Think then clarifies can be easily read if were reading whereas for all United States wonderful thing and at the bottom say were adopting the principles it is more a for the most part and then also values dating them we didnt sort of pick them out of thin air theyre related to how you testify those are the histories this is where people are using weve found used intoxicate appropriate therefore wish to add do you want them and resolve that the you know bar and then comes the principles so that. Commissioner chow would you like us to come back with a form or like to approve in principle this and then we presents to you here on behalf of the appellant that shoulders we should come back with a better foreman. On the agendas well discuss that and vote. We have other opportunities. So i think this works. multiple voices . Whatever final copy well come back with a final opportunity. Exactly those were on the principles on which to half the department is operating the public should be aware were looking at the promises principles. Any further comments. The only comment i thought i cant remember this came out in the last two years something on the Public Health mission pushing and i cant remember if, in fact, there was a chapter in under that dealt with that on or about you may want to check that i could be absolutely wrong i didnt flag that that way. Ill look at that. It might be worth looking. Also the board is recommending this code or a code. My understanding it could be a coincide node specifically this one but this seems to be the one that is the most comprehensive in terms of it being able to give you lad it is the duty in specific practices. Thats fine. So i think those should be whereas. Okay. Any further comments. No. Precede to the next item. Thank you very much for the suggestion. Well look forward to be able to see the principles. Okay. Great. Thank you. Item 9 is a dph Financial Report and mr. Wagner and quick intervention. Trying to figure out commissioners this report is for discussion no action you need to take. Its barely show up on the screen. No, i, probably make it through here so long as the mouse works on the screen. Thank you. Okay. Commissioners greg wagner chief Financial Officer we have a presentation on our yearend financial Quarterly Report so this is a summary of our yearend general funds financial position as recorded front seat in the Controllers Office this is a little bit later than the Financial Report because of the yearend in particular we have to go through a longer process of crossing out the books it making takes more times for the fabulous to settle we like to wait when we can bring them to you when in their fully cut our big picture for the fiscal year 20142015 is very positive we had a good year we have a couple of of things going on were ending the year with a net general Fund Contribution back of 11 million however, this is necessary of an additional contribution to reserve or so that will remain in place and be a cushion against future losses the operating expenditures and revenues were favorable . Allowed us to meet your targets and allowed us with the Controllers Office to Fund Additional refers this helps u. S. Bancorp us to have greater Financial Stability as we go forward into the continued changes in under the state and federal policy actions so again as you can see how the highlevel of numbers breakdown on the summary table when you take our flat operating expenses and revenues we had a fractiously surveillance of 74. 2 million of that amount 63. 02 is programmed into those revenue refers so those are not directly returned from the general fund their withhold by the Controllers Office that is available to us if we have a shortfall in the future years. So ill cbo through quickly by divisions and happy to answer questions i dont want to spend too much time San Francisco general living San FranciscoGeneral Hospital had a net surplus as you can see a lot of things moving around and we have seen this over the last 18 months how we experience the projections are matching up to the Affordable Health care act and so some go significant changes we have our night patient revenues higher bin budgeted 10 we are budgeted significantly this, an increased medical rate for Eligibility Program that allows us to enroll people into medical and we get paid fee services that has been a big boob do your our fee revenues were below budget on a number of the state and federal Revenue Streams as you can see here theres a addition safety net care pool and shawl we see that every year in our Financial Reports thats the second and thirds line on this slides are tied together learner we budget a significant amount of excess Budgetary Authority in this case we need it to draw down the funds the supplemental few minutes we have a make a loophole expenditure that gets matches and comes back to us we dont want to run out of Budgetary Authority to risk noted drawing funds as you can see a shortfall in revenues but an expenditure savings that is equal and offsetting we didnt center to put that the dollars to get matches but not matched because not enough money to do that shortfalls in our revenue and significantly in our realignment dollars that are associated with the recoupment of the align dollars a significant on or about were going to be continuing to watch over the next couple of years. Laguna honda has a modest surplus because of revenues help at home a small surplus in salary and fringe that help at home is a deficit for years and theyve corrected that in the black now for several quarters in a row that is a big effort sow so were happy to see that and primary care weve got a 13. 2 million surplus two convenes one capitated revenues were underestimated and second a salary and fringe benefit savings we see at the end both of the hospitals and primary care we have salary and fringe savings we dont expect that to continue as for ramping up on capacity and process changes to streamline and expedite our hire so well be looking at that closely but i think that is a with time catch up as weve involved in our h. R. Systems to be able to fill vacant positions Jail Health Services is essential around budget another one has historically had an expenditure deficit so they have gone a long way to terminate that as well in our Mental Health division some significant variances but most of what those are are results of changes in accounting more than theyre an indication of something happening operationally within Mental Health a change in the way our interim payment are made starting in 20132014 so were essentially paid at a higher rate we had to go back and elevate when were audited and have a supplement on the audits whats your liability to have to repay some of the funds back to the state we went through and experienced this year and look at it did dictated and updated our revenue model weve gone back and addressed add additional revenues for 20132014 to cover ourselves if we have to pay back because the live payment methodology we will be able to pay that and wont come off our bottom line there is a significant savings the bulk is a settlement of an old costs report that allowed us to release expenditure dollars thats a one time widen fall because of the settlement in Public Health again, youll see that we have a realignment loss that ab 85 recruitment is splits within the San Francisco general and pushing youll see a little bit of it in two places and some expenditures savings on the salary does the bulk of that from delays in phil newest budgeted it positions again as we get our hiring rammed up wiener well see that decrease as were able to catch up on the timing and get those positions fills Substance Abuse a 5. 1 million surplus Substance Abuse favorable expenditures due to a higher cost settlement a one time savings well not expect to repeat so kind of in summary of where we are ill be happy to answer any questions but weve under a new reserve policy weve talked about at the Commission Part of annual appropriation ordinance approves by the board of supervisors too years we have been able to build up reserves that burglary protect us against this volatility in state and federal revenues thats a big priority for us just because were weve limited ability to manage on the margins when we have those big swings in the revenue over the two years ago weve now working with the Controllers Office set aside 92. Million that reserve so give us a level of comfort in terms of how we can deal with future losses issues that are driving the deposits into the reserve well be watching closely over the year we have a potential dislife without the possibility of parole significant disallowance of payments maids in prior years from sb 28 that reenforces on the laguna honda replacement project so we put marine corp money in reserve in case we have to pay that amount back we have a reduction in the deexpansion rates that is gone into effect over the last couple of months and again as part of the ongoing uncertainly over what the state will recoup and interacts the waiver weve estimated 27. 9 million potential liabilities that is referred for in the fund as well so again, it is a good year weve hit over Key Financial Targets a second year in a row watt the supplemental appropriation that is always worth mentioning after a decade of supplemental appropriations and weve started to establish mechanisms foreign dealing with the uncertainly this is a beg source of Financial Anxiety for the department so ill be happy to answer any questions and questions dr. First of all, thank you this is really a great written summary it looked at the late late night and it was clear and i guess two issues were demonstrating great fiscal maternities with the captioners under our control wear containing costs and staying within our projected revenues and we have mostly positive surplus on a management prospective thank you to everyone director garcia and mr. Pickens and everything and, of course, yourself doing all the direction and also on the reports side i it out you emphasized the drivers so want to thank you for making any late night really pleasance and im glad i was helpful and im sorry. You have to change the reports this is a change in the reports and i got it it was very nice the question with regards to the drivers that are sort out of our control i think the one in our control there is services and safety were doing great im worried about hundred Million Dollars the 5 percent of over total budget the state we might get it how do wells address that i know you have contingency reserves at the local level but are the counties together working at the state level to make sure that captation praits rates dont fall below what is reasonable and the realignment revenues flow and promised i guess i would hope we can get a better grasp of hundred Million Dollars i know you guys are doing if you could reach. Weve worked with all the hospital and other communities colleen is the policy director we have worked diligently working on many of the issues together but this is has been a historical process for the departments and having this reserve is won the abilities for us to be able to responds to those at times revenue comes in it could be an audit from 5 years ago so it is very volatile that is why within our goals and one of my dowels to have the reserve for the department which the city has allowed us to do to insure were not spending the same and dont have a reserve and all of a sudden the costs that come to us are revenue that comes to us we cant spend either we have to go through due process on a policy and advocacy level we worked with all the counties hand to hand trying to look at this week on those specific issues if you have questions about those specifics. One id like to followup this disallowance im not sure i understand what is disallowed we can here on behalf of the appellant and sure i can. Rather than less controls. Sure and just briefly to add to our director garcia one of the big sources ever uncertainty is the funds that come through the 1115 waiver our addition and safety net pool few minutes it is because theres a formula that ties us to the Financial Performance of ever on the one hand, other counties that perhaps one of the things weve been pushing as we go into the negotiation of the new waiver to create a system that gives us a little bit more certainty and control predictability abilities one day get a letter the estimate for your allocation has changed by 36 millions positive or negative and we react we have a little way of knowing that is coming this is one of the big policy and legislative concerns how can we work on the new waiver to make it a little bit more structured and predictable. On the disallowance of the sb 1228 that one really is more of a technical item were in the process of working with the state and frequenting to fought what our option to appeal that but basically what it is their is a state plan amendment approved some years back to allows us to draw federal dollars to grurms us for the debt service of laguna honda weve been working closely what the state to do that we recently were notified that under federal accounting rules that the way they view those payments are sense they were maids on Debt Services about patients occupied the new facility theyre not an eligible experience for reimbursements that is a technical urgent care policy interpretation that came down to us were in the process of really trying to dig through that and figure out you know what our options for appeal and build our argument were going to make our best effort to change that but this really is one of the things where this is from fiscal year 2005 through 11 the payments were made it is many years later and all of a sudden one of those things that gets caught in the federal audit process those types of things so many years worth of times between the point you get paid and final audit is closed we have some exposure of uncertainty about are we going to are a negative or positive audit settlement and align for those kinds of technicalth issues are really our best strategy to have a reserve in place you think about 2 million operating budget to essential be operating on no reserve which weve been up until two years ago it is not a viable place those are the two policy approaches to next the way the payments are made and kind of a financially plan in a 2 billion budget bound to be variations or various and how to create a modest and reasonable cushion so were able to adapt to the new items as and come. With the disallowance with a one time i mean were going to get it or not not a reoccurring expense from our budget. Correct Going Forward once the patients have occupied the facility the initial theyve race is no longer a relevant grounsz for disallowance. So what it it sounds those are parts of the audits and thats correct. And go on i want to comment i thought again and this is in the just this year this formats were using a steel helpful and continues to be transparent and allows us to understand even in the good years what is happening and the good news this is second year as you say makes for a much more sounds sleep at night. Absolutely laughter . Im sure in our case. Absolutely. So any further comments on this ends of our report. Ill note no Public Comment requests for this. I dont know from the director wishes to comment. As a historian in the Defendant Department it is a good year despite the fact of audit extension again this was a goal we had to have a financial reserve to be able to manage unforeseen issues and the fact that state and federal government do take time to process those audits, etc. And so we never know what is going to come we just get surprised but encouraged one day it is positive and now it is negative so this is here on behalf of the appellant will allow is a more stable prediction of our financing as you can see what we are doing well from the operational point of view the issues the federal government and the State Government that interest changing their direction how we get paid. Thank you very much. When the summer goes if were on time and on budget maybe we should be our own country and states of San Francisco maybe thats the solution. So move on commissioned to the next item is that all right. And, yes. Item 10 new bus. Equal i said to thank everybody for having participated in the planning i know that commissioner pating has ideas of trying to hem formalize some of the thinking for the future and the Public Health so i hope the meeting was helpful. It was helpful thank you to the department of Public Health and decreasing doctors i felt i walked awful u away from that briefing feeling for the first time i understood all the divisions and how they Work Together and the importance of them as well i think that will help us in our smaller committee. Thank you next items please. Move on to the joint conference and commissioner sanchez you have summaries in front of you, you from the accepts j. C. Meeting and laguna honda meeting. So the september 22nd meeting we looked at the Quality Management report a new format and he guessed were all trying to learn it. It had a very good update on the security