001A lot that we do, some of it is across all departments and some of it is department specific. There's numerous data points across each department that we have to be tracking, whether it's quality improvement or CMS reportable data. It's multidisciplinary. It could be a nursing thing. It could be a physician thing. It could be pharmacy. Some of it's regulatory. Some of it is just our own internal processes. And most of them are reported publicly through multiple venues. And I would encourage... everybody in the public as well to look at our our quality board quality meetings on the last Wednesdays of every month because again we're very public with all of our quality data and I want folks to to be aware of all of that so on the next slide I just broke it down
002across all the departments this is just a quick snapshot of all the data points that I was talking about these are all the things that we're tracking all the time across all of the departments it's it's a lot a lot of data that we're tracking okay next slide please We are also responsible for emergency preparedness. So in 2025, we did a couple of exercises. In March, we participated with the Sonoma County Emergency Management Team in their MERCI, their Medical Response Surge Exercise. Each hospital, as they participate, they can do whatever they want to do, just use the opportunity to coordinate your care. We chose that opportunity to practice our downtime for the EPIC. So if we lost our computer systems, what would we do? In April, we had some training taught by the chief of
003police, Brendan Cutting. He came in. He gave three two-hour classes on active crisis response or active shooter in the hospital. And in June, we again participated with our military folks down at Travis Air Force Base on their mercy exercise, and that's the second year in a row that we've done that. And then on the next slide, this was our big exercise in October. We did this. This is the second year in a row that we practiced what we would do if there was a major earthquake. If you remember last year, we had... two goals and that was communications and departmental response. This year we tested those again and those improvements that we made and then also added two more goals. We opened the labor pool and practiced that process as well as evacuating patients. So
004if you have patients who are in a bed, how are you going to get them from the third floor down to the first floor to get them out with no elevators? So we practiced getting those folks down the stairs whether they were bed bound or wheelchair bound. Great participation and that was a lot of fun. A little bit more about the emergency department. So I included some stats here from 23, 24, and 25. You'll see the total volume has really increased a lot over the last couple of years. And I'd like to point out that the Napa Valley Emergency Medical Group, they started with us August of 2020. 2023 and Mary Lou joined our team in May of 2024. So you can see by the time we got to 2025 having all those great things
005in place things really have kind of taken off. So we ended the year with just under 12,000 patients and that's a lot especially when you look at the average daily volume. So you could see anywhere from 12 patients to some days we've had 45 to 50 patients and that's a lot to put in a small eight-bed emergency department. What I love about this was also if you look at the next line, the percent LWBS, that's the left without being seen, we tracked that as well. It went from 2% down to 1.3, down to below 1%. So even as the volume is increasing, that left without being seen is decreasing. The percent admitted, that kind of crept up closer to 10%, and that speaks very highly to our physicians' commitment to keeping our people in the
006valley. So if you live here, you get your care here, and you can stay here. So that's one of their metrics that they take very seriously. And then the percent transferred out, 8.3%. That hasn't changed a whole lot. I would just comment it's also their confidence in what you do. Absolutely. Absolutely. That translates. You know, the physician has to feel. That's absolutely true. Yeah, and there's partnership between the hospitalists and the ER physicians. They have to have that good communication. Okay, and the next slide, the APOT. This is the Ambulance Patient Offload Time. This is something that last year we were required to start tracking and reporting on. So I do not collect this data. This comes directly to me from the EMS. that is the Emergency Medical Services Authority. There's a state level and
007then below that you'll see on the blue line on the right side of the screen the CVEMSA and that is the Coastal Valleys Emergency Medical Services Authority. So that's our regional. group and they're the ones that report this data to me. So the goal is to get the first responders when they drop a patient off, get that patient off the stretcher and get the first responders back out into the community. We don't want them hanging around in the emergency department. You can see our APOT times are usually pretty darn good. So if the blue line is the less than 30 minutes on the right side, we kind of hover around 10, 11, 12 minutes. It goes up and down. If you look on the left side, that's the breakdown on kind of where they're staying.
008So you can see in February and March, there were two times when we were at 60 minutes or greater, and that's extremely rare. And quite honestly, I'd have to say that it could have been a very, like maybe a cardiac arrest or some very, very sick patient that our EMS partners stayed to help. There's such a good relationship between the first responders and the emergency department now that we really do try to support each other, and I guess that was the case in those two instances because it's very rare that we would have the offload time take that long. The bottom of that graph, you can see where it's less than 20 minutes, and that's where most of our cases fall, so 200 here, 172 there. That's mostly where we fall, below the 20-minute mark.
009So great work there. And then on the next slide, I wanted to talk a little bit about the AD throughput. So that's the experience of when you come into the emergency department, what happens to you and how long does it take for you to get through the emergency department, because that's very important to people. So the green boxes, this is a screenshot right out of EPIC. This is the EPIC timing data. The arrival to depart, that's the median time for all departures, and it does exclude those extreme emergency cases and psychiatric cases, because those are quite the... outliers. And then the one below that, the arrival to ED discharge, that is if you're not getting admitted, that's just You're coming in and we're getting you out. How quickly can that happen? And that's data that
010we have to report to CMS. So you can see it takes around, you know, 117 minutes, 115 minutes, 120 minutes. And, again, that's the median time. So there can be outliers. It can be faster. It can be longer. But then what happens within those minutes? So I also pulled out the median time. So registration takes two to four minutes. When you arrive, we also track the time you get there to the time you get into the room. The median time is five minutes. From the time you arrive to the time you get triaged, that can take about seven minutes. And then when the nurse finished triaging and she hits the triage end button, that sends an automatic notice to the physician, okay, the patient's ready for you. And that physician will usually get in there
011and see you within five minutes. The ED2 admission, that can take a while sometimes while they sort out, they get the lab results and make the determination that the patient does need to be admitted. That can take on average about three hours. So I do track that as well. But what I focus on mostly is from the time I get the admission order to the time I can get the patient upstairs because that's what nursing can impact. The median time for that is 58 minutes. So there's outliers. Sometimes patients do spend a long time in the ER. Sometimes we can get them up pretty quickly. But what normally happens is about 58 minutes. 69% of the patients definitely will get up there in less than 90 minutes from the time I get that physician order
012to the time I get them upstairs. Any questions on any of that data so far? Because I know it's a lot. And all of that ties into our service excellence. Next slide, please. And, you know, we talk about this a lot, but this is the queue reviews. This is the texting service. So as soon as the patient is discharged, they get a text. Hey, would you like to take a survey? For the inpatient side, it's, you know, once you're admitted, the next day you get a text. In the emergency department, they rounded out the year at 4.73 out of 5 stars, and that's an improvement. When I stood here last year and gave you the same data, it was 4.58. So they made a pretty good jump there. Not a whole lot of movement for
013inpatient and surgery, but still pretty good. 4.7 for inpatient and 4.86 for surgery. And then on the next slide, all total, it's 4.76. So pull all of those departments together. They do pretty well. I also put in there the age breakdowns. It's no surprise. Most of our patients are 50, 60, 70 years old. But surprisingly, it was more females that responded, 60% of females, as opposed to the 39% of males that responded. Isn't that usually the case? I think so. I don't have a lot to say. What you need to ask is how many of the males were filled. Yeah, that's the female number is probably closer than nine. I think that's fair. Yeah Okay, and then on the next slide is the age caps This is the mail survey that the survey that comes
014in the mail that we're required to do by CMS This data is is what's currently posted it is from 2024 from January 2024 to December of 2024 there were 137 responses And the patients who reported that the nurses always communicated. So these are the domains. Within communication, there's a bunch of different questions. So 85% of the patients that took the survey said that the nurses always communicated well and respectfully and that's upset that's up from 79% last year The patients who reported that they always received the help as soon as they wanted it was at 79% and that's up from 74% Last year and you can see I also included the the national and the state average on those as well On the patients that reported, the staff always explained about the medications, 62%. That's
015still right around the state and national average, but that is an improvement. We were at 56% last year. And then the patients that reported that, yes, they were given information about what to do about their recovery at home, didn't move the needle, that's at 92%, and we were at 91% last year. But that I tie into the next question that the patients strongly agree that they understood what to do when they got home is still very low at 57%, and you can see the state and national average is right around the same. I will say that's also an improvement from last year. Last year we were at 46%. So we did make some strides on that. And then the next slide is the outpatient ambulatory surgery. consumer assessment of providers and systems. So just like
016the HCAHPS but focusing on ambulatory surgery. Now historically CMS has not required this and they have not reported it but this is new for 2026 that they will start reporting it. So this is now publicly available data. We've always sent the surveys just to kind of see where we're at but now CMS is going to start reporting it and that's why they don't have any stars there yet. But again doing pretty well in there. The patients who reported that the facility was definitely clean and the staff were helpful was at 97. And the patients who reported that the staff gave good instructions was at 93. And the patients that reported that, yes, we had written information about what to do about when I got home, 97%. And then the patients who gave us a rating
017of 9 or 10, 87%. And the patients that said, yes, they would recommend the facility at 86%. Okay. And then I always have to end with a quote from Florence Nightingale because she is our founder of modern nursing. And I think this is true about everybody in this room, that we are all learners and we're all lifelong learners, which makes it such a joy to work with all of these people. But we should never consider ourselves finished and we should always be learning all of our lives. And that is the end of my report. If you have any questions, I'm happy to figure out the answer for you. Thank you very much. Okay. Thank you. We appreciate you. Thank you. Just as an aside I get to hear from Jessica every month at my meetings
018Thank you for being here, oh you're welcome I apologize for being late I was at a red comm our fire and EMS dispatch JPA I said as the president of the board and so we had a board meeting today I got out of it was in Windsor and so I got out thought with enough time, but then we know traffic, right? Yeah. So you can see from Jessica's report we appreciate the partnership Oh, that was what I was gonna lead with that's we we feel the very same way So thank you for the opportunity to share some news and updates from The fire district and fire and EMS provider here for the valley For those that don't know me. My name is Steve acre. I'm the fire chief for the Sonoma Valley Fire District we
019now cover from Kenwood all the way down through the city of Sonoma and into Temelec is our fire district proper and then our ambulance service is the same as the hospital districts boundary so we'll go all the way down to Sonoma Raceway with with ambulance service so I am a near lifelong resident here of the valley as well so very honored to be able to serve the community my hometown community in this capacity as many of us are in the district. So partnership is the big thing with Sonoma Valley Hospital. Can I have the next slide please? Thank you. So the first thing I wanted to do is just kind of give an update on what we've done in the last year and I know there's some, there's some. the familiar faces on the board,
020but I see new faces behind us. So I wanted to take just a minute to talk about Measure H, which was a countywide sales tax that we were able to pass in March of 24. almost two years ago, and that brought $62 million annually to fire agencies throughout the county. So with that, here in the valley, we've been able to increase our ambulance staffing from two staffed paramedic ambulances a day to three. That was on our wish list, needs list for many, many decades. And we just did not have a funding source to be able to provide that level of staffing. So what we would do in the past is we would take the... staffing from the fire engine and take them off of the engine and put them on to a third ambulance when
021we had that need which addressed that immediate need but it also it's not really good risk management in the in the bigger picture of things so that that's one of our proudest and biggest accomplishments from measure h dollars we also increased our fire engine staffing we had two engines that only had two firefighters per day and we were able to bring that up to three We are currently in the process, well, all of that staffing in total brought 17 new firefighter paramedics to our department and staffing to serve the community. And what's Kenwood Incorporated, 2025? Yep, 2025, July 1, 2025. So we were providing staffing and very proud like we have when we've expanded in the past is when we have done any of our expansions, it's brought paramedic service to the community from the
022fire engine based paramedics, which we know gets paramedic. and advanced life support services to community members when they dial 911 much faster than than relying on an ambulance to come and be that first paramedic to provide those interventions. We are currently doing two major fire station projects. We're underway with remodeling the Kenwood station which was never designed to staff firefighters 24-7. and we are going to do a new Fire Station 2 build in Alvarado. Right now our station is on Center Street, and that's about a 50-plus-year-old building, and the district purchased two properties just south of Juanita, Juanita, on Arnold Drive. And so we've got about eight acres. Our vision is we will build a new state-of-the-art fire station, which will house an engine crew and an ambulance crew. as well as building a training
023and community resiliency center on the property. So we're really excited about that vision and getting started on that. What's the timeline for those? Kenwood is, we expect to break ground with Kenwood, I would say, late summer. So we're in the process of getting architectural drawings right now and then securing a contractor once the plans are further along. And then the new Station 2 project in Alvarado, that's going to be a little bit further out. We're in the process right now, because those properties are not in the sanitation district, we're going through the LAFCO process to get annexed in so we don't have to take up... So we don't have to rely on a septic system. So a lot of the funding is going to come from Measure H. So when we put in our asks
024as a district, we put in for those two stations. We hope, we know for sure that we're going to get the Kenwood station off the ground and get that done. It's kind of remarkable. I know you guys know in the hospital world when you're building essential service facilities and you have to build to that standard. the Kenwood station remodel is going to be every bit of $8 million, which is just, it's mind blowing, but that's our world and the reality. And we're looking probably, the new station two is probably going to be every bit of $25 million. So big capital projects, but we're going to do them right and they'll be here to help serve the community for at least another 50 years, if not longer. A couple other things just of note about Measure
025H benefits. We're one of the only agencies in the county that was able to hire a full-time vegetation management coordinator. One of our captains moved into that role and he's out doing vegetation. roadside chipping projects burn piles Lots of the prescribed burn right behind us on Montini He was the one that that led that with a lot of partner agencies so working really closely with like the land trust and Ecology Center and resource conservation districts to be able to reduce fuels and Better protect our communities and and allow them to be more resilient to wildfire notify the community when you do prescribe burns? Absolutely. Is that on your website? It is on our website, and we do a lot of pushing out through social media. We use our LED signs that are in front of
026our Station 3 and Kenwood and Glen Ellyn. We utilize those to notify people of control burns. We will also, in some instances, use the portable roadway LED signs that Caltrans has and County Roads has. We do our very best to notify the community. I know there was a couple of instances. There was one a couple of seasons ago that was down at the Raceway area that got lit off probably when it shouldn't have, in all honesty. And the smoke, the wind shifted, and the smoke all came up here and into Napa Valley and everything. That's that's an example of why we try to Notify and inform our community as much as possible. It's really hard though to say Even a week from now that on this next Thursday at 10 o'clock in the morning We're
027gonna be able to burn because we don't know what the weather is gonna be right So we have to have we have to build in some of that flexibility So we do our very best but it's it we can't can't be a hundred percent certain And then some countywide benefits that we're doing through the Sonoma County Fire Chiefs Association is providing staffing for any sort of severe weather events, whether it's fire weather, whether it's severe storms, or for planned events that happen that we know that there's going to be a load on the emergency or more of a demand on emergency services. Things like... the crab season opener and salmon season opener and fourth of july some of those big events and would proven to be very helpful we also are doing investing a lot
028of money through the county chiefs association on improved technologies common operating platforms so so all of our responders are as interconnected as possible and working with the with the latest technology for things like weather and mapping and predictions all of that all of that good stuff next slide please now so our partnership as I mentioned we now have three staffed ambulances serving the entire Sonoma Valley Hospital District area. Our responses in 2025, we had a little bit under 3,100 patient transports, which was up 6%. Almost 2,600 of those go to Sonoma Valley Hospital. That's 83% of all of our transports and that is up from 80% in 2024 and I believe in 23 we're at 77. So it's kind of been a steady climb over the last couple of years. And I would say a
029couple of things in that. One, first of all, that is the biggest evidence of our partnership and the importance of our partnership to our community. Because for 83% of the transports to come to our hospital and have the patient get definitive treatment. and get our ambulances back in service to be able to serve the community for the next emergency that comes, that's the importance of our partnership. And to your point, one of the keys that I'd like to compliment you on, and I know our crews really value and appreciate it, is the APOT times. You know, we see vastly different numbers. I don't know if you see the numbers from the rest of the county included in that report. I get that report too. And in other jurisdictions statewide, it's a big problem for communities,
030for the hospitals and for the EMS field staff. And thankfully, we do not have that problem here in the Valley. So we're very, very grateful and appreciative of that fact. What are the other locations for transport? MarinHealth and Queen? Our two biggest that we go to is Queen of the Valley and Memorial. And most of the time, that's a decision that's driven based on EMS protocols. and things like trauma destinations. So if it's a trauma destination, if it's in the north part of the valley, we go to Memorial. If it's in the southern part of the valley, we go to the Queen. Yeah, the second thing I would say, it's kind of piggybacking. I think, you know, the shift that the hospital did to the new ED doc group I know makes a difference. And
031I'm going to get into a little bit more of the details of how that helps us in that partnership. But I think the reflection that our transports to Sonoma Valley ER and that they continue to grow in percentages, I think that can be attributed at least partly to that shift. I mentioned about the additional ambulances and having to up staff. We're down to having to do that on average just one time a month. And in years past, it was up 20 times a month or more that we would have to take an engine out of service and staff an ambulance. So next slide, please. Thank you. Here's where I want to spend a little bit more time and just really shout out for all of the hospital staff, especially in the ED. We have gotten
032to a point where we do regular live large-scale scenario-based training. We will start an incident at our fire station one, and we use... You can see the picture in there. They're really advanced mannequins. And we put our crews, the first responders, through treating a patient in various, whether it's a cardiac arrest or... chest pain COPD whatever the whatever the injury of the of the month is or condition and then we will run it as a full response and we'll have then we'll have hospital ED staff there with us watching us as we do that then we transport to the ED and then we continue together providing that continuity of treatment as they transition into the ED. So it's proven to be really, really a really valuable training tool. And because we're doing that for our
033real patients every day when we transport them, right? We're doing that handoff together. And to know the docs and the nurses and the techs that are in the ED and being able to work with them in a training capacity makes us stronger when we're bringing people in in the real-life cases. The ED docs provide a lot of training topics for our paramedics and EMTs. They come in regularly and teach on, I don't have the list of topics in front of me, but on current topics and things that they're seeing that they want us to know. Next slide, please. An example of that is they provide IV pump training for our new firefighter paramedics and ongoing training with that. And that allows us to take patients that have an IV pump that otherwise we might not
034be able to transport. That training allows us to then be able to transport them kind of in a critical care fashion to if they need to go to a different facility for a variety of reasons. This month we're doing again some of the live scenario based training and this one's going to be training for a call that none of us ever want to have to go on but we need to be prepared for that and that is pediatric cardiac arrests. And just to shout out our EMS Battalion Chief Brian Sear and our paramedic coordinator Carrie Pearson have developed a really, really strong relationship with the ED teams and they wanted to do a special shout out to the director, Dr. Cusick, and also Mary Lou Ehret. And a fun fact is Dr. Cusick and I
035went to school together. Yeah. And next slide, I think. That was it, but happy to answer any questions or provide any more details on anything. Thank you so much. Thank you. We appreciate you. Thank you all. And your team. All right. Thanks for allowing me to be a little tardy. And I look forward to seeing you all again. Thank you. Bye. Okay, great. All right. I'm going to tip the next two for you, Ben. You have a presentation or an ask on the chaff alone, and then if you could roll right into the telemetry system. Happy to do that. Yes. And apologies, I could not be there in person tonight, but happy to see you guys. This first item is good news. If you guys remember, we were approved to be part of the California
036Distressed Hospital Loan Program back in 2024. And we did learn probably closer to the spring last year that they were discussing, you know, is what they were discussing kind of a full forgiveness of the loan. But then they did implement a 12 month deferral, which is what this is right here. So we did apply for a 12 month deferral to basically move back the start of our repayment on this loan. 12 months. So instead of February 26, it becomes February 2027. So that's really all this modification does. And this is technically phase one of the program. They actually do have on their website and materials discussing phase two, which actually is a complete full forgiveness of the loan. There haven't There hasn't been many details released to provide additional clarification on that. But one thing
037that we do know is facilities cannot be eligible for loan forgiveness unless if they were approved for phase one. So this is kind of the first step to put us in line and tee up the possibility of getting full loan forgiveness. So we are asking the board to execute a resolution which authorizes management to move forward with signing and executing the loan modification document, which again kicks back our loan repayment from February 26 to February 27. So I guess, yeah, we'll stop there and happy to answer any questions you all may have. I just have one question, Ben. Will phase two kick off sometime between now and February of 20? Yes. Yes. Yes. And actually there was some discussion recently with district hospital leadership forum on that. They did say now that they're through the
038phase one approvals that their focus is going to turn to phase two. So we should know more on that. I would hope in the next couple of months. Any questions for Ben? Do we need to do roll call? So Dennis will sign this after telemetry. Telemetry, yes. We've got a couple in a row here, so we'll try to go. quickly through these. The next two items are requested actions of the board to allow management to move forward with these two particular projects. The first one is the replacement of our telemetry monitoring system across the hospital. We are asking the board to approve a management to move forward with executing a proposal from MindRay, which would be the vendor servicing this equipment for a total not to exceed cost of just over $620,000. This item has
039been on our capital needs list for a number of years. I think as early as 2023. it was identified and I think since then, you know, we've just been trying to a figure out, you know, how we would be able to fund this capital expenditure as well as, you know, kind of just try to see how long we could get by, you know, kind of while we sort through and figure out kind of a financing option. You know, this system is very old. It's over now over 15 years old. It is beyond, you know, the expected useful life of the equipment. And again, you know, we've just kind of been trying to see how we could be able to get this in, given just some of the financial challenges we had, especially with capital and
040cash. We did go through, you know, exhaustive due diligence process in terms of, you know, what vendor we would want to move forward with. Our current system is Space Labs, and we did receive a full proposal from them. And, you know, while going through the processing and getting kind of all the information, it became, I think, pretty clear to management that actually MindRay was going to be the preferred option. one on cost, it was significantly cheaper, as well as just the technology and the quality and just our increased capacity with the MindRay system. We kind of felt like it was a no-brainer when we kind of put it all together. UCSF actually uses MindRay down in their campus. So that was a great reference check for us. And they encourage us to move forward with
041selecting Mindray as the vendor. So I think we feel good about all of that. I do want to touch on just funding really quick because I think our initial plan or thought was that we would go forward and look to the vendor to finance directly through the vendor. But now, as time has passed, our IGT funds have started to come in. we now feel actually moving forward with the purchase actually just makes makes a lot more sense and there also potentially is an opportunity um to see if there's some funding available at the foundation to help um you know augment some of the purchase price so we're still kind of working through that but regardless um you know we know this is a critical need again now that we have the igt funds um you
042know we feel like the time is now to to move forward with this so um So with that, we are asking the board to approve us moving forward with the mine rate purchase. And again, I will stop and answer any questions you may have. I have one question. I don't know who it's to, but would we time the implementation of this system at the same time as Stryker or do it sequentially? Is there any risk with doing both at the same time? Oh, okay. Great question. Any other questions? Motion to approve. So moved. All in favor? Then we have Kimberly in the audience. I don't know who will be presenting the next, which is the air handling replacement. Excellent. Well, how about I will go through and tee this up, and Kimberly can be there
043to jump in when I misspeak. Get ready to jump. So this one is it may not be as exciting as the the telemetry replacement But we do feel it's it's kind of just as critical and this next item is an ask of the board to allow management to move forward with the public bidding process That will start a replacement of one of our air handlers in the building specifically East air handler number three This air handler is on our east wing. It's one of six air handlers on the east wing. All of the units were original to the 1980 east wing construction. They all need replacement. This one more critical than the others. This one actually has failed. And this has actually been on our capital plan along with the telemetry equipment probably since about
0442022, 2023. We did complete a feasibility study back in 2023, and we came up with a total project cost of approximately $1.5 million. I think since then, going into the design process and looking at some potential options in terms of a larger unit that would help us. kind of gain some redundancy with some of the other existing air handlers. The project cost we feel now in updated rough order magnitude is coming in right over $2 million. So upon board approval, we would proceed with the public bidding of this project and then we would bring those bids back to both the finance committee as well as the board for approval as well. And I'll get into just in specific in relation to just some of the capital needs there. But, you know, I guess for just
045really kind of laying out the need for East Air Handler 3, it does service, you know, administrative areas right now. But what this would do is this would create redundancy in specific to, you know, the two air handlers that actually serve in our skilled nursing unit. which also are going to need replacement. By moving forward with this replacement, we're creating that redundancy. We're also creating some protection. Should one of those two air handlers go down, this would create the capacity to be able to significantly limit any operational disruption, as opposed to if that were to happen now, we would be in a much more dire situation, and it would be much more expensive having to go into emergency repairs, those kind of things. So, you know, similar to the telemetry, I think we've been trying
046to kind of figure out a way how we could potentially fund something like this. You know, we do have some options to finance a project like this. You know, we are still kind of vetting that. The earliest we would have any financial obligation for this project would be April, April 26. But we are bringing it to the board because we do want to start the timeline of going through the public bidding process so we can keep that timeline moving. Do want to point out we did bring this forward to the Finance Committee last week. They were supportive of moving forward contingent upon management bringing a more robust capital needs plan back through the Finance Committee so the committee could kind of review those in totality with this request. In addition to that, we did commit
047to bring the public bids back to both the Finance Committee and Board for that respective approval as well. So I will stop there and happy to answer any questions and have Kimberly on phone a friend as well. So for the Board's modification, I feel like we're dealing with sequential F. So what Ben was saying is we have six here. This is the one that's going out. The administrative office backs up a part of the building that we're not responsible for. So the question is, should, but it does, and then as Ben was suggesting, if this one's going, the others are going to go. And if this one's $2 million, it's going to be potentially tentatively replace everything. The point is, I'd like to know what and when. What we've asked them to do is to
048bring back the more complete side, what we would be doing. conditional pending and committee seeing the updated information and getting a better clean its entirety it's we're in no-win situation because that so it's it's one of those we're trying to continue to deal with deferred maintenance make some steps and maybe there's a way I think finance committee felt and on track but we're not committing tonight I assume that if we're putting this out to bid that whoever is bidding on it is also going to give us a risk mitigation strategy for the other equipment, the rest of the equipment that's there. Kimberly's moving to the mic. Busted. So the risk mitigation strategy is that the air handler three, the one that's failed, has been designed to be upsized. There's ducting that's going to go across
049the roof to the other two air handlers. So whether it is a pre-planned replacement or a failure of one of those units, air handler three would provide air in that situation. So that is our strategy. This is the resiliency strategy that has been designed. So once we do the replacement of those two critical air handlers, three is still upsized and could provide that role for the other air handlers or replace, since it's a higher capacity, reduce the number of air handlers that we have for the rest, if that makes sense. Any other questions? I agree with the need for what I would call a master plan for the hospital because there is a lot of capital needs coming up. And I always had this, you know, if we're going to touch a wall, let's just
050touch it once. And then my second question is, is there consideration for a campaign through the foundation for all six air handlers versus one-off? Like a multi-year. Not sexy? It is sexy, but I do know we have this bucket right in this for foundational. We do have a hospital revitalization bucket that we've gotten very few donations towards at this point in time. So I would assume that it would need unrestricted donations, which are increasing, have increased this year. So we'll see how that continues to do. Dennis is right. It's not a super sexy thing. So, you know, I do. So part of my goals for 2026 is to also encourage a master plan for all the things that will need to be replaced at the hospital. So I hope to work with Kelly and the
051team to help put that together so that we have a more clear idea of what we're going to be raising funds for moving forward. And then we can talk about is it air handlers or sexy things. We're going to get, you know, have an air handler champion. I will be shocked if air handlers ever. I will be shocked, disappointed, and will have to resign my position for fundraising for air handlers. Somewhat related but not, did we ever hear back from the state when we did a response with respect to earthquake? Well, maybe that's like the next agenda. Thank you, Dennis. I just thought it's related. Very well. Did you and Ben coordinate this? Yeah. Do we need to vote? Yes. Motion to approve. I'll make the motion. I'll second. All in favor? Aye. Any opposed?
052And again, let's make sure the motion is, you know, it's conditional. It's not subject to, we're not committing $2 million. Public bidding process and further review at the Finance Committee. of a broader capital. Okay, Ben, you're three for three. Thank you. You're up next with seismic compliance. Yes, just a quick update on seismic. You know, we did meet, I think, in November to kind of outline and talk through our plan specific to, you know, a couple upcoming deadlines. You know, the one specific where we had to submit our... SPC, which is our seismic compliance plan, I believe by January 1st, 2026. So just updating the board that we did indeed file our SPC. We filed that shortly before the holiday. And as we discussed, we moved forward, at least within the plan, to select a
053retrofit option. Within the plan, you either had you know, an option to retrofit existing buildings to meet specific structural and non-structural compliance or put together a plan that had facilities construct, you know, a brand new compliant building. So the memo goes in a little bit more detail in terms of, you know, the specifics on what that plan entailed for Sonoma Valley Hospital. And in addition to that, we also put in our application, which would potentially extend the 2030 deadline to 2033. So that was part of the California Assembly Bill 869. And the requirement in order to be eligible, one of the requirements of criteria was that facilities that were designated as distressed hospitals through the Distressed Hospital Loan Program would be allowed to file that request as long as they also filed a seismic compliance
054plan, which we did. So we have also filed in conjunction with the seismic compliance plan our request to extend our deadline from 2030 to 2033. Both of those plan, the plan as well as the extension are currently under review. We've had some, you know, I think just initial back and forth this week with some individuals, but we're still early on in that process. And both of those submissions are being reviewed as we speak. Did also want to just update the board. We, in addition to all of this, we did send a letter to HCI officials, basically memorializing, you know, that while we are submitting our seismic compliance plan, and while this plan would get us into structural compliance, you know, it is not an acknowledgement that we have the necessary financing funds to be able
055to move forward with this. And just added some other... A couple of things in relation to specific district hospitals, small hospitals, and just the potential impact this would have on just the viability of rural health care. We did... We did confirm yesterday that those letters actually have been, we sent letters to three individuals at HCAI. A couple of them came back on return. We did receive validation yesterday that they have been delivered, one of them electronically, but they have been received, but we have yet to hear anything there, anything in addition. So we're kind of going through that process right now. You know, there is a upcoming deadline in March of 26 that requires facilities to submit actual construction documents. Kimberly, you can keep me honest here. I believe in our filing, we said that
056we intended to submit our documents not by March, but by the end of December. And part of that just being, you know. you know timing as well as just a financial piece of that because we are applying to a relief program that would allow us to tap into some grant funding potentially to help to help fund some of the expenditures related to putting together an actual construction plan. So certainly more to come on that. We're actively still discussing with the district hospital leadership forum, as well as kind of what next steps we're gonna be taking, as well as any potential legislative action, but we're kind of waiting to see what happens there. I think that's kind of the main things that I wanted to touch on. So any questions, I'm happy to answer. Not a
057question for you, Ben. More discussion with the board. So as of March, is there any... They're not withholding approvals of projects. They're not fining them, I don't know, so much a day. So the fact that we filed a letter, I think, is support that, you know, in good faith, we want to try to work this out. But in parallel, are we attempting to get part of the grant money to comply for December? Okay. I thought we heard that in a previous discussion that by applying for that grant money, that obligated us in some way, and I can't remember what that was. Does anybody remember that discussion? I don't know. I don't recall. Yeah, I remember that being discussed. But before you answer, just as an addendum to that. is do you have any idea what
058the cost would be to get to plans, the timing to get, if we started today, the timing to get? The grant is a reimbursement program as opposed to them giving us the money up front. So we are going to have to give them proposals of... what the architectural pieces and the engineering piece so we'll do it in parcels that will be the first piece and I imagine that once we select a firm it will be several months for them to develop their scope and and that's why we chose the end of the year to provide the construction documents and then anything going forward. And this is just for the non-structural category. For the structural category, that is a whole different component that, in addition to design, it's material testing and calculations and things like that.
059What's due March 1st? It is the NPC construction documents. The structural and the non-structural of both. Non-structural. Non-structural. So regardless of whether we get grants, we have to decide. And then before we spend, we should know what we need to get them, whether we can even make the December deadline if we start it today. I mean, until we hear back from them, you know, in terms of our letter saying that we're not prepared, it's all speculation. And if you recall, the legislature approved deferring this. The governor vetoed it. strong sense that the legislature is going to bring governors and that there's well but I don't think they're I don't think they're gonna force all the distressed hospital you know waiting for a new governor so no I know that you're rolling the dice no no
060I know that I'm just at my question is are we prepared if we said December are we prepared to get to December if we are prepared to get to December do we have any idea what the cost will be what the time will be What we said in the seismic compliance plan was that we were prepared to use the December deadline if we were awarded the grant. No, no, but you could be awarded the grant that may not be sufficient for you to get there. I think we could. I think we could. Well, that's what we're doing is we're getting an RFP for it. We've identified, I think, four or five different firms that we felt had the expertise to get us this proposal and do the work. So we're finding the cost right now.
061You know, my sense is we should not invest any money in getting to December until we know the answer to our request. And, you know, that may put us further out of compliance. But again, I'm and others are further out of the point. Yeah, whatever that means. Yeah, whatever that means. Thanks, Kimberly. Thanks, Ben. Thanks, Ben. Thank you. All right. Kelly, CEO report. All right. Thank you, everybody. I thought I would start by just sharing a quick update on our affiliation agreement discussions with UCSF. As you can see in my written report, we've had a number of meetings led by Dennis and Wendy in terms of moving those discussions forward. The areas we're focusing on are very similar to what we've been talking about historically. I think it's important to note that we have proposed
062adding a section. to the agreement titled Professional Clinical and Strategic Services. And within this section, it would direct the Joint Operating Committee to identify specific initiatives that directly fulfill our mission and then move those forward. And then of course, those go back to the Affiliation Oversight Committee as well. So we've really worked hard to put some additional deliverables and I would say teeth into the agreement. We continue to meet pretty regularly with them and anticipate hopefully getting this. done shortly so we're continuing to move that forward the areas of focus are the same as they have been and they're delineated down there quick question I know you and dr. Ocala have done a great job engaging with the medical staff and the foundation board and have we received any feedback from the medical staff on
063the affiliation agreement update We took it to the last medical staff meeting, and Dr. Colo presented where we were and really talked about the sharing related to educational opportunities. Do you want to add to that? Yes, so I think it's been received positively in terms of, number one, the overall perception, and people have an open mind and are hoping to see metrics that will confirm this change of heart about it. So they're happy about it, but there's a wait-and-see attitude. Okay. Thank you. All right. And then strategic planning, as you all know, we'll be having our strategic planning session next month. That's actually next month. Continuing to focus on the areas as we've talked about, really thinking of our four pillars as quality access and experience, community engagement, sustainability, and connected culture. And we'll be
064going through a lot more of that and how we perceive moving from where we are today to those areas. excited to share that I have made it 90 days. So I have wanted to share that with everybody. It's been amazing, as I've already mentioned, a great group of people to work with, an amazing community, and I've really enjoyed all my time here so far. I summarized the five areas I had shared back in my interview of areas to focus on in the first 90 days and just gave a few updates there. I won't read through all those for you, but they are there and have managed to navigate through those goals that I had. I just wanted to comment a little bit on the connected culture discussion around the strategic plan and then really some
065of the highlight of the 90 days. I think you've all been invited to our Employee Service Awards luncheon next week, and it's pretty exciting and goes along with what Jessica shared in terms of the tenure of our nurses. We're recognizing a nurse for 45 years of service at Sonoma Valley Hospital. So that's pretty amazing and really shows the culture and the connectivity here in this community and certainly at this organization. So I thought that was pretty amazing. Operating performance, I will not go through all that. Ben will be talking about that shortly in a second. He will also share that I will just not distill your thunder, Ben, but we did get our IGT money, so that is all really good. You already heard that the striker system is set to be installed at the
066end of the month. So again, I know that our clinical teams are very excited about that. And thank you for the mind ray. I know they are actually extremely excited about that, having met with a number of them as well as Dr. Kusick. excited about that so so thank you for that support the annual report to the community that Don Castelli shared an update with you last month has gone out and you all hopefully have received that and then our scorecard is in there and I will defer to dr. Akolo on some clinical and quality updates so happy to take any questions I don't have any questions but I do want to take a minute to congratulate you on your 90 days but more importantly acknowledge your engagement with the community. The other day I
067was out running and Kelly's coming out of City Hall and she had attended the master planning session to make sure the hospital was represented and the day before she was at Vintage House and I just wanted to acknowledge and say thank you for being in the community. Absolutely, thank you. Hey, Kelly, when you went to the city, did you talk about us getting any money? No. I did not get in line for public comment, so that was not on the list. I was really a listener, but yeah. Next year, maybe. Next year. Every other nonprofit, they should be giving it to us. Yeah, next year. Okay. All right. Take it. Better than nothing. All right. Thank you. A portable one. Good evening, I'll be succinct. Just we are, our activity in the clinical area for
068Q1 has really focused around mostly the survey, but I'd like to talk about a few things as well. So just very quickly, our census has remained at the upper bands of our capacity. You saw that in Jessica's presentation. It has remained that way. We anticipated that this would happen, but thought it would happen because of respiratory virus season. That wasn't the case. It turned out to be a diverse group of patient problems that's kept us going. The important thing is with the collaboration and the multidisciplinary approach at Sonoma Valley Hospital, there was no disruption and no reason to engage any extraordinary measures to keep up with this sustained high capacity. And so we've continued to do that with a few problems here and there in terms of interoperability. But to Wendy's other question, this seems
069to be working quite well. The interruptions with me going outside were from talking to Ted Abraham trying to transfer our patients to UCSF. So that continues to be something that has remained sustained, this sort of crosstalk between us and UCSF. and Marine General. The survey window has been defined for us. It's going to be between March 9th to May 9th. We are expecting a CIHQ survey. They are, by CMS mandate, not allowed to tell us when the time will be, so they will come unannounced. And so we have all hands on deck. It's a multi-team sport, and everybody is really engaged. with listening to people who've been through the survey like Jessica and our Quality Director Louise Wyatt and trying to fashion the way that we approach the survey. So I think we think we're
070going to be ready. We've been looking backwards at the last survey and looking at where areas of improvement were defined for us. Most of them were around policies and administrative flow. through and no substantive clinical issues. So we've been working through those policies, trying to get them ready, trying to get our medical staff bylaws, et cetera, and all of those kinds of policies which touch on different parts of the hospital and hospital operations, both and as well as clinical care, to have them all ready. and to define who is going to help during the survey, etc. So that's taking up much of the oxygen for this quarter and perhaps the early part of next quarter in the hospital. Quick question. What is the actual length of the survey? Is it March, April, May? Or is
071it, it will happen sometime? It will happen sometime in that window, in that 90-day window. Two days. It's a two-day survey. It's a two-day survey and looks like a collaborative survey that they've sort of given us what the anatomy of it would look like. And so it's not quite a take-home exam, but it's a fair exam, if you will. And it's a fair exam where we know what to expect and hopefully with the tutelage of people like Jessica, we should be able to get through it. So that's taking up much of our efforts to make sure that we come out well and that we don't just do it just for the sake of passing a survey. but to use it as an operational fulcrum to improve the overall coordination of the different parts of the
072hospital, if you will. In terms of the gaps that we had to close from the last survey, I think we're doing that very well. These were mostly administrative, as I said, and we're doing that. Over the course of the last part of the quarter and the early part of this quarter, we have really slimmed down our metrics. Slimmed down the metrics not in terms of their vigor, not in terms of their breadth and broad reach, but try to align them so that we all have the same North Star. Because we listen to CIHQ, we listen to CMS, we listen to the... to the California, to the state. So we have aligned our scorecards to reflect a real focus on aligning all of these different stakeholders and all of the regulatory agencies that govern our behavior.
073So in looking at that, we removed many of the things that were no longer relevant to Sonoma Valley Hospital in around obstetric care and the skilled nursing facility making sure that we remove that from all of our regulatory dome if you will and then took the metrics remove the metrics that were not important to us and really emphasized the metrics that are important for pulling operational dynamics in in the right concordant direction and so there were a number of things that you will see with with with the new scorecards which will be easy to follow and allow the Quality Board and this board to give us governance and to directly align with the governance that you give us. The harm scores, for example, which are reflected as a rate, we want to... to express those
074as a number because the rates are so low and when you express them as a rate, we're sometimes naive to some of the directional pull of some of these events. So with our PSI 90, and our falls, we'll be talking about these as discrete events as opposed to as poisson statistics, if you will. And so just by seeing the trend, we'll get a sense of what's happening within the hospital environment. We have slimmed down the sepsis bundle, which is one of the major drivers of CMS star ratings. Instead of reporting the different components and the different bullet points one by one, we're going to use the SEP1 bundle, which is one of the major cardinal drivers of star ratings, and we will report the SEP bundle. And the SEP bundle is a good summary measure
075for all the things that we'll be doing. It's a good driver because if we can get things like the SEP bundle well, it involves documenting things appropriately and in time and in a particular sequence so that we can get reimbursed properly. I think that those kinds of things really ensconce a culture of being deliberate and a culture of excellence as we try to keep up with these measures. PSI 90, as I said, we will express it in terms of numbers. For chronic diseases, there are many chronic diseases that are important here in the Valley and important at the hospital, but just for governance and for regulatory compliance, we'll focus on congestive heart failure, we'll focus on COPD, and we'll focus on... on hip fractures. This will be in compliance with what CMS looks at. And
076by so doing, use all these things, as I said, as a cultural pull-up for the hospital. Operationally and in terms of strategic growth, one of the, and today I will not talk about the 1206B, just much to everybody's relief, but within the hospital we are... looking for growth as well in terms of increasing the bandwidth of services and the number of things that we're able to offer to patients within the valley so that there is less need for egress of patient care outside of the valley. So in this quarter, Dr. Barron is... come in fully credentialed and is offering consultative nephrology services, has already started to do that. And so at first the thought would be that this would be consultative. He'll have an office right here in the valley for patients with renal problems
077as well as hypertension problems. And then over time, depending on what the demand is, And what the market is, look at renal replacement. So in other words, look at the viability of a dialysis unit here in the valley. But that will depend on some of the unknowns that we don't have a good handle on at the moment. GI, as you know, will come to the Valley at the end of this quarter, beginning of next quarter. It will be GI with a focus on general GI and weight loss and metabolism. So these are things that we are part of the strategic growth that we're talking about. Kelly and I have a meeting with Dr. Kaplan, who is a... well-known urologist that has significant footprint here in the valley and at Santa Rosa to see if we
078can just make it a little bit of a closer relationship with him. So those are growth areas for us. So I think with this just gives us sort of a template for how we want to grow. bringing people who will be Sonoma facing and who will be robust in their interest here and who are probably going to stay here for the long haul while we'll build the 1206B, which we won't talk about tonight. But I thank you indeed for your attention, and I'll take any questions. I don't have a question, but I just wanted to thank you and Louise and her team for all of the work that you've done to to streamline these metrics, I think it's going to really be a much better thing for us to be watching. I appreciate that. Thank
079you very much. And I'll anticipate one of Wendy's questions. We will keep the denominator in the appendices. So we'll keep that in the appendices and just so that you get a sense of so that these numbers are not being interpreted in a vacuum. We thought that was important, so we will do that in addition to what we have in the presentation. I was really aligned with you on that, though. Because without the end, we were all reacting. Yes, but I think we'll keep it in, just not express the... So we'll keep the numerator and we'll keep the denominator, and people will make their deductions. But we want to really keep them separate because the denominator is a false... It gives us false security, as it were. Thank you. So are you finding that the flu
080season is milder around the country or California or just Sonoma County? I think it's been a surprise because generally what happens is that you see it in one hemisphere and that hemisphere tells us what's going to happen. and it was quite bad in Australia. So we thought it was going to be a significant flu season in terms of that. It has not been around the country. And this is in spite of not getting the right serotype in terms of the flu vaccine this year. So I think we've... Or maybe it was. Perhaps it was. Perhaps it was. Yes, perhaps it was. But I think we've been quite lucky. We've been quite lucky, even though those who have had the flu have quite, you know, it's been lingering and bothersome. But we've been lucky in terms
081of community programming. I would just comment we had some good information earlier from Jessica on patients transferred. out of the ED, you know, 8.4%. Yes. At the Finance Committee, we had some information about inpatient market share or admissions. Hopefully, we can marry that information to why are people leaving the ED, what are the conditions, where are they going, and as we're designing our strategic plan, we'll be able to... extrapolate perhaps some direction on physician recruitment or service development because I think we're at a point where we're generating a lot of really good information that we have to somehow compile in an actionable response. I would say to that that there's no other methodology but exactly that to understand that and that's exactly what we'll be doing. to do it both from those statistics and then
082from the things that we know that may not show up in those statistics. But I think there's not a methodology than what you are describing. So thank you for that. Can I also say, similar to Dan, we're here almost every month of the year. And so many people from the hospital staff come to these meetings, obviously allow us to do our fiduciary responsibilities. But it makes for a very long day for all of you. It does not go unnoticed. It's much appreciated. Thanks, Ben, for those on the phone as well. Thank you very much. Thank you. Thank you. Thank you. All right, Ben. You're up with financials for December. All right. Yes, well, for December. We, December didn't produce quite the financial month that some of the other months have this fiscal year. But still,
083you know, especially compared to budget, it was a positive one. Posted a positive operating EBITDA, although we did post an operating loss of about $150,000. It did mark the sixth consecutive month. So six out of six this fiscal year. of exceeding our monthly budget target. So, you know, that certainly is positive. You know, and I think we're kind of getting into, you know, kind of a consistent foothold of just, you know, we've taken a next step financially. Obviously, a lot more work to be done, but. you know, through the first six months of this fiscal year, we actually have a positive operating margin, which I don't believe has happened since, at least since I've been here. And just a point of reference. Last fiscal year, fiscal year 25, where we were also enjoying some financial
084success compared to fiscal year 24, halfway through the year last year, we had an operating loss of a little over $2.5 million. So we've significantly improved over last year. Certainly some of that is IGT, but then also we've seen some... pretty big increases in some of our primary areas where we're looking to achieve growth, specifically kind of our MRI volumes. We've seen significant increase in volumes in the emergency department. as well as surgery too throughout this year. So I think all of those are aligning well and it's kind of gotten us back to, in some areas, you know, volume levels prior to some dips, you know, that we experienced in 24 and some, you know, we're just continuing to hit all-time highs. So feel really good about that. Just quickly within December, the month itself,
085you know, due to the fact that we pulled on our line of credit in November, we had 10 and a half million dollars outstanding the entire month of January. So that caused our interest expense to increase relative to previous months and added about $75,000 of expense to our operating expenses that was budgeted for actually year to date. We're still under budget, but we'll see that again in January's financials. And then that will fall off in February now. And I'll go through that in a second. But again, I think we're looking strong. Cash has been incredibly tight. I am pleased to report that Monday morning, half an hour into our workday, a $20-plus million check arrived in administration. So we now can happily report that we have received our full allotment of IGT funds for calendar
086year. 24s program applicable here in this fiscal year 26. So that results in a net benefit of $12 million. And again, just going back to fiscal year 24, we netted three through that program. So very, very happy about that and great to close that out. And actually just on the heels of that, had a meeting today to talk about kind of IGT glide path in for next fiscal year calendar year 25 program. So more to come on that. We actually should have some good insights into, you know, what that potentially looks like at the end of March. But yeah, so, you know, happy to get our check pivoting right away to, you know, kind of working towards next year's IGT. um yeah you know again i think you know we're going to be now with
087kelly on board really jumping into you know more operational um areas you know getting into more of our cost accounting allocations just really kind of getting into helping support the strategic uh planning process as well as getting into more robust departmental reviews so um a lot of work to do but but we're very excited to uh to go forward with that work so i will stop there and happy to answer any questions you all may have And I'm assuming that we paid. We did. Yep, we did. I have a non-finance question. What is the update on the permanent location of the MRI? Is Kimberly still here? You mean the permitting? The permitting. Permitting of the permanent. You have to come up here. So we have the hearing with the city on February 19th. And so
088you'll see when you walk into the hospital, we have our posting associated with that hearing. And so we should have an answer after that meeting. We reviewed our package with them before we submitted it, and they felt that everything was in order of what they had asked for, and that they felt that they wouldn't have any outstanding questions. So we expect it to pass. Okay. So the hearing is for city council to approve or not approve? And are we all going to show up? There's going to be a group of us. end result is consistent with where we've been discussing with some city over involvement which you would expect from the city of Sonoma and it'll be six instead of seven figures. Okay. Any committee updates? Board comments? No. All right. I have one. I
089have one. I know it's late but I just wanted to remind everybody that the this month's newsletter indicated that this is American Heart Month and tomorrow is wear red day too are you all wearing red okay we will too all right thank you thank you