Draft Transcript of Full Meeting Date: June 21, 2016 Case: State of Illinois Health Facilities and Services Review Board Planet Depos, LLC Phone: 888-433-3767 Fax: 888-503-3767 Email: transcripts@planetdepos.com Internet: www.planetdepos.com Worldwide Court Reporting Interpretation Trial Services Draft 1 1 ILLINOIS DEPARTMENT OF PUBLIC HEALTH 2 HEALTH FACILITIES AND SERVICES REVIEW BOARD 3 OPEN SESSION - MEETING 4 5 6 Bolingbrook, Illinois 60490 7 Tuesday, June 21, 2016 8 10:03 a.m. 9 10 11 12 13 14 15 Job No. 93892 16 Pages: 17 Reported by: 18 19 20 21 22 23 24 1 - 291 Melanie L. Humphrey-Sonntag, CSR, RDR, CRR, FAPR DraftFull Meeting Conducted on June 21, 2016 2 1 A P P E A R A N C E S 2 3 BOARD MEMBERS PRESENT: 4 KATHY OLSON, Chairperson 5 JOEL K. JOHNSON 6 DALE GALASSIE 7 JUSTICE ALAN GREIMAN 8 JOHN MC GLASSON, SR. 9 RICHARD SEWELL 10 11 EX OFFICIO MEMBERS PRESENT: 12 BILL DART, IDPH 13 ARVIND K. GOYAL, IHFS 14 15 ALSO PRESENT: 16 JUAN MORADO, JR., General Counsel 17 JEANNIE MITCHELL, Assistant General Counsel 18 COURTNEY AVERY, Administrator 19 MICHAEL CONSTANTINO, IDPH Staff 20 GEORGE ROATE, IDPH Staff 21 22 23 24 PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 3 C O N T E N T S 1 PAGE 2 3 CALL TO ORDER 6 4 ROLL CALL 6 5 EXECUTIVE SESSION 7 6 COMPLIANCE ISSUES/SETTLEMENT AGREEMENTS/ 7 FINAL ORDERS 8 Final Orders 9 Referrals to Legal Counsel 8 10 10 APPROVAL OF AGENDA 11 11 APPROVAL OF TRANSCRIPTS 11 12 PUBLIC PARTICIPATION 13 13 Transformative Health of McHenry 14 14 Southern Illinois Gastrointestinal 18 15 16 Endoscopy Center Northbrook Behavioral Hospital 17 ITEMS APPROVED BY THE CHAIRWOMAN 18 ITEMS FOR STATE BOARD ACTION 19 PERMIT RENEWAL REQUESTS 20 21 22 Park Pointe South Elgin Healthcare 28 102 103 & Rehabilitation EXTENSION REQUESTS 110 23 24 PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 4 1 C O N T E N T S C O N T I N U E D PAGE 2 3 EXEMPTION REQUESTS 4 ALTERATION REQUESTS 5 McAllister Nursing & Rehabilitation 110 111 6 DECLARATORY RULINGS/OTHER BUSINESS 114 7 HEALTH CARE WORKER SELF-REFERRAL ACT 114 8 STATUS REPORTS ON CONDITIONAL/CONTINGENT 114 9 10 PERMITS APPLICATIONS SUBSEQUENT TO INITIAL REVIEW 11 DaVita Forest City Dialysis 115 12 Griffin Medical Office Building 121 13 Southern Illinois Gastroenterology 126 14 Endoscopy Center 15 Northbrook Behavioral Health Hospital 175 16 Transitional Care of Lake County 217 17 St. Clara's Manor 233 18 Transformative Health of McHenry 244 19 OTHER BUSINESS 285 20 RULES DEVELOPMENT 285 21 OLD BUSINESS 285 22 23 24 PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 5 1 C O N T E N T S C O N T I N U E D PAGE 2 3 NEW BUSINESS 4 Financial Report 285 5 Executive Transcripts 285 6 Bed Changes 285 7 Capital Expenditures 285 8 Meeting Dates for 2017 286 9 Corrections to Profiles 286 10 ADJOURNMENT 290 11 12 13 14 15 16 17 18 19 20 21 22 23 24 PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 6 1 2 3 P R O C E E D I N G S CHAIRWOMAN OLSON: I'd like to call the meeting to order. 4 Can we have a roll call, please, George. 5 MR. ROATE: 6 Senator Burzynski is absent. 7 Senator Demuzio is absent. 8 Mr. Galassie. 9 (No response.) Thank you, Madam Chair. 10 MR. ROATE: Is inbound. 11 CHAIRWOMAN OLSON: 12 MR. ROATE: 13 Justice Greiman. 14 MEMBER GREIMAN: 15 MR. ROATE: 16 Mr. Hayes is absent. 17 Mr. Johnson. 18 MEMBER JOHNSON: 19 MR. ROATE: 20 MEMBER MC GLASSON: 21 MR. ROATE: 22 MEMBER SEWELL: 23 MR. ROATE: 24 CHAIRWOMAN OLSON: On the way. On his way. Here. He's here. Here. Mr. McGlasson. Yes, sir. Mr. Sewell. Here. Madam Chair. Here. PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 7 MR. ROATE: 1 2 That makes five in attendance so far. 3 CHAIRWOMAN OLSON: 4 The first order of business is executive 5 6 Thank you, George. session. May I have a motion to go into closed 7 session pursuant to Section 2(c)(1), 2(c)(5), 8 2(c)(11), and 2(c)(21) of the Open Meetings Act? MEMBER SEWELL: So moved. 10 MEMBER JOHNSON: Second. 11 CHAIRWOMAN OLSON: 9 12 All those in favor say aye. 13 (Ayes heard.) 14 CHAIRWOMAN OLSON: 15 (No response.) 16 CHAIRWOMAN OLSON: Opposed, like sign. We are now in executive 17 session for about 20 minutes, so I need everybody to 18 clear the room, please. 19 (At 10:04 a.m. the Board adjourned into 20 executive session, during which Member Galassie 21 joined the proceedings. 22 resumed at 10:34 a.m. as follows:) 23 24 CHAIRWOMAN OLSON: Open session proceedings Okay. We're back in session. PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 8 Is there business to come out of the 1 2 executive session? 3 MR. MORADO: 4 We're going to be seeking a final order on Yes, there is, Madam Chair. 5 HFSRB 16-01, the Albany Park Medical Surgical 6 Center. 7 CHAIRWOMAN OLSON: 8 accept this final order. 9 MEMBER GALASSIE: So moved. 10 CHAIRWOMAN OLSON: 11 MEMBER GREIMAN: 12 CHAIRWOMAN OLSON: 13 May I have a motion to And a second. Second. All those in favor say aye. 14 (Ayes heard.) 15 CHAIRWOMAN OLSON: 16 (No response.) 17 CHAIRWOMAN OLSON: 18 MR. MORADO: Opposed, like sign. Motion passes. We're also seeking a final 19 order on HFSRB 16-04, Decatur Memorial Hospital, 20 also known as Project No. 14-046. 21 CHAIRWOMAN OLSON: 22 accept this final order. 23 MEMBER SEWELL: 24 CHAIRWOMAN OLSON: May I have a motion to So moved. And a second. PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 9 1 MEMBER MC GLASSON: 2 MEMBER GALASSIE: 3 CHAIRWOMAN OLSON: 4 Second. Second. All those in favor say aye. 5 (Ayes heard.) 6 CHAIRWOMAN OLSON: 7 (No response.) 8 CHAIRWOMAN OLSON: 9 MR. MORADO: Opposed, like sign. Motion passes. Next, we have a final order on 10 HFSRB 16-05. 11 business as Chicago Behavioral Health. 12 also known as Exemption Application E-016-14. 13 14 This is the 2014 Health, LLC, doing CHAIRWOMAN OLSON: May I have a motion to approve this final order. 15 MEMBER GREIMAN: 16 CHAIRWOMAN OLSON: 17 A second. 18 MEMBER GALASSIE: 19 CHAIRWOMAN OLSON: 20 This was So moved. Moved by Justice Greiman. Second. All those in favor say aye. 21 (Ayes heard.) 22 CHAIRWOMAN OLSON: 23 (No response.) 24 CHAIRWOMAN OLSON: Opposed, like sign. The motion passes. PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 10 1 MR. MORADO: Finally for final orders, we 2 have one, HFSRB 16-06. 3 Incorporated, also known as Permit No. 13-067. 4 5 CHAIRWOMAN OLSON: May I have a motion to approve this final order. 6 MEMBER JOHNSON: 7 CHAIRWOMAN OLSON: 8 MEMBER GALASSIE: 9 CHAIRWOMAN OLSON: 10 That's for Luther Oaks, So moved. And a second, please. Second. All those in favor say aye. 11 (Ayes heard.) 12 CHAIRWOMAN OLSON: 13 (No response.) 14 CHAIRWOMAN OLSON: 15 MR. MORADO: Opposed, like sign. The motion passes. And I have one more for 16 referral because -- you can do all these in 17 one motion. 18 I'm asking for referrals to legal counsel 19 for Permit No. 13-067, Exemption No. E-023, 20 Exemption No. E-007-13, and Exemption E-016-14. 21 22 CHAIRWOMAN OLSON: May I have a motion to approve these referrals to legal counsel. 23 MEMBER MC GLASSON: 24 MEMBER GREIMAN: So moved. Second. PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 11 1 CHAIRWOMAN OLSON: 2 All those in favor say aye. 3 (Ayes heard.) 4 CHAIRWOMAN OLSON: 5 I'm sorry. (No response.) 7 CHAIRWOMAN OLSON: 8 Okay. 10 11 Motion passes. The next order of business is approval of the agenda. May I have a motion to approve the June 21st, 2016, agenda. 12 MEMBER GALASSIE: 13 CHAIRWOMAN OLSON: 14 MEMBER SEWELL: 15 CHAIRWOMAN OLSON: 16 The motion passes -- Anybody opposed? 6 9 And a second. So moved. And a second. Second. All those in favor say aye. 17 (Ayes heard.) 18 CHAIRWOMAN OLSON: 19 (No response.) 20 CHAIRWOMAN OLSON: 21 May I have a motion to approve the 22 Opposed? The motion passes. transcripts of the May 10th, 2016, meeting. 23 MEMBER GALASSIE: 24 CHAIRWOMAN OLSON: So moved. And a second, please. PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 12 1 MEMBER SEWELL: 2 CHAIRWOMAN OLSON: 3 Second. say aye. 4 (Ayes heard.) 5 CHAIRWOMAN OLSON: 6 (No response.) 7 CHAIRWOMAN OLSON: 8 All those in favor Opposed? The motion passes. - - - 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 13 1 2 CHAIRWOMAN OLSON: The next order of business is public participation. 3 Jeannie. 4 MS. MITCHELL: You will be called up in 5 groups of five. 6 order in which you are called. 7 up, please go to the table on your left, our right. 8 9 10 11 You do not have to speak in the When you are called The first five, first is Aaron Shepley for Transformative Health in McHenry. Second is Edward Goldberg, also for Transformative Health in McHenry. Next is Phil Schaefer for Southern Illinois 12 Gastrointestinal Endoscopy Center. 13 project is Bart Millstead and Fred Hall. 14 Also for that Since you're not all speaking on the same 15 project, please indicate which project you are 16 speaking on. 17 CHAIRWOMAN OLSON: And, George, I would ask 18 that you tell me in your loud voice when their 19 two minutes are up. 20 MR. ROATE: 21 MR. CONSTANTINO: 22 23 24 Yes, ma'am. Would you all please sign in. MS. MITCHELL: As Mike said, please remember to sign in. PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 14 MR. CONSTANTINO: 1 And if you have written 2 documents, if you could provide me with your written 3 comments for the court reporter. 4 THE COURT REPORTER: 5 CHAIRWOMAN OLSON: 6 Thank you. Mr. Shepley, you can proceed. 7 MR. SHEPLEY: 8 Good morning, ladies and gentlemen of the 9 Board. Thank you very much. My name is Aaron Shepley. I am here on 10 Project No. 15-44, the request from Transformative 11 Health of McHenry for a CON to create an acute 12 care -- or a postacute care facility in McHenry. 13 I am the general counsel and president of 14 insurance services for Centegra Health System, and 15 we're here today for two reasons: 16 I wish to express our unequivocal -- Centegra's 17 unequivocal -- I can't get it out -- unequivocal 18 support for this project. 19 access to care for members of our community. 20 going to help us to continue to keep people close to 21 home. 22 Number one, It's going to enhance It's It will not diminish Centegra Health 23 Systems' long-standing relationship with other 24 long-term care providers in the area and -- you PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 15 1 know, for example, in calendar year 2014 alone, we 2 had 750 of our patients who were required to get 3 postacute care services outside of McHenry County, 4 so this will help to eliminate that issue. 5 Number two and more importantly, I want to 6 make sure that members have a full understanding of 7 what Centegra's role in this project is and is not. 8 I want to make clear that, while we have unequivocal 9 support for this project, this is not Centegra's 10 11 project. Centegra has no ownership or other financial 12 interest in any Applicant, there is no mortgage or 13 loan being given by Centegra for any Applicant, 14 there is no sale of the property that's -- on which 15 this project is proposed to be located. 16 The only relationship that we have to this 17 project, other than its siting on our campus, is 18 that we will have a long-term land lease that will 19 involve nominal annual payments to Centegra. 20 is no other financial connection whatsoever to this 21 project by Centegra Health. 22 MR. ROATE: 23 CHAIRWOMAN OLSON: 24 MR. SHEPLEY: There Two minutes. Thank you. We hope you will support it. PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 16 1 Thank you. 2 CHAIRWOMAN OLSON: 3 MS. MITCHELL: Mr. Goldberg, you can go 5 MR. GOLDBERG: Thank you. 6 Good morning, Madam Chairman and respected 4 Thank you. next. 7 members of the Board. 8 opportunity to speak before you today in support of 9 Transformative Health of McHenry. 10 Thank you for allowing me the My name is Edward M. Goldberg, and I was a 11 hospital administrator for 38 years. 12 president of the St. Alexius Medical Center in 13 Hoffman Estates for 18 years, from July 19th, 1994, 14 until November 2nd, 2012. 15 diagnosed with incurable large B-cell lymphoma. 16 I am here today to encourage you to vote in favor of 17 Project No. 15-044. 18 I was the I retired due to being I've known the managers and owners of this 19 project since early 2008 when they approached me to 20 receive my input in developing a new project and 21 have required -- and they subsequently appointed me 22 to be a member of their community advisory board in 23 late 2008. 24 Claremont of Hanover Park, opened in 2010. This transitional care facility, the PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 17 1 Having an incurable disease, I have to face 2 the reality of seeking out a facility where my 3 cancer causes me to require skilled nursing 4 facilities. 5 31 miles from St. Alexius Medical Center and 6 35 miles from the Claremont, I want to be at a 7 facility that allows me to be transferred to 8 St. Alexius where all of my physicians practice. Although I live in Deerfield, Illinois, 9 To provide for some perspective, there are 10 118 nursing skilled facilities within a 30-minute 11 drive of St. Alexius Medical Center. 12 necessary, I will choose to go to the Claremont 13 because of the consistent positive feedback I heard 14 from patients who utilized the facility and then 15 returned to my hospital, St. Alexius. 16 comments focused on tangibles, such as cleanliness 17 of the facility, decor, homelike amenities, 18 friendliness of staff, and competencies of the 19 medical, nursing, and therapy teams. When Their 20 I also took notice of their intangible 21 comments that focused on the holistic healing 22 environment for which the Claremont is known. 23 During a recent tour of the Claremont, the facility 24 looked exactly the same as when it opened. PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 18 1 I strongly encourage the Board to approve -- 2 MR. ROATE: 3 MR. GOLDBERG: 4 CHAIRWOMAN OLSON: 5 6 Two minutes. Thank you. You can finish your sentence. MR. GOLDBERG: -- the Transformative Health 7 Care of McHenry project. It is patterned after the 8 Claremont and, as such, represents the future of 9 health care. 10 Thank you very much. 11 CHAIRWOMAN OLSON: 12 Next, please. 13 MR. SCHAEFER: 14 CHAIRWOMAN OLSON: 15 Thank you. Good morning. And be sure you tell us your project so -- 16 MR. SCHAEFER: 17 Southern Illinois Gastrointestinal Endoscopy 18 19 Yes. Center, Project 15-061. Good morning. My name is Philip Schaefer. 20 I'm the vice president and administrator for 21 Southern Illinois Healthcare. 22 three-hospital system headquartered in Carbondale, 23 Illinois. 24 We're a I'm here to express opposition to this PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 19 1 project and specifically to refute some of the 2 claims made by the Applicant's attorney in 3 communications during the project review. 4 The Applicant claims he needs to establish 5 his own ASTC in order to retain his patients because 6 SIH's employed physicians are penalized for 7 referring SIH physicians [sic] to him for 8 gastrointestinal services. 9 I personally know of many referrals to That's not the case and 10 Dr. Makhdoom's clinic from SIH physicians, including 11 since he resigned from our medical staffs. 12 Each employed physician's contract with us 13 states that patients may be referred to physicians 14 outside of SIH by any patient's request, and no 15 physicians are penalized in any such way for making 16 referrals. 17 While the Applicant's attorney claims that 18 Dr. Makhdoom treats all patients regardless of their 19 ability to pay through the offer of free screenings 20 and reduced cost-assist programs, these programs 21 provide very little benefit to the residents of 22 southern Illinois. 23 24 For example, his offer of 5 free colonoscopies a month to patients of a local health PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 20 1 center provides a grand total of 60 screenings 2 a year out of the 15,000 total colonoscopies that 3 patients receive who reside in our area. 4 Those patients who do not have insurance and 5 are not lucky enough to be one of the 60 must pay a 6 $1500 fee if they qualify for his free colonoscopy 7 assistance program. 8 his patients received this discounted rate. Last year only 10 percent of 9 In her April 7th letter to the Board, the 10 Applicant's attorney projects 5 percent Medicaid 11 revenue and no charity care for the proposed 12 facility while the existing ASTCs in the area have 13 reported 19 percent Medicaid. 14 our area residents are Medicaid recipients, the 15 Applicant will provide very little care to our most 16 vulnerable population. Since 28 percent of 17 Given the proposed payer mix for this 18 facility, the Applicant's assertion that the program 19 is designed to improve colorectal cancer screening 20 rates in southern Illinois targeting uninsured and 21 underinsured is a gross exaggeration. 22 Finally, unlike the Applicant, SIH and the 23 SIH Medical Group provide care to all patients 24 regardless of their ability to pay. We turn away no PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 21 1 one because of inability to pay. 2 providers for patients who not only need 3 screening -- 4 MR. ROATE: 5 CHAIRWOMAN OLSON: 6 MR. SCHAEFER: We are safety net Two minutes. Please conclude. -- who need screening 7 procedures but also complex medical treatments of 8 gastrointestinal abnormalities or complications. Thank you. 9 10 CHAIRWOMAN OLSON: Thank you. 11 Do you want to pass the mic? Make sure you 12 get that close to your mouth so we can hear real 13 well. 14 15 16 MR. MILLSTEAD: Hello. I'm with the same project. Good morning. My name is Bart Millstead. 17 I'm the administrator of Memorial Hospital of 18 Carbondale, and I would like to express my 19 opposition to the Southern Illinois Gastrointestinal 20 Endoscopy Center project and comment on some of the 21 claims that were made in the materials provided for 22 this project. 23 24 First, Dr. Makhdoom resigned from the medical staffs at both Memorial Hospital at PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 22 1 Carbondale and our sister hospital, St. Joseph's 2 Memorial Hospital in Murphysboro, in 2015 when he 3 elected not to fulfill the medical staff bylaws 4 requirement that physicians who perform procedures 5 in those hospitals must take emergency room and 6 after-hours call. 7 In her May 16th letter to the Board, the 8 Applicant's attorney stated that our hospitals would 9 not allow him to see his own patients during call 10 coverage and that he was not allowed follow-up on 11 emergency patients he saw during his call period. 12 These assertions are completely untrue. 13 Like every other physician on our medical staff, as 14 long as he has privileges, he has the ability to see 15 his own patients and to follow up with those 16 patients during such call coverage times. 17 Secondly, the assertions that the project 18 will not adversely impact any of the other health 19 care providers in our area is also untrue. 20 Dr. Makhdoom's resignation from our facilities' 21 medical staffs and the relocation of his endoscopy 22 caseload to his own practice has already had a 23 significant impact on our facilities at SIH. 24 Lastly, as health care professionals, we're PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 23 1 most concerned about the Applicant's apparent 2 disregard for patient safety. 3 not have and has not requested a transfer agreement 4 with a hospital within 15 minutes of travel time of 5 his facility, which is required for ASTC licensure. 6 The Applicant does His attorney stated in an April 7th letter 7 to the State Board that the solution to the 8 inevitable emergency is to simply call 911 and have 9 the patient taken to the nearest emergency room. 10 Dr. Makhdoom apparently intends to abandon patients 11 in an emergency situation and not be part of the 12 continuum of care. 13 Thank you. 14 CHAIRWOMAN OLSON: 15 Next. 16 MR. HALL: 17 project, 15-061. 18 Thank you. Good morning. Good morning. I'm on the same My name is Fred Hall, and I'm 19 perioperative services manager at St. Joseph's 20 Memorial Hospital in Murphysboro. 21 present testimony in opposition to the application 22 submitted for the Southern Illinois Gastrointestinal 23 Endoscopy Center. 24 I'm here to I worked alongside the Applicant, PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 24 1 Dr. Makhdoom, for many years as both a nurse and a 2 manager until he resigned his hospital privileges in 3 2015. 4 the Board during project review, she claimed that he 5 resigned from SIH hospital staffs because he became 6 concerned he would lose block time. 7 that he had block time at two of our hospitals with 8 regular block time at St. Joseph's four days a week 9 for eight hours each day. In a letter that Dr. Makhdoom's attorney sent The reality is To further accommodate his endoscopy volume, 10 11 St. Joseph's recently added two additional GI 12 procedure rooms. 13 began to greatly reduce his surgical caseload at 14 St. Joseph's and scheduled most of his patients at 15 his office-based practice. 16 did bring to the hospital were almost entirely 17 Medicaid or uninsured. During construction Dr. Makhdoom Those patients that he Prior to his resignation, his block time was 18 19 never reduced or reallocated. 20 available to him regardless of whether he used it 21 or not. 22 It remained open and The new rooms were completed shortly before 23 his resignation, and since his resignation the 24 GI procedure rooms at St. Joseph's operate PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 25 1 significantly below target utilization. 2 Dr. Makhdoom's attorney to claim that the other 3 hospitals have limited scheduling slots and cannot 4 accommodate the volume that he can perform is 5 untrue. 6 For The statement that his facility will not 7 impact other providers or health care facilities is 8 also untrue, as his office-based facility has 9 already had a very negative impact on my hospital, 10 which will only increase if you approve the proposed 11 project. 12 13 Thank you for allowing me the time to address my concerns today. 14 CHAIRWOMAN OLSON: 15 Jeannie. 16 MS. MITCHELL: 17 18 Thank you. The next five, please come up when called. First is for Southern Illinois 19 Gastrointestinal Endoscopy Center, Project 20 No. 15-061, Joe Ann Troue. 21 Carole Klaine. 22 Gastrointestinal Endoscopy Center project, 23 Cathy Blythe. 24 For that same project, Again for the Southern Illinois And for Northbrook Behavioral Hospital, PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 26 1 Project No. 16-011, Tina Cooper and Reverend 2 Tom Beckstrom. 3 Please do not forget to sign in. 4 CHAIRWOMAN OLSON: You don't have to sign in 5 before you speak; just make sure you sign in before 6 you leave the table. 7 start. So whoever is ready can please 8 Somebody please start. 9 MS. BLYTHE: 10 11 Hi. This is for Project 15-061, Southern Illinois Gastrointestinal Endoscopy Center. Good morning. My name is Cathy Blythe, and 12 I'm the system planning manager for Southern 13 Illinois Healthcare in Carbondale. 14 testimony in opposition to the Southern Illinois 15 Gastrointestinal Endoscopy Center project. I'm presenting 16 As the staff report documents, the proposed 17 ASTC is not necessary to improve access for health 18 care services, it will result in an unnecessary 19 duplication of services, and it will have a negative 20 impact on other ASTCs and hospitals in the area that 21 currently provide endoscopy services. 22 Of the nine licensed facilities providing 23 endoscopy procedures in the target market area, five 24 are operating significantly below target utilization PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 27 1 levels. Physicians Surgery Center -- which is 2 identified as Carbondale Clinic ASTC in the staff 3 report located just minutes away from the 4 Applicant's office which is the proposed site of the 5 ASTC -- has a procedure room that is currently 6 operating at 25 percent capacity as well as 7 two operating rooms that are operating below the 8 target occupancy level. 9 Additionally, hospital profiles for 2015 10 document that St. Joseph's Memorial Hospital in 11 Murphysboro, which is only seven minutes away from 12 the proposed site, experienced 27 percent occupancy 13 in its GI procedure rooms in 2015. State Board rules permit only endoscopic 14 15 procedures performed at a licensed health care 16 facility to be used to justify the approval of a new 17 ASTC. 18 historic volume to justify the establishment of a 19 new ASTC. The application does not present a sufficient 20 Additionally, the projected number of cases 21 to be performed in the facility, based on historic 22 procedures, will not justify the two procedure rooms 23 requested. 24 only performed 462 procedures in a licensed health During the last two years, the Applicant PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 28 1 care facility. 2 in his office, which the CON rules do not accept as 3 justification for the need to establish an 4 additional facility. I respectfully ask the Board to take these 5 6 The remaining were done -- performed facts into account when considering the application. 7 Thank you. 8 CHAIRWOMAN OLSON: 9 Next. MS. COOPER: 10 Hello. Thank you. I am Tina Cooper, the 11 director of resident services at Brookdale 12 Northbrook retirement community, and I am here to 13 speak on behalf of Project 16-011. 14 testify today since my written letter of support was 15 not previously considered by the Board. I am here to 16 For the 12 years that I have been the 17 director of resident services in Northbrook, it has 18 always been a struggle to obtain both inpatient and 19 outpatient senior psychiatric care, specific for 20 seniors. 21 an appropriate bed available for the senior mental 22 health. 23 24 Often there are no beds available or not The behavioral health unit in Des Plaines is small and most commonly full. That is our nearest PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 29 1 facility. 2 are not often nearby. 3 far away as Hoffman Estates and Christ Hospital in 4 Oak Lawn to receive treatment. 5 When available beds are available, they I've had residents sent as Continuity of care suffers when the care 6 team, family, and local current physicians are not 7 able to participate in care due to the senior being 8 removed from their area. 9 A recent example of many situations I have 10 seen -- I will call this person Marsha. She was 11 74 years old and had three admissions to psychiatric 12 facilities in less than two years. 13 to Evanston, Lutheran Geneva, and the last time 14 admitted to Christ Hospital because no beds were 15 available in the area. She was admitted 16 Marsha had no family and her support system 17 was not able to follow her progress well at Christ 18 Hospital. 19 available to take them that far to her, and she was 20 forced to wear donated clothing while there, which 21 further crushed her spirit. 22 me once while I spoke to her on the phone, "I look 23 like a homeless beggar." 24 She had no clothes there, no one She tearfully said to Marsha had three different psychiatric care PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 30 1 teams in less than two years, causing poor 2 continuity of care, and varying medications which 3 were changed by each new care team. 4 ever resulted. No good plan It did, however, result -- 5 MR. ROATE: 6 MS. COOPER: Two minutes. -- in her being admitted to 7 assisted living and then a locked-down memory care 8 facility with dementia patients -CHAIRWOMAN OLSON: 9 10 your remarks. MS. COOPER: 11 12 I need you to conclude -- where she, sadly, remains today. 13 CHAIRWOMAN OLSON: 14 MS. COOPER: 15 REVEREND BECKSTROM: Thank you. Thank you. Good morning. My name 16 is Tom Beckstrom. 17 Northbrook Evangelical Covenant Church, and I'm here 18 in support of the Northbrook Behavioral Hospital, 19 Project No. 16-011. 20 I'm the lead pastor at the We are a relatively small congregation. 21 I've been in Northbrook for six years. Whenever we 22 see a need, we try to meet that need. 23 surprised at the number of times our church has been 24 involved in the care of people with behavioral I have been PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 31 1 health issues. 2 There have been six teens or preteens and 3 three young adults that have been related to our 4 church in these six years. 5 I received a text saying, "Good-bye. 6 I love her." 7 were racing to her location where we were able to 8 talk her to safety. 9 One experience, Tell my mom My wife and I, while calling for help, We took her out to dinner, so calmly as we 10 talked, I said, "You realize I have to take you now 11 to the hospital." 12 13 14 She said, "Thank you. I don't have the strength to go there by myself." My wife and I sat with her half the night in 15 the ER as we waited for a room, and for the next 16 two days she sat in what is called a safe room from 17 the operat- -- or from the emergency room until she 18 was able to be transferred to a facility where they 19 found a room for her. 20 I've also been called in by parents with 21 kids who have been cutting themselves, harming 22 themselves, abusing drugs, or attempting to take 23 their lives in other ways. 24 have ended up in the emergency room and then wait In all these cases we PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 32 1 for a space where they could accommodate them. 2 time it was a horrific scene of a child setting 3 himself on fire. 4 One If our church of only 150 people has had 5 9 people in nine years that we have been in contact 6 with, I can verify there is a need in the North 7 Shore and we would welcome it in Northbrook. 8 9 I also believe in miracles. And one is you put a microphone in front of a pastor and say 10 "You've got two minutes," and I've said everything 11 I needed to say. 12 Thank you for listening. 13 MR. ROATE: 14 CHAIRWOMAN OLSON: 15 Next. 16 MS. KLAINE: Two minutes. Hi. It's a miracle. My name is Carol Klaine, 17 and I am a patient of Dr. Makhdoom, and I am here on 18 behalf of his application for an endoscopy center in 19 Jackson County, Illinois. 20 I can sum up my relationship with 21 Dr. Makhdoom and -- he saved my life and it is a 22 privilege to be here and speak with you on his 23 behalf today. 24 I grew up in Jackson County, and I know that PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 33 1 it is a very poor county. And, actually, it's the 2 poorest county in the state of Illinois. 3 that he serves many people that are underinsured or 4 have no insurance at all and his generosity to each 5 one of those patients in caring for them. I know The project will support early diagnosis and 6 7 treatment for colon cancer and allow Dr. Makhdoom to 8 continue to provide the type of excellent care that 9 I received from him. I can say that for myself. Jackson County has a population of over 10 11 60,000 with a median income of $33,000. 12 members of our community are either uninsured or 13 underinsured -- for example, they have insurance and 14 high deductibles -- and I know him to be one to 15 allow people to come in whether they have insurance 16 or not. 17 Many He's a kind man and has shown the community 18 and demonstrated many times how much he supports 19 southern Illinois and the constituents that live in 20 that area. 21 project. I urge you today to vote yes on this 22 Thank you for your time. 23 CHAIRWOMAN OLSON: 24 Next. Thank you. PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 34 MS. TROUE: 1 Good morning. My name is 2 Joe Ann Troue, and I am a patient of Dr. Makhdoom's. 3 I have been for about 15 years. I have Crohn's disease; I've had it for 4 5 45 years. And he has taken care of me. I have his 6 cell phone, if you can imagine, and he -- he has 7 taken care of me. 8 was in the middle of dinner, whatever. 9 caring person. I mean, no matter what, when he He's a very He is -- he wants to care for the 10 patient. That's his main objective, is to get the 11 patient the help that they need. He takes care of my whole family, and 12 13 it's -- he's -- I'm just here in his behalf for 14 Project 15-061. 15 And that's all I have to say. 16 CHAIRWOMAN OLSON: 17 Next, Jeannie. 18 MS. MITCHELL: Thank you. The next five are all 19 speaking on Project 16-011, Northbrook Behavioral 20 Hospital, and they are Nancy Brown, Dr. Shiraz Butt, 21 Anthony Bunin, Dr. Joe Troiani, and Dr. David Bawden. Please sign in. 22 You do not have to sign in 23 before you begin speaking, just before you leave the 24 table. And if you have written comments, please PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 35 1 hand them to Mr. Constantino. 2 You can begin speaking. 3 CHAIRWOMAN OLSON: Please begin. 4 have to sign in before you begin. 5 grab a mic and let's go. 6 Thank you. 7 DR. BUTT: Good morning. 8 Shiraz Butt. 9 in the area for over 15 years. You don't Just somebody My name is I'm a psychiatrist and I'm practicing I'm speaking in 10 support of the project, the Northbrook Behavioral 11 Hospital. 12 And what I've come across is a severe 13 shortage of services in the area. 14 examples of patients and their families not being 15 able to access severely needed mental health 16 services. 17 emergency rooms because they were not able to find 18 psychiatric beds. 19 I've come across I have seen patients languish in And I know on paper sometimes you see there 20 are a lot of psychiatric beds, but what these 21 patients' needs are -- what these patients need are 22 specialized services, and many times community 23 hospitals are not able to meet their needs, so -- 24 I'll give you a recent example of a 16-year-old PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 36 1 autistic boy who had to wait two days in the 2 emergency room. 3 aggression, was hitting himself, engaged in severe 4 property destruction. 5 not able to find a bed for this child, and so they 6 had to let the family go back home after medicating 7 the child. And the emergency room was Now, these are patients who are at risk of 8 9 He had presented with severe harm to themselves and others. We're talking about 10 suicidal patients, patients with addictions who need 11 detox. 12 for them, we are not only placing themselves -- them 13 at risk but also society at large. 14 numerous colleagues who have brought this to my 15 attention, and I keep getting calls from them 16 because they're not able to find psychiatric beds 17 for their patients. 18 And by not being able to provide services I also have We also have a shortage in terms of 19 continuity of care issues. So once the patient's 20 discharged from the hospital, we're not able to find 21 services close their home, and, as such, the 22 families have to travel 50, 60 miles to either go to 23 see a psychiatrist or go for other, less-intense 24 services like intensive outpatient programs or PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 37 1 2 3 larger hospital programs. Also, we have seen that there is an overall increase in the -- 4 MR. ROATE: 5 DR. BUTT: 6 Two minutes. -- increase in the prevalence of mental disorders locally and nationally. 7 CHAIRWOMAN OLSON: 8 Next. 9 MS. NANCY BROWN: 10 11 12 13 Thank you. Hello. My name is Nancy Brown. CHAIRWOMAN OLSON: You're going to need to pull that much closer. MS. NANCY BROWN: Hello. My name is 14 Nancy Brown, and I'm the president of Meier Clinics 15 Foundation, the business management services 16 division of Meier Clinics. 17 the Northbrook Behavioral health hospital in 16-011. 18 I am here in support of Meier Clinics has provided mental health 19 care services in Illinois for 30 years in Wheaton, 20 Northbrook, Geneva, and Chicago. 21 approximately 2400 outpatient sessions per month. 22 We provide I am here representing Meier Clinics and 23 Dr. Gary Casaccio, our medical director. He is very 24 supportive of HealthVest's request for approval of a PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 38 1 behavioral health hospital in Northbrook. 2 letter that Dr. Casaccio has signed. 3 was not previously recognized when letters of 4 support were sent. 5 I have a This letter Some of Dr. Casaccio's letter includes the 6 following information: 7 patients to experience frequent delays in accessing 8 inpatient care, often -- inpatient psychiatric 9 care -- often due to bed shortages or lack of 10 11 "It is not unusual for our services." US HealthVest is also known as a hospital 12 who uniquely offers specific hospital-unit programs 13 such as one specifically designed for military 14 members who are struggling with posttraumatic stress 15 syndrome or other emotional issues, a women's 16 program specifically designed for women who have had 17 trauma in their background, and a faith-based 18 program for those who want to work on their physical 19 and emotional aspects of care along with their 20 spirituality. 21 Our staff solicited feedback from several of 22 our medical and clinical staff. Together we 23 reported that we have referred approximately 24 66 people to inpatient care over the last 12 months. PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 39 1 This is not reflective of the total number we have 2 referred, as we have over 50 clinical staff in 3 Illinois, so the above is a very conservative 4 figure. 5 over a 24-month period after the project is 6 completed would conservatively be 122 people. 7 8 9 10 11 The estimated number of patient referrals I encourage you to support the approval of US HealthVest's application -MR. ROATE: Two minutes. MS. NANCY BROWN: -- and are in complete support of it. 12 Thank you very much. 13 CHAIRWOMAN OLSON: 14 DR. BUNIN: Yes. Thank you. Hello. My name is 15 Anthony Bunin. 16 the Chicagoland area for the last 15 years, 17 providing services to -- care of psychiatric 18 patients in the area and wanted to offer my support 19 for Project 16-011. 20 I'm a psychologist in practice in My sentiments echo many of the sentiments of 21 the other individuals. It turns out the lack of 22 access for inpatient psychiatric beds and 23 specialized -- the care of this particular 24 population, which is a very specific population, PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 40 1 differentiated from other traditional psychiatric 2 populations. 3 There's a significant lack of available 4 beds, as other individuals have mentioned, 5 oftentimes because individuals have to travel one to 6 two hours to find placement at a facility and 7 oftentimes now are using the emergency room as a 8 conduit to provide psychiatric services for this 9 population. 10 As such, there's a real lack of appropriate 11 services, yet a need for access in the local 12 communities for this very needy population, which is 13 demographically the largest growing population of 14 this -- certainly, the segment of the population 15 that's growing substantially. 16 Just in terms of general information, 17 there's been an 800 percent increase over the last 18 10 years in the use of emergency rooms for general 19 psych crises nationally due to a lack of specific 20 inpatient beds for this population, so the need for 21 specialized programming, for the understanding of 22 the comorbid medical conditions that many of these 23 elderly individuals present, it is -- is a desperate 24 need of the community currently and would be PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 41 1 serviced well through the support of this project. 2 CHAIRWOMAN OLSON: 3 DR. TROIANI: Next. I'm Dr. Joe Troiani. I am 4 director of behavioral health programs for Will 5 County health department. 6 Grundy County LAN. 7 community behavioral health providers in Grundy and 8 Will County who have been meeting monthly since 9 June of 1993. 10 I also chair the Will and It's a collaboration of I can't emphasize the critical shortage of 11 psychiatric beds in the area. 12 two crisis programs, and there have been weekends, 13 for example, where the closest psychiatric bed for 14 an adolescent was Champaign, Illinois, which is 15 almost four hours away from us. 16 from the closure of psychiatric beds, dramatic 17 downsizing since 1992. 18 of State psychiatric hospitals, Tinley Park. 19 other psychiatric hospitals have also seen a 20 downsizing of beds and, of course, with the current 21 fiscal crisis, the downsizing in capability. 22 We maintain This has resulted We've also had the closure The What we don't want is the default mental 23 health system to be the prisons. In Joliet they're 24 going to be opening up the Joliet Mental Health PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 42 1 Center, which is Illinois Department of Corrections. 2 It will be a complete mental health facility. 3 don't need the emergency rooms and the prisons to be 4 the default service providers. 5 We And in my other hat I'm a retired commander 6 of the United States Navy, having served 7 32 1/2 years. 8 of psychiatric beds for those who have served or 9 even those who are serving as well as their I'm critically aware of the shortage 10 families. Yes, we have Great Lakes; yes, we have 11 the VA center; but the ability to access services is 12 quite a challenge because of the large number of 13 people seeking services, so the availability of 14 psych beds and specialty programs such as we have in 15 Chicago Behavioral health hospital is of critical 16 importance. 17 Thank you. 18 CHAIRWOMAN OLSON: 19 DR. BAWDEN: Thank you. I'm Dr. David Bawden. 20 psychiatrist. 21 the Chicago area, currently specializing in 22 geropsychiatry. 23 24 I'm a I've been in practice 40 years in I think personally, if we asked everyone in the room, "Have you had someone -- a parent, uncle, PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 43 1 aunt -- who has had psychiatric problems, 2 geropsychiatric problems?" most of us would raise 3 our hands. 4 with it. 5 We've all had personal experience It's difficult to get enough beds. Even 6 last night -- I have availability of 50 beds around 7 the area. 8 in any of my beds. 9 18-bed geropsychiatric unit at Chicago Behavioral 10 11 I could not get a geropsychiatric patient About a year ago I started the Hospital, who are full most of the time. I go to several nursing homes. There are 12 always requests for admissions of patients with 13 behavioral disturbances. 14 demographics are very compelling. 15 going to become a larger and larger need as time 16 goes on. 17 I think that the This is only And, you know, it's -- first of all, you get 18 your AARP card and you realize you're moving in that 19 direction. 20 know you're really moving in that direction. 21 Then you get on social security and you So, personally, we're all going to need 22 these kind of services at some point, and it's our 23 opportunity to try and build them out not only for 24 our families but for ourselves. PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 44 1 Thank you very much. 2 CHAIRWOMAN OLSON: 3 Next, please. 4 MS. MITCHELL: Thank you. The next five will also be 5 speaking on Project 16-011, Northbrook Behavioral 6 Hospital. 7 8 9 10 Dr. Thodur Ranganathan, Kasia Wereszczynska, Alfa Murphy, Dr. Edgar Ramos, and Dr. Tony DeJoseph. Please do not forget to sign in. have to sign in before you begin speaking. 11 CHAIRWOMAN OLSON: 12 Did you call five? 13 MS. MITCHELL: 14 CHAIRWOMAN OLSON: 15 DR. DE JOSEPH: 16 procedure. He couldn't make it. 18 MS. MITCHELL: 19 CHAIRWOMAN OLSON: 20 DR. DE JOSEPH: 23 24 Last chance. Dr. Ramos had a medical CHAIRWOMAN OLSON: 22 Who are we missing? I did. 17 21 You do not Okay. Thank you. Thank you. Please go ahead. I'm Tony DeJoseph. I'm the CEO of Chicago Behavioral Hospital and -THE COURT REPORTER: Can you speak closer? I can't hear you. DR. DE JOSEPH: Tony DeJoseph, CEO of PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 45 1 Chicago Behavioral Hospital here in support of 2 Northbrook Behavioral Hospital. I want to talk about the environment right 3 4 now for psychiatric care in Illinois. We're looking 5 at cuts to a wide variety of outpatient and 6 residential providers. 7 infrastructure of community-based services decreases 8 the need for inpatient beds, but we should be 9 realists and realize we're not going in that We know that a strong 10 direction; instead, the cuts to services that we've 11 seen in Illinois are contributing to a trend of 12 increasing inpatient need. With the recent reductions in State-operated 13 14 facilities, coupled with the effects of the 15 Affordable Care Act and the advent of the new 16 Medicaid MCOs shifting the population to more 17 private sector providers, we're seeing a rise in 18 need. 19 closed 1481 inpatient psych beds in Illinois. 20 current trend in need for inpatient beds will only 21 continue to increase in this environment. 22 Preceding this, overall since 1991 we've The Lake County in particular has very few 23 options for psychiatric care. There are only two 24 facilities with a total of 75 beds in the entire PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 46 1 county, which is far less beds per thousand 2 residents than adequate. 3 Illinois, local treatment is not available, and 4 individuals from Lake County and the larger northern 5 area of Illinois must travel long distances to 6 receive inpatient psychiatric care. 7 lost beds with unit closures at several facilities 8 in recent years, and there are also no specialty 9 programs. As with many areas of Lake County has 10 Another result of the decrease in 11 psychiatric beds over recent years is the common 12 complaint that emergency departments, law 13 enforcement, jails, and prisons are compensating for 14 the lack of availability of care. 15 Chicago Behavioral Hospital seems to demonstrate the 16 need. 17 year and a half ago to a census that's been well 18 into the hundreds, and we've often hit capacity in 19 the various programs. Our experience at We've gone from a virtually empty hospital a 20 Finally, while there's a clear national 21 trend of increase in the number of individuals 22 needing psychiatric care, the National Alliance on 23 Mental Illness estimates that 60 percent of adults 24 and 50 percent of children -- PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 47 1 MR. ROATE: 2 DR. DE JOSEPH: 3 Two minutes. -- with a serious mental illness are not receiving treatment. 4 CHAIRWOMAN OLSON: 5 Next. 6 MS. MURPHY: Thank you. Good morning. My name is 7 Alfa Murphy, and I'm the practice manager for 8 Associates in Behavioral Science, a psychiatric 9 practice. I should note I've been told that our letter 10 11 of support was not accepted because it was signed by 12 me rather than one of our physicians. 13 in that letter that we would refer approximately -- 14 and this is only a number of the admissions that we 15 have been able to -- for patients that we are unable 16 to treat on our current basis -- 35 patients per 17 month to Northbrook Behavioral Hospital who are from 18 the zip codes in the Northbrook catchment area, for 19 inpatient treatment. We projected We have been providing care to our patients 20 21 for over 27 years. We are well aware of the need 22 for more psychiatric beds and the need for 23 Northbrook Behavioral Hospital in the Lake County 24 area. PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 48 Emergency rooms usually call upon us to 1 2 accept patients for psychiatric care. 3 are just not able to treat these patients as all 4 beds are filled, leaving our patients in these 5 emergency departments waiting for hours and 6 sometimes days until discharges occur of the few 7 available hospitals. As a professional in the mental health 8 9 Many times we field, we ask you to grant Northbrook Behavioral 10 Hospital a CON to operate and provide the care many 11 patients need. 12 urgent. 13 side of many of the social issues we face. 14 here to tell you that mental illness has no 15 boundaries, does not know social status, and it is 16 the cause of many suicides in patients of all ages. 17 Many of these illnesses can be treated rapidly, but 18 we need the resources and we need these hospital 19 beds. The care these patients need is Mental illness is sometimes pushed to the 20 Thank you so much for listening. 21 CHAIRWOMAN OLSON: 22 Next. 23 MS. WERESZCZYNSKA: 24 I am Thank you. Hello. My name is Kasia Wereszczynska, and over the last eight years PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 49 1 I have provided clinical mental health counseling 2 and crisis intervention to a culturally diverse 3 population serving the South Side of Chicago and the 4 North Shore area. 5 in various settings, including the mental health 6 court system within the Cook County Jail, hospital 7 emergency rooms, community mental health agencies, 8 and both inpatient and outpatient psychiatric 9 hospitals. 10 I also have a history of working Throughout this time I have had the vast 11 experience working with many helping professionals, 12 institutions, and agencies. 13 notice, though, is that, despite everything 14 currently in place -- the people, the buildings, the 15 resources, the money -- or lack thereof -- the State 16 of Illinois continually struggles to provide the 17 type of care when and where necessary to our 18 patients. 19 What I have come to As a first responder, I have entered into 20 unspeakable situations where I have only had moments 21 to make an informed decision that may mean the 22 difference between the patient receiving optimal 23 services or those that are anything but. 24 Due to hospitals being over capacity, there PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 50 1 have been many instances where patients with 2 psychosis were forced to wait on a bed for inpatient 3 or those with addictions were unable to get 4 treatment when experiencing severe withdrawal or in 5 need of detox. 6 There are other instances where, upon 7 arrival to the emergency rooms, clerical errors have 8 occurred. 9 dire situations from terrible to worse. 10 This took a toll on patients' already Perhaps even more frustrating was the time 11 when I called over 31 Chicagoland hospitals to place 12 an adolescent child that was suicidal but had to 13 resolve with sending her to the Pavilion in 14 Champaign, which is three hours away. 15 something is not right with this situation. 16 Clearly, I support the Northbrook Behavioral health 17 project. Every patient deserves respect, 18 compassion, integrity, and access to services. 19 such, this fine organization has the people, talent, 20 resources, and so on to provide our patients with 21 just that. 22 where patients -- 23 MR. ROATE: 24 MS. WERESZCZYNSKA: As Furthermore, it adds another location Two minutes. -- in the North Shore PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 51 1 suburbs may be served. 2 Thank you. 3 CHAIRWOMAN OLSON: 4 Next. 5 DR. RANGANATHAN: Thank you. Good morning, everyone. 6 My name is Dr. Ranganathan, Thodur Ranganathan. 7 I've been a practicing psychiatrist for about 8 28 years. I think you've heard a lot of stuff that 9 10 I probably wanted to share. In the interest of 11 time, I'll say this: 12 aspects of what some of the other speakers have 13 shared. I have been involved in many I've been in the system, the community 14 15 system. I worked as a community psychiatrist for 16 almost 24 years, the first 24 years of my career. 17 The last four years, unfortunately, that's been my 18 passion, but there's no more centers, especially in 19 inner cities, south side of Chicago, where I used 20 to get involved significantly. 21 five agencies that gather significant patients and 22 families with illnesses disappeared. About four to 23 Emergency rooms is the other thing. I've 24 developed an emergency psych service of an inner- PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 52 1 city hospital many years ago in conjunction with the 2 State of Illinois to offer some meaningful, 3 compassionate care, make sure the patients don't 4 just wait in the ER. 5 have the expertise for other patients, and they 6 don't want to be bothered with psych emergencies. ER physicians typically don't 7 What I see now is the shortage -- and, 8 again, when you look at numbers -- I kind of briefly 9 looked at some numbers as far as hospitals and beds. 10 My consensus is that there's about 35-, 36,000 total 11 hospital beds in the state of Illinois, 200-plus 12 hospitals. 13 10 percent of psychiatric beds, number one. 14 There's only about -- what? -- not even The other thing is some of the community 15 hospitals that do offer psychiatric beds, I think 16 they're walking away from it typically because they 17 don't want to be managing difficult patients, acute 18 patients for several reasons, which I probably don't 19 have the time to go into. 20 I think -- I've been in a couple of 21 specialty hospitals. I recently joined Chicago 22 Behavioral a few months ago. 23 another freestanding psych hospital, and these are 24 the hospitals, I think, that would be able to offer I've been part of PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 53 1 the specialized care that our population needs, 2 patients with significant mental illnesses. 3 need special things. 4 care; you've heard about the young adults, the child 5 and adolescents, probably other specialty care, the 6 veterans program. 7 absolutely critical and important. 8 9 You've heard about geriatric Women's mental health is I think some of the regular community hospitals probably don't have -- 10 MR. ROATE: 11 DR. RANGANATHAN: Two minutes. -- the resources, and 12 I would appreciate if you would consider the 13 approval. 14 Thank you for the time. 15 CHAIRWOMAN OLSON: 16 Next, Jeannie. 17 MS. MITCHELL: Thank you. The next five will also be 18 speaking on Project No. 16-011, Northbrook 19 Behavioral Hospital. 20 They And they are Nancy Carstedt, Colonel David 21 Sutherland, Donna Wattenberg, Renée Shopp, and 22 Ellen Brown. 23 24 Please don't forget to sign in, but you do not have to sign in before you begin speaking. PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM And DraftFull Meeting Conducted on June 21, 2016 54 1 if you have written comments, if you can please hand 2 them over to Mr. Mike Constantino. 3 MS. CARSTEDT: My name is Nancy Carstedt. 4 I am the executive director of the North Shore -- 5 Cook County North Shore affiliate of the National 6 Alliance on Mental Illness, NAMI. 7 Northbrook is one of the 17 communities in 8 our catchment area, and I'm here this morning to 9 strongly support the proposed 100-bed psychiatric 10 11 hospital in Northbrook. Recently I accompanied my disabled son to 12 the emergency room at Evanston Hospital. 13 were there, there were three security guards keeping 14 watch over three patients who were experiencing 15 acute symptoms of mental illness and were being held 16 in the emergency room pending transfer to a 17 psychiatric facility. 18 over 48 hours, another nearly 36 hours, and the 19 third over 6 hours. 20 on finding an available bed in a psychiatric 21 facility. 22 While we One patient had been there Their transfer was contingent During the time that my son and I were 23 there, the patient who had been there for over 24 48 hours was transferred to a psychiatric facility PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 55 1 in the south suburbs of Chicago, nearly 40 miles 2 away, making support of family members difficult, if 3 not impossible. Almost any day at any time, this is a common 4 5 occurrence in the emergency rooms of the several 6 hospitals in the northern suburbs of Chicago. 7 are simply too few psychiatric beds to meet the need 8 for such beds. There In any given year, one in five adults will 9 10 experience a serious mental health condition, many 11 requiring hospitalization. 12 Hospital would provide a much-needed option for the 13 dozens upon dozens of patients needing immediate 14 psychiatric services that are now being warehoused 15 in local emergency rooms awaiting bed availability. 16 During the past few years, we've seen 17 two psychiatric units in our area in local hospitals 18 close, only exacerbating the problem. Northbrook Behavioral Mental illness is a treatable illness, much 19 20 like cancer or diabetes. As with most illnesses, 21 the more prompt the treatment, the more likely a 22 successful outcome. 23 patient receives no treatment and valuable time is 24 lost. While waiting in ERs, the The voices become louder and more persistent PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 56 1 in the schizophrenic's head. 2 MR. ROATE: Two minutes. 3 MS. CARSTEDT: I urge you to support the 4 Northbrook Behavioral Hospital project as a means of 5 providing quality care in the northern suburbs. 6 Thank you. 7 CHAIRWOMAN OLSON: 8 COLONEL SUTHERLAND: 9 Thank you. My name is retired Army Colonel David Sutherland, and I'm a vocal advocate 10 for veterans and military families across the 11 nation, and I'm here in support of Northbrook 12 Hospital. 13 The needs of our veterans and military 14 families are evolving. 15 And it's happening at a time when the American 16 people are forgetting about the wars, and we cannot 17 allow them to forget about the veterans and military 18 families. 19 They're not disappearing. US HealthVest is changing the narrative 20 that, when it comes to Illinois veterans and their 21 families, specifically they don't have to be 22 isolated to government programs that are not readily 23 available in their communities. 24 this through a culture driven by shared values with HealthVest is doing PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 57 1 those that have served, an understanding of loyalty, 2 respect, personal courage, and honor. 3 I have watched US HealthVest and facilities 4 they've been associated with in communities across 5 the country since 2010 after I returned from 6 commanding 12,000 US service members and 7 45,000 coalition forces in -- during surge 8 operations in Iraq, and I recognize that their 9 outreach and their shared vision is one that will 10 not tolerate another generation of homeless veterans 11 or tolerate the status quo when it comes to the 12 22 veterans a day that are committing suicide, the 13 shortage of services and the fact that Illinois 14 ranks No. 10 of the most populated states for 15 veterans with more than 721,000 veterans living in 16 your communities yet ranks 41st in services as a 17 state, and some of these services include mental 18 health. 19 The shortage in services is caused by an 20 epidemic of disconnection between the military and 21 civil society. 22 of or shortage of services in terms of health care. 23 24 It's an epidemic that drives a lack Tom Young was an Army veteran living in the Chicago area who sought the VA help in dealing with PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 58 1 suicidal thoughts. Tom called the VA hotline -- 2 MR. ROATE: 3 COLONEL SUTHERLAND: 4 Two minutes. -- seeking treatment, and the next day he committed suicide. 5 I urge you to support Northbrook. 6 CHAIRWOMAN OLSON: 7 And thank you for your service. 8 MS. ELLEN BROWN: 9 Ellen Brown. Thank you. Hi. My name is I'm a licensed professional counselor 10 with Mental Health Solutions -- 11 CHAIRWOMAN OLSON: 12 You're going to need to pull that much closer. 13 MS. ELLEN BROWN: Oh. Sorry. 14 We're a therapy and counseling practice in 15 Barrington and Mundelein. 16 today to represent our practice in support of the 17 establishment of Northbrook Behavioral Hospital. 18 I'm here to testify directly to the Board because my 19 letter sent in support of Northbrook Behavioral 20 Hospital was not recognized when the Board reviewed 21 the letters. 22 I'm delighted to be here During my time in practice, I've already had 23 numerous experiences where clients have less than 24 adequate access to mental health resources. I've PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 59 1 had clients in crisis turned away from mental health 2 care due to lack of available resources. 3 clients wait hours in emergency rooms before they 4 could be seen, only to be told there were no 5 psychiatric beds available. 6 I've had Just waiting for hours in an emergency room 7 can be traumatizing to any person, let alone someone 8 suffering from anxiety, depression, or other mental 9 health conditions. The wait time and traumatic 10 experience is compounded by spending time in the 11 general emergency room full of other patients with 12 heart attacks and other serious mental -- medical 13 problems. 14 An emergency room and hospital dedicated to 15 mental health conditions would alleviate many of 16 these issues. 17 clients, and as a counseling community it is 18 extremely frustrating that we cannot provide the 19 optimal care that our clients require and deserve. 20 This is why it's so exciting to hear of the 21 potential opening of the Northbrook Behavioral 22 Hospital. 23 24 It's obviously frustrating for our This would open up so much more access and timely access in an area that is so sorely lacking. PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 60 1 Not only will Northbrook Behavioral Hospital improve 2 and expand upon access for mental health care but 3 they will offer care for a wide spectrum of client 4 types from adolescents to geriatric, women's focus 5 groups, and even military clients. It is my sincere hope that you will consider 6 7 these facts and vote in favor of the establishment 8 of the Northbrook Behavioral Hospital, help the 9 community at large, and our counseling communities 10 in particular will benefit from this. 11 Thank you. 12 CHAIRWOMAN OLSON: 13 Next. 14 MS. SHOPP: Thank you. My name Renée Shopp. I'm a 15 psychiatric nurse and practice manager for Mathers 16 Clinic. 17 the Board. 18 My letter was not previously recognized by Mathers Clinic is a mental health and 19 substance abuse practice in Rockford, Woodstock, 20 Crystal Lake, Elgin, and Fox Lake. 21 psychiatric services also to 15 assisted-living and 22 nursing homes. We provide 23 Our patients have experienced ongoing delays 24 in accessing inpatient psychiatric care, mainly due PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 61 1 to the lack of beds. There have been multiple times 2 when patients have had delayed access to care, and 3 an average admission can take me five to six hours 4 looking for a facility. 5 client who needs a geriatric psychiatric facility, 6 that might take me two to three days. And if I'm looking for a 7 We currently have clients coming from 8 Northbrook, Prospect Heights, Wheeling, Barrington 9 Hills, Fox Lake, Grayslake, Gurnee, Highland Park, 10 Ingleside, Island Lake, Lake Bluff, Libertyville, 11 Mundelein, Vernon Hills, North Chicago, Round Lake, 12 Waukegan, Buffalo Grove, and Zion and Niles. 13 This year our community mental health center 14 closed in McHenry, and Mathers Clinic is now a 15 community mental health center. 16 immediate care service so, instead of waiting two to 17 six months for psychiatric care, clients can receive 18 care the same day. 19 We also opened an In order to continue providing the services, 20 we need a place to refer, and we would really 21 appreciate your consideration of the Northbrook 22 Behavioral Hospital. 23 CHAIRWOMAN OLSON: 24 Next. Thank you. PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 62 1 MS. WATTENBERG: Good morning, Chairwoman 2 and Board members. 3 I am past president of NAMI -- which stands for 4 National Alliance of Mental Illness -- northwest 5 suburban. 6 the affiliate. 7 two years, our helpline, which extends into the 8 northwest area. 9 My name is Donna Wattenberg. My duties have been varied and many with I currently answer, for the last I can, you know, read a list. Just to keep 10 it short, we just celebrated -- NAMI northwest 11 suburban -- our 30th anniversary. 12 well-established community. 13 We are knowledgeable laypeople. 14 educate, and have support groups. 15 We're a We are volunteer based. We advocate, We, being NAMI northwest suburban, our board 16 members, and my fellow community members all support 17 the Northbrook Behavioral Hospital. 18 Please take into consideration that this 19 hospital is well needed. There are consumers of 20 mental health services in our local area that have 21 been refused -- refused, I said -- admittance. 22 Because there's not enough beds. Why? 23 These are cousins, sisters, brothers, 24 mothers, fathers, uncles, aunts, et cetera, people PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 63 1 like you and I being refused because there are no 2 beds available. 3 many family members and loved ones', you know, 4 traveling distance. 5 What's available is out of reach of When the consumers of mental health services 6 come through the ER, they are in need of immediate 7 services. 8 That's why they're in the ER room. 9 10 They are in need of immediate services. MR. ROATE: Two minutes. MS. WATTENBERG: I wish to let you know that 11 our community does need this hospital. 12 kindly for your time. 13 CHAIRWOMAN OLSON: 14 Next, Jeannie. 15 MS. MITCHELL: Thank you Thank you. The next two will be speaking 16 on Project 16-012, Transitional Care of Lake County. 17 Please come up. 18 Aaron Lawlor and John Lobaito. And the next three will be speaking on 19 Project 15-044, Transformative Health of McHenry, 20 and please come up. 21 Bebinger, and Dr. Birinder Marwah. 22 23 24 Michelle Stuercke, Jennifer L. Please sign in. Prior to signing in -- you can begin speaking before you sign in. MR. LAWLOR: Good morning and thank you. PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 64 1 I'm Aaron Lawlor. I'm the chairman of the 2 Lake County Board, and it's my honor to be here to 3 support Project No. 16-012, Transitional Care of 4 Lake County, Mundelein, and its establishment of a 5 new 185-bed long-term care facility because it's in 6 the best interests of the citizens of Lake County. Lake County formerly operated Winchester 7 8 House, which is currently located in Libertyville at 9 1125 North Milwaukee Avenue and is one of the oldest 10 continuously operated facilities in Illinois. In 11 keeping with Lake County's mission, Winchester House 12 provides skilled nursing facility services, 13 intermediate care services, and activities for the 14 physical, mental, social, and recreational needs for 15 the well-being of the elderly citizens of 16 Lake County in a setting that is compassionate, 17 loving, and a place to call home. In order to preserve that mission for years 18 19 to come, the Lake County Board and staff, as well as 20 a special task force comprised of citizens, health 21 care professionals, and board members, evaluated 22 various options to make Winchester House a viable 23 and financially self-sustaining entity in the 24 future. We determined that the best solution for PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 65 1 Winchester House was to transition its operation to 2 a private company. After an exhaustive and detailed selection 3 4 process, the Lake Board chose Transitional Care of 5 Lake County to lease and operate Winchester House 6 with the goal of eventually to replace it with a new 7 facility to provide continuing care to Winchester 8 House's residents, decrease the taxpayers' financial 9 obligations, and cease doing business in the nursing 10 home industry. 11 As a part of the multiyear project, 12 Transitional Care of Lake County applied for and 13 received a new license, continued participating 14 in -- 15 MR. ROATE: 16 MR. LAWLOR: 17 Thank you. 18 CHAIRWOMAN OLSON: 19 Next. 20 MR. LOBAITO: 21 22 Two minutes. We ask for your support. Thank you very much. Good morning, Madam Chairwoman, members of the Board. My name is John Lobaito. I am the Village 23 administrator for the Village of Mundelein, and I am 24 here on behalf of Mayor Lentz and the board of PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 66 1 trustees. I'm here to express the Village of 2 Mundelein's support for the Transitional Care of 3 Lake County, Project 16-012. Mundelein is a community of 32,000 people. 4 5 There are no transitional care or long-term care 6 facilities in the community. 7 concept plan for the facility was presented to the 8 Mundelein Village Board at a public meeting. 9 proposal received overwhelming support from the 10 Village Board. 11 this project. On February 22nd the The There were no negative comments on Since that time Innovative Health has been 12 13 working closely with Mundelein and has invested more 14 than a million dollars in the project to date. 15 We're on track for approving the project by the 16 year's end. It should also be noted that the petition is 17 18 for a new facility but, in reality, it is 19 replacement of beds for the Winchester nursing home 20 located in Libertyville adjacent to Mundelein. The demographics of the area: 21 There are 22 more than 82,000 people in Lake County over the age 23 of 65. 24 of the proposed facility location. There are more than 34,000 within 20 minutes Mundelein alone PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 67 1 2 has nearly 4,000 people over the age of 65. So today I urge the Board's approval of the 3 certificate of need that will ensure that there will 4 be access to quality long-term care services for 5 Mundelein and the surrounding area. 6 Thank you. 7 CHAIRWOMAN OLSON: 8 Next. 9 DR. MARWAH: Thank you. Good morning, Madam Chairman 10 and respected members of the Board. 11 allowing me this opportunity to speak today before 12 you in support of Transformative Health Care of 13 McHenry. 14 My name is Birinder Marwah. Thank you for I'm a physician 15 with board certification and training in internal 16 medicine, geriatrics, palliative medicine, and 17 hospice medicine. 18 experience taking care of geriatric patients in the 19 Chicagoland area. 20 at Advocate Masonic Medical Center. 21 I have more than 30 years of Currently I'm chief of geriatrics I am here to encourage you to vote in favor 22 of Project 15-044. I have known the Applicant for 23 this project for six years and can speak to his 24 ability and experience in developing and operating PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 68 1 transitional care facilities like THM. 2 Good aesthetics, customer service, and 3 state-of-the-art therapy are, of course, very 4 essential ingredients at a skilled nursing facility; 5 however, due to the increasing medical complexity of 6 residents at these facilities, they need diagnostic 7 and therapeutic medical care that is almost at par 8 with what hospitals provide. 9 The Applicant and I have worked closely for 10 four years in the past to develop and then actually 11 implement such a model of care. 12 included mechanisms for comprehensive transfer of 13 relevant clinical data both on admission and 14 discharge of residents to these facilities, 15 immediate availability of various state-of-the-art 16 diagnostic modalities, sophisticated algorithms to 17 monitor for side effects of medications, goal 18 setting to monitor for progress, and access need for 19 change in an ongoing treatment plan, and this is 20 just a partial list of the unique model of care that 21 both of us had run. 22 with him were amongst the most fulfilling time in my 23 professional career. 24 This care model Those four years that I worked I strongly urge the Board to vote in favor PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 69 1 of this innovative project. 2 immensely benefit from this project. 3 Thank you. 4 MR. ROATE: 5 CHAIRWOMAN OLSON: 6 Jeannie. 7 MS. MITCHELL: This community will Two minutes. Thank you. The next five speakers will 8 be speaking on Project 15-044, Transformative Health 9 of McHenry. Please come up. Lynette Rugg, 10 Mark Weldler, Joyce Surdick, Clare Ranalli, and 11 Chool Liyanapatabendi. 12 13 14 CHAIRWOMAN OLSON: Anyone can begin. Thank you. MS. RUGG: Good morning. My name is Lynette 15 Rugg, and I'm the licensed administrator at 16 Crossroads Care Center in Woodstock, Illinois. 17 I am here to voice my opposition to 18 Transformative Care of McHenry's application. 19 opposition is directly related to the concerns that 20 have already been identified by the Board and still 21 have not been answered adequately by the Applicant. 22 My They profess that the services they plan to 23 offer will be above and beyond what is currently 24 being provided in our facility; however, we have an PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 70 1 in-house dialysis center, skilled therapy, including 2 seven-day-a-week coverage, a designated short-term 3 unit with newly renovated rooms, a private dining 4 room area for this unit, both private and 5 semiprivate rooms, and both private and shared 6 bathrooms. 7 The Applicant has also falsely represented 8 the investments that have been made into the 9 physical plant of our facility by using the data 10 from the annual cost reports that does not include 11 the renovations we are currently doing as well as 12 the rooms that have been redone since the last data 13 has been reported. 14 The Applicant has recently provided the 15 Board with statistical data regarding hospital 16 discharge information that would lead you to believe 17 there have been over 700 referrals made throughout 18 our service area that were denied. 19 I can tell you that with respect to our 20 facility that data is incorrect, inaccurate. Over 21 80 percent of our residents have Medicaid as either 22 a primary or secondary payer source. 23 patients. 24 occupancy of 75 percent. We do not deny We still struggle to achieve an average We do not deny patients. PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 71 1 I must stress that our facility has invested 2 a tremendous amount of time and resources into 3 becoming a competitive -- being competitive, 4 being -- becoming competitive in the market to 5 service the short-term population in addition to the 6 already existing long-term care population we have 7 always serviced. 8 heavily on maintaining and even growing a larger 9 short-term census in order to balance out the 10 Our financial viability relies revenue needed to remain financially sound. 11 The proposed facility will divert the 12 cream-of-the-crop residents away from us and 13 imbalance the playing field. 14 MR. ROATE: 15 MS. RUGG: 16 Two minutes. I urge you, as a result of these facts, to deny the Applicant's request. 17 CHAIRWOMAN OLSON: 18 Next. 19 MS. SURDICK: Hi. Thank you. I'm Joyce Surdick and I'm 20 here from Fair Oaks Health Care Center in 21 Crystal Lake in opposition of the Transformative 22 Care project, 15-044. 23 24 To understand the impact this project will have on the Crystal Lake and surrounding area PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 72 1 nursing homes, you have to be aware of all the 2 changes that are occurring in the Medicare program. 3 We are currently participating in the bundled 4 payment program. 5 improve the quality of care, but it also has 6 expectations of much shorter lengths of stay. 7 are many rehab patients in our building for only 8 5 to 10 days. 9 Basically, this program strives to These are not the only hospital bundles, but 10 Fair Oaks is participating in 12 of their own 11 episode bundles which across the board has 12 expectations for shortened length of stays for 13 56 different DRGs. 14 are long over. 15 Advantage programs and private insurance. 16 There The days of 25- to 30-day stays This is also the trend with Medicare If Fair Oaks in our $4.4 million addition 17 with private rooms and showers and the surrounding 18 homes do not get these short-stay patients, we will 19 not have enough patients to keep our buildings 20 running. 21 Hospitals' backing, the intention is to send the 22 great majority of the rehab patients to the 23 Transformative Care facility right on their own 24 property. It is obvious, with the Centegra PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 73 1 We will also be losing potential referrals 2 as the Woodstock Centegra moves the majority of 3 their operation to their new Huntley facility, which 4 already has a brand-new Alden skilled nursing 5 facility in the works. 6 To address the statistics from the Board 7 staff -- the Board report for the predicted need for 8 nursing home beds in McHenry County, it is 9 imperative to realize that the private-pay nursing 10 home patients of 10 years ago are now being cared 11 for at assisted-living facilities which have sprung 12 up at a rather alarming rate. 13 private-pay census averaged a little over 50 percent 14 just five years ago; currently we average about 15 25 percent. 16 At Fair Oaks our There are predictions out in the field that 17 25 percent of the lower-rated homes will end up 18 closing. 19 lack of need for a new facility in our county. 20 these changing times it is a fight to just -- That number alone tells the story of the 21 MR. ROATE: 22 MS. SURDICK: 23 24 Two minutes. -- just stay viable without the addition of new nursing home beds. CHAIRWOMAN OLSON: Please conclude. PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM In DraftFull Meeting Conducted on June 21, 2016 74 1 2 MS. SURDICK: Thank you for your consideration. 3 CHAIRWOMAN OLSON: 4 MR. WELDLER: Next. My name is Mark Weldler and 5 I'm here in opposition of Transformative Health of 6 McHenry. 7 I'm here from The Springs at Crystal Lake, 8 which is a 97-bed facility that is accredited by the 9 Joint Commission. We just had our second 10 deficiency-free survey in the last five years. We 11 are a transitional care facility just minutes away 12 from the proposed site. 13 We have an on-site dialysis unit. 14 advanced programs to care for short-term 15 rehabilitation, and more complex, higher acuity 16 patients with all of the newest technologies 17 available in laboratory and all other services that 18 are there, imaging on the spot in order to ensure 19 that we get the outcomes to get them home as quick 20 as possible. 21 We have Our nurse staffing is double the state and 22 national levels. Our therapist staffing is over 23 four times the national and state levels. 24 facility that people go to when they don't want to We're the PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 75 1 go to a traditional nursing home. We are now doing what the Applicant says is 2 3 going to be the future of health care, and our 4 length of stay is shorter in our records today than 5 the Applicant proposes that they will have. 6 already have that. We The Applicant's referrals will be coming 7 8 from Centegra Hospital. The Applicant states that 9 the average length of stay in their facility will be 10 28 days. Now, in order to meet the target 11 utilization that the Board requires, that will be 12 simple math. 13 referrals coming out of Centegra Hospital, which is 14 the hospital in our area that we all get referrals 15 from, and that is the overwhelming place where we 16 get them from. We get a little from other places 17 but that's it. This is our hospital and we rely on 18 this hospital for our majority. They will need 70 percent of the To say that we are against competition would 19 20 not be true. We did not oppose the other two 21 faculties that have been approved that are not yet 22 open. 23 acknowledge those with their analysis of the market 24 with regards to capital improvement, with regard to That are not open yet nor did the Applicant PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 76 1 2 services, totally not there. To be clear, this will not be competition. 3 If this is approved, they will get those referrals 4 and we will not. 5 from past experience. And I say this not from fear but 6 The hospital had a financial -- 7 MR. ROATE: 8 MR. WELDLER: 9 Two minutes. I ask the Board to please consider the impact this is going to have on us, and 10 the length of stay doesn't make sense and the 11 information that they're presenting. 12 CHAIRWOMAN OLSON: 13 MR. WELDLER: 14 CHAIRWOMAN OLSON: 15 MS. RANALLI: Please. Please conclude. Thank you. Next. Good morning. My name is 16 Clare Ranalli, and I am legal counsel for Florence 17 Crystal Pines, The Springs, Crossroads, and 18 Fair Oaks, who you've heard from here today. 19 I would like to just briefly touch upon a 20 concern I have about the application which relates 21 to the referral letters in support of the project. 22 The Applicant did not comply with the Board's rules, 23 which require that a referral letter state the 24 12-month historical referrals and indicate where the PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 77 1 referrals were sent and provide patient-by-zip code 2 origin. 3 The Applicant said that it did not do this 4 because of HIPAA, which, in my opinion, is baloney. 5 All Applicants do it; all Applicants comply with 6 their rules. 7 and saying "10 patients went to The Springs or to 8 Crystal Pines" does not violate HIPAA. 9 Providing patient origin by zip code That is critical information and it should 10 have been provided, and the reason that it was not 11 is it would make it very clear what the dramatic 12 negative impact would be on the area facilities 13 within 30 minutes of the proposed site, two of which 14 provide the exact same services, subacute rehab, and 15 many will -- and those have the same services that 16 the Applicant says will set it apart, availability 17 of dialysis, imaging, lab, et cetera. 18 services are already provided in existing four-star 19 facilities in this service area. 20 All of those Lastly, I just want to conclude by also 21 stating I have an issue with the Applicant's claim 22 that within two years, due to the increase of 23 patients in the age cohort 65 and older, all 24 facilities in the area will be at target PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 78 1 2 utilization. Historically, the facilities within 3 30 minutes -- and "historically" means over the past 4 five years when there's been 10 percent growth in 5 people age 65 or older -- have remained static with 6 respect to their utilization. 7 don't compute for some of the reasons that you've 8 heard here today. 9 The numbers simply And, also, the Applicants did ignore the 10 two facilities that have been approved that are not 11 yet operating and the Manor Care facility which may 12 or may not be approved. 13 MR. ROATE: 14 MS. RANALLI: 15 Two minutes. Thank you. time here today. 16 CHAIRWOMAN OLSON: 17 Next. 18 DR. LIYANAPATABENDI: 19 20 I appreciate your everybody. Thank you. Good morning, My name is Chool Liyanapatabendi. I'm a practicing physician and practicing in 21 hospitals as well as in nursing homes, including 22 long-term care facilities and transitional care 23 facilities and skilled facilities. 24 I have been in private practice for PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 79 1 many years, and I am, as I said, a physician. 2 addition to that, I'm a medical director in several 3 universities. 4 In So I'm here completely in support of 5 Transformation Health of McHenry. 6 please understand -- and I heard everything what 7 people are being told, and I wanted to be clear 8 about what this facility is. 9 I want you to So this is not a skilled facility. This is 10 a transform -- a transitional care facility. 11 what we hear all about the skilled facility -- 12 I will give you a very simple example for you to 13 understand. 14 concern about my patients. 15 So I'm -- as a physician, what -- my I'll give you one example of my Patient A, 16 has congestive heart failure and has difficulty in 17 walking and shortness of breath, had a hip fracture 18 and went in the hospital and had a hip replacement. 19 And on the other hand, I have Patient B, 20 same age, do not have complicated medical history, 21 fell on ice, had a hip fracture and hip replacement, 22 and now my decision where I'm going to send these 23 two patients to rehab facility. 24 So my number one patient, A patient with PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 80 1 complication, I really want to send this patient to 2 a skilled facility because this patient cannot be 3 able to do part of it in therapy because this 4 patient already has heart failure, has other medical 5 problems. 6 watched and clearly be taken care of. So this patient needs to be clearly But I -- on the other hand, my Patient B, 7 8 without complicated medical history, this patient do 9 not match into the skilled area. This is the 10 patient that should go into the transitional care 11 because this patient does not need the help -- 12 MR. ROATE: Two minutes. 13 DR. LIYANAPATABENDI: -- and this patient 14 can leave early, so I will support Transitional 15 Care. 16 CHAIRWOMAN OLSON: Thank you. 17 DR. LIYANAPATABENDI: 18 CHAIRWOMAN OLSON: 19 MS. MITCHELL: Thank you. Next. The next five will be 20 speaking on Transformative Health of McHenry, 21 Project No. 15-044. 22 Ebony Scott, Matthew Thengil, Douglas Martin, and 23 Elizabeth J. Kreplin. 24 Please come up. Amanda Andrews, If you have your comments written, please PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 81 1 hand them to Mike Constantino. Please do not forget 2 to sign in before leaving the table. 3 have to speak in the order in which you are called. 4 Anyone can begin speaking. 5 MS. ANDREWS: You do not Good morning, Madam Chairwoman 6 and respected Board members. 7 me the opportunity to speak today in support of 8 Transformative Health of McHenry. 9 Thank you for allowing My name is Amanda Andrews, and I'm a 10 licensed nursing home administrator for a 11 transitional care facility and had the pleasure of 12 working with the manager of this project for 13 nine years. 14 When asked to speak on the benefits of this 15 project, many thoughts came rushing to my mind. 16 first and foremost was that this project will create 17 a modern-day inpatient rehabilitation center for the 18 increasing number of baby boomers, something which 19 the current PSA does not have to offer. 20 Characteristically speaking, baby boomers are very 21 particular in their research of products and what 22 they invest in. 23 They want new and better. 24 They do not settle for ordinary. Transformative Health of McHenry will meet PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM The DraftFull Meeting Conducted on June 21, 2016 82 1 all these criteria and more. 2 environment that will meet the individual needs, 3 allow for choice in their care, and rehabilitate 4 patients as quickly and safely as possible to return 5 home to their lifestyle. 6 THM offers a unique Think about yourself or your own family 7 members. If I was assisting my baby boomer parents 8 to look for a facility, I would not choose the 9 traditional long-term care nursing home model, which 10 many associate with the sick, frail, and elderly. 11 I would want my parents among the younger, 12 short-term patients who share the common goal of 13 returning home. 14 offers a hundred percent private suites for a 15 therapeutic recovery, call-to-order meals, state-of- 16 the-art rehabilitation equipment, and modern-day 17 medical equipment. 18 facility for the modern-day patient. 19 This can be done at THM, which This is truly a modern-day From my understanding, many of the opponents 20 of THM are weary of this project because they feel 21 THM will steal their patients and take business away 22 from them. 23 targeting versus the existing marketplace of 24 current, long-term nursing homes is vastly different. However, the marketplace THM is PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 83 1 In 2014 750 people went outside of the PSA 2 area to find a facility that could meet their needs 3 for rehabilitation because it didn't exist within 4 the current area. 5 750 people in McHenry. 6 economy of local businesses would be stimulated, and 7 the people of McHenry would stay in McHenry. 8 are all wins. 9 Jobs would be created, These I strongly -- 10 MR. ROATE: 11 MS. ANDREWS: 12 Imagine THM keeping these Two minutes. -- encourage the Board to vote in favor of THM. 13 CHAIRWOMAN OLSON: 14 Next. 15 MR. MARTIN: Thank you. My name is Douglas Martin. I'm 16 the director of economic development for the City of 17 McHenry and have worked for the City for nearly 18 15 years. 19 I hold a master's degree in urban planning 20 and policy from the University of Illinois at 21 Chicago, and I'm a credentialed manager from the 22 ICMA and a member of the American Institute of 23 Certified Planners. 24 I am before you to express the City of PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 84 1 McHenry's strong support for the Transformative 2 Health Care project. 3 land use, economic impact, and community benefit. 4 My comments today focus on Transformative Health of McHenry provides a 5 much-needed and desired level of care into the 6 existing continuum of care on our communities' 7 911 hospital and health care campus. 8 for this project is an approved health care district 9 in the city of McHenry. The location 10 Projections indicate the total direct, 11 indirect, and induced economic impact of this 12 project during and through construction is 13 $27.5 million. 14 economic impact is projected to be another 15 $26.4 million. 16 In addition, the annual operational The project is expected to address more than 17 280 economic indicators for our community and have 18 an aggregated economic impact of $53.9 million for 19 the first full year of operations alone. 20 project will generate approximately 200 new jobs 21 during construction and 150 full-time equivalent 22 jobs once the facility is up and operational. 23 24 The Transformative Health of McHenry will provide a unique, specialized, state-of-the-art PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 85 1 facility, enhancing the health care services of the 2 city and McHenry County. 3 projections for our county support the need for 4 transitional projects such as this. 5 Aging statistics and In conclusion, Transformative Health of 6 McHenry is consistent with the City of McHenry's 7 land use goals, provides an additional quality of 8 life continuum of care benefit, and necessary 9 services within the City's planned health care 10 district and an aggregated economic benefit of 11 $53.9 million. 12 On behalf of the City of McHenry, we urge 13 your yes vote for this beneficial and worthwhile 14 health care project. 15 services to our community. Thank you for bringing these 16 CHAIRWOMAN OLSON: 17 Next. 18 MR. THENGIL: Thank you. Good morning, Madam Chairwoman 19 and respected members of the Board. 20 allowing me the opportunity to speak before you 21 today and in support of Transformative Health of 22 McHenry. 23 24 Thank you for My name is Mat Thengil, and I am the director of therapy services for a transitional care PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 86 1 facility. 2 14 years of experience. 3 directly on the benefits of this innovative model 4 and how it differs from a skilled nursing facility 5 due to the short-term rehab. 6 I am an occupational therapist with over I would like to speak Unfortunately, many skilled nursing 7 facilities today often create a loss of independence 8 and instill an institutional feeling with their 9 clientele. This is because they provide primarily 10 long-term care services and then attempt to make 11 short-term rehab patients fit the long-term care 12 patient populations. 13 There is not a lot of choice for these 14 residents when it comes to their food, rooms, and 15 partnership with therapy. 16 institutional, and people seem to lose their sense 17 of self-worth and feel as though they give up a lot 18 of their privacy and independence once they enter 19 the traditional nursing home. 20 one give folks alternative choices that promote 21 recovery from illness, function, and independence. 22 A nursing home feels Projects like this For the last several years, there's been 23 greater scrutiny from CMS on lengths of stay and how 24 reimbursement is provided. New models of PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 87 1 reimbursement such as bundled payments were created 2 to increase efficiency and decrease waste. 3 like Transformative Health of McHenry provide those 4 efficiencies and ultimately save the government 5 money. Projects 6 Transitional care facilities like this 7 project have proven to have shorter lengths of stay 8 than the shorter-term rehab of a skilled nursing 9 facility. This allows the patients to return home 10 safely and independently much sooner by taking 11 advantage of seven days a week of therapy, state-of- 12 the-art equipment, multiple sessions of therapy 13 throughout the day, home safety evaluations, and 14 community reintegration tasks. 15 The goal of this program is to not only 16 rehabilitate our patient but to allow these patients 17 a better opportunity to prevent illness and avoid 18 future hospitalizations. 19 I strongly encourage the Board to vote in 20 favor of Transformative Health of McHenry. 21 and the government will benefit. 22 CHAIRWOMAN OLSON: 23 MS. KREPLIN: 24 Patients Thank you. Thank you. Good morning, Chairwoman and respected members of the Board. Thank you for this PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 88 1 opportunity to speak in support of Transformative 2 Health Care of McHenry. 3 My name is Elizabeth Kreplin. I'm a 4 lifelong learner and have professional experiences 5 in business and health care. 6 and privilege to provide care as a registered nurse 7 for the last 16 years. It has been an honor 8 My first nursing experiences were in home 9 health, followed by four years in a nursing home 10 from a staff nurse to director of care delivery. 11 The last five years were as director of nursing of a 12 new transitional care facility, hired by an owner/ 13 operator of the THM project. 14 work under his vision for patient-centered care with 15 high-acuity patients in a transitional health care 16 setting. 17 critical thinking skills dedicated to a culture of 18 respect and individualized patient care, providing 19 ongoing patient assessments and personalized 20 education. 21 I was privileged to We hired nurses with stellar clinical and We were consistently rated a CMS five-star 22 facility, Joint Commission certified, and provided 23 advanced medical practice protocols and programs as 24 well as state-of-the-art therapy. Continuity of PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 89 1 care from admission to discharge resulted in reduced 2 length of stay, reduced 30-day rehospitalization, 3 and enhanced patient satisfaction with optimal 4 function and timely recovery. 5 In my professional opinion and experience, 6 nursing homes with short-term rehab may be an 7 attempt at transitional care. 8 comprehensive solution. 9 indeed, transformative, not only as it serves They are not a Transitional care is, 10 patients but for its innovative impact on the health 11 care industry. 12 I strongly encourage the Board to vote yes 13 in favor of this innovative project, No. 15-044. 14 Thank you. 15 CHAIRWOMAN OLSON: 16 Next, Jeannie. 17 MS. MITCHELL: Thank you. The next five, also speaking 18 on Transformative Health of McHenry, Project 19 No. 15-044, please come up. 20 Lisa Ulm, Henry J. Ecker, Mary D. Tichelbaut, and 21 Kimberly Boike. 22 CHAIRWOMAN OLSON: 23 MS. ULM: 24 Bernie Powers, Go ahead. Good morning. Thank you for allowing me the opportunity to speak before you PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 90 1 today and in support of Transformative Health of 2 McHenry. 3 My name is Lisa Ulm. I am a licensed 4 nursing home administrator and have worked in the 5 skilled nursing and transitional care sector for the 6 last 15 years. 7 opened four and personally managed and directed the 8 stabilization and daily operations for three 9 transitional care facilities like this project. 10 Over the last six years I have I would like to speak to my experience 11 regarding the impact projects like this have on a 12 marketplace. 13 of McHenry not only fill gaps in the continuum of 14 care, they seem to act as catalysts that spark a 15 positive chain reaction of improved health care 16 services across the market. 17 up their game, access improves, surveys gets better, 18 managing return to hospitalizations improves, and 19 capital gets reinvested in aging properties. 20 this ultimately benefits the patients and their 21 families. 22 Facilities like Transformative Health As other area providers All Another phenomenon that I have witnessed is 23 that transitional care facilities can actually 24 create a new demand for their services in the PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 91 1 market. 2 One, access improves by decreasing restrictive 3 admissions practices, and, two, patients who may 4 have bypassed a traditional nursing home are willing 5 to admit to a transitional care facility for 6 rehabilitation. 7 I think this is due to two primary reasons. In 2011 I opened and operated a short-term 8 care facility with the managers of this project and 9 entered a very established market. Over a six-year 10 period there was not a single facility closure. 11 my opinion, adding this state-of-the-art facility 12 required the surrounding facilities to improve the 13 quality of their physical plant and overall service, 14 which most assuredly resulted in a better experience 15 for health care consumers in our area regardless of 16 which facility they chose to provide their care. 17 In conclusion, I strongly encourage the 18 Board to vote yes in favor of this much-needed 19 facility for the people of McHenry. 20 CHAIRWOMAN OLSON: 21 Next. 22 MS. POWERS: In Thank you. Thank you. Good morning, Madam Chairwoman 23 and respected members of the Board. Thank you for 24 allowing me to have the opportunity to speak before PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 92 1 you today in support of Transformative Health Care 2 of McHenry. 3 My name is Bernadette Powers, and I am a 4 director of food services in health care with 5 37 years in management experience. 6 here in McHenry County for almost 30 years, 26 of 7 those years in the town of McHenry, and I've seen 8 this community grow up from a sleepy little river 9 town to a vibrant community. 10 I have lived I'm here to encourage you to vote in favor 11 of Project 15-044 as we need to provide transitional 12 care for short-term patients, especially those under 13 the age of 60. 14 The hospitals in the area understand that, 15 in order to attract people to our community, both 16 patients and high-quality health care providers, 17 they need to compete with those high standards of 18 health care closer to the city. 19 needed a state-of-the-art health care facility that 20 could support what people deserve, the same quality 21 of health care they were getting in more affluent 22 areas closer to Chicago. 23 24 They knew that they Now we need to do the same for short-term patients in transitional care, as it does not exist PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 93 1 at present. I know of a lot of facilities that say 2 that they can take care of younger, short-term 3 patients by putting a few rooms aside or even a 4 hallway designated for this use. 5 long-term facility, this is very hard to do, and it 6 requires a different focus to their primary mission. But if you are a Presently I drive 40 miles, a three-hour 7 8 round-trip commute to work with a team of 9 professionals that truly understand the meaning of 10 hospital-to-transitional care-to-home model, 11 catering to the needs of patients that require a 12 fast recovery and return to their normal lives as 13 soon as possible. 14 drive this far -- 15 MR. ROATE: 16 MS. ULM: 17 CHAIRWOMAN OLSON: 18 MS. ULM: You may think this is crazy to Two minutes. -- but I -Please conclude. -- but I urge you that this is 19 very vital to the community, and I hope you approve 20 it. Thank you. 21 CHAIRWOMAN OLSON: 22 Next. 23 MS. TICHELBAUT: 24 Thank you. Good morning, Madam Chairwoman and members of the Board. PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 94 1 2 CHAIRWOMAN OLSON: Can you pull that closer so we can hear you? 3 Thank you. 4 MS. TICHELBAUT: My name is Mary Drislane- 5 Tichelbaut. 6 before you today. 7 McHenry Transformative Health Care facility. 8 9 Thank you for allowing me to speak I am here to speak on behalf of On February 3rd, 2016, I broke both of my knees due to a freak accident fall in my own home. 10 After spending three days at Lutheran General 11 Hospital, I was told that my needs would best be met 12 in a short-term rehab facility. 13 The search began for a facility. Of course, 14 not having any need to use so before, the Google 15 search began. 16 Illinois. 17 that I was not going to like this place because of 18 the stigma of what I thought it was going to be. 19 The website and various reviews were all very 20 positive in regard to this facility, so I figured 21 I would be okay. 22 I found a facility in Niles, Before arriving at my TCF, I was sure Wow, was I wrong about my initial feeling. 23 Upon my arrival I was made to feel like I was a 24 guest in a hotel, not a hospital patient. The staff PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 95 1 was very welcoming, kind, and generous to me. 2 I felt like I was a human being, not just a number. 3 I felt loved and treated with kindness and respect. 4 All the staff members knew me by my name 5 whenever they saw me. That was such a personal 6 touch to me. 7 screen televisions, table and chairs, mini fridge, 8 and loveseat all made my room seem like a hotel 9 room, not a hospital room. The private rooms with large flat- 10 I received the best transitional care 11 treatment through the help of my CNAs and nurses who 12 were always looking out for my safety as well as my 13 comfort. 14 MR. ROATE: 15 MS. TICHELBAUT: 16 Two minutes. At this point I can only say the therapists I had also were very -- 17 CHAIRWOMAN OLSON: 18 MS. TICHELBAUT: I need you to conclude. -- conscientious, and 19 I feel the need for a facility like this is much 20 needed in the McHenry area. 21 CHAIRWOMAN OLSON: 22 MS. BOIKE: Thank you. Good morning. My name is 23 Kimberly Boike. I'm presenting testimony in 24 opposition to Project 15-044, Transformative Health PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 96 1 of McHenry, on behalf of Manor Care Health Services, 2 LLC; HCR Healthcare, LLC; HCR Manor Care, Inc.; and 3 Manor Care Health Services-Libertyville, LLC. 4 On November 13, 2015, the Circuit Court of 5 McHenry County reversed this Board's decision 6 denying Manor Care's proposed project to construct a 7 130-bed skilled nursing facility in McHenry County 8 and issued an order instructing this Board to issue 9 a CON permit for the Manor Care project. This Board 10 has appealed that decision, which appeal is 11 currently pending. 12 Because the planning area bed need in 13 McHenry County should be considered after Manor 14 Care's project approval is finalized, this Board 15 must deny the Transformative Health project. 16 Further, if this Board believes that the 17 negative information supplied by Transformative 18 Health regarding existing providers constitutes a 19 good reason to overlook Transformative Health's 20 inability to comply with the criteria noted in the 21 staff report, then this Board should deny the 22 Transformative Health project, follow the direction 23 of the Circuit Court to approve the Manor Care 24 project, and withdraw its appeal of the Manor Care PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 97 1 project. 2 Thank you. 3 CHAIRWOMAN OLSON: 4 Next. 5 MS. MITCHELL: Thank you. The last two individuals will 6 also be speaking on Transformative Health of 7 McHenry, Project No. 15-044. 8 either Jamer or James. 9 Larry Banks. MR. JAMES: 10 First is Mark -- The second individual is Good morning. My name is 11 Mark James and I'm the business office manager at 12 Crystal Pines Rehabilitation & Health Care Center. 13 I'm here to oppose the Transformative Care project 14 primarily for -- I want to speak to a couple of 15 issues. First, at the last minute, the Applicant 16 17 sent in a chart that they presented as CMS 18 information purportedly to show referrals to various 19 facilities that were denied, attempting to claim 20 that facilities deny 50 percent of the referrals. There are a number of problems with this 21 22 chart. First, the chart is missing two facilities 23 in the area that had substantial admission from this 24 hospital. PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 98 Second, CMS can only track information on 1 2 traditional Medicare A-billed patients, which the 3 chart does not include admissions to area providers 4 whose stay in the hospital that was paid for by 5 Medicare Advantage, commercial insurance, Medicaid, 6 or private pay. 7 Third, they show a column representing 8 referrals from the hospital and want you to believe 9 this is CMS data. This is not, as CMS does not 10 track referrals from hospitals, only admission to 11 these. 12 a complete distortion of information. 13 The table/chart is, quite frankly, false and As the business officer manager at Crystal 14 Pines, it's my job to approve people that are 15 referred. 16 have been sent to us by -- for referrals by 17 Centegra. 18 patient -- a case manager will send it out to 19 multiple facilities at the same time. 20 only way that they could come up with that kind of 21 information with respect to Crystal Pines. 22 referral refusal rate would be somewhere below 23 10 percent. 24 We do not deny 48 percent of people who What happens is a lot of times a That is the Our My next point is to address the Applicant's PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 99 1 claim that despite taking anywhere from 30 to 2 80 percent -- depending on which of their numbers 3 you use -- of the current referrals from area 4 facilities, it will not matter because within the 5 next year and a half to two years this project and 6 all area facilities will be at target utilization 7 due to population growth in the age cohort -- 8 MR. ROATE: Two minutes. 9 MR. JAMES: Thank you for your time. 10 CHAIRWOMAN OLSON: 11 Next. 12 MR. BANKS: 13 Hi. Thank you. My name is Larry Banks, and I'm here in opposition to Project 15-044. 14 I'd like to start by saying there's 15 two facilities that have been approved in the area 16 that are currently going to open, which will already 17 be negatively impacting the facilities. 18 Secondly, it's talked again and again about 19 a transitional care facility. 20 facility is a licensed skill nursing facility. 21 That's the only thing that there is. 22 not a skilled nursing facility or it's not a 23 trend -- a typical facility -- it is not true. 24 A transitional care So to say it's I can give you an example of another PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 100 1 facility that is probably a mile from the current 2 proposed site, The Springs at Crystal Lake. 3 nothing institutional about that center. 4 100 percent transitional care. 5 short-term rehab patients and no long-term care 6 patients. 7 renovated, and has 65 percent occupancy. 8 not due to the fact that people aren't choosing it. 9 It's due to the fact that there are not people to 10 11 There's It is They only take It is a beautiful facility, recently That is fill it. This facility is not going to be built in a 12 medically underserved area. There are more than 13 enough beds in the service area. 14 going to address a need, why are they building a 15 limited-access facility in the middle of an area 16 that is already a densely bedded area? If they really are 17 They say that we are going to steal -- 18 we're -- the facilities in the area feel that 19 they're going to steal patients. 20 there's patients to be stolen. 21 mark this at 750 patients is not true. 22 the CMS information, it shouldn't be represented as 23 CMS information, and I think it's terrible that they 24 would have a misrepresentation like that in their It's not that The numbers that It is not PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 101 1 application. There are many modern-day facilities in the 2 3 area. You heard that there's been millions of 4 dollars in the last year -- 5 MR. ROATE: Two minutes. 6 MR. BANKS: Thank you. 7 CHAIRWOMAN OLSON: 8 MS. MITCHELL: 9 10 Please conclude. There are no additional speakers. CHAIRWOMAN OLSON: Is there anybody else 11 that did not have an opportunity to speak who was 12 signed in? 13 (No response.) 14 CHAIRWOMAN OLSON: 15 Okay. It is now 12:15. We'll break for lunch until one o'clock. 16 Please be back at one o'clock. 17 (A recess was taken from 12:15 p.m. to 18 19 1:03 p.m.) - - - 20 21 22 23 24 PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 102 1 CHAIRWOMAN OLSON: 2 The next item is Item No. 5, items approved 3 We'll return to session. by the Chairwoman. 4 Mr. Constantino. 5 MR. CONSTANTINO: 6 The following have been approved by the Thank you, Madam Chairwoman. 7 Chair: 8 Permit Renewal 13-013, permit renewal for 15-058, 9 permit renewal for 15-060, and permit renewal for 10 Permit Renewal 14-026, Permit Renewal 14-041, 14-022. 11 Thank you, Madam Chairwoman. 12 CHAIRWOMAN OLSON: 13 Thank you, Mike. - - - 14 15 16 17 18 19 20 21 22 23 24 PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 103 1 CHAIRWOMAN OLSON: The next item of business 2 is items for State Board action. First, we have one permit renewal request, 3 4 Project 10-065, Park Pointe South Elgin Healthcare & 5 Rehabilitation. May I have a motion to -- may I have a 6 7 motion to approve a permit renewal for 8 Project 10-065, Park Pointe South Elgin Healthcare & 9 Rehabilitation, for a 24-month permit renewal? 10 MEMBER GALASSIE: 11 MEMBER SEWELL: 12 CHAIRWOMAN OLSON: 13 So moved. Second. The Applicant will come to the table. 14 Please be sworn in by the court reporter. 15 (One witness sworn.) 16 THE COURT REPORTER: 17 CHAIRWOMAN OLSON: 18 Thank you. Mr. Constantino, your report. 19 MR. CONSTANTINO: 20 Park Pointe South Elgin Healthcare & Rehab 21 Center is requesting the third permit renewal for 22 this project. The renewal is for 24 months, until May of 23 24 Thank you, Madam Chairwoman. 2018. The original project was approved for PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 104 1 120 beds at an approximate cost of $21.7 million. 2 Thank you, Madam Chairwoman. 3 CHAIRWOMAN OLSON: 4 Questions by Board members? 5 MEMBER GREIMAN: 6 What -- what changes are being made to -- so Thank you. Yeah. 7 that you can be -- with your dollars -- the 2010 and 8 2016 must have a significant economic difference. 9 Doesn't it? MR. CONSTANTINO: 10 When it was originally 11 approved, Judge, it was -- they were going to use 12 financing from the County -- 13 MEMBER GREIMAN: 14 MR. CONSTANTINO: Yeah. -- bonds from the County, 15 and that fell through. 16 forward and found additional financing, and that's 17 been the biggest cause of the delay. MEMBER GREIMAN: 18 19 that. 24 I appreciate That was in your report. extra costs. MR. CONSTANTINO: 22 23 I understand. My question is, when was the loss -- the 20 21 Subsequently they've come Oh, there's been no extra costs. MEMBER GREIMAN: You mean they're PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 105 1 charging -- they're working on the 2010 numbers? MR. CONSTANTINO: 2 3 That's correct. As they reported to us, yes. 4 MEMBER GREIMAN: Is that right? 5 MS. WESTERKAMP: That is correct. The 6 original financing was through bonds, and bond 7 financing can be very expensive. 8 using private funds and private financing so the 9 cost -- 10 MEMBER GREIMAN: And we are now I understand that. But the 11 contractors, the subcontractors that are going to be 12 working on this thing, are they charging the 2010 -- 13 14 MS. WESTERKAMP: Actually, they are working off the 2010 budget and they've accepted that. 15 MEMBER GREIMAN: 16 That's what I wanted to know. 17 They are? Okay. I wanted to be sure. 18 CHAIRWOMAN OLSON: So I have a question. 19 So at this point no dirt has been moved? 20 MS. WESTERKAMP: No dirt has been moved. We 21 are ready to break ground on August 1st. We wanted 22 to actually -- because of the recoveries on bonds, 23 not being able to obtain the letter of credit with 24 the State that expired, we went to private PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 106 1 financing, and we didn't want to break ground until 2 we had all the private financing funds actually 3 secured in our account. 4 project and have to be in the position that we were 5 still trying to raise funds. 6 CHAIRWOMAN OLSON: We didn't want to start a I understand. But 7 I guess my concern is partially that these beds have 8 now been taken out of the bed count. 9 you open, it will be for eight years that the beds 10 11 12 have been tied up with all of the delays. Michael, the project was originally approved in 2010? 13 MR. CONSTANTINO: 14 CHAIRWOMAN OLSON: 15 completion date is 2018; right? 16 MR. CONSTANTINO: 17 That's correct. And the most recent They're requesting a completion date of May 2018, that's correct. 18 CHAIRWOMAN OLSON: 19 have been out of the inventory. 20 MR. CONSTANTINO: 21 CHAIRWOMAN OLSON: 22 By the time So eight years that beds That's correct. And not one shovel of dirt has been moved? 23 MR. CONSTANTINO: 24 CHAIRWOMAN OLSON: That is correct. Can you explain exactly PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 107 1 2 what the financing is now? MS. WESTERKAMP: The financing is secured 3 through DB5 investors which are private investors. 4 These are foreign investors who bring funds to the 5 United States through various types of banks and 6 whatnot. 7 And the benefit of having those investors is 8 that this is -- this is basically an interest-free 9 financing, so the cost of the project remained very 10 low and no monies are paid for accrued interest. 11 monies are paid for -- profits aren't distributed 12 until after the project is stabilized. 13 CHAIRWOMAN OLSON: And what is your level of 14 confidence that you will meet this May of 2018 15 completion date? 16 MS. WESTERKAMP: No We are ready to break 17 ground August 1st. 18 plans -- everything is in place. 19 shovel ready -- I know that's a term that's thrown 20 around all the time. 21 are -- the land developer is actually ready to put the 22 shovel in the ground. 23 month ago, but we've been waiting to get the approval. 24 We have our architecture When we talk about Everything's shovel ready. We And he would have done it a CHAIRWOMAN OLSON: So you're 50 percent PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 108 1 2 3 confident? 75 percent? MS. WESTERKAMP: I am a hundred percent confident that we'll be ready by May of '18. 4 CHAIRWOMAN OLSON: 5 (No response.) 6 CHAIRWOMAN OLSON: Other questions? Seeing none, I'll ask for 7 a roll call vote. 8 MR. ROATE: 9 Motion made by Mr. Galassie; seconded by 10 Thank you, Madam Chair. Mr. Sewell. 11 Mr. Galassie. 12 MEMBER GALASSIE: 13 MR. ROATE: 14 Justice Greiman. 15 MEMBER GREIMAN: 16 MR. ROATE: 17 MEMBER GREIMAN: Thank you. Yes. Thank you. 18 time we'll vote on this. 19 MR. ROATE: 20 MEMBER JOHNSON: 21 Yes. I hope this is the last Mr. Johnson. Yes. In -- echoing Justice Greiman, I hope this is the last time we hear this. 22 MR. ROATE: Thank you. 23 Mr. McGlasson. 24 MEMBER MC GLASSON: Yes. PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 109 1 MR. ROATE: 2 Mr. Sewell. 3 MEMBER SEWELL: 4 MR. ROATE: 5 Madam Chair. 6 CHAIRWOMAN OLSON: 7 8 9 Thank you. Yes. Thank you. I'm actually going to vote no. I don't see this being done in May of 2018, and I don't like the fact that these beds have been 10 tied up. It will be over eight years by the time we 11 get things done -- I'm going to guess close to 12 nine years -- so I vote no. 13 MR. ROATE: 14 That's 5 votes in the affirmative; 1 vote in 15 Thank you, Madam Chair. the negative. 16 CHAIRWOMAN OLSON: 17 Good luck. 18 MS. WESTERKAMP: 19 THE COURT REPORTER: 20 21 22 23 24 The motion passes. Thank you very much. Excuse me. Could you give me your name, please, and spell it. MS. WESTERKAMP: Sure. Janet Westerkamp, W-e-s-t-e-r-k-a-m-p. THE COURT REPORTER: Thank you. - - - PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 110 1 2 3 4 CHAIRWOMAN OLSON: Next item of business is extension requests and there are none. Next is exemption requests and we have none. - - - 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 111 CHAIRWOMAN OLSON: 1 We have one alteration 2 request, Project 11-104, McAllister Nursing & 3 Rehabilitation. May I have a motion to approve 4 5 Project 11-014 -- 104, I'm sorry -- McAllister 6 Nursing & Rehabilitation, to increase the overall 7 project cost by $3,926. 8 MEMBER JOHNSON: So moved. 9 MEMBER GALASSIE: Second. CHAIRWOMAN OLSON: 10 11 Mr. Constantino, your report. 12 MR. CONSTANTINO: Thank you, Madam Chairwoman. 13 This is the second alteration for McAllister 14 Nursing & Rehab, LLC. This project was originally 15 approved as a replacement facility for a 111-bed 16 skilled nursing facility with a 200-bed replacement 17 facility at a cost of approximately $24.9 million. The first alteration increased the gross 18 19 square footage by 4.3 percent for about 4500 gross 20 square foot. 21 time. 22 Chair said, to increase the cost by about $3926. There was no additional cost at that And then the second alteration is, like the 23 Thank you, Madam Chairwoman. 24 CHAIRWOMAN OLSON: Thank you. PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 112 1 Do you have any comments? 2 MR. KNIERY: 3 CHAIRWOMAN OLSON: 4 (No response.) 5 CHAIRWOMAN OLSON: I'll open it up to the Board. Any questions? Seeing none, I'll ask for 6 a roll call vote. 7 MR. ROATE: 8 Motion made by Mr. Johnson; seconded by 9 Thank you, Madam Chair. Mr. Galassie. 10 Mr. Galassie. 11 MEMBER GALASSIE: 12 MR. ROATE: 13 MEMBER JOHNSON: 14 MR. ROATE: 15 MEMBER MC GLASSON: 16 MR. ROATE: 17 MEMBER SEWELL: 18 MR. ROATE: 19 CHAIRWOMAN OLSON: 20 statements in the staff report. Aye. Mr. Johnson. Yes. Mr. McGlasson. Yes. Mr. Sewell. Yes, same. Madam Chair. 21 MR. ROATE: 22 MEMBER GREIMAN: 23 MR. ROATE: 24 MEMBER GREIMAN: Yes, based on the above Justice Greiman. Yeah, I'll vote aye. Sorry about that, sir. All right. PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 113 1 2 MR. ROATE: That's 6 votes in the affirmative. 3 CHAIRWOMAN OLSON: 4 Congratulations. 5 MR. KNIERY: 6 The motion passes. Thank you. - - - 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 114 1 2 3 CHAIRWOMAN OLSON: There are no declaratory rulings or other business. There is nothing under Health Care Worker 4 Self-Referral Act and nothing under status report on 5 conditional/contingent permits, which brings us to 6 applications subsequent to initial review. 7 - - - 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 115 CHAIRWOMAN OLSON: 1 2 Project 16-015, DaVita Forest City. May I have a project -- may I have a motion 3 4 to approve Project 16-015, DaVita Forest City 5 Dialysis, to establish a 12-station ESRD facility. 6 MEMBER SEWELL: So moved. 7 MEMBER MC GLASSON: Second. 8 CHAIRWOMAN OLSON: Thank you. 9 Mr. Constantino, your report. 10 MR. CONSTANTINO: Thank you, Madam Chairwoman. 11 The Applicants are proposing to establish a 12 12-station ESRD facility in Rockford, Illinois. 13 cost of the project is approximately $3.1 million, 14 and the completion date is June 30th, 2018. There was no public hearing, no opposition 15 16 The letters received, and there were no findings. 17 Thank you, Madam Chairwoman. 18 CHAIRWOMAN OLSON: 19 The Applicant -- or the people at the table 20 will be sworn. 22 Sorry. THE COURT REPORTER: 21 Thank you. Raise your right hands, please. 23 (Four witnesses sworn.) 24 THE COURT REPORTER: Thank you. And please PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 116 1 print your names. CHAIRWOMAN OLSON: 2 3 the Board? 4 to you. Do you have comments for No opposition, no findings. 5 MR. SHEETS: 6 We would take questions. It's up No, we don't have any comments. I have with me Annie Hike, who's the DaVita 7 8 regional operations director for the Rockford area, 9 and then Mr. Tinknell, who I think you know; 10 Anne Cooper from my office. CHAIRWOMAN OLSON: 11 12 Questions from Board members? 13 MEMBER GALASSIE: 14 CHAIRWOMAN OLSON: No. This is my stomping 15 grounds here, so I really applaud where you're 16 putting this facility because you guys are way out 17 on the west side, and that's where I know services 18 are desperately needed. So I think that's awesome. 19 Roll call vote, please. 20 MEMBER GREIMAN: 21 CHAIRWOMAN OLSON: 22 MEMBER GREIMAN: 23 24 I have a question. Oh, I'm sorry. I have a question of the staff. CHAIRWOMAN OLSON: Sorry, Justice. PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 117 1 MEMBER GREIMAN: When you figure out the 2 number of the activities in the district, one of our 3 districts, it says pending a -- you've given rights 4 to build, do you count that in your numbers as if it 5 was finished? 6 MR. CONSTANTINO: Are you talking about 7 projects approved, that have been approved and not 8 yet operational? 9 10 MEMBER GREIMAN: Yeah. MR. CONSTANTINO: Yeah, it's included in the 11 station need calculation. 12 they're immediately taken out of the need. 13 MEMBER GREIMAN: Once you approve it, I see. They are? Because 14 I see that DaVita has a number of pending issues, 15 and I wonder if -- how much that changes the 16 establishment of it. 17 18 If you look at page 4 of the staff report, you see about 10, 12 pending projects. 19 MR. CONSTANTINO: 20 MEMBER GREIMAN: That's correct. That seems to be a lot of 21 projects. How come you've not finished with them? 22 Why is it taking so long to finish these projects? 23 Not you. 24 You. PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 118 1 MR. CONSTANTINO: 2 MR. SHEETS: Thank you, Judge. Well, Judge, the way the need 3 is calculated for these types of facilities 4 basically revolves around people that have a certain 5 stage of the renal disease that will progress at 6 some point to where they need dialysis. 7 So in dialysis it's really a planning 8 activity. We're planning two years down the road -- 9 18 months to two years down the road -- for where 10 the patients are and where we think the need 11 calculation will be. 12 MEMBER GREIMAN: So -- okay. So when we 13 give you a right -- authority to have a facility, 14 you don't necessarily move on it because you're 15 waiting to see what's going on in the market; is 16 that right? 17 MR. SHEETS: Well, we do move immediately on 18 it, and it takes -- you know, it takes time to get 19 the building. 20 sometimes it's a rebuild. 21 Sometimes it's a new building; MEMBER GREIMAN: I understand but it's -- a 22 real market. You guys -- you and somebody else -- 23 own 90 percent of the renal stations in Illinois so 24 you have -- I'm sure you have it down pretty well. PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 119 1 2 3 4 MR. SHEETS: We like to think we do, just like McDonald's and Burger King. MEMBER GREIMAN: Well, I just -- I was just curious about why you delay and so -- okay. 5 Thank you. 6 CHAIRWOMAN OLSON: 7 You never know. Other questions or comments? 8 (No response.) 9 CHAIRWOMAN OLSON: Seeing none, I'll ask for 10 a roll call vote, please. 11 MR. ROATE: 12 Motion made by Mr. Sewell; seconded by 13 Thank you, Madam Chair. Mr. McGlasson. 14 Mr. Galassie. 15 MEMBER GALASSIE: 16 MR. ROATE: 17 MEMBER GREIMAN: 18 MR. ROATE: 19 MEMBER JOHNSON: 20 MR. ROATE: 21 MEMBER MC GLASSON: 22 Aye. Justice Greiman. Aye. Mr. Johnson. Yes. Mr. McGlasson. Yes, by virtue of the staff report. 23 MR. ROATE: 24 Mr. Sewell. Thank you. PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 120 1 MEMBER SEWELL: Yes, for reasons stated. 2 MR. ROATE: 3 CHAIRWOMAN OLSON: Madam Chair. Yes, based on the 4 positive State Board staff report and the no 5 opposition. 6 MR. ROATE: 7 CHAIRWOMAN OLSON: 8 Good luck. 9 MR. SHEETS: 10 11 6 votes in the affirmative. MR. TINKNELL: Motion passes. Thank you. Thank you. - - - 12 13 14 15 16 17 18 19 20 21 22 23 24 PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 121 1 2 3 CHAIRWOMAN OLSON: Next we have Project 16-017, Griffin Medical Office building. May I have a motion to approve 4 Project 16-017, Griffin Medical Office Building, to 5 construct a medical office building. 6 MEMBER GALASSIE: So moved. 7 CHAIRWOMAN OLSON: 8 MEMBER SEWELL: 9 CHAIRWOMAN OLSON: A second, please. Second. Thank you. 10 Mr. Constantino, your report. 11 MR. CONSTANTINO: 12 The Applicants are proposing to construct a Thank you, Madam Chairwoman. 13 medical office building in Pekin, Illinois. The 14 project cost is approximately $17.7 million, and the 15 completion date is April 2nd, 2018. 16 There's a mistake on the front page here. 17 That should be 17,671,566 and not 16 thousand -- 18 16,671,566. It's in the third line. 19 CHAIRWOMAN OLSON: Thank you, Mr. Constantino. 20 The Applicant will be sworn in. 21 MR. CONSTANTINO: 22 hearing, no opposition. There was no public 23 Thank you, Madam Chairwoman. 24 CHAIRWOMAN OLSON: Sorry. I didn't mean to PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 122 1 cut you off there. 2 MR. CONSTANTINO: 3 CHAIRWOMAN OLSON: 4 The Applicant will be sworn in. THE COURT REPORTER: 5 6 That's all right. Raise your right hands, please. 7 (Three witnesses sworn.) 8 THE COURT REPORTER: 9 CHAIRWOMAN OLSON: 10 11 Thank you. Do you have comments for the Board? MR. HALL: My name is Steve Hall. I'm the 12 chief financial officer for Park Court Limited and 13 Progressive Health System. 14 CON consultant, and Marcia Becker, the director of 15 finance, with me. 16 I have Ed Parkhurst, our I'd like to thank the staff for their 17 assistance during the application process and for 18 their determination that we meet the criteria for 19 Part 1110 and 1120. 20 I'd like to report that we've had 21 substantial support from the community, the City, 22 and the County Health Board, the chamber of 23 commerce. 24 we don't have any opposition. It's a very well-thought-out project, and PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 123 1 So I'm happy to take questions. 2 CHAIRWOMAN OLSON: 3 Questions from Board members? 4 (No response.) 5 CHAIRWOMAN OLSON: 6 Mike, this is actually for you. 7 Thank you. I just have one question. On page 13 of the -- of your State Board 8 staff report -- I love projects with no opposition 9 and no negative findings. 10 Those are the fun ones. But on -- if we say that the construction 11 and contingencies are high compared to our standard, 12 how are we able to -- how can we find that that's 13 not negative? 14 I mean, I -- 15 I just want to make sure that's -- MR. CONSTANTINO: When I looked at that, it 16 was high on the -- on what they considered to be the 17 clinical portion of the project, but when I compared 18 it to the other approved medical office building 19 projects, it was in the range that we have approved 20 in the past and accepted. 21 And the second reason we didn't have a 22 negative finding on it was because they have 23 financing already in place and they provided us with 24 a signed document. PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 124 1 CHAIRWOMAN OLSON: 2 MR. CONSTANTINO: 3 CHAIRWOMAN OLSON: 4 Okay. They're ready to go. Thank you. that explanation. 5 Other questions or comments? 6 (No response.) 7 CHAIRWOMAN OLSON: 8 I appreciate Okay. Seeing none, I would ask for a roll call vote. MR. MORADO: 9 Before you begin, can I just 10 remind the Board members to please make sure you 11 explain your vote as you do? 12 Thank you. 13 MR. ROATE: 14 Motion made by Mr. Galassie; seconded by 15 Thank you. Mr. Sewell. 16 Mr. Galassie. 17 MEMBER GALASSIE: 18 findings. 19 MR. ROATE: 20 Justice Greiman. 21 MEMBER GREIMAN: 22 MR. ROATE: 23 MEMBER JOHNSON: 24 Aye, based on the State Thank you. Aye. Mr. Johnson. Yes, based on the staff report. PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 125 1 MR. ROATE: 2 Mr. McGlasson. 3 MEMBER MC GLASSON: 4 Thank you. report. 5 MR. ROATE: 6 Mr. Sewell. 7 MEMBER SEWELL: 8 MR. ROATE: 9 Madam Chair. 10 11 Yes, based on the staff Thank you. Yes, for reasons stated. Thank you. CHAIRWOMAN OLSON: Yes, based on the positive State Board staff report and no opposition. 12 MR. ROATE: 13 That's 6 votes in the affirmative. 14 CHAIRWOMAN OLSON: 15 Congratulations and good luck. 16 MR. HALL: 17 MR. PARKHURST: 18 Thank you. Motion passes. Thank you. Thank you very much. - - - 19 20 21 22 23 24 PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 126 1 CHAIRWOMAN OLSON: Next, we'll move into 2 Project 15-061, Southern Illinois Gastroenterology 3 Endoscopy Center. 4 May I have a motion to approve Project 15-061, 5 Southern Illinois Gastroenterology Endoscopy Center, 6 to establish a single-specialty ASTC. 7 MEMBER SEWELL: 8 CHAIRWOMAN OLSON: 9 Mr. Sewell. So moved. May I have a second. 10 MEMBER GALASSIE: 11 CHAIRWOMAN OLSON: 12 I have a motion by Second. Mr. Constantino, your report, please. 13 MR. CONSTANTINO: Thank you, Madam Chairwoman. 14 The Applicants are proposing the 15 establishment of a limited-specialty ASTC in 16 approximately 3200 gross square feet of leased space 17 at a cost of approximately $1.7 million in 18 Carbondale, Illinois. 19 date is December 31st, 2017. 20 21 22 The anticipated completion There was no public hearing, there was opposition, and we did have findings. I would like to note, though, one comment 23 that was made during the public participation, that 24 to be -- if you do approve this as an ASTC, they PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 127 1 cannot have that license without a transfer 2 agreement with a hospital. CHAIRWOMAN OLSON: 3 4 MR. CONSTANTINO: IDPH will not give them a license without that transfer agreement. MEMBER GALASSIE: 7 8 And it's not currently in place? 5 6 IDPH -- Explain the transfer agreement. MR. CONSTANTINO: 9 It's a transfer 10 agreement -- if they have problems during the 11 procedures performed at the ASTC -- with the 12 hospital. 13 10 minutes of the proposed site. And there's two hospitals within MEMBER SEWELL: 14 I didn't hear your answer to 15 the Chairman's question. 16 CHAIRWOMAN OLSON: 17 MEMBER SEWELL: 18 CHAIRWOMAN OLSON: 19 It's not in place. Oh, it's not in place. Is that correct? not -- there's no transfer agreement? MR. SHEETS: 20 Well, there's no ASTC so there 21 can't be a transfer agreement. 22 CHAIRWOMAN OLSON: 23 24 It's So, it's a chicken-or-egg thing? MR. SHEETS: Right. PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 128 MEMBER GALASSIE: 1 2 So would we want to amend our motion to having that agreement in place? MR. MORADO: 3 They won't be able to receive 4 the licensing from IDPH without having something 5 like that in place, so it's a function that would 6 happen after they are either granted or denied 7 the CON. CHAIRWOMAN OLSON: 8 9 10 of ASTCs here before, and I've never -- did they all have transfer agreements? MR. CONSTANTINO: 11 12 CHAIRWOMAN OLSON: 14 before we approved them. MR. CONSTANTINO: 15 19 No, no, no. No. I mean That's not one of our -CHAIRWOMAN OLSON: 17 18 Oh, to get the license they had to have it. 13 16 Because we've had a lot So no one has ever had it? MR. CONSTANTINO: Not at the time -- they 20 did not submit a transfer agreement as part of our 21 application for permit. 22 It's not a requirement. But during public comment that issue was 23 raised, and I'm just pointing out that, if you 24 approve this project as an ASTC, they cannot get PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 129 1 that license without that transfer agreement being 2 in place. 3 4 CHAIRWOMAN OLSON: But that's the function of IDPH and not this Board? 5 I'm sure you have some comment. 6 MR. SHEETS: Well, I do briefly. But 7 I think I understand what Mr. Constantino is saying, 8 and I would wholeheartedly agree with that. 9 are a lot of different licensure requirements, and There 10 one of them is a transfer agreement. 11 those would have to be met before the facility is 12 licensed. 13 CHAIRWOMAN OLSON: So all of Well, the only reason 14 that's an issue right now as opposed to the other -- 15 how many ever million we've looked at -- is because 16 in public comment that was brought to light. 17 MR. CONSTANTINO: Yeah. We received, from 18 the Applicants, about re- -- that if there was a 19 problem, that the Applicant would just call 911. 20 Well, you can't do that if you are a licensed ASTC. 21 You have to have a transfer agreement with the 22 hospital. 23 transfer agreement. 24 You can't have that license without that During public comment that issue was PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 130 1 brought up. 2 CHAIRWOMAN OLSON: 3 MEMBER GOYAL: 4 I understand. Madam Chair, may I ask a question? 5 CHAIRWOMAN OLSON: 6 MEMBER GOYAL: Sure. Mr. Constantino, is the rule 7 for transfer agreement 30 minutes, or is there a 8 different time period for -MR. CONSTANTINO: 9 10 I couldn't tell you, Doctor. MEMBER GOYAL: 11 Would it be a reasonable 12 thing for the Board -- of course, I don't vote -- to 13 make their recommendation subject to the transfer 14 agreement even though it's another agency that has a 15 rule? 16 MR. CONSTANTINO: 17 MR. MORADO: 18 MR. CONSTANTINO: What -- what I -- I think I -- go ahead, Mike. What I was trying to get 19 across to the Board was, if you approve this ASTC, 20 they have to have a transfer agreement in place. 21 I didn't want the Board to think that they would 22 approve this and there would be no transfer 23 agreement. 24 the Board. That's all I'm trying to point out to PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 131 That's an IDPH function but I thought the 1 2 Board needed to realize that transfer agreement will 3 be required if you approve this project. MR. MORADO: 4 Right. And I just -- to 5 piggyback on that, public comments that are made at 6 the beginning of the meeting, these folks are not 7 under oath. 8 saying deliberate lies, but they're not under oath, 9 and they're making allegations against folks who I'm not saying that they're telling -- 10 have applications up, and you should take that 11 information as you will. That said, I don't believe that it's 12 13 necessary to put any kind of condition on the permit 14 with regard to a transfer agreement. 15 MEMBER GOYAL: 16 CHAIRWOMAN OLSON: 17 Okay. please. 18 MR. SHEETS: 19 CHAIRWOMAN OLSON: 20 I think we have to be sworn in. Thank you. 22 THE COURT REPORTER: 24 Oh, I'm sorry. I thought you did that. 21 23 Comments for the Board, Raise your right hands, please. (Three witnesses sworn.) PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 132 1 2 THE COURT REPORTER: Thank you. print your names. 3 MR. SHEETS: 4 Thank you, Mr. Constantino. 5 6 And please Okay. what you were saying. Good afternoon. I finally got I appreciate that. I have with me, Madam Chair, members of the 7 Board, essentially, the physician who is going to 8 run the project if approved, Dr. -- and forgive me, 9 Doctor, if I mispronounce your name -- Makhdoom. 10 DR. MAKHDOOM: 11 MR. SHEETS: That's right. And Dr. Makhdoom would like to 12 present some testimony with regard to the project. 13 And I also have with me Anne Cooper from my office, 14 as well. 15 DR. MAKHDOOM: Good afternoon, Madam Chairman 16 and members of the Board. 17 Makhdoom, and with me are Chuck Sheets and 18 Anne Cooper, as mentioned, our CON attorneys. 19 My name is Dr. Zahoor Thank you for the opportunity to appear 20 before the Board today regarding our CON 21 application. 22 Mike Hamby of Carbondale who, unfortunately, cannot 23 be here but for his strong support of the project 24 and Senator David Luechtefeld, Congressman Mike I would also like to thank Mayor PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 133 1 Bost, and candidate for Senate Sheila Simon and 2 other political leaders in the area, and my patients 3 Joe Ann Troue and Carole Klaine for their support 4 for this project. 5 I appreciate you taking time to provide the 6 community's point of view on the value of my 7 services to the community. 8 9 The description of the project. As Mr. Constantino previously noted in his report, our 10 project is a single-specialty endoscopy center to be 11 located in Carbondale, Illinois. 12 project is limited to endoscopy, which, for a 13 gastroenterologist like myself, is a vital tool 14 I use to diagnose and treat patients in my practice. 15 Purpose of the project. Importantly, this The purpose of the 16 project -- compliance with IDPH requirements. This 17 project is before the Board because of Illinois 18 Department of Public Health requirements. 19 I currently provide endoscopy services in 20 conjunction with the operation of my medical 21 practice as permitted by IDPH rules, the ratio of 22 surgical to nonsurgical procedures is increasing due 23 to my direct-access program, which makes it easier 24 for patients in good health to schedule endoscopy While PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 134 1 2 procedures. As you are probably aware, other physicians 3 have appeared before the Board to convert their 4 office-based surgical practices to ambulatory 5 surgical centers because IDPH regulations require a 6 facility to be licensed as an ambulatory surgical 7 center if more than 50 percent of the procedures in 8 the facility are surgical procedures. 9 Although we are currently at 45 percent of 10 surgical procedures, this percentage is growing, and 11 we are requesting Board approval to establish a 12 licensed endoscopy center to avoid a potential IDPH 13 compliance action in the future. 14 Further, as Mr. Constantino noted in the 15 staff report, IDPH does not license physicians' 16 offices. 17 medical office are regulated by the Illinois 18 Department of Financial and Professional Regulation 19 through my medical license. 20 The procedures currently performed in my As a family -- as a facility regulated by 21 the IDPH, the proposed endoscopy center will be 22 required to meet life safety code and quality 23 requirements of a licensed ambulatory surgical 24 center that will assure services we provide are on PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 135 1 par with other endoscopy centers in the state. 2 is a good public health policy. This 3 Expanding access to colonoscopy. 4 access to colonoscopy and upper GI endoscopy to 5 patients residing in and around Carbondale is an 6 integral part of this project. 7 practicing physician in Carbondale for 17 years and 8 have always given back to my community. 9 I have an ethical obligation to serve patients 10 11 Expanding I have been a I believe regardless of their situation and insurance status. Colorectal cancer is the third most common 12 cancer and the second leading cancer death in both 13 genders in the United States. 14 developing colorectal cancer is nearly 5 percent. 15 The American Cancer Society projects that in 2016 16 there will be close to 135,000 new cases of 17 colorectal cancer and 50,000, unfortunately, 18 will die. The lifetime risk of 19 Consistent with national figures, colorectal 20 cancer is the second leading cause of cancer deaths 21 among Illinois adults, with over 2500 deaths 22 per year across the state. 23 treatment of colorectal cancer is essential to 24 prevention and cure, and based on this, screening Early detection and PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 136 1 colonoscopy is one of the most important elements of 2 the services we offer to our patients. 3 many initiatives to encourage colorectal cancer 4 screening, and better access to endoscopy is an 5 important element of this. 6 There are As your colleague Senator Demuzio knows 7 based on her involvement in colon cancer screening 8 advocacy, colonoscopy is the gold standard for 9 diagnosing and treating colon cancer, and every 10 individual aged 50 and older must be screened for 11 this potentially deadly disease every 10 years. 12 Current levels of colorectal cancer 13 screening in this country lag behind those of other 14 effective cancer screening tests. 15 access to colorectal cancer screening, it must be 16 affordable. 17 survey conducted by the Federal Reserve Board, 18 47 percent of Americans would struggle to pay an 19 unexpected $400 medical bill. 20 Illinois Hospital Report Card, the median charge for 21 a colonoscopy at the Carbondale-area hospitals is 22 approximately $6,000. To increase According to the latest annual consumer According to the 2014 23 Carbondale is a predominantly rural 24 community, and many residents have insurance with PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 137 1 high deductible and co-pays. 2 2500 or 5,000 upfront deductible and 20 percent 3 co-pay, the out-of-pocket cost of a colonoscopy 4 could be between 1200 and 5,000, which is out of 5 reach for many patients. 6 For a patient with a Without a low-cost option, patients are 7 faced with the difficult choice of foregoing this 8 important screening procedure or traveling 50 miles 9 to Cape Girardeau or other areas of Missouri where 10 11 the cost of these procedures is much lower. I firmly believe better outcomes occur with 12 education, early detection, and treatment. 13 increase the rates of colorectal cancer screening, 14 this must be affordable to all. 15 agreed to provided free colonoscopies to patients 16 referred by Shawnee Health Center, offer colonoscopy 17 and upper GI endoscopy assistance programs for 18 uninsured and underinsured patients, and provide a 19 direct-access program to patients in good health who 20 want to save money on avoidable office visits. 21 To To that end I've In April of this year, I entered into an 22 arrangement to provide access to free colonoscopies 23 to uninsured patients who Shawnee Health Center 24 selects to refer to my clinic. Shawnee Health PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 138 1 Center strives to improve the health and welfare of 2 residents of southern Illinois by serving the needs 3 of vulnerable and underserved patients. 4 While the initial agreement provided for 5 five free colonoscopies per month, there is a 6 significantly increasing need for this service; 7 therefore, I've agreed to provide free colonoscopies 8 to any patient referred by Shawnee Health Center 9 even if the monthly cap is exceeded. 10 11 I have already opened my practice to these patients. Additionally, through a colonoscopy-assist 12 program I offer, patients with means to pay but 13 with inadequate insurance coverage pay a flat fee of 14 $1500, which covers my professional fee, anesthesia 15 fee, pathology fee, and facility fee, including 16 nursing costs. 17 In contrast, the $6,000 fee noted above only 18 includes one of the four elements, the hospital 19 facility fee. 20 the physician's fee separate, anesthesiology fee 21 separate, and pathology fee separate. 22 roughly 2,000 to $3,000, and that's added to the 23 cost to the patient. 24 Patients are separately billed for Those are Similar to the colonoscopy-assist program, PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 139 1 under the upper GI-assist program, patients pay a 2 flat $900 fee for an upper GI endoscopy or EGD, 3 called. 4 services. 5 The flat fee covers the same scope of As previously noted, Carbondale is 6 predominantly rural and average income is 33,000 on 7 the record, with just over 50 percent of the 8 population being below the Federal poverty level. 9 For those patients who can't afford the flat fee, 10 they pay what they can afford and the balance 11 generally is written off. 12 our 17 years of practice, any collection agencies. 13 We have never hired, in As I first mentioned, I offer a direct- 14 access program, but I need to explain what that is. 15 The direct-access program is something I do in 16 coordination with a patient's primary care 17 physician. 18 primary care physician can help patients in good 19 health get an appointment for a screening 20 colonoscopy without first having a face-to-face 21 consultation for the required history and physical 22 with the gastroenterologist who will perform the 23 screening exam. 24 During general periodic exams a As the screening exam is required at 50 and PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 140 1 periodically thereafter, we seamlessly coordinate 2 these screenings with the patient's primary 3 physician, which avoids an extra doctor's 4 appointment. 5 office doesn't occur when a patient is a direct- 6 access patient, it increases the ratios of surgical 7 versus nonsurgical encounters at my office. 8 has required me to delay some of my surgeries at 9 certain points in time in order to ensure that in Because a nonsurgical visit to my This 10 any given week I don't do more surgical cases than 11 nonsurgical consults. 12 It is important to note both my medical 13 practice and the proposed endoscopy center cannot 14 qualify for tax exemption as the hospitals do 15 because we are a private business. 16 is I, unlike the hospitals, do not avoid paying 17 taxes under Federal, state, property, and sales tax 18 laws nor am I eligible for tax-exempt bond financing 19 or to receive charitable contributions from donors. 20 What that means According to a 2011 Health Affairs study, 21 the estimated value of Federal, state, and local tax 22 exemptions, tax-deductible charitable contributions 23 and tax-exempt financing was 24.6 billion in 2011. 24 Based upon Southern Illinois Hospital PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 141 1 Services' -- or SIH Services' -- 2014 990 return, 2 the system's net income was approximately 3 57 million. 4 35 percent, SIHS' Federal tax liability would have 5 been 20 million; however, the collective charity 6 expense as reported in the annual hospital 7 questionnaire for the three hospitals controlled by 8 SIHS was approximately 13 million in 2014 or a 9 difference of 7 million between its potential Assuming a corporate tax rate of 10 Federal income tax liability and amount of 11 charitable -- charity care provided. 12 Further, my charitable activities are 13 voluntary. 14 the hospitals. 15 significant amounts of charity care, we do not track 16 it because we are not required to report it, nor 17 does it provide us any financial benefits as it does 18 the hospitals. 19 I have no charitable obligations like While my practice provides Negative findings. I would like to address 20 the negative findings to the State Board report. 21 Service demand/treatment room need 22 assessment. This project has the same elements out 23 of compliance as all the other ambulatory surgical 24 center applications have had in the past; namely, PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 142 1 treatment room need assessment and utilization of 2 other providers in the area. 3 situation where the medical practice associated with 4 the project is running up against the surgical 5 versus nonsurgical encounter threshold. 6 current Board rules provide that these referrals 7 cannot be taken into account to determine need for 8 the proposed facility, I'm seeking a license for my 9 endoscopy services to ensure my medical practice This is also another While 10 complies with IDPH requirements relating to the 11 scope of care permitted for a gastroenterology 12 medical practice. 13 Further, the provision of endoscopy services 14 in an ambulatory surgical center setting is 15 consistent with the cost-containment mandate of the 16 Board by providing endoscopy services at a lower 17 cost to patients and payers compared to the hospital 18 setting. 19 Service accessibility/unnecessary 20 duplication and maldistribution of services. The 21 other two findings concern underutilization of 22 existing providers in the area. 23 outpatient departments are not an appropriate 24 setting for endoscopy procedures that can be safely First, hospital PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 143 1 performed in an ambulatory surgical treatment 2 center. 3 seeking to improve cost efficiencies, now require 4 prior authorization for upper and lower 5 gastrointestinal procedures performed in a hospital 6 outpatient setting. 7 required to do the procedure in an ambulatory 8 surgical center. In fact, payers like UnitedHealthcare, No such prior approval is Further, hospitals that are more proactive 9 10 in ensuring lower cost access to services in the 11 community -- like Advocate, Northwest Community 12 Hospital, and Presence -- are investing in 13 ambulatory surgical centers to improve access to 14 lower-cost services for their communities. As noted above, the median charge for a 15 16 colonoscopy at one of the Carbondale hospitals is 17 approximately 6,000 plus 2,000 additional costs on 18 part of physician fee, anesthesia fee, pathology 19 fee. 20 proposed endoscopy center will only be $1500, 21 including all services. 22 The maximum charge for a colonoscopy at the Further, the proposed endoscopy center will 23 provide assistance programs to uninsured and 24 underinsured patients. Importantly, these PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 144 1 assistance programs will cover all of the costs of 2 the endoscopy procedure while the hospital financial 3 assistance programs will only provide the facility 4 fee, meaning the patient will still be responsible 5 for the physician fee, which is roughly around 550 6 or $750; anesthesia fee, roughly around 500 fee; 7 pathology fee, roughly around 1200 to 1500 fee. 8 9 Further, there are no single-specialty facilities in the service area that exclusively 10 provide endoscopy services with a focus on 11 colorectal cancer screening. 12 are multispecialty centers and not only perform 13 gastrointestinal procedures. 14 surgical procedures going on, too. 15 Two surgical centers There are other Physicians Surgical Center, which performs 16 gastrointestinal procedures, is operating at the 17 State Board standards. 18 Marion Healthcare are nearly 30 minutes away. 19 I had to perform endoscopy procedures at other 20 providers in the area, it would be extremely 21 disruptive to my practice and the physician extender 22 care model we have developed. 23 24 Marion Surgical Center and I need to be at the office location to supervise and collaborate with my physician PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM If DraftFull Meeting Conducted on June 21, 2016 145 1 extenders and to most effectively and efficiently 2 deliver care to my patients. 3 Gastroenterology is a relatively small 4 specialty and only roughly 225 new fellows enter the 5 field each year. 6 new doctor to a nonurban location in Illinois, so my 7 physician extenders are key to the delivery of GI 8 care in our community. 9 my practice if I don't do my work at the same 10 11 It is very difficult to recruit a I cannot effectively manage location as them. We are here today to require a CON permit so 12 we can pursue a license as required by IDPH in order 13 to continue this model where I perform my simple 14 endoscopy procedures in my office. 15 moving cases away from hospitals. 16 their own gastroenterologists. 17 SIHS opposition. We are not They have four of With regard to the 18 hospitals' opposition, I would like to add some 19 context to the comments. 20 gastroenterologist in the Carbondale area and have 21 been in practice there for 17 years. 22 directly with the primary hospital, which employs 23 its own gastroenterologists. 24 permitted by Federal law to require their employed I'm the only independent I compete Since hospitals are PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 146 1 physicians to refer to other hospital-employed 2 physicians, I'm in a tenuous position of potentially 3 losing my patient base to the hospital-employed 4 physicians. 5 employed physicians would be penalized for referring 6 patients to me for gastrointestinal services. 7 important to me to maintain my independence, as I 8 can better serve the Carbondale community as an 9 independent gastroenterologist. In fact, in 2014 I learned hospital- It is I should not be 10 forced to work with the health system that is trying 11 to strip me of my patient base due on their size and 12 power in the community. 13 SIHS System states there are existing 14 facilities in the area that are underutilized. 15 noted previously, hospitals are not appropriate 16 settings for endoscopy procedures that can be safely 17 and cost effectively performed in an ambulatory 18 surgical center. 19 specialty facility in the service area focused on 20 colorectal cancer screening. 21 30 minutes to perform endoscopy procedures at 22 underutilized facilities would be detrimental to my 23 model of care. 24 As Further, there is no single- Finally, traveling SIHS claims the in-office procedures should PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 147 1 not be used to justify the need for the project. 2 I want to reiterate that I'm seeking a license for 3 my endoscopy services to ensure my medical practice 4 complies with IDPH requirements. SIHS claims the proposed endoscopy center 5 6 does not have a transfer agreement with a hospital 7 in the region. 8 agreement -- requirement -- and -- not a CON permit 9 requirement. 10 First, this is not -- a licensure This is a licensure requirement and not a CON requirement. 11 Secondly, my practice currently has a 12 patient transfer agreement with Heartland Regional 13 Medical Center, which is 15 minutes away from my 14 center, where I'm currently on admin staff. 15 Finally, with regard to the payer mix of the 16 proposed endoscopy center, I'm enrolled in Medicaid 17 and my current patient base is approximately 18 5 percent Medicaid; however, it is increasing every 19 day. 20 Based on the 2014 annual questionnaire, the 21 statewide percentage of total net revenue from 22 Medicaid for ambulatory surgical centers was 23 2.3 percent. 24 project to provide is over twice the statewide The amount of Medicaid services we PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 148 1 average of surgery centers. Further, as previously discussed, we will 2 3 offer free colorectal cancer screening to patients 4 referred by Shawnee Health Center as well as 5 financial assistance to uninsured and underinsured 6 patients. 7 will be a safety net provider of much needed 8 endoscopy services to patients residing in 9 Carbondale. Thank you for your time and attention, and 10 11 I would be happy to answer any questions you have. CHAIRWOMAN OLSON: 12 13 In short, the proposed endoscopy center members? 14 Doctor. 15 MEMBER GOYAL: 16 Questions from Board Thank you, Madam Chair, for the opportunity to learn more. 17 Thank you, Dr. Makhdoom, for trying to do 18 something that is not necessarily common in your 19 area. 20 DR. MAKHDOOM: Thank you. 21 MEMBER GOYAL: So I have a series of 22 questions and please understand I represent 23 Medicaid -- 24 DR. MAKHDOOM: Sure. PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 149 1 2 3 4 MEMBER GOYAL: have a vote so -MR. SHEETS: Doctor, can I interrupt you for a minute? 5 MEMBER GOYAL: 6 MR. SHEETS: 7 -- on this Board and I don't It's short but go ahead. You said that before, you represent Medicaid -- 8 MEMBER GOYAL: 9 MR. SHEETS: I do. -- but -- 10 CHAIRWOMAN OLSON: 11 MR. SHEETS: 12 He does. Because I'm just a little -- you're Department of Public Health; correct? 13 MEMBER GOYAL: No, I'm not. 14 MR. SHEETS: 15 CHAIRWOMAN OLSON: 16 MEMBER GOYAL: 17 MR. SHEETS: 18 MEMBER GOYAL: 19 So my first question to you is, in these 20 documents that you submitted, you indicate that 21 there's is 5 percent Medicaid and there is 22 10 percent self-pay, meaning uninsured, and you also 23 indicated in your comments that approximately 24 50 percent of the population is below poverty. Oh, you're not? That's Bill. I look like it but I don't. My apologies. No problem. PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 150 Can you match that with your practice, what 1 2 the demand will be? DR. MAKHDOOM: 3 Yes. The numbers we 4 presented are from 2015, and '16 has just almost 5 doubled. We haven't assembled the numbers. 6 MEMBER GOYAL: 7 10 percent Medicaid? 8 DR. MAKHDOOM: 9 10 So "double" means you have 10 percent or even more. We are doing, every day, three to four patients of public aid on the record in 2016. 11 MEMBER GOYAL: Okay. 12 DR. MAKHDOOM: Now, hospital has 13 multispecialty. They have L&D, ob-gyn, surgery, 14 geriatrics, young medicine, family medicine, so the 15 number of public aid is high. 16 specialty. 17 number. I am one single So only GI services, we have that 18 MEMBER GOYAL: Yeah, I understand. 19 What is the wait time for somebody to 20 schedule a screening colonoscopy in your practice 21 today once the request is received? 22 DR. MAKHDOOM: Now, if the request is coming 23 from Shawnee Health physician, they all go with the 24 family history. If the history is strong, within a PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 151 1 week we scope. 2 approaches, within a week we scope. 3 screening colonoscopy. 4 5 This is screening. MEMBER GOYAL: Okay. If a patient That's a So the wait time normally is -- 6 DR. MAKHDOOM: One week. 7 MEMBER GOYAL: -- a week or less? 8 DR. MAKHDOOM: One week or less. 9 MEMBER GOYAL: Okay. And then my second 10 question is, currently -- the way I understand the 11 system -- for all of your patients, including 12 commercial, Medicaid, or whatever, you're not able 13 to charge a facility fee. 14 DR. MAKHDOOM: No. 15 MEMBER GOYAL: Right. With the ASTC 16 everybody will pay a facility fee unless it's one of 17 your free patients? 18 DR. MAKHDOOM: They do, but that will 19 cover -- not uninsured patients. Now, I'm not sure 20 how many insurances are going to pay that. 21 (An off-the-record discussion was held.) 22 DR. MAKHDOOM: We have a flat-fee program, 23 colonoscopy-assist and EGD-assist programs, so that 24 flat fee is $1500, including all services, for PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 152 1 colonoscopy and $900 for upper endoscopy, including 2 all services. MEMBER GOYAL: 3 Right. So it -- your answer 4 to my question is that, by having an ASTC, you think 5 you'd be able to serve more uninsured and Medicaid 6 patients -- 7 DR. MAKHDOOM: Absolutely. 8 MEMBER GOYAL: -- however, the cost of care 9 for everybody else will go up because now their bill 10 will be itemized to show a facility fee? 11 incorrect in saying that? 12 MR. SHEETS: Am I If the patient were to come to 13 his physician office practice, that is correct, 14 Doctor. 15 else because he's in -- But if the patient were to go somewhere 16 MEMBER GOYAL: 17 MR. SHEETS: I'm not comparing --- close to 50 percent, you 18 know, then they would have to be referred out, and 19 then they would have to pay that fee anyway. 20 21 22 But, in theory, you're correct if they came to his physician office practice now. MEMBER GOYAL: So if these numbers are 23 correct that you supplied -- and you've said that 24 the numbers had changed a little bit in the last -- PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 153 1 DR. MAKHDOOM: In '16, 2016. 2 MEMBER GOYAL: Right. So let's say if the 3 numbers were what you presented, 85 percent of your 4 patients with those previous numbers would pay 5 more -- will -- it will become more expensive for 6 them as opposed to the 15 percent according to these 7 numbers? 8 9 10 Am I extrapolating accurately? DR. MAKHDOOM: No. My maximum fee is 1500 whether from insurance or assist plans or whatever. It is not more than 1500. 11 MEMBER GOYAL: For colonoscopy? 12 DR. MAKHDOOM: For colonoscopy. 13 MEMBER GOYAL: So may I ask -- and it will 14 help me tremendously to understand your colonoscopy- 15 assist program. 16 DR. MAKHDOOM: Yes. 17 MEMBER GOYAL: The charge that you have 18 here, $1500 for colonoscopy, 900 for upper 19 endoscopy -- I'm curious. 20 get paid from commercial and Medicare patients for 21 the same procedure? 22 23 24 DR. MAKHDOOM: Sure. What do you charge and Commercial pay me $850 but they pay me -MEMBER GOYAL: For colonoscopy? PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 154 1 DR. MAKHDOOM: For EDG. 2 MEMBER GOYAL: Okay. 3 DR. MAKHDOOM: But they pay me for pathology 4 separate. MEMBER GOYAL: 5 6 But everybody doesn't need the pathology. 7 DR. MAKHDOOM: Mostly do. 8 MEMBER GOYAL: Really? 9 DR. MAKHDOOM: Well, we are looking for 10 polyps. At our age you would be surprised. 11 than half have pathology. 12 procedure to move. More Pathology is a simple We are subject to pathology -- 13 MEMBER GOYAL: Okay. 14 DR. MAKHDOOM: -- so our services include 15 16 17 18 pathology. And on colonoscopy commercial pays me -- in fact, on multiple tests -- not more than $1200. MEMBER GOYAL: Okay. So why is your 19 colonoscopy-assist program cheaper when you're 20 charging $1500 for colonoscopy and 900 for upper? 21 22 23 24 DR. MAKHDOOM: We want to serve the community. MEMBER GOYAL: No, no. But didn't you just say that Medicare pays you -- PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 155 1 DR. MAKHDOOM: No. Medicare pays me 2 nothing. Medicare pays me $250 for the scope, and 3 they pay separate for pathology if there's 4 pathology, as you said. 5 MEMBER GOYAL: 6 getting a bundled -- 7 DR. MAKHDOOM: Bundled. 8 MEMBER GOYAL: -- payment, which is about 9 10 11 Right. But here you're eight times more than Medicare. DR. MAKHDOOM: mentioning? Now, which are you We showed everything. 12 MEMBER GOYAL: Let's talk about colonoscopy. 13 DR. MAKHDOOM: Yes. 14 MEMBER GOYAL: Your colonoscopy-assist 15 program, you're charging them $1500. 16 DR. MAKHDOOM: 15. 17 MEMBER GOYAL: And you think it's a 18 Absolutely. community service and we appreciate that. 19 DR. MAKHDOOM: Yes. 20 MEMBER GOYAL: So when you do a colonoscopy 21 on a Medicare patient, did you just say that you're 22 being paid $250? 23 24 DR. MAKHDOOM: No -- if there's nothing. there's -- PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM If DraftFull Meeting Conducted on June 21, 2016 156 MEMBER GOYAL: Right. 3 DR. MAKHDOOM: Exactly. 4 So maximum per -- Medicare pays for only 1 2 Right. If there is -- 5 colonoscopies, about 450 or 500, but then they add 6 on pathology if you have pathology. 7 8 9 10 MEMBER GOYAL: I understand that but that's -- usually pathology's free. DR. MAKHDOOM: But we have in-house pathology -- 11 MEMBER GOYAL: Right. 12 DR. MAKHDOOM: -- and that's why I'm able to 13 provide a flat feet. 14 MEMBER GOYAL: Yeah. 15 DR. MAKHDOOM: Yes, for bundled. 16 MEMBER GOYAL: But your bundled price, the You've bundled them? 17 fee is higher than what Medicare and Medicaid are 18 paying you -- 19 20 MR. SHEETS: asking, Doctor -- 21 MEMBER GOYAL: 22 MR. SHEETS: 23 24 I think I know what you're -- correct? -- and you're a hundred percent correct. MEMBER GOYAL: Okay. PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 157 1 MR. SHEETS: The only thing I would mention 2 is, when you get a facility fee, a physician -- if 3 you get a physician fee in a setting that the doctor 4 has now, it is a larger physician fee than you would 5 get when you have a facility fee that goes along 6 with it. 7 So it's not just an add-on. The physician 8 fee goes down when there's a facility fee associated 9 with it. 10 MEMBER GOYAL: 11 MR. SHEETS: 12 MEMBER GOYAL: 13 So I have a need to ask you this one 14 15 16 17 Right. Yes. Just so you know. Yeah, I understand that. question that -- I'm totally unclear. What is your relationship -- why did you resign from these other hospitals? DR. MAKHDOOM: Now, I served them 13 years. 18 And while I was there, they started recruiting their 19 own gastroenterologists, and they told me that they 20 have to refer to their own gastroenterologists, so 21 they took away two days from me. 22 And they told me to go to St. Joseph's and 23 another facility close by. But then Tuesday was the 24 only day they could do now for a urologist, so I had PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 158 1 to take to my office. 2 started. 3 so I would do like a -- 150 in my office, 4 times in 4 the hospital. 5 That's where the system When I started practicing in my office -- But then sometimes I do one spouse in my 6 office and the other spouse in hospital, and then 7 the hospital bill would be so high that the spouse 8 would come in very angry, "Why didn't you do this in 9 your practice? 10 Because I cannot afford this bill." So -- and then they increased their number 11 of recruitment -- now they have four. 12 to work the same days, so I had to do something, so 13 I started doing them at my office. 14 They wanted And you would be surprised to see how they 15 were allocated, if they see the hospital bill versus 16 their spouse's that would be done in my office. 17 that's why we started doing it. 18 And they mentioned the opposition. So I used 19 to take Medicare patients with advanced conditions, 20 where anesthesia and other care was needed at the 21 hospital level. 22 in my office but now I don't. 23 I used to take to hospital, patient -- facility. 24 Initially I did have that capacity MEMBER GOYAL: So advanced cases Thank you, Doctor. PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 159 1 DR. MAKHDOOM: Thank you. 2 CHAIRWOMAN OLSON: 3 MEMBER SEWELL: 4 I'm looking at the State agency report, and Other questions? Yes. 5 it's the treatment room need assessment criteria. 6 And you stated in your testimony that, you 7 know, what you're doing is consistent with what 8 other applications we've received were with respect 9 to this criteria, but the -- according to the State 10 agency report, it's suggesting that, based on your 11 demand over the last two years, you only justify one 12 procedure room but you're proposing two. So can you give me a reason you're proposing 13 14 two other than the fact that all the other people do 15 that? 16 DR. MAKHDOOM: No. We initially started in 17 one procedure room, but the ADI -- unfortunately, 18 sometimes the machine will be down or whatever, then 19 my patients will wait. 20 So I created another room, and I have a 21 duplicate system in the room. 22 not working, I can just go to the other room. 23 24 So if this system is But now if you look at the two rooms, the flow is so quick. Patients are seen quicker, no PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 160 1 long wait. And while you finish this, other patient 2 is being wheeled into the other room. 3 really -- in every facility two rooms are justified 4 for better services. 5 room, and something goes wrong with the machines, 6 whatever, then I'm stuck. But if I had one system only, So I needed another room. 7 8 duplicate system there, too. 9 patients. MEMBER SEWELL: 10 11 I have a That helps my So it's to reduce patient wait time? 12 DR. MAKHDOOM: 13 MEMBER SEWELL: 14 So it is Wait time. Is there some standard for that? DR. MAKHDOOM: 15 No. The standards are the 16 same. 17 approved, accredited, and two times ASGE or 18 endoscopy society accredited for excellent center. 19 We hired an architect who is familiar with IDPH 20 rules and, according to him, he's satisfied we have 21 enough room to put two rooms and equipment in there. 22 23 24 We've got two times Joint Commission MEMBER SEWELL: Well, I'd like to ask Mr. Constantino. When you looked at their demand and you PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 161 1 determined that one procedure room was needed, was 2 there any slack in that at all or -- how did you 3 account for that? 4 MR. CONSTANTINO: Well, we can only accept 5 those procedures that were performed in a licensed 6 ASTC or a hospital -- 7 MEMBER SEWELL: 8 MR. CONSTANTINO: I see. -- and the 462 procedures 9 were performed in an ASTC or a hospital, and that 10 justifies the one procedure room, not two, as was 11 requested. 12 MEMBER SEWELL: Okay. 13 CHAIRWOMAN OLSON: What would you estimate 14 the turnover time of those rooms is? 15 who runs clinics, I can't imagine -- you have to 16 account for turnover time and, like you said, 17 equipment being down -- I can't imagine having one. 18 DR. MAKHDOOM: As somebody Upper endoscopy roughly take 19 the doctor 5 to 7 minutes, roughly, 10 minutes. 20 then take -- the patient is wheeled out, and then 21 I have an area where recovery is close by, and from 22 there patient is wheeled in. 23 20 minutes. 24 CHAIRWOMAN OLSON: And Colonoscopy takes us No, I'm asking -- in PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 162 1 between patients. 2 I think in hospital hours it's like 30 minutes -- 3 right? -- to turn -- 20 to 30 minutes to turn that 4 room over so it's ready for the next patient -DR. MAKHDOOM: 5 6 CHAIRWOMAN OLSON: 11 12 13 We Okay. Do you know what I'm -MR. SHEETS: 9 10 No, we have -- yeah. have -- in and out takes 1 hour 30 minutes. 7 8 What does it take you, like -- I think I know what you're saying. CHAIRWOMAN OLSON: You're not answering the question. MR. SHEETS: I think what she wants to know 14 is, once the patient gets wheeled into the room, 15 another patient's wheeled out, how long does it take 16 to get that room ready for the next patient? 17 CHAIRWOMAN OLSON: I'm trying to say I don't 18 know how you could -- from a workflow standpoint it 19 would make no sense to have one room because I'm 20 guessing it takes you 25 to 30 minutes to roll that 21 room over after the first patient's rolled out 22 before the second patient can come in. 23 DR. MAKHDOOM: Yeah. 24 CHAIRWOMAN OLSON: So your workflow -- now, PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 163 1 what you're going to do is, while they're turning 2 over that first room, you're going to take the next 3 patient in the second room, and then the first 4 room's ready for you again, and then the second 5 room's ready for you. 6 DR. MAKHDOOM: 7 CHAIRWOMAN OLSON: 8 Yes. Exactly. Exactly. Sounds like it's like 20, 25 minutes, I would suspect. MEMBER MC GLASSON: 9 Doctor, you mentioned 10 your work with Shawnee Health Service. 11 some similar organizations in the Carbondale area. 12 Are you exclusively offering that service to Shawnee 13 or -- 14 DR. MAKHDOOM: There are We offered a similar service 15 to Dixon Health Center, but then they were 16 shrinking, so they requested us to liaison with 17 Shawnee alone because they are losing the population 18 and their number of large services have been 19 falling, too. 20 facilities. So the offer was available at other 21 CHAIRWOMAN OLSON: 22 (No response.) 23 CHAIRWOMAN OLSON: 24 MR. SHEETS: Other questions? Actually -- You know, I hate to even bring PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 164 1 this up but I'm going to -- 2 CHAIRWOMAN OLSON: 3 MR. SHEETS: 4 5 Uh-huh. -- because I just turned 60 so all of this is really strikingly familiar to me. When I was 50 I had my first one, and I went 6 to a hospital, the same doctor's practice, DuPage 7 Medical Group; a lot of people know them. 8 it was time to schedule the second, because I turned 9 60, I went to a surgery center in Lombard. And when 10 So I think that the biggest thing that I can 11 emphasize in the doctor's presentation is that, you 12 know, the Blue Cross Blue Shields of the world are 13 not approving these procedures in hospitals without 14 some preapproval process because they believe the 15 charges are higher. 16 So, again, we're looking at a change in how 17 these particular procedures are provided, and 18 I would just emphasis this is a single-specialty 19 surgery center in southern Illinois and the doctor 20 just wants to be able to treat his patients and meet 21 the IDPH requirements. 22 23 24 CHAIRWOMAN OLSON: So while you're still on that -- because I have a question. So to your point there -- and I believe, PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 165 1 Doctor, what you stated was that there's one other 2 ASTC in Carbondale who does colonoscopies in the 3 ASTC but they're over capacity at this point. 4 Did I get that correctly? 5 DR. MAKHDOOM: I -- this is a multispecialty 6 center, is not single specialty. 7 services. CHAIRWOMAN OLSON: 8 9 And they're over -- they're over capacity? So if I wanted to -- if I -- because I'm 60, 10 11 too -- 60, also. 12 record. 13 They do all Make sure we got that on the If I wanted to have a colonoscopy and lived 14 in Carbondale, I don't want to go to a hospital and 15 have it, my insurance doesn't want me to go to the 16 hospital to have it, where can I go -- right now, 17 today -- in Carbondale? 18 DR. MAKHDOOM: My center. 19 CHAIRWOMAN OLSON: So the multispecialty 20 doesn't do it, either? Or they do do it but you 21 would be the only single specialty? 22 DR. MAKHDOOM: 23 CHAIRWOMAN OLSON: 24 That's right. And then -- and so you're the only, at this point, independent GI doc in -- PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 166 DR. MAKHDOOM: 1 2 Carbondale. CHAIRWOMAN OLSON: 3 4 The only independent in Carbondale -- 5 DR. MAKHDOOM: 6 CHAIRWOMAN OLSON: 7 -- is a hospital employee. And you did say that you're on active staff at Heartland Hospital? 8 DR. MAKHDOOM: 9 CHAIRWOMAN OLSON: 10 Every other GI doc in Heartland Hospital, yes. And does that require you to take call? 11 DR. MAKHDOOM: Yes. 12 CHAIRWOMAN OLSON: Okay. So if you were on 13 active staff at all these other hospitals, would you 14 have to take call at all these hospitals? 15 DR. MAKHDOOM: 16 CHAIRWOMAN OLSON: 17 No. With Heartland, yeah. But you don't -- if you're active staff with one hospital, you don't -- 18 DR. MAKHDOOM: One hospital. 19 CHAIRWOMAN OLSON: And then I want -- Mike, 20 this is a question for you. I want some 21 clarification on this IDPH issue. So can you explain that to me a little bit 22 23 more? He's really -- if he does any more 24 colonoscopies the way he is right now, he's going to PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 167 1 be out of IDPH compliance unless he's an ASTC? 2 Is that what I'm understanding from that? 3 MR. CONSTANTINO: 4 interpretation of that, Kath. 5 that requirement in that fashion. 6 7 8 9 10 That's not my Okay? I don't view And I've talked to IDPH about this, and I hope -- I tried to explain it in this -CHAIRWOMAN OLSON: And I wrote next to your explanation "Huh?" question mark. MR. CONSTANTINO: They look at everything 11 performed at that site, IDPH does -- visits, 12 procedures, everything -- to determine the 13 50 percent criteria. 14 MR. SHEETS: I think Anne would be better 15 suited to answer this because I think she 16 understands how IDPH defines "procedures." 17 Is that right, Anne? 18 MS. COOPER: Basically, what we did in order 19 to come up with the 45 percent threshold is we 20 looked at all the physician encounters, which is 21 essentially the surgical procedures that are being 22 performed as well as the consult -- the consults. 23 Dr. Makhdoom also does other procedures that are 24 related to Crohn's disease. And so any kind of PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 168 1 procedures that are performed by Dr. Makhdoom or his 2 physician extenders, we looked at that in 3 determining what the level of surgical versus 4 nonsurgical activities were. 5 And so based upon that -- and a lot of this 6 is driven by, as Dr. Makhdoom had mentioned, his 7 direct-access program whereby patients who are in 8 good health can coordinate with their PCP and 9 Dr. Makhdoom to actually have a colonoscopy without 10 having to come into the office to get a consult. 11 it's actually driving the number of physician 12 consults down and then the physician -- and the 13 actual procedures up, and that's kind of why we're 14 kind of butting up against that 50 percent 15 threshold. 16 CHAIRWOMAN OLSON: And your concern is that, 17 if you exceed that, you're going to be in trouble 18 with IDPH, and you don't want to go over that 19 threshold? 20 MS. COOPER: So Correct. And, basically -- and 21 as Dr. Makhdoom has said in his presentation, there 22 are some times during a week where he has more 23 endoscopies scheduled than consults. 24 within that 50 percent threshold, he'll push some of And so to stay PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 169 1 his colonoscopies or other endoscopic procedures off 2 to another week in order to stay within that 3 threshold. 4 5 6 7 8 9 So he's very aware of that threshold, and he's butting up against it. CHAIRWOMAN OLSON: Did IDPH weigh in? didn't ask them to? MR. CONSTANTINO: I talked to Karen Senger, who's in charge of that department, and that's not 10 the interpretation she gave me. 11 you all -- 12 CHAIRWOMAN OLSON: 13 their interpretation is. 14 yours is. 15 Or we MR. CONSTANTINO: Okay? I'm telling So I understand what I don't understand what The activity -- all 16 activity at that site needs to be taken into 17 consideration when you determine the 50 percent 18 threshold. 19 an activity. 20 that would be an activity. 21 interpreted that rule for years. 22 You could dispense an aspirin and that's You could have a patient visit and That's how IDPH has The other alternative -- if you don't 23 approve this, the doctor would have to send -- to 24 do -- perform some of these procedures at a hospital PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 170 1 or another facility if they -- if he feels he's in 2 danger of going over the 50 percent. CHAIRWOMAN OLSON: 3 Which, to your point, 4 Chuck, a lot of insurances don't want to do -- 5 I know mine won't. 6 thing or something else going on or I -- they won't 7 do it in a hospital. I mean, I have to have a heart 8 MR. SHEETS: There has to be some 9 complication or something. 10 CHAIRWOMAN OLSON: 11 Other questions? 12 MEMBER MC GLASSON: 13 Yes, Madam Chair, although I'm not sure if it's a question or statement. THE COURT REPORTER: 14 15 Right. Could you use your mic, please? 16 MEMBER MC GLASSON: 17 I'm not sure if it's a question or a 18 19 Yes. statement, Doctor. You are going to be such more reasonably 20 priced than anybody in your area. If you were to 21 become so terribly busy that it strains the 22 50 percent, is there a way we can be assured that 23 the charity care and the reduced care patients are 24 not going to be pushed out of the way? PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 171 1 DR. MAKHDOOM: I can give you assurance. 2 I've been doing these services and involved in 3 community service for 17 years. 4 practice, my purpose is to serve my community and 5 I belong there. 6 7 Outside a very good I can strongly assure you that. CHAIRWOMAN OLSON: Other questions or comments? 8 (No response.) 9 CHAIRWOMAN OLSON: Seeing none, I'll ask for 10 a roll call vote. 11 MR. ROATE: 12 Motion made by Mr. Sewell; seconded by 13 Thank you, Madam Chair. Mr. Galassie. 14 Mr. Galassie. 15 MEMBER GALASSIE: 16 upon staff concerns and financing. 17 MR. ROATE: 18 Justice Greiman. 19 MEMBER GREIMAN: 20 MR. ROATE: 21 Mr. Johnson. 22 MEMBER JOHNSON: 23 24 I'll be voting no based Thank you. I vote aye. Thank you. I vote no based on the staff report. MR. ROATE: Thank you. PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 172 1 Mr. McGlasson. 2 MEMBER MC GLASSON: 3 I will vote yes based on the fact that I believe it's a pioneering effort. 4 MR. ROATE: Thank you. 5 Mr. Sewell. 6 MEMBER SEWELL: I'm going to pass. I don't 7 completely understand all the issues in this 8 program. 9 alternatives to what's being proposed. It sounds like there are some systems 10 I'm just not sure so I'm going to pass. 11 MR. ROATE: 12 Madam Chair. 13 CHAIRWOMAN OLSON: 14 This is a hard one for me, but I'm 15 actually -- I'm actually going to vote yes based 16 upon a couple different factors. 17 Thank you, sir. Yes. First of all, as somebody who runs five 18 clinics, I can easily, in my head, understand why 19 you have to have two rooms instead of one. 20 can't have patients sitting, waiting 25 minutes for 21 the staff to clean it before the next procedure, so 22 I can explain that. 23 24 You I also -- I don't fully understand the ASTC issue, but I understand what he's running up against PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 173 1 when I sit and think of trying to schedule 11 docs 2 for a day and I have to go, "Okay. 3 so many appointments that are actual procedures, and 4 if I go over 50 percent of what are actual 5 procedures, I've got to push those procedures out 6 and do more exams or more" -- I don't know how you 7 can run a practice that way. 8 understand the rule, but I can't -- I can't wrap my 9 head around it. I can only have I guess I don't wholly 10 But I think -- I totally understand the 11 insurance thing because I've just been through this. 12 My insurance will not approve me to have a 13 colonoscopy in a hospital. 14 Carbondale, I'd drive out of town to have that done. 15 It's not a great thing to do anyway, but to have to 16 drive out of town to do it -- so I -- for those 17 reasons I vote yes. So if I lived in 18 MR. ROATE: Thank you, Madam Chair. 19 That's 3 votes in the affirmative; 2 votes 20 in the negative; 1 vote to pass. 21 CHAIRWOMAN OLSON: 22 MR. SHEETS: Thank you. 23 MR. MORADO: You're going to be receiving an 24 intent to deny. Motion fails. You'll have an opportunity to PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 174 1 provide more information. If you'd like, you can 2 appear again before the Board. 3 MR. SHEETS: Thank you. 4 MS. COOPER: Thank you. 5 CHAIRWOMAN OLSON: 6 We are going to take a 10-minute break. 7 8 9 10 is 2:10. Thank you. We'll be back here at 2:20. (A recess was taken from 2:10 p.m. to 2:20 p.m.) - - - 11 12 13 14 15 16 17 18 19 20 21 22 23 24 PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM It DraftFull Meeting Conducted on June 21, 2016 175 1 CHAIRWOMAN OLSON: Next we have 2 Project 16-011, Northbrook Behavioral Health 3 Hospital. 4 May I have a motion to approve 5 Project 16-011, Northbrook Behavioral Hospital, to 6 establish a 100-bed acute mental illness hospital. 7 MEMBER JOHNSON: 8 MEMBER SEWELL: 9 CHAIRWOMAN OLSON: 10 So moved. Second. Second, please -- thank you. 11 The Applicant will be sworn in. 12 (Six witnesses sworn.) 13 THE COURT REPORTER: 14 CHAIRWOMAN OLSON: 15 Thank you. Mr. Constantino, your report, please. 16 MR. CONSTANTINO: Thank you, Madam Chairwoman. 17 The Applicants are proposing to establish a 18 100-bed acute mental illness hospital in Northbrook, 19 Illinois. 20 approximately $31.3 million. 21 completion date is December 31st, 2017. 22 The proposed project cost is The anticipated There was no public hearing; we did not 23 receive any opposition letters. We did have 24 findings and we had a comment on the State Board PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 176 1 staff report that should be in front of you, 16-11. 2 You received this by e-mail, also. 3 MR. MORADO: 4 MR. CONSTANTINO: 5 MR. MORADO: 6 MR. CONSTANTINO: 7 CHAIRWOMAN OLSON: 8 Comments for the Board? 9 Do you want to introduce your group there 10 11 12 13 Was that submission timely? Yes. Thank you. Thank you, Madam Chair. Thank you, Mike. first? MR. KNIERY: Absolutely. Thank you, Madam Chairman. My name is John Kniery. I'm a certificate 14 of need consultant for the project. 15 have with me today Mr. Rich -- Dr. Richard Kresch. 16 He is the president and CEO of the Applicant 17 entities. 18 I am pleased to To my immediate right is Martina Sze, 19 executive vice president of US HealthVest. To our 20 far right is Mr. Marc Silberman, legal counsel to 21 the project; James Cha, the chief financial officer 22 for the Applicant; and on my far left is Miro 23 Petrovic. 24 president of physical facilities. He's the architect and he's the vice PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 177 1 CHAIRWOMAN OLSON: 2 DR. KRESCH: Thank you. So, first, I would like to 3 thank the committee and the staff for taking the 4 time to consider our application and to also thank 5 those of you who were able to attend the grand 6 opening of Chicago Behavioral Hospital and get an 7 idea of what we were able to accomplish there. 8 9 10 11 12 We are a company that has spent the last 30 years developing innovative and patient-centered approaches to the care of acute mental illness. MEMBER GREIMAN: Will you talk closer to the mic. 13 CHAIRWOMAN OLSON: We can't hear you. 14 DR. KRESCH: 15 So we have spent the last 30 years devoted Okay. 16 to developing new and innovative methods of both 17 providing care and the delivery of that care to 18 patients in need and have focused on reaching out to 19 individual groups of patients so that they can 20 receive care that's tailored to their needs instead 21 of a general standard type of treatment that applies 22 to a broad group of patients. 23 An acute mental illness hospital is 24 different from a general medical/surgical hospital PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 178 1 in that we offer a very limited scope of service and 2 our referral patterns are somewhat different. 3 as a result of the nature of our business and 4 particularly the focus of US HealthVest and its 5 hospitals that we own and operate, we become a very 6 community-based organization. 7 And We, as a practice in all of our facilities, 8 accept every insurance -- Medicaid and Medicare, 9 TRICARE, all insurances -- safety net type of 10 programs that exist in the communities we serve. 11 do not turn away any patient regardless of ability 12 to pay or type of insurance coverage that they have. 13 We So our referral base is pretty broad and 14 it's very community based, ranging from the police 15 to schools, to social service agencies, to 16 physicians and other practitioners in the 17 communities, and, to a large extent -- and probably 18 our biggest single referrer are the emergency 19 departments of nearby med/surg hospitals. 20 Everyone who is aware and listens to TV or 21 reads the newspapers is very aware of the shortage 22 of available inpatient beds for treatment of 23 high-acuity, at-risk acute mental illness patients. 24 As a result -- and you heard from many of the people PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 179 1 who spoke earlier today -- patients are often kept 2 in an inhumane fashion for days at a time, sometimes 3 chained to a bed in a psych -- in a medical/surgical 4 hospital emergency room for lack of better 5 alternatives. 6 spreads across the entire region. The need for access is great, and it 7 In my own experience -- and it's not really 8 a scientific observation but a practical one -- it 9 appears that the utilization rates for high-acuity 10 mental health services, including inpatient 11 psychiatric beds, has been increasing quite 12 dramatically over the past decade and will continue 13 to do so. 14 The good news is that many people who 15 previously could not access care currently can 16 because of the Affordable Care Act. 17 resulted in a wider acceptance and wider utilization 18 of all kinds of mental health services, but our 19 focus is on inpatient, and that's what we see. 20 And this has We are an experienced group as far as the 21 development and operation of hospitals. Were 22 Northbrook to be approved, it would be our 23 17th psychiatric hospital. 24 CBH is an example of our understanding of the We have shown -- I think PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 180 1 community needs, in that we acquired a hospital that 2 was in such poor condition in all respects that it 3 was about to close. 4 closing, and, within six months, we have been able 5 to rehabilitate it to the point where it was 6 self-sustaining financially. 7 It was literally within days of Within a year, less than a year, we were 8 able to renovate the entire half of the building to 9 provide high-quality, attractive, efficient patient 10 care rooms and to update life safety equipment in 11 the remaining part of the hospital. 12 During this time, in spite of the 13 construction going on, the hospital was operating in 14 full capacity of the available beds. 15 we've opened, as of February, the newly renovated 16 beds and are able to operate at full capacity, we 17 are again finding ourselves almost full. 18 And now that We -- an example, the hospital's licensed 19 for 125 beds. We have been consistently running 20 over the past few months -- since the new -- since 21 the renovated areas have opened -- census in the 22 one-teens. 23 essentially full in just a little over a year's 24 operation. So essentially -- the hospital's PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 181 1 In thinking about this project, because of 2 this unprecedented -- in our experience -- 3 unprecedented demand, we began looking further out 4 in the CBH market area and service areas, and we 5 realized that there was also a shortage of beds to 6 the north of us. 7 And we looked at the two in Lake County and 8 northern Cook County, and, unfortunately, the number 9 of available beds, according to the bed -- State 10 bed-need calculation, was very low in each district 11 and, as a result, it would not be feasible to 12 establish very small -- we're talking 20-, 30-bed 13 facilities. 14 The only conceivable way those beds could be 15 utilized would be as a unit in a med/surg hospital. 16 That is also unlikely to occur. 17 A facility of that size is not viable. And so we had the idea that, well, a way to 18 provide these needed beds would be to combine those 19 two regions, which are adjacent to each other, 20 establish a facility that's at the center and 21 intersects the two regions, and we did. 22 location that is right on the borderline of the 23 two regions, would equally serve them, and if -- 24 with putting the available beds and adding a few so We found a PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 182 1 that the hospital would be economically secure and 2 we could be assured that it would remain open and 3 viable for years to come, we came up with the idea 4 of combining the two regions, which we understand is 5 not consistent with policy, but we think that it's 6 consistent with good sense and a commitment to serve 7 people in need. We -- an issue came up and I will address 8 9 it. James will talk more about it, but our -- our 10 organization has been a successful organization. 11 have specialized, as I mentioned, in de novo 12 starting of new hospitals. 13 our acquisition, similar to CBH, we're -- the old 14 Maryville -- we focused on the acquisition of 15 distressed properties, and we have had a hundred 16 percent success rate in turning around all of the 17 distressed hospitals we have acquired. 18 result, we have found it relatively easy to gain 19 access to investment capital. 20 We've done six. We And in And as a When the financial statement was submitted 21 with the application in December, it reflected our 22 situation at the time. 23 new facilities to ensure that they are developed 24 with only quality in mind and not to worry about Our strategy for developing PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 183 1 financial aspects of the development is to make sure 2 that we have sufficient funds to complete the 3 project before we start it. 4 have been successful since the end of last year and 5 have raised an additional $59 million in equity 6 investment from our investor group and have at this 7 point significantly more capital than it would 8 require to build and develop Northbrook. 9 10 11 So, as a result, we So with that, I'd like to turn it over to James, who can provide a little more detail. MR. CHA: So, first of all, certainly there 12 was a concern raised in the staff report regarding 13 the availability of funds, and, you know, certainly 14 we apologize for any confusion therein. 15 There -- as Dr. Kresch mentioned, the 16 audited financial results that we had at the time 17 did, indeed, accurately reflect the resources we had 18 available. 19 we have been successful in raising additional equity 20 capital. 21 59 million, of which 9 million has currently been 22 drawn and put into the bank, and that is reflected 23 in the -- what we submitted for your consideration, 24 the letter from our bank, from City Bank -- "City" Over the course of this year, however, As Dr. Kresch mentioned, we raised PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 184 1 with a y -- dated May 16th showing that we have over 2 27 million in cash. And, again, we certainly appreciate that -- 3 4 you know, we had previously provided certain 5 unaudited numbers that could not have that sort of 6 third-party validation, so we certainly appreciated 7 that concern and have now provided this bank letter. CHAIRWOMAN OLSON: 8 9 I'm sorry. I don't want to interrupt you. But that means that Criterion 1120.120 has 10 11 Mike, if I'm correct -- been met? MR. CONSTANTINO: 12 Well, my concern with the 13 letter, Kath, it says over a number of accounts, 14 "aggregate deposit balance of these accounts." They have other facilities out there that 15 16 they're operating -- you know, I -- I had asked for 17 financial ratio information. 18 met the waiver. 19 different occasions, and they never provided it, and 20 then they provided this letter dated May 16th, 2016. That's why I asked for it on two I don't know where the 59 million is coming 21 22 I didn't think they from. I never -- I haven't seen anything on that. 23 MR. SILBERMAN: If I may approach that. 24 This is being entirely cash-financed through PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 185 1 funds that the company has. 2 I believe -- and Mike will correct me if I'm wrong. 3 In the audited financials it shows -- I think it was 4 somewhere between 11- and $14 million of cash on 5 hand, and there was some question with regards to a 6 debt that is no longer on the books, and that did 7 affect the cash utilization. 8 Where is the disconnect What we have supplemented in the letter in 9 May that showed the $23 million in cash -- or excuse 10 me, the 27 million in cash -- is money that has been 11 identified for funding of this project, that the 12 cash on hand is viable to finance this project in 13 its entirety. 14 Now, what Dr. Kresch has addressed -- and he 15 will point out -- is -- and this, I think, goes to 16 Mike's concern if there's other projects, other -- 17 DR. KRESCH: So in reference to the 18 statement by the banker that it's in a number of 19 accounts, we keep, at any given time, a lot of money 20 in the bank. 21 there's roughly 27-, $30 million in the bank. 22 The funds that are currently -- In order to -- the arrangement we had with 23 the bank -- in order to make sure that all of that 24 money is insured under FDIC insurance rules, the PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 186 1 banks have a system of dispersing and dividing up 2 the accounts and having multiple accounts, all of 3 which fall beneath the ceiling for coverage under 4 FDIC, so that by having the deposit in a number of 5 accounts divided up rather than a single account, we 6 have the protection of that money being insured by 7 FDIC should there be a problem. 8 CHAIRWOMAN OLSON: 9 10 11 Seems like a good problem to have. MEMBER SEWELL: Is there any problem with giving the staff the financial ratios they request? 12 MR. SILBERMAN: I -- 13 MEMBER SEWELL: Because that would confine 14 15 it to this project. MR. SILBERMAN: And I believe the answer is 16 we did, and that was in the supplemental material to 17 the staff report. 18 MR. CONSTANTINO: No. No. I need the 19 parent's financial ratio information. 20 one funding this project, and that's what 21 I requested twice. 22 They're the And we have a disagreement on whether they 23 met the waiver or not, and I didn't think they did 24 because I couldn't determine if they had sufficient PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 187 1 cash. And then I asked for the waiver -- or for the 2 financial ratios. 3 received them. That's required. MR. SILBERMAN: 4 And I haven't And I guess the response 5 would be that the Board's position has always been, 6 if a project is being financed entirely through 7 internal resources, that that qualifies for the 8 waiver of the financial viability ratios. 9 I would hope that the Board would consider that, as 10 we have our CEO and our CFO here under oath -- that 11 they're both here and available to represent that 12 the cash available, internal funds, is on hand to 13 finance this project in its entirety. MR. CONSTANTINO: 14 15 And So -- When -- just a comment on that. 16 When somebody tells us that they're going to 17 fund the project internally, we ask for the audited 18 financial statements. 19 at the funds restricted for construction. 20 that -- these are not-for-profits. 21 hospitals in the state they're not-for-profits. 22 That's what we look at. 23 line. 24 We look at cash and we look We do For most It's not just the cash Second, for-profit entities in the state -- PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 188 1 which are essentially just two, Community Health 2 Service and UHS -- they are publicly traded 3 companies, and they send us their 10-Ks. 4 they have sufficient cash to fund the projects they 5 want to do in this state. I know I don't know that from the information I've 6 7 looked at here, and that's why I didn't believe they 8 qualified for the waiver, and that's why I -- that's 9 why I requested the financial ratios. 10 CHAIRWOMAN OLSON: 11 MEMBER SEWELL: Go ahead. Not to change the subject 12 but -- turning to the unnecessary duplication of 13 services, do -- I guess I'd ask Mr. Constantino 14 this: 15 planning-area situation here? Do we have a two-planning-area-versus-one- 16 Is that where the problem is? 17 MR. CONSTANTINO: 18 MEMBER SEWELL: Yeah. We -- They're basing their need 19 determination on combining two contiguous planning 20 areas? 21 MR. CONSTANTINO: That is correct. There is 22 a need in two contiguous areas, 29 beds where this 23 facility's going to be located and adjacent to 24 it is a 24-bed need for a total of a -- what is PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 189 1 that? -- 53. 2 And they're requesting a hundred. 3 MR. SILBERMAN: And -- 4 MEMBER SEWELL: So a hundred would be okay 5 if we were allowed to do it based on two planning 6 areas? MR. CONSTANTINO: 7 8 9 That's correct. We have to -MEMBER SEWELL: 10 MR. CONSTANTINO: 11 MR. SILBERMAN: But we're not? No. That's correct. And the only thing is -- to 12 address that point -- because this was something we 13 understood in the design. 14 And if you note the geographic location, 15 this facility is proposed to be on Lake Cook Road. 16 Literally, the facility is on the edge of one 17 planning area and, if you walk across the street, 18 you're meeting a need. 19 Dr. Kresch raised in his opening comments, the 20 20-some bed needs isn't enough for a viable 21 facility. 22 And to the concern that And so, therefore, the question that we were 23 faced with and what this project is designed to do 24 is, instead of leaving two planning areas where PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 190 1 there's one unmet need, to propose one facility -- 2 that we fully understand, by the Board's rules, 3 that, indeed, will be looked at by the one planning 4 area unless we could have found a way to build it 5 across Lake Cook Road, which wasn't going to be 6 realistic. 7 But what we hope is, in the discretion of 8 the Board, when you look at the overall need of the 9 area, when you look at the 45-minute drive time -- 10 because that assessment does cross over the planning 11 areas -- and when you look at the overall need for 12 behavioral health services, that that will be 13 factored into the Board's decision. 14 15 16 MEMBER SEWELL: And we -- have we looked at the occupancy issues in both planning areas? I mean, it doesn't meet the criteria for the 17 one with respect to where all of the existing AMI 18 beds are and what their occupancy is, but what about 19 the other -- 20 MR. CONSTANTINO: 21 MEMBER SEWELL: 22 MR. CONSTANTINO: Yeah. We have a chart -- -- what it says? Go to page 21. There's 23 all acute mental health facilities within 24 45 minutes, and we have not identified an AMI PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 191 1 planning area. There's only one AMI planning area 2 or facility in A-08, which is where the 29 beds are 3 needed. 4 the threshold right now. 5 CHAIRWOMAN OLSON: That's Evanston Hospital and they're over So when you look at 6 Table 14, the first one on there, Chicago Behavioral 7 Hospital, and it's at 12.9 percent -- that's much 8 higher than that right now; right? 9 MR. SILBERMAN: Those are the most recent 10 available data that's reported. 11 CHAIRWOMAN OLSON: 12 MR. SILBERMAN: Right. But as we've reported -- 13 Chicago Behavioral Health is the closest facility, 14 and it's currently turning patients away, that there 15 are times where they're at capacity. 16 17 18 CHAIRWOMAN OLSON: And Martina -- You said 125 beds and you're at a hundred-teens on a regular basis. MS. SZE: The chart on Table 14 reflects 19 2014 data. We acquired that hospital in November, 20 so we are now at 125 beds and operating at 21 85 percent capacity. 22 CHAIRWOMAN OLSON: 23 MR. KNIERY: 24 That's what I thought. Mr. Sewell, if I could address your issues. PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 192 As you know, there are several indicators of 1 2 need. The staff has absolutely identified the 3 utilization rates of area facilities, and we 4 acknowledge that many of them are not at the State's 5 optimal capacity. I would like to note -- point out, also, not 6 7 only does that 45-minute travel time show the two 8 planning areas but many more, many additional. 9 there are many indicators of need, utilization rate But 10 being one, the fact that -- you know, with all these 11 underutilized hospitals -- that, you know, we have 12 no opposition on the project from them. 13 it's significant. I think That was -- you know, that's one of the -- 14 15 the second indicator of need is a calculated bed 16 need. 17 possible need for the service. 18 We have identified two areas that there is a The third indicator is sufficient population 19 to support your project. In the two planning -- 20 combined planning areas, A-08 and A-09, there's 21 1.2 million people. 22 contour, there's 5.9 million people, which kind of 23 brings us to the final indicator, is typically the 24 ratio of beds to population, and I would love to Within the 45-minute travel PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 193 1 2 have Martina just briefly address that for you. MS. SZE: So when we look at markets, we 3 assess bed need by using a beds-per-100,000 ratio. 4 The national benchmark is 30 beds per 100,000 people. 5 the Illinois State average is 31 beds per 6 100,000 people. 7 At CBH, as we've noted, we've had to turn 8 away a lot of patients due to lack of bed 9 availability. So based on this experience, we 10 started planning for a new psychiatric hospital. 11 looked at a number of areas, and the Northbrook 12 area, the planning area, stood out as having a 13 disproportionately low number of beds per 14 100,000 people. 15 per 100,000 people in the A-08 and A-09 areas. 16 you approve our project, there will be still only 17 15 beds per 100,000 people, which is less than the 18 State average. Right now there are only seven beds 19 MEMBER GREIMAN: 20 CHAIRWOMAN OLSON: 21 MEMBER GREIMAN: Chairman. Yes. Yeah. I wanted to ask 22 Mike, what will make you comfortable to give you 23 what you need to work -- what will satisfy you? 24 We MR. CONSTANTINO: I just want what we PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM If DraftFull Meeting Conducted on June 21, 2016 194 1 2 requested. MEMBER GALASSIE: 3 where I -- if I may -- 4 MEMBER GREIMAN: 5 MEMBER GALASSIE: Yeah. I'm in a position Yeah. I'm very supportive of 6 this concept. 7 issues and needs. 8 a yes vote without that financial information. 9 10 Very much. And I know Lake County's But I'm uncomfortable giving you MR. SILBERMAN: If I could offer one thing as an alternative consideration -- 11 MEMBER GALASSIE: 12 MEMBER GREIMAN: 13 MR. SILBERMAN: That's one vote. That's right. -- which is, when we look at 14 other projects that are being looked at with regard 15 to debt financing, one of the things this Board has 16 raised is that people will come in with a commitment 17 of someone who is willing to consider the financing, 18 and this Board will approve these projects with the 19 understanding that "We're going to find someone who 20 will give us the money and we have confidence based 21 on our experience." 22 What we actually have in front of you is an 23 Applicant who's not asking you to have confidence 24 that they will find the money. They're standing PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 195 1 here before you under oath telling you that "We have 2 the cash to acquire the facility and to build it 3 out." 4 MEMBER GALASSIE: 5 because I'm interrupting you -- 6 MR. SILBERMAN: 7 MEMBER GALASSIE: I'm going to apologize Please. -- but I have to tell you 8 I want to hear that from him, not from you, with all 9 due respect. 10 That's my level of confidence -- 11 MR. SILBERMAN: 12 MEMBER GALASSIE: 13 That's my -- but if I --- speaking as a single member. MR. SILBERMAN: 14 But if I understand 15 correctly -- and -- is -- what Mike is working from 16 is originally the audited financials, which are from 17 2015 and do give an accurate snapshot in time. 18 the Applicant has then updated the information, but 19 it hasn't risen to the level of an additional round 20 of audited financials, and so -- you know, and -- if 21 you want to -MR. KNIERY: 22 But I'd like to add, also, if 23 I may, Member Galassie, we did provide the entity's 24 ratios. And I'd love to even explore some of them, PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 196 1 if you wouldn't mind, if that would help you. 2 MEMBER GALASSIE: Sure. 3 MR. CONSTANTINO: Before John does that, 4 those are new entities -- okay? -- that -- and 5 they're not financing this project. US HealthVest is financing the project, and 6 7 I don't think they meet the waiver requirements, and 8 all I'm asking for is the financial ratios for the 9 most -- we asked for three years. That's '13, '14, 10 and '15. That's what we asked for. I didn't think 11 they met -- I didn't think they met the waiver 12 requirements. And now -- you know, they come in here now 13 14 and say they've got $59 million. 15 that. Well, I don't know I haven't see any documentation of that. And the comment about the letters we 16 17 received from people wanting to finance these 18 projects through a bank letter -- I don't accept 19 that. 20 constantly before the Board. 21 letter of commitment made -- I just don't -- we 22 don't -- the staff -- the reports do not accept 23 that. 24 I never have. MR. SILBERMAN: We've been negative on that We will not accept a And staff has been PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 197 1 consistent. 2 this gives me one opportunity to clarify one 3 specific point, if I may. 4 I don't want to -- and, by the way, There were some people who testified in the 5 public hearing that they had support that was not 6 accepted. 7 to clarify this because I -- this is another example 8 where staff is absolutely right. What this actually was -- and I just want 9 People had submitted referral letters where 10 they hadn't met all of the correct criteria, where 11 the letter was signed by the operations manager 12 instead of the physician, and so staff properly 13 rejected those referral letters. 14 were hearing was from people who still cared enough 15 to come here and have their voice heard and show 16 their commitment. The testimony you 17 So staff is absolutely right in its 18 rejection of those letters, and Michael is 19 consistent in his evaluation of the finances. 20 we're trying to do is to point out that this Board 21 does have a degree of discretion in evaluating -- 22 the real big-picture question is, "What is the 23 likelihood of this project to be successful 24 financially and operationally?" And -- PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM What DraftFull Meeting Conducted on June 21, 2016 198 1 (An off-the-record discussion was held.) 2 MR. KNIERY: In discussing with our client, 3 I believe our client would be able to offer -- 4 within, you know, a week's time -- documentation 5 from the investor group specifically to the extent 6 the funds are available for this project. 7 we could do that as a condition to the permit, 8 however you foresee. 9 MR. MORADO: You know, Are you referring to the 10 $59 million number or -- 11 MR. KNIERY: No. I'm talking specifically 12 about this project that -- you know, the money that 13 we are talking about that we do have. 14 provide you a specific signed affidavit, you know, 15 any -- what would fit? 16 17 18 19 20 MR. MORADO: We can So more than the letter you've already given us to -MR. SILBERMAN: So to have it certified so that it's sworn to. The idea being is this: We want the Board 21 and the staff to have the comfort that they want, 22 but our issue is that, at the end of the day, 23 there's a need for this care. 24 overwhelming. The comments were PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 199 1 I think to a point that John made is -- when 2 is the last time a project for a new hospital came 3 forward with zero opposition? 4 because this is designed not only to meet an 5 existing need but to complement existing services. 6 There were no competitors who opposed, and many came 7 forward to support. 8 9 10 11 12 13 14 CHAIRWOMAN OLSON: And the reason is Mr. Silber- -- Sewell. Mr. Sewell. MEMBER SEWELL: Why can't you just give Mike what he asked for? MR. SILBERMAN: The answer is, at this point, because it would delay the consideration. And if the answer was to provide the 15 guaranty in the process -- but the reasoning for why 16 it hadn't been provided previously was, very simply, 17 we had documented the cash available to finance the 18 project, which historically has been sufficient to 19 not require the financial. 20 And if I'm correct, what has been provided 21 is the ratios for the consolidated entities, but 22 what Mike is asking for is the ratios for the parent 23 company alone. 24 MR. CONSTANTINO: Yeah. PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 200 MEMBER SEWELL: 1 2 Because that's the source of the money. 3 MR. CONSTANTINO: 4 MEMBER SEWELL: 5 coming from. 6 Okay. Yeah. That's where the money's For me, as a member, I would want to 7 see the staff get exactly what they're requesting, 8 number one. And, number two, I'd like to see what we've 9 10 been talking about today so that it -- regardless of 11 the fact that we technically cannot consider two 12 planning areas -- I don't really care about that 13 technicality -- but I'd like to see what it looks 14 like if you were dealing with two planning areas 15 with respect to these criteria that you did meet. 16 The bed need and the occupancy -- occupancy is sort 17 of there with this Table 14, but I'd like to see 18 that. 19 And then this Board would have to decide 20 whether they were going to, you know, consider that 21 instead of just the one planning area. 22 we have any precedent for looking at more than one 23 planning area? 24 MR. CONSTANTINO: I mean, do Not that I can recall, PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 201 1 2 3 Mr. Sewell, but we can do it if you want us to. MEMBER SEWELL: But this Board has the discretion to -- 4 MR. CONSTANTINO: 5 MEMBER SEWELL: Oh, definitely, yeah. Yeah. I think, for 6 something like this category of beds and the way 7 that they are thinking more broadly about responding 8 to the need, I -- I personally would make an 9 exception to this one planning area. 10 I don't know how the other -- 11 CHAIRWOMAN OLSON: 12 MEMBER SEWELL: 13 CHAIRWOMAN OLSON: 14 MEMBER SEWELL: I agree. -- members feel. I'm totally fine. But I want to see that. 15 I want to see what that looks like in relation to 16 bed need, in relation to occupancy, and then I want 17 to see the ratios that you're asking for. 18 CHAIRWOMAN OLSON: So let me ask -- let me 19 throw this out there just for -- if we amend the 20 motion to put a condition on it that -- within, you 21 said, seven days -- Mike can get the information 22 that he needs to be able to give us -- and I'm 23 actually kind of sorry I brought it up. 24 I thought -- the only reason I brought it up PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 202 1 was I thought it was met. 2 our conversation last week, I thought it was met. 3 But, to me, 27 million in the bank is good enough 4 but that's my opinion. 5 But I'm with you. I thought -- when we had I hate to see -- I mean, 6 this project is meeting a huge need. 7 absolutely no opposition. 8 competitors were here supporting the project. 9 I don't know -- I don't want to hold them up -- can 10 we put a condition on it -- help me out here, Juan. 11 MR. MORADO: There is In fact, their So Yes, we could place a condition 12 allowing the Applicant to provide us with the 13 requested information specifically with regard to 14 the financial ratios within -- I think you said 15 seven days. 16 know -- 14. 17 18 19 We might want to make it -- I don't MR. SILBERMAN: Whatever time frame we will make happen. MR. MORADO: So if that -- and -- like -- 20 the condition would be that he would provide that 21 information that -- I mean, I guess what we have to 22 discuss -- is the condition going to be that they 23 just provide the information and, because we know 24 they have 27 million, we feel comfortable moving PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 203 1 forward or -MR. SILBERMAN: 2 We'd be prepared to offer up 3 both the ratios and the verification of the money so 4 that -MR. MORADO: 5 6 I think we have the verification of the money with the letter. 7 MR. SILBERMAN: 8 MR. MORADO: 9 said that here under oath. It's from their bank and they CHAIRWOMAN OLSON: 10 11 But I -- It's from their bank. I don't know what -- 12 (An off-the-record discussion was held.) 13 MEMBER GALASSIE: 14 But in addition to submitting it, Mike has to agree with it. CHAIRWOMAN OLSON: 15 Mike doesn't have to 16 agree with -- I mean, the Board has -- and I -- with 17 all due respect to Mike -- I know he goes by the 18 book. 19 CON where Mike didn't think that every single one of 20 these conditions was met. 21 I -- I don't know. 22 MR. MORADO: But the Board has certainly agreed to grant a In terms of the condition, they 23 would just -- we would need to have a defined 24 time line and a defined action. If the defined PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 204 1 action is to provide the information within 14 days, 2 then that meets the requirements of the condition. 3 4 CHAIRWOMAN OLSON: Are people comfortable with that or no? 5 MEMBER SEWELL: Sure. 6 MR. SILBERMAN: And we would accept that 7 I am. condition. 8 CHAIRWOMAN OLSON: 9 MEMBER GALASSIE: Other questions? I just -- I'm sorry. 10 I know it's late in the day. 11 want Mike to review it and accept it as opposed to 12 their just submitting it. 13 should be? 14 MEMBER SEWELL: 15 CHAIRWOMAN OLSON: 16 17 18 19 20 That's right. MEMBER GREIMAN: Well, then maybe they Well, then they won't have it. MEMBER GALASSIE: have it. Right. Then they won't I'm assuming they will. MS. MITCHELL: 22 that's placed on it. 24 What if it isn't what it have to come back at the next meeting. 21 23 But I still think we It depends on the condition CHAIRWOMAN OLSON: What would be the effect to the project of waiting until our next meeting? PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 205 DR. KRESCH: 1 The challenge for us from a 2 practical level is holding onto the real estate. 3 Landlords are not willing to keep buildings off the 4 market indefinitely. And we've been able to hang on by giving 5 6 them a -- the landlord -- a proposed date for the 7 hearing. 8 they would be willing to -- if we'd lose our site, 9 it would be very difficult. CHAIRWOMAN OLSON: 10 11 If it were postponed, I don't know that dice and take a vote. MEMBER GREIMAN: 12 So I guess we roll the I don't know. I think what I'd like to 13 know is specifically what Mike would be satisfied 14 with. Can you tell us that? 15 16 Then we can make that decision. MR. CONSTANTINO: 17 Judge, I think we need 18 the financial ratios for the historic years for 19 US HealthVest. And then Mr. Sewell had asked us to look at 20 21 it for two planning areas, AMI planning areas. 22 This -- and provide that to the Board. 23 that. 24 MEMBER GREIMAN: We can do That's different PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 206 1 conditions. MR. SILBERMAN: 2 And anyone in the room can 3 disagree with me, but I think -- Member Sewell, with 4 regards to the idea of looking at both planning 5 areas, I think that the one negative regarding need, 6 regarding the utilization of other area facilities 7 will hold true because it won't change that there 8 are other facilities. 9 need regarding population per hundred thousand we've But the other components of 10 already testified to and I think are already 11 factored in. MEMBER SEWELL: 12 I don't know if that 13 population -- that beds per hundred thousand 14 population is our standard. 15 MS. SZE: 16 MEMBER SEWELL: 17 MR. CONSTANTINO: 18 MEMBER SEWELL: 19 It is. It is. Is that our standard? It -I mean, it is a standard but -- 20 MS. SZE: 21 State standard. The calculation was based on the 22 MEMBER SEWELL: On what our standard is? 23 MS. SZE: Correct. 24 MR. SILBERMAN: Yes. It's a different assessment PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 207 1 2 3 4 of need. MEMBER SEWELL: Okay. Different way of saying it. MS. MITCHELL: If I may -- sorry to add to 5 this, but I just wanted -- so we're asking for the 6 historical ratios; right? 7 8 9 MR. CONSTANTINO: We asked for three years' historic and then the projected years. MS. MITCHELL: Okay. So if I'm 10 understanding this correctly, they just acquired 11 this new money. 12 provide ratios to us, historical ratios to us, will 13 they be able to meet this? So are they -- so even if they 14 It's -- am I -- 15 MR. CONSTANTINO: They're not -- from my 16 review of what they've sent us, they're not going to 17 meet the margin percentage, right. 18 that right now. 19 20 MS. MITCHELL: I can tell you Based on historical information; right? 21 MR. CONSTANTINO: 22 they provided to me right now. 23 MS. MITCHELL: 24 MR. CONSTANTINO: Based on the information Right. But that's not the PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 208 1 criteria. The criteria is the financial ratios for 2 the three historic years plus the projected years. My feeling was they had not adequately 3 4 addressed that waiver, and we needed the financial 5 ratios. 6 7 MR. SILBERMAN: And the one irony in all of this -- and I'll refer to our CFO. 8 But the one irony of all of this is, once 9 we've provided the financial ratios -- and we're 10 happy to if that's what the Board needs but -- we're 11 still financing this entirely by cash so -- but I'm 12 going to ask James, who knows this stuff better. 13 MR. CHA: Yeah. Just to clarify -- perhaps 14 this is already clear. 15 27 million that we show in the bank letter, that was 16 cash that we actually had in the bank as of May 16th, 17 you know. 18 May 31st, we have 28 million in cash, plus we still 19 have the 50 million that we have yet to draw because 20 that -- we just closed that financing last Friday. 21 We'll be putting out a press release probably 22 sometime this week, and we'll also be required to 23 file with the SEC a Form D, which will also be going 24 out within the next couple of weeks. But, you know, the Based on our unaudited statements as of PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 209 1 So we are a privately held company -- you 2 know, certainly I do appreciate Mike's concerns 3 regarding, you know, a certain lack of visibility 4 since we're not Universal, we're not Community. 5 know, our financials are more closely held. 6 know, we've -- we don't have, necessarily, the -- 7 it's not normal practice to do sort of quarterly 8 audits or things of that nature. 9 You You So the audit that we have available, you 10 know, again, happens to be as of our fiscal 11 year-end, which is December 31. 12 we did raise the 59 million, and certainly we have 13 documentation executed -- fully excluded 14 documentation regarding this $50 million financing 15 that we just closed. 16 Subsequent to that You know, I have it in my computer right 17 now, and certainly if -- insofar as that was useful 18 information or documentation that we could provide, 19 we could certainly do that, as well. 20 MR. MORADO: Is it fair to say that the 21 historical data will reflect that you're not going 22 to be in conformance with this criteria? 23 24 And that you are able to, today, show us that you have a letter here for the 27 million PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 210 1 that's available for this project and that perhaps 2 the Board could consider it as a negative on the 3 State Board staff report but we have additional 4 information which they can take for -- take it for 5 what it's worth and vote on it that way? MR. KNIERY: 6 7 I would like to add one point. It's not that we're trying to hide anything. 8 9 That would be fair. We did provide the statements -- all the audited 10 statements -- that those ratios then have to be 11 calculated from. 12 Mr. Constantino has that information. 13 go back and provide the ratios. MR. MORADO: 14 15 So you have that -- Mike has -We do have to But when we receive it -- the finding, it's not going to change. 16 MR. KNIERY: 17 MR. SILBERMAN: 18 MR. MORADO: The math will be exactly the 20 MR. KNIERY: That's what I was saying. 21 MR. MORADO: You will be coming in before 19 Right. The math will be the math. same. 22 us, and you'll say, "I know it says negative just 23 like it said last time, but here we have an 24 affidavit now versus a letter that says we have PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 211 1 $27 million" -- 2 MR. KNIERY: Right. 3 MR. MORADO: -- "that's in there to date." 4 CHAIRWOMAN OLSON: 5 MR. SILBERMAN: Are you ready to vote? Is there a condition being 6 added to -- attached to the -- 7 CHAIRWOMAN OLSON: 8 MEMBER GALASSIE: 9 I could vote aye with the condition that 10 they have to submit this information, financial 11 information, to Mike within two weeks. 12 CHAIRWOMAN OLSON: No. Yeah, I believe there is. Okay. So did you -- but 13 what they just said is they can submit the financial 14 ratios but it's still going to be a negative 15 finding. 16 It's not going to change. What they're using for the financing is the 17 27 million and the 59 million that they've raised 18 since they -- the historical -- the historical 19 financial ratios are not going to change the 20 findings, is what they're saying. 21 So I don't know -- 22 MR. MORADO: But I think, because 23 Mr. Constantino's asking for it, we should have the 24 Applicant provide that information along with -- it PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 212 1 seems like an affidavit might be a little stronger 2 than a letter. MR. SILBERMAN: 3 That's why -- what I was 4 suggesting. 5 historical ratios that Mike has asked for as well as 6 to update the letter to a certification or 7 verification. CHAIRWOMAN OLSON: 8 9 MR. SILBERMAN: So what you just And, for the record, we'll agree to it -- 12 CHAIRWOMAN OLSON: 13 MR. SILBERMAN: 14 Okay. said will be the condition. 10 11 We're happy to provide both the Yes. -- if that's required under the rule. 15 CHAIRWOMAN OLSON: 16 MEMBER GALASSIE: 17 MEMBER SEWELL: 18 two-planning area scenario. Works for me. And we want to see the CHAIRWOMAN OLSON: 19 Is that all right? I thought we were going 20 based on the population ratios on that. 21 need to see something else? 22 MEMBER SEWELL: 23 24 things. We still Well, but there's two Isn't that correct? There's the beds and the ratio will take PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 213 1 care of that. There's occupancy, too. MR. CONSTANTINO: 2 Yeah. We were just -- we 3 had requested the financial ratios, and it appears 4 they've come to -- the Board has come to a 5 resolution on that. And then you suggest -- you had requested 6 7 that we look at the two planning areas, AMI planning 8 areas up there, and look at the beds. 9 going to do that and provide that information to 10 you. 11 MEMBER SEWELL: 12 CHAIRWOMAN OLSON: 13 16 17 18 Yeah. But you -- But that's different than on Table 14. MR. SILBERMAN: 14 15 And we were No. That's, I believe, the same. CHAIRWOMAN OLSON: Is that what's on Table 14? MR. CONSTANTINO: Table 14 will show the 19 occupancy, but I believe -- and I -- maybe I'm wrong 20 on this. 21 But if you look on page -- we had put 22 together how we projected the beds for the one 23 planning area on page 6 of the report, A-08 AMI 24 planning area. And we were going to provide that PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 214 1 2 information to Mr. Sewell, how that is calculated. MR. SILBERMAN: But I guess that -- we 3 aren't challenging that. 4 provided that information to calculate the need 5 for -- that's how the need for A-9 was also 6 calculated. 7 And if I'm correct -- MR. CONSTANTINO: 8 here, maybe. 9 wanting us to do. 10 If I'm correct, you also Well, that's not presented That's what I thought Mr. Sewell was MR. SILBERMAN: But on page 21 it does have 11 the utilization of the two AMI services available in 12 A-9, A-09, the Highland Park Hospital and Vista 13 Medical Center. 14 MEMBER SEWELL: Okay. 15 CHAIRWOMAN OLSON: So the condition is that 16 they will supply -- we will get the financial ratios 17 for the three years and some documentation for -- 18 MR. MORADO: And an affidavit attesting to 19 the fact that there is, in fact, $27,326,184 -- at 20 least that much -- in the bank. 21 MR. SILBERMAN: 22 MR. MORADO: 23 24 In 14 days? Within 14 days of this date, if it's approved. CHAIRWOMAN OLSON: Any other questions? PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 215 1 (No response.) 2 CHAIRWOMAN OLSON: 3 I will call for a roll call vote. 4 MR. ROATE: 5 Motion made by Mr. Johnson; seconded by 6 Thank you, Madam Chair. Mr. Sewell. 7 Mr. Galassie. 8 MEMBER GALASSIE: 9 discussion. 10 MR. ROATE: 11 MEMBER GREIMAN: 12 Justice Greiman. Aye, based upon the agreement of the Applicant. 13 MR. ROATE: 14 Mr. Johnson. 15 MEMBER JOHNSON: 16 Aye, based upon Thank you. Yes, based on the discussion and the subsequent conditions. 17 MR. ROATE: Thank you. 18 Mr. McGlasson. 19 MEMBER MC GLASSON: Yes, based on the 20 testimony this morning that indicated there's a need 21 if not a really urgent need. 22 CHAIRWOMAN OLSON: 23 Mr. Sewell. 24 MEMBER SEWELL: Thank you. Yes, for reasons stated. PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 216 1 MR. ROATE: 2 CHAIRWOMAN OLSON: 3 MR. ROATE: 4 Madam Chair. That's 6 votes in the affirmative. 5 CHAIRWOMAN OLSON: 6 Congratulations. 7 MR. SILBERMAN: 8 DR. KRESCH: 9 CHAIRWOMAN OLSON: 10 Yes, for reasons stated. The motion passes. Thank you very much. Thank you very much. Good luck. - - - 11 12 13 14 15 16 17 18 19 20 21 22 23 24 PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 217 CHAIRWOMAN OLSON: 1 2 Okay. Next we have Project 16-012, Transitional Care of Lake County. May I have a motion to approve 3 4 Project 16-012, Transitional Care of Lake County, to 5 establish a 185-bed long-term care facility. 6 MEMBER GALASSIE: So moved. 7 CHAIRWOMAN OLSON: 8 And a second, please. 9 MEMBER SEWELL: Thank you. Second. CHAIRWOMAN OLSON: 10 The Applicant can come to 11 the table and be sworn in. 12 THE COURT REPORTER: 13 Would you raise your right hands, please. 14 (Four witnesses sworn.) 15 THE COURT REPORTER: 16 19 Please print your names. CHAIRWOMAN OLSON: 17 18 Thank you. Mr. Constantino, your report. MR. CONSTANTINO: The Applicants are 20 proposing to establish a 185-bed skilled nursing 21 facility in Mundelein, Illinois. 22 project is $29.3 million. 23 completion date is June 30th, 2019. 24 The cost of the The anticipated There was no public hearing and there were PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 218 1 no opposition letters received. 65 letters of 2 support were in the application for permit. 3 have findings on this project. We did 4 Thank you, Madam Chairwoman. 5 CHAIRWOMAN OLSON: 6 Comments for the Board? 7 They're sworn? 8 MR. SHEETS: 9 Charles Sheets, again, on behalf of the 10 Thank you. Good afternoon. Applicants here. 11 I have with me Mr. Bradley Haber and 12 Mr. Brian Cloch, who are the managing partners of 13 the Applicant, and Anne Cooper from my office. And I'll hand the microphone over to 14 15 Mr. Haber to present. MR. CLOCH: 16 My name is Brian Cloch, and I'm 17 one of the principals and cofounders of Innovative 18 Health. 19 preparing such a thorough report and the opportunity 20 to respond to it. 21 22 First, I'd like to thank the staff for Thank you, also, to the Board. We appreciate the time you've -- 23 THE COURT REPORTER: Excuse me. 24 speak more clearly or more slowly? Could you Either one. PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 219 1 MR. CLOCH: Yeah. No problem. 2 Thank you, also, to the Board. We 3 appreciate the time it takes for you to prep for 4 this meeting and be here today. 5 lending your expertise and volunteering your time to 6 ensure residents of Lake County have access to 7 quality skilled nursing care in a modern, state-of- 8 the-art facility. 9 Thank you also for Unlike the projects we presented to this 10 Board at the last meeting, the relocation of 11 Winchester House is the type of skilled nursing 12 facility project the Board typically considers. 13 proposed project will offer custodial long-term 14 care, specialized memory care, as well as a 15 transitional care section that is -- as we discussed 16 at length last meeting. 17 The It is also different than most proposals in 18 that it is a replacement proposal. We're replacing 19 an aging and deteriorating facility that is 20 approximately 170 years old that no longer 21 efficiently or effectively serves the needs of 22 Lake County residents. 23 actually removing 39 beds from the Board's inventory 24 while improving quality and access in lowering In the process, we are PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 220 1 overall health care costs. 2 As a resident of Lake County, I'm personally 3 committed to doing what it is -- what's in the best 4 interests of my community. 5 I'm particularly delighted to provide state-of-the- 6 art senior housing and skilled nursing care this 7 time to my neighbors. 8 9 Given the opportunity, Before we go into the details of the project, my partner Brad with Innovative Health will 10 address some of the financial concerns highlighted 11 in the staff report. 12 MR. HABER: Thanks, Brian. 13 As mentioned, my name is Brad Haber, B-r-a-d 14 H-a-b-e-r. 15 Innovative Health. 16 and Mr. Constantino for preparing such a thoughtful 17 and detailed report regarding Transitional Care of 18 Lake County. 19 I'm a principal and cofounder of I'd also like to thank the Board Realizing the Board has extensive experience 20 within health care and financial reporting, I've 21 attempted to address all the financial concerns 22 raised in the staff report in the most efficient 23 manner as possible. 24 With regard to availability of funds, as you PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 221 1 may recall, the same team sitting up here today was 2 in front of this Board at the May meeting, and we 3 had a fruitful conversation regarding commitment 4 letters and what can and cannot be obtained at this 5 point in the development process. 6 At that time I mentioned that I am the 7 former head of credit and underwriting for 8 GE Capital's health care finance division, a role 9 I held from 2002 through 2013, and I can attest that 10 at this stage of the development process a true 11 no-outs commitment from any financial institution 12 does not exist in the market today. 13 The last time we were in front of the Board, 14 the issue of a firm commitment was of obvious 15 concern from several Board members, and it was 16 suggested that a bank should provide a commitment 17 subject to just the CON approval. 18 a bank to provide that type of letter, we would be 19 required to provide the financial institution 20 everything that would be required to make the 21 project construction ready. 22 The truth is, for The major items on this list include but are 23 not limited to a recorded zoning ordinance 24 evidencing compliance for the to-be-built project, PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 222 1 which would be no less than about six months to 2 complete and in excess of a hundred thousand 3 dollars; completed architectural and engineering 4 permit-ready construction documents, which would 5 take about six months and cost in excess of 6 $700,000. 7 The developer would need to buy the land 8 outright versus an option because it will be highly 9 unlikely a land seller would provide for an option 10 to acquire the land for the extended period of time 11 required to get the previously mentioned steps 12 completed prior to applying for the CON. 13 alone for this project is $2 1/2 million. The land 14 Finally, assuming all the above was 15 completed and approved, any financial institution 16 will require the commitment fee to be paid at the 17 time the commitment letter is issued. 18 commitment fees for a project of this nature are 19 1 percent of the loan amount. 20 approximately $250,000 for this project. 21 Average That would equate to Having said so, the answer to the question 22 of "Why can't a financial institution provide a 23 commitment letter subject to CON approval?" is it 24 would cost the Applicant upwards of nine months of PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 223 1 additional time and $4 million of additional costs 2 before we could even come to the Board to be heard 3 and find out whether or not we'll be awarded a 4 certificate of need. 5 Clearly, that is not a prudent approach, and 6 because of this inherent constraint and with the 7 Board's concerns and requirements in mind, we have 8 been diligent in making sure we have pursued and 9 will procure the most cost-effective financing 10 11 available in today's market. Moving on from that particular point, we are 12 also confident in the financial viability of the 13 project. 14 availability ratios that are extremely relevant 15 within the overall health care sector but are not 16 specific to subsets of the industry, including 17 skilled nursing. 18 relevant to the nursing sector are percentage of 19 debt to total capitalization and debt service 20 coverage, with debt service coverage being most 21 critical as it demonstrates an organization's 22 operating efficiency and ability to meet current 23 debt obligations. 24 The State Board has a set of financial Financial ratios that are most The Board has set one and a half times debt PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 224 1 service coverage as the standard, and, from my 2 experience, that's spot-on accurate, and our project 3 overwhelmingly exceeds that metric at close to 4 four times. 5 In terms of total capitalization, the Board 6 has set a less-than-50 percent standard, which is 7 applicable to the health care field as a whole. 8 When you separate out skilled nursing, the standard 9 within the industry is a target of less than 10 80 percent from a conventional financing source and 11 90 percent for HUD. 12 The staff report notes that we are well 13 below that level in our first stabilized year, which 14 is well within market standard guidelines and also 15 meets the most stringent of underwriting criteria. 16 I would also like to note that the Board staff 17 report indicates the proposed project is in 18 conformance with the criterion reasonableness of 19 financing arrangements, terms of debt financing, and 20 the reasonableness of project costs. 21 Days of cash is a ratio that is not analyzed 22 within the skilled nursing but, rather, a ratio that 23 is critical when discussing hospital operations. 24 From the perspective of a hospital, something in the PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 225 1 neighborhood of 180 days' cash on hand is an ideal 2 target. 3 is set at greater than 40 days, and our project is 4 essentially at that target level with 32 days in 5 Year 1. 6 The Board's standard for days' cash on hand Of all the viability ratios, cushion ratio 7 is not particularly relevant to skilled nursing, and 8 I can say that, in my experience as a lender for the 9 better part of my career, my lending colleagues and 10 I have never placed any value on cushion ratio as a 11 meaningful criteria as it relates to health care 12 financing. 13 aware of any financial lending platform in today's 14 market that utilizes cushion ratio as part of their 15 underwriting and approval standards. 16 It is also important to note we are not As Mr. Constantino notes in the report, a 17 cushion ratio is an indication that an entity has 18 sufficient cash to pay principal and interest 19 related to the loan. 20 that particular trigger is debt service coverage, 21 and, as previously mentioned, we have four times 22 debt service coverage in Year 3, which would be 23 considered an A rating in terms of credit. 24 For a project such as this, With that being said, from a financial PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 226 1 viability and statistical review, our project meets 2 all the criteria that active lenders and equity 3 investors would look for when evaluating potential 4 opportunities. I'll now turn this over -- back over to 5 6 Brian. 7 MR. CLOCH: 8 First of all, I want to thank you in advance 9 Thanks, Brad. for giving this project due consideration. As 10 stated previously, today's project is unique because 11 it is a replacement facility where we're actually 12 reducing the existing bed inventory by 39 beds taken 13 out of circulation. 14 Plus it is unique because it not only 15 provided -- it not only will provide traditional 16 skilled nursing care, focused on the existing 17 current custodial and memory care clientele, but we 18 will also offer our signature transitional care for 19 short-term, acute rehab guests. 20 As you heard from Chairman Lawlor, the 21 current Winchester House enjoys a rich history of 22 providing care to the residents of Lake County for 23 well over a century. 24 process and board review, the Lake County Board Through an extensive RFP PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 227 1 chose the team in front of you today to help them 2 transition out of the business of health care while, 3 at the same time, providing ongoing, uninterrupted 4 care for current Winchester House residents and 5 increased access and quality in the future to Lake 6 County through privatization and innovation. 7 Clearly, operating according to today's 8 standards in a 60-year-old 200,000-square-foot 9 building, which is more than two times the proposed 10 Transitional Care of Lake County's size with less 11 amenities, to say the least, is not optimal. 12 such, Brad and I could not be more thrilled about 13 bringing this improvement to Lake County and this 14 proposed project to fruition. As The ability to innovate and create a new, 15 16 state-of-the-art facility that will provide a new 17 home for the current residents of Winchester House 18 is very exciting not only for us but for all the 19 current Winchester House residents and their 20 families. 21 address the future needs of Lake County residents, 22 as well, and be part of the transformational change 23 to the health care delivery system that is badly 24 needed. Plus the new Winchester House will PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 228 The proposed Transitional Care of 1 2 Lake County will be built on the current Winchester 3 House's time-tested, firm foundation of a century of 4 caring; strong skilled nursing program; high-quality 5 rehab department; growing, specialized memory care 6 program; robust life-enrichment offerings; and an 7 extensive community involvement. With the needs of the current Winchester 8 9 House residents at the forefront, this replacement 10 project will offer three distinct clinical focuses. 11 Each of these areas will operate separately from the 12 others. 13 crew member employee lounge, will be shared. 14 Only backroom functions, as the kitchen and The first focal area is the custodial care 15 neighborhood for residents who are no longer able to 16 live on their own and require long-term care. 17 The second is a memory care community that 18 is designed specifically to meet the special needs 19 of people who suffer from dementia related to 20 Alzheimer's disease or other neurological illnesses. 21 And the third is the transitional care for 22 people who require specialized short-term care. 23 Similar to our other projects you have previously 24 approved, transitional care is a successful model PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 229 1 that is growing across the country. 2 the long-standing, untapped need to reform 3 short-term rehabilitative care. 4 It addresses This project has received no opposition and 5 overwhelming support, as evidenced by the fact that 6 over 65 letters were sent in favor for this project 7 from Lake County residents. 8 letters of support from Congressman Robert Dold, 9 State Senator Carol Sente, State Representative 10 11 We have also presented Ed Sullivan, and Mundelein Mayor Steve Lentz. Comments along the way have included "It can 12 be very stressful having a loved one in a skilled 13 nursing or short-term rehab facility, but having one 14 of this caliber will definitely make my family 15 members feel more secure and improve the spirits of 16 the patients. 17 "As a Lake County taxpayer and someone who 18 worked with the Lake County system for over 19 30 years, this is good for Lake County. 20 for the residents that are currently in that 21 facility, and it's good for people in the future 22 that will be taking advantage of these services. 23 it's a win-win, in my opinion, that's been long 24 overdue." It's good PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM So DraftFull Meeting Conducted on June 21, 2016 230 1 In addition, the project concept is 2 supported by the Lake County Board throughout the 3 RFP process. 4 front of this -- we were in front of you this past 5 November where we were approved for the first phase 6 of the project, our change of ownership to operate 7 the current existing County facility. 8 9 As you probably recall, we were in We were extremely proud of the innovation we have been able to bring to the Chicago area 10 heretofore, and we are now excited about bringing 11 that level of passion, innovation, and expertise to 12 Lake County to meet our current Winchester House 13 residents' needs and the future needs of the growing 14 and aging Lake County population. 15 With your support, we look forward to 16 continuing the Winchester House tradition with -- of 17 providing compassionate, quality health care while 18 bringing new innovation in resident-centered senior 19 care to Lake County with the replacement of this 20 important community asset. 21 Thank you for allowing us the opportunity to 22 innovate and help with the transformational change 23 in the health care delivery system in Illinois. 24 CHAIRWOMAN OLSON: Thank you. PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 231 1 Questions from Board members? 2 (No response.) 3 CHAIRWOMAN OLSON: 4 Seeing none, I'll call for a roll call vote. 5 MR. ROATE: 6 Motion made by Mr. Galassie; seconded by 7 Thank you, Madam Chair. Mr. Sewell. 8 Mr. Galassie. 9 MEMBER GALASSIE: 10 vote aye. 11 MR. ROATE: 12 MEMBER GALASSIE: 13 I am very happy to Thank you. I've been disgusted for the last 25 years. 14 MR. ROATE: Justice Greiman. 15 MEMBER GREIMAN: 16 MR. ROATE: 17 Mr. Johnson. 18 MEMBER JOHNSON: Aye. Okay. Aye. Thank you. I'm going to vote no based 19 on the State report. 20 the testimony, I didn't really hear verification 21 based on the unnecessary duplication of services, so 22 I'm going to vote no. 23 MR. ROATE: 24 Mr. McGlasson. I still don't -- even based on Thank you. PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 232 1 MEMBER MC GLASSON: 2 MR. ROATE: 3 Mr. Sewell. 4 MEMBER SEWELL: Yes, based on testimony. Thank you. I'm voting yes because it 5 looks like they had more beds and they're replacing 6 them with less beds in an area that does have excess 7 capacity. 8 So I'm okay with that. 9 MR. ROATE: Thank you. 10 Madam Chair. 11 CHAIRWOMAN OLSON: 12 I vote yes for reasons stated. 13 MR. ROATE: 14 That's 5 votes in the affirmative; 1 vote in 15 Thank you. the negative. 16 CHAIRWOMAN OLSON: 17 Congratulations. 18 MR. HABER: 19 Motion passes. Thank you very much. - - - 20 21 22 23 24 PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 233 CHAIRWOMAN OLSON: 1 2 Next up we have Project 16-014, St. Clara's Manor. May I have a motion to approve Project 3 4 16-014, St. Clara's Manor, to establish a 140-bed 5 long-term care facility. 6 MEMBER GALASSIE: 7 CHAIRWOMAN OLSON: 8 MEMBER MC GLASSON: Second. 9 CHAIRWOMAN OLSON: Thank you. I need a second. THE COURT REPORTER: 10 11 So moved. Would you raise your right hands, please. 12 (Five witnesses sworn.) 13 THE COURT REPORTER: 14 17 Please print your names. CHAIRWOMAN OLSON: 15 16 Thank you. Mr. Constantino, your report. MR. CONSTANTINO: The Applicants are 18 proposing to establish a 106-bed skilled nursing 19 facility in Lincoln, Illinois. 20 project is approximately $20.6 million. 21 anticipated completion date is January 31st, 2018. 22 The cost of the The There was no public hearing, no opposition 23 letters received. We did have findings. And if you 24 would turn to page 3 under "Availability of Funds," PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 234 1 where it says "Hickory Point Bank & Trust," that 2 should read "State Bank of Lincoln." 3 changed after I had written this report, and 4 I forgot to change the bank in the report. 5 CHAIRWOMAN OLSON: 6 MR. CONSTANTINO: 7 commitment, though. Thank you, Mr. Constantino. It still wasn't a firm The finding remains unchanged. 8 CHAIRWOMAN OLSON: 9 MR. HART: 10 The bank was Comments for the Board? Good afternoon, Madam Chair and Board members. My name is Ben Hart. 11 I'm president and CFO 12 of Heritage Enterprises. 13 company for the Applicant, and I'd just like to 14 introduce the people here at the table with me 15 today. 16 We're the management On my right, of course, is our CON 17 consultant, Mr. Kniery. 18 Blake, who is our senior vice president of 19 facilities. 20 chief financial officer. 21 Reynolds, who is president of the board of 22 St. Clara's Manor, Inc., as well as St. Clara's 23 Senior Services. 24 On the far left is Mike Next to him is David Underwood, our And finally is Mr. Clyde I'm going to turn it over to Mr. Reynolds. PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 235 MR. REYNOLDS: 1 2 Good afternoon. first time here. I did want to make a clarification. 3 4 a 140-bed facility now. 5 downsize to 106 beds. 6 maybe they want to amend that. We are We're actually wanting to So whoever made the motion, But I wanted to say it's a pleasure to be 7 8 here. 9 time on our behalf. 10 This is my I want to thank you all for your efforts and So the project we're proposing is similar to 11 a lot of the things of what Lake County said. We 12 are -- started life, actually, 130 years ago as a 13 hospital in the Logan County area. 14 function there, critical needs and capacity there 15 until the '60s. We performed a 16 In 1954 the community built a new hospital, 17 and ultimately that led to the -- they didn't need 18 two hospitals, and the old St. Clara's facility was 19 losing its accreditation because of its age and 20 stature. 21 ceased to exist, and the St. Clara's organization 22 went into hiatus. 23 24 And so in 1962 the St. Clara's Hospital The following year the St. Clara's Auxiliary came out and formed St. Clara's Manor, Inc. It's a PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 236 1 not-for-profit, nondenominational organization with 2 the sole mission of providing facilities for the 3 aged, long-care facilities for the aged. 4 St. Clara's Manor arose out of the ashes of what had 5 been St. Clara's Hospital. 6 service to area residents then, and just six years 7 ago, in 2010, we purchased 20 acres of land out on 8 the west end of town and we built a 52-unit 9 supported-living facility. In 1973 It had provided a 10 Just sort of a side note, we built that 11 facility next to a 50-acre tract where Abraham 12 Lincoln Memorial Hospital just built their new 13 facility, so our SLF is located right next to the 14 new hospital. 15 But St. Clara's Manor itself now faces a 16 crossroads. We're once again in an aged facility. 17 We're landlocked. 18 two-story building. 19 style of the '60s and '70s that you would never do 20 today, and it's not as good a facility as other 21 facilities that are being built today. We're downtown. We're a It's built in the institutional 22 So we could certainly invest in this 23 building and try and restore it and bring it up to 24 better standards, but we'll still be landlocked; PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 237 1 we'll still be an institutional-style building; 2 we'll still be downtown. 3 go out and build a new facility on the edge of town, 4 on the same campus where Castle Manor is located. 5 Now, the Review Board evaluated our And the alternative is to 6 application as if we were establishing a new 7 facility because the rules and regs won't let them 8 consider us as a relocation, but that's a real 9 critical distinction. We're not bringing any new 10 beds to Logan County. We're actually retiring 11 34 beds. 12 existing. 13 The new community will be smaller than the Moreover, the new community is going to 14 be -- instead of having the institutional feel of 15 the current St. Clara's, it's going to have five 16 home-style subdivisions within the single one-story 17 building; it's going to have -- 87 percent of our 18 beds are going to be private beds as opposed to 19 semiprivate. 20 rooms for geriatric care. 21 short-term -- specialized levels of care for 22 short-term care and rehab care. 23 have indoor therapy, outdoor therapy, court -- we 24 have all these services we just can't do where we We're going to have two specialized We're going to have And we're going to PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 238 1 are now. 2 allow us to coordinate the services between Castle 3 Manor and St. Clara's Manor out on the same campus. 4 So, you know, the last thing will sort of That's a lot of change. There are some 5 things that aren't going to change. 6 2015, over 64 percent of St. Clara's residents were 7 receiving Medicaid payments and just 42 percent of 8 Castle Manor's were residents of Medicaid. 9 to continue that service. 10 In the end of We plan We will also have the same staff that the 11 residents have known and worked with and have a 12 comfort level with, and so that sense of homeliness 13 or at least community will continue. 14 I have tried to be brief here, but I don't 15 mean to gloss over anything. If people have 16 questions, I will be happy to try and answer them. 17 MEMBER SEWELL: 18 CHAIRWOMAN OLSON: 19 MEMBER SEWELL: 20 Mr. Constantino, I wanted to -- what more do 21 22 Madam Chairman. Mr. Sewell. Yeah. you need on this availability-of-funds issue. It looks like they have these tax-exempt 23 bonds in two categories for a little less than the 24 total cost of the project. PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 239 MR. CONSTANTINO: 1 Yeah. The letter -- it's 2 not a firm commitment that they are going to get the 3 financing. 4 commitment. That's what I'm looking for. MEMBER SEWELL: 5 6 The letter stated it wasn't a firm Can they get any more than this at that stage? 7 MR. CONSTANTINO: You'll have to ask them. 8 CHAIRWOMAN OLSON: Can we go back to the 9 comments that were just made? MR. KNIERY: 10 Yeah. I'd like to first 11 address it in terms of -- we are looking for -- it's 12 not traditional financing, conventional financing. 13 It is bond financing with a traditional construction 14 loan. 15 16 Mr. Underwood, if you'd like to take it and address it a little bit further. 17 MR. UNDERWOOD: Thank you, John. 18 In reality, the gentleman that was here 19 prior to us that discussed credit limitations really 20 kind of spelled it out as well as I possibly could. 21 But the signed letter that we did get from the 22 financial institution basically uses approval of 23 this project as one of their criteria plus a -- they 24 also indicated that there's final due diligence, PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 240 1 which is always the case right before they go ahead 2 and actually issue the money. So whether it's conventional financing or 3 4 bond financing or -- the letter from -- the 5 commitment letter at this point in time from the 6 lender is about as good as we could possibly expect 7 to receive at this juncture. But I've spoken with the lender on numerous 8 9 occasions. This current lender also provides 10 depository services currently for St. Clara Manor 11 and St. Clara Senior Services so -- they're Lincoln 12 based. 13 confident that they will follow through on their 14 commitment as stated in the letter that was earlier 15 distributed to the staff. We're very familiar with them and very 16 CHAIRWOMAN OLSON: 17 (No response.) 18 CHAIRWOMAN OLSON: 19 20 21 I just want to make sure I have my numbers right here. You're closing the current 140-bed facility and building a 106-bed facility? 22 MR. KNIERY: 23 CHAIRWOMAN OLSON: 24 Other questions? Correct. So while there's a 97-bed excess in the planning area, you're decreasing PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 241 1 by 36 beds. And then if you could look at Table 1 on 2 3 page 5 in the State Board staff report, it looks 4 here like, with the exception of the swing beds at 5 Lincoln Hospital, that Christian Nursing Home is the 6 only other nursing home in Lincoln. 7 MR. HART: 8 facilities in -CHAIRWOMAN OLSON: 9 10 Oh, yeah. I -- well, outside -MR. HART: 11 12 There are actually two other -- Symphony as well as Christian Nursing Home. CHAIRWOMAN OLSON: 13 And if you take out the 14 0 percent utilization in those swing beds, according 15 to my math, it comes up to over 70 percent 16 utilization in those current spaces combined, so 17 you're running out of beds. MR. KNIERY: 18 You're absolutely right. If we 19 were to discontinue even the number of beds to 20 create a zero net need, there's not enough places in 21 Lincoln to take care -- there's not enough beds in 22 Lincoln to take care of people. 23 CHAIRWOMAN OLSON: 24 That will be displaced by those? PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 242 1 2 3 MR. KNIERY: That's exactly right. And just one additional point I think is very important. Your rules require 30- and 45-minute travel 4 time, and I'm not contesting any of that. 5 is interesting is, looking at their patient origin, 6 96 percent of all residents in-house come from one 7 single zip code, the city of Lincoln. 8 9 CHAIRWOMAN OLSON: Coming from a small community, I understand that. 10 MR. KNIERY: 11 CHAIRWOMAN OLSON: 12 Okay. But what Yeah. Other questions or comments? 13 (No response.) 14 CHAIRWOMAN OLSON: Seeing none, I'd ask for 15 a roll call vote. 16 MR. ROATE: 17 Motion made by Mr. Galassie; seconded by 18 Thank you Madam Chair. Mr. McGlasson. 19 Mr. Galassie. 20 MEMBER GALASSIE: Aye. 21 MR. ROATE: Thank you. 22 Justice Greiman. 23 MEMBER GREIMAN: 24 MR. ROATE: Aye? Based on discussion. Aye. Thank you. PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 243 1 Mr. Johnson. 2 MEMBER JOHNSON: Yes, based on the 3 discussion we just had. 4 MR. ROATE: 5 Mr. McGlasson. 6 MEMBER MC GLASSON: 7 MR. ROATE: 8 Mr. Sewell. 9 MEMBER SEWELL: Thank you. Thank you. Yes, based on discussion. 10 MR. ROATE: 11 Madam Chair. 12 CHAIRWOMAN OLSON: 13 14 15 Yes, based on need. Thank you. Yes, based on the need in Lincoln. MR. ROATE: That's 6 votes in the affirmative. 16 CHAIRWOMAN OLSON: 17 Congratulations and good luck. 18 MR. KNIERY: 19 The motion passes. Thank you very much. - - - 20 21 22 23 24 PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 244 CHAIRWOMAN OLSON: 1 Next, we have -- that 2 actually ends our applications subsequent to initial 3 review. 4 intent to intend, Project 15-044, Transformative 5 Health of Mercy. We have one application subsequent to 6 Oh, I'm sorry. 7 MR. CONSTANTINO: Of McHenry. Madam Chair, the 8 Applicants have a presentation, and they provided 9 the Board with a handout here. 10 distribute it. 11 already in your material. 12 for you to follow. 14 You've already seen it. I've reviewed it. 13 MS. AVERY: 16 MR. MORADO: 17 CHAIRWOMAN OLSON: 18 Okay. 19 THE COURT REPORTER: It would just be easier It's all material you've Okay. That's fine. That's fine. The Applicant will be sworn in. Raise your right hands, please. 21 (Five witnesses sworn.) 22 THE COURT REPORTER: 23 24 It's seen before. 15 20 We'd like to Thank you. And please print your names. CHAIRWOMAN OLSON: May I have a motion to PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 245 1 approve Project 15-044, Transformative Health of 2 McHenry, to establish a 98-bed long-term care 3 facility. 4 MEMBER JOHNSON: 5 CHAIRWOMAN OLSON: 6 MEMBER SEWELL: 7 CHAIRWOMAN OLSON: 8 And a second, please. Second. Mr. Constantino, your report. MR. CONSTANTINO: 9 10 So moved. One other thing. didn't pay for this nice handout. 11 CHAIRWOMAN OLSON: 12 I know we don't have any money. MEMBER SEWELL: 13 14 We I'm sure you didn't. No, Mike, it doesn't look like your work. 15 CHAIRWOMAN OLSON: Ouch. 16 Mr. Constantino, your report. 17 MR. CONSTANTINO: The Applicants are 18 proposing to construct and operate a 98-bed 19 long-term care facility in McHenry, Illinois. 20 cost of the project is approximately $19.3 million. 21 The anticipated completion date is December 31st, 22 2017. The 23 There were findings on this project. This 24 project received an intent to deny at the February PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 246 1 2016 State Board meeting. 2 Thank you, Madam Chairwoman. 3 CHAIRWOMAN OLSON: 4 Comments for the Board? 5 MR. CONSTANTINO: 6 We did -- we do have two comments on the Thank you, Mike. Excuse me a minute. 7 State Board staff report. 8 They were received timely. 9 CHAIRWOMAN OLSON: 10 Comments? 11 MR. JENICH: 12 13 Yes. They're in front of you. Thank you. Good afternoon, Madam Chairwoman and respected members of the Board. My name is Gerry Jenich -- that's G-e-r-r-y 14 J-e-n-i-c-h -- and I am the manager for the 15 Applicant, TCO JV, LLC, for Project No. 15-044, 16 Transformative Health of McHenry. 17 I'm pleased to have with me today 18 Mr. Dan Lawler, our CON counsel; Mr. Scott Higgs, a 19 certified public accountant and the senior vice 20 president of finance for the Main Street Property 21 Group and the co-Applicant MS McHenry; Mr. John 22 Kniery, our CON consultant. 23 24 And also available and present to answer any additional questions you may have is Mr. Andy Van PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 247 1 Zee, representing MS McHenry, LLC, the co-Applicant 2 for this project. 3 today is Mr. Charles Foley, our CON consultant. 4 Not present but in our thoughts We are here before you today to respectfully 5 ask for your approval for the establishment of a 6 specialized 98-bed all-private room transitional 7 care facility to be named Transformative Health of 8 McHenry. 9 The skilled nursing project will provide 10 modernized transitional postacute health care 11 services in a purposeful, resident-centric facility 12 which has been designed to provide a unique and 13 significant role in the existing continuum of care. 14 There is an established bed need in McHenry 15 County planning service area for 127 additional 16 nursing home beds, which supports our request for a 17 98-bed skilled nursing facility to fill this need. 18 The Board considered our project at its 19 February 16th, 2016, meeting when it issued an 20 intent to deny. 21 the opportunity to respond to the Board's concerns, 22 and we have provided additional documentation that 23 we believe thoroughly addresses the Board's 24 questions and fulfills any additional information Since that time we have embraced PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 248 1 requests by the staff. 2 On behalf of our project team, I would like 3 to thank and recognize the staff for their work on 4 the State Board staff reports and for their patience 5 in participating in multiple technical assistance 6 meetings with us throughout this process. 7 been helpful, polite, timely in their responses, and 8 professional in performing their duties. They've Thank you, all. 9 I'd like to ask Mr. Lawler to first address 10 11 the most recent State Board staff report findings 12 and our responses to the Board's two negative 13 findings. 14 as to how this project is uniquely different from 15 existing providers and warrants your approval here 16 today. I will then follow up with an explanation 17 Mr. Lawler. 18 MR. LAWLER: 19 Madam Chair and members of the Board, we're Thank you, Gerry. 20 before you following an intent to deny, and we were 21 hoping for a bit fuller Board attendance today. 22 Given that we need 5 of 6 available votes, we 23 seriously considered a deferral today but we're 24 proceeding today. We had a lot of public comment PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 249 1 show up today. We didn't want to send them home and 2 bring them back later if they were even available 3 later. 4 A deferral is also costly, but the main 5 reason we're seeking a vote today is that all of the 6 negative votes the last time we were up were based 7 on staff's negative findings on two criteria. 8 if you will kindly bear with me today, I will show 9 that we meet the letter and intent of those two 10 11 And criteria and seek your positive consideration. As it stands, the staff report has 18 of 12 20 positives. 13 would take a report like that just about any day. 14 That's 90 percent positive and would get you an A on 15 most tests. 16 should receive an A plus on this test. 17 I've been doing this for 30 years and I'd like to make the case today that we The two negatives were on 1125.570, service 18 accessibility, and 1125.580, unnecessary 19 duplication, so I'll start with 570. 20 Mr. Constantino referred to my written 21 comment on the staff report -- that's the Barnes & 22 Thornburg letter dated June 13th -- and the service 23 accessibility criterion is included as Attachment 1. 24 You can see that, under paragraph A, there are five PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 250 1 listed factors -- five numbered factors -- and the 2 rule requires the Applicant to document at least one 3 of the factors in the planning area. 4 On page 13 of the staff report, the staff 5 also says that the Applicants must document at least 6 one of the factors exists in the planning area, then 7 page 16 of the staff report shows that we documented 8 at least one of the factors. 9 areas in McHenry County have been designated as We documented that 10 medically underserved populations, and we documented 11 that area facilities have restrictive admission 12 policies. 13 At this point you might think we were in 14 good shape. The rule requires at least one of five 15 factors exists in the planning area, and we 16 documented at least one exists in the planning area. 17 But I knew from past experience that this doesn't 18 always carry the day, so even before the staff 19 report was issued, I asked for a technical 20 assistance meeting to make the case that "at least 21 one" means "at least one" and does not mean 22 something other than "at least one." 23 I had supposed that, as an experienced 24 attorney with superior powers of persuasion, I would PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 251 1 knock this one out of the park on the first try and 2 convince everybody that "at least one" means "at 3 least one" and doesn't mean something else, but 4 I couldn't do it at the first technical assistance 5 meeting or the second. 6 I thought I was making headway, but as you can see 7 from the staff report, I struck out. 8 convince your staff that "at least one" means "at 9 least one." 10 At the third meeting I could not Page 15 of the staff report shows that the 11 staff is requiring documentation of one of the first 12 four factors plus the fifth factor. 13 ask how can that interpretation be derived from the 14 rule's language that at least one factor be 15 documented. 16 I respectfully Section 1125.570 is a duly promulgated 17 administrative regulation of this Board to which 18 certain legal principles apply that Justice Greiman 19 will be very familiar with. 20 regulations have the force and effect of law, and 21 they are interpreted according to the same rules of 22 construction that are applied to statutes. 23 primary rule of statutory construction is to give 24 effect to the drafter's intent, and the best Administrative The PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 252 1 indicator of legislative intent and agency intent is 2 the plain and ordinary language of a statute or rule 3 itself. 4 What could be more plain and ordinary than 5 the phrase "at least one"? 6 phrase, this Board, intended it to mean "at least 7 one of the five factors." 8 phrase to mean "one of the first four plus the 9 fifth" because that's not what the plain language of 10 11 The drafter of that It did not intend that the rule says. One more legal principle on agency 12 regulations: 13 regulation under its statutory authority, the agency 14 is bound by that rule as written and may not add 15 requirements to the plain language of the rule. 16 When an agency has adopted a The staff here has added requirements that 17 are not in the plain language of the rule itself and 18 that's not right. 19 concern here is, and it is a very legitimate 20 concern. 21 underutilization in the planning area, and this 22 Board is rightly concerned about that, too. 23 24 Now, I know what the staff's The staff is concerned about The Board has a separate rule, 1125.580, specifically addressing underutilization, and there PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 253 1 2 is no "at least one" language in that rule. In that rule the Board specifically lays out 3 what it wants to see from an Applicant when 4 there are underutilized facilities in the planning 5 area, and there are no exceptions or caveats or 6 options in that rule. 7 if you don't, then you should get a negative. 8 address that next because we got a negative there 9 even though we provided exactly what your rule asked 10 You meet it or you don't, and I'll for when there is underutilization. 11 We meet the letter and intent of Section 570 12 and should have a positive finding there because we 13 documented at least one of the five factors on 14 service accessibility, and that is all that the rule 15 requires by its plain and ordinary language. 16 As the rule is written, underutilization 17 should not automatically trigger a negative, but 18 that is how the staff is interpreting it. 19 ask the Board to apply the rule as written, and if 20 it's applied as written, we satisfy the rule. We only 21 Before I leave Section 570, I want to 22 address some points that have been raised in 23 connection with the factors we documented, and 24 that's medically underserved population and PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 254 1 2 restrictive admission policies. Some portions of the staff report might 3 leave the impression that medically underserved 4 populations are generally small geographic areas 5 with relatively few people in them, but that is 6 definitely not the case in McHenry County, and the 7 staff report does point that out. 8 report notes, over one-third of the geographic area 9 of McHenry County has been designated as a medically As the staff 10 underserved population. 11 Also, over 80 percent of the County's population 12 reside in that area. 13 That's 200 square miles. That's over 25,000 people. Under your rule, the size of a medically 14 underserved population doesn't matter, but even if 15 it did, the McHenry County planning area has a very 16 large medically underserved population in terms of 17 both geographic area and population. 18 Another point that has been raised is the 19 contention of our opponents that the proposed 20 project itself must be located inside the area 21 designated as medically underserved. 22 requirement of the rule. 23 opponents made up. 24 That is not a That is something that our The rule only requires that the planning PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 255 1 area in which the project is located have a 2 medically underserved population. 3 here is McHenry County. 4 medically underserved population, and our project is 5 located in McHenry County. 6 requirement of the rule as it's written. The planning area McHenry County has a large That satisfies the Another requirement that our opponents made 7 8 up is that the proposed facility must be within 9 30 minutes of the area designated as medically 10 underserved. 11 here. 12 that the project must be located inside the 13 medically underserved area, then they make up a new 14 requirement and say that the rule requires the 15 project to be within 30 minutes' travel time of the 16 medically underserved area. 17 not require the project to be located within 18 30 minutes, but even if it did, the record shows 19 that a very large portion of the medically 20 underserved population is within 30 minutes of our 21 proposed facility. 22 Note how they contradict themselves On the one hand they say the rule requires Again, the rule does With regard to these requirements that our 23 opponents have made up and change at will and that 24 are not in the Board's rule, I would again point out PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 256 1 the legal requirement that, when an agency has 2 adopted a regulation under its statutory authority, 3 the agency is bound by it, as written, and may not 4 add requirements to the plain language of the 5 regulation. 6 Opponents can't add requirements. 7 promulgated, has to be applied as written. The staff can't add requirements. The rule, once 8 Regarding the second factor under 570, the 9 staff report notes that we documented restrictive 10 admission policies at two facilities in the planning 11 area, one of which does not accept Medicaid 12 patients. 13 We had sent the staff the facility's 14 Long-Term Care Facility Profile and said it showed a 15 facility had zero Medicaid patients in 2014, and 16 staff relied on that representation as the basis for 17 finding that Medicaid admissions were restricted at 18 that facility. 19 facility that accepts no Medicaid, filed a response 20 to the staff report to dispute the staff's finding. 21 They claim that they do not have a restrictive 22 admission policy, that they do accept Medicaid 23 patients, and that 10 percent of the patients they 24 have are Medicaid patients. Our opponents, who include the PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 257 I freaked out a little when I saw that. 1 2 thinking, "Did we misrepresent something to 3 Mr. Constantino? 4 profile showed zero Medicaid when it showed 5 10 percent? 6 the 0?" Did we tell Mike the facility Did we not see the 1 in front of So I immediately went to the 2014 profile, 7 8 which is on your website, to confirm what it 9 actually says and it says 0. 10 of the 0. 11 "0." 12 I'm There is no 1 in front It does not say "10 percent." It says So now I'm wondering whether 2014 was an 13 off year for them. 14 patients in prior years. 15 profiles I could find on your website, which went 16 back to 2011. 17 facility reported its Medicaid patients as zero. 18 Not 10 percent, not even 1 percent, but 0, 0, 0, 0 19 for four straight years. 20 Maybe they had lots of Medicaid So I looked at all the For each and every year, this I knew that your old website had facility 21 profiles going back to 1995. I couldn't find them 22 on the new one, so I asked Mr. Kniery if he had them 23 and he did. 24 facility's own profiles show that it has not In those 20 years, 1995 to 2014, this PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 258 1 admitted a single Medicaid patient in all 2 those years. 3 policy. 4 Now, that is a restrictive admission And here's something most peculiar about our 5 opponents' response to the staff report: Regarding 6 our expectation of having a Medicaid payer mix at 7 least as comparable to area hospitals, which is 8 7.7 percent, our opponents say there is, quote, "no 9 way a facility like ours could reach that level," 10 and they say it is, quote, "amazing to suggest that 11 we will." 12 Now, I can understand how a facility that 13 has not admitted a single Medicaid patient in the 14 last 20 years would think there is no way to serve 15 7.7 percent Medicaid and that it would be amazing to 16 suggest that anyone can, but these are the same 17 folks who are saying that they have 10 percent 18 Medicaid even though 20 years of their own facility 19 profiles show that they have never admitted even one 20 Medicaid patient. 21 somebody to suggest. 22 Now, that's an amazing thing for And even if they did admit Medicaid, though 23 they've never reported any in 20 years, we still 24 documented the factor of medically underserved PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 259 1 population, and your rule requires only that at 2 least one factor be documented. 3 that we documented that factor, and we should 4 receive a positive finding under 570. The staff agrees Moving on to 1125.580, unnecessary 5 6 duplication, Section 580 is where the rules 7 specifically focus on underutilization and what the 8 Applicant can do about it. 9 included as Attachment 2 to my response to the staff The criterion is 10 report. 11 and it looks at future utilization. 12 The rule looks at historical utilization What is very important to note is that the 13 rule does not say that, if there is historical 14 utilization -- underutilization -- the Applicant is 15 out of luck and goes home empty-handed. 16 No. The rule says that, if there is 17 historical underutilization, the Applicant must 18 document something about future utilization, and the 19 rule is very specific about what must be documented. 20 There are two things. 21 First, if there are existing facilities that 22 are historically at or above target utilization, the 23 Applicant must document that the project will not 24 lower their utilization below target occupancy PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 260 1 within two years after project completion. Second, if there are existing facilities 2 3 that are historically below target utilization, the 4 Applicant must document the project will not lower 5 to a further extent the utilization of those 6 facilities. Note what is being said here. 7 The drafter 8 of this rule, the Board, is recognizing that there 9 will always be underperformers and there is really 10 nothing the Board or the Applicant can do about 11 that. 12 make them any worse than they already are. 13 reduce their utilization to a further extent." 14 That's what the rule says. 15 As to them, the rule is saying, "Just don't Don't As for the strong performers who are at or 16 above target occupancy, the rule is saying, "You can 17 take them down to target occupancy but no more. 18 They are strong now and we want them to remain 19 strong in the future." 20 encourages good performance and it does not enable 21 underperformance. 22 That's a good rule. It And please note again the rule recognizes 23 that there are and always will be underutilized 24 facilities, and that, alone, does not trigger a PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 261 1 negative under this rule. The rule does not 2 penalize Applicants for underperformance of other 3 facilities, but the staff has punished us with a 4 negative finding solely because of these 5 historically underutilized facilities without regard 6 to the future utilization aspect of your rule. 7 The negative finding here enables 8 underutilization. It provides a positive incentive 9 for facilities to remain underutilized because they 10 know their underutilization will result in a 11 automatic negative finding from the staff on new 12 project applications. 13 written, does not promote underutilization in this 14 way. 15 But the Board's rule, as If the Applicant can document that its 16 proposed project will not reduce strong facilities 17 below target utilization and will not reduce the 18 underperforming ones lower than they already are, 19 then the letter and intent of the rule are satisfied 20 and the Applicant should receive a positive finding. 21 We have documented above and beyond what the rule 22 requires and should have a positive finding on this 23 criterion. 24 How does an Applicant document what the PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 262 1 utilization of the planning area will be two years 2 from project completion? 3 do that. 4 take existing historical data, come up with a 5 methodology, and then use the historical data and 6 methodology to make projections about the future. 7 There is no other way to do it, and the rule says 8 you have to do it. There is only one way to You have to make projections. You have to Some Applicants just make up their own data 9 10 and their own methodology, and this is often looked 11 upon with suspicion because it's hardly objective 12 and often not reliable. 13 pays a professional consultant to make objections, 14 and their objectivity and reliability might also be 15 called into question. Sometimes the Applicant We haven't relied on either of those 16 17 sources. We are relying on the most objective, most 18 reliable, most professional source imaginable. 19 are relying on the State Board's own projections as 20 to what planning area utilization will be in the 21 future. 22 CON planning process. 23 validated and must be reliable or else we wouldn't 24 have a legitimate planning process at all. We Your projections are the foundation of the Those projections must be PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 263 Now, there may be a tendency to think that, 1 2 if there is a projected bed need in an area with 3 underutilized facilities, then something must be 4 wrong. 5 wrong, it must be the projections, but that's not 6 the case at all. 7 And since the historical data can't be Historical underutilization and future bed 8 need can, in some circumstances, be entirely 9 consistent, and that's the situation here. Your 10 projections for McHenry County fully account for the 11 current, existing underutilization. 12 Let's look at those projections. 13 contained in Attachment 4 to my response to the 14 staff report, and that page is directly from the 15 inventory of health care services for long-term care 16 category of service. 17 They are There are 997 long-term beds, long-term care 18 beds in the planning area. 19 shows that, of the nine long-term care facilities in 20 McHenry County, eight were underutilized, so that's 21 the starting point of your projections. 22 facility in the county but one is underutilized. 23 That's taken into account. 24 Your latest inventory Now let's project into the future. Every The PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 264 1 first place to look is projected population growth. 2 The total population growth in McHenry County is not 3 all that much. 4 only a little over 1 1/2 percent annually. 5 As noted in the staff report, it's But the growth rate in the 65-and-over age 6 cohorts is very high. As noted in the staff report, 7 the five-year growth in the 65-to-74 population is 8 over 31 percent and the 75-and-over population is 9 over 25 percent. The aging of the population is 10 guaranteed. 11 process, try as we might. 12 Nothing is going to stop the aging Inevitable aging of the population would 13 create a tremendous demand for long-term care beds, 14 so much so that, despite the fact that eight of 15 nine existing facilities are currently underutilized 16 and despite the fact that these facilities currently 17 have 254 dead beds which they don't even set up, the 18 Board has determined that future demand will be so 19 great that, even with 90 percent occupancy of all 20 997 beds, there will still be a need for 127 more 21 beds, and that means there is a need for our 22 proposed 98-bed facility. 23 24 That's not our projection. paid consultant's projection. That's not a That is the PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 265 1 projection of this Board and its professional staff 2 pursuant to the statutory mandate. 3 directs the Board to plan for and promote the 4 development of modern health care facilities, 5 especially in areas where the planning process has 6 identified unmet need. 7 has identified an unmet need in McHenry County, and 8 this project will provide modern, comprehensive, 9 long-term care services to meet that need. The Planning Act The Board's planning process So we have gone above and beyond what your 10 11 rule requires. We have documented that the one 12 facility above target utilization will remain at 13 target utilization, and we have documented that 14 future demand will allow all the underutilized 15 facilities to not merely maintain their current 16 occupancy levels, which is all the rule requires, 17 but, also, reach target occupancy themselves, which 18 is far beyond what the rule requires. Our opposition is saying that your 19 20 projections are off and that they will never be at 21 target utilization, but who's calling the shots 22 here? 23 authority and obligation to make these projections? 24 Or is it the self-interested competitors who never Is it the Board, who has the statutory PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 266 1 want to see a new, modern facility in McHenry 2 County? 3 And even if your projections are off some 4 and these facilities don't hit the target occupancy, 5 your rule does not require that they do. 6 requires that they maintain their current level of 7 utilization, and your projections amply demonstrate 8 at least that. 9 It only So with the most reliable, most objective, 10 most professional evidence out there, we have 11 documented complete compliance with your criteria, 12 and we should have a positive finding here. 13 There is an additional factor under 580 14 which strongly supports our project. Under 580 a 15 surplus of beds is indicated when the bed-to- 16 population ratio in the planning area exceeds 17 1 1/2 times the State average. 18 The bed-to-population ratio in McHenry 19 County is less than half the State average, which is 20 much less than 1 1/2 times the State average. 21 bed-to-population ratio is so low in McHenry County 22 that, according to the Board's inventory, it has the 23 second lowest number of long-term beds per person 24 among all 95 statewide planning areas. The It's so low PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 267 1 that, even with the addition of the 98 beds in this 2 project, McHenry County will still have the second 3 lowest bed-to-population ratio of all statewide 4 planning areas. Page 19 of the staff report concludes that, 5 6 based on these ratios, it does not appear that there 7 is a surplus of long-term care beds in McHenry 8 County. 9 staff report is mind-boggling. Our opponents' spin on this finding of the In their response to 10 the report, our opponents cite the staff's finding 11 that there is no surplus of beds, then they say, 12 quote, "This translates to there is an excess of 13 beds." I don't know what translation service our 14 15 opponents are using, but when the staff says there 16 is no surplus of beds, that does not mean there is a 17 surplus of beds. 18 Bizarro World, but in the real world, when the staff 19 says there is no surplus of beds in McHenry County, 20 it means there is no surplus of beds in McHenry 21 County. 22 Maybe that's what it means in One final point before I turn things back to 23 Mr. Jenich: You have heard our opponents say that 24 we are skimming the Medicare patients from area PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 268 1 hospitals. 2 health care data provider that the Applicants rely 3 on in the ordinary course of business to provide the 4 data on referrals and admissions from the area 5 hospitals. 6 area facilities admit only one-half -- about 7 one-half of the Medicare patients that are referred 8 to them. 9 these facilities in 2014, 860 were admitted and 10 We have examined that claim by asking a That data they supplied to us shows that Of over 1600 Medicare patients referred to 780 were not. That surprised us so we sought confirmation 11 12 from the hospitals themselves independently. We 13 sent the data to Centegra Hospitals and asked if it 14 was consistent with their experience, and they told 15 us that it was, and that was confirmed by the 16 Centegra executive who spoke this morning. Why are so many patients in need of skilled 17 18 nursing services not being admitted to area 19 facilities? 20 that. 21 patient or the patients and their families don't 22 accept the facility. 23 24 There are only two likely reasons for Either the facility doesn't accept the In either case, neither is a good reason for denying a new facility in McHenry County, but both PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 269 1 are excellent reasons to approve a new facility in 2 McHenry County. 3 existing facilities of their Medicare patients. 4 will be providing a very nice facility for many 5 McHenry County Medicare patients who are not being 6 admitted into existing area facilities. We are not going to deprive We 7 Madam Chair, in conclusion, because we have 8 an A-plus application, I respectfully request this 9 honorable Board to approve Project 15-044. 10 CHAIRWOMAN OLSON: Thank you. 11 Can I open it for questions? Or did you 12 have more comment? 13 MR. JENICH: 14 CHAIRWOMAN OLSON: 15 MR. JENICH: 16 And thank you, Dan. 17 Board members, at the February Board meeting I do. Okay. Please go ahead. Thank you. 18 Chairwoman Olson asked us to share distinguishing 19 features of this project. 20 heart. 21 focused on this specific question and produced what 22 we believe is a thorough, comprehensive response 23 that has been included in our submissions and the 24 materials provided to you by staff. we took that question to After the meeting, in the time since, we PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 270 For easy reference, I've provided you with 1 2 excerpts from that submission today. And, Mike and 3 Courtney, thank you for allowing those to be shared 4 with the Board. To begin, please refer to the comparison 5 6 chart on page 3 of the handout as well as pages 4 7 through 13. 8 provide transitional care services in a caring and 9 supportive, homelike environment designed to bridge Transformative Health of McHenry will 10 the gap from hospital to home. This unique physical 11 plant and its care-delivery model is what 12 differentiates this project from all other existing 13 service providers in the area. First, as written on pages 7 and 8, our 14 15 facility will have all private rooms. This means 16 98 private rooms with 98 private bathrooms and 17 98 private sinks, toilets, and shower facilities. 18 No other provider in the service area provides all 19 private rooms. By comparison and by their own submission, 20 21 our opponents show that they have very few private 22 rooms. 23 of opposition showing that it only has 7 private 24 rooms in its 114-bed facility, and Crossroads, a On May 31st Crystal Pines submitted a letter PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 271 1 115-bed facility, reported only 4 private rooms. 2 Altogether, four opposing facilities 3 identified by Crystal Pines report 380 total beds, 4 but they only offer 35 private rooms. 5 to less than 10 percent of their total beds. 6 providers offer very few private rooms and even 7 fewer private bathrooms. 8 rooms are actually conversions from double-occupancy 9 rooms where the majority of patients have to share That equates These Most of their private 10 bathrooms, sinks, and toilet facilities. Patients 11 today strongly desire private rooms, and their 12 families strongly desire for their loved ones to be 13 in private rooms. 14 available in the service area today. Unfortunately, there are few 15 At a 98 count, our single facility will 16 offer nearly three times the number of private rooms 17 currently available at the four opposing facilities 18 combined. 19 attached private bathrooms fully equipped with 20 toilet, sink, and shower, designed to limit the 21 spread of infection and provide for a patient's 22 privacy, comfort, and, most importantly, their 23 safety. 24 All our private rooms will include Another significant physical plant PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 272 1 distinction is found on page 17 of your handout. 2 page 17, here you will see that our total gross 3 square feet per bed per the project is one and a 4 half times larger than the required State minimum 5 and will be two times the size of the average gross 6 square feet per bed of existing providers in the 7 primary service area or the PSA. 8 On Stated another way, our 700 gross-square- 9 foot bed facility as compared to the service area 10 average of 342 gross square feet per bed provides 11 for larger rooms and more common spaces that result 12 in added patient comfort and safety. 13 private rooms will be larger than the average 14 double-occupancy rooms of existing providers. 15 Our single Our facility will be new and modern. Also 16 on page 17 you will note that the average age of 17 existing facilities in the primary service area is 18 36 years old. 19 were built in the early 1970s and before, and, for 20 the most part, these dated facilities are not being 21 modernized. 22 The majority of the area facilities Next, please refer to page 18. On page 18, 23 here you will notice that Medicare and Medicaid cost 24 report information filed by the facilities PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 273 1 themselves. This table shows that, over the last 2 five years, the average annual capital expenditure 3 of existing facilities was only $130,540 per year 4 per facility. 5 expenditure over three times greater than what the 6 opposing area facilities report to the State Board 7 in the past five years combined. Our project alone represents capital 8 Other important and noteworthy project 9 distinctions, Chairwoman, include an on-staff 10 psychiatrist, seven-day-a-week rehab staffing, 11 full-time physician services, realtime laboratory 12 and radiology services. 13 As noted in your handout, we have many other 14 distinctive features in our project that are 15 currently not available in the service area. 16 these features are designed to promote healing, 17 improve patient care, improve patient comfort, 18 improve patient safety, and improve patient and 19 family privacy. 20 All Patients will benefit from and thrive on the 21 comfort and convenience of this noninstitutional 22 alternative residence center, homelike environment. 23 As we have previously stated, most of the existing 24 area facilities were built in the 1970s or earlier, PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 274 1 and the vast majority of beds are in small, 2 multioccupancy rooms. We're introducing an alternative way to care 3 4 for these patients because we know people are no 5 longer satisfied with this level of care, and this 6 may be a significant contributing factor as to why 7 PSA utilization levels are reported as being low. 8 In fact, McHenry County residents and their families 9 are leaving the county to seek care at facilities 10 like our proposed project. 11 Anecdotally, we are aware of at least three 12 facilities outside of McHenry County that are most 13 similar to the proposed project which have admitted 14 over 75 residents from McHenry County in just the 15 last year. 16 an hour away. 17 inventory data because patients and families are 18 choosing to bypass existing providers because the 19 services that they desire do not currently exist in 20 the planning area. These facilities are 45 minutes to over They don't show up on any State As vocal as our opponents have been before 21 22 this Board, not one of them requested a public 23 hearing on our project, as they were all entitled to 24 do. Instead, they chose to come before you and PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 275 1 express opposition and ignore your own rules for 2 public participation by continually repeating the 3 same issue. 4 brand-new facility with 98 rooms is proposed for 5 McHenry or have the public comment on their own 6 facilities rather than reporting only nominal 7 expenditures for capital improvements over the past 8 five years. 9 type of old-style nursing homes which the public and Perhaps they don't want to publicize a These area facilities represent the 10 the industry are moving away from. 11 patients demand modern services. Today, modern 12 There are public policy makers who also wish 13 to see movement for the health care delivery system 14 that includes facilities like the one ours is 15 purposefully designed for. 16 to the General Assembly, the Illinois Task Force on 17 Health Planning Reform addressed the state of 18 long-term care industry in Illinois and encouraged 19 this health Review Board to consider the following, 20 beginning quote: 21 into the continuum of care with other care providers 22 and to encourage modernization, more private rooms, 23 the development of alternative services, and current 24 trends such as resident-focused care in the In the 2008 final report "Consider how skilled nursing fits PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 276 1 provision of long-term care services," end quote. 2 Our resident care focused -- our resident- 3 focused care project addresses each one of the task 4 force's desired reforms and provides the updated 5 level of care addressed in the 2008 final report. 6 More importantly, our project is specifically 7 designed to provide a continuum of care on the 8 campus of an existing acute care provider. 9 project will provide higher staff ratios, This 10 alternative clinical services, and amenities 11 designed to monitor patient changes in medicine, 12 promote healing, and manage the residents' total 13 well-being and families' peace of mind. In every industry and in life, competition 14 15 is what drives innovation. 16 translates into everyone working to be his or her 17 best. 18 positively impacts patients in terms of cost, 19 quality, and accessibility to the latest treatments 20 and care models available. 21 Healthy competition From a health care system perspective, this Our project introduces health care 22 innovation into the service area, and this results 23 in a more affordable, convenient, efficient, and 24 accessible health care system, all of which are good PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 277 1 for the patients and ultimately benefit the 2 community. In their book entitled "The Innovator's 3 4 Prescription: A Disruptive Solution for Health 5 Care," Dr. Jason Hwang of the University of 6 Michigan, Professor Clayton Christensen of the 7 Harvard Business School, and the late Dr. Jerome 8 Grossman, Harvard School of Government, state, "It's 9 not that health care is doing a poor job. It's 10 improving but it just doesn't change the way we want 11 it to." 12 For change to happen, what disruptive 13 innovation theory tells us is that it's almost 14 always a new entrant to the industry that figures 15 out another way of doing things. 16 entrant, and we have figured out a better way of 17 doing things. 18 you today to provide the residents of McHenry with 19 access to the future of transitional care. 20 want a more affordable, convenient, and innovative 21 health care delivery system, we must create it. We are the new We are proposing this project before If we 22 If our opponents choose to continue to treat 23 their patients in the same manner that they've been 24 doing it since the 1970s, in buildings that were PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 278 1 built in the 1970s, then, by all means, let them do 2 it. 3 be permitted to stop the development of new, 4 innovative, and modern facilities in McHenry County. 5 The data provided to you in your Board We certainly won't stop them, nor should they 6 packets indicates that this project will not hurt 7 the existing providers. 8 CMS cost reports filed by the opposition themselves, 9 and it shows that they are receiving hundreds upon The data is based on the 10 hundreds of patient referrals beyond what they've 11 actually admitted into their facilities. 12 right now. 13 projections show that the local referrals will 14 increase dramatically due to the aging population? 15 That's Can the State and this Board's As noted on page 7 of the Board -- of the 16 staff report, the five-year growth rate for the 17 65-plus age cohort in McHenry County is 31 percent 18 and the five-year growth rate for the 75-plus age 19 group is 25 percent. 20 need of 127 beds in the planning area, and this is 21 what the Board's methodology shows to allow all area 22 facilities, including our opponents' and including 23 our project, to be at target occupancy by 2018. 24 This is what creates a bed I developed this project and filed this PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 279 1 application because I relied upon and believed in 2 your data and your projections which support that 3 there was a need for more skilled beds in McHenry 4 County. 5 in our business planning, and I am personally 6 invested in that plan and those projections. 7 substantial portion of my life savings is now 8 committed to this project. 9 which I strongly believe, and this is a project that 10 11 Your projections were a fundamental factor A This is a project in is strongly supported by the Board's own data. In closing and with consideration of the 12 information made available to you in our 13 application, subsequent submissions, and the 14 testimony provided here today, I wish to create -- 15 reiterate or repeat the following set of facts. 16 17 18 Fact No. 1: There is an established bed need for 127 beds in the planning area. Fact No. 2: There is no surplus of beds in 19 the planning area as determined by both the staff 20 and the bed-to-population ratio. 21 has the lowest or the second lowest bed-to- 22 population ratio among all 95 statewide planning 23 areas, and it has less than half the beds per 24 individual than the State average. In fact, McHenry PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 280 1 Fact No. 3: As stated, our project 2 differentiates itself from a physical plant 3 perspective in that all of our beds will be private 4 rooms with private bathrooms, and no other facility 5 in the planning areas has all private rooms. 6 Fact No. 4: All of our beds will be dual 7 certified for Medicare and Medicaid, and our 8 financial projections track with what -- the 9 information that we see coming out of the hospitals 10 and will be a minimum of Medicaid patient volume of 11 10 percent. 12 Fact No. 5 -- 13 MEMBER GALASSIE: 14 There's not 75 of these facts, are there? 15 MR. JENICH: There are 10. 16 MS. AVERY: 17 MR. JENICH: 18 MEMBER GALASSIE: 19 MR. JENICH: 10. And I'm almost done. Thank you. -- area providers relegated 20 over 250 beds and bed status. On page 7 of the 21 staff report, it shows that, in 2014, 254 of 997 22 beds were set up. 23 planning area beds, and it is six times the State 24 average of dead beds. That's almost one-quarter of all Again, that's six times the PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 281 1 2 State average for dead beds. Reason No. 6 -- and I'm almost done, sir. 3 Thank you for allowing me to continue -- the Board's 4 bed-need projections show that the 65-and-older age 5 cohort in McHenry County are increasingly so rapidly 6 that all area providers will reach target occupancy 7 by 2018. 8 No. 7: Even now, CMS cost report data shows 9 that area facilities are admitting only about half 10 the patients referred to them from area hospitals. 11 Many McHenry County patients are leaving the 12 planning area seeking alternative skilled nursing 13 services elsewhere. 14 No. 8: Local patient referrals are not 15 currently being admitted to area facilities, and 16 these referrals will dramatically increase as the 17 population ages. 18 adversely affected by the proposed project. 19 are plenty of documented referrals in the planning 20 area to support both the area providers and this 21 project. 22 No. 9: Existing facilities will not be There The staff found that we met 18 of 23 20 criteria, and we have respectfully presented 24 extensive and compelling evidence to demonstrate our PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 282 1 substantial compliance with all 20 criteria. No. 10: 2 This project will deliver up-to- 3 date modern care -- modern nursing services in a 4 manner not currently provided in the planning area. 5 It meets all the concerns recognized by the Illinois 6 Task Force on Health Planning Reform in its final 7 report to the General Assembly, which encourages 8 this planning Board to consider modernization, more 9 private rooms, the development of alternative 10 services, and resident-focused care trends like this 11 project will provide. 12 assuredly have a positive impact on the residents 13 who desire access to alternative, high-quality, 14 resident-focused care and services in McHenry 15 County. This project will most 16 For all of the above reasons, we respectfully 17 request the Review Board approve Project No. 15-044, 18 Transformative Health of McHenry. 19 project for this community. This is a good 20 Thank you. 21 CHAIRWOMAN OLSON: 22 Questions from Board members? 23 (No response.) 24 CHAIRWOMAN OLSON: Thank you. That was pretty PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 283 1 comprehensive. 2 roll call vote. Seeing no questions, I'll ask for a 3 MR. ROATE: Motion made by Mr. Johnson; 4 seconded by Mr. Sewell. 5 Mr. Galassie. 6 MEMBER GALASSIE: 7 MR. MORADO: 8 explain your vote. I'll ask you just to please MEMBER GALASSIE: 9 Aye. I'm sorry. 10 MR. MORADO: 11 MEMBER GALASSIE: 12 Based on the discussion and findings of 13 Can you just explain your vote? Oh. staff, I'm voting aye. 14 MR. ROATE: Thank you. 15 Justice Greiman. 16 MEMBER GREIMAN: Well, I voted aye last 17 time, and, despite hearing all this, I'll still vote 18 aye. 19 MR. ROATE: Thank you. 20 Mr. Johnson. 21 MEMBER JOHNSON: Yes, based on the details, 22 defense of staff's findings, and explanation by the 23 Applicant. 24 MR. ROATE: Thank you. PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 284 1 Mr. McGlasson. 2 MEMBER MC GLASSON: 3 testimony heard. 4 MR. ROATE: 5 Mr. Sewell. 6 MEMBER SEWELL: 7 Thank you. Yes, based on the testimony, the interpretation of the rules. 8 MR. ROATE: 9 Madam Chair. 10 Yes, based on the Thank you. CHAIRWOMAN OLSON: Yes, based on testimony. 11 I think they addressed the negative findings 12 extremely adequately. 13 14 MR. ROATE: That's 6 votes in the affirmative. 15 CHAIRWOMAN OLSON: 16 Congratulations, gentlemen. 17 MR. JENICH: 18 (Applause.) 19 CHAIRWOMAN OLSON: 20 The motion passes. Thank you very much. Good luck. - - - 21 22 23 24 PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 285 1 CHAIRWOMAN OLSON: There's no other 2 business; there's nothing under rules development, 3 nothing under old business. 4 You have your financial report. If you have 5 questions, please address them to Courtney or Juan 6 or Jeannie. 7 I would like to have a motion to maintain 8 the July 2014 through December 2014 exec session 9 minutes confidential and closed. 10 May I have such a motion. 11 MEMBER JOHNSON: 12 CHAIRWOMAN OLSON: 13 MEMBER GALASSIE: 14 CHAIRWOMAN OLSON: 15 (Ayes heard.) 16 CHAIRWOMAN OLSON: 17 (No response.) 18 CHAIRWOMAN OLSON: 19 No discussion under bed changes, capital 20 21 22 23 24 So moved. Can I have a second, please. Second. All those in favor say aye. Opposed, like sign. Motion passes. expenditures. You have a list of meeting -- oh, you were -- I'm sorry. You received a report on bed change, capital expenditures for 2013 and capital expenditures for PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 286 1 2014 as well as the meeting dates for 2017. 2 have any questions, please let Courtney or Juan 3 know. 4 If you We are not firmed up on any of the sites for 5 2017, probably mostly because we haven't paid 6 anybody since 2014, so I think eventually we're 7 going to wear out our welcome. 8 be meeting at my house in 2017. 9 MEMBER GALASSIE: 10 11 12 13 CHAIRWOMAN OLSON: I think people will We'll second that. And, Mike, we have corrections to one of the profiles? MR. CONSTANTINO: Yes. We just need a voice vote on this, Kath. 14 CHAIRWOMAN OLSON: 15 MR. CONSTANTINO: 16 CHAIRWOMAN OLSON: 17 MR. CONSTANTINO: Okay. Go ahead. Rush -- go ahead. Go ahead. Rush University Medical 18 Center, Advocate South Suburban, and John Stroger 19 are asking the Board's permission to change profile 20 information. 21 MS. AVERY: Nelson's reviewed this? 22 CHAIRWOMAN OLSON: Nelson has reviewed it 23 and concurs with the changes? 24 MR. CONSTANTINO: Yes. PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 287 1 2 3 CHAIRWOMAN OLSON: I think you have, as well, Mike. May I have a motion to approve corrected 4 data profiles for Rush University Medical Center, 5 2012, 2013, 2014 -- 6 MEMBER GALASSIE: So moved. 7 MEMBER JOHNSON: 8 CHAIRWOMAN OLSON: 9 -- Advocate South Suburban Hospital for Second. I'm going to do them all. 10 2008, 2009, 2010, 2011, 2012, 2013, and 2014; and 11 John H. Stroger, Jr., Hospital for 2013 and 2014. 12 May I have a motion. 13 Dale -- Dale moved. 14 MEMBER JOHNSON: 15 CHAIRWOMAN OLSON: 16 (Ayes heard.) 17 CHAIRWOMAN OLSON: 18 (No response.) 19 CHAIRWOMAN OLSON: 20 MEMBER SEWELL: Do I have a second? Second. All those in favor? Opposed, like sign. Motion passes. Let the record show that 21 I abstained on that vote because the School of 22 Public Health has an active contract with the 23 Cook County Health and Facilities System, and I'm a 24 principal investor in that. PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 288 1 CHAIRWOMAN OLSON: 2 MEMBER MC GLASSON: 3 Thank you, Mr. Sewell. Would my abstention be a problem? 4 CHAIRWOMAN OLSON: 5 MEMBER MC GLASSON: 6 CHAIRWOMAN OLSON: 7 Is there -- why did you think -- finally, 8 9 It would. Then I vote aye. Okay. Juan, the interagency agreement. MR. MORADO: Yes. I just passed out a copy 10 to you and to Mike and George -- and, Melanie, 11 I apologize; I don't have your copies yet. 12 But there's only two changes from the IGA 13 that was approved last year. One change is that the 14 Board will now provide IDPH with a copy of our 15 personnel handbook, and the other change is that we 16 are going to be asking for the consultation with 17 HFSRB-IDPH regarding the number of staff designated 18 to us to happen by a certain date. 19 that would be by June 15th of the next fiscal year. 20 So we already have in our IGA that IDPH will 21 consult with us regarding who gets assigned to work 22 on Board matters. 23 it, have not happened. 24 it hasn't quite happened yet, so we're hoping to In this case, Those meetings, as I understand So it's been in writing but PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 289 1 2 strengthen that part a little bit more. CHAIRWOMAN OLSON: 3 motion to approve? 4 MR. MORADO: 5 CHAIRWOMAN OLSON: 6 And you would like a Yes. May I have a motion to approve the HFSRB-IDPH interagency agreement. 7 MEMBER GALASSIE: So moved. 8 CHAIRWOMAN OLSON: 9 MEMBER SEWELL: And a second. Second. 10 CHAIRWOMAN OLSON: 11 Any other questions or comments? 12 (No response.) 13 CHAIRWOMAN OLSON: 14 for a voice vote. Thank you. Seeing none, I would call All those in favor say aye. 15 (Ayes heard.) 16 CHAIRWOMAN OLSON: 17 (No response.) 18 CHAIRWOMAN OLSON: 19 I would like to just make one very quick 20 21 22 23 24 Opposed, like sign. Motion passes. announcement. I'd like to recognize Barb Haller. Is she still here? We want to thank you for all of your services at the Illinois Health and Hospital PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 290 1 Association. And enjoy your retirement. 2 MS. HALLER: Thank you. 3 CHAIRWOMAN OLSON: 4 (Applause.) 5 CHAIRWOMAN OLSON: And I'm very jealous. Okay. Our next meeting, 6 August 2nd in Chicago, Michael A. Bilandic Building. 7 It will start again at ten o'clock a.m. 8 And I will proceed -- 9 MS. AVERY: Across the street from me. 10 MS. MITCHELL: 11 the Thompson Center. It's across the street from 12 (An off-the-record discussion was held.) 13 CHAIRWOMAN OLSON: The next meeting, on 14 August 2nd, is at the Michael A. Bilandic Building 15 in Chicago. 16 May I have a motion to adjourn. 17 MEMBER JOHNSON: 18 CHAIRWOMAN OLSON: 19 MEMBER SEWELL: 20 CHAIRWOMAN OLSON: 21 (Ayes heard.) 22 CHAIRWOMAN OLSON: 23 (Off the record at 4:33 p.m.) So moved. And a second. Second. All those in favor? Thank you, everybody. 24 PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM DraftFull Meeting Conducted on June 21, 2016 291 1 CERTIFICATE OF SHORTHAND REPORTER 2 3 I, Melanie L. Humphrey-Sonntag, Certified 4 Shorthand Reporter No. 084-004299, CSR, RDR, CRR, 5 CRC, FAPR, and a Notary Public in and for the County 6 of Kane, State of Illinois, the officer before whom 7 the foregoing proceedings were taken, do certify 8 that the foregoing transcript is a true and correct 9 record of the proceedings, that said proceedings 10 were taken by me stenographically and thereafter 11 reduced to typewriting under my supervision, and 12 that I am neither counsel for, related to, nor 13 employed by any of the parties to this case and have 14 no interest, financial or otherwise, in its outcome. 15 16 IN WITNESS WHEREOF, I have hereunto set my 17 hand and affixed my notarial seal this 11th day of 18 July, 2016. 19 20 My commission expires: May 31, 2017 21 22 _____________________________ 23 Notary Public in and for the 24 State of Illinois PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM Draft Full Meeting Conducted on June 21, 2016 292 accepted 47:11 105:14 123:20 Aaron 197:6 13:8 14:9 63:17 64:1 accepts AARP 256:19 43:18 access abandon 14:19 26:17 35:15 23:10 39:22 40:11 42:11 ability 50:18 58:24 59:23,24 19:19 20:24 22:14 60:2 61:2 67:4 68:18 42:11 67:24 178:11 90:17 91:2 135:3,4 223:22 227:15 136:4,15 137:22 able 139:14 140:6 143:10 29:7,17 31:7,18 35:15 143:13 179:5,15 35:17,23 36:5,11,16 182:19 219:6,24 36:20 47:15 48:3 227:5 277:19 282:13 52:24 80:3 105:23 123:12 128:3 151:12 accessibility 152:5 156:12 164:20 249:18,23 253:14 276:19 177:5,7 180:4,8,16 accessibility/unneces... 198:3 201:22 205:5 207:13 209:23 228:15 142:19 accessible 230:9 276:24 abnormalities accessing 21:8 38:7 60:24 Abraham accident 236:11 94:9 absent accommodate 6:6,7,16 24:10 25:4 32:1 absolutely accompanied 53:7 152:7 155:16 54:11 176:11 192:2 197:8 accomplish 197:17 202:7 241:18 177:7 abstained account 287:21 28:6 106:3 142:7 161:3 abstention 161:16 186:5 263:10 288:2 263:23 abuse accountant 60:19 246:19 abusing accounts 31:22 184:13,14 185:19 accept 186:2,2,5 8:8,22 28:2 48:2 161:4 accreditation 178:8 196:18,20,22 235:19 204:6,11 256:11,22 accredited 268:20,22 74:8 160:17,18 acceptance accrued 179:17 A 107:10 accurate 195:17 224:2 accurately 153:7 183:17 achieve 70:23 acknowledge 75:23 192:4 acquire 195:2 222:10 acquired 180:1 182:17 191:19 207:10 acquisition 182:13,14 acres 236:7 act 4:7 7:8 45:15 90:14 114:4 179:16 265:2 action 3:18 103:2 134:13 203:24 204:1 active 166:7,13,17 226:2 287:22 activities 64:13 117:2 141:12 168:4 activity 118:8 169:15,16,19,20 actual 168:13 173:3,4 acuity 74:15 acute 14:11 52:17 54:15 175:6,18 177:10,23 178:23 190:23 226:19 276:8 add 145:18 156:5 195:22 207:4 210:7 252:14 256:4,5,6 added 24:11 138:22 211:6 PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM 252:16 272:12 addictions 36:10 50:3 adding 91:11 181:24 addition 71:5 72:16 73:23 79:2 84:13 203:13 230:1 267:1 additional 24:11 28:4 85:7 101:8 104:16 111:20 143:17 183:5,19 192:8 195:19 210:3 223:1,1 242:2 246:24 247:15 247:22,24 266:13 Additionally 27:9,20 138:11 address 25:13 73:6 84:16 98:24 100:14 141:19 182:8 189:12 191:23 193:1 220:10,21 227:21 239:11,16 248:10 253:8,22 285:5 addressed 185:14 208:4 275:17 276:5 284:11 addresses 229:1 247:23 276:3 addressing 252:24 adds 50:21 add-on 157:7 adequate 46:2 58:24 adequately 69:21 208:3 284:12 ADI 159:17 adjacent 66:20 181:19 188:23 adjourn 290:16 adjourned Draft Full Meeting Conducted on June 21, 2016 293 7:19 ADJOURNMENT 5:10 admin 147:14 administrative 251:17,19 administrator 2:18 16:11 18:20 21:17 65:23 69:15 81:10 90:4 admission 61:3 68:13 89:1 97:23 98:10 250:11 254:1 256:10,22 258:2 admissions 29:11 43:12 47:14 91:3 98:3 256:17 268:4 admit 91:5 258:22 268:6 admittance 62:21 admitted 29:12,14 30:6 258:1,13 258:19 268:9,18 269:6 274:13 278:11 281:15 admitting 281:9 adolescent 41:14 50:12 adolescents 53:5 60:4 adopted 252:12 256:2 adults 31:3 46:23 53:4 55:9 135:21 advance 226:8 advanced 74:14 88:23 158:19,22 advantage 72:15 87:11 98:5 229:22 advent 45:15 adversely 22:18 281:18 advisory 16:22 advocacy 136:8 advocate 56:9 62:13 67:20 143:11 286:18 287:9 aesthetics 68:2 Affairs 140:20 affect 185:7 affidavit 198:14 210:24 212:1 214:18 affiliate 54:5 62:6 affirmative 109:14 113:2 120:6 125:13 173:19 216:4 232:14 243:15 284:14 affixed 291:17 affluent 92:21 afford 139:9,10 158:9 affordable 45:15 136:16 137:14 179:16 276:23 277:20 afternoon 132:3,15 218:8 234:9 235:1 246:11 after-hours 22:6 age 66:22 67:1 77:23 78:5 79:20 92:13 99:7 154:10 235:19 264:5 272:16 278:17,18 281:4 aged 136:10 236:3,3,16 agencies 49:7,12 51:21 139:12 178:15 agency 130:14 159:4,10 252:1 252:11,12,13 256:1,3 agenda 3:10 11:9,11 ages 48:16 281:17 aggregate 184:14 aggregated 84:18 85:10 aggression 36:3 aging 85:2 90:19 219:19 230:14 264:9,10,12 278:14 ago 43:8 46:17 52:1,22 73:10,14 107:23 235:12 236:7 agree 129:8 201:11 203:14 203:16 212:11 agreed 137:15 138:7 203:18 agreement 23:3 127:2,6,8,10,19 127:21 128:2,20 129:1,10,21,23 130:7 130:14,20,23 131:2 131:14 138:4 147:6,8 147:12 215:12 288:8 289:6 agreements 3:6 128:10 agrees 259:2 ahead 44:19 89:22 130:17 149:5 188:10 240:1 269:14 286:14,15,16 aid 150:10,15 ALAN PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM 2:7 alarming 73:12 Albany 8:5 Alden 73:4 Alexius 16:12 17:5,8,11,15 Alfa 44:8 47:7 algorithms 68:16 allegations 131:9 alleviate 59:15 Alliance 46:22 54:6 62:4 allocated 158:15 allow 22:9 33:7,15 56:17 82:3 87:16 238:2 265:14 278:21 allowed 22:10 189:5 allowing 16:7 25:12 67:11 81:6 85:20 89:24 91:24 94:5 202:12 230:21 270:3 281:3 allows 17:7 87:9 all-private 247:6 alongside 23:24 alteration 4:4 111:1,13,18,21 alternative 86:20 169:22 194:10 237:2 273:22 274:3 275:23 276:10 281:12 282:9,13 alternatives 172:9 179:5 Draft Full Meeting Conducted on June 21, 2016 294 Altogether 271:2 Alzheimer's 228:20 Amanda 80:21 81:9 amazing 258:10,15,20 ambulatory 134:4,6,23 141:23 142:14 143:1,7,13 146:17 147:22 amend 128:1 201:19 235:6 amenities 17:17 227:11 276:10 American 56:15 83:22 135:15 Americans 136:18 AMI 190:17,24 191:1 205:21 213:7,23 214:11 amount 71:2 141:10 147:23 222:19 amounts 141:15 amply 266:7 analysis 75:23 analyzed 224:21 Andrews 80:21 81:5,9 83:11 Andy 246:24 Anecdotally 274:11 anesthesia 138:14 143:18 144:6 158:20 anesthesiology 138:20 angry 158:8 Ann 25:20 34:2 133:3 Anne 116:10 132:13,18 167:14,17 218:13 Annie 116:7 anniversary 62:11 announcement 289:20 annual 15:19 70:10 84:13 136:16 141:6 147:20 273:2 annually 264:4 answer 62:6 127:14 148:11 152:3 167:15 186:15 199:12,14 222:21 238:16 246:23 answered 69:21 answering 162:11 Anthony 34:21 39:15 anticipated 126:18 175:20 217:22 233:21 245:21 anxiety 59:8 anybody 11:5 101:10 170:20 286:6 anyway 152:19 173:15 apart 77:16 apologies 149:17 apologize 183:14 195:4 288:11 apparent 23:1 apparently 23:10 appeal 96:10,24 appealed 96:10 appear 132:19 174:2 267:6 appeared 134:3 appears 179:9 213:3 applaud 116:15 Applause 284:18 290:4 applicable 224:7 Applicant 15:12,13 19:4 20:15,22 23:2,24 27:23 67:22 68:9 69:21 70:7,14 75:2,5,8,22 76:22 77:3,16 97:16 103:12 115:19 121:20 122:3 129:19 175:11 176:16 176:22 194:23 195:18 202:12 211:24 215:12 217:10 218:13 222:24 234:13 244:18 246:15 250:2 253:3 259:8,14 259:17,23 260:4,10 261:15,20,24 262:12 283:23 Applicants 77:5,5 78:9 115:11 121:12 126:14 129:18 175:17 217:19 218:10 233:17 244:8 245:17 250:5 261:2 262:9 268:2 Applicant's 19:2,17 20:10,18 22:8 23:1 27:4 71:16 75:7 77:21 98:24 application 9:12 23:21 27:17 28:6 PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM 32:18 39:8 69:18 76:20 101:1 122:17 128:21 132:21 177:4 182:21 218:2 237:6 244:3 269:8 279:1,13 applications 4:10 114:6 131:10 141:24 159:8 244:2 261:12 applied 65:12 251:22 253:20 256:7 applies 177:21 apply 251:18 253:19 applying 222:12 appointed 16:21 appointment 139:19 140:4 appointments 173:3 appreciate 53:12 61:21 78:14 104:18 124:3 132:5 133:5 155:18 184:3 209:2 218:22 219:3 appreciated 184:6 approach 184:23 223:5 approached 16:19 approaches 151:2 177:10 appropriate 28:21 40:10 142:23 146:15 approval 3:10,11 11:9 27:16 37:24 39:7 53:13 67:2 96:14 107:23 134:11 143:6 221:17 222:23 225:15 239:22 247:5 248:15 Draft Full Meeting Conducted on June 21, 2016 295 43:7 46:5 47:18,24 approve 49:4 54:8 55:17 9:14 10:5,22 11:10,21 57:24 59:24 62:8,20 18:1 25:10 93:19 66:21 67:5,19 70:4,18 96:23 98:14 103:7 71:24 75:14 77:12,19 111:4 115:4 117:11 77:24 80:9 83:2,4 121:3 126:4,24 90:16 91:15 92:14 128:24 130:19,22 95:20 96:12 97:23 131:3 169:23 173:12 98:3 99:3,6,15 100:12 175:4 193:16 194:18 100:13,15,16,18 217:3 233:3 245:1 101:3 116:8 133:2 269:1,9 282:17 287:3 142:2,22 144:9,20 289:3,6 145:20 146:14,19 approved 148:19 161:21 163:11 3:17 75:21 76:3 78:10 170:20 181:4 189:17 78:12 84:8 99:15 190:4,9 191:1,1 192:3 102:2,6 103:24 193:12,12 200:21,23 104:11 106:11 111:15 201:9 206:6 212:18 117:7,7 123:18,19 213:23,24 228:14 128:14 132:8 160:17 230:9 232:6 235:13 179:22 214:23 222:15 236:6 240:24 247:15 228:24 230:5 288:13 250:3,6,11,15,16 approving 252:21 253:5 254:8 66:15 164:13 254:12,15,17,20 approximate 255:1,2,9,13,16 104:1 256:11 258:7 262:1 approximately 262:20 263:2,18 37:21 38:23 47:13 266:16 267:24 268:4 84:20 111:17 115:13 268:6,18 269:6 121:14 126:16,17 270:13,18 271:14 136:22 141:2,8 272:7,9,17,18 273:6 143:17 147:17 149:23 273:15,24 274:20 175:20 219:20 222:20 275:8 276:22 278:20 233:20 245:20 278:21 279:17,19 April 280:19,23 281:6,9,10 20:9 23:6 121:15 281:12,15,20,20 137:21 282:4 architect areas 160:19 176:23 46:2 92:22 137:9 architectural 180:21 181:4 188:20 222:3 188:22 189:6,24 architecture 190:11,15 192:8,16 107:17 192:20 193:11,15 area 200:12,14 205:21,21 14:24 20:3,12,14 22:19 206:5 213:7,8 228:11 26:20,23 29:8,15 250:9 254:4 265:5 33:20 35:9,13 39:16 266:24 267:4 279:23 39:18 41:11 42:21 280:5 Army 56:8 57:23 arose 236:4 arrangement 137:22 185:22 arrangements 224:19 arrival 50:7 94:23 arriving 94:16 art 220:6 ARVIND 2:13 ASGE 160:17 ashes 236:4 aside 93:3 asked 42:23 81:14 184:16,18 187:1 196:9,10 199:11 205:20 207:7 212:5 250:19 253:9 257:22 268:13 269:18 asking 10:18 156:20 161:24 194:23 196:8 199:22 201:17 207:5 211:23 268:1 286:19 288:16 aspect 261:6 aspects 38:19 51:12 183:1 aspirin 169:18 assembled 150:5 Assembly 275:16 282:7 assertion 20:18 assertions PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM 22:12,17 assess 193:3 assessment 141:22 142:1 159:5 190:10 206:24 assessments 88:19 asset 230:20 assigned 288:21 assist 153:9,15 assistance 20:7 122:17 137:17 143:23 144:1,3 148:5 248:5 250:20 251:4 Assistant 2:17 assisted 30:7 assisted-living 60:21 73:11 assisting 82:7 associate 82:10 associated 57:4 142:3 157:8 Associates 47:8 Association 290:1 assuming 141:3 204:20 222:14 assurance 171:1 assure 134:24 171:5 assured 170:22 182:2 assuredly 91:14 282:12 ASTC 19:5 23:5 26:17 27:2,5 27:17,19 126:6,15,24 Draft Full Meeting Conducted on June 21, 2016 296 127:11,20 128:24 129:20 130:19 151:15 152:4 161:6,9 165:2,3 167:1 172:23 ASTCs 20:12 26:20 128:9 attached 211:6 271:19 Attachment 249:23 259:9 263:13 attacks 59:12 attempt 86:10 89:7 attempted 220:21 attempting 31:22 97:19 attend 177:5 attendance 7:1 248:21 attention 36:15 148:10 attest 221:9 attesting 214:18 attorney 19:2,17 20:10 22:8 23:6 24:3 25:2 250:24 attorneys 132:18 attract 92:15 attractive 180:9 at-risk 178:23 audit 209:9 audited 183:16 185:3 187:17 195:16,20 210:9 audits 209:8 August 105:21 107:17 290:6 290:14 aunt 43:1 aunts 62:24 authority 118:13 252:13 256:2 265:23 authorization 143:4 autistic 36:1 automatic 261:11 automatically 253:17 Auxiliary 235:23 availability 42:13 43:6 46:14 55:15 68:15 77:16 183:13 193:9 220:24 223:14 233:24 availability-of-funds 238:21 available 24:20 28:20,21 29:1,1 29:15,19 40:3 46:3 48:7 54:20 56:23 59:2,5 63:2,2 74:17 163:19 178:22 180:14 181:9,24 183:18 187:11,12 191:10 198:6 199:17 209:9 210:1 214:11 223:10 246:23 248:22 249:2 271:14,17 273:15 276:20 279:12 Avenue 64:9 average 61:3 70:23 73:14 75:9 139:6 148:1 193:5,18 222:17 266:17,19,20 272:5,10,13,16 273:2 279:24 280:24 281:1 averaged 73:13 AVERY 2:18 244:15 280:16 286:21 290:9 avoid 87:17 134:12 140:16 avoidable 137:20 avoids 140:3 awaiting 55:15 awarded 223:3 aware 42:7 47:21 72:1 134:2 169:4 178:20,21 225:13 274:11 awesome 116:18 aye 7:12 8:13 9:4,20 10:10 11:2,16 12:3 112:11 112:22 119:15,17 124:17,21 171:19 211:9 215:8,11 231:10,15,15 242:20 242:21,23 283:6,13 283:16,18 285:14 288:5 289:14 Ayes 7:13 8:14 9:5,21 10:11 11:3,17 12:4 285:15 287:16 289:15 290:21 A-billed 98:2 A-plus 269:8 A-08 191:2 192:20 193:15 213:23 A-09 192:20 193:15 214:12 A-9 214:5,12 PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM a.m 7:19,22 290:7 B B 79:19 80:7 baby 81:18,20 82:7 back 7:23 36:6 101:16 135:8 174:7 204:16 210:13 226:5 239:8 249:2 257:16,21 267:22 background 38:17 backing 72:21 backroom 228:12 badly 227:23 balance 71:9 139:10 184:14 baloney 77:4 bank 183:22,24,24 184:7 185:20,21,23 196:18 202:3 203:8,10 208:15,16 214:20 221:16,18 234:1,2,2,4 banker 185:18 banks 97:9 99:12,12 101:6 107:5 186:1 Barb 289:21 Barnes 249:21 Barrington 58:15 61:8 Bart 13:13 21:16 base 146:3,11 147:17 178:13 based Draft Full Meeting Conducted on June 21, 2016 297 27:21 62:12 112:19 120:3 124:17,23 125:3,10 135:24 136:7 140:24 147:20 159:10 168:5 171:15 171:22 172:2,15 178:14 189:5 193:9 194:20 206:20 207:19 207:21 208:17 212:20 215:8,11,15,19 231:18,19,21 232:1 240:12 242:20 243:2 243:6,9,12 249:6 267:6 278:7 283:12 283:21 284:2,6,10 basically 72:4 107:8 118:4 167:18 168:20 239:22 basing 188:18 basis 47:16 191:17 256:16 bathrooms 70:6 270:16 271:7,10 271:19 280:4 Bawden 34:21 42:19,19 bear 249:8 beautiful 100:6 Bebinger 63:21 Becker 122:14 Beckstrom 26:2 30:15,16 becoming 71:3,4 bed 5:6 28:21 36:5 38:9 41:13 50:2 54:20 55:15 96:12 106:8 179:3 181:9 189:20 192:15 193:3,8 200:16 201:16 226:12 247:14 263:2,7 272:3 272:6,9,10 278:19 279:16 280:20 285:19 285:23 bedded 100:16 beds 28:20 29:1,14 35:18,20 36:16 39:22 40:4,20 41:11,16,20 42:8,14 43:5,6,8 45:8,19,20 45:24 46:1,7,11 47:22 48:4,19 52:9,11,13,15 55:7,8 59:5 61:1 62:22 63:2 66:19 73:8,23 100:13 104:1 106:7,9,18 109:9 178:22 179:11 180:14 180:16,19 181:5,9,14 181:18,24 188:22 190:18 191:2,16,20 192:24 193:4,5,13,14 193:17 201:6 206:13 212:24 213:8,22 219:23 226:12 232:5 232:6 235:5 237:10 237:11,18,18 241:1,4 241:14,17,19,21 247:16 263:17,18 264:13,17,20,21 266:15,23 267:1,7,11 267:13,16,17,19,20 271:3,5 274:1 278:20 279:3,17,18,23 280:3 280:6,20,22,23,24 281:1 beds-per-100,000 193:3 bed-need 181:10 281:4 bed-to 266:15 279:21 bed-to-population 266:18,21 267:3 279:20 began 24:13 94:13,15 181:3 beggar 29:23 beginning 131:6 275:20 behalf 28:13 32:18,23 34:13 65:24 85:12 94:6 96:1 218:9 235:9 248:2 behavioral 3:16 4:15 9:11 25:24 28:23 30:18,24 34:19 35:10 37:17 38:1 41:4,7 42:15 43:9,13 44:5,21 45:1,2 46:15 47:8,17,23 48:9 50:16 52:22 53:19 55:11 56:4 58:17,19 59:21 60:1,8 61:22 62:17 175:2,5 177:6 190:12 191:6,13 believe 32:8 70:16 98:8 131:12 135:8 137:11 164:14 164:24 172:3 185:2 186:15 188:7 198:3 211:8 213:14,19 247:23 269:22 279:9 believed 279:1 believes 96:16 belong 171:5 Ben 234:11 benchmark 193:4 beneath 186:3 beneficial 85:13 benefit 19:21 60:10 69:2 84:3 85:8,10 87:21 107:7 273:20 277:1 benefits 81:14 86:3 90:20 PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM 141:17 Bernadette 92:3 Bernie 89:19 best 64:6,24 94:11 95:10 220:3 251:24 276:17 better 81:23 87:17 90:17 91:14 136:4 137:11 146:8 160:4 167:14 179:4 208:12 225:9 236:24 277:16 beyond 69:23 261:21 265:10 265:18 278:10 biggest 104:17 164:10 178:18 big-picture 197:22 Bilandic 290:6,14 bill 2:12 136:19 149:15 152:9 158:7,9,15 billed 138:19 billion 140:23 Birinder 63:21 67:14 bit 152:24 166:22 239:16 248:21 289:1 Bizarro 267:18 Blake 234:18 block 24:6,7,8,18 Blue 164:12,12 Bluff 61:10 Blythe 25:23 26:9,11 Draft Full Meeting Conducted on June 21, 2016 298 board 1:2 2:3 3:18 7:19 14:9 16:7,22 18:1 20:9 22:7 23:7 24:4 27:14 28:5,15 58:18,20 60:17 62:2,15 64:2,19 64:21 65:4,21,24 66:8 66:10 67:10,15 68:24 69:20 70:15 72:11 73:6,7 75:11 76:8 81:6 83:11 85:19 87:19,24 89:12 91:18 91:23 93:24 96:8,9,14 96:16,21 103:2 104:4 112:2 116:3,11 120:4 122:10,22 123:3,7 124:10 125:11 129:4 130:12,19,21,24 131:2,16 132:7,16,20 133:17 134:3,11 136:17 141:20 142:6 142:16 144:17 148:12 149:1 174:2 175:24 176:8 187:9 190:8 194:15,18 196:20 197:20 198:20 200:19 201:2 203:16,18 205:22 208:10 210:2 210:3 213:4 218:6,21 219:2,10,12 220:15 220:19 221:2,13,15 223:2,13,24 224:5,16 226:24,24 230:2 231:1 234:8,10,21 237:5 241:3 244:9 246:1,4,7,12 247:18 248:4,11,19,21 251:17 252:6,22,23 253:2,19 260:8,10 264:18 265:1,3,22 269:9,17,17 270:4 273:6 274:22 275:19 278:5,15 282:8,17,22 288:14,22 Board's 67:2 76:22 96:5 187:5 190:2,13 219:23 223:7 225:2 247:21 247:23 248:12 255:24 261:12 262:19 265:6 266:22 278:12,21 279:10 281:3 286:19 Boike 89:21 95:22,23 Bolingbrook 1:6 bond 105:6 140:18 239:13 240:4 bonds 104:14 105:6,22 238:23 book 203:18 277:3 books 185:6 boomer 82:7 boomers 81:18,20 borderline 181:22 Bost 133:1 bothered 52:6 bound 252:14 256:3 boundaries 48:15 boy 36:1 Brad 220:9,13 226:7 227:12 Bradley 218:11 brand-new 73:4 275:4 break 101:15 105:21 106:1 107:16 174:6 breath 79:17 Brian 218:12,16 220:12 226:6 bridge 270:9 brief 238:14 briefly 52:8 76:19 129:6 193:1 bring 24:16 107:4 163:24 230:9 236:23 249:2 bringing 85:14 227:13 230:10 230:18 237:9 brings 114:5 192:23 broad 177:22 178:13 broadly 201:7 broke 94:8 Brookdale 28:11 brothers 62:23 brought 36:14 129:16 130:1 201:23,24 Brown 34:20 37:9,10,13,14 39:10 53:22 58:8,9,13 budget 105:14 Buffalo 61:12 build 43:23 117:4 183:8 190:4 195:2 237:3 building 4:12 72:7 100:14 118:19,19 121:2,4,5 121:13 123:18 180:8 227:9 236:18,23 237:1,17 240:21 290:6,14 buildings PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM 49:14 72:19 205:3 277:24 built 100:11 228:2 235:16 236:8,10,12,18,21 272:19 273:24 278:1 bundled 72:3 87:1 155:6,7 156:14,15,16 bundles 72:9,11 Bunin 34:21 39:14,15 Burger 119:2 Burzynski 6:6 business 4:6,19,21 5:3 7:4 8:1 9:11 11:8 13:2 37:15 65:9 82:21 88:5 97:11 98:13 103:1 110:1 114:2 140:15 178:3 227:2 268:3 277:7 279:5 285:2,3 businesses 83:6 busy 170:21 Butt 34:20 35:7,8 37:5 butting 168:14 169:5 buy 222:7 bylaws 22:3 bypass 274:18 bypassed 91:4 B-cell 16:15 B-r-a-d 220:13 C C Draft Full Meeting Conducted on June 21, 2016 299 2:1 3:1 4:1,1 5:1,1 6:1 calculate 214:4 calculated 118:3 192:15 210:11 214:1,6 calculation 117:11 118:11 181:10 206:20 calendar 15:1 caliber 229:14 call 3:3,4 6:2,4 22:6,9,11 22:16 23:8 29:10 44:12 48:1 64:17 108:7 112:6 116:19 119:10 124:8 129:19 166:10,14 171:10 215:2,3 231:3,4 242:15 283:2 289:13 called 13:4,6,6 25:17 31:16 31:20 50:11 58:1 81:3 139:3 262:15 calling 31:6 265:21 calls 36:15 call-to-order 82:15 calmly 31:9 campus 15:17 84:7 237:4 238:3 276:8 cancer 17:3 20:19 33:7 55:20 135:11,12,12,14,15 135:17,20,20,23 136:3,7,9,12,14,15 137:13 144:11 146:20 148:3 candidate 133:1 64:21 65:4,7,12 66:2 cap 66:5,5 67:4,12,18 138:9 68:1,7,11,11,20 69:16 capability 69:18 71:6,20,22 72:5 41:21 72:23 74:11,14 75:3 capacity 78:11,22,22 79:10 27:6 46:18 49:24 80:6,10,15 81:11 82:3 158:21 165:3,9 82:9 84:2,5,6,7,8 85:1 180:14,16 191:15,21 85:8,9,14,24 86:10,11 192:5 232:7 235:14 87:6 88:2,5,6,10,12 Cape 88:14,15,18 89:1,7,8 137:9 89:11 90:5,9,14,15,23 capital 91:5,8,15,16 92:1,4 5:7 75:24 90:19 182:19 92:12,16,18,19,21,24 183:7,20 273:2,4 93:2 94:7 95:10 96:1 275:7 285:19,23,24 96:2,3,9,23,24 97:12 capitalization 97:13 99:19,19 100:4 223:19 224:5 100:5 114:3 139:16 Capital's 139:18 141:11,15 221:8 142:11 144:22 145:2 Carbondale 145:8 146:23 152:8 18:22 21:18 22:1 26:13 158:20 170:23,23 27:2 126:18 132:22 177:10,17,17,20 133:11 135:5,7 179:15,16 180:10 136:23 139:5 143:16 198:23 200:12 213:1 145:20 146:8 148:9 217:2,4,5 219:7,14,14 163:11 165:2,14,17 219:15 220:1,6,17,20 166:2,4 173:14 221:8 223:15 224:7 Carbondale-area 225:11 226:16,17,18 136:21 226:22 227:2,4,10,23 card 228:1,5,14,16,17,21 43:18 136:20 228:22,24 229:3 care 230:17,19,23 233:5 4:7,16 14:12,12,19,24 237:20,21,22,22 15:3 16:23 18:7,9 241:21,22 245:2,19 20:11,15,23 22:19,24 247:7,10,13 256:14 23:12 25:7 26:18 263:15,15,17,19 27:15 28:1,19 29:5,5 264:13 265:4,9 267:7 29:7,24 30:2,3,7,24 268:2 270:8 273:17 33:8 34:5,7,9,12 274:3,5,9 275:13,18 36:19 37:19 38:8,9,19 275:21,21,24 276:1,2 38:24 39:17,23 45:4 276:3,5,7,8,17,20,21 45:15,23 46:6,14,22 276:24 277:5,9,19,21 47:20 48:2,10,11 282:3,10,14 49:17 52:3 53:1,4,5 cared 56:5 57:22 59:2,19 73:10 197:14 60:2,3,24 61:2,16,17 61:18 63:16 64:3,5,13 career PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM 51:16 68:23 225:9 Care's 96:6,14 care-delivery 270:11 care-to-home 93:10 caring 33:5 34:9 228:4 270:8 Carol 32:16 229:9 Carole 25:21 133:3 carry 250:18 Carstedt 53:20 54:3,3 56:3 Casaccio 37:23 38:2 Casaccio's 38:5 case 19:8 98:18 240:1 249:15 250:20 254:6 263:6 268:23 288:18 291:13 caseload 22:22 24:13 cases 27:20 31:23 135:16 140:10 145:15 158:22 cash 184:2 185:4,7,9,10,12 187:1,12,18,22 188:4 195:2 199:17 208:11 208:16,18 224:21 225:1,2,18 cash-financed 184:24 Castle 237:4 238:2,8 catalysts 90:14 catchment 47:18 54:8 categories 238:23 Draft Full Meeting Conducted on June 21, 2016 300 201:6 263:16 catering 93:11 Cathy 25:23 26:11 cause 48:16 104:17 135:20 caused 57:19 causes 17:3 causing 30:1 caveats 253:5 CBH 179:24 181:4 182:13 193:7 cease 65:9 ceased 235:21 ceiling 186:3 celebrated 62:10 cell 34:6 census 46:17 71:9 73:13 180:21 Centegra 14:14,22 15:11,13,19 15:21 72:20 73:2 75:8,13 98:17 268:13 268:16 Centegra's 14:16 15:7,9 center 3:15 4:14 8:6 13:12 16:12 17:5,11 18:18 20:1 21:20 23:23 25:19,22 26:10,15 27:1 32:18 42:1,11 61:13,15 67:20 69:16 70:1 71:20 81:17 97:12 100:3 103:21 126:3,5 133:10 134:7 134:12,21,24 137:16 137:23 138:1,8 140:13 141:24 142:14 143:2,8,20,22 144:15 144:17 146:18 147:5 147:13,14,16 148:4,6 160:18 163:15 164:9 164:19 165:6,18 181:20 214:13 273:22 286:18 287:4 290:11 centers 51:18 134:5 135:1 143:13 144:11,12 147:22 148:1 century 226:23 228:3 CEO 44:21,24 176:16 187:10 certain 118:4 140:9 184:4 209:3 251:18 288:18 certainly 40:14 183:11,13 184:3 184:6 203:18 209:2 209:12,17,19 236:22 278:2 certificate 67:3 176:13 223:4 291:1 certification 67:15 212:6 certified 83:23 88:22 198:18 246:19 280:7 291:3 certify 291:7 cetera 62:24 77:17 CFO 187:10 208:7 234:11 Cha 176:21 183:11 208:13 chain 90:15 chained 179:3 chair 6:5,23 8:3 41:5 102:7 108:8 109:5,13 111:22 112:7,18 119:11 120:2 125:9 130:3 132:6 148:15 170:12 171:11 172:12 173:18 176:6 215:4 216:1 231:5 232:10 234:9 242:16 243:11 244:7 248:19 269:7 284:9 chairman 16:6 64:1 67:9 132:15 176:12 193:19 226:20 238:17 Chairman's 127:15 Chairperson 2:4 chairs 95:7 Chairwoman 3:17 6:2,11,24 7:3,11 7:14,16,23 8:7,10,12 8:15,17,21,24 9:3,6,8 9:13,16,19,22,24 10:4 10:7,9,12,14,21 11:1 11:4,7,13,15,18,20,24 12:2,5,7 13:1,17 14:5 15:23 16:2 18:4,11,14 21:5,10 23:14 25:14 26:4 28:8 30:9,13 32:14 33:23 34:16 35:3 37:7,11 39:13 41:2 42:18 44:2,11,14 44:17,19 47:4 48:21 51:3 53:15 56:7 58:6 58:11 60:12 61:23 62:1 63:13 65:18,21 67:7 69:5,12 71:17 73:24 74:3 76:12,14 78:16 80:16,18 81:5 83:13 85:16,18 87:22 87:23 89:15,22 91:20 91:22 93:17,21,24 PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM 94:1 95:17,21 97:3 99:10 101:7,10,14 102:1,3,5,11,12 103:1 103:12,17,19 104:2,3 105:18 106:6,14,18 106:21,24 107:13,24 108:4,6 109:6,16 110:1 111:1,10,12,23 111:24 112:3,5,19 113:3 114:1 115:1,8 115:10,17,18 116:2 116:11,14,21,24 119:6,9 120:3,7 121:1 121:7,9,11,19,23,24 122:3,9 123:2,5 124:1 124:3,7 125:10,14 126:1,8,11,13 127:3 127:16,18,22 128:8 128:13,17 129:3,13 130:2,5 131:16,19 148:12 149:10,15 159:2 161:13,24 162:7,11,17,24 163:7 163:21,23 164:2,22 165:8,19,23 166:3,6,9 166:12,16,19 167:8 168:16 169:6,12 170:3,10 171:6,9 172:13 173:21 174:5 175:1,9,14,16 176:7 177:1,13 184:8 186:8 188:10 191:5,11,16 191:22 193:20 199:8 201:11,13,18 203:10 203:15 204:3,8,15,23 205:10 211:4,7,12 212:8,12,15,19 213:12,16 214:15,24 215:2,22 216:2,5,9 217:1,7,10,17 218:4,5 230:24 231:3 232:11 232:16 233:1,7,9,15 234:5,8 238:18 239:8 240:16,18,23 241:9 241:13,23 242:8,11 242:14 243:12,16 244:1,17,24 245:5,7 Draft Full Meeting Conducted on June 21, 2016 301 245:11,15 246:2,3,9 246:12 269:10,14,18 273:9 282:21,24 284:10,15,19 285:1 285:12,14,16,18 286:10,14,16,22 287:1,8,15,17,19 288:1,4,6 289:2,5,8 289:10,13,16,18 290:3,5,13,18,20,22 challenge 42:12 205:1 challenging 214:3 chamber 122:22 Champaign 41:14 50:14 chance 44:14 change 68:19 164:16 188:11 206:7 210:15 211:15 211:19 227:22 230:6 230:22 234:4 238:4,5 255:23 277:10,12 285:23 286:19 288:13 288:15 changed 30:3 152:24 234:3 changes 5:6 72:2 104:6 117:15 276:11 285:19 286:23 288:12 changing 56:19 73:20 Characteristically 81:20 charge 136:20 143:15,19 151:13 153:17,19 169:9 charges 164:15 charging 105:1,12 154:20 155:15 charitable 140:19,22 141:11,12 141:13 charity 20:11 141:5,11,15 170:23 Charles 218:9 247:3 chart 97:17,22,22 98:3 190:20 191:18 270:6 cheaper 154:19 Chicago 9:11 37:20 42:15,21 43:9 44:21 45:1 46:15 49:3 51:19 52:21 55:1,6 57:24 61:11 83:21 92:22 177:6 191:6,13 230:9 290:6,15 Chicagoland 39:16 50:11 67:19 chicken-or-egg 127:22 chief 67:19 122:12 176:21 234:20 child 32:2 36:5,7 50:12 53:4 children 46:24 choice 82:3 86:13 137:7 choices 86:20 Chool 69:11 78:19 choose 17:12 82:8 277:22 choosing 100:8 274:18 chose 65:4 91:16 227:1 274:24 Christ 29:3,14,17 Christensen 277:6 Christian 241:5,11 Chuck 132:17 170:4 church 30:17,23 31:4 32:4 Circuit 96:4,23 circulation 226:13 circumstances 263:8 cite 267:10 cities 51:19 citizens 64:6,15,20 city 4:11 52:1 83:16,17,24 84:9 85:2,6,12 92:18 115:2,4 122:21 183:24,24 242:7 City's 85:9 civil 57:21 claim 25:2 77:21 97:19 99:1 256:21 268:1 claimed 24:4 claims 19:2,4,17 21:21 146:24 147:5 Clara 240:10,11 Clara's 4:17 233:2,4 234:22,22 235:18,20,21,23,24 236:4,5,15 237:15 238:3,6 Clare 69:10 76:16 Claremont PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM 16:24 17:6,12,22,23 18:8 clarification 166:21 235:3 clarify 197:2,7 208:13 Clayton 277:6 clean 172:21 cleanliness 17:16 clear 7:18 15:8 46:20 76:2 77:11 79:7 208:14 clearly 50:14 80:5,6 218:24 223:5 227:7 clerical 50:7 client 60:3 61:5 198:2,3 clientele 86:9 226:17 clients 58:23 59:1,3,17,19 60:5 61:7,17 clinic 19:10 27:2 60:16,18 61:14 137:24 clinical 38:22 39:2 49:1 68:13 88:16 123:17 228:10 276:10 clinics 37:14,16,18,22 161:15 172:18 Cloch 218:12,16,16 219:1 226:7 close 14:20 21:12 36:21 55:18 109:11 135:16 152:17 157:23 161:21 180:3 224:3 closed 7:6 45:19 61:14 208:20 Draft Full Meeting Conducted on June 21, 2016 302 209:15 285:9 closely 66:13 68:9 209:5 closer 37:12 44:22 58:12 92:18,22 94:1 177:11 closest 41:13 191:13 closing 73:18 180:4 240:20 279:11 closure 41:16,17 91:10 closures 46:7 clothes 29:18 clothing 29:20 Clyde 234:20 CMS 86:23 88:21 97:17 98:1 98:9,9 100:22,23 278:8 281:8 CNAs 95:11 coalition 57:7 code 77:1,6 134:22 242:7 codes 47:18 cofounder 220:14 cofounders 218:17 cohort 77:23 99:7 278:17 281:5 cohorts 264:6 collaborate 144:24 collaboration 41:6 colleague 136:6 colleagues 36:14 225:9 collection 139:12 collective 141:5 colon 33:7 136:7,9 Colonel 53:20 56:8,9 58:3 colonoscopies 19:24 20:2 137:15,22 138:5,7 156:5 165:2 166:24 169:1 colonoscopy 20:6 135:3,4 136:1,8 136:21 137:3,16 139:20 143:16,19 150:20 151:3 152:1 153:11,12,14,18,24 154:16,20 155:12,20 161:22 165:13 168:9 173:13 colonoscopy-assist 138:11,24 151:23 154:19 155:14 colorectal 20:19 135:11,14,17,19 135:23 136:3,12,15 137:13 144:11 146:20 148:3 column 98:7 combine 181:18 combined 192:20 241:16 271:18 273:7 combining 182:4 188:19 come 8:1 25:16 33:15 35:12 35:13 49:12 63:6,17 63:20 64:19 69:9 80:21 89:19 98:20 103:12 104:15 117:21 152:12 158:8 162:22 167:19 168:10 182:3 194:16 196:13 197:15 204:16 213:4,4 217:10 223:2 242:6 262:4 274:24 comes 56:20 57:11 86:14 241:15 comfort 95:13 198:21 238:12 271:22 272:12 273:17 273:21 comfortable 193:22 202:24 204:3 coming 61:7 75:7,13 150:22 184:21 200:5 210:21 242:8 280:9 commander 42:5 commanding 57:6 comment 21:20 126:22 128:22 129:5,16,24 175:24 187:14 196:16 248:24 249:21 269:12 275:5 comments 14:3 17:16,21 34:24 54:1 66:10 80:24 84:2 112:1 116:2,5 119:7 122:9 124:5 131:5,16 145:19 149:23 171:7 176:8 189:19 198:23 218:6 229:11 234:8 239:9 242:12 246:4,6,10 289:11 commerce 122:23 commercial 98:5 151:12 153:20,22 154:16 commission 74:9 88:22 160:16 291:20 PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM commitment 182:6 194:16 196:21 197:16 221:3,11,14 221:16 222:16,17,18 222:23 234:7 239:2,4 240:5,14 committed 58:4 220:3 279:8 committee 177:3 committing 57:12 common 46:11 55:4 82:12 135:11 148:18 272:11 commonly 28:24 communications 19:3 communities 40:12 54:7 56:23 57:4 57:16 60:9 84:6 143:14 178:10,17 community 14:19 16:22 28:12 33:12,17 35:22 40:24 41:7 49:7 51:14,15 52:14 53:8 59:17 60:9 61:13,15 62:12 62:16 63:11 66:4,6 69:1 84:3,17 85:15 87:14 92:8,9,15 93:19 122:21 133:7 135:8 136:24 143:11,11 145:8 146:8,12 154:22 155:18 171:3 171:4 178:14 180:1 188:1 209:4 220:4 228:7,17 230:20 235:16 237:11,13 238:13 242:9 277:2 282:19 community's 133:6 community-based 45:7 178:6 commute Draft Full Meeting Conducted on June 21, 2016 303 93:8 comorbid 40:22 companies 188:3 company 65:2 177:8 185:1 199:23 209:1 234:13 comparable 258:7 compared 123:11,17 142:17 272:9 comparing 152:16 comparison 270:5,20 compassion 50:18 compassionate 52:3 64:16 230:17 compelling 43:14 281:24 compensating 46:13 compete 92:17 145:21 competencies 17:18 competition 75:19 76:2 276:14,15 competitive 71:3,3,4 competitors 199:6 202:8 265:24 complaint 46:12 complement 199:5 complete 39:10 42:2 98:12 183:2 222:2 266:11 completed 24:22 39:6 222:3,12,15 completely 22:12 79:4 172:7 completion 106:15,17 107:15 115:14 121:15 126:18 175:21 217:23 233:21 245:21 260:1 262:2 complex 21:7 74:15 complexity 68:5 compliance 3:6 133:16 134:13 141:23 167:1 221:24 266:11 282:1 complicated 79:20 80:8 complication 80:1 170:9 complications 21:8 complies 142:10 147:4 comply 76:22 77:5 96:20 components 206:8 compounded 59:10 comprehensive 68:12 89:8 265:8 269:22 283:1 comprised 64:20 compute 78:7 computer 209:16 CON 14:11 28:2 48:10 96:9 122:14 128:7 132:18 132:20 145:11 147:8 147:10 203:19 221:17 222:12,23 234:16 246:18,22 247:3 262:22 conceivable 181:14 concept 66:7 194:6 230:1 concern 76:20 79:14 106:7 142:21 168:16 183:12 184:7,12 185:16 189:18 221:15 252:19 252:20 concerned 23:1 24:6 252:20,22 concerns 25:13 69:19 171:16 209:2 220:10,21 223:7 247:21 282:5 conclude 21:5 30:9 73:24 76:12 77:20 93:17 95:17 101:7 concludes 267:5 conclusion 85:5 91:17 269:7 concurs 286:23 condition 55:10 131:13 180:2 198:7 201:20 202:10 202:11,20,22 203:22 204:2,7,21 211:5,9 212:9 214:15 conditional/contingent 4:8 114:5 conditions 40:22 59:9,15 158:19 203:20 206:1 215:16 conducted 136:17 conduit 40:8 confidence 107:14 194:20,23 195:10 confident 108:1,3 223:12 240:13 confidential 285:9 confine 186:13 confirm PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM 257:8 confirmation 268:11 confirmed 268:15 conformance 209:22 224:18 confusion 183:14 congestive 79:16 Congratulations 113:4 125:15 216:6 232:17 243:17 284:16 congregation 30:20 Congressman 132:24 229:8 conjunction 52:1 133:20 connection 15:20 253:23 conscientious 95:18 consensus 52:10 conservative 39:3 conservatively 39:6 consider 53:12 60:6 76:9 177:4 187:9 194:17 200:11 200:20 210:2 237:8 275:19,20 282:8 consideration 61:21 62:18 74:2 169:17 183:23 194:10 199:13 226:9 249:10 279:11 considered 28:15 96:13 123:16 225:23 247:18 248:23 considering 28:6 considers 219:12 Draft Full Meeting Conducted on June 21, 2016 304 consistent 17:13 85:6 135:19 142:15 159:7 182:5,6 197:1,19 263:9 268:14 consistently 88:21 180:19 consolidated 199:21 Constantino 2:19 13:21 14:1 35:1 54:2 81:1 102:4,5 103:17,19 104:10,14 104:22 105:2 106:13 106:16,20,23 111:10 111:12 115:9,10 117:6,10,19 118:1 121:10,11,19,21 122:2 123:15 124:2 126:11,13 127:5,9 128:11,15,19 129:7 129:17 130:6,9,16,18 132:4 133:9 134:14 160:23 161:4,8 167:3 167:10 169:8,15 175:14,16 176:4,6 184:12 186:18 187:14 188:13,17,21 189:7 189:10 190:20,22 193:24 196:3 199:24 200:3,24 201:4 205:17 206:17 207:7 207:15,21,24 210:12 213:2,18 214:7 217:17,19 220:16 225:16 233:15,17 234:5,6 238:20 239:1 239:7 244:7 245:7,9 245:16,17 246:5 249:20 257:3 286:12 286:15,17,24 Constantino's 211:23 constantly 196:20 constituents 33:19 constitutes 96:18 constraint 223:6 construct 96:6 121:5,12 245:18 construction 24:12 84:12,21 123:10 180:13 187:19 221:21 222:4 239:13 251:22 251:23 consult 167:22 168:10 288:21 consultant 122:14 176:14 234:17 246:22 247:3 262:13 consultant's 264:24 consultation 139:21 288:16 consults 140:11 167:22 168:12 168:23 consumer 136:16 consumers 62:19 63:5 91:15 contact 32:5 contained 263:13 contention 254:19 contesting 242:4 context 145:19 contiguous 188:19,22 contingencies 123:11 contingent 54:19 continually 49:16 275:2 continue 14:20 33:8 45:21 61:19 145:13 179:12 238:9 238:13 277:22 281:3 continued 65:13 continuing 65:7 230:16 continuity 29:5 30:2 36:19 88:24 continuously 64:10 continuum 23:12 84:6 85:8 90:13 247:13 275:21 276:7 contour 192:22 contract 19:12 287:22 contractors 105:11 contradict 255:10 contrast 138:17 contributing 45:11 274:6 contributions 140:19,22 controlled 141:7 convenience 273:21 convenient 276:23 277:20 conventional 224:10 239:12 240:3 conversation 202:2 221:3 conversions 271:8 convert 134:3 convince 251:2,8 Cook 49:6 54:5 181:8 189:15 190:5 287:23 Cooper PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM 26:1 28:10,10 30:6,11 30:14 116:10 132:13 132:18 167:18 168:20 174:4 218:13 coordinate 140:1 168:8 238:2 coordination 139:16 copies 288:11 copy 288:9,14 corporate 141:3 correct 105:2,5 106:13,17,20 106:23 117:19 127:18 149:12 152:13,20,23 156:21,23 168:20 184:8 185:2 188:21 189:7,10 197:10 199:20 206:23 212:23 214:3,6 240:22 291:8 corrected 287:3 corrections 5:9 42:1 286:11 correctly 165:4 195:15 207:10 cost 70:10 104:1 105:9 107:9 111:7,17,20,22 115:13 121:14 126:17 137:3,10 138:23 142:17 143:3,10 146:17 152:8 175:19 217:21 222:5,24 233:19 238:24 245:20 272:23 276:18 278:8 281:8 costly 249:4 costs 104:21,23 138:16 143:17 144:1 220:1 223:1 224:20 cost-assist Draft Full Meeting Conducted on June 21, 2016 305 19:20 cost-containment 142:15 cost-effective 223:9 counsel 2:16,17 3:9 10:18,22 14:13 76:16 176:20 246:18 291:12 counseling 49:1 58:14 59:17 60:9 counselor 58:9 count 106:8 117:4 271:15 country 57:5 136:13 229:1 county 4:16 15:3 32:19,24 33:1,2,10 41:5,6,8 45:22 46:1,4,6 47:23 49:6 54:5 63:16 64:2 64:4,6,7,16,19 65:5 65:12 66:3,22 73:8,19 85:2,3 92:6 96:5,7,13 104:12,14 122:22 181:7,8 217:2,4 219:6 219:22 220:2,18 226:22,24 227:6,13 227:21 228:2 229:7 229:17,18,19 230:2,7 230:12,14,19 235:11 235:13 237:10 247:15 250:9 254:6,9,15 255:3,3,5 263:10,20 263:22 264:2 265:7 266:2,19,21 267:2,8 267:19,21 268:24 269:2,5 274:8,9,12,14 278:4,17 279:4 281:5 281:11 282:15 287:23 291:5 County's 64:11 194:6 227:10 254:11 couple 52:20 97:14 172:16 208:24 coupled 45:14 courage 57:2 course 41:20 68:3 94:13 130:12 183:18 234:16 268:3 court 14:3,4 44:22 49:6 96:4 96:23 103:14,16 109:19,23 115:21,24 122:5,8,12 131:22 132:1 170:14 175:13 217:12,15 218:23 233:10,13 237:23 244:19,22 Courtney 2:18 270:3 285:5 286:2 cousins 62:23 Covenant 30:17 cover 144:1 151:19 coverage 22:10,16 70:2 138:13 178:12 186:3 223:20 223:20 224:1 225:20 225:22 covers 138:14 139:3 co-Applicant 246:21 247:1 co-pay 137:3 co-pays 137:1 crazy 93:13 CRC 291:5 cream-of-the-crop 71:12 create 14:11 81:16 86:7 90:24 227:15 241:20 264:13 277:21 279:14 created 83:5 87:1 159:20 creates 278:19 credentialed 83:21 credit 105:23 221:7 225:23 239:19 crew 228:13 crises 40:19 crisis 41:12,21 49:2 59:1 criteria 82:1 96:20 122:18 159:5,9 167:13 190:16 197:10 200:15 208:1,1 209:22 224:15 225:11 226:2 239:23 249:7,10 266:11 281:23 282:1 criterion 184:10 224:18 249:23 259:8 261:23 critical 41:10 42:15 53:7 77:9 88:17 223:21 224:23 235:14 237:9 critically 42:7 Crohn's 34:4 167:24 cross 164:12 190:10 crossroads 69:16 76:17 236:16 270:24 CRR 1:18 291:4 crushed 29:21 Crystal 60:20 71:21,24 74:7 PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM 76:17 77:8 97:12 98:13,21 100:2 270:22 271:3 CSR 1:18 291:4 culturally 49:2 culture 56:24 88:17 cure 135:24 curious 119:4 153:19 current 29:6 41:20 45:20 47:16 81:19 82:24 83:4 99:3 100:1 136:12 142:6 147:17 223:22 226:17,21 227:4,17 227:19 228:2,8 230:7 230:12 237:15 240:9 240:20 241:16 263:11 265:15 266:6 275:23 currently 26:21 27:5 40:24 42:21 49:14 61:7 62:6 64:8 67:19 69:23 70:11 72:3 73:14 96:11 99:16 127:3 133:19 134:9,16 147:11,14 151:10 179:15 183:21 185:20 191:14 229:20 240:10 264:15,16 271:17 273:15 274:19 281:15 282:4 cushion 225:6,10,14,17 custodial 219:13 226:17 228:14 customer 68:2 cut 122:1 cuts 45:5,10 cutting 31:21 Draft Full Meeting Conducted on June 21, 2016 306 61:6 72:8,13 75:10 87:11 94:10 157:21 D 158:12 179:2 180:3 4:1 5:1 6:1 89:20 201:21 202:15 204:1 208:23 214:21,22 224:21 daily 225:1,2,3,4 90:8 DB5 Dale 107:3 2:6 287:13,13 de Dan 44:15,20,24 47:2 246:18 269:16 182:11 danger dead 170:2 264:17 280:24 281:1 DART deadly 2:12 136:11 data dealing 68:13 70:9,12,15,20 57:24 200:14 98:9 191:10,19 death 209:21 262:4,5,9 135:12 263:4 268:2,4,5,13 deaths 274:17 278:5,7 279:2 135:20,21 279:10 281:8 287:4 debt date 185:6 194:15 223:19 66:14 106:15,17 223:19,20,23,24 107:15 115:14 121:15 224:19 225:20,22 126:19 175:21 205:6 211:3 214:22 217:23 decade 233:21 245:21 282:3 179:12 Decatur 288:18 8:19 dated December 184:1,20 249:22 126:19 175:21 182:21 272:20 209:11 245:21 285:8 dates decide 5:8 286:1 200:19 David decision 34:21 42:19 53:20 56:9 49:21 79:22 96:5,10 132:24 234:19 190:13 205:16 DaVita declaratory 4:11 115:1,4 116:7 4:6 114:1 117:14 decor day 17:17 24:9 55:4 57:12 58:4 decrease 61:18 87:13 147:19 46:10 65:8 87:2 150:9 157:24 173:2 decreases 198:22 204:10 249:13 45:7 250:18 291:17 decreasing days 91:2 240:24 24:8 31:16 36:1 48:6 D dedicated 59:14 88:17 deductible 137:1,2 deductibles 33:14 Deerfield 17:4 default 41:22 42:4 defense 283:22 deferral 248:23 249:4 deficiency-free 74:10 defined 203:23,24,24 defines 167:16 definitely 201:4 229:14 254:6 degree 83:19 197:21 DeJoseph 44:8,20,24 delay 104:17 119:4 140:8 199:13 delayed 61:2 delays 38:7 60:23 106:10 deliberate 131:8 delighted 58:15 220:5 deliver 145:2 282:2 delivery 88:10 145:7 177:17 227:23 230:23 275:13 277:21 demand 90:24 150:2 159:11 160:24 181:3 264:13 264:18 265:14 275:11 PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM demand/treatment 141:21 dementia 30:8 228:19 demographically 40:13 demographics 43:14 66:21 demonstrate 46:15 266:7 281:24 demonstrated 33:18 demonstrates 223:21 Demuzio 6:7 136:6 denied 70:18 97:19 128:6 densely 100:16 deny 70:22,24 71:16 96:15 96:21 97:20 98:15 173:24 245:24 247:20 248:20 denying 96:6 268:24 department 1:1 41:5 42:1 133:18 134:18 149:12 169:9 228:5 departments 46:12 48:5 142:23 178:19 depending 99:2 depends 204:21 deposit 184:14 186:4 depository 240:10 depression 59:8 deprive 269:2 derived Draft Full Meeting Conducted on June 21, 2016 307 251:13 Des 28:23 description 133:8 deserve 59:19 92:20 deserves 50:17 design 189:13 designated 70:2 93:4 250:9 254:9 254:21 255:9 288:17 designed 20:19 38:13,16 189:23 199:4 228:18 247:12 270:9 271:20 273:16 275:15 276:7,11 desire 271:11,12 274:19 282:13 desired 84:5 276:4 desperate 40:23 desperately 116:18 despite 49:13 99:1 264:14,16 283:17 destruction 36:4 detail 183:10 detailed 65:3 220:17 details 220:8 283:21 detection 135:22 137:12 deteriorating 219:19 determination 122:18 188:19 determine 142:7 167:12 169:17 186:24 determined 64:24 161:1 264:18 279:19 determining 168:3 detox 36:11 50:5 detrimental 146:22 develop 68:10 183:8 developed 51:24 144:22 182:23 278:24 developer 107:21 222:7 developing 16:20 67:24 135:14 177:9,16 182:22 development 4:20 83:16 179:21 183:1 221:5,10 265:4 275:23 278:3 282:9 285:2 devoted 177:15 diabetes 55:20 diagnose 133:14 diagnosed 16:15 diagnosing 136:9 diagnosis 33:6 diagnostic 68:6,16 dialysis 4:11 70:1 74:13 77:17 115:5 118:6,7 dice 205:11 die 135:18 difference 49:22 104:8 141:9 different 29:24 72:13 82:24 93:6 129:9 130:8 172:16 177:24 178:2 184:19 205:24 206:24 207:2 213:12 219:17 248:14 differentiated 40:1 differentiates 270:12 280:2 differs 86:4 difficult 43:5 52:17 55:2 137:7 145:5 205:9 difficulty 79:16 diligence 239:24 diligent 223:8 diminish 14:22 dining 70:3 dinner 31:9 34:8 dire 50:9 direct 84:10 139:13 140:5 directed 90:7 direction 43:19,20 45:10 96:22 directly 58:18 69:19 86:3 145:22 263:14 director 28:11,17 37:23 41:4 54:4 79:2 83:16 85:24 88:10,11 92:4 116:8 122:14 directs 265:3 direct-access PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM 133:23 137:19 139:15 168:7 dirt 105:19,20 106:22 disabled 54:11 disagree 206:3 disagreement 186:22 disappeared 51:22 disappearing 56:14 discharge 68:14 70:16 89:1 discharged 36:20 discharges 48:6 disconnect 185:1 disconnection 57:20 discontinue 241:19 discounted 20:8 discretion 190:7 197:21 201:3 discuss 202:22 discussed 148:2 219:15 239:19 discussing 198:2 224:23 discussion 151:21 198:1 203:12 215:9,16 242:20 243:3,9 283:12 285:19 290:12 disease 17:1 34:4 118:5 136:11 167:24 228:20 disgusted 231:12 disorders Draft Full Meeting Conducted on June 21, 2016 308 37:6 dispense 169:18 dispersing 186:1 displaced 241:23 disproportionately 193:13 dispute 256:20 disregard 23:2 disruptive 144:21 277:4,12 distance 63:4 distances 46:5 distinct 228:10 distinction 237:9 272:1 distinctions 273:9 distinctive 273:14 distinguishing 269:18 distortion 98:12 distressed 182:15,17 distribute 244:10 distributed 107:11 240:15 district 84:8 85:10 117:2 181:10 districts 117:3 disturbances 43:13 diverse 49:2 divert 71:11 divided 186:5 dividing 186:1 division 37:16 221:8 Dixon 163:15 doc 165:24 166:3 docs 173:1 doctor 130:10 132:9 145:6 148:14 149:3 152:14 156:20 157:3 158:24 161:19 163:9 164:19 165:1 169:23 170:18 doctor's 140:3 164:6,11 document 27:10 123:24 250:2,5 259:18,23 260:4 261:15,24 documentation 196:15 198:4 209:13 209:14,18 214:17 247:22 251:11 documented 199:17 250:7,8,10,16 251:15 253:13,23 256:9 258:24 259:2,3 259:19 261:21 265:11 265:13 266:11 281:19 documents 14:2 26:16 149:20 222:4 doing 9:10 56:23 65:9 70:11 75:2 150:9 158:13,17 159:7 171:2 220:3 249:12 277:9,15,17 277:24 Dold 229:8 dollars 66:14 101:4 104:7 222:3 donated 29:20 Donna 53:21 62:2 donors 140:19 double 74:21 150:6 doubled 150:5 double-occupancy 271:8 272:14 Douglas 80:22 83:15 downsize 235:5 downsizing 41:17,20,21 downtown 236:17 237:2 dozens 55:13,13 Dr 19:10,18 21:23 22:20 23:10 24:1,3,12 25:2 32:17,21 33:7 34:2,20 34:21,21 35:7 37:5,23 38:2,5 39:14 41:3,3 42:19,19 44:7,8,8,15 44:15,20,24 47:2 51:5 51:6 53:11 63:21 67:9 78:18 80:13,17 132:8,10,11,15,16 148:17,20,24 150:3,8 150:12,22 151:6,8,14 151:18,22 152:7 153:1,8,12,16,22 154:1,3,7,9,14,21 155:1,7,10,13,16,19 155:23 156:3,9,12,15 157:17 159:1,16 160:12,15 161:18 162:5,23 163:6,14 165:5,18,22 166:1,5,8 166:11,15,18 167:23 PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM 168:1,6,9,21 171:1 176:15 177:2,14 183:15,20 185:14,17 189:19 205:1 216:8 277:5,7 drafter 252:5 260:7 drafter's 251:24 dramatic 41:16 77:11 dramatically 179:12 278:14 281:16 draw 208:19 drawn 183:22 DRGs 72:13 Drislane 94:4 drive 17:11 93:7,14 173:14 173:16 190:9 driven 56:24 168:6 drives 57:21 276:15 driving 168:11 drugs 31:22 dual 280:6 due 16:14 29:7 38:9 40:19 49:24 59:2 60:24 68:5 77:22 86:5 91:1 94:9 99:7 100:8,9 133:22 146:11 193:8 195:9 203:17 226:9 239:24 278:14 duly 251:16 DuPage 164:6 duplicate Draft Full Meeting Conducted on June 21, 2016 309 88:20 137:12 Edward 13:9 16:10 effect 204:23 251:20,24 effective 136:14 E effectively E 145:1,8 146:17 219:21 2:1,1 3:1 4:1,1 5:1,1 effects 6:1,1 45:14 68:17 earlier efficiencies 179:1 240:14 273:24 87:4 143:3 early efficiency 16:19 33:6 80:14 87:2 223:22 135:22 137:12 272:19 efficient easier 180:9 220:22 276:23 133:23 244:11 efficiently easily 145:1 219:21 172:18 effort easy 172:3 182:18 270:1 efforts Ebony 235:8 80:22 EGD echo 139:2 39:20 EGD-assist echoing 151:23 108:20 eight Ecker 24:9 48:24 106:9,18 89:20 109:10 155:9 263:20 economic 264:14 83:16 84:3,11,14,17,18 either 85:10 104:8 33:12 36:22 70:21 97:8 economically 128:6 165:20 218:24 182:1 262:16 268:20,23 economy elderly 83:6 40:23 64:15 82:10 Ed elected 122:13 229:10 22:3 EDG element 154:1 136:5 Edgar elements 44:8 136:1 138:18 141:22 edge Elgin 189:16 237:3 3:20 60:20 103:4,8,20 educate eligible 62:14 140:18 education 159:21 160:8 duplication 26:19 142:20 188:12 231:21 249:19 259:6 duties 62:5 248:8 eliminate 15:4 Elizabeth 80:23 88:3 Ellen 53:22 58:8,9,13 embraced 247:20 emergencies 52:6 emergency 22:5,11 23:8,9,11 31:17,24 35:17 36:2,4 40:7,18 42:3 46:12 48:1,5 49:7 50:7 51:23,24 54:12,16 55:5,15 59:3,6,11,14 178:18 179:4 emotional 38:15,19 emphasis 164:18 emphasize 41:10 164:11 employed 19:6,12 145:24 146:5 291:13 employee 166:5 228:13 employs 145:22 empty 46:16 empty-handed 259:15 enable 260:20 enables 261:7 encounter 142:5 encounters 140:7 167:20 encourage 16:16 18:1 39:7 67:21 83:11 87:19 89:12 91:17 92:10 136:3 PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM 275:22 encouraged 275:18 encourages 260:20 282:7 ended 31:24 endoscopic 27:14 169:1 endoscopies 168:23 endoscopy 3:15 4:14 13:12 18:17 21:20 22:21 23:23 24:10 25:19,22 26:10 26:15,21,23 32:18 126:3,5 133:10,12,19 133:24 134:12,21 135:1,4 136:4 137:17 139:2 140:13 142:9 142:13,16,24 143:20 143:22 144:2,10,19 145:14 146:16,21 147:3,5,16 148:6,8 152:1 153:19 160:18 161:18 ends 244:2 enforcement 46:13 engaged 36:3 engineering 222:3 enhance 14:18 enhanced 89:3 enhancing 85:1 enjoy 290:1 enjoys 226:21 enrolled 147:16 ensure Draft Full Meeting Conducted on June 21, 2016 310 67:3 74:18 140:9 142:9 147:3 182:23 219:6 ensuring 143:10 enter 86:18 145:4 entered 49:19 91:9 137:21 Enterprises 234:12 entire 45:24 179:6 180:8 entirely 24:16 184:24 187:6 208:11 263:8 entirety 185:13 187:13 entities 176:17 187:24 196:4 199:21 entitled 274:23 277:3 entity 64:23 225:17 entity's 195:23 entrant 277:14,16 environment 17:22 45:3,21 82:2 270:9 273:22 epidemic 57:20,21 episode 72:11 equally 181:23 equate 222:19 equates 271:4 equipment 82:16,17 87:12 160:21 161:17 180:10 equipped 271:19 equity 183:5,19 226:2 equivalent 84:21 ER 31:15 52:4,4 63:6,8 errors 50:7 ERs 55:22 especially 51:18 92:12 265:5 ESRD 115:5,12 essential 68:4 135:23 essentially 132:7 167:21 180:22 180:23 188:1 225:4 establish 19:4 28:3 115:5,11 126:6 134:11 175:6 175:17 181:12,20 217:5,20 233:4,18 245:2 established 91:9 247:14 279:16 establishing 237:6 establishment 27:18 58:17 60:7 64:4 117:16 126:15 247:5 estate 205:2 Estates 16:13 29:3 estimate 161:13 estimated 39:4 140:21 estimates 46:23 et 62:24 77:17 ethical 135:9 evaluated 64:21 237:5 evaluating 197:21 226:3 evaluation 197:19 evaluations 87:13 Evangelical 30:17 Evanston 29:13 54:12 191:3 eventually 65:6 286:6 everybody 7:17 78:19 151:16 152:9 154:5 251:2 290:22 Everything's 107:20 evidence 266:10 281:24 evidenced 229:5 evidencing 221:24 evolving 56:14 EX 2:11 exacerbating 55:18 exact 77:14 exactly 17:24 106:24 156:3 163:6,6 200:7 210:18 242:1 253:9 exaggeration 20:21 exam 139:23,24 examined 268:1 example 15:1 19:23 29:9 33:13 35:24 41:13 79:12,15 99:24 179:24 180:18 PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM 197:7 examples 35:14 exams 139:17 173:6 exceed 168:17 exceeded 138:9 exceeds 224:3 266:16 excellent 33:8 160:18 269:1 exception 201:9 241:4 exceptions 253:5 excerpts 270:2 excess 222:2,5 232:6 240:24 267:12 excited 230:10 exciting 59:20 227:18 excluded 209:13 exclusively 144:9 163:12 excuse 109:19 185:9 218:23 246:5 exec 285:8 executed 209:13 executive 3:5 5:5 7:4,16,20 8:2 54:4 176:19 268:16 exemption 4:3 9:12 10:19,20,20 110:3 140:14 exemptions 140:22 exhaustive 65:3 Draft Full Meeting Conducted on June 21, 2016 311 83:3 92:24 178:10 221:12 235:21 274:19 existing 20:12 71:6 77:18 82:23 84:6 96:18 142:22 146:13 190:17 199:5 199:5 226:12,16 230:7 237:12 247:13 248:15 259:21 260:2 262:4 263:11 264:15 269:3,6 270:12 272:6 272:14,17 273:3,23 274:18 276:8 278:7 281:17 exists 250:6,15,16 expand 60:2 Expanding 135:3,3 expect 240:6 expectation 258:6 expectations 72:6,12 expected 84:16 expenditure 273:2,5 expenditures 5:7 275:7 285:20,24,24 expense 141:6 expensive 105:7 153:5 experience 31:4 38:7 43:3 46:14 49:11 55:10 59:10 67:18,24 76:5 86:2 89:5 90:10 91:14 92:5 179:7 181:2 193:9 194:21 220:19 224:2 225:8 250:17 268:14 experienced 27:12 60:23 179:20 250:23 experiences 58:23 88:4,8 experiencing 50:4 54:14 expertise 52:5 219:5 230:11 expired 105:24 expires 291:20 explain 106:24 124:11 127:7 139:14 166:22 167:7 172:22 283:8,10 explanation 124:4 167:9 248:13 283:22 explore 195:24 express 14:16 18:24 21:18 66:1 83:24 275:1 extended 222:10 extender 144:21 extenders 145:1,7 168:2 extends 62:7 extension 3:22 110:2 extensive 220:19 226:23 228:7 281:24 extent 178:17 198:5 260:5,13 extra 104:21,22 140:3 extrapolating 153:7 extremely 59:18 144:20 223:14 230:8 284:12 e-mail 176:2 E-007-13 10:20 E-016-14 9:12 10:20 E-023 10:19 F face 17:1 48:13 faced 137:7 189:23 faces 236:15 face-to-face 139:20 facilities 1:2 17:4,10 22:20,23 25:7 26:22 29:12 45:14,24 46:7 57:3 64:10 66:6 68:1,6,14 73:11 77:12,19,24 78:2,10,22,23,23 86:7 87:6 90:9,12,23 91:12 93:1 97:19,20,22 98:19 99:4,6,15,17 100:18 101:2 118:3 144:9 146:14,22 163:20 176:24 178:7 181:13 182:23 184:15 190:23 192:3 206:6,8 234:19 236:2,3,21 241:8 250:11 253:4 256:10 259:21 260:2 260:6,24 261:3,5,9,16 263:3,19 264:15,16 265:4,15 266:4 268:6 268:9,19 269:3,6 270:17 271:2,10,17 272:17,18,20,24 273:3,6,24 274:9,12 274:15 275:6,8,14 278:4,11,22 281:9,15 281:17 287:23 facility 14:12 16:23 17:2,7,14 17:17,23 20:12,18 23:5 25:6,8 27:16,21 PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM 28:1,4 29:1 30:8 31:18 40:6 42:2 54:17,21,24 61:4,5 64:5,12 65:7 66:7,18 66:24 68:4 69:24 70:9,20 71:1,11 72:23 73:3,5,19 74:8,11,24 75:9 78:11 79:8,9,10 79:11,23 80:2 81:11 82:8,18 83:2 84:22 85:1 86:1,4 87:9 88:12,22 91:5,8,10,11 91:16,19 92:19 93:5 94:7,12,13,15,20 95:19 96:7 99:19,20 99:20,22,23 100:1,6 100:11,15 111:15,16 111:17 115:5,12 116:16 118:13 129:11 134:6,8,20 138:15,19 142:8 144:3 146:19 151:13,16 152:10 157:2,5,8,23 158:23 160:3 170:1 181:13 181:20 189:15,16,21 190:1 191:2,13 195:2 217:5,21 219:8,12,19 226:11 227:16 229:13 229:21 230:7 233:5 233:19 235:4,18 236:9,11,13,16,20 237:3,7 240:20,21 245:3,19 247:7,11,17 255:8,21 256:14,15 256:18,19 257:3,17 257:20 258:9,12,18 263:22 264:22 265:12 266:1 268:20,22,24 269:1,4 270:15,24 271:1,15 272:9,15 273:4 275:4 280:4 facility's 188:23 256:13 257:24 fact 57:13 100:8,9 109:9 143:2 146:4 154:17 159:14 172:3 192:10 Draft Full Meeting Conducted on June 21, 2016 312 200:11 202:7 214:19 214:19 229:5 264:14 264:16 274:8 279:16 279:18,20 280:1,6,12 factor 251:12,14 256:8 258:24 259:2,3 266:13 274:6 279:4 factored 190:13 206:11 factors 172:16 250:1,1,3,6,8 250:15 251:12 252:7 253:13,23 facts 28:6 60:7 71:16 279:15 280:14 faculties 75:21 fails 173:21 failure 79:16 80:4 fair 71:20 72:10,16 73:12 76:18 209:20 210:6 faith-based 38:17 fall 94:9 186:3 falling 163:19 false 98:11 falsely 70:7 familiar 160:19 164:4 240:12 251:19 families 35:14 36:22 42:10 43:24 51:22 56:10,14 56:18,21 90:21 227:20 268:21 271:12 274:8,17 276:13 family 29:6,16 34:12 36:6 55:2 63:3 82:6 134:20 150:14,24 229:14 273:19 FAPR 1:18 291:5 far 7:2 29:3,19 46:1 52:9 93:14 176:20,22 179:20 234:17 265:18 fashion 167:5 179:2 fast 93:12 fathers 62:24 favor 7:11 8:12 9:3,19 10:9 11:2,15 12:2 16:16 60:7 67:21 68:24 83:12 87:20 89:13 91:18 92:10 229:6 285:14 287:15 289:14 290:20 FDIC 185:24 186:4,7 fear 76:4 feasible 181:11 features 269:19 273:14,16 February 66:6 94:8 180:15 245:24 247:19 269:17 Federal 136:17 139:8 140:17 140:21 141:4,10 145:24 fee 20:6 138:13,14,15,15 138:15,17,19,20,20 138:21 139:2,3,9 143:18,18,19 144:4,5 144:6,6,7,7 151:13,16 151:24 152:10,19 153:8 156:17 157:2,3 157:4,5,8,8 222:16 feedback 17:13 38:21 feel 82:20 86:17 94:23 95:19 100:18 201:12 202:24 229:15 237:14 feeling 86:8 94:22 208:3 feels 86:15 170:1 fees 222:18 feet 126:16 156:13 272:3,6 272:10 fell 79:21 104:15 fellow 62:16 fellows 145:4 felt 95:2,3 fewer 271:7 field 48:9 71:13 73:16 145:5 224:7 fifth 251:12 252:9 fight 73:20 figure 39:4 117:1 figured 94:20 277:16 figures 135:19 277:14 file 208:23 filed 256:19 272:24 278:8 278:24 fill 90:13 100:10 247:17 filled 48:4 PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM final 3:7,8 8:4,8,18,22 9:9 9:14 10:1,5 192:23 239:24 267:22 275:15 276:5 282:6 finalized 96:14 finally 10:1 20:22 46:20 132:4 146:20 147:15 222:14 234:20 288:7 finance 122:15 185:12 187:13 196:17 199:17 221:8 246:20 financed 187:6 finances 197:19 financial 5:4 15:11,20 65:8 71:7 76:6 122:12 134:18 141:17 144:2 148:5 176:21 182:20 183:1 183:16 184:17 186:11 186:19 187:2,8,18 188:9 194:8 196:8 199:19 202:14 205:18 208:1,4,9 211:10,13 211:19 213:3 214:16 220:10,20,21 221:11 221:19 222:15,22 223:12,13,17 225:13 225:24 234:20 239:22 280:8 285:4 291:14 financially 64:23 71:10 180:6 197:24 financials 185:3 195:16,20 209:5 financing 104:12,16 105:6,7,8 106:1,2 107:1,2,9 123:23 140:18,23 171:16 194:15,17 196:5,6 208:11,20 209:14 211:16 223:9 Draft Full Meeting Conducted on June 21, 2016 313 224:10,19,19 225:12 239:3,12,12,13 240:3 240:4 find 35:17 36:5,16,20 40:6 83:2 123:12 194:19 194:24 223:3 257:15 257:21 finding 54:20 123:22 180:17 210:15 211:15 234:7 253:12 256:17,20 259:4 261:4,7,11,20 261:22 266:12 267:8 267:10 findings 115:16 116:3 123:9 124:18 126:21 141:19 141:20 142:21 175:24 211:20 218:3 233:23 245:23 248:11,13 249:7 283:12,22 284:11 fine 50:19 201:13 244:16 244:17 finish 18:4 117:22 160:1 finished 117:5,21 fire 32:3 firm 221:14 228:3 234:6 239:2,3 firmed 286:4 firmly 137:11 first 7:4 13:8,8 21:23 25:18 43:17 49:19 51:16 81:16 84:19 88:8 97:7,16,22 103:3 111:18 139:13,20 142:22 147:7 149:19 162:21 163:2,3 164:5 172:17 176:10 177:2 183:11 191:6 218:18 224:13 226:8 228:14 230:5 235:2 239:10 248:10 251:1,4,11 252:8 259:21 264:1 270:14 fiscal 41:21 209:10 288:19 fit 86:11 198:15 fits 275:20 five 7:1 13:5,8 25:16 26:23 34:18 44:4,12 51:21 53:17 55:9 61:3 69:7 73:14 74:10 78:4 80:19 88:11 89:17 138:5 172:17 233:12 237:15 244:21 249:24 250:1,14 252:7 253:13 273:2,7 275:8 five-star 88:21 five-year 264:7 278:16,18 flat 95:6 138:13 139:2,3,9 151:24 156:13 flat-fee 151:22 Florence 76:16 flow 159:24 focal 228:14 focus 60:4 84:2 93:6 144:10 178:4 179:19 259:7 focused 17:16,21 146:19 177:18 182:14 226:16 269:21 276:2,3 focuses 228:10 Foley 247:3 folks 86:20 131:6,9 258:17 follow 22:15 29:17 96:22 240:13 244:12 248:13 followed 88:9 following 38:6 102:6 235:23 248:20 275:19 279:15 follows 7:22 follow-up 22:10 food 86:14 92:4 foot 111:20 272:9 footage 111:19 force 64:20 251:20 275:16 282:6 forced 29:20 50:2 146:10 forces 57:7 force's 276:4 forefront 228:9 foregoing 137:7 291:7,8 foreign 107:4 foremost 81:16 foresee 198:8 Forest 4:11 115:2,4 forget 26:3 44:9 53:23 56:17 81:1 forgetting PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM 56:16 forgive 132:8 forgot 234:4 Form 208:23 formed 235:24 former 221:7 formerly 64:7 forward 104:16 199:3,7 203:1 230:15 for-profit 187:24 found 31:19 94:15 104:16 181:21 182:18 190:4 272:1 281:22 foundation 37:15 228:3 262:21 four 24:8 41:15 51:17,20 68:10,21 74:23 88:9 90:7 115:23 138:18 145:15 150:9 158:11 217:14 224:4 225:21 251:12 252:8 257:19 271:2,17 four-star 77:18 Fox 60:20 61:9 fracture 79:17,21 frail 82:10 frame 202:17 frankly 98:11 freak 94:9 freaked Draft Full Meeting Conducted on June 21, 2016 314 257:1 Fred 13:13 23:18 free 19:19,23 20:6 137:15 137:22 138:5,7 148:3 151:17 156:8 freestanding 52:23 frequent 38:7 Friday 208:20 fridge 95:7 friendliness 17:18 front 32:9 121:16 176:1 194:22 221:2,13 227:1 230:4,4 246:7 257:5,9 fruitful 221:3 fruition 227:14 frustrating 50:10 59:16,18 fulfill 22:3 fulfilling 68:22 fulfills 247:24 full 15:6 28:24 43:10 59:11 84:19 180:14,16,17 180:23 fuller 248:21 fully 172:23 190:2 209:13 263:10 271:19 full-time 84:21 273:11 fun 123:9 function 86:21 89:4 128:5 129:3 131:1 235:14 functions 228:12 fund 187:17 188:4 fundamental 279:4 funding 185:11 186:20 funds 105:8 106:2,5 107:4 183:2,13 185:1,20 187:12,19 198:6 220:24 233:24 further 24:10 29:21 96:16 134:14 141:12 142:13 143:9,22 144:8 146:18 148:2 181:3 239:16 260:5,13 Furthermore 50:21 future 18:8 64:24 75:3 87:18 134:13 227:5,21 229:21 230:13 259:11 259:18 260:19 261:6 262:6,21 263:7,24 264:18 265:14 277:19 G G 6:1 gain 182:18 Galassie 2:6 6:8 7:20 8:9 9:2,18 10:8 11:12,23 103:10 108:9,11,12 111:9 112:9,10,11 116:13 119:14,15 121:6 124:14,16,17 126:10 127:7 128:1 171:13 171:14,15 194:2,5,11 195:4,7,12,23 196:2 203:13 204:9,19 211:8 212:16 215:7,8 217:6 231:6,8,9,12 233:6 242:17,19,20 280:13,18 283:5,6,9 283:11 285:13 286:9 287:6 289:7 game 90:17 gap 270:10 gaps 90:13 Gary 37:23 gastroenterologist 133:13 139:22 145:20 146:9 gastroenterologists 145:16,23 157:19,20 gastroenterology 4:13 126:2,5 142:11 145:3 gastrointestinal 3:14 13:12 18:17 19:8 21:8,19 23:22 25:19 25:22 26:10,15 143:5 144:13,16 146:6 gather 51:21 GE 221:8 genders 135:13 general 2:16,17 14:13 40:16,18 59:11 94:10 139:17 177:21,24 275:16 282:7 generally 139:11 254:4 generate 84:20 generation 57:10 generosity 33:4 generous PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM 95:1 Geneva 29:13 37:20 gentleman 239:18 gentlemen 14:8 284:16 geographic 189:14 254:4,8,17 George 2:20 6:4 7:3 13:17 288:10 geriatric 53:3 60:4 61:5 67:18 237:20 geriatrics 67:16,19 150:14 geropsychiatric 43:2,7,9 geropsychiatry 42:22 Gerry 246:13 248:18 getting 36:15 92:21 155:6 GI 24:11,24 27:13 135:4 137:17 139:2 145:7 150:16 165:24 166:3 Girardeau 137:9 give 35:24 79:12,15 86:17 86:20 99:24 109:20 118:13 127:5 159:13 171:1 193:22 194:20 195:17 199:10 201:22 251:23 given 15:13 20:17 55:9 117:3 135:8 140:10 185:19 198:17 220:4 248:22 gives 197:2 giving 186:11 194:7 205:5 226:9 Draft Full Meeting Conducted on June 21, 2016 315 GI-assist 139:1 GLASSON 2:8 6:20 9:1 10:23 108:24 112:15 115:7 119:21 125:3 163:9 170:12,16 172:2 215:19 232:1 233:8 243:6 284:2 288:2,5 gloss 238:15 go 7:6 13:7 16:3 17:12 31:13 35:5 36:6,22,23 43:11 44:19 52:19 74:24 75:1 80:10 89:22 124:2 130:17 149:5 150:23 152:9 152:14 157:22 159:22 165:14,15,16 168:18 173:2,4 188:10 190:22 210:13 220:8 237:3 239:8 240:1 269:14 286:14,15,16 goal 65:6 68:17 82:12 87:15 goals 85:7 goes 43:16 157:5,8 160:5 185:15 203:17 259:15 going 8:4 14:18,20 37:11 41:24 43:15,21 45:9 58:11 75:3 76:9 79:22 94:17,18 99:16 100:11,14,17,19 104:11 105:11 109:6 109:11 118:15 132:7 144:14 151:20 163:1 163:2 164:1 166:24 168:17 170:2,6,19,24 172:6,10,15 173:23 174:6 180:13 187:16 188:23 190:5 194:19 195:4 200:20 202:22 207:16 208:12,23 209:21 210:15 211:14 211:15,19 212:19 213:9,24 231:18,22 234:24 237:13,15,17 237:18,19,20,22 238:5 239:2 257:21 264:10 269:2 286:7 287:8 288:16 gold 136:8 Goldberg 13:10 16:3,5,10 18:3,6 good 14:8 16:6 18:13,19 21:16 23:16,18 26:11 30:3,15 34:1 35:7 47:6 51:5 62:1 63:24 65:20 67:9 68:2 69:14 76:15 78:18 81:5 85:18 87:23 89:23 91:22 93:23 95:22 96:19 97:10 109:17 120:8 125:15 132:3,15 133:24 135:2 137:19 139:18 168:8 171:3 179:14 182:6 186:8 202:3 216:9 218:8 229:19 229:19,21 234:9 235:1 236:20 240:6 243:17 246:11 250:14 260:19,20 268:23 276:24 282:18 284:19 Good-bye 31:5 Google 94:14 government 56:22 87:4,21 277:8 GOYAL 2:13 130:3,6,11 131:15 148:15,21 149:1,5,8 149:13,16,18 150:6 150:11,18 151:4,7,9 151:15 152:3,8,16,22 153:2,11,13,17,24 154:2,5,8,13,18,23 155:5,8,12,14,17,20 156:1,7,11,14,16,21 156:24 157:10,12 158:24 grab 35:5 grand 20:1 177:5 grant 48:9 203:18 granted 128:6 Grayslake 61:9 great 42:10 72:22 173:15 179:5 264:19 greater 86:23 225:3 273:5 greatly 24:13 Greiman 2:7 6:13,14 8:11 9:15 9:16 10:24 104:5,13 104:18,24 105:4,10 105:15 108:14,15,17 108:21 112:21,22,24 116:20,22 117:1,9,13 117:20 118:12,21 119:3,16,17 124:20 124:21 171:18,19 177:11 193:19,21 194:4,12 204:17 205:12,24 215:10,11 231:14,15 242:22,23 251:18 283:15,16 grew 32:24 Griffin 4:12 121:2,4 gross 20:21 111:18,19 126:16 272:2,5,10 Grossman 277:8 gross-square 272:8 PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM ground 105:21 106:1 107:17 107:22 grounds 116:15 group 20:23 164:7 176:9 177:22 179:20 183:6 198:5 246:21 278:19 groups 13:5 60:5 62:14 177:19 Grove 61:12 grow 92:8 growing 40:13,15 71:8 134:10 228:5 229:1 230:13 growth 78:4 99:7 264:1,2,5,7 278:16,18 Grundy 41:6,7 guaranteed 264:10 guaranty 199:15 guards 54:13 guess 106:7 109:11 173:7 187:4 188:13 202:21 205:10 214:2 guessing 162:20 guest 94:24 guests 226:19 guidelines 224:14 Gurnee 61:9 guys 116:16 118:22 G-e-r-r-y 246:13 Draft Full Meeting Conducted on June 21, 2016 316 happy 123:1 148:11 208:10 H 212:4 231:9 238:16 287:11 hard Haber 93:5 172:14 218:11,15 220:12,13 harm 232:18 36:9 half harming 31:14 46:17 99:5 154:11 180:8 223:24 31:21 266:19 272:4 279:23 Hart 234:9,11 241:7,11 281:9 Harvard Hall 13:13 23:16,18 122:11 277:7,8 hat 122:11 125:16 42:5 Haller hate 289:21 290:2 163:24 202:5 hallway Hayes 93:4 6:16 Hamby HCR 132:22 96:2,2 hand head 35:1 54:1 79:19 80:7 81:1 185:5,12 187:12 56:1 172:18 173:9 221:7 218:14 225:1,2 headquartered 255:11 291:17 18:22 handbook headway 288:15 251:6 handout healing 244:9 245:10 270:6 17:21 273:16 276:12 272:1 273:13 health hands 1:1,2 3:13 4:7,15,18 43:3 115:21 122:5 9:10,11 13:9,10 14:11 131:22 217:13 233:11 14:14,22 15:21 16:9 244:19 18:6,9 19:24 22:18,24 hang 25:7 26:17 27:15,24 205:5 28:22,23 31:1 35:15 Hanover 37:17,18 38:1 41:4,5 16:24 41:7,23,24 42:2,15 happen 48:8 49:1,5,7 50:16 128:6 202:18 277:12 53:6 55:10 57:18,22 288:18 58:10,24 59:1,9,15 happened 60:2,18 61:13,15 288:23,24 62:20 63:5,19 64:20 happening 66:12 67:12 69:8 56:15 71:20 74:5 75:3 79:5 happens 80:20 81:8,24 84:2,4 98:17 209:10 H 84:7,8,23 85:1,5,9,14 85:21 87:3,20 88:2,5 88:9,15 89:10,18 90:1 90:12,15 91:15 92:1,4 92:16,18,19,21 94:7 95:24 96:1,3,15,18,22 97:6,12 114:3 122:13 122:22 133:18,24 135:2 137:16,19,23 137:24 138:1,8 139:19 140:20 146:10 148:4 149:12 150:23 163:10,15 168:8 175:2 179:10,18 188:1 190:12,23 191:13 218:18 220:1 220:9,15,20 221:8 223:15 224:7 225:11 227:2,23 230:17,23 244:5 245:1 246:16 247:7,10 263:15 265:4 268:2 270:7 275:13,17,19 276:17 276:21,24 277:4,9,21 282:6,18 287:22,23 289:24 Healthcare 3:20 18:21 26:13 96:2 103:4,8,20 144:18 HealthVest 38:11 56:19,23 57:3 176:19 178:4 196:6 205:19 HealthVest's 37:24 39:8 Healthy 276:15 Health's 96:19 hear 21:12 44:23 59:20 79:11 94:2 108:21 127:14 177:13 195:8 231:20 heard 7:13 8:14 9:5,21 10:11 11:3,17 12:4 17:13 PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM 51:9 53:3,4 76:18 78:8 79:6 101:3 178:24 197:15 223:2 226:20 267:23 284:3 285:15 287:16 289:15 290:21 hearing 115:15 121:22 126:20 175:22 197:5,14 205:7 217:24 233:22 274:23 283:17 heart 59:12 79:16 80:4 170:5 269:20 Heartland 147:12 166:7,8,15 heavily 71:8 Heights 61:8 held 54:15 151:21 198:1 203:12 209:1,5 221:9 290:12 Hello 21:14 28:10 37:9,13 39:14 48:23 help 14:20 15:4 31:6 34:11 57:24 60:8 80:11 95:11 139:18 153:14 196:1 202:10 227:1 230:22 helpful 248:7 helping 49:11 helpline 62:7 helps 160:8 Henry 89:20 heretofore 230:10 hereunto 291:16 Draft Full Meeting Conducted on June 21, 2016 317 Heritage 234:12 he'll 168:24 HFSRB 8:5,19 9:10 10:2 HFSRB-IDPH 288:17 289:6 Hi 26:9 32:16 58:8 71:19 99:12 hiatus 235:22 Hickory 234:1 hide 210:8 Higgs 246:18 high 33:14 92:17 123:11,16 137:1 150:15 158:7 264:6 higher 74:15 156:17 164:15 191:8 276:9 Highland 61:9 214:12 highlighted 220:10 highly 222:8 high-acuity 88:15 178:23 179:9 high-quality 92:16 180:9 228:4 282:13 Hike 116:7 Hills 61:9,11 hip 79:17,18,21,21 HIPAA 77:4,8 hired 88:12,16 139:11 160:19 historic 27:18,21 205:18 207:8 208:2 historical 76:24 207:6,12,19 209:21 211:18,18 212:5 259:10,13,17 262:4,5 263:4,7 historically 78:2,3 199:18 259:22 260:3 261:5 history 49:4 79:20 80:8 139:21 150:24,24 226:21 hit 46:18 266:4 hitting 36:3 Hoffman 16:13 29:3 hold 83:19 202:9 206:7 holding 205:2 holistic 17:21 home 14:21 36:6,21 64:17 65:10 66:19 73:8,10 73:23 74:19 75:1 81:10 82:5,9,13 86:15 86:19 87:9,13 88:8,9 90:4 91:4 94:9 227:17 241:5,6,12 247:16 249:1 259:15 270:10 homeless 29:23 57:10 homelike 17:17 270:9 273:22 homeliness 238:12 homes 43:11 60:22 72:1,18 73:17 78:21 82:24 89:6 275:9 home-style 237:16 honor 57:2 64:2 88:5 honorable 269:9 hope 15:24 60:6 93:19 108:17,21 167:7 187:9 190:7 hoping 248:21 288:24 horrific 32:2 hospice 67:17 hospital 3:16 4:15 8:19 16:11 17:15 21:17,24 22:1,2 23:4,20 24:2,5,16 25:9,24 27:9,10 29:3 29:14,18 30:18 31:11 34:20 35:11 36:20 37:1,17 38:1,11 42:15 43:10 44:6,21 45:1,2 46:15,16 47:17,23 48:10,18 49:6 52:1,11 52:23 53:19 54:10,12 55:12 56:4,12 58:17 58:20 59:14,22 60:1,8 61:22 62:17,19 63:11 70:15 72:9 75:8,13,14 75:17,18 76:6 79:18 84:7 94:11,24 95:9 97:24 98:4,8 127:2,12 129:22 136:20 138:18 140:24 141:6 142:17 142:22 143:5,12 144:2 145:22 146:4 147:6 150:12 158:4,6 158:7,15,21,23 161:6 161:9 162:2 164:6 165:14,16 166:5,7,8 166:17,18 169:24 170:7 173:13 175:3,5 175:6,18 177:6,23,24 179:4,23 180:1,11,13 PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM 181:15 182:1 191:3,7 191:19 193:10 199:2 214:12 224:23,24 235:13,16,20 236:5 236:12,14 241:5 270:10 287:9,11 289:24 hospitalization 55:11 hospitalizations 87:18 90:18 hospitals 22:5,8 24:7 25:3 26:20 35:23 41:18,19 48:7 49:9,24 50:11 52:9,12 52:15,21,24 53:9 55:6 55:17 68:8 72:21 78:21 92:14 98:10 127:12 136:21 140:14 140:16 141:7,14,18 143:9,16 145:15,18 145:23 146:15 157:16 164:13 166:13,14 178:5,19 179:21 182:12,17 187:21 192:11 235:18 258:7 268:1,5,12,13 280:9 281:10 hospital's 180:18,22 hospital-employed 146:1,3 hospital-to-transitio... 93:10 hospital-unit 38:12 hotel 94:24 95:8 hotline 58:1 hour 162:6 274:16 hours 24:9 40:6 41:15 48:5 50:14 54:18,18,19,24 59:3,6 61:3 162:2 house Draft Full Meeting Conducted on June 21, 2016 318 64:8,11,22 65:1,5 219:11 226:21 227:4 227:17,19,20 228:9 230:12,16 286:8 House's 65:8 228:3 housing 220:6 HUD 224:11 huge 202:6 Huh 167:9 human 95:2 Humphrey-Sonntag 1:17 291:3 hundred 82:14 108:2 156:22 182:15 189:2,4 206:9 206:13 222:2 hundreds 46:18 278:9,10 hundred-teens 191:17 Huntley 73:3 hurt 278:6 Hwang 277:5 H-a-b-e-r 220:14 I ice 79:21 ICMA 83:22 idea 177:7 181:17 182:3 198:20 206:4 ideal 225:1 identified 27:2 69:20 185:11 190:24 192:2,16 265:6,7 271:3 IDPH 2:12,19,20 127:2,5 128:4 129:4 131:1 133:16,21 134:5,12 134:15,21 142:10 145:12 147:4 160:19 164:21 166:21 167:1 167:6,11,16 168:18 169:6,20 288:14,20 IGA 288:12,20 ignore 78:9 275:1 IHFS 2:13 Illinois 1:1,6 3:14 4:13 13:11 17:4 18:17,21,23 19:22 20:20 21:19 23:22 25:18,21 26:10 26:13,14 32:19 33:2 33:19 37:19 39:3 41:14 42:1 45:4,11,19 46:3,5 49:16 52:2,11 56:20 57:13 64:10 69:16 83:20 94:16 115:12 118:23 121:13 126:2,5,18 133:11,17 134:17 135:21 136:20 138:2 140:24 145:6 164:19 175:19 193:5 217:21 230:23 233:19 245:19 275:16,18 282:5 289:24 291:6 291:24 illness 46:23 47:3 48:12,14 54:6,15 55:19,19 62:4 86:21 87:17 175:6,18 177:10,23 178:23 illnesses 48:17 51:22 53:2 55:20 228:20 imaginable 262:18 imagine 34:6 83:4 161:15,17 imaging 74:18 77:17 imbalance 71:13 immediate 55:13 61:16 63:6,7 68:15 176:18 immediately 117:12 118:17 257:7 immensely 69:2 impact 22:18,23 25:7,9 26:20 71:23 76:9 77:12 84:3,11,14,18 89:10 90:11 282:12 impacting 99:17 impacts 276:18 imperative 73:9 implement 68:11 importance 42:16 important 53:7 136:1,5 137:8 140:12 146:7 225:12 230:20 242:2 259:12 273:8 importantly 15:5 133:11 143:24 271:22 276:6 impossible 55:3 impression 254:3 improve 20:19 26:17 60:1 72:5 91:12 138:1 143:3,13 229:15 273:17,17,18 273:18 improved 90:15 improvement PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM 75:24 227:13 improvements 275:7 improves 90:17,18 91:2 improving 219:24 277:10 inability 21:1 96:20 inaccurate 70:20 inadequate 138:13 inbound 6:10 incentive 261:8 include 57:17 70:10 98:3 154:14 221:22 256:18 271:18 273:9 included 68:12 117:10 229:11 249:23 259:9 269:23 includes 38:5 138:18 275:14 including 19:10 49:5 70:1 78:21 138:15 143:21 151:11 151:24 152:1 179:10 223:16 278:22,22 income 33:11 139:6 141:2,10 Incorporated 10:3 incorrect 70:20 152:11 increase 25:10 37:3,5 40:17 45:21 46:21 77:22 87:2 111:6,22 136:14 137:13 278:14 281:16 increased 111:18 158:10 227:5 increases 140:6 increasing Draft Full Meeting Conducted on June 21, 2016 319 45:12 68:5 81:18 133:22 138:6 147:18 179:11 increasingly 281:5 incurable 16:15 17:1 indefinitely 205:4 independence 86:7,18,21 146:7 independent 145:19 146:9 165:24 166:1 independently 87:10 268:12 indicate 13:15 76:24 84:10 149:20 indicated 149:23 215:20 239:24 266:15 indicates 224:17 278:6 indication 225:17 indicator 192:15,18,23 252:1 indicators 84:17 192:1,9 indirect 84:11 individual 82:2 97:8 136:10 177:19 279:24 individualized 88:18 individuals 39:21 40:4,5,23 46:4 46:21 97:5 indoor 237:23 induced 84:11 industry 65:10 89:11 223:16 224:9 275:10,18 276:14 277:14 inevitable 23:8 264:12 infection 271:21 information 38:6 40:16 70:16 76:11 77:9 96:17 97:18 98:1,12,21 100:22,23 131:11 174:1 184:17 186:19 188:6 194:8 195:18 201:21 202:13 202:21,23 204:1 207:20,21 209:18 210:4,12 211:10,11 211:24 213:9 214:1,4 247:24 272:24 279:12 280:9 286:20 informed 49:21 infrastructure 45:7 Ingleside 61:10 ingredients 68:4 inherent 223:6 inhumane 179:2 initial 4:10 94:22 114:6 138:4 244:2 initially 158:21 159:16 initiatives 136:3 inner 51:19,24 innovate 227:15 230:22 innovation 227:6 230:8,11,18 276:15,22 277:13 innovative 66:12 69:1 86:3 89:10 89:13 177:9,16 218:17 220:9,15 277:20 278:4 Innovator's 277:3 inpatient 28:18 38:8,8,24 39:22 40:20 45:8,12,19,20 46:6 47:19 49:8 50:2 60:24 81:17 178:22 179:10,19 input 16:20 inside 254:20 255:12 insofar 209:17 instances 50:1,6 instill 86:8 Institute 83:22 institution 221:11,19 222:15,22 239:22 institutional 86:8,16 100:3 236:18 237:14 institutional-style 237:1 institutions 49:12 instructing 96:8 insurance 14:14 20:4 33:4,13,15 72:15 98:5 135:10 136:24 138:13 153:9 165:15 173:11,12 178:8,12 185:24 insurances 151:20 170:4 178:9 insured 185:24 186:6 intangible 17:20 integral PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM 135:6 integrity 50:18 intend 244:4 252:7 intended 252:6 intends 23:10 intensive 36:24 intent 173:24 244:4 245:24 247:20 248:20 249:9 251:24 252:1,1 253:11 261:19 intention 72:21 interagency 288:8 289:6 interest 15:12 51:10 107:10 225:18 291:14 interesting 242:5 interests 64:6 220:4 interest-free 107:8 intermediate 64:13 internal 67:15 187:7,12 internally 187:17 interpretation 167:4 169:10,13 251:13 284:7 interpreted 169:21 251:21 interpreting 253:18 interrupt 149:3 184:9 interrupting 195:5 intersects Draft Full Meeting Conducted on June 21, 2016 320 181:21 intervention 49:2 introduce 176:9 234:14 introduces 276:21 introducing 274:3 inventory 106:19 219:23 226:12 263:15,18 266:22 274:17 invest 81:22 236:22 invested 66:13 71:1 279:6 investing 143:12 investment 182:19 183:6 investments 70:8 investor 183:6 198:5 287:24 investors 107:3,3,4,7 226:3 involve 15:19 involved 30:24 51:11,20 171:2 involvement 136:7 228:7 in-house 70:1 156:9 242:6 in-office 146:24 Iraq 57:8 irony 208:6,8 Island 61:10 isolated 56:22 issue 15:4 77:21 96:8 128:22 Jenich 246:11,13 267:23 269:13,15 280:15,17 280:19 284:17 Jennifer 63:20 Jerome 277:7 job 1:15 98:14 277:9 jobs 83:5 84:20,22 Joe 25:20 34:2,21 41:3 133:3 JOEL 2:5 John 2:8 63:17 65:22 176:13 196:3 199:1 239:17 246:21 286:18 287:11 Johnson J 2:5 6:17,18 7:10 10:6 J 108:19,20 111:8 80:23 89:20 112:8,12,13 119:18 Jackson 119:19 124:22,23 32:19,24 33:10 171:21,22 175:7 Jail 215:5,14,15 231:17 49:6 231:18 243:1,2 245:4 jails 283:3,20,21 285:11 46:13 287:7,14 290:17 Jamer joined 97:8 7:21 52:21 James Joint 97:8,10,11 99:9 176:21 74:9 88:22 160:16 182:9 183:10 208:12 Joliet Janet 41:23,24 109:21 JOSEPH January 44:15,20,24 47:2 233:21 Joseph's Jason 22:1 23:19 24:8,11,14 277:5 24:24 27:10 157:22 jealous Joyce 290:3 69:10 71:19 Jeannie Jr 2:17 13:3 25:15 34:17 2:16 287:11 53:16 63:14 69:6 Juan 89:16 285:6 129:14,24 166:21 172:24 182:8 198:22 221:14 238:21 240:2 275:3 issued 96:8 222:17 247:19 250:19 issues 31:1 36:19 38:15 48:13 59:16 97:15 117:14 172:7 190:15 191:24 194:7 ISSUES/SETTLEM... 3:6 item 102:2,2 103:1 110:1 itemized 152:10 items 3:17,18 102:2 103:2 221:22 PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM 2:16 202:10 285:5 286:2 288:8 Judge 104:11 118:1,2 205:17 July 16:13 285:8 291:18 juncture 240:7 June 1:7 11:11 41:9 115:14 217:23 249:22 288:19 Justice 2:7 6:13 9:16 108:14 108:20 112:21 116:24 119:16 124:20 171:18 215:10 231:14 242:22 251:18 283:15 justification 28:3 justified 160:3 justifies 161:10 justify 27:16,18,22 147:1 159:11 JV 246:15 J-e-n-i-c-h 246:14 K K 2:5,13 Kane 291:6 Karen 169:8 Kasia 44:7 48:24 Kath 167:4 184:13 286:13 KATHY 2:4 keep 14:20 36:15 62:9 72:19 185:19 205:3 keeping Draft Full Meeting Conducted on June 21, 2016 321 54:13 64:11 83:4 kept 179:1 key 145:7 kids 31:21 Kimberly 89:21 95:23 kind 33:17 43:22 52:8 95:1 98:20 131:13 167:24 168:13,14 192:22 201:23 239:20 kindly 63:12 249:8 kindness 95:3 kinds 179:18 King 119:2 kitchen 228:12 Klaine 25:21 32:16,16 133:3 knees 94:9 knew 92:18 95:4 250:17 257:20 Kniery 112:2 113:5 176:11,13 191:23 195:22 198:2 198:11 210:6,16,20 211:2 234:17 239:10 240:22 241:18 242:1 242:10 243:18 246:22 257:22 knock 251:1 know 15:1 19:9 32:24 33:2 33:14 35:19 43:17,20 45:6 48:15 62:9 63:3 63:10 93:1 105:16 107:19 116:9,17 118:18 119:2 152:18 156:19 157:11 159:7 162:7,9,13,18 163:24 164:7,12 170:5 173:6 183:13 184:4,16,21 188:3,6 192:1,10,11 192:14 194:6 195:20 196:13,14 198:4,6,12 198:14 200:20 201:9 202:9,16,23 203:11 203:17,21 204:10 205:7,11,13 206:12 208:14,17 209:2,3,5,6 209:10,16 210:22 211:21 238:1 245:12 252:18 261:10 267:14 274:4 286:3 knowledgeable 62:13 known 8:20 9:12 10:3 16:18 17:22 38:11 67:22 238:11 knows 136:6 208:12 Kreplin 80:23 87:23 88:3 Kresch 176:15 177:2,14 183:15,20 185:14,17 189:19 205:1 216:8 L L 1:17 63:20 291:3 lab 77:17 laboratory 74:17 273:11 lack 38:9 39:21 40:3,10,19 46:14 49:15 57:21 59:2 61:1 73:19 179:4 193:8 209:3 lacking 59:24 ladies 14:8 lag 136:13 Lake 4:16 45:22 46:4,6 47:23 60:20,20 61:9 61:10,10,11 63:16 64:2,4,6,7,11,16,19 65:4,5,12 66:3,22 71:21,24 74:7 100:2 181:7 189:15 190:5 194:6 217:2,4 219:6 219:22 220:2,18 226:22,24 227:5,10 227:13,21 228:2 229:7,17,18,19 230:2 230:12,14,19 235:11 Lakes 42:10 LAN 41:6 land 15:18 84:3 85:7 107:21 222:7,9,10,12 236:7 landlocked 236:17,24 landlord 205:6 Landlords 205:3 language 251:14 252:2,9,15,17 253:1,15 256:4 languish 35:16 large 16:15 36:13 42:12 60:9 95:6 163:18 178:17 254:16 255:3,19 larger 37:1 43:15,15 46:4 71:8 157:4 272:4,11 272:13 largest 40:13 Larry 97:9 99:12 Lastly PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM 22:24 77:20 late 16:23 204:10 277:7 latest 136:16 263:18 276:19 law 46:12 145:24 251:20 Lawler 246:18 248:10,17,18 Lawlor 63:17,24 64:1 65:16 226:20 Lawn 29:4 laws 140:18 laypeople 62:13 lays 253:2 lead 30:16 70:16 leaders 133:2 leading 135:12,20 learn 148:16 learned 146:4 learner 88:4 lease 15:18 65:5 leased 126:16 leave 26:6 34:23 80:14 253:21 254:3 leaving 48:4 81:2 189:24 274:9 281:11 led 235:17 left 13:7 176:22 234:17 legal Draft Full Meeting Conducted on June 21, 2016 322 3:9 10:18,22 76:16 176:20 251:18 252:11 256:1 legislative 252:1 legitimate 252:19 262:24 lender 225:8 240:6,8,9 lenders 226:2 lending 219:5 225:9,13 length 72:12 75:4,9 76:10 89:2 219:16 lengths 72:6 86:23 87:7 Lentz 65:24 229:10 less-intense 36:23 less-than-50 224:6 letter 20:9 22:7 23:6 24:3 28:14 38:2,2,5 47:10 47:13 58:19 60:16 76:23 105:23 183:24 184:7,13,20 185:8 196:18,21 197:11 198:16 203:6 208:15 209:24 210:24 212:2 212:6 221:18 222:17 222:23 239:1,3,21 240:4,5,14 249:9,22 253:11 261:19 270:22 letters 38:3 58:21 76:21 115:16 175:23 196:16 197:9,13,18 218:1,1 221:4 229:6,8 233:23 let's 35:5 153:2 155:12 263:12,24 level 27:8 84:5 107:13 139:8 158:21 168:3 195:10 195:19 205:2 224:13 225:4 230:11 238:12 258:9 266:6 274:5 276:5 levels 27:1 74:22,23 136:12 237:21 265:16 274:7 liability 141:4,10 liaison 163:16 Libertyville 61:10 64:8 66:20 license 65:13 127:1,6 128:11 129:1,22 134:15,19 142:8 145:12 147:2 licensed 26:22 27:15,24 58:9 69:15 81:10 90:3 99:20 129:12,20 134:6,12,23 161:5 180:18 licensing 128:4 licensure 23:5 129:9 147:7,9 lies 131:8 life 32:21 85:8 134:22 180:10 235:12 276:14 279:7 lifelong 88:4 lifestyle 82:5 lifetime 135:13 life-enrichment 228:6 light 129:16 likelihood 197:23 limit 271:20 limitations 239:19 limited 25:3 122:12 133:12 178:1 221:23 limited-access 100:15 limited-specialty 126:15 Lincoln 233:19 234:2 236:12 240:11 241:5,6,21,22 242:7 243:13 line 121:18 187:23 203:24 Lisa 89:20 90:3 list 62:9 68:20 221:22 285:21 listed 250:1 listening 32:12 48:20 listens 178:20 literally 180:3 189:16 little 19:21 20:15 73:13 75:16 92:8 149:11 152:24 166:22 180:23 183:10 212:1 238:23 239:16 257:1 264:4 289:1 live 17:4 33:19 228:16 lived 92:5 165:13 173:13 lives 31:23 93:12 living 30:7 57:15,23 Liyanapatabendi 69:11 78:18,19 80:13 80:17 PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM LLC 9:10 96:2,2,3 111:14 246:15 247:1 loan 15:13 222:19 225:19 239:14 Lobaito 63:17 65:20,22 local 19:24 29:6 40:11 46:3 55:15,17 62:20 83:6 140:21 278:13 281:14 locally 37:6 located 15:15 27:3 64:8 66:20 133:11 188:23 236:13 237:4 254:20 255:1,5 255:12,17 location 31:7 50:21 66:24 84:7 144:23 145:6,10 181:22 189:14 locked-down 30:7 Logan 235:13 237:10 Lombard 164:9 long 22:14 46:5 72:14 117:22 160:1 162:15 229:23 longer 185:6 219:20 228:15 274:5 long-care 236:3 long-standing 14:23 229:2 long-term 14:24 15:18 64:5 66:5 67:4 71:6 78:22 82:9 82:24 86:10,11 93:5 100:5 217:5 219:13 228:16 233:5 245:2 245:19 256:14 263:15 Draft Full Meeting Conducted on June 21, 2016 323 263:17,17,19 264:13 265:9 266:23 267:7 275:18 276:1 look 29:22 52:8 82:8 117:17 149:16 159:23 167:10 187:18,18,22 190:8,9 190:11 191:5 193:2 194:13 205:20 213:7 213:8,21 226:3 230:15 241:2 245:13 263:12 264:1 looked 17:24 52:9 123:15 129:15 160:24 167:20 168:2 181:7 188:7 190:3,14 193:11 194:14 257:14 262:10 looking 45:4 61:4,4 95:12 154:9 159:4 164:16 181:3 200:22 206:4 239:4,11 242:5 looks 200:13 201:15 232:5 238:22 241:3 259:10 259:11 lose 24:6 86:16 205:8 losing 73:1 146:3 163:17 235:19 loss 86:7 104:20 lost 46:7 55:24 lot 35:20 51:9 86:13,17 93:1 98:17 117:20 128:8 129:9 164:7 168:5 170:4 185:19 193:8 235:11 238:4 248:24 lots 257:13 loud 13:18 louder 55:24 lounge 228:13 love 31:6 123:8 192:24 195:24 loved 63:3 95:3 229:12 271:12 loveseat 95:8 loving 64:17 low 107:10 181:10 193:13 266:21,24 274:7 lower 137:10 142:16 143:4 143:10 259:24 260:4 261:18 lowering 219:24 lower-cost 143:14 lower-rated 73:17 lowest 266:23 267:3 279:21 279:21 low-cost 137:6 loyalty 57:1 luck 109:17 120:8 125:15 216:9 243:17 259:15 284:19 lucky 20:5 Luechtefeld 132:24 lunch 101:15 Luther 10:2 Lutheran 19:18 21:23 23:10 24:1 24:12 32:17,21 33:7 132:9,10,11,15,17 148:17,20,24 150:3,8 150:12,22 151:6,8,14 151:18,22 152:7 153:1,8,12,16,22 154:1,3,7,9,14,21 M 155:1,7,10,13,16,19 M 155:23 156:3,9,12,15 16:10 157:17 159:1,16 machine 160:12,15 161:18 159:18 162:5,23 163:6,14 machines 165:5,18,22 166:1,5,8 160:5 166:11,15,18 167:23 Madam 168:1,6,9,21 171:1 6:5,23 8:3 16:6 65:20 Makhdoom's 67:9 81:5 85:18 19:10 22:20 24:3 25:2 91:22 93:23 102:5,11 34:2 103:19 104:2 108:8 making 109:5,13 111:12,23 19:15 55:2 131:9 223:8 112:7,18 115:10,17 251:6 119:11 120:2 121:11 maldistribution 121:23 125:9 126:13 142:20 130:3 132:6,15 man 148:15 170:12 171:11 33:17 172:12 173:18 175:16 manage 176:6,12 215:4 216:1 145:8 276:12 218:4 231:5 232:10 managed 234:9 238:17 242:16 90:7 243:11 244:7 246:2 management 246:11 248:19 269:7 37:15 92:5 234:12 284:9 manager main 23:19 24:2 26:12 47:7 34:10 246:20 249:4 60:15 81:12 83:21 maintain 97:11 98:13,18 41:11 146:7 265:15 197:11 246:14 266:6 285:7 managers maintaining 16:18 91:8 71:8 managing major 52:17 90:18 218:12 221:22 mandate majority 142:15 265:2 72:22 73:2 75:18 271:9 manner 272:18 274:1 220:23 277:23 282:4 makers Manor 275:12 4:17 78:11 96:1,2,3,6,9 Makhdoom 29:13 94:10 lymphoma 16:15 Lynette 69:9,14 L&D 150:13 PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM Draft Full Meeting Conducted on June 21, 2016 324 96:13,23,24 233:2,4 234:22 235:24 236:4 236:15 237:4 238:3,3 240:10 Manor's 238:8 Marc 176:20 Marcia 122:14 margin 207:17 Marion 144:17,18 mark 69:10 74:4 97:7,11 100:21 167:9 market 26:23 71:4 75:23 90:16 91:1,9 118:15,22 181:4 205:4 221:12 223:10 224:14 225:14 marketplace 82:22,23 90:12 markets 193:2 Marsha 29:10,16,24 Martin 80:22 83:15,15 Martina 176:18 191:15 193:1 Marwah 63:21 67:9,14 Mary 89:20 94:4 Maryville 182:14 Masonic 67:20 master's 83:19 Mat 85:23 match 80:9 150:1 material 186:16 244:11,13 materials 21:21 269:24 math 75:12 210:17,17,18 241:15 Mathers 60:15,18 61:14 matter 34:7 99:4 254:14 matters 288:22 Matthew 80:22 maximum 143:19 153:8 156:4 Mayor 65:24 132:21 229:10 ma'am 13:20 MC 2:8 6:20 9:1 10:23 108:24 112:15 115:7 119:21 125:3 163:9 170:12,16 172:2 215:19 232:1 233:8 243:6 284:2 288:2,5 McAllister 4:5 111:2,5,13 McDonald's 119:2 McGlasson 6:19 108:23 112:14 119:13,20 125:2 172:1 215:18 231:24 242:18 243:5 284:1 McHenry 3:13 4:18 13:9,10 14:11,12 15:3 16:9 18:7 61:14 63:19 67:13 69:9 73:8 74:6 79:5 80:20 81:8,24 83:5,7,7,17 84:4,9,23 85:2,6,12,22 87:3,20 88:2 89:18 90:2,13 91:19 92:2,6,7 94:7 95:20 96:1,5,7,13 97:7 244:6 245:2,19 246:16,21 247:1,8,14 250:9 254:6,9,15 255:3,3,5 263:10,20 264:2 265:7 266:1,18 266:21 267:2,7,19,20 268:24 269:2,5 270:7 274:8,12,14 275:5 277:18 278:4,17 279:3,20 281:5,11 282:14,18 McHenry's 69:18 84:1 85:6 MCOs 45:16 meals 82:15 mean 34:7 49:21 104:24 121:24 123:14 128:13 170:5 190:16 200:21 202:5,21 203:16 206:18 238:15 250:21 251:3 252:6,8 267:16 meaning 93:9 144:4 149:22 meaningful 52:2 225:11 means 56:4 78:3 138:12 140:15 150:6 184:10 250:21 251:2,8 264:21 267:17,20 270:15 278:1 mechanisms 68:12 median 33:11 136:20 143:15 Medicaid 20:10,13,14 24:17 45:16 70:21 98:5 147:16,18,22,23 148:23 149:7,21 150:7 151:12 152:5 156:17 178:8 238:7,8 256:11,15,17,19,22 256:24 257:4,13,17 PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM 258:1,6,13,15,18,20 258:22 272:23 280:7 280:10 medical 4:12 8:5 16:12 17:5,11 17:19 19:11 20:23 21:7,24 22:3,13,21 37:23 38:22 40:22 44:15 59:12 67:20 68:5,7 79:2,20 80:4,8 82:17 88:23 121:2,4,5 121:13 123:18 133:20 134:17,19 136:19 140:12 142:3,9,12 147:3,13 164:7 214:13 286:17 287:4 medically 100:12 250:10 253:24 254:3,9,13,16,21 255:2,4,9,13,16,19 258:24 medical/surgical 177:24 179:3 Medicare 72:2,14 98:2,5 153:20 154:24 155:1,2,9,21 156:4,17 158:19 178:8 267:24 268:7,8 269:3,5 272:23 280:7 medicating 36:6 medications 30:2 68:17 medicine 67:16,16,17 150:14,14 276:11 med/surg 178:19 181:15 meet 30:22 35:23 55:7 75:10 81:24 82:2 83:2 107:14 122:18 134:22 164:20 190:16 196:7 199:4 200:15 207:13 207:17 223:22 228:18 230:12 249:9 253:6 253:11 265:9 Draft Full Meeting Conducted on June 21, 2016 325 meeting 1:4 5:8 6:3 11:22 41:8 66:8 131:6 189:18 202:6 204:16,24 219:4,10,16 221:2 246:1 247:19 250:20 251:5,5 269:17,20 285:21 286:1,8 290:5 290:13 meetings 7:8 248:6 288:22 meets 204:2 224:15 226:1 282:5 Meier 37:14,16,18,22 Melanie 1:17 288:10 291:3 member 6:14,18,20,22 7:9,10 7:20 8:9,11,23 9:1,2 9:15,18 10:6,8,23,24 11:12,14,23 12:1 16:22 83:22 103:10 103:11 104:5,13,18 104:24 105:4,10,15 108:12,15,17,20,24 109:3 111:8,9 112:11 112:13,15,17,22,24 115:6,7 116:13,20,22 117:1,9,13,20 118:12 118:21 119:3,15,17 119:19,21 120:1 121:6,8 124:17,21,23 125:3,7 126:7,10 127:7,14,17 128:1 130:3,6,11 131:15 148:15,21 149:1,5,8 149:13,16,18 150:6 150:11,18 151:4,7,9 151:15 152:3,8,16,22 153:2,11,13,17,24 154:2,5,8,13,18,23 155:5,8,12,14,17,20 156:1,7,11,14,16,21 156:24 157:10,12 158:24 159:3 160:10 160:13,22 161:7,12 163:9 170:12,16 171:15,19,22 172:2,6 175:7,8 177:11 186:10,13 188:11,18 189:4,9 190:14,21 193:19,21 194:2,4,5 194:11,12 195:4,7,12 195:13,23 196:2 199:10 200:1,4,6 201:2,5,12,14 203:13 204:5,9,14,17,19 205:12,24 206:3,12 206:16,18,22 207:2 211:8 212:16,17,22 213:11 214:14 215:8 215:11,15,19,24 217:6,9 228:13 231:9 231:12,15,18 232:1,4 233:6,8 238:17,19 239:5 242:20,23 243:2,6,9 245:4,6,13 280:13,18 283:6,9,11 283:16,21 284:2,6 285:11,13 286:9 287:6,7,14,20 288:2,5 289:7,9 290:17,19 members 2:3,11 14:19 15:6 16:7 33:12 38:14 55:2 57:6 62:2,16,16 63:3 64:21 65:21 67:10 81:6 82:7 85:19 87:24 91:23 93:24 95:4 104:4 116:12 123:3 124:10 132:6 132:16 148:13 201:12 221:15 229:15 231:1 234:10 246:12 248:19 269:17 282:22 Memorial 8:19 21:17,24 22:2 23:20 27:10 236:12 memory 30:7 219:14 226:17 228:5,17 mental 28:21 35:15 37:6,18 41:22,24 42:2 46:23 47:2 48:8,12,14 49:1 49:5,7 53:2,6 54:6,15 55:10,19 57:17 58:10 58:24 59:1,8,12,15 60:2,18 61:13,15 62:4 62:20 63:5 64:14 175:6,18 177:10,23 178:23 179:10,18 190:23 mention 157:1 mentioned 40:4 132:18 139:13 158:18 163:9 168:6 182:11 183:15,20 220:13 221:6 222:11 225:21 mentioning 155:11 Mercy 244:5 merely 265:15 met 94:11 129:11 184:11 184:18 186:23 196:11 196:11 197:10 202:1 202:2 203:20 281:22 methodology 262:5,6,10 278:21 methods 177:16 metric 224:3 mic 21:11 35:5 170:14 177:12 Michael 2:19 106:11 197:18 290:6,14 Michelle 63:20 Michigan 277:6 microphone PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM 32:9 218:14 middle 34:8 100:15 Mike 13:23 54:2 81:1 102:12 123:6 130:17 132:22 132:24 166:19 176:7 184:8 185:2 193:22 195:15 199:10,22 201:21 203:14,15,17 203:19 204:11 205:13 210:11 211:11 212:5 234:17 245:13 246:3 257:3 270:2 286:10 287:2 288:10 Mike's 185:16 209:2 mile 100:1 miles 17:5,6 36:22 55:1 93:7 137:8 254:10 military 38:13 56:10,13,17 57:20 60:5 million 66:14 72:16 84:13,15 84:18 85:11 104:1 111:17 115:13 121:14 126:17 129:15 141:3 141:5,8,9 175:20 183:5,21,21 184:2,21 185:4,9,10,21 192:21 192:22 196:14 198:10 202:3,24 208:15,18 208:19 209:12,14,24 211:1,17,17 217:22 222:13 223:1 233:20 245:20 millions 101:3 Millstead 13:13 21:14,16 Milwaukee 64:9 mind 81:15 182:24 196:1 Draft Full Meeting Conducted on June 21, 2016 326 223:7 276:13 mind-boggling 267:9 mine 170:5 mini 95:7 minimum 272:4 280:10 minute 97:16 149:4 246:5 minutes 7:17 13:19 15:22 18:2 21:4 23:4 27:3,11 30:5 32:10,13 37:4 39:9 47:1 50:23 53:10 56:2 58:2 63:9 65:15 66:23 69:4 71:14 73:21 74:11 76:7 77:13 78:3,13 80:12 83:10 93:15 95:14 99:8 101:5 127:13 130:7 144:18 146:21 147:13 161:19 161:19,23 162:2,3,6 162:20 163:8 172:20 190:24 255:9,15,18 255:20 274:15 285:9 miracle 32:14 miracles 32:8 Miro 176:22 mispronounce 132:9 misrepresent 257:2 misrepresentation 100:24 missing 44:11 97:22 mission 64:11,18 93:6 236:2 Missouri 137:9 mistake 121:16 MITCHELL 2:17 13:4,23 16:3 25:16 34:18 44:4,13 44:18 53:17 63:15 69:7 80:19 89:17 97:5 101:8 204:21 207:4,9,19,23 290:10 mix 20:17 147:15 258:6 modalities 68:16 model 68:11,11,20 82:9 86:3 93:10 144:22 145:13 146:23 228:24 270:11 models 86:24 276:20 modern 219:7 265:4,8 266:1 272:15 275:10,11 278:4 282:3,3 modernization 275:22 282:8 modernized 247:10 272:21 modern-day 81:17 82:16,17,18 101:2 mom 31:5 moments 49:20 money 49:15 87:5 137:20 185:10,19,24 186:6 194:20,24 198:12 200:2 203:3,6 207:11 240:2 245:12 money's 200:4 monies 107:10,11 monitor 68:17,18 276:11 month 19:24 37:21 47:17 107:23 138:5 monthly 41:8 138:9 months 38:24 52:22 61:17 103:23 118:9 180:4 180:20 222:1,5,24 MORADO 2:16 8:3,18 9:9 10:1,15 124:9 128:3 130:17 131:4 173:23 176:3,5 198:9,16 202:11,19 203:5,8,22 209:20 210:14,18,21 211:3 211:22 214:18,22 244:16 283:7,10 288:9 289:4 morning 14:8 16:6 18:13,19 21:16 23:16,18 26:11 30:15 34:1 35:7 47:6 51:5 54:8 62:1 63:24 65:20 67:9 69:14 76:15 78:18 81:5 85:18 87:23 89:23 91:22 93:23 95:22 97:10 215:20 268:16 mortgage 15:12 mothers 62:24 motion 7:6 8:7,17,21 9:8,13,24 10:4,14,17,21 11:4,7 11:10,20,21 12:7 103:6,7 108:9 109:16 111:4 112:8 113:3 115:3 119:12 120:7 121:3 124:14 125:14 126:4,8 128:2 171:12 173:21 175:4 201:20 215:5 216:5 217:3 231:6 232:16 233:3 235:5 242:17 243:16 244:24 283:3 284:15 285:7,10,18 287:3,12 287:19 289:3,5,18 PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM 290:16 mouth 21:12 move 118:14,17 126:1 154:12 moved 7:9 8:9,23 9:15,16 10:6 10:23 11:12,23 103:10 105:19,20 106:22 111:8 115:6 121:6 126:7 175:7 217:6 233:6 245:4 285:11 287:6,13 289:7 290:17 movement 275:13 moves 73:2 moving 43:18,20 145:15 202:24 223:11 259:5 275:10 much-needed 55:12 84:5 91:18 multioccupancy 274:2 multiple 61:1 87:12 98:19 154:17 186:2 248:5 multispecialty 144:12 150:13 165:5 165:19 multiyear 65:11 Mundelein 58:15 61:11 64:4 65:23 66:4,8,13,20,24 67:5 217:21 229:10 Mundelein's 66:2 Murphy 44:8 47:6,7 Murphysboro 22:2 23:20 27:11 N N Draft Full Meeting Conducted on June 21, 2016 327 2:1 3:1,1 4:1,1,1,1 5:1,1,1,1 6:1 name 14:9 16:10 18:19 21:16 23:18 26:11 30:15 32:16 34:1 35:7 37:9 37:13 39:14 47:6 48:23 51:6 54:3 56:8 58:8 60:14 62:2 65:22 67:14 69:14 74:4 76:15 78:19 81:9 83:15 85:23 88:3 90:3 92:3 94:4 95:4,22 97:10 99:12 109:20 122:11 132:9 132:16 176:13 218:16 220:13 234:11 246:13 named 247:7 names 116:1 132:2 217:16 233:14 244:23 NAMI 54:6 62:3,10,15 Nancy 34:20 37:9,10,13,14 39:10 53:20 54:3 narrative 56:19 nation 56:11 national 46:20,22 54:5 62:4 74:22,23 135:19 193:4 nationally 37:6 40:19 nature 178:3 209:8 222:18 Navy 42:6 nearby 29:2 178:19 nearest 23:9 28:24 nearly 54:18 55:1 67:1 83:17 135:14 144:18 271:16 necessarily 118:14 148:18 209:6 necessary 17:12 26:17 49:17 85:8 131:13 need 7:17 21:2,6 28:3 30:9 30:22,22 32:6 34:11 35:21 36:10 37:11 40:11,20,24 42:3 43:15,21 45:8,12,18 45:20 46:16 47:21,22 48:11,11,18,18 50:5 53:3 55:7 58:11 61:20 63:6,7,11 67:3 68:6,18 73:7,19 75:12 80:11 85:3 92:11,17 92:23 94:14 95:17,19 96:12 100:14 117:11 117:12 118:2,6,10 138:6 139:14 141:21 142:1,7 144:23 147:1 154:5 157:13 159:5 176:14 177:18 179:5 182:7 186:18 188:18 188:22,24 189:18 190:1,8,11 192:2,9,15 192:16,17 193:3,23 198:23 199:5 200:16 201:8,16 202:6 203:23 205:17 206:5 206:9 207:1 212:21 214:4,5 215:20,21 222:7 223:4 229:2 233:7 235:17 238:21 241:20 243:6,12 247:14,17 248:22 263:2,8 264:20,21 265:6,7,9 268:17 278:20 279:3,17 286:12 needed 32:11 35:15 62:19 71:10 92:19 95:20 116:18 131:2 148:7 158:20 160:7 161:1 181:18 191:3 208:4 227:24 needing 46:22 55:13 needs 19:4 35:21,23 53:1 56:13 61:5 64:14 80:5 82:2 83:2 93:11 94:11 138:2 169:16 177:20 180:1 189:20 194:7 201:22 208:10 219:21 227:21 228:8 228:18 230:13,13 235:14 needy 40:12 negative 25:9 26:19 66:10 77:12 96:17 109:15 123:9 123:13,22 141:19,20 173:20 196:19 206:5 210:2,22 211:14 232:15 248:12 249:6 249:7 253:7,8,17 261:1,4,7,11 284:11 negatively 99:17 negatives 249:17 neighborhood 225:1 228:15 neighbors 220:7 neither 268:23 291:12 Nelson 286:22 Nelson's 286:21 net 21:1 141:2 147:21 148:7 178:9 241:20 neurological 228:20 never 24:19 119:2 128:9 139:11 184:19,22 PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM 196:19 225:10 236:19 258:19,23 265:20,24 new 5:3 16:20 24:22 27:16 27:19 30:3 45:15 64:5 65:6,13 66:18 73:3,19,23 81:23 84:20 86:24 88:12 90:24 118:19 135:16 145:4,6 177:16 180:20 182:12,23 193:10 196:4 199:2 207:11 227:15,16,20 230:18 235:16 236:12 236:14 237:3,6,9,11 237:13 255:13 257:22 261:11 266:1 268:24 269:1 272:15 277:14 277:15 278:3 newest 74:16 newly 70:3 180:15 news 179:14 newspapers 178:21 nice 245:10 269:4 night 31:14 43:6 Niles 61:12 94:15 nine 26:22 32:5 81:13 109:12 222:24 263:19 264:15 nominal 15:19 275:6 nondenominational 236:1 noninstitutional 273:21 nonsurgical 133:22 140:4,7,11 142:5 168:4 nonurban Draft Full Meeting Conducted on June 21, 2016 328 145:6 normal 93:12 209:7 normally 151:5 north 32:6 49:4 50:24 54:4,5 61:11 64:9 181:6 Northbrook 3:16 4:15 25:24 28:12 28:17 30:17,18,21 32:7 34:19 35:10 37:17,20 38:1 44:5 45:2 47:17,18,23 48:9 50:16 53:18 54:7,10 55:11 56:4,11 58:5,17 58:19 59:21 60:1,8 61:8,21 62:17 175:2,5 175:18 179:22 183:8 193:11 northern 46:4 55:6 56:5 181:8 northwest 62:4,8,10,15 143:11 notarial 291:17 Notary 291:5,23 note 47:10 126:22 140:12 189:14 192:6 224:16 225:12 236:10 255:10 259:12 260:7,22 272:16 noted 66:17 96:20 133:9 134:14 138:17 139:5 143:15 146:15 193:7 264:3,6 273:13 278:15 notes 224:12 225:16 254:8 256:9 noteworthy 273:8 notice 17:20 49:13 272:23 not-for-profit 236:1 not-for-profits 187:20,21 November 16:14 96:4 191:19 230:5 novo 182:11 no-outs 221:11 number 14:15 15:5 27:20 30:23 39:1,4 42:12 46:21 47:14 52:13 73:18 79:24 81:18 95:2 97:21 117:2,14 150:15,17 158:10 163:18 168:11 181:8 184:13 185:18 186:4 193:11,13 198:10 200:8,9 241:19 266:23 271:16 288:17 numbered 250:1 numbers 52:8,9 78:6 99:2 100:20 105:1 117:4 150:3,5 152:22,24 153:3,4,7 184:5 240:19 numerous 36:14 58:23 240:8 nurse 24:1 60:15 74:21 88:6 88:10 nurses 88:16 95:11 nursing 4:5 17:3,10,19 43:11 60:22 64:12 65:9 66:19 68:4 72:1 73:4 73:8,9,23 75:1 78:21 81:10 82:9,24 86:4,6 86:15,19 87:8 88:8,9 88:11 89:6 90:4,5 91:4 96:7 99:20,22 111:2,6,14,16 138:16 217:20 219:7,11 220:6 223:17,18 224:8,22 225:7 226:16 228:4 229:13 233:18 241:5,6,12 247:9,16,17 268:18 275:9,20 281:12 282:3 O O 3:1 4:1,1 5:1,1 6:1 Oak 29:4 Oaks 10:2 71:20 72:10,16 73:12 76:18 oath 131:7,8 187:10 195:1 203:9 objections 262:13 objective 34:10 262:11,17 266:9 objectivity 262:14 obligation 135:9 265:23 obligations 65:9 141:13 223:23 observation 179:8 obtain 28:18 105:23 obtained 221:4 obvious 72:20 221:14 obviously 59:16 ob-gyn 150:13 occasions 184:19 240:9 occupancy 27:8,12 70:24 100:7 190:15,18 200:16,16 PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM 201:16 213:1,19 259:24 260:16,17 264:19 265:16,17 266:4 278:23 281:6 occupational 86:1 occur 48:6 137:11 140:5 181:16 occurred 50:8 occurrence 55:5 occurring 72:2 offer 19:19,23 39:18 52:2,15 52:24 60:3 69:23 81:19 136:2 137:16 138:12 139:13 148:3 163:19 178:1 194:9 198:3 203:2 219:13 226:18 228:10 271:4 271:6,16 offered 163:14 offering 163:12 offerings 228:6 offers 38:12 82:1,14 office 4:12 27:4 28:2 97:11 116:10 121:2,4,5,13 123:18 132:13 134:17 137:20 140:5,7 144:23 145:14 152:13 152:21 158:1,2,3,6,13 158:16,22 168:10 218:13 officer 98:13 122:12 176:21 234:20 291:6 offices 134:16 office-based Draft Full Meeting Conducted on June 21, 2016 329 24:15 25:8 134:4 OFFICIO 2:11 off-the-record 151:21 198:1 203:12 290:12 oftentimes 40:5,7 oh 58:13 104:22 116:21 127:17 128:11 131:19 149:14 201:4 241:9 244:6 283:11 285:21 okay 7:23 11:8 44:17 94:21 101:14 105:15 118:12 119:4 124:1,7 131:15 132:3 150:11 151:4,9 154:2,13,18 156:24 161:12 162:7 166:12 167:4 169:10 173:2 177:14 189:4 196:4 200:6 207:2,9 211:12 212:8 214:14 217:1 231:16 232:8 242:8 244:15,18 269:14 286:14 288:6 290:5 old 4:21 29:11 182:13 219:20 235:18 257:20 272:18 285:3 older 77:23 78:5 136:10 oldest 64:9 old-style 275:9 Olson 2:4 6:2,11,24 7:3,11,14 7:16,23 8:7,10,12,15 8:17,21,24 9:3,6,8,13 9:16,19,22,24 10:4,7 10:9,12,14,21 11:1,4 11:7,13,15,18,20,24 12:2,5,7 13:1,17 14:5 15:23 16:2 18:4,11,14 21:5,10 23:14 25:14 26:4 28:8 30:9,13 32:14 33:23 34:16 35:3 37:7,11 39:13 41:2 42:18 44:2,11,14 44:17,19 47:4 48:21 51:3 53:15 56:7 58:6 58:11 60:12 61:23 63:13 65:18 67:7 69:5,12 71:17 73:24 74:3 76:12,14 78:16 80:16,18 83:13 85:16 87:22 89:15,22 91:20 93:17,21 94:1 95:17 95:21 97:3 99:10 101:7,10,14 102:1,12 103:1,12,17 104:3 105:18 106:6,14,18 106:21,24 107:13,24 108:4,6 109:6,16 110:1 111:1,10,24 112:3,5,19 113:3 114:1 115:1,8,18 116:2,11,14,21,24 119:6,9 120:3,7 121:1 121:7,9,19,24 122:3,9 123:2,5 124:1,3,7 125:10,14 126:1,8,11 127:3,16,18,22 128:8 128:13,17 129:3,13 130:2,5 131:16,19 148:12 149:10,15 159:2 161:13,24 162:7,11,17,24 163:7 163:21,23 164:2,22 165:8,19,23 166:3,6,9 166:12,16,19 167:8 168:16 169:6,12 170:3,10 171:6,9 172:13 173:21 174:5 175:1,9,14 176:7 177:1,13 184:8 186:8 188:10 191:5,11,16 191:22 193:20 199:8 201:11,13,18 203:10 203:15 204:3,8,15,23 205:10 211:4,7,12 212:8,12,15,19 213:12,16 214:15,24 215:2,22 216:2,5,9 217:1,7,10,17 218:5 230:24 231:3 232:11 232:16 233:1,7,9,15 234:5,8 238:18 239:8 240:16,18,23 241:9 241:13,23 242:8,11 242:14 243:12,16 244:1,17,24 245:5,7 245:11,15 246:3,9 269:10,14,18 282:21 282:24 284:10,15,19 285:1,12,14,16,18 286:10,14,16,22 287:1,8,15,17,19 288:1,4,6 289:2,5,8 289:10,13,16,18 290:3,5,13,18,20,22 once 29:22 36:19 84:22 86:18 117:11 150:21 162:14 208:8 236:16 256:6 ones 63:3 123:9 261:18 271:12 one-half 268:6,7 one-quarter 280:22 one-story 237:16 one-teens 180:22 one-third 254:8 ongoing 60:23 68:19 88:19 227:3 on-site 74:13 on-staff 273:9 open 1:4 7:8,21 24:19 59:23 75:22,22 99:16 106:9 PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM 112:2 182:2 269:11 opened 16:24 17:24 61:15 90:7 91:7 138:10 180:15 180:21 opening 41:24 59:21 177:6 189:19 operat 31:17 operate 24:24 48:10 65:5 178:5 180:16 228:11 230:6 245:18 operated 64:7,10 91:7 operating 26:24 27:6,7,7 67:24 78:11 144:16 180:13 184:16 191:20 223:22 227:7 operation 65:1 73:3 133:20 179:21 180:24 operational 84:13,22 117:8 operationally 197:24 operations 57:8 84:19 90:8 116:8 197:11 224:23 operator 88:13 opinion 77:4 89:5 91:11 202:4 229:23 opponents 82:19 254:19,23 255:7 255:23 256:6,18 258:5,8 267:8,10,15 267:23 270:21 274:21 277:22 278:22 opportunities 226:4 opportunity 16:8 43:23 67:11 81:7 85:20 87:17 88:1 Draft Full Meeting Conducted on June 21, 2016 330 89:24 91:24 101:11 132:19 148:16 173:24 197:2 218:19 220:4 230:21 247:21 oppose 75:20 97:13 opposed 7:14 8:15 9:6,22 10:12 11:5,18 12:5 129:14 153:6 199:6 204:11 237:18 285:16 287:17 289:16 opposing 271:2,17 273:6 opposition 18:24 21:19 23:21 26:14 69:17,19 71:21 74:5 95:24 99:13 115:15 116:3 120:5 121:22 122:24 123:8 125:11 126:21 145:17 145:18 158:18 175:23 192:12 199:3 202:7 218:1 229:4 233:22 265:19 270:23 275:1 278:8 optimal 49:22 59:19 89:3 192:5 227:11 option 55:12 137:6 222:8,9 options 45:23 64:22 253:6 order 3:3 6:3 7:4 8:4,8,19,22 9:9,14 10:5 11:8 13:1 13:6 19:5 61:19 64:18 71:9 74:18 75:10 81:3 92:15 96:8 140:9 145:12 167:18 169:2 185:22 185:23 orders 3:7,8 10:1 ordinance 221:23 ordinary 81:22 252:2,4 253:15 268:3 organization 50:19 178:6 182:10,10 235:21 236:1 organizations 163:11 organization's 223:21 origin 77:2,6 242:5 original 103:24 105:6 originally 104:10 106:11 111:14 195:16 Ouch 245:15 outcome 55:22 291:14 outcomes 74:19 137:11 outdoor 237:23 outpatient 28:19 36:24 37:21 45:5 49:8 142:23 143:6 outreach 57:9 outright 222:8 outside 15:3 19:14 83:1 171:3 241:10 274:12 out-of-pocket 137:3 overall 37:2 45:18 91:13 111:6 190:8,11 220:1 223:15 overdue 229:24 overlook 96:19 overwhelming 66:9 75:15 198:24 229:5 Parkhurst 122:13 125:17 part 23:11 52:22 65:11 80:3 122:19 128:20 135:6 143:18 180:11 225:9 225:14 227:22 272:20 289:1 partial 68:20 partially P 106:7 P participate 2:1,1 6:1 29:7 packets participating 278:6 65:13 72:3,10 248:5 page participation 3:2 4:2 5:2 117:17 3:12 13:2 126:23 275:2 121:16 123:7 190:22 particular 213:21,23 214:10 39:23 45:22 60:10 233:24 241:3 250:4,7 81:21 164:17 223:11 251:10 263:14 267:5 225:20 270:6 272:1,2,16,22 particularly 272:22 278:15 280:20 178:4 220:5 225:7 pages parties 1:16 270:6,14 291:13 paid partner 98:4 107:10,11 153:20 220:9 155:22 222:16 264:24 partners 286:5 218:12 palliative partnership 67:16 86:15 paper pass 35:19 21:11 172:6,10 173:20 par passed 68:7 135:1 288:9 paragraph passes 249:24 8:17 9:8,24 10:14 11:4 parent 11:7,20 12:7 109:16 42:24 199:22 113:3 120:7 125:14 parents 216:5 232:16 243:16 31:20 82:7,11 284:15 285:18 287:19 parent's 289:18 186:19 passion park 51:18 230:11 3:20 8:5 16:24 41:18 pastor 61:9 103:4,8,20 30:16 32:9 122:12 214:12 251:1 overwhelmingly 224:3 owner 88:12 owners 16:18 ownership 15:11 230:6 o'clock 101:15,16 290:7 PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM Draft Full Meeting Conducted on June 21, 2016 331 pathology 138:15,21 143:18 144:7 154:3,6,11,11 154:12,15 155:3,4 156:6,6,10 pathology's 156:8 patience 248:4 patient 23:2,9 32:17 34:2,10 34:11 39:4 43:7 49:22 50:17 54:17,23 55:23 77:6 79:15,19 79:24,24 80:1,2,4,5,7 80:8,10,11,13 82:18 86:12 87:16 88:18,19 89:3 94:24 98:18 137:1 138:8,23 140:5 140:6 144:4 146:3,11 147:12,17 151:1 152:12,14 155:21 158:23 160:1,10 161:20,22 162:4,14 162:16,22 163:3 169:19 178:11 180:9 242:5 258:1,13,20 268:21 272:12 273:17 273:17,18,18 276:11 278:10 280:10 281:14 patients 15:2 17:14 19:5,13,18 19:24 20:3,4,8,23 21:2 22:9,11,15,16 23:10 24:14,15 30:8 33:5 35:14,16,21,21 36:8,10,10,17 38:7 39:18 43:12 47:15,16 47:20 48:2,3,4,11,11 48:16 49:18 50:1,8,20 50:22 51:21 52:3,5,17 52:18 53:2 54:14 55:13 59:11 60:23 61:2 67:18 70:23,24 72:7,18,19,22 73:10 74:16 77:7,23 79:14 79:23 82:4,12,21 86:11 87:9,16,20 88:15 89:10 90:20 91:3 92:12,16,24 93:3 93:11 98:2 100:5,6,19 100:20,21 118:10 133:2,14,24 135:5,9 136:2 137:5,6,15,18 137:19,23 138:3,10 138:12,19 139:1,9,18 142:17 143:24 145:2 146:6 148:3,6,8 150:9 151:11,17,19 152:6 153:4,20 158:19 159:19,24 160:9 162:1 164:20 168:7 170:23 172:20 177:18 177:19,22 178:23 179:1 191:14 193:8 229:16 256:12,15,23 256:23,24 257:14,17 267:24 268:7,8,17,21 269:3,5 271:9,10 273:20 274:4,17 275:11 276:18 277:1 277:23 281:10,11 patient's 19:14 36:19 139:16 140:2 162:15,21 271:21 patient-by-zip 77:1 patient-centered 88:14 177:9 patterned 18:7 patterns 178:2 Pavilion 50:13 pay 19:19 20:5,24 21:1 98:6 136:18 138:12 138:13 139:1,10 151:16,20 152:19 153:4,22,23 154:3 155:3 178:12 225:18 245:10 payer 20:17 70:22 147:15 258:6 payers 142:17 143:2 paying 140:16 156:18 payment 72:4 155:8 payments 15:19 87:1 238:7 pays 154:16,24 155:1,2 156:4 262:13 PCP 168:8 peace 276:13 peculiar 258:4 Pekin 121:13 penalize 261:2 penalized 19:6,15 146:5 pending 54:16 96:11 117:3,14 117:18 people 14:20 30:24 32:4,5 33:3,15 38:24 39:6 42:13 49:14 50:19 56:16 62:24 66:4,22 67:1 74:24 78:5 79:7 83:1,5,7 86:16 91:19 92:15,20 98:14,15 100:8,9 115:19 118:4 159:14 164:7 178:24 179:14 182:7 192:21 192:22 193:4,6,14,15 193:17 194:16 196:17 197:4,9,14 204:3 228:19,22 229:21 234:14 238:15 241:22 254:5,12 274:4 286:7 percent PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM 20:7,10,13,13 27:6,12 40:17 46:23,24 52:13 70:21,24 73:13,15,17 75:12 78:4 82:14 97:20 98:15,23 99:2 100:4,7 107:24 108:1 108:2 111:19 118:23 134:7,9 135:14 136:18 137:2 139:7 141:4 147:18,23 149:21,22,24 150:7,8 152:17 153:3,6 156:22 167:13,19 168:14,24 169:17 170:2,22 173:4 182:16 191:7,21 222:19 224:6,10,11 237:17 238:6,7 241:14,15 242:6 249:14 254:11 256:23 257:5,10,18,18 258:8 258:15,17 264:4,8,9 264:19 271:5 278:17 278:19 280:11 percentage 134:10 147:21 207:17 223:18 perform 22:4 25:4 139:22 144:12,19 145:13 146:21 169:24 performance 260:20 performed 27:15,21,24 28:1 127:11 134:16 143:1 143:5 146:17 161:5,9 167:11,22 168:1 235:13 performers 260:15 performing 248:8 performs 144:15 period 22:11 39:5 91:10 130:8 Draft Full Meeting Conducted on June 21, 2016 332 222:10 periodic 139:17 periodically 140:1 perioperative 23:19 permission 286:19 permit 3:19 10:3,19 27:14 96:9 102:7,7,8,8,9,9 103:3,7,9,21 128:21 131:13 145:11 147:8 198:7 218:2 permits 4:9 114:5 permitted 133:21 142:11 145:24 278:3 permit-ready 222:4 persistent 55:24 person 29:10 34:9 59:7 266:23 personal 43:3 57:2 95:5 personalized 88:19 personally 19:9 42:23 43:21 90:7 201:8 220:2 279:5 personnel 288:15 perspective 17:9 224:24 276:17 280:3 persuasion 250:24 petition 66:17 Petrovic 176:23 phase 230:5 phenomenon 90:22 Phil 13:11 Philip 18:19 phone 29:22 34:6 phrase 252:5,6,8 physical 38:18 64:14 70:9 91:13 139:21 176:24 270:10 271:24 280:2 physician 22:13 67:14 78:20 79:1 79:13 132:7 135:7 139:17,18 140:3 143:18 144:5,21,24 145:7 150:23 152:13 152:21 157:2,3,4,7 167:20 168:2,11,12 197:12 273:11 physicians 17:8 19:6,7,10,13,15 22:4 27:1 29:6 47:12 52:4 134:2,15 144:15 146:1,2,4,5 178:16 physician's 19:12 138:20 piggyback 131:5 Pines 76:17 77:8 97:12 98:14 98:21 270:22 271:3 pioneering 172:3 place 49:14 50:11 61:20 64:17 75:15 94:17 107:18 123:23 127:4 127:16,17 128:2,5 129:2 130:20 202:11 264:1 placed 204:22 225:10 placement 40:6 places 75:16 241:20 placing 36:12 plain 252:2,4,9,15,17 253:15 256:4 Plaines 28:23 plan 30:3 66:7 68:19 69:22 238:8 265:3 279:6 planned 85:9 Planners 83:23 planning 26:12 83:19 96:12 118:7,8 188:19 189:5 189:17,24 190:3,10 190:15 191:1,1 192:8 192:19,20 193:10,12 200:12,14,21,23 201:9 205:21,21 206:4 213:7,7,23,24 240:24 247:15 250:3 250:6,15,16 252:21 253:4 254:15,24 255:2 256:10 262:1 262:20,22,24 263:18 265:2,5,6 266:16,24 267:4 274:20 275:17 278:20 279:5,17,19 279:22 280:5,23 281:12,19 282:4,6,8 planning-area 188:15 plans 107:18 153:9 plant 70:9 91:13 270:11 271:24 280:2 platform 225:13 playing 71:13 please PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM 6:4 7:18 10:7 11:24 13:7,15,21,23 18:12 21:5 25:16 26:3,6,8 34:22,24 35:3 44:3,9 44:19 53:23 54:1 62:18 63:17,20,22 69:9 73:24 76:8,11,12 79:6 80:21,24 81:1 89:19 93:17 101:7,16 103:14 109:20 115:22 115:24 116:19 119:10 121:7 122:6 124:10 126:12 131:17,23 132:1 148:22 170:15 175:9,15 195:6 217:8 217:13,15 233:11,13 244:20,22 245:5 260:22 269:14 270:5 272:22 283:7 285:5 285:12 286:2 pleased 176:14 246:17 pleasure 81:11 235:7 plenty 281:19 plus 143:17 208:2,18 226:14 227:20 239:23 249:16 251:12 252:8 point 43:22 95:15 98:24 105:19 118:6 130:23 133:6 164:24 165:3 165:24 170:3 180:5 183:7 185:15 189:12 192:6 197:3,20 199:1 199:13 210:7 221:5 223:11 234:1 240:5 242:2 250:13 254:7 254:18 255:24 263:21 267:22 Pointe 3:20 103:4,8,20 pointing 128:23 points Draft Full Meeting Conducted on June 21, 2016 333 140:9 253:22 police 178:14 policies 250:12 254:1 256:10 policy 83:20 135:2 182:5 256:22 258:3 275:12 polite 248:7 political 133:2 polyps 154:10 poor 30:1 33:1 180:2 277:9 poorest 33:2 populated 57:14 population 20:16 33:10 39:24,24 40:9,12,13,14,20 45:16 49:3 53:1 71:5 71:6 99:7 139:8 149:24 163:17 192:18 192:24 206:9,13,14 212:20 230:14 253:24 254:10,11,14,16,17 255:2,4,20 259:1 264:1,2,7,8,9,12 266:16 278:14 279:22 281:17 populations 40:2 86:12 250:10 254:4 portion 123:17 255:19 279:7 portions 254:2 position 106:4 146:2 187:5 194:2 positive 17:13 90:15 94:20 120:4 125:11 249:10 249:14 253:12 259:4 261:8,20,22 266:12 282:12 positively 276:18 positives 249:12 possible 74:20 82:4 93:13 192:17 220:23 possibly 239:20 240:6 postacute 14:12 15:3 247:10 postponed 205:7 posttraumatic 38:14 potential 59:21 73:1 134:12 141:9 226:3 potentially 136:11 146:2 poverty 139:8 149:24 power 146:12 powers 89:19 91:22 92:3 250:24 practical 179:8 205:2 practice 17:8 22:22 24:15 39:15 42:20 47:7,9 58:14,16 58:22 60:15,19 78:24 88:23 133:14,21 138:10 139:12 140:13 141:14 142:3,9,12 144:21 145:9,21 147:3,11 150:1,20 152:13,21 158:9 164:6 171:4 173:7 178:7 209:7 practices 91:3 134:4 practicing 35:8 51:7 78:20,20 135:7 158:2 practitioners 178:16 preapproval 164:14 precedent 200:22 Preceding 45:18 predicted 73:7 predictions 73:16 predominantly 136:23 139:6 prep 219:3 prepared 203:2 preparing 218:19 220:16 Prescription 277:4 Presence 143:12 present 2:3,11,15 23:21 27:17 40:23 93:1 132:12 218:15 246:23 247:2 presentation 164:11 168:21 244:8 presented 36:2 66:7 97:17 150:4 153:3 214:7 219:9 229:7 281:23 presenting 26:13 76:11 95:23 Presently 93:7 preserve 64:18 president 14:13 16:12 18:20 37:14 62:3 176:16,19 176:24 234:11,18,21 246:20 press PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM 208:21 preteens 31:2 pretty 118:24 178:13 282:24 prevalence 37:5 prevent 87:17 prevention 135:24 previous 153:4 previously 28:15 38:3 60:16 133:9 139:5 146:15 148:2 179:15 184:4 199:16 222:11 225:21 226:10 228:23 273:23 price 156:16 priced 170:20 primarily 86:9 97:14 primary 70:22 91:1 93:6 139:16 139:18 140:2 145:22 251:23 272:7,17 principal 220:14 225:18 287:24 principals 218:17 principle 252:11 principles 251:18 print 116:1 132:2 217:16 233:14 244:23 prior 24:18 63:22 143:4,6 222:12 239:19 257:14 prisons 41:23 42:3 46:13 privacy 86:18 271:22 273:19 Draft Full Meeting Conducted on June 21, 2016 334 private 45:17 65:2 70:3,4,5 72:15,17 78:24 82:14 95:6 98:6 105:8,8,24 106:2 107:3 140:15 237:18 270:15,16,16 270:17,19,21,23 271:1,4,6,7,7,11,13 271:16,18,19 272:13 275:22 280:3,4,5 282:9 privately 209:1 private-pay 73:9,13 privatization 227:6 privilege 32:22 88:6 privileged 88:13 privileges 22:14 24:2 proactive 143:9 probably 51:10 52:18 53:5,9 100:1 134:2 178:17 208:21 230:3 286:5 problem 55:18 129:19 149:18 186:7,8,10 188:16 219:1 288:3 problems 43:1,2 59:13 80:5 97:21 127:10 procedure 24:12,24 27:5,13,22 44:16 137:8 143:7 144:2 153:21 154:12 159:12,17 161:1,10 172:21 procedures 21:7 22:4 26:23 27:15 27:22,24 127:11 133:22 134:1,7,8,10 134:16 137:10 142:24 143:5 144:13,14,16 144:19 145:14 146:16 146:21,24 161:5,8 164:13,17 167:12,16 167:21,23 168:1,13 169:1,24 173:3,5,5 proceed 14:6 290:8 proceeding 248:24 proceedings 7:21,21 291:7,9,9 process 65:4 122:17 164:14 199:15 219:22 221:5 221:10 226:24 230:3 248:6 262:22,24 264:11 265:5,6 procure 223:9 produced 269:21 products 81:21 profess 69:22 professional 48:8 58:9 68:23 88:4 89:5 134:18 138:14 248:8 262:13,18 265:1 266:10 professionals 22:24 49:11 64:21 93:9 Professor 277:6 profile 256:14 257:4,7 286:19 profiles 5:9 27:9 257:15,21,24 258:19 286:11 287:4 profits 107:11 program 20:7,18 38:16,18 53:6 72:2,4,4 87:15 133:23 137:19 138:12,24 139:1,14,15 151:22 153:15 154:19 155:15 168:7 172:8 228:4,6 programming 40:21 programs 19:20,20 36:24 37:1 38:12 41:4,12 42:14 46:9,19 56:22 72:15 74:14 88:23 137:17 143:23 144:1,3 151:23 178:10 progress 29:17 68:18 118:5 Progressive 122:13 project 8:20 13:13,15,15 14:10 14:18 15:7,9,10,15,17 15:21 16:17,19,20 18:7,15,18 19:1,3 21:15,20,22 22:17 23:17 24:4 25:11,19 25:20,22 26:1,9,15 28:13 30:19 33:6,21 34:14,19 35:10 39:5 39:19 41:1 44:5 50:17 53:18 56:4 63:16,19 64:3 65:11 66:3,11,14,15 67:22 67:23 69:1,2,8 71:22 71:23 76:21 80:21 81:12,15,16 82:20 84:2,8,12,16,20 85:14 87:7 88:13 89:13,18 90:9 91:8 92:11 95:24 96:6,9,14,15,22 96:24 97:1,7,13 99:5 99:13 103:4,8,22,24 106:4,11 107:9,12 111:2,5,7,14 115:1,3 115:4,13 121:2,4,14 122:23 123:17 126:2 126:4 128:24 131:3 132:8,12,23 133:4,8 133:10,12,15,16,17 135:6 141:22 142:4 147:1,24 175:2,5,19 PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM 176:14,21 181:1 183:3 185:11,12 186:14,20 187:6,13 187:17 189:23 192:12 192:19 193:16 196:5 196:6 197:23 198:6 198:12 199:2,18 202:6,8 204:24 210:1 217:2,4,22 218:3 219:12,13 220:9 221:21,24 222:13,18 222:20 223:13 224:2 224:17,20 225:3,19 226:1,9,10 227:14 228:10 229:4,6 230:1 230:6 233:2,3,20 235:10 238:24 239:23 244:4 245:1,20,23,24 246:15 247:2,9,18 248:2,14 254:20 255:1,4,12,15,17 259:23 260:1,4 261:12,16 262:2 263:24 265:8 266:14 267:2 269:9,19 270:12 272:3 273:4,8 273:14 274:10,13,23 276:3,6,9,21 277:17 278:6,23,24 279:8,8,9 280:1 281:18,21 282:2,11,11,17,19 projected 27:20 47:12 84:14 207:8 208:2 213:22 263:2 264:1 projection 264:23,24 265:1 projections 84:10 85:3 262:3,6,19 262:21,22 263:5,10 263:12,21 265:20,23 266:3,7 278:13 279:2 279:4,6 280:8 281:4 projects 20:10 85:4 86:19 87:2 90:11 117:7,18,21,22 123:8,19 135:15 Draft Full Meeting Conducted on June 21, 2016 335 185:16 188:4 194:14 194:18 196:18 219:9 228:23 promote 86:20 261:13 265:3 273:16 276:12 prompt 55:21 promulgated 251:16 256:7 properly 197:12 properties 90:19 182:15 property 15:14 36:4 72:24 140:17 246:20 proposal 66:9 219:18 proposals 219:17 propose 190:1 proposed 15:15 20:11,17 25:10 26:16 27:4,12 54:9 66:24 71:11 74:12 77:13 96:6 100:2 127:13 134:21 140:13 142:8 143:20,22 147:5,16 148:6 172:9 175:19 189:15 205:6 219:13 224:17 227:9 227:14 228:1 254:19 255:8,21 261:16 264:22 274:10,13 275:4 281:18 proposes 75:5 proposing 115:11 121:12 126:14 159:12,13 175:17 217:20 233:18 235:10 245:18 277:17 Prospect 61:8 protection 186:6 protocols 88:23 proud 230:8 proven 87:7 provide 14:2 17:9 19:21 20:15 20:23 26:21 33:8 36:11 37:20 40:8 48:10 49:16 50:20 55:12 59:18 60:20 65:7 68:8 77:1,14 84:24 86:9 87:3 88:6 91:16 92:11 133:5,19 134:24 137:18,22 138:7 141:17 142:6 143:23 144:3,10 147:24 156:13 174:1 180:9 181:18 183:10 195:23 198:14 199:14 202:12,20,23 204:1 205:22 207:12 209:18 210:9,13 211:24 212:4 213:9,24 220:5 221:16,18,19 222:9 222:22 226:15 227:16 247:9,12 265:8 268:3 270:8 271:21 276:7,9 277:18 282:11 288:14 provided 21:21 37:18 49:1 69:24 70:14 77:10,18 86:24 88:22 123:23 137:15 138:4 141:11 164:17 184:4,7,19,20 199:16 199:20 207:22 208:9 214:4 226:15 236:5 244:8 247:22 253:9 269:24 270:1 278:5 279:14 282:4 provider 148:7 268:2 270:18 276:8 providers 14:24 21:2 22:19 25:7 41:7 42:4 45:6,17 90:16 92:16 96:18 98:3 142:2,22 144:20 248:15 270:13 271:6 272:6,14 274:18 275:21 278:7 280:19 281:6,20 provides 20:1 64:12 84:4 85:7 141:14 240:9 261:8 270:18 272:10 276:4 providing 26:22 39:17 47:20 56:5 61:19 77:6 88:18 142:16 177:17 226:22 227:3 230:17 236:2 269:4 provision 142:13 276:1 prudent 223:5 PSA 81:19 83:1 272:7 274:7 psych 40:19 42:14 45:19 51:24 52:6,23 179:3 psychiatric 28:19 29:11,24 35:18 35:20 36:16 38:8 39:17,22 40:1,8 41:11 41:13,16,18,19 42:8 43:1 45:4,23 46:6,11 46:22 47:8,22 48:2 49:8 52:13,15 54:9,17 54:20,24 55:7,14,17 59:5 60:15,21,24 61:5 61:17 179:11,23 193:10 psychiatrist 35:8 36:23 42:20 51:7 51:15 273:10 psychologist 39:15 psychosis 50:2 public 1:1 3:12 13:2 66:8 PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM 115:15 121:21 126:20 126:23 128:22 129:16 129:24 131:5 133:18 135:2 149:12 150:10 150:15 175:22 197:5 217:24 233:22 246:19 248:24 274:22 275:2 275:5,9,12 287:22 291:5,23 publicize 275:3 publicly 188:2 pull 37:12 58:12 94:1 punished 261:3 purchased 236:7 purportedly 97:18 purpose 133:15,15 171:4 purposeful 247:11 purposefully 275:15 pursuant 7:7 265:2 pursue 145:12 pursued 223:8 push 168:24 173:5 pushed 48:12 170:24 put 32:9 107:21 131:13 160:21 183:22 201:20 202:10 213:21 putting 93:3 116:16 181:24 208:21 p.m 101:17 174:8 Q Draft Full Meeting Conducted on June 21, 2016 336 qualified 188:8 qualifies 187:7 qualify 20:6 140:14 quality 56:5 67:4 72:5 85:7 91:13 92:20 134:22 182:24 219:7,24 227:5 230:17 276:19 quarterly 209:7 question 104:20 105:18 116:20 116:22 123:5 127:15 130:4 149:19 151:10 152:4 157:14 162:12 164:23 166:20 167:9 170:13,17 185:5 189:22 197:22 222:21 262:15 269:19,21 questionnaire 141:7 147:20 questions 104:4 108:4 112:3 116:6,11 119:6 123:1 123:3 124:5 148:11 148:12,22 159:2 163:21 170:11 171:6 204:8 214:24 231:1 238:16 240:16 242:11 246:24 247:24 269:11 282:22 283:1 285:5 286:2 289:11 quick 74:19 159:24 289:19 quicker 159:24 quickly 82:4 quite 42:12 98:11 179:11 288:24 quo 57:11 quote 258:8,10 267:12 275:20 276:1 R R 2:1 6:1 racing 31:7 radiology 273:12 raise 43:2 106:5 115:21 122:5 131:22 209:12 217:12 233:10 244:19 raised 128:23 183:5,12,20 189:19 194:16 211:17 220:22 253:22 254:18 raising 183:19 Ramos 44:8,15 Ranalli 69:10 76:15,16 78:14 Ranganathan 44:7 51:5,6,6 53:11 range 123:19 ranging 178:14 ranks 57:14,16 rapidly 48:17 281:5 rate 20:8 73:12 98:22 141:3 182:16 192:9 264:5 278:16,18 rated 88:21 rates 20:20 137:13 179:9 192:3 rating 225:23 ratio 133:21 184:17 186:19 192:24 193:3 212:24 224:21,22 225:6,10 225:14,17 266:16,18 266:21 267:3 279:20 279:22 ratios 140:6 186:11 187:2,8 188:9 195:24 196:8 199:21,22 201:17 202:14 203:3 205:18 207:6,12,12 208:1,5,9 210:10,13 211:14,19 212:5,20 213:3 214:16 223:14,17 225:6 267:6 276:9 RDR 1:18 291:4 reach 63:2 137:5 258:9 265:17 281:6 reaching 177:18 reaction 90:15 read 62:9 234:2 readily 56:22 reads 178:21 ready 26:6 105:21 107:16,19 107:20,21 108:3 124:2 162:4,16 163:4 163:5 211:4 221:21 real 21:12 40:10 118:22 197:22 205:2 237:8 267:18 realistic 190:6 realists 45:9 reality 17:2 24:6 66:18 239:18 realize 31:10 43:18 45:9 73:9 131:2 PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM realized 181:5 Realizing 220:19 reallocated 24:19 really 43:20 61:20 80:1 100:13 116:15 118:7 154:8 160:3 164:4 166:23 179:7 200:12 215:21 231:20 239:19 260:9 realtime 273:11 reason 77:10 96:19 123:21 129:13 159:13 199:3 201:24 249:5 268:23 281:2 reasonable 130:11 reasonableness 224:18,20 reasonably 170:19 reasoning 199:15 reasons 14:15 52:18 78:7 91:1 120:1 125:7 173:17 215:24 216:2 232:11 268:19 269:1 282:16 rebuild 118:20 recall 200:24 221:1 230:3 receive 16:20 20:3 29:4 46:6 61:17 128:3 140:19 175:23 177:20 210:14 240:7 249:16 259:4 261:20 received 20:8 31:5 33:9 65:13 66:9 95:10 115:16 129:17 150:21 159:8 Draft Full Meeting Conducted on June 21, 2016 337 176:2 187:3 196:17 218:1 229:4 233:23 245:24 246:8 285:23 receives 55:23 receiving 47:3 49:22 173:23 238:7 278:9 recess 101:17 174:8 recipients 20:14 recognize 57:8 248:3 289:21 recognized 38:3 58:20 60:16 282:5 recognizes 260:22 recognizing 260:8 recommendation 130:13 record 139:7 150:10 165:12 212:10 255:18 287:20 290:23 291:9 recorded 221:23 records 75:4 recoveries 105:22 recovery 82:15 86:21 89:4 93:12 161:21 recreational 64:14 recruit 145:5 recruiting 157:18 recruitment 158:11 redone 70:12 reduce 24:13 160:10 260:13 261:16,17 reduced 19:20 24:19 89:1,2 170:23 291:11 reducing 226:12 reductions 45:13 refer 47:13 61:20 137:24 146:1 157:20 208:7 270:5 272:22 reference 185:17 270:1 referral 10:16 76:21,23 98:22 178:2,13 197:9,13 referrals 3:9 10:18,22 19:9,16 39:4 70:17 73:1 75:7 75:13,14 76:3,24 77:1 97:18,20 98:8,10,16 99:3 142:6 268:4 278:10,13 281:14,16 281:19 referred 19:13 38:23 39:2 98:15 137:16 138:8 148:4 152:18 249:20 268:7 268:8 281:10 referrer 178:18 referring 19:7 146:5 198:9 reflect 183:17 209:21 reflected 182:21 183:22 reflective 39:1 reflects 191:18 reform 229:2 275:17 282:6 reforms 276:4 refusal 98:22 refused 62:21,21 63:1 refute 19:1 regard 75:24 94:20 131:14 132:12 145:17 147:15 194:14 202:13 220:24 255:22 261:5 regarding 70:15 90:11 96:18 132:20 183:12 206:5 206:6,9 209:3,14 220:17 221:3 256:8 258:5 288:17,21 regardless 19:18 20:24 24:20 91:15 135:10 178:11 200:10 regards 75:24 185:5 206:4 region 147:7 179:6 regional 116:8 147:12 regions 181:19,21,23 182:4 registered 88:6 regs 237:7 regular 24:8 53:8 191:17 regulated 134:17,20 regulation 134:18 251:17 252:13 256:2,5 regulations 134:5 251:20 252:12 rehab 72:7,22 77:14 79:23 86:5,11 87:8 89:6 94:12 100:5 103:20 111:14 226:19 228:5 229:13 237:22 273:10 PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM rehabilitate 82:3 87:16 180:5 rehabilitation 3:21 4:5 74:15 81:17 82:16 83:3 91:6 97:12 103:5,9 111:3,6 rehabilitative 229:3 rehospitalization 89:2 reimbursement 86:24 87:1 reintegration 87:14 reinvested 90:19 reiterate 147:2 279:15 rejected 197:13 rejection 197:18 related 31:3 69:19 167:24 225:19 228:19 291:12 relates 76:20 225:11 relating 142:10 relation 201:15,16 relationship 14:23 15:16 32:20 157:15 relatively 30:20 145:3 182:18 254:5 release 208:21 relegated 280:19 relevant 68:13 223:14,18 225:7 reliability 262:14 reliable 262:12,18,23 266:9 Draft Full Meeting Conducted on June 21, 2016 338 relied 256:16 262:16 279:1 relies 71:7 relocation 22:21 219:10 237:8 rely 75:17 268:2 relying 262:17,19 remain 71:10 182:2 260:18 261:9 265:12 remained 24:19 78:5 107:9 remaining 28:1 180:11 remains 30:11 234:7 remarks 30:10 remember 13:23 remind 124:10 removed 29:8 removing 219:23 renal 118:5,23 renewal 3:19 102:7,7,8,8,9,9 103:3,7,9,21,23 renovate 180:8 renovated 70:3 100:7 180:15,21 renovations 70:11 Renée 53:21 60:14 repeat 279:15 repeating 275:2 replace 65:6 replacement 66:19 79:18,21 111:15 111:16 219:18 226:11 228:9 230:19 replacing 219:18 232:5 report 5:4 26:16 27:3 73:7 96:21 103:18 104:19 111:11 112:20 114:4 115:9 117:17 119:22 120:4 121:10 122:20 123:8 124:24 125:4 125:11 126:12 133:9 134:15 136:20 141:16 141:20 159:4,10 171:23 175:15 176:1 183:12 186:17 210:3 213:23 217:18 218:19 220:11,17,22 224:12 224:17 225:16 231:19 233:16 234:3,4 241:3 245:8,16 246:7 248:11 249:11,13,21 250:4,7,19 251:7,10 254:2,7,8 256:9,20 258:5 259:10 263:14 264:3,6 267:5,9,10 271:3 272:24 273:6 275:15 276:5 278:16 280:21 281:8 282:7 285:4,23 reported 1:17 20:13 38:23 70:13 105:3 141:6 191:10 191:12 257:17 258:23 271:1 274:7 reporter 14:3,4 44:22 103:14,16 109:19,23 115:21,24 122:5,8 131:22 132:1 170:14 175:13 217:12 217:15 218:23 233:10 233:13 244:19,22 291:1,4 reporting 220:20 275:6 reports 4:8 70:10 196:22 248:4 278:8 represent 58:16 148:22 149:7 187:11 275:8 representation 256:16 Representative 229:9 represented 70:7 100:22 representing 37:22 98:7 247:1 represents 18:8 273:4 request 14:10 19:14 37:24 71:16 103:3 111:2 150:21,22 186:11 247:16 269:8 282:17 requested 23:3 27:23 161:11 163:16 186:21 188:9 194:1 202:13 213:3,6 274:22 requesting 103:21 106:16 134:11 189:2 200:7 requests 3:19,22 4:3,4 43:12 110:2,3 248:1 require 17:3 59:19 76:23 93:11 134:5 143:3 145:11 145:24 166:9 183:8 199:19 222:16 228:16 228:22 242:3 255:17 266:5 required 15:2 16:21 23:5 91:12 131:3 134:22 139:21 139:24 140:8 141:16 143:7 145:12 187:2 208:22 212:13 221:19 221:20 222:11 272:4 PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM requirement 22:4 128:21 147:8,9,9 147:10 167:5 254:22 255:6,7,14 256:1 requirements 129:9 133:16,18 134:23 142:10 147:4 164:21 196:7,12 204:2 223:7 252:15 252:16 255:22 256:4 256:5,6 requires 75:11 93:6 250:2,14 253:15 254:24 255:11 255:14 259:1 261:22 265:11,16,18 266:6 requiring 55:11 251:11 research 81:21 Reserve 136:17 reside 20:3 254:12 residence 273:22 resident 28:11,17 220:2 276:2,2 residential 45:6 residents 19:21 20:14 29:2 46:2 65:8 68:6,14 70:21 71:12 86:14 136:24 138:2 219:6,22 226:22 227:4,17,19 227:21 228:9,15 229:7,20 230:13 236:6 238:6,8,11 242:6 274:8,14 276:12 277:18 282:12 resident-centered 230:18 resident-centric 247:11 resident-focused 275:24 282:10,14 Draft Full Meeting Conducted on June 21, 2016 339 residing 135:5 148:8 resign 157:16 resignation 22:20 24:18,23,23 resigned 19:11 21:23 24:2,5 resolution 213:5 resolve 50:13 resources 48:18 49:15 50:20 53:11 58:24 59:2 71:2 183:17 187:7 respect 50:17 57:2 70:19 78:6 88:18 95:3 98:21 159:8 190:17 195:9 200:15 203:17 respected 16:6 67:10 81:6 85:19 87:24 91:23 246:12 respectfully 28:5 247:4 251:12 269:8 281:23 282:16 respects 180:2 respond 218:20 247:21 responder 49:19 responding 201:7 response 6:9 7:15 8:16 9:7,23 10:13 11:6,19 12:6 101:13 108:5 112:4 119:8 123:4 124:6 163:22 171:8 187:4 215:1 231:2 240:17 242:13 256:19 258:5 259:9 263:13 267:9 269:22 282:23 285:17 287:18 289:12,17 responses 248:7,12 responsible 144:4 restore 236:23 restricted 187:19 256:17 restrictive 91:2 250:11 254:1 256:9,21 258:2 result 26:18 30:4 46:10 71:15 178:3,24 181:11 182:18 183:3 261:10 272:11 resulted 30:4 41:15 89:1 91:14 179:17 results 183:16 276:22 resumed 7:22 retain 19:5 retired 16:14 42:5 56:8 retirement 28:12 290:1 retiring 237:10 return 82:4 87:9 90:18 93:12 102:1 141:1 returned 17:15 57:5 returning 82:13 revenue 20:11 71:10 147:21 Reverend 26:1 30:15 reversed 96:5 review 1:2 4:10 19:3 24:4 114:6 204:11 207:16 226:1,24 237:5 244:3 275:19 282:17 reviewed 58:20 244:13 286:21 286:22 reviews 94:19 revolves 118:4 Reynolds 234:21,24 235:1 RFP 226:23 230:3 rich 176:15 226:21 Richard 2:9 176:15 right 13:7 45:3 50:15 72:23 105:4 106:15 112:24 115:21 118:13,16 122:2,5 127:24 129:14 131:4,22 132:10 151:15 152:3 153:2 155:5 156:1,1 156:11 157:10 162:3 165:16,22 166:24 167:17 170:10 176:18 176:20 181:22 191:4 191:8,8,11 193:14 194:12 197:8,17 204:14,19 207:6,17 207:18,20,22,23 209:16 210:16 211:2 212:15 217:13 233:11 234:16 236:13 240:1 240:19 241:18 242:1 244:19 252:18 278:12 rightly 252:22 rights 117:3 rise 45:17 risen 195:19 risk 36:8,13 135:13 PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM river 92:8 road 118:8,9 189:15 190:5 ROATE 2:20 6:5,10,12,15,19 6:21,23 7:1 13:20 15:22 18:2 21:4 30:5 32:13 37:4 39:9 47:1 50:23 53:10 56:2 58:2 63:9 65:15 69:4 71:14 73:21 76:7 78:13 80:12 83:10 93:15 95:14 99:8 101:5 108:8,13,16,19 108:22 109:1,4,13 112:7,12,14,16,18,21 112:23 113:1 119:11 119:16,18,20,23 120:2,6 124:13,19,22 125:1,5,8,12 171:11 171:17,20,24 172:4 172:11 173:18 215:4 215:10,13,17 216:1,3 231:5,11,14,16,23 232:2,9,13 242:16,21 242:24 243:4,7,10,14 283:3,14,19,24 284:4 284:8,13 Robert 229:8 robust 228:6 Rockford 60:19 115:12 116:8 role 15:7 221:8 247:13 roll 3:4 6:4 108:7 112:6 116:19 119:10 124:8 162:20 171:10 205:10 215:2 231:4 242:15 283:2 rolled 162:21 room 7:18 22:5 23:9 27:5 Draft Full Meeting Conducted on June 21, 2016 340 31:15,16,17,19,24 36:2,4 40:7 42:24 54:12,16 59:6,11,14 63:8 70:4 95:8,9,9 141:21 142:1 159:5 159:12,17,20,21,22 160:2,5,7,21 161:1,10 162:4,14,16,19,21 163:2,3 179:4 206:2 247:6 rooms 24:12,22,24 27:7,13,22 35:17 40:18 42:3 48:1 49:7 50:7 51:23 55:5,15 59:3 70:3,5 70:12 72:17 86:14 93:3 95:6 159:23 160:3,21 161:14 172:19 180:10 237:20 270:15,16,19,22,24 271:1,4,6,8,9,11,13 271:16,18 272:11,13 272:14 274:2 275:4 275:22 280:4,5 282:9 room's 163:4,5 roughly 138:22 144:5,6,7 145:4 161:18,19 185:21 round 61:11 195:19 round-trip 93:8 Rugg 69:9,14,15 71:15 rule 130:6,15 169:21 173:8 212:14 250:2,14 251:23 252:2,10,14 252:15,17,23 253:1,2 253:6,9,14,16,19,20 254:13,22,24 255:6 255:11,14,16,24 256:6 259:1,10,13,16 259:19 260:8,11,14 260:16,19,22 261:1,1 261:6,12,19,21 262:7 265:11,16,18 266:5 rules 4:20 27:14 28:2 76:22 77:6 133:21 142:6 160:20 185:24 190:2 237:7 242:3 251:21 259:6 275:1 284:7 285:2 rule's 251:14 rulings 114:2 RULINGS/OTHER 4:6 run 68:21 132:8 173:7 running 72:20 142:4 172:24 180:19 241:17 runs 161:15 172:17 rural 136:23 139:6 Rush 286:15,17 287:4 rushing 81:15 S S 2:1 3:1 4:1 5:1 6:1 sadly 30:11 safe 31:16 safely 82:4 87:10 142:24 146:16 safety 21:1 23:2 31:8 87:13 95:12 134:22 148:7 178:9 180:10 271:23 272:12 273:18 sale 15:14 sales 140:17 sat 31:14,16 satisfaction 89:3 satisfied 160:20 205:13 261:19 274:5 satisfies 255:5 satisfy 193:23 253:20 save 87:4 137:20 saved 32:21 savings 279:7 saw 22:11 95:5 257:1 saying 31:5 77:7 99:14 129:7 131:7,8 132:5 152:11 162:10 207:3 210:20 211:20 258:17 260:11 260:16 265:19 says 75:2 77:16 117:3 184:13 190:21 210:22 210:24 234:1 250:5 252:10 257:9,9,10 259:16 260:14 262:7 267:15,19 scenario 212:18 scene 32:2 Schaefer 13:11 18:13,16,19 21:6 schedule 133:24 150:20 164:8 173:1 scheduled 24:14 168:23 scheduling 25:3 schizophrenic's 56:1 School PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM 277:7,8 287:21 schools 178:15 Science 47:8 scientific 179:8 scope 139:3 142:11 151:1,2 155:2 178:1 Scott 80:22 246:18 screen 95:7 screened 136:10 screening 20:19 21:3,6 135:24 136:4,7,13,14,15 137:8,13 139:19,23 139:24 144:11 146:20 148:3 150:20 151:1,3 screenings 19:19 20:1 140:2 scrutiny 86:23 seal 291:17 seamlessly 140:1 search 94:13,15 SEC 208:23 second 7:10 8:10,11,24 9:1,2 9:17,18 10:7,8,24 11:1,13,14,24 12:1 13:9 74:9 97:8 98:1 103:11 111:9,13,21 115:7 121:7,8 123:21 126:9,10 135:12,20 151:9 162:22 163:3,4 164:8 175:8,9 187:24 192:15 217:8,9 228:17 233:7,8 245:5 245:6 251:5 256:8 Draft Full Meeting Conducted on June 21, 2016 341 260:2 266:23 267:2 279:21 285:12,13 286:9 287:7,13,14 289:8,9 290:18,19 secondary 70:22 seconded 108:9 112:8 119:12 124:14 171:12 215:5 231:6 242:17 283:4 Secondly 22:17 99:18 147:11 section 7:7 219:15 251:16 253:11,21 259:6 sector 45:17 90:5 223:15,18 secure 182:1 229:15 secured 106:3 107:2 security 43:19 54:13 see 22:9,14 30:22 35:19 36:23 52:7 109:8 117:13,14,18 118:15 158:14,15 161:7 179:19 196:15 200:7 200:9,13,17 201:14 201:15,17 202:5 212:17,21 249:24 251:6 253:3 257:5 266:1 272:2 275:13 280:9 seeing 45:17 108:6 112:5 119:9 124:7 171:9 231:3 242:14 283:1 289:13 seek 249:10 274:9 seeking 8:4,18 17:2 42:13 58:3 142:8 143:3 147:2 249:5 281:12 seen 29:10 35:16 37:2 41:19 45:11 55:16 59:4 92:7 159:24 184:22 244:10,14 segment 40:14 selection 65:3 selects 137:24 self-interested 265:24 self-pay 149:22 Self-Referral 4:7 114:4 self-sustaining 64:23 180:6 self-worth 86:17 seller 222:9 semiprivate 70:5 237:19 Senate 133:1 Senator 6:6,7 132:24 136:6 229:9 send 72:21 79:22 80:1 98:18 169:23 188:3 249:1 sending 50:13 Senger 169:8 senior 28:19,21 29:7 220:6 230:18 234:18,23 240:11 246:19 seniors 28:20 sense 76:10 86:16 162:19 182:6 238:12 sent 24:3 29:2 38:4 58:19 77:1 97:17 98:16 207:16 229:6 256:13 268:13 Sente 229:9 sentence 18:5 sentiments 39:20,20 separate 138:20,21,21 154:4 155:3 224:8 252:23 separately 138:19 228:11 series 148:21 serious 47:2 55:10 59:12 seriously 248:23 serve 135:9 146:8 152:5 154:21 171:4 178:10 181:23 182:6 258:14 served 42:6,8 51:1 57:1 157:17 serves 33:3 89:9 219:21 service 42:4 51:24 57:6 58:7 61:16 68:2 70:18 71:5 77:19 91:13 100:13 138:6 141:21 142:19 144:9 146:19 155:18 163:10,12,14 171:3 178:1,15 181:4 188:2 192:17 223:19 223:20 224:1 225:20 225:22 236:6 238:9 247:15 249:17,22 253:14 263:16 267:14 270:13,18 271:14 272:7,9,17 273:15 276:22 serviced 41:1 71:7 PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM services 1:2 14:14 15:3 19:8 23:19 26:18,19,21 28:11,17 35:13,16,22 36:11,21,24 37:15,19 38:10 39:17 40:8,11 42:11,13 43:22 45:7 45:10 49:23 50:18 55:14 57:13,16,17,19 57:22 60:21 61:19 62:20 63:5,7,7 64:12 64:13 67:4 69:22 74:17 76:1 77:14,15 77:18 85:1,9,15,24 86:10 90:16,24 92:4 96:1 116:17 133:7,19 134:24 136:2 139:4 141:1,1 142:9,13,16 142:20 143:10,14,21 144:10 146:6 147:3 147:23 148:8 150:16 151:24 152:2 154:14 160:4 163:18 165:7 171:2 179:10,18 188:13 190:12 199:5 214:11 229:22 231:21 234:23 237:24 238:2 240:10,11 247:11 263:15 265:9 268:18 270:8 273:11,12 274:19 275:11,23 276:1,10 281:13 282:3,10,14 289:24 Services-Libertyville 96:3 serving 42:9 49:3 138:2 session 1:4 3:5 7:5,7,17,20,21 7:24 8:2 102:1 285:8 sessions 37:21 87:12 set 77:16 223:13,24 224:6 225:3 264:17 279:15 280:22 291:16 setting Draft Full Meeting Conducted on June 21, 2016 342 32:2 64:16 68:18 88:16 142:14,18,24 143:6 157:3 settings 49:5 146:16 settle 81:22 seven 27:11 87:11 193:14 201:21 202:15 seven-day-a-week 70:2 273:10 severe 35:12 36:2,3 50:4 severely 35:15 Sewell 2:9 6:21,22 7:9 8:23 11:14 12:1 103:11 108:10 109:2,3 112:16,17 115:6 119:12,24 120:1 121:8 124:15 125:6,7 126:7,9 127:14,17 159:3 160:10,13,22 161:7,12 171:12 172:5,6 175:8 186:10 186:13 188:11,18 189:4,9 190:14,21 191:23 199:8,9,10 200:1,4 201:1,2,5,12 201:14 204:5,14 205:20 206:3,12,16 206:18,22 207:2 212:17,22 213:11 214:1,8,14 215:6,23 215:24 217:9 231:7 232:3,4 238:17,18,19 239:5 243:8,9 245:6 245:13 283:4 284:5,6 287:20 288:1 289:9 290:19 shape 250:14 share 51:10 82:12 269:18 271:9 shared 51:13 56:24 57:9 70:5 228:13 270:3 Shawnee 137:16,23,24 138:8 148:4 150:23 163:10 163:12,17 Sheets 116:5 118:2,17 119:1 120:9 127:20,24 129:6 131:18 132:3 132:11,17 149:3,6,9 149:11,14,17 152:12 152:17 156:19,22 157:1,11 162:9,13 163:24 164:3 167:14 170:8 173:22 174:3 218:8,9 Sheila 133:1 Shepley 13:8 14:5,7,9 15:24 Shields 164:12 shifting 45:16 Shiraz 34:20 35:8 Shopp 53:21 60:14,14 Shore 32:7 49:4 50:24 54:4,5 short 62:10 148:6 149:5 shortage 35:13 36:18 41:10 42:7 52:7 57:13,19,22 178:21 181:5 shortages 38:9 shortened 72:12 shorter 72:6 75:4 87:7 shorter-term 87:8 Shorthand 291:1,4 shortly 24:22 shortness 79:17 short-stay 72:18 short-term 70:2 71:5,9 74:14 82:12 86:5,11 89:6 91:7 92:12,23 93:2 94:12 100:5 226:19 228:22 229:3,13 237:21,22 shots 265:21 shovel 106:21 107:19,20,22 show 97:18 98:7 152:10 192:7 197:15 208:15 209:23 213:18 249:1 249:8 257:24 258:19 270:21 274:16 278:13 281:4 287:20 showed 155:11 185:9 256:14 257:4,4 shower 270:17 271:20 showers 72:17 showing 184:1 270:23 shown 33:17 179:23 shows 185:3 250:7 251:10 255:18 263:19 268:5 273:1 278:9,21 280:21 281:8 shrinking 163:16 sic 19:7 sick 82:10 PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM side 48:13 49:3 51:19 68:17 116:17 236:10 sign 7:14 8:15 9:6,22 10:12 13:22,24 26:3,4,5 34:22,22 35:4 44:9,10 53:23,24 63:22,23 81:2 285:16 287:17 289:16 signature 226:18 signed 38:2 47:11 101:12 123:24 197:11 198:14 239:21 significant 22:23 40:3 51:21 53:2 104:8 141:15 192:13 247:13 271:24 274:6 significantly 25:1 26:24 51:20 138:6 183:7 signing 63:22 SIH 19:7,10,14 20:22,23 22:23 24:5 141:1 SIHS 141:4,8 145:17 146:13 146:24 147:5 SIH's 19:6 Silber 199:8 Silberman 176:20 184:23 186:12 186:15 187:4 189:3 189:11 191:9,12 194:9,13 195:6,11,14 196:24 198:18 199:12 202:17 203:2,7 204:6 206:2,24 208:6 210:17 211:5 212:3 212:10,13 213:14 214:2,10,21 216:7 similar Draft Full Meeting Conducted on June 21, 2016 343 138:24 163:11,14 182:13 228:23 235:10 274:13 Simon 133:1 simple 75:12 79:12 145:13 154:11 simply 23:8 55:7 78:6 199:16 sincere 60:6 single 91:10 146:18 150:15 165:6,21 178:18 186:5 195:12 203:19 237:16 242:7 258:1 258:13 271:15 272:12 single-specialty 126:6 133:10 144:8 164:18 sink 271:20 sinks 270:17 271:10 sir 6:20 112:23 172:11 281:2 sister 22:1 sisters 62:23 sit 173:1 site 27:4,12 74:12 77:13 100:2 127:13 167:11 169:16 205:8 sites 286:4 siting 15:17 sitting 172:20 221:1 situation 23:11 50:15 135:10 142:3 182:22 188:15 263:9 situations 29:9 49:20 50:9 six 30:21 31:2,4 61:3,17 67:23 90:6 175:12 180:4 182:12 222:1,5 236:6 280:23,24 six-year 91:9 size 146:11 181:13 227:10 254:13 272:5 skill 99:20 skilled 17:3,10 64:12 68:4 70:1 73:4 78:23 79:9 79:11 80:2,9 86:4,6 87:8 90:5 96:7 99:22 111:16 217:20 219:7 219:11 220:6 223:17 224:8,22 225:7 226:16 228:4 229:12 233:18 247:9,17 268:17 275:20 279:3 281:12 skills 88:17 skimming 267:24 slack 161:2 sleepy 92:8 SLF 236:13 slots 25:3 slowly 218:24 small 28:24 30:20 145:3 181:12 242:9 254:4 274:1 smaller 237:11 snapshot 195:17 social 43:19 48:13,15 64:14 178:15 society 36:13 57:21 135:15 160:18 sole 236:2 solely 261:4 solicited 38:21 solution 23:7 64:24 89:8 277:4 Solutions 58:10 somebody 26:8 35:4 118:22 150:19 161:14 172:17 187:16 258:21 somewhat 178:2 son 54:11,22 soon 93:13 sooner 87:10 sophisticated 68:16 sorely 59:24 sorry 11:5 58:13 111:5 112:23 115:20 116:21 116:24 121:24 131:19 184:9 201:23 204:9 207:4 244:6 283:9 285:22 sort 184:5 200:16 209:7 236:10 238:1 sought 57:24 268:11 sound PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM 71:10 sounds 163:7 172:8 source 70:22 200:1 224:10 262:18 sources 262:17 south 3:20 49:3 51:19 55:1 103:4,8,20 286:18 287:9 southern 3:14 4:13 13:11 18:17 18:21 19:22 20:20 21:19 23:22 25:18,21 26:10,12,14 33:19 126:2,5 138:2 140:24 164:19 space 32:1 126:16 spaces 241:16 272:11 spark 90:14 speak 13:5 16:8 26:5 28:13 32:22 44:22 67:11,23 81:3,7,14 85:20 86:2 88:1 89:24 90:10 91:24 94:5,6 97:14 101:11 218:24 speakers 51:12 69:7 101:9 speaking 13:14,16 34:19,23 35:2 35:9 44:5,10 53:18,24 63:15,18,23 69:8 80:20 81:4,20 89:17 97:6 195:12 special 53:3 64:20 228:18 specialized 35:22 39:23 40:21 53:1 84:24 182:11 219:14 228:5,22 237:19,21 247:6 Draft Full Meeting Conducted on June 21, 2016 344 specializing 42:21 specialty 42:14 46:8 52:21 53:5 145:4 146:19 150:16 165:6,21 specific 28:19 38:12 39:24 40:19 197:3 198:14 223:16 259:19 269:21 specifically 19:1 38:13,16 56:21 198:5,11 202:13 205:13 228:18 252:24 253:2 259:7 276:6 spectrum 60:3 spell 109:20 spelled 239:20 spending 59:10 94:10 spent 177:8,15 spin 267:8 spirit 29:21 spirits 229:15 spirituality 38:20 spite 180:12 spoke 29:22 179:1 268:16 spoken 240:8 spot 74:18 spot-on 224:2 spouse 158:5,6,7 spouse's 158:16 spread 271:21 spreads 179:6 Springs 74:7 76:17 77:7 100:2 sprung 73:11 square 111:19,20 126:16 254:10 272:3,6,10 SR 2:8 St 4:17 16:12 17:5,8,11 17:15 22:1 23:19 24:8,11,14,24 27:10 157:22 233:2,4 234:22,22 235:18,20 235:21,23,24 236:4,5 236:15 237:15 238:3 238:6 240:10,11 stabilization 90:8 stabilized 107:12 224:13 staff 2:19,20 17:18 22:3,13 26:16 27:2 38:21,22 39:2 64:19 73:7 88:10 94:24 95:4 96:21 112:20 116:23 117:17 119:22 120:4 122:16 123:8 124:23 125:3,11 134:15 147:14 166:7,13,17 171:16,23 172:21 176:1 177:3 183:12 186:11,17 192:2 196:22,24 197:8,12 197:17 198:21 200:7 210:3 218:18 220:11 220:22 224:12,16 238:10 240:15 241:3 246:7 248:1,3,4,11 249:11,21 250:4,4,7 250:18 251:7,8,10,11 252:16,20 253:18 254:2,7,7 256:5,9,13 256:16,20 258:5 259:2,9 261:3,11 263:14 264:3,6 265:1 267:5,9,15,18 269:24 276:9 278:16 279:19 280:21 281:22 283:13 288:17 staffing 74:21,22 273:10 staffs 19:11 21:24 22:21 24:5 staff's 249:7 252:18 256:20 267:10 283:22 stage 118:5 221:10 239:6 standard 123:11 136:8 160:13 177:21 206:14,16,18 206:21,22 224:1,6,8 224:14 225:2 standards 92:17 144:17 160:15 225:15 227:8 236:24 standing 194:24 standpoint 162:18 stands 62:3 249:11 start 26:7,8 99:14 106:3 183:3 249:19 290:7 started 43:8 157:18 158:2,2,13 158:17 159:16 193:10 235:12 starting 182:12 263:21 state 3:18 23:7 27:14 33:2 41:18 49:15 52:2,11 57:17 74:21,23 76:23 103:2 105:24 120:4 123:7 124:17 125:11 PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM 135:1,22 140:17,21 141:20 144:17 159:4 159:9 175:24 181:9 187:21,24 188:5 193:5,18 206:21 210:3 223:13 229:9,9 231:19 234:2 241:3 246:1,7 248:4,11 262:19 266:17,19,20 272:4 273:6 274:16 275:17 277:8 278:12 279:24 280:23 281:1 291:6,24 stated 22:8 23:6 120:1 125:7 159:6 165:1 215:24 216:2 226:10 232:12 239:3 240:14 272:8 273:23 280:1 statement 25:6 170:13,18 182:20 185:18 statements 112:20 187:18 208:17 210:9,10 states 19:13 42:6 57:14 75:8 107:5 135:13 146:13 statewide 147:21,24 266:24 267:3 279:22 State's 192:4 state-of 82:15 87:11 219:7 state-of-the 220:5 state-of-the-art 68:3,15 84:24 88:24 91:11 92:19 227:16 State-operated 45:13 static 78:5 stating 77:21 station Draft Full Meeting Conducted on June 21, 2016 345 117:11 stations 118:23 statistical 70:15 226:1 statistics 73:6 85:2 stature 235:20 status 4:8 48:15 57:11 114:4 135:10 280:20 statute 252:2 statutes 251:22 statutory 251:23 252:13 256:2 265:2,22 stay 72:6 73:22 75:4,9 76:10 83:7 86:23 87:7 89:2 98:4 168:23 169:2 stays 72:12,13 steal 82:21 100:17,19 stellar 88:16 stenographically 291:10 steps 222:11 Steve 122:11 229:10 stigma 94:18 stimulated 83:6 stolen 100:20 stomping 116:14 stood 193:12 stop 264:10 278:2,3 story 73:18 straight 257:19 strains 170:21 strategy 182:22 street 189:17 246:20 290:9 290:10 strength 31:13 strengthen 289:1 stress 38:14 71:1 stressful 229:12 strikingly 164:4 stringent 224:15 strip 146:11 strives 72:4 138:1 Stroger 286:18 287:11 strong 45:6 84:1 132:23 150:24 228:4 260:15 260:18,19 261:16 stronger 212:1 strongly 18:1 54:9 68:24 83:9 87:19 89:12 91:17 171:5 266:14 271:11 271:12 279:9,10 struck 251:7 struggle 28:18 70:23 136:18 struggles 49:16 struggling 38:14 stuck 160:6 study 140:20 Stuercke 63:20 stuff 51:9 208:12 style 236:19 subacute 77:14 subcontractors 105:11 subdivisions 237:16 subject 130:13 154:12 188:11 221:17 222:23 submission 176:3 270:2,20 submissions 269:23 279:13 submit 128:20 211:10,13 submitted 23:22 149:20 182:20 183:23 197:9 270:22 submitting 203:14 204:12 subsequent 4:10 114:6 209:11 215:16 244:2,3 279:13 subsequently 16:21 104:15 subsets 223:16 substance 60:19 substantial 97:23 122:21 279:7 282:1 substantially 40:15 PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM suburban 62:5,11,15 286:18 287:9 suburbs 51:1 55:1,6 56:5 success 182:16 successful 55:22 182:10 183:4,19 197:23 228:24 suffer 228:19 suffering 59:8 suffers 29:5 sufficient 27:17 183:2 186:24 188:4 192:18 199:18 225:18 suggest 213:6 258:10,16,21 suggested 221:16 suggesting 159:10 212:4 suicidal 36:10 50:12 58:1 suicide 57:12 58:4 suicides 48:16 suited 167:15 suites 82:14 Sullivan 229:10 sum 32:20 superior 250:24 supervise 144:24 supervision 291:11 supplemental Draft Full Meeting Conducted on June 21, 2016 346 186:16 supplemented 185:8 supplied 96:17 152:23 268:5 supply 214:16 support 14:18 15:9,24 16:8 28:14 29:16 30:18 33:6 35:10 37:16 38:4 39:7,11,18 41:1 45:1 47:11 50:16 54:9 55:2 56:3,11 58:5,16,19 62:14,16 64:3 65:16 66:2,9 67:12 76:21 79:4 80:14 81:7 84:1 85:3 85:21 88:1 90:1 92:1 92:20 122:21 132:23 133:3 192:19 197:5 199:7 218:2 229:5,8 230:15 279:2 281:20 supported 230:2 279:10 supported-living 236:9 supporting 202:8 supportive 37:24 194:5 270:9 supports 33:18 247:16 266:14 supposed 250:23 Surdick 69:10 71:19,19 73:22 74:1 sure 15:6 18:14 21:11 26:5 52:3 94:16 105:17 109:21 118:24 123:13 124:10 129:5 130:5 148:24 151:19 153:22 165:11 170:13,17 172:10 183:1 185:23 196:2 204:5 223:8 240:18 245:11 surge 57:7 surgeries 140:8 surgery 27:1 148:1 150:13 164:9,19 surgical 8:5 24:13 133:22 134:4 134:5,6,8,10,23 140:6 140:10 141:23 142:4 142:14 143:1,8,13 144:11,14,15,17 146:18 147:22 167:21 168:3 surplus 266:15 267:7,11,16,17 267:19,20 279:18 surprised 30:23 154:10 158:14 268:11 surrounding 67:5 71:24 72:17 91:12 survey 74:10 136:17 surveys 90:17 suspect 163:8 suspicion 262:11 Sutherland 53:21 56:8,9 58:3 swing 241:4,14 sworn 103:14,15 115:20,23 121:20 122:4,7 131:18,24 175:11,12 198:19 217:11,14 218:7 233:12 244:18 244:21 Symphony 241:11 symptoms 54:15 syndrome 38:15 system 14:14 18:22 26:12 29:16 41:23 49:6 51:14,15 122:13 146:10,13 151:11 158:1 159:21,21 160:4,8 186:1 227:23 229:18 230:23 275:13 276:17,24 277:21 287:23 systems 14:23 172:8 system's 141:2 Sze 176:18 191:18 193:2 206:15,20,23 T T 3:1,1 4:1,1,1 5:1,1,1 table 13:7 26:6 34:24 81:2 95:7 103:13 115:19 191:6,18 200:17 213:13,17,18 217:11 234:14 241:2 273:1 table/chart 98:11 tailored 177:20 take 22:5 28:5 29:19 31:10 31:22 61:3,6 62:18 82:21 93:2 100:4 116:6 123:1 131:10 158:1,19,23 161:18 161:20 162:1,15 163:2 166:10,14 174:6 205:11 210:4,4 212:24 222:5 239:15 241:13,21,22 249:13 260:17 262:4 taken 23:9 34:5,7 80:6 101:17 106:8 117:12 PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM 142:7 169:16 174:8 226:12 263:23 291:7 291:10 takes 34:12 118:18,18 161:22 162:6,20 219:3 talent 50:19 talk 31:8 45:3 107:18 155:12 177:11 182:9 talked 31:10 99:18 167:6 169:8 talking 36:9 117:6 181:12 198:11,13 200:10 tangibles 17:16 target 25:1 26:23,24 27:8 75:10 77:24 99:6 224:9 225:2,4 259:22 259:24 260:3,16,17 261:17 265:12,13,17 265:21 266:4 278:23 281:6 targeting 20:20 82:23 task 64:20 275:16 276:3 282:6 tasks 87:14 tax 140:14,17,21 141:3,4 141:10 taxes 140:17 taxpayer 229:17 taxpayers 65:8 tax-deductible 140:22 tax-exempt Draft Full Meeting Conducted on June 21, 2016 347 140:18,23 238:22 TCF 94:16 TCO 246:15 team 29:6 30:3 93:8 221:1 227:1 248:2 teams 17:19 30:1 tearfully 29:21 technical 248:5 250:19 251:4 technicality 200:13 technically 200:11 technologies 74:16 teens 31:2 televisions 95:7 tell 13:18 18:14 31:5 48:14 70:19 130:9 195:7 205:15 207:17 257:3 telling 131:7 169:10 195:1 tells 73:18 187:16 277:13 ten 290:7 tendency 263:1 tenuous 146:2 term 107:19 terms 36:18 40:16 57:22 203:22 224:5,19 225:23 239:11 254:16 276:18 terrible 50:9 100:23 terribly 170:21 test 249:16 testified 197:4 206:10 testify 28:14 58:18 testimony 23:21 26:14 95:23 132:12 159:6 197:13 215:20 231:20 232:1 279:14 284:3,6,10 tests 136:14 154:17 249:15 text 31:5 thank 6:5 7:3 14:4,7 15:23 16:1,2,5,7 18:3,10,11 21:9,10 23:13,14 25:12,14 28:7,8 30:13 30:14 31:12 32:12 33:22,23 34:16 35:6 37:7 39:12,13 42:17 42:18 44:1,2,17,18 47:4 48:20,21 51:2,3 53:14,15 56:6,7 58:6 58:7 60:11,12 61:23 63:11,13,24 65:17,18 67:6,7,10 69:3,5,13 71:17 74:1 76:13 78:14,16 80:16,17 81:6 83:13 85:14,16 85:19 87:21,22,24 89:14,15,23 91:19,20 91:23 93:20,21 94:3,5 95:21 97:2,3 99:9,10 101:6 102:5,11,12 103:16,19 104:2,3 108:8,13,16,22 109:1 109:4,13,18,23 111:12,23,24 112:7 113:5 115:8,10,17,18 115:24 118:1 119:5 119:11,23 120:9,10 121:9,11,19,23 122:8 122:16 123:2 124:3 124:12,13,19 125:1,5 125:8,12,16,17 126:13 131:21 132:1 132:4,19,21 148:10 148:15,17,20 158:24 159:1 171:11,17,20 171:24 172:4,11 173:18,22 174:3,4,5 175:10,13,16 176:5,6 176:7,11 177:1,3,4 215:4,13,17,22 216:7 216:8 217:7,15 218:4 218:5,18,21 219:2,4 220:15 226:8 230:21 230:24 231:5,11,16 231:23 232:2,9,13,18 233:9,13 234:5 235:8 239:17 242:16,21,24 243:4,7,10,18 244:22 246:2,3,9 248:3,9,18 269:10,15,16 270:3 280:18 281:3 282:20 282:21 283:14,19,24 284:4,8,17 288:1 289:10,23 290:2,22 Thanks 220:12 226:7 Thengil 80:22 85:18,23 theory 152:20 277:13 therapeutic 68:7 82:15 therapist 74:22 86:1 therapists 95:16 therapy 17:19 58:14 68:3 70:1 80:3 85:24 86:15 87:11,12 88:24 237:23,23 thereof 49:15 the-art 82:16 87:12 219:8 PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM thing 51:23 52:14 99:21 105:12 127:23 130:12 157:1 164:10 170:6 173:11,15 189:11 194:9 238:1 245:9 258:20 things 53:3 109:11 194:15 209:8 212:23 235:11 238:5 259:20 267:22 277:15,17 think 42:23 43:13 51:9 52:15 52:20,24 53:8 82:6 91:1 93:13 100:23 116:9,18 118:10 119:1 129:7 130:17 130:21 131:18 152:4 155:17 156:19 162:2 162:9,13 164:10 167:14,15 173:1,10 179:23 182:5 184:17 185:3,15 186:23 192:12 196:7,10,11 199:1 201:5 202:14 203:5,19 204:10 205:12,17 206:3,5,10 211:22 242:2 250:13 258:14 263:1 284:11 286:6,7 287:1 288:7 thinking 88:17 181:1 201:7 257:2 third 54:19 98:7 103:21 121:18 135:11 192:18 228:21 251:5 third-party 184:6 THM 68:1 82:1,13,20,21,22 83:4,12 88:13 Thodur 44:7 51:6 Thompson 290:11 Draft Full Meeting Conducted on June 21, 2016 348 Thornburg 249:22 thorough 218:19 269:22 thoroughly 247:23 thought 94:18 131:1,19 191:22 201:24 202:1,1,2 212:19 214:8 251:6 thoughtful 220:16 thoughts 58:1 81:15 247:2 thousand 46:1 121:17 206:9,13 222:2 three 29:11,24 31:3 50:14 54:13,14 61:6 63:18 90:8 94:10 122:7 131:24 141:7 150:9 196:9 207:7 208:2 214:17 228:10 271:16 273:5 274:11 three-hospital 18:22 three-hour 93:7 threshold 142:5 167:19 168:15 168:19,24 169:3,4,18 191:4 thrilled 227:12 thrive 273:20 throw 201:19 thrown 107:19 Tichelbaut 89:20 93:23 94:4,5 95:15,18 tied 106:10 109:10 time 23:4 24:6,7,8,18 25:12 29:13 32:2 33:22 43:10,15 49:10 50:10 51:11 52:19 53:14 54:22 55:4,23 56:15 58:22 59:9,10 63:12 66:12 68:22 71:2 78:15 98:19 99:9 106:8 107:20 108:18 108:21 109:10 111:21 118:18 128:19 130:8 133:5 140:9 148:10 150:19 151:4 160:11 160:12 161:14,16 164:8 177:4 179:2 180:12 182:22 183:16 185:19 190:9 192:7 195:17 198:4 199:2 202:17 203:24 210:23 218:22 219:3,5 220:7 221:6,13 222:10,17 223:1 227:3 235:2,9 240:5 242:4 247:20 249:6 255:15 269:20 283:17 timely 59:24 89:4 176:3 246:8 248:7 times 22:16 30:23 33:18 35:22 48:2 61:1 73:20 74:23 98:17 155:9 158:3 160:16 160:17 168:22 191:15 223:24 224:4 225:21 227:9 266:17,20 271:16 272:4,5 273:5 280:23,24 time-tested 228:3 Tina 26:1 28:10 Tinknell 116:9 120:10 Tinley 41:18 today 14:15 16:8,16 25:13 28:14 30:12 32:23 33:20 58:16 67:2,11 75:4 76:18 78:8,15 81:7 84:2 85:21 86:7 90:1 92:1 94:6 132:20 145:11 150:21 165:17 176:15 179:1 200:10 209:23 219:4 221:1,12 227:1 234:15 236:20,21 246:17 247:3,4 248:16,21,23,24 249:1,5,8,15 270:2 271:11,14 275:10 277:18 279:14 today's 223:10 225:13 226:10 227:7 toilet 271:10,20 toilets 270:17 told 47:10 59:4 79:7 94:11 157:19,22 268:14 tolerate 57:10,11 toll 50:8 Tom 26:2 30:16 57:23 58:1 Tony 44:8,20,24 tool 133:13 total 20:1,2 39:1 45:24 52:10 84:10 147:21 188:24 223:19 224:5 238:24 264:2 271:3,5 272:2 276:12 totally 76:1 157:14 173:10 201:13 touch 76:19 95:6 PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM tour 17:23 town 92:7,9 173:14,16 236:8 237:3 to-be-built 221:24 track 66:15 98:1,10 141:15 280:8 tract 236:11 traded 188:2 tradition 230:16 traditional 40:1 75:1 82:9 86:19 91:4 98:2 226:15 239:12,13 training 67:15 transcript 291:8 transcripts 3:11 5:5 11:22 transfer 23:3 54:16,19 68:12 127:1,6,7,9,19,21 128:10,20 129:1,10 129:21,23 130:7,13 130:20,22 131:2,14 147:6,12 transferred 17:7 31:18 54:24 transform 79:10 Transformation 79:5 transformational 227:22 230:22 transformative 3:13 4:18 13:9,10 14:10 16:9 18:6 63:19 67:12 69:8,18 71:21 72:23 74:5 80:20 81:8,24 84:1,4 Draft Full Meeting Conducted on June 21, 2016 349 84:23 85:5,21 87:3,20 88:1 89:9,18 90:1,12 92:1 94:7 95:24 96:15,17,19,22 97:6 97:13 244:4 245:1 246:16 247:7 270:7 282:18 transition 65:1 227:2 transitional 4:16 16:23 63:16 64:3 65:4,12 66:2,5 68:1 74:11 78:22 79:10 80:10,14 81:11 85:4 85:24 87:6 88:12,15 89:7,8 90:5,9,23 91:5 92:11,24 95:10 99:19 99:19 100:4 217:2,4 219:15 220:17 226:18 227:10 228:1,21,24 247:6,10 270:8 277:19 translates 267:12 276:16 translation 267:14 trauma 38:17 traumatic 59:9 traumatizing 59:7 travel 23:4 36:22 40:5 46:5 192:7,21 242:3 255:15 traveling 63:4 137:8 146:20 treat 47:16 48:3 133:14 164:20 277:22 treatable 55:19 treated 48:17 95:3 treating 136:9 treatment 29:4 33:7 46:3 47:3,19 50:4 55:21,23 58:3 68:19 95:11 135:23 137:12 142:1 143:1 159:5 177:21 178:22 treatments 21:7 276:19 treats 19:18 tremendous 71:2 264:13 tremendously 153:14 trend 45:11,20 46:21 72:14 99:23 trends 275:24 282:10 TRICARE 178:9 tried 167:7 238:14 trigger 225:20 253:17 260:24 Troiani 34:21 41:3,3 trouble 168:17 Troue 25:20 34:1,2 133:3 true 75:20 99:23 100:21 206:7 221:10 291:8 truly 82:17 93:9 Trust 234:1 trustees 66:1 truth 221:17 try 30:22 43:23 236:23 238:16 251:1 264:11 trying 106:5 130:18,23 146:10 148:17 162:17 173:1 197:20 210:8 Tuesday 1:7 157:23 turn 20:24 162:3,3 178:11 183:9 193:7 226:5 233:24 234:24 267:22 turned 59:1 164:3,8 turning 163:1 182:16 188:12 191:14 turnover 161:14,16 turns 39:21 TV 178:20 twice 147:24 186:21 two 13:19 14:15 15:5,22 18:2 21:4 24:7,11 27:7,22,23 29:12 30:1 30:5 31:16 32:10,13 36:1 37:4 39:9 40:6 41:12 45:23 47:1 50:23 53:10 55:17 56:2 58:2 61:6,16 62:7 63:9,15 65:15 69:4 71:14 73:21 75:20 76:7 77:13,22 78:10,13 79:23 80:12 83:10 91:1,3 93:15 95:14 97:5,22 99:5,8 99:15 101:5 118:8,9 127:12 142:21 144:11 157:21 159:11,12,14 159:23 160:3,16,17 160:21 161:10 172:19 181:7,19,21,23 182:4 184:18 188:1,19,22 189:5,24 192:7,16,19 200:9,11,14 205:21 211:11 212:22 213:7 214:11 227:9 235:18 PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM 237:19 238:23 241:7 246:6 248:12 249:7,9 249:17 256:10 259:20 260:1 262:1 268:19 272:5 288:12 two-planning 212:18 two-planning-area-v... 188:14 two-story 236:18 type 33:8 49:17 177:21 178:9,12 219:11 221:18 275:9 types 60:4 107:5 118:3 typewriting 291:11 typical 99:23 typically 52:4,16 192:23 219:12 U U 4:1 5:1 UHS 188:2 Uh-huh 164:2 Ulm 89:20,23 90:3 93:16,18 ultimately 87:4 90:20 235:17 277:1 unable 47:15 50:3 unaudited 184:5 208:17 unchanged 234:7 uncle 42:24 unclear 157:14 uncles 62:24 Draft Full Meeting Conducted on June 21, 2016 350 uncomfortable 194:7 underinsured 20:21 33:3,13 137:18 143:24 148:5 underperformance 260:21 261:2 underperformers 260:9 underperforming 261:18 underserved 100:12 138:3 250:10 253:24 254:3,10,14 254:16,21 255:2,4,10 255:13,16,20 258:24 understand 71:23 79:6,13 92:14 93:9 104:18 105:10 106:6 118:21 129:7 130:2 148:22 150:18 151:10 153:14 156:7 157:12 169:12,13 172:7,18,23,24 173:8 173:10 182:4 190:2 195:14 242:9 258:12 288:22 understanding 15:6 40:21 57:1 82:19 167:2 179:24 194:19 207:10 understands 167:16 understood 189:13 underutilization 142:21 252:21,24 253:10,16 259:7,14 259:17 261:8,10,13 263:7,11 underutilized 146:14,22 192:11 253:4 260:23 261:5,9 263:3,20,22 264:15 265:14 Underwood 234:19 239:15,17 underwriting 221:7 224:15 225:15 unequivocal 14:16,17,17 15:8 unexpected 136:19 unfortunately 51:17 86:6 132:22 135:17 159:17 181:8 271:13 uninsured 20:20 24:17 33:12 137:18,23 143:23 148:5 149:22 151:19 152:5 uninterrupted 227:3 unique 68:20 82:1 84:24 226:10,14 247:12 270:10 uniquely 38:12 248:14 unit 28:23 43:9 46:7 70:3,4 74:13 181:15 United 42:6 107:5 135:13 UnitedHealthcare 143:2 units 55:17 Universal 209:4 universities 79:3 University 83:20 277:5 286:17 287:4 unmet 190:1 265:6,7 unnecessary 26:18 188:12 231:21 249:18 259:5 unprecedented 181:2,3 unspeakable 49:20 untapped 229:2 untrue 22:12,19 25:5,8 unusual 38:6 update 180:10 212:6 updated 195:18 276:4 upfront 137:2 upper 135:4 137:17 139:1,2 143:4 152:1 153:18 154:20 161:18 upwards 222:24 up-to 282:2 urban 83:19 urge 33:20 56:3 58:5 67:2 68:24 71:15 85:12 93:18 urgent 48:12 215:21 urologist 157:24 use 40:18 84:3 85:7 93:4 94:14 99:3 104:11 133:14 170:14 262:5 useful 209:17 uses 239:22 usually 48:1 156:8 utilization 25:1 26:24 75:11 78:1 78:6 99:6 142:1 179:9,17 185:7 192:3 192:9 206:6 214:11 241:14,16 259:10,11 PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM 259:14,18,22,24 260:3,5,13 261:6,17 262:1,20 265:12,13 265:21 266:7 274:7 utilized 17:14 181:15 utilizes 225:14 V VA 42:11 57:24 58:1 validated 262:23 validation 184:6 valuable 55:23 value 133:6 140:21 225:10 values 56:24 Van 246:24 varied 62:5 variety 45:5 various 46:19 49:5 64:22 68:15 94:19 97:18 107:5 varying 30:2 vast 49:10 274:1 vastly 82:24 verification 203:3,6 212:7 231:20 verify 32:6 Vernon 61:11 versus 82:23 140:7 142:5 158:15 168:3 210:24 222:8 veteran Draft Full Meeting Conducted on June 21, 2016 351 57:23 veterans 53:6 56:10,13,17,20 57:10,12,15,15 viability 71:7 187:8 223:12 225:6 226:1 viable 64:22 73:22 181:13 182:3 185:12 189:20 vibrant 92:9 vice 18:20 176:19,23 234:18 246:19 view 133:6 167:4 Village 65:22,23 66:1,8,10 violate 77:8 virtually 46:16 virtue 119:21 visibility 209:3 vision 57:9 88:14 visit 140:4 169:19 visits 137:20 167:11 Vista 214:12 vital 93:19 133:13 vocal 56:9 274:21 voice 13:18 69:17 197:15 286:12 289:14 voices 55:24 volume 24:10 25:4 27:18 280:10 voluntary 141:13 volunteer 62:12 volunteering 219:5 vote 16:16 33:20 60:7 67:21 68:24 83:11 85:13 87:19 89:12 91:18 92:10 108:7,18 109:7 109:12,14 112:6,22 116:19 119:10 124:8 124:11 130:12 149:2 171:10,19,22 172:2 172:15 173:17,20 194:8,11 205:11 210:5 211:4,9 215:3 231:4,10,18,22 232:11,14 242:15 249:5 283:2,8,10,17 286:13 287:21 288:5 289:14 voted 283:16 votes 109:14 113:1 120:6 125:13 173:19,19 216:3 232:14 243:14 248:22 249:6 284:13 voting 171:15 232:4 283:13 vulnerable 20:16 138:3 188:8 196:7,11 208:4 walk 189:17 walking 52:16 79:17 want 15:5,8 17:6 21:11 38:18 41:22 45:3 52:6,17 74:24 77:20 79:5 80:1 81:23 82:11 97:14 98:8 106:1,3 123:13 128:1 130:21 137:20 147:2 154:21 165:14,15 166:19,20 168:18 170:4 176:9 184:9 188:5 193:24 195:8 195:21 197:1,6 198:20,21 200:6 201:1,14,15,16 202:9 202:15 204:11 212:17 226:8 235:3,6,8 240:18 249:1 253:21 260:18 266:1 275:3 277:10,20 289:23 wanted 39:18 51:10 79:7 105:16,16,21 158:11 165:10,13 193:21 207:5 235:7 238:20 wanting 196:17 214:9 235:4 wants 34:9 162:13 164:20 253:3 W warehoused wait 55:14 31:24 36:1 50:2 52:4 warrants 59:3,9 150:19 151:4 248:15 159:19 160:1,11,12 wars waited 56:16 31:15 wasn't waiting 190:5 234:6 239:3 48:5 55:22 59:6 61:16 waste 107:23 118:15 172:20 87:2 204:24 watch waiver 54:14 184:18 186:23 187:1,8 PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM watched 57:3 80:6 Wattenberg 53:21 62:1,2 63:10 Waukegan 61:12 way 6:11,12 19:15 98:20 116:16 118:2 151:10 166:24 170:22,24 173:7 181:14,17 190:4 197:1 201:6 207:2 210:5 229:11 258:9,14 261:14 262:2,7 272:8 274:3 277:10,15,16 ways 31:23 wear 29:20 286:7 weary 82:20 website 94:19 257:8,15,20 week 24:8 87:11 140:10 151:1,2,6,7,8 168:22 169:2 202:2 208:22 weekends 41:12 weeks 208:24 211:11 week's 198:4 weigh 169:6 welcome 32:7 286:7 welcoming 95:1 Weldler 69:10 74:4,4 76:8,13 welfare 138:1 well-being 64:15 276:13 well-established Draft Full Meeting Conducted on June 21, 2016 352 62:12 well-thought-out 122:23 went 77:7 79:18 83:1 105:24 164:5,9 235:22 257:7 257:15 Wereszczynska 44:7 48:23,24 50:24 west 116:17 236:8 Westerkamp 105:5,13,20 107:2,16 108:2 109:18,21,21 we'll 101:15 102:1 108:3,18 126:1 174:7 208:21 208:22 212:10 223:3 236:24 237:1,2 286:9 we're 7:23 8:4,18 14:15 18:21 22:24 36:9,20 43:21 45:4,9,17 58:14 62:11 66:15 74:23 100:18 118:8 164:16 168:13 181:12 182:13 189:9 194:19 197:20 207:5 208:9,10 209:4 209:4 210:8 212:4 219:18 226:11 234:12 235:4,10 236:16,17 236:17,17 237:9,10 237:19,20,22 240:12 248:19,23 249:5 274:3 286:6 288:24 we've 41:17 43:3 45:10,18 46:16,18 55:16 107:23 122:20 128:8 129:15 159:8 160:16 180:15 182:12 191:12 193:7,7 196:19 200:9 205:5 206:9 208:9 209:6 whatnot 107:6 whatsoever 15:20 Wheaton 37:19 wheeled 160:2 161:20,22 162:14,15 Wheeling 61:8 WHEREOF 291:16 wholeheartedly 129:8 wholly 173:7 wide 45:5 60:3 wider 179:17,17 wife 31:6,14 willing 91:4 194:17 205:3,8 Winchester 64:7,11,22 65:1,5,7 66:19 219:11 226:21 227:4,17,19,20 228:2 228:8 230:12,16 wins 83:8 win-win 229:23 wish 14:16 63:10 275:12 279:14 withdraw 96:24 withdrawal 50:4 witness 103:15 291:16 witnessed 90:22 witnesses 115:23 122:7 131:24 175:12 217:14 233:12 244:21 women 38:16 women's 38:15 53:6 60:4 wonder 117:15 wondering 257:12 Woodstock 60:19 69:16 73:2 work 38:18 88:14 93:8 145:9 146:10 158:12 163:10 193:23 245:14 248:3 288:21 worked 23:24 51:15 68:9,21 83:17 90:4 229:18 238:11 Worker 4:7 114:3 workflow 162:18,24 working 49:4,11 66:13 81:12 105:1,12,13 159:22 195:15 276:16 works 73:5 212:16 world 164:12 267:18,18 worry 182:24 worse 50:9 260:12 worth 210:5 worthwhile 85:13 wouldn't 196:1 262:23 Wow 94:22 wrap 173:8 writing 288:23 written PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM 14:1,2 28:14 34:24 54:1 80:24 139:11 234:3 249:20 252:14 253:16,19,20 255:6 256:3,7 261:13 270:14 wrong 94:22 160:5 185:2 213:19 263:4,5 wrote 167:8 W-e-s-t-e-r-k-a-m-p 109:22 Y y 184:1 yeah 104:5,13 112:22 117:9 117:10 129:17 150:18 156:14 157:12 162:5 162:23 166:15 188:17 190:20 193:21 194:2 194:4 199:24 200:3 201:4,5 208:13 211:8 213:2,11 219:1 238:19 239:1,10 241:9 242:10 year 15:1 20:2,7 43:8 46:17 55:9 61:13 84:19 99:5 101:4 135:22 137:21 145:5 180:7,7 183:4,18 224:13 225:5,22 235:23 257:13,16 273:3 274:15 288:13,19 years 16:11,13 24:1 27:23 28:16 29:11,12 30:1 30:21 31:4 32:5 34:3 34:5 35:9 37:19 39:16 40:18 42:7,20 46:8,11 47:21 48:24 51:8,16,16,17 52:1 55:16 62:7 64:18 67:17,23 68:10,21 73:10,14 74:10 77:22 Draft Full Meeting Conducted on June 21, 2016 353 78:4 79:1 81:13 83:18 86:2,22 88:7,9 88:11 90:6,6 92:5,6,7 99:5 106:9,18 109:10 109:12 118:8,9 135:7 136:11 139:12 145:21 157:17 159:11 169:21 171:3 177:9,15 182:3 196:9 205:18 207:7,8 208:2,2 214:17 219:20 229:19 231:13 235:12 236:6 249:12 257:14,19,23 258:2 258:14,18,23 260:1 262:1 272:18 273:2,7 275:8 year's 66:16 180:23 year-end 209:11 young 31:3 53:4 57:23 150:14 younger 82:11 93:2 Z Zahoor 132:16 Zee 247:1 zero 199:3 241:20 256:15 257:4,17 Zion 61:12 zip 47:18 77:6 242:7 zoning 221:23 $ $1.7 126:17 $1200 154:17 $130,540 273:3 $14 185:4 $1500 20:6 138:14 143:20 151:24 153:18 154:20 155:15 $17.7 121:14 $19.3 245:20 $2 222:13 $20.6 233:20 $21.7 104:1 $23 185:9 $24.9 111:17 $250 155:2,22 $250,000 222:20 $26.4 84:15 $27 211:1 $27,326,184 214:19 $27.5 84:13 $29.3 217:22 $3,000 138:22 $3,926 111:7 $3.1 115:13 $30 185:21 $31.3 175:20 $33,000 33:11 $3926 111:22 $4 223:1 $4.4 72:16 $400 136:19 $50 209:14 $53.9 84:18 85:11 $59 183:5 196:14 198:10 $6,000 136:22 138:17 $700,000 222:6 $750 144:6 $850 153:22 $900 139:2 152:1 0 0 241:14 257:6,9,10,11 257:18,18,18,18 084-004299 291:4 1 1 1:16 109:14 162:6 173:20 222:19 225:5 232:14 241:2 249:23 257:5,9,18 264:4 266:17,20 279:16 1st 105:21 107:17 1.2 192:21 1/2 42:7 222:13 264:4 266:17,20 1:03 p.m 101:18 10 3:9 20:7 40:18 52:13 PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM 57:14 72:8 73:10 77:7 78:4 98:23 117:18 127:13 136:11 149:22 150:7,8 161:19 256:23 257:5 257:10,18 258:17 271:5 280:11,15,16 282:2 10th 11:22 10-Ks 188:3 10-minute 174:6 10-065 103:4,8 10:03 a.m 1:8 10:04 7:19 10:34 7:22 100 100:4 100,000 193:4,6,14,15,17 100-bed 54:9 175:6,18 102 3:17 103 3:20 104 111:5 106 235:5 106-bed 233:18 240:21 11 3:10,11 173:1 185:4 11th 291:17 11-014 111:5 11-104 111:2 110 Draft Full Meeting Conducted on June 21, 2016 354 3:22 4:3 111 4:5 111-bed 111:15 1110 122:19 1120 122:19 1120.120 184:10 1125 64:9 1125.570 249:17 251:16 1125.580 249:18 252:23 259:5 114 4:6,7,8 114-bed 270:24 115 4:11 115-bed 271:1 118 17:10 12 28:16 38:24 72:10 117:18 12,000 57:6 12-month 76:24 12-station 115:5,12 12.9 191:7 12:15 101:14,17 120 104:1 1200 137:4 144:7 121 4:12 122 39:6 125 180:19 191:16,20 126 4:13 127 247:15 264:20 278:20 279:17 13 3:12 96:4 123:7 141:8 157:17 196:9 250:4 270:7 13th 249:22 13-013 102:8 13-067 10:3,19 130 235:12 130-bed 96:7 135,000 135:16 14 3:13 86:2 191:6,18 196:9 200:17 202:16 204:1 213:13,17,18 214:21,22 14-022 102:10 14-026 102:7 14-041 102:7 14-046 8:20 140-bed 233:4 235:4 240:20 1481 45:19 15 23:4 34:3 35:9 39:16 60:21 83:18 90:6 147:13 153:6 155:16 193:17 196:10 251:10 15th 288:19 15,000 20:2 15-044 16:17 63:19 67:22 69:8 71:22 80:21 89:13,19 92:11 95:24 97:7 99:13 244:4 245:1 246:15 269:9 282:17 15-058 102:8 15-060 102:9 15-061 18:18 23:17 25:20 26:9 34:14 126:2,4 15-44 14:10 150 32:4 84:21 158:3 1500 144:7 153:8,10 16 88:7 121:17 150:4 153:1 250:7 16th 22:7 184:1,20 208:16 247:19 16,671,566 121:18 16-year-old 35:24 16-01 8:5 16-011 26:1 28:13 30:19 34:19 37:17 39:19 44:5 53:18 175:2,5 16-012 63:16 64:3 66:3 217:2 217:4 16-014 233:2,4 16-015 115:1,4 16-017 121:2,4 PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM 16-04 8:19 16-05 9:10 16-06 10:2 16-11 176:1 1600 268:8 17 54:7 135:7 139:12 145:21 171:3 272:1,2 272:16 17th 179:23 17,671,566 121:17 170 219:20 175 4:15 18 3:14 16:13 108:3 118:9 249:11 272:22,22 281:22 18-bed 43:9 180 225:1 185-bed 64:5 217:5,20 19 20:13 267:5 19th 16:13 1954 235:16 1962 235:20 1970s 272:19 273:24 277:24 278:1 1973 236:3 1991 45:18 Draft Full Meeting Conducted on June 21, 2016 355 2002 221:9 2008 16:19,23 275:15 276:5 287:10 2009 287:10 2010 16:24 57:5 104:7 105:1 2 105:12,14 106:12 2 236:7 287:10 173:19 259:9 279:18 2011 2nd 91:7 140:20,23 257:16 16:14 121:15 290:6,14 287:10 2(c)(1) 2012 7:7 16:14 287:5,10 2(c)(11) 2013 7:8 221:9 285:24 287:5,10 2(c)(21) 287:11 7:8 2014 2(c)(5) 9:10 15:1 83:1 136:19 7:7 141:1,8 146:4 147:20 2,000 191:19 256:15 257:7 138:22 143:17 257:12,23 268:9 2.3 280:21 285:8,8 286:1 147:23 286:6 287:5,10,11 2:10 2015 174:7,8 22:2 24:3 27:9,13 96:4 2:20 150:4 195:17 238:6 174:7 2016 2:20 p.m 1:7 11:11,22 94:8 174:9 104:8 135:15 150:10 20 153:1 184:20 246:1 7:17 66:23 137:2 141:5 247:19 291:18 161:23 162:3 163:7 2017 181:12 236:7 249:12 5:8 126:19 175:21 257:23 258:14,18,23 245:22 286:1,5,8 281:23 282:1 291:20 20-some 2018 189:20 103:24 106:15,17 200 107:14 109:8 115:14 84:20 254:10 121:15 233:21 278:23 200,000-square-foot 281:7 227:8 2019 200-bed 217:23 111:16 21 200-plus 1:7 190:22 214:10 52:11 1992 41:17 1993 41:9 1994 16:13 1995 257:21,23 21st 11:11 217 4:16 22 57:12 22nd 66:6 225 145:4 233 4:17 24 51:16,16 103:23 24-bed 188:24 24-month 39:5 103:9 24.6 140:23 2400 37:21 244 4:18 25 27:6 72:13 73:15,17 162:20 163:8 172:20 231:13 264:9 278:19 25,000 254:12 250 280:20 2500 135:21 137:2 254 264:17 280:21 26 92:6 27 27:12 47:21 184:2 185:10,21 202:3,24 208:15 209:24 211:17 28 3:16 20:13 51:8 75:10 208:18 280 84:17 PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM 285 4:19,20,21 5:4,5,6,7 286 5:8,9 29 188:22 191:2 290 5:10 291 1:16 3 3 173:19 225:22 233:24 270:6 280:1 3rd 94:8 30 37:19 67:17 77:13 78:3 92:6 99:1 130:7 144:18 146:21 162:2 162:3,6,20 177:9,15 193:4 229:19 242:3 249:12 255:9,15,18 255:20 30th 62:11 115:14 217:23 30-bed 181:12 30-day 72:13 89:2 30-minute 17:10 31 17:5 50:11 193:5 209:11 264:8 278:17 291:20 31st 126:19 175:21 208:18 233:21 245:21 270:22 32 42:7 225:4 32,000 66:4 3200 126:16 33,000 139:6 Draft Full Meeting Conducted on June 21, 2016 356 34 237:11 34,000 66:23 342 272:10 35 17:6 47:16 52:10 141:4 271:4 36 54:18 241:1 272:18 36,000 52:10 37 92:5 38 16:11 380 271:3 39 219:23 226:12 4 4 117:17 158:3 263:13 270:6 271:1 280:6 4,000 67:1 4.3 111:19 4:33 p.m 290:23 40 42:20 55:1 93:7 225:3 41st 57:16 42 238:7 45 34:5 134:9 167:19 190:24 274:15 45,000 57:7 45-minute 190:9 192:7,21 242:3 450 156:5 4500 111:19 462 27:24 161:8 47 136:18 48 54:18,24 98:15 59 183:21 184:21 209:12 211:17 6 6 3:3,4 54:19 113:1 120:6 125:13 213:23 5 216:3 243:14 248:22 5 281:2 284:13 19:23 20:10 72:8 102:2 6,000 109:14 135:14 147:18 143:17 149:21 161:19 232:14 60 241:3 248:22 280:12 20:1,5 36:22 46:23 5,000 92:13 164:3,9 165:10 137:2,4 165:11 5.9 60s 192:22 235:15 236:19 50 60,000 36:22 39:2 43:6 46:24 33:11 73:13 97:20 107:24 60-year-old 134:7 136:10 137:8 227:8 139:7,24 149:24 60490 152:17 164:5 167:13 1:6 168:14,24 169:17 64 170:2,22 173:4 238:6 208:19 65 50,000 66:23 67:1 77:23 78:5 135:17 100:7 218:1 229:6 50-acre 65-and-older 236:11 281:4 500 65-and-over 144:6 156:5 264:5 52-unit 65-plus 236:8 278:17 53 65-to-74 189:1 264:7 550 66 144:5 38:24 56 7 72:13 7 57 3:5 141:9 161:19 141:3 270:14,23 278:15 570 280:20 281:8 249:19 253:11,21 7th 256:8 259:4 20:9 23:6 580 7.7 259:6 266:13,14 PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM 258:8,15 70 75:12 241:15 70s 236:19 700 70:17 272:8 721,000 57:15 74 29:11 75 45:24 70:24 108:1 274:14 280:13 75-and-over 264:8 75-plus 278:18 750 15:2 83:1,5 100:21 780 268:10 8 8 3:8 270:14 281:14 80 70:21 99:2 224:10 254:11 800 40:17 82,000 66:22 85 153:3 191:21 860 268:9 87 237:17 9 9 32:5 183:21 281:22 90 118:23 224:11 249:14 264:19 900 153:18 154:20 Draft Full Meeting Conducted on June 21, 2016 357 911 23:8 84:7 129:19 93892 1:15 95 266:24 279:22 96 242:6 97-bed 74:8 240:24 98 267:1 270:16,16,17 271:15 275:4 98-bed 245:2,18 247:6,17 264:22 990 141:1 997 263:17 264:20 280:21 PLANET DEPOS 888.433.3767 WWW.PLANETDEPOS.COM