Indian River Memorial Hospital, Inc. d/b/a · 2018-08-30 · INDIAN RIVER MEMORIAL HOSPITAL, INC. D/B/A INDIAN RIVER MEDICAL CENTER BOARD OF DIRECTORS MINUTES The regular meeting

Indian River Memorial Hospital, Inc. d/b/a

Indian River Medical Center

January 26, 2018; 11:00 a.m.

Boardroom

1000 36th Street

Vero Beach, FL 32960

This meeting may be recorded

1. IRMC Board Minutes dated December 12, 2017

2. Indian RIver Health Services Corporation Minutesdated January 10, 2018

3. IRMC Board Minutes dated January 10, 2018

aa. . Approval of MinutesApproval of Minutes

IIII. . Consent AgendaConsent AgendaWayne T. Hockmeyer, Ph. D.

For Action

IVIV. . Foundation Chairman's ReportFoundation Chairman's ReportAnthony Woodruff

For Information

VV. . President's ReportPresident's ReportKaren Davis

For Information

a. FY 2018 YTD Consolidated, Hospital, Physician &Diagnostic Services

b. Strategy 8: Grown & Sustain Operating Margins

c. FY 2017 Post Audit Summary Review

d. Strategic Projects Update - Outpatient Endoscopy

VIVI. . Finance CommitteeFinance CommitteeJack Weisbaum

II. . Call to OrderCall to OrderWayne T. Hockmeyer, Ph. D.

For Information

4. Health Systems of Indian River, Inc. Minutes datedJanuary 10, 2018

IIIIII. . Chairman's ReportChairman's ReportWayne T. Hockmeyer, Ph. D.

For Information

a. December 2017

a. Marketing Update

Board of Directors

Board of Directors

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Page 7

Page 9

Page 12

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Page 16

Page 20

Page 28

Page 29

Page 30

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VIIVII. . Investment SubcommitteeInvestment SubcommitteeJack Pastor

e. Strategic Projects Update - MRI and CT Scanner Project

a. Fourth Quarter 2017 Investment Review

VIIIVIII. . Other BusinessOther BusinessWayne T. Hockmeyer, Ph. D.

For Information

IXIX. . Public CommentPublic Comment

XX. . Adjoun to the Private SessionAdjoun to the Private Session

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INDIAN RIVER MEMORIAL HOSPITAL, INC. D/B/A

INDIAN RIVER MEDICAL CENTER BOARD OF DIRECTORS

MINUTES

The regular meeting of the Indian River Medical Center Board of Directors was convened by Chairman Wayne T. Hockmeyer, Ph.D. on December 12, 2017 at 9:00 a.m. in the Medical Center Boardroom. MEMBERS PRESENT; Wayne T. Hockmeyer, Ph.D., Chairman

Hal Brown, M.D. Michael Hammes Kathy Hendrix Don Laurie Juliette Lomax-Homer, M.D. Keith Morgan Hugh McCrystal, M.D. Jack Pastor, via telephone Gerri Smith Jeffrey L. Susi Jack Weisbaum Anthony Woodruff

MEMBERS EXCUSED: John Lindenthal, M.D. Pranay Ramdev, M.D. Matthew Reiser

OTHERS PRESENT: Todd Bibens, R.N. Liz Bruner Jason Carey Marybeth Cunningham Karen Davis Angela Dickens Jan Donlan George Eighmy Warren Fuller Katherine Grichnik, M.D. Chester Kaletkowski Valerie Larcombe, Esq. Lisa Licitra Ann Marie McCrystal, R.N. William Neil Grace Simonson Ann Marie Suriano Richard Van LIth, Pharm. D. Linda Walton, R.N. Tracey Zudans

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Board of Directors December 12, 2017 Page 2

CONSENT AGENDA

1. Approval of Minutes

IRMC Board minutes date November 2, 2017

IRMC Board minutes dated November 17, 2017

2. Finance Committee

FY 2018 Operating & Capital Budget Dr. Hockmeyer asked the Board Members if anyone wished to remove any item under the Consent Agenda for further discussion. There were no further requests. Dr. Hockmeyer called for a Motion to Accept the Consent Agenda. Upon MOTION made by Mr. Weisbaum, duly seconded by Ms. Smith and unanimously carried the Board of Directors approved the Consent Agenda as presented. CHAIRMAN’S REPORT Dr. Hockmeyer welcomed Karen Davis as the Interim President and CEO. He thanked Mr. Susi for the nineteen years of service and reminded everyone of the retirement celebration scheduled for the evening. FOUNDATION CHAIRMAN’S REPORT Mr. Woodruff highlighted the challenges for the Foundation for this upcoming year given the uncertainty surrounding the selection of a partner. The Foundation kicked-off the season on November 7th with an event at Johns Island. Guests included major donors, members of the Foundation’s Board, Honorary Board, Advisory Council and volunteers. Dr. Hockmeyer provided an update to the group on the partnership selection and Dr. Tremml shared exciting advancements in stroke care. PRESIDENT’S REPORT

Scully Endoscopy Center The Agency for Healthcare Administration is scheduled to conduct the final inspection of the Scully Endoscopy Center during the week of Christmas. The project is scheduled to open on time (January 15th) and on budget. The Endoscopy Center will operate like a free-standing center.

Strategy #9 Brand Awareness & Public Confidence New targets measuring brand awareness for Strategy #9 Brand Awareness & Public Confidence are in development and will be presented in the future.

Recap of Tenure

Mr. Susi recapped the past 19 years thanking the Executive Team for their teamwork and highlighting some of the accomplishments during his tenure.

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Board of Directors December 12, 2017 Page 3

Finance Committee October is the beginning of the new fiscal year which finished with Excess Revenue over Expenses without partnering costs at $318,000. Tower Watson reported to the Finance Committee on the frozen Pension Plan which is doing very well. There being no further business to discuss, the meeting adjourned to the private session at approximately 9:34 a.m. Respectfully submitted, Gerri Smith Secretary

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January 10, 2018 Annual Meeting Minutes Page 1

INDIAN RIVER HEALTH SERVICES CORP. BOARD OF DIRECTORS

ANNUAL MEETING

The annual meeting of the Indian River Health Services Corp. was convened by Chairman, Wayne T. Hockmeyer, Ph.D. on January 10, 2018 in the Indian River Medical Center Boardroom. MEMBERS PRESENT: Wayne T. Hockmeyer, Ph.D., Chairman

Karen Davis Michael Hammes Kathy Hendrix Chester Kaletkowski Donald Laurie John Lindenthal, M.D. Juliette Lomax-Homier, M.D. Hugh McCrystal, M.D. Keith Morgan Jack Pastor, via telephone Matthew Reiser Gerri Smith Jack Weisbaum Anthony Woodruff

MEMBERS EXCUSED: Hal Brown, M.D. Pranay Ramdev, M.D.

OTHERS PRESENT: Todd Bibens, R.N. Liz Bruner Jason Carey, R.N. Angela Dickens George Eighmy Katherine Grichnik, M.D. Valerie Larcombe, Esq. Lisa Licitra Charles Mackett, M.D. Grace Simonson Linda Walton Richard Van Lith, Pharm. D.

Indian River Memorial Hospital, Inc., d/b/a Indian River Medical Center is the sole member of Indian River Health Services Corp. (IRHSC). IRHSC Board of Directors mirrors the IRMC Board of Directors. IRHSC is relatively inactive.

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Upon determining there was a quorum, a MOTION was made by Dr. McCrystal, duly seconded by Mr. Reiser and unanimously carried, the Board of Directors appointed the following individuals to serve as members of the Board of Directors for the year 2018:

Wayne Hockmeyer, Ph.D., Chairman Karen Davis, Interim President Jack Pastor, Vice Chairman Gerri Smith, Secretary Jack Weisbaum, Treasurer Hal Brown, M.D., Chief of Staff John Lindenthal, M.D., Vice Chief of Staff Pranay Ramdev, M.D. Medical Staff Representative Michael Hammes Kathleen Hendrix Chester Kaletkowski Donald Laurie Juliette Lomax-Homier, M.D. Hugh McCrystal, M.D. Keith Morgan Matthew Reiser Anthony Woodruff

Upon MOTION made by Dr. McCrystal, duly seconded by Dr. Lomax-Homier and unanimously carried, the Board of Directors appointed the following individuals to serve as Officers of the Corporation for 2018:

Wayne T. Hockmeyer, Ph.D. – Chairman Karen Davis – Interim President/CEO Jack Pastor – Vice Chairman Gerri Smith – Secretary Jack Weisbaum – Treasurer

Upon MOTION made by Mr. Hammes, duly seconded by Dr. Lomax-Homier and unanimously carried, the Board of Directors ratified all actions taken by the corporation since the last meeting of the Board of Directors. Other Business There was no report by the Chairman or the President. There was no new or old business to conduct. The meeting adjourned.

Respectfully submitted, Gerri Smith Secretary

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INDIAN RIVER MEMORIAL HOSPITAL, INC. D/B/A

INDIAN RIVER MEDICAL CENTER BOARD OF DIRECTORS

ANNUAL MEETING

The annual meeting of the Indian River Medical Center Board of Directors was convened by Chairman, Wayne T. Hockmeyer, Ph.D. on January 10, 2018 at 8:30 a.m. in the Indian River Medical Center Boardroom. MEMBERS PRESENT: Wayne T. Hockmeyer, Ph.D., Chairman




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2018 Board & Committee Meeting Schedule Dr. Hockmeyer presented the meeting schedule for Board and Committee meetings for 2018. As discussed at the Governance Committee, the schedule has been changed to quarterly meetings. Discussion ensued. Upon MOTION made by Dr. McCrystal, duly seconded by Dr. Lomax-Homier and unanimously carried, the Board of Directors approved the 2018 Board and Committee meeting schedule as presented. 2018 Committee Membership Dr. Hockmeyer proposed a list of Committee Members for 2018. Most of the Committee memberships have remained unchanged with two exceptions. Discussion ensued. The MOTION was made by Dr. McCrystal, duly seconded by Dr. Lomax-Homier and unanimously carried to approve the Committee Membership List for 2017 as presented. Health Systems of Indian River, Inc. Board of Directors Upon MOTION made by Dr. McCrystal, duly seconded by Dr. Lomax-Homer and unanimously carried, the Board of Directors appointed the following members to the Health Systems of Indian River, Inc. Board of Directors for 2018:


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Indian River Health Services Corp, Upon MOTION made by Dr. McCrystal, duly seconded by Dr. Lomax-Homier and unanimously carried, the Board of Directors appointed the following members to the Indian River Health Services Corp. for 2018:


Vero Radiology Associates Upon MOTION made by Dr. McCrystal, duly seconded by Dr. Lomax-Homier and unanimously carried the Board of Directors appoints the following members to the 2018 Vero Radiology Associates, LLC Board of Directors:

Karen Davis, Chairman George Eighmy, Treasurer/Secretary

The meeting adjourned at 8:40 a.m. Respectfully submitted, Gerri Smith Secretary

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HEALTH SYSTEMS OF INDIAN RIVER, INC. BOARD OF DIRECTORS

ANNUAL MEETING

The annual meeting of the Health Systems of Indian River, Inc. was convened by Chairman, Wayne T. Hockmeyer, Ph.D. on January 10, 2018 in the Indian River Medical Center Boardroom. MEMBERS PRESENT: Wayne T. Hockmeyer, Ph.D., Chairman




Indian River Memorial Hospital, Inc. d/b/a Indian River Medical Center (IRMC) is the sole member of Health Systems of Indian River, Inc. (HSIR). HSIR’s Board of Directors mirrors the IRMC Board of Directors. HSIR’s principal function is as a vehicle for purchasing real property or entering into joint ventures with third parties. Currently HSIR owns the 36-acre parcel of land adjunct to the Medical Center campus, approximately 8 acres in Sebastian

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where the Sebastian office complex is located and the real property occupied by Vero Radiology Associates. Upon determining there was a quorum, a MOTION was made by Dr. McCrystal, duly seconded by Mr. Pastor and unanimously carried, the Board of Directors appointed the following individuals to serve as members of the Board of Directors for the year 2018:

Wayne Hockmeyer, Ph.D., Chairman Karen Davis, Interim President Jack Pastor, Vice Chairman Gerri Smith, Secretary Jack Weisbaum, Treasurer Hal Brown, M.D., Chief of Staff John Lindenthal, M.D., Vice Chief of Staff Pranay Ramdev, M.D. Medical Staff Representative William Baxt, M.D. Michael Hammes Kathleen Hendrix Donald Laurie Juliette Lomax-Homier, M.D. Hugh McCrystal, M.D. Keith Morgan Matthew Reiser Anthony Woodruff

Upon MOTION made by Dr. McCrystal, duly seconded by Dr. Lomax-Homier and unanimously carried, the Board of Directors appointed the following individuals to serve as Officers of the Corporation for 2018:

Wayne T. Hockmeyer, Ph.D. – Chairman Karen Davis - Interim President/Chief Executive Officer Jack Pastor – Vice Chairman Gerri Smith – Secretary Jack Weisbaum – Treasurer

Upon MOTION made by Dr. McCrystal, duly seconded by Dr. Lomax-Homier and unanimously carried, the Board of Directors ratified all actions taken by the corporation since the last meeting of the Board of Directors. Other Business There was no report by the Chairman or the President. There was no new or old business to conduct. The meeting adjourned.

Respectfully submitted, Gerri Smith Secretary

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Indian River Medical Center Foundation Report

Indian River Medical Center

Board of Directors

December 2017

Leadership Committees

Members of the volunteer Leadership Committees in Grand Harbor, John’s Island,

Moorings, Oceanside and Orchid Island have begun their seasonal bi-weekly meetings

to develop outreach plans for their respective communities. Oak Harbor and Windsor

will begin meeting in January.

Each committee has a schedule of events planned for the season tailored to their

communities. Calendars include breakfasts, afternoon coffees, medical forums,

educational programs, dinners and receptions. Featured topics will range from

healthcare education and opportunities to meet physicians to updates on the IRMC

partnership selection process. Committee feedback indicates widespread interest in the

future of local healthcare so many of the planned activities will build upon news of the

preferred partner, when information is timely and substantive.

Funding Priorities

With the success of the Endoscopy Challenge, the completion of the Scully Endoscopy

Center is imminent. Following requisite inspections by the Agency for Healthcare

Administration, the new center will begin caring for patients in January.

The Foundation’s philanthropic focus has turned to support of continued advancements

in technology. Ensuring our clinicians have the latest equipment in their fields not only

raises the level of care available to the community but also ensures we recruit and retain

the best and brightest physicians and technicians.

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On December 1, the Foundation’s 2017 end-of-calendar-year direct mail appeal was sent

to 15,600 households. The mailing included a powerful statement of gratitude from 31

employed and private physicians who lauded philanthropy’s impact on quality of care

and their desire to practice at IRMC.

What Really Matters – Unrestricted

As of January 11, 2018 the Foundation had received $1,286,312 in gifts and pledges for

the FY 2018 Unrestricted Fund vs. $1,719,301 in unrestricted gifts and pledges for the

same period last year. Though not unexpected due to the uncertainty surrounding the

future of IRMC, this represents a marked decrease of $432,989, or 25.18%. In addition to

direct mail appeals, unrestricted contributions are also generated by special mailings,

honor/memorials, personal solicitations, and estate distributions.

Legacy Society

Continuing a long-held and treasured tradition, members of the Foundation’s Legacy

Society were honored at the annual holiday luncheon held December 6 at Quail Valley

River Club. Jan Donlan was the featured speaker, making this popular event even more

special to our donors. Reflecting on all that has been accomplished by those who

embraced the vision for IRMC, Jan shared memories and highlights of her Foundation

tenure as she approaches retirement. Our Legacy donors’ standing ovation beautifully

expressed the community’s widespread admiration and appreciation for Jan’s

passionate leadership over the past 17-plus years.

Planned Giving

The donor ranks of The Legacy Society donor ranks grew by two in the month of

December. As the direct result of their outstanding hospital experiences, a local couple

notified the Foundation that their trust now includes a provision for future support of

the Welsh Heart Center. Additionally, we were notified of an estate gift after the

passing of a Sapphire member of The Eagle Society.

Currently, the estates of four donors who included the Foundation in their plans are in

various stages of settlement.

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IRMC Marketing Update

Presented by Angela Dickens

Vice President, Marketing

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Outdoor Advertising

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Magazine and Newspaper

• Press Journal

• Vero Beach Newsweekly

• Hometown News

• Vero Beach Magazine

• Indian River Magazine

• Heartbeat Magazine

• Portfolio Magazine

• Inside Track Almanac

• Riverside Theatre

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Digital Advertising

Vero Beach FLASH e-newsletter

TCPalm and Geo-Targeted websites

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Act / Bud Act / PY Volume Actual Budget Prior Year % Var % Var

Admissions 3,797 3,487 3,371 8.9% 12.6%Observation Discharges 1,318 1,566 1,621 -15.8% -18.7%Total Admissions & Observation 5,115 5,053 4,992 1.2% 2.5%Adjusted Admissions 7,187 7,037 6,015 2.1% 19.5%Patient Days 15,823 14,608 13,637 8.3% 16.0%Adjusted Patient Days 29,952 29,479 24,333 1.6% 23.1%Average Daily Census 172 159 148 8.3% 16.0%Urgent Care Visits 5,150 4,857 4,857 6.0% 6.0%ER Visits 15,667 15,232 15,232 2.9% 2.9%Surgeries 2,002 1,759 1,745 13.8% 14.7%FTE's - Overall 1,739.4 1,675.0 1,626.0 3.8% 7.0%AR Days 53.5 49.0 50.4 9.3% 6.3%Days Cash on Hand 60.3 60.0 65.5 0.5% -7.9%Case Mix Index 1.70 1.68 1.64 1.1% 3.3%

Income Statement Act / Bud Act / PY (in thousands) Actual Budget Prior Year % Var % Var

Patient Revenue 72,162 68,581 60,177 5.2% 19.9%DSH / UPL 968 750 844 29.0% 14.7%Medicaid / UPL 350 375 1,000 -6.7% -65.0%Other Revenue 3,500 3,660 3,396 -4.4% 3.1%Bad Debt (3,873) (3,350) (2,369) 15.6% 63.5% Net Revenue 73,107 70,016 63,047 4.4% 16.0%

Total Personnel Cost 41,778 39,824 37,670 4.9% 10.9%Contracted and Other Services 13,520 14,157 14,137 -4.5% -4.4%Supplies 13,386 13,680 11,718 -2.2% 14.2%Depreciation 3,498 3,504 3,463 -0.2% 1.0%Interest 62 76 71 Total Operating Exp 72,244 71,241 67,058 1.4% 7.7%

Non Operating Revenue 28 23 (69)

Excess (Deficit) Revenue Over Expenses 892 (1,202) (4,081)

Partnering & Transition Costs 330 188 0

Total Excess (Deficit) Rev Over Expenses 562 (1,389) (4,081)

Indian River Medical CenterConsolidated Financial Information

YTD December 2017

Year to Date

Year to Date

1,600

1,800

2,000

2,200

2,400

2,600

2,800

Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep

Adjusted Admissions

Actual Budget

(2,500)

(1,000)

500

2,000

3,500


Excess (Deficit) Revenue Over Expenses to Budget (In Thousands)

Actual Budget

7,5008,5009,500

10,50011,50012,50013,500


Operating Expense Per Adjusted Admission

Actual Budget

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Admissions 1,273 1,164 1,156 9.4% 10.1%Observation Discharges 403 526 589 -23.4% -31.6%Total Admissions & Observation 1,676 1,690 1,745 -0.8% -4.0%Adjusted Admissions 2,435 2,315 2,050 5.2% 18.8%Patient Days 5,270 5,015 4,722 5.1% 11.6%Adjusted Patient Days 10,079 9,976 8,374 1.0% 20.4%Average Daily Census 170 162 152 5.1% 11.6%Urgent Care Visits 1,998 1,976 1,976 1.1% 1.1%ER Visits 5,319 5,254 5,254 1.2% 1.2%Surgeries 659 636 633 3.6% 4.1%FTE's - Overall 1,776.2 1,734.0 1,642.6 2.4% 8.1%AR Days 53.5 49.0 50.4 9.3% 6.3%Days Cash on Hand 60.3 60.0 65.5 0.5% -7.9%Case Mix Index 1.70 1.68 1.64 1.0% 3.4%


Patient Revenue 24,510 23,716 21,050 3.3% 16.4%DSH / UPL 321 250 297 28.6% 8.3%Medicaid / UPL 100 125 500 -20.0% -80.0%Other Revenue 1,231 1,286 1,114 -4.3% 10.6%Bad Debt (1,059) (1,083) (875) -2.2% 21.0% Net Revenue 25,104 24,295 22,086 3.3% 13.7%

Total Personnel Cost 14,306 13,788 12,518 3.8% 14.3%Contracted and Other Services 4,453 4,679 5,128 -4.8% -13.2%Supplies 4,495 4,495 4,123 0.0% 9.0%Depreciation 1,164 1,168 1,164 -0.4% -0.1%Interest Expense 21 25 24 Total Operating Exp 24,439 24,155 22,957 1.2% 6.5%

Non Operating Revenue 11 12 39

Excess (Deficit) Revenue Over Expenses 676 152 (832)

Partnering & Transition Costs 73 63 0

Total Excess (Deficit) Rev Over Expenses 603 89 (832)

Indian River Medical CenterConsolidated Financial Information

December 2017

Month to Date

Month to Date

1,600

1,800

2,000

2,200

2,400

2,600

2,800


Adjusted Admissions

Actual Budget

(2,500)

(1,000)

500

2,000

3,500



Actual Budget

7,5008,5009,500

10,50011,50012,50013,500



Actual Budget

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Admissions 3,797 3,487 3,371 8.9% 12.6%Observation Discharges 1,318 1,566 1,621 -15.8% -18.7%Total Admissions & Observation 5,115 5,053 4,992 1.2% 2.5%Adjusted Admissions 7,187 7,037 6,015 2.1% 19.5%Patient Days 15,823 14,608 13,637 8.3% 16.0%Adjusted Patient Days 29,952 29,479 24,333 1.6% 23.1%Average Daily Census 172 159 148 8.3% 16.0%ER Visits 15,667 15,232 15,232 2.9% 2.9%Surgeries 2,002 1,759 1,745 13.8% 14.7%FTE's - Overall 1,405.0 1,351.6 1,339.5 3.9% 4.9%AR Days 45.9 42.0 47.0 9.3% -2.4%Days Cash on Hand 38.1 47.0 45.4 -19.0% -16.2%Case Mix Index 1.70 1.68 1.64 1.1% 3.3%


Patient Revenue 55,223 52,029 44,344 6.1% 24.5%DSH / UPL 968 750 844 29.0% 14.7%Medicaid / UPL 350 375 1,000 -6.7% -65.0%Other Revenue 3,497 3,130 2,779 11.8% 25.8%Bad Debt (3,873) (3,350) (2,369) 15.6% 63.5% Net Revenue 56,165 52,934 46,598 6.1% 20.5%

Total Personnel Cost 26,686 25,751 24,991 3.6% 6.8%Contracted and Other Services 10,455 10,395 10,028 0.6% 4.3%Supplies 12,806 13,009 11,018 -1.6% 16.2%Depreciation 3,085 3,090 3,025 -0.2% 2.0%Interest - - - Total Operating Exp 53,032 52,245 49,063 1.5% 8.1%

Non Operating Revenue 28 23 (69)

Excess (Deficit) Revenue Over Expenses 3,161 712 (2,534)

Indian River Medical CenterHospital Only Financial Information

YTD December 2017

Year to Date

Year to Date

1,600

1,800

2,000

2,200

2,400

2,600

2,800


Adjusted Admissions

Actual Budget

5,5006,5007,5008,5009,500

10,50011,50012,50013,500



Actual Budget

(2,500)

(1,000)

500

2,000

3,500



Actual Budget

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Admissions 1,273 1,164 1,156 9.4% 10.1%Observation Discharges 403 526 589 -23.4% -31.6%Total Admissions & Observation 1,676 1,690 1,745 -0.8% -4.0%Adjusted Admissions 2,435 2,315 2,050 5.2% 18.8%Patient Days 5,270 5,015 4,722 5.1% 11.6%Adjusted Patient Days 10,079 9,976 8,374 1.0% 20.4%Average Daily Census 170 162 152 5.1% 11.6%ER Visits 5,319 5,254 5,254 1.2% 1.2%Surgeries 659 636 633 3.6% 4.1%FTE's - Overall 1,439.2 1,405.4 1,357.4 2.4% 6.0%AR Days 45.9 42.0 47.0 9.3% -2.4%Days Cash on Hand 38.1 47.0 45.4 -19.0% -16.2%Case Mix Index 1.70 1.68 1.64 1.0% 3.4%


Patient Revenue 18,478 17,834 15,128 3.6% 22.1%DSH / UPL 321 250 297 28.6% 8.3%Medicaid / UPL 100 125 500 -20.0% -80.0%Other Revenue 1,230 1,066 912 15.4% 34.8%Bad Debt (1,059) (1,083) (875) -2.2% 21.0% Net Revenue 19,071 18,193 15,963 4.8% 19.5%

Total Personnel Cost 9,115 8,898 8,177 2.4% 11.5%Contracted and Other Services 3,412 3,453 3,432 -1.2% -0.6%Supplies 4,346 4,265 3,862 1.9% 12.5%Depreciation 1,027 1,030 1,017 -0.3% 0.9%Interest Expense - - - Total Operating Exp 17,899 17,647 16,489 1.4% 8.6%


Excess (Deficit) Revenue Over Expenses 1,182 558 (487)

Indian River Medical CenterHospital Only Financial Information

December 2017

Month to Date

Month to Date

1,600

1,800

2,000

2,200

2,400 2,600

2,800


Adjusted Admissions

Actual Budget

5,5006,5007,5008,5009,500

10,50011,50012,50013,500



Actual Budget

(2,500)

(1,000)

500

2,000

3,500



Actual Budget

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Patient Visits 68,693 66,715 63,997 3.0% 7.3%Urgent Care Visits 5,150 4,857 4,857 6.0% 6.0%FTE's - Overall 334.4 323.4 245.4 3.4% 36.3%AR Days 82.4 77.0 58.1 7.1% 42.0%


Patient Revenue 14,441 13,755 12,800 5.0% 12.8%DSH / UPLMedicaid / UPLOther Revenue - 522 610 -100.0% -100.0%Bad Debt - - - Net Revenue 14,441 14,277 13,411 1.2% 7.7%

Total Personnel Cost 13,981 12,980 11,659 7.7% 19.9%Contracted and Other Services 2,515 3,032 3,213 -17.0% -21.7%Supplies 376 451 443 -16.6% -15.1%Depreciation 161 165 182 -2.6% -11.6%Interest - - - Total Operating Exp 17,032 16,628 15,497 2.4% 9.9%


Excess (Deficit) Revenue Over Expenses (2,591) (2,351) (2,086)

Indian River Medical CenterPhysician Financial Information

YTD December 2017

Year to Date

Year to Date

- 5,000

10,000 15,000 20,000 25,000 30,000


Total Patient and Urgent Care Visits

Actual Budget

(2,000)

(1,000)

0

1,000

2,000



Actual Budget

- 1,000 2,000 3,000 4,000 5,000 6,000 7,000


Operating Expense

Actual Budget

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Patient Visits 21,296 21,449 22,166 -0.7% -3.9%Urgent Care Visits 1,998 1,976 1,976 1.1% 1.1%FTE's - Overall 337.0 328.7 281.8 2.5% 19.6%AR Days 82.4 77.0 58.1 7.1% 42.0%


Patient Revenue 5,053 4,803 4,757 5.2% 6.2%DSH / UPLMedicaid / UPLOther Revenue - 217 199 -100.0% -100.0%Bad Debt - - - Net Revenue 5,053 5,020 4,956 0.6% 1.9%

Total Personnel Cost 4,795 4,505 3,971 6.4% 20.8%Contracted and Other Services 825 981 1,404 -15.9% -41.2%Supplies 97 142 180 -31.6% -45.7%Depreciation 53 55 61 -3.9% -13.2%Interest Expense - - - Total Operating Exp 5,771 5,683 5,615 1.5% 2.8%


Excess (Deficit) Revenue Over Expenses (718) (663) (659)

Indian River Medical CenterPhysician Financial Information

December 2017

Month to Date

Month to Date

- 5,000

10,000 15,000 20,000 25,000 30,000


Total Patient and Urgent Care Visits

Actual Budget

(2,000)

(1,000)

0

1,000

2,000



Actual Budget

- 1,000 2,000 3,000 4,000 5,000 6,000 7,000


Operating Expense

Actual Budget

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Patient Revenue 2,498 2,797 3,032 -10.7% -17.6%DSH / UPL 0 0 0Medicaid / UPL 0 0 0Other Revenue 3 9 6Bad Debt - - 0 Net Revenue 2,501 2,806 3,038 -10.9% -17.7%

Total Personnel Cost 1,111 1,093 1,020 1.6% 8.9%Contracted and Other Services 880 918 897 -4.1% -1.9%Supplies 204 220 257 -7.3% -20.6%Depreciation 252 249 256 1.2% -1.6%Interest 62 76 71 -18.4% -12.7% Total Operating Exp 2,509 2,556 2,501 -1.8% 0.3%

Non Operating Revenue 0 0 0 0.0% 0.0%

Excess (Deficit) Revenue Over Expenses (8) 250 537 -103.2% -101.5%

Indian River Medical CenterOutpatient Imaging Services Financial Information

YTD December 2017

Year to Date

Page 26 of 60


Patient Revenue 980 1,079 1,165 -9.2% -15.9%DSH / UPL 0 0 0Medicaid / UPL 0 0 0Other Revenue 1 3 2 Bad Debt - - - Net Revenue 981 1,082 1,167 -9.3% -15.9%

Total Personnel Cost 396 385 370 2.9% 7.0%Contracted and Other Services 289 308 292 -6.2% -1.0%Supplies 52 86 82 -39.5% -36.6%Depreciation 84 83 86 1.2% -2.3%Interest Expense 21 25 24 -16.0% -12.5% Total Operating Exp 842 887 854 -5.1% -1.4%

Non Operating Revenue 0 0 0 0.0% 0.0%

Excess (Deficit) Revenue Over Expenses 139 195 313 -28.7% -55.6%

Indian River Medical CenterOutpatient Imaging Services Financial Information

December 2017

Month to Date

Page 27 of 60

0

Strategic Plan ImplementationStrategy 8: Grow and Sustain Operating Margin

Strategy 8: Grow and Sustain Operating Margin

Quarterly Metrics FY 16

Actual

FY 17

Actual

FY 18

YTD

FY 18

Target/Budget

FY 20

Target

FY 21

Target

FY 20

Benchmark

Operating margin (%) (0.5%) (1.4%) 1.25% (1.5%) 2.5%-3.1% TBD Median

Days cash on hand 63 70 60 75 ---- TBD 25th %tile

Nursing Labor Cost per

Equivalent Patient Day--- --- $389 $397 TBD TBD N/A

Hospital Non-Nursing Labor

Cost--- --- $15.3M $14.7M TBD TBD N/A

Hospital Contracted and

Purchased Services--- --- $2.85M $2.83M TBD TBD N/A

Surgical Supply Cost per

Case--- --- $1,960 $2,500 TBD TBD N/A

Page 28 of 60

Indian River Memorial Hospital Inc

And Subsidiaries

FY2017 Post Audit Financial Recap

FYE 2017 FYE 2016 FYE 2017 FYE 2016

Excess (Deficiency) of Unrestricted

Revenue over Expenses (1,871,641) (1,158,744) (2,525,372) (2,611,012)

Operating Gain (Loss) (2,892,495) (2,354,435) (2,772,299) (2,695,248)

EBIDA 15,154,031 13,959,861 11,925,263 11,491,324

Investment of Capital 12,431,846 37,433,759 12,431,846 37,433,759

change In Debt (3,418,561) 13,554,909 (3,418,561) 13,554,909

Cash and Investments 75,304,226 78,757,172 34,090,911 40,389,796

Increase in Net Assets 10,337,414 2,935,378 8,595,953 5,372,583

IRMH and Subs IRMC

Page 29 of 60

Endoscopy Project

Page 30 of 60

Endoscopy Project Budget

Total Endoscopy Project Budget $6.15M

(Funded by Foundation)

Endoscopy Facilities $4.55M

• 1st Floor New Construction 3,889 sq.ft.

• 2nd Floor Renovation 3,450 sq. ft.

• Scopes x 4, plus Monitors

• Esophageal Manometry

Interventional Endoscopy Room $1.60M• Single Plane GI / ERCP Imaging System

• Includes construction/installation (Room #6)

Update • Completed: On Time and On Budget

• First Patient, January 22, 2018

• Foundation Dedication, January 23, 2018

Page 31 of 60

FY 18 Capital Projects Update

Capital Approved– August 22, Finance Committee

VRA-MRI #2: $2.6M Budgeted– Equipment: GE Architect 3T

– Projected Install: April 1, 2018

– Projected Cost: On Budget

IRMC-Ct Scanner: $2.6M Budgeted– Equipment: Siemens 256 Dual Energy CT

– Projected Install: April 25, 2018

– Projected Cost: At or slightly under Budget

Page 32 of 60

Investment Review for

As of December 31, 2017

Page 33 of 60

Investment Review for Indian River Medical Center

2

Tab Capital Market Review 1 Portfolio Performance Summary 2 Investment Environment Review 3

Investment Manager Summary 4

Table of Contents

Page 34 of 60

Capital Market Review

Page 35 of 60


4

Market Dashboard – As of December 31, 2017

Asset Class Fourth Quarter 4Q 2017 2017

Domestic Equity (S&P 500 Index)

• U.S. equity markets posted robust absolute returns during the fourth quarter with all of the eleven S&P sectors generating positive returns, led by the Consumer Discretionary (+9.9%) and Information Technology sectors (+9.0%).

• Equity markets have continued to be supported by strong fundamentals with the economy continuing to expand and corporate earnings continuing to grow.

6.6% 21.8%

International Equity (EAFE Index)

• Developed International Markets generated good results but lagged the U.S. and Emerging equity markets during the period. The U.S. Dollar depreciated against many major currencies.

• Asia-Pacific countries, as represented by Japan (+8.6%), Australia (+7.1%), and Hong Kong (+6.7%), were the strongest major markets in local currency terms. Italy (-3.8%) and Spain (-3.1%) experienced the weakest quarter in local currency.

4.2% 25.0%

Emerging Market Equity (MSCI Emerging Markets Index)

• South Africa (+11.3%), India (+9.3%), and China (+7.7%) were the top performers on a local currency basis during the quarter.

• Mexico (-1.0%) was the worst performer in local currency terms. 7.4% 37.3%

Fixed Income (Bloomberg Barclays Capital Aggregate Index)

• Domestic and global fixed income markets generated mostly positive returns during the quarter. The Treasury curve flattened as shorter term rates rose.

• Long Term Credit (+3.2%) and Long Term Government (+2.3%) were the strongest performing sectors during the quarter, while Intermediate Government (-0.4%) was the weakest.

0.4% 3.5%

Interest Rates

• The FOMC voted to raise the target federal funds rate by 25 bps for the third time this year to a range of 1.25% - 1.50%.

• The 10-year yield rose 8 basis points from 2.33% to 2.41%, and the 30-year yield fell 12 basis points from 2.86% to 2.74%.

Currencies USD / EUR USD / JPY

USD / GBP

USD / CNY USDX (DXY)

4Q 2017 -1.6% +0.2% -0.8% -1.9% -1.0%

2017 -12.4% -3.7% -8.6% -6.4% -9.9% Page 36 of 60


5

Economic Dashboard – As of December 31, 2017 Dec-17 Sep-17 Dec-16

10 Year Average

Economic Growth (GDP) #N/A 3.2% 1.8% 1.4%

Unemployment Rate #N/A 4.3% 4.7% 7.0%

Labor Participation Rate 62.7% 63.1% 62.7% 63.8%

Core Inflation 1.7% 1.7% #N/A 1.8%

Inflation (Headline) 2.2% 2.2% 2.1% 1.7%

Consumer Confidence 128.6 120.6 113.3 76.9

WTI Crude Oil (per barrel) $60.42 $51.67 $53.72 $76.79

Natural Gas $2.95 $3.01 $3.72 $4.09

Volatility 11.0 9.5 14.0 20.1

Gold $1,309.30 $1,281.50 $1,151.70 $1,261.83

LIBOR 1.43% 1.18% 0.69% 0.63%

Federal Funds Target Rate1 1.50% 1.25% 0.75% 0.53%

ECB Refinancing Rate 0.00% 0.00% 0.00% 0.86%

10-Year U.S. Treasury Yield 2.41% 2.33% 2.44% 2.55%

10-Year German Bund Yield 0.42% 0.46% 0.20% 1.76%

S&P 500 Index 2673.6 2519.4 2238.8 1626.1

EUR/USD Exchange Rate 1.201 1.181 1.052 1.288

USD/JPY Exchange Rate 112.7 112.5 117.0 99.21Fed Funds rate is a target range of 1.25% - 1.50% Source: Bloomberg

Page 37 of 60

Capital Market Review U.S. Equity Market – Sectors & Style

6

12.1% 10.8%

-1.3%

23.8%

38.8%

21.0% 22.1% 22.2%

-1.0%

13.5%

23.0%

0.2% 3.2% 3.6%

6.9% 9.0%

6.1% 1.5%

8.6% 6.0% 6.5%

9.9%

-5.0%

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

35.0%

40.0%

45.0%

Util

ities

(2.9

%)

Rea

l Est

ate

(2.9

%)

Tele

com

(2.1

%)

Mat

eria

ls (3

.0%

)

Inf.

Tech

. (23

.8%

)

Indu

stri

als

(10.

3%)

Hea

lth C

are

(13.

8%)

Fina

ncia

ls (1

4.8%

)

Ener

gy (6

.1%

)

Con

s. S

tapl

es (8

.2%

)

Con

s. D

iscr

. (12

.2%

)

Source: Bloomberg, S&P, Russell

+5% 0% -5%

S&P 500

Russell 3000

Large 5.3% 6.6% 7.9%Mid 5.5% 6.1% 6.8%

Small 2.0% 3.3% 4.6%

Value Core Growth

6.3%

4Q17

6.6% S&P 500

Russell 3000

Large 13.7% 21.7% 30.2%Mid 13.3% 18.5% 25.3%

Small 7.8% 14.6% 22.2%

Value Core Growth

2017

21.8%

21.1%

Page 38 of 60


7

Global Equity Returns

Source: Bloomberg, MSCI, mapchart.net

Local Return USD Return Local Return USD ReturnNorth AmericaCanada 4.5% 4.3% 8.4% 16.1%United States 6.6% 6.6% 21.8% 21.8%

EuropeFrance -0.1% 1.5% 13.1% 28.7%Germany 1.2% 2.8% 12.2% 27.7%Italy -3.8% -2.3% 12.8% 28.4%Spain -3.1% -1.6% 11.6% 27.0%Switzerland 2.5% 1.8% 17.5% 22.5%U.K. 4.9% 5.7% 11.7% 22.3%

Asia PacificAustralia 7.1% 6.8% 11.0% 19.9%Hong Kong 6.7% 6.6% 37.2% 36.2%Japan 8.6% 8.5% 19.7% 24.0%

International Developed IndexMSCI EAFE Index 3.7% 4.2% 15.2% 25.0%

Emerging MarketsBrazil 2.8% -2.0% 26.5% 24.1%China 7.7% 7.6% 55.0% 54.1%

A Shares -1.2% 0.7% 8.8% 16.0%H Shares 7.3% 7.3% 29.1% 28.7%

India 9.3% 11.8% 30.5% 38.8%Korea 4.1% 11.4% 30.6% 47.3%Mexico -1.0% -8.1% 10.1% 16.0%Russia 4.3% 4.3% 0.3% 5.2%South Africa 11.3% 21.4% 23.2% 36.1%Taiwan 2.1% 4.0% 17.8% 27.5%

Emerging Markets IndexMSCI EM Index 5.7% 7.4% 30.6% 37.3%

4Q2017 2017

Page 39 of 60

Capital Market Review Fixed Income – Treasury Yield Curve & Bond Market

Source: U.S. Treasury, Bloomberg, Barclays 8

Fixed Income Performance (Sector)

0.4% 0.0%

2.3%

1.3%

0.2% 1.2%

0.5% 0.7% 1.6%

-0.3%

3.5%

2.3%

8.5%

3.0% 2.5%

6.4%

7.5%

5.4%

10.3%

8.3%

-2.0%

0.0%

2.0%

4.0%

6.0%

8.0%

10.0%

12.0%

Agg Gov Long Gov TIPS MBS Corp HY Muni Int'l EM

4Q17 2017

0.0%

0.5%

1.0%

1.5%

2.0%

2.5%

3.0%

3.5%

December '17 September '17 March '17 December '16 June '161 Year 10 Year 20 Year 30 Year

Page 40 of 60

Portfolio Performance Summary

Page 41 of 60

Investment Review for Indian River Medical Center - Operating Fund

10

Calendar Beginning Ending Net InvestmentYear Market Value Market Value Cash Flow Gain/(Loss)

2000 (from 8/1/00) $93,892,319 $89,404,024 ($4,887,253) $398,958

2001 $89,404,024 $84,105,852 ($4,964,965) ($333,208)

2002 $84,105,852 $69,872,859 ($9,416,534) ($4,816,458)

2003 $69,872,859 $69,217,035 ($13,472,704) $12,816,880

2004 $69,217,035 $71,833,298 ($3,963,146) $6,579,410

2005 $71,833,298 $69,389,156 ($5,958,866) $3,514,724

2006 $69,389,156 $53,098,844 ($22,955,838) $6,665,527

2007 $53,098,844 $50,614,600 ($6,971,260) $4,487,015

2008 $50,614,600 $39,263,673 ($2,987,305) ($8,363,622)

2009 $39,263,673 $16,623,013 ($28,016,275) $5,375,615

2010 $16,623,013 $16,668,407 $0 $45,393

2011 $16,668,407 $16,668,961 $0 $554

2012 $16,668,961 $16,670,328 $0 $1,367

2013 $16,670,328 $16,672,007 $0 $1,678

2014 $16,672,007 $16,715,784 $0 $43,777

2015 $16,715,784 $16,803,863 $0 $88,080

2016 $16,803,863 $17,174,927 $0 $371,064

2017 $17,174,927 $13,444,414 ($4,000,000) $269,487

Cumulative Total ($107,594,146) $27,146,241

Financial Reconciliation as of December 31, 2017 Operating Fund

Page 42 of 60


11

Asset Class / Market Market Target Calendar Since Since Incept

Manager Value Value % % 4Q17 YTD 2Yr 3Yr 5Yr 10Yr 09/01/00 Incept Date

Fixed Income

FPA New Income $5,029,273 37.4% 0.4% 2.7% 2.6% 1.8% -- -- -- 1.6% Jun-14

Vanguard Short-Term Investment-Grade I $5,109,346 38.0% 0.0% 2.1% 2.5% 2.1% -- -- -- 1.8% Jun-14

Total Fixed Income $10,138,619 75.4% 0.2% 2.4% 2.5% 1.9% -- -- -- 1.7% Jun-14

BloomBarc 1-3 Year Gov/Credit Bond Idx -0.2% 0.8% 1.1% 0.9% 0.8% 1.9% 3.1% 0.8%

Cash & Equivalents

S tate Street ILR Fund Admin Class1 $3,305,795 24.6% 0.3% 0.8% 0.5% 0.3% 0.2% 0.4% -- 1.1% Jul-02

T-Bills (90 Day) Index 0.3% 0.8% 0.6% 0.4% 0.2% 0.3% 1.5% 1.2%

Total Short Term Portfolio $3,305,795 24.6% 0.3% 0.8% 0.5% 0.3% 0.2% 0.8% 2.7% 2.7% Sep-00

Total Operating Fund2 $13,444,414 100.0% 100.0% 0.2% 2.0% 2.1% 1.6% 1.0% 0.0% 2.6% 2.7% Aug-00

Note: Returns greater than one year are annualized. Past performance is no guarantee of future results.

Note: Fiscal Year 10/01 thru 09/301 Money market fund change August 2016 - previously SSgA Money Market Fund2 Performance is net of management fees.

Performance Summary as of December 31, 2017 Operating Fund

Page 43 of 60

Investment Review for Indian River Medical Center - Pension Plan

12

Calendar Beginning Ending Net InvestmentYear Market Value Market Value Cash Flow Gain/(Loss)

2000 $38,243,333 $42,424,210 $3,462,165 $718,712

2001 $42,424,210 $39,782,636 ($1,607,994) ($1,033,579)

2002 $39,782,636 $34,884,763 ($1,070,658) ($3,827,215)

2003 $34,884,763 $48,710,827 $5,025,775 $8,800,289

2004 $48,710,827 $55,597,520 $1,271,970 $5,614,724

2005 $55,597,520 $58,207,775 ($771,028) $3,381,284

2006 $58,207,775 $64,647,242 ($1,185,587) $7,625,054

2007 $64,647,242 $68,137,010 ($2,018,842) $5,508,610

2008 $68,137,010 $49,368,517 ($3,589,719) ($15,178,774)

2009 $49,368,517 $54,817,606 ($3,768,736) $9,217,824

2010 $54,817,606 $57,461,026 ($3,862,196) $6,505,617

2011 $57,461,026 $62,800,042 $4,706,313 $632,702

2012 $62,800,042 $67,731,719 ($1,905,323) $6,837,000

2013 $67,731,719 $74,737,167 ($2,564,202) $9,569,651

2014 $74,737,167 $75,801,716 ($3,873,473) $4,938,022

2015 $75,801,716 $71,153,508 ($4,115,214) ($532,994)

2016 $71,153,508 $69,464,730 ($7,334,587) $5,645,809

2017 $69,464,730 $70,054,282 ($8,032,455) $8,622,007

Cumulative Total ($31,233,791) $63,044,743

Financial Reconciliation as of December 31, 2017 Pension Plan

Page 44 of 60


13

Asset Class / Market Market Target Calendar Since Since Incept

Manager Value Value % % 4Q17 YTD 2Yr 3Yr 5Yr 10Yr 09/01/00 Incept Date

Domestic Equity

GMO Quality III $13,327,376 19.1% 7.6% 29.1% 19.0% 12.9% -- -- -- 13.2% May-13

AMG River Road Div All Cap Val II I1 $11,531,459 16.5% -2.0% 3.5% 11.4% 5.6% -- -- -- 8.5% May-13

S tralem Equity Instl $12,192,575 17.4% 3.4% 16.7% 12.5% 8.6% -- -- -- 10.1% May-13

Domestic Equity $37,051,410 53.0% 50.0% 3.1% 16.1% 14.4% 9.1% -- -- -- 10.7% May-13

S&P 500 Index 6.6% 21.8% 16.8% 11.4% 15.8% 8.5% 5.4% 14.0%

International Equity

BMO Pyrford International Stock I $5,466,851 7.8% 3.3% 18.5% 10.4% 5.4% -- -- -- 5.0% May-13

Dreyfus International Stock I $5,635,319 8.0% 4.6% 27.0% 15.2% 9.7% -- -- -- 5.5% May-13

International Equity $11,102,170 15.8% 15.0% 3.9% 22.7% 12.8% 7.5% -- -- -- 5.2% May-13

EAFE Index (in US Dollar NET) 4.2% 25.0% 12.4% 7.8% 7.9% 1.9% 4.0% 6.2%

Total Equity $48,153,580 68.8% 65.0% 3.3% 17.6% 14.3% 8.9% -- -- -- 9.8% May-13

Fixed Income

S tate Street Aggregate Bond Index K $21,235,400 30.3% 0.3% 3.3% 2.8% 2.0% -- -- -- 2.4% Oct-14

Fixed Income $21,235,400 30.3% 35.0% 0.3% 3.3% 2.8% 2.0% 1.9% 4.1% 5.0% 5.6% Jan-95

Cash & Equivalents

S tate Street STIF 25 Bps2 $665,301 0.9% 0.3% 0.8% 0.6% 0.4% 0.3% 0.5% 1.6% 2.3% Apr-97

Cash & Equivalents $665,301 0.9% 0.3% 0.8% 0.6% 0.4% 0.3% 0.5% 1.6% 1.8% Jan-00

Total Composite3 $70,054,281 100.0% 100.0% 2.3% 12.9% 10.4% 6.6% 8.1% 5.5% 5.6% 7.4% Jan-95

Custom Benchmark 4 4.1% 15.6% 11.3% 7.8% 9.9% 6.7% 5.2% 8.5%

Note: Returns greater than one year are annualized. Past performance is no guarantee of future results.

Note: Fiscal Year 10/01 thru 09/301 Effective 10/01/2016 Aston Funds changed its name to AMG Funds and all fund names were changed to reflect.2 Money market fund change July 2016 - previously State Street Short Term Investment Fund3 Performance is net of management fees.4 Custom Benchmark: Effective 5/1/2013-present: 50% S&P 500, 15% EAFE, 35% Barclays Aggregate Index

Prior to 5/1/2013: 65% S&P 500, 35% Barclays Aggregate Index.

Performance Summary as of December 31, 2017 Pension Plan

Page 45 of 60

Investment Environment Review

Page 46 of 60


15

2017: Year in Review

$2,257.8

$2,687.5

10.5

19.4

0

5

10

15

20

25

2,200

2,300

2,400

2,500

2,600

2,700

2,800

January February March April May June July August September October NovemberDecember

S&P 500 VIX Avg VIX

January Febuary March April May June July August September October November December

1.90% 3.97% 0.12% 1.03% 1.41% 0.62% 2.06% 0.31% 2.06% 2.33% 3.07% 1.11%

S&P 500 Total Return 2017 Monthly Returns

Page 47 of 60


16 1 Bull Market: continuous period without 20% downturn Source: Bloomberg, Data since 1929 2 1990 to 2016

Equity Bull Market Update

61 Months

75 Months

87 Months

106 Months (Current)

148 Months

0 20 40 60 80 100 120 140 160

8/1982 - 8/1987

10/1974 - 11/1980

6/1949 - 8/1956

3/2009 - 12/2017

12/1987 - 3/2000

Longest Historical Bull Market Run1 - S&P 500

1991 1992 1993 1994 1995 1996 1997 1998 199930.4% 7.6% 10.1% 1.3% 37.5% 23.0% 33.4% 28.6% 21.0%

2009 2010 2011 2012 2013 2014 2015 2016 201726.4% 15.1% 2.1% 16.0% 32.4% 13.7% 1.4% 12.0% 21.8%

Longest Consecutive Positive S&P 500 Calendar Year Returns

Current Consecutive Positive S&P 500 Calendar Year Returns

$895.6

$437.6

0

500

1,000

0 12 24 36 48 60 72 84 96 108 120 132 144Number of Months

Growth of $100

90's Bull Market Current Bull Market

-100

-50

0

50

100 S&P 500 Number of Days Above/Below 1%

Greater than 1% Less than -1%

Days %Greater than 2% 10.3 4.09%Greater than 1% 38.9 15.44%Less than -1% 36.3 14.38%Less than -2% 11.2 4.44%

252

Average2

Total Number of Days:

Days %0 0.00%4 1.59%4 1.59%0 0.00%

251

2017

Page 48 of 60


17

U.S. Equity Market – Valuations

Source: Bloomberg, JPMorgan

0

20

40

60

80

100

120

140

x

5x

10x

15x

20x

25x

30x

S&P

500

- Ear

ings

-per

-Sha

re

S&P

500

- Pri

ce-to

-Ear

ning

s

Forward P/E Trailing 12 Mo. P/E Historical P/E Average Trailing 12 Mo. EPS

+11.8% YoY increase in EPS for 2017

S&P Price Trailing P/E 12/29/17: 2,673.61 22.4x 12/18/17: 2,690.16 (all-time high) 22.6x 3/9/09: 676.53 (10 Year low) 11.1x

Financials Real Estate Materials Industrials Cons. Disc. Tech Energy Health Care TelecomCons.

StaplesUtilities

Forward P/E Ratio 14.9 17.9 18.4 19.6 21.2 18.6 25.7 16.6 13.3 19.9 17.4

20-yr avg. 12.9 15.3 13.9 16.3 18.0 20.9 17.6 17.5 16.5 17.1 14.1

Trailing P/E ratio 17.6 36.6 27.6 23.7 24.8 24.3 36.3 23.7 16.1 21.7 21.0

20-yr avg. 15.5 35.6 18.9 20.0 19.2 25.7 17.7 24.1 20.0 20.9 16.0

Dividend Yield 1.8% 3.5% 1.9% 1.9% 1.4% 1.3% 2.8% 1.7% 5.1% 2.8% 3.7%

20-yr avg. 2.3% 4.4% 2.6% 2.1% 1.4% 0.9% 2.3% 1.8% 4.1% 2.6% 4.0%

Page 49 of 60


18 18

High Valuations Lead to Lower Returns

Page 50 of 60


19 Note: High quality indicated average S&P Quality Ranking of B+ or higher; Low quality indicated average S&P Quality Ranking of B or lower. Source: Atlanta Capital, Standard & Poors, Russell, Wilshire Atlas

Quality as a Factor The High-Quality Index (7.6%) outpaced the Low-Quality Index (+4.8%) during the fourth quarter, bringing its 2018 Calendar

Year performance (+22.4%) ahead of Low Quality (+19.6%) as well.

Page 51 of 60

Investment Manager Summary

Page 52 of 60


21

Domestic Equity: GMO Quality III Style: Large Cap Core

Calendar Year Performance

2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

GMO Quality III -- -- -- -- -- -- 12.5% 1.5% 9.7% 29.1%

GMO Quality III -24.1% 19.8% 5.5% 11.7% 12.0% 25.4% 12.5% 1.5% 9.7% 29.1%

S&P 500 Index -37.0% 26.4% 15.1% 2.1% 16.0% 32.4% 13.7% 1.4% 12.0% 21.8%

Avg Large Cap Core Manager -37.7% 28.5% 13.9% -1.0% 14.7% 31.7% 10.7% -1.0% 9.6% 20.3%

Data as of December 31, 2017 Trailing Performance

3 Mths 1 Year 2 Years 3 Years 5 Years Std Dev 5 Years

GMO Quality III 7.6% 29.1% 19.0% 12.9% -- --

GMO Quality III 7.6% 29.1% 19.0% 12.9% 15.2% 7.5%

S&P 500 Index 6.6% 21.8% 16.8% 11.4% 15.8% 7.3%

Avg Large Cap Core Manager 6.2% 20.3% 14.8% 9.3% 13.8% 7.4%

Portfolio Characteristics Manager Benchmark

Number of Securities 54 505

Weighted Average Market Capitalization (MM) $244,960 $191,102

Price / Earnings (TTM) 23.4x 23.4x

Dividend Yield 1.6% 1.9%

Annual Turnover (TTM) 29.0% --

Strategy Overview

Firm AUM (MM) $74,385

Strategy AUM (MM) $9,687

Vehicle Mutual Fund

Expense Ratio (%) 0.48

Status Current Manager

0

25

50

75

100

Per

cen

tile

Manager Benchmark

Ranking of 5 Year ReturnsLarge Cap Core Universe

Top Half:Manager: 72%Bench: 92%

Bottom Half:Manager: 28%Bench: 8%

253 mgrs 237 mgrs

Average

RecentManager: 71%Bench: 85%

Manager: 63%Bench: 69%

4Q09 4Q10 4Q11 4Q12 4Q13 4Q14 4Q15 4Q16 4Q17 0% 5% 10% 15% 20% 25% 30% 35% 40% 45%

Cons DiscCons Stap

EnergyFinHCInd

TechMat

REITS/Real EstateTelecomUtilities

OtherCash

Manager Benchmark

Page 53 of 60


22

Domestic Equity: AMG River Road Div All Cap Val II I Style: Large Cap Value


2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

AMG River Road Div All Cap Val II I -- -- -- -- -- -- 10.1% -4.9% 19.8% 3.5%

AMG River Road Dividend All Cap Value I -28.4% 21.5% 19.0% 5.2% 9.3% 32.4% 9.4% -4.6% 20.5% 9.1%

S&P 500 Index -37.0% 26.4% 15.1% 2.1% 16.0% 32.4% 13.7% 1.4% 12.0% 21.8%




AMG River Road Div All Cap Val II I -2.0% 3.5% 11.4% 5.6% -- --

AMG River Road Dividend All Cap Value I 3.9% 9.1% 14.6% 7.8% 12.7% 8.4%

S&P 500 Index 6.6% 21.8% 16.8% 11.4% 15.8% 7.3%








Strategy Overview



Vehicle Mutual Fund



0

25

50

75

100

Per

cen

tile

Manager Benchmark




262 mgrs 237 mgrs

Average



4Q12 4Q13 4Q14 4Q15 4Q16 4Q17 0% 5% 10% 15% 20% 25%

Cons DiscCons Stap

EnergyFinHCInd

TechMat


OtherCash

Manager Benchmark

Page 54 of 60


23

Domestic Equity: Stralem Equity Instl Style: Large Cap Value


2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

Stralem Equity Instl -- -- -- -- -- -- 7.1% 1.2% 8.5% 16.7%

Stralem Equity -28.8% 18.8% 9.5% 8.0% 8.0% 28.8% 7.1% 1.2% 8.5% 16.7%

S&P 500 Index -37.0% 26.4% 15.1% 2.1% 16.0% 32.4% 13.7% 1.4% 12.0% 21.8%




Stralem Equity Instl 3.4% 16.7% 12.5% 8.6% -- --

Stralem Equity 3.4% 16.7% 12.5% 8.6% 12.1% 7.3%

S&P 500 Index 6.6% 21.8% 16.8% 11.4% 15.8% 7.3%




Wtd Avg Market Cap (MM) $178,280 $191,102




Strategy Overview

Firm AUM (MM) $685

Strategy AUM (MM) $621

Vehicle Mutual Fund



0

25

50

75

100

Per

cen

tile

Manager Benchmark




228 mgrs 237 mgrs

Average



4Q06 4Q08 4Q10 4Q12 4Q14 4Q16 4Q17 0% 5% 10% 15% 20% 25%

Cons DiscCons Stap

EnergyFinHCInd

TechMat


OtherCash

Manager Benchmark

Page 55 of 60


24

International Equity: BMO Pyrford International Stock I Style: Core


2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

BMO Pyrford International Stock I -- -- -- -- -- -- 0.6% -4.1% 2.9% 18.5%

EAFE Index (in US Dollar NET) -43.4% 31.8% 7.7% -12.1% 17.3% 22.8% -4.9% -0.8% 1.0% 25.0%

Avg International Equity Manager -43.9% 33.0% 10.7% -13.0% 18.1% 20.0% -5.0% -1.6% 1.1% 26.3%



BMO Pyrford International Stock I 3.3% 18.5% 10.4% 5.4% -- --

EAFE Index (in US Dollar NET) 4.2% 25.0% 12.4% 7.8% 7.9% 10.2%

Avg International Equity Manager 3.9% 26.3% 13.0% 7.9% 7.5% 9.8%







Strategy Overview


Strategy AUM (MM) $704

Vehicle Mutual Fund



0

25

50

75

100

Per

cen

tile

Manager Benchmark

Ranking of 1 Year ReturnsInternational Equity Universe



229 mgrs 244 mgrs

Average



4Q98 4Q01 4Q04 4Q07 4Q10 4Q13 4Q16 4Q17 0% 10% 20% 30% 40% 50% 60% 70%

Europe

Japan

Pacific (Ex Japan)

Canada

U.S.

Emerging Markets

Other

Cash

Manager Benchmark

Page 56 of 60


25

International Equity: Dreyfus International Stock I Style: Growth


2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

Dreyfus International Stock I -- -- -- -- -- -- -4.4% -0.6% 4.6% 27.0%

EAFE Index (in US Dollar NET) -43.4% 31.8% 7.7% -12.1% 17.3% 22.8% -4.9% -0.8% 1.0% 25.0%

Avg International Equity Manager -43.9% 33.0% 10.7% -13.0% 18.1% 20.0% -5.0% -1.6% 1.1% 26.3%



Dreyfus International Stock I 4.6% 27.0% 15.2% 9.7% -- --

EAFE Index (in US Dollar NET) 4.2% 25.0% 12.4% 7.8% 7.9% 10.2%

Avg International Equity Manager 3.9% 26.3% 13.0% 7.9% 7.5% 9.8%



Wtd Avg Market Cap (MM) $68,014 $64,121




Strategy Overview



Vehicle Mutual Fund



0

25

50

75

100

Per

cen

tile

Manager Benchmark

Ranking of 5 Year ReturnsInternational Equity Universe



237 mgrs 241 mgrs

Average



4Q11 4Q12 4Q13 4Q14 4Q15 4Q16 4Q17 0% 10% 20% 30% 40% 50% 60% 70%

Europe

Japan

Pacific (Ex Japan)

Canada

U.S.

Emerging Markets

Other

Cash

Manager Benchmark

Page 57 of 60


26

Fixed Income: State Street Aggregate Bond Index K Style: Intermediate


2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

State Street Aggregate Bond Index K -- -- -- -- -- -- -- 0.6% 2.3% 3.3%

BloomBarc Aggregate Bond Index 5.2% 5.9% 6.5% 7.8% 4.2% -2.0% 6.0% 0.5% 2.6% 3.5%

Avg Fixed Income - Core (Interm) Manager -4.0% 13.9% 7.8% 5.7% 7.1% -0.8% 4.8% -0.4% 4.2% 4.1%



State Street Aggregate Bond Index K 0.3% 3.3% 2.8% 2.0% -- --

BloomBarc Aggregate Bond Index 0.4% 3.5% 3.1% 2.2% 2.1% 3.0%

Avg Fixed Income - Core (Interm) Manager 0.4% 4.1% 4.2% 2.6% 2.3% 2.7%


Number of Securities 8,076 9,706

Average Quality AA/Aa2 AA/Aa2

Average Duration (years) 6.0 yrs 5.9 yrs

Average Maturity (years) 8.2 yrs 8.3 yrs

Yield 2.7% 2.7%

Strategy Overview

Firm AUM (MM) $2,673,189


Vehicle Mutual Fund



0

25

50

75

100

Per

cen

tile

Manager Benchmark

Ranking of 5 Year ReturnsFixed Income - Core (Intermediate) Universe



166 mgrs 251 mgrs

Average



4Q02 4Q04 4Q06 4Q08 4Q10 4Q12 4Q14 4Q16 4Q17 0% 5% 10% 15% 20% 25% 30% 35% 40%

TreasuryAgency MBS

Non-Agency MBSInflation-Linked

Agency Non-MBSABS

IG CorpNon IGYankee

Foreign (Non-Dollar)Emerging Markets

MuniBank Loan

OtherCash

Manager Benchmark

Page 58 of 60


27

Fixed Income: FPA New Income


2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

FPA New Income -- -- -- -- -- -- -- 0.2% 2.5% 2.7%

FPA New Income 4.3% 2.9% 3.2% 2.2% 2.2% 0.7% 1.3% 0.2% 2.5% 2.7%

BloomBarc 1-3 YR Gov/Credit 5.0% 3.8% 2.8% 1.6% 1.3% 0.6% 0.8% 0.7% 1.3% 0.8%

Avg Fixed Income - Core (Short) Manager -4.2% 8.9% 4.1% 1.5% 3.6% 0.6% 1.0% 0.1% 2.1% 1.6%



FPA New Income 0.4% 2.7% 2.6% 1.8% -- --

FPA New Income 0.4% 2.7% 2.6% 1.8% 1.5% 0.8%

BloomBarc 1-3 YR Gov/Credit -0.2% 0.8% 1.1% 0.9% 0.8% 0.6%

Avg Fixed Income - Core (Short) Manager 0.0% 1.6% 1.9% 1.3% 1.1% 0.9%


Number of Securities 450 1,512




Yield 3.0% 2.0%

Strategy Overview



Vehicle Mutual Fund



0

25

50

75

100

Per

cen

tile

Manager Benchmark

Ranking of 5 Year ReturnsFixed Income - Core (Short) Universe



5 mgrs 75 mgrs

Average



4Q76 4Q80 4Q84 4Q88 4Q92 4Q96 4Q00 4Q04 4Q08 4Q12 4Q16 0% 10% 20% 30% 40% 50% 60% 70%

TreasuryAgency MBS


Agency Non-MBSABS

IG CorpNon IGYankee


MuniBank Loan

OtherCash

Manager Benchmark

Page 59 of 60


28

Fixed Income: Vanguard Short-Term Investment-Grade I Style: Short


2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

Vanguard Short-Term Investment-Grade I -- -- -- -- -- -- -- 1.1% 2.9% 2.1%

Vanguard Short-Term Investment-Grade I -4.6% 14.2% 5.4% 2.1% 4.6% 1.1% 1.9% 1.1% 2.9% 2.2%

BloomBarc 1-3 YR Gov/Credit 5.0% 3.8% 2.8% 1.6% 1.3% 0.6% 0.8% 0.7% 1.3% 0.8%

Avg Fixed Income - Core (Short) Manager -4.2% 8.9% 4.1% 1.5% 3.6% 0.6% 1.0% 0.1% 2.1% 1.6%



Vanguard Short-Term Investment-Grade I 0.0% 2.1% 2.5% 2.1% -- --

Vanguard Short-Term Investment-Grade I 0.0% 2.2% 2.5% 2.1% 1.8% 1.3%

BloomBarc 1-3 YR Gov/Credit -0.2% 0.8% 1.1% 0.9% 0.8% 0.6%

Avg Fixed Income - Core (Short) Manager 0.0% 1.6% 1.9% 1.3% 1.1% 0.9%


Number of Securities 1,991 1,512




Yield 2.4% 2.0%

Strategy Overview

Firm AUM (MM) $4,700,000


Vehicle Mutual Fund



0

25

50

75

100

Perc

enti

le

Manager Benchmark

Ranking of 5 Year ReturnsFixed Income - Core (Short) Universe



61 mgrs 75 mgrs

Average



4Q02 4Q04 4Q06 4Q08 4Q10 4Q12 4Q14 4Q16 4Q17

0% 10% 20% 30% 40% 50% 60% 70%

TreasuryAgency MBS


Agency Non-MBSABS

IG CorpNon IGYankee


MuniBank Loan

OtherCash

Manager BenchmarkPage 60 of 60

Indian River Memorial Hospital, Inc. d/b/a · 2018-08-30 · INDIAN RIVER MEMORIAL HOSPITAL, INC. D/B/A INDIAN RIVER MEDICAL CENTER BOARD OF DIRECTORS MINUTES The regular meeting

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