that. that's a big reason i'm here. beyond the drug dealers, the streets are still really filthy. i'm very curious to know what will be done to help clean up our streets. i would recommend that we have more bathrooms because the fact of the matter is that people need bathrooms. [applause] >> director, i think that's for you. >> thank you for your question. mohammed, public works. okay mayor, so you know our job is obviously to keep the city clean and the tenderloin is one of the toughest areas that we have to clean, and we put a lot of resources into the tenderloin. we have several partnerships with the hunters point family,

civic, the tenderloin c.b.d., we support all of them. the first thing in the morning, we clean the tenderloin. we have 16 blocks of people, doing over 40 blocks of cleaning in the tenderloin. we try to wake everybody up and make sure the streets are clean. our departments come in and they wash down. you see the flush come through. if you are in the tenderloin by 7:00 or 8:00, everything looks clean and then a few hours later, you see the decline. with the mayor's leadership, one of the things we started is an afternoon cleaning. we know towards the afternoon, once the soup kitchens are closed and everybody goes home, then you have a new type of activity in the tenderloin. we started to put some block sweepers out there and we have a number of steamers that go up and down the blocks and wash down many of the alleys, so that's happening on a constant basis.

we're taking 15,000 calls a month in the department and we're doing our best to respond to them as fast as we can. so, we're working, i think the way we're going to make the difference is having all of you make sure you call, you use the 3-1-1 number so we get the information and two, we need the partnerships. we need to get jobs for many of the people that are standing on the corners. we have been hiring for many of the non-profits, we have a great partnership. many of the people who are on the streets, if they get a job, they can change their lives. we know that, and we know that for sure because of the pit stop program that started 2.5 years ago, started by just hiring a lot of those people who are hanging out on the streets. we're over 24 now when we started with 3. we're working on more, and that's through the mayor's leadership. we heard you from many of the town halls.

we are trying to expand the hours of those people who work on the pit stops. we're working to make sure that those garbage cans are picked up as soon as they go out, so they don't stay out for extended hours so someone do i haves in -- dives in them and throws things all over the place. there is a lot of work going on in the tenderloin, and we're starting this afternoon shift that will really make a difference. towards the evening, there are not that many services and the mayor pointed that out, that need to have those services. we added more bodies in there and we want to make sure that everybody on the streets have a place to go before the end of the evening so it's quiet at night, and in the morning, we don't have as much to do. we're working hard at it and everybody is intg -- being

supportive, we're all working together to come in. at the end of the day, we can't allow people to sleep on our streets. it's just not right. we are going to do everything we can with the leadership of our mayor to make sure that everybody has a place to go if they're ready to go. [applause] >> let me just add, we are going to add more pit stops to the tenderloin because it's necessary and we're going to extend the hours because that's important as well. ame and just to be clear, not everyone who is unfortunately homeless, are the people responsible for all the trash on the streets. so part of it is that we have to also hold our communities accountable because when i'm out there, i mean every time i'm out there, i see someone just tossing something on the ground or there's a pit stop right here, and the guy is choosing to be out in the open, using the bathroom, you know, and out in the open.

you know, i had conversations with people and i grew up in a community that was not a wealthy community, but we took care of the community. my grandmother would make us clean up and pick stuff up and yell at kids all the time. i'm not saying that you guys yell at kids, but i'm just saying that part of what we have to do is also get back to some basics here. you know, this is our city, these are our communities, so there are responsibilities to keep them clean. yes, the city has a role and we are investing millions of dollars into the power washing, the streets program, they do an incredible job. i met this job in the tenderloin, he's on the poop patrol, he was so proud of his work. he said i was born and raised here, i am so happy to have this job. he says the pit stop is right here. i'm not saying that's the only thing, but there are a number of

issues that we're dealing with as a city that are creating a number of these challenges. so we're going to continue to investment and do our part as a city, and we're hoping that san francisco will do their part and use the trash and pit stop, and our responsibility is to make sure the trash is picked up and there are more garbage cans and more pit stops for extended hours so people have places to use. >> thank you mayor breed. another question that came from the audience. as you increase the number of cops and law enforcement, what are other mental health services and community based policing training that you are implementing?

>> thank you mayor, in regards to non-violent behavioral services, substance use treatment, we have a number of crisis intersection te-- intervention teams that are available around the clock, meeting people where they are, on the streets, in a home, other places, to provide them the care and refer them to wrap around services. so it's key work being done independently of law enforcement and with law form. we have a number of case managers that go out to follow up and if people are really severely disabled and need to go to psych emergency services, we provide the care and hospitals for folks, and long-term what's key, is we need to build a better system of care for people who need beds, to provide the detox or substance abuse

treatment, whether it's psych emergency room to community based residential care, and more importantly, reuniting them with support systems and their families so they can be taken cared of. and we're building a robust prevention system, so rather than having someone on the street that's having a crisis, that person can reach out to our crisis team, healthcare provider, or their family knows who to call so they can stay the in the apartment and get the care they need before things spiral downward. we have a lot of work to do and we need to build a system where every door is the right door for the individual, family, and the community, but we're building that out with the support of the mayor and there's more legislation going forward so we're able to provide people with the care they need. if we missed multiple opportunities, right now we have a number of folks who are cycling through our system, who

are simply not able to accept the care voluntarily that we can provide them. we have strong interventions that we can provide and with laws, we will be able to make a difference to be able to stabilize that person and reunite that person with his or her family, or chosen family, or biologic family to get the support. i think with the police chief, we are providing collaborative work so along with law enforcement, that there is as much as possible an option for people to go into voluntary behavioral health or substance abuse treatment, rather than going down a legal course, but if they go down a legal course, we will provide robust behavioral health services. so collaboration with chief scott, with other folks at the department with strong backing, to build a better and robust system. >> thank you dr. colfax.

[applause] >> just one other thing i'll add to dr. colfax. we have a program called the street violence intervention program. it started in the mayor's office and last year the police department took over, or at least a piece of that. what that really is about is services to address the many things that go along with violence. when a violent crime occurs, if you're a victim of violent crime, particularly homicide shootings and those things, this team comes together and it's a collaborative effort from across the city, and the department of public health is involved in that, and basically what we do is we try to address some of the things that are associated with violence, the trauma, the wrap around services that are needed when a family suffers a violent crime, and what we have seen and i strongly believe this is the reason that our crime rate overtime is going down. you have to think about the future when you're addressing

violence. when a 5-year-old sees violence in their family, say their brother or sister became a victim of violent crime. that does something. the trauma has a tremendous impact on that child's propensity to be involved in a violent crime. the street violence intervention program addresses a lot of those issues. i think it really makes a difference in the terms of the services, and it really helps in addressing some of the causes of trauma that lead to other things that are not good. so, this team with dr. colfax and the mayor's leadership, it really does go to the route causes of violence, and that team is very effective of what they do. [applause] >> thank you chief scott. we have time for two or three more questions, and so i'm going to take one in the back right now. there are some of the questions that we received in terms of individual housing responses.

i want to make sure some of those get followed up in detail with some of our folk from the mayor's office of housing who are here at tables. i'm going to take this question at the back, and make our way to some folks in front as well, okay? your welcome. >> good evening, my name is michelle, and i promised that i did not pay the last two speakers to say their comments, but i want to thank you all that are on the stage. i know you workday -- work day in and day out. i have to shout out treasure island, and i have to represent soma. so talking about prevention, and talking about trauma. we have one school in soma, it's a k-8 school, we have the highest number of homeless

students in the district, and 85% of our middle schoolers are reading at below or far below basic reading levels. that means they drop out. if they drop out, they're more likely to become incarcerated, more likely to be murdered or homeless. we have been so inspired by the dental clinic here and the change that it's made on the community. we would love to partner with the city to make bessie a trauma informed model with a school with a mental health clinic on site. our young people see traumatic things on their way to school. this afternoon, my daughter saw a woman dying on her way home from school. our young people are impacted by what's going on, and i understand that there are a lot of people in crisis, but that crisis is rippling out and causing effects to everyone in the community. we would love to partner.

i'm sad there is not a representative here from the school district because we have one school and we want to make that school the best school it can be. we would love to partner with you to help give our young people, their parents have been murdered or incarcerated and they need help. we can't expect them to be successful in school without dealing with their hearts. we love to partner with the city and the school district to make that happen. thank you. [applause] >> thank you. we had some questions up in front, do we have someone with the microphone. a question up front. i want to make sure it works. thank you emma. >> thank you so much mayor for being here, thank you captain up in tenderloin being here and matt. i seen things work here like community ambassadors. i am now a tender rep organizer.

now when i used to work in seneca, i saw this young ma that would work, help, and listen. we need more community ambassadors. we need more in the tenderloin, but not only in the daytime, we need them in the evening, and the afternoon, because our community is hurting like we say, we keep saying it. the police captain over there had a coffee and greet at the golden gate the other day and he really listened to our complaints. it was just a coffee and greet, he was there, his officers were there, and i felt that it was a good step forward. i do see an improvement in our streets. i do see an improvement in the city cleaning up our parking lot areas, but what i don't see is more visibility of community ambassadors that are on the streets, and the pit stops, not just open from day or the

evening, but even 24 hours. i have two dogs, i walk my dogs at nighttime because they have to go out. dogs go out and we have poop bags and stuff. i'm scared to go out at night. i'm a senior. i'm scared to go out because a drug dealer may get me, kidnap my dogs, but visibility of community awareness, like community ambassadors are so important. so i like to see you address that please. >> thank you for your feedback because we are actually as we speak are working on a program for ambassadors to have visibility. in fact, there are -- i don't know when the chief is planning to announce it, but there are a number of retired police officers that we are lookings as possible ambassadors to assist

in areas where we know there are a number of challenges. i do think -- it's not about again policing, it's about having you know, eyes and ears on the streets, and that is, for example, someone asking for directions, or someone who needs a helping hand, or anything at any time that, that is really a part of a community, having people who are kind of out and about who know the community, who's really looking out for the community. i do agree that we do need a robust ambassador program that will effectively support the community and it's something that we're working on as we speak. thank you for your feedback. >> deanthony, we have someone on this side. again, department heads will be able to be here until 8:00 p.m. tonight to answer any additional questions. for those who asked questions and they were not answered, they will be followed up on by e-mail and the contact information that

you provided so we can get you that information. thank you so much. >> good evening, my name is josie, i'm a t.l. resident. i am out walking around all the time. i walk to work, i walk to the goodwill, and i'm just picking up litter as i go. i want to mention that i seen a lot of empty store fronts in the community. i'm just wondering, is there an opportunity to open up these storefronts that are empty in the evenings, bring in the homeless, give them a place to sleep that's safe off the sidewalk, and the mental health we need during the nighttime. we need homeless advocacy, homeless, mental illness, everything, 24/7, we appreciate your help during the day and afternoon, but it's a 24 hour situation, and with these empty store fronts, we have

opportunities, so much space to bring them in off the streets. thank you. >> thank you. [applause] >> so from the office of economics and workforce perspective is that the hope is to fill those storefronts by investing in spaces, and close leases in those spaces as well, to make sure we have a vibrant environment both day and night. we can have the director follow up later this evening with you as well in terms of other ideas of services that need it the most or not. >> just a few comments. first of all, i want to thank all of you for your kindness and caring. sometimes we go to these meetings and we get a different vibe. i worked here in the neighborhood since 2000. i worked in the tenderloin before i took this job and we're opening our offices in the

tenderloin. i will be working in the neighborhood again in july. so we really appreciate your openness and we will on the first floor of our building have a storefront, but a lobby of our office will be a place for people experiencing homelessness can come and use the restrooms and talk to our case managers. as far as opening storefronts, the preference is to use those as businesses if they were intended to bring vibrancy into the neighborhood. we can look at that option, north beach citizen is a great model, using a store front to provide those kinds of services during the day. so it's certain his something that we can take a look at, but again, really appreciate your openness to those kinds of solutions in the neighborhood. [applause] >> great, thank you director. we have time for one last question, and i need to rely on

deanthony and emma to make this last suggestion. this woman in front has had her hand up for some time. >> thank you london breed and chief of police for being here. i live in an s.r.o. for the last 2.5 years. day in and day out i deal with the homeless people defecating, urinating, and at one time someone started a fire. they graffitied on the wall and not too long ago, someone died in front of the building. it's like people are walking by like he was asleep, passed out, or drunk. no, he died in front of my building. that took a toll on me. me going to the stores, like this one store across the street from me, the homeless people come in there, cause a lot of chaos, a lot of ruckus, they even urinate and defecate in front of the store.

it's unbearable and untolerable. the people do drugs right in front of my building, right when kids are going down and they do not care. what can you do? >> thank you, and i think part of what we talked about today are some of the things that we are trying to implement in order to address these challenges. these are not things that happen overnight. sadly, this has been occurring for far too long in this particular community, and my plan is to make sure that we are continuing to invest in resources that can help address these challenges. investing in the street cleaning programs, power washing to the sidewalks, investing more to public safety, investing more in housing, providing wrap around services, and i think one of the things that we didn't really

touch on tonight in any of the questions is the fact that sadly, so many people in the neighborhood are not only suffering from challenges with mental health, but also substance abuse disorder. the fact is, and i want to be honest because this is about having an honest conversation. we don't have all the tools we need on a statewide level to address what we know is a mental health crisis. part of what we're trying to do with our resources is look at changes and making the kinds of reform necessary to deal with that, and also people who sadly, their psychosis that develops because of their drug use. that's a whole other conversation. that's the biggest challenge we face as a city and those are at the route causes on why so many people are experiencing the

challenges they're experiencing, and we're seeing it play out on our streets in the south of mark and the tenderloin neighborhood. so, part of what we are proposing to do along with changes to our conservatorship laws, so we added mental health stabilization beds, and we're going to add another 100 this year, but as dr. colfax mentioned, we don't have what we need to force someone into treatment. that is a very controversial thing. people, of course, are saying that we don't want to take away anyone's rights. i agree, but right now we have a mental health hospital and it's called 850 bryant street. people suffering from mental illness are cycling in and out of our jails and that is not a solution. part of what we have to do is make some changes and we are looking at going to the ballot on a statewide level if we can't

get the support, not only from our legislators in sacramento, but we are also going to need support from the members of the board of supervisors here because we need to make the changes, we need to make the hard decisions, so we can get people the help and support they need, and sadly that will continue to be a controversial thing, but if we are not prepared to make the hard decisions, the challenges you see will continue to play themselves out. yes, we can investme more, and can do more in clean up and provide more housing and all of these things but we have a crisis on our hands that need to be addressed in a different way than ever before. dr. colfax was here and he played an important role in what was happening in the '80s during the aids crisis. the work that was done, the investments made from a medical perspective to help us get to a place, you know, where we have -- we're at a point where we are focused on getting to

zero and the fact that we only have a little over 200 new cases of h.i.v. last year demonstrates we can do it with the right investments. we need to do the same thing with mental health. that's what i'm committed to, to really try and transform the tenderloin community and our entire city for the better. so, with that i know our time is kind of running out, but i appreciate your response and we are doing everything we can, but there is going to be a lot more that needs to be done and lot of that is going to be very controversial, but it's going to be necessary if we're going to have real change. >> thank you, deanthony, i think we have one more over here. and then i'm sorry everywherone will have to close, but we will be available as department heads to answer your questions. >> so she has a question, she lives on eddie and jones street,

and there are many homeless people and human feces on the streets as well. they live across from the police station on eddie street, and outside of the apartment building there are homeless people sleeping, sometimes there are three our four. in the building, most of the residents are seniors and they're always scared. they hope that the police department can actually help out these homeless people to make sure that the street is safe and clean, so the question is to the police department. >> okay. >> yes, so we're definitely wanting to help individuals that are sleeping on the sidewalks, and it goes back to what was said earlier by the mayor and others. we're trying to do this as a team. we're trying to create space for

people to go, if they're not going to sleep on the streets, they have to sleep somewhere. while that's being done, we have the crew trying to keep the streets clean and the police department, our role is to really be out and engage with people and see if we can get them to a better place. we do leave -- lead with services, because we have to get services to get people off the sidewalks. we're all working hard to do that and as the mayor said, there's more to come, there's more to come. we should be able to do more as we get those services so we can get people off the streets. >> thank you so much chief scott and thank you everyone for being here this evening. [applause] >> thank you mayor breed for bringing this together in the tenderloin area. if anyone has a question they

haven't had answered, we will be answering through the e-mails you provided with the questions, and we as the department heads will answer any questions you have directly. we want to thank you all for being here this evening. thank you all so much. [♪] >> sfgov tv, san francisco government television.

>> the health services systems

board will come to order. please stand for the pledge. [pledge of allegiance] >> madam secretary, roll call, please. [roll call] >> item number 3, roll call, please.

>> approval of possible modifications of the minutes of the meeting set forth below, regular meeting minutes from april 11th, 2019. >> are there any corrections to the minutes? seeing none. wait a minute, i have to open for public comment. any public comment on this item? >> you need a motion. >> i need a motion. >> i moved to approve the minutes of the april meeting as presented. >> second. >> okay. i asked for public comment already. all those in favor? >> aye. >> any opposed? it is unanimous. all right. item number 5, please. >> item five, general public comment on matters within the board's jurisdiction. >> please come forward.

>> good afternoon, commissioners i'm actually here to request that in future agenda items that aren't posted, can you please put some way that the public can communicate with you? these are posted on monday or tuesday, and it is hard to write a letter and have it arrive at 11:45 a.m. by thursday, and there is no e-mail address or phone number for people to call and leave comments who aren't able to take time off to come here. it is just a request. thank you. >> thank you. any other public comment on this item? seeing none, we will move on to item number -- >> item six is the president's report.

>> all right. i would like to welcome mary how to the board. she was appointed by the mayor, and she is presently the director of human resources in run county, and has prior experience in san francisco. she was at the human resources department for san francisco juvenile probation, and prior to that at san francisco human resources department for the employment division. she comes to us with a lot of experience. thank you. >> thank you. >> any public comment on this item? seeing none, item number 7. >> item seven is the director's report. this report is given by the executive director. >> good afternoon, commissioners i wanted to start off my report by recognizing that may ease

mental health awareness month, and we have given you all green ribbons that you may where this month in recognition of that, and i wanted to use this opportunity to call out the services and the individuals who provide employee assistance to employees of san francisco. we have three employee assistance councilors that are under our purview, and they do an excellent job. two of them are able to join us today, and i wanted to recognize cathy newsom and jeanette who have been with the organization for quite a while and provide an extraordinary amount of services both on an individual counciling basis, as well as departmental consultation and training so that we can reach more individuals. i personally have had a lot of interactions with them, and they do provide a really excellent

service, and more recently, we have been meeting with our health plans and they have been helping us look at the mental health services that are provided by our health plans and that bridge between our employees in the services that our plans have. it has been a really excellent in-house consultation that we have available. i would like to ask jeanette and , to step forward, please. [applause]

>> i also wanted to comment on the fact that natalie helped us put together a really robust orientation for our new commissioners and i wanted to thank her for doing that. members of the management team participated, but boy, she pulled it together any quick period of time. the only comment is we needed more time. that was great. i hope that it is given a good footing to new folks. i recognize we didn't do that for you, supervisor madeleine when you came onboard, but we can figure that one out for you if you'd like. it was very helpful to put all the materials together and i emphasize throughout the process that we put this together and it was indeed an orientation. it was not a training and education, that would have taken

much, much longer. we hope we have provided you with the know-how know how to find information that you may need in the ensuing months ahead the third thing i wanted to call out that is not included in the director's report because we were just meeting on this matter this morning, but h.s.h. leadership team. as you know, we have been in the extended blackout period due to the current rights and benefits cycle for much of what you will learn today, and approve today in june for the health plans for plan year 2020, and we have been in the process internally of constructing a proposal to bid out the system to resolve a number of challenges that we face for the year beginning in 2021. am i getting my years straight?

okay. and what we have ascertained is that the marketplace is pretty unstable and there's a lot of change underfoot, and some of it may be resolved sooner than later, some of it maybe never, but i feel it is our obligation to inform the board of what we know about the marketplace and to have a better understanding of the problems that we are trying to solve four. what i would like to recommend to the board is that we have a hold on your calendars for a may 30th meeting. that is a placeholder should be run into delays with the rates and benefits cycle. assuming we don't run into any delays in the agenda today, i would ask we use that meeting to bring in a board education on the marketplace, and to help inform the board of what we are

understanding and seeing, and the questions that it raises. the second thing that i will have together to present at that meeting is a stakeholder process in which we will involve our members in really doing some deep listening, and to understand the wants and needs and desires of our memberships so that is taken into consideration as we then conduct a request for proposal, which would not be had until january of next year. we are slowing down the process in order to get better educated. the better we get -- and to ensure that we have a process that understands the huge variation in it needs that we have from our memberships so that we can you well advised when you go into selecting and designing the services that are needed. so we can visit, and i would

like to assume that at the conclusion of this meeting, should we not need the may 30th meeting for rates and benefits, that we would keep that meeting on the calendar for the special meeting of the board , of which we are required to give a ten day notice, which is part of the reason why i wanted to bring it to your attention now. we would put out the ten day notice on the 20th, and orchestrate that meeting on the marketplace at the time. any questions regarding that or anything else in my report? >> so that's going to be a board of education meeting? >> correct. >> in october we usually have a board of education. >> right, that would be a little late in the process for this. this would be -- yeah, at least i have tried to use any time that we don't have action items

on the agenda to educate the board, but this meeting would be solely for that. >> okay. >> i know i can't make the may 30th meeting that was held months ago, but i had already made plans. i think we will be welcoming a new board member on may 15th. >> yes. >> that person, presumably would be able to come. i am saying we need to make sure that the schedule is inclusive of all board members. i'm certainly dispensable, so i don't need to request that we look at it, but i would appreciate consideration to postponing it until another date >> thank you for bringing that to our attention. we will do some polling and determine a date that is suitable for all members. i do think it will be worthwhile to do that. >> i just wanted to thank you

for your hard work. the employee assistance program is one of the programs that gets barely noticed, but i think it is one of the programs that is very employee -- very important to employees. thank you. and to the director, could you just give us a synopsis of the enrolment for the benefits, and i think we need to reach out to the unions, most likely to let them know. >> yes, would you like to step forward and explain what we're doing with the voluntary benefits this month? >> i'm the chief operating officer of the health services system. the voluntary benefits that we rolled out to the city workers, all city and county employees, a couple years ago, and, you know, these are benefits like

supplemental life insurance, pet insurance, et cetera. so we were working with a company to do a mid year enrolment post tax benefits. they're not like your medical and dental and vision benefits, which are pretax. that can only be held in october so we're doing this mid year because they are very popular. to give an opportunity so they don't get buried in the whole message of october enrolment. we notified everyone, not only some of the labor organizations, but directors of departments and h.r. people. >> thank you. >> any other questions? is that the conclusion of your report? >> that's all for today. >> very good. any public comment on this item?

>> good afternoon, commissioners welcome to mary how, and congratulations. e.a.p. was very special to me for all the years i worked in the city, and i know jeff very well and his predecessor jeanne. this is really exciting. congratulations. i'm representing claire, and i'm representing a p.u.b. protector benefits question. we are getting calls from members who want to know about finding mental health councilors , and i guess some of the calls came in and they were told to call member services and health service, and i didn't know if that was the way to go, or if they should be calling their own hmo to find out what those contract relationships are , and with the lists are so that they can find a marriage councilors, or mental health

therapists, and this is specifically in the mental health world. since it is mental health month, we would like some guidance in what to tell our members when they call us, because we are not going to do any referrals. thank you. >> we actually are developing some materials that we will distribute to other departments, and we can distribute them to the associations as well, and to have access through mental health services. i think that is a fabulous suggestion. i see jeanette nodding her head. great. >> hi, i'm so happy that there is an and open enrolment program for voluntary benefits. i'm rather new to looking at this, so i'm wondering if there was a vetting process that the department went through so that we can trust, and i'm sure we could, that these are suggestions, but that they are

also, kind of, like beneficial for the workers who will have the opportunity to join. for example, i would like to know that what is offered by the organization is comparable to what my credit union offers me in terms of certain types of programs. do you know what i am trying to say? >> yes. the voluntary benefits are for active employees. there was a vetting process, a contractual relationship has been in place now for three years or longer. >> the work tara relationship originally was ebs, and it has been going on for a very long

time, well over a decade. they are the ones who set of these benefits. we work with them on the particular carriers and the type of benefits. two years ago when we rolled them all out to the city and county, we did a survey of employees to see if they would be interested in these kinds of benefits before we took on that kind of work. >> right. and we don't do comparables to other employers. thank you. >> any other public comment on this item? seeing none, public comment is closed. item number 8, please. >> item eight is the financial report as of march 31st, 2019. this presentation is given by pamela leven 11, the chief financial officer. -- pamela 11 -- pamela will even

the chief financial officer. >> that report you have in front of you act as expenditures and revenue through march 31st, as well as a projection through the end of this fiscal year. i will first address the trust. the trust fund balance, as of june 30th, 2018 was $77.4 million, based on activity through march 31st. we are projecting the fund balance to be $84.3 million at the end of this fiscal year, which is an increase of $6.9 million. overall, we are seeing unfavourable claims of experience for both u.h.c. plan and access plus. for the blue shield trio plan and the delta dental self-funded plan, the claims experience continues to be favorable. we received $1.7 million in pharmacy rebates from blue shield in march, at a total received year-to-date of $3.8 million. we still have a projection of

ending the year at $6.9 million. the healthcare sustainability fund is expected to have a year and balance of approximately $1.4 million. a total of 500 up -- $500,000 in performance guarantees payments have been received as of march 31st. as of today, we spent $105,000 this fiscal year for the adoption and serves as an assistance plan, which totals about $200,000 for when we first started it in 2017. i remember hearing that we might have a scene on me of adoptions and this just proves that we have not. it is a benefit that many employees are very appreciative,

and then the amount of shares for the benefit accounts won't be known until june. we continue with having the grass for each plot -- graphs for each plant showing cumulative expenses compared to the budget premium. as a summary, the cumulative expenses are tracking greater then the cumulative revenues for the other plan, and the cumulative expenses are charging lasts for both blue shield, access plus, and trio, as well as delta dental. based on the financial results through march 31st, we are projecting to end the year within the general fund administration budget at $334,000, primarily due to salaries associated with delays not in our control.

are there any questions? thank you. >> i don't thank you can answer this question, but i heard today that the government has decided that all advertising for pharmaceuticals on a per month basis or above a certain minimum level will now include the cost of that medication. the pharmaceutical industry, of course, as opposed to this because they say does not reflect the actual cost to health plans, and part of this is through the pharmacy rebates system. i'm wondering if you, or anyone has any thoughts about whether this move, which i think is a very positive move, may actually impact some of our balance in terms of pharmacy rebates in the future, or is it all just speculation? >> if you are referring to the

legislation, or the rulemaking that c.m.s. is making for medicare for the point of sale, it is the other one. okay. >> it is too soon to tell, probably. >> it is really complicated. i don't know that it's going to help anybody because what they may advertise as their price may not be what is negotiated with your plan, and it may not be what you pay as a member, so i think as we mentioned, we talked extensively in the last meeting with about the whole pharmaceutical situation. >> that was hitting the newswires first thing this morning.

there was certainly a lot of emphasis on price transparency coming out of washington right now for pharmaceutical ways. in this particular instance, all that i know from what i have read is $35 is the minimum threshold for a price to be disclosed and advertised i think we will all be very interested on what other specifics come out of the amounts in the coming days. thank you for raising the question. we will all have our eyes on what exactly this means. >> any other questions? any public comment on this item? seeing none, public comment is closed. now we will move into our rates

and benefits section of the meeting, and that will be item number 9, please. >> item nine, revised recent benefits calendar as of april 16 th, 2019, presented by the executive director. >> i think the rates and benefits calendar is discussed previously, and we may indeed be cancelling the may 30th meeting should we make it through this completed agenda. >> any public comment on this item? any comment from the board? seeing none, item number 10, please. >> item ten, review and approve the 2020 delta dental plan rates and administrative fees. >> mike clark from aon. good afternoon, everyone. i am going to present to you our

plan year 2020 renewals recommendations for all of the dental plans that are sponsored through the san francisco health services system. as an introduction, this has rating recommendations for both active employees and retirees with the demo plans. i will start with the delta dental of california active plan it is the one plan that is self-funded among the dental plans offered, so our recommendation will improve administrative fees and our calculated total plan cost rates the other dental plans are fully insured, and so the recommendations include those insured rates, and then finally, we also have a design change recommendation we are making on the retiree dental p.t.o., that is rate neutral, that is designed to encourage and increase the availability of

dentists. bottom line on top, obviously getting through the details next on page 2. there are five different recommendations i will be presenting to you today for approval. first with the delta dental active employee p.t.o., no change in administrative fees, at a five-point 3% decrease in the self-funded total cost rates for the delta care u.s.a. fully insured dental h.m.o. for active employees and retirees, no change in those rates. for the united healthcare interdental united healthcare interdental h.m.o. plan, a three % increase for active employees, no change in rates for retirees. for the delta dental retiree p.t.o., no change in rates. as he mentioned before, a recommended plan design change on our rate neutral basis that would increase certain aspects of the p.t.o. network benefits in return for an increase in the

individual deductible for certain elements of the dental plan, which i will talk about in detail later. we also found it would be helpful, as we discuss these recommendations, to understand what the distribution of populations are for both active employees and for retirees. so on slide three, just for background, you see the current number of employees and retirees in each plan aced on information that was presented by the demographic report in february. so i will move to page 5. if you recall, you know, this being a self-funded plan, and last year we also came to you and presented a three year administrative services only the