3rd Quarter 2014 Mount Sinai Medical Center

Transcription

1 3rd Quarter 2014 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 free-standing emergency room in Aventura. Location: Miami Beach, Florida Issue: Third quarter 2014 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. The Mount Sinai Medical Center Foundation (the Foundation ) is a separate tax-exempt organization whose sole purpose is to support the activities of the hospital. Management Discussion During the third quarter of 2014, MSMC successfully completed the issuance of the Series 2014 Bonds, yielding approximately $11.2 million in overall savings on a net present value basis. The Series 2014 Bonds were issued to, along with other funding sources, (i) refund the outstanding principal of the Series 2004 Bonds and (ii) provide $110 million in new borrowing to construct a new, state of the art surgical tower and a replacement emergency department on the Miami Beach campus (the Project ). The Project will provide approximately 150 new private rooms, 12 modern operating suites, a new ICU and expand the emergency department from 16,700 to 37,000 square feet while improving the efficiency of support and ancillary services and maximizing the utilization of existing properties on MSMC s campus. Upon its completion in 2018, the Project will create a patient-centered healing environment that provides convenient access to the hospital for MSMC s patients and visitors and a supportive working environment for MSMC s physicians and staff while positioning MSMC for long-term success as a premier surgical destination center of excellence. For the third quarter ended September 30, 2014, MSMC s excess of revenues over expenses produced a net income of $2.4 million, which excludes a $4.5 million Loss on Extinguishment of Debt related to the required write-off of the cost of issuance and discount in connection with the refunding of the Series 2004 Bonds, as compared a net income of $11.4 million for the quarter ended September 30, 2013 and a budgeted net income of $3.0 million. The results through the third quarter of the prior year include approximately $8.0 million of material non-recurring items. Normalized for the above, MSMC, on a year-to-date basis, has produced a net income of $14.3 million in the current year as compared to $20.3 million in the prior year and $14.0 million as budgeted. Having risen over $18 million in the current year, the Foundation continues to show significant growth with Net Assets as of the current quarter of approximately $136.7 million compared to $112.3 million in the prior year. Net Revenue for the current quarter was $129.9 million compared to $126.5 million in the prior year and $127.3 million as budgeted, showing increases of 2.7% and 2.1% as compared to the prior year and budget, respectively. On a year-to-date basis, MSMC s Net Revenues were $393.7 million as compared to $390.2 million in the prior year and $393.3 million as budgeted, representing an increase of 0.9% as compared to the prior year and remaining flat as compared to budget. On a year-to-date basis, inclusive of observation admissions, which have increased by 15.9%, MSMC s total admissions have increased by 2.0% (+420) as compared to the prior year. MSMC has continued to benefit from an increase in emergency department visits (+5.2%), growth in outpatient surgical volume (+3.7%) and an increase in open heart surgical procedures performed (+4.3%). For the current quarter, MSMC incurred operational expenses of $132.0 million compared to $115.1 million in the prior year and $124.3 million as budgeted, showing increases of 14.7% and 6.2% compared to the prior year and budget, respectively. On a year-to-date basis, MSMC s operational expenses were $383.9 million for the current year compared to $361.9 million in the prior year and $379.3 million as budgeted, showing increases of 6.1% and 1.2% as compared to the prior year and budget, respectively. Exclusive of the Loss on Extinguishment of Debt noted above, MSMC s operating expenses increased by 4.8% as compared to the prior year and remains flat as compared to budget. MSMC experienced an increase in salaries and wages, driven by the impact of annual merit increases and an increase in insurance expense related to our professional and general liability insurance program. November 14, 2014 Page 1

2 3rd Quarter 2014 Mount Sinai Medical Center Consolidated Statement of Revenues and Expenses For the Quarter Ended September 30, 2014 (Amounts in 000 s) 2014 Q Q Q3 Budget Net Patient Service Revenue $123,447 $117,509 $5,938 $120,661 $2,786 Other Operating Revenues 4,994 8,010 (3,016) 5,320 (326) Net Assets Released from Restrictions 1,489 1, , Total Operating Revenues $129,930 $126,519 $3,411 $127,295 $2,635 Operating Expenses: Salaries and Benefits $64,159 $59,178 $4,981 $63,238 $921 Supplies 25,789 24,382 1,407 25,989 (200) Malpractice & Other Insurance 8,768 4,503 4,265 6,742 2,026 Interest Expense 2,984 2, ,174 (190) Depreciation & Amortization 6,335 5, , Other Expenses 19,472 18,054 1,418 18, Loss on Extinguishment of Debt 4,500-4,500-4,500 Total Operating Expenses $132,007 $115,085 $16,922 $124,294 $7,713 Net Income (Loss) $(2,077) $11,434 $(13,511) $3,001 $(5,078) Increase (Decrease) in Unrestricted Net Assets $(2,077) $11,434 $(13,511) $3,001 $(5,078) 2014 Q Q Q3 Budget Profitability Ratios (%) Operating Margin (1.4%) 8.0% (9.3%) 2.0% (3.4%) EBITDA Margin 4.8% 14.2% (9.4%) 8.4% (3.6%) Operational Ratios (%) Personnel Costs as % of Net Operating 42.8% 41.2% 1.6% 43.1% (0.3%) Revenue Supply Costs as % of Net Operating Revenue 17.2% 17.0% 0.2% 17.7% (0.5%) November 14, 2014 Page 2

3 3rd Quarter 2014 Mount Sinai Medical Center Consolidated Statement of Revenues and Expenses Y-T-D through September 30, 2014 (Amounts in 000 s) 2014 YTD 2013 YTD 2014 YTD Budget Net Patient Service Revenue $372,271 $363,545 $8,726 $373,713 $(1,442) Other Operating Revenues 17,022 23,070 (6,048) 15,623 1,399 Net Assets Released from Restrictions 4,361 3, , Total Operating Revenues $393,654 $390,214 $3,440 $393,279 $375 Operating Expenses: Salaries and Benefits $190,266 $180,531 $9,735 $191,092 $(826) Supplies 77,807 76,584 1,223 79,740 (1,933) Malpractice & Other Insurance 23,220 19,087 4,133 20,314 2,906 Interest Expense 8,382 8,441 (59) 9,521 (1,139) Depreciation & Amortization 20,723 21,191 (468) 20, Other Expenses 58,982 56,082 2,900 58, Loss on Extinguishment of Debt 4,500-4,500-4,500 Total Operating Expenses $383,880 $361,916 $21,964 $379,277 $4,603 Net Income (Loss) $9,774 $28,298 $(18,524) $14,002 $(4,228) Increase (Decrease) in Unrestricted Net Assets $9,774 $28,298 $(18,524) $14,002 $(4,228) 2014 YTD 2013 YTD 2014 YTD Budget Profitability Ratios (%) Operating Margin 2.2% 6.4% (4.2%) 3.1% (0.9%) EBITDA Margin 8.7% 13.1% (4.4%) 9.8% (1.0%) Operational Ratios (%) Personnel Costs as % of Net Operating 42.7% 40.9% 1.8% 42.8% (0.1%) Revenue Supply Costs as % of Net Operating Revenue 17.5% 17.4% 0.1% 17.9% (0.4%) November 14, 2014 Page 3

4 3rd Quarter 2014 Mount Sinai Medical Center Consolidated Balance Sheet (Amounts in 000 s) As of September 30, 2014 As of September 30, 2013 Current Assets $330,369 $306,312 Assets Limited as to Use 132,891 37,781 Assets held by Mount Sinai Medical Center 136, ,277 Foundation, Inc. Receivable for Insured Claims 23,716 21,697 Other Assets 7,638 6,386 Property, Plant and Equipment, Net 156, ,594 Total Assets $788,059 $648,048 Current Liabilities $94,009 $93,451 Other Liabilities 89,500 91,348 Long-Term Debt, Less Current Portion 325, ,685 Net Assets - Unrestricted 142, ,287 Net Assets Restricted 136, ,277 Total Liabilities and Net Assets $788,059 $648,048 Liquidity and Other Ratios Days Cash on Hand Days in Accounts Receivable Cushion Ratio (x) Payment Period (Days) Unrestricted Cash / Long Term Debt (%) 76.7% 96.7% Maximum Annual Debt Service Coverage Ratio (x) Combined Group (1) Days Cash on Hand Unrestricted Cash / Long Term Debt (%) 88.8% 110.6% 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 November 14, 2014 Page 4

5 3rd Quarter 2014 Mount Sinai Medical Center Consolidated Statements of Changes in Net Assets (Amounts in 000 s) YTD as of September 30, 2014 YTD as of September 30, 2013 UNRESTRICTED NET ASSETS (Deficiency) Excess Revenues over Expenses $9,774 $28,298 Net Assets Released from Restrictions 3, Extraordinary loss on bond defeasance - - Net change in unrealized gains on investments - - Increase (decrease) in unrestricted net assets $12,965 $28,671 TEMPORARILY RESTRICTED NET ASSETS Temporarily restricted grants and contributions $7,539 $3,972 Change in beneficial interest in net assets of Mount Sinai 15,290 5,576 Medical Center Foundation, Inc. Net Assets Released from Restrictions $(7,539) (3,972) Increase (decrease) in restricted net assets $15,290 $5,576 INCREASE/(DECREASE) IN NET ASSETS $28,255 $34,246 NET ASSETS, BEGINNING OF YEAR $251,267 $194,318 ASSETS, END OF YEAR $279,521 $228,564 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 upgrades MSMC s rating from Baa2 to Baa1 with a Stable outlook. November 14, 2014 Page 5

6 MOUNT SINAI MEDICAL CENTER QUARTER UTILIZATION STATISTICS 3rd Quarter rd Quarter 2013 % Var Inpatient Licensed Beds % Staffed Beds for Immediate Use % Percent Occupancy of Staffed Beds 62.2% 61.5% 1.2% Patient Days 34,060 33, % Admissions 5,614 5, % Average Length of Stay % Outpatient Visits Emergency Room 16,806 15, % Ambulatory Surgery 1,630 1, % Observation Visits 1, % Selected Ancillary Departments Cardiac Catheterizations % IP Surgical Procedures 1,400 1, % Open Heart Surgeries % Cardiac Angioplasties % Laboratory Tests 260, , % MRI Scans 2,322 2, % Live Births %

7 MOUNT SINAI MEDICAL CENTER YTD UTILIZATION STATISTICS YTD 2014 YTD 2013 % Var FYE 2013 FYE 2012 FYE 2011 FYE 2010 FYE 2010 FYE 2009 FYE 2008 FYE 2007 Inpatient Licensed Beds % Staffed Beds for Immediate Use % Percent Occupancy of Staffed Beds 61.0% 61.3% -0.6% 60.8% 59.5% 54.6% 55.6% 55.6% 54.4% 51.6% 52.2% Patient Days 101, , % 136, , , , , , , ,472 Admissions 17,051 17, % 22,742 22,126 22,926 22,898 22,898 21,682 22,439 22,240 Average Length of Stay % Outpatient Visits Emergency Room 51,360 48, % 64,820 63,205 60,114 58,343 58,343 56,219 51,092 43,685 Ambulatory Surgery 4,998 4, % 6,354 6,177 5,955 6,064 6,064 6,389 6,392 6,555 Observation Visits 4,027 3, % 4,539 4,894 4,176 4,573 4,573 4,628 4,167 2,824 Selected Ancillary Departments Cardiac Catheterizations 2,259 2, % 3,228 3,131 2,928 2,749 2,749 2,457 2,719 2,801 IP Surgical Procedures 4,265 4, % 5,903 5,661 5,935 5,692 5,692 5,814 6,088 6,171 Open Heart Surgeries % Cardiac Angioplasties % 1,186 1,261 1,117 1,134 1, Laboratory Tests 792, , % 1,067,209 1,045,369 1,062,887 1,108,794 1,108,794 1,139,137 1,082,023 1,050,640 MRI Scans 6,952 6, % 9,128 9,112 7,801 7,286 7,286 8,003 6,938 6,529 Live Births 2,078 1, % 2,710 2,786 2,748 2,583 2,583 1,924 1,972 1,906 Year to Date Payor Mix YTD 2014 FYE 2013 FYE 2012 FYE 2011 FYE Var Medicare 35.4% 34.5% 35.0% 36.7% 39.3% 0.9% Medicaid 9.3% 11.1% 12.0% 12.1% 11.7% -1.8% Managed Care / Commercial 44.4% 44.7% 43.9% 43.4% 42.1% -0.3% Self Pay 10.9% 9.7% 9.1% 7.8% 6.9% 1.2%

8 4:05 PM Mount Sinai Medical Center of Florida, Inc. and Subsidiaries BS as of 09/30/14, ($000's) 11/13/ Unaudited Audited Audited Audited Audited Audited Audited ASSETS: CURRENT ASSETS: Cash and cash equivalents 103,193 92,817 $ 36,074 $ 17,919 $ 14,211 $ 37,030 $ 29,382 Temporary investments 146, , , , ,074 84,038 42,241 Patient accounts receivable, net 67,183 67,732 60,045 61,160 56,401 51,971 56,685 Other receivables, net 1,385 1,333 2,669 1,225 3,352 3,802 6,816 Estimated third-party payor settlements ,289 Inventories 8,418 7,830 8,352 6,460 5,358 6,734 6,725 Prepaid and other expenses 4,113 4,018 3,534 2,476 2,272 2,374 3,086 Total current assets $ 330,369 $ 327,169 $ 270,001 $ 245,874 $ 230,668 $ 185,949 $ 154,224 ASSET'S WHOSE USE IS LIMITED: Funds held by trustee 127,575 22,122 22,128 27,276 27,539 28,042 28,544 Self-insurance trust fund 436 2, ,844 2,457 5,825 Other investments 4,880 4,885 4,884 4,973 6,935 6,935 2,645 Total assets whose use is limited $ 132,891 $ 29,658 $ 27,197 $ 32,342 $ 36,318 $ 37,434 $ 37,014 Beneficial interest in Mount Sinai Medical Center 136, , ,702 92,144 87,721 89,261 82,721 PP&E, net 156, , , , , , ,610 Assets Held for Sale , Receivable for Insured Claim 23,716 19,318 17,139 16,426 13, Other Assets 7,638 6,026 6,194 6,433 6,937 7,745 9,540 TOTAL ASSETS $ 788,059 $ 666,095 $ 598,604 $ 570,270 $ 583,918 $ 512,885 $ 483,109 LIABILITIES AND NET ASSETS CURRENT LIABILITIES: Accounts payable and accrued expenses 25,614 27,683 33,181 31,901 32,133 26,371 29,561 Accrued wages, salaries and benefits 22,451 26,786 24,742 22,825 21,716 21,712 17,878 Indigent care assessment, current portion 4,526 4,375 4,377 4,282 3,977 3,997 3,953 Other current liabilities 14,282 9,247 6,710 5,334 7,021 4,368 5,341 Due to third party payors 15,828 17,478 8,570 9,700 10,984 6,028 - Current portion of long-term debt 11,309 15,979 14,922 29,139 8,663 6,986 6,650 Due to Salick - 1,376 1,039 2,620 1,635 1,688 2,296 Total current liabilities $ 94,010 $ 102,924 $ 93,541 $ 105,801 $ 86,129 $ 71,150 $ 65,679 LTD, net of current portion 325, , , , , , ,321 Indigent Care assesment, net current portion 3,022 3,030 2,777 2,820 2,815 2,623 2,597 Other Long Term liabilities ,188 1, Reserve for self insured claims 86,048 83,799 72,462 66,604 60,475 39,060 38,213 Total liabilities $ 508,537 $ 414,827 $ 404,285 $ 409,546 $ 409,385 $ 367,290 $ 367,352 NET ASSETS: Unrestricted 142, ,904 87,617 68,580 86,812 56,334 33,036 Temporarily restricted 131, , ,032 86,474 82,051 83,591 77,119 Permanently restricted 5,290 5,290 5,670 5,670 5,670 5,670 5,602 Total net assets $ 279,522 $ 251,268 $ 194,319 $ 160,724 $ 174,533 $ 145,595 $ 115,757 TOTAL $ 788,059 $ 666,095 $ 598,604 $ 570,270 $ 583,918 $ 512,885 $ 483,109 3rd Quarter_2014 (2) Prepared by MSMC

9 4:05 PM Mount Sinai Medical Center of Florida, Inc. and Subsidiaries OPS as of 09/30/14, ($000's) 11/13/ rd Quarter Unaudited Audited Audited Audited Audited Audited Audited UNRESTRICTED REVENUES AND OTHER SUPPORT: Net patient service revenue $ 423,772 $ 555,360 $ 536,444 $ 514,935 $ 495,827 $ 478,849 $ 454,258 Other revenue 17,022 27,668 23,339 20,128 18,951 20,168 22,620 Contribution from Foundation ,500 10,000 10,000 10,000 Provision for doubtful accounts (51,501) (66,250) (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 4,361 2,224 2,964 3,700 5,316 13,598 9,149 Total unrestricted revenues and other support $ 393,654 $ 519,651 $ 497,120 $ 484,948 $ 531,321 $ 523,509 $ 496,870 EXPENSES: Wages, salaries and benefits 190, , , , , , ,506 Supplies 77, ,496 90,682 80,635 78,361 80,037 83,429 Malpractice & other insurance, net 23,220 23,413 23,610 17,048 25,548 21,013 18,239 Administrative and general 54,818 67,995 63,953 56,911 54,067 61,458 67,015 Provision for doubtful accounts ,476 50,347 39,195 Depreciation and amortization 20,723 26,629 25,078 23,865 22,111 22,828 22,985 Interest expense 8,382 11,103 14,144 16,100 16,817 17,311 16,664 Indigent care assessment 4,164 5,562 5,125 4,887 4,719 4,490 4,632 Management fees ,145 50,918 45,153 47,698 45,576 Loss on Extinguishment of Debt 4,500-6, Impairment of Long Lived Asset , Other operating expenses Total expenses $ 383,880 $ 477,977 $ 481,043 $ 504,518 $ 505,425 $ 509,720 $ 502,241 INC / (DEFICIENCY) OF REVS. OVER EXPS. $ 9,774 $ 41,674 $ 16,077 $ (19,570) $ 25,896 $ 13,789 $ (5,371) UNRESTRICTED NET ASSETS: Deficiency of revenues over expenses 9,774 41,674 16,077 (19,570) 25,896 13,789 (5,371) Foundation transfer Contributions from the Mount Sinai Medical Center Foundation, Inc.for CAPEX ,850 Net assets released from temporary restrictions used for capital purposes 3, ,946 1,338 3,908 8,790 6,135 Equity transfer Net unrealized gains or (losses) on investments Extraordinary loss on bond defeasance Increase / (Decrease) in unrestricted net assets $ 12,964 $ 42,286 $ 19,037 $ (18,232) $ 30,478 $ 23,298 $ 3,614 TEMPORARILY RESTRICTED NET ASSETS: Temporarily restricted giants and contributions 7,539 3,485 6,477 5,685 10,451 23,213 16,055 Equity transfer Net assets released from restrictions (7,539) (3,485) (6,477) (5,685) (10,451) (23,213) (16,055) Change in beneficial interest in net assets of Mount Sinai Medical Center Foundation, 15,290 15,042 14,558 4,423 (1,540) 6,472 (21,640) Inc. Increase / (Decrease) in temp. rest. net assets $ 15,290 $ 15,042 $ 14,558 $ 4,423 $ (1,540) $ 6,472 $ (21,640) PERMANENTLY RESTRICTED NET ASSETS: Change in beneficial interest in net assets of Mount Sinai Medical Center Foundation, - (380) Inc. Increase (decrease) in permanently restricted net assets - (380) INCREASE / (DECREASE) IN NET ASSETS $ 28,254 $ 56,948 $ 33,595 $ (13,809) $ 28,938 $ 29,838 $ (18,026) NET ASSETS, BEGINNING OF YEAR $ 251,267 $ 194,319 $ 160,724 $ 174,533 $ 145,595 $ 115,757 $ 133,783 NET ASSETS, END OF YEAR $ 279,521 $ 251,267 $ 194,319 $ 160,724 $ 174,533 $ 145,595 $ 115,757 3rd Quarter_2014 (2) Prepared by MSMC

10 4:05 PM Mount Sinai Medical Center of Florida, Inc. and Subsidiaries CashFlows as of 09/30/14, ($000's) 11/13/ rd Quarter CASH FLOWS FROM OPERATING ACTIVITIES: Unaudited Audited Audited Audited Audited Audited Audited Increase (decrease) in net assets $ 28,254 $ 56,948 $ 33,595 $ (13,809) $ 28,938 $ 29,838 $ (18,026) Adj. to rec.chg. in net assets to net cash provided by operating activities: Depreciation and amortization 20,973 27,031 25,383 24,117 22,363 23,080 22,985 Provision for doubtful accounts 51,502 66,250 67,575 56,962 51,476 50,347 39,195 (Gain) loss on disposal of PP&E (56) (29) Loss on Extinguishment of Bond / Amortization of Bond (682) (923) Gain on Sale of Business / Loss on impairment of Assets 4,500-6,686 35, Inherent Contribution/Insurance proceeds used for Capital Expenditures - - (1,381) Change in beneficial interest in Mount Sinai Medcial Center Foundation (15,290) (14,662) (14,558) (4,423) 1,540 (6,540) 21,640 Change in net unrealized losses (gains) on invest (61) (294) Increase in accounts receivable (50,954) (73,937) (66,460) (61,721) (55,906) (45,633) (38,267) (Increase) Decrease in other receivables (52) 1,336 (1,445) 2, ,014 (5,942) (Increase) Decrease in estimated third-party settlements (1,650) 8,908 (1,130) (1,284) 4,956 15,317 (421) Increase in inventories (588) 522 (72) (1,102) 1,376 (9) 522 Decrease (Increase) in prepaid expenses (93) 260 (960) (252) (365) Decrease in other assets (56) (644) (657) , (Decrease) Increase in due to Comprehensive Cancer Center (1,376) 337 (1,755) 985 (53) (608) 116 Increase (Decrease) in AP and accrued expenses (2,643) (4,885) 1, ,581 (3,552) 389 Increase (Decrease) in accrued wages, salaries and benefits (4,336) 2,044 1,917 1, ,834 1,505 Increase in indigent care assessment Increase in other current liabilities 5,035 2,537 1,233 (1,687) 2,653 (973) 265 Increase in Receivable for insured claims (4,398) (2,179) (713) (2,790) (13,636) - - Increase in other long-term liabilities (547) 659 (869) (505) (638) (Decrease) Increase in reserve for self-insured claims 2,249 11,337 5,858 6,129 21, (766) Net cash generated (used) in operating activities $ 29,930 $ 82,087 $ 54,475 $ 40,583 $ 73,536 $ 72,057 $ 22,740 CASH FLOWS FROM INVESTING ACTIVITIES: Purchases of PP&E (16,307) (14,255) (26,073) (24,347) (23,940) (13,929) (30,596) Proceeds from the sale of PP&E /Insurance proceeds used for Capital , (1,500) 20 Acquitions of Cancer Center/Proceeds from sales of Business, net - - (11,656) Purchases of investments (95,812) (127,280) (104,089) (157,392) (151,053) (102,842) (95,086) Proceeds from sales and maturities of temp. invest , , ,874 86,053 60, ,105 Assets whose use is limited: Purchases of investments - (29,151) (42,929) (30,507) (23,172) (51,559) (53,589) Proceeds from sales of investments - 26,659 48,060 34,144 23,892 51,096 55,944 Net cash used in investing activities $ (112,119) $ (11,586) $ (16,126) $ (28,228) $ (88,220) $ (57,985) $ (3,202) CASH FLOWS FROM FINANCING ACTIVTTIES: Debt financing costs (3,430) - (3,561) Proceeds from issuance of debt 181,734 6, ,924 Repayment of Capital Lease (4,854) (10,485) (2,778) (2,062) (1,915) (544) (114) Repayment of long-term debt (80,886) (10,218) (169,779) (6,585) (6,220) (5,880) (5,505) Net cash provided by (used in) financing activities $ 92,564 $ (13,759) $ (20,194) $ (8,647) $ (8,135) $ (6,424) $ (5,619) Net (decrease) increase in cash and cash equivalents $ 10,376 $ 56,743 $ 18,155 $ 3,708 $ (22,819) $ 7,648 $ 13,919 CASH AND CASH EQUIVALENTS, BEGINNING OF YEAR $ 92,817 $ 36,074 $ 17,919 $ 14,211 $ 37,030 $ 29,382 $ 15,463 CASH AND CASH EQUIVALENTS, END OF YEAR $ 103,193 $ 92,817 $ 36,074 $ 17,919 $ 14,211 $ 37,030 $ 29,382 SUPPLEMENTAL DISCLOSURE OF NON-CASH INVESTING AND FINANCING ACTIVITIES: Cash paid for interest, net of amounts capitalized of $228,000 in 2013 and $698,000 in 2012, was $12,346,000 in 2013 and $15,146,000 in NONCASH INVESTING AND FINANCING ACTIVITIES - Acquisition of equipment throught Note Payable or Accounts Payable was $548,000 in 2014, $6,376,000 in 2013 and $5,013,000 in rd Quarter_2014 (2) Prepared by MSMC

11 4:05 PM Mount Sinai Medical Center of Florida, Inc. and Subsidiaries Ratios as of 09/30/14, ($000's) 11/13/ rd Quarter RATIOS Unaudited Audited Audited Audited Audited Audited Audited Liquidity: Cash & Investments $ 249,270 $ 246,256 $ 195,401 $ 174,553 $ 163,285 $ 121,068 $ 71,623 Patient AR doubtful allowance $ 43,345 $ 44,971 $ 43,503 $ 36,089 $ 32,161 $ 25,407 $ 23,626 Accumulated depreciation $ 257,919 $ 242,953 $ 232,339 $ 255,800 $ 270,933 $ 283,493 $ 278,179 Investment Income $ 1,197,618 $ 1,386,720 $ 2,201,000 $ 1,947,000 $ 1,835,509 $ 2,030,589 $ 3,556,217 Current (%) 351% 318% 289% 232% 268% 261% 235% Cash & investments to debt (%) 76.7% 109.9% 83.1% 74.9% 63.2% 47.7% 27.5% # days revenue in gross recievable # days revenue in net recievable # days expenses of cash on hand # days expenses in payables Net working capital $ 236,359 $ 224,245 $ 176,460 $ 140,073 $ 144,539 $ 114,799 $ 88,545 Leverage: Long Term Debt to Assets % 41.2% 33.6% 39.3% 40.9% 44.2% 49.5% 53.9% Long Term Debt to equity % 228% 173% 268% 340% 298% 450% 788% Long Term Debt to capitalization % 69% 63% 73% 77% 75% 82% 89% Long Term Debt to net plant % 207% 138% 137% 148% 124% 132% 130% Average age of plant Debt: Coverage (annual) (X) Cushion (annual) (X) Interest coverage (annual) (X) Debt service as % Operating Revenue 3.8% 4.6% 5.1% 8.3% 4.8% 4.6% 4.7% Profitability Operating margin (%) 2.2% 7.1% 2.8% -3.6% 4.9% 2.6% -1.1% EBIDA $ 38,879 $ 79,406 $ 55,299 $ 20,395 $ 64,824 $ 53,928 $ 34,278 EBIDA margin (%) 8.7% 13.6% 9.8% 3.8% 12.2% 10.3% 6.9% Return on assets (%) 1.7% 6.3% 2.7% -3.4% 4.4% 2.7% -1.1% Return on equity (%) 9.1% 32.1% 18.3% -28.5% 29.8% 24.5% -16.3% Operating ratio (%) 91.3% 86.4% 90.2% 96.2% 87.8% 89.7% 93.1% Operational Personnel Cost % Operating revenue 42.7% 41.4% 40.5% 40.4% 39.0% 39.1% 41.2% Supplies % Operating revenue 17.5% 17.2% 16.1% 14.9% 14.7% 15.3% 16.8% Bad debt % Patient Revenue 12.2% 11.9% 12.6% 11.1% 10.4% 10.5% 8.6% Cash Flow: Simple cash flow $ 30,497 $ 68,303 $ 41,155 $ 4,295 $ 48,007 $ 36,617 $ 17,614 Free cash flow $ 13,623 $ 67,832 $ 28,402 $ 16,236 $ 49,596 $ 58,128 $ (7,856) Simple cash flow to total liabilities $ 0.06 $ 0.16 $ 0.10 $ 0.01 $ 0.12 $ 0.10 $ 0.05 Free cash Flow to total liabilities $ 0.03 $ 0.16 $ 0.07 $ 0.04 $ 0.12 $ 0.16 $ (0.02) 3rd Quarter_2014 (2) Prepared by MSMC

12 MOUNT SINAI MEDICAL CENTER FOUNDATION, INC. Consolidated Statement of Activities / Changes in Net Assets and Balance Sheet Through 3rd Quarter 2014 (Amounts in 000s) INCOME STATEMENT 2014 YTD Unaudited Audited Audited Audited Audited Audited Audited Audited REVENUES Pledges, cash gifts and other bequests, net of discounts $ 18,132 $ 16,539 $ 16,463 $ 13,556 $ 13,559 $ 15,773 $ 10,526 $ 16,164 Interest, dividends and other 175 2,949 3,289 (670) 2,224 8,081 (11,449) 5,683 TOTAL REVENUES $ 18,307 $ 19,488 $ 19,752 $ 12,886 $ 15,783 $ 23,854 $ (923) $ 21,847 EXPENSES: Operating Expenses 3,706 4,177 4,613 5,315 5,422 5,701 7,024 5,498 Transfers to the Medical Center ,148 11,901 11,613 13,693 10,948 TOTAL EXPENSES $ 4,270 $ 4,826 $ 5,194 $ 8,463 $ 17,323 $ 17,314 $ 20,717 $ 16,446 EXCESS/(DEFICIENCY) OF REVENUE OVER EXPENSES $ 14,037 $ 14,662 $ 14,558 $ 4,423 $ (1,540) $ 6,540 $ (21,640) $ 5,401 NET ASSETS $ 136,654 $ 121,364 $ 106,702 $ 92,144 $ 87,721 $ 89,261 $ 82,721 $ 104,361 BALANCE SHEET 2014 YTD Unaudited Audited Audited Audited Audited Audited Audited Audited ASSETS Cash and Investments $ 69,905 $ 65,230 $ 55,419 $ 45,246 $ 45,502 $ 50,813 $ 47,736 $ 67,043 Other Assets 67,237 56,761 51,981 47,554 42,988 39,134 35,764 38,161 TOTAL ASSETS $ 137,142 $ 121,991 $ 107,400 $ 92,800 $ 88,490 $ 89,947 $ 83,500 $ 105,204 TOTAL LIABILITIES $ 488 $ 627 $ 698 $ 656 $ 769 $ 686 $ 779 $ 843 TOTAL NET ASSETS $ 136,654 $ 121,364 $ 106,702 $ 92,144 $ 87,721 $ 89,261 $ 82,721 $ 104,361 TOTAL LIABILITIES AND NET ASSETS $ 137,142 $ 121,991 $ 107,400 $ 92,800 $ 88,490 $ 89,947 $ 83,500 $ 105,204

13 Mount Sinai Medical Center Bond Covenant - Days Cash on Hand Calculation 3rd Quarter 2014 FYE 2013 FYE 2012 FYE 2011 FYE 2010 FYE 2009 FYE 2008 FYE 2007 Cash & Cash Equivalents & Unrestricted Funds Obligated Group 249, , , , , ,068 71,623 82,381 Foundation 39,304 35,363 25,380 13,526 11,314 16,712 17,028 37,489 Less: Current Portion of Long-Term Debt (11,309) (15,979) (14,922) (29,139) (8,663) (6,986) (6,650) (5,722) $ 277,265 $ 265,640 $ 205,859 $ 158,940 $ 165,936 $ 130,794 $ 82,001 $ 114,148 Divided by: Operating Expenses: Obligated Group 383, , , , , , , ,335 Foundation 3,706 4,177 4,613 5,315 5,422 5,701 7,023 5,438 Less: Depreciation & Amortization (20,723) (26,629) (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 (1,446) (974) (1,732) (2,317) (2,258) (2,764) (3,316) (1,500) Adjusted Operating Expenses $ 365,417 $ 454,551 $ 458,846 $ 483,652 $ 435,002 $ 439,482 $ 443,768 $ 413,756 Number of Days in Period Average Expense per Day 1,339 1,245 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 09/30/14 Total revenues $524,301,423 Less: Total expenses ($511,840,000) Net Gain/(Loss) 12,461,423 + Depreciation and amortization 27,630,667 + Loss on Extinguishment of Debt 4,500,000 + Interest expense on Long Term Debt 11,176,000 Income available before other items $ 55,768,090 Other items: - Foundation - Increase in net assets before change 18,715,767 in unrealized gain/losses on investment + Foundation Capital Contributions 0 + Contributions other than Foundation 4,237,364 Maximum Annual Debt Service Annual Debt Service INCOME AVAILABLE FOR DEBT SERVICE $ 78,721,221 $ 78,721,221 $ 78,721,221 Annual Debt Service Requirement 28,155,265 28,155,265 LONG-TERM DEBT SERVICE COVERAGE RATIO REQUIRED RATIO