University Medical Center of El Paso El Paso Children s Hospital El Paso Health University Medical Center Foundation

Transcription

1 University Medical Center of El Paso El Paso Children s Hospital El Paso Health University Medical Center Foundation FINANCIAL REPORT September 2018

2 MONTHLY FINANCIAL REPORTS September 2018 TABLE OF CONTENTS Chief Financial Officer Report Financial Statements Balance Sheets Statements of Revenues, Expenses, and Changes in Net Position (MTD) Statements of Revenues, Expenses, and Changes in Net Position (YTD) Statements of Cash Flows Supplemental Information System Combined Balance Sheets Combined Statements of Revenues, Expenses, and Changes in Net Position (MTD) Combined Statements of Revenues, Expenses, and Changes in Net Position (YTD) University Medical Center Scorecard Statistical Supplemental Graphs Operational Indicator Graphs Payor Mix Graphs El Paso Children s Hospital Scorecard Statistical Supplemental Graphs Operational Indicator Graphs El Paso Health Operational Graphs... 37

3 Chief Financial Officer Report For the year ended September 30, 2018 (unaudited) ****************************************************************************** This narrative covers the following organizations: University Medical Center of El Paso (UMC) El Paso Health (EPH) University Medical Center Foundation (the Foundation), to include UMC Foundation and El Paso Children s Foundation El Paso Children s Hospital (EPCH) ****************************************************************************** The latest bond ratings are as follows: Bond Ratings Moody s Baa1, negative outlook September 2018 FitchRatings A, stable outlook June 2018 Standard & Poors BBB+, negative outlook June 2018 Year to date Change in Net Position (in 000 s) UMC EPH Foundation EPCH Elim Total Actual $ (26,324) 1, (10,301) 1,525 $ (32,484) Budget (11,837) 3,184 1,622 (2,516) 1,524 (8,023) Variance $ (14,487) (1,519) (671) (7,785) 1 $ (24,461) Earnings before depreciation and amortization expense approximate ($3.8) million. 1

4 September 2018 Year to Date Financial Results Key Operational Statistics UNIVERSITY MEDICAL CENTER Year to Date Statistics Sep 2018 Sep 2017 Sep 2016 Actual Budget Var Actual Var Actual Var Outpatient Adjustment Factor % % % Adjusted Admissions 32,227 31, % 30, % 29, % Admissions 16,042 14, % 14, % 14, % Average Daily Census % % % Average Length Of Stay % % % Surgery Cases 7,977 7, % 7, % 7, % Endoscopy Procedures 8,669 6, % 7, % 5, % Cath Lab Procedures 4,679 5, % 5, % 5, % Births 2,816 3, % 3, % 3, % Emergency Room Visits 61,960 58, % 58, % 55, % ER Admission Rate 90.5% 87.3% 3.6% 87.4% 3.5% 91.2% 0.8% Outpatient Visits 852, , % 761, % 724, % Hospital Ancillary 711, , % 642, % 619, % Primary Care Clinics 130, , % 108, % 91, % Womens and Prenatal 9,728 12, % 10, % 13, % EL PASO HEALTH Year to Date Statistics Sep 2018 Sep 2017 Sep 2016 Actual Budget Var Actual Var Actual Var State Program Membership 905, , % 909, % 913, % STAR 780, , % 781, % 788, % CHIP 120, , % 123, % 119, % Perinate 4,722 5, % 4, % 5, % Other Membership 253, , % 249, % 244, % HealthCare Options 174, , % 170, % 168, % UMC TPA 68,170 69, % 67, % 65, % UMC Retiree Program % % 100.0% EPCH TPA 10,597 11, % 11, % 10, % 2

5 EL PASO CHILDREN'S HOSPITAL Year to Date Statistics Sep 2018 Sep 2017 Sep 2016 Actual Budget Var Actual Var Actual Var Outpatient Adjustment Factor % % % Adjusted Admissions 7,182 7, % 7, % 6, % Admissions 3,599 3, % 3, % 3, % Discharges 3,588 3, % 3, % 3, % Patient Days 20,241 21, % 20, % 20, % Average Daily Census % % % Average Length Of Stay % % % Surgery Cases 3,431 2, % 3, % 3, % Endoscopy Procedures 1, % 1, % % ED Visits (Includes LWBS) 23,163 22, % 22, % 21, % ED Admission Rate 8.8% 7.9% 11.4% 8.7% 1.8% 8.1% 24.1% Outpatient Visits 42,254 42, % 42, % 41, % 3

6 Operating Revenues For the year ended September 30, (unaudited) actual budget % variance fav/(unfav) actual % variance fav/(unfav) Operating Revenues Patient Service revenue, net $ 303,365,702 $ 285,877,418 6% $ 266,731,816 14% Premium revenue 172,877, ,353,700 2% 174,421,140-1% Medicaid Supplemental revenue 81,578,156 98,732,073-17% 87,541,667-7% In-kind revenue 10,268,803 8,301,090 24% 8,689,943 18% Contribution revenue 4,391,825 3,548,839 24% 2,243,581 96% Other revenue 25,817,798 29,306,656-12% 30,755,645-16% Total operating revenues 598,299, ,119,776 1% 570,383,792 5% Operating revenues of $598 million exceed budgeted revenues of $595 million by 1% or $3 million primarily due to increases in Patient Service revenue of $17 million and Premium revenues of $4 million, offset by a decrease in Medicaid Supplemental revenue of $17 million. Operating revenues exceed prior year same period revenues of $570 million by 5% or $28 million primarily due to increases in Patient Service revenue of $36 million offset by decreases in Medicaid Supplemental revenue of $6 million and Premium revenue of $2 million and Other operating revenue, primarily Trauma revenue, of $5 million. Net Patient Service revenue of $303 million exceeds budgeted revenue of $286 million by 6% or $17 million primarily due to: increased UMC Net Patient Service revenue increase of $23 million due to increased inpatient admissions of 8%, increased outpatient visits of 4% and increased cash collections of $16 million; offset by decreased EPCH s Net Patient Service revenue of $6 million due to renegotiated managed care contracts which occurred during the year rather than the beginning of the year. Net Patient Service revenue exceeds prior year same period revenue of $267 million by 14% or $36 million primarily due to increased UMC Net Patient Service revenue of $32 million due to increased inpatient admissions of 8%, UMC increased outpatient visits of 12%, and increased UMC cash collections of $30 million. 4

7 UMC s Revenue Payor Mix, cash collections and Net Patient Revenue per AA are as follows: For both 2018 and 2017, the funded payor percentage is 63% and the unfunded payor percentage is 37%. Cash collections of $220 million exceed budgeted cash collections of $204 million by 8% or $16 million and also exceed prior year cash collections of $189 million by 16% or $30 million. The Net Patient Revenue per adjusted admission of $7,037 exceeds the budgeted amount of $6,566 by 7% and exceeds prior year amount of $6,416 by 10%. El Paso Children s cash collections of $73 million are higher than prior year cash collections of $72.4 million by.8% or $554 thousand. However, the current year contains $2.1 million in recoupments related to OIG and HMS audits for prior year claims. As a percentage of net patient revenue, cash collections represent 95% (including prior year recoupments.) Without prior year recoupments, the cash collections represent 98% of net patient revenue. Premium revenue Premium revenue of $173 million exceeds budgeted revenue of $169 million by 2% or $4 million primarily due to a $6 million UHRIP premium revenue increase offset by a $1.2 million pharmacy rate cut during the year and few member months. Premium revenue is less than prior year revenue of $174 million by 1% or $1 million, primarily due to SFY 2018 capitation rate decrease and fewer member months. State Program member months of 905,754 are less than budgeted member months of 936,883 thousand by 3% and are less than prior year member months of 909,717 by 0.5%. Premium revenue per member per month of $191 exceeds budgeted amount of $181 but is less than prior year amount of $192. 5

8 Medicaid Supplemental revenue Medicaid Supplemental revenue of $82 million is less than budgeted revenue of $99 million by 17% or $17 million primarily due to: a UMC Delivery System Reform Incentive Program (DSRIP) revenue decrease of $6 million due to certain current year program carryforwards to next year and certain program metrics that were not met, and a forecasted UMC Uncompensated Care (UC) payment decrease of $8.6 million primarily due to a recent federal judge ruling pertaining to the state s Medicaid Hospital Specific Limit (HSL) calculation and an Urban Rider 38 hospital state rule. HHSC s final determination as to the remaining 2018 UC payment will not be known until later in calendar year Medicaid Supplemental revenue is also less than prior year same period revenue of $85 million by 4% or $3 million. Contribution revenue Contribution revenue of $4.4 million exceeds budgeted revenue of $3.5 million by 24% or $900 thousand due to increased pledges. Contribution revenue exceeds prior year same period revenue of $2.2 million by 96% or $2.2 million. primarily due to a $1.2 million donor pledge. Other operating revenues Other operating revenue (consisting mainly of EPH NAIP, cafeteria, grant, trauma & gift shop revenues) of $25.8 million is less than budgeted revenue of $29.3 million by 12% or $3.5 million primarily due to Trauma revenue reduction. Other operating revenue is less than prior year revenue of $30.7 million by 16% or $4.9 million primarily due to Trauma revenue reduction. 6

9 Operating Expenses For the year ended September 30, (unaudited) % variance fav/(unfav) % variance fav/(unfav) actual budget actual Operating Expenses Salaries and wages expense 194,550, ,716,505-1% 190,877,689-2% Employee benefits expense 36,596,326 39,672,986 8% 44,011,258 17% Medical claims expense 151,833, ,880,449-4% 145,824,311-4% Supplies and pharmaceutical expenses 116,978, ,118,544-10% 112,446,356-4% Purchased services expense 72,505,241 60,335,605-20% 66,033,375-10% Intergovernmental transfers expense 40,987,525 37,000,004-11% 52,921,309 23% Professional fees expense 47,817,885 51,040,456 6% 20,995, % Other operating expenses 37,135,835 36,190,696-3% 35,663,511-4% Depreciation and amortization expense 28,726,832 30,201,646 5% 28,822,779 0% Total operating expenses 727,132, ,156,891-4% 697,596,140-4% Operating expenses of $727 million exceed budgeted expenses of $698 million by 4% or $29 million primarily due to Purchased Services and Supplies and Pharmaceuticals expenses. Operating expenses exceed prior year same period expenses of $697 million by 4% or $28 million primarily due to Professional fees, Purchased Services and Medical Claims expenses. Salaries and wages expense Salary and wages expense of $195 million exceeds budgeted expense of $192 million by 1% or $3 million, primarily in UMC s Pharmacy, Endoscopy, Cardiac Services, Orthopedic Trauma and Neuroscience. EPCH departments exceeding budget include Perioperative (Recovery Room), ICU and Administration. Salaries and wage expense exceeds prior year same period expense of $191 million by 2% or $4 million. UMC s salary information is as follows: District Paid FTEs, including contract labor, of 2,757 exceed the budgeted paid FTEs of 2,705 by 2% or 52 FTEs but are less than prior year paid FTEs of 2,790 by 1% or 33 FTEs. Contract labor approximates 38 FTE s, whereas prior year contract labor approximates 26 FTE s. UMC s Paid FTE s per AOB of 6.27 is less than the budgeted amount of 6.48 and is less than the prior year amount was Overtime hours are 3.1% of total paid hours, approximating 84 FTEs, and are less than prior year percentage of 3.8% which approximates 106 FTEs. 7

10 EPCH s salary information is as follows: Paid FTEs of 486 are less than budgeted paid FTEs of by 3.8%, and are less than prior year paid FTEs of 511 by 4.9%. Salaries and benefits per AA of $4,302 are less than budgeted amount of $5,217 by 17.5% and are also less than prior year same period amount of $5,218 by 17.5%. Employee Benefits expense Employee benefits expense of $36.6 million is less than budgeted expense of $39.7 million by 8% or $3.1 million due to decreased UMC OPEB plans costs of $4.6 million because of the recent OPEB plan amendment and decreased combined self insured health plan costs of $304 thousand, offset by increased combined retirement plan costs of $2.6 million mostly due to UMC s GASB No. 68 actuarial adjustment. Employee benefits are less than prior year same period expense of $44 million by 17% or $7.4 million primarily due to decreased UMC OPEB plans costs of $5.2 million because of the recent OPEB plan amendment and decreased combined self insured health plan costs of $530 thousand. Employee benefits to total Salaries expense of 19.1% is less than the budgeted percentage of 21.3% and also less than prior year same period percentage of 24.3%. Medical Claims expense Medical Claims expense of $152 million exceeds the budgeted amount of $146 million by 4% or $6 million primarily due to increased medical claims of $6.3 million. Medical claims expense exceeds prior year expense of $146 million by 4% or $6 million due to increased medical claims cost of $4.6 million and increased pharmacy costs of $1.5 million. The Medical Expense PMPM of $168 exceeds the budgeted amount of $156 and exceeds the prior year same period amount of $160. Supplies and Pharmaceutical expenses Supplies and pharmaceutical expense of $117 million exceeds the budgeted expense of $106 million by 10% or $11 million due to: UMC Pharmaceutical and free drug cost increases of $4.7 million Combined Implant cost increases of $2.3 million Combined Laboratory cost increases of $1.6 million UMC Cardiac unit cost increases of $958 thousand UMC Perioperative (primarily operating room and ambulatory surgical unit) cost increases of $780 thousand UMC Operating room cost increases of $1.1 million UMC Emergency department (including vascular unit) cost increases of $955 thousand 8

11 Supplies and pharmaceutical expense exceeds prior year same period expense of $112 million by 4% or $5 million due to: UMC Pharmaceutical and free drug cost increases of $4.5 million Combined Laboratory cost increases of $1.4 million UMC Operating room cost increases of $817 thousand UMC Emergency Department cost increases of $708 thousand Combined Non medical supply cost decrease of $754 thousand EPCH Pharmaceutical cost decrease of $602 thousand The UMC supply expense per AA of $3,246 exceeds the budgeted amount of $2,980 by 9% and exceeds prior year amount of $3,234 by 0.3%. The EPCH supply expense per AA of $1,734 is lower than both the budgeted amount of $1,943 and the prior year amount of $2,052. Purchased Services expense Purchased Services expense of $73 million exceeds the budgeted expense of $60 million by 20% or $12 million due to: Contract labor cost increase of $4.3 million, consisting of UMC s: o Perioperative unit, primarily Operating room, of $1.1 million o Orthopedic / Trauma unit of $1.2 million o Women s Surgical unit of $390 thousand o ICU unit of $273 thousand o Surgical unit of $249 thousand Other Purchased services cost increases of $6.1 million, consisting of: o UMC Laboratory costs of $762 thousand o UMC Engineering (including safety operations) costs of $920 thousand o UMC Fiscal Services of $425 thousand o UMC Materials Management costs of $474 thousand o Combined Patient Financial Services costs of $334 thousand o Combined Perioperative costs of $390 thousand o Combined Administration of $849 thousand UMC Indigent referral cost increases of $3.8 million UMC Computer fees cost decrease of $2.3 million Purchased Services expense exceeds prior year same period expense of $66 million by 10% or $6 million due to: Contract labor costs of $905 thousand, consisting of: o UMC Orthopedic / Trauma unit increase of $1.1 million o UMC Perioperative unit, primarily Operating room, increase of $708 thousand o UMC Women s Surgical unit increase of $350 thousand o UMC Neuroscience unit increase of $189 thousand o UMC Surgical unit increase of $204 thousand o UMC Cardiovascular ICU increase of $150 thousand 9

12 o EPCH Administration decrease of $1.7 million o EPCH Patient Financial Services decrease of $417 thousand Other Purchased services costs of $2.5 million, consisting of: o UMC Engineering unit (including safety operations) increase of $975 thousand o UMC Fiscal Services unit increase of $409 thousand o UMC Laboratory unit increase of $259 thousand o UMC Materials Management unit increase of $445 thousand o Neighborhood Health Clinics increase of $301 thousand o EPCH Administration unit increase of $547 thousand o EPCH Fiscal Services decrease of $453 thousand o EPCH Patient Financial Services decrease of $236 thousand Indigent referral cost increases of $3.5 million due to El Paso Collaborative contracts transferred in 2018 Professional Fees expense Professional fees of $48 million are less than budgeted expense of $51 million by 6% or $3 million primarily due to certain El Paso Collaborative physician contracts not transferred UMC, and indigent referral costs expensed in purchased services but budgeted in professional fees. Professional fees exceed prior year expense of $21 million by $27 million due to the transfer of certain physician contracts from the El Paso Collaborative back to UMC. Intergovernmental Transfer expense IGT expense of $41 million exceeds the budgeted expense of $37 million by 11% or $6 million primarily due to certain El Paso Collaborative physician contracts that were not transferred back to UMC as planned or were transferred back to UMC at a later date than expected. IGT expense is less than prior year same period expense of $53 million by 23% or $12 million due to the transfer of certain physician contracts from the El Paso Collaborative back to UMC. Other operating expenses Other operating expenses (consisting mainly of EPH NAIP, lease and rental, and Premium Revenue taxes) of $37.1 million exceed the budgeted amount of $36.2 million by 3% or $945 thousand. Other operating expenses exceed prior year same period expense of $36 million by 4% or $1.5 million due to increased combined fees and dues cost increase of $420 thousand, UMC NAIP medical claims increase of $494 thousand, and EPCH increased insurance cost of $514 thousand

13 Nonoperating Revenues, net For the year ended September 30, (unaudited) % variance fav/(unfav) % variance fav/(unfav) actual budget actual Nonoperating Revenues (Expenses) County appropriation property taxes 104,590, ,659,233 0% 95,526,418 9% Investment return 897, ,676 56% 548,160 64% Tobacco settlement 1,888,418 1,604,400 18% 1,824,952 3% Miscellaneous - other 1,915,700 1,457,950 31% 1,617,920 18% Interest expense (12,514,035) (13,012,155) -4% (12,437,437) -1% Contributions to others (430,621) (270,784) -59% (997,122) 57% Total nonoperating revenues 96,347,630 95,014,320 1% 86,082,891 12% Net Nonoperating revenues of $96 million exceed budgeted revenues of $95 million by 1% or $1.3 million. Net Nonoperating revenues exceed prior year same period revenues of $86 million by 12% or $10.3 million primarily due to property tax revenue increase of $9 million. 11

14 Additional Financial & Operational Information Unrestricted Cash and Investments Unrestricted Cash and Investments approximate $31 million, representing 15 Days Cash on Hand. Restricted Cash and Investments Restricted Cash and Investments consist of the following (in millions): Held for Project Construction $ 58.1 Held for Debt Service.0 Held by Foundation 4.3 Held for Self insured programs 2.9 Held for Medical claims 0.7 Held by El Paso Children s 0.1 $ 66.1 UMC Patient Accounts Receivable Patient Accounts Receivable consists of the following: UMC Patient Accounts Receivable (in thousands) 9/30/2017 9/30/2018 % Change Medicare 6,336 6,321 0% Medicaid 3,759 4,004 7% Other third-party payers 27,963 31,865 14% Patients 50,311 54,945 9% 88,369 97,135 10% Less: allowance for uncollectible accounts 60,120 64,622 7% 28,249 32,513 15% 12

15 El Paso County Hospital District d/b/a University Medical Center of El Paso A Component Unit of El Paso County, Texas Balance Sheets September 30, 2017, August 31, 2018 and September 30, 2018 (Audited) (Unaudited) (Unaudited) 9/30/2017 8/31/2018 9/30/2018 Assets and Deferred Outflows of Resources Current Assets Cash and cash equivalents $ 68,854,590 $ 38,240,031 $ 30,917,048 Short-term investments 66,799 73, ,026 Held by trustee for self-insurance, current portion 2,196,518 2,196,518 2,196,518 Patient accounts receivable, net 40,172,638 45,630,272 48,272,165 County appropriation - property taxes receivable, net 1,531,181 2,068,862 1,784,216 Medicaid supplemental revenue receivable 5,595,552 13,560,458 11,622,090 Estimated amount due from third-party payers 1,284,565 1,401, ,597 Supplies 10,112,813 10,505,418 11,211,538 Contract receivable, net of allowance Prepaid expenses and other 14,149,551 10,138,357 9,675,102 Total current assets 143,964, ,815, ,362,300 Noncurrent Cash and Investments Held for debt service - 87,975 - Held for self-funded insurance 2,825,577 3,001,751 2,869,876 Held for project construction 62,893,053 59,677,822 58,109,178 Held by Foundation 4,087,031 4,223,275 4,333,814 Held by EPCH - 80, ,907 Restricted for medical claims 700, , ,000 70,505,661 67,771,476 66,131,775 Less amount required to meet current obligations 2,196,518 2,196,518 2,196,518 Total noncurrent cash and investments 68,309,143 65,574,958 63,935,257 Capital Assets, net 430,095, ,512, ,858,873 Long-Term Contract Receivable - - Other Assets 1,716,819 2,526,256 2,422,826 Total assets 644,086, ,429, ,579,256 Deferred Outflows of Resources Loss on bond refunding 14,941,916 14,221,966 14,157,492 Pension 30,085,941 11,978,934 11,964,078 Goodwill 3,759,525 3,341,800 3,303,825 Total deferred outflows of resources 48,787,382 29,542,700 29,425,395 Total assets and deferred outflows of resources $ 692,873,410 $ 640,971,933 $ 632,004,651 Liabilities, Deferred Inflows of Resources and Net Position Current Liabilities Accounts payable and accrued expenses $ 111,920,533 $ 108,989,953 $ 113,065,057 Current maturities of long-term debt 8,907,285 9,060,919 9,060,919 Deferred revenues - 9,183,696 - Estimated self-insurance costs, current 2,439,222 2,542,780 2,526,668 Total current liabilities 123,267, ,777, ,652,644 Estimated Self-insurance Costs 625, , ,946 Other Long-Term Liabilities 1,399, , ,555 Long-Term Debt 376,727, ,812, ,666,800 Net OPEB Liability 685,585 3,097,245 1,277,907 Net Pension Liability 46,486,847 27,983,518 27,983,518 Total liabilities 549,191, ,806, ,857,370 Deferred Inflows of Resources - Pension 1,778,796 4,715,118 5,191,294 Net Position Net investment in capital assets 111,142, ,142, ,142,245 Restricted - expendable 4,400,501 4,799,759 5,077,855 Restricted - non-expendable 1,032,490 1,305,358 1,455,358 Unrestricted 25,327,922 (10,797,407) (13,719,471) Total net position 141,903, ,449, ,955,987 Total liabilities, deferred inflows of resources and net position $ 692,873,410 $ 640,971,933 $ 632,004,

16 El Paso County Hospital District d/b/a University Medical Center of El Paso A Component Unit of El Paso County, Texas Statements of Revenues, Expenses and Changes in Net Position For the month ended September 30, 2018 September 30, 2017 (unaudited) actual budget % variance fav/(unfav) actual % variance fav/(unfav) Operating Revenues Patient Service revenue, net $ 24,678,071 $ 23,111,675 7% $ 20,924,972 18% Premium revenue 15,532,185 14,260,572 9% 13,599,193 14% Medicaid Supplemental revenue 4,468,487 8,227,681-46% 6,223,836-28% In-kind revenue 967, ,583 38% 689,743 40% Contribution revenue 883, ,743 62% 868,680 2% Other revenue 1,112,251 2,546,981-56% 2,900,686-62% Total operating revenues 47,641,659 49,395,235-4% 45,207,110 5% Operating Expenses Salaries and wages expense 16,278,236 16,560,590 2% 16,576,455 2% Employee benefits expense 2,899,659 3,370,774 14% 4,462,438 35% Medical claims expense 12,436,105 12,188,266-2% 10,326,003-20% Supplies and pharmaceutical expenses 8,635,779 8,646,816 0% 9,262,724 7% Purchased services expense 7,312,669 5,066,635-44% 5,800,528-26% Intergovernmental transfers expense 913,889 3,083,330 70% 2,919,399 69% Professional fees expense 5,081,319 4,512,816-13% 2,987,010-70% Other operating expenses 3,117,348 3,026,029-3% 3,813,939 18% Depreciation and amortization expense 2,372,502 2,615,402 9% 2,440,209 3% Total operating expenses 59,047,506 59,070,658 0% 58,588,705-1% Operating Income (loss) (11,405,847) (9,675,423) -18% (13,381,595) 15% Nonoperating Revenues (Expenses) County appropriation property taxes 8,688,035 8,721,600 0% 8,280,193 5% Investment return 63,389 40,845 55% 64,384-2% Tobacco settlement 181, ,700 35% 191,284-5% Miscellaneous - other 203, ,868 71% 34, % Interest expense (1,000,591) (1,062,457) 6% (1,097,685) 9% Contributions to others (92,627) (132,237) 30% (242,444) 62% Total nonoperating revenues, net 8,043,028 7,820,319 3% 7,230,402 11% Changes in Net Position $ (3,362,819) $ (1,855,104) 81% $ (6,151,193) 45%

17 El Paso County Hospital District d/b/a University Medical Center of El Paso A Component Unit of El Paso County, Texas Statements of Revenues, Expenses and Changes in Net Position For the year ended September 30, (unaudited) actual budget % variance fav/(unfav) actual % variance fav/(unfav) Operating Revenues Patient Service revenue, net $ 303,365,702 $ 285,877,418 6% $ 266,731,816 14% Premium revenue 172,877, ,353,700 2% 174,421,140-1% Medicaid Supplemental revenue 81,578,156 98,732,073-17% 87,541,667-7% In-kind revenue 10,268,803 8,301,090 24% 8,689,943 18% Contribution revenue 4,391,825 3,548,839 24% 2,243,581 96% Other revenue 25,817,798 29,306,656-12% 30,755,645-16% Total operating revenues 598,299, ,119,776 1% 570,383,792 5% Operating Expenses Salaries and wages expense 194,550, ,716,505-1% 190,877,689-2% Employee benefits expense 36,596,326 39,672,986 8% 44,011,258 17% Medical claims expense 151,833, ,880,449-4% 145,824,311-4% Supplies and pharmaceutical expenses 116,978, ,118,544-10% 112,446,356-4% Purchased services expense 72,505,241 60,335,605-20% 66,033,375-10% Intergovernmental transfers expense 40,987,525 37,000,004-11% 52,921,309 23% Professional fees expense 47,817,885 51,040,456 6% 20,995, % Other operating expenses 37,135,835 36,190,696-3% 35,663,511-4% Depreciation and amortization expense 28,726,832 30,201,646 5% 28,822,779 0% Total operating expenses 727,132, ,156,891-4% 697,596,140-4% Operating Income (loss) (128,832,131) (103,037,115) -25% (127,212,348) -1% Nonoperating Revenues (Expenses) County appropriation property taxes 104,590, ,659,233 0% 95,526,418 9% Investment return 897, ,676 56% 548,160 64% Tobacco settlement 1,888,418 1,604,400 18% 1,824,952 3% Miscellaneous - other 1,915,700 1,457,950 31% 1,617,920 18% Interest expense (12,514,035) (13,012,155) -4% (12,437,437) -1% Contributions to others (430,621) (270,784) -59% (997,122) 57% Total nonoperating revenues 96,347,630 95,014,320 1% 86,082,891 12% Changes in Net Position $ (32,484,501) $ (8,022,795) 305% $ (41,129,457) 21%

18 EL PASO COUNTY HOSPITAL DISTRICT STATEMENT OF CASH FLOWS FOR THE MONTH and YEAR ENDED SEPTEMBER 30, 2018 Month ended Year to date 09/30/ /30/2018 OPERATING ACTIVITIES: Receipts from and on behalf of patients $ 38,388, ,883,373 Received from (payment to) uncompensated care related activities 4,944,298 65,928,286 Payments to employees (19,153,643) (235,727,248) Cash received from other operating activities 754,106 8,547,660 Payments to suppliers and contractors (33,918,392) (420,599,995) Net cash provided by (used in) operating activities (8,984,921) (112,967,924) NONCAPITAL FINANCING ACTIVITES: County appropriations supporting operations 204,146 80,781,707 Received from tobacco settlement 1,888,000 Paid for contributions to others (119,495) (1,697,539) Received from Trauma 102,756 Received from contributions 785,278 2,604,882 Other 148,301 1,675,653 Net cash provided by (used in) noncapital financing activities 1,018,230 85,355,459 CAPITAL AND RELATED FINANCING ACTIVITES: Purchase of capital assets (824,665) (15,179,980) Principal paid on bonds/notes payable (228,671) (9,738,365) County appropriations to acquire or retire debt for - - acquisitions of capital assets 23,679,000 Interest paid on bonds payable/note (5,506) (16,753,482) Interest accrued on LOC-needs to eliminate - - Net cash provided by (used in) capital and financing activities (1,058,842) (17,992,827) INVESTING ACTIVITIES: Purchase of investments - (39,352,343) Proceeds from disposition of investments - 58,897,000 Interest on investments 63, ,936 Net cash provided by (used in) investing activities 63,389 20,441,593 INCREASE IN CASH AND CASH EQUIVALENTS (8,962,144) (25,163,699) CASH AND CASH EQUIVALENTS AT BEGINNING OF MONTH 68,850,601 85,052,156 CASH AND CASH EQUIVALENTS AT END OF MONTH $ 59,888,457 59,888,

19 EL PASO COUNTY HOSPITAL DISTRICT CONSOLIDATED STATEMENT OF CASH FLOWS (continued) FOR THE MONTH and YEAR ENDED SEPTEMBER 30, 2018 Month ended Year to date 09/30/ /30/2018 Reconciliation of Cash and Cash Equivalents to the Balance Sheet: Cash and cash equivalents in current assets $ 30,813,427 30,813,427 Cash and cash equivalents in current portion of cash and investments held for self-funded insurance reserves 2,196,518 2,196,518 Cash and cash equivalents in noncurrent cash and investments 26,878,512 26,878,512 Total Cash and Cash Equivalents 59,888,457 59,888,457 Reconciliation of operating loss used for operating activities: Operating income (loss) (11,405,847) (128,832,130) Depreciation and amortization 2,372,502 28,726,830 Accrued self-insurance costs 55, ,987 Provison for uncollectible accounts 14,346, ,909,198 Changes in operating assets and liabilities: Patient accounts receivable, net (16,988,644) (168,009,497) Other assets and liabilities (724,732) 10,091,483 Accounts payable and accrued expenses 3,359,059 (15,175,795) Net cash provided by (used in) operating activities $ (8,984,921) (112,967,924)

20 El Paso County Hospital District d/b/a University Medical Center of El Paso A Component Unit of El Paso County, Texas Combined Balance Sheet September 30, 2018 Component Units UMC El Paso Health UMC Foundation EL Paso Children's Eliminations Total Assets and Deferred Outflows of Resources Current Assets Cash and cash equivalents $ (341,181) 30,659, ,627 - $ 30,917,048 Short-term investments 92,927 9, ,026 Held by trustee for self-insurance, current portion 2,196,518-2,196,518 Patient accounts receivable, net 32,512,976 15,759,189-48,272,165 County appropriation - property taxes receivable, net 1,784,216-1,784,216 Medicaid supplemental revenue receivable 11,622,090-11,622,090 Estimated amount due from third-party payers 544,201 37, ,597 Supplies 9,022,747 6,867 2,181,924-11,211,538 Due from related parties 7,868,409 21,146,071 (29,014,480) - Prepaid expenses and other 5,384,273 3,063, , ,250-9,675,102 Total current assets 70,687,176 54,869, ,940 18,925,386 (29,014,480) 116,362,300 Noncurrent Cash and Investments Held for debt service Held for self-funded insurance 2,869,876-2,869,876 Held for project construction 58,109,178-58,109,178 Held by Foundation - 4,333,814-4,333,814 Held by EPCH - 118, ,907 Restricted for medical claims - 700, ,000 60,979, ,000 4,333, ,907-66,131,775 Less amount required to meet current obligations 2,196,518-2,196,518 Total noncurrent cash and investments 58,782, ,000 4,333, ,907-63,935,257 Capital Assets, net 408,493,540 7,203,108 11,254 4,150, ,858,873 Long-Term Contract Receivable 8,914,480 (8,914,480) - Other Assets 531, ,000 1,141,145 3,162,120 (3,162,120) 2,422,826 Total assets 547,409,413 63,522,386 6,381,153 26,357,384 (41,091,080) 602,579,256 Deferred Outflows of Resources Loss on bond refunding 14,157,492-14,157,492 Employee benefits 11,964,078-11,964,078 Goodwill 3,303,825-3,303,825 Total deferred outflows of resources 26,121, ,303,825-29,425,395 Total assets and deferred outflows of resources $ 573,530,983 63,522,386 6,381,153 29,661,209 (41,091,080) $ 632,004,651 Liabilities, Deferred Inflows of Resources and Net Position Current Liabilities Accounts payable and accrued expenses $ 82,468,989 15,968, ,451 14,420,091 - $ 113,065,057 Due to related parties 21,074, , ,567 6,885,717 (29,014,480) - Estimated amount due to third-party payers Current maturities of long-term debt 9,060, ,060,919 Deferred revenues Estimated self-insurance costs, current 2,196, ,150-2,526,668 Total current liabilities 114,801,349 16,548, ,018 21,635,958 (29,014,480) 124,652,644 Estimated Self-insurance Costs 768, ,946 Other Long-Term Liabilities 507, ,555 Long-Term Debt 367,666,800 29,811,803 (29,811,803) 367,666,800 Net OPEB Liability 1,277,907-1,277,907 Net Pension Liability 27,983,518-27,983,518 Total liabilities 513,006,075 16,548, ,018 51,447,761 (58,826,283) 522,857,370 Deferred Inflows of Resources 5,191,294-5,191,294 - Net Position 55,333,614 46,973,587 5,700,135 (21,786,552) 17,735, ,955,987 Total liabilities, deferred inflows of resources and net position $ 573,530,983 63,522,386 6,381,153 29,661,209 (41,091,080) $ 632,004,

21 El Paso County Hospital District d/b/a University Medical Center of El Paso A Component Unit of El Paso County, Texas Combined Statement of Revenues, Expenses and Changes in Net Position For the month ended September 30, 2018 (Unaudited) Component Units UMC El Paso Health UMC Foundation El Paso Children's Eliminations Total Operating Revenues Net Patient Service revenue $ 17,562, ,116,065 - $ 24,678,071 Premium revenue - 15,532, ,532,185 Medicaid Supplemental revenue 4,089, ,166-4,468,487 Contract revenue, net 1,671, (1,671,119) - In-kind revenue 963,361-71,597 14,114 (81,948) 967,124 Contribution revenue 45, ,840 59,437 (122,736) 883,541 Other revenue 92,725 1,675,379 (86,198) 295,555 (865,210) 1,112,251 Total operating revenues 24,423,532 17,207, ,239 7,864,337 (2,741,013) 47,641,659 Operating Expenses Salaries and wages expense 13,767, ,536,628 (25,618) 16,278,236 Employee benefits expense 2,409, ,755 (1,747) 2,899,659 Medical claims expense - 12,442, (6,873) 12,436,105 Purchased services expense 5,770,754 1,326, ,493 1,720,190 (1,696,352) 7,312,669 Professional fees expense 3,256, ,825,073-5,081,319 Supplies and pharmaceutical expenses 8,009,849 3,767 37, ,876-8,635,779 Other operating expenses 1,006,034 1,902,593 9,496 1,079,672 (880,447) 3,117,348 Intergovernmental transfers expense 913, ,889 Depreciation and amortization expense 2,125, , ,951-2,372,502 Total operating expenses 37,259,631 15,776, ,110 8,383,145 (2,611,037) 59,047,506 Operating Income (Loss) (12,836,099) 1,430, ,129 (518,808) (129,976) (11,405,847) Nonoperating Revenues (Expenses) County appropriation property taxes 8,688, ,688,035 Investment return 68,143 50,672 2,049 - (57,475) 63,389 Tobacco settlement 181, ,036 Miscellaneous - other 126, ,254 32, ,786 Interest expense (1,034,236) - - (150,953) 184,598 (1,000,591) Contributions to others (17,634) - (172,360) 97,367 (92,627) Total nonoperating revenues 8,012,208 50,731 (170,311) (106,699) 257,099 8,043,028 Changes in Net Position $ (4,823,891) 1,481, ,818 (625,507) 127,123 $ (3,362,819) Budget (2,384,211) 358, ,588 (123,923) 127,040 (1,855,104) Variance $ (2,439,680) 1,123, ,230 (501,584) 83 $ (1,507,715)

22 El Paso County Hospital District d/b/a University Medical Center of El Paso A Component Unit of El Paso County, Texas Combined Statements of Revenues, Expenses and Changes in Net Position For the year ended September 30, 2018 (Unaudited) UMC El Paso Health Component Units UMC Foundation El Paso Children's Eliminations Total Operating Revenues Net Patient Service revenue $ 226,622, ,743,450 - $ 303,365,702 Premium revenue - 172,877, ,877,631 Medicaid Supplemental revenue 73,188, ,389,811-81,578,156 Contract revenue, net 19,494, (19,494,804) - In-kind revenue 10,120, , ,283 (960,123) 10,268,803 Contribution revenue 591,307-4,266,745 1,789,821 (2,256,048) 4,391,825 Other revenue 15,372,286 20,019,386 (86,328) 1,871,596 (11,359,142) 25,817,798 Total operating revenues 345,389, ,897,017 5,133,584 88,949,961 (34,070,117) 598,299,915 Operating Expenses Salaries and wages expense 164,320, ,374,399 (144,024) 194,550,577 Employee benefits expense 31,467, ,231,407 (102,288) 36,596,326 Medical claims expense - 151,913, (80,000) 151,833,826 Purchased services expense 58,722,057 15,519,339 1,253,386 17,793,411 (20,782,952) 72,505,241 Professional fees expense 30,435, ,382,438-47,817,885 Supplies and pharmaceutical expenses 104,193, , ,387 12,450, ,978,000 Other operating expenses 12,324,747 22,715,063 95,570 12,626,934 (10,626,479) 37,135,835 Intergovernmental transfers expense 40,987, ,987,525 Depreciation and amortization expense 25,878,103 1,222,092 5,002 1,621,635-28,726,832 Total operating expenses 468,329, ,484,785 1,573,345 97,480,407 (31,735,743) 727,132,047 Operating Income (loss) (122,939,783) 1,412,232 3,560,239 (8,530,446) (2,334,373) (128,832,131) Nonoperating Revenues (Expenses) County appropriation property taxes 104,590, ,590,457 Investment return 942, ,439 9,241 - (305,857) 897,711 Tobacco settlement 1,888, ,888,418 Miscellaneous - other 1,911,031 1,046-44,140 (40,517) 1,915,700 Interest expense (12,530,378) - - (1,814,990) 1,831,333 (12,514,035) Contributions to others (186,917) - (2,618,594) 2,374,890 (430,621) Total nonoperating revenues 96,615, ,485 (2,609,353) (1,770,850) 3,859,849 96,347,630 Changes in Net Position $ (26,324,284) 1,664, ,886 (10,301,296) 1,525,476 $ (32,484,501) Budget (11,837,250) 3,183,725 1,622,334 (2,516,084) 1,524,480 (8,022,795) Variance $ (14,487,034) (1,519,008) (671,448) (7,785,212) 996 $ (24,461,706)

23 University Medical Center Scorecard For the Month Ending 09/30/2018 Hospital Indicators Single Month Single Month FY18 FY18 FY17 FY18 FY17 % Var. + / ( ) % Var. Actual Budget Actual + / ( ) Adjusted Admissions 2,642 2, % 2, % Admissions, excluding well baby 1,331 1, % 1, % Patient Days, excluding well baby 6,289 5, % 6, % Average Length of Stay % % Average Daily Census, excluding well baby % % Surgeries % % Endoscopy Procedures % % Endoscopy Cases % % Catheterization Laboratory % % Births % % ED LWBS % % ED Visits (w/o LWBS ) 5,244 4, % 4, % Total ED Visits 5,309 4, % 5, % Case Mix Index, All Payors N/A N/A % Case Mix Index, Medicare N/A N/A % Outpatient Visits 68,687 68, % 63, % Infusion % % Occupational Health 3,577 2, % 1, % Lab Outreach Visits 20,568 20, % 19, % Radiology Visits 7,588 7, % 6, % Pharmacy Visits 20,776 21, % 20, % Rehabilitative Visits 4,234 4, % 4, % Hospital Ancillary Total 57,385 55, % 52, % Primary Care County Clinic % % Primary Care Fabens Clinic 1,406 1, % 1, % Primary Care Employee Clinic % % Primary Care Ysleta Clinic 2,621 2, % 2, % Primary Care George Dieter Clinic 1,128 1, % 1, % Primary Care Mattox % % Primary Care Crossroads 0.0% % Primary Care Neuro Surgical Clinic % % Primary Care County Delta % % Primary Care NHC West 1,972 2, % % Primary Care NHC East 2,789 2, % 1, % Primary Care Total 10,743 11, % 9, % WHS Annex % % PRENATAL Fabens % % PRENATAL Ysleta % % WHS / PRENATAL George Dieter % 0.0% WHS West % 0.0% WHS East % 0.0% Womens Health Services Total 559 1, % % Operational Indicators Total Cash Collections PFS, Lab and Pharmacy (in thousands ) 17,198 16, % 16, % Net Patient Revenue 17,562 16, % 18, % Net Patient Revenue as Percent of Gross Patient Revenue 16.82% 18.43% 8.7% 20.10% 16.3% Worked Hours per Adjusted Admission (district excluding EPH, grants ) % % Worked FTE per Adj Occupied Bed (district excluding EPH, grants ) % % Paid FTE per Adjusted Occupied Bed (district excluding EPH, grants ) % % Bad Debt as a Percent of Gross Patient Revenue 12.60% 10.41% 21.0% 12.42% 1.4% Charity Care as a Percent of Gross Patient Revenue 20.90% 23.30% 10.3% 20.38% 2.6%

24 University Medical Center Scorecard Year to Date as of 09/30/2018 Hospital Indicators Adjusted Admissions Admissions, excluding well baby Patient Days, excluding well baby Average Length of Stay Average Daily Census, excluding well baby Surgeries Endoscopy Procedures Endoscopy Cases Catheterization Laboratory Births ED LWBS ED Visits (w/o LWBS ) Total ED Visits Case Mix Index, All Payors Case Mix Index, Medicare Year To Date Year To Date FY18 FY18 FY17 FY18 FY17 % Var. + / ( ) % Var. Actual Budget Actual + / ( ) 32,227 31, % 30, % 16,042 14, % 14, % 75,149 68, % 67, % % % % % 7,977 7, % 7, % 8,669 6, % 7, % 7,324 5, % 6, % 4,679 5, % 5, % 2,816 3, % 3, % 470 1, % 1, % 61,490 57, % 57, % 61,960 58, % 58, % N/A N/A % N/A N/A % Outpatient Visits Infusion Occupational Health Lab Outreach Visits Radiology Visits Pharmacy Visits Rehabilitative Visits Hospital Ancillary Total Primary Care County Clinic Primary Care Fabens Clinic Primary Care Employee Clinic Primary Care Ysleta Clinic Primary Care George Dieter Clinic Primary Care Mattox Primary Care Crossroads Primary Care Neuro Surgical Clinic Primary Care County Delta Primary Care NHC West Primary Care NHC East Primary Care Total WHS Annex PRENATAL Fabens PRENATAL Ysleta WHS / PRENATAL George Dieter WHS West WHS East Womens Health Services Total 852, , % 761, % 7,095 6, % 6, % 37,114 26, % 25, % 254, , % 239, % 92,876 85, % 78, % 264, , % 239, % 55,577 55, % 52, % 711, , % 642, % 2,666 3, % 2, % 18,832 17, % 16, % 4,290 4, % 4, % 33,939 34, % 33, % 13,827 14, % 14, % 1,694 1, % 1, % 0.0% 6, % 1,711 1, % 1, % 1,046 2, % 2, % 21,931 27, % 8, % 30,849 22, % 14, % 130, , % 108, % 5,308 5, % 5, % 1,041 1, % 1, % 3,379 3, % 3, % % % % 0.0% % 0.0% 9,728 12, % 10, % Operational Indicators Total Cash Collections PFS, Lab and Pharmacy (in thousands ) Net Patient Revenue Net Patient Revenue as Percent of Gross Patient Revenue Worked Hours per Adjusted Admission (district excluding EPH, grants ) Worked FTE per Adj Occupied Bed (district excluding EPH, grants ) Paid FTE per Adjusted Occupied Bed (district excluding EPH, grants ) Bad Debt as a Percent of Gross Patient Revenue Charity Care as a Percent of Gross Patient Revenue , , % 189, % 226, , % 194, % 18.67% 18.43% 1.3% 17.60% 6.1% % % % % % % 12.28% 15.98% 23.2% 12.86% 4.5% 21.07% 21.13% 0.3% 21.68% 2.8%

25 Statistical Supplemental Information For the period ending: September 30, 2018 U M C A D M I S S I O N S Fiscal Year FY16 1,280 1,207 1,283 1,171 1,238 1,155 1,170 1,184 1,148 1,182 1,178 1,157 FY17 1,196 1,139 1,181 1,207 1,088 1,262 1,175 1,261 1,305 1,309 1,379 1,322 FY18 1,312 1,336 1,273 1,470 1,244 1,384 1,295 1,382 1,316 1,326 1,373 1,331 1,500 1,470 1,450 1,400 1,384 1,382 1,379 1,350 1,300 1,250 1,200 1,150 1,100 1,312 1,196 1,280 1,336 1,207 1,139 1,283 1,273 1,181 1,207 1,171 1,244 1,238 1,088 1,262 1,155 1,295 1,175 1,170 1,261 1,184 1,316 1,326 1,373 1,305 1,309 1,182 1,178 1,148 1,322 1,331 1,157 1,050 1,000 FY16 FY17 FY18 U M C O U T P A T I E N T V I S I T S Fiscal Year FY16 61,841 55,944 54,131 58,559 62,427 65,073 62,364 60,465 61,321 56,575 63,484 61,990 FY17 61,491 59,283 57,099 64,692 59,920 68,128 61,091 68,250 65,501 62,089 70,501 63,052 FY18 70,755 66,302 61,329 76,503 68,774 71,587 70,833 74,895 70,315 72,192 80,076 68,687 85,000 80,000 75,000 70,000 65,000 60,000 55,000 70,755 61,841 61,491 66,302 59,283 55,944 61,329 57,099 54,131 76,503 64,692 58,559 68,774 62,427 59,920 71,587 70,833 68,128 62,364 65,073 61,091 68,250 74,895 60,465 70,315 65,501 61,321 72,192 62,089 56,575 80,076 70,501 63,484 68,687 61,990 63,052 50,000 FY16 FY17 FY

26 Statistical Supplemental Information For the period ending: September 30, 2018 U M C E M E R G E N C Y R O O M V I S I T S Fiscal Year FY16 4,588 4,301 4,386 4,691 4,619 5,029 4,630 4,745 4,517 4,811 4,697 4,816 FY17 4,832 4,603 4,662 4,795 4,512 5,178 4,777 4,850 4,824 5,102 5,297 5,023 FY18 4,931 4,668 4,792 5,641 4,987 5,245 5,105 5,345 5,118 5,383 5,436 5,309 5,800 5,641 5,600 5,400 5,245 5,345 5,383 5,436 5,309 5,200 5,000 4,800 4,600 4,400 4,200 4,987 5,105 5,118 5,102 5,297 5,178 5,023 4,931 4,792 4,850 4,824 4,795 5,029 4,811 4,816 4,777 4,668 4,697 4,832 4,619 4,745 4,662 4,691 4,630 4,588 4,603 4,512 4,517 4,386 4,301 FY16 FY17 FY18 U M C B I R T H S Fiscal Year FY FY FY FY16 FY17 FY

27 Statistical Supplemental Information For the period ending: September 30, 2018 UMC Average Length of Stay Acute 12 Months September September September 2017 September

28 Operational Information For the period ending: September 30, 2018 U M C N E T P A T I E N T R E V E N U E P E R A D J U S T E D A D M I S S I O N Fiscal Year FY16 $6,014 $6,007 $6,170 $5,908 $5,721 $6,853 $6,191 $6,229 $6,429 $6,367 $6,351 $6,693 FY17 $5,919 $5,839 $6,063 $6,069 $6,373 $6,499 $6,445 $6,949 $6,706 $6,381 $6,895 $6,706 FY18 $6,610 $6,878 $6,924 $7,477 $7,469 $6,892 $7,160 $6,898 $7,079 $6,829 $7,463 $6,647 $8,000 $7,500 $7,000 $6,500 $6,000 $5,500 $6,878 $6,924 $6,610 $6,170 $6,014 $6,007 $6,063 $5,919 $5,839 $7,477 $7,469 $6,373 $6,069 $5,721 $5,908 $6,853 $6,892 $6,499 $7,160 $6,445 $6,191 $6,949 $6,898 $6,229 $7,079 $6,706 $6,429 $6,829 $6,381 $6,367 $7,463 $6,895 $6,351 $6,706 $6,693 $6,647 $5,000 FY16 FY17 FY18 U M C C A S H C O L L E C T I O N S Fiscal Year FY16 $11.6 $11.9 $13.1 $11.5 $11.2 $13.6 $12.7 $12.9 $13.1 $12.1 $12.7 $14.0 FY17 $14.2 $15.4 $14.3 $13.9 $14.6 $16.2 $16.1 $16.4 $17.1 $16.8 $17.2 $17.0 FY18 $17.2 $16.1 $15.3 $18.9 $18.3 $19.0 $20.2 $20.3 $17.2 $19.3 $20.5 $17.2 $22.0 $20.2 $20.3 $20.5 $20.0 $18.0 $16.0 $14.0 $12.0 $17.2 $14.2 $11.6 $16.1 $15.4 $11.9 $18.9 $15.3 $14.3 $13.9 $13.1 $11.5 $18.3 $14.6 $11.2 $19.0 $16.2 $16.1 $16.4 $13.6 $12.7 $12.9 $17.2 $17.1 $13.1 $19.3 $16.8 $12.1 $17.2 $12.7 $17.0 $14.0 $17.2 $10.0 FY16 FY17 FY

29 Operational Information For the period ending: September 30, 2018 P A I D F T E s ( E X C L U D I N G E P C H ) Fiscal Year FY16 2,702 2,903 2,706 2,700 2,742 2,738 2,751 2,776 2,794 2,808 2,794 2,773 FY17 2,767 2,753 2,723 2,751 2,775 2,801 2,775 2,798 2,817 2,842 2,851 2,828 FY18 2,857 2,879 2,821 2,820 2,757 2,710 2,671 2,688 2,718 2,726 2,718 2,718 2,950 2,900 2,903 2,850 2,800 2,750 2,700 2,650 2,857 2,767 2,702 2,879 2,753 2,821 2,820 2,751 2,723 2,700 2,706 2,775 2,742 2,757 2,801 2,738 2,710 2,775 2,671 2,751 2,798 2,776 2,688 2,817 2,718 2,794 2,842 2,808 2,726 2,851 2,828 2,794 2,773 2,718 2,718 2,600 FY16 FY17 FY18 U M C P A I D F T E s P E R A DJ U S T E D O C C U P I E D B E D ( A O B ) Fiscal Year FY FY FY FY16 FY17 FY

30 Operational Information For the period ending: September 30, 2018 U M C O V E R T I M E % Fiscal Year FY16 4.3% 4.7% 4.4% 3.6% 4.2% 4.0% 4.3% 4.1% 4.4% 4.4% 5.0% 4.1% FY17 4.2% 3.9% 3.0% 4.0% 4.2% 4.5% 3.3% 3.7% 3.6% 3.7% 4.0% 3.7% FY18 4.4% 4.7% 2.9% 3.6% 2.6% 2.5% 1.9% 2.2% 2.5% 3.2% 3.0% 3.1% 5.5% 5.0% 4.5% 4.0% 3.5% 3.0% 2.5% 2.0% 1.5% 5.0% 4.7% 4.5% 4.4% 4.4% 4.0% 4.2% 4.3% 4.1% 4.4% 4.0% 3.9% 4.3% 4.4% 4.1% 4.2% 4.2% 4.0% 3.7% 3.6% 3.7% 3.6% 3.3% 3.2% 3.7% 3.0% 3.6% 3.0% 3.1% 2.6% 2.5% 2.9% 2.2% 2.5% 1.9% FY16 FY17 FY18 U M C S U P P L Y C O S T P E R A D J U S T E D A D M I S S I O N Fiscal Year FY16 $3,112 $3,051 $3,080 $2,850 $2,825 $3,049 $2,959 $3,115 $2,985 $3,001 $3,173 $3,113 FY17 $3,093 $3,112 $3,101 $3,048 $3,362 $3,282 $3,220 $3,521 $3,207 $3,236 $3,216 $3,383 FY18 $3,256 $3,428 $3,185 $3,548 $3,058 $3,317 $3,088 $3,057 $3,253 $3,618 $3,089 $3,047 $3,700 $3,548 $3,521 $3,618 $3,500 $3,300 $3,100 $2,900 $3,256 $3,112 $3,093 $3,428 $3,185 $3,112 $3,101 $3,080 $3,051 $3,048 $3,362 $3,058 $3,317 $3,282 $3,049 $3,220 $3,088 $2,959 $3,115 $3,057 $3,253 $3,207 $2,985 $3,236 $3,001 $3,383 $3,216 $3,173 $3,113 $3,047 $3,089 $2,850 $2,825 $2,700 FY16 FY17 FY

31 UMC Payor Mix For the period ending: September 30, 2018 Medicare & Medicaid 35.00% 30.00% 25.00% 24.13% 24.21% 24.22% 24.46% 24.80% 24.82% 24.89% 24.95% 24.65% 24.46% 24.54% 24.61% 20.00% 15.00% 16.56% 16.65% 16.57% 16.59% 16.73% 16.71% 16.73% 16.67% 16.54% 15.95% 15.63% 15.64% 10.00% 5.00% 0.00% Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 Apr-18 May-18 Jun-18 Jul-18 Aug-18 Sep-18 Medicare Medicaid Commercial & HMO/PPO 9.50% 9.00% 8.50% 8.65% 8.53% 8.63% 8.56% 8.60% 8.72% 8.72% 8.67% 8.59% 8.50% 8.36% 8.34% 8.00% 7.50% 7.50% 7.47% 7.48% 7.66% 7.59% 7.59% 7.70% 7.74% 7.92% 8.06% 8.18% 8.18% 7.00% Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 Apr-18 May-18 Jun-18 Jul-18 Aug-18 Sep-18 Commercial HMO/PPO Self Pay, Charity & Other 25.00% 20.00% 15.00% 20.04% 19.96% 19.96% 17.01% 16.99% 16.87% 19.75% 19.85% 19.71% 19.85% 19.82% 19.97% 19.75% 19.70% 19.76% 16.88% 17.24% 17.20% 16.01% 15.65% 15.69% 15.95% 16.61% 16.03% 10.00% 6.10% 6.19% 6.28% 6.37% 6.41% 6.43% 6.46% 6.46% 6.37% 6.40% 6.36% 6.27% 5.00% 0.00% Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 Apr-18 May-18 Jun-18 Jul-18 Aug-18 Sep-18 Self-Pay Charity Other 29

32 El Paso Children's Hospital Scorecard For The Month Ending 9/30/2018 Single Month Single Month FY 2018 FY 2018 FY17 FY18 FY17 % Var. + / ( ) % Var. Actual Budget Actual + / ( ) Performance Indicators Days Cash on Hand 2.7 N/A N/A (0.1) % Days in AR 82.3 N/A N/A % Days in AP 67.3 N/A N/A % Paid FTE's % % Paid FTE's (W/O PTO Bank) 426 N/A N/A % EBITDA (in thousands) (418) % (1,669) 75.0% Excess Margin (7.3) % (41.9) 82.6% Quick Ratio 55.2% N/A N/A 81.3% 32.1% Current Ratio 62.3% N/A N/A 90.5% 31.1% Operating Margin 6.1% 0.1% % 39.2% 84.4% Net Margin 7.5% 1.6% 366.1% 44.0% 83.0% ROA 1.9% 0.4% 374.1% 7.4% 74.4% Debt Capitalization Ratio 1.7 N/A N/A % Supply Cost as a percent of Operating Revenue 7.44% 13.55% 45.1% 15.63% 52.4% Salaries and Benefits as a Percent of Operating Revenue 38.51% 37.11% 3.8% 61.30% 37.2% Hospital Indicators Adjusted Admissions % % Admissions % % Patient Days, Excluding Observation 1,765 1, % 1, % Average Length of Stay % % Average Daily Census % % Surgeries % % Endo Procedures % % Endo Cases % % ED LWBS % % ED Visits (w/o LWBS) 1,816 1, % 1, % Total ED Visits 1,856 1, % 1, % Ancillary Visits Outpatient Ancillary Visits 3,358 3, % 3, % Infusion Visits % % Total Lab Billable Tests 18,137 15, % 17, % Total Radiology Procedures 2,609 2, % 2, % Total Pharmacy Doses 35,696 26, % 41, % Rehabilitative Visits % % Hospital Ancillary Total 57,541 45, % 62, % Operational Indicators Net Patient Revenue as a % of Gross Revenue 26.40% 30.54% 13.5% 17.01% 55.3% Worked Man Hours per Adjusted Admission % % Worked FTE per Adjusted Occupied Bed % % Paid FTE per Adjusted Occupied Bed % % Bad Debt as % of Gross Patient Revenue 3.94% 3.60% 9.6% 5.68% 30.7% Charity Care as % of Gross Patient Revenue 0.16% 0.27% 39.1% 0.78% 79.1% 30