There are some misconceptions going around town and at Cedar County Memorial Hospital. I need to clarify a few things to the public and the hospital employees. When I called to get on the agenda, one week prior to the board meeting, to speak to the Cedar County Hospital Board of Trustees on September 20th, I and two other speakers were told that we had 10-15 minutes to speak. Then, on the day of the September board meeting I received a phone call, as did at least two of the other speakers, at approximately 3 p.m. on Sept. 20, from Chairman Marvin Manring that the board had decided that they were going to limit the speakers to 3-5 minutes. He hoped that I would understand that they are unpaid elected officials, and they didn’t have a lot of time to spend listening to concerned public comments. I told him that we had all been told the same, 10-15 minutes and I had planned my statement within that time frame, and I was going to take my allotted time. A great deal of information would have been revealed if we had been able to read our entire statements. Instead, it was just bits and pieces that didn’t tell the entire story. In spite of what is being told around town, and at the hospital, none of the three speakers have a vendetta against the hospital, in fact we are trying to save the hospital and jobs. I have several dear friends that work at the hospital and would never try to destroy anyone’s livelihood. My husband and I have always worked to bring jobs and businesses to town, not tear down or destroy businesses. What would any of us have to gain from destroying the hospital? Any new business coming to town look first at schools and available healthcare. After the board meeting opened, board member David Bozarth made a motion containing at least 8 bullet points as to why he was suggesting cutting our time down to 3 minutes. There was a second and then it was opened up to discussion. Two board members disagreed with limiting the time and asked that the speakers be allowed to speak for their originally allotted time. The motion was passed by a 3-2 margin restricting the speakers time to 5 minutes. At that point the speakers all scrambled to cut our statements down to 5 minutes. Several in attendance were quite upset that they didn’t get to hear the statements and expressed their outrage. Some board members even threatened to have a community member removed if he spoke again. I do understand that some concerned community members weren’t on the agenda, but it was handled in a very rude manner. I had a guest at the board meeting and her name is Norma Owens, she is serving on the board at Iron County Hospital and she was on the board when Mr. Nichols was there as CEO. She drove five hours to speak to any member of the public that wanted any information, or the truth about the disaster that Mr. Nichols left behind at the Iron County Hospital. She has known him for years. Norma only wants to help El Dorado Springs and the hospital so that we don’t have to go through what Iron County hospital went through, a bankruptcy! Mr. Nichols is doing the same thing at CCMH, that he did in Iron County, getting rid of general practitioners and hiring specialists at great expense. I have her number if anyone wants to talk to her.
I want to quote David Bozarth when he was elected to the board, “You can reach out to any board member, and we will be glad to listen. For my part, I would especially like to talk to each one of you and receive your inputs, suggestions, praise, criticisms, complaints, whatever you wish to share, AND if you desire, I will keep your name confidential. I will be YOUR VOICE on the Board of Trustees. I WILL REPRESENT YOU, the citizens of Cedar County, and I WILL BE ACCOUNTABLE to YOU! The board does NOT function as an oversight, and direction board. The Board needs to become the Board, and the CEO and the Director of Finance need to recognize they work for the BOARD and not the other way around.” Obviously, Mr. Bozarth has had a change of heart about representing the citizens of Cedar County. Since the meeting I understand he has now called the speakers untruthful, gossipers, biased against Mr. Nichols, and also said none of us had ever spoken to a board member about our concerns. I want to correct him on this. I did talk to 2 of the board members back in March about my concerns, it mostly fell on deaf ears. I know that there are many, many people upset about our lack of providers and have expressed concerns to the board but, they are not listening. I guess it depends on whose voice Mr. Bozarth wants to hear. Apparently, he is only listening to one voice and that is Mr. Nichols. Why doesn’t the board listen? You were elected to represent the citizens, taxpayers and voters of Cedar County. I am quite disappointed along with many others in this community that, apparently the board only wants Mr. Nichols truth but not the real truth. A packet was handed to the board and enclosed in that packet was letters from unjustly fired employees, telling how despicably they had been treated, along with letters from providers that had been forced into resigning. There was also signed letters from hospital CEO’s that had to lead hospitals through bankruptcy, or from the brink of bankruptcy after Mr. Nichols left those hospitals. Why is the board ignoring those letters? There is truth in those letters! Why did a board member or Mr. Nichols share those letters with the public that very night? What is it that Terry Nichols doesn’t want to be revealed? Actually, everything about that meeting was planned by Mr. Nichols and executed by some members of the board, to keep our statements from becoming public information. I spoke with at least 30 people over the course of 4 months and not one nice word was spoken about Mr. Nichols. Everything in my statement is factual and I have the documents or statements to prove that Mr. Nichols has failed at every hospital where he has been, and drove his own county (Iron) into debt while County Commissioner. I have names and numbers of all my sources if anyone is interested in knowing the whole story of Mr. Nichols.
Statement of Joshua Gilmore
My name is Joshua Gilmore. I am providing this statement in written form but am happy to talk in more detail if needed. This statement is true and correct to the best of my knowledge and belief:
I have an MBA in healthcare Administration. I presently sit on the Board of Trustees of the National Rural health Association. I am also the CEO of Sunshine Community Health Center in Alaska. Before that, I was the CEO of Iron County Medical Center (ICMC) in Missouri. In 2021, I was recognized as the Community Star by the National Organization of State Offices of Rural Health for the state of Missouri. I co-authored the once in a decade “Small Rural Hospital Blueprint for Performance Excellence an Value” with the National Rural health Resource Center. I sat on the Delta Regional Community Health systems Development (DRCHSD) Program’s Advisory Committee after successfully completing the program while at ICMC. In fact, our organization is included on the DRCHSD website as an example of what can be achieved when rural hospitals on the verge of failing participate in their Program.
My predecessor CEO at ICMC was Mr. Terry Nichols. He served there for five years. Under Mr. Nichols’ tenure as CEO, he led ICMC into such financial crisis that it eventually had to declare Chapter 9 Bankruptcy. When I took over for Mr. Nichols, I was forced to bring ICMC through bankruptcy. ICMC fortunately survived that and entered into a sustainable future.
Stroudwater and Associates, LLC performed a Financial and Operational Assessment (FOA) for ICMC after we had to declare the Chapter 9 Bankruptcy in February of 2018 under my tenure. To quote from their FOA, “ICMC has sustained a significant negative operating margin since FY 2014 driven by poor historical performance under prior management [Mr. Nichols], which has contributed to near depletion of cash reserves and steady increases in accounts payable. Since March 2017, new leadership [Joshua Gilmore] has been committed to improving ICMC’s financial position as seen by a 40% improvement in operating margin between FY 2017 and 2018 annualized. Effective February 2018, ICMC has filed for Chapter 9 Bankruptcy as a means to release financial pressure associated with significant levels of debt, which allow ICMC time to build financial stability.”
In that same FOA, they also noted that days of cash on hand decreased to 3 days in 2017, which is when I was brought on board. Between 2017 and 2018, I was able to reverse the downward trend of days cash on hand. Stroudwater concluded that “[ICMC’s] overall condition [indicated they had] sustained a significant negative operating margin since FY 2014, but has recently achieved improved performance between FY 2017 and FY 2018 driven by new leadership committed to improving ICMC’s critical financial position. Ongoing operational losses incurred between FY 2014 and FY 2017 have resulted in essentially no organizational liquidity, thus requiring ICMC to declare bankruptcy protection to allow time to improve financial performance. Opportunities currently [at the time this was written in 2018] underway by management…will result in significant improvement in financial performance.”
Prior to my coming on board at ICMC in February 2017, Mr. Nichols sent a letter to Clark Thomas at the Missouri office of the USDA’s Rural Development Program. The USDA held the bonds for the construction of ICMC. That letter was received by Mr. Thomas in late December 2016, just town months prior to my arrival. In that letter, Mr. Nichols painted a false picture of success and improvement financially and operationally at ICMC. Mr. Thomas shared this letter with me when I met with him in March of 2017 at his office. It was then that I informed him that ICMC did not have the cash to pay ICMC’s monthly bond payments. The disparity between the picture of operational success that Mr. Nichols presented and the factual reality that was evidenced by my sharing of our then current Statement of Cash Flows was abhorrent.
In my opinion, as I look back at my tenure at ICMC as CEO, it was clear to me that Mr. Nichols either willfully or by gross negligence ran ICMC into the ground both operationally and financially. He had no business being in healthcare. In an effort to make himself appear knowledgeable, he made multiple poor operating decisions. Those decisions included, but are not limited to, adding many unsustainable specialty services to ICMC. Additionally, Mr. Nichols unfortunately agreed to grossly overpay the specialists [this opinion was shared by Clifton Larson Allen, a national accounting firm] in his attempt to attract them to ICMC. Mr. Nichols appeared to have little concept as to how cost-based reimbursement worked. Furthermore, Mr. Nichols has a failed track record at the various Critical Access Hospitals he has run. These appears to be a pattern of poor leadership where he runs the facility into the ground and exits just prior to them imploding or, at best, leaves them with little chance of a future successful turnaround.
One of Mr. Nichols’ “right hands” was Ms. Angie Nations. She was my HR director for most of my tenure at CEO at ICMC. I can share that I would never hire her again and do not trust her. I can also share that she was caught on video and them lied repeatedly about it to executive leadership (I cannot share the details). She fostered an environment of distrust with the staff and leadership.
Rural hospitals serve a huge importance in their community. I am providing this statement not for any personal gain, but to alert others to my experience with Terry Nichols. With this statement, I hope that you will have additional information that can be used to make the best decisions for your community, for the rural hospital employees and for its patients, current and future.
Dated this 17th day of August, 2023, at Talkeetna, AK.
Joshua Gilmore, MBA