hospital that competes with Middlefield has opened a wellness center that offers a comprehensive array of preventative and wellness services to the community. This facility is attracting young families to seek services at this location. Most of Middlefield ' s managed care contracts are more than 2 years old. There are little reliable utilization and reimbursement data available. No one at Middlefield Hospital is assigned to manage these contracts or maintain ongoing relationships with managed care companies. The Joint Commission survey is scheduled for next year, and there are significant problems with the hospital ' s quality improvement program. The health plan offered to employees is getting more expensive each year. In fact, the costs are increasing at a rate of 20 % each year. This is adding significantly to the hospital ' s operational costs. The inpatient mental health services and neo-natal intensive care unit continue to lose money for the hospital.