Cant go to the bathroom in the high schools because theyre so full of smoke. So how, in fact, are you going to operationallize the what the goals are here . If you can get back to us. So just to let you know, in terms of that specific topic, we presented an indepth presentation to the Committee Just a few weeks ago and so we can make sure that you have the slides, because that slide goes into detail in terms of our Tobacco Control efforts. The article is in press and hopefully it will come out shortly and well make sure you get a copy. Then im wondering, if, in fact, we are such a high rate of vaping in the state, that was of 2018 right. Do you think or you have been able to measure whether or not any of the information now being put out to this population has reduced the amount of vaping . Youre asking a really good question. I think i mean, theres two major epidemics and one is in ecigaretting and juuls and theres cannabis and people because the National Outbreak is primarily from unregulated cannabis products. And so both of these are happening and most people use more than one product. So oftentimes people are using both cannabis and nicotine. And so i think were just at the beginning of trying to understand how were going to deal with the nicotine. If when you look at the slides, you can see that we were really low on tobacco and all of a sudden, in other parts of the country its worse, its up to 14 kids. We do have a work group right now thats meeting to figure out what well do next and i dont have a good answer at the moment, other than the first thing actually, let me back up. The first thing well do is well implement the ecigarette ban just like for flavours and menthol, week implement the ecigarette ban because proposition c lost 41 and that allows San Francisco to move forward. Same with the mental and flavour ban, well do it with esignature repeats. Thats our major focus in terms of retail and access. Thank you. Commissioners, any other questions . Thank you, commissioners and thank you dr. Eragon and your leadership in the division. I think its important we look at not only the clinical side of the department but the Population Health side and one thing to emphasize with a focus on Behavioral Health and you see in the Health Impact six areas, Behavioral Health, historically, the department has not focus on the other hand a population approach to Behavioral Health and i think you heard them talk about that a couple of weeks ago. And dr. Eragon has brought his team forward to take an approach to across the department in approving our clinical system. So in hearing the questions about implementation in how one moves from point x to point y in terms of outcomes, i do wonder, then, this goes back to dr. Bennets presentation, having a little more detail about how that Blood Pressure goal was achieved and sort of the steps and the discoveries that were made across the organization over that period of time. I think that would potentially be interesting because i think the Lessons Learned that chart took a lot of work. I would like to say what gets measured gets managed and thats a part of it, but it changed the church and there were a lot of unexpected learnings in that process, as well. The commission looks and holds us accountable for the outcomes and taking the Lessons Learned and applying them from nicotine addiction to, you know, some of the Behavioral Health issues that well be looking at. Just as we often use hiv as being the forefront of teaching us how to do better, i think that the Blood Pressure success that weve had in the department, across our clinics, could really help inform some of these implementation questions that have come up today. So just a thought and i will certainly talk to the commissioners and mark about potentially putting that on the agenda if thats something of interest. Thank you, doctor. Maybe i ask a question. When do you think it would be best to come back to the commission with more specifics on the metrics . Im wondering a time frame. Either every six months or quarterly, whatever the committee likes. Some comes into the Public Health committee, too. Thank you. Thank you. Item 9 is the fiscal year 1819 Fourth Quarter financial report, mr. Wagner. Good evening, ill be brief. Im reporting on the results of our Fourth Quarter for the prior fiscal year. This one, our yearend report is later than the other quarterly reports but we have to go true the yearin closing process and the numbers are moving. And in case, w addition, we pust back but this is late and in some sense, no way around it. Our yearend bottom line is a 96. 5 million favorable general fund balance. There are a number of pieces that are moving around this balance, but there i this is a r overall and consistent with the reports at the second and Third Quarters. Weve had strong revenue, particularly at zuckerburg San FranciscoGeneral Hospital and we have been close to expenditures on budget, so this yearend performance really allowed us to contribute fund balance that went to balancing the budget and went to funding the improvements that we received in the budget for the current year and the upcoming fiscal year. So all of our Financial Performance on the budget Work Together to the citys benefit and the department of Public Healths benefit. And so we had a 96. 5 million yearend balance. That is net of 26 million of expenditure Carry Forward and were also depositing 40 million into our management reserve and that is 40 million of revenue that we budgeted in the current year but received earlier than expected. So rather than allowing that to just fall to general fund balance, we put that in reserve so that we can have it to use in this year, which is the year that the revenues were budgeted. And so when you net those all out, thats about an 82. 5 million number and we net that out so that you can see an apples to apples comparison in the Third Quarter and thats what you see on the second slide. So 82. 5 is the number to marie tcompareand were 9. 8 million r than we were at the Third Quarter report. So not a big swing, but it is a positive favorable. The Third Quarter was used to balance the citys budget and had an additional 8 million will be netted with all of the positives and negatives from other general Fund Departments and that will be folded into the projected deficit released by the Mayors Office in middecember for the upcoming budget cycle. So i wont go through all of these divisions in detail, because i know its late and a lot are consistent with what we saw in the Third Quarter. But our biggest net driver of our surplus is zuckerburg San FranciscoGeneral Hospital and that is in particular our net patient revenues and we saw and discussed earlier in the second and Third QuarterFinancial Reports that were significantly above budget in the revenues thats due to a couple of factors and the first is that our census has been higher than budget on average over the course of the year and so that means additional expense but also additional revenue from patient billing. And secondly, the pair mix of that revenue has been more favorable than budget and that means a higher than budgeted proportion of commercial medicare and medicale versus uninsured or lower paying sources and thats not a policy decision. Its the way that things just kind of vary overtime depending who comes through the doors, particularly in the Emergency Department and that is a little bit of good luck and then finally we have for the last year or so have had a little bit of a structural underbudgeting of revenues where weve seen sur mrs. Surpluses and weve made n adjustment and the mayor and board of supervisors submitted so we should be closer to our actuals in the upcoming year. Laguna honda had a 10 million surplus and thats due to hire than budgeted per per dium rate. Im happy to answer any questions but ill skill through the slides because of time and im just note a couple of things. Again, all of this has been assumed in the budget or will be assumed in the fiveyear Financial Plan presented by the Mayors Office later this month. We, despite having a significantly positive revenue bottom line, our expenditures are close to budget, for the size of the variance and expenditures were cutting it close and were watching that closely. We have a legally adopted expenditure limit in the budget passed by the mayor and board of supervisors and we have to live within that budget. So we are, i think, putting the right controls in place to make sure that we dont exceed budget and that were able to move funds between divisions as needed to balance across where our priorities are. And then lastly, as i said, we deposited 40 million into our management reserve under the admin provisions of the budget ordinance. We started with a balance of 80. 9 million and with this additional 40, well be at 120. 9. So that is, i think, over the past several years, a very positive Financial Development for us, both for the ability to weather revenues that are patchy over the years and also sets us up much better than we have been in plier years i prior years ine have a significant recession or largescale event affecting or finances. So thats a positive to manage our budget and be prepared. So i will leave it at that. Again, happy to go into more details o on any sections from e report. Commissioners . Commissioner chow. Thank you for another good year in reporting and improvingg clarity. What i wanted to ask was on the management reserve, is any of that part of and is to pay for epic or is that a separate fund that we have been accumulating . So thats a separate fund. So for epic, and i think what youre referring to is we did two things that were kind of policy decisions and preparation for our ability to fund epic and also guard against financial risk. The first was this management reserve and what this does is reserves against risk of future revenue loss or uncertainty and its not quantifiable to meet a reserve to go through and audit and its a judgment call, a management call about the risk. So weve established that. The second is the fund that we sed uset up for the epic budgetd we were to take a portion of that good news and move it into the epic project to help fund that and the two are related in that they both draw on favorable yearend news to fund future risk or the ehr as a priority, but they are separate funds. So under this, just to have one followup, then, nothing is going to epic from this surplus and its all going into the management reserve . Within the 40 million, its going to the management reserve and that will be in the management reserve. Within the budget that we have adopted and within the financials that you see in front of you, there is a transfer, a budgeted transfer into the ehr and we had budget and equal actuals. So we made a budgeted transfer into the ehr project but that was done through the regular budget. It wasnt doing this, take the yearend surplus and allocate it to the epic project. So that was already within our current year, the fiscal year budget. Correct. So there is additional funding. There is funding for epic that will sustain at this point. Thats correct. Within budget, of course. Thats right, yes. Thank you. Commissioner green. Thank you very much for the presentation. I just have one question for clarification. You know, weve talked a lot about staffing and especially as we expend the Behavioral Health services and there was a line in this report that said the department is taking additional measures to monitor and control spending, including additional approval for proposed new hires. I wonder if you could maybe explain that in the context to of our our underlying concern that we can have great programs but we cant fill the positions. Absolutely. Department wide, we had a Salary Budget of a revised budget of 746 million and we had actual yearend salary expenditures of 746. 9 million, so were essentially at our Salary Budget. And so what that means is not that we are restricting our reducing positions. It just means that we have to prioritize which positions we choose to hire so that we make sure were getting the highest priority positions build versus the ones that may be a lower priority. So we do have to abide by when the board passes a budget, we have to abide by the limits of the Expenditure Authority that were granted and we have a couple of tools tha tool tools. We manage across divisions where theres a surplus in one division that that allows flexibility to meet Priority Areas of hiring. The second is, a lot of the areas in particular with hiring that were talking about, the net impact is really not an issue on our financials and in particular, what im referring to with that, is that the hospitals, we have a lot of vacant positions but we have Staffing Ratio requirements and so we need to fill those shifts and we need to do it with permanent positions or with per diems or registry because we need to meet the staterequired ratio. In those cases, when were hiring into a vacant position, thats not costing us. Theres a difference between a permanent position and the registry or per diems but theyre similar and were aggressivery trying to hire into those positions because we want those positions filled and we want to have the stability and we want the opportunity to fill as many shifts as possible with permanent staff who are familiar with the hospital who are working regular shifts, et cetera. So even though were at budget, there are a lot of areas that were very aggressively trying to hire permanent positions within the budget that we have. Thank you. Dr. Kolfax . I just wanted to acknowledge greg and his team, leadership in this work. They make it so clear that they risk making it seem easy and its not. [ laughter ] and i just think that, you know, with regard to the financial stewardship of the department, greg and his team have demonstrated excellence in this area and i want to acknowledge that. Thank you. Thank you, mr. Wagner. Commissioners, other business is the next item . And just a reminder that the next meeting is at the laguna hospital and youre now at a vote for ajourning the meeting. Moved. Second. Second. All those in favour . Meeting is adjourned. [ ] i just wanted to say a few words. One is to the parents and to all of the kids. Thank you for supporting this program and for trusting us to create a Soccer Program in the bayview. Soccer is the worlds game, and everybody plays, but in the united states, this is a sport that struggles with access for certain communities. I coached basketball in a coached football for years, it is the same thing. It is about motivating kids and keeping them together, and giving them new opportunities. When the kids came out, they had no idea really what the game was. Only one or two of them had played soccer before. We gave the kids very simple lessons every day and made sure that they had fun while they were doing it, and you really could see them evolve into a team over the course of the season. I think this is a great opportunity to be part of the community and be part of programs like this. I get to run around with my other teammates and pass the ball. This is new to me. Ive always played basketball or football. I am adjusting to be a soccer mom. The bayview is like my favorite team. Even though we lose it is still fine. Right on. I have lots of favorite memories, but i think one of them is just watching the kids enjoy themselves. My favorite memory was just having fun and playing. Bayview united will be in soccer camp all summer long. They are going to be at civic centre for two different weeklong sessions with america scores, then they will will have their own soccer camp later in the summer right here, and then they will be back on the pitch next fall. Now we know a little bit more about soccer, we are learning more, and the kids are really enjoying the program. We want to be united in the bayview. That is why this was appropriate this guy is the limit. The kids are already athletic, you know, they just need to learn the game. We have some potential collegebound kids, definitely. Today was the last practice of the season, and the sweetest moment was coming out here while , you know, we were setting up the barbecue and folding their uniforms, and looking out onto the field, and seven or eight of the kids were playing. This year we have first and second grade. We are going to expand to third, forth, and fifth grade next year bring them out and if you have middle school kids, we are starting a team for middle school. You know why . Why . Because we are . Bayview united. Thats right. Good to have you here. Welcome. I am the s. F. O. Airport director. Thank you all for being here. Thank you. [ applause ]. Thanks so much. You know, its a pleasure to welcome everyone here today. This is such an important day and were so excited to celebrate this unveiling and recognition and commemoration of our late mayor. Were so pleased to have the family here of ed. Thank you, anita, to have you here, eds wife. Eds daughters tania and rihanna, welcome to both of you, and natasha, the granddaughter, is also here, welcome. Pansie for being here, thank you for being here. 94 years young and she traveled from seattle to be with us today along with other members of the family. I u