3 rd Quarter FY2013. Senior Management. David J. Kilarski Chief Executive Officer

Transcription

1 Senior Management David J. Kilarski Chief Executive Officer Executive Summary Lynn DeJaco Chief Financial Officer FirstHealth of the Carolinas, Inc. ( FirstHealth ) is a private North Carolina nonprofit health care system headquartered in Pinehurst, North Carolina. FirstHealth and its six affiliates own and operate a health care delivery system (the Health System ) that provides health care services to patients throughout a 15-county service area in North Carolina and South Carolina (the "Total Service Area"). The Total Service Area includes a smaller 5-county primary service area (the "Primary Service Area") and larger 10-county secondary service area (the "Secondary Service Area"). FirstHealth operates two hospitals: FirstHealth Moore Regional Hospital ( FirstHealth Moore Regional ), and FirstHealth Montgomery Memorial Hospital ( FirstHealth Montgomery Memorial ). FirstHealth Moore Regional operates in two locations; the main campus in Pinehurst, North Carolina and a remote location in Rockingham, North Carolina. FirstHealth also provides primary care services at eleven medical clinics and one convenient care clinic, specialty services at thirteen medical clinics (including neurosurgery, cardiology, cardiothoracic surgery, women's care, wound care, infectious disease, back and neck pain and medical oncology), home health services, health and fitness centers, dental clinics, inpatient and outpatient behavioral programs, occupational health programs, mobile health services, 11-bed inpatient hospice facility and in-home hospice services, inpatient and outpatient rehabilitation, and regional emergency medical transport services. FirstHealth Moore Regional is the sole tertiary care hospital in its Primary Service Area and competes with only two other tertiary care hospitals in its Total Service Area. Those hospitals are located in Cumberland (Cape Fear Valley Medical Center) and Robeson (Southeastern Regional Medical Center) counties, approximately 43 and 52 miles away, respectively. Other competing tertiary care facilities are academic medical centers (Duke University Hospital and UNC Hospitals) located more than 60 miles away. FirstHealth is the leader in cardiology, oncology, orthopedic and neuroscience services in the Total Service Area. FirstHealth operates the only dedicated comprehensive heart and vascular hospital in the Primary Service Area - The Reid Heart Center, as well as a comprehensive community cancer center, and offers a full array of neurology and neurosurgery services. FirstHealth provides treatments for a multitude of devastating neurological disorders, as well as for those neurosurgical conditions affecting the brain and spinal cord. FirstHealth is a leader in medical innovation and an early adopter of medical technology, including: davinci robot, hybrid ORs, 64 Slice CT, 3D mammography, PACs, PET/CT and Stereotactic radiosurgery. FirstHealth has implemented Electronic Medical Records (EMR), computerized physician order entry (CPOE) and related information technology initiatives eligible for Federal stimulus payments under the Patient Protection and Affordable Care Act. 1

2 The following chart summarizes the organizational structure of the Health System: FirstHealth of the Carolinas, Inc. 1 (501(c)(3) non-profit) The Foundation of FirstHealth, Inc. 1 (501(c)(3) non-profit) (FirstHealth is sole member) FirstHealth Professional Services, Inc. (for-profit) (100% ownership by FirstHealth) Montgomery County Primary Care Corp. (501(c)(3) non-profit) (FirstHealth is sole member) MCPC-1-12, LLC* Surgery Center of Pinehurst Properties (SCOPP) (LLC) 2 (92% ownership by FirstHealth) Surgery Center of Pinehurst (SCOP) (LLC) 2 (40% ownership by FirstHealth) FirstImaging, LLC 2 (50% ownership by FirstHealth) StarFirst, LLC (100% ownership by FirstHealth) FirstCarolinaCare Insurance Company (FCCI) (non-profit) (100% ownership by FirstHealth) Cardiovascular Center of Scotland County (LLC) 2 (50% ownership by FirstHealth) FirstCarolinaCare Insurance Services (LLC) 2 (51% ownership by FirstHealth) (49% ownership by FCCI) Sanford Hematology & Oncology (LLC) 2 (50% ownership by FirstHealth) 1 Member of the Restricted Group. 2 Financial results are included with Moore Regional Hospital - Pinehurst results. * MCPC-1, LLC - FirstHealth Richmond Medical Group Women's Center * MCPC-2, LLC - FirstHealth Richmond Medical Group Internal Medicine * MCPC-3, LLC - FirstHealth Neurology Consultants * MCPC-4, LLC - FirstHealth Richmond Medical Group - General Surgery * MCPC-5, LLC - FirstHealth Cardiology Services * MCPC-6, LLC - FirstHealth Back and Neck Pain Center * MCPC-7, LLC - FirstHealth Richmond Anesthesiologists * MCPC-8, LLC - FirstHealth FirstCare Convenient Care Center * MCPC-9, LLC - FirstHealth Surgical Specialties * MCPC-10, LLC - FirstHealth Cardiovascular and Thoracic Services * MCPC-11, LLC - FirstHealth Behavioral Services * MCPC-12, LLC - FirstHealth Southern Pines Women's Health Center 2

3 FirstHealth of the Carolinas, Inc. Consolidated Balance Sheet (In $000's) June 30, 2013 June 30, 2012 Assets: Cash and Short-term Investments 21,621 55,458 Patient Accounts Receivable, Net 73,569 66,252 Other Receivables 8,227 4,353 Inventories 9,372 7,664 Prepaid Expenses 6,320 6,090 Total Current Assets 119, ,816 Assets Whose Use Is Limited: Designated by Board for Projects 371, ,769 Under Indenture Agreements 7,871 8,039 Insurance Reserves 39,317 37,508 Contributions by Donors to Foundations (Includes Fiduciary& Other Assets) 57,515 50,948 Total Assets Whose Use is Limited 476, ,264 Net Property, Plant and Equipment 334, ,813 Other Assets 4,646 5,279 Total Assets 933, ,173 Liabilities & Net Assets: Accounts Payable 20,298 14,967 Employee Compensation and Other 48,491 44,359 Estimated Settlements Due Third Parties* (4,300) 12,017 Current Portion of Long Term Debt 4,950 4,970 Total Current Liabilities 69,440 76,313 Long-Term Debt, Net of Current 223, ,316 Other Liabilities 24,574 27,103 Total Liabilities 317, ,731 Net Assets 616, ,442 Total Liabilities & Net Assets 933, ,173 * June 2013 balance is net of $9.4 million receivable from North Carolina for GAP assessment for the first three quarters of FY 2013, received in the fourth quarter. Capital and Liquidity Metrics: Unrestricted Days Cash on Hand Days in Accounts Receivable Unrestricted Cash to Long Term Debt 183% 177% Annual Debt Service Ratio Maximum Debt Service Ratio Debt to Capitalization Ratio 28% 31% 3

4 FirstHealth of the Carolinas Results of Operations (In $000's) 9 Months Ended June 30, 2013 June 30, 2012 Revenues: Inpatient Revenue 527, ,895 Outpatient Revenue 487, ,847 Gross Patient Revenue 1,015, ,742 Deductions from Revenue (627,317) (523,485) Net Patient Revenue 387, ,257 Other Operating Revenue 69,416 60,644 Net Revenue 457, ,900 Operating Expenses: Salary & Wages 157, ,085 Fringe Benefits 36,413 35,163 Supplies 83,499 72,100 Provision for Bad Debt 35,990 28,195 Other Operating Expense 104,764 98,398 Depreciation 24,324 24,202 Interest 4,669 5,284 Total Operating Expense 446, ,427 Income(Loss) from Operations 10,556 23,473 Nonoperating Gains: Unrestricted Investment Income 11,993 6,971 Loss on Bond Refunding (283) (7,343) Total Nonoperating Gains 11,710 (372) Excess of Revenue Over Expenses : 22,266 23,101 Unrealized Gains/Losses 12,522 25,331 Other Changes 112 (362) Increase in Unrestricted Net Assets 34,900 48,071 Restricted Net Asset Changes: Restricted Contributions 962 1,306 Other Changes - - Restricted Investment Income 1, Net Assets Released From Restriction (1,420) (1,094) Total Restricted Gains Unrealized Gains/Losses (353) 879 Increase in Restricted Net Assets 251 1,495 Operating Metrics: Operating Margin % 2.3% 5.5% Operating Cash Flow Margin % 8.6% 12.3% Excess Margin % 4.7% 5.4% 4

5 FirstHealth of the Carolinas Consolidated Statement of Cash Flows (In $000's) 9 Months Ended June 30, 2013 CASH FLOWS FROM OPERATING ACTIVITIES Increase in Net Assets $ 35,151 Adjustments to Reconcile Increase in Net Assets to Net Cash Provided by Operating Activities: Depreciation 24,324 Provision for Bad Debts 35,990 Amortization of Premium/Discount (10) Income and Unrealized (Gains) Losses on Investments and Derivatives (25,224) Loss on Refunding of Long Term Debt 283 Patient Accounts Receivable (43,829) Other Assets (7,115) Accounts Payable (478) Employee Compensation and Other (3,727) Estimated Settlements Due to Third-Party Payors (14,468) Net Cash Provided by Operating Activities 895 CASH FLOWS FROM INVESTING ACTIVITIES Purchases of Property and Equipment (42,601) Purchase of Assets Whose Use is Limited, Net 30,494 Net Cash Used in Investing Activities (12,106) CASH FLOWS FROM FINANCING ACTIVITIES Proceeds from Issuance of Bonds 28,435 Bond Discount 116 Refunding of Bonds (28,235) Cash paid for Issue Costs (172) Principal Payments of Long-Term Debt (4,930) Net Cash Used in Financing Activities (4,786) NET INCREASE (DECREASE) IN CASH AND CASH EQUIVALENTS (15,997) Cash and Cash Equivalents - Beginning of Year 37,617 CASH AND CASH EQUIVALENTS - END OF YEAR $ 21,621 5

6 FIRSTHEALTH OF THE CAROLINAS, INC. CONSOLIDATING BALANCE SHEET - RESTRICTED GROUP June 30, 2013 (in $000s) Moore Moore Moore Regional Regional Regional Montgomery The Restricted Hospital Hospital Hospital Memorial Foundation Group Pinehurst Richmond Hoke Campus Hospital of FirstHealth Eliminations Combined ASSETS CURRENT ASSETS: Cash and Cash Equivalents 13,992 (2) - (0) ,894 Accounts Receivable, net 46,819 22,857-2, ,171 Other Receivables 6, ,789 Inventories 7,825 1, ,370 Prepaid Expenses 5, (2) - - 5,739 Due From Affiliates 125,063 2, (131,423) (3,342) Total Current Assets 205,990 26,954-3, (131,423) 105,621 ASSETS LIMITED AS TO USE: By Board for Projects 353, ,147 Under Indenture Agreements-Held by Trustees 7, ,871 Self-Insurance Reserves 15, ,635 Contributions by Donors to Foundations ,515 57,515 Non Current Assets Limited as to Use 376, , ,168 PROPERTY AND EQUIPMENT, net 294,755 28,345-2,788 5, ,605 OTHER ASSETS 7, ,078 TOTAL ASSETS 885,393 55,299-5,952 64,251 (131,423) 879,473 LIABILITIES AND NET ASSETS CURRENT LIABILITIES: Accounts Payable 20, ,273 Accrued Expenses and Other Liabilities 27,921 1, ,386 Due To Affiliates 54,259 27,456-10, (131,423) (38,472) Estimated Settlements Due Third Party (4,824) (4,374) Current Portion of Long Term Debt 4, ,950 Total Current Liabilities 102,330 29,001-11,341 1,514 (131,423) 12,764 LONG TERM DEBT, less current portion 223, ,467 OTHER LIABILITIES 19, ,004-24,570 Total Liabilities 345,363 29,001-11,341 6,519 (131,423) 260,802 NET ASSETS: Unrestricted 539,475 26,297 - (6,160) 27, ,635 Temporarily Restricted ,932-17,259 Permanently Restricted ,777-14, ,030 26,297 - (5,389) 57, ,671 Total Liabilities and Net Assets 885,393 55,299-5,952 64,251 (131,423) 879,473 6

7 FIRSTHEALTH OF THE CAROLINAS, INC. COMBINING SCHEDULE OF EXCESS REVENUES OVER EXPENSE - RESTRICTED GROUP Nine Months Ended June 30, 2013 (in $000s) Moore Moore Moore Regional Regional Regional Montgomery The Restricted Hospital Hospital Hospital Memorial Foundation Group Pinehurst Richmond Hoke Campus Hospital of FirstHealth Eliminations Combined REVENUES, GAINS AND OTHER SUPPORT: Net patient service revenue 335,365 36,305-11,661 - (173) 383,158 Other Operating Revenue 22,629 1, ,610 (2,924) 23,679 Total revenues, gains and other support 357,994 37,543-11,786 2,610 (3,097) 406,837 OPERATING EXPENSES: Salaries 124,028 14,186-4, ,933 Fringe benefits 30,003 3,321-1,155 - (52) 34,426 Supplies 77,693 3, (3) 82,424 Depreciation and amortization 21,696 1, ,118 Interest 4, ,669 Provision for bad debts 27,458 5,829-2, ,728 Other 57,880 6,934-2,269 2,459 (3,041) 66,500 Total operating expense 343,167 36,278-11,695 2,755 (3,097) 390,798 INCOME (LOSS) FROM OPERATIONS 14,827 1, (145) - 16,039 NONOPERATING INCOME: Unrestricted investment income 10,374 (1) ,070 Loss on Advanced Refunding (283) (283) 10,092 (1) ,787 EXCESS OF REVENUES OVER (UNDER) EXPENSES 24,918 1, ,826 7

8 FIRSTHEALTH OF THE CAROLINAS, INC. CONSOLIDATING BALANCE SHEET June 30, 2013 (in $000s) Montgomery Restricted County FirstHealth Group Primary Care Professional FirstCarolina Combined Corporation Services Inc. Insurance Co. StarFirst LLC Eliminations Consolidated ASSETS CURRENT ASSETS: Cash and Cash Equivalents 14, , ,621 Accounts Receivable, Less Allow Uncoll Accts 72,171 1,398 (0) ,569 Other Receivables 6, ,227 Inventories 9, ,372 Prepaid Expenses 5, ,320 Due From Affiliates (3,342) (3,220) (119) (3) - 6,684 0 Total Current Assets 105,621 (900) 80 6,426 1,197 6, ,109 ASSETS LIMITED AS TO USE: By Board for Projects 353, , ,373 Under Indenture Agreements-Held by Trustees 7, ,871 Self-Insurance Reserves 15, ,242 9,439 39,317 Contributions by Donors to Foundations 57, ,515 Non Current Assets Limited as to Use 434, ,242 27, ,076 PROPERTY AND EQUIPMENT, net 331,605 2, ,089 OTHER ASSETS 8, (4,335) 4,646 TOTAL ASSETS 879,473 1, ,053 28,862 2, ,919 LIABILITIES AND NET ASSETS CURRENT LIABILITIES: Accounts Payable 20, (9) 34-20,298 Accrued Expenses and Other Liabilities 30, ,347 9,829 48,491 Due To Affiliates (38,472) 31,147 (109) ,684 0 Estimated Settlements Due Third Party (4,374) (4,300) Current Portion of Long Term Debt 4, ,950 Total Current Liabilities 12,764 32,149 (109) 8,068 9,884 6,684 69,440 LONG TERM DEBT, less current portion 223, ,467 OTHER LIABILITIES 24, ,574 Total Liabilities 260,802 32,149 (109) 8,071 9,884 6, ,481 NET ASSETS: Unrestricted 586,635 (30,230) ,981 18,979 (4,335) 584,403 Temporarily Restricted 17, ,259 Permanently Restricted 14, , ,671 (30,230) ,981 18,979 (4,335) 616,438 Total Liabilities and Net Assets 879,473 1, ,053 28,862 2, ,919 8

9 FIRSTHEALTH OF THE CAROLINAS, INC. COMBINING SCHEDULE OF EXCESS REVENUES OVER EXPENSE Nine Months Ended June 30, 2013 (in $000s) Montgomery Restricted County FirstHealth Group Primary Care Professional FirstCarolina FirstHealth Combined Corporation Services, Inc. Insurance Co. StarFirst Eliminations Consolidated REVENUES, GAINS AND OTHER SUPPORT: Net patient service revenue 383,158 11, (7,210) 387,822 Other Operating Revenue 23, ,402 1,766 (3,538) 69,416 Total revenues, gains and other support 406,837 12, ,402 1,766 (10,748) 457,237 OPERATING EXPENSES: Salaries 142,933 12,206-1, ,023 Fringe benefits 34,426 1, ,413 Supplies 82, ,499 Depreciation and amortization 24, ,324 Interest 4, ,669 Provision for bad debts 35, ,990 Other 66,500 3, , (11,167) 104,764 Total operating expense 390,798 18, , (10,748) 446,682 INCOME (LOSS) FROM OPERATIONS 16,039 (5,842) (0) (1,028) 1,386-10,556 NONOPERATING INCOME: Unrestricted investment income 11, ,993 Loss on Advanced Refunding (283) (283) 10, ,710 EXCESS OF REVENUES OVER (UNDER) EXPENSES 26,826 (5,842) (0) (748) 2,020-22,266 9

10 Summary of Operating Statistics Years Ending September 30 YTD QTR FY12 FY13 Total Licensed Beds * Total Staffed Beds Discharges 25,902 25,575 26,333 19,718 19,573 Patient Days 106, , ,173 82,332 84,002 Average Daily Census Percent Occupancy 61.9% 60.3% 60.9% 60.8% 62.3% Medicare Case Mix Index Emergency Room Visits 105, , ,476 80,485 81,808 Hospitalist Encounters 75,874 89, ,468 74,733 77,030 Hospitalist Admissions 10,616 13,016 15,257 11,280 12,096 Surgical Cases 12,141 11,804 11,567 8,641 9,073 Hospice ADC Total EMS Transports 18,130 18,653 19,390 14,376 14,465 FCCI Average Members 14,695 16,698 16,691 16,646 18,109 FamilyCareCenter RVUs , , ,102 Long Term Care: Licensed Beds Patient Days ** ** ** ** ** * Additional 23 beds became operational February 1, 2011 ** Closed (2/6/2009) FirstHealth of the Carolinas Acute Care Payor Mix Years Ending September 30 YTD Qtr FirstHealth of the Carolinas Medicare 56.1% 57.2% 56.6% 57.1% 57.1% Medicaid 11.2% 11.2% 12.2% 12.0% 12.1% Commercial Insurance/Third Party 24.4% 23.3% 22.4% 22.2% 21.8% Self Pay and Other (Tricare) 8.3% 8.3% 8.8% 8.7% 9.0% Total % % % % % 10