One Team. One Purpse. Extraordinary Caring. Every Person. Every Time.

Annual Report 2018 - 2019

03 Opening Message Who we are 04 Leading Practices 06 Strategic Plan Update Niagara Health is on a bold new journey to create a healthier Niagara. 08 Proud Moments Our CORE values inspire us to be EXTRAORDINARY: 10 Awards of Excellence 12 Financial Overview Compassion in Action, 14 Senior & Medical Leadership 15 Board of Directors Driven by Optimism, Achieving Ambitious Results. We are a regional healthcare provider with multiple sites and a growing network of community-based services. Our team is made up of more than 4,800 employees, 600 physicians and 850 volunteers who we count on to deliver extraordinary caring to every person, every time. We provide a wide range of inpatient and outpatient services to more than 450,000 residents across Niagara, including Acute Care, Cancer Care, Cardiac Care, Complex Care, Emergency and Urgent Care, Kidney Care, Long-Term Care, Mental Health and Addictions, Stroke Care and Surgical Care. Our Accreditation with Exemplary Standing is a clear demonstration of our team’s commitment to the highest safety and quality standards. As a community-based academic centre, teaching and learning, research, innovation and partnership are propelling us as we imagine a healthier Niagara. Cover photo: Members of our Niagara Health Engagement Network are part of our team, sharing their experiences and perspectives to help us deliver on our commitment of Extraordinary Caring. Every Person. Every Time. Read more on Page 9. Thank you to our partners, Bob Asham, Kirtan Kadia, Susan Gibson, Rose Dzugan and John Storm, and to our staff, Director Zeau Ismail, Manager Karen Paschert, Registered Nurse Karen Buckle, Director Sonia Pagura, Registered Practical Nurse Tristen Castro, Nurse Practitioner Jennifer Lee and Registration Clerk Cassie Edgar, and physician leader Dr. Julian Dobranowski for being part of the photo. Niagara Health receives funding from Hamilton Niagara Haldimand Produced by Corporate Communications June 2019 Brant Local Health Integration Network. The opinions expressed in this publication do not necessarily represent the views of Hamilton Niagara Haldimand Brant Local Health Integration Network.

Extraordinary Caring. Every Person. Every Time. We know we applied learning, which will increase are stronger opportunities to improve the overall John Bragagnolo Dr. Tom Stewart Dr. Suzanne Johnston when we work health and well-being in Niagara and Board Chair CEO President together. beyond. We are also proud of the partnerships As we reflect on the last year, there we have developed with St. Joseph’s are many examples of how we are Health System, Canadian Mental working with our patients, families, Health Association Niagara and many partners and communities as one other organizations. team to provide extraordinary And our planning for the new experiences for the people we serve South Niagara Hospital is moving and create a more seamless and forward. Our Board joined more integrated system of care and caring. than 1,000 Niagara Health staff, We are proud of our leading work to patients, families, partners and partner with patients, families and community members at design community members, bringing their vision sessions for the new South perspectives to decision-making Niagara Hospital. The design vision through our new Niagara Health outlines the desired look, feel and Engagement Network. purpose of the campus and hospital, Accreditation Canada and Health and we are all impressed by the Standards Organization’s acceptance level of engagement from everyone of 17 Leading Practices for Niagara attending these sessions. We have Health is another source of pride and also received a lot of thoughtful demonstration of the ways our teams feedback on the design vision are positively impacting safe, quality through our online survey, and there healthcare. will be many more opportunities to Our Board of Directors’ leadership engage with our stakeholders on this has been instrumental in significant investment in healthcare strengthening our research and in Niagara. academic mission by further We are inspired by the work bolstering our partnership with Brock happening inside and outside our University. Our two organizations hospital walls to achieve our vision are collaborating in new ways to of a healthier Niagara. We encourage intensify our efforts in research and you to read on to learn more about these and many other impressive accomplishments. One Purpose. One Team. 3

LEADING THE WAY Our commitment to provide extraordinary caring to Ontario Telemedicine Network (OTN) in Mental Health and Addictions every person, every time is receiving national attention, demonstrating Niagara Health’s leadership in creating positive change in quality and We are using OTN to help connect patients through video to many safety. We received national recognition by Accreditation Canada of our Mental Health and Addictions programs. The network uses and the Health Standards Organization for 17 Leading Practices telecommunications technology to increase healthcare access for following a rigorous evaluation process. These practices are people- patients who are unable to travel to the sites where services are centred, safe and efficient, and other healthcare institutions can look offered. This innovative system was used more than 7,000 times to our practices to make improvements in quality, safety and the care over the past year for many programs such as remote outpatient experience. assessments, psychiatrist on-call assessments and various group Providing high-quality, safe care is the No. 1 priority of Niagara Health, therapies. It’s another example of how we’re extending care outside of and we’re very proud to share this summary of our Leading Practices. the hospital walls and into the community. Real-Time Patient Experience Surveying Our trained volunteers conduct surveys with patients in their rooms using a hand-held tablet. The technology, developed by our Information and Communications Technology team, allows us to understand the care experience for patients in real time and address any concerns on the spot. Psychiatrist Dr. Sachin Sarin using the OTN technology at our St. Catharines Site. Volunteer Bob Gosselin asks patient Joe Rosebourgh for feedback 4 on his hospital stay.

Dr. Hala Hamed, Occupational Therapist Anterior Hip and Early Ambulation Other Leading Practices: Michelle Lowry and Dr. John Song from Discharge (AHEAD) the AHEAD team. • Extraordinary U leadership program The AHEAD program is built around an • Fit to Sit for patients brought to the Emergency innovative hip replacement procedure that’s less invasive and reduces recovery time to Department by ambulance and assessed to be well get people back on their feet sooner. The enough to transfer to a chair instead of unnecessarily procedure was brought to Niagara Health by waiting in a stretcher Orthopedic Surgeon Dr. John Song. More than • Innovative Injury Prevention and Return to Work 600 procedures have been performed since the Strategies program launched in 2015, and we’ve seen high • Integrated Comprehensive Care for Chronic patient satisfaction levels. The AHEAD program Obstructive Pulmonary Disease and Congestive Heart is part of our continuing commitment to provide Failure patients that provides patients and caregivers high-quality, safe care. with one point of contact for all healthcare needs both in the hospital and in the community Members of our Port Colborne team wearing their pink shirts • Music and Memory program to increase quality of life to take a stand against bullying. for people with dementia • Pain, Agitation and Delirium Management in the Be Kind Intensive Care Unit to enhance the patient and family At the heart of our respectful workplace strategy is our Be Kind campaign, which experience has a clear link to our CORE value of Compassion in Action. This campaign, launched • Patient Flow Simulation to reduce Emergency in 2017, promotes a safe, respectful, caring and inclusive environment and includes Department overcrowding initiatives like Kindness Rocks, Pink Shirt Day and our Workplace Acts of Kindness • Physician Reflective Review Tool supports Challenge. So far, more than 25,000 Acts of Kindness have been performed across ongoing development and education of healthcare our organization and in the community. The Be Kind movement has contributed to a practitioners reduction in workplace incidents and code of conduct incidents leading to improved • Rapid Access Addiction Medicine Clinic provides engagement in the organization. assessments and treatment for substance use • Route NHS internal communications strategy to prepare for Accreditation in 2015 • Targeting Malnutrition Using the Integrated Nutrition Pathway which identifies at-risk patients and works with them on nutrition treatment plans • Three Wishes Program comprised of acts of compassion for ICU patients and families • We TOA for Physicians, a structured approach to improve the safe sharing and exchange of information during patient transitions One Purpose. One Team. 5

HOW WE’RE DOING: Extraordinary Caring Year 3 of our 10-year Strategic Plan We provide the highest level of quality care by advancing a culture of safety and service excellence. We target initiatives Rehab Assistant Shannon Finn, right, to impact areas like medication safety, patient flow and and Physiotherapist Kristi Zimmerman quality of care. Our We Round initiative has helped reduce help patient Violet Henry safely patient falls across the organization, as well as decreasing conduct her rehab exercises. the number of pressure ulcers acquired in hospital. We 6 continue to focus on making improvements with patient flow, as Emergency Department wait times and length-of- stay remain higher than our target. This work includes our focus on Transfer of Care, an initiative designed to improve patient flow and the patient experience. Initiatives • Patient Flow: Reduce length of time patients admitted wait for a bed. • We Round: Decrease patient falls and decrease hospital-acquired pressure ulcers. • Transfer of Care: Ensure safe and timely exchange of patient information among care providers. • Maintain Exemplary Accreditation Status: Develop and implement a patient safety plan, a patient, family and community engagement/experience plan, and an integrated quality management plan. We submitted a number of potential leading practices to Accreditation Canada and Health Standards Organization for national recognition – 17 of which were accepted. Decrease the Number of Patient Safety Incidents with Mild Harm and Above by 1%. 400 332 Target Current Increase Patient Safety Culture Survey score results by 10%. 48.2% 52.7% Target Current

Extraordinary Teams Extraordinary Future Extraordinary Innovation We count on our teams to deliver extraordinary By investing in our hospitals – through people, We will collaborate and try new ways to deliver caring and we are proud to work with the equipment and technology – and working the best care to our patients and their families. absolute best. Our teams deserve to work in strategically in our community, we will create the Integrated Comprehensive Care enables us a respectful workplace that fosters critical future our patients deserve. Interconnectivity to reduce Emergency Department visits, thinking and innovative ideas. Our most and innovation are key to achieving this future. readmissions and length-of-stay for patients. recent employee engagement survey saw our Development has begun on the Niagara Health Bundling care for patients with hip and knee highest-ever response rate with more than Navigator, Ontario’s first digital health ecosystem injuries is another way we have reduced length- 2,300 employees and physicians sharing their designed to protect patient privacy and security of-stay and readmission rates. Niagara Health vision for engagement. Both employee and while connecting patients to their health data launched the Wellness Recovery Integrated physician engagement scores have increased by and to care providers in the region. We have Comprehensive Care Program in Mental Health more than 50 per cent since 2014. Unit-Based made progress in planning for the South Niagara and Addictions to help people fully understand Teams empower staff and physicians to make Hospital, which includes outlining program and their mental health needs and identify and improvements within their own areas of work. service requirements, equipment and space develop strategies to improve their wellness. This Our grassroots Workplace Acts of Kindness needs. Taking care of the people who work here will help reduce readmissions to hospital and Challenge reached a major milestone of 25,000 is also a priority. Progress continues to be made visits to an Emergency Department for non-urgent acts of kindness performed by 25 departments in reducing sick time and workplace injuries mental health concerns. across the organization. experienced by staff, physicians and volunteers. Initiatives Initiatives Initiatives • Integrated Comprehensive Care: Decrease the • Unit Based Teams: Increase the number of • Come to and Return to Work: Reduce sick time number of Emergency Department visits and ideas implemented per unit-based team. and decrease preventable workplace injuries. times admitted, as well as the length-of-stay in • Healthy Teams: Decrease reports of negative • South Niagara Hospital Project: Submission hospital, for congestive heart failure or chronic interactions in the workplace. of plan detailing the programs, services and obstructive pulmonary disease, and mental • Leadership Development: Leader satisfaction resources required at the new South Niagara health and addictions patients enrolled in our with learning events/programs. Demonstrated Hospital. Integrated Comprehensive Care programs. use of new skills and knowledge. • Clinical Transformation: Implement Year 1 plan • Innovative Care: Develop and implement for a new electronic health record. a mobile app, and pilot one innovative Achieve community average staff • Clinical Trials: Initiate three new clinical trials. technology. engagement score of 66% from 65.3%. 66% 64.7% Fiscally sustainable plan that ensures Sustain and expand innovative a balanced budget that includes care model from 2 to 6 Target Current $8 million investment in education, technology, research and capital. Sustain community average physician 6 4 engagement score of 71%. 0.62% 1.26% Target Current 71% 66.7% Target Current Target Current One Purpose. One Team. 7

EXTRAORDINARY YEAR Photo by Owen Thomas, Hamilton Health Sciences We’ve had much to celebrate over the past year and we’re pleased to share some of our proud moments with you. Working together Three-year-old Lucas Waring of Welland was the first patient to benefit from the Pediatric Tele-resuscitation system, our new partnership with McMaster Children’s Hospital. This first-of-its-kind system in Ontario uses video conferencing-like technology to allow emergency teams from Niagara Health and McMaster Children’s Hospital to remotely work together to care for pediatric patients who are critically ill. 8

Niagara Health Board Project Director Mark Rajack, left, and Chief Ontario’s first digital Chair John Bragagnolo Information Officer Sime Pavlovic are driving the health ecosystem and Executive Vice- creation of Niagara Health Navigator. President Angela Zangari We teamed up with sign the Memorandum technology partners of Understanding with IDENTOS Inc. and nCipher our partners at Brock to develop Niagara Health University. Navigator. This mobile application is designed to protect patient privacy and security while connecting patients to their health data and care providers. Improving health and well-being New shared location Our new partnership with Brock University places a heightened focus on We opened our new shared location research that will help people stay healthy, improve both patient outcomes with Canadian Mental Health and the way healthcare is delivered, and create training and employment Association Niagara at 264 Welland opportunities for Brock students and graduates. Together, Niagara Health Ave. in St. Catharines. The new location and Brock will build on existing research, creating innovative ways to answer offers programs previously provided by important questions that will improve the health of our region. our Adams Street Addiction Services and CMHA’s services in St. Catharines. International recognition Partnering under one roof improves for Niagara Health team care and access to mental health and addiction services for Niagara residents. Our Difficult Airway Program was highlighted at the Difficult Airway Unique approach to patient, family engagement Society’s Annual Scientific Assembly Research Day in Scotland. The pathway was created We have done a tremendous amount of work to make our Niagara Health by our team to treat patients with a Engagement Network meaningful and authentic. Our network provides Our first-ever Research Day was compromised airway in the fastest, opportunities for patients, families and community members to share their a huge success. More than 100 safest way possible. time, experiences and perspectives and help us make improvements in quality, researchers, students, academics safety and the care experience. Patient Partners choose the initiatives they and healthcare workers came to Top Employer work on based on their knowledge and experience. our St. Catharines Site to learn about medical research being done We were named a Top Employer Over the next three years, we will have a team of 75 Patient Partners. We look in Niagara. Dozens of researchers in the Hamilton-Niagara region forward to welcoming people from various backgrounds and experiences to also competed in a research poster by the editors of Canada’s Top 100 diversify the network and accurately represent the needs of our community. competition. Employers. This special designation We are indebted to all of our Patient Partners for their passion and willingness recognizes employers in the to contribute to a healthier Niagara. Hamilton-Niagara area that lead their One Purpose. One Team. 9 industries in offering exceptional places to work.

RECOGNIZING EXTRAORDINARY PERFORMANCE Niagara Health’s Awards of Excellence honour individuals across our organization for their commitment to our Purpose, Vision and Values. In addition to the President’s Award, which recognizes overall extraordinary performance, six awards were presented to valued members of our team following a formal nomination and selection process by their peers. Compassion in Action Award Driven by Optimism Award President’s Award: Extraordinary Performance Trillium Unit Team Sandy Harte | Welland Site Greater Niagara General Site Wellness Nurse, Occupational Dr. Melanie Senechal l St. Catharines Site Complex Care Unit Health and Safety Physician, Emergency Department The Complex Care Unit, known In her role, Sandy lives and breathes Dr. Melanie Senechal is a leader in her professional field and as the Trillium Unit at our Greater compassion and caring. Sandy assists in the Emergency Department (ED) at the St. Catharines Niagara General Site in Niagara Falls, staff through difficult experiences Site. She has positive energy and an optimistic outlook that discovered that a patient’s wife was such as bereavements, personal extends throughout the ED. She takes a holistic approach admitted to our St. Catharines Site and family addictions, mental to her delivery of care, which is founded on kindness, for a stroke and was not expected to wellness experiences, abuse and compassion, respect and an understanding heart. She survive. The team worked together to abandonment. In every interaction, consistently exceeds expectations through personalized help the patient’s son get his father, Sandy listens intently to see where service to patients and families and is passionate about the who was an admitted patient on the she can have the most impact, 10 professional development of students and colleagues. Trillium Unit, to the St. Catharines preserving dignity when staff Site so he could kiss his wife one last are at their lowest point. Sandy’s time. The patient’s family was very commitment to others often extends grateful and nominated the team her day well past normal hours. for a Giant Act of Kindness through Sandy brings positivity, strength and Giant FM Radio. It was an emotional optimism to her role, supporting staff experience for all. through challenging situations.

AWARDS OF EXCELLENCE Achieving Ambitious Results Award Extraordinary Caring Award Extraordinary Future Extraordinary Team Award through Innovation Award Debbie Jacques l Welland Site l Rachel Robinson l Port Colborne Sean Robb l St. Catharines Site l Jae Sonke, Carol Eaton, Shauna Speck, Human Resources Analyst, Executive Site l Registered Nurse, Neuropsychology Intern, Outpatient Patty Welychka, Jennifer Pratt, Tiffany Assistant, Human Resources Urgent Care Centre Mental Health Psychology Coy (absent) l Welland Site l Patient Flow Debbie’s optimism is contagious. Rachel’s skills as a Registered Nurse Sean is one of the friendliest people Team, Administration Whether it’s her kind, friendly at our Port Colborne Site go beyond who always arrives to work with a Our Welland Site Administration and encouraging words, or her providing physical care for her smile and willingness to help. He team advocated for a patient who support and “we-can-do-it” attitude, patients. She cares for her patients brings forward innovative ideas with was living in an unsafe condition everyone’s day will be brighter after as if they were her own family, other clinicians, such as creating at home. It was their commitment talking to Debbie. Her enthusiasm providing spiritual and emotional the Brief Individual Psychotherapy to our CORE Value of Compassion and willingness to go the extra mile support. Rachel sat with a young girl Intervention Team program to that led them to help this patient. helped make events like Pink Shirt in distress in triage and talked to her support Outpatient Mental Health The team immediately took action, Day and Take Your Kids to Work like a mother would to her daughter. clients who use mental health and making patient safety a priority. As Day a success. She volunteers for Patients feel genuine caring and emergency services frequently. a result of their efforts, the patient is all projects and ensures they are kindness from her when they are in He works collaboratively across all now living comfortably at home in a a success. Debbie always makes her care. areas of NH, living our CORE Values safe environment. sure the people around her are of Compassion, Optimism, and supported. She’s the kind of co- Achieving Ambitious Results. worker everyone wants on their team. One Purpose. One Team. 11

FINANCIAL OVERVIEW Expense breakdown for 2018-19 Niagara Health publishes our audited financial statements every year as part Approximately 70% of total expenses are related to salaries, benefits and medical of our financial accountability and responsibility to the community. Complete staff remuneration. Inflationary cost pressures for the fiscal year amounted to financial statements for 2018/2019 are posted on the Niagara Health website approximately $9 million and in addition $4 million of expense increases related to at www.niagarahealth.on.ca. new or expanded program funding. Our financial health continues to improve thanks to the work of our teams. Our total operating budget for the year was approximately $550 million Salaries and and we ended the year with a surplus of $10,480,300. The surplus will be Benefits 63% reinvested to improve our working capital position and for future capital Medical Staff expenditures. Remuneration 7% Revenue sources for 2018-19 Supplies and other Expenses 15% Approximately 88% in base and one-time funding was received from the Medical/Surgical Ministry of Health and Long-Term Care, the Hamilton Niagara Haldimand Supplies and Drugs Brant (HNHB) Local Health Integration Network (LHIN) and Cancer Care 12% Ontario during the fiscal year. Amortization of Equipment and Software Licenses 2% MOHLTC and HNHB Average Emergency Visit: $254 LHIN Base Funding 73% $136 $63 $28 $27 MOHLTC/LHIN Nursing Diagnostics and Therapies Support Services Administrative One-time and other Funding 4% 78% of expenses are related to direct patient care like nursing, pharmacy, Cancer Care Ontario 11% diagnostic imaging, laboratory and therapies. An additional 11% is related to support services like housekeeping, food and maintenance. The remaining 11% is for administrative costs. Average Inpatient cost per day: $1,093 Patient Revenue 7% $658 $165 $149 $121 Amortization of Grants Nursing Diagnostics and Therapies Support Services Administrative and Donations 2% 75% of expenses are related to direct patient care like nursing, pharmacy, Non-Patient 3% diagnostic imaging, laboratory and therapies. Preferred Accommodation 1% 12 An additional 14% is related to support services like housekeeping, food and maintenance. The remaining 11% is for administrative costs.

IN-PATIENT SURGICAL CASES Thanks to the generosity of Niagara Health Foundation donors, $975,000 967 Fast Facts 7,657 was raised for the replacement of defibrillators across all sites of *Beds Inpatient Niagara Health. Did you know that defibrillators are the single-most 34,527 32,021 important tool used during a cardiac arrest? That means that donors who Admissions Outpatient supported this initiative are literally helping save lives! CARE BY NUMBERS VISITS How Can You Help? 24,726 194,721 You can support Niagara Health MRI Scans Emergency and Urgent Care programs and services through a donation to Niagara Health 2,999 68,919 Foundation. Niagara Health Foundation fundraises exclusively for Babies Born Dialysis/Renal Clinics Niagara Health, to support Priority Equipment Needs, Redevelopment 6,269 37,452 Projects and Patient Programs not funded by the government. To learn Cataract Mental Health Clinics more about how you can support a Surgeries healthier Niagara, visit www.NiagaraHealthFoundation.com 2,389 1,351 175,837 or call 905-323-FUND. Heart Investigation Hip and Knee Other Outpatient David Murray and Liz Surtees are Unit Procedures Replacement Surgeries Clinics proud to be among the many donors who generously contributed to the * Includes Acute, Complex Care, Long-Term Care, Defibrillator Campaign. Mental Health and Addictions. One Purpose. One Team. 13

SENIOR & MEDICAL LEADERSHIP Thank you, Suzanne! Senior Executive Team 2018-19 Ms. Flo Paladino Executive Vice President, People & Organizational Our remarkable progress is a testament to the Dr. Tom Stewart Development strong leadership and vision of our President Chief Executive Officer Dr. Johan Viljoen Suzanne Johnston, who is stepping down from her Dr. Suzanne Johnston Interim Chief of Staff and Executive Vice President, role at the end of June 2019. President Medical Affairs Our annual report speaks volumes to Suzanne’s Ms. Linda Boich Ms. Angela Zangari contributions. Our successes are a culmination of Executive Vice President, Quality, Community Executive Vice President, Finance & Operations and her work to build a greater patient voice, engaged Development and Mental Health and Addictions Chief Financial Officer teams and a heightened focus on quality. Mr. Derek McNally Mr. Roger Ali Over her nearly five years as President, Suzanne Executive Vice President, Clinical Services and President and CEO, Niagara Health Foundation has led us with passion and commitment, and her Chief Nursing Executive inspired leadership has resulted in a culture shift Pediatrics: for Niagara Health, one that recognizes and values Medical Advisory Committee Dr. Madan Roy relationship building, partnerships and teamwork. Emergency Medicine: Under her leadership, and with the support of Reporting to the Board of Directors, this Dr. Rafi Setrak a dedicated team, she has achieved a number committee oversees quality patient care. Obstetrics/Gynecology: of significant advances for Niagara Health and Physician members are: Dr. Jerzy Sternadel (Interim) the community. Our teams will build on these Chair: Dr. Johan Viljoen Medical Staff Association accomplishments and continue to evolve and Department Chiefs President: grow to meet the needs of patients, families and Medicine: Dr. Parminder Brar the community. Dr. Terence Chan Vice President: We are grateful for the lasting contributions she Surgery: Dr. Maynard Luterman has made to create a healthier Niagara. Dr. Ian Brown Secretary/Treasurer: Diagnostic Imaging: Dr. Alison MacTavish 14 Dr. Julian Dobranowski Additional members (Non-voting members) Anaesthesia: Chief of Staff, Hotel Dieu Shaver Health and Dr. Donald DuVall Rehabilitation Centre: Oncology: Dr. Jack Luce Dr. Janice Geisbrecht Chair of Credentialing: Laboratory Medicine: Dr. Sven Pallie Dr. Sawtish Chawla Mental Health and Addictions: Dr. Maxine Lewis

BBoOarAdRoDf ODFireDcIRtoECrsTORS 2018-19 Our Board of Directors are dedicated Ms. Marti Jurmain Ex officio: One Purpose. One Team. 15 volunteers from across the Niagara region. Quality Chair Dr. Suzanne Johnston This diverse group is committed to ensuring Mr. Charles Rate Dr. Johan Viljoen high-quality, safe, sustainable care and is Resources and Audit Chair Dr. Parminder Brar accountable to the community. Ms. Bunny Alexander Mr. Derek McNally Board Vice-Chair and Governance Chair From left to right: Ms. Cathy Sutherland Mr. Ken Kawall Absent: Dr. Ronald Mergl Dr. Barry Wright Quality Vice-Chair Governance Vice-Chair Mr. Murray Paton Mr. John Bragagnolo Board Chair Mr. Robert Tiffin Resources and Audit Vice-Chair

Extraordinary Caring. Every Person. Every Time.