S.F. _____ Section 1. NEW SECTION . 66.31 County and city hospital 1 trustees. 2 A county or city hospital board of trustees may include in 3 their bylaws a process for removal of a trustee for which there 4 is cause that would be grounds for an equitable action for 5 removal in the district court. The process shall provide for a 6 hearing on written charges filed with the board of trustees. 7 Sec. 2. Section 347.9, Code 2018, is amended to read as 8 follows: 9 347.9 Trustees —— appointment —— terms of office. 10 1. When it has been determined by the voters of a county 11 to establish a county public hospital, the board shall appoint 12 five or seven trustees chosen from among the resident citizens 13 of the county with reference to their fitness for office , and 14 not more than four of the trustees shall be residents of the 15 city at which the hospital is located . The appointed trustees 16 shall hold office until the following general election, at 17 which time their successors shall be elected, two three for 18 a term of two four years , two for four years, and three for 19 six and the remainder for a term of two years, and they shall 20 determine by lot their respective terms, and thereafter their 21 successors shall be elected for regular terms of six four years 22 each. 23 2. Upon approval of a majority of the current board of 24 trustees, the board may reduce an existing seven-member board 25 to a five-member board. The board shall establish how to 26 reduce the number of trustees on the board and shall provide 27 for a staggered election cycle for election to the five-member 28 board, which election shall be for a term of four years. 29 However, the manner of reducing the number of trustees shall 30 ensure that the current trustees on the seven-member board may 31 continue to hold office through the end of their respective 32 terms. 33 Sec. 3. Section 347.10, Code 2018, is amended to read as 34 follows: 35 -1- LSB 6065XC (3) 87 ec/rn 1/ 4

S.F. _____ 347.10 Vacancies. 1 Vacancies on the board of trustees may, until the next 2 general election, be filled by appointment by the remaining 3 members of the board of trustees or, if fewer than four a 4 majority of the trustees remain on the board, by the board of 5 supervisors for the period until the vacancies are filled by 6 election. An appointment made under this section shall be for 7 the unexpired balance of the term of the preceding trustee. If 8 a board member is absent for four consecutive regular board 9 meetings, without prior excuse, or fails to comply with more 10 stringent attendance requirements for regular board meetings 11 included in the bylaws governing the board, the member’s 12 position shall be declared vacant and filled as set out in this 13 section . 14 Sec. 4. Section 347.11, Code 2018, is amended to read as 15 follows: 16 347.11 Organization —— meetings —— quorum. 17 Hospital trustees shall qualify by taking the usual oath of 18 office as provided in chapter 63 and organize by the election 19 of a chairperson, a secretary, and a treasurer. The secretary 20 shall report to the county auditor and county treasurer the 21 names of the chairperson, secretary, and treasurer of the 22 board of hospital trustees as soon as practicable after the 23 qualification of each. A board of hospital trustees shall 24 meet as necessary to adequately oversee the operation of the 25 hospital. Four A majority of the board of trustees shall 26 constitute a quorum necessary for actions by the board of 27 hospital trustees. The secretary shall maintain a complete 28 record of board meetings, proceedings, and actions. 29 Sec. 5. Section 347.13, subsection 3, Code 2018, is amended 30 to read as follows: 31 3. Adopt bylaws and rules for its own guidance and for the 32 government of the hospital. The bylaws may contain limits on 33 the number of terms a trustee may serve on the board. 34 Sec. 6. Section 347A.1, subsection 2, paragraph b, Code 35 -2- LSB 6065XC (3) 87 ec/rn 2/ 4

S.F. _____ 2018, is amended to read as follows: 1 b. The trustees shall hold office until the next succeeding 2 election, at which time their successors shall be elected, 3 two for a term of two years , two and three for a term of four 4 years, and one for a term of six years, and thereafter their 5 successors shall be elected for regular terms of six four years 6 each. Vacancies on the board of trustees may be filled in the 7 same manner as original appointments, to hold office until the 8 vacancies are filled pursuant to section 69.12 . If a board 9 member is absent for four consecutive regular board meetings, 10 without prior excuse, or fails to comply with more stringent 11 attendance requirements for regular board meetings included in 12 the bylaws governing the board, the member’s position shall be 13 declared vacant and filled as set out in this paragraph. 14 Sec. 7. Section 392.6, subsection 3, paragraph b, Code 2018, 15 is amended to read as follows: 16 b. Vacancies on the board of trustees may, until the next 17 general or regular city election, be filled in the same manner 18 as provided in section 347.10 . An appointment made under this 19 paragraph shall be for the unexpired balance of the term of 20 the preceding trustee. If a board member is absent for four 21 consecutive regular board meetings, without prior excuse, or 22 fails to comply with more stringent attendance requirements 23 for regular board meetings included in the bylaws governing 24 the board, the member’s position shall be declared vacant and 25 filled as set out in this paragraph. 26 EXPLANATION 27 The inclusion of this explanation does not constitute agreement with 28 the explanation’s substance by the members of the general assembly. 29 This bill concerns city and county hospital boards of 30 trustees. 31 New Code section 66.31 allows a county or city hospital board 32 of trustees to adopt bylaws to establish a process for the 33 removal of a trustee for cause. 34 Code section 347.9, concerning the number and appointment 35 -3- LSB 6065XC (3) 87 ec/rn 3/ 4

S.F. _____ of county hospital board trustees, is amended to authorize the 1 establishment of five or seven-member trustee boards and to 2 provide for four-year terms of office. Current law provides 3 for only seven-member trustee boards and for a six-year term of 4 office. The bill establishes the process and initial terms of 5 office for an initial five or seven-member trustee board, and 6 provides for the ability to change a seven-member trustee board 7 to a five-member trustee board. 8 Code section 347.10, concerning vacancies, is amended to 9 provide that the board of trustees may establish more stringent 10 attendance requirements for regular board meetings that can 11 result in a vacancy on the board. 12 Code section 347.11, concerning quorum requirements, is 13 amended to provide that a majority of the members of the board 14 constitute a quorum. 15 Code section 347.13, concerning board of trustee duties, is 16 amended to provide that the board may include term limits for 17 service on the board in the bylaws governing the board. 18 Code section 347A.1, concerning certain county hospitals 19 payable from revenue bonds, is amended to provide for 20 four-year, and not six-year, terms of office. The bill further 21 provides that a vacancy on the board of trustees can occur 22 if a member is absent for four consecutive regular board 23 meetings without excuse, or fails to comply with more stringent 24 attendance requirements for regular board meetings included in 25 the bylaws governing the board. 26 Code section 392.6, concerning city hospital or health care 27 facility trustees, is amended to provide that the board of 28 trustees may establish more stringent attendance requirements 29 for regular board meetings that can result in a vacancy on the 30 board. 31 -4- LSB 6065XC (3) 87 ec/rn 4/ 4