Inspira Health, NJ - Quarterly Report
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1 Inspira Health, NJ - Quarterly Report 1 New Jersey Health Care Facilities Financing Authority, Revenue Bonds, Inspira Health Obligated Group Issue, Series 2017A, $265,000,000, Dated: August 17, New Jersey Health Care Facilities Financing Authority, Refunding Bonds, Inspira Health Obligated Group Issue, Series 2016A, $177,765,000, Dated: June 30, 2016 Series 2017A, 2016A Unaudited Financial Statements of the Obligated Group Please see attached.
2 Series 2017A, 2016A Patient Utilization IMC & IMC Woodbury Utilization Statistics Licensed Beds: Med/ Surg 515 ICU/ CCU 57 OB/ GYN 47 Pediatric 24 Special Care Nursery 8 NICU 6 Total Licensed Beds: 657 Maintained Beds: Med/ Surg 455 ICU/ CCU 45 OB/ GYN 47 Pediatric 24 Special Care Nursery 8 NICU 6 Total Maintained Beds: 585 Admissions: Med/ Surg 15,274 ICU/ CCU 2,849 OB/ GYN 2,325 Pediatric 234 Special Care Nursery 46 NICU 180 Total Admissions: 20,908 Patient Days: Med/ Surg 71,035 ICU/ CCU 10,913 OB/ GYN 6,169 Pediatric 666 Special Care Nursery 1,869 NICU 1,469 Total Patient Days: 92,121 Occupancy % (Licensed Beds): Med/ Surg 50.52% ICU/ CCU 70.13% OB/ GYN 48.08% Pediatric 10.16% Special Care Nursery 85.58% NICU 89.68% Total Occupancy %: 51.36% Average Length of Stay (ALOS): Med/ Surg 4.65 ICU/ CCU 3.83 OB/ GYN 2.65 Pediatric 2.85 Special Care Nursery NICU 8.16 Total ALOS: 4.41 Outpatient Statistics: Emergency Room Visits 106,091 Outpatient Surgery 12,270 Physical Therapy Visits 114,641 Radiology Procedures 199,442 Nuclear Medicine 2,866 Laboratory Tests 670,975
3 Utilization Statistics - Psychiatric Services Licensed Beds: Adult 53 Child 14 Intermediate (Child) 12 Total Licensed Beds: 79 Maintained Beds: Adult 53 Child 14 Intermediate (Child) 12 Total Maintained Beds: 79 Admissions: Adult 1,405 Child 372 Intermediate (Child) 39 Total Admissions: 1,816 Patient Days: Adult 10,348 Child 1,909 Intermediate (Child) 2,076 Total Patient Days: 14,333 Occupancy % (Licensed Beds): Adult 71.52% Child 49.95% Intermediate (Child) 63.37% Total Occupancy %: 66.46% ALOS: Adult 7.37 Child 5.13 Intermediate (Child) Total ALOS: 7.89 Series 2017A, 2016A Financial Information- Combined Financial Statements of IMC and IMC Woodbury Revenue: Net patient service revenue $488,675,258 Other $18,685,760 Total revenue $507,361,018 Expenses: Salaries and wages $199,109,859 Employee benefits $62,725,267 Physician fees $22,323,638 Supplies and other expenses $134,568,754 Interest $5,417,279 Depreciation and Amortization $32,626,231 Total expenses $456,771,028 Operating income before other items $50,589,990 Other: Non-operating gains, net, primarily investment returns $24,179,452 Change in unrealized gains/(losses) from investments $9,006,951 Excess of revenue and gains over expenses $83,776,393
4 Series 2017A, 2016A Management's Discussion of Financial Performance As of September 30, 2017, the Obligated Group accounted for approximately 94% of total assets and approximately 90% of total revenues of the Network. The Obligated Group also accounted for over 100% of Inspira s consolidated operating income. This is due to there being an aggregate operating loss relative to entities outside of the Inspira Obligated Group. The primary component of these losses is attributable to the IMG physician practices. The Inspira Obligated Group supports the losses occurring outside of the Inspira Obligated Group via equity transfers. Transfer of asset tests are performed pursuant to the Master Trust Indenture relative to these transfers. The Obligated Group had income from operations of $50,590,000, through the nine months ended September 30, 2017, a $4,229,000 or 9% increase compared to the nine months ended September 30, This change is primarily due to improved payer contracts, patient acuity and increased volumes in key areas in As of September 30, 2017, salaries and wages were 41% of net patient service revenue, compared to 40% through September 30, Supplies and other expenses remained consistent at 28% of net patient service revenue for the nine months ended September 30, 2016 and the nine months ended September 30, Series 2017A, 2016A Outstanding Indebtedness Amount Description $132,240,000 IMC 2016a Bond ($1,110,100) IMC 2016a Bond Cost of Issuance - amortized over the life $14,663,122 IMC 2016a Bond Premium - amortized over bond life $39,184,800 IMC 2017 Bond ($262,239) IMC 2017 Bond Cost of Issuance - amortized over the life $2,662,021 IMC 2017 Bond Premium - amortized over bond life $3,254,754 IMC 2010 UEZ Debt - Paid off in 2030 $192,231 IMC EDA Revolving Loan - Paid off in 2020 $44,123 IMC Capital Lease - Respiratory Equipment ($27,120) IMC 2010 UEZ Bond Cost of Issuance - amortized over the life $38,945,000 IMCW 2016a Bond ($295,789) IMCW 2016a Bond Cost of Issuance - amortized over the life $5,705,688 IMCW 2016a Bond Premium - amortized over bond life $285,815,200 IMCW 2017 Bond ($1,964,314) IMCW 2017 Bond Cost of Issuance - amortized over the life $19,524,442 IMCW 2017 Bond Premium - amortized over bond life $16,312 IMCW Capital Lease - Respiratory Equipment $538,588,131 Total debt Series 2017A, 2016A Payor Mix Payer Medicare 39.0% Medicare Managed Care 7.9% Medicaid 6.9% Medicaid Managed Care 16.4% Other Government Plans 0.4% Managed Care 20.6% Charity 2.7% Self Pay 3.3% Commercial 2.9% Total 100.0%
5 MONTHLY STATISTICAL SUMMARY Prior YTD YEAR - TO - DATE OUTPATIENT SERVICES Actual Actual Budget Variance Outpatient Surgeries 12,012 12,270 11, Laboratory Tests 661, , ,119 14,856 Physical Therapy 104, , ,912 12,729 Dialysis Treatments 10, Diagnostic Radiology 193, , ,603 (2,466) MRI Procedures 9,911 10,171 10,509 (338) Ground Transport MICU 10,151 9,429 10,495 (1,066) Cardiac Cath Lab (15) Cardiac Cath Lab PCI Therapeutic Radiology - HDR Therapeutic Radiology - IMRT/Megavolt 5,783 6,309 5, Therapeutic Radiology - General 6,152 6,364 5, Emergency Room 108, , ,345 (5,254) TOTAL OUTPATIENT SERVICES 1,123,649 1,129,801 1,109,005 20,796 OBSERVATIONS 4,031 3,476 3,530 (54) NEW INPATIENT CASES Admissions - Adult & Pediatric 20,732 20,682 20,718 (36) Special Care Nursery & NICU Transitional Care Unit Subtotal 20,935 20,908 20, Mental Health 1,923 1,816 1,971 (155) TOTAL NEW INPATIENT CASES 22,858 22,724 22,865 (141) BIRTHS 2,263 2,236 2,250 (14) PATIENT DAYS Adults & Pediatrics 85,946 88,783 86,154 2,629 Special Care Nursery & NICU 3,229 3,338 3, Transitional Care Unit Subtotal 89,175 92,121 89,372 2,749 Mental Health 13,563 14,333 13, TOTAL PATIENT DAYS 102, , ,284 3,170
6 MONTHLY STATISTICAL SUMMARY Prior YTD YEAR - TO - DATE AVERAGE DAILY CENSUS Adults & Pediatrics Special Care Nursery & NICU Transitional Care Unit Subtotal Mental Health TOTAL AVERAGE DAILY CENSUS AVERAGE LENGTH OF STAY Adults & Pediatrics (0.1) Special Care Nursery & NICU Transitional Care Unit Subtotal (0.1) Mental Health (0.8) TOTAL AVERAGE LENGTH OF STAY (0.2) TOTAL OCCUPANCY 65.8% 68.5% 66.4% 2.0%
7 BALANCE SHEET ASSETS LIABILITIES & NET ASSETS August September December August September December CURRENT ASSETS: CURRENT LIABILITIES: Cash & Cash Equivalents $114,081,299 $103,675,394 $166,652,347 Current Portion of Debt $8,539,564 $8,540,400 $6,828,311 Assets Limited as to Use 9,762,338 11,422,023 7,436,125 Accounts Payable 11,455,001 13,186,438 9,320,150 Patient Service Receivables, Net 68,531,094 66,102,269 67,867,338 Accrued Expenses 62,819,467 65,894,655 61,746,521 Accrued Payroll 17,760,235 7,441,769 12,811,503 Due from Affiliates, Net 49,273,203 51,451,780 43,757,924 Accrued Pension 42,026 42, ,299 Inventory 5,931,886 5,979,672 5,892,156 Deferred Support 6,542,998 6,550,402 5,810,603 Other Current Assets 15,776,024 15,095,214 16,740,973 Accrued Interest Payable 3,273,872 5,166,746 4,859,374 Other Current Assets - TKC Receivable 0 0 2,394,060 Estimated Third Party Payables 58,979,871 58,276,453 50,436,197 Other Current Liablity - Cooper Bone & Joint Receivables Other Current Assets - Cooper Bone & Joint Receivables (200) (5,673) 552,542 Accrued Vacation/ PTO 20,379,205 17,965,268 17,800,101 TOTAL CURRENT ASSETS 263,355, ,720, ,293,465 TOTAL CURRENT LIABILITIES 189,792, ,064, ,796,059 LONG TERM ASSETS LIMITED AS TO USE: ACCRUED RETIREMENT BENEFITS 5,152,973 4,492,098 6,866,176 By Board of Directors 533,763, ,188, ,644,208 INTEREST RATE SWAPS 9,267,649 8,747,729 9,149,781 Interest Rate Swaps 9,267,649 8,747,729 9,149,781 OTHER LIABILITIES 55,541,276 55,267,337 59,894,143 Debt Service Reserve LONG-TERM DEBT 530,374, ,047, ,448,203 Under Bond Indenture Agreement 312,362, ,134,285 0 PROPERTY, PLANT, & EQUIPMENT, NET 371,489, ,949, ,174,787 TOTAL LIABILITIES 790,128, ,619, ,154,362 NET DEFERRED FINANCING COSTS & OTHER ASSETS 33,300,517 33,302,783 33,672,311 BENEFICIAL INTEREST IN CAPITAL CAMPAIGN 2,964,950 8,299,039 1,194,909 INVESTMENT IN SUBSIDIARY ,306 TRUSTEE HELD ASSETS 8,576,706 8,751,746 8,260,707 TOTAL NET ASSETS 744,953, ,475, ,371,112 TOTAL ASSETS $1,535,082,026 $1,543,094,825 $1,109,525,474 TOTAL LIABILITIES & NET ASSETS $1,535,082,026 $1,543,094,824 $1,109,525,474
8 STATEMENT OF REVENUES AND EXPENSES YEAR - TO - DATE Variance from Actual Actual Budget Budget Unrestricted net assets Operating Revenue: Net Patient Revenue $470,688,589 $483,645,516 $485,430,220 ($1,784,704) Other Operating Revenue 15,784,772 18,677,035 14,447,911 4,229,124 Subsidy Revenue 8,163,277 5,029,742 4,390, ,421 Asset Released from Restriction 11,568 8,725 1,080 7,645 Total Operating Revenue: 494,648, ,361, ,269,532 3,091,486 Operating Expenses: Salaries & Wages 189,292, ,109, ,147,961 (2,961,898) Physician Fees 20,966,896 22,323,638 22,456, ,559 Employee Health & Welfare 65,693,774 62,725,267 67,623,331 4,898,064 Agency Personnel 0 182,067 0 (182,067) Supplies & Other Expenses 132,683, ,386, ,926,549 1,539,862 Depreciation & Amortization 32,856,983 32,626,231 32,827, ,602 Interest 6,793,687 5,417,279 5,852, ,456 Total Operating Expenses 448,287, ,771, ,834,606 4,063,578 Excess (Deficit) from Operations 46,361,126 50,589,990 43,434,926 7,155,064 Non Operating Income 1,498,871 24,179,452 7,003,980 17,175,472 Change in unrealized gains/(losses) on investments 14,683,151 9,006, ,006,951 Excess (deficiency) of revenue and gains over expenses 62,543,148 83,776,393 50,438,906 33,337,487
9 STATEMENT OF REVENUES AND EXPENSES YEAR - TO - DATE Variance from Actual Actual Budget Budget Excess (deficiency) of revenue and gains over expenses 62,543,148 83,776,393 50,438,906 33,337,487 Other changes in unrestricted net assets: Net transfers to/(from) affiliates 686, , ,017 Assets released from restriction (5,325) 99, ,320 Other Changes in Net Assets 1,686, , ,948 Increase (decrease) in unrestricted net assets 64,910,783 85,502,678 50,438,906 35,063,772 Temporarily restricted net assets: Contributions 1,006 1, ,350 Other Transfers Assets released from restriction (93,131) (108,045) 0 (108,045) Increase (decrease) in beneficial interest in temporary trust 36, , ,164 Increase (decrease) in beneficial interest in capital campaign 0 7,217, ,217,628 Increase (decrease) in temporarily restricted net assets (55,628) 7,289, ,289,097 Permanently restricted net assets: Increase (decrease) in beneficial interest in perpetual trust (266,447) 312, ,877 Increase (decrease) in permanently restricted net assets (266,447) 312, ,877 Increase (decrease) in net assets 64,588,708 93,104,652 50,438,906 42,665,746 Net assets, beginning of year 581,089, ,371,112 Net assets, end of year 645,677, ,475,764
10 STATEMENT OF CASH FLOWS YTD 2017 Operating Activities: Excess/(deficit) $93,104,652 Adjustments to reconcile increase in net assets to net cash provided by operating activities: Transfers from affiliates, net 0 Depreciation & amortization 32,626,231 Net realized and unrealized losses/(gains) on investments (29,207,519) Beneficial interest in perpetual and temporary trusts (491,039) Estimated other liability costs (4,626,806) Change in certain assets and liabilities: 0 Patient accounts receivable 1,765,069 Inventory (87,516) Prepaid expenses and other current assets 4,440,015 Due from affiliates (7,535,837) Due to Inspira Medical Centers 0 Accounts payable & accrued expenses 1,034,304 Accrued interest payable 307,372 Estimated settlements to third-party payers 7,840,256 Net cash provided by/(used in) operating activities 99,169,182 Investing Activities: Additions to property and equipment, net (67,264,738) (Increase) / Decrease in assets limited as to use (424,055,018) Increase in other assets (7,210,252) Net cash provided by/(used in) investing activities (498,530,008) Financing Activities: (Increase) / Decrease in deferred financing costs 474,300 Proceeds from additional borrowings 345,178,586 (Increase) / decrease in interst rate swap (402,052) Principal payments of long-term debt (8,866,961) Net cash provided by/(used in) financing activities 336,383,873 Increase/(decrease) in cash (62,976,953) Cash and equivalents, beginning of month/year 166,652,347 Cash and equivalents, end of month/year $103,675,394
11 FINANCIAL RATIOS FAST Moody's Preferred 75th Percentile "A" Rated September Movement 6/30/2017 FY Total Occupancy (Maintained Beds) Increase 69.83% 66.50% 68.50% Total Occupancy (Licensed Beds) Increase 57.85% N/A 76.10% Operating Margin (%) Increase 8.70% 3.20% 10.00% Operating Cash Flow Margin (%) Increase N/A 10.00% 17.47% Total Margin (%) Increase 10.26% 6.10% 15.50% Current Ratio Increase Days Cash On Hand Increase Cash-to-debt (%) Increase N/A Cash Flow to Total Debt (%) Increase 21.00% N/A 19.91% LT Debt-to-equity (%) Decrease 26.00% N/A 69.61% A/R Days Outstanding Decrease Charity Care As A Percentage Of Gross Charges Decrease 1.49% N/A 0.98% Debt Service Coverage Increase N/A Cushion Ratio Increase N/A
12 DEBT SERVICE CALCULATION Actual Actual Projected September Annualized from Budget Budgeted* Net Income, year to date 83,776, ,701,857 98,433,600 66,464,023 Interest Expense 5,417,279 5,417,279 5,417,279 7,789,503 Depreciation & Amortization 32,626,231 43,501,641 32,626,231 43,770,440 Funds Available for Debt Service $121,819,903 $160,620,778 $136,477,110 $118,023,966 Maximum Annual Principle & Interest Payments 30,146,810 30,146,810 30,146,810 Debt Service Coverage Ratio
INSPIRA HEALTH OBLIGATED GROUP MONTHLY STATISTICAL SUMMARY FOR PERIOD ENDED MARCH 31, Prior YTD
MONTHLY STATISTICAL SUMMARY Prior YTD YEAR - TO - DATE OUTPATIENT SERVICES Actual Actual Budget Variance Outpatient Surgeries 4,057 4,282 3,842 440 Laboratory Tests 218,240 225,011 216,341 8,670 Physical
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