-I- MOUNTAIN COMMUNITIES HEALTHCARE DISTRICT AGENDA. Board Meeting January 27, :00 p.m. Trinity County Library.

-I- MOUNTAIN COMMUNITIES HEALTHCARE DISTRICT AGENDA Board Meeting January 27, 2016 6:00 p.m. Trinity County Library Weaverville CA Meetings convene at 6 p.m. on the last Wednesday of the month. Citizens wishing to schedule matters for Board consideration or to appear before the Board must contact the Clerk of the Board in writing stating the action requested. Appropriate requests will be scheduled before the Board as time allows. Deadline for submission of written materials is seven days in advance of the meeting. Public Presentations: The law provides the opportunity for the public to be heard on any item withm the subject matter jurisdiction of the Board, before or during the consideration of that item by the Board. For all items, including items not on the agenda, the public presentation time is appropriate. The President may set time limits as appropriate to manage the Agenda. State law does not allow action to be taken on any item not on the Agenda. The agenda shall be made available upon request in alternative formats to persons with a disability, as required by the Americans with Disabilities Act of 1990 (U.S.C.g 12132) the Ralph M. Brown Act (California Government Code 54954.2). Persons requesting a disability related modification or accommodation in order to participate in the meeting should contact the Board Clerk at (530) 623-5541 Ext. 3255 during regular business hours, at least twenty four hours prior to the time of the meetmg. Pursuant to the Brown Act as codified m Government Code Section 54957.5, any documents pertaining to a non-closed agenda item distributed to a majority of the Board of Directors in less than 72 hours before a Board meeting shall be available for public inspection. Said documents shall be available for inspection at the Mountain Communities Healthcare District Administrative Office located at 60 Easter Avenue, Weaverville, California, Monday through Friday, except Holidays, between the hours of 9:00 a.m. and 12:00 p.m. The Board may take action on any of the items listed on this agenda regardless of whether the matter is described as action item, a report, a communication, public input, or discussion item. Call to order Report from Closed Session on December 30, 2015 Public Input (3) Minute Time Limit) Reports a. Medical Staff Report - Daniel Harwood, MD/Donald Krouse, MD - No Report b. Chief Executive Officer - Aaron Rogers, CEO c. Financial Report - Jon Marshall, CFO and Jennifer Van Matre, Director of Finance 'd. Chief Nursing Officer - Peggy Manning, RN, Chief Nursing Officer e. Quality Improvement - Sarah Cordtz, RN, Coordinator

- Regular Board Meeting January 27,2016 Consent Agenda All matters listed under the Consent Agenda, are considered by the Board to be routine, and will be enacted by one motion in the form listed below. There will be no separate discussion of these items unless a request for discussion is made prior to the time the Board votes on the motion to approve. All policies have been approved by the Manager/Director, Midlevel/Interdisciplinary Practice Committee, Medical Staff/Medical Director, and Chief Executive Officer per policy. The intent is that the MCHD Board of Director's role is to assure the policy approval process for each policy. a. Minutes from November 24, 2015 b. Minutes from December 3 0,2015 c. Policies and Procedures - See Attached Discussion Items a. Clinic Action Items a. Items removed from the Consent Agenda Board Reports a. Board Member Reports Announcement Designated Representatives for Closed Session item "Salaries and Benefits" Close Public Session Closed Session MEDICAL STAFF PRIVILEGES Government Code Section 54962; Health and Safety Code Section 1461 LABOR NEGOTIATIONS Government Code Section 54957.6 Designated Representative: Mark Vegh/Aaron Rogers Employee Organization: Professional Group Adjourn Closed Session and Reconvene in Public Session Report of any actions taken during Closed Session Adjourn Posted: January 22, 2016 1600 By: Jeanne Silvers

+ Mountain Communities Healthcare District Medical Staff Report to the Board of Directors January 2016 1. Appointments - Recommendation for Approval Shan Shan Bao, MD JackSaunders, MD Romeo Abaya, MD Matthew Butler, MD Provisional Staff Provisional Staff Provisional Staff Provisional Staff Specialty: Tele-radiology Specialty: Emergency Medicine Specialty: Family Practice Specialty: Family Practice Resignation - Recommendation for Acceptance Young Song, MD II. Peer Review/Utilization Review: No charts reviewed. Reviewed "MCHD Quarterly Check List" for 2015 (1st and 2" quarter). There are still some charts that still need to be reviewed and staff is working on completing those reviews as quickly as possible. III. Laboratory Consultation Report:. Laboratory Consultation reports from November 13, November 18, December 7, December 15, 2015 and January 11,2016 were reviewed. There were 39 surgical charts reviewed (tissue) and 7 transfusion charts reviewed. Staffing still remains an issue in the laboratory. IV. Items Discussed/approved: Approved policies and procedures- recommend approval by the MCHD Board of Directors Reviewed progress on the plan of correction for skilled nursing survey from January 12, 2016 Medical Staff Officers were elected as follows: Chief of Staff-Daniel Harwood/ MD Vice Chief of Staff-Donald Krouse, MD V. Attendance: Medical Executive Committee -January 20, 2016 Present: Donald Krouse, MD Daniel Harwood, MD (Chief of Staff) Patrick Shipsey, MD (by Phone) Julia Mooney, MD Henry Edelstein, MD Ad Hoc Members: Aaron Rogers, CEO Jeanne Silvers, Executive Assistant Vicky Williams, Director Ancillary Services Kevin Livengood, PharmD Michael Novak, PA Peggy Manning, RN, CNO Guests: Dero Forslund, MCHD Board Member Jerry Cousins, MCHD Board Member Excused Maureen Breese, PA Christen Buirley, PA Clara Gordon, PA

r TRINITY HOSPITAL Owned and Operated by Mountain Communities Healthcare District Chief Executive Officer Report to the Board of Directors January 2016 From Aaron Rogers, CEO: The following is an update on the ongoing matters of interest as of this date. I will provide a status update as appropriate, at the Board Meeting on January 27,2016. Employee of the Month: Rebecca Huber Administrative Assistant Rebecca is always extremely polite, helpful, friendly and professional. She goes above and beyond without question and makes everyone's job easier. Whenever it's crunch time we can go to administration and count on Rebecca to help out. Recruitment: Clinical Lab Scientists, Nurses, Physicians, and PA/FNP's are still recruitment needs. Dr. Abaya is still on target to start March 1 We have signed a PA-C that will begin full-time in the clinic in February. Four RNs have been hired in the past few weeks. Physical Therapy: Ryan Rhoads and Jennifer Ferguson have started. We are currently setting up equipment to have a full-service outpatient practice in addition to PT for inpatients, SNF patients, and Home Health patients. Also, we expect to manage the care for the Trinity County Office of Education. Utilization: Census has been very high in January with an average of around 7. We are working on nurse staffing to increase even more. Skilled Nursing Facility: State has resurveyed the SNF. In their exit interview they informed us that we still have some documentation and processes that need to be improved still. They clearly stated that they saw "no patient safety concerns". Currently, we are waiting to hear from CMS regarding next steps, but we have hired an Interim Director of Nursing, done significant staff training, improved orders, improved provider and nursing oversight, and created numerous quality measures to track improvements daily/weekly/monthly/quarterly.

TRINITY HOSPITAL Owned and Operated by Mountain Communities Healthcare District Financial Narrative for the month of December 2015 Prepared by Jan Marshall Summary Mountain Communities Healthcare District incurred a loss from operations of ($323,726) for the month, which is ($200,264) lower than the budgeted operating loss of ($123,461). The month includes higher expenses than anticipated, detailed below. For the full year 2015, Operating Income is ($1.43m), which is a $321k improvement compared to a budget of ($1.75m). 500 Operating lncome/(loss) - Month 2015 0 (500) (1,000) Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec ^Actual 2015»-Budget 2015 "-^^Actual 2014 Volume and Revenue a Patient days are over budget by 5 in Acute and 68 in Swing, but under by 96 in SNF» Outpatient volumes vary compared to budget, with Observation and Home Health significantly under budget/ and Echocardiogram, Physical Therapy, and Top Care significantly over budget» Trinity Clinic visits were over budget by 34, Hayfork Clinic visits were under budget by 110» Total patient revenue is over budget by $54k or 2.5%. a Due to favorable payor mix and service mix. Net Patient Revenues are over budget by $113k or 11.0% <* For the full year 2015, net patient revenues are $13.4 million, which is over budget by $926k 3,000 Gross Revenue - Month 2015 2,500, T"*"- A ^ 2,000....-^'^^^^.^>s..^^ ^^^-^^^^.-^J^^ ^^^^-*; ^3^^-.^,..-. -^y^- ""s~s^' Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec 'Actual 2015 -«Budget 2015 -=<;-- > Actual 2014 Page 1 of 2

Expenses Salaries, benefits, and registry expenses are $817kforthe month, $118k higher than budget Labor costs include $50k for overtime, plus $20k over budget for Registry All other expense categories combined are over budget by $170k SNF fine incurred for $78k, plus $25k in supply/service invoices from prior month orders Physical Therapy program expenses $24k over budget, several other expenses up with patient volumes As a result, total expenses are $1.49 million, $287k higher than budget of $1.21 million For the full year 2015, total expenses are $14.9 million, which is $523k higher than the budget. Totai Expenses - Month 2015 1,600 1,400 1,200 1,000 Jan Feb Mar Apr May Jun Ju! Aug Sep Oct Nov Dec Actual 2015 Budget 2015 E^ Actual 2014 Labor Expense - Month 2015 850 750 650 550 Jan Feb Mar Apr May Jun Jui Aug Sep Oct Nov Dec Actual 2015 Budget 2015 -"&-=> Actuai 2014 Non-Operating Revenue and Expense a Non-operating activity includes $127k for the rebate payment on the Optum loan refinance as well as $131<forgrantfor IT equipment from Trinity County, and $73k for property tax revenue» Net Income for the month is a loss of ($114k) compared to a budgeted loss of ($53k).» For the full year 2015, the Net Income is $4.05 million compared to a budget of $lk. Balance Sheet a Cash remains relatively high at 50 days this month a Accounts Receivable dropped to $3.25 million due to good AR management and lower gross revenue s Days in Accounts Receivable are now down to 44 a Days in Accounts Payable remain low at 44 a No other major fluctuations in the Balance Sheet Page 2 of 2

Balance Sheet Dec-15 Nov-15 Dec, 2014 Assets (Unaudited) (Unaudited) (Audited) Current assets: Cash and cash equivalents 1,905,399 2,412,395 426,795 Gross accounts receivable 3,255,074 3,355,401 3,980,389 Net accounts receivable 1,192,243 1,238,068 1,387,429 Net% of gross 36.63% 36.90% 34.86% Other Receivables 645,419 772,774 829,287 Estimated third party settlements, net 219,209 Inventories 149,106 155,545 151,434 Prepaid expenses and deposits 252,264 208,093 186,522 Total current assets 4,144,431 4,786,875 3,200,676 Assets limited as to use 24,818 40,759 35,072 Total capital assets Total accumulated depreciation Capital assets,net of accumulated depreciation 11,035,291 10,710,446 6,700,727 6,605,525 4,334,564 4,104,921 10,599,676 5,569,061 5,030,615 Total assets 8,503,813 8,932,555 8,266,364 Liabilities and Net Assets Current Liabilities: Line of credit 301,150 Current maturities of debt borrowing 221,822 221,822 689,430 Accounts payable and accrued expenses 687,371 529,956 1,704,836 Accrued payroll and related liabilities 655,861 594,420 580,094 Estimated third party settlements, net 338,452 778,722 Deferred Revenue 802,837 878,016 829,408 Total current liabilities 2,706,343 3,002,936 4,104,918 Debt borrowings,net of current maturities 932,427 950,720 724,135 Total liabilities 3,638,770 3,953,656 4,829,053 Net assets: Invested in capital assets, net of related debt 3,180,315 2,932,379 3,617,051 Unrestricted 1,684,728 2,046,519 (179,740) Total net assets/deficit 4,865,043 4,978,898 3,437,311 Total liabilities and net assets 8,503,813 8,932,555 8,266,364 Days in cash Days in accounts receivable (gross) Days in accounts payable 50 44 44 64 45 35 12 63 120

Statement of Operations Dec-15 Dec-15 Monthly YTD YTD YTD Actual Budget Variance Actual Budget Variance Operating Revenues: 1,084,040 1,124,506 907,642 1,246,936 176,398 (122,430) Inpatient revenue Outpatient revenue 11,649,356 15,227,663 10,361,795 14,918,565 1,287,561 309,098 2,208,546 1,038,787 2,154,578 1,098,257 53,368 (59,469) Total gross patient service revenue Contractuals & Bad Debt 26,877,020 13,501,380 25,280,360 12,830,688 1,596,659 670,691 1,169,759 1,056,322 113,438 Net patient service revenue 13,375,640 12,449,672 925,968 53.0% 2,739 1,172,498 49.0% 23,355 5,493 1,085,170 (23,355) (2,754) 87,328 Net Revenue as a % of gross 340B Revenue EHR incentive revenue Other operating revenue Total operating revenues 49.8% 53,458 91,043 13,520,141 49.2% 70,065 53,458 102,096 12,675,291 (70,065) (0) (11,053) 844,850 Operating expenses: 563,853 171,263 81,887 175,751 147,461 86,229 23,182 95,202 151,396 1,496,224 518,227 158,210 22,491 153,177 119,112 72,886 29,771 93,644 41,114 1,208,631 45,626 13,053 59,396 22,574 28,349 13,343 (6,589) 1,558 110,282 287,593 Salaries Benefits Registry Professional fees Supplies Purchased services Utilities Depreciation and amortization Other operating expenses Total operating expenses 6,490,225 1,679.500 564,762 1,965,032 1,455,833 842,966 242,307 1,116,112 596,928 14,953,664 6,264,599 1,811,695 357,739 1,780,000 1,345,206 890,445 337,258 1,122,703 520,946 14,430,590 225,626 (132,195) 207,023 185,032 110,627 (47,479) (94,951) (6,590) 75,982 523,074 (323,726) (123,461) (200,264) Operating gain/floss) (1,433,523) (1,755,299) 321,776 Non-operating revenues/expenses: 72,943 127,500 13,605 (4,178) 209,870 70,710 70,710 2,233 127,500 13,605 (4,178) 139,160 Intergovernmental Transfer Cost Report (prior year) District tax revenue Rebate from Financing Activities Grants and contributions Interest expense Total non-operating revenues/expenses 4,822,661 (271,450) 850,905 127,500 34,904 (76,436) 5,488,084 808,016 848,520 127,000 10,089 (36,756) 1,756,868 4,014,645 (271,450) 2,385 500 24,816 (39,680) 3,731,217 (113,855) (52,751) (61,104) Net income/floss) 4,054,562 1,569 4,052,992 (87,419) (29,818) (57,601) Trinity EBIDTA 4,342,747 259,050 4,083,697 66.2% Staffing costs as a % of net patient revenue 65.3% 67.7% 127.9% 114.4% Total operating expenses as a % of net patient revenue 111.8% 115.9%

Cash Projection - 2015 Cash UecelvecS Actual January, 2015 Actual February, 2015 Actual March, 201S Actual April, 2015 Actual May,2015 Actual June,2015 Actuals July, 2015 Actuals August, 2015 Actual September, 2015 Actual October, 2015 Actual November, 2015 Actual December, 2015 BegInninE Cash Balance Patient Receipts Intergovernmental Transfer Activity AB-97 AB-915/PPS Recons/Cost Report MU Payments/CHAFF Refund Tax Receipts Miscellaneous Cash Receipts Total Cash Collected Total Cash Available 421,941 977,128 162,916 43,076 1,015 1,190,135 1,612,077 344.986 331,320 29,422 9,124 969.866 1,314,852 54,176 1,246,336 244,758 58,340 3,612 1.553,047 1,607,222 385,674 904,835 808,366 121,589 36,862 2S,2U 1,896,871 2,282,545 4G9.024 966,369 392,078 7.965 34,171 1,400,583 1,869,607 577,410 1,217,849 117,551 10,097 48,738 1,42<,235 2,001,735 141,344 1,431,662 20,487 3,835 1,455,984 1,597,328 56,723 1,023,129 248,495 5,422 55,590.74 1,336,636 1,393,365 671 1,439,010 162,130 100,392 1,828 1,703,360 1,704,031 2,176,928 1,179,284 3,450,437 179.494 35,075 4,354.290 7,031,217 83,462 1,024,106 142,990 179.277 1,346,373 1,429,835 64,033 1,084,869 107,974 2S,848 1,221,691 1,285,724 Cash Disbursed Payroll Accounts Payable Notes Payable Una of Credit Cost Report Repayment Intergovernmental Transfer Activity Cash Reserves Total Disbursements 688,906 446,005 12,2'M 25,000 44,128 1,267,090 628,180 146,813 12,Z<4 473,439 1,260,677 635,874 498,431 12,244 75,000 1,221,548 677,396 671,942 12,245 200,509 36,000 215,428 1,813,SZ1 675,768 sys.igo 12,244 28,966 1,292,168 655,230 703,404 12,246 28,966 460,545 1,860,391 689,747 759,641 12,246 28,966 50,000 1,540,600 569,144 657.339 12,244 2B.S66 25,000 1,332,694 688,443 58G,3<0 41,7«81,065 16,188 1,413,780 688,678 685,324 1,887/077 1,800,000 5,061,073 772,570 553,233 1,365,802 691,580 617,108 420,000 (740,000) 388,688 Cash Position Balance Before Financing Financing Cash Balance 344,987 344,327 34,175 54,175 385,674 385,674 469,024 453,024 577,440 577,440 141,344 14I,3«56,729 SC.729 671 S71 290,252 1,886,676 2,175.328 1.S70.138 (1,886,676) B3,4E2 64.033 64,033 237,036 297,036 Financing Activity Trinity Public Utilities District LOC Trinity Public Utilities District Note Payable Total Outstanding 275,000 Outstanding 275,000 Outstanding 200,000 Outstanding 1 ) Outstanding ( ) Outstandlne 1 ) Outstanding (0) Outstanding (0) Outstanding 1,886,676 1,886,676 Outstanding IB) Outstanding 10) Outstanding 10) Cash Reserve Balance (D 1 12,122) (40,372) 0 445,981 566.178 617,245 548,362 2,348,362 2,348,362 1,608,362 Total Cash on Hand 344,986 54,176 383,552 428,652 577,440 587.325 G22.907 617,916 838,614 2,431,824 2,412,395 1,9D5,39B

Line of Business Analysis with Overhead Allocated December, 2015 Expected Net Revenue SNF Home Health Trinity Hayfork Hospital with Total Community Community Emergency Health Clinic Health Clinic Department attached 229,164 14,947 120,598 48,383 756,667 1,169,759 Direct Expense Direct Expense - Net Gain/floss) 173,691 55,474 19,782 (4,834) 110,040 10,558 28,648 19,735 594,123 162,544 926,283 243,477 Overhead Expense Overhead Expense - Net Gain/(loss) 127,715 (72,242) 10,498 (15,332) 40,043 (29,485) 22,995 (3,260) 368,690 (206,146) 569,941 (326,464) Non Operating Revenue/Expense 47,643 3,916 14,937 8,578 137,535 212,609 Net lncome/(loss) (24,599) (11,416) (14,547) 5,318 (68,611) (113,855) Note: This supplemental schedule is designed to be an activity statement that shows details and results of the line of business's profit-related activities for a period of time. Overhead and Non Operating Revenue/Expense is allocated based on the most recent as filed Medicare Cost Report. This schedule is not an income statement. This analysis is designed to determine if a line of business is covering direct expenses and is contributing towards overhead expense. Page 4 of 5

Monthly Activity Log PATIENT DAYS: MED/SURG INPATIENT SURGERIES SWING BED OBSERVATION 5NF TOTAL PATIENT DAYS: TESTS/V1SITS: CT SCAN TESTS ECHOCa.RDIOGRAM TESTS EMERGENCY ROOM VISITS HAYFORK CLINIC VISITS HOME HEALTH VISITS LABORATORY TESTS PHYSICAL THERAPY RESPIRATORY THERAPY TESTS TOP CARE VISITS TRINIT/CLINIC VISITS ULTRASOUND TESTS X-RAY TESTS TOTAL TESTS/VISITS: Ort-14 97 1 18 25 55D 691 90 21 410 470 108 17,343 25 602 12 853 72 371 20,377 iov-u 78 0 42 21 567 708 52 24 375 337 83 16,032 62 B68 7 828 53 317 19,038 Dec-14 104 0 28 26 639 797 67 12 430 374 88 17,367 53 1,090 10 908 75 324 20,804 2014 YTD 1,018 42 32Z 252 7.076 8,710 834 250 4,698 4,907 1,134 194,216 472 8,097 89 10,880 703 4,026 230,306 Jan-15 86 2 36 24 603 751 58 21 399 401 68 16,127 30 895 17 957 59 365 19,397 Feb-15 76 3 38 24 536 677 67 12 419 337 59 15,086 33 785 3S 786 52 306 17,977 Mar-15 86 1 23 13 60S 731 5S 6 415 38G 84 16.41S 51 871 37 726 56 282 19,384 Apr-15 91 0 84 12 556 743 S7 10 467 377 88 17,636 60 979 18 945 57 367 21,061 Mav-15 94 0 87 14 559 754 58 15 466 355 69 1S.166 GO 694 26 694 36 257 17,896 Jun-15 86 0 88 11 581 766 74 27 471 378 84 19,259 64 822 18 929 54 324 22,504 Jul-15 100 0 137 10 595 842 81 57 513 372 81 20,828 77 839 12 955 81 296 24,192 Aue-15 104 0 165 12 553 834 71 33 478 300 82 17,442 72 1,132 17 726 42 294 20,689 Sep-15 112 0 62 14 519 707 68 60 437 377 79 18,140 54 984 27 880 56 302 21,464 Oct-15 69 3 72 7 520 671 68 18 371 350 99 17,322 100 837 22 858 60 312 20,117 Nov-15 56 0 70 3 49D 619 71 54 389 269 37 15,513 69 783 50 887 64 260 18,446 Dec-15 79 0 114 2 503 638 64 42 353 325 37 17,231 91 763 37 933 73 284 20,233 2015 YTD 1,039 9 976 146 6,623 8,793 792 355 5,178 4,227 867 206,165 761 10,384 316 10,276 630 3,649 243,660 2015 December Budget 74 7 46 26 539 752 66 7 383 435 91 15,935 39 627 7 899 57 329 18,875 2015 Monthh Average 86 2 36 24 603 751 58 21 399 401 68 16,127 30 895 17 957 59 365 19,397 2014 Monthh Average 81 4 29 19 596 730 69 23 376 410 97 15,852 38 600 7 917 56 333 18,776

TRINITY HOSPITAL Owned and Operated by Mountain Communities Healthcare District Chief Nursing Officer Report to the Board of Directors January 28,2016 1. Staff recruitment and retention a. We will be welcoming 4 RNs to MCHD in January b. Cross training has been successful: 2 SNF LVNs and 1 RN have been trained on Med/Surg. 1 RN from Med/Surg trained to ER and 1 RN from Med/Surg to pre/post-surgery. Plan is for 1 RN from Med/Surg to be trained to OR c. OR- recruiting a RN 2. CMS Survey a. Interim DON started 1/9/2016 for Skilled Nursing

TRINITY HOSPITAL Owned and Operated by Mountain Communities Healthcare District P.O. Box 1229 60 Easter Avenue Weaverville, CA 96093 Phone: (530) 623-5541 To: MCHD Board of Directors 01/20/2016 Re: Quality Assurance Greetings, We are beginning the first quarter of 2016. This means that staff is busy working to complete compiling their data for the last quarter of 2015. Results are starting to trickle in. In December we have started a Quality Assurance / Risk Management (QA/RM) monthly newsletter. This is to answer commonly asked questions and to provide further education for all staff members. A requirement for CAHs is to have an annual review of services completed. The managers have met to discuss how to divide up the assignments for this. The report is expected to be completed around March, 2016. Thank you for your time, Sarah Cordtz, RN Coordinator Quality Assurance / Risk Management.

MOUNTAIN COMMUNITIES HEALTHCARE DISTRICT MEETING MINUTES BOARD MEETING November 24, 2015 4:00 p.m. Trinity County Library Weave rvi I Ie CA & 29 Parliament Court Chico CA 95973 DISTRICT BOARD MEMBERS GERALD BRASUELL DERO FORSLUND JERRY H. COUSINS LYNN JUNGWIRTH FRANCIS MOORE Vice-President Clerk President Treasurer Member Note: These minutes contain a description for each item to be considered. Supporting documentation is available in the public packet at the Board meeting or at the Administrative Office at Trinity Hospital. District Board Members Present: Gerald Brasuell, Vice-President Dero Forslund, Clerk Lynn Jungwirth, Treasurer (by Phone) Jerry H. Cousins, President Francis Moore District Board Members Absent: None Staff Present: Aaron Rogers, CEO Christine Blackburn Peggy Manning, RN, Chief Nursing Officer Teresa Couch, CNA Wally Couch, Director of Plant Operations Jennifer Van Matre, Director of Finance Victoria Williams, Director, Ancillary Services Hollie Malloy, Manager TCHC Michael Novak, PA, Director of Clinic Services 4:00 PM CALLS MEETING TO ORDER IN OPEN SESSION Report from Closed Session on October 28, 2015 President Cousins reported that the Board reviewed the recommended actions on Medical Staff Privileges. For each applicant the following information has been reviewed and/or verified: Privilege List, NPDB Report, and AMA Profile, peer references and verifications of staff privileges at other facility and ongoing professional practice evaluations. Items verified were Liability Insurance Coverage, Licenses, Certifications, and the Medicare exclusion list was checked.

Board of Directors Board Meeting November 24, 2015 On motion of Director Brasuell seconded by Director Moore approves the following reappointments upon the recommendation from the Medical Staff. Appointments/Reappointments: Lisa Taleraco, Psychologies Provisional Staff Specialty: Psychology Mark Hornsby, CRNA Professional Staff Specialty: Anesthesia Resignation Thomas Knutson, MD The motion passed with the following voice vote: Ayes: Gerald Brasuell; Jerry Cousins; Lynn Jungwirth; Francis Moore Noes: None Absent: Dero Forslund Abstain: None President Cousins reported that the Board reviewed the proposed pay scale for non-exempt employees. On motion of Director Brasuell seconded by Director Jungwirth approves the pay scale for non-exempt employees. The motion passed with the following voice vote: Ayes: Gerald Brasuell; Jerry Cousins; Lynn Jungwirth; Francis Moore Noes: None Absent: Dero Forslund Abstam: None President Cousins reported that the Board discussed a case of existing litigation with the following action. On a motion of Director Brasuell and seconded by Director Jungwirth the Chief Executive Officer was given direction and parameters for negotiations in the case of Pamela Balsly vs Mountain Communities Healthcare District: Case No. 2:13-cv- 02334-GEB-CMK. The motion passed with the following voice vote: Ayes: Gerald Brasuell; Jen'y Cousins; Lymi Jungwu^h; Francis Moore Noes: None Absent: Dero Forslund Abstain: None Public Input - None Reports Medical Staff Report Received written report from Daniel Harwood, MD, Chief of Staff/Donald Krouse, MD, Vice Chief of Staff regarding activities of the Trinity Hospital Medical Staff. Other items discussed in addition to the written report were: Reappointments Utilization Review

Board of Directors Board Meeting November 24, 2015 Chief Executive Officer Received written /verbal report from Aaron Rogers, CEO on the current operations of the hospital. Other items discussed in addition to the written report were: Community Surveys - Jerry Cousins would like the surveys distributed to the Golden Age Center and the Moose Lodge in Lewiston. Chief Financial Officer Received written /verbal report from Jan Marshall, CFO and Jennifer Van Matre, Director of Finance, on the current financial status and current status of revenue cycle management and accounts receivable. Other items discussed in addition to the written report were: Gerald Brasuell reported that the roll off of gross charges were related to manpower to support patient intake. Chief Nursing Officer Received written/verbal report from Peggy Manning, RN, CNO on the current status of the nursing departments. Other items discussed in addition to the written report were: Staff RecruitmenVRetention SNF Survey Quality Improvement Received written/verbal report from Sarah Cordtz, RN, Coordinator, Q/RM on the cun-ent status of the Quality Program. MCHD Quarterly Checklist of ongoing professional practice evaluations was reviewed and staff reported that some of the reviews have not been completed. The Board requested of staff and physicians that delinquent reviews are completed immediately and future reviews are done in a timely manner. Staff will report to the medical staff and MCHD Board on a quarterly basis statistics regarding completed ongoing professional practice evaluations. Frank Moore reported that there has been progress regarding new goals being made. One goal is to have better attendance at meetings. There have been missing reports from various departments. Dero Forslund reviewed some of the skilled nursing survey concerns. Consent Agenda All matters listed under the Consent Agenda, are considered by the Board to be routine, and will be enacted by one motion in the form listed below. There will be no separate discussion of these items unless a request for discussion is made prior to the time the Board votes on the motion to approve. On Motion of Director Brasuell seconded by Director Moore approves the following consent items: a. Minutes from October 28, 2015 b. Policies (See Attached) The motion passed with the following voice vote: Ayes: Gerald Brasuell; Dero Forslund; Jeny Cousins; Lynn Jungwirth; Francis Moore Noes: None Absent: None Abstain: None

Board of Directors Board IVIeeting November 24, 2015 Discussion Items a. Clinic Aaron Rogers, CEO discussed overview of the proposed clinic expansion and introduced Michael Novak, PA, Director of Clinic Services. The following issues were reviewed: Size of the current clinic Increased services such as urgent care, physical therapy and dental which would allow us to provide the best care to our community. Business point of view - clinic will generate additional revenue through additional clinic visits and ancillaries. Increased clinic services will promote self-sufficiency. Traffic safety issues - no turn lanes and no sidewalks on Taylor street Physicians would like the lab and radiology department in close proximity to the clinic The MCHD Board of Directors heard concerns regarding traffic on Taylor street and possible traffic safety issues - no turn lanes and no sidewalks on Taylor street from Susan Corrigan Use permits will be submitted to the planning department and will be on the Planning Board of Directors meeting in February or March b. HVAC/DRI Grant Wally Couch reported that we are nearing the end of the project and that the exhaust fan needs to be replaced. Action Items a. Items removed from the Consent Agenda Minutes from October 28, 2015 On Motion of Director Brasuell seconded by Director Moore approves the minutes from October 28, 2015 with the following change: Change Dero Forslund to Absent The motion passed with the following voice vote: Ayes: Gerald Brasuell; Dero Forslund; Jeny Cousins; Lynn Jungwirth; Francis Moore Noes: None Absent: None Abstain: None b. Consider Approval of Extension of Option Period for Purchase of Property No Discussion or Action taken

Board of Directors Board Meeting November 24, 2015 Board Reports None Announcement Designated Representatives for Closed Session item "Salaries and Benefits" Announcement of Designated Representatives for Closed Session item "Salaries and Benefits". Representative is Aaron Rogers, CEO Close Public Session Closed Session The Board entered into closed session at 5:00 pm on the following: MEDICAL STAFF PRIVILEGES Government Code Section 54962; Health and Safety Code Section 1461 QUALITY IMPROVEMENT/RISK MANAGEMENT Government Code Section 54962: Health and Safety Code Section 32155 SALARIES AND BENEFITS Government Code Section 54957.6 Designated Representatives: Aaron Rogers PUBLIC EMPLOYEE PERFORMANCE EVALUATION Government Code Section 54957 - Public Employee Title: Chief Executive Officer The Board came out of Closed Session at 5:15 pm and immediately reconvened in Open Session. President Cousins reported that the Board reviewed the recommended actions on Medical Staff Privileges. For each applicant the following infomiation has been reviewed and/or verified: Privilege List, NPDB Report, and AMA Profile, peer references and verifications of staff privileges at other facility and ongoing professional practice evaluations. Items verified were Liability Insurance Coverage, Licenses, Certifications, and the Medicare exclusion list was checked. On motion of Director Moore seconded by Director Brasuell approves the following reappointments upon the recommendation from the Medical Staff. Appointments/Reappointments: Gary Carson, MD Albert Ybasco, MD Mailan Cao, MD Saadet Atay-Rosenthal, MD Harvey Greenberg, MD Consulting Staff Consulting Staff Consulting Staff Consulting Staff Consulting Staff 5 Specialty: Emergency Medicine Specialty: Teleradiology Specialty: Teleradiology Specialty: Teleradiology Specialty: Teleradiology

Board of Directors Board Meeting November 24, 2015 Stacy Greenspan, MD Consulting Staff Specialty: Teleradiology Dilan Samarawickrama, MD Provisional Staff Speciality: Radiology The motion passed with the following voice vote: Ayes: Dero Forslund Gerald Brasuell; JeiTy Cousins; Lymi Jungwirth; Francis Moore Noes: None Absent: None Abstain: None QUALITY IMPROVEMENT/RISK MANAGEMENT President Cousins reported that the Board thoroughly reviewed the quality data presented and there no action was taken. SALARIES AND BENEFITS President Cousins reported that Aaron Rogers, CEO reported on the bonuses and wage scale updates. It was reported that the cost to adjust salaries to at least $12.00 per hour was $109,000. CEO EVALUATION President Cousins reported that the Board discussed format for performance evaluations for the chief executive officer. Adjourn: There being no farther business, the meeting was adjourned at 5:55 p.m. Dero Forslund, Clerk of the Board Mountain Communities Healthcare District

+ MOUNTAIN COMMUNITIES HEALTHCARE DISTRICT MEETING MINUTES BOARD MEETING December 30, 2015 4:00 p.m. Trinity County Library Weave rvi I Ie CA DISTRICT BOARD MEMBERS GERALD BRASUELL DERO FORSLUND JERRY H. COUSINS LYNN JUNGWIRTH FRANCIS MOORE Vice-President Clerk President Treasurer Member Note: These minutes contain a description for each item to be considered. Supporting documentation is available in the public packet at the Board meeting or at the Administrative Office at Trinity Hospital. District Board Members Present: Gerald Brasuell, Vice-President Dero Forslund, Clerk Lynn Jungwirth, Treasurer (by Phone) Jerry H. Cousins, President Francis Moore District Board Members Absent: None Staff Present: Aaron Rogers, CEO Peggy Manning, RN, Chief Nursing Officer Jeanne Silvers, Executive Assistant Jennifer Van Matre, Director of Finance Victoria Williams, Director, Ancillary Services Michael Novak, PA, Director of Clinic Services Kelly Simpson, Business Services Manager Donald Krouse, MD, Vice Chief of Staff 4:00 PM CALLS MEETING TO ORDER IN OPEN SESSION Report from Closed Session on November 24, 2015 The Board came out of Closed Session at 5:15 pm and immediately reconvened m Open Session. President Cousins reported that the Board reviewed the recommended actions on Medical Staff Privileges. For each applicant the followmg information has been reviewed and/or verified: Privilege List, NPDB Report, and AMA Profile, peer references and verifications of staff privileges at other facility and ongoing professional practice evaluations. Items verified were Liability Insurance Coverage, Licenses, Certifications, and the Medicare exclusion list was checked. On motion of Director Moore seconded by Director Brasuell approves the following reappointments upon the recommendation from the Medical Staff.

Board of Directors Board Meeting December 3 0,2015 Appointments/Reappointments: Gary Carson, MD Consulting Staff Specialty: Emergency Medicine Albert Ybasco, MD Consulting Staff Specialty: Teleradiology Mailan Cao, MD Consulting Staff Specialty: Teleradiology Saadet Atay-Rosenthal, MD Consulting Staff Specialty: Teleradiology Harvey Greenberg, MD Consulting Staff Specialty: Teleradiology Stacy Greenspan, MD Consulting Staff Specialty: Teleradiology Dilan Samarawickrama, MD Provisional Staff Speciality: Radiology The motion passed with the following voice vote: Ayes: Dero Forslund Gerald Brasuell; Jerry Cousins; Lynn Jungwirth; Francis Moore Noes: None Absent: None Abstain: None QUALITY IMPROVEMENT/RISK MANAGEMENT President Cousins reported that the Board thoroughly reviewed the quality data presented and there no action was taken. SALARIES AND BENEFITS President Cousins reported that Aaron Rogers, CEO reported on the bonuses and wage scale updates. It was reported that the cost to adjust salaries to at least $12.00 per hour was $109,000. CEO EVALUATION President Cousins reported that the Board discussed format for performance evaluations for the chief executive officer. Public Input - None Subsequent Agenda Item Request to add a subsequent agenda item entitled: Resolution 2015-09 - Resolution of the Board of Directors of the Mountain Communities Healthcare District Accepting Title to Real Property On Motion of Director Brasuell seconded by Director Forslund approves addition of agenda item "Resolution 2015-09 - Resolution of the Board of Directors of the Mountain Communities Healthcare District Accepting Title to Real Property" to the agenda. The motion passed with the following voice vote: Ayes: Dero Forslund; Gerald Brasuell; Jerry Cousins; Lynn Jungwirth; Francis Moore Noes: None Absent: None Abstain: None Reports Medical Staff Report No Report

Board of Directors Board Meeting December 3 0,2015 Chief Executive Officer Received written /verbal report from Aaron Rogers, CEO on the current operations of the hospital. Other items discussed in addition to the written report were: DRI grant construction is complete but have not received sign off as of this date. Staff is actively recruiting Chief Financial Officer Received written /verbal report from Jon Marshall, CFO and Jennifer Van Matre, Director of Finance, on the current financial status and current status of revenue cycle management and accounts receivable. Other items discussed in addition to the written report were: Gerald Brasuell reported that the District continues to work towards a breakeven with patient revenues and the Finance Committee is pleased with the current progress. Chief Nursing Officer Received written/verbal report from Peggy Manning, RN, CNO on the current status of the nursing departments. Items discussed were: Staff Recruitment/Retention. SNF Survey - signed contract with Corky Rockwell, RN as SNF consultant. She will begin on January 11. Staff is developing a plan of correction for the statement of deficiencies. Quality Improvement Received written/verbal report from Sarah Cordtz, RN, Coordinator, Q/RM on the current status of the Quality Program. MCHD Quarterly Checklist of ongoing professional practice evaluations was reviewed and staff reported that some of the reviews have not been completed. The Board requested of staff and physicians that delinquent reviews are completed immediately and future reviews are done in a timely manner. Staff will report to the medical staff and MCHD Board on a quarterly basis statistics regarding completed ongoing professional practice evaluations. Frank IVtoore reported that Aaron Rogers, CEO attended the meeting and there were very dynamic discussions Consent Agenda All matters listed under the Consent Agenda, are considered by the Board to be routine, and will be enacted by one motion in the form listed below. There will be no separate discussion of these items unless a request for discussion is made prior to the time the Board votes on the motion to approve. On Motion of Director Jungwith seconded by Director Forslund approves the following consent items: a. Minutes from December 9, 2015 The motion passed with the following voice vote: Ayes: Gerald Brasuell; Dero Forslund; Jeny Cousins; Lynn Jungwirth; Francis Moore Noes: None Absent: None Abstain: None

Board of Directors Board Meeting December 3 0,2015 Discussion Items a. Clinic The MCHD Board of Directors has taken in to consideration all concerns regarding the expansion of the clinic and traffic issues on Taylor Street. The following items were discussed: Funding sources Architect and need for traffic engineer Scheduling of meeting with Trinity County Planning Department staff With new staff beginning to see patients soon there will be rotations to the Hayfork Clinic Budget update when appropriate regarding clinic expansion needs Action Items a. Items removed from the Consent Agenda None b. 2016 Budget On Motion of Director Forslund seconded by Director Moore approves the 2016 Budget The motion passed with the following voice vote: Ayes: Dero Forslund; Gerald Brasuell; Jen-y Cousins; Lynn Jungwirth; Francis Moore Noes: None Absent: None Abstain: None c. Resolution 2015-09 - Resolution of the Board of Directors of the Mountain Communities Healthcare District Accepting Title to Real Property On Motion of Director Forslund seconded by Director Moore approves Resolution 2015-09 - Resolution of the Board of Directors of the IVIountain Communities Healthcare District Accepting Title to Real Property The motion passed with the following roll call vote: Ayes: Dero Forslund; Gerald Brasuell; Jeiry Cousins; Lynn Jungwirth; Francis Moore Noes: None Absent: None Abstain: None Board Reports Jerry Cousins reported that the Board will be completing a CEO evaluation in February. Trinity Cares would like two Board members to be part of the group going forward.

Board of Directors Board Meeting December 3 0,2015 Lynn Jungwirth reported that residents in Hayfork are discussing the clinic expansion, services to be available in Hayfork and the upcoming tax vote and 80% comments are positive. Announcement Designated Representatives for Closed Session item "Salaries and Benefits" Announcement of Designated Representatives for Closed Session item "Salaries and Benefits". Representative is Aaron Rogers, CEO Close Public Session Closed Session The Board entered into closed session at 7:14 pm on the following: QUALITY IMPROVEMENT/RISK MANAGEMENT Government Code Section 54962: Health and Safety Code Section 32155 SALARIES AND BENEFITS Government Code Section 54957.6 Designated Representatives: Aaron Rogers CONFERENCE WITH LEGAL COUNSEL EXISTING LITIGATION (Subdivision (a) of Section 54956.9) Name of Case: Pamela Balsly vs. Mountain Comraunities Healthcare District: Case No. 2:13-cv-02334-GEB-CMK. LIABILITY CLAIMS - Claimant: Patricia McColm. Agency Claimed against: Mountain Communities Healthcare District. Section 54961 The Board came out of Closed Session at 8:05 pm and immediately reconvened in Open Session. Jerry Cousins reported that the Board reviewed the quality improvement issues regarding the skilled nursing unit. Jerry Cousins reported that the Board received a report from Aar Jerry Cousins reported that the Board heard a report from Aaron Rogers, CEO regarding 2% increase for employees on their date of hire, settlement of existing litigation and a claim that will be denied due to late filing. Adiourn: There being no further business, the meeting was adjourned at 8:10 p.m. Dero Forslund, Clerk of the Board IVIountain Communities Healthcare District