Friday, April 21, 2017 Page 3 V. Report from the Chief Financial Officer (Attachment #3) Report Metrics Financials through February 2017 Ekerete Akpan, Chief Financial Officer, presented the information contained in his report, which included Financials through February 2017. The Committee reviewed and discussed the information. During the discussion of the subject of overtime, Mr. Akpan stated that the administration is going to have a focused and detailed dive into that number. Dr. Shannon provided additional information. He stated that there is an inexorable trend for that overtime spend, and it is disquietingly stable. Overtime expenses fall into three (3) broad categories: 1) structurally related to holiday pay; 2) structurally related to pay under collective bargaining agreements; and 3) presumably immediately controllable. The administration is trying to put detail on what proportion of the overtime is in each of those categories. There is an upcoming meeting with approximately 100 members of leadership/department directors on that subject. At the meeting, they will be sharing information and data on overtime usage for each of their departments, talking about what is in their control in making the schedules, and talking about expectations and accountability. VI. Adjourn As the agenda was exhausted, Chairman Estrada declared the meeting ADJOURNED. Respectfully submitted, Finance Committee of the Board of Directors of the Cook County Health and Hospitals System XXXXXXXXXXXXXXXXXXXXXX Ric Estrada, Chairman Attest: XXXXXXXXXXXXXXXXXXXXXX Deborah Santana, Secretary Page 3 of 32

Cook County Health and Hospitals System Minutes of the Finance Committee Meeting April 21, 2017 ATTACHMENT #1 Page 4 of 32

COOK COUNTY HEALTH AND HOSPITALS SYSTEM ITEM III(B) APRIL 21, 2017 FINANCE COMMITTEE MEETING CONTRACTS AND PROCUREMENT ITEMS Request # Vendor/Entity Service or Product Fiscal impact not to exceed: Method of acquisition Total # of bidders/ RFP responses / GPO companies available Affiliate / System Begins on Page # Amend and Increase Contract 1 SmithGroupJJR, Inc. Service - architectural, This request - engineering and noncompetitive construction process administration services for Provident Hospital leveraging $982,500.00 existing contract Original contract - competitive RFP process in 2016 /10 responses) PHCC 3 Extend and Increase Contracts 2 O'Hare Record Retention Services This request - Service - off-site records noncompetitive storage, destruction, process retrieval and moving leveraging services $498,332.75 existing contract Original contract - competitive RFP process in 2011/5 responses) SHCC 4 3 Arthrex, Inc. Product - arthroscopy surgical supplies $301,809.00 Sole Source n/a SHCC 5 4 Vanguard Archives, LLC Service - off-site medical record and film storage $80,387.15 Sole Source n/a PHCC 6 Execute Contracts 5 Health Management Associates, Inc. (HMA) Service - consulting for operational and programmatic improvements $2,208,375.00 RFP 9 System 7 6 Medspeed, LLC Service - System-wide courier services $1,061,742.00 RFP 5 System 8 7 The Advisory Board Company Service - revenue cycle optimization $779,915.00 RFP 9 System 9 8 Bioventus, LLC Product - Exogen Low Intensity Pulsed Bone Healing Ultrasound System $403,200.00 Sole Source n/a SHCC 10 9 AlloSource Product - human tissue and synthetic supplies $258,000.00 Sole Source n/a SHCC 11 Page 5 of 32

COOK COUNTY HEALTH AND HOSPITALS SYSTEM ITEM III(B) APRIL 21, 2017 FINANCE COMMITTEE MEETING CONTRACTS AND PROCUREMENT ITEMS Request # Vendor/Entity Service or Product Fiscal impact not to exceed: Method of acquisition Total # of bidders/ RFP responses / GPO companies available Affiliate / System Begins on Page # Execute Contracts (continued) 10 Orkin, LLC 11 CSI Specialty Group Service - pest control services $241,679.88 GPO 2 System 12 Service - consultant services - Executive Resident $164,000.00 Sole Source n/a SHCC 13 Page 6 of 32

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Cook County Health and Hospitals System Minutes of the Finance Committee Meeting April 21, 2017 ATTACHMENT #2 Page 18 of 32

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Cook County Health and Hospitals System Minutes of the Finance Committee Meeting April 21, 2017 ATTACHMENT #3 Page 21 of 32

Cook County Health & Hospitals System Finance Committee Meeting April 2017 Ekerete Akpan CFO Finance Committee : April 2017 1 Page 22 of 32

Financial Statements Finance Committee : April 2017 2 Page 23 of 32

Income Statement for the Three Months ending February 2017 (in thousands) Year-To-Date Actual-Feb Budget Variance Operating Revenue 347,565 370,000-6.1% 0.0% Operating Expenses 0 0 0.0% Salaries & Benefits 228,561 228,045-0.2% Supplies 30,020 33,074 9.2% Purch. Svs., Rental, Oth. 44,210 50,000 11.6% External Claims Expense 155,101 154,303-0.5% Insurance Expense 9,287 9,572 3.0% Depreciation 6,682 6,718 0.5% Utilities 2,649 2,849 7.0% Total Operating Exp 476,511 484,559 2% Operating Margin (128,946) (114,559) -13% Operating Margin % -37% -31% -20% Non Operating Revenue 39,890 39,890 0% Net Income/(Loss) (89,056) (74,669) -19% *Year to Date (3 months) Pension Liability per GASB Finance Committee : April 2017 3 Page 24 of 32

CountyCare Income Statement for the Three Months ending February 2017 (in Millions) Year to Date Year to Date Year to Date Actual Budget Variance Member Months 428,847 427,500 1,347 Total Revenue 201.52 202.32 (0.79) Expense Total Admin Expenses 8.53 10.13 1.60 CCHHS Clinical Expenses CCHHS Claims 33.12 38.64 5.52 CCHHS Pharmacy Claims 7.90 11.71 3.81 CCHHS Care Management 3.88 4.93 1.05 Total CCHHS Clinical Expenses 44.90 55.28 10.38 External Clinical Expenses External Claims 103.56 78.05 (25.51) External Pharmacy Claims 38.40 28.83 (9.57) External Claims IBNR & MLR Reserve (5.76) 1.76 7.52 External Care Management 4.78 11.72 6.94 External Dental Claims 3.65 3.27 (0.37) External Transportation Claims 1.45 2.14 0.68 External Optical Claims 0.70 0.32 (0.38) Total External Clinical Expenses 146.78 126.09 (20.69) Total Clinical Expenses 191.68 181.37 (10.31) Total Expenses 200.21 191.50 (8.72) Medical Loss Ratio (MLR) 95% 91% -5% Net Income 1.31 10.82 (9.51) Total CCHHS Impact 46.21 66.10 (19.89) Finance Committee: April 2017 4 Page 25 of 32

Finance Committee : April 2017 5 Page 26 of 32

Volumes / Stats Finance Committee : April 2017 6 Page 27 of 32

30,000 Primary Care Provider Visits month over month trend 25,000 20,000 15,000 10,000 5,000 - Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov 2016 Actual 2017 Target 2017 Actual Finance Committee : April 2017 7 Page 28 of 32

30,000 Specialty Care Provider Visits month over month Trend 25,000 20,000 15,000 10,000 5,000 - Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov 2016 Actual 2017 Target 2017 Actual Finance Committee : April 2017 8 Page 29 of 32

2,500 Total Inpatient Dischargesmonth over month trend 2,000 1,500 1,000 500 - Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov 2016 Actual 2017 Actual 2017 Target *includes PICU Finance Committee : April 2017 9 Page 30 of 32

Average LOSmonth over month trend 6.00 5.00 4.00 3.00 2.00 1.00 - Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov 2016 Actual 2017 Actual 2017 Target *includes PICU Finance Committee : April 2017 10 Page 31 of 32

16,000 Total Emergency Room Visits - month over month trend 14,000 12,000 10,000 8,000 6,000 4,000 2,000 - Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov 2016 Actual 2017 Actual 2017 Target *includes Adult, Peds and Trauma Finance Committee : April 2017 11 Page 32 of 32