2017 LVGEA Las Vegas Perspective Event

Welcome to the 37th annual Las Vegas

Perspective.

My name is Jonas Peterson. I'm the CEO of

the Las Vegas Global Economic Alliance,

and I am so excited. I am honored to be

your host this morning. Truth is, this is

my favorite event of the entire year

And thanks to your support, thanks to

your overwhelming support this turned

out to be a really hot ticket this year

I don't know if you guys saw this but we

sold out not a week ahead of time, not

two weeks, but over a month in advance,

right? is that worth thank you thank you

not only that but I'm glad you guys are

here we had to turn away around a

hundred that wanted to be with us this

morning so congratulations to you for

making the cut early thank you for

coming out but seriously this tells us

two things one we're probably going to

need to look at a bigger room next year

and two more importantly that we're on

the right track to deliver on the brand

promise for perspective that brand

promise is to be Southern Nevada's

premier source for community and

economic information analysis and

forecasting now for this morning we've

been working with our perspective

Council to raise the bar once again and

I am excited for what we have in store

for you. Let me tell you a little bit

about what we have planned. It starts

with the prospective data book that you

received when you came in this morning.

In that book, you will find a

comprehensive overview of the market as

it exists today. It's jam-packed with

information and statistics that you need

to know to understand our community, our

economy and where it's going. That's just

the beginning. This year, we put in new

content from dozens of community and

business leaders so that you can hear in

their own words about major projects and

priorities that they expect for the next

12 months. These are the big

organizations in our reach.

fFom higher education to our cities to

our TC to the Water Authority, and much

more. In addition, in the book, we've

retooled our polling to do a deeper dive

into the attitudes and opinions of the

Southern Nevada workforce. We want you to

be able to understand what the business

community is thinking on key topics,

sometimes controversial topics like

marijuana, stadium development, minimum

wage and much more. Also in the book,

you got forecast content where we pull

in subject matter. Experts,

dozens of subject matter experts, and ask

them to give their prediction on what's

going to happen in the economy over the

next 12 months. All that packed into the

book. And if we can advance, all right? So

you starts with the book during the

event today. We've got a powerhouse

lineup for you of speakers that are

going to do a deep dive into our economy

into advancing the business of health

care and a look at the future of gaming.

This is a powerhouse group of

speakers, and it doesn't stop there.

As you know with perspective, we want you

to be equipped with the latest

information and analysis throughout the

year. So is our gift to you, we're going

to be sending each of you that are here

this morning, quarterly newsletters with

more data analysis on topics like

education, infrastructure and

competitiveness throughout the year. And

we're also extending your access to the

LVG, a data portal.

You probably remember last year, we

showcased this new product. This is an

online tool that has real-time data

thousands of indicators and data points

all updated in real time along with

community mapping and much more. This is

our gift to you as well. Where if you're

here this morning, we want you to be able

to have this. So you will receive an

email with a one-year subscription to

the data portal and one last thing as

you leave this morning, we have the

latest project from our research center.

We're calling it the Southern Nevada

community map. This is not an ordinary

map, you'll grab it on your way out.

I want to tell you how it was created

We approached our friends that applied

analysis, and we asked them, "Can you help

us make a map that tells the future?" We

expected them to say no because that's

that's a ridiculous request. They said,

"Yes." They always do and the result is a

map that showcases the billions of

dollars of capital investment that we

expect to move forward along the Strip.

The billions more that's moving in our

economy through private businesses

around the region, new school

construction key assets, and so much more.

Take a close look at that map

when you receive it on the way out. I

think you will agree that it is awesome.

Now, we hope all this content it's

designed to add value to you so that

through the upcoming year you can make

better decisions at LVG, we believe that

information is the currency of economic

development and when we can equip

leaders like you with better information,

we as a team will make better decisions,

have a stronger community and have a

stronger economy. That's what perspective

is all about. All right. So again, thank

you for coming this morning. I want to

recognize a very special group. Make sure

I get this right so pull out the cards

for this. This is our Perspective Council.

The Perspective Council is responsible

for leading everything you see here, the

event, the speakers, the content. They're

not only sponsors but they're involved

in the process. There's an exceptional

group and I want to recognize them and

then give them each a big round of

applause. It starts with Cox

Communications, Derek Hill and your team.

could you guys stand up? Where you guys

at? I just...

So let me tell you just a little bit.

Derek is our vice chairman at LVGEA. Cox

is our pinnacle level investor and

they're all two on the prospective

Council. An amazing group. Thank you so

much. We appreciate you guys. Derek, you

are amazing. Thank you. 8 News Now

Lisa Howfield and the team does, stand

up for you. There you are

stand up and take a look at the crowd

that Lisa brings with. I believe this is

the largest group, you know, from 8 News

now that we have a perspective this

morning. So thank you so much. We

appreciate it.

Awesome at Nevada State Bank, Shannon

Petersen and the team, many times they're

there. Shannon's one of our new board

members at LVGA.

Thank you so much for this court. A

champion for our community at Wells

Fargo, Curt Clawson and the team. Stand on

up, guys.

Curt is on our executive committee at LVGA.

A rock star for this community always

saying as. Curt, you are amazing. Thank you,

and last but not least. The team at

Applied Analysis guys sent up Jeremy,

Brian,

Rachel, Melanie. The team, this is our

go-to group this is the brains behind

perspective. Perspective, I want you know,

they always say yes. They're always

striving to make this better, and they

blow us away when we ask for crazy

research requests. They find a way to

make it happen. We love you guys. Thank

you so much, all right? So that is our

perspective council. We also got a group

of in-kind investors that stepped up

this year. Let me read them off. We'll

give them a round of applause at the end

for helping us get the word out about

this event. We got KNPR, Lotus

Broadcasting, Elite Media and Vegas PBS.

Let's give a round of applause for this

group.

Thank you. There's a lot of elected

officials in the room. I caught a few of

you as you're coming in. So this

is probably an incomplete list, but I'm

going to give it a shot.

We've got mayor elect Deborah March from

Henderson here. Stand on up. Councilman

John Mars I believe is with us. This

morning councilman Dan Stewart,

councilman Stavros Anthony and

Commissioner Susan Prager.

Welcome elected officials. Stand on up if

I missed anybody all right now. It's the

fun part. We get to kick off the party.

We're going to invite up our first panel

before I do that, though, I want to remind

you to join the conversation on Twitter

#LVperspective. If you do that, I

think there's even on the the tent on

your table. You can ask questions

following our panel. You can be a part of

the discussion. In fact. I think we're

going to throw up a live Twitter wall in

just a little bit, so you will see that

firsthand. Here's our first panel. It's on

advancing the business of healthcare. Why?

Because there are amazing things

happening in this, in this industry, right?

Now, in fact, if you look at our economy,

it's the fastest jobs reducing segment.

There's major projects plan that you're

going to hear about and to tell you

about that. We've got a rock star group

of panelists. Let's start it off.

Betsy Fretwell from the city of Las

Vegas city manager, Betsy, could you come

join us?

From UNLV, we got the founding dean of

the medical school, Dr. Barbara Atkinson.

Welcome. Come join us.

[Applause]

From Toro University, the one and only,

Shelley Berkley, yeah.

And Doug Geinzer from Las Vegas HEALS. A man

who knows a lot about healthcare. Welcome.

Welcome. All right, all right. Good morning.

How are we doing? Excellent. So that's big.

If we could, I would like to kick it off

with you. Have them start us off, and

here's the question? Could you give us

the big picture? Why is

healthcare important to growing our

economy and also what is the city of Las

Vegas doing in particular to grow this

industry? Thank you, good morning, everyone.

It's a real pleasure to be here.

Healthcare is a critical industry for us.

One: we're underweighted in it and

everyone knows that when we do our

surveys at the city of Las Vegas that

there is always a concern about access

and quality. And so we know that we have

incredible quality, here in town, but we

do have an access issue, and many of the

panelists who are here with me today, are

working to improve that access by

creating new doctors and new medical

professionals that will help us.

It also helps bolster our economy. These

are good-paying jobs people, who are well

educated and they help us grow and

diversify. And that's been a critical

component for the city of Las Vegas. Most

recently, we put together a medical

district advisory board, about three or

four years ago, at the request of

Councilman Tarkanian and Mayor Carolyn

Goodman. We did that because we have one

of the single largest footprints of

medical care, and service delivery in the

middle of the city of Las Vegas. So, of

the distribution of healthcare

providers. In this community, we represent

64% of them right? In the medical

district in the heart of the city of Las

Vegas. And if you're trying to figure out

where that medical district is, it's

right by UMC. So, if you can picture that

right along Charleston, near Rancho, near

I-15. And also the council embarked upon

a plan to expand that district. And we've

added over 400 acres to that 200 acres,

so that we have plenty of room for

expansion. The council also adopted an

incredible master plan for that area in

partnership with all the institutional

providers in that 200 original acres, and

the expanded area that will bring us

over 600 acres of medical district

development. This is critically important

because if the city is investing wisely

in infrastructure, and all of the

providers in the area are partnering on

things that have a common good to them.

So not programmatic decisions not

whether or not Dr. Atkinson has 60 or 80

students per class, but really how are we

providing Street networks and a variety

of other infrastructure that helps drive

the cost down

to providing quality and affordable

healthcare to our community. It can

happen in the health district in the

medical district through our healthcare

providers. We really feel like this is an

important play for the city's economic

development plan, and that's what we have

been focusing on to make a huge

difference for our entire community. And

we believe that we can be the hub. This

doesn't replace what needs to be

happening throughout the community. This

accentuates what needs to be happening

throughout the community and creates a

hub in the middle of the city where

everybody can get to it for those things

that we can only have one up. For

instance, and those are the kinds of

things that we've been pursuing at the

city, we have great hopes for the medical

school and what it brings to that

district. We're thrilled that the Medical

Education building is going to be there,

and we have high hopes for additional

expansion in that area as the medical

school grows. Those are the things we're

focusing in on at the city of Las Vegas

Beautiful. Dr. Atkinson, your

up next. We know that the, our first class

at the School of Medicine is coming

online this summer. Could you give us a

taste of the kind of? What's next? What

are the major steps? What are you excited

about? Well, I'm excited about it all or

what I'm excited about the class. First, I

just have to tell you quickly, it's sixty

students. They're starting on July 17th,

they're starting with EMT training, but

of those 60 students. They are all from

Nevada or they have very strong ties to

Nevada we just interviewed Nevada

students. We had over 900 applicants and

300 of them were from Nevada, so we

didn't even have to go beyond that and

that's exciting in itself so they're

getting ready to start what we're really

working on this summer, too, is setting up

the clinical Enterprise. So, on July 1st,

the people who were the faculty at UNR

School of Medicine, which who are

practicing in Las Vegas are all moving

over to be UNLV faculty. So that's about

a hundred and twenty-five physicians, and

another 25 or so administrators and so.

They practice in the medical district

mostly. Although, they have a few other

sites, as well. They'll be practicing

under UNLV medicine starting then. And so,

we have to convert those practices into

a whole different level of care. A level

of care that really is one that you

would be proud to come to. So, that's a

major effort that's going on right now.

Recontracting everything. Everything

from getting telephones, EMRs, patient

records, ready to move over. It's a big

deal to move that many people besides

them. Moving over, they have 300 practice

plan employees that front desk, the

billing, people, everybody else. That goes

with the practice . They're coming over,

and 300 residents are moving over to

become, you know, UNLV residents. So we're

going from having about 80 faculty and

staff in the School of Medicine to over

800 on July 1st. So that's a pretty big

deal. That's about a quarter of what UNLV

is altogether. So, adding that many new

people is, is really exciting but the

practice is going to be very exciting,

but it'll take us a little while to get

it to where it needs to be beside that.

We're working on starting that medical

education building, and I have to say, the

city has been an incredible partner with

us on this and the county has as well,

but County gave us 9 acres of land in

the medical district. We've already moved

all our current faculty to the medical

district so we are clearly in the

medical district. Now, we are in the

second phase of design of the building

whereas you've probably read in the

papers, looking for our hundred million

dollar donor. We hope we'll be able to

say we have that. We hope we'll be able

to actually break ground on the building

I hope in the fall. We'll see. So that's

going on, and I think those are probably

the major efforts. We do have a research

effort going on, and that's one that's

really important for the community. It's

sort of trailing to a certain degree.

Everything else, because we did education

first, clinical second and research third.

But it's coming, we just celebrated a big

Mountain West conglomeration of people

who are all part of a research team that

works together to build research

infrastructure, and that's what's really

going to drive the economic piece of the

healthcare district. And I'll just say

that the projection of a Medical School

in a help, in a medical district with

everything. It brings is something like a

3.6 billion dollar a year. A

year economic benefit to the community,

and should have something like

twenty-two thousand new jobs within the

next 15 years. So that's what we're up to

awesome all right? Shelley I'm coming

your way actually, for the next one. So

Shelly, you have a unique perspective,

right? You've been involved in the

highest levels of government, and in

medical education, I want to ask for your

thoughts on one of those topics that's

critical, involves both those graduates in

Medical Education. I know our state

legislature in particular is taking a look

at this. What is it? Why do we need more

of it? Could you give us your thoughts on

that? Yeah, thank you very much. And thanks

for having me. Good morning, everybody.

GME is a very important issue and very

critical to the state of Nevada.

We are going to attract doctors and keep

them here when you graduate medical

schools. You still cannot practice

medicine. You have a minimum of three

more years of training which is your

residency graduates medical education

now. Years ago, its graduate medical

education dollars. How do we pay for GME,

comes out of Medicare funding, from the

feds. Years ago, it was capped, which means

if you're an East Coast state that has

lots of GME. You continued getting

funding for a growth state like Nevada,

where we've had a huge population

explosion. It's been devastating to us,

because the GME is cap. There's no

funding from the feds, so are very

limited funding, from the feds so

understanding that you need three more

years of training before you can

practice medicine. It is essential that

the state of Nevada create its own GME.

And so the governor, and I am very high

on Governor Sandoval, for a whole host of

reasons, but he understood that we needed

to create and spend some money on the

state level in order to create GME. So,

last legislative session he ensured in

his budget was a 10 million dollar

appropriation to create primary care

GME's. Why is that important? Because the

greatest shortage of doctors. Although, we

have shortages across the board, greatest

shortage of doctors is primary care

physicians. As consequently, we were able

to utilize that ten million dollars, five

million each year, of the biennium to

create Graduate Medical Education. Now, in

this legislative session, he again in his

budget was another ten million dollars.

I've been tracking it in the legislature

and the legislature; I believe when their

budget is put to bed the

ten million dollars will survive, and we

will be able to use it for GME it is

very important that it stays in primary

care because that is the greatest need

in the state of Nevada.

Let me quickly end with this, and it's

easy to understand why is GME here and

Nevada important because 70% of doctors

end up practicing where they do their

GME, their Graduate Medical Education. If

we don't have enough Graduate Medical

Education in the state of Nevada. These

young men and women these future doctors

end up going away, and unless they have a

tie with the state of Nevada. They're not

coming back, and it makes sense. They're

making contacts in the medical community.

They're getting married. They're

establishing ties in the community that

they're getting having their residency.

And a simple way to understand this: Toro

University graduates a hundred and

thirty-five future doctors every year.

We're very proud of that. We had 3700

applications for a hundred and

thirty-five slots this year. We can

afford to be very selective of who we

admit into our program. If we admit you,

we expect you to graduate, and we're

going to do everything we can to help

you. We have 30 residences will 90 but 30,

30, 30. Because it's 30, a year with valid

with the valley health system that means

that if we feel every residency with the

Toro students. A hundred and five of my

graduates of future doctors have to

leave the state of Nevada in order to

get their training. That is insane. And

Barbara and I have talked about this. A

lot of you could have a new medical school.

You could have 20 new medical schools.

We're all still competing for the same

small number of residences. Until this

stage gets more residences, we are not

not going to be able to keep doctors

here, and it's simple math. And it doesn't

take a genius to figure this out. So if

you ask, and maybe doing something to ask

later, "What can I do?" Call your legislator.

We know them. That's the beauty of Nevada

tell them to make sure that GME money,

primary care physicians is in the budget

this year. So we can start more

residences in the following few years so

important, so important audience. So there.

Thank you. All right, Doug. You're up next

want to hop into your world for a little

bit the audience when they leave today,

they're going to look at that community

map, and they're going to see hospitals,

clinics springing up all over the valley.

Could you tell us a little bit striving

this trend? Maybe share a few examples.

Sure. So it's a lot of things during the

Great Recession. We went into that under

bedded as a community. We just flat out

did not have a bed enough beds to serve

the community. The tear during that

recession our unemployment rates went up.

Therefore, our uninsured what not. So a

lot of folks just didn't have access to

care because of that we were the first

state or the first republican governor

that approved the expansion of Medicaid

through the Affordable Care Act that

brought in 300,000 new additionally

insured so these 300,000 needed a place

to access care and what that's it. Is it

also provided a patient that would

present themselves at the hospitals that

now had a payer source not quite at the

level that they need to to be profitable?

But they had a payer source attached to

them, so everybody started growing again.

At the same time, some other things

happen where they started. They corrected

the reimbursement rate for inpatient

behavioral health, so you saw some

readjustment around the community. So now,

you're watching all of these facilities

and all these systems grow. I think a lot

of the growth that's going on in the

medical district and with the UNLV

School of Medicine is going to continue

and we're building out now to embrace

and be prepared for a major

transformation into academic medicine. So

as that happens and more residents are

coming through, and 70% of those are

staying here.

They're going to be opening up practices.

Then we'll start developing specialty

and subspecialty programs and fellowship

programs to bring on the the access to

care that we desperately need. You're

seeing other systems such as yesterday,

there's a great presentation from the

folks from Union Village in Henderson

Hospital. That was a hospital that was

opened up just a year ago, and they're

already expanding they're already at

that capacity. Every single Hospital in

this town is growing at some rate

whether it's Centennial, Spring Valley,

Mountain View, Sunrise is building a new

tower. You're seeing the introduction of

stand-alone ERs. You're seeing the

introduction of community hospitals or

micro hospitals, and this is all

improving access to care because we all

want to access care whereas closest to

where we live. And you're going to see a

huge transformation that's for years to

come.

So I think it's an exciting time for

medicine in Las Vegas. I think the great

work that's being done by our governor

with the expansion of Graduate Medical

Education, what's happening with you and

I'll be medicine. What's going on at the

medical district? Health care is now top

of mind, and tip of tongue. It's happening.

It's growing and it's driving this

community and it's going to require

strengthening that healthcare pillar for

true economic diversification to happen

because, as we're trying to recruit

attract and expand companies to come

here. Those executives want to offer

their family, their executives, families

and all of their employees, and their

families good health care, and good

education. And so I think the healthcare

community has really come together to

help provide that part of the equation

beautiful, beautiful. All right, panel. I'm

going to open up the next question to

everybody. This is a little bit of a hot

button issue: reimbursement rates. Could

you guys could you tell us about what's

going on with reimbursement rates? How do

we stack up to other markets? Why is it

important? What can we do about it?

So I'll jump in there. Sorry to hog the

microphone a little bit, and a little bit

of a selfish plug. So Las Vegas Heals has

a reimbursement survey out on the street.

We partnered up with the LVGEA on this.

So,

let me explain why reimbursements is so

important economic development really is

job creation, okay, and workforce

development. It's what it comes down to.

In workforce development, you've got two

parts of that equation recruitment of a

workforce and retention of a workforce.

We have worked extremely hard over the

course of the last four years to expand

our physician pipeline. So, the expansion

of Graduate Medical Education to put

some perspective to that we're going

from programs existing in three

hospitals by the end of this year. We

should probably have programs and 12

hospitals, which is gigantic. And so we've

spent all this time developing this

pipeline of physicians with the new

Medical School with the expansion of

Toro and everything that's going on we

now need to focus our attention to the

retention part of the equation and

that's keeping them here. And the

residency programs get them here. What

keeps doctors here is their pay, and

their pay is directly tied to

reimbursement rates? So if we are not

reimbursing them adequately all of this

infrastructure that we've been building

over the last five years is for naught.

So, we have to get this part of the

equation right? Nevada, as a whole, is one

of the worst reimburse markets in the

entire country, so physicians have the

choice because they're in demand

everywhere. The physician shortage is not

just in Nevada. It is in every single

state and so doctors have choices where

they could live and when they could go

to a neighboring states, and they could

earn 40 percent more and see less

patients and do what they truly care

about. And is delivering exceptional

patient care spending time with the

patient's they could choose where

they're going to go. So in order for

Nevada to have a competitive advantage,

we must address reimbursement rates. If

we don't get that right, we're going to

have serious serious challenges. Well,

my husband is a nephrologist. They

when I first started dating him, I

thought that was sex with dead people.

It's not. It's, he's a gay doctor, thank

God. A kid and Ragnar and my stepdaughter

is a primary care physician. So we do

health care in our family. It's a very

simple thing and just get on it.

Reimbursement is important because

doctors like to eat and support their

families and if the reimbursement rates

are low they are going to go elsewhere

but it also has a lot to do with the

insurance companies who are negotiating

the rates with the doctors and because

there is very few choices of private

health insurers. The insurance companies

can pretty well determine what they are

going to pay for the services if the

doctor wants to be in their network. And

so, my husband is a managing doctor of

his group. There's 33 doctors. 700

employees in his group. It's a big

practice, but when he is dealing with the

insurance companies they are offering to

reimburse them 50 percent of Medicare,

which is pathetic. Anyway, Medicare is one

of his high pays, not one of his low pays.

And you know, they could look, you know,

we just going to deal with your

competitor, and we're giving them 50. 50

percent of Medicare. You want it or you

don't want it. Now Larry's groups going

to want to be part of that Network, too.

So those primary care physicians can

refer their patient to whoever,

whatever doctors in that network. So it

has a lot to do with lack of competition

with insurance companies offering this

type of insurance medical insurance to

our so, I guess, our fellow citizens.

That's huge.

Another thing that is going to be

devastating for this state if President

Trump's proposal to cut eight hundred

billion dollars out of men,

the cave goes through. I sincerely doubt

it will. It is going to be devastating

for the state of Nevada because that's

how poor people get their services and

it's important to know this. In

conclusion, just because you don't have

health insurance doesn't mean you don't

get sick. You wait until you get really

sick and you end up in the emergency

rooms of the hospital. What is the most

expensive type of treatment? Emergency

room treatment and there is a reason

that UMC is no longer having 70 million

dollar yearly deficits. They're not in

the red anymore, and that's because

Obamacare expanded Medicaid. Governor

Sandoval agreed that they should that

the state of Nevada should expand its

Medicaid program and as the

reimbursement from the feds gets lower

and lower the cost to the taxpayers of

the state of Nevada is going to rise and

rise and rise. It could be a big budget

buster, and for somebody like Barbara, who

needs those state dollar, of course. Itoro

doesn't take any state or federal money.

However, for yes for a medical school

that's dependent on state funding, the

fact that Medicaid is going to be cut is

really going to hurt, that they're going

to have to make up the shortfall and

things like UNLV Medical School. And so

many other programs that we as citizens

expect from our government aren't going

to are going to be cut because this is a

low tax state and our fellow citizens

don't want their taxes increased, alright.

Thank you, thank you. We've got so many

more questions that I want to ask, but

it's important that we open it up to you

guys. So this is a segment where, let's

see if we can't fit in some questions

from Twitter. And then we're going to

have a roving microphone as well

Twitter's not working okay.

Our feed is not working, all right. What's

the visit? This is good to know. So from

the audience, do we have a question for

this panel? Anybody will come get you

with a microphone while you're waiting. Can

I make it? Yeah, all right. Rebuttal. A

little carrot. I just don't want to

leave the audience with something that I

think is a misconception. I agree with

Shelley on almost everything and for

sure on the GME, we absolutely need it

and it is in the governor's budget. So

and it does look like it's going through.

What I disagree with is that primary

care is all we need. We need specialty

care in this city as well. You do one

first, and then the other, and you're

right. We need to both make money from

primary care. And you don't get the

pipeline that refers, Let me just tell

you why we need specialties now too,

because almost half of the students that

that went to Reno University of

Nevada-reno School of Medicine left the

state because the specialty training

they wanted isn't given in the state so

to actually fix the students leaving the

state. They have to have specialty

residents, and if you look at the medical

care that's missing. It's the highest

level of medical care that doesn't exist

at all things like liver transplants,

bone marrow transplants, pancreas

transplants, a heart failure program was

an external pump. Those are all programs

that need to be here in Las Vegas, and

you shouldn't have to leave even

insurance companies have to pay to send

people out of state for those kinds of

things. So we really need the other

residences, and just to tell you what

residences are missing in this state.

Some very basic things like in

nephrology fellowship, for one, is missing.

But things like dermatology,

ophthalmology, neurosurgery, cardiac

surgery, orthopedics just started. So we

now have that all of the radiology,

anesthesia, pathology, radiation, oncology,

I could probably name a lot more and

there's not a single pediatric

fellowship.

Only three medicine fellowship. So if you

want to, there's no oncology cancer

fellowships. So all of those need to be

built in this city and as fast as they

can be built and I will say that

depending on what charts you look at if

you look at a national average of

specialty versus primary care were more

scarce in specialties. If you look at

the Mountain West which includes things

like Idaho, Wyoming, in Montana

primary care is more comparing us to

them is really more in demand. But it

just goes to show that their region as a

whole needs more specialty care. So

couldn't leave it without that super

important. And in four years, when you

graduate your first class. Barbara, I

think, we should start those specialties

right. Now, let's get the primary care

physicians, what? Let's be real. We need

all of them, and we need them all now. So

please, talk to the governor. Talk to your

legislators. Let's get the GME funded,

Let's get the Medical School funded, and

let's just get this done. So people quit

getting on the airplane to go get their

care, that should not be OK for us in

this city anymore. And all of these

people are completely dedicated to

turning that ship around, but it takes

every citizen to care and act that is

the perfect summary. A transition to you.

Guys, we do have a question from the

audience.

Team. Yup. There we go all right. Fire away.

Rachel's all Mesquite Regional Business.

We're about an hour east of here, and we

feel the same way except people get in

their car and come here for medical care.

So is there going to be an effort to

reach out to rural Clark County

communities? Can we have some residences

in Mesquite, in Boulder City, and Laughlin,

and some of our other partners? I can

start out saying that I think the big

the biggest thing that could help rural

Clark County, and rural Nevada is

telemedicine, and I think that's really

the thing of the future, and that's

something that's really good for urban

areas too. For follow-up, you need to be

see a doctor in person the first time,

but often for follow-up especially with

chronic diseases, it could happen in your

home,

and save you the drive and save you, save

you, the parking and so on.

Let the echo what Barbara is saying, Kuro

is very aggressively moving into

telemedicine. I think it is very

important if there are not enough health

care providers, and there are not in the

state of Nevada. See a very good way. It's

not the ideal perfect way, but a very

good way to access healthcare and to

speak to a health care provider is

through telemedicine. So, we are also

moving in that direction very very

rapidly and very aggressively. Excellent.

I know we're running short on time so

we're going to cut cut this segment

short. And give this group a huge round

of applause? Can you join me? Thank you so

much, all right. I hope you can see how

critical healthcare is to our economy,

and to really to our community and

getting to that next level. I hope you

learn something there. We're going to

move on to our first keynote, and I want

to introduce this by saying a friend

once told me, "You'll know when you

arrived in Las Vegas when Jeremy agüero

considers you a friend," right? I believe

that that's kind of true and I'm proud

to say Jeremy, I consider you a friend.

You're one of the smartest people I know.

This is the presentation that I know you

guys really keep coming back for year

after year. That makes perspective. Great,

let's give a warm welcome to Jeremy

Agüero with a plot analysis.

[Music]

Good morning. I appreciate everybody

being here today as Jonas, my very good

friend, indicated my job is to come up

here and provide you somewhat of an

overview in terms of where we are as an

economy. And where we think that were

ultimately heading. Before I do that,

Jonas was so nice to say thank you to

our firm and the other sponsors that we

have and everyone being here. But he

would never be so presumptive is to say

to mention the LVGEA and all the

wonderful things that they do and their

entire staff does to put on this event.

Please give them a round in developing

my presentation today. The title of my

presentation is Coming Full Circle. It

occurs to me that our community is going

through some unique brand approach

traumatic stress. Excuse me, yeah. Me too.

Post-traumatic stress disorder in terms

of this ability to start to

conceptualize the fact that our economy

is no longer in recession that we're

starting to move forward, and the

questions that I get are relatively

similar. Hey look. What's going to happen

next? When are we going to fall off this

cliff? Are we growing too fast? This means

we're getting out over our skis. Are we

just setting ourselves up to happen

again? Should I invest? All of those type

of things seem to be this recurring set

of questions. And so, I'd like to take

some time to put some of those arrests.

And I understand why we got to this

point. Let's not forget about all of the

articles that came out for the better,

part of a five-year period right?

Crowds returned but we're no one's going

to gamble the housing market continues

to slide Las Vegas economy, absolutely in

freefall. My personal favorite, Las Vegas

economy, among the worst in the world

report, says now I can think of lots of

places on planet Earth many of them end.

With something like Tajikistan, you

know, whatever that I don't even ever

believe that we are the worst on planet

earth. And then the other one that was

out there was, of course, Las Vegas from

Time magazine, where Joel Stein called

Las Vegas the world's greatest ghost

town

in waiting. Right? This is why we continue

to have this type of concern, and I get

it I get that the economic downturn was

significant. I get that it created a lot

of stress for us in here. But the fact

that this room is filled with so many

familiar faces among people who found a

way to make it work. I think is something

we should be very proud of. And I think

being realistic about where we are is

important because this community will

not be judged, based on our ability to

survive a recession our community will

be judged on the ability to sustain our

prosperity. That is what you heard today,

and that is what we need to do as a

community. I'm going to start with

population growth because our community

is geared for exactly that we are

designed to grow. We have been among the

nation's fastest growing for decades and

decades and decades. And here we are

still again. what I'd like to do is just

show you the population growth during

sort of a boom period. And then you see

that it sort of flattens out a little

bit, and here we are again. And today, we

are a community of 2.2 million people

overall. 2.2 million people call this

place home.

Now it's the same 500 people that you

see everywhere you go. I get that, okay.

But there really are 2.2 million people

have physically live in this community.

Now, I went relatively fast to this and

if I was to go back through it. You'd see

that the demographics, and I'll go

backward because my guys were so nice to

create this. If you look on the right

side of my chart, that's the shares in

terms of races in terms of our

demographics if you will. And we look at

2000, and then we look at 2006. And then

we look at 2012, and then where we are

today, we are becoming increasingly

diverse. We are minority-majority. All of

those type of things this diversity is

what makes our community great. It is

part of who we are. It is the fabric of

our society, and there is nothing wrong

with it. As a matter of fact, we only

today are starting to embrace that and

carry it forward. These are the 35

largest metropolitan areas in the United

States. We are the third fastest growing

of all of them, not a bad place to be.

Where are newcomers coming from? There's

no surprise here. Who want to think about

it in terms of full

circle. Yes, people did not move to

Southern Nevada when the economy was

going down? Why did they not move because

they weren't moving anywhere because

their house was underwater. That's why

people weren't moving. And now they're

moving again, and guess where they're

coming from, excuse me, California.

Because it's the seventh largest economy

on planet Earth and people can't get out

of there fast enough. All of which is

fine right? But it's benefiting us but

more important than this idea of full

circle is how we've changed in that.

Let's just take a look at what those

newcomer trends look like throughout the

years in 2000. Look at what the income

level was. Look at the age of people

moving in. What we know is that today

people are moving into our community to

find jobs that are at a higher level and

they're bringing more income with them.

They're also bringing more home equity

with them, and surprisingly enough, there

actually appears to be some

Millennials that are moving out of their

parents house because they appear to be

moving here right? If you look at the far

right at 2016, the age at which people

are moving in is dropping for every

reason and the LVGEA has been absolutely

a leader on. This is the reality that we

cannot create as many professionals as

we need in this community.

Things like GME and others are

essentially a roadblock until we are

going to have to attract talent

particularly from around the western

United States. And they're coming here,

and they're coming here because we offer

a better way of life overall. If we

transition from this idea of population

to this concept of employment, right. The

number one motivation for people moving

into our community as it has been for

most of the past 37 years has been this

idea of finding a job, probably much

longer than that. But it is this idea of

finding a job and if we look at how we

are creating jobs, and where we've been

this idea of sort of coming all the way

back around. This is what job growth

looked in 2007. Most of the folks here

remember what 2007 was like. Jobs were

plentiful, the unemployment rate was

approaching 4%. Everybody that wanted a

job could find a job except perhaps for

my brother-in-law. And it was

fine, right. It was good right. We were

growing at 4.3%, we

were the

we were the fifth fastest growing

metropolitan area, excuse me, states in

the nation. And here we look at a 2011,

when the world is kind of coming apart,

and only North Dakota has positive

growth right. You know, yeah. There's a lot

of jokes there. We'll just leave it, leave

it there. And then you look at 2017, and

here we are again here we are again at

the now the third fastest growing state

in the entire United States. And that's

great, and that full circle is what is

important to us. But the nature of it,

what is underlying, it is the reason that

we can at least exhale a little bit, and

say we are learning to do it better as

we go forward. Let's just talk about that

for a moment. Now, here's the

pre-recession growth in employment for

the top 35 MSA.

I guess I should show this in advance of

showing how we're changing to make sure

that I'm showing sort of an apples to

apples comparison. So we were just

looking at states we're now looking at

MSA, is you can see there's only one

large MSA now to the right of us. In 2007

we're dead last in the among large MSA.

And in 2011, and here we are today at

about three a little over 3% employment

growth, which I'm sure my good friends at

the Nevada Department of Employment

training and rehabilitation, that are

here today will tell you that is pretty

darn good growth overall. And we like it

so we look at where we are in terms of

having created all of those jobs, right.

Here's our last peak. There it is, in May

of 2007 when we had about let's call it

nine hundred and forty thousand today

where, let's call it nine hundred and

eighty thousand. We have forty thousand

more jobs today in our community than we

did then on the far right hand side of

my chart, of course, is what sectors are

showing the greatest growth. And I think

this is part of the angst that we have.

The number one growth sector we had over

the past 12 months has been construction.

We added 8,500 jobs, and I am here to

tell you that as we're going through

this exercise. By the time we get to the

end of this year, our community is going

to be 10,000 construction workers short

of the number. We're going to need to

keep pace with all the projects we have.

And if there's some construction folks

in the room, they're probably going to

tell you that I'm light on that number,

and we're all

10,000 construction workers short of

hitting that number. Look at the other

areas that we're growing professional

and business services, leisure and

hospitality, education, in health care, all

expanding. Let's take a look at the

unemployment rate, right? Our unemployment

rate, of course, was always approaching

15% at the peak of the market. The green

area at the bottom shows the

differential between our unemployment

rate and the United States unemployment

rate, which I will argue would be almost

more important than anything else that's

on this chart. Why? Because that led to an

out migration of folks, and was part of

the reason that we lost 1 out of every 8

private sector jobs in its southern

nevada during the peak of the recession.

Today, we've gotten almost all of it back

we are doing well we are at near full

employment, if not at full employment and

that is extremely positive overall under

where we were where we're headed.

All those types of things. Now, I

understand that this chart is is there's

a lot of colors and a lot of numbers, all

type of things. I'd like to talk about it

just for a moment that those sort of big

green blocks. That's leisure and

hospitality right? This shows us how many

employees we have, and every sector of

the economy, you can see the big green

block is still the big green block. You

will also see that if we look at 2007

versus 2017 that the yellow area which

is education and health services, which

of course, you just heard a great deal

about is getting larger we still have

only 70 percent of the healthcare

economy we should for an area of our

size and that is hugely problematic.

Although, you will notice that the yellow

area has gotten increasingly bigger. I'm

really glad that Shelley clarified in

terms of what nephrology is because

there's been growth there. And I was

really wondering, "What the hell was going

on," right? So I'm glad I now have all of

that straight. But at the end of the day

is the one that we probably care about.

The most is this one which is why we

created the chart in the first place, and

that's the idea of construction. So if

construction is now at the top of our

list, are we getting out over our skis? Do

we have this huge problem? In 2007, you

can see that 11.2%

of our employment was in construction at

the bottom of the market it was 4.8%.

Today, we're 6.3 and on the right-hand

side of my chart. I think it's what is

critically important. I just told you we

have 40,000 more employees than we did

at the prior peak of our economy, we did

that with 40 thousand fewer construction

workers in our economy at its peak. That

was a hundred and five thousand today.

It's 61 thousand, not a bad place for us

to be. And I would argue significantly

more healthy than where we were going in

to the economic downturn, now. Let's

take a look at what the U.S. averages

are for each one of those five point six

percent, three point nine percent and

four point six percent. Okay, we'll take

it that number starts that six point

three percent on that one. On the right

starts to approach 8 percent, we need to

start having a conversation about it. In

our community, that is the level of

growth that will start to be

unsustainable and something we'll need

to keep an eye on. If we look at it in

terms of the demand for space, right, is

this creation of jobs and what we're

developing leading to this demand for

space. This chart has all kinds of

information on it the vacancy rate and

how many employees are office using and

how many square feet they use and all

those types of things, all of which is

important and I appreciate my guys

putting it on here. But what is

critically important about this slide is

that the little green line is above the

little purple line, which means that we

are demanding more office space than we

are bringing on concurrent with this

fact that we are growing more rapidly. We

are also finding ways to utilize the

existing space that we have and we are

being pragmatic in terms of how much

we're bringing on. This chart shows the

number of the amount of occupied space

for every office using employee at the

peak of the market sort of, back sort of

looking far to the right and then we go

up into the recession and that number

gets to 130 square feet for every office

using employee. Why does it get to that

level? Because when you start laying

people off, you've got a lot of office

space out there, right? And so if we look

today, we're now at about 110, which means

we are utilizing our office space in a

way that's almost equally effective to a

period when the

vacancy rate was, you know, let's call it

sub 6% in our community. What we have is

a disconnect between functional space

and well located space and non

functional space and stuff that's just

not that well located. And that's what

we're seeing today. And so what's working

out okay, and in addition to that, what we

are building in our community. Our

corporate headquarters build two suits,

right, some of the most phenomenal office

developments in the entire western

United States are happening right, in our

backyard. Not the least of which is

something the UFC and aristocrat

facilities that are recently constructed.

Now, the housing market seems to me to be

something that's worthy of some extended

discussion along the same lines.

Why? Because housing was given all of the

blame in terms of the economic downturn,

and seems to be getting zero of the

credit in terms of coming back. We've

seen subdivisions have started to pop up

and those types of things, which is

creating some concern in terms of over

building, within our market or price is

getting out of line. Are we building too

many houses? Should I buy a house? Is my

house going to drop in value as a result?

I hear this question at least three

times a week. And so, let me try and

answer at the 500 people at one time on.

The critical way of looking at it is

something we refer to as the ep ratio or

the number of employees versus the

number of permits that you're

constructing. And forgive me for getting

overly technical, but there are generally

about 1.35 employees in every household.

It's just the way it averages out and so

if that number gets out of whack if you

start to permit more than that it

becomes problematic. If you permit less

than that, it becomes problematic from an

over/under supply standpoint. Today, the

little purple line is what Las Vegas is

doing in terms of the EP ratio which

means that there are two point four

employees for every home that we are

constructing today. With everything that

we're seeing, we're not building enough

homes for all of the employees that we

are generating. And the matter of fact, if

we look at the Green Line, which

represents the United States as a whole

the U.S. is building about 1.7 for 1.75

houses for, excuse me, employees generate

one additional housing unit. We are under

building our residential today which

leaves us with some degree of comfort

overall in terms of housing

affordability. Is it getting out of whack?

The answers really no. You can see places

like the bigger numbers are actually

better here, so don't we, excuse me. Don't

read this in any way incorrectly. UC San

Francisco Los Angeles and San Jose or at

the bottom in terms of housing

opportunity can people actually afford a

house? No they cannot. In those markets,

can they in our market? Yes they can. If

we look at the housing price index,

we're not even back to where we were

overall. Now, if we think about it in

terms of this coming full circle, let's

make sure that we are clear here, in

terms of how it all played out. This is

2004,

excuse me 2003 to 2004, arguably the peak

of the housing market the prior peak of

the housing market Nevada was number one

in the United States, with annual

appreciation of 37.2%. If anyone believes

that appreciation of 37.2%

is in any way sustainable, we can have a

conversation after this meeting. Okay,

it's just not right so now let's

fast-forward to the bottom of the market.

We go from number one in the United

States. We go all the way down to number

50 in the United States. We drop by

twenty five point, seven percent. Of

course, that's dramatic. Everyone's

concerned? So where are we today? The most

recent numbers place us in the top five.

Yes, I would prefer to be in the top 10

in the top five, but that number is 8

percent right? Much more sustainable than

something that's measured with a, you

know, then thirty eight percent or twenty

eight percent or even 18 percent. We'll

take it right. We understand where it is,

and it's certainly not as nearly as out

of whack as some have suggested. Now

arguably most important here is this

idea that people see building permits

are going up, and they're rising by

double-digit rates. And we're seeing all

these subdivision comes out, and we're

hearing about all of these new

communities that are out here. These are

new home market closings? Right,

how many housing units we are building

and are being sold in the market on the

left-hand side of the chart is what it

looked like when we were going up, right?

Over

40,000 housing units were being

constructed the past 12 months. That

number is 8300 in our community today.

Again, the idea that we are getting out

over our skis that it's becoming

increasingly problematic. Yes, we have

things to be concerned about, but I think

we should take a deep breath, and not be

scared by our prosperity again.

We will be defined by our ability to

sustain that prosperity over time on the

far right hand side of my chart is the

median price for newly constructed homes.

You can see that we're almost back to

peak. Of course, you also have 10 years

worth of inflation in there. And the

reality is that home builders are just

simply building bigger homes today than

they did a decade ago. So again, we're not

even very concerned about that number

and for most of us sitting in the room.

We're much more concerned about existing

homes than we are new construction

because that affects each one of us or

many of us. I'm sure if you look at the

number on the right, excuse me. The

numbers on the left that reflects how

many closings are out there. Very

consistent with what we'd expect. And on

the right hand side is what we call the

rollercoaster of doom, ok. And what the

rollercoaster of doom means is that if

you look on the far left-hand side of

that chart, this is what median closing

prices were all the way back in 03.

And if your little red line represents a

three percent growth rate, which is

pretty much exactly our housing prices

have appreciated over time for the past

50 years. Now, we have a period with a

huge boom. We have a spirit with a huge

bust. You wipe all of that out over about

a 12 year period, 13 year period.

And what happens? We're exactly back to

the three percent growth rate that we

should have been at the outset. It's just

markets doing what they do, and if we

look at new homes as a percentage of

existing homes. Are we getting out over

our skis in terms of the amount of

construction versus existing inventory?

It is 14 and a half percent nowhere near

what it was at the peak of the market

when it approached 60% of existing

inventory land. Land availability becomes

this big concern I've heard rumblings

about the fact that we have to go to the

federal government and get them to

release more land to drive down prices

because those prices are coming up this

the price of land that you see here. We

have excluded residential, excuse me,

resort casino development that's in

there. So you get the idea you see that

in 2007, the average price of land was

$800,000 a day. We all remember the land

auctions and the like and now I'm going

to lay over the top of that median new

home price and median existing home

price. We'll look at the expansion. We'll

look at the peak. We'll look at the

contraction. We'll look at the trough. And

where we are today, that is with a very

normal cycle and that frankly on the

right hand side of my chart the distance

between the price of land and the price

of housing is where we would like it to

be on this chart. Now, I'm not going to

say that I'm not somewhat concerned

about the fact that land prices are

escalating. But nonetheless, you get the

idea of where we are versus where we

were when things were overheated now if

we start to see a trend that looks like

what we saw in five six and seven. It's

time to bring the fire trucks up to the

front.

We cannot fear our prosperity as a

community. There are today seventy one

thousand five hundred developable acres

in Southern Nevada. We're developing

about five thousand of those every year.

That's what these charts show. And so, we

have about fourteen years worth of

affected inventory left. If we average

everything out, not bad and where we want

to be if we look at this idea. Well, we

hear all the time that incomes are not

keeping pace that housing prices are

going up, but all of our incomes are

remaining. They're remaining flat. I read

yesterday that incomes haven't gone up

since 2000 or something, along those

lines number one. That's not right. Number

two. Let's just take a look at it.

Here's household income versus home

price. This is what it was prior to 2004,

this is when incomes outstripped housing

prices. Of course, this is during the boom

period since when home prices

outstripped incomes, when the world is

coming apart. And here's where we are

today. That Green Zone is what we would

refer to as the safe zone, and you will

also notice that those numbers are going

down, not going up which is something

that you know we, we certainly want to

keep an eye on. But we're not outside of

where we should be the number of homes

available.

For sale is 1.64 in terms of available

inventory, I bifurcated that into the two

component parts: lower priced homes under

300,000 on the right hand side. On higher

priced homes are on the, excuse me, above

higher priced homes are beneath there.

And you can see that there are greater

inventory of higher priced homes.

Shockingly, there are fewer buyers for

million-dollar homes, and therefore the

inventory tends to stay a little higher.

Right now, the homeowner equity, right?

here's where we were in two thousand

nine ten eleven twelve right? And just to

be clear, we want positive. We don't want

negative, the green can get as big as it

wants to get, right? Here we are in

thirteen, fourteen, fifteen, and sixteen

again. We've made huge strides in terms

of reversing this trend. This is the mix

of property sold. Green is good.

Everything else really bad. We want green

to be big. We want everything else to be

small. You can see where we are. If we

look at it instead of looking at some of

these markets, and we start going to the

basics. What are consumers doing overall?

This is Clark County's taxable retail

sales. Overall, right? And we are four

billion dollars. That's four billion

dollars among the higher than we have

ever been before.

Eating and drinking places. Auto Sales

general merchandise are all up, clothing

and accessories, are dropping not because

people aren't buying them. I assure you

they are my wife and daughter

single-handedly trying to keep the

economy afloat, right?

They're just doing it online. Okay, we get

it autos are slowing a little bit.

Nationally thumb here. That's to be

expected after seven record years. That's

okay. So we should be doing, but if we're

going to look at it in terms of this

full circle concept where are we

relative. This. This is inflation adjusted

per capita taxable spending so we're we

getting out ahead of ourselves or not. So,

let's just draw the average over the

30-year period. We remain below the

average today which means that spending

could escalate some, and we would still

be in the healthy zone that area with

the peaks up there. 04, 05, and 06. Or

we get anywhere near that it's time to

have

conversation overall. And we know that

taxable retail sales are changing. We get

it. The red area is non store retailers.

You will refer to them as places like

Amazon and things like that right? You

get this idea they're growing. These

other ones, they're not growing quite as

quickly okay. That's just things are

changing, and we know that we're sort of

trading this bricks and mortar retail

for more distribution space. So let's

take a look at whether our economy is

adapting to this new reality. On the

left-hand side is retail. On the

right-hand side is industrial. Yes. The

retail rate is elevated, but dropping the

industrial area where retailers are now

actually doing their retailing.

Essentially, fulfillment centers. If you

will are down to six point nine percent

overall. If we look at completions versus

absorption, the green line and the purple

line aligned with one another like we

talked about with the office market. Yes

they are. If we look at planned and under

construction. No, we're not building

retail because we shouldn't, right? And on

the other side, we're building industrial

because that's where everybody is going.

And yes, it is at peak levels. Currently,

under construction space is sourced 100%

to distribution centers, exactly how it

should be overall. And if we're asking

the question about whether we're getting

out over our skis whether we're building

too much, let's look at whether the

future development as a share of planned

inventory for retail. In the peak period,

we were we essentially had under

construction, 36 percent of our market.

Today, at 7.3, for industrial, we had 14

percent. Today, we're at 11 again. Well,

within the range of normalcy, we look at

large store closings and this makes us

nervous. And we tend to ignore that the

guys on the right are building on

occupying or occupying. And maybe not

building 2 million square feet in the

last year alone. This is simply a

transitional step relative to our

economy overall.

Now, wrap all that up, the big green

area that I showed you on my chart has

to do with tourism and tourism related

activity. Our growth and visitor

volume is significant, and it continues

to be incredibly important to us in. I'd

like talking about that is critical. One

in six people, one in six people that

puts a head in a bed. On any given night

is not a resident of Southern Nevada,

that's how big our visitor economy is.

And that is bigger than almost anywhere

else in the entire United States. Where

are they coming from? Western United

States. We want to get that international

all the way up to thirty. We're working

on it, but we're setting records relative

to visitation overall. And in particular,

convention visitors who spend more

generate more stay longer all those

things than their traditional. These

leisure counterparts, McCarran

International Airport, is today the

eighth busiest airport in the entire

United States. It's the second largest

destination and origination. I should say

that differently origination and

destination Airport in the United States.

Someone is going to have to explain to

me why we care about someone flying into

an airport staying on a plane and flying

somewhere else, right? Makes no sense to

me whatsoever, but we count it anyway.

This is when we take all of that out.

We'll take the people that stay someone

else because Atlanta can have all the

people who just want to go through

whatever, right/ The, LDCVA is absolutely

should be commended for being able to

expand our international reach with all

of these new flights, including one to

Beijing, China, which would be critically

important overall. And again, thinking

about it in terms of coming full circle.

On the left-hand side of my chart is the

occupancy rate. On the right hand side is

the average daily room rate, these are

the two factors that will become they

will become critical in determining

whether we make reinvestment. Here we are,

approaching 90 percent. Not quite where

we were, but approaching 90 percent. And

on the right hand side, ADR is 128

dollars per night. Almost back to the

peak, but something we didn't have. In

2007 and 2008, is the resort fee, which is

also added, on which means we are at peak

ADR. Today, all of that having been saidm

let's wrap it all up and put a bow on it

because everyone wants to focus. At least,

the national media does on this concept

that gaming revenue is below where it

should be or has not grown, ignoring

fact that Las Vegas trip total revenue

is up to 11.2 billion, not

only the highest level that it's ever

been, but blowing the previous piece out

of the water. If we look at the amount of

development and I will tell you: Jonas's

map is much more extensive than this and

you should really take a look at it

because I think it's super cool. But if

we look at it in terms of development,

That has recently happened on the Strip.

Whereas occurring their 7.8

billion dollars, and I've talked a

lot about the amount of development

that's happening in our community

because I think it's great, but if we're

going to ask the question is, "Are we

building too much?" Here's what those

numbers look like in 2007, when we had

45.8 billion dollars

worth of project on the books. Forty five

point eight billion. How much do we have

today?

14.1 billion dollars on the

books. There are communities all over the

United States that would give their

eyeteeth to have 14.1 billion

dollars worth of projects on the books.

But before we freaked out about the fact

that we're all building too much, and

there's not going to be enough glass and

not enough concrete. And we just can't

handle this much growth, I think we

should put it all in a little bit of

perspective. And what we are building is

based on bringing people here for

special events, stadiums, convention

centers, all those things because we have

assets that we can leverage 150,000

hotel rooms. The second busiest airport

in the United States restaurants, dining

all those types of things but Las Vegas

is just as important for those events as

as we are to them as they are to us. It's

a symbiotic relationship. I hear it all

the time, because of the work we do on

the stadium and other things on the

left-hand side. It's the pac-12

tournament. These are the attendance

numbers, when it was in Los Angeles. The

numbers on the right hand side are the

attendance numbers when it came to Las

Vegas. What about the Mountain West

tournament Las Vegas (MM03)? They

moved to Denver: surprise, surprise. They

move it back. This is why it works.

Terrence is telling me that I have to

wrap it up, so I'm going to go a little

bit quickly. And you, forgive me, he's

great, and I need to get it done. The

other side of this is that when we think

about it overall the economic

implications of those special events are

massive,

right? Super Bowl, Houston Texas, 138,000

Super Bowl visitors and 350 million

dollars of impact. That's why I was so

great to see the article in the

newspaper today, that they're talking

about potentially getting us a Super

Bowl in 2023 or 2024.

Hopefully, it happens. But we cannot

forget about the fact that while Houston

was hosting the Super Bowl with a

hundred and thirty eight thousand people.

We had three hundred thousand people

that showed up for Super Bowl weekend,

right, while we were here, almost on our

phone. Convention centers are phenomenal.

We have among the best in the entire

country. We have been atop the list for

the past 22 years and the business tax

climate has benefited from this amount.

We reach the tourists generate two

billion dollars in taxes for us every

single year. I'm not going to spend a

whole lot of time here. Other than saying

those are all of the states that have an

individual income tax, and we're not one

of them. Because 43 million people

decided to get in a car or get in a

plane, and come here and spend money. And

if you don't believe me, this is what

your sales tax raise, property tax rates,

and personal income tax rate would be if

they didn't exist today. We need to

preserve that sector of our economy at

all cost. Those are huge numbers. These

are the companies we're bringing in.

Northern Nevada is also getting them. We

are innovating over all these are

companies. We all know them. They're

making great steps, and great progress

but I do not want to minimize small

business development in our community. We

have more businesses here than we have

ever had before. We've created ninety two

hundred businesses since 2010. Thank you

to the LVGEA because they have been

critical, as well as each one of you in

making that happen.

Overall, my friends at Nevada state bank

asked for this idea of power small

business folks thinking about all of

this. We asked them, "Are you optimistic

about the economy?" They are more

optimistic than they have been at any

point in the past five years. Do you plan

to expand over the next 12 months? Do you

think things are going to get

over the 12, next 12 months? Yes, they do.

In closing, yes. Things are okay. We're

doing better where we're finding our

footing, but I'm always reminded of the

salient words, "Those who cannot remember

the past are condemned to repeat it." We

cannot ignore where we were when all of

development we couldn't handle. So we

were spilling over into Arizona, Las

Vegas, Waze billion-dollar reliever

Airport, right? We don't have enough room.

It can, so, we're going to build Ivanpah,

right? Least affordable real estate

market in the United States. These are

the type of articles that were coming

out when we were at our absolute peak. We

cannot let this happen again. Las Vegas

closing on another full house. I love

that they have to come up with some type

of gambling analogy, no matter what they

write anyway that's my own personal

problem. Condomania in the West, and as

we all remember the Manhattan-ization of

Las Vegas, right? This is a map. We

actually been doing this presentation

since 2007, this is my 10th year doing it.

I'm very thankful for that.

This is a map we used in the very first

one of all the plans proposed or under

construction condos that were in

Southern Nevada. Almost, none of them were

actually built right. This is where we

can't go because we've got to come full

circle. So let's just fix, let's talk just

for one minute, and I promise I'll get

down from where we are downtown

Summerlin stall. During the economic

downturn, this is what it looks like

today. We can be proud of that.

The folks at Summerlin should be

incredibly proud of that. Yeah. thank you.

Anyway, they know the statistics only. See

Manhattan West all during the economic

downturn. This is what it looks like

today. Here's the Kyle Canyon master plan.

1,700 acres was foreclosed on. Here's

what it looks like today the folks, the

city of Las Vegas. Think Stavros was here.

Congratulations on what you guys have

been able to do. A salon stall, during

economic downturn, recently announced

they're getting that project going

forward, and it'll be happening pretty

soon. Interstate 11, of course, has that

met any number of delays and now is

actually going to happen. City Center, if

anyone's ever heard Jim Murr and talked

about how close it was to closing down.

It didn't, and not only have they

finished that project that they double

down with building the T-Mobile Arena,

which will probably be among the most

productive arenas in the entire United

States when everything's added up for

its first year of operation. And the very

last one south strip right, this property

was foreclosed on 62 acres there off the

freeway. It's going to be the home of the

new Las Vegas Stadium. Thank you very

much.

Sigh landing was that powerful. Did you

enjoy that can we get another round of

applause? Awesome, awesome. For our next

segment, you guys are in for a treat. We

wanted to show you a look at the future

of gaming. We have the best expert in the

entire country to talk to you about that

particular project.

Jeff Freeman is the CEO of the American

Gaming Association. He is a global leader.

He is responsible for positioning

commercial and tribal gaming for success.

And he's also a powerhouse speaker.

Please help me welcome to the stage,

Jeff Freeman. So I'm thinking of starting

every speech with that sex with a dead

person joke, it's bound to get.

Congresswoman Buerkle had to leave, so

it's even better. I'd say, this in her

absence. I've been in Washington 20 years.

I've met with a lot of members of

Congress, I have never met someone who

was a greater champion for an industry,

for a city, for a state. Than

Congresswoman Buerkle was, she was a

tremendous champion for this area and

it's something for which all of you

should be quite proud. We have today,

great champions from Nevada, we

appreciate the support from Nevada, but

not for one second. Should we forget what

Congresswoman Buerkle did? It's also

great to follow Jeremy. What great energy,

What great enthusiasm and passion for

this area, and the message that I heard.

There was fantastic about embrace the

prosperity embrace, what this area, this

region, has accomplished figure out. How

we sustain that? Figure out how we

capitalize on it. You know that same

message actually applies to the gaming

industry, and I'm excited to talk a

little bit about that today. Before I get

started, I want to thank Jonas, I want to

thank the LVGEA. I really appreciate the

invitation here and what, congratulate

you for everything you've done in this

area, supporting the economy here in

Nevada.

I represent a national industry. I'm

based in Washington, a national

organization, but I believe everything

we're doing whether we're doing it in

Nevada.

New Jersey, where I'll be tonight in

Atlantic City or whether we're doing in

Missouri or any other state. That is

gaming. It all comes back to helping Las

Vegas. It all comes back to helping

Nevada, so let me talk a little bit about

who this industry is right now where

we're going, and the great opportunities

we have ahead because this is an

exciting time in the gaming industry, not

just because we've got great new

properties opening. We've got new markets

emerging, we've got a former casino owner

as president of the United States and,

whatever you might think of President

Trump for this industry that only says

opportunity, that only says we've got an

opportunity to do something great that

we haven't had before. So let's talk

about why we have that opportunity

because I think it's important that we

embrace that, and then let's talk about

how we capitalize on this industry today.

This industry that just started, right?

Here in Nevada is today a 240 billion

dollar industry across 40 states in the

US. 1.7 million jobs supported nearly 40

billion dollars in tax revenue. This

industry is a major economic force and

it's only growing in the latest year for

which we have data available. Commercial

gaming did 39 billion dollars in revenue.

Tribal gaming 30 billion dollars in

revenue, nearly seventy billion dollars

in revenue between these two

entities: commercial and tribal. This is a

massive economic force in communities

across the country and that economic

footprint now speaks to the increasing

mainstream nature of our industry, you

know when you look at the critics of

gaming. The critics of gaming only exist

in the communities in which we don't do

business, and the communities in which

casinos operate were strong community

partners, and we are incredible economic

generators. And that's a big part of the

opportunity we have ahead. The second

part of the opportunity we have ahead,

and more to that mainstream nature of

this industry, is the improving

perception of this industry as all of,

you know, this October. The Vegas golden

eye.

We'll kick off their inaugural season.

The Raiders will arrive in one, two, three

years of stadium. Not too far after that,

we had a presidential debate last year

here in Las Vegas, and as I said, we have

a president who's a former casino owner

and one of the most amazing aspects

about that. And there are a lot of

amazing aspects about that one of the

most amazing aspects about that the act

of owning casinos never came up during

the campaign. The act of managing and the

ability to manage it came up a couple

times, but the act of owning casinos

never came up. So just as Jeremy was

talking about the prosperity here, in

Las Vegas. And in this area, think about

the prosperity of 2016

think of all the things that happen in

that year, and ask yourself, "Would that

have happened 10 years ago? Would have

happened five years ago?" In your wildest

dreams, did you think all of these things

would happen just last year? This

industry has come incredibly far in

terms of being a mainstream player in

the American economy in terms of being

accepted coast-to-coast. Eighty-five

percent of the American public. Now,

saying that they're perfectly

comfortable with casinos for themselves.

Their friends, their family were

mainstream. How do we take advantage of

it? These are the external factors that

are helping us as an industry? There are

also several, I think, internal and, excuse

me, internal factors inter industry

factors that are changing who we are

increasingly. I want to talk about these

three increasingly or a unified industry

for those of you that have been in Las

Vegas for some time, for those of you

that have been close to the gaming

industry, you know, that unity

collaboration. These are not hallmarks of

the casino gaming industry, but they are

critical to our future success. I often

talk about my own team asked me not to

talk about it, but we're much better at

having a circular firing squad in this

industry than we are about getting in a

straight line, and focusing on a common

target. Increasingly, we're identifying,

who, when, what that common target is the

American Gaming Association of today. My

organization was created. It was modeled

after the Motion Picture Association. If

you know anything about that

organization, Jack Valenti created it

years ago. It was the Six Day

studio heads in Los Angeles, and they

created this organization in Washington,

and they sent him one of two messages.

Either do what we tell you to do or

leave us the hell alone.

That was the MPAA message. A

simplified that it created the big, you

know, the big six from here on the Las

Vegas Strip. It had one simple message

for Washington: leave us the hell alone.

and that was the exclusive club that the

HEA was today. We're different today. We

represent that unified industry that

gaming is becoming we represent ninety

percent of all the revenue and

commercial gaming. Ninety five percent of

all the supplier revenue. That's critical

to this industry. We represent with just

ten prominent tribes in our organization.

A third of all tribal gaming revenue. The

industry is increasingly on the same

page, and getting in that straight line

to focus its sights on issues of common

cause. I'm gonna go back there. The second

aspect of that that we're doing as an

industry is we're beginning to gain

confidence or beginning to gain a sense

that we can go get stuff done. In 2016

alone, this industry saved off three

critical attacks from Washington. One: an

effort to suggest that our industry

didn't take its anti-money laundering

compliance efforts seriously, a sense

that this industry was not committed to

strict regulation and a threat of

hundreds of millions of dollars in fines

from the federal government. When the

head of the agency in Washington left

her role after getting to know this

industry and getting exposed to the

people in this industry, her message was,

"Your industry actually has a good story

to tell our industry." The gaming industry

is that a model for others in financial

services as to how to do anti-money

laundering compliance right when the IRS

said, we want to lower slop tax

thresholds from $1,200 to $600. And we

want to use all those loyalty marketing

cards that many of you probably play

with. We want to use those to track what

people are doing in the casinos that was

the proposal from the IRS. This industry

stood up it worked in a collaborative

fashion. It prevented that from happening

Also last year, when the federal

government set out to eliminate those

resort fees that Jeremy mentioned.

Resort fees that not everyone likes but

are worth a half a billion dollars on

the Las Vegas Strip alone. This industry

worked together to prevent that from

happening three critical successes. There

were only made possible because of the

unity of the industry and three critical

successes that give the industry

confidence. Next, we can do a lot more we

can make other great things happen.

The other great thing that make

positions us for future success is we're

not putting our head in the sand. We see

what's coming down the pike. We see what

the new issues are that are emerging. We

see the development of daily fantasy

sports and east boards of skill-based

games outside Nevada. The development

of what's called convenience gaming,

retail gaming, distributed gaming,

whatever you want to call it.

Machines and bars and taverns around the

country, we realize these challenges are

out there, and we're confronting them

head-on.

We're asking ourselves and for a 240

billion dollar industry today. How do we

become a 300 billion dollar industry

tomorrow? And how do we work with these

newfound challenges that are out there?

It's that type of bold thinking and

leadership that I think sets this

industry with these other factors, sets

this industry up for tremendous success.

In the future, I think we are paid to do

position to do great things in the years

ahead and to areas I want to highlight

for you. And you might be thinking to

yourself, "Well, we have these things in

Nevada, so why does that matter to me?" I'm

going to close by coming back why these

things that are going to happen

elsewhere in the United States, matter

and matter in a very good way right here.

In Nevada, the first tremendous

opportunity in front of this industry is

to take what Nevada has today. A legal

regulated sports betting market and

permit every state in the country to opt

into this if they so choose, you know,

there was a long time where Nevada felt.

Hey, we've got a monopoly on sports

betting. Why would we want to share this

with anybody else? We get all those

people coming here for the Super Bowl. We

get people coming here for March Madness.

Maybe, we won't have people coming here

if sports betting is permitted elsewhere.

Well, here's the dirty truth. There's no

monopoly here in Nevada. Last year, 4.7

billion dollars was wagered on the Super

Bowl. Three percent of that was wagered

legally here in Nevada. 160 billion

dollars was

spent on sports betting across the

United States. 3% of that was done

illegally here in Nevada. Americans are

finding a way to wager on sports. There

is incredible demand to be involved in

these games. Daily fantasy sports which

got all the attention is the tip of the

iceberg when it comes to how people want

to be engaged in games today and the

question becomes, "How do we open up these

other markets around the country to

enjoy this same product to regulate this

product to prove that they can regulate

effectively sports the same way they

regulate every other form of gaming?" I

think we're on the cusp of doing that.

You've got League leaders coming out and

saying it's time for regulation> Adam

Silver of the NBA leading the way and

others following. You've got law

enforcement increasingly coming to the

table to say that our resources are best

spent not trying to track down illegal

sports bettors, but to focus on other

more serious crimes. You've got states

and municipalities. The US Conference of

Mayors the National Conference of State

Legislators. And many others saying, it's

time to regulate in this area, I think

and I have said publicly in the first

term of the Trump administration sports

betting will be legalized or at least

Washington will get out of the way to

empower other states. They have sports

betting. Now, a disclaimer when I said

that I didn't realize this first term

might be shorter than usual. I think we

will get this done.

I'm confident we will get this done. It

is a multi-billion dollar growth

opportunity for the industry around the

country, and it's a growth opportunity

right here in Nevada. The other thing we

have to do as an industry absolutely

have to do, and this is where in many

senses, Nevada is a model we have to

improve reform the regulation that

guides this industry in the other 40

states, in which we're doing business. You

know when casino gaming expanded beyond

Nevada and New Jersey, and it went into

these other states. These other states

thought they were bringing in a great

evil a great sin. And they wanted to do

everything they could to get the revenue

from it, but paralyzed every other

activity there with it. The speed to

market of new machines, the ability to

innovate with new products in these

other markets, it's quite difficult the

ability to reinvest in your product when

you have 50 / 60 % tax rates in these

other states. It's quite

physical, our future success as an

industry demands that we've modernized

these regulations. in every other state

in which we're doing business now, the

obvious question on all these

modernizing regulations and sports

betting: "Why is that good for Nevada?' two

reasons. One as we've seen the gaming

industry, thrive and other communities

around this country.

Nevada's success has only increased

upwards of 50 million visitors. Now, to

Las Vegas, there was a fear when tribal

gaming came on in California that we see

a decline in visitation to Las Vegas.

don't think anyone's making that

argument today. As gaming thrives and

other markets gaming goes mainstream

Nevada's success only increases, it is in

Nevada's interest to see sports betting

legalized elsewhere. We don't want to be

the anomaly. We don't want to be this

thing that's okay here but illegal

everywhere else. We want what we do here

to become and practice a mainstream

industry. The second reason. This is

critical as so long, as we have all these

different policies and antiquated

approaches to gaming everywhere outside

Nevada. The ability to innovate in Nevada

remains difficult, the cost to do this

research and development the cost to

build these new products, and really give

tomorrow's customer what it is that

they're looking for is extraordinarily

difficult with the inefficiencies that

we have across the country the more we

can streamline that the more we can get

a level playing field around the country.

Nevada, which is the home to so much of

this innovation, the homes that some of

the biggest suppliers in this industry

stands to benefit, and that's why what is

good for gaming outside of Nevada is

good for Nevada. And it's our focus at

the aga, it's our focus every day to

strengthen this industry. I'm confident

that the future for the gaming industry

has never been brighter and the future

right here in Nevada has never been

brighter. The aga is committed every day

to working on behalf of the gaming

industry many of you in this room to

build an environment where the casino

gaming industry can thrive. My ask of

each of you in this room is to be our

partner in doing that to help us

understand.

There are the challenges where are the

roadblocks. Where are the issues that

need to be addressed? Because the

industry has never been more capable to

get in those roadblocks those challenges

out of the way right now. It's about

capitalizing on the opportunity we have

building on the success we've enjoyed

and building the strongest industry that

we can have in the years ahead I'm

confident that we're well on our way

there thank you for the opportunity I

don't we want to take any questions I

really appreciate the opportunity yes

sir excellent we do have time for just a

couple questions from the audience we've

got a roving mic out there Jeff is a

graciously agreed to stay on for a

couple minutes from the audience that

was a powerhouse presentation first. Can

we give him another round of applause?

If no-one has any questions, I see a

couple faces I recognize including

Marcus over there a couple others so

I'll just call on you: Ask questions.

Anybody going going once going twice

alright. Thank you very much again.

thank you Jeff I'm not closed with this

I hope you had fun this morning. I know I

did, and it is our sincere hope that the

perspectives you hope that you heard

today will be of assistance as you make

your critical decisions throughout the

upcoming year again thank you for coming.

Have a good day.