2nd Quarter 2013 Mount Sinai Medical Center

Transcription

1 2nd Quarter 2013 Mount Sinai Medical Center Senior Management Steven D. Sonenreich Alexander Mendez President Executive Vice President Chief Executive Officer Chief Financial Officer Investor Relations Wayne G. Chutkan Robert Fuller SVP, Finance Capital Markets Management Profile Type: Freestanding acute care research and teaching hospital with 672 licensed beds including 37 obstetric, 46 medical rehabilitation, 89 psychiatry beds, satellite Primary care centers in Key Biscayne, Hialeah and Coral Gables, a satellite outpatient diagnostic center, and a freestanding emergency room in Aventura. Location: Miami Beach, Florida Issue: Second quarter 2013 financial operating results Organization Established in 1946, Mount Sinai Medical Center (MSMC) is the only licensed hospital in Miami Beach and offers a wide range of tertiary services. MSMC offers a comprehensive range of specialty and subspecialty services and is known for its expertise in thoracic and cardiovascular surgery. MSMC also offers a wide variety of oncology services in its Comprehensive Cancer Center ( CCC ). The Mount Sinai Medical Center Foundation is a separate tax-exempt organization whose sole purpose is to support the activities of the hospital. Management Discussion Mount Sinai Medical Center s (MSMC) excess revenues over expenses produced a net income of $13.5 million for the second quarter ended June 30, 2013 as compared to a net income of $5.1 million for the quarter ended June 30, 2012 and a budgeted net income of $1.9 million. The results for the second quarter of the current year include revenues recorded of approximately $4.4 million stemming from a payment received from the federal government under the Electronic Health Records Stimulus Program. The MSMC Foundation continues to show significant growth with Net Assets as of the current quarter of approximately $110.6 million compared to $97.3 million in the prior year. Net Revenue for the current quarter was $138.2 million compared to $130.5 million in the prior year and $126.9 million as budgeted, showing increases of 5.9% and 8.8% as compared to the prior year and budget, respectively. On a year-to-date basis, the Medical Center s Net Revenues were $263.7 million as compared to $259.1 million in the prior year and $258.9 million as budgeted, representing an increase of 1.8% as compared to the prior year and 1.9% as compared to budget. This increase in Net Revenue can be attributed to the Medical Center s increased surgical volume and an increase in emergency room visits. On a year-to-date basis, the Medical Center experienced an overall decrease in inpatient admissions of (0.5%) over the prior year and (1.3%) as compared to budget, primarily driven by decreases in acute and psychiatric admissions. Inclusive of observation admissions, which have increased by 6.9%, the Medical Center s total admissions showed an increase of 0.7% as compared to the prior year. The Medical Center s emergency room visits increased by 1.9%, or 601 visits, as compared to the prior year, with the Aventura campus showing a 6.8% (+528) increase in visits and the Miami Beach campus remaining relatively flat at an increase of 0.3% (+73) over the prior year. Additionally, the Medical Center s overall surgical volume has increased by 1.7% as compared to the prior year, driven by the growth in open heart surgical procedures performed, which showed an increase of 24.1% as compared to the prior year. For the current quarter, the Medical Center incurred operational expenses of $124.7 million compared to $125.4 million in the prior year and $125.0 million as budgeted, showing a decrease of (0.6%) and (0.3%) compared to the prior year and budget, respectively. On a year-to-date basis, the Medical Center s operational expenses were $246.8 million for the current year compared to $250.1 million in the prior year and $254.8 million as budgeted, showing a decrease of (1.5%) and (3.1%) as compared to the prior year and budget, respectively. The Medical Center experienced an increase in salaries and wages as compared to the prior year, driven by the impact of annual merit increases and the transition of the CCC employees to Mount Sinai, which added approximately $3.5 million in labor costs for the current year. Additionally, the Medical Center has experienced an increase in supply costs as compared to the prior year related to highcost pharmaceuticals, primarily those that are cancer-related, as well as inflationary pricing that have driven up the cost of general medical and surgical supplies. These increases in salaries, wages and supplies were offset by decreases in interest expense resulting from the refinancing of the 1998 and 2001A Series Bonds as well as a decrease in management fees paid to Aptium which terminated effective with the transition to MSMC in the prior year. August 15, 2013 Page 1

2 2nd Quarter 2013 Mount Sinai Medical Center Consolidated Statement of Revenues and Expenses For the Quarter Ended June 30, 2013 (Amounts in 000 s) 2013 Q2 Actual 2012 Q2 Actual 2013 Q2 Budget Net Patient Service Revenue $127,286 $123,089 $4,197 $116,392 $10,894 Other Operating Revenues 9,503 5,591 3,912 8, Net Assets Released from Restrictions 1,363 1,795 (432) 1,795 (432) Total Operating Revenues $138,152 $130,475 $7,677 $126,925 $11,227 Operating Expenses: Salaries and Benefits $60,581 $56,170 $4,411 $63,397 $(2,816) Supplies 27,600 21,710 5,890 26,600 1,000 Malpractice & Other Insurance 7,206 7,277 (71) 6, Interest Expense 2,455 5,444 (2,989) 5,187 (2,732) Depreciation & Amortization 7,678 6,626 1,052 6, Other Expenses 19,152 28,186 (9,034) 15,867 3,285 Total Operating Expenses $124,672 $125,413 $(741) $124,985 $(313) Net Income (Loss) $13,480 $5,062 $8,418 $1,940 $11,540 Increase (Decrease) in Unrestricted Net Assets $13,480 $5,062 $8,418 $1,940 $11, Q2 Actual 2012 Q2 Actual 2013 Q2 Budget Profitability Ratios (%) Operating Margin 8.7% 3.5% 5.2% 1.3% 7.4% EBITDA Margin 15.3% 11.8% 3.5% 9.7% 5.6% Operational Ratios (%) Personnel Costs as % of Net Operating 39.2% 38.6% 0.6% 43.4% (4.2%) Revenue Supply Costs as % of Net Operating Revenue 17.9% 14.9% 2.9% 18.2% (0.4%) August 15, 2013 Page 2

3 2nd Quarter 2013 Mount Sinai Medical Center Consolidated Statement of Revenues and Expenses Y-T-D through June 30, 2013 (Amounts in 000 s) 2013 YTD Actual 2012 YTD Actual 2013 YTD Budget Net Patient Service Revenue $246,036 $243,800 $2,236 $239,143 $6,893 Other Operating Revenues 15,060 12,267 2,793 16,737 (1,677) Net Assets Released from Restrictions 2,599 2,993 (394) 2,993 (394) Total Operating Revenues $263,695 $259,060 $4,635 $258,873 $4,822 Operating Expenses: Salaries and Benefits $121,353 $112,954 $8,399 $130,188 $(8,835) Supplies 52,202 43,333 8,869 54,472 (2,270) Malpractice & Other Insurance 14,584 14, , Interest Expense 5,463 9,635 (4,172) 9,123 (3,660) Depreciation & Amortization 15,201 13,095 2,106 13,883 1,318 Other Expenses 38,028 57,211 (19,183) 32,582 5,446 Total Operating Expenses $246,831 $250,661 $(3,830) $254,733 $(7,902) Net Income (Loss) $16,864 $8,399 $8,465 $4,140 $12,724 Increase (Decrease) in Unrestricted Net Assets $16,864 $8,399 $8,465 $4,140 $12, YTD Actual 2012 YTD Actual * 2013 YTD Budget Profitability Ratios (%) Operating Margin 5.7% 2.9% 2.8% 1.4% 4.2% EBITDA Margin 12.6% 10.8% 1.8% 9.3% 3.3% Operational Ratios (%) Personnel Costs as % of Net Operating 40.8% 39.3% 1.5% 44.7% (3.9%) Revenue Supply Costs as % of Net Operating Revenue 17.6% 15.1% 2.5% 18.7% (1.2%) August 15, 2013 Page 3

4 2nd Quarter 2013 Mount Sinai Medical Center Consolidated Balance Sheet (Amounts in 000 s) As of June 30, 2013 As of June 30, 2012 Current Assets $286,652 $260,029 Assets Limited as to Use 32,821 33,280 Assets held by Mount Sinai Medical Center 110,587 97,293 Foundation, Inc. Receivable for Insured Claims 17,139 16,426 Other Assets 6,450 5,637 Property, Plant and Equipment, Net 168, ,118 Total Assets $621,655 $580,783 Current Liabilities $83,639 $89,507 Other Liabilities 85,173 75,444 Long-Term Debt, Less Current Portion 237, ,806 Net Assets - Unrestricted 104,798 78,733 Net Assets Restricted 110,587 97,293 Total Liabilities and Net Assets $621,655 $580,783 Liquidity and Other Ratios Days Cash on Hand Days in Accounts Receivable Cushion Ratio (x) Payment Period (Days) Unrestricted Cash / Long Term Debt (%) 86.0% 76.2% Maximum Annual Debt Service Coverage Ratio (x) Combined Group (1) Days Cash on Hand Unrestricted Cash / Long Term Debt (%) 98.4% 83.9% Maximum Debt Service Coverage Ratio (x) Annual Debt Service Coverage Ratio (x) (1) Members of the Combined Group include the Medical Center, less its subsidiaries, and the Foundation August 15, 2013 Page 4

5 2nd Quarter 2013 Mount Sinai Medical Center Consolidated Statements of Changes in Net Assets (Amounts in 000 s) YTD as of June 30, 2013 YTD as of June 30, 2012 UNRESTRICTED NET ASSETS (Deficiency) Excess Revenues over Expenses $16,864 $8,976 Net Assets Released from Restrictions 318 1,021 Extraordinary loss on bond defeasance - - Net change in unrealized gains on investments - - Increase (decrease) in unrestricted net assets $17,181 $9,997 TEMPORARILY RESTRICTED NET ASSETS Temporarily restricted grants and contributions $2,916 $4,281 Change in beneficial interest in net assets of Mount Sinai 3,885 (593) Medical Center Foundation, Inc. Net Assets Released from Restrictions (2,916) (4,281) Increase (decrease) in restricted net assets $3,885 $(593) INCREASE/(DECREASE) IN NET ASSETS $21,067 $9,404 NET ASSETS, BEGINNING OF YEAR $194,318 $174,533 ASSETS, END OF YEAR $215,385 $183,937 Material Event Disclosure Pursuant to Securities and Exchange Commission Rule 15c2-12(b)(5)(I)(C) and (D) the following is a listing of reportable events over the last quarter. Reportable Events Status Principal and interest payment delinquencies Non-payment related defaults Modifications to rights of Bondholders Optional, contingent or unscheduled bond calls Defeasances Rating changes Yes (1) Adverse tax opinions or events affecting the tax-exempt status of the Bonds Unscheduled draws on debt service reserves reflecting financial difficulties Unscheduled draws on credit enhancements reflecting financial difficulties Substitution of credit or liquidity providers, or their failure to perform Release, substitution or sale of property securing repayment of the Bonds 1. Moody s affirms MSMC s Baa2 rating, with a change in outlook from Stable to Positive August 15, 2013 Page 5

6 MOUNT SINAI MEDICAL CENTER QUARTER UTILIZATION STATISTICS 2nd Quarter nd Quarter 2012 % Var Inpatient Licensed Beds % Staffed Beds for Immediate Use % Percent Occupancy of Staffed Beds 61.7% 63.0% -2.2% Patient Days 34,393 35, % Admissions 5,783 5, % Average Length of Stay % Outpatient Visits Emergency Room 15,897 14, % Ambulatory Surgery 1,673 1, % Observation Visits 1,155 1, % Selected Ancillary Departments Cardiac Catheterizations % IP Surgical Procedures 1,543 1, % Open Heart Surgeries % Cardiac Angioplasties % Laboratory Tests 268, , % MRI Scans 1,964 1, % Live Births %

7 MOUNT SINAI MEDICAL CENTER YTD UTILIZATION STATISTICS 2nd Quarter 2013 FYE 2012 FYE 2011 % Var FYE 2010 FYE 2010 FYE 2009 FYE 2008 FYE 2007 Inpatient Licensed Beds % Staffed Beds for Immediate Use % Percent Occupancy of Staffed Beds 61.5% 59.5% 54.6% 9.1% 55.6% 55.6% 54.4% 51.6% 52.2% Patient Days 68, , , % 145, , , , ,472 Admissions 11,433 22,126 22, % 22,898 22,898 21,682 22,439 22,240 Average Length of Stay % Outpatient Visits Emergency Room 32,832 63,205 60, % 58,343 58,343 56,219 51,092 43,685 Ambulatory Surgery 3,300 6,177 5, % 6,064 6,064 6,389 6,392 6,555 Observation Visits 2,479 4,894 4, % 4,573 4,573 4,628 4,167 2,824 Selected Ancillary Departments Cardiac Catheterizations 1,631 3,131 2, % 2,749 2,749 2,457 2,719 2,801 IP Surgical Procedures 2,939 5,661 5, % 5,692 5,692 5,814 6,088 6,171 Open Heart Surgeries % Cardiac Angioplasties 607 1,261 1, % 1,134 1, Laboratory Tests 545,372 1,045,369 1,062, % 1,108,794 1,108,794 1,139,137 1,082,023 1,050,640 MRI Scans 3,840 7,883 7, % 7,286 7,286 8,003 6,938 6,529 Live Births 1,288 2,786 2, % 2,583 2,583 1,924 1,972 1,906 2nd Quarter Year to Date Payor Mix 2013 FYE 2012 FYE 2011 FYE Var Medicare 35.7% 35.0% 36.7% 39.3% 2.0% Medicaid 9.6% 12.0% 12.1% 11.7% -19.7% Managed Care / Commercial 45.1% 43.9% 43.4% 42.1% 2.6% Self Pay 9.6% 9.1% 7.8% 6.9% 4.9%

8 10:32 AM Mount Sinai Medical Center of Florida, Inc. and Subsidiaries BS as of 06/30/13, ($000's) 8/13/2013 2nd Quarter Audited Audited Audited Audited Audited Audited Audited Audited Audited Audited Audited Audited Audited Audited ASSETS: CURRENT ASSETS: Cash and cash equivalents $ 46,073 $ 36,074 $ 17,919 $ 14,211 $ 37,030 $ 29,382 $ 15,463 $ 34,250 $ 31,580 $ 12,200 $ 15,726 $ 34,551 $ 10,662 $ 3,363 $ 3,537 Temporary investments 158, , , ,074 84,038 42,241 66,918 31,832 40,334 55,507 37,769 5,011 3,925 7,030 16,740 Patient accounts receivable, net 68,840 60,045 61,160 56,401 51,971 56,685 57,613 59,403 52,187 47,765 54,066 58,350 70,893 79,605 46,433 Other receivables, net 2,372 2,669 1,225 3,352 3,802 6, ,588 1,787 2,311 1,740 3,378 4,838 3,944 Estimated third-party payor settlements ,289 8,868 16,555 10,274 8,498 5,377 2,228 (0) 4,839 1,033 Inventories 8,240 8,352 6,460 5,358 6,734 6,725 7,247 6,768 6,180 6,201 4,604 6,073 6,049 6,846 4,587 Prepaid and other expenses 3,098 3,534 2,476 2,272 2,374 3,086 2,721 2,807 3,066 3,189 3,672 1,380 1,665 1,955 2,067 Total current assets $ 286,652 $ 270,001 $ 245,874 $ 230,668 $ 185,949 $ 154,224 $ 159,704 $ 152,336 $ 145,209 $ 135,147 $ 123,525 $ 109,333 $ 96,572 $ 108,476 $ 78,341 ASSET'S WHOSE USE IS LIMITED: Funds held by trustee 26,357 22,128 27,276 27,539 28,042 28,544 28,120 28,135 28,800 30,957 42,940 57,554 74,158 75,822 98,085 Self-insurance trust fund 1, ,844 2,457 5,825 8,720 14,344 16,003 13,727 14,219 10,601 13,043 13,702 13,313 Other investments 4,882 4,884 4,973 6,935 6,935 2,645 2,547 2,431 2,331 2,270 3,438 3,581 3,716 3,708 3,464 Total assets whose use is limited $ 32,821 $ 27,197 $ 32,342 $ 36,318 $ 37,434 $ 37,014 $ 39,387 $ 44,910 $ 47,134 $ 46,954 $ 60,597 $ 71,736 $ 90,917 $ 93,232 $ 114,862 Beneficial interest in Mount Sinai Medical Center Foundation Inc. net assets 110, ,702 92,144 87,721 89,261 82, ,361 98,960 94,265 88,839 92,227 74, , ,109 92,858 PP&E, net 168, , , , , , , , , , , , , , ,397 Assets Held for Sale , Receivable for Insured Claim 17,139 17,139 16,426 13, Other Assets 6,450 6,194 6,433 6,937 7,745 9,540 10,316 10,537 8,582 7,721 6,709 6,679 7,261 6,242 10,331 TOTAL ASSETS $ 621,655 $ 598,604 $ 570,270 $ 583,918 $ 512,885 $ 483,109 $ 502,911 $ 483,679 $ 479,495 $ 465,625 $ 464,193 $ 450,125 $ 503,723 $ 517,779 $ 429,789 LIABILITIES AND NET ASSETS CURRENT LIABILITIES Accounts payable and accrued expenses 25,081 33,181 31,901 32,133 26,371 29,561 30,266 23,014 25,650 24,539 26,883 30,525 48,016 35,686 13,389 Accrued wages, salaries and benefits 24,866 24,742 22,825 21,716 21,712 17,878 16,373 15,833 19,029 15,803 18,852 17,973 16,311 14,891 10,641 Indigent care assessment, current portion 4,356 4,377 4,282 3,977 3,997 3,953 4,025 4,432 4,026 4,256 4,031 3,761 5,206 2,896 2,949 Other current liabilities 7,562 6,710 5,334 7,021 4,368 5,341 5,076 7,981 5,478 6,553 6,384 8,652 10,611 7,488 3,544 Due to third party payors 4,893 8,570 9,700 10,984 6, Current portion of long-term debt 15,649 14,922 29,139 8,663 6,986 6,650 5,722 5,351 5,110 4,764 2,707 3, ,143 2,548 Due to Salick 1,232 1,039 2,620 1,635 1,688 2,296 2,180 1,844 1, , ,303 2,391 20,699 Total current liabilities $ 83,639 $ 93,541 $ 105,801 $ 86,129 $ 71,150 $ 65,679 $ 63,642 $ 58,455 $ 60,871 $ 56,794 $ 60,397 $ 64,580 $ 81,700 $ 148,495 $ 53,770 LTD, net of current portion 237, , , , , , , , , , , , , , ,689 Indigent Care assesment, net current portion 2,978 2,777 2,820 2,815 2,623 2,597 2,412 2,105 2,448 2,346 2,535 2,268 2,009 1,787 1,655 Other Long Term liabilities ,188 1, , ,596 1,728 1,917 1, Reserve for self insured claims 81,342 72,462 66,604 60,475 39,060 38,213 38,979 36,200 32,512 31,272 35,753 22,718 19,705 18,509 19,048 Total liabilities $ 406,270 $ 404,285 $ 409,546 $ 409,385 $ 367,290 $ 367,352 $ 369,128 $ 365,473 $ 369,735 $ 368,995 $ 372,026 $ 365,554 $ 382,710 $ 334,538 $ 237,710 NET ASSETS: Unrestricted 104,798 87,617 68,580 86,812 56,334 33,036 29,422 19,246 15,495 7,791 (60) 9,673 17,221 74,784 91,873 Temporarily restricted 104, ,032 86,474 82,051 83,591 77,119 97,759 92,358 87,663 82,237 85,625 68,296 97, ,788 93,621 Permanently restricted 5,670 5,670 5,670 5,670 5,670 5,602 6,602 6,602 6,602 6,602 6,602 6,602 6,611 6,669 6,585 Total net assets $ 215,385 $ 194,319 $ 160,724 $ 174,533 $ 145,595 $ 115,757 $ 133,783 $ 118,206 $ 109,760 $ 96,630 $ 92,167 $ 84,571 $ 121,013 $ 183,241 $ 192,079 TOTAL $ 621,655 $ 598,604 $ 570,270 $ 583,918 $ 512,885 $ 483,109 $ 502,911 $ 483,679 $ 479,495 $ 465,625 $ 464,193 $ 450,125 $ 503,723 $ 517,779 $ 429,789 2nd Quarter_2013.xls Prepared by MSMC

9 10:32 AM Mount Sinai Medical Center of Florida, Inc. and Subsidiaries OPS as of 06/30/13, ($000's) 8/13/2013 2nd Quarter Audited Audited Audited Audited Audited Audited UNRESTRICTED REVENUES AND OTHER SUPPORT: Net patient service revenue $ 279,780 $ 536,444 $ 514,935 $ 495,827 $ 478,849 $ 454,258 $ 429,441 Other revenue 15,060 23,339 20,128 18,951 20,168 22,620 23,835 Contribution from Foundation - - 2,500 10,000 10,000 10,000 10,000 Provision for doubtful accounts (33,743) (67,575) (56,962) Inherent contribution - 1, Net assets released from temp. restrictions by Foundation , Net assets released from temp. restrictions for research and other 2,598 2,964 3,700 5,316 13,598 9,149 7,309 Total unrestricted revenues and other support $ 263,695 $ 497,120 $ 484,948 $ 531,321 $ 523,509 $ 496,870 $ 471,416 EXPENSES: Wages, salaries and benefits 121, , , , , , ,891 Supplies 52,202 90,682 80,635 78,361 80,037 83,429 78,285 Malpractice & other insurance, net 14,584 23,610 17,048 25,548 21,013 18,239 20,572 Administrative and general 34,988 63,953 56,911 54,067 61,458 67,015 56,329 Provision for doubtful accounts ,476 50,347 39,195 37,519 Depreciation and amortization 15,201 25,078 23,865 22,111 22,828 22,985 22,997 Interest expense 5,463 14,144 16,100 16,817 17,311 16,664 17,176 Indigent care assessment 2,838 5,125 4,887 4,719 4,490 4,632 4,166 Management fees ,145 50,918 45,153 47,698 45,576 42,400 Loss on Extinguishment of Debt - 6, Impairment of Long Lived Asset , Other operating expenses Total expenses $ 246,831 $ 481,043 $ 504,518 $ 505,425 $ 509,720 $ 502,241 $ 470,335 INC / (DEFICIENCY) OF REVS. OVER EXPS. $ 16,864 $ 16,077 $ (19,570) $ 25,896 $ 13,789 $ (5,371) $ 1,081 UNRESTRICTED NET ASSETS: Deficiency of revenues over expenses 16,864 16,077 (19,570) 25,896 13,789 (5,371) 1,081 Foundation transfer Contributions from the Mount Sinai Medical Center Foundation, Inc.for CAPEX , Net assets released from temporary restrictions used for capital purposes 317 2,946 1,338 3,908 8,790 6,135 8,447 Equity transfer Net unrealized gains or (losses) on investments Extraordinary loss on bond defeasance Increase / (Decrease) in unrestricted net assets $ 17,181 $ 19,037 $ (18,232) $ 30,478 $ 23,298 $ 3,614 $ 10,176 TEMPORARILY RESTRICTED NET ASSETS: Temporarily restricted giants and contributions 2,916 6,477 5,685 10,451 23,213 16,055 16,587 Equity transfer Net assets released from restrictions (2,916) (6,477) (5,685) (10,451) (23,213) (16,055) (16,587) Change in beneficial interest in net assets of Mount Sinai Medical Center Foundation, Inc. 3,885 14,558 4,423 (1,540) 6,472 (21,640) 5,401 Increase / (Decrease) in temp. rest. net assets $ 3,885 $ 14,558 $ 4,423 $ (1,540) $ 6,472 $ (21,640) $ 5,401 PERMANENTLY RESTRICTED NET ASSETS: Change in beneficial interest in net assets of Mount Sinai Medical Center Foundation, Inc Increase in permanently restricted net asset INCREASE / (DECREASE) IN NET ASSETS $ 21,066 $ 33,595 $ (13,809) $ 28,938 $ 29,838 $ (18,026) $ 15,577 NET ASSETS, BEGINNING OF YEAR $ 194,319 $ 160,724 $ 174,533 $ 145,595 $ 115,757 $ 133,783 $ 118,206 NET ASSETS, END OF YEAR $ 215,385 $ 194,319 $ 160,724 $ 174,533 $ 145,595 $ 115,757 $ 133,783 2nd Quarter_2013.xls Prepared by MSMC

10 10:32 AM Mount Sinai Medical Center of Florida, Inc. and Subsidiaries CashFlows as of 06/30/13, ($000's) 8/13/2013 2nd Quarter CASH FLOWS FROM OPERATING ACTIVITIES: 2013 Audited Audited Audited Audited Audited Audited Increase (decrease) in net assets $ 21,066 $ 33,595 $ (13,809) $ 28,938 $ 29,838 $ (18,026) $ 15,577 Adj. to rec.chg. in net assets to net cash provided by operating activities: Depreciation and amortization 15,391 25,383 24,117 22,363 23,080 22,985 22,997 Provision for doubtful accounts 33,743 67,575 56,962 51,476 50,347 39,195 37,519 (Gain) loss on disposal of PP&E (56) (29) 562 Loss on Extinguishment of Bond / Amortization of Bond (466) Gain on Sale of Business / Loss on impairment of Assets - 6,686 35, Inherent Contribution/Insurance proceeds used for Capital Expenditures - (1,381) (2,547) Change in beneficial interest in Mount Sinai Medcial Center Foundation (3,885) (14,558) (4,423) 1,540 (6,540) 21,640 (5,401) Change in net unrealized losses (gains) on invest (294) (531) Increase in accounts receivable (42,538) (66,460) (61,721) (55,906) (45,633) (38,267) (35,729) (Increase) Decrease in other receivables 297 (1,445) 2, ,014 (5,942) (153) (Increase) Decrease in estimated third-party settlements (3,677) (1,130) (1,284) 4,956 15,317 (421) 7,687 Increase in inventories 112 (72) (1,102) 1,376 (9) 522 (479) Decrease (Increase) in prepaid expenses 769 (960) (252) (365) 86 Decrease in other assets (445) (657) , (1) (Decrease) Increase in due to Comprehensive Cancer Center 192 (1,755) 985 (53) (608) Increase (Decrease) in AP and accrued expenses (6,272) 1, ,581 (3,552) 389 4,982 Increase (Decrease) in accrued wages, salaries and benefits 124 1,917 1, ,834 1, Increase in indigent care assessment (100) Increase in other current liabilities 852 1,233 (1,687) 2,653 (973) 265 (2,905) Increase in Receivable for insured claims - (713) (2,790) (13,636) Increase in other long-term liabilities 534 (869) (505) (638) 623 (Decrease) Increase in reserve for self-insured claims 8,880 5,858 6,129 21, (766) 2,779 Net cash generated (used) in operating activities $ 24,949 $ 54,475 $ 40,583 $ 73,536 $ 72,057 $ 22,740 $ 46,106 CASH FLOWS FROM INVESTING ACTIVITIES: Purchases of PP&E (8,721) (26,073) (24,347) (23,940) (13,929) (30,596) (33,222) Proceeds from the sale of PP&E /Insurance proceeds used for Capital - 19, (1,500) 20 2,636 Acquitions of Cancer Center/Proceeds from sales of Business, net - (11,656) Purchases of investments (4,417) (104,089) (157,392) (151,053) (102,842) (95,086) (148,318) Proceeds from sales and maturities of temp. invest , ,874 86,053 60, , ,378 Assets whose use is limited: Purchases of investments - (42,929) (30,507) (23,172) (51,559) (53,589) (60,492) Proceeds from sales of investments - 48,060 34,144 23,892 51,096 55,944 66,370 Net cash used in investing activities $ (13,138) $ (16,126) $ (28,228) $ (88,220) $ (57,985) $ (3,202) $ (59,648) CASH FLOWS FROM FINANCING ACTIVTTIES: Debt financing costs - (3,561) Proceeds from issuance of debt 1, ,924 Repayment of Capital Lease (2,931) (2,778) (2,062) (1,915) (544) (114) Repayment of long-term debt (505) (169,779) (6,585) (6,220) (5,880) (5,505) (5,245) Net cash provided by (used in) financing activities $ (1,812) $ (20,194) $ (8,647) $ (8,135) $ (6,424) $ (5,619) $ (5,245) Net (decrease) increase in cash and cash equivalents $ 9,999 $ 18,155 $ 3,708 $ (22,819) $ 7,648 $ 13,919 $ (18,787) CASH AND CASH EQUIVALENTS, BEGINNING OF YEAR $ 36,074 $ 17,919 $ 14,211 $ 37,030 $ 29,382 $ 15,463 $ 34,250 CASH AND CASH EQUIVALENTS, END OF YEAR $ 46,073 $ 36,074 $ 17,919 $ 14,211 $ 37,030 $ 29,382 $ 15,463 SUPPLEMENTAL DISCLOSURE OF NON-CASH INVESTING AND FINANCING ACTIVITIES: Cash paid for interest, net of amounts capitalized of $0 in 2013 and $698,000 in 2012, was $6,221,000 in 2013 and $15,146,000 in NONCASH INVESTING AND FINANCING ACTIVITIES - Acquisition of equipment throught Note Payable or Accounts Payable was $5,013,000 in 2012 and $3,635,000 in nd Quarter_2013.xls Prepared by MSMC

11 10:32 AM Mount Sinai Medical Center of Florida, Inc. and Subsidiaries Ratios as of 06/30/13, ($000's) 8/13/2013 2nd Quarter RATIOS 2013 Audited Audited Audited Audited Audited Audited Liquidity: Cash & Investments $ 204,102 $ 195,401 $ 174,553 $ 163,285 $ 121,068 $ 71,623 $ 82,381 Patient AR doubtful allowance $ 46,766 $ 43,503 $ 36,089 $ 32,161 $ 25,407 $ 23,626 $ 20,153 Accumulated depreciation $ 239,363 $ 232,339 $ 255,800 $ 270,933 $ 283,493 $ 278,179 $ 268,723 Investment Income $ 615,806 $ 2,201,000 $ 1,947,000 $ 1,835,509 $ 2,030,589 $ 3,556,217 $ 5,835,246 Current (%) 343% 289% 232% 268% 261% 235% 251% Cash & investments to debt (%) 86.0% 83.1% 74.9% 63.2% 47.7% 27.5% 31.3% # days revenue in gross recievable # days revenue in net recievable # days expenses of cash on hand # days expenses in payables Net working capital $ 203,013 $ 176,460 $ 140,073 $ 144,539 $ 114,799 $ 88,545 $ 96,062 Leverage: Long Term Debt to Assets % 38.2% 39.3% 40.9% 44.2% 49.5% 53.9% 52.3% Long Term Debt to equity % 227% 268% 340% 298% 450% 788% 894% Long Term Debt to capitalization % 69% 73% 77% 75% 82% 89% 90% Long Term Debt to net plant % 141% 137% 148% 124% 132% 130% 139% Average age of plant Debt: Coverage (annual) (X) Cushion (annual) (X) Interest coverage (annual) (X) Debt service as % Operating Revenue 4.5% 5.1% 8.3% 4.8% 4.6% 4.7% 4.9% Profitability Operating margin (%) 5.7% 2.8% -3.6% 4.9% 2.6% -1.1% 0.2% EBIDA $ 37,528 $ 55,299 $ 20,395 $ 64,824 $ 53,928 $ 34,278 $ 41,254 EBIDA margin (%) 12.6% 9.8% 3.8% 12.2% 10.3% 6.9% 8.8% Return on assets (%) 5.4% 2.7% -3.4% 4.4% 2.7% -1.1% 0.2% Return on equity (%) 32.2% 18.3% -28.5% 29.8% 24.5% -16.3% 3.7% Operating ratio (%) 87.4% 90.2% 96.2% 87.8% 89.7% 93.1% 91.2% Operational Personnel Cost % Operating revenue 40.8% 40.5% 40.4% 39.0% 39.1% 41.2% 40.5% Supplies % Operating revenue 17.6% 16.1% 14.9% 14.7% 15.3% 16.8% 16.6% Bad debt % Patient Revenue 12.1% 12.6% 11.1% 10.4% 10.5% 8.6% 8.7% Cash Flow: Simple cash flow $ 32,065 $ 41,155 $ 4,295 $ 48,007 $ 36,617 $ 17,614 $ 24,078 Free cash flow $ 16,228 $ 28,402 $ 16,236 $ 49,596 $ 58,128 $ (7,856) $ 12,884 Simple cash flow to total liabilities $ 0.08 $ 0.10 $ 0.01 $ 0.12 $ 0.10 $ 0.05 $ 0.07 Free cash Flow to total liabilities $ 0.04 $ 0.07 $ 0.04 $ 0.12 $ 0.16 $ (0.02) $ nd Quarter_2013.xls Prepared by MSMC

12 MOUNT SINAI MEDICAL CENTER FOUNDATION, INC. Consolidated Statement of Activities and Changes in Net Assets 2nd Quarter nd Quarter 2nd Quarter $ % REVENUES: Pledges, cash gifts and other bequests, net of discounts $ 5,690,775 $ 6,601,160 $ (910,385) -13.8% Membership dues n.a. Interest, dividends and other 580, , , % Gains/(losses) on investment sales 267,883 32, ,615 n.a. TOTAL REVENUES 6,539,597 6,913,630 (374,033) -5.4% EXPENSES: Salaries & Wages & Benefits 883, ,793 22, % Administrative & General 431, ,165 65, % Provision for Bad Debt 454, ,183 (393,903) -46.4% Fund Raising Expenses 134, ,188 (37,447) -21.7% Other Operating Expenses 46,688 56,325 (9,637) -17.1% TOTAL EXPENSES 1,950,377 2,303,654 (353,277) -15.3% TRANSFERS TO THE MEDICAL CENTER $ 316,919 $ 337,918 $ (20,999) -6.2% EXCESS OF REVENUE OVER EXPENSES AFTER TRANSFERS $ 4,272,301 $ 4,272,058 $ % Net Assets $ 110,586,716 $ 106,701,549 $ 3,885, %

13 Mount Sinai Medical Center Bond Covenant - Days Cash on Hand Calculation 2nd Quarter 2013 FYE 2012 FYE 2011 FYE 2010 FYE 2009 FYE 2008 FYE 2007 Cash & Cash Equivalents & Unrestricted Funds Obligated Group 204, , , , ,068 71,623 82,381 Foundation 29,522 25,380 13,526 11,314 16,712 17,028 37,489 Less: Current Portion of Long-Term Debt (15,649) (14,922) (29,139) (8,663) (6,986) (6,650) (5,722) Divided by: 217, , , , ,794 82, ,148 Operating Expenses: Obligated Group 246, , , , , , ,335 Foundation 1,950 4,613 5,315 5,422 5,701 7,023 5,438 Less: Depreciation & Amortization (15,201) (25,078) (23,865) (22,111) (22,828) (22,985) (22,997) Bad Debt Expense: Obligated Group - - (56,962) (51,476) (50,347) (39,195) (37,519) Foundation (454) (1,732) (2,317) (2,258) (2,764) (3,316) (1,500) Adjusted Operating Expenses 233, , , , , , ,756 Number of Days in Period Average Expense per Day 1,288 1,257 1,325 1,192 1,204 1,212 1,134 Days Cash on Hand

14 MOUNT SINAI MEDICAL CENTER COMBINED GROUP LONG-TERM DEBT SERVICE COVERAGE RATIO - ANNUAL DEBT SERVICE Annualized For the period Ended 06/30/13 Total revenues $521,281,000 Less: Total expenses ($493,664,000) Net Gain/(Loss) 27,617,000 + Depreciation and amortization 30,402,000 + Interest expense on Long Term Debt 10,926,000 Income available before other items $ 68,945,000 Other items: - Foundation - Increase in net assets before change 8,544,600 in unrealized gain/losses on investment + Foundation Capital Contributions 0 + Contributions other than Foundation 635,240 Maximum Annual Debt Service Annual Debt Service INCOME AVAILABLE FOR DEBT SERVICE $ 78,124,840 $ 78,124,840 $ 78,124,840 Annual Debt Service Requirement 29,581,997 27,914,763 LONG-TERM DEBT SERVICE COVERAGE RATIO REQUIRED RATIO