advanced notice of all the health care carriers. as we are entering them, they are getting the information now. with the exception of flexible spending accounts which we'll do in mid-december. we actually do have time. our biggest concern is the first pay period for 2014 because we need to make sure the deductions are correct and people have the right enrollments and right premiums. that starts december 20th. we want to make sure the confirmation letters are out and people may get there and they may need to call un. -- in. we are looking to have all the confirmation letters out before thanksgiving so they can take the 4-day holiday and look at their letters. we'll be working after 5 to get that

done. >> we are assuming it's beyond your control to influence the process of it being down. is that correct? is there anything that i can say publically that would help you? >> yes. it does impede us in getting things done and in answering questions when people call getting changes at that time. we have to save these types of changes to people's accounts until we are back up on a friday, for instance. again, this is active ccsf, cc and the retiree groups were able to enter. we were told by the controllers office that in time when they start narrowing that we'll be down for the payroll processing. >> will that be next year versus this year. >> they are telling us in 2015. >> 2 years.

>> dr. dodd, i think commissioner scott what you are asking is should the board make a request to the controllers office by next october. the processing, that we should be able to process everyday of the week at least from october 1st through december 1st. that should be one of the goals because clearly i know the last 3 years even before the people soft implementation, it required us to have over time which is an extra expense to the city and it certainly would save the over time dollars in terms of getting things processed and if we don't have it this year, we'll have over time as well. you have people working hard in the 85-day period and it's really unfair to expect them to put in

evenings and weekends because the city can't figure out people soft. >> if we are going to make a formal request, it maybe that it's completely down or maybe it's down for half a day versus the whole day. i recognize these systems implementations are always bigger than god. there are ways that we can say we want full processing everyday in open enrollment for 2013, but for 2014, we don't want to be down completely all day for two or three 3 days in a given week or two 2-week in a monthly payroll cycle; whatever it is. i think we should say something about it if we can. >> it's usually three pay periods in october. that makes it, so you are down, instead of

being down three whole days, you are down four 1/2 days. >> so, i guess i raise the question about how do we make a request to the controllers office? >> that is the question. >> can we request the director draft a letter for us to endorse? >> what do you suggest? >> we are using the right language. we don't want to in insult anybody. but there is an operational need that we need to address and that is a concern to our members and we need to express our views on that. >> well, i appreciate the board looking into that. >> thank you. >> the next item hs

communications. we had a video and it was a huge success and looking forward to doing more video communications. also i want to make sure that we talked a little bit about the member survey which is behind the first blue tab in your binder and it's a survey of what members valued most and what their concerns were and any other comments. i think what members reported valuing most was affordability, no. 1 was the most common. and also the security of having benefits for their family which is also i think a universal value. in terms of concerns it was cost and best doctors and best care. there is information here and

if anybody has any comments or wanted to talk about. but the other thing in terms of concerns was the retiree dental benefit which we heard and talked about which is not giving our retirees not enough coverage. we'll be talking about that in detail at the december meeting about delta dental and by our actuaries. and where the high tech is occurring and there was some very interesting insights into trends for 2013 self tracking the little -- and other devices people are going mainstream. i guess that's the word that people are using. and open data

for people to make better decisioning. that was a finding of 2.0. and employers are looking at wellness in a much expanded definition in stress and care giving and financial help in things that help employees be able to focus on work and not be having to deal with a lot of things at home. payment reform is another issue. then i thought the other part that they talked about it, health 2.0 was to think about the seven deadly since of health care. too much testing. management systems, electronic medical records that don't share data. that getting the message that it's not your data that you can't have it and that we don't do a good job in handling life care and families

members in that time of life. it was interesting to hear that technology was talking about that we all talk about in health care. i also wanted to mention the health care finances is completed and also in the wellness i wanted to point out that we did just a massive biometric screening at the hall of justice. 267 employees had bio metrics screening. what was important about this is that, i think this is in the slide in the wellness section, there were 361 people where their blood pressure was above normal. there was a lot of people that didn't know they had underlying cardiac risk who found out for the first time at this screening. this is an important kind of activity. it reminds me, we lost and amazing librarian last month. a

51-year-old woman who died of a heart attack. this kind of activities that everyone knows what their risk and labs are is important to prevent that. that brought me the importance of the wellness activities. i also wanted to point out the wellness resolution that is cl you had -- included in the packet itself. the staff, it's such a foundation component of wellness and looking at what the chp services should look like in the future and that's a rewarding activity to go through that. lastly i wanted to talk about meetings and presentations. we had at the board of supervisors on november 6th, there was a hearing on health care transparency. i was privileged

to be able to speak on behalf the joint labor management task force or transparency and accountability in health care which is a collaboration of many of our union leadership from the city and hsf working together towards the common goal on getting transparency around health care cost and health care quality and access issues. i think it was very rewarding to one, have this kind of a public hearing on such an important issue but also have some amazing speakers there talking about the challenges and how it is really the only way for us in terms of solving health care problems. last i wanted to mention a letter that was put into your packet late. this was a letter from local 21 thanking hsf for working on the contribution

models that will help support the affordable and sustainability. it was nice to receive a letter. it was much appreciated. any questions? >> i would like to thank the communications department for their leadership on the informal survey. as you know i had advocated more at our last meeting. i did have a chance to review the questions before they were sent out and i thank you for that. i think this survey should be a part of our on going process of outreach to try to get more firsthand on the ground reactions about what we are doing and my hope of course next year during the october hiatus that we may do

something more formal. thank you. >> dr. dodd? >> thank you, elisa. i wanted to just underscore one thing and thank supervisor ferrel for his leadership for calling the hearing on transparency and say we are the first local government to really tackle this and hopefully our leadership will have other local cities and counties fall into line. i think margaret's work with the treasurer's office on the healthy city and resolution by supervisor ferrel and passed by the board increases our liasons with the public employees. we are the leaders and it's great to be not only out in front but including other public agencies. i wanted to publically say when we were in

the old prop b hearings or c hearings, but the unions made it very clear that they didn't want to have one health care at the civic center, they wanted us to take things to them. we did four health fares and 17 flu shot clinics out and about the city in different departments is amazing. if we are not thanked by the people who asked us for it, i want to point out that we did it and saying thanks for responding to our request because we did it in a big way. lastly, it's listed in our report and i want to highlight the women's collaborative because you know the women's cancer rate of women firefighters is much larger

than the national survey. they received a $600,000 grant to do biochemical screening on 90 women firefighters and 90 women city employees who have similar demographics to the women firefighters. this will be the first in the country, probably the first in the world long-term study of firefighter chemical exposure and we'll be working on recruiting control subjects and did ask could they be commissioners, if the women commissioners wanted to be biomonitored in terms of what chemicals are in your body you are welcome to participate as long as you are over 18. i think, again it was the leadership of our department that pulled them together and got this started and got the huge grant. it's again the first in the country. if anyway

if our department is leading on transparency and looking at the risk factors and even in my absence, i'm really proud to be associated with our work. thank you lisa and staff. >> supervisor ferrel? >> thank you. thanks to katherine for the comments. i want to sup date everyone. i know there were a number of commissioners there. thanks for coming. we did have a hearing on health care transparency in the budget and finance committee that i chair. i just want to echo what catherine said and thank elisa and all the unions that participated in that and the care providers and insurance providers that came to the table. it was our talk

with kaiser that prompted all of this action. it's one whenever we all agree where data transparency is something that we believe going to the future is going to be a tool to help drive down health care cost. i will bring it to this body when i have it but we'll have legislation in the coming months that will empower the hsf board and the staff to demand if there are providers that want a contract with hsf in san francisco to require a certain amount of transparency and open data. it's going to be a good thing for all of us. i want to bring this back to this body for sure and thank you for your support. >> commissioner lynn?

>> i would like to acknowledge supervisor ferrel for his leadership and supervisor mar. i want to say thank you. >> dr. dodd? >> i just did one last announcement. on the tragedy in the philippines. if our department has circulated that and contributing through the sfgovtv.org website. please pick up one of those press releases and go to our website and contribute at this time. >> other comments? i would like to suggest anybody who has had a chance to read through this document that was presented at the transparency hearing. there is some really interesting statistics. one

that jumps out is the difference on the metabolic panel. $1700 in we are area and the lowest was $451 on another. a tylenol tab was no charge in one area and $7.06 in another. one tylenol tab. this is a real statistic and shows you the cost of things. i don't know if there is a copy of this out there for the public or not. yeah. okay. very good. thank you. that's all i have to say. >> i just wanted to give another personal example of the importance of transparency and the work we are doing. i am being treated as many of you know at stanford hospital and last week they insisted on

doing a pregnancy test on me. many of you know that i'm 57 years old and i'm a lesbian. although that's not entirely impossible. but i also had a hysterectomy in 1946. i said it's impossible for me to get a pregnancy test. i said, did he get one? she said -- no. he's a man. and he can't get pregnant. i said neither can i. we are paying $250 for that pregnancy test. somewhere those things appear and those personal experiences maybe anecdotes but enough anecdotes make data and there are going to be changes in contracting and other things that i have

experienced. good is coming out of my medical experience. i just wanted to share that. >> thank you. any public comment on this item? >> good afternoon commissioners. claire von'sky. retiree. i wanted to commend supervisor ferrel. i wasn't able to understand that hearing but a lot of good things came out of it. there was transparency legislation sponsored by leno and vetoed by governor brown and usually we don't get involved in anything at the state level but supervisor ferrel might have an ability to do more than rest of us and commissioners of this board and members of the department. but i wondered if there is any thought to reintroducing transparency legislation and bumping that up to the state level because that

would make a significant difference even in our process in what goes on here if that was a state level battle again. that's my question, thank you. >> so, thank you, claire. just to address your comments, i had the opportunity to speak with senator leno over the weekend at the veterans day parade and disappointment in the veto necessary legislation transparency at the state level. he's wanting to introduce some form of that next year. i'm certainly a great fan of senator leno and what we should take in mind is he said make no mistake about it what we are doing in san francisco is going to have a huge impact at the state level and his ability to be able to drive that back. so it's not just confined to having an in packet here in san francisco

but helping to push us at the state level in a very positive direction. so that dialogue continues. >> thank you. >> thank you. louis to the hotel workers union. you know, claire and supervisor ferrel said much of what i was going to say. our union was a sponsor of sp 46 and introduced by senator leno. i want to express our appreciation on this extraordinarily great issue. i also want to highlight the exceptionally great work of the deputy director gabby has led in her efforts at communicating your position and advocating the cause of transparency around sb 746. she did a really

remarkable job and in conversations with senator leno, other legislators as well as the executive bunch. it really has changed the character of the debate. in sacramento, i don't think many appreciate what we are facing right now. i think there is a real determination not just to move a redo of sb 746 but perhaps take it much bigger and i hope that will play out in the future. thanks to all of you and thanks to the deputy director. >> thank you. commissioner fraser? >> i want to commend everyone for the work on transparency but also want to remind us all that that is not the solution to the health care crisis. lest we abandon all other efforts

that the underlying disease on people is a major factor in driving health care cost and we should not let up in our efforts in that area as well, but thank you for the work on the transparency. >> any other comments? seeing none, item no. 4. >> the clerk: item 4 was covered in item 3. >> okay. all right. then item no. 5. >> the clerk: presentation of audited information for 2012-2013 pamela laufgey.

>> deputy director chief financial officer health care systems. we are going to review the results of the annual audit that is done of the trust fund by kp and g. we have a representative jamie coven from kp and g that was the partner or principal and they have an interesting structure at kp and g. we'll go over the audit and what they look for and what they found and i will go over the financial statement and where we end the last fiscal year. >> thank you for having me. my name is jamie cabin. i am a senior manager with kp and g and i will be presenting the

audit report for the fiscal year audit of the san francisco health and service trust fund. that's a mouth full of words. i will refer to it as a trust from this point. we have a powerpoint presentation to present here, but i believe you do have copies as well. so we can get through. you also have a copy of the financial statements audit report. so we will walk through that. this presentation will be a high level summary of the 2013 audit and will address the required communications to the board and we'll do a walk through of the audit report that you have there. the scope of the audit we will perform an audit to the

generally accepted auditing standards to make sure the information is free of mistakes and we audit to ensure the completeness and accuracy of the presentation with the financial information is also accurate and complete. so based on our audit work we issue two reports. we issue and independent auditors report on the financial statement of which we issued a clean and unmodified opinion for fiscal year 2013. you will see this on page one and two of your financial report. next we also issue a report on the internal control of the financial reporting and compliance in accordance with government auditing standards. this is a clean opinion unmodified of which we reported no

deficiencies and no non-compliance for the trust. you see this on page 20-21 of your report. in regards to audit results, based on our audit work we have identified three changes in the next fiscal year. you will see that management does an analysis which is on page 3-9 that goes through the variances over the past three 3 years and the actual statements are on page 10-11 of your report. once again we identify three of the most significant changes in the year. the first is a reserve for claims. this increase by 173 percent which was probably went from $9 million to $26 million. the increase was the blue shield plan from a full plan to a

flex plan in midyear. this plan incurred but not reported claims added $18.1 million to the account balance. next we have the premiums payable. it went from approximately $26 million down to $17 million. this is also due to the conversion of the blue shield plan to the flex funded plan. then last we have noted the city health benefit which is on the income statement as an income statement line item. it increased from $62 million down to $45 million. this is due to the movement of enrollment from the city plan to the hmo. according to a statement of audioing standard of no. 114 we are required to make specific

communication to this board. our first communication is our overall responsibility in accordance to the extent to design our audit approach but not for the purpose of providing an opinion on the operating effectiveness of those internal controls as you would do with the public traded company. next we design the implement audit procedures for the actual materials in the statement and finance statement and performance materiality and we do sampling. our test work is done on samples in the transactions. we do not do a hundred percent cast of all our transactions. next there are certain compliance, law provisions and contracts that could only have a direct and material effect