KAWEAH DELTA HEALTH CARE DISTRICT BOARD OF DIRECTORS HUMAN RESOURCES COMMITTEE

July 7, 2017 NOTICE The Kaweah Delta Health Care District Board of Directors will meet in a Human Resources Committee meeting at 11:00AM on Tuesday, July 11, 2017 in the Kaweah Delta Medical Center Acequia Wing - Executive Office Conference Room {400 W. Mineral King, Visalia}. All Kaweah Delta Health Care District regular board meeting and committee meeting notices and agendas are posted 72 hours prior to meetings in the Kaweah Delta Medical Center, Mineral King Wing entry corridor between the Mineral King lobby and the Emergency Department waiting room. The disclosable public records related to agendas are available for public inspection at the Kaweah Delta Medical Center Acequia Wing, Executive Offices (Administration Department) {1st floor}, 400 West Mineral King Avenue, Visalia, CA and on the Kaweah Delta Health Care District web page http://www.kaweahdelta.org. KAWEAH DELTA HEALTH CARE DISTRICT Lynn Havard Mirviss, Secretary/Treasurer Cindy Moccio Board Clerk & Executive Assistant to CEO DISTRIBUTION: Governing Board Legal Counsel Executive Team Chief of Staff http://www.kaweahdelta.org 400 West Mineral King Avenue Visalia, CA (559) 624 2000 www.kaweahdelta.org

KAWEAH DELTA HEALTH CARE DISTRICT BOARD OF DIRECTORS HUMAN RESOURCES COMMITTEE Tuesday, July 11, 2017 Kaweah Delta Medical Center / 400 West Mineral King Executive Office Conference Room (1 st floor Acequia Wing) ATTENDING: Directors; Carl Anderson (Chair) & Nevin House; Tom Rayner, Interim Chief Executive Officer & SVP / Chief Operating Officer; Dianne Cox, VP Human Resources; Regina Sawyer, VP & CNO; Blanca Bedolla, Recording OPEN MEETING 11:00AM Call to order Carl Anderson, Human Resources Committee Chair Public / Medical Staff participation Members of the public wishing to address the Committee concerning items not on the agenda and within the subject matter jurisdiction of the Committee may step forward and are requested to identify themselves at this time. Members of the public or the medical staff may comment on agenda items after the item has been discussed by the Committee but before a Committee recommendation is decided. In either case, each speaker will be allowed five minutes. 1) STARRS/Employee Connection Clubs- Overview of annual employee activities- Dianne Cox, VP Human Resources 2) Guidelines for Departmental Recognition Consistent guidelines for leaders for departmental and individual employee recognition, including use of Job Well Done funds- Dianne Cox, VP Human Resources 3) Employee Engagement Survey Plan Timeline of implementation of survey- Dianne Cox, VP Human Resources 4) Wellness Program for 2018 Employee Health and Wellness Plan for Calendar Year 2018, Dianne Cox, VP Human Resources 5) Physician Recruitment Report and Coker Study Updated report on recruitment and use of consulting firm Coker for Physician Needs Assessment for Tulare and Kings Counties - Dianne Cox, VP Human Resources Adjourn Carl Anderson, Human Resources Committee Chair In compliance with the Americans with Disabilities Act, if you need special assistance to participate at this meeting, please contact the Board Clerk (559) 624-2330. Notification 48 hours prior to the meeting will enable the District to make reasonable arrangements to ensure accessibility to the Kaweah Delta Health Care District Board of Directors meeting. Herb Hawkins Zone I Lynn Havard Mirviss Zone II John Hipskind, MD Zone III Carl Anderson Zone IV Nevin House Zone V Board Member Secretary/Treasurer Board Member President Board Member

STARRS January Service Awards o Luncheon for recipients of 15+ years of service Movie Night o Free Event for employees & family (free popcorn & water) KD Night at Visalia Rawhide o 4 free tickets per employee Hospital Week BBQ o Meal at every campus and free giveaway June Service Awards o Luncheon for recipients of 15+ years of service Ducky Races o Build a ducky float and race on Packwood creek Employee Connection Team Nurses Week Breakfast o Free meal at every campus Pinewood Box Derby o Build pinewood derby car, race, best design and fastest car wins. Dinner Dance o Social event, KD staff and guest. After hours. Make a Difference Day o Select one organization, KD employees assist. Christmas Parade o Build a float, decorate, represent KD at Candy Cane Lane Parade Holiday Cheer o Santa, refreshments, carolers, tree lighting event Corporate Games o 20 different events (i.e. soccer, dodge ball, trivia, tug of war, etc.) KD employees play against other Visalia employers/businesses Pumpkin Carving Contest o Pumpkin provided to departments, best carved pumpkin wins Bowling Night o At Visalia Lanes, free soda, popcorn, shoe rental. Halloween themed, best costume and highest score wins. Holiday Open House o Free meal at every campus, music Service Excellence Award (Monthly)- Professional photo taken, put on Mineral King wing light box, free parking for one month, $125 Down Town Visalia, $50 Kaweah Korner merchandise gift certificate, desk stand with name plate. Employee Emergency Relief (As needed)- Maximum of $2K free monetary assistance for (major medical emergency employee or immediate family member, death of immediate family member, a catastrophic event (fire). Job Well Done- Employee appreciation (lunches, gift cards, DTV gift certs)

From: To: Subject: Date: Macareno, Raymond Bedolla, Blanca; Lizardo, Robert; Nowak, Geoff; Johnson, Cheryl; Quesnoy, Dru; Vidal, Gina; Sanchez, Sonia; Lynch, Kris UPDATE: STARRs survey on clubs and groups Monday, May 22, 2017 10:31:31 AM Good Team, Attached is an update on the STARRs survey on clubs and groups that are of interest to KD Employees. Please let me know if you have any questions. Total Responses: 72 Q1: Please list here if you know of local clubs/activities/leagues currently seeking new members: 11 Clubs/Groups Recommended by KD Employees with Contact Info Q2: If you are interested in being contacted about joining a new or existing club, please provide your contact information: 31 Contacts (Employees) interested in clubs/group info Q3: Interested in starting your own club or group? If you would like to manage or lead a new group, please provide your contact information: 10 Contacts (Employees) would like to lead group Top of Clubs/Groups of Interest by Kaweah Delta Employees Answer Options Response Percent Response Count Do It Yourself 49.3% 33 Cooking Club 41.8% 28 Camping 25.4% 17 Book/Reading Club 23.9% 16 Other (please specify) 20.9% 14 Couponing 19.4% 13 Bowling 17.9% 12 Crocheting/Cross- 16.4% 11 stitching/sewing/quilting Outdoor Sports 14.9% 10 Restoration 14.9% 10 Art (Painting/Drawing/Sketching) 11.9% 8 Scrapbooking 11.9% 8 Service Club 10.4% 7 Other Category: off roading Tennis Fitness gardening/ plants VOLLEYBALL football Vegetarian/Vegan diy-home, cake decorating, makeup

autism Foot Golf it s like golf but all you need is a soccer ball. Professional - Personal Development/Networking within KDHCD Professional / Personal Development within KDHCD Welding Club

Kaweah Delta Health Care District Guidelines for Departmental Celebrations 1. Department leadership should internally celebrate and recognize their department(s) on National Healthcare Appreciation Days/Week. Acknowledge department via District Daily. Email Marketing to publish National Healthcare department recognition on Communication Boards. Write acknowledgement, thanking department and submit to Marketing to publish article on Communi-K. Department Potlucks or use of Job Well Done funds for celebration ($20/employee/yr) with VP approval. 2. Other recognized appreciation days may include some District observed holidays. Celebration may consist of small thank you items, cards, potlucks and/or use of Job Well Done funds. New Year s Day Independence Day Thanksgiving Christmas 3. Personal Acknowledgements Personal thank you notes or cards Birthdays (celebrate individual birthdays or host a monthly birthday celebration). Births (congratulations card) and deaths (department sentiment card and/or send flowers/plant to employees home). May use Job Well Done funds ($20/employee/yr) with VP approval; for flowers, may use department subaccount 90 Misc. KD Anniversaries Employee Retirements following HR Policy and with use of Job Well Done funds 4. Examples for the use of Job Well Done funds may include: Department breakfast/lunch Recognition items (Positive Promotions is a good source) $5 Starbucks cards (non taxable)

Ideal Work Environment Employee Engagement Survey Implementation: August/September 2017 Results to Board: October 2017 Organization Communication: November/December 2017 Action Planningand Meeting Facilitation: November 2017 through March 2018 Ongoing follow up through 2018 and 2019 Survey Questions - Scaled Statement Text Domain Strongly Agree to Strongly Disagree 1 My work unit works well together. Employee Strongly Agree to Strongly Disagree 2 I enjoy working with my coworkers. Employee Strongly Agree to Strongly Disagree 3 Employees in my work unit help clients/patients even when it's not part of their Employee job. CHANGE TO: customers/patients Strongly Agree to Strongly Disagree 4 Employees in my work unit help others to accomplish their work. Employee Strongly Agree to Strongly Disagree 5 I like the work I do. Employee Strongly Agree to Strongly Disagree 6 The environment at this organization makes employees in my work unit want to Employee go above and beyond what's expected of them. CHANGE: THIS ORGANIZATION TO KAWEAH DELTA Strongly Agree to Strongly Disagree 7 Employees in my work unit make every effort to deliver safe, error-free care. Employee Strongly Agree to Strongly Disagree 8 My job makes good use of my skills and abilities. Employee Strongly Agree to Strongly Disagree 9 My work unit provides high-quality care and service. Employee Strongly Agree to Strongly Disagree 10 Employees in my work unit follow proper procedures for patient care/customer Employee service. Strongly Agree to Strongly Disagree 11 My work gives me a feeling of accomplishment. Employee Strongly Agree to Strongly Disagree 12 My work is meaningful. Employee Strongly Agree to Strongly Disagree 13 Communication between shifts is effective in my work unit. Employee Strongly Agree to Strongly Disagree 14 The employees in my work unit are careful in how they manage hospital Employee resources. Strongly Agree to Strongly Disagree 15 Members of my work group treat one another with dignity and respect. Employee Strongly Agree to Strongly Disagree 16 Employees of Kaweah Delta treat one another with dignity and respect. Employee Strongly Agree to Strongly Disagree 17 I am proud to tell people I work for this organization. CHANGE: THIS Engagement Indicator ORGANIZATION TO KAWEAH DELTA Strongly Agree to Strongly Disagree 18 I would stay with this organization if offered a similar position elsewhere. Engagement Indicator CHANGE THIS ORGANIZATION TO KAWEAH DELTA Strongly Agree to Strongly Disagree 19 I would recommend this organization to family and friends who need care. CHANGE THIS ORGANIZATION TO KAWEAH DELTA Engagement Indicator Strongly Agree to Strongly Disagree 20 I would like to be working at this organization three years from now. CHANGE Engagement Indicator THIS ORGANIZATION TO KAWAEH DELTA Strongly Agree to Strongly Disagree 21 I would recommend this organization as a good place to work. CHANGE: THIS Engagement Indicator ORGANIZATION TO KAWEAH DELTA Strongly Agree to Strongly Disagree 22 Overall, I am a satisfied employee. Engagement Indicator Strongly Agree to Strongly Disagree 23 The person I report to treats me with respect. Manager Strongly Agree to Strongly Disagree 24 My manager treats me with respect. Manager Strongly Agree to Strongly Disagree 25 My director treats me with respect. Manager Strongly Agree to Strongly Disagree 26 The person I report to cares about my job satisfaction. Manager Strongly Agree to Strongly Disagree 27 I am satisfied with the recognition I receive for doing a good job. Manager Strongly Agree to Strongly Disagree 28 I am involved in decisions that affect my work. Manager Strongly Agree to Strongly Disagree 29 The person I report to cares about quality improvement. CHANGE TO: My Manager work group leadership cares about quality improvement. Strongly Agree to Strongly Disagree 30 The person I report to encourages teamwork. Manager Strongly Agree to Strongly Disagree 31 The person I report to values great customer service. CHANGE TO: My work Manager group leadership values great customer service. Strongly Agree to Strongly Disagree 32 I respect the abilities of the person to whom I report. Manager Strongly Agree to Strongly Disagree 33 I respect my manager. Manager Strongly Agree to Strongly Disagree 34 I respect my director. Manager Strongly Agree to Strongly Disagree 35 My job responsibilities are clear. Manager

Strongly Agree to Strongly Disagree 36 The person I report to is a good communicator. Manager Strongly Agree to Strongly Disagree 37 My manager is a good communicator. Manager Strongly Agree to Strongly Disagree 38 My director is a good communicator. Manager Strongly Agree to Strongly Disagree 39 Different work units work well together in this organization. CHANGE: IN THIS ORGANIZATION TO AT KAWEAH DELTA Organization Strongly Agree to Strongly Disagree 40 This organization conducts business in an ethical manner. CHANGE: THIS Organization ORGANIZATION TO KAWEAH DELTA Strongly Agree to Strongly Disagree 41 I am satisfied with my benefits. Organization Strongly Agree to Strongly Disagree 42 This organization provides high-quality care and service. CHANGE: THIS ORGANIZATION TO KAWEAH DELTA Organization Strongly Agree to Strongly Disagree 43 Physicians and staff work well together. Organization Strongly Agree to Strongly Disagree 44 This organization supports me in balancing my work life and personal life. Organization CHANGE: THIS ORGANIZATION TO KAWEAH DELTA Strongly Agree to Strongly Disagree 45 This organization makes every effort to deliver safe, error-free care to patients. CHANGE: THIS ORGANIZATION TO KAWEAH DELTA Organization Strongly Agree to Strongly Disagree 46 My pay is fair compared to other healthcare employers in this area. Organization Strongly Agree to Strongly Disagree 47 My work unit is adequately staffed. Organization Strongly Agree to Strongly Disagree 48 I get the training I need to do a good job. Organization Strongly Agree to Strongly Disagree 49 Patient safety is a priority in this organization. CHANGE IN THIS ORGANIZATION Organization TO AT KAWEAH DELTA Strongly Agree to Strongly Disagree 50 This organization treats employees with respect. CHANGE THIS ORGANIZATION Organization TO KAWEAH DELTA Strongly Agree to Strongly Disagree 51 This organization cares about quality improvement. CHANGE: THIS Organization ORGANIZATION TO KAWEAH DELTA Strongly Agree to Strongly Disagree 52 This organization provides career development opportunities. CHANGE: THIS Organization ORGANIZATION TO KAWEAH DELTA Strongly Agree to Strongly Disagree 53 I get the tools and resources I need to provide the best care/service for our Organization clients/patients. Strongly Agree to Strongly Disagree 54 I am satisfied with the information I receive about what is going on in this Organization organization. CHANGE: IN THIS ORGANIZATION TO AT KAWEAH DELTA Strongly Agree to Strongly Disagree 55 Communication between work units is effective in this organization. CHANGE: Organization IN THIS ORGANIZATION TO AT KAWEAH DELTA Strongly Agree to Strongly Disagree 56 The physicians at this organization respect the clinical staff's knowledge and Organization abilities. CHANGE: THIS ORGANIZATION TO KAWEAH DELTA Strongly Agree to Strongly Disagree 57 We are actively doing things to improve patient safety. Organization Strongly Agree to Strongly Disagree 58 Senior management's actions support this organization's mission and values. Organization CHANGE: THIS ORGANIZATION TO KAWEAH DELTA'S Strongly Agree to Strongly Disagree 59 Senior management does a good job of communicating major developments. Organization Strongly Agree to Strongly Disagree 60 Information from this survey will be used to make improvements. Organization Open Ended #1 1 What do you like most about working for this organization? What feedback, input or suggestions do you have for your manager, Open Ended #2 2 department leaders, or the executive team?

Humana Vitality and Go365: Employee Health and Wellness for Calendar Years 2016 and 2017 Employee Wellness has long been an initiative at Kaweah Delta, with various programs implemented over the years. Humana Vitality kicked off in 2015, ending the year with 250 participants. In 2016, as a result of linking participation to health insurance premiums, we enrolled 2,000 participants. The annualized direct cost for this fiscal year will be almost $500,000, including the contract for the website as well as gift cards for points earned. In addition to the direct cost, the Kaweah Delta staff time is approximately 3,000 hours at a cost of almost $100,000: 600 hours of Biometrics screening 600 hours of Employee Health/Life Style Center time Champ time of 220 hours Alana Unger time of 1,000 hours HR/Foundation/Payroll time of 500 hours Leadership time of 100 hours Miscellaneous event time of 100 hours The total spend is $600,000, with debatable return on investment. For Calendar Year 2018 The Employee Wellness team has proposed the following, which was approved by the Executive Team. For health and wellness, the focus will be on three areas: 1. Annual physical with physician, and know your biometric numbers 2. Exercise via Kaweah Delta sponsored walks, and promotion of The Lifestyle Center 3. Healthy eating We will continue with the health insurance premium discount for completing an annual physical and biometric testing with a physician. Reviewing biometric numbers with the physician gives an opportunity to speak to action planning on the results. There is significant data to support that an annual physical is a best practice. To facilitate participation, Kaweah Delta will waive employee $20.00 copays at a cost of $40,000. There may be an increase in physician fees for employees that don t normally see their physician each year. Continue with Kaweah Delta sponsored bi-monthly walks, with eligibility for prizes and drawings for participation. Budget $20,000. Staff time to promote/administer program $40,000. Total cost is expected to be approximately $100,000. To focus on food and nutrition, we will include Kaweah Delta s Food and Nutrition Department for healthy food alternatives in the various cafeterias. In addition, we will consider offering on-site Weight Watchers programs, a program popular here in the past.

Medical Staff Recruitment Report July 2017 - Board of Directors Meeting Prepared By: Brittany Taylor, Physician/Leadership Recruiter - btaylor@kdhcd.org - (559)624-2899 Adult Primary Care: Available Openings - 3 (1 - Kaweah Exeter Medical Group; 3 - KDMF; Search Firms Assigned - Delta Physician Placement) Internal Medicine Hopkins, M.D. Keith 10/17 Medicine, Eligible (taking boards this year) KEMG CA Licensed; Currently practicing in Sacramento, CA Currently under review, Phone Interview: 6/26/17 - Site visit pending dates. Internal Medicine Atchabahian, M.D. Lara 10/17 Medicine, Eligible KDMF CA Licensed; Spouse, Dr. Edward Samourjian, Site Visit: 4/24/17; Offer Vascular Surgeon, joining Accepted. Tentative Start Visalia group. Candidate Date: 10/2017 reached out directly on 4/4/17. Cardiology: Available Openings - 1 (1 Invasive - KDMF; Search Firm Assigned - Pacific Companies) Sourcing Invasive/Non-Interventional Candidates CA Licensed; Planning Interventional Cardiology - Invasive, Non- Medicine, Certified; American Cardiology fellowship Site visit 8/13/16; Start Rafie, M.D. Reza 07/16 KDMF Interventional Board of Cardiovascular 2018-2019; Referred by date: 6/15/17. Disease, Eligible Dr. Ashkan Attaran, Cardiologist. Cardiology - EP Haija, M.D. Basil 07/17 Medicine, Certified; American Board of Cardiovascular Disease, certified. Sequoia Cardiology Medical Group CA licensed; Currently completing EP fellowship Site visit - 3/10/17; Offer at University of NC accepted; Signed contract Hospital, Center of Heart should be rec'd 4/6/17. and Vascular Care; Tentative start date: 9/17. Presented on 2/2/17 by Pacific Companies. 1

Cardiology, Interventional Gupta, M.D. Ankur 07/17 Cardiology: Available Openings - 1 (1 Invasive - KDMF; Search Firm Assigned - Pacific Companies) Medicine, Certified; Certification Board of Nuclear Cardiology, Certified; National Board of Echocardiography, Certified; American Board of Cardiovascular Disease, certification pending. Sequoia Cardiology Medical Group CA Licensed; Presented on 11/15/16 by Pacific Companies. Site visit: 1/13/17; Contract signed; Tentative start date 8/17. Cardiovascular Surgery: Available Openings - 1 (Search Firm Assigned - Pacific Companies) Sourcing Candidates Cardiovascular Surgery Lee, M.D. Richard TBD American Board of Surgery, Certified; American Board of Thoracic Surgery, Certified Golden State Cardiac & Thoracic Surgery, Inc. CA licensed; Completed MD at Harvard Medical School; Surgery residency completed at Massachusetts General Hospital; Thoracic Surgery, Pediatric Cardiac Surgery and Cardiopulmonary Transplantation residency completed at Stanford University Medical Center; Family lives in San Jose, CA Site Visit: 4/27/16; Candidate not ready to make a move yet. Remains active for future f/up. Dermatology - Available Openings - 1 KDMF (Search Firm Assigned - TBD as needed) Sourcing Candidates Endocrinology: Available Openings - 0 (Search Firm Assigned - Cejka) Endocrinology Saif, M.D. Noman TBD - pending CA License Medicine, Certified; American Board of Internal Medicine - Endocrinology, Certified KDMF No CA license, application submitted; Currently practicing in Longview, TX; Brother is moving to Fresno. Presented by Cejka on 2/1/17. Site Visit: 3/9/17; Offer accepted. 2

Gastroenterology: Available Openings -4 (4 - KDMF; 4 Hospitalist- IQ Surgical Associates; Search Firm Assigned - Fidelis Partners) No CA license. Completing Gastroenterology (Hospitalist) Al-Khedr, M.D. Hany 07/18 Gastroenterology & IQSA Hepatology fellowship Medicine, Certified 6/2017. Presented by Physician Empire on 5/11/17. Phone Interview: 6/22/17 Gastroenterology Ameer, M.D. Adnan 07/18 Medicine, Certified KDMF CA licensed; Advanced Endoscopy Therapeutic Fellowship 2017-2018 at Harbor-UCLA; Referred by Dr. Oberer on 2/3/17. Initial site visit: 2/17/17; 2nd Site visit: 4/10/17. Offer extended. Will make decision August 2017. Gastroenterology Elbatta, M.D. Mohammad 07/18 Medicine, Certified KDMF No CA license; Family in Southern CA; Met in Chicago at Digestive Disease Week 2017 on 5/7/17. Currently under review. 6/23/17 - Scheduled to speak at 3:30PM. Gastroenterology Kumar, M.D. Vivek TBD - pending CA License Medicine, Certified; American Board of Internal Medicine Gastroenterology, Certified KDMF No CA license; Currently practicing in Williamsport, PA. Candidate reached out directly on 6/12/17. Currently under review. Gastroenterology Kutty, M.D. Geeta 07/18 Gastroenterology Pua, M.D. Shirley TBD - pending CA License Medicine, Certified Medicine, Diplomate; Medicine Gastroenterology, Certified KDMF KDMF CA license in progress; friends in Fresno; presented by Fidelis Partners on 5/23/17. CA license in progress; presented by Integro Healthcare on 4/19/17. Site visit pending dates. Tentative date: 7/21/2017 Currently under review. Met at conference 5/8/17. Site visit: 7/11/17 Gastroenterology Rehman, M.D. Abdul TBD - pending CA License Medicine, Certified; American Board of Internal Medicine Gastroenterology, Certified KDMF CA License in progress, will start process; Currently practicing with Site Visit: 5/26/17; pending Gundersen Health additional f/up 6/27/17. System La Crosse in WI; Referred by Dr. Lovelace and Dr. Attaran. 3

Gastroenterology: Available Openings -4 (4 - KDMF; 4 Hospitalist- IQ Surgical Associates; Search Firm Assigned - Fidelis Partners) Gastroenterology Sahebjam, M.D. Farhad 08/18 Medicine, Certified KDMF No CA License; Interested in CA to be closer to family; Completed Hepatology & Liver Transplantation fellowship. Currently completing GI & Hepatology fellowship in VA; Presented by Physician Empire on 4/27/17. Currently under review. 6/23/17 - LM to f/up on phone availability. General Surgery - 1 (IQ Surgical Associates; Search Firm Assigned - Fidelis Partners) General Surgery (Trauma/Surgical Critical Care) Jeffcoach, M.D. David 08/18 American Board of Surgery - General Surgery, Eligible Open Visalia native interested in returning after fellowship. Wife is a PA. Trauma/Surgical Critical Site Visit: 7/21/2016; Care Fellowship in Dinner with Dr. Sebastiano Fresno, completion date - Cassaro on 4/24/17 at 6PM. 7/2017. CV rec'd directly from Dr. Jeffcoach on 7/17/15. General Surgery (Hepato- Pancreato-Biliary Surgery) Royall, M.D. Nelson 07/17 American Board of Surgery - General Surgery, Certified IQSA No CA License; Presented by Dr. Sebastiano Cassaro on 5/12/17. Site visit: 6/16/17 GME - Core Faculty Family Medicine: Available Openings - 1 GME Family Medicine Faculty (full-time) Ramirez, M.D. Magda 07/17 American Board of Family Medicine, Eligible CEP Completing residency in NM; Presented through CEP recruitment team 1/3/17. Site Visit: 1/25/17; Offer accepted. Anticipated start date: 8/2017 Hospitalist: Available Openings - 3 Valley CV rec'd directly through Hospitalist Boparai, M.D. Namrita 09/17 Hospitalist CareerMD posting on Currently under review. Medicine, Eligible Group 4/26/17. 4

Hospitalist Digdigan, M.D. Leevaneigh 08/17 Hospitalist: Available Openings - 3 American Board of Family Medicine, Certified Valley Hospitalist Group CA licensed; Hospitalist at Sierra View District Hospital. Candidate reached out directly on 5/2/17. Site Visit: 5/12/17 Hospitalist Sattar, D.O. Hammad 09/18 Medicine, Eligible Valley Hospitalist Group No CA license; Interested in Nocturnist hours; Presented by Physician Empire on 5/11/17. Currently under review. Hospitalist Munjal, M.D. Atul 07/17 American Board of Family Medicine, Certified Valley Hospitalist Group CA licensed; Currently working with Community Hospitalist Medical Group; Candidate reached out directly 1/4/17 Site Visit: 2/23/17; 2nd Site Visit: 5/11/17. Offer accepted; tentative start date July 2017. Intensivist: Available Openings - 2 (Contingent Search Firm Assigned - Puzzle Piece Solutions) Sourcing Candidates Maternal-Fetal Medicine (MFM): Available Openings - 2 (Valley Children's Healthcare is handling recruitment efforts) MFM Shah, M.D. Bharat 01/17 American Board of Obstetrics and Gynecology, Diplomat; American Board of Obstetrics and Gynecology, Maternal- Fetal Medicine - Diplomat Valley Children's Healthcare CA licensed; currently practicing in Las Vegas, NV. CV presented by Children's on 10/14/16. Site visit - 11/11/16; pending 2nd visit. Neonatology: Available Openings - 0 (Valley Children's Healthcare) Neonatology Dosado, M.D. Jose 07/17 American Board of Pediatrics, Certified; American Board of Pediatrics - Neonatal- Perinatal, Certified. Valley Children's Healthcare No CA license; Currently practicing in IA. CV presented by Children's on 1/20/17. Site Visit - 1/24/17; Offer accepted; start date - 7/31/17 Neonatology Younis, M.D. Usama Mohamed 07/17 American Board of Pediatrics, Certified; American Board of Pediatrics - Neonatal- Perinatal, Certified. Valley Children's Healthcare No CA license; Currently practicing in SD. CV presented by Children's on 1/20/17. Site Visit - 1/23/17; Offer accepted; start date - 7/10/17 5

CA Licensed; Current Neurology Joshi, M.D. Rohini ASAP VMC Independent 6/23/17 - Rick Strid will call KDMF Medicine, Certified Contractor interested in Dr. Joshi to f/up. Full-Time. Neurosurgery: Available Openings - 2 (Search Firm Assigned - Pacific Companies) Sourcing Candidates OB/GYN: Available Openings - 1 (Kaweah Exeter Medical Group) OB/GYN Dhillon, M.D. Satwant TBD OB/GYN Sabogal, M.D. Juan Carlos 04/17 American Board of Obstetrics and Gynecology, Certified American Board of Obstetrics and Gynecology, Diplomat KEMG KEMG CA Licensed; Currently practicing in Porterville, CA. Candidate reached out directly. CA Licensed; Currently practicing at Family Health Care Network in Visalia since 2007. Site Visit: 4/12/17; Remains under review. Site Visit: 11/29/17; Offer accepted, Start date: 4/1/17 Orthopedic Surgery: Available Openings - 2 (1 - KDMF; 1 - Orthopaedic & Associates) - (Search Firm Assigned - Fidelis Solutions) Orthopedic Surgeon, Adult Reconstruction Galan, M.D. Timothy 07/18 Neurology: Available Openings - 1 (Search Firm Assigned - Cejka) American Board of Orthopedic Surgery, Eligible Orthopaedic & Associates CA Licensed; Currently completing Orthopaedic Surgery Residency in Fresno. Attending Adult Reconstruction fellowship in Florida 7/2017-6/2018. Presented by Fidelis Partners on 1/10/17. Site Visit: 2/24/17; 2nd site visit: 3/27/17. Meeting with Orthopedic & Associates 4/25/17. Extended offer for VMC and Orthopedic & Associates. Updated offer 6/30/2017. Orthopedic Surgeon, Hand & Upper Extremity Kolahi, M.D. Kourosh Michael 07/18 American Board of Orthopedic Surgery, Eligible Orthopaedic & Associates CA Licensed; Currently completing Orthopaedic Surgery Residency in Fresno. Attending Hand & Upper Extremity Surgery fellowship in New Mexico 7/2017-6/2018. Referred by Dr. Bruce Le on 1/25/17. Site Visit: 4/7/17 Palliative Care - Available Openings - 1 (Search Firm Assigned - Fidelis Partners) Sourcing Candidates 6

Sourcing Candidates Pediatric Hospitalist: Available Openings - 3 (Valley Children's Hospital is handling recruitment efforts) Pediatric Hospitalist Abebe, M.D. Samuel TBD - pending CA License Pediatric Hospitalist Zakieh, M.D. Abdulhafiz 07/17 Valley Children's Hospital Valley Children's Hospital No CA license; Currently working locums assignments; Presented by VCH on 6/1/17. CA licensed; Completing residency in Alabama. Presented by VCH on 3/28/17. Site Visit: 6/7/17 Site Visit: 4/3/17; Offer accepted, tentative start date July 2017 Urology: Available Openings - 1 KDMF (Search Firm Assigned - Pacific Companies) Urology Ford, M.D. Joseph 07/18 KDMF No CA License; Completing Oncology fellowship 2017-2018; Presented by Fidelis Partners on 6/14/17. Currently under review. Site Visit: 7/7/17 Vascular Surgery: Available Openings - 0 Vascular Surgery Hamdi, M.D. Abdulrahman 07/17 Pediatrics - Available Openings - 2 (1 - KDMF; 1 - Kaweah Exeter Medical Group) Emergency Medicine Specialty Last Name First Name Availability Group Emergency Medicine Miguel, D.O. Erik 07/17 CEP Emergency Medicine Sukhija, M.D. Kunal 07/17 CEP Emergency Medicine Andrews, D.O. Sean 07/17 N/A American Board of General Surgery, Eligible South Valley Vascular Kaweah Delta 2017 Graduating Residents - Retention Update Completing Vascular Surgery Fellowship at Maryland University Medical Center 06/2017 Miscellaneous/Current Status Offer Accepted Offer Accepted Accepted a position with Central Coast Emergency Physicians covering hospitals in San Luis Obispo and Templeton. Site Visit: 5/23/2016; Offer accepted, contract signed; Tentative start date 8/2017 Emergency Medicine Denson, M.D. David 07/17 N/A Emergency Medicine Le, M.D. Tam 07/17 N/A Emergency Medicine Slife, D.O. Annie 07/17 Accepted a position in Stockton, CA with St. Joseph Medical Center. Accepted a position in Los Angeles Accepted a position in Port Angeles, WA with Olympic Medical Center. 7

Family Medicine Specialty Last Name First Name Availability Group Miscellaneous/Current Status Family Medicine Ellis, M.D. Desta 07/17 CEP - Urgent Care Offer accepted Family Medicine Hanif, M.D. Aisha 07/17 N/A Accepted a position in Sacramento, CA Family Medicine Qureshi, M.D. Uzma 07/17 Valley Hospitalist Group Returning to Minneapolis, MN. Family Medicine Sadeghi, M.D. Pouria 07/17 N/A Accepted a position in Canada Family Medicine Sanni, M.D. Adesina 07/17 N/A Accepted a position in Arizona Family Medicine Shorish, M.D. Tehniyat 07/17 Valley Hospitalist Group Accepted a position in Orange County. 8

Community Need Physician Supply/Demand Analysis Overview

Overview of Coker Group Coker By the Numbers Strategy & Operations Finance Technology Key Areas of Expertise Executive Search Accountable Care / Quality-Based Collaboratives Health System/Practice Strategic Planning Medical Staff Development Planning Community Physician Need Assessment Community Health Needs Assessment Hospital/Physician Alignment Physician Employment & Prof. Service Agmts. Healthcare Mergers & Acquisitions Healthcare Entity Valuations Physician Compensation Models & Design Practice Management & Operations Coding & Compliance (auditing, risk mgmt, etc.) IT Project/Program Mgmt & Outsourcing Personnel & Human Capital Management Nearly 30 years in healthcare industry Approximately 100 associates throughout the US Work in 45+ states throughout each year Published over 70 books on healthcare topics Named to Inc. 500/5000 fastest growing firms Ranked in Top 25 Healthcare Consulting firms Four offices throughout the US Completed over $50 billion in transactions Coker s National Presence 2

from the Community Point of View 3

Charter/Purpose To develop a comprehensive, proactive, multi-year community need physician supply/demand analysis and conclusions for physician recruitment, compliance, and strategic capacity building for ensuring access within the hospital's service areas and the communities they serve. 1. For Hospital Compliance: A hospital may provide remuneration to a recruit to relocate to the hospital s geographic service area to join its medical staff. Geographic area is defined as the area comprised of the lowest number of contiguous zip codes from which the hospital draws at least 75% of its patients. (or 90% For rural area hospitals). Hospitals must document: That there are not enough physicians in the community overall by population demand ratios (affiliated/non-affiliated) Document current and forecasted need for a defined service area Demonstrate inadequate access (specific payor access) Demonstrate loss of essential community program, not hospital-specific (i.e., trauma) Demonstrate risk of loss of physicians next several years due to departures or risk of retirement 2. For Physician Labor Management: As a strategic business physician staffing predictive analysis model coordinated with hospital strategic planning important even for when only employing doctors. 4

Methodology/Process Our differentiating factors QUANTITATIVE -- Statistical Analysis Scope: Generally 3-5 years, by an objective party validation/documentation of physician need. Define service area: by Zip Codes, demographics/population for: 75 th %tile geographic service area (90 th for rural hospitals) plus defined planning service areas (zones), if needed. Compile a current physician supply database by specialty with FTEs through physician inquiry calls and interviews. Compare FTE Physician-to-Population requirements. Current and forecasted 2020 FTEs needed (100% market share need) QUALITATIVE -- Market Factors Analysis Conduct a practice access analysis (new patient appointment timeliness, by payor, full or limited practices, other barriers). Consider market driven conditions (use of mid-levels, new service need, call coverage gaps, etc.). Ability to factor in population health needs Ability to market share-adjust forecasted FTE needs by specialty Project additional succession factors. Recommendations Demand Tool and PPT Summary Report. 5

Deliverables The Demand Tool for each hospital and a ability for a corporate rollup and a PowerPoint Summary Report of Findings including Objective Party Recommendations demonstrating forecasted need by: Stark 75 th % tile and 90 th % tile (Rural Hospitals) geographic service areas by hospital. Current market share and market share-adjusted need 2020 by service line and by hospital within each primary service area zip code (if available). Community Need Physician Supply/Demand Assessment To comply with all government guidelines, rules, and regulations regarding physician recruitment to meet federal physician recruitment recommendations for documented community need. To serve as strategic planning input. To make available for use to prospective physician s candidates the need for their specialty. Understand and quantify: Forecasted community physician FTEs needed Access to care Projected succession needs 6

Sample Demand Tool 75Th%tile at 100% Market Share 2016 76,350 2020 76,606 2016 2020 Current 2016 Surplus 2020 Surplus Specialty FTEs Ratio Dem and (Shortfall) Dem and (Shortfall) Primary Care FP 12.56 3,500 21.81 (9.25) 21.89 (9.33) Internal Medicine 10.27 5,000 15.27 (5.00) 15.32 (5.05) Pediatrics 9.37 7,500 10.18 (0.81) 10.21 (0.84) Medical Specialties Allergy 0.85 88,000 0.87 (0.02) 0.87 (0.02) Cardiology 4.95 15,300 4.99 (0.04) 5.01 (0.06) Dermatology 1.25 36,259 2.11 (0.86) 2.11 (0.86) Endocrinology 0.12 76,000 1.00 (0.88) 1.01 (0.89) Gastroenterology 2.75 30,911 2.47 0.28 2.48 0.27 Nephrology 2.35 80,000 0.95 1.40 0.96 1.39 Neurology 2.00 31,000 2.46 (0.46) 2.47 (0.47) Occ Med 1.00 42,064 1.82 (0.82) 1.82 (0.82) Oncology 2.00 34,881 2.19 (0.19) 2.20 (0.20) Physical Medicine 0.00 48,100 1.59 (1.59) 1.59 (1.59) Psychiatry 1.75 12,817 5.96 (4.21) 5.98 (4.23) Pulmonary Medicine 2.35 44,000 1.74 0.61 1.74 0.61 Radiation Onc 1.00 76,923 0.99 0.01 1.00 0.00 Rheumatology 0.00 80,000 0.95 (0.95) 0.96 (0.96) Surgical Specialties Cardiac Surgery 0.00 82,522 0.93 (0.93) 0.93 (0.93) General Surgery 7.25 13,878 5.50 1.75 5.52 1.73 Neurosurgery 0.00 68,613 1.11 (1.11) 1.12 (1.12) Obstetrics/GYN 7.62 10,800 7.07 0.55 7.09 0.53 Ophthalmology 2.10 20,220 3.78 (1.68) 3.79 (1.69) Orthopedic Surgery 5.35 17,011 4.49 0.86 4.50 0.85 Otolaryngology 3.00 35,454 2.15 0.85 2.16 0.84 Plastic Surgery 0.75 53,969 1.41 (0.66) 1.42 (0.67) Urology 1.00 34,190 2.23 (1.23) 2.24 (1.24) Vascular 0.00 78,000 0.98 (0.98) 0.98 (0.98) 7

Sample Qualitative Analysis Current Qualitative Factors Affecting Access- 75th Primary Care # Practices Total FTEs Specialty Not Available Closed to New Patients % Limit or Closed to New Pts % Limit or Closed to New Medicare % Limit or Closed to New Medicaid Appt Wait Weeks 2020 Avg Age 2020 Succession Needs FTEs FP 16 12.56 6% 75% 6% 69% 1.0 51.4 (1.00) Internal Medicine 14 10.27 14% 93% 2% 93% 1.7 53.8 (2.00) Pediatrics 11 9.37 27% 27% 1.9 54.6 (1.00) Medical Specialties # Practices Total FTEs Specialty Not Available Closed to New Patients % Limit or Closed to New Pts % Limit or Closed to New Medicare % Limit or Closed to New Medicaid Appt Wait Weeks 2020 Avg Age 2020 Succession Needs FTEs Allergy 3 0.85 open open open 3.7 61.0 Cardiology 5 4.95 60% open 60% 3.4 58.8 (2.00) Dermatology 2 1.00 50% open 50% 8.0 Endocrinology 1 0.12 100% 100% 100% 12.0 Gastroenterology 3 2.75 100% open 100% 5.3 66.3 (1.00) Nephrology 5 2.35 open open open 2.4 58.6 (1.00) Neurology 2 2.00 100% open 100% 2.5 52.0 Occupational Med 1 1.00 open open open 2.0 70.0 (1.00) Oncology 2 2.00 open open open 1.0 53.0 Physical Medicine X Psychiatry 3 1.75 75% open open 3.5 58.7 Pulmonary Medicine 3 1.00 open open open 7.7 52.7 (0.60) Radiation Oncology 1 1.00 open open open 1.0 51.0 Rheumatology X Surgical Specialties Cardiac Surgery # Practices Total FTEs Specialty Not Available X Closed to New Patients % Limit or Closed to New Pts % Limit or Closed to New Medicare % Limit or Closed to New Medicaid Appt Wait Weeks 2020 Avg Age 2020 Succession Needs FTEs General Surgery 8 7.25 25% 13% 13% 1.0 61.5 (2.25) Neurosurgery X Obstetrics/GYN 11 7.62 9% 27% open 18% 2.3 60.2 (2.50) Ophthalmology 3 2.10 open open open 5.0 55.0 Orthopedic Surgery 11 5.35 8% open open 2.4 63.8 (3.50) Otolaryngology 3 3.00 open open open 2.0 61.3 (1.00) Plastic Surgery 1 0.75 100% open 100% 4.0 49.0 Urology 1 1.00 open open open 2.0 54.0 Vascular X (18.85) 8

Sample Recommendations 2020 Recommendations Recommendations 100% MS Current MS Adjusted Reason 2017 100% MS Need 2015 MS 2020 MS Adjusted Need 2020 Additional Succession 2020 Total Need Current MS Total # Recommended 2020 New Replacement Low Need Stable Priority 4. Moderate Need Priority 3. High Need Priority 2. Critical Need Priority 1. Primary Care FP (21.54) 48.6% (10.47) (4.00) (14.47) Internal Medicine (14.54) 48.6% (7.07) (2.00) (9.07) FP/IM net (36.08) 48.6% (17.53) (6.00) (23.53) 10 Deficit, replacement, access 6 4 X Pediatrics (8.50) 48.6% (4.13) (1.00) (5.13) 2 Deficit, replacement 1 1 X Medical Specialties Allergy (0.67) 88.0% (0.59) (0.59) Cardiology (3.76) 86.3% (3.24) (2.00) (5.24) 2 General cardiology, deficit, replacement 1 1 X Dermatology (2.45) 67.5% (1.65) (1.65) Endocrinology (1.64) 86.2% (1.42) (1.42) 1 No consistent coverage in service area 1 X Gastroenterology (0.59) 88.5% (0.52) (1.00) (1.52) 1 Replacement 1 X Nephrology 0.67 87.0% 0.59 (1.00) (0.41) Neurology (2.32) 68.9% (1.60) (1.60) 1 Lack access, deficit, ER Coverage 1 X Occ.Med (2.19) 88.0% (1.92) (1.00) (2.92) 1 Deficit, replacement, solo provider 1 X Oncology (1.84) 62.0% (1.14) (1.14) 1 Deficit growth to staff of 3 FTEs 1 X Physical Medicine (2.79) 0.0% (2.79) (2.79) None available in service area Psychiatry (8.21) 1.8% (0.15) (0.15) 2 Lack Access, wait time, Deficit 2 X Pulmonary Medicine (0.70) 84.7% (0.59) (0.60) (1.19) 1 Deficit, replacement 1 X Radiation Oncology (0.74) 62.0% (0.46) (0.46) Rheumatology (1.68) 52.8% (0.88) (0.88) 1 None available in service area 1 X Surgical Specialties Cardiac Surgery (1.62) 0.0% (1.62) (1.62) None available in service area General Surgery (1.41) 72.0% (1.01) (2.25) (3.26) 1 Deficit, replacement 1 X Neurosurgery (1.95) 8.6% (0.17) (0.17) None available in service area OB/GYN (5.79) 71.5% (4.14) (2.50) (6.64) 2 Moderate deficit need, replacement 1 1 X Ophthalmology (4.53) 42.0% (1.90) (1.90) Orthopedic Surgery (2.53) 53.0% (1.34) (3.50) (4.84) 1 Replacement, Deficit, local growth 1 X Otolaryngology (0.78) 40.0% (0.31) (1.00) (1.31) 1 Moderate deficit, Replacement 1 X Plastic Surgery (1.73) 64.9% (1.13) (1.13) Solo provider Urology (2.92) 53.8% (1.57) (1.57) 1 Deficit, solo provider 1 X Vascular (1.72) 39.7% (0.68) (0.68) None available in service area (21.85) 29 16 13 9

Benefits of the Demand Tool Compliance An objective party validation and documentation for community need Demand by 75 th and 90 th % tiles (Rural Hospitals) demonstrating Stark Geographic Service Area Contiguous zip code maps Checklist for Recruitment Documentation Comprehensive Database and ability to self manage updates Ability to project demand and maintain updates in-house with the interactive desktop Excel electronic tool Quantitative Analysis: Demand Tool Ability to predict forecasted needs and Succession Plan by any age cohort Qualitative Analysis Access to care criteria: Ability to sort by physician, group, employed vs independent providers, specialty, Zip Code, planning zone Appointment timeliness by payer Actual days available to see patients in an office setting (+surgery days) Average new patient appointment wait factor Project population health factor to physician supply Primary care Midlevel use Full, CLOSED, or limited practices Average number of patients see per day per provider Ability to project physician demand by market share growth needs by specialty Market share-adjusted need Other access barriers Recruitment Plan with Prioritized Recommendations 10

Thank You Sandy Champion, CMSR Coker Group (206) 658-5113 mobile schampion@cokergroup.com 11