Hospital trustee education reports to WVHA by VP8177

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									Dear Governance Education Coordinator:

This file contains the spreadsheets that accompany the Step-by-Step Guide for Tracking and
Certifying Governance Education. Included are quarterly report forms to track each trustee's
ecucational hours, and a summary Quarterly Report.

For technical assistance or to submit your reports, please contact:
Debbie Moore, Administrative Assistant WVHA
dmoore@wvha.org
304.353.9746
Quarterly Education Report

Hospital Name:                                        Anytown Community Hospital
Number of Trustees                                    9

January - March 2008
Total Hours By Educational Topic
                                                      Total Hours           Avg. Hours Per Trustee
Mission, Vision and Strategic Direction               0.00                  0.00
Hire and Oversee the CEO                              0.00                  0.00
Evaluate CEO Compensation and Performance             0.00                  0.00
Quality and Patient Safety                            0.00                  0.00
Medical Staff Credentialing                           0.00                  0.00
Organizational Structure (Mgmt and Governance)        0.00                  0.00
Regulatory Compliance                                 0.00                  0.00
Financial Performance                                 0.00                  0.00
Legal and Ethical Integrity and Compliance            0.00                  0.00
Governing Accountability and Leadership Performance   0.00                  0.00
Advocacy/ Community Connections                       0.00                  0.00
Total Hours                                           0.00                  0.00




                                                                                                     2
Quarterly Education Report

Hospital Name:                                        Anytown Community Hospital
Number of Trustees                                    9

April - June 2008
Total Hours By Educational Topic
                                                      Total Hours           Avg. Hours Per Trustee
Mission, Vision and Strategic Direction               0.00                  0.00
Hire and Oversee the CEO                              0.00                  0.00
Evaluate CEO Compensation and Performance             0.00                  0.00
Quality and Patient Safety                            0.00                  0.00
Medical Staff Credentialing                           0.00                  0.00
Organizational Structure (Mgmt and Governance)        0.00                  0.00
Regulatory Compliance                                 0.00                  0.00
Financial Performance                                 0.00                  0.00
Legal and Ethical Integrity and Compliance            0.00                  0.00
Governing Accountability and Leadership Performance   0.00                  0.00
Advocacy/ Community Connections                       0.00                  0.00
Total Hours                                           0.00                  0.00




                                                                                                     3
Quarterly Education Report

Hospital Name:                                        Anytown Community Hospital
Number of Trustees                                    9

July - September 2008
Total Hours By Educational Topic
                                                      Total Hours           Avg. Hours Per Trustee
Mission, Vision and Strategic Direction               0.00                  0.00
Hire and Oversee the CEO                              0.00                  0.00
Evaluate CEO Compensation and Performance             0.00                  0.00
Quality and Patient Safety                            0.00                  0.00
Medical Staff Credentialing                           0.00                  0.00
Organizational Structure (Mgmt and Governance)        0.00                  0.00
Regulatory Compliance                                 0.00                  0.00
Financial Performance                                 0.00                  0.00
Legal and Ethical Integrity and Compliance            0.00                  0.00
Governing Accountability and Leadership Performance   0.00                  0.00
Advocacy/ Community Connections                       0.00                  0.00
Total Hours                                           0.00                  0.00




                                                                                                     4
Quarterly Education Report

Hospital Name:                                        Anytown Community Hospital
Number of Trustees                                    9

October - December 2008
Total Hours By Educational Topic
                                                      Total Hours           Avg. Hours Per Trustee
Mission, Vision and Strategic Direction               0.00                  0.00
Hire and Oversee the CEO                              0.00                  0.00
Evaluate CEO Compensation and Performance             0.00                  0.00
Quality and Patient Safety                            0.00                  0.00
Medical Staff Credentialing                           0.00                  0.00
Organizational Structure (Mgmt and Governance)        0.00                  0.00
Regulatory Compliance                                 0.00                  0.00
Financial Performance                                 0.00                  0.00
Legal and Ethical Integrity and Compliance            0.00                  0.00
Governing Accountability and Leadership Performance   0.00                  0.00
Advocacy/ Community Connections                       0.00                  0.00
Total Hours                                           0.00                  0.00




                                                                                                     5
Quarterly Education Report

Hospital Name:                                        Anytown Community Hospital
Number of Trustees                                    9

2008 Summary
Total Hours By Educational Topic
                                                      Total Hours           Avg. Hours Per Trustee
Mission, Vision and Strategic Direction               0.00                  0.00
Hire and Oversee the CEO                              0.00                  0.00
Evaluate CEO Compensation and Performance             0.00                  0.00
Quality and Patient Safety                            0.00                  0.00
Medical Staff Credentialing                           0.00                  0.00
Organizational Structure (Mgmt and Governance)        0.00                  0.00
Regulatory Compliance                                 0.00                  0.00
Financial Performance                                 0.00                  0.00
Legal and Ethical Integrity and Compliance            0.00                  0.00
Governing Accountability and Leadership Performance   0.00                  0.00
Advocacy/ Community Connections                       0.00                  0.00
Total Hours                                           0.00                  0.00




                                                                                                     6
January - March 2008
Education Topic

Enter the total number of education hours each trustee participated in during January - March 2008. For example, if the first trustee attended a program on CEO compensation that was 1 hour
and a program on financial performance that was 2 hours, type a 1 under "Evaluate CEO Compensation and Performance" in the row of that trustee's name, and a 2 under "Financial
Performance" in the row of that trustee's name.


                                                                                   Evaluate CEO
                                          Mission, Vision and Hire and Oversee   Compensation and                                   Medical Staff      Organizational Structure   Regulatory
                                          Strategic Direction      the CEO         Performance        Quality and Patient Safety    Credentialing      (Mgmt and Governance)      Compliance
                          Trustee Name
                          Trustee Name
                          Trustee Name
                          Trustee Name
                          Trustee Name
                          Trustee Name
                          Trustee Name
                          Trustee Name
                          Trustee Name
                          Trustee Name
                          Trustee Name
                          Trustee Name
                          Trustee Name
                          Trustee Name
                          Trustee Name
                          Trustee Name
                          Trustee Name
                          Trustee Name
                          Trustee Name
                          Trustee Name
                          Trustee Name
                          Trustee Name
                          Trustee Name
                          Trustee Name
                          Trustee Name
                          Trustee Name
                          Trustee Name
                          Trustee Name
              Legal and Ethical   Governing Accountability
 Financial      Integrity and         and Leadership       Advocacy/ Community
Performance      Compliance            Performance             Connections     TOTAL HOURS
                                                                                 0.00
                                                                                 0.00
                                                                                 0.00
                                                                                 0.00
                                                                                 0.00
                                                                                 0.00
                                                                                 0.00
                                                                                 0.00
                                                                                 0.00
                                                                                 0.00
                                                                                 0.00
                                                                                 0.00
                                                                                 0.00
                                                                                 0.00
                                                                                 0.00
                                                                                 0.00
                                                                                 0.00
                                                                                 0.00
                                                                                 0.00
                                                                                 0.00
                                                                                 0.00
                                                                                 0.00
                                                                                 0.00
                                                                                 0.00
                                                                                 0.00
                                                                                 0.00
                                                                                 0.00
                                                                                 0.00
January - March 2008
             Trustee Name
             Trustee Name
             Trustee Name
             Trustee Name
             Trustee Name
             Trustee Name
             Trustee Name
             Trustee Name
             Trustee Name
             Trustee Name
             Trustee Name
             Trustee Name
              Total Hours   0   0   0   0   0   0   0
                0.00
                0.00
                0.00
                0.00
                0.00
                0.00
                0.00
                0.00
                0.00
                0.00
                0.00
                0.00
0   0   0   0   0.00
April - June 2008
Education Topic

Enter the total number of education hours each trustee participated in during April - June 2008. For example, if the first trustee attended a program on CEO compensation that was 1 hour and a
program on financial performance that was 2 hours, type a 1 under "Evaluate CEO Compensation and Performance" in the row of that trustee's name, and a 2 under "Financial Performance" in
the row of that trustee's name.


                                                                                    Evaluate CEO
                                           Mission, Vision and Hire and Oversee   Compensation and                                   Medical Staff      Organizational Structure    Regulatory
                                           Strategic Direction      the CEO         Performance        Quality and Patient Safety    Credentialing      (Mgmt and Governance)       Compliance
                           Trustee Name
                           Trustee Name
                           Trustee Name
                           Trustee Name
                           Trustee Name
                           Trustee Name
                           Trustee Name
                           Trustee Name
                           Trustee Name
                           Trustee Name
                           Trustee Name
                           Trustee Name
                           Trustee Name
                           Trustee Name
                           Trustee Name
                           Trustee Name
                           Trustee Name
                           Trustee Name
                           Trustee Name
                           Trustee Name
                           Trustee Name
                           Trustee Name
                           Trustee Name
                           Trustee Name
                           Trustee Name
                           Trustee Name
                           Trustee Name
                           Trustee Name
                           Trustee Name
April - June 2008
Education Topic

Enter the total number of education hours each trustee participated in during April - June 2008. For example, if the first trustee attended a program on CEO compensation that was 1 hour and a
program on financial performance that was 2 hours, type a 1 under "Evaluate CEO Compensation and Performance" in the row of that trustee's name, and a 2 under "Financial Performance" in
the row of that trustee's name.


                                                                Legal and Ethical   Governing Accountability
                                              Financial           Integrity and         and Leadership       Advocacy/ Community
                                             Performance           Compliance            Performance             Connections     TOTAL HOURS
                           Trustee Name                                                                                                 0.00
                           Trustee Name                                                                                                 0.00
                           Trustee Name                                                                                                 0.00
                           Trustee Name                                                                                                 0.00
                           Trustee Name                                                                                                 0.00
                           Trustee Name                                                                                                 0.00
                           Trustee Name                                                                                                 0.00
                           Trustee Name                                                                                                 0.00
                           Trustee Name                                                                                                 0.00
                           Trustee Name                                                                                                 0.00
                           Trustee Name                                                                                                 0.00
                           Trustee Name                                                                                                 0.00
                           Trustee Name                                                                                                 0.00
                           Trustee Name                                                                                                 0.00
                           Trustee Name                                                                                                 0.00
                           Trustee Name                                                                                                 0.00
                           Trustee Name                                                                                                 0.00
                           Trustee Name                                                                                                 0.00
                           Trustee Name                                                                                                 0.00
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                           Trustee Name                                                                                                 0.00
                           Trustee Name                                                                                                 0.00
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                           Trustee Name                                                                                                 0.00
                           Trustee Name                                                                                                 0.00
                           Trustee Name                                                                                                 0.00
Trustee Name
Trustee Name
Trustee Name
Trustee Name
Trustee Name
Trustee Name
Trustee Name
Trustee Name
Trustee Name
Trustee Name
Trustee Name
 Total Hours   0   0   0   0   0   0   0
Trustee Name                   0.00
Trustee Name                   0.00
Trustee Name                   0.00
Trustee Name                   0.00
Trustee Name                   0.00
Trustee Name                   0.00
Trustee Name                   0.00
Trustee Name                   0.00
Trustee Name                   0.00
Trustee Name                   0.00
Trustee Name                   0.00
 Total Hours   0   0   0   0   0.00
July - September 2008
Education Topic

Enter the total number of education hours each trustee participated in during July - September 2008. For example, if the first trustee attended a program on CEO compensation that was 1 hour
and a program on financial performance that was 2 hours, type a 1 under "Evaluate CEO Compensation and Performance" in the row of that trustee's name, and a 2 under "Financial
Performance" in the row of that trustee's name.


                                                                                   Evaluate CEO
                                          Mission, Vision and Hire and Oversee   Compensation and                                   Medical Staff      Organizational Structure    Regulatory
                                          Strategic Direction      the CEO         Performance        Quality and Patient Safety    Credentialing      (Mgmt and Governance)       Compliance
                          Trustee Name
                          Trustee Name
                          Trustee Name
                          Trustee Name
                          Trustee Name
                          Trustee Name
                          Trustee Name
                          Trustee Name
                          Trustee Name
                          Trustee Name
                          Trustee Name
                          Trustee Name
                          Trustee Name
                          Trustee Name
                          Trustee Name
                          Trustee Name
                          Trustee Name
                          Trustee Name
                          Trustee Name
                          Trustee Name
                          Trustee Name
                          Trustee Name
                          Trustee Name
                          Trustee Name
                          Trustee Name
                          Trustee Name
                          Trustee Name
                          Trustee Name
                          Trustee Name
July - September 2008
Education Topic

Enter the total number of education hours each trustee participated in during July - September 2008. For example, if the first trustee attended a program on CEO compensation that was 1 hour
and a program on financial performance that was 2 hours, type a 1 under "Evaluate CEO Compensation and Performance" in the row of that trustee's name, and a 2 under "Financial
Performance" in the row of that trustee's name.


                                                                Legal and Ethical   Governing Accountability
                                              Financial           Integrity and         and Leadership       Advocacy/ Community
                                             Performance           Compliance            Performance             Connections     TOTAL HOURS
                          Trustee Name                                                                                                 0.00
                          Trustee Name                                                                                                 0.00
                          Trustee Name                                                                                                 0.00
                          Trustee Name                                                                                                 0.00
                          Trustee Name                                                                                                 0.00
                          Trustee Name                                                                                                 0.00
                          Trustee Name                                                                                                 0.00
                          Trustee Name                                                                                                 0.00
                          Trustee Name                                                                                                 0.00
                          Trustee Name                                                                                                 0.00
                          Trustee Name                                                                                                 0.00
                          Trustee Name                                                                                                 0.00
                          Trustee Name                                                                                                 0.00
                          Trustee Name                                                                                                 0.00
                          Trustee Name                                                                                                 0.00
                          Trustee Name                                                                                                 0.00
                          Trustee Name                                                                                                 0.00
                          Trustee Name                                                                                                 0.00
                          Trustee Name                                                                                                 0.00
                          Trustee Name                                                                                                 0.00
                          Trustee Name                                                                                                 0.00
                          Trustee Name                                                                                                 0.00
                          Trustee Name                                                                                                 0.00
                          Trustee Name                                                                                                 0.00
                          Trustee Name                                                                                                 0.00
                          Trustee Name                                                                                                 0.00
                          Trustee Name                                                                                                 0.00
                          Trustee Name                                                                                                 0.00
                          Trustee Name                                                                                                 0.00
Trustee Name
Trustee Name
Trustee Name
Trustee Name
Trustee Name
Trustee Name
Trustee Name
Trustee Name
Trustee Name
Trustee Name
Trustee Name
 Total Hours   0   0   0   0   0   0   0
Trustee Name                   0.00
Trustee Name                   0.00
Trustee Name                   0.00
Trustee Name                   0.00
Trustee Name                   0.00
Trustee Name                   0.00
Trustee Name                   0.00
Trustee Name                   0.00
Trustee Name                   0.00
Trustee Name                   0.00
Trustee Name                   0.00
 Total Hours   0   0   0   0   0.00
October - December 2008
Education Topic

Enter the total number of education hours each trustee participated in during October - December 2008. For example, if the first trustee attended a program on CEO compensation that was 1 hour
and a program on financial performance that was 2 hours, type a 1 under "Evaluate CEO Compensation and Performance" in the row of that trustee's name, and a 2 under "Financial
Performance" in the row of that trustee's name.


                                                                                   Evaluate CEO
                                          Mission, Vision and Hire and Oversee   Compensation and                                  Medical Staff      Organizational Structure    Regulatory
                                          Strategic Direction      the CEO         Performance        Quality and Patient Safety   Credentialing      (Mgmt and Governance)       Compliance
                          Trustee Name
                          Trustee Name
                          Trustee Name
                          Trustee Name
                          Trustee Name
                          Trustee Name
                          Trustee Name
                          Trustee Name
                          Trustee Name
                          Trustee Name
                          Trustee Name
                          Trustee Name
                          Trustee Name
                          Trustee Name
                          Trustee Name
                          Trustee Name
                          Trustee Name
                          Trustee Name
                          Trustee Name
                          Trustee Name
                          Trustee Name
                          Trustee Name
                          Trustee Name
                          Trustee Name
                          Trustee Name
                          Trustee Name
                          Trustee Name
                          Trustee Name
                          Trustee Name
October - December 2008
Education Topic

Enter the total number of education hours each trustee participated in during October - December 2008. For example, if the first trustee attended a program on CEO compensation that was 1 hour
and a program on financial performance that was 2 hours, type a 1 under "Evaluate CEO Compensation and Performance" in the row of that trustee's name, and a 2 under "Financial
Performance" in the row of that trustee's name.


                                                               Legal and Ethical   Governing Accountability
                                              Financial          Integrity and         and Leadership       Advocacy/ Community
                                             Performance          Compliance            Performance             Connections     TOTAL HOURS
                          Trustee Name                                                                                                 0.00
                          Trustee Name                                                                                                 0.00
                          Trustee Name                                                                                                 0.00
                          Trustee Name                                                                                                 0.00
                          Trustee Name                                                                                                 0.00
                          Trustee Name                                                                                                 0.00
                          Trustee Name                                                                                                 0.00
                          Trustee Name                                                                                                 0.00
                          Trustee Name                                                                                                 0.00
                          Trustee Name                                                                                                 0.00
                          Trustee Name                                                                                                 0.00
                          Trustee Name                                                                                                 0.00
                          Trustee Name                                                                                                 0.00
                          Trustee Name                                                                                                 0.00
                          Trustee Name                                                                                                 0.00
                          Trustee Name                                                                                                 0.00
                          Trustee Name                                                                                                 0.00
                          Trustee Name                                                                                                 0.00
                          Trustee Name                                                                                                 0.00
                          Trustee Name                                                                                                 0.00
                          Trustee Name                                                                                                 0.00
                          Trustee Name                                                                                                 0.00
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                          Trustee Name                                                                                                 0.00
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                          Trustee Name                                                                                                 0.00
Trustee Name
Trustee Name
Trustee Name
Trustee Name
Trustee Name
Trustee Name
Trustee Name
Trustee Name
Trustee Name
Trustee Name
Trustee Name
 Total Hours   0   0   0   0   0   0   0
Trustee Name                   0.00
Trustee Name                   0.00
Trustee Name                   0.00
Trustee Name                   0.00
Trustee Name                   0.00
Trustee Name                   0.00
Trustee Name                   0.00
Trustee Name                   0.00
Trustee Name                   0.00
Trustee Name                   0.00
Trustee Name                   0.00
 Total Hours   0   0   0   0   0.00

								
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