QuickBooks Online 2022, subaccounts, categories for fixed assets or depreciable assets, property planting equipment, PP and E. Get ready because it's go time with QuickBooks Online 2022. Here we are in our Get Great Guitars practice file we set up with the 30 day free trial holding down control, scrolling up a bit to get to the 1-2-5% currently in the home page, otherwise known as the Get Things Done page. Change to the accounting view it is something that you can do by going to the cog up top and going down below to the switch to the accounting view we will be toggling back and forth between the two views either here or by jumping over to the sample company currently in the accounting view. Going back to the Get Great Guitars going to open a few tabs up top by right clicking on the tab up top duplicating it back to the tab to the left right clicking on it duplicating it again we plan on putting some reports in those tabs as they are thinking. Let's jump on over to the other company so that we can look at in the accounting view where the reports are located which are on the left side under reports. Let's go back on over to the business views second tab the thinking has been done the reports are located in the business view in the business overview section and then in the reports closing up the hamburger report ranging changing up top from 010122 to 123122 and run it go to the tab to the right tab to the right go back down to the business overview and in reports closing up the hamburger open up the other the other financial statement report the income statement the profit and loss the P&L range change from 010122 this time to 022822 and let's see if we can change this to see the months so we can see the month by month side by side running it so we've got Jan, Feb, Tote and the side by side view we're currently working on February I'm going to go back to the first tab and note that down below we're focusing in on our fixed asset area down below now when you first set up a company file then QuickBooks will give you some suggested items for the fixed assets which could also be called property planted equipment or P&E and this is a good area for us to kind of practice alternative things that we can have with regards to the demonstration or the reporting of items with the use of sub accounts now with the fixed assets note that you're typically going to be tracking the detail on them with your accountant and the fixed assets themselves are an accrual kind of component so you might be saying I'm on a cash basis I don't want to do any accrual stuff but sometimes it's unavoidable and this is typically one of those times because even if you paid cash for like a building and you paid 100,000 cash for it and it was a business office building you can't just expense it for tax purposes typically you got to put it on the books as an asset and then depreciate it for tax purposes so the tax code if nothing else will not allow you to stick to a cash basis at least with regards to property planted equipment typically now the tax code is typically going to be different than what you would depreciate if you were choosing to depreciate under a method not driven by the tax code so that depreciation method that you choose to use for bookkeeping versus tax is something that you might want to discuss of course with your accountant but that leads us to the issue of doing this accrual kind of component to do an accrual kind of component it's a little bit more work we got to put it on the books as an asset and then we've got to depreciate it over its useful life we've got to track the assets then on a sub ledger which you would think then quick books would have a sub ledger to track the assets by the actual assets that we have but oftentimes we don't do that within quick books because it might be easier to do oftentimes is with tax software because there could be multiple depreciation schedules one of which we're going to have to do is the tax depreciation schedules which is better or more easily maintained with the tax software and we don't really want to do two quite complicated depreciation schedules that are into separate systems so oftentimes will be dependent on the tax software on the accountant to help us out with the adjusting entries with relation to the depreciation expense that we might do periodically at the end of the month or the end of the year using depreciation schedules we get from tax software often from a CPA firm or tax office so that would mean if we're going to use something like that which might look something like this then this being this the external schedules that we're putting together periodically every year or as we buy and sell equipment in alignment and with the help from our CPA firm and note that the changes in the equipment are not too many typically in the year we don't have a whole lot of things we purchase and dispose of that are really large kind of items so and all the stuff that's in the past is already on the schedule so we're really once we get the system set up we're looking at the changes which isn't too bad to kind of kind of adjust as we go so so then the question is well if you're going to be working with this external report from your tax from your accountant you'd probably like to set up your categories of fixed assets that line up with the categories that they're going to put in place on their tax software making the adjusting entries as easy as possible so in other words you the easiest thing to do would say i'm just going to make one fixed asset account and then i'm going to make one accumulated depreciation account and one depreciation account and just have all of my fixed assets kind of combined together in that one category however most people break out their property plant into equipment into some standardized categories and these are the ones you probably want to get from your CPA firm in other words how are you going to group the stuff on the sub ledger if i look at their schedule and they use furniture and equipment and then machinery and equipment for their categorization which is somewhat standard then if i go into my assets and i've got furniture and equipment instead of furniture and fixtures it might be a little bit more difficult for me to line up category by category the items that i have versus the other depreciation schedule so what i'd like to do is clean this up i'm going to say i'm going to make my categories line up to the categories that are on the depreciation schedule and i i then have the question of do i want one accumulated depreciation account or do i want an accumulated depreciation account per category which would allow us to then give the cost per category and then the accumulated depreciation and the book value per category and do i want a depreciation expense account that is just one depreciation account or one per category so those are so what we're going to do is i'm going to align this to the categories we have here and then i'm also going to make another depreciation account two depreciation accounts to line up to the two categories we have here on our schedule i'm going to adjust my balances to match the balances that are on my sub schedule here as you can see these items happened in 2021 these items are what we're saying that we purchased in 2022 the total cost on this schedule is 98000 for the category of furniture and fixtures and note that we're listing out the actual items here the sofas the chairs the recliners and so on and so forth that's going to be on the sub schedule which you want your tax preparer to list out properly because if they just put one lump sum of furniture and equipment and then just some big amount of 98000 when you sell something in the future they're going to have run into a problem because you only sold one piece of the thing that's included in that 98000 dollar amount and it's going to be it's going to be a pain to try to figure out how you're going to record that and then the machinery and equipment we've got the two items that we're have down here for the 5000 so i want to just tie up to the totals this total and then this total and then have the related accumulated depreciation accounts okay so that's the goal i'm going to go back on over and go to the first tab i'm going to be working in the gl so i don't want to do that in the business view i want to go to the accounting view to do that personally i think you uh that would be the way to go and then i'm going to switch go into the cog up top and switch it on over to the accounting view so that the business view when i'm adding and uh changing accounts does not drive me crazy i don't want to go i don't want to be driven to crazy the business view tried to drive me to crazy and i'm getting out of the car i don't care if it's going like 60 miles an hour whatever i've got my own car i'm going to go into the reports actually no we're going to go into the accounting now on the left hand side and then we're in the chart of accounts closing up the hamburger and then we're going to scroll down we're looking at the fixed assets area so the fixed asset there's our furniture and equipment so let's first change the name on that to tie out to what the tax software says which is which is furniture and fixtures and then we got this 98 000 in there also note that if you talk to your tax professional they might they of course have to do the depreciation schedule for the tax purposes and then they might have to do some different if you want them to have a different schedule for the book so in this case i i've recorded this on the books for a straight line method and if you looked at the tax code the tax code i have down here with using double declining just to see some of the differences but note that the tax code will also have like 179 and bonus depreciation which has nothing to do with bookkeeping it's just that's just what the tax law whatever they negotiated on the tax law so it has whole whole different kind of reasons as to why you're depreciating different ways on the tax code so you might want to then have a different depreciation schedule for the books which makes more sense for bookkeeping although that's more work or you can just do the tax depreciation and just say i'm just going to record my books on a tax basis those are the some things to discuss with your accounting firm and see and see what what they think is best so i'm going to use this one here okay now let's do it then let's do it i'm going to adjust this one furniture and equipment i'm going to hit the drop down and edit it and let's just call it we want this one to be furniture and fixture furniture and fixture not furniture and equipment furniture and fixture and then save it scrolling back down it takes me back up i'm looking for the furniture and equipment so i've got that one so now i got furniture and fixture and then if they have one down here for equipment notice they got this sub account i don't really want all this detail usually in my account quickbooks is trying i think what they're trying to do is trying to guide you to say hey these are the kind of things that you might need to basically capitalize but it gets kind of messy if you have all this detail on your books when you know you can have that it's going to have to be in these categories for taxes so so i wouldn't i'm going to not use those tools machinery and equipment so this one's pretty close but i would just like to call it machinery and equipment again i think they're trying to imply in the name the kind of stuff you should put in there but what i would like to do is tie it to what is on the depreciation schedules because that's what i'm going to have to tie to when i i report this to my accountant and when i do the the schedules and record depreciation so i'm going to edit this one and let's just call this one machinery and equipment machinery and equipment i think i'm kind of messing up whether i should capitalize the second word or not but i'll keep it at that and then i'm going to save it and close it so there's our two accounts going down if i go back down now we've got the machinery and equipment and and the other account of the furniture the furniture and fixture so those are the two accounts i'm using all these other accounts i might i might just like make them inactive or remove them let's go ahead and do that i'll just make them inactive notice that you might even if you're not going to use them at all you might try to change the name so it doesn't show up in some of the drop down lists when you're trying to record something because sometimes they still show up in the drop down lists so i'm going to say like this one all of these all of these i'm going to get rid of all of the sub accounts i'm going to make it and and it might cause me a problem to make this one inactive because there's sub accounts to it but i'm going to try to make all these inactive let's just do it i'm going to say this is going to be inactive and then yes and then i got to scroll all the way back down to do it again so i'm looking at the furniture and equipment this phone thing under the long-term equipment i'm going to make that inactive just make some of them inactive so it's not just a ridiculous it's just ridiculous furniture let's make this one inactive and then scroll down and then we're going to say that we got the furniture this one where is it where did it go where did it go custom this one let's make that one inactive custom software app i mean it's kind of a specialty let's make that inactive and then we're going to go back down and then this one copiers let's make that inactive and then let's go back down rolling back down and then long-term let's make this one inactive and now here's i'm wondering if they're going to allow me to make this one inactive because those sub accounts are all inactive but they still have sub accounts so sometimes they get picky with the sub accounts so let's go back to the furniture and equipment and we got the land then this one i'm going to try to make this one inactive inactive it's a you are you sure yes it did because i made all the sub accounts inactive good good that's good okay so then i'm going to go down so now we got the furniture and equipment machinery and equipment much easier to find and now i'm going to make a sub account for each of them that's accumulated depreciation accumulated depreciation so i think we've got one right here accumulated depreciation i want that to tie up to the furniture and equipment no i'm not going to i'm not going to do any adjusting entry to match my accumulated depreciation here here's the prior period there's the 75 right there we'll do another adjustment in the adjusting entry process to record the depreciation but for now i just want to say this one i want to tie it to the furniture and equipment so i'm going to edit that let's edit that and say i want to say this is now accumulated depreciation it's quite long so sometimes uh and notice it says accumulated de depletion i should have recorded depreciation accumulated depreciation instead of depletion it's going to do the same thing but i'm going to say depreciation and then i'm going to say that this should be acc i'm just going to call it acc d pre so i'll sub us and then i'm going to i'm going to make that for now notice you you might want you could use the full word because i'm going to make it a subcategory of the furniture and fixture but i like to actually put the name that the accumulated depreciation is related to because that makes it a little bit easier to see it and that makes a really long words so but i like to be able to see it furniture when i when i hit the drop down and fixture to record something so i'm going to say furniture and fixture so there we there we have it i'm going to and it's a subcategory so i'm going to save that changing the type or detail that's okay it shouldn't delete anything i have in it it'll just change it to another area so there it is now i got the furniture and equipment and the acc d pre let's see what it looks like on the balance sheet let's check it out see what it looks like run it and if i go down to these fixed assets there's the furniture and equipment and now i've got this amount under it now this three one oh three is uh is not correct now according to my data here it should be 98 and 5000 so that 5000 i want to break out into its own category so i'm going to do an adjusting entry to do that so i'm going to go back to the first tab and i can do that by going to either the furniture and equipment i'm going to do it with a journal entry because there's there's no there's no form that that's designed specifically to do that so i'm going to go to either the furniture and equipment or to the machinery and equipment it might be easier to go to this one because it's an increase so sometimes it's easier to think about the increase so let's go into the register here this is the register for machinery and equipment which is going to go up by 5000 i'm going to make a new journal a new journal and this is going to happen let's say it happens on uh o two let's say the end of the month o 228 22 so it's kind of like an adjusting entry and this is going to be to adjust the fixed asset balances to match depreciation category categories on on the depreciation sketch on the depreciation schedule or something like that it's going to be an increase of 5000 the other side's going to go into furniture furniture and fixture so we're going to increase this one and decrease the furniture and fixture so i'm going to save it and close it and then if i if i go to my balance sheet and see does it do what it what it should do let's run it again running it scrolling down and now we've got the 98000 that matches here 98000 for the total i don't need all this detail because that's that's what i have this sub report for but i want the categories to match up and then the 5000 matches up here so then i'm going to have another sub account for the accumulated depreciation which won't show up here on this report because there's nothing in it but i want to have it there so when i do my adjusting entries i'll be able to pick that one up so i'm going to go back to the first tab go back to my chart of accounts hold control get back to that 125 sweet spot and then i'm going to go into now notice we also could have entered that transaction by going into the furniture and fixture register and recorded the decrease on this side so i could have recorded the decrease for this one so let's go back on up top and then go back to our chart of accounts and now now i want to create another sub account ACC D pre for the machinery and equipment so i'm going to go back up top and say another account this is going to be a fixed asset type of account and a accumulated amortization i don't know why it does that on the default it should go here on the default i would think accumulated depreciation and i'm just going to call it abbreviated ACC D pre for and then for the what i call equipment machinery machinery and and equipment equipment and that's pretty standardized category so and then i'm going to make it a sub account of machinery and equipment so if you want to have the full word here you could just call it accumulated depreciation but then you're going to have two accumulated depreciation accounts because you can put it as a sub account and you'll see it a difference because it'll be the sub account but i like to see the actual name and the accumulated depreciation accounts so that helps me when i record the transactions so i'll save it and close it and then i'm going to scroll down and check that out check it out so there we have it so now we got the furniture and equipment and the ACC D pre the machinery and equipment and the ACC D pre there's no change on the balance sheet from that transaction because there's nothing in the the accumulated depreciation for the machinery and equipment so we still see we're still at the same spot at this point now the other thing we could make an adjustment to is we can think about the other side of the transaction which is depreciation expense which is going to be on the expense side of things and we might want to make multiple we can either have one depreciation expense down here or we could have multiple depreciation expense they might not have anything for it so they might not have anything yet we'll add that when we when we actually record the depreciation but the question is do i want one depreciation expense or do i want multiple you might in that case i'm almost i'm generally okay with just having one depreciation expense and just recording all the depreciation to the one expense unless there's some reason that it's it's useful for reporting purposes to break out the multiple different categories of depreciation because the depreciation expense will simply roll into like all income accounts to the retained earnings so unless it's valuable to me to see the different depreciation expenses broken out you can put them into one account it would be easier to do that's what we will do here so if i go then back to the balance sheet now we've got our information here and you can see in the fixed assets we got the triangle which represents all of the fixed asset type accounts both accumulated depreciation and the actual fixed asset accounts and then we've got this added subcategory and notice that by making this one subordinate to this one there's two ways we could have done this we could have made an overarching account called furniture and fixture and then the cost and the accumulated depreciation being sub subordinate to it the problem with that is that the because this starts with an a and we're not using account numbers then the a account would be first by using the furniture and fixture and as the parents and having this as the sub then it actually is in the right order which is kind of nice and so we've got this and then this and then that gives us the subtotal and then the machinery and equipment would also have the drop down if we had anything in the sub account which we created but doesn't have anything in it so that's going to be that's going to be the detail people often get kind of confused with the fixed asset how to break out the fixed asset how to match it up with your tax preparer what should you do with the recordings of it so if you get that down it helps out a lot also when they convert these acc accumulated depreciation accounts to like a trial balance or something that throws people off because it's a contra asset account so so it's it's good to you know get an idea of how how are people reporting this people can report it different ways get a get a feel for what's being done in whatever bookkeeping system you are using and and just have an understanding of how it works so we're not going to go to the trial balance because we haven't really made any changes other than just breaking out between these two accounts


Aftonoon, kaikkiaan. Olen vähän erittäin uusia, koska kaikki olet nativista englannista-sirjaa, ja en ole, mutta olen tosi, että oletko, jos sinä ymmärtää, jos sinä en ymmärtää, niin olen voittanut. Minä olen vähän ymmärtänyt ymmärrä. Tämä on ymmärrä, että tämä on universitettä, ja meidän mainita task is educate and do research and development and my special area is this research and development and the use of ICT online learning, online teaching. And a little bit where I come from. I live in Helsinki in south of Finland, but I work in Hämälina and it is 100 kilometers from Helsinki and this is very practical way to practice also e-working all the time. I don't want to drive every day to 100 kilometers by car. That's why I work quite a lot from distance. I have done it now 12 years in HAMK and also our university is located on seven different campuses. That's why also our teachers and staff all the time use quite a lot e-working methods. During my 12 and another 12 years I have considered this triangle and I have noticed that also in this conference you all consider which of these angles goes ahead and mostly we who are developing online learning and ICT methods we are criticized that we go always to technology shoulder ahead. So I have done also there were times when we developed and have done research on how to use learning platforms. Then came online meeting rooms and online classes, WebEx, ASDPE, Illuminate, things like that, Skype and we researched how to use those. Then came social media, again new tools and now of course everybody is considering how to use tablets and what is the most clever way to use those. In Finland we have used more mobiles, not so much tablets and you can understand why especially when you have read news what has happened with Nokia. Nokia didn't trust on tablets and that's why in Finland we more like mobiles. Now we start to consider. Perhaps we also need more tablets. When we consider this pedagotsi, of course there have been times when we have taught more when we use ICT that what is the best pedagotsical model is it action research or is it question based training or project based training or what it is. And then we also have had the times when we have mostly considered teachers and staff competencies. So teachers know enough how to use ICT and I believe that we have put thousands and thousands euros and pounds to educate our teachers to use these tools and technologies and develop the pedagotsical methods. Sometimes I wonder if I am very bad teacher. I have now trained 30 years teachers and I see the huge work in front of my again. What have I done wrong but I was very happy when I have now listened what happens in England. I am not the only one who has this problem. That's why I also have considered new teaching and learning methods and I must say that this morning when I listened Eric Mathieu I really was happy. I realized that I can agree all those things he told and actually I don't need any more speak about what is peer learning because he told everything I was trying to say and he have done it very perfect way. But I really consider if all the students achieve better outcomes when we use peer learning methods and why I am now concentrating on audit learning is that I have done now research during five years with audit students. I am not teaching very much. I instruct two courses per year. One for young students they are 18 until 24 years old and then all the people they are 25 and 65 years old between that but I have now during five years giving courses for all the people and I have done also research and I have developed this peer teaching and learning methods and I really wonder if formal learning is nowadays enough even for young people but for adults that that's any more the way to develop professional competencies and one research area is also how these new digital literacy skills are learned and taught. This peer learning it means for us mostly collaboration and communication and there are some elements which we really need that peer learning happens and the most important perhaps is trust and respect that there is the feeling that I can share my opinions I can share my knowledge, my wisdom I can share my experiences and also I can share my errors that's perhaps the most important thing that we also can tell that now I haven't managed very well and I have problem. Only if we share what we have done and we can also learn from each others and as Erik Matsers said we learn truth doing what others are doing that's the only way and when we share and we trust and respect it really motivates us and keeps meaning for peer learning and also then we are engaged we are empowered to do things together and this is quite exciting for instance with Elizabeth we have been peer learners now during 12 years and I believe that we have we are all the time in two roles we are evaluators and we are target of evaluation and it really demands that we concentrate on peer learning and we also stand if other people are not saying only kind things for us that's the best way to learn if I really hear what I can do and what I cannot do and where I can be better and so we learn to know or recognize what is important and we also recognize the quality and how we can use these high quality best practices in our own practice I call these best practices and quality that these are like sweet cakes different sweet cakes I can use and perhaps I can develop these then further and be better when I consider all as peer learners I don't know if they are different than young people but I have a feeling that they are constructs like in Finland we have summers and winters so also when we are peer learning with all people we have different experiences and attitudes and motivations needs and this really demands lot of discussions and trust that we can share ideas During last year I have done some online courses English online courses and there I found this 70, 20, 10 learning and this is quite exciting structure and with all students I really must consider this framework because that's true that our all students learning or studying during weekends and evenings they don't come very often to our campus and we ought to offer teaching and training and exercises, practices where they can practice the knowledge in their own workplace and we also ought to offer them possibilities to learn from other people that they are networks and conversations Charles Jennings hasn't he's not the father of this idea but I have listened him and found that he has very nice ideas you can find better more theory of this and how I have now developed this peer learning it's the course where we study various working methods and possibilities of new technologies and social media and it's five credits and at the beginning this course was compulsory the students they had possibilities through this but nowadays students have been so interested in this course that they demanded that everybody must go through this course that's why our students amounts have been increased and when we start the course we always ask what are their skills when they start and how they feel how is their online identity and this is quite exciting that nowadays most of the students they think that they have moderate skills there are some experts who already think that we know already these things actually we don't need anymore this course but I'm always amazed when I offer the opportunity that you can get the great if you just saw that you have these skills and all those students who tell that they are experts they want to stay and have the experience of this peer learning and all those who say that they are experts they are I must say almost always most enthusiastic that they have done this course because they have so much new things during this course and then there are students from many branches and I must say that people who are working on social and healthcare for instance and business they are very interested in these things but there are many engineers who say that I never will use any open tools and I never will tell that what I'm doing I don't go to Facebook and tell everybody that I'm reading the book or I have traveled there and there and when they realize that perhaps this is not only Facebook this is really the method to do networks those engineers who at the beginning was claiming that this is not important for them they have realized that this is just a huge possibility and it was just two weeks ago I received email from one student he had studied three years ago and he thanked me because he has now opened his own business and he told that this course was the beginning for the whole new life it was just I felt a little bit that can't be true but the self-organized learning this is the main focus in this peer learning these students themselves take responsibility for their learning and the idea is that they are working with other people and in workplace and not so much at the university and we have at the beginning the face-to-face meeting it's two hours till the main idea of what we are going to do but students don't need to come to campus we arrange also the possibility to do all this online we record all lessons and nowadays lessons are recorded ahead so that everybody can go through those recordings and all learning materials are open they are in Google Docs if you are interested in you can go and look what kind of materials we have we have also offered English course nowadays the materials also in English but I must say that it's better in Finnish because we now have developed it five years and I have very good teacher team I started alone then I there were one student who wanted to come with me and prepare some learning materials when we had English course there were five teachers offering this course you consider there must be a huge amount of money that there are so many teachers but we have such shared the money that everybody receives what they want and what they can receive they have special hours for that course but I must say that nowadays teachers also see that this is the way to develop their own skills and they are just interested to be in this course and develop their competencies the most important method is team project so at the beginning students form teams and they are working for five persons teams then we offer them online meetings and small group coaching and at the end they write a report where they tell what they have learned and then they reflect each other's reports and learn something more when they are giving this feedback and when I think this my triangle technology pedagogy competencies we have developed all the time new pedagogical methods and competencies and we have considered a lot of these technological issues in universities we have used quite a lot closed learning environments and tools then we have taken so called semi open tools to use but our students they really need these open methods so that they have possibility also form their own groups where they can discuss and do things for instance my students they have their own Facebook where they discuss and it's also easy way to receive the message to all students and one thing I wonder is that they have free hands but they have done quite well this course only few have finished the course and then they have had a good reason and I must say that at the beginning students are quite confused they haven't used to have so open possibilities because they have free hands but then they notice the idea and I think that they just empowered to do these things and I see that pure learning really works in this kind of courses and we develop it further but we need all the time new practices channels and networks, connections and collaboration and leading on all levels individual leading I must really know what I am doing team leading and then the whole organization needs leading methods that we can improve this pure learning thank you, that's all


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So it's eight o'clock, so I'm going to call the meeting of the Green Mountain Care Board to order. Good morning, everyone. I see that all the board members are present. I see that Alan Rick are here from UVM. So, Kim, I'm anticipating at some point, we may be asking Alan Rick some questions. So if you could swear them in now, we'll get that over with. Okay. Would you please raise your right hands? Do you swear the testimony you are about to give shall be the truth, the whole truth, excuse me, and nothing but the truth to help you God. I do. I do. Thank you. Okay. So good morning, everyone. We're here in a continuation of a hearing on a mid-year request for a budget adjustment from UVM Medical Center and from San Framont Medical Center. At this point, I'm going to turn the meeting over to Patrick Rooney. Patrick. Thank you, Mr. Chair. Good morning, everyone. Kim, can you hear me? I can. Thank you. Very good. All right. Good morning, board members, members of the public and stakeholders. As the Chair discussed, we're here to pick up our conversation for the mid-year rate request for the University of Vermont Medical Center and Central Vermont Medical Center here on Friday, April 8th. I'm going to move through some of the slides rather quickly because we covered this grounds just a couple short days ago. For the most part, there haven't been any changes for the bulk of the slide deck. If there's a particular slide that a board member would like me to cover in a little more detail, please speak up. I'm happy to do so. Recapping here, public comments received as of <IP_ADDRESS>. 58 in total, 57 here that the staff is categorized based on common themes throughout those public comments that were received. If members of the public want to read public comments, they can go to the public comment section of the Green Mountain Care Board for this mid-year rate request. Not all of these will be published should the authors have not given us permission to do so, but all of them were shared with the board. The comment missing from that categorization there is the response from the Agency of Human Services. Executive Director Barrett shared these points at the beginning of the meeting on Wednesday. I will not reiterate this letter is also posted on the Green Mountain Care Board website under public comment. Some of the quick considerations and following factors for the board in this process, this is something we've outlined in each one of the three mid-year rate requests that we've received thus far. We provided a brief overview of UVM's rate submitted and approved and differential and the NPR value of that over the last six years, and the performance based around NPR submitted, approved, and actual budgets for the Academic Medical Center. The request was received for both hospitals on March 18th. The reason for the request, as we all know, unanticipated demand for services, adverse effect, payer mix, and workforce challenges in recruiting and maintaining staff are causing budgets to be busted. These anticipated challenges are having adverse effect of operating expenses for the FY22 budget, which are nearly 93.3 million for the Medical Center in Burlington and 7 million for Central Vermont respectively. The result of this is some significant margin erosion due to these factors. The update based on that, there is a revenue budget miss that's occurring at the Medical Center by about 74 million dollars. Operating revenues are over budget due to receipt of the insurance from the cyber attack and also some unanticipated federal relief coming into the organization. The operating expenses are driven by workforce pressures and rising costs and are projected to exceed budget by 93 million dollars. The result of that is an operating margin of loss of 39 million dollars, which is a 90 million dollar variance from budget. Central Vermont experiencing similar financial issues here. Their reason is decreasing volumes of higher margin services, increasing average length of stay, cost inflation, and growing traveler FTEs and cost per FTE have contributed to the net patient face projected payments falling by 7.7 million. Operating revenues as with the Medical Center in Burlington are over budget due to unbudgeted federal relief, which is aiding and offsetting a portion of the rising cost and further constraining margin erosion. Operating expenses, however, driven by workforce pressures and rising costs are projected at 2.60 budget. And the result is an operating margin that's currently projected to be nearly a $5 million loss, which is a $7.6 million variance from budget. We can see here a quick recap of where the hospitals stand for approved budgets. The budget projection without the requests considered here today and the projection with the full 10% for each organization, noting of course that that is still budget misses from a revenue perspective for both hospitals. The financial impact here, MPR increase of $28 million over the current projection, mostly recaptured now patient services, net patient revenues are still projected to be under budget by 46 million. And if approved, the projected margin will fall to a $12 million loss instead of the $39 million loss that is currently projected. Central Vermont net patient revenue increased to 4.5 million over the current projection, mostly recaptured in the inpatient side. If approved, these revenues are still projected to be under budget by 3.2 million. And the margins will be significantly improved from the near a $5 million loss to just under 700,000 with the 10% increase. So I'm not gonna go through these, most of what we just covered is built into these next several Excel tables that were provided by UVM and Central Vermont respectively. A quick history of NPR, both as a projection here in 2022 and then projection with the rate adjustment. Again, we've covered that on Wednesday and briefly here just a short time ago. And the same for Central Vermont, that same perspective on NPR with and without the rate increase for the projection, the current projection for 2022. History of Days cash on hand for both organizations and average age of plant. Again, noting that we did not ask for a 2022 projection for age of plant for either of these organizations. So that's why we have that drop off there in 2022. Quick margin history here. UVM having several years of very solid operating margin performance going back into the mid 2010s. But we've seen that decrease over time here initially bottoming out with the pandemic year of 2020 in which significant pressures were put on the medical center up in Burlington. And then kind of a rebound here on margin for 2021. But as we discussed about a month ago, that's largely driven by the sheer volume of federal relief that the hospital received for the 2021 pandemic year. And then we have the projections and the projection with rate increase here at the very end looking left to right for the organization. Central Vermont, a very different story becoming a long history of operating losses. The projection for 2022, as you can see is not out of the context here as it relates to this history of loss, but the rate increase would produce a significant mitigate factor to the operating loss that's being projected at this time coming in just under 690,000 dollars. Five year history, UVM and CBMC for their change in charge are right with each other throughout 3.5% for a five year average and 3% for a median. And looking here at that history in more detail and what the approved 10% increase would provide for fiscal year 2022 as a base increase over 2021. A quick peer group comparison based on first quarter results comparing UVM and CBMC to their Vermont PPS counterparts here and then relative revenue and geographic footprint in the Fitch's rating solutions, bond rating information that we collect and some of the reasoning behind this request here and some additional questions from staff to follow up. Looking at the health networks, debt service coverage capacity and where the current projection would be and then additional losses that would have to be incurred to bring them into the consultant call and default level for their capacity of service debt. And at the bottom here, we have each hospital within the network's capacity to contribute to that debt service coverage ratio. And as you saw last Wednesday, we went through a brief overview here of where this net patient revenue impact is going to land for each hospital. I will not go back through all of this unless a board member wants us to, but you can see that for UVM and CBMC, it's happening in the commercial space and largely the outpatient space and looking at the gross to net versions across those various service buckets and central Vermont again, commercial space and largely in the outpatient space for net patient revenue impact of this rate request at 10% and then the gross to net for each one of those. So moving into the updated information here on slide 32, we wanna thank UVM for parsing out some of the information which we said we could not do on the Wednesday meeting. So we took a different approach at that time to our recommendation, but they provided us with a more detailed breakout of the information that we wanted to see. So we're gonna walk you through what was provided and our logic in reaching a revised recommendation based on the detail that we received yesterday. So this is the initial inflation table that the medical center provided for these major categories in their fiscal year 2022 budget. Relatively nominal impact here as originally intentioned and you can see the contract staffing line which has been kind of the cornerstone of this discussion had no inflation component built in for the medical center. The revised table yesterday provides a very different perspective in addition to the fact that upon breaking out the wages and compensation for their non-medical staff, UVM also broke out non-medical staff positions that are being filled by travelers. So these are vacancies at permanent positions that are being filled by the travelers. So if we recall, they originally budgeted for 80 traveling FTEs and their projection for fiscal year 22 is now 405 which is a 325 FTE variance. So they're using that variance there primarily to fill empty positions at their organization and we can see the inflation impact that comes with those 325 extra persons. It's a very significant figure here but they also broke out the contracted staffing as budgeted and the inflation factor that's coming with that. In addition to that, they updated their fringe drugs and supplies as well in addition. So what we did was we took a look at that and the changes and I'm gonna focus on the red fields first here because we have the built in wages and compensation. So the 4.8% increase you see is the variance between the projection and the budget. And that of course changes the weighted average for inflation on the right, the 1.5. The fringe drugs and supplies were adjusted similarly for what was originally budgeted versus what they're projecting. And that of course is gonna have an impact on the weighted average as well. So those four areas and then including the contract staffing travelers in the orange originally not budgeted, but however, the 1.2% is as submitted. So we're looking at those four or sorry, five categories respectively. And I'll explain why we're not looking at the large non-medical staff travelers filled positions as I walk you through our reconciliation here. So the sum of the adjusted red fields on the previous slide is equal to an inflation factor of 2.5%. The sum of the adjusted red fields plus the orange field is 3.7%. The addition of the orange field would recognize the inflation component of the originally budgeted 80 traveling FTEs. So that's the logic behind where we're going with our recommendation for the UVM Medical Center in that the unanticipated originally budgeted 80 FTEs have a significant inflation factor that was not able to be considered at that time with what the administration at UVM Medical Center knew or the health network. The other component is related to the unanticipated FTEs and the inflation factor tied to that. And that is a component that is going to ebb and flow as this year continues and as their needs go on and as they fill permanent positions over time as we know they've said that's their plan to do to lower their reliance on that. We wanna see that continue. And so that piece we're not willing to consider for our recommendation. But as I said, we are willing to consider the inflation factor of the original budgeted 80 traveling staff and then the changes that have occurred for wages and compensation for the non-medical staff, drugs, fringe and supplies. We apply the similar logic. Oh, sorry, I'll continue here. So now here we have a breakdown of those red fields, reconciliation showing the subtotal and then the contributing factor of the inflation for the 80 FTEs that were originally budgeted and we get to a 3.7% increase. UVMMC supplied us with the 1% value of this rate request over nine months and over six months. The six months would be if this is retroactively put in place for the rest of their fiscal year taking the April 1st to September 30th. And the nine months is if this is retroactively applied to April 1st through the end of the calendar year or the contract year that these rates would be in effect before they are renegotiated them in similar format and also considered the contract status component. So the sum of the red fields on slide 38 is equal to 2.7. The sum of the adjusted red fields plus the orange field is 3%. And the addition of the orange field again would recognize the inflation component of the originally budgeted nearly 16 traveling FTEs. Our reconciliation again, they've had lower than anticipated inflation on drugs. So that's a factor here mitigating factor to a higher rate but it brings that range between 2.7 and 3% if you consider the contract staffing component and then the breakdown and value of NPR for the same periods looking at these different rate options. So our staff recommendation for the medical center is between 2.5 and 3.7. I will say that the unanticipated contract staffing related to those 80 FTEs is very important. And so getting to a place from my perspective it would be on the higher end of this to pay respect to the fact that that has occurred in this healthcare environment. And I would say the same thing about the central Vermont medical center going at the higher end of the 2.7 to 3%. So that would also pay respect to the fact that there has been an unanticipated increase in that original budgeted amount of persons that they needed to provide care. So that brings us to the conclusion here. Here's the appendix for the NPR as we did the other day but that's our logic based on the materials provided yesterday by the UVim Health Network again. We thank them for providing that detail that allows us to provide a more quantifiable recommendation for the board this morning. So with that, Mr. Chair, I'll turn it back over to you. Thank you, Patrick. At this point, I'm going to open it up to the board for any questions or comments. And I'll go in alphabetical order starting with board member Holmes. Jessica. If you're talking, you're going to be on the board's mode and the hospital budget adjustment. And whoever is bleeding through, if you could mute your mic. OK, can you hear me now, Kevin? I can. Mark, it was you that was bleeding through. So hopefully you're muted now. Perfect. OK, go ahead, Jess. I don't have any questions for Patrick. I appreciate this analysis quite a bit. So I don't have any additional comments or questions. OK. Next I'm going to turn to board member Lange-Robin. Yes. So I wanted to start by talking about the retroactivity, which just in thinking about that piece of it, I had some thoughts about it that I wanted that I would welcome Mike or Russ chiming in on if they think I'm off base. I haven't really had a chance to deeply speak with them about this. So I just want to be clear that I don't think a retroactive approval is something that I'm comfortable with either legally or practically. We haven't basically, I think the request was in part from UVM, at least the justification, was that in order for the 10% increase to get to the result that they were arguing for, it would need to start April 1st. However, I personally am not comfortable with a 10% increase. So I think that argument then isn't as persuasive to me if the rate is less than 10%. So that's sort of the persuasive part. But I am uncomfortable with retroactive for a number of reasons. First of all, I don't recall us ever doing a retroactive approval. And while there's certainly, I certainly have not done a legal deep dive, there can be legal issues with retroactive, particularly when there are contracts in place. And we don't, we've not heard any evidence about the contractual terms, whether that's permissible, whether that'd be a violation of the contractual terms. In the utility context, it's my understanding that rates, there are some legal issues with setting rates retroactively. So I just wanted to put that out there that I don't feel comfortable with it. It would be a very big precedent. And I don't have enough of a legal analysis or justification for doing that to set that precedent. So if Russ or Mike think I'm off base on the legal side, I'd welcome their comments. But I certainly don't want to put them on the spot. The other practical letter is- Well, I don't mind putting them on the spot, Robin. I mean, that's what they're here for. So let's see if Russ has an opinion. Russ? Sure, thank you, Mr. Chair. I agree with Board Member Lunge's comment that I have some, I definitely have some concerns from a legal aspect that applying a rate increase to transactions that have already occurred could be considered some impermissible retroactive rate making. That is, there are some cases in the utility context that courts have found that sort of action not allowed by commissions with the authority to set rates. So it is not something that a court has weighed in on as far as I know in this specific context, but I agree with Board Member Lunge's summary that there are some definite legal concerns with that approach. And to that end, that's why the staff's recommendation is prospective and not retroactive. Thank you. So that was my first comment. I also have an approach for decision making that I'd like to propose to my fellow Board Members, which is that, and you're getting stuck now with my legal mind. For me, there's a threshold question of is a mid-year adjustment warranted in the circumstances of each of these hospitals, which I think needs to be taken separately. One decision for each hospital. And if there is a majority that says yes to that question, then I think it would make sense to get to a rate amount and a justification for that. So I know I wanna give other people obviously the opportunity to make any other comments, but I just wanted to mention that that is how I was gonna approach the motions, although of course other people are welcome to make motions differently if they would prefer. Thank you, Robin. Next, I'm gonna go to Board Member Pelham. Tom. Well, good morning, everyone. And thank you, Patrick and team, for this work over the last couple of days and thank the UVM and Central Vermont team for their cooperation. For me, as I said the other day, there are kind of two major forces at work here. One is this request happening outside the context of the needs of all 14 hospitals. And we've embarked on that process. Guidelines are available and issued. We'll be deep into it in a couple of months. And I just feel given the large impact of the UVM Medical Network, it's just important to kind of, to have the analysis and work done in the context that all hospitals have kind of an equal standing for access to additional resources. So that's number one. And number two is the context of healthcare reform that this request is happening outside the context of healthcare reform. There are a lot of major moving parts that we'll know during the regular hospital budget process, such as maybe the APM all-paramodal renewal document, the renewal of the Global Commitment 1115 waiver, the starting of the hospital sustainability plan. The legislature will have gone home. And so my thought is that, and this request is all fee for service. So it's trying to end something or it's supporting something that we're actually trying to diminish. So given that, that's what my feeling is. And but I do want to thank you for the effort. Thank you, Tom. Next we'll turn to Board Member Walsh, Tom. Thank you, Chair. Thank you, Patrick and team for the analysis, the depth that you've gone in a short period of time has been extremely helpful. I want to share Member Pellum's feelings about the direction of this. We're in an era of trying to transform more toward fixed prospective payments and staying within a budget. This is not aligned with those efforts. The claim that this is an unprecedented position for an organization doesn't bear out when looking at previous data. The organizations have faced losses larger than they're set to face right now and have a proven record of reversing those losses without any mid-rate change. So the situation isn't unprecedented. The situation they face isn't unprecedented, but the request is and the effect that it would have on Vermont businesses and Vermonters, that's unprecedented. I was willing to reconsider my position based on the new data with the inflationary tables, but I just didn't find that compelling enough to make any large changes. They were very diminished in the percentage coming from 10 down to 2.5 to three, retroactive or not. We're slicing and dicing, trying to find some way to do something, but I'm still not convinced that anything is needed other than things that have been done before to address larger losses. I'm also concerned with the precedent we had denied Rutland Regional. We're now looking at a different situation, different organizations that aren't in as strong a financial position that's evident from the data presented. I still don't feel compelled to move toward any increase. I agree with Member Lunge's approach. I hadn't thought of it quite that way myself explicitly, but I think that's what I've been doing internally. Is it appropriate to grant any increase? And then if that were moved seconded and a majority ruled, then thinking of what amount?  Thank you, Tom. I guess I'm going to start by saying the troubling thing here is that the impacts of our decisions could have an effect on Vermonters and one of the troubling things for me has been not an explicit threat, but almost an implied threat that the inpatient psych beds would have to be rethought. And so, Al, I'm going to put you on the spot and I know you guys were refusing to come in and talk to us about that project on the normal course of reporting, but I'm going to put you on the spot. Does even that inflationary increase that the staff recommended change any of the thinking that you are going through with your team at UVM as you move towards the future? Chair Mullin, thank you for the opportunity to comment on that and good morning to everyone. What I would say is that the losses that you see on what I think of his slide 19 from Patrick's work should concern every board member and every Vermont citizen, and in fact, everyone in our catchment area. They are not one year, they are a pattern, they are not something that's easily recovered from and we will have to do things in order to make our services aligned with our budget. That's all we're willing to talk about at this time, but this is a very serious moment. That's why we came for a mid-year request and we really appreciate the time to talk about where we're at and thank you. And unfortunately, that doesn't help me get to where I had hoped to be able to get to because I have a feeling that even if a request is granted to you based on what I'm hearing from my fellow board members, it won't be enough to stop some of the scaling back of what I think are essential services. I think that mental health has to be placed on an equal platform with physical health and I'm truly worried about where we're headed here and I do believe that central Vermont is a troubled institution that should be given the help because quite frankly, UVM should be commended for having build out two Vermont hospitals. And so I'm at the point where I'm still struggling here. I do not believe that the increases are transitory in any fashion whatsoever. Once you give someone an increase in pay that doesn't go away and in addition to that, we already know that it's a three-year contract. It's not a one-year contract. So yes, it's went up 10% this year but it's going up 5% the next year and 5% the following year. And that's contrary to what the historical pattern has been towards a more of a 3% increase. And I think that anybody that doesn't recognize the effect that the wage pressure has had on hospitals isn't seeing the bigger picture. With that being said, I'm totally opposed to a mid-year increase but there's a reason why there's the ability to come in in the mid-year and that's for an emergency situation. The question is, do we believe today that anything that we're going to do is going to change the direction that these institutions go in? And that's what I'm struggling with. So with that, I'll throw it over to any board members for follow-up comments or questions. So hearing none, I'll open it up for public comment. Does any member of the public wish to offer comment at this time on the UVM budget or the Central Vermont Medical Center budget? I almost said Central Vermont Public Service. Boy, does any member of the public wish to comment on these budget requests? Well, that is unusual. So Robin, I believe that you had an idea on how you wished to proceed. Not sure how helpful it'll be because I believe these are two separate requests but I'm willing to follow your lead and listen to what you have to say. Okay, so yes. And I think that we will deal with them as two separate requests for sure, we have to. So I'll just start by saying, for me the mid-year aspect of this makes it particularly challenging. And I know that in UVM's initial statement when they first came in, they indicated they were looking at this as a directional cue. I would just for myself say this is not a directional cue that I am giving in any of my votes today. It is the result of the fact that mid-year adjustments are just tough because we're asking folks who also have a budget for their health and care costs to absorb an impact that was unexpected. So the mid-year aspect of this is I think we've all said is very troubling and makes it challenging. The other challenging aspect, quite frankly, is the turnaround time is much faster than during the regular budget season, which makes feeling like you have full, accurate information more challenging. So with those comments, what I would do is move to approve, and I'm gonna do this two parts. First, whether we would approve any adjustment or not and then get to a number. So the first motion would be to approve a mid-year adjustment for Central Vermont Medical Center in an amount to be determined in a second motion. I'll second that. It's been moved and seconded to on the motion by member launch to really it's almost a polling of the board on whether to move forward with a mid-year adjustment for Central Vermont Medical Center. Is there discussion? I'll just say for myself, obviously I voted to deny a request for Rutland as a threshold matter for me. The financial situation at CVMC is what swayed me to move towards approving an adjustment. And Rutland was in much stronger financial position to weather the unexpected inflationary pressures. I do think that even so, this is a tough choice, but given Central Vermont's financial position, I do feel supportive of a mid-year adjustment. I too agree with Robin. I'm supportive of a mid-year adjustment to the rate ceiling. I'm concerned about their shrinking reserves. I'm concerned about their negative margins. I think the revised inflation tables validate permanent changes in their underlying cost structure, particularly compelling are the increases in wages that are not one-time bonuses, but the result of permanent increases in the base wage necessary to retain their critical staff. So I am supportive of a conversation about a mid-year adjustment for CVMC. For me, my vote isn't an indication of whether or not I feel that the need is there. I obviously do think that there's a need for resolution in terms of both the UVM Medical Center and at Central Vermont. I just think that isolating this is the wrong way to go and that we should deal with these issues in the regular budget process, where I may be supportive of some of this, but we should deal with it in the regular budget process and we should deal with it in the context of our efforts on healthcare reform, which are picking up momentum, speed and increases now seem to be quite contrary to the goals that we have for ourselves in healthcare reform. And I'll just respond to that, Tom, because I know that both the Toms have mentioned that. The states that do, of which there are only two other states that are working towards doing fixed perspective payments in a regulatory fashion, they do do mid-year adjustments on occasion in extraordinary circumstances. So I think it's a point well taken that the purpose behind the fixed payments is to live within a budget, but it's also not, for example, Maryland makes adjustments much more frequently with that to keep the budget sort of aligned. And in this case, the NPR is below budget. So if this, if we were Maryland, we would be increasing rate to offset the decrease in volume and we'd be doing that on a regular basis to keep the budget out of budget. So, but I recognize that for you, the mid-year aspect is troubling and is the deciding factor. And I totally understand that because that is a big challenge for me too. Yeah, well, I appreciate that Robin. And I'm familiar with Maryland and their approach and an aspect to this that we haven't discussed so far. I think there's been some talk around it, but moving toward a Maryland or Pennsylvania type approach to get at the first year calculation for that requires looking back over several years at what the base has been. The changes that we're talking about now combined with the last approval, some approval now and approval in the spring creates a large step baked into that base. And so I've just, I've wanted to come away from a denial. I haven't been compelled to come away from a denial. So I'm a no. Any further discussion? All those in favor of the motion signify by, oh, wait. Russ McCracken, could you please call the roll? Yeah, Mr. Chair. Board member Holmes. Yes. Board member Lunge. Yes. Board member Pellin. No. Board member Walsh. No. Chair Mullen. Yes. Robin, would you like to make another motion? I would. So for me in thinking about what rate increase ceiling would be appropriate, I very much appreciate, am I muted? No, but I'm just going to say, hopefully you are already doing this, but if you could just confine your motion to Central Vermont Medical Center. Absolutely. Yep. Absolutely. That's my plan. So, and I'm sorry, I'm looking back at the staff presentation on another screen. So my apologies if I'm looking a little funny. So I appreciate the staff and UVM working together to fill out the inflation tables as intended. To me, I, given the financial situation and the permanent, I think, nature of to your point, heaven, the wages and compensation for the non-medical staff, where I'm falling on Central Vermont is at the 2.7% rate increase. Again, because I am very concerned about the impact on Vermonters and employers and the unanticipated impacts to them. And quite frankly, I just don't have enough information about the contractual arrangements to know, which makes me want to be on the lower side. Also, in the motion, I just want to explain that the way that I will make the motion, recognizing UVMs and CVMC's responses about the need to then go to the payers and negotiate that I would make the motion that this would be the ceiling and that leave room for negotiation between the parties. So the motion that I will make is to approve a 2.7%, to approve no more than a 2.7% rate increase for Central Vermont Medical Center, which is tied to adjusted inflation to mitigate projected margin erosion and provide hospital leadership financial flexibility to meet the unforeseen circumstances related to workforce and other cost pressures. And that is for the approved fiscal year 22 budget. And Robin, just as a clarification, since I did listen carefully to your comments earlier, did you want to set either a proposed effective date or any language that prohibited it from being retroactive? So I think typically in order for it to be retroactive, there would have to be language directing that. So I think I would follow our normal practice, which is we don't typically include an effective date. Unless Russ or I would ask Russ McCracken without us putting in a date, when would it be effective? Could it be mid month or are we talking May 1st or what is happening here? When we do the budgets in the normal course of business, the true effective date is really the beginning of the calendar year, even though the hospital budgets are on a September 30th ending year. So Russ, if you could just tell the board what it means. Well, I think when the board does the normal yearly budget process, the rate increase is effective calendar year because of the contracts between the hospitals and the insurers, not specifically because of the board's approval of the rate increase. So I remember lunch is correct that a rate increase isn't retroactive and action isn't retroactive unless it's specifically stated to be retroactive. It's assumed to be effective the date that it's taken. So if the board were to approve a rate increase today, I would see that as effective, could be effective as of today. So it wouldn't be effective when the official order was sent to them. It would be effective as of the time of the vote. Just wanna make sure everybody's on the same page here. So there's no questions later, Ron. Yeah, the only other thing, sorry, Russ, I don't mean to jump in, but part of why I didn't pick a date is I don't know what the contracts say. The contracts may require notice from the hospital to the carriers, and we just don't know that. So I think understanding that there will have to be negotiations, I think the true effective date will be governed in part by whatever the contractual terms are, between the hospital and the carriers and couldn't be before today, but that actual date would be negotiated at some point after today. That's my thought, but Russ, feel free to contradict me if I'm wrong. I'm not hearing a contradiction. No, I was just pondering. I don't, I'm not contradicting you. I'm thinking if the approval is effective today or the date, the written order is issued, I'm candidly not sure off hand. It definitely, similarly, I don't know how that works for the hospitals under their contract with the carriers. That's a separate issue. I would, frankly, I would take it if the board approved this today, I think that is approval for the hospitals and negotiate the rate increase with their carriers. A written order would follow sometime relatively soon. Okay, is there a second to member Lunge's motion? I will second it. Okay, further discussion? Yeah, I would just like to add here. I would be very sympathetic toward working with Central Vermont doing the normal budget process. I do look here, I went back and I looked at the total operating margin across all hospitals for the five years from 2017 till now. And the total operating margin across all hospitals was $208.2 million over the five year period. Of that, the UVM Medical Center accrued 178.6 million and the network accrued 180.1 million, which is 86.5% of all the operating margin. But Central Vermont stands out. They were negative all five years. So again, I just like to emphasize that I'm more than open to trying to resolve these issues during the regular budget process. But this ad hoc situation just doesn't work for me. So that said, I'll be a no-vote. Thank you, Tom. I see that Rick Vinson has his hand up, Rick. Thank you, Chair Mollard. I just wanted to make sure, I've been just kind of sitting here thinking about saying silent on this issue, but I do want to make sure that I share this with the board before you finalize this discussion on the actual rate. Just obviously we haven't had a chance to review the staff recommendation, but I was hoping just to highlight one piece that I want to just make sure is that the board is aware. From my perspective, if we can pull up the slide deck again on slide 41, I just want to point out one. Okay. In terms of how the rate is being used here, where we're using the 2.7 and the 3% number, the inflation number to essentially come up with what the range or the rate increase might be. In reality, what should be used in those two columns is the actual amount of the inflation, so the dollar value of that inflation. That divided into what a 1% commercial rate increase equals is what should generate that percentage. So I just wanted to highlight that, not trying to influence in any way, I just want to make sure the record is clear in terms of something that I see in here in terms of the calculation that's been done for the recommendation. Patrick, any response? Was a late night. No, I don't. I was using the logic that we've used throughout the budget process in the past to gather the 1% value times the rate request to arrive at an MPR impact. So perhaps that would have to be a discussion that I have with Rick after any vote were to occur. Okay, is there any further discussion from the board? If not, Russ, I'm gonna ask you to take the roll. Member Holmes. Couldn't hear you, Jess. Yes. Member Lunge. Yes. The member Appellum. No. Member Walsh. No. And Chair Mullen. Yes. But the record shows a three to two vote for Center Vermont Medical Center. We'll now move on to the budget for UVM Medical Center. And the request for a mid-year adjustment. Does any board member wish to make a motion at this time? Go ahead and make a motion. So I am similarly troubled about the financial position at UVM because the days cash on hand are not in for me a spot where I feel comfortable where they should be for an academic medical center. It is our only academic medical center in state and there have been significant headwinds in their direction between the pandemic and the cyber attack and Fannie Allen and now the broken pipe. So I do think those circumstances have been hard to manage too. And I also want to recognize that the wage increases for staff retention again are permanent and so will have an ongoing impact. So with that I would move to approve a mid-year adjustment for UVM Medical Center with the rate to be determined in a second motion. I'll second. Is there any further discussion. Any further discussion. If not Russ if you could call the roll. Yes. Member Holmes. Yes. Member Lunge. Yes. Member Pelham. No. Member Walsh. No. And Chair Mullen. Yes. Let the record show the motion carried by a 3-2 vote and Robin are you prepared to make a second motion. I am and I my logic is is basically the same as for CVMC so I'm not going to repeat it. I'll just go straight to the motion which is to approve a 2.5 percent mid-year adjustment sorry an up to 2.5 percent rate increase to UVM's fiscal year 22 budget as a mid-year adjustment to mitigate projected financial erosion and provide hospital leadership financial flexibility to meet unforeseen circumstances related to workforce and other cost pressures. I will second. Can you repeat the number that you used Robin. 2.5 it's the lower end of the staff recommended range. Okay. It's been moved and seconded is their discussion from the board. I just want to say that I don't think that this solves the problem but it recognizes that the shoes that the people at UVM are in now given the nature of the pressures that have been put on each and every one of our hospitals around the state. They're not alone. And I think these pressures are being seen through by hospitals throughout the country and not just by hospitals by nursing homes and everyone else that's delivering health care and I'm troubled a little bit by the fact that I really am not assured that in order that was done three years ago by the board and was put on hold because of covid which is the site beds. I worry about where that's headed. I don't appreciate not getting answers to that before having to vote on this mid-year adjustment. So I just want to state publicly before voting on this that as the regulator I will be looking to hold the feet to the fire of making sure that new inpatients like beds get built and that the order from over three years ago is actually followed through. So with that is there other discussion. Is there other discussion. If not Russ if you could call the roll. Board member Holmes. Yes. Board member Lunge. Yes. Board member Pelham. No. Board member Walsh. No. And Chair Mullen. Yes. Now we will expect you to be in next week to do that quarterly report on the inpatient site beds. So I realize that you're still in a tough spot but all Vermonters are and we have to move forward and hopefully we can do this together. I don't believe there's any other business to come before the board today. Is there a motion to adjourn. Guess nobody wants to leave. So moved. Second. It's been moved and seconded to adjourn. All those in favor please signify by saying aye. Aye. Any opposed please signify by saying nay. Thank you everyone have a great day.


Footage released on June 7 showed severe flooding in Ukraine's Kursan region following the destruction of a major dam as rescuers worked to evacuate residents. The floodwaters seemed to be at least chest high in a video released by the Ukrainian Defense Ministry, inundated the streets while people sought safety on top of a truck and in a boat. Part of the rescue in the video posted by the military was also filmed and reported by local media. Several people were helped down a truck upon reaching drier ground where ambulances were stationed to help the injured. Ukraine and Russia blame each other for the collapse of the Soviet-era Nova Kukovka Dam on Tuesday, June 6, which sent floodwaters across a swathe of Ukraine's war zone leaving about 42,000 people at risk. Ukraine and Russia blame each other for the collapse of the Soviet-era Nova Kukovka Dam on Tuesday, June 6, which sent floodwaters across a swathe of Ukraine's war zone leaving about 42,000 people at risk.