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Palomar Health
Operating and Capital Budgets Fiscal Year 2013
Presentation to
Board of Directors
June 4, 2012
Delivering on Our Promise
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Drivers of the Budget Process
• Strategic Initiatives
• 10 Year Financial and Capital Plan
• Growth Opportunities
• New Palomar Medical Center
• Transformation and Move In
• Workforce Plan
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FY 2013 Operating Budget Recap (In thousands)
Palomar PalomarHealth North Health South Consolidated
Change % Change % Change %INPATIENT
Discharges Acute 6,245 32.2% 370 5.7% 6,615 25.6% SNF 4 .6% (5) (.9%) (1) (.1%)
Patient Days Acute 18,218 23.6% 1,745 7.1% 19,963 19.6% SNF 297 1.0% 156 .4% 453 .6%
Avg Length Of Stay Acute (0.26) (6.5%) 0.05 1.3% (0.19) (4.8%) SNF 0.16 .3% 0.94 1.2% 0.41 .7%
Deliveries 684 19.0% 0 .0% 684 14.4%
Inpatient Surgeries 1,768 32.6% (120) (5.9%) 1,648 22.0%
Change = FY12 Mar YTD annualized vs FY13 Budget
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FY 2013 Operating Budget Recap (In thousands)
Palomar Palomar Health North Health South Consolidated
Change % Change % Change %OUTPATIENT
ER Visits 2,231 3.2% 245 0.8% 2,476 2.5%
O/P Registrations 14,754 25.4% 5,952 13.5% 20,706 20.3%
O/P Surgeries (14) (0.3%) 119 2.9% 105 1.2%
Home Health Visits (1,549) (2.8%) 0 0.0% (1,549) (2.8%)
Change = FY12 Mar YTD annualized vs FY13 Budget
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Gross Revenue by Financial Class
Mgd Care Cap2.2%
Sr HMO13.2%
Sr Cap6.7%
Medi-Cal14.0%
Mgd Care29.8%
CMS3.1%
Work Comp0.8% Self-Pay
4.6%
Ins2.5% Medicare
23.1%
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Key Revenue Assumptions/Considerations
• Rates – Inpatient and Outpatient – 8% Increase – Contracts / 3rd Party Reimbursement – At Risk Capitation Contracting with Three
Medical Groups – Bad Debt/Uncompensated Care – 4.3%
• Historical FY12 – 5.0% • Historical FY11 – 4.5%
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Key Inflationary Assumptions/Considerations
FY 12 Budget
FY 13 Budget
Supplies:
Pharmaceuticals 0.0% 1.0% Prosthesis (Non-tech Price Changes) 0.0% 0.5% Surgical Instruments 0.0% 0.0% Surgical Supplies 0.5% 0.5% Other Medical 0.5% 0.5% Food Other 3.0% 3.0% Minor Equipment/Instruments 0.0% 0.0%
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Key Expense Assumptions/Considerations
• Labor – Reinvestment in Our Employees
• Salary Increases / Adjustments Totaling: $11,020,464 – FTEs
• Productive FTEs adjusted for Productivity Stds, Operating Efficiencies and Initiatives 3,229 FTE’s
– Adherence to Productivity Labor Standards – Adherence to Nurse Staffing Ratios
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Recap of Productive FTE’s by Service Type
PalomarHealth North
Palomar Health South Central Outreach
Palomar Health Consolidated
Productive FTE's by Service Type:-
Daily Hospital Services (Nursing Units) 753.51 325.05 - - 1,078.56 Ancillary Services 688.17 234.75 - 103.53 1,026.45 General / Support Services 386.20 115.89 123.71 0.68 626.48 Administrative Services 138.77 34.66 155.14 - 328.57 Fiscal Services 54.33 25.27 89.24 - 168.84
FY 2012 Budgeted Productive FTE's 2,020.98 735.62 368.09 104.21 3,228.90
Estimated Productive FTE's FY 2012 1,654.38 734.19 316.10 101.62 2,806.29
(Increase) / Decrease FY12 To FY13 (366.60) (1.43) (51.99) (2.59) (422.61)
% (Increase) / Decrease FY12 To FY13 (15.06%)
(Increases) / Decreases in FTE's Due to:Volume Changes (319.10) (6.42) (44.27) 2.61 (367.18) Increases Due to Transformation (51.40) 0.00 0.00 0.00 (51.40) Increases Due to Organizational Training 0.00 0.00 (8.38) 0.00 (8.38) Other Changes in Labor Standards 3.90 4.99 0.66 (5.20) 4.35
(366.60) (1.43) (51.99) (2.59) (422.61)
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Recap of
Salaries and Wages
Palomar Health Consolidated
FY 2013 Uninflated Base Salary Expense 272,786,541$ FY 2013 Registry Expense 6,722,124$ Increase due to:
Labor Contracts and Merit Adjustments 11,020,464$ Volume, New Positions, Labor Std Adjustments 717,279$
Total Salary and Registry Expense FY 2013 291,246,408
Estimated Salary and Registry Expense FY 2012 241,227,937
(Increase) / Decrease FY12 To FY13 (50,018,471)$
% (Increase) / Decrease FY12 To FY13 (20.73%)
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Recap of Benefits
FY12 Annualized
FY13Projected
% (Increase) / Decrease
Group Health Insurance 31,133,624 33,787,071 (8.5%)FICA 16,852,068 20,033,626 (18.9%)
Pension 14,985,371 17,617,859 (17.6%)
Work Comp 2,905,213 3,304,262 (13.7%)
Group Life Insurance 233,037 295,074 (26.6%)Other Benefits 1,282,093 1,339,978 (4.5%)
Total Benefit Expense 67,391,406 76,377,870 (13.3%)
(Increase) / Decrease FY12 To FY13 (8,986,464)$ % (Increase) / Decrease FY12 To FY13 (13.33%)
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Recap of Supplies FY12
AnnualizedFY13
Projected
Implants / Prosthesis 19,970,829 20,828,225 Surgical Supplies 10,004,065 14,590,856
Pharmaceuticals 12,412,795 13,277,242
Other Medical Supplies 15,550,299 17,286,724
Food 2,977,854 4,391,656
Office Supplies and Forms 1,339,334 1,636,564
Minor Equipment 1,467,889 2,998,917 Other Non-Medical Supplies 11,545,580 11,461,171
Total Supply Expense 75,268,645 86,471,355
(Increase) / Decrease FY12 To FY13 (11,202,710)$ % (Increase) / Decrease FY12 To FY13 (14.88%)
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Recap of Professional Fees
FY12 Annualized
FY13Projected
Physician Fees
ED Call / Trauma / Hospitalists / OB, OB Anesthesia, Perinatology 16,060,115 19,452,974 Other Physician Fees 3,700,291 8,260,776 Total Physician Fees 19,760,406 27,713,750
Consulting Fees 4,410,334 6,038,155 Legal Fees 502,632 519,183
Audit Fees 325,407 453,600
Other Professional Fees 2,332,864 2,426,188
Total Professional Fees 27,331,643 37,150,876
(Increase) / Decrease FY12 To FY13 (9,819,233)$ % (Increase) / Decrease FY12 To FY13 (35.93%)
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Recap of Purchased Services
FY12 Annualized
FY13Projected
Medical Purchased Services 4,455,240 4,973,364 Maintenance and Repair
Information Systems - Hardware/Software Maintenance Fees 12,561,834 17,370,172 Other Maintenance and Repair 8,434,555 14,402,044 Total Maintenance and Repair 20,996,389 31,772,216
Linen Services 2,322,926 2,084,281 Management Services 1,515,132 1,229,617
Other Purchased Services 14,147,202 16,543,108
Total Purchased Services 43,436,889 56,602,586
(Increase) / Decrease FY12To FY13 (13,165,697)$ % (Increase) / Decrease FY12 To FY13 (30.31%)
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Recap of Other Direct Expense FY12
AnnualizedFY13
Projected
Total Building and Equipment Rental 7,722,617 8,820,961 Total Tax/License (Includes Software Licensing) 924,572 1,652,566 Total Utility Expense 4,507,546 10,246,157 Professional Liability / Insurance Expense 4,008,078 5,519,826 Telephone / Communications Expense 1,065,292 1,652,437 Outside Training/Tuition Reimbursement 574,561 1,511,238 Advertising and Marketing 2,096,071 2,494,451 Other Direct Expense 6,535,056 4,887,989
Total Other Direct Expense 27,433,793 36,785,625
(Increase) / Decrease FY12 To FY13 (9,351,832)$ % (Increase) / Decrease FY12 To FY13 (34.09%)
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Recap of Depreciation Expense Total
Projected FY 2013 61,042,053
Estimated FY 2012 21,289,287
(Increase) / Decrease FY12 To FY13 (39,752,766)$
Depreciation for FY 2013 Capital Budget Based On Requests Totaling:
Routine Capital 7,000,000$ Facility Pool 3,000,000 Information Technology Pool 5,000,000 Subtotal 15,000,000 Capital Reserve - FMP - Capital Reserve - Strategic 2,000,000 TOTAL 17,000,000
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Initiatives and Budget Impact
FY '13 Initiative Description
Budgeted Income Benefit
Budgeted Additional Expense
1.1(a) Grow volume in agreed upon service lines 1,999,936 859,500
1.2(a) Manage expenses (2,200,000)
2.1(a)Stabilize and optimize operations at the new Palomar Medical Center and the Palomar Health Downtown Campus - 6,899,483
2.2(a)Create a customer-focused accountability culture to achieve top quartile HCAHPS performance - 285,000
2.2(b) Strengthen physician leadership and partnership integration - -
GRAND TOTAL 1,999,936$ 5,843,983$
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FY 2013 Operating Budget Recap (In thousands)
Results FY11
Forecast FY12
Projected FY13
% Change FY12 to FY13
Revenue:Gross Revenue 1,831,951 1,998,476 2,446,958 22.44%Net Revenue 478,815 506,026 621,321 22.78%Other Operating Revenue 11,192 11,633 11,937 2.61%Total Operating Revenue 490,007 517,659 633,258 22.33%
Expenses:Salaries, Wages, Registry, Benefits 291,178 308,619 367,624 -19.12%Supplies 74,332 75,269 86,471 -14.88%Depreciation 21,346 21,289 61,042 -186.73%Other 91,637 98,202 130,540 -32.93%Total Operating Expense 478,493 503,379 645,677 -28.27%
Operating Income 11,514 14,280 (12,419) -186.97%
Non-Operating Income 10,634 4,425 2,815 -36.38%Interest Expense (3,805) (2,878) (29,801) -935.48%Property Tax Revenue 12,625 13,000 13,300 2.31%Income (Loss) 30,968 28,827 (26,105) -190.56%
Net Margin % 6.3% 5.6% -4.1%OEBIDA Margin (Excl Property Tax Rev) 6.7% 6.9% 7.7%OEBIDA Margin (Incl Property Tax Rev) 9.3% 9.4% 9.8%EBIDA Margin 11.5% 10.2% 10.2%Total Uncompensated Care 81,887$ 99,046$ 105,432$ Total Uncompensated Care as % of Gross 4.47% 4.96% 4.31%
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FY 2013 Operating Budget Recap (In thousands)
Forecast ProjectedFY 2008 FY 2009 FY 2010 FY 2011 FY 2012 FY 2013
Net Income from Ops (Excluding Interest Expense) (9,437) 9,476 17,035 11,514 14,280 (12,418)
Less: D epreciation Expense 21,391 21,215 21,359 21,346 21,289 61,042
OEBIDA 11,954 30,692 38,395 32,861 35,570 48,624
OEBIDA Margin (Excl Property Tax Rev) 2.8% 6.9% 8.2% 6.7% 6.9% 7.7%OEBIDA Margin (Incl Property Tax Rev) 6.0% 9.9% 11.0% 9.3% 9.4% 9.8%
EBIDA 32,250 48,772 58,045 56,119 52,994 64,738 EBIDA Margin 7.7% 10.9% 12.4% 11.5% 10.2% 10.2%
Total Uncompensated Care 63,959 74,557 82,012 81,887 99,046 105,432 Total Uncompensated Care as % of Gross 4.53% 4.72% 4.85% 4.47% 4.96% 4.31%
Note:Net Income/(Loss) after Non-Op Income (4,053) 11,477 24,488 30,968 28,827 (26,105)
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Capital Budget Recap Category: Equipment Pool $ 7.0 million Facilities Renovation Pool 3.0 million Information Technology Pool 5.0 million FY 2013 Allocated Capital Budget $ 15.0 million Capital Reserve - FMP 0.0 million Capital Reserve - Strategic 2.0 million Total FY 2013 Capital Budget $ 17.0 million
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Three Year Capital Budget Summary (in Millions)
Fiscal Year 2013 2014 2015 Total Equipment $7.0 $10.0 $10.0 $27.0 Facilities 3.0 5.0 5.0 13.0 Info Tech 5.0 5.0 5.0 15.0 Consolidated Requests $15.0 $20.0 $20.0 $55.0
FISCAL YEAR 2012 FINANCIAL STATEMENTS
MAY 2012
FINANCIAL SERVICES
FISCAL YEAR 2012
Balanced Scorecard Comparison .......................................................................................................................3 Executive Summary of Key Indicators ...............................................................................................................4 Key Variance – MTD & YTD ...............................................................................................................................5 Balance Sheet ...................................................................................................................................................8 Income Statement
Month-to-Date.............................................................................................................................................10 Year-to-Date ................................................................................................................................................11 Current vs. Prior Year-to-Date ......................................................................................................................12 Fiscal Year Projection ...................................................................................................................................13 Monthly Trend .............................................................................................................................................14
Cash Flow Statement – Consolidated ................................................................................................................15 Financial Report Narrative ................................................................................................................................16 Key Statistical Indicators ...................................................................................................................................19 Year-to-Date Supplies Expense by Account .......................................................................................................22 Bond Covenant Ratios .......................................................................................................................................23 Budget Comparison Graphs
Statistical Indicators .....................................................................................................................................24 Payor Mix .....................................................................................................................................................41
Case Mix Index Graphs ......................................................................................................................................42 Budget Comparison Graphs – Adjusted Discharges ...........................................................................................45 Cash Collections ................................................................................................................................................51 HealthWoRx Dashboard ....................................................................................................................................52 Supplemental Information
Flash Report .................................................................................................................................................54
TABLE OF CONTENTS 2
FISCAL YEAR 2012
BALANCED SCORECARD COMPARISON 3
February March April
Actual Actual Actual Actual Budget Variance%Actual
to Budget Actual Budget Variance%Actual
to BudgetPPH Indicators:
8.41% 8.93% 5.89% 9.11% 9.43% (0.32%) 96.6% OEBITDA Margin w/Prop Tax 9.37% 10.30% (0.93%) 91.0%12,449.16$ 12,288.87$ 13,209.75$ 12,735.66$ 12,253.33$ (482.33)$ 103.9% Expenses/Adj Discharge 12,507.59$ 12,149.09$ (358.50)$ 103.0%
7,726.94$ 7,604.98$ 8,348.54$ 7,924.52$ 7,439.18$ (485.34)$ 106.5% SWB/Adj Discharge 7,684.84$ 7,314.43$ (370.41)$ 105.1%6.63 6.54 7.04 6.82 6.64 (0.18) 102.7% Prod FTE's/Adj Occupied Bed 6.71 6.65 (0.06) 100.9%
3,259 3,572 3,176 3,423 3,510 (87) 97.5% Adjusted Discharges 36,959 38,072 (1,113) 97.1%
PPH North Indicators:
10.25% 7.09% 0.46% 9.97% 9.30% 0.67% 107.2% OEBITDA Margin w/Prop Tax 9.13% 10.18% (1.05%) 89.7%11,548.78$ 11,552.74$ 12,090.35$ 11,880.51$ 11,369.38$ (511.13)$ 104.5% Expenses/Adj Discharge 11,617.39$ 11,274.30$ (343.09)$ 103.0%
6,222.44$ 6,246.09$ 6,651.16$ 6,452.96$ 5,958.83$ (494.13)$ 108.3% SWB/Adj Discharge 6,252.40$ 5,855.69$ (396.71)$ 106.8%5.33 5.32 5.64 5.45 5.30 (0.15) 102.8% Prod FTE's/Adj Occupied Bed 5.41 5.31 (0.10) 101.9%
2,382 2,547 2,298 2,476 2,507 (31) 98.8% Adjusted Discharges 26,546 27,175 (629) 97.7%
PPH South Indicators:
(0.36%) 11.66% 14.55% 5.55% 6.86% (1.31%) 80.90% OEBITDA Margin w/Prop Tax 7.80% 7.60% 0.20% 102.6%13,874.12$ 12,652.79$ 14,321.07$ 13,786.95$ 13,344.21$ (442.74)$ 103.3% Expenses/Adj Discharge 13,361.07$ 13,214.17$ (146.90)$ 101.1%
7,029.31$ 6,642.67$ 7,403.50$ 6,868.12$ 6,732.93$ (135.19)$ 102.0% SWB/Adj Discharge 6,779.11$ 6,601.91$ (177.20)$ 102.7%6.78 6.33 7.10 6.94 6.41 (0.53) 108.3% Prod FTE's/Adj Occupied Bed 6.73 6.42 (0.31) 104.8%850 1,001 860 930 981 (51) 94.8% Adjusted Discharges 10,200 10,662 (462) 95.7%
May YTD 2012
FISCAL YEAR 2012
EXECUTIVE SUMMARY OF KEY INDICATORS 4
Actual Budget Variance Actual Budget VarianceMoody
BenchmarkStatistics:Adjusted Discharges 3,423 3,510 (87) 36,959 38,072 (1,113) Acute Admissions 2,156 2,252 (96) 23,603 24,407 (804) Acute Patient Days 8,323 8,721 (398) 92,726 94,526 (1,800)
Acute ALOS 3.95 3.85 0.10 3.94 3.85 0.09
Acute ADC 268.48 281.32 (12.84) 275.98 282.17 (6.19) Case Mix Index (w/o Births) 1.50 1.50 - 1.48 1.48 - Total Surgeries 1,548 1,590 (42) 16,656 17,231 (575) Births 411 419 (8) 4,343 4,590 (247) E/R Visits & Admissions 8,679 8,320 359 90,911 90,186 725
ER to Admit Rate 13.9% 15.5% (1.6%) 15.1% 15.5% (0.4%)Productivity % 93.5% 100.0% (6.5%) 97.2% 100.0% (2.8%)
Income Statement:Net Patient Revenue 44,041,145 43,214,797 826,348 464,781,194 468,359,615 (3,578,421) Total Net Revenue 44,808,342 44,091,150 717,192 475,328,069 477,999,498 (2,671,429) Sal., Wages, Cont. Lbr 21,299,071 20,428,300 (870,771) 221,882,268 217,432,420 (4,449,848) Supplies 6,363,897 6,170,343 (193,554) 69,178,279 66,880,905 (2,297,374) Total Expenses 43,594,158 43,009,171 (584,987) 462,267,961 462,540,043 272,082 Net Inc. (Loss) before Non-Op 1,214,184 1,081,979 132,205 13,060,108 15,459,455 (2,399,347) Net Income (Loss) 2,149,103 2,051,070 98,033 26,265,829 26,119,456 146,373
Cash Flow:Cash Collections 44,100,000 42,000,000 2,100,000 428,200,000 462,000,000 (33,800,000)
Days Cash on Hand 133.9 80.0 53.9 97.1
Ratios:OEBITDA w/ Prop. Tax 9.11% 9.43% (0.32%) 9.37% 10.30% (0.93%)Net Income Margin 4.80% 4.65% 0.15% 5.53% 5.46% 0.07%Bad Debt % of Net Patient Revenue 13.9% 12.4% (1.5%) 14.7% 12.4% (2.3%) 7.1%Return On Assets 1.7% 1.7% 0.0% 2.2%Annual Debt Service Coverage 1.8 2.5Cushion Ratio 5.9 9.0
May 2012 FY 12 Y-T-D @ May 2012
FISCAL YEAR 2012
KEY VARIANCE EXPLANATIONS 5
Actual Budget Variance
Detail Variance Actual Budget Variance
Detail Variance
1,214,184 1,081,979 132,205 Net Income From Operations 13,060,108 15,459,455 (2,399,347)
826,348 Total Net Patient Revenue (3,578,421) 826,348 Net Patient Revenue (3,578,421)
(109,156) Other Operating Revenue 906,992 (26,083) Rebates and Refunds 790,693 (83,073) Other 116,299
(498,765) Salaries & Wages (1,579,750) 500,117 Volume Variance 6,276,815
(998,882) Rate & Efficiency (7,856,565)
(143,344) Benefits (1,099,270) (152,237) Pension (1,640,409)
8,893 Other 541,139
(372,006) Contract Labor (2,870,098) 6,225 Volume Variance 79,623
(378,231) Rate & Efficiency (2,949,721)
74,863 Professional Fees 645,90774,863 Professional Fees 645,907
Month-to Date Year-to Date
FISCAL YEAR 2012
KEY VARIANCE EXPLANATIONS 6
Actual Budget Variance
Detail Variance Actual Budget Variance
Detail Variance
(193,554) Supplies (2,297,374) 152,940 Volume Variance 1,955,202
(346,494) Rate & Efficiency (4,252,576)
Breakdown of Variance:(124,060) Surgery General (1,307,935) (442,846) Prosthesis (1,088,097) 373,352 Other 98,658
139,304 Purchased Services 1,228,922 (115,262) Patient Financial Services - contra to revenue (465,760) 254,566 Other 1,694,682
207,439 Depreciation 2,326,001 207,439 Depreciation 2,326,001
201,076 Other Direct Expenses 3,917,744 201,076 Other Direct 3,917,744
132,205 (2,399,347)
Month-to Date Year-to Date
Net Income From Operations Var
FISCAL YEAR 2012
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Actual Budget Variance Actual Budget Variance
1,214,184 1,081,979 132,205 13,060,108 15,459,455 (2,399,347)
934,919 969,091 (34,172) 13,205,721 10,660,001 2,545,720
1,083,333 1,083,334 (1) Property Tax Revenue 11,934,350 11,916,674 17,676
26,713 217,142 (190,429) Investment Income (Loss) 2,200,048 2,388,562 (188,514)Breakdown:
(17,739) 58,333 (76,072) Pacific Income Advisors 500,592 641,667 (141,075)(22,286) 97,917 (120,203) Legg Mason / Clearbridge 938,692 1,077,083 (138,391)12,781 9,417 3,364 LAIF 160,956 103,591 57,36553,957 51,475 2,482 Other 599,808 566,221 33,587
249,043 368,415 119,372 Interest Expense 2,623,823 4,052,565 1,428,742
73,916 37,030 36,886 Other 1,695,146 407,330 1,287,816
2,149,103 2,051,070 98,033 26,265,829 26,119,456 146,373
Month-to Date Year-to Date
Net Income from Operations
Non-Operating Income
Net Income
KEY VARIANCE EXPLANATIONS
FISCAL YEAR 2012
BALANCE SHEET CONSOLIDATED (INCLUDES G.O. BONDS)
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Current Prior Prior Fiscal Current Prior Prior Fiscal Month Month Year End Month Month Year End
Assets LiabilitiesCurrent Assets Current Liabilities Cash on Hand $6,365,494 $10,283,816 $11,960,791 Accounts Payable $24,356,105 $25,486,168 $56,116,169 Cash Marketable Securities 161,226,391 150,823,486 176,340,613 Accrued Payroll 13,903,659 12,449,511 13,216,614Total Cash & Cash Equivalents 167,591,885 161,107,302 188,301,404 Accrued PTO 18,486,698 18,099,712 17,284,147
Accrued Interest Payable 6,317,109 16,218,286 9,490,711Patient Accounts Receivable 259,194,376 266,827,181 197,412,396 Current Portion of Bonds 9,311,650 9,311,650 8,366,793 Allowance on Accounts (160,914,823) (167,467,748) (117,860,257) Est Third Party Settlements 1,773,811 3,012,688 3,353,441Net Accounts Receivable 98,279,553 99,359,433 79,552,139 Other Current Liabilities 24,190,045 25,477,093 28,049,558
Total Current Liabilities 98,339,077 110,055,108 135,877,433 Inventories 7,140,940 7,058,484 7,175,585 Prepaid Expenses 4,665,416 2,616,319 2,742,378 Long Term Liabilities Other 2,073,537 9,390,234 8,014,960 Other LT Liabilities 1,695,597 1,725,356 1,637,734Total Current Assets 279,751,331 279,531,772 285,786,466 Bonds & Contracts Payable 1,132,275,779 1,130,815,483 1,125,514,469
Total Long Term Liabilities 1,133,971,376 1,132,540,839 1,127,152,203Non-Current Assets Restricted Assets 113,342,660 138,335,529 291,559,885 General Fund Balance Restricted by Donor 326,094 325,750 317,613 Unrestricted 434,524,859 430,723,939 406,096,646 Board Designated 8,828,289 9,258,782 0 Restricted for Other Purpose 326,094 325,750 317,613Total Restricted Assets 122,497,043 147,920,061 291,877,498 Board Designated 8,828,289 9,258,782 0
Total Fund Balance 443,679,242 440,308,471 406,414,259 Property Plant & Equipment 428,589,111 427,690,372 427,894,261 Accumulated Depreciation (267,317,557) (265,533,249) (251,051,249) Total Liabilities / Fund Balance $1,675,989,695 $1,682,904,418 $1,669,443,895 Construction in Process 1,080,864,389 1,062,312,116 884,800,710Net Property Plant & Equipment 1,242,135,943 1,224,469,239 1,061,643,722
Investment in Related Companies 2,755,326 2,758,061 2,884,377 Deferred Financing Costs 23,174,510 23,289,636 24,441,044 Other Non-Current Assets 5,675,542 4,935,649 2,810,788Total Non-Current Assets 1,396,238,364 1,403,372,646 1,383,657,429
Total Assets $1,675,989,695 $1,682,904,418 $1,669,443,895
FISCAL YEAR 2012
BALANCE SHEET CONSOLIDATED (EXCLUDES G.O. BONDS)
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Current Prior Prior Fiscal Current Prior Prior Fiscal Month Month Year End Month Month Year End
Assets LiabilitiesCurrent Assets Current Liabilities Cash on Hand $6,365,494 $10,283,816 $11,960,791 Accounts Payable $24,356,105 $25,486,168 $56,116,169 Cash Marketable Securities 161,226,391 150,823,486 176,340,613 Accrued Payroll 13,903,659 12,449,511 13,216,614Total Cash & Cash Equivalents 167,591,885 161,107,302 188,301,404 Accrued PTO 18,486,698 18,099,712 17,284,147
Accrued Interest Payable 2,174,392 13,086,454 4,428,990Patient Accounts Receivable 259,194,376 266,827,181 197,412,396 Current Portion of Bonds 7,080,000 7,080,000 6,715,000 Allowance on Accounts (160,914,823) (167,467,748) (117,860,257) Est Third Party Settlements 1,773,811 3,012,688 3,353,441Net Accounts Receivable 98,279,553 99,359,433 79,552,139 Other Current Liabilities 24,190,045 25,477,093 28,049,558
Total Current Liabilities 91,964,710 104,691,626 129,163,919 Inventories 7,140,940 7,058,484 7,175,585 Prepaid Expenses 4,665,416 2,616,319 2,742,378 Long Term Liabilities Other 3,387,701 10,338,358 7,917,214 Other LT Liabilities 1,695,597 1,725,356 1,637,734Total Current Assets 281,065,495 280,479,896 285,688,720 Bonds & Contracts Payable 593,853,431 593,796,768 600,310,134
Total Long Term Liabilities 595,549,028 595,522,124 601,947,868Non-Current Assets Restricted Assets 96,909,504 123,518,552 276,605,560 General Fund Balance Restricted by Donor 326,094 325,750 317,613 Unrestricted 954,500,168 949,492,506 912,793,870 Board Designated 8,828,289 9,258,782 0 Restricted for Other Purpose 326,094 325,750 317,613Total Restricted Assets 106,063,887 133,103,084 276,923,173 Board Designated 8,828,289 9,258,782 0
Total Fund Balance 963,654,551 959,077,038 913,111,483 Property Plant & Equipment 428,589,111 427,690,372 427,894,261 Accumulated Depreciation (267,317,557) (265,533,249) (251,051,249) Total Liabilities / Fund Balance $1,651,168,289 $1,659,290,788 $1,644,223,270 Construction in Process 1,080,864,389 1,062,312,116 884,800,710Net Property Plant & Equipment 1,242,135,943 1,224,469,239 1,061,643,722
Investment in Related Companies 2,755,326 2,758,061 2,884,377 Deferred Financing Costs 13,472,096 13,544,859 14,272,490 Other Non-Current Assets 5,675,542 4,935,649 2,810,788Total Non-Current Assets 1,370,102,794 1,378,810,892 1,358,534,550
Total Assets $1,651,168,289 $1,659,290,788 $1,644,223,270
FISCAL YEAR 2012
INCOME STATEMENT: MONTH-TO-DATE CONSOLIDATED – ADJUSTED DISCHARGES
10
Variance $/Adjusted DischargesActual Budget Variance Volume Rate/Eff Actual Budget Variance
Statistics: Admissions - Acute 2,156 2,252 (96) Admissions - SNF 115 90 25 Patient Days - Acute 8,323 8,721 (398) Patient Days - SNF 6,393 6,376 17 ALOS - Acute 3.95 3.85 0.10 ALOS - SNF 53.72 47.94 5.78 Adjusted Discharges 3,423 3,510 (87)
Revenue: Gross Revenue 176,383,420$ 164,620,532$ 11,762,888$ F (4,080,338)$ 15,843,226$ 51,528.90$ 46,900.44$ 4,628.46$ Deductions from Rev (132,342,275) (121,405,735) (10,936,540) U 3,009,202 (13,945,742) (38,662.66) (34,588.53) (4,074.13) Net Patient Revenue 44,041,145 43,214,797 826,348 F (1,071,136) 1,897,484 12,866.24 12,311.91 554.33 Other Oper Revenue 767,197 876,353 (109,156) U (21,722) (87,434) 224.13 249.67 (25.54) Total Net Revenue 44,808,342 44,091,150 717,192 F (1,092,858) 1,810,050 13,090.37 12,561.58 528.79
Expenses: Salaries, Wages & Contr Labor 21,299,071 20,428,300 (870,771) U 506,342 (1,377,113) 6,222.34 5,820.03 (402.31) Benefits 5,826,551 5,683,207 (143,344) U 140,866 (284,210) 1,702.18 1,619.15 (83.03) Supplies 6,363,897 6,170,343 (193,554) U 152,940 (346,494) 1,859.16 1,757.93 (101.23) Prof Fees & Purch Svc 5,892,727 6,106,894 214,167 F 151,367 62,800 1,721.51 1,739.86 18.35 Depreciation 1,784,309 1,991,748 207,439 F 49,368 158,071 521.27 567.45 46.18 Other 2,427,603 2,628,679 201,076 F 65,155 135,921 709.20 748.91 39.71 Total Expenses 43,594,158 43,009,171 (584,987) U 1,066,039 (1,651,026) 12,735.66 12,253.33 (482.33)
Net Inc Before Non-Oper Income 1,214,184 1,081,979 132,205 F (26,818) 159,023 354.71 308.26 46.46
Property Tax Revenue 1,083,333 1,083,334 (1) U (26,852) 26,851 316.49 308.64 7.84 Non-Operating Income (148,414) (114,243) (34,171) U 2,832 (37,003) (43.36) (32.55) (10.81)
Net Income (Loss) 2,149,103$ 2,051,070$ 98,033$ F (50,838)$ 148,871$ 627.84$ 584.35$ 43.49$
Net Income Margin 4.80% 4.65% 0.15%OEBITDA Margin w/o Prop Tax 6.69% 6.97% (0.28%)OEBITDA Margin with Prop Tax 9.11% 9.43% (0.32%)
F= Favorable varianceU= Unfavorable variance
1= Property Tax Revenue does not include G.O. Bonds Levy2= Interest Expense does not include G.O. Bonds Interest
2
1
12212
FISCAL YEAR 2012
INCOME STATEMENT: YEAR-TO-DATE CONSOLIDATED – ADJUSTED DISCHARGES
11
VarianceActual Budget Variance Volume Rate/Eff Actual Budget Variance
Statistics: Admissions - Acute 23,603 24,407 (804) Admissions - SNF 1,173 998 175 Patient Days - Acute 92,726 94,526 (1,800) Patient Days - SNF 68,599 69,129 (530) ALOS - Acute 3.94 3.85 0.09 ALOS - SNF 59.91 47.28 12.63 Adjusted Discharges 36,959 38,072 (1,113)
Revenue: Gross Revenue 1,841,712,379$ 1,784,518,385$ 57,193,994$ F (52,168,758)$ 109,362,752$ 49,831.23$ 46,872.20$ 2,959.03$ Deductions from Rev (1,376,931,185) (1,316,158,770) (60,772,415) U 38,476,694 (99,249,109) (37,255.64) (34,570.26) (2,685.38) Net Patient Revenue 464,781,194 468,359,615 (3,578,421) U (13,692,064) 10,113,643 12,575.59 12,301.94 273.64 Other Oper Revenue 10,546,875 9,639,883 906,992 F (281,813) 1,188,805 285.37 253.20 32.17 Total Net Revenue 475,328,069 477,999,498 (2,671,429) U (13,973,877) 11,302,448 12,860.96 12,555.15 305.81
Expenses: Salaries, Wages & Contr Labor 221,882,268 217,432,420 (4,449,848) U 6,356,437 (10,806,285) 6,003.47 5,711.08 (292.39) Benefits 62,141,699 61,042,429 (1,099,270) U 1,784,519 (2,883,789) 1,681.37 1,603.34 (78.03) Supplies 69,178,279 66,880,905 (2,297,374) U 1,955,202 (4,252,576) 1,871.76 1,756.70 (115.06) Prof Fees & Purch Svc 64,699,087 66,573,916 1,874,829 F 1,946,227 (71,398) 1,750.56 1,748.63 (1.93) Depreciation 19,530,871 21,856,872 2,326,001 F 638,966 1,687,035 528.45 574.09 45.65 Other 24,835,757 28,753,501 3,917,744 F 840,582 3,077,162 671.98 755.24 83.26 Total Expenses 462,267,961 462,540,043 272,082 F 13,521,934 (13,249,852) 12,507.59 12,149.09 (358.50)
Net Inc Before Non-Oper Income 13,060,108 15,459,455 (2,399,347) U (451,943) (1,947,404) 353.37 406.06 (52.69)
Property Tax Revenue 11,934,350 11,916,674 17,676 F (348,373) 366,049 322.91 313.00 9.90 Non-Operating Income 1,271,371 (1,256,673) 2,528,044 F 36,738 2,491,306 34.40 (33.01) 67.41
Net Income (Loss) 26,265,829$ 26,119,456$ 146,373$ F (763,578)$ 909,951$ 710.67$ 686.05$ 24.62$
Net Income Margin 5.53% 5.46% 0.07%OEBITDA Margin w/o Prop Tax 6.86% 7.81% (0.95%)OEBITDA Margin with Prop Tax 9.37% 10.30% (0.93%)
F= Favorable varianceU= Unfavorable variance
1= Property Tax Revenue does not include G.O. Bonds Levy2= Interest Expense does not include G.O. Bonds Interest
$/Adjusted Discharges
2
1
FISCAL YEAR 2012
INCOME STATEMENT: CURRENT VS. PRIOR YEAR-TO-DATE CONSOLIDATED – ADJUSTED DISCHARGES
12
Variance $/Adjusted Discharges
May 12 YTD May 11 YTD Variance Volume Rate/Eff Actual FY12 Actual FY11 VarianceStatistics: Admissions - Acute 23,603 24,127 (524) Admissions - SNF 1,173 1,086 87 Patient Days - Acute 92,726 94,985 (2,259) Patient Days - SNF 68,599 69,044 (445) ALOS - Acute 3.94 3.92 0.02 ALOS - SNF 59.91 64.71 (4.80) Adjusted Discharges 36,959 37,104 (145)
Revenue: Gross Revenue 1,841,712,379$ 1,682,417,991$ 159,294,388$ F (6,574,779)$ 165,869,167$ 49,831.23$ 45,343.31$ 4,487.92$ Deductions from Rev (1,376,931,185) (1,241,667,790) (135,263,395) U 4,852,356 (140,115,751) (37,255.64) (33,464.53) (3,791.11) Net Patient Revenue 464,781,194 440,750,201 24,030,993 F (1,722,423) 25,753,416 12,575.59 11,878.78 696.81 Other Oper Revenue 10,546,875 10,007,053 539,822 F (39,107) 578,929 285.37 269.70 15.66 Total Net Revenue 475,328,069 450,757,254 24,570,815 F (1,761,530) 26,332,345 12,860.96 12,148.48 712.47
Expenses: Salaries, Wages & Contr Labor 221,882,268 209,277,071 (12,605,197) U 817,841 (13,423,038) 6,003.47 5,640.28 (363.19) Benefits 62,141,699 57,843,091 (4,298,608) U 226,047 (4,524,655) 1,681.37 1,558.94 (122.42) Supplies 69,178,279 67,993,770 (1,184,509) U 265,715 (1,450,224) 1,871.76 1,832.52 (39.24) Prof Fees & Purch Svc 64,699,087 58,445,687 (6,253,400) U 228,402 (6,481,802) 1,750.56 1,575.19 (175.38) Depreciation 19,530,871 19,412,501 (118,370) U 75,863 (194,233) 528.45 523.19 (5.26) Other 24,835,757 24,507,683 (328,074) U 95,774 (423,848) 671.98 660.51 (11.47) Total Expenses 462,267,961 437,479,803 (24,788,158) U 1,709,642 (26,497,800) 12,507.59 11,790.64 (716.95)
Net Inc Before Non-Oper Income 13,060,108 13,277,451 (217,343) U (51,887) (165,456) 353.37 357.84 (4.48)
Property Tax Revenue 11,934,350 11,591,663 342,687 F (45,299) 387,986 322.91 312.41 10.50 Non-Operating Income 1,271,371 544,256 727,115 F (2,127) 729,242 34.40 14.67 19.73
Net Income (Loss) 26,265,829$ 25,413,370$ 852,459$ F (99,314)$ 951,773$ 710.67$ 684.92$ 25.75$
Net Income Margin 5.53% 5.64% (0.11%)OEBITDA Margin w/o Prop Tax 6.86% 7.25% (0.39%)OEBITDA Margin with Prop Tax 9.37% 9.82% (0.45%)
F= Favorable varianceU= Unfavorable variance
1= Property Tax Revenue does not include G.O. Bonds Levy2= Interest Expense does not include G.O. Bonds Interest
2
1
FISCAL YEAR 2012
INCOME STATEMENT: FISCAL YEAR PROJECTION CONSOLIDATED – ADJUSTED DISCHARGES
13
Variance11 Act + 1 Bud FY 12 Budget Variance Volume Rate/Eff Actual Budget Variance
Statistics: Admissions - Acute 25,780 26,584 (804) Admissions - SNF 1,264 1,089 175 Patient Days - Acute 101,161 102,961 (1,800) Patient Days - SNF 74,769 75,299 (530) Adjusted Discharges 40,351 41,464 (1,113)
Revenue: Gross Revenue 2,001,303,482$ 1,944,109,488$ 57,193,994$ F (52,184,880)$ 109,378,874$ 49,597.37$ 46,886.68$ 2,710.69$ Deductions from Rev (1,494,628,928) (1,433,856,513) (60,772,415) U 38,488,383 (99,260,798) (37,040.69) (34,580.76) (2,459.93) Net Patient Revenue 506,674,554 510,252,975 (3,578,421) U (13,696,497) 10,118,076 12,556.68 12,305.93 250.75 Other Oper Revenue 11,423,228 10,516,236 906,992 F (282,283) 1,189,275 283.10 253.62 29.47 Total Net Revenue 518,097,782 520,769,211 (2,671,429) U (13,978,780) 11,307,351 12,839.78 12,559.55 280.22
Expenses: Salaries, Wages & Contr Labor 241,672,302 237,222,454 (4,449,848) U 6,367,658 (10,817,506) 5,989.25 5,721.17 (268.09) Benefits 67,644,451 66,545,182 (1,099,270) U 1,786,243 (2,885,512) 1,676.40 1,604.89 (71.51) Supplies 75,170,262 72,872,888 (2,297,374) U 1,956,095 (4,253,469) 1,862.91 1,757.50 (105.41) Prof Fees & Purch Svc 70,684,803 72,559,632 1,874,829 F 1,947,686 (72,857) 1,751.75 1,749.94 (1.81) Depreciation 21,522,619 23,848,620 2,326,001 F 640,158 1,685,843 533.39 575.16 41.78 Other 27,432,042 31,349,786 3,917,744 F 841,509 3,076,235 679.84 756.07 76.24 Total Expenses 504,126,479 504,398,562 272,082 F 13,539,350 (13,267,267) 12,493.53 12,164.73 (328.80)
Net Inc Before Non-Oper Income 13,971,303 16,370,649 (2,399,347) U (439,430) (1,959,916) 346.24 394.82 (48.57)
Property Tax Revenue 13,017,684 13,000,008 17,676 F (348,954) 366,630 322.61 313.53 9.09 Non-Operating Income 1,157,128 (1,370,916) 2,528,044 F 36,799 2,491,245 28.68 (33.06) 61.74
Net Income (Loss) 28,146,115$ 27,999,741$ 146,373$ F (751,585)$ 897,959$ 697.53$ 675.28$ 22.25$
F= Favorable varianceU= Unfavorable variance
1= Property Tax Revenue does not include G.O. Bonds Levy2= Interest Expense does not include G.O. Bonds Interest
$/Adjusted Discharges
2
1
FISCAL YEAR 2012
INCOME STATEMENT: MONTHLY TREND CONSOLIDATED – ADJUSTED DISCHARGES
14
Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May YTDStatistics: Admissions - Acute 2,121 2,280 2,188 2,096 2,168 2,204 2,131 2,053 2,198 2,008 2,156 23,603 Admissions - SNF 97 102 107 88 110 108 119 114 111 102 115 1,173 Patient Days - Acute 8,197 8,388 8,232 8,619 8,428 8,749 8,866 8,032 9,004 7,888 8,323 92,726 Patient Days - SNF 6,174 6,325 6,139 6,288 6,093 6,304 6,357 6,043 6,359 6,124 6,393 68,599 ALOS - Acute 3.81 3.72 3.76 4.14 3.96 3.89 4.15 3.99 4.02 3.97 3.95 3.94 ALOS - SNF 63.00 65.21 63.29 64.82 58.03 57.31 61.13 54.44 56.27 65.15 53.72 59.91 Adjusted Discharges 3,334 3,514 3,399 3,211 3,275 3,428 3,363 3,259 3,572 3,176 3,423 36,959
Revenue: Gross Revenue 155,393,449$ 166,103,989$ 161,234,847$ 170,586,964$ 167,125,136$ 168,704,378$ 173,541,065$ 163,203,707$ 175,693,424$ 163,742,001$ 176,383,420$ 1,841,712,379$ Deductions from Rev (114,548,915) (122,862,300) (119,724,189) (127,741,102) (125,413,158) (125,273,854) (131,424,654) (122,886,881) (131,500,841) (123,213,015) (132,342,275) (1,376,931,185) Net Patient Revenue 40,844,534 43,241,689 41,510,658 42,845,862 41,711,978 43,430,524 42,116,411 40,316,826 44,192,583 40,528,986 44,041,145 464,781,194 Other Oper Revenue 830,576 836,270 1,385,488 1,006,116 871,986 1,105,830 896,319 898,463 909,606 1,039,023 767,197 10,546,875 Total Net Revenue 41,675,110 44,077,959 42,896,146 43,851,978 42,583,964 44,536,354 43,012,730 41,215,289 45,102,189 41,568,009 44,808,342 475,328,069
Expenses: Salaries, Wages & Contr Labor 19,549,232 19,771,982 19,149,834 19,809,340 19,638,785 20,359,334 20,497,235 19,674,969 21,297,055 20,835,430 21,299,071 221,882,268 Benefits 5,727,318 5,672,364 5,408,660 5,621,446 5,425,500 5,729,743 5,675,522 5,507,140 5,867,925 5,679,529 5,826,551 62,141,699 Supplies 6,138,762 6,222,648 6,340,266 6,186,979 6,162,802 6,711,095 6,273,748 5,799,051 6,718,960 6,260,073 6,363,897 69,178,279 Prof Fees & Purch Svc 5,728,447 5,938,803 5,818,583 6,038,706 5,924,010 6,190,737 5,806,359 5,913,798 5,813,634 5,633,283 5,892,727 64,699,087 Depreciation 1,811,075 1,797,915 1,789,316 1,795,535 1,795,429 1,801,732 1,728,752 1,737,997 1,738,299 1,750,513 1,784,309 19,530,871 Other 2,143,909 2,429,088 2,341,764 2,494,794 2,492,820 2,177,737 2,133,883 1,938,844 2,459,983 1,795,331 2,427,603 24,835,757 Total Expenses 41,098,743 41,832,800 40,848,423 41,946,800 41,439,346 42,970,378 42,115,499 40,571,799 43,895,856 41,954,159 43,594,158 462,267,961
Net Inc Before Non-Oper Income 576,367 2,245,159 2,047,723 1,905,178 1,144,618 1,565,976 897,231 643,490 1,206,333 (386,150) 1,214,184 13,060,108
Property Tax Revenue 1,083,333 1,083,333 1,083,333 1,097,779 1,086,607 1,083,297 1,083,333 1,083,333 1,083,333 1,083,333 1,083,333 11,934,350 Non-Operating Income 599,642 (93,181) (488,961) 283,172 83,806 836,147 411,583 (208,076) (261,787) 257,441 (148,414) 1,271,371
Net Income (Loss) 2,259,342$ 3,235,311$ 2,642,095$ 3,286,129$ 2,315,031$ 3,485,420$ 2,392,147$ 1,518,747$ 2,027,879$ 954,624$ 2,149,103$ 26,265,829$
Net Income Margin 5.42% 7.34% 6.16% 7.49% 5.44% 7.83% 5.56% 3.68% 4.50% 2.30% 4.80% 5.53%OEBITDA Margin w/o Prop Tax 5.73% 9.17% 8.94% 8.44% 6.90% 7.56% 6.11% 5.78% 6.53% 3.28% 6.69% 6.86%OEBITDA Margin with Prop Tax 8.33% 11.63% 11.47% 10.94% 9.46% 9.99% 8.62% 8.41% 8.93% 5.89% 9.11% 9.37%
1= Property Tax Revenue does not include G.O. Bonds Levy2= Interest Expense does not include G.O. Bonds Interest
2
1
212
FISCAL YEAR 2012
CASH FLOW STATEMENT 15
May YTD
CASH FLOWS FROM OPERATING ACTIVITIES: Income (Loss) from operations 1,214,184 13,060,108 Adjustments to reconcile change in net assets to net cash provided by operating activities: Depreciation Expense 1,784,309 19,530,871 Provision for bad debts 6,123,338 68,380,162
Changes in operating assets and liabilities: Patient accounts receivable (5,043,458) (87,107,575) Property Tax and other receivables 4,226,680 (23,102,059) Inventories (82,456) 34,645 Prepaid expenses and other current assets (2,558,370) (4,117,936) Accounts payable (1,130,063) (31,760,064) Accrued compensation 1,841,134 1,889,596 Estimated settlement amounts due third-party payors (1,238,877) (1,579,630) Other current liabilities 584,364 17,320,514 Net cash provided by operating activities 5,720,784 (27,451,367)
CASH FLOWS FROM INVESTING ACTIVITIES: Net (purchases) sales of investments 15,020,113 184,494,677 Income (Loss) on investments 26,713 2,200,048 Investment in affiliates 75,611 1,760,690 Net cash used in investing activities 15,122,437 188,455,415
CASH FLOWS FROM NON-CAPITAL FINANCING ACTIVITIES: Receipt of G.O. Bond Taxes 1,616,041 15,161,911 Receipt of District Taxes 1,204,037 12,529,386 Net cash used in non-capital financing activities 2,820,078 27,691,297 CASH FLOWS FROM CAPITAL AND RELATED FINANCING ACTIVITIES: Acquisition of property plant and equipment (14,208,499) (145,057,289) Deferred Financing Costs 115,126 1,266,534 G.O. Bond Interest paid 0 (12,032,382) Revenue Bond Interest paid (13,488,248) (30,100,712) Payments of Long Term Debt 0 (8,366,793) Net cash used in activities (27,581,622) (194,290,642)
NET INCREASE (DECREASE) IN CASH AND CASH EQUIVALENTS (3,918,322) (5,595,297)
CASH AND CASH EQUIVALENTS - Beginning of period 10,283,816 11,960,791
CASH AND CASH EQUIVALENTS - End of period 6,365,494 6,365,494
FISCAL YEAR 2012
FINANCIAL REPORT NARRATIVE STATISTICS
16
Apr vs May May Act vs BudApr May % Change Budget % Variance
CONSOLIDATED
Patient Days Acute 7,888 8,323 5.51% 8,721 (4.6%)Patient Days SNF 6,124 6,393 4.4% 6,376 0.3%ADC Acute 262.94 268.48 2.1% 281.32 (4.6%)ADC SNF 204.13 206.23 1.0% 205.68 0.3%Surgeries CVS Cases 8 9 12.5% 10 (10.0%)Surgeries Total 1,508 1,548 2.7% 1,590 (2.6%)Number of Births 356 411 15.4% 419 (1.9%)
NORTH
Patient Days Acute 6,092 6,419 5.4% 6,494 (1.2%)Patient Days SNF 2,597 2,744 5.7% 2,646 3.7%ADC Acute 203.06 207.06 2.0% 209.48 (1.2%)ADC SNF 86.57 88.52 2.3% 85.35 3.7%
SOUTH
Patient Days Acute 1,796 1,904 6.0% 2,227 (14.5%)Patient Days SNF 3,527 3,649 3.5% 3,730 (2.2%)ADC Acute 59.86 61.43 2.6% 71.84 (14.5%)ADC SNF 117.57 117.71 0.1% 120.32 (2.2%)
FISCAL YEAR 2012
FINANCIAL REPORT NARRATIVE BALANCE SHEET
17
Current Cash & Cash Equivalents increased $6.5 million from $161.1 million in April to $167.6 million in May. Total Cash and Investments are $176.7 million in May, compared to $170.7 million in April. Days Cash on Hand increased from 129.6 days in April to 133.9 days in May. Net Accounts Receivable decreased $1.1 million from $99.4 million in April to $98.3 million in May. Gross A/R days decreased from 47.9 days in April to 46.3 days in May. YTD collections, including capitation, are $428.2 million compared to budget of $462.0 million. Other Current Liabilities decreased $1.3 million from $25.5 million in April to $24.2 million in May. The decrease is due to the realization of deferred property tax revenue of $1.1 million and a decrease in Other of $0.2 million. Construction-in-Progress increased $18.6 million from $1.06 billion in April to $1.08 billion in May. The increase is attributed to Building Expansion construction, equipment and interest costs of $18.6 million.
FISCAL YEAR 2012
FINANCIAL REPORT NARRATIVE INCOME STATEMENT
18
Gross Patient Revenue reflects a YTD favorable budget variance of $57.2 million.
North South Outreach ConsolidatedTotal 67,101,438$ (11,517,184)$ 1,609,740$ 57,193,994$
Routine 10,083,649 (6,385,160) - 3,698,489 IP Ancillary 16,022,151 (10,780,480) - 5,241,671 Outpatient 40,995,638 5,648,456 1,609,740 48,253,834
Net Capitation reflects a YTD favorable budget variance of $2.0 million. Capitation Premium and Out-of-Network Claim expense both show a favorable variance of $2.3 million and $2.1 million, respectively. The favorable variance in Capitation Premium is due to retro 2011 and 2010 premium adjustments in July and August. This favorable amount is offset by a $2.4 million increase in In-Network Claim expense. Salaries, Wages & Contract Labor reflect a YTD unfavorable budget variance of $4.5 million.
YTD Actual YTD Budget VarianceConsolidated 221,882,268$ 217,432,420$ (4,449,848)$
North 130,762,819 124,390,266 (6,372,553) South 54,586,319 55,582,856 996,537 Central 28,519,854 30,576,978 2,057,124 Outreach 8,013,276 6,882,320 (1,130,956)
Employee Benefits Expense reflects a YTD unfavorable budget variance of $1.1 million due to an unfavorable budget variance in Pension of $1.6 million which was partially offset by favorable budget variances in Other of $0.5 million. Supplies reflect a YTD unfavorable budget variance of $2.3 million due to unfavorable budget variances in Surgery General of $1.3 million and Prosthesis of $1.0 million. Professional Fees, Purchased Services and Other Direct reflect a combined YTD favorable budget variance of $5.7 million. Ratios & Margins: All required Bond Covenant Ratios were achieved in May 2012.
FISCAL YEAR 2012
KEY STATISTICAL INDICATORS YEAR-TO-DATE
19
ACTUAL BUDGET VARIANCE FY 2011ADMISSIONS - Acute:
Palomar Medical Center 17,806 18,232 (426) 18,126
Pomerado Hospital 5,797 6,175 (378) 6,001
Total: 23,603 24,407 (804) 24,127
ADMISSIONS - SNF:Palomar Medical Center 638 446 192 500
Pomerado Hospital 535 552 (17) 586
Total: 1,173 998 175 1,086
PATIENT DAYS - Acute:Palomar Medical Center 70,634 70,389 245 71,025
Pomerado Hospital 22,092 24,137 (2,045) 23,960
Total: 92,726 94,526 (1,800) 94,985
PATIENT DAYS- SNF:Palomar Medical Center 28,525 28,680 (155) 28,464
Pomerado Hospital 40,074 40,449 (375) 40,580
Total: 68,599 69,129 (530) 69,044
FISCAL YEAR 2012
KEY STATISTICAL INDICATORS YEAR-TO-DATE
20
ACTUAL BUDGET VARIANCE FY 2011
EMERGENCY ROOM VISITS & TRAUMA CASES:Palomar Medical Center 53,336 52,252 1,084 51,705
Pomerado Hospital 23,857 23,911 (54) 23,681
Total: 77,193 76,163 1,030 75,386
EMERGENCY & TRAUMA ADMISSIONS:Palomar Medical Center 10,222 10,317 (95) 9,986
Pomerado Hospital 3,496 3,706 (210) 3,537
Total: 13,718 14,023 (305) 13,523
SURGERIES: Palomar Medical Center 11,018 11,414 (396) 10,094
Pomerado Hospital 5,638 5,817 (179) 5,775
Total: 16,656 17,231 (575) 15,869
BIRTHS:Palomar Medical Center 3,293 3,508 (215) 3,340
Pomerado Hospital 1,050 1,082 (32) 1,047
Total: 4,343 4,590 (247) 4,387
FISCAL YEAR 2012
KEY STATISTICAL INDICATORS YEAR-TO-DATE
21
ACTUAL BUDGET VARIANCE FY 2011
ADJUSTED DISCHARGESPalomar Medical Center 26,546 27,175 (629) 26,433
Pomerado Hospital 10,200 10,662 (462) 10,422 Other Activities 213 235 (22) 249 Total: 36,959 38,072 (1,113) 37,104
AVERAGE LENGTH OF STAY- Acute:Palomar Medical Center 3.99 3.84 0.15 3.91
Pomerado Hospital 3.80 3.85 (0.05) 3.94
Total: 3.94 3.85 0.09 3.92
AVERAGE LENGTH OF STAY - SNF:Palomar Medical Center 46.31 32.22 14.09 58.69
Pomerado Hospital 75.75 70.72 5.03 69.73
Total: 59.91 47.28 12.63 64.71
FISCAL YEAR 2012
SUPPLIES EXPENSE YEAR-TO-DATE
22
Account Description Actual Budget Variance634000 Supplies Surgery General 7,087,640 5,779,705 (1,307,935) 631000 Prosthesis 17,426,573 16,338,476 (1,088,097) 643000 Supplies Food Other 2,603,432 2,286,708 (316,724) 636000 Supplies Oxygen/Gas 265,911 82,492 (183,419) 633000 Supplies Surgical Pack 2,099,493 1,971,557 (127,936) 632000 Sutures/Surgical Needles 2,103,528 1,993,834 (109,694) 637000 Supplies IV Solutions 532,392 461,895 (70,497) 647000 Supplies Employee Apparel 225,320 178,380 (46,940) 635000 Supplies Anesthesia Material 93,788 47,166 (46,622) 642000 Supplies Food/Meat 571,750 561,358 (10,392) 645000 Supplies Cleaning 449,097 442,131 (6,966) 644000 Supplies Linen 28,132 31,446 3,314 640000 Supplies X-ray Material 14,250 22,853 8,603 639000 Supplies Radioactive 617,735 642,688 24,953 649000 Other Minor Equipment 1,544,450 1,607,718 63,268 646000 Supplies Office/Administration 932,109 1,025,277 93,168 646100 Supplies Forms 301,945 407,378 105,433 641000 Supplies Other Medical 13,114,459 13,225,683 111,224 650000 Other Non Medical 7,757,100 7,908,686 151,586 648000 Instruments/Minor Equipment 825,925 982,513 156,588 638000 Supplies Pharmaceutical 10,583,250 10,882,961 299,711
Total 69,178,279 66,880,905 (2,297,374)
FISCAL YEAR 2012
BOND COVENANT RATIOS 23
Cushion Ratio Jun-10 Jun-11 May-12
Cash and Cash Equivalents 171,574,390 188,301,404 167,591,885 Board Designated Reserves - - 8,828,289 Trustee-held Funds (Revenue Fund only) 3,085 20,275 28,737 Total 171,577,475 188,321,679 176,448,911
Divided by:Maximum Annual Debt Service (excludes GO Bonds) (1) 13,766,910 13,769,523 29,699,638 (Fiscal Year 6/30/2040)
Cushion Ratio 12.5 13.7 5.9 REQUIREMENT 1.5 1.5 1.5
Achieved Achieved Achieved
Days Cash on Hand Jun-10 Jun-11 May-12
Cash and Cash Equivalents 171,574,390 188,301,404 167,591,885 Board Designated Reserves - - 8,828,289 Trustee-held Funds (Revenue Fund only) 3,085 20,275 28,737 Total 171,577,475 188,321,679 176,448,911
Divide Total by Average Adjusted Expenses per DayTotal Expenses 451,348,266 478,493,349 462,267,961 Less: Depreciation 21,358,985 21,345,777 19,530,871 Adjusted Expenses 429,989,281 457,147,572 442,737,090
Number of days in period 365 365 336 Average Adjusted Expenses per Day 1,178,053 1,252,459 1,317,670
Days Cash on Hand 145.6 150.4 133.9 REQUIREMENT 80 80 80
Achieved Achieved Achieved
Debt Service Coverage Ratio Jun-10 Jun-11 May-12
Excess of revenues over expenses YTD 24,487,453 30,967,811 26,265,829(General Funds)ADD: Depreciation and Amortization 21,358,985 21,345,777 19,530,871 Interest Expense 4,628,028 3,805,187 2,623,823 Market Value Adj - Auction Rate Securities 7,570,218 (4,859,396) 0Income Available for Debt Service 58,044,684 51,259,379 48,420,523
Divided by:
Maximum Annual Debt Service (excludes GO Bonds) (1) 14,724,311 13,768,652 27,224,668 (Fiscal Year 6/30/2040)
Debt Service Coverage Ratio 3.94 3.72 1.78REQUIREMENT 1.15 1.15 1.15
Achieved Achieved Achieved
(1) The 2010 Certificates of Participation interest is pre-funded through November 1, 2012, therefore, by definition, they are excluded from the maximum annual debt service total for these ratios.
24
PY
BUD
FISCAL YEAR 2012
Statistical Indicators Discharges - Acute
-
500
1,000
1,500
2,000
2,500 PM
C
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
JUL AUG SEP OCT NOV DEC JAN FEB MAR APR MAY JUN
JUL AUG SEP OCT NOV DEC JAN FEB MAR APR MAY JUN YTD B-YTDPMC 1,595 1,697 1,645 1,564 1,606 1,648 1,589 1,548 1,689 1,527 1,608 - 17,716 18,308 POM 556 558 542 516 524 599 545 467 550 462 497 - 5,816 6,274 CON 2,151 2,255 2,187 2,080 2,130 2,247 2,134 2,015 2,239 1,989 2,105 - 23,532 24,582
25
PY
BUD
FISCAL YEAR 2012
-
1,000
2,000
3,000
4,000
5,000
6,000
7,000
8,000
9,000
10,000 PM
C
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
JUL AUG SEP OCT NOV DEC JAN FEB MAR APR MAY JUN
JUL AUG SEP OCT NOV DEC JAN FEB MAR APR MAY JUN YTD B-YTDPMC 6,057 6,462 6,315 6,623 6,476 6,556 6,651 6,186 6,797 6,092 6,419 - 70,634 70,389 POM 2,140 1,926 1,917 1,996 1,952 2,193 2,215 1,846 2,207 1,796 1,904 - 22,092 24,137 CON 8,197 8,388 8,232 8,619 8,428 8,749 8,866 8,032 9,004 7,888 8,323 - 92,726 94,526
Statistical Indicators Patient Days - Acute
26
PY
BUD
FISCAL YEAR 2012
JUL AUG SEP OCT NOV DEC JAN FEB MAR APR MAY JUN YTD B-YTDPMC 3.80 3.81 3.84 4.23 4.03 3.98 4.19 4.00 4.02 3.99 3.99 - 3.99 3.84 POM 3.85 3.45 3.54 3.87 3.73 3.66 4.06 3.95 4.01 3.89 3.83 - 3.80 3.85 CON 3.81 3.72 3.76 4.14 3.96 3.89 4.15 3.99 4.02 3.97 3.95 - 3.94 3.85
3.25
3.45
3.65
3.85
4.05
4.25
4.45
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
JUL AUG SEP OCT NOV DEC JAN FEB MAR APR MAY JUN
Statistical Indicators Average Length of Stay - Acute
27
PY
BUD
FISCAL YEAR 2012
-
50
100
150
200
250
300
350
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
JUL AUG SEP OCT NOV DEC JAN FEB MAR APR MAY JUN
JUL AUG SEP OCT NOV DEC JAN FEB MAR APR MAY JUN YTD B-YTDPMC 195 208 211 214 216 211 215 213 219 203 207 - 210 210 POM 69 62 64 64 65 71 71 64 71 60 61 - 66 72 CON 264 271 274 278 281 282 286 277 290 263 268 - 276 282
Statistical Indicators Average Daily Census - Acute
FISCAL YEAR 2012
28
1,080
1,020
1,048
952
1,104
1,141
1,168
1,172
964
1,123
1,010
1,135
-
670
642
641
672
660
720
659
685
629
639
557
561
-
981
968
1,042
986
1,022
992
1,083
1,066
957
1,040
952
989
-
800
692
703
780
893
756
801
844
745
841
733
787
-
801
692
793
740
832
777
761
790
749
800
750
746
-
1,956
1,821
1,742
1,899
1,856
1,837
1,975
2,049
1,814
2,207
1,583
1,686
-
864
990
988
953
852
895
893
840
860
875
823
908
-
469
418
456
373
384
430
491
490
421
394
455
457
-
884
926
938
868
987
868
893
911
1,437
1,043
1,005
1,052
-
67
28
37
9
29
12
25
19
15
42
20
2
-
- 2,000 4,000 6,000 8,000 10,000
PY AVG
JUL
AUG
SEP
OCT
NOV
DEC
JAN
FEB
MAR
APR
MAY
JUN
ICU/CCU Telemetry IMC Med-Oncology Surg-Ortho Med Surg Labor Delivery Recovery Rehb Acute MHU NICU
JUL AUG SEP OCT NOV DEC JAN FEB MAR APR MAY JUN YTD B-YTDPMC 6,057 6,462 6,315 6,623 6,476 6,556 6,651 6,186 6,797 6,092 6,419 - 70,634 70,389 POM 2,140 1,926 1,917 1,996 1,952 2,193 2,215 1,846 2,207 1,796 1,904 - 22,092 24,137 CON 8,197 8,388 8,232 8,619 8,428 8,749 8,866 8,032 9,004 7,888 8,323 - 92,726 94,526
Statistical Indicators Patient Days
29
PY
BUD
FISCAL YEAR 2012
-
100
200
300
400
500
600
700
800
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
JUL AUG SEP OCT NOV DEC JAN FEB MAR APR MAY JUN
JUL AUG SEP OCT NOV DEC JAN FEB MAR APR MAY JUN YTD B-YTDPMC 482 514 535 494 512 510 509 461 568 489 530 - 5,604 5,727 POM 177 181 169 182 175 178 162 150 164 141 158 - 1,837 1,775 CON 659 695 704 676 687 688 671 611 732 630 688 - 7,441 7,502
Statistical Indicators Surgeries (Inpatient only)
30
PY
BUD
FISCAL YEAR 2012
-
200
400
600
800
1,000
1,200 PM
C
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
JUL AUG SEP OCT NOV DEC JAN FEB MAR APR MAY JUN
JUL AUG SEP OCT NOV DEC JAN FEB MAR APR MAY JUN YTD B-YTDPMC 418 490 467 487 491 453 483 515 533 492 492 - 5,321 5,581 POM 306 352 342 332 325 378 335 319 375 378 359 - 3,801 4,042 CON 724 842 809 819 816 831 818 834 908 870 851 - 9,122 9,623
Statistical Indicators Surgeries (Outpatient only)
31
PY
BUD
FISCAL YEAR 2012
-
2
4
6
8
10
12
14
JUL AUG SEP OCT NOV DEC JAN FEB MAR APR MAY JUNJUL AUG SEP OCT NOV DEC JAN FEB MAR APR MAY JUN YTD B-YTD
PMC 8 9 7 12 9 4 8 10 9 8 9 - 93 106 POM - - - - - - - - - - - - - - CON 8 9 7 12 9 4 8 10 9 8 9 - 93 106
Statistical Indicators Surgeries – CVS (PMC only)
32
PY
BUD
FISCAL YEAR 2012
-
200
400
600
800
1,000
1,200
1,400
1,600
1,800 PM
C
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
JUL AUG SEP OCT NOV DEC JAN FEB MAR APR MAY JUN
JUL AUG SEP OCT NOV DEC JAN FEB MAR APR MAY JUN YTD B-YTDPMC 908 1,013 1,009 993 1,012 967 1,000 986 1,110 989 1,031 - 11,018 11,414 POM 483 533 511 514 500 556 497 469 539 519 517 - 5,638 5,817 CON 1,391 1,546 1,520 1,507 1,512 1,523 1,497 1,455 1,649 1,508 1,548 - 16,656 17,231
Statistical Indicators Total Surgeries
33
PY
BUD
FISCAL YEAR 2012
-
1,000
2,000
3,000
4,000
5,000
6,000
7,000 PM
C
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
JUL AUG SEP OCT NOV DEC JAN FEB MAR APR MAY JUN
JUL AUG SEP OCT NOV DEC JAN FEB MAR APR MAY JUN YTD B-YTDPMC 2,180 2,677 2,862 3,473 2,733 2,449 2,744 2,639 3,083 2,816 3,287 - 30,943 26,530 POM 1,862 2,164 2,004 2,293 1,931 2,130 1,992 2,019 2,155 2,030 2,203 - 22,783 23,129 CON 4,042 4,841 4,866 5,766 4,664 4,579 4,736 4,658 5,238 4,846 5,490 - 53,726 49,659
Statistical Indicators Outpatient Registrations (excludes Lab)
Oct-11 registrations are high as “recurring” encounters were discharged on Sep 30, 2011. New encounters were created on Oct 1, 2011.
34
PY
BUD
FISCAL YEAR 2012
-
1,000
2,000
3,000
4,000
5,000
6,000
7,000
8,000 PM
C
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
JUL AUG SEP OCT NOV DEC JAN FEB MAR APR MAY JUN
JUL AUG SEP OCT NOV DEC JAN FEB MAR APR MAY JUN YTD B-YTDPMC 4,864 4,816 4,779 5,004 4,393 4,560 5,190 4,719 5,055 4,730 5,226 - 53,336 52,252 POM 2,118 2,241 1,966 2,113 2,104 2,099 2,311 2,241 2,241 2,179 2,244 - 23,857 23,911 CON 6,982 7,057 6,745 7,117 6,497 6,659 7,501 6,960 7,296 6,909 7,470 - 77,193 76,163 CON/DAY 225 228 225 230 217 215 242 240 235 230 241 - 230 227
Statistical Indicators ER Visits (includes Trauma, Outpatient only)
35
PY
BUD
FISCAL YEAR 2012
-
200
400
600
800
1,000
1,200
1,400
1,600 PM
C
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
JUL AUG SEP OCT NOV DEC JAN FEB MAR APR MAY JUN
JUL AUG SEP OCT NOV DEC JAN FEB MAR APR MAY JUN YTD B-YTDPMC 966 915 920 926 928 918 974 913 968 879 915 - 10,222 10,317 POM 299 322 323 299 317 369 373 306 319 275 294 - 3,496 3,706 CON 1,265 1,237 1,243 1,225 1,245 1,287 1,347 1,219 1,287 1,154 1,209 - 13,718 14,023
Statistical Indicators ER Admissions (includes Trauma, Inpatient only)
36
PY
BUD
FISCAL YEAR 2012
-
1,000
2,000
3,000
4,000
5,000
6,000
7,000
8,000
9,000
10,000 PM
C
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
JUL AUG SEP OCT NOV DEC JAN FEB MAR APR MAY JUN
JUL AUG SEP OCT NOV DEC JAN FEB MAR APR MAY JUN YTD B-YTDPMC 5,830 5,731 5,699 5,930 5,321 5,478 6,164 5,632 6,023 5,609 6,141 - 63,558 62,569 POM 2,417 2,563 2,289 2,412 2,421 2,468 2,684 2,547 2,560 2,454 2,538 - 27,353 27,617 CON 8,247 8,294 7,988 8,342 7,742 7,946 8,848 8,179 8,583 8,063 8,679 - 90,911 90,186
Statistical Indicators Total ER Visits (includes Trauma & Admissions)
37
PY
BUD
FISCAL YEAR 2012
-
2
4
6
8
10
12
14
16
18
20
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
JUL AUG SEP OCT NOV DEC JAN FEB MAR APR MAY JUN
JUL AUG SEP OCT NOV DEC JAN FEB MAR APR MAY JUN YTD B-YTDPMC 16.6 16.0 16.1 15.6 17.4 16.8 15.8 16.2 16.1 15.7 14.9 - 16.1 16.5 POM 12.4 12.6 14.1 12.4 13.1 15.0 13.9 12.0 12.5 11.2 11.6 - 12.8 13.4 CON 15.3 14.9 15.6 14.7 16.1 16.2 15.2 14.9 15.0 14.3 13.9 - 15.1 15.6
Statistical Indicators ER Conversion (ER Admits as % of ER Visits)
38
PY
BUD
FISCAL YEAR 2012
-
20
40
60
80
100
120
140
JUL AUG SEP OCT NOV DEC JAN FEB MAR APR MAY JUN
JUL AUG SEP OCT NOV DEC JAN FEB MAR APR MAY JUN YTD B-YTDPMC 111 114 113 123 120 108 92 89 89 105 108 - 1,172 1,027 POM - - - - - - - - - - - - - - CON 111 114 113 123 120 108 92 89 89 105 108 - 1,172 1,027
Statistical Indicators Trauma Cases (PMC only)
39
PY
BUD
FISCAL YEAR 2012
-
20
40
60
80
100
120
JUL AUG SEP OCT NOV DEC JAN FEB MAR APR MAY JUN
JUL AUG SEP OCT NOV DEC JAN FEB MAR APR MAY JUN YTD B-YTDPMC 89 93 89 96 99 86 75 79 76 89 98 - 969 855 POM - - - - - - - - - - - - - - CON 89 93 89 96 99 86 75 79 76 89 98 - 969 855
Statistical Indicators Trauma Admissions (PMC only)
40
PY
BUD
FISCAL YEAR 2012
-
50
100
150
200
250
300
350
400
450
500
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
JUL AUG SEP OCT NOV DEC JAN FEB MAR APR MAY JUN
JUL AUG SEP OCT NOV DEC JAN FEB MAR APR MAY JUN YTD B-YTDPMC 301 345 343 288 276 305 288 283 276 271 317 - 3,293 3,508 POM 109 110 105 84 115 91 73 86 98 85 94 - 1,050 1,082 CON 410 455 448 372 391 396 361 369 374 356 411 - 4,343 4,590
Statistical Indicators Deliveries
FISCAL YEAR 2012
41 Payor Mix Based on Gross Revenue
28
26
24
26
28
27
27
27
28
28
27
28
9
8
10
10
9
11
9
10
10
11
11
10
13
12
13
10
13
10
12
10
11
10
11
9
4
4
4
5
5
5
5
5
6
5
6
5
5
7
4
5
5
6
5
5
5
3
3
5
27
28
31
29
27
27
28
29
28
30
28
28
10
11
10
11
10
11
11
10
9
9
10
10
4
4
4
4
3
3
3
4
3
4
4
5
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
PY AVG
JUL
AUG
SEP
OCT
NOV
DEC
JAN
FEB
MAR
APR
MAY
JUN
MEDICARE MCAR MGD MEDI-CAL MCAL MGD SELF PAY MGD CARE CAP OTHER
BUD
FISCAL YEAR 2012
42
1.00
1.10
1.20
1.30
1.40
1.50
1.60
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
JUL AUG SEP OCT NOV DEC JAN FEB MAR APR MAY JUN YTD
JUL AUG SEP OCT NOV DEC JAN FEB MAR APR MAY JUN YTDPMC 1.28 1.30 1.30 1.34 1.39 1.36 1.36 1.32 1.36 1.38 1.35 - 1.34 POM 1.27 1.27 1.25 1.34 1.26 1.42 1.39 1.34 1.34 1.39 1.38 - 1.33 CON 1.28 1.29 1.29 1.34 1.36 1.38 1.37 1.33 1.35 1.38 1.36 - 1.34
Case Mix Index
BUD
FISCAL YEAR 2012
43
1.00
1.10
1.20
1.30
1.40
1.50
1.60
1.70
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
JUL AUG SEP OCT NOV DEC JAN FEB MAR APR MAY JUN YTD
JUL AUG SEP OCT NOV DEC JAN FEB MAR APR MAY JUN YTDPMC 1.42 1.45 1.47 1.48 1.52 1.51 1.50 1.46 1.48 1.52 1.49 - 1.48 POM 1.43 1.43 1.39 1.48 1.43 1.54 1.51 1.48 1.48 1.56 1.53 - 1.48 CON 1.42 1.44 1.45 1.48 1.50 1.52 1.50 1.47 1.48 1.53 1.50 - 1.48
Case Mix Index by Region (excludes Deliveries)
BUD
FISCAL YEAR 2012
44
1.00
1.10
1.20
1.30
1.40
1.50
1.60
1.70
1.80
1.90
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
JUL AUG SEP OCT NOV DEC JAN FEB MAR APR MAY JUN YTD
JUL AUG SEP OCT NOV DEC JAN FEB MAR APR MAY JUN YTDPMC 1.61 1.55 1.55 1.66 1.74 1.70 1.69 1.54 1.68 1.67 1.71 - 1.65 POM 1.57 1.52 1.34 1.53 1.45 1.61 1.59 1.57 1.62 1.56 1.56 - 1.54 CON 1.59 1.54 1.48 1.62 1.65 1.66 1.66 1.55 1.66 1.63 1.66 - 1.61
Case Mix Index by Region Medicare
45
PY
BUD
FISCAL YEAR 2012
Adjusted Discharges Gross Patient Revenue per Adjusted Discharges
Dolla
rs p
er A
djus
ted
Disc
harg
e
40,000
42,000
44,000
46,000
48,000
50,000
52,000
54,000
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
JUL AUG SEP OCT NOV DEC JAN FEB MAR APR MAY JUN YTD
JUL AUG SEP OCT NOV DEC JAN FEB MAR APR MAY JUN YTD B-YTDPMC 47,313 47,614 48,486 54,048 52,585 49,986 52,317 50,139 49,736 51,884 52,046 - 50,522 46,884 POM 44,683 46,267 44,417 50,420 46,584 47,171 49,619 49,894 47,619 50,504 49,983 - 47,833 46,840 CON 46,609 47,269 47,436 53,126 51,031 49,214 51,603 50,078 49,186 51,556 51,529 - 49,831 46,872
46
PY
BUD
FISCAL YEAR 2012
Adjusted Discharges Net Patient Revenue per Adjusted Discharges
Dolla
rs p
er A
djus
ted
Disc
harg
e
JUL AUG SEP OCT NOV DEC JAN FEB MAR APR MAY JUN YTD B-YTDPMC 11,579 11,921 11,768 12,729 12,318 12,112 11,810 11,941 11,707 11,459 12,368 - 11,972 11,713 POM 13,377 12,788 12,741 14,273 13,040 13,462 13,625 12,817 13,362 15,610 13,575 - 13,489 13,309 CON 12,251 12,306 12,213 13,343 12,736 12,669 12,523 12,371 12,372 12,761 12,866 - 12,576 12,302
10,250
11,250
12,250
13,250
14,250
15,250
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
JUL AUG SEP OCT NOV DEC JAN FEB MAR APR MAY JUN YTD
47
PY
BUD
FISCAL YEAR 2012
Adjusted Discharges Salaries per Adjusted Discharges
Dolla
rs p
er A
djus
ted
Disc
harg
e
3,500
4,000
4,500
5,000
5,500
6,000
6,500
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
JUL AUG SEP OCT NOV DEC JAN FEB MAR APR MAY JUN YTD
JUL AUG SEP OCT NOV DEC JAN FEB MAR APR MAY JUN YTD B-YTDPMC 4,875 4,564 4,542 4,956 4,957 5,017 5,077 4,919 4,930 5,264 5,120 - 4,926 4,577 POM 5,379 5,086 5,164 5,576 5,099 5,166 5,394 5,557 5,294 5,872 5,412 - 5,352 5,213 CON 5,864 5,627 5,634 6,169 5,997 5,939 6,095 6,037 5,962 6,560 6,222 - 6,003 5,711
48
PY
BUD
FISCAL YEAR 2012
Adjusted Discharges Supplies per Adjusted Discharges
Dolla
rs p
er A
djus
ted
Disc
harg
e
1,500
1,600
1,700
1,800
1,900
2,000
2,100
2,200
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
JUL AUG SEP OCT NOV DEC JAN FEB MAR APR MAY JUN YTD
JUL AUG SEP OCT NOV DEC JAN FEB MAR APR MAY JUN YTD B-YTDPMC 1,599 1,882 1,831 1,823 1,768 1,952 1,816 1,700 1,915 1,940 1,750 - 1,817 1,688 POM 1,801 1,878 1,760 1,846 2,215 1,770 1,824 1,798 1,782 1,870 2,039 - 1,869 1,784 CON 1,841 1,771 1,865 1,927 1,882 1,958 1,866 1,779 1,881 1,971 1,859 - 1,872 1,757
49
PY
BUD
FISCAL YEAR 2012
Adjusted Discharges Total Expenses per Adjusted Discharges
Dolla
rs p
er A
djus
ted
Disc
harg
e
10,000
11,000
12,000
13,000
14,000
15,000
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
JUL AUG SEP OCT NOV DEC JAN FEB MAR APR MAY JUN YTD
JUL AUG SEP OCT NOV DEC JAN FEB MAR APR MAY JUN YTD B-YTDPMC 11,385 11,162 10,888 11,947 12,022 11,823 11,566 11,549 11,553 12,090 11,881 - 11,617 11,274 POM 13,488 12,538 13,335 13,551 13,663 12,782 13,335 13,874 12,653 14,321 13,787 - 13,361 13,214 CON 12,327 11,905 12,018 13,063 12,653 12,535 12,523 12,449 12,289 13,210 12,736 - 12,508 12,149
50
PY
BUD
FISCAL YEAR 2012
Adjusted Discharges Net Operating Income per Adjusted Discharges
Dolla
rs p
er A
djus
ted
Disc
harg
e
(2,500)
(2,000)
(1,500)
(1,000)
(500)
-
500
1,000
1,500
2,000
2,500 PM
C
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
PMC
POM
CO
N
JUL AUG SEP OCT NOV DEC JAN FEB MAR APR MAY JUN YTD
JUL AUG SEP OCT NOV DEC JAN FEB MAR APR MAY JUN YTD B-YTDPMC 403 933 1,101 693 825 510 378 712 332 (515) 731 - 560 637 POM (62) 298 (536) 788 (579) 729 342 (984) 769 1,347 (143) - 185 156 CON 173 639 602 593 350 457 267 197 338 (122) 355 - 353 406
FISCAL YEAR 2012
PFS MONTHLY CASH COLLECTIONS 51
July Aug. Sept. Oct. Nov. Dec. Jan. Feb. March April May JuneFY12 Goal $42.0 $42.0 $42.0 $42.0 $42.0 $42.0 $42.0 $42.0 $42.0 $42.0 $42.0 $42.0Curr. Yr Actual $33.8 $39.5 $37.0 $41.6 $36.4 $37.7 $38.2 $37.3 $41.0 $41.6 $44.1Pr. Yr Actual $37.1 $36.9 $33.7 $37.8 $39.7 $43.7 $39.1 $39.3 $44.0 $34.1 $37.7 $43.7
$20.0 $24.0 $28.0 $32.0 $36.0 $40.0 $44.0
Mill
ions
PPH Monthly Collections in Millions
July Aug. Sept. Oct. Nov. Dec. Jan. Feb. March April May JuneFY12 Goal $42.0 $42.0 $42.0 $42.0 $42.0 $42.0 $42.0 $42.0 $42.0 $42.0 $42.0 $42.0Curr. Yr Actual $33.8 $39.5 $37.0 $41.6 $36.4 $37.7 $38.2 $37.3 $41.0 $41.6 $44.1Pr. Yr Actual $37.1 $36.9 $33.7 $37.8 $39.7 $43.7 $39.1 $39.3 $44.0 $34.1 $37.7 $43.7
$20.0 $24.0 $28.0 $32.0 $36.0 $40.0 $44.0
Mil
lio
ns
PPH Monthly Collections in Millions
FISCAL YEAR 2012
HEALTHWORX DASHBOARD REVENUE CYCLE KEY INDICATORS
52
SUPPLEMENTAL INFORMATION
53
FISCAL YEAR 2012
WEEKLY FLASH REPORT 54
6/7/2012 6/14/2012 6/21/2012 6/28/2012 MTD Total MTD Budget%
VariancePalomar Medical CenterAverage daily census 220 - - - 220 209 5.28 Acute Patient Days 1,542 1,542 1,465 5.28 PCCC Days 616 616 597 3.21 Acute Discharges 347 347 381 (8.92) Observation Discharges 91 91 62 46.77 Births 65 65 73 (10.96) OP Visits w/o Lab 731 731 553 32.19 Lab Registrations 470 470 641 (26.68) ED Visits 1,345 1,345 1,305 3.07 Trauma Admits 27 27 17 58.82 Trauma Outpatient 4 4 3 33.33 Inpatient surgeries 110 110 105 4.76 Outpatient surgeries 104 104 102 1.96
Pomerado HospitalAverage daily census 68 - - - 68 72 (6.06) Acute Patient Days 473 473 504 (6.06) VP Days 800 800 843 (5.08) Acute Discharges 123 123 131 (6.11) Observation Discharges 41 41 26 57.69 Births 25 25 23 8.70 OP Visits w/o Lab 495 495 483 2.48 Lab Registrations 375 375 458 (18.12) ED visits 578 578 577 0.17 Inpatient surgeries 21 21 31 (32.26) Outpatient surgeries 50 50 50 -
Volu
me
FISCAL YEAR 2012
WEEKLY FLASH REPORT 55
6/7/2012 6/14/2012 6/21/2012 6/28/2012 MTD Total MTD Budget%
VariancePalomar Medical CenterGross Inpatient Charges 20,484,811$ 20,484,811$ 18,782,234$ 9.06 Gross Outpatient Charges 9,625,952$ 9,625,952$ 7,823,939$ 23.03 Average Length of Stay 4.44 4.44 3.84 15.60 Acute Case Mix Index 1.37
Pomerado HospitalGross Inpatient Charges 6,707,817$ 6,707,817$ 6,688,538$ 0.29 Gross Outpatient Charges 4,245,758$ 4,245,758$ 3,714,309$ 14.31 Average Length of Stay 3.85 3.85 3.84 0.05 Acute Case Mix Index 1.28
Cash Collection 11,762,631 11,762,631 12,000,000 (1.98)Dollars Held in Billing Edits 2,597,276 2,597,276 3,000,000 13.42Days Cash on Hand 145 145 80
Productivity Hrs (PP 25) 236,061 236,061 225,578 (4.65) PMC 130,863 130,863 131,707 0.64 POM 57,415 57,415 56,410 (1.78) Others 47,783 - - 47,783 37,461 (27.55)
Productivity $$$ (PP 25) 8,715,637 8,715,637 8,421,738 (3.49) PMC 4,848,707 4,848,707 4,914,118 1.33 POM 2,012,074 2,012,074 2,003,743 (0.42) Others 1,854,856 - - 1,854,856 1,503,877 (23.34)
Fina
ncia
l and
Acu
ityPr
oduc
tivity
and
Cas
h
Annual Business Review June 2012
Victoria Lister, FACHE Executive Director Arch Health Partners
1
• Acquire one if not two practices in San
Marcos/Vista
Status: Have not been able to acquire practices in this area
2011-2015 Strategic Initiatives
• Add new office locations in 4-S & San Marcos
San Marcos Status: Opened office in SMACC mid November 2011 with Dr. Cheng Lee and 2 mid-level providers.
Had planned to have Urgent Care hours during the week and on weekends, however demand is not there.
Have changed provider staffing to 1.5. X-ray available mid-June, Dr. Owsley will begin seeing orthopedic patients.
4-S Ranch Status: Will open in the next few weeks with 2 female Family Physicians, X-ray, blood draw.
Grow Primary Care physicians, locations, patient volume
2
Status:
- Acquired ENT Specialty Center in December 2010
- In collaboration with PPH, hired 3 full-time and several per diem Psychiatrists to support PPH Behavioral Medicine program with physician coverage
- Recruited a new Dermatologist in February who will bring cosmetic and Mohs procedures. 26 cases have been performed since mid-March, averaging 3.5 cases each week
- In collaboration with PPH, recruited a fellowship trained breast surgeon to staff the Women’s Center beginning August/September
- Closed negotiations with Drs. Bried, Cohen and Owsley in August 2011, also McKinley and Knutson in Escondido in December 2011.
- In discussions with Escondido Cardiology Associates
2011-2015 Strategic Initiatives
Add Specialty Physicians as the need arises to support AHP / PIMG or Palomar Health Service Line & meet community need
3
- PCMH – Implementation of a pilot project with small group of physicians using Care Coordinators who will do pre-visit planning and post-visit follow-up with the patient
- Customer Service Plan 2012 focuses on 4 questions:
- Returning patient telephone calls
- Informing patient of delays
- Courtesy/friendliness of Clinical Staff
- Would you recommend the practice
2011-2015 Strategic Initiatives
Move to Patient Centric practice through the transition to a Patient Centered Medical Home (PCMH) and Service Excellence
4
Status:
- Went live with Novo/Medicity unidirectional interface in May 2011
- New website launched May 6, 2011, with appointment request capability
- Moved NextGen servers to an off-site hosting facility June 2011
- NextGen EPM upgrade to 5.6 accomplished September 2011
- 25 physicians qualified for MU in 2011; received $360,000 in MU payments in April, expect $696,000 by year end
2011-2015 Strategic Initiatives
Implement a robust information and technology infrastructure to support practice growth and service enhancement
5
Status:
- Arthritis Care and Research Center, ActivCenter, potentially ExpressCare
2011-2015 Strategic Initiatives
Expand affiliation with additional network physicians through the provision of MSO services, such as EMR and Practice Management
6
- Internal Medicine (6) Total Number of Physicians - 51
- Pediatrics (4) April 1, 2010 - 37
- Dermatology (2)
- Orthopedics (6)
- Psychiatry (4)
- ENT (2)
- Family Practice (21)
- Cardiology (2)
- Ophthalmology (1)
- Gastroenterology (2)
- Breast Surgery (1)
Physician Profile
Specialties Represented
7
• In-patient Case Management – Hospital
and SNF
• Disease Management
- Coumadin Clinic
- Diabetes Registry
- Hypertension
Additional Services
• Urgent Care
• Diabetes Education
• Audiology
• Hearing Aid Dispensing
• Optometry
• Lenses Dispensing
• Physical Therapy
• MRI
• X-ray
8
• 10 Office Locations
- Main PCP office and corporate offices
- Ramona
- Orthopedics
- MRI
- PT
- ENT / Audiology in Poway
- San Marcos
- 2 Orthopedic offices in Escondido
- 4-S Medical Plaza
Arch Health Partners Profile
• 180.4 FTEs as of 1/1/2012
• Average over 12,000 patient visits per month/144,000 patient visits per year
• 15,000 new patients over the past 12 months
9
OSA joins AHP
McKinley & Knutson join AHP
Office Visits from May 2011 to April 2012
Generated by Decision Support 5/8/2012
10
11
Financial Summary
Actual Budget
Revenue $26,573,346 $26,987,681
MD Expense (Includes Outside Provider Expense) ($14,421,220) ($15,170,838)
Management Expense ($14,025,514) ($13,403,096)
Contribution from PPH* Initial acquisition of CHC $ 3,565,734 $ 0.00
Net Income (Loss) $ 1,692,386 ($1,586,253)
April – December 2010
12
Financial Summary
Actual Budget
Revenue $41,893,198 $37,499,228
MD Expense (includes outside provider expense) ($35,222,814) ($31,652,394)
Management Expense ($10,231,667) ($7,605,067 )
Contributions from PPH & PIMG $1,893,221 $0.00
Net Loss ($1,668,061) ($1,758,232)
January – December 2011
13
Financial Summary
Actual Budget
Revenue $11,672,404 $12,220,687
MD Expense (includes outside provider expense) $9,090,492 $9,054,110
Management Expense
$3,799,800* (includes $134,609 PPH contributions)
$4,019,238* (includes $134,500 PPH contributions)
Net Loss ($1,197,888) ($852,661)
January – March 2012
14
• Maximum amount: $9,067,360
• Commencement Date: April 1, 2010
• Draws: $1,525,000 during 2010
$1,773,278 during 2011
$1,000,000 YTD at April 30, 2012
• Available balance as of April 30, 2012: $5,027,900
Line of Credit Status
15
• Aetna - 2,300
• Blue Cross – 2,650
• Blue Shield – 1,300
• Cigna – 630
• Health Net – 3,550
• United Health Care – 2,525
• Sharp Health Plan - 720
HMO Contracts – 16,341 Members
• Aetna Senior - 140
• Blue Cross Senior – 210
• Secure Horizons – 2,000
16
Awards
• IHA – Bangasser Award for Quality Improvement 2009, Top Performing Medical Group
in 2010 and 2011
• CAPG – Standards of Excellence Exemplary status 2009 and 2010; achieved Elite status for 2011
• Department of Managed Health Care Right Care Initiative – Gold Performance Award
• Office of the Patient Advocate – Top Medical Group
17
Diabetic A1c < 9%
Diabetic LDL-c < 100
Cardiac LDL-c < 100
Diabetic BP < 140/90*
2007 63% 46% 55%
2008 78% 55% 58%
2009 81% 60% 72%
2010 84% 65% 88% 69%
RCI Goal 81% 52% 70% 70%
40%
50%
60%
70%
80%
90%
100%
% Pa
tient
Ach
ieve
men
t
Right Care Initiative Trends - Arch Health Partners
18
19
Thomson Reuters Practice Assessment Strengths • Development of infrastructure • Physician Comp plan methodology using WRVUs and MGMA
national standards • Loss/MD is $87,804, less than half compared to national norms • Growth in new providers and locations • Quality systems Weaknesses • Need to add capital and management • Small by comparison to Kaiser, Sharp, Scripps Opportunities • Ability to secure a true, fully integrated delivery system around
Palomar Health • Significant investment will be required • P&L will always show a loss but will increase the profitability of
the Enterprise Threats • Competition for providers and management • Competition for patients
20
21