Onboarding tasks open
—
across 4 hires
Offboarding active
0
no separations
401k alerts due
2
Morales + Patino · Jul 1
Feb subsidy check
$0
Q2 overage applied
Critical actions
401k — Morales + Patino eligible July 1, 2026
60-day notice emails must go out May 1, 2026. Miss the window → they wait until Jan 1, 2027.
March subsidy check: $544,135.63 — process in April/May
Q2 overage $1,339,197.71 applied. Remaining $397,531.04 reduces March. All numbers verified against live QuickBooks.
HSA enrollment — confirm all 2025 hires received guidance email
CRNA: $1,248/yr employer · MD: $2,366/yr employer. Over-contribution = IRS penalties. Must send before ADP enrollment.
Feb 2026 P&L verified against QuickBooks ✓
Net income -$105,724.26 matches QB to $1. Subsidy math independently verified. All three numbers in Brandon's email confirmed correct.
How the platform works
Hire confirmed
→
Onboarding agent
→
Tasks auto-assigned
→
Reminders sent
→
First paycheck ✓
Separation notice
→
Offboarding agent
→
Access revoked · benefits ended
→
COBRA + records
→
Clean exit ✓
QB export
→
Parse expenses
→
Subsidy calc engine
→
Invoice + Gloria email drafted
→
Brandon reviews + sends ✓
J. Morales eligible
Jul 1, 2026
— days
K. Patino eligible
Jul 1, 2026
— days
60-day notice due
May 1, 2026
for both Morales + Patino
Rule
Eligible after 1 full year → next July 1 or January 1. Auto emails: 60-day heads-up, 30-day enrollment guide, day-of confirmation to employee + internal alert to Terri.
Calculate for any employee
Automated email — 60-day notice
To: Jessica Morales <[email protected]> · Subject: Your 401k eligibility is approaching — AAGM
Hi Jessica,
You're approaching your 401k eligibility date at AAGM.
— Start date: April 28, 2025
— Eligibility date: July 1, 2026
— Enrollment instructions will follow in approximately 30 days.
Questions: [email protected]
— AAGM HR (automated notice)
You're approaching your 401k eligibility date at AAGM.
— Start date: April 28, 2025
— Eligibility date: July 1, 2026
— Enrollment instructions will follow in approximately 30 days.
Questions: [email protected]
— AAGM HR (automated notice)
CRNA employer HSA
$1,248
per year
MD employer HSA
$2,366
per year
2025 IRS individual limit
$4,150
combined employer + employee
Recurring problem
ADP does not warn when HSA elections exceed IRS limits
Employee elects without knowing employer already contributes. Combined total exceeds IRS limit. ADP processes it. Employee gets IRS penalty notice at year-end. One email at enrollment time prevents this entirely.
Generate enrollment guidance email
Side-by-side comparison
| Term | Meir Douek, M.D. | Eric Longfellow, M.D. |
|---|---|---|
| Start date | Sep 1, 2026 | Jul 20, 2026 |
| Contract length | 3 years | 2 years |
| Facility | SMH + West Kendall Baptist | Boca Regional Hospital |
| Year 1 base | $400,000 | $525,000 |
| Year 2 base | $425,000 | $550,000 |
| Year 3 base | $450,000 | N/A (2-yr term) |
| Sign-on | $10,000 | None |
| Relocation | $10,000 | None |
| CME | $3,000/yr | $3,000/yr |
| Vacation | 8/10/10 wks | 12/12 wks |
| Shareholder | After 3 yrs | Max 2 yrs (guaranteed) |
| 401k eligible | ~Jul 1, 2027 | Jan 1, 2028 |
| Non-compete | None | 2 yrs · AAGM facilities |
| Non-solicit | None | 1 yr post-term |
| Malpractice | Employer provided | Employer provided (if acceptable) |
Action items
Add both to HR Matrix onboarding checklist
Douek (Sep 1, 2026) and Longfellow (Jul 20, 2026) — malpractice apps, email creation, ADP setup, benefits enrollment
Set 401k reminders — Douek: May 1 2027 · Longfellow: Nov 1 2027
Both need 60-day notice emails before their respective eligibility dates
Longfellow shareholder timeline — confirm board approval process
Contract says "maximum 2 years" — this is a firm commitment, not discretionary like Douek
Update payroll master — both MDs start mid-2026
Douek biweekly = ~$15,385/check · Longfellow biweekly = ~$20,192/check
Manual entry passes/cycle
4–6×
per data source
Hours lost per payroll
6–10+
entry & reconciliation
Data sources
6
all different formats
6 sources — current vs AI-powered
Automation (cron)
No thinking needed
Smartsheet API pull → auto-populate Master Sheet. ADP Register variance check. Summary email to Ruan. All run on schedule — zero manual entry.
Reasoning (AI agent)
Judgment required
Qgenda PDF → agent reads schedule, applies day vs weekend rate. ADP variance flagged → agent identifies source and drafts correction note.
Overview
Auto-pay
Invoices
Reimbursements
Calendar
Track 1 — Auto-pay
Set once, runs forever
Recurring bills with fixed amounts. Agent confirms each one posted the day after expected date. Flags if amount differs >5% from prior cycle.
Track 2 — Invoices
Received → approved → paid
Agent monitors inbox, parses vendor + amount + due date. Terri approves one-click → Bill.com schedules payment. 5-day escalation if not approved.
Track 3 — Reimbursements
Form → verified → paid
Jotform with receipt upload. Agent checks annual balance before Terri sees it. Auto-confirmation + balance update sent to employee on payment.
| Vendor | Amount | Due | Category | Status | Action |
|---|
Log new invoice
Submit reimbursement
Pending reimbursements
Feb snapshot
Calculator
Collections
Gloria emails
Workflow
Feb net collections (DoS)
$1,758,442
5 locations
Required monthly
$1,837,500
per contract
Max monthly subsidy
$941,667
per contract
Feb check issued
$0
Q2 overage applies
Q2 (Dec–Feb) quarterly reconciliation — independently verified from QuickBooks
Net collections Dec + Jan + Feb (DoS)$6,851,697.71
Required (3 × $1,837,500)$5,512,500.00
Q2 overage$1,339,197.71
Max quarterly subsidy$941,666.67
Overage > max → no Feb check$0.00
Remaining overage owed to Baptist$397,531.04
March check: $941,666.67 − $397,531.04$544,135.63
Independent verification — all match
✓
Q2 overage $1,339,197.71 — exact match
Independent calc from live QB data matches Brandon's email to Gloria
✓
Remaining to Baptist $397,531.04 — exact match
$1,339,197.71 − $941,666.67 = $397,531.04 ✓
✓
March check $544,135.63 — exact match
$941,666.67 − $397,531.04 = $544,135.63 ✓
✓
QB net income -$105,724.26 — matches to $1
Independent reconstruction of all QB line items = -$105,723.26 (rounding only)
!
Collections gap $453,495 — expected, not an error
QB cash received vs Date-of-Service earned. Normal 30–90 day medical billing float. Subsidy uses DoS — correct.
Result
February 2026 — by location (Coronis / Date-of-Service)
SMH
$997,522
29,178 ASA units
SMH – Cardiac
$57,677
1,917 ASA units
West Kendall
$373,056
11,220 ASA units
Doctors Hospital
$296,223
9,306 ASA units
Doral (BHHD)
$33,964
644 ASA units
Aggregate
$1,758,442
52,265 ASA units
Source note
Per-location collections come from the Coronis billing system, not QuickBooks. QB shows one line: "Anesthesia Fees - Coronis" as a lump sum ($2,211,937 cash received in Feb). The hospital breakdown requires a Coronis export each month — this is the one input the automation needs beyond QB.
YTD (Sep 2025 – Feb 2026)
| Month | Net collections | Required | Overage | Subsidy paid | Check |
|---|---|---|---|---|---|
| Sep-25 | $2,041,208 | $1,837,500 | $203,708 | $941,667 | $941,667 ✓ |
| Oct-25 | $2,119,643 | $1,837,500 | $282,143 | $941,667 | $941,667 ✓ |
| Nov-25 | $2,158,293 | $1,837,500 | $320,793 | $135,023 | $135,023 (adj) |
| Dec-25 | $2,832,124 | $1,837,500 | $994,624 | $941,667 | $941,667 ✓ |
| Jan-26 | $2,261,132 | $1,837,500 | $423,632 | $941,667 | $941,667 ✓ |
| Feb-26 | $1,758,442 | $1,837,500 | — | $0 | No check |
Monthly P&L package email
To: Gloria Montero · Subject: AAGM Monthly Statements – February 2026
Gloria,
Please find attached for approval the Monthly Statements (including Collections, Expenses, and hours worked) for February 2026.
Monthly Collections are per Date of Service and expenses are for all 5 clinics: SMH, SMH Cardiac, West Kendall, Doral, and Doctors Hospital.
Thank you,
Brandon Cheema
BSC Accounting Services · [email protected] · 305-923-0852
Please find attached for approval the Monthly Statements (including Collections, Expenses, and hours worked) for February 2026.
Monthly Collections are per Date of Service and expenses are for all 5 clinics: SMH, SMH Cardiac, West Kendall, Doral, and Doctors Hospital.
Thank you,
Brandon Cheema
BSC Accounting Services · [email protected] · 305-923-0852
8-step automation: QB + Coronis → Gloria email
📜
The SOP Bible is append-only — it can never be replaced
New versions, updates, and corrections are added as addenda and permanently logged below. The original document and all prior amendments are always preserved.
+
Add Amendment / Addendum
§1 — Payroll
§2 — Onboarding
§3 — Benefits
§4 — Communication
§5 — Issues Log
AI Roadmap
Section 1 — Payroll Processing (Bi-Weekly Cycle)
The payroll process involves collecting data from 6 separate sources each bi-weekly cycle. Each source arrives in a different format. Data is manually entered 4–6 times across Notes Sheet, Master Sheet, ADP, 1099 Sheet, Bill.com, and summary emails. Estimated 6–10+ hours per cycle.
1.1
Dr. Volsky Email — Weekend Physician Shifts
Bi-weekly
Email
Doctors Hospital
Content: MDs who worked weekend shifts (Sat & Sun) at Doctors Hospital.
Collection: Automated email request sent to Dr. Volsky — he replies with weekend MD data.
Collection: Automated email request sent to Dr. Volsky — he replies with weekend MD data.
Processing steps
01Save Dr. Volsky's email response in payroll folder
02Enter information into Notes Sheet
03Enter into Master Sheet — cross-check against ADP gross pay totals
04Add to ADP for actual payroll processing
05Download ADP Register — compare with Master Sheet
1.2
Dr. Canning Excel Sheet — CRNA Data (1099 & W2)
Bi-weekly
Excel
All Locations
1099 + W2
Content: CRNA data for 1099 contractors AND W2 employees across ALL locations (DH, SMH, West Kendall, Doral, Mariners).
Collection: Dr. Canning maintains and sends Excel file each pay period.
Collection: Dr. Canning maintains and sends Excel file each pay period.
Processing steps
01Save Dr. Canning's Excel file in payroll folder
02Enter totals into Notes Sheet
03Enter W2 CRNA data (by individual) into Master Sheet — cross-check vs ADP
04Enter 1099 contractor data into separate 1099 Tracking Sheet
05Add to ADP for actual payroll processing
06Download ADP Register — compare with Master Sheet
07Enter 1099 payment amounts into Bill.com to process contractor payments
1.3
Smartsheet #1 — DH Physician OT
Bi-weeklySmartsheetDoctors Hospital
Overtime hours for DH physicians with different pay rates per work type. Doctors self-enter timesheets. New MD hires given Smartsheet access link when they join.
1.4
Smartsheet #2 — SMH & Other MDs OT
Bi-weeklySmartsheetSMH + All Locations
Separate from DH sheet. Same structure, different doctor group covering South Miami Hospital and all other non-DH locations. Same 4-step process.
1.5
Mariners Schedule — Day & Weekend Rate
Bi-weeklyQgenda PDFMariners Hospital
Schedule printed from Qgenda. Manually determine who worked and calculate day rate vs. weekend rate. Each 2-week period spans parts of two calendar months.
1.6
NICU Calendar — Dr. Lee Monthly
MonthlyEmail CalendarNICU
Dr. Lee sends NICU calendar on 1st or 2nd of each month. Processed each bi-weekly cycle. Standard flow: Save → Notes → Master → ADP → Register compare.
1.7
Final Consolidation — Two Summary Emails to Ruan
Summary Email #1 — Doctors Hospital
Combined payroll: 1099 contractor payments + W2 payroll + all overtime for DH
Summary Email #2 — South Miami Hospital
Overtime hours summary for SMH physicians
Section 2 — New Hire Onboarding & Malpractice Insurance
Onboarding requires coordination between the CPA firm, Office Manager, head doctor, and new hire — in strict sequence. Each step is a dependency for the next. The HR Matrix in this platform tracks every step with due dates and overdue alerts.
Complete 14-Step Onboarding Workflow
1
Head doctor decides to hire → informs CPA to create offer letter / employment contract
Owner: Dr. Meister · Trigger: this kicks off the entire onboarding chain
2
Office Manager (Gloria) notified — she maintains hiring tracker and begins credentialing coordination
Owner: Gloria · Issue: her tracker is Excel-only, not shareable
3
Gloria requests malpractice application be sent to the new employee
4
We send malpractice application to new employee
⚠ Frequently filled out incorrectly — wrong dates, missing checkboxes. Causes activation delays.
5
Employee fills out and returns application → We submit to malpractice insurance carrier
6
Malpractice confirmed active → We notify Gloria → Credentialing begins
7
Credentialing complete → Gloria + head doctor notified → Doctor begins assigning shifts
8
Send onboarding packet — different for 1099 vs W2. Request I-9, W-9, direct deposit.
⚠ Repeated follow-ups required. 1099/I-9 frequently not returned on time.
9
Inform employee of company policies — request all required compliance forms
10
Create @aagmia.com email in GoDaddy Outlook → Coordinate with Dr. Canning on distribution groups
Format: firstname.lastname@aagmia.com
11
ADP TotalSource onboarding — send login, employee enters personal data + elects benefit plans
12
Send HSA guidance email — show exact employer contribution and max employee can add ✓
Prevents IRS over-contribution penalties
13
Set 401k eligibility reminder in tracker — calendar 60-day notice date ✓
14
MD hires only: give access links to appropriate Smartsheets for overtime entry ✓
Section 3 — Ongoing Benefits & Compliance Management
CRNA — HSA Employer
$1,248
per year · employer contribution
MD — HSA Employer
$2,366
per year · employer contribution
401k Eligibility
1 yr
then Jul 1 or Jan 1, whichever first
3.1 — HSA Contributions
Over-contribution is a recurring IRS problem
Employees frequently elect the wrong HSA amounts during ADP enrollment. ADP TotalSource does NOT alert employees when they over-contribute — this results in IRS penalty notices. Fix: send personalized HSA guidance email BEFORE ADP enrollment showing exact employer contribution and max allowed employee addition. Use the HSA module in this platform to generate this email.
3.2 — 401(k) Eligibility
Entirely manual — no automated notifications
After 1 year of employment. Eligibility = earlier of July 1 or January 1 after the 1-year mark. 60-day notice emails to employees are manually tracked. Fix: Use the 401k Tracker in this platform — it auto-calculates eligibility dates and generates enrollment notice emails.
3.3 — Reimbursements
Different rules for CRNAs vs. MDs
Rules are in each individual employment contract. Currently: Requisition Summaries submitted to Bill.com with supporting docs. Employees constantly ask about balances — no self-service view exists. Fix: Payables → Reimbursements module tracks all submissions and balances.
3.4 — Email Account & Distribution Groups
GoDaddy Outlook + manual Dr. Canning coordination
Create
firstname.lastname@aagmia.com in GoDaddy Outlook. Then coordinate with Dr. Canning to determine which email distribution groups to add the new hire to. This is fully manual with no automated role-based assignment.Section 4 — Email & Communication System
Current State — Critical Gap
hr@aagmia shared inbox has no accountability
The entire team uses one shared inbox for all HR communications. There is no system for who handles what — items get lost, there is no audit trail, and there is no way to confirm an inquiry has been actioned. This is an operational risk that grows with every new hire.
Recommended Fix
Implement a proper shared inbox tool
In order of preference: (1) Front — shared inbox with assignment, read receipts, and SLA tracking. (2) Help Scout — similar features, good for small teams. (3) Google Groups with better threading — free but limited. Long term: the AI orchestrator routes all hr@aagmia emails to the correct agent and logs every action to this platform automatically.
Section 5 — Comprehensive Issues Log (18 Items)
5.1 — Payroll Processing (6 issues)
Same data manually entered 4–6× per source
Notes Sheet → Master Sheet → ADP → 1099 Sheet → Bill.com → Summary emails. No API connections. Total: ~24–36 manual entries per payroll cycle.
6 sources in 6 different formats — no unified intake
Email, Excel, two Smartsheets, Qgenda PDF, monthly calendar. Each requires a different manual workflow.
6–10+ hours per bi-weekly payroll cycle
Estimated manual data entry and reconciliation time only. Does not include error correction time.
High transcription error risk with no automated validation
Errors only caught during ADP Register comparison step — sometimes after payroll is already processed.
ADP Register must be manually downloaded and compared every run
No automated download or variance-flagging system. Fully manual comparison to Master Sheet.
Single-source delay blocks entire payroll
Any one source being late or wrong holds up the entire payroll cycle for all employees.
5.2 — Onboarding & Malpractice (6 issues)
Malpractice applications frequently filled incorrectly
Wrong dates, missing checkboxes cause insurance carrier rejections. No validation layer or guided form exists.
Gloria's hiring tracker is Excel-only — not shareable
Single point of failure. If she is out, the entire onboarding pipeline status is unknown to the rest of the team.
No automated reminder system for any onboarding step
Malpractice follow-ups, missing forms, approaching start dates — all manually tracked with no alerts.
I-9 and W-9 forms frequently not returned on time
Despite repeated manual follow-ups. No digital form with embedded deadlines or auto-escalation.
New MD hires not always given Smartsheet access promptly
Leads to missed overtime entries in the first pay period. No automated provisioning on hire date.
Distribution groups require manual Dr. Canning coordination
Every single new hire requires a manual touchpoint with Dr. Canning. No self-service or role-based assignment.
5.3 — Benefits & Compliance (3 issues)
HSA over-contribution → recurring IRS penalty notices
ADP TotalSource does not warn employees. Fixed by the HSA module in this platform generating pre-enrollment guidance emails.
401k eligibility tracking is 100% manual
No automated notifications exist. Fixed by the 401k Tracker module automating 60/30-day notice emails.
No self-service reimbursement portal
Employees constantly call/email asking about balances. Fixed by Payables → Reimbursements module.
5.4 — Communication (1 issue)
Shared hr@aagmia inbox — no accountability or audit trail
Items get lost, no one knows who handled what. Recommend Front or Help Scout as immediate fix. Long-term: AI triage agent.
AI Automation Roadmap — Issues to Solutions
Every issue in Section 5 maps directly to a module or agent in this platform. Build order = risk × frequency × hours saved. Red = critical path. This document is the specification for the entire automation build.
| SOP Issue | Platform Solution | Priority | Est. Savings |
|---|---|---|---|
| Manual 4–6× data entry per source | Smartsheet API → Master Sheet auto-populate | Critical | 4–6 hrs/cycle |
| Malpractice app errors | Jotform with validation + auto-submit to carrier | Critical | Eliminates rejections |
| HSA over-contributions / IRS penalties | HSA module auto-sends guidance email at hire | Critical | IRS penalties gone |
| 401k manual tracking | 401k Tracker with 60/30-day auto emails | High | Compliance risk |
| No onboarding pipeline visibility | HR Matrix — due dates + overdue alerts | High | Full visibility |
| Qgenda manual rate calculation | Agent reads PDF → applies day/weekend rates | High | 2–3 hrs/cycle |
| Subsidy calc manual + Gloria email | QB export → auto calc → email drafted | High | 2 hrs/month |
| No reimbursement portal | Payables → Reimbursements self-service | Medium | Reduces Q&A volume |
| hr@aagmia no accountability | Front/Help Scout + AI triage agent | Medium | Audit trail + speed |
| ADP Register manual comparison | Auto-download → variance flagging agent | Medium | 1–2 hrs/cycle |
Mike's AI = Human analogy — applied to AAGM
| Human | AI equivalent | In AAGM |
|---|---|---|
| Orders | Prompt | Terri types "Morales start date Apr 28" → structured prompt to agent |
| Brain | LLM (Claude/GPT-4) | Reads context, reasons, decides next action |
| Ability / Skills | skills.MD | How to onboard CRNA W2, draft 401k notice, process malpractice app |
| Tools | tools.MD | Gmail API, ADP, Google Sheets, Smartsheet API, Jotform, Bill.com, QB API |
| Personality | souls.MD | Professional, concise, confirms with Terri before any sensitive external email |
| Decision Tree | Complex decision tree | If CRNA W2 → packet A + groups [1,2,3]. If MD 1099 → packet B + Smartsheet links |
| Referee | Orchestrator | Routes tasks, enforces guardrails, logs every action |
| Notepad | Obsidian AI | Every action logged: what sent, when, to whom, response received |
| Memory | memGPT / Letta | Short-term: current task. Long-term: full employee history, 401k dates, balances |
| Scheduler | Cron → HeartBeat.MD | Daily: check 401k dates in 60 days, malpractice status, overdue I-9s |
Guardrails
allowed Read sheets · send pre-approved template emails · flag issues · look up records
confirm first Non-template external emails · ADP record updates · Bill.com submissions
never Adjust payroll >10% · delete records · access banking data · act without approval on new scenarios
confirm first Non-template external emails · ADP record updates · Bill.com submissions
never Adjust payroll >10% · delete records · access banking data · act without approval on new scenarios
Automation vs reasoning
Automation (cron)
No thinking needed
Send 401k reminder on a date. Pull Smartsheet data. Add hire to email group. Generate payroll summary. These run on schedule — no LLM involved.
Reasoning (LLM agent)
Judgment required
Malpractice form has errors → agent reads and identifies what's wrong. Employee asks about balance → agent looks up record and responds. These need the LLM brain.
Phase 1 — Automation
Weeks 1–2
Cron, scheduled emails, forms
Phase 2 — Reasoning
Weeks 3–4
LLM reads, drafts, flags issues
Phase 3 — Full agents
Month 2+
Orchestrator + memory + autonomous
Build sequence — highest ROI first
Agent roster
Onboarding agent
Hire confirmed → first paycheck
Offboarding agent
Separation → clean exit + records
Compliance agent
401k, HSA, I-9 deadlines
Payroll agent
6 sources → Master → ADP
Subsidy agent
QB export → calc → invoice → emails
Payables agent
Auto-pay · invoices · reimbursements