Fiscal Meeting July 17 , 2014

1. Board of Directors Meeting • May 8, 2018 Fiscal MeetingJuly 17, 2014 By: Kathy Martinez, CFO

2. HRSA Billing and Collection Requirements • NCHS must prepare a schedule of fees for the provision of its services consistent with locally prevailing rates or charges and designed to cover its reasonable costs of operation. • NCHS must assure that any fees or payments required by us for healthcare services will be reduced or waived in order to assure that no patient will be denied services due to an individuals inability to pay for such services. We are required to provide a slide based on the patient’s family size & income. NO patient will be denied services for their inability to pay.

3. NCHS Medical Fee Schedule • Our current Medical Fee schedule is based on data from 2014. • We are proposing and seeking approval to change the Usual & Customary charges to reflect the 2018 fee schedule.

4. NCHS Medical Fee Schedule • The 2018 Medical Fee Schedule is in accordance with American Medical Association in developing the Usual & Customary (UCR) fee schedule that is comparable to other like clinics in our area. • Under the proposed fee schedule the UCR charges are set at the 90% with a 4 slides/discounts based on patients family size and income. • Slide A 25% for patients 0-100% poverty level • Slide B 40% for patients 101-150% poverty level • Slide C 50% for patients 151-175% poverty level • Slide D 75% for patients 176-200% poverty level

5. NCHS Medical Fee Exceptions • Pharmacy Dispensing Fee • From $8 to $10 • 2 Procedures in which we are proposing a nominal fee vs. a slide for patients that qualify. • INS physical • Retinal screenings

6. The second handout is the proposed fee schedule with the four slides. These fees will only be charged if we eliminate the bundle payment or they are bundle carve outs.

7. The final handout is our current & proposed Nominal Fee and Bundle visit schedule.

8. Page 2 of the final handout provides information on what is included and excluded in our Bundle Visit fee.

9. Action Item We are seeking BOD approval: • Nominal Fees and Bundle Visits schedule • Proposed fee schedule adjusting UCR charges to the 2018 Medical Fee Schedule 90% with Slide A, B, C, & D. • INS fee to $250 • Retinal Screening for a Nominal Fee • Pharmacy dispensing fee to $10 Pending approval the proposed effective date May 21, 2018

10. RAMONA CAPITAL BUDGET

11. Ramona Capital Project Ramona Capital Project Budget $3,047,473 • Construction-inclusive of IT cabling 1,928,516 • Architectural 305,231 • Permits & City Fees 74,975 • Signage, Artwork & Moving Expenses 72,000 • Contingency @ 8% 225,739 • Capital & Minor Equipment 441,012 The approved 2018 Operational budget included the expansion of services for the Ramona clinic.

12. Ramona Capital Project Ramona Capital Project Budget $3,047,473 2018 Capital Budget Placeholder (2,000,000) 2018 Capital & Minor Equipment ( 441,012) Variance from original estimate $606,461 While the project exceeds the 2018 budget placeholder we have saved $200k plus through negotiations with the City of Ramona and San Diego County.

13. Ramona Capital Budget Change in Construction Cost • Painting the exterior of the building $10,800 • Build out of the exterior patio for additional waiting space $60,000 • Lot Landscaping $60,000 • Windows in Dental bay areas for more light $8,400 • Moving of trash enclosures for additional parking $24,400 • General conditions and contractor fees for changes $27,000 Change in Design Mgmt • Civil & Structural for dental bay windows $3,600 • Structural engineering for new roof hatch $2,750 • Interior rendering of clinic $3,960 • Exterior elevations and board $2,725 • Coordination with San Diego County regarding land development and potential upgrades, including planning meetings and reviews $25,500 • Landscaping-planting and irrigation for building and parking area $7,700 Construction and Design Management account for 50% of the increased cost.

14. Questions