1. Welcome!

2. Strategic Development and Facility Master Planning Board Approved in October 2010 Hot Springs County Memorial Hospital

3.  Research the Market  Evaluate Demographic Trends  Assess Hospital Performance  Identify Opportunities What is our context? Phase 1: Awareness

4. What works well and what does not? Phase 1: Awareness  Site Analysis  Departmental Assessment  Clinical Flow and Adjacencies  Code Compliance

5. Phase 1: Awareness What do the stakeholders want?  Patient Perceptions  Unmet Needs  Community Support

6. Phase 1: Awareness How much can we afford?  Capital Capacity and Resources  Current and Historic Financial Performance  Plan Within Our Means  Realistically Achievable  Financing Options

7. Phase 2: Actionable Outcomes What would it look like?  Explore Multiple Options: Renovation Expansion Replacement

8. The Deliverable  Assessment of our market and how we are doing in it  Understanding of our current facility situation, areas of exposure and for improvement  Awareness of our community’s unmet needs  Evaluation of what we can realistically afford  A financially and market appropriate facility response

10. Current Facility Issues  Current building in place since 1959 (Utilized Hill Burton funds)  No private showers or bath  Imaging equipment spread throughout facility  Significant lack of efficiency  Very ‘inpatient’centered  “Upstairs/Downstairs” services  Maintenance tunnel infrastructure  Heating and cooling challenges  HIPAA  Recruitment and retention

11. 55,000-60,000 square feet in size. More focus on outpatient services Two operating rooms One endoscopy room Emergency room with six treatment spaces An expanded/consolidated imaging area 14 medical/surgical patient rooms Two obstetrical rooms Pharmacy Laboratory Specialty clinic Cardiopulmonary space Cardiac rehab space Dietary area New Facility ALL ON ONE FLOOR

12. Cost Estimate  Remodeling costs were equivalent to roughly 80% of full replacement.  The projected budget for this project as of July 2012 was $27,786,689  This figure does NOT include financing costs or required construction period interest  Assumes 17-month construction duration, and this was presented with an anticipated construction start date of Spring 2013

13. Financial Affordability

14.  County bonding capacity as of 2013 valuation is $2. 35 million  County bonding with a district would result in bonding capacity of up to $5 million  A 3-mill levy based on 2013 valuation), would generate $684,000  A 1% optional sales tax (based on sales from 2013) will result in gross proceeds of $333,153.76 Financial Affordability

15.  Hospital District  Consistent funding mechanism Provides improved strategic and long-term planning capabilities Large equipment purchases Bonds Cash flow Anticipated decrease in Medicare and Medicaid reimbursement Continued use, and potential increase in charity care and bad debt service (FY 2013 HSCMH provided more than $1, 423,447 in bad debt and charity care-$513,762 FY14 as of Feb)

16. Financial Affordability  Spreads support across all county taxpayers  Currently 16 hospitals in Wyoming are considered Critical Access Hospitals (CAH)  11 of these hospitals are district-funded facilities, including West Park Hospital, Powell Valley Healthcare, North Big Horn Hospital and South Big Horn Hospital  Improved support from State Land and Investment Board because we are taking steps to tax ourselves  Improved bonding capacity  Provides for ongoing operational needs

17. Questions? Additional Information Needs?